[Evaluation of the Viral Hemorrhagic Fever Surveillance System in the Assaba region, Mauritania (2020-2022)]. / Évaluation du système de surveillance des fièvres hémorragiques virales dans la wilaya d'Assaba, Mauritanie (2020-2022).

Introduction: Several arboviral diseases have been known to be endemic (e.g., Crimean-Congo hemorrhagic fever, Rift Valley fever) or are emerging (dengue fever, chikungunya, O'nyong-nyong) in human populations in Mauritania, while others have become rare in recent years (e.g. yellow fever). Moreover, domestic animals, especially cattle, camels, goats, and sheep, are also known to be infected with some of these arboviruses (e.g. Crimean-Congo hemorrhagic fever, Rift Valley fever). For these reasons, viral hemorrhagic fever surveillance in Mauritania is part of the Integrated Disease Surveillance and Response (IDSR). However, limited information is available on the efficacy of the viral hemorrhagic fever surveillance system in the Assaba region of Mauritania. The aim of the present study was to assess the performance of the surveillance system, in particular its general utility, simplicity, flexibility, acceptability, and reactivity. Methods: A descriptive cross-sectional study was conducted from July to August 2022 in the Assaba region with the objective of evaluating the characteristics of the system by interviewing key actors involved in the surveillance of viral hemorrhagic fevers, with a focus on Rift Valley fever and Crimean-Congo hemorrhagic fever, using questionnaires developed following the guidelines of the Centers for Disease Control and Prevention (Atlanta, Georgia, USA). Data from 2020-2022 on viral hemorrhagic fevers from the National Institute of Public Health laboratory were analyzed. Medians, interquartile ranges, and proportions were calculated using Epi Info® 7.2.5.0 and Excel® 2021. Results: The questionnaire was answered by all twenty-six persons involved in the viral hemorrhagic fever surveillance system in Assaba region. The majority of survey respondents found the system to be useful (51%), simple (63%), acceptable (46%), responsive (64%), and flexible (46%). An analysis of the data revealed a positive predictive value of 28% for Rift Valley Fever. The weekly distribution of cases within the wilaya indicates that the moughataa of Kiffa recorded the highest number of cases in September, with a notable weekly peak during that month in 2020. According to the analysis of the National Institute of Public Health database, cases of viral hemorrhagic fevers were promptly handled. Survey responses and database analysis revealed issues related to data quality and data management mechanisms. These limitations in the surveillance system are likely to be due to insufficient resources and training of the personnel, in particular with regards to data collection and management, which in turn led to incomplete or missing data and invalid data entry. These weak points can be ascribed, at least in part, to financial constraints and inadequate attribution of priority to arboviral diseases. Despite these limitations, disease data generated by the surveillance system were generally reliable. Conclusion: The viral hemorrhagic fever surveillance system in the Assaba region adheres to the organization and functioning of the national viral hemorrhagic fever surveillance system, which is part of the IDSR. The characteristics of utility, simplicity, responsiveness, and flexibility of the viral hemorrhagic fever surveillance system are good, but acceptability and flexibility need further improvement. The earlier the first arboviral human or animal cases are detected, the more likely an active intervention can be organized in response to the emerging epidemic or epizootic and prevent the spread of the disease. An efficient viral surveillance system is the key to reducing the negative impact of arboviral diseases in Assaba region.

Factors associated with COVID-19 in children aged 0 to 15 in Niger, 2020.

On January 30, 2020, the WHO declared COVID-19 a global health emergency. Children were affected in less severe forms. Niger had implemented measures in a context where children were a source of contamination. The aim was to determine the factors associated with COVID-19 in children in Niger from February to August 2020 through an analysis of the national database. We conducted an analytical cross-sectional study including all COVID-19 suspects in the database. We used Excel and Epi Info 7.2.4. software for data extraction and analysis. Frequencies and proportions were calculated, and in a logistic regression, we estimated the ORs of association with their 95% confidence intervals, the factors associated with COVID-19 at the threshold of p<0.05. Of 572 notified cases of suspected COVID-19 in children aged 0-15, 11.36% were positive. The median age of infected children was 10 years [IQR: 5- 13 years]. The male/female sex ratio was 2.1. Children aged 11 to 15 accounted for 49.2%, 61.5% lived in Niamey, 4.6% had comorbidities. The notion of travel was 12.3% and 40% had a notion of contact, 24.4% had a fever, 23.2% had a cough, 18% were hospitalized, and a case-fatality rate of 1.5%. In etiological analysis, the factors associated with COVID-19 were sex ORa=0.51 [0.28-0.93] p=0.028, presence of symptoms ORa=2.29 [1.23-4.25] p=0.008 and notion of contact ORa=0.32 [0.13-0.77] p=0.011. Exposed children were sensitive to COVID-19, and all age groups were affected, with a predominance of males. We recommend barrier measures adapted to young people, and early detection and management of infected children.

