[Epidemiological profile of female victims of psychological violence during the pre and postpartum periods in the Sédhiou region, Senegal]. / Profil épidémiologique des femmes victimes de violences psychologiques en période pré- et post-partum dans la région de Sédhiou, Sénégal.

BACKGROUND: In Senegal, psychological violence remains a taboo subject insofar as it often arises in the closed circle of family life. It has a highly negative impact on the health of pregnant women. The objective of this work was to study the epidemiological profile of female victims of psychological violence before and after birth in the Sédhiou region. METHOD: An observational, cross-sectional and analytical study was carried out from December 4, 2018 to April 4, 2019. The study population consisted of all the women received for postnatal consultation in one of the referral health structures in the Sédhiou region. Data were collected using a survey form and a questionnaire administered to the women having met the inclusion criteria. The data were entered using CS Pro software and subsequently analyzed using R 3.4.4 software. RESULTS: The mean age of the women was 25.4±7.8 (14-43 years). A total of 222 women (55.5 %) had suffered psychological violence during the prepartum period. Isolated psychological violence represented 44.3 % of the surveyed population, while psychological violence associated with sexual or physical violence represented 8.0 % and 5.4 % of the respondent population, respectively. The factors associated with psychological violence during the prepartum period were pursuit of a professional activity [ORaj=4.7 (1.3-17.0)], high educational status [ORaj=7.0 (4.2-11.5)] and performance of fewer than 3 antenatal consultations (ANC) [ORaj=2.2 (1.2-4.0)]. Maternal, fetal and neonatal complications were more frequent among victims of psychological violence (P<0.05). During the postpartum period, 26.5 % of the women who had been victims of violence during the prepartum period mentioned the fact that the aggression had ceased. The other women continued to endure violence, which was even more intense among 2.5 %. CONCLUSION: Psychological violence among pregnant women has a negative impact on the health of the mother and the newborn. This state of affairs should induce health care providers to increase popular awareness of its detrimental effects. Communication efforts aimed at behavioral change will need to be combined during prenatal consultations with strengthened screening for violence, the objective being to achieve improved care.

Women's autonomy in health decision-making and its effect on access to family planning services in Senegal in 2017: a propensity score analysis.

BACKGROUND: The effect of women's autonomy in decision-making for fertility control has been highlighted by research. The objective of this study was to analyze the effect of women's autonomy over decision-making regarding their health and access to family planning in Senegal in 2017. METHODS: The analyses in this study were carried out using data from the Senegal Demographic and Health Survey in 2017. The sample consisted of 8865 women aged 15-49. The propensity score-matching method was applied. Autonomy in health decision-making was considered the treatment variable. Matching was performed using confounding variables. The outcome variables were the current use of modern contraceptive methods and the existence of unmet needs. The common support condition had been met. The analysis was conducted using STATA.15 software. RESULTS: This study showed that 6.26% of women had decision-making autonomy in relation to their health. For 80.33% of the women, their husbands/partners made health-related decisions for them. Decision-making autonomy increased significantly with the age of the woman (p < 0.05). In addition, 15.24% of women were using a modern method of contraception. An estimated 26.2% of women had unmet needs. Propensity score matching split the women into two groups based on autonomy over decision-making for their health. After matching, there was no longer a significant difference between women who were autonomous with respect to their decision-making and those who were not autonomous with respect to their current use of a modern contraceptive method. On the other hand, there was a 14.42% reduction (p < 0.05) in unmet needs for family planning in the group of women who were autonomous with respect to their health decision-making. CONCLUSION: Autonomy in health decision-making would reduce unmet needs among Senegalese women. These results show the importance of accounting for gender in health interventions for the accessibility of family planning services.

[Study of the factors associated with the delay of health consultation of victims of rape in Senegal]. / Étude des facteurs associés au retard de consultation sanitaire des victimes de viols au Sénégal.

