Factors associated with traction alopecia in women living in Yaoundé (Cameroon).

BACKGROUND: Traction alopecia (TA) is very common in Africa but few studies on African population are available. We sought to determine factors associated with TA and measure the association between these factors and TA. METHODS: We carried out an analytical cross-sectional study in 29 hairdressing saloons in the city of Yaoundé. A questionnaire was administered and scalp exams were performed in order to look for TA and determine Marginal TA severity score if present. Participants were separated in two groups: TA group and a group without TA. RESULTS: We finally included 223 women (77 having TA and 146 without TA). The median age was 26 years for women with TA and 24 years for women without TA. The factors associated with traction alopecia we found included: age ≥ 35 years (adjusted OR = 4; p = 0.016). Hairdressing undertaken by hairdressers only (adjusted OR = 0.2; p = 0.008), the avoidance of the regular use of nets, caps and head ties (OR = 0.2; p = 0.006) and relaxing hairs once a year or less (adjusted OR = 0.2; p = 0.005) could be protective factors. As well, we found a positive correlation between age and TA severity (r = 0.235; p < 0.001). CONCLUSION: Age and some haircare practices are associated to TA occurrence in our context. Women therefore need to be educated on these various factors that could be able to cause, worsen or prevent TA.

Predictors of stroke favorable functional outcome in Guinea, results from the Conakry stroke registry.

Low- to middle-income countries (LMICs) now bear most of the stroke burden. In LMICs, stroke epidemiology and health care systems are different from HICs. Therefore, a high-income country (HIC)-based predictive model may not correspond to the LMIC stroke context. Identify the impact of modifiable variables in acute stroke management in Conakry, Guinea as potential predictors of favorable stroke outcome. Data were extracted from the Conakry stroke registry that includes 1018 patients. A logistic regression model was built to predict favorable stroke outcomes, defined as mRS 0-2. Age, admission NIHSS score, mean arterial blood pressure and capillary glycemia were chosen as covariates. Delay to brain CT imaging under 24 h from symptom onset, fever, presence of sores and abnormal lung auscultation were included as factors. NIHSS score on admission, age and ischemic stroke were included in the null model as nuisance parameters to determine the contribution of modifiable variables to predict stroke favorable outcome. Lower admission NIHSS, brain CT imaging within 24 h of symptoms onset and lower mean arterial blood pressure emerged as a significant positive predictors of favorable stroke outcome with respective odd ratios (OR) of 1.35 [1.28-1.43], 2.1 [1.16-3.8] and 1.01 [1.01-1.04]. The presence of fever or sores impacted negatively stroke favorable outcomes with OR of 0.3 [0.1-0.85] and 0.25 [0.14-0.45]. The area under receiver operating characteristic curves (AUC) of the model was 0.86. This model explained 44.5% of the variability of the favorable stroke outcome with 10.2% of the variability explained by the modifiable variables when admission NIHSS, and ischemic stroke were included in the null model as nuisance parameter. In the Conakry stroke registry, using a logistic regression to predict stroke favorable outcome, five variables that led to an AUC of 0.86: admission NIHSS, early brain CT imaging, fever, sores and mean blood pressure. This paves the way for future public health interventions to test whether modulating amendable variables leads to increased favorable stroke outcomes in LMICs.

Leveraging Partnerships to Maximize Global Health Security Improvements in Guinea, 2015-2019.

In response to the 2014-2016 West Africa Ebola virus disease (EVD) outbreak, a US congressional appropriation provided funds to the US Centers for Disease Control and Prevention (CDC) to support global health security capacity building in 17 partner countries, including Guinea. The 2014 funding enabled CDC to provide more than 300 deployments of personnel to Guinea during the Ebola response, establish a country office, and fund 11 implementing partners through cooperative agreements to support global health security engagement efforts in 4 core technical areas: workforce development, surveillance systems, laboratory systems, and emergency management. This article reflects on almost 4 years of collaboration between CDC and its implementing partners in Guinea during the Ebola outbreak response and the recovery period. We highlight examples of collaborative synergies between cooperative agreement partners and local Guinean partners and discuss the impact of these collaborations in strengthening the above 4 core capacities. Finally, we identify the key elements of the successful collaborations, including communication and information sharing as a core cooperative agreement activity, a flexible funding mechanism, and willingness to adapt to local needs. We hope these observations can serve as guidance for future endeavors seeking to establish strong and effective partnerships between government and nongovernment organizations providing technical and operational assistance.

[Medical certificates for intentional wounds and blows in medico-legal practice in Dakar]. / Certificats médicaux pour coups et blessures volontaires en pratique médico-judiciaire à Dakar.

