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Effective, scalable and sustainable strategies to improve quality of care are needed to address the substantial burden of preventable deaths of children under-five in resource-constrained settings. Clinical decision support systems (CDSS), digital tools which generate recommendations for healthcare providers based on patient-specific information, show promise. By strengthening adherence to evidence-based assessment, diagnosis and management and generating high-quality data, CDSS can improve quality care - care that is effective, safe, people-centered, timely, equitable, integrated and efficient. Designing and implementing CDSS that deliver this impact is a complex and iterative process. We advocate for collaboration on developing and evaluating these tools to guide their implementation for maximal impact.
Des stratégies efficaces pour améliorer la qualité des soins sont nécessaires pour réduire les nombreux décès évitables d'enfants de moins de cinq ans dans des contextes aux ressources limitées. Les systèmes d'aide à la décision clinique (SADC) sont des outils numériques générant des recommandations aux prestataires de soins sur la base des informations du patient. En orientant l'évaluation et la prise en charge de façon méthodique, ils peuvent permettre d'améliorer la qualité des soins et de générer des données de qualité. Ainsi, les soins peuvent être plus sûrs, centrés sur la personne, opportuns, équitables, intégrés et efficients. La conception et la mise en Åuvre d'un SADC de manière durable est un processus complexe et continu. Nous plaidons pour la collaboration afin de guider leur mise en Åuvre pour un impact maximal.
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Sistemas de Apoio a Decisões Clínicas , Humanos , Criança , Saúde GlobalRESUMO
BACKGROUND: Senegal introduced a 13-valent pneumococcal conjugate vaccine (PCV13) in October 2013, given at 6, 10, and 14 weeks of age. We document trends of meningitis and pneumonia after the PCV13 introduction. METHODS: From October 2010-October 2016, hospitalization data for clinical meningitis and pneumonia in children aged <5 years were collected from logbooks at a large, tertiary, pediatric hospital in Dakar. We used a set of predetermined keywords to define hospitalizations for extraction from hospital registers. We conducted a time-series analysis and compared hospitalizations before and after the PCV13 introduction, accounting for seasonality. The initial PCV13 uptake period (October 2013-September 2014) was considered to be transitional and was excluded. RESULTS: Over the 7-year period, 1836 and 889 hospitalizations with a discharge diagnosis of pneumonia and meningitis, respectively, occurred in children aged <5 years. In children aged <12 months, a small, significant reduction in pneumonia was observed post-PCV13 (-3.8%, 95% confidence interval [CI] -1.5 to -5.9%). No decline was observed among children aged 12-59 months (-0.7%, 95% CI -0.8 to 2.2%). Meningitis hospitalizations remained stable for children aged <12 months (1.8%, 95% CI -0.9 to 4.4%) and 12-59 months (-0.5%, 95% CI -3.6 to 2.6%). CONCLUSIONS: We used data from 1 hospital to detect a small, significant reduction in all-cause pneumonia hospitalizations 2 years post-PCV13 introduction in infants; the same trend was not measurable in children aged 12-59 months or in meningitis cases. There is a need for continued surveillance to assess the long-term impact of sustained PCV13 use and to monitor how pneumococcus is causing disease in the meningitis belt.
