Amadou Gallo Diop

Neurology in sub-Saharan Africa : A challenge for world federation of neurology

It is time to end the underappreciation of the burden of neurological disorders in global health.1 The Chairman of the Commission of the African Union, Alpha Oumar Konare, recently claimed that Africa now confronts the world’s most dramatic public health crisis.2 Sub-Saharan Africa has become the poorest region in the world. Many countries still suffer from the legacies of colonialism and slavery. Interethnic conflicts add to the problems. With a population of about 700 million, around 45% live for less than a dollar a day. The medical infrastructure is poorly developed and has approached collapse in some areas. The AIDS situation represents an additional socioeconomic problem. There is a lack of hospital beds for neurologic disorders in sub-Saharan Africa. The median number of neurologic beds per 10,000 population in low-income countries is 0.03, compared with 0.73 in high-income countries. Neurologists are scarce and unequally distributed. In Europe, there is one specialist per 20,000 population; in Africa, one per 3 million people. Less than 50% of the sub-Saharan African countries have neurologic societies. There is a lack of nurses and subspecialized neurologic services (neurologic rehabilitation, EEG, EMG, neuroradiology, and stroke units), facilities for postgraduate training are poorly developed, more than two thirds have no disability benefits available, and basic drugs used for neurologic disorders may not be available or are too expensive. While social insurance is the most important source of financing health service in Europe, none of the responding countries in Africa use social insurance as the primary method of financing. Out-of-pocket expenditure is still the primary method of financing in 84.2% of low-income countries. This is likely to result in further inequity of neurologic services. The major conclusion is that the available resources are insufficient to meet the global burden associated with neurologic disorders.3 Neurologic and …

NeuroAIDS in Africa

In July 2009, the Center for Mental Health Research on AIDS at the National Institute of Mental Health organized and supported the meeting “NeuroAIDS in Africa.” This meeting was held in Cape Town, South Africa, and was affiliated with the 5th IAS Conference on HIV Pathogenesis, Treatment and Prevention. Presentations began with an overview of the epidemiology of HIV in sub-Saharan Africa, the molecular epidemiology of HIV, HIV-associated neurocognitive disorders (HANDs), and HAND treatment. These introductory talks were followed by presentations on HAND research and clinical care in Botswana, Cameroon, Ethiopia, The Gambia, Kenya, Malawi, Nigeria, Senegal, South Africa, Uganda, and Zambia. Topics discussed included best practices for assessing neurocognitive disorders, patterns of central nervous system (CNS) involvement in the region, subtype-associated risk for HAND, pediatric HIV assessments and neurodevelopment, HIV-associated CNS opportunistic infections and immune reconstitution syndrome, the evolving changes in treatment implementation, and various opportunities and strategies for NeuroAIDS research and capacity building in the region.

Enquête sur l’épilepsie chez des enseignants d’un pays en développement : exemple du Sénégal

Resume Il s’agit d’une etude transversale effectuee sur la base d’un questionnaire elabore par nos soins et portant sur les connaissances de la maladie et les attitudes et pratiques des enseignants face a l’epileptique. Cette enquete a eu lieu au niveau de l’Academie Scolaire de Dakar et a porte sur 400 enseignants. Trois cent soixante-treize enseignants (93 p. 100) ont repondu au questionnaire. Leur âge moyen etait de 40 ans. La duree d’exercice dans l’enseignement variait de 10 a 30 ans. Pour 28,7 p. 100 des enseignants, l’epilepsie etait consideree comme due a des phenomenes surnaturels. Pour 69 p. 100 des enseignants, le cerveau etait l’organe dont le dereglement pouvait etre a l’origine des crises epileptiques, tandis que 31 p. 100 incriminaient d’autres organes. Parmi les causes de l’epilepsie, les enseignants citaient les traumatismes crâniens, les malformations et les infections du systeme nerveux central et l’heredite. Les manifestations et les facteurs declenchants etaient relativement bien connus. Vingt-quatre pour cent des enseignants pensaient que l’epilepsie etait contagieuse et que la salive etait la principale voie de transmission incriminee. Pour 73 p. 100 des enseignants, l’epilepsie etait curable ; ils faisaient confiance a la medecine moderne mais une proportion non negligeable (34,9 p. 100) d’entre eux estimait necessaire d’y associer la medecine traditionnelle. Pour 73 p. 100 des enseignants, l’epilepsie etait grave en raison des risques d’accidents mortels et du handicap social et cognitif. La prise en charge de l’epilepsie devrait mobiliser outre les enseignants, les medecins et les familles pour 25,7 p. 100 des enseignants. Soixante-trois pour cent des enseignants estimaient que les epileptiques pouvaient etre scolarises dans les ecoles traditionnelles ; 31,1 p. 100 proposaient une scolarisation specialisee. Quatre-vingt-quatre pour cent des enseignants estimaient leurs connaissances sur l’epilepsie insuffisante et 99 p. 100 souhaitaient l’organisation de seminaires de formation sur l’epilepsie.