Drawing up the medical certificate is a crucial step in the judicial process. This judicial document should be drafted during a medical legal consultation. This study aims to evaluate the quality of medical certificates in a medico-judicial consultation and to study interpretative criteria of medical certificate validity. We conducted a retrospective study of patient's victims of intentional wounds and blows receiving a medico-judicial consultation at the Grand Yoff General Hospital, from April 2012 to February 2015. The whole of medical certificates were recorded on a survey form analyzed by Epi Info Version 6.04. The whole of the 249 certificates studied was printed in legible and understandable "Arial police 12". All the studied medical certificates included complete identification of the physician and the victim. The date and the time of aggression were written in 248 certificates (99.6%). The type of abuse suffered was specified on the whole of the 249 certificates: 164 brawls (65.9%), 64 unilateral aggressions (25.7%). The precise description and nature of the lesions was written in 246 certificates. The site of the lesions was established based on fixed anatomical landmarks in the various body plans. Medico-judicial consultation, coordinated by the forensic physician, helped to significantly improve the quality of the documents issued. The dissemination of these drafting practices and of the practices concerning the issuing of certificates is essential in particular in the regional hospital as part of an ongoing training or postgraduate training.

[Causes of death in Dakar and health policy]. / Causes de décès à Dakar et politique de santé.

The study of mortality enables to identify the major public health problems in the countries under consideration. It can give an indication on the preventive and "medico-curative" measures as well as on the investments in research that could increase life expectancy of the population. This study aims to evaluate the causes of death in the general population based on the informations contained in the register of deaths in Dakar. Our specific aim was to determine the causes of death, to identify the socio-demographic factors influencing death and to identify the kinds of death and types of death. We conducted a retrospective study on the cases of death in the general population who underwent an autopsy in Dakar, from 2003 to 2012. Data were taken from the autopsy registers from the Aristide Le Dantec Hospital (HALD) and the General Hospital of Grand Yoff (HOGGY), which are the only hospitals in Dakar where autopsies are made. The informations contained in the different data sources were recorded on a survey form and analyzed using Epi-Info 6.04. During the study period, 985 patients died among whom 693 of violent death (70.3%), 261 of natural death (26.5%), and 14 of unspecified cause (1.4%). There was a predominance of traffic accidents (394; 40%). With respect to the kind of death, more than half of the cases were due to traffic accidents (violent deaths). Traffic-related deaths most often occurred during the pre-hospitalization period or on arrival to the hospital. The Ministry of Health should continue to promote measures for preventing and managing communicable diseases. The two priorities should be as follows: cardiovascular diseases and traumas.

Breast Milk Lipidome Is Associated with Early Growth Trajectory in Preterm Infants.

Human milk is recommended for feeding preterm infants. The current pilot study aims to determine whether breast-milk lipidome had any impact on the early growth-pattern of preterm infants fed their own mother's milk. A prospective-monocentric-observational birth-cohort was established, enrolling 138 preterm infants, who received their own mother's breast-milk throughout hospital stay. All infants were ranked according to the change in weight Z-score between birth and hospital discharge. Then, we selected infants who experienced "slower" (n = 15, -1.54 ± 0.42 Z-score) or "faster" (n = 11, -0.48 ± 0.19 Z-score) growth; as expected, although groups did not differ regarding gestational age, birth weight Z-score was lower in the "faster-growth" group (0.56 ± 0.72 vs. -1.59 ± 0.96). Liquid chromatography-mass spectrometry lipidomic signatures combined with multivariate analyses made it possible to identify breast-milk lipid species that allowed clear-cut discrimination between groups. Validation of the selected biomarkers was performed using multidimensional statistical, false-discovery-rate and ROC (Receiver Operating Characteristic) tools. Breast-milk associated with faster growth contained more medium-chain saturated fatty acid and sphingomyelin, dihomo-γ-linolenic acid (DGLA)-containing phosphethanolamine, and less oleic acid-containing triglyceride and DGLA-oxylipin. The ability of such biomarkers to predict early-growth was validated in presence of confounding clinical factors but remains to be ascertained in larger cohort studies.

Assessing the outcomes of HIV-infected persons receiving treatment for Kaposi sarcoma in Conakry-Guinea.

BACKGROUND: Médecins Sans Frontières is supporting comprehensive HIV care and treatment for Kaposi Sarcoma (KS) in Guinea, where antiretroviral coverage is low and access to KS treatment is very limited. We aimed to evaluate treatment response and survival outcomes of epidemic KS in this setting. METHODS: Retrospective survival analysis of routinely collected clinical data of HIV-infected patients with clinically diagnosed KS, receiving ART and chemotherapy consisting of a combination of bleomycin and vincristine at the Donka National Hospital in Conakry between 2012 and 2015. RESULTS: A total of 225 patients were enrolled for KS treatment within the three-year period. Late presentation with stage T1 disease was common (82.7%). At the end of a median of 8 cycles of chemotherapy (IQR: 2-12), complete remission was observed in 65 (28.9%), partial remission in 53 (23.6%), stable disease in 15 (6.7%) and unknown response for all 92 (40.9%) patients who dropped out of care. The chances of achieving complete remission doubled after each additional cycle of chemotherapy (aOR = 2.09 95% CI: 1.44-3.01) but were reduced by about two-thirds for each additional month delay between treatment and onset of KS (aOR = 0.31, 95% CI: 0.11-0.86). Treatment response was seriously compromised in patients with woody skin oedema (aOR = 0.05, 95% CI: 0.01-0.38) and those with prior chemotherapy (aOR = 0.21, 95% CI: 0.05-0.80). The median survival time was 7.6 months (95% CI: 5.9-9.8). Attrition from care was reduced by 22% for every additional cycle of chemotherapy administered (aH0R = 0.78, 95% CI: 0.71-0.84) and was lower in those with complete remission compared with those with partial or no response (aHR = 0.05, 95% CI: 0.007-0.43). CONCLUSION: There has been an increased access to KS treatment. The overall response rate is 52.4%, which is considered a satisfactory result. Poor outcomes were common and were largely due to late presentation and defaulting on treatment. Efforts towards early HIV/KS diagnosis and adherence to a full round of chemotherapy are needed for optimising outcomes. Newer drugs may be required for patients previously exposed to chemotherapy.

