["Natural remedy" but without scientific evidence! Ethnography of the logics structuring the prescription of phyto-drugs by physicians in Burkina Faso]. / Des « remèdes naturels ¼ mais sans preuves scientifiques ! Ethnographie des logiques structurant la prescription des phyto-médicaments par les médecins au Burkina Faso.

INTRODUCTION: Since the 1970s, WHO has recommended the valorization of medicines derived from "traditional" medicine. In Burkina Faso, despite a political will to promote phyto-medications, their prescription by health professionals remains weak. The purpose of this article is to highlight the logics behind the prescribing practices of phyto-drugs by Burkinabe doctors. METHODS: Adopting a qualitative approach, this study was conducted in Ouagadougou with general practitioners and specialists. Data collected were from semi-directive individual interviews and direct observation. A total of 47 interviews were conducted at medical centers with a surgical unit (CMA) and university hospital centers (CHU). RESULTS: Our results show that phyto-drugs have not been included in the initial training of the doctors surveyed. The only sources of information for doctors are then from colleagues, family, patients or the media. Their perceptions of this type of medication are ambivalent, ranging from "natural products" to products at risk due to lack of studies. Prescribing practices are subject to four main rationales : personal and professional experiences, patient judgment, validation by clinical trials and consideration of iatrogenic risk. DISCUSSION: In the absence of a strong academic setting, knowledge of phyto-drugs has been acquired informally. As the standards and technical references remain weak, several subjective logics are essential in the construction of prescribing practices. CONCLUSION: Beyond the symbolic and subjective logics explaining the low prescription of phyto-medications, our study invites us to wonder about the place of political and institutional logics in the weak integration of traditional medicine into the Burkinabé healthcare system.

[Perception of HIV infection prevention messages by truck drivers in Togo with respect to the <> billboard]. / Perception des messages de prévention de l'infection à VIH chez les chauffeurs routiers au Togo: cas du panneau d'affichage <>.

BACKGROUND: Togo is one of the West African countries in which HIV prevalence remains high in the general population. Several HIV prevention interventions have targeted truck drivers. The purpose of this study was to describe and analyse the perceptions of truck drivers with respect to the HIVprevention message of the <> billboard. METHODS: A qualitative study was conducted among truck drivers at "Terminal du Sahel" in Lomé in May 2013 in French and sometimes in a local language. The data generated by this survey were submitted to qualitative analysis. RESULTS: A total of 24 truck drivers were interviewed. They had already heard about HIV/AIDS and were able to list various modes of HIV transmission and various ways of protecting oneselffrom HIV However, they had a poor perception of the risk of contracting HIV infection. Although all participants had seen the "Roulez Protégé" billboard several times in various places, it made them feelguilty, as itsuggested that they were responsiblefor spread of the HIV/AIDS epidemic. Truck drivers had a poor understanding of the message expressed by this billboard. CONCLUSION: In Togo, truck drivers constitute a group at high risk of HIV in which prevention interventions must be intensified.

Acceptability and Feasibility of Human Papillomavirus Vaccine Introduction in Cameroon: A Mixed-Methods Study.

INTRODUCTION: Human papillomaviruses (HPV) are responsible for sexually transmitted infections, and some of these viruses have oncogenic potential. The HPV vaccine is due to be introduced in Cameroon in September 2019. Our study looked at the knowledge, perceptions, and attitudes of the population and healthcare professionals regarding cervical cancer and its vaccine prevention. This approach provides a solid basis for, among other things, developing a clear communication strategy for the introduction of the vaccine. OBJECTIVE: This study aimed to assess the feasibility and acceptability of introducing the HPV vaccine in Cameroon among key stakeholders including health workers and parents. METHODS: From March to May 2019, we conducted a qualitative and quantitative descriptive study in six health districts in the Centre Region. A total of 257 study participants were recruited, including 168 parents and 89 health professionals; 60 interviews were also conducted, 30 with parents and 30 with health professionals. The quantitative data collected were analyzed using IBM SPSS Statistics for Windows, Version 20.0 (Released 2011; IBM Corp., Armonk, New York, United States); for the qualitative analysis, we carried out repeated readings of the transcribed interviews. This work enabled us to identify the significant themes emerging from the interviewees' discourse. RESULTS: The vast majority of healthcare professionals claim to be aware of cervical cancer (93.3%), but only 15.7% of female healthcare professionals claim to have ever carried out a screening test. A significant proportion of these professionals have actual experience of cervical cancer. Among parents, knowledge of this cancer also appears to be relatively high for a lay audience (54.2%), with a low screening rate (7.1%). Awareness of the HPV vaccine as a cervical cancer prevention tool was very low: 14.9% among parents and 44.9% among healthcare professionals. In addition, we found that information about the existence of an HPV vaccine was still very low among parents (83.9% had never heard of it); 43.8% of healthcare professionals had been informed about the vaccine at their training school. As regards acceptance of the HPV vaccine, the quantitative and qualitative results point in the same direction. The majority of parents are in favor of a campaign and access to this new vaccine via the Expanded Program on Immunization (EPI). However, many of them (94.6%) explained that they wanted more information before making a decision. CONCLUSION: Informing and raising public awareness of cervical cancer, the HPV vaccine, and vaccine safety are essential measures to encourage public support for the HPV vaccination campaign.

