Abstract
A recent study in French Guiana suggested that populations living in precarious neighborhoods were more at risk for Chikungunya CHIKV than those living in more privileged areas. The objective of the present study was to test the hypothesis that Zika virus (ZIKV) infection was more frequent in precarious pregnant women than in non-precarious pregnant women, as reflected by their health insurance status. A multicentric cross-sectional study was conducted in Cayenne hospital including ZIKV pregnant women with serological or molecular proof of ZIKV during their pregnancy between January and December 2016. Health insurance information was recorded at delivery, which allowed separating women in: undocumented foreigners, precarious but with residence permit, and non-precarious. A total of 6654 women were included. Among them 1509 (22,7%) had confirmed ZIKV infection. Most women were precarious (2275/3439) but the proportion of precarious women was significantly greater in ZIKV-confirmed 728/906 (80.4%) than the ZIKV-negatives 1747/2533 (69.0%), p<0.0001. There were 1142 women classified as non-precarious, 1671 were precarious legal residents, and 1435 were precarious and undocumented. Precariousness and undocumented status were associated with a higher prevalence of ZIKV during pregnancy (adjusted prevalence ratio = 1.59 (95%CI = 1.29-1.97), p<0.0001), (adjusted prevalence ratio = 1.5 (95%CI = 1.2-1.8), p<0.0001), respectively. These results illustrate that in French Guiana ZIKV transmission disproportionately affected the socially vulnerable pregnant women, presumably because of poorer housing conditions, and lack of vector control measures in poor neighborhoods.
Highlights
French Guiana (FG) is a French overseas territory in South America
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Precariousness and undocumented status were associated with a higher prevalence of Zika virus (ZIKV) during pregnancy (adjusted prevalence ratio = 1.59 (95%CI = 1.29–1.97), p
Summary
French Guiana (FG) is a French overseas territory in South America. It has the highest Gross Domestic Product per capita in South America, and attracts numerous migrants in search of better economic opportunities. In studies on health inequalities in French Guiana, being an immigrant is associated with poverty, vulnerability and difficulties in accessing care leading to poor health outcomes. With informal housing, lack of sanitation and presence of vector breeding places are especially suited for Aedes aegypti, the main vector for arboviruses in FG. This urban mosquito preferentially breeds around human dwellings, in outdoor water storage containers and in any recipient containing stagnant rain water. A recent study in French Guiana suggested that populations living in precarious neighborhoods were more at risk for Chikungunya CHIKV than those living in more privileged areas.
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