Publications des membres du Ceped

2021



  • Jones Forrest K, Mensah Keitly, Heraud Jean-Michel, Randriatsarafara Fidiniaina Mamy, Metcalf C Jessica E et Wesolowski Amy (2021) « The Challenge of Achieving Immunity Through Multiple-Dose Vaccines in Madagascar », American Journal of Epidemiology, 190 (10) (octobre 1), p. 2085-2093. DOI : 10.1093/aje/kwab145. https://academic.oup.com/aje/article/190/10/2085/6280147.
    Résumé : Abstract Administration of many childhood vaccines requires that multiple doses be delivered within a narrow time window to provide adequate protection and reduce disease transmission. Accurately quantifying vaccination coverage is complicated by limited individual-level data and multiple vaccination mechanisms (routine and supplementary vaccination programs). We analyzed 12,541 vaccination cards from 6 districts across Madagascar for children born in 2015 and 2016. For 3 vaccines—pentavalent diphtheria-tetanus-pertussis-hepatitis B-Haemophilus influenzae type b vaccine (DTP-HB-Hib; 3 doses), 10-valent pneumococcal conjugate vaccine (PCV10; 3 doses), and rotavirus vaccine (2 doses)—we used dates of vaccination and birth to estimate coverage at 1 year of age and timeliness of delivery. Vaccination coverage at age 1 year for the first dose was consistently high, with decreases for subsequent doses (DTP-HB-Hib: 91%, 81%, and 72%; PCV10: 82%, 74%, and 64%; rotavirus: 73% and 63%). Coverage levels between urban districts and their rural counterparts did not differ consistently. For each dose of DTP-HB-Hib, the overall percentage of individuals receiving late doses was 29%, 7%, and 6%, respectively; estimates were similar for other vaccines. Supplementary vaccination weeks, held to help children who had missed routine care to catch up, did not appear to increase the likelihood of being vaccinated. Maintaining population-level immunity with multiple-dose vaccines requires a robust stand-alone routine immunization program.
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  • Mensah Keitly (2021) « Dépistage opportuniste du cancer du col par test HPV dans les pays à faibles et moyens revenus : exemples de la Côte d’Ivoire et du Burkina Faso », Thèse de doctorat en santé publique, Paris : Université Paris Cité.
    Résumé : En Afrique subsaharienne, la prévention du cancer du col de l’utérus (CCU) repose essentiellement sur l’inspection visuelle après coloration à l’acide acétique (IVA). Le recours à la détection des papillomavirus humains à haut risque oncogène (test HPV) en première intention pourrait améliorer la performance du dépistage, mais le succès de son introduction dans des systèmes de santé fragiles et en développement reste incertain. L’objectif général de cette thèse était d’évaluer les stratégies de mise en œuvre du dépistage opportuniste par test HPV primaire au sein de trois formations sanitaires : un centre prenant en charge les femmes vivant avec le VIH en Côte d’Ivoire et deux centres de santé primaire à Ouagadougou au Burkina Faso. Une recherche formative initiale a été réalisée pour évaluer les freins et les leviers potentiels à la mise en œuvre du test HPV et adapter la stratégie à chaque contexte. Puis une étude hybride multi-sites d’efficacité et de mise en œuvre a été menée afin d’explorer les déterminants de la complétude du dépistage (réalisation d’un test de triage et d’un traitement si nécessaire) et de la satisfaction des participantes à l’égard de leur prise en charge. Une approche mixte quantitative et qualitative a été utilisée. Le dépistage par test HPV a pu être intégré avec succès aux activités de routine des différents centres participants. Le taux de complétude dépassait 80% bien que la prise en charge des femmes non éligibles à un traitement sur place et adressées vers d’autres structures ait été le plus souvent incomplète. Au Burkina Faso, une minorité de femmes a pu être dépistée et traitée le même jour lorsque cela s’avérait nécessaire. Toutefois, la compréhension des informations délivrées par les soignants, l’usage de l’auto-prélèvement ainsi que les temps d’attentes réduits augmentaient la complétude du dépistage et la satisfaction des participantes. En Côte d’Ivoire, toutes les femmes éligibles ont été dépistées et traitées le même jour comme l’exigeait le protocole de recherche. Mais les temps d’attente associés, jugés trop long par les soignants, n’étaient pas compatibles avec une intégration pérenne de ce type de dépistage dans l’offre de soins. Par ailleurs, les patientes étaient d’autant plus satisfaites qu’elles avaient confiance en l’auto-prélèvement et que le diagnostic de séropositivité au VIH était ancien. Les patientes dépistées positives et traitées avaient plus de chance d’être suivie à 12 mois lorsqu’ elles étaient âgées, bien informées et avaient eu une visite intermédiaire. Mais l’annonce du résultat générait parmi les femmes HPV positives une anxiété qui pourrait avoir un impact négatif sur le suivi à un an. Mettre en place un dépistage par test HPV au sein des centres de santé s’avère faisable dans des contextes à ressources limitées. Une approche « dépister et traiter » en deux temps semble la plus adaptée et bien acceptée par les femmes vivant en milieu urbain. Les futurs programmes devraient mettre l’accent sur l’auto-prélèvement, la communication des résultats, la réduction des temps d’attente, l’accompagnement psychologique des femmes dépistées HPV positives et l’intégration du dépistage dans la charge de travail du personnel de santé.
