Suchergebnisse

L'auteur explique les difficultes d'integrer des institutions dites modernes, l'Etat, les cooperatives et les partis politiques, dans un milieu rural organise a partir de la solidarite ethnique. Le cas examine ici est celui d'une communaute rurale senegalaise, celle de Thiepp dans la region de Louga. Cette zone fertile est devenue objet d'enjeux ou s'affrontent deux conceptions opposees: celle d'une organisation ethnique traditionelle et celle qui tend a regrouper des individus sur la seule base d'interets economiques communs. (DÜI-Ott)

Dokumentation über die Casamance unter Berücksichtigung historischer, politischer und religiöser Aspekte: Widerstand gegen den französischen Kolonialismus, sozio-kulturelle und ideologische Einflüsse nach 1917, Erreichung der Unabhängigkeit 1960 und postkoloniale Phase mit regionalen und ethnischen Besonderheiten sowie aktuelle ideologische Auseinandersetzungen. (DÜI-Fry)

International audience ; Background: In Sub-Saharan Africa, chronic hepatitis C (CHC) is a major public health issue. We estimated the long-term clinical benefits of treating CHC with sofosbuvir-based regimens in Cameroon, Côte d'Ivoire and Senegal using Markov model combining data from the literature with estimates of direct-acting antiviral (DAAs) effectiveness in West and Central Africa.Methods: Disease progression was simulated with and without treatment in fictive cohorts of patients "diagnosed" with CHC in Cameroon (n = 3224), Côte d'Ivoire (n = 9748) and Senegal (n = 6358). Lifetime treatment benefits were assessed using (a) life-years saved (LYS); (b) life-years (LY) avoided in compensated cirrhosis (CC), decompensated cirrhosis (DC) and hepatocellular carcinoma; and (c) comparison of the proportions of patients at each disease stage with and without treatment. Probabilistic and determinist sensitivity analyses were performed to address uncertainty.Results: Sofosbuvir-based treatment would save [mean, 95% confidence intervals] 3.3 (2.5; 5.7) LY per patient in Cameroon, 2.7 (2.1; 4.8) in Côte d'Ivoire and 3.6 (2.8; 6.3) in Senegal. With treatment, approximately 6% (1%) of the patients still alive in each of the study countries would be in the CC (DC) health state 11 (15) years after CHC diagnosis, vs 15% (5%) without treatment. Scenario analysis showed earlier diagnosis and treatment initiation would dramatically improve LYS and morbidity.Conclusion: Sofosbuvir-based treatment could significantly reduce CHC-related mortality and help control CHC-related liver disease progression in West and Central Africa. However, the goal of disease elimination necessitates a substantial decrease in DAAs prices, greater political commitment and increases in both national and external health expenditures.

International audience ; Background: In Sub-Saharan Africa, chronic hepatitis C (CHC) is a major public health issue. We estimated the long-term clinical benefits of treating CHC with sofosbuvir-based regimens in Cameroon, Côte d'Ivoire and Senegal using Markov model combining data from the literature with estimates of direct-acting antiviral (DAAs) effectiveness in West and Central Africa.Methods: Disease progression was simulated with and without treatment in fictive cohorts of patients "diagnosed" with CHC in Cameroon (n = 3224), Côte d'Ivoire (n = 9748) and Senegal (n = 6358). Lifetime treatment benefits were assessed using (a) life-years saved (LYS); (b) life-years (LY) avoided in compensated cirrhosis (CC), decompensated cirrhosis (DC) and hepatocellular carcinoma; and (c) comparison of the proportions of patients at each disease stage with and without treatment. Probabilistic and determinist sensitivity analyses were performed to address uncertainty.Results: Sofosbuvir-based treatment would save [mean, 95% confidence intervals] 3.3 (2.5; 5.7) LY per patient in Cameroon, 2.7 (2.1; 4.8) in Côte d'Ivoire and 3.6 (2.8; 6.3) in Senegal. With treatment, approximately 6% (1%) of the patients still alive in each of the study countries would be in the CC (DC) health state 11 (15) years after CHC diagnosis, vs 15% (5%) without treatment. Scenario analysis showed earlier diagnosis and treatment initiation would dramatically improve LYS and morbidity.Conclusion: Sofosbuvir-based treatment could significantly reduce CHC-related mortality and help control CHC-related liver disease progression in West and Central Africa. However, the goal of disease elimination necessitates a substantial decrease in DAAs prices, greater political commitment and increases in both national and external health expenditures.

