Assessing Institutional Stakeholders' Perception and Limitations on Coping Strategies in Flooding Risk Management in West Africa.

Despite efforts at the national and international levels to mitigate adverse effects of climate change on the environment and human health in developing countries, there is still a paucity of data and information concerning stakeholder's engagement and their level of collaboration, responses and assistance in West Africa. This study aimed at assessing the perception of institutional stakeholders and limitations on coping strategies in flooding risk management in Abidjan (Côte d'Ivoire) and Lomé (Togo). Using a transdisciplinary framework, the methodological approach basically relied on qualitative data collected through desk review and key informant interviews with various stakeholders, covering a range of topics related to flooding risk. Findings show that flooding experiences cause serious environmental and health problems to populations. Poor hygiene practices and contacts with contaminated water are the main causes of risks. Collaboration between stakeholders is limited, reducing the efficiency of planned interventions. Furthermore, health risk prevention strategies are still inadequately developed and implemented. Findings also show limited capacities of affected and displaced people to cope and plan for their activities. Engaging various stakeholders in the health risk prevention plans is likely to improve the efficiency of coping strategies in flooding risk management in West Africa.

Combining multi-criteria decision analysis with GIS approaches for decentralized organic wastes composting plants site selection in Tiassalé, Southern Côte d'Ivoire.

In recent years, decentralized composting appeared as one of the most appropriate treatment options for organic waste valorization in low- and middle-income countries. In Cote d'Ivoire, a pilot project has proved the feasibility of organic municipal solid waste composting for the city of Tiassalé. However, numerous issues still need to be addressed for the establishment of a sustainable decentralized composting system in this city. One of the key issues is site selection. Until now, there is no clear model for such plant site selection. In this study, multi-criteria decision analysis (MCDA) and geographical information system (GIS) approaches were combined to develop an appropriate model for selecting decentralized composting sites in the city of Tiassalé. The methodology used involved two different and complementary phases. First, MCDA and GIS techniques were used to identify the most suitable site areas. Seven criteria clustered in three main factors (environmental, social and economic), and five constraints were considered in the analysis process. Second, five sites were selected within the most suitable areas after a basic field visit and ranked using the Analytic Hierarchy Process. The results showed that the most suitable spaces for decentralized composting plant siting represent only 2.6% of the study area. The investigation yielded on the selection of the two best options for decentralized composting plant siting for the city of Tiassalé. This study proved that the combination of MCDA and GIS is a practical and efficient method to identify suitable sites for decentralized composting plants.

Material Flows and Greenhouse Gas Emissions Reduction Potential of Decentralized Composting in Sub-Saharan Africa: A Case Study in Tiassalé, Côte d'Ivoire.

Despite many composting initiatives implemented in recent years throughout Sub-Saharan Africa, there is yet a lack of data on material flows and the potential contribution of decentralized composting towards greenhouse gas (GHG) mitigation. This study fills this gap assessing flows, emissions reduction and other environmental benefits of decentralized composting, based on a pilot composting facility implemented in the municipality of Tiassalé in Côte d'Ivoire. Primary data collected at the site were visualized with the STAN version 2.6 software developed at the Vienna University of Technology (Austria), for material flows, while carbon emissions reduction was estimated using the UNFCCC methods. Results show that in 2017, from the 59.4 metric tons of organic waste processed by this pilot station, 14.2 metric tons of mature compost was produced, which correspond to 24% of the input mass (on wet weight basis). On dry weight basis, mature compost represents 36% of the input mass. The nutrient content of the compost is in line with data from literature on sub-Saharan African compost, and heavy metal contamination fulfils both French and German compost standards. Concerning the GHG emissions reduction potential, the results show that with this composting scenario, 87% of the baseline emissions occurring in open dumping can be avoided.

Are schoolchildren less infected if they have good knowledge about parasitic worms? A case study from rural Côte d'Ivoire.

