The Diamniadio Institute for Health Research, Epidemiological Surveillance, and Training (Iressef): One Man's Vision and a Bet on the Future.

To reduce congestion in its capital, Dakar, Senegal decided in 2012 to construct a new city in Diamniadio, in the suburbs. This new urban center, an integral part of the Emerging Senegal Plan (PSE), is a major first step towards the organization of land use planning. The Institute for Health Research, Epidemiologic Surveillance and Training (Iressef) is one of the very first new operational buildings in this new city. Conceived and directed by Professor Souleymane Mboup, Iressef was made possible by the support of the government of Senegal and the GILEAD Foundation. The vision of its sponsors is to make it a hub of excellence for research in the domain of tropical infectious diseases, with expertise and technical equipment and facilities comparable to those in research institutes in developed countries. The existing platforms include, among others, several state-of-the-art laboratories, a health and demographic surveillance system covering a population of 30 000 inhabitants, a clinical trial center, a dynamic community participation program, and a training center. To achieve this vision in the short- and long-terms, Iressef has developed a strategic 5-year plan focusing on two principal objectives, that is: (i) to conduct research programs according to the strictest ethical standards, and (ii) to train an elite group of Senegalese and African scientists, competitive and capable of developing health research in Africa. To attain these objectives, international partners will play an essential role.

[Smoking among health workers at four large hospitals in Dakar (Senegal)]. / Le tabagisme chez le personnel médical et paramédical dans quatre grands hôpitaux de Dakar.

INTRODUCTION: The addiction to tobacco remains a significant problem in the context of medical practice in African in general and in Senegal in particular. It is an important cause of morbidity and mortality. The main purposes of this study were to establish the smoking habits of hospital staff as a step towards elaborating a strategy for an anti-smoking campaign within the hospital environment. PATIENTS AND METHOD: The study was a cross-sectional, prospective, descriptive going study conducted between 1st March 2007 and May 15th, 2008. We recovered 662 out of 750 questionnaires collected representing a 75% participation rate. RESULTS: Eighty-five respondents reported that they were smokers (12.8%). The sex-ratio was 7.5 times more common in men. The paramedical staff were more likely to smoke than doctors (14% versus 12.2%). The average age of the smokers was of 37.4 years. Women had begun to smoke at an earlier age (17.4 years against 20.5 years). According to the Fagerström test, 87% were averagely or strongly dependent on nicotine. It was mainly the pleasure (41.2%) and the influence of their circle of acquaintances (36.5%) that prompted the staff to smoke. Smoking cessation was most commonly achieved through the use of willpower alone (44.4%). CONCLUSION: The mortality and morbidity arising from the addiction to smoking is entirely avoidable in contrast to other pandemics. Consequently, engagement in the fight against smoking must constitute a major priority for health workers who must set an example for their patients.

[Miliary tuberculosis: a report of 49 cases]. / Miliaire tuberculeuse: à propos de 49 cas.

INTRODUCTION: Miliary tuberculosis is a severe, acute form of tuberculosis due to lymphohaematogenous dissemination of tubercle bacilli from a focal lesion. PATIENTS AND METHODS: A prospective study of was undertaken at the Pneumology Clinic of the National University Hospital Centre (CHUN) of Fann, over a period of 30 months (January 2007-June 2009), in order to assess the epidemiological, clinical, paraclinical and evolutionary aspects of miliary tuberculosis. RESULTS: Miliary tuberculosis accounted for 3.8% (n=49) of all diagnosed cases of tuberculosis. The sex-ratio was 1.7. The average age of patients was 37.5 years with a range of 15 to 70 years. The typical radiological appearances were present in 88% of cases whereas only 10% were positive on direct smear. HIV serology was positive in 29%. In the hospital environment, the mortality was 12.2%. CONCLUSION: Miliary tuberculosis is a severe form of the disease. The prognosis depends on early diagnosis and treatment.

