Organization of funding for community-based HIV testing in Côte d'Ivoire: potentially counterproductive search for efficiency?

Since the early 2010s, the President's Emergency Plan for AIDS Relief (Pepfar) and the Global Fund to Fight AIDS, Tuberculosis and Malaria have stiffened their result-based management strategies. Disbursement conditions are increasingly demanding for funded NGOs (achievement of quantified objectives, frequent reporting, and monitoring of activities), and their remuneration depends on the results achieved. This article aims to analyze the effects of this strengthening of policies based on New Public Management on local implementation of activities, based on the example of community-based HIV testing. In three health districts of Côte d'Ivoire, in 2015 and 2016, we mapped the actors involved in community-based HIV testing and conducted semi-directive interviews with members of the community-based NGOs (n = 18). The funding of local HIV testing organizations is channeled through intermediary organizations according to a complex pyramid system. This, combined with cumbersome activity reporting and data validation, results in delays in the disbursement of funds and significantly reduces the actual time available to implement activities, i.e., to less than half the time planned for this purpose. This managerialization -of both Pepfar and the Global Fund - produces the counterproductive effects against which it was supposed to fight.

[Intestinal parasites in children in Biankouma, Ivory Coast (mountaineous western region): efficacy and safety of praziquantel and albendazole]. / Parasitoses intestinales infantiles à Biankouma, région des 18 Montagnes (ouest de la Côte d'Ivoire): étude de l'efficacité et de la tolérance du praziquantel et de l'albendazole.

Schistosomiasis and soil-transmitted helminthiasis are a global public health problem, especially among schoolchildren. The purpose of this study was to determine the overall and specific prevalences of intestinal helminth infection and to assess the clinical efficacy, tolerance, and safety of praziquantel and albendazole for treating it. A descriptive cross-sectional study based on random sampling with one degree of freedom was conducted from November 2006 to March 2007 in the primary schools of Biankouma, Côte d'Ivoire. Stool samples were collected from 386 children aged from 4 to 15 years and analyzed by direct examination, with both the simplified Ritchie and Kato techniques. Children infected by schistosomiasis and soil-transmitted helminthiasis eggs were treated with praziquantel (40 mg/kg in a single dose), albendazole (400 mg/kg in a single dose) or both, as deemed necessary. The prevalence rate of intestinal parasite infection was 55.2%, including overall 15.4% with more than one parasite: two in 14.2% and three in 1.2%. Infection was correlated with male gender and older age. The most frequent helminths were Schistosoma mansoni (35.5%) and Necator americanus (25.9%). The efficacy rate for praziquantel, defined as parasite-free stools, was 57.7% on day 14 and 80.9% on day 90. The efficacy rate for albendazole on day 7 was 96.1% for Ascaris lumbricoides, 93% for Necator americanus and 81.3% for Trichuris trichiura. Adverse effects were common (40.8%) but minor (abdominal pain, headache, and itching) within 2 to 4 hours after intake of praziquantel.

[A new focus of human paragonimosis discovered in Côte d'Ivoire (West Africa): the case of the Lauzoua Island]. / Un nouveau foyer de paragonimose humaine découvert en Côte d'Ivoire (Afrique de l'ouest): le cas de l'île de Lauzoua.

Fifteen cases of human paragonimosis were detected in Ivory Coast from 1974 to 1999. Since no further cases have been reported, an epidemiological survey was carried out in local health centers. The purpose of this paper is to described a new focus of paragonimosis discovered on Lauzoua Island. Clinical and parasitological examinations were performed on 17 patients presenting chronic cough, haemoptysis and/or epilepsy. Stools belonging to cats, dogs and pigs as well as river crustaceans were also examined to identify parasite eggs and metacercariae respectively. Paragonimus eggs were found in stools and/or sputum of five patients. Measurements of these eggs after fixation in formalin allowed division into three groups. Stools from cats, dogs and pigs were negative. Small Paragonimus metacercariae (mean: 277 to 323 microm) were found in three Callinectes marginatus crabs (out of 15 caught near the island). No metacercariae were found in local prawns. The presence of these three Paragonimus egg groups as well as of infected crabs near the island will require further study to identify the species and determine the prevalence of each in human infection.

