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Background Bacterial meningitis is a major cause of mortality among children under 5 years of age. Senegal is part of World Health Organization–coordinated sentinel site surveillance for pediatric bacterial meningitis surveillance. We conducted this analysis to describe the epidemiology and etiology of bacterial meningitis among children less than 5 years in Senegal from 2010 and to 2016. Methods Children who met the inclusion criteria for suspected meningitis at the Centre Hospitalier National d’Enfants Albert Royer, Senegal, from 2010 to 2016 were included. Cerebrospinal fluid specimens were collected from suspected cases examined by routine bacteriology and molecular assays. Serotyping, antimicrobial susceptibility testing, and whole-genome sequencing were performed. Results A total of 1013 children were admitted with suspected meningitis during the surveillance period. Streptococcus pneumoniae, Neisseria meningitidis, and Haemophilus accounted for 66% (76/115), 25% (29/115), and 9% (10/115) of all confirmed cases, respectively. Most of the suspected cases (63%; 639/1013) and laboratory-confirmed (57%; 66/115) cases occurred during the first year of life. Pneumococcal meningitis case fatality rate was 6-fold higher than that of meningococcal meningitis (28% vs 5%). The predominant pneumococcal lineage causing meningitis was sequence type 618 (n = 7), commonly found among serotype 1 isolates. An ST 2174 lineage that included serotypes 19A and 23F was resistant to trimethoprim-sulfamethoxazole. Conclusions There has been a decline in pneumococcal meningitis post–pneumococcal conjugate vaccine introduction in Senegal. However, disease caused by pathogens covered by vaccines in widespread use still persists. There is need for continued effective monitoring of vaccine-preventable meningitis., Disease caused by pathogens covered by conjugate vaccines in widespread use still persists in Senegal. There is need for continued effective monitoring of vaccine-preventable meningitis.

Background Senegal introduced a 13-valent pneumococcal conjugate vaccine (PCV13) in October 2013, given at 6, 10, and 14 weeks of age. We document trends of meningitis and pneumonia after the PCV13 introduction. Methods From October 2010–October 2016, hospitalization data for clinical meningitis and pneumonia in children aged Results Over the 7-year period, 1836 and 889 hospitalizations with a discharge diagnosis of pneumonia and meningitis, respectively, occurred in children aged Conclusions We used data from 1 hospital to detect a small, significant reduction in all-cause pneumonia hospitalizations 2 years post-PCV13 introduction in infants; the same trend was not measurable in children aged 12–59 months or in meningitis cases. There is a need for continued surveillance to assess the long-term impact of sustained PCV13 use and to monitor how pneumococcus is causing disease in the meningitis belt.

Little is known about volunteers from Northern research settings who participate in vaccine trials of highly infectious diseases with no approved treatments. This article explores the motivations of HIV immunocompromised study participants in Canada who volunteered in a Phase II clinical trial that evaluated the safety and immunogenicity of an Ebola vaccine candidate.Observation at the clinical study site and semi-structured interviews employing situational and discursive analysis were conducted with clinical trial participants and staff over one year. Interviews were recorded, transcribed and analysed using critical qualitative interpretivist thematic analytical techniques. Patterns were identified, clustered and sorted to generate distinct and comprehensive themes. We then reassembled events and contexts from the study participants' stories to develop two ideal portraits based on "composite characters" based on study participants features. These provide ethnographically rich details of participants' meaningful social worlds while protecting individual identities.Ten of the 14 clinical trial participants, and 3 study staff were interviewed. Participant demographics and socio-economic profiles expressed limited contextual diversity. Half were men who have sex with men, half were former injection drug users experiencing homelessness, one was female, none were racialized minorities and there were no people from HIV endemic countries. Fully 90% had previous involvement in other clinical studies. Their stories point to particular socio-economic situations that motivated their participation as clinical labor through trial participation.Our findings support Fisher's argument of "structural coercion" in clinical trial recruitment of vulnerable individuals experiencing precarious living conditions. Clinical trials should provide more detail of the structural socio-economic conditions and healthcare needs which lie "under consent" of study participants. Going well beyond an overly convenient narrative of altruism, ethical deliberation frameworks need to sufficiently address the structural conditions of clinical trials. We offer concrete possibilities for this and acknowledge that further research and clinical data should be made available underlying study participant contexts with regards to recruitment and participation in resource poor settings, in both the South and the North.

