Randomised controlled trial on the effect of social support on disease control, mental health and health-related quality of life in people with diabetes from Côte d'Ivoire: the SoDDiCo study protocol.

INTRODUCTION: Diabetes mellitus (DM) and its severe complications contribute significantly to disability and, hence, burden of disease. Poor mental health, a frequent DM consequence, may hinder successful diabetes control in low-income and middle-income countries (LMICs). Evidence suggests social support as a cost-effective tool to improve diabetes self-management, behaviour and mental health. However, its real-world application in LMICs has rarely been tested. We aim to investigate the effect of a social support intervention on disease control, mental health and health-related quality of life in people with diabetes from Côte d'Ivoire (SoDDiCo) through a randomised controlled trial. METHODS AND ANALYSIS: The trial will take place in the Centre Antidiabétique d'Abidjan, Institut National de Santé Publique, Abidjan, Côte d'Ivoire. We will prospectively randomise up to 1500 people with newly diagnosed diabetes into two parallel arms: intervention (routine care+family supporter accompanying clinical management) and control (routine care), using gender-stratified blocked randomisation with random block sizes of 10, 16, 20 and 24. Participants will undergo baseline, 3-month and 12-month postrandomisation assessments. The primary study outcome will be glycated haemoglobin (HbA1c). Secondary outcomes will include glycaemic control (HbA1c<7.0%), presence at follow-up visits, mental health and quality of life scores. Using intention-to-treat framework, we will assess the impact of the family support intervention on these endpoints over the course of the 1-year follow-up. Effect modification by baseline social capital will be assessed. ETHICS AND DISSEMINATION: The SoDDiCo trial was approved by the Ethikkommission Nordwest- und Zentralschweiz (ref: AO_2021-00041; approved: 12 July 2021) and by Comité National d'Éthique des Sciences de la Vie et de la Santé (ref: 049-22/MSHPCMU/CNESVS-kp; approved: 20 April 2022). The randomised intervention trial will follow good clinical practice guidelines. All results will be made available to the public through abstracts at conferences as well as through peer-reviewed articles. International guidelines for authorship will be respected. TRIAL REGISTRATION NUMBER: ISRCTN10901121, ISRCTN registry.

Factors associated with exclusive breastfeeding of children under six months of age in Cote d'Ivoire.

BACKGROUND: Despite benefits of exclusive breastfeeding (EBF) and its strategic place in the national guidelines for infant and young child feeding, its practice remains insufficient in Cote d'Ivoire. It is therefore important to identify its early stopping associated factors. We aimed to (i) assess the extent of children's exposure to exclusive breastfeeding and the associated explanatory factors for discontinuation before six months, and (ii) to profile non-exclusively breastfed children and interrelationships between these factors. METHODS: A secondary analysis of data from the 2016 Cote d'Ivoire Fifth Multi Indicator Cluster Survey (MICS5) of 980 children under six months of age was conducted in this study. Data were analyzed using the actuarial method of survival hazard estimation combined with the Wilcoxon (Gehan) test, discrete time proportional hazards regression models, and Multiple Correspondence Analysis (MCA) to profile the children. RESULTS: Maternal exposure to counseling session, age at delivery, and child sex were significantly associated with the likelihood of discontinuing exclusive breastfeeding before the first six months of life. Children deprived of EBF resided in urban areas, in high and very high economic welfare households. Their mothers had a secondary education or higher and had three or fewer children. Logistic analysis showed that health status and sex of the child were significantly associated (P < 0.001) with exclusive breastfeeding. An extremely important and rarely studied factor is that children who were sick in weeks prior to the survey were more likely to remain exclusive breastfeeding (adjusted OR 1.80; 95% Confidence Interval (CI) 1.452, 2.234). Girls are less likely to be exclusively breastfed than boys (adjusted OR 1.48; 95% CI 1.22, 1.798). Low standard of living was associated with early cessation of EBF (adjusted OR 2.15; CI 1.325, 3.499). The duration of the exclusive breastfeeding was significantly longer among mothers with high exposure to medical discourse (adjusted OR 0.74; CI 0.595, 0.91). CONCLUSIONS: Improving the practice of exclusive breastfeeding in Cote d'Ivoire requires strengthening the capacities of health professionals in terms of advice and assistance to mothers for the practice of exclusive breastfeeding and its maintenance until six months of age, regardless of the health status and sex of the child.

