[Asthma control in adult Algerian patients. Comparison with other North African and Middle-East countries]. / Contrôle de l'asthme chez l'adulte en Algérie. Comparaison avec les autres pays d'Afrique du Nord et du Moyen Orient.

INTRODUCTION: Lack of recent data on asthma control in Algeria led to this study whose results were compared with those of the same study conducted in the Middle East and North Africa (MENA). METHOD: This cross-sectional epidemiological study was performed in adults who had been diagnosed with asthma for at least one year and without exacerbation within the last 4 weeks. Asthma control was assessed using the 2012 Global Initiative for Asthma (GINA) criteria and the Asthma control test (ACT) questionnaire. RESULTS: We studied 984 patients mainly managed by specialist physicians; 61% female, mean age 45 years, body mass index 27kg/m2, active smokers 2%. Medication was prescribed in 92% with 78% receiving inhaled corticosteroids alone or with add-on therapies. Good adherence was observed in 27%. Asthma control was observed in 34.6% vs. 28.6% in other countries (P < 0.001). Low level of education, absence of medical insurance, lack of physical exercise, and-long duration of the disease were significantly associated with uncontrolled asthma. CONCLUSION: Poor control of asthma is still observed in Algeria despite a high level of specialist involvement. Except for adherence, known predictive factors of poor asthma control have been observed. Quality improvement training of health care professionals and patient education are probably the main issues to be addressed.

[Common variable immunodeficiency (CVID): clinical and immunological features of 29 Algerian patients]. / Déficit immunitaire commun variable (DICV) : caractéristiques cliniques et immunologiques de 29 patients algériens.

PURPOSE: Common variable immunodeficiency (CVID) is the commonest symptomatic primary immunodeficiency. It is characterized by a defect of antibody production, recurrent respiratory tract infections and increased occurrence of auto-immune discords and lymphoproliferative disease. METHODS: This retrospective study was conducted on 29 patients fulfilling the classical CVID definition. Blood tests included immunoglobulin measurement and lymphocyte subpopulations phenotyping. RESULTS: This study includes 29 patients. The mean age at diagnosis was 23years. Recurrent upper and lower bacterial respiratory tract infections were common in almost all patients. Five patients developed auto-immune conditions and six had lymphoproliferative disease. Decreased IgG was found in almost all patients. Low IgA and IgM levels were found in 89.6 % and 65.5 % of cases respectively. Abnormal T and/or B phenotype was found in 75 % of cases; the most common abnormalities were decreased circulating B (54.2 %) and T CD4+ (41.7 %) cells and inversion of the CD4/CD8 ratio (70.8 %). Patients with decreased circulating B and T CD4+ cells were significantly more likely to have auto-immune cytopenias and lymphoproliferative disease. CONCLUSIONS: Our study confirms the heterogeneity of CVID. A patient's classification is necessary to define homogeneous groups of patients and to characterize specific molecular abnormalities in each group.

[Practical approach to lung health strategy in Algeria]. / L'approche pratique de la santé respiratoire en algérie.

SETTING: A total of 77 health care facilities in 10 provinces. OBJECTIVE: To perform a feasibility study before the extension of the Practical Approach to Lung (PAL) health strategy. METHOD: A cross-sectional study comparing before and after findings of a training course for general practitioners. RESULTS: Respiratory symptoms were the main reason for attending the primary health care services, accounting for 31.6% and 31.1% in the two periods studied. Acute respiratory infections constituted 70% of all respiratory disorders identified during the two periods. Chronic respiratory disorders, particularly asthma, were diagnosed more frequently after the training course (15.9% vs. 10.9%). Tuberculosis (TB) suspects accounted for only a minority of patients seeking health care and were more easily identified post-training. Treatment recommendations were more rational after training, which led to a reduction in prescription costs. CONCLUSIONS: The adoption of the PAL strategy by general practitioners led to an improvement in the quality of diagnosis of respiratory disorders and TB, fewer secondary investigations, less patient travel and an increase in the efficiency of medical practice by lowering prescription costs.

A multinational study of treatment failures in asthma management.