International audience ; Background: In Sub-Saharan Africa, chronic hepatitis C (CHC) is a major public health issue. We estimated the long-term clinical benefits of treating CHC with sofosbuvir-based regimens in Cameroon, Côte d'Ivoire and Senegal using Markov model combining data from the literature with estimates of direct-acting antiviral (DAAs) effectiveness in West and Central Africa.Methods: Disease progression was simulated with and without treatment in fictive cohorts of patients "diagnosed" with CHC in Cameroon (n = 3224), Côte d'Ivoire (n = 9748) and Senegal (n = 6358). Lifetime treatment benefits were assessed using (a) life-years saved (LYS); (b) life-years (LY) avoided in compensated cirrhosis (CC), decompensated cirrhosis (DC) and hepatocellular carcinoma; and (c) comparison of the proportions of patients at each disease stage with and without treatment. Probabilistic and determinist sensitivity analyses were performed to address uncertainty.Results: Sofosbuvir-based treatment would save [mean, 95% confidence intervals] 3.3 (2.5; 5.7) LY per patient in Cameroon, 2.7 (2.1; 4.8) in Côte d'Ivoire and 3.6 (2.8; 6.3) in Senegal. With treatment, approximately 6% (1%) of the patients still alive in each of the study countries would be in the CC (DC) health state 11 (15) years after CHC diagnosis, vs 15% (5%) without treatment. Scenario analysis showed earlier diagnosis and treatment initiation would dramatically improve LYS and morbidity.Conclusion: Sofosbuvir-based treatment could significantly reduce CHC-related mortality and help control CHC-related liver disease progression in West and Central Africa. However, the goal of disease elimination necessitates a substantial decrease in DAAs prices, greater political commitment and increases in both national and external health expenditures.

INTRODUCTION: Understanding how to deliver interventions more effectively is a growing emphasis in Global Health. Simultaneously, health system strengthening is a key component to improving delivery. As a result, it is challenging to evaluate programme implementation while reflecting real-world complexity. We present our experience in using a health systems modelling approach as part of a mixed-methods evaluation and describe applications of these models. METHODS: We developed a framework for how health systems translate financial inputs into health outcomes, with in-country and international experts. We collated available data to measure framework indicators and developed models for malaria in Democratic Republic of the Congo (DRC), and tuberculosis in Guatemala and Senegal using Bayesian structural equation modelling. We conducted several postmodelling analyses: measuring efficiency, assessing bottlenecks, understanding mediation, analysing the cascade of care and measuring subnational effectiveness. RESULTS: The DRC model indicated a strong relationship between shipment of commodities and utilisation thereof. In Guatemala, the strongest model coefficients were more evenly distributed. Results in Senegal varied most, but pathways related to community care had the strongest relationships. In DRC, we used model results to estimate the end-to-end cost of delivering commodities. In Guatemala, we used model results to identify potential bottlenecks and understand mediation. In Senegal, we used model results to identify potential weak links in the cascade of care, and explore subnationally. CONCLUSION: This study demonstrates a complementary modelling approach to traditional evaluation methods. Although these models have limitations, they can be applied in a variety of ways to gain greater insight into implementation and functioning of health service delivery.

International audience ; Background: In Sub-Saharan Africa, chronic hepatitis C (CHC) is a major public health issue. We estimated the long-term clinical benefits of treating CHC with sofosbuvir-based regimens in Cameroon, Côte d'Ivoire and Senegal using Markov model combining data from the literature with estimates of direct-acting antiviral (DAAs) effectiveness in West and Central Africa.Methods: Disease progression was simulated with and without treatment in fictive cohorts of patients "diagnosed" with CHC in Cameroon (n = 3224), Côte d'Ivoire (n = 9748) and Senegal (n = 6358). Lifetime treatment benefits were assessed using (a) life-years saved (LYS); (b) life-years (LY) avoided in compensated cirrhosis (CC), decompensated cirrhosis (DC) and hepatocellular carcinoma; and (c) comparison of the proportions of patients at each disease stage with and without treatment. Probabilistic and determinist sensitivity analyses were performed to address uncertainty.Results: Sofosbuvir-based treatment would save [mean, 95% confidence intervals] 3.3 (2.5; 5.7) LY per patient in Cameroon, 2.7 (2.1; 4.8) in Côte d'Ivoire and 3.6 (2.8; 6.3) in Senegal. With treatment, approximately 6% (1%) of the patients still alive in each of the study countries would be in the CC (DC) health state 11 (15) years after CHC diagnosis, vs 15% (5%) without treatment. Scenario analysis showed earlier diagnosis and treatment initiation would dramatically improve LYS and morbidity.Conclusion: Sofosbuvir-based treatment could significantly reduce CHC-related mortality and help control CHC-related liver disease progression in West and Central Africa. However, the goal of disease elimination necessitates a substantial decrease in DAAs prices, greater political commitment and increases in both national and external health expenditures.

