Identification of hydrogeological and geoelectrical parameters influencing the productivity of boreholes in the commune of Daloa (Central-Western of Côte d'Ivoire).

This study was to determine the hydrogeological and geoelectrical parameters affecting the productivity of water boreholes in the Daloa commune. Using the Schlumberger configuration, we carried out 15 parallel and perpendicular electrical profiling and 40 Vertical Electrical Soundings (VES). We also performed Electrical Resistivity Tomography (ERT) with a pole-dipole configuration at one site. The data processing allowed the identification of the different layers of the subsurface and their geoelectric properties that influence the productivity of the boreholes in the study area. These geoelectric data have shown that the productivity of the boreholes is more related to the conductive anomalies (W and U) than to the vertical electrical sounding. The processing of the hydrogeological data has shown that borehole productivity in the study area using Self-Organising Map (SOM) is a function of the hydraulic conductivity but also the thickness and density of the fracturing. Sixteen new boreholes on the main campus of Jean Lorougnon Guede University, Daloa, validate these results. The yield of these productive boreholes varies between 7.5 and 22 m3/h, with an average of 15.2 m3/h, four times higher than the values usually obtained in the study area. The success rate of these boreholes is about 70 %. This study has shown how effectively integrating hydrogeological and geoelectrical parameters provides information on the lithology and structural conditions in the subsurface necessary for productive drilling.

An mHealth App (eSkinHealth) for Detecting and Managing Skin Diseases in Resource-Limited Settings: Mixed Methods Pilot Study.

BACKGROUND: In sub-Saharan Africa, the disease burden from skin diseases, including skin-related neglected tropical diseases (skin NTDs), is extremely high. These diseases often are overlooked due to limited access to health care stemming from, for example, remote geographical locations and a lack of experts. To address these gaps, we developed a mobile health app, eSkinHealth, which is a field-adapted platform to serve as a portable electronic patient chart and for teledermatology. OBJECTIVE: The purpose of the study is to evaluate the usability and effectiveness of the app in rural Côte d'Ivoire for diagnosing and managing skin NTDs and other skin diseases. METHODS: A 2-arm trial with local health care providers and patients with skin diseases was implemented over a 3-month period. The providers were assigned to an intervention receiving the eSkinHealth app or control with usual care. Four nurses and 8 community health care workers participated in each arm. The training was provided on the use of the app to the intervention arm only, while both arms were trained on skin diseases. For the usability study, we evaluated our approach with the System Usability Scale (SUS) and in-depth interviews. For the effectiveness study, our primary outcome was to evaluate the detection and management of 5 skin NTDs as our targeted diseases, namely, Buruli ulcer, leprosy, lymphatic filariasis, scabies, and yaws, using the eSkinHealth app. Procedures of our methods were reviewed and approved by the institutional review board of the Ministry of Health and by Tulane University. RESULTS: The mean age of our participants (providers) was 40.5 and 42.5 years for the intervention and control arms, respectively, and all were male (n=24). The average SUS scores taken from the intervention arm at baseline, the midpoint (6 weeks), and the end of study (12 weeks) were 72.3 (SD 11.5), 72.3 (SD 12.4), and 86.3 (SD 10.8), respectively. All participants interviewed, including 4 dermatologists and program managers, were satisfied with the app. Especially community health care workers felt empowered by being equipped with the tool. A total of 79 cases of skin NTDs were reported in the intervention arm as compared to 17 cases in the control arm (P=.002). Besides the skin NTDs, more skin diseases and conditions were reported from the control than from the intervention arm (P<.001). However, 100 cases (66%) were not given any particular diagnosis in the control arm and were documented only as a "dermatosis." In the intervention arm, 151 cases (72.9%) were diagnosed within the eSkinHealth platform, and the remaining were diagnosed on-site by dermatologists. CONCLUSIONS: The study provided evidence for the usability and effectiveness of the eSkinHealth app embedded into our surveillance approach to improve the detection and management of skin NTDs and other skin diseases in Côte d'Ivoire and, furthermore, is expected to contribute to knowledge on mobile health approaches in the control of skin diseases in resource-limited settings. TRIAL REGISTRATION: ClinicalTrials.gov NCT05300399; https://clinicaltrials.gov/ct2/show/NCT05300399.

Evaluation of the Usability of a Mobile Application on Neglected Skin Diseases in Côte d'Ivoire: A Pilot Study.

This study investigated the usability of a mobile phone-based system, "eSkinHealth", for healthcare providers in Côte d'Ivoire. The eSkinHealth can be used both online and offline to address the poor Internet connectivity of these rural settings. Data recorded in the mobile application were synchronized with an online database, and specialists in Abidjan, Côte d'Ivoire and in Japan advised local healthcare providers on difficult cases. In this pilot study, 21 healthcare providers used the eSkinHealth and completed questionnaires assessing the usability. The average score of a system usability scale for eSkinHealth was 84.2 (SD 11.7), which can be interpreted as excellent. The average registration for patient information (e.g., name, sex, age, area of residence) was 8.6 (SD 15.5). Further studies with more targeted areas and participants are needed to evaluate the usability of eSkinHealth in rural Côte d'Ivoire.

