How is equity approached in universal health coverage? An analysis of global and country policy documents in Benin and Senegal.

BACKGROUND: Equity seems inherent to the pursuance of universal health coverage (UHC), but it is not a natural consequence of it. We explore how the multidimensional concept of equity has been approached in key global UHC policy documents, as well as in country-level UHC policies. METHODS: We analysed a purposeful sample of UHC reports and policy documents both at global level and in two Western African countries (Benin and Senegal). We manually searched each document for its use and discussion of equity and related terms. The content was summarised and thematically analysed, in order to comprehend how these concepts were understood in the documents. We distinguished between the level at which inequity takes place and the origin or types of inequities. RESULTS: Most of the documents analysed do not define equity in the first place, and speak about "health inequities" in the broad sense, without mentioning the dimension or type of inequity considered. Some dimensions of equity are ambiguous - especially coverage and financing. Many documents assimilate equity to an overall objective or guiding principle closely associated to UHC. The concept of equity is also often linked to other concepts and values (social justice, inclusion, solidarity, human rights - but also to efficiency and sustainability). Regarding the levels of equity most often considered, access (availability, coverage, provision) is the most often quoted dimension, followed by financial protection. Regarding the types of equity considered, those most referred to are socio-economic, geographic, and gender-based disparities. In Benin and Senegal, geographic inequities are mostly pinpointed by UHC policy documents, but concrete interventions mostly target the poor. Overall, the UHC policy of both countries are quite similar in terms of their approach to equity. CONCLUSIONS: While equity is widely referred to in global and country-specific UHC policy documents, its multiple dimensions results in a rather rhetorical utilisation of the concept. Whereas equity covers various levels and types, many global UHC documents fail to define it properly and to comprehend the breadth of the concept. Consequently, perhaps, country-specific policy documents also use equity as a rhetoric principle, without sufficient consideration for concrete ways for implementation.

Crystal structure of poly[hexa-µ-bro-mido-bis{2-[1-(py-ri-din-2-yl)ethyl-idene-amino]ethanol-ato}tetracopper(II)].

The reaction of the Schiff base 2-[1-(pyridin-2-yl)ethyl-idene-amino]-ethanol (HL), which is formed by reaction of 2-amino-ethanol and 2-acetyl-pyridine with CuBr2 in ethanol results in the isolation of the new polymeric complex poly[hexa-µ-bromido-bis-{2-[1-(pyridin-2-yl)ethyl-idene-amino]-ethano-lato}tetra-copper(II)], [Cu4Br6(C9H11N2O)2]n or [Cu4Br6 L 2]n. The asymmetric unit of the crystal structure of the polymeric [Cu4Br6 L 2]n complex is composed by four copper (II) cations, two monodeprotonated mol-ecules of the ligand, and six bromide anions, which act as bridges. The ligand mol-ecules act in a tridentate fashion through their azomethine nitro-gen atoms, their pyridine nitro-gen atoms, and their alcoholate O atoms. The crystal structure shows two types of geometries in the coordination polyhedrons around Cu2+ ions. Two copper cations are situated in a square-based pyramidal environment, while the two other copper cations adopt a tetra-hedral geometry. Bromides anions acting as bridges between two metal ions connect the units, resulting in a tetra-nuclear polymer compound.

Dichlorido{N'-[phen-yl(pyridin-2-yl-κN)methyl-idene]isonicotinohydrazide-κ(2)N',O}zinc.

The title compound, [ZnCl(2)(C(18)H(14)N(4)O)], crystallizes with two mol-ecules in the asymmetric unit, which differ in the tautomeric (neutral and zwitterionic) forms of the coordin-ating organic ligand. In both mol-ecules, the Zn(II) atom adopts a distorted square-pyramidal geometry by two N and one O atoms of the Schiff base ligand and two Cl atoms acting as monodentate chloride anions. The crystal packing is stabilized by N-H⋯N and N-H⋯Cl hydrogen bonds, forming a two-dimensional network parallel to the ac plane.

