Surveillance in the field: Over-identification of Ebola suspect cases and its contributing factors in West African at-risk contexts.

During an Ebola outbreak, the WHO recommends that health professionals consider people as suspect cases (SCs) when they show key signs such as the sudden onset of high fever or specific symptoms after having had contact with a suspect or confirmed Ebola case. SCs should then get care, be isolated and be reported to health authorities until the Ebola virus disease is confirmed through a lab test. This exploratory study aims to understand this identification process in the field based on a qualitative analysis of the diagnosis and therapeutic itineraries of 19 SCs in Cote d'Ivoire and Senegal (2014-2015). Results indicate that the main criteria for SC identification at the field level were fever (understood broadly) and provenance from a highly affected country (applied indiscriminately). WHO criteria were not followed in at least 9 of the 19 cases. Several medical, social and cultural factors favour over-identification of people as SCs, including relativism in defining 'high fever', placism, humanitarian or securitarian bias, issues in categorising SC's contact cases, and the context of fear. To avoid undue categorisation and its possible harmful social effects, the WHO definition should be implemented more carefully in various contexts and with greater consideration for ethical issues, while prioritising diagnosis strategies with higher specificity.

[Security agents on the front line against Ebola: roles, perceptions and knowledge in Fann Teaching Hospital, Dakar, Senegal]. / Les agents de sécurité en première ligne face à Ebola : rôles, perceptions et connaissances au CHU de Fann, Dakar, Sénégal.

Security agents are on the front line when patients arrive at health facilities, giving them a potential role to play in an Ebola virus disease (EVD) outbreak. The position of security agents within health services is poorly documented. A survey was conducted to clarify their understanding of Ebola pathology, to assess their need for information and to determine their role in patient management. The survey included both qualitative and quantitative aspects. 80 security agents of the Fann teaching hospital (Dakar) completed questionnaires, and 11 were interviewed. Qualitative analysis was performed with Dedoose and the quantitative analysis using Excel. The results show that security agents' activities go beyond their mission of security and control. They are involved in informing, orienting and assisting patients and those accompanying them in the hospital. The security agents have basic knowledge of EVD, but overestimate the risk of transmission. They want to be more informed and to have access to protective material. These results suggest that these professionals should be taken into account when developing response strategies to Ebola outbreaks. Their knowledge of and protection against the disease must be strengthened. Non-health professionals working in health facilities should be trained in order to be able to relay information to the public.

[Ebola contacts' surveillance: social impact and ethical issues in Senegal]. / La surveillance des personnes contacts pour Ébola : effets sociaux et enjeux éthiques au Sénégal.

Quarantine has been widely used during the Ebola outbreak in West Africa mainly to control transmission chains. This measure raises ethical issues that require documentation of the modalities of quarantine at the field level and its social effects for contact persons. In Senegal, 74 people were in contact with the Ebola case coming from Guinea in September 2014. Of these, 34 members of the case's household were contained together at home and monitored by officers. The remaining 40 health care workers from two facilities were dispersed in their family households and monitored by telephone or during doctors' visits. The study is based on in-depth interviews with 43 adult contacts about their experiences and perceptions, with additional observation for interpretation and contextualization.Containment at home was applied differently to contacts who lived with patient zero than to professional health care contacts. No coercion was used at first since all contacts adhered to surveillance, but some of them did not fully comply with movement restrictions. Contacts found biosafety precautions stigmatizing, especially during the first days when health workers and contacts were feeling an acute fear of contagion. The material support that was provided-food and money-was necessary since contacts could not work nor get resources, but it was too limited and delayed. The relational support they received was appreciated, as well as the protection from stigmatization by the police and follow-up workers. But the information delivered to contacts was insufficient, and some of them, including health workers, had little knowledge about EVD and Ebola transmission, which caused anxiety and emotional suffering. Some contacts experienced the loss of their jobs and loss of income; several could not easily or fully return to their previous living routines.Beyond its recommendations to enhance support measures, the study identifies the ethical stakes of quarantine in Senegal regarding informed consent and individual autonomy, non-maleficence and benevolence, and equity and adaptation to specific situations. Nevertheless, the balance between preventive benefits and individual inconveniences of quarantine should still be evaluated from a public health perspective.

CTX-M-15-producing Morganella morganii from Hôpital Principal de Dakar, Senegal.

