Prevalence and mortality rate of abdominal surgical emergencies in Sub-Saharan Africa: a systematic review and meta-analysis.

INTRODUCTION: Abdominal surgical emergencies remain prevalent in various healthcare settings, particularly in regions with limited access to basic surgical care, such as Africa. The aim of this literature review is to systematically assess publications on abdominal surgical emergencies in adults in sub-Saharan Africa to estimate their prevalence and mortality rate. METHODOLOGY: A systematic review was conducted. The latest search was performed on October 31, 2022. We estimated the pooled prevalence with a 95% confidence interval (CI) for each abdominal surgical emergency, as well as overall postoperative mortality and morbidity rates. RESULTS: A total of 78 studies were included, and 55.1% were single-center retrospective and monocentric studies. The mean age of the patients was 32.5 years, with a sex ratio of 1.94. The prevalence of each abdominal surgical emergency among all of them was as follows: appendicitis: 30.0% (95% CI: 26.1-33.9); bowel obstruction: 28.6% (95% CI: 25.3-31.8); peritonitis: 26.6% (95% CI: 22.2-30.9); strangulated hernias: 13,4% (95% CI: 10,3-16,5) and abdominal trauma: 9.4% (95% CI: 7.5-11.3). The prevalence of complications was as follows: mortality rate: 7.4% (95% CI: 6.0-8.8); overall postoperative morbidity: 24.2% (95% CI: 19.4-29.0); and surgical site infection 14.4% (95% CI: 10.86-18.06). CONCLUSION: Our study revealed a high prevalence of postoperative complications associated with abdominal surgical emergencies in sub-Saharan Africa. More research and efforts should be made to improve access and quality of patient care.

Enhancing the value of death registration with verbal autopsy data: a pilot study in the Senegalese urban population in 2019.

BACKGROUND: There is no source of data on causes of death in Senegal that covers both community and hospital deaths. Yet the death registration system in the Dakar region is relatively complete (>80%) and could be expanded to provide information on the diseases and injuries that led to death. METHODS: In this pilot study, we recorded all deaths that occurred over 2 months and were reported in the 72 civil registration offices in the Dakar region. We selected the deaths of residents of the region and administered a verbal autopsy to a relative of the deceased to identify the underlying causes of death. Causes of death were assigned using the InterVA5 model. RESULTS: The age structure of deaths registered at the civil registry differed from that of the census, with a proportion of infant deaths about twice as high as in the census. The main causes of death were prematurity and obstetric asphyxia in newborns. Meningitis and encephalitis, severe malnutrition, and acute respiratory infections were the leading causes from 1 month to 15 years of age. Cardiovascular diseases accounted for 27% of deaths in adults aged 15-64 and 45% of deaths among adults above age 65, while neoplasms accounted for 20% and 12% of deaths in these two age groups, respectively. CONCLUSIONS: This study demonstrates that the epidemiological transition is at an advanced stage in urban areas of Dakar, and underlines the importance of conducting regular studies based on verbal autopsies of deaths reported in civil registration offices.

Delivering Vitamin A Supplements to Children Aged 6-59 Months: Comparing Delivery through Campaigns and through Routine Health Services in Senegal.

BACKGROUND: Using twice-yearly campaigns such as Child Health Days to deliver vitamin A supplements has been a key strategy over the last 2 decades, and was an important component in helping reach the Millennium Development Goals in child health. As countries move to strengthen their routine health services under the Sustainable Development Goals, efforts are underway to shift supplementation from campaign to routine delivery. OBJECTIVE: The aim of this study was to compare cost, coverage, and user satisfaction between twice-yearly campaigns and routine delivery of vitamin A supplements in Senegal. METHODS: Information was collected on cost, coverage, and user satisfaction with both types of delivery, using administrative data, interviews at various levels in the health system, and focus group discussions with caregivers. Both qualitative and quantitative information were obtained, for 2 regions using routine delivery and 2 regions using campaign delivery. RESULTS: Routine delivery receives fewer dedicated resources. Coverage is lower, especially of children >12 mo of age. Districts undertake outreach ("mini-campaigns") to try to improve coverage in regions using routine delivery, in effect using a hybrid approach. Some mothers prefer the administration of supplements at a health facility as it is perceived as more hygienic and involving professional health workers, but others, especially those living further away, prefer house-to-house delivery which was the norm for the campaign mode. CONCLUSIONS: Advance planning for the shift to routine delivery is important in maintaining coverage, as is strengthening the primary health care system by having an appropriate ratio of salaried workers to population. When the system relies heavily on volunteers, and the small incentive payments to volunteers are discontinued, coverage suffers. Routine delivery also relies on good record-keeping and hence literacy. Community understanding of, and support for, supplementation are even more important for routine than for campaign delivery.