INTRODUCTION: Rape remains one of the most serious forms of sexual violence because of its negative impact on the physical and mental health of victims. The objective of this study is to identify the factors associated with the delay in rape victims seeking medical assistance from healthcare professionals in Senegal. METHODOLOGY: A retrospective, descriptive and analytical observation study was conducted. The study population consisted of all the court files of girls or women victims of rape recorded by the investigators at the 11 high courts of Senegal during the period from 2006 to 2015. An exhaustive recruitment of the full records of rape victims meeting the inclusion criteria were completed. The uni and multivariate analyses were carried out with Epi Info 2000 and R 2.2.9 software respectively. RESULTS: At the end of the collection, 1,037 cases of rape were included in the study population. The average age of the victims was 16.3±7.9 years (range 1-72). Minors (<18 years) accounted for 24.8 %. The median time from rape to consultation at a health facility was 24hours. Long delay in consultation (>24hours) was noted for 38.6 % of victims. Risk of late consultation after rape was higher among victims residing in the southern areas (ORaj=4.31 [1.15-16.14]), or northern areas (ORaj=4.22 [1.26-14.14]), who were major (ORaj=1.67 [1.04-2.68]) or married (ORaj=3.44 [1.58-7.5]) or who were pregnant after the aggression (ORaj=34.03 [15.47-74.85]) or had an abortion (ORaj=5.45 [1.04-24.47]). CONCLUSION: Medical and judicial assistance are more difficult if there is a long delay between the aggression and consultation. Thus, it is important for the health and judicial authorities to raise awareness about the harmful consequences of sexual violence, and to put forward the benefits of therapeutic care, compensation for the harm suffered by rape victims, as well as the availability of holistic care services 24hours a day.

[Ambulatory Blood Pressure Measurement's Reults And Indications At Cadiology Department At Hôpital Aristide Le Dantec]. / Indications Et Resultats De La Mesure Ambulatoire De Pression Arterielle Au Service De Cardiologie De L'Hopital Aristide Le Dantec.

High blood pressure (HTA) is a public health problem. It affects more than one billion people around the world, more than a quarter of the world's population. In recent years the ABPM (Ambulatory Blood Pressure Measurement) has become a valuable and widely used tool for the diagnosis and management of hypertension. The aims of this study were to determine the indications of MAPA to the cardiology department of Aristide le Dantec Hospital; to determine the results and to evaluate the blood pressure profile of our patients. METHODS: We carried out a retrospective study, over 37 months from December 2010 to December 2013 covering all the results of the ABPMs recorded during this period. Was included any patient over 18 years of age with an ABPM. All ABPMs with less than 50 good measures per 24 hours were not included. RESULTS: A total of 204 MAPA results were included of a total of 307. The mean age was 49.6 ± 11.5 years with extremes of 25 years and 78 years. The sex ratio was 1.5 in favour of women. Indications were dominated by labile HTA (34.8%); masked HTA (27.9%) and suspicious of the white coat effect (12.3%). The analysis of the results showed that MAPA was normal in 49.5%. The white coat effect was found in 32% (65 patients) of ABPM. In patients with abnormal ABPM, permanent systolic-diastolic hypertension predominated (57%). HTA masked was noted in 25.7% of our patients and HTA white coat was found in 3.8% of cases. In the hypertensive patients treated, MAPA revealed a poor blood pressure balance in 42.1%. Among the HTA prognostic factors we noted32.4% of patients were "Non Dippers", a pulse pressure greater than or equal to 60 mmHg in 59%. CONCLUSION: The use of this exploration is an important aid to practitioners in the diagnostic, therapeutic and prognosis phase of the management of hypertension. It should become more important as it provides better information on the blood pressure profile for the patients.

