Social and health determinants of the efficiency of cotton farmers in Northern Côte d'Ivoire

This article assesses the role of malaria and some social determinants on the agricultural development and more precisely on efficiency in the context of cotton crop in the Korhogo region in the North of C?te d'Ivoire. Data envelopment analyses (DEA) was first applied for the purpose of calculating relative efficiencies in production. A Tobit regression model was then used to explain the variation in the DEA scores and check the hypotheses that the efficiency deviations between farmers can be explained by the disparity of malaria morbidity rate among the farmers and their family, by social cohesiveness and cultural behaviour. Field data were collected by the authors between March 1997 and February 1998 on 700 rural households living in three rice production systems differently exposed to the malaria risk. Two malaria indicators were used for the active (11-55 years old) family members of the farm: Plasmodium falciparum infection rate and high parasite density infection rate. The DEA model was applied on the sub-sample of cotton growers (about one third of the households of the full sample). Results of the different DEA and Tobit models (depending of the production process hypothesis) show that high parasite density infection has a direct and indirect negative effect on efficiency in the cotton crop. They also show that more cotton growers in the village improve efficiency, although villages where cotton is growing more widespread have weaker social cohesion.     

Tracing health system challenges in post-conflict Côte d'Ivoire from 1893 to 2013

While scholarship on health in conflict-affected countries is growing, there has been relatively little analysis of how armed conflict affects health systems in specific African countries, especially former French colonies. There is even less literature on the role of history in shaping health systems and how historical factors such as inequity may influence health impacts of armed conflict. Based on Côte d'Ivoire, this article argues that historical multidisciplinary analysis can provide valuable insight into the macro-level political, economic and social determinants of the health system over time. It explores how armed conflict has affected health services and exacerbates historically inherited challenges to the health system including unequal distribution of health services, bias towards curative care in urban areas, inadequate human resources and weak health governance. In the post-conflict period, this understanding may assist governments and other stakeholders to develop more appropriate health policies that address both urgent and long-term health needs.     

Surveillance of STD syndromes: contributing to the STD programme in Côte d'Ivoire

In C?te d'Ivoire, management of sexually transmitted diseases (STDs) is based on a syndromic approach. The National Health Information System (NHIS), set up in 1995, supervises data drawn monthly on three STD syndromes: genital ulcers, discharges and warts. Information is collected in each community-based public clinic, collated in the 29 districts, then in the 10 regions, and finally centralized. We assessed the relevance of this information and its usefulness for the STD programme. The number of cases notified in adults of 15 years and above was compared in men and women for the years 1995 and 1996. The absolute number of cases was related to the number of consultations to evaluate the relative share of STDs in health care services, and to the population size to estimate STD annual incidence. Between 1995 and 1996, the number of reported STD cases remained steady in men, 32 410 and 31 470 cases, respectively, but increased by 35% in women, from 64 794 to 87 622 cases. As a result, STD annual incidence was unchanging in men (8%), but increased in women from 17 to 23%. However, between these two years, the relative contribution of STDs to all consultations decreased from 4.7 to 3.5% in men, while remaining steady in women, at around 7.0%. In this 2-year period, the ratio of the numbers of ulcers in men and women was about 1:1, and did not vary by district. In contrast, discharges were reported 2.7 times more by women, with a differing sex ratio from district to district. We suggest that vaginal discharges are often physiological, and are poorly instructive for STD surveillance. In contrast, ulcers in both genders, and male discharges, provide relevant information for the STD programme, for example to estimate the volume of STD drugs needed for public health services and to assess the epidemiological trends of STDs.     

Cryptoccocal meningitis and HIV in the era of HAART in Côte d'Ivoire

Objective

The authors had for aim to describe the management of cryptococcal meningitis in HIV infected adults, in Ivory Coast.

Patients and methods

A retrospective study was made from January 1, 2005 to December 31, 2008 on the files of consecutive hospitalized patients presenting with cryptococcal meningitis, at the Treichville University Hospital, Infectious and tropical diseases department (Abidjan). The socio-demographic, clinical, and biological aspects as well as the outcome were analyzed.

