[Epidemiological profile of female victims of psychological violence during the pre and postpartum periods in the Sédhiou region, Senegal]. / Profil épidémiologique des femmes victimes de violences psychologiques en période pré- et post-partum dans la région de Sédhiou, Sénégal.

BACKGROUND: In Senegal, psychological violence remains a taboo subject insofar as it often arises in the closed circle of family life. It has a highly negative impact on the health of pregnant women. The objective of this work was to study the epidemiological profile of female victims of psychological violence before and after birth in the Sédhiou region. METHOD: An observational, cross-sectional and analytical study was carried out from December 4, 2018 to April 4, 2019. The study population consisted of all the women received for postnatal consultation in one of the referral health structures in the Sédhiou region. Data were collected using a survey form and a questionnaire administered to the women having met the inclusion criteria. The data were entered using CS Pro software and subsequently analyzed using R 3.4.4 software. RESULTS: The mean age of the women was 25.4±7.8 (14-43 years). A total of 222 women (55.5 %) had suffered psychological violence during the prepartum period. Isolated psychological violence represented 44.3 % of the surveyed population, while psychological violence associated with sexual or physical violence represented 8.0 % and 5.4 % of the respondent population, respectively. The factors associated with psychological violence during the prepartum period were pursuit of a professional activity [ORaj=4.7 (1.3-17.0)], high educational status [ORaj=7.0 (4.2-11.5)] and performance of fewer than 3 antenatal consultations (ANC) [ORaj=2.2 (1.2-4.0)]. Maternal, fetal and neonatal complications were more frequent among victims of psychological violence (P<0.05). During the postpartum period, 26.5 % of the women who had been victims of violence during the prepartum period mentioned the fact that the aggression had ceased. The other women continued to endure violence, which was even more intense among 2.5 %. CONCLUSION: Psychological violence among pregnant women has a negative impact on the health of the mother and the newborn. This state of affairs should induce health care providers to increase popular awareness of its detrimental effects. Communication efforts aimed at behavioral change will need to be combined during prenatal consultations with strengthened screening for violence, the objective being to achieve improved care.

[Study of the factors associated with the delay of health consultation of victims of rape in Senegal]. / Étude des facteurs associés au retard de consultation sanitaire des victimes de viols au Sénégal.

INTRODUCTION: Rape remains one of the most serious forms of sexual violence because of its negative impact on the physical and mental health of victims. The objective of this study is to identify the factors associated with the delay in rape victims seeking medical assistance from healthcare professionals in Senegal. METHODOLOGY: A retrospective, descriptive and analytical observation study was conducted. The study population consisted of all the court files of girls or women victims of rape recorded by the investigators at the 11 high courts of Senegal during the period from 2006 to 2015. An exhaustive recruitment of the full records of rape victims meeting the inclusion criteria were completed. The uni and multivariate analyses were carried out with Epi Info 2000 and R 2.2.9 software respectively. RESULTS: At the end of the collection, 1,037 cases of rape were included in the study population. The average age of the victims was 16.3±7.9 years (range 1-72). Minors (<18 years) accounted for 24.8 %. The median time from rape to consultation at a health facility was 24hours. Long delay in consultation (>24hours) was noted for 38.6 % of victims. Risk of late consultation after rape was higher among victims residing in the southern areas (ORaj=4.31 [1.15-16.14]), or northern areas (ORaj=4.22 [1.26-14.14]), who were major (ORaj=1.67 [1.04-2.68]) or married (ORaj=3.44 [1.58-7.5]) or who were pregnant after the aggression (ORaj=34.03 [15.47-74.85]) or had an abortion (ORaj=5.45 [1.04-24.47]). CONCLUSION: Medical and judicial assistance are more difficult if there is a long delay between the aggression and consultation. Thus, it is important for the health and judicial authorities to raise awareness about the harmful consequences of sexual violence, and to put forward the benefits of therapeutic care, compensation for the harm suffered by rape victims, as well as the availability of holistic care services 24hours a day.

[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.

[Study of the Consumers' preference on the universal health coverage development strategy through health mutual in Ziguinchor Region, Southwest of Senegal]. / Étude de la préférence des usagers sur les stratégies de développement de la couverture sanitaire universelle à travers les mutuelles de santé dans la région de Ziguinchor au sud-ouest du Sénégal.

