L’utilisation de l’approche CTC: quel impact sur la couverture vaccinale lors de la campagne préventive de vaccination contre la méningite A avec le MenAfriVac au Togo en 2014?

Introduction: Une campagne de vaccination contre la méningite A avec le vaccin MenAfriVac a été organisée dans les quatre régions septentrionales du Togo du 28 novembre au 07 décembre 2014. L'approche CTC a été utilisée pour la première fois à une grande échelle pour la campagne de vaccination dans dix districts sanitaires du Togo. L'objectif de cette étude était d'estimer la couverture vaccinale et, de déterminer l'effet de l'utilisation de la Chaîne à Température Contrôlée (CTC) sur ces couvertures vaccinales.Méthodes: L'enquête s'est déroulée du 9 au 14 mars 2015, soit environ 3 mois après la fin de la campagne de vaccination dans ces quatre régions. Le sondage en grappe à deux degrés stratifiés selon les régions a été utilisé. Dans 10 districts, le Togo a fait le choix d'utiliser le vaccin MenAfriVac en CTC.Résultats: Au total, 2707 ménages ont été enquêtés et 9082 personnes âgées de 1 à 29 ans ont été interviewées. L'âge moyen des personnes enquêtées était de 11,8±7,7 ans et le sex-ratio (H/F) de 1,01. Le nombre moyen de personnes par ménage était de 5,7 et celui des personnes de 1 à 29 ans ciblées par la campagne était de 3,4. Sur les 9082 personnes enquêtées, 8889 (98%) étaient vaccinées. En analyse multivariée, les facteurs associés à la couverture vaccinale avec le MenAfrivac étaient la résidence dans la zone au moment de la campagne (aOR = 4,52 ; 95%IC = [4.07 - 4.97]) et le fait d'être informé de la campagne avant son démarrage (aOR=2,42 ; 95%IC = [2.05 - 2.80]). Par contre, la couverture vaccinale n'était pas différente selon la zone ayant utilisé l'approche CTC ou non (aOR=0,09 ; 95%IC = [-0,27-0,45]). Deux cent sept personnes interrogées (2,3%) ont déclaré avoir eu une Manifestation Adverse Post Immunisation (MAPI) après l'administration du vaccin. Il s'agissait surtout de MAPI mineures à type de fièvre,  d'abcès et de gonflement au point d'injection.Conclusion: Les résultats de cette enquête montrent que l'utilisation de la CTC dans un pays à ressources limitées comme le Togo n'a pas eu un effet négatif sur les couvertures vaccinales. En effet, il n'y avait pas de différence entre la couverture vaccinale dans les zones CTC et celles non CTC. Il importe de capitaliser l'expérience acquise pour l'utilisation des vaccins du Programme Elargi de Vaccination avec l'approche CTC surtout dans les pays à ressources limitées confrontés à la disponibilité de la chaîne de froid.Mots clés: Meningitis A, MenAfriVac vaccine, CTC, immunization coverage, TogoEnglish Title: Impact of Controlled Temperature Chain (CTC) approach on immunization coverage achieved during the preventive vaccination campaign against meningitis A using MenAfriVac in Togo in 2014English AbstractBackground: a vaccination campaign against meningitis A using MenAfriVac vaccine was implemented in the four regions of northern Togo from 28 November to 7 December 2014. CTC approach was first used on a large scale in a vaccination campaign in ten health districts in Togo. This study aims to estimate the immunization coverage and to determine the effect of Controlled Temperature Chain (CTC) approach on these immunization coverages.Method: we conducted a survey from 9 to 14 March 2015 (for approximately 3 months) after the end of the vaccination campaign in these four regions. Interviewees were selected using two stages cluster sampling stratified according to the regions. MenAfriVac vaccine in Controlled Temperature Chain (CTC) was used in 10 districts, in Togo.Results: a total of 2707 households were surveyed and 9082 people aged 1-29 years were interviewed. The average age of the individuals surveyed was 11.8±7.7 years and sex-ratio (H/F) was 1.01. The average number of individuals per household was 5.7 and that of persons aged 1-29 years targeted in the campaign was 3.4. Out of 9082 people surveyed 8889 (98%) were vaccinated. Multivariate analysis showed that the factors associated with immunization coverage using MenAfrivac vaccine were: habitual residence in the area at the time of the campaign (AOR = 4.52; 95%CI = [4.07 - 4.97]) and level of information about the campaign before it starts (AOR=2.42; 95%CI = [2.05 - 2.80]). By contrast, there were no differences in vaccination coverage between the areas based on whether the CTC approach was used or not (AOR=0.09; 95%CI = [-0.27 - 0.45]). Two hundred and seven respondents (2.3%) reported that they had Adverse Event Following Immunisation (AEFI) after the administration of the vaccine. These were usually minor AEFI involving fever, abscesses and swelling at the injection site.Conclusion: survey results show that the use of CTC in a country with limited resources such as Togo doesn't have a negative impact on immunization coverage. Indeed, there was no difference between immunization coverage in CTC and non-CTC areas. It is important to capitalize on the experience gained in order to use vaccines by Expanded Program of Immunization in CTC approach especially in countries with limited resources in terms of cold chain availability.Keywords: Meningitis A, MenAfriVac vaccine, CTC, vaccine coverage, Tog

