Evaluation of the diagnostic accuracy of a hemoglobin S and C screening test: Sickle Scan

New tools for the rapid diagnosis of hemoglobinosis could encourage the extension of their screening in Africa. Our goal was to assess the analytical performances of a rapid hemoglobin S and C detection test, the Sickle Scan. This was a cross-sectional study carried out in March 2019 at the Yopougon Teaching Hospital. The subjects followed for hemoglobinosis as well as the subjects seeking out an electrophoresis of their hemoglobin were included. We carried out the hemogram, the electrophoresis of hemoglobin at alkaline pH (reference method) coupled with the metabisulfite sickling test (Emmel test) and the rapid detection test to be evaluated. This immunochromatographic test is capable of detecting hemoglobins A, S, and C, and to infer the hemoglobin phenotype from there. The study recruited 191 individuals. The test detected hemoglobins S and C with a sensitivity of 99.4% and 97.7% respectively; a specificity of 93.3% and 99.3%. The positive likelihood ratio for hemoglobins S and C was 15 and 144 respectively. The negative likelihood ratio was 0.01 for hemoglobin S, and 0.02 for hemoglobin C. The intrinsic characteristics obtained make this test an interesting screening tool for hemoglobinosis S and C. Keywords: Diagnostic test, hemoglobinosis, Abidjan, sensitivity, specificity

Patient's site of first access to health system influences length of delay for tuberculosis treatment in Tajikistan

BACKGROUND: Tajikistan has the highest incidence rate of tuberculosis (TB) in Central Asia. Its health system still bears many features from Soviet times and is under-funded. Affordability is a major barrier to health care. Little is known about health care seeking of TB patients in post-Soviet countries and their delay until the start of TB therapy. The low estimated case detection rate in Tajikistan suggests major problems with access to care and consequently long delays are likely. METHODS: The study investigated extent and determinants of patient and health system delays for TB. A questionnaire was administered to a cohort of TB patients in twelve study districts representing a wide range of conditions found in Tajikistan. Common patterns of health care seeking were analysed. Cox proportional hazards models using eight predictor variables, including characteristics of health services delivery, were built to identify determinants of patient and health system delays. RESULTS: Two-hundred-and-four TB patients were interviewed. A common pattern in treatment-seeking was visiting a specialised TB facility at some stage. Typical delays until start of TB therapy were moderate and did not confirm the expectation of long delays. Median patient, health system and total delays to TB treatment were 21.5, 16 and 52 days, respectively. None of the investigated predictors was significantly associated with patient delay. The type of facility, where patients made their first contact with the health system, was the main determinant of health system delay (p > 0.00005). We show for the first time that patients who had fallen ill and first presented to health care in Russia had the longest delays. Those who first presented to peripheral primary care facilities also had relatively long delays. CONCLUSIONS: While overall delays were moderate, further improvement is needed for different subgroups. An international referral system between Russia and Tajikistan to reduce delays of Tajik migrants who develop active TB in Russia is urgently needed and would benefit both countries. Within Tajikistan, diagnostic pathways for patients in the periphery should be shortened. To achieve this, strengthening of sputum smear examination possibly including collection of sputa at peripheral primary care facilities may be needed

Low Efficacy of Single-Dose Albendazole and Mebendazole against Hookworm and Effect on Concomitant Helminth Infection in Lao PDR

Parasitic worms remain a public health problem in developing countries. Regular deworming with the drugs albendazole and mebendazole is the current global control strategy. We assessed the efficacies of a single tablet of albendazole (400 mg) and mebendazole (500 mg) against hookworm in children of southern Lao PDR. From each child, two stool samples were examined for the presence and number of hookworm eggs. Two hundred children were found to be infected. They were randomly assigned to albendazole (n = 100) or mebendazole (n = 100) treatment. Three weeks later, another two stool samples were analyzed for hookworm eggs. Thirty-two children who were given albendazole had no hookworm eggs anymore in their stool, while only 15 children who received mebendazole were found egg-negative. The total number of hookworm eggs was reduced by 85.3% in the albendazole and 74.5% in the mebendazole group. About one third of the children who were co-infected with the Asian liver fluke Opisthorchis viverrini were cleared from this infection following albendazole treatment and about one forth in the mebendazole group. Concluding, both albendazole and mebendazole showed disappointingly low cure rates against hookworm, with albendazole performing somewhat better. The effect of these two drugs against O. viverrini should be studied in greater detail

Out-of-pocket expenditures for primary health care in Tajikistan : a time-trend analysis