In Senegal, the informal and rural sector that accounts for over 80% of the population is covered only up to 7% by a health insurance system. That is why, for the implementation of development strategy of the universal health coverage (UHC) through mutual health insurance providers, the Government of Senegal has focused on this sector. The objective of this study was to assess the consumer's preference on the UHC development strategies through mutual health insurance providers. This was a qualitative and exploratory study based on a literature review, and indepth interview with the heads of households. It was also based on focus groups of people with and without health mutual membership, and the Expert Committee meetings. The results showed that the most critical attributes in the decision-making of consumers to join the health mutual in Ziguinchor were the membership units; the content of the benefit package, the payment modalities of the premium, the premium amount, the availability of transportation, the co-payment level, convention arrangement with health facilities, and health mutual governance. For a successful implementation of the UHC development strategy through health mutual organizations, policymakers should explore the possibility of introducing the modality of payment in kind, the revision of the co-payment amount, and the promotion of equity through the introduction of a differentiated premium contribution by income. They should also establish a crossborder strategy with The Gambia and Guinea-Bissau to improve health care access to people living in the borders. The promotion of innovative funding and risk equalization between health insurance schemes is also recommended. In areas where the microfinance institutions are well organized and structured their substitution to health mutuals should be an option the decision-makers have to explore.

[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.

Connaissances et pratiques des hommes en âge de procréer sur la contraception moderne dans la commune de Boghé, Mauritanie

Introduction : La mortalité maternelle reste élevée dans la République Islamique de Mauritanie. L'Organisation Mondiale de la Santé recommande la promotion de la contraception moderne comme stratégie efficace de réduction de la réduction de la mortalité maternelle. L'objectif général était connaissances et pratiques des hommes en âge de procréer sur la contraception moderne dans la commune de Boghé, Mauritanie.Patients et méthodes : Il s'agissait d'une étude transversale, descriptive et analytique. La population d'étude était constituée par l'ensemble des hommes âgés d'au moins 18 ans vivants depuis au moins 3 mois dans de la commune de Boghé. Un sondage à deux degrés a été effectué. L'analyse multivariée et la régression logistique simple étaient utilisées grâce au logiciel R 2.2.9 pour identifier les caractéristiques qui influençaientla non-utilisation de la contraception moderne.Résultats : La taille de l'échantillon était de 384 hommes en âge de procréer. L'âge moyen des hommes en âge de procréer était de 42,1 ± 9,5 ans. Ils avaient entendu parler de la contraception moderne dans 70,3% des cas). Ils étaient informés par leurs parents/amis (76%), la radio (32%), leurs conjointes (18%), les services de santé (8%) et la télévision /journaux (5%). Les mariés, utilisaient une méthode contraceptive au sein du couple dans 9,4% des cas. Parmi eux, pour 80% leurs femmes utilisaient la pilule, un contraceptif injectable (14,3%) et des implants (5,7%). Le déterminant de la non-utilisation de méthodes contraceptives modernes était le manque d'informations relatives à la contraception moderne (OR ajusté = 8,13 (1,9-34,72)). Conclusion : Face à cette situation, il importe aux autorités sanitaires de Boghé de mener des activités de sensibilisation relatives à la contraception moderne tout en impliquant les hommes en vue de soutenir leurs conjointes à utuliser les produits contraceptifs modernes

Etude de l'etat nutritionnel d'enfants nes de meres seropositives suivies dans l'unite de traitement ambulatoire du centre hospitalier regional de Thies (Senegal)

Introduction : La degradation de l'etat nutritionnel est un des premiers signes lies a l'infection a VIH chez l'enfant. Objectif : c' etait d'evaluer l'etat nutritionnel et les facteurs de risque des enfants nes de meres seropositives suivies au Centre Hospitalier Regional de Thies (CHRT). Materiel et methodes : u ne etude transversale etait menee du 1 er au 14 aout 2008. Elle portait sur une population de 40 enfants ages de 6 a 59 mois nes de meres seropositives. Resultats : la moyenne d'age etait de 32;17 mois [26;43 - 37;92] 95 ; 52 de etaient de sexe masculin. Les 40 avaient recu des ARV a la naissance; 45 etaient seropositifs et 40 avaient une malnutrition aigue. Plus de la moitie des enfants (60) avaient beneficie de l'allaitement maternel exclusif. Il y avait un lien statistiquement significatif entre : la non prise des ARV a la naissance et la presence de la maigreur (p= 0;010) ; la serologie positive des enfants et la presence d'insuffisance ponderale (p= 0;012) et de la maigreur (p= 0;0052) ; le bas taux de CD4 des meres et la presence d'insuffisance ponderale chez les enfants (p= 0;023) ; l'allaitement maternel exclusif et la presence de la maigreur chez les enfants (p= 0;010) ; le bas taux de CD4 des meres et le statut serologique des enfants (p= 0;0031). Conclusion : les programmes en charge de la lutte contre le SIDA; la malnutrition et de la sante de la reproduction doivent travailler ensemble pour developper les composantes de la prevention de la transmission mere enfant et des strategies de renforcement nutritionnel pour garantir le succes de la lutte contre la malnutrition chez les enfants dans le cadre du VIH

