Health workforce incentives and dis-incentives during the COVID-19 pandemic: experiences from Democratic Republic of Congo, Nigeria, Senegal, and Uganda.

BACKGROUND: The COVID-19 pandemic presented a myriad of challenges for the health workforce around the world due to its escalating demand on service delivery. A motivated health workforce is critical to effectual emergency response and in some settings, incentivizing health workers motivates them and ensures continuity in the provision of health services. We describe health workforce experiences with incentives and dis-incentives during the COVID-19 response in the Democratic Republic of Congo (DRC), Senegal, Nigeria, and Uganda. METHODS: This is a multi-country qualitative research study involving four African countries namely: DRC, Nigeria, Senegal, and Uganda which assessed the workplace incentives instituted in response to the COVID-19 pandemic. Key informant interviews (n = 60) were conducted with staff at ministries of health, policy makers and health workers. Interviews were virtual using the telephone or Zoom. They were audio recorded, transcribed verbatim, and analyzed thematically. Themes were identified and quotes were used to support findings. RESULTS: Health worker incentives included (i) financial rewards in the form of allowances and salary increments. These motivated health workers, sustaining the health system and the health workers' efforts during the COVID-19 response across the four countries. (ii) Non-financial incentives related to COVID-19 management such as provision of medicines/supplies, on the job trainings, medical care for health workers, social welfare including meals, transportation and housing, recognition, health insurance, psychosocial support, and supervision. Improvised determination and distribution of both financial and non-financial incentives were common across the countries. Dis-incentives included the lack of personal protective equipment, lack of transportation to health facilities during lockdown, long working hours, harassment by security forces and perceived unfairness in access to and inadequacy of financial incentives. CONCLUSION: Although important for worker motivation, financial and non-financial incentives generated some dis-incentives because of the perceived unfairness in their provision. Financial and non-financial incentives deployed during health emergencies should preferably be pre-determined, equitably and transparently provided because when arbitrarily applied, these same financial and non-financial incentives can potentially become dis-incentives. Moreover, financial incentives are useful only as far as they are administered together with non-financial incentives such as supportive and well-resourced work environments. The potential negative impacts of interventions such as service delivery re-organization and lockdown within already weakened systems need to be anticipated and due precautions exercised to reduce dis-incentives during emergencies.

Factors associated with diabetes knowledge, attitudes and practices among people aged 18 and over in the commune of Niakhene in Senegal.

More than 422 million people worldwide have diabetes in 2016, and 1.6 million deaths are attributed to diabetes each year. Knowledge of preventive measures would enable the adjustment of preventive policies. Hence this study on knowledge and practices in rural Senegal. This was a cross-sectional, descriptive and analytical survey of subjects aged at least 18 and living in the commune of Niakhene, carried out in October 2020. A systematic random sample, stratified by sex and age group, was used. The questionnaire was based on the STEPS 2015 tool and a review of the literature. In addition to personal characteristics, the questionnaire was used to measure knowledge of symptoms, complications, risk factors, attitude to the disease and screening practices. Descriptive and analytical analyses were performed using R 4.0.2 software. A total of 300 subjects were surveyed. The average age was 35.3 years (+/-16.9), and 52.3% were women. Knowledge (62.7%) was associated with higher education (ORaj2.46{1.16-3.44}), awareness by healthcare staff (ORaj2.88{1.60-5.34}), and a family history of diabetes (ORaj3.09{1.06-11.3}). The positive attitude (53%) was associated with male sex (ORaj1.98{2.07-7.52}), awareness via audio-visual information sources (ORaj3.87{2.07-7.52}), community awareness (ORaj 3.87{2.07-7.52}), existence of a family history of hypertension and knowledge of diabetes (ORaj3.34{2.5-7.69}). Screening was carried out in 34.3% of patients. The associated risk factors were male sex (ORaj 1.95{1.12-3.34}), higher education (ORaj2.49{1.12-559}) and positive attitudes to diabetes (ORaj1.83{1.04-3.26}). One of the most effective interventions against this disease is the adoption of preventive measures which involve early detection and strengthening communication for more effective prevention.

Improving testing capacity for COVID-19: experiences and lessons from Senegal, Uganda, Nigeria, and the Democratic Republic of Congo.

