Effects of a collaborative approach to documentation of care for people living with HIV (PLWHIV) in Côte d'Ivoire.

The aim of this project implemented in 37 treatment settings for PLWHIV in Côte d'Ivoire was to improve the documentation of the provision of their care through a collaborative approach. This study aims to evaluate the impact of this approach. This descriptive cross-sectional study took place from July to September 2011 and focused on the documentation of care provided to PLWHIV at 32 sites according to the collaborative approach for improving care and services that was introduced from January 2009 to June 2010. We found that the documentation was improved at these sites because of the collaborative approach. The documentation quality indicator rose from less than 20% at the beginning of the project to about 85% at the end. This improvement differed according to facilities' level on the health pyramid. Primary health facilities improved more than general or regional hospitals because the former used the data documented for making decisions about how to improve their quality. On the other hand, the archiving of the files was faulty (lack of space in the cabinets and absence of data managers in all the sites). The collaborative approach method should to be extended to other health facilities in the country to improve the documentation of health activities to improve patient welfare.

Heterogeneity in individually experienced temperatures (IETs) within an urban neighborhood: insights from a new approach to measuring heat exposure.

Urban environmental health hazards, including exposure to extreme heat, have become increasingly important to understand in light of ongoing climate change and urbanization. In cities, neighborhoods are often considered a homogenous and appropriate unit with which to assess heat risk. This manuscript presents results from a pilot study examining the variability of individually experienced temperatures (IETs) within a single urban neighborhood. In July 2013, 23 research participants were recruited from the South End neighborhood of Boston and equipped with Thermochron iButtons that measured the air temperatures surrounding individuals as they went about their daily lives. IETs were measured during a heat wave period (July 17-20), which included 2 days with excessive heat warnings and 1 day with a heat advisory, as well as a reference period (July 20-23) in which temperatures were below seasonal averages. IETs were not homogeneous during the heat wave period; mean IETs were significantly different between participants (p < 0.001). The majority of participants recorded IETs significantly lower than outdoor ambient temperatures (OATs), and on average, the mean IET was 3.7 °C below the mean OAT. Compared with IETs during the reference period, IETs during the heat wave period were 1.0 °C higher. More than half of participants did not experience statistically different temperatures between the two test periods, despite the fact that the mean OAT was 6.5 °C higher during the heat wave period. The IET data collected for this sample and study period suggest that (1) heterogeneity in individual heat exposure exists within this neighborhood and that (2) outdoor temperatures misrepresent the mean experienced temperatures during a heat wave period. Individual differences in attributes (gender, race, socioeconomic status, etc.), behaviors (schedules, preferences, lifestyle, etc.), and access to resources are overlooked determinants of heat exposure and should be better integrated with group- and neighborhood-level characteristics. Understanding IETs for the population at large may lead to innovative advances in heat-health intervention and mitigation strategies.

[Impact of armed conflict on the health care system of a sanitary district in Cote d'Ivoire]. / Impact du conflit armé sur le système de santé d'un district sanitaire en Côte d'Ivoire.

Since September 2002, Côte d'Ivoire has been in the throes of armed conflict that has split the country in two. In the government-controlled area, access to health care services has continued. In the area under the control of the "New Forces", access to health care services decreased dramatically due to departure of qualified health personnel and subsequent shutdown of sanitary facilities. The purpose of this transversal descriptive survey was to measure the impact of this crisis on the health care system in the Séguéla sanitary district that is located in the war zone. Findings showed that 60.7% of sanitary facilities are no longer operational, that 77.7% of qualified personnel have left their workstation, and that 46.2% of sanitary structures have been damaged. A few reference hospitals and sanitary facilitates have been able to remain open thanks to the support of the humanitarian organisations. As a result of declining access to health care services, a recrudescence of measles and IST has been observed and gastritis and traumatology have appeared among the top 10 causes of morbidity. Access to effective health care in the Séguéla sanitary district cannot be envisioned without the return of qualified health care personnel and the renovation of the sanitary facilities.

[Resurgence of yellow fever epidemics in Côte-d'Ivoire]. / Résurgence des épidémies de fièvre jaune en Côte-d'Ivoire.