Comparison of Para-Selles Bailenger/Kop-Color Fumouze, Para-Selles-Iodésine/Kop-Color II Fumouze diagnostic kits with conventional microscopic methods in identifying intestinal parasitic diseases in Senegal.

In the context of controlling intestinal parasites, accurate diagnosis is essential. Our objective was to evaluate the performance of new diagnostic kits compared to conventional microscopic methods in identifying intestinal parasites. Faeces collected in rural area in Senegal were subjected to several detection techniques. Thus, the sensitivity, specificity, positive and negative predictive values of new diagnostic techniques were compared to conventional merthiolate-iodine-formalin, conventional Bailenger and modified Ritchie. Furthermore, the kappa coefficient was calculated to evaluate the correlation between the new kit and those of modified Ritchie. Out of the 117 patients examined, 102 presented with a parasite, or prevalence of 87.1%. The Fumouze techniques proved to be as effective as the conventional methods in detecting flagellates and helminths with sensitivities ranging from 97 to 100%. However, conventional techniques were slightly more sensitive in identifying Endolimax nana and Blastocystis hominis. The correlation was nearly perfect (k = 0.83 and 1), respectively between Bailenger Fumouze, Iodesine Fumouze and modified Ritchie in identifying helminths while it was just acceptable (k = 0.27 and 0.28) in identifying B. hominis. The modified Ritchie technique routinely used in our laboratory remains a good diagnostic tool. However, the use of kit techniques was interesting when reading the pellet after concentration and the Colour KOP staining was a considerable contribution to the diagnosis of the vegetative forms. Therefore, it would be interesting to determine the cost of a stool test using Fumouze kit techniques to provide the most cost effective way.

Screening for cervical cancer in Senegal: Contributing factors

Context: Cervical cancer is first cancer in women in Africa. The disease is often diagnosed at a late stage. Aims: The purpose of this survey is to study the factors of cervical cancer screening. Settings and Design: This is a descriptive and analytical cross-sectional survey carried out in the health district of Thiès in Senegal. Subjects and Methods: Sampling was in two-stage clusters. The data were collected during an individual interview at home. The collection focused on knowledge, attitudes, and practices on cervical cancer. Statistical Analysis Used: Logistic regression was used for data analysis. Results: A total of 498 women were interviewed; 77% of them lived in urban areas, 38% have not been to school, and 82% were married. Nearly, 82.7% of them have already heard about the disease. Infection was the most reported risk factor (55.8%). The screening practice was 35.5% in our sample. Nonschooling reduced screening, while women living in urban areas were seven times more likely to be screened. Screening increased from the poorest quartile to the richest quartile. The knowledge of risk factors and the possibility of recovery increased by 4.80 and 2.34, respectively, the chance of being screened. Conclusions: Improved screening requires multiple strategies that target particularly poor uneducated people living in rural areas but also the strengthening of the capacity of health-care providers

[Study of determinants of rape in minors in the Kolda region of Senegal]. / Etude des déterminants de viols chez les mineurs dans la région de Kolda au Sénégal.

