In Senegal, the widespread use of vector control measures has resulted in a significant reduction in the malaria burden and led the country to consider the possibility of elimination. Given this ...shift and changing context, it is important to characterize the malaria burden across all age groups to guide decision-making on programmatic interventions to interrupt transmission and ultimately eradicate the disease. In Senegal, there is a lack of information on malaria prevalence among certain populations, particularly among adolescents and adults. This study sought to assess the magnitude of malaria infections in all age groups, as well as malaria associated factors in an area of persistent transmission in Senegal.
A cross-sectional household survey was conducted in four health posts (Khossanto, Mamakhona, Diakhaling and Sambrambougou), of the health district of Saraya, in November 2021, among individuals over 6 months of age. Households were selected using multistage sampling. Consented participants were screened for malaria parasites by microscopic examination of blood smears, and hemoglobin levels were measured using the Hemocue HB 301TM analyzer. Socio-demographic information of the participants, household heads, household assets, and information on ownership and use of preventive measures were collected using a structured questionnaire. Weighted generalized mixed effects logistic regression model was used to identify factors associated with microscopically confirmed malaria infection.
A total of 1759 participants were enrolled in the study. Overall, about 21% of participants were classified as having Plasmodium infection; children aged 5-10 years old (26.6%), adolescents aged 10-19 years old (24.7%), and children under five years of age (20.5%) had higher rates of infection compared to adults (13.5%). Plasmodium falciparum accounted for 99.2% of the malaria infections, and most infections (69%) were asymptomatic. Around one-third of study participants had anemia (hemoglobin level <11.0 g/dl), with under five children bearing the highest burden (67.3%). Multivariate analysis showed that the odds of having a malaria infection were around 2 times higher among participants in Khossanto compared to Diakhaling (aOR = 1.84, 95% CI:1.06-3.20). Participants aged 5-9 years were more likely to have malaria infection compared to under five children (aOR = 1.40, 95% CI:1.02-1.91). Factors associated with anemia were P. falciparum infection (aOR = 1.36, p = 0.027), females (aOR = 2.16, p = 0.000), under-five age group (aOR = 13.01, p = 0.000).
Malaria burden was considerable among adolescents and under ten children living in an area of persistent transmission, with adolescents more commonly presenting as asymptomatic. Interventions tailored to this specific group of the population are needed to better control the disease and reduce its burden.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
This study was an explanatory, sequential, mixed-methods design conducted in Senegal. We collected quantitative data from December 24, 2020, to January 16, 2021, and qualitative data from February 19 ...to March 30, 2021. We conducted a telephone survey among a marginal quota sample of 607 people over 18 years old. We performed descriptive, bivariate, and multivariate analyses with R software for the quantitative phase; and performed manual content analyses for the qualitative phase. We surveyed 607 people for the quantitative phase and interviewed 30 people for the qualitative phase. Individuals who hesitated or refused to be vaccinated represented 12.9% and 32.8%, respectively. Vaccine hesitancy was related to gender, living in large cities, having a poor attitude toward the vaccine, thinking that the vaccine would not help protect them from the virus, being influenced by people important to them, and lacking information from health professionals. Vaccine refusal was related to living in large cities, having a poor attitude toward the vaccine, thinking that the vaccine would not help protect them from the virus, thinking that the vaccine could endanger their health, trusting opinions of people who were important to them, and lacking information from health professionals. The results of the study show that the factors associated with COVID-19 vaccine hesitancy and refusal are diverse and complex. Addressing these factors will help to ensure better vaccination coverage. Governments and health authorities should intensify their efforts to promote vaccine confidence and reduce misinformation.
The World Health Organization recommends recording vaccination status according to maternal recall in countries where administrative reporting systems are insufficiently reliable, as maternal recall ...in developing countries has been shown to be quite reliable compared with data from vaccination cards. This study aimed to investigate childhood vaccination coverage and its determinants according to the mothers' presentation of vaccination cards.
