Clinical Effect of Yinhuang Qingfei Capsules in Treatment of Asymptomatic and Mild/Common Severe Acute Respiratory Syndrome Coronavirus 2 Infection:An Analysis of 242 Cases

[Objectives]To investigate the clinical effect of Yinhuang Qingfei capsules in the treatment of asymptomatic and mild/common severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)infection.[Methods]A total of 362 patients with SARS-CoV-2 infection were divided into the treatment group with 242 patients and control group with 120 patients according to their treatment regimen.The patients in the control group were given standard treatment regimen and those in the treatment group were given Yinhuang Qingfei capsules in addition to the treatment in the control group.The two groups were observed in terms of average length of hospital stay,mean time for nucleic acid clearance,TCM syndrome score,and progression to severe/critical illness,and clinical outcome was compared between the two groups.[Results]There was a significant difference in the overall response rate between the treatment group and the control group[97.52%(236/242)vs 95.00%(114/120),P<0.05].Compared with the control group,the treatment group had significantly shorter length of hospital stay and time for nucleic acid clearance(P<0.05).After 7 days of treatment,both groups had a significant change in TCM syndrome score,and there was a significant difference in TCM syndrome score between the two groups(P<0.05);after 15 days of treatment,both groups had a TCM syndrome score of 0.Progression to severe/critical illness was not observed in either group.[Conclusions]Compared with the standard treatment regimen alone,standard treatment regimen combined with Yinhuang Qingfei capsules can effectively shorten the length of hospital stay and time for nucleic acid clearance and improve TCM symptoms in patients with asymptomatic and mild/common SARS-CoV-2 infection.

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.

Clinical Management and Long-Term Follow-Up of Patients with Peripartum Cardiomyopathy: A Prospective Registry Study

Introduction: Peripartum cardiomyopathy (PPCM) is a rare pathology in Western countries but is common in Africa. Its progression is highly variable, left ventricular function improves in almost one-third to one-half of patients. In sub-Saharan Africa, there are few prospective cohort studies. We aimed to describe the long-term evolutionary aspects of this pathology in a sub-Saharan African country, so we developed a PPCM registry;here, we present the first results after 2 years of follow-up. Methodology: This work was performed at the cardiology clinic of the Aristide Le Dantec Teaching Hospital of Dakar from January 01, 2017, to January 01, 2021, for a total duration of 4 years. This was an observational, longitudinal prospective study including patients admitted for peripartum cardiomyopathy. Results: During our study, 5372 patients were admitted to the cardiology clinic. Considering the inclusion criteria, 79 patients were consecutively recruited. The mean age was 30.5 ± 6.7 years, ranging from 18 to 42 years. Half of the patients came from rural areas (56.3%), and 78.2% of patients had a low socioeconomic status. Multiparity and twin pregnancies were noted in 72.8% and 20% of the patients, respectively. A total of 91% of patients had advanced NYHA stage 4 heart failure, and 3 patients had cardiogenic shock. Left ventricular dilatation was found in 52 patients, and severe left ventricular systolic dysfunction was found in 50 patients (90.9%). During hospitalization, 19 patients (34.5%) had complications. The evolution in the hospital was favourable in 45 patients (81.8%). The global mortality rate was 7.3% at 2 years. In multivariate analysis, fewer patients with a dilated left ventricle, a severe alteration of the LVEF and an advanced age progressed towards remission. Conclusion: The long-term evolution of PPCM is very variable. Despite a good rate of remission, progression to end-stage heart failure and death is not negligible in cases of advanced maternal age and severe left ventricular impairment.

Research Progress in Occupational Health Risk Assessment Methods in China

Traditional occupational disease control and prevention has remained prevalent in China over recent decades. There are appropriately 30,000 new case reports of occupational diseases annually. Although China has already established a series of occupational disease prevention programs, occupational health risk assessment （OHRA） strategies continue to be a limitation.

