Background Despite accounting for a substantial proportion of the global population and disease burden, African countries are underrepresented in randomized controlled trials (RCTs), including those informing cardiovascular (CV) care. Objectives In this study, we sought to quantify African representation in RCTs published from 2019 to 2024 in: 1) 5 leading general medical journals; and 2) 3 leading CV journals. Methods We conducted a systematic review of RCTs published from 2019 to 2024 in the British Medical Journal, the Journal of the American Medical Association, The Lancet, Nature Medicine, and the New England Journal of Medicine, and in Circulation, the European Heart Journal, and the Journal of the American College of Cardiology. Eligible studies included traditional, pragmatic, cluster, and stepped-wedge RCTs. African representation was assessed by trial scope (Africa-only vs multicontinental), country and regional participation, disease category, and African authorship. Results Among 2,138 RCTs published in leading general medical journals, only 83 (3.9%) were conducted exclusively in Africa, and 195 (9.1%) were multicontinental studies including at least 1 African site. In the CV journals, 2 out of 334 RCTs (0.6%) were conducted exclusively in Africa, and African sites were included in only 9 multicontinental trials (2.7%). South Africa accounted for the majority of Africa-based RCTs across both journal categories. Regionally, southern Africa predominated and central Africa was minimally represented. Trials published in general medical journals and conducted exclusively in Africa largely focused on infectious diseases (n = 63; 75.9%), with only 3 addressing cardiovascular disease (CVD). In contrast, Africa-including multicontinental trials more frequently investigated noncommunicable diseases, including CVD. African leadership was common in Africa-only trials but rare in multicontinental studies. Conclusions African countries are profoundly underrepresented in RCTs published in the world’s most influential medical and CV journals. Addressing this imbalance requires expanding African participation in global trials, investing in local research capacity, and promoting equitable leadership to strengthen the relevance and validity of clinical evidence. (Underrepresentation of African Countries in Randomized Controlled Trials: A Systematic Review of Leading General Medical and Cardiovascular Journals; CRD42024603157)

Chikungunya virus (CHIKV) is a mosquito-borne Alphavirus that has caused several epidemics around the world in recent years. CHIKV is endemic in eastern Senegal, particularly in Kédougou, where epidemiological and virological surveillance is implemented in combination with the 4S network. In August 2023, an outbreak was reported in Kédougou, which rapidly spread to Tambacounda. Epidemiological and virological investigations were carried out in both regions by teams from the Institut Pasteur de Dakar, the WHO, the Africa CDC and the Senegalese Ministry of Health. The team first visited residential areas of confirmed cases, then a definition of suspected cases including socio-demographic aspects and clinical signs was used in an active door-to-door search for other cases. The blood samples were tested for CHIKV infection by real-time RT-PCR and anti-CHIKV IgM ELISA. Continuous variables were described using mean ± SD or median (IQR), and categorical variables as percentages with 95

Introduction:Mpox has re-emerged as a public health issue in West Africa, underscoring the need for robust surveillance systems that can detect outbreaks and facilitate effective responses. This study evaluates Senegal's mpox surveillance system, focusing on performance, data quality, governance, and potential for Artificial Intelligence-powered, predictive epidemic intelligence. It reviews trends and system operations while exploring AI and modeling to improve early warnings. Methodology:A descriptive, exploratory approach combined quantitative and qualitative data from various sources. A retrospective review of mpox cases from January 2024 to October 2025 utilized DHIS2 Tracker to analyze geographical, temporal, and demographic patterns, as well as reporting delays and biases. Data-quality checks and stakeholder interviews provided insights into system performance, intersectoral coordination, and preparedness for advanced analytics. Results:By late October 2025, Senegal had reported seven mpox cases, all in Dakar, primarily affecting young, mobile populations, with a higher incidence among children and working-age adults. Transmission followed population movement along the Dakar-Thiès-Diourbel corridor, showing how urban density and mobility influence spread. The surveillance system improved reporting, geolocation, and follow-up, supported by One Health coordination and digital health infrastructure. Challenges include underreporting in rural areas, uneven coverage, limited real-time analytics, and gaps in data interoperability and responsible AI regulation. The AI4MPOX-SN initiative offers an opportunity to enhance epidemic intelligence by integrating human-animal-environment data, using AI for anomaly detection and predictive modeling to inform interventions. Conclusion:To develop predictive epidemic intelligence in Senegal, it's vital to involve local stakeholders, promote transparency, build workforce capacity, and establish safeguards for the ethical use of data. Combining technology, participatory governance, and institutional strengthening will enable Senegal to transition from reactive detection to proactive surveillance, positioning it as a regional leader in health security in West Africa.