We report the detection and molecular characterization of extended spectrum ß-lactamases in a series of 112 clinical isolates of Enterobacteriaceae from the Hôpital Principal de Dakar, Senegal, including five CTX-M-15-producing Morganella morganii isolates, which are reported for the first time in this country.

[Childbearing in the era of antiretroviral drugs in Senegal, representations and practices among PLHIV and health care professionals]. / Procréation au temps des antirétroviraux au Sénégal, représentations et pratiques des PVVIH et des professionnels de santé

This article describes and analyzes the attitudes towards the risk of sexual transmission of HIVand childbearing among PLHIV who have received antiretroviral therapy for ten years and the attitudes and representations of health care professionals who conduct their medical follow-up. The results highlight the contradictions between the magnitude of the social advantages of motherhood for women living with HIVand the reluctance among health care professionals to support them. In a context where the pressure to bear children is strong, the biomedical system that supports childbearing for PLHIVon ARVs should be readapted without failing to also address men living with HIV.

[Experience of people living with HIV (PLHIV) on chronic disease: a typology]. / Typologie de l'expérience des personnes vivant avec le VIH (PVVIH) au temps de la maladie chronique.

While discourses focus on the "normalization" of the situation of people with long term antiretroviral treatment, this qualitative analysis aimed at considering more accurately the diversity of their experiences. Five profiles were identified: patients who became experts, patients in medical difficulty, patients dominated by financial insecurity, people who live an almost normal life and people suffering from social disqualification.

[Moving from prevention to elimination of mother-to-child transmission of HIV before 2015, an unrealistic objective? Social stakes in Senegal]. / Passer de la prévention de la transmission mère-enfant du VIH à son élimination avant 2015 : un objectif irréaliste ? Enjeux sociaux au Sénégal.

In 2010, international agencies began to promote the elimination of mother-to-child HIV transmission (EMTCT) in 2015 by proposing a new preventive strategy based on the extensive use of antiretrovirals. For a country like Senegal where the epidemic is considered to be concentrated, since prevalence is beyond 1%, and where the prevention program was fully applied to only 7 to 15% of children exposed to HIV, the objective is ambitious. The pharmacological efficacy of antiretrovirals will not be sufficient if the experience of actors in the field about the social aspects and the acceptability of the program to women are not considered. The aim of this article is to describe the social issues on the basis of two studies conducted in the region of Dakar (an exploratory study of the effects of the new prevention strategies and a study of the experience of patients receiving antiretroviral treatment for 10 years). The results reveal the main issues: community prevention showed its limits at the stage of access to the program and test, which suggests the importance of strategies to promote awareness and prevention that are focused on women; retention depends highly on the attitudes of health workers and on the role of peer counselors, but the integration of HIV testing and treatment in reproductive health services is not fully established; ambivalent perceptions of antiretrovirals complicate adherence; and finally, the organization of health services hinders a family approach of prevention. These results are innovative, since most publications on this topic concern southern and east Africa.

Partager l'information sur son statut serologique VIH dans un contexte de polygamie au Senegal

Au Senegal; ou la prevalence du VIH est inferieure a 1 et la stigmatisation reste importante; 40 des unions sont polygamiques. L'objet de cet article est de decrire et analyser les motivations; les avantages et les contraintes lies au partage de l'information a propos du statut VIH + ; en explorant les particularites relatives aux situations de polygamie. Il repose sur les donnees d'une recherche qualitative par entretiens approfondis et repetes sur l'experience du traitement antiretroviral et ses effets sociaux; menee sur une periode de 10 ans aupres de personnes sous traitement et de leurs soignants. Les professionnels de sante encouragent les personnes a partager leur statut; surtout dans certaines circonstances telles que la prevention de la transmission mere-enfant; neanmoins ils sont bien conscients des risques sociaux que courent certains patients; notamment des femmes. Certains insistent; d'autres n'interviennent pas aupres de celles qui ne partagent pas avec leur conjoint; tout en soulignant leur dilemme ethique. Les entretiens retracent l'evolution des attitudes des soignants a cet egard. La majorite des femmes mariees commencent par partager leur statut VIH+ avec leur mere; attendant d'elle qu'elle atteste que la contamination n'est pas due a des comportements amoraux et qu'elle participe a la mise en place d'une strategie. Dans les foyers polygames; les femmes tentent de partager l'information avec leur conjoint; en maintenant le secret au-dela du couple. Certaines craignent la divulgation par leur conjoint aupres des coepouses; dont les attitudes peuvent etre tres diverses: des recits rapportent le rejet collectif hors du foyer dont certaines femmes ont ete victimes; l'annonce est parfois faite de maniere progressive en suivant la hierarchie des positions de chaque interlocuteur dans le foyer; une autre personne rapporte la solidarite montree par ses coepouses qui lui a permis de maintenir le secret hors du foyer. L'article montre la diversite des situations et leur caractere evolutif tant en matiere de partage du statut qu'a propos des effets sociaux de ce partage

