Amadou Moctar Dièye

Medicinal plants and the treatment of diabetes in Senegal: survey with patients

Diabetes is the most common metabolic disorder worldwide and is a major public health problem. Its frequency increases every day in all countries. However, in developing African countries, few people have access to drugs. In addition, in Africa, traditional beliefs induce people to use medicinal plants whenever they have health problems. Thus, many people in these developing countries use plants for the treatment of diabetes. Yet, few studies are focused on the knowledge and attitudes of the users on medicinal plants in Africa in general and in Senegal in particular. Hence we undertook this survey on the use of medicinal plants for the treatment of diabetes in Senegal in order to make recommendations which could contribute to the increase of the value of herbal medicines in developing countries. We did a cross‐sectional survey by direct interview at a university teaching hospital, in Dakar with a representative sample of 220 patients. Forty‐one plants were used by the patients and the two most frequently cited were Moringa oleifera Lam (65.90%) and Sclerocarya birrea (A. Rich) Hochst (43.20%). Patients gave several reasons for using medicinal plants (traditional treatment: 40%, efficacy: 32%, low cost: 20%). The principal suppliers of plants were tradesmen in the market (66.8%) and traditional therapists (5%). Sixty‐five per cent of patients think that medicinal plants are efficient for the treatment of diabetes and 20% have reported adverse effects which could be caused by medicinal plants. In conclusion, many people in our study think that medicinal plants are efficient for the treatment of diabetes, which requires research work by scientists in developing countries in this field in order to prove their efficacy and innocuousness.

Antidiabetic properties of aqueous barks extract of Parinari excelsa in alloxan-induced diabetic rats

The aqueous extract of the Parinari excelsa barks at doses of 100 and 300 mg/kg/day for 7 days has a significant antihyperglycemic effect on alloxan-induced diabetic rats. At the same dose the acute oral administration of aqueous extract of the P. excelsa barks (100 and 300 mg/kg) induced a significant decrease of blood glucose on glucose-loaded normoglycaemic rats. Our results seem to confirm the rational bases for its use in traditional medicine.

Benzodiazepines prescription in Dakar: a study about prescribing habits and knowledge in general practitioners, neurologists and psychiatrists

Benzodiazepines are relatively well‐tolerated medicines but can induce serious problems of addiction and that is why their use is regulated. However, in developing countries like Senegal, these products are used without clear indications on their prescription, their dispensation or their use. This work focuses on the prescription of these medicines with a view to make recommendations for their rational use. Benzodiazepine prescription was studied with psychiatrists or neurologists and generalists in 2003. Specialist doctors work in two Dakar university hospitals and generalists in the 11 health centres in Dakar. We did a survey by direct interview with 29 of 35 specialists and 23 of 25 generalists. All doctors were interviewed in their office. The questionnaire focused on benzodiazepine indications, their pharmacological properties, benzodiazepines prescribed in first intention against a given disease and the level of training in benzodiazepines by doctors. Comparisons between specialists and generalists were made by chi‐square test. Benzodiazepines were essentially used for anxiety, insomnia and epilepsy. With these diseases, the most benzodiazepines prescribed are prazepam against anxiety and insomnia and diazepam against epilepsy. About 10% of doctors do not know that there is a limitation for the period of benzodiazepine use. The principal reasons of drugs choice are knowledge of the drugs, habit and low side effects of drugs. All generalists (100%) said that their training on benzodiazepines is poor vs. 62.1% of specialists, and doctors suggest seminars, journals adhesions and conferences to complete their training in this field. There are not many differences between specialists and generalists except the fact that specialists prefer prazepam in first intention in the insomnia treatment where generalists choose bromazepam. In addition, our survey showed that specialists’ training in benzodiazepines is better than that of generalists. Overall, benzodiazepine prescription poses problems particularly in training, and national authorities must take urgent measures for rational use of these drugs.

Évaluation de la prescription et de l’utilisation des benzodiazépines dans la commune de Saint-Louis du Sénégal : enquête auprès des patients

Prescription and use of benzodiazepins were evaluated with a patients survey. Direct interview were conducted with 150 patients in ten pharmacies in the city of Saint-Louis, Senegal from January to June 2002. Ten of the 15 retail pharmacies in this city agreed to participate in the survey. All patients gave their agreement to participate to the study; the questionnaire contained essentially closed questions. Writers of prescriptions were general practitioners (38.67%), specialists (34.67%), nurses (18%) and midwifes (8.66%). The most prescribed benzodiazepins were prazepam, dipotassic clorazepate, lorazepam and diazepam. Use of these drugs during night is most recommended. Nevertheless, 26.67% of the prescriptions indicated the drug should be use during the day. The period of use was between one and three Months for 33.99% of patients and three Months or more in 42%. Benzodiazepins were used by 66.67% for insomnia, alone or associated with another condition, for anxiety by 14.6% and for epilepsy by 10%. Prescriptions were for benzodiazepins alone in 47.37% of the patients and in combination with other psychotropic drugs for 19.33%. Somnolence and dependence were the most reported side effects.Resume La prescription et l’utilisation des benzodiazepines (BZD) ont ete evaluees aupres de patients. Nous avons mene une enquete par entretien direct aupres de 150 sujets dans dix officines (15 patients par officine) de la commune de Saint-Louis du Senegal, de janvier 2002 a Juin de la meme annee. Cette commune compte 15 officines mais cinq pharmaciens n’ont pas accepte que l’enquete soit menee dans leur officine. Tous les patients ont donne leur consentement a participer a l’etude et le questionnaire comportait essentiellement des questions fermees. Les prescripteurs sont constitues de medecins generalistes (38,67 %), specialistes (34,67 %), d’infirmiers (18 %) et de sages femmes (8,66 %). Les BZD les plus prescrites sont le prazepam, le clorazepate dipotassique, le lorazepam et le diazepam. La prise nocturne a ete la plus indiquee sur les ordonnances. Neanmoins, pour 26,67 % des ordonnances, il y avait une prise matinale. La duree d’utilisation etait de un a trois mois pour 33,99 % des patients et superieure ou egale a trois mois dans 42 % des cas. Les benzodiazepines ont ete utilisees dans 66,67 % cas pour combattre l’insomnie seule ou associee a une pathologie, dans 14,67 % contre l’anxiete et dans 10 % contre l’epilepsie. Les BZD ont ete prescrites en monotherapie dans 47,37 % des cas et associees a d’autres psychotropes chez 19,33 % des patients. Les effets secondaires les plus rapportes sont la somnolence et la dependance.

