Universal health insurance in Africa: a narrative review of the literature on institutional models.

INTRODUCTION: Several African countries have introduced universal health insurance (UHI) programmes. These programmes aim to extend health insurance to groups that are usually excluded, namely informal workers and the indigent. Countries use different approaches. The purpose of this article is to study their institutional characteristics and their contribution to the achievement of universal health coverage (UHC) goals. METHOD: This study is a narrative review. It focused on African countries with a UHI programme for at least 4 years. We identified 16 countries. We then compared how these UHI schemes mobilise, pool and use funds to purchase healthcare. Finally, we synthesised how all these aspects contribute to achieving the main objectives of UHC (access to care and financial protection). RESULTS: Ninety-two studies were selected. They found that government-run health insurance was the dominant model in Africa and that it produced better results than community-based health insurance (CBHI). They also showed that private health insurance was marginal. In a context with a large informal sector and a substantial number of people with low contributory capacity, the review also confirmed the limitations of contribution-based financing and the need to strengthen tax-based financing. It also showed that high fragmentation and voluntary enrolment, which are considered irreconcilable with universal insurance, characterise most UHI systems in Africa. CONCLUSION: Public health insurance is more likely to contribute to the achievement of UHC goals than CBHI, as it ensures better management and promotes the pooling of resources on a larger scale.

Impact of community-based health insurance on healthcare utilisation and out-of-pocket expenditures for the poor in Senegal.

OBJECTIVES: This study aims to assess the impact of the subsidised community health insurance scheme in Senegal particularly on the poor. DESIGN AND SETTING: The study used data from a household survey conducted in 2019 in three regions, representing 29.3% of the total population. Inverse probability of treatment weighting approach was applied for the analysis. PARTICIPANTS: 1766 households with 15 584 individuals selected through a stratified random sampling with two draws. MAIN OUTCOME MEASURES: The impact of community-based health insurance (CBHI) was evaluated on poor people's access to care and on their financial protection. For the measurement of access to care, we were interested in the use of health services and non-withdrawal from care in case of illness. To assess financial protection, we looked at out-of-pocket expenditure by type of provider and by type of service, the weight of out-of-pocket expenditure on household income, non-exposure to impoverishing health expenditure and non-exposure to catastrophic health expenditure. RESULTS: The results indicate that the CBHI increases primary healthcare utilisation for non-poor (OR 1.36 (CI90 1.02-1.8) for the general scheme and 1.37 (CI90 1.06-1.77) for the special scheme for indigent recipients of social cash transfers), protect them against catastrophic (OR 1.63 (CI90 1.12-2.39)) or impoverishing (OR 2.4 (CI90 1.27-4.5)) health expenditures. However, CBHI has no impact on the poor's healthcare utilisation (OR 0.61 (CI90 0.4-0.94)) and do not protect them from the burden related to healthcare expenditures (OR: 0.27 (CI90 0.13-0.54)). CONCLUSION: Our study found that CBHI has an impact on the non-poor but does not sufficiently protect the poor. This leads us to conclude that a health insurance programme designed for the general population may not be appropriate for the poor. A qualitative study should be conducted to better understand the non-financial barriers to accessing care that may disproportionately affect the poorest.

Malrotation of an iliac ectopic kidney with pyelo-ureteral duplication: An incidental three-in-one congenital anomaly.

Renal ectopia is a rare congenital anomaly that mostly occurs in the pelvic area. An ectopic kidney is usually associated with other anomalies such as a malrotation. We report the case of a 15-year-old male who consulted after a blunt abdominal trauma. A left iliac renal ectopia was incidentally discovered. This ectopic kidney was associated with a malrotation, and a pyelo-ureteral duplication. Iliac renal ectopia should be dissociated from other abdominal renal ectopias, and its association with other renal malformations should be further investigated.

[Sorting and detection of COVID-19 by low-dose thoracic CT scan in patients consulting the radiology department of Fann hospital (Dakar-Senegal)]. / Tri et détection du COVID-19 par TDM thoracique low-dose chez des patients tout-venant au service de radiologie de l´hôpital de Fann (Dakar-Sénégal).

INTRODUCTION: COVID-19 has spread rapidly since its emergence in China and is currently a global health issue. Its definitive diagnosis is made by PCR on nasopharyngeal swabs. However, this diagnostic test has low sensitivity with delayed results. Hence, thoracic computed tomography represents an interesting alternative. The aims of this study were to assess the frequency of computed tomography (CT) lesions suggestive of COVID-19 and to compare the results of CT and PCR test. METHODS: a prospective study carried out over15 working days and involved 47 patients. These patients were recruited based on the presence of at least 2 clinical signs of COVID-19. Chest CT without contrast according to the "LOW-DOSE" protocol was performed. A PCR test on nasopharyngeal swabs was done in patients with signs suggestive of COVID on CT. A serological test was performed in case of a discrepancy between the CT and PCR results. RESULTS: thoracic CT was abnormal in 38 patients and normal in 9 patients. Lesions suggestive of COVID-19 have been identified in 32 patients. Two patients had lesions of non-specific pneumonia. Tuberculosis lesions were visualized in 3 patients. One patient had lesions of interstitial pneumonia. The mean DLP was 59 mGy.cm with extremes of 25 and 95 mGy.cm. Ground-glass opacity was present in 100% of COVID-19 suspects on CT. The results of the PCR test were the same than CT in 12 patients. The positive predictive value for CT was 37.5%. In 20 patients with COVID lesions on CT, the PCR test was negative with a false positive rate of 62.5%. In the patients with negative PCR test, 4 had a serological test for COVID-19 and this test was positive in 3. CONCLUSION: low-dose chest CT can reduce radiation exposure in COVID-19 patients who are at risk of cumulative dose due to repetitive exam. CT can identify lesions suggestive of COVID-19. It also enables the triage of patients by identifying other diagnoses.