INTRODUCTION: L'hypertension artérielle(HTA) représente un problème de santé publique. Elle concerne plus d'un milliard d'individus à travers le monde, soit plus du quart de la population mondiale. Ces dernières années la MAPA (mesure ambulatoire de la pression artérielle) est devenue un outil précieux et largement utilisé pour le diagnostic et la prise en charge de l'HTA. Les objectifs de ce travail étaient de déterminer les indications de la MAPA au service de cardiologie de l'hôpital Aristide le Dantec ; d'en déterminer les résultats et d'évaluer le profil tensionnel de nos patients. MÉTHODES: Nous avons réalisé une étude rétrospective, sur 37 mois allant de Décembre 2010 à Décembre 2013 portant sur l'ensemble des résultats des MAPA enregistrées durant cette période. Était inclus tout patient âgé de plus de 18 ans chez qui une MAPA a été enregistré Toutes les MAPA ayant moins de 50 bonnes mesures par 24 heures n'ont pas été inclus. RÉSULTATS: Au total 204 résultats de MAPA ont été inclus sur un total de 307. L'âge moyen était de 49,6 ± 11,5 ans avec des extrêmes de 25 ans et 78 ans. Le sex ratio était de 1,5 en faveur des femmes. Les indications étaient dominées par l'HTA labile (34,8%) ; l'HTA masquée (27,9%) et la recherche de l'effet blouse blanche (12,3%). L'analyse des résultats avait montré que la MAPA était normale dans 49,5% des cas. L'effet blouse blanche était retrouvé dans 32% (65 patients) des MAPA réalisées à visée diagnostique. Chez les patients dont les résultats étaient anormaux l'HTA systolo-diastolique permanente prédominait (57%) avec une différence significative (p=0,003). L'HTA masquée étaient notée chez 25,7% de nos patients et l'HTA blouse blanche était retrouvée dans 3,8% des cas. Chez les hypertendus traités, la MAPA avait révélé un mauvais équilibre tensionnel dans 42.1% des cas et cela au dépens de la systolique avec une différence significative (p=0,02). Parmi les facteurs pronostiques on retrouvait 32,4% de patients « Non Dippers ¼, une pression pulsée supérieure ou égale à 60 mm Hg dans 59%. Le caractère adrénergique était retrouvé chez 65,7% de nos patients. CONCLUSION: L'utilisation de cette exploration constitue une aide importante aux praticiens à la phase diagnostique, thérapeutique, et pronostique de la prise en charge de l'HTA. Elle devrait occuper de plus en plus de place car elle donne de meilleurs renseignements sur le profil tensionnel dans l'environnement quotidien habituel du patient.

[Congenital heart disease in adolescents and adults: Management in a general cardiology department in Senegal]. / Cardiopathies congénitales de l'adolescent et de l'adulte : prise en charge dans un service de cardiologie générale au Sénégal.

BACKGROUND: Congenital heart diseases in adults include malformations treated in childhood that decompensate secondarily and those asymptomatic at birth, appear later. This study aims to identify congenital heart diseases in adults in general cardiology department of Senegal and to assess clinical presentations, treatment and outcomes. METHODS: We conducted a cross-sectional and descriptive study based on the records of patients aged at least 16 years and followed for congenital heart disease in the cardiology department of the General Hospital of Grand-Yoff in Dakar between May 2003 and March 2015. Diagnosis of heart disease was based on echocardiography. RESULTS: We have registered 50 dossiers of patients equivalent to a prevalence of 0.75%, with a female predominance (64%). The average age of patients was 36.2±18.4 years (16-79 years), and mean age of diagnosis was 29.76±22.58 years. Dyspnea was the main sign (60%). Main malformations were the atrial septal defect (38%), pulmonary stenosis (14%), the ventricular septal defect (12%) and patent ductus arteriosus (10%). According to the classification of Bethesda, heart disease was simple complexity (42%), intermediate (58%) or severe (10%). The treatment was medical in 43 patients and 7 patients had surgical repair. Main complications were infective endocarditis (10%), atrial fibrillation (12%), heart failure (24%) and pulmonary arterial hypertension (50%). CONCLUSION: Congenital heart diseases in adults seem underestimated in our countries. Surgical repair is rare. It is necessary to ensure a good management of the transition between pediatric and adult age.

[Epidemiological, clinical and forensic physical violence against women in Tambacounda (Senegal)]. / Aspects épidémiologiques, cliniques et judiciaires des violences physiques faites aux femmes dans la région de Tambacounda (Sénégal).

