Evaluation of the implementation of hospital hygiene components in 30 health-care facilities in the autonomous district of Abidjan (Cote d'Ivoire) with the WHO Infection Prevention and Control Assessment Framework (IPCAF).

INTRODUCTION: As part of the implementation of its mission "to integrate hygiene activities into healthcare", the general directorate of health conducted in 2018 with its technical structures, an evaluation of the implementation of Infection Prevention and Control (IPC) using the WHO IPCAF tool in 30 health-care facilities in the autonomous district of Abidjan. MATERIALS AND METHODS: This were a cross-sectional survey with a conceptualized component considering the issue of injection safety and sanitary waste management, which was conducted in the named health-care facilities from March 20 to 28, 2018. The scores of the essential components of the IPC made it possible to assess the IPC level of each health-care facility evaluated and the overall IPCAF score of all facilities. RESULTS: The overall median IPCAF score of the health-care facilities was 242.5/800 and corresponded to an inadequate level overall. No facility reached the "advanced" level of performance, 5 facilities (17%) reached the "intermediate" level, 10 (33%) fell into the "basic" level, and 15 (50%) were at the "inadequate" level. Baseline institutions had much higher scores than first contact institutions. CONCLUSION: IPC component activities were inadequate and fragmented in the under-resourced health facilities at the time of the assessment. It would be appropriate to provide adequate resources and develop expertise in IPC through strong political will and leadership. This will contribute to the achievement of universal health insurance objectives with safe health services for patients.

Factors associated with the use of maternal health services by mothers in a post-conflict area of western Côte d'Ivoire in 2016.

BACKGROUND: In Côte d'Ivoire, maternal health service utilization indicators remain low despite improvements in health coverage and the availability of free health care for pregnant women. The objective of the study was to identify the determinants associated with the use of maternal health services in the department of Bloléquin, in western Côte d'Ivoire. METHODS: We conducted a cross-sectional study with an analytical focus. The study sample size was 400 women. Study participants were selected through a two-stage cluster survey. The data were collected using a standardized questionnaire whose items concerned socio-demographic data, the different uses of maternal health services, namely childbirth assisted by a health professional, use of family planning, prenatal consultation and postnatal consultation. Logistic regression was used to investigate factors associated with the use of maternal health services. The significance of the statistical tests was set at 5%. The odds ratios and 95% confidence intervals were calculated and interpreted. RESULTS: The results showed that women made less use of family planning services (OR = 0.4), prenatal consultation (OR = 0.2) and assisted childbirth (OR = 0.2) when they provided the funding for care themselves. Women with monthly incomes above $26.8 used family planning services 4 times more than those with lower incomes. Married women used prenatal consultations 3 times more often than unmarried women (CI95% = 1.4-7.3). Desiring pregnancy increased the use of post-natal consultations by 3 times (CI95% = 1.5-6.1). CONCLUSION: Improving the use of maternal health services in western Côte d'Ivoire requires taking into account women's socio-cultural and economic challenges. In initiatives related to the financial empowerment of women, efforts must be made at the level of emotional considerations related to pregnancy.

Obstacles socioculturels liés à l'utilisation de la contraception moderne en Côte d'Ivoire.

INTRODUCTION: In Côte d’Ivoire, national modern contraceptive prevalence remains low, at 21% in 2017.Purpose of research: The objective of this study was to identify socio-cultural obstacles related to the use of modern contraception among women of reproductive age. METHODS: We conducted a descriptive and qualitative study in Dallas, in the Adjamé commune, located in the center of Abidjan. The survey took place from 9th June to 7th July 2018. In addition, we conducted four focus groups with men over 20 years old, women of reproductive age between 15 and 49 years old, and two religious leaders recruited according to a reasoned sampling. Group discussion guides and individual interview guides were used as data collection tools. Moreover, we analyzed data after recording and transcribing, following a thematic content analysis. RESULTS: We interviewed thirty participants including 14 men, 14 women, and two religious leaders. The main obstacles described were the lack of reliable and adequate information, misconceptions about contraception, fear of side effects, illiteracy, male decision-making power, religious prohibitions, and the socio-cultural contradictions. To circumvent these obstacles, women secretly used contraceptives, thereby exposing themselves to social risks. CONCLUSION: Our study highlighted the persistence of socio-cultural practices. For that reason, taking into account people’s perceptions is necessary to improve the use of modern contraception at the community level.

