SANTE INCLUSIVE ET DEVELOPPEMENT ECONOMIQUE AU SENEGAL

This article is an attempt to elaborate an Inclusive Health Index (ISI) in Senegal to assess the performance of the health system. The health map previously supposed to be the reference tool for health policy planning by public authorities did not favor the holistic approach to a better understanding of the constraints of the sector. Analysis of the three dimensions of health (accessibility, quality and quantity) using the PAC (Principal Component Analysis)Finance & Finance Internationale N°21 janvier 2021http://revues.imist.ma/?journal=FFI ISSN: 2489-12902method and the Tottaly Fuzzy Analysis method indicates a low composite index value of 0.008 on average over the period 1995-2014. The results show also that the level of development has a positive impact on Inclusive Health Index (ISI)

HIV infection risk and condom use among sex workers in Senegal::evidence from the list experiment method

International audienceSocial desirability bias, which is the tendency to under-report socially undesirable health behaviours, significantly distorts information on sensitive behaviours that is gained from self-reports. As a result, self-reported condom use among high-risk populations is thought to be systematically over-reported, and it is impossible to identify the determinants of condom use. The main objective of the article is to elicit unbiased information on condom use among female sex workers (FSWs) using the double list experiment method to analyse the role of HIV infection and exposure to HIV prevention methods in condom use. More specifically, the difference in levels of condom use between HIV-positive and HIV-negative FSWs is estimated. In addition, the role of FSWs’ registration and participation in a pre-exposure prophylaxis (PrEP) demonstration project in condom use is considered. A list experiment was designed to elicit condom use information from 786 FSWs in Senegal who were surveyed in 2015 and 2017. Using the list experiment method, participants were randomly assigned to one of two groups (treatment or control) and were asked to report the number of statements they agreed with. Respondents assigned to the control group were presented with three non-sensitive items, whereas those allocated to the treatment group were presented with the same three statements plus the sensitive item (e.g. ‘I used a condom during my last intercourse with a client’). Comparing the average number of sentences that were agreed with in both groups provides an estimation of the condom use rate in the treatment group and estimating such prevalence for several sub-groups allows the role of HIV infection risk in condom use to be identified. The percentage of FSWs using condoms in their last sexual intercourse with a client was 80% in 2015 and 78% in 2017, which was significantly lower than the 97% obtained in the face-to-face surveys in both waves. When estimating condom use among sub-groups with the list experiment method, we found that condom use among HIV-positive FSWs was only 34%, which was 47 percentage points lower than condom use among HIV-negative FSWs. We also found that registered FSWs are more likely to use condoms than clandestine FSWs. However, we did not find any difference in condom use between FSWs who were enrolled in the PrEP demonstration project and those who were not enrolled. Health policies should therefore aim to increase condom use among HIV-positive FSWs

Reforming the registration policy of female sex workers in Senegal? Evidence from a discrete choice experiment

Evidence suggests that treating sexually transmitted infections (STIs) amongst female sex workers (FSWs) is a cost-effective strategy to reduce the spread of HIV/AIDS. Senegal is the only African country where sex work is regulated by a public health policy which aims to monitor and routinely treat STIs. The law requires FSWs to be at least 21 years old, register with a health centre and the police, carry an up-to-date registration booklet, attend monthly health check-ups, and test negative for STIs. Despite health and legal benefits of registration, 80% of FSWs in Senegal are not registered. Hence, the potential health benefits of the policy have not materialised. To understand why FSWs do not want to register and to define policy changes that would increase the registration rate of FSWs in Senegal, we designed and implemented a discrete choice experiment (DCE) completed by 241 registered and 273 non-registered FSWs. Participants made choices between a series of hypothetical but realistic registration policy changes. Conditional logit models were used to analyse the DCE data. The results highlighted that confidentiality at the health facility was an important element, registered and non-registered FWs were respectively 26.0 percentage points (pp) and 22.1 pp more likely to prefer a policy that guaranteed confidentiality at the health centre. Similarly, both groups preferred a policy where their health record was only held at the health centre and not with the police. Several interventions to increase FSW registration rate and improve their wellbeing may be implemented without modifying the law. For example, the introduction of psychosocial support in the registration policy package, replacing the registration booklet by a QR code, the use of electronic medical files and the integration of FSWs routine visits with maternal health appointments to increase confidentiality have the potential to encourage registration of FSWs

Reforming the registration policy of female sex workers in Senegal? Evidence from a discrete choice experiment

