Schistosomiasis and soil-transmitted helminthiasis control in Cameroon and Côte d'Ivoire: implementing control on a limited budget

Schistosomiasis and soil-transmitted helminthiasis occur throughout the developing world and remain a major public health problem in the poorest communities with enormous consequences for development. The extent of the problem has long been neglected because these diseases rarely kill at a young age and also because of their insidious nature. Today there exists a momentum and an unprecedented opportunity for a cost-effective control of these neglected tropical diseases. The control of these diseases has become a priority on the agenda of many governments, donors and international agencies. This paper highlights the progress made and future control activities in Cameroon and Côte d'Ivoire, where schistosomiasis and soil-transmitted helminthiasis control measures have been implemented over the past decade with limited budgets. In Cameroon, deworming activities were increased to encompass all ten regions in 2007 as a result of a co-ordinated effort of the Ministry of Health and the Ministry of Education with national and international partners. In Côte d'Ivoire, focal control activities were achieved with support from various partners. Prospects, opportunities and challenges for the control of neglected tropical diseases in these two countries are discusse

Efficacy and safety of praziquantel in preschool-aged children in an area co-endemic for Schistosoma mansoni and S. haematobium

BACKGROUND: In sub-Saharan Africa the recommended strategy to control schistosomiasis is preventive chemotherapy. Emphasis is placed on school-aged children, but in high endemicity areas, preschool-aged children are also at risk, and hence might need treatment with praziquantel. Since a pediatric formulation (e.g., syrup) is not available outside of Egypt, crushed praziquantel tablets are used, but the efficacy and safety of this treatment regimen is insufficiently studied.METHODOLOGY: We assessed the efficacy and safety of crushed praziquantel tablets among preschool-aged children (>6 years) in the Azaguié district, south Côte d'Ivoire, where Schistosoma mansoni and S. haematobium coexist. Using a cross-sectional design, children provided two stool and two urine samples before and 3 weeks after treatment. Crushed praziquantel tablets, mixed with water, were administered at a dose of 40 mg/kg. Adverse events were assessed and graded 4 and 24 hours posttreatment by interviewing mothers/guardians.PRINCIPAL FINDINGS: Overall, 160 preschool-aged children had at least one stool and one urine sample examined with duplicate Kato-Katz thick smears and a point-of-care circulating cathodic antigen (POC-CCA) cassette for S. mansoni, and urine filtration for S. haematobium diagnosis before and 3 weeks after praziquantel administration. According to the Kato-Katz and urine filtration results, we found high efficacy against S. mansoni (cure rate (CR), 88.6%; egg reduction rate (ERR), 96.7%) and S. haematobium (CR, 88.9%; ERR, 98.0%). POC-CCA revealed considerably lower efficacy against S. mansoni (CR, 53.8%). Treatment was generally well tolerated, but moderately severe adverse events (i.e., body and face inflammation), were observed in four Schistosoma egg-negative children. CONCLUSIONS/SIGNIFICANCE: Crushed praziquantel administered to preschool-aged children at a dose of 40 mg/kg is efficacious against S. mansoni and S. haematobium in a co-endemic setting of Côte d'Ivoire. Further research is required with highly sensitive diagnostic tools and safety must be investigated in more depth.TRIAL REGISTRATION: Controlled-Trials.com ISRCTN53172722

Bayesian geostatistical modelling for mapping schistosomiasis transmission

Progress has been made in mapping and predicting the risk of schistosomiasis using Bayesian geostatistical inference. Applications primarily focused on risk profiling of prevalence rather than infection intensity, although the latter is particularly important for morbidity control. In this review, the underlying assumptions used in a study mapping Schistosoma mansoni infection intensity in East Africa are examined. We argue that the assumption of stationarity needs to be relaxed, and that the negative binomial assumption might result in misleading inference because of a high number of excess zeros (individuals without an infection). We developed a Bayesian geostatistical zero-inflated (ZI) regression model that assumes a non-stationary spatial process. Our model is validated with a high-quality georeferenced database from western Côte d'Ivoire, consisting of demographic, environmental, parasitological and socio-economic data. Nearly 40% of the 3818 participating schoolchildren were infected with S. mansoni, and the mean egg count among infected children was 162 eggs per gram of stool (EPG), ranging between 24 and 6768 EPG. Compared to a negative binomial and ZI Poisson and negative binomial models, the Bayesian non-stationary ZI negative binomial model showed a better fit to the data. We conclude that geostatistical ZI models produce more accurate maps of helminth infection intensity than the spatial negative binomial one

Risk factors and spatial distribution of Schistosoma mansoni infection among preschool-aged children in Blapleu, Biankouma district, Western Côte d'Ivoire

