To replace trade in slaves, the French promoted peanut cultivation on the mainland. Large public expenditure for infrastructure was allocated by the colonial authorities to Dakar's development. The port facilities were improved with jetties, a telegraph line was established along the coast to Saint-Louis and the Dakar-Saint-Louis railway was completed in , at which point the city became an important base for the conquest of the western Sudan.
The citizens of the city elected their own mayor and municipal council and helped send an elected representative to the National Assembly in Paris. Urbanization during the colonial period was marked by forms of racial and social segregation—often expressed in terms of health and hygiene—which continue to structure the city today. As first occupants of the land, the Lebou inhabitants of the city successfully resisted this expropriation.
Nonetheless, the Plateau thereafter became an administrative, commercial, and residential district increasingly reserved for Europeans and served as model for similar exclusionary administrative enclaves in French Africa's other colonial capitals Bamako, Conakry, Abidjan, Brazzaville. Since independence, urbanization has sprawled eastward past Pikine, a commuter suburb whose population est. In its colonial heyday Dakar was one of the major cities of the French Empire, comparable to Hanoi or Beirut.
French trading firms established branch offices there and industrial investments mills, breweries, refineries, canneries were attracted by its port and rail facilities. It was also strategically important to France, which maintained an important naval base and coaling station in its harbor and which integrated it into its earliest air force and airmail circuits, most notably with the legendary Mermoz airfield no longer extant. In Dakar became involved in the Second World War when General de Gaulle, leader of the Free French Forces, sought to make the city the base of his resistance operations.
The object was to raise the Free French flag in West Africa, to occupy Dakar and thus start to consolidate the French resistance of its colonies in Africa. The plan had British naval support when fighting alone against the Axis powers. However, due to delays and the plan becoming known, Dakar had already come under the influence of the German controlled will of the Vichy government.
With the arrival of French naval forces under Vichy control and faced by stubborn defences onshore, de Gaulle's proposals were resisted and the Battle of Dakar ensued off the coast lasting three days September 23—25, , between the Vichy defences and the attack of the Free French and British navy. The enterprise was abandoned after appreciable naval losses. Although the initiative on Dakar failed, General de Gaulle was able to establish himself at Duala in the Cameroons which became the rallying point for the resistance of the Free French cause. In November West African conscripts of the French army mutinied against poor conditions at the Thiaroye camp, on the outskirts of the city.
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The mutiny was seen as an indictment of the colonial system and constituted a watershed for the nationalist movement. Dakar was the capital of the short-lived Mali Federation from to , after which it became the capital of Senegal. Dakar is a major financial center, home to a dozen national and regional banks including the BCEAO which manages the unified West African CFA currency , and to numerous international organizations, NGOs and international research centers.
Dakar has a large Lebanese community concentrated in the import-export sector that dates to the s, a community of Moroccan business people, as well as Mauritanian, Cape Verdean , and Guinean communities. France still maintains an air force base at Yoff and the French fleet is serviced in Dakar's port. Beginning and until , Dakar was frequently the ending point of the Dakar Rally. It is located on the Cap-Vert peninsula on the Atlantic coast and is the westernmost city on the African mainland.
The Dakarois climate is generally warm. Dakar's rainy season lasts from July to October while the dry season covers the remaining eight months. Dakar is cooled year-round by sea breezes. The commune of Dakar has been in continuous existence since , being preserved by the new state of Senegal after independence in , although its limits have varied considerably over time.
The limits of the commune of Dakar have been unchanged since The commune of Dakar is ruled by a democratically elected municipal council conseil municipal serving five years, and a mayor elected by the municipal council. The first black mayor was Blaise Diagne , mayor of Dakar from to This situation is quite similar to Paris , which is both a commune and a department. However, contrary to French departments, departments in Senegal have no political power no departmental assembly , and are merely local administrative structures of the central state, in charge of carrying out some administrative services as well as controlling the activities of the communes within the department.
These arrondissements are quite different from the arrondissements of Paris , being merely local administrative structures of the central state, like the Senegalese departments , and are thus more comparable to French departmental arrondissements. In a massive reform of the administrative and political divisions of Senegal was voted by the Parliament of Senegal. These communes d'arrondissement were given extensive powers, and are very much like regular communes. They have more powers than the arrondissements of Paris, and are more akin to the London boroughs. Its territory is thus roughly the same as the territory of the metropolitan area of Dakar.
