[Epidemiological, clinical and forensic physical violence against women in Tambacounda (Senegal)]. / Aspects épidémiologiques, cliniques et judiciaires des violences physiques faites aux femmes dans la région de Tambacounda (Sénégal).

INTRODUCTION: To contribute to the fight against physical violence against women, this work aimed to make a 10-year review of cases treated at the Regional Court of Tambacounda. METHODOLOGY: This observational, retrospective, descriptive and analytical study was conducted from 15 October 2014 to 15 April 2015. It covered all the court records of victims of intentional injury from 2006 to 2015. The data was entered and analyzed using Epi info 3.3.2 software. RESULTS: In all, 113 cases were treated. The mean age was 26.5±10.08 years for victims versus 32.5±13.8 years for the aggressors. The victims were all female, and 77.9% of offenders were male. The assaults took place mostly during the day (57.5%), and especially in the homes of victims (61.0%), in the street (16.8%) in the bush (12.4%). The consultation period was less than 24hours for 54.9% of the victims. Clinical examination differentiated: fractures (15%); contusions (13.5%); penetrating wounds (10.6%); bruises (9.7%); eye injuries (7.9%); broken teeth (7.9%); diffuse pains (7.1%), 6.2% polytrauma (6.2%), and 5.3% of trauma on pregnancies. Among the violence, 33.6% were domestic; 11.5% were associated with rape (7.1%); psychological violence (3.6%); rape and death threat (1.8%). Rape was statistically more common among child victims [OR=10.7 (3.2-35.5)] and/or educated victims [OR=5.8 (1.7-19.9)] and aggression in the bush [OR=7.5 (2.2 to 14.2)]. The attackers were lonely and imprisoned in 94.7% and 73.5% of cases respectively. The sentence was firm imprisonment for 89.2% of cases. CONCLUSION: In Tambacounda, health and judicial authorities should enhance public awareness concerning the risk of violence. The extension of this type of study to the national level would have enabled better orientation of control strategies against this scourge.

[Cardiovascular risk factors associated with erectile dysfunction in the region of Dakar, Senegal]. / Facteurs de risque cardiovasculaires associés au dysfonctionnement érectile dans la région de Dakar, Sénégal.

BACKGROUND: Erectile dysfunction (ED) is often a reason for consultation revealing the existence of cardiovascular risk factors. The objective of this study was to determine the cardiovascular risk factors associated with ED in the Dakar region. METHODS: A descriptive and analytical cross-sectional study was conducted from March 18 to June 2, 2013. The study population was composed of married male subjects who sought care at the Ouakam Geriatric and Gerontology Center and the Grand Yoff General Hospital. Erectile function was assessed with the International Index of Erectile Function using the simplified five-item questionnaire (IIEF 5). R 2.2.9 software was used for the logistic regression multivariate analysis. Associations were measured using the adjusted odds ratio (ORaj) with confidence intervals. RESULTS: A total of 253 men were surveyed during this period. Average age was 16.7±58.2 years, range 24-90 years; 47% were aged under 60 years. ED was diagnosed in 110 patients (43.5%). ED was considered mild (33.6%), moderate (5.5%) or severe (4.3%). ED was more severe in patients older than 60 years. Cardiovascular risk factors associated with ED were diabetes ORaj=2.4 (1.24-4.68), sedentary lifestyle ORaj=3.08 (1.69-5.61), and hypertension ORaj=2.53 (1.33-4.81). CONCLUSION: These results should prompt health care providers to target patients with diabetes, hypertension and sedentary lifestyle for systematic ED screening as a routine practice in order to ensure early and effective care.

