Prevalence of Schistosoma mono- and co-infections with multiple common parasites and associated risk factors and morbidity profile among adults in the Taabo health and demographic surveillance system, South-Central Côte d'Ivoire.

BACKGROUND: Schistosomiasis remains an important public health problem, also among adults, and infected individuals not treated serve as a reservoir for continued transmission. Despite this fact, evidence on the epidemiology of schistosomiasis in adults in Côte d'Ivoire is scanty. This study aimed to determine the prevalence and risk factors of Schistosoma infection and co-infection with other helminth species and Plasmodium among adults in the Taabo region in the south-central part of Côte d'Ivoire. METHODS: A cross-sectional survey was carried out in April and May 2017 in the frame of the "Côte d'Ivoire Dual Burden of Disease Study" (CoDuBu). A total of 901 randomly selected individuals, aged 18-90 years, provided blood, stool and urine samples for the diagnosis of malaria and helminth infections. Stool samples were subjected to the Kato-Katz technique for detection of Schistosoma mansoni and soil-transmitted helminth eggs, while urine samples were examined for eggs of Schistosoma haematobium and circulating cathodic antigen of S. mansoni. Risk factors and morbidity profiles were assessed using health examination and questionnaires. Multinomial logistic regressions were employed to identify risk factors and morbidity patterns associated with S. mansoni mono- and co-infections. RESULTS: The prevalence of S. mansoni and S. haematobium was 23.2% and 1.0%, respectively. Most S. mansoni were mono-infections (81.3%). Independent determinants of S. mansoni infection were young age, low socioeconomic status (mono- and co-infection) and poor hygiene practices (co-infection) (P < 0.05). S. mansoni infection was independently associated with higher pain and symptom scores (mono-infection), poor self-rated health and low healthcare use (co-infection) (P < 0.05). CONCLUSIONS: This study showed that adults represent a substantial reservoir of S. mansoni. To sustain schistosomiasis control and improve people's wellbeing, it is important to expand preventive chemotherapy from school-aged children to adults, coupled with hygiene and health education.

Epidemiologic Profile of Overweight and Obesity in Abidjan, Ivory Coast: A Cross-Sectional Study.

Background: In sub-Saharan Africa, the prevalence of overweight and obesity is high, and it is estimated to increase within the next ten years. In Ivory Coast, the rise in and public health consequences of overweight and obese people are evident. Moreover, data concerning this status are scarce, old, local, and describe only a small sample of the population. Objective: This study has been conducted in order to describe the epidemiologic profile of overweight and obese people in Ivory Coast and identify the potential risk factors of obesity. Methods: From January 2014 to July 2017, 2,643 patients aged 17-70 years old from Abidjan of Ivory Coast were recruited. Statistical analysis was carried out using SPSS 20.0. Chi-square test and binary logistic regression analysis were used to identify risk factors for overweight and obesity. Results: Most of our patients were females (86.3%) with an estimated average age of 43.7 ± 12.19 years. Among 2,643 patients recruited in this study, 83.3% were obese and 87.2% were affected by central abdominal obesity. Binary logistic regression analysis identified seven factors significantly associated with overweight and obesity, including females (OR: 2.06; 95% CI [1.58-2.68]), >54 years old of age (OR: 3.71; 95% CI [1.84-7.50]), occupation of salesperson and traders (OR: 2.42; 95% CI [1.78-3.29]), ethnic group of North Mande ethnicity (OR: 1.47; 95% CI [1.07-2.02]), family history of obesity (OR: 1.96; 95% CI [1.46-2.63]), ≥150 minutes of sport practice (OR:0.72; 95% CI [0.55-0.96]), and parous females (OR: 1.63; 95% CI [1.11-2.38]). Conclusions: Overall, gender (female), older age, and occupation were associated with greater risks of overweight and obesity in patients. Ethnic group, pregnancy and family history of obesity posed a lower but significant risk for obesity. More sport practice played a protective role against the acquisition of overweight and obesity.

Asymptomatic Plasmodium infection and glycemic control in adults: Results from a population-based survey in south-central Côte d'Ivoire.