They were given extensive powers, and manage economic development, transportation, or environmental protection issues at the regional level, thus coordinating the actions of the communes below them. The city of Dakar is a member of the Organization of World Heritage Cities , and contains several landmarks. One of the most notable is Deux Mamelles , twin hills located in Ouakam commune.
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The hills are the only high ground in the city, providing views of the entire area area and sweeping views of the city. The first hill is topped with Mamelles Lighthouse built in The second hill has the newly completed African Renaissance Monument built on top, which is considered the tallest statue in Africa. Today it is a traditional commercial center packed with tailor's shops. The quarter also houses Dakar Grand Mosque at the heart of the commune, which is built in and one of the prominent landmarks of the city.
The former is on the northern shore of N'Gor commune with beaches providing attractions such as surfing. N'Gor commune also has other popular beach resorts such as Plage de N'Gor. Today, the island is also hosting the art scene of the hundreds of local artists who line up their works at the outdoor exhibitions.
Among the places of worship , they are predominantly Muslim mosques. Seydina is buried in the Layen Mausoleum which is among the major landmarks of Dakar. It is also the third biggest Sufi order in Senegal.
In Senegal the traditional culture is very centred around the idea of family. This even includes the way that they eat. When it is time to eat a typical meal someone will say "kay lekk" which means 'come eat'. Everyone will come together and sit around the plate and eat with their hands. The etiquette of people in Dakar is very simple but very vital. To not greet someone upon sight is to portray rudeness and oftentimes ignorance. Due to French colonialism the children of Dakar have a unique school system.
The school will get a break at about midday and return home to get some rest. Since the population is majority Muslim there are daily activities such as going to the mosque at noon prayer and attending the mosque on Fridays. Music has a big influence on the youth with famous artists like Daara J Family who use their voice to represent the problems in their communities.
Dakar is home to multiple national and international festivals, like World Festival of Black Arts , Festival international du film de quartier de Dakar, Dakar Biennale. Dakar used to be the finishing point of the Dakar Rally until , before the event was moved to South America for the security concerns in Mauritania. Dakar will host the Summer Youth Olympics , it will be the first of its kind Olympics ever held in Africa. Dakar unites all the significant sporting events and infrastructures of the country, especially those dedicated to the national sports: soccer and Senegalese wrestling.
Many of Dakar's inhabitants lead an athletic lifestyle: it is common to see the beaches packed with locals of all ages playing soccer, working out or running. The town is home to the Autonomous Port of Dakar and the terminus of the non-functioning Dakar-Niger railroad line. S Paratyphi A three isolates was isolated in Senegal only.
Study population was adjusted for health-seeking behaviour and crude cases were adjusted for recruitment proportion number of patients analysed divided by number of patients with febrile illness from study area who visited a recruitment health facility, multiplied by Among age groups of children younger than 15 years, the highest AIR for typhoid fever was observed in children aged 2—4 years from Polesgo, Asante Akim North, Moshi Urban District, and Kibera, and in children aged 5—14 years from Kibera and Polesgo table 2.
The antimicrobial susceptibility profiles of S Typhi and iNTS isolates differed between sites table 3. Most multidrug-resistant S Typhi isolates were obtained at the sites in Kenya, Ghana, and Tanzania both sites combined. S Typhi isolates that had reduced ciprofloxacin susceptibility were cultured in Kenya and South Africa, only; one ciprofloxacin-resistant S Paratyphi A organism was isolated in Senegal. One iNTS isolate in Kenya was resistant to ceftriaxone table 3. Antimicrobial resistance patterns of Salmonella enterica serotype Typhi and iNTS isolates across sites.
Resistant isolates are reported per country, rather than per site. This study identified Salmonella as a major cause of invasive bacterial febrile illness across sub-Saharan Africa, affecting children aged 2—14 years rather than adults, and arising in both high-population and low-population density settings. Other major causes of invasive bacterial febrile illnesses varied by country; E coli and S aureus were the most frequent non- Salmonella pathogens isolated from blood.
Results from previous studies 18 , 19 suggest that typhoid fever in some sub-Saharan Africa settings occurs predominately in urban settlements with high-population densities, and that disease incidence could have been overestimated by the use of the Widal test. Our study, done using a standardised protocol in both urban and rural settings, indicated high incidences of typhoid fever and iNTS in areas with high-population and low-population densities. Separate analyses done at the Ghana site confirmed this observation and revealed a higher disease incidence in children living in rural areas than in those living in urban areas.
