Perception of PrEP-related stigma in PrEP users: Results from the ANRS-PREVENIR cohort

INTRODUCTION

Since the advent of HIV pre-exposure prophylaxis (PrEP), stigma has been shown to be a major barrier to its uptake and adherence. It is therefore essential to define the proportion of users who consider that PrEP can negatively impact their image and the factors associated with this perception.

METHOD

We performed a multivariable logistic regression on data from the 2567 participants in the ANRS-PREVENIR study who answered the outcome question.

RESULTS

Almost one-third of the sample (comprising mostly cisgender men who have sex with men [94.3%]) considered that taking PrEP could give others a negative image of them. Younger participants (adjusted odds ratio [aOR] 0.98; 95% confidence interval [CI] 0.97-0.99) and more psychologically vulnerable participants (i.e., lower self-esteem score [aOR 0.98; 95% CI 0.96-0.99] and higher depression score [aOR 1.02; 95% CI 1.00-1.03]) were also more likely to have this perception. In contrast, participants encouraged to take PrEP by their main partner (aOR 0.67; 95% CI 0.51-0.88) and friends (aOR 0.79; 95% CI 0.66-0.95), and those who protected themselves more because they had knowledge of their most recent sexual partner's HIV status (aOR 0.83; 95% CI 0.69-0.99) and systematic use of PrEP and/or condoms during intercourse in the previous 3 months (aOR 0.80; 95% CI 0.67-0.96) were less likely to have this perception.

DISCUSSION

Given the strong interrelation between stigmatization (real or perceived), risky behaviours and adherence, our results emphasize the need for HIV prevention campaigns to promote a positive image of PrEP users. They also show that stigmatization and its effects need to be fully considered to improve HIV prevention offers to current and potential PrEP users who are most likely to be psychologically vulnerable.

Isolated esophageal tuberculosis: A case report

BACKGROUND

Tuberculosis is endemic in Senegal. While its extra-pulmonary localization is rare, esophageal tuberculosis, particularly the isolated form, is exceptional. We report here a case of isolated esophageal tuberculosis in an immunocompetent patient.

CASE SUMMARY

A 58-year-old man underwent consultation for mechanical dysphagia that had developed over 3 mo with non-quantified weight loss, anorexia, and fever. Upper digestive endoscopy showed extensive ulcerated lesions, suggesting neoplasia. The diagnosis was confirmed by histopathology, which showed gigantocellular epithelioid granuloma surrounding a caseous necrosis. Thoracoabdominal computed tomography scan did not show another localization of the tuberculosis. The outcome was favorable with treatment.

CONCLUSION

Esophageal tuberculosis should be considered when dysphagia is associated with atypical ulcerated lesions of the esophageal mucosa, in an endemic area.

462 - Renforcement des capacités des acteurs de riposte de la COVID-19 en Afrique de l'Ouest - Expérience de l'Organisation Ouest Africaine de la Santé (OOAS)

Contexte

En mars 2020, l'avènement de la pandémie COVID-19 et les mesures de restriction mises en place afin de la contenir limitaient l'organisation des formations physiques. Le besoin de mise à jour des connaissances, compétences et pratiques des agents de riposte des pays de l'Afrique de l'Ouest a conduit l'Organisation Ouest Africaine de la Santé, à mettre en place un programme de formations en ligne au profit des acteurs de riposte de l'Afrique de l'Ouest.

Méthodes

Il s'est agit de la revue des rapports des formations organisées et des expériences vécues par les organisateurs de ces formations. Cette revue a pris en compte les résultats des pré et post-test qui étaient réalisées au cours de la formation.

Résultats

De mars à juillet 2020, 33 formations ont été organisées dans les trois langues officielles de l'Afrique de l'Ouest (17 francophones, 14 anglophones et 02 lusophones). Les formations ont couvert l’épidémiologie/surveillance, le diagnostic du laboratoire, la prise en charge des cas, la communication sur les risques, la prévention et du contrôle infections. Le contenu des formations était basé sur les guides internationaux édités et les formateurs étaient des experts expérimentés. Les bénéficiaires au nombre de 3241, venaient de tous les niveaux du système de santé et étaient des médecins, des infirmiers, des aides-soignants, des biologistes, des hygiénistes, des communicateurs et acteurs de la surveillance. Les évaluations pré et post test ont permis de noter l'amélioration dans l'acquisition des connaissances dans 92 % des cas des formations.

Discussions/Conclusion

Cette expérience, qui était une innovation en Afrique de l'Ouest, a contribué à la mise à niveau des acteurs. Les leçons tirées vont aider au développement du programme de renforcement continu des capacités professionnelles en Afrique de l'Ouest.

Déclaration de liens d'intérêts

Les auteurs déclarent ne pas avoir de liens d'intérêts.

[Quality of health worker-patient communication: What are the benefits of integrating mental health into front-line services in Guinea?]

BACKGROUND

Patient-centred care presupposes communication based on empathy, active listening and dialogue. Our study examines the effects of integrating mental health in multi-purpose health centres on health workers' communication with patients who consult for problems unrelated to mental health. The objective is to compare the quality of communication in health centres where staff have received specific training in the management of mental disorders (SM+) compared to those without such training (SM-).

METHODS

The study was conducted among 18 health workers in charge of primary curative consultations in 12 non-governmental health centers in Guinea: 7 health workers in 4 SM+ health centers and 11 health workers in 8 SM- health centres. The study is based on mixed methods: observation, semi-structured and group interviews. The Global Consultation Rating Scale (GCRS) was applied to assess patient-centered communication.