AIMS: We investigated the cross-sectional associations of Plasmodium infection (PI) with fasting glucose (FG) and glycated hemoglobin (HbA1c) in malaria-endemic south-central Côte d'Ivoire. METHODS: We studied 979 participants (non-pregnant; no treated diabetes; 51% males; 18-87 years) of the Côte d'Ivoire Dual Burden of Disease study. Fasting venous blood was obtained for PI, FG, and HbA1c assessment. We defined PI as a positive malaria rapid diagnostic test (RDT) or microscopic identification of Plasmodium species. We applied multivariable linear regressions to assess beta coefficients (ß) and 95% confidence intervals (CIs) of PI positivity for FG and HbA1c independent of diabetes risk factors. RESULTS: Prevalence of PI was 10.1% (5.5% microscopy; 9.7% RDT) without clinical fever. Prevalence of FG-based prediabetes (45.8%) and diabetes (3.6%) were considerably higher than HbA1c-based values (2.7% and 0.7%, respectively). PI was independently associated with FG among participants with higher body temperature (ß 0.34, 95% CI 0.06-0.63, pheterogeneity = 0.028), or family history of diabetes (ß 0.88, 95% CI 0.28-1.47, pheterogeneity = 0.009). Similar patterns observed with HbA1c were obliterated on accounting for FG. We also observed consistent associations with parasite density. CONCLUSIONS: FG-based diabetes diagnosis in the presence of asymptomatic PI may misclassify or overestimate diabetes burden in malaria-endemic settings. Longitudinal studies are needed to confirm these findings and determine the risk for diabetes.

Epidemiological links between malaria parasitaemia and hypertension: findings from a population-based survey in rural Côte d'Ivoire.

BACKGROUND: Although potential links between malaria parasitaemia and hypertension have been hypothesized, there is paucity of epidemiologic evidence on this link. We investigated in a population-based survey, the association between malaria parasitaemia and hypertension in Ivorian adults. METHODS: We estimated the adjusted odds ratios (OR) and 95% confidence intervals (CI) of hypertension in relation to malaria parasitaemia using multinomial regression, in 997 randomly selected adults in the 'Côte d'Ivoire Dual Burden of Disease Study' (CoDuBu), in south-central Côte d'Ivoire. We defined malaria parasitaemia as a positive rapid diagnostic test or identification of Plasmodium spp. on microscopy. Using the mean of the last two of three blood pressure (BP) measurements and questionnaire data, we defined hypertension as SBP at least 140 mmHg or DBP at least 90 mmHg or clinician-diagnosed hypertension. RESULTS: Prevalence of malaria parasitaemia and hypertension were 10 and 22%, respectively. Malaria parasitaemia was negatively associated with hypertension in participants with body temperature 36.5 °C or less [OR 0.23 (95% CI 0.06-0.84)]. Contrastingly, microscopic malaria parasitaemia showed positive associations with hypertension in participants with elevated body temperature [>36.5 °C; OR: 2.93 (95% CI 0.94-9.14)]. Participants having microscopic malaria parasitaemia with elevated body temperature had three-fold higher odds of hypertension [OR: 3.37 (95% CI 1.12-10.0)] than malaria parasitaemia-negatives with lower body temperature. CONCLUSION: Malaria parasitaemia and hypertension are prevalent and seemingly linked comorbidities in African settings. This link may depend on malaria parasitaemia symptomaticity/latency where individuals with more latent/asymptomatic malaria parasitaemia have lower risk of hypertension and those with more acute/symptomatic malaria parasitaemia have a tendency toward higher BP. The cross-sectional nature of the study limited the distinction of short-term BP elevation (interim pathophysiological stress) from hypertension development. Future longitudinal studies considering malaria/hypertension phenotypes and host molecular variations are needed to clarify involved biological mechanisms, toward comorbidity management.

[Working in underserved areas in Côte d'Ivoire: motivation of students and healthcare professionals.] / Travailler en zones mal desservies en Côte d'Ivoire : motivation des étudiants et personnel de santé.

INTRODUCTION: The shortage and poor distribution of the Health Workforce in Ivory Coast remains a major challenge for government authorities. The aim of this study was to identify factors related to healthcare workers' preferences for job posting in underserved areas. METHODS: The Discrete Choice Experiment method was used. The survey was conducted during the months of August and September 2015 among 490 students in healthcare worker training programmes and 574 in-service healthcare workers randomly selected from 8 health regions of Ivory Coast. The mixed logit model was used for data analysis. RESULTS: Availability of safe drinking water, electricity, phone network, and internet connexion (p = 0.001), availability of regular transportation (p < 0.001), family proximity (p < 0.001) were the most important job attributes for accepting job posting in underserved areas for in-service medical officers, nursing officers, and midwives.The main factors for accepting job posting in underserved areas by students in medical training programmes (medical school, nursing and midwifery school) were the availability of a scholarship after 5 years of employment (p = 0.009), the availability of safe drinking water, electricity, phone network, and internet connexion (p = 0.001), and availability of regular transportation (p < 0.001). Various combinations of these attributes with a financial bonus of 20% of the current salary would increase the proportion of health workers willing to work in underserved areas. CONCLUSION: These results could help to elaborate effective strategies for the attraction and maintenance of healthcare workers in underserved areas in Ivory Coast.