[Analysis of national leprosy surveillance data in Mauritania from 2009 to 2019]. / Analyse des données nationales de surveillance de la lèpre en Mauritanie de 2009 à 2019.

Introduction: Leprosy is a chronic infectious disease that mainly affects the skin, mucous membranes and the peripheral nervous system. Its elimination as a public health problem seems to lead to its ignorance and therefore to a risk of late diagnosis. An analysis of leprosy surveillance data in Mauritania was conducted to determine epidemiological trends and clinical forms of reported cases. Material and method: The retrospective study was based on the epidemiological records of leprosy in Mauritania from 2009 to 2019. The diagnosis of leprosy was made on the basis of the diagnostic criteria of the World Health Organization (WHO). Data were analyzed using Epi Info version 7.2.5.0. The frequencies, proportions, and rates were calculated. Results: Over the past 11 years, 164 cases have been notified. Among the notified cases, 96/164 (58.5%) were males and 68/164 (41.5%) females, with a sex ratio of 1.4. The mean age (± standard deviation) was 44.0 ± 17.1 years [range, 9 - 86 years], and the median was 45 years [interquartile range, 32.5; 57.5]. Children under the age of 16 accounted for 9/164 (5.5%). The wilayas (i.e. "regions") of Nouakchott were the most endemic regions in the country. The multibacillary form (MB) represented 109/164 (66.5%) cases among the observed clinical forms. The average annual incidence was 0.3 case/100,000 population for MB and 0.1 case/100,000 for PB (paucibacillary). All reported cases were treated with multidrug therapy. Conclusion: The results of leprosy surveillance showed a persistence of this disease in Mauritania. It is necessary to relaunch leprosy services at all levels in order to continue to reduce the morbidity associated with this disease, and eventually eliminate it from the country.

Epidemiological profile of measles in Niger: analysis of measles case-based surveillance data from 2010 to 2019.

Measles is a rapidly growing disease in the world with 869,770 cases and 207,500 deaths recorded in 2019. Niger continues to record epidemic outbreaks despite the actions taken. This study aims to analyze the national database from 2010 to 2019 to characterize the epidemiology of measles in Niger. This is a descriptive retrospective study. Our sample is exhaustive of suspected and positive measles cases from the database of the department of surveillance and response to epidemics for 10 years. Data extraction and analysis was done using Epi Info 7.2.3.1 software. In our study we found n=11,784 suspected measles cases notified from 2010 to 2019 with 37.2% of positive cases (IgM+). All regions are concerned. The female/male sex ratio was 1.1. The 1-to-5-year age group was the most representative (44.44%); 28.3% received at least one dose of vaccine; 62.22% lived in urban areas. The number of deaths was 225 (1.9%). The proportion of samples received at the laboratory within 3 days is 70.38%. The baseline analysis allowed us to find that all regions recorded cases and deaths with a low vaccination rate of 28.3%. Improved response and immunization strategies are recommended.

Investigation Around Cases of Crimean-Congo Hemorrhagic Fever-Mauritania, 2022.

Background: Crimean-Congo hemorrhagic fever (CCHF) is a zoonotic arbovirosis. Humans are infected by tick bites or contact with blood of infected animals. CCHF can be responsible for severe outbreaks due to human-to-human transmission. Our aims were to increase awareness and promote the search for risk factors and disease monitoring to prevent CCHF epidemic, capacity building, appropriate measures to treat patients, and information for the local population. Methods: During the outbreak of hemorrhagic fever from February to May 2022, blood samples were collected from 88 patients suspected to be infected with the virus. Diagnosis was established by reverse-transcription polymerase chain reaction (RT-PCR) and/or enzyme-linked immunosorbent assay. Results: CCHF was confirmed by RT-PCR in 7 of 88 (8%) patients. Ticks were found in cattle, sheep, or goats in the areas where the subjects resided, with the exception of 1 CCHF-positive patient in close contact with fresh animal meat. Exposure to potential risk factors was found in all patients. The interval between the onset of symptoms and hospital admission was 2-3 days. All 7 patients were admitted to our hospital and treated promptly by blood transfusion. Two patients died. Conclusions: Mortality is high in patients with the hemorrhagic form of CCHF. Disease prevention is necessary by strengthening vector control, avoiding contact and consumption of organic products from diseased animals, and vaccinating animals in areas where the disease is endemic. Furthermore, it is essential to establish management procedures for patients infected with CCHF virus.