Burden of Clostridium difficile infection between 2010 and 2013:Trends and outcomes from an academic center in Eastern Europe

AIM:To analyze the incidence and possible risk factors in hospitalized patients treated with Clostridium difficile infection(CDI).METHODS:A total of 11751 patients were admitted to our clinic between 1 January 2010 and 1 May2013.Two hundred and forty-seven inpatients were prospectively diagnosed with CDI.For the risk analysis a 1:3 matching was used.Data of 732 patients matched for age,sex,and inpatient care period and unit were compared to those of the CDI population.Inpatient records were collected from an electronic hospital database and comprehensively reviewed.RESULTS:Incidence of CDI was 21.0/1000 admissions(2.1%of all-cause hospitalizations and 4.45%of total inpatient days).The incidence of severe CDI was 12.6%(2.63/1000 of all-cause hospitalizations).Distribution of CDI cases was different according to the unit type,with highest incidence rates in hematology,gastroenterology and nephrology units(32.9,25 and24.6/1000 admissions,respectively) and lowest rates in 1.4%(33/2312) in endocrinology and general internal medicine(14.2 and 16.9/1000 admissions)units.Recurrence of CDI was 11.3%within 12 wk after discharge.Duration of hospital stay was longer in patients with CDI compared to controls(17.6 ± 10.8d vs 12.4 ± 7.71 d).CDI accounted for 6.3%of allinpatient deaths,and 30-d mortality rate was 21.9%(54/247 cases).Risk factors for CDI were antibiotic therapy[including third-generation cephalosporins or fluoroquinolones,odds ratio(OR) = 4.559;P < 0.001],use of proton pump inhibitors(OR = 2.082,P< 0.001),previous hospitaiization within 12 mo(OR = 3.167,P < 0.001),previous CDI(OR = 15.32;P < 0.001),while presence of diabetes mellitus was associated with a decreased risk for CDI(OR = 0.484;P< 0.001).Treatment of recurrent cases was significantly different from primary infections with more frequent use of vancomycin alone or in combination(P < 0.001),and antibiotic therapy duration was longer(P < 0.02).Severity,mortality and outcome of primary infections and relapsing cases did not significantly differ.CONCLUSION:CDI was accounted for significant burden with longer hospitaiization and adverse outcomes.Antibiotic,PPI therapy and previous hospitaiization or CDI were risk factors for CDI.

Evaluation of the Care of Children Aged 0 to 10 Years Hospitalized for Severe Malaria at the Tambacounda Health Center, Senegal

Introduction: Malaria remains a public health priority in Senegal, particularly in Tambacounda, where it is one of the main causes of child mortality. The objective of this work was to evaluate the care of children under 10 years of age hospitalized at the Tambacounda Health Center and the factors associated with recovery. Methods: An analytical, retrospective, and descriptive cross-sectional study with exhaustive recruitment of children 0 to 120 months hospitalized at the Tambacounda reference health center for severe malaria (according to WHO criteria) between 1 January 2018 and 31 December 2021 was performed. Data collection was done through a questionnaire. Records, hospitalization records, and treatment records were the sources of collection. Data entry and analysis were performed on Epi Info 7.2 and R. Results: A total of 481 children hospitalized with severe malaria were recruited. The highest number of cases was recorded in 2018 (33.05%). In the four years of the study, peaks were always observed between October and November and the highest peak in November 2020 with 95 cases. The mean age was 65.64 months with a standard deviation of 29.28 months and a predominance of male (53.43%). The majority of people were admitted from the outpatient clinic (57.79%) and the rest (42.21%) on the recommendation of a peripheral health post. All hospitalized patients had a positive RDT and/or a positive thick drop. However, the sharp decline at admission or during hospitalization was positive in 93.80% of patients in our series, negative in 5.20% and not achieved in 1.00%. Seizures and severe anemia topped the list of signs of severity with 45.94% and 8.11%, respectively. In terms of evolution, for all hospitalized patients, there were 81.29% recovery, 10.19% referral to the Tambacounda regional hospital center for hospitalization, 4.99% death, 0.83% discharge and 2.70% unknown evolution. There was a statistically significant association between recovery without referral from a health post (OR = 1.85), absence of 2 or more signs of severity (OR = 1.82), absence of seizures (OR = 1.51), prostration (OR = 2.78), cardiovascular shock (OR = 6.67), coma (OR = 7.69), lack of evidence of biological severity (OR = 3.70), and hypoglycemia with blood glucose less than 0.4 g/L (OR = 5.88). Conclusion: In addition to the routine malaria prevention and management strategies implemented in Tambacounda, and the early referral of cases of severe malaria from health posts to the health center, all children hospitalized for severe malaria with certain symptomatology such as coma, prostration, cardiovascular shock, etc. Seizures and/or hypoglycemia should be systematically referred to the regional hospital to increase their chance of recovery.