Côte d'Ivoire Dual Burden of Disease (CoDuBu): Study Protocol to Investigate the Co-occurrence of Chronic Infections and Noncommunicable Diseases in Rural Settings of Epidemiological Transition.

BACKGROUND: Individual-level concomitance of infectious diseases and noncommunicable diseases (NCDs) is poorly studied, despite the reality of this dual disease burden for many low- and middle-income countries (LMICs). OBJECTIVE: This study protocol describes the implementation of a cohort and biobank aiming for a better understanding of interrelation of helminth and Plasmodium infections with NCD phenotypes like metabolic syndrome, hypertension, and diabetes. METHODS: A baseline cross-sectional population-based survey was conducted over one year, in the Taabo health and demographic surveillance system (HDSS) in south-central Côte d'Ivoire. We randomly identified 1020 consenting participants aged ≥18 years in three communities (Taabo-Cité, Amani-Ménou, and Tokohiri) reflecting varying stages of epidemiological transition. Participants underwent health examinations consisting of NCD phenotyping (anthropometry, blood pressure, renal function, glycemia, and lipids) and infectious disease testing (infections with soil-transmitted helminths, schistosomes, and Plasmodium). Individuals identified to have elevated blood pressure, glucose, lipids, or with infections were referred to the central/national health center for diagnostic confirmation and treatment. Aliquots of urine, stool, and venous blood were stored in a biobank for future exposome/phenome research. In-person interviews on sociodemographic attributes, risk factors for infectious diseases and NCDs, medication, vaccinations, and health care were also conducted. Appropriate statistical techniques will be applied in exploring the concomitance of infectious diseases and NCDs and their determinants. Participants' consent for follow-up contact was obtained. RESULTS: Key results from this baseline study, which will be published in peer-reviewed literature, will provide information on the prevalence and co-occurrence of infectious diseases, NCDs, and their risk factors. The Taabo HDSS consists of rural and somewhat more urbanized areas, allowing for comparative studies at different levels of epidemiological transition. An HDSS setting is ideal as a basis for longitudinal studies since their sustainable field work teams hold close contact with the local population. CONCLUSIONS: The collaboration between research institutions, public health organizations, health care providers, and staff from the Taabo HDSS in this study assures that the synthesized evidence will feed into health policy towards integrated infectious disease-NCD management. The preparation of health systems for the dual burden of disease is pressing in low- and middle-income countries. The established biobank will strengthen the local research capacity and offer opportunities for biomarker studies to deepen the understanding of the cross-talk between infectious diseases and NCDs. TRIAL REGISTRATION: International Standard Randomized Controlled Trials Number (ISRCTN): 87099939; http://www.isrctn.com/ISRCTN87099939 (Archived by WebCite at http://www.webcitation.org/6uLEs1EsX).

[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.

[The impact of chemotherapy on haematological and biochemical profiles during malignant blood diseases in Abidjan, Côte d'Ivoire]. / Impact de la chimiothérapie sur les profils hématologiques et biochimiques au cours des hémopathies malignes à Abidjan (Côte d'lvoire).

Our research concerned the impact of chemotherapy on the haematological and biochemical profiles of patients diagnosed with malignant blood diseases and receiving treatment in Abidjan. The study covered 57 patients, 26 of whom were receiving treatment. Burkitt's lymphoma was the most common type of malignant blood disease encountered (33%). The proportion of men was slightly higher, at 54%, and the average age of patients was 26. Hyperleucocytosis, anaemia and medullar blastosis were the most common blood disorders. The tumours arising from hyperleucocytosis and medullar blastosis caused increases in proteins from inflammatory reaction. The increase was moderate for alpha 1 globulins and haptoglobin and high (at least twice the reference levels) for C Reactive Protein (CRP) and orosomucoid. Full remission was only achieved in the cases of Burkitt's lymphoma, in which the haematological and biochemical parameters reached near-normal levels following treatment. In cases of chronic myeloid leukaemia the treatment lowered the hyperleucocytosis but the high rate of CRP might indicate that the disease was reaching a more acute phase. In the cases of acute leukaemia, chemotherapy did not achieve full remission: the alpha 1 globulins, including orosomucoids, were the most sensitive proteins to treatment. Even though the rate of CRP was lowered, it remained high in all cases of acute leukaemia. Neither haematological nor biochemical data proved superior to the other in monitoring the effectiveness of the treatment or the gradual return of the disease. It would be beneficial to combine them in order to obtain a clearer assessment of the effectiveness of chemotherapy.