INTRODUCTION: To contribute to the fight against physical violence against women, this work aimed to make a 10-year review of cases treated at the Regional Court of Tambacounda. METHODOLOGY: This observational, retrospective, descriptive and analytical study was conducted from 15 October 2014 to 15 April 2015. It covered all the court records of victims of intentional injury from 2006 to 2015. The data was entered and analyzed using Epi info 3.3.2 software. RESULTS: In all, 113 cases were treated. The mean age was 26.5±10.08 years for victims versus 32.5±13.8 years for the aggressors. The victims were all female, and 77.9% of offenders were male. The assaults took place mostly during the day (57.5%), and especially in the homes of victims (61.0%), in the street (16.8%) in the bush (12.4%). The consultation period was less than 24hours for 54.9% of the victims. Clinical examination differentiated: fractures (15%); contusions (13.5%); penetrating wounds (10.6%); bruises (9.7%); eye injuries (7.9%); broken teeth (7.9%); diffuse pains (7.1%), 6.2% polytrauma (6.2%), and 5.3% of trauma on pregnancies. Among the violence, 33.6% were domestic; 11.5% were associated with rape (7.1%); psychological violence (3.6%); rape and death threat (1.8%). Rape was statistically more common among child victims [OR=10.7 (3.2-35.5)] and/or educated victims [OR=5.8 (1.7-19.9)] and aggression in the bush [OR=7.5 (2.2 to 14.2)]. The attackers were lonely and imprisoned in 94.7% and 73.5% of cases respectively. The sentence was firm imprisonment for 89.2% of cases. CONCLUSION: In Tambacounda, health and judicial authorities should enhance public awareness concerning the risk of violence. The extension of this type of study to the national level would have enabled better orientation of control strategies against this scourge.

[Cardiovascular manifestations in systemic lupus erythematosus in Dakar: Descriptive study about 50 cases]. / Les manifestations cardio-vasculaires au cours du lupus érythémateux systémique à Dakar : étude descriptive à propos de 50 cas.

Systemic lupus erythematosus is a non-specific inflammatory disorder of an organ of unknown cause and autoimmune origin. Visceral injuries, including those cardiovascular, determine the prognosis of this disease primarily affecting women. The objectives of this study were to determine the frequency and describe the cardiovascular manifestations in systemic lupus erythematosus in a lupus population of the Dakar region. This is a multicenter prospective study descriptive and analytical conducted in the region of Dakar (Senegal) from 14 February 2011 to 2 July 2012. Patients were either hospitalized or monitored as outpatients. Included were all patients with lupus and meeting at least four criteria of the American College of Rheumatology of lupus disease classification 1997. All patients underwent physical examination, an electrocardiogram and an echocardiogram looking for cardiovascular damage. The collected data were entered into the Epi Info version 3.5.1 and processed with SPSS 16.0 software. Quantitative variables are described in the median and the qualitative workforce, percentage and frequency. We have included 50 patients. The average age of the population was 36.18 years. A female predominance is noted with a sex ratio man/woman of 0.09. Cardiovascular functional symptoms were dominated by dyspnea stage II to IV NYHA (26%) and palpitations (22%). The physical signs we have found were mainly tachycardia (40%), spontaneous turgor of the jugular veins (29%), a muffling of the heart sounds (29%) and a infandibulopulmonairy shock (18%). The frequency of cardiovascular events was 46%. Electrical cardiac events were dominated by sinus tachycardia (40%) of repolarization disorders (16.3%) type of ischemia, injury, ischemia injury, necrosis and hypertrophy with 18% atrial and left ventricular hypertrophy each. Furthermore, one case of BAV first degree at 280 ms was recorded. We found 19 cases of pericarditis including 2 tamponade, 3 cases of dilated cardiomyopathy hyperkinesias with impaired ejection fraction less than 35% and 8 patients with mild PAH important. In systemic lupus erythematosus, cardiovascular events are worrying and may remain asymptomatic for awhile. Their research must be systematic in order to treat early.

[Cardiovascular risk factors associated with erectile dysfunction in the region of Dakar, Senegal]. / Facteurs de risque cardiovasculaires associés au dysfonctionnement érectile dans la région de Dakar, Sénégal.

