Analyse physico-chimique de l’eau de l’unité d’hémodialyse du chr de Saint- Louis (Sénégal)

L’insuffisance rénale chronique est un des problèmes majeurs de la santé publique dans le monde. Au Sénégal, une étude récente réalisée dans la population générale adulte avait retrouvé une prévalence de l’ordre de 6,1%. «L’eau pour dilution de concentrées d’hémodialyse» est produite en continue et utilisée en grande quantité chez l’hémodialysé chronique, donc il apparaît primordial de veiller à sa bonne qualité. Au Sénégal, aucune étude n’a été faite à ce jour pour évaluer l’efficacité du système de traitement de l’eau pour dilution des concentrés de dialyse dans les différents centres de dialyse du pays. L’objectif de ce travail est de contrôler l’efficacité du système de traitement de l’eau pour dilution de concentrées d’hémodialyse afin de s’assurer de son innocuité. Les prélèvements ont été effectués au niveau de trois points clés du circuit de traitement de l’eau pour hémodialyse. A l’entrée et à la sortie de l’osmoseur, à la sortie de la boucle de distribution. Les analyses ont été effectuées à l’aide d’électrodes spécifiques. Les valeurs de potentiels ont permis de tracer les courbes d’étalonnage. La détermination par régression des pentes et des ordonnées à l’origine de la relation de Nernst donne E(mV ) = B - A Log Cm avec des coefficients de corrélation variant entre 0,988 et 0,999 prouvant que 98% au moins des variations de tensions mesurées (E) sont attribuables à la concentration. L’analyse physico-chimique des teneurs en chlorures, nitrates et fluorures révèle des teneurs plus élevées à l’entrée de l’osmoseur qu’à la sortie. Ces basses valeurs découlent du rôle de l’osmoseur qui filtre une grande partie des électrolytes. Par contre, à la sortie de la boucle de distribution les teneurs en électrolytes des différents échantillons étaient plus importantes que celles à la sortie de l’osmoseur. Cette forte concentration en électrolytes atteste d’une pollution par la boucle de distribution de l’eau déjà filtrée par l’osmoseur. L’intérêt de cette étude réside dans le fait qu’elle met en lumière l’importance du contrôle de la qualité de l’eau pour l’hémodialyse et la nécessité d’un bon planning de maintenance préventive efficace de l’ensemble de la boucle de traitement d’eau au sein de chaque centre.© 2016 International Formulae Group. All rights reserved.Mots clés: Hémodialyse, eau, chlorures, fluorures, nitrates, électrodes spécifiquesEnglish Title: Physicochemical analysis of Saint–Louis regional hospital’s hemodialysis unit’s water (Senegal)English AbstractChronic kidney disease is a major public health problem worldwide. In Senegal, a recent study in the general adult population found a prevalence of about 6,1%. "Water for diluting concentrated hemodialysis" is produced and used continuously at high levels in hemodialysis chronic. It is therefore essential to ensure its quality. In Senegal, no study has been done to assess the effectiveness of water treatment system for dialysis concentrates dilution in different dialysis centers of the country. The objective of this work is to monitor the effectiveness of the water treatment system for hemodialysis concentrated dilution to ensure its safety. The samples were taken on key issues of hemodialysis water’s treatment circuit. Three levels of sampling were selected. At the entrance and at the outlet of the reverse osmosis unit at the outlet of the distribution loop. Analyses were performed using specific electrodes. Potential values allowed us to map the calibration curves. Determination by regression of slopes and intercepts of the Nernst relation gives with correlation coefficients ranging from 0.988 to 0.999 showing that at least 98% of the measured voltages fluctuations (E) are attributable to the concentration. Physicochemical analysis of the levels of chlorides, nitrates and fluorides reveals higher levels at the entrance of the reverse osmosis unit than at the outlet. These low values resulting of the role of reverse osmosis which filter much of the electrolytes. For against, at the outlet of the distribution loop the electrolyte content of the different samples were greater than those at the outlet of the reverse osmosis unit. This high electrolyte concentration attests to pollution of the water distribution loop already filtered by reverse osmosis. The interest of this study lies in the fact that it highlights the importance of monitoring the quality of water for hemodialysis and the need for good planning for effective preventive maintenance throughout the water treatment loop within each center.© 2016 International Formulae Group. All rights reserved.Keywords: Hemodialysis, water, nitrates, fluoride, chloride, specific electrode

