Rabies burden in Côte d'Ivoire.

BACKGROUND: In Côte d'Ivoire, just as in the majority of developing countries, rabies cases are underestimated. The official data are based on passive surveillance studies which cannot provide true estimates. Therefore, the economic and health burden of rabies is underestimated. To be able to better estimate the true burden of rabies, this study looked at surveillance data of bite records and household survey. METHODOLOGY: The data was collected from a cross-sectional survey of 8004 households, of which 4002 were in the Department of Bouaké and 4002 in the Department of San Pedro. Further data was collected from Human Rabies control centres and from the respective veterinary services. We estimate the burden of rabies through data from the bites surveillance records. Human deaths from rabies were estimated using a series of probability steps to determine the likelihood of clinical rabies in a person after being bitten by a suspected rabid dog. Monte Carlo simulations of a series of interconnected probabilities were used to estimate the rabies burden in the country. RESULTS: The number of deaths from rabies was estimated at 637deaths per year [95% CI 442-849] and human mortality from rabies was estimated at 2.61 per 100'000 [95% CI 1.81-3.56], which represents 24-47 times more cases than the official data. Deaths due to rabies are responsible for 23,252 Disability Adjusted Life Years (DALY) lost each year [95% CI 16,122-30,969]. The estimated annual cost of rabies is 40.15 million USD [95% CI 27.8-53.4]. Overall, 99% of the cost was due to premature deaths. The cost of post-exposure prophylaxis was estimated at 1.6 million USD and represented 1% of the overall cost of rabies. CONCLUSION: This study highlights the underreporting of rabies cases by the official health information system in Côte d'Ivoire and the annual financial losses related to rabies are equivalent to the estimated cost of the elimination of rabies by 2030. Thus, investing in the fight against in Côte d'Ivoire will be cost effective.

From reverse innovation to global innovation in animal health: A review.

Reverse innovation refers to learning from or diffusion of innovations developed in low income settings and further translated to industrialized countries. There is lack of consensus regarding terminology, but the idea that innovations in low-income countries are promising for adoption in high-income contexts is not new. However, in healthcare literature globally, the vast majority of publications referring to 'disruptive innovation' were published in the last ten years. To assess the potential of innovative developments and technologies for improving animal health, we initiated a literature review in 2020. We used a combined approach, incorporating targeted searching in PubMed using a key word algorithm with a snowball technique, to identify 120 relevant publications and extract data for qualitative coding. Heterogeneity of articles precluded meta-analysis, quality scoring and risk of bias analysis. We can distinguish technical innovations like new digital devices, diagnostic tests and procedures, and social innovations of intersectoral cooperation. We profile two case studies to describe potential global innovations: an integrated surveillance and response system in Somali Regional State, Ethiopia and a blockchain secured One Health intervention to optimally provide post-exposure prophylaxis for rabies exposed people in West Africa. Innovation follows no borders and can also occur in low-income settings, under constraints of cost, lack of services and infrastructure. Lower administrative and legal barriers may contribute to produce innovations that would not be possible under conditions of high density of regulation. We recommend using the term global innovation, which highlights those emanating from international partnership to solve problems of global implications.

Rabies surveillance-response in Mali in the past 18 years and requirements for the future.