BACKGROUND: Parasitic worms (helminths) are common infections in low- and middle-income countries. For most helminth species, school-aged children are at highest risk of infection and morbidity, such as impaired cognitive and physical development. Preventive chemotherapy is the current mainstay for helminthiases control. Sanitation improvement and hygiene-related education are important complementary strategies, which act by altering children's behaviour. However, little is known about the effect of improved knowledge on the risk of helminth infection. The aim of this study was to assess the potential influence of knowledge that children acquired at home or in school, without any specific health education intervention, on helminth infections. METHODS: In May 2014, we conducted a cross-sectional survey in western Côte d'Ivoire. A total of 2498 children, aged 9-12 years, were subjected to three consecutive stool examinations using duplicate Kato-Katz thick smears to determine infections with soil-transmitted helminths and Schistosoma mansoni. Additionally, children were interviewed to assess their knowledge about helminth infections. Four knowledge scores were constructed by factor analysis; one, reflecting general knowledge about helminths and three manifesting helminth species-specific knowledge. The effect of general and specific knowledge on children's helminth infection status was determined using meta-analysis. RESULTS: Children who scored high in the hookworm-specific knowledge were less likely to be infected with hookworm but no association was found for the other helminth species. Moreover, greater general knowledge was not associated with lower odds of being infected with any helminth species. Most of the children interviewed believed that the effect of preventive chemotherapy is permanent, and hence, re-treatment is not necessary. CONCLUSIONS: Specific knowledge about different types of helminths might not suffice to induce behavioural change which in turn reduces infection and reinfection with helminths. Health education interventions should strive to strengthen the perception of risk and to clarify the true benefit of preventive chemotherapy.

Barriers to access improved water and sanitation in poor peri-urban settlements of Abidjan, Côte d'Ivoire.

Achieving access to safe water and sanitation still pose major challenges in urban areas of sub-Saharan Africa countries, despite all the progress achieved in the last decade. This study assessed the ability of populations living in poor peri-urban settlements to access improved water and sanitation and identified factors influencing this access, in order to guide sustainable mitigating solutions to address associated health and environmental risks. We conducted a cross-sectional study in six poor peri-urban settlements of Yopougon, the largest municipality of Abidjan. A total of 556 randomly selected households were included. The factors associated with access to improved water and sanitation were identified through explanatory models using multivariate logistic regression. A proportion of 25% of all households assessed did not have access to clean water and 57% lacked improved sanitation. Socioeconomic status and settlement characteristics appear as the main indicators of poor access to reliable water and sanitation in peri-urban settlements. The presence of the household head's wife at home was associated with greater access to clean water (OR = 3.57; 95% CI: 1.74, 7.31), thus highlighting the important role of women in ensuring access to clean water in these specific environments. Household size, education and religion were not significantly associated with the two considered outcomes. Women therefore should be involved at all levels of programming in water promotion in these settlements to improve the population's well-being. While religion does not appear to play an important role in access to water and sanitation, successful interventions should involve religious communities because of their large representation.

An Integrated Approach to Control Soil-Transmitted Helminthiasis, Schistosomiasis, Intestinal Protozoa Infection, and Diarrhea: Protocol for a Cluster Randomized Trial.

