[Preparedness for influenza A/H5N1 pandemic in Niger: a study on health care workers' knowledge and global organization of health activities]. / Pandémie grippale A/H5N1 et niveau de préparation du Niger: une étude sur les connaissances des soignants et l'organisation générale des soins.

In industrialized countries, the emergence of potentially pandemic influenza virus has invited reactions consistent with the potential threat represented by these infectious agents. However, with globalization, controlling epidemics depends as much on an effective global coordination of control methods as on preparedness of northern and southern national health care systems, at the core of which are health care workers. Our study was conducted in the National Hospital of Niamey, the main Nigerian hospital. Its objective was to evaluate the knowledge of health care professionals regarding flu pandemic and control of infection. We interviewed 178 nursing staff, doctors and paramedics on the basis of a survey. This study - the first to our knowledge to explore these issues in the African context-revealed that caregivers have a rather good mastery of theoretical knowledge. Nevertheless, beyond theoretical knowledge, miscellaneous factors compromise the effectiveness of the health care structure. Some of them seem to occupy a critical position, particularly the absence of shared references among sanitary authorities and health care professionals, and the weaknesses of global coordination of preventive activities and case management.

[Anthropological analysis of interactions between health care providers and children in some paediatrics services in Western Africa (Abidjan, Bamako, Conakry)]. / Analyse anthropologique des interactions entre soignants et enfants dans quelques services de pédiatrie d'Afrique de l'Ouest (Abidjan, Bamako, Conakry).

Africa represents a major part of infant global mortality. But if the medical causes of these deaths are well-known, the quality of the medical care provided to the children and the way it affects them are not really studied. Our study conducted in three countries of western Africa describes how much the care given to children involves a part of violence and emphasizes how the social status and the children educational popular modes influence the quality of care. The article underlines how the improvement of the quality of care in pediatrics services cannot be limited to a simple improvement of techniques but must also include all these socio-emotional aspects which constitute the foundations of real ethics.

[When health makes the headlines. Press, elite complicities and health globalisation in Bamako, Mali]. / Quand la santé fait l'article. Presse, connivences élitaires et globalisation sanitaire à Bamako, Mali.

To overcome the socio-medical failures observed in Africa's health services, researchers and practitioners of public health often mention the necessity to resort to counter-powers. But, what are precisely these counter-powers? To analyse the problem, we describe the treatment of health issues in the Bamako press during one year. The analysis of various processes (external references, lack of training, insufficient deontological standards, "elite" complicity among journalists and health directors) allows us to underline the complexity of the links between the press and health. The economic flows related to the economy of development "projects" in particular with AIDS, encourage the journalists to see themselves as "educationalists" of populations rather than spokesmen for their claims or difficulties. Two consequences follow. First of all the press counter-power has to be developed in the case one wishes to see it as the expression of "the voice of the voiceless" and a good help to make an "informal" evaluation of the quality of health cares by users. But, more generally within this context of globalisation of health, instead of encouraging the expression of a "popular" criticism, newspapers work out a system of mutual legitimacies and social connivances among local "elites". Far from contributing to the improvement of the health system by looking actively into the problem leading to a modernity under control, health journalism disconnects the discourse from its referent and contributes to discredit "political" language. This journalistic construction of the insignificance is one of the principal political effects of this medical journalism instrumentalized by institutions of development.

[Imported malaria at the Marseilles Hôpital-Nord, France: a prospective study on 352 cases between 2001 and 2003]. / Le paludisme d'importation à l'Hôpital-Nord de Marseille en 2001-2003: étude prospective de 352 cas.