Results

Eighty patients presenting with cryptococcal meningitis, (2.6% of hospitalized patients) were included: 41 men (51.25%) and 39 women (48.75%); mean age: 40 years (range 26 to 58 years). The delay before consultation was 5.4 days, range 2–12 days). The mains symptoms were headache (83.7%), fever (63.7%), and consciousness disorders (60%). Meningo-encephalitis accounted for 75% of the clinical presentations; 54 patients (67.5%) were naive of antiretroviral treatment (mean CD4: 45/mm³ (range 5–103/mm³), while 26 (32.5%) had received antiretrovirals before presenting with cryptococcal meningitis (Nadir CD4 = 81/mm³). Amphotericin B relayed by fluconazole was prescribed to 86.2% of the patients, associated with a therapeutic lumbar puncture for 30 patients. The death rate was 41.2%.

Conclusion

In spite of antiretroviral treatment availability in Ivory Coast, cryptococcal meningitis remains frequent with a high death rate. This study stresses the importance of early management to improve the prognosis.     

Intestinal parasitoses in a village of Côte d'Ivoire. I: Control and prevention plan

The goal was to develop a complex medical, hygienic, sanitary and educational plan for control and prevention of intestinal parasitic infections in the rural areas in Ivory Coast. In a village situated at the border of the Ebrié lagoon, 416 persons were examined: 371 children, of which 343 were school and preschool children, aged 4 to 15 years (195 boys and 148 girls), 28 young children aged 6 months to 3 years, and a group of 45 adults. The parasitologic exams included perianal swabs (Graham's method), stool examination using saline solution, iodized solution (Lugol) and preparation Kato-Miura's method in thick layer. Parasitic intensity was done for helminths and worm burden have been carried after specific treatment of roundworms. Hygienic conditions as environment, school, dwelling and personal hygiene, eating habits, drinking water sanitation, garbage disposal, toilets, reproduction areas of hematophagous and mechanical vectors etc. have recorded. The prevalence of intestinal parasites was 84.8% in children (with 76.7 % polyparasites) and 29.0 % in adults. The results pointed out a hyperendemic zone. Parasitic infectious transmitted from person to person was frequent among children: 37.3% pinworms in school children, 30.3% amoeba cysts and 30.3% flagellate. Infections transmitted by soil were predominant, with 62.1 % roundworms (78.6 % in children aged 7 to 10 years) presenting an important parasitic intensity and worm burden. The parasitoses transmitted as larvae were frequent, only Strongyloides stercoralis being most frequent parasite in adults compared to children. A feasible plan of control the intestinal parasites has been established in collaboration with the local hospital, village leaders and health workers. Short-term measures have been carefully chosen, targeting especially the schools, teachers and health workers. The first health education measure concerns the hand cleanliness at home and at schools. It was suggested that a bucket of water be used per class, that the water be changed more often during the day, and soap be made available at all time. Lessons on the ways of transmission of parasites will be introduced in schools. A door-to-door education plan was discussed with village health workers and hospital nurses and laboratory technicians during the maternal-infantile prophylactic visits. The health education problems have been discussed extensively with village health workers. As a preliminary example, the prevention and campaign against the pinworm, a common parasite in children was chosen, whose transmission mechanism from person to person can be easily understood by children and mothers. Simultaneously the prevention of parasitic infections contributes extensively to the prevention of other serious diseases, as the typhoid fever etc. which are endemic in the region. Long-term preventive measures have been discussed with village leaders. The first measure is to fix the deep-well drinking water pump station of the village, financed by outside parties, with labour provided by the village. Measures for proper maintenance of the water pump station have also been discussed with representatives of the village. The program of the World Health Organization and National Institute of Hygiene of Ivory Coast concerning the periodic treatment of intestinal helminths, especially A. lumbricoides, given to all school aged children was discussed.     