BACKGROUND: The global strategy to control helminthiases (schistosomiasis and soil-transmitted helminthiasis) emphasizes preventive chemotherapy. However, in the absence of access to clean water, improved sanitation, and adequate hygiene, reinfection after treatment can occur rapidly. Integrated approaches might be necessary to sustain the benefits of preventive chemotherapy and make progress toward interruption of helminthiases transmission. OBJECTIVE: The aim of this study was to assess and quantify the effect of an integrated control package that consists of preventive chemotherapy, community-led total sanitation, and health education on soil-transmitted helminthiasis, schistosomiasis, intestinal protozoa infection, and diarrhea in rural Côte d'Ivoire. METHODS: In a first step, a community health education program was developed that includes an animated cartoon to promote improved hygiene and health targeting school-aged children, coupled with a health education theater for the entire community. In a second step, a cluster randomized trial was implemented in 56 communities of south-central Côte d'Ivoire with 4 intervention arms: (1) preventive chemotherapy; (2) preventive chemotherapy plus community-led total sanitation; (3) preventive chemotherapy plus health education; and (4) all 3 interventions combined. Before implementation of the aforementioned interventions, a baseline parasitologic, anthropometric, and hygiene-related knowledge, attitudes, practices, and beliefs survey was conducted. These surveys were repeated 18 and 39 months after the baseline cross-sectional survey to determine the effect of different interventions on helminth and intestinal protozoa infection, nutritional indicators, and knowledge, attitudes, practices, and beliefs. Monitoring of diarrhea was done over a 24-month period at 2-week intervals, starting right after the baseline survey. RESULTS: Key results from this cluster randomized trial will shed light on the effect of integrated approaches consisting of preventive chemotherapy, community-led total sanitation, and health education against infections with soil-transmitted helminths, schistosomes, an intestinal protozoa and prevention of diarrhea in a rural part of Côte d'Ivoire. CONCLUSIONS: The research provided new insights into the acceptability, strengths, and limitations of an integrated community-based control package targeting helminthiases, intestinal protozoa infections, and diarrhea in rural communities of Côte d'Ivoire. In the longer term, the study will allow determining the effect of the integrated control approach on infection patterns with parasitic worms and intestinal protozoa, diarrheal incidence, anthropometric measures, and hygiene-related knowledge, attitudes, practices, and beliefs. TRIAL REGISTRATION: International Standard Randomized Controlled Trial Number (ISRCTN): 53102033; http://www.isrctn.com/ISRCTN53102033 (Archived by WebCite at http://www.webcitation.org/6wpnXEiHo). REGISTERED REPORT IDENTIFIER: RR1-10.2196/9166.

Epidemiology of intestinal parasite infections in three departments of south-central Côte d'Ivoire before the implementation of a cluster-randomised trial.

Hundreds of millions of people are infected with helminths and intestinal protozoa, particularly children in low- and middle-income countries. Preventive chemotherapy is the main strategy to control helminthiases. However, rapid re-infection occurs in settings where there is a lack of clean water, sanitation and hygiene. In August and September 2014, we conducted a cross-sectional epidemiological survey in 56 communities of three departments of south-central Côte d'Ivoire. Study participants were invited to provide stool and urine samples. Stool samples were examined for helminth and intestinal protozoa infections using the Kato-Katz technique and a formalin-ether concentration method. Urine samples were subjected to a filtration method for the diagnosis of Schistosoma haematobium. Information on sociodemographic characteristics, knowledge, attitude, practices and beliefs with regard to hygiene, sanitation and intestinal parasitic diseases were collected using a questionnaire administered to household heads. Multivariable logistic regression models were employed to analyse associations between parasite infections and risk factors. Overall, 4,305 participants had complete parasitological and questionnaire data. Hookworm was the predominant helminth species (21.2%), while Ascaris lumbricoides, Trichuris trichiura, Schistosoma mansoni and S. haematobium showed prevalences below 10%. Infections with pathogenic intestinal protozoa (e.g. Entamoeba histolytica/E. dispar and Giardia intestinalis) were similarly prevalent in the three departments. Hookworm infection was associated with open defecation and participants' age and sex. Entamoeba coli infection was negatively associated with the use of tap water at home (odds ratio (OR) = 0.66; p = 0.032). Disposal of garbage in close proximity to people's home was positively associated with G. intestinalis (OR = 1.30; p = 0.015). Taken together, helminth and intestinal protozoa infections affected a considerable proportion of rural dwellers in south-central Côte d'Ivoire at the onset of a cluster-randomised intervention trial. Our results will serve as baseline to monitor the effect of a package of interventions, including preventive chemotherapy, sanitation and health education on re-infection with helminths and intestinal protozoa. TRIAL REGISTRATION: ISRCTN53102033 (date assigned: 26 March 2014).

