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The aim of this pilot study was to analyze the Hepatitis C Virus (HCV) genotypes circulating in Senegal among Drug User (DUs), using Dried Blood Spots (DBS) as RNA source for molecular assays. Heroin and/or cocaine users (n = 506) were recruited in Dakar from April to July 2011, using a Respondent Driven Sampling (RDS) method. DBS preparation consisted of five drops of whole blood from finger applied to a Whatman paper card. HCV infection was screened by the detection of anti-HCV antibodies, using a rapid immune-chromatographic test. HCV RNA was quantified on anti-HCV positive DBS, using the Abbott RealTime HCV® Genotyping was performed on DBS with detectable viral load with Versant® HCV Genotype 2.0 Assay (LiPA) and Abbott RealTime HCV Genotype II assay®. Among the 506 participants, 120 were tested as positive for anti-HCV antibodies and their samples were analyzed for HCV RNA viral load and genotype. Out of the 120 DBS tested, HCV RNA was detected on 25 (20.8%). The median viral load was 15,058 IU/ml (ranging from 710 to 766,740 IU/ml). All positive DBS were suitable for the genotyping assay, that showed a predominance of genotype 1 (21/25) including 16 genotypes 1a and 5 genotypes 1b. HCV genotype 1 prevails in a DU population in Dakar. DBS could be useful for HCV RNA genotyping, but optimal storage conditions should required avoiding RNA impairment. Acknowledging this limitation, DBS could be a great interest for detecting and genotyping HCV viremic patients. J. Med. Virol. 89:484-488, 2017. © 2015 Wiley Periodicals, Inc.

Inpatient mortality is an indicator of the quality of care. We analyzed the mortality of under 5-year-old hospitalized children in the pediatric ward of Aristide Le Dantec Hospital for updating our data 10 years after our first study.We analyzed the data of the children hospitalized between 1 January and 31 December 2012. For each child, we collected anthropometric measurements converted to a z-score related to World Health Organization growth data. Logistic regression-generating models built separately with different anthropometric parameters were used to assess the risk of mortality according to children's characteristics.Data from 393 children were included. The overall mortality rate was 10% (39/393). Using logistic regression, the risk factors associated with death were severe wasting (odds ratio [OR]=8.27; 95% confidence interval [95% CI]) [3.79-18], male gender (OR=2.98; 95% CI [1.25-7.1]), dehydration (OR=5.4; 95% CI [2.54-13.43]) in the model using the weight-for-height z-score; male gender (OR=2.5; 95% CI [1.11-5.63]), dehydration (OR=8.43; 95% CI [3.83-18.5]) in the model using the height-for-age z-score; male gender (OR=2.7; 95% CI [1.19-6.24]), dehydration (OR=7.5; 95% CI [3.39-16.76]), severe deficit in the weight-for-age z-score (OR=2.4; 95% CI [1.11-5.63]) in the model using the weight-for-age z-score; and male gender (OR=2.5; 95% CI [1.11-5.63]) and dehydration (OR=8.43; 94% CI [3.83-18.5]) in the last model with mid-upper arm circumference (MUAC). Dehydration and malnutrition were two independent risk factors of death. The protocols addressing dehydration and malnutrition management should be audited and performed systematically for each child's anthropometric measurements at admission.

In developing countries, maternal and neonatal mortality is high. Among the causes of death during the neonatal period, low birth weight is crucial. A dose of fluoride beyond 2mg/L causes enamel damage, possibly affecting the fetus. The aim of this study was to search for an association between dental fluorosis in the mother and low birthweight of the newborn.This was a case-control study performed in an endemic area in Senegal (Diourbel). It included 108 mothers who gave birth to newborns weighing less than 2500 g (cases) and 216 mothers with newborns weighing greater or equal to 2500 g (controls). Data on socio-demographic, lifestyle, history and pregnancy variables were collected. Those related to water consumption during pregnancy and dental fluorosis (Dean's index) were measured. The data were analyzed by R software. Logistic regression was used to identify associations and the statistical significance level was set to 0.05.The proportions of mothers consuming well water were 62% among cases versus 43.5% among controls. The score 4 of Dean's Index was reported for 25.9% of cases versus 6.9% of controls. The water consumed and the modal score of Dean's Index were significantly associated with the occurrence of low birthweight adjusted for gender, consanguinity, anemia and hypertension.Low birthweight was associated with pregnant women living in endemic areas. Defluoridation programs and access for pregnant women and children to high quality water are necessary in areas of endemic fluorosis.

