Publications des membres du Ceped

2022

  • Boye Sokhna, Kouadio Alexis Brou, Vautier Anthony, Ky-Zerbo Odette, Rouveau Nicolas, Kouvahe Amélé Florence, Maheu-Giroux Mathieu, Larmarange Joseph, Pourette Dolorès et équipe ATLAS (2022) « L’introduction de l’autodépistage du VIH dans les consultations des Infections Sexuellement Transmissibles (IST) peut-elle améliorer l’accès au dépistage des patients IST et leurs partenaires ? Une étude qualitative exploratoire du projet ATLAS à Abidjan/Côte d’Ivoire » (poster #PV340), présenté à AFRAVIH, Marseille.
    Résumé : Objectifs Dans le cadre de son projet d’introduction de l’auto dépistage du VIH (ADVIH), le programme ATLAS a initié une étude pour documenter les modalités de dispensation des kits d’ADVIH aux patient.e.s présentant une Infection Sexuellement Transmissible (IST) et leurs partenaires à Abidjan/Côte d’Ivoire. Matériels et Méthodes Une enquête qualitative a été réalisée entre mars et août 2021 dans trois services dispensant des ADVIH auprès des patient.e.s IST: (1) consultation prénatale (CPN) ; (2) consultation générale incluant IST et (3) dispensaire IST dédié. Les données ont été collectées par (i) des observations de consultations médicales de patient·e·s IST (N=98) et (ii) des entretiens auprès de soignants impliqués dans la dispensation des kits d’ADVIH (N=18), de patient.e.s ayant reçu des kits ADVIH à proposer à leurs partenaires (N=21) et de partenaires de patientes IST ayant réalisé l’ADVIH (N=2). Résultats Les trois services présentent des différences d’organisation du circuit du patient et des modalités de dispensation des kits d’ADVIH. En CPN, le dépistage du VIH est proposé systématiquement à toute femme enceinte lors de la première consultation. Lorsqu’une IST est diagnostiquée, un ADVIH est proposé presque systématiquement pour le partenaire (N=27/29). En consultation générale, il y a eu peu de propositions de dépistage et d’ADVIH aux patient.e.s IST et pour leurs partenaires (N=3/16). Malgré l’existence d’une délégation des tâches du dépistage et l’offre d’ADVIH, il n’y a pas de routinisation du dépistage dans ce service. Au dispensaire IST, le circuit du patient est mieux défini : diffusion de la vidéo ADVIH en salle d’attente, consultation des patient.e.s et référencement aux infirmières pour le dépistage avec proposition fréquente de kits d’ADVIH aux patient.e.s IST pour leurs partenaires (N=28/53). De manière générale, l’ADVIH est accepté lorsqu’il est proposé. Mais, la proposition de l’ADVIH aux partenaires n’est pas toujours facile, surtout pour les femmes : difficultés à aborder la question du VIH avec le conjoint, relation de couple « fragile ». Les soignants en général ont une perception positive des ADVIH, mais, ils soulignent le caractère chronophage de la dispensation des ADVIH et souhaitent une meilleure organisation : délégation des tâches (CPN). Conclusion L’organisation des consultations est déterminante : les contraintes structurelles (organisation du service, délégation des tâches) influent sur la proposition d’un dépistage VIH et l’ADVIH ne suffit pas à les lever. La proposition par les soignants d’un ADVIH pour les partenaires nécessite du temps et un accompagnement des patients.e.s. La proposition est plus systématique quand le dépistage est « routinisé » et concerne tous les patient.e.s. Quand l’ADVIH est proposé, il est en général accepté. Si l’ADVIH constitue une opportunité d’améliorer l’accès au dépistage des patient.e.s et de leurs partenaires, une intégration réussie implique d’améliorer l’organisation des services et de promouvoir la délégation des tâches.


  • Ky-Zerbo Odette, Desclaux Alice, Boye Sokhna, Vautier Anthony, Rouveau Nicolas, Kouadio Brou Alexis, Fotso Arlette Simo, Pourette Dolorès, Maheu-Giroux Mathieu, Sow Souleymane, Camara Cheick Sidi, Doumenc-Aïdara Clémence, Keita Abdelaye, Boily Marie Claude, Silhol Romain, d’Elbée Marc, Bekelynck Anne, Gueye Papa Alioune, Diop Papa Moussa, Geoffroy Olivier, Kamemba Odé Kanku, Diallo Sanata, Ehui Eboi, Ndour Cheick Tidiane, Larmarange Joseph et for the ATLAS team (2022) « Willingness to use and distribute HIV self-test kits to clients and partners: A qualitative analysis of female sex workers’ collective opinion and attitude in Côte d’Ivoire, Mali, and Senegal », Women's Health, 18 (avril 17), p. 1-11. DOI : 10.1177/17455057221092268. https://doi.org/10.1177/17455057221092268.
    Résumé : Background:In West Africa, female sex workers are at increased risk of HIV acquisition and transmission. HIV self-testing could be an effective tool to improve access to and frequency of HIV testing to female sex workers, their clients and partners. This article explores their perceptions regarding HIV self-testing use and the redistribution of HIV self-testing kits to their partners and clients.Methods:Embedded within ATLAS, a qualitative study was conducted in Côte-d?Ivoire, Mali, and Senegal in 2020. Nine focus group discussions were conducted. A thematic analysis was performed.Results:A total of 87 participants expressed both positive attitudes toward HIV self-testing and their willingness to use or reuse HIV self-testing. HIV self-testing was perceived to be discreet, confidential, and convenient. HIV self-testing provides autonomy from testing by providers and reduces stigma. Some perceived HIV self-testing as a valuable tool for testing their clients who are willing to offer a premium for condomless sex. While highlighting some potential issues, overall, female sex workers were optimistic about linkage to confirmatory testing following a reactive HIV self-testing. Female sex workers expressed positive attitudes toward secondary distribution to their partners and clients, although it depended on relationship types. They seemed more enthusiastic about secondary distribution to their regular/emotional partners and regular clients with whom they had difficulty using condoms, and whom they knew enough to discuss HIV self-testing. However, they expressed that it could be more difficult with casual clients; the duration of the interaction being too short to discuss HIV self-testing, and they fear violence and/or losing them.Conclusion:Overall, female sex workers have positive attitudes toward HIV self-testing use and are willing to redistribute to their regular partners and clients. However, they are reluctant to promote such use with their casual clients. HIV self-testing can improve access to HIV testing for female sex workers and the members of their sexual and social network.
    Mots-clés : ATLAS, female sex workers, HIV self-testing, partners, perception, secondary distribution, West Africa.
  • Pourette Dolorès (2022) « Etude qualitative des freins et leviers au dépistage du cancer du col de l’utérus à La Réunion » (Communication orale), présenté à Conférence de l'Institut Pasteur de Madagascar, Antananarivo.


