Evaluation of the tele-expertise project in the management of common dermatoses in Togo / Évaluation du projet de téléexpertise dans la prise en charge des dermatoses courantes au Togo

Introduction: Tele-expertise in dermatology represents an opportunity to change medical practice in response to the need for cost savings in the health sector. The aim of this study was to evaluate the medical activities of the pilot phase of the tele-expertise project in Togo. Method: A cross-sectional study was conducted in October 2020 on the 20 sites of the pilot phase. This evaluation consisted of a literature review and analysis of data posted on the tele-expertise platform. Results: A total of 738 (10.8%) of the 6810 dermatological consultations were posted on the tele-expertise platform. Of the 738 cases, the dermatologist's expertise did not allow a diagnosis to be made in 119 cases (16.1%). This expertise confirmed the single clinical hypothesis proposed by the health worker in 275 cases (37.3%) and allowed a diagnosis to be made among several clinical hypotheses in 30 cases (4.1%). On the contrary, the dermatologist's diagnosis was not included in the health worker's hypotheses in 201 cases (27.2%), and no clinical hypothesis was formulated in 113 cases (15.3%). The concordance between the clinical hypothesis proposed by the health worker and the diagnosis of the dermatologist was 48.8%. Regarding the acceptability of the tele-expertise, only one refusal was recorded. All patients were very satisfied with this practice. Conclusions: The results show the feasibility and acceptability of tele-expertise by health care personnel and patients. The diagnostic concordance of 48.8% shows the relative efficiency of task delegation.

Introduction: La téléexpertise en dermatologie représente une piste pour modifier l'exercice médical en réponse aux besoins d'économies de la santé. Le but de cette étude était d'évaluer les activités médicales de la phase pilote du projet de téléexpertise en dermatologie au Togo. Méthode: Il s'agit d'une étude transversale menée en octobre 2020 sur les 20 sites de la phase pilote. Cette évaluation consistait en une revue documentaire et l'analyse des données postées sur la plateforme de téléexpertise. Résultats: Au total, 738 (10,8 %) des 6 810 consultations dermatologiques ont été postées sur la plateforme de téléexpertise. Sur les 738 cas, l'expertise du dermatologue n'a pas permis de poser un diagnostic dans 119 cas (16,1 %). Cette expertise a confirmé l'hypothèse clinique unique proposée par l'agent de santé dans 275 cas (37,3 %) et a permis de conclure à un diagnostic parmi plusieurs hypothèses cliniques dans 30 cas (4,1 %). Au contraire, le diagnostic du dermatologue ne figurait pas dans les hypothèses de l'agent de santé dans 201 cas (27,2 %), et aucune hypothèse clinique n'avait été formulée dans 113 cas (15,3 %). La concordance entre l'hypothèse clinique proposée par l'agent de santé et le diagnostic du dermatologue était de 48,8 %. Concernant l'acceptabilité de la téléexpertise, un seul refus a été enregistré. Tous les patients étaient très satisfaits de cette pratique. Conclusions: Les résultats montrent la faisabilité et l'acceptabilité de la téléexpertise par les personnels de santé et les patients. La concordance diagnostique de 48,8 % montre la relative efficacité de la délégation de tâches.

[Care of covid-19 patients at the dermatology hospital of Bamako]. / Prise en charge des patients covid-19 a l'hopital de dermatologie de Bamako.

AIM: To assess the COVID-19 patients' treatment duration according to the place of treatment at the Dermatology Hospital of Bamako (DHB). METHODS: This was a cross-sectional study comparing the management of COVID-19 PCR-positive patients in the hospital to that of those managed at home from March 2020 to April 2021 until two consecutive negative PCR 48 hours apart. RESULTS: Among the 1109 patients, 369 were hospitalized, 497 followed at home. As of April 31, 2021, 81.2% (900/1109) of the patients recovered, 1.3% (14/1109) were transferred to another health structure, and 2.5% (28/1109) died. No statistically significant difference was observed between the mean duration of the treatment for patients treated at home (10 days) in (95% CI, 9.69-10.3) and those managed at hospital (10 days95% CI, 9.76-10.23) (Mantel-Cox test, p= 0.060). CONCLUSION: These results suggest that the place of treatment do not influence the time to recovery. This is particularly important given the current burden of COVID-19 management on the health workforce.

