Using cognitive mapping to understand Senegalese infant and young child feeding decisions.

Caregivers make decisions about how to feed their infants and young children based on complex interactions of knowledge, beliefs, and values, as well as assessments of situational determinants, including economic and social constraints and opportunities. Because of the relationship of these factors to the adoption of new feeding behaviours, the development of nutrition interventions for this age group must be grounded in knowledge about the target population. This paper presents the results of a study that used cognitive mapping techniques to gain insight into mothers' knowledge and perceptions of foods for infants and young children and examine their significance for feeding decisions in Saint-Louis, northern Senegal. Guided by mixed-methods protocols from the Focused Ethnographic Study for Infant and Young Child Feeding Manual, in-depth interviews that included qualitative discussions and cognitive mapping techniques were conducted with 46 mothers in rural and peri-urban communities. We explored mothers' perceptions about five dimensions that affect food decision-making-healthiness, convenience, child acceptance, appeal, and modernity-and the relationship of these dimensions to 38 local food items. Data analysis entailed a combination of qualitative thematic analysis and descriptive statistics. In both communities, "healthiness" was the most valued dimension for food decision-making by a large margin, followed by child acceptance, appeal, modernity, and convenience. We explore how different interpretations and definitions of these dimensions, and their relationship to specific local food items, may influence the design and planning of nutrition interventions. The results support the importance of mixed-methods formative research to illuminate the emic perspectives of caregivers.

[The challenges of the effectiveness of the planning process in the West African Health Systems]. / Les défis de l'efficacité dans la planification des systèmes de santé en Afrique de l'Ouest.

Health planning is one of the main activities in Health Systems management. It is considered as an important function by the health managers and technicians. Indeed, important resources and time are allocated to this activity.Today, evidence shows that, partly under the influence of some key partners, the health planning process has become an expensive process whose outcomes are, at the very least, questionable. The produced plans are rarely implemented in a systematic way.Several software programs to support the planning process exist. However, they are either misused or not used by the technicians. In a more general way, the ?Business As Usual? model for solving public health problems deserves to be questioned. There is a need to move towards more engaging and pragmatic approaches to address the major challenges of Public Health in Africa.

[Determinants of modern contraceptive use in the Mbacké health district (Senegal)]. / Determinants de l'utilisation de la contraception moderne dans le district sanitaire de Mbacké (Séngal).

INTRODUCTION: Contraceptive prevalence is low in Senegal, particularly in the Mbacké health district. The objective of this study was to identify the determinants of use of modern contraception by women of reproductive age in this district. METHODOLOGY: A quantitative and qualitative analytical study was conducted. The quantitative survey was conducted from 1st to 20 July 2011. The study population consisted of women of childbearing age living in the district. A two-stage survey was conducted. Data were entered and bivariate analysis was performed using Epi Info 3.3.5software. Multivariate analysiswas performed by R 2.2.9 software. The adjusted odds ratios were calculatedfor variables with significant p values. The qualitative study was conducted from 25 to 31 July2011. Grouped interviews were used to collect women's perceptions of modern contraception. Content analysis was performed. CONCLUSION: Improving the socio-economic characteristics of women and raising public awareness about modern contraception would contribute to a better use of modern contraceptives in the Mbacké health district.

"When I sleep under the net, nothing bothers me; I sleep well and I'm happy": Senegal's culture of net use and how inconveniences to net use do not translate to net abandonment.

