Air Pollution Related to Traffic and Chronic Respiratory Diseases (Asthma and COPD) in Africa

Introduction: Chronic respiratory diseases (CRD) are obvious effects of air pollution and the third reason of death in developing countries. In Africa, air pollution from road traffic is one of the main causes of poor air quality. We set out to systematically review existing published researches on traffic related to air pollution and CRD, particularly asthma and Chronic Obstructive Pulmonary Disease (COPD) in Africa. Methods: A literature search of PubMed, Scholar and LISSA databases, published journals, reference articles, published up to 31 December 2016, has been done by using a research strategy procedure. Texts were reviewed for inclusion. Studies were included if they met the following criteria: 1) the relationship between asthma or COPD with ambient air pollution related to road traffic was studied and 2) the population included people from Africa or lived in Africa. Articles written in English and French were included. Results: Fifty-five articles were selected in this review, of which twenty-seven were on air pollution and CRD in Africa. The proximity of the residence or workplace to the traffic is associated with an increased risk of asthma with a dose-response relationship. The estimated prevalence of COPD varies between 2.7% and 38.5%. Conclusion: There is little research on traffic related to air pollution and CRD in Africa. Strategies to reduce traffic related to air pollution in African cities have been proposed in order to have a healthier ambient air.

HBsAg seroprevalence among Senegalese militaries

Background: Chronic hepatitis is a major public health problem. The hepatitis B virus is the primary cause, and Hepatitis B and C together are responsible for 60% of cirrhosis and 80% of hepatocellular carcinomas. This study measured the prevalence of HBsAg among Senegalese military to develop a strategy to prevent cirrhosis and hepatocellular carcinoma in the army.Methods: We conducted a descriptive cross-sectional study among Senegalese army staff aged 25 to 60 years and divided this group into three strata: 25-34, 35-44 and 45-60 years. A sample of 1224 participants was selected following a two-level stratification. The mark of surface HBs antigen(Ag) was performed on 1195 participants using chemiluminescence(qualitative Architect HBsAg of Abbott Diagnostics Laboratories Germany) and enzyme immunoassay(Determines HBsAg) methods. The presence of HBsAg was analyzed according to age, marital status, alcohol consumption and glomerular filtration rate. Epi-info6 and R software were used, respectively, for data capture and analyses. A Chi-square test was performed to compare proportions considering an alpha significance level of 5% and a confidence interval of 95%.Results: The average age was 39.8±9.2 years. Participants in the age groups of 25-34 years, 45-60 years and 35-44 years were 30.7%, 34.4% and 34.9% of the sample, respectively. Married persons accounted for 82.6% of participants, and 17.08% were single. Most participants were educated(99%), and 56% had reached at least the secondary school level. Alcohol consumption was at 11.5%. The HBsAg prevalence rate was 10.8% [9.1% to 12.7%] with a significant difference between age groups(P<0.001), which ranged from 5.6% for 45-60 years, 9.62% in the 25-34 years group and 16.9% for the 35-44 years group. Marital status and alcohol consumption did not affect the carriage of HBsAg. The prevalence of HBsAg was more common among participants who had a glomerular filtration rate greater than 90 ml/min. Transaminases rate exceeded the normal threshold in 43 participants(3.6%). The increase was 6.6% [2.7% to 11.8%] of HBsAg carriers and 3.2% [1.2% to 6.7%] of alcohol users.Conclusion: The high prevalence of HBsAg in the military requires the implementation of an accessible prevention and care program to reduce the risk of cirrhosis and hepatocellular carcinoma. This program will contribute to reducing the burden of communicable diseases, such as hepatitis and HIV/AIDS, and non-communicable diseases in the armed forces.