Nutritional status and wound healing in patients with Mycobacterium ulcerans disease (Buruli ulcer): a pilot study from rural Côte d'Ivoire

Background: Buruli ulcer (BU) is a neglected tropical disease caused by Mycobacterium ulcerans which manifests as deep ulceration of the skin. Wounds from any cause heal slowly if individuals are malnourished. Objectives: To assess the impact of nutritional status on wound healing, we carried out a nutritional assessment of 11 patients diagnosed with BU in rural Côte d'Ivoire, and followed them longitudinally through the wound healing process. Materials & Methods: We conducted patient interviews to collect data on their socioeconomic characteristics, food intake and perception of nutrition. We then prospectively carried out clinical observations to assess their wound healing until complete healing or the end of the study period (median follow-up period: 19 weeks). Results: The age of the patients ranged from 6 to 66 years (median: 24; interquartile range: 20.5-52). Nine patients had normal nutritional status, one had mild malnutrition and one had moderate malnutrition as assessed by their body mass index and/or mid-upper arm circumference. Three (60%) of the five patients with adequate caloric intake, but only 1/6 (17%) of the patients with an inadequate caloric intake achieved complete healing during follow-up. Low food intake from appetite loss primarily due to wound pain and odour was reported by seven patients after developing wounds. Conclusion: Our study is the first of its kind, and the findings highlight the importance of integrating nutritional interventions into wound management protocols, and properly assessing and controlling wound pain in patients with BU.

The Early Detection and Case Management of Skin Diseases With an mHealth App (eSkinHealth): Protocol for a Mixed Methods Pilot Study in Côte d'Ivoire.

BACKGROUND: There is a high prevalence of skin diseases sub-Saharan Africa, including skin neglected tropical diseases (NTDs) that could lead to lifelong disabilities and deformities if not diagnosed and treated early. To achieve early detection and early treatment of these skin diseases, we developed a mobile health app, eSkinHealth. OBJECTIVE: This paper outlines a protocol for evaluating the effect of our eSkinHealth app in the early detection and effective management of skin diseases in Côte d'Ivoire. METHODS: A mixed methods pilot trial will be conducted in Côte d'Ivoire and will consist of 3 phases: (1) the development and improvement of the eSkinHealth app, (2) a pilot trial to evaluate the usability of the eSkinHealth app for local medical staff in Côte d'Ivoire, and (3) a pilot trial to evaluate the effectiveness of early detection and case management of targeted skin NTDs (Buruli ulcer, leprosy, yaws, and lymphatic filariasis) with the eSkinHealth app in Côte d'Ivoire. The pilot study will be implemented as a 2-arm trial with local health care providers and patients with skin NTDs over a 3-month follow-up period. The local health care providers will be assigned to an intervention group receiving the eSkinHealth app to be used in their daily practices or a control group. Training will be provided on the use and implementation of the app and the diagnostic pipeline to the intervention group only, while both groups will receive training on skin diseases. Our primary outcome is to evaluate the early detection and effective management of skin diseases using the eSkinHealth app in Côte d'Ivoire by the number of cases diagnosed and managed. Additionally, we will evaluate the eSkinHealth app with validated questionnaires and in-depth interviews. Procedures of our methods have been reviewed and approved by the Institutional Review Board of the Ministry of Health, Côte d'Ivoire and by Tulane University in 2021. RESULTS: This study was funded in 2021. We started the enrollment of patients in February 2022, and data collection is currently underway. We expect the first results to be submitted for publication in 2023. CONCLUSIONS: Our eSkinHealth app is a field-adapted platform that could provide both direct diagnostic and management assistance to health workers in remote settings. The study will provide evidence for the usability and the effectiveness of the eSkinHealth app to improve the early detection and case management of skin NTDs in Côte d'Ivoire and, furthermore, is expected to contribute to knowledge on mobile health approaches in the control of skin NTDs. TRIAL REGISTRATION: ClinicalTrials.gov NCT05300399; https://clinicaltrials.gov/ct2/show/study/NCT05300399. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/39867.

Tinea Capitis Caused by Microsporum audouninii: A Report of Two Cases from Côte D'Ivoire, West Africa.

