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Nacher M, Basurko C, Osei L, Thomas N, Louis A, Leneuve M, Dotou D, Tosi A, Lambert V, Monjardé E, Muhigirwa GB, Elenga N, Hcini N. Timing of infant mortality in French Guiana: The persistence of high post neonatal mortality. JOURNAL OF EPIDEMIOLOGY AND POPULATION HEALTH 2024; 72:202535. [PMID: 38851108 DOI: 10.1016/j.jeph.2024.202535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 03/25/2024] [Accepted: 04/05/2024] [Indexed: 06/10/2024]
Abstract
BACKGROUND Infant mortality in French Guiana, a French overseas territory, is 2.7 times greater than in mainland France. Given the importance of better understanding infant mortality we aimed to describe the early & late neonatal, and postneonatal mortality in French Guiana between 2007 and 2022. METHODS We used data from the Institut National de la Statistique et des Etudes Economiques to describe trends and performed survival analysis. RESULTS Overall, there were 1 073 deaths before one year of age, of which 297 (27.7 %) occurred on the first day of life. The overall proportion of early neonatal deaths was 47.1 %, late neonatal deaths was 17.3 %, and post-neonatal deaths was 35.6 %. The overall incidences were 4.6 per 1,000 for early neonatal mortality, 1.4 per 1,000 for late neonatal mortality, and 3.1 per 1,000 for post neonatal mortality. The incidence for infant mortality for French Guiana residents was thus 9.1 per 1,000. CONCLUSIONS We show that post neonatal deaths in French Guiana are proportionally greater than in mainland France and they do not seem to decline, as they did in France. The relative proportions of post-neonatal mortality can thus help to identify important areas for action to correct excess infant mortality. Although poor pregnancy follow-up remains a problem we show that follow-up of infants is also a pressing problem that warrants increased efforts.
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Affiliation(s)
- Mathieu Nacher
- CIC INSERM 1424, Centre Hospitalier de Cayenne, 97300 Cayenne, French Guiana, France; Universite de Guyane, 97300 Cayenne, French Guiana, France; Amazonian Infrastructures for Population Health, 97300 Cayenne, French Guiana, France.
| | - Celia Basurko
- CIC INSERM 1424, Centre Hospitalier de Cayenne, 97300 Cayenne, French Guiana, France
| | - Lindsay Osei
- Pediatrics department, Centre Hospitalier de Cayenne, 97300 Cayenne, French Guiana, France; Protection Maternelle et Infantile, 97300 Cayenne, French Guiana, France
| | - Nadia Thomas
- Departement des centres délocalisés de prévention et de soins, Centre Hospitalier de Cayenne, 97300 Cayenne, French Guiana, France
| | - Alphonse Louis
- Service de Gynécologie Obstétrique, Centre Hospitalier de Cayenne, 97300 Cayenne, French Guiana, France
| | - Malika Leneuve
- Service de Gynécologie Obstétrique, Centre Hospitalier de Cayenne, 97300 Cayenne, French Guiana, France
| | - Dominique Dotou
- Service de Gynécologie Obstétrique, Centre Hospitalier de Cayenne, 97300 Cayenne, French Guiana, France
| | - Alice Tosi
- Registre des Handicaps de l'Enfant et observatoire de la périnatalité, Centre Hospitalier de Cayenne, 97300 Cayenne, French Guiana, France
| | - Veronique Lambert
- Western French Guiana Hospital, Saint Laurent du Maroni, 97320, French Guiana, France
| | | | | | - Narcisse Elenga
- Pediatrics department, Centre Hospitalier de Cayenne, 97300 Cayenne, French Guiana, France
| | - Najeh Hcini
- Western French Guiana Hospital, Saint Laurent du Maroni, 97320, French Guiana, France
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Nacher M, Lucarelli A, Van-Melle A, Basurko C, Rabier S, Chroum M, Santana T, Verin K, Bienvenu K, El Guedj M, Vaz T, Cisse H, Epelboin L, Le Turnier P, Abboud P, Djossou F, Pradinaud R, Adenis A, Couppié P. Forty Years of HIV Research in French Guiana: Comprehend to Combat. Pathogens 2024; 13:459. [PMID: 38921756 PMCID: PMC11206598 DOI: 10.3390/pathogens13060459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 05/10/2024] [Accepted: 05/17/2024] [Indexed: 06/27/2024] Open
Abstract
The drivers of the HIV epidemic, the viruses, the opportunistic infections, the attitudes and the resources allocated to the fight against HIV/AIDS, vary substantially across countries. French Guiana, at the crossroads between Amazonian South America and the Caribbean, constitutes a singular context with poor populations and rich country health funding, which has allowed researchers to gather lots of information on the particulars of our epidemic. We aimed to focus on the little known story of forty years of HIV research in French Guiana and emphasize how local research intertwined with public health action has yielded continuous progress, despite the difficult social conditions of the affected population. We searched Web of Science and associated local experts who worked through much of the epidemic in selecting the most meaningful products of local research for clinical and public health outcomes in French Guiana. Research tools and facilities included, from 1991 onwards, the HIV hospital cohort and the HIV-histoplasmosis cohort. Ad hoc studies funded by the ANRS or the European Regional Development fund shed light on vulnerable groups. The cumulative impact of prospective routine collection and focused efforts has yielded a breadth of knowledge, allowing for informed decisions and the adaptation of prevention, testing and care in French Guiana. After this overview, we emphasize that the close integration of research and public health was crucial in adapting interventions to the singular context of French Guiana.