Evidence suggests that treating sexually transmitted infections (STIs) amongst female sex workers (FSWs) is a cost-effective strategy to reduce the spread of HIV/AIDS. Senegal is the only African country where sex work is regulated by a public health policy which aims to monitor and routinely treat STIs. The law requires FSWs to be at least 21 years old, register with a health centre and the police, carry an up-to-date registration booklet, attend monthly health check-ups, and test negative for STIs. Despite health and legal benefits of registration, 80% of FSWs in Senegal are not registered. Hence, the potential health benefits of the policy have not materialised. To understand why FSWs do not want to register and to define policy changes that would increase the registration rate of FSWs in Senegal, we designed and implemented a discrete choice experiment (DCE) completed by 241 registered and 273 non-registered FSWs. Participants made choices between a series of hypothetical but realistic registration policy changes. Conditional logit models were used to analyse the DCE data. The results highlighted that confidentiality at the health facility was an important element, registered and non-registered FWs were respectively 26.0 percentage points (pp) and 22.1 pp more likely to prefer a policy that guaranteed confidentiality at the health centre. Similarly, both groups preferred a policy where their health record was only held at the health centre and not with the police. Several interventions to increase FSW registration rate and improve their wellbeing may be implemented without modifying the law. For example, the introduction of psychosocial support in the registration policy package, replacing the registration booklet by a QR code, the use of electronic medical files and the integration of FSWs routine visits with maternal health appointments to increase confidentiality have the potential to encourage registration of FSWs

Sexuality-Based Stigma and Access to Care: Intersecting Perspectives Between Health Care Providers and Men Who Have Sex With Men in HIV Care Centres in Senegal

Context: Men who have sex with men (MSM) in Senegal face a challenging socio-legal context, marked by homophobia and the illegality of homosexuality. In addition, HIV prevalence among MSM is 27.6%, 46 times greater than the one in the general population (0.5%). Nevertheless, access to health care by MSM may be hampered by stigmatising attitudes from health facility staff (medical and non-medical). // Aims and Methods: This article describes the health facility staff/MSM relationship and analyses its effects on access to healthcare by MSM. The data used was collected through a field survey based on observations and qualitative interviews conducted in 2019 and 2020 with 16 MSM, 1 NGO staff and 9 health care providers in Dakar (the capital city) and Mbour (secondary city on the West Coast) hospitals. The data was subject to a thematic analysis assisted by the ATLAS software. // Results: The relationship between MSM and health care providers is ambiguous. On the one hand, health care providers are torn between their professional duty to treat MSM and the cost of being stigmatised by other colleagues. Therefore, they often limit their empathy with MSM within the hospital context. On the other hand, MSM, trusting in the confidentiality of health care providers, feel safe in the care pathway. However, we identify the following stigmatising factors limiting access to care include: (1) fear of meeting a relative, (2) difficult relationships with non-medical support staff (mainly security guards), (3) HIV status disclosure and (4) potential conflicts with other MSM. // Conclusion: This study is unique as it includes non-medical staff in its respondents. It shows that hospitals are divided into several areas, based on the stigma perceived by MSM. It is important to map out MSM’s care trajectories and spaces and to identify all types of staff working within them, including non-medical staff, and enrol them in stigma reduction interventions

Connaissances, attitudes et pratiques du personnel infirmier du centre hospitalier universitaire de Fann en matière d’infection à VIH

Il s’agissait d’une étude transversale à visée descriptive et analytique visant à étudier les connaissances, attitudes et pratiques des personnels infirmiers dans le but de réduire les comportements à risque  et les attitudes de stigmatisation face à l’infection à VIH au sein de cette population. Les données ont été recueillies sur un questionnaire auto-administré et saisies grâce au logiciel Epi Info version 3.5.1. Le taux de participation était de 90,1%. Les infirmiers à 20,2%  pensaient qu’il faut isoler les patients séropositifs dans les unités de soins. Un bon niveau de connaissances des moyens de prévention sexuelle du VIH-Sida était retrouvé chez 37% de la population. La principale source d’information était les médias. Le niveau de connaissance était statistiquement lié à l’âge.  Les infirmiers sexuellement actifs  déclaraient à 15,3% avoir déjà été traités pour une IST. L’usage systématiquement du préservatif lors des rapports sexuels était pratiqué par 6,5% des infirmiers. Le multipartenariat sexuel et la pratique de rapports sexuels avec un(e) professionnel (le) du sexe  étaient statistiquement liés au sexe (p < 0,001). Les pénétrations anale et buccale étaient retrouvées chez respectivement 2,1 et 18,5% des infirmiers enquêtés. Deux infirmiers ont déclaré un résultat positif au dernier test de dépistage de l’infection à VIH. Il convient de renforcer périodiquement les connaissances du personnel infirmier au travers des médias en vue d’améliorer leurs pratiques et prévenir la transmission du VIH

