Determinants of Fatal Road Traffic Injuries in Côte d'Ivoire from 2002 to 2011 / Déterminants des accidents mortels de la circulation routière en Côte d'Ivoire de 2002 à 2011.

Introduction : In most developing countries, with rapidly changing lifestyles, urbanization, and increasing numbers of vehicles, Road Traffic Injuries (RTI) are expected to have a growing impact on mortality and morbidity.The objective of this study was to identify factors associated with fatal RTI in Côte d'Ivoire.Methods : We conducted a cross-sectional study of data concerning RTI in Côte d'Ivoire over a ten-year period (2002 to 2011) from the Road Safety Office (RSO) database. All RTI reported by the police were included in the study. Fatal RTI was the dependent variable, while sociodemographic, behavioural and environmental risk factors were independent variables. Data were analysed using SPSS Version 16 software.Results : Out of a total of 56,966 reported RTI, 3008 were fatal, representing 0.6 deaths per 100,000. The majority (93.5%) of RTI occurred in urban areas. Pedestrian victims were identified in more than one half (59.3%) of cases. Subjects under the age of 18 and subjects between the ages of 43 and 47 years had 2.4-fold and 4.9-fold higher risks of fatal accidents, respectively. Excessive speed (OR = 5.3 ; p = 0.000) and dangerous overtaking (OR = 4.9 ; p = 0.000) were the leading causes of fatal accidents. Mechanical failure was also a risk factor (OR = 3.9 ; p < 0.005). The risk of a fatal accident was 6.8-fold higher in rural areas than in urban areas.Conclusion : Fatal RTI were related to human and environmental factors, hence the need for awareness campaigns to promote behaviour changes among road users.

[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.

[Seroprevalence of HIV infection in the context of a mobile counseling and voluntary testing strategy in rural areas of Côte d'Ivoire]. / Séroprévalence de l'infection à VIH en conseil et dépistage volontaire par stratégie mobile en Zone rurale en Côte d'Ivoire.

INTRODUCTION: In Côte d'Ivoire, HIV testing and counselling has been identified as a priority in the National 2006-2010 AIDS Strategic Plan, which is designed to evaluate the prevalence of HIV in rural areas measured by means of a mobile strategy. METHODS: We conducted a cross-sectional descriptive and analytical study from 1st April, 2007 to 31st March 2008 in six rural areas of Côte d'Ivoire: Dabou, San Pedro, Abengourou, Tanda, Daloa, and Soubré*. The study population consisted of subjects attending the mobile voluntary counselling and testing units. RESULTS: The mean prevalence of HIV infection in this study was 5.30%. The mean prevalence rate in men was 5.26%, with a peak of 7.55% in the 30-34 years age-group. The mean prevalence rate in women was 5.35%, with a peak of 6.59% in the same age-group. Type HIV-1 was predominant (84.2% of the total). The most affected area was Dabou, with a rate three times higher (15.83%) than the average rate observed during the study. More educated people (university level) presented 3.5-fold (for men) or 6-fold (for women) higher infection rates than illiterate people. Although 100% of people who tested positive received a medical or community referral according to their specific needs, only 62.1% were first-line referred for medical care. CONCLUSION: In the light of the results of this study, we believe that community mobilization must be redirected to the most severely affected populations to facilitate earlier diagnosis. Actions such as training and prevention based on communication to encourage changes of behaviour should therefore be priorities in the national counselling and testing programme.

[Epidemiology of induced abortion in Côte d'Ivoire]. / Épidémiologie des avortements provoqués en Côte d'Ivoire.

The objective of this study was to examine induced abortion in Côte d'Ivoire. A nationwide cross-sectional descriptive study of induced abortion was carried out in 2007 among 3,057 women aged 15-49 years. The study showed that induced abortion is a widespread practice in Côte d'Ivoire, with a prevalence estimated at 42.5%. The women who had undergone an abortion were generally under 25, unmarried, and illiterate, and had used contraception. More than half (52.1%) of all induced abortions were performed at home by traditional abortionists or were self-induced with plants or decoctions. The main reasons for induced abortion were concern about the reaction of parents (27.7%), age (22.2%), a lack of financial resources (21.3%) and the desire of women to continue their education. More than half of the participants (55.8%) stated that they had suffered complications, which were more common after a home abortion than after a hospital abortion. Political and legal measures or reforms aimed at changing abortion laws in Côte d'Ivoire and better access to family planning are required in order to prevent or treat the social issue of induced abortion.

[The quality of immunization services in community centers in Abidjan, Côte d'Ivoire]. / Qualité des prestations vaccinales des centres sociaux publics d'Abidjan, Côte d'Ivoire.

