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.

OBJECTIVE: Our study aimed to investigate associated factors with TT2 + coverage (at least two doses of tetanus-toxoid vaccine) in pregnant women in the Health Zone Zogbodomey- Bohicon-Zakpota, Benin in 2013.
UNASSIGNED: A cross-sectional, descriptive and analytical study was conducted in june-July 2013 on mothers of children aged 0-11 months. The sampling method of immunization coverage cluster of WHO has been adapted. Logistic regression was used to identify factors associated to with TT2 +.
RESULTS: Our study included 210 mothers of children aged 0-11 months. TT2 + coverage of the women surveyed were 61.7% [95% CI 61.4 to 62.0]. The final model, factors associated with TT2 + coverage were: the number of antenatal care, the use of a private health center, knowledge of the immunization schedule, the use of radio and television, marital status, occupation, waiting time, residence, fear of undesirable reactions, the permanence of immunization services, education level, distance, family support and explanation of the immunization schedule the woman. Conclusion: Measures to improve TT2 + coverage should put more emphasis on these identified factors to hope to eliminate maternal and neonatal tetanus.
UNASSIGNED: Notre étude avait pour objectif d\'étudier les facteurs associés à la faible couverture en Vaccin Anti Tétanique deuxième dose (VAT2+) chez les femmes enceintes dans la Zone Sanitaire de Zogbodomey-Zakpota-Bohicon au Benin.
UNASSIGNED: Une étude transversale, descriptive et analytique a été menée en juin-juillet 2013 et a porté sur les mères d\'enfants de 0–11 mois. La méthode de couverture vaccinale en grappes de l\'OMS a été utilisée. Les données ont été analysées avec Epi Info 7 et Stata 11. La régression logistique a été utilisée pour déterminer les facteurs associés à la VAT2+.
UNASSIGNED: La couverture en VAT2 + des 210 mères enquêtées était de 61,7 % IC95% =[61,4–62,0]. Les facteurs associés à la couverture en VAT2+ étaient: le nombre de CPN, le recours à un centre de santé privé, la connaissance et l\'explication du calendrier vaccinal, l\'utilisation des médias, le statut matrimonial, la profession, le temps d\'attente, la résidence, la peur des réactions secondaires, la permanence des services de vaccination, le niveau d\'instruction, la distance, le soutien de la famille.
CONCLUSIONS: Les mesures visant à améliorer la couverture en VAT2+ doivent davantage mettre l\'accent sur ces facteurs pour espérer éliminer le tétanos maternel et néonatal.

OBJECTIVE: Our study aimed to investigate factors associated with TT2+ coverage (at least two doses of tetanus-toxoid vaccine) in pregnant women in the Zogbodomey- Bohicon-Zakpota Health Zone, Benin in 2013.
UNASSIGNED: A cross-sectional, descriptive and analytical study was conducted between June-July 2013 on mothers of children aged 0-11 months. The sampling method of immunization coverage cluster of WHO has been adapted. Logistic regression was used to identify factors associated to with TT2+.
RESULTS: Our study included 210 mothers of children aged 0-11 months. TT2+ coverage of the women surveyed were 61.7% [95% CI 61.4 to 62.0]. The factors associated with TT2+ coverage were: the amount of antenatal care, the use of a private health center, knowledge of the immunization schedule, the use of radio and television, marital status, occupation, waiting time, residence, fear of undesirable reactions, the permanence of immunization services, education level, distance, family support and explanation of the immunization schedule to the women.
CONCLUSIONS: Measures to improve TT2+ coverage should put more emphasis on these identified factors to hope to eliminate maternal and neonatal tetanus.
UNASSIGNED: Notre étude avait pour objectif d\'étudier les facteurs associés à la faible couverture en Vaccin Anti Tétanique deuxième dose (VAT2+) chez les femmes enceintes dans la Zone Sanitaire de Zogbodomey-Zakpota-Bohicon au Benin.
UNASSIGNED: Une étude transversale, descriptive et analytique a été menée en juin-juillet 2013 et a porté sur les mères d\'enfants de 0–11 mois. La méthode de couverture vaccinale en grappes de l\'OMS a été utilisée. Les données ont été analysées avec Epi Info 7 et Stata 11. La régression logistique a été utilisée pour déterminer les facteurs associés à la VAT2+.
UNASSIGNED: La couverture en VAT2 + des 210 mères enquêtées était de 61,7 % IC95% =[61,4 –62,0]. Les facteurs associés à la couverture en VAT2+ étaient : le nombre de CPN, le recours à un centre de santé privé, la connaissance et l\'explication du calendrier vaccinal, l\'utilisation des médias, le statut matrimonial, la profession, le temps d\'attente, la résidence, la peur des réactions secondaires, la permanence des services de vaccination, le niveau d\'instruction, la distance, le soutien de la famille.
CONCLUSIONS: Les mesures visant à améliorer la couverture en VAT2+ doivent davantage mettre l\'accent sur ces facteurs pour espérer éliminer le tétanos maternel et néonatal.

