Incidences de la présence des garde-malades sur la prise en charge médicale des patients. Etude menée au Centre Hospitalier Universitaire de Brazzaville

La gestion du malade dans l?univers hospitalier implique non seulement le personnel soignant, mais aussi d?autres acteurs sociaux encore moins connus des gestionnaires des structures hospitalières et des catégories socio professionnelles y évoluant. Parmi ces acteurs encore moins connu, il y a le garde-malade faisant partie du personnel hospitalier en charge de la prise en charge des patients en milieu hospitalier. Cependant au Centre Hospitalier et Universitaire de Brazzaville en République du Congo, les garde-malades sont constitués des parents, amis et connaissances dont la représentation est importante dans cet univers hospitalier. Cette représentation aussi remarquable soit ­ elle, interpelle plus d?un observateur au point de s?interroger sur les raisons à l?origine de cette présence. Notre étude répond à la logique qui est celle de tenter de comprendre et d?analyser ce phénomène devenu très inquiétant. Ce phénomène est donc à lire dans la perspective de la complexité des réalités sociales qui s?expliquent à partir des déterminants socio culturels, fondements de la vie sociale. Aussi, la faiblesse des services sous tutelle du C.H.U-B et la culture bantoue, laquelle repose sur la solidarité mécanique qui, appelle à la cohésion sociale, constituent des facteurs qui expliquent ce phénomène. A cet effet, une observation participante a été effectuée dans cette structure hospitalière. Celle-ci a permis de relever une influence importante qui, pour diverses raisons réponde aux préoccupations des malades. Cette étude présente trois intérêts : scientifique, social et personnel. D?abord, elle montre la difficulté en ressources humaines qui se traduit par la sous représentativité des catégories socio professionnelles qui, contribueraient à résoudre la question de l?effectivité de prise en charge du malade. Ensuite, l?étude présente un autre intérêt qui met en exergue la cohésion sociale qui, s?exprime à travers la chaine de solidarité dont la famille est le maillon. Le dernier centre d?intérêt est personnel. Il met en relief un aspect culturel très intéressant, celui de l?homogénéité et de la dynamique des rapports des acteurs impliqués dans la gestion du malade. Quoi qu?il en soit, le garde-malade joue un rôle de premier plan dans la gestion du malade. Il accompagne le personnel soignant, car partageant le même environnement social que le malade. Aussi, sa visibilité nécessite un encadrement juridique pour lui donner une véritable identité.

The management of the patient in the hospital word involves not only the nursing staff, but also other social actors even less known to the manager of hospital structures and socio-professional categories. Among these actors even less known, there is the nurse who is part of the hospital staff in charge of the care of patients in hospital environment. Howerver at the Brazzaville Hospital and University Center in the Republic of Congo, the nurses are made up of relatives, friends and acquaintanees whose representation is important in this hospital environment. This representation, as remarkable as it is, calls out to more than one observer to the point of questioning the reasons behind this presence.Our study reponds to the logic of trying to understand and analyze this phenomenon, which has become very worrying. This phenomenon should therefore be read in the perspective of the complexity of social realities which can be explained on the basis of socio-cultural determinants, the foundations of social life. Also, the weakness of the services under the supervision of the C.H.U-B and of the Bantu culture, which is based on mechanical solidarity, which, calls for social cohesion, are factors that explain this phenomenon. To this end, a participant observation was carried out this hospital structure. This made it possible to identify an important influence which, for various reasons, responds to the concerns of patients. This study has three interests: scientific, social and personal. First, it shows the difficulty in human resources which result in the representativeness of the socio-professional categories which would help to resolve the issue of effectiveness of patient care. The study presents another interest which highlights the social cohesion which is expressed through the chain of solidarity of which the family is the link. The last area of interest is personal. It highlights a very interesting cultural aspect, that of the homogeneity and dynamics of relationships of the actors involved in the management of the patient. In any case, the nurse plays a leading role in management of the patient. He supports the nursing staff, because they share the same social environment as the patient. Also, its visibility requires a legal framework to give it a real identity

