[Study of the factors associated with the delay of health consultation of victims of rape in Senegal]. / Étude des facteurs associés au retard de consultation sanitaire des victimes de viols au Sénégal.

INTRODUCTION: Rape remains one of the most serious forms of sexual violence because of its negative impact on the physical and mental health of victims. The objective of this study is to identify the factors associated with the delay in rape victims seeking medical assistance from healthcare professionals in Senegal. METHODOLOGY: A retrospective, descriptive and analytical observation study was conducted. The study population consisted of all the court files of girls or women victims of rape recorded by the investigators at the 11 high courts of Senegal during the period from 2006 to 2015. An exhaustive recruitment of the full records of rape victims meeting the inclusion criteria were completed. The uni and multivariate analyses were carried out with Epi Info 2000 and R 2.2.9 software respectively. RESULTS: At the end of the collection, 1,037 cases of rape were included in the study population. The average age of the victims was 16.3±7.9 years (range 1-72). Minors (<18 years) accounted for 24.8 %. The median time from rape to consultation at a health facility was 24hours. Long delay in consultation (>24hours) was noted for 38.6 % of victims. Risk of late consultation after rape was higher among victims residing in the southern areas (ORaj=4.31 [1.15-16.14]), or northern areas (ORaj=4.22 [1.26-14.14]), who were major (ORaj=1.67 [1.04-2.68]) or married (ORaj=3.44 [1.58-7.5]) or who were pregnant after the aggression (ORaj=34.03 [15.47-74.85]) or had an abortion (ORaj=5.45 [1.04-24.47]). CONCLUSION: Medical and judicial assistance are more difficult if there is a long delay between the aggression and consultation. Thus, it is important for the health and judicial authorities to raise awareness about the harmful consequences of sexual violence, and to put forward the benefits of therapeutic care, compensation for the harm suffered by rape victims, as well as the availability of holistic care services 24hours a day.

[Knowledge, Attitudes And Practice Of The Pupils Of The High School Famolo Coulibaly Of Kolokani On The HIV And The AIDS (Mali)]. / Connaissances, Attitudes Et Pratiques Des Eleves Du Lycee Famolo Coulibaly De Kolokani Sur Le VIH Et Le Sida (Mali).

INTRODUCTION: The epidemic of the AIDS is global. No country or territory is saved. Mali takes into account the preventive education in the AIDS in the sectorial programs of the Ministry of Education and the courses of study. OBJECTIVE: to estimate the level of the Knowledge, Attitudes and Practice of the pupils regarding prevention of the HIV and the AIDS. METHODS: it was about an exhaustive, quantitative and transverse survey led to the high school of Kolokani. The survey concerned 515 pupils questioned from 2 till 7 March 2007. RESULTS: At the level of the knowledge the mode of transmission the most quoted by the pupils was the sexual intercourse with multiple partners (78.46 % for the boys and 71.22 % for the girls). Compared with the behavior, 62.89% of sexually active pupils used the condom in their last high-risk sexual intercourse. Only 25.05% of students reported having conducted a voluntary screening test. Attitudes of discrimination exist because 18.06 % of pupils have a feeling of fear towards the People Living with the HIV. CONCLUSION: These results show that there is a risk of transmission of the HIV and the AIDS in schools. This has to motivate the intensification of the activities of raising sensitization and prevention to improve the indicators of prevention of this pandemic.

INTRODUCTION: L'épidémie du SIDA est globale. Aucun pays ou territoire n'est épargné. Le Mali prend en compte l'éducation préventive au SIDA dans les programmes sectoriels du Ministère chargé de l'éducation et des programmes scolaires. OBJECTIF: Evaluer le niveau des Connaissances, Attitudes et Pratiques des élèves en matière de prévention du VIH et du SIDA. MÉTHODES: Il s'agissait d'une étude exhaustive, quantitative et transversale menée au lycée de Kolokani. L'enquête a porté sur 515 élèves interrogés du 2 au 7 Mars 2007. RÉSULTATS: Au niveau des connaissances le mode de transmission le plus cité par les élèves était le rapport sexuel avec les partenaires multiples (78,46% pour garçons et 71,22% pour les filles). Par rapport aux comportements 62,89% des élèves sexuellement actifs ont utilisé le préservatif lors de leur dernier rapport sexuel à haut risque. Seulement 25,05% des élèves ont déclaré avoir effectué un test de dépistage volontaire. Les attitudes de discrimination existent car 18,06% des élèves ont un sentiment de peur envers les Personnes Vivant avec le VIH. CONCLUSION: Ces résultats montrent qu'il y a un risque de transmission du VIH et du SIDA en milieu scolaire. Ceci doit motiver l'intensification des activités de sensibilisation et de prévention pour améliorer les indicateurs de prévention de cette pandémie.