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Affiliation(s)
- Mathieu Nacher
- Comité de Coordination Régionale de la Lutte contre le VIH et les IST, Centre Hospitalier de Cayenne, 97300 Cayenne, French Guiana; (A.L.); (S.R.); (M.C.); (T.S.); (K.V.); (K.B.); (A.A.)
- Centre d’Investigation Clinique INSERM 1424, Centre Hospitalier de Cayenne, 97300 Cayenne, French Guiana; (A.V.-M.); (C.B.)
- Département Formation Recherche en Santé, Université de Guyane, 97300 Cayenne, French Guiana;
- Institut Santé des Populations en Amazonie, Centre Hospitalier de Cayenne, 97300 Cayenne, French Guiana
| | - Aude Lucarelli
- Comité de Coordination Régionale de la Lutte contre le VIH et les IST, Centre Hospitalier de Cayenne, 97300 Cayenne, French Guiana; (A.L.); (S.R.); (M.C.); (T.S.); (K.V.); (K.B.); (A.A.)
| | - Astrid Van-Melle
- Centre d’Investigation Clinique INSERM 1424, Centre Hospitalier de Cayenne, 97300 Cayenne, French Guiana; (A.V.-M.); (C.B.)
| | - Célia Basurko
- Centre d’Investigation Clinique INSERM 1424, Centre Hospitalier de Cayenne, 97300 Cayenne, French Guiana; (A.V.-M.); (C.B.)
| | - Sébastien Rabier
- Comité de Coordination Régionale de la Lutte contre le VIH et les IST, Centre Hospitalier de Cayenne, 97300 Cayenne, French Guiana; (A.L.); (S.R.); (M.C.); (T.S.); (K.V.); (K.B.); (A.A.)
| | - Malorie Chroum
- Comité de Coordination Régionale de la Lutte contre le VIH et les IST, Centre Hospitalier de Cayenne, 97300 Cayenne, French Guiana; (A.L.); (S.R.); (M.C.); (T.S.); (K.V.); (K.B.); (A.A.)
| | - Thiago Santana
- Comité de Coordination Régionale de la Lutte contre le VIH et les IST, Centre Hospitalier de Cayenne, 97300 Cayenne, French Guiana; (A.L.); (S.R.); (M.C.); (T.S.); (K.V.); (K.B.); (A.A.)
| | - Karine Verin
- Comité de Coordination Régionale de la Lutte contre le VIH et les IST, Centre Hospitalier de Cayenne, 97300 Cayenne, French Guiana; (A.L.); (S.R.); (M.C.); (T.S.); (K.V.); (K.B.); (A.A.)
| | - Ketty Bienvenu
- Comité de Coordination Régionale de la Lutte contre le VIH et les IST, Centre Hospitalier de Cayenne, 97300 Cayenne, French Guiana; (A.L.); (S.R.); (M.C.); (T.S.); (K.V.); (K.B.); (A.A.)