OBJECTIF: Evaluer la durée du traitement des patients COVID-19 selon le lieu de pris en charge à l'Hôpital de Dermatologie de Bamako (HDB). MÉTHODOLOGIE: Il s'agissait d'une étude transversale comparant la prise en charge des patients COVID-19 PCR-positifs à l'hôpital à celle à domicile de mars 2020 à avril 2021 jusqu'à l'obtention de deux tests PCR négatifs consécutifs à 48 heures d'intervalle. RÉSULTATS: Parmi les 1109 patients, 369 ont été hospitalisés, 497 suivis à domicile. Au 31 avril 2021, 81,2% (900/1109) des patients se sont rétablis, 1,3% (14/1109) ont été transférés dans une autre structure de santé et 2,5% (28/1109) sont décédés. Aucune différence statistiquement significative n'a été observée entre la durée moyenne du traitement pour les patients traités à domicile (10 jours) en (IC 95 %, 9,69-10,3) et ceux pris en charge à l'hôpital (10 jours IC 95 %, 9,76-10,23) (test de Mantel-Cox, p= 0,060). CONCLUSION: Ces résultats suggèrent que le lieu de traitement n'influence pas le temps de récupération. Ceci est particulièrement important étant donné la charge actuelle de la gestion des COVID-19 sur le personnel de santé.

Prise en charge des patients COVID-19 à l'hôpital de dermatologie de Bamako / Care of COVID-19 patients at the dermatology hospital of Bamako

Aim: To assess the COVID-19 patients' treatment duration according to the place of treatment at the Dermatology Hospital of Bamako (DHB). Methods: This was a cross-sectional study comparing the management of COVID-19 PCR-positive patients in the hospital to that of those managed at home from March 2020 to April 2021 until two consecutive negative PCR 48 hours apart. Results: Among the 1109 patients, 369 were hospitalized, 497 followed at home. As of April 31, 2021, 81.2% (900/1109) of the patients recovered, 1.3% (14/1109) were transferred to another health structure, and 2.5% (28/1109) died. No statisticallysignificant difference was observed between the meanduration of the treatment for patients treated at home (10 days) in (95% CI, 9.69-10.3) and those managedathospital (10 days95% CI, 9.76-10.23) (Mantel-Cox test, p= 0.060). Conclusion: These results suggest that the place of treatment do not influence the time to recovery. This is particularly important given the current burden of COVID-19 management on the health workforce

Objectif: Evaluer la durée du traitement des patients COVID-19 selon le lieu de pris en charge à l'Hôpital de Dermatologie de Bamako (HDB). Méthodologie : Il s'agissait d'une étude transversale comparant la prise en charge des patients COVID-19 PCR-positifs à l'hôpital à celle à domicile de mars 2020 à avril 2021 jusqu'à l'obtention de deux tests PCR négatifs consécutifs à 48 heures d'intervalle. Résultats : Parmi les 1109 patients, 369 ont été hospitalisés, 497 suivis à domicile. Au 31 avril 2021, 81,2% (900/1109) des patients se sont rétablis, 1,3% (14/1109) ont été transférés dans une autre structure de santé et 2,5% (28/1109) sont décédés. Aucune différence statistiquement significative n'a été observée entre la durée moyenne du traitement pour les patients traités à domicile (10 jours) en (IC 95 %, 9,69-10,3) et ceux pris en charge à l'hôpital (10 jours IC 95 %, 9,76-10,23) (test de Mantel Cox, p= 0,060). Conclusion: Ces résultats suggèrent que le lieu de traitement n'influence pas le temps de récupération. Ceci est particulièrement important étant donné la charge actuelle de la gestion des COVID-19 sur le personnel de santé

[Intestinal parasitoses in a village of Côte d'Ivoire. II: Relationship between intestinal parasitoses, physical and physiological development and child nutrition]. / Les parasitoses intestinales dans un village de Côte d'Ivoire. II: relations entre le parasitisme intestinal et le développement physique, physiologique et l'état de nutrition des enfants.

