Indications and Morbidity of Reoperative Thyroid Surgeries in a Military Hospital of Senegal

Objectives. To describe reoperative thyroid surgeries in our department. Study Design. Retrospective cross-sectional and descriptive study at the Ouakam Military Hospital in Dakar (Senegal), over a period of eight and a half years. Methods. The study involved all records of patients who had a reoperative thyroidectomy regardless of the indication and time of the second surgery. Parameters evaluated for first and reoperative surgery were time interval between the two surgeries, operative indications, surgical procedures, intraoperative findings, pathological examination, and morbidity. Results. 30 records of patients were selected out of a total of 698 thyroidectomies (4.3%). Thyroid cancers diagnosed on first surgical specimens were the first indications of reoperations (46.67%) followed by neck hematoma (20%). Completion thyroidectomy with a prophylactic central lymph nodes dissection was the most performed surgical procedure (43.33%) followed by haemostasis (20%). During reoperation, we found active bleeding (20%), textiloma (6.67%), and fourth branchial cleft fistula (3.33%). The morbidity accounted for 10%: lymphorrhea, permanent hypocalcemia, and permanent recurrent nerve palsy, in one case, respectively. There were no statistically significant differences between the morbidity in patients reoperated on and the one for patients operated on once. Conclusion. We did not find an increased risk of postoperative morbidity after reintervention

Acceptability of contraceptive implants at the maternity ward of the Matam Communal Medical Center

Background: World Health Organization (WHO), defines contraception as "the use of agents, devices, methods or procedures to decrease the likelihood of conception or avoid it". In Africa, only 24% of women of childbearing age have access to a modern contraceptive method. The objective of the study was to determine the frequency of use of the contraceptive implant, to describe the socio-demographic characteristics of the users, to identify the reasons for the choice of the method and to assess the degree of satisfaction of the clients.Methods: The study was conducted at the Matam Communal Medical Center on level 2 of the health pyramid in Guinea. This was a 12-month cross-sectional, descriptive and analytical study (June 2017 to May 2018), including all women admitted for desire for contraception and who agreed to choose the implant as a contraceptive method.Results: The study involved 512 clients. The proportion of female users was 26.21%. The average age was 27.8 years, the main users were women of liberal trade, married, multiparous. The main reasons for choice cited by clients were the effectiveness and long duration of action of the method, i.e. 35.2% and 30.9% respectively. The majority of providers of the method were represented by midwives (73.3%) and the degree of client satisfaction with the method was 97%.Conclusions: The implant is a long-acting method of contraction. It is frequently used at the Communal Medical Center of Matam. Its efficient use would involve effective counselling

1-(Thio­phen-2-yl)ethanone thio­semi­carbazone

The title compound, C7H9N3S2, crystallizes with two unique mol­ecules in the unit cell, both present as thio­semicarbazide tautomers. The mol­ecules differ principally in the dihedral angles between the thio­phene ring planes and the planes through the non-H atoms of the hydrazinecarbothio­amide units, viz. 9.80 (8)° for one mol­ecule and 19.37 (7)° for the other. The hydrazinecarbothio­amide units are reasonably planar, with r.m.s. deviations of 0.001Å for each of the mol­ecules. In the crystal, N—H⋯S hydrogen bonds link like mol­ecules into R 2 2(8) inversion dimers. A three-dimensional network structure is generated by additional N—H⋯S hydrogen bonds and weak C—H⋯S contacts between the unique mol­ecules

Association between childhood diarrhoeal incidence and climatic factors in urban and rural settings in the health district of Mbour, Senegal

