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Objective: To audit maternal deaths at the regional hospital center of Saint-Louis. Materials and methods: This was a retrospective cross-sectional study of all maternal deaths that occurred between January 1, 2017 and December 31, 2019 at the Saint-Louis regional hospital center. Data were entered on EXCEL 2013 software. Analysis was performed on Epi Info version 3 software. Results: During our study, 73 cases of maternal death were collected. Maternal mortality was 520 per 100 000 live births. The mean age of the patients was 28.1 years±6.8. Multiparous women accounted for 43.8% and nulliparous women for 1.3%. The causes of maternal death were obstetric hemorrhage (28.77%), hypertension and its complications (20.55%), labour dystocia (15.07%) and anemia (6.85%). Direct obstetric causes of death were responsible for 64.38% of cases and indirect obstetric causes were seen in 35.62%. Death occurred postpartum in 68% of cases, during pregnancy in 25% and during labor in 7%. Death was preventable in 77.5% of cases. Conclusion: Maternal mortality is a real health problem in our practice. It affects young women. Indirect causes of death are becoming more significant causes of death in our practice. Maternal mortality is avoidable in the majority of cases.

Introduction: Timely availability of safe blood or blood products is essential for all health care facilities where transfusion occurs, but in many developing and transitional countries, there is still a considerable gap between the need for blood and the supply available. The overall objective was to study knowledge attitudes, practices, and factors influencing blood donation in the general population in Senegal. Methods: This was a cross-sectional descriptive and analytical study conducted among the Fatick health district population from April 1 to 15, 2019. Thus, the sample is based on a two-stage survey. Data collection was conducted through a questionnaire designed, pretested, and administered to 466 people by selected and trained enumerators. The data collected on the smartphone was analyzed using Epi Info 7.2.1.0 software. A descriptive and bivariate analysis was performed with a 5% risk of alpha error. Results: The average age of respondents was 35 years (±13), with 34 years (±12) for women and 38 years (±15) for men, and more than half of them between 20 and 40 years of age. A proportion of 87% of respondents lived in rural areas and had agriculture as their primary income source. More than half of the individuals (70%) were married, and 68% were educated. The level of knowledge of individuals about blood donation was low at 91.8%. On the other hand, more than half of them had good habits (53.65%). A proportion of 68.0% of individuals had an intention to donate in the future. However, only 24.68% of the population surveyed had already donated blood. Eighty percent of the donations were voluntary. However, 26.09% had repeated this practice. Factors that could influence the practice of blood donation were age, male sex (ORb = 2.18 [1.40 - 3. 37]), high level of education, good knowledge of blood donation (ORb = 2.14 [1.07 - 4.26]), the existence of a relatives donor (ORb = 3.4 [2.19 - 5.26]) and individuals who did not necessarily require permission from a parent or spouse (ORb = 3.37 [2.13 - 5.31]). Conclusion: It is necessary to develop mass communication and proximity strategies, also strengthen the blood bank in terms of human resources and logistics to increase voluntary blood donations in the district. An increase and better planning of mobile clinic outings can facilitate and improve voluntary blood donation by improving accessibility to this service.

Introduction: Menopause is a biological phenomenon that occurs at a more or less early or late age in the life of every woman. The general objective is to study the factors associated with the age of natural menopause in menopausal women aged between 30 and 80 years who have gone through down Keur Massar health district in 2015. Methodology: This was an observational, cross-sectional, descriptive and analytical study conducted in Keur Massar health district from December 1st to 10th, 2015. Two-stage cluster sampling was conducted. Data were collected during an individual interview at home after consent. They covered socio-economic conditions, health and nutrition status, gynecological-obstetrical history, and lifestyle. A multivariate analysis was performed using the Cox model with a 5% risk of alpha error. Results: A total of 627 postmenopausal women were surveyed. Mean age of these women was 54.5 years (±8.6 years). A proportion of 72.1% of the women was married and 46.7% was in school. Mean age of natural menopause was 47.1 years (±5.03 years). The median age of natural menopause was 47 years. Factors associated with the age of natural menopause were high parity of more than 4 children (Hra = 0.35 [0.13 - 0.92]), the existence of frequent childhood illnesses (Hra = 1.72 [1.13 - 2.64]), use of the intra-uterine device—IUD—as a modern contraceptive method (HRa = 0.39 [0.24 - 0.63]), sibling size (HRa = 0.85 [0.78 - 0.93]), family size (HRa = 1.03 [1.01 - 1.06]), and polygamy regime (HRa = 0.56 [0.37 - 0.85]). Conclusion: Many factors in childhood as well as during the period of female genital activity can impact the age of natural menopause. It is then important to improve the health status of women, children and the standard of living of the population.

To improve vaccination coverage among children under one year of age in the Tambacounda health district, a household survey was carried out among mothers or babysitters. The objective was to study the factors related to child’s fully immunized in children aged 12 to 23 months. The cross-sectional, descriptive and analytical survey was carried out during the month of April 2019. A multistage cluster survey selected a sample of 657 mothers and babysitters. The data was collected using a questionnaire made from the World Health Organization reference guide. Data entry and analysis were done with Epi Info software and R. Among the women surveyed, biological mothers were the most representative (96.9%). In the series, 74.1% had a good knowledge of the age for initiating vaccination, 78.2% knew the number of contacts. The vaccination record of the children was available in 92.2%, and 71.0% of them had presented an adverse event. The proportion of children fully immunized was 41.0%. Complete childhood vaccination was positively associated with income-generating activity in women (0R = 2.4) and the short distance (

Rabies is still a deadly disease, but it is 100% preventable through vaccination. In 2016, Senegal notified 1214 cases of dog bites. In the same year, the district of Sokone recorded 50 cases of dog bites, of which 31.2% of the cases were notified in the region of Fatick. The objective of this study is to assess the level of knowledge, attitudes and practices of communities and healthcare providers when faced with a case of exposure to rabies in Sokone health district. This quantitative estimation study is of a descriptive cross-sectional type, which took place during the third quarter of 2017. It targeted the community and health care providers in the Sokone health district. Three-stage cluster sampling was carried out in the community. The recruitment of healthcare providers has been comprehensive. A questionnaire was administered to the community in the form of individual interviews and another questionnaire was sent to health care providers in the form of self-administration. Knowledge, attitude and practice rating grids were developed for the two categories of interviewees. Data entry and analysis was done with Epi Info 3.5.3 software and R 3.3.1. Out of 813 community members surveyed, 6.8% had already been bitten by an animal. A good level of knowledge about rabies was found in 22.4% of the community members. The attitude to a bite was correct for 94.1%. Of the 38 healthcare providers surveyed, only 5.6% had a good understanding of rabies. No provider knew the indications for rabies vaccination and the post-exposure vaccination schedule. In the Sokone health district, communities knew little about rabies. Healthcare providers who are supposed to inform and supervise them in the fight against rabies know less about it. Strengthening the skills of healthcare staff in dealing with bites exposing them to rabies is of urgency in the Sokone health district.

