A public health e-learning master's programme with a focus on health workforce development targeting francophone Africa: the University of Geneva experience.

BACKGROUND: Shortage of a competent public health workforce is as a worldwide problem. The situation is especially bad in sub-Saharan Africa. In 2008, the World Health Organization and the Global Health Workforce Alliance launched a call for proposals for a public health training programme with an emphasis on health workforce development specifically targeting Africa. Our article presents the development, implementation and evaluation of an e-learning Master of Advanced Studies in Public Health on Workforce Development. The project was developed in collaboration with academic partner institutions of 10 French-speaking African countries and local/regional/HQ WHO offices. METHODS: A five-step approach was adopted. First, a needs assessment study was done in the target countries, with identification of priority health issues. Second, student and tutor selection was done in collaboration with local WHO offices, health authorities and partner universities. Third, the e-platform was developed and a training workshop for tutors was organized. Fourth, the learning objectives were derived from the needs assessment study and an interactive educational approach was adopted. Fifth, the participation of students, their perception of the programme, their performance on assignments and community outcomes were monitored. RESULTS: The needs assessment allowed the identification of 12 priority health issues (trauma related to road accidents, maternal and child health, HIV/AIDS, mental heath, food and malnutrition, health resource management, infectious diseases, access to essential drugs, chronic diseases, health promotion, ageing and violence/conflicts) of which 10 were studied through the lens of the key public health disciplines (epidemiology, human resources, health project/service planning, health policy, communication, health economics/management, informatics and ethics/human rights), each validated through a certifying examination. Student participation, measured through connection hits (total: 58 256; mean: 168/student/module) and posted messages (total: 5994; mean: 18/student/module), was good, and global satisfaction was high (7.7/10). Twenty-nine students out of 37 obtained their master's degree from the University of Geneva. Outcomes reported include career development, strengthening of inter-country networks and common projects. CONCLUSIONS: Keys to the success of the programme were the enthusiasm and commitment of students, the availability of the coordination team, the simplicity of the electronic platform and the support of local/regional/WHO offices. Yet, the sustainability of the programme is not assured.

[International Health Electives in developing countries for medical and nursing students: four experiences from French-speaking Switzerland]. / Stages dans des pays en développement au cours des etudes de médecine. Eléments de littérature et réflexions basées sur quatre expériences en Suisse romande.

International Health Electives performed in developing countries by students of medical and nursing schools from industrialized nations have recently become a highly valued element in curricula of medical and nursing schools. We report here four examples of such electives developed over the years at the Faculties of medicine of Geneva and Lausanne, one involving both medical and nursing school students. These electives foster enthusiasm and commitment among students and host institutions abroad. A selective review of the literature highlights the many positive aspects of such electives for the professional and personal development of students. It also emphasizes what the host institutions can gain from these electives provided the latter are organized in a balanced partnership and that the students receive a careful preparation to avoid possible pitfalls.

[School-detected child abuse in Geneva: outlook on the past 10 years]. / Maltraitance repérée dans le cadre scolaire a Genéve: regard sur ces dix dernières années.

The Child and youth health service of the Canton of Geneva is an important actor in support of abused children attending school. Incidence of child abuse is stable at around 3.5 per 1,000 school children. Physical, psychological abuse and neglect are the types most frequently encountered. The main risk factors for abuse are precarious socio-economic situations, parenting issues and finally issues related to young people themselves. Although the incidence of abuse is stable in recent years, with respect to the growing number of children attending school, we can conclude that the absolute number of children at risk increases, confirming the need to develop and maintain common policies and prevention actions in this area.

Health workforce development: a needs assessment study in French speaking African countries.

In 2006, WHO alerted the world to a global health workforce crisis, demonstrated through critical shortages of health workers, primarily in Sub-Saharan Africa (WHO in World Health Report, 2006). The objective of our study was to assess, in a participative way, the educational needs for public health and health workforce development among potential trainees and training institutions in nine French-speaking African countries. A needs assessment was conducted in the target countries according to four approaches: (1) Review at national level of health challenges. (2) Semi-directed interviews with heads of relevant training institutions. (3) Focus group discussions with key-informants. (4) A questionnaire-based study targeting health professionals identified as potential trainees. A needs assessment showed important public health challenges in the field of health workforce development among the target countries (e.g. unequal HRH distribution in the country, ageing of HRH, lack of adequate training). It also showed a demand for education and training institutions that are able to offer a training programme in health workforce development, and identified training objectives and core competencies useful to potential employers and future trainees (e.g. leadership, planning/evaluation, management, research skill). In combining various approaches our study was able to show a general demand for health managers who are able to plan, develop and manage a nation's health workforce. It also identified specific competencies that should be developed through an education and training program in public health with a focus on health workforce development.