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  • Mensah Keitly, Kaboré Charles, Zeba Salifou, Bouchon Magali, Duchesne Véronique, Pourette Dolorès, DeBeaudrap Pierre et Dumont Alexandre (2021) « Implementation of HPV-based screening in Burkina Faso: lessons learned from the PARACAO hybrid-effectiveness study », BMC Women's Health, 21 (1) (décembre), p. 251. DOI : 10.1186/s12905-021-01392-4. https://bmcwomenshealth.biomedcentral.com/articles/10.1186/s12905-021-01392-4.
    Résumé : Abstract Background Cervical cancer screening in sub-Saharan countries relies on primary visual inspection with acetic acid (VIA). Primary human papillomavirus (HPV)-based screening is considered a promising alternative. However, the implementation and real-life effectiveness of this strategy at the primary-care level in limited-resource contexts remain under explored. In Ouagadougou, Burkina Faso, free HPV-based screening was implemented in 2019 in two primary healthcare centers. We carried out a process and effectiveness evaluation of this intervention. Methods Effectiveness outcomes and implementation indicators were assessed through a cohort study of screened women, observations in participating centers, individual interviews with women and healthcare providers and monitoring reports. Effectiveness outcomes were screening completeness and women’s satisfaction. Logistic regression models and concurrent qualitative analysis explored how implementation variability, acceptability by women and the context affected effectiveness outcomes. Results After a 3-month implementation period, of the 350 women included in the cohort, 94% completed the screening, although only 26% had their screening completed in a single visit as planned in the protocol. The proportion of highly satisfied women was higher after result disclosure (95%) than after sampling (65%). A good understanding of the screening results and recommendations increased screening completeness and women’s satisfaction, while time to result disclosure decreased satisfaction. Adaptations were made to fit healthcare workers’ workload. Conclusion Free HPV-based screening was successfully integrated within primary care in Ouagadougou, Burkina Faso, leading to a high level of screening completeness despite the frequent use of multiple visits. Future implementation in primary healthcare centers needs to improve counseling and reduce wait times at the various steps of the screening sequence.
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  • Rice Benjamin L., Annapragada Akshaya, Baker Rachel E., Bruijning Marjolein, Dotse-Gborgbortsi Winfred, Mensah Keitly, Miller Ian F., Motaze Nkengafac Villyen, Raherinandrasana Antso, Rajeev Malavika, Rakotonirina Julio, Ramiadantsoa Tanjona, Rasambainarivo Fidisoa, Yu Weiyu, Grenfell Bryan T., Tatem Andrew J. et Metcalf C. Jessica E. (2021) « Variation in SARS-CoV-2 outbreaks across sub-Saharan Africa », Nature Medicine, 27 (3) (mars), p. 447-453. DOI : 10.1038/s41591-021-01234-8. http://www.nature.com/articles/s41591-021-01234-8.
    Résumé : A surprising feature of the SARS-CoV-2 pandemic to date is the low burdens reported in sub-Saharan Africa (SSA) countries relative to other global regions. Potential explanations (for example, warmer environments(1), younger populations(2-4)) have yet to be framed within a comprehensive analysis. We synthesized factors hypothesized to drive the pace and burden of this pandemic in SSA during the period from 25 February to 20 December 2020, encompassing demographic, comorbidity, climatic, healthcare capacity, intervention efforts and human mobility dimensions. Large diversity in the probable drivers indicates a need for caution in interpreting analyses that aggregate data across low- and middle-income settings. Our simulation shows that climatic variation between SSA population centers has little effect on early outbreak trajectories; however, heterogeneity in connectivity, although rarely considered, is likely an important contributor to variance in the pace of viral spread across SSA. Our synthesis points to the potential benefits of context-specific adaptation of surveillance systems during the ongoing pandemic. In particular, characterizing patterns of severity over age will be a priority in settings with high comorbidity burdens and poor access to care. Understanding the spatial extent of outbreaks warrants emphasis in settings where low connectivity could drive prolonged, asynchronous outbreaks resulting in extended stress to health systems.
