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Résumé Kodio (Belco), Etard (Jean-François). - Évolution récente de la mortalité infantile à Bamako, Mali Le suivi de 4 575 enfants nés vivants issus de 4 718 femmes enceintes du quartier de Bankoni à Bamako, a permis d'estimer les différentes composantes de la mortalité infantile. La cohorte s'est constituée en 1989-1992, et la dernière naissance a eu lieu en août 1993. Les quotients de mortalité néonatale, post-néonatale et infantile ont respectivement été estimés à 15, 40 et 55,6 pour 1 000 naissances vivantes. Une analyse de survie a identifié certains prédicteurs indépendants de la mortalité infantile : la gémellité (RR = 5,0 [3,3-7,7]), la primiparité (RR = 1,5 [1,1-2,1]), la durée de résidence dans le quartier inférieure à 5 ans (RR= 1,4 [1,0-1,9]), les enfants nés entre 1991-93 (RR = 1,4 [1,1-1,9]) et pendant la saison chaude ou humide (RR = 1,4 [1,1-1,9]). Un biais de sélection lié à la proportion d'enfants nés vivants mais non revus à la date anniversaire est discuté. Cette estimation de la mortalité infantile, sur une courte et récente période, est inférieure aux estimations antérieures des années quatre-vingt de la ville de Bamako. Elle est cependant équivalente à la mortalité infantile sur la période 1983-1992 en milieu urbain sénégalais, où une forte baisse est observée depuis le milieu des années quatre-vingt. Une estimation récente pour la 3e ville du Mali (Sikasso) fournit des arguments pour une évolution identique à celle de Bamako.

Résumé Pison Gilles, Kodio Belco, Guyavarch Emmanuelle, Etard Jean-François.- La mortalité maternelle en milieu rural au Sénégal Nous avons mesuré la fréquence et les causes de décès maternels dans trois sites ruraux du Sénégal : Bandafassi, Niakhar et Mlomp. Leurs populations font l'objet d'une observation démographique suivie depuis de nombreuses années, en utilisant la même méthode, ce qui rend les résultats comparables. Les trois sites diffèrent selon la proportion de femmes accouchant en maternité -99% à Mlomp, 15% à Niakhar et 3% à Bandafassi-, l'éloignement des hôpitaux pratiquant des césariennes et les facilités pour y évacuer les femmes ayant des difficultés à accoucher. La mortalité maternelle varie de 1 à 2 selon le site : elle est la plus faible à Mlomp (436 décès pour cent mille naissances vivantes), la plus élevée à Bandafassi (826) et intermédiaire à Niakhar (516). Ces variations sont fortement liées aux facilités d'évacuation en urgence des femmes ayant des difficultés à accoucher. En revanche, les conditions d'accouchement, notamment la proportion de ceux qui se déroulent en maternité, ne semblent pas jouer un rôle aussi important qu'on l'imagine. Enfin, l'OMS a estimé la mortalité maternelle pour l'ensemble du Sénégal à 1 200 décès maternels pour 100 000 naissances vivantes en 1990. Notre étude montre qu'à la même période elle était nettement en dessous dans les trois sites, qui se trouvent pourtant en zone rurale. L'OMS a donc sans doute nettement surestimé la mortalité maternelle pour l'ensemble de ce pays.

IntroductionThe antiretroviral therapy (ART) programme supported by Médecins Sans Frontières in the rural Malawian district of Chiradzulu was one of the first in sub‐Saharan Africa to scale up ART delivery in 2002. After more than a decade of continuous involvement, we conducted a population survey to evaluate the cascade of care, including population viral load, in the district.MethodsA cross‐sectional household‐based survey was conducted between February and May 2013. Using a multistage cluster sampling method, we recruited all individuals aged 15 to 59 years living in 4125 randomly selected households. Each consenting individual was interviewed and tested for HIV at home. All participants who tested positive had their CD4 count and viral load measured. The LAg‐Avidity assay was used to distinguish recent from long‐term infections. Viral suppression was defined as a viral load below 1000 copies/mL.ResultsOf 8271 individuals eligible for the study, 7269 agreed to participate and were tested for HIV (94.1% inclusion for women and 80.3% for men). Overall HIV prevalence and incidence were 17.0% (95% CI 16.1 to 17.9) and 0.39 new cases per 100 person‐years (95% CI 0.0 to 0.77), respectively. Coverage at the other steps along the HIV care cascade was as follows: 76.7% (95% CI 74.4 to 79.1) had been previously diagnosed, 71.2% (95% CI 68.6 to 73.6) were under care and 65.8% (95% CI 62.8 to 68.2) were receiving ART. Finally, the proportion of participants who were HIV positive with a viral load ≤1000 copies/mL reached 61.8% (95% CI 59.0 to 64.5).ConclusionsThis study demonstrates that a high level of population viral suppression and low incidence can be achieved in high HIV prevalence and resource‐limited settings.

