High-risk human papillomavirus distribution according to human immunodeficiency virus status among women with cervical cancer in Abidjan, Côte d'Ivoire, 2018 to 2020

As human papillomavirus (HPV) immunisation and HPV-based cervical cancer (CC) screening programmes expand across sub-Saharan Africa, we investigated the potential impact of human immunodeficiency virus (HIV) status on high-risk (HR)-HPV distribution among women with CC in Côte d'Ivoire. From July 2018 to June 2020, paraffin-embedded CC specimens diagnosed in Abidjan, Côte d'Ivoire were systematically collected and tested for HR-HPV DNA. Type-specific HR-HPV prevalence was compared according to HIV status. Of the 170 CC specimens analysed (median age 52 years, interquartile range: [43.0-60.0]), 43 (25.3%) were from women living with HIV (WLHIV) with a median CD4 count of 526 [373-833] cells/mm3 and 86% were on antiretroviral therapy (ART). The overall HR-HPV prevalence was 89.4% [95% CI: 84.7-94.1]. All were single HR-HPV infections with no differences according to HIV status (P = .8). Among HR-HPV-positive CC specimens, the most prevalent HR-HPV types were HPV16 (57.2%), HPV18 (19.7%), HPV45 (8.6%) and HPV35 (4.6%), with no significant differences according to HIV status. Altogether, infection with HPV16/18 accounted for 71.1% [95% CI: 55.9-86.2] of CC cases in WLHIV vs 78.9% [95% CI: 71.3-86.5] in women without HIV (P = .3). The study confirms the major role of HPV16/18 in CC in Côte d'Ivoire and should support a regional scale-up of HPV16/18 vaccination programmes regardless of HIV status. However, vaccines targeting additional HR-HPV types, including HPV45 and HPV35, could further decrease future CC incidence in Côte d'Ivoire, both for WLHIV and women without HIV.

[Leprosy epidemiology in Daoukro health district (Côte d'Ivoire) from 1999 to 2017]

Introduction

Leprosy is a real problem in the Daoukro health district despite the actions of the National programme for elimination.

Objective

To describe the epidemiological and clinical profile of new leprosy cases in the Daoukro health district from 1999 to 2017.

Method

Descriptive survey including leprosy patients admitted to the dermato-leprology department from 1999 to 2017.

Results

From 1999 to 2017, the incidence of leprosy fluctuated from 4.4 to 0 per 100,000 with a peak of 14.2 in 2003. In 2016 and 2017 no cases of leprosy were reported. The mean age was 36.8 years (SD=20). A majority of cases were uneducated and living in rural areas. Females and children under 15 years of age accounted for 53% and 16% of cases respectively. Clinically, cutaneous signs were predominant in the patients. The multibacillary form accounted for 82%. Nearly 1 out of 4 patients had a grade 2 disability (24%). All patients received treatment (multidrug therapy). Among them, 83.8% were cured, while 0.5% were not cured. In addition, regarding 29 patients (15.7%) details of how their disease progressed were not available. Among the patients declared cured, 26% had sequels.

Conclusion

Leprosy control activities must be strengthened in order to maintain the achievements in this non-endemic district.

Impact of HIV infection on access to cancer care and survival among women with invasive cervical cancer in Côte d'Ivoire: A prospective cohort study

OBJECTIVE

To assess the impact of HIV on access to invasive cervical cancer (ICC) care and overall survival (OS) in a time of universal access to antiretroviral therapy (ART).

METHODS

A cohort of women prospectively diagnosed with ICC was consecutively recruited from 2018 to 2020 in public/private cancer centers in Côte d'Ivoire. Follow-up data were collected through facility- and phone-based approaches. Logistic and Cox regression models allowed analysis of factors associated with access to cancer care and OS, respectively.

RESULTS

Overall, 294 women with ICC aged 50 years (interquartile range [IQR] 43-60) were enrolled, including 21.4% of women living with HIV (WLHIV), 87% being on ART. An advanced ICC clinical stage (III-IV) was less frequent in WLHIV (63.5% vs. 77.1% in HIV-uninfected women; P = 0.029). Cancer care was initiated in 124 (42.2%) women (54.0% in WLHIV; 39.0% in HIV-uninfected; P = 0.030). Factors independently associated with access to cancer care were International Federation of Gynecology and Obstetrics (FIGO) stage I-II (adjusted odds ratio [aOR] 3.58, 95% CI 2.01-6.38) and no treatment by traditional healers prior to ICC diagnosis (aOR 3.69, 95% CI 1.96-6.96). The 2-year OS was 37.9% (95% CI 30.0-47.9). HIV status was not predictive of mortality (adjusted hazard ratio [aHR] 0.98, 95% CI 0.60-1.69). An advanced clinical stage was the only measured predictor of death (aHR 1.59, 95% CI 1.02-2.47).

CONCLUSION

In a time of universal access to ART, HIV infection was not associated with OS among women with ICC in Côte d'Ivoire. Higher access to cancer care in WLHIV might be mediated by enhanced access to ICC screening services, supporting the need to expand these services to other types of healthcare facilities.

Accelerating the healing of hard-to-heal wounds with food supplements: nutritional analysis in the Côte d'Ivoire

OBJECTIVE

Hard-to-heal wounds are an important, yet often neglected, public health issue in low- and middle-income countries (LMICs). Malnutrition has been identified as a risk factor for prolonged healing times. However, nutritional supplements are not routinely provided for patients with hard-to-heal wounds, and so this study aimed to investigate their benefits.

METHOD

This 9-month study was conducted in the Taabo Health and Demographic Surveillance System in the south-central part of Côte d'Ivoire. Patients with wounds (≥30mm2) were recruited. Treatment was standardised for inpatients (72%) and outpatients (28%). There were three intervention groups: supplemented with soy; orange flesh sweet potato (OFSP); or both. Another group was included without supplement, serving as control. General linear models were employed to assess the effects of log initial wound size, type of wound, food treatment group, haemoglobin, sex, age, place of treatment and body mass index on the rate of wound closure.

RESULTS

The cohort consisted of 56 patients, 41 of whom were placed in intervention groups, and the remainder as controls. Within the cohort, 37 (66%) patients suffered from Buruli ulcer, 15 (27%) from traumatic wounds and four (7%) from erysipelas. We found a significant effect (p=0.004) of diet supplemented with OFSP on the wound healing rate.

CONCLUSION

OFSP is a nutritional rehabilitation supplement, characterised by a high content of beta-carotene and carbohydrates. It is associated with shortened wound healing times, reduced discomfort and reduced cost of wound care. Further research should investigate the effect of a diet rich in beta-carotene, in combination with standard medical care, on hard-to-heal wound healing in LMICs.

Sociodemographic predictors of depression and anxiety symptomatology among parents in rural Côte d'Ivoire

BACKGROUND

In Côte d'Ivoire, cocoa farming is a widespread practice in rural households, an occupation with increased risks of depression and anxiety exacerbated by economic instability. We used the Goldberg-18 Depression and Anxiety diagnostic tool to identify predictors of depressive and anxiety symptomatology among a sample of parents in rural cocoa farming communities.

METHODS

In a cross-sectional survey, the Goldberg-18 was administered to Ivorian parents (N = 2471). Confirmatory factor analysis (CFA) was conducted to confirm the factor structure of the assessment tool, and Ordinary Least Squares (OLS) regression with clustered standard errors was used to identify sociodemographic predictors of symptomatology.

RESULTS

CFA showed adequate fit statistics for a two-factor model measuring depressive and anxiety symptoms. Among respondents, 87 % screened positive for requiring further referral for clinical diagnosis. Sociodemographic predictors of depressive and anxiety symptoms were similar for males and females. For the total sample, higher monthly income, more years of education, and belonging to the Mandinka ethnic group predicted fewer depressive and anxiety symptoms. In contrast, higher depressive and anxiety symptomatology were associated with age. Single marital status predicted increased anxiety but not depressive symptoms for the full sample model and the female only sample, but not the male sample.

LIMITATIONS

This is a cross-sectional study.

CONCLUSIONS

The Goldberg-18 measures distinct domains of depressive and anxiety symptoms in a rural Ivorian sample. Age and single marital status are predictors of increased symptoms. Higher monthly income, higher education, and certain ethnic affiliations are protective factors.

Dermatophytosis and the associated risk factors among primary school children in southern and central Côte d'Ivoire

BACKGROUND

Dermatophytosis, particularly the subtype tinea capitis, is common among African children; however, the risk factors associated with this condition are poorly understood.

OBJECTIVES

This study aimed to determine the factors associated with tinea capitis and the prevalence rate of other dermatophytoses among primary school students in the rural and urban areas of the southern and central Côte d'Ivoire.

PATIENTS AND METHODS

The study was carried out in seven towns of Côte d'Ivoire from October 2008 to July 2009, among 17,745 children aged 4-17 years and attending urban and rural primary schools; a complete physical examination of the skin and appendages, including nails and hair, was performed by the physicians. Direct microscopic examination using 30% potassium hydroxide solution and culture on Sabouraud's dextrose agar supplemented with 0.5 g/L chloramphenicol and 0.4 g/L actidione was performed during sampling.

RESULTS

For the 17,745 children clinically examined, 2645 exhibited symptoms suggestive of tinea capitis. Positive cultures for dermatophytes were found in 2635 patients, and the overall prevalence rate of tinea capitis was 14.8%. The following factors, age, sex, pets at home, number of bathing daily, sharing of sponges, combs and towels and hair length, were statistically associated with tinea capitis (p < .001). In addition to tinea capitis, other superficial fungal infections were identified among these children. These included tinea corporis (0.9%), tinea unguium (0.6%) and pityriasis versicolor (0.4%).

CONCLUSION

Tinea capitis is common among pupils in rural southern and central Côte d'Ivoire, especially in young boys.