International audience; This commentary draws on sub-Saharan African health researchers’ accounts of their countries’ responses to control the spread of COVID-19, including social and health impacts, home-grown solutions, and gaps in knowledge. Limited human and material resources for infection control and lack of understanding or appreciation by the government of the realities of vulnerable populations have contributed to failed interventions to curb transmission, and further deepened inequalities. Some governments have adapted or limited lockdowns due to the negative impacts on livelihoods and taken specific measures to minimize the impact on the most vulnerable citizens. However, these measures may not reach the majority of the poor. Yet, African countries’ responses to COVID-19 have also included a range of innovations, including diversification of local businesses to produce personal protective equipment, disinfectants, test kits, etc., which may expand domestic manufacturing capabilities and deepen self-reliance. African and high-income governments, donors, non-governmental organizations, and businesses should work to strengthen existing health system capacity and back African-led business. Social scientific understandings of public perceptions, their interactions with COVID-19 control measures, and studies on promising clinical interventions are needed. However, a decolonizing response to COVID-19 must include explicit and meaningful commitments to sharing the power—the authority and resources—to study and endorse solutions.; Le présent commentaire est fondé sur les témoignages de chercheurs en santé d’Afrique subsaharienne sur les mesures prises par leurs pays pour enrayer la propagation de la COVID-19, dont les effets sociosanitaires, les solutions « maison » et les lacunes à combler. L’insuffisance de ressources humaines et matérielles pour contrôler l’infection et le manque de compréhension ou de reconnaissance par les gouvernements des réalités des populations vulnérables ont contribué à l’échec des interventions pour enrayer la transmission et ont creusé les inégalités. Certains gouvernements ont adapté ou limité les confinements pour en réduire les effets nuisibles sur les moyens de subsistance des gens et pris des mesures particulières pour réduire les répercussions sur leurs citoyens les plus vulnérables. Ces mesures ne profitent pas toujours à la majorité des pauvres, cependant. Néanmoins, la riposte des pays africains à la COVID-19 comporte aussi des innovations, dont la diversification des entreprises locales pour produire de l’équipement de protection individuelle, des désinfectants, des trousses d’analyse, etc., qui pourrait renforcer les capacités du secteur manufacturier intérieur et favoriser l’autonomie. Les gouvernements des pays africains et à revenu élevé, les bailleurs de fonds, les organisations non gouvernementales et les entreprises devraient collaborer pour renforcer les capacités des systèmes de santé existants et financer les entreprises africaines. Il faut combler le manque de compréhension par les sciences sociales des perceptions du public et de leurs interactions avec les mesures de contrôle de la COVID-19, et le manque d’études sur les interventions cliniques prometteuses. Toutefois, une riposte à la COVID-19 fondée sur la décolonisation doit inclure des engagements explicites et concrets à partager le pouvoir d’étudier et d’approuver des solutions – tant l’autorité que les ressources nécessaires.

Introduction l’objectif de cette étude est d´évaluer l´impact du COVID-19 sur les activités de soins et les recettes au Centre Hospitalier National d´Enfant Albert Royer de Dakar au Sénégal. Méthodes il s´agissait d´une étude rétrospective, descriptive et analytique comparant les activités de consultations externes, d´hospitalisation et les recettes du premier trimestre des années 2019 et 2020. Résultats une baisse moyenne de 33% des consultations externes a été notée au premier trimestre de l´année 2020 correspondant à la période de la pandémie comparée au premier trimestre de 2019. Une augmentation des hospitalisations était observée surtout pour les mois de janvier et février. Cependant, au mois de mars, une baisse de 11% était notée. Il en est de même pour les recettes où une baisse n´est observée qu´au mois de mars; elle était de 10%. Conclusion l´épidémie actuelle au COVID-19 impacte fortement sur les activités de consultations externes, de soins et les recettes du centre hospitalier national d´Enfants Albert Royer. Des mesures efficaces doivent être prises pour éviter les conséquences sur la mortalité et le fonctionnement de la structure.

BACKGROUND: Acute gastroenteritis (AGE) is a leading cause of morbidity and mortality among children

Hypoxaemia is a predictor of pneumonia-related mortality. WHO published recommendations for oxygen therapy based on clinical signs which state that, when oxygen is plentiful, it should be given to children with central cyanosis, inability to drink, severe chest indrawing, RR >70 breaths/min, grunting with every breath (in young infants) or those who display head nodding. These guidelines, however, are based on a few studies only. To assess the accuracy of combinations of clinical signs which predict hypoxaemia in pre-school children aged 2 months to 5 years with acute respiratory distress in hospitals in Switzerland and Senegal. This observational study was conducted in four emergency units, two in Switzerland and two in Senegal. Patients aged 2 months to 5 years with acute respiratory distress were eligible for inclusion. Clinical signs were compared with transcutaneous blood saturation levels (SaO 2 ). About 111 children were assessed, 67 in Switzerland and 44 in Senegal. The prevalence of hypoxaemia was 13%. Twelve models of combined symptoms were analysed. The WHO model, for when oxygen supply is ample, had the highest diagnostic performance with a sensitivity of 0.93 and a specificity of 0.60. Clinical signs alone are unreliable for the detection of hypoxaemia. The current WHO model, for ample oxygen supply proved to be the best clinical predictor, although a great number of non-hypoxaemic children were unnecessarily treated because of the low specificity of this model.