IntroductionThe COVID-19 pandemic was first reported in West Africa on 27 February 2020 in Nigeria. It subsequently spread to other countries in the region. The objective of this study is to analyze the epidemiological profile of COVID-19 in West Africa from the first reported case to 31 January 2021.MethodWe publicly used available data from reliable sources and from the “COVID-19R” package. We used epidemic curves to describe the trends in the daily evolution of confirmed cases and deaths of COVID-19 in West Africa and specifically in the five countries. The reproduction rate and evolution rates were calculated from these trends.ResultsAs of 31 January 2021, West Africa had 342,938 confirmed cases of COVID-19 with 4,496 deaths. Nigeria had 131,242 cases with 1,586 deaths. Senegal had 26,523 cases with 628 deaths. The case-fatality rate in Mali was 4.08% and the attack rate in Cape Verde was 2587 cases per 100,000 inhabitants. In Nigeria, Senegal, Mauritania and Mali, the epidemic curves supported by the evolution rates showed an increase in confirmed cases and deaths of COVID-19 during December 2020 and January 2021 compared to the last two months. The effective reproduction rates (Re) inferred a slowdown in virus transmission (Re < 1) in these countries except for Senegal.ConclusionThe results showed that COVID-19 was still circulating in some West African countries in late 2020 and early 2021. By improving the health system and with context-specific public health interventions and vaccination, these countries should effectively control COVID-19.

Strengthening civil registration systems requires a better understanding of motivations and barriers related to the registration of deaths. We used data from the 2013 Senegalese census to identify deaths that are more likely to be registered in the Dakar region, where the completeness of death registration is higher than 80%. We also interviewed relatives of the deceased whose death had been registered to collect data on reasons for registration and sources of information about the process. The likelihood of death registration was positively associated with age at death and household wealth. Death registration was also more likely in households whose head was older, had attended school, and had a birth certificate. At the borough commune level, the geographical accessibility of civil registration centres and population density were both positively associated with completeness of death registration. The main motivations for registering deaths were compliance with the legal obligation to do so and willingness to obtain a burial permit and a death certificate. Families, health facilities, and friends were the primary sources of information about death registration. Further research is needed to identify effective interventions to increase death registration completeness in Dakar, particularly amongst the poorest households and neighbourhoods on the outskirts of the city.

Introduction: In Senegal, breast cancer is the second most common cancer of women after cervical cancer. It is a cancer accessible to clinical and radiological screening. The objective of this study was to study the determinants of the use of breast cancer screening among women aged 35 to 65 in the Thies region in 2015. Material and Methods: It was a descriptive and analytical cross-sectional study. It was conducted with a sample of women selected using a two-stage cluster survey. The study used a questionnaire to collect data on the individual characteristics of women, knowledge, attitudes and practice on breast cancer and quality of care in an individual interview at the homes of women after consent. The data was entered on the Epi Info 3.5.3 software and analyzed with the R 3.3.3 software. A description of qualitative variables across proportions and quantitative variables by mean and standard deviation was performed. Parametric or non-parametric tests were used to examine the association between the dependent variable (breast cancer screening) and explanatory variables (predisposing factors, resources, health needs) according to their applicability conditions and at a risk α equal 5%. Finally, all variables with p less than 0.25 were used to construct an explanatory model by simple logistic regression. Results: The study involved 960 women aged 35 to 65 years. The average age was 43.8 years with a standard deviation of 8.3 years. The rate of breast cancer screening was 25.7%. Educated women (OR adjusted = 1.89 [1.25 - 2.85]), women who resided in urban settings (adjusted OR = 1.79 [1.05 - 3.04]), those who experienced at least one risk factor for breast cancer (OR adjusted = 2.71 [1.81 - 4.06]) were more likely to use screening breast cancer. In contrast, women with low socioeconomic status (adjusted OR = 0.66 [0.45 - 0.97]) were less likely to be screened. Conclusion: Level of education, knowledge of breast cancer and having received screening advice are factors to consider in improving the rate of breast cancer screening in Thies, and the most important remains public awareness.

Introduction: Lack of dietary diversity is a nutritional problem among poor people in developing countries whose daily diet is usually based on a starch source with one or two additional components. Senegal has food insecure regions such as Kolda and Kedougou despite improved agricultural production. This study aims to investigate the determinants of dietary diversity in the Kolda and Kedougou regions. Methodology: It was a cross-sectional, descriptive and analytic household-level study in two southern regions of Senegal (Kolda and Kedougou) between October and December 2015. This was a three-stage random sample survey. Dietary diversity in women of reproductive age was measured using the Women’s Dietary Diversity Score (WDDS) recommended by Food and Agriculture Organization of the United Nations (FAO). The WDDS is a global qualitative indicator of nutrition, which counts the number of food groups consumed by a person in the 24 hours preceding the survey. The data was collected during an individual interview. Linear regression was used to identify the associated factors of dietary diversity. The free and informed consent of the individuals surveyed and the protection of anonymity were respected. Results: A total of 1926 women were surveyed. The mean of WDDS was 2.9 with a standard deviation of 1.4. The Kedougou department has a better WDDS with 3.3 (±1.2) followed by the Kolda department with a score of 3.2 (±1.3). The higher the household’s welfare score, the better the WDDS with a s coefficient of 0.11 [0.09 - 0.13]. Households that are in urban areas have a better score than households in rural areas (0.27 [0.13 - 0.41]). The improvement of knowledge in food diversification, in good culinary practice improves the dietary diversity score in women. Conclusion: The WDDS is low in the southern regions of Senegal. To improve dietary diversification in this area, the practice of good cooking practices, the accessibility of micronutrient-rich foods, and the decision-making power of women in the household should be promoted.

Resume Objectifs Evaluer la prevalence de l’hypertrophie ventriculaire gauche (HVG) electrocardiographique et echographique ainsi que ses corollaires dans une population d’hypertendus vivant en milieu semi-rural au Senegal. Patients et methode Selon l’approche STEPS de l’organisation mondiale de la sante, nous avons mene, en novembre 2012, une enquete transversale et exhaustive chez les sujets âges d’au moins 35 ans et vivant depuis au moins 6 mois, dans la zone semi-rurale de Gueoul. Les facteurs de risque cardiovasculaire ont ete depistes et l’hypertrophie ventriculaire gauche recherchee a l’electrocardiogramme et a l’echocardiographie chez les hypertendus. Les donnees etaient analysees grâce au logiciel SPSS 18.0 et le seuil de significativite fixe pour une valeur de p Resultats Nous avons examine 1411 sujets âges en moyenne de 48,5 ± 12,7 ans. Au total, 654 sujets etaient hypertendus et une hypertrophie ventriculaire gauche a ete la recherche chez 515 sujets parmi eux. Selon l’indice de Sokolow-Lyon, 86 sujets (16,7 %) presentaient une HVG electrocardiographique, plus frequemment chez les hommes (p = 0,002). Selon l’indice de Cornell et le produit de Cornell, elle etait retrouvee respectivement chez 66 (12,8 %) et 52 sujets (10,1 %), avec une predominant feminine (p = 0,0001 ; p = 0,004). Elle etait plus frequente chez les hypertendus en grade 3 quel que soit l’indice. A l’echocardiographie, la prevalence de l’HVG selon la masse ventriculaire gauche etait de 2,5 % (13 cas), de 9,3 % (48 cas) selon la masse ventriculaire gauche indexee a la surface corporelle et de 8,2 % (42 cas) selon la masse ventriculaire gauche indexee a la taille2,7. L’HVG selon la masse ventriculaire gauche indexee a la surface corporelle etait significativement correlee a l’HVG electrocardiographique selon l’indice de Sokolow-Lyon (p Conclusion Bien que rare chez l’hypertendu senegalais vivant en milieu semi-rural, l’hypertrophie ventriculaire gauche est correlee a la severite de l’hypertension arterielle. Un depistage par l’electrocardiogramme permettra un meilleur suivi de ces hypertendus.