Statistical learning and children's emergent literacy in rural Côte d'Ivoire

Studies of non-linguistic statistical learning (SL) have often linked performance in SL tasks with differences in language outcomes. Most of these studies have focused on Western and high-income educational contexts, but children worldwide learn in radically different educational systems and communities, and often in a second language. In the west African nation of Côte d'Ivoire, children enter fifth grade (CM-1) with widely varying ages and literacy skills. Across three iteratively-developed experiments, 157 children, age 8-15 years, in rural communities in the greater-Adzópe region of Côte d'Ivoire watched sequences of cartoon images with embedded triplet patterns on touchscreen tablets, while performing a target-detection task. We assessed these tablet-based adaptations of non-linguistic visual SL and asked whether the children's individual differences in performance on the SL tasks were related to their first and second language and literacy skills. We found group-level evidence that children used the statistical regularities in the image sequence to gradually decrease their response times, but their responses on post-test discrimination did not reflect this learning. When evaluating the correlation between SL and language skills, individual differences related to other task demands predicted oral language skills shared by first and second languages, while SL better predicted second language print skills. These findings suggest that non-linguistic SL paradigms can measure similar skills in Ivorian children as previous samples, but they also echo recent calls for further cross-cultural validation, greater internal reliability, and tests for confounding variables (such as processing speed) in studies of individual differences in statistical learning. RESEARCH HIGHLIGHTS: We iteratively adapted three visual statistical learning studies for children in rural Côte d'Ivoire. Group-level analyses indicates that the children learn the underlying statistical regularities. Individual-differences analyses reveal some evidence that the statistical learning measure is also correlated with task demands that may be driven by cross-cultural differences. Like previous research, statistical learning is correlated with second language literacy, but we did not find a relationship between SL and oral language skills in first and second languages.

Insecticide Resistance and Metabolic Mechanisms in Aedes aegypti from Two Agrosystems (Vegetable and Cotton Crops) in Côte d'Ivoire

Background: The emergence of insecticide resistance in Aedes vectors mosquitoes poses a real challenge for arboviral-borne disease control. In Côte d'Ivoire, data are available on phenotypic resistance and the presence of kdr mutations in Aedes aegypti. Therefore, information on metabolic resistance in Aedes populations is very scarce. Here, we assessed the insecticide resistance status of Ae. aegypti in periurban and rural areas of Côte d'Ivoire, and we investigated the role of detoxification enzymes as possible resistance mechanisms. Materials and Methods: Aedes mosquito eggs were collected between June 2019 to April 2021 in two agricultural sites. Adults of Ae. aegypti were tested using World Health Organization tube assays, with seven insecticides belonging to pyrethroids, organochlorines, carbamates, and organophosphates classes. We determined the knockdown times (KdT50, KdT95) and resistance ratios of pyrethroids in natural populations. The synergist piperonyl butoxide (PBO) was used to investigate the role of enzymes in resistance. Biochemical assays were performed to detect potential increased activities in mixed-function oxidase levels, nonspecific esterases (NSEs), and glutathione S-transferases. Results: The results showed that Ae. aegypti populations were resistant to five insecticides with mortality of 46% and 89% for 0.75% permethrin, 68% and 92% for 0.05% deltamethrin, 57% and 89% for lambda-cyhalothrin, 41% and 47% for dichlorodiphenyltrichloroethane (DDT), 82% and 91% for chlorpyrifos-methyl in Songon-Agban and Kaforo, respectively. Susceptibility to carbamates was observed in our study sites. After exposure to PBO, the susceptibility of Ae. aegypti to pyrethroids and DDT was partially restored in Songon-Agban. Whereas in Kaforo, none increase of the mortality rates of Ae. aegypti for these four insecticides was observed after exposure to PBO. Increased activity of NSE (α-esterases) was found in Songon-Agban compared with the reference susceptible strain. Conclusion: These findings provide valuable information to support decisions for vector control strategies in Cote d'Ivoire. Also, we highlight the need for the monitoring of insecticide resistance management in Aedes vectors.

Seroprevalence of porcine cysticercosis in traditional farms in South-Eastern Côte d'Ivoire

Background

Porcine cysticercosis is an endemic parasitic zoonosis in many developing countries. The objective of this study was to estimate the seroprevalence of porcine cysticercosis in traditional pig farms in the departments of Dabou, Aboisso and Agboville.

Methods

Blood samples were taken from pigs and analyzed by ELISA (IgG) and western blot. Data on farming practices and pig characteristics were collected. Multivariate logistic regression models were constructed to identify risk factors.

Results

A total of 668 pigs were sampled from 116 farms and 639 samples were analyzed. The seroprevalence of cysticercosis was estimated at 13.2%. Overweight [OR = 2.6; 95%CI (1.3-4.9)] and fat pigs [OR = 2.3; 95%CI (1.0-4.8)] were twice as likely to be seropositive for cysticercosis. This risk was increased in farms using well water for drinking [OR = 2.5; 95%CI (1.0-6.3)] as well as those reporting veterinary care of the animals (OR = 2.9; 95%CI (1.2-7.3)).

Conclusions

This study demonstrated the circulation of Taenia solium in pig farms in southern Côte d'Ivoire.

[Heart rate recovery and presence of coronary lesions in case of ischemic heart disease at the Abidjan Cardiology Institute in Côte d'Ivoire]

Introduction

Heart rate recovery (HRR) measured during stress tests, assesses the vago-sympathetic balance. It is a known prognostic and predictive parameter of cardiovascular mortality that is believed to be correlated with the presence and severity of coronary artery disease. The aim of this work was to assess the predictive value of heart rate recovery in the diagnostic and severity of coronary lesions in a major metropolis of sub-Saharan Africa where access to specialist care is unevenly distributed.

Patients and method

We conducted a retrospective observational study from January 2010 to February 2020 at the Abidjan Cardiology Institute, including patients who performed a diagnostic coronary angiography after a positive exercise test. Clinical, angiographic and exercise parameters were analyzed and compared in patients with abnormal heart rate recovery (HRR) and those with normal one.

Results

The main study limitation is small sampling due to the cost of the angiographic procedure which limits its realization. We recorded 41 subjects whose mean age was 53.4 ± 9.6 years with a male predominance (sex ratio of 3.6). The predominant age group was between 50 and 60 years. Males were older than females with no significant difference. The predominant cardiovascular risk factors were overweight/obesity (68.29%) and hypertension (61%). Eight patients (19.5%) presenting an abnormal HRR (≤12 bpm) had more significant coronary disease (p=0.02) and more severe ones (p=0.003). Patients with abnormal HRR tended to be older without statistical significance (p=0.081), and had lower chronotropic reserve and maximum heart rate (p=0.008 and p=0.042, respectively). The positive predictive value of HHR was 87.5% and its negative predictive value was 60.6%.

Conclusion

Abnormal HRR can predict the presence of coronary artery disease and its severity. Evaluating HRR during stress tests could help in the detection, evaluation, and monitoring of ischemic heart disease in our resource-limited countries.

Human interactions with bats and bat coronaviruses in rural Côte d'Ivoire

Bats are presumed reservoirs of diverse α- and β- coronaviruses (CoVs) and understanding the diversity of bat-CoVs and the role bats play in CoV transmission is highly relevant in the context of the current COVID pandemic. We sampled bats in Côte d'Ivoire (2016-2018) living at ecotones between anthropogenic and wild habitats in the Marahoué National Park, a recently encroached protected area, to detect and characterize the CoVs circulating in bats and humans. A total of 314 bats were captured, mostly during the rainy season (78%), and CoV RNA was detected in three of the bats (0.96%). A CoV RNA sequence similar to Chaerephon bat coronavirus/Kenya/KY22/2006 (BtKY22) was found in a Chaerephon cf. pumilus and a Mops sp. fecal swab, while a CoV RNA sequence similar to the two almost identical Kenya bat coronaviruses BtKY55 and BtKY56 (BtKY55/56) was detected in an Epomops buettikoferi oral swab. Phylogenetic analyses indicated differences in the degree of evolutionary host-virus co-speciation for BtKY22 and BtKY55/56. To assess potential for human exposure to these viruses, we conducted human syndromic and community-based surveillance in clinics and high-risk communities. We collected data on participant characteristics, livelihoods, animal contact, and high-risk behaviors that may be associated with exposure to zoonotic diseases. We then collected biological samples for viral testing from 401 people. PCR testing of these biological samples revealed no evidence of CoV infection among the enrolled individuals. We identified higher levels of exposure to bats in people working in crop production and in hunting, trapping and fishing. Finally, we used the 'Spillover' risk-ranking tool to assess the potential for viral spillover and concluded that, while there is no evidence to suggest imminent risk of spillover for these CoVs, their host range and other traits suggest caution and vigilance are warranted in people with high exposure risk.

Molecular epidemiological survey of pathogenic trypanosomes in naturally infected cattle in northern Côte d'ivoire

Bovine trypanosomiasis is a significant health concern for livestock intensification in Côte d'Ivoire. This study aimed to determine the prevalence and distribution of pathogenic trypanosomes and identify the most infected cattle breed in northern Côte d&apos;Ivoire. We examined 700 cattle and found that polymerase chain reaction (PCR) was more sensitive (12.3%) than microscopic observation (5.6%). Among the trypanosome species detected in naturally infected cattle, Trypanosoma vivax was 7.3%, Trypanosoma simiae tsavo was 6.7%, and Trypanosoma congolense was 0.4%. The overall prevalence of trypanosome infection in all cattle breeds was 12.3%, while the prevalence in individual breeds was 14.8%, 7.3%, 10.6%, and 12.3% for N'Dama, Baoule, Zebu, and Mere breed, respectively. The infected animals had low packed cell volume, influencing the prevalence. Our findings indicate that bovine trypanosomes are prevalent in Côte d'Ivoire, and their prevalence varies by region and breed. These pathogens include T. vivax, T. simiae tsavo, and T. congolense.

[Characteristics and predictive factors of death in acute coronary syndromes among the elderly: data from the Acute coronary syndrome registry at the Abidjan Heart Institute]

Introduction-Objective

Acute coronary syndromes (ACS) are the leading cause of death among the elderly in sub-Saharan Africa. The aim of this study was to analyze the characteristics of ACS among the elderly at the Abidjan Heart Institute.

Materials and methods

Cross-sectional study from January 1, 2015, to December 31, 2019. All patients aged 18 or more admitted to the Abidjan Heart Institute for ACS were included. These patients were divided into two groups: elderly (≥ 65 years old) and non-elderly (< 65 years old). Clinical data, management and outcomes were compared and analyzed in both groups.