Introduction : L'hyperthyroidie de l'enfant semble rare et constitue un probleme de par son retentissement psychosomatique. L’objectif etait de faire le point sur ses aspects epidemiologiques et diagnostiques chez l’enfant a Dakar. Methodes : Il s'agissait d'une etude multicentrique, descriptive sur 15 ans. Etaient analyses les aspects epidemiologiques, cliniques et etiologiques. Resultats : 239 patients selectionnes avec une prevalence de 2.4%, un sex ratio (H/F) de 0.36, un âge moyen de 10.8 ans. A l'inclusion, il s'agissait d'un aine de famille (26.3%), d'une croissance avancee (36.9%), retardee (12.5%), d'une corpulence insuffisante (40.1%). L'etiologie etait la maladie de Basedow dans 90.3% avec un facteur psychoaffectif dans 22.1%. Sur le plan clinique, predominaient la tachycardie (92.4%), le goitre (91.1%), l'exophtalmie (81.8%), l'amaigrissement (69.8%) avec cependant une enuresie (30.2%) et des manifestations psychiques (3.1%). Les manifestations cardiovasculaires et cutanees etaient positivement associees avec l'âge (p < 0.05). Le goitre etait associe au sexe feminin (p = 0.005), aux signes cardiovasculaires (p = 0.02), neuropsychiques (p = 0.03), cutanees (p = 0.03) et a la diarrhee (p = 0.03). La T4 libre etait correlee a l'âge (p = 0.007), la diarrhee (p = 0.021), l'anxiete (p = 0.024), la frequence cardiaque (p = 0.00) et la maladie de Basedow (p = 0.04). Plus le goitre etait volumineux, plus etait augmentee la T4 libre (p = 0.007). Conclusion : L'hyperthyroidie de l'enfant se differencie de celle de l'adulte par les facteurs d'induction, les perturbations sur la croissance et l'enuresie. L’âge et le sexe semble favoriser le tableau clinique de thyrotoxicose et les signes associes. Mots cles : Hyperthyroidie, enfant, Senegal

Senegal will be spared by phenomenon of population ageing, which will surely have socioeconomic and cultural consequences that will not be easy to tackle, as all sectors will be affected. In regard to legal protection, there are not any special legal acts for the elderly as is the case for children and women. They are treated just as responsible adults whose legal status is the same as everyone else. As far as the framework of legal protection of elderly people is concerned, Senegal has ratified all international and regional means and mecanisms for the protection of the rights of the elderly. In addition, the authorities have adopted policies and programs that favor taking charge of old people's interests. At the present, Senegal possesses a legal framework for the protection of its elderly people. So the matter is about creating new rights, because even the existing rights are not known to their beneficiaries. What is important is to ensure that the elderly fully enjoy their rights in the same way as the other members of society. It is wise, therefore, to put in place plan for information, public awareness and communication concerning the legal regulating framework. Thus, Senegal could be regarded as a pioneer in terms of the protection the elderly, and these leading programs can represent models for the countries of the region, whose social, sanitary and economic contexts are similar.

International audience; Objectives: Neisseria meningitidis is the major cause of seasonal meningitis epidemics in the African meningitis belt. In the changing context of a reduction in incidence of serogroup A and an increase in incidence of serogroups W and C and of Streptococcus pneumoniae, a better understanding of the determinants driving the disease transmission dynamics remains crucial to improving bacterial meningitis control.Methods: The literature was searched to provide a multi-disciplinary overview of the determinants of meningitis transmission dynamics in the African meningitis belt.Results: Seasonal hyperendemicity is likely predominantly caused by increased invasion rates, sporadic localized epidemics by increased transmission rates, and larger pluri-annual epidemic waves by changing population immunity. Carriage likely involves competition for colonization and cross-immunity. The duration of immunity likely depends on the acquisition type. Major risk factors include dust and low humidity, and presumably human contact rates and co-infections; social studies highlighted environmental and dietary factors, with supernatural explanations.Conclusions: Efforts should focus on implementing multi-country, longitudinal seroprevalence and epidemiological studies, validating immune markers of protection, and improving surveillance, including more systematic molecular characterizations of the bacteria. Integrating climate and social factors into disease control strategies represents a high priority for optimizing the public health response and anticipating the geographic evolution of the African meningitis belt.

Le cavernome portal est une anomalie vasculaire veineuse caractérisée par la formation d'un réseau de veines dont le calibre est augmenté et au sein duquel chemine un sang portal. Il est la conséquence d'occlusion thrombotique et toujours chronique du système porte extra hépatique. C'est une des causes les plus fréquentes d'hypertension portale chez l'enfant. Ainsi sa gravité est surtout liée au risque important d''hémorragies digestives. Très peu de cas ont été décrits dans la littérature notamment africaine. Nous rapportons l'bservation d'un garçon de 4 ans reçu pour hématémèse de grande abondance, méléna et vertiges qui présentait à l'exameLe cavernome portal est une anomalie vasculaire veineuse caractérisée par la formation d'un réseau de veines dont le calibre est augmenté et au sein duquel chemine un sang portal. Il est la conséquence d'une occlusion thrombotique et toujours chronique du système porte extra hépatique. C'est une des causes les plus fréquentes d'hypertension portale chez l'enfant. Ainsi sa gravité est surtout liée au risque important d'hémorragies digestives. Très peu de cas ont été décrits dans la littérature notamment africaine. Nous rapportons l'observation d'un garçon de 4 ans reçu pour hématémèse de grande abondance, méléna et vertiges qui présentait à l'examen un syndrome anémique. Le bilan iologique retrouvait une anémie sévère hypochrome microcytaire avec une fonction rénale ethépatique normale. L'endoscopie oeso-gastrique montrait des varices oesophagiennes grade III avec signes rouges. échographie abdominale mit en évidence un lacis veineux portal en faveur d'un cavernome. Le scanner abdominal confirmait le cavernome porte avec syndrome d'a été effectuée et il a été mis sous bétabloquant. Le cavernome portal peut être une complication majeure de malformations vasculaires souvent méconnues. Il faut y penser devant toute hémorragie digestive chez l'enfant. La prise en charge doit être urgente et adaptée pour éviter une évolution fatalen un syndrome anémique. Le bilan biologique retrouvait une anémie sévère hypochrome microcytaire avec une fonction rénale et hépatique normale. L'endoscopie oeso-gastrique montrait des varices oesophagiennes grade III avec signes rouges. L'échographie abdominale mit en évidence un lacis veineux portal en faveur d'un cavernome. Le scanner abdominal confirmait le cavernome porte avec syndrome d'hypertension portale et anomalie vasculaire à type l'abouchement ectopique de la veine splénique au tronc formé par la veine gonadique et la veine mésentérique inférieure. Sur le plan thérapeutique une transfusion sanguine a été effectuée et il a été mis sous bétabloquant. Le cavernome portal peut être une complication majeure de malformations vasculaires souvent méconnues. Il faut y penser devant toute hémorragie digestive chez l'enfant. La prise en charge doit être urgente et adaptée pour éviter une évolution fatale.