| | - Myriam El Guedj
- Hôpital de Jour Adultes, Centre Hospitalier de Cayenne, 97300 Cayenne, French Guiana
| | - Tania Vaz
- Hôpital de Jour Adultes, Centre Hospitalier de Cayenne, 97300 Cayenne, French Guiana
| | - Hawa Cisse
- Hôpital de Jour Adultes, Centre Hospitalier de Cayenne, 97300 Cayenne, French Guiana
| | - Loïc Epelboin
- Service des Maladies Infectieuses et Tropicales, Centre Hospitalier de Cayenne, 97300 Cayenne, French Guiana; (L.E.); (P.L.T.); (P.A.); (F.D.)
| | - Paul Le Turnier
- Service des Maladies Infectieuses et Tropicales, Centre Hospitalier de Cayenne, 97300 Cayenne, French Guiana; (L.E.); (P.L.T.); (P.A.); (F.D.)
| | - Philippe Abboud
- Service des Maladies Infectieuses et Tropicales, Centre Hospitalier de Cayenne, 97300 Cayenne, French Guiana; (L.E.); (P.L.T.); (P.A.); (F.D.)
| | - Félix Djossou
- Service des Maladies Infectieuses et Tropicales, Centre Hospitalier de Cayenne, 97300 Cayenne, French Guiana; (L.E.); (P.L.T.); (P.A.); (F.D.)
| | - Roger Pradinaud
- Service de Dermatologie Vénéréologie, Centre Hospitalier de Cayenne, 97300 Cayenne, French Guiana;
| | - Antoine Adenis
- Comité de Coordination Régionale de la Lutte contre le VIH et les IST, Centre Hospitalier de Cayenne, 97300 Cayenne, French Guiana; (A.L.); (S.R.); (M.C.); (T.S.); (K.V.); (K.B.); (A.A.)
- Centre d’Investigation Clinique INSERM 1424, Centre Hospitalier de Cayenne, 97300 Cayenne, French Guiana; (A.V.-M.); (C.B.)
- Département Formation Recherche en Santé, Université de Guyane, 97300 Cayenne, French Guiana;
- Institut Santé des Populations en Amazonie, Centre Hospitalier de Cayenne, 97300 Cayenne, French Guiana
| | - Pierre Couppié
- Département Formation Recherche en Santé, Université de Guyane, 97300 Cayenne, French Guiana;
- Institut Santé des Populations en Amazonie, Centre Hospitalier de Cayenne, 97300 Cayenne, French Guiana
- Service de Dermatologie Vénéréologie, Centre Hospitalier de Cayenne, 97300 Cayenne, French Guiana;
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Nacher M, Wang Q, Osei L, Faivre B, Elenga N, Adenis A, Deschamps N, Drak Alsibai K. Incidence of Pediatric Cancers in French Guiana: How Does It Compare to Global Estimates? Cancers (Basel) 2024; 16:1829. [PMID: 38791908 PMCID: PMC11120532 DOI: 10.3390/cancers16101829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Revised: 05/06/2024] [Accepted: 05/07/2024] [Indexed: 05/26/2024] Open
Abstract
French Guiana is a French territory in South America. The exposome of persons living there is quite different from that in mainland France and the ethnic make-up of the population is also quite different. Poverty is also widespread with difficulties in accessing care magnified by the low medical-professional density. In this singular context, we aimed to measure the incidence of pediatric cancers and to compare it with other continents. We used French Guiana's certified cancer registry to study this between 2003 and 2017. Incidences were standardized using the world population with three strata: 0-4 years, 5-9 years, and 10-14 years. There were 164 solid tumors or hematologic malignancies diagnosed in children under the age of 15 (92 in boys and 72 in girls). Over the study period, the standardized incidence rate was 14.1 per 100,000 among children aged under 15 years. There was no significant trend during the study period. The three most common causes of cancer were leukemias-mostly lymphoblastic-CNS tumors, and sarcoma. The standardized incidence of pediatric cancers in French Guiana was similar to those in Western Europe and North America. As others have discovered, we found that males tended to be more likely to develop cancer, notably leukemia, CNS tumors, sarcoma, and retinoblastoma. As elsewhere, the predominant cancer types changed with age. Our initial assumption was that given the singular context of French Guiana, there may have been differences in pediatric cancer incidences. Here we showed that overall, contrary to our assumption and to trends in tropical countries, the incidence of pediatric cancers was in a range between Western Europe and North America with some apparent but non-significant differences in the main types of cancers observed in global statistics. Quality cancer registry data in this tropical region confirm the suspicion that lower incidences in tropical low- and middle-income countries are likely to result from incomplete diagnosis and data collection.
