Détournement des logiques d'état par les élites masculines et problématique foncière en milieu rural Sénégalais

Le foncier au Sénégal, plus qu'une ressource physique, offre le lieu de lecture et d'analyse des rapports et interrelations entre les acteurs, surtout en zone rurale. Longtemps sous le monopole d'une certaine élite, l'accès et la gestion de ce patrimoine a été démocratisé par l'État post indépendance et bien avant. Si cette démocratisation a favorisé l'émergence de nouveaux propriétaires fonciers, elle sera remise en cause par une élite prête à reprendre ses droits sur ce qu'elle considère comme son patrimoine inaliénable. Ce retour en force des élites dans la gestion du foncier va connaître un nouvel élan avec l'apparition d'une gestion élitiste qui a favorisé l'accaparement du foncier au détriment des populations rurales surtout des femmes. C'est autour de ces réalités qui caractérisent la gestion et le contrôle du foncier au Sénégal que cette contribution va analyser, en partant des données d'une recherche menée par le Groupe d'études et de recherches genre et sociétés (GESTES) sur « Droits des femmes et accès au foncier : une citoyenneté à conquérir », financée par le Centre de recherches pour le développement international (CRDI

Insulin resistance and arterial stiffness: impact of gestational diabetes on pulse wave velocity

Background: Gestational diabetes is an intolerance of glucose with the first appearance during the pregnancy. This hyperglycaemia status, because of the pre-existing insulin-resistance, constitute a favourable land of arterial stiffness. The aim of this study is to determine the impact of non obese gestational diabetes on arterial stiffness by measuring the pulse wave velocity (PWV).Methods: We recruited 60 pregnant women aged from 20 to 35 years old. They were between twentieth four and thirtieth five weeks of gestational age. Subjects were divided into two groups: the first group (G1), considered as control group, included 25 normoglycemic pregnant subjects without any history of illness or risk factors of gestational diabetes; the second group (G2) included 35 women with Gestational Diabetes Mellitus (GDM). All pregnant women had not history of smoking, were not taking decoction or medicine, which could disturb pregnancy evolution. Anthropo-physiological and biochemical parameters studied, were: age, body mass index (BMI), blood pressure (BP), triglyceride, cholesterol and HOMA-IR index. The PWV between finger and toe (PWVft) was measured by pOpmètre®.Results: The two groups are matched by age (G1:28±4ans; G2:29±3ans) and BMI (G1:25.6±1.27; G2:26.9±1.3). Blood pressure (BP) values are in normal interval (systolic BP: [110-132mmHg]; diastolic BP: [63-87mmHg]; mean BP: [79-103mmHg]). Total cholesterol (G1:0.95±0.08;G2:2.4±0.7; p˂0.0001), HDL cholesterol (G1:0.44±0.02; G2:0.76±0.2; p˂0.0001, LDL cholesterol (G1:0.40±0.05; G2:1.3±0.5; p˂0.0001), triglyceride (G1:0.57±0.45; G2:1.6±0.4;p˂0.0001), HOMA.IR (G1:1.31±1.05; G2:7.4±1.07; p˂0.01), PWVft (G1:5.99±1.23; G2:10.3±1.9; p˂0.0001) are significantly higher in diabetic group. PWVft is positively correlate to HOMA-IR index, total cholesterol, LDL cholesterol and triglycerides (r=0.3348, p=0.032; r=0.5275, p˂0.0001; r=0.4855,p˂0.0001; r=0.5581, p˂0.0001respectively).Conclusions: Gestational diabetes might induce an increase of pulse wave velocity expressing increment of arterial stiffness. This last constitute an early underlying cardiovascular risk.

