Biomedical subjects
Publications and source records attributed to S Diallo.
Thirteen cases of genital tuberculosis are reported to make emphasis onto the difficulties of diagnosis, management and prognosis of the disease. The average age of the patients is 31 years. Most of them were under 30. The circumstances of diagnosis were variable. The diagnosis was essentially made thanks to histology. The evolution was favorable under antibiotics. But clinical sequels as amenorrhea and infertility are frequent.
A battery of sixty-six blood samples from Senegal was analysed by the ParaSight F test, the ICT Malaria PF and the Malaria IgG CELISA. These three assays detect the histidine rich protein 2 antigen of Plasmodium falciparum. Thick smear microscopy was used as the reference method. Sensitivity, specificity, predictive positive and negative values were respectively 89%, 100%, 100%, 88% for the ICT; 86%, 93%, 94%, 85% for the paraSight and 88%, 87%, 88%, 87% for the Malaria IgG CELISA. The three assays failed to detect two positive samples with P. ovale and P. malariae. Assays were also compared with regard to the expense of equipment and reagents and speed and ease of use. The rapid ICT and ParaSight F test can be performed with minimal training and may be specially useful in areas where P. falciparum is the predominant malaria species, in epidemic malaria regions, and where skilled microscopy is not readily available.
In order to assess the parasitic risk for street-food consumers, the authors conducted two studies from September to August 1996, one on street-food sellers (305) and the other on consumers (235). Among the consumers, 127 were considered as not exposed to risk, since they did not frequent the sector being surveyed, and 108 were exposed because they consumed at least one meal per day cooked by the sellers of this area. Both groups filled out a questionnaire and had their stools analysed according to the RITCHIE method. The infection rate was 60% among sellers and 45.5% among consumers. Protozoans were predominant in both groups. Among the consumers, those exposed were significantly more infected. Even though the sellers represent a parasitic risk due to their level of infection and the typology of parasites they shelter, one cannot assume that consumers are contaminated only by the sellers of street food. However, appropriate measures must be implemented in order to minimize risks for street-food consumers.
A survey of endemic malaria in Dakar was carried out in the southern sanitary district covering the city centre and neighbouring areas. The survey was scheduled from June 1994 to May 1995 in 12 sites distant from each other by 1000 to 1500 meters. Clinical and parasitological data were collected during weekly medical follow-ups at the patients' home with the systematic research of Plasmodium once a month. The study included 2,337 persons aged between 1 month and 88 years and belonging to 284 volunteer resident families. Through monthly parasitological examinations, a parasite rate (P.R.) of 0.3% and a gametocyte rate (G.R.) of 0.005% were recorded. Only Plasmodium falciparum was observed. The P.R. varied according to age: from 0.1% in the children under 2 years to 0.7% in the young adults (15-20 years) who appeared significantly more affected than the other age groups, including that of children from 2 to 9 years, of whom only 0.3% were infected by the parasite. The P.R. varied also according to the site surveyed: from 0% in the city centre to 1.3% at the periphery of the sanitary district and according to the time of year, reaching its height of 0.8%, between October and December, that is just after the rainy season. At the end of the year of survey, 929 among those surveyed were considered to have been satisfactorily followed. Their annual incidence rate was 2.4% for the parasitemia and of 1.5% for the malaria attacks. None of the participants aged under 2 years had the parasite. Among the others, the annual incidence rate varied according to the age--although not significantly--passing from 1.1% to 5.3% for parasitemia and from 0.4% to 3.0% for malaria attacks. Theses rates did not differ significantly according to site; the cases registered varied between 1% and 8% for parasitemia and 1% and 5.8% for malaria attacks. Only 10.6% of febrile subjects suffered from malaria attacks, but this rate seemed to go up between October to December, rising to 26.6% which corresponds to 1 case of malaria attacks for 4 cases of hyperthermia in that period. Weak density of Anopheline population and satisfactory medical surveillance explain the recorded results.
Thanks to a serological survey carried out in Dakar from January to November 1993 among 353 procreative women, immune cover regarding toxoplasmosis was assessed using ELISA methodology: 40.2% of the surveyed population had antibodies of toxoplasmosis. No evidence of age, pregnancy, number of previous pregnancies was noted in antitoxoplasmosis antibodies prevalence. The seroconversion risk seems to be low even when it has existed during pregnancy. Contamination occurred during childhood. Some sanitary education should be provided to the procreative population in order to achieve a better compliance with basic hygiene regulations during pregnancy.