Monkeypox (Mpox) is a zoonotic viral infection caused by a virus of the Orthopoxvirus genus. In response to global alerts, efforts in epidemiological surveillance and infection control have intensified, following WHO recommendations for enhanced monitoring, contact tracing, and the implementation of appropriate public health measures. This study aimed to assess the epidemiological surveillance of Mpox in Senegal in 2024. This was a retrospective, cross-sectional, descriptive, and analytical study conducted over a four-month period (from July 14 to November 10, 2024). The study population included all cases sampled as part of Mpox surveillance in Senegal during this period. Key strengths in the response included the adaptation to the IDSR Kit, training of personnel at all levels on the IDSR strategy, case definition and monitoring training, development of surveillance procedures, presence of focal points for surveillance, a diversified network of reference laboratories, and the use of an electronic case notification platform. A total of 56.25% of the initially planned priority activities were completed. During the surveillance period, 100 suspected Mpox cases were reported, corresponding to 6 cases per 1 million inhabitants. Biological samples were collected from all patients. At the time of the study, no confirmed cases of Mpox were detected. Alternative viral diagnoses were established in 32% of cases—most frequently varicella-zoster virus. Co-infections were observed in 4 patients (12.5%). The median delay between symptom onset and result availability was 7 days. Symptom duration had a median of 3 days, and the median interval from consultation to result delivery was 2 days. Longer delays were significantly observed in remote or hard-to-reach areas. Overall, patient-related delays were significantly longer than surveillance-related delays (p = 0.002). Strengthening epidemiological surveillance improves sample processing times and response effectiveness. This enhancement should be prioritized in border areas and hard-to-reach regions.

Based on a One Health approach, the Senegalese National Action Plan for Antimicrobial Resistance (NAPAMR 2018–2022) was elaborated. Its implementation has improved the International Health Regulations’ (IHR) capacities. However, this plan was not yet evaluated in 2022, making it urgent to analyse the said NAPAMR implementation level through a mixed design study. First, the quantitative component was a cross-sectional, retrospective and evaluative study with a structured closed survey on coverage and implementation indicators. Then, the qualitative component was a case study with a semi-structured opened interview guide in order to identify the implementation’s determining (either facilitating or blocking) factors. Covering the 2018–2022 implementation period (5 years), the implementation was analysed each time by dividing the number of activities effectively implemented by the number planned. It focused on the key sectoral actors in Senegalese AMR control who implemented and evaluated the NAPAMR using Excel 2010 ® and QDA MinerLite1.4.1©2004 software. The approval of the National Ethics Committee for Health Research (NECHR/ CNERS ) was obtained. Findings showed that human, animal and environmental health were represented at 73.9, 8.7 and 4.3%, respectively. Regional level accounted for 2.2%, compared with the sub-regional levels, which were absent from the plan development process. The transdisciplinarity coverage rate was adequate at 45% and effective at 40%, with the overall achievement of NAPAMR activities at 53.6%. Those specific to the laboratory and hygiene were respectively 70.6 and 69.2%. Implementation was delayed overall by 37.3%, and specifically by 75% for coordination, communication and research, with 38.1% of activities rescheduled. Temporal analysis shows an overall decreasing 5-year trend, with better achievements in annual transition (e.g. 23%, Q4 2020). A similar trend has also been noted especially for hygiene, infection prevention and control (54%). Finally, the determining factors for implementation were funding, M&E including research, training, integration and COVID-19 was a major blocking factor. © The Authors 2025