Resurgence of yellow fever epidemics in Côted'Ivoire remains a major problem of public health. To describe this disease through the early alarm system of National Institute of Public Hygiene (NIPH) is convenient to us. This is a cross-sectional study with descriptive aiming, which proceeded with epidemiological surveillance service of NIPH. The data were collected over 7 years (from 2001 to 2007), starting from the cards of notification, reports, and registers of the service. The main findings of our study are that: 1) we listed 1468 suspect cases including 41 confirmed and the lethality rate was 17.07% among the confirmed cases; 2) most cases of yellow fever were recorded between the years 2001 and 2007; 3) confirmed cases of yellow fever were above 15 years old in 83% of cases. This could be explained by absence of immunization during this age period; 4) recrudescence of cases was observed during the rainy season (June-July and September-October) and the principal vector was Aedes aegypti; 5) data analysis revealed a mean level of 79% for completude and 57%for promptitude of notification; these rates are inferior to WHO norms and; 6) average time of vaccine response post-epidemic was 31 days. Late response is due to difficulties in supplying vaccines. Reinforcement of epidemiological surveillance, prevention by mass immunization, and measurements of hygiene and cleansing are essential to slow down the evolution of this disease.

[Five years of cholera surveillance in Ivory Coast during social and political crisis, 2001 to 2005]. / Cinq années de surveillance du choléra en Côte d'Ivoire dans un contexte de crise socio-politique, 2001 à 2005.

For an efficient struggle against infectious diseases with epidemic potential, the Cdte d'Ivoire set up a precocious alert system in 2001 with a main objective: to detect epidemics of cholera, measles, yellow fever and meningitis and to provide necessary information for their control and their prevention. During the 2001 to 2005 period, the country was marked by military and political crisis which occurred in 2002; the country had to face up to a reappearance of cholera. How did it evolve in such a context? The question was to describe the performances of the system and the evolution of cholera from weekly data collected by the centers of epidemiological monitoring in health districts. The cases and declared deaths were compiled and the indicators of morbidity and mortality were then studied according to time site and individual features on the period of 2001 to 2005. From 2001 to 2005, 11,874 cases were notified with 564 deaths and a lethal rate of 4.7%. In 2001, from the initial source of infection, the civil jail, the epidemic of cholera disseminated itself through visitors in the whole city of Abidjan where 3250 cases were notified. Out of city, 20 outbreaks have been declared with a total of 3010 cases. The yearly highest impact, 37 living cases/100,000 inhabitants recorded in 2001, decreased regularly until 2005 with 0.2 living cases/100,000. After 2002, outbreaks were located mainly in the half south of the country which welcomed displaced populations from the north, preferably in transition or settling zones near the front line. The lethal rate in Abidjan (2.3%) was less important than that of other health districts (8.6%). The lethal rate globally increased as the impact decreased. Vibrio cholerae was responsible for the epidemics. The group of 15 years old and over was the most affected (12.69 living cases/100,000) whereas the highest lethal rate appeared in the group under 5 years old (6.6%). The reappearance and constant cholera epidemics in Côte d'Ivoire are due to bad general hygiene conditions, insufficient supply of drinking water from wells or packaged, concentration of populations in the south of the country due to war and uncontrolled development of the poor and unsanitary precarious boroughs. Outburst during the dry season is a warning signal of an important epidemic during the raining season especially in poor urban areas. The precocious alert system has permitted to detect the epidemics, to follow up their evolution and to orientate the struggle against cholera in Côte d'Ivoire.

[Compliance with veterinary surveillance orders at the rabies control center in Abijan, Ivory Coast]. / Observance de la surveillance vétérinaire au centre antirabique d'Abidjan.