Analyse de la prise en charge communautaire des orphelins et enfants rendus vulnerables (OEV) par le VIH/SIDA : experience de l'organisation communautaire de base (OCB) Jammixale yi Thies (Senegal)

Introduction: le VIH/SIDA ne cesse de provoquer de multiples difficultes avec l'accroissement du nombre d'orphelins et enfants vulnerables (OEV). Au Senegal; 3193 OEV etaient recenses en 2008. L'objectif etait d' analyser la prise en charge communautaire des OEV par l'organisation communautaire de base (OCB) JammiXale Yi (JXY) de Thies afin de mieux apprecier les effets psychologiques du VIH sur les enfants; les parents. Population et methode: Il s'agissait d'une etude transversale faite en 2009 aupres des agents de sante; des OEV et de leurs parents. Des entretiens individuels et des focus groups ont permis de recueillir des donnees. Selon la source et la cible; une triangulation des informations avait ete faite Resultats : 61 OEV etaient suivis. L'age moyen etait de 9;82 ans; variant entre 2 mois et 17 ans. Le sex- ratio etait de 1;08 (filles = 48).Dans cet OCB; 99 des enfants etaient a l'ecole publique; 20 avaient une bourse scolaire ; 92 n'etaient pas depistes. Parmi ceux depistes; 8 etaient seropositifs.Selon la cible; les principaux effets psychosociaux du VIH/SIDA etaient pour les enfants: l'utilisation de l'alcool; de la drogue; la prostitution. Pour les parents venaient au premier rang : la discrimination; le non depistage des enfants; les difficultes d'acces aux soins de qualite; l'attitude d'indiscretion du personnel de la sante. Les agents de sante avaient surtout souligne le manque de formation sur la prise en charge psychologique des OEV. Conclusion : on note l'importance des effets psychosociaux du VIH/SIDA sur les enfants; leurs parents et la difficulte de la prise en charge communautaire de cette maladie dans les pays a ressources limitees

[Economic impact of skin-lightening products on household income in sub-Saharan Africa: the case of Senegal]. / Poids économique de la dépigmentation artificielle sur le revenu des ménages d'Afrique subsaharienne : cas du Sénégal.

INTRODUCTION: As throughout sub-Saharan Africa, the use of skin-lightening (or brightening or bleaching) products is widespread in Senegal (67%). Although the medical and social determinants of this phenomenon have been documented, its cost is poorly defined. Thus, this work aims to evaluate the economic effects of skin bleaching on women's income. METHODOLOGY: A cross-sectional, quantitative, and descriptive survey was conducted in 2010 (October 7 to November 8) among women consulting for outpatient care at a reference dermatology clinic for complications related to use of skin-lightening products. We calculated the direct costs (products) and indirect costs (transportation costs, medical fees, dermatological treatment of complications). The social damage (pain and suffering and esthetics) was assessed. RESULTS: This study included 65 women; their mean age was 33 years and 26% had not attended school. In all, 52% were merchants, 29% housewives, 9% civil servants, and 5% students. The average duration of product use was 9 years, and the mean age at onset of use, 23 years. Most (80%) had a low income (<100,000 FCFA or US $204). The total monthly income of the 65 women in the study was 5,675,000 CFA (US $ 11,582). The total monthly cost of skin lightening for them was 1081,658 CFA (US $ 2207), that is, 19% of their total income. The esthetic harm was categorized as moderate by 20% and high by 22%. CONCLUSION: This study opens perspectives for further studies of the intangible costs of skin bleaching and for increasing awareness of the complications and social damage induced.

Prevalence of necrotizing ulcerative gingivitis and associated factors in Koranic boarding schools in Senegal.