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Affiliation(s)
- Mathieu Nacher
- Centre d’Investigation Clinique (INSERM 1424), Institut Santé des Populations en Amazonie, Centre Hospitalier de Cayenne, 97300 Cayenne, French Guiana;
- Université de Guyane, 97300 Cayenne, French Guiana;
| | - Qiannan Wang
- Registre des Cancers de Guyane, Centre Hospitalier de Cayenne, 97300 Cayenne, French Guiana; (Q.W.); (K.D.A.)
| | - Lindsay Osei
- Service de Pédiatrie, Centre Hospitalier de Cayenne, 97300 Cayenne, French Guiana; (L.O.); (B.F.)
| | - Benjamin Faivre
- Service de Pédiatrie, Centre Hospitalier de Cayenne, 97300 Cayenne, French Guiana; (L.O.); (B.F.)
| | - Narcisse Elenga
- Université de Guyane, 97300 Cayenne, French Guiana;
- Service de Pédiatrie, Centre Hospitalier de Cayenne, 97300 Cayenne, French Guiana; (L.O.); (B.F.)
| | - Antoine Adenis
- Centre d’Investigation Clinique (INSERM 1424), Institut Santé des Populations en Amazonie, Centre Hospitalier de Cayenne, 97300 Cayenne, French Guiana;
- Université de Guyane, 97300 Cayenne, French Guiana;
| | - Nathalie Deschamps
- Service de Neurologie, Centre Hospitalier de Cayenne, 97300 Cayenne, French Guiana;
| | - Kinan Drak Alsibai
- Registre des Cancers de Guyane, Centre Hospitalier de Cayenne, 97300 Cayenne, French Guiana; (Q.W.); (K.D.A.)
- Service d’Anatomo-Pathologie, Centre Hospitalier de Cayenne, 97300 Cayenne, French Guiana
- Centre de Ressources Biologiques Amazonie, Centre Hospitalier de Cayenne, 97300 Cayenne, French Guiana
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Osei L, Vignier N, Nacher M, Laumonnier J, Conan C, Clarke L, Koivogui A, Covis S, Valony L, Basurko C, Wiedner-Papin S, Prual A, Cardoso T, Leneuve-Dorilas M, Alcouffe L, Hcini N, Bernard S, Succo T, Vendittelli F, Elenga N. Small for Gestational Age Newborns in French Guiana: The Importance of Health Insurance for Prevention. Int J Public Health 2024; 69:1606423. [PMID: 38681119 PMCID: PMC11048969 DOI: 10.3389/ijph.2024.1606423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 02/06/2024] [Indexed: 05/01/2024] Open
Abstract
Objectives: Small for gestational age (SGA) newborns have a higher risk of poor outcomes. French Guiana (FG) is a territory in South America with poor living conditions. The objectives of this study were to describe risk factors associated with SGA newborns in FG. Methods: We used the birth cohort that compiles data from all pregnancies that ended in FG from 2013 to 2021. We analysed data of newborns born after 22 weeks of gestation and/or weighing more than 500 g and their mothers. Results: 67,962 newborns were included. SGA newborns represented 11.7% of all newborns. Lack of health insurance was associated with SGA newborns (p < 0.001) whereas no difference was found between different types of health insurance and the proportion of SGA newborns (p = 0.86). Mothers aged less than 20 years (aOR = 1.65 [1.55-1.77]), from Haiti (aOR = 1.24 [1.11-1.39]) or Guyana (aOR = 1.30 [1.01-1.68]) and lack of health insurance (aOR = 1.24 [1.10-1.40]) were associated with SGA newborns. Conclusion: Immigration and precariousness appear to be determinants of SGA newborns in FG. Other studies are needed to refine these results.