To complete a parasitological survey, entomological prospections were carried out in the southern sanitary District of Dakar, the most urbanized of the city and which includes the city centre and the oldest administrative districts. The prospections took place between June 1994 and May 1995 in sites 1.5 km apart, and distributed in such a manner that they covered the entire area. On a monthly basis, female Culicidae were collected in each site at night on human volunteers, followed the next day by the collection of early morning residual fauna in 10 bedrooms located in district concessions. For a total of 308 collections at night on human volunteers and from 1,510 rooms for the residual fauna, 22,901 female Culicidae were caught of which 167 anopheles, corresponding to 0.7%, the remaining 98.5% being Culex quinquefasciatus. This was the species that thus explained the mosquito-nuisance of which the inhabitants of the southern District complained during the period of survey. The female anopheles collected belonged to 2 species, An. arabiensis for 97.6% of those caught and An. pharoensis for 2.4%. An. arabiensis were very slightly represented in the southern District with a density of aggressive females of 0.26 bite/man/night (B/M/N) and a density per room of 0.05 female. The aggressive populations appeared to be relatively important only at the end of the rainy season (September-October) with an average of 0.65 B/M/N in sites located at the periphery of the district with a maximum of 1.33 B/M/N. The highest density of endophilic females registered at the end of the rainy season was 0.1 and its highest value in a given site was 0.36 female/room. The parturity rate of aggressive females was 43.5% and those collected in houses of 84% with an anthropophilic index of 0.98. None of the dissected An. arabiensis females (77.3% of those collected) was a carrier of Plasmodium sporozoites and the circum-sporozoite antigen was not found. A very weak density of An. arabiensis and absence of plasmodial infection among dissected females favoured the absence of malarial transmission in the southern District for the period considered. However malaria transmission could not be absolutely ruled out given the presence of hematozoa carriers, as was revealed by the longitudinal follow-up of a cohort carried out concurrently with the entomological prospections of whom some were residents having declared permanent residence in the city for over two years. This entomological data explain the results of the afore mentioned parasitological survey which, with a registered plasmodic index of 0.3%, means that the southern District can be considered as non endemic. The area is however exposed to the risk of epidemic malaria following an important proliferation of anopheles, which is always possible after heavy rains and flooding and/or an important immigration of persons coming from regions of high malarial endemicity.
The authors carried out a parasitologic survey on 367 inhabitants of Malika, a village located in the immediate surroundings of M'Beubeuss disposal, as well as on 433 other residents of Keur Massar, a location 2 km farther, in order to assess parasitic hazards encountered by people neighbouring this disposal. As far as intestinal parasitosis are concerned, the prevalence rate was significantly higher in Malika (61.3%) than in Keur Massar (48.5%) The sex, social and economic status, level of education as well as the time of dwelling in the neighbouring area were identified as the risk factors of intestinal parasitism. Only the last one can be considered as significantly and independently related to a risk of intestinal parasitism. As for malaria, the plasmodial index in Malika was 6% versus 7.6% in Keur Massar (no significant difference). Thus, if it does exist for neighbouring people, an infestation risk by intestinal parasites related to exposure duration, contrarily, it does not exist for malaria. Appropriate steps should be taken to prevent the hazards encountered by inhabitants of surrounding villages.
In order to determine the prevalence rates of malaria, urinary schistosomiasis and intestinal parasitosis in Saloum's valley, the authors carried out a study which took place from november 16 to november 24, 1996. For malaria, the global parasites index was 22% (146/662). Malaria prevails at a hypoendemic level in N'Diobène and N'Guent-paté villages and at a medium-endemic level in Ribo-Escale and N'Dodj. The infestation index for urinary schistosomiasis was 8.9% (137/154) About intestinal parasite, among 868 persons screened, 124 showed one or several parasites, that is an infestation index of 14.3%. Appropriate steps should be taken to prevent an extension of these conditions along the fossil Saloum's valley.