A review of the framework and strategy for disability and rehabilitation services in South Africa

Background: Rehabilitation is imperative for the successful integration of persons with disabilities into their social environments. The Framework and strategy for disability and rehabilitation services (FSDR) in South Africa, 2015-2020.was developed to strengthen access to rehabilitation services and ensure the inclusion of persons with disabilities in all aspects of community life. Despite the FSDR being commissioned, access to rehabilitation is a challenge for persons with disabilities and further compounded in rural communities. Objective: The study aimed to describe the barriers and facilitators that influenced the process of development, implementation and monitoring of the FSDR. Method: This qualitative study employed a single case study design. Data was collected through document analysis and in-depth interviews utilising the Walt & Gilson policy analysis framework that outlines the context, content, actors and process of policy development and implementation. In-depth interviews were conducted with twelve key informants (N=12) who were selected purposively for the study. Data obtained from the in-depth interviews were analysed using inductive thematic analysis. Results: We found many factors that influenced the implementation of the framework. Actor dynamics, insufficient resources, the rushed process, poor record-keeping, inappropriate leadership, negative attitudes of staff members and the insufficient monitoring impeded the successful implementation of the framework. While positive attitude, mentorship and support amongst the task team facilitated the implementation process, albeit with challenges. Conclusion: There is a need to address implementation gaps so that the FSDR is responsive to the current rehabilitation needs of persons with disabilities in South Africa. Contribution: This study may inform future disability policy, and can be used as a tool to advocate for the rights for persons with disabilities

Perceived causes of change in Nigerian adolescent sexual risk behaviour ­ Results from semi-structured mobile instant messaging interviews

The study explores the perceived causes of change in sexual risk behaviour among Nigerian adolescents over the past years. By embedding the results into a theoretical context, the study aims to further develop interventions targeting adolescent sexual health. To do so, 23 semi-structured interviews are conducted through the mobile-instant-messaging tool WhatsApp. The interview sample consists of both female and male adolescents and adults from different regions in Nigeria. The interviews are conducted as simultaneous chats and analysed based on the qualitative content analysis approach. Respondents perceive a multitude of different factors as causes of change in sexual risk behaviour among Nigerian adolescents. They can be categorised into (1) individual actors, (2) structural factors, and (3) socio-cultural factors. Interrelations between the different factors can partly be observed. The other factors are mostly modifiable and can therefore contribute to reducing adolescent SRB.

Health system strengthening for human capital development in Eswatini project. P168564

Description of the Strengthening the Health System and Nutrition for Human Capital Development in Eswatini Project The Government of the Kingdom of Eswatini is preparing a project, Health System Strengthening for Human Capital Development in Eswatini Project financed by an IBRD loan of US$20 million, using an Investment Project Financing (IPF) instrument, over a five-year period. The Project Development Objective (PDO) isto improve the coverage and quality of key reproductive, maternal, neonatal, child and adolescent health (RMNCAH), nutrition and NCD services (hypertension and diabetes) in Eswatini. To address key sector challenges and support the achievement of the PDO, the proposed project will focus on strengthening the health system and ramping up investments in RMNCAH services as well as nutrition and non-communicable diseases (hypertension and diabetes) to address critical human capital challenges, including stunting and child and adult mortality, applying a life course approach. The Ministry of Health will house the (PIU) the project implementing unit (PIU). The MOH will be supported by the Environmental Health Department (EHD) in the MOH.