SETTING: Emergency rooms. OBJECTIVE: To assess quality of care and its determinants for asthma patients before emergency room treatment. DESIGN: Consecutive patients with acute severe asthma attending emergency rooms were questioned about the severity of their disease and treatment in the previous 4 weeks. Prescriptions of inhaled corticosteroids were recorded. Other outcomes included self-reported adherence to treatment and loss of work. RESULTS: Thirteen centres in 11 countries recruited 1156 patients. Only 36% of patients with persistent asthma had been prescribed an adequate dose of inhaled corticosteroids. This percentage improved in those receiving regular care from the same doctor (OR 2.86, 95%CI 1.38-5.96), and was at least as good for the 10% of patients receiving 'private' health care (OR 3.08, 95%CI 1.69-5.62). Forty-four per cent of patients had health insurance covering some asthma medications. These patients were more likely to be receiving adequate inhaled corticosteroids (OR 1.74, 95%CI 1.17-2.58), and reported better adherence than those without insurance (OR 3.00, 95%CI 1.64-5.50). Of those on adequate inhaled corticosteroids, 18% had lost work in each of the 4 previous weeks compared with 59% among those more than one treatment step below the recommended dose. CONCLUSIONS: Access to adequate treatment is critical for better management of asthma.

Health effects of PM10 air pollution in a low-income country: the case of Algiers.

SETTING: Although there are proven risk factors related to air pollution, the prevalent situation in low-income countries is not well known. OBJECTIVE: To quantify the health impacts associated with particulate air pollution in the city of Algiers. DESIGN: Descriptive study to evaluate a health impact assessment (HIA) approach based on a dose-response curve from the literature. A study area was defined around an air quality monitoring site in Algiers. Daily health data were obtained from a network of physicians practising in out-patient health centres. RESULTS: Over the period studied, the number of consultations for respiratory reasons attributable to PM10 exposure was 439, representing 4.5% of all health events observed. Different scenarios were examined, showing that a reduction in ambient levels of PM10 would be accompanied by important public health gains. CONCLUSION: The study allowed us to test the applicability of the HIA approach in a low-income country and to confirm the interest of the approach. Although the estimation of dose-response functions obeys a complex methodology, the HIA is an alternative that constitutes an important decision-making tool.

Treatment outcome of asthma after one year follow-up in health centres of several developing countries.

SETTING: Seven selected out-patient clinics caring for asthma patients in Algeria, Guinea, Morocco, Syria, Turkey and Vietnam. DESIGN: Evaluation of treatment outcomes after one year of follow-up of a cohort of asthma patients consecutively enrolled in a prospective study evaluating routine practice. RESULTS: Among 310 asthma patients registered, the following outcomes were recorded after one year of follow-up: 95 (31%) successful, 61 (20%) under control, 35 (11%) failed, 116 (37%) defaulted and 3 (1%) transferred. Among the 167 (53.9%) patients still on treatment after one year there was a substantial increase in the proportion of patients classified as intermittent at the end of treatment (from 11% to 53%), with a decrease in all categories of persistent asthma (from 34% to 12% for mild, 45% to 28% for moderate and 10% to 8% for severe asthma). CONCLUSIONS: While patients' quality of life can be improved if they follow regular treatment, the key challenge in providing care is to ensure that patients adhere to their treatment.

Implementation of asthma guidelines in health centres of several developing countries.

SETTING: Nine selected out-patient clinics caring for asthma patients in Algeria, Guinea, Ivory Coast, Kenya, Mali, Morocco, Syria, Turkey and Vietnam. DESIGN: Prospective enrolment of consecutive patients considered by the practitioner to have asthma with evaluation of adherence of the practitioner with recommended standard case management, including proportion of patients confirmed to have asthma, proportion in whom severity was correctly graded and proportion in whom treatment with inhaled corticosteroids corresponded to severity grade. RESULTS: Of 499 consecutive patients, 456 (91%) were enrolled and evaluated. The diagnosis was confirmed in 263 (58%). Agreement between the practitioner and the guidelines in assigning grade of severity was moderate overall (kappa = 0.42). It was higher for assignment of grade using symptoms (K = 0.51), but poor for assignment of grade using peak expiratory flow (PEF) rate (kappa = 0.29), with practitioners tending to underestimate the severity. Agreement between the practitioners' assessment of severity and treatment with inhaled corticosteroids was poor (kappa = 0.18), with underutilisation of inhaled corticosteroids. CONCLUSIONS: Practitioners caring for asthma patients in this study tended to underutilise the PEF rate in assessing their patients and underutilised treatment of patients with inhaled corticosteroids.

