[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 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.

[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.

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.

[Digestive pathology and oral condition in the rural populations of the Ferlo in Senegal]. / Pathologie digestive et état bucco-dentaire chez les populations rurales du Ferlo au Sénégal.

UNLABELLED: The aim of this work was to study the association between dental and periodontal status and digestive pathology in the Ferlo populations in Senegal. METHOD: This was a cross sectional study involving 300 people living in the area of the Ferlo in the Centre East of Senegal. Selected individuals must be over the age of 15 years and resided in the area. Cluster sampling helped recruit individuals. Collected information related to digestive pathology (yes or no), periodontal status (plate index, inflammation, bleeding, loss of attachment, the depth of pocket and the CPITN.) Dental status was evaluated by the DMFT. The data analyzed with software R and the Student's t test used to compare the averages of the indices in both groups at the threshold of 5%. Multivariate logistic regression analysis was used to isolate the final model with a threshold of 5%. RESULTS: Averages of dental and periodontal index were broadly equal in both groups (sick and not sick). The DMF and missing teeth were significantly associated with the digestive pathology after adjustment on gender, age, BMI, marital status, the number of cigarettes smoked and the depth of pocket. CONCLUSION: This study revealed a significant association between dental status and digestive pathology. The comprehensive care of patients therefore raises the interest of collaboration between surgeons, dentists and gastroenterologists for effective and adequate treatment.

[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.

[Knowledge, attitudes and practices related to STD and HIV/AIDS: men having sex with men in Senegal]. / Connaissances, attitudes et pratiques relatives aux IST/VIH/sida: cas des hommes ayant des rapports sexuels avec d'autres hommes au Sénégal.

BACKGROUND: This study aimed to review knowledge, attitudes and practices related to sexual transmitted diseases (STD) and HIV/AIDS among men who have sex with men (MSM) in Senegal. METHOD: The study was undertaken from February 1st to June 30th 2007, in three capitals cities in Senegal (one national, and two regional). It concerned the MSM that benefited from at least one of services of an MSM association. Studied variables included socio demographic characteristics, sexual practices, as well as knowledge and attitudes related to STDs and VIH/AIDS. Interviews took place during appointments obtained by direct phone call or by two MSM leaders intermediary. Data were seized and analyzed with Epi2000 Software. RESULTS: Among 245 registered MSM, 63 had a precise contact (address and/or phone number), and 49 aged in average of 25 years were investigated. Among them, one was illiterate, five studied Koran, seven Arab and 36 French. The socio-professional categories differentiated two officials, two merchants, one mechanic, one fighter, five artists, five restorers, seven tailors, 11 students, and 15 unemployed. The associations, to which 35 HSH belonged, were related to sexuality (66%), religion (20%), social matters (8%) and economy (6%). Sexual habits, according to anal intercourse, differentiated the "Ubbi" or receptive/passive (57%), the "Yoos" or incertif/active (25%), the "Ubbi/Yoos" who play the two roles (14%) and the "neitherUbbi/norYoos" who had other practices than anal (4%). Practices between men, concerned mutual strokes (100%), fellatio (61%) and anal intercourse (49%), counted 45% for remuneration, 35% of multi-unprotected partnership, and 12% of breaking condom. Practices with women were reported by 15 MSM (31%). Concerning STDs, at least one sign was reported by 43 MSM, one transmission way by 42, one mean of protection by 47; and the first recourse was a health system for 36 MSM. The test of HIV/AIDS screening was done by 38 HSH among which 30 withdrew the results. The "Ubby" adhered much more to associations, and practiced less unprotected vaginal intercourses and multi partnerships. CONCLUSION: Sexual relations between men, in Senegal, constitute a factor of propagation for STDs and HIV/AIDS. Beliefs, values, and popular reactions still limit the big principles (liberty, equality, solidarity, and participation) of preventive and curative care. Therefore, ethics and effectiveness must be conciliated to face more MSM needs, for a better health of the populations.

[Acceptability of implementation of mutual health in a Senegalese rural area]. / Acceptabilité de la mise en place de mutuelle de santé en milieu rural sénégalais.