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Hospitalização/estatística & dados numéricos , Meningites Bacterianas/epidemiologia , Vacinas Pneumocócicas/administração & dosagem , Pneumonia Pneumocócica/epidemiologia , Sistema de Registros , Pré-Escolar , Hospitais Pediátricos/estatística & dados numéricos , Humanos , Lactente , Meningites Bacterianas/prevenção & controle , Pneumonia Pneumocócica/prevenção & controle , Senegal/epidemiologia , Vacinas Conjugadas/administração & dosagemRESUMO
BACKGROUND: Bacterial meningitis is a major cause of mortality among children under 5 years of age. Senegal is part of World Health Organization-coordinated sentinel site surveillance for pediatric bacterial meningitis surveillance. We conducted this analysis to describe the epidemiology and etiology of bacterial meningitis among children less than 5 years in Senegal from 2010 and to 2016. METHODS: Children who met the inclusion criteria for suspected meningitis at the Centre Hospitalier National d'Enfants Albert Royer, Senegal, from 2010 to 2016 were included. Cerebrospinal fluid specimens were collected from suspected cases examined by routine bacteriology and molecular assays. Serotyping, antimicrobial susceptibility testing, and whole-genome sequencing were performed. RESULTS: A total of 1013 children were admitted with suspected meningitis during the surveillance period. Streptococcus pneumoniae, Neisseria meningitidis, and Haemophilus accounted for 66% (76/115), 25% (29/115), and 9% (10/115) of all confirmed cases, respectively. Most of the suspected cases (63%; 639/1013) and laboratory-confirmed (57%; 66/115) cases occurred during the first year of life. Pneumococcal meningitis case fatality rate was 6-fold higher than that of meningococcal meningitis (28% vs 5%). The predominant pneumococcal lineage causing meningitis was sequence type 618 (n = 7), commonly found among serotype 1 isolates. An ST 2174 lineage that included serotypes 19A and 23F was resistant to trimethoprim-sulfamethoxazole. CONCLUSIONS: There has been a decline in pneumococcal meningitis post-pneumococcal conjugate vaccine introduction in Senegal. However, disease caused by pathogens covered by vaccines in widespread use still persists. There is need for continued effective monitoring of vaccine-preventable meningitis.
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Meningites Bacterianas/epidemiologia , Vacinas Pneumocócicas/administração & dosagem , Vigilância de Evento Sentinela , Pré-Escolar , Feminino , Haemophilus influenzae/classificação , Humanos , Lactente , Recém-Nascido , Masculino , Meningites Bacterianas/líquido cefalorraquidiano , Meningites Bacterianas/mortalidade , Neisseria meningitidis/classificação , Senegal/epidemiologia , Sorotipagem , Streptococcus pneumoniae/classificação , Combinação Trimetoprima e Sulfametoxazol/farmacologia , Vacinas Conjugadas/administração & dosagem , Sequenciamento Completo do GenomaRESUMO
BACKGROUND: Neonatal infection constitutes one of Senegal's most important public health problems, with a mortality rate of 41 deaths per 1,000 live births. METHODS: Between January 2007 and March 2008, 242 neonates with suspected infection were recruited at three neonatal intensive care units in three major tertiary care centers in Dakar, the capital of Senegal. Neonatal infections were confirmed by positive bacterial blood or cerebrospinal fluid culture. The microbiological pattern of neonatal infections and the antibiotic susceptibility of the isolates were characterized. In addition, the genetic basis for antibiotic resistance and the genetic background of third-generation cephalosporin-resistant (3GC-R) Enterobacteriaceae were studied. RESULTS: A bacteriological infection was confirmed in 36.4 % (88/242) of neonates: 22.7 % (30/132) during the early-onset and 52.7 % (58/110) during the late-onset periods (p > 0.20). Group B streptococci accounted for 6.8 % of the 88 collected bacterial isolates, while most of them were Enterobacteriaceae (n = 69, 78.4 %). Of these, 55/69 (79.7 %) were 3GC-R. The bla CTX-M-15 allele, the bla SHV and the bla TEM were highly prevalent (63.5, 65.4 and 53.8 %, respectively), usually associated with qnr genes (65.4 %). Clonally related strains of 3GC-R Klebsiella pneumoniae and 3GC-R Enterobacter cloacae, the two most commonly recovered 3GC-R Enterobacteriaceae (48/55), were detected at the three hospitals, underlining the role of cross-transmission in their spread. The overall case fatality rate was 18.6 %. CONCLUSIONS: Measures should be taken to prevent nosocomial infections and the selection of resistant bacteria.