Results

A total of 570 patients were included, of which 137 (24%) were elderly. Sixty percent (60%) of elderly patients presented with ST Segment Elevation Myocardial Infarction (STEMI). Percutaneous coronary intervention (PCI) was less performed among elderly patients (21.1% vs 30.2%, p = 0.039). Heart failure was the most important complication among the elderly group (56.9% vs 44.6%, p = 0.012). In-hospital mortality was 8% among the elderly. Predictive factors for in-hospital mortality were history of hypertension (HR 2.58; CI95% 1.10-6.08) and STEMI presentation (OR 11.60; CI95% 2.70-49.76). PCI was a protective factor for in-hospital mortality (OR 0.14; IC95% 0.03-0.62).

Conclusion

ACS occur with increasing frequency with age. Poor outcomes among the elderly are determined by the clinical presentation and comorbidities. PCI appears to significantly reduce in-hospital mortality.

Plants used in Côte d'Ivoire (West Africa) against ticks: Evaluation for acaricidal activity against Rhipicephalus (Boophilus) microplus

Rhipicephalus (Boophilus) microplus is a tick that is now a real constraint to cattle breeding in many West African countries such as Côte d'Ivoire. Antitick control is difficult because of the cost, ecotoxicity and resistance. The main objective of this study was to evaluate the acaricidal activity of plants used in Côte d'Ivoire for tick infestation control in cattle. Ethanol extracts from 17 plants were tested in vitro on eggs, larvae and adults of two amitraz resistant strains of R. (B.) microplus, using respectively LTT (Larval Tarsal Test), LPT (Larval Packet Test) and AIT (Adult Immersion Test) methods, at concentrations of 5 mg/mL -1 mg/mL. Out of the 22 extracts tested, four showed acaricidal activity against eggs (4 mg/mL) and three against larvae at 5 mg/mL. These extracts inhibited fertility and resulted in adult females mortality. These results give credence to the traditional use of active plants that may be used for plant-based bioacaricide development and R. (B.) microplus control in cattle as well.

Using and improving the PHISICC paper-based tools in the health facility laboratories: Examples of Human Centered Design taking systems thinking into practice, in Côte d'Ivoire and Nigeria

Background

Health workers in low- and middle-income countries are increasingly demanded to collect more and more data to report them to higher levels of the health information system (HIS), in detriment of useful data for clinical and public health decision-making, potentially compromising the quality of their health care provison. In order to support health workers' decision-making, we engaged with partners in Côte d'Ivoire, Mozambique and Nigeria in a research project to conceive, design, produce, implement and test paper-based health information tools: the PHISICC tools. Our aim was to understand the use of PHISICC tools by health workers and to improve them based on their feedback.

Methods

The design Health Facility Laboratories (HF Labs) in Côte d'Ivoire and in Nigeria were set up after months of use of PHISICC tools. Activities were structured in three phases or 'sprints' of co-creative research. We used a transdisciplinary approach, including anthropology and Human Centered Design (HCD), observations, shadowing, structured interviews and co-creation.

Results

Health workers appreciated the standardization of the tools across different health care areas, with a common visual language that optimized use. Several design issues were raised, in terms of formats and contents. They strongly appreciated how the PHISICC registers guided their clinical decision-making and how it facilitated tallying and counting for monthly reporting. However, adherence to new procedures was not universal. The co-creation sessions resulted in modifications to the PHISICC tools of out-patient care and postnatal care.

Discussion

Although health systems and systemic thinking allowed the teams to embrace complexity, it was the HCD approach that actually produced a shift in researchers' mind-set: from HIS as data management tools to HIS as quality of care instruments. HCD allowed navigating the complexity of health systems interventions due to its capacity to operate change: it not only allowed us to understand how the PHISICC tools were used but also how to further improve them. In the absence of (or even with) an analytical health systems framework, HCD approaches can work in real-life situations for the ideation, testing and implementation of interventions to improve health systems and health status outcomes.

Promising trends and influencing factors of complementary feeding practices in Côte d'Ivoire: An analysis of nationally representative survey data between 1994 and 2016

Poor complementary feeding (CF) challenges early childhood growth. We examined the trends and influencing factors of CF practices among children aged 6-23 months in Côte d'Ivoire. Using data from Demographic and Health Surveys (DHS, 1994-2011) and Multiple Indicator Cluster Surveys (MICS, 2000-2016), the trends and predictors of World Health Organization-United Nations International Children's Emergency Fund CF indicators including the timely introduction of complementary foods (INTRO), minimum meal frequency (MMF), minimum dietary diversity (MDD) and minimum acceptable diet (MAD) were determined. Using 2016 MICS data, we applied multivariate logistic regression models to identify factors associated with CF indicators. Between 1994 and 2016, the mean proportion of children aged 6-8 months achieving INTRO was 56.9% and increased by about 25% points since 2006. Over 2011-2016, the proportion of children aged 6-23 months meeting MMF, MDD and MAD increased from 40.2% to 47.7%, 11.3% to 26.0% and 4.6% to 12.5%, respectively. Older children and those from urban households had higher odds of meeting MDD and MAD. Maternal TV watching was associated with higher odds of meeting MDD. The secondary or higher education levels of mothers significantly predicted higher odds of meeting INTRO and MDD. Currently, breastfeeding was also positively associated with odds of meeting MMF and MAD. Children from poorer households had lower odds of meeting MMF, MDD and MAD. Despite the improvements, CF practices remain suboptimal in Côte d'Ivoire. Influencing factors associated with CF were distributed across individual, household and community levels, calling for future programmes and policies to implement multi-level strategies to improve young children's diet in Côte d'Ivoire.

Evaluation of antibody responses to tsetse fly saliva in domestic animals in the sleeping sickness endemic foci of Bonon and Sinfra, Côte d'Ivoire

After intensive control efforts, human African trypanosomiasis (HAT) was declared eliminated in Côte d'Ivoire as a public health problem in December 2020 and the current objective is to achieve the interruption of the transmission (zero cases). Reaching this objective could be hindered by the existence of an animal reservoir of Trypanosoma (T.) brucei (b.) gambiense. In the framework of a study led in 2013 to assess the role of domestic animals in the epidemiology of HAT in the two last active foci from Côte d'Ivoire (Bonon and Sinfra), plasmas were sampled from four species of domestic animals for parasitological (microscopic examination by the buffy coat technique (BCT)), serological (immune trypanolysis (TL)) and molecular (specific PCR: TBR for T. brucei s.l., TCF for T. congolense forest type, TVW for T. vivax and PCR for T. b. gambiense) testing. In order to improve the understanding of the involvement/role of these animals in the transmission of T. b. gambiense, we have quantified in this study the IgG response to whole saliva extracts of Glossina palpalis gambiensis in order to perform an association analysis between anti-saliva responses and the positivity of diagnostic tests. Cattle and pigs had significantly higher rates of anti-tsetse saliva responses compared to goats and sheep (p < 0.01). In addition, the anti-tsetse saliva responses were strongly associated with the parasitology (BCT+), serology (TL+) and PCR (TBR+ and TCF+) results (p < 0.001). These associations indicate a high level of contacts between the positive/infected animals and tsetse flies. Our findings suggest that protecting cattle and pigs against tsetse bites could have a significant impact in reducing transmission of both animal and human trypanosome species, and advocates for a "One health" approach to better control African trypanosomosis in Côte d'Ivoire.

[Evolution of epidemiology and management of acute coronary syndromes in Abidjan : A cross-sectional study of 1011 patients.]

BACKGROUND

To assess the evolution of the epidemiology and management of patients hospitalized to Abidjan Heart Institute for acute coronary syndrome (ACS).

METHODS

Cross-sectional study comparing two periods: from January 2002 to December 2009 (period 1) and from January 2010 to December 2016 (period 2), including all patients aged 18 years old, admitted to Intensive Care Unit of Abidjan Heart Institute for ACS.

RESULTS

One thousand eleven (1011) patients were included among the 6784 patients admitted to Intensive Care Unit of Abidjan Heart Institute for a cardiovascular disease. The overall prevalence of ACS was 14.9%. The prevalence in period 2 was significantly higher than in period 1 (22.6% and 7.3% respectively, p < 0.001). Diabetes (33.5%, p < 0.001) significantly, and smoking (30.7%, p = 0.30) had the largest rises from period 1 to period 2. ST-segment Elevation Myocardial Infarction was the main clinical presentation during both periods. The median time to treatment (p = 0.46) and length of hospital stay (p <0.001) decreased during period 2. Percutaneous coronary intervention (PCI) was performed in 173 patients (22.6%) during the period 2 and 42 patients (5.5%) underwent primary PCI. The rate of fibrinolysis increased significantly between the two periods (9.5%, p <0.001). In-hospital death increased during period 2 (10.4%, p = 0.07).

CONCLUSION

The burden of ACS and its related mortality have risen alarmingly past years in Côte d'Ivoire. Healthcare policies should help improve the management and outcomes of patients.

Assessing public debt sustainability under COVID-19 uncertainty: Evidence from Côte d'Ivoire

This article investigates public debt sustainability, in the context of a novel exogenous shock, by proposing a realistic forecasting procedure. The procedure implies the combination of a Bayesian VAR model and a nonlinear fiscal reaction model to derive a large number of simulated public debt paths and construct a probabilistic debt sustainability indicator. Annual data covering the period from 1970 to 2019 are used in the African context, with Côte d'Ivoire as a case study. Forecasts suggest low probabilities of non-increasing trend and well-contained upside risks (16%-27%) in Côte d'Ivoire for the forecasting period 2021-2024, regardless of the scenario underlying the evolution of COVID-19 and suggesting that the country remains vulnerable to debt distress risks. Government should promote a sound and reliable debt management system to mitigate such risks. Results also highlight the importance of domestic resources mobilization in reducing the country's fiscal vulnerability and building a sustainable post-COVID recovery.

[Study Of Musculoskeletal Disorders Among The Secretaries Of The Yopougon University Hospital Center - Ivory Coast]

INTRODUCTION

Musculoskeletal disorders are the most common occupational disease in the world. They constitute a major health problem.

METHODS

A cross-sectional study was carried out over a period of three months involving the secretaries of the Yopougon University Hospital. The data were collected using a questionnaire inspired by the National Research and Security Institute (INRS) questionnaire.

RESULTS

The study found an exclusively female population with an average age of 40.6 years ± 8.6, mostly overweight or obese (71%). Almost half of the secretaries had more than ten years of seniority in the post (44.7%) and the absence of an ergonomic chair was noted in 84% of cases. In this population of 38 secretaries, the prevalence of MSDs was 89.5% with pain as the main symptom (89.5%). The preferred locations for MSDs were the dorsolumbar spine (78.9%) and the cervical spine (57.9%). The study showed a predominance of MSDs in the following populations: overweight secretaries (63.1%); more than ten years in the post (39.6%); poor working posture (68.4%); the use of a non-ergonomic seat (81.6%).