[Water access and storage: survey in a peri-urban area of Abidjan in 2010]. / Conditions d'accès et de stockage de l'eau : enquête dans les ménages en zone périurbaine à Abidjan en 2010.

A health survey on access to water and a chemical and bacteriological analysis were conducted between May and October 2010 on 200 tanks of drinking water in 669 households in a peri-urban area of Abidjan. The results show that 70% of the population used piped water and that 64% of the population used approximately 20 litres of water per person per day. The study found that households that used alternative sources of water spent more than those that used piped water (p < 0,001). The study also found that 75.6% of the surveyed households stored water. The survey showed that 81% of the samples contained coliforms and 42.5% contained Escherichia coli. The presence of bacteria can be explained by the large quantities of water stored in open containers (i.e. containers without lids). Basic water supply combined with health education and safe water storage containers are needed.

Prevalence and Risks Factors of Prehypertension in Africa: A Systematic Review.

Background: Hypertension is one of the major factors for high mortality of adults in Africa. However, complications occur at lower values than those previously classified as hypertension. Thus, prehypertension is considered as a new category of hypertension and a major risk factor for developing clinical hypertension relative to those with normotension, it has been linked with increased future risk of hypertension as well as cardiovascular diseases. Objectives: The objective of this review was to determine prevalence of prehypertension and describe the associated factors of prehypertension in Africa during the past 10 years. Methods: We did a systematic review using the databases PubMed/Medline, and search engine google scholar. We selected sources of publications and conducted an analysis of articles. Keywords in English were: prehypertension, high normal blood pressure, high blood pressure, elevated blood pressure, Africa. Keywords in french were: préhypertension artérielle, préhypertension, pression artérielle normale haute, pression artérielle normale, Afrique. Mesh terms were: Prehypertension, Africa. Results: Twenty-seven articles were selected. Prevalence of prehypertension ranged from 2.5% to 34% in children and adolescents. In adults, prevalence varied from 32.9% to 56.8%. Several factors were associated with prehypertension in Africa. These factors included: age; sex; lifestyle such as smoking, alcohol consumption, low physical activity, overweight and obesity. There were also cardiometabolic factors and few others factors which were associated with prehypertension. Conclusion: This review allowed us to observe that the prevalence of prehypertension was variable according to age of the population and prehypertension is associated with several factors.

[Interest of microalbuminuria in preventing kidney damage during systemic lupus erythematosus (SLE) under corticoid therapy]. / Intérêt de la microalbuminurie dans la prévention des atteintes rénales au cours du lupus érythémateux disséminé (LED) sous corticothérapie.

This study aimed to evaluate the benefits of microalbuminuria in preventing kidney damage in systemic lupus erythemathosus. This was a prospective study of 6 months has focused on 25 patients of both sexes aged over 14 with SLE whose diagnosis was based on the criteria of the American College of Rheumatology, having a negative proteinuria at the dipstick (Ketodiastix(®)) and a balance sheet normal renal (creatinine and uraemia normal). Each month, samples of venous blood were achieved at the elbow in patients fasted for the night (12pm). The serum obtained was used for measurement of creatinine and urea, according to conventional methods, by a Hitachi 902(®) automated random type. The determination of urinary albumin by immuno-nephelometric method (Hitachi 902(®)), in search of microalbuminuria has involved the collection of urine over 24 hours in a sterile jar containing crystals of thymol as an antiseptic. In the presence of microalbuminuria, the dose of prednisone was progressively increased by 5 mg until no microalbuminuria. We found: 1) that creatinine and blood urea remained normal during the 6 months of study, 2) the disappearance of microalbuminuria first two months after increasing the daily dose of corticosteroid with a significant decrease of albuminuria from day 0 to day 180 (p = 0.001, day 180 vs day 0), 3) a female predominance with a sex ratio of 0.13. In conclusion, the regular dosage and systematic albuminuria to microalbuminuria appears to be a reliable means for diagnosis of lupus glomerulonephritis in the subclinical stage to prevent renal complications that occur during the Supported Lupus erythematosus.