L’hypothyroïdie de l’enfant é été peu étudiée au Sénégal. Le but de cette étude était d’évaluer les aspects épidémiologiques, diagnostiques et évolutifs de l’hypothyroïdie congénitale. Il s’agissait d’une étude rétrospective descriptive et analytique portant sur tous les enfants suivis pour hypothyroïdie congénitale au Centre Hospitalier National d’Enfants Albert Royer sur la période de 2001 à 2014 (14 ans). A partir des dossiers des malades, nous avons recueilli et analysé les données sociodémographiques, cliniques et évolutives. Au total, 28 patients ont été inclus, soit une moyenne de 2 cas par an. L’âge moyen de découverte de l’hypothyroïdie était de 54,25 ± 43 mois avec une prédominance féminine (Sex- ratio 0,47). Seuls 2 cas d’hypothyroïdie ont été diagnostiqués dans la période néonatale. La consanguinité était présente chez 68% des patients. Les signes cliniques étaient dominés par le retard des acquisitions psychomotrices (96%), l’hypothermie (46%), la dysmorphie cranio-faciale (43%) et le goitre (39%). Le retard statural était constant au-delà de 6 mois. Les étiologies étaient dominées par les troubles de l’hormonosynthèse (84,21%). Dans l’évolution, la taille moyenne des patients était passée de -3,5 DS à -2,25 DS pour une durée de traitement moyenne de 28 mois. La débilité mentale était présente dans 73% des cas. Le retard de croissance et la débilité mentale étaient d’autant plus sévères que le diagnostic était tardif. Nos résultats confirment l’insuffisance d’une prise en charge précoce des patients. Il urge de mettre en place un système de dépistage néonatale systématique, afin d’améliorer le pronostic mental de cette affection.

Le syndrome hémolytique et urémique (SHU) est une cause fréquente d’insuffisance rénale aiguë (IRA) organique chez l’enfant. C’est une complication évolutive des gastroentérites aiguës (GEA) en particulier à Escherichia coli de l’enfant. Notre objectif était de décrire les aspects cliniques, thérapeutiques et évolutifs de cette affection chez quatre enfants. Nous avions colligé quatre cas de SHU. L’âge moyen était de 10,5 mois (5-15mois) exclusivement des garçons. L’examen clinique retrouvait une anémie de type hémolytique (pâleur et ictére), un syndrome oedémateux avec oligo-anurie (2 cas), une hypertension artérielle (1 patient), une GEA avec déshydratation sévère et choc hypovolémique (2 patients), des troubles de conscience. L’IRA était notée chez tous les patients de même que la thrombopénie et les schizocytes au frottis. Le Coombs direct était négatif. Il y avait une hyperkaliémie (3patients) dont 1 patient supérieure à 9,2 mmol/l, une hyponatrémie à 129mmol/l(1 patient) et une hypernatrémie à 153mmol/l (1 patient). Le shu était secondaire à une pneumonie à pneumocoque (1 patient), une GEA à E. coli (1 patient). Le traitement était essentiellement symptomatique et comprenait la restriction hydrique, la transfusion de concentrés érythrocytaires, les diurétiques, la dialyse péritonéale et l’hémodialyse. L’évolution était marquée par la survenue d’une insuffisance rénale chronique (1 patient) après 6 mois de suivi et la guérison (1 cas). Nous avions noté 3décés.Le SHU est la cause la plus fréquente d’IRA organique du nourrisson. Le diagnostic est essentiellement biologique, le traitement est surtout symptomatique. The Pan African Medical Journal 2016;24

Background Rapid diagnostics are not available for several human pathogens in the genus Phlebovirus of the Bunyaviridae. Objectives To develop RT-PCR assays for Sandfly Fever Sicilian virus (SFSV), Sandfly Fever Naples virus (SFNV), Toscana virus (TOSV) and Rift Valley Fever virus (RVFV). Study design RNA standards were generated and used to test the performance of the assays. Results A detection limit of 10–100 RNA molecules was determined for the SFSV, TOSV and RVFV assays. The sensitivity of the SFNV assay was not determined. The TOSV and the RVFV assays detected recent isolates from Spain and Africa, respectively. Conclusion The assays should help to improve surveillance of pathogenic Phleboviruses.