BACKGROUND: Necrotizing ulcerative gingivitis is the most common clinical syndrome preceding noma. It is found in developing countries and in malnourished children and especially in deprived groups such as children at Koranic boarding schools. The objective of this study was to determine the prevalence of necrotizing ulcerative gingivitis and factors associated with its occurrence in a boarding school population. METHODS: This was a cross-sectional study of children in Koranic boarding schools in the city of Touba, Senegal. A multistage sampling strategy was used and 8 out of 17 schools were selected. The variables collected were gender, age, oral hygiene habits, duration of residence, presence of ulcerative gingivitis and plaque, and gingival bleeding index. A logistic regression analysis with R software using the manual procedure down was used to identify factors associated with the dependent variables. RESULTS: There were 501 participants and boys made up 92% of the study group. The mean age was 9.3 (sd 4.0) years. The mean of duration residence was 3.4 (sd 1.5) years. The prevalence of necrotizing ulcerative gingivitis was 37% and 81% of children did not use a toothbrush or a chewing-stick. The length of residence, school size, hygiene habits and plaque and bleeding indices were significantly associated with necrotizing gingivitis after adjustment for other variables. CONCLUSION: It is necessary to develop oral hygiene programs, to establish policies to manage the oral health of children and to improve health and nutrition at Koranic boarding-schools.

[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.

[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.

[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.

Connaissances, attitudes et pratiques des femmes sur le paludisme, dans la zone rurale de Poponguine, Sénégal

Au Sénégal, le paludisme est un problème majeur de santé publique et de développement, car il représente la première cause de morbidité et de mortalité. Ce sont les enfants de 0-5 ans et les femmes enceintes qui sont les plus vulnérables. L'objectif est d'évaluer les connaissances, attitudes et pratiques des femmes en zone rurale sur le paludisme. Il s'agit d'une étude transversale, descriptive et analytique menée dans le district de Poponguine du 1er au 15 avril 2005. Il s'agissait d'une enquête en grappe. La taille de l'échantillon calculée était égale à 800. La population d'étude était constituée par des femmes vivant dans le district depuis plus de 1 an et âgées de 15 à 45 ans. L'âge moyen des femmes était de 28 ans, (intervalle de confiance à 95% = 27,7 ­ 28,8). Parmi ces femmes, 49,6% étaient scolarisées et 65,5% avaient un niveau socioéconomique faible. 82,25% savaient que le paludisme est dû à la piqûre d'un moustique. Le signe principal (la fièvre ou corps chaud) a été cité dans 81% des cas. Cependant les signes du paludisme grave n'étaient pas bien connus. Il existait une bonne connaissance des mesures préventives aussi bien chez l'enfant que chez la femme enceinte : la Moustiquaire Imprégnée (MI) (62,9%) et la pratique du Traitement Préventif Intermittent (TPI) lors de la grossesse (52,4%). Il existait une bonne accessibilité géographique et financière des femmes interrogées par rapport aux MI. Plus de la moitié des femmes interrogées (92%) disait avoir recours à la structure sanitaire en cas de grossesse et/ou pour un enfant suspect de paludisme. Le personnel de santé (60,4%) et les relais communautaires (62,9%) constituaient la principale source d'information. La couverture en MI était de 33% et le taux d'utilisation du TPI de 71,1%. Il existait une relation significative entre le niveau de connaissances et les pratiques (p < 0,05). Les facteurs déterminant les connaissances étaient l'âge et le niveau d'instruction. Les pratiques des mères étaient influencées par l'âge, la source de revenus et la situation matrimoniale. A l'issue de cette étude, nous recommandons, pour le district de Poponguine, en accord avec le programme national de lutte contre le paludisme de renforcer le programme de sensibilisation afin d'amener les populations à améliorer leur connaissance en matière de paludisme et à changer de comportement mais aussi de mener une enquête qualitative pour compléter cette étude épidémiologique

[An action research network to improve the quality of tuberculosis care in West Africa]. / Améliorer la qualité des soins aux patients tuberculeux par la recherche-action en réseau. Une expérience en Afrique de l'Ouest.