Personal hygiene in schools: retrospective survey in the northern part of Côte d'Ivoire.

INTRODUCTION: Students' personal hygiene helps maintain health and promote good academic performance. When health facilities are insufficient, this hygiene can be difficult to achieve. We wanted to analyse the determinants of personal hygiene in schools in the northern region of Côte d'Ivoire. METHODS: The retrospective cross-sectional study brings together data on 2,035 schoolchildren recruited from thirty schools in northern Côte d'Ivoire. Indexes on personal hygiene were constructed and analysed in comparison to the socio-demographic characteristics of students, homes and schools. They were analysed with R Software version 1.1.463, the χ2 test and a logistic regression model. RESULTS: Overall, the majority of students had good personal hygiene (82.75%) with an average personal hygiene score of 4.74 ± 1.36. The predictors of good personal hygiene among schoolchildren were female gender (OR = 1.5; 95% CI = 4.31-16.37), father's primary education level (OR = 1.55; 95% CI = 1.07-2.29), the father's income level above 60,000 FCFA (90 Euros) and modern housing (OR = 1.45; 95% CI = 1.05-2.03). However, the poor level of home sanitation resulted in poor personal hygiene among the students (OR = 0.34; 95% CI = 0.23-0.5). CONCLUSIONS: Measures to raise the standard of living of families and the provision of sanitary facilities in homes becomes necessary in order to improve students personal hygiene.

[Evaluation of the operational capacity of first-line health facilities in the management of malaria in Ivory Coast]. / Evaluation de la capacité opérationnelle des établissements sanitaires de première ligne dans la prise en charge du paludisme en Côte d'Ivoire.

INTRODUCTION: Do health facilities (HF) have basic resources needed to manage malaria? The purpose of our study was to analyze the operational capacity (OC) of first-line health facilities in Ivory Coast in the management of malaria. METHODS: SARA methodology was used to conduct a descriptive cross-sectional study from 10 to 30 July 2016. The operational capacity in the management showed an average availability of 9 identification tracers divided in 3 areas: (i) staff and guidelines; (ii) capacity of diagnosis; (iii) drugs and products. This operational capacity was assessed through the calculation of an index and then compared with the health facilities according to the management authority and the geographical area using Chi-square test with p-values α fixed at 0.05. RESULTS: Out of 818 HFs, 651(79.6%) were in the public sector and 487(59.5%) were located in the rural area. The operational capacity of first line health facilities was 74.5%. This OC was higher in the public sector (81.3%) than in the private sector (48.8%) (p < 10-3) as well as in the rural area (82.7%) compared to the urban area (62.9%) (p < 10-3). CONCLUSION: In 2016, first line health facilities in Ivory Coast had basic resources needed to manage malaria. It is necessary to focus on the need to strengthen health facility services in addition to prevention.

Prevalence and factors associated with hypertension in Anonkoi 3, a peri-urban area in Abidjan (Côte d'Ivoire).

Hypertension affects more than a quarter of the world adult population, with ruralurban disparities. In Cote d'Ivoire, the prevalence was 21.7% in 2005. The aim of this study was to determine factors associated with hypertension in a peri-urban community in Abidjan. A cross-sectional study was conducted at Anonkoi 3 a peri-urban area in Abidjan. The sample was of 360 subjects aged 18 and older. Behavioral, anthropometric and blood pressure characteristics were determined using WHO STEPS questionnaire and multivariate logistic regression was performed. Prevalence of hypertension was 18.61%. Subjects were low fruit and vegetable consumption (3.3%), low level of physical activity (64.2%) and abdominal obesity at 40%. The risk of hypertension was significant from age 45, in subjects living with a partner and in those with low level of physical activity. Health education programs are essential to prevent cardiovascular risks.

HPV seminal shedding among men seeking fertility evaluation in Abidjan, Ivory Coast.

