Epidemiology of group A rotavirus in children under five years of age with gastroenteritis in N'Djamena, Chad

BACKGROUND

Group A Rotaviruses (RVA) is one of the most common causes of severe diarrhoea in infants and children under 5 years of age. Unlike many countries in the world where RVA surveillance/control is active, in Chad , there is currently no applied RVA immunization program and surveillance strategy. The present study aims to determine the prevalence and associated risk factors of RVA gastroenteritis among children under five years of age in N'Djamena.

METHOD

This study comprised two parts: (1) A cross-sectional study carried in four hospitals in N'Djamena between August and November 2019, to determine infection risk factors and evidence of RVA infection among children aged five and below, consulted or hospitalized for diarrhea. An ELISA based RVA VP6 protein detection was used to determine RVA infection prevalence. Infection results and sociodemographic data were statistically analysed to determine RVA infection risk factors. (2) A retrospective study that consisted of analysing the records of stool examinations of the period from January 2016 to December 2018, to determine the prevalence of infectious gastroenteritis among the target population.

RESULTS

For the cross-sectional study, RVA infection prevalence was 12.76% (18/141) with males (61.11%) being more affected (sex ratio: 1.57). Children below 12 months were the most affected age group (44.44%) and 44.4% were malnourished. The mean Vesikari score shows that 38.8% of children have a high severity level and 41.1% have a moderate level. For the retrospective study, 2,592 cases of gastroenteritis hospitalization were analysed; 980 out of 2,592 cases (37.81%) of hospitalization due to diarrhoea were due to diarrhoeagenic pathogens including Emtamoeba hystolitica, Gardia lamblia, Trichomonas hominis, Hymenolepis nana, Escherichia coli, Shigella spp, Proteus mirabilis, and Klebsiella oxytoca. Cases of diarrhoea with negative pathogen search were 1,612 cases (62.19%). The diarrhoea peak was observed during the dry seasons, and the age group under 11 months was the most affected was (57.3%).

CONCLUSION

This study describes the evidence of RVA infection among diarrhoeic children below five years of age in N'Djamena, thus indicates a serious health burden. Malnourishment younger age was the higher risk factor. Further studies are needed to determine the circulating strains prior to considering introduction of RVA vaccine and setup a routine rotavirus surveillance in Chad.

[Complications of limb trauma traditional treatment at the University Hospital Center Le Bon Samaritain in Walia (N'Djamena, Chad)]

Introduction

Traditional treatment of limb trauma by traditional healers is ubiquitous in Sub-Saharan Africa. These practices are the source of many complications. This study aims to clarify the profile of these complications and to identify the factors favoring the consultation of traditional healers.

Material and methods

Descriptive and analytical study over 12 months, from February 1, 2018 to January 31, 2019, covering all the patients who consulted at the surgery department of the CHU Le Bon Samaritain in N'Djamena (CHUBS) for a complication of a fracture or dislocation of a limb treated by a traditional healer. Data collection was carried out using a pre-established questionnaire with an average follow-up of 14 months.

Results

Out of 144 patients, 47 (33%) suffered from at least one complication of fracture or dislocation following traditional treatment. Thirty-two were included in the survey. Their mean age was 23 years (range 10-61) and the sex ratio 2.6 in favor of men. The origin was mainly rural: pupils/students and farmers/breeders were the most represented. We identified individuals from all levels of education, mainly primary level. Road accidents were the most frequent (n = 20). The influence of the entourage (n = 14) was the first factor leading to the choice of traditional treatment. The wooden splint, which did not immobilize the proximal fracture joints, associated with the ischemic bandage causing the gangrene, was the first means of restraint (n = 15). The mean time between trauma and the start of traditional treatment was 8.5 hours. The mean time from traditional treatment to onset of complications was 106 days (range 1-302). The most common complications were swelling of the limbs, malunions, gangrene and pseudarthrosis. The initial lesion was a closed fracture in most cases (n = 22) with a predominance of the pelvic limbs (n = 22). Hospital management was surgical (n = 19) or orthopedic (n = 13). Therapeutic progress has been good, fairly good or bad regarding 24, 2 and 6 cases respectively.The solicitation of traditional healers is frequent in traumatology. The influence of social background and ease of access to traditional "doctors" were noted as determining factors in the choice of this kind of treatment. The consequences of this practice have various origin: insufficient immobilization not respecting the standards; intense and untimely massages causing severe pain, secondary displacements and abnormal consolidation. Another study extended to patients who satisfied or not with the result of traditional fracture treatment in addition to those who consulted for complications would be more representative.

Conclusion

The complications of traditional treatments for traumatic limb injuries are serious. The training of the traditional healers on basic notions of immobilization and the recognition of signs of seriousness, their collaboration with health structures as well as free care in hospital services would make possible to reduce this phenomenon. The media and social networks should help to reach a large audience.

The Plight of Female Cameroonian Migrant Sex Workers in N'Djamena, Chad: A Case of Intersectionality

In most countries, sex-work is criminalized and frowned upon. This leads to human rights abuses, especially for migrant female sex workers. The burden is heavier on migrant female sex-workers whose gender and foreign citizenship intersect to produce a plethora of adverse health, social, and legal outcomes. This phenomenological study explores the intersectionality of individual factors leading to human rights abuses among migrant Cameroonian female sex workers in N’Djamena, Chad. Ten female sex workers and two key-informants were interviewed, and being a small sample, they gave detailed information about their experiences. The data was later analyzed using thematic analysis. Participants narrated experiences of social exclusion, exposure to diverse abuses, and health risks due to gender, immigrant status, and illegality of sex work. The experiences of female migrant sex workers, within contexts of sex work criminalization, are exacerbated by the intersectionality of these factors. Women endure several vulnerabilities in many African countries, more so when they have to survive on sex work as foreigners in a country where the act is illegal.