BACKGROUND: Despite recent advances in the fight against the disease, malaria remains a serious threat to the health and well-being of populations in endemic countries. The use of long-lasting insecticidal nets (LLIN) reduces contact between the vector and humans, thereby reducing transmission of the disease. LLINs have become an essential component of malaria control programmes worldwide. METHODS: The Culture of Net Use study used qualitative and quantitative methods in a longitudinal and iterative design over two phases, in order to capture changes in net use over a year and a half period and covering both dry and rainy seasons. Data were collected from a total of 56 households in eight regions to understand variations due to geographical, cultural, and universal coverage differences. At the time of the data collection, the universal coverage campaign had been completed in six of the eight regions (Dakar and Thies excluded). RESULTS: Perceived barriers to use were primarily related to the characteristics of the net itself, include shape, insecticide, and a variety of minority responses, such as perceived lack of mosquito density and being unaccustomed to using nets. Insecticide-related complaints found that insecticide did not present a significant barrier to use, but was cited as a nuisance. Feelings of suffocation continued to be the most commonly cited nuisance. Respondents who favoured the use of insecticide on nets appeared to be more aware of the health and malaria prevention benefits of the insecticide than those who perceived it negatively. CONCLUSION: Despite prior evidence that barriers such as heat, shape, insecticide and perceived mosquito density contribute to non-use of LLINs in other countries, this study has shown that these factors are considered more as nuisances and that they do not consistently prevent the use of nets among respondents in Senegal. Of those who cited inconveniences with their nets, few were moved to stop using a net. Respondents from this study overcame these barriers and continue to value the importance of nets.

"You need to take care of it like you take care of your soul": perceptions and behaviours related to mosquito net damage, care, and repair in Senegal.

BACKGROUND: Net care and repair behaviours are essential for prolonging the durability of long-lasting insecticidal nets. Increased net durability has implications for protection against malaria as well as cost savings from less frequent net distributions. This study investigated behaviours and motivations for net care and repair behaviours in Senegal with the aim of informing social and behaviour change communication (SBCC) programmes, using the Health Belief Model as a framework. METHODS: Data were collected from 114 participants in eight regions of Senegal. Participants were eligible for the study if they were at least 18 years old and if their household owned at least one net. These respondents included 56 in-depth interview respondents and eight focus groups with 58 participants. In addition, the qualitative data were supplemented with observational questionnaire data from a total of 556 sleeping spaces. Of these spaces, 394 had an associated net. RESULTS: Reported net care and repair behaviours and motivations varied substantially within this sample. Children and improper handling were seen as major sources of net damage and respondents often tried to prevent damage by storing nets when not in use. Washing was seen as an additional method of care, but practices for washing varied and may have been damaging to nets in some cases. Participants mentioned a sense of pride of having a net in good condition and the uncertainty around when they could expect another net distribution as motivations for net care. Net repair appeared to be a less common behaviour and was limited by the perspective that net degradation was inevitable and that repairs themselves could weaken nets. CONCLUSION: These findings can be understood using the Health Belief Model framework of perceived severity, perceived susceptibility, perceived barriers, perceived benefits, self-efficacy, and cues to action. This model can guide SBCC messages surrounding net care and repair to promote practices associated with net longevity. Such messages should promote the benefits of intact nets and provide tools for overcoming barriers to care and repair.

[Evaluation: an avenue to improvement of health promotion in Africa?]. / L'évaluation, une voie pour faire progresser la promotion de la santé en Afrique ?

Are the methods used to evaluate health promotion interventions in Africa adapted to the specificities of this field ? The authors try to answer this question based on reflective analysis of four evaluations that they conducted in Benin, Burkina Faso and Mali. The experiences reported illustrate the desire to conduct the evaluation approach in line with the principles of health promotion but also the difficulties involved to overcome the obstacles to practical application of evaluation. Considerable progress has yet to be made to ensure that evaluation fully meets the expectations of stakeholders and the values of health promotion : all of the dynamics generated by health promotion interventions must be taken into account, equity must be integrated at the heart of the reflection, innovative practices must be supported in view of their durability. Because it facilitates the emergence and sharing of multiple visions of this still poorly defined concept, evaluation constitutes an avenue to improvement of health promotion in Africa.

[Study of determinants of rape in minors in the Kolda region of Senegal]. / Etude des déterminants de viols chez les mineurs dans la région de Kolda au Sénégal.

INTRODUCTION: The objective of this study was to investigate the determinants of rape among minors in the Kolda region. METHODOLOGY: 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. RESULTS: 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)]. CONCLUSION: 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.