Neonatal mortality is a major public health problem. The main causes are infections, prematurity and asphyxia at birth. In view of reducing this high mortality, primary healthcare facilities were equipped with basic equipment for the care of newborns and their key workers were trained in essential newborn care. Three years after this implementation, the present study assesses the state and conditions of use of this basic equipment intended for taking care of newborns at birth.This assessment was conducted from 16 March to 3 April 2009. It was based on observations and interviews on a sample of healthcare facilities.Healthcare facilities were generally equipped with ventilator bags and masks (87%) (60/69). In more than half of the healthcare centers (20/38), they were not used often because the workers were renewed and not educated in their use. They were practically all in good condition. Eighty-five percent (59/69) of healthcare facilities had at least one aspirator, generally adapted to newborns (negative pressure, 100 mmHg). The maintenance of the material was globally satisfactory because the aspirator bottles were most often clean. As for the aspirator tubes, they were always available but a few cases of supply rupture were observed in some healthcare centers. The warming table was available in only 52% (36/69) of healthcare facilities. Fifteen tables did not comply with initial specifications.This assessment highlights that the basic equipment intended for newborn care was generally available, functional and maintained well after 3 years. This strategy could be scaled up in order to contribute to reducing the newborn mortality.

A case-control study was conducted between September 2003 and January 2004. Fifty four newborn babies born before 37 weeks of gestation resulting from 47 pregnancies including 7 multiple pregnancies were compared to 105 newborn babies born between 37 and the 42 weeks of gestation. Parturient geographical origin, marital status, age, alcohol or tea consumption and height were not significantly associated to premature birth (p0.05). On the other hand, a higher parity or equal to 3, a number of antenatal care lower than 3 were significantly associated with the risk of premature birth (p0.05). But a gestity and a parity lower than 3 and a number of antenatal consultations higher or equal to 3 had a protective effect (OR1; p0.05). We recommend a reinforcement of malarial prevention during pregnancy according to WHO recommendations and the improvement of the quality of the antenatal care in the Ziguinchor medical district.

To evaluate early neonatal mortality at the University Teaching Hospital and assess changes in the rate and causes during the last ten years.We performed a retrospective analysis of neonatal deaths recorded at the Neonatal and Premature Unit (NPU) in 2003. The results were compared with earlier evaluations. Comparison of proportions was used for statistical analysis to eliminate the random element in rate variations. The significance threshold wasor =5%.We registered 364 neonatal deaths: 243 among 4853 newborns in our maternity ward and 121 among 213 newborns transferred from a referring maternity. Early neonatal mortality rate 45.5 per 1,000 live births. Mortality particularly concerned newborns with a birth weightor =2,500 grams (66%) and Apgar scoresor =6. Early neonatal mortality fell significantly since 1994, while overall mortality remained high among newborns transferred from referring maternities. The most frequent causes were premature birth (49%), acute fetal distress (23%) and neonatal infection (18%).Early neonatal mortality has decreased remains at a high level. It could be improved by limiting the number of premature births, neonatal suffering and neonatal infection. In a parallel direction we recommend organizing a perinatal network in Dakar.

This report is a retrospective study carried out from records of diseased of asthma, fallowed up in a paediatric national center of reference during the period from 1st of November 1987 to 31 st of august 1993. The goal was to describe the epidemiological and clinical factors linked to that affection in order to better contribute to improve its managment. For all the diseaseds of this report we notice and analysed the socio economical data, the promoting factors the occurring mode of the disease, the main clinical manifestations of the affection and their consequences. The morbid association and the data of the paraclinical exploration particularly the functional breathing exploration. Thus we noticed that the consultation in a specialized center occurs relatively late because of bad orientation of the deseaseds. In effect the mean age of diseaseds at the first consultation is 7.5 years while the disease begins in average at 3.5 years. By elsewhere we notice that 15% of these diseaseds live in an aggressive mesologic medium. With an atopy in 78.4% of the cases, loaded personal case history in 96.6% of the cases and that the releasing factors are not known for most of them (81.9%). Asthma in our diseaseds is not very frequent (77%) in general with a moderate intensity of crises (69%). However disturbances of physical activity are noted among 23% of the sample which corresponds nearly to the number of subjects with severe respiratory obstruction (25%). We quoted that there is an relation ship between the frequency of the cases the intensity of the crisis and the disturbances of physical activities of the diseaseds (x2:25.9, df = 2, p= 0,000002). Tacking count of all these factors may serve to set up a asthma prevention and treatment project in Senegal based on populations education and care providers training.

