Facteurs associés à la coadministration des vaccins à la naissance chez des enfants sénégalais.

INTRODUCTION: Co-administration of the bilié de Calmette et Guérin (BCG) and birth doses of oral polio (OPV zero) and hepatitis B (HepB BD) vaccines is strongly recommended. The objective was to determine the factors associated with this co-administration in the health district of Podor (Senegal). METHODS: This cross-sectional study was conducted among 726 children aged 12 to 23 months. This was a two-stage cluster sampling. The data was collected in June 2020. An electronic questionnaire was developed using the Open Data Kit Collect application. Co-administration was modeled as one dose, two doses and three doses. Ordinal logistic regression was used to search for factors likely to influence co-administration. RESULTS: Of the 726 children, 115 (16%), 234 (32%) and 377 (52%) received a single dose, two and three doses, respectively. Factors associated with co-administration were recognition by mothers or caregivers that several vaccines can be administered simultaneously (adjusted OR = 1.46, p-value = 0.017), availability of a health record kept at home (adjusted OR = 6.88, p-value = 0.006), hospitalization of the newborn after birth (adjusted OR = 1.74, p-value = 0.002) and receipt of advice during postnatal care (adjusted OR = 1.72, p-value = 0.01). CONCLUSION: Co-administration of birth doses is an infrequent practice in Podor. Awareness and availability and proper maintenance of health information management tools would be necessary.

Vaccination against tuberculosis, polio and hepatitis B at birth in Podor health district, Northern Senegal: cross-sectional study of vaccination coverage and its associated factors.

BACKGROUND: In Senegal, studies focusing specifically on vaccination coverage with the Bacille de Calmette et Guérin (BCG) vaccine, the birth dose of oral polio vaccine (OPV zero dose) and the birth dose of hepatitis B (HepB-BD) vaccine are insufficient. This study aimed to highlight vaccination coverages with birth doses and factors associated with timely vaccination in Podor health district. METHODS: A cross-sectional study was carried out from June 19 to 22, 2020. The study population consisted of children aged 12 to 23 months of which 832 were included. A stratified two-stage cluster survey was carried out. The sources of data were home-based records (HBR), health facility registries (HFR) and parental recalls. Timely vaccination refers to any vaccination that has taken place within 24 h after birth. Descriptive analyzes, the chi-square test and logistic regression were performed. RESULTS: The crude vaccination coverages with BCG, OPV zero dose and HepB-BD were 95.2%, 88.3% and 88.1%, respectively. Vaccination coverages within 24 h after birth were estimated at 13.9%, 30% and 42.1%, respectively. The factors associated with timely HepB-BD are delivery in a health facility (AOR = 1.55; 95% CI = 1.02-2.40), access to television (AOR = 1.63; 95% CI = 1.16-2.29), weighing (AOR = 3.92; 95% CI = 1.97-8.53) and hospitalization of the newborn immediately after birth (AOR = 0.42; 95% CI = 0.28-0.62). CONCLUSION: Timely administration of birth doses is a challenge in the Podor health district. The solutions would be improving geographic access to health facilities, involving community health workers, raising awareness and integrating health services.

Coverage and Timeliness of Birth Dose Vaccination in Sub-Saharan Africa: A Systematic Review and Meta-Analysis.

Background: Depending on the epidemiological context of each country, three vaccines are recommended by the World Health Organization (WHO) to be administered as soon as possible after birth (birth vaccines); namely, BCG, zero dose of oral polio vaccine (OPV0), and birth dose of hepatitis B vaccine (HepB-BD). The timely administration of these vaccines immediately after birth might pose significant challenges in sub-Saharan Africa, where about half of childbirths occur outside health facilities. We therefore conducted a systematic review and meta-analysis to estimate the coverage rate of these vaccines at a specific timing in neonates in sub-Saharan Africa. Methods: We searched PubMed, Embase, CINAHL, and Web of Science for studies conducted in sub-Saharan Africa and published up to March 31, 2017, which provided a coverage rate of the birth vaccines at any specific time points within 28 days after birth. Two investigators independently screened the titles and abstracts and extracted data from the eligible full-text articles. This study was registered in PROSPERO (CRD42017071269). Results: Of 7283 articles identified, we finally included 31 studies with 204,111 infants in the meta-analysis. The pooled coverage rates at day 0-1 after birth were 14.2% (95% CI: 10.1-18.9) for BCG and 1.3% (0.0-4.5) for HepB-BD. No data were available for OPV0 at day 0-1. The coverage at day 28 was 71.7% (63.7-79.2) for BCG, 60.8% (45.8-74.7) for HepB-BD, and 76.1% (67.1-84.0) for OPV0. No significant difference in the vaccine coverage was observed between infants born in healthcare facilities and those born outside facilities. Conclusions: The rates of vaccine coverage immediately after birth were very low for BCG and HepB-BD, and no data for OPV0. We need additional data to better define barriers and facilitators for the timely administration of the birth vaccines in sub-Saharan Africa, since the delay in its provision may increase the burden of these vaccine-preventable diseases.