CONTEXT: Rabies is endemic in Mali, but little is known about the distribution of rabies and its surveillance across the country. Documenting the evolution of rabies and the problems related to surveillance is useful to facilitate elimination of human rabies by 2030. METHOD: Data collected at the Central Veterinary Laboratory (LCV) from 1999 to 2017 and through the surveillance system functioning at household, health and veterinary structure levels, as established by the Global Vaccine Alliance funded project on the burden of rabies, between 2016 and 2017 in Bamako and the Sikasso region were used in this study. All data on animals examined for rabies by the direct fluorescence antibody test (DFA) during the specified time period were summarized, and the proportion of rabies positive tested among animals suspected of rabies was estimated. From the number of dogs tested positive for rabies, a cumulative incidence was estimated for the total canine population. The number of positive tested samples was divided by the product of the estimated canine population and number of years (18). In addition, the number of human rabies cases was analyzed to estimate a cumulative incidence. RESULTS: Among all animal samples suspected for rabies, 93.2% [95% CI 90.6-95.3] were positive by the DFA test. From the 486 included animal samples, 94.7% [95% CI 92.3-96.5] were domestic dogs with 90.9% [95% CI 87.9-93.3] positive, which stands out as the main reservoir of rabies in Mali. Cats, cattle, sheep and donkeys also tested positive using the DFA test. The cumulative incidence of canine rabies was estimated at 0.371 [95% CI: 0.336-0.408] / 10'000 dogs. The highest incidence was observed in Bamako, the capital of Mali, with a cumulative incidence of 2.242 [95% CI: 2.001-2.504] / 10'000 dogs, followed by Koulikoro with 0.335 [95% CI: 0.258-0.429] / 10'000 dogs. For other areas far from LCV, the cumulative incidence was low, with zero in Kidal. Nationally reported cases of human rabies declined in recent years with an average of 12.6 [95% CI: 8.7-16.5] deaths per year. This result gives an annual incidence of 0.1047 [0.0742-0.1352] / 100'000 inhabitants. CONCLUSION: Over the past 18 years, rabies is endemically stable in Mali despite the decrease in reported human cases. The disparity among regions in number of samples tested indicates a low level of clinical and laboratory surveillance and likely a high level of underreporting. Dogs play the main role in rabies transmission in Mali. Monitoring of and decisions for post-exposure prophylaxis (PEP) includes other animals (cats, cattle, and monkeys) involved in transmission. Mali should develop a national rabies strategy to include better communication between the public health and animal health sectors, strengthening of laboratory surveillance capacity, mass vaccination of dogs and guaranteed access to PEP.

Burden of rabies in Mali.

Rabies is the most dreaded neglected zoonosis worldwide. It affects mostly developing countries with limited access to post-exposure prophylaxis and a low coverage of dog vaccination. OBJECTIVE: This study estimates the burden of human rabies in Mali from the extrapolation of animal bite surveillance, mostly dogs, in the region of Sikasso and the District of Bamako in 2016 and 2017. MATERIAL AND METHODS: Monte Carlo simulations of a series of interconnected probabilities were used to estimate the burden of rabies. The data was collected from cross-sectional surveys of 8775 households of which 4172 were in the District of Bamako and 4603 in the region of Sikasso. Further data was collected in health centres and from the respective veterinary services. RESULTS: We estimate that in the year 2016 133 [95% Confidence Interval (95%CI) 87-186] people died and that 5'366 [95%CI 3'510-7'504] years of life (YLL) were lost and in 2017 et 136 [95%CI 96-181] people died and that 5530 [IC 95% 3'913-7'377] YLLs were lost. The loss of income was estimated at 3.2 million USD [95%CI 2,1-4,5] en 2016, and 3,3 million USD [95%CI 2,3-4,4] in 2017. This represents the highest financial loss from rabies, followed by the cost of postexposure prophylaxis (PEP) of 86'848 $USD and 89'371 $ USD respectively. From the whole cost of rabies in Mali, 92% of the cost in 2016 and 94% of those in 2017 were attributable to premature mortality and the cost of help seeking. The proportion of cost of PEP was 3% in 2016 and 2017 of the total cost of disease. The cost related to dog vaccination changed from 3% to 1% in the same time period. CONCLUSION: This study shows that despite the possibility of preventing human rabies by PEP, its burden remains important in Malian communities. Rabies control by mass vaccination of dogs is hardly done and access to PEP is difficult. However, Rabies elimination by mass vaccination of dogs has been demonstrated to be feasible. Hence a coordinated regional effort between countries by funding dog mass vaccination and full access to PEP can eliminate rabies in West Africa.

Surveillance des paralysies flasques aiguës en Côte d'Ivoire de 2007 à 2016 : importance et profil épidémiologique des entérovirus non poliovirus.

INTRODUCTION: Côte d'Ivoire's status as a polio-free country requires high quality surveillance of acute flaccid paralysis. Our study aims to determine the prevalence of non-poliovirus enteroviruses found in the surveillance of Acute Flaccid Paralysis (AFP) in Côte d'Ivoire and to study their distribution according to individual characteristics and associated factors. METHOD: We conducted an exhaustive descriptive and analytical cross-sectional retrospective study on 3597 cases of acute flaccid paralysis notified in the context of surveillance of AFP from 2007 to 2016 in Côte d'Ivoire. RESULTS: The mean annual rate of non-poliovirus enterovirus over the period was 11.3% over the study period with extremes of 9.2% and 15.9%. The absence of fever at the onset of illness and early age were factors associated with the occurrence of acute flaccid paralysis due to non-poliovirus enterovirus. CONCLUSION: Our study found a downward trend in non-poliovirus enteroviruses detected in AFP surveillance in Côte d'Ivoire, and identified the absence of fever and the age of the subject as being the factors associated with their occurrence. It is therefore necessary to type all cases of non-poliovirus enteroviruses detected in AFP surveillance to assess the risks of vaccine-derived polioviruses.