In the context of controlling intestinal parasites, accurate diagnosis is essential. Our objective was to evaluate the performance of new diagnostic kits compared to conventional microscopic methods in identifying intestinal parasites. Faeces collected in rural area in Senegal were subjected to several detection techniques. Thus, the sensitivity, specificity, positive and negative predictive values of new diagnostic techniques were compared to conventional merthiolate-iodine-formalin, conventional Bailenger and modified Ritchie. Furthermore, the kappa coefficient was calculated to evaluate the correlation between the new kit and those of modified Ritchie. Out of the 117 patients examined, 102 presented with a parasite, or prevalence of 87.1%. The Fumouze techniques proved to be as effective as the conventional methods in detecting flagellates and helminths with sensitivities ranging from 97 to 100%. However, conventional techniques were slightly more sensitive in identifying Endolimax nana and Blastocystis hominis. The correlation was nearly perfect (k = 0.83 and 1), respectively between Bailenger Fumouze, Iodesine Fumouze and modified Ritchie in identifying helminths while it was just acceptable (k = 0.27 and 0.28) in identifying B. hominis. The modified Ritchie technique routinely used in our laboratory remains a good diagnostic tool. However, the use of kit techniques was interesting when reading the pellet after concentration and the Colour KOP staining was a considerable contribution to the diagnosis of the vegetative forms. Therefore, it would be interesting to determine the cost of a stool test using Fumouze kit techniques to provide the most cost effective way.

The fight against iron deficiency anemia in pregnant women is a public health priority, especially in sub-Saharan Africa. Spirulina is an alga very rich in iron, used as a dietary supplement. This research proposes to study its effect on the hemogloblobinaemia of pregnant women. This was a blind randomized cohort study with a supplemented group of spirulina (1500 mg/d) and a second supplemented with iron and folic acid supplementation (IFAS). Included in this study were pregnant women attending four health centers in the Dakar region, with pregnancy at 28th amenorrhea, agreeing to participate and not having complications or twin pregnancies. Follow-up of the two groups was identical throughout the study from the 28th week of amenorrhea to the 42nd postnatal day. The study was conducted among 920 women, evenly distributed among the groups. IFAS allowed a statistically significant increase in hemoglobinemia with an average gain of 0.3 g/dl between the 28th and 32nd weeks of amenorrhea (p = 0.022) and 0.2 g/dl between the 28th week and the delivery (p = 0.043). Spirulina supplementation showed statistically higher gains than those observed with IFAS. These gains were 0.48 g/dl between the 28th and 32nd weeks of amenorrhea and 0.36 g/dl between the 28th week and the delivery, with p values less than 0.001. Spirulina, more accessible to developing countries, is a good option to strengthen the arsenal of iron deficiency anemia control, and therefore maternal mortality.

The anemia by iron deficiency is a public health problem. To palliate the multiple maternal and fetal consequences, the WHO recommends the iron supplementation during at least 90 days to all pregnant women. The goal of our study is to study the determinants of this consumption in the Kolda area (Senegal). It’s the analytical cross-sectional study referred. We use the survey by clusters with 2 levels and it’s about all of the women who gave birth in Kolda area between February 2013 and January 2014. The dependent variable was iron consumption during at least 90 days and the independents variables were grouped on personal factors, knowledge and practices. Data were collected during a personal interview face to face. We used logistic regression to identify the determinants of this consumption. The average age of women surveyed in 1442 was 25.5 years. They had knowledge of iron consumption (93%) and the number of antennal consultation (ANC) (66%). The prevalence of pregnant women who consumed iron at least for 90 days was 51%. The factors associated with consumption were schooling (ORa = 2.49 [1.54 - 4.03]), health awareness (ORa = 1.61 [1.25 to 2.07]), knowledge about number of ANC (ORa = 1.54 [1.18 - 2.00]), councils on the benefits of iron (ORa = 2.66 [1.77 - 4.00]), the household wealth index (ORa = 1.83 [1.04 to 3.19]), number of ANC (ORa = 2.05 [1.56 - 2.69]), age pregnancy on the first ANC (ORa = 2 [1.47 - 2.7]) and iron prescription (ORa = 1.64 [1.25 - 2.16]). The prevalence of iron consumption during at least 90 days is low in Kolda area (51%); however, its determinants are identified; we can solve the problem by increasing communicate more about iron supplementation and antenatal consultation.

Introduction: The development of non-communicable diseases is supported by modifiable and non-modifiable risk factors. In both primary prevention and secondary prevention, the possibility of action remains possible for individual modifiable risk factors. This study on the frequencies of individual and modifiable risk factors of a behavioral and metabolic nature within the population of patients accommodated in the services of the population is in order to carry out preventive actions on the major non-communicable diseases of vulnerable populations. hospitality and emergency services were carried out in Senegal. Methods: The framework of the study was the reception and emergency services of the hospital of Pikine and the hospital of Dakar. It was an observational, cross-sectional and descriptive study. The study period was from January 25 to March 5, 2018. The source population consisted of patients over 18 years of age and not pregnant, who were seen in consultation in both services and who gave their free and informed consent for participate in the survey. The data collection tool was based on the WHO STEPwise survey questionnaire. The questionnaire was administered during a face-to-face interview with each patient. The data was collected confidentially with strict respect for the privacy of the participant. Results: The study involved 615 patients 53.7% at the main hospital in Dakar and 46.3% at the Pikine hospital. The proportion of active smoking was 12%. The share of current alcohol consumption is 7.8% and daily consumption concerns 8.3% of these current drinkers. Regarding abdominal obesity, 55.5% of women had a waist size corresponding to a high risk against 10.2% of men. Insufficient physical activity and insufficient consumption of fruits and vegetables were the most common comorbidities. For blood pressure values, 38.9% of patients had blood pressure values above 140 mmhg / 90 mmhg and for random blood sugar values, 10.5% of patients had random blood sugar values above 2 g / l with signs of hyperglycemia. Finally, 40.4% of our patients declared that they had never controlled their blood sugar in their life and 32.2% declared that they had never had their blood pressure controlled in their life. Conclusion: The measurement of glycemia, blood pressure and BMI must be systematic for all patients seen in the emergency departments, whatever the reason for their visit. They should also continue their efforts to develop public spaces for sport and to make fruit and vegetables more accessible to the community.