Connaissances et pratiques des hommes en âge de procréer sur la contraception moderne dans la commune de Boghé, Mauritanie

Introduction : La mortalité maternelle reste élevée dans la République Islamique de Mauritanie. L'Organisation Mondiale de la Santé recommande la promotion de la contraception moderne comme stratégie efficace de réduction de la réduction de la mortalité maternelle. L'objectif général était connaissances et pratiques des hommes en âge de procréer sur la contraception moderne dans la commune de Boghé, Mauritanie.Patients et méthodes : Il s'agissait d'une étude transversale, descriptive et analytique. La population d'étude était constituée par l'ensemble des hommes âgés d'au moins 18 ans vivants depuis au moins 3 mois dans de la commune de Boghé. Un sondage à deux degrés a été effectué. L'analyse multivariée et la régression logistique simple étaient utilisées grâce au logiciel R 2.2.9 pour identifier les caractéristiques qui influençaientla non-utilisation de la contraception moderne.Résultats : La taille de l'échantillon était de 384 hommes en âge de procréer. L'âge moyen des hommes en âge de procréer était de 42,1 ± 9,5 ans. Ils avaient entendu parler de la contraception moderne dans 70,3% des cas). Ils étaient informés par leurs parents/amis (76%), la radio (32%), leurs conjointes (18%), les services de santé (8%) et la télévision /journaux (5%). Les mariés, utilisaient une méthode contraceptive au sein du couple dans 9,4% des cas. Parmi eux, pour 80% leurs femmes utilisaient la pilule, un contraceptif injectable (14,3%) et des implants (5,7%). Le déterminant de la non-utilisation de méthodes contraceptives modernes était le manque d'informations relatives à la contraception moderne (OR ajusté = 8,13 (1,9-34,72)). Conclusion : Face à cette situation, il importe aux autorités sanitaires de Boghé de mener des activités de sensibilisation relatives à la contraception moderne tout en impliquant les hommes en vue de soutenir leurs conjointes à utuliser les produits contraceptifs modernes

[Study of the immunization coverage determinants of vaccination campaign against meningococcal A meningitis in Burkina Faso]. / Étude des déterminants de la couverture vaccinale de la campagne de vaccination contre la méningite à méningocoque A au Burkina Faso.

BACKGROUND: Sub-Saharan Africa countries suffer from repeated and explosive epidemics of meningitis mainly due to Neisseria meningitidis A. In December 2010, Burkina Faso organized a vaccination campaign with MenAfriVac® for people aged 1-29 years old. The objective of this study was to analyze the determinants of immunization coverage. METHODS: We used a cross-sectional survey by cluster sampling in two stages, descriptive and analytical, conducted in the region of "Boucle du Mouhoun". Data were collected during a home interview. The dependent variable was vaccination status and the independent variables included individual and household characteristics but also the means of communication used during the campaign. A logistic regression model was used to estimate the risk of being vaccinated using the 'Survey' Package (SVYGLM) of R. RESULTS: Two thousand and twenty-five people were included with a 93.5 % estimated coverage. Factors associated with high vaccination coverage are rural areas (ORa=2.53 [1.53-4.17]) and smaller households (ORa=3.06 [1.36-6.91]). The risk of being vaccinated was lower for persons from salaried heads of household (ORa=0.14 [0.02-0.87]) versus farmers, persons informed by religious and traditional leaders (ORa=0.25 [0.11-0.57]) or family and friends (ORa=0.51 [0.29-0.9]) versus community mobilizers. CONCLUSION: The coverage recorded is sufficient to provide community immunity. However, a part of the target population could not benefit from vaccination due to lack of information. Particular emphasis should be placed on large urban families using community mobilizers.

[Assistance and Support Units for the elderly: A tool for promoting health in seniors: Example of the CAAPA unit of "Sicap Rue 10", in Dakar]. / Cellules D'aide et D'appui aux Personnes Agees : Outil de promotion de la sante des seniors : Exemple la CAAPA de « Sicap Rue 10 ¼ a Dakar.

