[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.

[Nutritional status of street children in the district of Manga (Burkina Faso)]. / État nutritionnel des enfants de la rue dans la commune de Manga (Burkina Faso).

Malnutrition is an important indicator of development, and its consequences in children and adolescents produce a serious socioeconomic burden. Children living on the street are more vulnerable than others. Thus, our objective was to analyze the nutritional status of children living on the streets of Manga, through a cross-sectional and analytical study. The snowball technique was used for sampling. Data came from individual interviews, blood samples and medical examinations. Of the 237 children studied, 84.8% were boys; the overall mean age was 11.5 years, and 72.6% were adolescents (aged 10 to 17 years). Growth retardation (15.9%) predominated among the children aged 4 to 9 years, while a weight deficit (27.9%) was most common among those aged 10 to 17. Half of the children (50.2%) with blood tests (N = 119) had anemia. There was a link between anemia and underweight (p = 0.0145). Children who ate at least three times a day were 2.63 times less likely to be anemic (p<0.001). Factors associated with anemia (p<0.005) included survival activities. We frequently found nutritional deficits and anemia in these children. A targeted nutritional program would be a good entry point for their successful reintegration..

[Study of determinants of unprotected sex in sailors of the Senegalese merchant navy]. / Étude des déterminants des rapports sexuels non protégés chez les marins de la marine marchande sénégalaise.

Sailors are a mobile population travelling a lot and therefore being often exposed to casual sex. The aim of this study is to analyze the determinants of unprotected sex among sailors in Senegal. A descriptive and analytical study was conducted among sailors of the merchant navy. Data on knowledge, attitudes and practices were collected during a personal interview. A multivariate analysis was performed using a multiple logistic regression. A total of 400 sailors were interviewed, 57.9% had casual sex of whom 23.7% were not protected. Sexual intercourse without protection was more common among the uneducated (OR = 2.29 [1.23 to 5.99]) and married (OR = 2.29 [1.23-5.99]). Sailors who thought that using condom reduces pleasure during sexual intercourse (OR = 2.5 [1.2-5.1]) and those who consumed alcohol (OR = 5.4 [2.07-14.2]) were less protected during casual sex. Sexual contact is one of the main modes of transmission of HIV / AIDS. Sailors often have unprotected sex. Interventions using specific ways must be performed taking into account the mobility of these men who are often uneducated.

Analyse de la prise en charge communautaire des orphelins et enfants rendus vulnerables (OEV) par le VIH/SIDA : experience de l'organisation communautaire de base (OCB) Jammixale yi Thies (Senegal)

Introduction: le VIH/SIDA ne cesse de provoquer de multiples difficultes avec l'accroissement du nombre d'orphelins et enfants vulnerables (OEV). Au Senegal; 3193 OEV etaient recenses en 2008. L'objectif etait d' analyser la prise en charge communautaire des OEV par l'organisation communautaire de base (OCB) JammiXale Yi (JXY) de Thies afin de mieux apprecier les effets psychologiques du VIH sur les enfants; les parents. Population et methode: Il s'agissait d'une etude transversale faite en 2009 aupres des agents de sante; des OEV et de leurs parents. Des entretiens individuels et des focus groups ont permis de recueillir des donnees. Selon la source et la cible; une triangulation des informations avait ete faite Resultats : 61 OEV etaient suivis. L'age moyen etait de 9;82 ans; variant entre 2 mois et 17 ans. Le sex- ratio etait de 1;08 (filles = 48).Dans cet OCB; 99 des enfants etaient a l'ecole publique; 20 avaient une bourse scolaire ; 92 n'etaient pas depistes. Parmi ceux depistes; 8 etaient seropositifs.Selon la cible; les principaux effets psychosociaux du VIH/SIDA etaient pour les enfants: l'utilisation de l'alcool; de la drogue; la prostitution. Pour les parents venaient au premier rang : la discrimination; le non depistage des enfants; les difficultes d'acces aux soins de qualite; l'attitude d'indiscretion du personnel de la sante. Les agents de sante avaient surtout souligne le manque de formation sur la prise en charge psychologique des OEV. Conclusion : on note l'importance des effets psychosociaux du VIH/SIDA sur les enfants; leurs parents et la difficulte de la prise en charge communautaire de cette maladie dans les pays a ressources limitees