[Epidemiological, clinical, therapeutic and evolutionary aspects of pulmonary aspergilloma in Dakar]. / Aspects épidémiologiques, cliniques, thérapeutiques et évolutifs de l'aspergillome pulmonaire à Dakar.

INTRODUCTION: The presentation of pulmonary aspergilloma is dominated by haemoptysis, the results of medical treatment are disappointing and there is significant morbidity and mortality following surgery; the only really curative treatment. These facts emphasise the gravity of this condition. We undertook a study to estimate the current profile of the disease and its management in Senegal. PATIENTS AND METHODS: A retrospective study took place between January 2004 and September 2008 including all the cases of pulmonary aspergilloma diagnosed in private practice and\or the thoracic and cardiovascular surgery service of the Fann Hospital, Dakar. RESULTS: Thirty-five patient records were collected. The sex ratio was four males to one female. The average age of the patients was 43.7 years. All the patients had a history of pulmonary tuberculosis. Serology was positive for Aspergillus fumigatus at 22 patients out of 29 (75.86%). Histological examination of surgical biopsies confirmed the diagnosis in 88.46%. The treatment was essentially surgical with no recorded mortality. Nine cases of haemorrhage and eight of suppuration were reported. CONCLUSION: Surgery remains the reference treatment for pulmonary aspergilloma. In view of the morbidity of this condition we emphasize the importance of early screening and correct treatment of tuberculosis, particularly in endemic countries, to achieve clinical cure and prevent serious after effects.

[Lung cancer in Dakar, Senegal]. / La cancer bronchique a Dakar, Sénégal.

A prospective, multicenter was conducted in all specialized centers in the city of Dakar. The objective was to describe the epidemiology to assess the management of lung cancer. 45 patients were included. The sex ratio M/F = 8. The average age of patients was 57.5 years. Smoking was found in 84.4% of cases. The average time for consultation after the onset of symptoms was 6 months. The average time to diagnosis was 2 months. Two out of three patients (66%) had seen beyond the stage III B. Improved diagnostic performance for early diagnosis of cancer is needed. Emphasis should be on prevention through tobacco control.

[Tuberculosis in elderly persons]. / Tuberculose du sujet âgé

OBJECTIVES: The purpose of this study was to compare the epidemiology, clinical features and clinical course of primary presentations with pulmonary tuberculosis occurring in older and younger patients. PATIENTS AND METHODS: We undertook a prospective, comparative study in the Pneumology clinic of the National University Hospital of Fann in Dakar, from April 1, 2005 to March 31, 2006, collecting data on all patients presenting with a first episode of bacterially confirmed pulmonary tuberculosis. RESULTS: We studied 187 first presentations with confirmed pulmonary tuberculosis including 12.8% (n=24) elderly (>55 years) subjects (20 men and four women) and 87.2% (n=163) younger subjects (105 men and 58 women). In the older subjects, patients were more commonly men (sex-ratio: 5), without formal education, and working in the primary or informal sector. Comorbidities were more frequent in the older group, including smoking (P=0.002), alcohol consumption (P=0.01), diabetes (37.5%) (P<0.005) and obesity with BMI superior than 20 in 25%. Pulmonary shadowing was common (41.7% of the cases), P=0.008 and generally bilateral P=0.0001 with cavitation, but this observation was not statistically significant. COMPLICATIONS: Complications were more frequent in the older patient (20.8%), as was mortality (29.3%, P=0.000) and rate of clinical improvement in response to treatment was less satisfactory (50%) there.

[Etiology of spontaneous pneumothorax in Senegal: prospective study in Dakar University Hospital]. / Etiologies du pneumothorax spontané au Sénégal: étude prospective au CHU de Fann-Dakar.

