[Health in Africa, dynamics and socio-territorial challenges]. / La santé en Afrique : dynamiques et défis socio-territoriaux.

Because health is the product of a combination of political, economic, social, cultural, technical factors, the values of the indicators of health are an observatory of the African continent and its billion people in all their dimensions. So, the reading of the program of the 9(th) French-speaking international Congress of the Society of Exotic Pathology is significant of the state of Africa in this second decade of the 21(th) century. The age-old infectious plagues go alongside to emergent fevers there, but the program also dedicates a wide time to the chronic pathologies. This kaleidoscope invites to discuss the concept of epidemiological transition chosen by the Congress. What is its meaning when the order of magnitude of the values of the indicators of health was distended never also and became the most contrasted by the world, in all the scales of observation? Which is its meaning when, in Black Africa, unlike the processes observed in the countries which formed the Third World in 1950, the evolution observed for the last five decades is chaotic, made by a succession of advances, by a progress, by blockings, even by walking back, original expression of the health transition, the process which includes the evolution of the health and the answers of States and societies. The geography of the values of indicators shows the socio-territorial dynamics in process, which place societies in more or less protective systems for their health. More than ever, diverse worlds are next to a sum of challenges, of which that to improve the knowledge of the needs for health, in relatively fine scale to avoid generalizations and amalgams, and target priorities of health according to the socio-territorial contexts.

Choosing where to deliver: decision criteria among women with low-risk pregnancies in France.

As in the rest of Europe, the supply of maternity hospitals has progressively decreased over the past few decades in France. An understanding of user choice criteria is important to help health planners reorganize obstetrical services and to predict changes in utilization patterns in response to supply changes. The objectives were to understand the criteria that women use to select their maternity hospital in France and to analyse the relation to individual and community characteristics. A survey of 536 recently delivered women with low-risk pregnancies explored the factors motivating user choice in three territories with distinct geographical and health service supply characteristics: four districts in Burgundy, two districts in Pays de la Loire, and the district of Seine-Saint-Denis in Ile-de-France. Women were asked to select a principal choice criterion. Their responses were grouped into categories: Accessibility/proximity, reputation of the establishment among users, advice of treating physician, technical quality and cost. Accessibility and proximity were the most selected criteria (33%), followed by the reputation of the maternity (29%), technical quality (15%) and advice of treating physician (13%). Age, parity and education influenced choice criteria. After controlling for individual determinants, region of residence was highly related to choice criteria; women living in Burgundy were more likely to select an establishment based on proximity, in Seine-Saint-Denis women were more likely to follow the advice of their physician, and in Pays de la Loire, more likely to base their decisions on the reputation of the establishment. The association between choice criteria and community characteristics could explain the failure of previous models to predict behaviour in different contexts. It is important to carry out local surveys of user perceptions before restructuring in order to take into consideration women's opinions on their future places of delivery and to refine geographic models.

[Climatic changes and transmissible diseases]. / Variations climatiques et maladies transmissibles.

Transmissible disease geography can be defined as the study of the spatial expression of pathogenic processes. The three main elements implicated in this study are environmental conditions affecting biophysical dynamics, political, economic, social, and cultural events, and evolution of pathogenic agents under the influence of the first two factors. A number of pathogenic areas or regions can be delimited in function of different combinations of these factors. These territories are subject to rapid change and variation. Meteorological changes and cycles are contributing factors. However the underlying mechanisms appear to be increasingly affected by human activity. Several disturbing signs have been attributed to man including desertification, drought, and global warming, but the cause-and-effect relationship is unsure. Much research is in progress but resulting data remains contradictory except insofar as to confirm the complexity of atmospheric phenomena. The natural geography of transmissible diseases is affected by these variations but it is mainly the expression of the dialogue between man and nature.

[The island of Mauritius: insularity, tropicality, modernity, a dialogue in the form of a lesson]. / L'ile Maurice: insularité, tropicalité, modernité, un dialogue en forme de leçon.

