[Access to health care in Dakar (Senegal): frequency, type of provider, and non-communicable chronic diseases]. / Accès aux soins à Dakar (Sénégal): fréquence, type de soignants et maladies chroniques non transmissibles.

OBJECTIVES: (1) To describe access to health care in the population of Dakar; (2) to analyze the influence of socioeconomic and demographic characteristics on access to health care; (3) and to describe the fraction of consultations accounted for by chronic non-communicable diseases. METHODS: These data come from a 2009 survey of 600 individuals aged 20 years and over. Socioeconomic and demographic characteristics and information about access to health care were collected. Chi-square tests and binary logistic regressions were used for the statistical analyses. RESULTS: Men, people with no schooling, and poor people were underrepresented among users of health care services. Moreover, the majority of Dakar residents who sought health care during the year preceding the survey went to see a doctor (as opposed to a traditional healer, pharmacist, nurse, midwife, or dentist). Finally, chronic diseases accounted for the smallest fraction of reasons for medical consultations; they were mentioned most often by those aged 50 years or older who consult more than 5 times a year. CONCLUSIONS: Dakar residents have an access to health care similar to that of people in other African countries, but this conclusion hides major inequalities. Moreover, at the same time that Senegal is undergoing an epidemiological transition, chronic non-communicable diseases are not a major reason for consultations. The epidemiological projections made for Africa for the next 15 years indicate that the development of strategies to avert the development of these diseases in Senegal must be a priority objective.

[Ageing and chronic diseases in Senegal. A comparison between rural (Ferlo) and urban (Dakar) populations]. / Vieillissement et pathologies chroniques au Sénégal. Comparaison entre des populations vivant en milieu rural (Ferlo) et urbain (Dakar).

The objectives of this study were: to compare the prevalence of hypertension, overweight and obesity in rural (Ferlo) and urban (Dakar) Senegalese populations aged 50 and over. The survey was conducted on individuals aged 50 and older living in the rural area (N=478) and in the urban area (N=220). We have collected data about age, gender, marital status, education level, and knowledge, treatment of hypertension, height, weight and blood pressure. We have observed that overweight and obesity were more prevalent in the urban area (Dakar) than in the rural one (Ferlo). The risk of overweight or obesity decreased when age increased, and women had weight problems more often than men. The prevalence of arterial hypertension was lower in rural area (55.86%) than in Dakar (66.36%), but increased at an older age. However, the logistic regression showed that these increased proportion of hypertension in Dakar is linked to the more important proportion of overweight and obese people in this area. Moreover, rates of knowledge, treatment and control of hypertension are particularly low in the rural area of Senegal. In conclusion, age-associated diseases should be better managed in Senegal, particularly in rural areas.

Hypertension prevalence, awareness, treatment and control in Dakar (Senegal).

The prediction of risk profile trends associated with non-communicable diseases in developing countries is among the greatest global health challenges. The aim of this study is to estimate prevalence, awareness, treatment and control of hypertension in Dakar (Senegal). This study was carried out between January and June 2009 on a population sample of 600 individuals living in the department of Dakar. This sample was constructed using the quota method in order to strive for representativeness. Sociodemographic characteristics, hypertension, hypertension awareness, treatment and control, and body mass index of individuals were collected during face-to-face interviews. Statistical analyses used were χ2-tests and binary logistic regressions. Prevalence of hypertension was 27.50%. Prevalence of awareness, treatment and control among hypertensives were 27.88%, 16.97% and 5.45%, respectively. Logistic regression showed that the prevalence, awareness and treatment of hypertension increased with increasing age. Overweight and obese subjects were more often hypertensive but did not differ from others in awareness and treatment. This could be linked to the social valorization of stoutness in West Africa, which explains that excess weight is not perceived as a risk factor for hypertension. In conclusion, given the very low rates of awareness, treatment and control in our sample, developing strategies for averting a hypertension epidemic must be a priority objective.

Social valorisation of stoutness as a determinant of obesity in the context of nutritional transition in Cameroon: the Bamiléké case.