Pneumothorax is defined as the presence of air in the pleural space. There is a paucity of data on pneumothorax in Senegal. The purpose of this prospective study conducted over a 18-month period was to determine the etiological and clinical characteristics of spontaneous pneumothorax in Senegal. This study was conducted in the respiratory disease unit of Dakar University Hospital between June 2005 and November 2006. All patients over the age of 15 years admitted with a diagnosis of spontaneous pneumothorax were included. Sociodemographic, clinical, radiological and biological data were recorded for all patients. Of the 1,053 patients admitted to the unit during the study period, 73 (6.93%) presented spontaneous pneumothorax that was classified as primary in 8 cases and secondary in 65. Median patient age was 32 years (range, 16 to 86). The male-to-female ratio was 3.6/1. The most common cause of secondary spontaneous pneumothorax was pulmonary tuberculosis followed by emphysema. The findings of this study indicate that secondary spontaneous pneumothorax is predominant in Senegal. Pulmonary tuberculosis that is endemic in the country is the main cause of secondary spontaneous pneumothorax and accounts for almost 3/4 of cases.

[Smoking among students at the School of Health and Social Development and the Health Service Institute in Senegal]. / Le tabagisme chez les élèves de l'Ecole de Développement Sanitaire et Social et de l'Institut Santé Service.

We have undertaken a transverse study of smoking among students at the National School of Health and Social Development (ENDSS) and the Health Service Institute (ISS) in Senegal. 683 out of 1142 students were questioned. 609 (89%) replied, of whom 313 (52%) were at the ENDSS and 293 (48%) at the ISS. Senior technical students were most strongly represented at 37.8%, followed by student nurses (27.4%) and midwifery students (23.3%). There were more women (n=378) than men with a sex ratio of 0.61. The average age of the population was 27.5 +/- 6.8 years (range 15 to 58). The average age was 26.2 +/- 5.6 years in the women and 29.6 +/- 8 in the men. The group aged 25-34 was significantly the most affected in both men and women (p=0.0000). The population comprised 502 non-smokers (82.4%), 62 ex-smokers (10.2%) and 45 smokers (7.4%).We found variable alcohol consumption in 119 subjects (19.2%) and 5 students admitted using cannabis. The 62 ex-smokers made up 10.2% of the population. The average age was 31.4 years. 25 ex-smokers (40.3%) drank alcohol, with a sex ratio of 1.95. The reasons for stopping smoking were illness and guilt in 27.4% of cases respectively, economic in 24.2%, medical statements on the effects of smoking on health in 17.7% and personal wishes in only 11.3%. The smokers, numbering 45 (7.4%), had an average age of 27.6 +/- 6.6 years with a sex ratio of 2 (p=0.00000). The age of starting smoking was 20.7 +/- 4.2 years for the women and 19.9 +/- 2.9 years for the men. The latter had smoked for an average of 9.2 years. Cigarettes were used by the great majority of smokers. It was associated with alcohol consumption in 35.6% and cannabis in 11.1% of cases. In the men the motives for starting smoking were stress (60%), pleasure (55.2%) and social influence (53.3%). By contrast, among the women, the two main reasons were stress and fashion in 60% (p=0.04). Our students smoked mostly in public places and in their homes. 34 smokers (75.6%) wished to stop (p=0.02) but only 27 of them expressed the need for medical or psychological support to do this. Dependence, quantified by the Fagerström Score, was medium (score 5-6) in 60% (n=27) and strong (score 7-10) in 31.1% (n=14).The estimated monthly cost of smoking increased with the degree of dependence. It was, on average, 12,143 F CFA (18.5euro) in cases of high dependence, representing 37% of the minimum wage in Senegal which is 33000F CFA (50euro). The students understood well the diseases caused by smoking (whether they were smokers, ex-smokers or non-smokers). These comprise mainly pulmonary diseases (96.2%) and cardio-vascular diseases (78.3%) All the recommended methods of the fight against smoking presented in the media, the publicity, national anti-smoking campaigns, personal contact and consultation, received more than 60% of favourable opinions among the total population studied.