Ponction biopsie transthoracique guidée par imagerie : technique et performance diagnostique

OBJECTIFS : décrire la technique et donner les résultats de la ponction biopsie transthoracique (PBTT) guidée par imagerie (TDM, échographie).MATERIELS ET METHODES : étude prospective incluant vingt-cinq (25) patients porteurs de masse pulmonaire ou médiatinale tous adressés pour PBTT à visée diagnostique. Les prélèvements étaient réalisés sous contrôle échographique ou tomodensitométrique, à l'aide d'aiguilles de 16 Gauge ou 14 Gauge, avec ou sans coaxiale. RESULTATS : l'âge moyen de nos patients était de 54,5 ans (23 ­ 72 ans) avec un sexe ratio 2,57. La topographie lésionnelle était pulmonaire dans 22 cas et médiastinale dans 3 cas. La PBTT étaient réalisés sous contrôle échographique dans 19 cas (76%) et TDM chez le reste. Les prélèvements étaient majoritairement tissulaires non fragmentés avec un nombre moyen de deux carottes (extrêmes 1-2). Nous avions relevé des complications dans 6 cas (24%) à type de pneumothorax chez 5 patients (83%) et d'hémoptysie chez le dernier. La PBTT était contributive dans 76% des cas avec 58% de lésions malignes dont 72% carcinomes épidermoïdes.CONCLUSION : La PBTT guidée par échographie ou scanner est une technique de choix peu invasive, à moindre coût dans l'évaluation rapide de l'étiologie néoplasique des opacités médiastino-pulmonaires périphériques

Médulloblastome versus épendymome : qu'apporte l'IRM multimodale

Objectifs : décrire et comparer les aspects IRM de l'épendymome et du médulloblastome de la fosse postérieure. Matériels et méthodes : étude rétrospective incluant 29 cas de médulloblastome et 11 cas d'épendymome de la fosse postérieure. Les examens étaient réalisés en pondération T1 sans puis après injection de gadolinium, T2, T2*, Flair, diffusion, séquences de perfusion et de spectroscopie. Résultats : sur le plan morphologique, nous n'avions pas relevé de différence significative en ce qui concerne la taille tumorale, leur signal et leur rehaussement. Par contre les épendymomes étaient de topographie intra ventriculaire dans 90,9% contre 62,1% pour les médulloblastomes avec une extension dans le trou occipital respective de 81,8% et 10,3%. Les médulloblastomes présentaient une restriction de la diffusion dans 86,2% contre 27,3%. Une néoangiogenèse était notée dans 79,3% des médulloblastomes contre 45,5% pour les épendymomes. Sur le plan spectral, une chute du NAA et de la créatine associée à une augmentation du pic de Choline était retrouvée chez tous nos patients avec accumulation de myo-inositol dans 72,8% des épendymomes et présence de taurine dans 34,5% des médulloblastomes. Conclusion : l'IRM morphologique associée aux techniques avancées permet une meilleure approche diagnostique du type et du grading des tumeurs de la fosse postérieure

[Role of biliary MRI in etiological diagnosis of cholestatic icteruses in Dakar]. / Place de la bili-IRM dans le diagnostic etiologique des icteres cholestatiques à Dakar.

Biliary MRI is a relatively new diagnostic test in the arsenal of exploration techniques in biliopancreatic pathology. This is a reproducible and reliable non invasive technique for direct visualization of biliary and pancreatic ducts. This study aims to evaluate the morphological features of major abnormalities and the role of biliary MRI in the etiological diagnosis of cholestatic icteruses. This is a retrospective study of 17 patients conducted in the Imaging Unit of the University Hospital of Fann and of the Principal hospital of Dakar over a period of 4 years and six months (January 2008 at July 2012). All patients underwent MRI (1.5T) according to the standardized protocols for the explored pathology. Only medical records of patients whose diagnosis was established based on laboratory tests and who underwent biliary MRI and surgical exploration were retained. The study involved 5 women and 12 men with a sex ratio of 2.4. The average age of patients was 58 years, ranging between 35 and 81 years. Klatskin tumors were found in 7 patients with infiltrative form in 71% of cases and exophytic form was found in 28% of cases. Cancers of the gallbladder were found in 28% of cases. Cancers in the head of the pancreas accounted for 28% of cases. Major bile duct lithiasis was detected in 5 patients, choledocholithiasis in 60% of cases and a single lithiasis in 40% of cases. All these lesions were responsible for an expansion of intrahepatic bile duct (IHBD). One case of intra and extrahepatic bile ducts dilatation was found without biliopancreatic cause. Biliary MRI is the test of choice for the exploration of cholestatic icteruses. It should be recommended as first-line examination when residual lithiasis is suspected and as second-line examination after ultrasound, when the latter shows a suspected bile ducts tumoral obstruction. Its association with CT scan is the best combination of screening tests for etiologic diagnosis and pre-operative assessment of tumoral biliary obstructions.

Experience on the management of the first imported Ebola virus disease case in Senegal.

The Ebola virus disease, as a first epidemic in West Africa, stands as the most deadly one throughout history. Guinea, the source of the epidemic, Sierra Leone and Liberia remain the most strongly affected. That epidemic thoroughly destabilized the health system of those countries. Following Nigeria, Senegal received its first imported case from the neighboring Republic of Guinea. In that sub regional psychotic context, such a situation has been handled and managed starting from the potential of a health system that is already suitably structured. The organization of the response, the management of the communication system and the rigorous monitoring of contacts have been decisive in the control of the epidemic. Our countries have to be prepared in order to face health threats, and that is the reason why the need to empower our health systems is important.