Knowledge and Attitudes of Health Care Providers and the Population about Rabies in Sokone Health District, Senegal

Rabies is still a deadly disease, but it is 100% preventable through vaccination. In 2016, Senegal notified 1214 cases of dog bites. In the same year, the district of Sokone recorded 50 cases of dog bites, of which 31.2% of the cases were notified in the region of Fatick. The objective of this study is to assess the level of knowledge, attitudes and practices of communities and healthcare providers when faced with a case of exposure to rabies in Sokone health district. This quantitative estimation study is of a descriptive cross-sectional type, which took place during the third quarter of 2017. It targeted the community and health care providers in the Sokone health district. Three-stage cluster sampling was carried out in the community. The recruitment of healthcare providers has been comprehensive. A questionnaire was administered to the community in the form of individual interviews and another questionnaire was sent to health care providers in the form of self-administration. Knowledge, attitude and practice rating grids were developed for the two categories of interviewees. Data entry and analysis was done with Epi Info 3.5.3 software and R 3.3.1. Out of 813 community members surveyed, 6.8% had already been bitten by an animal. A good level of knowledge about rabies was found in 22.4% of the community members. The attitude to a bite was correct for 94.1%. Of the 38 healthcare providers surveyed, only 5.6% had a good understanding of rabies. No provider knew the indications for rabies vaccination and the post-exposure vaccination schedule. In the Sokone health district, communities knew little about rabies. Healthcare providers who are supposed to inform and supervise them in the fight against rabies know less about it. Strengthening the skills of healthcare staff in dealing with bites exposing them to rabies is of urgency in the Sokone health district.

Perceptions of Actors on the Community-Based Maternal and Neonatal Health Services Project at the Kolda and Sedhiou Regions

Introduction: The health of mothers and children remains a major concern in developing countries. Infant and maternal mortality rates, although declining, are still high. Access to health services is a major obstacle to reducing maternal and infant mortality. To support the Ministry of Health and Social Action in the implementation of its Strategic Plan for Reproductive Health (2012-2015), the NGO Micronutriment Initiative has developed a project based on community-based maternal and neonatal health services (CBMNHS) in the Kolda region. The general objective of this study is to collect the perceptions of the actors on the Community-Based Maternal and Neonatal Health Services project in the Kolda and Sedhiou regions. Method: This was a qualitative study consisting of an evaluation of the activities carried out within the framework of the CBMNHS project at the level of the intervention zone. The study focused on support groups, community actors, post nurses and implementers of the intervention. Sampling was comprehensive for community actors and nurse heads. Focus groups and in-depth individual interviews were used to assess the perceptions of women and support groups, as well as to better understand the dynamics of the intervention. The content analysis was performed to exploit the qualitative data. Results: All local and national health authorities interviewed are unanimous about the relevance of the project. The project’s strategies are essentially community-oriented. Thus, a large number of committees have been set up. A total of 1258 support groups were set up during the project, distributed as follows: 260 grandmother groups (Grandmothers Strategy);266 groups of pregnant women (Pregnant Women’s Solidarity Circles);248 Care Group;468 community watch and alert circles and 16 Future Fathers’ Groups (Future Fathers’ Solidarity Circles). These committees aimed to involve women of reproductive age, mothers, mothers-in-law and fathers. More than 70% of women surveyed agree that support groups have improved their knowledge of maternal health, nutrition, and children’s health. Groups also improved their attendance at health facilities, which is a major asset of the project. Conclusion: The analysis of the perception of the different actors of the CBMNHS project shows that the project is well conducted in the area of intervention that is the region of Kolda. However, the central question of the success of sustainability is the existence of a withdrawal plan. Indeed, this plan must be studied from the very beginning and must be adapted to the local context. As a result, support groups are urged to become more involved in reproductive health activities, especially those related to the exclusive breastfeeding, and to continue to provide all forms of support (financial and moral) to women of reproductive age for reproductive health carrying out reproductive health activities for better access to services.