  • Pourette Dolorès, Cripps Amber, Guerrien Margaux, Desprès Caroline, Opigez Eric, Bardou Marc et Dumont Alexandre (2022) « Assessing the Acceptability of Home-Based HPV Self-Sampling: A Qualitative Study on Cervical Cancer Screening Conducted in Reunion Island Prior to the RESISTE Trial », Cancers, 14 (6), p. 1380. DOI : 10.3390/cancers14061380. https://www.mdpi.com/2072-6694/14/6/1380.
    Résumé : Cervical cancer incidence and mortality rates are 2 to 3 times higher in the overseas department of Reunion compared with mainland France. RESISTE’s cluster-randomized controlled trial aims to test the effectiveness of home-based self-sampling (HBSS) through a high-risk oncogenic papillomavirus test sent out by post to women who have not been screened in the past 3 years, despite having been invited to do so through a reminder letter. Prior to the trial, qualitative research was carried out to understand screening barriers and assess anticipated acceptability. Semi-structured interviews were conducted with 35 women and 20 healthcare providers. Providers consider HBSS a viable method in reaching women who tend not to visit a doctor regularly, or who are reluctant to undergo a smear pap, as well as those who are geographically isolated. They considered, however, that women would require support, and that outreach was necessary to ensure more socially isolated women participate. The majority of the women surveyed were in favour of HBSS. However, two-thirds voiced concerns regarding the test’s efficiency and their ability to perform the test correctly, without harming themselves. Based on these findings, recommendations were formulated to reassure women on usage and quality, and to help reach socially isolated women.
    Mots-clés : cervical cancer screening, home-based self-sampling, HPV testing, qualitative study, Reunion Island, social disadvantage, social isolation, socio-economic insecurity.

2021



  • Andrianantoandro Voahirana Tantely, Pourette Dolorès, Rakotomalala Olivier, Ramaroson Henintsoa Joyce Valentina, Ratovoson Rila et Rakotoarimanana Feno M. Jacob (2021) « Factors influencing maternal healthcare seeking in a highland region of Madagascar: a mixed methods analysis », BMC Pregnancy and Childbirth, 21 (1) (décembre), p. 428-440. DOI : 10.1186/s12884-021-03930-2. https://doi.org/10.1186/s12884-021-03930-2.
    Résumé : In Madagascar, maternal mortality remains stable and high (426 deaths per 100,000 live births). This situation is mainly due to a delay or lack of use of maternal healthcare services. Problems related to maternal healthcare services are well documented in Madagascar, but little information related to maternal healthcare seeking is known. Thus, this paper aims to identify and analyze the factors that influence the utilization of maternal services, specifically, the use of antenatal care (ANC) during pregnancy and the use of skilled birth attendants (SBAs) at delivery.
    Mots-clés : Determinants, Highlands of Madagascar, Maternal healthcare seeking, Mixed methods.

  • Andrianantoandro, Tantely, Rakotoarimanana, Feno, Pourette, Dolorès, Razakamanana, Marilys, Rakotomalala, Olivier et Ramiaramanana, Jeannot (2021) « Une méthode mixte pour explorer les facteurs de recours et de non-recours aux soins de santé maternelle dans la région de Vakinankaratra, Madagascar (étude RESOFEN) » (Poster), présenté à 1er Colloque Virtuel de la Communauté Méthodes Mixtes Francophonies (MMF). Théories et pratiques en méthodes mixtes. http://methodesmixtesfrancophonie.pbworks.com.


  • Boye Sokhna, Bouaré Seydou, Ky-Zerbo Odette, Rouveau Nicolas, Simo Fotso Arlette, d'Elbée Marc, Silhol Romain, Maheu-Giroux Mathieu, Vautier Anthony, Breton Guillaume, Keita Abdelaye, Bekelynck Anne, Desclaux Alice, Larmarange Joseph et Pourette Dolorès (2021) « Challenges of HIV Self-Test Distribution for Index Testing When HIV Status Disclosure Is Low: Preliminary Results of a Qualitative Study in Bamako (Mali) as Part of the ATLAS Project », Frontiers in Public Health, 9 (mai 19). DOI : 10.3389/fpubh.2021.653543. https://www.frontiersin.org/articles/10.3389/fpubh.2021.653543/full?&utm_source=Email_to_authors_&utm_medium=Email&utm_content=T1_11.5e1_author&utm_campaign=Email_publication&field=&journalName=Frontiers_in_Public_Health&id=653543.
    Résumé : The rate of HIV status disclosure to partners is low in Mali, a West African country with a national HIV prevalence of 1.2%. HIV self-testing (HIVST) could increase testing coverage among partners of people living with HIV (PLHIV). This study aims to improve our understanding of the practices, limitations and issues related to the distribution of HIV self-tests at an HIV care clinic in Bamako, Mali. An ethnographic survey was conducted in 2019. It consisted of (i) individual interviews with 8 health professionals involved in the distribution of HIV self-tests; (ii) 591 observations of medical consultations, including social service consultations, with PLHIV; (iii) 7 observations of peer educator-led PLHIV group discussions. HIVST was discussed in only 9% of the observed consultations (51/591). When HIVST was discussed, the discussion was almost always initiated by the health professional rather than PLHIV. HIVST was discussed infrequently because in most of the consultations, it was not appropriate to propose partner HIVST (e.g., when PLHIV were widowed, did not have partners, or had delegated someone to renew their prescriptions). Some PLHIV had not disclosed their HIV status to their partners. Dispensing HIV self-tests was time-consuming, and medical consultations were very short. Three main barriers to HIV self-test distribution when HIV status had not been disclosed to partners were identified: (1) almost all health professionals avoided offering HIVST to PLHIV when they thought or knew that the PLHIV had not disclosed their HIV status to partners; (2) PLHIV were reluctant to offer HIVST to their partners if they had not disclosed their HIV-positive status to them; (3) there was limited use of strategies to support the disclosure of HIV status. In conclusion, it is essential to strengthen strategies to support the disclosure of HIV+ status. It is necessary to develop a specific approach for the provision of HIV self-tests for the partners of PLHIV by rethinking the involvement of stakeholders. This approach should provide them with training tailored to the issues related to the (non)disclosure of HIV status and gender inequalities, and improving counseling for PLHIV.
    Mots-clés : HIV self-testing, HIV status disclosure, Index testing, Knowledge of HIV status, Mali, Partners of PLHIV, People living with HIV, Screening -.