Knowledge Attitudes, Practices and Factors Associated with Blood Donation in the Fatick Health District in 2019 (Senegal)

Introduction: Timely availability of safe blood or blood products is essential for all health care facilities where transfusion occurs, but in many developing and transitional countries, there is still a considerable gap between the need for blood and the supply available. The overall objective was to study knowledge attitudes, practices, and factors influencing blood donation in the general population in Senegal. Methods: This was a cross-sectional descriptive and analytical study conducted among the Fatick health district population from April 1 to 15, 2019. Thus, the sample is based on a two-stage survey. Data collection was conducted through a questionnaire designed, pretested, and administered to 466 people by selected and trained enumerators. The data collected on the smartphone was analyzed using Epi Info 7.2.1.0 software. A descriptive and bivariate analysis was performed with a 5% risk of alpha error. Results: The average age of respondents was 35 years (±13), with 34 years (±12) for women and 38 years (±15) for men, and more than half of them between 20 and 40 years of age. A proportion of 87% of respondents lived in rural areas and had agriculture as their primary income source. More than half of the individuals (70%) were married, and 68% were educated. The level of knowledge of individuals about blood donation was low at 91.8%. On the other hand, more than half of them had good habits (53.65%). A proportion of 68.0% of individuals had an intention to donate in the future. However, only 24.68% of the population surveyed had already donated blood. Eighty percent of the donations were voluntary. However, 26.09% had repeated this practice. Factors that could influence the practice of blood donation were age, male sex (ORb = 2.18 [1.40 - 3. 37]), high level of education, good knowledge of blood donation (ORb = 2.14 [1.07 - 4.26]), the existence of a relatives donor (ORb = 3.4 [2.19 - 5.26]) and individuals who did not necessarily require permission from a parent or spouse (ORb = 3.37 [2.13 - 5.31]). Conclusion: It is necessary to develop mass communication and proximity strategies, also strengthen the blood bank in terms of human resources and logistics to increase voluntary blood donations in the district. An increase and better planning of mobile clinic outings can facilitate and improve voluntary blood donation by improving accessibility to this service.

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.

Study of the Determinants of the Use of Breast Cancer Screening in Women 35 to 65 Years in the Region of Thies (Senegal)

Introduction: In Senegal, breast cancer is the second most common cancer of women after cervical cancer. It is a cancer accessible to clinical and radiological screening. The objective of this study was to study the determinants of the use of breast cancer screening among women aged 35 to 65 in the Thies region in 2015. Material and Methods: It was a descriptive and analytical cross-sectional study. It was conducted with a sample of women selected using a two-stage cluster survey. The study used a questionnaire to collect data on the individual characteristics of women, knowledge, attitudes and practice on breast cancer and quality of care in an individual interview at the homes of women after consent. The data was entered on the Epi Info 3.5.3 software and analyzed with the R 3.3.3 software. A description of qualitative variables across proportions and quantitative variables by mean and standard deviation was performed. Parametric or non-parametric tests were used to examine the association between the dependent variable (breast cancer screening) and explanatory variables (predisposing factors, resources, health needs) according to their applicability conditions and at a risk α equal 5%. Finally, all variables with p less than 0.25 were used to construct an explanatory model by simple logistic regression. Results: The study involved 960 women aged 35 to 65 years. The average age was 43.8 years with a standard deviation of 8.3 years. The rate of breast cancer screening was 25.7%. Educated women (OR adjusted = 1.89 [1.25 - 2.85]), women who resided in urban settings (adjusted OR = 1.79 [1.05 - 3.04]), those who experienced at least one risk factor for breast cancer (OR adjusted = 2.71 [1.81 - 4.06]) were more likely to use screening breast cancer. In contrast, women with low socioeconomic status (adjusted OR = 0.66 [0.45 - 0.97]) were less likely to be screened. Conclusion: Level of education, knowledge of breast cancer and having received screening advice are factors to consider in improving the rate of breast cancer screening in Thies, and the most important remains public awareness.