Similar to the Diseases of the Most Impoverished programme done in Asia, 21 our results show that children aged 2—14 years bear the greatest burden of typhoid fever. Notably, our data indicate that the AIR for typhoid fever at TSAP sites was equal to or even greater than incidences reported in five Asian countries in the early s. For iNTS disease, we observed an AIR equal or higher than previously estimated and a bimodal age distribution with very young children and adults being the key age group for symptomatic infection. Results of our study identified a high prevalence of resistance against first-line antimicrobials in both S Typhi and iNTS infections.
Reduced susceptibility to ciprofloxacin was identified in S Typhi from Kibera and Pietermaritzburg. Multidrug-resistant iNTS isolates were isolated at several sites and have been isolated in sub-Saharan Africa previously. Genomic analyses 27 have described the spread of S Typhi haplotype H58 into Africa, a multidrug-resistant strain associated with reduced ciprofloxacin susceptibility.
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The susceptibility patterns observed in our study are concerning, particularly because some antimicrobial-resistant S Typhi can have a selective fitness advantage. We made all efforts to minimise bias; however, our study has some limitations. The restricted sensitivity of blood culture to detect Salmonella pathogens applies to other bacterial pathogens as well—ie, S pneumoniae and Haemophilus influenzae type b—however, those are universally recognised as important infections for which vaccines are cost-effective, and vaccination programmes have been established.
Second, our results represent incidence in sites selected because of their previous reports on typhoid fever. The site selection strategy limits the generalisability of the AIR to other locations and might result in the reduced detection of iNTS disease. Third, given the vast number of patients and restricted diagnostics capacity , not every patient with a history of fever was enrolled—eg, at sites where inpatients were recruited, patients with a fever for 72 h or longer were excluded to minimise the inclusion of patients pretreated with antimicrobials and to maximise blood culture yield.
Fourth, the proportion of the catchment population using the TSAP health-care facilities for febrile illness was low in some sites, and antimicrobial treatment before blood collection and its potential effect on blood culture sensitivity were not assessed. Fifth, the classification of the settings as either urban, rural, semi-urban, or urban-slum reflects the classification commonly used at each site and does not refer to a standard definition; instead, the population density of each site is presented to make setting comparisons.
Sixth, sites with no previous experience of blood collection for blood culture assessment had a higher incidence of contamination than sites with previous experience of blood collection South Africa, Ghana, Tanzania, and Kenya ; these incidences might have led to errors in clinical interpretation and uncertainty to distinguish between clinically significant bacteraemia and contamination.
Available isolates and blood samples collected from participants were PCR tested at the reference lab to minimise misclassification of isolated organisms. Seventh, the site in Ghana recruited only children younger than 15 years and the proportion of recruited inpatients varied greatly across all sites. Finally, data on disease severity, complications, mortality, and HIV status were not assessed because these were not primary study objectives.
Despite these limitations, this multisite study, the largest study of typhoid fever and iNTS done across sub-Saharan Africa to date, provides the most current and accurate incidence figures for these major infectious diseases across the continent and has substantial implications for their control. We surmise that the incidence of invasive salmonella infections among children in sub-Saharan Africa is much higher than previously estimated, underscoring the need for preventive measures.
Therefore, until access to safe drinking water and improved sanitation is greatly expanded, the prevention of typhoid fever will require immunisation and effective treatment options.
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Data from TSAP will be incorporated into the GAVI Alliances' review of potential subsidies for typhoid fever vaccines in ; their recommendation will be crucial for deployment of these vaccines. Hence, the need to understand the pragmatic aspects of vaccine targeting and delivery is pressing, particularly given the burden of disease in children, the associated risk factors, and the focal and unpredictable nature of the disease.
Similarly, in the absence of vaccines targeting iNTS disease, prevention will require a major investment in infrastructure for diagnosis and effective treatment of iNTS disease. When appropriate diagnosis and treatment are available, the use of effective antimicrobials might be impaired by the presence and potential increase of multidrug-resistant salmonella.
Further assessment of incidences in infants 0—5 months vs 6—11 months and data on severe typhoid fever or iNTS, including mortality, is crucial to determine the potential effect of future vaccines. We conclude that typhoid fever and iNTS disease are major agents of invasive bloodstream infections in urban and rural locations, affecting children more commonly than adults across sub-Saharan Africa.
Immunisation of high-risk age groups with existing and new vaccines should be a priority.
The next generation of epidemiological studies in sub-Saharan Africa needs to provide better data regarding the severity and mortality of typhoid fever and iNTS to guide the introduction of new typhoid and iNTS vaccines. Lastly, the accelerated development and introduction of iNTS vaccines needs to become a fundamental goal on the global health agenda.