Alumni evaluation of a community-oriented master of public health program.

Health workforce development is a public health priority for the World Health Organization. Public Health training programs need to be relevant in a public health perspective and efficient in and educational perspective. This implies evaluating the programs: in this regard student's perception might be interesting, or the opinion of external experts, or the experience of alumni. To study the perception of alumni of a master's program in public health in order to reevaluate the goals and objectives of the program, a cross-sectional survey through a self-administered questionnaire among former students that graduated from the Geneva University Master in Public Health program was done. This self-administered questionnaire included closed questions on a Likert five-point scale for regarding the use at work of tools acquired during the course, as well as open questions. Overall the alumni gave a positive evaluation of the course. As strong points were mentioned: networking opportunities, student-centered approach and multi-professional background of the student body. More critically judged were: tutorship, time constraints and costs. As most useful tools in their professional settings alumni mentioned: communication skills, project evaluation competencies and literature search strategies and again networking which in this case seemed to be quite active. Evaluation surveys among alumni allow reevaluation of the program's goals and objectives in the light of their professional needs.

Computer literacy and E-learning perception in Cameroon: the case of Yaounde Faculty of Medicine and Biomedical Sciences.

BACKGROUND: Health science education faces numerous challenges: assimilation of knowledge, management of increasing numbers of learners or changes in educational models and methodologies. With the emergence of e-learning, the use of information and communication technologies (ICT) and Internet to improve teaching and learning in health science training institutions has become a crucial issue for low and middle income countries, including sub-Saharan Africa. In this perspective, the Faculty of Medicine and Biomedical Sciences (FMBS) of Yaoundé has played a pioneering role in Cameroon in making significant efforts to improve students' and lecturers' access to computers and to Internet on its campus.The objective is to investigate how computer literacy and the perception towards e-learning and its potential could contribute to the learning and teaching process within the FMBS academic community. METHOD: A cross-sectional survey was carried out among students, residents and lecturers. The data was gathered through a written questionnaire distributed at FMBS campus and analysed with routine statistical software. RESULTS: 307 participants answered the questionnaire: 218 students, 57 residents and 32 lecturers. Results show that most students, residents and lecturers have access to computers and Internet, although students' access is mainly at home for computers and at cyber cafés for Internet. Most of the participants have a fairly good mastery of ICT. However, some basic rules of good practices concerning the use of ICT in the health domain were still not well known. Google is the most frequently used engine to retrieve health literature for all participants; only 7% of students and 16% of residents have heard about Medical Subject Headings (MeSH).The potential of e-learning in the improvement of teaching and learning still remains insufficiently exploited. About two thirds of the students are not familiar with the concept of e-leaning. 84% of students and 58% of residents had never had access to e-learning resources. However, most of the participants perceive the potential of e-learning for learning and teaching, and are in favour of its development at the FMBS. CONCLUSION: The strong interest revealed by the study participants to adopt and follow-up the development of e-learning, opens new perspectives to a faculty like the FMBS, located in a country with limited resources. However, the success of its development will depend on different factors: the definition of an e-learning strategy, the implementation of concrete measures and the adoption of a more active and participative pedagogy.

[Community immersion program at Geneva medical school: a fifteen-year experience]. / Immersion en communauté au cours des etudes de médecine a Genève: un bilan a quinze ans.

Over the past decades there have been many new developments in medical education due to new public health challenges and to new learning theories. Medical schools throughout the world have adapted to these challenges in adopting community-based learning activities, an approach that the World Health Organization has promoted. The aim of the present article is to describe the characteristics, as well as the evolution, of such a community-based training program which has been implemented over 15 years at the Faculty of medicine of the University of Geneva and to present some evaluation data addressing students' perception, achievement of learning objectives as well as interactions between students and the community.

Artificial Intelligence and Human Rights: Are There Signs of an Emerging Discipline? A Systematic Review.

