Biomedical subjects

I Diallo

Publications and source records attributed to I Diallo.

At least 37 records · Page 2Linked to original sources

PubMed1999

Successful contracting of prevention services: fighting malnutrition in Senegal and Madagascar.

There are very few documented large-scale successes in nutrition in Africa, and virtually no consideration of contracting for preventive services. This paper describes two successful large-scale community nutrition projects in Africa as examples of what can be done in prevention using the contracting approach in rural as well as urban areas. The two case-studies are the Secaline project in Madagascar, and the Community Nutrition Project in Senegal. The article explains what is meant by 'success' in the context of these two projects, how these results were achieved, and how certain bottlenecks were avoided. Both projects are very similar in the type of service they provide, and in combining private administration with public finance. The article illustrates that contracting out is a feasible option to be seriously considered for organizing certain prevention programmes on a large scale. There are strong indications from these projects of success in terms of reducing malnutrition, replicability and scale, and community involvement. When choosing that option, a government can tap available private local human resources through contracting out, rather than delivering those services by the public sector. However, as was done in both projects studied, consideration needs to be given to using a contract management unit for execution and monitoring, which costs 13-17% of the total project's budget. Rigorous assessments of the cost-effectiveness of contracted services are not available, but improved health outcomes, targeting of the poor, and basic cost data suggest that the programmes may well be relatively cost-effective. Although the contracting approach is not presented as the panacea to solve the malnutrition problem faced by Africa, it can certainly provide an alternative in many countries to increase coverage and quality of services.

Child, Preschool↗

PubMed1998

Radiation dose, chemotherapy and risk of osteosarcoma after solid tumours during childhood.

Osteosarcoma is the most frequent second primary cancer occurring during the first 20 years following treatment for a solid cancer in childhood. Using a cohort study of children treated for a solid cancer, we investigated the incidence and etiology of osteosarcoma as a second malignant neoplasm after childhood cancer in a cohort and a case-control study. We analysed the relationship between the local dose of radiation and the risk of osteosarcoma, taking into account chemotherapy received. A cohort study of 4,400 3-year survivors of a first solid cancer during childhood diagnosed in France or the United Kingdom, between 1942 and 1986, revealed 32 subsequent osteosarcomas. In a nested case-control study, we matched 32 cases and 160 controls for sex, type of first cancer, age at first cancer and the duration of follow-up. Parameters studied were the incidence of osteosarcoma, the cumulative local dose of irradiation and the cumulative dose of chemotherapy received by cases and controls. The risk of a osteosarcoma was found to be a linear function of the local dose of radiation (excess relative risk per gray=1.8), and was found to increase with the number of moles of electrophilic agents per square meter but not with other drugs. No interaction was noted between radiotherapy and chemotherapy. Bilateral retinoblastoma, Ewing's sarcoma and soft tissue sarcoma were found to render patients susceptible to a higher risk of developing an osteosarcoma as a second malignant neoplasm. We recommend long-term surveillance of patients who were treated during childhood for bilateral retinoblastoma, Ewing's sarcoma, soft tissue sarcoma, as well as other first cancer treated with radiotherapy plus high doses of chemotherapy, without focusing exclusively on the radiation field.

Adolescent↗

PubMed1998

Individualized phantom based on CT slices and auxological data (ICTA) for dose estimations following radiotherapy for skin haemangioma in childhood.

BACKGROUND AND PURPOSE: Before 1974 about 5000 children were treated by radiotherapy at the Institut Gustave-Roussy (IGR) for a skin haemangioma. A human model whose characteristics are as close as possible to those of the patient at the time of the treatment is necessary to effectuate an accurate retrospective estimation of the radiation doses received at distant organs. METHODS: We have developed a software package which constructs an individualized phantom based on CT slices and auxological data (ICTA) for this purpose. A set of real CT slices is used to produce a 3-D representation of the human body which is then adjusted to fit the dimensions supplied by published auxological data relative to sex and age for each patient. One hundred sixty-one anatomical landmarks of epidemiological interest have been defined inside the phantom for dose estimation. RESULTS: The transverse, frontal and sagittal views of the phantom displayed permit accurate positioning of radioactive applicators. The software calculates the relevant parameters required for dose estimation based on the patient's probable anatomy.

