[Predictors Of The Use Of Prenatal Care Among Women Who Have Given Birth In Burundi: A Multilevel Analysis]. / Predicteurs Du Recours Aux Soins Prenataux Chez Les Femmes Ayant Accouchees Au Burundi : Une Analyse Multiniveau.

OBJECTIVE: Identify the predictors of the use of antenatal care in Burundi. DATA AND METHODS: This were an analysis of secondary data from the 2016 - 2017 demographic and health surveys in Burundi. The survey population was women who gave birth in the last five (05) years prior to the survey and gave their informed consent. Our sample consisted of 7,372 women. The data were analyzed with Stata 15.1 software. In bivariate analysis, the Chi-2 test, and simple logistic regression allowed us to identify the candidate variables for modelling at the 20% threshold. Multilevel ordinal logistic regression identified individual and contextual predictors of prenatal care use. RESULTS: The use of antenatal care by women who gave birth in Burundi was influenced by the area of residence (rural area : OR=1.25; 95% CI [1.05 - 1.49]), level of education (secondary level: OR=1.36; 95% CI [1.12 - 1.65]), parity (OR=0.77; 95% CI [0.68 - 0.87]), HIV transmission during pregnancy (OR=1.22; 95% CI [1.06 - 1.41]) and internet use frequency (OR=1.60; 95% CI [1.16 - 2.20]). The intraclass correlation coefficient was (Ii 3 = 0.0050083). CONCLUSION: Consideration of these determinants in the development of strategies to improve antenatal care utilization is necessary.

OBJECTIF: Identifier les facteurs prédictifs du recours aux soins prénatals au Burundi. DONNÉES ET MÉTHODES: Il s'agissait d'une analyse de données secondaires provenant des enquêtes de démographie et de santé 2016 ­ 2017 du Burundi. Notre échantillon était constitué de 7372 femmes. Les données ont été analysées avec le logiciel stata 15.1. La régression logistique ordinale multiniveau a permis d'identifier les prédicteurs individuels et contextuels du recours aux soins prénatals. RÉSULTATS: Le recours aux soins prénataux par les femmes ayant accouché au Burundi était influencé par le milieu de résidence (milieu rural : OR=1.25 ; IC 95% [1.05 ­ 1.49]), le niveau d'éducation (niveau secondaire : OR=1.36 ; IC 95% [1.12 ­ 1.65]), la parité (OR=0.77 ; IC 95% [0.68 ­ 0.87]), la transmission du VIH pendant la grossesse (OR=1.22 ; IC 95% [1.06 ­ 1.41]) et la fréquence d'utilisation de l'internet (OR=1.60 ; IC 95% [1.16 ­ 2.20]). Le coefficient de corrélation intraclasse était (Ii 3 = 0.0050083). CONCLUSION: La prise en compte de ces déterminants dans l'élaboration des stratégies d'amélioration de l'utilisation des soins prénataux s'avère nécessaire.

Assessment of poliovirus antibody seroprevalence in polio high risk areas of West Africa.

We conducted a serological survey of anti-polio antibodies in polio high-risk areas of Mali, Guinea and Cote d'Ivoire to assess risk of future poliovirus outbreaks. Random community sampling of children 6-11 and 36-48 months-old was conducted; neutralizing antibodies against poliovirus were detected using microneutralization assay. We analysed 1059/1064 (99.5%) of enrolled children. Seroprevalence to poliovirus type 1 (PV1) across all age groups and locations ranged between 92 and 100%, for PV2 it was 77-100%, and 89-95% for PV3. PV2 seroprevalence in the younger age group in Guinea and Cote d'Ivoire was <80%. History of <4 polio vaccine doses and acute malnutrition were associated with seronegativity (OR = 2.1 CI95% = 1.5-3.1, OR = 1.8 CI95% = 1.1-3.3 respectively). The risk of poliovirus outbreak following importation is low because of high population immunity to PV1, however, due to large cohort of PV2 seronegative children any future detection of vaccine-derived poliovirus type 2 requires urgent response to arrest rapid spread.

[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.

Determinants of Fatal Road Traffic Injuries in Côte d'Ivoire from 2002 to 2011 / Déterminants des accidents mortels de la circulation routière en Côte d'Ivoire de 2002 à 2011.

