Personal hygiene in schools: retrospective survey in the northern part of Côte d'Ivoire.

INTRODUCTION: Students' personal hygiene helps maintain health and promote good academic performance. When health facilities are insufficient, this hygiene can be difficult to achieve. We wanted to analyse the determinants of personal hygiene in schools in the northern region of Côte d'Ivoire. METHODS: The retrospective cross-sectional study brings together data on 2,035 schoolchildren recruited from thirty schools in northern Côte d'Ivoire. Indexes on personal hygiene were constructed and analysed in comparison to the socio-demographic characteristics of students, homes and schools. They were analysed with R Software version 1.1.463, the χ2 test and a logistic regression model. RESULTS: Overall, the majority of students had good personal hygiene (82.75%) with an average personal hygiene score of 4.74 ± 1.36. The predictors of good personal hygiene among schoolchildren were female gender (OR = 1.5; 95% CI = 4.31-16.37), father's primary education level (OR = 1.55; 95% CI = 1.07-2.29), the father's income level above 60,000 FCFA (90 Euros) and modern housing (OR = 1.45; 95% CI = 1.05-2.03). However, the poor level of home sanitation resulted in poor personal hygiene among the students (OR = 0.34; 95% CI = 0.23-0.5). CONCLUSIONS: Measures to raise the standard of living of families and the provision of sanitary facilities in homes becomes necessary in order to improve students personal hygiene.

Efficacy and tolerability of artesunate-amodiaquine versus artemether-lumefantrine in the treatment of uncomplicated Plasmodium falciparum malaria at two sentinel sites across Côte d'Ivore

Malaria remains a major public health problem in Côte d'Ivoire. The aim of this study is to compare the efficacy and tolerability of artesunate-amodiaquine (ASAQ) versus artemether-lumefantrine (AL) for the treatment of uncomplicated malaria, at two malaria surveillance sites in Côte d'Ivoire. The World Health Organization 2003 protocol was used for this multicenter open randomized clinical trial with a 42-day follow-up. We recruited 240 patients (120 per arm), of whom 114 (ASAQ group) and 112 (AL group) were fully followed-up. According to intention-to-treat statistical analysis, PCR-corrected cure rates for ASAQ and AL treatments were 95.8% and 92.5% on day 28, and 95% and 92.5% on day 42, respectively. Based on per-protocol statistical analysis, ASAQ and AL treatment rates reached 100% and 99.1%, respectively, on day 28 and remained the same on day 42. Overall, both drugs were well-tolerated at the clinical and biological level. This study shows that ASAQ and AL are still effective and well-tolerated. Accordingly, they can continue being used to treat uncomplicated malaria in Côte d'Ivoire. However, monitoring of their efficacy should remain a priority for health authorities.

Oropharyngeal candidiasis prevalence among HIV-infected patients at the teaching hospital of Treichville (Abidjan, Côte d'Ivoire).

AIM OF THE STUDY: The aim of this study was to determine the mycological profile of oropharyngeal candidiasis among HIV-infected patients from Internal Medicine, Infectious and Tropical Diseases, and Pneumo-Phthisiology Diseases departments of the Teaching Hospital of Treichville in Abidjan, Côte d'Ivoire. PATIENTS AND METHODS: This was a cross-sectional study carried out on patients with lesions suggestive of oropharyngeal candidiasis from October 2010 to April 2011. Oral swabs were cultured, and Candida species were identified using a germ tube test, a chlamydospore formation assay, and the API 20C system. RESULTS: A total of 286 patients were included, among whom 99.1% were infected with HIV. The prevalence of oropharyngeal candidiasis was 79.4% (CI95%=74.4-83.8). Five different species of Candida were identified, with the predominant species being Candida albicans (95.2%). Most affected patients were female (54.6%, P<0.0001) between the ages of 30 and 45 (78.4%, P<0.0001). The most lesion types observed were thrush (87.8%). Patients infected with HIV1 (95.6%), with a primary school level of education (52.8%), under antiretroviral therapy (88.5%) and with tuberculosis as an associated pathology (62.5%) were the most commonly affected. Patients were mostly under ART first line treatment (86.4%) and at the beginning of the treatment (86.4%). CONCLUSION: Oropharyngeal candidiasis is frequent among HIV-infected patients. Better and early management of this vulnerable population should allow for a reduction in the high prevalence observed.

