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BACKGROUND: A steady decline in the number of cases of malaria was observed in the 2000s in French Guiana. This enabled regional health policies to shift their public health goal from control to elimination. To include inhabitants in this strategy, the main objective of this study was to describe knowledge about malaria, and related attitudes and practices in persons living in the French Guiana border. METHODS: We conducted a survey in people over 15 years old living in the twelve neighbourhoods of Saint-Georges de l'Oyapock with the highest malaria incidence. It comprised a 147-item questionnaire which collected data on socio-demographic characteristics and included a Knowledge Attitude and Practices survey on malaria. Knowledge-related data were studied using exploratory statistical methods to derive summary variables. A binary variable assessing level of knowledge was proposed and then assessed using exploratory approaches. RESULTS: The mean age of the 844 participants was 37.2 years [15.8], the male/female sex ratio was 0.8. In terms of nationality, 485 (57.5%) participants were Brazilian and 352 (41.7%) French. One third (305, 36.1%) spoke Brazilian Portuguese as their native language, 295 (34.9%) the Amerindian language Palikur, 36 (4.3%) French. The symptoms of malaria and prevention means were poorly known by 213 (25.2%) and 378 (44.8%) respondents, respectively. A quarter (206, 24.4%) did not know that malaria can be fatal. Overall, 251 people (29.7%) had an overall poor level of knowledge about malaria. Being under 25 years old, living in a native Amerindian neighbourhood, having an Amerindian mother tongue language, having risk behaviours related to gold mining were significantly associated with a poor level of knowledge. CONCLUSIONS: This study is the first to describe the poor level of knowledge about malaria in populations living in the malaria endemic border area along the Oyapock river in French Guiana. Results will allow to reinforce, to diversify and to culturally adapt prevention messages and health promotion to increase their effectiveness with a view to quickly reaching the goal of malaria elimination through empowerment.
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Malária , Grupo Social , Humanos , Feminino , Masculino , Adulto , Adolescente , Brasil , Diversidade Cultural , Etnicidade , Malária/epidemiologia , Malária/prevenção & controleRESUMO
Background: Influenza has been shown to increase the risk for severe bacterial infection, in the tropics the seasonality of influenza epidemics is less marked, and this may not be the case. Dengue is often followed by prolonged asthenia and some physicians hypothesized increased susceptibility to infections based on anecdotal observations. Design and Methods: Time series of influenza and dengue surveillance were confronted bacterial sepsis admissions to test the hypotheses. Monthly surveillance data on influenza and dengue and aggregated sepsis data in Cayenne hospital were matched between 24/10/2007 and 27/09/2016. An ARIMA (1,0,1) model was used. Results The series of the number of monthly cases of sepsis was positively associated with the monthly number of cases of influenza at time t (ß=0.001, p=0.0359). Forecasts were imperfectly correlated with sepsis since influenza is not the only risk factor for sepsis. None of the ARIMA models showed a significant link between the dengue series and the sepsis series. Conclusions: There was thus no link between dengue epidemics and sepsis, but it was estimated that for every 1,000 cases of flu there was one additional case of sepsis. In this tropical setting, influenza was highly seasonal, and improved vaccination coverage could have benefits on sepsis.