User-determined end of net life in Senegal: a qualitative assessment of decision-making related to the retirement of expired nets.

BACKGROUND: Procurement and distribution of long-lasting insecticidal nets (LLINs) in the African region has decreased from 145 million in 2010 to 66 million nets in 2012. As resources for LLIN distribution appear to stagnate, it is important to understand the users' perception of the life span of a net and at what point and why they stop using it. In order to get the most value out of distributed nets and to ensure that they are used for as long as possible, programmes must communicate to users about how to assess useful net life and how to extend it. METHODS: Data were collected from 114 respondents who participated in 56 in-depth interviews (IDIs) and eight focus group discussions (FGDs) in August 2012 in eight regions in Senegal. Households were eligible for the study if they owned at least one net and had an available household member over the age of 18. Data were coded by a team of four coders in ATLAS.ti using a primarily deductive approach. RESULTS: Respondents reported assessing useful net life using the following criteria: the age of net, the number and size of holes and the presence of mosquitoes in the net at night. If they had the means to do so, many respondents preferred the acquisition of a new net rather than the continued use of a very torn net. However, respondents would preferentially use newer nets, saving older, but useable nets for the future or sharing them with family or friends. Participants reported observing alternative uses of nets, primarily for nets that were considered expired. CONCLUSIONS: The results indicate that decisions regarding the end of net life vary among community members in Senegal, but are primarily related to net integrity. Additional research is needed into user-determined end of net life as well as care and repair behaviours, which could extend useful net life. The results from this study and from future research on this topic should be used to understand current behaviours and develop communication programmes to prolong the useful life of nets.

[Analysis of free health care for the elderly in the context of the "Plan Sésame" in Senegal]. / Analyse du fonctionnement du plan de prise en charge gratuite des soins chez les personnes âgées "Plan Sesame" au Senegal.

INTRODUCTION: 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). METHODS: 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. RESULTS: 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" CONCLUSION: The health authorities need to audit the "Plan Sésame:, to comply with standard procedures through regular monitoring and to redefine conditions of access.

[Results-based management and health development strategies: some reflections on recent experiences in Africa]. / Gestion axée sur les résultats et stratégies de développement sanitaire en Afrique.

The Paris Declaration on Aid Effectiveness (PD), launched in 2005, and the International Health Partnership (IHP+) have promoted a results-based management approach (RBM) to health care based on 6 principles: simplicity, action-based learning, accountability, adaptability, partnership, and transparency. These principles have been implemented in the form of health policies as part of the development and implementation of National Health Sector Strategic Plans. The recent experience of several African countries provides an indication of the strengths and weaknesses of results-based management in the health sector. In Senegal, inadequate training has resulted in inadequate planning, particularly in the development of the Medium-Term Expenditure Framework (MTEF). In its last Health Sector Strategic Plan, Burundi, against all results-based logic, allocated 93 % of its budget to the central level, compared to just 1 % and 6 % respectively to the intermediate and peripheral levels. In Mauritania, the state has not complied with the MTEF, despite the significant increase in the resources allocated to the health sector. By contrast, in Rwanda, there has been a significant improvement in health indicators as a result of the harmonious development of the HSSP and the related MTEF and compliance with the budget. These challenges require an extensive use of RBM through improved governance in the health sector and capacity building.

[Economic evaluation of rapid diagnostic tests in malaria treatment]. / Evaluation économique des tests de diagnostic rapide dans le traitement du paludisme.

