Factors associated with the abandonment of postexposure prophylaxis at the antirabies center in Abidjan, Côte d'Ivoire

The main objective of this work is to analyze the factors associated with patients dropping out of postexposure prophylaxis (PEP) at the antirabies center of Abidjan (ARC). This descriptive, analytic cross-sectional study took place at the ARC of Abidjan from September 2014 through May 2015. Data were collected in two stages: first, all patients were interviewed at their first consultation. Exposed patients who failed to return were interviewed by telephone three days later. We recorded 441 subjects (59.3%) who had dropped out of their PEP. After multivariate analysis of social and demographic factors, the dropout rate was low in the groups aged 40-49 years (aOR = 0.40, 95% CI = 0.2, 0.8), 50-59 years (aOR = 0.40, 95% CI = 0.21; 0.82), and 60 years and older (aOR = 0.26, 95% CI = 0.09; 0.76), while it was elevated in retired persons (aOR = 10.07, 95% CI = [1.11, 91 , 7]). Moreover, the choice of protocol influenced PEP adherence, with subjects who chose the 5-dose protocol dropping out more frequently (P≤0.001). The main reason given by the subjects exposed to a suspect animal to explain dropping out of PEP was the lack of financial resources (41.5%). To alleviate this dropout problem, the ARC should strengthen public awareness of human rabies and the Ivorian government must implement universal health coverage to help the poor or make the vaccine available for free to all.

Effects of climatological parameters in modeling and forecasting seasonal influenza transmission in Abidjan, Cote d'Ivoire

Background

In temperate regions, influenza epidemics occur in the winter and correlate with certain climatological parameters. In African tropical regions, the effects of climatological parameters on influenza epidemics are not well defined. This study aims to identify and model the effects of climatological parameters on seasonal influenza activity in Abidjan, Cote d’Ivoire.

Methods

We studied the effects of weekly rainfall, humidity, and temperature on laboratory-confirmed influenza cases in Abidjan from 2007 to 2010. We used the Box-Jenkins method with the autoregressive integrated moving average (ARIMA) process to create models using data from 2007–2010 and to assess the predictive value of best model on data from 2011 to 2012.

Results

The weekly number of influenza cases showed significant cross-correlation with certain prior weeks for both rainfall, and relative humidity. The best fitting multivariate model (ARIMAX (2,0,0) _RF) included the number of influenza cases during 1-week and 2-weeks prior, and the rainfall during the current week and 5-weeks prior. The performance of this model showed an increase of >3 % for Akaike Information Criterion (AIC) and 2.5 % for Bayesian Information Criterion (BIC) compared to the reference univariate ARIMA (2,0,0). The prediction of the weekly number of influenza cases during 2011–2012 with the best fitting multivariate model (ARIMAX (2,0,0) _RF), showed that the observed values were within the 95 % confidence interval of the predicted values during 97 of 104 weeks.

Conclusion

Including rainfall increases the performances of fitted and predicted models. The timing of influenza in Abidjan can be partially explained by rainfall influence, in a setting with little change in temperature throughout the year. These findings can help clinicians to anticipate influenza cases during the rainy season by implementing preventive measures.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-016-3503-1) contains supplementary material, which is available to authorized users.

[Assessment of measles diagnostic from gingival fluid in Côte d'Ivoire]

After the adoption of the Global Initiative for Measles Elimination in 2001, Côte d'Ivoire has created monitoring case by case. Thus, the diagnosis of measles from the gingival fluid was implemented, through a pilot project. This study aimed to evaluate the performance of this diagnostic test. We conducted a cross-sectional survey, in four health districts of Abidjan, during a period from July 2010 to December 2012. The study consisted in collecting gingival fluid and serum samples in all suspected measles children. These samples were analyzed by ELISA test at Pasteur Institute of Côte d'Ivoire. Standard formulas were used to calculate sensitivity, specificity, positive predictive value and negative predictive value of oral fluid compared to serum taken as the "gold standard" and confidence intervals were estimated with error alpha risk (α =0.05). The concordance of kappa coefficient (k) was used to estimate agreement level between the results of oral fluid analysis and those of serum. The sensitivity and specificity of the test were 98% and 82% respectively while the positive predictive value and the negative predictive value were 84% and 98%. The comparison of oral fluid with the reference test showed high agreement, between 0.61 and 0.80. The diagnostic test on gingival fluid is acceptable because its sensitivity, specificity and negative predictive value had high level. Therefore it can be extended to all sanitary districts.