We assessed the association between childhood diarrhoeal incidence and climatic factors in rural and urban settings in the health district of Mbour in western Senegal. We used monthly diarrhoeal case records among children under five years registered in 24 health facilities over a four-year period (2011-2014). Climatic data (i.e., daily temperature, night temperature and rainfall) for the same four-year period were obtained. We performed a negative binomial regression model to establish the relationship between monthly diarrhoeal incidence and climatic factors of the same and the previous month. There were two annual peaks in diarrhoeal incidence: one during the cold dry season and one during the rainy season. We observed a positive association between diarrhoeal incidence and high average temperature of 36 °C and above and high cumulative monthly rainfall at 57 mm and above. The association between diarrhoeal incidence and temperature was stronger in rural compared to urban settings, while higher rainfall was associated with higher diarrhoeal incidence in the urban settings. Concluding, this study identified significant health-climate interactions and calls for effective preventive measures in the health district of Mbour. Particular attention should be paid to urban settings where diarrhoea was most common in order to reduce the high incidence in the context of climatic variability, which is expected to increase in urban areas in the face of global warming

Prevalence of diarrhoea and risk factors among children under five years old in Mbour, Senegal: a cross-sectional study

Diarrhoeal diseases remain an important cause of mortality and morbidity among children, particularly in low- and middle-income countries. In Senegal, diarrhoea is responsible for 15% of all deaths in children under the age of five and is the third leading cause of childhood deaths. For targeted planning and implementation of prevention strategies, a context-specific understanding of the determinants of diarrhoeal diseases is needed. The aim of this study was to identify risk factors of diarrhoeal diseases in children under the age of five in Mbour, Senegal.; Between February and March 2014, a cross-sectional survey was conducted in four zones of Mbour to estimate the burden of diarrhoeal diseases (i.e. diarrhoea episodes in the 2 weeks preceding the survey) and associated risk factors. The zones covered urban central, peri-central, north peripheral and south peripheral areas. Overall, 596 households were surveyed by a questionnaire, yielding information on sociodemographic, environmental and hygiene behavioural factors. Univariable and multivariable logistic regression analyses were used to identify risk factors associated with the occurrence of diarrhoea.; The reported prevalence of diarrhoea among children under the age of five during the 2 weeks preceding the survey was 26%. Without adjustment, the highest diarrhoea prevalence rates were observed in the peri-central (44.8%) and urban central zones (36.3%). Multivariable regression revealed significant associations between diarrhoeal diseases and unemployment of mothers (adjusted odds ratio [aOR] = 1.62, 95% confidence interval [CI]: 1.18-2.23), use of open bags for storing household waste (aOR = 1.75, 95% CI: 1.00-3.02), evacuation of household waste in public streets (aOR = 2.07, 95% CI: 1.20-3.55), no treatment of stored drinking water (aOR = 1.69, 95% CI: 1.11-2.56) and use of shared toilets (aOR = 1.69, 95% CI: 1.11-2.56).; We found a high prevalence of diarrhoea in children under the age of five in Mbour, with the highest prevalence occurring in the central and peri-central areas. These findings underscore the need for public health interventions to alleviate the burden of diarrhoea among vulnerable groups. Promotion of solid waste disposal and reduction of wastewater exposure should be implemented without delay

High unhealthy food and beverage consumption is associated with poor diet quality among 12–35-month-olds in Guédiawaye Department, Senegal

BackgroundHigh consumption of unhealthy foods and beverages (UFB) during early childhood is cause for concern, with growing evidence from low- and middle-income countries finding associations with poor diet quality and malnutrition. Research from sub-Saharan Africa remains limited, with no studies quantifying the contribution of UFB to total energy intakes among young children or exploring the relationship between such intakes and diet quality or anthropometric outcomes.ObjectivesAssess UFB consumption patterns and their contribution to total energy intake from non-breastmilk foods/beverages (TEI-NBF), assess the association between high UFB consumption and dietary/nutrition outcomes, and explore drivers of unhealthy food choice among young children in Guédiawaye Department, Senegal.MethodsWe conducted a cross-sectional study of a representative sample of 724 primary caregivers and their 12–35.9-month-old children. The study included a questionnaire, a quantitative four-pass 24-h dietary recall, and anthropometric measurements. The contribution of UFB to TEI-NBF was calculated and terciles generated. Logistic and linear models were used to compare outcomes of high versus low UFB consumption terciles.ResultsUFB contributed on average 22.2% of TEI-NBF, averaging 5.9% for the lowest tercile and 39.9% for the highest. Diets of high UFB consumers, as compared to low, were significantly less dense in protein, fiber, and seven of the 11 micronutrients assessed and significantly denser in total fat, saturated fat, and total sugar. No associations were found with anthropometric outcomes. High UFB consumers were older and more likely to be living in food insecurity. The most common drivers of commercial UFB consumption were related to child preference, the use of these products as behavior management tools, treats, or gifts, and the sharing of these products by someone else eating them.ConclusionHigh UFB consumption is associated with poor diet quality among 12–35-month-olds in Guédiawaye Department, Senegal. Addressing high UFB consumption during this critical developmental period should be prioritized in young child nutrition research, programming, and policy development