Introduction : In most developing countries, with rapidly changing lifestyles, urbanization, and increasing numbers of vehicles, Road Traffic Injuries (RTI) are expected to have a growing impact on mortality and morbidity.The objective of this study was to identify factors associated with fatal RTI in Côte d'Ivoire.Methods : We conducted a cross-sectional study of data concerning RTI in Côte d'Ivoire over a ten-year period (2002 to 2011) from the Road Safety Office (RSO) database. All RTI reported by the police were included in the study. Fatal RTI was the dependent variable, while sociodemographic, behavioural and environmental risk factors were independent variables. Data were analysed using SPSS Version 16 software.Results : Out of a total of 56,966 reported RTI, 3008 were fatal, representing 0.6 deaths per 100,000. The majority (93.5%) of RTI occurred in urban areas. Pedestrian victims were identified in more than one half (59.3%) of cases. Subjects under the age of 18 and subjects between the ages of 43 and 47 years had 2.4-fold and 4.9-fold higher risks of fatal accidents, respectively. Excessive speed (OR = 5.3 ; p = 0.000) and dangerous overtaking (OR = 4.9 ; p = 0.000) were the leading causes of fatal accidents. Mechanical failure was also a risk factor (OR = 3.9 ; p < 0.005). The risk of a fatal accident was 6.8-fold higher in rural areas than in urban areas.Conclusion : Fatal RTI were related to human and environmental factors, hence the need for awareness campaigns to promote behaviour changes among road users.

Investigation of an outbreak of acute respiratory disease in côte d'ivoire in april 2007.

BACKGROUND: This study aim was to investigate an outbreak of human cases of unexplained influenza-like illness and fatal acute respiratory infection (ARI), with simultaneous poultry illness and high mortality raising concerns of possible influenza A (H5N1), virus in Cote d'Ivoire in February and March 2007. MATERIALS AND METHODS: To investigate the outbreak, we conducted active surveillance in the community and reviewed health registries. Persons meeting the case definition were asked to provide nasopharyngeal specimens. On the basis of clinical and epidemiological information, specimens were tested using conventional RT-PCR for the M gene of the influenza viruses and hemagglutinin H5 of avian influenza A (H5N1), virus; negative samples were tested for other respiratory viruses. Specimens from healthy animals were also collected. RESULTS: Between October 2006, and February 2007, 104 suspected cases of Acute Respiratory Disease that included; 31 deaths recorded. We collected and tested 73 nasopharyngeal specimens; of which, 2, were positive for human Coronavirus OC43 and 1 for influenza C virus. No pathogens were identified in animal specimens. CONCLUSIONS: The investigation quickly ruled out influenza A (H5N1), virus as the cause and found laboratory-confirmed cases of influenza C virus and human Coronavirus OC 43 for the first time in both Côte d'Ivoire and in a Sub-Saharan African country. However we were not able to show that these viruses caused the outbreak. Monitoring of influenza viruses must be a priority but other respiratory viruses and non-viral causes may be of interest too.

Investigation of an outbreak of acute respiratory disease in Côte d'Ivoire in april 2007

Background: This study aim was to investigate an outbreak of human cases of unexplained influenza-like illness and fatal acute respiratory infection (ARI); with simultaneous poultry illness and high mortality raising concerns of possible influenza A (H5N1); virus in Cote d'Ivoire in February and March 2007. Materials and Methods: To investigate the outbreak; we conducted active surveillance in the community and reviewed health registries. Persons meeting the case definition were asked to provide nasopharyngeal specimens. On the basis of clinical and epidemiological information; specimens were tested using conventional RT-PCR for the M gene of the influenza viruses and hemagglutinin H5 of avian influenza A (H5N1); virus; negative samples were tested for other respiratory viruses. Specimens from healthy animals were also collected. Results: Between October 2006; and February 2007; 104 suspected cases of Acute Respiratory Disease that included; 31 deaths recorded. We collected and tested 73 nasopharyngeal specimens; of which; 2; were positive for human Coronavirus OC43 and 1 for influenza C virus. No pathogens were identified in animal specimens. Conclusions: The investigation quickly ruled out influenza A (H5N1); virus as the cause and found laboratory-confirmed cases of influenza C virus and human Coronavirus OC 43 for the first time in both Cote d'Ivoire and in a Sub-Saharan African country. However we were not able to show that these viruses caused the outbreak. Monitoring of influenza viruses must be a priority but other respiratory viruses and non-viral causes may be of interest too

Pandemic Influenza A(H1N1) in Cote d'Ivoire: health-care providers' knowledge of influenza and attitudes towards vaccination.