Etude de l'etat nutritionnel d'enfants nes de meres seropositives suivies dans l'unite de traitement ambulatoire du centre hospitalier regional de Thies (Senegal)

Introduction : La degradation de l'etat nutritionnel est un des premiers signes lies a l'infection a VIH chez l'enfant. Objectif : c' etait d'evaluer l'etat nutritionnel et les facteurs de risque des enfants nes de meres seropositives suivies au Centre Hospitalier Regional de Thies (CHRT). Materiel et methodes : u ne etude transversale etait menee du 1 er au 14 aout 2008. Elle portait sur une population de 40 enfants ages de 6 a 59 mois nes de meres seropositives. Resultats : la moyenne d'age etait de 32;17 mois [26;43 - 37;92] 95 ; 52 de etaient de sexe masculin. Les 40 avaient recu des ARV a la naissance; 45 etaient seropositifs et 40 avaient une malnutrition aigue. Plus de la moitie des enfants (60) avaient beneficie de l'allaitement maternel exclusif. Il y avait un lien statistiquement significatif entre : la non prise des ARV a la naissance et la presence de la maigreur (p= 0;010) ; la serologie positive des enfants et la presence d'insuffisance ponderale (p= 0;012) et de la maigreur (p= 0;0052) ; le bas taux de CD4 des meres et la presence d'insuffisance ponderale chez les enfants (p= 0;023) ; l'allaitement maternel exclusif et la presence de la maigreur chez les enfants (p= 0;010) ; le bas taux de CD4 des meres et le statut serologique des enfants (p= 0;0031). Conclusion : les programmes en charge de la lutte contre le SIDA; la malnutrition et de la sante de la reproduction doivent travailler ensemble pour developper les composantes de la prevention de la transmission mere enfant et des strategies de renforcement nutritionnel pour garantir le succes de la lutte contre la malnutrition chez les enfants dans le cadre du VIH

[Economic impact of skin-lightening products on household income in sub-Saharan Africa: the case of Senegal]. / Poids économique de la dépigmentation artificielle sur le revenu des ménages d'Afrique subsaharienne : cas du Sénégal.

INTRODUCTION: As throughout sub-Saharan Africa, the use of skin-lightening (or brightening or bleaching) products is widespread in Senegal (67%). Although the medical and social determinants of this phenomenon have been documented, its cost is poorly defined. Thus, this work aims to evaluate the economic effects of skin bleaching on women's income. METHODOLOGY: A cross-sectional, quantitative, and descriptive survey was conducted in 2010 (October 7 to November 8) among women consulting for outpatient care at a reference dermatology clinic for complications related to use of skin-lightening products. We calculated the direct costs (products) and indirect costs (transportation costs, medical fees, dermatological treatment of complications). The social damage (pain and suffering and esthetics) was assessed. RESULTS: This study included 65 women; their mean age was 33 years and 26% had not attended school. In all, 52% were merchants, 29% housewives, 9% civil servants, and 5% students. The average duration of product use was 9 years, and the mean age at onset of use, 23 years. Most (80%) had a low income (<100,000 FCFA or US $204). The total monthly income of the 65 women in the study was 5,675,000 CFA (US $ 11,582). The total monthly cost of skin lightening for them was 1081,658 CFA (US $ 2207), that is, 19% of their total income. The esthetic harm was categorized as moderate by 20% and high by 22%. CONCLUSION: This study opens perspectives for further studies of the intangible costs of skin bleaching and for increasing awareness of the complications and social damage induced.

[Access to intermittent preventive treatment (IPt) in a situation of abolition of user's fee: role of economic welfare]. / Accès au traitement préventif intermittent (TPI) dans une situation de gratuité : rôle du bien-être économique.