[Onychomycosis mycological profile in Abidjan (Cote d'Ivoire)]. / Profil mycologique des onychomycoses à Abidjan (Côte d'Ivoire).

AIM OF THE STUDY: The epidemiological profile of onychomycosis is poorly determined in Cote d'Ivoire. This study aimed to determine the fungal aetiologies of these onychomycosis in Abidjan. PATIENTS AND METHODS: This cross-sectional study was conducted from February to August 2011 at the Department of Dermatology of the University Hospital of Treichville. All patients who consulted for onycholysis were interviewed. All samples were analyzed by direct examination and Sabouraud-chloramphenicol and Sabouraud-chloramphenicol-actidione culture was performed. Species identification was based on microscopic characteristics of the fungus observed. RESULTS: A total of 53 patients were included. The prevalence of onychomycosis was estimated at 66%. The unilateral lesions were statistically different from bilateral lesions (P=0.010). Women were more affected at the hands than men (P=0.010). Five species of yeasts and two dermatophytes species were identified. Yeasts species were essentially Candida tropicalis (36.4%) and Candida albicans (30.3%). Trichophyton rubrum and Trichophyton soudanense were the only dermatophytes isolated. No contributing factors were statistically related to the occurrence of onychomycosis in our series. CONCLUSION: The observed onychomycosis in Côte d'Ivoire are mainly caused by yeasts. Although in our series the risk factors have not been identified, hygiene of the nails should provide effective prevention.

Aetiologies and contributing factors of vulvovaginal candidiasis in Abidjan (Cote d'Ivoire).

AIM OF THE STUDY: In order to update the data and contribute to optimizing the management of vulvovaginal candidiasis, we conducted this study to determine their etiology (and hence the sensitivity of the isolated fungal organisms) and the factors contributing to their occurrence in Abidjan (Cote d'Ivoire). PATIENTS AND METHODS: This cross-sectional survey involving 400 women with clinically vulvovaginitis was conducted from May to July 2011. It was carried out at the health centre for venereal diseases located at the National Institute of Public Hygiene in Abidjan. After a swab collecting, direct examination and culture on Sabouraud Chloramphenicol and Sabouraud Chloramphenicol Actidione media were implemented to research yeasts. After identifying yeast species through blastesis tests and auxanogram, its in vitro susceptibility to amphotericin B, 5-fluorocytosine, clotrimazole, miconazole, econazole and ketoconazole was assessed. RESULTS: As a whole, 172 patients suffered from vulvovaginal candidiasis i.e. an overall prevalence of 43%. Candida albicans was most frequently isolated (82.5%) followed by C. glabrata (10.5%). C. albicans and C. tropicalis were resistant to the 5-fluorocytosine (respectively 24.65 and 33.33%). Other molecules have shown excellent activity on all yeasts isolated. Type of housing, type of underwear and patients personal history were statistically associated with the presence of vulvovaginal candidiasis (respectively P=0.003; 0.010; 0.022). CONCLUSION: Vulvovaginal candidiasis is relatively frequent in Abidjan and antifungal compounds are in general still effective for treatment. Being knowledgeable of risk factors for this vulvovaginitis will ensure better prevention of their occurrence.

[Epidemiology of anguillulosis among public school children in Abidjan, Cote d'Ivoire]. / Epidémiologie de l'anguillulose chez les enfants scolarisés à l'école publique à Abidjan (Côte d'Ivoire).