Body size perceptions were assessed among members of the Bamiléké, an ethnic group in an urban setting in Cameroon with high rates of obesity, but also a positive perception of stoutness in its social representations. We first implemented a qualitative study (April 2007) to identify local representations of body weight among Bamiléké using semi-structured interviews. We then quantitatively assessed body size perceptions among a representative sample of Bamiléké (May to June 2007), employing a body image assessment scale and a questionnaire that included declarative body weight self-satisfaction, health status, and attempts to reduce weight. Results indicate Desired Body Size (DBS) for women, and particularly for men, was situated in the overweight category. Qualitative analyses show that overweight is considered as a normal and healthy body size in the Bamiléké. On the other hand, the quantitative study reveals that high rates of obesity, especially in women (40.8% obese), are associated with high blood pressure. Moreover, subjects who had a negative perception of their health status wanted to lose weight (p < 0.01). Unlike males, females have a DBS lower than their Current Body Size (p < 0.001). In addition, subjects (particularly males) who felt they were too lean, were older than those who felt too fat. We therefore conclude that the social valorisation of stoutness exposes Bamiléké, particularly males, to obesity. Although the women stated a desire to lose weight and present aesthetic criteria more oriented towards slimness, the attitude of the Bamiléké remained oriented toward stoutness appreciation. This preference can help protect against body image disturbances identified in Western societies, but may also increase of the incidence of obesity and its associated pathologies in this part of the world.

[Digestive pathology and oral condition in the rural populations of the Ferlo in Senegal]. / Pathologie digestive et état bucco-dentaire chez les populations rurales du Ferlo au Sénégal.

UNLABELLED: The aim of this work was to study the association between dental and periodontal status and digestive pathology in the Ferlo populations in Senegal. METHOD: This was a cross sectional study involving 300 people living in the area of the Ferlo in the Centre East of Senegal. Selected individuals must be over the age of 15 years and resided in the area. Cluster sampling helped recruit individuals. Collected information related to digestive pathology (yes or no), periodontal status (plate index, inflammation, bleeding, loss of attachment, the depth of pocket and the CPITN.) Dental status was evaluated by the DMFT. The data analyzed with software R and the Student's t test used to compare the averages of the indices in both groups at the threshold of 5%. Multivariate logistic regression analysis was used to isolate the final model with a threshold of 5%. RESULTS: Averages of dental and periodontal index were broadly equal in both groups (sick and not sick). The DMF and missing teeth were significantly associated with the digestive pathology after adjustment on gender, age, BMI, marital status, the number of cigarettes smoked and the depth of pocket. CONCLUSION: This study revealed a significant association between dental status and digestive pathology. The comprehensive care of patients therefore raises the interest of collaboration between surgeons, dentists and gastroenterologists for effective and adequate treatment.

[Lifestyles and oral health in Fulani populations of Ferlo in Senegal]. / Modes de vie et santé buccodentaire chez les populations peuhls du Ferlo au Sénégal.

BACKGROUND: The population of Ferlo consists mainly of Fulani, whose lifestyle is characterized by nomadism and cattle breeding. The aim of this work was to study their dietary, living, and hygiene habits and their oral health. METHODOLOGY: This cross-sectional study included 300 individuals living in Tessekere and Widou Thiengoli, in the heart of the Great Green Wall of Senegal. These individuals were selected by cluster sampling and had lived in the area for over fifteen years. The 1997 WHO questionnaire was used to collect data from interviews and clinical observations. Information was collected specifically about eating habits, lifestyle and hygiene, dental caries (DMF) and periodontal treatment needs (CPITN). The coefficients of determination and correlation were used to explain and identify significant associations (defined by a p-value <0.05). RESULTS: Milk was consumed by 96% of the population and tea by 90%;47% of the population smoked more than half a pack of tobacco a day, 11% drank "boulfalé" (Cologne water of 45°), and 88.6% used toothpicks for dental hygiene. Tooth cleaning frequency was negatively correlated with the DMF index and CPITN, and consumption of milk, fruit and cigarettes were positively correlated with the CPITN. CONCLUSION: Dietary factors, smoking and hygiene appear to influence the oral health of populations in Ferlo. Prevention programs should be established, focusing on simple information to induce behavioral change.