BACKGROUND: Erectile dysfunction (ED) is often a reason for consultation revealing the existence of cardiovascular risk factors. The objective of this study was to determine the cardiovascular risk factors associated with ED in the Dakar region. METHODS: A descriptive and analytical cross-sectional study was conducted from March 18 to June 2, 2013. The study population was composed of married male subjects who sought care at the Ouakam Geriatric and Gerontology Center and the Grand Yoff General Hospital. Erectile function was assessed with the International Index of Erectile Function using the simplified five-item questionnaire (IIEF 5). R 2.2.9 software was used for the logistic regression multivariate analysis. Associations were measured using the adjusted odds ratio (ORaj) with confidence intervals. RESULTS: A total of 253 men were surveyed during this period. Average age was 16.7±58.2 years, range 24-90 years; 47% were aged under 60 years. ED was diagnosed in 110 patients (43.5%). ED was considered mild (33.6%), moderate (5.5%) or severe (4.3%). ED was more severe in patients older than 60 years. Cardiovascular risk factors associated with ED were diabetes ORaj=2.4 (1.24-4.68), sedentary lifestyle ORaj=3.08 (1.69-5.61), and hypertension ORaj=2.53 (1.33-4.81). CONCLUSION: These results should prompt health care providers to target patients with diabetes, hypertension and sedentary lifestyle for systematic ED screening as a routine practice in order to ensure early and effective care.

Intrapericardial rupture of a mitral subannular aneurysm: A case report and review of the literature.

Mitral subannular aneurysm is a rare heart disease that can have many different forms of clinical presentations. It was first described in young men of African descent and was later reported in other geographical areas of the world. The etiopathogenesis as per data from the literature can be congenital, acquired or idiopathic. We report the case of a 19-year-old male in whom we made the diagnosis of mitral subannular aneurysm. The evolution was fatal following a rupture of the aneurysm into the pericardium. Through this case report, we stress the importance of echocardiography in the diagnosis of this condition. In resource-limited countries, the prognosis is unfortunately often unfavorable especially the ruptured forms. Therefore, a high degree of suspicion is needed to make a prompt diagnosis and timely surgical intervention.

[How Bone Densitometry contributes to the diagnosis of Osteoporosis at the Gerontology and Geriatrics Center of Ouakam, Dakar City: 102 observation]. / Apport de l'osteodensitometrie dans le diagnostic de l'osteoporose au Centre de Gerontologie et Geriatrie de Ouakam/ Ville de Dakar: a propos de 102 observations.

INTRODUCTION: This study aims at assessing the morbidity rate and risk factors of osteoporosis. METHODS: This is a cross-sectional study conducted at the Gerontology and Geriatrics Center of Ouakam from 2010 to 2012 with patients who had benefited from a bone densitometry examination. The study variables were: sex, current age, menopausal age, past individual fractures, past family fractures, prolonged corticoid intake, prolonged immobilization, tobacco addiction, and alcoholism. Epi-info version 6 Software was used to process and analyze the data. RESULTS: The study included 102 patients the majority of which were women (75%), with an average age of 74 years; among these people, 31% had individual past fractures and 10% had family fractures; 8% of the patients had used a prolonged corticoid-based therapy and 2% were tobacco-addicts. The average age of menopause was 48 years. The prevalence rate for osteoporosis was 44%, based on Rachis T-score, 20%, based on Femur T-score and 45%, based on Rachis and Femur T-score. It has been noted that being a woman and past individual fractures rated among the major risk factors of osteoporosis. CONCLUSION: These results speak in favor of health authorities setting-up a program to fight osteoporosis centered mainly on primary prevention and screening.

INTRODUCTION: L'objectif de notre travail est d'évaluer la morbidité et les déterminants de l'ostéoporose. MÉTHODES: Il s'agissait d'une étude transversale qui s'est déroulée au Centre de Gérontologie et Gériatrie de Ouakam de 2010 à 2012 chez des patients qui ont bénéficié de l'examen ostéodensitométrique. Les variables étudiés étaient: sexe, âge actuel, âge de la ménopause, antécédent de fracture personnel, antécédent de fracture familial, prise prolongée de corticoïdes, immobilisation prolongée, tabagisme, consommation d'alcool. Le logiciel Epi-info version 6 a été utilisé pour analyse des données. RÉSULTATS: 102 patients ont été inclus dans l'étude avec une prédominance féminine (75%), un âge moyen de 74 ans; 31% des patients avaient des antécédents personnels de fracture et 10% des antécédents familiaux de fracture; 8% des patients présentaient une corticothérapie prolongée et 2% des patients un tabagisme. L'âge moyen de survenue de la ménopause était de 48 ans. La prévalence de l'ostéoporose était de 44% en se basant sur le T score Rachis, de 20% en se basant sur le T score Fémur et de 45 % en se basant sur le T score Rachis et Fémur. Il a été noté que le sexe féminin et les antécédents personnels de fracture constituaient des facteurs de risque de survenue de l'ostéoporose. CONCLUSION: Former les professionnels au depistage et à la prévention de cette affection.