PURPOSE: Strongyloides stercoralis is a neglected soil-transmitted helminth species. In Cote d'Ivoire, as elsewhere, there is a lack of parasitologic and epidemiologic data pertaining to this parasite. The purpose of this study was to evaluate the prevalence and impact of sociodemographic factors on anguillulosis among public school children in Abidjan, Cote d'Ivoire. METHODS: Testing for Strongyloides stercoralis was performed in a random sample of 411 children from 10 public primary schools in Abidjan. Detection methods included direct examination of stool smears, the Baermann test and helminth coproculture study. RESULTS: The overall prevalence of anguillulosis was 2.7% (N=411) (IC95% = 1.34-4.73). The M/F sex-ratio was 1. No correlation was found between prevalence and sex (p = 0.12). Prevalence was higher among children who reported contact with swamps and rivers (respectively 80% and 7.9%) than those who did not report such contact (respectively 1.7% and 1.5%) (p <0.01). CONCLUSION: Contact with swamps and rivers is correlated with an increase in anguillulosis prevalence. Avoiding these areas and proper sanitation could help to reduce the prevalence of anguillulosis in Abidjan.

Etude comparative de l'efficacite et de la tolerance de l'association sulfadoxine-pyrimethamine versus l'association sulfadoxine-pyrimethamine dans le traitement du paludisme simple en zone d'endemie

En depit des efforts deployes a travers plusieurs initiatives internationales; le paludisme constitue toujours un veritable probleme de sante publique. La prise en charge des cas de la maladie s'est compliquee avec l'emergence et l'extension des resistances de plasmodium Falciparum aux antipaludiques usuels. Parmi les strategies de lutte; outre la prise en charge des cas; la prevention reste l'element majeur. La moustiquaire impregnee d'insecticides est une composante de la strategie de lutte antivectorielle. La chloroquine; utilisee il y a quelques annees dans la chimioprophylaxie chez la femme enceinte a ete abandonnee du fait de niveaux de resistance devenus trop eleves. Elle est desormais remplacee par l'association sulfadoxine-pyrimethamine en traitement preventif intermittent (TPI).Cependant; il est urgent aujourd'hui de trouver une alternative a cet antipaludique; en raison de taux de resistances de Plasmodium Falciparum en augmentation. Aussi; avons-nous juge opportun de mettre en ouvre une etude comparee de l'efficacite et de la tolerance de l'association sulfalene-pyrimethamine ou metakelfin (MK) et de l'association sulfadoxine-pyrimethamine (SP); molecule de reference dans le TPI de la femme en ceinte. L'etude; multicentrique; randomisee; comparative; s'est deroulee simultanement au Cameroun; en Cote d'Ivoire et au Senegal durant la seconde semestre de l'annee 2005. La methodologie OMS d'etude de l'efficacite des antipaludiques a ete utilisee. Au total; 444 patients ont ete inclus dans cette etude. L'efficacite des deux medicaments etaient comparable; avec des taux de reponses cliniques et parasitologiques adequat respectifs de 92pour l'association sulfalene-pyrimethamine et 92;1pour l'association sulfadoxine-pyrimethamine apres correction PCR. La tolerance dans les deux groupes de traitement etait egalement comparable. L'association sulfalene-pyrimethamine pourrait etre utilisee dans le TPI chez les femmes enceinte; ce qui pourrait diminuer la pression exercee sur l'association sulfadoxine-pyrimethamine

Comparaison of Clinical and Parasitological Responses to Sulfalene-Pyrimethamine plus Amodiaquine versus Amodiaquine plus Artesunate in the Treatment of Uncomplicated Malaria in Endemic Areas in Africa

