Le cadre juridique de la gouvernance : un système de droit syncrétique

L’analyse du cadre juridique met en lumière l’inspiration internationale des politiques de protection des aires marines et côtières protégées d’Afrique de l’Ouest. Cette inspiration internationale apparaît comme une originalité des espaces protégés dans les pays en développement et se manifeste tant par leur origine conceptuelle et politique, que par l’appui prodigué aux états pour leur mise en œuvre. Cette analyse permet également de définir juridiquement l’aire marine protégée comme un disp..

Les objectifs et les fonctions des aires marines protégées

Les aires protégées en général et les aires marines en particulier font l’objet de nombreuses études scientifiques, de colloques, de rencontres internationales, d’échanges de points de vues et de prises de positions politiques. Elles sont aujourd’hui disséminées sur toute la planète selon un processus engagé depuis déjà trois quarts de siècle. Présentées comme un instrument de politique publique nationale, elles sont conduites par les gouvernements de toute obédience et dans des pays quelque ..

Fractures de la mandibule en pratique odontologique : à propos de 103 cas

La fracture mandibulaire constitue un motif fréquent de consultation en Odontologie à Dakar. Elle peut être considérée comme une urgence médicale de par l’hémorragie, mais aussi par les troubles respiratoires qui peuvent en découler. Nous nous sommes fixés comme objectif d’étudier les aspects socio-démographiques, cliniques et thérapeutiques des fractures mandibulaires dans notre pratique. Matériel et méthode : Il s’agit d’une étude transversale et descriptive qui s’est déroulée de février 2003 à décembre 2006 et a concerné 103 patients ayant une fracture mandibulaire. Elle a eu pour cadre le service d’Odontologie de l’Hôpital général de Grand Yoff. Nous avons exploité le registre des patients et les fiches individuelles d’examen des patients Résultats : L’âge moyen était de 27,6 ans avec des extrêmes allant de 3 ans et 73 ans. Le sex-ratio était de 3,9. Les délais de consultation varient de 0 à 40 jours. Le plus souvent les fractures mandibulaires sont dues à des accidents de la voie publique (46 cas, 44,70 %) et dans 57 cas (55,30 %) la fracture siège dans la région symphysaire. Le traitement consiste à faire une prescription médicamenteuse avant tout acte, avec réduction suivie d’une contention orthopédique ou chirurgicale. (Med Buccale Chir Buccale 2009 ; 15 : 137-145)

Schistosomiasis control in Senegal: results from community data analysis for optimizing preventive chemotherapy intervention with praziquantel

Abstract Background Over the past two decades, preventive chemotherapy (PC) with praziquantel (PZQ) is the major strategy for controlling schistosomiasis in Senegal. The objective of this analysis was to update the endemicity of schistosomiasis at community level for better targeting mass treatment with PZQ in Senegal. Methods Demographic and epidemiological data from 1610 community health areas were analyzed using the schistosomiasis community data analysis tool of Expanded Special Project for Elimination of Neglected Tropical Diseases which developed by World Health Organization/Africa Office (WHO/AFRO). The tool uses a WHO/AFRO decision tree for areas without epidemiological data to determine whether mass treatment should be continued at community level. Descriptive analysis was performed. Results Overall, the endemicity of 1610 community health areas were updated based on the data from the district endemicity (33.5%) and the form of Join request for selected PC medicine (40.5%). Up to 282 (17.5%) and 398 (24.7%) of community health areas were classified as moderate and high endemicity. 41.1% of communities were non endemic. High endemicity was more important in Tambacounda, Saint Louis, Matam, Louga and Kedougou. A change in endemicity category was observed when data was disagregted from district level to community level. Implementation units classified non endemic were more important at community level (n = 666) compared to district level (n = 324). Among 540 areas previously classified high endemic at district level, 392 (72.6%) remained high prevalence category, while 92 (17.0%) became moderate, 43 (8.0%) low and 13 (2.4%) non-endemics at community level. Number of implementation units requiring PC was more important at district level (1286) compared to community level (944). Number of school aged children requiring treatment was also more important at district level compared to community level. Conclusions The analysis to disaggregate data from district level to community level using the WHO/AFRO schistosomiasis sub-district data optimization tool provide an update of schistosomiasis endemicity at community level. This study has allowed to better target schistosomiasis interventions, optimize use of available PZQ and exposed data gaps

Bland-Altman analysis.

