[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.

Women's autonomy in health decision-making and its effect on access to family planning services in Senegal in 2017: a propensity score analysis.

BACKGROUND: The effect of women's autonomy in decision-making for fertility control has been highlighted by research. The objective of this study was to analyze the effect of women's autonomy over decision-making regarding their health and access to family planning in Senegal in 2017. METHODS: The analyses in this study were carried out using data from the Senegal Demographic and Health Survey in 2017. The sample consisted of 8865 women aged 15-49. The propensity score-matching method was applied. Autonomy in health decision-making was considered the treatment variable. Matching was performed using confounding variables. The outcome variables were the current use of modern contraceptive methods and the existence of unmet needs. The common support condition had been met. The analysis was conducted using STATA.15 software. RESULTS: This study showed that 6.26% of women had decision-making autonomy in relation to their health. For 80.33% of the women, their husbands/partners made health-related decisions for them. Decision-making autonomy increased significantly with the age of the woman (p < 0.05). In addition, 15.24% of women were using a modern method of contraception. An estimated 26.2% of women had unmet needs. Propensity score matching split the women into two groups based on autonomy over decision-making for their health. After matching, there was no longer a significant difference between women who were autonomous with respect to their decision-making and those who were not autonomous with respect to their current use of a modern contraceptive method. On the other hand, there was a 14.42% reduction (p < 0.05) in unmet needs for family planning in the group of women who were autonomous with respect to their health decision-making. CONCLUSION: Autonomy in health decision-making would reduce unmet needs among Senegalese women. These results show the importance of accounting for gender in health interventions for the accessibility of family planning services.

[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.

[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.

[How Bone Densitometry contributes to the diagnosis of Osteoporosis at the Gerontology and Geriatrics Center of Ouakam, Dakar City: 102 observation]. / Apport de l'osteodensitometrie dans le diagnostic de l'osteoporose au Centre de Gerontologie et Geriatrie de Ouakam/ Ville de Dakar: a propos de 102 observations.

INTRODUCTION: This study aims at assessing the morbidity rate and risk factors of osteoporosis. METHODS: This is a cross-sectional study conducted at the Gerontology and Geriatrics Center of Ouakam from 2010 to 2012 with patients who had benefited from a bone densitometry examination. The study variables were: sex, current age, menopausal age, past individual fractures, past family fractures, prolonged corticoid intake, prolonged immobilization, tobacco addiction, and alcoholism. Epi-info version 6 Software was used to process and analyze the data. RESULTS: The study included 102 patients the majority of which were women (75%), with an average age of 74 years; among these people, 31% had individual past fractures and 10% had family fractures; 8% of the patients had used a prolonged corticoid-based therapy and 2% were tobacco-addicts. The average age of menopause was 48 years. The prevalence rate for osteoporosis was 44%, based on Rachis T-score, 20%, based on Femur T-score and 45%, based on Rachis and Femur T-score. It has been noted that being a woman and past individual fractures rated among the major risk factors of osteoporosis. CONCLUSION: These results speak in favor of health authorities setting-up a program to fight osteoporosis centered mainly on primary prevention and screening.

INTRODUCTION: L'objectif de notre travail est d'évaluer la morbidité et les déterminants de l'ostéoporose. MÉTHODES: Il s'agissait d'une étude transversale qui s'est déroulée au Centre de Gérontologie et Gériatrie de Ouakam de 2010 à 2012 chez des patients qui ont bénéficié de l'examen ostéodensitométrique. Les variables étudiés étaient: sexe, âge actuel, âge de la ménopause, antécédent de fracture personnel, antécédent de fracture familial, prise prolongée de corticoïdes, immobilisation prolongée, tabagisme, consommation d'alcool. Le logiciel Epi-info version 6 a été utilisé pour analyse des données. RÉSULTATS: 102 patients ont été inclus dans l'étude avec une prédominance féminine (75%), un âge moyen de 74 ans; 31% des patients avaient des antécédents personnels de fracture et 10% des antécédents familiaux de fracture; 8% des patients présentaient une corticothérapie prolongée et 2% des patients un tabagisme. L'âge moyen de survenue de la ménopause était de 48 ans. La prévalence de l'ostéoporose était de 44% en se basant sur le T score Rachis, de 20% en se basant sur le T score Fémur et de 45 % en se basant sur le T score Rachis et Fémur. Il a été noté que le sexe féminin et les antécédents personnels de fracture constituaient des facteurs de risque de survenue de l'ostéoporose. CONCLUSION: Former les professionnels au depistage et à la prévention de cette affection.

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

[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.

Pediatric invasive pneumococcal disease in Senegal.