International audience ; Background: In most health areas, an information system is necessary for an effective fight against COVID-19. Current methods for surveillance of diseases with epidemic potential do not include monitoring the adherence to preventive measures. Furthermore, modern data collection methods depend often on technologies (e.g., cameras or drones) that are hardly available in low-income countries. Simpler solutions could be just as effective. Methods: A dashboard was used over a whole week to monitor preventive measures in Bukavu (DRC) by mid-May 2020. It was designed to collect from street passers-by information on the adherence to barrier measures, the level of awareness of these measures, the opinion on their usefulness, and the health status of people in the households.Results: Creating a dashboard and collecting the necessary data proved feasible. The use of barrier measures was very limited and that of masks practically nil despite repeated recommendations from the health authorities. The end of each day was the worst moment due to clearly insufficient distancing. Barrier measures were significantly more used in areas where they were best known and most acknowledged. At the time of the study, there were few sick people and only rare severe cases were attributed to COVID-19.Conclusions: Creating COVID-19 situation dashboards in limited-resource metropoles is feasible. They give real-time access to data that help fight the epidemic. The findings of this pilot study call for a rapid community awareness actions to back national media-based prevention campaigns.

International audience ; Background: In most health areas, an information system is necessary for an effective fight against COVID-19. Current methods for surveillance of diseases with epidemic potential do not include monitoring the adherence to preventive measures. Furthermore, modern data collection methods depend often on technologies (e.g., cameras or drones) that are hardly available in low-income countries. Simpler solutions could be just as effective. Methods: A dashboard was used over a whole week to monitor preventive measures in Bukavu (DRC) by mid-May 2020. It was designed to collect from street passers-by information on the adherence to barrier measures, the level of awareness of these measures, the opinion on their usefulness, and the health status of people in the households.Results: Creating a dashboard and collecting the necessary data proved feasible. The use of barrier measures was very limited and that of masks practically nil despite repeated recommendations from the health authorities. The end of each day was the worst moment due to clearly insufficient distancing. Barrier measures were significantly more used in areas where they were best known and most acknowledged. At the time of the study, there were few sick people and only rare severe cases were attributed to COVID-19.Conclusions: Creating COVID-19 situation dashboards in limited-resource metropoles is feasible. They give real-time access to data that help fight the epidemic. The findings of this pilot study call for a rapid community awareness actions to back national media-based prevention campaigns.

International audience ; Background: In most health areas, an information system is necessary for an effective fight against COVID-19. Current methods for surveillance of diseases with epidemic potential do not include monitoring the adherence to preventive measures. Furthermore, modern data collection methods depend often on technologies (e.g., cameras or drones) that are hardly available in low-income countries. Simpler solutions could be just as effective. Methods: A dashboard was used over a whole week to monitor preventive measures in Bukavu (DRC) by mid-May 2020. It was designed to collect from street passers-by information on the adherence to barrier measures, the level of awareness of these measures, the opinion on their usefulness, and the health status of people in the households.Results: Creating a dashboard and collecting the necessary data proved feasible. The use of barrier measures was very limited and that of masks practically nil despite repeated recommendations from the health authorities. The end of each day was the worst moment due to clearly insufficient distancing. Barrier measures were significantly more used in areas where they were best known and most acknowledged. At the time of the study, there were few sick people and only rare severe cases were attributed to COVID-19.Conclusions: Creating COVID-19 situation dashboards in limited-resource metropoles is feasible. They give real-time access to data that help fight the epidemic. The findings of this pilot study call for a rapid community awareness actions to back national media-based prevention campaigns.