RESULTS

The SM+ GCRS scores obtained by SM+s during observations are generally higher than the SM- scores. The odds of having a "good quality" consultation are almost 3 times higher in SM+ than in SM- for some steps in the consultation process. The SM+ discourse is more patient-centered, and differs from the more biomedical discourse of SM-. SM- health workers do not consider all of the stages of a patient-centred consultation to be applicable and recommend "leapfrogging". On the contrary, SM+ health workers consider all stages to be important and are convinced that the integration of mental health has improved their communication through the training they have received and the practice of caring for persons with mental disorders.

CONCLUSION

The integration of mental health into primary care provision represents an opportunity to improve the quality of care in its "patient-centred care" dimension. That said, optimal development of patient-centred care presupposes favorable structural conditions.

[Impact of the COVID-19 pandemic on the activities of the cardiology department of the Ignace Deen National Hospital at the Conakry University Hospital]

The new coronavirus pandemic (COVID-19) is the main global health crisis of our time and the greatest threat we have faced in this century. According to the National Health Security Agency (ANSS), which is the national body responsible for managing epidemics and pandemics, 1927 cases of COVID-19 were confirmed, 11 deaths with more than 4000 contact subjects. The objective of this study was to assess the impact of the COVID-19 pandemic on the activities of the cardiology department of the Ignace Deen National Hospital at the Conakry University Hospital. This was a descriptive retrospective study from January 2020 to April 2020, focusing on consultation and hospitalisation activities in the cardiology department of Ignace Deen National Hospital at Conakry University Hospital. The study consisted of assessing the impact of the pandemic on patient use of the service during the first weeks of the pandemic. We recorded the frequency of consultations and hospitalisations from March to April 2020, which we compared to the frequency of consultations and hospitalisations in January and February 2020. During this study from March to April 2020, we identified 130 patients in consultation against 450 patients for the two months preceding the official declaration of the pandemic in Guinea, a drop of 71.1% (320 patients). The same remark was made in hospitalisation with a drop of 75% (35 patients against 140 for the two months preceding the pandemic). At the start of the COVID-19 pandemic in Guinea, it is clear that there has been a rapid and significant drop in the effective use of the cardiology service.

Insulin therapy in childhood type 1 diabetes: Knowledge and practice in Senegal

INTRODUCTION

Childhood type 1 diabetes (T1D) is a chronic condition with serious repercussions on both the quality of life of the child and the family. Insulin therapy is the cornerstone of optimal blood sugar control. The main objective of our study was to assess the level of knowledge of physicians about insulin therapy in diabetes.

METHODS

This was a multicenter survey over a period of 5 months (from March 5 to August 2, 2018). It took place in five reference university hospital centers in the Dakar region.

RESULT

The number of doctors interviewed in our study was 82, 47.6% of whom were confirmed pediatricians or pediatricians in the process of specialization. The number of years of experience in the field of diabetes was on average 3 years. Fast-acting regular insulins were recommended by 75.6% of doctors and mixtures of insulin (intermediate and rapid-acting) by 50% of doctors. Overall, 91% of doctors recommend a variation in insulin injection sites. The "basal bolus" treatment regimen with insulin analogs was recommended by 50% of doctors, while 31.7% recommended it with human insulin. Regarding adapting insulin doses for leisure and sports activities, more than half (54.9%) of the doctors had to reduce the doses.

CONCLUSION

This study enabled us to assess the level of knowledge of insulin therapy among doctors caring for children with diabetes in Senegal, which proved to be limited. We recommend the reinforcement and follow-up of training on the management of T1D for providers at the different facilities.

Hepatocellular carcinoma in Senegal: epidemiological, clinical and etiological aspects about 229 cases at Hôpital Principal de Dakar

Hepatocellular carcinoma (HCC) is a major public health problem in Senegal, and the third most common cancer in terms of incidence. However, there are no recent data on the characteristics of this pathology in our country. The aim was to describe the epidemiological, clinical, aetiological and therapeutic aspects of HCC at Hôpital Principal de Dakar, Senegal. We did a descriptive retrospective study, including patients hospitalized from January 2012 to December 2017. We included 229 patients. The mean age was 47.4 years (21 - 88 years), and 77 patients (33.6%) were under 40 years of age. The sex ratio was 6.6. Twelve patients (5.2%) had a family history of 1st degree cirrhosis or HCC. Ten patients (4.4%) were previously treated with nucleotide analogues. The most common clinical sign at diagnosis was abdominal pain (91.7%). Alpha-fetoprotein level was normal in 12.2% of patients, and greater than 400 ng/ml in 68.1% of cases. Abdominal ultrasound found nodular HCC in 122 patients (68.2%), infiltrative HCC in 19 patients (10.6%), and was normal in 38 cases (21.2%). Subjacent cirrhosis was detected in 71.3% of cases. Abdominal computed tomography (CT) scan showed compatible HCC lesions in 88.8% of cases. A histological diagnosis was obtained in 2 patients (0.9%). The most common etiological factor was hepatitis B virus (69.4%), characterized mostly by a younger age (p = 0.001). In 20.9% of cases, no aetiology was found. An advanced or terminal stage (BCLC C/D) was found in 217 cases (94.8%). The treatment was curative in 12 patients (5.2%), and palliative in 7 cases (3.1%). The evolution at one year was favourable in 6 patients (2.6%). Hepatocellular carcinoma (HCC) is a disease that mainly affects young male adults in Senegal. The main aetiological factor remains HBV infection. The diagnosis is made at an advanced stage and the prognosis very bad.