BACKGROUND: Improvement in management systems for tuberculosis (TB) care is urgently needed in West Africa. In 2003, an experimental action research network began there, involving care providers, health system managers, and TB programme managers. Each project in all 6 countries used a "patient-centered" approach to improve tuberculosis case management. METHODS: The research teams included care providers, district medical officers, anthropologists and TB programme managers. Each research team conducted its project for a one-year period and then assessed its results. The specific problems identified were low TB detection rates (Burkina Faso, Côte d'Ivoire and Niger) and poor compliance among patients receiving treatment, including their ensuing loss to follow-up (Benin, Mali and Senegal). Investigators concluded that these weaknesses were due to the lack of access to care (geographical, financial and cultural), the complexity of the care system and the low quality of care. Solutions for all 6 countries aimed at improving access to high-quality care. RESULTS: One year after the experiment began, results varied from one country to another. In general, all participants understood the need to collaborate beyond national health systems because the problems from all 6 countries were quite similar. The research process led to better sharing of work between care providers and sometimes between care providers and TB patients. It provided participants with new concepts and a constant opportunity to implement them. These repeated meetings, however, keep care providers away from their offices. CONCLUSION: The research would have improved case management and care more effectively had the teams taken into account the psychological and sociological need of TB patients. A new regional dynamic has begun and must be pursued to help improve health care systems.

[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.

Analyse des déterminants de la qualité de la microscopie pour la lutte contre la tuberculose dans les laboratoires des centres de santé de la région de Dakar

Introduction : Dans le but d'améliorer la qualité de la microscopie dans le cadre du dépistage et du suivi des patients atteints de tuberculose pulmonaire; une étude des déterminants de la qualité de la microscopie a été réalisée dans les laboratoires des centres de santé de Dakar; Sénégal. Matériels et Méthodes : Il s'agit d'une étude épidémiologique de type transversal qui s'est déroulée dans la période du 19 avril au 05 mai 2004. Elle a consisté en une série d'observations; d'entretiens; de revue des registres de laboratoire et a une relecture et recoloration; au niveau du Laboratoire National de Reference du Programme National de lutte contre la Tuberculose (LNR); de 50 lames collectées au hasard dans les centres de santé de Dakar. Résultats: Il ressort de cette étude qu'il n'y avait pas de lien statistiquement significatif entre les facteurs de risque d' erreurs tels que la surcharge du travail; le mauvais état du microscope; le manque de compétence et les erreurs observées dans certains laboratoires. Par contre l'aspect des frottis; l'épaisseur des frottis et la présence de cristaux pouvait altérer la qualité de la microscopie car on a trouve qu'il existait une liaison statistiquement significative entre la qualité de la microscopie et ces différents déterminants. Par ailleurs on a noté une bonne concordance des résultats de ces laboratoires avec ceux du LNR (test Kappa = 0;981; p 0;0001). Conclusions : Au vu de ces résultats; nous recommandons : un renforcement des compétences (formation/recyclage) régulier des laborantins et une mise en place d'un système de contrôle de la qualité de la microscopie; interne au sein des laboratoires mais aussi externe par le biais du Laboratoire National de Référence

[Models for calculating the cost of operational expenditure for a health centre in Senegal]. / Coûts de fonctionnement d'un centre de santé au Sénégal: modalités de calculs.

The transformation of a health post into a health centre generates new services which mobilise different resources. The objective of this work is to propose a budgetary forecasting model for this specific type of case, one which is recurrent although seldom documented. As a preliminary step, the quarterly operational costs were determined, and the "complete costs method" (or the homogeneous sections method) was utilised for this purpose. In the second phase, the "pre-established costs method" was used to set the budget forecasts. The amount to be recovered by the health committee for a three month period of operation is estimated at 1,574,967 F CFA (equivalent to approximately 2,400 Euros), representing 42% of the total cost. The states assures the contribution of public funds to cover 54.2% of the cost, and the commune of Kanel furnishes 3.8% of the total cost, however only in the form of in-kind contributions or other material resources. The overall estimated budget for the year 2004 is estimated at 14,835,425 F CFA (about 22,615 Euros) of which 57.6% is expected to be received from the state.

[Monitoring and evaluation of health care programs in Subsaharian Africa]. / Monitoring et évaluation des programmes de santé en Afrique subsaharienne.

The monitoring and evaluation is usually the weakest component of health programs in sub-Saharan Africa, what is undermining the sustainability of funding. The problems are complex and the weaknesses of the health systems are reflected on the monitoring and evaluation of specific programs. This paper gives an insight of the problems faced during field missions for monitoring and evaluation. The steps for building the M&E system have been reviewed and keys points for implementation have been provided.