Tontines et empowerment des femmes au Sénégal : le cas des tontinières du marché des Habitations à Loyer Modéré (hlm) Nimzatt à Dakar

Cette recherche de type qualitative est axée sur l’effet de la participation à une tontine sur l’empowerment des femmes au Sénégal. Les données proviennent d’une étude de cas réalisée dans la tontine AND DANNE au Marché des habitations à loyer modéré (HLM) Nimzatt à Dakar (Sénégal). À l’aide de guides d’entretien semi-structurés, douze femmes ont été interviewées. Dans le cadre conceptuel, nous avons défini les concepts de l’empowerment et celui de la participation. L’applicabilité de l’approche empowerment comme méthode d’analyse des données nous a permis de voir les effets bénéfiques de la participation tontinière. Le constat est que la participation à la tontine a augmenté l’estime de soi des participantes et a amélioré considérablement leur relation avec elles-mêmes et leur communauté. La conscience critique des femmes est née des difficultés d’accès au crédit que vivent la majorité des femmes sénégalaises. La participation de fait et la participation volontaire sont les deux types de participation observés dans la tontine. Aussi, la tontine se situe au niveau du pouvoir réel de l’échelle de la participation proposée par Arnstein (1969), car on y constate la présence des échelons du partenariat et de la délégation. L’analyse des données met en lumière d’autres pistes de recherche, notamment les comportements de type communautaire observés chez les participantes qui ont offert un soutien moral et une prise en charge alimentaire à des jeunes talibés mendiants. Ces initiatives pourraient servir d’exemples à l’État sénégalais pour la mise en place des programmes sociaux. Mots clés : Tontine - participation - empowerment - étude de casThis qualitative research focuses on the effect of participating in a tontine, a type of rotating savings and credit association, on Senegalese women’s empowerment. The data provided in this document come from a study case that was carried out in the tontine AND DANNE at a moderate rental housing market in Nimzatt. Twelve women have been interviewed using semi-structured interviewing guides. The concepts of “empowerment” and “participation” were defined in a conceptual framework. The applicability of the empowerment approach as the chosen method of data analysis has allowed us to see the beneficial effects of participating in a tontine. The fact is that the participation of women to such financial association increased their self-esteem and significantly improved their relationship with other women from within the group as well as with their community. The critical awareness of the participants comes from the lack of access to credit experienced by the majority of Senegalese women. Both “de facto” and voluntary participation were observed within the tontine. Also, the tontine is at the real power of the scale of participation proposed by Arnstein (1969), as there noted the presence of levels of partnership and delegation. The data analysis highlights other avenues of research, including community-based behaviours observed in participants who provided moral support and dietary management to young Talib beggars. These initiatives could well serve as examples to follow for the Senegalese government for the implementation of social programs. Key words : Tontine - participation - empowerment – study cas

Maintenance haemodialysis with low dialysate flow rates in Senegal

Introduction: The objective of the study reported here was to demonstrate that maintenance haemodialysis using a reduced dialysate flow rate of 300 mL/min (RQD) is not inferior to haemodialysis using the standard flow rate of 500 mL/min (SQD) in respect of the delivered dose of dialysis. Methods: A prospective, single-centre, sequential study was performed at the haemodialysis  centre of Pikine Hospital in Dakar. Twenty patients were included. During the first week, three haemodialysis sessions were performed with SQD and during the second week three haemodialysis  sessions were conducted with RQD for each patient. Results: For SQD, the mean eKt/V was 1.38 ± 0.58. There were 38 (63%) sessions with eKt/V greater than 1.2 and 16 patients (80%) had adequate dialysis, based on the average eKt/V. For RQD, the mean eKt/V was 1.2 ± 0.43 with 25 sessions (42%) having an eKt/V greater than 1.2. There were 11 patients (55%) with adequate dialysis. The dialysis dose was higher with the SQD prescription (P < 0.001). Ten patients with dry weight ≤60 kg had adequate dialysis with RQD. Cases of hypokalaemia were significantly higher with the SQD (P = 0.001). Conclusions: RQD appears to be inferior in terms of dialysis dose. However, for patients with dry weight ≤60 kg, adequate dialysis could be delivered with RQD, consequently allowing substantial saving of water in haemodialysis