Assessment of General Public's Knowledge and Opinions towards Antibiotic Use and Bacterial Resistance: A Cross-Sectional Study in an Urban Setting, Rufisque, Senegal.

Background: Bacterial resistance is a major public health problem worldwide. One solution to this scourge is to sensitize the general public on rational use of antibiotics. Our goal was to assess people's knowledge and opinions about antibiotic use and bacterial resistance in an urban setting. Method: We performed a cross-sectional study. A convenience sampling was done. A questionnaire was administered to 400 persons during face-to-face interviews. Results: Most respondents thought that antibiotics are effective against colds/flu (69.8%), cough (72.3%) and sore throat (64.4%). At the same time, 42.8% stated that antibiotic therapy can be stopped as soon as the symptoms disappear. Only 8.8% and 41.8% of people knew that handwashing and vaccination prevented bacterial resistance. Globally, 7% of people had a good knowledge. Socio-demographic variables were not associated with the level of knowledge. The main sources of information were entourage and pharmacy staff. Regarding the opinions, 78.3% of surveyed participants the people thought that that people overuse antibiotics. Additionally, 28% said that they have no role to play against bacterial resistance. Conclusion: People living in an urban setting had a low knowledge about antibiotic use and bacterial resistance. There is a need to implement awareness campaigns. Further studies on population practices toward antibiotic use are necessary.

Assessment of potentially preventable hospitalizations in the regional hospital of Saint-Louis, Senegal.

INTRODUCTION: The "potentially preventable hospitalizations (PPH)'' are hospital admissions that could have been avoided through effective primary care given at the appropriate time. Non-communicable diseases (NCDs), causes of PPH, are the leading cause of death worldwide with significant socioeconomic consequences especially in developing countries. This study aimed to assess the burden of potentially preventable hospitalizations in the St. Louis regional hospital. METHODS: This was a descriptive cross-sectional study. The surveyed population consisted of all patients older than one year, admitted to St. Louis hospital for more than four (04) hours time between January 20 and April 30, 2015. Patients hospitalized in surgery (general surgery, ENT, ophthalmology), maternity and neonatology, as well as those who refused or were unable to participate in the study were excluded. RESULTS: The study included one hundred forty four (144) individuals with an average age of 54.68±15 years (17-88 years) and sex ratio woman/man of 1.21. The PPH represented 54% of all hospitalizations. The main causes of hospitalizations were diabetes with 22.1%, chronic kidney disease 12%, hypertension 10.9%, Stroke 6.4% and finally broncho-pulmonary diseases 2.6%. The average length of stay was 6.68±5.51 days. The average distance between the residence and the hospital was 26.51±60KM with a median of 3.5KM. The average cost of care was Euros 104.583 ±83.51. For 61.10%, it was a first hospitalization and for 30.60%, a second one. The Knowledge about signs of disease severity had changed significantly at the end of hospitalization, from 29% at the beginning to 98% at the end of stay in hospital. As for the means of prevention, 30.55% reported knowing them before their hospitalization and 68% after hospitalization. CONCLUSION: Potentially preventable hospitalizations are a heavy burden for the population of St. Louis. Their negative social and economic impacts may hinder health policies initiated to relieve vulnerable groups. Their prevention should be a national priority.

Satisfaction Determinants of Women during Childbirth in Health Facilities in Senegal: Literature Review.