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Cefalosporinas/farmacologia , Infecções por Enterobacteriaceae/microbiologia , Enterobacteriaceae/efeitos dos fármacos , Resistência beta-Lactâmica/efeitos dos fármacos , Enterobacter cloacae/efeitos dos fármacos , Enterobacter cloacae/isolamento & purificação , Enterobacter cloacae/patogenicidade , Enterobacteriaceae/isolamento & purificação , Enterobacteriaceae/patogenicidade , Infecções por Enterobacteriaceae/tratamento farmacológico , Infecções por Enterobacteriaceae/epidemiologia , Feminino , Humanos , Recém-Nascido , Klebsiella pneumoniae/efeitos dos fármacos , Klebsiella pneumoniae/isolamento & purificação , Klebsiella pneumoniae/patogenicidade , Masculino , Testes de Sensibilidade Microbiana , Senegal/epidemiologia , Centros de Atenção Terciária , Resultado do Tratamento , Resistência beta-Lactâmica/genética , beta-Lactamases/genéticaRESUMO
Effective and sustainable strategies are needed to address the burden of preventable deaths among children under-five in resource-constrained settings. The Tools for Integrated Management of Childhood Illness (TIMCI) project aims to support healthcare providers to identify and manage severe illness, whilst promoting resource stewardship, by introducing pulse oximetry and clinical decision support algorithms (CDSAs) to primary care facilities in India, Kenya, Senegal and Tanzania. Health impact is assessed through: a pragmatic parallel group, superiority cluster randomised controlled trial (RCT), with primary care facilities randomly allocated (1:1) in India to pulse oximetry or control, and (1:1:1) in Tanzania to pulse oximetry plus CDSA, pulse oximetry, or control; and through a quasi-experimental pre-post study in Kenya and Senegal. Devices are implemented with guidance and training, mentorship, and community engagement. Sociodemographic and clinical data are collected from caregivers and records of enrolled sick children aged 0-59 months at study facilities, with phone follow-up on Day 7 (and Day 28 in the RCT). The primary outcomes assessed for the RCT are severe complications (mortality and secondary hospitalisations) by Day 7 and primary hospitalisations (within 24 hours and with referral); and, for the pre-post study, referrals and antibiotic. Secondary outcomes on other aspects of health status, hypoxaemia, referral, follow-up and antimicrobial prescription are also evaluated. In all countries, embedded mixed-method studies further evaluate the effects of the intervention on care and care processes, implementation, cost and cost-effectiveness. Pilot and baseline studies started mid-2021, RCT and post-intervention mid-2022, with anticipated completion mid-2023 and first results late-2023. Study approval has been granted by all relevant institutional review boards, national and WHO ethical review committees. Findings will be shared with communities, healthcare providers, Ministries of Health and other local, national and international stakeholders to facilitate evidence-based decision-making on scale-up.Study registration: NCT04910750 and NCT05065320.
Pulse oximetry and clinical decision support algorithms show potential for supporting healthcare providers to identify and manage severe illness among children under-five attending primary care in resource-constrained settings, whilst promoting resource stewardship but scale-up has been hampered by evidence gaps.This study design article describes the largest scale evaluation of these interventions to date, the results of which will inform country- and global-level policy and planning .
