Différences dans la prise en charge de l’asthme associé à la polypose nasosinusienne : cas de deux patients travaillant dans les secteurs privé et informel sénégalais

Abstract

The recommendations of global initiative for asthma (GINA) do not take into account asthma associated with sinonasal polyposis which in our country remains a frequent entity in spite of its unknown prevalence. Based on two observations made at health facilities, we undertook an analysis of different ways of managing this combination based on the patient's place of residence, his place in the working world, i.e., either a structured or an informal setting, whether or not he had health insurance coverage and the type of health care service he frequents. In our country, the efficient treatment of asthma associated with sinonasal polyposis is hindered by delay in access to health care facilities due to the systematic use of traditional medicine by most patients, by under-equipped medical facilities, for example, lack of spirometry equipment which is available only in public medical facilities and in three private medical entities, the shortage of qualified staff, with only 10 respiratory physicians and four allergists practicing in Dakar, the capital. In the public sector, medical coverage for civil servants is ensured by budgetary charges and public health institutions and by private insurance for workers in the private sector whereas those in the informal sector experience enormous difficulties due to medical expenses in spite of the promotion of mutual health insurance companies. Furthermore, beta-2 mimetics and inhaled corticoids, indispensable for the treatment of asthma, do not appear on the list of essential drugs promoted by the Bamako Initiative which was aimed at making drugs more accessible and less expensive.