Catherine Enel

Impact of chloroquine resistance on malaria mortality

Over 12 years, from 1984 to 1995, we conducted a prospective study of overall and malaria specific mortality among three rural populations in the Sahel, savanna and forest areas of Senegal. The emergence of chloroquine resistance has been associated with a dramatic increase in malaria mortality in each of the studied populations. After the emergence of chloroquine resistance, the risk of malaria death among children 0-9 years old in the three populations was multiplied by 2.1, 2.5 and 5.5, respectively. This is the first study to document malaria mortality at the community level in Africa before and after the emergence of chloroquine resistance. Findings suggest that the spread of chloroquine resistance has had a dramatic impact on the level of malaria mortality in most epidemiological contexts in tropical Africa.

Combating malaria in Africa

The spread of antimalarial drug resistance has major consequences for malaria control in tropical Africa. Here, the impact of chloroquine resistance on the burden of malaria is analyzed and its implications for the Roll Back Malaria initiative are examined. Malaria mortality has increased at least twofold during the past two decades. Combination therapy should be available for home treatment of young children. The potential toxicity of most antimalarials will require special surveillance programs. The main contribution to malaria control using methods to reduce the entomological inoculation rate is expected in areas with low or unstable transmission. Classic vector-control methods could potentially eliminate malaria in most urban areas and such programs deserve high priority.

Religion and protective behaviours towards AIDS in rural Senegal.

ObjectivesTo describe the association between religion and factors related to sexually transmitted diseases (STD)/AIDS in a country where religious leaders were involved early in prevention. DesignA cross-sectional study conducted in a rural area in central Senegal. MethodsQuestionnaire-based interviews of a random sample of 858 adults from the general population aged 15–59 years and in-depth interviews of four religious leaders and 50 people. ResultsSeventy-six per cent of the respondents were Muslim, 24% Catholic, 1% Animist and 0.2% Protestant. A total of 86% of men and 87% of women reported religion to be very important to them. Important prevention-related variables were inversely associated with the importance of religion. Men who considered religion to be very important were less likely to cite AIDS as a major health problem [odds ratio (OR) 0.4, P = 0.008] and were less likely to feel at risk of getting HIV (OR 0.5, P = 0.0005). Women who considered religion to be very important were less likely to report an intention to change to protect themselves from AIDS (OR 0.2, P = 0.0001), less likely to report having discussed AIDS with others (OR 0.4, P = 0.01) and much more likely to feel at risk of getting HIV (OR 9.3, P = 10−4). Individuals who considered religion to be very important were not more likely to report intending to or actually having become faithful to protect themselves from AIDS. ConclusionThese findings stress the need to intensify the involvement of religious authorities in HIV/STD prevention at the local level.

A Study of Sexual Behavior Change in Rural Senegal

This study describes recent sociodemographic and behavioral changes in a rural community in Senegal and investigates how these changes may have modified the risk of HIV/STD transmission. The authors combine findings from two surveys: (a) a marriage survey among all adults of a rural community of approximately 7,000 inhabitants; and (b) a sexual practices survey conducted among a sample of the same population (165 men and 165 women) between 1989 and 1994. During the last 30 years--between 1955-64 and 1985-92--age at first marriage increased in the study area from 25 to 32 years for men and from 21 to 24 years for women. At the same time, age at first sexual intercourse decreased by approximately 10 years on average for men. As expected, this has led to an increase in premarital sexual activity, and we have documented both an increase in the percentage of individuals declaring sexual relations before marriage and, for men, an increase in the number of sexual partners before marriage. Multipartnership is more frequent among men than women (OR=4.4), among those who had their first intercourse at an early age (OR=3.3), among rural migrants (OR=2.7), and among those who had a good knowledge of AIDS. These findings show how recent changes in marriage, sexual behaviors, and seasonal migration have combined to increase the risk of HIV/STD infection within the community. Male rural migrants and their partners are particularly exposed.