Schistosoma mansoni infection is common among school-age children (SAC) in western Cote d'Ivoire. Little is known on the infection rate of preschool-aged children (PSAC) due to epidemiological data deficiency and nonappropriate formulation of the drug. Thus, mass drug administration for schistosomiasis control mainly targets SAC. This study aims to identify the risk factors and spatial distribution of S. mansoni infection among PSAC in Blapleu, endemic foci of S. mansoni. We carried out a cross-sectional study in households with PSAC aged 1-6 years. A structured questionnaire was administered to mothers/guardians to obtain data on sociodemographics and water contact behaviour of children. Point-of-care circulating cathodic antigen (POC-CCA) immunodiagnostic test in urine and Kato-Katz (K-K) method with stool were used for S. mansoni infection diagnosis. Multiple logistic regression analysis was performed to determine the relationship between S. mansoni infection and sociodemographic data. Coordinates recorded by a Global Positioning System of households, water source points, and infected PSAC were used to map the spatial distribution of S. mansoni infection cases. This study was conducted with 350 PSAC aged 1-6 years. The overall infection prevalence of S. mansoni varies from 31.43% with the K-K method to 62.86% with the POC-CCA. PSAC aged 2-6 years were highly infected with S. mansoni than those aged 1-2 years (OR = 14.24, 95% CI: 5.85-34.64). PSAC who did not have access and who do not live close to the infected water source were at a significant lower risk of S. mansoni infection (OR = 0.13, 95% CI: 0.057-0.30). The main purpose of water contact of PSAC was to help their mother for laundry that occurs weekly. In Blapleu, a high risk of S. mansoni infection was observed among PSAC. Schistosomiasis control effort in such localities should include information, education, and communication, water, sanitation, and hygiene, and particularly chemotherapy targeting PSAC, reinforcing the need of the paediatric praziquantel formulation

Impact of newly constructed primary healthcare centres on antenatal care attendance, facility delivery and all-cause mortality: quasi-experimental evidence from Taabo health and demographic surveillance system, Côte d'Ivoire

OBJECTIVES: Access to quality care remains limited, particularly in low-income and middle-income countries. Although better health outcomes for families living in close proximity to healthcare facilities have been documented in cross-sectional studies, evidence on the extent to which additional health facilities can contribute to improved population health remains scanty. We aimed to estimate the causal impact of newly constructed primary healthcare facilities within a health and demographic surveillance (HDSS) site in Cote d'Ivoire. DESIGN: We conducted a quasi-experimental study. Logistic and Cox proportional hazards regression models were used to estimate the impact of new healthcare facilities on healthcare-seeking behaviour and all-cause mortality. SETTING: Data were collected prospectively through the Taabo HDSS located in south-central Cote d'Ivoire between 2010 and 2018. PARTICIPANTS: We analysed 2957 deaths across 440 973 person-year observations as well as 14 132 live births. PRIMARY OUTCOME MEASURES: The primary outcomes were antenatal care (ANC) attendance, facility delivery and mortality. Logistic and Cox proportional hazards models were employed to estimate the impact of the new health facilities on ANC attendance, facility delivery and child as well as adult mortality. RESULTS: Average distance to the nearest healthcare facility declined from 5.5 km before to 2.8 km after opening of four new healthcare facilities in targeted villages. No improvement was observed for ANC attendance, institutional deliveries and adult mortality. New facilities reduced the risk of post-neonatal infant mortality by 46% (HR 0.54, 95% CI 0.31 to 0.94, p<0.05), suggesting a mortality gradient of 2 deaths per 1000 for each additional km (Coef=0.002, 95% CI 0.000 to 0.004, p<0.05). CONCLUSIONS: Our results suggest that new facilities do not necessarily improve healthcare utilisation and health outcomes. Further research is needed to identify the best ways to ensure access to quality care in resource-constrained settings

Distribution of bovine Fasciola gigantica (Cobbold, 1885) in the district des Savanes, northern Côte d'Ivoire

Fascioliasis, caused by an infection with liver flukes of the genus Fasciola, is an important disease of livestock in most parts of the world. However, little is known about the distribution of fascioliasis in sub-Saharan Africa. We report results of a cross-sectional study conducted in 2014 in the district des Savanes in the northern part of Cote d'Ivoire. We obtained 275 livers from bovine suspected with fascioliasis and 51 unsuspected livers from 24 slaughterhouses. Livers were dissected using a standard operating procedure and all Fasciola gigantica flukes were removed from the tissues of the liver and the biliary ducts. We found F. gigantica in 125 livers from bovines suspected with fascioliasis (45.5%) in 10 departments of the district des Savanes. Among the unsuspected livers, five were positive for F. gigantica (9.8%). The distribution of fascioliasis showed considerable spatial heterogeneity, both at regional (ranging from 18.0% to 52.3%) and departmental level (ranging from 14.3% to 64.0%). Poro region was the most affected (52.3%) with a relatively homogeneous distribution. The departments most affected by fascioliasis were M'Bengue (64.0%), Sinematiali (62.1%) and Ferkessedougou (52.9%). Our study confirms that fascioliasis is an important veterinary disease in the northern part of Cote d'Ivoire, and hence, high-risk areas need to be targeted for prevention and control measures

Schistosomiasis and neglected tropical diseases: towards integrated and sustainable control and a word of caution

