Diabetes management in Senegalese families: A dyadic-narrative illustration.

Objectives In many Sub-Saharan African cultures, diabetes self-management behaviors such as dietary adherence do not occur in isolation but are carried out in the context of local culture, a significant factor in shaping those health behaviors. Methods Using a family-based narrative approach, we explore how Senegalese families manage diabetes. We interviewed twenty people living with diabetes and selected family caregivers from MBour, Senegal. Results We found that people living with diabetes experienced physical, emotional, and financial stressors as a result of managing their condition. In addition, family caregivers play an important role in managing their family member's diabetes. Discussion The act of caregiving affects caregiver diabetes prevention behaviors. In some cases, this caregiving role leads to an increase of healthy behaviors such as reducing dietary sugar; however, in some cases, caregivers do not see the need to engage in healthy behaviors. Diabetes prevention and management interventions that support both Senegalese people living with diabetes and their family caregivers are warranted.

Prevalence of TB/HIV coinfection in antiretroviral-naïve patients at the Fann Ambulatory Treatment Center in Dakar.

To determine the prevalence of tuberculosis and describe its epidemiological, clinical, paraclinical, and therapeutic characteristics and its outcome in patients with HIV. This retrospective, descriptive, and analytical study examined the records of patients with HIV at our outpatient treatment center and selected those who were antiretroviral-naive and presented tuberculosis between January 2008 and December 2012. Among a total of 757 HIV-positive patients, 76 had tuberculosis, for a prevalence of 10 %. The sex ratio of 1.23 favored men. The average age was 42.5 years (range: 25 to 69 years. Nearly all these patients (71 cases) had HIV-1. A history of tuberculosis was reported by 39.5 %. Seventeen patients were malnourished. Management included chemoprophylaxis with cotrimoxazole for 64 patients. The pulmonary form predominated (72.4 %). Among these forms, there were 34 cases of negative microscopy tuberculosis and 21 cases of positive microscopy tuberculosis. The extrapulmonary forms (21 cases) were dominated by tuberculosis in the lymph nodes (11 cases), the pleura (7), pericardium (2), and peritoneum (1). Anemia was found in 44 patients. Severe immunosuppression was noted in 90 %, with CD4+ cell counts <350/mm3. Lethality was 7.9 %. TB/HIV coinfection is a major public health problem in Africa. Better coordination of activities in support of programs for tuberculosis and HIV/AIDS are needed.

[Profiles of IgG responses against CSP, GLURP and LSA-3NR2 in urban malaria (Dakar): relations with haemoglobin levels and parasite densities]. / Profils des réponses IgG dirigées contre CSP, GLURP et LSA-3NR2 dans le paludisme urbain à Dakar : influence sur l'hémoglobinémie et les parasitémies circulantes.

Malaria remains a major health problem in sub- Saharan African countries despite substantial decreases in morbidity and mortality due to sustained control programs. Vaccines candidates were mainly tested in rural endemic setting; however increasing proportion of the population is living in urban area. Evaluation of the qualitative or quantitative immune responses to key targets of anti-Plasmodium immunity requires further investigation in urban area. In a cohort of 144 patients with mild malaria living in Dakar, we analyzed IgG responses against target antigens of P. falciparum: CSP, LSA-3NR2 and GLURP by ELISA. A mean age of 15 yrs (4-65 yrs) was found and patients were separated in 59 adults (<15yrs) and 85 children (≤15 yrs). Parasites densities (0,01-15%) did not differ between the two age groups. In contrast, haemoglobin levels appeared lower in children (4.5-16.6 g/dl) (p<0.01). For the immune results, the most recognized antigens were GLURP and CSP compared to LSA-3NR2. Levels of IgG against these antigens were significantly different between the two age groups and they were positively correlated (rho = 0.32; p<0.001). In addition, levels of IgG anti-GLURP were associated with low parasitemia (≤1%) and absence of anemia (≥11g/dl), particularly in adults (p<0.001). In a multiple regression analysis, no significant relationship was found between parasite densities and IgG responses against all the tested antigens. Our study shows the implication of IgG anti-GLURP in humoral immune response against the parasite. The present work contributes to determine IgG levels that can be used as relevant immunologic biomarkers in urban clinical malaria.