INTRODUCTION: The objective of this study was to investigate the determinants of rape among minors in the Kolda region. METHODOLOGY: A retrospective, cross-sectional, descriptive and analytical was conducted from 23 December 1992 to 31 December 2011, based on the charts of rape victims under the age of 18 years. Sampling was complete. Bivariate and multivariate analyses were performed using Epi Info 3.3.2 and R 2.9.2 software, respectively. RESULTS: The study included 162 cases of sexual assault. The mean age of victims was 12.3 +/- 3 years (range: 4-17 years). The mean age of perpetrators of sexual assault was 26.4 +/- 9.5 years and minors accounted for 13% of perpetrators. 54.9% of victims, were raped. Victims of sexual assault knew the perpetrator in 66% of cases and were attacked in broad daylight in 53.4% of cases. The perpetrators were drunk at the time of sexual assault in 15.3% of cases. The assault took place in the bush (14.8%). Twenty eight percent (28%) of rapists were jailed and 38.6% of them were jailed for between 5 and 10 years. Sexual assault in the bush [adjusted OR = 3.46 (1.02-11.77)] and intoxication of the perpetrator at the time of sexual assault [adjusted OR = 3.47 (1.04-11.61)] were associated with a high risk of rape. In contrast, victims who knew their assailants were at a lower risk of rape [adjusted OR = 0.09 (0.03 to 0.24)]. CONCLUSION: Extension of this study to the national scale would provide health and judicial authorities with an overview of sexual assault among minors, to allow more effective prevention at the national level.

Prevalence and determinants of hypertension and associated cardiovascular risk factors: data from a population-based, cross-sectional survey in Saint Louis, Senegal.

BACKGROUND: The incidence of cardiovascular disease is growing worldwide and this is of major public health concern. In sub-Saharan Africa, there is a lack of epidemiological data on the prevalence and distribution of risk factors of cardiovascular disease. This study aimed at assessing the prevalence of hypertension and other cardiovascular risk factors among an urban Senegalese population. METHODS: Using an adaptation of the WHO STEPwise approach to chronic disease risk-factor surveillance, we conducted a population-based, cross-sectional survey from 3 to 30 May 2010 on 1 424 participants aged over 15 years. Socio-demographic and behavioural risk factors were collected in step 1. Physical anthropometryc measurements and blood pressure were documented in step 2. Blood tests (cholesterol, fasting blood glucose, and creatinine levels) were carried out in step 3. RESULTS: The prevalence of hypertension was 46% (95% CI: 43.4-48%), with a higher prevalence in females (47.9%) than males (41.7%) (p = 0.015), and 50% of these hypertensive were previously undiagnosed. Mean age was 53.6 years (SD: 15.8). In known cases of hypertension, the average length of its evolution was 6 years 9 months (range 1 month to 60 years). Hypertension was significantly associated with age (p = 0.001), socio-professional category (p = 0.003), dyslipidaemia (p < 0.001), obesity (p < 0.001), physical inactivity (p < 0.001), diabetes (p < 0.001) and stroke (p < 0.001). CONCLUSION: We found a high prevalence of hypertension and other cardiovascular risk factors in this population. There is need of a specific programme for the management and prevention of cardiovascular disease in this population.

[Dystocia risk score: a decision making tool to combat maternal mortality]. / Le score de risque dystocique (SRD) : un outil d'aide à la décision médicale pour combattre la mortalité maternelle.

As a way to prevent maternal mortality and stillbirth, the dystocia risk score includes three components: a left column provides a list of eight characteristics to check for in the woman; an upper horizontal section provides a checklist of possible outcomes of the pregnancy itself: and a rectangular grid indicates the prognosis in three zones: a large red (dangerous), a medium-sized grey (doubtful) and a small blue (hopeful). The DRS is positive if there is at least one cross in the dangerous zone and/or two crosses in the doubtful zone (it indicates that the woman should be referred to a center specialized in obstetric emergency care); elsewhere, the DRS is negative. The validation test gives good results (sensitivity=83.61%, specificity=90.05%, positive predictive value=72.34%, and negative predictive value=94.04%). Its large-scale use would accelerate the identification of pregnant women with a high risk of dystocia. Their timely referral to specialized emergency obstetrics centers would increase the efficacy of care and reduce the levels of maternal mortality and stillbirth.

[Analysis of free health care for the elderly in the context of the "Plan Sésame" in Senegal]. / Analyse du fonctionnement du plan de prise en charge gratuite des soins chez les personnes âgées "Plan Sesame" au Senegal.