Given the scale of healthcare-associated infections worldwide, particularly in Senegal, and the key role played by healthcare personnel in preventing them, it is necessary to study the factors associated with healthcare providers' knowledge and practices regarding healthcare-associated infections (HAI). A descriptive and analytical cross-sectional study was carried out among nursing staff at Semi-Urban Health center (Keur Massar) in 2024. An exhaustive recruitment was carried out and data were collected using an anonymous self-administered questionnaire. Univariate, bivariate and multivariate analyses were performed using R 4.4.2 software. Qualitative variables were described by absolute and relative frequencies and quantitative variables by mean, standard deviation and extremes. The binary logistic regression method was used for the multivariate analysis. The adjusted Odds Ratios with their 95% confidence intervals were determined for each variable retained in the final model. A total of 90 people were surveyed. The average age of those surveyed was 35 ± 9.37 years, with extremes of 19 and 64 years. Women predominated, accounting for 74.4% of respondents. Only 22.2% of staff had a good knowledge of healthcare-associated infections. In all, 56.7% of those surveyed had good preventive practices with regard to healthcare-associated infections. Doctors (aOR = 19.30 [4.07 - 126]) and people with more than 10 years' professional experience (aOR = 5.88 [1.15-33.33]) were more likely to have good knowledge of HAIs. Paramedics (nurses, midwives) were more likely to have good HAI prevention practices (aOR= 5 [1.37- 20]). The knowledge and practices of healthcare providers in relation to HAIs were found to be inadequate. Professional experience of more than 10 years and the profession of doctor were positively associated with knowledge; the professions of nurse and midwife were associated with good HAI prevention practices. Ongoing training and the availability of the necessary guidelines can help to improve the knowledge and practices of healthcare personnel in the prevention of HAIs.

Mental health among students in Senegal remains an under-explored area, with limited research and prevention efforts. At the African Center for Higher Studies in Management (CESAG), students face high academic demands, highlighting the importance of investigating stress, anxiety, and depression within this population. This study aimed to identify factors associated with anxiety-depressive states, specifically stress, anxiety and depression, among CESAG students. A cross-sectional, observational, descriptive, and analytical study was conducted from July 22 to August 23, 2024. Data were collected through an electronic questionnaire. Stress, anxiety, and depression were assessed using the Perceived Stress Scale (PSS), the Generalized Anxiety Disorder-7 (GAD-7) score, and the Patient Health Questionnaire-9 (PHQ-9) score, respectively. Data analysis was performed using RStudio (version 2024.12.1.563). Informed and voluntary consent of the participants was ensured. A total of 426 students completed the online questionnaire. The mean age was 23.4 years. Stress was observed in 45.6% of students, anxiety in 21.4%, and depression in 35.4%. Risk factors for stress included belonging to the [20-25 years[ age group (ORa = 5.68, 95%CI [1.67-19.31]) or the ≥30 years group (ORa = 8.8, 95%CI [1.5-51.64]), poor sleep quality (ORa = 7.05, 95%CI [2.32-21.44]), low financial income (ORa = 11.23, 95%CI [4.34-29.06]), low self-esteem (ORa = 15.13, 95%CI [3.18-72.13]) or moderate self-esteem (ORa = 7.96, 95%CI [2.83-22.4]), a negative emotional state (ORa = 4.7, 95%CI [1.64-13.46]), and the absence of physical activity (ORa = 5.03, 95%CI [1.88-13.49]). Living alone was a protective factor against anxiety among students (ORa = 0.16, 95%CI [0.09-0.29]). Depression was associated with several risk factors: poor sleep quality (ORa = 8.07, 95%CI [2.72-23.88]), low financial income (ORa = 4.38, 95%CI [1.42-13.48]), living alone (ORa = 3.53, 95%CI [1.1-11.34]), poor diet (ORa = 13.03, 95%CI [3.84-44.18]), low self-esteem (ORa = 18.21; 95%CI [2.62-126.41]) or moderate self-esteem (ORa = 9.19, 95%CI [1.66-51.01]), and a negative emotional state (ORa = 5.54, 95%CI [1.64-18.71]). A passive coping style was found to be protective (ORa = 0.25, 95%CI [0.08-0.8]). These findings emphasize the importance of preventive strategies to promote CESAG students’ mental health and well-being. Targeted awareness campaigns and psychological support are essential to achieving this goal.