Gestational diabetes and endothelial function: impact of gestational insulin resistance on reactive hyperhemia index

Our aim was to characterize endothelial function in gestational diabetes by evaluating the reactive hyperemia index (RHI, LnRHI). A prospective, descriptive and comparative study was conducted on a population of pregnant women aged over 20 and under 36, located in the gestational age group 24-38th week of amenorrhea. They were divided into two groups. Group 1 (G1): group of pregnancies without diabetes, consists of pregnant women with no risk factor for gestational diabetes and with normal fasting blood glucose. Group 2 (G2): group of pregnancies with diabetes, includes pregnancies whose oral glucose tolerance tests (OGTT) came back positive. Anthropo-physiological parameters (age, weight, height, blood pressure (PA) and biochemical parameters (glycemia, insulinemia, HOMA-IR, cholesterol, triglycerides) were measured. RHI and LnRHI were determined at Endopat 2000. The two groups were matched for age, weight, heart rate (HR) and blood pressure (BP). Levels of glucose (G1:0.76±0.11; G2:1.11±0.11; p˂0.0001), insulin (G1:7.67±4.35; G2:22.9±3.75; p˂0.0001), HOMA-IR (G1:1.51±0.97; G2:6.29±1.23; p˂0.0001), total cholesterol (G1:1±0.81; G2:2.49±0.74; p=0.002), HDL cholesterol (G1:0.45±0.23; G2: 0.8±0.19; p=0.004, LDL cholesterol (G1:0.42±0.54; G2:1.39±0.6; p=0.004), triglycerides (G1:0.65±0.49; G2:1.48±0.27; p=0.0018), were significantly higher in the diabetic group. Both RHI and LnRHI were negatively correlated with HOMA-IR (respectively, r=-0.8931, p<0.0001; r=-0.8938; p<0.0001). HOMA-IR index was independently associated with levels of RHI and LnRHI (respectively r²=0.797; p<0.0001); (r²=0.804; p<0.0001)). Thus, gestational insulin resistance would be associated with a change in endothelial function such as a decrease in endothelium-dependent vasodilatation reflecting endothelial dysfunction, hence an increase in cardiovascular risk

Effects of lenten fasting on body composition and biochemical parameters

Background: The catholic lenten fasting is the period of 40 days of fasting that precedes Easter. It is one of religious fasting less documented in the scientific literature. Thus the aim of our study was to evaluate the evolution of anthropometric and body composition and biochemical profile during Catholic lenten fasting.Methods: We conducted a prospective study, which took place during the period between one week before at the end of lenten fasting. Eleven fasters (4 women and 7 men), aged between 18 and 59 years were included in present study. Anthropometric, body composition parameters and biochemical profile were evaluated one week before, at 15th day and at the end of Lenten fasting.Results: Weight, body mass index (BMI) and visceral fat decreased significantly at the end of Lenten fasting. Lipid profile changed significantly during this fasting period. Total cholesterol (TC), low density lipoprotein – cholesterol (LDL-C) and triglycerides decreased significantly with fasting. High density lipoprotein – cholesterol (HDL-C) was remained unchanged during this fasting period while TC/HDL ratio was significantly decreased at the end of Lent.Conclusions: Present study showed that the fasting of Lent seems to have beneficial effects on reducing cardiovascular risk factors. Further studies are required to better understand the physiological mechanisms involved for a therapeutic use

Human IgG response to a salivary peptide, gSG6-P1, as a new immuno-epidemiological tool for evaluating low-level exposure to Anopheles bites

<p>Abstract</p> <p>Background</p> <p>Human populations exposed to low malaria transmission present particular severe risks of malaria morbidity and mortality. In addition, in a context of low-level exposure to <it>Anopheles </it>vector, conventional entomological methods used for sampling <it>Anopheles </it>populations are insufficiently sensitive and probably under-estimate the real risk of malaria transmission. The evaluation of antibody (Ab) responses to arthropod salivary proteins constitutes a novel tool for estimating exposure level to insect bites. In the case of malaria, a recent study has shown that human IgG responses to the gSG6-P1 peptide represented a specific biomarker of exposure to <it>Anopheles gambiae </it>bites. The objective of this study was to investigate if this biomarker can be used to estimate low-level exposure of individuals to <it>Anopheles </it>vector.</p> <p>Methods</p> <p>The IgG Ab level to gSG6-P1 was evaluated at the peak and at the end of the <it>An. gambiae </it>exposure season in children living in Senegalese villages, where the <it>Anophele</it>s density was estimated to be very low by classical entomological trapping but where malaria transmission occurred during the studied season.</p> <p>Results</p> <p>Specific IgG responses to gSG6-P1 were observed in children exposed to very low-level of <it>Anopheles </it>bites. In addition, a significant increase in the specific IgG Ab level was observed during the <it>Anopheles </it>exposure season whereas classical entomological data have reported very few or no <it>Anopheles </it>during the studied period. Furthermore, this biomarker may also be applicable to evaluate the heterogeneity of individual exposure.</p> <p>Conclusion</p> <p>The results strengthen the hypothesis that the evaluation of IgG responses to gSG6-P1 during the season of exposure could reflect the real human contact with anthropophilic <it>Anopheles </it>and suggest that this biomarker of low exposure could be used at the individual level. This promising immuno-epidemiological marker could represent a useful tool to assess the risk to very low exposure to malaria vectors as observed in seasonal, urban, altitude or travellers contexts. In addition, this biomarker could be used for the surveillance survey after applying anti-vector strategy.</p

