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Contraceptive Use Measured in a National Population–Based Approach: Cross-Sectional Study of Administrative Versus Survey Data
No full textBackground: Prescribed contraception is used worldwide by over 400 million women of reproductive age. Monitoring contraceptive use is a major public health issue that usually relies on population-based surveys. However, these surveys are conducted on average every 6 years and do not allow close follow-up of contraceptive use. Moreover, their sample size is often too limited for the study of specific population subgroups such as people with low income. Health administrative data could be an innovative and less costly source to study contraceptive use.
Objective: We aimed to explore the potential of health administrative data to study prescribed contraceptive use and compare these data with observations based on survey data.
Methods: We selected all women aged 15-49 years, covered by French health insurance and living in France, in the health administrative database, which covers 98% of the resident population (n=14,788,124), and in the last French population–based representative survey, the Health Barometer Survey, conducted in 2016 (n=4285). In health administrative data, contraceptive use was recorded with detailed information on the product delivered, whereas in the survey, it was self-declared by the women. In both sources, the prevalence of contraceptive use was estimated globally for all prescribed contraceptives and by type of contraceptive: oral contraceptives, intrauterine devices (IUDs), and implants. Prevalences were analyzed by age.
Results: There were more low-income women in health administrative data than in the population-based survey (1,576,066/14,770,256, 11% vs 188/4285, 7%, respectively; P<.001). In health administrative data, 47.6% (7034,710/14,770,256; 95% CI 47.6%-47.7%) of women aged 15-49 years used a prescribed contraceptive versus 50.5% (2297/4285; 95% CI 49.1%-52.0%) in the population-based survey. Considering prevalences by the type of contraceptive in health administrative data versus survey data, they were 26.9% (95% CI 26.9%-26.9%) versus 27.7% (95% CI 26.4%-29.0%) for oral contraceptives, 17.7% (95% CI 17.7%-17.8%) versus 19.6% (95% CI 18.5%-20.8%) for IUDs, and 3% (95% CI 3.0%-3.0%) versus 3.2% (95% CI 2.7%-3.7%) for implants. In both sources, the same overall tendency in prevalence was observed for these 3 contraceptives. Implants remained little used at all ages, oral contraceptives were highly used among young women, whereas IUD use was low among young women.
Conclusions: Compared with survey data, health administrative data exhibited the same overall tendencies for oral contraceptives, IUDs, and implants. One of the main strengths of health administrative data is the high quality of information on contraceptive use and the large number of observations, allowing studies of subgroups of population. Health administrative data therefore appear as a promising new source to monitor contraception in a population-based approach. They could open new perspectives for research and be a valuable new asset to guide public policies on reproductive and sexual health
Interroger (et s’interroger sur) les trajectoires administratives des immigré·es dans l’enquête Trajectoires et Origines 2 (TeO2)
No full textCe document de travail interroge la qualité des réponses sur la trajectoire légale des immigré·es enregistrée dans l'enquête Trajectoires et Origines 2 (2019-2020). Répondre à des questions sur sa trajectoire légale peut susciter de la défiance quand le parcours migratoire a été marqué par des épisodes de précarité administrative (biais de désirabilité sociale). Renseigner sa trajectoire légale peut aussi être difficile si la migration est ancienne (biais mémoriel), ou si la personne n'a pas effectué ses démarches elle-même (biais de non-proactivité). L'étude montre que ces biais sont faibles : les données montrent de faibles taux de non-réponse et une remarquable cohérence interne et externe des réponses. L'absence de réponse, ou encore des réponses incohérentes, peuvent être attribuées à la difficulté de se souvenir des événements ou de saisir certains termes techniques du vocabulaire administratif. Elles peuvent aussi être liées au désir de contrôler son récit migratoire dans un contexte de déclassement social en migration. Ces résultats informent sur la manière dont les immigré·es s'emparent des catégories administratives liées au séjour, suggérant qu'ils et elles ont plus d'expertise et moins de défiance à les rapporter que nous aurions pu le supposer. Ils soulignent que le statut légal devrait être plus souvent inclus dans les enquêtes, ce qui permettrait d'améliorer la théorisation des expériences des immigré·es
Potential population-level effects of HIV self-test distribution among key populations in Côte d'Ivoire, Mali, and Senegal: a mathematical modelling analysis
No full textBackground
During 2019–21, the AutoTest VIH, Libre d'accéder à la connaissance de son Statut (ATLAS) programme distributed around 380 000 HIV self-testing kits to key populations, including female sex workers, men who have sex with men, and their partners, in Côte d'Ivoire, Mali, and Senegal. We aimed to estimate the effects of the ATLAS programme and national scale-up of HIV self-test distribution on HIV diagnosis, HIV treatment coverage, HIV incidence, and HIV-related mortality.