Facteurs socioéconomiques des maladies mentales des patients hospitalisés à l'hôpital Errazi, Tétouan, Maroc

Le présent travail s'inscrit dans le cadre des travaux de recherche de fin d'étude au niveau de l'ISPITS de Tétouan (étudiants, option infirmier en santé mentale, promotion 2011-2014), a intéressé tous les patients hospitalisés (soit 405 dossiers) à l'Hôpital psychiatrique Errazi de Tétouan durant l'année 2013. Ce travail correspond à une étude des facteurs de risques socioéconomiques et environnementaux en relation avec le diagnostic des maladies mentales révélé. L'exploitation des dossiers a montré que la majorité des patients psychiatriques hospitalisés sont de sexe masculin (85%) appartenant à la tranche d'âge 20-35ans (52%) qui sont célibataires (78%) avec un niveau intellectuel très faible (56%) et sans scolarisation (24%) et dont la plus part sans emploi (62%). Pour les femmes (15%) dont la plus part appartiennent à la tranche d'âge de 20-35 ans (32%) et 35-50 ans (39%) et qui sont célibataires (45%) et divorcées (24%). Elles sont non scolarisées (44%) ou avec un niveau de scolarisation primaire (29%) et dont la majorité reste sans emploi (89%). Cette situation socioéconomique tellement défavorable a une grande influence sur l'état de santé mentale des patients et sur leur personnalité. En effet, le diagnostic pathologiques enregistrés a montré une diversité de maladies mentales dont la schizophrénie (F20-F29), les troubles schizophréniques et les troubles délirantes avec plus de 93% (dont 75% de F20), les troubles d'humeur (F16-F18) de 2%, les troubles liés à l'utilisation des substances psycho-actives (F30-F32) de 1,5%, les troubles de la personnalité (F43-F48) de 1%, les troubles névrotiques (F60-F68) 2% et les affections paraxystiques (G40) de 0,5%. Durant cette étude, nous pourrons conclure que le diagnostic pathologique révélé des patients hospitalisés dans cet hôpital, pourrait être favorisé par leurs faibles niveaux socio-économiques et environnementaux

Mother to Daughter Transmission of Female Genital Cutting in Egypt; Burkina Faso and Senegal

The aim of article is to assess the determinants of mothers to daughters transmission of female genital cutting (FGC) in Senegal; Burkina Faso and Egypt. Using the most recent DHS surveys the study confirms that the main dimension related to daughters' circumcision is mother's personal experience as circumcised mothers more likely to perpetrate the practice on daughters. Policies aim at changing this social norm could therefore generate a virtuous circle: for each child who is not circumcised; a risk-free third-generation is projected. Factors related to women's empowerment as better education; higher autonomy and wealth of the family as well social environment against FGC also discourage the continuation of the practice and protect daughters from the risk to be circumcised in each country analyzed

Indications, résultats et rendement de la coloscopie dans un environnement économique défavorable: le cas du Cameroun

OBJECTIF : le rendement diagnostique de la coloscopie dépend de plusieurs facteurs, notamment les indications. La pertinence de ces indications est influencée par l'environnement économique et les structures locales. Le but de notre étude était d'analyser les indications et les résultats des coloscopies, et d'évaluer leur rendement diagnostique afin de juger de la pertinence de ces indications. MATÉRIELS ET MÉTHODES : un recueil rétrospectif de données de coloscopies réalisées de janvier 2001 à juin 2011 dans trois hôpitaux universitaires de Yaoundé a été effectué. Les variables enregistrés étaient l'âge, le sexe, les indications et les résultats. RÉSULTATS : un total de 908 protocoles de coloscopie ont satisfait à nos critères de sélection (dont 622 hommes (68,5%)). L'âge médian était de 48 ans (IQR 36-59 ans). Les indications principales étaient les rectorragies 281 patients (30,9%), les douleurs abdominales 267 patients (29,4%) et les diarrhées chroniques 107 patients (11,8%). L'examen était normal 451 fois (49,7%). Les lésions retrouvées étaient les polypes colorectaux 110 cas (12,1% ; IC 95% : 10,1-14,5), les hémorroïdes 104 cas (11, 5% ; IC 95% : 9,5-13,7), la diverticulose 71 cas (7,8% ; IC 95% : 6,2-9,8) le cancer colorectal 64 cas (7,0% ; IC 95% : 5,5-9,0) et les colites 64 cas (7,0% ; IC 95% : 5,5-9,0). Le rendement diagnostique de la coloscopie pour le cancer colorectal selon les indications était élevé en cas d'image radiologique suspecte (27,7%), de masse abdominale (25%) et d'anémie ferriprive (22,2%). les douleurs abdominales et/ou TFI non accompagnées de perte de sang macroscopique ou occulte, la constipation et le dépistage du cancer colorectal avaient un rendement faible. CONCLUSION : le rendement diagnostique de la coloscopie dans la détection des principales lésions coliques n'est pas différent dans un environnement économique défavorable malgré les indications peu pertinentes. Les symptômes digestifs avec une valeur prédictive positive élevée pour le diagnostic de cancer colorectal sont retrouvés. Les polypes et les hémorroïdes constituent les principales lésions colorectales au Cameroun. Le cancer colorectal a une prévalence élevée et inattendue méritant notre attention