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  • Zeba Salifou, Pourette Dolorès, Duchesne Véronique, Mensah Keitly, DeBeaudrap Pierre, Dumont Alexandre et Poveda Juan-Diego (2021) « Analyse anthropologique d’une intervention de dépistage du cancer du col de l’utérus à Ouagadougou (Burkina Faso). Expériences contrastées des professionnels de santé et des femmes » (communication orale), présenté à Congrès international "Les cancers dans les pays du Sud", 8èmes rencontres des sciences sociales et santé de Fès, Fès, Maroc.

2020



  • Mensah Keitly, Assoumou Nelly, Duchesne Véronique, Pourette Dolorès, DeBeaudrap Pierre et Dumont Alexandre (2020) « Acceptability of HPV screening among HIV-infected women attending an HIV-dedicated clinic in Abidjan, Côte d’Ivoire », BMC Women's Health, 20 (1) (juillet 28), p. 155. DOI : 10.1186/s12905-020-01021-6. https://doi.org/10.1186/s12905-020-01021-6.
    Résumé : Cervical cancer incidence is high among women living with HIV due to high-risk HPV persistence in the cervix. In low-income countries, cervical cancer screening is based on visual inspection with acetic acid. Implementing human papilloma virus (HPV) screening through self-sampling could increase women’s participation and screening performance. Our study aims to assess the preintervention acceptability of HPV screening among HIV-infected women in Abidjan, Côte d’Ivoire.
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  • Rice Benjamin L., Annapragada Akshaya, Baker Rachel E., Bruijning Marjolein, Dotse-Gborgbortsi Winfred, Mensah Keitly, Miller Ian F., Motaze Nkengafac Villyen, Raherinandrasana Antso, Rajeev Malavika, Rakotonirina Julio, Ramiadantsoa Tanjona, Rasambainarivo Fidisoa, Chen Wei-yu, Grenfell Bryan T., Tatem Andrew J. et Metcalf C. Jessica E. (2020) « High variation expected in the pace and burden of SARS-CoV-2 outbreaks across sub-Saharan Africa », Medrxiv : the Preprint Server For Health Sciences (juillet 29). DOI : 10.1101/2020.07.23.20161208. https://hal.science/hal-04149495.
    Résumé : A surprising feature of the SARS-CoV-2 pandemic to date is the low burdens reported in sub-Saharan Africa (SSA) countries relative to other global regions. Potential explanations (e.g., warmer environments(1), younger populations(2-4)) have yet to be framed within a comprehensive analysis accounting for factors that may offset the effects of climate and demography. Here, we synthesize factors hypothesized to shape the pace of this pandemic and its burden as it moves across SSA, encompassing demographic, comorbidity, climatic, healthcare and intervention capacity, and human mobility dimensions of risk. We find large scale diversity in probable drivers, such that outcomes are likely to be highly variable among SSA countries. While simulation shows that extensive climatic variation among SSA population centers has little effect on early outbreak trajectories, heterogeneity in connectivity is likely to play a large role in shaping the pace of viral spread. The prolonged, asynchronous outbreaks expected in weakly connected settings may result in extended stress to health systems. In addition, the observed variability in comorbidities and access to care will likely modulate the severity of infection: We show that even small shifts in the infection fatality ratio towards younger ages, which are likely in high risk settings, can eliminate the protective effect of younger populations. We highlight countries with elevated risk of ’slow pace’, high burden outbreaks. Empirical data on the spatial extent of outbreaks within SSA countries, their patterns in severity over age, and the relationship between epidemic pace and health system disruptions are urgently needed to guide efforts to mitigate the high burden scenarios explored here.
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2019

  • Mensah Keitly (2019) « Interactive activity and discussion », European Journal of Public Health, 29 ((Supplement_4) (novembre), p. ckz185-718.
  • Mensah Keitly, Heraud Jean-Michel, Takahashi Saki, Winter Amy, Metcalf Jessica et Wesolowski Amy (2019) « Seasonal gaps in measles vaccination coverage in Madagascar », Vaccine, 37 (18) (avril 24), p. 2511-2519.