Adult↗

PubMed1998

Dose distribution throughout the body from radiotherapy for Hodgkin's disease in childhood.

BACKGROUND AND PURPOSE: The individual dosimetry performed for a multicentre European cohort study of second malignant neoplasm following radiotherapy for a solid cancer in childhood demonstrated a large variation in the radiation doses estimated to any site. MATERIALS AND METHODS: From this study we have extracted the present work, i.e. estimation of doses for patients who underwent radiotherapy for Hodgkin's disease in their childhood. These patients were treated using high energy X-rays from linear accelerators (MV group), gamma-radiation from Cobalt machines (Cobalt group), soft X-rays from orthovoltage machines (kV group) and electron beams from accelerators (MeV group) at six French and UK centres. All patients started their radiotherapy between 1955 and 1985 and about 12% of them received more than one beam quality. Most of the patients were irradiated with large mantle AP/PA or partial mantle fields. Patients with transdiaphragmatic extension were also irradiated using inverted-Y paraaortic fields. The absorbed doses at the 91 skeleton points are used to calculate the mean dose to the active bone marrow. RESULTS: Estimates of the median and mean doses, standard deviations and ranges to 13 specific sites of the body and to the active bone marrow are reported. Depending upon the size and sex of patients, target volume and position and radiotherapy techniques, the estimated doses are highly spread, attaining 0.19-106.07% of the target dose. This study underscores the need for individual dosimetry in epidemiological studies. Comparison with the available measured and calculated doses to the ovary and testis shows good agreement. CONCLUSION: This study underscores the need for individual dosimetry in epidemiological studies.

Adolescent↗

PubMed1998

[Community nutrition strategy project: an innovation in community health].

The strategy of the community nutrition project is based on the utilization of the community development structures to deliver the nutrition services. These structures, represented in Senegal by youth associations, women groups, GIEs and NGOs, are part of the decentralization process, and as such play an important role in health and health development activities in poor urban districts. The Community Nutrition Project (CNP), funded for five years by the World Bank, German Cooperation (KFW), World Food Program (WFP) and the Senegalese government aims to halt further deterioration in the nutrition status of the most vulnerable groups in the poorest urban districts of Senegal. All nutrition services and particularly the IEC services have been entirely contracted out the first year to 76 GIEs involving 323 unemployed persons, operating as micro-enterprises "MIC" and 17 "GIEs" of unemployed physicians, pharmacists, and social workers for a total of 34 persons, organized as "maître d'Oeuvre communautaires "MOC", in charge of the supervision tasks. Each community nutrition center recruits and monitors every six months 460 to 600 beneficiaries composed of women at six months of pregnancy, lactating mother of children under 6 months, and a group of children aged from 6 to 35 months old. An average of 87% of registered children in the nutrition centers are weekly or monthly weighted. Thus the proportion of malnourished children in cohort of children followed from January to July 1996 has decreased from 70% to 25% within six months. The malnutrition rate has been reduced up to 65% after six months.

Adult↗

PubMed1997

Dirt and diarrhoea: formative research in hygiene promotion programmes.

Investment in the promotion of better hygiene for the prevention of diarrhoeal diseases and as a component of water and sanitation programmes is increasing. Before designing programmes capable of sustainably modifying hygiene behaviour in large populations, valid answers to a number of basic questions concerning the site and the intended beneficiaries have to be obtained. Such questions include 'what practices favour the transmission of enteric pathogens?', 'what advantages will be perceived by those who adopt safe practices?' and 'what channels of communication are currently employed by the target population?' A study of hygiene and diarrhoea in Bobo-Dioulasso, Burkina Faso, used a mixture of methods to address such questions. This paper draws on that experience to propose a plan of preliminary research using a variety of techniques which could be implemented over a period of a few months by planners of hygiene promotion programmes. The techniques discussed include structured observation, focus group discussions and behavioural trials. Modest investment in such systematic formative research with clear and limited goals is likely to be repaid many times over in the increased effectiveness of hygiene promotion programmes.

Adult↗

PubMed1997

[Drug management at the level of the Psychiatry Department of the Fann University Hospital Center: problem and perspectives].