[Clinical, biological and radiological spectrum of newly diagnosed pulmonary tuberculosis]. / Profil clinique, biologique et radiologique des nouveaux cas de tuberculose pulmonaire au Centre Hospitalier Universitaire de Fann-Dakar.

The aim of the present study was to describe the clinical, biological and the chest-X ray presentations of newly diagnosed pulmonary tuberculosis. A retrospective study of 200 patients was performed from January to October 2004 in the respiratory diseases unit of Dakar's University Teaching Hospital. Among the 200 cases, 140 (70%) were male, giving a sex ratio of 2.3. The mean age of our patients was 35.5 years (range: 14-81 years). The group age of 20 to 39 years was the most affected (55,5% of patients). The median diagnostic delay was 4 months (range: 7 days to 2 years). Haemoptysis revealed the disease in 27% of cases. The chest X-ray showed bilateral lesions in 65% of cases. When they were unilateral, the right side was the most concerned. Of the 200 patients, the lesions interested all parts of at least one lung in 106 (53%). Among our patients, 153 (76.5%) had cavitations and 145 (72.5%) had infiltrates. A pleural effusion was associated to the lung lesions in 10% of the patients. Biologically, we reported 80% cases (n=160) of hypochromic microcytic anaemia. Of the 27 HIV tests done, 18 (66.7%) were positive all for HIV1. Delay in the diagnosis of pulmonary tuberculosis was very long and our data illustrate the need for improved education of the community and event of healthcare workers about the benefit of early diagnosis of tuberculosis.

[Tuberculosis and diabetes]. / Tuberculose et diabète.

INTRODUCTION: We performed a retrospective case control study for the period between 1st January 1999 and 31st August 2004, comparing the radiological appearances of tuberculosis in 100 diabetics to those in patients matched for age and sex, with pulmonary TB alone presenting to The Chest clinic of the National Hospital of Fann. METHODS AND RESULTS: Diabetes was present in 4.7% of the 2116 patients hospitalized for pulmonary tuberculosis during the period of study and occurred more commonly in men (60%) with an average age of 51 years (73%). 82% had type II, non-insulin dependent diabetes. The various types of radiological lesions classically described in tuberculosis were found in nearly identical proportions in the two groups of patients, with parenchymal shadowing the most frequent appearance in both diabetics (N=86) and controls (N=88). Cavitation occurred significantly less frequently in diabetics (72%) than controls (88%) (p=0.04). Where radiological abnormalities were bilateral, they were worse on the left in the diabetics (27% versus 15% in controls). There was a trend for basal lesions to occur more frequently in diabetics (15%) than controls (3%) (p=0.06). CONCLUSION: Mortality was higher in diabetics (18%) than controls (6%), with death generally occurring within the first 24 hours of hospitalization.

[Familial tuberculosis: tracing the contacts of an infectious case]. / Tuberculose familiale: dépistage parmi les sujets contacts autour d'un cas index contagieux.

INTRODUCTION: This is a prospective study of 30 cases of smear positive pulmonary tuberculosis, with at least two sputum positive members of the family, seen in the respiratory clinic between January 2003 and June 2004. METHODS: They constitute the index cases who represent 3.5% of the cases of tuberculosis (n=850) and 2.9% of hospital admissions (n=1034) during the same period. Four patients were HIV positive. In the family circle, all contacts received an intradermal tuberculin test (IDTT) of 10 IU and/or a chest x-ray and/or sputum examination for AFB. RESULTS: Of the 601 contacts 359 (60%) had a positive IDTT with a mean diameter of 13 mm. Active pulmonary tuberculosis was found in 16 contacts giving a prevalence of 2.7% and an incidence of 4.5% (16/359). 67% of the contacts were adults aged 16-87 with a mean age of 35 years. The IDTT was positive with a mean diameter of 12.3 mm. The chest x-ray was abnormal in 40 adults (16.7%) and sputum examination confirmed pulmonary tuberculosis in 14 cases. 33% of the contacts were children (n=119) aged from 3 months to 15 years with the majority (85%) aged under 10. The IDTT was positive with a mean diameter of 12 mm and the chest x-ray was abnormal in 22 cases (18.5%). Two children of 15 years had active tuberculosis. CONCLUSION: The contacts identified were treated according to the tuberculosis protocol of Senegal (2RHEZ/6EH) with the intensive phase dispensed in hospital. It is of major importance therefore to develop effective strategies of information, education, diagnosis and management for cases of infectious pulmonary tuberculosis.