AbstractIntroductionExcessive alcohol consumption leads to unfavourable outcomes in people living with HIV (PLHIV), including reduced adherence to antiretroviral therapy (ART) and engagement into care. However, there is limited information on alcohol consumption patterns among PLHIV in sub‐Saharan Africa.MethodsUsing a cross‐sectional approach, the Alcohol Use Disorders Identification Test (AUDIT‐C) was administered to PLHIV attending HIV clinics in Côte d'Ivoire, Togo, Senegal and Zambia (2013 to 2015). Hazardous drinking was defined as an AUDIT‐C score ≥4 for men or ≥3 for women, and binge drinking as ≥6 drinks at least once per month. The prevalence of binge drinking was compared to estimates from the general population using data from the World Health Organization. Factors associated with binge drinking among persons declaring any alcohol use in the past year were assessed using a logistic regression model to estimate odds ratio (OR) and their corresponding 95% confidence intervals (CI).ResultsAmong 1824 PLHIV (median age 39 years, 62.8% female), the prevalence of hazardous alcohol use ranged from 0.9% in Senegal to 38.4% in Zambia. The prevalence of binge drinking ranged from 14.3% among drinkers in Senegal to 81.8% in Zambia, with higher estimates among PLHIV than in the general population. Male sex (OR 2.4, 95% CI 1.6 to 3.7), tobacco use (OR 1.7, 95% CI 1.0 to 2.9) and living in Zambia were associated with binge drinking.ConclusionsAlcohol consumption patterns varied widely across settings and binge drinking was more frequent in HIV‐positive individuals compared to the general population. Interventions to reduce excessive alcohol use are urgently needed to optimize adherence in the era of universal ART.

Euro-Mediterranean Consortium for Applied Research on International Migration (CARIM) ; Au cours des dernières années, la composition des flux migratoires depuis et vers le Sénégal a connu de profondes évolutions, notamment en raison de la présence croissante de migrants hautement qualifiés. La crise économique, sociale, politique, etc. et la faillite des services sociaux consécutive aux programmes d'ajustement structurel ont considérablement alimenté ce phénomène. L'émigration des Sénégalais hautement qualifiés s'explique en partie par la recherche de meilleures conditions de travail et de salaires plus élevés. Parallèlement, la profonde instabilité politique de la région a précipité l'arrivée massive au Sénégal de migrants hautement qualifiés originaires d'autres pays africains. Ainsi, au Sénégal comme dans les autres pays de départ, la migration hautement qualifiée s'est accentuée - en dépit des efforts mobilisés par les politiques - et concerne désormais tous les secteurs professionnels (santé, enseignement, etc.). In the last years, migratory flows to and from Senegal have taken on new forms . In particular, the migration of highly-skilled individuals has become significant, in the wake of profound political and economic crises and particularly following on from the collapse of the country's social services provoked by extensive structural adjustment programs. The departure of highly-skilled Senegalese nationals is largely due to economic push and pull factors. But chronic political instability in the region has also brought into Senegal substantial numbers of highly-skilled workers from other African countries. Consequently, highly-skilled migration is on the rise in Senegal as well as in other sending countries and, despite various policy initiatives, it is to be found along the whole spectrum of professional activities (health, teaching, etc.).

Covers -- Editorial boards -- Guest editorial -- Contribution of policy change on maize varietal development and yields in Kenya -- Building African Agribusiness through Trust and Accountability -- Political will and public will for climate-smart agriculture in Senegal -- Farmers' usage preferences for Rwanda's Volcanoes National Park -- Distribution of agricultural productivity gains in selected Feed the Future African countries.

Nach der offiziellen Gründung der Afrikanischen Union (AU) im Juli 2002 in Durban betrachtet der Autor deren Entwicklung und die Chancen, die afrikanischen Länder unter dem Dach der AU zu integrieren. Er entdeckt zwei große Strömungen: Revisionisten (v.a. Südafrika, Nigeria, Algerien und Senegal) und Gegen-Revisionisten (v.a. Libyen und Simbabwe). Die enorme Schwierigkeit der Integration bestehe in der Tatsache, dass sich die Länder nicht (wie in der EU) für eine Mitgliedschaft qualifizieren müssten, sondern schon durch ihre geographische Lage willkommen seien. (DÜI-Sbd)

This publication encompasses a selection of educational tools and learning units developed by EAThink2015, a project co-funded by the European Union to foster the concept of global learning within schools in Austria, Burkina Faso, Croatia, Cyprus, France, Hungary, Italy, Malta, Poland, Portugal, Romania, Senegal, Slovenia and Spain (Basque Country). ; N/A

(*) Revised version of a paper commissioned by the ECOWAS Commission and presented during a workshop on the Gulf of Guinea Conflict System, 21-23 August 2013 at Lome, Togo. (**) 'Kunle Amuwo, Professor of Political Science & International Relations, lives in Dakar, Senegal and currently works as an International Consultant on Conflict, Governance & Development.