In a village situated at the border of the Ebrié lagoon, with economical problems, 343 school and preschool children, aged 4 to 15 (195 boys and 148 girls), considered by the school and their families to be in good health, were submitted for clinical and coproparasitologic examination. Basic clinical tests, anthropometric examination, spleen rate, nutrition status assessment (brachial perimeter of children aged 4 to 10 years) and the puberty level evaluation (using Tanner's scale) were independently completed. Splenomegaly rate among children between 4 and 9 years old was particularly important (78.0 %). Intestinal parasites were found in 84.8% of cases during the first examination (70.4% of children were diagnosed with multiple parasitosis). The most frequent parasite identified was Ascaris lumbricoides, being in 62.1 % of the cases, with a parasitic intensity between 1.000 and 52.000 OPG and worm burden between 1 and 16. According to the age, the highest prevalence of A. lumbricoides was higher (78.6 %) in children between 7 and 10 years. Results of anthropometric data, interpreted using NCHS percentile chart, indicated a significant stature-ponderal underdevelopment. Thus, concerning the height, 22.7% of all children were below normal value (below the 5th percentile), 74.3% between normal values and only 2.9% were above the 95th percentile. Among the 255 children with values between the normal limits, 73.7% (more than two thirds) were in the lower half, below the 50th percentile and only 26.3% (less than one third) were between the 50th and 95th percentile. According to the weight, 20.7% of children were below the normal value (below the 5th percentile), 77.8% had normal weight and 1.5% were above the 95th percentile. Even among children with normal weight, two thirds were in the lower half, below the 50th percentile. The underdevelopment was more evident after 9 years of age, particularly in girls. This coincided with higher rates of infection with roundworms. Regarding the nutritional status, 76.9% of the boys and 77.2% of the girls had a lower brachial perimeter than normal data, most frequently by one or two centimeters. A deficit of 3 to 4 cm. was found in 16.2% of the children, and it was higher among girls. The evaluation of pubertal development highlighted a certain delay in girls aged 10 to 12, with a preadolescence state of 76.0 % at age 10, 20.0 % at age 11 and 15.8 % at age 12. Between 13 and 15 years of age, all girls began pubertal development, but none reached Tanner's stage 5. It is concluded that the highest intestinal parasitism (particularly roundworms) can have a negative effect on the staturo-ponderal development of children, their nutrition status and pubertal development. Paludism and alimentary deficiencies have to be also considered.

[Intestinal parasitoses in a village of Côte d'Ivoire. I: Control and prevention plan]. / Les parasitoses intestinales dans un village de Côte d'Ivoire. I: essai de mise en place d'une stratégie de lutte et de prévention.

The goal was to develop a complex medical, hygienic, sanitary and educational plan for control and prevention of intestinal parasitic infections in the rural areas in Ivory Coast. In a village situated at the border of the Ebrié lagoon, 416 persons were examined: 371 children, of which 343 were school and preschool children, aged 4 to 15 years (195 boys and 148 girls), 28 young children aged 6 months to 3 years, and a group of 45 adults. The parasitologic exams included perianal swabs (Graham's method), stool examination using saline solution, iodized solution (Lugol) and preparation Kato-Miura's method in thick layer. Parasitic intensity was done for helminths and worm burden have been carried after specific treatment of roundworms. Hygienic conditions as environment, school, dwelling and personal hygiene, eating habits, drinking water sanitation, garbage disposal, toilets, reproduction areas of hematophagous and mechanical vectors etc. have recorded. The prevalence of intestinal parasites was 84.8% in children (with 76.7 % polyparasites) and 29.0 % in adults. The results pointed out a hyperendemic zone. Parasitic infectious transmitted from person to person was frequent among children: 37.3% pinworms in school children, 30.3% amoeba cysts and 30.3% flagellate. Infections transmitted by soil were predominant, with 62.1 % roundworms (78.6 % in children aged 7 to 10 years) presenting an important parasitic intensity and worm burden. The parasitoses transmitted as larvae were frequent, only Strongyloides stercoralis being most frequent parasite in adults compared to children. A feasible plan of control the intestinal parasites has been established in collaboration with the local hospital, village leaders and health workers. Short-term measures have been carefully chosen, targeting especially the schools, teachers and health workers. The first health education measure concerns the hand cleanliness at home and at schools. It was suggested that a bucket of water be used per class, that the water be changed more often during the day, and soap be made available at all time. Lessons on the ways of transmission of parasites will be introduced in schools. A door-to-door education plan was discussed with village health workers and hospital nurses and laboratory technicians during the maternal-infantile prophylactic visits. The health education problems have been discussed extensively with village health workers. As a preliminary example, the prevention and campaign against the pinworm, a common parasite in children was chosen, whose transmission mechanism from person to person can be easily understood by children and mothers. Simultaneously the prevention of parasitic infections contributes extensively to the prevention of other serious diseases, as the typhoid fever etc. which are endemic in the region. Long-term preventive measures have been discussed with village leaders. The first measure is to fix the deep-well drinking water pump station of the village, financed by outside parties, with labour provided by the village. Measures for proper maintenance of the water pump station have also been discussed with representatives of the village. The program of the World Health Organization and National Institute of Hygiene of Ivory Coast concerning the periodic treatment of intestinal helminths, especially A. lumbricoides, given to all school aged children was discussed.