CONCLUSION

Musculoskeletal disorders are common among secretaries. They are associated with many factors. It is imperative to implement preventive measures to reduce their risk of occurrence.

Economic Analysis of Low Volume Interventions Using Real-World Data: Costs of HIV Self-Testing Distribution and HIV Testing Services in West Africa From the ATLAS Project

Achieving the first 95 of the UNAIDS targets requires the implementation of innovative approaches to knowing one's HIV status. Among these innovations is the provision of HIV self-testing (HIVST) kits in west Africa by the international partner organization Solthis (IPO). In order to provide guidance for the optimal use of financial resources, this study aims to estimate the program and site level costs of dispensing HIVST as well as HIV testing services (HTS)-excluding HIVST-in health facilities in Côte d'Ivoire, Mali and Senegal as part of the ATLAS project. We estimated from the provider's perspective, HIVST and HTS incremental costs using top-down and bottom-up costing approaches and conducted a time and motion study. We identified costs at the program level for HIVST (including IPO central costs) and at the site level for HIVST and HTS. The economic costs of distributing HIVST kits were assessed in 37 health facilities between July 2019 and March 2021 (21 months). Sensitivity analyses were also performed on unit costs to examine the robustness of our estimates related to key assumptions. In total, 16,001 HIVST kits were dispensed for 32,194 HTS sessions carried out. Program level HIVST average costs ranged $12-286, whereas site level costs ranged $4-26 across distribution channels and countries. Site level HTS costs ranged $7-8 per testing session, and ranged $72-705 per HIV diagnosis. Across countries and channels, HIVST costs were driven by personnel (27-68%) and HIVST kits (32-73%) costs. The drivers of HTS costs were personnel costs ranging between 65 and 71% of total costs across distribution channels and countries, followed by supplies costs between 21 and 30%. While program level HIVST average costs were high, site level HIVST average costs remained comparable to HTS costs in all countries. Health facility-based distribution channels operating at low volume exhibit high proportion of central costs which should be considered carefully for financial planning when run alongside high volumes mobile outreach distribution channels. HIVST can diversify the HIV testing offer at health facilities, thus improving access to screening for target populations not reached by HTS services.

infection in cattle in Côte d'Ivoire: a randomised blinded trial

Triclabendazole is the anthelminthic of choice for the treatment of fascioliasis, however, it is only registered in a few countries. We investigated the efficacy of a single-dose of triclabendazole (12 mg/kg) or albendazole (15 mg/kg) against Fasciola spp. infection in cattle on farms in the northern part of Côte d'Ivoire in a randomized clinical trial. Faecal samples were obtained from 196 cattle, of which 155 (79.1%) were found positive for Fasciola spp. by the sedimentation technique. Cattle infected with Fasciola spp. were randomly allocated (3:3:1) to receive triclabendazole (n = 66), albendazole (n = 67) or left untreated to serve as control (n = 22). Follow-up faecal samples were collected on days 21, 28, 90 and 188 post-treatment. No adverse events were observed as reported by farmers in any of the treatment groups. The proportion of non-egg shedding cattle, assessed at day 21 (primary outcome), was significantly higher in cattle treated with triclabendazole (95.4%) compared to those receiving albendazole (70.3%; odds ratio [OR] 8.73, 95% confidence interval [CI] 2.43-31.28, p <0.001). The egg reduction rate (ERR) expressed as number of eggs per gram of faeces, a secondary endpoint assessed at day 21 post-treatment, was significantly higher in the triclabendazole arm (arithmetic mean (AM) ERR = 99.8%) than in the albendazole arm (AM ERR = 92.2%), with a difference of 7.6%-points (95% CI: 0.9-14.5%-points, p=0.026). This is the first report of efficacy of triclabendazole against Fasciola spp. in naturally infected cattle in Côte d'Ivoire. Our results confirm that triclabendazole is the most effective treatment of fascioliasis and therefore, should be considered for the control of livestock fascioliasis; if resources allow in combination with intermediate host snail control and raising farmers awareness of pasture and livestock management to avoid reinfection.

Barriers and facilitators in cervical cancer screening uptake in Abidjan, Côte d'Ivoire in 2018: a cross-sectional study

Backgrounds

Cervical cancer (CC) incidence remains unacceptably high in Côte d’Ivoire. In an effort to prevent this malignant condition, a national CC screening program has been scaled up in the country. This study aimed at assessing CC screening uptake and its associated factors in Abidjan in 2018.

Methods

A cross-sectional survey was conducted from July to September 2018 in the main healthcare facilities of three randomly selected out of the eight health districts of Abidjan. During the study period, a standardized questionnaire was administrated by research assistants to all women aged 25 to 55 years old, attending the three participating facilities. Demographics, knowledge on CC, personal history of CC screening and reasons for not attending CC screening were collected. A logistic regression model was computed to document factors associated with reported CC screening uptake.

Results

A total of 1158 women with a median age of 32 years (IQR [27–36]), including 364 (31.4%) with no formal education were included. Of those participants, 786 (67.9%) had ever heard about CC. CC screening uptake at least once was reported by 7.5% [95% CI: 6.0–9.0] participants. In multivariable analysis, being ≥45 years (aOR: 6.2 [2.3–17.2]), having a university level (aOR: 2.8 [1.2–6.6]) (versus non formal education) and access to mass campaign information (aOR: 18.2 [8.5–39.1]) were associated with a reported CC screening uptake. The main reported barriers to CC screening were unawareness towards CC screening (75.5%), negligence (20.5%), fear of CC detection (3.9%) and fear of additional costs (3.3%).

Conclusion

CC screening uptake remains low despite current initiatives to support awareness and prevention in Abidjan. Awareness campaigns need to be massively increased with the adjunction of tailored messages based on the level of women’s education to enhance the CC screening coverage and reach the WHO goal of CC elimination by 2030.

[Couple life and management of HIV infection in the pneumology department of the Teaching hospital center of Cocody, Abidjan, Côte d'Ivoire]

Introduction

The life of a couple is a place of emotional support. It can allow the management of patients infected with HIV on antiretroviral therapy to be optimized.The objective of our study was to analyze the impact of married life on the therapeutic follow-up of patients living with HIV.

Methodology

We carried out a mono-centric, prospective, descriptive and analytical study in the care unit of patients living with HIV of the pneumology service of the Cocody Teaching Hospital in Abidjan. The investigation took place from September 1, 2015 to March 31, 2016.

Results

We included 411 patients. The sex ratio was 0.51. The average age was 43.2 years with extremes of 19 and 69 years. The patients lived as a couple in 59.1% of cases. Couple life was associated with severe immunosuppression at 12 months in 23.3% (42/180) of cases [p = 0.043 OR = 1.735 (0.964 - 3.121)], the appearance of new opportunistic conditions between the 6th and the 12th month of treatment in 5.6% (13/232) of cases [p = 0.006; OR = 9.438 (1.222 - 72.890)], information sharing with the partner before the start of treatment in 92.4% (208/225) of cases [p = 0.035; OR = 1.976 (1.005-3886)] and the existence of sexual intercourse since the discovery of the disease in 92.6% (225/243) of cases [p < 0.001; OR = 14.423 (8.174 - 25.448)]. Sexual relationships were less protected among people living in a couple 65.9% (149/226) versus 78% (64/82) among others [p = 0.027; OR = 0.544 (0.301 - 0.923)]. The loss of the sexual partner at the onset of the disease was observed regardless of marital status (p = 0.203).

Conclusion

The life of a couple negatively influences the management of HIV infection. It appears necessary to set up counseling and testing programs for couples.

Moderate-to-Vigorous Physical Activity Is Associated With Cardiorespiratory Fitness Among Primary Schoolchildren Living in Côte d'Ivoire, South Africa, and Tanzania

Background: Physical inactivity and low cardiorespiratory fitness (CRF) are independent cardiovascular risk factors among children, but have rarely been investigated concurrently in sub-Saharan Africa. The purpose of this study was to compare physical activity (PA) and CRF of primary schoolchildren living in Côte d'Ivoire (CI), South Africa (ZA), and Tanzania (TZ), to test sex- and age-related differences, and to examine whether PA and CRF are associated with each other. Methods: Baseline data from an ongoing cluster-randomized controlled trial were used, including 499 children from CI (Taabo, 49% girls, M = 8.0 ± 1.6 years), 1,074 children from ZA (Gqeberha, 49% girls, M = 8.3 ± 1.4 years), and 593 children from TZ (Ifakara, 51% girls, M = 9.4 ± 1.7 years). PA was assessed by accelerometry and CRF by a 20 m shuttle-run test. The data were analyzed using multi-/univariate analyses of variance and mixed linear models. Results: Most children met recommendations put forward by the World Health Organization for moderate-to-vigorous PA (MVPA) and achieved high CRF scores. In CI, 89.6% of the children met MVPA recommendations (boys: 91.7%, girls: 87.4%), whereas this rate was 76.9% in ZA (boys: 91.0%, girls: 62.4%), and 93.8% in TZ (boys: 95.5%, girls: 92.0%). Children from TZ had the highest CRF and MVPA levels, followed by children from CI and ZA. Boys had higher MVPA levels than girls, whereas girls engaged in more sedentary behavior. Sex differences were strongest in ZA. Sedentary behavior and MVPA were higher among older schoolchildren compared to their younger peers. Higher MVPA, but not sedentary behavior, was associated with better CRF. Conclusions: In all three settings, higher levels of MVPA were associated with higher CRF scores. Nevertheless, children living in the most urbanized setting (such as observed in ZA) were physically less active and had lower CRF than peers living in more rural areas (such as observed in CI and TZ). Particularly for girls, urbanization might increase the risk for insufficient MVPA, which may have negative effects on their CRF, thus negatively influencing health and well-being at later age.

Introducing and Implementing HIV Self-Testing in Côte d'Ivoire, Mali, and Senegal: What Can We Learn From ATLAS Project Activity Reports in the Context of the COVID-19 Crisis?

