[The lessons of the Ebola epidemic for a more effective preparedness face to health crises]. / Les enseignements de l'épidémie d'Ebola pour une meilleure préparation aux urgences.

Although uncommon, public health crises cause considerable human suffering and death and have major political, economic and social impacts. For many years, countries have made considerable efforts to prepare for emergencies. The Ebola epidemic in West Africa, as well as recent events and emerging public health threats force countries to strengthen, adapt or implement their Emergency Preparedness Plans. Emergency Preparedness is a difficult process. Some authors would even say that it is an impossible mission. What do we mean by preparedness ? How can preparedness be evaluated ? What measures must be taken following the Ebola crisis ? Preparedness is one of the Emergency Management phases and is essential to meet the challenges of future crises. Preparedness still constitutes a major challenge for countries and the international community. Based on missions conducted in West Africa and on a review of the literature, the authors review the concepts of emergency preparedness. In particular, they present standards and tools to assess emergency preparedness, using the example of Ebola preparedness assessment in West Africa.

[Quality of immunization data in children aged 0 to 11 months in Côte d'Ivoire]. / Qualité des données de vaccination chez les enfants de 0 à 11 mois en Côte d’Ivoire.

INTRODUCTION: In order to guide the decisions of programme managers, an immunization Data Quality Self-Assessment was performed in Côte d'Ivoire in 2012. This study was designed to assess the accuracy of immunization data and the quality of the immunization tracking system with this tool. METHODS: A descriptive cross-sectional study was conducted in 88 randomly selected immunization facilities from 30 health districts. These structures were included in the study based on the number of children aged 0-11 months who received three doses of vaccine against Diphtheria, Tetanus, Pertussis, Hepatitis B Viral and Haemophilus Influenzae b on the one hand and measles vaccine coverage on the other. This assessment focused on two criteria in particular: accuracy of immunization data measured by the verification factor (VF) and the quality of the immunization tracking system. RESULTS: The accuracy of immunization data was satisfactory at the district level (VF=95%), but not for the health centre level (VF=81%), as 73% of health districts and health centres obtained a satisfactory factor (≥95%).The number of children aged 0-11 months vaccinated differed from one level of the health system to another and from one document to another.The mean quality index was not satisfactory for both the district and health centre levels (64% vs 50%). Only one health district and one health centre obtained a quality index greater than 80%. Furthermore, 93% of health districts and 50% of health centres obtained quality indices ranging from 50% and 80%, respectively.The weakest components at both levels were "supervision and monitoring" and "analysis and use of data". CONCLUSION: The deficiencies in data reporting and the quality of the immunization monitoring system need to be improved by supportive supervision.

[Effect of reproductive health services restructuring on antenatal care at Marcory General Hospital, Ivory Coast]. / Effet de la réorganisation des services sur les consultations prénatales à l’Hôpital Général de Marcory, Côte d’Ivoire.

INTRODUCTION: Improvement of the work environment and staff training are health promotion strategies that can contribute to improving the supply of health care. This study evaluated the effects of reorganization of health services on antenatal care (ANC) activities. MATERIALS AND METHODS: A cross-sectional study was conducted over a period of 4 months in the ANC unit of Marcory General Hospital in Abidjan. The study population was health workers in charge of ANC and pregnant women attending the health facility. Self-administered questionnaires and observation sheets were used to collect data that were analysed with Epi Info 3.5.1 software. results: After reorganization, health workers said they were satisfied with the work environment and the care provided in 91% and 96.9% of cases, respectively. These results were confirmed by all pregnant respondents (100%) attending the centre, who said they were satisfied with the quality of care received. This could explain the ANC 4 coverage rate, which increased from 39.4% in 2010 to 56.7% in 2012 and tetanus vaccination coverage which increased from 59.4% to 87.5%, although the waiting time was still too long. CONCLUSION: This study showed an increase of ANC activity indicators, such as ANC 4 and tetanus vaccination coverage rate, after reorganization of health care services. This strategy could be an opportunity to strengthen ANC services.

[Knowledge, attitudes and practices of household heads regarding rabies in the Abobo district (Abidjan, Côte d'Ivoire) in 2008]. / Connaissances, attitudes et pratiques des chefs de ménage de la commune d'Abobo (Abidjan, Côte d'Ivoire) en matière de rage, en 2008.

INTRODUCTION: In order to investigate the factors predisposing to human rabies in Abobo, we conducted a study to assess the knowledge, attitudes and practices of household heads in this district. MATERIALS AND METHODS: This cross-sectional study was conducted from 13 September to 13 December 2008 and consisted of interviewing, by means of a questionnaire, household heads or their representatives at home. We randomly selected 53 households in each sub-district, with a total of 702 households for the 13 sub-districts. Informed consent was obtained from each participant prior to the interview. Data were analysed using Epi-Info 2000. RESULTS: Of the total of 152 households, 22% had a pet; 109 (71.7%) households had a dog, that was not vaccinated in 38% of cases. Furthermore, 577 (82.19%) of household heads knew about rabies and school was the source of information for 511 households (88.6%). Five hundred fifty five household heads (96.18%) did not know that the wound should be washed with soap and water immediately after exposure and 118 household heads (20.45%) reported that nothing should be done after a bite. After exposure, only 30.70% of household heads would attend a health centre 50 kilometres from home. CONCLUSION: This study shows a good level of knowledge of household heads concerning rabies. However, harmful health practices persist. Public awareness of rabies therefore needs to be reinforced.

