Risk factor of HIV in the Horn of Africa : a case control study in Djibouti and setting up an early warning system against outbreaks in limited ressources country

• Main Author: Ahmed, Ammar Abdo
• Other Authors: Epidémiologie des maladies infectieuses et modélisation (ESIM), Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Department of Epidemiology and Health Information, Ministry of Health- Djibouti, Université Pierre et Marie Curie - Paris VI, Antoine Flahault, Department of Health, Ministry of Health, Djibouti
• Format: Doctoral or Postdoctoral Thesis
• Language: French
• Published: HAL CCSD 2009
• Subjects: Epidemiology of HIV; Blood transfusion; Risk behavior; Early Warning System; Entomological surveillance; Khat-chewing; Épidémiologie du VIH; Transfusion sanguine; Comportements à risque; Système d'alerte précoce; surveillance entomologique; Choléra; Khat; Hygiène; [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie; Avian flu
• Online Access: https://theses.hal.science/tel-00813143; https://theses.hal.science/tel-00813143/document; https://theses.hal.science/tel-00813143/file/These_V0.pdf

This work was initially designed to identify risk factors that may be associated with the HIV epidemic in Djibouti. The value of this research led to the establishment of an epidemiological surveillance system for HIV. But we cannot develop an alone surveillance system without addressing the epidemiological surveillance system in its entirety. Which system suffered from a lack of resources, low adherence of the healthcare system and lack of political will to make it a tool for decision support. In this context, we conducted our research and we received all the political and technical support to meet this challenge in a developing country. With support from WHO, we have implemented a sentinel surveillance system for HIV that does not rely only risk group or limited area but on the general population through annual anonymous surveys noncorrelated. Actually, we move to the second generation surveillance. We have also established an integrated surveillance system for vaccinepreventable diseases (diphtheria, pertussis, neonatal tetanus, Poliomyelitis, Measles, Meningitis, Mumps and Rubella) and epidemic-prone diseases such as Cholera, Malaria, avian flu and hemorrhagic fevers. The surveillance approach is primarily a clinical or syndromic secondarily confirmed by biology. Two objectives have been attended: 1. Risk factors for HIV in Djibouti: This study found specific risk factors to our context; Khat consumption by the unemployed and blood transfusion are specifically associated with HIV infection in Djibouti. 2. Dynamics of the epidemic of cholera in the Horn of Africa (HoA), this study is nourished by a rich field experience that led to the monitoring of stowaways migrants of the cholera epidemic in the HoA. We discovered the emergence of a new serotype unknown in previous waves of cholera outbreaks. 11 In addition, we are not limited ourself in the establishment of a disease surveillance system on human level. We had been interested on vectors level. At Djibouti, vector-borne diseases constitute a public health ...