[Security agents on the front line against Ebola: roles, perceptions and knowledge in Fann Teaching Hospital, Dakar, Senegal]. / Les agents de sécurité en première ligne face à Ebola : rôles, perceptions et connaissances au CHU de Fann, Dakar, Sénégal.

Security agents are on the front line when patients arrive at health facilities, giving them a potential role to play in an Ebola virus disease (EVD) outbreak. The position of security agents within health services is poorly documented. A survey was conducted to clarify their understanding of Ebola pathology, to assess their need for information and to determine their role in patient management. The survey included both qualitative and quantitative aspects. 80 security agents of the Fann teaching hospital (Dakar) completed questionnaires, and 11 were interviewed. Qualitative analysis was performed with Dedoose and the quantitative analysis using Excel. The results show that security agents' activities go beyond their mission of security and control. They are involved in informing, orienting and assisting patients and those accompanying them in the hospital. The security agents have basic knowledge of EVD, but overestimate the risk of transmission. They want to be more informed and to have access to protective material. These results suggest that these professionals should be taken into account when developing response strategies to Ebola outbreaks. Their knowledge of and protection against the disease must be strengthened. Non-health professionals working in health facilities should be trained in order to be able to relay information to the public.

[Incidence of cancer in Mauritius in 1989-1993]. / Incidence des cancers à Maurice en 1989-1993.

Systematic registration of cases of cancer was introduced in Mauritius as of 1989. This article analyzes the data concerning the incidence and mortality of the disease from 1989 to 1993. At the end of each year, the archives of the Central Laboratory of Hospitals, the admissions register at the only center for radiotherapy, the discharge résumés of patients classified as suffering from cancer of all the regional hospitals and the archives of the Medical Assistance Service regarding treatment abroad were examined and information drawn from them in order to fill out the information form of the cancer register (10 items per case). For the period studied, 4293 new cases of cancer were detected of which 1784 (41.6%) among men. The main organs affected were, for men: the lungs (12%), the mouth/pharynx (10%), and the stomach (8%); for women: the breast (24%), the cervix (21%), and the ovaries (6%). The incidence of cancer has increased at an annual average of 8% for both sexes, reaching in 1993 the standard (world) incidence of respectively 106 and 122 cases per 100,000. Over the same period, cancer rose to 2nd to 3rd place in causes of death, accounting for approximately 8 to 9% of deaths. The ratio of mortality/incidence is 0.85 among men and 0.58 among women. The distribution of cancer according to age, location and ethnic group points to interesting and significant results which can be subsequently compared to that of other countries in the region. The second phase of registering cancer in Mauritius is presently being undertaken.

[The development of public health education: the Mauritius experience]. / Evolution de l'enseignement de la santé publique: l'expérience mauricienne.

A public course has been initiated in 1990 in Mauritius for covering the national growing needs of public health specialists. This training course was organized jointly by the Ministry of Health, the University of Bordeaux II and the French Cooperation. After 3 sessions dedicated specifically to the Mauritian physicians, the course has been re-designed for the needs of the other countries of the region. A feasibility study performed in 1994 in the countries of the Indian ocean region showed that during the past decade, the district level had become the focus point to integrate the health programs. This process has progressively transferred a wider and stronger part of the responsibilities from the central level to the district level and the survey showed that most of the health district managers were physicians that did not have the proper background for carrying such responsibilities. According to these results, a course curriculum was created by the Mauritian Ministry of Health and the University of Bordeaux II and submitted to various organisms supporting health program development in the region. This proposal was strongly supported by several agencies (the french Cooperation, Unicef, WHO, World Bank...) who agreed to sponsor candidates for that training course. The first session was organized in 1995, a second one in 1996. This training course is targeted to the medical doctors who are in charge of the management of health services at the district level. It is divided in two parts: A six-weeks intensive training course performed in Mauritius that include formal teaching and practical exercises in small groups for a total of 210 hours. The curriculum is mainly targeted on the various aspects of management as the management of health information (biostatistics epidemiology and computing), the management of human resources, financial resources and material resources. In addition to these main topics, there is an introduction to pedagogy, communication skills and applied research methodology. Following this six-weeks, training the students come back to work in their country and have 8 months to perform a thesis supervised by a local public health specialist. The subject of the thesis has to be closely related with one of the topic taught and should provide an obvious improvement for the public health situation in the district where this physician is acting. In 1995, 22 candidates attend to the course (13 from Madagascar, 4 from Mauritius, 3 from Comoros, 1 from Angola, 1 from Equatorial Guinea and 1 from Tchad), 19 had successively completed all the modules and got the diploma of public health delivered by the University of Bordeaux II. This diploma has been recognized as an equivalent to a master in public health in Mauritius. The evaluation of the courses-performed by the students, the teachers and the financial agencies gave a very positive results although the workload was considered as too important for a six-weeks training course. The recommendations of the 1995 session were included in the 1996 programs which is still on going for 23 candidates. The 97 session will probably extend the number of students up to 40, divided in 4 subgroups for practical exercises. In parallel to the course, a quarterly bulletin will be created and sent to the present and past candidates of this course in order to support a continuous medical education training program targeted to the district physicians.

[Education in public health in Mauritius. Presentation of an experience]. / Enseignement de la santé publique à l'île Maurice. Présentation d'une expérience.

In December 1991, fourteen physicians in the public sector received a degree entitled "Methods in public health", awarded by the dean of Université de Bordeaux II (France) and the Mauritius minister of health. The ceremony crowned a two-year course consisting of 350 hours of lectures and other teaching exercises, broken down into 12 subject areas (epidemiology, biostatistics, medical informatics, demographics, health care, planning, health economics, etc.). The graduates did an average of 10 year's field work in a primary health care center. The degree was awarded after completion of a mini-thesis based on an original study of a selected Mauritian public health problem. In 1992 and 1993, a new, shorter course in community health was offered to other Mauritian physicians by staff from Université de Bordeaux II. We consider that such initiatives would be profitable in other countries like Mauritius, where commonly encountered health care problems of the developing countries coexist with those found in the industrialized world. This will also be an important initiative in countries where initial training in various contexts and therefore can benefit from a common continuing medical education, particularly in public health. One key factor in the success of such projects is their full integration within the medical sciences.