[Tuberculosis in the mother and child]. / La Tuberculose dans le couple mère-enfant.

INTRODUCTION: Tuberculosis is a scourge in our region; it is particularly dangerous in young children, above all those of tuberculous mothers. The object of this study is to evaluate the prevalence of tuberculosis in the children of tuberculous mothers and to determine how to increase their chances of survival and healthy development. METHODS: Between 1 January and 31 July 2002, 45 women were admitted to hospital with a child of less than 5 years. They received (mothers and children) an intradermal tuberculin test (IDTT) of 10 i.u., chest x-ray, and sputum examination for the mothers. RESULTS: 45 women (aged from 18 to 45 years) were hospitalised for sputum positive tuberculosis, an average IDTT of 13 mm and a high bacterial load (1 to>10 bacilli/hpf). Almost all (96%) presented with cavitating parenchymatous disease. We found no cases positive for HIV. Progress was satisfactory in 43 mothers treated with SRHZ. There were 2 deaths. In the children who were systematically examined, 82% (37) were less than 20 months old, there were 23 boys (51%), and 26 children (58%) were symptomatic at the first consultation. All the children were breast fed, explaining their admission with their mother. Evidence of tuberculous contact was found, 6 times with the father and 4 times with the grandparents. The most common physical signs were fever (92%) cough and weight loss (77%), malnutrition (69%). The IDTT was positive in 38/45 (84.5%) and pustular in 16/38 (42%). The chest x-ray was normal in 16/45 (35.6%), revealed mediastinal adenopathy in 19/29 (65.5%), accompanied by ipsilateral ventilatory problems in 11/29 (38%) and by parenchymal involvement in 3/29 (10.3%). Progress was satisfactory in 44 children on antituberculous treatment (RHE). There was one death on account over severe malnutrition. CONCLUSION: Treatment of tuberculosis in the mother and child is a guarantee of recovery for the mother and healthy development for the child. S: streptomycin, R: rifampicin, H: isoniazid, E: ethambutol, Z: pyrazinamide.

[Knowledge of the risks of smoking in patients admitted to a respiratory clinic in Senegal]. / Connaissances des risques liés au tabagisme chez des patients hospitalisés à la Clinique de Pneumologie du CHN de Fann de Dakar.

INTRODUCTION: Tobacco smoking is truly a modern plague. The WHO estimates that there are 1.3 billion smokers worldwide, about a third of the world's population. In various studies in Senegal the prevalence of smoking has varied between 16 and 36%. The risks associated with smoking are well established. However it is also well established that 'knowledge of risks alone is not sufficient to modify behaviour.' We undertook a study to assess knowledge of the risks of smoking among patients admitted to The Pulmonology Clinic of the Centre Hospitalier National de Fann de Dakar. PATIENTS AND METHODS: All patients admitted to the clinic between 1st December 2003 and 31st May 2004 were enrolled into this prospective, cross-sectional study. A questionnaire in French was administered together with the Fagerstrom test of clinical addiction. RESULTS: Of 343 patients admitted 75 (22%) were smokers. Only 2 (2.6%) of the smokers were female. As in previous studies, smoking was associated with social disadvantage. 34.7% of smokers had attended school to primary level only and 33.3% had had no schooling at all. Mean age of starting smoking was 16 (range 9 to 38 years). The monthly cost of smoking to individuals was estimated at between 2 and 45% of the Guaranteed Minimum Wage (SMIG). 44% of smokers also consumed alcohol and 2.6% smoked cannabis. More than two thirds of patients (68%) thought that smoking caused ill health. The majority of subjects (93.3%) had stopped smoking, at least since admission, though 6.7% continued to smoke. Previous consumption was estimated as a mean of 20 pack-years. Nicotine dependence was defined as medium in 37 patients (49.3%). CONCLUSION: Certain diseases such as malaria, tuberculosis and AIDS exist at endemic levels producing considerable morbidity and mortality. We should not allow the epidemic of smoking to continue. Collective action, particularly by pneumologists is required.

