[Prevalence survey of cardiovascular risk factors in the general population in St. Louis (Senegal)]. / Enquête de prévalence des facteurs de risque cardiovasculaire en population générale à Saint-Louis (Sénégal).

BACKGROUND: Cardiovascular diseases are becoming with their risk factors a real health problem in Africa. The objectives of this study were to assess the prevalence of risk factors for cardiovascular diseases in the general population in Saint-Louis, Senegal. METHODOLOGY: This is a cross-sectional, descriptive and analytical made in May 2010, in the Senegalese aged 15, residing in the city of Saint-Louis, Senegal. A systematic random sampling and stratified cluster has been achieved. Cardiovascular risk factors for research were: hypertension, diabetes, dyslipidemia, smoking, obesity, physical inactivity and metabolic syndrome. RESULTS: The survey involved 1424 individuals with 983 women (69%). The average age was 43.4±17.8years. The prevalence of risk factors was: hypertension (46%), diabetes (10.4%), total cholesterol (36.3%), hyperLDLcholesterol (20.6%), obesity (body mass index≥30kg/m(2)) (23%), abdominal obesity (48.7% according to International Diabetes Federation and 33.2% according to National Cholesterol Education Program) physical inactivity (64.7%), smoking (5.8%) and metabolic syndrome (15.7%). There was predominance in women of risk factors except for smoking and diabetes. The overall cardiovascular risk was high in 24.9% according to the Framingham model, 28.8% (European Society of Hypertension) and 6.1% (SCORE). CONCLUSION: This survey found a high prevalence of cardiovascular risk factors in a general population in Senegal, predominant in women. This should lead to better develop a strategy to prevent cardiovascular diseases.

[Study of echocardiographic parameters of type 2 black African diabetics at high cardiovascular risk. A cross-sectional study of 79 cases in Senegal]. / Étude des paramètres échocardiographiques du diabétique de type II noir africain à haut risque cardiovasculaire. Étude transversale de 79 cas sénégalais.

INTRODUCTION: The discovery of silent myocardial ischemia in a diabetic placed in a logic of secondary prevention. The objectives of this study were to investigate the echocardiographic parameters of type 2 Senegalese diabetics at high cardiovascular risk and identify those that are predictors of silent myocardial ischemia. PATIENTS AND METHODS: We conducted a cross-sectional study in 79 diabetic patients at high cardiovascular risk. After clinical examination, we conducted laboratory tests (glucose, creatinine, lipid profile, blood count and blood chemistry panel), ECG, standard echocardiography and dobutamine stress echocardiography looking for silent myocardial ischemia. Data were analyzed using SPSS 17 and echocardiographic parameters determining predictors of silent myocardial ischemia using a multivariate analysis. RESULTS: Seventy-nine with type 2 diabetics at high cardiovascular risk were assessed, including 56 women. The mean age was 58.8±11.8 years (44-72ans). The abnormalities found in echocardiography were dominated by left atrium dilation (72.2%), increased filling pressures of left ventricle and increased left ventricular mass in 62.02% cases respectively. At stress echocardiography, regional wall motion abnormalities were found in 67.1% of patients. These disorders were significantly more frequent in patients who had a dilated left atrium (P=0.0001), increased filling pressures (P=0.001) and high left ventricular mass (P=0.001). CONCLUSION: In diabetic patients at high cardiovascular risk, the existence of a dilation of the left atrium to left ventricular hypertrophy or increased filling pressures of the left ventricle may indicate a silent myocardial ischemia.

[Screening for asymptomatic peripheral arterial occlusive disease of the lower limbs by measuring the ankle-brachial index in the general population (Senegal)]. / Dépistage de l'artériopathie oblitérante asymptomatique des membres inférieurs par la mesure de l'index de pression systolique dans la population générale de Saint-Louis (Sénégal).

