Déterminants de la supplémentation en vitamine A chez les enfants âgés de 6 à 59 mois au Sénégal en 2017: Étude transversale / NA

La supplémentation en vitamine A (SVA) est une des stratégies de prévention de la carence en vitamine A. L'objectif était d'étudier les déterminants de la SVA au Sénégal. Ils'agissait d'une analyse secondaire de l'enquête démographique et de santé conduite en 2017. Un échantillonnage en grappes à deux degrés était réalisé. La population d'étude était constituée des enfants âgés de 6 à59 mois. La régression logistique a permis l'identification des déterminants de la SVA. L'odds ratio ajusté (ORA) et son intervalle de confiance à 95% (IC95%) étaient calculés. La couverture en SVA était de 63,8%. Ses déterminants étaient le fait de résider dans les régions Sud-Est (ORA = 2,88 ; IC95%= 2,19-3,79), Centre (ORA = 2,77; IC95% = 2,14-3,59) et Nord (ORA =3,57; IC95%= 2,69-7,73), la taille du ménage ≥ 10 (ORA = 1,28 ;IC95%= 1,11-1,49), la taille de la fratrie ≥ 4 (ORA =1,23 ; IC95%= 1,07-1,43), et l'accouchement en établissement sanitaire (ORA = 1,35 ; IC95%= 1,01-1,80), l'utilisation de la radio (ORA = 1,46 ; IC95%= 1,20-1,77), l'utilisation de la télévision (ORA = 1,33; IC95%= 1,12-,157), la tranche d'âge 12-59 mois (ORA = 2,5 ; IC95%=2,14-2,92), la vaccination par le penta3 (ORA =2 ; IC95% :1,53-2,62). La couverture en SVA n'est pas optimale. La SVA à domicile dans la région Ouest, la promotion de l'accouchement institutionnel, la communication de masse, le renforcement des connaissances des vaccinateurs sur la SVA seraient nécessaires.

Vitamin A supplementation (VAS) is one of the strategies to prevent vitamin A deficiency. The objective was to study the determinants of VAS in Senegal. This was a secondary analysis of the Demographic and Health Survey conducted in 2017. Two-stage cluster sampling was used. The study population consisted of children aged 6-59 months. Logistic regression was used to identify the determinants of VAS. The adjusted odds ratio (AOR) and its 95% confidence interval (95% CI) were calculated. VAS coverage was 63.8%. Its determinants were residence in the South-East (AOR = 2.88; 95% CI= 2.19-3.79), Centre (AOR = 2.77; 95% CI= 2.14-3.59) and North (AOR =3.57; 95% CI= 2.69-7.73) regions, household size ≥ 10 (AOR = 1.28; 95% CI95= 1.11-1.49), sibling size ≥ 4 (AOR =1.23 ; CI95%= 1.07-1.43), and delivery in a health facility (AOR= 1.35; 95% CI= 1.01-1.80), radio use (ARO = 1.46; 95% CI= 1.20-1.77), television use (AOR = 1.33; 95% CI= 1.12-.157), age group 12-59 months (AOR = 2.5;95% CI=2.14-2.92), vaccination with penta3 (AOR =2; 95% CI=1,53-2,62). VAS coverage is not optimal. Home-based VAS in the western region, promotion of institutional delivery, mass communication, strengthening of vaccinators' knowledge on VAS would be necessary.

Knowledge and social beliefs of malaria and prevention strategies among itinerant Nomadic Arabs, Fulanis and Dagazada groups in Chad: a mixed method study.

BACKGROUND: Nomadic populations in Chad are at increased risk of contracting malaria because of their lifestyle. Being highly mobile they are often excluded from disease control programmes, and access to preventive measures and treatment is more difficult. Effective malaria control interventions take account of local modes of transmission, patterns of care-seeking behaviour and community perceptions of cause and prevention practices. There is currently little information about malaria knowledge and perceptions among nomadic groups in Chad, or their awareness of malaria control interventions and this study sought to address this knowledge gap. METHODS: A mixed methods study, including a cross-sectional survey with men and women (n = 78) to determine the level of knowledge and use of malaria prevention strategies among Arabs, Peuls and Dagazada nomadic groups. Three focus group discussions were conducted with women to explore their representation of malaria and knowledge of preventive methods. Key informant interviews were held with leaders of nomadic groups (n = 6) to understand perception of malaria risk among itinerant communities. RESULTS: Nomads are aware of the risk of malaria, recognize the symptoms and have local explanations for the disease. Reported use of preventive interventions such as Seasonal Malaria Chemoprevention (SMC) for children and Intermittent Preventive Treatment (IPT) of malaria in pregnancy was very low. However, 42.3% of respondents reported owning at least one LLIN and 60% said they slept under an LLIN the night before the survey. In case of a malaria episode, nomads seek clinicians, informal drug sellers in the street or market for self-medication, or traditional medicine depending on their financial means. Interviews with nomad leaders and discussions with women provide key themes on: (i) social representation of malaria risk and (ii) social representation of malaria and (iii) perspectives on malaria prevention and (iv) malaria treatment practices. CONCLUSION: The nomadic groups included in this study are aware of risk of malaria and their level of exposure. Local interpretations of the cause of malaria could be addressed through tailored and appropriate health education. Except for LLINs, malaria prevention interventions are not well known or used. Financial barriers lowered access to both mosquito nets and malaria treatment. Reducing the barriers highlighted in this study will improve access to the healthcare system for nomadic groups, and increase the opportunity to create awareness of and improve uptake of SMC and IPT among women and children.