[Description of sexual practices of women who have sex with other women to HIV / AIDS in Abidjan (Côte d'Ivoire)]

The response to HIV must be based on all situations of risk and vulnerability related to sexual behavior. Sexual practices of women who have sex with other women to HIV described in his study come within this framework. This transversal and descriptive study on the sexual practices of 150 women who have sex with other women to HIV was conducted from July to September 2010 in Abidjan. Mean age of the respondents was 26.6 years. Among them, 21.3% was illiterate, 41.4% had no earned income and 57.3% was Christians. At the time of data collection, the majority (70.7%) did not know their HIV status. The analysis of sexual practices has found 13.3% of lesbians, bisexual, 36% and 50.7% of women who say they are lesbian even if they have had sex with men. Women who have sex with other women had sexual risk behavior. It was mostly the non-systematic use of the condom during sexual relation (60%). Among the 26.7% of respondents who had lesbian practices with penetration, 40% took no precaution to prevent HIV and other sexually transmitted infections. Taking into account these results could help to develop specific strategies to promote responsible sexual practices among women who have sex with other women.

[Impact of armed conflict on the health care system of a sanitary district in Cote d'Ivoire]

Since September 2002, Côte d'Ivoire has been in the throes of armed conflict that has split the country in two. In the government-controlled area, access to health care services has continued. In the area under the control of the "New Forces", access to health care services decreased dramatically due to departure of qualified health personnel and subsequent shutdown of sanitary facilities. The purpose of this transversal descriptive survey was to measure the impact of this crisis on the health care system in the Séguéla sanitary district that is located in the war zone. Findings showed that 60.7% of sanitary facilities are no longer operational, that 77.7% of qualified personnel have left their workstation, and that 46.2% of sanitary structures have been damaged. A few reference hospitals and sanitary facilitates have been able to remain open thanks to the support of the humanitarian organisations. As a result of declining access to health care services, a recrudescence of measles and IST has been observed and gastritis and traumatology have appeared among the top 10 causes of morbidity. Access to effective health care in the Séguéla sanitary district cannot be envisioned without the return of qualified health care personnel and the renovation of the sanitary facilities.

[Socio-economic impact at the household level of the health consequences of toxic waste discharge in Abidjan in 2006]

In August 2006, toxic wastes were discharged in the district of Abidjan, causing important health consequences in many households in the area. In order to appreciate the socio-economic impact of the consequences of toxic waste discharge on the households and of the measures taken by the authorities to deal with this catastrophe, and to appreciate the spatial extent of the pollution, we undertook a multidisciplinary transversal investigation at the sites of discharge of oxic waste, from October the 19th to December the 8th, 2006, using a transect sampling methodology. This paper presents the results related to the socio-economic aspects of the survey while the environmental and epidemiological results are presented in two other published papers. The socioeconomics investigation, conducted using a questionnaire, concerned 809 households across the various sites of discharge of toxic waste. More than 62% of households had at least one person who had been affected by toxic waste (affected households). 62.47% of these households were in Cocody district (with 2 sites and 4 points of discharge), 30.14% in Abobo district (with 2 sites and 3 points) and 7.39% in Koumassi district (with 1 site and 1 point). To escape the bad smell and the nuisance, 22.75% of the 501 "affected" households had left their houses. To face the health consequences generated by the toxic waste, 30.54% of the "affected" households engaged expenses. Those were on average of 92 450 FCFA (€141), with a minimum of 1 000 FCFA (€1.5) and a maximum of 1500000 FCFA (€2.287), in spite of the advertisement of the exemption from payment treatment fees made by the government. The decision of destroying cultures and farms near the points of discharge of the toxic products in a radius of 200 meters, taken by the authorities, touched 2.22% of the households. For these households, it did nothing but worsen their state of poverty, since the zone of influence of the toxic waste went well beyond the 200 meters prescribed by the authorities as the limit of the operations of destruction.

[Epidemiologic monitoring of human rabies in an endemic canine rabies area in the Ivory Coast]

AIM

The objective of this study was to analyze the epidemiologic monitoring of human rabies in the rabies medical center of Abidjan.

PATIENT

A cross-sectional study was undertaken based on files of patients having consulted in the rabies center after exposure and suspicion of human rabies between January 2001 and June 2009.

