Les maladies chroniques non transmissibles chez les militaires sénégalais: étude transversale en 2013

Introduction: Les maladies chroniques non transmissibles (MCNT) constituent un problème de santé publique. La transition épidémiologique coexiste avec les maladies infectieuses. En Afrique  subsaharienne, leur ampleur est peu connue et l'OMS recommande aux pays à faible et moyen revenu de réaliser des enquêtes STEPS portant sur les comportements, des mesures physiques et biochimiques.  L'absence de données au niveau national justifie cette étude auprès d'un groupe spécifique. L'objectif de l'étude était de déterminer la prévalence des MCNT et de leurs facteurs de risque chez les militaires  Sénégalais.Méthodes: Une enquête transversale a été réalisée incluant les militaires âgés de 25 à 60 ans. La participation était volontaire et l'accord des autorités hiérarchiques a préalablement été obtenu. Un sondage stratifié à deux niveaux a été utilisé permettant d'avoir un échantillon ajusté de 1513 individus. Les données ont été saisies avec le logiciel EPI Info 6 et analysées à l'aide de R. Un score de risque a été déterminé sur la base de cinq facteurs. Résultats: Les résultats préliminaires concernent 1125 personnes. L'âge moyen était de 39,7 ±9,1 ans et le sex-ratio de 28,6. La prévalence du tabagisme actif était de 17,3% et ne variait pas significativement entre les différentes catégories d'âge. L'âge moyen auquel ils ont commencé à fumer était de 20,8 ±4,05 ans. La consommation médiane de fruits et légumes était de l'ordre de 4 par jour et seulement 5,7% des enquêtés prenaient au moins 5 portions par jour. Environs 72% des enquêtés avaient une activité physique intense ou modérée. Les prévalences de la surcharge pondérale, de l'HTA et du diabète étaient de 30,5%, 28,4% et 3,0% respectivement alors que la maladie rénale chronique était retrouvée chez un seul cas. Le calcul du score de risque cardiovasculaire a montré que 39,1% des militaires étaient à risque élevé (≥3 facteurs de risque) et que ce dernier  augmentait avec l'âge. Conclusion: La prévalence élevée des MCNT dans ce groupe particulier laisse présager de l'ampleur dans la population générale. De ce point de vue, il est urgent de mettre en place un programme de prévention primaire et de dépistage pour anticiper les lourdes conséquences liées à ces maladies.Key words: Epidémiologie, maladies non-transmissibles, militaires, Sénéga

Use of HRP-2-based rapid diagnostic test for Plasmodium falciparum malaria: assessing accuracy and cost-effectiveness in the villages of Dielmo and Ndiop, Senegal

Background: In 2006, the Senegalese National Malaria Control Programme (NMCP) has recommended artemisinin-based combination therapy (ACT) as the first-line treatment for uncomplicated malaria and, in 2007, mandated testing for all suspected cases of malaria with a Plasmodium falciparum HRP-2-based rapid diagnostic test for malaria (RDT(Paracheck (R)). Given the higher cost of ACT compared to earlier anti-malarials, the objectives of the present study were i) to study the accuracy of Paracheck (R) compared to the thick blood smear (TBS) in two areas with different levels of malaria endemicity and ii) analyse the cost-effectiveness of the strategy of the parasitological confirmation of clinically suspected malaria cases management recommended by the NMCP. Methods: A cross-sectional study was undertaken in the villages of Dielmo and Ndiop (Senegal) nested in a cohort study of about 800 inhabitants. For all the individuals consulting between October 2008 and January 2009 with a clinical diagnosis of malaria, a questionnaire was filled and finger-prick blood samples were taken both for microscopic examination and RDT. The estimated costs and cost-effectiveness analysis were made considering five scenarios, the recommendations of the NMCP being the reference scenario. In addition, a sensitivity analysis was performed assuming that all the RDT-positive patients and 50% of RDT-negative patients were treated with ACT. Results: A total of 189 consultations for clinically suspected malaria occurred during the study period. The sensitivity, specificity, positive and negative predictive values were respectively 100%, 98.3%, 80.0% and 100%. The estimated cost of the reference scenario was close to 700(sic) per 1000 episodes of illness, approximately twice as expensive as most of the other scenarios. Nevertheless, it appeared to us cost-effective while ensuring the diagnosis and the treatment of 100% of malaria attacks and an adequate management of 98.4% of episodes of illness. The present study also demonstrated that full compliance of health care providers with RDT results was required in order to avoid severe incremental costs. Conclusions: A rational use of ACT requires laboratory testing of all patients presenting with presumed malaria. Use of RDTs inevitably has incremental costs, but the strategy associating RDT use for all clinically suspected malaria and prescribing ACT only to patients tested positive is cost-effective in areas where microscopy is unavailable

An Exhaustive, Non-Euclidean, Non-Parametric Data Mining Tool for Unraveling the Complexity of Biological Systems – Novel Insights into Malaria