Mauritius, a lost volcanic island in the indian ocean situated at the 20th degree of latitude, is a tiny state which got its independence in 1968. The isolation, the tropicality, the demographic boom, the ethnic diversity and the absence of raw materials could funnel this peaceful beauty to become a hot-bed of desperation and violence. This place which is one of the most densely populated areas, is an example of modern democracy and cultural coexistence. Owing to a skillful and pragmatic politic, its leaders have transformed handicaps into trump cards. The allocation of a part of the GNP for social and hygienic investments had been the locomotive pulling the train of improvements and raising the standard of living for the inhabitants. The ageing population, the rapidity of evolution the demographic and health transitions are expression of this skillful politic. In less than twenty years, this island conquered underdevelopment and proved that there is no tropical fatality when a programme of health accompanies development.

[Geographic inequalities in HIV infection and AIDS in sub-saharan Africa]. / Les inégalites géographiques de l'infection à VIH et du SIDA en Afrique sud-saharienne.

The geography of HIV infection in Africa (which is the continent with the highest incidence rates) has varied features at each scale. The transmission is oriented preferentially according to axes and poles where the virus--because of local environmental factors--found favorable conditions to dissemination and spread. The dynamic of the epidemic results from factors related to sociologic, cultural, religious behaviour and to geographical, political and economic situations. The local combination of all the causal factors explains the complexity and diversity of the geographic characteristics of the African epidemic. The knowledge of the complexity and diversity of the geographic characteristics of the African epidemic. The knowledge of the causal factors calls upon various disciplines. Spatial networks, population movements and their consequences are analyzed. Geographical data together with sero-epidemiologic information initiate hypothesises related to the spatial dynamic of the epidemic and to the processes of regionalization.

[Geographic approach to the epidemiology of chloroquine-resistance of Plasmodium falciparum in tropical Africa]. / Abord géographique de l'épidémiologie de la chloroquino-résistance de Plasmodium falciparum en Afrique tropicale.

Plasmodium falciparum chloroquine-resistance occurred initially in 1978 in East Africa. Its step by step propagation towards West Africa is due to several factors which coincide with a high increase of population migration and urbanization since the seventies. Several maps show the dynamics of chloroquine-resistance in Africa during that era.

[The geography of infection with the human immunodeficiency virus (HIV) in black Africa: determination of epidemiological and regional factors]. / La géographie de l'infection par les virus de l'immunodéficience humaine (VIH) en Afrique noire: mise en évidence de facteurs d'épidémisation et de régionalisation.

In Africa, the continent most affected by HIV, the geography of the epidemic shows major contrasts. Strong regionalization differentiates both central-east Africa from west Africa and, within the countries, the urban zones from rural ones. Spatial and population factors are important when mapping the geography of the infection. An analysis of the evolution of movements--merchandise as well as populations--of the landlocked countries of the Great Lakes region of Africa leads the author to formulate a hypothesis involving regional considerations.

[Urbanization in tropical countries]. / L'urbanisaton dans les pays tropicaux.

Rural populations are still the most numerous in tropical countries. But we can witness an unprecedent process of urbanization. However the dynamics of the phenomenon differs greatly in different countries and in different towns. As a matter of fact, the greatest overcrowded metropolis attract the greatest part of the migrants from rural areas; the attractive factors are multifarious and universal. This not easily controllable trend seems to be irreversible. The migrant farmers will generally find a job within the informed economic sector. The zones of spontaneous and precarious settlement are often their first environmental living conditions. Some of these unhealthy dwelling areas are subject to development plans; some of them being extremely well designed.

[Epidemiological feature of malaria in the Ivory Coast and Upper Volta area]. / Paysage épidémiologique du paludisme dans l'espace Ivoiro-Voltaïque.

Several steps of the malarial epidemiological chain depend upon the environment. In West Africa, environment had no constant patterns neither in space and nor even in time. Its major discontinuities introduce disparities, at various levels, in the conditions met by the parasite for its transmission. In return, these conditions induced disparities in the immunological resistance of people. The malarial epidemiological feature is the result of the discontinuities of the environment in the Ivory Coast and Upper Volta area of the resulting epidemiological disparities. It accounts for the various possible aspects of the disease among the human populations. Malarial epidemiological feature is not only useful to understand the present situation but it is a guide of great value for any action adjusted to the needs of this area. It is also a good way to appreciate the risks resulting of the evolutions, either spontaneous or voluntary, of the natural or human environment.