[Measles epidemic and response in the region of Dakar (Senegal) in 2009]. / Épidémie de rougeole et de sa riposte en 2009, dans la région de Dakar, Sénégal.

In 2009, the region of Dakar (Senegal) experienced a major measles epidemic, in the context of the failure of the immunization program. The objective of this study was to examine the epidemic and the effectiveness of the response. A cross-sectional epidemiological study of all cases of measles confirmed by laboratory tests or epidemiological linkage was conducted between June and December 2009. The study also assessed the effectiveness of the response. The results show that out of 767 confirmed cases, less than a third (30 %) were laboratory-confirmed, while the remaining cases were confirmed by epidemiological linkage with one or several other confirmed cases. The minimum age was 4 months and the maximum age was 35 years. Children under 5 accounted for 67.4 % of the total number of cases. The male population was more affected than the female population (52.2 %). Most of the cases of were not vaccinated (88.5 %). The southern district had the highest incidence of measles, with more than 68 cases per 100,000 inhabitants. The vaccination coverage rate over the last 3 years was found to be satisfactory (average rate: 82.2 %). The response campaign resulted in the vaccination of 54,793 children aged 9 to 59 months (55.9%) distributed throughout the high-risk areas with low immunization coverage. No deaths were reported. The results suggest that it is important i) to continue to promote measles vaccination; ii) to combine routine vaccinations with supplements (for example vitamin A); iii) to introduce national vaccination campaigns targeting specific groups (new army recruits, students, refugees, etc.); and iv) to introduce a second dose of vaccine to ensure that the children who did not receive the first vaccine are covered and to address primary vaccine failures among those who were vaccinated.

Improving malaria control in West Africa: interruption of transmission as a paradigm shift.

With the paradigm shift from the reduction of morbidity and mortality to the interruption of transmission, the focus of malaria control broadens from symptomatic infections in children ≤5 years of age to include asymptomatic infections in older children and adults. In addition, as control efforts intensify and the number of interventions increases, there will be decreases in prevalence, incidence and transmission with additional decreases in morbidity and mortality. Expected secondary consequences of these changes include upward shifts in the peak ages for infection (parasitemia) and disease, increases in the ages for acquisition of antiparasite humoral and cellular immune responses and increases in false-negative blood smears and rapid diagnostic tests. Strategies to monitor these changes must include: (1) studies of the entire population (that are not restricted to children ≤5 or ≤10 years of age), (2) study sites in both cities and rural areas (because of increasing urbanization across sub-Saharan Africa) and (3) innovative strategies for surveillance as the prevalence of infection decreases and the frequency of false-negative smears and rapid diagnostic tests increases.

[Contribution of supplementation by spirulina to the performance of school children in an introductory course in Dakar (Senegal)]. / Apport de la supplémentation en spiruline sur les performances scolaires des enfants en cours d'initiation a Dakar (Sénégal).

Senegal initiated a program to improve the nutritional status of school-age children with the use of spirulina. The objective of this study was to evaluate the effects of spirulina on academic performance of school children in the municipality of Dakar, Senegal. The evaluation was conducted as a prospective study, comparing school performance of schoolchildren from public elementary schools located in three National Education Departments of Dakar (before supplements, during and after). The study population consisted of students from six schools randomly selected among the 100 who were in the program. We included all children with agreement of their parent or guardian, and those who rejected the spirulina were not included. Supplemental feeding with spirulina was given to young children during two months (from mid-April to mid June 2005). Over these 60 days, the students took a daily dose of 2 grams of spirulina mixed with 10g of honey to make the taste acceptable. The data on age, gender and monitoring of school performance (i.e. the average compositions of the second and third quarters) were collected. Mean differences in grades between second quarter and third quarter (after two months of supplementation) were analyzed and compared by the paired student test. The sample size was a total of 549 schoolchildren: 273 (49.72%) were girls, and 276 (50.28%) boys. The mean age was 91 months [90.29-91.71]. The average of 2rd quarter marks before supplementation was 5.17 out of 10 IC = [4.99-5.35] and the same for the 3rd quarter after two months of supplementation was 5.78 out of 10 IC = [5.59-5.97]. The mean difference between pupils' marks at the 3rd and the 2nd trimester was 0.59 (p <-- 0.0001). After two months of supplemental feeding, the academic performance of the children was improved.