The data come from the 2017 Senegalese Demographic and Health Survey, a nationally representative household survey of women aged 15-49 years, with a questionnaire focusing on children's health. This analysis was restricted to children aged 12-35 months (n = 4032) and it assessed vaccination coverage and associated sociodemographic factors with weighted multivariate logistic regressions. Stratified multivariate logistic regressions were also performed to investigate factors associated with routine childhood immunization uptake of the Bacillus Calmette-Guérin (BCG) vaccine, recommended for administration shortly after birth, as well as of the vaccines against yellow fever and measles (recommended at 9 months).
Comparison of vaccination coverage estimates according to the vaccination card or parental recall resulted in a 5-10% difference in estimated coverage for the BCG, pentavalent, measles, and yellow fever vaccines, but a huge difference for the polio vaccine (93.0% with the card, 32.0% without it). Presentation of the vaccination card was correlated with mothers' attendance at health facilities (suggesting it serves as a concrete manifestation of a bond between mothers and the healthcare system) and their region of residence, but it was not correlated with usually strong predictors of childhood vaccination, such as maternal education level. Factors associated with vaccinations differed depending on whether they were administered shortly after birth or later on.
Maternal recall was found to be quite reliable except for oral polio vaccination, which raises the possibility that complete immunization coverage rates could have been significantly underestimated due to potential confusion between injection and vaccination. Considering the ability to present vaccination cards as the materialization of a bond with the healthcare system, the decision path leading to vaccination among those who lack such a bond appears longer and more likely to be driven by supply-side effects.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
As the global burden of malaria decreases, routine health information systems (RHIS) have become invaluable for monitoring progress towards elimination. The District Health Information System, ...version 2 (DHIS2) has been widely adopted across countries and is expected to increase the quality of reporting of RHIS. In this study, we evaluated the quality of reporting of key indicators of childhood malaria from January 2014 through December 2017, the first 4 years of DHIS2 implementation in Senegal.
Monthly data on the number of confirmed and suspected malaria cases as well as tests done were extracted from the Senegal DHIS2. Reporting completeness was measured as the number of monthly reports received divided by the expected number of reports in a given year. Completeness of indicator data was measured as the percentage of non-missing indicator values. We used a quasi-Poisson model with natural cubic spline terms of month of reporting to impute values missing at the facility level. We used the imputed values to take into account the percentage of malaria cases that were missed due to lack of reporting. Consistency was measured as the absence of moderate and extreme outliers, internal consistency between related indicators, and consistency of indicators over time.
In contrast to public facilities of which 92.7% reported data in the DHIS2 system during the study period, only 15.3% of the private facilities used the reporting system. At the national level, completeness of facility reporting increased from 84.5% in 2014 to 97.5% in 2017. The percentage of expected malaria cases reported increased from 76.5% in 2014 to 94.7% in 2017. Over the study period, the percentage of malaria cases reported across all districts was on average 7.5% higher (P < 0.01) during the rainy season relative to the dry season. Reporting completeness rates were lower among hospitals compared to health centers and health posts. The incidence of moderate and extreme outlier values was 5.2 and 2.3%, respectively. The number of confirmed malaria cases increased by 15% whereas the numbers of suspected cases and tests conducted more than doubled from 2014 to 2017 likely due to a policy shift towards universal testing of pediatric febrile cases.
The quality of reporting for malaria indicators in the Senegal DHIS2 has improved over time and the data are suitable for use to monitor progress in malaria programs, with an understanding of their limitations. Senegalese health authorities should maintain the focus on broader adoption of DHIS2 reporting by private facilities, the sustainability of district-level data quality reviews, facility-level supervision and feedback mechanisms at all levels of the health system.