As a body for reflection, dialogue and integration, the CAAPA Assistance and Support Unit of "Sicap Rue 10" allows the elderly to fully participate in the life of their society while being in good health. The unit has been set up by the local authorities following recommendations from interdepartmental cabinet meeting on 13 November, 200. Nine years after the creation of the unit, it becomes important to evaluate the degree of community participation of the elderly within that unit. This is a qualitative, descriptive and analytic study that took place from 9 October to 23 October, 2010. The two methods used to collect the data are interviewing and focus group. Using Bichmann's scale, which has been modified and adapted, the results have shown an "average-level" participation of the elderly in the creation of the CAAPA unit, its implementation as well as the follow-up and the evaluation of its activities; this participation being "open" in the composition of the piloting committee and "restricted" in mobilizing and managing material and financial resources. Recommendations have been stated for the CAAPA unit to fully play its role.

La Cellule d'Appui et d'Aide aux Personnes Agées (CAAPA) de la SICAP rue 10, instance de réflexion, de concertation et d'intégration permet aux personnes âgées de participer à la vie sociale tout en se maintenant en bonne santé. Elle a été mise en place par les autorités de la dite localité suite aux recommandations du conseil interministériel du 13 novembre 2003. Neuf années après sa mise en œuvre, il est important d'évaluer le degré de participation communautaire des personnes âgées dans le fonctionnement de cette CAAPA. Il s'agit d'une étude qualitative descriptive et analytique qui s'est déroulée du 09 au 23 Octobre 2010. Les techniques de collecte des données utilisées sont l'entretien individuel et le focus group. Grâce à l'échelle de Bichmann modifiée et adaptée, les résultats ont montré une participation des personnes âgées « moyenne ¼ dans la conception de la CAAAPA, la mise en œuvre ainsi que le suivi/évaluation des activités, « ouverte ¼ dans la composition du comité de pilotage et « restreinte ¼ dans la mobilisation et la gestion des ressources matérielles et financières. Des recommandations ont été proposées pour que la CAAPA puisse jouer pleinement son rôle.

[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.

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

[Digestive pathology and oral condition in the rural populations of the Ferlo in Senegal]. / Pathologie digestive et état bucco-dentaire chez les populations rurales du Ferlo au Sénégal.

UNLABELLED: The aim of this work was to study the association between dental and periodontal status and digestive pathology in the Ferlo populations in Senegal. METHOD: This was a cross sectional study involving 300 people living in the area of the Ferlo in the Centre East of Senegal. Selected individuals must be over the age of 15 years and resided in the area. Cluster sampling helped recruit individuals. Collected information related to digestive pathology (yes or no), periodontal status (plate index, inflammation, bleeding, loss of attachment, the depth of pocket and the CPITN.) Dental status was evaluated by the DMFT. The data analyzed with software R and the Student's t test used to compare the averages of the indices in both groups at the threshold of 5%. Multivariate logistic regression analysis was used to isolate the final model with a threshold of 5%. RESULTS: Averages of dental and periodontal index were broadly equal in both groups (sick and not sick). The DMF and missing teeth were significantly associated with the digestive pathology after adjustment on gender, age, BMI, marital status, the number of cigarettes smoked and the depth of pocket. CONCLUSION: This study revealed a significant association between dental status and digestive pathology. The comprehensive care of patients therefore raises the interest of collaboration between surgeons, dentists and gastroenterologists for effective and adequate treatment.

Social inequality and antenatal care: impact of economic welfare on pregnancy monitoring in Senegal.