Health system in developing countries is facing difficulties due to lack of resources and poor management of the available ones reinforced by the economic crisis and the structural adjustment program since 1980. The situation will be worsened by the recent devaluation of the France CFA. The consequences are a permanent shortage of drugs, a decreased motivation of the health personnel with at the end the decrease of health services reliability. Teaching Hospitals, which are essential for the implementation of PHC, are facing such situation. Thus, a study was conducted at the Department of Psychiatry, Fann Hospital to analyse the process of drug management and to find out suitable solutions. The study, qualitative, showed that that the main problems encountered are: inexistence of management tools with inexploitable health information systems, insufficient budget allocated for drug purchase, selection of drug exclusively on brand name with a standard list unrenewed since 1986, weak drug delivery system, frequent stock-outs. Prescribers are unaware of available drug at the pharmacy. Patients are not informed about their diseases and the use of drugs prescribed. Therefore, adopting the EDP in Teaching Hospitals will help for better management of drug delivery.

Drug Costs↗

PubMed1996

Estimation of the radiation dose delivered to any point outside the target volume per patient treated with external beam radiotherapy.

The methodology we have developed to study dose distribution outside the target volume during external beam radiotherapy allows us to determine the dose received by the patient arising from leakage radiation and scattered radiation from both the head of the treatment machine and from the treatment room. It also allows us to evaluate the dose due to photon scattering in the patient by means of a dedicated 3-D algorithm permitting computations for the whole body of the patient and taking into account height, sex and anatomical data at the time of the treatment, dosimetric data and lung heterogeneity parameters. This methodology offers solid criteria for recommendations concerning radiation protection.

Algorithms↗

PubMed1996

Reactivity and repeatability of hygiene behaviour: structured observations from Burkina Faso.

If interventions promoting improved hygiene behaviour to prevent childhood diarrhoea are to be implemented and evaluated, valid methods for measuring this behaviour will be required. This paper presents findings from a study to investigate the use of structured observations to measure hygiene behaviour in Burkina Faso. Two hundred mothers with young children (2-36 months) were observed on several occasions, with particular attention focused on events/behaviour surrounding defaecation. Child defaecation occurred most often in a potty (67% of occasions). Stools were most often disposed of into a latrine (79%). Following defaecation the child's bottom was usually rinsed using water alone with a bare hand (76%). Subsequent hand washing by the mother/caretaker was much rarer (29%). None of these behaviours appeared "reactive" to the presence of the observer. Less common behaviors showed some evidence of reactivity. The frequency of child defaecation in the yard increased over the course of three observations (5% to 16%; P = 0.01) and the proportion of occasions on which the child was observed to be cleaned after defaecation declined (95% to 85%; P = 0.01). Mothers usually took with them to the latrine a water recipient (91%). Hand washing after leaving the latrine was observed on 30% of occasions. This proportion declined from 36% to 22% over three observations (P = 0.05). Defaecation by older siblings (aged 3-5 years) was usually into a potty (48%) or directly in a latrine (30%). There was no evidence that this behaviour was reactive. The repeatability of behaviours at the individual level was generally low. The site of index child defaecation (kappa = 0.27), how the child's bottom was cleaned (kappa = -0.01) and whether the caretaker washed her hands afterwards (kappa = 0.26) all showed low repeatability. The method of stool disposal was more repeatable (kappa = 0.73). Hand washing by mothers after using the latrine showed moderate repeatability (kappa = 0.40). Older sibling's defaecation behavior had excellent repeatability (kappa = 0.90). Our findings suggest that, in studies which aim to measure behaviour at the population level, structured observations may provide a useful tool. Studies which investigate links between hygiene behaviour and diarrhoea incidence at the individual level will require repeated observations of mothers and children since measuring behaviour during a single observation will lead to misclassification of exposure status, resulting in bias which could mask any underlying association. This is likely to be very costly.

Adult↗

PubMed1996

Bamako boost for primary care.

In Senegal the generation of funds from the users of public health services in accordance with a strategy based on the Bamako Initiative is proving to be an extremely effective means of cost recovery and, in conjunction with management changes, is helping to improve the standard and scope of primary care.

Community Health Services↗

PubMed1995

Potties, pits and pipes: explaining hygiene behaviour in Burkina Faso.

