[Hepatonephritis during the treatment of malaria by the therapeutic combinations from a pharmacovigilance database]. / Hépatonéphrites au cours du traitement du paludisme par les combinaisons thérapeutiques à partir d'une base de données de pharmacovigilance.

INTRODUCTION: Prior studies have shown an association between the onset of hepatonephritis and the use of arteminisin-based combination therapy (ACT) during the treatment of uncomplicated malaria. The objective of this study was to identify the risk factors of hepatonephritis occurrence because of the uncertainty regarding the appearance and the aggravation of this syndrome. METHODS: A case-non case study was carried out on 428 notifications of pharmacovigilance extracted from the database of the clinical pharmacology department of the teaching hospital of Cocody from 2008 to 2012. Twenty-two cases of hepatonephritis were identified. Univariate analysis and multivariate logistic regression were performed to identify the risk factors and an adjusted odds ratio (AOR) was calculated for each factor. The cut-off for significant association was set at 0.05. RESULTS: The average age of cases was comparable with that of non-cases (34.04±3.68 years versus 33.94±3.92 years) with a median duration of therapy of 5 days and 6 days respectively. Male (AOR: 6.71; P<0.0001), toxic antecedents, traditherapy (AOR: 6.25; P<0.0001), consumption of CTA (AOR: 1.25; P<0.0001), betalactam (AOR: 0.46; P<0.0001), fluoroquinolone and self-medication (AOR: 2.89; P<0.0001) would be the majors risk factors associated with hepatonephritis onset. The risk increased with the number of antimalarial drugs taken. The evolution towards the offset was less frequent (AOR: 0.078; P<0.02). CONCLUSION: The risk factors of hepatonephritis were the consumption of malarial drugs and connected molecules, self-medication and misuse. The outcome was generally unfavourable. Both the general population and health professionals should be trained on the good use of the antimalarial drugs.

Oral health and HIV infection among female sex workers in Abidjan, Côte d'Ivoire.

BACKGROUND: Worldwide, female sex workers (FSW) represent a vulnerable population for oral diseases due to many risk factors including HIV infection and drug abuse. In sub-Saharan Africa, little is known about the burden of oral diseases and their determinants in vulnerable populations. The aim of the study was to estimate the prevalence and associated factors of oral diseases among FSW. METHODS: A cross sectional study was conducted among FSW who attended a dedicated non-profit clinic in Abidjan, Côte d'Ivoire from June to August 2013. Data about the presence of dental caries, periodontitis and oral-mucosal lesions were collected by a dentist during an oral examination. Behavioural information related to oral hygiene habits as well as tobacco and alcohol consumption were collected through a standardized questionnaire. Information related to HIV infection including HIV diagnosis, last known CD4 count and antiretroviral therapy were documented through a medical chart review. Logistic regression models were used to identify factors associated with oral diseases. RESULTS: A total of 249 FSW with a median age of 29 years, [Inter Quartile Range (IQR) = 23-36] and a median duration of sex work of 24 months [IQR 9-60]) were included. Current tobacco use and hazardous alcohol use were reported in 21.7 % and 19.7 % of FSW, respectively. The estimated prevalence of HIV infection was 33.7 % [95 % confidence interval (CI); 27.8 - 39.6]) and 82.1 % of HIV-infected FSW were on antiretroviral therapy . The prevalence of dental caries, periodontitis and oral-mucosal lesions were 62.3 % [95 % CI 55.5 - 67.5], 14.5 % [95 % CI 10.2 - 18.9] and 8.2 % [95 % CI 4.8 - 11.5], respectively. In multivariate analysis, periodontitis, oral-mucosal lesions and HIV infection were associated with odds ratio of 2.6 [95 % CI, 1.2-5.8]) and 50.0 [95 % CI; 6.4-384.6]. CONCLUSIONS: This study showed a high prevalence of oral diseases among FSW in Abidjan. HIV infection was common and significantly associated with periodontal diseases and oral-mucosal lesions. There is a need to integrate regular screening and treatment of oral lesions into the medical follow-up of FSW along with strategies for HIV prevention.

Oral lesions among HIV-infected children on antiretroviral treatment in West Africa.

OBJECTIVE: To estimate the prevalence of oral mucosal diseases and dental caries among HIV-infected children receiving antiretroviral treatment (ART) in West Africa and to identify the factors associated with the prevalence of oral mucosal lesions. METHODS: Multicentre cross-sectional survey in five paediatric HIV clinics in Côte d'Ivoire, Mali and Sénégal. A standardised examination was performed by trained dentists on a random sample of HIV-infected children aged 5-15 years receiving ART. The prevalence of oral and dental lesions and mean number of decayed, missing/extracted and filled teeth (DMFdefT) in temporary and permanent dentition were estimated with their 95% confidence interval (95% CI). We used logistic regression to explore the association between children's characteristics and the prevalence of oral mucosal lesions, expressed as prevalence odds ratio (POR). RESULTS: The median age of the 420 children (47% females) enrolled was 10.4 years [interquartile range (IQR) = 8.3-12.6]. The median duration on ART was 4.6 years (IQR = 2.6-6.2); 84 (20.0%) had CD4 count<350 cells/mm(3). A total of 35 children (8.3%; 95% CI: 6.1-11.1) exhibited 42 oral mucosal lesions (24 were candidiasis); 86.0% (95% CI = 82.6-89.3) of children had DMFdefT ≥ 1. The presence of oral mucosal lesions was independently associated with CD4 count < 350 cells/mm(3) (POR = 2.96, 95% CI = 1.06-4.36) and poor oral hygiene (POR = 2.69, 95% CI = 1.07-6.76). CONCLUSIONS: Oral mucosal lesions still occur in HIV-infected African children despite ART, but rarely. However, dental caries were common and severe in this population, reflecting the need to include oral health in the comprehensive care of HIV.