Libido-sexual disorders and abandonment of injectable contraceptives among users of the Ivorian Association for Family Well-Being in Korhogo, Côte d'Ivoire.

Introduction: The recent introduction of modern contraceptive methods in resource-limited countries is confronted with the occurrence of undesirable effects that hinder their use in the long term. This study conducted among the users of the Ivorian Association for Family Well-Being in Korhogo describes the libido-sexual problems associated with the discontinuation of injectable contraceptives in former users. The objective of the study was to identify the factors that led to the abandonment of injectable contraceptives among female users of the Ivorian Association for Family Well-Being in Korhogo between 2018 and 2019. Materials and methods: Qualitative data were collected from 15 former users (24-38 years old) of injectable contraceptives duration of 2-3 months. Additional data were collected from five health workers aged 35-60 years. In-depth interviews were conducted to explore the experience with injectable contraceptives and reasons for discontinuation. Following data collection, audio-recorded data were transcribed, translated, and coded using thematic analysis through an inductive approach. Results: Side effects identified as associated with injectable contraceptives include libido-sexual disorders, unusual bleeding, and weight gain. The most common reason for discontinuation were libido-sexual disorders, which impacted the households' intimacy and provoked their abandonment or the change of contraceptive methods among injectable contraceptive users. Conclusion: Adverse events were dominated by libido-sexual disorders, unusual bleeding, and weight gain leading to the abandonment or change of the contraceptive. These results suggest points of intervention for increasing continuation among users. This intervention should include training of health workers to investigate and manage adverse events related to the use of injectable contraceptives and the improvement of communication between health workers and users on adverse events of injectable contraceptive use.

Development of Monitoring and Evaluation Systems in Four National Programs Addressing Mother and Child Health in Cote d'Ivoire: Qualitative Analysis of the Emergence and Formulation Process.

Background: Monitoring and evaluation were introduced into the management of national health programs to ensure that results were attained, and that donors' funds were used transparently. This study aims to describe the process of the emergence and formulation of monitoring and evaluation (M&E) systems in national programs addressing maternal and child health in Cote d'Ivoire. Methods: We conducted a multilevel case study combining a qualitative investigation and a literature review. This study took place in the city of Abidjan, where in-depth interviews were conducted with twenty-four (24) former officials who served at the central level of the health system and with six (06) employees from the technical and financial partners' agencies. A total of 31 interviews were conducted from January 10 to April 20, 2020. Data analysis was conducted according to the Kingdon conceptual framework modified by Lemieux and adapted by Ridde. Results: The introduction of M&E in national health programs was due to the will of the technical and financial partners and the political and technical decision-makers at the central level of the national health system, who were concerned with accountability and convincing results in these programs. However, its formulation through a top-down approach was sketchy and lacked content to guide its implementation and future evaluation in the absence of national expertise in M&E. Conclusion: The emergence of M&E systems in national health programs was originally endogenous and exogenous but strongly recommended by donors. Its formulation in the context of limited national expertise was marked by the absence of standards and guidelines that could codify the development of robust M&E systems.

Feasibility of the eight or more contacts of the WHO new antenatal care model in Cote d'Ivoire: an antenatal care providers' perspective.

This paper examines the feasibility of the eight or more ANC contacts in Cote d'Ivoire through a qualitative study among twenty antenatal care providers through individual interviews. The eight or more ANC contacts were found useful as they will allow a better follow up of the pregnancy. Main barriers were: the lack of training on the 2016 WHO ANC model, the late initiation of ANC and the fear of increased workload. Drivers identified were: availability of supplies, adoption and dissemination of the new guidelines, assignment of antenatal care providers in underserved area, digitization of the mother and child health handbook, pregnant women and community engagement, intensification of communication for behavior change and a good relationship provider-pregnant woman-community. To ensure appropriate design and effective delivery of the eight or more ANC contacts, attention should be paid to barriers and facilitators identified.