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Algoritmos , Sistemas de Apoio a Decisões Clínicas , Oximetria , Humanos , Lactente , Pré-Escolar , Recém-Nascido , Quênia , Atenção Primária à Saúde/organização & administração , Senegal , Índia , TanzâniaRESUMO
BACKGROUND: The Demographic Surveillance System established in 1962 in Niakhar, Senegal, is the oldest in Africa. Here, we analyze trends in overall child mortality, malaria, and other causes of death in Niakhar from the beginning of data collection to 2010. METHODS: After an initial census, demographic data were updated yearly from 1963 through 2010. From 1984, causes of death were determined by the verbal autopsy technique. RESULTS: During 1963-2010, infant and under-5 mortality rates decreased from 223 to 18 and from 485 to 41, respectively. The decrease was progressive during the entire observation period, except during 1990-2000, when a plateau and then an increase was observed. Malaria-attributable mortality in under-5 children decreased from 13.5 deaths per 1000 children per year during 1992-1999 to 2.2 deaths per 1000 children per year in 2010. During this period, all-cause mortality among children aged <5 years decreased by 80%. CONCLUSIONS: Inadequate treatment for chloroquine-resistant malaria and an epidemic of meningitis during the 1990s were the 2 factors that interrupted a continuous decrease in child mortality. Direct and indirect effects of new malaria-control policies, introduced in 2003 and completed during 2006-2008, are likely to have been the key cause of the recent dramatic decrease in child mortality.
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Mortalidade da Criança/tendências , Controle de Doenças Transmissíveis/métodos , Política de Saúde , Malária/mortalidade , Malária/prevenção & controle , Criança , Pré-Escolar , Pesquisa sobre Serviços de Saúde , Humanos , Lactente , Recém-Nascido , Malária/tratamento farmacológico , Malária/epidemiologia , Senegal/epidemiologiaRESUMO
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.
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Assistência Farmacêutica , Farmácia , Estudantes de Farmácia , Humanos , Antibacterianos/uso terapêutico , Universidades , Senegal , Estudos Transversais , Conhecimentos, Atitudes e Prática em Saúde , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Low birth weight (LBW) is defined as a birth weight <2500â¯g at birth, regardless of the term of pregnancy. The objective of this study was to evaluate the height and weight development of LBW infants from 0 to 9 months of corrected age (CA) in Senegal. METHOD: This was a prospective, descriptive, and analytical cohort follow-up of up to 9 months of CA including all live newborns of LBW hospitalized and followed up from 1 August 2019 to 31 May 2020. World Health Organization growth charts were used to assess height and weight growth. RESULTS: During the study, 136 LBW newborns were included. The mean gestational age was 32 weeks of amenorrhea. At discharge, 46 children (33.82%) were exclusively breastfed. At birth, the mean weight was 1487â¯g (3rd-10th percentile) and the mean height was 41.52â¯cm (10th-25th percentile). At 9 months of CA, the mean weight was 8119â¯g (median) and the mean height was 74â¯cm (median). The children had achieved satisfactory growth in weight (84%) and height (89%). At 9 months of CA, 27% of the children were behind in one of the four areas of psychomotor development. CONCLUSION: At the end of 9 months of CA, height and weight were normal.
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Aleitamento Materno , Recém-Nascido de Baixo Peso , Lactente , Gravidez , Criança , Feminino , Recém-Nascido , Humanos , Estudos Prospectivos , Idade Gestacional , Parto , Peso ao NascerRESUMO
Introduction: Bart's syndrome is an uncommon inherited congenital disorder associating congenital cutaneous aplasia of the extremities and inherited epidermolysis bullosa. Bilateral and symmetrical involvement of the limbs is exceptionally described on black skin. In most cases, the diagnosis is clinical; however, the management remains very difficult and the extended forms are a real therapeutic challenge. We report 2 cases of Bart's syndrome observed in a sub-Saharan African country (Senegal, Dakar). Case Presentation: It was about 2 premature female and male newborns. On physical examination, the girl presented with a total absence of skin on the limbs, associated with cutaneous detachment of the trunk representing a detached and detachable skin surface of 46%; the boy underwent a total absence of skin of more than 50% of the skin surface. The diagnosis of Bart's syndrome was set based on the typical clinical aspect. The blood count and CRP were normal for the girl whereas it revealed some disorders for the boy. The 2 newborns were urgently admitted to an incubator, and the intensive care was started with hyperhydration, anti-staphylococcal prophylaxis, and daily dermatological care with antiseptic baths and fatty dressings. Conclusion: Bart's syndrome is an uncommon genodermatosis characterized by a clinical triad associating congenital cutaneous aplasia of the extremities, inherited epidermolysis bullosa suspected in the presence of bubbles, and areas of cutaneous fragility and nail deformity. All types of which can be associated with this syndrome. The easy clinical diagnosis but the difficult management encumber the vital prognosis of our cases.