This study aimed to evaluate the economic implications of rapid diagnostic tests (RDTs) on malaria management through the rational use of artemisinin-based combination therapy (ACT). The study was carried out in 2006 from November 10th to December 10th; it focused on patients who were seen and treated with ACT for suspicion of uncomplicated malaria in the health district of Ziguinchor, Senegal. The variables studied included age, sex, RDT results, and costs of care and RDT. The cost of care for malaria, estimated in CFA Francs, was evaluated both with and without the use of RDT. Among the 379 patients, 25,1% were aged 0-4 years, 12,7% of 5-14 years and 62,2% of at least 15 years; 51% were women. The result of the RDT was negative in 60% of cases. Without the use of diagnostic testing, the cost of care for all 379 cases was estimated at 299 957 CFA: patient contributions would cover 184 500 CFA and the State would cover the rest (115 457 CFA). With the use of RDTs, the overall cost of the RDT screening for 379 patients and the cost of treatment for the 150 positive cases amounted to 254 786 CFA, with patients bearing the cost of 205 550 CFA and the State subsidizing up to 49 236 CFA. RDT can help identify the positive cases of malaria, and avoid up to 60% of unnecessary treatments, corresponding to an estimated 27 297 cases at the district level and 584 630 cases nationally. The RDT also allow a more rational use of ACTs and a lower risk of emergence of Plasmodium resistance. The use of RDTs could result in savings of 45 171 CFA at the level of the district health centre and 111 240 136 CFA nationally.

Cancer ecosystem assessment in West Africa: health systems gaps to prevent and control cancers in three countries: Ghana, Nigeria and Senegal.

INTRODUCTION: Sub-Saharan Africa is experiencing a rapid epidemiological transition with the increasing incidence of Non-Communicable Diseases (NCD). Among these, cancer is one of the main causes of death in adults. This is a public health problem whose burden is unknown due to lack of statistical data. In addition, the already overburdened health systems are experiencing enormous constraints to address the problem with the double challenge of communicable and NCDs. METHODS: The purpose of this evaluation was to assess the capacity and needs of health systems to prevent and control cancer. A cross-sectional study, using both quantitative and qualitative methods, was conducted between April 2017 and February 2018 in target countries, through in-depth interviews with key actors, direct observations and documents review. The WHO framework for health system strengthening with the 6 pillars was used for the gaps analysis. RESULTS: Little priority is given to the fight against cancer because of low political commitment. Programs´ resources are very limited and there is a poor coordination of the actions. Human resources are insufficient, and most of them are concentrated in the capital city. This limits access to care with a late consultation of patients. Diagnosis and treatment services are expensive and generally paid by households. Finally, the unavailability of reliable data at national level hinders the decision-based evidence. CONCLUSION: There is an urgent need to create strong partnerships at national and regional levels to (i) Advocate for a strong political commitment; (ii) Strengthen the coordination of actions and create more synergy among stakeholders; (iii) Improve the quality and quantity of human resources; (iv) Extend universal health coverage to cancer and improve program funding; and (v) Set up cancer registries at national level.

[Contribution of supplementation by spirulina to the performance of school children in an introductory course in Dakar (Senegal)]. / Apport de la supplémentation en spiruline sur les performances scolaires des enfants en cours d'initiation a Dakar (Sénégal).

Senegal initiated a program to improve the nutritional status of school-age children with the use of spirulina. The objective of this study was to evaluate the effects of spirulina on academic performance of school children in the municipality of Dakar, Senegal. The evaluation was conducted as a prospective study, comparing school performance of schoolchildren from public elementary schools located in three National Education Departments of Dakar (before supplements, during and after). The study population consisted of students from six schools randomly selected among the 100 who were in the program. We included all children with agreement of their parent or guardian, and those who rejected the spirulina were not included. Supplemental feeding with spirulina was given to young children during two months (from mid-April to mid June 2005). Over these 60 days, the students took a daily dose of 2 grams of spirulina mixed with 10g of honey to make the taste acceptable. The data on age, gender and monitoring of school performance (i.e. the average compositions of the second and third quarters) were collected. Mean differences in grades between second quarter and third quarter (after two months of supplementation) were analyzed and compared by the paired student test. The sample size was a total of 549 schoolchildren: 273 (49.72%) were girls, and 276 (50.28%) boys. The mean age was 91 months [90.29-91.71]. The average of 2rd quarter marks before supplementation was 5.17 out of 10 IC = [4.99-5.35] and the same for the 3rd quarter after two months of supplementation was 5.78 out of 10 IC = [5.59-5.97]. The mean difference between pupils' marks at the 3rd and the 2nd trimester was 0.59 (p <-- 0.0001). After two months of supplemental feeding, the academic performance of the children was improved.