[A plea for introduction of hepatitis B vaccination at birth in Côte d'Ivoire]. / Plaidoyer pour l?introduction du vaccin contre l?hépatite virale B à la naissance en Côte d?Ivoire.

The Côte d'Ivoire National Immunization Technical Advisory Group 2015 work plan included elaboration of an opinion on inclusion of hepatitis B vaccination at birth in the Expanded Program on Immunization (EPI) in Côte d'Ivoire. A task force was set up to conduct this assessment according to a systematized method. The task force analysed scientific articles on the burden of hepatitis B in Côte d'Ivoire, the burden of mother-child transmission, the impact of hepatitis B vaccination at birth in countries which have adopted this strategy, the efficacy and safety of hepatitis B vaccine in newborns, the cost-effectiveness of hepatitis B vaccination at birth, and the best strategy to introduce hepatitis B vaccination at birth in the EPI. The National Immunization Technical Advisory Group of Côte d'Ivoire finally recommended introduction of a dose of hepatitis B vaccine at birth in the context of the Expanded Program on Immunization with maintenance of three doses of pentavalent vaccine (DPT-HepB-Hib) at 6, 10, and 14 weeks of age.

[Evaluation of early warning indicators of HIV resistance to antiretroviral (ARV) drugs in Ivory Coast in 2011]. / Evaluation des indicateurs d'alerte précoce de la résistance du VIH aux ARV en Côte d'Ivoire en 2011.

INTRODUCTION: In 2001, the United Nations recommended that antiretroviral (ARV) drugs be made available in resource-limited countries. However, the use of these large-scale drugs is associated with the development of drug-resistant virus. In Ivory Coast, several health care/treatment centres prescribe antiretroviral drugs. This study aimed to evaluate the programmatic factors associated with high risk of emergence of HIV ARV drug resistance. METHODS: We conducted a retrospective cohort study involving 20 health care/treatment centres for people living with HIV. The study population consisted of patients who started HIV treatment at the health care/treatment centres in 2008-2009. Sample size calculation was based on WHO sampling method. RESULTS: Of the 20 health care/treatment centres, 98% of initial prescriptions were in accordance with national guidelines and 20% of health care/treatment centres had 100% of compliant prescriptions. In total, 33% of patients were lost to follow-up during the first 12 months of antiretroviral therapy and 20% of health care/treatment centres had less than 20% of patients lost to follow-up. At 12 months, 51% of patients were under appropriate first-line treatment and 11% of the health care/treatment centres reached the threshold of at least 70% of patients under appropriate first-line treatment. Only one health care/treatment centre didn't experienced an interruption in antiretroviral therapy over 12 months. CONCLUSION: Shortcomings in the treatment of people living with HIV justify the existence of a significant risk of viral resistance to antiretroviral drugs in 2008-2009. In order to minimize this risk prescribing practices should be improved, appointment reminder systems should be implemented and a constant availability of antiretroviral drugs should be ensured.

Inequalities in child mortality in ten major African cities.