A new multi-beam apparatus for the study of surface chemistry routes to formation of complex organic molecules in space

A multi-beam ultra-high vacuum apparatus is presented. In this article, we describe the design and construction of a new laboratory astrophysics experiment-VErs de NoUvelles Synthèses (VENUS)-that recreates the solid-state non-energetic formation conditions of complex organic molecules in dark clouds and circumstellar environments. The novel implementation of four operational differentially pumped beam lines will be used to determine the feasibility and the rates for the various reactions that contribute to formation of molecules containing more than six atoms. Data are collected by means of Fourier transform infrared spectroscopy and quadrupole mass spectrometry. The gold-coated sample holder reaches temperatures between 7 K and 400 K. The apparatus was carefully calibrated and the acquisition system was developed to ensure that experimental parameters are recorded as accurately as possible. A great effort has been made to have the beam lines converge toward the sample. Experiments have been developed to check the beam alignment using reacting systems of neutral species (NH₃ and H₂CO). Preliminary original results were obtained for the {NO + H} system, which shows that chemistry occurs only in the very first outer layer of the deposited species, that is, the chemical layer and the physical layer coincide. This article illustrates the characteristics, performance, and future potential of the new apparatus in view of the forthcoming launch of the James Webb Space Telescope. We show that VENUS will have a major impact through its contributions to surface science and astrochemistry.

Hospital STI prevention scheme adapted to target undiagnosed LGBT migrants in Paris area since 2018

Background

In Île-de-France region, 10 000 people do not know they are living with HIV (Supervie, 2016). 70% are men, including 40% men having sex with other men (MSM) and 40% sub-Saharan African migrants. From 35% to 49% of those sub-Saharan African migrants are infected in France. The main HIV prevention issues is to target populations that are unrepresented in screening test centers.

Methods

To achieve these aims, a sexual health promotion scheme has been designed by a public health association, a Sexual Transmitted Infections (STI) center and an association supporting people asking asylum because of their “sexual orientation or gender identity”. Outreach STI screening test actions are organized monthly in places crowded by asylum seekers and associative sexual health consultation including screening, results reporting, treatments, vaccinations and Pre-Exposition Prophylaxis (PrEP), devoted to asylum seekers are taking place weekly into the hospital. Pear community members have been trained to be referent in health matters and enhance the scheme effectiveness.

Results

549 people were screened for STI through 110 actions from March 2018 to December 2019, of which 25 were outreach and 85 inside the hospital. 74% were from sub-Saharan Africa and 86% were presumed MSM. 89% were under 40 years old. 20% of the screened people were diagnosed positive to at least one STI and 52 people have been engaged in PrEP treatment after a risky assessment. Pear referent involvement reduced the number of unreported results, 10% are still unreported. 21 people have stopped PrEP follow-up. Around 3/4 of those followed by the association on the period stand unreached.

Conclusions

The scheme allowed to targeted population according to epidemiology's indicators but we don't know if the most exposed part of the population is reached. Partnership between associations and hospital improved public health system as well as community involvement.

Key messages

Public health system needs adaptations to struggles epidemics. Community involvement must be a priority to increase prevention’s efficiency .

Combined sexual prevention targeted to LGBTI+ migrants: between ’outdoor’ and ’indoor’ hospial

Issue

It is estimated that there are about 10,000 HIV-positive and undiagnosed people in Île-de-France (French region). They are composed of 70% men, 40% of whom are MSM and 40% of sub-Saharan African migrants. A bridging process has been designed by the Public Health association AREMEDIA and developed in partnership with Fernand-Widal Hospital’s testing center, to reach underserved populations. From March 2018, a screening test session for sexually transmitted infections (STIs) is taking place weekly in the hospital walls. This action is dedicated to the population of ARDHIS association, which accompanies more than 1,000 people each year, seeking asylum because of their sexual orientation or gender identity.

Description of the problem

Despite the promotion of this ’indoor’ targeted consultation via ARDHIS volunteers and directly to asylum seekers during occasional community events, the consultation only allowed the screening of 23 people in 4 months. It has been decided to carry out screening ’outside the hospitals walls’, where the people are, in order to promote the return of results, treatment, access to PrEP, HBV vaccination at the weekly indoor hospital consultation. “Community health relays” training together with the development of phone contact procedures were developed to facilitate the access to the indoor consultation.

Results

The methodology made it possible to double the average number of consultations over the following 5 months from 5 to 10 consultations per 3-hour slot, not counting PrEP appointments and vaccines, which averaged 6 per session. By the end of 2018, 261 people were screened, 23 had a PrEP treatment and many were vaccinated. As the scheme continues to develop, the results from January to July 2019 will be reported.

Leçons

To reach the most at risk populations, specific public health approaches are needed, taking account the context and representations of the target populations. Community involvement has proven to be effective.

Key messages

To fight HIV, innovative devices are needed to reach targeted populations. This has allowed hundreds of LGBTI asylum seekers to be screened and a significant number to receive preventive treatment.

A closer look at the spectrum of drug-induced liver injury in sub-Saharan Africa

Introduction: Drug-induced liver injury (DILI) has become the most frequent cause of acute liver failure in high-income countries. However, little is known about the determinants of DILI in sub-Saharan Africa (SSA), where the prescription of antimicrobials and the use of potentially hepatotoxic traditional medicine are common. Areas covered: Based on an extensive literature search, we summarize current data available on the epidemiology and risk factors of DILI in SSA. We discuss the most likely causes of DILI in the region, including antimicrobial therapies and traditional medicine. We also highlight research gaps as well as barriers to diagnosis and management of the condition, and explore ways to address these important challenges. Expert opinion: DILI is underestimated in SSA and several factors challenge its early diagnosis, including lack of information on the causes of DILI in the region, sub-optimal knowledge about the condition among clinicians, and structural difficulties faced by health care systems. In order to better prevent the occurrence of DILI and its complications, it is crucial to enhance awareness among health care providers and patients, adapt drug prescription habits and regulations, and improve current knowledge on the main risk factors for DILI, including host genetic and environmental determinants.