Spirulina Supplementation in Pregnant Women in the Dakar Region (Senegal)

The fight against iron deficiency anemia in pregnant women is a public health priority, especially in sub-Saharan Africa. Spirulina is an alga very rich in iron, used as a dietary supplement. This research proposes to study its effect on the hemogloblobinaemia of pregnant women. This was a blind randomized cohort study with a supplemented group of spirulina (1500 mg/d) and a second supplemented with iron and folic acid supplementation (IFAS). Included in this study were pregnant women attending four health centers in the Dakar region, with pregnancy at 28th amenorrhea, agreeing to participate and not having complications or twin pregnancies. Follow-up of the two groups was identical throughout the study from the 28th week of amenorrhea to the 42nd postnatal day. The study was conducted among 920 women, evenly distributed among the groups. IFAS allowed a statistically significant increase in hemoglobinemia with an average gain of 0.3 g/dl between the 28th and 32nd weeks of amenorrhea (p = 0.022) and 0.2 g/dl between the 28th week and the delivery (p = 0.043). Spirulina supplementation showed statistically higher gains than those observed with IFAS. These gains were 0.48 g/dl between the 28th and 32nd weeks of amenorrhea and 0.36 g/dl between the 28th week and the delivery, with p values less than 0.001. Spirulina, more accessible to developing countries, is a good option to strengthen the arsenal of iron deficiency anemia control, and therefore maternal mortality.

Determinants of Iron Consumption among Pregnant Women in Southern Senegal

The anemia by iron deficiency is a public health problem. To palliate the multiple maternal and fetal consequences, the WHO recommends the iron supplementation during at least 90 days to all pregnant women. The goal of our study is to study the determinants of this consumption in the Kolda area (Senegal). It’s the analytical cross-sectional study referred. We use the survey by clusters with 2 levels and it’s about all of the women who gave birth in Kolda area between February 2013 and January 2014. The dependent variable was iron consumption during at least 90 days and the independents variables were grouped on personal factors, knowledge and practices. Data were collected during a personal interview face to face. We used logistic regression to identify the determinants of this consumption. The average age of women surveyed in 1442 was 25.5 years. They had knowledge of iron consumption (93%) and the number of antennal consultation (ANC) (66%). The prevalence of pregnant women who consumed iron at least for 90 days was 51%. The factors associated with consumption were schooling (ORa = 2.49 [1.54 - 4.03]), health awareness (ORa = 1.61 [1.25 to 2.07]), knowledge about number of ANC (ORa = 1.54 [1.18 - 2.00]), councils on the benefits of iron (ORa = 2.66 [1.77 - 4.00]), the household wealth index (ORa = 1.83 [1.04 to 3.19]), number of ANC (ORa = 2.05 [1.56 - 2.69]), age pregnancy on the first ANC (ORa = 2 [1.47 - 2.7]) and iron prescription (ORa = 1.64 [1.25 - 2.16]). The prevalence of iron consumption during at least 90 days is low in Kolda area (51%);however, its determinants are identified;we can solve the problem by increasing communicate more about iron supplementation and antenatal consultation.

Study of Factors Associated with the Age of Natural Menopause in Menopausal Women Aged 30 to 80 Years from the Keur Massar Health District in 2015 (Senegal)

Introduction: Menopause is a biological phenomenon that occurs at a more or less early or late age in the life of every woman. The general objective is to study the factors associated with the age of natural menopause in menopausal women aged between 30 and 80 years who have gone through down Keur Massar health district in 2015. Methodology: This was an observational, cross-sectional, descriptive and analytical study conducted in Keur Massar health district from December 1st to 10th, 2015. Two-stage cluster sampling was conducted. Data were collected during an individual interview at home after consent. They covered socio-economic conditions, health and nutrition status, gynecological-obstetrical history, and lifestyle. A multivariate analysis was performed using the Cox model with a 5% risk of alpha error. Results: A total of 627 postmenopausal women were surveyed. Mean age of these women was 54.5 years (±8.6 years). A proportion of 72.1% of the women was married and 46.7% was in school. Mean age of natural menopause was 47.1 years (±5.03 years). The median age of natural menopause was 47 years. Factors associated with the age of natural menopause were high parity of more than 4 children (Hra = 0.35 [0.13 - 0.92]), the existence of frequent childhood illnesses (Hra = 1.72 [1.13 - 2.64]), use of the intra-uterine device—IUD—as a modern contraceptive method (HRa = 0.39 [0.24 - 0.63]), sibling size (HRa = 0.85 [0.78 - 0.93]), family size (HRa = 1.03 [1.01 - 1.06]), and polygamy regime (HRa = 0.56 [0.37 - 0.85]). Conclusion: Many factors in childhood as well as during the period of female genital activity can impact the age of natural menopause. It is then important to improve the health status of women, children and the standard of living of the population.