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Electronic clinical decision support algorithms (CDSAs) have been developed to address high childhood mortality and inappropriate antibiotic prescription by helping clinicians adhere to guidelines. Previously identified challenges of CDSAs include their limited scope, usability, and outdated clinical content. To address these challenges we developed ePOCT+, a CDSA for the care of pediatric outpatients in low- and middle-income settings, and the medical algorithm suite (medAL-suite), a software for the creation and execution of CDSAs. Following the principles of digital development, we aim to describe the process and lessons learnt from the development of ePOCT+ and the medAL-suite. In particular, this work outlines the systematic integrative development process in the design and implementation of these tools required to meet the needs of clinicians to improve uptake and quality of care. We considered the feasibility, acceptability and reliability of clinical signs and symptoms, as well as the diagnostic and prognostic performance of predictors. To assure clinical validity, and appropriateness for the country of implementation the algorithm underwent numerous reviews by clinical experts and health authorities from the implementing countries. The digitalization process involved the creation of medAL-creator, a digital platform which allows clinicians without IT programming skills to easily create the algorithms, and medAL-reader the mobile health (mHealth) application used by clinicians during the consultation. Extensive feasibility tests were done with feedback from end-users of multiple countries to improve the clinical algorithm and medAL-reader software. We hope that the development framework used for developing ePOCT+ will help support the development of other CDSAs, and that the open-source medAL-suite will enable others to easily and independently implement them. Further clinical validation studies are underway in Tanzania, Rwanda, Kenya, Senegal, and India.
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The Sahelian zone of Senegal experienced heat waves in the previous decades, such as 2013, 2016 and 2018 that were characterised by temperatures exceeding 45°C for up to 3 successive days. The health impacts of these heat waves are not yet analysed in Senegal although their negative effects have been shown in many countries. This study analyses the health impacts of observed extreme temperatures in the Sahelian zone of the country, focusing on morbidity and mortality by combining data from station observation, climate model projections, and household survey to investigate heat wave detection, occurrence of climate-sensitive diseases and risk factors for exposure. To do this, a set of climatic (temperatures) and health (morbidity, mortality) data were collected for the months of April, May and June from 2009 to 2019. These data have been completed with 1246 households' surveys on risk factor exposure. Statistical methods were used to carry out univariate and bivariate analyses while cartographic techniques allowed mapping of the main climatic and health indicators. The results show an increase in temperatures compared to seasonal normal for the 1971-2000 reference period with threshold exceedances of the 90th percentiles (42°C) for the maxima and (27°C) the minima and higher temperatures during the months of May and June. From health perspective, it was noted an increase in cases of consultation in health facilities as well as a rise in declared morbidity by households especially in the departments of Kanel (17.7%), Ranérou (16.1 %), Matam (13.7%) and Bakel (13.7%). The heat waves of May 2013 were also associated with cases of death with a reported mortality (observed by medical staff) of 12.4% unequally distributed according to the departments with a higher number of deaths in Matam (25, 2%) and in Bakel (23.5%) than in Podor (8.4%) and Kanel (0.8%). The morbidity and mortality distribution according to gender shows that women (57%) were more affected than men (43%). These health risks have been associated with a number of factors including age, access to drinkable water, type of fuel, type of housing and construction materials, existence of fan and an air conditioner, and health history.The heat wave recurrence has led to a frequency in certain diseases sensitive to rising temperatures, which is increasingly a public health issue in the Sahelian zone of Senegal.