Effect of an integrated intervention package of preventive chemotherapy, community-led total sanitation and health education on the prevalence of helminth and intestinal protozoa infections in Côte d'Ivoire.

BACKGROUND: Preventive chemotherapy with donated anthelminthic drugs is the cornerstone for the control of helminthiases. However, reinfection can occur rapidly in the absence of clean water and sanitation coupled with unhygienic behaviour. The purpose of this study was to assess the effect of an integrated package of interventions, consisting of preventive chemotherapy, community-led total sanitation (CLTS) and health education, on the prevalence of helminth and intestinal protozoa infections and on participants' knowledge, attitude, practice and beliefs (KAPB) towards these diseases including water, sanitation and hygiene (WASH). METHODS: A cross-sectional survey was carried out in nine communities of south-central Côte d'Ivoire to assess people's infection with helminths and intestinal protozoa and KAPB. Subsequently, interventions were targeted to five communities, while the remaining communities served as control. The intervention encouraged latrine construction and an evaluation was done 6-7 months later to determine open defecation status of the respective communities. Anthelminthic treatment was provided to all community members. A follow-up cross-sectional survey was conducted approximately one year later, using the same procedures. RESULTS: Overall, 810 people had complete baseline and follow-up data and were given anthelminthic treatment. The baseline prevalence of hookworm, Schistosoma haematobium, Trichuris trichiura, Schistosoma mansoni and Ascaris lumbricoides was 31.1%, 7.0%, 2.0%, 1.0% and 0.3%, respectively. Four of the five intervention communities were classified open-defecation free. For hookworm infection, we observed higher negative changes in terms of proportion of decrease (-0.10; 95% confidence interval (CI): - 0.16, -0.04) and higher egg reduction rate (64.9 vs 15.2%) when comparing intervention with control communities. For intestinal protozoa, prevalence reduction was higher in intervention compared to control communities (8.2 vs 2.6%) and WASH indicators and intervention outcomes associated with lower odds for infection at follow-up. The intervention significantly impacted on reported latrine use (before: 15.5%, after: 94.6%), open defecation in the community surroundings (before: 75.0%, after: 16.7%) and awareness for environmental contamination through open defecation (before: 20.4%, after: 52.2%). CONCLUSIONS: An integrated package of interventions consisting of preventive chemotherapy, health education and CLTS reduces the prevalence of helminth and intestinal protozoa infection. Additional studies in other social-ecological settings are warranted to confirm our findings.

Microbiological risk infection assessment using QMRA in agriculture systems in Côte d'Ivoire, West Africa.

Poor wastewater management that results from a lack of appropriate sanitation infrastructure contributes to increasing health risks in urban areas in Côte d'Ivoire. We assessed the health risks associated with the use of wastewater for watering salad destined for human consumption, to help local authorities in developing appropriate risk mitigation measures for Yamoussoukro, the political capital of Côte d'Ivoire. We applied a stochastic approach based on quantitative microbiological risk assessment (QMRA), focusing on wastewater for farming activities and salad consumption at the household level. Farming activities rely on a large degree on contaminated water and are conducted without any protection. The QMRA highlights that the poor quality of watering water increased the microbiological risk of the two assessed groups of urban farmers and individual households. The annual risk of infection due to watering wastewater in the city is estimated at 0.01 per person per year (pppy) for Giardia lamblia and 0.2 pppy for Escherichia coli O157:H7. The annual risk from salad consumption is 0.01 pppy for G. lamblia and 0.9 pppy for E. coli O157:H7. Both the annual risks from farming activities and salad consumption were higher than the tolerable standard of risk of 10-4 pppy as defined by the World Health Organization. There is a need to conduct a risk analysis and a cost-effectiveness study on intervention to improve public health and the livelihoods of the producers which are women in majority in Yamoussoukro.