This article presents the results of the literature review performed on the main conceptual models used in the measurement of the satisfaction of women during childbirth in health facilities and the main determinants of their satisfaction. The review focused on PubMed, Google scholar and Public Health data. Several conceptual models for measuring satisfaction were found through the literature. It is clear from this review that a multitude of determinants are associated with women's satisfaction such as health care provider's attitude, the environment as well as the socio-demographic, economic and even psychological characteristics of the patient herself. These results were used to develop a conceptual framework for measuring the satisfaction of women who gave birth in Senegal health facilities.

[Overweight, obesity and associated factors among public secondary school students in Dakar]. / Surpoids, obésité et facteurs associés chez les élèves du 2nd cycle d’enseignement public de Dakar.

These results support outreach activities for students, and the involvement of parents and teachers in strategies focused on food hygiene and sport..

Social Determinants of Routine Immunization Coverage of Children Aged 12 to 23 Months in the Kaolack Region of Senegal / Déterminants sociaux de la couverture vaccinale de routine des enfants de 12 à 23 mois dans la région de Kaolack, Sénégal.

Introduction: The lowest immunization coverages (IC) are recorded in Africa, where health systems fail to take geographical disparities into account. The objective of this study was to identify the social determinants of routine immunization coverage for children aged 12 to 23 months in the Kaolack region.Methodology: A cross-sectional, descriptive and analytical study was conducted in four health districts of Kaolack region from 1 to 30 June 2014. A cluster survey was conducted. Data collection was based on a pretested questionnaire administered to mothers or guardians of children aged 12 to 23 months by trained and supervised interviewers. Bivariate analysis was performed using Epi Info 3.5.4 software.Results: The sample included 849 mothers or guardians between the ages of 15 and 70 years with a mean age of 26.8 years (± 6.9). The majority of these women lived in rural areas (73.3%), were married (96.3%), with no income-generating activities (79.7%), literacy (62.5%) and had at least 4 children (75.1%). 20.1% of them were familiar with the immunization schedule, 87.9% could name at least one adverse event following injection (AEFI), 63.3% knew the EPI target diseases. The majority of women (91.3%) complied with the immunization schedule and attended the facility in case of missed appointments (52.3%). Only 39.1% of them reported AEFI and 59.7% provided home care.Those who lived in rural areas and who had income-generating activities (IGA) knew more about the immunization schedule (p<0.05). Those who lived in rural areas reported more AEFI (p<0.05). Children of mothers educated in French, urban inhabitants with an IGA had better routine immunization coverage (p<0.05).Conclusion: Social determinants such as education, economy and governance contribute to improved routine immunization coverage of children aged 12-23 months.

HBsAg seroprevalence among Senegalese militaries.

BACKGROUND: Chronic hepatitis is a major public health problem. Hepatitis B virus is the primary cause, and Hepatitis B and C together are responsible for 60% of cirrhosis and 80% of hepatocellular carcinomas. This study measured the prevalence of HBsAg among Senegalese military to develop an appropriate strategy to prevent cirrhosis and hepatocellular carcinoma. METHODS: We conducted a descriptive cross-sectional study among Senegalese military aged 25 to 60 years. A sample of 1224 participants was selected following a two-level-stratification. The mark of surface HBs antigen using chemiluminescence concerned 1195 participants. The presence of HBsAg was analyzed according to age, marital status, alcohol consumption and glomerular filtration rate. Epi-info6fr and R software were used, respectively, for data capture and analyses. A Chi-square test was performed to compare proportions considering a significance level of 5% and a confidence interval of 95%. RESULTS: The average age was 39.8 ± 9.2 years. Participants in the age groups of 25-34 years, 45-60 years and 35-44 years were respectively 30.7%, 34.4% and 34.9% of the sample. Married persons represented 82.6% of participants and 17.08% were single. Most participants were educated (99%), and 56% had reached at least secondary school level. Alcohol consumption was at 11.5%. The HBsAg prevalence rate was 10.8% [9.1% to 12.7%] with a significant difference between age groups (P < 0.001), which ranged from 5.6% for 45-60 years, 9.62% for 25-34 years to 16.9% for 35-44 years. Marital status and alcohol consumption did not affect the carriage of HBsAg. HBsAg prevalence was more common among participants who had a glomerular filtration rate greater than 90 ml/min. Transaminases rate exceeded the normal threshold for 43 participants (3.6%); the increase was 6.6% [2.7% to 11.8%] for HBsAg carriers and 3.2% [1.2% to 6.7%] for alcohol users. CONCLUSIONS: The high prevalence of HBsAg in the military requires the implementation of an effective prevention and care program to reduce the risk of cirrhosis and hepatocellular carcinoma and contribute to reducing the burden of communicable diseases, such as hepatitis and HIV/AIDS, and non-communicable diseases.