Connaissances, attitudes et pratiques des élevés du lycée famolo coulibaly de Kolokani sur le VIH et le sida (Mali)

Introduction : L'épidémie du SIDA est globale. Aucun pays ou territoire n'est épargné. Le Mali prend en compte l'éducation préventive au SIDA dans les programmes sectoriels du Ministère chargé de l'éducation et des programmes scolaires. Objectif : Evaluer le niveau des Connaissances, Attitudes et Pratiques des élèves en matière de prévention du VIH et du SIDA. Méthodes : Il s'agissait d'une étude exhaustive, quantitative et transversale menée au lycée de Kolokani. L'enquête a porté sur 515 élèves interrogés du 2 au 7 Mars 2007. Résultats : Au niveau des connaissances le mode de transmission le plus cité par les élèves était le rapport sexuel avec les partenaires multiples (78,46% pour garçons et 71,22% pour les filles). Par rapport aux comportements 62,89% des élèves sexuellement actifs ont utilisé le préservatif lors de leur dernier rapport sexuel à haut risque. Seulement 25,05% des élèves ont déclaré avoir effectué un test de dépistage volontaire. Les attitudes de discrimination existent car 18,06% des élèves ont un sentiment de peur envers les Personnes Vivant avec le VIH. Conclusion : Ces résultats montrent qu'il y a un risque de transmission du VIH et du SIDA en milieu scolaire. Ceci doit motiver l'intensification des activités de sensibilisation et de prévention pour améliorer les indicateurs de prévention de cette pandémie

[Study of the Consumers' preference on the universal health coverage development strategy through health mutual in Ziguinchor Region, Southwest of Senegal]. / Étude de la préférence des usagers sur les stratégies de développement de la couverture sanitaire universelle à travers les mutuelles de santé dans la région de Ziguinchor au sud-ouest du Sénégal.

In Senegal, the informal and rural sector that accounts for over 80% of the population is covered only up to 7% by a health insurance system. That is why, for the implementation of development strategy of the universal health coverage (UHC) through mutual health insurance providers, the Government of Senegal has focused on this sector. The objective of this study was to assess the consumer's preference on the UHC development strategies through mutual health insurance providers. This was a qualitative and exploratory study based on a literature review, and indepth interview with the heads of households. It was also based on focus groups of people with and without health mutual membership, and the Expert Committee meetings. The results showed that the most critical attributes in the decision-making of consumers to join the health mutual in Ziguinchor were the membership units; the content of the benefit package, the payment modalities of the premium, the premium amount, the availability of transportation, the co-payment level, convention arrangement with health facilities, and health mutual governance. For a successful implementation of the UHC development strategy through health mutual organizations, policymakers should explore the possibility of introducing the modality of payment in kind, the revision of the co-payment amount, and the promotion of equity through the introduction of a differentiated premium contribution by income. They should also establish a crossborder strategy with The Gambia and Guinea-Bissau to improve health care access to people living in the borders. The promotion of innovative funding and risk equalization between health insurance schemes is also recommended. In areas where the microfinance institutions are well organized and structured their substitution to health mutuals should be an option the decision-makers have to explore.

[Comparative study of two anti-antiretroviral protocols used for treatment of a cohort of HIV 1-positive patients followed at the Institute of Public Health and Hygiene in Dakar, Senegal]. / Etude comparative de deux protocoles de traite- ment antirétroviral des patients VIH-1 positifs de la cohorte suivie à l'lnstitut d'hygiène sociale de Dakar, Sénégal.

In the last ten years, the discovery of several antiretroviral drugs has greatly contributed to improving the survival and quality of life of HIV-infected persons. The purpose of this retrospective study was to compare the effectiveness and tolerance of two anti-retroviral combinations, i.e., Lamivudine + Zidovudine and Efavirenz versus Lamivudine + Zidovudine and Nevirapine. The files of HIV1-infected patients treated between July 2003 and December 2004 (18 months) and followed at the Institute of public health and hygiene in Dakar were reviewed. A total of 70 patients, i.e., 35 in each protocol group, were included. The following data were collected for each patient: age, sex, locality, elements to assess tolerance, and elements to assess effectiveness (CD4 count, viral load and opportunistic infection immuno-failure). Results indicated that the immunovirologic effectiveness of the two protocols was identical with regard to mean CD4 count, i.e., 327 cells/mm3 for AZT+3TC+EFV versus 334 cells/mm3 for AZT+ 3TC+NVP (p < 0.05). Immuno effectiveness was better for Lamivudine + Zidovudine + Efavirenz than Lamivudine + Zidovudine + Nevirapine. Significant therapeutic advances in recent years have improved survival and quality of life in patients under retroviral treatment. There are currently many anti-retroviral molecules available and several relatively well codified therapeutic protocols.

