Prise en charge précoce de l’infection par le VIH du nourrisson de moins de deux ans en Afrique de l’Ouest : accessibilité, acceptabilité, observance et efficacité du traitement antirétroviral de première ligne basé sur le lopinavir et ses déterminants dans la cohorte initiale MONOD ANRS 12206

We assessed the accessibility, acceptability and efficacy at 12 months of early antiretroviraltherapy (EAT) initiated before two years of age in children HIV-infected in Côte d'Ivoire andBurkina Faso.We conducted two baseline surveys and analyzed the enrolment and therapeutic response inthe cohort recruited ahead of the MONOD ANRS 12206 trial.Despite a high prenatal HIV screening coverage of 88%, only 29% [95% CI: 27-32] exposedchildren had access to early HIV diagnosis in 2011 in Ouagadougou.In terms of knowledge, 97% of parents/caregivers of children were aware of the main route ofHIV transmission in infants. All the parents thought the child EAT was necessary, withoutreally know in what it consists.Among the 217 children referred for inclusion, 161 (74%) have initiated EAT with a medianage of 13.5 months; 70% had reached the 3/4 WHO stage, and 57% had a severe immunedeficiency. The reasons for non-inclusion were: fear or the father's refusal (48%), mortality(24%), false positives (16%), others (12%). Having already shared the child or the motherHIV status with the father and having an age ≥ 12 months were the factors associated with theinitiation of EAT.Among the 156 children who received an EAT-based lopinavir/ritonavir, 11 children died(7%), 5 were lost to follow-up (3%), 140 were followed for 12 months (90%), with 70%virological success (viral load <500 cp / mL).In 2011-2013, the challenges for improving access to EAT in HIV-infected children in WestAfrica remain. Late access is associated with a high early mortality. Nevertheless, the successrate of EAT is high.Nous avons évalué l’accessibilité, l’acceptabilité et l’efficacité à 12 mois du traitement antirétroviral précoce (TAP) initié avant 2 ans chez l’enfant infecté par le VIH en Côte d’Ivoire et au Burkina Faso. Nous avons mené deux enquêtes de base, puis analysé le recrutement et la réponse dans la cohorte thérapeutique recrutée en amont de l’essai MONOD ANRS 12206. En dépit d’une couverture prénatale du dépistage VIH élevée de 88%, seulement 29% [IC à 95% : 27-32] des enfants exposés avaient eu accès au diagnostic virologique précoce en 2011 à Ouagadougou. En termes de connaissances, 97% des parents/tuteurs d’enfants connaissaient la principale voie de transmission du VIH chez les nourrissons. Tous les parents pensaient que le TAP de l’enfant était nécessaire, sans savoir en quoi il consistait. Parmi les 217 enfants référés pour inclusion, 161 (74%) ont initié un TAP à un âge médian de 13,5 mois ; 70% avaient atteint le stade 3/4 de l'OMS, et 57% un déficit immunitaire sévère. Les raisons de non-inclusion étaient : peur ou refus du père (48%), mortalité (24%), faux-positifs (16%), autres (12%). Avoir déjà partagé le statut VIH de l'enfant ou de la mère avec le père et avoir un âge ≥12 mois étaient les deux facteurs associés à l’initiation du TAP. Parmi les 156 enfants ayant reçu un TAP à base de LPV/r, 11 enfants sont décédés (7%), 5 perdus de vue (3%), 140 ont été suivis à 12 mois (90%), avec 70% de succès virologique (charge virale<500 cp/mL). En 2011-2013, les défis pour améliorer l’accès au TAP chez les enfants infectés par le VIH en Afrique de l'Ouest demeurent. L’accès tardif est associé à une forte mortalité précoce. Néanmoins, le taux de succès au TAP est élevé

Perceptions et Practiques en Matiere de Contraception dans une Communaute Urbaine de la Ville d’Abidjan (Cote d’ Ivore)