Perceptions of HIV/AIDS Leaders about Faith-Based Organisations' Influence on HIV/AIDS Stigma in South Africa

The extent of the HIV pandemic - particularly in the hardest-hit countries; including South Africa - has prompted a call for greater engagement of all groups; including faith-based organisations (FBOs). Although FBOs are known to play a substantial role in providing care and support to those affected by HIV and AIDS; empirical evidence in regard to their actions in the broader context of stigma is limited. A qualitative; key-informant survey was conducted in South Africa as part of a six-country international study to examine perceptions of how FBOs have contributed to reduction in HIV risk; vulnerability and related impacts. The special emphasis of this paper is the influence of FBOs on stigma and discrimination. In-depth interviews were held with 34 senior-level key informants who act as key decision-makers in the response to HIV and AIDS in South Africa. Secular and faith-based respondents shared their perceptions of the faith-based response; including FBOs' actions in relation to HIV/AIDS stigma and discrimination. Our study revealed that while FBOs were perceived as taking some action to address stigma in South Africa; FBOs were also thought to contribute to HIV/AIDS- discrimination through conflating issues of sexuality and morality; and through associating HIV and AIDS with sin. The interviewees indicated a number of internal and external challenges faced by FBOs to deal effectively with stigma; including lack of information and skills; the difficulty of maintaining confidentiality in health services; and self-stigmatisation which prevents HIV-infected persons from revealing their status. Findings from this study may help both faith-based and secular groups capitalise on the perceived strengths of FBOs as well as to elucidate their perceived weaknesses so that these areas of concern can be further explored and addressed

The social and gender context of HIV disclosure in sub-saharan Africa: a review of policies and practices

This paper reviews the legal and policy context of HIV disclosure in sub-Saharan Africa; as well as what is known about rates; consequences and social context of disclosure; with special attention to gender issues and the role of health services. Persistent rates of nondisclosure by those diagnosed with HIV raise difficult ethical; public health and human rights questions about how to protect the medical confidentiality; health and well-being of people living with HIV on the one hand; and how to protect partners and children from HIV transmission on the other. Both globally and within the sub-Saharan African region; a spate of recent laws; policies and programmes have tried to encourage or - in some cases - mandate HIV disclosure. These policies have generated ethical and policy debates. While there is consensus that the criminalization of transmission and nondisclosure undermines rights while serving little public health benefit; there is less clarity about the ethics of third party notification; especially in resource-constrained settings. Despite initiatives to encourage voluntary HIV disclosure and to increase partner testing in sub-Saharan Africa; health workers continue to grapple with difficult challenges in the face of nondisclosure; and often express a need for more guidance and support in this area. A large body of research indicates that gender issues are key to HIV disclosure in the region; and must be considered within policies and programmes. Taken as a whole; this evidence suggests a need for more attention to the challenges and dilemmas faced by both clients and providers in relation to HIV disclosure in this region and for continued efforts to consider the perspectives and rights of all those affected

Problématique de garde-malade au Centre Hospitalier et Universitaire de Brazzaville (CHU-B) / NA

Le Centre Hospitalier et Universitaire de Brazzaville (C.H.U-B), est l'une des grandes structures sanitaires en République du Congo. Dans ce centre hospitalier, on constate une présence massive des gardes ­ malades, qui interpelle plus d'un observateur au point de s'interroger sur leur nécessité. Celle-ci serait ­ elle l'expression de la solidarité ou du dysfonctionnement des services sous tutelle du C.H.U-B? Pour vérifier nos hypothèses, nous nous sommes parvenus au résultat selon lequel, cette présence des gardes ­ malades dans ce centre hospitalier résulte de la conjonction de ces deux (02) facteurs, c'est ­ à ­ dire la solidarité mécanique et le dysfonctionnement du C.H.U-B. À cela s'ajoute l'inadéquation entre les nouvelles attentes des malades et l'état actuel des structures de ce centre.