Background: The ATLAS program promotes and implements HIVST in Côte d'Ivoire, Mali, and Senegal. Priority groups include members of key populations-female sex workers (FSW), men having sex with men (MSM), and people who use drugs (PWUD)-and their partners and relatives. HIVST distribution activities, which began in mid-2019, were impacted in early 2020 by the COVID-19 pandemic. Methods: This article, focusing only on outreach activities among key populations, analyzes quantitative, and qualitative program data collected during implementation to examine temporal trends in HIVST distribution and their evolution in the context of the COVID-19 health crisis. Specifically, we investigated the impact on, the adaptation of and the disruption of field activities. Results: In all three countries, the pre-COVID-19 period was marked by a gradual increase in HIVST distribution. The period corresponding to the initial emergency response (March-May 2020) witnessed an important disruption of activities: a total suspension in Senegal, a significant decline in Côte d'Ivoire, and a less pronounced decrease in Mali. Secondary distribution was also negatively impacted. Peer educators showed resilience and adapted by relocating from public to private areas, reducing group sizes, moving night activities to the daytime, increasing the use of social networks, integrating hygiene measures, and promoting assisted HIVST as an alternative to conventional rapid testing. From June 2020 onward, with the routine management of the COVID-19 pandemic, a catch-up phenomenon was observed with the resumption of activities in Senegal, the opening of new distribution sites, a rebound in the number of distributed HIVST kits, a resurgence in larger group activities, and a rebound in the average number of distributed HIVST kits per primary contact. Conclusions: Although imperfect, the program data provide useful information to describe changes in the implementation of HIVST outreach activities over time. The impact of the COVID-19 pandemic on HIVST distribution among key populations was visible in the monthly activity reports. Focus groups and individual interviews allowed us to document the adaptations made by peer educators, with variations across countries and populations. These adaptations demonstrate the resilience and learning capacities of peer educators and key populations.

Spatial Heterogeneity and Seasonal Distribution of Aedes (Stegomyia) aegypti (L) in Abidjan, Côte d'Ivoire

Although the urban areas of Abidjan, Côte d'Ivoire have faced recurrent outbreaks of Aedes-borne arboviruses, the seasonal dynamics of local populations of the key vector Aedes aegypti remained still underexplored for an effective vector control. The current study thus assessed the seasonal dynamics and the spatial distribution of Ae. aegypti in three neighborhoods of Abidjan city. Aedes eggs were collected using ovitraps in three different neighborhoods (Anoumambo, Bromakoté, and Petit-Bassam) during the four climatic seasons of Abidjan. Aedes egg samples were immersed into distilled water, and emerged larvae were reared until the adult stage for species morphological identification. Spatial autocorrelation was measured with the Moran's Index, and areas with high egg abundance were identified. In total, 3837 eggs were collected providing 1882 adult mosquitoes in the 3 neighborhoods. All the specimens belonged to only one Aedes species, Ae. aegypti. The average of 15.89 eggs per ovitrap, 13.67 eggs per ovitrap, and 19.87 eggs per ovitrap were obtained in Anoumambo, Bromakoté, and Petit-Bassam, respectively, with no statistical difference between the three sites. A higher abundance of Ae. aegypti was observed during the long rainy season and the short dry season. The Moran analysis showed a clustered distribution of Ae. aegypti eggs during the long rainy season in the three sites and a random spatial distribution during the short dry season. Ovitraps with high number of eggs were aggregated in the peripheral part (near to the lagoon) of Anoumambo and Petit-Bassam in central Bromakoté and extending along the railway during the long rainy season. This study revealed a heterogeneous potential risk of transmission of arbovirus according to neighborhood. It provided data to better understand Ae. aegypti ecology to select appropriate periods and places for Aedes vector control actions and surveillance of arboviruses in Abidjan.

[Effects of Monitoring "Out-of-Area" Vaccinated Children on Data Quality, San Pedro Health District, Côte D'ivoire in 2019]

In order to improve the quality of vaccination data from the health centers, we carried out the follow-up of "out-of-area" children, vaccinated in the district of San Pedro. The objective of this work was to measure the effects of taking into account the "out-of-area" vaccinated children on the quality of the data and the immunization performance of the health centers. This monitoring, which was carried out between March and August 2019, consisted of four steps: the vaccination of "out-of-area" children by the health center, the monthly update in the register of the status of vaccinated "out-of-area" children, the accounting of these children, and the re-evaluation of the health center's vaccine performance. A total of 37 of the 40 district centers had 980 "out-of-area" vaccinated children, representing 5.7% of the immunization target. The quarter of these children resided outside the district. The vaccination of "out-of-area" children included all EPI vaccines, but especially BCG, DTP-HepB-Hib and Pneumococcus_13. The number of "outside the extra-district area" vaccinated children had not changed the district's immunization coverage. On the other hand, in the health centers concerned, the accuracy of the data had been improved in 65% of the centers for DTP-HepB-Hib_1, in 70% of the centers for RR and in 65% of the centers for the overall immunization dropout rate. The approach used had made it possible to improve the quality of immunization data from health centers at no additional cost.

[Regulatory environment: Example of the Agence Ivoirienne de régulation de la mutualité sociale in Côte d'Ivoire]

The Agence ivoirienne de régulation de la mutualité sociale (AIRMS) is the administrative body for social mutuality in Côte d'Ivoire. Its mission is to examine, register and monitor applications for approval of social mutual insurances and their umbrella organizations.In practice, AIRMS has positioned itself as a true partner of the Ivorian mutualist movement. Favoring an awareness-raising approach, the agency has encouraged mutual insurances to meet the standards set by the community regulation of social mutuality in the WAEMU zone to become credible players in the health financing landscape in Côte d'Ivoire. In addition, the Director General of the Agency, Ms. Koné Collette, is at the forefront of advocacy for the evolution of women's participation in the governance of mutualist structures. With the Programme d'appui aux Stratégies sociales (PASS), she is leading an ambitious program in this regard: the Réseau International des Femmes Solidaires (RIFES).

Factors Influencing the Transborder Transmission of Brucellosis in Cattle Between Côte d'Ivoire and Mali: Evidence From Literature and Current Key Stakeholders

Brucellosis is one of the main zoonoses affecting ruminants. Cattle and small ruminants are involved in transhumance and trade between Côte d'Ivoire and Mali. The endemic nature of the disease in both countries, connected through transhumance, poses unique challenges and requires more information to facilitate disease surveillance and the development of integrated control strategies. This study aimed to assess the main factors influencing the historical and current transborder transmission of brucellosis between Côte d'Ivoire and Mali. A literature review was conducted and data collection was performed through a participatory, transdisciplinary process by holding focus group discussions and interviews with key stakeholders. Cattle breeders, herdsmen, professionals of animal and human health, border control agents and experts took part. The data was analyzed to generate essential new knowledge for transborder brucellosis transmission factors and control strategies. From the literature, the seroprevalence of brucellosis in both countries varied from 11% (1987) to 20% (2013) and 15% (1972-1973) to 5% (2012-2014) in Mali and Côte d'Ivoire, respectively. The reduction of seroprevalence in Côte d'Ivoire was the result of the annual vaccination campaigns which lowered it from 28% (1978) to 14% (1984) after an increase due to livestock policy implemented in 1976. The meta-analysis and interviews jointly showed that the cross-border mobility was associated with the livestock development policy in Côte d'Ivoire as well as the ECOWAS act on the free movement of people and goods. This act supported the seasonal transhumance of livestock for access to pasture land in southern humid zones in Côte d'Ivoire. The seasonal mobility for grazing and trade was the main risk factor for the spread of brucellosis between pastoral zones of both countries. The existing legal health framework and border control mechanism do not achieve transborder surveillance to control brucellosis. Existing sanitary regulations should be adapted at regional scale to integrate a joint surveillance of high priority zoonotic diseases like brucellosis at border controls.

Upstanding Youngsters: Ivorian Scouting and the Manufacture of a Subordinate Citizenship (1937-1979)

This research focuses on Ivoirian scouting from its colonial implementation in the late 1930s up to the late 1970s, under Félix Houphouet-Boigny's regime. Using a novel perspective, it highlights the gender lines of scouting youth training in West Africa. Furthermore, this paper argues that understanding this history of Ivoirian youth through the lens of the scouting movement allows us to articulate youth governance between the colonial and postcolonial era, notably in order to understand the political and moral subordination of Ivoirian youth during the twentieth century. This research is based on archives collected in France, Côte d'Ivoire and Switzerland as well as biographical interviews conducted in 2016.

Insights gained from conducting a randomised controlled trial on Ivermectin-Albendazole against Trichuris trichiura in Côte d'Ivoire, Lao PDR and Pemba Island

There is only limited scientific literature on trial methodology, trial procedures and mitigation strategies to overcome challenges faced during clinical research taking place in resource constrained healthcare environments. Organisational, cultural, infrastructural and ethical challenges may vary between settings although conduct of clinical trials for the same disease (in our case soil-transmitted helminth (STH) infections) share similar risks for implementation. We use the example of a phase III randomised controlled trial, conducted between 2018 and 2020 in Côte d'Ivoire, Lao PDR and Pemba Island (Tanzania), to share challenges faced and mitigation strategies to guide future planning of studies in similar settings. We describe the planning, screening, enrolment and implementation phases in each of the three settings. Our findings indicate that involvement of local staff and close collaboration are essential factors for successful trial preparation and implementation. A strategic plan adapted to each setting with a distinct focus on community engagement and workforce is crucial to proceed efficiently. Mutual trust between the trial population and the trial team is of utmost importance and allows for early reaction and adaption to emerging issues.

Molecular Detection of Pathogenic Leptospira in Grasscutters (Thryonomys swinderianus) from Côte d'Ivoire

The geographical and climatic conditions, hot and humid in Côte d'Ivoire, are favorable to the prolonged survival of leptospira in the environment. In this country, cases of human leptospirosis are underestimated and the wild reservoirs unknown. In this study, 16S rDNA PCR-sequencing and variable number of tandem repeats typing investigations were performed in kidneys collected from 60 grasscutters (Thryonomys swinderianus) around the city of Yamoussoukro, including 10 bred grasscutters and 50 bush meat grasscutters. One sample was positive for Leptospira borgptersenii and another one for Leptospira interrogans; both collected from wild animals. Our study suggests that grasscutters, which are abundant wild rodents hunted and bred for culinary preparations in this region, can be healthy carriers of leptospira. Thus, hygiene measures should be taken, particularly by hunters and cooks.