Synthesis and crystal structures of two related Co and Mn complexes: a celebration of collaboration between the universities of Dakar and Southampton.

We report the synthesis and structures of two transition-metal complexes involving 2-(2-hy-droxy-phen-yl)benzimidazole (2hpbi - a ligand of inter-est for its photoluminescent applications), with cobalt, namely, bis-[µ-2-(1H-1,3-benzo-diazol-2-yl)phenolato]bis-[ethanol(thio-cyanato)-cobalt(II)], [Co2(C13H9N2O)2(NCS)2(C2H6O)2], (1), and manganese, namely, bis-[µ-2-(1H-1,3-benzo-diazol-2-yl)phenolato]bis-{[2-(1H-1,3-benzo-diazol-2-yl)phenolato](thio-cyanato)-mang-an-ese(III)} dihydrate, [Mn2(C13H9N2O)4(NCS)2]·2H2O, (2). These structures are two recent examples of a fruitful collaboration between researchers at the Laboratoire de Chimie de Coordination Organique/Organic Coordination Chemistry Laboratory (LCCO), University of Dakar, Senegal and the National Crystallography Service (NCS), School of Chemistry, University Southampton, UK. This productive partnership was forged through meeting at Pan-African Conferences on Crystallography and quickly grew as the plans for the AfCA (African Crystallographic Association) developed. This article therefore also showcases this productive partnership, in celebration of the IUCr's 75 year anniversary and the recent inclusion of AfCA as a Regional Associate of the IUCr.

Syntheses and crystal structure of 4-[(pyridin-3-yl)diazen-yl]morpholine and 1-[(pyridin-3-yl)diazen-yl]-1,2,3,4-tetra-hydro-quinoline.

Two new heterocyclic 1,2,3-triazenes were synthesized by diazo-tation of 3-amino-pyridine following respectively by coupling with morpholine or 1,2,3,4-tetra-hydro-quinoline. 4-[(Pyridin-3-yl)diazen-yl]morpholine (I), C9H12N4O, has monoclinic P21/c symmetry at 100 K, while 1-[(pyridin-3-yl)diazen-yl]-1,2,3,4-tetra-hydro-quinoline (II), C14H14N4, has monoclinic P21/n symmetry at 100 K. These 1,2,3-triazene derivatives were synthesized by the organic medium method by coupling reactions of 3-amino-pyridine with morpholine and 1,2,3,4-tetra-hydro-quinoline, respectively, and characterized by 1H NMR, 13C NMR, IR, mass spectrometry, and single-crystal X-ray diffraction. The mol-ecule of compound I consists of pyridine and morpholine rings connected by an azo moiety (-N=N-). In the mol-ecule of II, the pyridine ring and the 1,2,3,4-tetra-hydro-quinoline unit are also connected by an azo moiety. The double- and single-bond distances in the triazene chain are comparable for the two compounds. In both crystal structures, the mol-ecules are connected by C-H⋯N inter-actions, forming infinite chains for I and layers parallel to the bc plane for II.

Dichlorido[2-(pyridin-2-yl)-N-(pyridin-2-yl-methyl-idene)ethanamine-κ(3)N,N',N'']manganese(II) monohydrate.

In the title complex, [MnCl(2)(C(13)H(13)N(3))]·H(2)O, the Mn(II) atom is in a distorted square-pyramidal environment, with an Addison τ parameter of 0.037. The coordination geometry is defined by three N-atom donors from the tridentate 2-(pyridin-2-yl)-N-(pyridin-2-yl-methyl-idene)ethanamine ligand and two terminal Cl atoms. Although the H atoms of the lattice water molecule were not located, O⋯O distances of 3.103 (7) Šand O⋯Cl distances of 3.240 (3) and 3.482 (4) Šsuggest that hydrogen bonding is responsible for the stabilization of the crystal packing.