Community Pharmacists’ Knowledge, Practices and Perceptions on Antibiotic Use and Resistance: A Cross-Sectional, Self-Administered Questionnaire Survey, in Guediawaye and Pikine, Senegal

Background: Antibiotic resistance is a threat to global health. Community pharmacists are among the most accessible health professionals. Therefore, their role in improving antibiotic use and subsequently in fighting resistance is crucial. The objective of this study was to evaluate community pharmacists’ knowledge, practices and perceptions on antibiotic use and resistance. Methods: We conducted a cross-sectional study in community pharmacies located in the departments of Guediawaye and Pikine, Senegal. The study took place between November 2017 and February 2018. A total of 121 community pharmacies were located. In each of them, we planned to include one pharmacist. A self-administered questionnaire was used. The data were analyzed using Epi Info 7. The analysis was descriptive. Variables were expressed as number (n) and percentage (%). Results: The response rate was 75.2%. The majority mistakenly thought that antibiotics are always effective against sore throat (64.8%), bronchitis (51.6%), paronychia (72.5%) and dental caries (65.9%). Most respondents knew that self-medication (96.7%), poor treatment compliance (94.5%), inappropriate antibiotic dispensing (79.1%), inappropriate antibiotic prescribing (85.7%) were causes of resistance. Further, causes such as poor hand hygiene and lack of immunization were cited by 9.9% and 6.6% of participants. Moreover, 25.2% knew that third-generation cephalosporins, macrolides and quinolones are critically important antibiotics. In addition, 96.7% and 90.2% said to dispense antibiotics without a prescription and to contact prescribers in case of doubt about the reliability of an antibiotic prescription, respectively. The majority was of the opinion that some antibiotic prescriptions were inadequate (29.7%) and that the consumption of antibiotics was high (92.3%). Conclusion: This study showed a lack of knowledge among community pharmacists practicing in Guediawaye and Pikine towards antibiotic use and resistance. Therefore, it is necessary to sensitize them. Further studies should be conducted to better understand the beliefs and behavior of community pharmacists regarding antibiotic use and resistance.

Traffic Air Pollution and Respiratory Health: A Cross-Sectional Study among Bus Drivers in Dakar (Senegal)

Introduction: Road traffic exposes bus drivers to the detrimental effects of air pollutants on respiratory health. This study determined the frequency of chronic respiratory illnesses and its related factors among bus drivers in Dakar, Senegal. Methods: This study had a cross-sectional design conducted in a total of 178 bus drivers in Dakar, Senegal. A questionnaire was used to inquire about socio-economic characteristics, occupational factors and respiratory symptoms of bus drivers. Lung function tests were used to determine the presence of asthma and Chronic Obstructive Pulmonary Disease (COPD). The relationship between our variables of interest and respiratory diseases was determined by logistic regression analysis. Results: The results of the study show that 57.9% of bus drivers had a chronic cough, and 65.7% had recurrent cold. Lung function tests showed that 38.8% of bus drivers had asthma and 30.3% COPD. Multivariate analysis found that recurrent cold increased the risk of asthma (OR = 6.3, 95% CI: 1.12 - 35.79) and COPD (OR = 7.7, 95% CI: 1.14 - 52.8). The respiratory health status of bus drivers depended on the work area (OR = 3.2, 95% CI: 1.13 - 9.31). Conclusion: The respiratory symptoms and illnesses observed among bus drivers are associated with their exposure to air pollutants from road traffic.