[Preliminary study of smoking in medical and paramedical staff at the Centre Hospitalier National de Fann Dakar]. / Etude préliminaire sur le tabagisme chez le personnel médical et paramédical du CHN de Fann.

BACKGROUND: Smoking represents a major threat to public health, being responsible for considerable morbidity and mortality. We undertook this study to establish the prevalence of smoking among personnel at the Centre Hospitalier National de Fann, their smoking habits and the attitude of staff to the problems caused by smoking as well as their understanding of their role in promoting smoking cessation. METHODS: A prospective study was undertaken between February and April 2004 in which a standardised, anonymous, self-completion questionnaire in French was administered to 262 medical and paramedical staff at the CHN de Fann. RESULTS: The response rate was 95%. The biggest single group of respondents came from the infectious diseases service (24.5%). 63% of participants were paramedical and 54% of respondents were male. The mean age of respondents was 39.2 for men and 35.9 for women. 11.6% were smokers and 13.3% were ex-smokers. The mean age of ex-smokers was 43.8 years with a male/female ration of 7.25 to 1. Among the ex-smokers 51.7% had stopped smoking within the last 10 years with health problems the most commonly cited reason for quitting (24.2%), followed by guilt (21.2%). Smokers had a mean age of 38.6 with a male to female ratio of 8.6 to 1. Mean age at which they had started to smoke was 14.3 for women and 21 for men with a mean duration of smoking of 21 in women and 17 in men. 96.6% smoked cigarettes with 31% smoking > 20 cigarettes per day. 75.9% of our smokers had tried to quit at least three times. 86.2% wished to stop but only 48.3% considered getting medical and or psychological support to help them to quit. The Fagerström score showed a high level of dependency in 27.6% of smokers. More than half the total population studied (65.6%) thought that healthcare workers should help others to stop smoking and 75.5% thought that they had influence to do this. CONCLUSION: Healthcare workers in Senegal have an opportunity and a responsibility to promote smoking cessation. Legislative proposals and smoking cessation clinics should help to combat the tobacco epidemic.

[Skin tuberculin test (STT) for screening tuberculosis in contacts of tuberculosis patients]. / Interet de l'intradermoreaction a la tuberculine (IDRT) dans le depistage de la tuberculose chez les sujets contacts.

INTRODUCTION: Many studies have underlined the theorical and practical role of Skin Tuberculin Test (STT) as an important tool for the diagnosis and for the screening of tuberculosis in the population. PATIENTS AND METHOD: This prospective study evaluated STT in 51 smear positive tuberculosis patients and 108 contacts tuberculosis patients apparently in a good health condition. Twenty seven patients have disappeared before the end of the study and 7 patients were excluded for non suitable results. So we analysed only 73 cases. RESULTS: The mean age was 34 years, with extreme of 1 and 77 years. There were 33 male and 40 female patients for a sex-ratio of 0,8. BCG vaccination scar was found in 64% of patients. We calculated the Body-Mass-Index and we found a proteinocaloric malnutrition (BMI<18,5) in 30%. The mean diameter of STT induration was 12,3mm with extremes of 7 and 20mm. Considering a STT < 7 mm as negative, 4 patients (5%) had a negative STT and 69 (95%) a positive STT. 13 of these 69 patients had a STT > 15mm. The age group of the 10 to 50 years had more positive STT. Meanwhile, according to the sexe and to the nutritional status, there was no statistical difference. All patients with a negative STT received BCG vaccination after 2 months of follow-up. Those with STT>15mm were examinated and had a chest X-ray the day of their enrolment, at the second month and at the sixth month and we didn't find any evolutive tuberculosis. CONCLUSION: According to these results, we can conclude that STT is not an important test for the screening of pulmonary tuberculosis in contact patients. Clinical examination, chest X-ray and sputum smear remain very important for the diagnosis. Despite these results, STT remain the only validated technic between the different tuberculin tests. Its interest was twofold: the research of an acquired immunity against tuberculosis after BCG immunisation and it is clinical test for the diagnosis of tuberculosis in children.

