Analyse des effets liés à la pollution atmosphérique au Sénégal, le cas de Dakar

L’objectif principal est de déterminer l’impact des effets négatifs liés à la pollution atmosphérique au Sénégal, particulièrement à Dakar, sur l’environnement, la santé et l’économie. La pollution atmosphérique a des impacts irréversibles sur la santé publique, l’environnement et l’économie en lien aux activités quotidiennes des Dakarois. En effet, les améliorations recherchées peuvent s’appliquer à Dakar et dans la sous-région. Elles doivent être mises en place telles que proposées. Les données empiriques relevées sur le terrain et celles obtenues à partir des recherches effectuées ont d’une part, facilité l’identification des impacts négatifs des polluants atmosphériques à Dakar. D’autre part, elles ont permis de déterminer les sources génératrices d’impacts négatifs suivants : la vétusté du parc automobile, la mauvaise gestion des huiles usées, l’incinération de matières dangereuses, l’utilisation du bois comme combustibles urbain, les activités de l’industrie de raffinage et de la cimenterie, la poussière provenant du désert du Sahara et un manque d’éducation lié à l’environnement. Pour lutter contre ces impacts, le gouvernement a mis en place des stratégies axées au développement durable, en vain jusqu’à ce jour. Les perspectives suggérées se fondent sur l’analyse critériée de pertinence. Celles-ci se rapportent aux principes de développement durable. Il s’agit notamment de renforcer : les moyens du système de santé, déployer les moyens logistiques liés à la gestion de la qualité de l’air, investir dans la formation et à l’éveil des consciences, des programmes axés au développement socioéconomique, inclure les citoyens au processus de prise de décision, renforcer les capacités de la collecte des matières résiduelles, resserrer sa politique d’importation de véhicules usagés, mettre en place des entreprises de recyclage et de valorisation de l’acier des vieilles voitures, la revitalisation des forêts et des milieux humides, mettre en application une taxe verte, opter pour le reboisement du nord du Sénégal en partenariat avec les communautés locales. La conclusion de l’analyse démontre que l’objectif de l’essai est atteint par des recommandations efficaces formulées à l’égard des décideurs. Ces derniers peuvent les appliquer et réduire de façon significative les impacts négatifs de la pollution de l’air sur la santé des populations, l’économie et l’environnement

Communicating seasonal forecasts to farmers in Kaffrine, Senegal for better agricultural management

Our project explaining seasonal forecasting to farmers in central Senegal built common ground between scientific forecasting and traditional knowledge. It helped farmers understand and use seasonal forecasts to improve crop strategies, and let farmers explain to meteorologists what seasonal climate information they most needed, in turn improving the forecasts’ usefulness

Morbidity associated with sickle cell trait carriers

Background: Sickle cell trait carriers has long considered asymptomatic. This affirmation is now challenged because many patients complain of osteoarticular pain and several organic degenerative complications in particular; renal, eye and sudden death have been described. The objective of this study was to evaluate the morbidity of sickle cell trait and identify risk factors associated.Methods: This is a prospective study with duration of 16 months including 50 patients with sickle cell trait received regular visits (every 6 months) for painful events. Biological assessment was carried out systematically to eliminate rheumatic disease (CRP, ASLO, latex Waler Rose) or metabolic disorders (serum calcium, serum magnesium, and serum uric acid). A correlation between clinical and laboratory data was performed to study the relationship between morbidity observed and biological abnormalities.Results: Mean age of patients was 32 years (12-59) and mean age at diagnosis was 24 years (12-55 years). Sex ratio M/F was 0.16. Clinical symptoms were osteoarticular pain (88%), headache (86%), abdominal pain (76%), muscle cramps (70%), dizziness (56%), biliary lithiasis (6%), femoral head osteonecrosis (2%) and gross haematuria (2%). Seventeen patients (34%) had abnormal metabolic or rheumatic analysis. No risk factor associated with morbidity of patients was identified.Conclusions: This work has allowed us to find that the symptoms presented by sickle cell trait patients are dominated by painful events. This morbidity associated with porting sickle cell trait was not secondary to inflammatory or metabolic disorders or physical activity

