Why are IPTp Coverage Targets so Elusive in Sub-Saharan Africa? A Systematic Review of Health System Barriers.

Use of intermittent preventive treatment (IPTp) is a proven cost-effective intervention for preventing malaria in pregnancy. However, despite the roll-out of IPTp policies across Africa more than ten years ago, utilization levels remain low. This review sought to consolidate scattered evidence as to the health system barriers for IPTp coverage in the continent.Methods and findings: Relevant literature from Africa was systematically searched, reviewed and synthesized. Only studies containing primary data were considered. Studies reveal that: (i) poor leadership and governance contribute to slow decentralization of programme management, lack of harmonized guidelines, poor accountability mechanisms, such as robust monitoring and evaluation systems; (ii) low budgetary allocation towards policy implementation slows scale-up, while out-of-pocket expenditure deters women from seeking antenatal services that include IPTp; (iii) there are rampant human resource challenges including low staff motivation levels attributed to such factors as incorrect knowledge of IPTp recommendations and inadequate staffing; (iv) implementation of IPTp policies is hampered by prevailing service delivery barriers, such as long waiting time, long distances to health facilities and poor service provider/client relations; and (v) drug stock-outs and poor management of information and supply chains impair sustained availability of drugs for IPTp. For successful IPTp policy implementation, it is imperative that malaria control programmes target health system barriers that result in low coverage and hence programme ineffectiveness

Ball back in Africa’s court: funding malaria control and elimination

Pan African Medical Journal 2013; 14: 7

Asphyxie Perinatale Au Service De Neonatologie De L’hopital De La Paix De Ziguinchor (Senegal)

Introduction: Perinatal asphyxia (PA) is one of the reasons for the transfer of the newborn to neonatal resuscitation services. The objective of this work was to study the epidemiological, obstetrical, clinical and evolutionary aspects of PA at the Ziguinchor Peace Hospital. Materials and methods: This was a retrospective study of cases of hospitalized HAs during the period 1 December 2015 to 31 May 2017. The diagnosis of PA was based on an anomaly of the rhythm Fetal heart rate and / or amniotic fluid abnormality; A score of Apgar <7 at the 5th minute and / or the absence of an immediate cry at birth. We collected epidemiological, obstetric, clinical and evolutionary data. Results: We collected 153 cases of PA (90 boys and 63 girls) among 742 newborns, an incidence of 20.6% of neonatal hospitalizations. The mean age of mothers was 17.2 years; 82.0% of mothers were between 18 and 35 years of age and half (50.3%) had four or more NPCs. Anemia (37.0%), maternal infection (36.4%), hypertension (30.9%), premature rupture of membranes (RPM) (28.6%), eclampsia and Preeclampsia (9.9%) were the main obstetric complications. The delivery was performed by Caesarean section in 52.3% of cases and by low procedure in 47.7% of cases. The term of birth was between 37 and 41 SA in 53.3% of the cases. The amniotic fluid (LA) was tinted in 55.7% of the cases and meconium in 12.3%. At the 5th minute, 42.6% of the infants had an Apgar score <7. One hundred percent of the children (n = 153) had been aspirated at birth and 24.8% (n = 38) had been ventilated To the mask. One hundred and twenty-three patients (80.3%) had anoxo-ischemic encephalopathy, of which 95 (77.2%) were in stage 1; 27 (22.0%) were in stage 2 and 1 (0.8%) was in stage 3 of the Sarnat classification. The main neurological signs were the anomalies of archaic reflexes (64.2%); Tone disorders (57.7%); Disorders of consciousness (22.8%); Convulsions (21.9%). The case fatality rate was 10.4% (16 deaths). Deaths were significantly associated with low birth, MMP, mask ventilation, respiratory distress, and convulsion. Conclusion: PA accounts for 20.6% of neonatal hospitalizations at the Ziguinchor Peace Hospital. Its lethality is 10.4%. It is associated with high morbidity

Plastic Surgery of Male External Genitalia after a Trauma Caused by a Mill in Rural Area