UNLABELLED: Funding for healthcare poses a major problem in developing countries. The purpose of this study was to assess public perceptions toward the implementation of mutual healthcare coverage in rural Senegal. METHODS: A descriptive transversal study was conducted from 24/09/07 to 05/10/07 in a randomly selected sample of 208 heads of households living in the rural communities of Ngogom and Réfane. Data were collected by means of individual interviews and focus group discussions. Topics included population health, community solidarity, health insurance and implementation of mutual healthcare insurance. RESULTS: The sample population was 94% male, 91% married, 36% uneducated and 11% unemployed. Household income was irregular in 36% and 84% had no savings. In case of medical emergency, 43% relied on family for assistance, 36% had no recourse and 21% would have to contract, a loan. Nearly half the sample population, i.e., 46%, were familiar with the principle of mutual healthcare insurance and 98% wanted to join. The main reasons for wanting to join were to reduce medical costs (57%), improve access to care (25%) and build community solidarity (11%). In focus groups, people expressed the need for micro health insurance. Findings also showed good community dynamics and a tradition of pooling resources to implement collective activities. CONCLUSION: The public perception of mutual healthcare insurance is favorable. However, due to economic difficulties, support from political and health authorities will be needed.

[Water quality and personal hygiene in rural areas of Senegal]. / Qualité de l'eau et comportements hygiéniques des populations en milieu rural sénégalais.

INTRODUCTION: The high prevalence of diarrhea in developing countries is mostly due to poor water quality and hygiene practices. The purpose of this study was to assess water quality as well as hygiene practices and their determinants in Ngohé, i.e., a rural community (RC) in Senegal. METHOD: A combined approach consisting of a cross-sectional descriptive survey and bacterial analysis of water was used. Study was conducted in 312 randomly selected households. Data was collected through individual interviews with the assistance of a guide. Water for bacteriological analysis was collected from various sources, i.e., 3 modem borehole wells, 2 protected wells, and 10 traditional wells. Study points included home water treatment, drinking water source, latrine use, hand washing habits, and bacteria identified in water. A multiple regression model was used for data analysis. RESULTS: The household survey population was 59% male, 61% illiterate, and 93% married. Mean age was 44.8 +/- 18.1 years. Chlorination technique was inadequate in 62% of cases. Latrines were not restricted to adult use in 76% of homes. Hand washing was not performed at critical times in 94%. Drinking water was drawn from traditional wells in 48% of households, modem borehole wells in 45% and protected wells in 7%. Escherichia coli was found in water from all three sources and Vibrio cholerae was found in two traditional wells. Level of education, average monthly income, knowledge about chlorination techniques, and source of the water consumed were the main behavioral determinants (p < 0.05). CONCLUSION: Water treatment at the source and in the home as well as protection of water sources is necessary to ensure water quality. This will require effective public education campaigns and financial support for improvement of sanitary facilities.

[Factors determining the place of delivery in women who attended at least one antenatal consultation in a health facility (Senegal)]. / Facteurs déterminant le lieu d'accouchement chez des femmes ayant bénéficié au moins d'une consultation prénatale dans une structure sanitaire (Sénégal).

BACKGROUND: Home birth remains a major cause of maternal and neonatal deaths in Senegal. The objective of this study was to identify the determinants of home birth in women who attended at least one antenatal consultation during their last pregnancy. METHOD: The study was cross-sectional and analytical. It covered a sample of 380 women selected at random among those who have given birth in the last 12 months in the health district Gossas. Data were collected at home using a questionnaire during an interview after informed consent. Multiple logistic regression was used to explore the determinants of childbirth at home using the Andersen model. RESULTS: The mean age was 26.2 ± 6.1 years. Women were married (97.3%), illiterate (81.8%) and lived in rural areas (78.4%). Available means of transportation at home were car (7.6%), cart (62.9%) or none 29.5%. In addition, 52.2% of the women lived more than 5 km from a health facility. For 59.0% of the women, the prenatal exam was considered satisfactory. The prevalence of home birth was 24%. Factors related to birth at home are polygamous marriage (OR=2.04 [1.13-3.70]), lack of transportation (OR=2.11 [1.13-5.01]) and residence more than 5 km from a health facility (OR=2.68 [1.56-4.16]). Late (3.90 [2.30-6.65]) or low quality (4.27 [2.25-8.10]) prenatal exams were also risk factors. CONCLUSION: Home birth is linked to access to health facilities but also to the prenatal consultation. Particular emphasis should be placed on training health care providers to improve the quality of the patients in the structures.