Introduction : A woman dies every two minutes from causes related to pregnancy or childbirth. One of the well-documented factors associated with maternal mortality is home delivery. Husbands play a significant role in determining the place of delivery for their spouses, and several factors influence this decision. Objective : The aim of this study was to examine the factors associated with husbands’ choice of place of delivery and those related to the number of children born at home under their responsibility in the health districts of Anié (Plateaux Region) and Kéran (Kara Region) in Togo. Methodology : This was a cross-sectional study using a three-stage systematic sampling method. Result : The results showed that the average age of the husbands was 32.18 ± 0.58 years, with the average age at marriage being 23.20 ± 0.24 years, and respective medians of 32 years and 23 years. Husbands aged between 22 and 40 years were the most frequently surveyed. The typical age range at which these male partners marry was between 19 and 28 years. The results of the linear analysis on the average number of home births by socio-professional characteristics showed that male partners with no formal education had the highest average number of home births (3.68±0.41), followed by those who had a religious marriage (3.66±0.66). The analysis revealed a correlation between the number of home births and the husband’s age (p-value = 0.001) as well as between the number of home births and the age at marriage (p-value = 0.015), with a significance threshold set at 5%. The logistic regression results showed that a woman whose husbands decides on a home delivery is 382.23 times more likely to deliver at home rather than in a healthcare facility (p = 0.040; OR = 382.23; CI [1.32 – 110368.89]). Conclusion : The husband’s age, age at marriage, education level, and the choice of delivery location for his spouse were statistically significant factors associated with the number of home births and the decision to deliver either at home or in a healthcare facility.

Introduction: Our work has examined the controversial role of NGOs in health development in Africa. NGOs are criticized for perpetuating the power structures of domination inherited from colonialism by appropriating development assistance for health (DAH) resources, thereby replacing national governments on the ground and imposing their own agenda in the provision of health services to populations. Methods: We have utilized two sources of knowledge to address this concern. A review of the literature published after 2014 was used to explain the inappropriate practices of the development aid industry in relation to the health sector in Africa. Next, the authors' experiences in dealing with this situation were drawn on to define a new partnership for global public health that meets Africa's needs. Results: The strategy of Africa's Global North partners is increasingly to use NGOs as the preferred intermediaries for their support, accusing African countries of being corrupt and incompetent. With the resources they appropriate, the NGOs take the place of national governments on the ground and, in many cases, undermine four key pillars in the development of any health system: governance, financing, human resources, and the provision of services, thereby contributing to the ongoing weakening of healthcare systems in Africa. The accompaniment approach, in which donors transfer DAH resources to governments, who in turn choose the NGOs they wish to work with, would be a more beneficial partnership for Africa. The fight against corruption and the strengthening of Africa's capacity for health action would be technical-assistance priorities in a new partnership grounded in mutual trust. Discussion: The decolonization of public health in Africa is underway. Africa offers TFPs and NGOs a new partnership based on trust, in which it decides on the health agenda and the support model that will be most beneficial to it.

In Senegal, data on the responsible use of medicines in the paediatric population are poorly documented at the level of primary health care services. The aim of this study was to assess prescribing indicators in children under five years of age in the Bambey health center in Senegal. This was a retrospective study. The study population consisted of prescriptions for children seen in outpatient consultations between January 1 and June 30, 2021. The sample size was 600 prescriptions selected according to a simple random sampling stratified by month. Data were collected between June and August 2021. Data were analyzed using descriptive statistics. The mean age of the children was 24±19 months. Diseases of the respiratory system accounted for 41%. The number of drugs prescribed was estimated at 1,284; the average number per prescription was 2.14. The percentages of drugs prescribed under international non-proprietary names and according to the national essential medicines list were 32.32% and 66.82% respectively. In addition, 63.2% of prescriptions contained antibiotics, of which 70.2% belonged to the Access group of the AWaRe classification of antibiotics. Injectables were used in 1.5% of cases. This study showed that prescribing practices at the Bambey health center are generally irrational, with excessive use of antibiotics in particular. Among the consequences, the most serious is antibiotic resistance. Interventions to promote the proper use of drugs seem necessary. In addition, further studies, including an assessment of the availability of Access group antibiotics, should be considered in order to gain a better understanding of the problem of antibiotic resistance.