Etude physico-chimique et minéralogique comparative des attapulgites de Mbodiène (Sénégal) et de Mormoiron (France)

La valorisation des ressources locales constitue un impératif afin d’atteindre des objectifs de développement durable. Cette étude a consisté à évaluer les caractéristiques physiques, chimiques et minéralogiques d’une argile provenant de Mbodiène (Sénégal), l’attapulgite, comparativement avec un médicament antidiarrhéique, constitué d’attapulgite, dénommé Actapulgite®. L’échantillon d’attapulgite brute a été purifié avec une solution de HNO3 1M. Une étude morphologique effectuée par visualisation à la Microscopie Electronique à Balayage a montré pour les deux argiles étudiées, une structure fibreuse caractéristique de la palygorskite, représentant le minéral dominant. L’analyse chimique par la spectrométrie à fluorescence X a donné pour l’attapulgite purifiée : 65,69% Si, 7,89% Al, 5,92% Fe, 17,90% Mg, 0,43% Ca et 0,93% K contre respectivement 63,98 % Si, 12,92% Al, 10,32% Fe, 6,20% Mg, 2,48% Ca et 2,25% K pour l’Actapulgite®. La diffraction aux rayons X a montré une présence de palygorskite, quartz et carbonates dans les échantillons étudiés. L’étude des isothermes d’adsorption a montré une surface spécifique nettement plus élevée pour l’attapulgite purifiée, 138,96 m2.g-1 contre 98,72 m2.g-1 pour l’Actapulgite®. Ces résultats ont montré que l’attapulgite de Mbodiène pourrait être utilisée comme antidiarrhéique orale après lavage à l’eau et séchage.© 2016 International Formulae Group. All rights reservedMots clés: Argile, attapulgite, antidiarrhéique, SénégalEnglish Title: Physico-chemical and mineralogical comparative study of attapulgites Mbodiène (Senegal) and Mormoiron (France)English AbstractThe development of local resources is imperative to achieve sustainable development goals. This study was to assess physical, chemical and mineralogical characteristics of a clay from Mbodiène (Senegal), named attapulgite, compared with Actapulgite® (antidiarrheal drug), composed of attapulgite. A sample of attapulgite from Mbodiène was purified with a 1M HNO3 solution to remove impurities including carbonates. A morphological study using Scanning Electron Microscopy showed for both types of clay studied, a fibrous structure characteristic of palygorskite which represent major mineral. Chemical analysis by XRF spectrometry gave for purified attapulgite: 65.69% Si, 7.89% Al, 5.92% Fe, 17.90% Mg, 0.43% Ca and 0.93% K against respectively 63.98% Si, 12.92% Al, 10.32% Fe, 6.20% Mg, 2.48% Ca and 2.25% K for Actapulgite®. X-ray diffraction showed the presence of palygorskite, quartz and carbonates for both samples studied. The study of adsorption isotherms showed a significantly higher surface area for purified attapulgite, 138.96 m2.g-1 versus 98.72 m2.g-1 for Actapulgite®. These results have shown that Mbodiène attapulgite compared to Actapulgite®, could be used as an oral antidiarrheal after washing with water and drying.© 2016 International Formulae Group. All rights reserved.Keywords: Clay, attapulgite, antidiarrheal, Senega

Aetiology of lobar pneumonia determined by multiplex molecular analyses of lung and pleural aspirate specimens in the Gambia: findings from population-based pneumonia surveillance.

