[Investigation of a shigellosis outbreak in a rural zone of Senegal]. / Investigation d'une épidémie de shigellose en zone rurale au Sénégal.

The investigation of this outbreak took place in Niakhar (IRD project study area), a rural area located 150 km East of Dakar. Covering 30 villages, with a population of about 30,000 inhabitants, the area has been under demographic and epidemiological surveillance. In 1999, the surveillance allowed 973 cases of shigellosis to be recorded out of 1,751 cases of dysenteric diarrhoeas. The outbreak reached a peak during the raining season (73% of the cases in September and October). All the villages and all age groups were concerned. The attack rate in the population was 3%. During the same period, 22 deaths were attributed to shigellosis, leading to a lethality of 2.3%. Children under five were the most affected. The bacteriological examination isolated S. flexneri in 72% of 12 stools samples and S. dysenteriae A1 (SD1) in 14%. All serotypes were resistant to ampicillin and susceptible to quinolones. Susceptibility to cotrimoxazole was unconstant. Apart from the usual factors involved in the spread of diarrhoeas, the main reason evoked to explain the duration of the epidemic has been the lack of adequate emergency antibiotherapy treatment. Quinolones, recommended by the health authorities, could not be provided by health services. The identification of the SD1 serotype confirmed its involvement in the outbreak of shigellosis. The exact role of S. flexneri in shigellosis epidemics should be further studied.

[Genital prolapse in Dakar]. / Les prolapsus génitaux à Dakar.

Genital prolapses are the result of musculo-ligamentary alterations often caused or complicated by traumatic delivery and senible atrophy of the tissues. From 1969 to 1988, we gathered 104 files of patients with genital prolapses. The age of the patients ranged from 20 to 70 years with an average age of 30. The subject between the ages of 20 and 39 were the most affected (64%). The average number of children per woman was 4. 60 patients had 5 children. No case of prolapses was found among virgin or mulliparous women. In 48 cases delivery was dystocic. The clinical symptomatology was a feeling of intravaginal globus, pelvic algia and discomfort (57 cases). Straingul urinary incontinence wax manifest in 15 patients. Colpocystocele (88 cases), rectocele (66 cases) and hysterocele (50 cases) were among the most frequently evidence lesions. On the therapeutic matter, the low passage was used 58 times and the high passage 32 times. An urinary gesture was made 33 times. There was no operatory fatality. Urinary troubles related to infection, acute retention of urine and strainful urinary incontinence were observed. Later 10 cases of recurrence were observed within an average time interval of 2 years. This work is characterized by the young age of the patients. It denotes the noticeable role played by obstétrical traumatisms in the genesis of genital prolapses in the African context. The senescence and atrophy of the tissues seem to have a less important role in contrast with the developed countries. Finally, the surgical treatment of these patients must take into account, among other things, the child bearing desire of the patients, given the social and psychological weight of maternity in our society.