Use of methotrexate in the management of rheumatoid arthritis in Dakar. Potential pitfalls.
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Adult↗
Biomedical subjects
S Diallo
Publications and source records attributed to S Diallo.
The spirit of Dakar: a call for action on malaria.
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Africa↗
Local cost sharing in Bamako Initiative systems in Benin and Guinea: assuring the financial viability of primary health care.
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.
Benin↗
[Acute thoracic aortic dissection with occlusion of the left coronary artery].
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.
Aged↗
[Evaluation of the treatment of malaria using a 3-day regimen of quinine in Dakar].
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.
Acute Disease↗
[Knowledge and treatment of malaria in rural Senegal].
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.
Antimalarials↗
[Impact of antimalarial drug accessibility on malarial morbidity and chloroquine resistance. A study carried out in Touba (Senegal)].
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.
Adolescent↗
[Malaria in an urban environment: the case of the city of Rufisque in Senegal].
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.
Adolescent↗
[Prevalence of malaria in Dakar, Senegal. Results of serological survey of pregnant and non-pregnant women].
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.
Adolescent↗
[Prevalence of malaria in the Senegal river basin in 1991].
In order to determine the prevalence of malaria and its epidemiological characteristics, a survey was carried out in 11 villages situated in all the Basin of River Senegal (B.R.S.). 3306 (0-14 years) children are examined. The results show that malaria is hypo-endemic in the B.R.S. with a plasmodic index of 8.6% and a splenic index of 9.9%. But these malariametric indexes change according to the areas visited. Thus, malaria prevails at a hypo-endemic level in Dagana and Podor districts while at a medium if not hyperendemic level in Matam and Bakel districts. The plasmodial index also change according to age reaching a maximum within children from 10 to 14 years. As for the spleen index, it is low among children from 10-14 years. As for the spleen index, it is low among children from 0 to 4 years old, then increases among those aging from 5 to 9 years, before decreasing within children ranging from 10 to 14 years. P.falciparum is the most prevalent species, representing 96% of the cases; it is followed by P.malarioe (3%) and P.ovale (1%). If our results are compared with those obtained before by other authors, we can conclude that the recent hydro-agricultural plannings carried out in the area, have not yet provoked an increase of the cases of malaria. But, in order to avoid this risk, it is necessary to take from now some preventive measures.
Adolescent↗
[Evaluation of malaria chemoprevention among 359 pregnant women attending a health center in Dakar].
The authors carried out an epidemiological survey from october 12 to december 4, 1995, at Medina's mother and Child care centre (MCC) in Dakar in order to assess chemoprophylaxis among pregnant women in Dakar. The midwife/pregnant women ratio is 0.08 The mentioned diagnosis criteria were relevant regards to the references established for most of the answers because since the latter base malaria diagnosis on the following signs: fever, chills, headaches and vomiting. 64.6% of them assume compliance to antimalarial chemoporphylaxis. Education level seems to be the main determining factor in this trend. Although chloroquine is the most widely used drug, nevertheless 11.9% of pregnant women assuming compliance use it at inappropriate posology. Besides, pyrimethamine is used by 12.3% of them. 34% of pregnant women do show chloroquine in urine. The plasmodial index is 1.4%. Only 8.1% of these women are supplied by health centres where shortages are noted.
Adolescent↗
[Identification of HLA-DR alleles for susceptibility to rheumatoid polyarthritis in Senegal].
Rheumatoid arthritis is the most frequent inflammatory rheumatism disease. Several studies were aimed to understand its physiopathogenesis in particular the association between some HLA-DR alleles and rheumatoid arthritis. A prospective study was carried out in 34 patients suffering from RA (30 Women and 4 men). The diagnosis was clinically and radiologically made. The control group included 220 persons of which the HLA-DR distribution was known. The HLA-DRB1 alleles were typed by PCR-SSP (Sequence Specific Primers). The most frequent HLA-DR alleles found in patients group were: DR10 (85.3%), DR52 (53%), DR14 (38.2%), DR11 (26.5%), and DR13 (20.3%). A significant difference was observed between RA patients and control group for the following alleles: DR3, DR10, DR18, and DR52 (p < 0.001; Chi square with Yates' correction). HLA-DR3 and DR10 were positively associated with RA. The relative risk was up 30 for DR10.
Adult↗
[Informal care of malaria: determinants of demand and supply inventory. A study conducted in Touba City (Senegal)].
In Senegal, identifying the determining factors of the informal health care demand for malaria on the one hand and the supply's inventory in that condition on the other hand, are prerequisites to the definition of any realistic pharmaceutical policy. Wanted to make these parameters available in the city of Touba which shows religious and administrative particularities as compared to the rest of Senegal, by conducting a study on malaria morbidity and by submitting to people and informal health care providers two different questionnaires. Besides a malaria morbidity rate of 7.4%, the resort to informal health care was linked to economic reasons for 64% of householders resorting to this type of health care. Sociocultural determining factors were also identified. Among health care providers whom community's request is important, we observed the relevance of the malaria regular diagnosis as compared to established references. However we did not observed it as far as treatment and chemoprophylaxis are concerned. The supply is done along underground lines. The training of these informal health care providers and their integration in the general health care system should be considered.