Defects on the palmar surface of the fingers are an important part of hand emergencies, especially fingertip wounds. Luckily, many coverage methods are available. We will review the anatomy of this area and the thought process for treating these defects. We will also propose an algorithm that can be used to select the best technique based on the type of injury present.

To ascertain household coverage achieved by Swaziland\'s national community health worker (CHW) programme and differences in household coverage across clients\' sociodemographic characteristics.
Household survey from June to September 2015 in two of Swaziland\'s four administrative regions using two-stage cluster random sampling. Interviewers administered a questionnaire to all household members in 1542 households across 85 census enumeration areas.
While the CHW programme aims to cover all households in the country, only 44.5% (95% confidence interval: 38.0% to 51.1%) reported that they had ever been visited by a CHW. In both uni- and multivariable regressions, coverage was negatively associated with household wealth (OR for most vs. least wealthy quartile: 0.30 [0.16 to 0.58], P < 0.001) and education (OR for >secondary schooling vs. no schooling: 0.65 [0.47 to 0.90], P = 0.009), and positively associated with residing in a rural area (OR: 2.95 [1.77 to 4.91], P < 0.001). Coverage varied widely between census enumeration areas.
Swaziland\'s national CHW programme is falling far short of its coverage goal. To improve coverage, the programme would likely need to recruit additional CHWs and/or assign more households to each CHW. Alternatively, changing the programme\'s ambitious coverage goal to visiting only certain types of households would likely reduce existing arbitrary differences in coverage between households and communities. This study highlights the need to evaluate and reform large long-standing CHW programmes in sub-Saharan Africa.

To compare administrative coverage data with results from household coverage surveys for vitamin A supplementation (VAS) and deworming campaigns conducted during 2010-2015 in 12 African countries.
Paired t-tests examined differences between administrative and survey coverage for 52 VAS and 34 deworming dyads. Independent t-tests measured VAS and deworming coverage differences between data sources for door-to-door and fixed-site delivery strategies and VAS coverage differences between 6- to 11-month and 12- to 59-month age group.
For VAS, administrative coverage was higher than survey estimates in 47 of 52 (90%) campaign rounds, with a mean difference of 16.1% (95% CI: 9.5-22.7; P < 0.001). For deworming, administrative coverage exceeded survey estimates in 31 of 34 (91%) comparisons, with a mean difference of 29.8% (95% CI: 16.9-42.6; P < 0.001). Mean ± SD differences in coverage between administrative and survey data were 12.2% ± 22.5% for the door-to-door delivery strategy and 25.9% ± 24.7% for the fixed-site model (P = 0.06). For deworming, mean ± SD differences in coverage between data sources were 28.1% ± 43.5% and 33.1% ± 17.9% for door-to-door and fixed-site distribution, respectively (P = 0.64). VAS administrative coverage was higher than survey estimates in 37 of 49 (76%) comparisons for the 6- to 11-month age group and 45 of 48 (94%) comparisons for the 12- to 59-month age group.
Reliance on health facility data alone for calculating VAS and deworming coverage may mask low coverage and prevent measures to improve programmes. Countries should periodically validate administrative coverage estimates with population-based methods.

Lower limb multi-tissular injuries are rare in children but require elaborate surgical care considering the child\'s growth potential, donor-site morbidity and the psychological consequences for the child and his family. This review outlines the various coverage options, from simple to more complex, developing their principles and their results. Technical features of wound repair of the lower limb in children will be detailed. An efficient and ambitious care can give excellent functional outcomes in children, even when extended, multi-tissue lesions members are involved.

We describe the different cheek reconstruction techniques with primary emphasis on the superficial layers. In addition to the clinical context, location and size of the lesion will be taken into account to choose the best method that will optimize the functional and aesthetic results while minimizing potential sequelae. Main evaluation criteria include absence of natural orifice deformation, scar location, skin cover quality and respect of volumes.

BACKGROUND: Heel coverage requires the surgeon to considerate of multiple parameters: the type of defect, the exposed tissues, the weight-bearing requirements, the donor site morbidity, and the shape of the reconstructed heel allowing at best normal footwear. Although many methods of coverage exist, they are often chosen at the cost of a compromise between all the parameters described. In recent years, perforator freestyle free flaps offer plastic surgeons an unparalleled freedom that can adapt the constraints of the reconstruction while minimizing the functional and scar donor site morbidity.
METHODS: We present four cases of heel defect of different origins treated by three types of tailored perforator freestyle free flaps (ALT, TAP and SCIP Flaps). End-to-side anastomosis to the posterior tibial vessels was used in three flaps while one flap was anastomosed to the internal plantar artery in an end-to-end fashion.
RESULTS: No postoperative complication occurred. This approach allowed, in all patients, a reconstruction of excellent quality with minimal cicatricial morbidity. All patients were walking effectively at 21 days postoperatively.
CONCLUSIONS: Perforator freestyle free flaps offer a solution of first choice for heel reconstruction. At the price of a linear hidden scar, they offer a functional, aesthetic and durable coverage.