Midwives’ Professional Satisfaction and the Quality of Obstetric Care in Developing Country

Introduction: In Africa, poor working conditions affect the motivation of health care providers. The objective is to study midwives’ professional satisfaction on the technical quality of emergency obstetric care in Senegal. Material and Methods: This was a prospective study of 16 hospitals in Senegal. The job satisfaction of midwives was measured during a personal interview. The instrument used was validated in Senegal and Mali. Other data collected relate to professional and institutional characteristics. A treatment observation grid was used to measure the quality of obstetric care in labour wards. Mixed-model linear regression was used to estimate the effect of satisfaction on the quality of obstetric care. Results: A total of 65 midwives were interviewed and 325 patients observed. The average quality score was 8.7 ± 1.7. The satisfaction scores ranged from 42.2 ± 17.4 (salary) to 76.7 ± 12.1 (morale satisfaction). A positive and significant correlation was found between quality of care and management (cc = 0.56), remuneration (cc = 0.40), task (cc = 0.32), workload (cc = 0.24) and training (cc = 0.29). The linear mixed model shows that salary (β = 0.40), continuing education (β = 0.17) and management style (β = 0.42) improved the quality of care. Association between moral satisfaction and quality care was negative (β = ﹣0.53). Conclusion: The satisfaction of health professionals is a major determinant of the quality of obstetric care. Its inclusion in the fight against mortality has become imperative in developing.

Study of the Determinants of Dietary Diversity among Pregnant Women in the Dakar Region (Senegal) in 2017

Introduction: Many health problems in pregnant women result in part from inadequate nutrition. Much progress has been made in improving the nutritional situation in Dakar, but it remains a concern to this day. Promoting dietary diversity is an effective way to combat any kind of nutrient deficiency. This study aims to investigate the determinants of dietary diversity in pregnant women in the Dakar region. Method: It was a cross-sectional, descriptive, analytical study with a three-stage survey. The calculated sample was 292 pregnant women. Socio-demographic, economic, pregnancy-related data, related to practices and knowledge on nutrition were collected using a questionnaire and an observation grid. The collection was conducted from November 01 to December 15, 2017 among pregnant women in the Dakar region. Data were entered using epi info software and analyses were done with R. Simple linear regression was used to find the explanatory factors of dietary diversification. The fit of the regression model was done by the Hosmer Lemeshow test. The odds ratios were measured with a 5% alpha risk. Results: A total of 300 pregnant women were surveyed in two different health districts. The mean dietary diversification score was 5.47, the median was 5 and the standard deviation was 1.24. Factors associated with dietary diversity were age -1.14 [-1.8;-0.48], place of follow-up 0.39 [0.12;0.67], number of children 0.56 [0.25;1.1], mineral water consumption 0.27 [0.001;0.5] and husband’s income 0.79 [0.24;1.35]. Discussion-Conclusion: The Dietary Diversity Score was average, although it is important to note a real lack of dietary variety among women, which needs to be corrected through quality communication at prenatal consultations, but also the training of midwives in the field of nutrition remains essential.

Impact of COVID-19 in the Hospital Activities of a Cardiology Department: Case of the General Hospital Idrissa Pouye in Dakar, Senegal in 2020

