La mortalité maternelle en milieu rural au Sénégal

Nous avons mesuré la fréquence et les causes de décès maternels dans trois sites ruraux du Sénégal : Bandafassi, Niakhar et Mlomp. Leurs populations font l'objet d'une observation démographique suivie depuis de nombreuses années, en utilisant la même méthode, ce qui rend les résultats comparables. Les trois sites diffèrent selon la proportion de femmes accouchant en maternité - 99% à Mlomp, 15% à Niakhar et 3% à Bandafassi -, l'éloignement des hôpitaux pratiquant des césariennes et les facilités pour y évacuer les femmes ayant des difficultés à accoucher. La mortalité maternelle varie de 1 à 2 selon le site : elle est la plus faible à Mlomp (436 décès pour cent mille naissances vivantes), la plus élevée à Bandafassi (826) et intermédiaire à Niakhar (516). Ces variations sont fortement liées aux facilités d'évacuation en urgence des femmes ayant des difficultés à accoucher. En revanche, les conditions d'accouchement, notamment la proportion de ceux qui se déroulent en maternité, ne semblent pas jouer un rôle aussi important qu'on l'imagine. Enfin, l'OMS a estimé la mortalité maternelle pour l'ensemble du Sénégal à 1200 décès maternels pour 100 000 naissances vivantes en 1990. Notre étude montre qu'à la même période elle était nettement en dessous dans les trois sites, qui se trouvent pourtant en zone rurale. L'OMS a donc sans doute nettement surestimé la mortalité maternelle pour l'ensemble de ce pays. (Résumé d'auteur

High mortality from snakebite in south-eastern Senegal

Over 24 years, from 1976 to 1999, we conducted a prospective study of overall and cause-specific mortality among the population of 42 villages of south-eastern Senegal. Of 4228 deaths registered during this period, 26 were caused by snakebite, 4 by invertebrate stings and 8 by other wild or domestic animals. The average annual mortality rate from snakebite was 14 deaths per 100 000 population. Among persons aged ⩾ 1 year, 0·9% (26/2880) of deaths were caused by snakebite and this cause represented 28% (26/94) of total deaths by accidents. We also investigated the snake fauna of the area. Of 1280 snakes belonging to 34 species that were collected, one-third were dangerous and the proportion of Viperidae, Elapidae and Atractaspidae was 23%, 11% and 0·6%, respectively. The saw-scaled viper Echis ocellatus was the most abundant species (13·6%). Other venomous species were Causus maculatus (6·5%), Naja katiensis (5·5%), Bitis arietans (2·7%), Elapsoidea trapei (2·4%), Naja nigricollis (1·2%), Naja melanokuca (1·1%), Atractaspis aterrima (0·4%), Dendroaspis polylepis (0·3%) and Naja haje (0·1%)

Mortality due to external causes in three rural areas of Senegal

Mortality due to external causes was measured over the period 1985-2004 in three rural areas of Senegal-Bandafassi, Niakhar and Mlomp - whose populations have been under continuous demographic surveillance for many years. The standardized annual rate of deaths due to external causes is 31 deaths per 100,000 inhabitants in Niakhar, 56 in Bandafassi and 102 in Mlomp. The causes of injury-related deaths generally reflect the rural living environment, with relatively few deaths due to road accidents (1.9 deaths per 100,000 inhabitants in Niakhar, 3.0 in Bandafassi and 2.0 in Mlomp), but many deaths due to falls (8.6 deaths per 100,000 inhabitants in Niakhar, 15.1 in Bandafassi and 23.3 in Mlomp). For certain causes, mortality varies considerably. Snake bites, for example, cause 0.1 deaths per 100,000 inhabitants in Niakhar, 13.4 in Bandafassi and 3.0 in Mlomp. The differences between sites are linked in this case to the relative concentrations of wildlife, in turn linked to differences in the local environment and in population densities (144 inhabitants per sq.km in Niakhar versus 19 in Bandafassi and 114 in Mlomp). Although the study areas are still largely unaffected by causes of death associated with development, such as traffic accidents, mortality due to external causes is high