Pediatric invasive pneumococcal disease in Senegal.

OBJECTIVES: We aimed to describe the clinical, epidemiological, and outcome characteristics of IPD case patients hospitalized at the Albert-Royer National Children's Hospital (French acronym CHNEAR) to evaluate the disease burden of IPDs in a pediatric hospital of Dakar (Senegal). PATIENTS AND METHODS: All children aged 0-15 years hospitalized at the CHNEAR between January 1st, 2008 and December 31st, 2013 for a documented IPD were included in the study. Medical history, risk factors, clinical, bacteriological, and outcome data was collected. Data was then analyzed using the SPSS software, version 16 (Pearson's Chi(2) test: a P-value<0.05 was considered statistically significant). RESULTS: A total of 218 IPD patients were hospitalized at the CHNEAR during the study period (hospital prevalence: 0.79%). The mean age was 36.1 months. The male to female ratio was 1.27 (122 boys and 96 girls). Infants<2 years of age represented 61.46% of patients. Prior antibiotic therapy was found in 54% of patients but details were lacking. Infection sites were mostly meningeal (61%) and pleuropulmonary (28.9%). The main isolated serotypes were 1, 6A, 14, 5, and 23F. Case fatality was 17.4% and it was five times higher for pneumococcal meningitis. CONCLUSION: IPDs are very common in children in Senegal. Infants<2 years of age are particularly affected. The very high case fatality (17%) was significantly associated with meningeal infection sites hence the need for better access to pneumococcal vaccines.

[Study of the immunization coverage determinants of vaccination campaign against meningococcal A meningitis in Burkina Faso]. / Étude des déterminants de la couverture vaccinale de la campagne de vaccination contre la méningite à méningocoque A au Burkina Faso.

BACKGROUND: Sub-Saharan Africa countries suffer from repeated and explosive epidemics of meningitis mainly due to Neisseria meningitidis A. In December 2010, Burkina Faso organized a vaccination campaign with MenAfriVac® for people aged 1-29 years old. The objective of this study was to analyze the determinants of immunization coverage. METHODS: We used a cross-sectional survey by cluster sampling in two stages, descriptive and analytical, conducted in the region of "Boucle du Mouhoun". Data were collected during a home interview. The dependent variable was vaccination status and the independent variables included individual and household characteristics but also the means of communication used during the campaign. A logistic regression model was used to estimate the risk of being vaccinated using the 'Survey' Package (SVYGLM) of R. RESULTS: Two thousand and twenty-five people were included with a 93.5 % estimated coverage. Factors associated with high vaccination coverage are rural areas (ORa=2.53 [1.53-4.17]) and smaller households (ORa=3.06 [1.36-6.91]). The risk of being vaccinated was lower for persons from salaried heads of household (ORa=0.14 [0.02-0.87]) versus farmers, persons informed by religious and traditional leaders (ORa=0.25 [0.11-0.57]) or family and friends (ORa=0.51 [0.29-0.9]) versus community mobilizers. CONCLUSION: The coverage recorded is sufficient to provide community immunity. However, a part of the target population could not benefit from vaccination due to lack of information. Particular emphasis should be placed on large urban families using community mobilizers.

[Prevalence of decreasing vitamin D reserves in black patients undergoing intermittent hemodialysis in Dakar (Senegal): 37 cases]. / Prévalence de la baisse des réserves en vitamine D chez les sujets à peau noire en hémodialyse périodique vivant à Dakar (Sénégal) : à propos de trente-sept cas.

It is now established that vitamin D acts as a steroid hormone via a nuclear receptor to perform its varied functions in mineral metabolism. Very few studies in sub-Saharan Africa, and in Senegal in particular, have focused on the prevalence of low vitamin D reserves in black individuals living in this sunny region. We conducted this study to assess the prevalence of a drop in vitamin D reserves in a population of blacks undergoing intermittent hemodialysis. This descriptive study took place at three hemodialysis centers in Dakar and included 37 patients whose 25-hydroxyvitamin D (25-OH-D) levels had been assayed. The patients' mean age was 51 years, and their sex ratio 1.49. The average concentration of 25-OH-D was 70 nmol/L. Below-normal reserves were found in 23 patients (62.2%), especially among those aged 50-75 years. All patients with low 25-OH-D reserves received vitamin D3 supplementation at a dose of 100,000 IU of cholecalciferol per month. This supplementation normalized 25-OH-D levels in the 10 patients subsequently tested. Given the small sample size, a study with a larger number of patients is needed to reach a conclusion about the exact prevalence of low vitamin D reserves in this population and to investigate possible associated factors.

