Health, illness and cancer in Mayotte: Multicultural experiences in a medically underserved French Territory.

The island of Mayotte is part of the French territory and one of the European Union's Outermost Regions but there is a significant lack of data and research on health and cancers in Mayotte. This article reviews the literature on health, disease and cancer in Mayotte, from the perspectives of social science and epidemiology. It starts by shedding light on the specificities of Mahoran demography and society, and shows the healthcare infrastructure is insufficient to meet the population's needs. It then reviews social science studies on health and illness in Mayotte and shows that the political issue of migration permeates the management and the experiences of health on the island. It ends with a focus on the epidemiology of cervical cancer and a review of the available data on screening, treatment and prevention. The article concludes with a quick review of ongoing research and urgently calls for more data and research on this critical public health issue.

[Reality of healthcare access for migrant children in Mayotte]. / La réalité de l'accès aux soins des enfants de migrants à Mayotte.

The implementation of the social security system in 2005 in Mayotte has resulted in the end of free healthcare for all non-affiliated residents, primarily Comorians, due to the absence of the State Medical Aid (AME) in this department. Doctors of the World France opened a paediatric clinic in December 2009. The sociomedical data were collected during 5286 consultations in 2010. Analysis of these data demonstrates a link between access to healthcare for children and the residential status of their parents. The analysis concerns 2,350 patients met during consultations held by Doctors of the World France in Mayotte in 2010. The data have been electronically recorded and analysed by the Sphinx software. The results show that there are several obstacles to healthcare resulting in non-attendance. This situation is made worse if one of the parents has an irregular residential status and all the more so if both the parents have an irregular status. Affiliation to the social security system, however, improves the situation. The results show a delay in accessing healthcare, a poor vaccination programme and disturbing data on severe acute malnutrition. The specific healthcare measures in Mayotte do not respect the International Convention on the Rights of the Child. Direct affiliation to the social security system for children would entail a reduction in health insecurity for the children of parents with irregular residential status. It would also be necessary to reduce the factors that provoke fear of displacement, which would facilitate physical access to consultations.

Improving minority blood donation: anthropologic approach in a migrant community.

BACKGROUND: As a result of blood group polymorphism, distinctive blood types have evolved in populations around the world. In countries with large migrant populations, finding rare blood types for transfusion can be challenging. This is especially true for sub-Saharan African immigrants living in countries with predominantly European populations. This problem is further compounded by hereditary disorders such as sickle cell disease and by traditional cultural values that discourage routine donation. STUDY DESIGN AND METHODS: The purpose of this report is to describe the drive to recruit more safe rare blood type donors in a Comorian immigrant community living in Marseilles, France. With a culturally adapted message developed on an anthropologic approach and working in close collaboration with scientific and medical members of the Comorian community, it is proposed that this population be sensitized with the gift of blood. RESULTS: Targeted collection of specific sub-Saharan African blood types was achieved. Taking into account the high rate of infectious markers among products collected in this targeted collection, however, it was decided to promote blood donation in this minority by addressing people directly toward our principal blood center site. Since setup of this adapted communication, regular donors present themselves spontaneously without community pressure. Infectious markers rate is then equal to general blood donor population's rate. CONCLUSION: The results of this drive demonstrate the utility of an anthropologic approach and cultural mediation in identifying donors with specific blood types in migrant communities and recruiting second-generation donors. The techniques described in this study could also be applied to collection of other tissues including organs and peripheral blood progenitor cells in minorities.

[Perceived health and migration: a new sanitary approach?]. / Santé perçue et migration : une nouvelle approche pour l'intégration sanitaire ?

BACKGROUND: Six percent of the French population is foreign. Paradoxically, there are in France few recent data about the health of these communities. Because a lot of different foreign communities are living in Marseille, it seemed important for us to examine the health of one of these populations. The difficulties encountered in studying the health status in the general population allow us to propose a measure based on perceived health opinion. Our first objective was to state that perceived health status of one community differs between its original country and its emigration country, taking into account the level of morbidity. Our second objective was to show that the perceived health status in the emigration population was close to the one observed in France. METHODS: Two cross-sectional studies were performed in the Comoro Islands and in Marseille, a French south eastern city. The perceived health was assessed with the Duke Health Profile (DHP); the objective health was assessed by a specific questionnaire developed in the USA: the Ridit. The comparisons were conducted, taking into account the major confounding factors. RESULTS: Emigrated people relate higher perceived health status, than those living in the Comoro Islands, for the main dimensions assessed by DHP: physical (71.0 +/- 23.8 vs. 55.9 +/- 23.0), mental (74.6 +/- 19.3 vs. 50.0 +/- 18.5), general health (68.3 +/- 16.3 vs. 61.4 +/- 12.7) and perceived health (62.7 +/- 32.9 vs. 57.1 +/- 48.2). Social health score is the only one which is lower (59.2 +/- 21.8 vs. 77.6 +/- 18.3). The health status levels of the emigrated people are close to those reported in France. The variations of perceived health scores are coherent with those of the objective health indicators. CONCLUSIONS: If these results were confirmed, then this approach, based on self perceived health assessment, could be recommended to study health needs, and the management care, prevention and health promotion impact among these specific communities.