Celotno besedilo
Dostopno za:
CEKLJ, DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
With the low adherence to voluntary mutual health insurance, Senegal’s policymakers have sought to understand the feasibility of compulsory health insurance membership. This study aims to measure the ...acceptability of mandatory membership in community-based mutual health insurance (CBHI) and to understand its possible administrative modalities. The study consists of a national survey among a representative population sample selected by marginal quotas. The survey was conducted in 2022 over the phone, with a random composition method involving 914 people. The questionnaire measured the socio-economic characteristics of households, their level of acceptability concerning voluntary and compulsory membership, and their level of confidence in CBHIs and the health system. Respondents preferred voluntary (86%) over mandatory (70%) membership of a CBHI. The gap between voluntary and compulsory membership scores was smaller among women (p = 0.040), people under 35 (p = 0.033), and people with no health coverage (p = 0.011). Voluntary or compulsory membership was correlated (p = 0.000) to trust in current CBHIs and health systems. Lack of trust in the CBHI management has been more disadvantageous for acceptance of the mandatory than the voluntary membership. No particular preference emerged as the preferred administrative channel (e.g. death certificate, identity card, etc.) to enforce the mandatory option. The results confirmed the well-known challenges of building universal health coverage based on CBHIs—a poorly appreciated model whose low performance reduces the acceptability of populations to adhere to it, whether voluntary or mandatory. Suppose Senegal persists in its health insurance approach. In that case, it will be essential to strengthen the performance and funding of CBHIs, and to gain population trust to enable a mandatory or more systemic membership.
Abstract
Background
Increasing the performance of routine health information systems (RHIS) is an important policy priority both globally and in Senegal. As RHIS data become increasingly important in ...driving decision-making in Senegal, it is imperative to understand the factors that determine their use.
Methods
Semi-structured interviews were conducted with 18 high- and mid-level key informants active in the malaria, tuberculosis and HIV programmatic areas in Senegal. Key informants were employed in the relevant divisions of the Senegal Ministry of Health or nongovernmental / civil society organizations. We asked respondents questions related to the flow, quality and use of RHIS data in their organizations. A framework approach was used to analyze the qualitative data.
Results
Although the respondents worked at the strategic levels of their respective organizations, they consistently indicated that data quality and data use issues began at the operational level of the health system before the data made its way to the central level. We classify the main identified barriers and facilitators to the use of routine data into six categories and attempt to describe their interrelated nature. We find that data quality is a central and direct determinant of RHIS data use. We report that a number of upstream factors in the Senegal context interact to influence the quality of routine data produced. We identify the sociopolitical, financial and system design determinants of RHIS data collection, dissemination and use. We also discuss the organizational and infrastructural factors that influence the use of RHIS data.
Conclusions
We recommend specific prescriptive actions with potential to improve RHIS performance in Senegal, the quality of the data produced and their use. These actions include addressing sociopolitical factors that often interrupt RHIS functioning in Senegal, supporting and motivating staff that maintain RHIS data systems as well as ensuring RHIS data completeness and representativeness. We argue for improved coordination between the various stakeholders in order to streamline RHIS data processes and improve transparency. Finally, we recommend the promotion of a sustained culture of data quality assessment and use.
Celotno besedilo
Dostopno za:
CEKLJ, DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Vaccination is considered one of the solutions to the Coronavirus Disease 2019 (COVID-19) pandemic. However, a small proportion of the population were fully vaccinated in Benin (20.9%) and Senegal ...(7.6%) by December 2022. This study explores the determinants of intent to vaccinate. This was a cross-sectional, descriptive, and analytical study of 865 Beninese and 813 Senegalese aged 18 years and older. Marginal quota sampling by age, gender and region was adopted. Data collection, using a survey instrument based on the Random Digit Dialing method, was conducted from December 24, 2020, to January 16, 2021, in Senegal and from March 29 to May 14, 2021, in Benin. The questionnaire used the Theory of Planned Behavior and the Health Belief Model. The influence of factors was assessed using a structural equation model based on a diagonally weighted least squares estimator to account for ordered categorical data (Likert scales). In Benin and Senegal, the intention to vaccinate against COVID-19 is influenced by distinct factors. In Benin, social influence (β = 0.42, p = 0.003) and perception of vaccine safety (β = -0.53, p<0.001) play pivotal roles, suggesting those socially influenced have a higher vaccination intention. In Senegal, vaccination intentions are primarily driven by positive attitudes towards the vaccine (β = 0.65, p = 0.013) and social influence (β = 0.25, p = 0.048). This underscores the importance of individual beliefs, personal perceptions, and supportive social contexts in decision-making. Notably, positive vaccination attitudes and perceptions in both countries are strongly tied to increased social influence. While nuances exist between Benin and Senegal regarding factors influencing COVID-19 vaccination intentions, both nations underscore the pivotal roles of social influence and individual vaccination perceptions. Emphasizing trust in vaccine safety and promoting positive attitudes through effective communication are crucial for enhancing vaccination uptake in these West African countries.
