[Improved adherence to post-exposure prophylaxis through the use of mobile telephony at the Treichville anti-rabies center, Côte d'Ivoire.] / Amélioration de l'observance de la prophylaxie post-exposition par l'usage de la téléphonie mobile, Côte d'Ivoire.

OBJECTIVE: The objective of this study is to determine the effects of mobile telephony on the improvement of post-exposure prophylaxis compliance at the Abidjan anti-rabies center. METHODS: This is a descriptive and analytical cross-sectional study, which ran from September 2014 to May 2015. The data collection took place in two stages: first interview of all patients at the anti-rabies center at their first consultation, then a telephone interview three days after, only for those who had abandoned their prophylaxis. RESULTS: The results indicated that after telephone calls, the dropout rate dropped from 59.3% to 44.8%. Discontinuations were less frequent in patients who received a veterinary surveillance notice (ORa = 0.23, 95% CI [0.11-0.48]), who had at least one veterinary certificate (ORa = 0.25 95% CI [0.15-0.43]) or more than two doses of vaccine (ORa = 0.23, 95% CI [0.12-0.42]) before telephone call. However, dropout rates were high in patients aged 20 to 29 years (ORa = 2.66, 95% CI [1.25-5.68]) and in patients with category III exposure (ORa = 2.19, 95% CI [1.12-54.3]). CONCLUSION: These results show that mobile telephony is a useful tool for educating patients to adhere to post-exposure prophylaxis. However, information and public awareness campaigns on the fatal outcome of rabies must be organized.

[Abortion practices in high school students in Yamoussoukro, Côte d'Ivoire]. / Pratiques d?avortement chez des lycéennes à Yamoussoukro, Côte d?Ivoire.

INTRODUCTION: Induced abortion is illegal in Cote d'Ivoire, except when the mother's life is in danger. The primary objective of this study was to describe abortion practices among Yamoussoukro high school students. More specifically, this study estimated the prevalence of induced abortion, described the pathway and the methods used for abortion and determined any abortion-related complications. MATERIAL AND METHODS: This cross-sectional study was conducted in July 2011 on 312 randomly selected girls attending the Lycée Jeunes Filles in Yamoussoukro. RESULTS: These girls had a mean age (SD) of 16.1 (4.7) years; 258 (82.7%) of them had already had sexual intercourse and 81 (31.4%) had already been pregnant. Fifty (61.7% [56.3-67.1%]) of these 81 girls had already had an abortion. The abortion pathway was as follows: the main method was self-prescribed medication (70%) as first attempt, followed, in case of failure, by traditional healers (56.4%). Healthcare practitioners were usually consulted at the third attempt (85.7%). The most commonly used methods of abortion were drugs (91.9%), ingestion of plants/beverages (68.5%) and introduction of devices into the uterine cavity (62.3%). Twenty-two (44%) out of 50 induced abortions resulted in complications, mostly infectious complications (81.8%), and bleeding (68.2%). Complications were significantly associated with self-induced abortions or abortions performed by traditional healers (p < 0.001). CONCLUSION: More intensive sexual education, access to modern methods of contraception, awareness campaigns concerning the risks related to unwanted pregnancies and abortions performed by non-medical personnel need to be implemented to prevent school abortions. The quality and accessibility of post-abortion services also need to be reinforced.

[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.

[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.

[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.

[Estimated operational costs of vaccination campaign to combat yellow fever in Abidjan]. / Coûts de la riposte vaccinate contre la fièvre jaune à Abidjan, 2001.

A cost effectiveness study was conducted with the main objective to assess the operational costs of a vaccination campaign against yellow fever organised and implemented in Abidjan from September 21st to October 2nd, 2001. The study was carried out from the perspective of the health authorities. Data was collected retrospectively on all information related to resources needed and required activities. The justification of the monetary value of resources was provided with written proof and receipts as well as other supporting documents. The coverage achieved was 91.33% with 2 584 360 doses of vaccine having been administered. Spending on vaccines and vaccine supplies amounted to 1 123 177 128 FCFA; the average cost per dose was 539.40 FCFA. Human resource costs amounted to 2590 people who were mobilized for a total cost of 125 678 400 FCFA. The total operational cost of the vaccination campaign was 1 394 010 829 FCFA. Vaccines and supplies were the largest item of expenditure, or 80.57% of the total spent. The results of this study could serve as a tool for decision-making related to funding a vaccination campaign. Taking account of these results could contribute to the development of strategies to effectively reduce the operational cost of a vaccination campaign.

[Knowledge, attitudes and practices of parents on vaccination against polio in Abeche-Tchad]. / Connaissances, attitudes et pratiques des parents face à la vaccination contre la poliomyélite à Abéché-Tchad.

INTRODUCTION: in Chad, transmission of poliovirus has been interrupted in 2000, but imports from Nigeria and weakness of vaccination coverage are a major risk of disease reactivation. This study aims to investigate knowledge, attitudes and practices of parents of children aged 0 to 5 years on vaccination against polio in Chad. METHODS: this cross-sectional study was carried out in the six districts of Abéché. Only households who had children under 5 years of age were included. Data were collected through interviews with parents and guardians of eligible children using a tested and validated questionnaire. RESULTS: we interviewed 210 households. No family had a vaccination record notebook of their children. However, 97% reported vaccinated children who had participated in mass vaccination campaigns. About 97% were aware of poliomyelitis disease and 98% knew vaccination campaign. The most cited channels of information were radio (98%) and vaccinators (72%). Only 3% of parents reported refusing vaccination. There was an association between the negative influence of the relatives and the non-vaccination of children (p = 0.005). CONCLUSION: disease and vaccine knowledge is good in Chad despite the existence of rumours about, in particular, vaccine effects. The lack of immunization cards limited the analysis of survey results which were only declarative with a very high declared vaccination rate. Immunization cards are essential for eradication in association with prevention policy.