OBJECTIVES: To determine the causes of lobar pneumonia in rural Gambia. DESIGN AND SETTING: Population-based pneumonia surveillance at seven peripheral health facilities and two regional hospitals in rural Gambia. 7-valent pneumococcal conjugate vaccine (PCV7) was introduced routinely in August 2009 and replaced by PCV13 from May 2011. METHODS: Prospective pneumonia surveillance was undertaken among all ages with referral of suspected pneumonia cases to the regional hospitals. Blood culture and chest radiographs were performed routinely while lung or pleural aspirates were collected from selected, clinically stable patients with pleural effusion on radiograph and/or large, dense, peripheral consolidation. We used conventional microbiology, and from 8 April 2011 to 17 July 2012, used a multiplex PCR assay on lung and pleural aspirates. We calculated proportions with pathogens, associations between coinfecting pathogens and PCV effectiveness. PARTICIPANTS: 2550 patients were admitted with clinical pneumonia; 741 with lobar pneumonia or pleural effusion. We performed 181 lung or pleural aspirates and multiplex PCR on 156 lung and 4 pleural aspirates. RESULTS: Pathogens were detected in 116/160 specimens, the most common being Streptococcus pneumoniae(n=68), Staphylococcus aureus (n=26) and Haemophilus influenzae type b (n=11). Bacteria (n=97) were more common than viruses (n=49). Common viruses were bocavirus (n=11) and influenza (n=11). Coinfections were frequent (n=55). Moraxella catarrhalis was detected in eight patients and in every case there was coinfection with S. pneumoniae. The odds ratio of vaccine-type pneumococcal pneumonia in patients with two or three compared with zero doses of PCV was 0.17 (95% CI 0.06 to 0.51). CONCLUSIONS: Lobar pneumonia in rural Gambia was caused primarily by bacteria, particularly S. pneumoniae and S. aureus. Coinfection was common and M. catarrhalis always coinfected with S. pneumoniae. PCV was highly efficacious against vaccine-type pneumococcal pneumonia

Impact of the introduction of pneumococcal conjugate vaccination on pneumonia in The Gambia: population-based surveillance and case-control studies.

BACKGROUND: Pneumococcal conjugate vaccines (PCVs) are used in many low-income countries but their impact on the incidence of pneumonia is unclear. The Gambia introduced PCV7 in August, 2009, and PCV13 in May, 2011. We aimed to measure the impact of the introduction of these vaccines on pneumonia incidence. METHODS: We did population-based surveillance and case-control studies. The primary endpoint was WHO-defined radiological pneumonia with pulmonary consolidation. Population-based surveillance was for suspected pneumonia in children aged 2-59 months (minimum age 3 months in the case-control study) between May 12, 2008, and Dec 31, 2015. Surveillance for the impact study was limited to the Basse Health and Demographic Surveillance System (BHDSS), whereas surveillance for the case-control study included both the BHDSS and Fuladu West Health and Demographic Surveillance System. Nurses screened all outpatients and inpatients at all health facilities in the surveillance area using standardised criteria for referral to clinicians in Basse and Bansang. These clinicians recorded clinical findings and applied standardised criteria to identify patients with suspected pneumonia. We compared the incidence of pneumonia during the baseline period (May 12, 2008, to May 11, 2010) and the PCV13 period (Jan 1, 2014, to Dec 31, 2015). We also investigated the effectiveness of PCV13 using case-control methods between Sept 12, 2011, and Sept 31, 2014. Controls were aged 90 days or older, and were eligible to have received at least one dose of PCV13; cases had the same eligibility criteria with the addition of having WHO-defined radiological pneumonia. FINDINGS: We investigated 18 833 children with clinical pneumonia and identified 2156 cases of radiological pneumonia. Among children aged 2-11 months, the incidence of radiological pneumonia fell from 21·0 cases per 1000 person-years in the baseline period to 16·2 cases per 1000 person-years (23% decline, 95% CI 7-36) in 2014-15. In the 12-23 month age group, radiological pneumonia decreased from 15·3 to 10·9 cases per 1000 person-years (29% decline, 12-42). In children aged 2-4 years, incidence fell from 5·2 to 4·1 cases per 1000 person-years (22% decline, 1-39). Incidence of all clinical pneumonia increased by 4% (-1 to 8), but hospitalised cases declined by 8% (3-13). Pneumococcal pneumonia declined from 2·9 to 1·2 cases per 1000 person-years (58% decline, 22-77) in children aged 2-11 months and from 2·6 to 0·7 cases per 1000 person-years (75% decline, 47-88) in children aged 12-23 months. Hypoxic pneumonia fell from 13·1 to 5·7 cases per 1000 person-years (57% decline, 42-67) in children aged 2-11 months and from 6·8 to 1·9 cases per 1000 person-years (72% decline, 58-82) in children aged 12-23 months. In the case-control study, the best estimate of the effectiveness of three doses of PCV13 against radiological pneumonia was an adjusted odds ratio of 0·57 (0·30-1·08) in children aged 3-11 months and vaccine effectiveness increased with greater numbers of doses (p=0·026). The analysis in children aged 12 months and older was underpowered because there were few unvaccinated cases and controls. INTERPRETATION: The introduction of PCV in The Gambia was associated with a moderate impact on the incidence of radiological pneumonia, a small reduction in cases of hospitalised pneumonia, and substantial reductions of pneumococcal and hypoxic pneumonia in young children. Low-income countries that introduce PCV13 with reasonable coverage can expect modest reductions in hospitalised cases of pneumonia and a marked impact on the incidence of severe childhood pneumonia. FUNDING: GAVI's Pneumococcal vaccines Accelerated Development and Introduction Plan, Bill & Melinda Gates Foundation, and UK Medical Research Council