    Résumé : INTRODUCTION: Measles elimination depends on the successful deployment of measles containing vaccine. Vaccination programs often depend on a combination of routine and non-routine services, including supplementary immunization activities (SIAs) and vaccination weeks (VWs), that both aim to vaccinate all eligible children regardless of vaccination history or natural infection. Madagascar has used a combination of these activities to improve measles coverage. However, ongoing massive measles outbreak suggests that the country was in a "honeymoon" period and that coverage achieved needs to be re-evaluated. Although healthcare access is expected to vary seasonally in low resources settings, little evidence exists to quantify temporal fluctuations in routine vaccination, and interactions with other immunization activities. METHODS: We used three data sources: national administrative data on measles vaccine delivery from 2013 to 2016, digitized vaccination cards from 49 health centers in 6 health districts, and a survey of health workers. Data were analyzed using linear regressions, analysis of variance, and t-tests. FINDINGS: From 2013 to 2016, the footprint of SIAs and VWs is apparent, with more doses distributed during the relevant timeframes. Routine vaccination decreases in subsequent months, suggesting that additional activities may be interfering with routine services. The majority of missed vaccination opportunities occur during the rainy season. Health facility organization and shortage of vaccine contributed to vaccination gaps. Children born in June were the least likely to be vaccinated on time. DISCUSSION: Evidence that routine vaccination coverage varies over the year and is diminished by other activities suggests that maintaining routine vaccination during SIAs and VWs is a key direction for strengthening immunization programs, ensuring population immunity and avoiding future outbreaks. FUNDING: Wellcome Trust Fund, Burroughs Wellcome Fund, Gates Foundation, National Institutes of Health.
    Mots-clés : Healthcare access, Madagascar, Measles, Vaccination.
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  • Mensah Keitly, Pourette Dolores, Duchesne Véronique, Debeaudrap Pierre et Dumont Alexandre (2019) « Barriers and facilitators on cervical cancer screening among HIV women in Cote d'Ivoire », European Journal of Public Health, 29 (Suppl. 4) (novembre 13), p. 27-27. DOI : 10.1093/eurpub/ckz185.055. http://www.documentation.ird.fr/hor/fdi:010077767.
    Résumé : Background With 50,000 death every year, cervical cancer is the fourth most common cause of death by cancer in sub-Saharan countries. Due to high risk human papilloma virus (hr-HPV) persistence on the cervix, leading to pre-malignous lesions, the disease is more frequent among HIV-positive women. In low- and middle-income countries, cervical cancer screening strategy relies on visual inspection with acetic acid, an operator-associated technic. As an alternative, HPV-based detection and its better performances are considered as it could lead to a potential screening uptake and women empowerment through self-sampling. Côte d’Ivoire, with a high HIV prevalence, is considering this innovative strategy. Yet, few studies analyzed the potential socio-cultural factors associated with cervical cancer screening in this context. Our study aims to assess beliefs and perceptions toward cervical cancer among HIV positive women in Abidjan, Côte d’Ivoire. Methods We performed in-depth interviews with 21 HIV positive women randomly attending a health center or member of a women’s association, in November 2018. All interviews were recorded and transcribed. A theoretical framework with the Health Belief Model and the PEN-3 was used to categorize women’s perceptions, enablers, nurturers, perceived gravity and self-efficacy about cervical cancer, screening and self-sampling technique introduction. Results Positive findings were knowledge about cervical cancer, awareness about women’s vulnerability and HIV status role on it and relationship to caregivers. Fear appeared as a barrier to screening but also a facilitator among women with health awareness. Negative findings were reluctance for HIV-associated diseases, poor screening knowledge and lack of resources to get treated. Self-sampling introduction was disregarded due to lack of self-confidence. Conclusions This study provides useful information for counselling and opens the door to HPV-based screening implementation.
    Mots-clés : COTE D'IVOIRE.
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  • Pourette Dolorès, Duchesne Véronique, Bouchon Magalie, Zongo Sylvie, Mensah Keitly, DeBeaudrap Pierre et Dumont Alexandre (2019) Accès à la prévention et aux soins du cancer du col de l’utérus à Ouagadougou (Burkina Faso). Etude socio-anthropologique, Rapport de recherche, PARIS, France : Médecins du Monde / Ceped, 72 p.
  • Pourette, Dolorès, Duchesne, Véronique, Bouchon, Magali, DeBeaudrap, Pierre, Dumont, Alexandre et Mensah, Keitly (2019) « Étude socio-anthropologique des facteurs influençant l’accès à la prévention et aux soins du cancer du col de l’utérus à Ouagadougou, Burkina Faso, 2018-2019 » (communication orale), présenté à Journée scientifique de la santé humanitaire et solidaire (Médecins du Monde), Paris.
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