Stool disposal practices have been shown to be associated with childhood diarrhoea. However, efforts to promote improved hygiene behaviour are hampered by a lack of understanding of what determines those behaviours. Data from 2793 household interviews with mothers of children from the town of Bobo-Dioulasso in Burkina Faso were analyzed to examine what differentiated mothers who reported using safer stool disposal practices from those who did not. Three 'outcomes' were considered: where the child was reported to defaecate; where the mother reported disposing of the child stools; and whether excreta were observed in the compound. Regression models were developed to identify those factors with the strongest independent associations with the outcomes. There was a consistent association between the source of water and the outcomes. Mothers with access to a tap in the yard reported using safe hygiene practices three times more often than mothers using wells outside the compound and twice as often as mothers who used public standpipes or wells within the yard. The source of water showed a similar pattern of association with observations of faecal matter in the environment. Improved sources of water may contribute to safer stool hygiene by reducing the time spent on water collection or by encouraging mothers to conform to higher standards of hygiene. Other factors which played a role in predicting the hygiene behaviour of mothers were the husbands' occupation, the number of health education sessions that she had attended, her zone of residence and family ownership of certain valuable objects. These factors are likely to be related and to be, to some extent, proxies for the real determinants of her behaviour. A model of the cultural, psycho-social and infrastructural proximate determinants of hygiene behaviour is proposed. Data from focus group discussions suggested that the main purpose of hygienic behaviour is to conform to existing norms of social etiquette. Trials of interventions based on changing such norms are needed to test whether this is an effective means of promoting of safer hygiene practices.

Burkina Faso↗

PubMed1995

A probable outbreak of rabies in a group of camels in Niger.

Seven camels in a herd of approximately 40 camels belonging to nomadic people in Niger died over a short period. No diagnostic samples were obtained. Brain was obtained from the eighth camel in the group, which died after a clinical illness manifested by unusual behaviour, aggression, pica, ptyalism and terminal paralysis. Rabies virus was demonstrated in the brain of this camel by immunofluorescent staining. Before the deaths of the camels a feral dog had joined the nomadic encampment and died there, and a domestic dog belonging to the group had then died after displaying aggressive behaviour. It is postulated that canine rabies had been transmitted to the camels in the herd.

Animals↗

PubMed1995

Motorcycles for nurses in rural health posts of Senegal.

The role of senior nurses at health posts in Senegal's Nioro District was strengthened by supplying them with motorcycles financed by contributions from the general public through the committees running the posts. One vehicle was purchased each month, and the allocation sequence was determined by drawing lots.

Child↗

PubMed1995

[Evaluation of the financial participation of the users of 102 health services in 3 districts of Senegal].

Primary Health Care (PHC) financing is today one of the major concern of public health system managers in developing countries. Their governments never allocated appropriate and sufficient resources to the sector of PHC. The external donors' funds are mostly allocated to short term PHC projects. They stop with the end of the projects. The undesirable consequences of that situation are well known. They are mainly related to a persistence of high rate of mortality and morbidity due to preventable diseases. To better address that situation the health ministers of the WHO african region adopted in September 1987 in Mali the Bamako alternative, to the country economical situation, for PHC services financing. It permitted to finance up to 80% of the recurrent costs of health system of Pikine department in 1980. In the three pilot districts where the Bamako initiative strategy has been tested: Podor, Matam and Bignona, all of the one hundred and two (102) health posts are self financed for their recurrent costs, since 1992.

Adult↗

PubMed1994

Child defecation behaviour, stool disposal practices, and childhood diarrhoea in Burkina Faso: results from a case-control study.