Initial suboptimal CD4 reconstitution with antiretroviral therapy despite full viral suppression in a cohort of HIV-infected patients in Senegal.

OBJECTIVE: We determined the risk factors and incidence of clinical events associated with suboptimal immune reconstitution (SIR) defined by an increase in CD4 inferior to 50 cells/µL, from inclusion up to six months of antiretroviral treatment (ARVT), in patients with an undetectable viral load (<50 copies/mL). METHODS: Logistic regression and Cox's proportional hazards model were used to examine risk factors for SIR and the association between SIR and the risk of new clinical events or death, respectively after six months of ARVT. RESULTS: One hundred and two (15.5%) of the 657 patients presented with SIR. Age > 40 years (aOR = 1.74, 95% CI = 1.10-2.75), baseline CD4 ≥ 100 cells/µL (aOR = 2.06, 95% CI = 1.24-3.42), ARVT including AZT (aOR = 4.57, 95% CI=1.06-19.76), and the occurrence of a severe opportunistic infection during the first semester of ARVT (aOR = 2.38 95% CI= 1.49-3.80) were associated with SIR. After six months of ARVT and up to seven years of follow-up, 39 patients with SIR had presented with an opportunistic infection or death (rate= 9.78/100 person-years) compared to 168 with a normal recovery (rate = 7.75/100 person-years) but the difference was not statistically significant (aHR = 1.22, 95% CI = 0.85 to 1.74). CONCLUSION: SIR is less common in our country and is not associated with increased mortality or a greater incidence of opportunistic infections after six months of ARVT.

[Dental fluorosis and dental caries prevalence in Senegalese children living in a high-fluoride area and consuming a poor fluoridated drinking water]. / Prevalence de la fluorose et de la carie dentaire chez des enfants Senegalais vivant dans une zone de fluorose endemique et consommant de l'eau pauvre en fluor.

INTRODUCTION: The role of fluoride in dental caries prevention when applied at optimal levels is well established. However, ingestion of excessive fluoride during tooth development can cause structural changes in tooth enamel named fluorosis. At Gandiaye a city situated in the Senegalese endemic fluorosis area, the main water supply provided by a unique drilling with highly fluoridated water has broken down in 1996. Since then, the drinking water comes from wells which have poor levels of fluorides. The aims of this study were to evaluate the prevalence and severity of dental fluorosis and tooth decays in children born and reared continuously at Gandiaye after the stoppage of the drills and who were drinking water well. METHODS: Water samples were collected from two wells and analyzed using a spectrometer and a specific fluoride electrode. The prevalence and severity of dental fluorosis was evaluated according to Dean's method, and the caries experience was measured using the DMF teeth index in 150 children aged from 6 to 8 years. RESULTS: The fluoride levels in the water well were comprised between 0.03 ppm and 0.09 ppm according to the method used. The prevalence of dental fluorosis was 39.33% with the predominance of the very low to low fluorosis forms. The tooth decay prevalence was 48.66% and the mean DMF tooth was 0.98. A significant relationship was found between the dental fluorosis and the low caries levels. CONCLUSION: A low to moderate dental fluorosis associated with a significant decrease of caries prevalence was found in children living in a high-fluoride area and consuming poorly fluorided water.

Size-selection of cDNA libraries for the cloning of cDNAs after suppression subtractive hybridization.

Here we describe the establishment of size-selected cDNA libraries for the cloning of full-length cDNAs that were initially identified by suppression subtractive hybridization (SSH) technology as being differentially expressed. First, the SSH-cDNA fragments were used as 32P-probes to verify their level and differential pattern of expression by virtual Northern and to establish their corresponding full-length cDNA size. Second, cDNAs were separated by size on agarose gels and used to construct size-selected cDNA plasmid libraries, which were then screened by colony hybridization with the SSH-cDNA fragments. We conclude that the described approach complements SSH technology by allowing efficient cloning and characterization of the corresponding full-length cDNA from any desired cell type or species. This approach will give researchers the ability to specifically target and study differentially expressed genes in an efficient manner for functional genomic studies.

Rift Valley fever outbreak, Mauritania, 1998: seroepidemiologic, virologic, entomologic, and zoologic investigations.

