Medical check-up of newly arrived unaccompanied minors: A dedicated pediatric consultation service in a hospital

BACKGROUND AND AIMS

Healthcare for the increasing number of migrants in Europe, and particularly of unaccompanied minors (UMs) seeking asylum, has become a major challenge. We aimed to describe the health issues of UMs managed in a dedicated pediatric consultation service in a care center in Paris.

METHODS

All UMs attending a dedicated migrant medical consultation service in Robert Debré Hospital, Paris, France, were included in a single-center retrospective observational study from September 1, 2017, to September 30, 2018.

RESULTS

Out of the 107 UMs who were included, 87% had a health problem (n=93) and 52% had an infectious disease (n=56). The main infectious diagnoses were schistosomiasis (22%), latent tuberculosis (22%), intestinal parasitosis (16%), and chronic hepatitis B (8%). Posttraumatic stress disorder (PTSD) and overweight were common (35% and 20%, respectively). The median age was 15 years old (IQR, 14-16), the male/female ratio was 95/12. Most of the children were from sub-Saharan Africa (n=67), 46% had crossed Libya (n=49) and, when compared to the other migration routes, faced an increasing risk of violence (69%, p=0.04), imprisonment (53%, p=0.03), and forced labor (48%, p=0.02). The median duration of the trip before reaching France was 6 months (IQR, 2-13), the median time to consultation was 2 months (0-5) and was not associated with an increased risk of health problems. A total of 43 UMs were lost to follow-up.

CONCLUSION

Health problems, particularly infectious diseases and PTSD, are common among UMs and should prompt an early medical consultation with psychiatric evaluation. Follow-up is problematic and could be improved by an on-line health book.

The COVID-19 pandemic in francophone West Africa: from the first cases to responses in seven countries

Background

In early March 2020, the COVID-19 pandemic hit West Africa. In response, countries in the region quickly set up crisis management committees and implemented drastic measures to stem the spread of the SARS-CoV-2 virus. The objective of this article is to analyse the epidemiological evolution of COVID-19 in seven Francophone West African countries (Benin, Burkina Faso, Côte d’Ivoire, Guinea, Mali, Niger, Senegal) as well as the public health measures decided upon during the first 7 months of the pandemic.

Methods

Our method is based on quantitative and qualitative data from the pooling of information from a COVID-19 data platform and collected by a network of interdisciplinary collaborators present in the seven countries. Descriptive and spatial analyses of quantitative epidemiological data, as well as content analyses of qualitative data on public measures and management committees were performed.

Results

Attack rates (October 2020) for COVID-19 have ranged from 20 per 100,000 inhabitants (Benin) to more than 94 per 100,000 inhabitants (Senegal). All these countries reacted quickly to the crisis, in some cases before the first reported infection, and implemented public measures in a relatively homogeneous manner. None of the countries implemented country-wide lockdowns, but some implemented partial or local containment measures. At the end of June 2020, countries began to lift certain restrictive measures, sometimes under pressure from the general population or from certain economic sectors.

Conclusion

Much research on COVID-19 remains to be conducted in West Africa to better understand the dynamics of the pandemic, and to further examine the state responses to ensure their appropriateness and adaptation to the national contexts.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-11529-7.

Participating in a vaccine trial for COVID-19 in Senegal: trust and information

This research aims to understand the level and determinants of people's willingness to participate in a vaccine trial for COVID-19 in Senegal. We conducted a telephone survey among a marginal quota sample of 607 people over 18 years of age. Only 44.3% of the participants wanted to participate in a vaccine trial for COVID-19, with females intending to participate more than males (AOR = 1.82, 95% CI [1.22-2.72]). Participants who intended to be vaccinated against COVID-19 (AOR = 6.48, 95% CI [4.12-10.4]) and who thought that being infected with the coronavirus would have a significant impact on their health (AOR = 2.34, 95% CI [1.57, 3.51]) were more likely to agree to take part in the COVID-19 vaccine trial. Confidence in the vaccine, health personnel, and the government in the fight against the pandemic are key factors in participants' willingness to participate in a vaccine trial in Senegal.

Projecting potential impact of COVID-19 on major cereal crops in Senegal and Burkina Faso using crop simulation models

CONTEXT

The rapid emergence of COVID-19 could have direct and indirect impacts on food production systems and livelihoods of farmers. From the farming perspective, disruption of critical input availability, supply chains and labor, influence crop management. Disruptions to food systems can affect (a) planting area; and (b) crop yields.

OBJECTIVES

To quantify the impacts of COVID-19 on major cereal crop's production and their cascading impact on national economy and related policies.