[Study of determinants of unprotected sex in sailors of the Senegalese merchant navy]. / Étude des déterminants des rapports sexuels non protégés chez les marins de la marine marchande sénégalaise.

Sailors are a mobile population travelling a lot and therefore being often exposed to casual sex. The aim of this study is to analyze the determinants of unprotected sex among sailors in Senegal. A descriptive and analytical study was conducted among sailors of the merchant navy. Data on knowledge, attitudes and practices were collected during a personal interview. A multivariate analysis was performed using a multiple logistic regression. A total of 400 sailors were interviewed, 57.9% had casual sex of whom 23.7% were not protected. Sexual intercourse without protection was more common among the uneducated (OR = 2.29 [1.23 to 5.99]) and married (OR = 2.29 [1.23-5.99]). Sailors who thought that using condom reduces pleasure during sexual intercourse (OR = 2.5 [1.2-5.1]) and those who consumed alcohol (OR = 5.4 [2.07-14.2]) were less protected during casual sex. Sexual contact is one of the main modes of transmission of HIV / AIDS. Sailors often have unprotected sex. Interventions using specific ways must be performed taking into account the mobility of these men who are often uneducated.

[Evaluation of tolerance of zidovudine-lamivudine-nevirapine combination in HIV 1 patients in Fann Teaching Hospital in Dakar]. / Évaluation de la tolérance de l'association zidovudine-lamivudine-névirapine chez les patients VIH-1 au Centre hospitalier de Fann à Dakar.

We conducted a study to evaluate the tolerance of the zidovudine (AZT), lamivudine (3TC) and nevirapine (NVP) combination regimen in HIV-1 patients by a descriptive analytical retrospective study of all HIV-1 patients receiving AZT-3TC-NVP combination between 2008 and 2011. Seventy patients were included. Two thirds of the patients presented at least one side effect (44 cases). The digestive disorders (15 cases) and neuropsychiatric (14 cases) were the most frequent. Epigastralgia (20%), headaches (20%) and arthralgias (13%) were main side effects. A maculo-papular exanthema was noted in three cases. During the follow-up, five patients presented with anemia. No patient presented hepatic cytolysis due to NVP. All the patients followed for more than six months presented a side effect against 29.7% when the duration of treatment was equal to or less than 6 months (p=10(-5)). Most of the side effects due to the association AZT/3TC/NVP are minor. The evaluation of the clinical and biological tolerance must be maintained during all the follow-up.

[Economic impact of skin-lightening products on household income in sub-Saharan Africa: the case of Senegal]. / Poids économique de la dépigmentation artificielle sur le revenu des ménages d'Afrique subsaharienne : cas du Sénégal.

INTRODUCTION: As throughout sub-Saharan Africa, the use of skin-lightening (or brightening or bleaching) products is widespread in Senegal (67%). Although the medical and social determinants of this phenomenon have been documented, its cost is poorly defined. Thus, this work aims to evaluate the economic effects of skin bleaching on women's income. METHODOLOGY: A cross-sectional, quantitative, and descriptive survey was conducted in 2010 (October 7 to November 8) among women consulting for outpatient care at a reference dermatology clinic for complications related to use of skin-lightening products. We calculated the direct costs (products) and indirect costs (transportation costs, medical fees, dermatological treatment of complications). The social damage (pain and suffering and esthetics) was assessed. RESULTS: This study included 65 women; their mean age was 33 years and 26% had not attended school. In all, 52% were merchants, 29% housewives, 9% civil servants, and 5% students. The average duration of product use was 9 years, and the mean age at onset of use, 23 years. Most (80%) had a low income (<100,000 FCFA or US $204). The total monthly income of the 65 women in the study was 5,675,000 CFA (US $ 11,582). The total monthly cost of skin lightening for them was 1081,658 CFA (US $ 2207), that is, 19% of their total income. The esthetic harm was categorized as moderate by 20% and high by 22%. CONCLUSION: This study opens perspectives for further studies of the intangible costs of skin bleaching and for increasing awareness of the complications and social damage induced.

