Assessment of progress of the Postabortion Care Initiative in Francophone Africa

The goals of this study were to assess the national situation concerning postabortion care (PAC) in six countries (Burkina Faso, Guinea, Mali, Niger, Senegal and Togo), including the process of introduction, integration and decentralization of PAC; the successes and obstacles in the process of introducing PAC; and recommended key steps to strengthen the introductory process. The study used two approaches: a comprehensive review of the introduction and institutionalization of PAC in the six countries, and a situation analysis of PAC services within each country

Hepatocellular carcinoma associated with pregnancy about 2 cases at the gynecological and obstetrical clinic of the Aristide Le Dantec hospital, Dakar, Senegal

The objective of our study was to report 2 cases of hepatocellular carcinomas associated with pregnancy followed in our structure and to review the literature. Our patients were 30 and 37-year-old multi-gesture females with chronic unattended viral hepatitis B in whom the diagnosis of hepatocellular carcinoma was made in the third trimester of pregnancy at 31 weeks of amenorrhea and 4 days and at 32 weeks of amenorrhea after the incidental finding of tumor hepatomegaly on abdominal-pelvic ultrasound. The main clinical signs were jaundice and hepatomegaly and paraclinical signs were dominated by hepatic cytolysis and anemia in addition to ultrasound images. Follow-up of pregnancies revealed no particularities. A caesarean section was scheduled at 32 weeks of amenorrhea and 32 weeks of amenorrhea and 3 days allowing the birth of two preterm newborns weighing 1210 and 1500 gm with Apgar scores of 8-10/10 and 7-9/10 respectively at the fifth minute. The immediate post-operative follow-up was simple. However, the maternal-fetal prognosis was poor with the death of both patients in a multi-visceral failure table occurring respectively at 6 weeks and 3 weeks after caesarean section. The newborns had died 8 days after birth. Although rare, these two cases challenge any obstetrician to think about liver cancer in pregnant women, especially those with chronic hepatitis B. Ultrasound examination of the liver, or even better, the MRI, which is more efficient, in order to suspect early on a possible liver cancer. Indeed, early diagnosis and a thorough medical approach are essential for the treatment of HCC in pregnant patients

Improving fetal dystocia management using simulation in Senegal: midterm results

Background: Maternal mortality, which constitutes the extreme point of the existing inequality between women in poor and rich countries, remains very high in Africa south of the Sahara. The objective of this study was to introduce a new training approach in Emergency Obstetric and Neonatal Care (EmONC) entered in Senegal to strengthen the skills of healthcare providers.Methods: The approach was based on the skills training using the so-called "humanist" method and "lifesaving skills". Simulated practice took place in the classroom through thirteen clinical stations summarizing the clinical skills on EmONC. The evaluation was done in all phases and the results were recorded in a database to document the progress of each learner.Results: With this approach, 432 providers were trained in 10 months. The increase in technical achievements of each participant was documented through the database. The combination of training based on the model “learning by doing” has ensured learning and mastering all EmONC skills and reduced missed learning opportunities as observed in former EmONC trainings.Conclusions: The impact of training on EmONC indicators and the introduction of this learning modality in basic training are the two major challenges in terms of prospects

Are we ready to track climate-driven shifts in marine species across international boundaries? - A global survey of scientific bottom trawl data