Risk factors for rabies in Côte d'Ivoire

Rabies affects more than 150 countries worldwide. Côte d'Ivoire is one of the rabies-endemic countries that has recorded deaths every year since 2006. The evolution of these deaths is almost constant with an average of 18 annual deaths (annual incidence = 0.06-0.08 per 100,000). Children predominate among these victims. However, prevention measures exist in anti-rabies centers distributed throughout the country. The objective of this study was to determine the factors related to rabies risk in Côte d'Ivoire through Gavi rabies project entitled 'Impact of rabies and immunization in Central and West Africa'. The implementation was conducted from 2016 to 2018 in two departments of Côte d'Ivoire (Bouake and San Pedro). The study population was dog-bite victims vaccinated in anti-rabies centers of project sites from January to December 2016. Two non-free rabies immunization protocols are used in the country (Essen and Zagreb). Information was collected from bites victims for an adequate follow-up. It was to apprciate the risk of developing rabies through access to care, the immunization status of biting animal, the category of exposure and the result of rabies post exposure prophylaxis (compliance). Local program implementers responsible for these bite-management activities and veterinary staff had receved training and the necessary material. The public health education and information dissemination activities were carried out in support of promoting a wide spread of rabies prevention messages. Household surveys were conducted by sociology students in 4002 households each in urban and in rural areas. This activity helped to find people exposed by dogs and who did not receive any Post Exposure Prophylaxis (PEP). The study registered 1,263 bite victims in pilot anti-rabies centers in 2016, 51% of them were children. People living in urban areas were strongly represented (87%) because of anti-rabies centers proximity. Dog was the most animal associated to exposure (94%). Seventy-two percent (72%) of them had owners, but only 14% were vaccinated against rabies. More than half of dog bite victims had category III of exposure (58%). PEP compliance record was very low (37%), which means that 63% of bite victims have not completed the protocol. This study conducted in Bouaké and San Pedro showed somes factors responsible for rabies deaths evolution in Côte d'Ivoire. Main issues identified are the geographical accessibility of anti-rabies centers, frequent bites caused by unvaccinated dogs, often category III of exposure and many non-completions of rabies PEP in ignorance context. The establishment of national comprehensive and integrated rabies control program is needed in Côte d'Ivoire. It must take into account all these factors by focusing on public awareness, dog vaccination and adoption of modern intradermal vaccination regimens to better manage rabies situation in Côte d'Ivoire.

The Thai Red Cross protocol experience in Côte d'Ivoire

Rabies is a public health problem in the world especially in Côte d'Ivoire. The epidemiological surveillance of rabies revealed 10,197 exposures with 17 deaths in 2015 and 11,481 exposures with 18 deaths in 2016. The management of exposed people was based on WHO's intramuscular (IM) protocols (Essen and Zagreb). The usual results from these anti-rabies protocols showed low compliance corresponding to 45-50% exposed people who did not complete the Post Exposure Prophylaxis (PEP) schedule,mainly due to the cost of vaccines. The main objective of the project was to test the feasibility of a free rabies PEP based on the Thai Red Cross (TRC) protocol used by intradermal route. The study population was exposed people (patients) vaccinated in the anti-rabies center of Bouake and San Pédro which were two departments selected for this study. The TRC protocol was implemented in y ear 2017. Patients have been vaccinated according to IM post exposure protocols or by the TRC schedule.This new protocol was administered free of charge to exposed people with their consent. Patients who did not complete the PEP schedule were researched and interviewed for having the reasons related to this non-completion. In 2017, 1625 exposures were registered including 1121 in Bouaké and 504 in San Pedro. Overall immunization compliance was 63%. Patients who received the TRC schedule were 829 (52%)With 70% PEP compliance The PEP compliance of Zagreb protocol was 67%%and the Essen protocol recorded 38% of PEP compliance. The research of exposed people who did not complete the PEP schedule has shown that cost effectively remains the major limiting factor among exposed people vaccinated by Essen or Zagreb protocols. But negligencewas main cause for the non-completion PEP among exposed people who accepted the TRC schedule. Introduction of free rabies PEP through the TRC protocol has found the population support. This experience has been successful with a better PEP compliance, which means safe protection of people from rabies.This study has demonstrate that free rabies vaccine used by ID route is one of the best solutions to improve the PEP compliance in Côte d'Ivoire.Nevertheless, alternatives ways should be provided in order to minimize vaccine wastage rates in anti-rabies center receiving very few exposed persons.Community engagementwould be necessary for more rabies awareness raising and improving bite victim's follow-up.

Analysis of the qualitative evolution of groundwater in the Abouabou area in the Port-Bouët municipality (Abidjan, Côte d'Ivoire)

The study aimed to analyze the seasonal qualitative evolution of the Quaternary groundwater in the Abouabou area in order to see the capacity of this water to be used as a water supply by the populations. In-situ measurements (temperature, electrical conductivity, dissolved oxygen, turbidity and pH) and chemical parameter analyses (NH₄⁺, Ca²⁺, Mg²⁺, K⁺, Na⁺, NO₃^-, NO₂^-, PO₄^3-, SO₄^2-, Cl⁻ and HCO₃^-) were performed on the 24 samples collected during the four (4) seasons of the year. The use of Kruskal-Wallis and ANOVA tests has allowed the monitoring of seasonal variations in hydro-chemical parameters in well and borehole water. Also, the Piper diagram permit to identify the main hydrochemical facies according to the seasons. Finally, the Kohonen Self Organizing Maps (SOM) method was applied to physico-chemical parameters in order to highlight the spatial distribution of groundwater quality in the Abouabou area. The results show that, based on the physico-chemical parameters analysed, the groundwater is of good quality due to meeting WHO standards for drinking water consumption during all seasons of the year. Significant seasonal variations were recorded in the values of the parameters like turbidity, pH and Cl⁻ for well water and turbidity, PO₄^3-, NO₃^-, NH₄⁺, K⁺, Cl⁻ for borehole water. The hydrochemical facies shows a seasonal variation. Analysis of Abouabou's water reveals the variation of its hydrochemical facies. Thus, bicarbonate, calcium and magnesium facies during the long dry and rainy seasons move towards the chlorine, calcium and magnesium facies during the short dry and rainy seasons. Four water groups have been identified using SOM method, including heterogeneous groups composed mainly of borehole water (I and III) or of well water (II and IV). Borehole and well water acquire most of their mineralization by the infiltration of surface elements. Drinking water from boreholes is of good quality.

Community-Based Surveillance in Côte d'Ivoire

Community-based surveillance can be an important component of early warning systems. In 2016, the Côte d'Ivoire Ministry of Health launched a community-based surveillance project in 3 districts along the Guinea border. Community health workers were trained in detection and immediate reporting of diseases and events using a text-messaging platform. In December 2017, surveillance data from before and after implementation of community-based surveillance were analyzed in intervention and control districts. A total of 3,734 signals of priority diseases and 4,918 unusual health events were reported, of which 420 were investigated as suspect diseases and none were investigated as unusual health events. Of the 420 suspected cases reported, 23 (6%) were laboratory confirmed for a specific pathogen. Following implementation of community-based surveillance, 5-fold and 8-fold increases in reporting of suspected measles and yellow fever clusters, respectively, were documented. Reporting incidence rates in intervention districts for suspected measles, yellow fever, and acute flaccid paralysis were significantly higher after implementation, with a difference of 29.2, 19.0, and 2.5 cases per 100,000 person-years, respectively. All rate differences were significantly higher in intervention districts (p < 0.05); no significant increase in reporting was noted in control districts. These findings suggest that community-based surveillance strengthened detection and reporting capacity for several suspect priority diseases and events. However, the surveillance program was very sensitive, resulting in numerous false-positives. Learning from the community-based surveillance implementation experience, the ministry of health is revising signal definitions to reduce sensitivity and increase specificity, reviewing training materials, considering scaling up sustainable reporting platforms, and standardizing community health worker roles.

First report of Sugarcane Streak Mosaic Virus (SCSMV) infecting sugarcane in Côte d'Ivoire

Sugarcane streak mosaic virus (SCSMV; Poaceavirus; Potiviridae) is the causal agent of streak mosaic disease of sugarcane (Saccharum interspecific hybrids), a major industrial crop that is widely cultivated in tropical and subtropical regions for sugar and ethanol production. was first reported by Hall et al. (1998) from quarantined germplasm material exhibiting mosaic symptoms imported from Pakistan into the USA. Subsequently, the virus was also reported to occur in most of the Asian countries like Bangladesh, India, Indonesia, Iran, Sri Lanka, Thailand, Vietnam and China (Chatenet et al. 2005; Hema et al. 2008, Kasemsin et al. 2016, Putra et al. 2014, Xu et al. 2010, Moradi et al. 2015; Moradi et al. 2018, Zhang et al. 2018). Until now, there is no report of SCSMV outside the Asian continent. From February to October 2018, sugarcane plants exhibiting symptoms such as irregular yellow and green mosaic, interveinal chlorotic specks, and streaks were observed in Bafing (Borotou-Koro), Marahoué (Zuénoula) and Tchologo (Ferkéssédougou) regions of Côte d'Ivoire (Fig. 1a). Varieties under large-scale commercial cultivation such as R570, R579, SP711406, Co997, Co449, M1176/77, M2593/92, M2580/95, and M1400/86 were all symptomatic. A total of 94 sugarcane leaf samples were collected from these regions and, among those, 82 showed disease symptoms and 12 were symptomless. Samples were first tested for the presence of sugarcane mosaic virus (SCMV), which causes mosaic a disease that is already present in Africa. Serological tests with infected sap using a Double Antibody Sandwich (DAS)- Enzyme Linked Immuno Sorbent Assay (ELISA) kit (DSMZ, RT-0166, Braunschweig, Germany) were negative for SCMV and no amplification product was obtained by RT-PCR using primers specific to the coat protein (CP) gene of SCMV (Putra et al. 2003). The 82 symptomatic leaves tested positive by DAS-ELISA with SCSMV antiserum (polyclonal antibodies were graciously provided by Prof. Hema M. of the Sri Venkateswara University, Tirupati, AP, India), whereas the 12 symptomless samples tested negative. To confirm these results, virus free greenhouse-grown sugarcane varieties Co997 and M1176/77, were mechanically inoculated with 10 sap extracts from 10 SCSMV-infected sugarcane leaf samples. Sap was also extracted from DAS-ELISA negative sugarcane leaves and used as negative control. For sap preparation, leaves were homogenized with a mortar in 2 mL of phosphate buffer 0.01 M pH 7.2 (ratio 1:10). Fifteen 4-week-old plants per variety were inoculated separately with each sap. All inoculated plants exhibited streak mosaic symptoms 13 days post-inoculation (fig. 1b), and the presence of SCSMV in the inoculated plants was confirmed by DAS-ELISA. Total RNA was extracted from four symptomatic leaf samples, one symptomless and one DAS-ELISA positive sample using TRIzol reagent (Invitrogen, Carlsbad, CA, USA). cDNA was synthesized using M-MLV Reverse Transcriptase (Promega, Cat.No.M1705, Madison, WI, USA) following the manufacturer's instructions. A 690-nucleotide fragment of the CP gene was amplified by reverse transcription-polymerase chain reaction (RT-PCR) with primers SCSMV-F690 and SCSMV-R690 (Viswanathan et al. 2008). All primers were synthesized by Eurogentec (Seraing, Belgium). Aliquots of RT-PCR products (5 μl) were analyzed by electrophoresis on 1.2 % (w/v) agarose gel, stained with ethidium bromide and visualized on a UV transilluminator (Fig. 2). An amplification product of the expected size was obtained for all five symptomatic or DAS ELISA positive but not for the symptomless sample. Two RT-PCR products were sequenced and deposited in GenBank under accession Nos. LR594547 and LR594582. These partial CP gene sequences shared highest nucleotide identity with two isolates of SCSMV from India in GenBank: 91% with JN315855 and 90% with EF655859, thus confirming that SCSMV was occurring in sugarcane in Côte d'Ivoire. To our knowledge, this is the first report of natural infection of sugarcane by SCSMV in Africa. Streak mosaic is a serious threat to the entire sugar industry in West Africa and needs further investigations as it may affect sugarcane yields and impact local economies. Our findings further illustrate the need to develop virus-free germplasm for local, national, and international distribution of sugarcane.

