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To make the hospital environment healthier for those it serves, the management of biomedical waste (BMW) was studied in the Ziguinchor Regional Hospital Center (RHC) in Senegal from 1 March through 15 March, 2000. The RHC incinerator had stopped operating in 1993. Problems in BMW management were observed at all levels. Neither identification nor sorting took place during collection. Waste bins were exposed everywhere. Workers, rather than carrying waste bins on their back or head, used rolling tables. BMW ended up in a shallow open pit where they were periodically burned. Workers collected, stored, and transported BMW without any type of protection (gloves, boots, masks, aprons, etc.). The principal determinants of this poor management appear to be inadequate funding and training for the cleaning staff, the staff's failure to realize the dangers, and their use of non-standardized practices, due to the absence of BMW policies. BMW management at Ziguinchor RHC must be corrected. Protective equipment must be used systematically. Similarly, standardized practices must be applied to the decontamination of used objects, the identification and sorting at the source, the recovery and recycling of all objects with any remaining value, and the correct storage of BMW. This waste must be transported under high security from its place of storage to its final disposal site. Deep burial has been selected as the most feasible method of disposal under current conditions. A year-long program has been proposed towards this end. Strategies include training, information, motivation, equipment, supervision and evaluation. The budget to implement this program is CFA 5,423,454 francs, distributed between training (22%), equipment (40%), construction of the pit, and follow-up (38%). The tasks are distributed between a public health doctor, department supervisors, and cleaning staff. The follow-up will include three quarterly inspections, at 3, 6, and 9 months and an evaluation at the end of the program. The effect of the program will be judged by the disappearance of unlawful dumping due to the disposal of all BMW in the RHS's deep burial pit., (Copyright John Libbey Eurotext 2003)

We studied the ultrastructure of spermiogenesis and of the mature spermatozoon of Taenia parva, an intestinal cestode of the common genet, Genetta genetta. Spermiogenesis in T. parva is characterized by the growth of the axoneme externally to a cytoplasmic extension. After a slight rotation, the free flagellum fuses with the cytoplasmic extension. This pattern corresponds to type III spermiogenesis according to the scheme proposed by Bâ and Marchand. The zone of differentiation lacks both striated roots associated with the centrioles and the intercentriolar body between them. Nevertheless, the flagellar rotation of about 45 degrees is observed in this species. On the other hand, the mature spermatozoon of T. parva, as in other cestodes, is filiform, tapered at both extremities and lacks mitochondria. The presence of a single crest-like body, periaxonemal sheath, and transverse intracytoplasmic walls are also characteristic ultrastructural features. The pattern of spermiogenesis and the ultrastructural organization of the spermatozoon of T. parva are compared with the available data on cyclophyllideans and, in particular, species of the family Taeniidae.

At the Ziguinchor regional hospital centre (RHC), the populations participate in the health effort by paying care services and medicines. The financial assessment of the participation of the community at the Ziguinchor RHC, from January 1,1998 to June 30, 2000, did not give good results. CFAF 263,066,092 of receipts have been generated, especially through the sale of medicines (38.85%) and via the obstetrical and gynecological clinic services (13.30%). The expenditures went up to CFAF 267,120,718; 41.87% were given to the staff, and 25.39% were used to buy medicines. Globally, expenditures exceeded receipts. At the beginning of January 1998, CFAF 7,600,524 were left to the Health Committee's budget. At the end of June 2000, there only remained CFAF 3,365,898. The decrease in the budget was expected because the RHC Health Committee board, set since 1984, never been renewed. Its management never followed the present recommendations. The board members, who were arbitrarily elected, didn't respect their commitment and were just represented by the treasurer. The latter had only a financial executive role. The board's decisions, which should have had the agreement of its president, were taken unilaterally by the direction of the RHC. Consequently, expenses evolved in keeping with gains, completely ignoring the use of the state budget. For a successful start of the RHC in the hospital reform, ten recommendations have been put across. The objective is to improve the organization of the Health Committee in order to better answer the population health problems.

In order to increase the effectiveness and the efficiency of diagnosis and treatment procedures of the most common diseases, algorithmic pathways have been developed and applied within the implementation of the "Bamako Initiative Strategy" at the health post level in Senegal. Among the many expected advantages of these pathways, was a reduction of abusive prescriptions of parental drugs. A study comparing the trend of the prescriptions 2 years before (1991) and 2 years after (1996) the implementation of the Bamako Initiative strategy, was conducted using 810 randomly selected patients in 7 out of the 19 health posts of the Tambacounda Health district, one of the 45 health districts of Senegal. In 1991, all the oral drugs prescribed (sirup, pills, powder) represented 54.5% against 45.5% for parental drugs (intramuscular and intravenous drugs). These proportions had risen to respectively 78.1% and 21.9% in 1996. The difference thus observed is statistically significant with a khi2 test of 47.76 and p<10(-7). This result then suggests that the use of pathways had highly reduced the prescription of parental drugs among patients treated in the health posts of the Tambacounda health district in Senegal.