Un nouveau foyer de paragonimose humaine découvert en Côte d'Ivoire (Afrique de l'Ouest): le cas de l'île de Lauzoua

Quinze cas de paragonimose humaine ont été détectés en Côte d'Ivoire de 1974 à 1999. Comme aucun autre cas n'a été trouvé depuis cette dernière date, une étude épidémiologique a été réalisée dans les centres locaux de santé. La présente note rapporte un nouveau foyer de paragonimose dans l'île de Lauzoua. Des examens cliniques et parasitologiques ont été effectués chez 17 patients souffrant de toux chronique, d'hémoptysie ou d'épilepsie. Des fèces de chats, de chiens et de porcs de même que des crustacés de rivière ont été également examinés pour y trouver les oeufs du parasite ou des métacercaires respectivement.Des oeufs de Paragonimus ont été trouvés dans les selles ou les expectorations de cinq patients. Les dimensions des oeufs (fixés dans du formol)permettent de caractériser trois groupes. L'examen des fèces provenant des chats, des chiens et des porcs s'est révélé négatif.Desmétacercaires de Paragonimus,de petite taille (de 277 à 323 µm en moyenne), ont été trouvées dans trois crabes (sur les 15 Callinectes marginatus capturés autour de l'île) tandis que l'examen des crevettes locales était négatif. La présence de trois types d'oeufs pour Paragonimus et celle des crabes parasités autour de l'île nécessitent d'autres études pour déterminer les espèces de ces parasites et la prévalence de l'infestation humaine pour chaque espèce

First findings on the seroepidemiology of human paragonimosis at the anti-tuberculosis centre of Divo, Repubuc of Ivory Coast (West Africa).

An epidemiological study was carried out in 2004-2005 at the anti-tuberculosis centre of Divo (Ivory Coast) to collect sera from patients who consulted for tuberculosis suspicion and to estimate the seroprevalence of human paragonimosis in the context of a systematic screening. No Paragonimus egg was found in the stools and/or sputa of the 167 persons investigated. In contrast, 41 sera were ascertained with antibodies against Paragonimus africanus using ELISA testing. As the optical density (OD) values related to seropositive findings were found under 0.6 (the minimal OD to detect an active paragonimosis), the above antibody titres might originate from patients in chronic or in convalescent stages, or might result of cross reactions with trematodes. Concomitantly, dissection of local crabs (Callinectes marginatus) demonstrated the presence of Paragonimus metacercariae in six out of 34 examined. The parasite burdens in crabs ranged from two to 35 cysts with a mean diameter of 302 microm. In Ivory Coast, the locality of Divo must be considered an at-risk zone in reason of the presence of anti-Paragonimus antibodies in several human sera and the presence of infected crabs at the local market.

[Symptomatic and asymptomatic Plasmodium falciparum infection in children from 6 months to 6 years old in the Abobo general hospital (Abidjan, Côte d'Ivoire)]. / Portage symptomatique et asymptomatique de Plasmodium falciparum chez les enfants de 6 mois a 6 ans a l'hôpital général d'Abobo (Abidjan, Côte d'Ivoire).

It is commonly admitted that people living in malarial zone are carrying asymptomatic Plasmodium. Côte d'Ivoire is one of these zones. The studies carried out on malaria in these areas have focused mainly on the clinical forms of the disease and effectiveness of the antimalarial drugs. The purpose of this study was to determine the prevalence of the symptomatic and asymptomatic carriage of Plasmodium falciparum in children of 6 months to 180 months old in the Abidjan area. Over a period of twelve months, 902 feverish subjects and 681 non-feverish subjects were selected among the 7,017 people admitted in the paediatrics service of the Abobo general hospital for detection of malaria parasite. Among 1,583 selected subjects, 358 were carrying Plasmodium falciparum implying a total prevalence rate of 22.6%. The prevalence rate was 13.5% and 29.5% respectively in the asymptomatic subjects and symptomatic subjects. The highest proportions of positive thick smears were observed during the long rainy and dry seasons but, parasitaemia was the highest during the short dry season. In 31.5% of the cases, the asymptomatic carriers had a parasitic density higher or equal to 10,000 trophozoites/microl of blood and fever was not related to parasitic load. The prevalence rates of Plasmodium carriage and malaria were higher during the long rainy season. This study highlighted a considerable proportion of asymptomatic Plasmodium falciparum carriers. Improving environmental conditions should help to reduce this rate of carriage.

[Persistence of a paragonimosis focus in the department of Lakota, Côte d'Ivoire (West Africa)]. / Persistance d'un foyer de paragonimose dans le département de Lakota, Côte d'Ivoire (Afrique de l'Ouest).

