De nombreuses villes moyennes d’Afrique voient se perenniser ou se developper des activites agricoles intra-urbaines. L’intrication etroite d’espaces « ruraux » et « urbains » pose de nouveaux problemes de sante publique : presence simultanee de pathologies tres diverses, probleme de prise en charge par le systeme de soins, etc. Une approche geographique permet de dresser un premier etat des lieux sanitaire en confrontant les distributions spatiales des facteurs de risque environnementaux, des donnees purement bio-medicales et des indicateurs de fonctionnement du systeme de soins. L’etude de la schistosomiase urinaire illustre la demarche adoptee. Les amenagements crees pour la riziculture favorisent le developpement des populations d’hotes intermediaires de la schistosomiase urinaire. Les groupes de populations et les zones a risques determines dans la ville sont confrontes aux resultats obtenus lors de l’analyse du systeme de soins. Les dispensaires publics diagnostiquent quelques cas a l’echelle de la ville. Une enquete parasitologique ponctuelle, dans deux quartiers, montre des prevalences relativement elevees surtout chez les enfants.
Objectives:In France cervical cancer screening (CCS) by Pap smear can be performed by general practitioners (GPs), andmedical gynecologists. Medical gynecologists manage contraception, cancer screening, menopause, while deliveries andsurgery remain to obstetricians. Women have direct access to gynecologists as primary care practitioners. Our aim was tomeasure GPs’ involvement in CCS and investigate the characteristics of GPs associated with no practice of CCS. Methods:Data came from 3 cross-sectional surveys conducted among representative samples of French GPs in 1998,2002 and 2009 (n = 6213).We conducted univariate and multivariate logistic regressions stratified on GPs’ sex to investi-gate the characteristics (age, solo or group practice, professional network, area of practice...) of the GPs associated withno practice of CCS ever. Results:The proportion of GPs not performing CCS increased from 24.1% to 34.8% over the period (χ2,p<0.0001). Womenperformed CCS increasingly more than men in all three years, from 8.7% more than men up to 17.1%. In multivariate analy-ses, female GPs with unregulated fees were more likely not to perform CCS (2.31, 95% CI: 1.50-3.56) as were male GPsbelonging to no professional network (1.38, 95% CI: 1.15-1.66). Male GPs from the Paris metropolitan area were less likelyto perform CCS until 2002. Conclusions:Less and less GPs engage in CCS when the growing scarcity of medical gynecologists calls for more partic-ipation. Female GPs remain significantly more active in CCS than male GPs. The participation in CCS is determined differ-ently according to the practitioner’s gender.
Although tools to control sleeping sickness do exist, their use is difficult; areas where intervention is most required often cannot be targeted for lack of appropriate risk indicators. The importance of human behaviour and habits in the manifestation of the disease is clear. In the development of effective new approaches to the control of the disease, information must be gathered about human populations, and their interaction with the environment, in rural as well as in urban and peri-urban areas. The results of a study carried out in Daloa show that use of some methods for the development of agricultural land leads to increased human-vector contact and, as a result, increased risk of sleeping sickness. Such land-management methods may therefore be useful as risk indicators for transmission. Transmission does not occur in the town of Daloa itself but in surrounding areas under cultivation. The use of the epidemiological risk index seems to be inappropriate in urban (and perhaps peri-urban) areas. The results emphasise not only the importance of environmental and demographic data in elucidating the epidemiology of human trypanosomiasis but also the need for further investigations in peri-urban areas.