(S,E)-3-[(2-Hy-droxy-benzyl-idene)amino]-2-(2-hy-droxy-phen-yl)-2,3-dihydro-quinazolin-4(1H)-one.

In the title compound, C(21)H(17)N(3)O(3), the dihydro-quinazoline ring adopts a screw-boat conformation and its stereogenic C atom has an S configuration. The dihedral angle between the mean planes of the two hy-droxy-phenyl rings is 86.61 (12)°. The amino H atom forms an intra-molecular hydrogen bond with a phenol O atom, while the hydrazine N atom acts as an acceptor for the H atom of the other phenol group. In the crystal, O-H⋯N and O-H⋯O hydrogen bonds and weak C-H⋯centroid(π-ring) inter-molecular inter-actions are observed, forming chains along [1-10] and [110].

Bis{2-amino-2-oxo-N-[(1E)-1-(pyridin-2-yl-κN)ethyl-idene]acetohydrazidato-κ(2)N',O(1)}nickel(II).

In the title compound, [Ni(C(9)H(9)N(4)O(2))(2)], the Ni(II) ion is situated on a twofold rotation axis and is coordinated by two O and four N atoms from two tridentate {2-amino-2-oxo-N-[(1E)-1-(pyridin-2-yl-κN)ethyl-idene]acetohydrazidate ligands in a distorted octa-hedral geometry. In the crystal, N-H⋯O and N-H⋯N hydrogen bonds link the mol-ecules into columns in [001]. The porous crystal packing is further stabilized via π-π inter-actions between the pyridine rings of neighbouring mol-ecules [centroid-centroid distance = 3.746 (3) Å] with voids of 270 Å(3).

Bis(2-{[2-(2-hy-droxy-benzyl-amino)-eth-yl]amino-meth-yl}phenolato-κN,N',O)cobalt(III) nitrate monohydrate.

In the title compound, [Co(C(16)H(19)N(2)O(2))(2)]NO(3)·H(2)O, the Co(III) ion is located on an inversion center and is six-coordinated by two phenolate O atoms and four amino N atoms from two diamine ligands, forming an octa-hedral geometry. The water mol-ecule and the nitrate anion are located close to an inversion center, and are thus equally disordered by symmetry. The crystal packing is stabilized by inter-molecular O-H⋯O hydrogen bonds involving the uncoordinated water mol-ecule and the free phenol hydroxyl group with the nitrate anion. N-H⋯O hydrogen bonds involving the amino groups and the nitrate anions connect the complex mol-ecules along the c axis.

Tetra-nuclear copper(II) complex of 2-hydroxy-N,N'-bis-[1-(2-hy-droxy-phen-yl)ethyl-idene]-propane-1,3-di-amine.

The title mol-ecular structure, namely, (µ3-acetato)(µ2-acetato)-bis-(µ3-1,3-bis-{[1-(2-oxidophen-yl)ethyl-idene]amino}-propan-2-olato)tetra-copper(II) monohydrate, [Cu4(C19H19N2O3)2(CH3CO2)2]·H2O, corresponds to a non-symmetric tetra-nuclear copper complex. The complex exhibits one ligand mol-ecule that connects two copper CuII metal centres via its ethano-lato oxygen anion acting in a µ2-mode and one ligand mol-ecule that connects three copper CuII metal centres via its ethano-lato oxygen anion acting in a µ3-mode. One bridging acetate group acting in an η1:η1-µ2-mode connects two copper(II) ions while another bridging acetate group connects three copper(II) ions in an η1:-η2-µ3-mode. A chair-like Cu3O3 structure is generated in which the two CuO4N units are connected by one µ2-O ethano-late oxygen atom. These two units are connected respectively to the CuO3N unit via one µ3-O ethano-late oxygen atom and one µ2-O atom from an acetate group. The µ3-O atom also connects one of the CuO4N units and the CuO3N unit to another CuO3N unit, which is out of the chair-like structure. Each of the two penta-coordinated CuII cations has a distorted NO4 square-pyramidal environment. The geometry of each of the two CuNO3 units is best described as a slightly square-planar environment. A series of intra-molecular O-H⋯O hydrogen bonds is observed. In the crystal, the units are connected by inter-molecular C-H⋯O and O-H⋯O hydrogen bonds, thus forming sheets parallel to the ac plane.