"Koko et les lunettes magiques": An educational entertainment tool to prevent parasitic worms and diarrheal diseases in Côte d'Ivoire.

BACKGROUND: Integrated control programs, emphasizing preventive chemotherapy along with health education, can reduce the incidence of soil-transmitted helminthiasis and schistosomiasis. The aim of this study was to develop an educational animated cartoon to improve school children's awareness regarding soil-transmitted helminthiasis, diarrheal diseases, and related hygiene practices in Côte d'Ivoire. The key messages included in the cartoon were identified through prior formative research to specifically address local knowledge gaps. METHODOLOGY: In a first step, preliminary research was conducted to assess the knowledge, attitudes, practices, and beliefs of school-aged children regarding parasitic worm infections and hygiene, to identify key health messages to be included in an animated cartoon. Second, an animated cartoon was produced, which included the drafting of the script and story board, and the production of the cartoon's initial version. Finally, the animated cartoon was pilot tested in eight selected schools and further fine-tuned. PRINCIPAL FINDINGS: According to the questionnaire results, children believed that the consumption of sweet food, eating without washing their hands, sitting on the floor, and eating spoiled food were the main causes of parasitic worm infections. Abdominal pain, diarrhea, lack of appetite, failure to grow, and general fatigue were mentioned as symptoms of parasitic worm infections. Most of the children knew that they should go to the hospital for treatment if they experienced symptoms of parasitic worm diseases. The animated cartoon titled "Koko et les lunettes magiques" was produced by Afrika Toon, in collaboration with a scientific team composed of epidemiologists, civil engineers, and social scientists, and the local school children and teachers. Pilot testing of the animated cartoon revealed that, in the short term, children grasped and kept key messages. Most of the children who were shown the cartoon reported to like it. Acceptance of the animated cartoon was high among children and teachers alike. The messaging was tailored to improve knowledge and practices for prevention of helminthiases and diarrheal diseases through prior identification of knowledge gaps. Integration of such education tools into the school curriculum, along with deworming campaigns, might improve sustainability of control and elimination efforts against helminthiases and diarrheal diseases.

Ecohealth approach to urban waste management: exposure to environmental pollutants and health risks in Yamoussoukro, Côte d'Ivoire.

Poor waste management is a key driver of ill-health in urban settlements of developing countries. The current study aimed at assessing environmental and human health risks related to urban waste management in Yamoussoukro, the political capital of Côte d'Ivoire. We undertook trans-disciplinary research within an Ecohealth approach, comprised of a participatory workshop with stakeholders and mapping of exposure patterns. A total of 492 randomly selected households participated in a cross-sectional survey. Waste deposit sites were characterised and 108 wastewater samples were subjected to laboratory examinations. The physico-chemical parameters of the surface water (temperature, pH, conductivity, potential oxidise reduction, BOD5, COD, dissolved oxygen, nitrates, ammonia and total Kendal nitrogen) did not comply with World Health Organization standards of surface water quality. Questionnaire results showed that malaria was the most commonly reported disease. Diarrhoea and malaria were associated with poor sanitation. Households having dry latrines had a higher risk of diarrhoea (odds ratio (OR) = 1.8, 95% confidence interval (CI) 1.2-2.7) compared to latrines with septic tanks and also a higher risk for malaria (OR = 1.9, 95% (CI) 1.1-3.3). Our research showed that combining health and environmental assessments enables a deeper understanding of environmental threats and disease burdens linked to poor waste management. Further study should investigate the sanitation strategy aspects that could reduce the environmental and health risks in the study area.

Exposure to toxic waste containing high concentrations of hydrogen sulphide illegally dumped in Abidjan, Côte d'Ivoire.