The Brazzaville Hospital and University Center (C.H.U-B) is one of the largest health facilities in the Republic of Congo. In this hospital, there is a massive presence of sick keepers, which challenges more than one observer to question the reason of their existence. Would this be the expression of the solidarity or the dysfunction of the services under the supervision of the C.H.U-B? To verify our hypotheses, we arrived at the result according to which, this presence of the sick keepers in this hospital center results from the conjunction of these two (02) factors, that is to say the mechanical solidarity and the dysfunction of the CHU-B. Added to this is the mismatch between the new expectations of the patients and the current state of the structures of this center.

Social Aspect of Urological Practice in this Country

"Disease in an individual has personal and immediate family stress and certainly has undesirable effects on the socio-economic health of the country. Urological diseases share this general attribute but have peculia characteristics that make it stand out. Most of the patients seen in the urological clinic are senior citizens; towards the evening of their lives. The majority present with urinary tract obstruction from either disease of the prostate or lower urinary tract narrowing from scarring due to infection or trauma (urinary stictures). This touches an area of significant sensitivity from the cultural point of view. Most societies in our country lead a puritan image to old age; thus patients with genitourinary complaints sometimes fear to present themselves lest they are regarded as having venereal diseases. Genitalia are also accorded awesome privacy and mentioning the genetal parts in public is regarded as taboo and in some cases a breach of this etiquette was punishable in some of our societies. Disease of these parts therefore is presented to the medical personnel with a lot of reluctancy and this is compounded by the fact that the sufferers are in most cases dependent socio-economically thus lacking the priviledge of presenting themselves to their doctors without involving a third party who would normally facilitate treatment. Urology disease is mainly a problem of the elderly with rather reduced physiological reserves; their treatment calls for extensive clinical examination and widely varied laboratory investigations. This is aggravated by the late manner of presentation with complications; thus rendering the whole work up a very expensive affair. In the developed world; prostate enlargement with symptoms is regarded as a ""quality of life"" disease but in the third world where it presents with late complciations it is a ""life threatening"" disease; therefore; requiring more extensive investigation. This highlights the irony of the poor paying more than the rich."

Environnement socio-economique et sante

La promotion de la sante passe par d'indispensables gains de developpement economique et social qui se traduisent par une amelioration du cadre de vie et des conditions d'existence des populations. L'environnement socio-economique serait donc determinant au point d'influer positivement ou negativement sur l'etat de sante des populations

Socioeconomic background and feeding practices of families with severely malnourished children

A total of 58 mothers and 2 guardians whose children were admitted with severe malnutrition at the Mitundu Nutrition Rehabilitation Centre were interviewed to identify the socioeconomic background and feeding practices. 80 percent of the families depended solely on farming for food and income. 57 percent of the mothers were illiterate; 42 percent of the mothers had polygamous husbands. 40 percent of the children were completely weaned before 12 months of age and a total of 76 percent of the mothers used harsh methods for weaning their children. Inappropriate weaning methods appear to be an important cause of childhood malnutrition

Malnutrition in Malawi: identifying the reasons; the at-risk groups and the possible solutions

A proposal for a research project to study the factors related to malnutrition in Malawi

Attitudes and use of the condom in Malawi: a report of Focus Group Findings; April 1991

The purpose of the study was to explore attitudies and use of the condom as well as specific advertising concepts; brand names; pack sizes; and prices for the condom among target male consumers. Results from this study will be used to guide the development of marketing and advertising campaigns for the condom