AIM: Our systematic review seeks to understand the linkages and reciprocal relationships between the artificial intelligence (AI) and human rights (HRs) and to unveil the signs of emergence of a new discipline at the crossroads of these two disciplines. BACKGROUND: AI and HRs have evolved in parallel as two fields, with AI technology engineers eventually interested in the consequences of their products on HRs, while more recently HRs experts have been exploring the benefits and threats of AI technologies on the protection and promotion of HRs. METHODS: A broad range of databases within the fields of legal sciences, social sciences, health-care sciences and the more general sciences practitioner base "Web of Science" were explored. Articles were selected according to strict inclusion/exclusion criteria and systematically analyzed regarding their content and authorship. RESULTS: The crossroad between AI and HRs is a dynamic field where researchers from different disciplines have been exploring issues such as autonomous lethal weapons, privacy protection, discriminatory decision-making in the insurance and finance systems, intellectual property, and legal personality of the robots. Signs of the emergence of a new discipline were identified. CONCLUSION: Identifying appropriate strategies to consolidate this emerging discipline seems necessary: one could be the development of academic programs at the crossroad of these two fields.

Health and human rights: epistemological status and perspectives of development.

The health and human rights movement (HHR) shows obvious signs of maturation both internally and externally. Yet there are still many questions to be addressed. These issues include the movement's epistemological status and its perspectives of development. This paper discusses critically the conditions of emergence of HHR, its identity, its dominant schools of thought, its epistemological postures and its methodological issues. Our analysis shows that: (a) the epistemological status of HHR is ambiguous; (b) its identity is uncertain in the absence of a validated definition: is it an action movement, an interdisciplinary field, a domain, an approach, a setting or a scientific discipline? (c) its main schools of thoughts are defined as "advocacists", "ethicists", "interventionists", "normativists"; (d) the movement is in the maturation process as a discipline in which "interface", "distance", "interference" and "fusion" epistemological postures represent the fundamental steps; (e) parent disciplines (health sciences and law) competences, logics and cultures introduce duality and difficulties in knowledge production, validation and diffusion; (f) there is need to re-write the history of the HHR movement by inscribing it not only into the humanitarian or public health perspectives but also into the evolution of sciences and its social, political and economical conditions of emergence. The ambiguous epistemological status of this field, the need to re-write its history, the methodological duality in its research, the question of the competence of the knowledge validation, as well as the impact of HHR practice on national and international health governance are the challenges of its future development. To meet those challenges; we call for the creation and implementation of an international research agenda, the exploration of new research topics and the evaluation of the movement's contribution to the national and global public health and human rights governance.

Morphinofobia: the situation among the general population and health care professionals in North-Eastern Portugal.

BACKGROUND: Morphinofobia among the general population (GP) and among health care professionals (HP) is not without danger for the patients: it may lead to the inappropriate management of debilitating pain. The aim of our study was to explore among GP and HP the representation and attitudes concerning the use of morphine in health care. METHODS: A cross-sectional study was done among 412 HP (physicians and nurses) of the 4 hospitals and 10 community health centers of Beira Interior (Portugal)and among 193 persons of the GP randomly selected in public places. Opinions were collected through a translated self-administered questionnaire. RESULTS: A significant difference of opinion exists among GP and HP about the use of morphine. The word morphine first suggests drug to GP (36,2%) and analgesia to HP (32,9%.). The reasons for not using morphine most frequently cited are: for GP morphine use means advanced disease (56%), risk of addiction (50%), legal requirements (49,7%); for HP it means legal risks (56,3%) and adverse side effects of morphine such as somnolence - sedation (30,5%) The socio-demographic situation was correlated with the opinions about the use of morphine. CONCLUSIONS: False beliefs about the use of morphine exist among the studied groups. There seems to be a need for developing information campaigns on pain management and the use of morphine targeting. Better training and more information of HP might also be needed.

Developing a health and human rights training program for french speaking Africa: lessons learned, from needs assessment to a pilot program.