Adolescent↗
[Scanning electron microscope sudy of the morphology of fungi isolated from patients at the Aristide La Dantec Hospital in Dakar, Senegal].
In order to improve the identification of fungi usually isolated among some patients at Dantec Hospital, a study by scanning electron microscopy has been carried out. It deals with four species of yeasts (Candida albicans, Candida parapsilosis, Rhodotorula rubra Sacharomyces cerevisiae) six species of dermatophytes (Trichophyton rubrum, Trichophyton soudanense, Trichophyton interdigitale, Microsporum canis, Trichophyton violaceum, Microsporum audouinii); two species of mildew, (Aspergullus flavus, Aspergillus niger) and one species of dimorphic fungi (Histoplasma duboisii). The yeasts get a smooth surface with, often, a mark of but on it. Microsporum canis presents some echinulate macroconidia. Trichophyton violaceum is characterized by the appearance of echinulate chlamydoconidium with a twofold bulge and Microsporum audouinii by a echinulate chlamydoconidium with a bulge only. Trichophyton rubrum presents macroconidia with smooth surface and in "sausage" form, as for Trichophyton soudanense it presents some arthroconidia that are cells which get more or less rectangular form and with smooth surface. Aspergillus flavus is characterized by the presence of a conidiophore with a verrucosis surface and an aspergillary head of about 36 microns having some spores with almost smooth inner surface. On the other hand, Aspergillus niger gets a conidiophore with smooth surface. As for Histoplasma duboisii, the surface of the chlamydoconidium presents some verrucosis that are real conidia in formation. The scanning electron microscopy enables use to discover the existence of characters that are likely to be used for the identification of fungi.
Dermatomycoses↗
[Strongyloidiasis: current incidence in the Dakar pediatric environment].
The authors have conducted from November 20th 1992 to May 26th 1993 a study about the incidence of Strongyloidiasis in two pediatric units in Dakar. Direct examination followed by Lee and Baerman's concentration technic both applied to 610 stool specimen, have shown that 26.6% of children were carrying parasites. 9 cases of strongyloidiasis have been shown the incidence was 1.4%. These cases represent 5.5% and ranks at fifth position among intestinal parasitic diseases. They all come from suburbs of Dakar. Malignant forms could be easily detected among children suffering a secondary immune deficiency due to malnutrition, or corticotherapy.
Adolescent↗
[Current aspects of gastric cancer in Senegal. Epidemiological and clinical study of 220 cases (1984-1991)].
220 cases of gastric cancer were selected from Dakar Hospitals during seven years (1984-1991). This retrospective study confirms that gastric cancer is the most common cancer of the Gastro-intestinal tract (48.4%). The sex ratio was 2.7 (M/F) with mean age of 50 years. However, a steady progression of gastric cancer was noticed beginning at 40 years. Despite the introduction of upper gastro-intestinal endoscopy the classical evolved form was the most commonly found (83.2%). The associated lesions known to be premalignant were found in 22.7% of cases. The patients were seen with a long delay after the first symptoms. This is why we have long delays of diagnosis in our centers. 61.7% of them are seen 3 to 12 months after their first symptoms. In 70% of cases, lesions were found on antropyloric region. The most common histological type remain adenocarcinoma (90% of cases). Even though endoscopy has contributed to increase the incidence of gastric cancer, it did not allow to discover early gastric carcinoma.
Adult↗
[A case of joint toxicity from pefloxacin in the treatment of nephrotic syndrome in a child].
In order to improve the nephrotic syndrome management, we tried to treat one patient by pefloxacin. A polytenosynotis was noticed during this treatment and motivated it stopping. Remission of proteinuria was obtained after an eleven days treatment. This case give us the opportunity to discuss the possible toxicity of quinolones on joints and the efficacy of pefloxacin in this disease.
Adolescent↗
[Health personnel and population practices in the diagnosis of malaria and use of antimalarial drugs in Dakar].
The practices of health care workers and the population with regard to diagnosis of malaria and use of antimalarial drugs were studied in the city of Dakar from September 1991 to March 1992. Study included 847 heads of family, 191 treatment prescribers including 77 physicians, 53 nurses and 61 midwives, and 60 pharmacists. Three separate questionnaires were used: one for the population, one for physicians and paramedical staff, and one for pharmacists. The data collected showed that the 4 main symptoms used by both health care workers and the general population for diagnosis of malaria were fever, chills, vomiting, and headache. Treatment was administered upon suspicion of infection by 72% of treatment prescribers. Chloroquine was the drug most widely used by prescribers and for self-treatment of malaria. Prophylactic drug treatment was practised by all groups studied except treatment prescribers but was unappropriate for the target groups. Chloroquine is the drug most widely used to protect against the disease. Pharmacists have adequate supplies but distribution is poor. Despite promising results in the fight against malaria, further effort is needed to train health care workers and provide information to the population.
Antimalarials↗