[Prescription And Delivery's Survey Of Benzodiazepines In The Occurrence Of Addictions At Mbour's District]

Impact of the prescription and delivery of benzodiazepines in the occurrence of addictions in the district of Mbour.

INTRODUCTION

Benzodiazepines (BZD) are widely used nowadays and are at the origin of an addiction.

OBJECTIVES

The objective was to evaluate the quality of benzodiazepine prescribing and delivery in the Mbour department of Senegal and subsequently to implement an addictovigilance strategy. Thus, we studied the prescribing habits, the quality of delivery and identified the consumption habits of these drugs.

MATERIALS AND METHODS

It was a cross-sectional, prospective study with two questionnaires: addressed to patients and prescribers, conducted in pharmacies, hospitals, districts and Mbour health posts.

RESULTS

44% of BZD prescriptions were prescribed by doctors and especially general practitioner. 31.1% did not comply with the rules of prescription (marketing authorization). As for the dispensing rules, (85.3%) were dispensed without a prescription. The level of consumption was high in the 30-40 age group (43.95%) predominantly female (59%). Insomnia predominated as a reason for prescription (16.4%) on anxiety (11.94%) with (65.5%) dependence.

CONCLUSION

The abuses observed in the prescription, the delivery and consumption of BZD, constitutes a real health problem. Half of the consumers become addicted, hence the need for a national addictovigilance program.

[Fatal female genital mutilation in a 10-year-old girl]

Female genital mutilation (FGM) comprises all procedures involving partial or total removal of the external genitalia and/or any other procedures affecting the female genitalia, for cultural or religious reasons or for nontherapeutic purposes in general. FGM is responsible for a number of short-, medium-, and long-term complications that can engage the vital and functional prognosis, especially in African countries. We report on a case in a 10-year-old girl who underwent genital mutilation, a traditional type of total excision during the neonatal period. She was followed for urethral meatus stenosis, which then was complicated by obstructive chronic kidney failure and urinary sepsis, whose progression was fatal.

The "pouch" of the Douglas's pouch

Hernia is described as the protrusion of an organ into the wall of its normal containing cavity. Internal hernia (IH) involves protrusion of viscera through: a peritoneal or mesentery defect, a normal or abnormal compartment of the peritoneal cavity. Hernias occurring in the pelvis cavity are usually classified according to the fascial margins breached and include sciatic, obturator and those through the rectouterin pouch: elytrocele and enterocele. Those hernias are defined by the protrusion of a viscus through the wall of the pelvis due to weakness of the pelvic fascia and/or muscles. Pelvic hernia through the pouch of Douglas (PD) involves the genital tract in female (elytrocele and enterocele). Sometimes described in the literature as Douglas hernia, this type of hernia must be distinguished from the conventional IH. As defined before, the borders to be considered for IH is the peritoneal membrane, which is not a real solid wall but delimitates the peritoneal cavity; and there is no peritoneal defect in elytrocele or enterocele. A PubMed search for IH through a defect in the peritoneal PD revealed only five female cases, making this an extremely rare condition. To our knowledge, we have presented here the only published case in a male. This probably congenital and morphologic anomaly (defect) of pouch of Sir Douglas must be distinguished as the real "Douglas IH". Authors discuss the concept of a new and more detailed classification of IH.

Implementation of an in-house quantitative real-time polymerase chain reaction method for Hepatitis B virus quantification in West African countries

Hepatitis B virus (HBV) is a major cause of chronic liver disease worldwide. HBV infection is diagnosed by serological tests, while real-time polymerase chain reaction (qRT-PCR) assays are used to quantify viral load, which is a crucial parameter to determine viral replication and to monitor antiviral treatments. However, measuring viral load in resource-limited countries remains nonsystematic, due to the high cost of commercial kits. Here, we describe the development, validation and implementation of a low-cost, in-house qRT-PCR assay to monitor HBV viral load in chronic carriers enrolled in the PROLIFICA programme in the Gambia and Senegal. Over 1500 HBsAg-positive patients, including 210 chronically infected HBV patients, who were given antiviral treatment (tenofovir), were monitored by qRT-PCR using the SYBR Green- and HBV-specific primers. Twenty-four tenofovir-treated patients were followed up and their viral load was tested every 3 months over the 12-month experimental time course. Compared to commercial assays, our in-house assay was shown to be (i) highly reliable, with good intra- and interassay reproducibility over a wide range (45-4.5 × 108 copies mL-1 ), (ii) very similar in the viral loads detected (R2  = .90), (iii) highly sensitive, as it detected loads as low as 30 copies mL-1 (~5 IU mL-1 ), (iv) cheaper (2- to 3-fold), (v) easier to implement and (vi) more rapid. Based on our experience, we recommend this assay as a reliable alternative to commercial assays, for monitoring HBV viraemia in resource-limited, highly endemic countries to reduce the cost and technical obstacles associated with commercial kits.

[Profiles of IgG responses against CSP, GLURP and LSA-3NR2 in urban malaria (Dakar): relations with haemoglobin levels and parasite densities]

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.

[Particularities of liver abscesses in children in Senegal: Description of a series of 26 cases]

Liver abscess is a serious infection that can cause life-threatening complications.

OBJECTIVE

To describe the epidemiology, diagnosis, and progression of liver abscess at the Dakar National Albert-Royer Children's Hospital.