<p>Bland-Altman plots of <b>(A)</b> CD4 T-cells < 200/mm³, <b>(B)</b> between 200 and 350/mm³, <b>(C)</b> between 350 and 500/mm³, and <b>(D)</b> above 500/mm³ according the CD4 cell count levels. For each plot, the x-axis represents the average of CD4 count between the PIMA and the BD FACSCount^TM, and the y-axis represents the bias (difference) between the PIMA^TM Alere and the BD FACSCount^TM. The solid red line represents the mean of the difference between the two measurements, and the light black lines represent the upper and lower limits of agreement (ULA: mean differences plus and 1,96 x standard deviation of the mean difference; LLA: mean differences minus and 1,96 x standard deviation of the mean difference)</p

Passing-Bablok regression between PIMA^TM Alere CD4 and BD FACSCount^TM.

<p>The x-axis represents CD4 counts provided by the BD FACSCount^TM reference and the y-axis represents the CD4 counts provided by the PIMA^TM CD4. The solid line represents the regression line, and the dashed line represents the line y = x. The linear equation of the regression is y = 0.9347 x + 11.</p

Bland-Altman plot of the whole data.

<p>The x-axis represents the average of CD4 count between the PIMA and the BD FACSCount^TM, and the y-axis represents the bias (difference) between the PIMA^TM Alere and the BD FACSCount^TM. The solid blue line represents the mean of the difference between the two measurements, and the light black lines represent the upper and lower limits of agreement (ULA: mean differences plus and 1,96 x standard deviation of the mean difference; LLA: mean differences minus and 1,96 x standard deviation of the mean difference). Legend for CD4 categories: 1: CD4 T-cells < 200/mm³; 2: CD4 T-cells between 200 and 350/mm³; 3: CD4 T-cells between 351 and 500/mm³; 4: CD4 T-cells above 500/mm³.</p

Analysis of the median CD4 counts between the PIMA and the FACSCount.

<p>Categories of absolute CD4+ T-cells counts (< 200/mm³, [200-350/mm³], [351-500/mm³], and > 500/mm³, in before-after scatter plots comparing the PIMA^TM Alere and the BD FACSCount^TM are shown. Data are shown as median values. P-values were calculated in SPSS 20 using nonparametric Mann-Whitney U test and the graphing was performed using GraphPad Prism software version 5.00.</p

Evaluation of PIMA^TM CD4 System for Decentralization of Immunological Monitoring of HIV-Infected Patients in Senegal

<div><p>Background</p><p>HIV infection is a concern in the army troupes because of the risk behaviour of the military population. In order to allow regular access to CD4⁺ T cell enumeration of military personnel as well as their dependents and civilians living with HIV, the Senegalese Army AIDS program is implementing PIMA^TM Alere technology in urban and semi-urban military medical centres. Validation such device is therefore required prior their wide implementation. The purpose of this study was to compare CD4⁺ T cell count measurements between the PIMA^TM Alere to the BD FACSCount^TM.</p><p>Methodology</p><p>We selected a total of 200 subjects including 50 patients with CD4⁺ T-cells below 200/mm³, 50 between 200 and 350/mm³, 50 between 351 and 500/mm³, and 50 above 500/mm³. CD4⁺ T-cell count was performed on venous blood using the BD FASCount^TM as reference method and the PIMA^TM Point of Care technology. The mean biases and limits of agreement between the PIMA^TM Alere and BD FACSCount^TM were assessed with the Bland-Altman analysis, the linear regression performed using the Passing-Bablok regression analysis, and the percent similarity calculated using the Scott method.</p><p>Results</p><p>Our data have shown a mean difference of 22.3 cells/mm³ [95%CI:9.1–35.5] between the BD FACSCount^TM and PIMA^TM Alere CD4 measurements. However, the mean differences of the two methods was not significantly different to zero when CD4⁺ T-cell count was below 350/mm³ (P = 0.76). The Passing-Bablok regression in categorized CD4 counts has also showed concordance correlation coefficient of 0.89 for CD4⁺ T cell counts below 350/mm³ whilst it was 0.5 when CD4 was above 350/mm³.</p><p>Conclusion</p><p>Overall, our data have shown that for low CD4 counts, the results from the PIMA^TM Alere provided accurate CD4⁺ T cell counts with a good agreement compared to the FACSCount^TM.</p></div

Comparison of the mean difference between the CD4 PIMA^TM Alere and BD FACSCount^TM CD4 measurements.

<p>Comparison of the mean difference between the CD4 PIMA^TM Alere and BD FACSCount^TM CD4 measurements.</p