Introduction: In Senegal, at the end of 2020, there were a cumulative 18,728 confirmed cases of COVID-19 and 390 deaths. Patients with cardiovascular disease were the most affected by this morbidity and mortality. This is why we were given the objective of analyzing the effect of COVID-19 on the hospital activities of a cardiology service in Senegal. In this case that of the General Idrissa Pouye Hospital (HOGIP), by comparing admissions, deaths, average monthly length of stay and overall annual mortality of the service in 2020 with each of the four previous years. Methodology: This was a descriptive study from January 2016 to December 2020 by retrospective data collection. The collection ran from January 5, 2021 to March 30, 2021. Statistical analysis was performed with Rstudio 4.1.0 statistical analysis software. We expressed these variables as their absolute values and then we calculated the difference between the absolute value of 2020 and that of each of the previous years, both on a monthly and annual scale for each of the variables. Finally, we calculated the annual global mortality (each year from 2012 to 2020). Results: The total number of admissions in 2020 was significantly lower than in 2016 (-7.59%), 2017 (-8.78%) and 2018 (-2.16%). On the other hand, it was clearly higher than that of 2019 (+12.83%). A record in admissions was found during the month of December 2020 compared to 2016 (+64.70%), 2017 (+95.34%), 2018 (+127.02%) and 2019 (+127.02%). The average monthly length of stay in 2020 was less than or equal to those of 2016 (-7.62%), 2017 (-8.57%), 2018 (-3.03%) and 2019 (-0.00%). The total number of annual deaths in 2020 was significantly lower than in 2016 (-24.39%), 2017 (-27.06%), 2018 (-39.81%) and 2019 (-23.46%). Over the 5 years of our study, the year 2020 was the least lethal in service with an overall annual mortality of 9.79%. Conclusion: COVID-19 being a viral transmissible pathology with pulmonary tropism, its mortality is due to both respiratory failure and cardiovascular damage. Its morbidity and mortality are supported by major non-communicable diseases and their risk factors (Heart disease, Asthma, Chronic obstructive pulmonary disease, Diabetes, Smoking, Obesity, etc.). It, therefore, follows that the considerable drop in overall annual mortality in the service in 2020 can only be explained by a massive diversion of patients, to epidemic treatment centers and infectious diseases services, who should have, in normal times, been taken care of in cardiology departments until November 2020. In conclusion, we will say that the authorities should not relegate to the background, at any time, the fight against major non-communicable diseases, especially cardiovascular diseases, even in times of an infectious disease pandemic. They should capacity early cardiology services to maintain the offer of care and follow-up even in infectious and contagious contexts.

Epidemiological, Clinical, Therapeutic and evolutionary Aspects of Children Living with HIV in Guédiawaye, Senegal

Introduction: HIV infection in children is a major public health problem. The objective of this study carried out in the paediatric department of the Centre Hospitalier Roi Baudouin de Guédiawaye, was to evaluate the epidemiological, clinical, therapeutic and evolutionary aspects of a cohort of children with HIV over a 15-year period and to determine the factors associated with discontinuation of treatment and transition to second-line treatment. Patients and Methods: This was a descriptive and analytical cross-sectional study from August 2004 to December 2019 at the Centre Hospitalier Roi Baudouin de Guédiawaye. Through this study, age at diagnosis, current age, gender, orphan status, therapeutic aspects, status announcement and evolution were evaluated. A total of 129 patient records were studied over a 15-year period (2004-2019). HIV-positive children with profile I represented 93.8% and there was a male predominance with a sex ratio of 1.43. The current mean age of the children was 12.2 ± 4.5 and the median was 14 years. Fatherless and motherless children represented 24.0% and 20.2%, respectively, while both fatherless and motherless children represented 11.6%. The mean age at the start of ARV treatment was 7.6 ± 4.3 years and the median was 7.5 years. The mean age at the start of second-line treatment was 13.7 years with a standard deviation of 2.6 while the median was 13 years. AZT + 3TC + NVP was the most commonly used combination (29.5%) followed by TDF + FTC + NVP (26.2%). The mean age at treatment discontinuation was 13.3 ± 4.3 years while the median was 15 years. More than half of the children (57.0%) (N = 69) were aware of their status. Factors associated with discontinuation were gender (p value = 0.025 and OR = 3.2), orphan status (p value = 0.027 and OR = 3.0) and follow-up time greater than 10 years (p value = 0.013 and OR = 5.6). The mortality rate was 3.9%. Factors associated with transition to second-line treatment were year of inclusion (p value = 0.001 and OR = 15.6), age group (p value = 0.001 and OR = 19.2), orphan status (p value = 0.040 and OR = 2.6), treatment regimen (p value = 0.019 and OR = 5.7), duration of ARV treatment (p value < 0.001 and OR = 38.0) and announcement (p value = 0.002 and OR = 4.7). Conclusion The cohort of HIV-infected children followed up in Guédiawaye remains dominated by adolescents. Orphan status, announcement of status and duration of follow-up are associated with transition to second-line treatment and treatment discontinuation.