METHODS

We used the calibrated crop simulation model (DSSAT suite) to project the impact of potential changes in planting area and grain yield of four major cereal crops (i.e., rice, maize, sorghum, and millet) in Senegal and Burkina Faso in terms of yield, total production, crop value and contribution to agricultural gross domestic product (GDP). Appropriate data (i.e., weather, soil, crop, and management practices) for the specific agroecological zones were used as an input in the model.

RESULTS AND CONCLUSIONS

The simulated yields for 2020 were then used to estimate crop production at country scale for the matrix of different scenarios of planting area and yield change (-15, -10, -5, 0, +5, +10%). Depending on the scenario, changes in total production of four cereals combined at country levels varied from 1.47 M tons to 2.47 M tons in Senegal and 4.51 M tons to 7.52 M tons in Burkina Faso. The economic value of all four cereals under different scenarios ranged from $771 Million (M) to $1292 M in Senegal and from $1251 M to $2098 M in Burkina Faso. These estimated total crop values under different scenarios were compared with total agricultural GDP of the country (in 2019 terms which was $3995 M in Senegal and $3957 M in Burkina Faso) to assess the economic impact of the pandemic on major cereal grain production. Based on the scenarios, the impact on total agricultural GDP can change -7% to +6% in Senegal and - 8% to +9% in Burkina Faso.

SIGNIFICANCE

Results obtained from this modeling exercise will be valuable to policymakers and end-to-end value chain practitioners to prepare and develop appropriate policies to cope or manage the impact of COVID-19 on food systems.

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.

Macrophage activation syndrome, a rare complication of primary Sjögren's syndrome: a case report

Background

The association of macrophage activation syndrome and primary Sjögren’s syndrome has been rarely reported in the literature. We report the first observation of this association in Africa, south of the Sahara, and we discuss the diagnosis and therapeutic challenge.

Case presentation

A 26-year-old Mauritanian and Berber woman was followed for primary Sjögren’s syndrome. After a voluntary cessation of her usual background treatment, she was admitted to our department for an outbreak of her illness. A clinical examination revealed anemic syndrome, peripheral polyarthritis, coughing rales at both pulmonary bases, and fever at 39.5 °C. On biologic examination, there was bicytopenia with anemia at 5.70 g/dl, lymphopenia at 796/mm³, a biological inflammatory syndrome with a sedimentation rate at 137 mm in the first hour, C-reactive protein at 97 mg/l, hyperferritinemia at 1778 mg/l (9 normal value), and hypergammaglobulinemia at 20.7 g/l of polyclonal appearance. The triglycerides were 1.95 g/l (1.4 normal value) and the lactate dehydrogenase level was 491 IU/l (1.5 normal value). Cytological examination of a medullary puncture revealed an image of hemophagocytosis. An infectious screening was negative. Thoracic computed tomography showed non-specific interstitial lung disease. A diagnosis of macrophage activation syndrome complicating primary Sjögren’s syndrome was selected with a probability of 97.2%, according to H-Score. The evolution was favorable under a treatment including etoposide (VP-16).

Conclusion

Macrophage activation syndrome is a rare entity, rarely reported during primary Sjögren’s syndrome. Its spontaneous evolution is invariably fatal. There is no consensus on therapeutic treatment. Etoposide is a therapeutic option especially in forms refractory to corticosteroid therapy.

Management and prevention of imported malaria in children. Update of the French guidelines

Since the 2007 French guidelines on imported Falciparum malaria, the epidemiology, treatment, and prevention of malaria have changed considerably requiring guidelines for all Plasmodium species to be updated. Over the past decade, the incidence of imported malaria has decreased in all age groups, reflecting the decrease in the incidence of malaria in endemic areas. The rates of severe pediatric cases have increased as in adults, but fatalities are rare. The parasitological diagnosis requires a thick blood smear (or a rapid immunochromatographic test) and a thin blood film. Alternatively, a rapid antigen detection test can be paired with a thin blood film. Thrombocytopenia in children presenting with fever is highly predictive of malaria following travel to a malaria-endemic area and, when detected, malaria should be strongly considered. The first-line treatment of uncomplicated P. falciparum malaria is now an artemisinin-based combination therapy (ACT), either artemether-lumefantrine or artenimol-piperaquine, as recommended by the World Health Organization in endemic areas. Uncomplicated presentations of non-falciparum malaria should be treated either with chloroquine or ACT. The first-line treatment of severe malaria is now intravenous artesunate which is more effective than quinine in endemic areas. Quinine is restricted to cases where artesunate is contraindicated or unavailable. Prevention of malaria in pediatric travelers consists of nocturnal personal protection against mosquitoes (especially insecticide-treated nets) combined with chemoprophylaxis according to the risk level.