RESULTS

Twenty-six cases of human rabies were reported in 10,706,136 inhabitants (annual incidence of 0.028 cases per 100,000). The number of detected cases increased considerably after reinforcing the monitoring of the disease. Most cases occurred in an urban environment and concerned both sexes. The most concerned age range was under 31 years. The patients' were mostly school children and housewives. In all cases, the rabid animal was a dog and the type of exposure was a bite. Fifty-six percent of the victims had not received any local treatment and almost all no post-exposure prophylaxis. The mean delay before the first symptoms was 49.5 days after exposure and for death, 4 days after the onset of symptoms. Virological diagnosis was made in four cases.

CONCLUSION

In spite of the increase of cases observed since 2006, certainly due to reinforcement of the monitoring network, improvement is needed to assess the real incidence of rabies in the Ivory Coast.

[Five years of cholera surveillance in Ivory Coast during social and political crisis, 2001 to 2005]

For an efficient struggle against infectious diseases with epidemic potential, the Cdte d'Ivoire set up a precocious alert system in 2001 with a main objective: to detect epidemics of cholera, measles, yellow fever and meningitis and to provide necessary information for their control and their prevention. During the 2001 to 2005 period, the country was marked by military and political crisis which occurred in 2002; the country had to face up to a reappearance of cholera. How did it evolve in such a context? The question was to describe the performances of the system and the evolution of cholera from weekly data collected by the centers of epidemiological monitoring in health districts. The cases and declared deaths were compiled and the indicators of morbidity and mortality were then studied according to time site and individual features on the period of 2001 to 2005. From 2001 to 2005, 11,874 cases were notified with 564 deaths and a lethal rate of 4.7%. In 2001, from the initial source of infection, the civil jail, the epidemic of cholera disseminated itself through visitors in the whole city of Abidjan where 3250 cases were notified. Out of city, 20 outbreaks have been declared with a total of 3010 cases. The yearly highest impact, 37 living cases/100,000 inhabitants recorded in 2001, decreased regularly until 2005 with 0.2 living cases/100,000. After 2002, outbreaks were located mainly in the half south of the country which welcomed displaced populations from the north, preferably in transition or settling zones near the front line. The lethal rate in Abidjan (2.3%) was less important than that of other health districts (8.6%). The lethal rate globally increased as the impact decreased. Vibrio cholerae was responsible for the epidemics. The group of 15 years old and over was the most affected (12.69 living cases/100,000) whereas the highest lethal rate appeared in the group under 5 years old (6.6%). The reappearance and constant cholera epidemics in Côte d'Ivoire are due to bad general hygiene conditions, insufficient supply of drinking water from wells or packaged, concentration of populations in the south of the country due to war and uncontrolled development of the poor and unsanitary precarious boroughs. Outburst during the dry season is a warning signal of an important epidemic during the raining season especially in poor urban areas. The precocious alert system has permitted to detect the epidemics, to follow up their evolution and to orientate the struggle against cholera in Côte d'Ivoire.

[Compliance with veterinary surveillance orders at the rabies control center in Abijan, Ivory Coast]

Rabies remains a major health public health problem in many developing countries. This is particularly the case in the Ivory Coast. Surveillance orders play an important role in patient management. The purpose of this transverse study conducted at Abidjan Rabies Control Center from July 1 to September 30, 2003 was to assess compliance with veterinary surveillance orders by owners of animals that have bitten or scratched persons. Persons reporting to the rabies control center after exposure to the risk of rabies infection and owners of the animals that had bitten, scratched, or licked these persons were included in this study. Most animals involved in these cases (94.8%) were dogs including 69.5% that had been vaccinated. Most persons (71.7 %) at risk reported within two days following exposure and 31.3% provided all three veterinary certificates. The mean time required to provide the first certificate was 4.2 days. The gender of the persona at risk and the vaccination status of the animal involved were correlated with compliance with veterinary surveillance orders. Four main difficulties were cited as hindrances for compliance with veterinary surveillance, i.e., cost (373%), distance (28.4%), time (9.9%), and veterinary clinic accessibility (2.5%). These findings indicate that stricter laws and a national prevention program are needed.

Fighting rabies in Africa: the Africa Rabies Expert Bureau (AfroREB)

Rabies experts from 14 francophone African countries met in Grand Bassam (Côte d'Ivoire), 10-13 March 2008. They presented the situation in their respective countries, acknowledging the lack of rabies awareness among the population, health care workers and health authorities. They recognized that infrastructure for the management of rabies exposure is scarce, modern vaccines are in limited quantity and immunoglobulins are lacking in most of their countries. They defined as a priority the need to have reliable figures on the disease burden, which is necessary for informed decision making and priority setting, and for applying for aid in controlling the disease. This meeting sealed the establishment of the Africa Rabies Expert Bureau (AfroREB).