  • Ky-Zerbo Odette, Desclaux Alice, Kouadio Alexis Brou, Rouveau Nicolas, Vautier Anthony, Sow Souleymane, Camara Sidi Cheick, Boye Sokhna, Pourette Dolorès, Sidibé Younoussa, Maheu-Giroux Mathieu, Larmarange Joseph et on behalf of the ATLAS Team (2021) « Enthusiasm for Introducing and Integrating HIV Self-Testing but Doubts About Users: A Baseline Qualitative Analysis of Key Stakeholders' Attitudes and Perceptions in Côte d'Ivoire, Mali and Senegal », Frontiers in Public Health, 9 (octobre 18). DOI : 10.3389/fpubh.2021.653481. https://www.frontiersin.org/article/10.3389/fpubh.2021.653481.
    Résumé : Since 2019, the ATLAS project, coordinated by Solthis in collaboration with national AIDS programs, has introduced, promoted and delivered HIV self-testing (HIVST) in Côte d'Ivoire, Mali and Senegal. Several delivery channels have been defined, including key populations: men who have sex with men, female sex workers and people who use injectable drugs. At project initiation, a qualitative study analyzing the perceptions and attitudes of key stakeholders regarding the introduction of HIVST in their countries and its integration with other testing strategies for key populations was conducted. The study was conducted from September to November 2019 within 3 months of the initiation of HIVST distribution. Individual interviews were conducted with 60 key informants involved in the project or in providing support and care to key populations: members of health ministries, national AIDS councils, international organizations, national and international non-governmental organizations, and peer educators. Semi structured interviews were recorded, translated when necessary, and transcribed. Data were coded using Dedoose© software for thematic analyses. We found that stakeholders' perceptions and attitudes are favorable to the introduction and integration of HIVST for several reasons. Some of these reasons are held in common, and some are specific to each key population and country. Overall, HIVST is considered able to reduce stigma; preserve anonymity and confidentiality; reach key populations that do not access testing via the usual strategies; remove spatial barriers; save time for users and providers; and empower users with autonomy and responsibility. It is non-invasive and easy to use. However, participants also fear, question and doubt users' autonomy regarding their ability to use HIVST kits correctly; to ensure quality secondary distribution; to accept a reactive test result; and to use confirmation testing and care services. For stakeholders, HIVST is considered an attractive strategy to improve access to HIV testing for key populations. Their doubts about users' capacities could be a matter for reflective communication with stakeholders and local adaptation before the implementation of HIVST in new countries. Those perceptions may reflect the West African HIV situation through the emphasis they place on the roles of HIV stigma and disclosure in HIVST efficiency.

  • Ky-Zerbo Odette, Desclaux Alice, Kouadio Brou Alexis, Rouveau Nicolas, Vautier Anthony, Sow Souleymane, Camara Cheick Sidi, Boye Sokhna, Pourette Dolorès, Younoussa Sidibé, Maheu-Giroux Mathieu, Larmarange Joseph et for the ATLAS Team (2021) « Introducing HIV self-testing (HIVST) among key populations in West Africa: a baseline qualitative analysis of key stakeholders' attitudes and perceptions in Côte d'Ivoire, Mali, and Senegal » (poster PEC320), présenté à 11th IAS Conference on HIV Science, Berlin. https://theprogramme.ias2021.org/Abstract/Abstract/972.
    Résumé : BACKGROUND: HIV self-testing (HIVST) is a way to improve HIV status knowledge and access to HIV testing. Since 2019, the ATLAS project has introduced, promoted, and delivered HIVST in Côte d'Ivoire, Mali, and Senegal, in particular among female sex workers (FSW), men who have sex with men (MSM), people who use drugs (PWUD), these key populations being particularly vulnerable to HIV and stigmatized in West Africa. Stakeholders involved in HIV testing activities targeting key populations are essential for the deployment of HIVST. Here, we analyze their perceptions of the introduction of HIVST in their countries. METHODS: A qualitative survey was conducted from September to November 2019 within three months of HIVST distribution initiation. Individual interviews were conducted with 60 stakeholders (Côte d'Ivoire, 19; Mali, 20; Senegal, 21). Semi-structured interviews were recorded, translated when necessary, and transcribed. Data were coded using Dedoose"© software for thematic analyses. RESULTS: In the three countries, stakeholders express enthusiasm and willingness to introduce HIVST for several reasons. HIVST is considered able to reduce stigma, preserve anonymity and confidentiality, especially for MSM and PWUD; reach key populations that do not access testing via usual strategies and HIV+ key populations; remove spatial barriers; save time for providers and users, notably for FSW; and empower users with autonomy and responsibility. HIVST is noninvasive and easy to use. Secondary distribution of HIVST seems appropriate for reaching partners of MSM, with confidentiality. However, stakeholders expressed doubts about key populations' ability, particularly PWUD, to correctly use HIVST kits, ensure quality secondary distribution, accept a reactive test result, and use confirmation testing and care services. They also mentioned that FSW might have difficulties redistributing HIVST to their clients and partners. CONCLUSIONS: HIVST is considered an attractive strategy to improve access to HIV testing for key populations. The doubts about users' capacities could be a matter of reflective communication with stakeholders before HIVST implementation in other western African countries.


  • 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.


  • Njatosoa Ammy Fiadanana, Mattern Chiarella, Pourette Dolorès, Kesteman Thomas, Rakotomanana Elliot, Rahaivondrafahitra Bakoly, Andriamananjara Mauricette, Harimanana Aina, Razafindrakoto Jocelyn, Raboanary Emma, Andrianasolo Andry et Rogier Christophe (2021) « Family, social and cultural determinants of long-lasting insecticidal net (LLIN) use in Madagascar: secondary analysis of three qualitative studies focused on children aged 5–15 years », Malaria Journal, 20 (1) (mars 26), p. 168. DOI : 10.1186/s12936-021-03705-2. https://doi.org/10.1186/s12936-021-03705-2.
    Résumé : Although it is accepted that long-lasting insecticidal net (LLIN) use is an effective means to prevent malaria, children aged 5 to 15 years do not appear to be sufficiently protected in Madagascar; the malaria prevalence is highest in this age group. The purpose of this research is to summarize recent qualitative studies describing LLIN use among the Malagasy people with a focus on children aged 5–15 years.
    Mots-clés : Children over five, LLIN use, Madagascar, Malaria, Sociocultural factors.