METHOD

A retrospective study was conducted from over a period of 5 years (1st January 2010 to 31st December 2014). All children aged 0-15 years hospitalized for liver abscess with ultrasound confirmation were included. We collected demographic data (age, gender, socioeconomic status, origin), clinical data (general and hepatic symptoms), diagnostic data (ultrasound, bacteriology) and progression (death, complications, sequelae). The data were analyzed with Epi-info (P<0.05 was considered significant).

RESULTS

We collected 26 cases of liver abscesses, representing a hospital prevalence of 100 cases per 100,000 admissions. Males predominated (sex ratio: 1.36). The children's average age was 7.2 years. Most of the children came from urban areas of Dakar. Low socioeconomic status and precarious lifestyle were the contributing factors. Anemia (69.2%), malnutrition (42.3%), and abdominal trauma (15.3%) were the main causes found. The Fontan triad characteristic of the liver abscess was found in 57.7% of cases. At ultrasound, a single abscess was found in 21 cases. The abscess was located in the right lobe in 18 cases, the left lobe in three cases, and in both lobes in three cases. Segment VI (four cases) was the most frequently involved. Bacteriologically, the abscess was pyogenic in 17 cases and an amoebic abscess in nine cases. The main pyogenic sources found were Klebsiella pneumoniae in two cases, Pseudomonas aeruginosa in one case, Streptococcus pneumoniae in one case, and Staphylococcus aureus in one case. The average duration of antibiotic treatment was 14.5 days. Liver drainage was carried out in 24 cases. The outcome was favorable in all children.

CONCLUSION

The prevalence of liver abscesses at the Albert-Royer Children's Hospital is relatively high, compared to the literature data. Percutaneous drainage combined with antibiotics remains the treatment of choice. The prognosis is favorable.

[Using routine information system data to assess maternal and perinatal care services in Mali and Senegal (QUARITE trial)]

BACKGROUND

In sub-Saharan Africa, problems of access to relevant and high-quality facility-based statistics hinder the assessment of safe motherhood programs. The objective of this study was to assess the quality of data collected in referral hospitals in Mali and Senegal after the routine information system (RIS) was strengthened.

METHODS

This was a multicenter observational study conducted during the pre-intervention period of a randomized controlled trial (trial QUARITE). The RIS was strengthened based on technical, organizational and behavioral factors. We included all women who gave birth in the 46 referral hospitals from October 1, 2007 to October 30, 2008. The completeness, completion and accuracy rates were monitored every 3 months in each hospital. The cost of investment needed to strengthen the existing RIS was also determined.

RESULTS

The mean completeness rate ranged from 94 to 97% depending on the study period. The completion and accuracy rates increased during the study period from 72% and 79% to 87% and 93%, respectively (significant differences). The average investment per hospital was less than 1% of state subsidies for public hospitals.

CONCLUSION

Strengthening the existing information system has set up an economically and technologically appropriate system for monitoring maternal and perinatal health in Senegal and Mali. We encourage policy makers and researchers from countries with limited resources to invest in RIS to improve and monitor the performance of health systems.

High acceptability of HIV voluntary counselling and testing among female sex workers: impact of individual and social factors

OBJECTIVES

Voluntary counselling and testing (VCT) for HIV infection is an important tool for prevention of HIV infection and AIDS in high-risk groups. Our goal was to describe the acceptability and consequences of VCT among a stigmatized and vulnerable group, female sex workers (FSWs), in Conakry, Guinea.

METHODS

Acceptance of the test and return for test results at baseline and consequences of testing 1 year later were described. The perceived risk of HIV infection and perceived benefits and barriers to testing were examined using quantitative and qualitative methods.

RESULTS

All 421 FSW participants agreed to undergo VCT and most participants (92%) returned for their results. The main reason cited for VCT acceptance was the wish to know their HIV status. However, some managers of FSW worksites urged FSWs to be tested, curtailing FSWs' free decision-making. One year later, status disclosure was common (90% of the 198 individuals who knew their results among those who participated in the follow-up part of the study). Positive consequences of testing were far more frequently reported than negative consequences (98% vs. 2%, respectively). Negative life events included banishment from the worksite (one case) and verbal abuse (two cases).

CONCLUSION

Acceptability of VCT appears high in the FSW population in Conakry as a consequence of both perceptions of high individual risk and social pressures.

Phylogenetic analysis of rabies viruses from Burkina Faso, 2007

Genetic characterization of 32 canine rabies viruses circulating in Burkina Faso in 2007 identified two clades both belonging to the Africa 2 lineage. Sequence homology data suggest that transboundary spread is the most likely means of introduction, highlighting an evolving epidemiological situation.

Molecular and antigenic evolution and geographical spread of H5N1 highly pathogenic avian influenza viruses in western Africa

In Africa, highly pathogenic avian influenza H5N1 virus was first detected in northern Nigeria and later also in other regions of the country. Since then, seven other African countries have reported H5N1 infections. This study reports a comparison of full-length genomic sequences of H5N1 isolates from seven chicken farms in Nigeria and chicken and hooded vultures in Burkina Faso with earlier H5N1 outbreaks worldwide. In addition, the antigenicity of Nigerian H5N1 isolates was compared with earlier strains. All African strains clustered within three sublineages denominated A (south-west Nigeria, Niger), B (south-west Nigeria, Egypt, Djibouti) and C (northern Nigeria, Burkina Faso, Sudan, Côte d'Ivoire), with distinct nucleotide and amino acid signatures and distinct geographical distributions within Africa. Probable non-African ancestors within the west Asian/Russian/European lineage distinct from the south-east Asian lineages were identified for each sublineage. All reported human cases in Africa were caused by sublineage B. Substitution rates were calculated on the basis of sequences from 11 strains from a single farm in south-west Nigeria. As H5N1 emerged essentially at the same time in the north and south-west of Nigeria, the substitution rates confirmed that the virus probably did not spread from the north to the south, given the observed sequence diversity, but that it entered the country via three independent introductions. The strains from Burkina Faso seemed to originate from northern Nigeria. At least two of the sublineages also circulated in Europe in 2006 as seen in Germany, further suggesting that the sublineages had already emerged outside of Africa and seemed to have followed the east African/west Asian and Black Sea/Mediterranean flyways of migratory birds.