Evaluation du risque thromboembolique veineux et pratique de la thromboprophylaxie en médecine interne

Introduction: Le risque thromboembolique veineux en médecine a été largement incriminé dans la charge humaine et financière de l'ensemble de cette pathologie. Les facteurs de risque sont identifiés et côtés pour optimiser la prise en charge. Notre objectif était d'évaluer le niveau de risque thromboembolique et la pratique de la thromboprophylaxie.Méthodes: Il s'agissait d'une étude rétrospective réalisée sur une durée de 12 mois dans le service de médecine interne du CHU le Dantec. L'inclusion des patients était systématique à l'exclusion des patients ayant une durée d'hospitalisation de moins de 3 jours et de ceux venus avec un traitement anticoagulant.Résultats: Nous avons colligé 352 dossiers. Le sexe ratio était à 1,21 en faveur des hommes. L'âge moyen des patients est de 47ans. Le niveau de risque  thromboembolique a été faible dans 23%, modéré dans 22%, élevé dans 36%, et maximal dans 19% des cas. Les facteurs de risque retrouvés sont représentés  par l'alitement (98%), l'âge compris entre 41-74 ans (47%), les néoplasies (20,1%). L'insuffisance cardiaque et les affections respiratoires graves sont  rapportées  chez respectivement 9,3% et 8,5% des patients. Une prophylaxie était nécessaire chez 77% des patients hospitalisés mais seuls 12% des patients en avait  bénéficié.Conclusion: La nécessité d'une prévention de la maladie thromboembolique veineuse est bien cernée par les praticiens mais se heurte à de nombreux obstacles d'où la nécessité d'une mise en place d'outils pratiques et fonctionnels de dépistages et de produits anticoagulants accessibles

Evaluation de l’état hydrique chez les patients hémodialysés chroniques : une étude transversale monocentrique: Assessment of the hydration status in chronic hemodialysis patients: a single-center cross-sectional study

Context and objective. For many practitioners, blood pressure is the main indicator of the hydration status of the chronic hemodialysis patient. The objective of this study was to assess the extent to which bioimpedance analysis (BIA) can assist in determining acute changes in fluid volume during the hemodialysis session. Methods. This was a 9-week longitudinal study. The total body water (TBW) was measured with a BIA analyzer, before and after 6 successive sessions. The ΔWeight was compared to the ΔTBW by calculating the P/V ratio (ΔWeight/ΔTBW) with the assumption that the dry weight is reached when P/V = 1. Results. The measurements made in 22 patients (46.6 years, 54.5% men, 92.3 months on dialysis) were reproducible. There was no statistically significant difference between ΔTBW and ΔWeight. However, at the individual level, significant differences had been observed. Using hypertension as a marker for a state of hyperhydration, a 31.8% agreement was noted between the P/V ratio and hypertension. Conclusion. Although the loss of water predicted by the BIA did not always correspond to the weight loss, BIA is a technique that can be used to assess the variations in TBW during the hemodialysis session in patients. Contexte et objectif. La pression artérielle est pour de nombreux praticiens, l’indicateur principal du statut hydrique du patient hémodialysé chronique. L’objectif de la présente étude était d’évaluer dans quelle mesure l’analyse d’impédance bioélectrique (BIA) pourrait aider à la détermination des variations aigues du volume hydrique au cours de la séance d’hémodialyse. Méthodes. Il s’agissait d’une étude de suivi longitudinal sur 9 semaines. Le volume total d’eau (VTE) a été mesuré par BIA, avant et après 6 séances. Le ΔPoids a été comparé au ΔVTE par le calcul du ratio P/V (ΔPoids / ΔVTE) dans l’hypothèse que le poids sec est atteint lorsque P/V = 1. Résultats. Les mesures faites chez 22 patients (46,6 ans, 54,5% hommes, 92,3 mois en dialyse) étaient reproductibles. Il n’y avait pas de différence statistiquement significative entre le ΔVTE et le ΔPoids. Cependant à l’échelon individuel des différences importantes étaient observées. En utilisant l’hypertension artérielle (HTA) comme marqueur d’un état d’hyperhydratation, une concordance de 31,8% était notée entre le ratio P/V et l’HTA. Conclusion. Bien que la perte d’eau prédite par la BIA ne corresponde pas toujours à celle du poids, la BIA est une technique qui peut être utilisée pour évaluer les variations du VTE au cours de la séance d’hémodialys