A field survey was carried out from March to August 2006 in three villages around the town of Lakota (Côte d'Ivoire) to verify the presence of paragonimosis in local people, wild vertebrates, and crabs. Out of the 92 patients who were recruited because of their chronic cough, haemoptysis and/or epilepsy, 3 had Paragonimus eggs in their stools and/or sputa. Examination of stools belonging to 24 wild mammals and a reptile revealed the presence of eggs in three civets (Viverra civetta) and a mongoose (Crossarchus obscurus). Six local crabs (out of the 30 Liberonautes latidactylus dissected) harboured Paragonimus metacercariae having low diameters (299 to 315 pm). The presence of several paragonimid species (at least 2) in the district of Lakota was hypothesized. However, the existence of quantitative variations in metacercarial diameters for the same species of Paragonimus cannot be excluded.

[Epidemiological profile of the schistosomiasis in school children in the Agneby Region (south-east of Côte-d'Ivoire)]. / Profil epidémiologique des schistosomoses chez les enfants d'age scolaire dans la région de l'Agnéby (sud-est de la Cote-d'Ivoire).

A parasitological survey was conducted in the Agnéby region (south-east Côte-d'Ivoire) from November 2000 to February 2001 in order to establish the epidemiological profile of schistosomiasis in school children in this region. Stools and urines of 724 school children were examined. Faeces were examined by direct analysis completed by Kato and Ritchie methods. Analysis of urine samples was made through the technique of centrifugation (2.000 g for 10 minutes). This survey revealed the importance of schistosomiasis. 20.6% of the subjects were found carriers of Schistosoma mansoni eggs, 12.6% carriers of Schistosoma haematobium eggs and 3.2% were found carriers of eggs of two Schistosoma species. Prevalence was higher in Adzope than in Agboville and Schistosoma mansoni was globally prevalent. Males were significantly more infected than females and older children were more infected than young children. The prevalence distribution among people could be explained by behaviour and occupations.

[Revaluation of chloroquine therapeutic efficacy on children with uncomplicated Plasmodium falciparum malaria in eastern Ivory Coast (1999-2002)]. / Efficacité thérapeutique de la chloroquine dans le traitement du paludisme simple à Plasmodium falciparum de l'enfant dans l'est de la Côte-d'Ivoire (1999-2002).

OBJECTIVE: A prospective study was made from November 1999 to May 2002 in order to revaluate the therapeutic efficacy of chloroquine in pediatric Plamodium falciparum malaria in Ivory Coast. DESIGN: This study was included in the national Plasmodium falciparum-susceptibility supervision program. Two hundred and fifty-six out of 594 patients from six to 59 months of age were included. Chloroquine was administered in accordance with the standard 14 day WHO protocol; i.e. administered dose of 25 mg/kg, in split doses, over three days. RESULTS: Two hundred and forty-seven patients completed the treatment. Among these, 217 presented with adequate clinical response (87.8%). The percentage of therapeutic failure was 12.2% with 12 early cases of therapeutic failure and 18 late cases of therapeutic failure. Chloroquine was more efficacious in Agnibilékrou (11.3% of therapeutic failure), Bondoukou (10.4%), and Tanda (10%), than in Abengourou (16.4%). Parasitic reduction on patients with resistant Plasmodium was superior to 90%, from day 0 to day 3. The risk of therapeutic failure was significantly linked to patient age. CONCLUSION: Considering these results, the authors suggest that the first-line treatment with chloroquine must be continued for uncomplicated malaria in humans.

[Epidemiology of tinea capitis in Abidjan, Cote d'Ivoire]. / Epidémiologie des teignes a Abidjan (Côte d'Ivoire).