Booster Vaccination With GVGH Shigella sonnei 1790GAHB GMMA Vaccine Compared to Single Vaccination in Unvaccinated Healthy European Adults: Results From a Phase 1 Clinical Trial

The investigational Shigella sonnei vaccine (1790GAHB) based on GMMA (generalized modules for membrane antigens) is immunogenic, with an acceptable safety profile in adults. However, pre-vaccination anti-S. sonnei lipopolysaccharide (LPS) antibody levels seemed to impact vaccine-related immune responses. This phase 1, open-label, non-randomized extension study (ClinicalTrials.gov: NCT03089879) evaluated immunogenicity of a 1790GAHB booster dose in seven adults with undetectable antibodies prior to priming with three 1790GAHB vaccinations 2–3 years earlier (boosted group), compared to one dose in 28 vaccine-naïve individuals (vaccine-naïve group). Anti-S. sonnei LPS serum IgG geometric mean concentrations and seroresponse (increase of ≥25 EU or ≥50% from baseline antibody ≤ 50 EU and ≥50 EU, respectively) rates were calculated at vaccination (day [D]1), D8, D15, D29, D85. Safety was assessed. Geometric mean concentrations at D8 were 168 EU (boosted group) and 32 EU (vaccine-naïve group). Response peaked at D15 (883 EU) and D29 (100 EU) for the boosted and vaccine-naïve groups. Seroresponse rates at D8 were 86% (boosted group) and 24% (vaccine-naïve group) and increased at subsequent time points. Across both groups, pain (local) and fatigue (systemic) were the most frequent solicited adverse events (AEs). Unsolicited AEs were reported by 57% of boosted and 25% of vaccine-naïve participants. No deaths, serious AEs, or AEs of special interest (except one mild neutropenia case, possibly vaccination-related) were reported. One 1790GAHB dose induced a significant booster response in previously-primed adults, regardless of priming dose, and strong immune response in vaccine-naïve individuals. Vaccination was well tolerated

Effect of the introduction of pneumococcal conjugate vaccination on invasive pneumococcal disease in The Gambia: a population-based surveillance study.

BACKGROUND: Little information is available about the effect of pneumococcal conjugate vaccines (PCVs) in low-income countries. We measured the effect of these vaccines on invasive pneumococcal disease in The Gambia where the 7-valent vaccine (PCV7) was introduced in August, 2009, followed by the 13-valent vaccine (PCV13) in May, 2011. METHODS: We conducted population-based surveillance for invasive pneumococcal disease in individuals aged 2 months and older who were residents of the Basse Health and Demographic Surveillance System (BHDSS) in the Upper River Region, The Gambia, using standardised criteria to identify and investigate patients. Surveillance was done between May, 2008, and December, 2014. We compared the incidence of invasive pneumococcal disease between baseline (May 12, 2008-May 11, 2010) and after the introduction of PCV13 (Jan 1, 2013-Dec 31, 2014), adjusting for changes in case ascertainment over time. FINDINGS: We investigated 14 650 patients, in whom we identified 320 cases of invasive pneumococcal disease. Compared with baseline, after the introduction of the PCV programme, the incidence of invasive pneumococcal disease decreased by 55% (95% CI 30-71) in the 2-23 months age group, from 253 to 113 per 100 000 population. This decrease was due to an 82% (95% CI 64-91) reduction in serotypes covered by the PCV13 vaccine. In the 2-4 years age group, the incidence of invasive pneumococcal disease decreased by 56% (95% CI 25-75), from 113 to 49 cases per 100 000, with a 68% (95% CI 39-83) reduction in PCV13 serotypes. The incidence of non-PCV13 serotypes in children aged 2-59 months increased by 47% (-21 to 275) from 28 to 41 per 100 000, with a broad range of serotypes. The incidence of non-pneumococcal bacteraemia varied little over time. INTERPRETATION: The Gambian PCV programme reduced the incidence of invasive pneumococcal disease in children aged 2-59 months by around 55%. Further surveillance is needed to ascertain the maximum effect of the vaccine in the 2-4 years and older age groups, and to monitor serotype replacement. Low-income and middle-income countries that introduce PCV13 can expect substantial reductions in invasive pneumococcal disease. FUNDING: GAVI's Pneumococcal vaccines Accelerated Development and Introduction Plan (PneumoADIP), Bill & Melinda Gates Foundation, and the UK Medical Research Council