In May 2001, the World Health Assembly (WHA) passed a resolution which urged member states to attain, by 2010, a minimum target of regularly administering anthelminthic drugs to at least 75% and up to 100% of all school-aged children at risk of morbidity. The refined global strategy for the prevention and control of schistosomiasis and soil-transmitted helminthiasis was issued in the following year and large-scale administration of anthelminthic drugs endorsed as the central feature. This strategy has subsequently been termed ‘preventive chemotherapy'. Clearly, the 2001 WHA resolution led the way for concurrently controlling multiple neglected tropical diseases. In this paper, we recall the schistosomiasis situation in Africa in mid-2003. Adhering to strategic guidelines issued by the World Health Organization, we estimate the projected annual treatment needs with praziquantel among the school-aged population and critically discuss these estimates. The important role of geospatial tools for disease risk mapping, surveillance and predictions for resource allocation is emphasised. We clarify that schistosomiasis is only one of many neglected tropical diseases and that considerable uncertainties remain regarding global burden estimates. We examine new control initiatives targeting schistosomiasis and other tropical diseases that are often neglected. The prospect and challenges of integrated control are discussed and the need for combining biomedical, educational and engineering strategies and geospatial tools for sustainable disease control are highlighted. We conclude that, for achieving integrated and sustainable control of neglected tropical diseases, a set of interventions must be tailored to a given endemic setting and fine-tuned over time in response to the changing nature and impact of control. Consequently, besides the environment, the prevailing demographic, health and social systems contexts need to be considere

Diagnosis, clinical features, and self-reported morbidity of Strongyloides stercoralis and hookworm infection in a Co-endemic setting

BACKGROUND: Infections with Strongyloides stercoralis and other helminths represent important, yet often neglected issues in developing countries. Indeed, strongyloidiasis can be fatal, but only a few studies provide information regarding its health relevance in Africa. Moreover, clinical data on symptomatology and typical recognition patterns mainly originate from Western travel clinics. METHODOLOGY: A cross-sectional epidemiological survey was carried out in a rural part of south-central Côte d'Ivoire. Stool samples from 292 randomly selected individuals were examined for intestinal helminths, using a suite of diagnostic techniques (i.e., Kato-Katz, Baermann funnel, and Koga agar plate). Participants were interviewed with a pre-tested questionnaire and clinically examined. Multivariate logistic regression analysis was done to relate perceived morbidity and clinical findings to helminth infection status. PRINCIPAL FINDINGS: The prevalence of hookworm and S. stercoralis was 51.0% and 12.7%, respectively. Both infections were strongly associated with each other (adjusted odds ratio, 6.73; P < 0.001) and higher prevalences were observed with age. S. stercoralis-infected individuals expressed self-reported morbidity considerably more often than those with hookworm infection. Clinical examination identified high prevalences of various pathologies and detected tendencies to worse health conditions in helminth-infected subjects. CONCLUSIONS/SIGNIFICANCE: The use of multiple diagnostic tools showed that S. stercoralis and hookworm are co-endemic in rural Côte d'Ivoire and that each infection causes clinical symptoms and sequelae. Our findings are important for (re-)estimating the burden of helminth infections, and highlight the need for integrating epidemiological surveys, rigorous diagnostic approaches, and clinical assessments in the developing world

Management of Hypertension in the Elderly Patient at Abidjan Cardiology Institute (Ivory Coast)

Background. Since the treatment of hypertension is beneficial for the elderly, we have undertaken this study that aims to evaluate the management of hypertension in elderly patient in Côte d'Ivoire. Methods. A retrospective study was conducted among 854 hypertensive elderly patients of Abidjan Cardiology Institute who were followed for a minimum of one year, between January 2000 and December 2009. Results. The patients mean age was 73.1 ± 5.3 years, and 59% were women. At the first presentation, it was mostly systolic-diastolic hypertension (51.8%) and isolated systolic hypertension (38.5%). Mean blood pressure was 169.4 ± 28.4 mmHg for systolic, 95.3 ± 15.7 mmHg for diastolic, and 74.1 ± 22.8 mmHg for pulse pressure. Pulse pressure was ≥60 mmHg in 80.4%. According to the European Guidelines stratification of the cardiovascular risk-excess attributable to high blood pressure, 82.1% of the sample had a very high added risk. The pharmacological therapy was prescribed in 93.5%. More than 66% of patients were receiving ≥2 antihypertensive drugs including fixed-dose combination drugs. The most common agents used were diuretics (63.5%) followed by angiotensin-converting enzyme inhibitors or angiotensin receptor blockers in 61.3%. The most common agents used for monotherapy were calcium antagonists. When ≥2 drugs were used, diuretics and angiotensin-converting enzyme inhibitors or angiotensin receptor blockers were the most common. Blood pressure control was achieved in 42.6%. Conclusion. The control of elderly hypertension can be effective in Sub-Saharan Africa. He required at least two antihypertensive drugs to meet the recommended blood pressure target

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 Cote 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 Cote d'Ivoire. METHODS: A cross-sectional survey was carried out in April and May 2017 in the frame of the "Cote 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