[Study of the contributing factors to home delivery (Senegal)]. / Etude des facteurs contributifs de l'accouchement à domicile (Sénégal).

In Senegal, 38% of deliveries occur at home. We believe that preparation for childbirth, informing women about the place of birth and the person who will assist in delivery, and the necessity of saving money in case of complications, can reduce deliveries at home. The purpose of this study is to determine the impact of preparation for delivery on place of delivery in Senegal. Matching was done on the preparation for delivery by the propensity score using the R package Matchit. A conditional logistic regression was used to analyze the relationship between preparation for birth and place of birth. The data were collected in 2006 from a sample of 3,093 women aged 15 to 49 years, mothers of children from 0 to 23 months in 5 regions of Senegal. The average age of women was 26.3 years (±6.6). The prevalence of delivery at home was 0.33 and 0.31 were given a preparation for childbirth. The following factors were associated with childbirth at home: preparing for the birth (OR: 0.36, CI 95%: [0.28-0.45]), at least primary school (OR: 0.59, CI 95%: [0.46-0.74]), number of prenatal care >3 (OR: 0.40, CI 95%: [0.29-0.54]) and early prenatal care (OR: 0.69 [0.51-0.83]). The relation with the profession of the person who performed the prenatal consultation was of borderline significance (P = 0.06). Particular emphasis should be placed on the preparation of delivery, especially during prenatal consultations.

[Traditional healers in the fight against HIV/AIDS infection in the health district of Fada N'Gourma (Burkina Faso)]. / Enquête sur le rôle des tradipraticiens de santé dans la lutte contre l'infection VIH/sida au Burkina Faso.

The purpose of this study was to evaluate collaboration between traditional healers (TH) and registered nurses (RN) in the care of people living with HIV (PLHIV) in the health district N'Gourma Fada, Burkina Faso. A survey was conducted among 26 RN, 33 TH working in the health district and 96 PLHIV under treatment at the Fada N'Gourma Regional Hospital. Survey data showed that only 9.1% had sound knowledge about HIV/AIDS and 18.2% about prevention methods. Conversely 84.8% had a good knowledge about clinical manifestations. Among TH, 84.8% claimed to refer patients to health facilities that provided no support for HIV/AIDS, 51.1% called for establishment of a framework of cooperation and 21.2% asked for reciprocity. Among nurses, 85.2% did not consider TH as part of the health community fighting against HIV/AIDS. Proposals focused on association of TH, frameworks of cooperation, and coordination of TH activities in the fight against HIV/AIDS.

[Care for elderly patients in Africa: Analysis of the financial implications of the SESAME plan on the budget of the regional hospital center in Thies, Senegal]. / Prise en charge des patients du 3e âge en Afrique: étude des implications financières du plan SESAME sur le budget du centre hospitalier régional de Thiès (Sénégal).

PURPOSE: The SESAME plan has been implemented at the Thies Regional Hospital Center (TRHC) for one year. The purpose of this study was to analyze the financial implications of the plan on the hospital budget for the sustainability of care for persons aged 60 and over. METHODS: This descriptive study included analysis of budget data from October 2006 to September 2007 plus information obtained by interviewing the accountant and head of SESAME plan. The number of patients managed, sources of CHRT funding, grants from various SESAME plan partners, and expenditures for each partner were determined. The weight of the SESAME plan in the CHRT operating budget was determined by calculating the ratio of the overall cost of care for elderly persons in relation to the hospital's revenues and SESAME grants. RESULTS: During the study period, the CHRT received a total of 17375 elderly persons including 89% with no pension or social security. The institute pension scheme (IPRES) covered 21% of the plan as compared to 79% for the state. Utilization plan grants in relation to funding source was 41% for IPRES and 124% for the State. The total cost of services provided to beneficiaries of the SESAME plan exceeded the aggregate amount by 26 083 847 CFA francs. The weight of the SESAME plan in the operating cost of the CHRT was 17%. CONCLUSION: Prefinancing a plan to cover elderly care in hospitals should be sufficient to prevent deficits from impacting negatively on the operating budget of the hospital.