Impact of social deprivation on length of stay for common infectious diseases in two French university-affiliated general pediatric departments

BACKGROUND

Adult deprived patients consume more healthcare resources than others, particularly in terms of increased length of stay (LOS) and costs. Very few pediatric studies have focused on LOS, although the effect of deprivation could be greater in children due to the vulnerability of this population. Our objective was to compare LOS between deprived and nondeprived children hospitalized for acute infectious diseases in two university-affiliated pediatric departments located in a low-income area of northern Paris.

METHODS

We performed a prospective observational multicenter study in two university-affiliated hospitals, Hôpital Robert-Debré and Hôpital Jean-Verdier. All the patients under 15 years of age admitted to the general pediatric department for pneumonia, bronchiolitis, gastroenteritis, or pyelonephritis between 20 October 2016 and 20 March 2017 were included. Deprivation was assessed with an individual questionnaire and score (EPICES). Endpoints included length of stay, costs, and readmission rates at 15 days in each quintile of deprivation. Multivariate regression assessed the association between deprivation and each endpoint.

RESULTS

A total of 556 patients were included in the study and 540 were analyzed. Sixty percent were boys and the mean age was 9 months±18. Bronchiolitis was the most frequent diagnosis (67.8%). Fifty-six percent of patients were considered to be deprived based on the EPICES questionnaire. Mean LOS was 4.6±3.5 days and we found no significant difference in LOS between the different deprivation quintiles (P=0.83). Multivariate regression did not show an association between LOS and deprivation.

CONCLUSION

There was no difference between deprived and nondeprived patients in terms of LOS. Deprivation may therefore impact hospitals in other ways such as admission rates. The impact of deprivation during hospitalization for chronic diseases should also be investigated.

[Nosocomial rotavirus gastroenteritis]

Rotavirus is the most common cause of gastroenteritis in children requiring hospitalization. It is a very resistant and contagious virus causing nosocomial gastroenteritis. In France, the vaccine against rotavirus has been available since 2006, but the vaccine is not recommended for infant vaccination. The aim of this retrospective study was to describe nosocomial rotavirus gastroenteritis (NRGE) and to assess its impact on children hospitalized in the General Pediatrics Department of Robert-Debré Hospital (Paris) between 1 January 2009 and 31 December 2013. We analyzed the demographic characteristics of children (age, term birth, underlying diseases) and the severity of the NRGE (oral or intravenous hydration), and assessed whether these children could benefit from vaccination against rotavirus.

RESULTS

One hundred thirty-six children presented nosocomial rotavirus infection, with an incidence of 2.5 NRGE per 1000 days of hospitalization. The incidence of NRGE was stable between 2009 and 2013 despite the introduction of specific hygiene measures. The average age of the children was 7 months (range: 0.5-111 months). Most often NRGE occurred in children hospitalized for respiratory diseases (65% of cases) and requiring prolonged hospitalization (median: 18 days). One-third of children were born premature (25%). Hydration was oral in 80 patients (59%), by intravenous infusion in 18 patients (13%), and intraosseous in one patient. Half of the patients were aged less than 5 months and could benefit from the protection afforded by vaccination.

CONCLUSION

NRGE are common. Rotavirus mass vaccination should have a positive impact on the incidence of NRGE by reducing the number of children hospitalized for gastroenteritis, therefore indirectly reducing the number of hospital cross-infections of hospitalized children who are too young to be vaccinated.

Phylogeography of the genus Podococcus (Palmae/Arecaceae) in Central African rain forests: Climate stability predicts unique genetic diversity

The tropical rain forests of Central Africa contain high levels of species diversity. Paleovegetation or biodiversity patterns suggested successive contraction/expansion phases on this rain forest cover during the last glacial maximum (LGM). Consequently, the hypothesis of the existence of refugia e.g. habitat stability that harbored populations during adverse climatic periods has been proposed. Understory species are tightly associated to forest cover and consequently are ideal markers of forest dynamics. Here, we used two central African rain forest understory species of the palm genus, Podococcus, to assess the role of past climate variation on their distribution and genetic diversity. Species distribution modeling in the present and at the LGM was used to estimate areas of climatic stability. Genetic diversity and phylogeography were estimated by sequencing near complete plastomes for over 120 individuals. Areas of climatic stability were mainly located in mountainous areas like the Monts de Cristal and Monts Doudou in Gabon, but also lowland coastal forests in southeast Cameroon and northeast Gabon. Genetic diversity analyses shows a clear North-South structure of genetic diversity within one species. This divide was estimated to have originated some 500,000years ago. We show that, in Central Africa, high and unique genetic diversity is strongly correlated with inferred areas of climatic stability since the LGM. Our results further highlight the importance of coastal lowland rain forests in Central Africa as harboring not only high species diversity but also important high levels of unique genetic diversity. In the context of strong human pressure on coastal land use and destruction, such unique diversity hotspots need to be considered in future conservation planning.