A Rift Valley fever outbreak occurred in Mauritania in 1998. Seroepidemiologic and virologic investigation showed active circulation of the Rift Valley fever virus, with 13 strains isolated, and 16% (range 1.5%-38%) immunoglobulin (Ig) M-positivity in sera from 90 humans and 343 animals (sheep, goats, camels, cattle, and donkeys). One human case was fatal.

Epidemiological and virological influenza survey in Dakar, Senegal: 1996-1998.

An influenza survey was conducted in seven sentinel sites in Dakar, Senegal from June 1996 to December 1998. Throat or nasal swab cultures were randomly collected from 804 patients suffering from influenza-like symptoms. Influenza viruses were isolated at a similar proportion in adults and in children (P = 0.29). Strains of influenza B viruses were isolated from sporadic cases in 1997, whereas type A virus was associated with an isolated peak. Proportions of influenza virus isolation varied from 17.5% to 40.0% between 1996 and 1998 during the peak period (July/September) of acute respiratory infection in Dakar. Rainfall, humidity, and temperatures rose during the same period. Influenza in Dakar seems to be an-all-age groups respiratory infection characterized by high transmission during the hot and rainy season. The antigenic similarity of the A(H3N2) and B viruses to those circulating elsewhere in the world at the same time was confirmed. However, the A(H1N1) strains were found to be more closely related to an Asiatic strain which had not been isolated outside Asia previously. Consequently, the strain close to the A(H1N1)/Wuhan/371/95 strain isolated in Dakar was included in the composition of the 1998/1999 influenza vaccine. This reinforces the importance of setting up a national influenza control strategy in tropical regions.

[Nuptiality and fertility in Senegal]. / Nuptialite et fecondite au Senegal.

PIP: Data from Senegal's 1978 World Fertility Survey were used to demonstrate the decisive role of intermediate variables in the determination of general and marital fertility rates. Senegal's total fertility rate of 7.2 in 1974-78 indicates a high level of fertility which, moreover, appears to have changed little over time. Marital fertility is slightly higher than general fertility: married women had an average of 4.03 live births, vs. 3.53 for all women. A seemingly significant fertility differential by maternal educational status amounting to 1.34 child disappears when age and age at marriage are controlled. Age at marriage is a significant influence on fertility in the 1st 5 years of marriage, with fertility lower among women aged 15 or under at marriage. Abortion is a marginal practice in Senegal, and contraception is not widespread. 10% of ever married women reported having ever used a traditional method, and 1% a modern method. At the time of the survey only .5% used a modern method. Few significant differentials were noted in abortion or contraception by rural or urban residence. A slightly longer period of breastfeeding in rural areas (19.1 months vs. 17.6 months in urban areas) probably accounts for more of the slight rural-urban fertility differential than does abortion or contraception. Nuptiality in Senegal is early and intense, but is less stable than in most other African countries. The average age at 1st marriage of women aged 20-29 years was 16.4 for urban women, 15.6 for rural women, 17.0 for literate women, 15.7 for illiterate women, 16.0 for Wolofs, 15.1 for Poulars, 15.5 for Mandingos, 16.5 for Serers, 17.0 for Diolas, and 15.8 for the entire sample. Differences in age at marriage by rural or urban residence and women's educational level were more marked in younger cohorts. 95.6% of women aged 25-29 and 99.8% of those aged 30-34 at the time of the survey were already married. Age at marriage influences the propensity to divorce. 23.6% of marriages of women married at under 20 years vs. 19.1% of marriages of women over 20 ended in divorce. But 89% of divorced women subsequently remarried. Education, residence, and ethnic group also influenced the risk of divorce. 33% of Poular women, 27% of urban women, 27% of literate women, and 23% of Serer women ended their 1st unions in divorce. Wolof, Diola, and illiterate women had an average tendency to divorce, with 19% in each group terminating their 1st unions. 17% or rural women and 11% of Mandingo women divorced. Polygamy is widespread in Senegal. 48% of married women and 32% of married men are in polygamous unions. Senegal Fertility Survey data were limited to the current union, preventing a profound study of the interrelations between fertility and polygamy. But available data suggest that there are no fertility differences between monogamous and polygamous women either in the early years of marriage or overall. But divorce is much more likely for women infertile in the 1st years of marriage.^ieng