Introduction : L’utilisation efficace de la contraception dépend de l’attitude des utilisatrices à l’égard de celle-ci. L’objectif de cette étude était de déterminer les perceptions et pratiques en matière de contraception en milieu urbain. Matériel et Méthodes : Une étude transversale descriptive mixte a été réalisée au quartier Dallas, dans la commune d'Adjamé, auprès de femmes en âge de reproduction, d'hommes et de chefs religieux. L'aspect quantitatif a eu lieu du 5 mai au 4 juin 2018, tandis que l'aspect qualitatif a eu lieu du 5 juin au 4 juillet. De plus, des données quantitatives et qualitatives ont été saisies et analysées à l'aide du logiciel Epi info 6.1. Après l'enregistrement et la transcription, une analyse du contenu a été effectuée. Résultats :Troiscent femmes ont été sélectionnées pour l’enquête quantitative et 29 personnes ont participé à l’enquête qualitative. L’âge moyen des femmes était de 29,4 ±9,1 ans. Cent trente-deux femmes n’avaient pas abordé le sujet de la contraception avec leur partenaire. Les principales raisons étaient le désintérêt de la femme pour le sujet et l’ignorance. Soixante-deux femmes pensaient que la contraception était une pratique non bénéfique pour la santé. Les raisons pour lesquelles les femmes désapprouvaient la contraception étaient le rejet et les maladies. Les méthodes modernes étaient les plus utilisées. Conclusion : Les campagnes de sensibilisation et d’information au niveau communautaire peuvent permettre aux femmes et aux hommes d’avoir des attitudes adéquates vis à vis de la contraception moderne. Introduction: The effective use of contraceptive depends on user's attitudes towards contraception. This paper focuses on determining the perceptions and practices of contraception in urban areas. Material and Methods: A mixed descriptive cross-sectional study was carried out in Dallas, district of Adjamé, among women of reproductive age, men, and religious leaders. The quantitative aspect took place from May 5th to June 4th, 2018, while the qualitative aspect took place from June 5th to July 4th. Also, quantitative and qualitative data were captured and analyzed using Epi info software. After recording and transcription, a content analysis was carried out. Results: Three hundred women were selected for the quantitative survey, and 29 people participated in the qualitative survey. The average age of the women was 29.4 ± 9.1 years. Among them, one hundred and thirty-two women had not discussed contraception with their partners. The main reasons were theirignorance and lack of interest in the subject. In addition, sixty-two women thought that contraception was a non-healthy practice. The main reason for their disapproval was rejection and disease. Moreover, modern methods were the most widely used. Conclusion: Awareness and information campaigns at the community level can help women and men to develop appropriate attitudes towards modern contraception

Implémentation du Field Epidemiology Training Programme Frontline au Burkina Faso, 2016 à 2019: leçons apprises et Défis: Implementation of the Frontline Field Epidemiology Training Programme in Burkina Faso, 2016 to 2019: Lessons Learned and Challenges

Introduction: Dans le contexte de l'agenda de la sécurité mondiale de la santé lancé en 2015. The Centers for Disease Control and Prevention (CDC Atlanta) a initié le renforcement de capacités des acteurs dans l'épidémiologie de terrain Frontline (FETP). Pour l'implémentation du programme, des réunions, une évaluation de base, le recrutement et formation de mentors, sélection et formation de participants en utilisant l'approche « One Health », travaux de terrain, supervision et interviews de sortie ont été menés. Au Burkina Faso ce programme a commencé en avril 2016. L'objectif de cette étude était de décrire le processus d'implémentation, les défis et les leçons apprises. Méthodes: Une étude transversale rétrospective qualitative à visée descriptive conduite d'avril 2016 à septembre 2019 incluant tous les participants. Des interviews et une revue documentaire avaient été réalisés. Résultats: L'évaluation de base avait montré un besoin dans le renforcement des capacités pour le système de surveillance. Au total 22 mentors formés. Fin décembre 2019, neuf cohortes (100%) formées dont 6 (75%) avec approche « One Health ». Au total 210 participants devraient être formés sans distinction de sexe, ainsi 267 capacités (127%). Sur les 267 formés, 22 femmes (8%). Deux qui n'ont pas achevé la formation (0,7%), un décès (0,3%). Au total 1040 travaux réalisés. Les défis restent le suivi post formation, les mutations des agents formés et la pérennisation. Conclusion: L'implémentation de FETP Frontline au Burkina Faso a été effective et a fait face à plusieurs défis et des leçons apprises ont été tirées. Il est recommandé la poursuite de ces formations pour le renforcement des capacités des acteurs de la surveillance. Introduction: In the context of the global health security agenda launched in 2015, the Center for Disease Control and Prevention (CDC Atlanta) initiated capacity building for stakeholders in Frontline Field Epidemiology (FETP). To implement the programme, meetings, a baseline assessment, recruitment and training of mentors, selection and training of participants using the "One Health" approach, fieldwork, supervision and exit interviews were conducted. In Burkina Faso this programme started in April 2016. The objective of this study was to describe the implementation process, challenges and lessons learned. Methods: A retrospective qualitative descriptive cross-sectional study conducted from April 2016 to September 2019 including all participants. Interviews and a literature review were conducted. Results: The baseline assessment showed a need in capacity building for the surveillance system. In total 22 mentors trained. By the end of December 2019, nine cohorts (100%) trained, of which six (75%) with a "One Health" approach. A total of 210 participants should be trained regardless of gender, thus 267 were trained (127%). Of the 267 trained, 22 were women (8%). Two did not complete the training (0.7%), one died (0.3%). A total of 1,040 works were completed. The challenges remain post-training follow-up, transfers of trained agents and sustainability. Conclusion: The implementation of FETP Frontline in Burkina Faso was effective, faced several challenges and lessons were learned. It is recommended that these training sessions be continued in order to strengthen the capacities of surveillance actors