Methods
We adapted a deterministic compartmental model of HIV transmission in Côte d'Ivoire, parameterised and fitted to country-specific demographic, behavioural, HIV epidemiological, and intervention data in Côte d'Ivoire, Mali, and Senegal separately during 1980–2020. We simulated dynamics of new HIV infections, HIV diagnoses, and HIV-related deaths within scenarios with and without HIV self-test distribution among key populations. Models were separately parameterised and fitted to country-specific sets of epidemiological and intervention outcomes (stratified by sex, risk, age group, and HIV status, if available) over time within a Bayesian framework. We estimated the effects on the absolute increase in the proportion of people with HIV diagnosed at the end of 2021 for the ATLAS-only scenario and at the end of 2028 and 2038 for the HIV self-testing scale-up scenario. We estimated cumulative numbers of additional HIV diagnoses and initiations of antiretroviral therapy and the proportion and absolute numbers of new HIV infections and HIV-related deaths averted during 2019–21 and 2019–28 for the ATLAS-only scenario and during 2019–28 and 2019–38 for the HIV self-testing scale-up scenario.
Findings
Our model estimated that ATLAS could have led to 700 (90% uncertainty interval [UI] 500–900) additional HIV diagnoses in Côte d'Ivoire, 500 (300–900) in Mali, and 300 (50–700) in Senegal during 2019–21, a 0·4 percentage point (90% UI 0·3–0·5) increase overall by the end of 2021. During 2019–28, ATLAS was estimated to avert 1900 (90% UI 1300–2700) new HIV infections and 600 (400–800) HIV-related deaths across the three countries, of which 38·6% (90% UI 31·8–48·3) of new infections and 70·1% (60·4–77·3) of HIV-related deaths would be among key populations. ATLAS would avert 1·5% (0·8–3·1) of all HIV-related deaths across the three countries during this period. Scaling up HIV self-testing would avert 16·2% (90% UI 10·0–23·1) of all new HIV infections during 2019–28 in Senegal, 5·3% (3·0–8·9) in Mali, and 1·6% (1·0–2·4) in Côte d'Ivoire. HIV self-testing scale-up among key populations was estimated to increase HIV diagnosis by the end of 2028 to 1·3 percentage points (90% UI 0·8–1·9) in Côte d'Ivoire, 10·6 percentage points (5·3–16·8) in Senegal, and 3·6 percentage points (2·0–6·4) in Mali.
Interpretation
Scaling up HIV self-test distribution among key populations in western Africa could attenuate disparities in access to HIV testing and reduce infections and deaths among key populations and their partners
Infant feeding practices and body mass index up to 7.5 years in the French nationwide ELFE study
No full textBACKGROUND/OBJECTIVES: The infant diet represents one of the main modifiable determinants of early growth. This study aimed to investigate the associations of infant feeding practices with body mass index (BMI) until 7.5 years.
SUBJECTS/METHODS: Analyses were based on data from the French nationwide ELFE birth cohort. Data on breastfeeding (BF) and complementary feeding (CF) were collected monthly from 2 to 10 months. Infant feeding practices were characterized using principal component analyses (PCA) and hierarchical ascendant classification. BMI z-score was computed at 1, 2, 3, 5 and 7.5 years, from data collected in the child's health booklet; 7.5-year overweight was defined according to IOTF references. Associations between infant feeding practices and BMI were investigated by linear regression models adjusted for main confounders.
RESULTS: Ever breastfeeding was not associated with BMI up to 7.5 years. Compared to intermediate breastfeeding duration (1 to <3 months), longer breastfeeding duration (≥6 months) was related to lower 1-year BMI, but not at older ages. Compared to the recommended age at CF introduction (4-6 months), early CF (<4 months) was related to higher BMI up to 5 years with a similar trend at 7.5 years, but not to the risk of overweight. The PCA patterns characterized by early baby cereal introduction and late food pieces introduction or by frequent intake of main food groups were related to a lower BMI up to 7.5 years.
CONCLUSION: Breastfeeding was related with a lower BMI in infancy but not thereafter, whereas an early CF initiation (<4 months) was associated with a higher BMI in childhood
Victim of Abuse, Violence, or Harm?