Introduction: People with disabilities are disproportionately exposed to violence, often resulting in significant physical and psychological harm. This study examines the prevalence and determinants of violence among persons with disabilities aged 15–69 years in Senegal in 2023, focusing on physical, verbal, and sexual violence. Methods: A nationwide cross-sectional descriptive study with an analytical component was conducted from February 9 to March 10, 2023, after approval by the National Ethics Committee for Health Research of Senegal. A total of 1,442 individuals with disabilities were surveyed using standardized tools. Logistic regression analyses were performed to identify factors associated with different forms of violence. Results: The most prevalent forms of violence were verbal abuse (42.9%), stigmatization (31.6%), and physical assault (20.3%), while sexual violence was reported by 4.3% of participants. Age was a protective factor, with each additional year reducing the risk of experiencing violence. Women were significantly more likely to report sexual violence. Compared with individuals with regular income, those without income were less exposed to verbal and physical violence, while irregular income reduced the risk of physical violence. Early onset of disability (at birth or during childhood/adolescence) increased vulnerability to verbal and physical abuse, while onset during childhood/adolescence also heightened the risk of sexual violence. Membership in disability organizations and food insecurity were associated with higher risks of verbal and physical violence, whereas drug use was strongly linked to physical violence. Conclusion: This study highlights the high prevalence of violence against people with disabilities in Senegal and identifies key sociodemographic and behavioral risk factors. Addressing these determinants is essential to achieving Sustainable Development Goal (SDG) 3 by strengthening health system responses and promoting inclusive protection policies.

Road accidents are a public health problem throughout the world, particularly in developing countries such as Senegal. In the Kaolack region, located in the centre of the country, the advent of motorbikes commonly known as ‘Moto Jakarta’ has only increased this road morbidity and mortality, the consequences of which are taking a heavy toll on global and national economies, as well as household finances. It is in this context that this study was undertaken to identify the factors associated with road accidents among motorcyclists in the Kaolack health district. A cross-sectional, descriptive and analytical study was conducted during the first half of 2019. Among motorcyclists active in the Kaolack health district. A recruitment of 400 motorcyclists meeting the inclusion criteria was carried out. Data were analysed using Epi Info and R software. Qualitative variables were described by absolute and relative frequencies and quantitative variables by mean, standard deviation and extremes. The binary logistic regression method was used for the multivariate analysis. The adjusted Odds Ratios (aOR) with their 95% confidence intervals were determined for each variable retained in the final model. The average age of participants was 27.5. Motorbike taxi drivers were in the majority (61%). Only 17.8% of participants had a driving licence. More than half of the drivers (63.7%) had been involved in a road accident at least once in their lifetime. Road accidents among motorcyclists were favoured by the fact that they: living outside Kaolack (aOR = 3.7 [1.4-9.7]); driving a motorbike that was at least 5 years old (aOR =1.8 [1.5-3]); owning the motorbike (aOR =1.9 [1.1-3]); driving at night (aOR =1.8 [1.1-2.9]); drinking alcohol (aOR = 3.1 [1.5-3.4]) and driving with more than one supported person (aOR =2.0 [1.2-3.2]). Road accidents among motorcyclists are a real public health problem in the Kaolack region. More in-depth investigations, particularly of a qualitative nature, will be needed to gain a more exhaustive understanding of this phenomenon, in order to provide a more rigorous and well-founded basis for decision-making in this area.

Purpose: The aim of the study was to investigate the profile of psychoactive substance users in Senegal from 2018 to 2022. Methodology: These were retrospective descriptive studies of patient consultation and hospitalization records in the 17 psychiatric and addictology care centers in Senegal from 2018 to 2022. This was an exhaustive survey. All usable consultation and hospitalization registers were included in the study. Non-usable consultation and hospitalization registers were not included. Data were collected from January 1 to December 31 of each respective year. Data were cleaned using Excel before analysis. R software version 4.3.3 was used for analysis. Results: Between 2018 and 2022, 26,029 patients were registered in mental health facilities in Senegal. The Fann Psychiatry Department (CHNU Fann) admitted 23.2% of patients and the Thiaroye National Psychiatric Hospital registered 17.6% of drug users. For the year 2019, we found 8259 and in 2021, we had 6607 patients. The male gender was more represented with 14,750 patients, or 90.9%. The age group [25 - 34] was the majority (7013 patients or 39.5%). The majority of patients (17,425 patients, or 84.6%) were followed as outpatients. The drugs were mainly inhaled (96.7%). The most consumed substance was cannabis with 8847 patients, or 54.2%. Withdrawal was the main reason for treatment, 11,614 patients, or 85.7%. Conclusion: In the light of the results of our study, we can say that the use of psychoactive substances is a real public health and development problem in Senegal. The peaks in psychoactive substance consumption preceded the peaks in psychiatric care centers, so we need to promote information, education and communication on the harmful effects of psychoactive substance consumption among the population in general and young people in particular, in order to safeguard the country's development.