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To implement future malaria elimination strategies in French Guiana, a characterization of the infectious reservoir is recommended. A cross-sectional survey was conducted between October and December 2017 in the French Guianese municipality of St Georges de l'Oyapock, located along the Brazilian border. The prevalence of Plasmodium spp. was determined using a rapid diagnostic test (RDT) and a polymerase chain reaction (PCR). Demographic, house locations, medical history, and biological data were analyzed. Factors associated with Plasmodium spp. carriage were analyzed using logistic regression, and the carriage localization was investigated through spatial cluster analysis. Of the 1,501 samples analyzed with PCR, positive results totaled 90 and 10 for Plasmodium vivax and Plasmodium falciparum, respectively. The general PCR prevalence was 6.6% [5.3-7.9], among which 74% were asymptomatic. Only 13/1,549 were positive by RDT. In multivariate analysis, participants older than 15 years, living in a remote neighborhood, with a prior history of malaria, anemia, and thrombocytopenia were associated with an increased odds of Plasmodium spp. carriage. High-risk clusters of P. vivax carriage were detected in the most remote neighborhoods on the village outskirts and two small foci in the village center. We also detected a hot spot for both P. vivax and P. falciparum symptomatic carriers in the northwestern part of the village. The present study confirms a wide-scale presence of asymptomatic P. falciparum and P. vivax carriers in this area. Although they were more often located in remote areas, their geographic distribution was spatially heterogeneous and complex.
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Malária Falciparum/epidemiologia , Malária Vivax/epidemiologia , Plasmodium falciparum , Plasmodium vivax , Adolescente , Adulto , Brasil/epidemiologia , Criança , Pré-Escolar , Feminino , Guiana Francesa/epidemiologia , Humanos , Lactente , Masculino , Adulto JovemRESUMO
(1) Objectives: French Guiana is the French territory most affected by sickle cell disease (SCD). This study investigates the associations between different environmental factors relative to climate, infectious outbreaks, and emergency visits or weekly hospital admissions for vaso-occlusive crisis (VOC). The identification of risk factors would lead to better patient care and patient management, and more targeted prevention and therapeutic education for patients with SCD in French Guiana. (2) Methods: This study was performed using data collected from the medicalized information system and emergency medical records of Cayenne General Hospital, between 1 January 2010 and 31 December 2016. ARIMA models were used to investigate the potential impact of weather conditions and flu epidemics on VOC occurrence. (3) Results: During the study period, 1739 emergency visits were recorded among 384 patients, of which 856 (49.2%) resulted in hospitalization, 811 (46.6%) resulted in hospital discharge, and 72 (4.2%) in another orientation. Decreased temperature and decreased humidity were both independent factors associated with an increase of VOC cases (p = 0.0128 and p = 0.0004, respectively). When studying severe VOC (leading to hospitalization, with or without prior emergency visit), 2104 hospital admissions were recorded for 326 patients. The only factor associated with severe VOC, in the multivariate analysis, was flu epidemics (p = 0.0148). (4) Conclusions: This study shows a link between climate, flu epidemics, and VOC in French Guiana. Patient's awareness of risks related to climate and flu epidemics should be encouraged, as home prevention measures can help avoid painful crises. Moreover, physicians should encourage patients to get immunized for influenza every year.
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Anemia Falciforme/fisiopatologia , Progressão da Doença , Influenza Humana/complicações , Tempo (Meteorologia) , Anemia Falciforme/diagnóstico , Serviço Hospitalar de Emergência/estatística & dados numéricos , Epidemias , Guiana Francesa/epidemiologia , Hospitalização/estatística & dados numéricos , Humanos , Influenza Humana/epidemiologia , Análise Multivariada , Estudos Retrospectivos , Fatores de RiscoRESUMO
BACKGROUND: Prisoners in French Guiana, a French territory located in South America, have a HIV and hepatitis B prevalence of 4%. Body modifications such as penile implants, tattoos, and body piercings are common among detainees, increasing the risk of blood-borne virus transmission. METHODS: We conducted a cross-sectional randomised survey in which the primary objective was to estimate the prevalence of high risk 'bloody practices' (penile implants, tattoos, body piercings) in French Guiana's only correctional facility. The secondary objective was to describe the risk factors for penile implants, the procedures and motivations for insertion, the reported complications, their risk factors and adverse impact on condom use. RESULTS: Of the 221 male inmates interviewed, 19% had tattoos or body piercings while incarcerated, and 68% had penile implants, of which, 85% had been inserted inside the correctional facility. Addictive behaviors such as cannabis use and alcohol addiction (positive AUDIT-C score), early age at first sexual intercourse, and the number of incarcerations correlated positively with having inserted one or more penile implants while incarcerated. In contrast, having reported previous psychiatric hospitalizations and having a high knowledge score for HIV/AIDS and sexually transmitted infections (STIs) were negatively correlated with the insertion of penile implants while incarcerated. Penile implants were inserted in poor hygienic conditions, usually using the sharp lid of a canned food container, with 18% of early complications, mostly haemorrhage and edema. Condom use was negatively impacted for 52% of men with penile implants. CONCLUSIONS: Our results highlight the need for prevention interventions which should aim at increasing knowledge levels and at implementing comprehensive risk-reduction measures.