Lessons learned from stakeholder-driven sustainability analysis of six national HIV programmes.

BACKGROUND: In light of the decline in donor HIV funding, HIV programmes increasingly need to assess their available and potential resources and maximize their utilization. This article presents lessons learned related to how countries have addressed the sustainability of HIV programmes in a stakeholder-driven sustainability analysis. METHODOLOGY: During HIV/AIDS Programme Sustainability Analysis Tool (HAPSAT) applications in six countries (Benin, Guyana, Kenya, Lesotho, Sierra Leone and South Sudan), stakeholders identified key sustainability challenges for their HIV responses. Possible policy approaches were prepared, and those related to prioritization and resource mobilization are analysed in this article. RESULTS: The need to prioritize evidence-based interventions and apply efficiency measures is being accepted by countries. Five of the six countries in this study requested that the HAPSAT team prepare 'prioritization' strategies. Countries recognize the need to prepare for an alternative to 'universal access by 2015', acknowledging that their capacity might be insufficient to reach such high-coverage levels by then. There is further acceptance of the importance of reaching the most-at-risk, marginalized populations, as seen, for example, in South Sudan and Sierra Leone. However, the pace at which resources are shifting towards these populations is slow. Finally, only two of the six countries, Kenya and Benin, chose to examine options for generating additional financial resources beyond donor funding. In Kenya, three non-donor sources were recommended, yet even if all were to be implemented, it would cover only 25% of the funding needed. CONCLUSIONS: Countries are increasingly willing to address the challenges of HIV programme sustainability, yet in different ways and with varying urgency. To secure achievements made to date and maximize future impact, countries would benefit from strengthening their strategic plans, operational plans and funding proposals with concrete timelines and responsibilities for addressing sustainability issues.

Knowledge and attitudes of Senegalese sailors about HIV/AIDS.

BACKGROUND: In West Africa there is little information on the behavior of sailors with respect to HIV/AIDS. AIM: The objective of this study was to assess the knowledge and attitudes on HIV/AIDS and their risk factors. MATERIALS AND METHODS: This was a cross-sectional study on a sample of 400 sailors. Information was collected on knowledge and attitudes. Multiple logistic regression was performed to analyse the factors related to knowledge and attitudes. RESULTS: The mean age was 38.1 ± 9.8 years. Among sailors, 7.5% knew the 3 main modes of HIV transmissionand 48.3% did not sail with a crew member infected with HIV. Knowledge was related to occupationalcategory (OR = 14.07 [5.40-36.65]). Stigmatisation was related to education (OR = 0.45 [0.27-0.74]) and fear (0.19 [0.09-0.41]). CONCLUSIONS: Sailors have a low level of knowledge and negative attitudes towards people living with HIV. Intervention simplemented must take into account the low level of knowledge and the mobility of the target population.

Socio-cultural aspects of oral health among the Fulani in Ferlo (Senegal): a qualitative study.

OBJECTIVES: Health is a subjective concept that considers the social, cultural, environmental and behavioural problems of the individual. This study was conducted with the objective of better understanding the sociocultural aspects related to the oral health of the Fulani populations of Ferlo, Senegal. METHODS: The study was qualitative and based in the area of the Great Green Wall (GGW) in the region known as Ferlo, northern Senegal. Data were collected by semi-structured interviews in a sample of the population and through discussions with a focus group. It concerned health and aesthetics of the teeth, care and traditional herbal recipes, teeth and superstitions. RESULTS: It appears that people were using the toothpick, the chewing stick and/or charcoal to clean their teeth. Confusion persisted with respect to the types of food consumed that were implicated in the occurrence of dental caries: tea, rice, 'jumbo' (a seasoning spice) and tobacco. 'Borom bop', which means 'master of the head', was the most commonly reported cause of caries. Healthy, beautiful teeth were attributes of beauty and elegance, enhanced by tattoos and crafted crowns in the Fulani. Their health problems were generally managed by healers or traditional practitioners who based their practices on empirical and 'handed down' knowledge. Socio-anthropological meanings were given to children with neonatal teeth. CONCLUSIONS: It is therefore important to consider the sociocultural aspects in oral health projects and programmes; the place of herbal medicine in dentistry should be recognized and maybe researched in the region of the Great Green Wall.