Background: African countries leveraged testing capacities to enhance public health action in response to the COVID-19 pandemic. This paper describes experiences and lessons learned during the improvement of testing capacity throughout the COVID-19 response in Senegal, Uganda, Nigeria, and the Democratic Republic of the Congo (DRC). Methods: The four countries' testing strategies were studied using a mixed-methods approach. Desk research on COVID-19 testing strategies was conducted and complemented by interviewing key informants. The findings were synthesized to demonstrate learning outcomes across the four countries. Results: The four countries demonstrated severely limited testing capacities at the onset of the pandemic. These countries decentralized COVID-19 testing services by leveraging preexisting laboratory systems such as PCR and GeneXpert used for the diagnosis of tuberculosis (TB) to address this gap and the related inequities, engaging the private sector, establishing new laboratories, and using rapid diagnostic tests (RDTs) to expand testing capacity and reduce the turnaround time (TAT). The use of digital platforms improved the TAT. Testing supplies were sourced through partners, although access to global markets was challenging. Case detection remains suboptimal due to high costs, restrictive testing strategies, testing access challenges, and misinformation, which hinder the demand for testing. The TAT for PCR remained a challenge, while RDT use was underreported, although Senegal manufactured RDTs locally. Key findings indicate that regionally coordinated procurement and manufacturing mechanisms are required, that testing modalities must be simplified for improved access, and that the risk-based testing strategy limits comprehensive understanding of the disease burden. Conclusion: Although testing capacities improved significantly during the pandemic, case detection and access to testing remained suboptimal. The four countries could benefit from further simplification of testing modalities and cost reduction. Local manufacturing and pooled procurement mechanisms for diagnostics are needed for optimal pandemic preparedness and response.

Predictors of cessation of exclusive breastfeeding according to the Cox regression model: survey of mothers of children aged 6-12 months, Thiès, Senegal.

Introduction: even though exclusive breastfeeding (EBF) for up to six months is recognised as essential infant care, it is still insufficiently practiced. The objective of this study was to identify predictors of EBF cessation in Thiès. Methods: this was a survival analysis of data collected using a cross-sectional procedure. Data collection took place from 2nd December 2019 to 21st January 2020. The study population consisted of mothers of children aged 6 to 12 months residing in Thiès and seen at the reference health centre of the Thiès Health District during infant vaccination sessions. The number of subjects was 400 mothers recruited using a systematic survey, with a sampling interval equal to two. Data were collected through a face-to-face interview. Predictive factors were identified using the Cox regression model. The adjusted hazard ratio (AHR) and its 95% confidence interval (95% CI) are calculated. Results: the average age of the mothers was 27.08 ± 6.34 years. The proportion of mothers who breastfed their child within one hour of birth was 29.25%. The proportion of those who practiced EBF was 41.50%. The incidence density of EBF cessation was 14 person-months per 100 breastfeeding mothers. The median duration of EBF was 5 months. Lack of advice on EBF during antenatal care (AHR=1.42; 95% CI =1.08-1.85), sources of information other than health professionals (AHR =1.51; 95% CI =1.05-2.19), late initiation of EBF, i.e. breastfeeding beyond 24 hours after birth (AHR =1.53; 95% CI =1.02-2.28) and low level of knowledge about EBF (AHR =1.46; 95% CI =1.11-1.92) were significantly associated with early termination of EBF. Conclusion: the promotion of EBF for up to six months will necessarily involve the promotion of prenatal consultations during which professionals should raise awareness among future mothers.

Associated factors with hypertension, known poorly controlled hypertension, and newly diagnosed hypertension among people aged 18-70 in Senegal.

