Highly precarious general and sexual health conditions of young domestic servants: results from a qualitative exploratory study and perspectives for community-based research in Bamako, Mali.

Most domestic servants (DS) in Mali are very young female migrants living in precarious conditions. We aimed to understand their living and working conditions in relation to their general and sexual health. Seven focus groups (53 participants) were conducted by the DS community-based organization ADDAD. Narratives were thematically analyzed using an inductive method. The dominant emerging theme was DS' strong dependence on their employers. Employers' attitudes regarding DS workload, the provision of food, water and hygiene products, housing conditions, and healthcare cover, appeared decisive for DS' physical and mental health, and the type of healthcare they used (self-medication, traditional care, healthcare facilities). Psychological, physical and sexual violence in employers' households was frequent. HIV/STI prevention knowledge was poor. These results highlight the serious risks for DS in terms of HIV/STI and unwanted pregnancies. DS were interested in receiving healthcare from ADDAD; this was motivated by the organization's trusting and understanding community-based environment, and DS' fear of discrimination in healthcare facilities. This study highlights the relevance of tackling the defense of rights and sexual health promotion for DS at the community level. Its findings can help identify research questions to evaluate the extent to which DS constitute a key HIV population.

Implementing community-based health program in conflict settings: documenting experiences from the Central African Republic and South Sudan.

BACKGROUND: The delivery of quality healthcare for women and children in conflict-affected settings remains a challenge that cannot be mitigated unless global health policymakers and implementers find an effective modality in these contexts. The International Committee of the Red Cross (ICRC) and the Canadian Red Cross (CRC) used an integrated public health approach to pilot a program for delivering community-based health services in the Central African Republic (CAR) and South Sudan in partnership with National Red Cross Societies in both countries. This study explored the feasibility, barriers, and strategies for context-specific agile programming in armed conflict affected settings. METHODS: A qualitative study design with key informant interviews and focus group discussions using purposive sampling was used for this study. Focus groups with community health workers/volunteers, community elders, men, women, and adolescents in the community and key informant interviews with program implementers were conducted in CAR and South Sudan. Data were analyzed by two independent researchers using a content analysis approach. RESULTS: In total, 15 focus groups and 16 key informant interviews were conducted, and a total of 169 people participated in the study. The feasibility of service delivery in armed conflict settings depends on well-defined and clear messaging, community inclusiveness and a localized plan for delivery of services. Security and knowledge gaps, including language barriers and gaps in literacy negatively impacted service delivery. Empowering women and adolescents and providing context-specific resources can mitigate some barriers. Community engagement, collaboration and negotiating safe passage, comprehensive delivery of services and continued training were key strategies identified for agile programming in conflict settings. CONCLUSION: Using an integrative community-based approach to health service delivery in CAR and South Sudan is feasible for humanitarian organizations operating in conflict-affected areas. For agile, and responsive implementation of health services in conflict-affected settings, decision-makers should focus on effectively engaging communities, bridge inequities through the engagement of vulnerable groups, collaborate and negotiate for safe passage for delivery of services, keep logistical and resource constraints in consideration and contextualize service delivery with the support of local actors.

[Profile of non-traumatic osteoarticular diseases in elderly black Africans: about 157 cases seen in Abidjan]. / Profil des affections ostéoarticulaires des sujets ages noirs africains : A propos de 157 cas vus à Abidjan.

BACKGROUND: The aging of the world population is a phenomenon that is growing progressively. Specific knowledge of osteoarticular disorders in the elderly in black Africa seems limited. AIM: Describe the epidemiological, clinical and etiological characteristics of non-traumatic osteoarticular disorders in elderly black Africans. METHODS: Retrospective and descriptive study concerning black africans patients aged 60 years and over hospitalized in the department of Rheumatology of hospital center of Cocody (Abidjan) in a period of 7 years from January 2000 to December 2007. Were included, 157 records of black africans patients, suffering from a osteoarticular disorder non traumatic with an accurate diagnosis. A structured questionnaire was used to gather epidemiological, clinical and etiological characteristics. RESULTS: The prevalence of elders was 5% of all patients seen in the period of study. The average age was 67 years with the predominance of women (59,7%) and sex-ratio was 0,68. Housewives were predominant (40,6%). The reason for hospitalization was a pain from spine (85,8%) dominated by common low back pain (84,4%). Fever (51,9%) and impaired general health (53.4%) were dominant extraarticular signs. The main etiologies were degenerative (50.5%) with a predominance of common low back pain (38.2%), followed by bacterial osteitis and/or bacterial arthritis (20.5%) and malignancies (hematologic malignancies and metastasis of cancer) in 15.9% of cases. Degenerative pathology was significantly observed in females (p=0.004). CONCLUSION: Non-traumatic osteoarticular diseases in elderly black africans are little frequent in Abidjan and are dominated by degenerative diseases of spine.