BACKGROUND: The existence of socio-economic inequalities in child mortality is well documented. African cities grow faster than cities in most other regions of the world; and inequalities in African cities are thought to be particularly large. Revealing health-related inequalities is essential in order for governments to be able to act against them. This study aimed to systematically compare inequalities in child mortality across 10 major African cities (Cairo, Lagos, Kinshasa, Luanda, Abidjan, Dar es Salaam, Nairobi, Dakar, Addis Ababa, Accra), and to investigate trends in such inequalities over time. METHODS: Data from two rounds of demographic and health surveys (DHS) were used for this study (if available): one from around the year 2000 and one from between 2007 and 2011. Child mortality rates within cities were calculated by population wealth quintiles. Inequality in child mortality was assessed by computing two measures of relative inequality (the rate ratio and the concentration index) and two measures of absolute inequality (the difference and the Erreyger's index). RESULTS: Mean child mortality rates ranged from about 39 deaths per 1,000 live births in Cairo (2008) to about 107 deaths per 1,000 live births in Dar es Salaam (2010). Significant inequalities were found in Kinshasa, Luanda, Abidjan, and Addis Ababa in the most recent survey. The difference between the poorest quintile and the richest quintile was as much as 108 deaths per 1,000 live births (95% confidence interval 55 to 166) in Abidjan in 2011-2012. When comparing inequalities across cities or over time, confidence intervals of all measures almost always overlap. Nevertheless, inequalities appear to have increased in Abidjan, while they appear to have decreased in Cairo, Lagos, Dar es Salaam, Nairobi and Dakar. CONCLUSIONS: Considerable inequalities exist in almost all cities but the level of inequalities and their development over time appear to differ across cities. This implies that inequalities are amenable to policy interventions and that it is worth investigating why inequalities are higher in one city than in another. However, larger samples are needed in order to improve the certainty of our results. Currently available data samples from DHS are too small to reliably quantify the level of inequalities within cities.

[Estimated costs of the expanded program of immunization in the health district of Grand Bassam, Cote d'Ivoire]. / Estimation des coûts du programme élargi de vaccination dans le district sanitaire de Grand Bassam, Côte d'Ivoire.

The vaccines of the Expanded Immunization Program are administered free of charge to beneficiaries. However, these vaccines are purchased by countries and partners of immunization. These costs need to be estimated to be better understood. We conducted a descriptive cross-sectional study of the costs of the Expanded Immunization Program in the health district of Grand-Bassam from January 1 to December 31, 2006, with questions aiming to understand the costs from the point of view of the state and partners. We aimed to determine costs by level of expenditure, calculate the cost per child who received 3 doses of vaccine against Diphtheria-Tetanus-Pertussis-Hepatitis B and cost per strategy. Vaccines and injection supplies accounted for 49% of recurrent costs. Vehicles and motorcycles for transport accounted for 73% of non-recurrent costs. The recurrent cost per child who received 3 doses of the vaccine was 10 797 FCFA (16 euros). The recurrent cost per dose administered was 1,041 FCFA (1,58 euros) for the fixed strategy, 4,232 FCFA (6,45 euros) for the outreach strategy and 4,058 FCFA (6,18 euros) for the mobile strategy. Because of the scarcity of financial resources, the Côte d'Ivoire government must strengthen efficient public-health measures, including vaccination.

[Adherence to rabies vaccine treatment for people exposed to rabies in Abidjan (Côte d' Ivoire)]. / Observance du traitement vaccinal antirabique chez les sujets exposés à la rage à Abidjan (Côte d'Ivoire).

This descriptive retrospective study ran from August 2003 to December 2003 at the Rabies Center of the National Institute of Public Health in Abidjan. It covers subjects at risk of rabies transmission during 2004. Identification of participants in the study was made via a census of patients consulting the rabies clinic: a total of 533 subjects were included, predominantly male (54.6%), without gainful employment (57%), with an average age of 26.7 years. Those who lived outside the city of Abidjan accounted for 21.6%. In 88.2% of cases, they were exposed due to a bite. Dogs (90.8%) represented the main species responsible for this kind of exposure. Only 3.2% of these animals had a current valid rabies vaccine. The owner of the animal was not known in 71% of cases. The observance of the recommended immunization schedule for 4 doses was 53.1%. Of the 533 patients registered in the study, 46.9% had stopped treatment vaccine. Some factors have been identified as adversely affecting adherence, such as the vaccination treatment plan of 5 doses, exposure outside the city of Abidjan, unemployment, incurrence of superficial injuries, exposure from an animal bite and lack of immunization of the animal. The results show that the strategies against rabies must focus increasingly on the importance of adherence to treatment and education of the population vis-à-vis the risk of rabies.