Total, Patient and System Diagnostic Delays for Pulmonary Bacilliferous Tuberculosis in the Six Diagnostic and Treatment Centers in the Five Health Districts of the Central Region, Burkina Faso, 2018.

INTRODUCTION: Long diagnosis delay contributes significantly to the failure to eradicate tuberculosis. The objective of this study was to evaluate the total, patient and system delays in diagnosis of pulmonary bacilliferous in the six tuberculosis Diagnostic and Treatment Centers in the five health districts of the central region in Burkina Faso. METHODS: A descriptive cross-sectional study was conducted among 384 microscopy-positive pulmonary tuberculosis patients in 2018 to address this objective. It concerned the socio-demographic, clinical, microbiological characteristics, and referral location/pathway characteristics of the patients. We then calculated the different delays. The "patient" (time from first symptoms to first consultation), "system" (time from first consultation to first diagnosis) and total (time from first symptoms to diagnosis) median diagnostic delay were estimated. RESULTS: The median "total", "patient" and "system" diagnostic times were 37, 21 and 7 days, respectively. Of the 384 patients surveyed, 158 patients or 41.25% of patients had a long total diagnostic delay (> 45 days). The number of patients with a long system diagnostic delay was 125 patients (32.55%; p < 0.001) and those with a long patient diagnostic delay were 105 patients (27.34%; p < 0.001). CONCLUSION: The total diagnosis delay of pulmonary tuberculosis was long for almost half of the patients. Awareness of the signs of tuberculosis among patients and caregivers, and consultation in a health center must be intensified to help considerably reduce these delays.

Time and risk factors for death among smear-positive pulmonary tuberculosis patients in the Health District of commune VI of Bamako, Mali, 2016.

BACKGROUND: The End Tuberculosis (TB) Strategy aims to achieve 90% reduction of deaths due to TB by 2030, compared with 2015. Mortality due to tuberculosis in Mali was 13 per 100,000 inhabitants in 2014 and 11 per 100,000 inhabitants in 2017. Risk factors for death are not known. The objective of this study was to determine the time and risk factors for death in pulmonary TB patients with positive microscopy. METHODS: We conducted a retrospective cohort study from October to December 2016 in Commune VI of Bamako. Smear positive cases pulmonary tuberculosis from 2011 to 2015 were included. We reviewed the treatment registers and collected sociodemographic, clinical, biological and therapeutic data. Median time to death and hazard ratio (HR) were estimated by the Kaplan-Meier method and a Cox regression model, respectively. RESULTS: In total, we analysed 1362 smear positive cases of pulmonary TB including 104 (8%) HIV positive and 90 (7%) deaths. The mean age was 36 ± 13 years, the sex ratio of males to females was 2:1. Among the deaths, 48 (53%) occurred during the first 2 months of treatment. Age ≥ 45 years (HR 2.09 95% CI [1.35-3.23]), weight <  40 kg (HR 2.20 95% CI [1.89-5.42]), HIV unknown status (HR 1.96, 95% CI [1.04-3.67]) and HIV-positive (HR 7.10 95% CI [3.53-14.26]) were significantly associated with death. CONCLUSIONS: The median time to death was 2 months from the start of treatment. Independent risk factors for death were age ≥ 45 years, weight <  40 kg, unknown and positive HIV status. We recommend close monitoring of patients over 45 years, HIV testing in those with unknown status, an adequate care for positive HIV status, as well as a nutritional support for those with weight below 40 kg during the intensive phase of TB treatment.

[Prevalence and factors associated with missed opportunities for vaccination at Niamey, Niger]. / Prevalence et facteurs associes aux occasions manquees de vaccination (OMV) a Niamey au Niger.

AIM: determine the prevalence and factors associated with missed opportunities for vaccination of children 0-23 months old in the health district Niamey 2 (Niger) in 2018. MATERIALS AND METHODS: It was a cross - sectional study conducted in the health district of Niamey 2 in 2018. All children aged of 0 - 23 months which had parents aged more than 15 years old, who accepted to answer our questions were included. RESULTS: The prevalence of the missed opportunities immunization was 42.8%. Parent's perception on health services, the long waiting time, the refusal of immunization, the date of next appointment were the factors associated with the missed opportunities immunization. CONCLUSION: Taking into consideration the results of this study, the missed opportunities immunization remain important public health problems in Niger. Some actions need to be taken to improve the sensitization of communities about children immunization completeness.