La fievre bilieuse hemoglobinurique (FBH) est une forme grave du paludisme; caracterisee par la survenue d'une hemolyse intravasculaire aigue se traduisant par une anemie hemolytique, une insuffisance renale aigue et une hypovolemie. Son diagnostic repose essentiellement sur la clinique notamment la couleur des urines d'aspect rouge porto. Nous rapportons un cas de fievre bilieuse hemoglobinurique chez un jeune garcon de 10 ans originaire et vivant dans une zone d'endemie palustre, collige dans un CHU de Dakar (Senegal). V.G est un garcon de 10 ans qui etait hospitalise pendant 2 jours au service des urgences dans un centre de sante de proximite pour une fievre associee a des vomissements qui evoluaient depuis 3 jours. Le test de diagnostic rapide (TDR) au paludisme etait positif a la presence d'antigenes de Plasmodium falciparum dans le sang. Un traitement a base de quinine injectable (25 mg/kg/j), a ete entrepris pendant 03 jours. Au quatrieme jour, sont apparues une hemolyse intravasculaire aigue et une hemoglobinurie avec une insuffisance renale aigue anurique. La goutte epaisse etait revenue negative et le traitement par la quinine injectable arrete. Le relais a ete fait avec les derives de l'artemisinine. Trois (03) seances d'hemodialyse ont ete realisees. L'evolution etait favorable, par la reprise de la diurese et la normalisation de la fonction renale. La FBH existe encore dans notre pratique quotidienne. Il faut y penser devant l'apparition brutale d'une hemolyse avec insuffisance renale aigue et urines rouges porto au cours du traitement d'un paludisme. Key words : Paludisme grave, hemoglobinurie, quinine

Malignant infantile osteopetrosis is a rare genetic disease characterized by increased bone density due to osteoclastic dysfunction. We report on the case of a 3-month-old girl who was referred to our hospital by the ENT department for severe anemia in the context of bilateral choanal atresia. Clinical examination showed failure to thrive, anemia, respiratory distress, bilateral choanal atresia, and chest deformation. The abdomen was soft with large hepatosplenomegaly. We noted a lack of eye tracking, no optical-visual reflexes, and left nerve facial paralysis. The blood count showed normocytic normochromic anemia with severe thrombocytopenia. The infectious work-up and blood smears were negative. The skeleton X-ray showed diffuse bone densification of the skull, long bones, pelvis, vertebrae, and ribs. The facial bone CT confirmed membranous choanal atresia. The molecular biology search for the TCIRG1 gene mutation was not available. The patient had supportive treatment (transfusion, oral steroid, vitamin D, oxygen, nutrition). Bone marrow transplantation was indicated but not available. She died at 6 months in a context of severe anemia and bleeding. Malignant infantile osteopetrosis is rare and symptoms are nonspecific. Diagnosis should be considered in young infants presenting refractory anemia, particularly in the context of choanal atresia. Bone marrow transplantation remains the only curative treatment.

Liver abscess is a serious infection that can cause life-threatening complications.To describe the epidemiology, diagnosis, and progression of liver abscess at the Dakar National Albert-Royer Children's Hospital.A retrospective study was conducted from over a period of 5 years (1st January 2010 to 31st December 2014). All children aged 0-15 years hospitalized for liver abscess with ultrasound confirmation were included. We collected demographic data (age, gender, socioeconomic status, origin), clinical data (general and hepatic symptoms), diagnostic data (ultrasound, bacteriology) and progression (death, complications, sequelae). The data were analyzed with Epi-info (P0.05 was considered significant).We collected 26 cases of liver abscesses, representing a hospital prevalence of 100 cases per 100,000 admissions. Males predominated (sex ratio: 1.36). The children's average age was 7.2 years. Most of the children came from urban areas of Dakar. Low socioeconomic status and precarious lifestyle were the contributing factors. Anemia (69.2%), malnutrition (42.3%), and abdominal trauma (15.3%) were the main causes found. The Fontan triad characteristic of the liver abscess was found in 57.7% of cases. At ultrasound, a single abscess was found in 21 cases. The abscess was located in the right lobe in 18 cases, the left lobe in three cases, and in both lobes in three cases. Segment VI (four cases) was the most frequently involved. Bacteriologically, the abscess was pyogenic in 17 cases and an amoebic abscess in nine cases. The main pyogenic sources found were Klebsiella pneumoniae in two cases, Pseudomonas aeruginosa in one case, Streptococcus pneumoniae in one case, and Staphylococcus aureus in one case. The average duration of antibiotic treatment was 14.5 days. Liver drainage was carried out in 24 cases. The outcome was favorable in all children.The prevalence of liver abscesses at the Albert-Royer Children's Hospital is relatively high, compared to the literature data. Percutaneous drainage combined with antibiotics remains the treatment of choice. The prognosis is favorable.