BACKGROUND: Aligned with the international call for universal coverage of affordable and quality health care, the government of Tajikistan is undertaking reforms of its health system aiming amongst others at reducing the out-of-pocket expenditures (OPE) of patients seeking care. Household surveys were conducted in 2005, 2007, 2008 and 2011 to explore the scale and determinants of OPE of users in four district of Tajikistan, where health care is legally free of charge at the primary level. METHODS: Using the data from four cross-sectional household surveys conducted between 2005 and 2011, time trends in OPE for consultation fees, drugs and transport costs of adult users of family medicine services were analysed. To investigate differences along the economic status, an asset index was constructed using principal component analysis. RESULTS: Adjusted for inflation, OPE for primary care have substantially increased in the period 2005 to 2011. While the proportion of patients reporting the payment of informal consultation fees to providers and their amount were constant over time, the proportion of patients reporting expenditures for drugs has increased, and the median amounts have doubled from 5.3 US$to 10.7 US$. Thus, the expenditures on medicine represent the biggest financial burden for patients accessing a primary care facility. Regression models showed that in 2011 patients from the most remote district with spread-out villages reported significant higher expenditures on medicine. Besides the steady increase in the median amount for OPE, the proportion of patients reporting making an informal payment to their care provider showed great variations across district of residence (between 20% and 73%) and economic status (between 33% among the 'worst-off' group and 68% among the 'better-off' group). CONCLUSIONS: In a context of limited governmental funds allocated to health and financing reforms aiming to improve financial access to primary care, the present paper indicates that in Tajikistan OPE – especially in relation to expenditures for drugs – have increased over time, and vary substantially across geographical areas and economic status. The fact that better-off households report disbursing more and in higher proportions hints towards a discrimination along the capacity to pay from providers. Increased public investments in the health sector, incentives for family doctors to provide PHC services free of charge and a strengthened drug control and supply system are necessary strategies to improve access of patients to services

Recherche des hémoglobinopathies qualitatives chez les hémophiles à Abidjan, Côte d’Ivoire

Introduction : L’hémophilie est une maladie héréditaire rare à transmission récessive liée au chromosome X. Les principaux  symptômes sont l’hémorragie, les hématomes, l’anémie et les douleurs articulaires dans les hémarthroses. Ces deux derniers signespeuvent se retrouver au cours des hémoglobinopathies. Ainsi, l’objectif de cette étude était de rechercher la présence d’hémoglobinopathies qualitatives dans une cohorte d’hémophiles suivis au service d’hématologie clinique du CHU de Yopougon.Méthodes : C’est une étude transversale qui s’est déroulée de Janvier à Juillet 2017 au niveau de l’unité d’hématologie du laboratoire central du CHU de Yopougon. Sur les prélèvements de 49 patients, ont été effectués l’hémogramme, l’électrophorèse de l’hémoglobine, le taux de prothrombine (TP), le temps de céphaline activée (TCA) et le dosage des facteurs VIII et IX par la méthode chronométrique.Résultats : La moyenne d’âge était de 17 ans avec 73,5% d’élèves et étudiants. Les hémarthroses (75,5%) et les hématomes (36,7%) constituaient l’essentiel des signes cliniques. La complication majeure était la déformation articulaire à 34,7%. Sur les 49 patients constituant la cohorte, le pourcentage d’hémophiles A était de 89.8% (44/49) et celui d’hémophiles B 10,2% (5/49), avec 81,6% (40/49) d’hémophiles sévères. La fréquence des hémoglobinopathies qualitatives est de 8,2% (4/49) avec 6,2% de trait drépanocytaire AS (3/49) et 2% d’hémoglobine AC (1/49).Conclusion : Cette étude a mis en évidence la présence d’hémoglobinopathies qualitatives, pouvant coexister avec l’hémophilie, ce qui peut compliquer la prise en charge et la qualité de vie des patients. Mots clés : Hémophilie, hémogramme, électrophorèse, Abidjan.   English title: Research of qualitative haemoglobinopathies in hemophiliacs in Abidjan, Côte d’Ivoire Introduction: Hemophilia is a rare hereditary disease with X-linked recessive inheritance. The main symptoms are haemorrhage, hematoma, anemia and joint pain associated with hemarthrosis. These last two signs can also be found during haemoglobinopathies. Thus, the objective of this study was to investigate the presence of qualitative haemoglobinopathies in a cohort of hemophiliacs followed in the clinical hematology department of Yopougon University Hospital. Methods: This is a cross-sectional study that took place from January to July 2017 at the hematology unit of the central laboratory of the Yopougon University Hospital. On the samples of 49 patients, blood count, haemoglobin electrophoresis, prothrombin time (PT), activated partial thromboplastin time (APTT) and factor VIII and IX were measured by the chronometric method. Results: The average age was 17 with 73.5% of students. Haemarthrosis (75.5%) and hematoma (36.7%) constituted the bulk of clinical signs. The major complication was joint deformity with 34.7%. Of the 49 patients in the cohort, the proportion of hemophiliacs A was 89.8% (44/49) and that of hemophiliac B was 10.2% (5/49), with 81.6% (40/49) of all patients showing severe haemophilia. The frequency of qualitative haemoglobinopathies was 8.2% (4/49) with 6.2% of haemoglobin AS or sickle cell trait (3/49) and 2% of haemoglobin AC (1/49). Conclusion: This study highlighted the presence of qualitative hemoglobinopathies that can coexist with hemophilia, which can  complicate the management and quality of life of patients. Keywords: Hemophilia, hemogram, electrophoresis, Abidjan.  &nbsp