Prevalence of diabetes and associated risk factors in a Senegalese urban (Dakar) population.

AIM: The aim of this study was to estimate the prevalence of diabetes in the urban population living in Dakar, Senegal, and to investigate the factors associated with diabetes. METHODS: Data from a 2009 survey of 600 individuals, aged 20 years or above and considered representative of the population of the city of Dakar, were evaluated. Socioeconomic characteristics, hypertension, capillary whole blood glucose, and weight and height measurements of these subjects were collected during face-to-face interviews. The statistical analyses used chi-square (chi2) tests and binary logistic regressions. RESULTS: The percentage of participants with fasting blood glucose levels greater than or equal to 1.10 g/L and/or currently being treated for diabetes was 17.9% (n=107, 95% CI: 14.7-20.8). Observed rates of diabetes were significantly higher among women (chi2 = 6.3; P < 0.05), in subjects aged > 40 years (chi2=33.6; P < 0.001), in those with low educational levels (chi2=11.9; P < 0.05) and in those with hypertension (chi2 = 13.9; P < 0.001), and in those who were overweight (BMI ≥ 25 kg/m2 and < 30 kg/m2) or obese (BMI ≥ 30 kg/m2; chi2=40.3; P < 0.001). After adjusting for gender, age, educational level, BMI and blood pressure, the results showed that gender, age and BMI were associated with diabetes: women, older people and those with a higher BMI had significantly greater chances of being diabetic than the rest of the population, whatever their blood pressure and educational level. CONCLUSION: Diabetes is becoming a pressing public-health problem in Senegal, and the major risk factors for the increasing diabetes prevalence in the city of Dakar are gender, age and body mass index.

[Regular versus lapsed donors: sociodemographic differences and motivational factors]. / Donneurs de sang réguliers ou donneurs occasionnels : différences sociodémographiques et motivationnelles.

AIM: Blood donor retention represents a fundamental objective in public health. Comparison between the sociodemographic characteristics and motivational factors between lapsed and regular donors is then required. The objectives of this analysis were: (1) to compare the sociodemographic characteristics of lapsed donors and current donors; (2) to compare the motivations to donate blood expressed by lapsed and current donors. PATIENTS AND METHODS: Data from a 2008 survey, representative of the population by crossed quotas method, of 1400 individuals questioned by phone were used to reach these objectives. Chi(2) tests and binary logistic regressions were used. RESULTS: Results show that socio-occupational categories and motivational factors are different between lapsed and regular donors. Workers, senior management and higher intellectual professions are more often lapsed than regular donors. Concerning motivations, results show that lapsed donors more frequently mention the first experience with blood donation (with colleagues, friends, and parents) than regular donors, for whom altruistic and community motivations are more frequently cited. CONCLUSION: Workers, senior management and higher intellectual professions should be targeted uppermost, in order to convert them in regular donors. Finally, concerning motivations, the social pressure applied to lapsed donors for their first blood donation appears crucial, whereas regular donors have internalized their motives, more often altruistic and community motivations.

Influence of socioeconomic status and body mass index on bone age.

BACKGROUND/AIMS: To evaluate the relationship of socioeconomic status (SES) and body mass index (BMI) with skeletal maturation in children from Marrakech (Morocco). METHODS: SES, BMI z-score and bone age (BA) were measured in a cohort of 623 children (280 boys and 343 girls, chronological age (CA) ranged from 6.6 to 18.8 years, mean 14.1 years). BA estimation was performed with the Greulich and Pyle atlas. Two social groups (privileged and unfavorable SES) were defined. A multiple linear regression analysis was performed to assess the relationship between BA-CA and age-and sex-specific BMI z-score. RESULTS: Global maturation delay was seen in the sample (BA-CA -0.56; SD 1.29). There was a significant relationship between skeletal maturation (BA-CA) and child BMI z-score among both genders. Bone age was more advanced in children with a greater BMI z-score. Privileged SES was positively associated with children's BA-CA for girls but there was no association for boys. In the boys' sample, there was no evidence that BA-CA variations with BMI z-score depended on socioeconomic status (p=0.664). Whatever the gender of the child, a greater BMI z-score increases the maturation. CONCLUSION: The multiple linear regression analysis is an interesting approach to understand the links between skeletal maturation, BMI and SES. In Moroccan children, excess weight is associated with privileged SES.