In addition to health care centers, other institutions such as community centers are also involved in providing immunization services, the purpose being to address the inadequate provision of services in this area. The purpose of this study was to assess the quality of immunization services provided by non-medical staff. A cross-sectional descriptive study was conducted over the course of two months in the 15 public community centers providing immunization services in Abidjan. Data collection was performed by two physicians using three questionnaires (one for center managers, one for vaccinators and one for vaccine recipients) and two observation checklists (to assess vaccination equipment and to observe the behaviors and practices of vaccinators). The study found that none of the centers had a generator. One community center had no refrigerator. Refrigerators were not placed in a ventilated area in 14.3 % of the centers and were not exclusively used for the storage of vaccines in 26.7 % of the centers. None of the centers had an incinerator. 21.1 % of staff did not know the correct storage temperature. In 88.9 % of cases, the swab used to stop bleeding was also used to clean the injection site. The injection site was not sterilized in 10.8 % of cases. 73.9 % of the recipients did not know what vaccine they had been administered, while 95 % of the recipients did not know the date of their next vaccination appointment. The results indicate that immunization services in public community centers have many shortcomings. To address these issues, it is necessary to implement a training policy and to provide appropriate equipment and supervision.

[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.

[Evaluation of the quality of prenatal consultations in the health district of Grand Bassam, Côte d'Ivoire]. / Evaluation de la qualité des consultations prénatales dans le district sanitaire de Grand Bassam (Côte d'Ivoire).

Maternal mortality constitutes a major public health problem in Côte d'Ivoire. Better management of pregnant patients and improved quality of pre-natal consultations could contribute to solving this problem. But what is the current situation of these a pre-natal consultations in the medical district of Grand-Bassam? To answer to this question, a descriptive cross-sectional study was carried out between August 26th and September 30th, 2002 in three medical establishments in charge of pre-natal consultations in that District. It was noted that the privacy and the confidentiality during the examination were respected; yet on the other hand, the structures were sometimes unsuited and were insufficiently equipped. The health care professionals were not very accessible or friendly, and they had poor interpersonal communication skill. Recommendations were made to remedy these insufficiencies.

[Prevalence and determinants of childbirth at home in two vulnerable neighborhoods of Yopougon (Abidjan), Côte d'Ivoire]. / Prévalence et déterminants des accouchements à domicile dans deux quartiers précaires de la commune de Yopougon (Abidjan), Côte d'Ivoire.

A household survey was conducted from February 13 to May 12, 2006, to determine the frequency of childbirth at home in two vulnerable districts of the township of Yopougon, and to identify the factors that determine this choice. We interviewed all women residing in these districts who gave birth during the period from January 2005 to the date of our investigation. This study showed that 17% of deliveries took place outside of a maternity ward. Most of the women interviewed, averaging 26 years of age, were illiterate and had no professional occupation; 64% were unaware of the risks associated with pregnancy and home birth. Furthermore, 25% of these women found the services and the reception at the maternity hospital to be poor and 54% felt the cost of delivery at the maternity ward to be too high. Factors that promote the choice of home birth are geographic and financial inaccessibility, ignorance of women and the poor perception of maternity services. All of the determining influences that can sway and impact a women's decision on where to give birth should be taken into account in order to improve the use of maternity services and reduce the frequency of home childbirth without medical assistance.

[Adherence to rabies vaccine treatment for people exposed to rabies in Abidjan (Côte d' Ivoire)]. / Observance du traitement vaccinal antirabique chez les sujets exposés à la rage à Abidjan (Côte d'Ivoire).

This descriptive retrospective study ran from August 2003 to December 2003 at the Rabies Center of the National Institute of Public Health in Abidjan. It covers subjects at risk of rabies transmission during 2004. Identification of participants in the study was made via a census of patients consulting the rabies clinic: a total of 533 subjects were included, predominantly male (54.6%), without gainful employment (57%), with an average age of 26.7 years. Those who lived outside the city of Abidjan accounted for 21.6%. In 88.2% of cases, they were exposed due to a bite. Dogs (90.8%) represented the main species responsible for this kind of exposure. Only 3.2% of these animals had a current valid rabies vaccine. The owner of the animal was not known in 71% of cases. The observance of the recommended immunization schedule for 4 doses was 53.1%. Of the 533 patients registered in the study, 46.9% had stopped treatment vaccine. Some factors have been identified as adversely affecting adherence, such as the vaccination treatment plan of 5 doses, exposure outside the city of Abidjan, unemployment, incurrence of superficial injuries, exposure from an animal bite and lack of immunization of the animal. The results show that the strategies against rabies must focus increasingly on the importance of adherence to treatment and education of the population vis-à-vis the risk of rabies.

[Quality of emergency obstetric care in Abidjan]. / Qualité de l'offre des Soins Obstétricaux d'Urgence (SOU) dans le district autonome d'Abidjan, Côte d'Ivoire.

This study aims to assess the quality of emergency obstetric care in 69 health facilities in Abidjan. The results show lethality was evaluated at 1.7 deaths out of 100 complications that received treatment. Obstetrical complications are largely dominated by the presence of bleeding, accounting for 36.1% of cases. Only 60.1% of emergency obstetric cases were fully covered and completely treated. Caesarian sections are rarely done (3.6%). The ratio of availability of comprehensive emergency obstetric care is poor (.79 for 500,000). Mobilization of all levels of actors in the health system is necessary to lead to any significant improvement in the current situation.