OBJECTIVES: We aimed to describe the clinical, epidemiological, and outcome characteristics of IPD case patients hospitalized at the Albert-Royer National Children's Hospital (French acronym CHNEAR) to evaluate the disease burden of IPDs in a pediatric hospital of Dakar (Senegal). PATIENTS AND METHODS: All children aged 0-15 years hospitalized at the CHNEAR between January 1st, 2008 and December 31st, 2013 for a documented IPD were included in the study. Medical history, risk factors, clinical, bacteriological, and outcome data was collected. Data was then analyzed using the SPSS software, version 16 (Pearson's Chi(2) test: a P-value<0.05 was considered statistically significant). RESULTS: A total of 218 IPD patients were hospitalized at the CHNEAR during the study period (hospital prevalence: 0.79%). The mean age was 36.1 months. The male to female ratio was 1.27 (122 boys and 96 girls). Infants<2 years of age represented 61.46% of patients. Prior antibiotic therapy was found in 54% of patients but details were lacking. Infection sites were mostly meningeal (61%) and pleuropulmonary (28.9%). The main isolated serotypes were 1, 6A, 14, 5, and 23F. Case fatality was 17.4% and it was five times higher for pneumococcal meningitis. CONCLUSION: IPDs are very common in children in Senegal. Infants<2 years of age are particularly affected. The very high case fatality (17%) was significantly associated with meningeal infection sites hence the need for better access to pneumococcal vaccines.

Apport de l'IRM haut champ dans la prise en charge des cancers du col de l'uterus au Senegal

Objectifs: Decrire le profil des cancers du col de l'uterus au CHU de Fann avec une classification FIGO-IRM et situer l'interet de l'IRM dans la recidive post-operatoire. Patientes et Methode : Etude retrospective monocentrique ayant inclus 30 patientes dont 3 apres chirurgie. Les examens etaient realises avec une IRM de 1;5 Tesla. Des sequences ponderees en T2 dans les 3 plans etaient realisees suivies d'une sequence de diffusion dans le plan axial. Les sequences dynamiques en ponderation T1 etaient realisees dans le plan axial perpendiculaire au grand axe du col; avec saturation de la graisse avant et apres injection de gadolinium. La taille et le signal des tumeurs ont permis de faire une classification FIGO-IRM. La recherche de ganglions et de recidives post operatoires chez trois femmes a ete realisee.Resultats : L'age moyen des patientes etait de 45;7 ans (31 ans-70 ans). La taille moyenne des tumeurs etait de 6;25 cm (2 cm-15;2 cm). Le seuil des 4 cm etait depasse chez 92% des patientes. Toutes les lesions apparaissaient en hyposignal T1; avec restriction de la diffusion. Leur signal en T2 etait variable avec une predominance des lesions en hypersignal intermediaire (72%) et le rehaussement apres injection etait note dans 96% des cas. Le stade II B FIGO-IRM etait le plus representatif (56%) suivi du stade IV A (28%); soit une extension aux parametres dans 84% de cas. Des ganglions suspects etaient notes chez 60% des patientes. Une patiente presentait une recidive post operatoire.Conclusion : L'IRM est devenu quasi incontournable dans le bilan pre-therapeutique et la recherche de recidive post-operatoire des cancers du col de l'uterus dans notre CHU

Place de la scintigraphie osseuse dans le bilan d'extension des metastases osseuses du cancer du sein au Senegal : etude preliminaire a propos de 40 cas

L'etude portait sur 40 patients dont l'age variait entre 26 et 84 ans avec une moyenne de 46;9 et un ecart type de 13 ans. Le cancer du sein droit predominait avec 62.5 contre 32.5 pour le sein gauche. Seul deux cas de cancer bilateral ont ete retrouves (5). Douze (12) patientes sur 40 presentaient une hyperfixation (30).Parmi ces dernieres; 11 presentaient des localisations multiples a type d'hyperfixations diffuses et focales (91;67 ) et 1 cas (8;33) avait une localisation unique et focale. Deux patientes (5) avaient une scintigraphie non contributive. La duree d'evolution du cancer etait inferieur ou egale a 3 ans dans 66;67 et superieure a 3 ans dans 33;33 avaient des fixations extra osseuses associees du radio-traceur.Les sites associes les plus frequents sont le poumon (40); le cour; la rate et l'estomac qui representait chacun (20)

[Evaluation of tolerance of zidovudine-lamivudine-nevirapine combination in HIV 1 patients in Fann Teaching Hospital in Dakar]. / Évaluation de la tolérance de l'association zidovudine-lamivudine-névirapine chez les patients VIH-1 au Centre hospitalier de Fann à Dakar.

We conducted a study to evaluate the tolerance of the zidovudine (AZT), lamivudine (3TC) and nevirapine (NVP) combination regimen in HIV-1 patients by a descriptive analytical retrospective study of all HIV-1 patients receiving AZT-3TC-NVP combination between 2008 and 2011. Seventy patients were included. Two thirds of the patients presented at least one side effect (44 cases). The digestive disorders (15 cases) and neuropsychiatric (14 cases) were the most frequent. Epigastralgia (20%), headaches (20%) and arthralgias (13%) were main side effects. A maculo-papular exanthema was noted in three cases. During the follow-up, five patients presented with anemia. No patient presented hepatic cytolysis due to NVP. All the patients followed for more than six months presented a side effect against 29.7% when the duration of treatment was equal to or less than 6 months (p=10(-5)). Most of the side effects due to the association AZT/3TC/NVP are minor. The evaluation of the clinical and biological tolerance must be maintained during all the follow-up.

[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.