AIM: To explore the links between antenatal care (ANC) non-attendance and economic welfare. METHOD AND SUBJECT: This was a cross-sectional, descriptive and analytical study of women aged 15 to 49 years living in Senegal in 2005. Data were from the Demography and Health Survey using a two-stage random sampling procedure. Participants were classed by quintile using an economic well-being score based on housing characteristics and ownership of sustainable goods. The quality of ANC was determined from the number of visits, the qualification of the person delivering care, and content (counseling, weight, height and blood pressure measurements). Logistic regression was used for data analysis. RESULTS: A total of 6927 women were surveyed. Mean age was 28.15 years (±2.6); 20.3% were primiparous; 61.2% resided in rural areas; 70.0% had received no education. Each of the first four economic quintiles included about 20% (19.2% to 21.5%) of the participants while 16.9% were in the fifth (richest) quintile. A total of 457 women (6.6%) did not undergo any ANC visit. ANC non-attendance increased with parity, decreased with education level and was higher in rural areas than in urban areas, OR=7.2 (95% CI [5.1-10.1]). It decreased with increasing economic well-being: OR=0.6 [0.47-0.75] 2nd quintile vs. 1st, OR=0.02 [0.01-0.05] 5th quintile vs. 1st, p<0.05 overall. CONCLUSION: Economic welfare plays a major role in determining use of ANC. The only way to solve health problems is to reduce inequalities. The solution to this problem is beyond the scope of health but concerns an overall economic program involving the entire community, including policy-makers.

[Lifestyles and oral health in Fulani populations of Ferlo in Senegal]. / Modes de vie et santé buccodentaire chez les populations peuhls du Ferlo au Sénégal.

BACKGROUND: The population of Ferlo consists mainly of Fulani, whose lifestyle is characterized by nomadism and cattle breeding. The aim of this work was to study their dietary, living, and hygiene habits and their oral health. METHODOLOGY: This cross-sectional study included 300 individuals living in Tessekere and Widou Thiengoli, in the heart of the Great Green Wall of Senegal. These individuals were selected by cluster sampling and had lived in the area for over fifteen years. The 1997 WHO questionnaire was used to collect data from interviews and clinical observations. Information was collected specifically about eating habits, lifestyle and hygiene, dental caries (DMF) and periodontal treatment needs (CPITN). The coefficients of determination and correlation were used to explain and identify significant associations (defined by a p-value <0.05). RESULTS: Milk was consumed by 96% of the population and tea by 90%;47% of the population smoked more than half a pack of tobacco a day, 11% drank "boulfalé" (Cologne water of 45°), and 88.6% used toothpicks for dental hygiene. Tooth cleaning frequency was negatively correlated with the DMF index and CPITN, and consumption of milk, fruit and cigarettes were positively correlated with the CPITN. CONCLUSION: Dietary factors, smoking and hygiene appear to influence the oral health of populations in Ferlo. Prevention programs should be established, focusing on simple information to induce behavioral change.

[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.

[Water quality and personal hygiene in rural areas of Senegal]. / Qualité de l'eau et comportements hygiéniques des populations en milieu rural sénégalais.

INTRODUCTION: The high prevalence of diarrhea in developing countries is mostly due to poor water quality and hygiene practices. The purpose of this study was to assess water quality as well as hygiene practices and their determinants in Ngohé, i.e., a rural community (RC) in Senegal. METHOD: A combined approach consisting of a cross-sectional descriptive survey and bacterial analysis of water was used. Study was conducted in 312 randomly selected households. Data was collected through individual interviews with the assistance of a guide. Water for bacteriological analysis was collected from various sources, i.e., 3 modem borehole wells, 2 protected wells, and 10 traditional wells. Study points included home water treatment, drinking water source, latrine use, hand washing habits, and bacteria identified in water. A multiple regression model was used for data analysis. RESULTS: The household survey population was 59% male, 61% illiterate, and 93% married. Mean age was 44.8 +/- 18.1 years. Chlorination technique was inadequate in 62% of cases. Latrines were not restricted to adult use in 76% of homes. Hand washing was not performed at critical times in 94%. Drinking water was drawn from traditional wells in 48% of households, modem borehole wells in 45% and protected wells in 7%. Escherichia coli was found in water from all three sources and Vibrio cholerae was found in two traditional wells. Level of education, average monthly income, knowledge about chlorination techniques, and source of the water consumed were the main behavioral determinants (p < 0.05). CONCLUSION: Water treatment at the source and in the home as well as protection of water sources is necessary to ensure water quality. This will require effective public education campaigns and financial support for improvement of sanitary facilities.