The trauma of the external genital organs is a common urological emergency that can affect the patient's functional and psychosocial prognosis as well as his family. We report a case of direct trauma of the external genitalia of a 27-year-old by a mill, requiring a recover plastic surgery in rural area. The examination at admission revealed a significant damage of penile and scrotal skin, denuding testes and cavernous bodies. A cover plastic surgery was performed. After a year of follow up, the outcome was good

Evaluation De La Denutrition Chez Les Enfants Ages De 2 A 60 Mois Hospitalises Aux Services De Pediatrie Des Hopitaux De Ziguinchor (Senegal)

Introduction: Malnutrition is a public health problem in developing countries. The prevalence of malnutrition at the national level hardly reflects the reality in hospitals. It is in this context that we assessed the nutritional status of children from 2 months to 5 years hospitalized in the pediatric ward of the regional hospital and the Ziguinchor Peace Hospital. Materials and methods: This was a prospective study from June 1 to October 30, 2016. Children aged 2 to 60 months, hospitalized in one of the two services, were included. Children with esdato-ascetic syndrome were not included. Epidemiological, anthropometric data, and associated diagnosis were studied. Results: We included 114 children (70 boys and 44 girls). The average age was 21.9 months [4-59]. Forty-two point one percent (42.1%) of infants <6 months were breastfed exclusively with breast milk. The weaning of children was done early in 55.3%. The mean age of mothers was 26.6 years [17-38]. The socioeconomic level was low in 62.3% of cases. The prevalence of malnutrition averaged 35.5% for underweight; 32.9% for wasting and 32.0% for stunting. Acute respiratory infections (ARI) and acute gastroenteritis were the most common associated conditions. Mean hospital stay was 8 days ± 009 [3-28]. About two thirds of the patients (n = 72) had a hospital stay of more than 7 days. Malnutrition was significantly associated with multiparity, low socioeconomic status, hospital stay of more than 7 days and infectious diseases. Conclusion: Infections and a hospital stay longer than a week are factors favoring malnutrition in children from 2 months to 5 years

Dietary Intakes and Nutritional Status of Mother-Child (6-23 Months Old) Pair Targeted through the "Organic Residual Products for Biofortified Foods for Africa Project" in Rural Area in Senegal

Background: Despite micronutrient supplementation and food fortification strategies carried out for decades, micronutrient deficiencies remain prevalent among children under 5 years old in rural area in Senegal. The OR4FOOD project was implemented as a preventive and long-term approach to reduce malnutrition through biofortification. Objective: We aimed to assess the baseline dietary intakes and nutritional status of the mother-child (6-23 months old) pair in a rural community in Senegal. Methods: Dietary intakes were assessed using dietary recall questionnaires and weight food records. All foods and beverages consumed from waking to bedtime were quantified, and nutrient intakes were calculated. The nutritional status was measured by anthropometry. Results: Results showed that 77.2% of children had low dietary diversity score. Only 18% of them received an appropriate complementary feeding according to the minimum acceptable diet. Cereals and legumes were among the most consumed food groups, whereas orange-fleshed sweet potato (OFSP) and animal food products were rarely consumed. Median dietary intakes of iron, zinc, and vitamin A were lower than the recommended dietary allowances. Acute malnutrition and stunting affected 14.6% and 16.9% of children, respectively. Overall, 20.8% of mothers were underweighted, and overweight/obesity affected 23.1% of them. Conclusion: Malnutrition remains prevalent in rural areas of Senegal and affects both mothers and children. Furthermore, their nutrient requirements were not covered by the diet. Millet and cowpea being widely consumed, optimizing their iron and zinc content through biofortification and the introduction of OFSP might improve micronutrient intakes and would be promising strategies to prevent child malnutrition

Factors Affecting the Statural Growth Retardation in Children using Steroids in Idiopathic Nephrotic Syndrome