BACKGROUND: The importance of human rights education has widely been recognized as one of the strategies for their protection and promotion of health. Yet training programs have not always taken into account neither local needs, nor public health relevance, nor pedagogical efficacy.The objectives of our study were to assess, in a participative way, educational needs in the field of health and human rights among potential trainees in six French-speaking African countries and to test the feasibility of a training program through a pilot test. Ultimately the project aims to implement a health and human rights training program most appropriate to the African context. METHODS: Needs assessment was done according to four approaches: Revue of available data on health and human rights in the targeted countries; Country visits by one of the authors meeting key institutions; Focus group discussions with key-informants in each country; A questionnaire-based study targeting health professionals and human rights activists.Pilot training program: an interactive e-learning pilot program was developed integrating training needs expressed by partner institutions and potential trainees. RESULTS: Needs assessment showed high public health and human rights challenges that the target countries have to face. It also showed precise demands of partner institutions in regard to a health and human rights training program. It further allowed defining training objectives and core competencies useful to potential employers and future students as well as specific training contents.A pilot program allowed testing the motivation of students, the feasibility of an interactive educational approach and identifying potential difficulties. CONCLUSION: In combining various approaches our study was able to show that training needs concentrate around tools allowing the identification of basic human rights violations in the health system, the analysis of their causes and coordinated responses through specific intervention projects.

[Pain and conflicts: a comparative approach and implications for end-of-life quality of care]. / Douleurs et conflits : approche comparative et implications pour la qualité de soins en fin de vie.

UNLABELLED: Are conflicts to an organization what pain is to an organism? OBJECTIVES: To explore the similarities and the differences between pain and conflicts in palliative care settings, and to better understand the potential importance of conflicts in end of life quality of care. METHODS: Comparative and reflective methods focusing on how conflicts and pain are taken care of in health structures. RESULTS: Pain and conflicts present numerous similarities such as identity, typology, prevalence, warning function, economic and social costs, denial, occultation and hurdles to appropriate management. Differences also exist regarding pain - there are prevention programs on local and international levels; there are specific research and training programs; and there is also some social visibility. This does not yet exist on a larger scale regarding conflicts. CONCLUSION: Decision makers at clinical and public health levels should probably push to label conflicts as indicators of quality of care and develop appropriate health policy programs.

[Evolution of the immunization coverage of 13 to 14 year-old adolescents in Geneva between four years]. / Evolution à quatre ans de la couverture vaccinale chez les 13-14 ans à Genève.

This study aims to examine changes in immunization coverage for diphtheria, tetanus, whooping cough, polio, measles, mumps, rubella and hepatitis B during the academic calendars of 2003-2004 and 2007-2008 for students aged 13 to 14 years. Data were collected on an annual basis and systematically from the vaccination records 85% of adolescents enrolled in public institutions in Geneva. The immunization coverage increased for diphtheria, tetanus and polio by 2.3, 2.1 and 1.1 points respectively. Vaccination for pertussis (whooping cough) increased from 20.7% in 2003-2004 to 61% in 2007-2008. Vaccinations administered against measles, mumps and rubella increased by nearly 20 points. During this period, the coverage rate for hepatitis B increased by 10.3 points in 5 years. The recommended vaccination coverage rates are not being achieved for any of the vaccines currently being used in Switzerland, with the exception of those for diphtheria and polio.

The Geneva University Global Health and Human Rights Summer School: A 5-Year Intercultural Collaborative Experience.

Education and training in human rights has been set as a priority by the United Nations. Health and human rights are closely related. Training professionals from various backgrounds in human rights might ultimately contribute to improve the health of individuals and communities. We present the 5 years' experience with a 3-week residential Global Health and Human Rights Course developed at the University of Geneva and implemented with the support/participation of international organizations (IOs) and non-governmental organizations active in the health and human rights sector. Over the years, roughly 150 students from 43 nationalities, with many different educational backgrounds, attended the course. The male/female ratio was 1/5. The adopted educational approach was multifold and comprised lectures from academics and experts with field experience, group work, individual case studies, journal clubs, and site visits. Evaluation data show that site visits at IOs were highly appreciated as well as networking opportunities among students, with academics and experts with field experience. The variety of topics discussed was, at times, "too much"; yet, it allowed students to measure the extent of the challenges the field is facing. The adopted active learning approach facilitated the exchange of experiences among students and allowed them to get acquainted with different cultural sensitivities. The Global Health and Human Rights Summer-School of the University of Geneva allowed its participants, coming from all over the world, to identify challenges of the interlinked fields of health and human rights, reflect upon their underlying causes, and imagine possible solutions. Sharing our experience will hopefully help passionate educators around the world to develop similar programs.

Health Priorities in French-Speaking Swiss Cantons.