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Affiliation(s)
- Lindsay Osei
- Department of Pediatrics, Cayenne Hospital, Cayenne, French Guiana
- Centre d’Investigation Clinique Antilles Guyane, INSERM, Centre d’Investigation Clinique 1424, Cayenne Hospital, Cayenne, French Guiana
- Collectivité Territoriale de Guyane, Cayenne, French Guiana
| | - Nicolas Vignier
- Centre d’Investigation Clinique Antilles Guyane, INSERM, Centre d’Investigation Clinique 1424, Cayenne Hospital, Cayenne, French Guiana
- Hôpitaux Universitaires Paris Seine-Saint-Denis, Avicenne Hospital, Assistance Publique—Hôpitaux de Paris, Department of Infectious and Tropical Diseases, Bobigny, France
- Infection, Antimicrobials, Modelling, Evolution, Inserm Unité Mixte de Recherche 1137, Université Sorbonne Paris Nord, Unité de Formation et de Recherche Santé Médecine et Biologie Humaine, Paris, France
| | - Mathieu Nacher
- Centre d’Investigation Clinique Antilles Guyane, INSERM, Centre d’Investigation Clinique 1424, Cayenne Hospital, Cayenne, French Guiana
| | | | - Claude Conan
- Caisse Générale de Sécurité Sociale, Cayenne, French Guiana
| | | | - Akoï Koivogui
- Centre Régional de Coordination des Dépistages des Cancers Ile-de-France, Bondy, France
| | - Sabrina Covis
- Collectivité Territoriale de Guyane, Cayenne, French Guiana
| | - Luciano Valony
- Institut National des Statistiques et Études Économiques, Cayenne, French Guiana
| | - Célia Basurko
- Centre d’Investigation Clinique Antilles Guyane, INSERM, Centre d’Investigation Clinique 1424, Cayenne Hospital, Cayenne, French Guiana
| | | | - Alain Prual
- Collectivité Territoriale de Mayotte, Mamoudzou, Mayotte
| | | | - Malika Leneuve-Dorilas
- Centre d’Investigation Clinique Antilles Guyane, INSERM, Centre d’Investigation Clinique 1424, Cayenne Hospital, Cayenne, French Guiana
- Réseau Perinat Guyane, Cayenne, French Guiana
| | - Leslie Alcouffe
- Centre d’Investigation Clinique Antilles Guyane, INSERM, Centre d’Investigation Clinique 1424, Cayenne Hospital, Cayenne, French Guiana
- COREVIH Guyane, Cayenne Hospital, Cayenne, French Guiana
| | - Najeh Hcini
- Department of Obstetrics, Saint-Laurent-du-Maroni Hospital, Saint-Laurent-du-Maroni, French Guiana
| | | | - Tiphanie Succo
- Santé Publique France Regional Unit, Cayenne, French Guiana
| | - Françoise Vendittelli
- Université Clermont Auvergne, Centre Hospitalier Universitaire Clermont-Ferrand, Centre National de la Recherche Scientifique, SIGMA Clermont, Institut Pascal, Clermont-Ferrand, France
- Audipog, Université Claude Bernard Lyon 1, Lyon, France
| | - Narcisse Elenga
- Department of Pediatrics, Cayenne Hospital, Cayenne, French Guiana
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Nacher M, Basurko C, Douine M, Lambert Y, Rousseau C, Michaud C, Garlantezec R, Adenis A, Gomes MM, Alsibai KD, Sabbah N, Lambert V, Epelboin L, Sukul RG, Terlutter F, Janvier C, Hcini N. Contrasted life trajectories: reconstituting the main population exposomes in French Guiana. Front Public Health 2024; 11:1247310. [PMID: 38274531 PMCID: PMC10808558 DOI: 10.3389/fpubh.2023.1247310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 12/21/2023] [Indexed: 01/27/2024] Open
Abstract
In French Guiana, life expectancy is between 2 and 3 years below that of France, reflecting differences in mortality rates that are largely sensitive to primary healthcare and thus preventable. However, because poverty affects half of the population in French Guiana, global measurements of life expectancy presumably conflate at least two distinct situations: persons who have similar life expectancies as in mainland France and persons living in precariousness who have far greater mortality rates than their wealthier counterparts. We thus aimed to synthesize what is known about statistical regularities regarding exposures and sketch typical French Guiana exposomes in relation to health outcomes. We conducted a narrative review on common exposures in French Guiana and made comparisons between French Guiana and mainland France, between rich and poor in French Guiana, and between urban and rural areas within French Guiana. The most striking fact this panorama shows is that being a fetus or a young child in French Guiana is fraught with multiple threats. In French Guiana, poverty and poor pregnancy follow-up; renouncing healthcare; wide variety of infectious diseases; very high prevalence of food insecurity; psychosocial stress; micronutrient deficiencies; obesity and metabolic problems; and frequent exposure to lead and mercury in rural areas constitute a stunningly challenging exposome for a new human being to develop into. A substantial part of the population's health is hence affected by poverty and its sources of nutrition.