Prevalence and correlates of hypothyroidism in pregnancy: a cross-sectional study at Bouget General Hospital, Ivory Coast.

Introduction: several adverse pregnancy outcomes have been reported in gestations with associated hypothyroidism. The prevalence of hypothyroidism has not been frequently reported in Black Africans. This study sorts to report the prevalence and associated factors of hypothyroidism in Black African pregnant women. Methods: this was a hospital-based cross-sectional study, including all pregnant women attending the gynecologic unit of Bouget General Hospital Abidjan. Serum thyroid-stimulating hormone and T4 were obtained from all participants and analyzed using a fluorescent Immunochemistry assay. Data were analyzed using R version 4.05. Univariable and multivariable logistic regression was used to assess factors associated with hypothyroidism and statistical significance considered as p < 0.05. Results: overall there were 693 participants, mean age of 28.1(SD 6.4) years with an average gestational age of 24.1 (SD 8) weeks, and a majority of study participants were in the second trimester of gestation. The prevalence of hypothyroidism was 12.1% (n = 84) (10.8% subclinical hypothyroidism and 1.3% clinical hypothyroidism) whereas 1.9% (n = 13) had hyperthyroidism. In addition, patients with reported type 1 diabetes mellitus had an increased risk of hypothyroidism (aOR: 12.6, 95% CI 1.9-100.8; p ≤ 0.01). Conclusion: this study revealed a high prevalence of hypothyroidism, though mostly in the subclinical form. Further research is warranted to confirm these findings which may have implications on early screening of hypothyroidism in black African women.

[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.

Anthropometric and behavioral patterns associated with weight maintenance after an obesity treatment in adolescents.

OBJECTIVE: To identify anthropometric and behavioral characteristics associated with weight maintenance after an obesity treatment. STUDY DESIGN: Adolescents (n = 72) enrolled in a 9-month obesity treatment were observed 1 and 2 years after discharge. Two groups, "successful" versus "limited or no success," were created on the basis of the differences in body mass index (BMI) z-score between inclusion and end of follow-up. Anthropometric and behavioral characteristics were compared between groups. RESULTS: Both groups showed a decrease in BMI z-score between inclusion and end of follow-up, 2.09 +/- 0.68 SD for the successful group and 0.65 +/- 0.43 SD for the group with limited or no success. Groups did not differ during treatment for any of the anthropometric characteristics considered, whereas differences clearly appeared 1 year after treatment and generally stabilized during the second year. Later adiposity rebound, trend for lower BMI in the mother, and, during follow-up, lower total energy intake, more energy at breakfast, and less snacking and television were recorded in the successful group. CONCLUSIONS: Weight loss maintenance can neither be predicted with anthropometry during treatment nor with behavioral characteristics at inclusion, but can be estimated 1 year after discharge. Early life factors should also be taken into account for predicting treatment outcome.

High prevalence of dental caries among HIV-infected children in West Africa compared to uninfected siblings.

INTRODUCTION: The objectives of this study were to investigate the association between HIV infection and dental caries among children in West Africa, and to identify factors associated with dental caries among HIV-infected children. METHODS: We conducted a multi-center cross-sectional study in Mali, Senegal and Côte d'Ivoire with a random sample of HIV-infected children aged 5-15 years on antiretroviral therapy and their uninfected siblings. A standardized examination was performed by calibrated dentists. The association between the number of decayed, missing or filled permanent and primary teeth surfaces (DMFdefS) and HIV status was investigated by fitting multivariable zero-inflated negative binomial models, for each age group (<12 and ≥12 years). Factors associated with dental caries could be investigated only for HIV-infected children <12 years old. RESULTS: The sample included 420 HIV-infected children and 418 non-infected siblings. The median DMFdefS was 7 for the HIV-infected children and 2 for the uninfected siblings. The proportion of children with DMFdefS ≥1 was significantly higher among the HIV-infected children than uninfected children (86.0 percent versus 64.4 percent, P < 0.001). The HIV-infected children were less likely to be caries-free than the uninfected siblings in both age groups. We found a higher degree of caries experience among HIV-infected children < 12 years old, in whom it was associated with sweet drink consumption, history of night bottle use, immunosuppression, and younger age at study entry. CONCLUSIONS: Although preventable, the burden of dental disease was high in children from families affected by HIV in West Africa and was associated with HIV infection and immunosuppression.