INTRODUCTION: On August 2006, a cargo ship illegally dumped 500 t of toxic waste containing high concentrations of hydrogen sulphide in numerous sites across Abidjan. Thousands of people became ill. Seventeen deaths were associated with toxic waste exposure. MATERIALS AND METHODS: This study reports on environmental and health problems associated with the incident. A cross-sectional transect study was conducted in five waste dumping site areas. RESULTS: Of the households, 62.1% (n = 502) were exposed to the effects of the pollutants and 51.1% of the interviewed people (n = 2,368) in these households showed signs of poisoning. Most important symptoms were cough (37.1%), asthenia (33.1%), pruritus (29.9%) and nausea (29.1%). DISCUSSION: The health effects showed different frequencies in the five waste impact sites. Among the poisoned persons, 21.1% (n = 532) presented symptoms on the survey day (i.e., 4 months after incident). Transect sampling allowed to determine a radius of vulnerability to exposure of up to 3 km from the point of toxic waste disposal. CONCLUSION: The area of higher vulnerability is influenced by various environmental factors, such as size and severity of pollution site, duration of toxic waste pollution on the impact site and locally climatic conditions. The surveillance of effects on environment and human health is warranted to monitor the development.

[Epidemiologic and clinical aspects of toxic waste poisoning in Abidjan]. / Aspects épidémiologiques et cliniques de l'intoxication par les déchets toxiques dans le district d'Abidjan.

UNLABELLED: In the nights of 19 to 21 August, 2006, highly toxic waste products were dumped at various sites in Abidjan, and numerous cases of poisoning were reported to the health authorities, who were unprepared for such a problem. The research group on Environment and Health in Urban Environment from the Swiss Center of Scientific Research and its partners at the Swiss Tropical Institute undertook this study whose objectives were to: describe the epidemiologic profile of the people poisoned; identify the main clinical symptoms and the risk factors for poisoning; and recommend steps to attenuate the effects and to prevent intermediate- and long-term consequences. METHODOLOGY: This cross-sectional study examined the populations living around the discharge sites (n=6). The sample size was calculated at 619 people per site, to identify a 1% risk and a standard error of 0.4%, because of variability of the human impact factor at the different sites. Households were chosen at each site by the transect technique. Six teams, each including a physician, a public health agent and a local guide collected the data, after specific training. A pilot investigation made it possible to validate the final questionnaire. RESULTS: Of 4573 people surveyed, 4344 people, about 95%, were home during the toxic waste discharge. In all, 2369 (51.8%) had signs of poisoning. Sex, district of residence, and presence at home at the time of the discharge were all statistically related to poisoning. The distribution of poison victims according to health centre shows that 1297 people (64.4%) visited a health center AA(3/4) 615 of them (about 47.4%) a public or official centre, and 778 (about 60%), an unofficial centre; 379 (29.2%) were managed by an NGO, 159 individuals (12.3%) by mobile units, 63 individuals (4.8%) by the unofficial public health centre, and 35 (2.7%) at an unspecified site. Of those who sought care, 673 people (about 51.8%) received a medical prescription, and 815 (or 62.7%) had been given the drug directly, for free. 94 individuals (about 7.2%) chose their own self-medication, and 74 people (5.7%) a traditional treatment. In all, 34 people, about 2.6% of those who sought care, were hospitalized. Of the subjects who went to a health centre, 1421 (72.8%) had a positive course and 532 (27.7%) an unfavourable course. The latter complained especially of respiratory signs, in particular a cough and thoracic pains (21.8%), digestive signs (diarrhoea and abdominal distension, about 21.5%), and cutaneous (pruritus) and neurological (headaches) signs (20.7%). Overall, 532 people (21.%) still presented signs during the investigation. CONCLUSION: This study highlighted the persistence of the symptoms among many of those poisoned more than 4 months afterwards. This phenomenon continues, although the sites have been partially cleaned: the long-term effects on population health remain alarming. Thorough multidisciplinary studies are essential to explore the long-term effects.