[Fever in children returning from travel]

Child travelers are numerous, exposed to the risk of diseases, both infectious and noninfectious, for which practitioners often lack experience. The assessment of febrile returning child travelers is becoming more frequent and challenging. The question of previous travel should be foremost in the checklist of the interview of any febrile child traveler, because this implies a possible tropical disease such as malaria that may be life-threatening. These need to be investigated and treated effectively and rapidly. There are highly contagious infections that could pose public health risks requiring implementation of hygienic and public health measures. A detailed immunization, medical, and travel history for exposure to infectious risks using geographic, seasonal, environmental, sociocultural, and epidemiological data are needed. Along with clinical examination and elementary first-line investigations, the history should guide second-line exams, which will provide the etiology and optimal treatment in approximately 75 % of cases. The majority of children will have a cosmopolitan infection that resolves spontaneously or is simple to treat. Malaria will need urgent and specific treatment. This article describes guidance on first-line evaluation and management of febrile child travelers as recommended in France.

Evaluation of frequency of paediatric oral liquid medication dosing errors by caregivers: amoxicillin and josamycin

OBJECTIVE

To study reconstitution and preparation dosing errors of liquid oral medications given by caregivers to children.

METHODS

A prospective observational study was carried out in the departments of general paediatrics and emergency paediatrics at the Robert-Debré Children's University Hospital. An interview with caregivers involved (1) practical reconstitution and preparation of an oral liquid medication from a prescription drawn at random (amoxicillin (Clamoxyl, dosing spoon) or josamycin (Josacine, dose-weight pipette)) and (2) a questionnaire about their use.

RESULTS

One hundred caregivers were included. Clamoxyl and Josacine were incorrectly reconstituted in 46% (23/50) and 56% (28/50) of cases, respectively, with a risk of underdosing of Clamoxyl (16/23) and overdosing of Josacine (23/28). Dose preparation with the dosing spoon was incorrect in 56% of cases, and in 10% of cases with the dose-weight pipette. Female sex, native French speaker, and age were significantly associated with correct reconstitution. Male sex and medication were significantly associated with correct preparation.

CONCLUSIONS

This study highlights the high incidence of errors made by caregivers in reconstituting and preparing doses of these liquid oral medicines, which are associated with considerable risks of over- and underdosing. Factors associated with these errors have been identified which could help health professionals to optimise their strategy for educating families about the use of liquid oral medications and the need to check that they understand these instructions.

[How Bone Densitometry contributes to the diagnosis of Osteoporosis at the Gerontology and Geriatrics Center of Ouakam, Dakar City: 102 observation]

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.

[Perception and assessment of pain by caregiver and adolescent with sickle cell disease: The impact of the patient's anxiety]

Pain is the main symptom in sickle cell disease and is a major issue in its management. Its complexity often makes assessment difficult for both patients and caregivers. This study looks for a link between anxiety in children with sickle cell disease at the beginning of their hospital stay and the difficulties experienced by caregivers to assess their pain. Forty teenagers hospitalized for a vaso-occlusive crisis were included in this prospective study. To determine which patients were "difficult to assess," a self-assessment of pain combined with a nursing assessment were proposed to patients (NS [numerical scale] and FLACC [Face Legs Activity Cry Consolability]). Feedback from specialized physicians was collected. In this study, no objective criteria allowed us to determine whether patients were "difficult to assess." At the beginning of the hospital stay, self-assessment for pain and nurse assessment with the NS matched. In this context, the FLACC scale did not assist in determining the pain score accurately. Patients identified as difficult to assess by physicians are more anxious than others.

[Study of the immunization coverage determinants of vaccination campaign against meningococcal A meningitis in 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.

A large national cohort of French patients with chronic recurrent multifocal osteitis

OBJECTIVE

To document more fully the characteristics of chronic recurrent multifocal osteomyelitis (CRMO) in pediatric patients, to collect data on the outcomes and management of the disease, and to define prognostic factors.

METHODS

One hundred seventy-eight patients were included (123 female patients and 55 male patients), with a mean ± SD age at diagnosis of 10.9 ± 2.9 years. Inclusion criteria were a diagnosis of CRMO, evidence of at least one lesion of osteitis confirmed by imaging, and development of the syndrome before age 18 years.

