To estimate geographical variations of child immunisation at the regional level in Senegal, to identify individual and contextual factors that could explain these regional discrepancies, and to measure their effects.
Data come from the 2015, 2016 and 2017 Senegalese Demographic and Health Survey, a national survey targeting women aged 15-49, with a questionnaire focusing on health and reproductive issues including their children\'s immunisation status. We restricted the analysis to children aged 12-23 months (n = 4955) and conducted a multilevel logistic regression to assess individual and contextual factors associated with complete immunisation coverage.
The complete immunisation coverage rate of children was estimated at 68% and ranged from 41% in the region of Kedougou to 83% in the region of Dakar. The inter-regional variance was significantly different from zero (P = 0.006) in the empty multilevel model. It decreased by more than half (57 %) after adjusting for individual factors but remained significantly different from zero (P = 0.010). Regional variations of complete immunisation rates drastically decreased and were no longer statistically significant (P = 0.343) after adjusting for the following regional factors: population density, density of hospitals, literacy rate and proportion of health facilities with an antenatal care service.
Regarding health policies designed to improve childhood immunisation and to reduce related inequalities, our results highlight the need to take into account both individual and contextual factors, with a focus on rural and deprived areas where children are at higher risk of incomplete immunisation.
Estimer les variations géographiques de la vaccination des enfants au niveau régional au Sénégal, identifier les facteurs individuels et contextuels qui pourraient expliquer ces écarts régionaux et mesurer leurs effets. MÉTHODES: Les données proviennent de l\'enquête démographique et la santé du Sénégal de 2015, 2016 et 2017, une enquête nationale ciblant les femmes âgées de 15 à 49 ans, avec un questionnaire axé sur les problèmes de santé et de reproduction, y compris le statut vaccinal de leurs enfants. Nous avons limité l\'analyse aux enfants âgés de 12 à 23 mois (n = 4.955) et avons effectué une régression logistique à plusieurs niveaux pour évaluer les facteurs individuels et contextuels associés à une couverture vaccinale complète. RÉSULTATS: Le taux de couverture vaccinale complète des enfants était estimé à 68% et variait de 41% dans la région de Kédougou à 83% dans la région de Dakar. La variance interrégionale était significativement différente de zéro (P = 0,006) dans le modèle vide à plusieurs niveaux. Il diminuait de plus de la moitié (57%) après ajustement pour les facteurs individuels mais est restait significativement différent de zéro (P = 0,010). Les variations régionales des taux de vaccination complète ont considérablement diminué et n\'étaient plus statistiquement significatives (P = 0,343) après ajustement pour les facteurs régionaux suivants: densité de population, densité des hôpitaux, taux d\'alphabétisation et proportion d\'établissements de santé disposant d\'un service de soins prénatals.
En ce qui concerne les politiques de santé conçues pour améliorer la vaccination des enfants et réduire les inégalités associées, nos résultats soulignent la nécessité de prendre en compte les facteurs individuels et contextuels, en mettant l\'accent sur les zones rurales et défavorisées où les enfants sont plus à risque de vaccination incomplète.

In Senegal, patients are seen an average of 16 months after their injury in a specialized hand and upper limb surgery department. Because of this lengthy delay, these patients have severe functional sequelae, such as wrist flexion contracture, averaging 45 degrees in our case series (range, 35 to 90 degrees). After reviewing the literature, we did not find any splint that was well suited to these patients. Inspired by the general splinting rules set out by Schultz, MacConaill and Brand, we constructed a volar/dorsal splint to reduce these contractures. We have been using this serial static splint for 2 years. We performed a prospective study of 17 wrists to evaluate its therapeutic benefit, describe its use and outline its optimal application.

OBJECTIVE: To determine the epidemiological and etiological profile of tinea capitis in adults in Dakar (Senegal).
METHODS: A 9-month prospective, multicenter, descriptive and analytic study. Patients included were aged over 18 years. Mycological tests were used to confirm the diagnosis.
RESULTS: 121 patients were included with a mean age of 36.1 years and a hospitalisation frequency of 0.8%. The age range of 64.4% of patients was between19 and 38 years. 51% of patients were housewives. A low socioeconomic level was found in 72.8% of cases. In 3.3% of patients, the disease began in childhood. 31.4% of patients had already consulted a traditional healer. Similar familial cases were noted in 60.3% of patients. Contact with a sheep was noted in 32.2% of cases, deliberate skin lightening in 64% of women, hair salon attendance in 46.7% of women, and immunosuppression in 17.3% of patients, while itching was present in 95.5%. Dermatologic examination showed scaled plaques and a diffuse form, with 92.6% and 64% (n=75) respectively. Wood\'s light examination was positive in 40.2% of patients. A positive culture test was found in 71%. The most frequently encountered species were: T. soudanense (65%), M. audouinii (21%), T. rubrum (4.7%), M. gypseum (3.5%), T. violaceum (2.3%), T. verrucosum (2.3%) and M. canis (1 case). The clinical course was favorable under treatment with griseofulvin or terbinafine.
CONCLUSIONS: Tinea capitis in adults mainly affects young women. The diffuse form is the most common. The most frequently encountered species was T. soudanense.

