L’épilepsie survient à tout âge, mais les causes, l’expression clinique, les complications et le retentissement social, sont fonction de l’âge des sujets. En Afrique subsaharienne, les données épidémiologiques, les données portant sur la scolarisation et le retentissement de l’épilepsie de l’enfant sont peu accessibles. Afin d’évaluer les aspects socioculturels et thérapeutiques de l’épilepsie de l’enfant au Gabon, nous avons réalisé une revue de la littérature sur l’épilepsie de l’enfant en Afrique subsaharienne et deux enquêtes transversales, l’une sur les connaissances, attitudes et pratiques et les représentations socioculturelles de l’épilepsie de l’enfant auprès des enseignants et des personnels de santé, l’autre sur la qualité de vie des enfants souffrant d’épilepsie et de leurs parents. En Afrique subsaharienne, les données sur l’épilepsie de l’enfant sont diluées dans les études étendues à la population entière. La prévalence de l’épilepsie de l’enfant varie de 2 à 297 ‰ et son incidence de 17 à 930 / 100 000 personnes-années. Les facteurs périnataux, les crises fébriles et les facteurs infectieux sont les plus décrits alors que les facteurs génétiques demeurent peu étudiés. La prise en charge de l’enfant reste limitée à cause de l’insuffisance des ressources humaines, des moyens diagnostics et de l’accès aux traitements antiépileptiques mais aussi à cause de la persistance des préjugés et des croyances négatives sur l’épilepsie communément retrouvées parmi les enseignants, les enfants en âge scolaire et dans la population. Les enfants épileptiques sont une source d’angoisse, de perturbations socioprofessionnelles et scolaires pour leurs parents et de leur fratrie. Les enquêtes ont retrouvé un niveau de connaissance bas, une persistance de croyances négatives, notamment celles qui considèrent l’épilepsie comme une affection contagieuse ou transmissible, une maladie psychiatrique ou un retard mental ou encore une maladie surnaturelle. Ces considérations rencontrées indifféremment en milieu urbain ou rural semblent tenir leur explication dans la conception culturelle de l’épilepsie qui renvoie cette maladie à une cause extérieure ; un animal ou un mauvais esprit. En milieu rural, les enfants n’ont généralement pas d’avis médical, mais la scolarisation reste supérieure à 50 % indépendamment de leur milieu de vie. La non-scolarisation est liée aux comorbidités, à l’attitude réfractaire des parents et de certains chefs d’établissements scolaires. L’anxiété, les troubles du comportement, les troubles cognitifs et les troubles de la sociabilité restent élevés. La qualité de vie des parents de l’enfant épileptique est altérée. Ce travail sera étendu à d’autres localités du Gabon pour inclure plus d’enfants épileptiques et mettre en place une cohorte. Cette cohorte pourra servir à l’évaluation de la fraction attribuable des infections (notamment celle du paludisme grave) dans la survenue de l’épilepsie ; l’évaluation du stigma chez l’enfant épileptique et leurs parents et à la mise en place de programmes d’éducation thérapeutique et de promotion de la santé auprès des familles, des enseignants et des personnels de santé. / Epilepsy occurs at any age, but the causes, clinical manifestations, complications and social impact, depend on the age of the subjects. In Sub-Saharan Africa epidemiological data, data on enrollment and the impact of the child's epilepsy are difficult to access. To assess the socio-cultural and therapeutic aspects of the child's epilepsy in Gabon, we conducted a review of the literature on child epilepsy in SSA and two cross-sectional surveys, one on knowledge, attitudes, practices and socio-cultural representations of childhood epilepsy in teachers and health workers, the other on the impact of epilepsy on the children with epilepsy and their parent. In SSA, the data on child epilepsy drowned in studies extended to the general community. The prevalence of childhood epilepsy varies from 2.04 to 297/1000 and its incidence from 17 to 930/100.000 person-years. Perinatal factors, febrile seizures and infectious factors are most described while genetic factors remain poorly studied. The care of the child remains limited due to the lack of human resources, diagnostic means and access to AEDs but also because of the persistence of prejudices and negative beliefs about epilepsy commonly found in teachers, school children and in the community. Children with epilepsy are a source of anxiety, disruption of socio-professional and academic activities for parents and their siblings. The surveys found a low level of knowledge, persistence of negative beliefs, including those that consider epilepsy as a contagious or communicable disease, psychiatric illness or mental retardation or a supernatural disease. These considerations found in urban and rural areas could be explained by the cultural conception of epilepsy that links the disease to an external cause, to an animal, or an evil spirit. In rural areas, children usually have no medical advice, but enrollment is still above 50% regardless of their living environment. Non-enrollment is related to comorbidities, the refractory attitude of parents and some school heads. Anxiety, behavioral disorders, cognitive disorders and disorders of sociability remain high. The quality of life of epileptic children's parents is impaired. This work will be extended to other areas to include more children with epilepsy and build a cohort. This cohort will be used to assess the attributable fraction of infections (including that of severe malaria) in the occurrence of epilepsy; to assess the stigma of epileptic children and their parents and to implement the therapeutic education programs and health promotion with families, teachers and health workers.