Osler’s Subacute Infective Endocarditis on Rheumatic Heart: A Complicated Clinical Case That Reflects Four (4) Major Public Health Issues in Sub-Saharan Africa

Endocarditis is an inflammation of the endocardium and its structures (valves), most often of infectious origin, described by William Osler in 1885. In the 21st century, infective endocarditis remains a reality in our countries. We report a complicated case of infective endocarditis (IE). This is a 53-year-old woman, obese and passive smoker who died on the 5th day of her hospitalization following an infective endocarditis (IE) with bacterial strains resistant to the usual antibiotics: daughter of acute lithiasic cholecystitis, mother of major mitral valve perforation, brain abscess, ischemic stroke and atrial fibrillation. All were responsible for septic shock and fatal coma. Surgical management of the infective endocarditis in the first hours of her admission could have improved her prognosis. To conclude, in addition to its interests and its clinical particularities, our present observation has highlighted major public health problems specific to our sub-Saharan African countries, namely: The problem of the double health burden, the problem of delays in seeking care, the problem of resistance to antibiotics and the problem of the insufficiency of reference health technical platforms.

Study of the Frequency of Cardiovascular Diseases and Their Risk Factors in the Emergency Units of Two Hospitals in Dakar (Senegal)

Introduction: Cardiovascular diseases constitute the deadliest pathology in the world with 31% of global mortality in 2018. This is how we felt it necessary to conduct a study on cardiovascular diseases in emergency units of Senegal, more precisely in Dakar, in order to know epidemiological profile of these patients. Methods: The study setting was the reception and emergency units of the Hôpital de Pikine and Hôpital Principal de Dakar. This was an observational, descriptive cross-sectional study with an analytical aim to search for factors associated with the occurrence of cardiovascular disease. The study ran from January 25th to February 5th, 2018 at the Hôpital de Pikine and from February 25th to March 5th, 2018 at Hôpital Principal de Dakar. The source population consisted of patients over 18 years of age and not in a state of pregnancy, who were been received there and had given their free and informed consent to participate in the survey. A representative sample had drawn and a consecutive recruitment of eligible patients were been carried out. The data collection tools were been based on the WHO STEPwise survey questionnaire. Data collection was been carried out in accordance with ethical rules. Results: The study involved 615 patients. The proportions of sedentary lifestyle, low daily consumption of fruits/vegetables, overweight and obesity were 72.4%, 96.4%, 22.7% and 17.3% respectively. This was 55.5% of women who had a waist circumference that corresponded to a high risk of a cardiovascular event and 10.2% for men. 38.9% of patients had blood pressure above 140/90mmhg and 32.2% said they had never controlled their blood pressure in their life. The use of a consultation in a health structure to control his blood pressure was by far the most frequent modality with 61.4%. The proportion of people with cardiovascular disease was 50.1%. Hypertensive flare-ups/hypertensive emergencies were the leading complications diagnosed with 33.33%. Factors associated with the occurrence of cardiovascular disease were sex, age, professional status and body mass index. Discussion & Conclusion: The risk factors for cardiovascular disease are highly represented in our emergency units. In addition to the available care offer, the identification of factors associated with the occurrence of cardiovascular diseases in patients who are been seen there will allow targeted preventive actions within this fragile and vulnerable population. All this to help achieve target 3.4 of the Sustainable Development Goals (SDGs) by 2030. Furthermore, according to the associated factors identified, it appears that achieving SDG 8 will greatly contribute to the prevention of cardiovascular disease. This proves the urgency and interest of an integrated multi-ministerial vision in our strategic plans for the prevention against major non-communicable diseases and cardiovascular diseases in particular.

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.

Differences of maternal mortality rate between Shanghai and New York city from the perspective of regulatory policy