Connaissances, attitudes et pratiques du personnel infirmier du centre hospitalier universitaire de Fann en matière d’infection à VIH

Il s’agissait d’une étude transversale à visée descriptive et analytique visant à étudier les connaissances, attitudes et pratiques des personnels infirmiers dans le but de réduire les comportements à risque  et les attitudes de stigmatisation face à l’infection à VIH au sein de cette population. Les données ont été recueillies sur un questionnaire auto-administré et saisies grâce au logiciel Epi Info version 3.5.1. Le taux de participation était de 90,1%. Les infirmiers à 20,2%  pensaient qu’il faut isoler les patients séropositifs dans les unités de soins. Un bon niveau de connaissances des moyens de prévention sexuelle du VIH-Sida était retrouvé chez 37% de la population. La principale source d’information était les médias. Le niveau de connaissance était statistiquement lié à l’âge.  Les infirmiers sexuellement actifs  déclaraient à 15,3% avoir déjà été traités pour une IST. L’usage systématiquement du préservatif lors des rapports sexuels était pratiqué par 6,5% des infirmiers. Le multipartenariat sexuel et la pratique de rapports sexuels avec un(e) professionnel (le) du sexe  étaient statistiquement liés au sexe (p < 0,001). Les pénétrations anale et buccale étaient retrouvées chez respectivement 2,1 et 18,5% des infirmiers enquêtés. Deux infirmiers ont déclaré un résultat positif au dernier test de dépistage de l’infection à VIH. Il convient de renforcer périodiquement les connaissances du personnel infirmier au travers des médias en vue d’améliorer leurs pratiques et prévenir la transmission du VIH

Utilisation du test GeneXpert pour le diagnostic de la tuberculose au service des maladies infectieuses du CHNU de Fann

Introduction: Nous avons réalisé ce travail pour montrer notre expérience d’utilisation du GeneXpert et évaluer son apport dans la confirmation du diagnostic de la tuberculose. Méthodes: Etude prospective descriptive et analytique de janvier à Décembre 2013. Résultats: Quatre vingt quatorze patients ont bénéficié du geneXpert pour le dépistage de la tuberculose toute localisation confondue. Le geneXpert avait été positif dans 62% des cas. Les images radiologiques fortement évocatrices de tuberculose était associées à un geneXpert positif dans 25% des cas. La recherche de BAAR réalisée chez 55 patients était positive dans 9 cas (16%). Le geneXpert était positif sur 46 frottis négatif (54%)et dans 89% sur les frottis positifs. La prévalence de la tuberculose extrapulmonaire était de 34%. Le taux de positivité était variable en fonction du type de prélèvement. Deux cas de résistance à la rifampicine ont été détectées. Conclusion: Le geneXpert a été d’un grand apport pour le diagnostic de la tuberculose pulmonaire et extrapulmonaire mais la bacilloscopie reste incontournable.Pan African Medical Journal 2016; 2

Tuberculose intestinale révélée par une occlusion intestinale aigüe au cours d’une réaction paradoxale au traitement anti-tuberculeux chez un patient immunocompétent: à propos d’un cas et revue de la littérature

La tuberculose intestinale représente 3 à 5% de toutes les localisations viscérales. Malgré l'efficacité démontrée des anti-tuberculeux, des cas d'exacerbation du tableau clinique initial ont été décrits à l'initiation du traitement. Ces réactions dites «paradoxales» sont cependant rarement rapportées chez les immunocompétents et beaucoup moins sous forme d'occlusion intestinale. Nous rapportons un cas de tuberculose intestinale révélée par une occlusion intestinale aigüe au cours d'une réaction paradoxale aux anti-tuberculeux. Il s'agit d'un patient de 26 ans, immunocompétent qui a présenté un syndrome occlusif à un mois de traitement d'une tuberculose pleuro-pulmonaire. La tomodensitométrie (TDM) abdominale était en faveur d'une occlusion intestinale grêlique. La laparotomie objectivait une masse intra-péritonéale avec de multiples adhérences. L'examen anatomopathologique de la pièce opératoire était en faveur d'une tuberculose intestinale. L'évolution était favorable après la poursuite du traitement anti-tuberculeux initial