[Effects of Monitoring "Out-of-Area" Vaccinated Children on Data Quality, San Pedro Health District, Côte D'ivoire in 2019]. / Effets du Suivi des Enfants « Hors Zone ¼ Vaccinés sur la Qualité des Données, District Sanitaire de San Pedro, Côte D'ivoire, 2019.

In order to improve the quality of vaccination data from the health centers, we carried out the follow-up of "out-of-area" children, vaccinated in the district of San Pedro. The objective of this work was to measure the effects of taking into account the "out-of-area" vaccinated children on the quality of the data and the immunization performance of the health centers. This monitoring, which was carried out between March and August 2019, consisted of four steps: the vaccination of "out-of-area" children by the health center, the monthly update in the register of the status of vaccinated "out-of-area" children, the accounting of these children, and the re-evaluation of the health center's vaccine performance. A total of 37 of the 40 district centers had 980 "out-of-area" vaccinated children, representing 5.7% of the immunization target. The quarter of these children resided outside the district. The vaccination of "out-of-area" children included all EPI vaccines, but especially BCG, DTP-HepB-Hib and Pneumococcus_13. The number of "outside the extra-district area" vaccinated children had not changed the district's immunization coverage. On the other hand, in the health centers concerned, the accuracy of the data had been improved in 65% of the centers for DTP-HepB-Hib_1, in 70% of the centers for RR and in 65% of the centers for the overall immunization dropout rate. The approach used had made it possible to improve the quality of immunization data from health centers at no additional cost.

[Performance of the Strategy to Catch Up with Drop Out and Unvaccinated Children in Côte d'Ivoire in 2018]. / Performance de la stratégie de rattrapage des enfants perdus de vue et non vaccinés en Côte d'Ivoire en 2018.

To improve the performance of Côte-d'Ivoire's immunization program, we have implemented a strategy to catch up with drop out children (DOC) and unvaccinated children (UVC) in 14 Health Districts (HDs) with the lowest measles vaccination coverage. This article presents the effectiveness and cost of this strategy. We selected the areas with the highest numbers of DOC: 5 health areas (HAs) per HD and 5 villages/neighborhoods per HA. The strategy, which was implemented by civil society organizations, health centre managers (HCMs) and community health workers (CHWs), combined sensitization of community leaders and groups, home visits (HV) and referral of children to the HCs for immunization. Out of the 17,912 reported DOC, 9,425 found (52.6%) and 8,245 were vaccinated (46% of declared, 87.5% of found). The HCMs reported 484 UVC while the home visits identified 1,315 of which 1,087 were vaccinated (82.7%). Out of a total declared number of 18,396 children to be caught up, 10,740 found (58.4%) and 9,332 vaccinated, i.e. 50.8% (9,332/18,396) of children to be caught up and 86.9% (9,332/10,740) of children found. The total specific recurrent cost of the strategy was XOF 22,375,008, with XOF 2,083 (22,375,008/10,740) per child found and XOF 2,398 (22,375,009/9,332) per child found and vaccinated. In view of these results, this strategy should be implemented in all of the country's low-performing HDs.

Pour améliorer la performance du programme élargi de vaccination de Côte d'Ivoire, nous avons mis en place une stratégie de rattrapage des enfants perdus de vue (EPDV) et des enfants non vaccinés (ENV) dans les 14 districts sanitaires (DS) ayant les plus faibles couvertures vaccinales antirougeoleuses. Cet article présente l'efficacité et le coût de cette stratégie. Nous avons retenu les localités ayant les plus grands nombres d'EPDV : cinq aires de santé (AS) par DS et cinq villages/quartiers par AS. La stratégie qui a été mise en oeuvre par les organisations de la société civile, les responsables des centres de santé (RCS) et les agents de santé communautaire a combiné la sensibilisation des leaders et groupes communautaires, les visites à domicile (VAD) et la référence des enfants aux CS pour la vaccination. Sur les 17 912 EPDV déclarés, 9 425 ont été retrouvés (52,6 %) et 8 245 vaccinés (46 % des déclarés et 87,5 % des retrouvés). Les RCS ont déclaré 484 ENValors que les VAD ont permis d'en identifier 1 315 dont 1 087 ont été vaccinés (82,7 %). Sur un nombre total déclaré de 18 396 enfants à rattraper, 10 740 ont été retrouvés (58,4 %) et 9 332 vaccinés, soit 50,8 % (9 332/18 396) d'enfants à rattraper et 86,9 % (9 332/10 740) d'enfants retrouvés. Le coût récurrent spécifique total de la stratégie était de 22 375 008 FCFA, soit 2 083 FCFA (22 375 008/10 740) par enfant retrouvé et 2 398 FCFA (22 375 008/9 332) par enfant retrouvé et vacciné. Au vu de ces résultats, cette stratégie devrait être mise en oeuvre dans tous les DS à faible performance du pays.

[Cost Analysis of the Immunization Program Supportive Supervision in Côte-d'Ivoire]. / Analyse des coûts de supervision formative du programme de vaccination en Côte-d'Ivoire.