Introduction: In this study, we aimed to determine the factors associated with hypertension, known poorly controlled hypertension, and newly diagnosed hypertension in 2015 to improve the prevention of this pathology in our country. Methods: This was a secondary analysis of the national WHO STEPwise survey database. It had a quantitative, descriptive, and analytical aim. The sampling was done in stratification in three stages of sampling. Statistical analysis was performed using Rstudio 4.0.2 software. It was a descriptive, bivariate, and multivariate analysis using binomial logistic regression for explanatory purposes. Results: The risk factors for being hypertensive among 18-70- year-olds in Senegal in 2015 were: having taken their blood pressure at least once in their life; having taken their cholesterol levels at least once in their life; having received advice to reduce salt consumption; having received advice on how to reduce the amount of sugar; having a lean body mass index; being overweight; being obese III; and being between 35-39 and 65-70 years old. The protective factors are: checking the salt content indicated on the labels; and consuming salt-rich dishes "often" compared to "never". The risk factors for being newly diagnosed with hypertension among 18-70-year-olds in Senegal in 2015 were: having a history of stroke; having a resting heart rate greater than 80 beats per minute; consuming palm oil; and having high fasting blood sugar. The protective factors are: having a high average number of meals eaten per week not prepared at home; checking the salt content indicated on the label; and being of female sex. The risk factors for being known to have poorly controlled hypertension among 18-70- year-olds in Senegal in 2015 were: judging their reduction in salt consumption as "very important"; and having received advice to reduce their salt consumption. The protective factors are: performing physical activity only when traveling; and limiting the consumption of salty meals. Conclusion: Senegalese family cooking exposes to hypertension, small actions limiting salt consumption strongly protect against hypertension, and simple physical activity during travel strongly protects against hypertension, but the health system is very little proactive in the primordial and primary prevention of hypertension.

[Factors associated with the practice of exclusive breastfeeding among mothers of children aged 6 to 12 months in Kaolack (Senegal)]. / Facteurs associés à la pratique de l´allaitement maternel exclusif chez les mères d´enfants âgés de 6 à 12 mois dans la commune de Kaolack (Sénégal).

Introduction: the World Health Organization (WHO) recommends immediate and exclusive breastfeeding in order to reduce malnutrition and neonatal mortality. The purpose of this study was to determine the prevalence of exclusive breastfeeding (EBF) and to identify its associated factors among mothers of children aged 6 to 12 months in Kaolack. Method: we conducted a cross-sectional descriptive and analytical study. The study was conducted from July 8th, 2020 to February 8th, 2021. Multivariate analysis was performed using the logistic regression model. The target population consisted of mothers of children aged 6 to 12 months residing in the city of Kaolack and met during vaccination sessions. Results: a total of 400 women were enrolled in the study. Among them, 51.8% practiced EBF according to the WHO recommendations. The average age of mothers was 27.42 years; 56.3% were housewives and 82.7% have done at least 4 antenatal care (ANC). Logistic regression showed an association between EBF and the following factors: age < 25 years (OR=2.03 CI 95% [1.23-3.36]), receiving advice on EBF during ANCs (OR=2.92 CI 95% [1.70-5.01]), receiving advice on EBF during postnatal care (PNC) (OR=4.33 CI 95% [2.51-7.45]), the permanent presence of mother with her baby (OR=3.97 CI 95% [1.99-7.91]), and a good knowledge of EBF (OR=4.54 CI 95% [1.96-10.51]). Conclusion: these modifiable factors can help improve the practice of EBF in the city of Kaolack.

Paying more attention to arterial hypertension, dyslipidaemia, women and the rural environment in our ongoing fight against cardiovascular diseases and their risk factors.

BACKGROUND: The diagnostic and therapeutic efforts instituted by the state of Senegal since the results of the STEPwise survey in 2015 could and should be reinforced with an effective and targeted preventative approach against cardiovascular accidents. This study aimed to (1) identify the pathological population that contains the most incidents of stroke in Senegal, (2) identify the prevalence, and geographical and gender distribution of biological co-morbidities with hypertension, stroke and advice for a change in behaviour, and (3) research the factors associated with the occurrence of cardiovascular accidents specific to the Senegalese context. METHODS: This was a secondary analysis of the STEPwise WHO Senegal 2015 survey: a descriptive quantitative epidemiological study with an analytical aim. RESULTS: Biological co-morbidities with arterial hypertension as well as cardiovascular accidents affected more women than men. Biological co-morbidities with arterial hypertension predominated in urban areas, while cardiovascular accidents were more common in rural areas. The population with arterial hypertension and total hypercholesterolaemia simultaneously was at the top of a list of 25 pathological populations in terms of the proportion of cardiovascular accidents within them. In addition, total hypercholesterolaemia was found in the first three populations with the most cardiovascular accidents. Regarding advice for behavioural change, advice for smoking cessation was the most widespread. All advice was given mostly to the gender most affected by the health problem, but some advice was mostly addressed to the environment least affected by the problem. Therefore, despite being the most affected, the rural environment received the least advice for a change in behaviour with regard to the practice of any of the forms of the physical activities described, the consumption of oil of palm, the consumption of cubed sugar or sugary drinks, smoked and non-smoked tobacco and attempted smoking cessation. In multivariate analysis, it was found that arterial hypertension produced a 2.74 times greater risk of having a cardiovascular accident (adjusted odds ratio = 2.74; 95% confidence interval = 1.88-3.99; p < 0.001). CONCLUSION: In Senegal, we need to pay more attention to arterial hypertension, dyslipidaemia, women and the rural environment in our ongoing fight against cardiovascular diseases and their risk factors.