Bis(N,N'-dimethyl-ethylenediammonium) tris-(oxalato-κO,O)cobaltate(II) dihydrate: an ion-pair complex.

The Co(II) ion in the title complex, (C(4)H(14)N(2))(2)[Co(C(2)O(4))(3)]·2H(2)O, is coordinated by three oxalate ions, resulting in a distorted octa-hedral geometry. Two uncoordinated water mol-ecules are present in asymmetric unit. Inter-molecular N-H⋯O and O-H⋯O hydrogen bonds between the different entities stabilize the crystal structure.

Hexanuclear copper(II) complex of 2-hy-droxy-N,N'-bis-[1-(2-hy-droxy-phen-yl)ethyl-idene]propane-1,3-di-amine incorporating an open-cubane core.

The title mol-ecular structure, namely, di-aqua-tris-(µ3-1,3-bis-{[1-(2-oxidophen-yl)ethyl-idene]amino}-propan-2-olato)-µ3-hydroxido-dinitrato-hexa-copper(II) ethanol tris-olvate, [Cu6(C19H19N2O3)3(NO3)2(OH)(H2O)2]·3C2H5OH, corres-ponds to a non-symmetric hexa-nuclear copper complex. The complex exhibits one core in which three CuII metal centres are mutually inter-connected, two by two, via three phenolato oxygen anions acting in a µ2-mode. These three copper cations are inter-connected in a µ3-mode by one hydroxyl group. An open-cube structure is generated in which each of the CuII cations of the three CuO4N units is connected by two µ2-O anions from phenolate groups and one µ3-O atom from a hy-droxy anion. Each of the three penta-coordinated CuII cations situated in the open-cube unit has a distorted NO4 square-pyramidal environment. Each of these three CuII centres is inter-connected with another CuII cation via one enolate O atom in µ2-mode, yielding one CuNO4 unit and two CuNO3 units. The penta-coordinated CuII atom has a distorted square-pyramidal environment while the two tetra-coordinated copper(II) cations are situated in a square-planar environment. A series of intra-molecular O-H⋯O hydrogen bonds are observed. In the crystal, the units are connected two by two by inter-molecular C-H⋯O and O-H⋯O hydrogen bonds, thus forming sheets parallel to the ac plane.

{2-[(2-Acetyl-hydrazin-1-yl-idene)methyl-κN,O]-6-methoxy-phenolato-κO}(nitrato-κO)copper(II) monohydrate.

In the title complex, [Cu(C(10)H(11)N(2)O(3))(NO(3))]·H(2)O, prepared from the Schiff base N'-(3-meth-oxy-2-oxidobenzyl-idene)-acetohydrazide, the Cu(II) atom is coordinated by two O atoms and one N atom from the ligand and one O atom from a nitrate group in a distorted square-planar geometry. The Cu(II) atom has a weak inter-action with another O atom of the nitrate group. The two O atoms of the tridentate Schiff base ligand are in a trans arrangement. O-H⋯O and N-H⋯O hydrogen bonds involving the uncoordinated water mol-ecule are observed.

Crystal structure of N'-[4-(di-methyl-amino)-benzyl-idene]furan-2-carbohydrazide monohydrate.

The condensation of 2-furoic hydrazide and 4-dimethyl amino-benzaldehyde in ethanol yielded a yellow solid formulated as the title compound, C14H15N3O2·H2O. The crystal packing is stabilized by inter-molecular O(water)-H⋯O,N(carbohydrazide) and N-H⋯O(water) hydrogen bonds, which form a two-dimensional network along the bc plane. Additional C-H⋯O inter-actions link the mol-ecules into a three-dimensional network. The dihedral angle between the mean planes of the benzene and the furan ring is 34.47 (6)°. The carbohydrazide moiety, i.e., the C=N-N-C=O fragment and the benzene ring are almost coplanar, with an angle of 6.75 (9)° between their mean planes.