INTRODUCTION: An anxiolytic is a psychotropic drug used in the treatment of pathological anxiety. Because of the risks associated with the irrational use of these drugs, their prescription and dispensing must be strictly controlled. The objective of this research is to evaluate the knowledge, attitudes and practices of dispensing anxiolytics by providers of dispensing pharmacies in the region of Thies in Senegal. METHODOLOGY: This is an observational, cross-sectional, descriptive and analytical study at the level of providers of dispensing pharmacies in the departments of Mbour and Thies, in October 2018. Data collection was done by direct interview with administration of a questionnaire after informed consent from the provider. They were entered and analysed using EPI-Info. 7 software. RESULTS: A total of 221 pharmacy providers were surveyed. The average age of the providers was 36.8 years with a standard deviation of 9.5 years. Married people represented 68.8%. Full time pharmacists represented 24.4%. Anxiolytic dispensing practice was good in 78.3% of the providers. Good dispensing practice depended on professional level in the pharmacy (OR=14.0 (6.2 - 33.2)), good knowledge of pharmacological effects (OR=5.5 (2.5 - 12.2)) and good knowledge of adverse effects of anxiolytics (OR=5.0 (2.0 - 12.2)). The better the knowledge of anxiolytics, the better the dispensing practice. CONCLUSION: In order to improve the practice of dispensing anxiolytics and other psychotropic drugs in general, it will be necessary to strengthen the knowledge of providers through regular continuous training and to strengthen the supervision of dispensing sites by Ministry of Health inspectors.

Resume Position du probleme Les pays d’Afrique sub-saharienne souffrent d’epidemies explosives et repetees de meningites dues principalement a Neisseria meningitidis A. En decembre 2010, le Burkina Faso a organise une campagne de vaccination, avec le MenAfriVac®, chez les sujets âges de 1 a 29 ans. L’objectif de cette etude est l’analyse des determinants de la couverture vaccinale. Methodes Il s’agissait d’une enquete transversale par sondage en grappe a deux degres, a visee descriptive et analytique, menee dans la region de la Boucle du Mouhoun. Les donnees ont ete recueillies a domicile lors d’un entretien individuel. La variable dependante etait le statut vaccinal et les variables independantes comprenaient les caracteristiques individuelles et des menages mais aussi les moyens de communication utilises lors de la campagne. La regression logistique a ete utilisee pour modeliser la probabilite d’etre vaccine en utilisant la librairie « Survey » du logiciel R. Resultats Au total, 2025 sujets ont ete inclus avec une couverture vaccinale estimee a 93,5 %. Les facteurs associes a une couverture vaccinale elevee etaient le milieu rural (ORa = 2,53 [1,53–4,17]) et les menages de petite taille (ORa = 3,06 [1,36–6,91]). La chance d’etre vaccinee etait moins elevee chez les sujets issus de chefs de menages salaries (ORa = 0,14 [0,02–0,87]), chez les sujets informes par les leaders religieux et coutumiers (ORa = 0,25 [0,11–0,57]) ou les proches (ORa = 0,51 [0,29–0,9]). Conclusion La couverture vaccinale enregistree est suffisante pour procurer une immunite de groupe. Cependant, des populations cibles n’ont pas pu beneficier de la vaccination par manque d’informations. Un accent particulier doit etre mis sur les familles nombreuses en milieu urbain en utilisant les relais communautaires.

As part of the prevention of nutritional deficiencies in pregnant women, the objective of the study is to identify the determinants of food diversity in pregnant women in the Dakar region. Cross-sectional survey in a three-stage cluster design. Two health districts in the Dakar region were randomly selected from urban and peri-urban areas. All pregnant women in the health centers were surveyed until the sample size was obtained. The data collected are socio-demographic, economic, pregnancy-related factors, practices and knowledge about nutrition and food groups consumed the day before the survey. A bivariate analysis was done using R software. Relevant covariables were included in the linear regression analysis to identify the factors associated with food diversity. A total of 300 pregnant women were surveyed in two different health districts, one in urban and one in peri-urban areas. The average age of women varies between 16 and 45 years with an average of 28.02 years, with a standard deviation of 5.4 years. The average dietary diversity score was 5.47, with a standard deviation of 1.24. Women aged 16 to 19 had the highest food diversity score of 6.12 (±1.54) with a β=-1.14 [-1.8; -0.48]. This score is lower in urban areas (CS Gaspard Camara) 5.28 than in peri-urban areas (CS Mbao) 5.67, β=0.39 [0.12; 0.67]. Women with three or more children had a more diversified diet with β=0.56 [0.12; 0.67]. The income of the head of household is decisive for the diversification of pregnant women with β=0.79 [0.24; 1.35]. The dietary knowledge and practices related to dietary diversity of pregnant women was the consumption of mineral water β=0.27 [0.001; 0.5].

Les marins constituent une population mobile avec de nombreux deplacements les exposant souvent a des rapports sexuels occasionnels. L’objectif de cette etude est d’analyser les determinants des rapports sexuels non proteges chez les marins de la marine marchande au Senegal suivis par le Service de sante des gens de mer, institue par decret au sein de la direction de la marine marchande depuis 2007. Une etude descriptive et analytique a donc ete realisee chez ces marins. Les donnees portant sur les connaissances, attitudes et pratiques ont ete recueillies lors d’un entretien individuel. Une analyse multivariee a ete realisee a l’aide d’une regression logistique multiple. Au total 400 marins ont ete interroges, 57,9 % ont eu des rapports sexuels occasionnels dont 23,7 % n’etaient pas proteges. Les rapports sexuels sans protection etaient plus frequents chez les non instruits (OR=2,29 [1,23–28,99]) et les maries (OR=2,29 [1,23–5,99]). Les marins qui pensaient que le port du preservatif reduisait le plaisir lors du rapport sexuel (OR=2,5 [1–5, 1]) et ceux qui consommaient de l’alcool (OR=5,4 [2,07–14,2]) se protegeaient moins lors des rapports sexuels occasionnels. Les marins de la marine marchande pratiquent souvent des rapports sexuels non proteges. Des interventions avec des canaux specifiques doivent donc etre mises en oeuvre en prenant en compte le caractere mobile de ces hommes, souvent non instruits.

Introduction : l’objectif de cette etude etait d’identifier les determinants de viols chez les mineurs dans la region de Kolda. Methodologie : une etude retrospective, transversale, descriptive et analytique a ete menee du 23 decembre 1992 au 31 decembre 2011. Elle portait sur les dossiers des victimes mineurs âgees de moins de 18 ans. L’echantillonnage etait exhaustif. Les analyses bi-variee et multi-variee ont ete effectuees respectivement par les logiciels Epi Info 3.3.2 et R 2.9.2. Resultats : l’etude a porte sur 162 cas de violences sexuelles. L’âge moyen de victimes etait de 12,3?±?3 ans. Il variait de 4 a 17 ans. Chez les agresseurs, l’âge moyen etait de 26,4?±?9,5 ans et les mineurs representaient 13 %. Parmi les victimes, 54,9 % ont subi des viols. Les victimes de violences sexuelles connaissaient leurs agresseurs dans 66 % des cas et etaient agressees en plein jour (53,4 %). Au moment des violences sexuelles, les agresseurs etaient ivres dans 15,3 % des cas. Les violences avaient lieu en brousse (14,8 %). Vingt-huit pour cent (28 %) des auteurs de viol ont ete emprisonnes dont 38,6 % entre 5 a 10 ans. L’agression en brousse [OR ajuste =3,46 (1,02 – 11,77)] et l’etat d’ivresse de l’agresseur au moment de la violence sexuelle [OR ajuste = 3,47 (1,04 – 11,61)] exposaient plus les victimes aux viols. Par contre, celles qui connaissaient leurs agresseurs etaient moins exposees aux viols [OR ajuste =0,09 (0,03 – 0,24)]. Conclusion : la vulgarisation d’une telle etude au niveau national permet aux autorites sanitaires et judiciaires d’avoir une analyse situationnelle des violences sexuelles chez les mineurs, en vue de mener une lutte efficace au niveau national.