BUT: déterminer la prévalence et les facteurs associés aux occasions manquées de vaccination selon la communauté (OMV) chez les enfants de 0 - 23 mois. MATÉRIELS ET MÉTHODES: Il s'est agi d'une étude descriptive transversale à visée analytique chez les enfants de 0 à 23 mois et leurs parents dans le district sanitaire Niamey 2 du 01 juin au 31 août 2018. Etaient inclus tous les enfants de 0 - 23 mois et leurs parents âgés de plus de 15 ans, acceptant de répondre à nos questions. RÉSULTATS: La prévalence des OMV était de 42,8%. Les perceptions des parents vis-à-vis des services de vaccination, le long temps d'attente, le refus de vaccination, la courtoisie des agents en demandant le carnet de vaccination des enfants, la date du prochain rendez ­ vous de même que la satisfaction des parents des services de vaccination étaient statistiquement liés aux occasions manquées de vaccination. CONCLUSION: Au regard de nos résultats, les occasions manquées de vaccination demeurent un problème de santé publique au Niger. Il revient donc aux autorités sanitaires la mise en œuvre des programmes d'intensification de sensibilisations communautaires pour assurer aux enfants une bonne complétude vaccinale.

Risk factors of hepatitis B virus surface antigen carriage and serological profile of HBsAg carriers in Lomé Togo, 2016.

BACKGROUND: In Togo, the prevalence of Hepatitis B Virus Surface Antigen (HBsAg) among young people aged 15-24 years was estimated at 16.4% in 2010; however, risk factors for HBsAg carriage are poorly documented. We sought to identify risk factors for HBsAg carriage and the serological profile of HBsAg carriers in Lomé (capital city of Togo). METHOD: We conducted a case control study from October 2016 to March 2017 in Lomé. Cases and controls were randomly selected from a database of Institut National d'Hygiène (INH) of Lomé during a free screening campaign for hepatitis B. We calculated means, frequencies, proportions, odds ratios (OR), and 95% confidence interval (CI) and performed logistic regression. RESULTS: We included 83 confirmed cases and 249 controls. The median age was 31 years among cases and 30 years among the controls. The sex ratios (M/F) were 11/6 among cases and 4/3 for the controls. The independent risk factors for HBsAg carriage were the awareness of hepatitis B serological status (OR = 3.56, 95% CI [1.80-7.04]) and Kabyè-tem ethnic group (OR = 3.56, 95% CI [1.98-6.39]). Among HBsAg carriers, 13.3% were at the viral replication stage (all of whom were between 30 and 45 years of age) and 1.2% were at the acute stage of the disease. The prevalence of co-infection with hepatitis B and C was 4.80%. All co-infections were in women aged 24-28 years. CONCLUSION: The Kabyè-tem ethnic group is at risk of HBsAg carriage in Lomé. Of note, most HBsAg carriers in this ethnic group are aware of their HBsAg serological status. Furthermore, the prevalence of Hepatitis among adults of reproductive age is high and is cause for concern. We therefore recommend screening and vaccination campaigns at subsidized prices among people aged 30 years and older.

Factors associated with multi-drug-resistant tuberculosis in Dakar, Senegal, 2010-2016.

According to the World Health Organization, multidrug-resistant tuberculosis (MDR-TB) represents a major obstacle towards successful TB treatment and control. In Dakar, MDR-TB management began in 2010 with the strengthening of diagnostic resources. The objective of this study was to identify the factors associated with multidrug-resistant tuberculosis in Dakar between 2010 and 2016. We conducted a case-control study from January 10 to February 28, 2017 in tuberculosis centers in Dakar. of 169 cases and 507 controls. We used logistic regression with Epi-info version 7.2.1. to estimate the odds ratios of association. Factors significantly associated with MDR-TB were: residing in a periurban area (ORa=1.8; 95% CI (1.5-4.9); p=0.024), presence of MDR-TB in the entourage of patient (ORa=7.0; 95% CI (6.1-9.5); p=0.002), previous treatment failure (ORa=29.5; 95% CI (27.3-30.1); p=0.000), treatment not directly observed by a health care provider (ORa=4.3; 95% CI (4.1-7,2); p=0.000) and irregularity of treatment (ORa=1.7; 95% CI (0.5-5.4); p=0.037). Focusing interventions on population at-risk will prevent MDR-TB.