Background Bacterial meningitis remains a major disease affecting children in Côte d’Ivoire. Thus, with support from the World Health Organization (WHO), Côte d’Ivoire has implemented pediatric bacterial meningitis (PBM) surveillance at 2 sentinel hospitals in Abidjan, targeting the main causes of PBM: Streptococcus pneumoniae (pneumococcus), Haemophilus influenzae, and Neisseria meningitidis (meningococcus). Herein we describe the epidemiological characteristics of PBM observed in Côte d’Ivoire during 2010–2016. Methods Cerebrospinal fluid (CSF) was collected from children aged <5 years admitted to the Abobo General Hospital or University Hospital Center Yopougon with suspected meningitis. Microbiology and polymerase chain reaction (PCR) techniques were used to detect the presence of pathogens in CSF. Where possible, serotyping/grouping was performed to determine the specific causative agents. Results Overall, 2762 cases of suspected meningitis were reported, with CSF from 39.2% (1083/2762) of patients analyzed at the WHO regional reference laboratory in The Gambia. In total, 82 (3.0% [82/2762]) CSF samples were positive for bacterial meningitis. Pneumococcus was the main pathogen responsible for PBM, accounting for 69.5% (52/82) of positive cases. Pneumococcal conjugate vaccine serotypes 5, 18C, 19F, and 6A/B were identified post–vaccine introduction. Emergence of H. influenzae nontypeable meningitis was observed after H. influenzae type b vaccine introduction. Conclusions Despite widespread use and high coverage of conjugate vaccines, pneumococcal vaccine serotypes and H. influenzae type b remain associated with bacterial meningitis among children aged <5 years in Côte d’Ivoire. This reinforces the need for enhanced surveillance for vaccine-preventable diseases to determine the prevalence of bacterial meningitis and vaccine impact across the country.
Côte d’Ivoire introduced rotavirus vaccine in March 2017. Rotavirus surveillance is conducted at Centre Hospitalier Universitaire de Yopougon in Abidjan, the capital city. Children <5 years of age are enrolled in rotavirus surveillance if admitted to the hospital with acute gastroenteritis. We used sentinel surveillance data from 2014 through mid-2019 to compare trends in rotavirus pediatric gastroenteritis hospitalizations before and after rotavirus vaccine introduction. We used Poisson regression to analyze changes in rotavirus prevalence, adjusting for calendar month and accounting for total monthly admissions; January 2014 – December 2016 was considered “pre-vaccine,” and January 2017 – June 2019 was considered “post-vaccine.” Age distribution and severity were compared between periods using the Mann-Whitney U test. Rotavirus-positive admissions declined 51% (95% CI: 28%-67%), from 31.5% pre-vaccine to 14.9% afterward. The median age of rotavirus-positive children increased from 7 months (interquartile range [IQR]: 5–11) in the pre-vaccine period to 11 months (IQR: 7–18, p = .005) in the post-vaccine period. The median severity score decreased from 11 to 9 ( p = .008) among all children, and from 12 pre- to 10.5 post-vaccine ( p = .35) among rotavirus-positive children. Our findings suggest that rotavirus vaccine introduction contributed to reduced rotavirus hospitalization in Abidjan and possibly more broadly.
L’innovation frugale va devenir un enjeu pour les sociétés actuelles, que ce soit au niveau des pays développés ou des pays en développement. La recherche de nouvelles idées ou produits, l’adaptation de produits anciens à ce nouveau contexte nécessitent une adaptation technologique. Dans un tel contexte, l’analyse de l’information contenue dans les brevets devient une aide indispensable.