Les ruptures traumatiques de l'uretre posterieur : analyse de 87 cas au CHU de Conakry

Objectif : Rapporter notre experience dans la prise en charge des ruptures traumatiques de l'uretre posterieur. Patients et methodes : Quatre-vingt-sept patients presentant une rupture traumatique de l'uretre posterieur ont ete traites dans le service d'Urologie-Andrologie du CHU de Conakry de janvier 1988 a decembre 2004. Le contexte traumatique a ete un accident de la voie publique dans 68 (78;2) cas et un accident de travail dans 19 (21;8) cas. Seuls 32 (36;8) des patients ont ete recus dans les 72 heures qui ont suivi le traumatisme; les autres ont ete recus au stade de stenose uretrale constituee. Une fracture du bassin a ete notee chez 56 (64;4) patients. La symptomatologie clinique etait dominee par la retention d'urine dans 62 (71;3); l'uretrorragie dans 59 (67;8) et l'hematome perineal dans 23 (26;4) cas. Resultats : Le traitement a consiste en un realignement sur sonde uretrale en urgence; une reparation uretrale en urgence differee entre le 8e et le 10e jour et une uretroplastie tardive selon qu'il s'agissait d'une rupture recente ou ancienne de l'uretre. Les resultats therapeutiques ont ete bons dans 32 (36;8) et moyens dans 39 (44;8) cas. Une dysfonction erectile a ete notee chez 19 (21;8) patientsConclusion : Le traitement des ruptures de l'uretre posterieur demeure controverse; cependant pour nous; l'uretrorraphie termino-terminale en urgence differee reste la methode therapeutique de choix dans notre contexte devant l'impossibilite de pouvoir realiser un realignement endoscopique et en l'absence de lesions associees severes. Devant des lesions associees graves la refection uretrale passe au second plan cedant la priorite aux lesions engageant le pronostic vital

[Urologic complications of gynecologic surgery. Report of 16 cases]. / Les complications urologiques de la chirurgie gynécologique. A propos de 16 cas.

From 16 cases collected in eight years (January 1991-December 1999) in the I. Deen Teaching Hospital Department of Urology, the authors study the gynaecological and obstetric surgery urological complications. They noted that these complications interest in 80% of cases the 18-47 years old woman with a high parity in 70% of cases. Hysterectomy, whatever the indication is the main etiology: 62.50%, caeserean takes the second place with 25%. The anatomic lesions are ureteral in 68.75% of cases and bladder in 31.25%. In the 14 cases treated, in the department, uretero reimplantation has been done in 46.66%, bladder suture in 40% and nephrectomy in 6.66%. Thirteen women were healed and one died.

[Endoscopic internal urethrotomy in the treatment of male urethral stenosis at the urology service of the CHU Ignace Deen]. / L'urétrotomie interne endoscopique dans le traitement des sténoses de l'urètre masculin au service d'urologie du CHU Ignace Deen.

The authors report a series of 157 stenoses of the urethra treated by endoscopic urethrotomy between 1991 and 1997. After a first urethrotomy the success rate is 51.8%, with a decline of one year. Mortality is zero, and the morbidity assessed at 9%. For these authors, the result is better when the urethrotomy concerns an uninfected, one-time, short (less than 2 cm) stenosis, whatever the etiology, located on the proximal urethra. The duration of the postoperatory catheter has been fixed at three days. Poor results (35.20%) have been reported in stretched stenoses located on the distal urethra. These poor results have been treated by another urethrotomy, with 25% good results. The remaining 10.2% have needed sessions of urethral dilatation, even a plasty.

[Bladder diverticulosis at a urologic service of the Ignace Deen de Conakry teaching hospital. Retrospective study of 28 cases]. / Les diverticules de la vessie au service d'urologie du CHU Ignace Deen de Conakry. Etude rétrospective de 28 cas.