Antibiotics have saved millions of lives around the world. However, their effectiveness is compromised by the emergence and spread of antibiotic resistance. The latter is a threat to global health. Under the International Health Regulations, a national self-assessment was conducted in Senegal to assess the country's capacity to cope with this scourge. It is followed by the joint external evaluation of the World Health Organization. One of the main recommendations is raising public awareness about the rational use of antibiotics. The goal of this study was to evaluate the general public's practices regarding antibiotics and the determinants of antibiotic use without a medical prescription. The study was cross-sectional. It was conducted at the Rufisque bus station. Rufisque is a city located in the region of Dakar, capital of Senegal. We estimated the sample size using Raosoft. Participants were selected according to a convenience sampling. A questionnaire was administered in an individual interview. Logistic regression was used to identify the determinants of antibiotic use without a prescription. A total of 400 people were included. Among them, 75% (300/400) said they had taken antibiotics during the last twelve months. The sources of supply were the community pharmacy (81%), the entourage (12%), the remaining antibiotics (5%) and the illicit drugs market (2%). The use of antibiotics without a prescription was reported by 75% of participants (225/300). It was more common among the uneducated people (OR = 2.7, P =.002). In addition, 16.8% (67/400) said they had shared their antibiotic treatment with their relatives or friends. Shortening the duration and frequency of antibiotic treatment was found in 65.8% (263/400) and 29.3% (117/400) of respondents, respectively. About 7% (29/400) said they sometimes demand antibiotics to prescribers. Almost all (98.8%, 395/400) stated that they had never returned unwanted medicines to pharmacies or health facilities while 37.8% (151/400) said they had never checked the expiry dates of medicines. This study, conducted in an urban setting, showed that respondents have recourse to inadequate practices toward antibiotics. We recommend the sensitization of populations especially those who are not educated. Other studies should be conducted mainly in rural areas to identify the most commonly used antibiotics and the extent of inappropriate practices and their determinants.

Background : The incidence of cardiovascular disease is growing worldwide and this is of major public health concern. In sub-Saharan Africa, there is a lack of epidemiological data on the prevalence and distribution of risk factors of cardiovascular disease. This study aimed at assessing the prevalence of hypertension and other cardiovascular risk factors among an urban Senegalese population. Methods : Using an adaptation of the WHO STEPwise approach to chronic disease risk-factor surveillance, we conducted a population-based, cross-sectional survey from 3 to 30 May 2010 on 1 424 participants aged over 15 years. Socio-demographic and behavioural risk factors were collected in step 1. Physical anthropometric measurements and blood pressure were documented in step 2. Blood tests (cholesterol, fasting blood glucose, and creatinine levels) were carried out in step 3. Results : The prevalence of hypertension was 46% (95% CI: 43.4-48%), with a higher prevalence in females (47.9%) than males (41.7%) (p = 0.015), and 50% of these hypertensive were previously undiagnosed. Mean age was 53.6 years (SD: 15.8). In known cases of hypertension, the average length of its evolution was 6 years 9 months (range 1 month to 60 years). Hypertension was significantly associated with age (p = 0.001), socio-professional category (p = 0.003), dyslipidaemia (p < 0.001), obesity (p < 0.001), physical inactivity (p < 0.001), diabetes (p < 0.001) and stroke (p < 0.001). Conclusion : We found a high prevalence of hypertension and other cardiovascular risk factors in this population. There is need of a specific programme for the management and prevention of cardiovascular disease in this population.

Resume Introduction Les maladies cardiovasculaires deviennent avec leurs facteurs de risque un veritable probleme de sante en Afrique. Les objectifs de cette etude etaient d’evaluer la prevalence des facteurs de risque cardiovasculaire dans la population generale de la ville de Saint-Louis au Senegal. Methodologie Il s’agit d’une etude transversale, descriptive et analytique realisee en mai 2010, chez des senegalais âges d’au moins 15 ans, residant de la ville de Saint-Louis au Senegal. Un sondage aleatoire systematique et stratifie en grappes a ete realise. Les facteurs de risque cardiovasculaire recherches etaient : hypertension arterielle, diabete, dyslipidemie, tabagisme, obesite, sedentarite et syndrome metabolique. Resultats L’enquete a concerne 1424 individus dont 983 femmes (69 %). L’âge moyen etait de 43,4 ± 17,8 ans. La prevalence des facteurs de risque etait : hypertension arterielle (46 %), diabete (10,4 %), hypercholesterolemie totale (36,3 %), hyperLDLcholeserolemie (20,6 %), obesite (indice de masse corporelle superieur ou egal a 30 kg/m 2 ) (23 %), obesite abdominale (48,7 % selon l’International Diabetes Federation et 33,2 % selon National Cholesterol Education Program) sedentarite (64,7 %), tabagisme (5,8 %) et syndrome metabolique (15,7 %). On notait une predominance chez les femmes des facteurs de risque sauf pour le tabagisme et le diabete. Le risque cardiovasculaire global etait eleve dans 24,9 % selon le modele de Framingham, 28,8 % (Societe europeenne d’hypertension) et 6,1 % (SCORE). Conclusion Cette enquete retrouve une forte prevalence des facteurs de risque cardiovasculaire dans une population generale senegalaise, avec une predominance chez les femmes. Cela doit amener a elaborer une meilleure strategie de prevention des affections cardiovasculaires.

Resume Le score de risque dystocique (SRD) comprend trois parties : une verticale ou le bilan de la femme individualise huit eventualites ; une horizontale, ou le bilan de la grossesse identifie sept eventualites, et une centrale de pronostic, subdivisee en trois zones (« dangereuse », « douteuse » et « d’espoir »). Le SRD est positif s’il existe au moins une croix dans la zone dangereuse et/ou deux croix dans la zone douteuse ; autrement, il est negatif. Le test de validation donne de bons resultats (sensibilite = 83,61 % ; specificite = 90,05 % ; valeur predictive positive = 72,34 % ; valeur predictive negative = 94,04 %). L’utilisation du SRD a large echelle permet une identification plus rapide des femmes enceintes a haut risque de dystocie obstetricale. Une orientation a temps de ces dernieres vers un centre specialise en soins obstetricaux et neonataux contribue a la reduction de la mortalite maternelle et de la mortinatalite.