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Temperatura Alta , Mortalidade , Feminino , Humanos , Masculino , Previsões , Fatores de Risco , Senegal/epidemiologia , TemperaturaRESUMO
Appendicitis is the first etiology for abdominal surgical emergency. Ascariasis is the most common helminth infection in tropical countries where it is endemic. The ability of intestinal helminths to wander through the digestive system means that it can end up in the appendix lumen and lead to appendicitis by luminal obstruction. However, this presentation is still rarely described in the literature. In fact, most of the diagnoses of roundworm associated with appendicitis are made retrospectively by the discovery of its eggs on the pathological examination of an appendectomy specimen. We report the case of a 7-year-old patient living in a tropical area who consulted for acute right lower quadrant pain. The ultrasound suspected the diagnosis of appendicitis and also revealed multiple intestinal worms including one in contact with the inflamed appendix. Surgical exploration confirmed appendicitis associated with roundworm partly in the appendicular lumen through a perforation.
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Herbaceous aboveground biomass (HAB) is a key indicator of grassland vegetation and indirect estimation tools, such as remote sensing imagery, increase the potential for covering larger areas in a timely and cost-efficient way. Structure from Motion (SfM) is an image analysis process that can create a variety of 3D spatial models as well as 2D orthomosaics from a set of images. Computed from Unmanned Aerial Vehicle (UAV) and ground camera measurements, the SfM potential to estimate the herbaceous aboveground biomass in Sahelian rangelands was tested in this study. Both UAV and ground camera recordings were used at three different scales: temporal, landscape, and national (across Senegal). All images were processed using PIX4D software (photogrammetry software) and were used to extract vegetation indices and heights. A random forest algorithm was used to estimate the HAB and the average estimation errors were around 150 g m-² for fresh mass (20% relative error) and 60 g m-² for dry mass (around 25% error). A comparison between different datasets revealed that the estimates based on camera data were slightly more accurate than those from UAV data. It was also found that combining datasets across scales for the same type of tool (UAV or camera) could be a useful option for monitoring HAB in Sahelian rangelands or in other grassy ecosystems.
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Blood biomarkers of oxidative stress and inflammation have been associated with increased risk of hypertension development; yet their application in sub-Saharan Africa has been limited due to the lack of blood collection facilities. In this study, we evaluated the usefulness of dried blood spots (DBS), a more feasible alternative to venous blood, in rural sub-Saharan residents. We recruited 342 women with incident hypertension from rural Senegal, and measured C-reactive protein (CRP) and malondialdehyde (MDA) in DBS and concurrent blood pressure (BP) at baseline and 1-year follow-up. Associations of DBS biomarkers with current levels of and 1-year changes in BP were examined after adjusting for demographic, medical, and socioeconomic covariates. DBS concentrations of MDA were significantly associated with concurrent systolic BP (SBP) (p < 0.05), while DBS baseline concentrations of CRP were associated with longitudinal changes in SBP between baseline and follow-up. Compared to participants with baseline CRP < 1 mg/L, those with CRP of 1-3 mg/L and 3-10 mg/L had 2.11 mmHg (95%CI: -2.79 to 7.02 mmHg) and 4.68 mmHg (95%CI: 0.01 to 9.36 mmHg) increases in SBP at follow-up, respectively. The results support the use of DBS biomarkers for hypertension prevention and control, especially in settings with limited clinical resources.