Kangaroo care (KC) is an effective method to care for low birth weight (LBW) newborns, particularly in developing countries. The objective of this study was to estimate the efficacy of this method and its impact on morbidity and mortality of LBW infants admitted to the KC unit of Albert-Royer National Children's Hospital Center (ARNCHC) in Dakar, Senegal.This was a retrospective, single-center study from July 2011 to July 2013. We collected sociodemographic, maternal, and obstetrical data, neonatal characteristics and information during KC (age and weight at inclusion, thermoregulation, feeding, growth, and overall progression). Data were entered and analyzed using SPSS version 9.0.We included 135 newborns, with a female predominance (sex ratio: 0.78). One-third of the mothers (35.5%) were primiparous and only 21.1% had a socioprofessional activity and the majority had a low educational level. The mean gestational age (GA) was 33.08±2.06 weeks of amenorrhea and the mean birth weight 1485±370 g. There were 20 term babies with intrauterine growth restriction (IUGR) (14.8%) and 115 (85.2%) preterm newborns, 83 (72.2%) of whom, showed IUGR. The mean duration of conventional care was 12.3 days (range: 4-27 days) and the main complications were respiratory distress (46.2%), infection (36.9%), and necrotizing enterocolitis (15.1%). At KC admission, the mean post-conceptional age was 34.2±2.46 weeks and the mean weight 1445±319 g (minimum, 700 g). The main complications in KC were infections (20.2%), hypoglycemia (18.5%), and gastro-esophageal reflux disease (16.4%). Only 56.3% of the babies were exclusively breastfed. The mean weight gain during the stay in the KC unit was 15.3±9.08 g/kg/day and the mean weight at discharge was 1761±308 g. Only three episodes of hypothermia were noted. The mean duration in the KC unit was 10.2 days (range: 3-24 days). Five babies died (3.7%): one during KC, one at home, and the three others after readmission to neonatology.Kangaroo care for LBW infants is highly effective in our context. This method should be spread to a large majority of health centers in the country.

We aimed to describe the clinical, epidemiological, and outcome characteristics of IPD case patients hospitalized at the Albert-Royer National Children's Hospital (French acronym CHNEAR) to evaluate the disease burden of IPDs in a pediatric hospital of Dakar (Senegal).All children aged 0-15 years hospitalized at the CHNEAR between January 1st, 2008 and December 31st, 2013 for a documented IPD were included in the study. Medical history, risk factors, clinical, bacteriological, and outcome data was collected. Data was then analyzed using the SPSS software, version 16 (Pearson's Chi(2) test: a P-value0.05 was considered statistically significant).A total of 218 IPD patients were hospitalized at the CHNEAR during the study period (hospital prevalence: 0.79%). The mean age was 36.1 months. The male to female ratio was 1.27 (122 boys and 96 girls). Infants2 years of age represented 61.46% of patients. Prior antibiotic therapy was found in 54% of patients but details were lacking. Infection sites were mostly meningeal (61%) and pleuropulmonary (28.9%). The main isolated serotypes were 1, 6A, 14, 5, and 23F. Case fatality was 17.4% and it was five times higher for pneumococcal meningitis.IPDs are very common in children in Senegal. Infants2 years of age are particularly affected. The very high case fatality (17%) was significantly associated with meningeal infection sites hence the need for better access to pneumococcal vaccines.

Rift Valley fever virus (RVFV), a phlebovirus of the Bunyaviridae family, is an arthropod-borne virus which emerges periodically throughout Africa, emphasizing that it poses a major threat for animal and human populations. To assess the genetic variability of RVFV, several isolates from diverse localities of Africa were investigated by means of reverse transcription-PCR followed by direct sequencing of a region of the small (S), medium (M), and large (L) genomic segments. Phylogenetic analysis showed the existence of three major lineages corresponding to geographic variants from West Africa, Egypt, and Central-East Africa. However, incongruences detected between the L, M, and S phylogenies suggested that genetic exchange via reassortment occurred between strains from different lineages. This hypothesis, depicted by parallel phylogenies, was further confirmed by statistical tests. Our findings, which strongly suggest exchanges between strains from areas of endemicity in West and East Africa, strengthen the potential existence of a sylvatic cycle in the tropical rain forest. This also emphasizes the risk of generating uncontrolled chimeric viruses by using live attenuated vaccines in areas of endemicity.

After the Rift valley fever (RVF) epidemic of 1987 in the Senegal River Basin, RVF surveillance based on serosurveys has been conducted for 10 years. Serum samples were obtained from 1336 persons and from sheep and goats in selected areas, and these were tested for IgG/IgM RVF antibodies by ELISA. After a period of regular decrease in RVF prevalence in domestic animals until 1993, an epizootic was observed in all herds in 1994-95 with increases in IgM levels and abortions. During the same period, no human cases or RVF IgM were detected. The RVF IgG prevalence significantly correlated with date of birth: children born after 1987 have a low prevalence (5%) in clear contrast to the older population (25.3%) in Podor district. A retrospective analysis of rainfall and RVF prevalence in small domestic animals over the last 10 years showed that the re-emergence correlated with heavy rainfall. A general analysis of the risk of re-emergence and the efficiency of this RVF surveillance system are presented.