Proliferative Glomerulonephritis: Risk Factor for Hypertension in Lupus

Studies report a high prevalence of hypertension in lupus, reaching up to 74%. The incidence of hypertension in SLE patients is increased with the severity of the kidney damage. This work was carried out with the objective of determining the prevalence of hypertension in lupus nephritis and to seek the existence of an association between the presence of a proliferative glomerulonephritis and hypertension. Patients and Methods. This was a case-control study, carried out in the nephrology department of the Aristide Le Dantec University Hospital in Dakar. All records of patients with lupus nephritis over a 10-year period, from January 01, 2007, to December 31, 2016, were included. Results. During the study period, out of 64 lupus nephritis records collected, 28 patients had hypertension, for a hospital prevalence of 43.75%. The mean age of the patients was 30.64 years ± 10.44. There were 24 women and 4 men. The mean systolic blood pressure was 156 mmHg (110–220) and the mean diastolic blood pressure was 100 mmHg (80–130). The mean serum creatinine was 29.48 mg/l ± 24.99. The mean proteinuria was 4.50 g/24 h ± 2.87. Hypertriglyceridemia was observed in one patient. Hypercholesterolemia was present in 3 patients. HDL levels were normal in all patients and elevated LDL levels were noted in all 4 patients. None of our patients had diabetes. Class III was found in 11 cases, class IV in 14 cases, pure class V in 2 cases, and class II in 1 case. Hypertension was associated with the presence of proliferative glomerulonephritis (odds ratio, 7.45; 95% CI, 1.9 to 29.1; p=0.002). Conclusion. Hypertension is common in lupus nephritis. The presence of a proliferative glomerulonephritis is a risk factor for the development of arterial hypertension. Screening and adequate management of hypertension are essential for the prevention of the progression of chronic kidney disease in lupus

The implementation of long-lasting insecticidal bed nets has differential effects on the genetic structure of the African malaria vectors in the Anopheles gambiae complex in Dielmo, Senegal

International audienceBackground: Mosquitoes belonging to the Anopheles gambiae complex are the main vectors of malaria in sub-Saharan Africa. Among these, An. gambiae, Anopheles coluzzii and Anopheles arabiensis are the most efficient vectors and are largely distributed in sympatric locations. However, these species present ecological and behavioural differences that impact their vectorial capacity and complicate vector-control efforts, mainly based on long-lasting insecticidal bed nets (LLINs) and indoor residual spraying (IRS). In this study, the genetic structure of these three species in a Senegalese village (Dielmo) was investigated using microsatellite data in samples collected in 2006 before implementation of LLINs, in 2008, when they were introduced, and in 2010, 2 years after the use of LLINs.Results: In this study 611 individuals were included, namely 136 An. coluzzii, 101 An. gambiae, 6 An. coluzzii/An. gambiae hybrids and 368 An. arabiensis. According to the species, the effect of the implementation of LLINs in Dielmo is differentiated. Populations of the sister species An. coluzzii and An. gambiae regularly experienced bottleneck events, but without significant inbreeding. The Fst values suggested in 2006 a breakdown of assortative mating resulting in hybrids, but the introduction of LLINs was followed by a decrease in the number of hybrids. This suggests a decrease in mating success of hybrids, ecological maladaptation, or a lesser probability of mating between species due to a decrease in An. coluzzii population size. By contrast, the introduction of LLINs has favoured the sibling species An. arabiensis. In this study, some spatial and temporal structuration between An. arabiensis populations were detected, especially in 2008, and the higher genetic diversity observed could result from a diversifying selection.Conclusions: This work demonstrates the complexity of the malaria context and shows the need to study the genetic structure of Anopheles populations to evaluate the effectiveness of vector-control tools and successful management of malaria vector control