Introduction: In 2021, (88.6%) of Senegal's 79 districts had not reached the full Human papillomavirus (HPV) vaccination coverage target of (90%). The Diakhao health district had full vaccination coverage of (10%) in the same year. This study aimed to identify factors associated with full vaccination coverage among girls aged 11-13 in Diakhao health district. Method: This was a descriptive and analytical study conducted in Diakhao health district among 228 custodial mothers of young girls aged 11-13 years. Data were collected using a questionnaire assessing the knowledge, attitudes, practices, and satisfaction of custodial mothers of young girls aged 11-13 years about HPV vaccination. Descriptive, bivariate analysis, and logistic regression were performed at 5% alpha. Results: The majority (74.12%) of mothers and guardians had heard of cervical cancer, and 81.58% had heard of HPV vaccination. According to the mothers and guardians of young girls, there was complete coverage (17.54%). According to the vaccination card, complete coverage was (15.79%). Factors associated with complete coverage were: the girl's schooling (ORa = 3.56 (1.12-11.29); having heard about cervical cancer vaccination (ORa = 0.09 (0.02, 0.32)]); rural residence (ORa = 0.13 (0.04-0. 44); agreement with vaccination for reasons of protection against certain communicable diseases (ORa = 8.95 (1.27-63.11) or reasons of vaccination of neighbors' children (ORa = 3.25 (1.24-8.55), satisfaction with counseling (ORa = 6.49 (1.63-25.8). Conclusion: Information to mothers or guardians of young girls is crucial to achieving the goal of full immunization coverage. It could be significantly improved by an acceleration plan focusing on interpersonal communication.

BACKGROUND: Female genital mutilation (FGM) is a deeply rooted practice in Senegal, generally affecting girls at a very young age. The prevalence of FGM has remained virtually unchanged for at least two decades. The aim of this study is to identify the factors associated with the evolution of this practice in Senegal. METHODS: This study is a secondary analysis of data extracted from the Senegalese Demographic and Health Surveys (DHS) from 2015 to 2023. The record individual file of women aged 15 to 49 was used for the analysis. For both women aged 15-49 and their daughters, the dependent variable was "being circumcised". This is a binary qualitative variable which was coded as"Yes" if the woman and/or her daughter had been circumcised. A descriptive analysis was performed. A multivariate analysis was performed to determine the Adjusted Odds Ratios (ORaj) and estimate the corresponding 95% confidence intervals (CI) for all variables. Adjustment was made on a yearly basis. RESULTS: The prevalence of female circumcision was 24.2% in 2015, 22.7% in 2016, 24.0% in 2017, 23.3% in 2018, 25.2% in 2019 and 20.1% in 2023. The majority of women who undergo FGM do so between the ages of 0 and 9. The most frequent form of mutilation is "flesh removed from genital area", the frequency of which rises from 58.3% in 2015 to 76.5% of cases of mutilation in 2023. Infibulation (genital area sewn closed), which was the least common form of mutilation at 7% in 2015, will increase to 25.6% in 2023. The factors associated with the development of FGM among Senegalese women were region of residence and socio-economic level. CONCLUSION: Our study has shown that the fact that the mother has been circumcised is a risk factor for the daughter. However, the level of wealth and education of women and their husbands would appear to be protective factors against the development of FGM in girls. To bend the curve, political decision-makers need to take targeted action in hotspot regions, considering aspects linked to women's empowerment.