Determinants of Health Care Renunciation among Women in Ivory Coast: Case of the District of Abobo Anonkoi-3

Background: Health care renunciation aims to identify unmet care needs that a health con­dition would have justified. This behavior appears to be more common in women than in men. The objective of this work was to analyze the determinants of the health care renuncia­tion among women in the city of Abidjan.Subjects and Method: We carried out a cross-sectional study from March to May 2019 in Anonkoi-3, a peri-urban district of the muni­cipality of Abobo, in the north of the city of Abidjan. Questionnaires served to collect infor­mations. Bivariate analyzes and a multiple logistic regression were used to measure the association between the different types of renunciation and the characteristics of women. Dependant variable was healthcare renuncia­tion. Independent variables were socio-demo­graphic, economic, health status characte­ristics and reasons for renouncing to health care.Results: The population sample consisted of 423 women (with mean age= 32; SD= 12 years). The renunciation on consultations with the general practitioner concerned, 72.34% of women. Regarding consultation with the spe­cialist, the ophthalmologist (25.05%), the dentist (21.99%), and the gynecologist (14.89%) were those mostly renounced by the women. After consultation, 31.2% of them renounced to pursuing other treatment. They most often renounced to buying drugs from conventional medicine (19.62%) and preferred to use street drugs and traditional drugs (87.71%). All things being equal, women aged 28 to 38 (OR= 2.45; 95% CI= 1.31 to 4.68; p= 0.013), artisans and traders (OR= 3.22; 95% CI= 1.48 to 7.38; p= 0.004) and those in trade learning (OR= 2.42; 95% CI= 1.12 to 5.49; p= 0.028) significantly renouncing more on health care.Conclusion: In addition to financial reasons, the renunciation on health care can be explained by individual and social behaviors specific to individuals.Keywords: women, healthcare renunciation, precariousness, social inequalities, ivory coastCorrespondence: Jérôme Kouame, Faculty of Pharmaceutical and Biological Sciences, Department of Public Health, Hydrology and Toxicology, University Félix Houphouët Boigny, BPV 34 Abidjan 01, Ivory Coast. Email: jerome.kouamejj­@­gmail.­com. Mobile: 0022565237900.Journal of Health Policy and Management (2021), 06(02): 116-129https://doi.org/10.26911/thejhpm.2021.06.02.0

Thermal degradation assessment of Kraft paper in power transformers insulated with natural esters

Kraft paper in combination with dielectric oil is the most common as insulation system used in power transformers. The most used oil in power transformers is mineral oil. However, dielectric oils based on natural esters possess some advantages in comparison with mineral oil such as higher biodegradability, fire safety and availability. Therefore, they might be the most ideal substitute for mineral oil. The introduction of a new material requires the evaluation of its degradation rate because this determines transformers’ life span. In order to assess the performance of new insulating systems based on vegetable oils, simulations to obtain the hot-spot temperatures in power transformers using vegetable oils and controlled laboratory experiments of ageing were carried out. The reason is that hot spot temperature inside windings of the oil-immersed power transformers is one of the main manifestations of the thermal stress which leads to aging of insulation systems.The research leading to these results has received funding from multiple sources during years but we would specifically like to acknowledge the support received in the later stages from the Spanish Plan Estatal de I+D under the grant agreement DPI2013- 43897-P