Near-Road Exposure to Air Pollution and Allergic Rhinitis: A Cross-Sectional Study among Vendors in Dakar, Senegal

Introduction: The work environment is one of the main causes of allergic rhinitis. The majority of vendors in Dakar work in places close to roads that are very frequented by vehicles, exposing them to increased air pollution. The study determined the prevalence of allergic rhinitis and its associated risk factors in these vendors. Methods: This was a cross-sectional survey based on a structured questionnaire, conducted among vendors in the neighborhoods of HLM, Medina and Petersen in Dakar, Senegal. A total of 200 vendors were interviewed. Symptoms of allergic rhinitis were defined as the simultaneous presence of rhinorrhea, nasal congestion and sneezing in the absence of respiratory infection. A logistic regression analysis was performed to determine the relationship between socio-demographic characteristics, occupational factors, and allergic rhinitis. Results: Results of the study show a prevalence of 43% of allergic rhinitis among vendors. Multivariate analysis showed that the independent factors associated with allergic rhinitis in these vendors were age [OR: 3.28 (1.02 - 10.51)], working area [OR: 8.31 (2.39 - 28.95)], exposure to multiple sources of pollution [OR: 4.08 (1.43 - 11.63)], and recurrent cold [OR: 4.39 (1.15 - 16.85)]. Conclusion: The prevalence of allergic rhinitis was high among vendors in Dakar. Our data suggest that exposure to air pollution at the workplace in vendors could lead to allergic rhinitis.

Study of the Factors Associated with Home Delivery in a Situation of Free Care in Senegal

Introduction: Home delivery is still a health problem in Kolda (Senegal). The aim of this work is to study the factors associated with the place of delivery in a situation of free care delivery. Method: A descriptive and analytical cross-sectional study was carried out. Sampling was in two-stage clusters. The study focused on women who gave birth in the last 12months. The data were collected during an individual interview at home. The collection focused on knowledge, attitudes and practices about delivery. Logistic regression was used to explore the determinants of childbirth at the level of health facility. Results: The average age was 25.4 ± 6.5 years. Among the interviewed women, education was reported in 35% of the women and 55% of women estimate that the closest health facility is within 5 km to their home. The time to get to the nearest health facility is less than 15 minutes for 39% of the interviewed women. The prevalence of home delivery was 43.5%. Home delivery was related to the remoteness of the health facility (2.43 [1.75 - 3.37]) but also to incomplete antenatal care (2.52 [1.59 - 4.00]). Support groups highlighted difficulties of access to health facilities because of remoteness. Interviews revealed a lack of involvement of husbands in seeking care for women. Cultural barriers are still there. Conclusions: Despite the gratuity of delivery, the remoteness of health structures and socio-cultural factors are still barriers to access to care for pregnant women. These aspects must be taken into account in health policies. Multi-lateral interventions should be implemented to provide solutions for this health problem.

Oral care offerings in populations of Ferlo (Senegal): The contribution of traditional dentistry

The aim of this study was to examine whether the offering of traditional treatments can constitute a positive contribution to integrate in an oral public health care settings. Method: This was a cross-sectional study involving 300 people living in the area of Ferlo in East Central Senegal. Selected individuals must be residents of the area over the age of 15 years. Cluster sampling was used as a recruitment method. Data collected concerned the type of oral health care used whether modern or traditional, the periodontal condition (plaque, gingival and bleeding index, attachment loss, pocket depth and CPITN). Dental status was evaluated by DMFT. The data were analyzed with R software and the Student’s t test was used to compare the averages of indices in both groups at the threshold of 5%. A co-variance analysis was allowed in order to determine associations between some indices and therapy type in multivariate approach. Results: Averages of dental and periodontal indices were globally higher in people using modern therapies. DMFT, CPITN and gingival index increased significantly when the type of therapy was modern after adjustment on the plaque index and age. Conclusion: The traditional dentistry could constitute a positive contribution to a public health care, especially in a context of developing country. However, this practice should be guided and validated by a research-based evidence to allow better use of the therapeutic processes, and promote the health of populations.