International audience ; Background: In most health areas, an information system is necessary for an effective fight against COVID-19. Current methods for surveillance of diseases with epidemic potential do not include monitoring the adherence to preventive measures. Furthermore, modern data collection methods depend often on technologies (e.g., cameras or drones) that are hardly available in low-income countries. Simpler solutions could be just as effective. Methods: A dashboard was used over a whole week to monitor preventive measures in Bukavu (DRC) by mid-May 2020. It was designed to collect from street passers-by information on the adherence to barrier measures, the level of awareness of these measures, the opinion on their usefulness, and the health status of people in the households.Results: Creating a dashboard and collecting the necessary data proved feasible. The use of barrier measures was very limited and that of masks practically nil despite repeated recommendations from the health authorities. The end of each day was the worst moment due to clearly insufficient distancing. Barrier measures were significantly more used in areas where they were best known and most acknowledged. At the time of the study, there were few sick people and only rare severe cases were attributed to COVID-19.Conclusions: Creating COVID-19 situation dashboards in limited-resource metropoles is feasible. They give real-time access to data that help fight the epidemic. The findings of this pilot study call for a rapid community awareness actions to back national media-based prevention campaigns.

International audience ; Background: In most health areas, an information system is necessary for an effective fight against COVID-19. Current methods for surveillance of diseases with epidemic potential do not include monitoring the adherence to preventive measures. Furthermore, modern data collection methods depend often on technologies (e.g., cameras or drones) that are hardly available in low-income countries. Simpler solutions could be just as effective. Methods: A dashboard was used over a whole week to monitor preventive measures in Bukavu (DRC) by mid-May 2020. It was designed to collect from street passers-by information on the adherence to barrier measures, the level of awareness of these measures, the opinion on their usefulness, and the health status of people in the households.Results: Creating a dashboard and collecting the necessary data proved feasible. The use of barrier measures was very limited and that of masks practically nil despite repeated recommendations from the health authorities. The end of each day was the worst moment due to clearly insufficient distancing. Barrier measures were significantly more used in areas where they were best known and most acknowledged. At the time of the study, there were few sick people and only rare severe cases were attributed to COVID-19.Conclusions: Creating COVID-19 situation dashboards in limited-resource metropoles is feasible. They give real-time access to data that help fight the epidemic. The findings of this pilot study call for a rapid community awareness actions to back national media-based prevention campaigns.

BACKGROUND: On October, 2020, after the first wave of COVID-19, only 8290 confirmed cases were reported in Kinshasa, Democratic Republic of the Congo, but the real prevalence remains unknown. To guide public health policies, we aimed to describe the prevalence of SARS-CoV-2 IgG antibodies in the general population in Kinshasa. METHODS: We conducted a cross-sectional, household-based serosurvey between October 22, 2020, and November 8, 2020. Participants were interviewed at home and tested for antibodies against SARS-CoV-2 spike and nucleocapsid proteins in a Luminex based assay. A positive serology was defined as a sample that reacted with both SARS-CoV-2 proteins (100% sensitivity, 99.7% specificity). The overall weighted, age-standardized prevalence was estimated and the infection-to-case ratio was calculated to determine the proportion of undiagnosed SARS-CoV-2 infections. RESULTS: A total of 1233 participants from 292 households were included (mean age, 32.4 years; 764 [61.2%] were women). The overall weighted, age-standardized SARS-CoV-2 seroprevalence was 16.6% (95% CI 14.0-19.5). The estimated infection-to-case ratio was 292:1. Prevalence was higher among participants ≥ 40 years than among those ˂18 years (21.2% vs 14.9%, respectively; p˂0.05). It was also higher in participants who reported hospitalization than among those who did not (29.8% vs 16.0%, respectively; p˂0.05). However, differences were not significant in the multivariate model (p=0.1). CONCLUSION: The prevalence of SARS-CoV-2 is much higher than the number of COVID-19 cases reported. These results justify the organization of a sequential series of serosurveys by public health authorities to adapt response measures to the dynamics of the pandemic.