Aim To explore the links between antenatal care (ANC) non-attendance and economic welfare. Method and subject This was a cross-sectional, descriptive and analytical study of women aged 15 to 49 years living in Senegal in 2005. Data were from the Demography and Health Survey using a two-stage random sampling procedure. Participants were classed by quintile using an economic well-being score based on housing characteristics and ownership of sustainable goods. The quality of ANC was determined from the number of visits, the qualification of the person delivering care, and content (counseling, weight, height and blood pressure measurements). Logistic regression was used for data analysis. Results A total of 6927 women were surveyed. Mean age was 28.15 years (± 2.6); 20.3% were primiparous; 61.2% resided in rural areas; 70.0% had received no education. Each of the first four economic quintiles included about 20% (19.2% to 21.5%) of the participants while 16.9% were in the fifth (richest) quintile. A total of 457 women (6.6%) did not undergo any ANC visit. ANC non-attendance increased with parity, decreased with education level and was higher in rural areas than in urban areas, OR = 7.2 (95% CI [5.1–10.1]). It decreased with increasing economic well-being: OR = 0.6 [0.47–0.75] 2nd quintile vs. 1st, OR = 0.02 [0.01–0.05] 5th quintile vs. 1st, p Conclusion Economic welfare plays a major role in determining use of ANC. The only way to solve health problems is to reduce inequalities. The solution to this problem is beyond the scope of health but concerns an overall economic program involving the entire community, including policy-makers.

Introduction : Au Senegal, l’acces aux soins pose toujours probleme surtout aupres des groupes vulnerables comme les personnes âgees. Face a cette situation, l’Etat a mis en place en 2006 un plan national de gratuite denomme « Plan Sesame ». L’objectif de cette etude etait d’analyser le fonctionnement du Plan Sesame au niveau des hopitaux nationaux du Senegal apres quatre ans de mise en œuvre (2006-2009).Methodes : Une approche qualitative par des entretiens individuels a ete menee du 15 mars au 14 mai 2010 aupres de cinq populations cibles : les directeurs des hopitaux, les prestataires de soins, les responsables du Plan Sesame au niveau des bureaux des entrees des hopitaux, les controleurs de gestion et les beneficiaires. L’analyse du contenu a ete utilisee.Resultats : De 2006 a 2008, le niveau de frequentation des hopitaux nationaux croissait d’annee en annee. Mais a partir de l’annee 2009, ce niveau a baisse sauf au niveau de l’hopital Principal. Face aux remboursements insuffisants des depenses des prestations du Plan Sesame, l’Etat contractait une dette qui s’accumulait au fil du temps. Cette situation obligeait les hopitaux nationaux a restreindre certaines prestations du Plan Sesame voire arreter la prise en charge gratuite des personnes âgees. Par consequent, ces problemes vont compromettre la perennite du Plan Sesame.Conclusion : Il importe aux autorites sanitaires d’auditer le Plan Sesame, de respecter les procedures par un suivi regulier et de recadrer les conditions d’acces.

Resume Objectifs Etudier la prevalence de l’arteriopathie des membres inferieurs (AOMI) dans la population âgee de 40 ans ou plus et analyser les facteurs associes aux anomalies de l’index de pression systolique (IPS) dans la population generale de Saint-Louis au Senegal. Methodologie Il s’agit d’une etude transversale, descriptive et analytique realisee du 3 au 30 mai 2010, chez 771 senegalais âges d’au moins 40 ans. Un sondage aleatoire systematique et stratifie en grappes a ete realise. La mesure de l’IPS a ete faite a l’aide d’un doppler de poche de marque DIADOP 50 muni, d’une sonde bifrequence 4 et 8 Hz. L’AOMI etait definie par un IPS inferieur a 0,9 et la mediacalcose par un IPS superieur a 1,3. Resultats Ces sujets (âge moyen 57 ± 11,2 ans, 559 femmes) avaient comme facteurs de risque cardiovasculaire la sedentarite (76,4 %), l’hypertension arterielle (68 %), l’obesite (32,1 %), l’hyperLDL-cholesterolemie (27,8 %), le diabete (18,3 %) et le tabac (6,9 %). Quatre-vingt-treize sujets (12,1 %) avaient une AOMI et 37 (4,8 %) avaient une mediacalcose. L’AOMI etait significativement plus frequente chez les sedentaires ( p = 0,008), les sujets âges ( p = 0,0006) et chez les sujets presentant une coronaropathie ( p = 0,04). En revanche, le tabac n’etait pas fortement associe a l’AOMI. Conclusion L’AOMI est frequente a Saint-Louis et cela du fait de la prevalence elevee des facteurs de risque cardiovasculaire. Des strategies de prevention et de prise en charge correctes de ces facteurs de risque, en particulier la sedentarite, sont necessaires.

L’objectif de ce travail etait de decrire le profil sociodemographique et la prise en charge des femmes souffrant de fistules vesico-vaginales (FVV) au Sud-Est du Senegal. L’etude, menee d’aout 2007 a janvier 2008, concerne les femmes consultant pour FVV au niveau des hopitaux regionaux de Tambacounda et de Kolda. Les donnees, recueillies par des interviews sur la base d’un questionnaire, ont ensuite ete saisies puis analysees avec le logiciel Epi Info version 3.3.1. Les patientes, âgees en moyenne de 24 ans a la survenue de la FVV, etaient en majorite de la zone rurale (86 %), analphabetes (89 %), et excisees (93 %). La principale cause evoquee etait la longue duree du travail (42 %). Les femmes declaraient plus souvent apres la FVV qu’avant, ne pas avoir d’activite generatrice de revenu (84 % vs 22 %) et une situation de divorces (19 % vs 2 %). De meme, ont ete notes, des troubles psychologiques (62 %), un repli sur soi (22 %), un abandon par l’entourage (16 %) ou par le mari (7 %) et une reduction de l’efficacite des activites menageres (4 %). Le delai moyen entre la survenue de la FVV et la premiere consultation etait de 50,7 mois (± 55,3). L’evolution de la FVV a permis de distinguer ; 44 % d’attentes de traitement chirurgicale, 35 % d’echecs operatoires, 14 % de guerisons, 6 % d’interventions chirurgicales recentes et 1 % de recidives. Une bonne accessibilite des services est necessaire pour le traitement ; mais une qualite des soins obstetricaux et une meilleure sensibilisation de la population sont les priorites pour la prevention de la FVV au Sud-Est du Senegal.

Au Senegal, la distribution gratuite de medicaments lors des consultations prenatales est preconisee pour supprimer les disparites. L’objectif de cette etude est d’etudier les facteurs influencant l’acces au traitement dans une situation de gratuite. Il s’agit d’une etude transversale et analytique portant sur un echantillon de 1 906 femmes âgees de 15 a 49 ans tire au sort lors de l’enquete nationale sur le paludisme au Senegal. Les donnees ont ete collectees lors d’un entretien individuel. Le bien-etre economique etait mesure a partir des caracteristiques du logement et des biens durables. L’analyse multivariee a ete realisee a l’aide d’une regression logistique. La moyenne d’âge des femmes etait de 27,9 ± 5,34; 64,3 % residaient en milieu rural; 71,8 % des femmes n’avaient recu aucune instruction. Parmi les femmes etudiees, 23 % etaient dans le quintile le plus pauvre tandis que 16,3 % etaient dans le plus riche. Le traitement preventif intermittent (TPI) etait effectue dans 49,3 % des cas. Le TPI etait plus souvent realise en milieu urbain (OR: 1,45; IC 95 %: [1,17–1,72]). Il augmentait avec le niveau d’instruction avec un OR a 1,5 au primaire et 1,68 au secondaire et plus. La realisation du TPI augmentait avec le bien-etre economique. L’OR variait de 1,44 au deuxieme quintile a 2,95 pour les plus riches. La gratuite ne profite pas souvent aux plus pauvres. D’autres mesures d’accompagnement devront etre developpees pour faciliter la distribution des medicaments particulierement au niveau communautaire avec l’implication des populations.

