[Feedback from primary care practitioners two years after the chikungunya epidemic on Reunion Island, 2005-2006]. / Retour d'expérience des médecins généralistes deux ans après l'épidémie de chikungunya de 2005-2006 à La Réunion.

Primary care practitioners constitute key stakeholders in the surveillance and control of epidemic-prone infectious diseases. We carried out a survey in Reunion Island two years after the 2006 chikungunya epidemic using a purposive random sample of 100 general practitioners (GP). The objective was to describe and identity factors associated to GP involvement in case notification during the 2006 chikungunya epidemic. The methods were: administered face-to-face questionnaire and identification of notification determinants by univariate and multivariate analyses. Nearly 60% of participants declared having failed to join the case notification procedure. The main impeding factor was the acknowledgment of limited capacities consecutive to massive influx of patients. Inversely, practicing in group organization tended to show a favorable effect on case notification. In addition, most responders reported the relevance of the information provided by health authorities, despite a perceived limited efficacy of the procedure in the field. Primary care practitioners' involvement in the surveillance of epidemic infectious diseases requires to be reinforced by a preestablished partnership within a proactive network. This goal comprehends relevant training and preparation for epidemic surveillance.

[Understanding and awareness of malaria among 103 French individuals traveling to endemic areas, having consulted the Bordeaux university hospital travel clinic, France]. / Connaissances et perceptions du paludisme chez 103 voyageurs à destination intertropicale consultant le centre de conseil aux voyageurs du centre hospitalier universitaire de Bordeaux, France.

OBJECTIVE: Malaria is increasing worldwide due to the emergence and spread of drug resistant strains. As globalization in business and commerce and appetites for more adventurous travel increase, more people from non-endemic countries are being exposed to malaria. The management of travelers before departure or returning from visiting endemic countries with malaria is a challenge, both for exposed individuals and for physicians, considering the weak knowledge of the disease. METHODS: A survey was conducted among French individuals traveling to endemic areas to evaluate their knowledge and perception of malaria. An observational study using guided questionnaires was made on 103 travelers recruited in the Bordeaux University Hospital travel clinic, France. RESULTS: The findings of the survey were consistent with previously reported data concerning the knowledge of signs and symptoms of malaria, as well as with the global level of knowledge on the disease, and with the number of travelers not understanding the mode of infection appropriately. Irrelevant data was reported concerning the typical pattern of the disease, the objectives of malaria management for travelers, and the attention given to the most susceptible groups: children, pregnant women, and immuno-compromised individuals. CONCLUSION: Our findings show a link between gender and adhesion to prophylactic measures, and an inverse gradient in the subgroup of frequent overseas travelers, between knowledge and risk perception of illness.

[The impact of socioeconomic status in the estimation of non-adult dental age]. / Impact du niveau socioéconomique dans l'estimation de l'age dentaire des non-adultes.

The aim of this study is to observe the possible impact of socioeconomic level on stages of macroscopic dental development. The sample consists of 456 children from European origin, aged 3.5 to 16 years (242 girls and 214 boys). We apply a radiographic method of non-adult dental age estimation based on Bayes' theorem. Both socioeconomic level and geographic origin of grandparents are given in a questionnaire devised by the first author. First, results obtained with the Bayesian dependent method (BD method) are compared to those obtained with a more commonly used method of dental age estimation based on Correspondence Analysis and linear Regression (CAR method). Second, two approaches are proposed in order to test potential relationships between socioeconomic level and stages of macroscopic dental development. Both are based on observed shifts between dental age and chronological age with regard to socioeconomic level. Results obtained with the BD method are better, in terms of quality, than those obtained with the CAR method. We observed no influence of socioeconomic level on stages of macroscopic dental development.

Determinants of contraceptive use in Morocco: stopping behaviour in traditional populations.

The determinants of modern contraceptive use in traditional populations are analysed in married women aged 30-44 living in the province of Marrakech (Morocco). Women who have never used contraception have smaller family sizes than those who do: the number of live children (or live births) is the variable with maximum predictive power on contraceptive use, while child mortality is the main inhibiting factor. The probability of contraceptive use increases with female age at marriage and decreases with the woman's age, indicating a generational change in reproductive behaviour. The socioeconomic variables education, employment and residence, have no significant independent predictive character on contraceptive use, although the interaction between education and residence does. The paper evaluates the hypothesis that traditional populations in the initial phase of their demographic transition resort to modern contraception in order to stop childbearing, when they have reached a desired number of children, rather than to space births or reduce their fertility.

PIP: The authors conclude that the determinants of contraceptive use among the rural population in Marrakech province, Morocco, were multiple and interrelated in complex ways. Birth control was a consequence of changes at both the individual and social levels. Findings indicate that women who had never used contraception had smaller family sizes than those women who used contraception. Contraceptive users had a significantly higher number of live births and living children. Child mortality was significantly greater among noncontracepting women. Contraceptive users had a significantly longer reproductive period than nonusers, which was attributed to a longer delay in the last live birth. Logistic models show that significant independent predictors of contraceptive use were the number of live births, the number of children who died before the age of 5, the age of the mother, the type of marriage, and the age at first marriage. The probability of access to contraceptives decreased with under-5 mortality, female age, marriage age, and increases in polygynous unions. This model explained 63.9% of the variance. Although residence and educational level did not significantly increase the fit of the model, the probability of contraceptive use did increase in relation to urban residence and a basic educational level. The number of live children was a predictor of contraceptive use but the best predictor of contraceptive use was family size (65.8%). The probability of contraceptive use increased among women with three or more children. Female education had no independent predictive impact on contraceptive use. Contraceptive use increased among women in polygynous unions, regardless of residence or schooling.

Some recent trends in infant mortality in the province of Marrakech, Morocco: a demographic transition in process.

PIP: 2 studies designed to appraise fecundity and mortality were carried out in Morocco in 1983 and 1984, on samples of 3,000 and 5,000 women respectively, in the city and in the province of Marrakech. Infant mortality was studied using the biometric method of J. Bourgeois-Pichat. The 1st results presented in this article highlight the absence of excess exogenous mortality among women under 30 years of age living in a provincial urban environment and among women from the city of Marrakech whose husbands were employed in service activities. 1st, this points to a link between the level of exogenous mortality and the standard of living of the population. In the city, exogenous mortality varies according to the occupation of the head of the family, an important factor in estimating its economic level. In the province one can assume that the standard of living of women from urban areas is higher than in the country. Moreover, small urban centers benefit from a larger infrastructure with easier access to medical care. 2nd, mortality has declined among young women. This result is certainly closely linked to the improvement of living conditions in Morocco over the last 2 decades. It is therefore reasonable to consider that a demographic transition is taking place, one which impacts on the level and structure of infant mortality.^ieng