INTRODUCTION: During the 2009 influenza A(H1N1) pandemic (pH1N1), different methods were promoted to reduce the spread of influenza, including respiratory etiquette and vaccination. To identify knowledge gaps about influenza and to plan the vaccination campaign against the pandemic in Côte d'Ivoire, a survey was conducted among health-care providers (HCPs) to assess their knowledge about influenza and their willingness to be vaccinated. METHODOLOGY: A cross-sectional survey was performed in the city of Abidjan on 16-18 February 2010, in the three university teaching hospitals, a randomly selected general hospital, and two randomly selected private clinics. In face-to-face interviews, 383 health-care professionals were asked questions about their knowledge of influenza, means of influenza prevention, and their willingness to be vaccinated. Data analysis, both univariate and multivariate, was performed using SPSS. RESULTS: Willingness to be vaccinated against pH1N1 was 80% (n = 284), and 83% of the HCPs would recommend the vaccine to others. The respiratory mode of transmission of influenza was known by 85% (n = 295) of the participants and 50% (n = 174) believed that seasonal influenza virus and pH1N1 virus were different. In a multivariate model, the factors significantly associated with willingness to receive pH1N1vaccine were fear of pH1N1 disease (OR = 2.1; IC = 1.02-4.35), having only a high school education (OR = 8.28; IC = 2.04-33.60), and feeling at risk to contract pH1N1 (OR = 11.43; IC = 4.77-27.38). CONCLUSION: The willingness to be vaccinated against influenza A (H1N1) by health professionals is real.

Aedes aegypti susceptibility to insecticide from Abidjan City, Cote D'ivoire.

The susceptibility of Aedes aegypti adults of three places in Abidjan city selected for an entomological surveillance of potential arbovirus vectors to permethrin, deltamethrin, lambdacyhalothrin, and propoxur was determined using WHO standard procedures. The wild populations of A. aegypti were susceptible to permethrin, deltamethirn, and lambdacyhalothin. Resistance to propoxur was detected in strains collected at the Autonomous Port of Abidjan and at Koumassi (mortality rate: 77%) but possibly resistance to this insecticide at the national zoological park (mortality rate: 90.8%). Populations of the national zoological park were possibly resistant to propoxur whereas those of the Autonomous port of Abidjan and of Koumassi were resistant.

[The epidemiological profile of subjects exposed to rabies in Abidjan, Ivory Coast]. / Profil épidémiologique des personnes exposées à la rage à Abidjan, Côte d'Ivoire.

The purpose of this study is to describe the epidemiological profile of subjects exposed to rabies in the anti-rabies center of Abidjan in Ivory Coast. The paper is based on a cross-sectional study conducted among all people exposed to the risk of rabies and followed in the anti-rabies center from January to December 2008. During the study period, 2,673 subjects were exposed, i.e. 5 exposures for every 10,000 persons. 1,534 patients (57.4%) were male. The most exposed age groups were the 0-9 and 10-19 age groups (22.4% and 29.5% respectively). In Abidjan, 608 individuals (22.7%) were exposed in Cocody, 471 individuals (17.6%) in Abobo, and 310 individuals (11.6%) in Yopougon. Exposure occurred in 76.9% of cases (2,055 subjects) at home and exclusively concerned visitors of the family. Exposures by animal bites represented 88.1% (2,354 subjects) of all cases, while 23.2% (620 subjects) of exposures were category III. The average period between exposure and consultation was 10 days. Subjects were exposed as a result of contact with a dog in 92.1 % of cases (2,462 subjects). The animal was found alive in 74.9% (2,002 cases) and was not immunized in 87.2% of cases (2,331). Post-exposure prophylaxis was given up by 1,470 persons (55.2%). 13 subjects were received at the stage of clinical rabies. Increased knowledge of the epidemiological profile of rabies exposure will contribute to improving the management of the disease in Ivory Coast.

[Evaluation of the quality of prenatal consultations in the health district of Grand Bassam, Côte d'Ivoire]. / Evaluation de la qualité des consultations prénatales dans le district sanitaire de Grand Bassam (Côte d'Ivoire).