  • Pourette Dolorès (2021) « Les défis du transfert de connaissances scientifiques. Réflexions à partir d'un projet en cours (Madagascar, Maurice) », présenté à Conférence internationale de la Fondation Croix rouge française : Transition humanitaire dans l’océan Indien : enjeux, acteurs et dynamiques, Saint-Denis, La Réunion. https://www.fondation-croix-rouge.fr/conference-internationale-fondation/.
  • Pourette Dolorès (2021) « Réflexions à partir de deux études socio-anthropologiques sur le cancer du col de l'utérus à (Madagascar, Burkina Faso) » (Communication orale), présenté à La recherche en sciences sociales au service de la lutte contre les cancers féminins en Afrique, Fondation Sylvia Bongo Ondimba, Gabon (virtuel).
  • Pourette Dolorès, Rakotoarisoa Onintsoa, Louault Marion, Rakotomanana Elliot et Mattern Chiarella (2021) « The impact of Covid-19 on healthcare provision and support services for PLHIV in Antananarivo: ANRS CoVIH-OI qualitative study initial results (2021) » (Communication orale), présenté à 21st ICASA Conference, Durban.

  • Pourette Dolorès, Rakotoarisoa Onintsoa, Louault Marion, Rakotomanana Elliot et Mattern Chiarella (2021) « Effets de la Covid-19 sur le suivi médical des personnes vivant avec le VIH à Antananarivo, Madagascar. Premiers résultats de l’étude qualitative ANRS CoVIH-OI (2021) » (Unesco), présenté à Colloque international "Les sciences sociales face à la pandémie de Covid-19. Etat des connaissances et propositions concrètes" organisé par l'UNESCO, Paris. https://events.unesco.org/event?id=309483114&lang=1033.


  • Rouveau Nicolas, Ky-Zerbo Odette, Boye Sokhna, Simo Fotso Arlette, d’Elbée Marc, Maheu-Giroux Mathieu, Silhol Romain, Kouassi Arsène Kra, Vautier Anthony, Doumenc-Aïdara Clémence, Breton Guillaume, Keita Abdelaye, Ehui Eboi, Ndour Cheikh Tidiane, Boilly Marie-Claude, Terris-Prestholt Fern, Pourette Dolorès, Desclaux Alice, Larmarange Joseph et ATLAS Team (2021) « Describing, analysing and understanding the effects of the introduction of HIV self-testing in West Africa through the ATLAS programme in Côte d’Ivoire, Mali and Senegal », BMC Public Health, 21 (1) (janvier 21), p. 181. DOI : 10.1186/s12889-021-10212-1. https://doi.org/10.1186/s12889-021-10212-1.
    Résumé : The ATLAS programme aims to promote and implement HIV self-testing (HIVST) in three West African countries: Côte d’Ivoire, Mali, and Senegal. During 2019–2021, in close collaboration with the national AIDS implementing partners and communities, ATLAS plans to distribute 500,000 HIVST kits through eight delivery channels, combining facility-based, community-based strategies, primary and secondary distribution of HIVST. Considering the characteristics of West African HIV epidemics, the targets of the ATLAS programme are hard-to-reach populations: key populations (female sex workers, men who have sex with men, and drug users), their clients or sexual partners, partners of people living with HIV and patients diagnosed with sexually transmitted infections and their partners. The ATLAS programme includes research support implementation to generate evidence for HIVST scale-up in West Africa. The main objective is to describe, analyse and understand the social, health, epidemiological effects and cost-effectiveness of HIVST introduction in Côte d’Ivoire, Mali and Senegal to improve the overall HIV testing strategy (accessibility, efficacy, ethics). Methods ATLAS research is organised into five multidisciplinary workpackages (WPs): Key Populations WP: qualitative surveys (individual in-depth interviews, focus group discussions) conducted with key actors, key populations, and HIVST users. Index testing WP: ethnographic observation of three HIV care services introducing HIVST for partner testing. Coupons survey WP: an anonymous telephone survey of HIVST users. Cost study WP: incremental economic cost analysis of each delivery model using a top-down costing with programmatic data, complemented by a bottom-up costing of a representative sample of HIVST distribution sites, and a time-motion study for health professionals providing HIVST. Modelling WP: Adaptation, parameterisation and calibration of a dynamic compartmental model that considers the varied populations targeted by the ATLAS programme and the different testing modalities and strategies. Discussion ATLAS is the first comprehensive study on HIV self-testing in West Africa. The ATLAS programme focuses particularly on the secondary distribution of HIVST. This protocol was approved by three national ethic committees and the WHO’s Ethical Research Committee.
    Mots-clés : Côte d’Ivoire, HIV self-testing, HIV/AIDS, Mali, Senegal, West Africa.
  • Sambou Césarine, Allavena Clotilde, DeBeaudrap Pierre, Pourette Dolorès et Raho-Moussa Mariem (2021) « Les médecins généralistes face à la prise en charge des personnes âgées de 70 ans et plus vivant avec le VIH (PvVIH 70+) et polypathologiques : cloisonnements, fractionnements des soins et difficultés associées » (Poster), présenté à Congrès SLFS 22éme édition, Grenoble.
  • 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 », présenté à Congrès international "Les cancers dans les pays du Sud", 8èmes rencontres des sciences sociales et santé de Fès, Fès, Maroc.