OBJECTIVES: The purpose of this study was to investigate the prevalence of peripheral arterial disease (PAOD) and cardiovascular risk factors associated with the ankle-brachial index (ABI) in Senegalese patients aged 40 years and over. METHODOLOGY: We prospectively studied a random sample of Senegalese aged 40 years and older, residing in the city of St.-Louis, Senegal. The ABI was measured with a portable doppler (DIADOP 50) using 4 and 8Hz dual frequency probes. The standards were: normal ABI 0.9 to 1.3; peripheral artery obstructive disease (PAOD) ABI less than 0.9; incompressible artery ABI greater than 1.3. Cardiovascular risk factors were also studied. RESULTS: Seven hundred and seventy-one subjects (mean age 57 ± 11.2 years, 559 women) were examined. Cardiovascular risk factors were: sedentary lifestyle (76.4%), hypertension (68%), obesity (32.1%), elevated LDL-cholesterolemia (27.8%), diabetes (18.3%) and tobacco smoking (6.9%). Ninety-three subjects (12.1%) had PAOD and 37 subjects (4.8%) had an incompressible artery. PAOD was significantly more common in sedentary subjects (P=0.008), in the elderly (P=0.0006) and in patients with a history of coronary artery disease (P=0.04). Smoking was not strongly associated with PAOD. CONCLUSION: PAOD is common in Senegalese and is associated with high prevalence of cardiovascular risk factors.

[HIV and sexually transmitted disease among female sex workers in Benin]. / VIH et infections sexuellement transmissibles chez les travailleuses du sexe au Bénin.

BACKGROUND: This report describes a follow-up study conducted in 2005 to evaluate programs intended to reduce HIV/AIDS among registered and unregistered female sex workers (FSW) and their male clients in six major urban areas in Benin (Cotonou, Abomey-Bohicon, Parakou, Porto-Novo, Kandi, Malanville). The objectives of this second study combining laboratory testing and behavioral questionnaires were to estimate the prevalence of HIV and sexually transmitted diseases (STI), to determine the sociodemographic and behavioral characteristics of FSW, and to assess changes in the behavior of registered FSW in the first four cites (Cotonou, Abomey-Bohicon, Parakou, and Porto-Novo) included in the initial study in 2002. DESIGN AND METHODS: A cross-sectional study was conducted in a cohort of 930 self-identified FSW. The chi-square or Fisher's exact test were used to test correlation between HIV and social, demographic and behavioral factors and the Wilcoxon test to compare the distribution of continuous variables. Correlation was measured based on prevalence odd ratios (POR) obtained by multivariate logistic regression. RESULTS: The overall prevalence of HIV, Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) were 30.5%, 3.6% and 5.7% respectively. The prevalence of HIV was highest in Parakou (48.2%) and lowest in Abomey/Bohicon (16.4%). The prevalence of NG and CT were highest in Abomey/Bohicon and Porto-Nova respectively. Multivariate logistic regression analysis showed that HIV prevalence increased significantly for FSW who had had more than 10 clients in the previous week (POR = 1.40, 95% CI: 1.02-1.94), who had no other source of income (POR = 1.47, 95% CI: 1.08-2.00), who were currently unmarried or separated (POR = 2.63, 95% CI: 1.73-4.02), and who had never been married (POR = 2.07, 95% CI: 1.43-3.00). Older age and having had no non-paying partner in the last seven days were positively correlated with HIV infection. Between 2002 and 2005 there was a significant increase in the number of FSW who reported condom use with all clients (79% vs. 90%, p < 0.0001) and with all sexual partners (78% vs. 87%, p = 0.0007) during the last 7 days as well as in the median number of visits to a health care facility in the last 12 days (3 vs. 6, p < 0.0001). Overall these follow-up data showed a large decrease in the prevalence of HIV/STI. This finding supports continuation of programs aimed at FSW especially with regard to risk awareness, condom use, and STI screening and treatment.

Interventions among male clients of female sex workers in Benin, West Africa: an essential component of targeted HIV preventive interventions.