Multiple parasite infections and their relationship to self-reported morbidity in a community of rural Côte d'Ivoire

BACKGROUND: Concomitant parasitic infections are common in the developing world, yet most studies focus on a single parasite in a narrow age group. We investigated the extent of polyparasitism and parasite associations, and related these findings to self-reported morbidity. METHODS: Inhabitants of 75 randomly selected households from a single village in western C?te d'Ivoire provided multiple faecal specimens and a single finger prick blood sample. The Kato-Katz technique and a formol-ether concentration method were employed to screen faecal samples for Schistosoma mansoni, soil-transmitted helminths and intestinal protozoa. Giemsa-stained blood smears were analysed for malaria parasites. A questionnaire was administered for collection of demographic information and self-reported morbidity indicators. RESULTS: Complete parasitological data were obtained for 500/561 (89.1%) participants, similarly distributed among sex, with an age range from 5 days to 91 years. The prevalences of Plasmodium falciparum, hookworms, Entamoeba histolytica/E. dispar, and S. mansoni were 76.4%, 45.0%, 42.2%, and 39.8%, respectively. Three-quarters of the population harboured three or more parasites concurrently. Multivariate analysis revealed significant associations between several pairs of parasites. Some parasitic infections and the total number of parasites were significantly associated with self-reported morbidity indicators. CONCLUSIONS: Our data confirm that polyparasitism is very common in rural C?te d'Ivoire and that people have clear perceptions about the morbidity caused by some of these parasitic infections. Our findings can be used for the design and implementation of sound intervention strategies to mitigate morbidity and co-morbidity.     

Intestinal helminthiasis among school children: preliminary results of a prospective study in Agboville in Southern Côte d'Ivoire

Intestinal helminthiasis affects the health and academic performance of children in developing countries. To highlight a few socio-economic factors that impact the presence and upholding of intestinal helminthiasis, a cohort study was performed from February to June 2001. This study took place in Agboville in Southern C?te d'Ivoire on 363 children, under the age of 15, regularly enrolled in school and selected by two-step clustered sampling. After the survey was completed, their stools were examined using 3 methods: direct exam, Kato's technique, and Graham's anal scotch-test. Infected students received an appropriate anti-helminthic treatment. After performing a test two weeks later, a new sample of 348 parasite-free children was made up and re-examined after three months, through the aforementioned techniques. In this sample, we assumed that students who were infested in the initial exam were "exposed", while those who were not infested in the first place were deemed to be "not exposed". The results showed that 135 students out of the 360 admitted for the first exam were infested; or a 37.5% of intestinal helminthiasis prevalence (IC95%=30.5-45). The prevalent parasite species were Necator americanus (15%), Trichuris trichiura (13.6%), Schistosoma mansoni (10%). Twenty-eight per cent of 135 infested students were infected by more than one parasite. After three months, the incidence rate of intestinal helminthiasis calculated out of the remaining 336 students was 7.7% (IC95%=4.4-13.1). The likelihood of re-infestation amounted to 3.4 (IC95%=1.5-7.3). The pattern of re-infestation rates according to socio-economic factors differed from that of infested prevalence. The prevalent parasites in re-infested patients were Trichuris trichiura (16.3%), Schistosoma mansoni (12.5%). All intestinal nematodes and Schistosoma mansoni were observed. The most frequent parasites species where those transmitted cutaneously. The high re-infestation rate suggests that intestinal helminthiasis in this region affects roughly the same children. These results show the necessity to continue our investigations in order to highlight essential hygienic factors in our long-term fight against intestinal helminthiasis.     