Impact of the introduction of pneumococcal conjugate vaccination on invasive pneumococcal disease and pneumonia in The Gambia: 10 years of population-based surveillance.

BACKGROUND: The Gambia introduced seven-valent pneumococcal conjugate vaccine (PCV7) in August 2009, followed by PCV13 in May, 2011, using a schedule of three primary doses without a booster dose or catch-up immunisation. We aimed to assess the long-term impact of PCV on disease incidence. METHODS: We did 10 years of population-based surveillance for invasive pneumococcal disease (IPD) and WHO defined radiological pneumonia with consolidation in rural Gambia. The surveillance population included all Basse Health and Demographic Surveillance System residents aged 2 months or older. Nurses screened all outpatients and inpatients at all health facilities using standardised criteria for referral. Clinicians then applied criteria for patient investigation. We defined IPD as a compatible illness with isolation of Streptococcus pneumoniae from a normally sterile site (cerebrospinal fluid, blood, or pleural fluid). We compared disease incidence between baseline (May 12, 2008-May 11, 2010) and post-vaccine years (2016-2017), in children aged 2 months to 14 years, adjusting for changes in case ascertainment over time. FINDINGS: We identified 22 728 patients for investigation and detected 342 cases of IPD and 2623 cases of radiological pneumonia. Among children aged 2-59 months, IPD incidence declined from 184 cases per 100 000 person-years to 38 cases per 100 000 person-years, an 80% reduction (95% CI 69-87). Non-pneumococcal bacteraemia incidence did not change significantly over time (incidence rate ratio 0·88; 95% CI, 0·64-1·21). We detected zero cases of vaccine-type IPD in the 2-11 month age group in 2016-17. Incidence of radiological pneumonia decreased by 33% (95% CI 24-40), from 10·5 to 7·0 per 1000 person-years in the 2-59 month age group, while pneumonia hospitalisations declined by 27% (95% CI 22-31). In the 5-14 year age group, IPD incidence declined by 69% (95% CI -28 to 91) and radiological pneumonia by 27% (95% CI -5 to 49). INTERPRETATION: Routine introduction of PCV13 substantially reduced the incidence of childhood IPD and pneumonia in rural Gambia, including elimination of vaccine-type IPD in infants. Other low-income countries can expect substantial impact from the introduction of PCV13 using a schedule of three primary doses. FUNDING: Gavi, The Vaccine Alliance; Bill & Melinda Gates Foundation; UK Medical Research Council; Pfizer Ltd