2020


  • Boye Sokhna, Bouaré Seydou, Ky-Zerbo Odette, Rouveau Nicolas, Simo Fotso Arlette, d'Elbée Marc, Silhol Romain, Keita Adbelaye, Bekelynck Anne, Desclaux Alice, Larmarange Joseph, Pourette Dolorès et ATLAS Team (2020) « Challenges of HIV self-tests distribution for index testing in a context where HIV status disclosure is low: preliminary experience of the ATLAS project in Bamako, Mali » (poster PED1255), présenté à 23rd AIDS International Conference, San Francisco (virtual). https://cattendee.abstractsonline.com/meeting/9289/Presentation/2271.
    Résumé : BACKGROUND: In Côte d''Ivoire, Mali and Senegal, ATLAS project has introduced HIV self-testing (HIVST) as an index testing strategy, distributing HIVST kits to people living with HIV (PLHIV) during consultations for secondary distribution to their partners. Here, we present preliminary results of an ethnographic survey conducted in one HIV clinic in Bamako, Mali, where most HIV patients have not disclosed their HIV status to their partner(s), notably for women for fear of jeopardizing their relationships. In such a context, how non-disclosure affect the distribution of HIVST kits? METHODS: The study was conducted from September 25 to November 27, 2019, and included individual interviews with 8 health workers; 591 observations of medical consultations; and 7 observations of patient groups discussions led by peer educators. RESULTS: Three principal barriers to HIVST distribution for index testing were identified. (1) Reluctance of PLHIV to offer HIVST to partners to whom they have not (yet) disclosed their status and desire to learn tactics for offering testing without disclosing their HIV status. (2) Near-universal hesitancy among health workers to offer HIVST to persons who, they believe, have not disclosed their HIV status to their partner(s). (3) Absence of strategies, among health workers, to support discussion of status disclosure with PLHIV. In the rare cases where HIVST was offered to a PLHIV whose partner did not know their status, either the PLHIV declined the offer or the provider left it to the patient to find a way to deliver the HIVST without disclosing his/her status. CONCLUSIONS: HIV self-testing distribution could serve as an opportunity for PLHIV to disclose their HIV status to partners. The continuing reluctance of PLHIV to heed advice to share their status and promote secondary HIV self-testing distribution highlights the structural factors (social inequalities and stigma) that limit awareness of HIV status and that favour the persistence of the epidemic.

  • d'Elbée Marc, Badiane Kéba, Ky-Zerbo Odette, Boye Sokhna, Kanku Kabemba Odé, Traore Mohamed, Simo Fotso Arlette, Pourette Dolorès, Desclaux Alice, Larmarange Joseph et Terris-Prestholt Fern (2020) « Can task shifting improve efficiency of HIV self-testing kits distribution? A case study in Mali » (poster), présenté à INTEREST 2020, online. http://interestworkshop.org/.
    Résumé : Background: The ATLAS project introduced HIV self-testing (HIVST) in consultations of people living with HIV (PLHIV) at public health facilities in Côte d'Ivoire, Mali and Senegal for secondary distribution to their partners. Preliminary data from a qualitative study (observations of consultations, interviews with distributing agents) carried out in two clinics in Mali highlight implementation challenges associated with the counselling on self-testing and kit distribution currently done by the medical staff (doctor/nurse) and reported time-consuming. While implementation teams are considering the possibility of delegating certain tasks, it is important to consider the cost of alternative delivery models. Materials & Methods: We analysed preliminary economic costs data for the provision of rapid HIV testing services (HTS) (analysis period: October 2018 – September 2019) and HIVST services (August 2019 – October 2019) in these same two Malian clinics. Above service level costs are excluded. We then modelled the costs of provision using alternative cadres of medical and non-medical staff (psychosocial counsellors/peer educators) and the consumables used to simulate task shifting scenarios for the provision of HTS and HIVST services. The three scenarios correspond to 1. partial delegation: individual counselling done by non-medical staff and HIVST distribution by the medical staff ; 2. total delegation: individual counselling and distribution done by non-medical staff only; and 3. total delegation with group counselling: where group counselling and distribution are done by non-medical staff only. Results: Findings show that the unit costs per HIVST provided for the observed model are 58% higher than those of a conventional rapid test: $7,50 and $4.75, respectively. The costs are less high in scenarios of partial ($5.45, +15%) or total ($5.29, +11%) delegation but always higher than those of a rapid test due to the greater costs of consumables (HIVST kit). Finally, in the case where counselling on self-testing were carried out in a group, the costs per kit provided ($4.44, -6%) would become slightly lower than those of a rapid test, where counselling is always done individually. Conclusion: Task delegation from medical to non-medical staff can generate substantial cost savings. These preliminary results can guide the implementation strategy of HIVST in care consultations, to ensure sustainability from early introduction through scale-up.
  • Darsot Anjarasoa, Mattern Chiarella, Pourette Dolorès, Shimakawa Yusuke, Mac-Seing Muriel et Giles-Vernick Tamara (2020) « Barriers to accessing hepatitis B diagnosis and prevention in Madagascar: a qualitative approach » (Poster), présenté à 16th World Congres of Public Health 2020, Rome (virtual).
  • Darsot Anjarasoa, Mattern Chiarella, Pourette Dolorès, Shimakawa Yusuke, Mac-Seing Muriel et Giles-Vernick Tamara (2020) « Accès aux traitements des personnes atteintes d’une hépatite B chronique à Madagascar: enjeux et difficultés » (Poster PM164), présenté à 10ème Conférence Internationale Francophone Dakar - AFRAVIH 2020, virtuel.


  • 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.


  • Pourette Dolorès, Andrianantoandro T V, Rakotoarimanana F M J, Razakamanana M, Rakotomalala O et Ramiaramanana J (2020) « Use of healthcare services at time of delivery: a prospective community based study in Madagascar », European Journal of Public Health, 30 (Supplement_5) (septembre 1), p. ckaa166.908. DOI : 10.1093/eurpub/ckaa166.908. https://academic.oup.com/eurpub/article/doi/10.1093/eurpub/ckaa166.908/5915795.
    Résumé : Abstract Background Maternal mortality remains high in Madagascar (478 deaths per 100,000 live births) and more than 60% of birth are not assisted by professional health workers. This study aimed to determine factors that influence choices of delivery place in two municipalities of Vakinakaratra region. Methods This was a prospective study. 245 pregnant women in the 2nd and 3rd trimester of pregnancy were included and surveyed during Oct-Nov 2016. The same women were re-surveyed 3 months or more after their respective deliveries (June-July 2017). Binary logistic regression was used and the analysis were supported by qualitative interviews conducted with 35 women from the sample, 7 community health workers, 5 professionals health workers and 15 traditional healers and traditional births attendants or 'reninjaza'. Results Overall, 91.8 % of women intended to give birth at health facilities. The reasons given are the quality of services and the medical support in case of complications, the registration of birth and the referrals and encouragement from reninjaza. However, out of 229 mothers interviewed after delivery, only 60.7% gave birth in a health facility. Educated mothers were ORa=6.6 (p < 0.001) times more likely to deliver at health facility and mothers with at least 4 births are ORa=0.17 (p < 0.01) times less likely to do it. The qualitative analysis highlights the cost (logistics and care) as well as the fear of caesarean sections as a brake on childbirth in a health facility. The distance from the health center and the lack of preparation to travel there were also identified. Decisions at the time of childbirth come under the close family. Conclusions Use of maternity services remains low. The implementation of free delivery care policies, formalizing the collaboration between reninjaza and health workers and raising awareness among close family should improve the access to healthcare. Key messages Collaborations between health workers and traditional healers should be formalized. The close family of pregnant women (spouse, mother, mother-in-law) should be the target of awareness raising strategies.
  • Pourette Dolorès, Andrianantoandro Tantely, Rakotoarimanana Feno, Rakotomalala, Olivier et Razakamanana Marilys (2020) « Use of healthcare services at time of delivery: a prospective community based study in Madagascar » (Poster DQ 69), présenté à 16th World Congress on Public Health 2020, Rome (virtual).