No full textThe language used to describe the embodied experience of “victims of gender-based violence” is contested and evolving. Descriptions of violence are shaped by socio-historic context and by academic, media, and legal discourses. These in turn inform and delimit the production of knowledge. Yet victims themselves may struggle to recognise their experience in these words. We explore how lexical choices in French and in English construct and categorise individuals who experience sexual and domestic violence. We call for a more radical commitment to reflexively naming, collecting, and publishing data, and for the direct involvement of individuals with lived experience in shaping that work
Surmortalité des filles de moins de 5 ans en Afrique de l'Ouest et Centrale : biais de données ou phénomène réel?
No full textLes études qui portent sur les préférences de sexe et leurs implications sur la santé des petites filles se concentrent sur les pays d’Asie. En Afrique de l’ouest et centrale, la mortalité des enfants est encore élevée, la discrimination féminine en matière de santé peut sembler négligeable, et lorsque des niveaux anormaux de mortalité des filles sont observés, la fiabilité des données est mise en cause. Pourtant, il existe bien des inégalités de genre. L'objectif de cette communication est de s’appuyer sur diverses sources de données (recensements, estimations UN-IGME) pour identifier d’éventuels déséquilibres entre les sexes dans : (1) la population et (2) la mortalité infanto-juvénile. En effet, alors que la mortalité des filles devrait être inférieure à celle des garçons, on observe dans plusieurs pays de la région des rapports de masculinité qui augmentent au fil des jeunes âges et une surmortalité des filles dans la période infanto-juvénile
Le déclin urbain comme question sociale. Une analyse des dynamiques contrastées des villes moyennes
No full textCet article analyse les transformations sociodémographiques des villes moyennes depuis 1968 et s’intéresse plus particulièrement au phénomène de déclin urbain qui concerne une partie d’entre elles. À partir des données des recensements de la population de 2007 et 2017, une classification des villes moyennes met en évidence les dynamiques contrastées qu’elles connaissent depuis les années 2000. La typologie ainsi obtenue est ensuite analysée au prisme des transformations sociodémographiques de 1968 à 2017 des différentes classes qui la composent. Nous montrons que le déclin urbain concerne prioritairement les villes moyennes situées dans le centre et le nord-est de la France, caractérisées par une spécialisation ancienne dans la production industrielle. Nous analysons, ensuite, certaines conséquences de ces dynamiques contrastées. Si celles-ci procèdent initialement des différences de spécialisation productive, elles tendent de plus en plus à distinguer les villes selon leur degré de paupérisation
The Social Differentiation of Access to Water in 19th & 20th Century Paris
No full textWater management in large cities depends on both their physical and social structures. In Paris, they interacted to limit and constraint access to water for large segment of the population for long period of time. The very unequal distribution of property in the city is central to understand the water regimes in Paris, and their evolution over time. In this text, we document the evolution of water systems in Paris in the 19th century, considering access to water (and its quality) as well as sewers necessary to get rid of soiled materials. Important social variations in the modalities of access to water within the city persisted for a long time. They were a consequence of choices made in organizing the distribution of water in the city
“These are just finishing our medicines”: older persons’ perceptions and experiences of access to healthcare in public and private health facilities in Uganda
No full textBackground
There is limited research on the experiences of access to medicines for non-communicable diseases (NCDs) in health facilities among older persons in Uganda. This paper explores the perspectives of older persons and healthcare providers concerning older persons’ access to essential medicines in Uganda.
Methods
It is based on qualitative data from three districts of Hoima, Kiboga, and Busia in Uganda. Data collection methods included seven (07) focus group discussions (FGDs) and eighteen (18) in-depth interviews with older persons. Nine (9) key informant interviews with healthcare providers were conducted. Deductive and inductive thematic analysis (using Health Access Livelihood Framework) was used to analyze the barriers and facilitators of access to healthcare using QSR International NVivo software.
Results
The key facilitators and barriers to access to healthcare included both health system and individual-level factors. The facilitators of access to essential medicines included family or social support, earning some income or Social Assistance Grants for Empowerment (SAGE) money, and knowing a healthcare provider at a health facility. The health system barriers included the unavailability of specialized personnel, equipment, and essential medicines for non-communicable diseases, frequent stock-outs, financial challenges, long waiting times, high costs for medicines for NCDs, and long distances to health facilities.
Conclusion
Access to essential medicines for NCDs is a critical challenge for older persons in Uganda. The Ministry of Health should make essential drugs for NCDS to be readily available and train geriatricians to provide specialized healthcare for older persons to reduce health inequities in old age. Social support systems need to be strengthened to enable older persons to access healthcare