Profil épidémiologique de la rougeole au Mali de 2009 à 2018: Epidemiological profile of measles in Mali from 2009 to 2018

Introduction: La rougeole, maladie virale hautement contagieuse causée par un Morbillivirus, reste un important problèeme de santé publique dans de nombreux pays malgré l'existence d'un vaccin efficace. La surveillance de la rougeole est l'un des aspects clés de la lutte contre cette maladie. La présente étude avait pour objectif de décrire la mortalité et la morbidité de la rougeole au Mali entre 2009 et 2018. Méthodes: Il s'agissait d'étude transversale descriptive. Les données de surveillance de la rougeole au Mali de 2009 à 2018 ont été analysées en personne, lieu et temps. Résultats: De 2009 à 2018, le nombre de cas confirmés de rougeole était de 6461 dont 29 décès soit une létalité de 0,45%. La confirmation des cas avait été faite par le laboratoire pour 2551 cas (39,48%), par lien épidémiologique pour 3738 cas (57,85%) et cliniquement pour 172 cas (2,66%). Les enfants de moins de 5 ans représentaient 50,97% des cas et 75,86% des décès. La majorité des cas (95,71 %) n'avaient jamais été vaccinés contre la rougeole. Les incidences les plus élevées avaient été observées en 2009 (22,65 pour 100 000 hbts) et 2010 (11,81 pour 100 000 hbts). Tombouctou, Gao et Mopti avaient enregistrés les plus grands nombres de cas en 2009 et Bamako, Koulikoro et Mopti en 2010. Conclusion: La majorité des cas et des décès étaient les enfants non vaccinés de moins de cinq ans. Un renforcement du programme élargi de vaccination de routine, une riposte aux épidéemies et des stratéegies de vaccination couvrant tout le pays sont nécessaires. Introduction: Measles, a highly contagious viral disease caused by a Morbillivirus, remains an important public health problem in many countries despite the availability of an effective vaccine. Measles surveillance is one of the key aspects of measles control. The objective of this study was to describe measles mortality and morbidity in Mali between 2009 and 2018. Methods: This was a descriptive cross-sectional study. Measles surveillance data in Mali from 2009 to 2018 were analysed by person, place and time. Results: From 2009 to 2018, the number of confirmed measles cases was 6461 including 29 deaths, i.e. a case-fatality rate of 0.45%. Cases were confirmed by the laboratory for 2551 cases (39.48%), by epidemiological link for 3738 cases (57.85%) and clinically for 172 cases (2.66%). Children under 5 years of age represented 50.97% of cases and 75.86% of deaths. The majority of cases (95.71%) had never been vaccinated against measles. The highest incidences were observed in 2009 (22.65 per 100,000 inhabitants) and 2010 (11.81 per 100,000 inhabitants). Timbuktu, Gao and Mopti had the highest number of cases in 2009 and Bamako, Koulikoro and Mopti in 2010. Conclusion: The majority of cases and deaths were among unvaccinated children under five years of age. Strengthening of the routine expanded programme of immunisation, response to epidemics and nationwide immunisation strategies are needed

High resolution melting: a useful field-deployable method to measure dhfr and dhps drug resistance in both highly and lowly endemic Plasmodium populations