Rabies remains a major health public health problem in many developing countries. This is particularly the case in the Ivory Coast. Surveillance orders play an important role in patient management. The purpose of this transverse study conducted at Abidjan Rabies Control Center from July 1 to September 30, 2003 was to assess compliance with veterinary surveillance orders by owners of animals that have bitten or scratched persons. Persons reporting to the rabies control center after exposure to the risk of rabies infection and owners of the animals that had bitten, scratched, or licked these persons were included in this study. Most animals involved in these cases (94.8%) were dogs including 69.5% that had been vaccinated. Most persons (71.7 %) at risk reported within two days following exposure and 31.3% provided all three veterinary certificates. The mean time required to provide the first certificate was 4.2 days. The gender of the persona at risk and the vaccination status of the animal involved were correlated with compliance with veterinary surveillance orders. Four main difficulties were cited as hindrances for compliance with veterinary surveillance, i.e., cost (373%), distance (28.4%), time (9.9%), and veterinary clinic accessibility (2.5%). These findings indicate that stricter laws and a national prevention program are needed.

[Systematic serologic detection of treponema at the antivenereal centre of the National Institute of Public Health in Abidjan (Côte-d'Ivoire), from 1994 to 1999]. / Dépistage systématique sérologique des tréponé- matoses au dispensaire antivénérien (DAV) de l'Ins- titut national d'hygiène publique (INHP) d'Abidjan (Côte-d'Ivoire) de 1994 a 1999.

We conducted a medical records review on 11,662 patients consulting the antivenereal clinic of Treichville from 1994 to 1999. The main objective of the study was to analyse the data from systematic screening of syphilis in this specialized centre for sexual transmitted infection. The results of this study were: 162 (1.39%) patients had active syphilis; we noticed a decreasing incidence of syphilis during the last six years, 98.77% of the patients had symptoms of sexual transmitted diseases that did not directly evoke syphilis. In summary we can say that syphilis remains an important problem in the sexually transmitted infections consultation. The screening of syphilis must continue and needs to be extended to other services, because of the high frequency of asymptomatic forms and the existence of severe complications.

[Impact of aerial mosquito control on populations of Aedes aegypti in two communities of Abidjan]. / Impact de la demoustication sur les populations d'Aedes aegypti de deux communes de la ville d'Abidjan.

INTRODUCTION: From May 2nd to 13th 1997, an aerial mosquito control took place in Abidjan. This mosquitoes control has been undertaken by the municipality. He made two Ultra Low Volume (ULV) applications of d eltamethrine (K O thrineR). The second application took place one week after the first one. Each application used 2g per ha of deltamethrine diluted with gasoil. MATERIALS AND METHOD: We evaluated the impact of this mosquitoes control on Aedes aegypti populations in two districts : Port-Bouët and Yopougon. We compared the bite number per person and per day obtained by catching mosquitoes on human from 16 pm to midnight. RESULTS: We thus captured 308 females of mosquitoes with 33% of Aedes aegypti representing 5.58 bites per person and per day in Port-Bouët and 2.5 bites per person and per day in yopougon. We noticed that 49% of Aedes aegypti live and bite inside. The bite number per person and per day has been reduce to 37.5% after treatment in Port-Bouët and to 66% in Yopougon. But we noted that five days after treatment the bite number per person and per day was the same level before the treatment. Aerial application of insecticide has more impact on Aedes aegypti population biting outside than the population biting inside. CONCLUSION: Aerial application of insecticide reduces the bite number of mosquitoes per person and per day and in particular of Aedes aegypti but this reduction does not last long. This reduction is better on outside population than the inside one; so bio ecology studies are required before aerial application of insecticide.

[Prevalence of HIV infection in patients of the anti-venereal center of the National Institute of Public Hygiene, Abidjan]. / Séroprévalence du VIH au dispensaire antivénérien de l'Institut national d'hygiène publique d'Abidjan.

This cross-sectional study includes all new patients consulting for the first time in the anti-venereal center of the National Institute of Public Health (NIPH) during the period of May to July 1997. Among them, 20.1% of the consulting patients and 31.3% of those suffering from STI were positive to HIV. The STI particularly those with ulceration are a risk factor in HIV transmission. This study points up the need of an adequate management of sexual transmitted diseases as a main strategy to struggle against HIV/AIDS infection.

[Detection and management of the yellow fever epidemic in the Ivory Coast, 2001]. / Detection et gestion de l'epidemie de fievre jaune en Cote d'Ivoire, 2001.