[Analysis of free health care for the elderly in the context of the "Plan Sésame" in Senegal]. / Analyse du fonctionnement du plan de prise en charge gratuite des soins chez les personnes âgées "Plan Sesame" au Senegal.

INTRODUCTION: Access to health care remains a major problem in Senegal, particularly among vulnerable groups such as the elderly. In 2006, the Senegalese government introduced a national plan for the provision of free health care known as "Plan Sésame" to improve access to care. The purpose of this study was to examine the current state of the "Plan Sésame" in national hospitals four years after its implementation (2006-2009). METHODS: A qualitative study using individual interviews was conducted between 15 March and 14 May 2010 among five target populations: hospital directors, health care providers, managers of the "Plan Sésame" in hospital admission services, management accountants, and beneficiaries. Content analysis was used. RESULTS: Between 2006 and 2008, hospital attendance rates increased every year. However, attendance rates began to decrease in 2009, except in the main hospital. The state has been left with a growing debt because of issues surrounding the reimbursement of expenses related to the "Plan Sésame'. As a result, national hospitals have been forced to restrict certain services included in the "Plan Sésame" and even to withdraw free health care for the elderly. These difficulties are likely to undermine the sustainability of the "Plan Sésame" CONCLUSION: The health authorities need to audit the "Plan Sésame:, to comply with standard procedures through regular monitoring and to redefine conditions of access.

[Socio-demographic factors and the treatment of obstetric fistula in southeastern Senegal]. / Facteurs sociodémographiques et prise en charge des fistules obstétricales au Sud-Est du Sénégal.

The objective of this study was to examine the socio-demographic profile and treatment of women suffering from obstetric fistula (OF) in southeastern Senegal. Conducted between August 2007 and January 2008, the study focused on women treated in regional hospitals in Tambacounda and Kolda. The data were collected using questionnaire-based interviews and analyzed using the Epi Info 3.3.1 software package. The patients (mean age of occurrence of OF: 24) were mostly from rural areas (86%), illiterate (89%), and excised (93%). The main cause of the condition cited by the participants was long working hours (42%). The study found that the participants were more likely to have no income-generating activity (84% compared to 22%) and to be divorced (19% compared to 2%) after (as opposed to before) the OF. The study also highlighted the prevalence of psychological disorders (62%), withdrawal (22%), abandonment by friends and/or family (16%) or by the husband (7%), and decreased effectiveness in household chores (4%). The average time between the occurrence of OF and the first consultation was 50.7 (± 55.3) months. The study found that 44% of the participants were waiting for an operation, 35% had undergone unsuccessful surgery, 14% had been treated and cured, 6% had recently undergone surgery, and 1% had suffered a recurrence. Good access to services was found to be necessary for effective treatment, although high-quality obstetric care and increased awareness were identified as the most important factors for the prevention of OF in southeastern Senegal.

[Results-based management and health development strategies: some reflections on recent experiences in Africa]. / Gestion axée sur les résultats et stratégies de développement sanitaire en Afrique.

The Paris Declaration on Aid Effectiveness (PD), launched in 2005, and the International Health Partnership (IHP+) have promoted a results-based management approach (RBM) to health care based on 6 principles: simplicity, action-based learning, accountability, adaptability, partnership, and transparency. These principles have been implemented in the form of health policies as part of the development and implementation of National Health Sector Strategic Plans. The recent experience of several African countries provides an indication of the strengths and weaknesses of results-based management in the health sector. In Senegal, inadequate training has resulted in inadequate planning, particularly in the development of the Medium-Term Expenditure Framework (MTEF). In its last Health Sector Strategic Plan, Burundi, against all results-based logic, allocated 93 % of its budget to the central level, compared to just 1 % and 6 % respectively to the intermediate and peripheral levels. In Mauritania, the state has not complied with the MTEF, despite the significant increase in the resources allocated to the health sector. By contrast, in Rwanda, there has been a significant improvement in health indicators as a result of the harmonious development of the HSSP and the related MTEF and compliance with the budget. These challenges require an extensive use of RBM through improved governance in the health sector and capacity building.