Investigating insecticide resistance and knock-down resistance (kdr) mutation in Dielmo, Senegal, an area under long lasting insecticidal-treated nets universal coverage for 10 years

Abstract Background The use of insecticides, through indoor residual spraying and long-lasting insecticide-treated nets (LLINs), is essential to control malaria vectors. However, the sustainability of these tools is challenged by the spread of insecticide resistance in Anopheles mosquitoes. This study was conducted to assess the susceptibility to insecticides and to determine the resistance mechanisms in malaria vectors in Dielmo, a rural area of western Senegal where LLINs were introduced a decade ago. Methods CDC bottle bioassays were used to determine the susceptibility of 2–5 day-old unfed Anopheles gambiae s.l. females to alphacypermethrin (12.5 µg/bottle), deltamethrin (12.5 µg/bottle), etofenprox (12.5 µg/bottle), lambdacyhalothrin (12.5 µg/bottle), permethrin (21.5 µg/bottle), DDT (100 µg/bottle), bendiocarb (12.5 µg/bottle), pirimiphos-methyl (20 µg/bottle) and fenitrothion (50 µg/bottle). The involvement of glutathione-S-transferases (GSTs) in insecticide resistance was assessed using a synergist, etacrynic acid (EA, 80 µg/bottle). Polymerase chain reaction (PCR) was used to investigate the presence of ‘knock-down resistance (kdr)’ mutation and to identify sibling species within the An. gambiae complex. Results CDC bottle bioassays showed that mosquitoes were fully susceptible to lambdacyhalothrin, bendiocarb and fenitrothion. Overall, mortality rates of 97, 94.6, 93.5, 92.1, and 90.1% were, respectively, observed for permethrin, deltamethrin, pirimiphos-methyl, etofenprox and alphacypermethrin. Resistance to DDT was observed, with a mortality rate of 62%. The use of EA significantly improved the susceptibility of An. gambiae s.l. to DDT by inhibiting GSTs (p = 0.03). PCR revealed that Anopheles arabiensis was the predominant species (91.3%; IC 95 86.6–94%) within An. gambiae complex from Dielmo, followed by Anopheles coluzzii (5.4%; IC 95 2.7–8.1%) and Anopheles gambiae s.s. (3.3%; IC 95 0.6–5.9%). Both 1014F and 1014S alleles were found in An. arabiensis population with frequencies of 0.08 and 0.361, respectively, and 0.233 and 0.133, respectively in An. coluzzii. In An. gambiae s.s. population, only kdr L1014F mutation was detected, with a frequency of 0.167. It was observed that some individual mosquitoes carried both alleles, with 19 specimens recorded for An. arabiensis and 2 for An. coluzzii. The presence of L1014F and L1014S alleles were not associated with resistance to pyrethroids and DDT in An. arabiensis. Conclusions The co-occurrence of 1014F and 1014S alleles and the probable involvement of GSTs enzymes in insecticide resistance in An. gambiae s.l. should prompt the local vector programme to implement non-pyrethroid/DDT insecticides alternatives

Evaluation of the Efficacy of Fludora^® Fusion WP-SB 56.25 (Mixture of Clothianidin and Deltamethrin) against <i>Anopheles coluzzii</i> Laboratory and <i>An. arabiensis</i> Wild Colonies