  • Pourette, Dolorès, Rakotomalala, Olivier et Mattern, Chiarella (2020) « Donner naissance à Madagascar. Articulation des recours « traditionnels » et biomédicaux autour de la naissance », in Naître et grandir. Normes du Sud, du Nord, d’hier et d’aujourd’hui, éd. par Laurence Pourchez, Paris : Editions des archives contemporaines, p. 61-67. ISBN : 978-2-8130-0261-7. https://doi.org/10.17184/eac.9782813002617.


  • Raberahona Mihaja, Monge François, Andrianiaina Rijasoa Harivelo, Randria Mamy Jean de Dieu, Ratefiharimanana Andosoa, Rakatoarivelo Rivo Andry, Randrianary Lanto, Randriamilahatra Emma, Rakotobe Liva, Mattern Chiarella, Andriananja Volatiana, Rajaonarison Hobimahanina, Randrianarisoa Mirella, Rakotomanana Elliott, Pourette Dolorès, Andriamahenina Hery Zo, Dezé Charlotte, Boukli Narjis, Baril Laurence et Vallès Xavier (2020) « Is Madagascar at the edge of a generalised HIV epidemic? Situational analysis », Sexually Transmitted Infections (mai 18). DOI : 10.1136/sextrans-2019-054254. https://sti.bmj.com/content/early/2020/05/17/sextrans-2019-054254.
    Résumé : Objectives To describe the epidemiological situation of the HIV/AIDS epidemic and to identify the main drivers for vulnerability in Madagascar. Design Literature review, qualitative research and situational analysis. Data sources Search of electronic bibliographic databases, national repositories of documentation from 1998 to 2018. Search keywords included Madagascar, HIV, sexually transmitted infections, men who have sex with men (MSM), sex workers (SWs), transactional sex (TS), injecting drug users (IDUs), vulnerability and sexual behaviour. Qualitative sources were interviews and focus group discussions. Review methods Studies focused on HIV and/or vulnerability of HIV in Madagascar in general, and key populations (KPs) and HIV/AIDS response were taken into account. National reports from key HIV response actors were included. Results Madagascar is characterised by a low HIV/AIDS epidemic profile in the general population (GP) (0.3%) combined with a high prevalence of HIV among KPs (SWs, MSM and IDUs).An increase in HIV prevalence among KP has been observed during recent years. Hospital-based data suggest an increase in HIV prevalence among the GP. The vulnerability traits are inconsistent use of condoms, multipartner relationships and other contextual factors like widespread TS and gender inequality. A high prevalence/incidence of sexually transmitted infections could indicate a high vulnerability to HIV/AIDS. However, there are no reports of HIV prevalence of >1% in antenatal consultation. Conclusion There is not enough evidence to make a conclusion about the HIV epidemiological situation in Madagascar due to the scarcity of the epidemiological data. However, Madagascar may be closer to a turning point towards a high-prevalence epidemic with severe consequences, particularly when taking into account its socioeconomical fragility and underlying vulnerabilities. More precise epidemiological data and improved HIV/AIDS diagnosis and case management should be a public health priority.
    Mots-clés : Africa, AIDS, HIV.


  • Ratovoson Rila, Kunkel Amber, Rakotovao Jean Pierre, Pourette Dolores, Mattern Chiarella, Andriamiadana Jocelyne, Harimanana Aina et Piola Patrice (2020) « Frequency, risk factors, and complications of induced abortion in ten districts of Madagascar: results from a cross-sectional household survey », BMC Women's Health, 20 (1) (mai 6). DOI : 10.1186/s12905-020-00962-2. https://pubmed.ncbi.nlm.nih.gov/32375746/.
    Résumé : Madagascar has restrictive abortion laws with no explicit exception to preserve the woman’s life. This study aimed to estimate the incidence of abortion in the country and examine the methods, consequences, and risk factors of these abortions.


  • Ravaoarisoa Lantonirina, Razafimahatratra Mamy Jean Jacques, Rakotondratsara Mamy Andrianirina, Pourette Dolorès, Rakotonirina Julio et Rakotomanga Jean de Dieu Marie (2020) « Appréciation des interventions de lutte contre la malnutrition maternelle par la population à Madagascar », Sante Publique, Vol. 32 (1) (juin 29), p. 113-122. DOI : 10.3917/spub.201.0113. https://www.cairn.info/revue-sante-publique-2020-1-page-113.htm.
    Résumé : Madagascar has adopted strategies to fight against maternal malnutrition, but the evaluation of their implementation is not effective. Purpose of research: The present study aims to describe beneficiary appreciation of interventions to fight maternal malnutrition and to identify their expectations. Method: A qualitative study was conducted in the Amoron'i Mania region, Madagascar. The study included mothers of children under 5, pregnant women, and other family members and community members (fathers, grandmothers, matrons and community workers). Six focus groups and 16 individual interviews were conducted to collect the data. The thematic analysis was used. Results: Food supplementation, improved production of agriculture and livestock, and nutrition education, operated by NGOs, are the best-known interventions. The health centers were not mentioned as interveners and their interventions were ignored. The effectiveness of the intervention is generally judged on the benefits perceived by the beneficiaries. Interveners working on a project basis were assessed as unsustainable. Two main problems were mentioned: first, the insufficiency of agricultural production resulting in the inaccessibility of the ingredients required for the nutrition education, and second the low coverage of the interventions. The improvement of agricultural production is the main suggestion mentioned to fight against maternal undernutrition. Conclusions: Beneficiaries thought that existing interventions in the region are insufficient to address the problem of malnutrition among mothers.
  • Sambou Césarine, Allavena Clotilde, DeBeaudrap Pierre et Pourette Dolorès (2020) « Pratiques et logiques de hiérarchisation des maladies chroniques dans la prise en charge en médecine générale des personnes vivants avec le VIH (PvVIH) polypathologiques âgées de 70 ans et plus : Étude SEPTAVIH-Quali » (Poster), présenté à E-Congrès SFLS 2020.

