Risk Factors for Dementia in a Senegalese Elderly Population Aged 65 Years and Over

Background: With the aging of the population, dementia is increasing worldwide. The objective of this study was to identify risk factors for dementia in an elderly population utilizing a primary health care service in Dakar, Senegal. Methods: Through a cross-sectional study conducted from March 2004 to December 31, 2005, 507 elderly patients aged ≥65 years who came to the Social and Medical Center of IPRES, Dakar, Senegal, were first screened with the screening interview questionnaire ‘Aging in Senegal’. Those who were cognitively impaired underwent a clinical examination to detect dementia. Univariate, bivariate, and multivariate logistic regression analyses were done. Results: The whole population had a mean age of 72.4 years (±5.2) and was mostly male, married, and non-educated. Hypertension, arthritis, and gastrointestinal diseases were the main health conditions reported in the past medical history. Smoking was important while alcohol consumption was rare. Social network was high. Forty-five patients (8.87%) had dementia. In the multivariate model, only advanced age, education, epilepsy, and family history of dementia were independently associated with dementia. Conclusion: The risk factors identified are also found in developed countries confirming their role in dementia. It is important to take dementia into consideration in Senegal and to sensitize the community for prevention

Oral microbial pathogens isolates in newly diagnosed HIV positive patients. A baseline survey of the sociale institute of health and hygiene of Dakar

ABSTRACT The subjects were evaluated in correlation of the CD4 count, viral load and types of oral microbes isolated and the fungal infections in newly diagnosed patients with HIV infection prior to commencement of the highly active anti-retroviral therapy (HAART). Fifty -seven newly diagnosed HIV positive patients were included in this on going study. The CD4 count, viral load were obtained. Oral examination was carried out and Buccal swabs was taken for Microscopy, Culture and Sensitivity. Males were 14(24.6%) and 43(75.4%) were females. About 39% of the patients are within 30-39 years.The pattern of microbial pathogens isolated were: Pseudomonas spp 16.5% , Klebsiella spp. 15.3% , Proteus spp. 12.9% Staphylococcus aureus in 12.9% Escherichia coli 9.40%, Candida albican 7.1%, Streptococcus faecalis 2.4%, Non Haemolytic streptococcus 2.4% and Staphylococcus albus 21.2%. Concomitant tuberculosis infection was found in 3 patients .An inverse correlation was noted between the CD4 count and the viral load, which was statistically significant. The frequency of the oral lesions and the microbial isolates increased with high viral load. Seventy percent of the newly diagnosed HIV patients had CD4 counts less than 500 mm 3. The reduction of the oral microbial load may decrease the incidence of opportunistic infection. Unmet oral health needs of people living with HIV/AIDS have been consistently documented and finding new strategies for meeting these needs is urgent

Investigation of Factors Affecting Medication Adherence Among People Living with HIV/AIDS under Non - Governmental Organizations in Senegal

Abstract A ims:This prospective cross-sectional study was carried out to determine factors such as clinical and demographic variab les that may affect medication adherence among people living with HIV/AIDS (PLWHA) receiving treatment at the Institute of health and hygiene of Dakar, but are affiliated to Non-Govern mental Organizations which are HIV/AIDS support group based in Dakar..All consenting subjects from these two support groups were enrolled into study but 305 PLWHA volunteered to participate throughout the three months period of the study. Methods: The study was conducted with the aid of structured interview assisted questionnaires to obtain informat ion on demographic characteristics such as age, sex, occupation, marital status, educational backgrounds, and source of support. Information on availability and side effects of antiretroviral drugs were also obtained. Results:This study indicated that majority of people liv ing with HIV/AIDS interviewed were females (80.3%) while (19.7%) were males. Male respondents show better adherence (91.7%) to ARV med ications than female counterparts (83.7%). Subjects in age the age groups 24-35 years wh ich is the most sexually active groups are mo re vulnerab le (59.1%) when co mpared to other age groups. A large nu mber, (67.2%) were married and there was a significant difference between marital status of PHWHA (P<0.05) and level of adherence to antiretroviral med ications. Descriptive and Chi-square statistical tests were used respectively to evaluate the distribution of respondent's opinion and investigate the level of association between the variables being consideredand respondent'sadherence to antiretroviral med ications. Conclusion: We conclude that there is need to carry out further study in order to fully exp lore the extent to which marital status and other factors can affect medication adherence of people living with HIV/AIDS

Epidemiology of neurodegenerative diseases in sub-Saharan Africa: a systematic review