Early treatment of HIV infection in infants under two years in West Africa : accessibility, acceptability, adherence and efficacy of first-line antiretroviral treatment based on lopinavir and its determinants in the ANRS MONOD 12206 initial cohort

Nous avons évalué l’accessibilité, l’acceptabilité et l’efficacité à 12 mois du traitement antirétroviral précoce (TAP) initié avant 2 ans chez l’enfant infecté par le VIH en Côte d’Ivoire et au Burkina Faso. Nous avons mené deux enquêtes de base, puis analysé le recrutement et la réponse dans la cohorte thérapeutique recrutée en amont de l’essai MONOD ANRS 12206. En dépit d’une couverture prénatale du dépistage VIH élevée de 88%, seulement 29% [IC à 95% : 27-32] des enfants exposés avaient eu accès au diagnostic virologique précoce en 2011 à Ouagadougou. En termes de connaissances, 97% des parents/tuteurs d’enfants connaissaient la principale voie de transmission du VIH chez les nourrissons. Tous les parents pensaient que le TAP de l’enfant était nécessaire, sans savoir en quoi il consistait. Parmi les 217 enfants référés pour inclusion, 161 (74%) ont initié un TAP à un âge médian de 13,5 mois ; 70% avaient atteint le stade 3/4 de l'OMS, et 57% un déficit immunitaire sévère. Les raisons de non-inclusion étaient : peur ou refus du père (48%), mortalité (24%), faux-positifs (16%), autres (12%). Avoir déjà partagé le statut VIH de l'enfant ou de la mère avec le père et avoir un âge ≥12 mois étaient les deux facteurs associés à l’initiation du TAP. Parmi les 156 enfants ayant reçu un TAP à base de LPV/r, 11 enfants sont décédés (7%), 5 perdus de vue (3%), 140 ont été suivis à 12 mois (90%), avec 70% de succès virologique (charge virale<500 cp/mL). En 2011-2013, les défis pour améliorer l’accès au TAP chez les enfants infectés par le VIH en Afrique de l'Ouest demeurent. L’accès tardif est associé à une forte mortalité précoce. Néanmoins, le taux de succès au TAP est élevé.We assessed the accessibility, acceptability and efficacy at 12 months of early antiretroviraltherapy (EAT) initiated before two years of age in children HIV-infected in Côte d'Ivoire andBurkina Faso.We conducted two baseline surveys and analyzed the enrolment and therapeutic response inthe cohort recruited ahead of the MONOD ANRS 12206 trial.Despite a high prenatal HIV screening coverage of 88%, only 29% [95% CI: 27-32] exposedchildren had access to early HIV diagnosis in 2011 in Ouagadougou.In terms of knowledge, 97% of parents/caregivers of children were aware of the main route ofHIV transmission in infants. All the parents thought the child EAT was necessary, withoutreally know in what it consists.Among the 217 children referred for inclusion, 161 (74%) have initiated EAT with a medianage of 13.5 months; 70% had reached the 3/4 WHO stage, and 57% had a severe immunedeficiency. The reasons for non-inclusion were: fear or the father's refusal (48%), mortality(24%), false positives (16%), others (12%). Having already shared the child or the motherHIV status with the father and having an age ≥ 12 months were the factors associated with theinitiation of EAT.Among the 156 children who received an EAT-based lopinavir/ritonavir, 11 children died(7%), 5 were lost to follow-up (3%), 140 were followed for 12 months (90%), with 70%virological success (viral load <500 cp / mL).In 2011-2013, the challenges for improving access to EAT in HIV-infected children in WestAfrica remain. Late access is associated with a high early mortality. Nevertheless, the successrate of EAT is high

Prevention and care of paediatric HIV infection in Ouagadougou, Burkina Faso: knowledge, attitudes and practices of the caregivers