OBJECTIVE: To investigate the association between where young children defecate, where stools are disposed of, and the presence of human stools on the ground in the compound and the rate of hospital admission with diarrhoea. DESIGN: This was a case-control study with two control groups. SETTING: The study took place in Bobo-Dioulasso, the second city of Burkina Faso in West Africa. PARTICIPANTS: Three groups of children aged 36 months and under, and living in Bobo-Dioulasso were studied. Cases were 757 children admitted to hospital with symptoms of diarrhoea or dysentery. The first control group comprised 757 neighbourhood control children approximately matched on age and date of recruitment, and the second, 631 children admitted to the same hospital without symptoms of diarrhoea or dysentery. MAIN RESULTS: There was no evidence of any association between where the child was reported to defecate and hospital admission with diarrhoea or dysentery (odds ratio = 1.10; 95% confidence interval (CI) 0.78, 1.57, cases v neighbourhood controls; odds ratio = 0.84; 95% CI 0.60, 1.18, cases v hospital controls). There was evidence of an association between where the mother reported disposing of the child's stools and hospital admission with diarrhoea or dysentery (odds ratio = 1.50; 95% CI 1.09, 2.06, cases v neighbourhood controls; odds ratio = 1.31; 95% CI 0.96, 1.79, cases v hospital controls). Human stools were more frequently observed in the yards of cases than controls (odds ratio = 1.38; 95% CI 0.98, 1.95, cases compared with neighbourhood controls; odds ratio = 1.33; 95% CI 0.96, 1.84, cases compared with hospital controls). CONCLUSIONS: The findings suggest that it is not where the child defecates that matters but how the mother then deals with the child's stools.

Age Distribution↗

PubMed1994

[Acute respiratory infections in pediatric hospital at Bobo-Dioulasso (Burkina Faso)].

BACKGROUND: Acute lower respiratory tract infections are the primary cause of morbidity in developing countries. POPULATION AND METHODS: Six hundred and sixty seven children (379 boys, 288 girls, aged 0-30 months) admitted for lower respiratory tract infections from January 1990 to March 1991 were included in the study. Immediate medical history was collected from the mother. The weight, height, temperature and clinical manifestations, plus the results of chest X-rays, parasitologic and bacteriological examination of stools, and blood smear for malaria were recorded for each patient. Sero-immunologic study for HIV infection of 473 of the patients aged 12-36 months and their mothers also took part in a sero-immunological study for HIV infection. RESULTS: Lower respiratory tract infections were the second major cause of admission (16.8%) after malaria (28.7%). Infections peaked between 6 and 11 months of age (29.5%). The main diseases were pneumonia and bronchial pneumonia (54%) followed by bronchiolitis (21.7%). Almost half the patients were admitted during the hot, dry season. Two hundred and eighty seven patients (43.4%) were referred only after they had been suffering from the disease for 3 to 9 days, partly explaining the high level of mortality. One hundred and twenty one patients (20.9%) died; the main cause of death was staphylococcal pneumonia (57.9%), followed by pneumonia and bronchial pneumonia (29.3%). Some criteria for severity could be identified, based on pulmonary signs and symptoms and associated manifestations (dehydration, malnutrition, convulsions, anemia). Twenty two patients were positive for HIV-1 infection. CONCLUSIONS: This study confirms that acute lower respiratory tract infections remain a public health problem. Early diagnosis and treatment are necessary to reduce mortality.

Acquired Immunodeficiency Syndrome↗

PubMed1993

Primary health care: from aspiration to achievement.

A review is presented of Senegal's response to the Bamako Initiative, aimed at strengthening primary health care. The experience gained is of broad interest since the basic principles involved are the same everywhere. Of particular importance are users' financial contributions and improved organization and management.

Developing Countries↗

PubMed1993

[Clinical value of C-reactive protein, alpha 1-glycoprotein acid and transferrin assay in homozygous sickle cell disease].

Two acute phase reactants (C-reactive protein: CRP and alpha 1-acid glycoprotein: alpha 1-AGP) and transferrin (Tf) levels change were measured in order to evaluate their clinical or prognostic value during the vaso-occlusive crisis. Measurements were performed in normal controls, painful crisis with or without treatment and during steady state. Immunochemical determinations indicate that markedly acute inflammation occurred in sickle cell painful crisis, as revealed CRP and alpha 1-AGP levels. Compared to controls, during periods of steady state in the absence of any intercurrent condition, a lesser but significative increase of alpha 1-GPA was observed. Transferrin level remained lower and did not sufficient to discriminate between crisis and steady state. Compared to the vasodilatator drug effect, non steroidal anti-inflammatory drug showed more efficiency in the sickle cell disease inflammatory process. Taken together, these findings indicate that serial determinations of CRP, alpha 1-GPA and Tf may be helpful in monitoring the course of sickle cell disease and response to treatment. Then, non steroidal anti-inflammatory drugs appear necessary to reduce the length of the sickle cell crisis.

Acute Disease↗