Marine biota are redistributing at a rapid pace in response to climate change and shifting seascapes. While changes in fish populations and community structure threaten the sustainability of fisheries, our capacity to adapt by tracking and projecting marine species remains a challenge due to data discontinuities in biological observations, lack of data availability, and mismatch between data and real species distributions. To assess the extent of this challenge, we review the global status and accessibility of ongoing scientific bottom trawl surveys. In total, we gathered metadata for 283,925 samples from 95 surveys conducted regularly from 2001 to 2019. We identified that 59% of the metadata collected are not publicly available, highlighting that the availability of data is the most important challenge to assess species redistributions under global climate change. Given that the primary purpose of surveys is to provide independent data to inform stock assessment of commercially important populations, we further highlight that single surveys do not cover the full range of the main commercial demersal fish species. An average of 18 surveys is needed to cover at least 50% of species ranges, demonstrating the importance of combining multiple surveys to evaluate species range shifts. We assess the potential for combining surveys to track transboundary species redistributions and show that differences in sampling schemes and inconsistency in sampling can be overcome with spatio-temporal modeling to follow species density redistributions. In light of our global assessment, we establish a framework for improving the management and conservation of transboundary and migrating marine demersal species. We provide directions to improve data availability and encourage countries to share survey data, to assess species vulnerabilities, and to support management adaptation in a time of climate-driven ocean changes.En prensa6,86

Les vues d'informateur clef d'un accouchement gratuit d'une politique césarienne au Sénégal

This article presents the findings of one component of an evaluation of the national policy for free deliveries and caesareans in Senegal. The policy was introduced in 2005 in five more deprived regions of the country. It aimed to reduce the financial barriers to using maternity services and to increase the number of facility-based deliveries. The findings are drawn from 54 semi-structured interviews with key informants who had technical and administrative or political responsibility for the policy at national, regional, district and health post level. These were carried out from November 2006 to January 2007. The evaluation findings emphasise the importance of careful planning and communication before a major national policy is implemented, and also of simple and clear definition of the package of ‘free’ services on offer. Long term investment in supply will also be needed to increase access for the most remote areas (Afr J Reprod Health 2008; 12[3]:93-112).Cet article présente des constatations d’un composant d’une évaluation de la politique nationale sur les accouchements gratuits et césariens au Sénégal. La politique a été introduite en 2005 dans cinq régions défavorisées du pays. Il a comme but de réduire les barrières financières d’utiliser les services maternels et d’augmenter le nombre d’accouchements à l’aide des installations. Les conclusions sont tirées de 54 interviews demi-structurées avec des informateurs clefs ayant des responsabilités techniques, administratives ou politiques pour la politique au niveau national, régional, au quartier et au poste sanitaire. L’étude a été entreprise du novembre 2006 au janvier 2007. Les conclusions évaluées soulignent l’importance du planning soigneux et la communication avant l’application d’une politique national majeure ainsi que de la simple définition claire de la présentation des services ‘gratuits’ en demande. L’investissement en offre à terme long sera important pour augmenter l’accès pour des régions isolées (Afr J Reprod Health 2008; 12[3]:93-112)

Understanding the financial burden of incomplete abortion: An analysis of the out-of-pocket expenditure on postabortion care in eight public-sector health care facilities in Dakar, Senegal

Timely access to treatment is essential for women when they experience abortion complications. Out-of-pocket (OOP) expenditure is a known barrier to health care access. In 2018, we assessed the financial burden of accessing postabortion care (PAC) borne by women in Dakar, Senegal, where studies estimate that half of poor women with complications obtain PAC. We interviewed 729 women following discharge from PAC. Women reported expenditures on transportation, admission, treatment, family planning, hospitalisation, complementary tests, prescriptions, other medicines and materials. We compare women’s OOP on PAC by expenditure category, type of treatment and facility type, and use multiple generalised linear regression analysis to explain variation in overall OOP and forecast it under alternate scenarios. The average OOP was USD $93.84. At health centres it was$65.47 and at hospitals it was $120.47. The average cost of PAC using dilation and curettage was$112.37, manual vacuum aspiration was $99.84, and misoprostol$61.80. Overall OOP on PAC amounts, on average, to 15% of the average monthly salary for women living in Dakar. Strategies that emphasise timely access to misoprostol for treating complications in primary care settings will address the contribution of OOP costs to Senegal’s appreciable unmet need for PAC among the poor

Methanogenic and fertilizing potential of aquaculture waste: towards freshwater farms energy self‐sufficiency in the framework of blue growth

