Hepatitis B in Senegal: A Successful Infant Vaccination Program but Urgent Need to Scale Up Screening and Treatment (ANRS 12356 AmBASS survey).

Senegal introduced the infant hepatitis B virus (HBV) vaccination in 2004 and recently committed to eliminating hepatitis B by 2030. Updated epidemiological data are needed to provide information on the progress being made and to develop new interventions. We estimated the prevalence of hepatitis B surface antigen (HBsAg) in children and adults living in rural Senegal and assessed hepatitis B treatment eligibility. A cross-sectional population-based serosurvey of HBsAg was conducted in 2018-2019 in a large sample (n = 3,118) of residents living in the Niakhar area (Fatick region, Senegal). Individuals positive for HBsAg subsequently underwent clinical and biological assessments. Data were weighted for age and sex and calibrated to be representative of the area's population. Among the 3,118 participants, 206 were HBsAg positive (prevalence, 6.9%; 95% confidence interval [CI], 5.6-8.1). Prevalence varied markedly according to age group in individuals aged 0-4, 5-14, 15-34, and ≥35 years as follows: 0.0% (95% CI, 0.00-0.01); 1.5% (95% CI, 0.0-2.3); 12.4% (95% CI, 9.1-15.6); and 8.8% (95% CI, 6.1-11.5), respectively. Of those subsequently assessed, 50.9% (95% CI, 41.8-60.0) had active HBV infection; 4 (2.9%; 95% CI, 0.9-9.4) were eligible for hepatitis B treatment. Conclusion: In this first population-based serosurvey targeting children and adults in rural Senegal, HBsAg prevalence was very low in the former, meeting the World Health Organization's (WHO) < 1% HBsAg 2020 target; however, it was high in young adults (15-34 years old) born before the HBV vaccine was introduced in 2004. To reach national and WHO hepatitis elimination goals, general population testing (particularly for adolescents and young adults), care, and treatment scale-up need to be implemented.

[Particularities of psycho-physiological aspects of sleeping disorders among women performing hospitals night work (Senegal)]. / Particularites des aspects psycho-physiologiques des troubles du sommeil chez les femmes effectuant des gardes de nuit en milieu hospitalier (Senegal).

OBJECTIVE: Todescribe the different psycho-physiological repercussions of night work among female health professionals subject to numerous socio-cultural constraints. MATERIAL AND METHODS: This was a cross-sectional and descriptive study including female professionals performing night work, conducted between July 1 and July 30, 2018 at the Kolda Regional Hospital Center.The study was carried out using anonymous questionnaires. The data collected was entered and analyzed with Microsoft Excel version 2013. RESULTS: A total of 41 women participated in the study. The average age was 30.9 years old. The average night work was 5.9 years. 51.2% of the workers felt comfortable with this type of schedule, compared to 48.8% feeling disrupted. 73.1% preferred daytime work. 36.5% wanted to stop this type of schedule. Several impacts of night work were identified.Physiologically, poor sleep quality (36.6%), insufficient sleep duration (36.6%), menstrual disorders (29.2%) were noted. On the psychological level, stress (48.8%), temperamental disorders (17.5%), anxiety and depression (10.7%) were found. CONCLUSION: A regular medical and psychological follow-up should be necessary for these professionals.

BUT: Il consistait à décrireles différentes répercussions psycho-physiologiques du travail de nuit, chez desprofessionnelles de santé sujettes à de nombreuses contraintes socioculturelles. MATÉRIEL ET MÉTHODES: Il s'agissait d'une étude transversale et descriptive incluant des professionnels de santé féminins, menée entre le 1er juillet et le 30 juillet 2018 au Centre Hospitalier Régional de Kolda. L'étude a été réalisée à l'aide de questionnaires anonymes.Les données recueillies ont été saisies et analysées avec Microsoft Excel version 2013. RÉSULTATS: Au total, 41 femmes avaient participé à l'étude. L'âge moyen était de 30,9 ans. La moyenne d'ancienneté dans le travail de nuit était de 5,9 ans. Les travailleuses se sentant à l'aiseavec ce type d'horaire représentaient 51,2% contre, 48,8% se sentant perturbées. La majorité (73,1%) préférait le travail de jour et 36,5% souhaitaient arrêter le travail de nuit. Plusieurs répercussions du travail de nuit étaient recensées. Sur le plan physiologique, une mauvaise qualité du sommeil (36,6%), une insuffisance de la durée du sommeil (36,6%), des troubles menstruels (29,2%) ont été notés. Sur le plan psychologique, le stress (48,8%), les troubles caractériels (17,5%), l'anxiété et la dépression (10,7%) étaient retrouvés. CONCLUSION: Un suivi médico-psychologique régulier serait nécessaire pour ces professionnelles.