Drinking water quality and risk for human health in Pelengana commune, Segou, Mali.

Water is an indispensable commodity for the survival of all living beings and for their well-being. The objective of this work is to evaluate the level of pollution of different drinking water sources consumed and its link with health in Pelengana commune, Mali. Samples of water were taken from various sources, namely, hand pumps, boreholes, dug wells, and shallow wells for physical, chemical, heavy metals, and bacteriological analyses, using American Public Health Association (APHA) Standard Techniques. Results revealed that the nitrate-nitrogen (NO3 -N) values of the water samples from the different water sources had concentrations exceeding the United States Environmental Protection Agency's (US-EPA) regulation of 10 mg/L, as well as World Health Organization Guideline for Drinking Water Quality (WHO GDWQ) (11 mg/L). The same applies to heavy metals such as Cd, Pb, and Fe, in which, concentrations exceed their allowable limits in certain locations. Moreover, apart from water samples from some different boreholes, total coliform, and Escherichia coli have been detected in all selected water sources, which indicates fecal contamination. In all, there is a pressing need to stop the consumption of drinking water from contaminated sources and to effect appropriate treatment.

Investigation of the water quality of daily used surface-sources for drinking and irrigation by the population of Segou in the center of Mali.

This study evaluates the quality and pollution status of source surface waters in Segou, Mali. The nature, sources, and extent of pollution of Comatex Stream, Cerfitex Pond, and Sonikoura River were studied for a period of twelve months (July 2016-June 2017). Analysis included 209 water samples collected from eleven different locations in the study area. Laboratory and field analysis were realized using the standard methods and concerned eleven parameters including four physicals, six chemicals and one bacteriological. Also, organoleptic parameters were observed. Most of the average values of parameters addressing the quality of water were significantly higher (P < 0.05) in both the stream and river compared to the pond. Fecal coliform counts (FCC) were not in significant correlation with the temperature; pH and turbidity; but had a significant and positive correlation (P < 0.05) with conductivity: total dissolved solids (TDS); total suspended solids (TSS); Cl-; PO4 -P; NO3 -N and 5-day biochemical oxygen demand (BOD5). Analysis of samples revealed a level of FCC that is above the permissible limit for both drinking water and of fresh vegetable irrigation water. In all, there is a pressing need to inform the public about the state of water bodies and the application of relevant laws regarding the proper treatment of sewage before it is discharged into surface water.

[Surveillance of acute flaccid paralysis in Ivory Coast between 2007 and 2016: Significance and epidemiological profile of non-poliovirus enteroviruses]. / Surveillance des paralysies flasques aiguës en Côte d'Ivoire de 2007 à 2016 : importance et profil épidémiologique des entérovirus non poliovirus.

INTRODUCTION: Côte d'Ivoire's status as a polio-free country requires high quality surveillance of acute flaccid paralysis. Our study aims to determine the prevalence of non-poliovirus enteroviruses found in the surveillance of Acute Flaccid Paralysis (AFP) in Côte d'Ivoire and to study their distribution according to individual characteristics and associated factors. METHOD: We conducted an exhaustive descriptive and analytical cross-sectional retrospective study on 3597 cases of acute flaccid paralysis notified in the context of surveillance of AFP from 2007 to 2016 in Côte d'Ivoire. RESULTS: The mean annual rate of non-poliovirus enterovirus over the period was 11.3% over the study period with extremes of 9.2% and 15.9%. The absence of fever at the onset of illness and early age were factors associated with the occurrence of acute flaccid paralysis due to non-poliovirus enterovirus. CONCLUSION: Our study found a downward trend in non-poliovirus enteroviruses detected in AFP surveillance in Côte d'Ivoire, and identified the absence of fever and the age of the subject as being the factors associated with their occurrence. It is therefore necessary to type all cases of non-poliovirus enteroviruses detected in AFP surveillance to assess the risks of vaccine-derived polioviruses.