[Safe motherhood: is the initiative an orphan?]. / Maternité sans risque: une initiative orpheline?

Ten years after the Safe Motherhood Initiative has been set up, maternal morbidity and mortality remain a major public health issue in most developing countries. This presentation reviews the background of the initiative and the strategies adopted in Nairobi. Then, it undertakes an analysis of recent developments in maternal health policies. The authors discuss the comparative impact on maternal mortality of efforts aimed at a global improvement of the socio-economic and educative status of women, family planning activities, traditional birth attendants training programmes, and antenatal care. They stress the importance of the effective accessibility to life saving obstetric. Finally, they advocate a major involvement by gynecologist-obstetricians in the development and in the implementation of safe motherhood programmes.

[European public health professionals express ten priorities for the European Union...to be followed]. / Des professionnels de santé publique européens pour experimer dix priorités pour l'Union européenne ... à suivre.

Even if the European Union acquired explicit competencies in public health with the Maastricht and Amsterdam Treaties (articles 129 and 152), public health professionals still have not had their word in the definition of public health priorities. Yet it is they, whatever their mission, who must take into consideration the new constraints imposed by Community directives. The French Society for Public Health (FSPH) took the initiative of running a project, financed by the European Commission, aiming to shed light on some of the public health problems considered priority in the 15 member states, and to provide suggestions for facing them. The FSPH adopted a resolutely participative and pragmatic process. At each step (definition of priorities and compiling arguments), the intention of the SFPH was more to allow different, even diverging, points of view to be expressed, than to aim for a hypothetical representativeness. The undertaken themes are the social gradients in health, alcohol, illicit drugs, tobacco, surveillance of health issues, quality of care, older persons, mental health, the environment, nutrition and food security. This work marks the wish of the FSPH for international openness toward Europe. The FSPH hopes that this work becomes a platform for the development of a reinforced dialogue between public health professionals and European decision makers.

[Obstacles and reticences in the screening of cancer of the cervix by the general practitioner]. / Obstacles et réticences au dépistage du cancer du col de l'utérus par le médecin généraliste.

To have a better understanding of the poor participation rate among general practitioners (GPs) in cervical cancer screening, we have conducted a survey in the department of Bas-Rhin on a small sample of GPs. This helped to explain how they perceived this technical act, the problems or barriers related to it: rate, function and status of general practitioner in the current health care system, the difficulty to combine the scientific and technical aspects of modern medicine with the need to care for the patients.

The cholera epidemic in Ecuador: towards an endemic in Latin America.

We present an epidemiological study of the first wave of cholera in Ecuador in 1991. One month after the 7th cholera pandemic hit the Pacific coast of Peru, the disease reached the coast of Ecuador and spread to the rest of the country within a few weeks. One year later, 46,320 cases have been notified, giving an incidence of 481 cases per 100,000 inhabitants. The overall mortality rate has been low (697 deaths, i.e. 1.50%), although there have been large differences between the various provinces: in the Andes (Sierra), for example, rates above 8% have been recorded. The first wave peaked about eight weeks after the first case, with 3400 new cases per week throughout the country. This was followed by a gradual decrease towards a baseline of 250-500 new cases per week. A resurgence was observed in most coastal and Andean provinces from November 1991 onwards. The kinetics of the epidemic are compatible with an endemic implantation of the disease in Ecuador, as is probably the case in the entire intertropical Pacific coast region of Latin America. From the data presented, the latin-american episode of the 7th pandemic starting on the Pacific coast, is characterized by a very high attack rate and a low mortality rate as compared to Africa, and the unexpected involvement of populations living on the high Andean plateaux. It is probable from the results collected in Ecuador that cholera will become endemic in Latin America.