The use of misoprostol in outpatient treatment of abortions in the first quarter of pregnancy in Dakar

Background: The objective of this study was to compare the effectiveness of misoprostol comparing to MVA in support of abortion from the first quarter.Methods: This was a prospective, descriptive and analytical study (case-control study) made between January 1st and December 31st, 2015 in a level 1 maternity in Dakar.Results: The study included316 first trimester abortions (158 were treated with misoprostol and 158 with MVA). The epidemiological profile was a woman aged on average 28.5 years and nulliparous (37%). The mean gestational age was 8 weeks 6 days. The rate of complete uterine evacuation was comparable in both groups (93% for misoprostol versus 94.3%for MVA) with a non-significant p-value. Side effects found (40.8%) were minor. The hospital stay averaged two hours in the misoprostol group against 24 hours for MVA. Anaemia was more common in the MVA group (44.1%) than in the misoprostol group (23.6%) (p = 0.0006). The cost of treatment with misoprostol (5620 CFA francs) was on average four times less than that of MVA (21,623 CFA francs).Conclusions: Misoprostol can be seen as a credible alternative in the management of first quarter abortions because of its many advantages including its effectiveness, its easiness to be used in ambulatory, its low cost and safety

The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance

INTRODUCTION Investment in Africa over the past year with regard to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing has led to a massive increase in the number of sequences, which, to date, exceeds 100,000 sequences generated to track the pandemic on the continent. These sequences have profoundly affected how public health officials in Africa have navigated the COVID-19 pandemic. RATIONALE We demonstrate how the first 100,000 SARS-CoV-2 sequences from Africa have helped monitor the epidemic on the continent, how genomic surveillance expanded over the course of the pandemic, and how we adapted our sequencing methods to deal with an evolving virus. Finally, we also examine how viral lineages have spread across the continent in a phylogeographic framework to gain insights into the underlying temporal and spatial transmission dynamics for several variants of concern (VOCs). RESULTS Our results indicate that the number of countries in Africa that can sequence the virus within their own borders is growing and that this is coupled with a shorter turnaround time from the time of sampling to sequence submission. Ongoing evolution necessitated the continual updating of primer sets, and, as a result, eight primer sets were designed in tandem with viral evolution and used to ensure effective sequencing of the virus. The pandemic unfolded through multiple waves of infection that were each driven by distinct genetic lineages, with B.1-like ancestral strains associated with the first pandemic wave of infections in 2020. Successive waves on the continent were fueled by different VOCs, with Alpha and Beta cocirculating in distinct spatial patterns during the second wave and Delta and Omicron affecting the whole continent during the third and fourth waves, respectively. Phylogeographic reconstruction points toward distinct differences in viral importation and exportation patterns associated with the Alpha, Beta, Delta, and Omicron variants and subvariants, when considering both Africa versus the rest of the world and viral dissemination within the continent. Our epidemiological and phylogenetic inferences therefore underscore the heterogeneous nature of the pandemic on the continent and highlight key insights and challenges, for instance, recognizing the limitations of low testing proportions. We also highlight the early warning capacity that genomic surveillance in Africa has had for the rest of the world with the detection of new lineages and variants, the most recent being the characterization of various Omicron subvariants. CONCLUSION Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve. This is important not only to help combat SARS-CoV-2 on the continent but also because it can be used as a platform to help address the many emerging and reemerging infectious disease threats in Africa. In particular, capacity building for local sequencing within countries or within the continent should be prioritized because this is generally associated with shorter turnaround times, providing the most benefit to local public health authorities tasked with pandemic response and mitigation and allowing for the fastest reaction to localized outbreaks. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century

Epidemiological profile and treatment outcomes of patients referred from rural areas to a regional hospital in Ndioum, Senegal

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Comment promouvoir l\u27utilisation des résultats d\u27une analyse situationnelle à l\u27échelle nationale: Expérience du Sénégal

Avec cette dissémination des résultats de l’Analyse Situationnelle (AS) de 1998 le Ministère de la Santé réalise la troisième activité de ce genre. Au sortir de la dissémination, plusieurs enseignements sont tirés: Une bonne préparation de l’activité est nécessaire et, dans ce sens, la place de l’atelier de planification et l’établissement concerté d’un calendrier des activités par les niveaux national et régional sont prépondérants. L’organisation pratique des ateliers de dissémination doit compter avec l’utilisation des professionnels de la santé des régions et des médias locaux. Cette initiative a permis de crédibiliser les résultats ce qui a favorisé leur appropriation par les autorités médicales. Les quelques limites qui peuvent entacher la dissémination régionale des résultats de l’AS de 1998 portent principalement sur la durée d’un jour-atelier, qui peut compromettre une bonne analyse des résultats et la formulation de recommandations pertinentes de la part des régionaux, et la petite taille des échantillons régionaux qui peut compromettre l’appréciation de la qualité des services. --- This dissemination of findings from the 1998 Situation Analysis (SA) on Reproductive Health Service Delivery Points constitutes the third such activity organized by the Senegal Ministry of Health. The report lists several lessons learned after this dissemination of findings: good planning is essential, especially the workshop location and the creation of a detailed activity calendar at the regional and national levels. The practical organization of the dissemination workshops should involve health professionals in the regions as well as the local media. This initiative improves the credibility of the SA results and facilitates their utilization by medical authorities. The few limitations of the 1998 SA results\u27 regional dissemination are related to the duration of the one-day workshop, which can compromise a good analysis of the findings as well as formulation of relevant recommendations by the regions. Also, the small size of the regional samples can weaken conclusions regarding the quality of services

Prise en charge des fistules entéro-cutanées post-opératoires au Service de Chirurgie Générale du CHU A Le Dantec.