[Obstetric urogenital fistula (OUGF): cost analysis at the Niamey National Hospital (Niger)]. / Fistule urogénitale d'origine obstétricale (Fugo) : coût de la prise en charge à l'hôpital national de Niamey (Niger).

BACKGROUND: A program to eliminate obstetric urogenital fistula (OUGF) was set up on February 19, 2004 in Niger. Though the consultations were free of charge, there was a cost involved, which constitutes the objective of this study. METHOD: The data were obtained from a documentary study completed by discussions with the principal management participants and interviews targeting the women suffering from OUGF attending the national hospital of Niamey during the surgery sessions of April and November 2006. Cost assessment included all resources devoted to activities involved in the program: hospital stay, hygiene education, medical and surgical treatment, social rehabilitation interventions (preparation for revenue generating activities and return to residence). Data analysis was performed with Excel and Epi2000 software. Average cost per item and patient was determined. RESULTS: The cost of the stay at the National hospital of Niamey was 96,445 francs CFA divided between transportation (4,688), room and board (21,572), assistance bonus (3,708) and indirect costs (66,477). The hygiene education cost 194,140 francs CFA: 30,150 for human resources, 143,965 for material resources and 20,025 for operational costs. The medical and surgery treatment had a cost of 144,009 francs CFA divided between consultations (15,000), complementary explorations (44,900), surgical operation (50,000) and consumables (34,109). The preparation for revenue generating activities had a cost of 118,244 francs CFA including training for clothes dying (22,084), soap manufacture (46,160) and the financial supportive grant (50,000). The return to the community cost 295,000 francs CFA, included room and board (2,500), human resources (65,000) and material resources (227,500). Altogether, the cost of the OUGF program came up to 742,018 francs CFA for our sample (76% of women with revenue generating activity), and was assessed at a maximum of 781,362 francs CFA if none of the woman had a revenue generating activity, and a minimum of 729,594 francs CFA if all of them did. CONCLUSION: Without the free consultations, the high cost of the OUGF program at the national hospital of Niamey would be inaccessible to Nigerian women owing to poverty and ignorance. Because of this observation, a long-term program is warranted for the treatment of overt cases and the reduction of prevalence, to enable Nigerian women to contribute to the development activities of their country.

[Epidemiology of women suffering from obstetric fistula in Niger]. / Parcours de la femme souffrant de fistule obstétricale au Niger.

OBJECTIVE: The purpose of this epidemiological study was to determine factors influencing management of obstetrical fistula (OF) by attempting to understand the itinerary followed by women suffering from OF in Niger. Study was carried out during the surgery session that took place at the Niamey National Hospital from April 18 to 29, 2006. Study variables were socioeconomic profile, obstetric/surgical history, support resources, and level of education. Four trained investigators using a specially designed questionnaire carried out patient interviews. Data were analyzed using the Epi Info 3.3.1 software package. A total of 91 patients with average age of 27.30 years (+/- 8.94) were interviewed. Most patients had no schooling (95%), came from the southwest region of the country (85%), and belonged to the Djerma ethnic group (52%). Most were married (76%) or divorced (19%). In the majority of cases the age at the time of marriage and first childbirth was under 18 years (76% and 55% respectively). The delivery that resulted in OF was the first in 59%, took place in a health care facility in 88%, lasted more than 24 hours in 97%, and took place by the vaginal route in 71%. The delay for the first medical visit was at least 3 months in most cases (66%) usually due to a lack of awareness of treatment availability, or to unavailability of transportation. Most patients had a history of surgery (63%) and were unaware of the probable date of the treatment (99%) with many waiting more than 3 months (44%). Prevention of gainful activity was 4.79 times more frequent after occurrence of OF. Management of OF requires not only qualified personnel but also and especially access to the quality obstetric care and greater awareness among the population. Education for girls is a crucial factor for a better health in Niger.