Thyroid size and goiter prevalence after introduction of iodized salt: a 5-y prospective study in schoolchildren in Côte d'Ivoire

BACKGROUND: The long-term goal of salt iodization is elimination of iodine deficiency and reduction of the goiter rate to < 5% in school-aged children. Normalization of the goiter rate probably indicates disappearance of iodine deficiency disorders as a public health problem. However, thyroid size may not return to normal for months or years after correction of iodine deficiency. OBJECTIVE: We described the time course and pattern of changes in thyroid size and goiter rate in response to the introduction of iodized salt in an area of severe endemic goiter. DESIGN: In a 5-y prospective study, we measured thyroid size by ultrasonography and urinary iodine and thyroid hormone concentrations in schoolchildren 6 mo before the introduction of iodized salt and annually for 4 y thereafter. RESULTS: Four years after the introduction of iodized salt and normalization of the median urinary iodine concentration, mean thyroid size had decreased 56% (P < 0.0001). However, 29% of the children remained goitrous, with a significant age shift in the distribution of goiter. At baseline, the goiter rate was significantly higher in younger (age: 5-9 y) than in older (age: 10-14 y) children (P < 0.0001). At 2, 3, and 4 y after salt iodization, the goiter rate was significantly higher in the older than in the younger children (at 4 y: 52% compared with 19%), and the difference increased with time (P < 0.0001). CONCLUSION: The goiter rate in school-aged children may remain sharply elevated for up to 4 y after successful introduction of iodized salt, primarily because of persistent goiter in older children.     

Origin of human T-lymphotropic virus type 1 in rural Côte d'Ivoire

Simian T-lymphotropic virus type 1 (STLV-1) strains occasionally infect humans. However, the frequency of such infections is unknown. We show that direct transmission of STLV-1 from nonhuman primates to humans may be responsible for a substantial proportion of human T-lymphotropic virus type 1 infections in rural Côte d’Ivoire, where primate hunting is common.     

Establishment of a National Immunization Technical Advisory Group in Côte d'Ivoire: process and lessons learned

In January 2010, Côte d’Ivoire became the first GAVI-eligible country in sub-Saharan Africa to establish a National Immunization Technical Advisory Group (NITAG). The Côte d’Ivoire “National Committee of Independent Experts for Vaccination and Vaccines” (CNEIV-CI) was created to strengthen national capacity for evidence-based policy decisions with regard to immunization and vaccines. The primary reasons for success in Côte d’Ivoire were a strong political will, the availability of sufficient national expertise, a step-by-step country-driven process, and the provision of technical assistance to the Ministry of Health. The challenges included operating within the socio-political crisis, and initial reluctance from some stakeholders due to the potential overlap with other existing committees. The latter rapidly dissolved over the course of numerous meetings held with the SIVAC Initiative to clarify the mandate of a NITAG.     

HIV vulnerability and the erasure of sexual and gender diversity in Abidjan,Côte d'Ivoire

ABSTRACT

In the fight against concentrated HIV epidemics, men who have sex with men (MSM) are often framed as a homogeneous population, with little attention paid to sexual and gender diversity and its impact on HIV vulnerability. This article draws on ethnographic research conducted in Abidjan, Côte d'Ivoire among les branchés – a local term encompassing several categories of same-sex desire and practice. In the context of increased HIV prevention programming targeting Ivoirian sexual and gender minorities, such diversity is effectively erased. This obfuscation of difference has particularly negative impacts for travestis, who may be at higher risk for HIV infection, though research and prevention efforts in which they are grouped with ‘MSM’ render them underrepresented and make their vulnerability difficult to quantify. Branchés whose class and/or ethnic backgrounds compound their stigmatised status as sexual and gender minorities also bear the burden of this exclusion. Furthermore, some branchés deploy ‘MSM’ as a form of self-identification, further complicating who such categories represent. By highlighting the ways in which constructions of gender and sexuality within HIV/AIDS programming obscure complex social realities, I aim to reorient thinking around the development of purposeful HIV programming that engages the complexity of sexual and gender minority experience.     

