Epidemiological and clinical profile of intestinal parasitosis of children in rural areas in Central African Republic.

OBJECTIVE: To describe the epidemiological and clinical profile of intestinal parasites in children in rural Central African Republic. PATIENTS AND METHODS: We conducted a multicenter cross-sectional study in Central African Republic rural areas. Children seen as outpatients regardless of the reason for consultation were included in the study after parental consent. Each stool sample sent to the laboratory in a plastic pot was subjected to a direct co-examination with physiological water. RESULTS: A total of 102 children were included in the study, of whom 53 were boys (51.96%), the median age was 4 years (3 months; 15 years old). They had a primary level of education in 31.37% of cases, 76.47% came from Health Region 1. Drilling was the source of drinking water in 61.76% of cases and the backwater was used for bathing by 26.47% of children. Abdominal pain was observed in 55 children (53.92%). The prevalence of intestinal parasitosis was 88.23%. Of 122 identified parasites, 96 were helminths (78.69%) and 26 were protozoa (21.31%). Of the three protozoan species isolated, Entamoeba histolytica was found in 15 cases (14.70%). The most common helminthiasis was Ascaris lumbricoides (40.19%). The frequency of parasitic infection was 92% in children aged from 5 to 9 years. Mono-parasitism was observed in 52.94% versus 33.33% for poly-parasitism. CONCLUSION: Intestinal parasitosis is a public health problem in Central African Republic rural areas. Improving access to drinking water for populations could reduce the magnitude of these diseases.

Treatment outcome with a short multidrug-resistant tuberculosis regimen in nine African countries.

SETTING: Nine countries in West and Central Africa. OBJECTIVE: To assess outcomes and adverse drug events of a standardised 9-month treatment regimen for multidrug-resistant tuberculosis (MDR-TB) among patients never previously treated with second-line drugs. DESIGN: Prospective observational study of MDR-TB patients treated with a standardised 9-month regimen including moxifloxacin, clofazimine, ethambutol (EMB) and pyrazinamide (PZA) throughout, supplemented by kanamycin, prothionamide and high-dose isoniazid during an intensive phase of a minimum of 4 to a maximum of 6 months. RESULTS: Among the 1006 MDR-TB patients included in the study, 200 (19.9%) were infected with the human immunodeficiency virus (HIV). Outcomes were as follows: 728 (72.4%) cured, 93 (9.2%) treatment completed (81.6% success), 59 (5.9%) failures, 78 (7.8%) deaths, 48 (4.8%) lost to follow-up. The proportion of deaths was much higher among HIV-infected patients (19.0% vs. 5.0%). Treatment success did not differ by HIV status among survivors. Fluoroquinolone resistance was the main cause of failure, while resistance to PZA, ethionamide or EMB did not influence bacteriological outcome. The most important adverse drug event was hearing impairment (11.4% severe deterioration after 4 months). CONCLUSIONS: The study results support the use of the short regimen recently recommended by the World Health Organization. Its high level of success even among HIV-positive patients promises substantial improvements in TB control.

[Cryptococcal neuromeningitidis in HIV-infected patients in Bangui, in the era of antiretroviral treatment]. / La cryptococcose neuroméningée au cours de l'infection à VIH à Bangui, à l'ère du traitement antirétroviral.

The cryptococcal neuromeningitis is the most common fungal meningitis infections in the course of HIV/AIDS. This is the number two of opportunist infection of the central nervous system. The authors post the outcomes of a retrospective study conducted related to 122 cases of cryptococcal neuromeningitis observed over for four years ago, in Bangui in the Central African Republic, this at time when antiretroviral treatment has been avaible, corresponding to a prevalence of 6.5%. These infections very aften occur more in female folk, and to patients whose average age is 35 years old, ranging from 18 to 69 years old. The clinical symptoms often found had been headache (98,3.%), fever (95.0%), the impairing of the overall condition of the patient (86.7%) and neck stiffness (85.9%). It makes sense to notice that comorbidity case alowgwith tuberculosis, intestinal candidiasis, bacterial pneumonia and Kaposi's diseases were found out. The screening of the cerebrospinal fluid showed a sound cell count and even low count in 12.2% of cases. Direct examination of cerebrospinal fluid with India ink helps in diagnosis of 97.5% of cases, and the culture carried out from 74 patients was in any case positive. This culture allowed the diagnosis of three patients whose examination along side with India ink has been negative. The CD4 cell count was less than 100/mm(3) in 97.7% of cases. The rate of the fatality cases has been 66.4%, it has been badly impacted by a CD4 count <50/mm(3) and the lack of antiretroviral therapy. Despite the establishment of a national antiretroviral treatment program to do influence the frequency of opportunistic infections whose cryptococcal neuromeningitis, this condition is still present although it is declining. The clinical variability of this disease requires early diagnosis to avoid delayed treatment corollary of a very high mortality as we have observed.

[Ten years of commitment to persons living with HIV-AIDS: evaluation of the management in three ambulatory treatment centers of the French Red Cross in Africa]. / Dix ans d'engagement auprès des personnes vivant avec le VIH-sida : évaluation de la prise en charge dans trois centres de traitement ambulatoire de la Croix-Rouge française en Afrique.