OBJECTIVES: To assess the impact of interventions targeted towards female sex workers (FSWs) and their male clients on client HIV/STI prevalence and sexual behaviour. METHODS: From 1993 to 2006, an HIV/STI preventive intervention focusing on condom promotion and STI care was implemented among FSWs in Cotonou, Benin, and then expanded to cover their male sexual partners in 2000. The interventions were scaled up to five other cities of Benin in 2001-2002. Serial cross-sectional surveys of HIV/STI prevalence and sexual behaviour were carried out among clients in Cotonou in 1998, 2002 and 2005; and in the five other cities (O/Cotonou) in 2002 and 2005. RESULTS: Significant declines in gonorrhoea prevalence among clients of FSWs: Cotonou, from 5.4% in 1998 to 1.6% in 2005; O/Cotonou: from 3.5% in 2002 to 0.59% in 2005. Chlamydia prevalence also declined O/Cotonou, from 4.8% to 1.8%, while HIV prevalence remained stable. Reported condom use by clients with both FSWs and casual non-FSW partners, but not regular partners, increased significantly. While condom use at last sex with an FSW was similar in Cotonou to O/Cotonou around the time of implementation of the interventions (56% in 1998 vs 49% in 2002, respectively), it had risen to similar levels by 2005 (95% and 96%, respectively). CONCLUSIONS: These results demonstrate that it is possible to implement preventive and clinical services for clients of FSWs, and suggest that such interventions, integrated with those targeted towards FSWs, can have a significant effect on sexual behaviour and STI prevalence (particularly gonorrhoea) among this population.

Evaluation of a rapid point-of-care test for the detection of gonococcal infection among female sex workers in Benin.

OBJECTIVES: To assess the validity of the PATH (Seattle, Washington, USA) GC-Check rapid test, a point-of-care immunochromatographic strip test, in the detection of gonococcal infection among female sex workers (FSWs) in Benin. METHODS: Women consulting consecutively at two FSW-dedicated clinics in Cotonou and Porto Novo (Benin) were recruited over three, 1-month periods between October 2003 and July 2004. After written informed consent, participants were administered a short interview and underwent a speculum examination where two cervical swabs were collected (in a subset of women, a vaginal swab was also collected). One cervical swab and the vaginal swab were immediately tested with the rapid test. The other cervical swab was frozen at -20 degrees C for at most four weeks and then transported to Québec (Canada), where it was tested with the Roche Amplicor CT/NG PCR assay. Samples positive for gonococcal infection were confirmed using a 16SrRNA PCR assay. RESULTS: 1084 FSWs (median age 29 years) participated in the study, of whom 50 (4.6%) had a confirmed gonococcal infection. The sensitivity, specificity, positive and negative predictive values of the rapid test on cervical samples were 70.0% (95% confidence interval (CI) 55.4% to 82.1%), 97.2% (95% CI 96.0% to 98.1%), 54.7% and 98.5%, respectively. The sensitivity of the rapid test on vaginal swabs among 759 women (37 positives for gonococcal infection) was significantly lower than with the cervical swab (54.1%, p = 0.008), whereas the specificity was comparable (98.2%, p = 0.13). CONCLUSIONS: The PATH GC-Check test may be as efficient as a gold standard polymerase chain reaction (PCR) test for treating gonococcal infection when taking into account the proportion of women who do not return for their test results. In clinics serving populations with moderate prevalence of this infection, it could significantly reduce over-treatment compared to the syndromic approach.

AIDS caused by HIV1 and HIV2 infection: are there clinical differences? Results of AIDS surveillance 1986-97 at Fann Hospital in Dakar, Senegal.

OBJECTIVE: To compare the clinical manifestations observed in AIDS patients infected with HIV2 and HIV1 infection. METHODS: The medical records of AIDS patients hospitalized between January 1986 and July 1997 at the Department of Infectious Diseases of Fann Hospital, Dakar, were reviewed. RESULTS: 599 hospitalizations (76%) were HIV1 seropositive patients, 137 (17%) were HIV2 seropositive patients and 54 (7%) were patients serologically dually reactive to HIV1 and HIV2. There was no significant difference in medium CD4 lymphocyte count between patients with HIV1 and HIV2 infection. Chronic diarrhoea and diarrhoea caused by bacterial infections were more frequently observed in HIV2-infected individuals. Oral candidiasis and chronic fever were more often noted in patients with HIV1 infection. Bacterial and cryptococcal meningitis was only observed among patients with HIV1 infection. CONCLUSIONS: Certain clinical differences were observed comparing AIDS patients with HIV1 and those with HIV2 infection. As there is no clear physiopathological explanation for these differences, additional studies with larger numbers of AIDS patients are needed to determine whether these differences are real.