[Knowledge and practice of graduating students of pharmacy at the Cheikh Anta Diop University relating to antibiotic use and bacterial resistance in 2019 (Senegal)]. / Connaissances et pratiques des étudiants en fin d'études de pharmacie à l'Université Cheikh Anta Diop sur l'utilisation des antibiotiques et la résistance bactérienne en 2019 (Sénégal).

Introduction: pharmacy students are future providers of pharmaceutical care and should play a critical role in combating bacterial resistance (BR). The purpose of this study was to evaluate the knowledge and practice of students at the end of pharmacy course relating to BR and antibiotic use. Methods: we conducted a cross-sectional, descriptive and analytic study. The study population consisted of students enrolled in Master 2 and PhD in Pharmacy at the Cheikh Anta Diop University over the year 2019. Data were collected between July and October 2019 using an electronic questionnaire whose link was shared through the social network WhatsApp. Knowledge was assessed using a 5-point Likert scale while closed-ended questions were used to determine practice. Descriptive analyses were performed. Factors associated with practice were identified using logistic regression. Analyses were performed using the EPI InfoTM software 7.2.2.16. The significance threshold was set to 0.05. Results: out of 559 eligible students, 278 responded to the questionnaire, reflecting a participation rate of 60.6%. Of these, 72.3% reported having used antibiotics in the 12 months preceding the survey. Regarding knowledge, 85.6% of students surveyed had an adequate level. In addition, 38.2% of students had inadequate practice. These were associated with having a relative or friend as a health worker (OR = 1.69; p-value = 0.04), being a PhD student (OR = 0.55; p-value = 0.02) and having an insufficient level of knowledge (OR = 2.21; p-value = 0.02). Conclusion: this study shows that antibiotic consumption is high among pharmacy students and that their practice is inadequate despite their satisfactory level of knowledge about antibiotics and BR. It is urgent to strengthen the awareness of students and their entourage about good practices concerning antibiotic use.

COVID-19 surveillance in Democratic Republic of Congo, Nigeria, Senegal and Uganda: strengths, weaknesses and key Lessons.

INTRODUCTION: As part of efforts to rapidly identify and care for individuals with COVID-19, trace and quarantine contacts, and monitor disease trends over time, most African countries implemented interventions to strengthen their existing disease surveillance systems. This research describes the strengths, weaknesses and lessons learnt from the COVID-19 surveillance strategies implemented in four African countries to inform the enhancement of surveillance systems for future epidemics on the continent. METHODS: The four countries namely the Democratic Republic of Congo (DRC), Nigeria, Senegal, and Uganda, were selected based on their variability in COVID-19 response and representation of Francophone and Anglophone countries. A mixed-methods observational study was conducted including desk review and key informant interviews, to document best practices, gaps, and innovations in surveillance at the national, sub-national, health facilities, and community levels, and these learnings were synthesized across the countries. RESULTS: Surveillance approaches across countries included - case investigation, contact tracing, community-based, laboratory-based sentinel, serological, telephone hotlines, and genomic sequencing surveillance. As the COVID-19 pandemic progressed, the health systems moved from aggressive testing and contact tracing to detect virus and triage individual contacts into quarantine and confirmed cases, isolation and clinical care. Surveillance, including case definitions, changed from contact tracing of all contacts of confirmed cases to only symptomatic contacts and travelers. All countries reported inadequate staffing, staff capacity gaps and lack of full integration of data sources. All four countries under study improved data management and surveillance capacity by training health workers and increasing resources for laboratories, but the disease burden was under-detected. Decentralizing surveillance to enable swifter implementation of targeted public health measures at the subnational level was a challenge. There were also gaps in genomic and postmortem surveillance including community level sero-prevalence studies, as well as digital technologies to provide more timely and accurate surveillance data. CONCLUSION: All the four countries demonstrated a prompt public health surveillance response and adopted similar approaches to surveillance with some adaptations as the pandemic progresses. There is need for investments to enhance surveillance approaches and systems including decentralizing surveillance to the subnational and community levels, strengthening capabilities for genomic surveillance and use of digital technologies, among others. Investing in health worker capacity, ensuring data quality and availability and improving ability to transmit surveillance data between and across multiple levels of the health care system is also critical. Countries need to take immediate action in strengthening their surveillance systems to better prepare for the next major disease outbreak and pandemic.