INTRODUCTION: Many studies have reported the association of SARS-CoV-2 with benign and malignant hemopathies. Data from African series are scarce. This work was conducted in sub-Saharan Africa and ...aimed to study the clinical, biological, and evolutionary features of hemopathies associated with this infection. MATERIALS AND METHODS: It was a retrospective, cross-sectional study carried out over 32 months including 86 patients with benign or malignant hemopathies who underwent coronavirus disease-2019 (COVID-19) confirmed by the real-time reverse transcriptase-polymerase chain reaction or presenting with atypical clinical signs associated with highly suggestive computed tomography (CT) scan signs. RESULTS: The mean age of patients was 48.3 ± 18.7 years with a sex ratio of 0.75. The main benign hemopathies were sickle cell trait (SCT) (n = 51), sickle cell disease SS (n = 8), and sickle cell disease SC (n = 1), while malignant hemopathies were represented by multiple myeloma (n = 5), non-Hodgkin lymphoma (n = 5), and chronic lymphocytic leukemia (n = 4). The clinical symptoms mainly featured anemic syndrome (16.3%) and a vaso-occlusive crisis was found in 9.3% of homozygous sickle-cell patients. The infection was moderate in 48% of cases and severe in 19.7%. The severe forms were commonly found in patients with malignant hemopathies (47.6%) and the benign forms were noted in benign hemopathies (38.4%). Full blood count outlined anemia in 32.5% and lymphopenia in 23.2% of cases. On imaging, the CT scan reported severe lesions in 41.3% of cases. The outcome resulted in full recovery in 76.7% of cases, and mortality occurred in 23.3%. In univariate analysis, death was mainly noted in patients with lymphoid hemopathies (15%). Comorbidities (P < 0.0001), lymphoid hemopathies (P < 0.0001), and the severity of COVID-19 (P < 0.0001) had a positive impact on death occurrence in univariate analysis. CONCLUSION: The association between SARS-CoV-2 and hemopathy is not uncommon and is dominated by benign hemopathies. Malignant hemopathies are at-risk underlying conditions justifying a hospital follow-up of mild forms, allowing better survival. Particular attention must be paid to SCT with comorbidities and those with sickle cell disease of disease.
Introduction. Today, in Sub-Saharan Africa, vaccine-preventable diseases still contribute heavily to high child mortality. Maintaining high coverage rates for childhood vaccines and reducing related ...social inequalities are public health priorities in Senegal. Our aim was to investigate the determinants of childhood vaccination, including sociodemographic factors and previous vaccine-related decision-making.
Methods. Data come from the 2016 Senegalese Demographic and Health Survey, a nationally representative household survey targeting women aged 15-49, with a questionnaire focusing on health and reproductive issues, including their children's health. We restricted the analysis to children aged 12-23 months (n = 1,143). We used bivariate and multivariate analyses for investigating the determinants of several childhood vaccinations (Bacillus Calmette-Guérin, pentavalent, polio, measles and yellow fever vaccines), including sociodemographic factors and previous shots.
Results. We identified two main sociodemographic predictors of childhood vaccination in Senegal: the mother's education level, which was strongly and positively correlated to every vaccination considered, except from the BCG vaccination, and the region of residence, with higher vaccination coverage rates in the Centre and West of Senegal. Moreover, previous shots were also strongly predictive of subsequent shots.
Conclusion. The positive impact of mother's education on child vaccination illustrates the wide-ranging benefits of educating girls, while the regional variability of immunization rates requires more research to be better understood. Previous shots are probably a proxy variable for unobservable factors strongly correlated to vaccinations, but beyond this 'proxy effect', they may also have their own specific effect on following shots. We believe this topic deserves further research.
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