Tinea capitis is a dermatosis of the scalp due to dermatophytes that can cause hair loss. It remains a significant endemic problem mainly in school children in tropical regions. The purpose of this case-control study carried out in the Dermatology Center of Treichville Hospital was to identify risk factors for tinea capitis in Abidjan, Cote d'Ivoire. A total of 80 cases were recruited on the basis of clinical findings showing one or several plaques showing desquamation or parakeratosis suggestive of tinea capitis. Diagnosis was confirmed by mycology using samples seeded on Sabouraud-chloramphenicol glucose agar and incubated at 27 degrees C for a mean period of 15 days. Species identification was based on growth rate, macroscopic aspect of isolates, production and potential diffusion of pigment, and microscopic examination. Controls were the next patient of the same age and sex with no evidence of mycosis. All subjects were questioned about previous history of mycosis, duration of tinea capitis lesions, functional signs, grooming habits, and pet-keeping. Size of selection was calculated by epi info 6.04 fr according to following estimations: percentage of exposed subjects in control group: 30%; percentage of exposed subjects in case group: 50%; probability threshold of 5% to find a difference between case and control groups even though there was no difference; and probability threshold of 20% to find no difference between cases and controls even though there was a difference. Study findings demonstrated a 3 times higher incidence of tinea capitis in boys than in girls and a peak during childhood especially between the of 5 to 9. The most frequent etiologic agents were Trichophyton soudanense and Microsporum langeroniise. Subjects at highest risk lived in dwellings having less than 4 rooms, used soap to wash the hair, cut their hair with a blade, and had low income.

[Serological survey of acquired toxoplasmosis in women of child-bearing age in Yopougon (Abidjan, Côte d'Ivoire)]. / Dépistage sérologique de la toxoplasmose acquise chez les femmes en âge de procréer dans la commune de Yopougon (Abidjan, Côte d'Ivoire).

The seroprevalence of toxoplasmosis was assessed from August 2000 to March 2001 on 1025 women in child-bearing age while consulting in the preventive health center (PHC) of Yopougon (Abidjan). Indirect immunofluorescent test was used for detection of IgG and Remington test for detection of IgM. Among the women under investigation, 60% were found to be IG seropositive, including 0.4% IgM seropositive. Soil and food were sources of contamination. When compared to previous studies conducted in the same region for several years, these results give evidence of a stability of the seroprevalence of toxoplasmosis, contributing to increase the risk of toxoplasmic encephalitis occurrence in AIDS patients.

Epidémiologie des teignes à Abidjan (Côte d'Ivoire)

Due à des dermatophytes, la teigne est une dermatose du cuir ch evelu pouvant entraîner la chute des ch eveux. Elle reste un problème d'actualité car elle sévit à l'état endémique touchant surtout les enfants d'âge scolaire. Notre étude avait pour objectif de rechercher les facteurs de risque de teigne à Abidjan. Nous avons réalisé une enquête cas-témoins au Centre de Dermatologie du CHU de Treichville. Quatre-vingt (80) cas ont été recrutés sur la base de symptômes cliniques et confirmés après un prélèvement mycologique ensemencé sur milieu gélosé de Sabouraud-chloramphénicol et sur milieu gélosé de Sabouraud- chloramphénicol- cycloheximide, incubé à 27°C pendant 15 jours en moye n n e. Au terme de cette étude, nous avons noté : la prédominance masculine de l'affection avec un sex ratio de 3 ; la prédominance de l'atteinte dans l'enfance avec un pic entre 5 et 9 ans ; que Trichophyton soudanense et Microsporum langeronii partagent les étiologies de façon équivalente ; que les sujets les plus exposés à la teigne habitent dans un logement de moins de 4 pièces, utilisent le savon pour le lavage des cheveux, se font couper les cheveux avec une lame et ont de faibles ressources économiques

[Therapeutic efficacy of chloroquine in the uncomplicated malaria due to Plasmodium falciparum in hospital patients in central Ivory Coast (1997-2000)]. / Efficacité thérapeutique de la chloroquine dans le traitement du paludisme simple dû à Plasmodium falciparum des consultants hospitaliers dans le centre de la Côte d'Ivoire (1997-2000).

A study in vivo of Plasmodium falciparum sensitivity to chloroquine was carried out from April 1997 to February 2000 at Yamoussoukro, Kossou and Bouaké in the central region of Côte d'Ivoire. This study was included in the national Plasmodium falciparum-sensitivity program. One hundred and sixteen subjects consulting for suspected malaria were included according to the WHO's standard of 14 days. Chloroquine was administered on a dosage of 25 mg/kg, spread over three days. Among 108 subjects who finished the treatment, 26.9% (29/108) had therapeutic failure to chloroquine (23 precocious therapeutic failure and 6 late therapeutic failure). Chloroquine was more efficacious in Yamoussoukro (87.5% of clinical appropriate response) and Bouaké (82.5%) than in Kossou (61.7%). Parasitic reduction on subjects with therapeutic failure was higher than 85%. The risk of therapeutic failure is not linked to age of patient. Before a revaluation of this situation, chloroquine should always be recommended as a first-line treatment for uncomplicated malaria for the local populations.

