[Challenges in accessing treatment for chronic hepatitis B in Madagascar : A qualitative study of caregivers and patients]. / Enjeux et difficultés de l'accès aux traitements pour la prise en charge de l'hépatite B chronique à Madagascar : étude qualitative auprès des soignants et personnes atteintes.

OBJECTIVES: Madagascar faces many difficulties in accessing diagnosis and treatment of hepatitis B. The prevalence of chronic hepatitis B infection is estimated at 6.9%. The costs associated with screening and treatment are high and not easily accessible. This article proposes a reflection on the challenges and difficulties of access to diagnosis and treatment for patients with chronic hepatitis B. METHOD: The "Neo Vac" study aimed to document the life paths of people living with chronic hepatitis B, their difficulties and their perceptions of HBV. Twenty-three semi-structured interviews were conducted in 2019 in Antananarivo with patients and gastroenterologists. RESULTS: The study describes the numerous obstacles that mark the therapeutic pathways of chronic HBV patients. The first result indicates lack of knowledge of the disease by chronic HBV patients and the varied circumstances in which the disease is discovered. None of the persons interviewed had been screened on their own initiative, the screening having taken place during prenatal consultations or emergency hospitalizations or during a morbidity episode. The care pathway was characterized by doubt and anxiety due to lack of knowledge about the possible disease outcome and concern about the costs of care. DISCUSSION: Little known by the population and health professionals, hepatitis B is rarely the subject of voluntary screening and is most often detected during an apparently unrelated health event. The exorbitant cost of treatment for patients, the cost of medical analyses and secondary costs, and the unavailability of follow-up tests outside the capital constitute barriers to access to care that are insurmountable for the majority of the Malagasy population. CONCLUSIONS: This first qualitative study on the experiences of HBV-infected persons in terms of access to care and treatment in Madagascar underlines the extent to which access to treatment remains limited, due to the absence of a national policy for the prevention, screening and management of hepatitis B, which remains a highly neglected and unrecognized disease in Madagascar as well as internationally.

Entomology in translation: interpreting French medical entomological knowledge in colonial Mali.

This essay examines how knowledge and practices around entomology and parasitology travelled and the consequences of their mobility. In exploring three anti-malaria campaigns in French Soudan before 1960, it argues that the history of medical entomology's travels entailed multiple temporal, spatial, social translations that African medical personnel, intellectuals, healers, and farmers in French Soudan reinterpreted, appropriated, and sometimes wholly rejected. This essay also focuses on "erroneous" translations, detailing how and why middle class medical personnel and intellectuals interpreted and reformulated farmers' and healers' diagnostic categories that may or may not be malaria. Anti-mosquito and antilarval interventions, and more generally anti-malaria interventions, influenced how African colonial subjects and health workers understood certain vectors and of certain maladies. These understandings, in turn, shaped the consequences of subsequent public health measures. Histories of translated parasitological and entomological knowledge and etiologies of illness have critical implications for contemporary malaria control efforts: interventions to reduce malaria transmission through various kinds of entomological controls that require active participation of local populations cannot be effective if all participants cannot agree upon what is being controlled or prevented.