En Afrique de l'Ouest, les décès maternels sont plus élevés dans les zones rurales. Les accouchements à domicile sans assistance qualifiée contribuent à la mortalité maternelle élevée. Parmi les raisons évoquées des accouchements à domiciles dans ces zones rurales, il serait cité la faible autonomie décisionnelle des femmes pour leur santé dans l’accès aux services de santé plus particulièrement dans les sociétés de type patriarcale comme au Sénégal. L'objectif de cette étude est d'examiner l'effet de l'autonomie des femmes pour leur propre santé sur les accouchements à domicile au Sénégal. Pour examiner la relation entre l'autonomie de la femme dans la décision de soins et l'accouchement à domicile, l'appariement par score de propension serait performé. Il s’agit d’une stratégie visant à réduire le biais d'échantillonnage en équilibrant les caractéristiques de l'échantillon, une technique qui imite la randomisation sur les données transversales. Les données ont été collectées à partir de l’enquête démographique Sénégalaise réalisées en 2017. L'autonomie décisionnelle de la femme était la principale variable explicative d'intérêt pour l'accouchement à domicile. Les analyses ont été réalisées avec le logiciel STATA.15. Huit mille huit cent soixante-cinq (8865) femmes âgées de 15 à 49 ans avaient été enquêtées dans le cadre de l'EDS 2017. Les femmes qui avaient la latitude de décider de leur propre santé représentaient 6,26%. Celles qui accouchaient à domicile représentaient 21,67%. L'accouchement à domicile avait diminué de 53,33% à 21,15% parmi les femmes ayant une autonomie décisionnelle, soit une réduction de 31,64%. L'autonomie dans la prise de décision en matière de soins de santé permettrait de réduire les accouchements à domicile. Ces résultats montrent l'importance de l'intégration du genre pour l'accessibilité des services de maternité au Sénégal. In West Africa, studies have shown that maternal deaths are higher in rural areas, where 80% of deliveries are performed at home without skilled attendants. This study examines the effect of women's autonomy for their health on home deliveries in Senegal. We applied the propensity score matching (PSM) approach to explore the relationship between women's autonomy in healthcare decisions and home birth. PSM is a strategy for reducing sampling bias by balancing sample characteristics and miming randomization on cross-sectional data. Data were collected from Senegal DHS surveys conducted in 2017. Women's decision-making autonomy was the primary explanatory variable of interest for home birth. Analyses were done with STATA.15 software. Eight thousand eight hundred and sixty-five (8865) women between the ages of 15 and 49 were surveyed in the DHS 2017. Women who have the latitude to decide on their health represent 6.26%. Women giving birth at home accounted for 21.67%. There was a decrease in home births of 31.64% from 53.33% to 21.15% among women who were autonomous in deciding about their health. Autonomy in healthcare decision-making would reduce home births. These results show the importance of gender mainstreaming for accessing maternity services in Senegal.

The Corona Virus Disease 2019 (COVID-19) pandemic overwhelmed health systems and disrupted the delivery of health services globally. Community Health Workers (CHWs) play a critical role in linking communities to health systems, supporting the prevention and control of diseases in many low- and middle-income countries. However, their roles, barriers, and facilitators in the response and control of the COVID-19 pandemic have not been well documented. We described the roles of CHWs in the COVID-19 response, including the barriers and facilitators. A cross-sectional study design was used to assess the COVID-19 response in the Democratic Republic of Congo (DRC), Nigeria, Senegal, and Uganda. This involved 110 key informant interviews with policymakers, health facility managers, district health managers, and CHWs to understand the role of CHWs in the COVID 19 response, selected purposively. The total sample size was based on information saturation in each of the countries. A document review on the COVID-19 response was also conducted. We searched Google, Google Scholar, and PubMed for published and grey literature. Data from the selected documents were extracted into a Google master matrix in MS Excel and analyzed thematically. In COVID-19 Control, CHWs supported community-based surveillance, contact tracing, risk communication, community mobilization, and home-based care. To support the continuity of other non-COVID-19 services, the CHWs conducted community mobilization, sensitizations, outreaches, referrals, and patient follow-ups. CHWs were challenged by movement restrictions, especially in the initial stages of the lockdown, inadequate PPE, increased workload, low allowances, and motivation. CHW were facilitated by trainings, the development of guidelines, development partners’ support/funding, and the provision of personal protective equipment (PPE) and tools. CHWs supported both the COVID-19 control and continuity of non-COVID-19 health care during the COVID-19 pandemic. CHWs are a critical resource that must be adequately supported to build resilient health systems.