Introduction : Seul ou associe a d’autres facteurs de risque vasculaire, le diabete est responsable d’une lourde morbi-mortalite partout dans le monde. Son expansion prend des allures de pandemie, mais elle reste encore peu documentee en Afrique sub-saharienne. Ce travail fournit quelques aspects epidemiologiques du diabete parmi les autres facteurs de risque vasculaire en milieu urbain a Saint-Louis, au Senegal. Patients et methodes : Il s’agit d’une etude observationnelle, transversale, descriptive, qui s’est deroulee du 3 au 30 mai 2010. Les unites de sondage etaient constituees par les Senegalais habitant la ville de Saint-Louis, âges de 15 ans au moins. L’echantillonnage utilise etait un sondage aleatoire, stratifie en grappes, utilisant comme base de sondage les donnees du recensement general de l’habitat de Saint-Louis. Resultats : L’enquete a concerne 1 424 individus. Le sex-ratio femmes/hommes etait de 2,23. L’âge moyen de la population etait de 43,4 ± 17,8 ans. La prevalence du diabete etait de 10,4 %, incluant 7,8 % de cas connus et 2,6 % de cas nouvellement diagnostiques. Ce diabete etait dit « controle » dans 33,3 % des cas selon les criteres de la Federation internationale du diabete (IDF) et 39,6 % selon ceux de l’Association americaine du diabete (ADA). Le traitement etait medicamenteux dans 74,3 % des cas et par traditherapie dans 54,3 % des cas. Les autres facteurs de risque vasculaire etaient : – la dyslipidemie (64,6 %), connue dans 2,4 % des cas et depistee dans 62,2 % des cas. Seuls 20 % des patients etaient traites par hypolipemiants et 12 % etaient a l’objectif ; – la sedentarite (64,0 %), plus frequente chez les femmes que chez les hommes ( p – l’hypertension arterielle (HTA, 46,0 %), connue de l’individu dans 23,0 % des cas et ignoree chez les 23,0 % restants ; 31,0 % des hypertendus n’etaient pas traites et 30,5 % l’etaient par traditherapie ; – l’obesite (23,0 %), a predominance feminine ; – le tabac (5,8 %) et l’alcool etaient moins frequents. Le diabete etait associe a l’HTA ou a la dyslipidemie dans 87,8 % des cas ; 62,8 % des sujets avaient au moins trois facteurs de risque associes. Sur le plan des complications, 16,6 % des sujets presentaient une insuffisance renale, 17,0 % une arteriopathie des membres inferieurs (indice de pression systolique [IPS] abaisse) et 3,2 % avaient presente un accident vasculaire cerebral. Conclusion : Cette enquete revele des chiffres alarmants sur la prevalence du diabete, ainsi que celle de la dyslipidemie, de l’HTA et meme de l’insuffisance renale dans la population autochtone de la ville de Saint-Louis. Ces facteurs de risque vasculaire sont probablement sous-estimes dans la population generale. Il est necessaire de conduire des enquetes de prevalence a l’echelle nationale afin de mettre en place des politiques de prevention efficaces et perennes.

Background Using twice-yearly campaigns such as Child Health Days to deliver vitamin A supplements has been a key strategy over the last 2 decades, and was an important component in helping reach the Millennium Development Goals in child health. As countries move to strengthen their routine health services under the Sustainable Development Goals, efforts are underway to shift supplementation from campaign to routine delivery. Objective The aim of this study was to compare cost, coverage, and user satisfaction between twice-yearly campaigns and routine delivery of vitamin A supplements in Senegal. Methods Information was collected on cost, coverage, and user satisfaction with both types of delivery, using administrative data, interviews at various levels in the health system, and focus group discussions with caregivers. Both qualitative and quantitative information were obtained, for 2 regions using routine delivery and 2 regions using campaign delivery. Results Routine delivery receives fewer dedicated resources. Coverage is lower, especially of children >12 mo of age. Districts undertake outreach (“mini-campaigns”) to try to improve coverage in regions using routine delivery, in effect using a hybrid approach. Some mothers prefer the administration of supplements at a health facility as it is perceived as more hygienic and involving professional health workers, but others, especially those living further away, prefer house-to-house delivery which was the norm for the campaign mode. Conclusions Advance planning for the shift to routine delivery is important in maintaining coverage, as is strengthening the primary health care system by having an appropriate ratio of salaried workers to population. When the system relies heavily on volunteers, and the small incentive payments to volunteers are discontinued, coverage suffers. Routine delivery also relies on good record-keeping and hence literacy. Community understanding of, and support for, supplementation are even more important for routine than for campaign delivery.

Cervical cancer is the first gynecological cancer in Senegal. As part of the cancer control plan, the Ministry of Health and Social Action conducted a pilot phase of HPV vaccination in the districts of Dakar and Mekhe between 2014 and 2016. The objective of this survey is to study the determinants of HPV vaccination coverage in 10-year-old girls in 2016 in the Mekhe health district. This is a descriptive cross-sectional epidemiological study for analytical purposes. A two-stage survey was conducted. The data were collected during an individual interview at the homes of the mothers. The compendium focused on personal characteristics, knowledge and practices on immunization. Full vaccination coverage was determined. Logistic regression was used to identify factors associated with immunization coverage. Respondents were 300 The mean age was 35 ± 9.64 years. Mothers who knew how to prevent cervical cancer were 171 or 57% [95% CI: 51.2-62.7]. Immunization coverage for girls aged 10 years was 86.3% [95% CI: 81.9-90.0]. The discontinuation between the first and second dose of the vaccine was 6.5% [95% CI: 3.9-10.1]. HPV vaccine coverage was related to the residence environment (OR = 3, 18 [95% CI: 1.34-7.56]); (OR = 22.02, [95% CI: 4.2-113.4]) and information for mothers (OR = 10.92 [95% CI: 2.93-40.64]). Vaccination against HPV is a preventive activity that requires the collaboration with the education sector and a good proximity communication.

Context: Cervical cancer is first cancer in women in Africa. The disease is often diagnosed at a late stage. Aims: The purpose of this survey is to study the factors of cervical cancer screening. Settings and Design: This is a descriptive and analytical cross-sectional survey carried out in the health district of Thies in Senegal. Subjects and Methods: Sampling was in two-stage clusters. The data were collected during an individual interview at home. The collection focused on knowledge, attitudes, and practices on cervical cancer. Statistical Analysis Used: Logistic regression was used for data analysis. Results: A total of 498 women were interviewed; 77% of them lived in urban areas, 38% have not been to school, and 82% were married. Nearly, 82.7% of them have already heard about the disease. Infection was the most reported risk factor (55.8%). The screening practice was 35.5% in our sample. Nonschooling reduced screening, while women living in urban areas were seven times more likely to be screened. Screening increased from the poorest quartile to the richest quartile. The knowledge of risk factors and the possibility of recovery increased by 4.80 and 2.34, respectively, the chance of being screened. Conclusions: Improved screening requires multiple strategies that target particularly poor uneducated people living in rural areas but also the strengthening of the capacity of health-care providers.