[Improvement of the quality of prevention of mother-to-child transmission in Côte d'Ivoire]. / Amélioration de la qualité de la prévention de la transmission du VIH de la mère à l'enfant en Côte d'Ivoire.

OBJECTIVE: This study analysed the impact of improvement collaborative activities on the quality of prevention of mother-to-child transmission of AIDS in 28 health services in Côte d'Ivoire. METHODS: This descriptive, longitudinal, analytical study was based on the main information concerning HIV-infected pregnant women, and the integration and maintenance of HIV-infected subjects in the healthcare system. The study was conducted in 28 heathcare structures of 26 health districts in 12 health areas of Côte d'Ivoire,from January to September 2009. Monitoring of HIV-infected pregnant women and their children was analysed by quality indicators developed in the context of the demonstration phase of the collaborative. RESULTS: This study shows that only 16 (57.1%) out of 28 structures had the 6 PMTCT documents defined in this study. The various quality indicators gradually improved on all sites, from 34.7% to 90.3% of items collected in the PMTCT register; the testing rate of infants born to HIV-positive women increased from 30% to 62.5%. More than 95% of children screened were referred to paediatric care. CONCLUSION: Improvement collaborative approach is important for the improvement of the quality of PMTCT. However, the sustainability of the results of this approach remains the key challenge and will only be possible on the basis of a quality culture of health workers, and greater commitment of authorities.

Effect of gender on the association between weight status and health-related quality of life in adolescents.

BACKGROUND: Some studies have investigated the association between body mass index (BMI) and health-related quality of life (HRQoL) among adolescents, but their results have been discrepant and few paid attention to the role of gender. The present investigation aimed to assess the relationship between weight status and HRQoL in adolescents and to verify whether it was similar in boys and girls. METHODS: Five thousand two hundred and twenty six adolescents aged 14 to 18 years were included in the PRomotion de l'ALIMentation et de l'Activité Physique (PRALIMAP) trial, a 2x2x2 factorial cluster randomized trial performed in 24 high schools in France. Sociodemographic, anthropometric and HRQoL data were collected. BMI was categorized in four classes (thin, normal-weight, overweight, obese). Linear regression models were used to estimate the association between weight status and HRQoL, adjusting for confounders. RESULTS: The mean age of adolescents was 15.7±0.6 years and their mean BMI was 21.6 ±3.5 kg/m2; 55% were girls. Boys were more often overweight and obese than were girls (overweight: 15.6% vs 14.2%, obese: 4.8% vs 3.3%), and girls were more likely to be thin (5.5% vs 4.5%, p=0.0042). All HRQoL scores were higher for boys (p=<0.0001). Weight status was not associated with physical and social scores neither in boys nor in girls. Conversely, it was associated with mental score, but differently in girls than boys. As compared with normal-weight girls, thin girls had better mental HRQoL (ß=+6.17, p=0.0010), and overweight and obese girls had lower mental HRQoL (ß=-3.89 and ß=-5.90, respectively, p<0.001). Mental HRQoL was lower for thin, overweight and obese boys than for normal-weight boys (ß= -4.97, ß= -1.68 and ß= -3.17, respectively, p<0.0001). CONCLUSIONS: Gender can modify the association between weight status and HRQoL in adolescents. Body image could be an important target of public health programs to improve subjective health during adolescence.

[The epidemiological profile of subjects exposed to rabies in Abidjan, Ivory Coast]. / Profil épidémiologique des personnes exposées à la rage à Abidjan, Côte d'Ivoire.

The purpose of this study is to describe the epidemiological profile of subjects exposed to rabies in the anti-rabies center of Abidjan in Ivory Coast. The paper is based on a cross-sectional study conducted among all people exposed to the risk of rabies and followed in the anti-rabies center from January to December 2008. During the study period, 2,673 subjects were exposed, i.e. 5 exposures for every 10,000 persons. 1,534 patients (57.4%) were male. The most exposed age groups were the 0-9 and 10-19 age groups (22.4% and 29.5% respectively). In Abidjan, 608 individuals (22.7%) were exposed in Cocody, 471 individuals (17.6%) in Abobo, and 310 individuals (11.6%) in Yopougon. Exposure occurred in 76.9% of cases (2,055 subjects) at home and exclusively concerned visitors of the family. Exposures by animal bites represented 88.1% (2,354 subjects) of all cases, while 23.2% (620 subjects) of exposures were category III. The average period between exposure and consultation was 10 days. Subjects were exposed as a result of contact with a dog in 92.1 % of cases (2,462 subjects). The animal was found alive in 74.9% (2,002 cases) and was not immunized in 87.2% of cases (2,331). Post-exposure prophylaxis was given up by 1,470 persons (55.2%). 13 subjects were received at the stage of clinical rabies. Increased knowledge of the epidemiological profile of rabies exposure will contribute to improving the management of the disease in Ivory Coast.