In Switzerland, the federal authorities, the cantons, and the communes share the responsibility of healthcare, disease prevention and health promotion policies. Yet, the cantons are in most health matters independent in their decisions, thus defining as a matter of fact their own health priorities. We examined and analysed the content of the disease prevention and health promotion plans elaborated during the last decade in six French-speaking cantons with different political contexts and resources, but quite similar population health data, in order to identify the set health priorities. The plans appear significantly inhomogeneous in their structure, scope and priorities. Most of the formal documents are short, in the 16 to 40 pages range. Core values such as equity, solidarity and sustainability are explicitly put forward in 2/6 cantonal plans. Priority health issues shared by all 6 cantons are "physical activity/sedentariness" and "nutrition/food." Mental health is explicitly mentioned in 5 cantonal plans, whereas tobacco and alcohol consumptions are mentioned 4 times. Less attention has been given to topics that appear as major public health challenges at present and in the future in Switzerland, eg, ageing of the population, rise of social inequalities, increase of vulnerable populations. Little attention has also been paid to issues like domestic violence or healthy work environments. Despite some heterogeneity, there is a common base that should make inter-cantonal collaborations possible and coordination with national strategies easily feasible.

Training medical students in health promotion: twenty years of experience at the Faculty of Medicine of the University of Geneva.

Background: In most cases, the work of medical doctors, be they general practitioners or specialists, involves some dimension of health promotion (HP). There is thus ample justification for increasing the awareness of medical students vis-à-vis HP and its relevance for their future practice. Methods: In the context of a major curriculum reform (problem-based learning [PBL]) at the Faculty of Medicine of the University of Geneva in the mid-1990s, several steps were taken to strengthen HP throughout the curriculum and include HP in its key domains as defined by the Ottawa Charter (OC). Results: First, the political dimension of HP was developed in a series of first- and fifth-year lectures and third-year workshops; second, community action was strengthened through a third-year one-month community immersion program; third, the development of personal skills was integrated into second- and third-year PBL cases and into fourth-and fifth-year learning activities in clinical settings as well as second- and third-year HP electives; in terms of reorienting health services, the chosen approach included the development of a HP-specific track in the context of a Certificate of Advanced Studies (CAS) in Community Health and a Master of Advanced Studies(MAS) in Public Health. Furthermore, a supportive intra-university environment was created through a collaborative convention with Health Promotion Switzerland, which is in charge of coordinating HP in Switzerland. Conclusion: In our view, HP teaching for medical students seems all the more relevant given that future medical doctors will have to take care of an increasing number of patients likely to develop chronic non-communicable diseases.

Rape in Armed Conflicts in the Democratic Republic of Congo: A Systematic Review of the Scientific Literature.

We conducted a systematic review of the scientific literature between 1996 and 2013 on rape in war-ridden Eastern Democratic Republic of Congo (DRC) in order to better understand the interest of the scientific community in describing the magnitude and characteristics of the problem. The literature search was conducted in French and English using several databases (Pubmed, PsycInfo, Sapphire, BDSP, Embase, Rero, and Web of Science) with the key words "rape and DRC" combined with several Medical Subject Headings concepts. Our systematic review yielded 2,087 references, among which only 27 are original studies, that is 20 are based on population surveys and the remaining 7 are original data based on case studies and reviews. Ten studies provided prevalence rates of rape victims, 18 provided specific information on the profile of the victims, 10 reported that most of the perpetrators of rape were military personnel, 14 referred to the negligence of the government in protecting victims, and 10 reported a lack of competent health-care facilities. The awareness of rape in conflict-ridden DRC is still limited as reported in the scientific literature: Published scientific papers are scarce. Yet more research would probably help mobilize local authorities and the international community against this basic human rights violation.

[End of life conflicts in palliative care: a systematic review of the literature]. / Conflits et fin de vie dans le contexte des soins palliatifs: une revue systématique de littérature.