Spread and seasonality of COVID-19 pandemic confirmed cases in sub-Saharan Africa: experience from Democratic Republic of Congo, Nigeria, Senegal, and Uganda.

BACKGROUND: The COVID-19 pandemic has impacted the world negatively with huge health and socioeconomic consequences. This study estimated the seasonality, trajectory, and projection of COVID-19 cases to understand the dynamics of the disease spread and inform response interventions. METHOD: Descriptive analysis of daily confirmed COVID-19 cases from January 2020 to 12th March 2022 was conducted in four purposefully selected sub-Saharan African countries (Nigeria, Democratic Republic of Congo (DRC), Senegal, and Uganda). We extrapolated the COVID-19 data from (2020 to 2022) to 2023 using a trigonometric time series model. A decomposition time series method was used to examine the seasonality in the data. RESULTS: Nigeria had the highest rate of spread (ß) of COVID-19 (ß = 381.2) while DRC had the least rate (ß = 119.4). DRC, Uganda, and Senegal had a similar pattern of COVID-19 spread from the onset through December 2020. The average doubling time in COVID-19 case count was highest in Uganda (148 days) and least in Nigeria (83 days). A seasonal variation was found in the COVID-19 data for all four countries but the timing of the cases showed some variations across countries. More cases are expected in the 1st (January-March) and 3rd (July-September) quarters of the year in Nigeria and Senegal, and in the 2nd (April-June) and 3rd (October-December) quarters in DRC and Uganda. CONCLUSION: Our findings show a seasonality that may warrant consideration for COVID-19 periodic interventions in the peak seasons in the preparedness and response strategies.

Private sector engagement in the COVID-19 response: experiences and lessons from the Democratic Republic of Congo, Nigeria, Senegal and Uganda.

BACKGROUND: Private entities play a major role in health globally. However, their contribution has not been fully optimized to strengthen delivery of public health services. The COVID-19 pandemic has overwhelmed health systems and precipitated coalitions between public and private sectors to address critical gaps in the response. We conducted a study to document the public and private sector partnerships and engagements to inform current and future responses to public health emergencies. METHODS: This was a multi-country cross-sectional study conducted in the Democratic Republic of Congo, Nigeria, Senegal and Uganda between November 2020 and March 2021 to assess responses to the COVID-19 pandemic. We conducted a scoping literature review and key informant interviews (KIIs) with private and public health sector stakeholders. The literature reviewed included COVID-19 country guidelines and response plans, program reports and peer-reviewed and non-peer-reviewed publications. KIIs elicited information on country approaches and response strategies specifically the engagement of the private sector in any of the strategic response operations. RESULTS: Across the 4 countries, private sector strengthened laboratory systems, COVID-19 case management, risk communication and health service continuity. In the DRC and Nigeria, private entities supported contact tracing and surveillance activities. Across the 4 countries, the private sector supported expansion of access to COVID-19 testing services through establishing partnerships with the public health sector albeit at unregulated fees. In Senegal and Uganda, governments established partnerships with private sector to manufacture COVID-19 rapid diagnostic tests. The private sector also contributed to treatment and management of COVID-19 cases. In addition, private entities provided personal protective equipment, conducted risk communication to promote adherence to safety procedures and health promotion for health service continuity. However, there were concerns related to reporting, quality and cost of services, calling for quality and price regulation in the provision of services. CONCLUSIONS: The private sector contributed to the COVID-19 response through engagement in COVID-19 surveillance and testing, management of COVID-19 cases, and health promotion to maintain health access. There is a need to develop regulatory frameworks for sustainable public-private engagements including regulation of pricing, quality assurance and alignment with national plans and priorities during response to epidemics.

Facteurs associés à la coadministration des vaccins à la naissance chez des enfants sénégalais.