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Modificação Corporal não Terapêutica/estatística & dados numéricos , Infecções por HIV/transmissão , Prótese de Pênis , Infecções Sexualmente Transmissíveis/transmissão , Adolescente , Adulto , Piercing Corporal , Estudos Transversais , Guiana Francesa , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Prisioneiros , Prisões , Fatores de Risco , Assunção de Riscos , Inquéritos e Questionários , Tatuagem , Adulto JovemRESUMO
BACKGROUND: In French Guiana, health inequalities are patent for a broad range of pathologies for all age groups. The objective of the present study was to quantify the proportion of the population that had renounced care in the past year, to study predictive factors, and to compare results with other French territories. METHODS: A two-stage random sample of 2015 individuals aged 15 to 75 years was surveyed by telephone. A descriptive analysis of variables relative to renouncing care, use of health care, screening, and vaccination was initially performed. Multivariate analysis was then used to determine variables associated with renouncing care for financial reasons and renouncing for reasons linked to time were directly estimated using a Poisson model on weighted data. Variables with a significance level < 0.2 in the bivariate analysis were included in the full multivariate model. RESULTS: In French Guiana, during the past 12 months, 30.9% of surveyed persons renounced care whatever the type for financial reasons. Results of the multivariate analysis showed that gender, perceived financial situation, perceived health and complementary insurance status were independent predictive factors of care renouncement for financial reasons. Overall, 24% of the surveyed population declared having renounced to care for time-related motives. The independent predictors for time-related renouncing were different than those for renouncing care for financial reasons: a higher education level and a poor perceived health were independently associated with time-related renouncement; retired persons and students were found to renounce care less frequently than persons with a job. CONCLUSIONS: Renouncing for financial reasons, a major target of the 2016 health law, represented a public health problem in French Guiana. Renouncing for lack of time was an important motive for renouncing, which is aggravated by the insufficient number of health professionals, but may benefit from organizational solutions. There are avenues for improvement of health for the most vulnerable: promote health, act on risk factors, and facilitate the readability and accessibility of the health system. Recent reforms to stabilize health insurance may however have some adverse consequences for migrants.
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Disparidades em Assistência à Saúde/estatística & dados numéricos , Cobertura do Seguro/estatística & dados numéricos , Recusa do Paciente ao Tratamento/estatística & dados numéricos , Adolescente , Adulto , Idoso , Feminino , Guiana Francesa , Pesquisas sobre Atenção à Saúde , Gastos em Saúde/estatística & dados numéricos , Disparidades nos Níveis de Saúde , Humanos , Seguro Saúde/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Fatores Socioeconômicos , Inquéritos e Questionários , Fatores de Tempo , Migrantes/estatística & dados numéricos , Adulto JovemRESUMO
OBJECTIVE: The overall rate of suicide in French Guiana is estimated at 6 per 100,000, a rate that is lower than in mainland France. Given the frequent reports of suicide in Amerindian communities, our hypothesis was that this figure fails to capture a more contrasted reality. Our objective was to refine estimates and determine suicide rates in remote villages of French Guiana. METHODS: We included patients for whom a suicide attempt or suicide was mentioned in medical records. The Health centers were grouped into two zones according to geographical remoteness. RESULTS: The highest suicide rates observed in the remote Amerindian villages of Camopi and Trois Sauts were, respectively, 118 and 78/100,000. The median age at the time of suicide was significantly younger in remote zones [23 years (95% CI 21.59-25.06)] than in non-remote zones-[27 years (95% CI 24.47-29.31)]. The most frequent methods were hanging (78%) and intoxication (22%). CONCLUSIONS: The suicide rate in remote areas in French Guiana was eight times higher than in France. The suicide of young people in remote areas in French Guiana and specifically in Amerindian villages must be better understood and prevented with contextualized and adapted care.