Results of Applying Cultural Domain Analysis Techniques and Implications for the Design of Complementary Feeding Interventions in Northern Senegal.

BACKGROUND: Designing effective nutrition interventions for infants and young children requires knowledge about the population to which the intervention is directed, including insights into the cognitive systems and values that inform caregiver feeding practices. OBJECTIVE: To apply cultural domain analysis techniques in the context of implementation research for the purpose of understanding caregivers' knowledge frameworks in Northern Senegal with respect to infant and young child (IYC) feeding. This study was intended to inform decisions for interventions to improve infant and young child nutrition. METHODS: Modules from the Focused Ethnographic Study for Infant and Young Child Feeding Manual were employed in interviews with a sample of 126 key informants and caregivers from rural and peri-urban sites in the Saint-Louis region of northern Senegal. Descriptive statistics, cluster analysis, and qualitative thematic analysis were used to analyze the data. RESULTS: Cluster analysis showed that caregivers identified 6 food clusters: heavy foods, light foods, snack foods, foraged foods, packaged foods, and foods that are good for the body. The study also revealed similarities and differences between the 2 study sites in caregivers' knowledge frameworks. CONCLUSIONS: The demonstration of differences between biomedical concepts of nutrition and the knowledge frameworks of northern Senegalese women with regard to IYC feeding highlights the value of knowledge about emic perspectives of local communities to help guide decisions about interventions to improve nutrition.

Prevalence of epilepsy its treatment gap and knowledge, attitude and practice of its population in sub-urban Senegal an ILAE/IBE/WHO study.

A door-to-door survey was used to determine the prevalence of epilepsy among 4500 people within the Pikine Health District (population 480,000) Senegal. Prevalence was 14.2/1000, and 23.4% of all people with epilepsy had never received appropriate treatment. Figures for the prevalence had increased since a previous survey in 1989. In parallel a study of knowledge attitude and practice was performed in the same district. Salient findings were that: two-thirds of interviewees had at some time witnessed a seizure, 51% agreed when asked if epilepsy is caused by evil spirits, 35% said epilepsy is contagious, only about 18% said that traditional therapy is best, 60% would not mind their child to play with a child with epilepsy but only 32% would agree if their child would want to marry a person with epilepsy.

[Assessment and prospects of the community's participation at the Ziguinchor regional hospital centre (Senegal)]. / Bilan et perspectives de la participation communautaire au centre hospitalier régional de Ziguinchor (Sénégal).

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

[Prevalence of cannabis use among students in Dakar]. / Prévalence de l'usage du cannabis en milieu étudiant à Dakar.

Cannabis (Cannabis sativa) is the most frequently used drug worldwide. It has multiple dangers, related to its power to involve abuse and dependency phenomena and to their social implications. Our study, which was carried out on a representative sample of 446 students living on the Dakar campus, aimed at measuring the prevalence of Cannabis use and at describing the main factors associated with it. We found a prevalence rate of 19.7%. Cannabis use starts relatively early, around 16-17 years. Young users are generally initiated by a close friend or relative and are motivated by curiosity for their first experience. The fact of having a grant or not and the field of study have no influence on the use of cannabis. On the other hand, religion might play a determining role, Christians seeming to be more affected than Moslems (p = 0.026). A similar prevalence among students has been noted in Kenya, but the rate is definitely lower than those found in developed countries. The identification of cannabis use predictors would make it possible to consider interesting prevention perspectives based on targeted education and on a more adequate legislation. .

[Impact of algorithms on abusive prescriptions of parental drugs at the health post level in the Tambacounda health district, Senegal]. / Impact des ordinogrammes sur la prescription abusive des produits injectables au niveau des postes de santé du district de Tambacounda, Sénégal.

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