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Affiliation(s)
- Mathieu Nacher
- CIC INSERM, Centre Hospitalier de Cayenne, Cayenne, French Guiana
- Université de Guyane, Cayenne, French Guiana
- Amazonian Infrastructures for Population Health, Cayenne, French Guiana
| | - Célia Basurko
- CIC INSERM, Centre Hospitalier de Cayenne, Cayenne, French Guiana
- Amazonian Infrastructures for Population Health, Cayenne, French Guiana
| | - Maylis Douine
- CIC INSERM, Centre Hospitalier de Cayenne, Cayenne, French Guiana
- Université de Guyane, Cayenne, French Guiana
- Amazonian Infrastructures for Population Health, Cayenne, French Guiana
| | - Yann Lambert
- CIC INSERM, Centre Hospitalier de Cayenne, Cayenne, French Guiana
- Université de Guyane, Cayenne, French Guiana
- Amazonian Infrastructures for Population Health, Cayenne, French Guiana
| | - Cyril Rousseau
- Centres délocalisés de Prévention et de Soins, Centre hospitalier de Cayenne, Cayenne, French Guiana
| | - Celine Michaud
- Centres délocalisés de Prévention et de Soins, Centre hospitalier de Cayenne, Cayenne, French Guiana
| | - Ronan Garlantezec
- Épidémiologie et science de l’exposition en santé-environnement (Elixir), Institut de Recherche en Santé Environnement et Travail (IRSET), Rennes, France
- Santé publique et épidémiologie, CHU de Rennes, Rennes, France
| | - Antoine Adenis
- CIC INSERM, Centre Hospitalier de Cayenne, Cayenne, French Guiana
- Université de Guyane, Cayenne, French Guiana
- Amazonian Infrastructures for Population Health, Cayenne, French Guiana
| | | | - Kinan Drak Alsibai
- Amazonian Infrastructures for Population Health, Cayenne, French Guiana
- Centre de Ressources Biologiques Amazonie, Centre Hospitalier de Cayenne, Cayenne, French Guiana
| | - Nadia Sabbah
- Amazonian Infrastructures for Population Health, Cayenne, French Guiana
- Service d’endocrinologie diabétologie, Centre hospitalier de Cayenne, Cayenne, French Guiana
| | - Véronique Lambert
- Amazonian Infrastructures for Population Health, Cayenne, French Guiana
- Western French Guiana Hospital, Saint Laurent du Maroni, French Guiana
| | - Loïc Epelboin
- CIC INSERM, Centre Hospitalier de Cayenne, Cayenne, French Guiana
- Université de Guyane, Cayenne, French Guiana
- Amazonian Infrastructures for Population Health, Cayenne, French Guiana
- Service des Maladies Infectieuses et Tropicales, Centre hospitalier de Cayenne, Cayenne, French Guiana
| | | | - Fredrik Terlutter
- Western French Guiana Hospital, Saint Laurent du Maroni, French Guiana
| | - Caroline Janvier
- Service de Psychiatrie, Centre hospitalier de Cayenne, Cayenne, French Guiana
| | - Najeh Hcini
- Amazonian Infrastructures for Population Health, Cayenne, French Guiana
- Western French Guiana Hospital, Saint Laurent du Maroni, French Guiana
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Nacher M, Blanc J, Rabier S, Lucarelli A, Adenis A, Basurko C, Louis A, Dotou D, Leneuve M, Osei L, Elenga N, Hcini N. Thirty years of HIV pregnancies in French Guiana: prevention successes and remaining obstetrical challenges. Front Glob Womens Health 2024; 4:1264837. [PMID: 38234591 PMCID: PMC10791775 DOI: 10.3389/fgwh.2023.1264837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 12/13/2023] [Indexed: 01/19/2024] Open
Abstract
Introduction In a context of high HIV prevalence, poor pregnancy follow-up, frequent poverty, preeclampsia, and preterm delivery, we aimed to describe the characteristics and outcomes of pregnancies among women living with HIV in French Guiana. Methods A retrospective cohort study was conducted on HIV-infected pregnancies enrolled between January 1st 1992 to 31st July 2022. Overall, there were 1,774 pregnancies in 881 women living with HIV. Results For 75.1% of pregnancies, the HIV diagnosis was already known before pregnancy and in 67.6% of women, HIV follow-up predated pregnancy. Nearly half of women, 49.6%, only had one pregnancy since having been