Air pollution: a new respiratory risk for cities in low-income countries.

Since the major accidents that occurred in the 1960s, air pollution has commonly been considered as a respiratory risk factor whose effects are most often studied in industrialised countries. Our aim is to show that it is now the turn of low- and middle-income countries to take this risk factor into account. After a discussion of the characteristics of air pollution, how it is diffused and the main known health effects (short- and long-term effects), we describe the specific differences between the cities in the North and the South. As a result of late industrialisation, cities in the South are now faced with pollution from industrial sources and urban traffic with polluting vehicles. The case of Algeria and Morocco illustrates this situation and its potential health risks. In order to prevent the health risks of air pollution in the cities of the South, systems for measuring pollution levels and epidemiological surveillance need to be put in place rapidly. This strategy can only work if it is supported by a strong partnership from industrialised countries.

Affordability of inhaled corticosteroids as a potential barrier to treatment of asthma in some developing countries.

SETTING: The cost and availability of the medications required for the treatment of asthma may represent potential barriers to effective management. METHOD: A survey of prices and policies for components of asthma treatment in 1998, in Algeria, Burkina Faso, Ivory Coast, Guinea, Mali, Syria, Turkey and Vietnam. RESULTS: Medications were consistently available in only four of the eight countries studied. The cost of essential medications for standard case management varied by over five times for beclomethasone and by over three times for inhaled salbutamol. In all but two countries, the cost of one year of drugs for treatment of a moderate, persistent case exceeded the monthly salary of a nurse in that country. The essential drugs list included inhaled salbutamol in five of eight countries and beclomethasone in three of eight. The costs of medications were lower where generic preparations were available and, to a lesser extent, where the medications are on the essential drugs list. CONCLUSIONS: The cost and availability of medications vary widely, and may represent an important barrier to effective management in some low and middle income countries.

[Curative treatment of tuberculosis in the world]. / Le traitement curatif de la tuberculose dans le monde.

Recent WHO recommendations for the treatment of tuberculosis have emphasized the need for simplicity and standardization of short term chemotherapy regims which can be applied in all forms of tuberculosis, including both pulmonary and extrapulmonary forms. But in order for the recommended chemotherapy regimes to be effective, there is a need for precise organization. Patient care must begin with the first consultation, dosage must be adapted to patient weight, drug intake must, at least during the initial phase of treatment, be supervised and patients who are absent or irregular should be recalled, surveillance and correction of rare side effects should be recorded, global consideration of the patient's medical and social problems and laboratory (and clinical) check-ups at the end of the initial phase of treatment and again at the end of treatment. Together, the aim of these technical and organizational measures is the limit the development bacterial resistance both to isoniazid and to rifampicin. In countries with limited financial resources, where the majority of the tuberculosis population lives, a reliable network of laboratories equipped with microscopes and a permanent anti-tuberculosis supply organization are required for any and all treatment programmes. In all countries, the evaluation of results using representative cohorts and surveillance of bacterial resistance provide evidence that such policies are successful.

Involvement of a properly structured network of primary health care in the management of tuberculous patients during a community survey in 45 health districts in Algeria.

PIP: A primary health care network was used to implement a chemotherapy program in Algeria. The program was evaluated using a survey of 8 counties with a population of 6 million people serviced by 45 health districts. Chemotherapy was given daily for 2 months and then administered by the patient. There were 2,985 cases of tuberculosis put on this treatment between 1981-86. More than 90% of the cases recovered and less than 1% were disease carriers 3 years after treatment. In each of the 45 districts there is a monitoring center, a laboratory, and hospital beds. These centers supervise the initial treatment after an average of 30 days in a hospital, supply the drugs during the maintenance period, and check on patients through sputum smear microscopy. The central group monitors the district activities through patient lists and records. This helps keep track of new cases, relapses, and transfers to other districts. The central reference laboratory confirmed the diagnosis in 94% of the cases. They also monitor failures and relapses, and check proper prescriptions of chemotherapy by doing tests on positive cultures. There were interviews with 542 patients at the end of, or after their treatment; 70% had complied with treatment and in 67% of the cases, the treatment duration was in agreement with the prescribed duration. They also used urine tests to check compliance with prescribed treatment and 90% were tested positive showing a high compliance. The results indicate that a treatment program could be monitored and managed by a small central team over a large area with a large population.^ieng