Di-aqua-bis-{µ-1,5-bis-[(pyridin-2-yl)methyl-idene]carbonohydrazide(1-)}di-µ-chlorido-tetra-chlorido-tetra-zinc(II).

A tetra-nuclear ZnII complex, [Zn4(C13H11N6O)2Cl6(H2O)2] or {[Zn2(HL)(H2O)(Cl2)](µCl)2[Zn2(HL)(H2O)(Cl)]}2, was synthesized by mixing an equimolar amount of a methanol solution containing ZnCl2 and a methanol solution containing the ligand H2 L [1,5-bis-(pyridin-2-yl-methyl-ene)carbono-hydrazide]. In the tetra-nuclear complex, each of the two ligand mol-ecules forms a dinuclear unit that is connected to another dinuclear unit by two bridging chloride anions. In each dinuclear unit, one ZnII cation is penta-coordinated in a N2OCl2 in a distorted square-pyramidal geometry, while the other ZnII cation is hexa-coordinated in a N3OCl2 environment with a distorted octa-hedral geometry. The basal plane around the penta-coordinated ZnII cation is formed by one chloride anion, one oxygen atom, one imino nitro-gen atom and one pyridine nitro-gen atom with the apical position occupied by a chloride anion. The basal plane of the hexa-coordinated ZnII cation is formed by one chloride anion, one hydrazinyl nitro-gen atom, one imino nitro-gen atom and one pyridine nitro-gen atom with the apical positions occupied by a water oxygen atom and a bridged chloro anion from another dinuclear unit, leading to a tetra-nuclear complex. A series of intra-molecular C-H⋯Cl hydrogen bonds is observed in each tetra-nuclear unit. In the crystal, the tetra-nuclear units are connected by inter-molecular C-H⋯Cl, C-H⋯O and N-H⋯O hydrogen bonds, forming a planar two-dimensional structure in the ac plane.

Quality of Life During Chemotherapy for Breast Cancer in a West African Population in Dakar, Senegal: A Prospective Study.

PURPOSE: The prevalence of breast cancer is increasing in low- to middle-income countries such as Senegal. Our prospective study assessed the quality of life (QoL) of patients with breast cancer undergoing chemotherapy in Senegal. PATIENTS AND METHODS: Our study included women with breast cancer undergoing chemotherapy as initial treatment at the Center Aristide Le Dantec University Hospital in Dakar. Clinical, sociodemographic, and QoL data were collected and analyzed at three different times: baseline, 3 months, and 6 months after the start of systemic therapy. Health-related QoL was assessed using a Functional Assessment of Cancer Therapies-Breast (FACT-B) questionnaire after translation into the Wolof language. Linear mixed-effects models were performed to assess the changes in QoL scores. RESULTS: Between July 2017 and February 2018, 120 patients were included in the study. Their median age was 45 years. Most patients (n = 105; 92%) had locally advanced disease (T3 to T4 stage) and lymph node involvement (n = 103; 88%), and half had metastatic disease. The FACT-B total scores significantly improved over time (ß = 1.58; 95% CI, 0.50 to 2.67; P < .01). Nausea and vomiting were significantly associated with a decrease in FACT-B total scores (ß = -16.89, 95% CI, -29.58 to -4.24, P = .012; and ß = -13.44, 95% CI, -25.15 to -1.72, P = .028, respectively). CONCLUSION: Our study confirmed the feasibility of standardized QoL assessment in Senegalese patients with breast cancer. Our results indicated a potential improvement of QoL over the course of chemotherapy. Optimizing nausea and vomiting prevention may improve QoL.