More than 30 years after the first case of HIV/AIDS was reported, the disease continues to pose challenges for governments and communities across the world, but particularly in Southern Africa. Response to the disease is hindered by contextual influences, which vary between countries and cultural groups. With HIV/AIDS, one size does not fit all. The complexity of this disease is still not fully understood and information regarding its spread and prevalence is often fluid and unreliable. Communities’ emotional reaction to HIV/AIDS, including stigmatising, plays a role in this scenario. FBOs (including churches) are uniquely positioned to provide HIV/AIDS education and prevention messages through their extensive networks that reach even the most remote villages. However, during the era of HIV/AIDS, FBOs or their members have been the target of criticism. They have been accused of promoting stigmatising and discriminatory attitudes based on fear and prejudice, of pronouncing harsh moral judgements on those infected and of reducing the issues of AIDS to mere moral issues. The primary research question in this research focused on determining the nature and extent of HIV/AIDS-related stigma reported by aspiring faith-based leaders. The study questionnaires were completed by aspiring faith-based leaders who participated in Choose Life training programmes. These aspiring faith-based leaders were used as an indirect measure of stigma in their respective FBOs. The assumption is made that the attitude of faith-based leaders may affect the communities they serve. A KAP survey was used to determine the knowledge, attitudes and practices within these organisations. A group of 133 aspiring faith-based leaders who attended a HospiVision training programme, Choose Life, participated in the study. Non-parametric tests were used in the analysis of the data. Test include Spearman Rho correlations, Kruskal-Wallis and Mann-Whitney. It was found that respondents are knowledgeable about HIV/AIDS. Despite their high level of knowledge, there is still fear and worry about sharing eating or drinking utensils with those infected. Unrealistic fear of HIV transmission is one of the building blocks of HIV-related stigma. Respondents were generally unaware of people living with the virus in their congregation. This demonstrates that disclosure of HIV status is relatively low. It may be a fear of stigma that represents a barrier to disclosure. A high percentage of respondents (44%) indicated that they would feel ashamed should the virus infect them or someone in their family (28%). They were, however, more accepting of other people who are infected (only 12% indicated PLWHA should be ashamed). These contradictions make it difficult to understand the level of stigmatising and the reasons behind the responses. In spite of prevention campaigns run by various organisations, stigma and discrimination still exist and this may hamper our response to the illness. The study was relatively small, but its results are similar to those of earlier studies conducted nationally among faith-based leaders. Stigma and discrimination remain factors that have to be considered in all programmes developed to address the current HIV crisis. Even when knowledge about the disease is significant and respondents are well educated, some stigma still prevails. FBOs are amongst the institutions in society that shape the values and attitudes that guide responses to illness and vulnerability and that support appropriate and compassionate responses. This research shows that FBOs have an important role to play in promoting religious beliefs that confront stigma and in encouraging positive dialogue to counter damaging thought patterns in communities. / Dissertation (MA)--University of Pretoria, 2013. / am2014 / Psychology / unrestricted

The presented thesis is focused on a comprehensive evaluation of situation related to the Tick-borne encephalitis on the territory of the Liberec Region in years 2001 2016. One of the main aims was to process the results of a demographic analysis of the Tick-borne encephalitis cases. These cases have been reported for 16 years within the so-called Tick-borne encephalitis surveillance to the system called EPIDAT by the Regional public health authority of the Liberec Region. Thank these analyzed data it was possible to create maps which illustrate particular focuses of the Tick-borne encephalitis in the Liberec Region and which graphically draw attention to locations threatened with infection. The KAP questionnaire study was held in a chosen Tick-borne encephalitis focus in order to improve a prevention of the Tick-borne encephalitis in the Region. This study was focused on knowledge, attitudes, opinions and practice of locals related to an occurrence of ticks and also of the Tick-borne encephalitis transmitted by them. Together with data gathering was held the distribution of the informative leaflets and also edification in this issue by a discussion about respondent´s questions. The collected data were processed by a descriptive method and also were detailed to a statistics testing. Due to an amount of analyzed information, this testing did not bring any statistic important results in most of the questions. The contribution of this thesis is especially the processed data of the Tick-borne encephalitis for those mentioned 16 years. These data could be useful for example for arguments of the public health authorities in case of discussion related to the Tick-borne encephalitis issue. The questionnaire study pointed out a problem which could cause a failure of people prevention. This problem means less of interest in health issues from their side. The question is how to learn population to perceive the risk of this disease when the half of the respondents do not feel threatened by the Tick-borne encephalitis? This fact is not certainly a problem only in the prevention of infectious diseases.