Eighteen strains of Rift Valley fever (RVF) virus collected over a period of 38 years and isolated from diverse localities in Africa and from various hosts (human, animal and arthropod) were investigated by RT-PCR followed by sequencing of the NS(S) protein coding region. This region was chosen to analyse variability because, in contrast to the N protein, the NS(S) protein differs in various phleboviruses and there exists an RVF virus (clone 13) in which 70% of the NS(S) ORF is deleted, suggesting that this sequence is under a weak selective pressure. Sequence data indicated that percentage divergence among isolates ranged from 0 to 9.6% at the nucleotide level and from 0 to 9.5% at the amino acid level. Phylogenetic analysis based on the NS(S) gene revealed two major lineages: Egyptian and sub-Saharan. This led to the establishment of the relatedness between strains and insights into the NS(S) protein, the function of which is still undetermined. Alignment of the deduced amino acid sequences indicated that the cysteine residues are conserved, as are several motifs representing potential phosphorylation sites.

Introduction: Dynamics of most of vector-borne diseases are strongly linked to global and local environmental changes. Landscape changes are indicators of human activities or natural processes that are likely to modify the ecology of the diseases. Here, a landscape approach developed at a local scale is proposed for extracting mosquito favourable biotopes, and for testing ecological parameters when identifying risk areas of Rift Valley fever (RVF) transmission. The study was carried out around Barkedji village, Ferlo region, Senegal. Methods: In order to test whether pond characteristics may influence the density and the dispersal behaviour of RVF vectors, and thus the spatial variation in RVFV transmission, we used a very high spatial resolution remote sensing image (2.4 m resolution) provided by the Quickbird sensor to produce a detailed land-cover map of the study area. Based on knowledge of vector and disease ecology, seven landscape attributes were defined at the pond level and computed from the land-cover map. Then, the relationships between landscape attributes and RVF serologic incidence rates in small ruminants were analyzed through a beta-binomial regression. Finally, the best statistical model according to the Akaike Information Criterion corrected for small samples (AICC), was used to map areas at risk for RVF. Results: Among the derived landscape variables, the vegetation density index (VDI) computed within a 500 m buffer around ponds was positively correlated with serologic incidence (p

Background Rift Valley fever (RVF) is a vector-borne viral zoonosis of increasing global importance. RVF virus (RVFV) is transmitted either through exposure to infected animals or through bites from different species of infected mosquitoes, mainly of Aedes and Culex genera. These mosquitoes are very sensitive to environmental conditions, which may determine their presence, biology, and abundance. In East Africa, RVF outbreaks are known to be closely associated with heavy rainfall events, unlike in the semi-arid regions of West Africa where the drivers of RVF emergence remain poorly understood. The assumed importance of temporary ponds and rainfall temporal distribution therefore needs to be investigated. Methodology/Principal Findings A hydrological model is combined with a mosquito population model to predict the abundance of the two main mosquito species (Aedes vexans and Culex poicilipes) involved in RVFV transmission in Senegal. The study area is an agropastoral zone located in the Ferlo Valley, characterized by a dense network of temporary water ponds which constitute mosquito breeding sites. The hydrological model uses daily rainfall as input to simulate variations of pond surface areas. The mosquito population model is mechanistic, considers both aquatic and adult stages and is driven by pond dynamics. Once validated using hydrological and entomological field data, the model was used to simulate the abundance dynamics of the two mosquito species over a 43-year period (1961–2003). We analysed the predicted dynamics of mosquito populations with regards to the years of main outbreaks. The results showed that the main RVF outbreaks occurred during years with simultaneous high abundances of both species. Conclusion/Significance Our study provides for the first time a mechanistic insight on RVFV transmission in West Africa. It highlights the complementary roles of Aedes vexans and Culex poicilipes mosquitoes in virus transmission, and recommends the identification of rainfall patterns favourable for RVFV amplification., Author Summary Rift Valley fever (RVF) is a zoonotic disease that affects domestic livestock and humans. During inter-epizootic periods, the main infection mechanism is suspected to be through bites by infected mosquitoes, mainly of Aedes and Culex genera. In East Africa, RVF outbreaks are known to be closely associated with heavy rainfall events, unlike in the semi-arid regions of West Africa where the drivers of RVF emergence remain poorly understood. This study brings mechanistic insight to explain why reported RVF outbreaks in Northern Senegal cannot be correlated directly to rainfall. This is done through the use of a rainfall-driven model of RVF vector populations that combines a hydrological model to simulate daily water variations of mosquito breeding sites, with mosquito population models capable of reproducing the major trends in population dynamics of the two main vectors of RVF virus in Senegal, Ae. vexans and Cx. poicilipes. Results show that RVF occurs during years when both species are present simultaneously in high densities. Simulations of inter-annual variations in mosquito populations successfully explained the dates of RVF outbreaks observed between 1961 and 2003.

During September–October 2010, an unprecedented outbreak of Rift Valley fever was reported in the northern Sahelian region of Mauritania after exceptionally heavy rainfall. Camels probably played a central role in the local amplifi cation of the virus. We describe the main clinical signs (hemorrhagic fever, icterus, and nervous symptoms) observed during the outbreak.