To determine the characteristics of evolution of systemic lupus erythematosus (SLE), the authors studied 30 cases retrospectively. All were black women aged from 16 to 73 years (with a mean of 30 years) at the time of diagnosis. Dermatological manifestations consisting in discoid lupus or alopecia inaugurated the disease in 12 cases, joint symptoms in 10 cases. Polyarthritis was the most common inaugural manifestation, followed by discoid lupus. Corticosteroids therapy alone or associated to chloroquine or immunosuppressor led to good results; 88% of patients who received treatment had good outcomes in the first 5 months after diagnosis. After this time lapse, 6 cases of complications related to the corticosteroids therapy occurred. After one year, 5 patients presented one or more flare-ups and had to be re-hospitalized; 8 others were lost to the follow-up. The overall mortality rate was 27% (8 cases out of 30). Causes of death were first renal failure (3/8) followed by infectious complications (2/8). The management of SLE could be improved by a close follow-up and providing the patients and their family with adequate information.
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The fourth in a series of five, this article presents and analyses data on cost recovery and community cost-sharing, two key aspects of the Bamako Initiative which have been implemented in Benin and Guinea since 1986. The data come from approximately 400 health centres and result from the six-monthly monitoring sessions conducted from 1989 to 1993. Community involvement in the financing of local operating costs in the two national scale programmes is also described. In Benin and Guinea, a user fee system generates the community financed revenue with the aim of covering local operating costs including drugs. Health worker salaries remain the responsibility of the government and donor funding covers vaccine and investment costs. Village health committees manage and control resources and revenue. The community is also involved in decision making, strategy definition and quality control. In Benin in 1993, community financing revenue amounted to about US$0.6 per capita per year and generally covered all local recurrent non salary costs except vaccines and left a surplus. Although total costs and revenues were slightly lower in Guinea for the same period, over-all user fee revenue (around US$0.3 per capita per year) covered local recurrent costs (not including salaries or vaccines). A comparison of costs and revenue between regions and individual health centres revealed important differences in cost recovery ratios. In Benin, some centres recovered more than twice the local costs targeted for community financing. Twenty-five per cent of centres in Guinea did not manage to cover their designated local recurrent costs. The longitudinal analysis showed that the level of cost recovery remained stable over time even as preventive care (and especially EPI) coverage rose significantly. To better understand the most important characteristics affecting cost recovery levels, best performing health centres in terms of cost-recovery levels in 1993 were compared to worst performing centres. This analysis showed that the size of the target population of the health centre is a key determinant of cost-recovery in both countries. In addition, in Guinea the utilization of curative care linked to geographical access and in Benin the average revenue per case linked to the number of deliveries proved to be additional factors of importance. In best performing centres, financial viability improved over time in both countries between 1990 and 1993. Finally, the implications of these conclusions for the planning of health centre revitalization in West Africa are discussed.
Aortic dissection is the most common fatal condition that involves the aorta. Occasionally, symptoms mimic acute myocardial infarction leading to thrombolytic treatment. Accurate diagnosis in patients with chest pain is therefore essential. We describe a case of acute aortic dissection which resulted in myocardial infarction due to obstruction of the left coronary ostium. A 65-year-old female patient with no previous cardiac history was admitted to a local hospital because of severe chest pain of acute onset. Physical examination was normal except for a low blood pressure (90/50 mm Hg), heart rate 45 beats/min and parasthesia in both hands. The ECG showed sinus bradycardia with negative T-wave in VI and with 1 mm ST-segment elevation in V3. A chest X-ray was normal. Five hours later, the patient experienced once more severe chest pain followed by non-sustained polymorphic ventricular tachycardia (Figure 1). Another ECG showed bifascicular bundle branch block (right bundle branch block and left anterior fascicular block). The ECG was interpreted as showing acute myocardial infarction and treatment with intravenous streptokinase started. Since the patient remained severely hypotensive despite infusion of dobutamine, she was intubated, ventilated and transferred to our hospital. Cardiac catheterization showed acute dissection of the ascending aorta with an aortic intimal flap and an occlusion of the left coronary artery (Figures 2a and b). During catheterization, she suffered a cardiac arrest from which she could not be resuscitated. A postmortem examination confirmed the acute aortic dissection which reached to the ostium of the left coronary artery (Figures 3a and b, 4a and b) and an anterior myocardial infarction probably due to intermitted diastolic obstruction of the ostium of the left coronary artery by an aortic intimal flap.