[Value of the sesamoid bone of the thumb in the determination of bone age]. / Quelle valeur accorder à l'os sésamoïde du pouce dans la détermination de l'âge osseux?

PURPOSE: To assess the presence of ossification of the sesamoid bone of the thumb as a function of age and compare the results to data from the atlas by Greulich and Pyle describing the ossification of this bone in girls of 11 years and boys of 13 years. Materials and methods. Prospective study of 1372 children (780 boys and 592 girls between the ages of 0.4 and 19.7 years, mean age of 9.7 years) with known chronological age requiring radiographic evaluation of the wrist-hand after minor trauma. The presence of a sesamoid was analyzed by logistic regression using the method of probits. RESULTS: The minimum and maximum ages in our sample population were 10-15.1 years for boys and 8.8-15.2 years for girls. The P50 value (method of probits) corresponded to the chronological age at which 50% of the population had a visible sesamoid. It was 12.1 years for boys and 10.2 years for girls. CONCLUSION: The timing of ossification of the sesamoid of the thumb is widely variable. Ossification of this sesamoid should not be used as a precise indicator when determining bone age using the atlas by Greulich and Pyle.

Obesity, overweight and body-weight perception in a High Atlas Moroccan population.

In order to study the prevalence of obesity and overweight and to understand how the human body is perceived among Moroccan mountain populations, we carried out a survey that covered a sample of 436 Amazigh individuals aged 20 years and more from the High Moroccan Atlas. Through this survey, we noticed that obesity is still low among men (2.4%), whereas the prevalence of obesity among women is alarming and reaches 13.3%. The prevalence of overweight is also high, especially among women, with 32.8% vs. 21.8% among men. Obesity prevalence, especially overweight, is higher than that recorded in the national rural level. The high prevalence of overweight that can develop to obesity should be taken into account mainly when dealing with women that still value overweight. In fact, women in our sample underestimate their overweight more than men and wish to have a heavier body.

Surname analysis in biological anthropology: Alpine populations in the 17th and 18th centuries.

As part of an interdisciplinary research program on Alpine populations, we studied the biodemographic evolution of two populations of the Dauphiné in the period 1690-1799. We analyzed several indexes derived from surname analysis to infer the genetic structure of the populations. Although situated in the same area of the Dauphiné, the two communities of Vallouise and Chiomonte had different biodemographic characteristics. Vallouise was heavily populated but genetically homogeneous, whereas Chiomonte was less populated but more heterogeneous. The two districts also differed in geographic position: Vallouise was a glacier-enclosed valley that did not attract new inhabitants; Chiomonte was situated in an open valley served by important roads and thus was able to attract many new inhabitants. The demographic differences between the two populations explain the differences in genetic structure. The index of isonymous relationship (R(i)) being different from 0 is due to the rare marriages between members of the two populations. Because R(i) is based on surnames, which are mostly polyphyletic, it can overestimate the genetic relationships between the populations, as in the case of consanguinity assessed by matrimonial isonymy.

HLA-DRB1 frequencies of the Comorian population and their genetic affinities with Sub-Saharan African and Indian Oceanian populations.