RESULTS

Longitudinal clinical and imaging studies revealed that only 12 of 178 CRMO patients (7%) had unifocal lesions at the last medical visit. We were able to apply the clinical chronic nonbacterial osteomyelitis score to 110 of 178 patients (62%), which indicated that bone biopsy could have been avoided in 27 cases (25%). At the last medical visit, disease was in remission in only 73 of 171 patients (43%) (41% receiving therapy) after a mean ± SD of 47.9 ± 38.9 months; 44 of 171 patients (26%) experienced sequelae. Using cluster analysis, the CRMO cohort was separated into 3 homogeneous phenotypes (severe, mild, and intermediate). Patients with the severe phenotype had the worst prognosis. This group was entirely composed of male patients, most of whom had the multifocal form of CRMO and inflammatory syndrome. Patients with the mild phenotype had the best prognosis. This group was primarily composed of female patients with a unifocal form of CRMO and infrequent clavicle involvement and inflammatory syndrome. Patients with the intermediate phenotype had a good prognosis but greater reliance on treatment. This group primarily included female patients with multifocal lesions and inflammatory syndrome.

CONCLUSION

This is the largest CRMO cohort described in the literature to date. Clinical evolution and imaging investigations confirmed the multifocal pattern of the disease. Three distinct subgroups of CRMO patients were distinguished, with very different prognoses.

[Management of urinary tract infections in children. Recommendations of the Pediatric Infectious Diseases Group of the French Pediatrics Society and the French-Language Infectious Diseases Society]

Urine dipsticks have to be used more frequently for the screening of urinary tract infections (UTI) in febrile infants and children (grade A). Confirmation of the UTI by urine culture should prefer other methods of sampling than the urine bag: sampling jet, urethral catheterization, or pubic puncture (grade A). The percentage of Escherichia coli producing extended-spectrum beta-lactamases (ESBL) in children accounts for less than 10 % in France and does not justify revising the 2007 recommendations (grade B). An increase in the use of carbapenems in first-line treatment is a major environmental hazard and exposes the patient to the risk of untreatable infections. For febrile UTI, the expert group recommended: (1) recover the results of susceptibility testing as soon as possible to quickly adapt treatment for possible resistant strains; (2) favor initial treatment with aminoglycosides (particularly amikacin) which remain active in the majority of ESBL strains for patients seen in the pediatric emergency department and/or hospital; (3) ceftriaxone (IV or IM) remains an appropriate treatment for patients seen in the emergency department or outpatient clinic because the percentage of ESBL-producing enterobacteria strains remains low; (4) use oral cefixime (grade B) in nonsevere cases and low-risk patients defined as age>3 months, general condition preserved, disease duration of fever<4 days, no associated comorbidity, and no history of urinary tract infection, uropathy, or prior antibiotic therapy in the last 3 months; (5) oral relay for parenteral treatment is guided by in vitro susceptibility testing, in an attempt to reduce the use of oral cephalosporins to limit the selection of resistant bacterial strains. The total duration of treatment recommended is usually 10 days. Except for special circumstances, there is no need to prescribe retrograde cystography or antibiotic prophylaxis after a first febrile urinary tract infection. For cystitis, the panel recommends systematic urinalysis and initial prescription before the results of the urine culture of one of the three following oral antibiotics: amoxicillin-clavulanate, cotrimoxazole, cefixime. The total duration of antibiotic treatment is 5days to tailor treatment based on clinical progression and antibiotic susceptibility.

[Assistance and Support Units for the elderly: A tool for promoting health in seniors: Example of the CAAPA unit of "Sicap Rue 10", in Dakar]

As a body for reflection, dialogue and integration, the CAAPA Assistance and Support Unit of "Sicap Rue 10" allows the elderly to fully participate in the life of their society while being in good health. The unit has been set up by the local authorities following recommendations from interdepartmental cabinet meeting on 13 November, 200. Nine years after the creation of the unit, it becomes important to evaluate the degree of community participation of the elderly within that unit. This is a qualitative, descriptive and analytic study that took place from 9 October to 23 October, 2010. The two methods used to collect the data are interviewing and focus group. Using Bichmann's scale, which has been modified and adapted, the results have shown an "average-level" participation of the elderly in the creation of the CAAPA unit, its implementation as well as the follow-up and the evaluation of its activities; this participation being "open" in the composition of the piloting committee and "restricted" in mobilizing and managing material and financial resources. Recommendations have been stated for the CAAPA unit to fully play its role.