For malaria control, the application of long-lasting insecticidal nets and indoor residual spraying has led to a significant reduction in morbidity and mortality. However, the sustainability of these gains is hampered by the increase in insecticide resistance. It is therefore judicious to evaluate new insecticide formulations. In comparison to clothianidin and deltamethrin, the efficacy and residual effect of Fludora® Fusion was evaluated using an Anopheles coluzzii laboratory and An. arabiensis wild colonies in huts from August 2016 to June 2017 on cement and mud walls. Mortality was recorded at 24, 48, 72, and 96 h post exposure. Like deltamethrin and clothianidin, Fludora® Fusion showed delayed mortality rates above the WHO’s 80% threshold over a period of 11 months with the laboratory strain. With the wild strain, while residual efficacy was observed at 2 months for the three insecticides, no residual efficacy was observed at 8 months at 24 h in both substrates. However, the increased efficacy was observed with increased holding periods (72 h and 96 h). These findings suggest that Fludora® Fusion could be an alternative candidate since this duration covers the transmission period in most areas in Senegal

The impact of periodic distribution campaigns of long-lasting insecticidal-treated bed nets on malaria vector dynamics and human exposure in Dielmo, Senegal

International audienceThe implementation of long-lasting insecticidal-treated bed nets (LLINs) has contributed to halving the mortality rate due to malaria since 2000 in sub-Saharan Africa. These tools are highly effective against indoor-feeding malaria vectors. Thus, to achieve the World Health Assembly's new target to reduce the burden of malaria over the next 15 years by 90%, it is necessary to understand how the spatiotemporal dynamics of malaria vectors and human exposure to bites is modified in the context of scaling up global efforts to control malaria transmission. This study was conducted in Dielmo, a Senegalese village, after the introduction of LLINs and two rounds of LLINs renewals. Data analysis showed that implementation of LLINscorrelatedwith a significant decrease in the biting densities of themainmalaria vectors, Anopheles gambiae s. l. and Anopheles funestus, reducing malaria transmission. Other environment factors likely contributed to the decrease in An. funestus, but this trend was enhanced with the introduction of LLINs. The bulk of bites occurred during sleeping hours, but the residual vector populations of An. gambiae s. l. and An. funestus had an increased propensity to bite outdoors, so a risk of infectious bites remained for LLINs users. These results highlight the need to increase the level and correct use of LLINs and to combine this intervention with complementary control measures against residual exposure, such as spatial repellents and larval source management, to achieve the goal of eliminating malaria transmission

Resistance profile of bacteria isolated from the environment of high-risk departments in Ziguinchor hospitals

Background: The environment of our hospital facilities is colonised by various microorganisms. These microorganisms in general and bacteria in particular are often responsible for nosocomial infections. The occurrence of these infections is linked firstly to the lack of asepsis, secondly to the nature of the colonising bacteria and thirdly to the immune status of the patients. The objective of this study was to evaluate the composition of the bacterial flora and to determine the antibiotic resistance profile of these bacteria. Methods : We proceeded to swab the surface of the work areas (table, bench, trolley, hospital bed, door wrist, gurney, incubator, respirator, etc.).  The swabs were then soaked in a culture broth (Thioglycolate Broth or BT) for 18 to 24 hours before being plated on selective media for identification ; Chapman agar, EMB agar (Eosin Methylen Blue), GSN agar (Blood Agar + nalidixic acid), Sabouraud agar. Results: The isolated bacteria consisted mainly of multidrug-resistant bacteria (MDR). Thus, extended-spectrum beta-lactamase-secreting bacteria represented 5.5% (8 strains) of the isolated bacteria were distributed as follows: Enterobacter spp (25%, n=4) Klebsiella pneumoniae (12.5%, n=2) and Escherichia coli (12.5%, n=2). Among the other BMR, we found Acinetobacter spp (25%, n=4), Pseudomonas aeruginosa (6.25%, n=1) and methicillin-resistant Staphylococcus aureus (18.75%, n=3). Conclusion: Nosocomial infections are nowadays one of the main causes of prolonged hospital stay. The isolated bacteria of medical interest were mainly multidrug resistant bacteria. It is therefore imperative to respect the rules of hygiene during care and to evaluate the composition of the bacterial flora of the services in order to set up a strategic plan to fight against these infections