Extracellular calcium level is crucial for aortic contractile response in pregnant rat.

Studies of vascular reactivity during late pregnancy were performed to investigate the previously described hyporeactivity to vasopressors. Two groups of seven control (nonpregnant) and seven late pregnant (day 20) Wistar rats were used. Rubbed (E‐) segments from thoracic aorta were studied for contractile studies in a Krebs solution containing either 1.25 or 2.50 mmol/L Ca concentration. Norepinephrine (NE; 10−9–3 × 10−5) or depolarization induced (KCl, 100 mmol/L) contractions are given as mN/mm2.

4(e) Conférence internationale sur les envenimations par morsures de serpent et piqûres de scorpion en Afrique : Dakar, 25-29 avril 2011.

The authors present a summary of the proceedings and the recommendations of the Fourth International Conference on Envenomations by Snakebites and Scorpion Stings in Africa, held from 25 to 29 April 2011 in Dakar. After a two-day workshop for Senegalese health personnel on the most relevant aspects of the management of envenomations, about 270 participants met to share their experiences in the field. Nearly a hundred oral and poster presentations were made on the epidemiology of snakebites and scorpion stings in Africa, the composition and action of venoms and the manufacture and use of antivenoms. The last day was devoted to an institutional debate involving experts, representatives of national health authorities and concerned professionals (physicians, pharmacists, nurses and traditional healers) as well as members of the pharmaceutical industry to discuss and elaborate a set of recommendations. It was agreed that it is necessary to improve knowledge of the epidemiological situation by case reporting. Quality control of antivenoms and procedures for their registration at the level of national health authorities should aim at improving the distribution of safe and effective antivenoms in peripheral health centers for the better assessment of victims. It was also recommended that adequate training should be provided for health personnel in all aspects of medical management of envenomations. Equitable distribution of funding and the establishment of a network of African experts were also discussed in the conference.

Essais cliniques à Dakar : enquête sur les connaissances, attitudes et pratiques des principaux acteurs sur une période allant de 2003 à 2007

AIM The general objective of this study was to agree an inventory of fixtures of clinical trials done in Dakar, in order to make recommendations to improve the quality of clinical trials in Senegal. METHOD We have done a survey from mars to may 2007, with investigators of the two biggest Senegalese university teaching hospitals and to the pharmacy management and the ethical committee. RESULTS Our key results showed: 1) a small participation rate of teachers to clinical trials (11 on 37 interviewed); 2) that the principal sponsor is pharmaceutical industry; 3) that most of investigators have not degree in clinical trials; 4) that most pathologies concerned were malaria and AIDS; 5) that there are regulations related to clinical trials in Senegal. CONCLUSION This study shows the necessity to integrate, in Senegal, clinical trials in the curricula of students training.

4e Conférence internationale sur les envenimations par morsures de serpent et piqûres de scorpion en Afrique : Dakar, 25–29 avril 2011@@@Report of the 4th International Conference on Envenomations by Snakebites and Scorpion Stings in Africa, Dakar, April 25–29, 2011

The authors present a summary of the proceedings and the recommendations of the Fourth International Conference on Envenomations by Snakebites and Scorpion Stings in Africa, held from 25 to 29 April 2011 in Dakar. After a two-day workshop for Senegalese health personnel on the most relevant aspects of the management of envenomations, about 270 participants met to share their experiences in the field. Nearly a hundred oral and poster presentations were made on the epidemiology of snakebites and scorpion stings in Africa, the composition and action of venoms and the manufacture and use of antivenoms. The last day was devoted to an institutional debate involving experts, representatives of national health authorities and concerned professionals (physicians, pharmacists, nurses and traditional healers) as well as members of the pharmaceutical industry to discuss and elaborate a set of recommendations. It was agreed that it is necessary to improve knowledge of the epidemiological situation by case reporting. Quality control of antivenoms and procedures for their registration at the level of national health authorities should aim at improving the distribution of safe and effective antivenoms in peripheral health centers for the better assessment of victims. It was also recommended that adequate training should be provided for health personnel in all aspects of medical management of envenomations. Equitable distribution of funding and the establishment of a network of African experts were also discussed in the conference.