BACKGROUND: Acute coronary syndromes have been rarely studied in the female population in Sub-Saharan Africa. This Sub-Saharan serie has shown an increase in the prevalence of acute coronary syndromes among the female population, compared to previous studies. Through this retrospective study, we evaluated the epidemiological, clinical, paraclinical, therapeutic and evolutionary features of acute coronary syndromes on women at the Principal Hospital of Dakar.
METHODS: This was a retrospective study of patients hospitalized for acute coronary syndrome over a period of 5 years from January 1st, 2010 to December 31st, 2014, at the Cardiology Department of the Principal Hospital of Dakar.
RESULTS: The prevalence of diabetes and obesity was statistically higher for women than for men. Atypical symptomatology was much more apparent (P=0.0000), admission times at the emergency department for acute coronary syndromes were relatively longer (=0.005). Therapeutically, medical care was almost identical regardless of gender.
CONCLUSIONS: In Senegal, acute coronary syndrome in women is characterized by the atypical symptomatology with delayed diagnosis and management. The fight against this reputedly masculine pathology requires a good awareness campaign.

OBJECTIVE: To study the prevalence of atherosclerosis (aortic and coronary lesions) in Senegalese people, to determine main risks factors and morphological patterns.
METHODS: A prospective autopsy study was conducted in the pathology department of Aristide Le Dantec Hospital (Dakar-Senegal) where 116 specimens aged over 5 years old were studied.
RESULTS: Autopsy study of 116 Senegalese specimens for atherosclerotic lesions revealed aortic lesions in 100 cases (86%), aortic and coronary lesions both in 48 cases. There were 88 men versus 12 women. The median age was 37.1 years comprised 5 to 77 years old. Hypertensive, smoking and abdominal obesity were detected respectively in 5 cases, 37 cases and 33 cases. In aortic vessel, the main lesions detected were severe fibrous plaques detected in 40 cases. In coronary arteries, fibrous plaques were detected in 18 cases, severe fibrous plaques in 17 cases.
CONCLUSIONS: Our study in Senegalese population showed existence of atherosclerotic lesions. These lesions were more responsible for complications as myocardial infarction.

BACKGROUND: The long diagnostic delay is responsible for the extension of radiological lesions and spread of TB in the community. These radiological lesions can leave significant scars responsible for respiratory disability.
OBJECTIVE: The aim of the study is to characterize radiologic features according to tuberculosis diagnostic delay.
METHODS: We conducted a prospective cross-sectional study, about 66 patients with positive sputum.
RESULTS: The average diagnostic delay was 16 (±15) weeks; whether 22 (±14.1) weeks in the female gender versus 14.6 (±14.3) weeks in the male gender (P=0.10). The first care use was respectively health centers (62.1%), drugstores (51.9%), and traditional medicine (28.7%). Only 27.2% of patients used the marabouts care. Bilateral radiographic abnormalities in bivariate analysis were associated with consultation at the health center (66.7% versus 33.3%; P<0.031), as is the extension of the lesions (70.2% versus 29.8% RP=1.66 [1.05 to 2.91]; P<0.03). Lake of knowledge of the symptoms of TB was associated with the use of marabouts care (12.5% versus 87.5; PR=0.35 [0.11 to 1.08], P<0.04).
CONCLUSIONS: These results should prompt consideration in an emergency, appropriate control interventions, advocacy, patient information and medical personnel on the reality of tuberculosis to prevent its spread often causing respiratory disability with radological effects.