The efficacy of quinine treatment for Plasmodium falciparum strains remains sound. However reports of decreased sensitivity and resistance of some strains in Asia and East Africa indicate that current treatment regimens should be re-adjusted. The purpose for the present study carried out in Dakar, Senegal, was to evaluate the local regimen for acute Plasmodium falciparum malaria using quinine at a dose of 20 mg/kg per day in two daily injections on 3 consecutive days. Thirty-seven patients with acute Plasmodium falciparum malaria including 10 severe cases were treated using the standard regimen and followed up clinically and parasitologically from Day 0 to Day 7. On Day 7 parasites were still detectable in the blood of four patients for a failure rate of 10.8%. Persistence of parasites despite disappearance of clinical symptoms suggests that the regimen should be increased to 25 mg/kg per day for at least for 3 days or longer if symptoms persist. Due to its adverse effects and cost (10 times higher than chloroquine treatment), quinine treatment should be prescribed only for patients with severe malaria forms.
Evaluating knowledge about the diagnosis and treatment of malaria is a prerequisite for both understanding the development of chemoresistance and improving ongoing programs of chemotherapy and chemoprophylaxis. To gain such knowledge we distributed a questionnaire to 900 household heads in twelve villages in the M'Backe district of Senegal. Awareness of the main symptoms of malaria was satisfactory in comparison with previous references. Public health care facilities such as dispensaries were cited as the first resort for treatment by 72.6% of respondents. Chloroquine was mentioned as the first line antimalarial by 23% of respondents who practiced self-medication. Improper dosages were stated by 60% of the respondents. A total of 52.3% of respondents practiced chemoprophylaxis mainly using chloroquine. In 65.8% of cases antimalarial drugs were obtained from public health care units but drugs were purchased on the market in 15.7% of cases. These findings indicate the threefold Bamako initiative should be reinforced and that a campaign should be undertaken to educate people living in rural areas about malaria.
In Touba, more important accessibility to antimalarial drugs and their uncontrolled use let to assure that the rate of malarial morbidity would be lower there than in other place in Senegal whereas the rate of chloroquine resistance would be higher. A checking survey of these assumptions has been carried out from october 15 to november 10, 1995 in Touba's health center. Among 227 feverish subjects investigated, 111 were Plasmodium falciparum carriers. Malarial bouts accounted for 48.9% of the feverish fits observed and for the major cause of consultation during the rainy season. These figures are higher than those usually observed in urban environment. Conversely, the rate of chloroquine resistance is lower than those observed in urban zones, since the therapeutic efficacy of chloroquine on Plasmodium falciparum was 100% in that survey.
From April to November 1994, we carried out a study in Rufisque, an urban area located in Dakar Region. During dry season, 5.32% of febrile outpatients were infected with Plasmodium falciparum with a mean parasitic density evaluated at 12,471 p/microliter. One case of cerebral malaria was noted. During raining season, malaria represented 58.75% of the fevers. Ten presented neurological signs; the mean parasitic density was high, 131,140 p/microliter. Two children died. Good efficiency of quinine was noted but chloroquine treatment failures was present: 50%. Generally malaria is less prevalent in urban areas. But in Rufisque ecological conditions are main factors which permit spreading of the disease. Prior measures of control such correct treatment of cases and good management of environment must be done.
The study of malarial seroprevalence in Dakar has interested 598 women among whom 377 pregnant and 221 non pregnant, between 15 to 45 years old and happens during the dry season, period of which malaria transmission is practically stopped in the locality. Among the tested serums by indirect immunofluorescence with Plasmodium falciparum asexual blood forms as antigen, 24.4% contained antimalarial antibodies. The serological index does'nt vary significantly according to the months during the dry season, the women age and their previous pregnancy number. On the contrary, the women who live in Dakar since less than 2 years, have e higher seropositivity rate of 33.7% than those who are there since more than 2 years, 20.0%. It is likewise for the women practicing chemoprophylaxy with chloroquine of whom 16.5% have antibodies against 26.0% among those who don't practice it. The seropositivity rate doesn't vary significantly according as the women are pregnant (24.7% of positive) or not pregnant (24.0% of positive). The weakness of the serological rate in the examined women, can be explained by the situation of Dakar in a weak malarial hypoendemic area. II shows that the major examined subjects have lost or have never had contact with Plasmodium what predispose them to make severe and complicated malarial attacks.