Assessment of Suspected COVID-19 Deaths in Nonhealthcare Settings in Côte d'Ivoire, March 11 to July 31, 2020.

According to hospital records, 5 months after reporting its first case of COVID-19, Côte d'Ivoire reported only 102 deaths. We conducted a community mortality survey in the 13 districts where 95% of COVID-19 cases were reported to assess COVID-19 mortality in nonhealthcare settings. To identify suspected COVID-19 deaths in communities, we used data from social and administrative institutions, such as police and fire departments, funeral homes, and places of worship, whose functions include providing services related to deaths. Our survey identified 54 (17.6%) suspected COVID-19 deaths, which is more than half of the official reported number. Our study showed that in areas with low access to healthcare and poorly functioning death notification and registration systems, community-based data sources could be used to identify suspected COVID-19 deaths outside of the health sector. They can provide early warning data on events, such as an unusual number of community deaths or diseases.

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.

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.

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.

[Seroprevalence of HIV infection in the context of a mobile counseling and voluntary testing strategy in rural areas of Côte d'Ivoire]. / Séroprévalence de l'infection à VIH en conseil et dépistage volontaire par stratégie mobile en Zone rurale en Côte d'Ivoire.

INTRODUCTION: In Côte d'Ivoire, HIV testing and counselling has been identified as a priority in the National 2006-2010 AIDS Strategic Plan, which is designed to evaluate the prevalence of HIV in rural areas measured by means of a mobile strategy. METHODS: We conducted a cross-sectional descriptive and analytical study from 1st April, 2007 to 31st March 2008 in six rural areas of Côte d'Ivoire: Dabou, San Pedro, Abengourou, Tanda, Daloa, and Soubré*. The study population consisted of subjects attending the mobile voluntary counselling and testing units. RESULTS: The mean prevalence of HIV infection in this study was 5.30%. The mean prevalence rate in men was 5.26%, with a peak of 7.55% in the 30-34 years age-group. The mean prevalence rate in women was 5.35%, with a peak of 6.59% in the same age-group. Type HIV-1 was predominant (84.2% of the total). The most affected area was Dabou, with a rate three times higher (15.83%) than the average rate observed during the study. More educated people (university level) presented 3.5-fold (for men) or 6-fold (for women) higher infection rates than illiterate people. Although 100% of people who tested positive received a medical or community referral according to their specific needs, only 62.1% were first-line referred for medical care. CONCLUSION: In the light of the results of this study, we believe that community mobilization must be redirected to the most severely affected populations to facilitate earlier diagnosis. Actions such as training and prevention based on communication to encourage changes of behaviour should therefore be priorities in the national counselling and testing programme.

[Epidemiology of induced abortion in Côte d'Ivoire]. / Épidémiologie des avortements provoqués en Côte d'Ivoire.

The objective of this study was to examine induced abortion in Côte d'Ivoire. A nationwide cross-sectional descriptive study of induced abortion was carried out in 2007 among 3,057 women aged 15-49 years. The study showed that induced abortion is a widespread practice in Côte d'Ivoire, with a prevalence estimated at 42.5%. The women who had undergone an abortion were generally under 25, unmarried, and illiterate, and had used contraception. More than half (52.1%) of all induced abortions were performed at home by traditional abortionists or were self-induced with plants or decoctions. The main reasons for induced abortion were concern about the reaction of parents (27.7%), age (22.2%), a lack of financial resources (21.3%) and the desire of women to continue their education. More than half of the participants (55.8%) stated that they had suffered complications, which were more common after a home abortion than after a hospital abortion. Political and legal measures or reforms aimed at changing abortion laws in Côte d'Ivoire and better access to family planning are required in order to prevent or treat the social issue of induced abortion.

[Adherence to rabies vaccine treatment for people exposed to rabies in Abidjan (Côte d' Ivoire)]. / Observance du traitement vaccinal antirabique chez les sujets exposés à la rage à Abidjan (Côte d'Ivoire).

This descriptive retrospective study ran from August 2003 to December 2003 at the Rabies Center of the National Institute of Public Health in Abidjan. It covers subjects at risk of rabies transmission during 2004. Identification of participants in the study was made via a census of patients consulting the rabies clinic: a total of 533 subjects were included, predominantly male (54.6%), without gainful employment (57%), with an average age of 26.7 years. Those who lived outside the city of Abidjan accounted for 21.6%. In 88.2% of cases, they were exposed due to a bite. Dogs (90.8%) represented the main species responsible for this kind of exposure. Only 3.2% of these animals had a current valid rabies vaccine. The owner of the animal was not known in 71% of cases. The observance of the recommended immunization schedule for 4 doses was 53.1%. Of the 533 patients registered in the study, 46.9% had stopped treatment vaccine. Some factors have been identified as adversely affecting adherence, such as the vaccination treatment plan of 5 doses, exposure outside the city of Abidjan, unemployment, incurrence of superficial injuries, exposure from an animal bite and lack of immunization of the animal. The results show that the strategies against rabies must focus increasingly on the importance of adherence to treatment and education of the population vis-à-vis the risk of rabies.