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INTRODUCTION: Pneumothorax are frequent reasons for hospitalization in African pneumological settings. The objective of this work was to describe the epidemiological-clinical, etiological, therapeutic and evolutionary aspects of pneumothorax at the Center Hospitalier Universitaire d'Abéché (CHU-A) in Chad. MATERIALS AND METHODS: This was a prospective and descriptive study conducted in the internal medicine department, from January 1, 2020 to December 31, 2021 concerning cases of pneumothorax. RESULTS: A total of 40 cases of pneumothorax were collected, representing a hospital frequency of 2.38%. The most affected age group was that of 26-45 years (40%) with a male predominance (M/F ratio=2.33). The main contributing factors were smoking (32.5%) and being underweight (55.5%). Acute bacterial pneumonia (57.5%) and tuberculosis (27.5%) were the main etiologies of secondary pneumothorax. Pleural drainage (62.5%), combined with non-specific antibiotic therapy (57.5%) or antituberculous treatment (27.5%) were the main means of management. The evolution was favorable at 90%. We had recorded a hospital mortality of 7.5%. CONCLUSION: Pneumothorax remains frequent in our hospital settings. The dominant etiologies were acute bacterial pneumonia and tuberculosis. The evolution is sometimes interspersed with complications such as residual pneumothorax or pachypleuritis.
BUT: Les pneumothorax sont des motifs fréquents d'hospitalisation en milieux pneumologiques africains. L'objectif de ce travail était de décrire les aspects épidémiologiques, cliniques, étiologiques, thérapeutiques et évolutifs des pneumothorax spontanés au service de médecine interne du Centre Hospitalier Universitaire d'Abéché (CHU-A) au Tchad. MATÉRIEL ET MÉTHODES: Il s'agissait d'une étude prospective et descriptive réalisée dans le service de médecine interne, incluant les patients pris en charge pour pneumothorax spontané, allant du 1er janvier 2020 au 31 décembre 2021. RÉSULTATS: Au total, 40 cas de pneumothorax étaient colligés représentant une fréquence hospitalière de 2,4%. La tranche d'âge la plus touchée était celle de 26-45 ans (40%) avec une prédominance masculine (ratio H/F=2,33). Les principaux facteurs favorisant étaient le tabagisme (32,5%), et l'insuffisance pondérale (55,5%). La pneumopathie aiguë bactérienne (57,5%) et la tuberculose (27,5%) constituaient les principales étiologies du pneumothorax secondaire. Le drainage pleural (62,5%), associé à l'antibiothérapie non spécifique (57,5%) ou au traitement antituberculeux (27,5%) étaient les principaux moyens de prise en charge. L'évolution était favorable à 90%, et la mortalité hospitalière était de 7,5%. CONCLUSION: Le pneumothorax spontané reste une urgence surtout s'il est compressif ou suffocant ou associé à d'autres lésions. Sa prévention repose sur l'éviction des principaux facteurs favorisant qui sont le tabagisme et la dénutrition. Son traitement de référence qui est le drainage pleural impose des politiques sanitaires dans nos pays pour son accessibilité à tous.
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BACKGROUND: A serogroup A meningococcal polysaccharide-tetanus toxoid conjugate vaccine (PsA-TT, MenAfriVac) was licensed in India in 2009, and pre-qualified by WHO in 2010, on the basis of its safety and immunogenicity. This vaccine is now being deployed across the African meningitis belt. We studied the effect of PsA-TT on meningococcal meningitis and carriage in Chad during a serogroup A meningococcal meningitis epidemic. METHODS: We obtained data for the incidence of meningitis before and after vaccination from national records between January, 2009, and June, 2012. In 2012, surveillance was enhanced in regions where vaccination with PsA-TT had been undertaken in 2011, and in one district where a reactive vaccination campaign in response to an outbreak of meningitis was undertaken. Meningococcal carriage was studied in an age-stratified sample of residents aged 1-29 years of a rural area roughly 13-15 and 2-4 months before and 4-6 months after vaccination. Meningococci obtained from cerebrospinal fluid or oropharyngeal swabs were characterised by conventional microbiological and molecular methods. FINDINGS: Roughly 1·8 million individuals aged 1-29 years received one dose of PsA-TT during a vaccination campaign in three regions of Chad in and around the capital N'Djamena during 10 days in December, 2011. The incidence of meningitis during the 2012 meningitis season in these three regions was 2·48 per 100,000 (57 cases in the 2·3 million population), whereas in regions without mass vaccination, incidence was 43·8 per 100,000 (3809 cases per 8·7 million population), a 94% difference in crude incidence (p<0·0001), and an incidence rate ratio of 0·096 (95% CI 0·046-0·198). Despite enhanced surveillance, no case of serogroup A meningococcal meningitis was reported in the three vaccinated regions. 32 serogroup A carriers were identified in 4278 age-stratified individuals (0·75%) living in a rural area near the capital 2-4 months before vaccination, whereas only one serogroup A meningococcus was isolated in 5001 people living in the same community 4-6 months after vaccination (adjusted odds ratio 0·019, 95% CI 0·002-0·138; p<0·0001). INTERPRETATION: PSA-TT was highly effective at prevention of serogroup A invasive meningococcal disease and carriage in Chad. How long this protection will persist needs to be established. FUNDING: The Bill & Melinda Gates Foundation, the Wellcome Trust, and Médecins Sans Frontères.