Treponemal infection rates, risk factors and pregnancy outcome in a rural area of Senegal

A rural population of east Senegal has been under demographic surveillance for more than 30 years and a high rate of infertility has been reported. The aim of the study is to describe HIV and treponemal infection epidemiology and association with outcome of pregnancy in a population of rural Senegal. A population-based cross-sectional study was conducted among 952 randomly-selected adults of a rural community of Senegal. No participant was found to be infected with HIV, 11% had evidence of past syphilis and 5% of active syphilis. Active syphilis was associated among men with age, long-term mobility and having partners in an urban area in the last 12 months and among women with being divorced or widowed. No association was found between past or active syphilis and abortion or stillbirth but women aged 40 and more with past or active syphilis were significantly more likely to have had no history of gestation than women with no evidence of syphilis infection. In conclusion our results call for more research to understand the epidemiology of treponemal infection and to elucidate types of Treponema pallidum involved.

HIV-2 prevalence in three rural regions of Sénégal: low levels and heterogeneous distribution

Between 1986 and 1989 health workers collected 3072 serum samples from 3 rural regions of Senegal (Casamance Kedougou and Fleuve) to test for HIV-1 and HIV-2 seropositivity. 43.3% of the samples were from school children and non of them tested positive for HIV-2 but none were for HIV-1 and HIV-2 prevalence was not uniform throughout the country. No one in the Fleuve region tested positive but 0.95% did in Casamance and 0.3% did in Kedougou. Yet 4% of migrant male workers from other regions of Senegal on a cotton plantation in Kedougou tested positive for HIV-2. These results indicated the need to further examine HIV prevalence in Casamance since it had the highest prevalence rate. In 1990 in Casamance health workers collected sera from 3239 adults. Overall HIV prevalence was 0.8% (27 people). 25 were HIV-2 seropositive and 2 were HIV-1 seropositive. 1 of the HIV-1 seropositive individuals had just come back from the Ivory Coast and the other had recently lived elsewhere. Median age for HIV infected persons was 39 years. HIV-infected men were more likely to be young (24-39 years old) than were the women (73% vs. 25%; p=.034). HIV prevalence was highest among 25-30 year old men (2.6%) and among 45-50 year old women (2%). Most of the 27 HIV seropositive people 12 were married 12 were single 2 women were divorced and 1 women was a widow. Even though HIV-1 and HIV-2 prevalence rates were low specific counseling HIV campaigns are needed to curb transmission.

Homosexualité et bisexualité au Sénégal : une réalité multiforme

The first surveys on men who have sex with men (MSM) carried out in Senegal in the context of the fight against AIDS, revealed high rates of bisexuality. In 2007, a new epidemiological and behavioural survey (ELIHoS) approached the question of bisexual practices in greater depth. That survey is used here to depict the plurality of forms that bisexuality may take in Senegal. A six-group typology of current modes of sexual activity was constructed based on the characteristics of sexual partners over the past year and at the time of the survey. Various factors in the respondents? social and sexual life event histories were then analysed according to their current mode of sexual activity. It showed that these modes correspond to different sexual practices and characteristics of first sexual intercourse with a man. However, the systematic use of a condom for similar sexual practices did not depend on the mode of sexual activity. Fewer men who engaged in regular intercourse with women and only occasionally with men were infected with HIV because they less frequently engaged in high-risk anal intercourse.

Prevention of HIV and Other STIs in Rural Senegal: A Study of Prevention-Related Events Collected by Sentinel Observers

We conducted a study of AIDS/STI prevention-related events based on a network of sentinel observers over a 35-month period in three rural communities of Senegal (May 2000 – March 2003). In one of these communities we also conducted a population-based study on self-reported prevention events and attitudes towards AIDS. Sentinel observers recorded 1 590 AIDS/STI prevention-related events. More than half of the reported events were radio programmes. The proportion of events on the occasion of which therapies was addressed increased significantly between 2000 and 2001, from less than 3% to about 10%, while sharp decreases in the proportion of events dealing with condoms and STIs, both from around 25% to less than 15%, were observed at the same time. The population-based survey indicated that men were more influenced by individual events like informal discussions or radio programmes while women seemed to be more influenced by collective events such as public meetings and school education.