[Features of the incarcerated population followed on an outpatient basis in the Department of Psychiatry of the National University Hospital of Fann in Senegal]. / Caractéristiques de la population carcérale suivie en ambulatoire au service de psychiatrie du Centre Hospitalier National Universitaire de Fann, Sénégal.

INTRODUCTION: psychiatric disorders affect the highest number of incarcerated individuals. Indeed, detention conditions in Senegal have been criticized for several years by referring, in particular, to overcrowding. These conditions probably play a determining role in the occurrence of mental disorders in this population. This work describes the socio-demographic and clinical characteristics of these inmates followed on an outpatient basis in the Department of Psychiatry of the National University Hospital Center in Fann. METHOD: we conducted a retrospective and descriptive study. Data were collected from all the inmates presenting to the External Consultation Unit of the Department of Psychiatry of the National University Hospital Center of Fann between 1st January 2005 and 31st December 2010. RESULTS: our study population consisted of 62 inmates, 92% men and 8% women. The average age of patients was 32 years, nearly three-quarters (72.6%) of individuals were single. In the majority of cases they were in a precarious employment situation and 69.3% of them had not completed secondary education. Insomnia was the leading reason for consultation (29%) followed by auditory verbal hallucinations (22.6%). Physical aggression and/or threats to fellow inmates were observed in 17.7% of cases. The main diagnostic categories found were schizophrenic disorders (32.3%) and depressive disorders (27.4%). Between 2005 and 2010, the number of consultations increased threefold/year, from 7 to 19. CONCLUSION: this study showed that the incarcerated population, followed on an outpatient basis in the Department of Psychiatry, were young, mostly male and single, with low level of education and disadvantaged professional status. Similar cases have been reported in the international literature. Considering Senegal's socio-economic situation and health systems development, we note that, although the number of consultations has increased over the years, only inmates with severe mental disorders are followed in specialized health services. Given the number of incarcerated subjects, the biography background of these subjects, the conditions of detention and the absence of some diseases, a survey should be conducted in prisons in order to assess mental healthcare needs of incarcerated subjects and the specific issues that could affect them.

Sibling status, home birth, tattoos and stitches are risk factors for chronic hepatitis B virus infection in Senegalese children: A cross-sectional survey.

Sub-Saharan Africa's hepatitis B virus (HBV) burden is primarily due to infection in infancy. However, data on chronic HBV infection prevalence and associated risk factors in children born post-HBV vaccination introduction are scarce. We estimated hepatitis B surface antigen (HBsAg) prevalence and risk factors in Senegalese children born during the HBV vaccination era. In 2018-2019, a community-based cross-sectional survey was conducted in Senegal among children born between 2004 and 2015 (ie after the three-dose HBV vaccine series was introduced (2004) but before the birth dose's introduction (2016)). HBsAg-positive children were identified using dried blood spots. A standardized questionnaire collected socioeconomic information. Data were age-sex weighted and calibrated to be representative of children living in the study area. Risk factors associated with HBsAg positivity were identified using negative binomial regression. Among 1,327 children, 17 were HBsAg-positive (prevalence = 1.23% (95% confidence interval [CI] 0.61-1.85)). Older age (adjusted incidence-rate ratio [aIRR] 1.31 per one-year increase, 95% CI 1.10-1.57), home vs healthcare facility delivery (aIRR 3.55, 95% CI 1.39-9.02), stitches (lifetime) (aIRR 4.79; 95% CI 1.84-12.39), tattoos (aIRR 8.97, 95% CI 1.01-79.11) and having an HBsAg-positive sibling with the same mother (aIRR 3.05, 95% CI 1.09-8.57) were all independently associated with HBsAg positivity. The low HBsAg prevalence highlights the success of the Senegalese HBV vaccination program. To further reduce HBV acquisition in children, high-risk groups, including pregnant women and siblings of HBsAg-positive individuals, must be screened. Vital HBV infection prevention measures include promoting delivery in healthcare facilities, and increasing awareness of prevention and control procedures.