We report here two cases of tinea capitis caused by Microsporum (M.) audouinii in Côte d'Ivoire, West Africa. The patients were a three-year-old boy and a six-year-old girl who presented with scaly patches on the scalp. The causative fungus was isolated using an adhesive tape-sampling method and cultured on Sabouraud dextrose agar plates. It was identified as M. audouinii both by its macroscopic and microscopic features, confirmed by DNA sequencing. These are the first documented cases of M. audouinii infections confirmed with DNA sequencing to be reported from Côte d'Ivoire. The practicality of the tape-sampling method makes it possible to carry out epidemiological surveys evaluating the distribution of these dermatophytic infections in remote, resource-limited settings.

[Epidemioclinical and ultrasonographic profile of hydatidiform moles in Abidjan]. / Profil épidemio-clinique et échographique des moles hydatiformes à Abidjan.

INTRODUCTION: The purpose of our study was to describe the epidemioclinical and ultrasonographic features of hydatidiform moles (HM) in Abidjan. METHODS: We conducted a cross-sectional study in the Department of Radiology, University Teaching Hospital of Yopougon over a 6-year period (January 2011-December 2016). In this study we describe the epidemioclinical and ultrasonographic profile of patients with HM. Ultrasonographic exams were performed using a mixed-methods approach (intravaginal and subpubic) based on B-mode and Color Doppler by senior radiologists. Anatomopathological examination of uterine content was performed. RESULTS: Out of 12190 obstetric ultrasound performed, twenty-five cases of HM were diagnosed reflecting a radiological referral rate of 0.2%. The average age of patients was 33.4 years, ranging from 22 to 50 years. There was no dominant age class. The main clinical signs associated with amenorrhea (100%) included abdominal mass 36% and vaginal bleeding 28%. Ultrasound showed hypertrophic uterus in 100% of cases, homogeneous uterus in 96% of cases and myomatous uterus in 4% of cases. MH had an average thickness of 42.7 mm with vesicular appearance in 68% of cases, "honeycomb" appearance in 16%, multicystic appearance in 12% and snowstorm appearance in 4%. MHs were classified as partial in 4% of cases, complete in 92% of cases and invasive in 4% of cases. Hypertrophic ovaries were found in 44% of cases with macrofollicles in 32% of cases and cysts in 8% of cases. Ultrasonographic diagnosis of HM was confirmed by anatomopathological examination in 100% of cases. CONCLUSION: HMs are rare in Abidjan and are dominated by the complete hydatidiform mole. Its occurrence at the extreme ages wasn't found.

Skin disease prevalence study in schoolchildren in rural Côte d'Ivoire: Implications for integration of neglected skin diseases (skin NTDs).

BACKGROUND: Early detection of several skin-related neglected tropical diseases (skin NTDs)-including leprosy, Buruli ulcer, yaws, and scabies- may be achieved through school surveys, but such an approach has seldom been tested systematically on a large scale in endemic countries. Additionally, a better understanding of the spectrum of skin diseases and the at-risk populations to be encountered during such surveys is necessary to facilitate the process. METHODS: We performed a school skin survey for selected NTDs and the spectrum of skin diseases, among primary schoolchildren aged 5 to 15 in Côte d'Ivoire, West Africa. This 2-phase survey took place in 49 schools from 16 villages in the Adzopé health district from November 2015 to January 2016. The first phase involved a rapid visual examination of the skin by local community healthcare workers (village nurses) to identify any skin abnormality. In a second phase, a specialized medical team including dermatologists performed a total skin examination of all screened students with any skin lesion and provided treatment where necessary. RESULTS: Of a total of 13,019 children, 3,504 screened positive for skin lesions and were listed for the next stage examination. The medical team examined 1,138 of these children. The overall prevalence of skin diseases was 25.6% (95% CI: 24.3-26.9%). The predominant diagnoses were fungal infections (n = 858, prevalence: 22.3%), followed by inflammatory skin diseases (n = 265, prevalence: 6.9%). Skin diseases were more common in boys and in children living along the main road with heavy traffic. One case of multi-bacillary type leprosy was detected early, along with 36 cases of scabies. Our survey was met with very good community acceptance. CONCLUSION: We carried out the first large-scale integrated, two-phase pediatric multi-skin NTD survey in rural Côte d'Ivoire, effectively reaching a large population. We found a high prevalence of skin diseases in children, but only limited number of skin NTDs. With the lessons learned, we plan to expand the project to a wider area to further explore its potential to better integrate skin NTD screening in the public health agenda.

Associations between lifestyle and mental health in a group of Japanese overseas workers and their spouses resident in Düsseldorf, Germany.

This study investigated associations between lifestyle factors and selected aspects of mental health in a group of Japanese overseas workers and their accompanying spouses who were residing in and around Düsseldorf, Germany, in February 1994. Considering four aspects of mental health (depression, mental instability, nervousness and neurosis) and six lifestyle factors (alcohol consumption, sleeping hours, cigarette smoking, physical exercise, eating breakfast and eating snacks), a cross-sectional study involving 822 volunteers (486 workers and 336 spouses) was performed using the Todai Health Index (THI) for surveying self-perceived health and a lifestyle related self-administered questionnaire. Alcohol consumption had no associations with any of the four aspects of mental health, and only very weak inverse associations were found between the other five lifestyle factors and the four aspects of mental health in the workers group. In the spouses group, physical exercise was the only lifestyle factor significantly associated with mental health.