BACKGROUND: Ethnic-historic sources have considered the Comorian population to be the result of an amalgamation of African, Arabian and Southeast Asian groups. AIM: This study seeks to determine the genetic relationships and contributions from Sub-Saharan Africa and Indian Oceania and to reconstruct past migration events. SUBJECTS AND METHODS: The human leukocyte antigen (HLA) polymorphism of a Comorian population was described and analysed. RESULTS: Genetic distances and multidimensional scaling analyses showed complex patterns of genetic differentiation in the Indian Oceanian area as a result of continuous gene flow occurring within the past approximately 2500 years. Nevertheless, the Comorian genetic pool appears to be a mix of Bantu-speaking and Arab populations as testified to by admixture estimations of almost 50-60% and 27-33%, respectively. CONCLUSION: The Comorian population may represent the eastern limit of the recent and massive eastward Bantu expansion. In contrast to the population from Madagascar (Merina), only a restricted influence of Austronesian populations was found.

Distribution of killer-cell immunoglobulin-like receptor (KIR) in Comoros and Southeast France.

Killer-cell immunoglobulin-like receptors (KIRs) expressed by natural killer cells are cell surface molecules able to recognize groups of HLA class I alleles. The number and distribution of KIR genes vary among individuals and populations. The aim of this study is to analyse the KIR gene content in a Comorian population in order to investigate genetic relationships with other populations and to reconstruct past migration events. The Comorian population consisted of 54 unrelated immigrants living in France and a control population consisted of 38 individuals from Southeast France. We investigated the presence or absence of 15 KIR genes, two pseudogenes expressed and non-expressed forms of KIR2DL5 and the two major subtype full-length and deleted forms of KIR2DS4. All individuals were typed positive for the framework genes, i.e. KIR2DL4, KIR3DL2 and KIR3DL3, and the two pseudogenes KIR3DP1 and KIR2DP1. The frequencies of full-length KIR2DS4 (*00101/00102/002) were lower in the French population (F = 29%) than in the Comorian population (F = 72%) (P(c) < 0.05). No significant differences were found for other KIR genes. A total of 11 genotypes were identified in the Southeast French population and 22 genotypes in the Comorian population. The most common genotype (2DL1, 2DL3, 2DL4, 3DL1, 3DL2, 3DL3 and 2DS4) accounted for 41% in the Comorian population and 34% in the Southeast French population. Principal component analysis using KIR gene data from 20 populations was performed to determine genetic differences and relations between populations. The Comorian population exhibited closest kinship with Africans and Asians. As KIR gene content is heterogeneous among ethnic groups, it can probably be used to assess the genetic relationships among populations from different geographic areas.

Relationship between formation of the femoral bicondylar angle and trochlear shape: independence of diaphyseal and epiphyseal growth.

During hominin evolution, an increase in the femoral bicondylar angle was the initial change that led to selection for protuberance of the lateral trochlear lip and the elliptical profile of the lateral condyle. No correlation is found during ontogeny between the degree of femoral obliquity and of the prominence of the lateral trochlear lip. Might there be a relationship with the elliptical profile of the lateral condyle? On intact femoral diaphyses of juvenile humans and great apes, we compared the anteroposterior length of the lateral and medial sides of the distal metaphysis. The two diaphyseal pillars remain equal during postnatal growth in great apes, while the growth of the lateral pillar far exceeds that of the medial pillar in humans. Increase in bicondylar angle is correlated with disproportionate anteroposterior lengthening of the lateral pillar. The increased anteroposterior length of the lateral side of the metaphysis would contribute to increasing the radius of the curvature of the lateral condyle, but not to the projection of the lateral trochlear lip. The similar neonatal and adult femoro-patellar joint shape in humans prompted an assessment of the similarity during growth of the entire neonatal and adult epiphyses. We showed that the entire epiphysis undergoes drastic changes in proportions during postnatal growth. Finally, we emphasize the need to distinguish the cartilaginous phenotype and the ossified phenotype of the distal femoral epiphysis (and of any epiphysis) during postnatal growth. This crucial distinction applies to most postcranial bones, for they almost all develop following the process of endochondral ossification.

[Determining factors in the wearing of a removable prosthesis: the role of familial example. Prosthetic risk: the influence of parental behavior]. / Facteurs déterminant le port d'une prothèse amovible: rôle particulier de l'exemple familial. Risque prothétique: l'influence du comportement parental.