The objective of this study was to investigate the determinants of rape among minors in the Kolda region.A retrospective, cross-sectional, descriptive and analytical was conducted from 23 December 1992 to 31 December 2011, based on the charts of rape victims under the age of 18 years. Sampling was complete. Bivariate and multivariate analyses were performed using Epi Info 3.3.2 and R 2.9.2 software, respectively.The study included 162 cases of sexual assault. The mean age of victims was 12.3 +/- 3 years (range: 4-17 years). The mean age of perpetrators of sexual assault was 26.4 +/- 9.5 years and minors accounted for 13% of perpetrators. 54.9% of victims, were raped. Victims of sexual assault knew the perpetrator in 66% of cases and were attacked in broad daylight in 53.4% of cases. The perpetrators were drunk at the time of sexual assault in 15.3% of cases. The assault took place in the bush (14.8%). Twenty eight percent (28%) of rapists were jailed and 38.6% of them were jailed for between 5 and 10 years. Sexual assault in the bush [adjusted OR = 3.46 (1.02-11.77)] and intoxication of the perpetrator at the time of sexual assault [adjusted OR = 3.47 (1.04-11.61)] were associated with a high risk of rape. In contrast, victims who knew their assailants were at a lower risk of rape [adjusted OR = 0.09 (0.03 to 0.24)].Extension of this study to the national scale would provide health and judicial authorities with an overview of sexual assault among minors, to allow more effective prevention at the national level.

Access to health care remains a major problem in Senegal, particularly among vulnerable groups such as the elderly. In 2006, the Senegalese government introduced a national plan for the provision of free health care known as "Plan Sésame" to improve access to care. The purpose of this study was to examine the current state of the "Plan Sésame" in national hospitals four years after its implementation (2006-2009).A qualitative study using individual interviews was conducted between 15 March and 14 May 2010 among five target populations: hospital directors, health care providers, managers of the "Plan Sésame" in hospital admission services, management accountants, and beneficiaries. Content analysis was used.Between 2006 and 2008, hospital attendance rates increased every year. However, attendance rates began to decrease in 2009, except in the main hospital. The state has been left with a growing debt because of issues surrounding the reimbursement of expenses related to the "Plan Sésame'. As a result, national hospitals have been forced to restrict certain services included in the "Plan Sésame" and even to withdraw free health care for the elderly. These difficulties are likely to undermine the sustainability of the "Plan Sésame"The health authorities need to audit the "Plan Sésame:, to comply with standard procedures through regular monitoring and to redefine conditions of access.

The purpose of this study was to assess the feasibility and diagnostic performance of an unenhanced MR angiography sequence (Syngo Native Space, Siemens Healthcare) to detect and quantify lower-limb peripheral arterial disease (PAD), with gadolinium-enhanced MR angiography (CE-MRA) as the reference standard.Fifty-one patients known to have lower-limb arteriopathy were included in this prospective study. For every patient, we performed Native sequence and CE-MRA on a 1.5-T system. We evaluated examination duration, image quality, and location, number, and severity of lesions.Examination duration was longer for Native sequence (mean, 39.6 min, vs 10 min for CE-MRA). Image quality was significantly better for CE-MRA, with 92% of images listed as good to excellent for CE-MRA, compared to 53% for Native. Sensitivity, specificity, negative predictive value (NPV), and accuracy of Native were respectively 75%, 95%, 89%, and 88% for all mixed levels; 52%, 97%, 88%, and 87% for aortoiliac level; 87%, 99%, 95%, and 92% for femoropopliteal level; and 82%, 87%, 87%, and 85% for subpopliteal level. If we considered only patients with Leriche and Fontaine stage II arteriopathy, Native results were slightly better, with respective specificities and NPVs of 96% and 91% for all mixed levels; 98% and 90% for aortoiliac level; 98% and 93% for femoropopliteal level; and 91% and 90% for subpopliteal level.Unenhanced MR angiography, cheaper than CE-MRA, showed in our study a good NPV, which suggests its utility as first-line test to screen for PAD, especially in patients at risk of nephrogenic systemic fibrosis.

The objective of this study was to examine the socio-demographic profile andnp pagenum="048"/treatment of women suffering from obstetric fistula (OF) in southeastern Senegal. Conducted between August 2007 and January 2008, the study focused on women treated in regional hospitals in Tambacounda and Kolda. The data were collected using questionnaire-based interviews and analyzed using the Epi Info 3.3.1 software package. The patients (mean age of occurrence of OF: 24) were mostly from rural areas (86%), illiterate (89%), and excised (93%). The main cause of the condition cited by the participants was long working hours (42%). The study found that the participants were more likely to have no income-generating activity (84% compared to 22%) and to be divorced (19% compared to 2%) after (as opposed to before) the OF. The study also highlighted the prevalence of psychological disorders (62%), withdrawal (22%), abandonment by friends and/or family (16%) or by the husband (7%), and decreased effectiveness in household chores (4%). The average time between the occurrence of OF and the first consultation was 50.7 (± 55.3) months. The study found that 44% of the participants were waiting for an operation, 35% had undergone unsuccessful surgery, 14% had been treated and cured, 6% had recently undergone surgery, and 1% had suffered a recurrence. Good access to services was found to be necessary for effective treatment, although high-quality obstetric care and increased awareness were identified as the most important factors for the prevention of OF in southeastern Senegal.

Background The incidence of cardiovascular disease is growing worldwide and this is of major public health concern. In sub-Saharan Africa, there is a lack of epidemiological data on the prevalence and distribution of risk factors of cardiovascular disease. This study aimed at assessing the prevalence of hypertension and other cardiovascular risk factors among an urban Senegalese population. Methods Using an adaptation of the WHO STEPwise approach to chronic disease risk-factor surveillance, we conducted a population-based, cross-sectional survey from 3 to 30 May 2010 on 1 424 participants aged over 15 years. Socio-demographic and behavioural risk factors were collected in step 1. Physical anthropometric measurements and blood pressure were documented in step 2. Blood tests (cholesterol, fasting blood glucose, and creatinine levels) were carried out in step 3. Results The prevalence of hypertension was 46% (95% CI: 43.4–48%), with a higher prevalence in females (47.9%) than males (41.7%) (p = 0.015), and 50% of these hypertensive were previously undiagnosed. Mean age was 53.6 years (SD: 15.8). In known cases of hypertension, the average length of its evolution was 6 years 9 months (range 1 month to 60 years). Hypertension was significantly associated with age (p = 0.001), socio-professional category (p = 0.003), dyslipidaemia (p < 0.001), obesity (p < 0.001), physical inactivity (p < 0.001), diabetes (p < 0.001) and stroke (p < 0.001). Conclusion We found a high prevalence of hypertension and other cardiovascular risk factors in this population. There is need of a specific programme for the management and prevention of cardiovascular disease in this population.