Airway inflammatory and immunological events in a rat model exposed to toluene diisocyanate.

To investigate the inflammatory and immunological events in the airway induced by a short period of repeated exposure to toluene diisocyanate (TDI), an animal model was established, which resembled the industrial field exposure. After whole body exposure of Wistar rats to 0.38 and 1.20 ppm TDI vapor 4h a day for five consecutive days in a glass chamber, bronchoalveolar lavage (BAL) was performed. BAL fluid cellular and cytokine contents were then determined. Histopathological examinations were also carried out on the lungs. The TDI vapor exposure resulted in airway symptoms similar to those in occupational asthma. BAL fluid cellular analysis and lung histopathological examination revealed that inflammatory response was characterized by marked eosinophil infiltration of the airways. The cytokine assay revealed significant production of IL-4 in the airways of the TDI exposed rats as compared to the control rats. These findings indicated that a short period of repeated exposure to TDI vapor may cause respiratory hypersensitivity in which airway inflammatory and immunological events represented by eosinophil infiltration and Th2 cytokines may play an important role. Also, this animal model may be suitable for exploring the mechanism underlying TDI-induced occupational asthma.

Causes of death in the Taabo health and demographic surveillance system, Côte d'Ivoire, from 2009 to 2011.

BACKGROUND: Current vital statistics from governmental institutions in Côte d'Ivoire are incomplete. This problem is particularly notable for remote rural areas that have limited access to the health system. OBJECTIVE: To record all deaths from 2009 to 2011 and to identify the leading causes of death in the Taabo health and demographic surveillance system (HDSS) in south-central Côte d'Ivoire. DESIGN: Deaths recorded in the first 3 years of operation of the Taabo HDSS were investigated by verbal autopsy (VA), using the InterVA-4 model. InterVA-4 is based on the World Health Organization 2012 VA tool in terms of input indicators and categories of causes of death. RESULTS: Overall, 948 deaths were recorded, of which 236 (24.9%) had incomplete VA data. Among the 712 deaths analyzed, communicable diseases represented the leading causes (58.9%), with most deaths attributed to malaria (n=129), acute respiratory tract infections (n=110), HIV/AIDS (n=80), and pulmonary tuberculosis (n=46). Non-communicable diseases accounted for 18.9% of the deaths and included mainly acute abdomen (n=38), unspecified cardiac diseases (n=15), and digestive neoplasms (n=13). Maternal and neonatal conditions accounted for 8.3% of deaths, primarily pneumonia (n=19) and birth asphyxia (n=16) in newborns. Among the 3.8% of deaths linked to trauma and injury, the main causes were assault (n=6), accidental drowning (n=4), contact with venomous plants/animals (n=4), and traffic-related accidents (n=4). No clear causes were determined in 10.0% of the analyzed deaths. CONCLUSIONS: Communicable diseases remain the predominant cause of death in rural Côte d'Ivoire. Based on these findings, measures are now being implemented in the Taabo HDSS. It will be interesting to monitor patterns of mortality and causes of death in the face of rapid demographic and epidemiological transitions in this part of West Africa.

IL-4 and IL-5 secretions predominate in the airways of wistar rats exposed to toluene diisocyanate vapor.

OBJECTIVES: We established a Wistar rat model of asthma caused by toluene diisocyanate (TDI) exposure, and investigated the relationship between TDI exposure concentrations and respiratory hypersensitivity, airway inflammation, and cytokine secretions in animals, to better understand the mechanism of TDI induced occupational asthma. METHODS: Wistar rats were exposed to two different concentrations of TDI vapor four hours a day for five consecutive days. Bronchoalveolar lavage (BAL) was performed, and differential leucocytes from the BAL fluid were analyzed. Lung histopathological examination was carried out to investigate the inflammatory status in the airways. Production of cytokines interleukin (IL)-4 and IL-5 productions in the BAL fluid in vivo was determined with enzyme-linked immunosorbent assay kits. RESULTS: The TDI-exposed rats exhibited greater airway hypersensitivity symptoms than the control rats. The BAL differential cell count and lung histopathological examination demonstrated that inflammation reactions were present in both the central and peripheral airways, characterized with marked infiltration of eosinophils in the TDI-exposed rats. The cytokine assay showed that IL-4 and IL-5 were predominantly produced in the BAL fluid in vivo. CONCLUSIONS: These findings imply that TDI exposure concentrations may greatly affect the occurrence and extent of inflammatory events and that Th2 type cytokines may play an important role in the immunopathogenesis of TDI-induced occupational respiratory hypersensitivity.