The authors report the results of a retrospective study on the effect of traumatic injuries observed among newborns from forceps deliveries in the maternity ward of Abass Ndao hospital between January 1st, 1995 and December 31, 1996. Forceps deliveries represent 5.89 for 1000 of total deliveries and 47 for 1000 of nursery admissions. Traumatic injuries are found in 44.77 % of the newborn by forceps deliveries. They are dominated by the hematoma of scalp in 23 cases and facial nerve injuries in 6 cases. The were about 76.66 percent of primipare among which 30 percent were adolescents. Maternal age, parity, gravity as well as birth weight for forceps deliveries were not significantly different from those without any injuries (p0.05). However, traumatic injuries of the newborn were more frequent when the forceps were performed by medical resident. The neonatal mortality is 10.44%. We recommend the teaching of the technique for an improvement of technical competence.

To study frequency of moderate pelvic dystocia, to evaluate the diagnosis value of clinical pelvic evaluation and prognosis of trial labor with only clinical monitoring.This is a prospective, exposed and non-exposed study concerning 296 women selected among deliveries presenting moderate pelvic dystocia recorded at Dakar University Teaching Hospital from February 1st 2001 to July 31 2002. Trial labor was undertaken in 148 patients; the control group was chosen among women who underwent prophylactic caesarean section and had no other risk factors of maternal and perinatal complications. Pearson's chi-square test was used or statistic analysis with p value 5% and test of Kappa.Moderate pelvic dystocia was observed 5.3 per 100 deliveries. The most common epidemiological profile was primipara, young age (mean 24 years), height 161 cm (mean), 38-week pregnancy (mean). Clinical evaluation had good diagnosis value comparable with the radiological pelvimetry. Trial labor was undertaken in 148 women, 109 trials (73.6%) were successful; vaginal delivery rate was 27% in women with moderate pelvic dystocia. There were no maternal deaths, maternal morbidity was 4% in trial labor patients and 2.7% in prophylactic caesarean section patents (mainly infection). Post-natal mortality was 7.4% after trial of labour versus 4.1% of newborn child after prophylactic caesarean.These results confirm that trial of labor on moderate pelvic dystocia should be the rule whenever possible, even when only clinical monitoring is available.

Type I spinal muscular atrophy or Werdnig-Hoffman disease is rarely described in black populations. We report five such cases diagnosed in a paediatric outpatient clinic in Dakar. We conducted a retrospective study relating to patients examined for hypotonia progressing since birth for whom the electromyogram had made it possible to confirm an involvement of the peripheral nerve without nerve conduction anomaly. Mean age of diagnosis was 12.3 +/- 7.6 months. Respiratory distress was noted for 2 patients. A family background of similar symptomatology was found in 1 case and consanguinity in 2 cases. Only 1 case of death occurred whereas the 4 other patients were lost to follow-up. The diagnosis of spinal muscular atrophy must be considered in the presence of any severe hypotonia in infants.

Sickle cell disease is an hereditary hemoglobinopathy syndrome which provokes deglobulization crisis and infectious complications. These infectious diseases may be due to a permanent activation of the immune system. The aim of our study was to explore alternative pathway by measuring C3 complement and the classical pathway by C4 complement. The level of immunoglobulins IgA, IgG and IgM was also measured in the subjects sera. Thirty homozygous sickle cell anemia (SS), 25 heterozygous (AS) and 34 controls subjects (AA) were recruited in the Hôpital d'Enfants Albert Royer (HEAR), Fann hospital and Centre National de Transfusion Sanguine (CNTS). Radial Immunodiffusion (RID) technics using specific antisera for C3c, C4c, IgA, IgG and IgM were used in our study. Homozygous SS proved an increase level of IgA (50%, p0.003) and IgG (47%, p0.003), unlike of IgM level. The C3c complement decrease significantly in (27%) of homozygous SS patients (p0.0005) unlike of C4c level. This low level of C3 and IgG in sickle cell homozygous patients can explain the higher susceptibility to infection in these patients. Normal level of C4 and low level of C3 show activation of alternative pathway. Heterozygous AS showed a normal level of C4, C3 and immunoglobulins. Our results suggests a direct involvement of the complement system in sickle cell disease and the depletion of C3 registered was a possible cause of increased susceptibility to infections in patients with homozygous sickle cell anemia.