INTRODUCTION: Co-administration of the bilié de Calmette et Guérin (BCG) and birth doses of oral polio (OPV zero) and hepatitis B (HepB BD) vaccines is strongly recommended. The objective was to determine the factors associated with this co-administration in the health district of Podor (Senegal). METHODS: This cross-sectional study was conducted among 726 children aged 12 to 23 months. This was a two-stage cluster sampling. The data was collected in June 2020. An electronic questionnaire was developed using the Open Data Kit Collect application. Co-administration was modeled as one dose, two doses and three doses. Ordinal logistic regression was used to search for factors likely to influence co-administration. RESULTS: Of the 726 children, 115 (16%), 234 (32%) and 377 (52%) received a single dose, two and three doses, respectively. Factors associated with co-administration were recognition by mothers or caregivers that several vaccines can be administered simultaneously (adjusted OR = 1.46, p-value = 0.017), availability of a health record kept at home (adjusted OR = 6.88, p-value = 0.006), hospitalization of the newborn after birth (adjusted OR = 1.74, p-value = 0.002) and receipt of advice during postnatal care (adjusted OR = 1.72, p-value = 0.01). CONCLUSION: Co-administration of birth doses is an infrequent practice in Podor. Awareness and availability and proper maintenance of health information management tools would be necessary.

Universal health insurance in Africa: a narrative review of the literature on institutional models.

INTRODUCTION: Several African countries have introduced universal health insurance (UHI) programmes. These programmes aim to extend health insurance to groups that are usually excluded, namely informal workers and the indigent. Countries use different approaches. The purpose of this article is to study their institutional characteristics and their contribution to the achievement of universal health coverage (UHC) goals. METHOD: This study is a narrative review. It focused on African countries with a UHI programme for at least 4 years. We identified 16 countries. We then compared how these UHI schemes mobilise, pool and use funds to purchase healthcare. Finally, we synthesised how all these aspects contribute to achieving the main objectives of UHC (access to care and financial protection). RESULTS: Ninety-two studies were selected. They found that government-run health insurance was the dominant model in Africa and that it produced better results than community-based health insurance (CBHI). They also showed that private health insurance was marginal. In a context with a large informal sector and a substantial number of people with low contributory capacity, the review also confirmed the limitations of contribution-based financing and the need to strengthen tax-based financing. It also showed that high fragmentation and voluntary enrolment, which are considered irreconcilable with universal insurance, characterise most UHI systems in Africa. CONCLUSION: Public health insurance is more likely to contribute to the achievement of UHC goals than CBHI, as it ensures better management and promotes the pooling of resources on a larger scale.

Vaccination against tuberculosis, polio and hepatitis B at birth in Podor health district, Northern Senegal: cross-sectional study of vaccination coverage and its associated factors.

BACKGROUND: In Senegal, studies focusing specifically on vaccination coverage with the Bacille de Calmette et Guérin (BCG) vaccine, the birth dose of oral polio vaccine (OPV zero dose) and the birth dose of hepatitis B (HepB-BD) vaccine are insufficient. This study aimed to highlight vaccination coverages with birth doses and factors associated with timely vaccination in Podor health district. METHODS: A cross-sectional study was carried out from June 19 to 22, 2020. The study population consisted of children aged 12 to 23 months of which 832 were included. A stratified two-stage cluster survey was carried out. The sources of data were home-based records (HBR), health facility registries (HFR) and parental recalls. Timely vaccination refers to any vaccination that has taken place within 24 h after birth. Descriptive analyzes, the chi-square test and logistic regression were performed. RESULTS: The crude vaccination coverages with BCG, OPV zero dose and HepB-BD were 95.2%, 88.3% and 88.1%, respectively. Vaccination coverages within 24 h after birth were estimated at 13.9%, 30% and 42.1%, respectively. The factors associated with timely HepB-BD are delivery in a health facility (AOR = 1.55; 95% CI = 1.02-2.40), access to television (AOR = 1.63; 95% CI = 1.16-2.29), weighing (AOR = 3.92; 95% CI = 1.97-8.53) and hospitalization of the newborn immediately after birth (AOR = 0.42; 95% CI = 0.28-0.62). CONCLUSION: Timely administration of birth doses is a challenge in the Podor health district. The solutions would be improving geographic access to health facilities, involving community health workers, raising awareness and integrating health services.

Knowledge, Attitudes and Practices on Rabies among Human and Animal Health Professionals in Senegal.