CONTRIBUTION OF HEALTH MUTUALITIES TO HEALTH CARE ACCESS AND TO COMMUNITY RESILIENCE IN THE DRC

Introduction : Dans la plupart des pays en développement, l'accès financier aux services de santé reste un problème persistant. Cette étude avait pour objectifs d'évaluer le recours aux soins des mutualistes. Méthodologie : Nous avons utilisé le test de Fischer-Snedecor puis le test de Chi-carré d'homogénéité pour comparer les distributions observées entre plusieurs échantillons. La résilience de la communauté a été évaluée grâce au test du coefficient de corrélation et avec un indice de résilience multidimensionnel. Résultats : Les structures les plus équipées étaient majoritairement fréquentées par les mutualistes avec un risque de consommation rapide du budget utile. La satisfaction des adhérents vis-à-vis des prestations de la mutuelle et de la qualité des soins était bonne mais la fidélisation des anciens membres ne semble pas être influencée le nombre des adhésions. Conclusion : L’utilisation des services de santé par les patients dans un mécanisme d’assurance maladie restent un indicateur pertinent.   ENGLISH Introduction: In most developing countries, the financial access to health services is still a persistent problem. This study  had objectives evaluate the recourse to care of mutualists . Methodology: We have used the test of Fischer-Snedecor then the test of Chi-carré of homogeneity to compare the observed distributions among several samples. The community resilience has been evaluated thanks to the test of correlation coefficient and whith a multidimensional resilience index. Results:  The most equipped structured were mostly frequented by the mutualists  with a risk of quick consumption of the useful budget. Satisfaction of members with the services of the mutual insurance company and the quality of care, internal growth is not does not seem to be influenced by this indicator. Conclusion: The usages of health service by patients in a mechanism of health insurance stay a pertinent indicator. Key Words: Disease insurance. Community. Health mutuality. Resilience. Health service.Introduction : Dans la plupart des pays en développement, l'accès financier aux services de santé reste un problème persistant. Cette étude avait pour objectifs d'évaluer le recours aux soins des mutualistes. Méthodologie : Nous avons utilisé le test de Fischer-Snedecor puis le test de Chi-carré d'homogénéité pour comparer les distributions observées entre plusieurs échantillons. La résilience de la communauté a été évaluée grâce au test du coefficient de corrélation et avec un indice de résilience multidimensionnel. Résultats : Les structures les plus équipées étaient majoritairement fréquentées par les mutualistes avec un risque de consommation rapide du budget utile. La satisfaction des adhérents vis-à-vis des prestations de la mutuelle et de la qualité des soins était bonne mais la fidélisation des anciens membres ne semble pas être influencée le nombre des adhésions. Conclusion : L’utilisation des services de santé par les patients dans un mécanisme d’assurance maladie restent un indicateur pertinent. Mots clés : Assurance maladie. Communauté. Mutualité de santé. Résilience. Services de santé

Caractérisation des périmètres maraîchers institués par les groupements des femmes comme stratégie de résilience en zone post conflit (Casamance, Sénégal)

L’Afrique subsaharienne est marquée, en ce début de 21ième siècle, par une situation d’insécurité alimentaire généralisée, aussi bien dans les campagnes que dans les villes. Pour corriger ce déséquilibre, les groupements des femmes de l’arrondissement de Kataba 1 instituent des blocs maraichers comme stratégie de résilience. C’est dans cette perspective que cette étude se propose de faire une caractérisation des périmètres maraichers des femmes dans l’arrondissement de Kataba 1. Elle a été réalisée sur la base des enquêtes socioéconomiques, menées auprès de 140 producteurs répartis dans 73 blocs maraichers (soit 53,3% des blocs) appartenant à 53 villages. Les enquêtes ont révélé que 36,62% des productrices se trouvent sur la tranche d’âge 40 - 50 ans. Les superficies emblavées contenant 19 spéculations maraichères varient de 0,01 à 7,5 ha, . Le fertilisant le plus utilisé est le fumier avec l’application d‘une dose deux (2) bassines par planche de 10 m2 . Toutefois, les cultures sont attaquées par de nombreux bioagresseurs qui occasionnent chaque année des pertes importantes de récoltes. Pour lutter contre ces ennemis de culture, les producteurs adoptent selon les moyens disposés, deux types de traitements phytosanitaires à savoir l’usage des produits chimiques de synthèse d’une part et l’application d’extraits naturels.   Sub-Saharan Africa is marked by widespread food insecurity at the beginning of the 21st century, both in rural and city areas. To correct this imbalance, women's groups in the Kataba 1 borough are instituting market garden blocks as a resilience strategy. It is with this in mind that the study carried out in the district of Kataba 1 proposes to make a characterization of the market garden perimeters of the area. It was carried out on the basis of surveys of 140 producers in 73 winery blocks (or 53.3% 2 blocks) belonging to 53 villages. Surveys revealed that 36.62% of produccers are on the 40- to 50-year age group. With areas ranging from 0.01 to 7.5 ha, 19 market garden speculations were noted in the area. In addition, the most commonly used fertilizer is manure in doses of two (2) basins per 10 m2 board. However, crops are attacked by many enemies who cause significant crop losses each year. To combat these enemies, producers adopt two types of treatments, namely treatments with chemicals and those with natural products, according to the means available