[Determination of risk factors of smear-negative pulmonary tuberculosis]. / Etude des facteurs de risque de survenue d'une tuberculose pulmonaire a bacilloscopie negative.

OBJECTIVES: to compare the epidemiological, clinical and paraclinical features of smear-negative pulmonary tuberculosis (PT-) and the smear-positive pulmonary tuberculosis (PT+), to determine the risk factors of smear-negative pulmonary tuberculosis. PATIENTS AND METHODS: It was a prospective study, conducted from November 1995 to November 1996. Data were analysed by EPI-INFO 6.04 (OMS/CDC). RESULTS: The study included 426 patients with pulmonary tuberculosis. Among them, 348 (81.7%) were PT+ and 78 (18.3%) were PT-. The sex-ratio was 2.4. Age group of 26 to 45 years was more affected (58.4% for the PT+ and 52.6% for the PT-). The prevalence of HIV infection was statistically higher in PT- (p = 0.01). Cough, sputum and lung condensation syndrom were more observed in PT+ group (p = 0.01). PT- patients had best nutritional status (p = 0.01). The chest X-ray showed more cavitations in the PT+ group (p = 0.000). While, in the PT- group, extra pulmonary lesions as pleural fluid were more frequent (p = 0.02). The full blood count found an anaemia (Hb=9 g/dl) associated to a neutrophilic h yperleucocytosis and an increased e rythrocyte sedimentation at the first hour in the both groups, without significant differance. The rates of CD4, CD8 lymphocytes and the ratio CD4/CD8 were in the normal range. Negative skin tuberculin test was more found in PT- (p = 0.04). The culture of sputum for PT- patients was positive in 15 patients out of 23 (65.2%). CONCLUSION: The risk factors of PT- identified are: Age >45 years, HIV infected patients, no expectoration, no or inefficient cough, no cavitations at the Chest X-ray.

[Application of the WHO chronic respiratory diseases programme in Sub-Saharian Africa: problems in Senegal]. / Application du programme "maladies respiratoires chroniques" de l'OMS en Afrique subsaharienne: problématique au Sénégal.

INTRODUCTION: To prevent and control chronic respiratory diseases, the WHO has outlined a programme to be applied in all the countries. In Sub-Saharan countries like Senegal, its application faces many barriers. METHODS: This work is a detailed analysis of the main areas of the programme based on the socio-economic, cultural and medical realities present in Sub-Saharan Africa countries, and particularly in Senegal. RESULTS: There is a lack of political engagement resulting from the precarious socio-economical situation. The demand for care is impaired because of the prevalence of illiteracy and the practice of traditional healing methods which is the first recourse for patients. The inaccessibility and lack of adequate health structures, technical equipment and qualified medical staff, and the high cost of medications for the majority of the population is the cause of this weakness of the healthcare system. These international recommendations are both not compatible with the local realities and not known to the majority of health providers. CONCLUSIONS: The mobilisation of international and national human and financial resources, the involvement of community-based structures, the adaptation and revision of the recommendations, the introduction of medications advocated by the Bamako Initiative, the training of health providers, the adaptation of regional and continental initiatives against tobacco and the creation of smoking cessation centres are needed if this chronic respiratory diseases programme is to be efficiently implemented.