From March to December 2001, an outbreak of yellow fever was observed in Cote d'Ivoire. Sentinel surveillance for hemorrhagic fever allowed detection of the first case in the Duekoue health district in the heavily wooded western part of the country. A weekly reporting system was established. For each suspected case recorded and reported to the Epidemiological Surveillance Department at the National Institute of Public Hygiene, a sample was collected and sent for confirmation at the Pasteur Institute of the Cote d'Ivoire. The outbreak progressed from West to East reaching Abidjan, the economic capital of the country located in the southeast. The epidemic emergency plan consisted of setting up a crisis committee to implement epidemiological, entomological and virological surveillance, mass vaccination campaigns in areas around confirmed cases, and vector control. A total of 280 cases were reported including 32 confirmed cases and 6 deaths. Eleven out of 62 districts were affected with most cases occurring in cities with more than 10000 inhabitants. Over 3.7 million persons were vaccinated for an overall coverage of 92.2% in the areas where campaigns were carried out. As a result of this outbreak, surveillance for potentially epidemic diseases has been reinforced and surveillance of viral transmission is now being considered. A vaccination program for adults has also been established.

Positive steps toward a multicultural association.

Diversity is a common denominator in all three initiatives of ADA's 1996-1999 Strategic Framework, "Creating The Future." With a diversified membership and practice base, which can be achieved by incorporating diversity within the Association's member initiative, ADA will more effectively accomplish its policy and public education activities. Members of ADA's Diversity Committee believe increased communication with the Association's members is one of the best strategies to identify and promote diversity accomplishments and opportunities. "Creating the Future" for dietetics professionals can be accomplished for all members if we all work together on this important task.

[Chronic diarrhea and parasitoses in adults suspected of AIDS in the Ivory Coast]. / Diarrhées chroniques et parasitoses chez des adultes suspectés de SIDA en Côte-d'Ivoire.

148 adult patients with chronic diarrhoea and suspected to be HIV infected have had stool examinations. 46 are without any enteric parasite. Those detected in the others patients are Sporozoans: I. belli (16.2%) and Cryptosporidium sp. (6.7%) found alone or joint, together or with other parasites. Among those, all Flagellate species are identified, but T. intestinalis (6%) is predominant. Entamoeba coli (8.%) is the most frequent amebic species, however, E. histolytica histolytica have been found twice, once singly, the second associated with I. belli, Schistosoma mansoni and Candida albicans. Necator americanus (14%) and Strongyloides stercoralis (12%) are the predominant worm species. Among the yeasts, C. albicans (35.8%) is the most important species isolated, singly in 13.5% of the patients. In an intertropical and parasitical endemic area where many parasites are not considered uncommon, opportunist agents as I. belli, Cryptosporidium sp. and C. albicans appear in an non-negligible frequency in our study.

[Carrier state of enteric viruses in Ivory Coast pregnant women in good health]. / Portage de virus entérique chez des femmes enceintes ivoiriennes en bonne santé.

The present work emphasize the great diversity of the viral species encountered in pregnant women (Rotavirus, Coronavirus, Adenovirus, Poliovirus, Coxsackievirus). In each of the different regions studied, one or two viral types are usually predominant. In Man (West Ivory Coast) region for instance, Rotaviruses and Coronaviruses were mainly encountered; in Bouaké, Polioviruses and Adenoviruses were predominant whereas in Bondoukou and Odienné respectively Coxsackieviruses and Adenoviruses were predominantly identified. Multiple viral infections were also evidenced: Rotaviruses + Coronaviruses, Rotaviruses + Polioviruses, Coronaviruses + Polioviruses, Polioviruses and Adenoviruses. The greatest number of multiple infections was found in Man (8 cases). Inapparent infections were mainly detected in Man where the prevalence for at least one viral type is very high 91.6%; in Bouaké, prevalence of at least one viral type is around 36%. The least level of prevalence was recorded in Bondoukou (East of Ivory Coast) and Odienné (North-West) respectively 17% and 20%.

[An epidemic of diarrhea caused by Vibrio parahaemolyticus occurring in Abidjan in 1985]. / A propos d'une épidémie de diarrhées dues a Vibrio parahemolyticus survenue a Abidjan en 1985.

The authors report the epidemiological results of an epidemic about 84 choleriform syndrome in Abidjan (Ivory Coast), June 1985.