Senegal: Explorer le processus de la collaboration multisectorielle mise en place pour l’étude qualitative

En 2015, STEP UP a mené une étude qualitative sur l’expérience de femmes ayant subi une grossesse non désirée suite à un viol ou inceste dans la région de Dakar, Sénégal, en partenariat avec le Comité de plaidoyer pour l’accès à l’avortement médicalisé, plus connu sous le nom de «Taskforce». L’objectif général de l’étude était de développer une meilleure compréhension de la vie de ces femmes et d’apporter leur voix au débat sur la légalisation de l’avortement médicalisé. Cette étude de cas examine les caractéristiques de la collaboration, comment elle a été efficace, les leçons apprises, et les recommandations formulées pour de telles futures collaborations. --- In 2015, STEP UP conducted a qualitative study on the experience of women who have undergone an unwanted pregnancy following rape or incest in the region of Dakar, Senegal, in partnership with the Advocacy Committee for Access to Medical Abortion, better known as “Taskforce.” The overall objective of the study was to develop a better understanding of the lives of these women and to add their voice to the debate over the legalization of safe abortion. This case study examines the characteristics of the collaboration, how effective it has been, lessons learned, and recommendations for future such collaborations

Antimalarial drug use in general populations of tropical Africa

<p>Abstract</p> <p>Background</p> <p>The burden of <it>Plasmodium falciparum </it>malaria has worsened because of the emergence of chloroquine resistance. Antimalarial drug use and drug pressure are critical factors contributing to the selection and spread of resistance. The present study explores the geographical, socio-economic and behavioural factors associated with the use of antimalarial drugs in Africa.</p> <p>Methods</p> <p>The presence of chloroquine (CQ), pyrimethamine (PYR) and other antimalarial drugs has been evaluated by immuno-capture and high-performance liquid chromatography in the urine samples of 3,052 children (2–9 y), randomly drawn in 2003 from the general populations at 30 sites in Senegal (10), Burkina-Faso (10) and Cameroon (10). Questionnaires have been administered to the parents of sampled children and to a random sample of households in each site. The presence of CQ in urine was analysed as dependent variable according to individual and site characteristics using a random – effect logistic regression model to take into account the interdependency of observations made within the same site.</p> <p>Results</p> <p>According to the sites, the prevalence rates of CQ and PYR ranged from 9% to 91% and from 0% to 21%, respectively. In multivariate analysis, the presence of CQ in urine was significantly associated with a history of fever during the three days preceding urine sampling (OR = 1.22, p = 0.043), socio-economic level of the population of the sites (OR = 2.74, p = 0.029), age (2–5 y = reference level; 6–9 y OR = 0.76, p = 0.002), prevalence of anti-circumsporozoite protein (CSP) antibodies (low prevalence: reference level; intermediate level OR = 2.47, p = 0.023), proportion of inhabitants who lived in another site one year before (OR = 2.53, p = 0.003), and duration to reach the nearest tarmacked road (duration less than one hour = reference level, duration equal to or more than one hour OR = 0.49, p = 0.019).</p> <p>Conclusion</p> <p>Antimalarial drug pressure varied considerably from one site to another. It was significantly higher in areas with intermediate malaria transmission level and in the most accessible sites. Thus, <it>P. falciparum </it>strains arriving in cross-road sites or in areas with intermediate malaria transmission are exposed to higher drug pressure, which could favour the selection and the spread of drug resistance.</p

Effectiveness of Seasonal Malaria Chemoprevention in Children under Ten Years of Age in Senegal: A Stepped-Wedge Cluster-Randomised Trial.