Despite all the effort expended in the context of diverse international programmes; malaria still represents a massive public health problem. The treatment of patients has been complicated by the emergence and spread of Plasmodium Falciparum resistant to the regular antimalarial drugs. Thus research has focused on the identification of more effective but safe treatment modalities; notably drug combination. In this context; we have investigated the efficacy and safety of a novel combination; namely sulfalene/ pyrimethamine plus amodiaquine; by comparing it to amodiaquine plus artesunate (a combination recently adopted as first-line treatment in many countries). The randomized; multicentre; comparative study was conducted simultaneously in Cameroon and Cote d'Ivoire in the first six months of 2005. WHO methods for the evaluation of the efficacy of antimalarial drugs was used and a total of 467 patients were included. The two regime comparably effective with a clinical and parasitologic response rate of 97for sulfalene/pyrimethamine plus amodiaquine compared with 98.1for artesunate plus amodiaquine after PCR correction. Tolerance was also comparable in both groups

[Intestinal helminthiasis in school background in six towns of southwestern Côte d'Ivoire]. / Helminthoses intestinales en milieu scolaire dans six villes du sud-ouest de la Côte d'Ivoire.

A coproparasitological investigation was conducted in six towns located in the humid dense forest area of South West Côte d'Ivoire in order to determine the prevalence of intestinal helminthosis. During this study faeces of 2220 school children aged from 4 to 15 years old were analysed by four coprological techniques: direct analysis, Kato, Baermann and Graham methods. The overall prevalence rate of intestinal helminthosis in school children in the area is 37.9%. Male subjects are more infested than females. The more frequent parasite species were: hookworm (17%), Ascaris lumbricoides (10.8%), Trichuris trichiura (8.9%) and Enterobius vermicularis (7.2%).

[Evaluation of the therapeutic efficacy of amodiaquine versus chloroquine in the treatment of uncomplicated malaria in Abie, Côte-d'Ivoire]. / Evaluation de l'efficacité thérapeutique de la chloro- quine versus amodiaquine dans le traitement du palu- disme simple a Abié, Côte-d'Ivoire.

The WHO 14-days' test and an in vitro survey were carried out to study the efficacy of amodiaquine versus chloroquine in Abie, a hyperendemic village in the southern forest area of Côte-d'Ivoire. One hundred and nineteen children less than 15 years old suffering from uncomplicated malaria were randomised. Among these, 62 were given amodiaquine treatment and 57 chloroquine treatment. both 4-aminoquinoleines were administered at the same dose of 30 mg/kg spread over three days by 10 mg/kg/day. Before the drug was administered, parasites were taken from some patients of each group and were evaluated in vitro to both drugs. In vivo, the amodiaquine treatment shows 95% of clinical success, 2% of early clinical failures and 3% of late clinical failures. For the chloroquine treatment, the rates are respectively. 79%, 7% and 14%. However, some patients still had a level of parasitaemia for both treatments but were asymptomatic. These parasites were found to be resistant in vitro. The authors recommend that the treatment to be used in Abie must be firstly amodiaquine followed by sulfadoxine-pyrimethamine in cases where there is persistent asymptomatic parasitemia.

[Efficacy of chloroquine in treatment of non-complicated malaria with Plasmodium falciparum in children at the San Pedro dispensary in Côte d'Ivoire]. / Effcacité thérapeutique de la chloroquine dans le traitement du paludisme simple dû à Plasmodium falciparum chez les enfants du dispensaire de San Pedro en Côte d'Ivoire.

A survey has been carried out in south-west of Côte d'Ivoire in order to study chloroquine resistance in treatment of malaria according to 14 days protocol of WHO (World Health Organisation) (1996) for evaluation of antimalarial drugs activity; 63 children, aged from 6 months to 15 years and suffering from noncomplicated malaria due to Plasmodium falciparum, received by oral way 25 mg/kg of chloroquine over three days (10-10-5). During the survey, they were subjected to a clinic and parasitologic (thick and thin blood film) follow up. We obtained, for 51 children (81%), a satisfactory clinical answer, for 8 children (13%) an early therapeutic failure and for the other 4 (6%) a late therapeutic failure. Moreover, we obtained 40% of failure in children of less than 24 months old, 25% between 24 months and 59 months and 7% beyond 6 years old.

[Cryptosporidiosis and isosporiasis in children suffering from diarrhoea in Abidjan]. / Cryptosporidiose et isosporose dans les diarrhées infantiles à Abidjan.