[Acceptability of implementation of mutual health in a Senegalese rural area]. / Acceptabilité de la mise en place de mutuelle de santé en milieu rural sénégalais.

UNLABELLED: Funding for healthcare poses a major problem in developing countries. The purpose of this study was to assess public perceptions toward the implementation of mutual healthcare coverage in rural Senegal. METHODS: A descriptive transversal study was conducted from 24/09/07 to 05/10/07 in a randomly selected sample of 208 heads of households living in the rural communities of Ngogom and Réfane. Data were collected by means of individual interviews and focus group discussions. Topics included population health, community solidarity, health insurance and implementation of mutual healthcare insurance. RESULTS: The sample population was 94% male, 91% married, 36% uneducated and 11% unemployed. Household income was irregular in 36% and 84% had no savings. In case of medical emergency, 43% relied on family for assistance, 36% had no recourse and 21% would have to contract, a loan. Nearly half the sample population, i.e., 46%, were familiar with the principle of mutual healthcare insurance and 98% wanted to join. The main reasons for wanting to join were to reduce medical costs (57%), improve access to care (25%) and build community solidarity (11%). In focus groups, people expressed the need for micro health insurance. Findings also showed good community dynamics and a tradition of pooling resources to implement collective activities. CONCLUSION: The public perception of mutual healthcare insurance is favorable. However, due to economic difficulties, support from political and health authorities will be needed.

[Factors determining the place of delivery in women who attended at least one antenatal consultation in a health facility (Senegal)]. / Facteurs déterminant le lieu d'accouchement chez des femmes ayant bénéficié au moins d'une consultation prénatale dans une structure sanitaire (Sénégal).

BACKGROUND: Home birth remains a major cause of maternal and neonatal deaths in Senegal. The objective of this study was to identify the determinants of home birth in women who attended at least one antenatal consultation during their last pregnancy. METHOD: The study was cross-sectional and analytical. It covered a sample of 380 women selected at random among those who have given birth in the last 12 months in the health district Gossas. Data were collected at home using a questionnaire during an interview after informed consent. Multiple logistic regression was used to explore the determinants of childbirth at home using the Andersen model. RESULTS: The mean age was 26.2 ± 6.1 years. Women were married (97.3%), illiterate (81.8%) and lived in rural areas (78.4%). Available means of transportation at home were car (7.6%), cart (62.9%) or none 29.5%. In addition, 52.2% of the women lived more than 5 km from a health facility. For 59.0% of the women, the prenatal exam was considered satisfactory. The prevalence of home birth was 24%. Factors related to birth at home are polygamous marriage (OR=2.04 [1.13-3.70]), lack of transportation (OR=2.11 [1.13-5.01]) and residence more than 5 km from a health facility (OR=2.68 [1.56-4.16]). Late (3.90 [2.30-6.65]) or low quality (4.27 [2.25-8.10]) prenatal exams were also risk factors. CONCLUSION: Home birth is linked to access to health facilities but also to the prenatal consultation. Particular emphasis should be placed on training health care providers to improve the quality of the patients in the structures.

[Study of the contributing factors to home delivery (Senegal)]. / Etude des facteurs contributifs de l'accouchement à domicile (Sénégal).

In Senegal, 38% of deliveries occur at home. We believe that preparation for childbirth, informing women about the place of birth and the person who will assist in delivery, and the necessity of saving money in case of complications, can reduce deliveries at home. The purpose of this study is to determine the impact of preparation for delivery on place of delivery in Senegal. Matching was done on the preparation for delivery by the propensity score using the R package Matchit. A conditional logistic regression was used to analyze the relationship between preparation for birth and place of birth. The data were collected in 2006 from a sample of 3,093 women aged 15 to 49 years, mothers of children from 0 to 23 months in 5 regions of Senegal. The average age of women was 26.3 years (±6.6). The prevalence of delivery at home was 0.33 and 0.31 were given a preparation for childbirth. The following factors were associated with childbirth at home: preparing for the birth (OR: 0.36, CI 95%: [0.28-0.45]), at least primary school (OR: 0.59, CI 95%: [0.46-0.74]), number of prenatal care >3 (OR: 0.40, CI 95%: [0.29-0.54]) and early prenatal care (OR: 0.69 [0.51-0.83]). The relation with the profession of the person who performed the prenatal consultation was of borderline significance (P = 0.06). Particular emphasis should be placed on the preparation of delivery, especially during prenatal consultations.