[Epidemiological, clinical and judicial aspects of sexual assault in Bamako (Mali)]. / Aspects épidémio-cliniques et judiciaires des agressions sexuelles au Mali.

BACKGROUND: Sexual assault rates are underestimated in Mali. This study was designed to assess the epidemiological, clinical and judicial aspects of sexual assault. PATIENTS AND METHOD: A retrospective study was conducted from 1st July 2007 to 30 April 2010 in the health care centre of the 4th Commune of Bamako. The study included 37 sexual assault victims selected from the medical records and sexual assault certificates from a total of 1,810 patients attending the gynaecology clinic during the study period. RESULTS: The frequency of sexual assault was therefore 2%. 78.4% of the victims took legal action against the alleged perpetrator. Victims admitted at the request of Police officers accounted for 43.25%; 59.5% of victims attended the clinic within 24 hours following the assault. The age ranged from 2 to 40 years with a mean of 21 years; 37.9% were single and 48.6% were students. The assault was perpetrated by one person in 89.2%, a relative was involved in 5.4%; rape consisted of genito-genital intercourse in 64.9%; 32.4% of the victims had perineal and/or vulval injuries. CONCLUSION: Sexual assault is relatively frequent in Mali, particularly among students and housewives. It represents a real tragedy, which must be prevented by increasing the awareness of the population, judicial assistance to victims and prosecution of perpetrators.

Autopsy following death by homicide in 644 cases.

The objectives of this study are to determine the cause of death and based on the wounds, to analyze the different epidemiological variables on homicide in Dakar. Included were all homicides cases where an autopsy was performed and these results recorded in the autopsy register. The data collected in our work included, identity, sex, age, place of crime (location), the cause of death (the causative agent and the anatomical region injured) and the mechanism of death (the pathophysiological phenomenon causing death). On average 56 cases of homicide a year are reported, ranging from 44 cases in 2005 to 80 cases in 1999. Extrapolated to the population of Dakar this corresponds to 1.9 homicides per 100,000 inhabitants. Victims aged over 55 years represented only 4.03% of all victims. 6.52% of cases were infanticide. The crimes mainly took place in the suburbs of Dakar (51.42% of cases). Hand held weapons were used in 578 cases (89.7%) followed by firearms in 44 cases (6.8%). The study of the age of the victims has some interesting points. The homicide of elderly people in Senegal was relatively low in contrast to what is found in a developed country. The youthfulness of our population also explains the large number of homicide victims between 21 and 25. Infanticide is a particular problem in Senegal. In our study, 50.6% of homicides were found in the suburbs of Dakar followed by the peripheral area which accounted for 29.3% of homicides. The incidence of homicide can be directly correlated with the level of economic development. This frequency is much higher where incomes are low and particularly affect young males. The study of this phenomenon should lead to better prevention. The victim-type in Dakar is a young man, aged 20-25 years, killed by an instrument with an injury to the skull, neck, heart or main arteries, causing bleeding and death.

Detention provisoire des jeunes femmes accusees d'avortement clandestin ou d'infanticide au Senegal

Introduction: L'activite sexuelle chez les jeunes les expose a un accroissement du risque de contracter des grossesses non desirees. Le recours a l'avortement clandestin avec son corollaire de complications peut entrainer le deces de la jeune femme. Avortement et infanticide sont interdits et sanctionnes par la loi senegalaise. Comment ces jeunes femmes vivent-elles leur detention ? Existe-il des alternatives a la detention pour eviter leur desocialisation ? Methodes: Cette etude retrospective portait sur la maison d'arret des femmes de Dakar situee a Liberte 6; un quartier deDakar. Nous avons procede a des entretiens avec des femmes detenues a la maison d'arret des femmes de Dakar et suspectees d'infanticide ou d'avortement clandestin. Resultats: Les femmes de notre echantillon ont une moyenne d'age inferieure a 25 ans avec parmi elles une fille mineure de 16 ans. Nous avons trouve 18;51 de femmes suspectees d'infanticide ou d'avortement. Dans notre etude 50 des femmes sont originaires de la peripherie et de la banlieue de Dakar et presque 44 proviennent des autres regions du pays. La duree moyenne de detention provisoire est de neuf mois. Conclusion: Malgre leur qualification distincte dans le code penal : l'infanticide est un crime et l'avortement un delit; les femmes suspectees d'avoir commis ces actes sont soumises a de longues detentions preventives