Le but de notre étude était de rapporter notre expérience dans la prise en charge des fistules entéro-cutanées post-opératoires (FECPO). Il s’agissait d’une étude rétrospective qui s’est déroulée au CHU A Le Dantec sur 10 ans (2000- 2010). Les critères d’inclusion étaient les patients qui présentaient une FEC PO durant la période d’étude. Les paramètres étudiés étaient les suivants : le terrain, l’intervention initiale, les circonstances de découverte, le délai d’apparition et les caractéristiques de la FEC PO, l’évolution sous traitement médical, les indications et les résultats du traitement chirurgical. Ont été inclus dans l’étude 25 patients d’âge moyen de 30 ans. Il s’agissait de 17 hommes et de 8 femmes avec un sex-ratio de 2,1. Six patients (24%) avaient au minimum un antécédent de laparotomie. Sept cas de dénutrition (28%) ont été notés. L’intervention initiale concernait le grêle dans 40% des cas et le côlon dans 32% des cas ; elle avait été réalisée dans un contexte d’urgence chez 17 patients (68%). Des incidents et difficultés opératoires avaient été rapportés chez 7 patients (28%). Les circonstances de découverte de la fistule étaient à type d’écoulement anormal de liquide digestif à travers l’incision dans 72% des cas. Les fistules étaient semi-précoces dans 56% des cas ; elles étaient iléales dans 13 cas (52%), et de bas débit dans 19 cas (76%). Sous traitement médical, 15 patients (60%) avaient évolué vers une guérison spontanée. Un traitement chirurgical était indiqué chez 9 patients (36%) avec évolution favorable dans 66 % des cas. La mortalité globale était de 12% (n=3), par défaillance multi viscérale. Dans notre service, les FEC PO sont surtout des complications du sujet jeune, de type semiprécoce, de siège invariablement iléal et colique, à bas débit et à trajet latéral qui guérissent majoritairement sous traitement médical dans un délai moyen de 3 semaines. Le traitement chirurgical est surtout indiqué devant le sepsis intra abdominal qui explique la mortalité rapportée.Mots clés : Fistule entéro-cutanée, traitement, chirurgie

Community case management in malaria: review and perspectives after four years of operational experience in Saraya district, south-east Senegal.

BACKGROUND: Despite recent advances in malaria diagnosis and treatment, many isolated communities in rural settings continue to lack access to these life-saving tools. Community-case management of malaria (CCMm), consisting of lay health workers (LHWs) using malaria rapid diagnostic tests (RDTs) and artemisinin-based combination therapy (ACT) in their villages, can address this disparity. METHODS: This study examined routine reporting data from a CCMm programme between 2008 and 2011 in Saraya, a rural district in Senegal, and assessed its impact on timely access to rapid diagnostic tests and ACT. RESULTS: There was a seven-fold increase in the number of LHWs providing care and in the number of patients seen. LHW engagement in the CCM programme varied seasonally, 24,3% of all patients prescribed an ACT had a negative RDT or were never administered an RDT, and less than half of patients with absolute indications for referral (severe symptoms, age under two months and pregnancy) were referred. There were few stock-outs. DISCUSSION: This CCMm programme successfully increased the number of patients with access to RDT and ACT, but further investigation is required to identify the cause for over-prescription, and low rates of referrals for patients with absolute indications. In contrast, previous widespread stock-outs in Saraya's CCMm programme have now been resolved. CONCLUSION: This study demonstrates the potential for CCMm programmes to substantially increase access to life-saving malarial diagnostics and treatment, but also highlights important challenges in ensuring quality

Scale-up of home-based management of malaria based on rapid diagnostic tests and artemisinin-based combination therapy in a resource-poor country: results in Senegal

<p>Abstract</p> <p>Background</p> <p>Effective case management of malaria requires prompt diagnosis and treatment within 24 hours. Home-based management of malaria (HMM) improves access to treatment for populations with limited access to health facilities. In Senegal, an HMM pilot study in 2008 demonstrated the feasibility of integrated use of RDTs and ACT in remote villages by volunteer Home Care Providers (HCP). Scale-up of the strategy began in 2009, reaching 408 villages in 2009 and 861 villages in 2010. This paper reports the results of the scale-up in the targeted communities and the impact of the strategy on malaria in the formal health sector.</p> <p>Methods</p> <p>Data reported by the HCPs were used to assess their performance in 2009 and 2010, while routine malaria morbidity and mortality data were used to assess the impact of the HMM programme. Two high transmission regions where HMM was not implemented until 2010 were used as a comparison.</p> <p>Results and discussion</p> <p>From July 2009 through May 2010, 12582 suspected cases were managed by HCPs, 93% (11672) of whom were tested with an RDT. Among those tested, 37% (4270) had a positive RDT, 97% (4126) of whom were reported treated and cured. Home care providers referred 6871 patients to health posts for management: 6486 with a negative RDT, 119 infants < 2 months, 105 pregnant women, and 161 severe cases. There were no deaths among these patients. In 2009 compared to 2008, incidence of suspected and confirmed malaria cases, all hospitalizations and malaria-related hospitalizations decreased in both intervention and comparison regions. Incidence of in-hospital deaths due to malaria decreased by 62.5% (95% CI 43.8-81.2) in the intervention regions, while the decrease in comparison regions was smaller and not statistically significant.</p> <p>Conclusion</p> <p>Home-based management of malaria including diagnosis with RDT and treatment based on test results is a promising strategy to improve the access of remote populations to prompt and effective management of uncomplicated malaria and to decrease mortality due to malaria. When scaled-up to serve remote village communities in the regions of Senegal with the highest malaria prevalence, home care providers demonstrated excellent adherence to guidelines, potentially contributing to a decrease in hospital deaths attributed to malaria.</p