a) to identify the risk factors associated with newborn babies' low birth weight in teenage mothers; b) to propose prevention strategies for lower-ing neonatal morbidity and mortality. SPHERE OF THE STUDY: the study was carried out at the maternity and neonatology service of the Abass Ndao hospital centre, a urban community hospital located in the Southern part of Dakar. MATIERIAL AND METHODS: this retrospective study was carried out between July 1, 1998 and June 31, 1999. All new mothers under 20 who had given birth to living newborn babies have been included in the study and categorised into two groups, according to their babies' birth weight: 1) a first group of teenagers whose newborn babies' birth weight was lower than 2,500 g (low birth weight); 2) a second group constituted of women whose newborn babies' birth weight was higher than 2,500 g, and which was used as a control. The socio-demographic, biometrics, maternal and obstetric factors have been analysed and compared.out of the 4,586 women in childbirth during the study period, 456 were under 20 years of age, which corresponds to a prevalence rate of 10%. One hundred and five women had newborns weighing less than 2,500 g, which corresponds to a prevalence rate of 23%. Certain factors were found to be significantly associated with low birth weight: low weight gain during pregnancy (p = 0.04), fewer antenatal consultations (0.006), and kidney-related syndromes during pregnancy (0.0005).The results of that study allow us to recommend the following strategies: - control and improvement of nutritional behaviour during pregnancy; campaigning for a better attendance at antenatal consultation services for the early detection of pathologies during pregnancy and for preventing kidney-related syndromes.

We report a retrospective study of 58 cases of empyema caused by Staphylococcus aureus at the Albert Royer Children's Hospital at the Fann University Hospital, between January 1st 1992 and December 31st 1995. Staphylococcus aureus is the principal bacterium responsible for pleural effusions in children (54%), way ahead of Streptococcus pneumoniae (19%). Most of the children affected (86%) are less than 30 months old. Theses infections are often serious due to the resistance of the bacterium to the usual antibiotics, the lack of solid research data and mechanical complications associated with the effusion. Treatment is based on the use of an appropriate bactericidal antibiotic treatment and pleural drainage.

The authors report here by a retrospective study 58 cases of Staphylococcus aureus empyema at Albert ROYER child hospital located in the Fann University Teaching Hospital of Fann between January 1st 1992 and December 31, 1995. In this study staphylococcus aureus is the bacterium involved in pleural effusions of the children (54%) a long way ahead Streptococcus pneumoniae (16%). Infant less than 30 month is more affected (86%). The average age of the patients is 16.8 month +/- 16.6. The resistance of the germ to usual antibiotics, the precariousness of the research field and mechanical complications linked to the outpouring explain their seriousness. The treatment lies upon an adapted antibiotic and bactericidal therapy associated to closed chest tube drainage.

To determine the socioeconomic, clinical and biological aspects of sickle cell disease (SCD) in Senegalese children and adolescents, we retrospectively analysed all records of follow-up attending patients in the Albert Royer Children Hospital of Dakar (Senegal).Homozygous sickle cell (SS) was the most frequent genotype (307 cases). Sickle cell hemoglobin C (13 cases) and sickle cell beta-thalassemia (three cases) were uncommon. Patients were aged from five months to 22 years (mean age: eight years). Most of them came from poor families. The mean number of children was five in patients' families, with at least two cases of SCD in 60% of them. Immunization against hepatitis B virus (10.2%), Haemophilus influenzae b (8.4%), Salmonella (8.7%) and Streptococcus pneumoniae (21.4%) was insufficiently performed, because of its relatively high cost. Only 30% of the patients had received a blood transfusion. Painful crises occurred less than three times a year in 74% of the cases. Complications such as acute chest syndrome (1%), stroke (1%), cholelithiasis (9%), meningitis (0.4%), septicemia (2%) and osteomyelitis (6%) were rare. Mean steady state hemoglobin (Hb) and hemoglobin F(HbF) levels were 8.27 +/- 1.36 g/dL and 6.8 +/- 5.9% respectively among SS patients. No correlations were found neither between Hb and HbF nor between these parameters and the frequency of complications. Eleven patients (1.1% per year of follow-up) died, and infection was the main cause of death (73%).In comparison with published data, SCD seems to have mild severity in Senegalese children and adolescents in spite of poor follow-up conditions. In addition to genetic factors, environmental factors might have an important role in disease tolerance.