The Costs of Introducing the Hepatitis B Birth Dose Vaccine into the National Immunization Programme in Senegal (NéoVac Study).

Some African countries are still reluctant to introduce the hepatitis B vaccine birth dose (HepB-BD) into their expanded program of immunization (EPI), partly because of logistical, economic, and cost information constraints. To assist decision-makers in these countries, we assessed the economic and financial costs of HepB-BD introduction in Senegal in 2016. We performed a micro-costing study in a representative sample of Senegal's EPI sites at all levels in 2018. Information on EPI and HepB-BD activity-related inputs and costs was collected using standardized questionnaires and semi-structured interviews. Using inverse probability weighting, we computed weighted average costs associated with HepB-BD introduction for each EPI level, country-level aggregated costs and estimated costs per newborn. Economic and financial costs from a government perspective were estimated in US dollars for 2015, 2016 and 2017. Total economic costs were USD 143,364 in 2015, USD 759,406 in 2016 and USD 867,311 in 2017, while financial costs were USD 127,745, USD 82,519 and USD 29,853, respectively. When annualizing pre-introduction and initial training costs, the economic (financial) cost per vaccinated newborn was USD 2.10 (USD 0.30) in 2016 and USD 1.90 (USD 0.20) in 2017. Our estimates provide valuable information to implement HepB-BD in Sub-Saharan African countries that have not yet integrated this vaccine.

Hepatitis B Vaccination in Senegalese Children: Coverage, Timeliness, and Sociodemographic Determinants of Non-Adherence to Immunisation Schedules (ANRS 12356 AmBASS Survey).

Detailed knowledge about hepatitis B virus (HBV) vaccination coverage and timeliness for sub-Saharan Africa is scarce. We used data from a community-based cross-sectional survey conducted in 2018-2019 in the area of Niakhar, Senegal, to estimate coverage, timeliness, and factors associated with non-adherence to the World Health Organisation-recommended vaccination schedules in children born in 2016 (year of the birth dose (BD) introduction in Senegal) and 2017-2018. Vaccination status was assessed from vaccination cards, surveillance data, and healthcare post vaccination records. Among 241 children with available data, for 2016 and 2017-2018, respectively, 31.0% and 66.8% received the BD within 24 h of birth (BD schedule), and 24.3% and 53.7% received the BD plus at least two pentavalent vaccine doses within the recommended timeframes (three-dose schedule). In logistic regression models, home birth, dry season birth, and birth in 2016 were all associated with non-adherence to the recommended BD and three-dose schedules. Living over three kilometres from the nearest healthcare post, being the firstborn, and living in an agriculturally poorer household were only associated with non-adherence to the three-dose schedule. The substantial proportion of children not vaccinated according to recommended schedules highlights the importance of considering vaccination timeliness when evaluating vaccination programme effectiveness. Outreach vaccination activities and incentives to bring children born at home to healthcare facilities within 24 h of birth, must be strengthened to improve timely HBV vaccination.

Towards harmonization of microscopy methods for malaria clinical research studies.

Microscopy performed on stained films of peripheral blood for detection, identification and quantification of malaria parasites is an essential reference standard for clinical trials of drugs, vaccines and diagnostic tests for malaria. The value of data from such research is greatly enhanced if this reference standard is consistent across time and geography. Adherence to common standards and practices is a prerequisite to achieve this. The rationale for proposed research standards and procedures for the preparation, staining and microscopic examination of blood films for malaria parasites is presented here with the aim of improving the consistency and reliability of malaria microscopy performed in such studies. These standards constitute the core of a quality management system for clinical research studies employing microscopy as a reference standard. They can be used as the basis for the design of training and proficiency testing programmes as well as for procedures and quality assurance of malaria microscopy in clinical research.

[Anaesthesia in on-pump cardiac surgery for congenital heart diseases at the Cuomo Pediatric Cardiology Center (Senegal)]. / Prise en charge anesthésique des cardiopathies congénitales opérées sous circulation extra - corporelle au Centre de Chirurgie Cardiaque Pédiatrique Cuomo (Sénégal).