INTRODUCTION: Access to health care remains a major problem in Senegal, particularly among vulnerable groups such as the elderly. In 2006, the Senegalese government introduced a national plan for the provision of free health care known as "Plan Sésame" to improve access to care. The purpose of this study was to examine the current state of the "Plan Sésame" in national hospitals four years after its implementation (2006-2009). METHODS: A qualitative study using individual interviews was conducted between 15 March and 14 May 2010 among five target populations: hospital directors, health care providers, managers of the "Plan Sésame" in hospital admission services, management accountants, and beneficiaries. Content analysis was used. RESULTS: Between 2006 and 2008, hospital attendance rates increased every year. However, attendance rates began to decrease in 2009, except in the main hospital. The state has been left with a growing debt because of issues surrounding the reimbursement of expenses related to the "Plan Sésame'. As a result, national hospitals have been forced to restrict certain services included in the "Plan Sésame" and even to withdraw free health care for the elderly. These difficulties are likely to undermine the sustainability of the "Plan Sésame" CONCLUSION: The health authorities need to audit the "Plan Sésame:, to comply with standard procedures through regular monitoring and to redefine conditions of access.

Unenhanced 3D turbo spin-echo MR angiography of lower limbs in peripheral arterial disease: a comparative study with gadolinium-enhanced MR angiography.

OBJECTIVE: The purpose of this study was to assess the feasibility and diagnostic performance of an unenhanced MR angiography sequence (Syngo Native Space, Siemens Healthcare) to detect and quantify lower-limb peripheral arterial disease (PAD), with gadolinium-enhanced MR angiography (CE-MRA) as the reference standard. SUBJECTS AND METHODS: Fifty-one patients known to have lower-limb arteriopathy were included in this prospective study. For every patient, we performed Native sequence and CE-MRA on a 1.5-T system. We evaluated examination duration, image quality, and location, number, and severity of lesions. RESULTS: Examination duration was longer for Native sequence (mean, 39.6 min, vs 10 min for CE-MRA). Image quality was significantly better for CE-MRA, with 92% of images listed as good to excellent for CE-MRA, compared to 53% for Native. Sensitivity, specificity, negative predictive value (NPV), and accuracy of Native were respectively 75%, 95%, 89%, and 88% for all mixed levels; 52%, 97%, 88%, and 87% for aortoiliac level; 87%, 99%, 95%, and 92% for femoropopliteal level; and 82%, 87%, 87%, and 85% for subpopliteal level. If we considered only patients with Leriche and Fontaine stage II arteriopathy, Native results were slightly better, with respective specificities and NPVs of 96% and 91% for all mixed levels; 98% and 90% for aortoiliac level; 98% and 93% for femoropopliteal level; and 91% and 90% for subpopliteal level. CONCLUSION: Unenhanced MR angiography, cheaper than CE-MRA, showed in our study a good NPV, which suggests its utility as first-line test to screen for PAD, especially in patients at risk of nephrogenic systemic fibrosis.

[Socio-demographic factors and the treatment of obstetric fistula in southeastern Senegal]. / Facteurs sociodémographiques et prise en charge des fistules obstétricales au Sud-Est du Sénégal.

The objective of this study was to examine the socio-demographic profile and treatment of women suffering from obstetric fistula (OF) in southeastern Senegal. Conducted between August 2007 and January 2008, the study focused on women treated in regional hospitals in Tambacounda and Kolda. The data were collected using questionnaire-based interviews and analyzed using the Epi Info 3.3.1 software package. The patients (mean age of occurrence of OF: 24) were mostly from rural areas (86%), illiterate (89%), and excised (93%). The main cause of the condition cited by the participants was long working hours (42%). The study found that the participants were more likely to have no income-generating activity (84% compared to 22%) and to be divorced (19% compared to 2%) after (as opposed to before) the OF. The study also highlighted the prevalence of psychological disorders (62%), withdrawal (22%), abandonment by friends and/or family (16%) or by the husband (7%), and decreased effectiveness in household chores (4%). The average time between the occurrence of OF and the first consultation was 50.7 (± 55.3) months. The study found that 44% of the participants were waiting for an operation, 35% had undergone unsuccessful surgery, 14% had been treated and cured, 6% had recently undergone surgery, and 1% had suffered a recurrence. Good access to services was found to be necessary for effective treatment, although high-quality obstetric care and increased awareness were identified as the most important factors for the prevention of OF in southeastern Senegal.