Cholelithiasis is a well recognized complication of sickle-cell anemia (SCA) because of chronic hemolysis. It is usually asymptomatic but may result in acute cholecystitis or cholangitis. The aim of this study was to assess prevalence of cholelithiasis and its associated factors among Senegalese children and adolescents with SCA.We analyzed the follow-up records and results of systematic clinical, biological and ultrasonographic examinations in 106 patients with SCA aged 11 months to 22 years (median: 10 years, 6 months), followed up in the Albert-Royer Children's Hospital (Dakar).Cholelithiasis was detected in 9.4% of the patients. Gender, ethnic group, geographic origin and socioeconomic conditions did not have any association with cholelithiasis frequency. The youngest patient with cholelithiasis was 7 years old, and prevalence of cholelithiasis increased with age. The mean age at the beginning of SCA follow-up was higher among patients with cholelithiasis. They were more frequently transfused and tended to present more frequent pain crises and other complications of SCA. We found no spontaneous clinical manifestations attributed to cholelithiasis. Nevertheless, provoked right upper quadrant pain was more frequently observed in patients with cholelithiasis. Fetal hemoglobin, steady-state hemoglobin, reticulocytes count, serum bilirubin, alkaline phosphatase and transaminase levels were not significantly different in these patients, compared to the others. However, those with cholelithiasis had significantly higher mean red cell volume.Prevalence of cholelithiasis appears relatively low in Senegalese patients with SCA, probably owing to the tolerance of the Senegal haplotype. Advanced age and severe chronic hemolysis are etiologic factors in evidence. We recommend systematic abdominal ultrasound at least once a year for patients older than 5 years, or when right upper quadrant pain is observed. Cholecystectomy should be performed in cases of cholelithiasis in order to prevent complications.

A retrospective study conducted between january 1st and december 31st 1993 allowed for the identification and comparison of 100 cases of new born with macrosomia accounting for 1.34% of birth. Males constitute the majority of those cases (60%) and the average weight found is 4212 g. Foetal complications are in the main made of lesions of the brachial plexus (9%). Hypoglycemia is found in 4% of cases. These complications are more frequent in forceps assisted deliveries or cesareans (P0.05). Obesity (20%), Fat child related past history (15%), Maternal diabetes (5%) are the most common risk factors. We therefore advocate a more effective prevention of foeto-pelvic disproportions through a close supervision of pregnancy among women at risk.

The study of non-typhoidic salmonellosis in A. royer pediatric Hospital (Dakar) during a five year term (1985-1989) was realised on thirty five medical records. This pathology accounts for 0.4% of admissions and occurs mainly on children under 3 years old (83%) essentially with a pathologic background. The main clinical forms were septicemia (46%) and gastro-enteritis (31%). Purulent meningitidis represented 45% of all the localized forms. Only one case of asymptomatic carriage has been identified. The seventeen serotypes of Salmonella identified belong to eight serogroups. S. enteritidis and S. typhimurium represented 51% of the isolates. Susceptibility to antibiotics of these different serotypes were variable, the third generation cephalosporins and gentamycin having inhibited more than 80% of the strains. The mean duration of antibiotherapy was 21 days with a mortality rising to 17%. The association ampicilline-gentamycin although criticable, remains indication as first treatment because of the availability of these drugs.

to evaluate the efficacy of kangaroo method on thermoregulation and weight gain of a cohort of preterm.it is a retrospective study based on files of preterm baby weighting below 2000 g, included after discharge to neonatal unit of Aristide Le Dantec maternity for kangaroo method care. Efficiency was appreciated on thermic curve evolution and daily weight gain.56 preterm babies were including. Mean gestational age was 33 +/- 7,6 weeks and mean birth weight, 1488 +/- 277,6 g (median = 1500 g). Mean temperature was satisfying during follow up and was stable around 37 +/- 0,5 degrees C at discharge of program with mean daily weight gain of 33 +/- 7,6 g. We had only one case of death.The results of this study point out efficacy of kangaroo method on thermoregulation, weight gain and survival of preterm babies. We advocate for promotion in developing countries because of its low cost.