BACKGROUND: Little is known about the semen shedding of human papillomaviruses (HPV) in African men. OBJECTIVES: To detect and identify HPV types in semen samples from men seeking fertility evaluation in Abidjan, Ivory Cost. STUDY DESIGN: Sixty-three semen samples were tested by PCR using consensus primers and HPV types were determined by PCR product sequencing or by line probe assay (LiPA) when sequencing was inconclusive. RESULTS: A total of 19 HPV isolates belonging to 11 HPV types were identified in semen samples from 18 (28.6%) men. Ten (55.5%) of the HPV-positive men shed oncogenic HPV types. An association of borderline significance (P=0.06) was observed between HPV semen shedding and a lower sperm count. CONCLUSION: HPV shedding in semen is common in African men. The relationship between HPV semen shedding and sperm quality merits to be further investigated.

[Intestinal helminthiasis among school children: preliminary results of a prospective study in Agboville in Southern Côte d'Ivoire]. / Helminthiases intestinales chez les enfants d'âge scolaire: résultats préliminaires d'une étude prospective à Agboville dans le sud de la Côte d'Ivoire.

Intestinal helminthiasis affects the health and academic performance of children in developing countries. To highlight a few socio-economic factors that impact the presence and upholding of intestinal helminthiasis, a cohort study was performed from February to June 2001. This study took place in Agboville in Southern Côte d'Ivoire on 363 children, under the age of 15, regularly enrolled in school and selected by two-step clustered sampling. After the survey was completed, their stools were examined using 3 methods: direct exam, Kato's technique, and Graham's anal scotch-test. Infected students received an appropriate anti-helminthic treatment. After performing a test two weeks later, a new sample of 348 parasite-free children was made up and re-examined after three months, through the aforementioned techniques. In this sample, we assumed that students who were infested in the initial exam were "exposed", while those who were not infested in the first place were deemed to be "not exposed". The results showed that 135 students out of the 360 admitted for the first exam were infested; or a 37.5% of intestinal helminthiasis prevalence (IC95%=30.5-45). The prevalent parasite species were Necator americanus (15%), Trichuris trichiura (13.6%), Schistosoma mansoni (10%). Twenty-eight per cent of 135 infested students were infected by more than one parasite. After three months, the incidence rate of intestinal helminthiasis calculated out of the remaining 336 students was 7.7% (IC95%=4.4-13.1). The likelihood of re-infestation amounted to 3.4 (IC95%=1.5-7.3). The pattern of re-infestation rates according to socio-economic factors differed from that of infested prevalence. The prevalent parasites in re-infested patients were Trichuris trichiura (16.3%), Schistosoma mansoni (12.5%). All intestinal nematodes and Schistosoma mansoni were observed. The most frequent parasites species where those transmitted cutaneously. The high re-infestation rate suggests that intestinal helminthiasis in this region affects roughly the same children. These results show the necessity to continue our investigations in order to highlight essential hygienic factors in our long-term fight against intestinal helminthiasis.

Determinants of glycaemic control in type 2 diabetes African patients monitored by physicians from 1991 to 2004 in Cote d'Ivoire.

The aim of this study was to propose determinants of glycaemic control which are useful to adequately manage the healthcare of type 2 diabetes patients attending an out-patient clinic. A retrospective, descriptive research design was implemented at the Centre AntiDiabétique d'Abidjan in 2399 African patients. Glycaemic control was calculated from the average of at least 12 fasting plasma glucose levels measured during at least three years. Logistic and multiple linear regressions were performed at the limit of the glycaemia average of 6.7mmol/l (120mg/dl). The determinants of poor glycaemic control were: long duration of monitoring (odds ratio (OR)=1.66, then 2.68), annual frequency of visits outside the 2-3 per year interval (OR=3.25) and insulin treatment (OR=4.66) in 'non-obese men'; the aforementioned frequency of visits (OR=3.69) and insulin treatment (OR=3.72) in 'non-obese women'; the duration of monitoring reaching the 10-14 year interval (OR=3.48), the aforementioned frequency of visits (OR=2.51), insulin treatment (OR=26.16) and housewife status (OR=1.94) in 'obese women'. In 'obese men', insulin treatment was the sole determinant (r(2)=0.24). Healthcare parameters (treatment, frequency of visits, and duration of monitoring) seemed to be predominant as effective predictors of glycaemic control in our study context. These findings reveal the urgent need for both more concern and further research in diabetes management to improve the quality of care and tackle this health challenge.