[Models for calculating the cost of operational expenditure for a health centre in Senegal]. / Coûts de fonctionnement d'un centre de santé au Sénégal: modalités de calculs.

The transformation of a health post into a health centre generates new services which mobilise different resources. The objective of this work is to propose a budgetary forecasting model for this specific type of case, one which is recurrent although seldom documented. As a preliminary step, the quarterly operational costs were determined, and the "complete costs method" (or the homogeneous sections method) was utilised for this purpose. In the second phase, the "pre-established costs method" was used to set the budget forecasts. The amount to be recovered by the health committee for a three month period of operation is estimated at 1,574,967 F CFA (equivalent to approximately 2,400 Euros), representing 42% of the total cost. The states assures the contribution of public funds to cover 54.2% of the cost, and the commune of Kanel furnishes 3.8% of the total cost, however only in the form of in-kind contributions or other material resources. The overall estimated budget for the year 2004 is estimated at 14,835,425 F CFA (about 22,615 Euros) of which 57.6% is expected to be received from the state.

[Cost analysis of operating the oral health service of the regional hospital center of Ziguinchor (Senegal)]. / Analyse des coûts de fonctionnement du service de stomatologie du Centre Hospitalier Régional de Ziguinchor (Sénégal).

This study related to the analysis of the cost of operation of the service of oral health in the regional hospital complex of Ziguinchor for the year 2002. Its objective is to analyze the costs of operation of the service in order to allow a good covering of the costs while guaranteeing the accessibility to care and the perennity of the offer of service. The methodology used for the determination of the costs was the method of the complete costs (or method of the homogeneous sections). The various services provided by the service were identified. The resources mobilized for the realization of these services were determined and developed. They were classified in direct loads, i.e. directly ascribable to the provided service and in indirect loads when the resources are common to more than one service. The charge of the indirect loads was done thanks to a scale. The total cost of operation of the service of stomatology for year 2002 amounts to 11464943 F CFA. Two financial backers intervened with the financing of the service. The public funds support 75% of the loads and the community 25%. The cost to be recovered is 2845513 FCFA. The rate of covering is surplus for all the services safe for the oral surgery, the obturations with the composites and radiography. It is thus of primary importance to re-examine tariffing in force with the fall. This fall of tariffing will certainly make it possible to take restraint measures of the exemptions from payment. The covering of the costs by the means of the Community participation requires the installation of a tariffing likely to ensure the perennity of the services and to avoid exclusion.

[Prognostic factors of pregnancy and delivery complications in Senegalese adolescents and their newborn]. / Facteurs pronostiques des complications de la grossesse et de l'accouchement chez l'adolescente et son nouveau-né au Sénégal.

Developing countries exhibit the highest adolescent fertility rate in the world. Undesirable outcome frequency during adolescents' pregnancy and delivery is debated. The aim of this study is to determine the incidence of these events and the factors predicting their occurrence among pregnant Senegalese adolescents and their newborn. The study was conducted between August 1st, 1999 and July 31st, 2000 in a national sample of 435 women attending prenatal clinics after a 20-week gestation. The data were collected by interviews: sociodemographic characteristics, obstetrical antecedents, current pregnancy history before inclusion in the study; the clinical characteristics were determined at inclusion. Then pregnancy and delivery complication occurrences were observed for mothers and their newborn during follow-up. Logistic regression analyses were performed to determine the factors associated with each complication, controlling the effects of other sociodemographic and clinical factors. The most frequent pregnancy complications were pregnancy-induced hypertension and toxaemia (17.5%). Anemia occurred in 25% of the women. At delivery, at least one of dystocia, eclampsia, or placenta haemorrhage complications occurred in 46% of women. The caesarian rate was 20% and the mortality rate was 71%. When planned, caesarian interventions lowered mortality. Forty percent of the newborns presented a neonatal distress while 17.9% of them weighed less than 2,500 g. The pregnancy-induced hypertension and toxaemia incidence rates were higher when the weight at onset of pregnancy was unknown (OR = 3.7 [1.9-7.5] for hypertension and 3.1 [1.3-7.6] for toxaemia). When a woman with a narrow pelvis was less than 1.50 m tall, the delivery was more frequently assisted by forceps and extracting action in breech delivery. Dystocia, eclampsia, placenta haemorrhage and premature delivery were associated with high mortality. Overall, complications were not more frequent in the youngest (16 years and below), as suggested in previous studies. Those results suggest that undesirable events occur frequently during adolescents' pregnancy and delivery, and in their newborn, while attendance in prenatal clinics is adequate. The prognostic factors of these complications are identified. These complications can be avoided by improving ante- and perinatal care quality.