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BackgroundIt is thought that low-income countries are undergoing an epidemiological transition from infectious to non-communicable diseases; however, this phenomenon is yet to be examined with long-term data on morbidity.MethodsWe performed a prospective evaluation of all emergency medical consultations at a major emergency service provider in Dakar, Senegal from 2005 to 2014. Using standardised definitions, the primary diagnosis for each consultation was classified using the International Classification of Diseases-10 and then broadly categorised as ‘infectious’, ‘non-communicable’ and ‘other’ diseases. Morbidity rates for each year in the 10-year observation period were plotted to depict the epidemiological transition over time. To quantify the yearly rate ratios of non-communicable over infectious diagnosis, we used a generalised Poisson mixed model.ResultsComplete data were obtained from 49 702 visits by African patients. The mean age was 36.5±23.2 and 34.8±24.3 years for women and men, respectively. Overall, infections accounted for 46.3% and 42.9% and non-communicable conditions 32.2% and 40.1% of consultations in women and men, respectively. Consultation for non-communicable compared with infectious conditions increased by 7% every year (95% CI: 5% to 9%; p<0.0001) over the 10 years. Consultations for non-communicable condition were more likely in women compared with men (RR=1.29, 95% CI: 1.18, 1.40) and at older ages (RR=1.27; 95% CI 1.25, 1.29 for 10-year increase in age).ConclusionUsing high-quality disease morbidity data over a decade, we provide novel data showing the epidemiological transition of diseases as manifested in emergency service consultations in a large Sub-Saharan African city. These results can help reorientation of healthcare policy in Sub-Saharan Africa.

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Background: The impact of COVID-19 preventative measures (use of face masks, social distancing, quarantines, and sanitation and hygiene practices) on the time trends in infectious and chronic disease consultations in Sub-Saharan Africa remains unknown. Methods: We conducted a cohort study on all emergency medical consultations over a five-year period, January 2016 to July 2020, from SOS Medecins in Dakar, Senegal. The consultation records provided basic demographic information such as age, ethnicity (Senegalese v. Caucasian), and sex as well as the principal diagnosis using an ICD-10 classification (‘infectious, ‘chronic’, and ‘other’). Firstly, we investigated how the pattern in emergency consultation differed from March to July 2020 compared to previous years. Secondly, we examined any potential racial/ethnic disparities in COVID-19 consultation. Findings: Data on emergency medical consultations were obtained from 53,583 patients of all ethnic origins. The mean age of patients was 37·0 ± 25·2 and 30·3 ± 21·7 in 2016-2019 and 45·5 ± 24·7 and 39·5 ± 23·3 in 2020 for Senegalese and Caucasians. The type of consultations between the months of January and July were similar from 2016 and 2019; however, in 2020, there was a drop among the numbers of infectious disease consultations, particularly from April to May 2020 when sanitary measures for COVID-19 were applied (average of 366·5 and 358·25 in 2016-1019 and 133 and 125 in 2020). The prevalence of chronic conditions remained steady during the same period (average of 381 and 394·75 in 2016-2019 and 373 and 367 in 2020). In a multivariate analysis after adjusting to age and sex, infectious disease consultations were significantly more likely to occur in 2016-2019 compared to 2020 (OR for 2016= 2·39, 2017= 2·74, 2018= 2·39, 2019= 2·01). Furthermore, the trend in the number of infectious and chronic consultations were similar among Senegalese and Caucasian groups, indicating no disparities among those seeking treatment. Conclusion: During the implementation of COVID-19 preventative measures, infectious disease rates dropped as chronic disease rates stayed stagnant in Dakar. Furthermore, no racial/ethnic disparities were observed among the infectious and chronic consultations.