Background and Aim: Idiopathic nephrotic syndrome or nephrosis causes massive protein leakage in the urine. Its treatment requires steroids (prednisone, methylprednisolone), often for a prolonged period, notably in case of steroid-dependence or steroid-resistance. In children, long-term use of steroids can lead to several side effects such as statural growth retardation/ stunting. This study evaluated the frequency of stunting in idiopathic nephrotic syndrome in children on steroids and identified the associated factors.     
 Material and Methods: This was a retrospective, descriptive cohort study carried out in children aged 0 to 16 years treated at the paediatric nephrology unit of Aristide Le Dantec Hospital in Dakar, between 1 December 2017 and 31 May 2020. All records of nephrotic children treated in outpatient or inpatient setting were included. These children had to be on corticosteroid therapy for at least 30 months and have a height taken regularly during follow-up consultations.
 Results: Of 259 children followed for idiopathic nephrotic syndrome, 93 were included in the study. The median age was 96.5 months and the sex ratio was 1.9. The mean height of the children at the beginning of the follow-up was -0.26 DS, at the end it was -0.88 DS. At the beginning of the follow-up, 8 children had already stunting. At 12 months follow-up, 72 children (77.4%) had a decrease in z-score; and at 30 months, there were 7 more children (84.9%) who had a decrease in z-score. Methylprednisolone boluses were given to 17 children (18.3%). Calcium supplementation was done in 91 children (97.8%). Vitamin D supplementation was given to 91 children (97.8%). The mean number of relapses was 1.8. Factors associated with stunting were number of relapses ≤3 (p=0.03), duration of corticosteroid therapy >6 months (p<0.0001) and cumulative doses of prednisone >100 mg/kg (p=0.04).
 Conclusion: In prolonged nephrotic syndrome in children, corticosteroids can cause stunting

Major Reduction in Anti-Malarial Drug Consumption in Senegal after Nation-Wide Introduction of Malaria Rapid Diagnostic Tests

BACKGROUND: While WHO recently recommended universal parasitological confirmation of suspected malaria prior to treatment, debate has continued as to whether wide-scale use of rapid diagnostic tests (RDTs) can achieve this goal. Adherence of health service personnel to RDT results has been poor in some settings, with little impact on anti-malarial drug consumption. The Senegal national malaria control programme introduced universal parasite-based diagnosis using malaria RDTs from late 2007 in all public health facilities. This paper assesses the impact of this programme on anti-malarial drug consumption and disease reporting. METHODS AND FINDINGS: Nationally-collated programme data from 2007 to 2009 including malaria diagnostic outcomes, prescription of artemisinin-based combination therapy (ACT) and consumption of RDTs in public health facilities, were reviewed and compared. Against a marked seasonal variation in all-cause out-patient visits, non-malarial fever and confirmed malaria, parasite-based diagnosis increased nationally from 3.9% of reported malaria-like febrile illness to 86.0% over a 3 year period. The prescription of ACT dropped throughout this period from 72.9% of malaria-like febrile illness to 31.5%, reaching close equivalence to confirmed malaria (29.9% of 584,873 suspect fever cases). An estimated 516,576 courses of inappropriate ACT prescription were averted. CONCLUSIONS: The data indicate high adherence of anti-malarial prescribing practice to RDT results after an initial run-in period. The large reduction in ACT consumption enabled by the move from symptom-based to parasite-based diagnosis demonstrates that effective roll-out and use of malaria RDTs is achievable on a national scale through well planned and structured implementation. While more detailed information on management of parasite-negative cases is required at point of care level to assess overall cost-benefits to the health sector, considerable cost-savings were achieved in ACT procurement. Programmes need to be allowed flexibility in management of these funds to address increases in other programmatic costs that may accrue from improved diagnosis of febrile disease

Senegal: Presidential elections 2019 - The shining example of democratic transition immersed in muddy power-politics

Whereas Senegal has long been sold as a showcase of democracy in Africa, including peaceful political alternance, things apparently changed fundamentally with the Senegalese presidentials of 2019 that brought new configurations. One of the major issues was political transhumance that has been elevated to the rank of religion in defiance of morality. It threatened political stability and peace. In response, social networks of predominantly young activists, created in 2011 in the aftermath of the Arab Spring focused on grass-roots advocacy with the electorate on good governance and democracy. They proposed a break with a political system that they consider as neo-colonialist. Moreover, Senegal’s justice is frequently accused to be biased, and the servility of the Constitutional Council which is in the first place an electoral court has often been denounced