In 1998, circulation of the Rift Valley Fever (RVF) virus was revealed in Diawara by detection of IgM antibodies in sheep and isolation of the virus from mosquitoes caught outside a village. A seroprevalence study was carried out. Finger-prick blood samples, individual and collective details were obtained. One thousand five hundred twenty people (6 months - 83 years) were included. Overall prevalence in this group was approximately 5.2%. The prevalence in infants (6 months - 2 years) was 8.5%. Age, gender, contact with a pond, presence of sheep, and abortion among sheep, and individual or collective travel history were not statistically associated with prevalence. Prevalence increased significantly when the distance to a small ravine, located in the middle of the village, decreased. The results suggest a low, recent, not endemic circulation of the virus. Culex quinquefasciatus was captured near the ravine. This mosquito, similar to Culex pipiens, can play a similar role in human-to-human transmission of the RVF virus.

Authors record a preliminary study led so as to develope techniques of preparation of the cardiac homograft valves. Eight human hearts have been appropriated in the course of medico-legal autopsy. Under sterile hodd, the heart was dissected, aortic and pulmonary valves as well as a mitral valve fragment were collected for a total of 24 valvular levies. After sterlization in an antibiotic solution, valves were preserved at 4 degrees C for the mitral fragment specimen of fresh allograft and to - 196 degrees C in Nitrogen liquidates for the pulmonary and aortic valves. The control of graft quality had consisted in tests of competence during the dissection, to the evaluation of the histological study as well as tests of sterility. Cellular cultures had shown a fibroblast proliferation in 3 cases. It concerned an indeed reliable method but difficult and little sensitivity. Histological tests had shown two types of injurie: the myxoid degeneration (7 times on 8 valves) cryopreserved and a coagulative necrosis whose distribution was identical forthe two modes of conservation. Antibiotic's solution seemed to induce these injuries as do heart ischemia, and the traumatism lihleed to the great cold. The tests of sterility had shown a rate of contamination to 25 % essentially by Pseudomonas. In view of the installation of a behle of allograft bank of quality, we'll need to improve conditions of leavy, to use a freezer adaptation for progressive cryocongelation and the choice of simple method to evaluate valvular viabilty.

In two areas of Senegal where previous evidence of Rift Valley Fever (RVF) virus circulation was detected, Barkedji in the Sahelian bioclimatic zone and Kedougou in the Sudano-Guinean zone, a longitudinal study of the enzootic maintenance of RVF virus was undertaken from 1991 to 1993. Mosquitoes, sand flies, and ticks were collected and domestic ungulates were monitored with serologic surveys. RVF virus was not isolated in Kedougou. In Barkedji, RVF virus was isolated from #Aedes vexans$ and #Ae. ochraceus$ mosquitoes collected in traps near ground pools and cattle droves and from one healthy sheep. Sand flies were not involved in the maintenance cycle. Seroconversions were recorded in three (1,9%) of 160 monitored sheep and goats. The interepizootic vectors appeared to belong to the #Aedes$ subgenus #neomelaniconion$ in East Africa, and to the subgenus #aedimorphus$ in West Africa. Epizootics in East Africa are associated with an increase in rainfall. However, factors associated with epizootics remain unknown for West Africa. (Résumé d'auteur)

Background Since 2000, the Global Alliance for Vaccines and Immunization (GAVI) and WHO have supported the introduction of the Pneumococcal Conjugate Vaccine (PCV) in the immunization programs of developing countries. The highest pneumococcal nasopharyngeal carriage rates have been reported (40-60%) in these countries, and the highest incidence and case fatality rates of pneumococcal infections have been demonstrated in Africa. Methods Studies concerning nasopharyngeal pneumococcal carriage and pneumococcal infection in children less than 5 years old were conducted in Dakar from 2007 to 2008. Serotype, antibiotic susceptibility and minimum inhibitory concentrations were determined. In addition, among 17 overall publications, 6 manuscripts of the Senegalese literature published from 1972 to 2013 were selected for data comparisons. Results Among the 264 children observed, 132 (50%) children generated a nasopharyngeal (NP) positive culture with Streptococcus pneumoniae. The five most prevalent serotypes, were 6B (9%), 19 F (9%), 23 F (7.6%), 14 (7.6%) and 6A (6.8%). Fifteen percent of the strains (20/132) showed reduced susceptibility to penicillin and 3% (4/132) showed reduced susceptibility to anti-pneumococcal fluoroquinolones. Among the 196 suspected pneumococcal infections, 62 (31.6%) Streptococcus pneumoniae were isolated. Serogroup 1 was the most prevalent serotype (21.3%), followed by 6B (14.9%), 23 F (14.9%) and 5 (8.5%). Vaccine coverage for PCV-7, PCV-10 and PCV-13, were 36.2% (17/47), 66% (31/47) and 70.2% (33/47) respectively. Reduced susceptibility to penicillin and anti-pneumococcal fluoroquinolones was 6.4% and 4.3%, respectively, and the overall lethality was 42.4% (14/33). Conclusions This study confirms a high rate of carriage and disease caused by Streptococcus pneumoniae serotypes contained within the current generation of pneumococcal conjugate vaccines and consistent with reports from other countries in sub-Saharan Africa prior to PCV introduction. Antimicrobial resistance in this small unselected sample confirms a low rate of antibiotic resistance. Case-fatality is high. Introduction of a high valency pneumococcal vaccine should be a priority for health planners with the establishment of an effective surveillance system to monitor post vaccine changes. Electronic supplementary material The online version of this article (doi:10.1186/s12879-014-0627-8) contains supplementary material, which is available to authorized users.