Background: Emergence and spread of drug resistance to every anti-malarial used to date, creates an urgent need for development of sensitive, specifc and feld-deployable molecular tools for detection and surveillance of validated drug resistance markers. Such tools would allow early detection of mutations in resistance loci. The aim of this study was to compare common population signatures and drug resistance marker frequencies between two populations with diferent levels of malaria endemicity and history of anti-malarial drug use: Tanzania and Sénégal. This was accomplished by implementing a high resolution melting assay to study molecular markers of drug resistance as compared to polymerase chain reaction–restriction fragment length polymorphism (PCR/RFLP) methodology. Methods: Fifty blood samples were collected each from a lowly malaria endemic site (Sénégal), and a highly malaria endemic site (Tanzania) from patients presenting with uncomplicated Plasmodium falciparum malaria at clinic. Data representing the DHFR were derived using both PCR–RFLP and HRM assay; while genotyping data representing the DHPS were evaluated in Senegal and Tanzania using HRM. Msp genotyping analysis was used to characterize the multiplicity of infection in both countries. Results: A high prevalence of samples harbouring mutant DHFR alleles was observed in both population using both genotyping techniques. HRM was better able to detect mixed alleles compared to PCR/RFLP for DHFR codon 51 in Tanzania; and only HRM was able to detect mixed infections from Senegal. A high prevalence of mutant alleles in DHFR (codons 51, 59, 108) and DHPS (codon 437) were found among samples from Sénégal while no mutations were observed at DHPS codons 540 and 581, from both countries. Overall, the frequency of samples harbouring either a single DHFR mutation (S108N) or double mutation in DHFR (C59R/S108N) was greater in Sénégal compared to Tanzania Conclusion: Here the results demonstrate that HRM is a rapid, sensitive, and feld-deployable alternative technique to PCR–RFLP genotyping that is useful in populations harbouring more than one parasite genome (polygenomic infections). In this study, a high levels of resistance polymorphisms was observed in both dhfr and dhps, among samples from Tanzania and Sénégal. A routine monitoring by molecular markers can be a way to detect emergence of resistance involving a change in the treatment policy

Ex vivo susceptibility and genotyping of Plasmodium falciparum isolates from Pikine, Senegal

Background: The monitoring of Plasmodium falciparum sensitivity to anti-malarial drugs is a necessity for effective case management of malaria. This species is characterized by a strong resistance to anti-malarial drugs. In Senegal, the first cases of chloroquine resistance were reported in the Dakar region in 1988 with nearly 7% population prevalence, reaching 47% by 1990. It is in this context that sulfadoxine–pyrimethamine temporarily replaced chloroquine as first line treatment in 2003, pending the introduction of artemisinin-based combination therapy in 2006. The purpose of this study is to assess the ex vivo sensitivity to different anti-malarial drugs of the P. falciparum population from Pikine. Methods: Fifty-four samples were collected from patients with non-complicated malaria and aged between 2 and 20 years in the Deggo health centre in Pikine in 2014. An assay in which parasites are stained with 4′, 6-di-amidino-2-phenylindole (DAPI), was used to study the ex vivo sensitivity of isolates to chloroquine, amodiaquine, piperaquine, pyrimethamine, and dihydroartemisinin. High resolution melting was used for genotyping of pfdhps, pfdhfr, pfmdr1, and pfcrt genes. Results: The mean IC50s of chloroquine, amodiaquine, piperaquine, dihydroartemisinin, and pyrimethamine were, respectively, 39.44, 54.02, 15.28, 2.23, and 64.70 nM. Resistance mutations in pfdhfr gene, in codon 437 of pfdhps gene, and an absence of mutation at position 540 of pfdhps were observed. Mutations in codons K76T of pfcrt and N86Y of pfmdr1 were observed at 51 and 11% population prevalence, respectively. A relationship was found between the K76T and N86Y mutations and ex vivo resistance to chloroquine. Conclusion: An increase in sensitivity of isolates to chloroquine was observed. A high sensitivity to dihydroartemisinin was observed; whereas, a decrease in sensitivity to pyrimethamine was observed in the parasite population from Pikine

Effectiveness of Seasonal Malaria Chemoprevention in Children under Ten Years of Age in Senegal: A Stepped-Wedge Cluster-Randomised Trial.