Rabies is still a public health problem in Senegal. This study aimed to assess the knowledge, attitudes and practices on rabies among human and animal health professionals. It was a cross-sectional, descriptive and analytical study conducted in the Kaffrine district. Data were collected from 28 June to 01 July 2021. An exhaustive recruitment was done, and the final sample size was 95 health professionals. R software was used for descriptive, bivariate and multivariate analyses. Health professionals with sufficient knowledge, positive attitudes and good practices in relation to rabies represented 35.8%, 26.3% and 45.3% of the study respectively. The results of the multivariate analysis showed that professionals who worked in urban areas (AOR = 11.10; 95% CI = [3.50-41.69]) and who worked in animal health (AOR = 7.45; 95% CI = [1.16-70.40]) were more likely to have sufficient knowledge about rabies. Professionals with tertiary education (AOR = 12.40; CI95% = [1.80-268.00]) and with sufficient knowledge (AOR = 3.41; CI95% = [1.01-12.70]) were more likely to have a positive attitude about rabies. Professionals with a positive attitude about rabies (AOR = 3.23; 95% CI = [1.08-10.70]) were more likely to have a good practice when presented with an animal bite case. These results suggest that improving health professionals' knowledge about rabies is essential in order to influence their attitudes and practices against rabies.

Evaluation of Prescribing Indicators in a Paediatric Population Seen in an Outpatient Consultation at the Gaspard Kamara Health Centre in 2019 (Senegal).

Introduction: Data on drug use in paediatrics are scarce in Senegal. The objective of this study was to assess the prescribing indicators in a paediatric population seen in an outpatient consultation at a Health Centre in Dakar, Senegal. Methods: A retrospective and analytical study was conducted. The study population consisted of prescriptions for children aged 0 to 14 years who were seen in ambulatory consultation between 1 June and 30 November 2019. The sample size was 600 prescriptions. The systematic survey was then conducted. Five prescription indicators recommended by the World Health Organization were calculated. The R software was used for descriptive analysis, bivariate analysis and binomial logistic regression. Results: The average number of drugs per prescription was 2.56. The proportion of drugs prescribed under the International Nonproprietary Name (INN) was 18.9%, while the proportion of drugs on the National Essential Medicines List (NEML) was 41.3%. The proportions of prescriptions with at least one antibiotic and one injectable product were 41.5% and 1.3%, respectively. Conclusions: This study showed that prescribing habits were inadequate. Thus, it would be necessary to move towards continuing training of prescribers in the wise use of medicines.

Connaissances, attitudes et pratiques de la population de la région de Dakar sur la COVID-19.

INTRODUCTION: Faced with the increase in confirmed cases of COVID-19 in Senegal, particularly in the region of Dakar, epicenter of the disease, it is necessary to study the knowledge, attitudes and practices of the populations of the West and South districts on COVID-19. METHODS: A cross-sectional and analytical study was conducted from May 9 to 30, 2020. A four-stage cluster survey was carried out at the level of the West and South districts. Univariate and multivariate analyzes were carried out using R 3.4.4 software. RESULTS: In total, 400 people were surveyed. The mean age of those surveyed was 40.2 ± 14.7 years and extremes of 18 and 82 years. The male sex predominated in 66.5% of cases. People had good knowledge of the signs, transmission risks and prevention measures respectively in 4.7%; 3% and 47.8%. In total, 74% of the people surveyed respected the concept of "stay at home". Wearing a mask and systematic hand washing with soap and water were noted among the people surveyed in 53.6% and 34.8% of cases, respectively. People who had good knowledge of preventive measures against COVID-19 wore the mask more (ORaj = 2.1 [1.2-3.5]) and washed their hands more with soap and water (ORaj = 1.9 [1.1-3.4]). CONCLUSION: For an effective fight against this epidemic, it is important to strengthen risk communication with full community participation. This strategy must be coupled with actions aimed at making prevention means available to the benefit of the entire population.

Coverage and Timeliness of Birth Dose Vaccination in Sub-Saharan Africa: A Systematic Review and Meta-Analysis.