Maternal mortality constitutes a major public health problem in Côte d'Ivoire. Better management of pregnant patients and improved quality of pre-natal consultations could contribute to solving this problem. But what is the current situation of these a pre-natal consultations in the medical district of Grand-Bassam? To answer to this question, a descriptive cross-sectional study was carried out between August 26th and September 30th, 2002 in three medical establishments in charge of pre-natal consultations in that District. It was noted that the privacy and the confidentiality during the examination were respected; yet on the other hand, the structures were sometimes unsuited and were insufficiently equipped. The health care professionals were not very accessible or friendly, and they had poor interpersonal communication skill. Recommendations were made to remedy these insufficiencies.

[Estimated operational costs of vaccination campaign to combat yellow fever in Abidjan]. / Coûts de la riposte vaccinate contre la fièvre jaune à Abidjan, 2001.

A cost effectiveness study was conducted with the main objective to assess the operational costs of a vaccination campaign against yellow fever organised and implemented in Abidjan from September 21st to October 2nd, 2001. The study was carried out from the perspective of the health authorities. Data was collected retrospectively on all information related to resources needed and required activities. The justification of the monetary value of resources was provided with written proof and receipts as well as other supporting documents. The coverage achieved was 91.33% with 2 584 360 doses of vaccine having been administered. Spending on vaccines and vaccine supplies amounted to 1 123 177 128 FCFA; the average cost per dose was 539.40 FCFA. Human resource costs amounted to 2590 people who were mobilized for a total cost of 125 678 400 FCFA. The total operational cost of the vaccination campaign was 1 394 010 829 FCFA. Vaccines and supplies were the largest item of expenditure, or 80.57% of the total spent. The results of this study could serve as a tool for decision-making related to funding a vaccination campaign. Taking account of these results could contribute to the development of strategies to effectively reduce the operational cost of a vaccination campaign.

A non-randomized vaccine effectiveness trial of accelerated infant hepatitis B immunization schedules with a first dose at birth or age 6 weeks in Côte d'Ivoire.

Most African countries do not initiate hepatitis B vaccination at birth. We conducted a non-randomized controlled trial comparing hepatitis B vaccination given at age 0, 6, and 14 weeks versus the current Côte d'Ivoire schedule of 6, 10, and 14 weeks. Pregnant women were enrolled at four health centers in Abidjan. At age 9 months, 0.5% of infants in both the birth and 6-week cohorts were positive for HBsAg and all were born to HBeAg-positive women. Among infants of HBeAg-positive mothers, 9 of 24 (37.5%) in the birth cohort and 10 of 17 (58.8%) in the 6-week cohort were HBsAg positive (adjusted OR, 2.7; 95% CI: 0.7-11.0). While both vaccine schedules prevented most cases of infant HBV transmission, both also had high failure rates among infants of HBeAg-positive mothers. African infants may benefit from a birth dose but additional studies are needed to verify this hypothesis.

Clinical and biological evolution of HIV-1 seroconverters in Abidjan, Côte d'Ivoire, 1997-2000.

OBJECTIVE: To describe the clinical and biologic evolution of HIV-1 infection in Africa. METHODS: One hundred four HIV-1-infected individuals were identified prospectively from regular blood donors in Abidjan, Côte d'Ivoire. The date of seroconversion was estimated from results of sequential serologic tests. Biologic and clinical follow-up was performed every 6 months, starting as early as possible after seroconversion. Case management followed national guidelines. RESULTS: The median interval between estimated seroconversion and study inclusion was 9.7 months, and the median window of seroconversion was 2.8 months. At baseline, all but two patients were asymptomatic; the median CD4 + cell count was 527/mm 3 (interquartile range [IR], 395-684), and the median plasma HIV RNA level was 4.6 log 10 copies/ml (IR, 3.8-4.9). The median follow-up was 23.9 months, and 95% of the patients received primary prophylaxis with co-trimoxazole for opportunistic infections. Of the patients, 1 presented with wasting syndrome, 3 developed tuberculosis, and 17 had a Centers for Disease Control and Prevention category B-defining event. The 3-year AIDS-free and symptom-free probabilities were 96.7% (95% confidence interval [CI], 87.0-99.2] and 79.3% (95% CI, 67.5-87.2), respectively. During the first 3 years of follow-up, we observed that the median plasma viral load stabilized at >4 log 10 copies/ml and that the median CD4 + cell count declined by 20 to 25/mm 3 per year. CONCLUSION: These African seroconverters were moderately immunosuppressed. The median HIV RNA level was high and varied very little during the first 3 years, and there were few clinical events.