Monitoring survey of the use patterns and pesticide residues on vegetables in the Niayes zone, Senegal

The main objective of this work was to determine the impact of pesticide use practices on vegetables contamination in the Niayes zone of Dakar. A preliminary survey involving 200 farmers, showed the application of pesticides belonging to different groups on vegetable crops. Use practices in terms of application intervals and methods, measuring tools and dosage were not in compliance with good agricultural practices. In view of survey results, investigations on vegetable contamination were conducted. Therefore, 175 vegetable samples including cabbage (31 samples), lettuce (88 samples), tomato (57 samples) collected from four sites of the Niayes zone during four campaigns, were analyzed for residues of 21 pesticides, eighteen of which (18) were cited to be used by farmers. The results indicated that 65% of tomato samples, 71% of lettuce and 93% of cabbage contained one or more detectable residues. Among the monitored pesticides dicofol, chlorpyrifos, DDTs, dimethoate, and λ-cyhalothrin were the most predominant, found in at least 35% of samples for each vegetable. The frequencies of pesticide detection were, generally in agreement with the citation frequencies. The results provided important information on vegetable contamination status and pointed an urgent need to control pesticide use.

Addressing the treatment gap and societal impact of epilepsy in Rwanda--Results of a survey conducted in 2005 and subsequent actions.

This study, supported by the Rwandan Ministry of Health and the World Health Organization, was conducted in 2005 to determine the prevalence of epilepsy and its sociocultural perception in Rwanda, as well as epilepsy-related knowledge and practices of health-care professionals (HCPs). A cross-sectional, nationally representative survey was conducted throughout Rwanda by trained investigators. Participants were recruited by random cluster sampling based on the organization of administrative units in the country. Overall, 1137 individuals (62% from rural areas) were interviewed. The prevalence of epilepsy was estimated to be 49 per 1000 people or 41 per 1000 for active epilepsy. Onset of epilepsy before the age of 2 years was reported in 32% of the cases. Family history of epilepsy, head trauma, and premature delivery were reported in 53%, 50%, and 68% of the cases, respectively. Most (68%) patients did not receive any medical treatment for epilepsy; 21.5% had received some form of traditional treatment. According to responses from the general population, people with epilepsy should not be entitled to schooling (according to 66%), to work (according to 72%), to the use of public places (according to 69%), or to marriage (according to 66%). Furthermore, 50% believed that epilepsy was untreatable, and 40% thought that it was transmissible. Of the 29 HCPs interviewed, the majority knew the definition of epilepsy and status epilepticus, as well as basic treatment options and side effects. However, 90% believed that treatment was only necessary in the first week after a seizure. Living with epilepsy was associated heavily with stigma, and a significant treatment gap (68%) was identified. Following this study, numerous actions have been taken by the Rwandan government, the Rwandan League Against Epilepsy, and several nongovernmental organizations to increase awareness about epilepsy and to close the treatment gap. An overview of these activities is provided.

Prise en charge des accidents vasculaires cérébraux au Sénégal

Resume Objectif La gravite et l’evolution rapide vers des lesions irreversibles font des accidents vasculaires cerebraux une extreme urgence. L’objectif de cette etude prospective etait de determiner le delai moyen de prise en charge des accidents vasculaires cerebraux et les attitudes et moyens therapeutiques qui leur sont appliques au centre hospitalier national de la capitale senegalaise suppose etre le dernier maillon dans l’organisation sanitaire du pays. Patients et Methodes Nous avons collige 170 dossiers de patients âges de 25 a 90 ans avec une moyenne d’âge de 61 ± 13 ans. Le sex-ratio etait de 0,68. Soixante-dix pour cent des patients etaient originaires de Dakar. Resultats Le recours a une structure medicale etait dans la plupart des cas tardif. Aucun patient n’a ete recu avant la 3 e heure, un seul a ete recu avant la 6 e heure. L’eloignement des structures joue un role dans ce retard de prise en charge car 36 p. 100 des patients originaires de Dakar ont consulte entre 6 et 24 heures contre 7,8 p. 100 des patients venant de l’interieur du pays. Ni le niveau d’instruction, ni le niveau socio-economique ne joue un role majeur dans la prise en charge tardive. Aucun patient n’a beneficie d’un transport medicalise ni de soins prehospitaliers. Le traitement etait essentiellement symptomatique dans les accidents vasculaires hemorragiques. Il reposait sur les anticoagulants ou les antiagregants plaquettaires dans les accidents vasculaires ischemiques. La reeducation motrice en milieu specialise n’a ete suivie que par 29,4 p. 100 des patients. Le taux de mortalite etait de 50,6 p. 100 a un an et le taux de dependance de 41,7 p. 100. Conclusion La prise en charge des accidents vasculaires cerebraux au Senegal est souvent tardive du fait de l’insuffisance des ressources humaines et materielles et de l’inaccessibilite aux soins.