Congenital heart diseases account for 0.5-1% of births. The management of children with cardiac malformation requires treatment in a suitable center, adequate medical equipment and specific anesthetic and surgical knowledge. The purpose of this study was to evaluate the anesthetic management of patients with congenital heart diseases in our center after the first year of activity and to compare the obtained results with literature reported data. We conducted a retrospective, descriptive study over a 1-year period, from January to December 2017. All patients undergoing on-pump cardiac surgery for congenital heart disease during this period were included. We collected data from 80 records of patients undergoing surgery for congenital heart disease. Out of these 80 patients, 60 underwent on-pump cardiac surgery (75%). The average age of patients was 7.41 years, with a sex-ratio of 1.22. The mean duration of on-pump cardiac surgery was 82.82 min and the mean duration of aortic clamping was 58.31 min. At the end of the procedure catecholamine production was found in 70% of patients. The most common complication in the postoperative period was right-side heart failure (69%). The average length of stay in the Emergency room was 4.33 days. One patient died, bringing mortality to 1.6%. Congenital heart diseases are complex and highly variable. Improved management techniques have strongly reduced morbi-mortality.

Susac syndrome: about two cases.

Susac syndrome is an autoimmune endothelopathy that affects precapillary arterioles of the brain, retina and inner ear. We report for the first time observations of two patients with Susac syndrome in Senegal.

Evaluation of the effectiveness of a targeted community-based IRS approach for malaria elimination in an area of low malaria transmission of the central-western Senegal.

The implementation of effective malaria control strategies in the central-western Senegal, such as Indoor Residual Spraying (IRS), long-lasting insecticide-treated nets (LLIN), Seasonal malaria chemoprophylaxis (SMC) and appropriate management of malaria cases, has led to the decline of malaria transmission in the region. However, residual malaria transmission still occurring in some localities, known as hotspots villages, making challenging the achievement of the malaria elimination goal. A pilot study was undertaken between 2013 and 2014 to test the feasibility of a community-based IRS approach for malaria elimination in four targeted health districts of the Central Western Senegal. The residual efficacy of the Actellic® 300CS formulation on the sprayed surface was monitored using WHO cone test. Overall, 615 walls were tested over the two successive years, respectively 240 and 375 in 2013 and 2014 IRS campaigns. The residual efficacy of the IRS with Actellic®300 CS was longer in the second year due to the improvement of community agents spraying skill the second year thanks to the refreshing training and a better supervision by professional agent of the National Hygiene Service. The analysis of the Incidence Rate Ratio under the Poisson model shows no significant difference of IRS effectiveness according to the building type. In conclusion, the quality of training of community agents and good supervision of IRS activities play a key role in the quality and the residual efficacy of IRS campaigns. A good planning and implementation of IRS campaign ensure a high quality and a good effectiveness of spraying with the Actellic®300 CS formulation.

[Intra-anesthetic arterial hypotension in elderly patients during emergency surgery: what are the risk factors?] / Hypotension artérielle per-anesthésique du sujet âgé lors d'une chirurgie urgente: quels facteurs de risque?

Emergency anesthesia in elderly patients aged 65 years and older is complex. The occurrence of intraoperative incidents and arterial hypotension is conditioned by patients' initial health status and by the quality of intraoperative management. This study aimed to determine the incidence of intra-anesthetic arterial hypotension in elderly patients during emergency surgery and to assess the involvement of certain factors in its occurrence: age, sex, patient's history, ASA class, anesthetic technique. We conducted a retrospective descriptive and analytical study in the Emergency Surgery Department at the Aristide Le Dantec University Hospital from 1 March 2014 to 28 February 2015. We collected data from 210 patients out of 224 elderly patients aged 65 years and older undergoing emergency anesthesias (10.93%). Data of 101 men and 109 women were included in the analysis, of whom 64.3% had at least one defect. Patients' preoperative status was assessed using American Society of Anesthesiology (ASA) classification: 71% of patients were ASA class 1 and 2 and 29% were ASA class 3 and 4. Locoregional anesthesia was the most practiced anesthetic technique (56.7%). 28 patients (13.33%) had intra-anesthetic arterial hypotension, of whom 16 under general anesthesia and 12 under locoregional anesthesia. It was more frequent in patients with high ASA class and a little less frequent in patients with PAH and underlying heart disease. Arterial hypotension in elderly patients during emergency surgery exposes the subject to the risk of not negligible intraoperative hypotension, especially in patients with high ASA class. Prevention is based on adequate preoperative assessment and anesthetic management.