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BACKGROUND: There are few oxidative biomarkers that can be used in resource-limited settings (e.g., rural Africa) where blood collection facilities are lacking. This study aims to evaluate the potential of malondialdehyde (MDA) in dried blood spots (DBS) as a useful biomarker to monitor cardiopulmonary health. METHODS: We first conducted a cross-validation comparison of matched capillary DBS, plasma, and whole venous blood collected from nine healthy volunteers for the measurement of total MDA (free + conjugated) and C-reactive protein (CRP), a well-established biomarker of systemic inflammation. Then a field study was conducted in a rural Senegal with a population of 441 women routinely exposed to severe household air pollution, examining associations of MDA and CRP levels in 882 DBS with self-reported cardiopulmonary symptoms. RESULTS: In the cross-validation study, CRP levels were strongly correlated across DBS, plasma, and whole blood. MDA levels were correlated between DBS and whole blood and were 1-2 orders of magnitude lower in plasma, suggesting that DBS MDA may reflect total oxidation levels in intracellular and extracellular compartments. In the field study, we observed significantly higher MDA levels in women with secondhand smoke exposure. An interquartile range increase in MDA concentration was associated with 27.0% (95% CI: 3.1-56.5%) and 21.1% (95% CI: -3.5% to 52.0%) increases in the incidence of chest tightness and breath difficulty, respectively. In contrast, CRP levels were not associated with worse outcomes or risk factors. CONCLUSIONS: These results support the use of DBS as a convenient alternative to venous blood when MDA is measured as a biomarker for cardiopulmonary health risk.
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INTRODUCTION: the purpose of our study was to assess the impact of COVID-19 on health care activities and prescriptions at the Albert Royer National Children´s Hospital in Dakar, Senegal. METHODS: we conducted a retrospective, descriptive and analytical study comparing outpatient activity, hospitalizations and prescriptions over the first-quarter of 2019 and 2020. RESULTS: an average drop in external consultations of 33% was reported in the first quarter of 2020 (the pandemic period) compared to the first quarter of 2019. An increase in hospitalizations was observed mainly in the months of January and February. However, a drop of 11% was reported in the month of March. The same is true for prescriptions, for which a drop of 10% was reported only in the month of March.Conclusion: the current COVID-19 pandemic has a significant impact on outpatients´ consultations, health care activities and prescriptions at the Albert Royer National Children´s Hospital. Effective measures should be taken to prevent effects on mortality and Hospital activities.
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Infecções por Coronavirus/epidemiologia , Atenção à Saúde/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Hospitais Pediátricos/estatística & dados numéricos , Pneumonia Viral/epidemiologia , COVID-19 , Criança , Humanos , Pandemias , Estudos Retrospectivos , Senegal/epidemiologiaRESUMO
INTRODUCTION: the COVID-19 pandemic has pushed the world to implement drastic prevention methods based on limiting population movements that have an impact on public health policies, such as vaccination. The purpose of this work was to assess the effect of these preventive measures on routine immunization schedules in hospitals after the outbreak of this pandemic in Senegal. METHODS: we conducted a retrospective cross-sectional study in the Vaccination Unit of the Abass NDAO hospital center in August 2020. We compared data from the Vaccination Unit over the period March-August of the last three years (2018, 2019 and 2020). The parameter studied was the number of vaccine doses administered in the different periods according to the expanded immunization program. RESULTS: in April, the number of doses of vaccines given at 6 weeks was 36 in 2018, 29 in 2019 and 15 in 2020, reflecting a decrease of 50% compared to March. In July, the number of doses given was 40 in 2018, 35 in 2019 and 15 in 2020, reflecting a reduction of 42% compared to 2019. CONCLUSION: measures to combat this pandemic should not affect routine immunization programmes, especially in our resource-constrained country. It is essential to continue vaccination schedule for children and to identify children who have missed vaccine doses in order to implement catch-up vaccination.
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COVID-19 , Esquemas de Imunização , Vacinação/estatística & dados numéricos , Vacinas/administração & dosagem , Estudos Transversais , Hospitais , Humanos , Programas de Imunização , Lactente , Recém-Nascido , Estudos Retrospectivos , SenegalRESUMO
In internationally adopted children disorders of linear growth, puberty development, thyroid function, and bone metabolism are frequently reported. It is important that these children receive careful auxological and endocrinological evaluations and follow-up.Pediatricians and other healthcare providers should be aware that auxological and endocrinological problems are common in newly arrived international adoptees.