OBJECTIVE: The authors had for aim to study epidemiological, clinical, and parasitological characteristics, as well as regimen received, of imported malaria cases hospitalised at the North University Hospital, in Marseilles, France. DESIGN: The patients presenting with imported malaria included in this study were hospitalised in the infectious and tropical diseases unit and in the pediatrics unit at the North University Hospital, from January 1, 2001 to December 31, 2003. Variables were prospectively collected and recorded. RESULTS: 352 patients including 240 adults and 112 children were included. Most of them (67% of the adults and 92% of the children) were contaminated during a trip to the Comoros Islands. Plasmodium falciparum was the most common species identified. 97.5% of adult and 98% of child patients back from Comoros did not take any chemoprophylaxis against malaria or took inadequate regimens. Halofantrin was the most commonly used drug for children to treat uncomplicated P. falciparum malaria. In adults, atovaquone-proguanil was used as a first line drug in the absence of vomiting, and a 3-day intravenous regimen of quinine-clindamycin in case of vomiting. CONCLUSION: The specificity of imported malaria in Marseilles is the high proportion of Comorian patients who go back home periodically to visit friends and relatives. A better education of the Comorian population in Marseilles, regarding malaria risks and prophylaxis, needs to be implemented.

[Prolegomena to reform of healthcare services: from identification of problems to development of effective tools]. / Prolégomènes à une réforme des services de santé: de l'identification des dysfonctionnements à la définition d'outils efficaces.

Various institutions have developed healthcare programs to cope with the serious epidemiologic situation in many developing counties. Although these programs are indispensable, many are "disconnected" from the social context for which they were developed. Perusal of a few anthropological texts describing problems associated with providing healthcare services in Africa allows identification of the difficulties and modalities of interaction between caregivers and populations and a basis for proposing avenues for reflection about improvement.

[Control of tuberculosis as seen "in the field": popular perceptions of the disease and access to care in Conakry, Guinea]. / La lutte contre la tuberculose vue du "terrain" représentations populaires de la maladie et accès aux soins à Conakry (Guinée).

Tuberculosis is a public health priority especially in developing countries. A variety of control programs have been implemented. The purpose of this survey was to study the perceptions and practices of the victims of this disease "in the field". The findings of this survey carried out in a cohort of 65 patients and their families in Conakry, Guinea underline the importance of popular perceptions of the disease in care-seeking behavior. This survey also shows that health care workers share the same perceptions as the general population, which constitutes a major impediment for screening and treatment.

"La lutte contre la tuberculose vue du ""terrain"" representations populaires de la maladie et acces aux soins a Conakry (Guinee)"

"Tuberculosis is a public health priority especially in developing countries. A variety of control programs have been implemented. The purpose of this survey was to study the perceptions and practices of the victims of this disease ""in the field"". The findings of this survey carried out in a cohort of 65 patients and their families in Conakry; Guinea underline the importance of popular perceptions of the disease in care-seeking behavior. This survey also shows that health care workers share the same perceptions as the general population; which constitutes a major impediment for screening and treatment."

[Contribution of social anthropology to malaria control]. / Les apports de l'anthropologie sociale à la lutte contre le paludisme.

Most countries with endemic malaria have implemented national control programs. However there has been practically no change in the burden caused by malaria in zones of highest transmission, especially in Africa. Development of forms resistant to antimalarial agents suggests that adaptation of the treatment to the disease has not been adequately monitored, that insecticide-impregnated bednets and screens have not been used sufficiently, and that the vertical approach to these problems has destabilized a fragile health care system. Application of social anthropology could help to resolve these problems. The five main areas in which social anthropology could make a positive contribution can be summarized as follows: (1) improving mutual understanding between the population and heath care providers by describing popular systems for interpreting the disease; (2) describing available care services and popular healing practices as a means of understanding the reasoning underlying access to care; (3) analysing the implications of recommended preventive measures for social behavior (e.g. "bed manners") that must take into account the modalities of appropriation of the proposed innovations; (4) improving the relationship between care givers and patients by evaluating local moral perceptions; and (5) reducing the adverse effects of oververticalization of control programs by promoting opportunities for synthesis with projects initiated by community groups and local officials. By undertaking work on these problem areas, preliminary and permanent pluridisciplinary teams could improve the current situation.

[Kirikirimasien (epilepsy) in Mali: etiologic and nosologic dimensions]. / Etude du Kirikirimasien (épilepsie) au Mali: dimensions étiologique et nosographique.

