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Malgré de nombreux progrès, les maladies diarrhéiques demeurent la principale charge de morbidité chez l’enfant en milieu urbain d’Afrique subsaharienne. Dans ce contexte, la présente étude traite du rôle que joue l’environnement immédiat (du ménage et du quartier) sur la morbidité diarrhéique chez les enfants de 2 à 10 ans vivant dans l’agglomération de Dakar, la capitale du Sénégal. La recherche a adopté une approche de méthodes mixtes et a été menée en deux étapes. La première est quantitative et la seconde, qualitative. Les résultats montrent, premièrement, que les comportements individuels en termes de santé sont souvent une fonction de l’environnement immédiat. Ils révèlent aussi que les indicateurs statistiques couramment utilisés pour mesurer l’assainissement donnent, dans certains cas, une compréhension biaisée des conditions de vie des populations concernées. Ainsi, l’étude illustre comment la triangulation des approches quantitative et qualitative permet d’obtenir une image plus fiable de ces aspects et de pallier les sources de biais inhérentes à chacune des approches. Elle avance aussi les bénéfices liés au fait de baser la construction de l’instrument quantitatif sur un volet qualitatif exploratoire, afin de mieux adapter les informations chiffrées aux conditions spécifiques de vie des individus et des ménages., Despite much progress, diarrhoea and associated illnesses still represent the main burden of childhood morbidity in urban areas of Sub-Saharan Africa. In this context, the study presented here deals with the role played by the immediate environment (the household or neighbourhood) in diarrhoea-linked morbidity among children aged 2 to 10 living in the conurbation of Dakar, the capital of Senegal. The research used a mixed methods approach and was carried out in two stages, the first quantitative and the second qualitative. The findings show, firstly, that individual health behaviour is often a function of the immediate environment. They also reveal that the statistical indicators generally used to measure sanitation result in some cases in a skewed understanding of the living conditions of the populations concerned. The study illustrates how triangulation of quantitative and qualitative approaches enables the construction of a more reliable picture of these aspects, and serves to counteract the sources of inherent bias in each approach. It also provides evidence for the advantages of basing the design of quantitative tools on an exploratory qualitative study, so as to fine-tune statistical information to be in concert with the specific living conditions of individuals and households.

International audience; La mortalité maternelle est un problème majeur de santé publique en Afrique Sub-saharienne.Son taux est parmi les plus élevés au monde, de 70 à 100 fois plus que dans les pays industrialisés (Hill et al., 2007). Au Bénin, le rapport de mortalité maternelle atteint 397 décès maternels pour 100 000 naissances vivantes1. Malgré l’inscription de la baisse de la mortalité maternelle dans les Objectifs du Millénaire pour le Développement fixés par les Nations Unies et dont l’échéance était l’année 2015, les progrès ont été trop lents et les objectifs n’ont pas été atteints. La baisse de la mortalité maternelle y est globalement de moins de 1 % par an (Finlayson & Downe, 2013). Au Bénin, la mortalité maternelle a baissé de seulement environ 5 % sur les 10 dernières années (498 décès pour 100.000 naissances vivantes en 1996 et 397 en 2006).

International audience

This study aimed at describing the burden of malaria at delivery in a urban maternity in Senegal. We measured the prevalence of placental malaria infection. We described the association between placental malaria and low birth weight and the impact of chemoprophylaxis.Guediawaye is the most important suburb of the city of Dakar, Senegal, surrounded by a permanent marsh (niayes). Malaria in this area is hypo endemic transmission: 1 infective bite/person/year. An. arabiensis is the principal vector and P. falciparum (98%) the most frequent species. The Maternité Roi Baudoin in Guediawaye is the gynecologic and obstetrical reference centre of this area with more than 6000 deliveries/year.We carried out an exhaustive survey from August 98 to December 99 at the maternité Roi Baudoin in Guediawaye. The socio-demographic data, the clinical data and information about prophylaxy were collected by questionnary. For each woman at delivery, one placental apposition was carried out. Presence of trophozoïtes or schizontes indicated malaria placental infection.8310 women were included in the study. They were from 13 to 49 years old with an average age of 26.1; 28% were primigravidae. The prevalence of placental malaria infection was 8.1% (674/8310) [Ic95: 7.4-8.8%]. Schizontes were present in 80.5% of infected placenta. The prevalence was 8.8% within primigravidae group and 7.4% in the other parity groups, p = 0.28 (NS). Placental infection was present all the year long. However, there were important seasonal variations. The risk of placental infection increased during seasonal transmission (10%) compared to the period of low transmission (3%). The prevalence of placental malaria was lower in the group of women who declares regular chloroquine intake compared with those who declared taking no prophylaxy or irregular prophylaxy (RR = 0.78 [0.62-0.98]). The risk of low birth weight was of 1.9 [1.6-2.1] when the placenta was infected compared with non infected placenta.This study indicates that placental malaria infection is frequent in this low transmission area where more than 70% of women declared taking regular chloroquine. This observation could be explained by a resistance of P. falciparum to chloroquine or a poor observance of chemoprophylaxis.

The authors report the results of 4 sample surveys carried out in Equatorial Guinea and Cameroon in the Bonny's Bay area, to evaluate the main malarial indexes. In rural and semi-rural areas one notice a high rate of fever attacks and splenomegaly. Parasitaemia is more important in rural areas than in urban areas and is decreasing where the therapeutic pressure is strong and long-lasting. Immunological indexes are high everywhere.