An epidemiological study to assess Plasmodium falciparum parasite prevalence and malaria control measures in Burkina Faso and Senegal.

BACKGROUND: Malariometric information is needed to decide how to introduce malaria vaccines and evaluate their impact in sub-Saharan African countries. METHODS: This cross-sectional study (NCT01954264) was conducted between October and November, 2013, corresponding to the high malaria transmission season, in four sites with Health and Demographic Surveillance Systems (DSS) [two sites with moderate-to-high malaria endemicity in Burkina Faso (Nouna and Saponé) and two sites with low malaria endemicity in Senegal (Keur Socé and Niakhar)]. Children (N = 2421) were randomly selected from the DSS lists of the study sites and were stratified into two age groups (6 months-4 years and 5-9 years). A blood sample was collected from each child to evaluate parasite prevalence of Plasmodium falciparum and other Plasmodium species and gametocyte density by microscopy, and rapid diagnosis test in the event of fever within 24 h. Case report forms were used to evaluate malaria control measures and other factors. RESULTS: Plasmodium falciparum was identified in 707 (29.2%) children, with a higher prevalence in Burkina Faso than Senegal (57.5 vs 0.9% of children). In Burkina Faso, prevalence was 57.7% in Nouna and 41.9% in Saponé in the 6 months-4 years age group, and 75.4% in Nouna and 70.1% in Saponé in the 5-9 years age group. Infections with other Plasmodium species were rare and only detected in Burkina Faso. While mosquito nets were used by 88.6-97.0 and 64.7-80.2% of children in Burkina Faso and Senegal, other malaria control measures evaluated at individual level were uncommon. In Burkina Faso, exploratory analyses suggested that use of malaria treatment or any other medication within 14 days, and use of insecticide spray within 7 days decreased the prevalence of malaria infection; older age, rural residence, natural floor, grass/palm roof, and unavailability of electricity in the house were factors associated with increased malaria occurrence. CONCLUSIONS: Plasmodium falciparum infection prevalence in children younger than 10 years was 57.5% in Burkina Faso and 0.9% in Senegal, and variability was observed, among others, by age, study site and malaria control measures.

[Perioperative management of emergency abdominal surgery in adult patients at the Aristide Le Dantec University Hospital]. / Prise en charge péri opératoire des urgences chirurgicales abdominales chez l'adulte au CHU Aristide Le Dantec.

Perioperative management of emergency abdominal surgery remains a major concern for anesthesiologists due to hemodynamic and/or metabolic disorders often present preoperatively as well as to potential postoperative complications. This study aims to evaluate the epidemiological, diagnostic, therapeutic and prognostic factors of abdominal emergencies. We conducted a retrospective descriptive study involving patients over 16 years old undergoing emergency abdominal surgery at the Aristide Le Dantec University Hospital over a period of six months. The parameters studied were the epidemiological, diagnostic, therapeutic and prognostic factors of emergency abdominal surgery. We collected 161 cases, nearly 20% of the activity in the department. The average age was 41 years [16, 80 years]. The sex ratio was 2.9. The mean consultation time was 4.6 days. Peritonitis was the most frequent pathologies (25.5%). The average heart rate in patients was 92 bpm (beats/ min) and 97 bpm in patients who underwent preoperative hemodynamic preparation. The average Mean Arterial Pressure (MAP) was 96.6 mmHg and 86.1 mmHg in prepared patients. 49.1% of patients were ASA class 1, 39.9% were ASA2, 8.7% ASA3, 2.5% ASA4 and 0.6% ASA5. Antibiotic prophylaxis was used in 46.30% of patients and 53.41% of them underwent antibiotic therapy. 95.6% of patients underwent general anesthesia and 4.4% underwent spinal anesthesia. The frequency of perioperative incidents was 11.08%. Morbidity was 4.3% and mortality was 4.96%. The management of emergency abdominal surgery requires a multidisciplinary approach that involves anesthetists, surgeons and biologists to further reduce morbidity and mortality rate which remains significant even today.