[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.

[Traditional healers in the fight against HIV/AIDS infection in the health district of Fada N'Gourma (Burkina Faso)]. / Enquête sur le rôle des tradipraticiens de santé dans la lutte contre l'infection VIH/sida au Burkina Faso.

The purpose of this study was to evaluate collaboration between traditional healers (TH) and registered nurses (RN) in the care of people living with HIV (PLHIV) in the health district N'Gourma Fada, Burkina Faso. A survey was conducted among 26 RN, 33 TH working in the health district and 96 PLHIV under treatment at the Fada N'Gourma Regional Hospital. Survey data showed that only 9.1% had sound knowledge about HIV/AIDS and 18.2% about prevention methods. Conversely 84.8% had a good knowledge about clinical manifestations. Among TH, 84.8% claimed to refer patients to health facilities that provided no support for HIV/AIDS, 51.1% called for establishment of a framework of cooperation and 21.2% asked for reciprocity. Among nurses, 85.2% did not consider TH as part of the health community fighting against HIV/AIDS. Proposals focused on association of TH, frameworks of cooperation, and coordination of TH activities in the fight against HIV/AIDS.

[Obstetric urogenital fistula (OUGF): cost analysis at the Niamey National Hospital (Niger)]. / Fistule urogénitale d'origine obstétricale (Fugo) : coût de la prise en charge à l'hôpital national de Niamey (Niger).

BACKGROUND: A program to eliminate obstetric urogenital fistula (OUGF) was set up on February 19, 2004 in Niger. Though the consultations were free of charge, there was a cost involved, which constitutes the objective of this study. METHOD: The data were obtained from a documentary study completed by discussions with the principal management participants and interviews targeting the women suffering from OUGF attending the national hospital of Niamey during the surgery sessions of April and November 2006. Cost assessment included all resources devoted to activities involved in the program: hospital stay, hygiene education, medical and surgical treatment, social rehabilitation interventions (preparation for revenue generating activities and return to residence). Data analysis was performed with Excel and Epi2000 software. Average cost per item and patient was determined. RESULTS: The cost of the stay at the National hospital of Niamey was 96,445 francs CFA divided between transportation (4,688), room and board (21,572), assistance bonus (3,708) and indirect costs (66,477). The hygiene education cost 194,140 francs CFA: 30,150 for human resources, 143,965 for material resources and 20,025 for operational costs. The medical and surgery treatment had a cost of 144,009 francs CFA divided between consultations (15,000), complementary explorations (44,900), surgical operation (50,000) and consumables (34,109). The preparation for revenue generating activities had a cost of 118,244 francs CFA including training for clothes dying (22,084), soap manufacture (46,160) and the financial supportive grant (50,000). The return to the community cost 295,000 francs CFA, included room and board (2,500), human resources (65,000) and material resources (227,500). Altogether, the cost of the OUGF program came up to 742,018 francs CFA for our sample (76% of women with revenue generating activity), and was assessed at a maximum of 781,362 francs CFA if none of the woman had a revenue generating activity, and a minimum of 729,594 francs CFA if all of them did. CONCLUSION: Without the free consultations, the high cost of the OUGF program at the national hospital of Niamey would be inaccessible to Nigerian women owing to poverty and ignorance. Because of this observation, a long-term program is warranted for the treatment of overt cases and the reduction of prevalence, to enable Nigerian women to contribute to the development activities of their country.