diagnosed with HIV. Although most women received antiretroviral therapy during pregnancy, for those with the available information we found only 48.5% had an undetectable viral load at delivery. Overall, 15.3% of pregnancies ended with an abortion. There were a total of 110 newborns infected with HIV representing an overall transmission rate of 6.2% (110/1,771). Between 1993 and 2002, the transmission rate was 34%, between 2003 and 2012 it was 1.3%, and between 2013 and 2022 it was 0.7%. Overall, in Cayenne, since 2008, 106 of 581 HIV-infected pregnancies (18.2%) with available information were premature before 37 weeks of pregnancy; of these, 33 (5.7%) were very preterm deliveries and 73 (13.3%) were late preterm deliveries. Over time, in Cayenne, preterm delivery declined significantly. Conclusions The present study emphasizes that, despite spectacular progress in reducing mother to child transmission, pregnancy outcomes among women living with HIV are still preoccupying with high incidence of preterm delivery and low birth weight. Teasing out what fraction is linked to HIV and what fraction is linked to social precariousness and poor follow-up was not possible in this study. Despite the high incidence of very preterm delivery recent progress suggests that coordination efforts to improve follow-up may also have improved obstetrical outcomes.
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Affiliation(s)
- Mathieu Nacher
- Centre d'Investigation Clinique INSERM 1424, Centre Hospitalier de Cayenne, Cayenne, French Guiana
- Amazonian Infrastructures for Population Health, Centre Hospitalier de Cayenne, Cayenne, French Guiana
- Département Formation Recherche Santé, Université de Guyane, Cayenne, French Guiana
| | - Julie Blanc
- Centre d'Investigation Clinique INSERM 1424, Centre Hospitalier de Cayenne, Cayenne, French Guiana
- Amazonian Infrastructures for Population Health, Centre Hospitalier de Cayenne, Cayenne, French Guiana
| | - Sebastien Rabier
- Amazonian Infrastructures for Population Health, Centre Hospitalier de Cayenne, Cayenne, French Guiana
- COREVIH Guyane, Centre Hospitalier de Cayenne, Cayenne, French Guiana
| | - Aude Lucarelli
- Amazonian Infrastructures for Population Health, Centre Hospitalier de Cayenne, Cayenne, French Guiana
- COREVIH Guyane, Centre Hospitalier de Cayenne, Cayenne, French Guiana
| | - Antoine Adenis
- Centre d'Investigation Clinique INSERM 1424, Centre Hospitalier de Cayenne, Cayenne, French Guiana
- Amazonian Infrastructures for Population Health, Centre Hospitalier de Cayenne, Cayenne, French Guiana
- Département Formation Recherche Santé, Université de Guyane, Cayenne, French Guiana
| | - Celia Basurko
- Centre d'Investigation Clinique INSERM 1424, Centre Hospitalier de Cayenne, Cayenne, French Guiana
- Amazonian Infrastructures for Population Health, Centre Hospitalier de Cayenne, Cayenne, French Guiana
- Département Formation Recherche Santé, Université de Guyane, Cayenne, French Guiana
| | - Alphonse Louis
- Service de Gynécologie Obstétrique, Centre Hospitalier de Cayenne, Cayenne, French Guiana
| | - Dominique Dotou
- Service de Gynécologie Obstétrique, Centre Hospitalier de Cayenne, Cayenne, French Guiana
| | - Malika Leneuve
- Service de Gynécologie Obstétrique, Centre Hospitalier de Cayenne, Cayenne, French Guiana
| | - Lindsay Osei
- Collectivité territoriale de Guyane, Protection Maternelle et Infantile, Cayenne, French Guiana
| | - Narcisse Elenga
- Amazonian Infrastructures for Population Health, Centre Hospitalier de Cayenne, Cayenne, French Guiana
- Service de Pédiatrie, Centre Hospitalier de Cayenne, Cayenne, French Guiana
| | - Najeh Hcini
- Amazonian Infrastructures for Population Health, Centre Hospitalier de Cayenne, Cayenne, French Guiana
- Service de Gynécologie Obstétrique, Centre Hospitalier de l’Ouest Guyanais, Saint Laurent du Maroni, French Guiana
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