Epilepsy is a chronic, disabling disease. Its incidence in Mali is 15.6 cases per 1000 people which is four to five times higher than in the West. Kirikirimasien is the name of a local bambaran disease entity similar to epilepsy with respect to both manifestations and course. A field study in a rural, bambaran area was performed to ascertain the nosologic nature of kirikirimasien and determine whether it was comparable with epilepsy in the west. Interviews with patients, family, friends, and healers were carried out and analyzed using qualitative investigative techniques, results showed that diagnosis was established on the basis of symptoms as well as underlying etiology. Nosologic information from the descriptions was correlated with contextual data in order to better understand the nature of the disease. To some extent close attention to pathologic signs associated with this disease such as dreaming and running away, revealed the important sociocultural dimension of kirikirimasien. This dimension is further supported by circumlocutions to avoid pronouncing the name of this disease considered as socially unacceptable. In summary, the sociocultural implications of kirikirimasien are evident in both criteria used for diagnosis and language used to describe it.

[Anthropology and cardiology in Niamey (Niger)]. / Anthropologie et cardiologie à Niamey (Niger).

The study concern the folk interpretation of heart disease and describe the meaning of these sickness and illness in zarma ethnic group. This work shows many dissonances between health personnel and patients. In many ways these lacks of understanding are prejudiciable. It incites patients to use popular health system and doesn't permit the patient to understand his disease and his treatment. The study emphasize fact of studying and paying attention closely to popular meaning and interpretation systems. Medical team have to take care of patient's representation. In short, chronic heart disease obliges to include anthropologic data in medical care activity.

Midwives in Niger: an uncomfortable position between social behaviours and health care constraints.

Maternal mortality rates are very high in developing countries. In Niamey, the capital of Niger, maternal mortality rate is 280/100,000, in spite of a high concentration of health services and of health personnel. Several studies demonstrated that the efficiency of maternal health services was low, both because the quality and the quantity of work were insufficient. The usual response to the poor performances of health services in developing countries is mainly technical. If improvement of the training of health personnel and re-organization of health services are necessary, they are not sufficient. A good effectiveness of care cannot be achieved without a mutual confident relationship between providers and patients. Focus group discussions were held in Niamey with women users of maternal health services, with student midwives and experienced midwives. Sources of complaints between providers and patients appeared to be numerous. However, they are centered around two themes, delivery techniques and cultural requirements, which correspond to two types of constraints: technical constraints and social representations and practices of the population. A description of traditional practices and beliefs related to delivery were obtained through discussion groups with old women and traditional birth attendants (TBAs). Both women and midwives are tied up by the same social rules (e.g. linguistic taboos, respect and shame) but technical constraints force midwives to violate those rules, making the application of their technical skills very difficult. Thus, the mutual relationship between users and providers is source of dissatisfaction, which often degenerates into an open confrontation. Midwives must learn how to implement obstetrical techniques within specific cultural environments.

[Importance of socio-cultural data for accessibility of health care and observance of treatment in leprosy. Example of the Zarma region in Niger]. / L'importance des données socio-culturelles pour l'accès aux soins et l'observance des traitements dans la lèpre. L'exemple du pays zarma au Niger.

From an epidemiological point of view leprosy remains a problem of public health. Various factors influence the accessibility to health care and the observance of treatment. The study carried out in Niger shows that beyond the stigmatism associated with the disease, the most important factors concern the difference between scientific and popular etiology and semiology. In the face of such problems it is necessary, from a theoretical point of view, to make anthropological enquiries based on the theme of the different representations of this pathology, and from a practical point of view, to examine the possibility of the participation of former patients in public health teams.

["To be blind", blindness between an epidemiological and a sociological definition]. / "Etre aveugle" la cécité, entre une définition épidémiologique et sociale.

From an epidemiological point of view, blindness refers to a visual acuity inferior to 1/20 in each eye. Though such a definition is necessary for the installation of public health programs, it is insufficient as far as the elaboration of actions aimed at prevention and rehabilitation are concerned. Qualitative data reveal that a similar physical deficiency is lived in various ways according to precise social context. In addition to the physical handicap objectively defended and to its social interpretation, the same must also be analysed in the light of another important linking factor; the individuals' social status and specific task and obligations of various groups in a given population. Considered together, these factors provide a better understanding of the social condition of blind persons, their economic and matrimonial resulting in the conception of appropriate health programs.