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Adoção , Criança Adotada/estatística & dados numéricos , Doenças do Sistema Endócrino/epidemiologia , Transtornos do Crescimento/epidemiologia , Cooperação Internacional , Criança , Criança Adotada/psicologia , HumanosRESUMO
Epilepsy poses a public health problem in Senegal. The purpose of the study was to describe the clinical and paramedical features of epilepsy in children at the Ziguinchor Peace Hospital (ZPH). We conducted a literature review of the medical records of children with epilepsy, from January 1, 2015 to December 31, 2018. Patients aged < 15 years followed up for epilepsy at the ZPH were included. Incomplete medical records were excluded. Data from fifty-five (37 boys and 18 girls) children were collected; 70.9% of them were ≤5 years of age. Mean age of patients was 4.3 years. Patients were from rural (60%) and disadvantaged families (67.3%). Seizures were generalized (72.7%) and focal (27.3%). Eighteen patients had idiopathic epilepsy, 17 had non-idiopathic epilepsy. Etiological factors were dominated by abnormalities associated with pregnancy and childbirth (29.1%). Epilepsy is common at the ZPH. It is most common in rural areas among boys under the age of 5 years from disadvantaged families. Generalized tonic-clonic and focal seizures are the most frequent clinical state and abnormalities associated with pregnancy and childbirth are the most commonly found etiologies.
Assuntos
Epilepsia/epidemiologia , População Rural/estatística & dados numéricos , Adolescente , Distribuição por Idade , Criança , Pré-Escolar , Epilepsia/etiologia , Epilepsia/fisiopatologia , Feminino , Humanos , Lactente , Masculino , Senegal , Distribuição por Sexo , População Urbana/estatística & dados numéricosRESUMO
BACKGROUND: Anopheles multicolor is known to be present in the arid areas of Africa north of the Sahara Desert, especially in oases. To date, its presence in Mauritania has not been reported. Here, we present the first record of its presence in Nouakchott, the capital of Mauritania. The larvae of An. multicolor, together with those of An. arabiensis, the major malaria vector in the city, were found thriving in highly saline surface water collections. METHODS: Entomological surveys were carried out during 2016-2017 in Nouakchott. Mosquito larval habitats were investigated through larval surveys while indoor resting culicid fauna were collected using hand-held aspirator. Physicochemical parameters of the larval habitats were measured on-site, at the time mosquitoes were collected. Larvae and pupae were reared to adults in the insectaries. Morphological and polymerase chain reaction (PCR)-based methods were used to identify newly emerged adults. Batches of fourth-instar larvae were used to assess salinity tolerance by exposing them to increasing concentrations of NaCl, and mortality was monitored throughout development. RESULTS: Morphological and molecular results confirmed that the specimens were An. multicolor and An. arabiensis. Sequences of 24 An. multicolor adult mosquitoes showed 100% nucleotide identity with the published sequences of An. multicolor from Iran. The physicochemical analysis of the water from the two larval habitats revealed highly saline conditions, with NaCl content ranging between 16.8 and 28.9 g/l (i.e. between c.50-80% seawater). Anopheles multicolor and An. arabiensis fourth-instar larvae survival rates at 17.5 g/l NaCl were 86.5% and 75%, respectively. Anopheles arabiensis larvae showed variable levels of salt tolerance according to the larval habitat. Adult An. multicolor specimens were collected resting indoor at low frequency (0.7%) compared to the other culicid mosquitoes. CONCLUSIONS: To the best of our knowledge, this paper is the first report of An. multicolor in Mauritania, extending the known distributional range of the species to the south, as well as to the west. Highly salt-tolerant populations of An. arabiensis and An. multicolor were observed. Because salt-water collections are widespread in Nouakchott, the relevance of these findings for the dynamics and epidemiology of malaria transmission needs to be assessed.