Background: Depending on the epidemiological context of each country, three vaccines are recommended by the World Health Organization (WHO) to be administered as soon as possible after birth (birth vaccines); namely, BCG, zero dose of oral polio vaccine (OPV0), and birth dose of hepatitis B vaccine (HepB-BD). The timely administration of these vaccines immediately after birth might pose significant challenges in sub-Saharan Africa, where about half of childbirths occur outside health facilities. We therefore conducted a systematic review and meta-analysis to estimate the coverage rate of these vaccines at a specific timing in neonates in sub-Saharan Africa. Methods: We searched PubMed, Embase, CINAHL, and Web of Science for studies conducted in sub-Saharan Africa and published up to March 31, 2017, which provided a coverage rate of the birth vaccines at any specific time points within 28 days after birth. Two investigators independently screened the titles and abstracts and extracted data from the eligible full-text articles. This study was registered in PROSPERO (CRD42017071269). Results: Of 7283 articles identified, we finally included 31 studies with 204,111 infants in the meta-analysis. The pooled coverage rates at day 0-1 after birth were 14.2% (95% CI: 10.1-18.9) for BCG and 1.3% (0.0-4.5) for HepB-BD. No data were available for OPV0 at day 0-1. The coverage at day 28 was 71.7% (63.7-79.2) for BCG, 60.8% (45.8-74.7) for HepB-BD, and 76.1% (67.1-84.0) for OPV0. No significant difference in the vaccine coverage was observed between infants born in healthcare facilities and those born outside facilities. Conclusions: The rates of vaccine coverage immediately after birth were very low for BCG and HepB-BD, and no data for OPV0. We need additional data to better define barriers and facilitators for the timely administration of the birth vaccines in sub-Saharan Africa, since the delay in its provision may increase the burden of these vaccine-preventable diseases.

Facteurs associés à l'autonomie de décision des femmes pour leur santé au Sénégal.

INTRODUCTION: In Senegal, the issue of access to maternal, reproductive and sexual health services remains a health priority. Although there have been many health interventions, women’s access to health services remains limited due to women’s limited autonomy in making decisions about their health.Purpose of research: The objective of this study was to study the factors associated with women’s decision-making autonomy in relation to their own health in Senegal in 2017. RESULTS: Six-point twenty-six percent (6.26%) of women were autonomous in making decisions about their health. For 80.33% of women, it was their husband or partner who decided for them.The factors associated with women’s decision-making autonomy were the 20-24 and 45-49 age groups with AOR of 0.28 [0.10-0.77] and 2.99 [1.25-7.17], rural housing environment (AOR = 0.52 [0.34-0.80]), higher women’s level of education (AOR = 4.10 [1.54-10.93]), the level of education of the husband/primary partner (AOR = 1.98 [1.08-3.61]), the marital status of the married woman (AOR = 0.09 [0.02-0.38]) and the fact that the woman is engaged in an income-generating activity (AOR = 3.70 [2.52-5.44]). CONCLUSIONS: This study highlights a low rate of decision-making autonomy among Senegalese women. It also made it possible to identify the factors on which action should be taken to improve women’s decision-making autonomy for their health. These factors include women’s access to education and the promotion of income-generating activities among women.

[Knowledge, attitudes and practices of the population of Dakar region on the COVID-19]. / Connaissances, attitudes et pratiques de la population de la région de Dakar sur la COVID-19.

INTRODUCTION: Faced with the increase in confirmed cases of COVID-19 in Senegal, particularly in the region of Dakar, epicenter of the disease, it is necessary to study the knowledge, attitudes and practices of the populations of the West and South districts on COVID-19. METHODS: A cross-sectional and analytical study was conducted from May 9 to 30, 2020. A four-stage cluster survey was carried out at the level of the West and South districts. Univariate and multivariate analyzes were carried out using R 3.4.4 software. RESULTS: In total, 400 people were surveyed. The mean age of those surveyed was 40.2 ± 14.7 years and extremes of 18 and 82 years. The male sex predominated in 66.5% of cases. People had good knowledge of the signs, transmission risks and prevention measures respectively in 4.7%; 3% and 47.8%. In total, 74% of the people surveyed respected the concept of "stay at home". Wearing a mask and systematic hand washing with soap and water were noted among the people surveyed in 53.6% and 34.8% of cases, respectively. People who had good knowledge of preventive measures against COVID-19 wore the mask more (ORaj = 2.1 [1.2-3.5]) and washed their hands more with soap and water (ORaj = 1.9 [1.1-3.4]). CONCLUSION: For an effective fight against this epidemic, it is important to strengthen risk communication with full community participation. This strategy must be coupled with actions aimed at making prevention means available to the benefit of the entire population.