Eurycoma longifolia extract-artemisinin combination: parasitemia suppression of Plasmodium yoelii-infected mice

Eurycoma longifolia, locally known as 'Tongkat Ali' is a popular local medicinal plant that possess a lot of medicinal properties as claimed traditionally, especially in the treatment of malaria. The claims have been proven scientifically on isolated compounds from the plant. The present study is to investigate the anti malaria properties of Eurycoma longifolia standardized extract (root) (TA164) alone and in combination with artemisinin in vivo. Combination treatment of the standardized extract (TA164) with artemisinin suppressed P. yoelii infection in the experimental mice. The 4 day suppressive test showed that TA164 suppressed the parasitemia of P. yoelii-infected mice as dose dependent manner (10, 30 and 60 mg/kg BW) by oral and subcutaneous treatment. By oral administration, combination of TA164 at 10, 30 and 60 mg/kg BW each with artemisinin respectively showed a significant increase in the parasitemia suppression to 63, 67 and 80 percent as compared to artemisinin single treatment (31%). Using subcutaneous administration, at 10 mg/kg BW of TA164 in combination with 1.7 mg/kg BW of artemisinin gave a suppression of 80% of infection. This study showed that combination treatment of TA164 with artemisinin gives a promising potential anti malaria candidate using both oral and subcutaneous route, the later being the most potent.

[Primary peritonitis in Sub-Saharian Africa: a 15 case series]

Primary peritonitis (PP) is an infection of the peritoneal cavity occurring in the absence of a documented intraabdominal source of contamination. It is one of the main infectious complications of cirrhosis but is rare in healthy subjects. The purpose of this retrospective study is to describe a series of 15 cases of PP treated over a 3-year period at the Principal Hospital in Dakar, Senegal. The patient population was young (all but 2 under age of 13 years) and predominantly female (87%) with no predisposing factors. Clinical presentation always involved typical peritonitis. Surgical exploration was performed in all cases by laparotomy (n=13) or laparoscopy (n=2). Intra-operative bacteriologic sampling was performed systematically. Probabilistic antimicrobial therapy was administered in all cases using a triple-drug combination including a cephalosporin or betalactamine, an aminoside and metronidazole. This unconventional combination was designed to allow low-cost wide-spectrum coverage. As in patients with cirrhosis, the most common microbial agents were gram-negative bacteria (47%). Streptococcus pneumoniae was identified in 40% of cases. Infectious ORL and pulmonary sites were suspected in some cases. Although no supporting bacteriologic evidence was obtained, the high frequency of pneumococcal involvement as well as the age and female predominance of the patient population is consistent with contamination via the female genital tract. The cases in this series present unusual epidemiological, clinical and bacteriologic features. In Europe surgical treatment can be avoided thanks to the availability of modern facilities to support further laboratory examinations. In Africa antimicrobial therapy and peritoneal lavage are the mainstay treatments. Use of laparoscopy should be expanded.

[A systemic approach to the diagnosis and treatment of allergic conjunctivitis]

The diagnosis of allergic conjunctivis begins by a meticulous questioning emphasizing the existence of ocular itching, the way of evolution of the signs and allergic preceeding. The examination searchs after follicles and papillae of the conjunctiva who usually go with serous discharges, blepharitis and keratitis. So four clinical forms may be described the chronic conjunctivitis, the vernal kerato-conjunctivitis, the atopic conjunctivitis and the giganto-papillar conjunctivitis. For the treatment, all non specific signs of allergy must be eliminated, the focal infections also and allergic substance isolated. If evolution is worse, an antiallergic eye drop is given until the disappearance of all the physical signs. In the same time, steroids and anti H1 drugs must be avoided. In case of failure, the specialist in allergy will be helpful to exam the patient.

[Ultrastructural aspects of the spermatozoon abnormalities on infertile men in Senegal]

Oligo-astheno-teratozoospermia being frequently observed (44,1%) in male subjects among hypofertiles couples of the sample population, we studied it at the ultrastuctural level. Our investigations have shown that, in addition to morphological and functional abnormalities, spermatic cells in said persons also presented serious ultrasructural disorders which would cause sterility. However in the absence of specific codified treatment for the majority of abnormalities found in sperms and given the high cost of the utrastructural analysis, we propose to limit our study to precise cases of male sterility through routine sample evaluations.

The application of PCR-ELISA to the detection of Trypanosoma congolense type savannah (TCS) in bovine blood samples

PCR-ELISA was set up to detect strains of Trypanosoma congolense type savannah (TCS) in field samples of buffy coats. Results of PCR-ELISA and PCR were compared and the effectiveness of both techniques was also compared with the Murray's method for the detection of TCS in 257 bovine buffy coats. The PCR products were labelled with digoxigenin (DIG-dUTP) during amplification cycles of the repetitive satellite DNA. A biotinylated DNA capture probe was used to detect the PCR products by ELISA in streptavidin coated microplates. Both the PCR-ELISA and PCR were more sensitive and more specific than the Murray's method. Of the 257 buffy coats analysed by the three techniques, PCR-ELISA and PCR detected TCS in 98 and 97 buffy coats respectively, whereas the Murray's method detected only 39 samples. PCR-ELISA and PCR had almost the same sensitivity and specificity. PCR-ELISA and PCR respectively detected TCS in 39.2% and 38.6% in all the 334 samples analysed by both techniques in this study.