A Cross-Sectional Survey on Non-Communicable Diseases and Risk Factors in the Senegalese Army

Background: The non-communicable diseases (NCDs) have become a public health priority. The objectives of this study were to measure the prevalence and to assess the risk factors of NCDs among the Senegalese military population to initiate an intervention program. Methods: A cross-sectional survey was conducted in 2014. Two-level stratification was used to sample participants. Data were collected following the protocol recommended by the World Health Organization. Data were managed using Epi-Info 6 software and analyzed using R software. Results: A total of 1224 participants were recruited, of whom 96.9% were men. Their ages ranged from 25 to 60 years with a mean of 39.7 ± 9.2 years. Of participants, 17.2% were active smokers. Average duration of active smoking was 19.9 ± 9 years. The prevalence of current alcohol consumption was 11.5%, with an average of 4 ± 2.7 glasses a day. 97.17% of participants consumed fewer than 5 servings of fruits and vegetables a day. 18.63% had insufficient physical activity. The overall prevalence of high blood pressure was 26.9%. The proportion of those who were overweight was 27.2%;3.3% were obese. 3.0% of participants had diabetes and 44.1% had hypercholesterolemia. After adjusting for waist circumference, the risk of high cholesterol was 2.42 in the 35 - 44 age group and 2.86 in the 45 - 60 age group in comparison with the 25 - 34 age group. 32% were classified as having stage 2 chronic kidney. Conclusions: The findings of this study indicate the importance of risk factors for NCDs in the Senegalese military population. Intervention based on prevention and health promotion is needed.

Assessment of Knowledge, Attitudes and Practices Related to Contraceptive Use among Teenagers in High Schools and Colleges in Dakar, Senegal

Introduction: In Senegal, adolescents aged 10 to 19 years represent 22.9% of the total population. The unmet need for contraception in this part of the population remains high despite the health interventions implemented to promote their sexual health. The aim of this study is to analyze the practice of modern contraception in schools in Dakar high schools in Senegal during the year 2018. Methods: A cross-sectional study was conducted in high schools and colleges in Dakar from March 1 to April 30, 2018. This study involved 452 students. This was a self-administration of the questionnaires. After univaried and bivaried analyses, a multivariate logistic analysis identified the factors associated with students’ use of modern contraception. Results: The prevalence of modern contraceptive use among students is 8.84%. Factors associated with the use of modern contraceptive methods among students were age over 18 years (AR: 4.7, 95% CI [1.02 - 22.5]), male sex (AR: 27.8, 95% CI [6.8 - 100.0]), secondary school level (AR: 10.6, 95% CI [2.1 - 53.0]), access to a youth socio-educational home (AR: 3.9, 95% CI [1.1 - 14.9]) and having a child (AR: 25.6, 95% CI [2.2 - 100.0]). Conclusion: Our results concluded that modern contraceptive needs were better met among older male students, those who had an unfortunate experience of unwanted pregnancy and those attending school’s youth socio-educational homes. This suggests shortcomings in the promotion of sexual health among younger students, particularly those in the secondary grades.

Availability,Management and Use of Priority Life-Saving Medicines for Under-Five Children in Two Health Districts in Senegal:A Cross-Sectional Study

Under-five mortality remains a major concern in the world and in Senegal. It is mainly due to preventable and treatable diseases with priority life-saving medicines for under-five children. This study evaluated the availability, management and use of these drugs in two health districts in Senegal. A descriptive cross-sectional study was conducted in the health districts of Guediawaye and Pete from 01 November 2018 to 31 January 2019. The health district of Guediawaye is in the region hosting the Senegalese capital while that of Pete is located in the region of Saint Louis, northern Senegal. Nine drugs that can prevent and treat malaria, diarrhea, pneumonia and malnutrition were selected. An inventory form and a self-administered questionnaire were used to collect data that was analyzed with SPSS and expressed as a percentage and average. Drug availability was 50.4% and 54.3% in Guediawaye and in Pete, respectively. Average stock-out duration in the past three months was estimated at 22.6 and 26 days, respectively. The drug management was marked, on the one hand, by a good availability of stock cards in the two districts with proportions equal to 100% and 94.1%, respectively, and on the other hand, by the presence of expired stocks in Pete (12.2%). About 79% and 88% of prescribers reported prescribing the basket drug, respectively. These results show that access to priority life-saving medicines for children remains a challenge. Measures to be taken should include improving the distribution channels and training of health professionals. Further studies should be conducted in other health districts to better understand the barriers to access to child health services.