Identification of malfunctioning in the treatment and quality of care of maternal morbidity in Abidjan, Côte d'Ivoire

A study was carried out using a clinical audit aimed at identifying the dysfunctions in the care of female patients with serious morbidity. The study was done at the University Hospital of Cocody (CHU de Codody) and in the health training unit in the southern part of Abobo (Abidjan) from January to May 2000. The study allowed us to track and record the frequency of women who nearly died (40.4%) in both of the sites during the period of the study. Malfunctions were found at all stages of the female patients' care. The provision of medical care during the patients' hospitalisation and care provided in the emergency room were the cases and situations wherein the most frequency was noted, with 42.8% and 39.6% of dysfunctions found respectively. The delay for patients to wait to receive care was long, varying from 80 minutes to 5 days coupled with a lack of follow-up and surveillance of patients. This data demonstrates the inadequacy of the quality of obstetrical care.     

Efficacy and side effects of praziquantel against Schistosoma mansoni in a community of western Côte d'Ivoire

Praziquantel is efficacious against the adult stages of all human schistosome parasites, and has become the drug of choice for morbidity control of schistosomiasis. There is concern that resistance to praziquantel might develop or already exists, and could be further facilitated through new control initiatives relying on large-scale administration of praziquantel. Therefore, monitoring praziquantel efficacy in different epidemiological settings is required. We assessed the efficacy and side effects of praziquantel against Schistosoma mansoni in a rural community of western C?te d'Ivoire. Three consecutive stool specimens from 545 children and adults were examined by the Kato-Katz technique, revealing an overall prevalence of 40.9%. S. mansoni-infected individuals were treated with a single oral dose of praziquantel at 40 mg/kg. The most frequent side effects were abdominal pain, dizziness and diarrhoea. The overall cure rate, assessed 6 weeks post-treatment, was 60.9%. Moderate or heavy infections were only cleared in half or one-third of the individuals, respectively. The total egg count reduction was 61.4%. Infection intensity pre-treatment was significantly associated with age, cure rate, reported diarrhoea and dizziness. Our findings call for additional studies that rigorously evaluate the efficacy of praziquantel against different schistosome species in entire communities, using similarly sensitive diagnostic approaches as employed here.     

Assessment of iodine content of dietary salt in Abidjan (Côte d'Ivoire)

C?te d'Ivoire is one of the countries engaged in the strategy of universal salt iodization set up to prevent and control iodine deficiency disorders. However, no systematic monitoring of iodine content of salt has been performed up to now. Therefore, a survey was conducted on a random sample of 400 households in the Marcory district of Abidjan in order to study consumers' behaviour regarding the purchase and storage of salt, and to determine the iodine content of dietary salt. The proportioning of iodine was carried out by the titrimetric method. The salt consumed in the homes was bought at the market, the shop, the supermarket or was delivered at residence by a hawker in the proportions of 82.8%, 10.3%, 6.3%, and 0.8%, respectively. At the warehouse, the salt purchased was packaged into bags of 25 kg for 0.5% of homes. 1% of homes bought salt in tins. 9.5% of homes bought their salt in sachets. Most homes (89%) replenished their stock in bulk from the market. Laboratory analyses showed that all salt samples were iodised. The average content of iodine in salt was 52.74 ppm with a standard deviation of 32.56. We observed that in 23.3% of households the iodine content of salt was weak (< 30 ppm). Contents higher than the upper limit of normality (30-50 ppm) were found in 44.8% of cases. The level of iodine was adequate for 32% of households. The major risk to which the population is exposed is the outbreak of iodine-induced hyperthyroidism (IIH) despite the fact that the Abidjan area is not naturally deprived of iodine. The risk is even more significant in the goitre endemic zone of the western and northern areas of the country, because these regions receive the same salt as Abidjan. From this arises the need for setting up an effective system of controlling the iodine content in dietary salt to continuously adjust it, taking into consideration the minimum needs of the population.     