Parametrization of groundwater quality of the Quaternary aquifer in N'Djamena (Chad), Lake Chad Basin: application of numerical and multivariate analyses

The urban groundwater of the Quaternary aquifer of the Lake Chad basin in N'Djamena has been subject to many hydrochemical studies. However, the results are often not presented in a way that enables water quality managers to make an appropriate decisions, which restrict development and poverty reduction efforts. The objective of the present study was to contribute the improved management of the local groundwater resources. A total of 85 groundwater samples were interpreted using hydrochemical techniques associated with integrated numerical indices and multivariate statistical analysis. The hydrochemical results coupled with the relative residence time of water have shown that the chemical composition of these waters is linked to geogenic and anthropogenic factors and to their proximity to the Chari-Logone rivers. These investigations showed that the groundwater quality in N'Djamena is characterized by a high spatial variability. This study also assessed the suitability of groundwater for user needs and identified areas which are more/less favorable for a specific use. The evaluation of water quality and its suitability for human consumption is also a problem of optimizing data acquisition strategy, and this study used the correlation between water quality index (WQI) and electrical conductivity (EC) to orientate future data acquisition strategies. This parametrization can assist the decision makers and water management professionals in evaluating groundwater availability and setting up a robust water quality management plan in areas with similar hydrogeological and climatic conditions.

Suscepibility of Anopheles gambiae sl and Culex quinquefasciatus to diverse insecticides in the city of N'Djamena

Mosquito resistance to insecticides remains a major concern for vector control programs based on chemical methods. Hence, a thorough knowledge of vector susceptibility to products recommended for public health is required for effective vector control programs. In this study, we assessed the susceptibility of wild Anopheles gambiae sl and Culex quinquefasciatus populations from N'Djamena (Chad) to four insecticide classes recommended for public health. The study took place from July to October 2014. Following WHO guidelines, bioassays were performed on two- to four-day-old, non-engorged female mosquitoes of both species, collected in the field. The insecticides used were deltamethrin (0.05%), permethrin (1%), DDT (4%), bendiocarb (0.01%), and malathion (5%). Anopheles gambiae sl showed full susceptibility to bendiocarb and malathion but was resistant to pyrethroids; mortality rates were 2% for deltamethrin, 2% for permethrin, and 0% for DDT. Culex quinquefasciatus was susceptible to malathion but resistant to the other insecticides, with a mortality rate of 22% for deltamethrin, 29% for permethrin, 23% for DDT, and 45% bendiocarb. The resistance of Anopheles gambiae sl and of Culex quinquefasciatus may affect the population's adherence to the use of insecticide-treated mosquito nets. Malaria control programs are advised to extend insecticide resistance monitoring to the main culicide species that bite human populations.

[Profile of diabetic nephropathy at the National Reference General Hospital of N'Djamena (Chad)]

Introduction

Le diabète sucré constitue un véritable problème de santé et ses complications touchent plusieurs organes dont les reins. Un diagnostic précoce de la néphropathie diabétique permet de prendre en charge les patients plus efficacement et de façon multidisciplinaire, de retarder sa progression vers l'insuffisance rénale chronique. Peu d'études ont été faites en Afrique dans ce domaine. Au Tchad, nous ne disposons pas de données statistiques sur l'atteinte rénale liée au diabète. C'est pourquoi nous nous proposons d'étudier la néphropathie diabétique avec pour objectifs d'analyser le profil de la néphropathie diabétique des patients de l'hôpital général de référence nationale de N'Djamena.

Méthodes

Nous avions mené une étude transversale descriptive à l'Hôpital Générale de Référence Nationale de N'Djamena d'avril à septembre 2012. Etaient inclus dans l'étude tous les patients diabétiques hospitalisés ou suivis dans les services de néphrologie et d'endocrinologie.

Résultats

Il y avait 54 cas de néphropathie diabétique sur 181 patients soit 29,80%. L'âge de plus de 50 ans représentait 87%, le sexe masculin dominait avec 67%, la durée d'évolution du diabète au moment de la découverte de la néphropathie était de 10,25 ans, la pression artérielle moyenne était de 138 mm Hg, l'HbA1C était supérieur à 6,5% dans 74,5%, l'insuffisance rénale terminale était retrouvée dans 26,90%, une protéinurie à 2,65 g/24 h était détectée dans 60,30%. 57,4% des patients avaient une rétinopathie diabétique au stade III.

Conclusion

Au Tchad, la fréquence de la néphropathie diabétique est de l'ordre de 29,83%. C'est une affection qui touche les hommes avec une moyenne d'âge de 58,7 ans. Le diabète de type 2 est le plus fréquent avec 90,7% des cas. Les facteurs de risque mal contrôlés pouvaient conduire la néphropathie diabétique vers une altération de la fonction rénale notamment l'HTA (70,8%), un déséquilibre glycémique (66,7%) et une protéinurie (62,5%).