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Causas de Morte , Indígenas Sul-Americanos/estatística & dados numéricos , Suicídio/estatística & dados numéricos , Adolescente , Adulto , Idoso , Criança , Feminino , Guiana Francesa/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Tentativa de Suicídio/estatística & dados numéricos , Adulto JovemRESUMO
Leptospirosis is a worldwide zoonotic bacterial infection with a rising incidence. French Guiana is mostly covered by Amazonian rain forest. Despite a potentially favorable environment, leptospirosis has been barely studied in French Guiana. The objective of this study was to describe the current trends of leptospirosis epidemiology in French Guiana. A cross-sectional study was performed in the two main hospitals of French Guiana. Cases of leptospirosis from 2007 to 2014 were retrospectively identified with a systematic screening of serological and polymerase chain reaction results to classify them as confirmed, probable, or excluded cases. Medical files were reviewed to collect epidemiological data. Among the 72 included patients, 55 (76.4%) cases were confirmed and 17 (23.6%) were probable. The median age was 39 years (range: 16-82 years) and the M/F sex ratio 6.2. Sixty-two (86.1%) patients required hospitalization, including 12 (16.7%) in the intensive care unit. Three (4.2%) patients died. The monthly distribution of cases was correlated with rainfall (P = 0.004) and moisture (P = 0.038). Professional exposure was frequently identified (especially gold mining and construction). Among 16 different serogroups identified by microagglutination test, Icterohaemorrhagiae was the most frequent (38.0%). This study revealed an epidemiology close to that observed in Brazilian regions, and professional and climatic risk factors. The high diversity of serogroups may reveal a complex environmental reservoir requiring further investigations. Only 20% of leptospirosis patients were suspected as such on hospital admission, thus emphasizing the need to inform local physicians.
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Leptospira/isolamento & purificação , Leptospirose/epidemiologia , Zoonoses/epidemiologia , Zoonoses/microbiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Animais , Clima , Estudos Transversais , Feminino , Guiana Francesa/epidemiologia , Hospitalização/estatística & dados numéricos , Humanos , Incidência , Leptospira/classificação , Leptospirose/diagnóstico , Leptospirose/mortalidade , Masculino , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase , Chuva , Estudos Retrospectivos , Fatores de Risco , Sorogrupo , Adulto JovemRESUMO
BACKGROUND: French Guiana is highly affected by HIV. The migrant population is particularly susceptible. The objective of this study was to evaluate the level of risk of HIV transmission and its perception among migrants in French Guiana and to identify predictive factors. METHODS: An HIV/AIDS Knowledge, Attitudes, Behaviors and Practices study was conducted in 2012 among migrants living in precarious neighborhoods of French Guiana. RESULTS: Of the 1039 participants surveyed, 893 were analyzed, of which 35.6% had risky sex during the past 12 months. Sexual risk taking was higher among the migrant population than in the general population. The predictors of sexual risk taking behavior were: younger age groups, males, having a job, not living with a spouse, having first had sex before age 16, using alcohol or drugs before sex, and having engaged in commercial sex recently. The factors associated with not being aware of one's risk were: being a woman, being from Guyana or Suriname, non-systematic use of condoms with a regular partner, and never or not recently having been tested for HIV. CONCLUSIONS: The results suggest there is still a need for information on HIV risks in a highly vulnerable population.