Background:Regulatory policy(RP)is known as a major factor to improve health care system performance.A significant difference in maternal mortality rates(MMRs)was observed between New York city(NYC)and Shanghai(SH),both first-class international metropolises.This study aims to adopt a quantitative evaluation model to analyze whether RP differences contribute to the different MMRs of the two cities.Methods:Based on collection of all publicly released policy documents regarding maternal health in the two cities,we assessed and compared the status of their maternal health care RPs from 2006 to 2017 through a series of quantitative indicators as regulatory elements coverage rate(RECR),departmental responsibility clarity rate(DRCR),and accountability mechanism clarity rate(AMCR),based on two characteristics of comprehensiveness and effectiveness of RPs.Pearson correlation analysis,principal component analysis,and linear regression analysis were used to test the relationships between the indicators and MMR in SH and NYC.Results:By 2017,disparities of maternal health care RP are found between SH and NYC,from the indicators of RECR(100%vs.77.0%),DRCR(38.9%vs.45.1%),and AMCR(29.2%vs.22.5%).From 2006 to 2017,RECR,DRCR,and AMCR in SH have shown a higher growth of 8.7%,53.2%,and 45.2%,compared with growth of 25.0%,12.5%,and 2.9%in NYC.The three indicators were found all negatively correlated with MMR in SH(Coefficients=-0.831,-0.833,and-0.909,and P<0.01),while only RECR and DRCR had negative correlation with MMR in NYC(Coefficients=-0.736 and-0.683,and P<0.05).Linear regression showed that the principal components of the three indicators were found with significant impact on MMRs both in SH(R=0.914,R2=0.836,P<0.001)and NYC(R=0.854,R2=0.357,P=0.04).Conclusion:Compared with NYC,the more comprehensive and effective maternal health care RPs in SH had a stronger impact on MMR control,which contributed to the differences between the two cities’MMRs to some extent.The methods and indicators we adopted for assessment are reasonable and comparable.

Effect of the new maternity insurance scheme on medical expenditures for caesarean delivery in Wuxi, China： a retrospective pre/post-reform case study

Aiming to control rising medical expenditures and help improve China＇s healthcare systems, this study examined whether a cap-based medical insurance scheme with shared financial interest between the insurance and healthcare providers is effective in containing hospitals＇ C-section medical expenditures. We used 6547 caesarean delivery case records from a teaching tertiary-level general public hospital located in Wuxi, China （2004-2013）, and used the Chow test to investigate the possibility of significant variation in mean medical expenditures for caesarean deliveries pre- and post-reform. We also used paired sample t-tests and linear regression models to compare the mean medical expenditures between insured and uninsured women undergoing caesarean delivery during the post-reform period. After the scheme＇s implementation, medical expenditures for caesarean deliveries declined and the medical expenditures of women covered by the scheme were significantly lower than those of uninsured patients. These findings indicated the scheme＇s effectiveness in minimizing caesarean delivery expenditures. The cap-based medical insurance scheme with shared financial interest between insurance and healthcare providers would likely steer healtbcare providers＇ behaviors in a more cost-effective direction.

Yogurt Intake Reduces All-Cause and Cardiovascular Disease Mortality: A Meta-Analysis of Eight Prospective Cohort Studies

Objective:To assess the relationship between yogurt intake and mortality risk from prospective cohort studies.Methods:The PubMed,EMBASE,and Web of Science databases were searched for all records related to yogurt intake and mortality risk[all-cause or cardiovascular disease(CVD)or cancer mortality]before October 1,2018.The Newcastle-Ottawa Quality Scale was used to estimate the quality of all eligible articles.The results of the highest and lowest categories of yogurt intake in each study were collected and the effect size was pooled using a random effects model.The dose-response analysis was calculated using the generalized least squares trend estimation model.Results:Eight eligible cohort studies were included in this meta-analysis.There were 235,676 participants in the 8 studies,and the number of deaths was 14,831.Compared with the lowest category,the highest category of yogurt intake was not significantly related with all cause mortality[hazard ratio(HR)=0.93;95%confidence interval(CI):0.85,1.01],CVD mortality(HR=0.92;95%CI:0.81,1.03)and cancer mortality(HR=0.97;95%CI:0.83,1.12).These studies were homogenous,since the homogeneity test showed that I2 was 28.7%,15.1%and 11.8%,respectively.However,yogurt intake 200 g/d was significantly associated with a lower all-cause mortality(HR=0.88;95%CI:0.80,0.96)and CVD mortality(HR=0.87;95%CI:0.77,0.99)in the subgroup analysis.The dose-response analysis showed that yogurt intake of 200 g/d was inversely associated with all-cause mortality(P=0.041,HR=0.95,95%CI:0.92,1.00)and CVD mortality(P=0.009,HR=0.92,95%CI:0.86,0.98),and all of which were linear relationship(P>0.05).Conclusions:This review provided the evidence regarding yogurt intake can reduce all-cause and CVD mortality.Although some positive findings were identified,more high-quality cohort studies and randomized controlled trials are warranted on a possible protective effect of yoghurt on health.