La diarrhée, avec un taux d’incidence de 88,86‰ en 2016, est la troisième cause de la morbidité chez les enfants de moins de 5 ans en Côte d’Ivoire (INS & ICF, 2012). Pour faire face aux maladies diarrhéiques, l’OMS et l’UNICEF recommandent comme mesures curatives la thérapie de réhydratation par voie orale (TRO) composée de la SRO et de la SMR. En dépit du programme de lutte contre les maladies diarrhéiques par la promotion de la thérapie notamment la réhydratation par voie orale, initié depuis 1985 en Côte d’Ivoire, le pourcentage des enfants diarrhéiques ayant reçu une réhydratation par voie orale en 2016 n’était de 56,4%. Il ressort de l’analyse multivariée explicative que la contribution du contexte communautaire dans l’explication de la réhydratation par voie orale des enfants diarrhéiques de moins de 5 ans est estimée à plus 42 %. Les facteurs contextuels associés à la TRO sont : la région de résidence et le milieu de résidence. Quant aux facteurs individuels associés, ce sont : le sexe de l’enfant et le niveau d’instruction de la mère. Ainsi, nous recommandons à l’Etat de Côte d’Ivoire, à travers le Ministère de la santé et de l’hygiène publique d’intensifier les compagnes de lutte contre les maladies diarrhéiques chez l’enfant de moins de cinq ans par la promotion de la thérapie de réhydratation orale (SRO et LMR) auprès de la population du milieu rural surtout dans la région du Nord. Diarrhea, with an incidence rate of 88.86‰ in 2016, is the third leading cause of morbidity in children under 5 years of age in Côte d'Ivoire (INS & ICF, 2012). To address diarrheal diseases, WHO and UNICEF recommend oral rehydration therapy (ORT) composed of ORS and SMR as curative measures. Despite the program to control diarrheal diseases through the promotion of oral rehydration therapy, initiated since 1985 in Côte d'Ivoire, the percentage of diarrheic children who received oral rehydration therapy in 2016 was only 56.4%. The explanatory multivariate analysis shows that the contribution of the community context in explaining oral rehydration of diarrheic children under 5 years of age is estimated at more than 42%. The contextual factors associated with ORT are: region of residence and environment of residence. The individual factors associated with ORT are: the child's sex and the mother's level of education. Thus, we recommend that the State of Côte d'Ivoire, through the Ministry of Health and Public Hygiene, intensify the campaigns against diarrheal diseases in children under five years of age by promoting oral rehydration therapy (ORT and MRL) among the rural population, especially in the northern region.
Plusieurs études révèlent que près de 80 % des décès maternels pourraient être évités si les femmes avaient fait un recours adéquat aux soins obstétricaux modernes (Adiko et al., 2018). Au Togo, seulement 33% des femmes ont fait un recours adéquat aux consultations prénatales et 64% ont fait recours à l’accouchement moderne en 2017 (Institut Nationale de Statistique et des Etudes Démographiques(INSEED), 2017). Des modèles mixtes en particulier de la régression logistique multiniveau appliqués aux données de l’enquête par grappes à indicateurs multiples (2017), il ressort que, les femmes faisant recours adéquat aux consultations prénatales uniquement, pratiquaient la contraception moderne, sans union ou en union monogame, vivaient dans des ménages dirigés par une personne ayant un niveau d’instruction secondaire ou plus. Elles habitent dans les communautés à degrés de modernité sanitaire élevé et de fragmentation religieuse homogène. Celles qui ont fait recours uniquement à l’accouchement moderne ont une assurance santé, sont plus épanouies et dirigées par une personne du groupe ethnique Adja/Ewé. Elles résident dans les ménages non loués. Ce sont elles qui habitent dans des communautés plus riches. Tandis que celles qui font les deux recours sont des primipares, plus exposées aux médias, résidant dans un ménage à niveau de vie élevé et dirigé par un chef catholique ou musulman. Au Togo, il serait pertinent d’agir sur le recours adéquat aux consultations prénatales en rendant plus disponibles les soins et sur le recours à l’accouchement moderne par la sensibilisation sur son l’utilité. Several studies show that nearly 80 per cent of maternal deaths could be prevented if women had made adequate use of modern obstetric care (Adiko and al., 2018). In Togo, only 33% of women made adequate use of antenatal consultations and 64% resorted to modern childbirth in 2017 (INSEED, 2017). Mixed models in particular the multilevel logistic regression on data from the Multiple Indicator Cluster Survey (2017), it appears that women making adequate use of antenatal consultations only, has used modern contraception, without a union or in a monogamous union, lived in households headed by a person with secondary education or higher. They live in communities with high degrees of sanitary modernity and homogeneous religious fragmentation. Those who rely solely on modern childbirth have health insurance, are more fulfilled and are led by someone from the Adja/Ewé ethnic group. They reside in non-rented households. They are the ones who live in wealthier communities. While those who make both appeals are primiparous, more exposed to the media, residing in a household with a high standard of living and headed by a chief Catholic or Muslim religious. In Togo, it would be relevant to act on the appropriate use of antenatal cares by making care more available and on the use of modern childbirth by raising public awareness of its usefulness.
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