[Female genital mutilation and complications in childbirth in the province of Gourma (Burkina Faso)]. / Mutilation génitale fémminine et complications de l'accouchement dans la province de Gourma (Burkina Faso).

In order strengthen activities against female genital mutilation (FGM), this study aimed to assess the prevalence of childbirth complications due to FGM in the province of Gourma, Burkina Faso. The cross-sectional study was both descriptive and analytical; it was conducted between June 15 and August 15, 2007. The sampling was comprehensive, incorporating all of the women who gave birth in the four maternity wards in Fada Ngourma, the provincial capital. The survey included an interview, clinical examination and document analysis of archives and records. The 354 respondents were younger than 25 years-old in 58% of the cases, and 78% of all women participating were illiterate. FGM was Type I, II or III for 28%, 28% and 3% for them respectively. Obstructed labor occurred in 29% of the cases, and a caesarean section was preformed in 7% of the cases. Of all the normal vaginal deliveries, 24% required episiotomies, 18% experienced obstetric Hemorrhaging, 20% had uterine retroversion and 3% needed blood transfusions. Among the newborns, 5% were resuscitated and 4% were stillbirths. The existence of FGM has statistically increased the proportion of dystocia (OR = 11.5), cesarean section (OR = 17.6), episiotomy (OR = 64), perineal tears (OR = 10, 2), postpartum hemorrhage (OR = 13.0), retroverted uterus (OR = 14.7), blood transfusions (OR = 8.0) and stillbirths (OR = 10.2). Women with FGM Type 2 and 3 were more prone to dystocia and obstructed labor (OR = 5.7) and cesarean delivery (OR = 5.2) than those with FGM Type 1. FGM constitutes an important risk factor for complications during childbirth. It should be eradicated for good health of the mother, newborn and child in Burkina Faso.

[Factors related to failure to complete immunization of children aged 10-23 months in Ndoulo (Senegal)]. / Facteurs d'abandon de la vaccination des enfants âgés de 10 à 23 mois à Ndoulo (Sénégal).

INTRODUCTION: Avoidable diseases cause more than two million deaths worldwide every year. In sub-Saharan Africa, only half of all children receive their complete vaccine series. In Senegal, an expanded program of immunization began as a pilot program in 1979 and was generalised in 1985. Nonetheless poor population adherence to child immunization makes it difficult to meet its annual target of 80% per vaccine. This study sought to explore the factors related to failure to complete routine immunization in Ndoulo, in the health district of Diourbel. METHOD: A cross-sectional descriptive and analytical survey was conducted from 16-25 April 2005 among mothers of 562 children aged 10 to 23 months in Ndoulo. RESULTS: Among children who started their vaccine series (with BCG vaccine against tuberculosis), 68.0% received the measles vaccine (the last of the series), 67.1% completed the vaccine series (receiving all required vaccines) but only 19.4% were correctly vaccinated according to the program's vaccination schedule, with the correct number of boosters at the appropriate time. Non-compliance with the immunization schedule was related to parents' lack of time (40.3%), forgetting to return (33.2%), losing the immunization card (10.3%), travels (7.7%), and lack of money (1.1%). Completely vaccinated children were more likely to be male, to have their immunization card available, to have parents aware of the vaccines' side effects and the immunization schedule, and to have their immunization paid for by their father. DISCUSSION: In Ndoulo, health district of Diourbel, adequate immunization coverage is very low because of the high rate of abandonment and poor compliance with vaccination schedules. The predominant factors, especially related to the populations, are negligence. CONCLUSION: Actions such as increasing parental awareness, promoting child sponsorship systems, and requiring immunization records for school enrollment, are needed to address these factors, to improve immunization coverage in Diourbel.

[Public health and the North-South transfer of skills: conditions for an inter-cultural approach]. / Santé publique et transfert de compétences Nord-Sud : les conditions d'une approche inter-culturelle.

The article aims to present critical elements to support inter-cultural reflection based upon a sociological reference framework. This necessitates engagement in a process of exchange that takes local context into account. This approach, using a dynamic relationship of interaction, provides opportunity for re-balancing, adjustment, and monitoring and regulation of the implementation of health promotion programmes. Finally, it also allows for better supervision and driving change for action on the social determinants of health as well as the step by step development of a more equitable ethical core group in health. This approach is based on the validity and relevance of the skills transfer and on the conditions of its implementation.