[Clinical trial of amodiaquine in the community of Attécoubé (Abidjan, Côte d'Ivoire)(May-December 1955)]. / Essai clinique de l'amodiaquine dans la commune d'Attécoubé (Abidjan, Côte d'Ivoire) (mai-décembre 1995).

A prospective study in the municipality of Attécoubé (Abidjan, Côte d'Ivoire) evaluated the sensitivity of P. falciparum to amodiaquine with a posology of 35 mg/kg over 3 days (1st day: 15 mg/kg; 2nd day: 10 mg/kg; 3rd day: 10 mg/kg) as well as its tolerance of this dosage. One hundred five WHO in vivo standard tests were performed over 7 days on subjects aged > 15 years from May to December 1995. The subjects were carriers of varying number of trophozoites: between 1000 to 34,000 trophozoites were recorded with a mean of 5193 trophozoites by microliter. We divided the subjects into two groups: group A with 43 patients to whom we administered medication and group B with 62 subjects who took their medication on their own. Clinical and parasitological verifications were made on D0, D2 and D7. Biological verification was conducted for 31 subjects of group A by mean of SGOT and SGPT quantity determination on D0 and D2. This survey revealed that 1.9% of P. falciparum malaria patients had precocious therapeutic failure to amodiaquine (35 mg/kg over 3 days) in this area. Clinical and biological tolerance was good and there was no difference between the two groups. We suggest that amodiaquine might be used for uncomplicated malaria at first intention in Abidjan.

Morphometric analysis of human gingival elastic fibres degradation by human leukocyte elastase protective effect of avocado and soybean unsaponifiables (ASU).

Degradation of preelastic fibres (oxytalan and elaunin) and mature elastic fibres by human leukocyte elastase (HLE) was investigated using automated image analysis. Specimens from two young healthy adults were used. Although HLE hydrolyzed both fibre types, mature elastic fibres exhibited greater susceptibility to this effect than preelastic fibres. Avocado and soybean unsaponifiables are widely prescribed in rheumatology and parodontology and have also been the focus of ex vivo experiments aimed at determining whether they protect elastic fibres against degradation by HLE. Findings from the present study indicate that avocado and soybean unsaponifiables protect all types of gingival elastic fibres from degradation by HLE. Avocado and soybean unsaponifiables may be beneficial in patients with gingival inflammation and parodontitis, since HLE plays a major role in these disease states.

[Traditional esthetic concepts of Akan women in Ivory Coast]. / Concept traditionnel de l'esthetique chez la femme Akan en Cote d'Ivoire.

Akan is a linguistic group living in the Middle-East and South-East parts of Ivory Coast. This group has its particular esthetic concept: esthetic should produce first, a general harmony. The most beautiful young girl is a very important personality in the society. She should wear the most beautiful jewels and clothes of the family to represent the village everywhere. Akan esthetic concept concerns both physical features and moral characteristics.

[Profound mycoses in AIDS in Abidjan (Côte d'Ivoire)]. / Mycoses profondes au cours du SIDA à Abidjan (Côte d'Ivoire).

During 1995, among 1105 HIV patients explored in our department, 64 presented a deep fungic infection (5.8%). The yeast was searched for in cerebrospinal fluid, blood, urine, and bronchoalveolar aspiration. Isolated germs were Cryptococcus neoformans (95%), Candida tropicalis (1 case), Saccharomyces cerevisiae (1 case) et Aspergillus fumigatus (1 case). Results of treatment with amphotericin B were: recovery (9%), clinical success (11%), out of sight (14%), letality (66%), relapse (23%) and side effects (19%). We emphasized diagnostical and therapeutical difficulties, and bad prognostic of mycoses in patients with AIDS.

Etiologies fongique et parasitaire des vulvo-vaginites a Abidjan. [lettre]

Une etude retrospective d'une annee d'activite allant de janvier 1989 a decembre 1989 du laboratoire de parasitologie-mycologie de la Faculute de Medecine d'Abidjan; portant sur 124 prelevements vaginaux; a permis aux auteurs de trouver un taux de positivite globale de 56;45 pour cent. Par ordre de frequence; ils ont trouve Candida albicans a un taux de 38;70 pour cent; Candida tropicalis 5;64 pour cent; puis Candida guillermondii 0;80 pour cent. Au cours de cette meme etude; Trichomonas vaginalis a ete mis en evidence 17 fois par l'examen direct; soit une prevalence de 13;70 pour cent