BACKGROUND: Seasonal Malaria Chemoprevention (SMC) with sulfadoxine-pyrimethamine (SP) plus amodiaquine (AQ), given each month during the transmission season, is recommended for children living in areas of the Sahel where malaria transmission is highly seasonal. The recommendation for SMC is currently limited to children under five years of age, but, in many areas of seasonal transmission, the burden in older children may justify extending this age limit. This study was done to determine the effectiveness of SMC in Senegalese children up to ten years of age. METHODS AND FINDINGS: SMC was introduced into three districts over three years in central Senegal using a stepped-wedge cluster-randomised design. A census of the population was undertaken and a surveillance system was established to record all deaths and to record all cases of malaria seen at health facilities. A pharmacovigilance system was put in place to detect adverse drug reactions. Fifty-four health posts were randomised. Nine started implementation of SMC in 2008, 18 in 2009, and a further 18 in 2010, with 9 remaining as controls. In the first year of implementation, SMC was delivered to children aged 3-59 months; the age range was then extended for the latter two years of the study to include children up to 10 years of age. Cluster sample surveys at the end of each transmission season were done to measure coverage of SMC and the prevalence of parasitaemia and anaemia, to monitor molecular markers of drug resistance, and to measure insecticide-treated net (ITN) use. Entomological monitoring and assessment of costs of delivery in each health post and of community attitudes to SMC were also undertaken. About 780,000 treatments were administered over three years. Coverage exceeded 80% each month. Mortality, the primary endpoint, was similar in SMC and control areas (4.6 and 4.5 per 1000 respectively in children under 5 years and 1.3 and 1.2 per 1000 in children 5-9 years of age; the overall mortality rate ratio [SMC: no SMC] was 0.90, 95% CI 0.68-1.2, p = 0.496). A reduction of 60% (95% CI 54%-64%, p < 0.001) in the incidence of malaria cases confirmed by a rapid diagnostic test (RDT) and a reduction of 69% (95% CI 65%-72%, p < 0.001) in the number of treatments for malaria (confirmed and unconfirmed) was observed in children. In areas where SMC was implemented, incidence of confirmed malaria in adults and in children too old to receive SMC was reduced by 26% (95% CI 18%-33%, p < 0.001) and the total number of treatments for malaria (confirmed and unconfirmed) in these older age groups was reduced by 29% (95% CI 21%-35%, p < 0.001). One hundred and twenty-three children were admitted to hospital with a diagnosis of severe malaria, with 64 in control areas and 59 in SMC areas, showing a reduction in the incidence rate of severe disease of 45% (95% CI 5%-68%, p = 0.031). Estimates of the reduction in the prevalence of parasitaemia at the end of the transmission season in SMC areas were 68% (95% CI 35%-85%) p = 0.002 in 2008, 84% (95% CI 58%-94%, p < 0.001) in 2009, and 30% (95% CI -130%-79%, p = 0.56) in 2010. SMC was well tolerated with no serious adverse reactions attributable to SMC drugs. Vomiting was the most commonly reported mild adverse event but was reported in less than 1% of treatments. The average cost of delivery was US$0.50 per child per month, but varied widely depending on the size of the health post. Limitations included the low rate of mortality, which limited our ability to detect an effect on this endpoint. CONCLUSIONS: SMC substantially reduced the incidence of outpatient cases of malaria and of severe malaria in children, but no difference in all-cause mortality was observed. Introduction of SMC was associated with an overall reduction in malaria incidence in untreated age groups. In many areas of Africa with seasonal malaria, there is a substantial burden in older children that could be prevented by SMC. SMC in older children is well tolerated and effective and can contribute to reducing malaria transmission. TRIAL REGISTRATION: ClinicalTrials.gov NCT00712374

Politiques commerciales, intégration régionale et distribution de revenus au Sénégal

Numéro de projet relié au soutien financier du CRDI n'a pu être détermin