[Physical activity: Tools for customized assessment and prescription]. / Activité physique : des outils pour un bilan et une prescription adaptés.

PHYSICAL ACTIVITY: TOOLS FOR CUSTOMIZED ASSESSMENT AND PRESCRIPTION. Physical activity is a significant part of the global therapeutic care of chronic diseases. It also effectively contributes to prevent complications and relapses of these diseases. Thus, the prescription of physical activity must find its place in physician everyday practice. However, this prescription remains too unusual due to a number of obstacles. Simple, practical tools have been developed to facilitate its implementation, including a contraindications sheet, an effort level prescription, a functional phenotype table, a general and specific indications sheet, and a physical activity prescription template. These tools for prescribing physical activity should enable it to be integrated more systematically and as early as possible into patient care. Following a decision tree, a medical assessment can be carried out to take into account the particular conditions of each patient and propose a more detailed medical prescription.

ACTIVITÉ PHYSIQUE : DES OUTILS POUR UN BILAN ET UNE PRESCRIPTION ADAPTÉS. L'activité physique est une composante essentielle de la prise en charge thérapeutique des maladies chroniques. Elle contribue de façon majeure à la prévention des complications et des récidives de ces maladies. La prescription d'activité physique doit donc trouver sa place dans la pratique quotidienne des médecins. Pourtant, cette prescription reste trop marginale, en raison de différents freins. Des outils simples et concrets facilitent sa mise en oeuvre : fiche des contre-indications, ordonnance du niveau d'effort, tableau des phénotypes fonctionnels, fiche des indications générales et spécifiques, modèle de prescription d'activité physique. Ces outils d'aide à la prescription d'activité physique doivent permettre de l'intégrer dans le parcours de soins des patients de façon plus systématique et aussi précocement que possible. Suivant un arbre décisionnel, un bilan médical peut être réalisé pour prendre en compte les conditions particulières de chaque patient et proposer une prescription médicale plus détaillée.

Human activities and microbial geographies. An anthropological approach to the risk of infections in West African hospitals.

In hospital care, management of the risk of infection represents a crucial issue. Nevertheless, this question remains a neglected area in anthropological research, especially in African countries. To shed new light on this question, we conducted an anthropological investigation in the infectious disease department of a hospital in Niger. Daily observation of the work of the hospital staff for a total period of 6 months was spread out over 2008 and 2009. During our prolonged stay, we also collected 64 in-depth interviews of health care workers and attendants in the department. This study method made it possible to describe many of the practices and discourses related to the issues of medical and personal care and hospital hygiene and to compare the practices observed to standard principles for preventing hospital-acquired infections. Our ethnographic attention to the behavior of the actors showed the absence of formal spatial segmentations between different activities. The care provided by the untrained relatives serving as personal attendants introduced territorial enclaves governed by home hygiene standards into the interior of technical spaces. At the same time, privatizing equipment and space for their diverse activities, the medical staff disrupted technical chains and generated the recurrent crossing of microbial geographies. These results allow us to offer two principal guidelines for improving the quality of care and the management of risks of infection in hospitals in West Africa: (1) the essential role of the attendants in the care provided to hospital inpatients must be officially taken into account, especially by including them in the organization of medical hygiene procedures; (2) the different overlapping technical activities and social activities in the work space must be limited by their geographic and architectural segmentation.

Determinants of refusal of A/H1N1 pandemic vaccination in a high risk population: a qualitative approach.

BACKGROUND: Our study analyses the main determinants of refusal or acceptance of the 2009 A/H1N1 vaccine in patients with cystic fibrosis, a high-risk population for severe flu infection, usually very compliant for seasonal flu vaccine. METHODOLOGY/PRINCIPAL FINDINGS: We conducted a qualitative study based on semi-structured interviews in 3 cystic fibrosis referral centres in Paris, France. The study included 42 patients with cystic fibrosis: 24 who refused the vaccine and 18 who were vaccinated. The two groups differed quite substantially in their perceptions of vaccine- and disease-related risks. Those who refused the vaccine were motivated mainly by the fears it aroused and did not explicitly consider the 2009 A/H1N1 flu a potentially severe disease. People who were vaccinated explained their choice, first and foremost, as intended to prevent the flu's potential consequences on respiratory cystic fibrosis disease. Moreover, they considered vaccination to be an indirect collective prevention tool. Patients who refused the vaccine mentioned multiple, contradictory information sources and did not appear to consider the recommendation of their local health care provider as predominant. On the contrary, those who were vaccinated stated that they had based their decision solely on the clear and unequivocal advice of their health care provider. CONCLUSIONS/SIGNIFICANCE: These results of our survey led us to formulate three main recommendations for improving adhesion to new pandemic vaccines. (1) it appears necessary to reinforce patient education about the disease and its specific risks, but also general population information about community immunity. (2) it is essential to disseminate a clear and effective message about the safety of novel vaccines. (3) this message should be conveyed by local health care providers, who should be involved in implementing immunization.