From January 1st 1993 to December 31st 1998, 28 cases of bladder diverticula have been collected in Ignace Deen teaching hospital department of urology. The purpose of authors is to study the epidemiological aspects of diverticula of the bladder. They noted that bladder diverticula in 96.40% of cases are male disease, diagnosed by cystography, intravenous urography, ultrasonography or cystoscopy in 86%; and the etiology of bladder diverticula is a prostatic tumor in 68% of cases. A diverticulectomy is done by open surgery, associated to relieving outlet obstruction in 42.90%.

[Early complications of transvesical prostatectomy for prostatic adenoma at the Conakry urologic department: report of 96 cases]. / Les complications précoces de l'adénomectomie prostatique transvésicale au service d'urologie de Conakry: à propos de 96 cas.

Hryntschak Technic is the most common method in the prostatic hyperplasia surgical treatment in the Ignace Deen Urological Department. The aim of the authors in this paper is to study the epidemiological aspects of hryntschak early complications from january 1994 to December 1998. They found, from 96 cases that 41.70% are specific complications and 58.30% are non specific complications. Wound infection (35.40%), bladder fistula (15.60%) and epididymitis (11.50%) are the most frequent complications. The 61 to 80 years old rural man, with a urethral catheter placed before operation is the first interested by Hryntschak early complications.

[Epidemiologic and therapeutic features of urogenital fistulae in Guinea (Conakry)]. / Aspects épidémiologiques et thérapeutiques des fistules uro-génitales en Guinée (Conakry).

OBJECTIVE: The authors analyse the epidemiological and therapeutic aspects of 186 cases of urogenital fistulas and attempt to define a preventive approach to these lesions. METHODS: From January 1986 to December 31, 1993, 186 patients were admitted to the urology department of Ignace Deen hospital for urogenital fistulas. Each patient was submitted to the following assessment: complete clinical examination, laboratory examination, endoscopic examination, radiological examination. A therapeutic classification was established on the basis of this assessment: Group 1: complex fistulas. Group 2: difficult fistulas. Group 3: simple fistulas. RESULTS: Urogenital fistulas were predominantly observed in young primiparous women living in rural zones and the principal cause was a dystocic delivery: 179 cases (96.23%), while only 7 cases (3.7%) were due to gynaecological lesions. 246 primary and secondary repair operations were performed, corresponding to an average of 1.3 operations per patient. Cure was obtained in 131 patients (70.43%) including 37.63%) in Group 1, 8.61% in Group 2 and 21.19% in Group 3. In three cases of partial success, the fistulas were closed; two patients have persistent dysuria with reduced bladder capacity and one patient suffers from dyspareunia with impossibility of coital penetration. Finally, the 49 failures (26.34%) concerned 34 type 1 fistulas; 5 type 2 fistulas and 10 type 3 fistulas. CONCLUSIONS: In the light of our eight-year experience, urogenital fistula still appears to be a real problem in Guinea, where it represents a public health problem for which surgical cure still raises technical difficulties. In the fight for eradication of urogenital fistula in developing countries, emphasis must be placed on prevention with a just and equitable distribution of health care personnel in rural zones which are often underprivileged: constant improvement of the road network to allow rapid transfer of cases of foetomaternal dystocia to a reference centre; improvement of health structures; urological and obstetric surveillance of any woman operated for urogenital fistula.

[Repair of a vesicovaginal fistula in the ventral supine position (34 cases)]. / Cure de fistule vésicovaginale par voie basse en décubitus ventral (34 cas).

The authors report the efficacy of a transvaginal approach in the ventral supine position for repair of vesicovaginal fistula based on a series of 34 consecutive patients. 34 patients, between the ages of 15 and 60 years, with vesicovaginal fistula (cervicotrigonal in one half of cases) of obstetric origin (73% of dystocia) in multiparous women (62% were treated by transvaginal closure of the fistula in the ventral supine position). 29 complete successes were obtained with 5 residual fistulae which were lost to follow-up. The use of the ventral supine position is valuable in the transvaginal repair of vesicovaginal fistulae.

[Retrocaval ureter (apropos of a case)]. / L'uretère rétrocave (a propos d'un cas).

The authors are reporting a case of lumbar pain secondary to a retrocaval ureter. Pathogeny, diagnostic implications and treatment of this entity is discussed.