One of the major obstacles to improve the performance of immunization programs is the lack of competent health personnel. To increase the availability of qualified health personnel, the Agence de Médecine Préventive (Agency of Preventive Medicine) has set up a technical assistance focused on supportive supervision. The objective of this study is to analyze the cost of this supportive supervision in 10 health districts of Côte-d'Ivoire. The data extracted from the financial and technical reports of the supportive supervisions included personnel costs (salary, per diem), transportation, communication, office supplies, vehicle maintenance and depreciation. The analysis consisted of estimating the total cost of the supportive supervision, the total cost per item and the average cost of a supervisory visit. The conduct of 40 supportive supervision visits amounted to 44,675.12 USD. Of this amount, recurring costs were 40,112.12 USD (89.79%) and non-recurring costs were 4,563 USD (10.21%). The unit cost per supervisory visit was 1,116.88 USD. The cost of personnel was the largest cost. The total cost of the formative supervision would be reduced by 58.68% through the resort to local facilities' staff for the supervision, and the review of the useful life of the vehicles. The costs for implementing supportive supervision were acceptable in comparison to the benefits. Mastering personnel costs, optimizing the scheduling of supervision tours and frequency of visits focused on districts with the lowest EPI indicators could lead to cost savings.

Un des obstacles à l'amélioration des performances des programmes de vaccination est l'insuffisance de ressources humaines compétentes. Pour accroître la disponibilité de personnel de santé qualifié, l'Agence de médecine préventive a mis en place une assistance technique centrée sur la supervision formative. L'objectif de cette étude est d'analyser les coûts de cette supervision formative dans dix districts sanitaires de Côte-d'Ivoire à partir des données extraites des rapports techniques et financiers de supervision. L'analyse a consisté en l'estimation du coût total des supervisions, du coût total par poste et du coût moyen par visite de supervision. Les 40 visites de supervision réalisées ont coûté 44 675,12 USD dont 40 112,12 USD de coûts récurrents (89,78 %) et 4 563 USD de coûts non récurrents. Le coût par visite de supervision était de 1 116,87 USD. Le coût du personnel était le poste de coûts le plus important. Le coût total et le coût unitaire de la supervision seraient réduits de 58,68 % par l'utilisation des superviseurs locaux et des recommandations de l'OMS sur la durée de vie utile des véhicules. Les coûts de la supervision formative étaient acceptables au regard des bénéfices obtenus. La maîtrise des coûts du personnel, une programmation optimale des tournées de supervision et une fréquence des visites centrée davantage sur les districts présentant les plus faibles indicateurs du PEV pourraient favoriser des économies.

[Impact of a targeted technical assistance to improve vaccine coverage in Cameroon, Côte d'Ivoire, and Mauritania in 2014]. / Effets d'une assistance technique ciblée pour l'amélioration de la couverture vaccinale au Cameroun, en Côte d'Ivoire et en Mauritanie en 2014.

Within the framework of its strategic goal of vaccine coverage (VC) improvement, GAVI, The Vaccine Alliance has entrusted the Agence de médecine préventive (agency for preventive medicine, AMP) with technical assistance services to Cameroon, Cote d'Ivoire (Ivory Coast), and Mauritania. This support was provided to selected priority districts (PDs) with the worst Penta3 coverage performances. In 2014, PDs benefited from technical and management capacities in vaccinology strengthening for district medical officers, supportive supervisions and technical assistance in health logistics, data management and quality. We analyzed the effects of the AMP technical assistance on the improvement of the cumulative Penta3 coverage, which is the key performance indicator of the expanded programme on immunization (EPI) performance. We compared Penta3 coverage between PDs and other non-priority districts (NPDs), Penta3 coverage evolution within each PD, and the distribution of PDs and NPDs according to Penta3 coverage category between January and December 2014. Technical assistance had a positive effect on the EPI performance. Indeed Penta3 coverage progression was higher in PDs than in NPDs throughout the period. Besides, between January and December 2014, the Penta3 VC increased in 70%, 100% and 86% of DPs in Cameroon, Côte d'Ivoire and Mauritania, respectively. Furthermore, the increase in the number of PDs with a Penta3 coverage over 80% was higher in DPs than in NPDs: 20% versus 8% for Cameroon, 58% versus 29% for Côte d'Ivoire and 17% versus 8% for Mauritania. Despite positive and encouraging results, this technical assistance service can be improved and efforts are needed to ensure that all health districts have a VC above 80% for all EPI vaccines. The current challenge is for African countries to mobilize resources for maintaining the knowledge and benefits and scaling such interventions in the public health area.

[Molecular diagnosis of bacterial meningitis in Burkina Faso]. / Diagnostic moléculaire par PCR en temps réel d'agents bactériens responsables des méningites purulentes au Burkina Faso.

STUDY OBJECTIVES: The aim of this pilot study was to evaluate the use of real-time polymerase chain reaction (RT-PCR) in the diagnosis of bacterial meningitis in Burkina Faso. METHODOLOGY: This retrospective study reviewed the analyses of specimens collected from April 2009 through February 2010. DNA was extracted from cerebrospinal fluid (CSF) from patients with suspected meningitis from different health districts in Burkina Faso and analyzed with RT-PCR. Many patients were also tested with traditional diagnostic methods for meningitis: culture and serology (latex agglutination test). RESULTS: The study included 171 patients hospitalized in 8 health districts. Bacterial DNA for germs causing purulent meningitis was identified in 108/171 patients (63%); corresponding percentages for culture and latex were 60% (56/93) and 77% (66/86), respectively. All three methods found that NmA and Spn were the two main bacteria responsible for purulent meningitis in our cohort: with real time PCR, NmA = 59.3% and Spn = 34.3%), culture (NmA = 78.6% and Spn = 17.8%) or latex (NmA = 77.3% and Spn = 21.2%). Real-time PCR improved the sensitivity and the specificity of the diagnosis of the germs involved in this study and allowed the detection of the serogroups NmY and NmW135, which could not be detected by culture or latex agglutination test. RT-PCR permitted the detection and the characterization of bacteria responsible for purulent meningitis from CSF-contaminated cultures that could not otherwise be detected.