The objective of this study was to assess the level of integration of prevention of mother-to-child HIV transmission (PMTCT) in facilities providing services for maternal, newborn, and child health (MNCH) and reproductive health (RH) in Senegal. The survey, conducted from August through November, 2014, comprised five parts : a literature review to assess the place of this integration in the health policies, standards, and protocols in effect in Senegal; an analysis by direct observation of attitudes and practices of 25 healthcare providers at 5 randomly-selected obstetrics and gynecology departments representative of different levels of the health pyramid; a questionnaire evaluating knowledge and attitudes of 10 providers about the integration of PMTCT services into MNCH/RH facilities; interviews to collect the opinions of 70 clients, including 16 HIV-positive, about the quality of PMTCT services they received; and a questionnaire evaluating knowledge and opinions of 14 policy-makers/managers of health programs focusing on mothers and children about this integration. The literature review revealed several constraints impeding this integration : the policy documents, standards, and protocols of each of the programs involved do not clearly indicate the modalities of this integration; the programs are housed in two different divisions while the national Program against the Human Immunodeficiency Virus reports directly to the Prime Minister; program operations remains generally vertical; the resources for the different programs are not sufficiently shared; there is no integrated training module covering integrated management of pregnancy and delivery; and supervision for each of the different programs is organized separately.The observation of the providers supporting women during pregnancy, during childbirth, and in the postpartum period, showed an effort to integrate PMTCT into the MNCH/RH services delivered daily to clients. But this desire is hampered by many problems, including the inconsistent availability of HIV testing and antiretroviral drugs at program sites and the deficit in training and supervision for PMTCT. Clients interviewed after their contact with providers often complained about the lack of information received about PMTCT. They considered that effective integration of these services would provide them with better quality care while reducing their waiting time, costs, and trips to health facilities. The responses of policymakers and program managers interviewed mostly revealed gaps in their understanding and implementation of the integration. There is an effort to integrate MNCH/RH and PMTCT services at the healthcare facilities we visited. But our investigation revealed many shortcomings in both the screening and support of new or expectant HIV+ mothers. To improve this situation it is necessary to improve the skills and motivation of PMTCT providers, enhance the level of equipment, and empower local maternity wards.

To determine the prevalence and factors associated with optimal antiretroviral therapy (ART) adherence and virological failure (VLF) among HIV-infected adults enrolled in the national ART programme at the teaching hospital of Fann, Dakar, Senegal.
Cross-sectional study from 1 September 2013 to 30 January 2014.
(1) optimal ART adherence by the Center for Adherence Support Evaluation (CASE) Index Score (>10) and (2) VLF (HIV RNA > 1000 copies/ml). Diagnostic accuracy of CASE Index Score assessed using sensitivity (Se), specificity (Sp), positive predictive value (PPV), negative predictive value (NPV) and corresponding 95% confidence intervals (CIs). Multivariate logistic regression analysis was performed to identify independent factors associated with optimal adherence and VLF.
Of 98 HIV-infected patients on ART, 68% were female. The median (IQR) age was 42 (20-50) years. A total of 57 of 98 (60%) were on ART more than 3 years, and majority (88%) were on NNRTI-based first-line ART regimen. A total of 79 of 98 (80%) patients reported optimal ART adherence, and only five of 84 (5.9%) had documented VLF. Patients with VLF were significantly more likely to have suboptimal ART adherence (17.7% vs. 2.9%; P = 0.02). CASE Index Score showed the best trade-off in Se (78.9%, 95% CI: 54.4-93.9%), Sp (20.0%, 95% CI: 11.1-31.7), PPV (22.4, 95% CI: 13.1-34.2%) and NPV (76.5%, 95% CI: 50.1-93.2), when used VLF threshold of HIV RNA >50 copies/ml. Factors independently associated with VLF were CASE Index Score <10 ([aOR] = 13.0, 95% CI: 1.1-147.9; P = 0.04) and being a boosted PI-based ART regimen ([aOR] = 27.0, 95% CI: 2.4-309.4; P = 0.008).
Optimal ART adherence is achievable in a high proportion of HIV-infected adults in this study population. CASE Index Score was independently associated with virological outcomes, supporting usefulness of this low-cost ART adherence monitoring tool in this setting.

The Superior Foville Syndrome is a rare clinical feature of stroke or brain hemorrhage. Few cases have been reported worldwide particularly in Africa. We report the case of a 20 years old patient resident in Senegal with no known medical history. He was admitted on August 2015 in the Neurology Department of Fann National Teaching Hospital for an abrupt onset of left body side weakness, acute headaches and rotatory vertigo five days before admission. The physical examination found a superior Foville Syndrome. And the brain CT scan shown hemorrhage at the right inferior part of the pons compressing the fourth ventricle. No cause of this hemorrhage stroke has been found. Superior Foville syndrome is a rare clinical presentation of stroke and presented a rich semiological feature of the posterior cerebral fossa.

BACKGROUND: 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.
METHODS: 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.
CONCLUSIONS: 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.