International audienceThe fisheries sector, particularly aquaculture, is a fundamental source of nutrition for humans, particularly in developing countries. The modern development of fish farming requires energy for production systems. This study investigates the potential of using organic wastes derived from fish fattening to produce on-farm energy through the process of methanization. Oreochromis niloticus faeces methanogen potential was determined with (IFF) and without (UIFF) methanizer microbial inoculum. At the end of the manure methanation trials, the resulting digestates were tested as organic fertilizers for agriculture. The tests showed that inoculated fish faeces had faster biogas kinetics production compared with uninoculated fish faeces. In both cases, the produced biogas contained more than 60% methane (CH4) from the second week of incubation, indicating that it was of good quality. Furthermore, the total CH4 volume was twice as larger in IFF compared with UIFF. Biofertilizer tests showed no significant differences for most of the growth parameters in onion and tomato when compared to the unfertilized control, except in one case for tomato plants, which significantly increased its aboveground biomass. The results show that fish faeces are good methanogenic substrates conducive to energy recovery that could facilitate farm autonomy; however, valorization of the digestates as biofertilizer still requires extensive agronomic optimization. Based on our results, we estimate that equivalents of energy need of almost ten millions of people could be covered using the aquaculture potential in freshwater fish faeces biogas worldwide or that at least aquaculture farm energy self-sufficiency could be fostered

Prevalence and Risk Factors of Lower Reproductive Tract Infections in Symptomatic Women in Dakar, Senegal

Background: Lower reproductive tract infections in women are important causes of morbidity but can also lead to complications and sequelae. This study aimed to establish the prevalence and risk factors of lower genital tract infections among women of reproductive age in Dakar (Senegal). Methods: This was a prospective study conducted in 6 maternity hospitals from July to November 2015. Participants ranged in age from 18 to 49 years and presented at health facilities with signs and symptoms of genital infection. Consenting individuals who met the inclusion criteria were recruited for the study. Results: During the reporting period, 276 patients were enrolled. According to the laboratory results, the prevalence of any genital infection was 69.6% (192 of 276). The most common vaginal infections were bacterial vaginosis (39.5%) and vaginal candidiasis (29%), with the third most common cause, trichomoniasis, trailing behind in terms of prevalence (2.5%). Among the microorganisms responsible for cervical infections, Ureaplasma urealyticum was the most frequent (27.5%), followed by Mycoplasma hominis (14.5%), Chlamydia trachomatis (4.7%), and Neisseria gonorrhoeae (1.1%). Multivariate analysis showed that young women and women with low levels of education were at increased risk for vaginal/cervical infections. Conclusions: This study revealed a high prevalence of bacterial vaginosis and vaginal candidiasis and suggests that health care providers should increase awareness and communication to improve vaginal hygiene practices. If infection with Trichomonas vaginalis, C trachomatis or N gonorrhoeae is suspected, we also recommend systematically performing laboratory diagnostic confirmation

Improving fetal dystocia management using simulation in Senegal: midterm results

Background: Maternal mortality, which constitutes the extreme point of the existing inequality between women in poor and rich countries, remains very high in Africa south of the Sahara. The objective of this study was to introduce a new training approach in Emergency Obstetric and Neonatal Care (EmONC) entered in Senegal to strengthen the skills of healthcare providers.Methods: The approach was based on the skills training using the so-called "humanist" method and "lifesaving skills". Simulated practice took place in the classroom through thirteen clinical stations summarizing the clinical skills on EmONC. The evaluation was done in all phases and the results were recorded in a database to document the progress of each learner.Results: With this approach, 432 providers were trained in 10 months. The increase in technical achievements of each participant was documented through the database. The combination of training based on the model “learning by doing” has ensured learning and mastering all EmONC skills and reduced missed learning opportunities as observed in former EmONC trainings.Conclusions: The impact of training on EmONC indicators and the introduction of this learning modality in basic training are the two major challenges in terms of prospects