2019

  • Andrianasolo, Andry Herisoa, Raboanary, Emma, Mattern, Chiarella, Kesteman Thomas, Pourette, Dolorès et Rogier, Christophe (2019) « Dimensions de la vulnérabilité liée au paludisme dans deux zones de Madagascar : apports d’une approche mixte », Populations vulnérables, 5, p. 129-156.
    Résumé : Le risque de décès, d’aggravation d’une maladie, ou d’endettement dans ses suites, dépend des dispositifs et moyens disponibles et accessibles à la population pour y faire face. Ainsi, la vulnérabilité liée au paludisme dépend du contexte socio-économique et géoclimatique qui déterminent le risque de transmission, des comportements individuels ou collectifs, et des moyens des ménages pour faire face à la maladie, pour la prendre en charge ou la prévenir. La présente étude vise à identifier les déterminants de la vulnérabilité liée au paludisme de la population de Madagascar, en analysant le contexte et les comportements de prévention et de recours aux soins médicaux en cas de fièvre. Une étude quantitative sur 4043 personnes de 803 ménages a été combinée à une étude qualitative reposant sur une soixantaine d’entretiens, dans deux districts, Ankazobe (Hautes Terres) et Brickaville (côte est), où le risque de paludisme et les contextes psycho-sociaux différaient. Les données ont été collectées en 2014 dans le cadre d’une thèse et d’une étude pluridisciplinaire, multicentrique et internationale (projet PALEVALUT1) pour laquelle un questionnaire et des guides d’entretien ont été développés, standardisés et validés. À Brickaville, les conditions bioclimatiques (chaudes et humides) sont plus favorables au développement des moustiques vecteurs du paludisme qu’à Ankazobe. La survenue de fièvre, la connaissance d’une personne décédée du paludisme, la perception de la dangerosité de cette maladie, la citation de fausses croyances à son sujet, l’utilisation de moustiquaires, le recours à un professionnel de santé et à un test sanguin pour son diagnostic, et le paiement de frais pour le déplacement vers une structure de santé ou pour obtenir des soins en cas de fièvre, y étaient significativement plus fréquentes. En revanche, l’exposition à l’éducation pour la santé, la compréhension du paludisme, le recours aux agents communautaires et la prise d’une combinaison thérapeutique à base d’artémisinine en cas de prise d’antipaludique, y étaient significativement moins fréquent qu’à Ankazobe. Ainsi, à Brickaville où la prévalence du paludisme était la plus élevée, certaines connaissances, attitudes et pratiques, associées à la prévention ou au traitement étaient plus fréquentes alors que d’autres, notamment en matière thérapeutique, étaient plus souvent inappropriées. L’écosystème, la disponibilité, l’accessibilité et la nature des lieux de recours, l’exposition à l’éducation pour la santé, les pratiques médicales des soignants et des patients, différaient significativement dans ces sites distants de moins de 300 km ou entre des sous-populations d’un même site. Ces déterminants de la vulnérabilité liée au paludisme, multidimensionnels et complexes, sont présentés et discutés ici sur les plans quantitatifs et qualitatifs.


  • 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.
  • 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.
  • Rakotomanana, Elliot, Mattern, Chiarella, Pourette, Dolorès, Bouchon, Magali, Randrianarisoa, Mirella Malala, Ramaroson, Henintsoa Joyce Valentina, de Monge, François et Baril, Laurence (2019) « Secret burden and fear of stigmatization on non-compliance of antiretroviral treatment among people living with HIV/AIDS in Mahajanga (Madagascar) » (Communication orale), présenté à Oxford Global Health and Bioethics International Conference, Oxford.
  • Ramaroson Henintsoa Joyce Valentina, Mattern Chiarella, Rakotomanana Elliot, Monge de François, Bouchon Magali, Pourette Dolorès et Randrianarisoa Mirella Malala (2019) « Analyse anthropologique des arrêts ponctuels de traitement ARV chez les personnes vivant avec le VIH à Madagascar » (communication orale), présenté à 2ème Congrès de Recherche en Santé Publique de l’Océan Indien, Saint Leu, La Réunion.
  • Ramaroson Henintsoa Joyce Valentina, Mattern Chiarella, Rakotomanana Elliot, Randrianarisoa Mirella Malala, Monge de François, Bouchon Magali et Pourette Dolorès (2019) « Anthropological analysis of occasional discontinuations of ARV treatment among people living with HIV in Madagascar » (poster), présenté à International Conference on Aids and STIs in Africa, Kigali, Rwanda.

2018


  • Atchessi Nicole, De Allegri Manuela, Kadio Kadidiatou, Pigeon-Gagné Emilie, Ouédraogo Samiratou et Ridde Valéry (2018) « Du concept d’indigence aux interventions de santé publique réflexions du Burkina Faso », in Femmes, enfants et santé à Madagascar. Approche anthropologiques comparées, éd. par Dolorès Pourette, Chiarella Mattern, Christine Bellas Cabane, et Bodo Ravololomanga, Paris : L'Harmattan, p. 211-222. (Anthropologie & Médecines). ISBN : 978-2-343-14681-2.

  • Bellas Cabane Christine, Pourette Dolorès, Mattern Chiarella et Ravololomanga Bodo (2018) « Conclusion », in Femmes, enfants et santé à Madagascar. Approche anthropologiques comparées, éd. par Dolorès Pourette, Chiarella Mattern, Christine Bellas Cabane, et Bodo Ravololomanga, Paris : L'Harmattan, p. 261-274. (Anthropologies & Médecines). ISBN : 978-2-343-14681-2.
  • Mattern, Chiarella et Pourette, Dolorès (2018) « Défiance et défaillance : des stratégies en marge de l’offre de soins public à Madagascar, recours aux matrones et recours au marché informel du médicament », in Vulnérabiliés et territoires, éd. par Maryse Gaimard, Gateau M., et Ribeyre F., Nancy : Kaïros, p. 201-219. (Questions humaines).
  • Pourette Dolorès (2018) « Les recours informels à l'avortement médicamenteux à Madagascar » avril 9, Université de Bordeaux.

  • Pourette Dolorès, Bellas Cabane Christine et Mattern Chiarella (2018) « Entretien avec Bodo Ravololomanga, sage-femme et ethnologue », in Femmes, enfants et santé à Madagascar. Approche anthropologiques comparées, éd. par Dolorès Pourette, Chiarella Mattern, Christine Bellas Cabane, et Bodo Ravololomanga, Paris : L'Harmattan, p. 153-159. (Anthropologies & Médecines). ISBN : 978-2-343-14681-2.