To evaluate the extent and the quality of the research related to End of life conflicts in palliative care from 1995 to 2004. Accessible Literature of several electronic data bases (BDSP, Cinhal, Cochrane, Francis, Medline, Psychinfo, Saphir, Scopus and Web of science) as well as the grey literature. Studies published in French and English between 1995 and 2004 reporting end of life conflicts, tensions, disagreements, disputes in the context of palliative care. One hundred and two studies were included (87.2% published in English, 12.8% in French). Study designs include revues 27.4%), cross-sections 18.6% and case studies 18.6%. Reported conflicts are related to ethical issues 26.2%, to care 19.1%, to tensions between professionals and patients or families 11.1%, to team experiences 9%. Six studies 5.8% give prevalence figures of conflicts. Half of the studies 51.3% identify possible causes of conflicts: communication issues, euthanasia and suicide assistance demands, autonomy of patients, non respect of advance directives, cultural differences. Ten studies 9.8% identify specifically some effects of the conflicts: moral distress of patients; stress, burn out and guilt of health professionals; lack of trust between doctors and patients or families. Conflicts are mainly resolved through mediation and ethical discussions. Research data on end of life conflicts is scarce at all levels (quantity, quality, methods, social impact, and epistemology). A better understanding of end of life conflict might foster a more adequate management of difficult situations and ultimately a more peaceful death of patients, mourning of families and every day work of health professionals

[End of life conflicts: perceptions of health professionals in French speaking Valais]. / Conflits en fin de vie: perceptions des professionnels de santé en valais romand.

The aim of the study was to identify the perception health professionals in palliative care had of end of life conflicts. The nature of t he conflicts,their prevalence, intensity, causes andeffects were specially addressed. Furthermore proposals of possible solutions of conflicts were investigated. A cross-sectional study was done through a self-administered questionnaire among 460 health professionals in the French Speaking Valais. The health professionals worked either in acute care hospitals, chronic health institutions, and old people nursing homes or in ambulatory palliative care units. Among the target population 233 persons replied to the questionnaire (50.6%). Among the respondents 82.4% reported to be confronted to end of life conflicts. Conflicts were quite rare (66%) and of medium or high intensity (86%). Conflicts were of medical nature (74%) or related to ethic issues (64%). Conflicts occurred among family members (68%), medical doctors and nurses (49%) or patients et medical staff (16%). Conflicts were due mainly (50-60%) to lack of communication, ambivalence among parties, differences in value systems. Mentioned (50-60%) consequences of conflicts were the waste of resources, the physical and the psychological burnout. Possible identified solutions to conflicts were interdisciplinary seminars, internal supervision procedure and the sharing of experiences. Neither age, nor gender, professional experience, working par place, training were predictive of exposure toconflicts. End of life conflicts are a common reality. They may compromise the quality of care and may contribute to high economic and social costs. They should be put on the public health agenda as a high priority.

Female genital mutilation: a systematic review of research on its economic and social impacts across four decades.

BACKGROUND: Global efforts to end female genital mutilation (FGM) have intensified in recent decades because of the rising awareness that such a practice is an act of extreme violence against women and girls. Articles on FGM have been published highlighting the combined efforts of international and non-governmental organizations, governments, as well as religious and civil society groups to end the practice. However, the consequences of this research are not well known, and it seems that the socioeconomic aspects of the practice are underreported. OBJECTIVE: This review aims to characterize over a 40-year period the scientific output on the consequences of FGM in African countries, the most affected region known for the high prevalence of FGM, and review data on the socioeconomic consequences of the practice. DESIGN: A systematic review of literature was done, looking at the following databases: PubMed, Embase, CINAHL, BDSP, Web of Science, PsycINFO, FRANCIS, Sociological Abstracts, WHOLIS, RERO, and SAPHIR. The analysis was limited to articles concerning the African continent, published in English and French, from January 1, 1972, to December 31, 2011. RESULTS: One hundred ninety-eight articles were reviewed. More than half of the articles were published during the last decade of the study period. The majority of papers were published in biomedical journals (64.1%). Most studies looked at Africa as a region (33.3%). Nigeria was the single country most investigated (19.2%), followed by Egypt (10.6%). Most first authors were affiliated to non-African countries (60.6%): among them 21.2% were US-based, 4% were from African institutions, and 16.2% from Nigeria.The medical and psychological consequences (51.5%) and the prevalence and ethics of the practice (34.4%) were the most frequently investigated topics. The socioeconomic consequences were addressed in a minority of the papers (14.1%): they were classified into direct economic consequences (2.5%), school attendance (1%), marriageability (2%), sexual and marital consequences (3.5%), fertility (2.5%), domestic violence (1%), and discrimination (1.5%). CONCLUSIONS: The publication of articles on the consequences of FGM is increasing, but there is little research on the socioeconomic consequences of the practice. More scientific data focusing on this dimension is necessary to strengthen prevention, advocacy, and intervention campaigns.