La santé des enfants en France : un enjeu négligé ?

INTRODUCTION: As part of the National Health Strategy, the High Council for Public Health (HCSP) was tasked with leading a reflection on a “comprehensive and concerted child health policy”. Policy-making requires relevant knowledge and statistical benchmarks. It therefore seemed useful to examine the French statistical system and active research topics. This assessment is expected to provide a current portrait of the priorities and implicit health choices for the children. It also aims to reveal insufficiently explored aspects of children’s health. METHODS: The inventory of this system was carried out on the basis of several methods, hearings, work of two documentalists, and analysis of the published and grey literature. RESULTS: The emphasis is on pathologies, medical prevention and behaviors conceived primarily as individual. The idea that the health of tomorrow’s adults is built up behind this apparent good health and its inequalities does not appear, or only marginally. The elements on affective, cognitive or relational development are not sufficiently analyzed, for lack of data. The living conditions of children, especially poverty and violence in all its forms, are not sufficiently considered as health issues. Research is developing today with a hospital-centric vision, without a real strategy of research on children’s health. DISCUSSION: Given the dispersion of data, publishing a summary report on children’s health on a regular basis is essential, as enriching the system with data on the environment, poverty and psychomotor, psychosocial and cognitive development. There is an urgent need to develop research on children’s health and to define a research strategy that does not exist today.

[Method and participation in a preschool immunization survey in Isère (France) during the 2010-11 school year]. / Méthode et participation à une enquête en milieu scolaire sur la vaccination des enfants isérois (2010/2011).

INTRODUCTION: The Isère department has carried out a study on vaccination programmes and sites of vaccination among schoolchildren in Isère. The objective of this article is to present the original and robust method used in the study. We also describe the participation rate in the study. METHODS: A cross-sectional study was conducted among 4-year-old children in 2010/2011 during nursery school checkups. One hundred schools were randomly selected according to a complex sampling plan. The vaccination records of all children examined at checkups were photographed and data were cleared and adjusted. The participation of children in the study was investigated by distinguishing the reasons for exclusion from the study due to the mode of data collection and due to factors specific to the checkups. The factors studied concerned the intrinsic characteristics of the schools as well as data on organisation of the checkups. A total of 2,588 children from the 100 schools surveyed were included in the study, corresponding to a participation rate of 85.1%. RESULTS: 9.6% of the children selected were excluded for reasons specific to the checkups and 5.3% for reasons related to the study. Participation was higher for children examined by a team from the Maternal and Child Protection Unit (PMI: Protection maternelle et infantile), specialised in checkups. This was the only factor that appeared to impact the typical attendance of children at in nursery school health checkups. DISCUSSION: This result can probably be generalised to the other tasks of the PMI and provides important information for the future organisation of the PMI's activities.

Occupational risk for cytomegalovirus, but not for parvovirus B19 in child-care personnel in France.

BACKGROUND: Studies assessing the risk of cytomegalovirus (CMV), parvovirus B19 (B19V), rubella and varicella infections in female child-care personnel may help define appropriate preventive strategies during pregnancy. METHODS: Serologic testing for all four viruses and a self-administered questionnaire to identify risk factors were conducted on child-care staff aged 20-50 years old and on a reference group of women. RESULTS: In 395 exposed and 382 reference women, CMV, B19V, rubella and varicella seroprevalence were 69.4, 79.4, 98.7, 100% for exposed women, and 41.1, 68.0, 98.2, 99.7% for reference women, respectively. For CMV, the adjusted seroprevalence ratio (PR) of exposed versus reference workers, (PR, 1.43 [95% IC, 1.22-1.69]) was observed as of the first year of exposure. The risk attributed to occupation was 30.1%. Identified risk factors included exposure duration, past employment in maternity hospital, and participation in cleaning tasks. The risk attributable to personal factors ranged from 14.5% to 32.4%. The adjusted B19V PR was not significant (PR, 1.05 [95% IC, 0.94-1.16]). CONCLUSIONS: French female child-care staff runs an occupational risk for CMV infection, but not for B19V infection. The fraction attributable to this CMV occupational risk was not higher than the risk associated with personal factors.