We are grateful to Sooyoung Kwon for her invaluable administrative support of the project. We also thank all patients who consented to participate and hospital and clinic staff for their support. We especially acknowledge those who personally contributed to the implementation and execution of the study, additional to routine clinical work. Without the efforts of dedicated field staff this research would not have been possible. All other authors declare no competing interests. FM and TFW contributed to study conception and design, analysis of data, interpretation of results, and drafting and editing of the paper.
KT and BL contributed to study conception and design, data acquisition in the field, interpretation of the results, and editing of the paper. All authors read and approved the final draft. National Center for Biotechnology Information , U. Sponsored Document from. Lancet Glob Health. Published online Feb Author information Copyright and License information Disclaimer. Florian Marks: tni. Published by Elsevier Ltd. See " Typhoid in Africa and vaccine deployment.
This article has been cited by other articles in PMC. Summary Background Available incidence data for invasive salmonella disease in sub-Saharan Africa are scarce. Methods We established a systematic, standardised surveillance of blood culture-based febrile illness in 13 African sentinel sites with previous reports of typhoid fever: Burkina Faso two sites , Ethiopia, Ghana, Guinea-Bissau, Kenya, Madagascar two sites , Senegal, South Africa, Sudan, and Tanzania two sites. Interpretation Typhoid fever and iNTS disease are major causes of invasive bacterial febrile illness in the sampled locations, most commonly affecting children in both low and high population density settings.
Introduction Salmonella infections contribute substantially to global morbidity and mortality.
Research in context. Methods Study design, site selection, and participants We used a multicentre, population-based, prospective surveillance study design. Open in a separate window. Figure 1. Laboratory procedures We standardised laboratory, quality control, and blood sample collection procedures across sites. Health-care utilisation survey and person-years of observation calculation The health-care-seeking behaviour of the populations under surveillance was investigated with the assumption that access to the TSAP health-care facility was non-uniform throughout the population.
Statistical analysis We established a multicountry database using FoxPro software. Role of the funding source The funder of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report. Figure 2. If funds allowed, the scheduled period was extended. Population data correspond to the population census and estimated population for the area, respectively. It includes 53 towns distributed in what is now Asante Akim North and Central. Broader values were applied to each stratum. Missing data on recruitment patterns in Senegal, Ethiopia, and South Africa did not allow calculation of adjusted incidences.
Crude rates are presented. Adjusted cases presented inside parentheses were used to calculate crude rate. One of the S Paratyphi isolates was resistant to ciprofloxacin. Discussion This study identified Salmonella as a major cause of invasive bacterial febrile illness across sub-Saharan Africa, affecting children aged 2—14 years rather than adults, and arising in both high-population and low-population density settings. Contributors FM and TFW contributed to study conception and design, analysis of data, interpretation of results, and drafting and editing of the paper.
References 1. The global burden of typhoid fever. Bull World Health Organ. Global burden of invasive non-typhoidal Salmonella disease. Emerg Infect Dis. Nontyphoidal Salmonella serovars cause different degrees of invasive disease globally. J Infect Dis. Burden of typhoid fever in low-income and middle-income countries: a systematic, literature-based update with risk-factor adjustment.
Lancet Global Health. Typhoid fever and paratyphoid fever: systematic review to estimate global morbidity and mortality for J Global Health. Incidence and characteristics of bacteremia among children in rural Ghana. PLoS One.
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Population-based incidence of typhoid fever in an urban informal settlement and a rural area in Kenya: implications for typhoid vaccine use in Africa. Typhoid fever among children, Ghana. No authors listed Typhoid vaccines: WHO position paper. Wkly Epidemiol Rec. Clin Infect Dis. Clemens JD. Meeting on establishment of consortium to study invasive salmonellosis in sub-Saharan Africa. Sankoh O, Byass P.
Int J Epidemiol.
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Murray P, Baro EJ. Chapter Enterobacteriaceae—introduction and identification. Manual of Clinical Microbiology. Clinical and Laboratory Standards Institute. Performance standards for antimicrobial susceptibility testing; 23rd informational supplement; MS Healthcare-seeking behaviour for common infectious disease-related illnesses in rural Kenya: a community-based house-to-house survey.
J Health Popul Nutr. Health-seeking patterns among participants of population-based morbidity surveillance in rural western Kenya: implications for calculating disease rates. Int J Infect Dis. Differing burden and epidemiology of non-Typhi Salmonella bacteremia in rural and urban Kenya, — Mweu E, English M.
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