Willingness to use HIV self-test kits and willingness to pay among urban antenatal clients in Cote d'Ivoire and Tanzania: a cross-sectional study

Objectives

To generate evidence on willingness to use HIV self‐test kits and willingness to pay among antenatal care clients in public and private facilities in Cote d’Ivoire and Tanzania.

Methods

Cross‐sectional survey data were collected from 414 clients recruited from 35 high‐volume facilities in Cote d’Ivoire and from 385 clients in 33 high‐volume facilities in Tanzania. Surveys covered willingness to use HIV self‐test kits, prices clients were willing to pay, advantages and disadvantages and views on specific qualities of HIV self‐tests. Market data on availability of proxy self‐testing products (e.g. pregnancy and malaria tests) and attitudes of pharmacists towards HIV self‐test kits were collected from 51 pharmacies in Cote d’Ivoire and 59 in Tanzania.

Results

Willingness to use HIV self‐test kits was 65% in Cote d’Ivoire and 69% in Tanzania. Median ideal prices women would pay ranged from USD 1.77 in Cote d’Ivoire to USD 0.87 in Tanzania. Proxy self‐test kits were available in pharmacies, and interest was high in stocking HIV self‐test kits.

Conclusions

Implications for national HIV self‐test policy and planning include keeping prices low, providing psychological and HIV counselling, and ensuring linkage to HIV care and treatment services. Private pharmacies will play a key role in providing access to HIV self‐test kits.

Pediculosis capitis in Abidjan, Côte d'Ivoire: Epidemiological profile and associated risk factors

Pediculosis capitis (PC) is a parasitic infestation, common in children's communities caused by Pediculus humanus capitis. Various factors including infestation-related stigma, treatment cost and health risks make this infestation deserves special attention. This study aims to determine epidemiological profile of pediculosis capitis twenty years after the last study in Abidjan, Côte d’Ivoire.

An epidemiological cross-sectional survey was carried out from April to June 2018 across 40 public primary schools in the ten districts of Abidjan. Data from schoolchildren and parents and/or guardians were collected using a pretested questionnaire after agreement and signature of the informed consent form. Head lice were identified visually with a magnifying glass, and then collected using fine combs and hairbrushes. The positive diagnosis was made by the detection of living lice in the hair.

Of the 4, 805 included participants, 28 (0.58%) were hosting living lice in hair. Analysis of associated factors showed that gender related-status was associated with PC. In this case, girls were more affected than boys (p=0.018). Plateau, Treichville and Port Bouët municipalities were the most affected (p=0.018). The length hair was associated with the occurrence of PC (p<0,001). Schoolchildren from families with low monthly income was most infected by PC (p=0.023). Some parameters such as promiscuity and collective use of washing facilities and bedding, were not found to be associated to head lice infestation.

This study shows a drastic decrease of PC prevalence in Abidjan corresponding to 97%. This could be due to the improvement in the quality of life and education of the population of Abidjan. The establishment of hygiene committees and the teaching of basic hygiene practices from the first school years have contributed to these achievements. Maintaining these measures will contribute to the sustainable elimination of CP among children in Abidjan.

Evaluation of antiplasmodial activity of extracts from endemic medicinal plants used to treat malaria in Côte d'Ivoire

Introduction:Plasmodium falciparum strains had been increasingly resistant to commonly used molecules including artemisinin. It is therefore urges to find new therapeutic alternatives.

Methods: In this study, the antiplasmodial activity of 21 extracts obtained from seven plants of the Anthocleista djalonensis, Cochlospermum planchonii, Harungana madagascariensis, Hoslundia opposita, Mangifera indica, Margaritaria discoidea and Pericopsis laxiflora of the Ivorian pharmacopoeia was evaluated on the chloroquine sensitive (NF54) and multi-resistant (K1) reference strains and on clinical isolates as well. The technique used was the microtiter method based on fluorescence reading with SYBR Green.

Results: The aqueous extract of the bark of H. madagascariensis and methanolic extracts of P. laxiflora showed the best antiplasmodial activity with IC₅₀ values of 6.16 µg/mL and 7.44 µg/mL, respectively. On the other hand, extracts of M. indica showed a very moderate activity with IC₅₀ values between 15 µg/mL and 50 µg/mL (5<IC₅₀<50 µg/mL) on the same strains of P. falciparum. Only the aqueous extract of A. djalonensis had IC₅₀ values greater than 50 µg/mL. The phytochemical analysis showed a strong presence of polyphenols and alkaloids in extracts with a cumulative rate of 90.47% and 95.23%, respectively.

Conclusion: The results obtained were also justified by the composition of these plants, which have several secondary metabolites involved in the treatment of malaria. The antiplasmodial properties of these plants could partially justify their use in malaria treatment. Further studies on these extracts are needed to manufacture a stable galenic formulation for the development of an improved traditional medicine.

Use of pre-ART laboratory screening to identify renal, hepatic and haematological abnormalities in Côte d'Ivoire

BACKGROUND

High demand for HIV-services and extensive clinical guidelines force health systems in low-resource settings to dedicate resources to service delivery at the expense of other priorities. Simplifying services may reduce the burden on health systems and pre-antiretroviral therapy (ART) laboratory screening is among the services under consideration for simplification.

METHODS

We assessed the frequencies of conditions linked to ART toxicities among 34,994 adult, ART-naïve patients with specimens referred to the RETRO-CI laboratory in Abidjan, Côte d'Ivoire between 1998 and 2017. Screening included tests for serum creatinine, alanine aminotransferase (ALT) and haemoglobin (Hb) to identify renal dysfunction (estimated glomerular filtration rate < 50 mL/min), hepatic abnormalities (ALT > 5× upper limit of normal) and severe anaemia (Hb < 6.5 g/dL), respectively. We considered screening results across four eras and identified factors associated with the conditions in question.

RESULTS

The prevalence of renal dysfunction, hepatic abnormalities and severe anaemia were largely unchanged over time and just 8.4% of patients had any of the three conditions. Key factors associated with renal dysfunction and severe anaemia were age > 50 years (adjusted odds ratio (aOR): 2.53; 95% confidence interval (CI): 2.19-2.92; P < 0.001) and CD4 < 100 cells/µl (aOR: 2.57; 95% CI: 2.30-2.88; P < 0.001).

CONCLUSION

The relative infrequency of conditions linked to toxicity in Côte d'Ivoire supports the notion that simplification of pre-ART laboratory screening may be undertaken with limited negative impact on identification of adverse events. Targeted screening may be a feasible strategy to balance detection of conditions associated with ART toxicities with simplification of services.

[Efficacy against Malaria Vectors of Long-Lasting Insecticide-Treated Mosquito Nets after 17 Months of Use in the City of Bouaké, in the Center of Côte d'Ivoire]

Malaria remains a public health problem in Côte d'Ivoire despite a 95% coverage rate with long-lasting insecticide-treated mosquito nets (LLINs) since 2015. A study was conducted in Bouaké to determine the residual efficacy of LLINs used during 17 months (N = 30) and of stored and unpacked LLINs (N = 8). The physical integrity of LLINs and their biological efficacy on populations of Anopheles gambiae (sensitive and resistant to insecticides) were assessed. The study revealed that 57% (17/30) of LLINs recovered from households have a hole. The proportional hole indices indicated that 70% (21/30) of LLINs were in good condition, 20% (6/30) were repairable and 10% (3/30) were unusable.This study also showed that the LLINs used and stored were effective on the sensitive Kisumu strain but ineffective on resistant populations of An. gambiae of Bouaké. Average knock-down and mortality rates induced by LLINs used on the populations of An. gambiae from Bouaké were 23% and 9%, respectively. The resistance of mosquitoes to insecticides and the alteration of the physil integrity of mosquito nets are probably major factors to be taken into account in estimating the efficacy of LLINs in the field.