[HIV/AIDS prevalence among the attendees at the Center for Voluntary Anonymous Detection and Support in Pikine/Guediawaye, Senegal]. / Prévalence du VIH/sida chez les clients du Centre de Dépistage Volontaire Anonyme et d'Accompagnement de Pikine/Guédiawaye, au Sénégal.

Within the framework of HIV/AIDS epidemic control, a Center for Voluntary Anonymous Detection and Support (CDVAA) was opened in March 2003 in Pikine/Guediawaye, Senegal. The purpose of this study was to analyze the prevalence of the HIV infection among attendees at the center over a one-year period as a basis for targeting the services of the CDVAA towards improving public health. This retrospective epidemiological study based on analysis of CDVAA attendee records was carried out from April 8, 2003 to April 7, 2004. The CDVAA in Pikine/Guediawaye shares premises with the Departmental Center for Popular and Sports Education. Sampling was exhaustive with inclusion of all people that attended the CDVAA during the study period. Study variables were age, sex, family status, educational level, ethnic group, religion, reason for detection, knowledge about HIV/AIDS prevention methods, results of the test, and, in case of infection, acceptance/refusal of referral to an appropriate management facility. Data were computed and analyzed using EpiInfo 6.04d software. The most common reason for detection was curiosity to know serologic status (69%). Test results were positive in 3% of cases. Infection was due to HIV1 in 65% of cases, HIV2 in 24%, and both (HIV1-HIV2 co-infection) in 11%. Ninety-one percent of attendees that underwent testing returned to pick-up their results. Sixty-eight percent of attendees that tested positive accepted referral to an appropriate management facility. HIV infection was significantly more frequent in attendees who were 24 years old, married, or illiterate and in attendees reporting risky behavior. To further encouraging progress already achieved, the CDVAA must improve the quality of its services and promote its activities as a means of familiarizing the target population on prevention of sexual transmitted diseases and HIV/AIDS, with a particular focus on safe behavior.

[Malaria knowledge, attitudes and practices among women living in the rural area of Poponguine, Senegal]. / Connaissances, attitudes et pratiques des femmes sur le paludisme, dans la zone rurale de Poponguine, Sénégal.

Malaria is a major public health and development problem in Senegal where it is the leading cause of morbidity and mortality. Children under five and pregnant women are the most vulnerable groups. The purpose of this transverse, descriptive, analytical study was to assess rural women's knowledge, attitudes and practices regarding malaria. It was conducted in the Poponguine district of Senegal from April 1 to 15, 2005. The estimated population size needed for this cluster survey was 800. Women between the ages of 15 and 45 years who had been living in the district for more than one year were recruited for study. The mean age of the population was 28 years (95% confidence interval, 27.7 - 28.8). Teenagers accounted for over one eighth of the population (13.75%) and three fourths (75.87%) were married. Almost half (49.6%) were attending school and nearly two thirds (65.5%) were classified at the low socioeconomic level. Most (82.25%) knew that mosquitoes transmitted malaria and that the main signs were fever or warm body (82.25% and 81% respectively). However knowledge about the clinical features of severe malaria was poor. Geographical and financial access to IB was good for most of the women interviewed. Over half had a good understanding of preventive strategies for children less than five years of age and pregnant women, i.e., use of insecticide-treated nets (ITN) (62.9%) and of intermittent preventive therapy (IPT) during pregnancy (52.4%). Most (92%) declared that they would go to the health center for care in case of malaria. The main sources of information were medical personal (60.4%) or community volunteers (62,9%). Coverage for ITN and IPT was 33% and 71.1% respectively. There was a good correlation between good knowledge and practices (p<0.05). The main predictors of good knowledge were age and level of education. Practices by mothers were correlated with age, source of income, and marital status. Based on the findings of the study our recommendations for the Poponguine district are in agreement with those of the national malaria control program, i.e., reinforcement of the behavior change program to improve public knowledge about malaria. Further study will be needed to gain more epidemiological insight.