Convulsions néonatales révélant une hypomagnésémie congénitale familiale

Congenital hypomagnesemia is a rare disease, with an impact on cognitive and neurological development. We report on three familial cases of congenital hypomagnesemia, two boys and one girl who belong to the same consanguineous family. They all presented neonatal seizures and a psychomotor developmental delay. Cerebral computed tomography showed cerebral atrophy and calcifications in one case and magnetic resonance imaging found predominant cerebellar atrophy in the two other cases. All three patients also had hypocalcemia, hyperphosphoremia, and hypomagnesemia. The parathyroid hormone blood level was low in two cases and normal in the third. One 7-month old patient died. The others received a supplementation of calcium and magnesium, which normalized calcemia, phosphatemia but not magnesemia, which remained low despite high doses. They have both developed cognitive and behavioral impairments.

Addressing neurologic needs in sub–Saharan Africa: An opportunity for multisociety cooperation

Approximately 26,000,000 people live in sub-Saharan African (SSA) nations where there are no neurologists. A total of 270,000,000 live in nations where there are fewer than 5 neurologists per country.1 There are neurologic societies in fewer than 50% of SSA countries.2 The WHO recommends a ratio of 1 neurologist:100,000 people. In those SSA nations where there are neurologists, the ratio is up to 175 times that recommended by the WHO.1

Impact of rotavirus vaccine on acute gastroenteritis in children under 5 years in Senegal: Experience of sentinel site of the Albert Royer Children's Hospital in Dakar

BACKGROUND Acute gastroenteritis (AGE) is a leading cause of morbidity and mortality among children <5 years of age in developing countries, with rotavirus being the most common infectious etiology. In November 2014, monovalent rotavirus vaccine was introduced in Senegal. We determined the impact of rotavirus vaccine on hospitalizations for all-cause and rotavirus related AGE in children <60 months of age. METHODS We examined two data sources from the national referral hospital. Using sentinel surveillance data from March 2011 to February 2017, we examined the proportion of AGE hospitalizations among children <60 months of age attributable to rotavirus, stratified by age groups (0-11, 12-23 and 24-59 months). Using pediatric logbook data from March 2010 to February 2017, we examined the proportion of all childhood hospitalizations attributable to AGE, among the same age groups. RESULTS In sentinel surveillance, 673 patients <60 months were hospitalized for AGE, with 30% (203/673) due to rotavirus. In pre-vaccine years, the median proportion of rotavirus-positive hospitalizations was 42%; this proportion declined by 76% to 10% rotavirus positive in 2015-2016 (p < .001) and by 59% to 17% in 2016-2017 (p < .001). From the logbook data, among all children <60 months, a median of 11% of all hospitalizations in the pre-vaccine period were due to AGE, with 2015-2016 seeing a 16% decline (p < .001), to 9% of all hospitalizations, and 2016-2017 seeing a 39% decline (p < .001), to 7% of all hospitalizations. Declines in both rotavirus-associated and all-cause AGE hospitalizations were most marked among infants, with a suggestion of herd effect among older children seen in the surveillance data. CONCLUSION Rotavirus vaccine demonstrated a significant impact on rotavirus-associated hospitalizations and all-cause AGE hospitalizations in the first two seasons after vaccine introduction in Senegal. Our data support the continued use of this vaccine in national immunization program.

Antioxidant activity study and total phenolic determination of leaf extracts of Ximenia americana L. (Olacaceae) an antitumor plant used traditionally in Mali. Madani

Objectives: Most of the currently used anticancer drugs are highly toxic and expensive. There is a continuing need to identify new drugs that are more effective and less toxic. Plants are an important source of potentially useful compounds for the development of new anticancer drugs. Methodology and results: This work was used to study the antioxidant activity of two extracts of Ximenia americana (Tallow wood) by the methods of ABTS•+ and DPPH using ascorbic acid as standard. It determined the rate of total phenolic in these extracts by the Folin-Ciocalteu (FC) method using Gallic acid as standard. The extracts inhibited the absorbance of DPPH• depending concentrations attesting that extracts of this plant contains antioxidants. The calculated IC50 are 2.78 and 4.05 μg/mL for ethanolic and aqueous extracts respectively with DPPH•. Phenolic rates are 43.10; 41; 2 mg/mL respectively for alcoholic and aqueous extracts. Conclusion and application of results: Future studies can be oriented on the isolation and identification of compounds involved in an anti-cancerous activity. The knowledge of this plant could be used to build an appropriate conservation strategy for this specie.