In Senegal, the free distribution of sulfadoxine pyrimethamine during antenatal care is recommended to remove the disparity in the context of intermittent preventive treatment against malaria. The objective of this study was thus to identify factors influencing access to treatment in a situation of abolition of user fees. It was a cross-sectional and analytical study. It covered a sample of 1906 women aged 15-49 years randomly selected during the national survey on malaria in Senegal. Data were collected during a personal interview. The economic well-being was measured from the characteristics of housing and durable goods. The multivariate analysis was performed using logistic regression. The average age was 27.94 ± 5.34, 64.27% resided in rural area and 71.8% had received no schooling. Among the surveyed women, 23% were in the poorest quintile, while 16.3% were in the richest. Intermittent preventive treatment was performed in 49.3%. IPt were made more in urban areas (OR 1.45 95% [1.17 to 1.72]). It increased with the level of education with an OR of 1.5 and 1.68 in primary and secondary. The completion of the IPt increased with economic welfare. The OR ranged from 1.44 to 2.95 in the second quintile to the richest. Free medication does not necessarily benefit poor people. Other accompanying measures must be developed to facilitate the distribution of drugs particularly at community level with the involvement of people.

[Knowledge, attitudes and practices related to STD and HIV/AIDS: men having sex with men in Senegal]. / Connaissances, attitudes et pratiques relatives aux IST/VIH/sida: cas des hommes ayant des rapports sexuels avec d'autres hommes au Sénégal.

BACKGROUND: This study aimed to review knowledge, attitudes and practices related to sexual transmitted diseases (STD) and HIV/AIDS among men who have sex with men (MSM) in Senegal. METHOD: The study was undertaken from February 1st to June 30th 2007, in three capitals cities in Senegal (one national, and two regional). It concerned the MSM that benefited from at least one of services of an MSM association. Studied variables included socio demographic characteristics, sexual practices, as well as knowledge and attitudes related to STDs and VIH/AIDS. Interviews took place during appointments obtained by direct phone call or by two MSM leaders intermediary. Data were seized and analyzed with Epi2000 Software. RESULTS: Among 245 registered MSM, 63 had a precise contact (address and/or phone number), and 49 aged in average of 25 years were investigated. Among them, one was illiterate, five studied Koran, seven Arab and 36 French. The socio-professional categories differentiated two officials, two merchants, one mechanic, one fighter, five artists, five restorers, seven tailors, 11 students, and 15 unemployed. The associations, to which 35 HSH belonged, were related to sexuality (66%), religion (20%), social matters (8%) and economy (6%). Sexual habits, according to anal intercourse, differentiated the "Ubbi" or receptive/passive (57%), the "Yoos" or incertif/active (25%), the "Ubbi/Yoos" who play the two roles (14%) and the "neitherUbbi/norYoos" who had other practices than anal (4%). Practices between men, concerned mutual strokes (100%), fellatio (61%) and anal intercourse (49%), counted 45% for remuneration, 35% of multi-unprotected partnership, and 12% of breaking condom. Practices with women were reported by 15 MSM (31%). Concerning STDs, at least one sign was reported by 43 MSM, one transmission way by 42, one mean of protection by 47; and the first recourse was a health system for 36 MSM. The test of HIV/AIDS screening was done by 38 HSH among which 30 withdrew the results. The "Ubby" adhered much more to associations, and practiced less unprotected vaginal intercourses and multi partnerships. CONCLUSION: Sexual relations between men, in Senegal, constitute a factor of propagation for STDs and HIV/AIDS. Beliefs, values, and popular reactions still limit the big principles (liberty, equality, solidarity, and participation) of preventive and curative care. Therefore, ethics and effectiveness must be conciliated to face more MSM needs, for a better health of the populations.

[Care for elderly patients in Africa: Analysis of the financial implications of the SESAME plan on the budget of the regional hospital center in Thies, Senegal]. / Prise en charge des patients du 3e âge en Afrique: étude des implications financières du plan SESAME sur le budget du centre hospitalier régional de Thiès (Sénégal).

