Elderly and preventive care of the geriatric pathologies in African environment.

Senegal will not be spared by the process of the aging of its population. In fact, according to surveys, the demographic increase in the population of the old people, which is 3.5% higher than the national average (2.5%). But for the time being, gerontology problems are not arising in terms of demographic weight, but rather in terms of the breaking up of solidarity networks, uncontrolled urbanization and poverty. As far as health is concerned, the old people generally are faced with the same problems as their Northern counterparts; they are exposed to chronic diseases that demand their taking in charge in a long period of time. Besides, these diseases are a great handicap and they are also disabling diseases. So taking them in charge puts a financial on their meager family budgets or their pensions. In addition, there are no specialists in geriatrics, and those working in the field did not receive any training for that. Moreover, most of our health facilities are lacking in diagnostic means. Therefore, gerontology-geriatrics solutions that are adapted to our socio-economic context should be assigned straight away. The problem is not about stopping the process of aging, which, as a physiological process, is inevitable and irreversible, but rather delaying its effects. The matter at issue will be about how to set up a decentralized and integrated program that is designed to fight against geriatric diseases and disorders and that mainly focuses on screening and primary and secondary prevention, for our low financial resources and the low medical equipment of our health facilities cannot help us to adequately take charge of complications related to these diseases.

[Sesame Health Programme at Senegal: Limitations of this free healthcare model]. / Plan Sésame au Sénégal : limites de ce modèle de gratuité.

INTRODUCTION: Up until now, elderly people have experienced medical management difficulties despite the free care provided by the Sesame Health Programme. The objective of this study was to determine the costs borne by beneficiaries and/or their families and to evaluate these costs in relation to overall management. This comprehensive, cross-sectional, quantitative study was conducted from 21 February to 21 March 2011 in the Ouakam gerontology centre. METHODS: Epi Info Version 6 software was used for data analysis. The study population was composed of 203 patients with a mean age of 68 years, with 59% of women and 63% of retired subjects. The most common diseases were hypertension (52%), cataract (16%), and osteoarthritis (12%). RESULTS: The beneficiaries healthcare costs were covered by the Sesame Health Programme, apart from most of the drugs used to treat chronic diseases, which remained at the charge of patients and/or their families. The overall mean cost of monthly management of the diseases detected in elderly people was estimated to be CFA 37,700, a large share of which (65%) was supported by the patient and/or the family corresponding to the purchase of these drugs. Other dysfunctions were also observed, particularly the difficulty of targeting beneficiaries, generic stock shortages, absence of generics for the treatment of chronic diseases. CONCLUSION: Recommendations are formulated to improve implementation of the Sesame Health Programme.

[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.