BACKGROUND:Sub-Saharan African (SSA) countries are experiencing rapid transitions with increased life expectancy. As a result the burden of age-related conditions such as neurodegenerative diseases might be increasing. We conducted a systematic review of published studies on common neurodegenerative diseases, and HIV-related neurocognitive impairment in SSA, in order to identify research gaps and inform prevention and control solutions. METHODS: We searched MEDLINE via PubMed, 'Banque de Donnees de Sante Publique' and the database of the 'Institut d'Epidemiologie Neurologique et de Neurologie Tropicale' from inception to February 2013 for published original studies from SSA on neurodegenerative diseases and HIV-related neurocognitive impairment. Screening and data extraction were conducted by two investigators. Bibliographies and citations of eligible studies were investigated. RESULTS: In all 144 publications reporting on dementia (n=49 publications, mainly Alzheimer disease), Parkinsonism (PD, n=20), HIV-related neurocognitive impairment (n=47), Huntington disease (HD, n=19), amyotrophic lateral sclerosis (ALS, n=15), cerebellar degeneration (n=4) and Lewy body dementia (n=1). Of these studies, largely based on prevalent cases from retrospective data on urban populations, half originated from Nigeria and South Africa. The prevalence of dementia (Alzheimer disease) varied between <1% and 10.1% (0.7% and 5.6%) in population-based studies and from <1% to 47.8% in hospital-based studies. Incidence of dementia (Alzheimer disease) ranged from 8.7 to 21.8/1000/year (9.5 to 11.1), and major risk factors were advanced age and female sex. HIV-related neurocognitive impairment's prevalence (all from hospital-based studies) ranged from <1% to 80%. Population-based prevalence of PD and ALS varied from 10 to 235/100,000, and from 5 to 15/100,000 respectively while that for Huntington disease was 3.5/100,000. Equivalent figures for hospital based studies were the following: PD (0.41 to 7.2%), ALS (0.2 to 8.0/1000), and HD (0.2/100,000 to 46.0/100,000). CONCLUSIONS: The body of literature on neurodegenerative disorders in SSA is large with regard to dementia and HIV-related neurocognitive disorders but limited for other neurodegenerative disorders. Shortcomings include few population-based studies, heterogeneous diagnostic criteria and uneven representation of countries on the continent. There are important knowledge gaps that need urgent action, in order to prepare the sub-continent for the anticipated local surge in neurodegenerative diseases

Determinants of medication adherence among people living with HIV/AIDS in Senegal

This prospective cross-sectional study was carried out to determine factors such as clinical and demographic variables that may affect medication adherence among people living with HIV/AIDS (PLWHA) receiving treatment at the Institute of health and hygiene of Dakar, but HIV/AIDS group based in Dakar are affiliated to Non-Governmental Organizations which are all consenting. Groups were enrolled into study but 305 PLWHA volunteered to participate throughout the three months period of the study. The study was conducted with the aid of structured interview assisted questionnaires to obtain information on demographic characteristics such as age, sex, occupation, marital status, educational backgrounds, and source of support. Information on availability and side effects of antiretroviral drugs were also obtained. This study indicated that majority of people living with HIV/AIDS interviewed were females (80.3%) while (19.7%) were males. Male respondents show better adherence (91.7%) to ARV medications than female counterparts (83.7%). Subjects in age the age groups 24-35 years which is the most sexually active groups are more vulnerable (59.1%) when compared to other age groups. A large number, (67.2%) were married and there was a significant difference between marital status of PHWHA (P&lt;0.05) and level of adherence to antiretroviral medications. Descriptive and Chi-square statistical tests were used respectively to evaluate the distribution of respondent&apos;s opinion and investigate the level of association between the variables being considered and respondent&apos;s adherence to antiretroviral medications. We conclude that there is need to carry out further study in order to fully explore the extent to which marital status and other factors can affect medication adherence of people living with HIV/AIDS

Atypie semiologique du sujet age : Une alteration de l'etat general d’origine tuberculeuse pulmonaire occasionnant une errance diagnostique et therapeutique

La tuberculose est fréquente chez le sujet âgé (SA) du fait de la baisse de l’immunité. La tuberculose surtout pulmonaire présente une atypie sémiologique d’emprunt cardiaque ou pulmonaire sur terrain  polypathologique en gériatrie. La persistance des symptômes malgré les traitements doit faire réviser les diagnostics. L’évolution est favorable en cas de traitement précoce pour éviter le risque de cachexie, de  grabatisation et de décès. Le théléthorax systématique associé à la bacilloscopie des crachats orientent le diagnostic. La thérapeutique est superposable à celle des sujets adultes en dehors d’une adaptation en fonction de la clairance rénale, hépatique, des pathologies et leurtraitement. Nous rapportons un cas de tuberculose pulmonaire chez une patiente de 85 ans évoluant depuis plus de deux ans justifiant la réalisation systématique du théléthorax pour orienter l’atypie sémiologique en gériatrie.Mots clés : Tuberculose pulmonaire, téléthorax, bacilloscopie, sujet âgé, Togo.  Semiologic atypia in elderly: general state alteration by pulmonary tuberculosis causing diagnostic and therapeutic difficultTuberculosis is common in dysimmune patients. In elderly patients, many factors depress immunity. Tuberculosis, especially pulmonary, presents a semiological atypia with signs of other diseases, especially cardiac and pulmonary in polypathological patients. The symptoms persistence despite different treatments should help to revise  diagnosis. Unfavourable events  occur without treatment such as cachexia, getting bedridden and finally death. Systematic Chest X-Ray associated to sputum microscopy must help to diagnosis. The treatment is generally same than for young patients, although adaptation to renal and hepatic function are necessary. Evolution is favourable if early treatment. We report a 85 years old case of pulmonary tuberculosis. This observation justifies the systematic chest radiography to diagnose tuberculosis in elderly.Keywords: Pulmonary tuberculosis, chest radiography, sputum bacteriology, elderly, Togo