Dermatomyosite avec atteinte cardiaque : A propos d’un cas observe au Senegal

Introduction : La dermatomyosite est une myopathie inflammatoire chronique caractérisée essentiellement par une faiblesse musculaire associée à des lésions cutanées caractéristiques.Cas clinique : Nous rapportons l‘observation d‘une patiente de 20 ans qui a présenté 6 mois auparavant une faiblesse musculaire d‘installation progressive associée à des troubles de la déglutition. L‘examen clinique retrouvait un déficit moteur des 4 membres à 1/5 en proximal et 3/5 en distal avec des lésions dermatologiques érythématosquameuses, et une tachyarythmie à l‘auscultation cardiaque. L‘électroneuromyogramme a montré des potentiels d‘unités motrices polyphasiques, d‘amplitude et de durée limitée, avec des vitesses de  conduction nerveuse motrice et sensitive normales. L‘écho-Doppler cardiaque a montré une fraction d‘éjection systolique à 40%. Le dosage des enzymes musculaires révélait une élévation des CPK à 1200 UI/L, LDH à 1284 UI/L et des aldolases à 35 UI/L. Le diagnostic de dermatomyosite associée à une atteinte cardiaque a été  retenu. La patiente a été traitée par corticothérapie avec une bonne évolution clinique.Conclusion : Notre observation souligne l‘intérêt de rechercher systématiquement une atteinte cardiaque chez les patients présentant un tableau de dermatomyosite. English title: Introduction : Dermatomyositis associated with cardiac involvement: A case observed in Senegal Background: Dermatomyositis is a chronic inflammatory myopathy characterized by muscle weakness associated with characteristic skin lesions.Case report: We report the case of a 20-year-old woman who presented 6 months before muscle weakness and swallowing disorders. Clinical examination showed a motor deficit of four limbs (1/5 proximal and 3/5 distal)  with dermatological lesions and tachyarrhythmia in cardiac auscultation. Electromyography showed multiphase motor unit potentials, with decreased amplitude and duration, and normal motor and sensory nerve   conduction velocities. Echocardiography showed a reduced left ventricular ejection of 40%. The dosage of the muscle enzymes revealed a high rate of Creatine Phosphokinase at 1200 IU/L, LDH at 1284 UI/L and aldolase at 35 UI/L. Diagnosis of dermatomyositis associated with cardiac involvement was retained. The patient was   treated with steroids with a good clinical response.Conclusion: Our observation underlines the value of systematically looking at cardiac involvement in patients with dermatomyositis

Scleroderma renal crisis in tropical region: two senegalese cases

Scleroderma renal crisis (SRC) is defined as the new onset of accelerated arterial hypertension and /or rapidly progressive oliguric renal failure during the course of systemic sclerosis. It is a rare but life-threatening complication. This formerly serious complication has got a considerable brighter outlook since the introduction of angiotensin converting enzyme inhibitors (ACE) however the mortality is still remaining high. We report two cases of SRC which to our knowledge are the firsts described in Dakar. They were two women aged 45 and 32 years, one of them was previously following for systemic sclerosis. Both of them had malignant hypertension associated with rapidly progressive renal failure, the other was put under corticosteroid therapy four months before SRC occurrence. The histological and laboratory finding showed thrombotic microangiopathy. The height blood pressure returned to normal value after treatment with ACE inhibitors. The final outcome was undesirable with the death of one after two months due to the hemodialysis discontinuation and persistence of renal failure in the other.Keywords: Scleroderma renal crisis, corticosteroids, thrombotic microangiopathy, Daka

Seasonal malaria chemoprevention combined with community case management of malaria in children under 10 years of age, over 5 months, in south-east Senegal: A cluster-randomised trial.

BACKGROUND: Seasonal malaria chemoprevention (SMC) is recommended in the Sahel region of Africa for children under 5 years of age, for up to 4 months of the year. It may be appropriate to include older children, and to provide protection for more than 4 months. We evaluated the effectiveness of SMC using sulfadoxine-pyrimethamine plus amodiaquine given over 5 months to children under 10 years of age in Saraya district in south-east Senegal in 2011. METHODS AND FINDINGS: Twenty-four villages, including 2,301 children aged 3-59 months and 2,245 aged 5-9 years, were randomised to receive SMC with community case management (CCM) (SMC villages) or CCM alone (control villages). In all villages, community health workers (CHWs) were trained to treat malaria cases with artemisinin combination therapy after testing with a rapid diagnostic test (RDT). In SMC villages, CHWs administered SMC to children aged 3 months to 9 years once a month for 5 months. The study was conducted from 27 July to 31 December 2011. The primary outcome was malaria (fever or history of fever with a positive RDT). The prevalence of anaemia and parasitaemia was measured in a survey at the end of the transmission season. Molecular markers associated with resistance to SMC drugs were analysed in samples from incident malaria cases and from children with parasitaemia in the survey. SMC was well tolerated with no serious adverse reactions. There were 1,472 RDT-confirmed malaria cases in the control villages and 270 in the SMC villages. Among children under 5 years of age, the rate difference was 110.8/1,000/month (95% CI 64.7, 156.8; p < 0.001) and among children 5-9 years of age, 101.3/1,000/month (95% CI 66.7, 136.0; p < 0.001). The mean haemoglobin concentration at the end of the transmission season was higher in SMC than control villages, by 6.5 g/l (95% CI 2.0, 11; p = 0.007) among children under 5 years of age, and by 5.2 g/l (95% CI 0.4, 9.9; p = 0.035) among children 5-9 years of age. The prevalence of parasitaemia was 18% in children under 5 years of age and 25% in children 5-9 years of age in the control villages, and 5.7% and 5.8%, respectively, in these 2 age groups in the SMC villages, with prevalence differences of 12.5% (95% CI 6.8%, 18.2%; p < 0.001) in children under 5 years of age and 19.3% (95% CI 8.3%, 30.2%; p < 0.001) in children 5-9 years of age. The pfdhps-540E mutation associated with clinical resistance to sulfadoxine-pyrimethamine was found in 0.8% of samples from malaria cases but not in the final survey. Twelve children died in the control group and 14 in the SMC group, a rate difference of 0.096/1,000 child-months (95% CI 0.99, 1.18; p = 0.895). Limitations of this study include that we were not able to obtain blood smears for microscopy for all suspected malaria cases, such that we had to rely on RDTs for confirmation, which may have included false positives. CONCLUSIONS: In this study SMC for children under 10 years of age given over 5 months was feasible, well tolerated, and effective in preventing malaria episodes, and reduced the prevalence of parasitaemia and anaemia. SMC with CCM achieved high coverage and ensured children with malaria were promptly treated with artemether-lumefantrine. TRIAL REGISTRATION: www.clinicaltrials.gov NCT01449045