PURPOSE: The SESAME plan has been implemented at the Thies Regional Hospital Center (TRHC) for one year. The purpose of this study was to analyze the financial implications of the plan on the hospital budget for the sustainability of care for persons aged 60 and over. METHODS: This descriptive study included analysis of budget data from October 2006 to September 2007 plus information obtained by interviewing the accountant and head of SESAME plan. The number of patients managed, sources of CHRT funding, grants from various SESAME plan partners, and expenditures for each partner were determined. The weight of the SESAME plan in the CHRT operating budget was determined by calculating the ratio of the overall cost of care for elderly persons in relation to the hospital's revenues and SESAME grants. RESULTS: During the study period, the CHRT received a total of 17375 elderly persons including 89% with no pension or social security. The institute pension scheme (IPRES) covered 21% of the plan as compared to 79% for the state. Utilization plan grants in relation to funding source was 41% for IPRES and 124% for the State. The total cost of services provided to beneficiaries of the SESAME plan exceeded the aggregate amount by 26 083 847 CFA francs. The weight of the SESAME plan in the operating cost of the CHRT was 17%. CONCLUSION: Prefinancing a plan to cover elderly care in hospitals should be sufficient to prevent deficits from impacting negatively on the operating budget of the hospital.

[Analize of the determinants of microscopy's quality in the context of tuberculosis fighting within the health centers laboratories in Dakar Region]. / Analyse des déterminants de la qualité de la microscopie pour la lutte contre la tuberculose dans les laboratoires des Centres de Santé de la Region de Dakar.

INTRODUCTION: In order to improve the quality of the microscopy in the context of tracking and following-up the pulmonary tuberculosis patients, a study of the determinants of the quality of microscopy was carried out in the laboratories of the health centres in Dakar Region, Senegal. MATERIALS AND METHODS: We did an epidemiologic study, transversal type which proceeded during April 19th at May 05th, 2004. It consisted of a series of observations, interviews, review of the registers of laboratory and with a second reading and re staining, on the level of the National Laboratory of Reference of the National Programme of fight against Tuberculosis (LNR), of 50 blades collected blindly in the health centres of Dakar. RESULTS: It comes out from this study that there was no statistically significant link between the factors of risk of errors such as the overload of work, the bad condition of the microscope, the lack of competence and the errors observed in certain laboratories. On the other hand the aspect of the smears, the thickness of the smears and the presence of crystals could deteriorate the quality of microscopy because it was found that there was a statistically significant connection between the quality of microscopy and these various determinants. In addition we noted a good agreement of the results of these laboratories with those of the LNR (Kappa test = 0,981, p < 0,0001). CONCLUSION: According to these results, we recommend: a reinforcement of competences (training/recycling) regular of the laboratory assistants, and an installation of a system of quality control of microscopy, interns within the laboratories but also external by the National Laboratory of Reference.

[Systemic scleroderma: 92 cases in Dakar]. / La sclérodermie systémique à Dakar: à propos d'une série de 92 cas.

We performed a retrospective study in order to characterize epidemiological data and signs of systemic scleroderma in Sénégal. All patients with the diagnosis according the ACR's criteria of scleroderma were recruited. We included 92 patients, the mean age was 33 years and sex ratio male to female was 0.19 (15 men and 77 women). There were 8 children in our series (8.9%). The initial complaints were cutaneous manifestations (64%) and Raynaud's syndrome (16.3%). Clinical manifestations at admission were muco-cutaneous (100%), osteo-articular and muscular (59%) and Raynaud's syndrome (57%). Focal hypopigmentation was common (70%). Anti-nuclear antibodies were present in 67.4% of patients. Skin biopsy was contributive in all patients in which it was performed (79 cases). Electrocardiogram was abnormal in 55%, non specific inflammatory syndrome was present in 44% and pulmonary function was abnormal in 52%. Our data suggest that systemic scleroderma is more common in younger people in black population. Disorders of pigmentation are common and Raynaud's syndrome is uncommon.