Oral epidemiological profile of patients attending public oral health services in Haut Sassandra region, in Côte d'Ivoire

The objective of this cross-sectional study was to determine the type of care that can be achieved and the epidemiological profile of patients attending the 3 public dental practices in the Haut-Sassandra region, in Côte d’Ivoire. The data collection concerned socio-demographic characteristics, reason for consultation, oral hygiene, dental condition, malocclusions and the availability of equipment for the performance of procedures. The 400 patients observed (51.5% male) were aged 16.0 to 86.0 years (mean=35.5 years; SD=13.1 years). The main reasons for consultation were pain (91.5%) and aesthetics (23.5%). Oral hygiene was insufficient for 36.8% of subjects. Oral conditions were malocclusions (12.8%), caries (98.7%) and edentulous (65.7%) with only 11.8% with prosthesis. The average DMFT index was 9.3. Only extractions and resin attached prostheses were possible in all 3 health facilities. Preventive dentistry (sealent, fluoridation), dentofacial orthopedics and implantology were not available in any dental practice. The most frequently performed acts were extractions (74.5%). The results of this study highlight the need for oral health planning with service equipment and awareness among populations who shouldn’t wait until they are in pain to consult.

Characterizing social cohesion and gender identity as risk determinants of HIV among cisgender men who have sex with men and transgender women in Côte d'Ivoire

PURPOSE

HIV prevalence has been previously estimated among cisgender men who have sex with men (MSM) in Côte d'Ivoire; however, limited data exist relating to the role of social cohesion and gender identity within this population. This study aims to examine these factors as risk determinants of HIV among MSM in Côte d'Ivoire.

METHODS

We conducted a cross-sectional study using respondent-driven sampling for recruitment with a structured sociobehavioral instrument and testing for HIV. After respondent-driven sampling adjustment, chi-squared tests and bivariate logistic regression and multivariate logistic regression analyses were performed to characterize social and identity-based risk determinants of biologically confirmed prevalent HIV infection.

RESULTS

HIV prevalence was 11.2% (n = 146/1301). Transgender woman identity was associated with higher odds of HIV compared with cisgender MSM (aOR = 3.4, 95% CI [2.0-5.8], P < .001). Having a combined social cohesion score of medium (aOR = 0.4, 95% CI [0.2-0.8], P < .01) or high (aOR = 0.2, 95% CI [0.1-0.3], P < .001) was associated with lower odds of HIV compared with a low score.

CONCLUSION

These data suggest that social cohesion is a determinant of prevalent HIV infection in Côte d'Ivoire among gay men, other cisgender MSM, and transgender women. The differences in HIV burden and social cohesion between transgender women and cisgender MSM highlight the need to better target the diversity of people traditionally included in the MSM umbrella to ensure comprehensive HIV prevention and treatment interventions.

Composition and Intraspecific Chemical Variability of Leaf Essential Oil of Laggera pterodonta from Côte d'Ivoire

The chemical composition of 44 leaf oil samples of Laggera pterodonta (DC.) Sch.Bip. ex Oliv. (Asteraceae) from Côte d'Ivoire was investigated, using combination of chromatographic (GC-FID) and spectroscopic (GC/MS, ¹³ C-NMR) techniques. Two oil samples chosen according to their chromatographic profiles were submitted to column chromatography and all fractions of CC were analyzed by GC-FID, GC/MS and ¹³ C-NMR. In total, 83 components accounting for 96.5 to 99.4 % of the whole chemical composition were identified. Significant variations were observed within terpene classes: monoterpene hydrocarbons (0.4-22.7 %), oxygenated monoterpenes (32.9-54.9 %), sesquiterpene hydrocarbons (18.6-38.3 %) and oxygenated sesquiterpenes (3.5-38.4 %). Thus, the 44 compositions were subjected to hierarchical cluster analysis (HCA) and principal component analysis (PCA). Two groups were differentiated according to their composition. All the samples contained 2,5-dimethoxy-p-cymene, α-humulene and (E)-β-caryophyllene among the main components. Other components were present at appreciable contents and allowed differentiation of two groups: sabinene and germacrene D for Group I; 10-epi-γ-eudesmol and eudesm-7(11)-en-4α-ol for Group II. All the samples collected in Eastern Côte d'Ivoire constituted Group I, while samples collected in the Central area of the country constituted Group II.

Pepfar 3.0's HIV testing policy in Côte d'Ivoire (2014 to 2018): fragmentation, acceleration and disconnection

INTRODUCTION

HIV Testing and Counselling (HTC) remains a key challenge in achieving control of the HIV epidemic by 2030. In the early 2010s, the President's Emergency Plan for AIDS Relief (Pepfar) adopted targeted HTC strategies for populations and geographical areas most affected by HIV. We examine how Pepfar defined targeted HTC in Côte d'Ivoire, a country with a mixed HIV epidemic, after a decade of expanding HTC services.

METHODS

We explored the evolution of HTC strategies through the Country Operational Plans (COP) of Pepfar during its phase 3.0, from COP 14 to COP 17 (October 2014 to September 2018) in Côte d'Ivoire. We conducted an analysis of the grey literature over the period 2014 to 2018 (Budget & Target Report, Strategic Direction Summary, Sustainability Index and Dashboard Summary, https://data.pepfar.gov). We also conducted a qualitative study in Côte d'Ivoire (2015 to 2018) using in-depth interviews with stakeholders in the AIDS public response: CDC/Pepfar (3), Ministry of Health (3), intermediary NGOs (7); and public meeting observations (14).

RESULTS

Since the COP 14, Pepfar's HIV testing strategies have been characterized by significant variations in terms of numerical, geographical and population targets. While the aim of COP 14 and COP 15 seemed to be the improvement of testing efficacy in general and testing yield in particular, COP 16 and COP 17 prioritized accelerating progress towards the "first 90" (i.e. reducing the proportion of people living with HIV who are unaware of their HIV). A shift was observed in the definition of testing targets, with less focus on the inclusion of programmatic data and feedback from field actors, and greater emphasis on the use of models to estimate and disaggregate the targets by geographical units and sub-populations (even if the availability of data by this disaggregation was limited or uncertain); increasingly leading to gaps between targets and results.

CONCLUSIONS

These trials and tribulations question the real and long-term effectiveness of annually-revised, fragmented strategies, which widen an increasing disparity between the realities of the actors on the ground and the objectives set in Washington.

Expansion of Aedes africanus (Diptera: Culicidae), a sylvatic vector of arboviruses, into an urban environment of Abidjan, Côte d'Ivoire

In 2008, an outbreak of yellow fever occurred in Abidjan. The entomological investigations confirm that Abidjan is at risk of yellow fever with a suspicion of the National Park of Banco (NPB) forest as a likely area of re-emergence. This study aims to assess the dispersion of sylvatic vectors of arboviruses from the NPB forest to the surrounding areas (Andokoi and Sagbé). The sampling was done in the rainy season using the WHO layer-traps technique. Among the six species of Aedes sampled, Aedes aegypti and Aedes africanus were the potential vectors of arboviruses. Both species were collected in Sagbé but only Ae. aegypti in Andokoi. Only Ae. aegypti were present 400 and 800 m from NPB forest, but at 200 m, it showed respective proportions of 75.5% and 87.5% in Sagbé and Andokoi. In the NPB forest, however, Ae. africanus has been the predominant species. The study showed the presence of Ae. aegypti in Andokoi and Sagbé. However, Ae. africanus was found in the NPB forest and in the 200 m radius in Sagbé. The establishment of an entomological surveillance program in all areas would therefore be essential for the prevention of arboviruses outbreaks in Abidjan.

High prevalence of Schistosoma haematobium × Schistosoma bovis hybrids in schoolchildren in Côte d'Ivoire

Schistosomiasis is a neglected tropical disease, though it is highly prevalent in many parts of sub-Saharan Africa. While Schistosoma haematobium-bovis hybrids have been reported in West Africa, no data about Schistosoma hybrids in humans are available from Côte d'Ivoire. This study aimed to identify and quantify S. haematobium-bovis hybrids among schoolchildren in four localities of Côte d'Ivoire. Urine samples were collected and examined by filtration to detect Schistosoma eggs. Eggs were hatched and 503 miracidia were individually collected and stored on Whatman® FTA cards for molecular analysis. Individual miracidia were molecularly characterized by analysis of mitochondrial cox1 and nuclear internal transcribed spacer 2 (ITS 2) DNA regions. A mitochondrial cox1-based diagnostic polymerase chain reaction was performed on 459 miracidia, with 239 (52.1%) exhibiting the typical band for S. haematobium and 220 (47.9%) the S. bovis band. The cox1 and ITS 2 amplicons were Sanger sequenced from 40 randomly selected miracidia to confirm species and hybrids status. Among the 33 cox1 sequences analysed, we identified 15 S. haematobium sequences (45.5%) belonging to seven haplotypes and 18 S. bovis sequences (54.5%) belonging to 12 haplotypes. Of 40 ITS 2 sequences analysed, 31 (77.5%) were assigned to pure S. haematobium, four (10.0%) to pure S. bovis and five (12.5%) to S. haematobium-bovis hybrids. Our findings suggest that S. haematobium-bovis hybrids are common in Côte d'Ivoire. Hence, intense prospection of domestic and wild animals is warranted to determine whether zoonotic transmission occurs.

Increased liver injury in patients with chronic hepatitis and IgG directed against hepatitis E virus

Type-E hepatitis is responsible for more than three million symptomatic cases and more than 40,000 deaths worldwide. The situation of this hepatitis is overall poorly known in sub-Saharan Africa. Notably, the baseline circulation of HEV outside sporadic outbreaks has been barely characterized in this large region. More specifically, the impact of superinfection by this virus on the health status of the large reservoir of patients chronically infected with other hepatitis viruses remains to be evaluated. We searched for anti-HEV immunoglobulins in a series of 200 pregnant women and 92 patients with persistent liver infections with hepatitis B or C viruses and subsequently tried to assess serological co-variations with demographical and clinical features. We observed that only 1.5 % of expectant mothers were seropositive of anti-HEV IgG while it was the case for 18.4 % of patients with chronic liver diseases (P=4.5E-07). The presence of anti-HEV was not linked to any of the collected demographical features (age, sex, education, pork meat consumption, water supply, …). By contrast, the presence of anti-HEV was significantly associated with increased levels (1.6-1.8-fold, P<0.0001) of blood aminotransferases (AST, ALT) in patients with persistent hepatitis B or C. Our work indicates that, in Ivory Coast, the presence of IgG directed against HEV might contribute to a deterioration of liver health in patients with already installed persistent liver infections. The mechanisms explaining such phenomenon at distance of acute phase of infection are still unknown but might be linked either to a residual persistence of HEV in a context of general immune exhaustion or to an inappropriate auto-immune reaction as already observed in the aftermath of other viral infection types.