Social inequality and antenatal care: impact of economic welfare on pregnancy monitoring in Senegal.

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

[Unusual aspect of pernicious anemia during association of beta-thalassemia: a new case report and literature review]. / Maladie De Biermer De Presentation Inhabituelle Sur Un Profil Beta Thalassemique : Apport D'Un Nouveau Cas Et Revue De La Litterature.

Pernicious anemia appears classically by macrocytosis. We report a case of a late discovered Biermer disease, on a 42-year-old young black woman. The reason was an unusual aspect of this disease in a context of betathalassemia. The patient presented chronic anemia which evolved during about ten year. Biology showed a normocytosis and signs of hemolysis according to beta-thalassemia. This was confirmed by an electrophoresis showing 9.1 % of fraction F some haemoglobin. Since this date, the patient was treated by folic acid alone with periodic transfusions of red blood cell. She presented eight years after the beginning of her disease, neurological deterioration. Diagnosis of pernicious anemia was finally established up on histological gastritis, low level of the blood rate of vitamin B12, macrocytosis, and presence of intrinsic anti-factor and parietal anti-cells antibodies.

Acute renal failure in the postpartum due to calcified myoma: a case report.

BACKGROUND: It has been reported that delivery can be a cause of urine retention. This complication occurs especially in case which are associated with a pelvic mass like calcified uterine myoma. But this unusual aspect of myoma can make ultrasonographic traps. OBJECTIVE: To report an unusual case of calcified uterine myoma which was unnoticed during pregnancy and made so obstructive renal failure few days after the delivery. CASE REPORT: Seven days after delivery a Twenty-nine-year-old Senegalese woman was admitted at a private hospital for a slight alteration of consciousness(Glasgow Coma Scale at 12). Emergency check-up showed an acute obstructive renal failure. Biological investigations showed ascendancy of granulocytes, deterioration of renal function with creatinin in 78 mg / l and urea in 1.82 g/l. Ultrasonographic examination revealed bilateral dilatation of renal calyces and an interstitial calcified uterine myoma compressing the bladder. Management consisted on a urethral catheterization of bladder, correction of hydro-electrolytic troubles and antibiotherapy (ciprofloxacin).Global evolution leads to fast fully consciousness, with disappearance of biological and ultrasonographic disorders. CONCLUSION: Calcified myoma can look like cephalic pole during pregnancy. This unusual aspect can be sometimes source of acute obstructive renal failure requiring urinary drainage in emergency. Improvement of women's management during postpartum can prevent such complications.

[Access to intermittent preventive treatment (IPt) in a situation of abolition of user's fee: role of economic welfare]. / Accès au traitement préventif intermittent (TPI) dans une situation de gratuité : rôle du bien-être économique.

In Senegal, the free distribution of sulfadoxine pyrimethamine during antenatal care is recommended to remove the disparity in the context of intermittent preventive treatment against malaria. The objective of this study was thus to identify factors influencing access to treatment in a situation of abolition of user fees. It was a cross-sectional and analytical study. It covered a sample of 1906 women aged 15-49 years randomly selected during the national survey on malaria in Senegal. Data were collected during a personal interview. The economic well-being was measured from the characteristics of housing and durable goods. The multivariate analysis was performed using logistic regression. The average age was 27.94 ± 5.34, 64.27% resided in rural area and 71.8% had received no schooling. Among the surveyed women, 23% were in the poorest quintile, while 16.3% were in the richest. Intermittent preventive treatment was performed in 49.3%. IPt were made more in urban areas (OR 1.45 95% [1.17 to 1.72]). It increased with the level of education with an OR of 1.5 and 1.68 in primary and secondary. The completion of the IPt increased with economic welfare. The OR ranged from 1.44 to 2.95 in the second quintile to the richest. Free medication does not necessarily benefit poor people. Other accompanying measures must be developed to facilitate the distribution of drugs particularly at community level with the involvement of people.