  • Pourette Dolorès, Bellas Cabane Christine, Mattern Chiarella et Ravololomanga Bodo (2018) « Introduction », in Femmes, enfants et santé à Madagascar. Approche anthropologiques comparées, éd. par Dolorès Pourette, Chiarella Mattern, Christine Bellas Cabane, et Bodo Ravololomanga, Paris : L'Harmattan, p. 21-38. (Anthropologies & Médecines). ISBN : 978-2-343-14681-2.

  • Pourette Dolorès, Mattern Chiarella, Bellas Cabane Christine et Ravololomanga Bodo (2018) Femmes, enfants et santé à Madagascar. Approches anthropologiques comparées, Paris : L'Harmattan, 294 p. (Anthropologies & Médecines). ISBN : 978-2-343-14681-2.
  • Pourette Dolorès, Mattern Chiarella et Ratovoson Rila (2018) « Recourir à l'avortement médicamenteux à Madagascar : une pratique banalisée ? / Using medical abortion in Madagascar: a trivalized practice? » (Poster), présenté à Colloque international GLOBALMED. Régulations, marchés, santé. Interroger les enjeux actuels du médicament en Afrique, Ouidah, Bénin.


  • Pourette Dolorès, Mattern Chiarella, Ratovoson Rila et Raharimalala Patricia (2018) « Complications with use of misoprostol for abortion in Madagascar: between ease of access and lack of information », Contraception, 97 (2) (février), p. 116-121. DOI : 10.1016/j.contraception.2017.12.005. http://linkinghub.elsevier.com/retrieve/pii/S0010782417305310.
    Résumé : Objectives: To learn what complications some women experienced in Madagascar following use of misoprostol for abortion and what treatment they received post-misoprostol use. Study design: This was a qualitative study in 2015-16 among women who had experienced complications after use of misoprostol, with or without additional methods, for abortion, what information they received before use, what dosage and regimens they used, what complications they experienced and what treatment they received post-use. We initially conducted in-depth, semistructured interviews with 60 women who had undergone an abortion that resulted in complications. The results presented here are based on interviews with the sub-set of 19 women who had used misoprostol. Results: The 19 women were aged 16-40, with an average age of 21-26 at interview and average age of 18-21 at abortion. To obtain an abortion, they sought advice from partners, friends, family members, and/or traditional practitioners and healthcare providers. Misoprostol was easily accessible through the formal and informal sectors, but the dosages and regimens the women used on the advice of others were extremely variable, did not match WHO guidelines, and were apparently ineffective, resulting in failed abortion, incomplete abortion, heavy bleeding/hemorrhage, strong pain, and/or infection. Conclusions: This study provides data on complications from the use of misoprostol as an abortifacient in Madagascar. Healthcare providers need training in correct misoprostol use and how to treat complications. Law and policy reform are needed to support such training and to ensure the provision of safe abortion services in the public health system.
  • Pourette Dolorès, Mattern Chiarella, Razafiarimanana Hobisandratra, Shimakawa Yusuke et Giles-Vernick Tamara (2018) « Les obstacles potentiels à la vaccination contre l'hépatite B à la naissance à Madagascar - Programme NéoVac » (Communication orale), présenté à 9e Conférence Internationale Francophone sur le VIH et les Hépatites Virales (AFRAVIH 2018), Bordeaux.


  • Pourette Dolorès, Pierlovisi Carole, Randriantsara Ranjatiana, Rakotomanana Elliot et Mattern Chiarella (2018) « Avoiding a "big" baby: Local perceptions and social responses toward childbirth-related complications in Menabe, Madagascar », Social Science & Medicine, 218 (décembre), p. 52-61. DOI : 10.1016/j.socscimed.2018.10.002. http://www.sciencedirect.com/science/article/pii/S0277953618305689.
    Résumé : In Madagascar, a country where over 60% of deliveries are not attended by a healthcare professional, late or inadequate responses to complications during childbirth account for a great number of maternal deaths. In this article, we analyse local perceptions of birth-related risks and strategies used to avoid these risks or manage complications of childbirth. We conduct this analysis in light of the social meanings of childbirth and the social expectations placed upon women in a context of socio-economic vulnerability and a challenged public health system. We conducted two separate studies in the district of Morondava (Menabe region) in June 2014 and March 2015, comprising semi-directive interviews with 111 people (59 mothers, 18 members of their immediate entourage and 34 institutional or healthcare stakeholders), and eight focus groups discussions – two with community leaders, and six with fathers. The results show that the social pressure exerted on women to give birth without complications leads them to practices aimed at avoiding a "big" baby including dietary restrictions, physical activity, and refusal of iron supplementation intake. During pregnancy, women are usually accompanied by a traditional birth attendant or matron (reninjaza). Further, they use the public health system by attending antenatal consultations. However, women are reluctant to deliver in a health facility, where the practices of health professionals are in discordance with the social realities of women and local beliefs around childbirth. If complications arise, they are explained by social causes. The parturient woman is only taken to a healthcare facility after carrying out rituals and if the problems do not resolve themselves. These findings support recommendations to reduce the cultural distance between health workers and childbearing women, strengthen the collaborations with reninjazas, and inform women and their decision makers (mother, reninjaza, spouse) about nutrition during pregnancy and signs of complications.
    Mots-clés : Anthropological approach, Childbirth-related complications, Local knowledge, Madagascar, Maternal mortality, Pregnant women's care pathways.

  • Pourette Dolorès (2018) « Les "matrones" à Madagascar : reconnaissance locale, déni institutionnel et collaborations avec des professionnels », in Femmes, enfants et santé à Madagascar. Approche anthropologiques comparées, éd. par Dolorès Pourette, Chiarella Mattern, Christine Bellas Cabane, et Bodo Ravololomanga, Paris : L'Harmattan, p. 115-126. (Anthropologies & Médecines). ISBN : 978-2-343-14681-2.

  • Pourette, Dolorès (2018) « Anthropologie de la santé et temporalités de l'intervention humanitaire », in Transition humanitaire à Madagascar / Humanitarian Transition in Madagascar, éd. par Fouquet, Thomas et Troit, Virginie, Paris : Karthala, p. 115-125. (Devenir humanitaire). ISBN : 978-2-8111-2536-3.
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