Chronic leg ulcers in hospitalized patients in Lomé, Togo: 125 cases.

The aim of this study was to document the profile and causes of chronic leg ulcers (CLU) in patients hospitalized in Lomé, Togo. This retrospective study reviewed records from the dermatology departments (CHU Sylvanus Olympio and Campus, and the dermatology center of Gbossimé) from 2000 to 2017 and from the general surgery department of CHU Sylvanus Olympio from 2013 to 2017 to identify cases. In all, 125 cases of CLU were identified during the study period. The patients' mean age was 56.6 years and the sex ratio (M/F) was 0.89. The average time from CLU onset to consultation was 10.9 weeks (range : 7 weeks to 4 years). They were mainly associated with a history of diabetes (32 cases), arterial hypertension (16 cases), varicose veins (14 cases), and malnutrition (14 cases). The main causes were : ulcers of infectious origin in 49.6% of cases (including 38 with phagedenic ulcers), ulcers of vascular origin in 36% (including 21 cases with a venous ulcer) and diabetic ulcers in 8.8% of cases. The ulcer was unilateral in 122 patients (67 on the right and 55 on the left) and bilateral in 3 patients. The locations were the foot in 56 cases, the leg in 37 cases, and leg and foot in 32 cases. In addition to dressings, surgical debridement was performed in 23 patients, followed by skin autografts for 16. Amputation was performed for 31 patients. Sixteen (12.8%) of the 125 patients died. Our study observed a high rate of phagedenic ulcers among CLU in Togo. It also pointed to a problem explaining the very high mortality rate: delayed consultation by patients who arrive only after the onset of complications.

A multi-state spatio-temporal Markov model for categorized incidence of meningitis in sub-Saharan Africa.

Meningococcal meningitis is a major public health problem in the African Belt. Despite the obvious seasonality of epidemics, the factors driving them are still poorly understood. Here, we provide a first attempt to predict epidemics at the spatio-temporal scale required for in-year response, using a purely empirical approach. District-level weekly incidence rates for Niger (1986-2007) were discretized into latent, alert and epidemic states according to pre-specified epidemiological thresholds. We modelled the probabilities of transition between states, accounting for seasonality and spatio-temporal dependence. One-week-ahead predictions for entering the epidemic state were generated with specificity and negative predictive value >99%, sensitivity and positive predictive value >72%. On the annual scale, we predict the first entry of a district into the epidemic state with sensitivity 65∙0%, positive predictive value 49∙0%, and an average time gained of 4∙6 weeks. These results could inform decisions on preparatory actions.

A Bayesian network approach to the study of historical epidemiological databases: modelling meningitis outbreaks in the Niger.

OBJECTIVE: To develop a tool for evaluating the risk that an outbreak of meningitis will occur in a particular district of the Niger after outbreaks have been reported in other, specified districts of the country. METHODS: A Bayesian network was represented by a graph composed of 38 nodes (one for each district in the Niger) connected by arrows. In the graph, each node directly influenced each of the "child" nodes that lay at the ends of the arrows arising from that node, according to conditional probabilities. The probabilities between "influencing" and "influenced" districts were estimated by analysis of databases that held weekly records of meningitis outbreaks in the Niger between 1986 and 2005. For each week of interest, each district was given a Boolean-variable score of 1 (if meningitis incidence in the district reached an epidemic threshold in that week) or 0. FINDINGS: The Bayesian network approach provided important and original information, allowing the identification of the districts that influence meningitis risk in other districts (and the districts that are influenced by any particular district) and the evaluation of the level of influence between each pair of districts. CONCLUSION: Bayesian networks offer a promising approach to understanding the dynamics of epidemics, estimating the risk of outbreaks in particular areas and allowing control interventions to be targeted at high-risk areas.

Meningitis outbreaks and vaccination strategy.

Three outbreaks of meningitis caused by Neisseria meningitidis serogroup A (subgroup III) are described: Niger (1991), Burundi (1992), and Guinea (1993). These outbreaks showed unusual characteristics: a shorter inter-epidemic interval (Niger), unusual geographical location outside the meningitis belt (Burundi and Guinea), and high age-specific attack rates in all age groups (Burundi and Guinea). Mass immunization campaigns mobilized considerable human and financial means (US $322,000 and 3000 person-days of work for health personnel to immunize 629,000 people in Guinea). The vaccination coverage was over 80% in densely populated areas (Burundi and urban Guinea), but below 50% in less populated areas (24/27 and 26/30 sub-districts in Niger and Guinea, respectively). The preventive fraction (proportion of cases prevented by vaccination) was substantial in Guinea (35% for a vaccine efficacy of 85%) and was higher where the campaign was initiated earlier. An 'alert' threshold indicating the onset of an epidemic of 15/100,000 cases in one week showed good sensitivity (94%), specificity (98%) and positive predictive value (89%) in Burundi, permitting quick decision making outside the meningitis belt. These 3 meningococcal meningitis outbreaks show the need for epidemic emergency preparedness and for vigilance on the whole African continent.

Long-acting chloramphenicol versus intravenous ampicillin for treatment of bacterial meningitis.

In most developing countries, bacterial meningitis (BM) is associated with a high case-fatality rate. The search for a simple, convenient, and inexpensive antibiotic treatment remains a priority. In this study, a non-blinded, multicentre, randomised clinical trial of 528 cases of BM was done in two hospitals in Mali and Niger, between March, 1989, and May, 1990, to see whether a double injection of long-acting chloramphenicol (on admission to hospital and 48 h later) is as effective as a course of intravenous ampicillin (8 days, 4 times a day). The cumulative case-fatality rate on day 4 (principal end-point) among the chloramphenicol (254 patients) and ampicillin (274) groups were, respectively, 28% and 24.5% (relative risk 1.14, 95% confidence interval 0.86-1.52). No outbreak occurred during the study period. The hospital case-fatality rate was 33.1%. Main risk factors for death were associated with clinical condition on admission--ie, altered consciousness, convulsions, or dehydration. The case-fatality rates were 13% (21/161) for Neisseria meningitidis, 36.1% (48/133) for Haemophilus influenzae, and 67% (77/115) for Streptococcus pneumoniae. In a multiple logistic regression model, controlling for the differential distribution of potential risk factors (including bacterial species), there was no difference between treatment groups. Our findings suggest that long-acting chloramphenicol is a useful first-line presumptive treatment for BM in high-incidence countries.

Mortality from neonatal tetanus in rural Côte d'Ivoire.

A 30-cluster survey was carried out in order to estimate the incidence of neonatal tetanus in rural Côte d'Ivoire. Births in the 19 months preceding the survey were enumerated by interviewers in house-to-house visits. If a child born in that period had died, the interviewer asked a series of questions to establish a presumptive diagnosis of neonatal tetanus. A total of 41 deaths from neonatal tetanus was found in the study area among 2324 live births that occurred from 1 January 1981 to 31 July 1982. This gives a neonatal tetanus mortality rate of about 2%. Most deliveries and almost all deaths occurred at home, and only about 2% of neonatal tetanus cases were reported through the routine health information system. Birth in a clinic and antiseptic care of the umbilical cord protected infants from neonatal tetanus. Tetanus immunization of all women of child-bearing age is recommended as a preventive measure.