BACKGROUND: Seasonal Malaria Chemoprevention (SMC) with sulfadoxine-pyrimethamine (SP) plus amodiaquine (AQ), given each month during the transmission season, is recommended for children living in areas of the Sahel where malaria transmission is highly seasonal. The recommendation for SMC is currently limited to children under five years of age, but, in many areas of seasonal transmission, the burden in older children may justify extending this age limit. This study was done to determine the effectiveness of SMC in Senegalese children up to ten years of age. METHODS AND FINDINGS: SMC was introduced into three districts over three years in central Senegal using a stepped-wedge cluster-randomised design. A census of the population was undertaken and a surveillance system was established to record all deaths and to record all cases of malaria seen at health facilities. A pharmacovigilance system was put in place to detect adverse drug reactions. Fifty-four health posts were randomised. Nine started implementation of SMC in 2008, 18 in 2009, and a further 18 in 2010, with 9 remaining as controls. In the first year of implementation, SMC was delivered to children aged 3-59 months; the age range was then extended for the latter two years of the study to include children up to 10 years of age. Cluster sample surveys at the end of each transmission season were done to measure coverage of SMC and the prevalence of parasitaemia and anaemia, to monitor molecular markers of drug resistance, and to measure insecticide-treated net (ITN) use. Entomological monitoring and assessment of costs of delivery in each health post and of community attitudes to SMC were also undertaken. About 780,000 treatments were administered over three years. Coverage exceeded 80% each month. Mortality, the primary endpoint, was similar in SMC and control areas (4.6 and 4.5 per 1000 respectively in children under 5 years and 1.3 and 1.2 per 1000 in children 5-9 years of age; the overall mortality rate ratio [SMC: no SMC] was 0.90, 95% CI 0.68-1.2, p = 0.496). A reduction of 60% (95% CI 54%-64%, p < 0.001) in the incidence of malaria cases confirmed by a rapid diagnostic test (RDT) and a reduction of 69% (95% CI 65%-72%, p < 0.001) in the number of treatments for malaria (confirmed and unconfirmed) was observed in children. In areas where SMC was implemented, incidence of confirmed malaria in adults and in children too old to receive SMC was reduced by 26% (95% CI 18%-33%, p < 0.001) and the total number of treatments for malaria (confirmed and unconfirmed) in these older age groups was reduced by 29% (95% CI 21%-35%, p < 0.001). One hundred and twenty-three children were admitted to hospital with a diagnosis of severe malaria, with 64 in control areas and 59 in SMC areas, showing a reduction in the incidence rate of severe disease of 45% (95% CI 5%-68%, p = 0.031). Estimates of the reduction in the prevalence of parasitaemia at the end of the transmission season in SMC areas were 68% (95% CI 35%-85%) p = 0.002 in 2008, 84% (95% CI 58%-94%, p < 0.001) in 2009, and 30% (95% CI -130%-79%, p = 0.56) in 2010. SMC was well tolerated with no serious adverse reactions attributable to SMC drugs. Vomiting was the most commonly reported mild adverse event but was reported in less than 1% of treatments. The average cost of delivery was US$0.50 per child per month, but varied widely depending on the size of the health post. Limitations included the low rate of mortality, which limited our ability to detect an effect on this endpoint. CONCLUSIONS: SMC substantially reduced the incidence of outpatient cases of malaria and of severe malaria in children, but no difference in all-cause mortality was observed. Introduction of SMC was associated with an overall reduction in malaria incidence in untreated age groups. In many areas of Africa with seasonal malaria, there is a substantial burden in older children that could be prevented by SMC. SMC in older children is well tolerated and effective and can contribute to reducing malaria transmission. TRIAL REGISTRATION: ClinicalTrials.gov NCT00712374