[Preliminary study of the association of tuberculosis and pregnancy: about 9 cases]. / Etude préliminaire sur l'association tuberculose et grossesse: apropos de neuf cas.

From June 1668 to June 2002, we have studied at the Pneumology Clinic of Fann Hospital, pulmonary tuberculosis among 9 pregnant women. The average age was 26 years old and the consultation's delay was 5 months. All our patients had a productive cough and an evening fever coupled with a thoracic pain and a deterioration of the general condition in 7 patients (77.7%). The dyspnea and the heamoptisis were a consultation motive for 44.4% and 33.3% of the patients. The evolution of pregnancies was 29 weeks. They had all benefited from the intradermal reaction with tuberculin (IDRT) with an average diameter of 11.7 mm; it was negative in one patient. The bacilloscopy systematically done was negative in 2 patients. At the front thoracic radiography, we have found basal lesions unilateral in more than half of the cases and excavated in 44.4% of cases. They benefited from an antitubercular treatment (Rifampicine (R) + Isoniazide (H) + Pyrazinamide (Z) with a good clinical, biological, bacteriological and radiological progression. From the obstetrical point of view, there was an abortion after 5 months, 2 premature deliveries between the 7th and the 8th month and 6 normal deliveries at 9 months. Babies born from bacillary mothers systematically received an antitubercular treatment with breast feeding. In conclusion, pregnant women with pulmonary tuberculosis essentially pose a therapeutic problem, requiring a good collaboration between the lung specialist, the gyneco-obstetrician and the pediatrician. It could be more hazardous not to act early in treating a pregnant women with pulmonary tuberculosis.

[Diffculties in medico-social management of tuberculosis in Pneumology Departement of Fann University Teaching Hospital]. / Difficultés dans la prise en charge médico-sociale de la tuberculose a la clinique de Pneumologie du CHU de Fann.

This prospective study included all the patients who, during the month of September 1995, were admitted for pulmonary baclliferous tuberculosis to the Pneumology Clinic of the Fann University Hospital, Dakar. The patient's escorts and the health personnel were also included in this study. The aim of the study was to find the different socio-economic and health factors impeding the hospitalization of tuberculosis patients in the Pneumology Clinic of Fann University Hospital. 22 members of the health team, 209 patients aged between 15 and 65 years and 209 escorts were interviewed. Out of the 10% of tuberculosis patients with HIV seropositivity, 80% admitted not to have informed their spouses of their infection. The decision to be admitted was made by the patient himself in 54.4% of cases and by his family in 45.5% of cases. Late admittance with regards to the beginning of symptoms was due to the recourse to traditional medicine in 43.7% of cases, wrong diagnosis in 24%, ignorance in 19.3% and, in 13% of cases, due to inappropiate anti tuberculosis treatment. Despite the fact that anti tuberculosis medicine was free of charge, each patient or his family spent an average sum of 87,500 CFA F (US dollar 175) for a month's admission (the minimal salary (SMIG) in Senegal is 32,000 CFA F (US dollar 64), and 40% of the patients and escorts had difficulties making this payment. 9 patients were judged to be poor by 25.7% of the patients and 8.7% found relations with the health personnel difficult. The escorts deplored the lack of toilets (only 1 out of 4 was functional), the time worn facilities, the overcrowding as well as the irregularity and poor quality of the hospital meals. The entire health team deplored the lack of adequate personnel and 30% of them deplored the lack of hygiene of some patients and escorts. Taking financial charge of tuberculosis patients at the Pneumology Clinic of the Fann University Hospital requires an increased financial effort from the State (rehabilitation of the facilities, recruitment of medical and paramedical personnel, improved meals) harmonisation on a national scale of anti tuberculosis therapeutic protocoles and an Information-Education-Communication (IEC) programme on tuberculosis and hygiene.