What the percentage of births in facilities does not measure: readiness for emergency obstetric care and referral in Senegal.

Introduction: Increases in facility deliveries in sub-Saharan Africa have not yielded expected declines in maternal mortality, raising concerns about the quality of care provided in facilities. The readiness of facilities at different health system levels to provide both emergency obstetric and newborn care (EmONC) as well as referral is unknown. We describe this combined readiness by facility level and region in Senegal. Methods: For this cross-sectional study, we used data from nine Demographic and Health Surveys between 1992 and 2017 in Senegal to describe trends in location of births over time. We used data from the 2017 Service Provision Assessment to describe EmONC and emergency referral readiness across facility levels in the public system, where 94% of facility births occur. A national global positioning system facility census was used to map access from lower-level facilities to the nearest facility performing caesareans. Results: Births in facilities increased from 47% in 1992 to 80% in 2016, driven by births in lower-level health posts, where half of facility births now occur. Caesarean rates in rural areas more than doubled but only to 3.7%, indicating minor improvements in EmONC access. Only 9% of health posts had full readiness for basic EmONC, and 62% had adequate referral readiness (vehicle on-site or telephone and vehicle access elsewhere). Although public facilities accounted for three-quarters of all births in 2016, only 16% of such births occurred in facilities able to provide adequate combined readiness for EmONC and referral. Conclusions: Our findings imply that many lower-level public facilities-the most common place of birth in Senegal-are unable to treat or refer women with obstetric complications, especially in rural areas. In light of rising lower-level facility births in Senegal and elsewhere, improvements in EmONC and referral readiness are urgently needed to accelerate reductions in maternal and perinatal mortality

Risk factors for infection with equine influenza virus in donkeys (Equus asinus) in Senegal

In recent years, outbreaks of equine influenza are reported in several countries in the world particulary in Africa. This study is designed to assess the potential risk factors associated with equine influenza virus infection in donkeys in Senegal. The study consists in comparing, depending on the exposure to risk factors, a batch of donkeys infected with the equine influenza virus to another batch of donkeys not infected with the virus during the epizootic of March 2019 which affected the department of Foundiougne. The study reveals that the spread of the equine influenza virus in Foundiougne is associated with the lack of access to veterinary care and infected donkeys were exposed in a ratio of 2 times (95% CI: 1.38; 4.71) more than donkeys unharmed. The wandering of donkeys is also linked with the disease. The indicator reflecting the strength of the relationship, the Odds Ratio is 2.06 (95% CI: 1.10; 3.87). However, the results indicate that attendance at rural markets (Odds Ratio = 0.90; 95% CI: 0.44; 1.82), young age (Odds Ratio = 0.90; 95% CI: 0.52, 1.55) and female sex (Odds Ratio = 0.97; 95% CI: 0.57; 1, 66) do not appear to be related to the spread of the disease. At present, in Senegal, control focused on sensitizing and informing donkey owners on the sanitary management and rational use of donkeys is essential for their well-being

Surveillance of Viral Encephalitis in the Context of COVID-19: A One-Year Observational Study among Hospitalized Patients in Dakar, Senegal

The burden of encephalitis and its associated viral etiology is poorly described in Africa. Moreover, neurological manifestations of COVID-19 are increasingly reported in many countries, but less so in Africa. Our prospective study aimed to characterize the main viral etiologies of patients hospitalized for encephalitis in two hospitals in Dakar. From January to December 2021, all adult patients that met the inclusion criteria for clinical infectious encephalitis were enrolled. Cerebrospinal fluids, blood, and nasopharyngeal swabs were taken and tested for 27 viruses. During the study period, 122 patients were enrolled. Viral etiology was confirmed or probable in 27 patients (22.1%), with SARS-CoV-2 (n = 8), HSV-1 (n = 7), HHV-7 (n = 5), and EBV (n = 4) being the most detected viruses. Age groups 40–49 was more likely to be positive for at least one virus with an odds ratio of 7.7. The mortality was high among infected patients, with 11 (41%) deaths notified during hospitalization. Interestingly, SARS-CoV-2 was the most prevalent virus in hospitalized patients presenting with encephalitis. Our results reveal the crucial need to establish a country-wide surveillance of encephalitis in Senegal to estimate the burden of this disease in our population and implement strategies to improve care and reduce mortality