International audienceAbstractBackgroundThe paediatric Human Immunodeficiency Virus (HIV) epidemic still progresses because of operational challenges in implementing prevention of mother-to-child HIV transmission (PMCT) programs. We assessed the knowledge, attitudes and practices (KAP) of children’s caregivers regarding mother-to-child transmission (MTCT) of HIV, paediatric HIV infection, early infant diagnosis (EID), and paediatric antiretroviral treatment in Ouagadougou, Burkina Faso.MethodsWe undertook a qualitative survey in the four public hospitals managing HIV exposed or infected children, in Ouagadougou in 2011. A sociologist used a semi-structured questionnaire to interview caregivers of children less than 5 years old attending the paediatrics wards on their KAP. Study participants were divided into four groups as follows:those who did not yet know their children’s HIV infection status, those who were waiting for their children’s HIV test results, those who were waiting for antiretroviral treatment, and those who were already on antiretroviral treatment.ResultsA total of 37 caregivers were interviewed. The mean age was 32.5 years, and 29 (78 %) were mothers. Twenty seven (73 %) caregivers had primary or higher level of education, and 15 (40 %) described their occupation as “housewife”. Overall, 36 (97 %) of caregivers knew that the main route of HIV transmission for infants was through MTCT and 14 (38 %) specified that it occurred during pregnancy or delivery. Five percent thought that MTCT of HIV occurred during conception. PMTCT interventions could help prevent infant HIV infection according to 32 (87 %) caregivers. Thirty five percent of caregivers stated EID as a prevention strategy. Fifty-four percent of the participants believed that replacement feeding option would prevent MTCT of HIV; 24 (65 %) stated that they would prefer medical practitioners seek caregivers’ consent before carrying out any HIV-test for their child, and that caregivers’ consent was not compulsory before antiretroviral treatment. All caregivers thought that it was necessary to treat HIV-infected children, although they did not know what interventions could be done.ConclusionsThis study highlighted the low level of caregivers’ knowledge on paediatric HIV prevention and care in Ouagadougou. Awareness programs targeting caregivers need to be strengthened in order to improve the uptake of HIV early infant diagnosis and care

Missed opportunities of inclusion in a cohort of HIV-infected children to initiate antiretroviral treatment before the age of two in West Africa, 2011 to 2013

CITATION: Dahourou, D. L. et al. 2016. Missed opportunities of inclusion in a cohort of HIV-infected children to initiate antiretroviral treatment before the age of two in West Africa, 2011 to 2013. Journal of the International AIDS Society, 19:20601, doi:10.7448/IAS.19.1.20601.The original publication is available at http://www.jiasociety.orgIntroduction: The World Health Organization (WHO) 2010 guidelines recommended to treat all HIV-infected children less than two years of age. We described the inclusion process and its correlates of HIV-infected children initiated on early antiretroviral therapy (EART) at less than two years of age in Abidjan, Côte d’Ivoire, and Ouagadougou, Burkina Faso. Methods: All children with HIV-1 infection confirmed with a DNA PCR test of a blood sample, aged less than two years, living at a distance less than two hours from the centres and whose parents (or mother if she was the only legal guardian or the legal caregiver if parents were not alive) agreed to participate in the MONOD ANRS 12206 project were included in a cohort to receive EART based on lopinavir/r. We used logistic regression to identify correlates of inclusion. Results: Among the 217 children screened and referred to the MONOD centres, 161 (74%) were included and initiated on EART. The main reasons of non-inclusion were fear of father’s refusal (48%), mortality (24%), false-positive HIV infection test (16%) and other ineligibility reasons (12%). Having previously disclosed the child’s and mother’s HIV status to the father (adjusted odds ratio (aOR): 3.20; 95% confidence interval (95% CI): 1.55 to 6.69) and being older than 12 months (aOR: 2.05; 95% CI: 1.02 to 4.12) were correlates of EART initiation. At EART initiation, the median age was 13.5 months, 70% had reached WHO Stage 3/4 and 57% had a severe immune deficiency. Conclusions: Fear of stigmatization by the father and early competing mortality were the major reasons for missed opportunities of EART initiation. There is an urgent need to involve fathers in the care of their HIV-exposed children and to promote early infant diagnosis to improve their future access to EART and survival.http://www.jiasociety.org/index.php/jias/article/view/20601Publisher's versio