Polymyositis anti-SRP antibodies and pregnancy about 2 cases.

Anti-SRP myopathy represents 4 to 6% of all the inflammatory myopathies. It has been described since the 80s and its influence on pregnancy and vice versa has been highlighted recently. We report two cases of anti-SRP myopathy associated with pregnancy. In the first case, the initial manifestations of the disease started in post partum and the second case was an anti-SRP myopathy patient before pregnancy. In both cases we objectified outbreaks during post-partum. Pregnancy seems to promote outbreaks. The inactive myopathy seems to presents no serious maternal-fetal complications as well as the usual dose of corticosteroids. The treatment (corticosteroid) during pregnancy is indicated given the risk of worsening during the post-partum.

[Lipid and glucose profile in patients with ischemic cerebrovascular accidents in Dakar]. / Le profil lipidique et glucidique des accidents vasculaires cérébraux ischémiques à Dakar.

Cerebrovascular accident (CVA) is defined as the rapid development of localized or global clinical signs of neurological dysfunction with no apparent cause other than that of vascular origin. A variety of risk factors have been identified and associated with the occurrence of Ischemic CVA, including glucose and lipid metabolism disturbances. We conducted a retrospective study at the Clinic of Neurology, Fann. Our study focused on medical records of patients with ICVA confirmed by imaging, hospitalized from January 1 to December 31 2010. All patients underwent complete lipid profile (total cholesterol, triglycerides, HDL; LDL level was calculated using Friedwald formula), kidney function tests and fasting blood sugar test were performed within 48 hours of admission. Data were analysed using univariate technique and then using bivariate technique tanks to SPSS 16.0 software. We collected 235 files. We here report a case series of patients between ages 10-99 years, with an average age of 67,06 years. Males were 42,55%, sex-ratio was 0,74 in favour of women. 26% of cases had impaired fasting glucose levels during the acute phase of ICVA. The lipid profile showed an increase in total cholesterol level in 52.34% of patients. Low levels of HDL cholesterol were found in 34.47% of patients. Hypertriglyceridemia was only observed in 3% of patients. LDL levels were high in 12,76% of patients. Atherogenicity index was high in 25,53% of patients. Disturbances of blood glucose and lipid profile are often associated with ICVA and should be taken into account to ensure better secondary prevention.

(Not) Keeping the stem straight: a proteomic analysis of maritime pine seedlings undergoing phototropism and gravitropism.

BACKGROUND: Plants are subjected to continuous stimuli from the environment and have evolved an ability to respond through various growth and development processes. Phototropism and gravitropism responses enable the plant to reorient with regard to light and gravity. RESULTS: We quantified the speed of maritime pine seedlings to reorient with regard to light and gravity over 22 days. Seedlings were inclined at 15, 30 and 45 degrees with vertical plants as controls. A lateral light source illuminated the plants and stem movement over time was recorded. Depending on the initial angle of stem lean, the apical response to the lateral light source differed. In control and 15° inclined plants, the apex turned directly towards the light source after only 2 h. In plants inclined at 30° and 45°, the apex first reoriented in the vertical plane after 2 h, then turned towards the light source after 24 h. Two-dimensional gel electrophoresis coupled with mass spectrometry was then used to describe the molecular response of stem bending involved in photo- and gravi-tropism after 22 hr and 8 days of treatment. A total of 486 spots were quantitatively analyzed using image analysis software. Significant changes were determined in the protein accumulation of 68 protein spots. Early response gravitropic associated proteins were identified, which are known to function in energy related and primary metabolism. A group of thirty eight proteins were found to be involved in primary metabolism and energy related metabolic pathways. Degradation of Rubisco was implicated in some protein shifts. CONCLUSIONS: Our study demonstrates a rapid gravitropic response in apices of maritime pine seedlings inclined >30°. Little or no response was observed at the stem bases of the same plants. The primary gravitropic response is concomitant with a modification of the proteome, consisting of an over accumulation of energy and metabolism associated proteins, which may allow the stem to reorient rapidly after bending.