The aim of the present study was to provide a fuller clarification of the influence of sociocultural and socioeconomic data on the bucco-dental ageing. In Particular, was suspected, the influence of the parental behavior towards the wearing of their own prostheses in the wearing of removable prostheses among the descendants. The study was led in a dental service (CHU of Marseille) on 260 from 50 to 70 years old persons. Variables in the study were mainly basic sociocultural and socioeconomic variables (sex, age, educational level and social-professional groups...); the dental morbidity (DMF); the periodontal state (corrected CPITN, plaque index, gingival index), the prosthetic state of the subjects, the prosthetic state of the parents, the behavior of the parents towards the port of their prosthesis (CPP), the behavior of the subjects in front of dental care. The data were analyzed mainly by the method of logistic regression. They indicated that the most determining variables concerning the wearing of removable prostheses were: the plaque index (OR = 1.730), the behavior in front of dental care (OR = 1.306) and especially, the parental prosthetic behavior (OR = 4.420). In others words, the fact that the parents had removable prostheses and well tolerated it, constituted an important risk factor so that the children had removable prostheses. It was here, according to the authors, about sociological and psychological determinants on the bucco-dental aging.

HLA-DRB1 and DQB1 polymorphisms in southern France and genetic relationships with other Mediterranean populations.

This study presents the results of HLA-DRB1 and DQB1 sequence-specific oligonucleotide probe (SSOP) typing for a population sample of 181 individuals originating from southern France. On the basis of allele and haplotype frequencies, we compared our population with others from the Mediterranean area. Allele frequencies are comparable to those found in other western European populations (France, Portugal, Spain) and indicate neighboring exchanges. The haplotype frequencies showed relationships with North Africans and Jewish populations, as well as the common origin of Moroccan and Lebanese Jews. Therefore, allele frequencies seem to be more able to show recent exchanges while haplotype frequencies might show ancestral relationships. These results may serve as references for future studies of HLA and disease in southern France.

Determinants of contraceptive use in Morocco: stopping behaviour in traditional populations.

The determinants of modern contraceptive use in traditional populations are analysed in married women aged 30-44 living in the province of Marrakech (Morocco). Women who have never used contraception have smaller family sizes than those who do: the number of live children (or live births) is the variable with maximum predictive power on contraceptive use, while child mortality is the main inhibiting factor. The probability of contraceptive use increases with female age at marriage and decreases with the woman's age, indicating a generational change in reproductive behaviour. The socioeconomic variables education, employment and residence, have no significant independent predictive character on contraceptive use, although the interaction between education and residence does. The paper evaluates the hypothesis that traditional populations in the initial phase of their demographic transition resort to modern contraception in order to stop childbearing, when they have reached a desired number of children, rather than to space births or reduce their fertility.

PIP: The authors conclude that the determinants of contraceptive use among the rural population in Marrakech province, Morocco, were multiple and interrelated in complex ways. Birth control was a consequence of changes at both the individual and social levels. Findings indicate that women who had never used contraception had smaller family sizes than those women who used contraception. Contraceptive users had a significantly higher number of live births and living children. Child mortality was significantly greater among noncontracepting women. Contraceptive users had a significantly longer reproductive period than nonusers, which was attributed to a longer delay in the last live birth. Logistic models show that significant independent predictors of contraceptive use were the number of live births, the number of children who died before the age of 5, the age of the mother, the type of marriage, and the age at first marriage. The probability of access to contraceptives decreased with under-5 mortality, female age, marriage age, and increases in polygynous unions. This model explained 63.9% of the variance. Although residence and educational level did not significantly increase the fit of the model, the probability of contraceptive use did increase in relation to urban residence and a basic educational level. The number of live children was a predictor of contraceptive use but the best predictor of contraceptive use was family size (65.8%). The probability of contraceptive use increased among women with three or more children. Female education had no independent predictive impact on contraceptive use. Contraceptive use increased among women in polygynous unions, regardless of residence or schooling.