[Epidemiology of stroke at the Clinic of Neurology, Fann University Teaching Hospital, Dakar-Senegal]. / Epidémiologie des accidents vasculaires cérébraux (AVC) à la clinique neurologique du CHU de Fann, Dakar-Sénégal.

OBJECTIVE: Describe the epidemiology of stroke among patients hospitalized at the Clinic of Neurology , Fann University, Dakar-Senegal. METHODOLOGY: Retrospectively, sociodemographic, medical history and clinical data were collected for patients hospitalized for stroke from January 1st 2001 to November 1st 2003 and to whom a Computed Tomography scan of the brain was done. RESULTS: The population of study (314 patients) had a mean age of 61.3 years (+/-13.8) and was composed of 56.1% of women. The mean time of admission was 8.4 days (+/-23.5). The leading risk factors of stroke were hypertension, history of stroke and diabetes. Ischemic stroke represented 60.2%. The occurrence of stroke was associated with coma and hypertension. The letality rate was 24.8%. CONCLUSION: It is necessary to develop and implement health education program against risk factors for the population to reduce stroke morbidity and mortality.

[Quality of malaria prevention during prenatal consultations in Niakhar (Senegal)]. / Qualité de la prévention du paludisme au cours des Consultations prénatales a Niakhar (Sénégal).

INTRODUCTION: To evaluate the quality of malaria prevention during prenatal consultations, this study was carried out in Niakhar, one sub-prefecture of the Fatick region. METHOD: It was a matter of a descriptive transverse study, based on the listens and the observation of 60 prenatal consultations carried out within three health posts. The studied variables were related to the criteria of a good quality of prophylaxis at three levels: questioning, examination, and attitude after consultation. RESULTS: Questioning was centred by frequency order on: the pregnancy antecedents (65%), the chloroquine direction for use (34.3%), the fever notion (6%), and the chloroquine secondary effects (3%). During the physical examination, all the providers looked for clinical signs of weakens, blood pressure, and presence of oedemas of the legs; but the temperature was taken only in 8.6% of the cases. At the end of the consultation, the chemoprophylaxis prescription and the next consultation appointment were systematic; the duration of the treatment recalled in 57% and malaria seriousness during the pregnancy in 3% of the cases; no one of the providers didn't evoked neither the methods of the treatment nor the attitude to hold in case of fever. CONCLUSION: The prevention of the malaria in pregnancy through the CPN necessitates a fitting formation supported by regular supervision of the health posts.

[Analize of the determinants of microscopy's quality in the context of tuberculosis fighting within the health centers laboratories in Dakar Region]. / Analyse des déterminants de la qualité de la microscopie pour la lutte contre la tuberculose dans les laboratoires des Centres de Santé de la Region de Dakar.

INTRODUCTION: In order to improve the quality of the microscopy in the context of tracking and following-up the pulmonary tuberculosis patients, a study of the determinants of the quality of microscopy was carried out in the laboratories of the health centres in Dakar Region, Senegal. MATERIALS AND METHODS: We did an epidemiologic study, transversal type which proceeded during April 19th at May 05th, 2004. It consisted of a series of observations, interviews, review of the registers of laboratory and with a second reading and re staining, on the level of the National Laboratory of Reference of the National Programme of fight against Tuberculosis (LNR), of 50 blades collected blindly in the health centres of Dakar. RESULTS: It comes out from this study that there was no statistically significant link between the factors of risk of errors such as the overload of work, the bad condition of the microscope, the lack of competence and the errors observed in certain laboratories. On the other hand the aspect of the smears, the thickness of the smears and the presence of crystals could deteriorate the quality of microscopy because it was found that there was a statistically significant connection between the quality of microscopy and these various determinants. In addition we noted a good agreement of the results of these laboratories with those of the LNR (Kappa test = 0,981, p < 0,0001). CONCLUSION: According to these results, we recommend: a reinforcement of competences (training/recycling) regular of the laboratory assistants, and an installation of a system of quality control of microscopy, interns within the laboratories but also external by the National Laboratory of Reference.