The effect of structural characteristics on family planning program performance in Côte d'Ivoire and Nigeria

This paper uses C?te d'Ivoire and Nigeria survey data on both supply and demand characteristics to examine how structural and demographic factors influence family planning provision and cost. The model, which takes into account the endogenous influence of service provision on average cost, explains provision well but poorly explains what influences service cost. We show that both size and specialization matter. In both countries, vertical (exclusive family planning) facilities provide significantly more contraception than integrated medical establishments. In the Nigeria sample, larger facilities also offer services at lower average cost. Since vertical facilities tend to be large, they at most incur no higher unit costs than integrated facilities. These results are consistent across most model specifications, and are robust to corrections for endogenous facility placement in Nigeria. Model results and cost recovery information point to the relative efficiency of the International Planned Parenthood Federation, which operates large, mostly vertically organized facilities.     

Iron status influences the efficacy of iodine prophylaxis in goitrous children in Côte d'Ivoire

In the developing countries of Africa, many children are at high risk for both goiter and iron-deficiency anemia (IDA). Because iron (Fe) deficiency can have adverse effects on thyroid metabolism, Fe deficiency may influence response to supplemental iodine in areas of endemic goiter. Therefore, our aims were to determine: 1) if goitrous children also suffering from IDA could respond to oral iodine supplementation; and 2) if Fe supplementation in goitrous children with IDA would improve their response to oral iodized oil and iodized salt. First, we compared the efficacy of oral iodized oil in two groups of goitrous children: a nonanaemic group vs. an IDA group. The therapeutic response to iodized oil was impaired in the goitrous children with IDA. Second, an open trial of Fe treatment in goitrous children with IDA improved their response to oral iodized oil. Finally, in a randomized double-blind trial, goitrous, Fe-deficient children consuming iodized salt were given Fe supplementation or placebo. Fe supplementation improved the efficacy of the iodized salt. In these studies, both anatomic (thyroid size) and biochemical (TSH, T4) measures indicated that iodine significantly improved thyroid function in the nonanaemic children compared to the Fe deficient children. Iodine was less efficacious in children with lower Hb at baseline and in those with a poorer response to Fe. The data suggest that a high prevalence of IDA among children in areas of endemic goiter may reduce the effectiveness of iodine prophylaxis.     

Incidence of neutropenia in HIV-infected African adults receiving co-trimoxazole prophylaxis: a 6-year cohort study in Abidjan, Côte d'Ivoire

In a placebo-controlled trial of co-trimoxazole prophylaxis in C?te d'Ivoire, neutropenia was the most frequent short-term side effect. The long-term incidence of neutropenia in sub-Saharan African adults receiving co-trimoxazole has never been reported. We followed a prospective cohort of HIV-infected adults receiving co-trimoxazole (sulphamethoxazole 800 mg/trimethoprim 160 mg daily) in Abidjan. Grades of neutropenia were successively defined as at least one absolute neutrophil count (ANC) of: <1500/mm(3) (severity grade >/=1), <1000/mm(3) (grade >/=2), <750/mm(3) (grade >/=3) or <500/mm(3) (grade 4). In total, 533 adults were followed-up during 1450 person-years, with a total of 3154 ANCs. The probability of remaining free of neutropenia at 48 months was 0.29 (95% CI 0.23-0.34) for grade >/=1, 0.64 (95% CI 0.60-0.71) for grade >/=2, 0.82 (95% CI 0.77-0.86) for grade >/=3 and 0.96 (95% CI 0.93-0.99) for grade 4. The only factor significantly associated with a higher rate of all grades of neutropenia was a low baseline CD4 count. There was no association between any grade of neutropenia and the global risk of serious morbidity during the study period. In adults receiving co-trimoxazole in Abidjan, mild neutropenia is a common observation with no evidence of negative clinical consequences. The consequences of associating co-trimoxazole with other haematotoxic drugs should be carefully assessed.     

Multiple-Insecticide Resistance in Anopheles gambiae Mosquitoes, Southern Côte d'Ivoire

Malaria control depends on mosquito susceptibility to insecticides. We tested Anopheles gambiae mosquitoes from Côte d’Ivoire for resistance and screened a subset for target site mutations. Mosquitoes were resistant to insecticides of all approved classes. Such complete resistance, which includes exceptionally strong phenotypes, presents a major threat to malaria control.