A parasitological survey on intestinal coccidia, Cryptosporidium sp and Isospora belli, has been carried out in paediatric service of an teaching hospital in the district of Abidjan (Côte d'Ivoire). 130 children under 5 years old suffering from diarrhoea have been enrolled. Direct stools examination method, simplified Ritchie technique and Ziehl Neelsen modified coloration were used for analysis. Moreover, the AIDS serological status of the patients has been determined. The results show that Cryptosporidium sp and Isospora belli were found respectively with a prevalence of 7.7% and 3.9%. Only one case of mixed infestation between theses two parasites has been found. Coccidia were the most recurrent parasites found in diarrhoea after flagellates. Parasitism by coccidia was not related to AIDS serological status of the children. These results point out the necessity to make common coccidian parasitical diagnosis in children under 5 years old suffering from diarrhoea.

[In vivo sensitivity of Plasmodium falciparum to amino-4-quinolines and sulfadoxine pyrimethamine in Agou (Ivory Coast)]. / Sensibilité in vivo de Plasmodium falciparum aux amino-4 quinoléines et à la sulfadoxine pyriméthamine à Agou (Côte d'Ivoire).

A comparative study of the in vivo sensitivity of Plasmodium falciparum to amodiaquine versus chloroquine has been made among children in Agou (south Côte d'Ivoire). In case of resistance to these drugs, the association of sulfadoxine-pyrimethamine was administered and followed by a J14 checking. We have noticed: (1) 8.47% of amodiaquine resistance versus 36.96% of chloroquine resistance (all these resistances are from type II), (2) a good clinical efficiency of the 4 amino quinolines. Only 1.69% of the subjects having resistant stocks to amodiaquine have gone feverish down to J7 whereas 10.47% of subjects have clinically resisted to chloroquine, (3) a good tolerance of drugs and an excellent clinical and parasitological efficiency of the second intention treatment. These data are in favour of using first the 4 amino quinolines (particularly the amodiaquine) in the treatment of simple bout of malaria to Plasmodium falciparum in this region. In case of resistance to these drugs, we recommend the combination sulfadoxine-pyrimethamine.

[Comparative study of four malaria diagnostic techniques used in Ivory Coast]. / Etude comparative de quatre techniques de diagnostic biologique du paludisme utilisées en Côte d'Ivoire.

The biological diagnosis of malaria plays an important part in the patients' treatment for malaria. Thus, many techniques have been developed to reach this purpose. We have compared four of them concerning 196 patients from October, 1996 to January, 1997 in Abidjan. Thick blood film has been chosen as the technique for reference. It has come out that the plasmodic index was 18.3%. The Plasmodium falciparum has been the only encountered species. The different sensitivities of the QBC test and of the Parasight F test reached 100% against 83.3% in the case of the thin blood film. The QBC test and the thin blood film had each a specificity of 100% against 88.1% for the Parasight F test. Unlike the QBC test, the thick blood film and the thin blood film have remained the most difficult to be realised. Therefore, the analysis of parameters of credibility (sensitivity, specificity), predictable values and the time involved will allow in a given situation to use the appropriate biological diagnosis technique.

[Influence of socioeconomic conditions on the occurrence of intestinal helminthiases. Study of 1001 students in Abidjan (Ivory Coast)]. / Influence des conditions socio-économiques sur la survenue des helminthiases intestinales. Etude réalisée chez 1001 enfants d'âge scolaire à Abidjan (Côte d'Ivoire).

We report the results of epidemiological research carried out using a sample of 1,001 children between the ages of 4 and 15 in the city of Abidjan. The aim of the study was to explore the relationship between socioeconomic conditions and the occurrence of intestinal helminthiasis. The variables evaluated in this study were the monthly income of the parents, daily food budget per person, number of people sharing accommodation, availability of running water and electricity, availability of food near schools and regular anti-parasite treatment.