Complex, high-dimensional data sets pose significant analytical challenges in the post-genomic era. Such data sets are not exclusive to genetic analyses and are also pertinent to epidemiology. There has been considerable effort to develop hypothesis-free data mining and machine learning methodologies. However, current methodologies lack exhaustivity and general applicability. Here we use a novel non-parametric, non-euclidean data mining tool, HyperCube®, to explore exhaustively a complex epidemiological malaria data set by searching for over density of events in m-dimensional space. Hotspots of over density correspond to strings of variables, rules, that determine, in this case, the occurrence of Plasmodium falciparum clinical malaria episodes. The data set contained 46,837 outcome events from 1,653 individuals and 34 explanatory variables. The best predictive rule contained 1,689 events from 148 individuals and was defined as: individuals present during 1992–2003, aged 1–5 years old, having hemoglobin AA, and having had previous Plasmodium malariae malaria parasite infection ≤10 times. These individuals had 3.71 times more P. falciparum clinical malaria episodes than the general population. We validated the rule in two different cohorts. We compared and contrasted the HyperCube® rule with the rules using variables identified by both traditional statistical methods and non-parametric regression tree methods. In addition, we tried all possible sub-stratified quantitative variables. No other model with equal or greater representativity gave a higher Relative Risk. Although three of the four variables in the rule were intuitive, the effect of number of P. malariae episodes was not. HyperCube® efficiently sub-stratified quantitative variables to optimize the rule and was able to identify interactions among the variables, tasks not easy to perform using standard data mining methods. Search of local over density in m-dimensional space, explained by easily interpretable rules, is thus seemingly ideal for generating hypotheses for large datasets to unravel the complexity inherent in biological systems

Perception of Beneficiaries and Stakeholders about the Services Offered by Health Huts Put in Place by the Health Project—Community Health of USAID in the Goudomp Health District (Senegal)

The Health Project—Community Health USAID is a community-based intervention that has been implemented by a group of NGOs, among which there is Africare, for a period of 5 years (2006-2011). It seeks to strengthen the community health system through a package of basic services offered at the health center, and as well as to improve the skills and knowledge of community actors. The main objective of this study is to capture the perceptions of beneficiaries and stakeholders about the services offered at the PSSC health posts located in the health district Goudomp. A qualitative cross-sectional study on the perception of the community of the USAID PSSC and quality of servic-es offered by the health huts was conducted from the 2nd to 5th of May 2009 in the Goudomp health district. To achieve the objectives of this study, we conducted focus group discussions with all the community leaders and had individual interviews with the community health workers (CHWs) and the supervisor of the NGO Africare. From most of the discussions, it can be concluded that the activities of the health hut are not well known by the populations. The best known activities are those performed by the nurse: immunization and pre-natal care. The existence of health huts a

The Geographical Study of Anopheline Densities on a Small Space, using Satellite Imagery and Geographical Information Systems

International audienceTo predict the spatial distribution of anopheles in the Dielmo village (located in the southeastern part of Senegal), we used residual fauna collected from 104 different rooms during four separate trips conducted in 1994 and 1995. Thanks Generalized Estimating Equations, we were able to identify factors influencing the distribution of Anopheles in the village. Several variables, such as the number of persons sleeping in the room, population density around the hut, construction materials, presence of mosquito nets, were found to be significant, while many spatial variables relevant to the scale of a region (vegetation index, distance to larval sites...) were not found to be significant on the village level. As a result, it became clear that it is difficult to correctly predict the anopheline density for each house even with precise spatial data created with Satellite imagery and Geographical Information Systems (GIS). This work highlights the complexity of the geographical study of anopheline density and its limits on a small space

The Geographical Study of Anopheline Densities on a Small Space, using Satellite Imagery and Geographical Information Systems

International audienceTo predict the spatial distribution of anopheles in the Dielmo village (located in the southeastern part of Senegal), we used residual fauna collected from 104 different rooms during four separate trips conducted in 1994 and 1995. Thanks Generalized Estimating Equations, we were able to identify factors influencing the distribution of Anopheles in the village. Several variables, such as the number of persons sleeping in the room, population density around the hut, construction materials, presence of mosquito nets, were found to be significant, while many spatial variables relevant to the scale of a region (vegetation index, distance to larval sites...) were not found to be significant on the village level. As a result, it became clear that it is difficult to correctly predict the anopheline density for each house even with precise spatial data created with Satellite imagery and Geographical Information Systems (GIS). This work highlights the complexity of the geographical study of anopheline density and its limits on a small space

Correlation of individual estimates of (i) the intra-individual and (ii) additive genetic effects underlying the variation in the number of <i>P. falciparum</i> clinical episodes according to drug period.

<p>*P<0.05,</p><p>**P<0.01,</p><p>***P<0.001.</p