Détermination du débit de filtration glomérulaire au cours de la drépanocytose au Sénégal: Schwartz, Cockcroft et Gault, MDRD, CKD-EPI ou JSCCS ?

La détermination du Débit de Filtration Glomérulaire (DFG) est importante chez les drépanocytaires du fait qu’ils constituent un groupe de patients chez lesquels des atteintes rénales sont fréquemment décrites notamment l’hyperfiltration glomérulaire. Dès lors, à une époque où les calculateurs en ligne proposent simultanément différentes formules de détermination du DFG, il serait important d’évaluer au sein d’une population noire africaine drépanocytaire l’équivalence entre ces formules qui ont été développées et validées sur des populations caucasiennes et afro-américaines à DFG normal ou diminué. Ainsi cette étude avait pour but d’évaluer l’interchangeabilité des différentes formules de détermination du DFG en les appliquant à des drépanocytaires. Des enfants et adultes sénégalais drépanocytaires homozygotes ont été alors recrutés et leur DFG calculé. La fréquence de l’hyperfiltration glomérulaire et celle de l’insuffisance rénale ont été calculées à partir des résultats obtenus avec les formules de Schwartz et du CKD-EPI. La concordance des différentes formules a été évaluée avec la méthode Bland-Altman. Au total 56 adultes et 62 enfants ont été inclus dans l’étude. L’insuffisance rénale a été notée chez 1,78% des adultes et 9,68% des enfants ; l’hyperfiltration glomérulaire chez 66,10% des adultes et 25,8% des enfants. Par rapport aux formules de référence (CKD-EPI, Schwartz), tous les biais relevés étaient significativement différents de zéro à l’exception de celui de Cockcroftet Gault qui était statistiquement nul. Les limites de concordance étaient toutes inacceptablement larges par rapport aux limites attendues à l’exception de celles du CKD-EPI sans ajustement sur la race. Ainsi, la formule de Schwartz n’était pas interchangeable avec celle du JSCCS chez les enfants, tout comme celle du CKD-EPI ne l’était pas non plus avec celles du JSCCS, de Cockcroft, du MDRD ou du CKD-EPI sans ajustement sur la race chez les adultes drépanocytaires. &nbsp; English title: Determination of glomerular filtration rate in sickle cell disease in Senegal: Schwartz, Cockcroft and Gault, MDRD, CKD-EPI or JSCCS? Determination of Glomerular Filtration Rate (GFR) is important in patients living with sickle cell disease (SCD) because they constitute a group of patients where kidney dysfunction is frequently described, in particular glomerular hyperfiltration. Therefore, at a time when online calculators simultaneously propose different formulas to estimate GFR, it would be important to evaluate in a black African population living with SCD the equivalence between these formulas which have been developed and validated on Caucasian and African American populations with normal or decreased GFR. Thus, the aim of this study was to evaluate interchangeability of different GFR formulas in a group of patients living with SCD. Homozygous Senegalese sickle cell children and adults were then recruited and their GFR computed using Schwartz and JSCCS in children, Cockcroft and Gault, CKD-EPI with and without adjustment for ethnicity, MDRD and JSCCS formulas in adults. The frequency of glomerular hyperfiltration and renal failure was computed based on the results generated using Schwartz and CKD-EPI formulas. The agreement between formulas was assessed with BlandAltman method. A total of 56 adults and 62 children were included in this study. Renal failure was observed in 1.78% of adults and 9.68% of children; glomerular hyperfiltration in 66.10% of adults and 25.8% of children. Compared with reference formulas (CKD-EPI, Schwartz), all biases found were significantly different from zero except for Cockcroft and Gault formula bias, which was statistically zero. The limits of agreement were all unacceptably wide compared with the expected limits with the exception of CKD-EPI without adjustment for ethnicity. Thus, Schwartz formula would not be interchangeable with JSCCS formula in children, nor was the CKD-EPI formula interchangeable with the JSCCS, Cockcroft and Gault, MDRD or CKD-EPI without adjustment for ethnicity formulas in adults living with sickle cell anemia