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  • Recent Demographic Developments in France: Life Expectancy Still Rising - F. Prioux
  • Strengths and Uncertainties of the French Annual Census Surveys - G. Desplanques

ARTICLES: Infectious diseases and public health in Africa

Malaria Resurgence in Senegal: Measuring Malaria Mortality in Mlomp - G. Duthé

  • Village Context and Health-Seeking Behaviour in the Fatick Region of Senegal - A. Franckel, F. Arcens, R. Lalou.
  • Chikungunya on Réunion Island: Social, Environmental and Behavioural Factors in an Epidemic Context - M. Setbon, J. Raude




Recent Demographic Developments in France: Life Expectancy Still Rising
France Prioux

The population of metropolitan France (mainland + Corsica) on 1 January 2008 is estimated at 61.88 million. The natural increase in 2007 was a still-robust 270,000, despite a moderate decline in births. The number of foreigners admitted as residents dipped slightly in 2006. The total fertility rate (TFR) fell 1% to 1.96 children per woman in 2007, but stayed above all the other values observed since 1975. Completed fertility decreased between the 1960 and 1969 cohorts, but should then stabilize at around 2 children per woman. The number of induced abortions held steady, but their frequency registered a further small increase in the youngest age group. The number of civil unions (PACSs) started rising sharply again. More than 90% of them concern opposite-sex couples. Nuptiality is down, the probability of marriage for the never-married having reached an all-time low. After the exceptional rise in divorces in 2005 due to the new legislation, their number declined to 131,300 in 2007, the same level as in 2004, and concerned around 132,000 underage children. Life expectancy at birth gained 0.4 years to 77.6 years for men and 0.3 years to 84.5 years for women in 2007. In the period 1995-2005, the main driver of the increase in female life expectancy was the decline in mortality at the oldest ages (around 80-85); for men, the most powerful factor was the reduction at ages 65-70.

Strengths and Uncertainties of the French Annual Census Surveys
Guy Desplanques

Since 2004, Insee has implemented a new population census method based on an annual sample survey of nearly nine million people. The first detailed results will be produced after completion of five consecutive surveys. Using data from four surveys, this article shows that in early 2006 the population enumerated using the new method is appreciably larger - by 540,000 - than the estimate based on the 1999 census. The disparity is greatest for the total female population and for the 5-19 and 55-84 age groups. The new census also over-estimates the number of 18-year-olds. For measurement of international migration flows (for which data are incomplete in France), the census supplements information from government sources, in particular thanks to the question on year of arrival in France. This question is subject to a high level of non-response, but comparison of the different surveys with each other and with the 1999 census yields indications on how to adjust the results accordingly. Lastly, because it records household family structure, the new census enables fertility to be measured using the own children method. In spite of slight under-estimation, this method is effective for measuring disparities in fertility resulting from life course changes. The results confirm that immigrant fertility is low in the years before arrival in France but, through a catch-up effect, high in subsequent years. On a different level, the results suggest that the fertility increase of 2005 and 2006 is due partly to second and higher births.

Malaria Resurgence in Senegal: Measuring Malaria Mortality in Mlomp
Géraldine Duthé

Malaria is one of the leading causes of child mortality in sub-Saharan Africa. With the development of drug-resistant parasites, the fight against malaria has become complex, and because demographic and health data are scarce in the most hard-hit countries, the impact of the disease is difficult to evaluate. Demographic surveillance sites provide a means to measure levels and trends in mortality and causes of death. The data they provide are not exhaustive, however, for malaria in particular. At the Mlomp site in Senegal, information from inhabitants can be matched against data from local health facilities for more precise study of malaria mortality. From very low levels in the late 1980s, malaria mortality increased as the Plasmodium falciparum became resistant to chloroquine, the standard drug which, until then, had been an effective treatment. Although the introduction of new treatments in the early 2000s reduced diagnosed malaria mortality, the adoption of a broad definition of deaths attributable to malaria shows that the disease still accounts for a large share of mortality.

Village Context and Health-Seeking Behaviour in the Fatick Region of Senegal
A.Franckel - F.Arcens - R.Lalou

In the dense literature on health-seeking behaviour in the African rural environment, contextual aspects, and, more especially, differences between villages, are rarely studied. This article therefore considers the village or group of villages as an aggregate level of analysis, based on a study conducted in the Fatick region in Senegal. The descriptive results show significant variations in therapeutic practices, disease management and health care planning strategies from one village to the next. At different levels, individual health-seeking behaviours appear to be conditioned by a set of collective norms developed by the village community. The spatial analysis shows that these variations in behaviour describe two distinct geographic sets, distinguished by different levels of access to health facilities and different historical, social and cultural characteristics. These results challenge the validity of a unified approach to the African rural environment and call for further research to analyse the impact of numerous contextual, quantitative and qualitative factors on health-seeking behaviour.

Chikungunya on Réunion Island: Social, Environmental and Behavioural Factors in an Epidemic Context
Michel Setbon and Jocelyn Raude

Between March 2005 and May 2006, Réunion Island was hit by an epidemic of chikungunya which affected 260,000 people (38% of the island’s population). Chikungunya is a viral disease transmitted through mosquito bites for which there is no effective treatment. A socio-epidemiological survey was conducted in May 2006 on a representative sample of the population (N = 1,035) which aimed to identify the factors related to high probability of contamination: on the one hand, objective socio-economic, demographic and environmental factors, and on the other hand, subjective factors such as perceptions of risk, the disease and the available methods of protection, knowledge and beliefs about the origin of the disease and how it is transmitted, attitudes and protection methods employed. This analysis shows that contamination is significantly linked to: 1) a socio-economic status characterizing disadvantaged people living in individual houses with gardens; 2) the existence of "alternative" (not scientifically proven) beliefs which, along with a fatalistic attitude, create a sense of being powerless to prevent contamination. As far as behaviours are concerned, only the frequent use of repellent sprays and creams was found to be positively associated with a reduced probability of contamination. In sum, factors such as socio-economic conditions, place of residence, belief systems and behaviours were all closely interdependent, forming socio-cultural models that were more or less favourable to contamination.

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