Transferrin overexpression alters testicular function in aged mice

Many studies have shown a correlation between transferrin (Tf) concentration and sperm yield in several mammalian species. We have used transgenic mice expressing human Tf (hTf) to investigate if overexpression of Tf increases the efficiency of mouse spermatogenesis. We demonstrated that a 36% increase of Tf does not ameliorate the efficiency of mouse spermatogenesis but on the contrary resulted in a 36% decrease of testis sperm reserves. Tf overexpression had no effect on testicular determination and development, however testicular function of these transgenic mice was affected in an age-dependent manner. At 16 months of age, testicular and epididymal weights were significantly reduced. While spermatogenesis was qualitatively normal, testicular functions were perturbed. In fact, testosterone rate after human chorionic gonadotropin (hCG) stimulation was lower in Tf overexpressing mice. Intratesticular concentration of estradiol-17beta was increased and fluid accumulation after ligation of rete testis was more abundant in these transgenic mice. Surprisingly, we found that endogenous Tf levels were also increased in Tf overexpressing mice and we demonstrated for the first time that Tf may serve to upregulate its own expression in testis. Collectively, our data show that Tf overexpression has negative effects on testicular function and that Tf levels require strict regulation in the testis.

[Appendicectomy in the tropics: prospective study at Hôpital Principal in Dakar]

Acute appendicitis is the most common surgical indication in Africa. It is associated with higher mortality and morbidity than in industrialized countries. The purpose of this prospective 100 case study was to evaluate diagnostic, clinical and paraclinical features as well as surgical modalities especially with regard to approach and postoperative recovery in patients that underwent surgical treatment for appendicitic syndromes over a 9-month period at our institution. Analysis of study data confirmed that surgical indications could be established based on clinical examination alone and that adjuvant investigations only delayed therapy while providing little specific, useful information. Delayed management is a specific feature of tropical areas. Surgical exposure was achieved by the MacBurney approach in 65% of cases, celioscopic approach in 18%, and median laparotomy in 17%. The benefit of the celiosocopic approach was statistically signicant in terms of resumption of eating, duration of hospitalization and incidence of postoperative complications. Mortality in this series was 0% and morbidity was 7% mainly due to parietal complications.

[Dermatomyositis in Senegal. Study of 56 cases]

INTRODUCTION

Dermatomyositis (DM) is rarely reported in black African. We report a retrospective study of epidemiological, clinical and evolutive aspects of dermatomyositis observed from 1983 to 2001 in dermatological department of Senegal.

MATERIALS AND METHOD

The diagnosis of D M was a ccepted when patients proved to fulfil Bohan and Peter's diagnostic criteria. We had recruited 56 African black patients of average age 34.5 years and of sex-ratio (M/F) 0.27.

RESULTS

The first clinical manifestation was cutaneous in 94% of cases. Dermatoligical signs were dominated bye rythema (77%), characterized by zebra-like aspect on extension faces of limbs. The erythema was pruriginous in 45% of cases. The others clinical manifestations were: muscular (86%), a rticular (60%), cardiac (34%), broncho-pulmonary (30.4%), digestive (30%), Raynaud's phenomena (20%) and ocular (7%). Muscular enzymes were increased in 95% for lacticodeshydrogenase and 71% for creatininine phosphokinase. Electromyography (in 25 cases), revealed a myogenic tracing in all cases, associated in 22 cases with a decreasing speed of the peripheral nervous conduction. Muscular biopsy made in 3 patients showed specific signs of DM and in one case, those were associated to a perivascular infiltration in the muscles and nerves with axonal nervous degeneration images. Dermatomyositis were p araneoplasic in 6 cases and the cancers were genital in all cases. The evolution after corticotherapy was favourable in 59% of cases. The cases of death (14 cases) were caused by the associated cancer (6 cases), repirator distress (4 cases) and infectious's complication of corticotherapy (4 cases). The relapses (16%) were secondary to treatement's interruption.

CONCLUSION

DM in Senegal affects young people with zebra-like erythema, often scratched and frequently associated with peripheral neuropathy. Genital cancers predomined in paraneoplasic forms.

[Prevalence of malnutrition in the Mbao Health District]

Protein-energy malnutrition is a real health priority in developing countries specially in african ones. So, a cross-sectional study was conducted, from April 14 to July 28 1995, in the health district of Mbao in Senegal, to determine the prevalence of protein-energy malnutrition (PEM) in a population of children 0-5 year old utilizing the health center, for a curative care, an immunization, a growth monitoring. Anthropometric and sociodemographic data were collected and analysed using a microcomputer with WHO/CDC Epi Info 6.0. The index weight/age expressed on Zscore was used with comparison to NCHS/CDC/WHO population's international reference. Among 204 children, 89 (43.6%) present a PEM.51 (57.3%) are male. More than 60% of the children with PEM are 6-29 months old. 74 (83.2%) live in the surroundings of Mbao. They all come from different ethnic group. 67.4% utilize the health center for a curative care and 7.9% for growth monitoring. There is no relation statistically significant between protein-energy malnutrition and the parameters we studied. To overcome such problem, it is necessary to strengthen the management of malnourished children in specialized centers, to educate families in the nutritional properties of local products and to improve the socioeconomic status of the population for better access to these products.