The French Red Cross (FRC) has developed a strategy for the follow-up of people living with HIV-AIDS in Africa by setting-up and managing healthcare centers specialized in the management of HIV infection. Nearly one hundred and seventy thousand patients have had access to care in fifteen Ambulatory Treatment Centers (ATCs). For the ten years anniversary of the FRC's AIDS programs, we present the results of the evaluation of three ATCs in Africa. These results which show a low mortality rate in the patients on antiretroviral therapy and a very low rate of second line patients (1.5%) confirm the efficiency of the management of people living with HIV in the ATCs and generally of the AIDS programs of the FRC. However, the mortality remains high in patients who have a CD4+ cell count of less than 50/mm3 when antiretrovirals (ARVs) initiation. Services and care dispensed in the ATCs and particularly the antiretroviral therapy have demonstrated their feasibility and efficiency. In ten years, the challenge of the management of HIV has changed. Today, there is a need to integrate additional actions in the area of the supply of primary healthcare, of training and of motivation of the care providers. In addition, the follow-up/evaluation of the patient management programs remains useful to determine the impact and long-term efficacy of ARVs in resource-limited countries.

[Bacterial meningiditis in adult patients in Central African hospitals]. / Les méningites bactériennes de l'adulte en milieu hospitalier centrafricain.

Bacterial meningitidis of the adult remain frequent and serious affections in spite of therapeutic progress. The authors report results from a retrospective study of 502 cases over 5 years. Hospital prevalence was 12.1%. These infections occur during the dry season between November and April in 75% of the cases. An important peak was observed in March, that is to say 24.5%. Patients' average age was 34.7 years old with extremes ranging from 15 to 80. The isolated micro-organisms were: the pneumococcus (45.2%), the meningococcus (14.5%), salmonella (1.6%) and the Haemophilus influenzae (1.2%). Meningitidis decapitated by a preliminary antibiotherapy represented 37,5%. Seroprevalence of the HIV infection during this work was 55.1%. Patients suffering from pneumococcus meningitis were contaminated by the HIV in 51.7% of the cases. Those suffering from meningococcus infection were infected with HIV in 52.9% of the cases. Those presenting meningitidis to Haemophilus influenzae and salmonellas had contracted the HIV respectively in 83% and 87.5% of the cases. The average duration of hospitalization was 14.2% days. The average mortality rate was 31.7% for the pneumococcus, 30. 1% for the meningococcus one. 53.4% of the patients recovered.

[Measuring treatment compliance in patients with HIV in Bangui, Central African Republic]. / Mesure de l'observance thérapeutique des patients vivant avec le VIH à Bangui.

The purpose of this trial was to test a simple method of measuring and identifying non-compliance with antiretroviral (ARV) therapy and cotrimoxazole (CTX) prophylaxis in a resource-limited setting. A cross-sectional study was undertaken among HIV patients attending two outpatient clinics in Bangui, Central African Republic. Compliance with ARV and CTX treatment was assessed based on 5 measurement modalities, i.e., skipping medication during the 4 days prior to attendance, attendance assiduity, number of remaining tablets, patient visual analogue scale (VAS), and physician VAS. These measures were combined to obtain an overall medication compliance score. A total of 141 patients were interviewed including 89 using ARV and 52 using CTX. Compliance scores varied according to measurement modality from 66.3% to 96.6% for ARV and from 67.3% to 90.4% for CTX. The only significant difference between patients using ARV and CTX involved physician VAS that was significantly lower for CTX than ARV (p=0.04). Overall medication compliance scores classified 117 patients (83%) as compliant and 21 patients (17%) as non-compliant. According to this study the level of medication compliance was relatively good (83%). Findings also indicated that measurement of compliance was feasible using a combination of remaining tablet count and assessment of medication skipping in the last 4 or 7 days. Routine clinical use of these modalities allows assessment and improvement of medication compliance.

Mesure de l'observance des patients vivant avec le VIH a Bangui

L'objectif a ete de tester une methode simple adaptee a un contexte de ressources; limitees pour mesurer l'observance; et identifier les motifs de non observance rencontres dans le suivi des traitements antiretroviraux (ARV) et de la prophylaxie par cotrimoxazole (CTX). Il s'agit d'une etude transversale chez des patients VIH suivis en consultations externes dans 2 services de Bangui. L'observance pour les ARV et le CTX a ete mesuree par 5 modes de mesure : le saut de prise de medicaments durant les 4 jours precedents la consultation; la regularite aux visites medicales ; le comptage des comprimes restants ; l'echelle visuelle analogique (EVA) du patient ; l'echelle visuelle analogique (EVA) du medecin. Un indice global d'observance a ete obtenu a partir des resultats des differentes methodes de mesure. 141 patients ont ete interroges (89 sous antiretroviral et 52 sous cotrimxazole). L'observance selon les modes de mesure pour les ARV va rie de 66;3a 96;6et de 67;3a 90;4pour le CTX. Elle ne differe pas significativement entre patients sous ARV et patients sous CTX sauf pour EVA medecin qui est significativement plus bas pour CTX que pour ARV (p= 0;04). L'indice global d'observance donne 117 patients (83) comme observants et 24 patients (17) comme non observants. L'observance therapeutique dans l'etude est relativement correcte (83des patients). Cette etude montre que la mesure de l'observance est possible et faisable en utilisant conjointement le compte des comprimes restant et une question sur un saut de prise dans les 4 ou 7 derniers jours. En pratique clinique de routine; son usage permettra de juger de l'observance des patients et de l'ameliorer