[Prevalence of serum markers of hepatitis B and C virus in blood donors of Nouakchott, Mauritania]

This preliminary survey was intended to collect transversal data to ensure a better understanding of the hepatitis B and C epidemiology in Mauritania. The authors have studied the seroprevalence rate of HBs antigen and HCV antibodies among 349 blood donors. Data of this study showed that anti-HCV antibody was detected in 1.1% and HBs antigen in 20.3% blood donors.

Linkage-disequilibrium of the senegal haplotype with the beta S gene in the republic of guinea

We have determined the beta gene cluster haplotype in 40 chromosomes carrying the beta S mutation from individuals of the major ethnic groups living in the Republic of Guinea. Thirty-one of these were either the typical (n = 29) or the atypical (n = 2) Senegal haplotype demonstrating that in this region of Atlantic West Africa, the sickle mutation is in linkage disequilibrium with this particular beta-gene cluster haplotype. Two individuals carrying one chromosome bearing the Benin haplotype were of Malinke ethnic origin. This is in keeping with the hypothesis that the Senegal beta-gene cluster haplotype is linked to the beta S gene in Atlantic West Africa.

Clinical efficacy of a new, enhanced-potency, inactivated poliovirus vaccine

The 1986-87 outbreak of paralytic poliomyelitis in Senegal, with 676 reported cases, provided an opportunity to evaluate the efficacy of an enhanced-potency inactivated poliovirus vaccine (N-IPV) in the Kolda region, where this vaccine has been used since 1980. 89 cases, confirmed to have poliomyelitis with residual paralysis, were enrolled in a case-control study, up to 5 matched controls being obtained for each case. The clinical efficacy for one dose of N-IPV was 36% (95% confidence interval 0%, 67%) and for two doses was 89% (95% CI 62%, 97%).

The epidemiology of measles in a partially vaccinated population in an African city: implications for immunization programs

A large outbreak of measles was reported in Pointe-Noire, Congo, between October 1984 and March 1985. An investigation was conducted to determine the epidemiology of measles in this community in which, in 1985, 54% of the children 12-23 months of age had documented evidence of vaccination against measles. The investigation included hospital and clinic record reviews and a community survey. Measles has been continuously transmitted in Pointe-Noire since at least 1979, with seasonal epidemics. In early 1984, the expected epidemic did not occur, and at least 1,000 measles hospital admissions and 100 measles deaths were prevented. Between October 1984 and March 1985, 1,942 measles cases were hospitalized, of which 306 (15.8%) died. During the epidemic, the proportion of nonpreventable cases (cases occurring before nine months of age) was 17%, reflecting the change in age distribution of measles cases in childhood since the immunization program started in Pointe-Noire in 1982. From the community survey, it was estimated that 13% of all children under age five years acquired measles in Pointe-Noire in 1985. Vaccine efficacy was calculated from community and hospital samples to be between 78% and 87%. Our findings suggest that increasing vaccination coverage levels to well above 50% is necessary to substantially reduce measles morbidity and mortality in African cities.

Cefotaxime treatment of meningitis in children

Dangerous in all circumstances, purulent meningitis is even more life-threatening in tropical areas. This results from underlying malnutrition, haemoglobinopathy and enzymopathy, but also from delays in treatment. We have treated 28 patients, 16 boys and 12 girls, aged from 16 days to 7 years suffering from purulent meningitis, with cefotaxime. Almost half of the patients were suffering from malnutrition and low body weight, or from haemoglobinopathy. Cefotaxime, administered 2 or 3 times daily intramuscularly, was given at 90 to 200/mg/kg with a mean of 150/mg/kg/day. Overall, results showed a 79% cure rate including 71% complete recovery, the highest ever seen in the department.

[The prognosis and treatment of pneumococcal meningitis in Africa. 402 cases (author's transl)]

Over a period of 5 years (1973--1977), 1083 patients were hospitalised in the Infectious Disease Clinic of the Dakar University Hospital Centre with bacteriologically confirmed purulent meningitis. The pneumococcus was responsible in 462 cases (42.6%). Analysis of 402 records showed that 234 patients (58.2% of cases) died, 123 were completely cured (30.6%) whilst there were neurological sequelae in 45 cases (28% of the survivors). The chief factors in poor prognosis were the existence and depth of changes in conscious level, age over 20 years, a CSF cell count of less than 500 per mm3, a CSF protein level greater than 2 g per 1 and I CSF antigen level over 8 microgram per ml. From a therapeutic standpoint, the percentage mortality was similar with chloramphenicol and with penicillin G, but complete cures were statistically more frequent in the patients treated initially with chloramphenicol.

[The rapid detection and specific identification of bacterial antigens by electro-immunodiffusion in 80 cases of purulent meningitis (author's transl)]

The cerebrospinal fluid of 120 subjects, 80 of whom were suffering from a purulent meningitis, were examined comparatively by classical bacteriological techniques (direct examination and culture) and by electro-immunodiffusion. This procedure makes it possible to detect not only viable bacteria, but also capsular polysaccharide antigens. It revealed the diagnosis in 96.9% of cases of meningococcal, pneumococcal and Haemophilus meningitis, as against 80.3% positive results using classical bacteriological techniques, for the same organisms. Electro-immunodiffusion provides a rapid answer (20 minutes) and, amongst other things, makes it possible: - to confirm the serotype or capsular type within the species, - to determine the aetiological diagnosis in certain types of meningitis where diagnosis is rendered difficult by blind antibiotic therapy, - to quantify and follow over a period of time the levels of polysaccharide antigens in the cerebrospinal fluid and serum of the patients. The sensitivity and specificity of electro-immunodiffusion render it a technique of the future in the diagnosis of purulent meningitis. By virtue of its simplicity, it should become a routine examination.