PLoS One

BACKGROUND: Direct-acting antivirals (DAA) have dramatically increased HCV cure rates with minimal toxicity in HIV-HCV co-infected patients. This study aimed to compare the socio-behavioral characteristics of patients initiating pegylated-interferon (PEG-IFN)-based HCV treatment with those of patients initiating DAA-based treatment. METHODS: ANRS CO13 HEPAVIH is a national multicenter prospective cohort started in 2005, which enrolled 1,859 HIV-HCV co-infected patients followed up in French hospital outpatient units. Both clinical/biological and socio-behavioral data were collected during follow-up. We selected patients with socio-behavioral data available before HCV treatment initiation. RESULTS: A total of 580 patients were included in this analysis. Of these, 347 initiated PEG-IFN-based treatment, and 233 DAA-based treatment. There were significant differences regarding patient mean age (45 years+/-6 for the PEG-IFN group vs. 52 years+/-8 for the DAA group, p<0.001), unstable housing (21.4% vs. 11.2%, p = 0.0016), drug use (44.7% vs. 29.6%, p = 0.0003), regular or daily use of cannabis (24.3% vs. 15.6%, p = 0.0002), a history of drug injection (68.9% vs 39.0%, p<0.0001) and significant liver fibrosis (62.4% vs 72.3%, p = 0.0293). In multivariable analysis, patients initiating DAA-based treatment were older than their PEG-IFN-based treatment counterparts (aOR = 1.17; 95%CI [1.13; 1.22]). Patients receiving DAA treatment were less likely to report unstable housing (0.46 [0.24; 0.88]), cannabis use (regular or daily use:0.50 [0.28; 0.91]; non-regular use: 0.41 [0.22; 0.77]), and a history of drug injection (0.19 [0.12; 0.31]). CONCLUSION: It is possible that a majority of patients who had socio-economic problems and/or a history of drug injection and/or a non-advanced disease stage were already treated for HCV in the PEG-IFN era. Today, patients with unstable housing conditions are prescribed DAA less frequently than other populations. As HCV treatment is prevention, improving access to DAA remains a major clinical and public health strategy, in particular for individuals with high-risk behaviors

Nutrients

BACKGROUND: Coffee intake has been shown to modulate both the effect of ethanol on serum GGT activities in some alcohol consumers and the risk of alcoholic cirrhosis in some patients with chronic diseases. This study aimed to analyze the impact of coffee intake and alcohol consumption on advanced liver fibrosis (ALF) in HIV-HCV co-infected patients. METHODS: ANRS CO13-HEPAVIH is a French, nationwide, multicenter cohort of HIV-HCV-co-infected patients. Sociodemographic, behavioral, and clinical data including alcohol and coffee consumption were prospectively collected using annual self-administered questionnaires during five years of follow-up. Mixed logistic regression models were performed, relating coffee intake and alcohol consumption to ALF. RESULTS: 1019 patients were included. At the last available visit, 5.8% reported high-risk alcohol consumption, 27.4% reported high coffee intake and 14.5% had ALF. Compared with patients with low coffee intake and high-risk alcohol consumption, patients with low coffee intake and low-risk alcohol consumption had a lower risk of ALF (aOR (95% CI) 0.24 (0.12(-)0.50)). In addition, patients with high coffee intake had a lower risk of ALF than the reference group (0.14 (0.03(-)0.64) in high-risk alcohol drinkers and 0.11 (0.05(-)0.25) in low-risk alcohol drinkers). CONCLUSIONS: High coffee intake was associated with a low risk of liver fibrosis even in HIV-HCV co-infected patients with high-risk alcohol consumption

Tropical Data: Approach and Methodology as Applied to Trachoma Prevalence Surveys

PURPOSE: Population-based prevalence surveys are essential for decision-making on interventions to achieve trachoma elimination as a public health problem. This paper outlines the methodologies of Tropical Data, which supports work to undertake those surveys. METHODS: Tropical Data is a consortium of partners that supports health ministries worldwide to conduct globally standardised prevalence surveys that conform to World Health Organization recommendations. Founding principles are health ministry ownership, partnership and collaboration, and quality assurance and quality control at every step of the survey process. Support covers survey planning, survey design, training, electronic data collection and fieldwork, and data management, analysis and dissemination. Methods are adapted to meet local context and needs. Customisations, operational research and integration of other diseases into routine trachoma surveys have also been supported. RESULTS: Between 29th February 2016 and 24th April 2023, 3373 trachoma surveys across 50 countries have been supported, resulting in 10,818,502 people being examined for trachoma. CONCLUSION: This health ministry-led, standardised approach, with support from the start to the end of the survey process, has helped all trachoma elimination stakeholders to know where interventions are needed, where interventions can be stopped, and when elimination as a public health problem has been achieved. Flexibility to meet specific country contexts, adaptation to changes in global guidance and adjustments in response to user feedback have facilitated innovation in evidence-based methodologies, and supported health ministries to strive for global disease control targets

Health behaviour and lifestyle of patients coinfected by HIV and HCV : impact of access to care and clinical evolution of hepatitis C

Objectifs : Les objectifs principaux de cette thèse sont les suivants : 1) analyse de l’évolution du profil épidémiologique des patients coinfectés VIH-VHC initiant le traitement de l’hépatite C; 2) l’évaluation de l’impact des comportements de santé et des styles de vie sur l’évolution clinique de la maladie Résultats : J’ai pu mettre en évidence que le profil des patients coinfectés VIH-VHC initiant un traitement de l’hépatite C a changé en France avec l’évolution des traitements.Mes travaux ont permis de montrer que, chez les patients coinfectés VIH-VHC, une consommation élevée de café (3 tasses par jour et plus) diminue le risque de fibrose hépatique avancée. Cet effet bénéfique du café est également observé chez les patients coinfectés VIH-VHC avec une consommation élevée d’alcool. De plus, mes travaux ont mis en évidence une relation dose-dépendante entre la fréquence de consommation de cacao et la réduction du risque de fibrose hépatique avancée chez les patients coinfectés VIH-VHC. Par ailleurs, mes analyses n’ont pas mis en évidence un effet significatif de la consommation de café sur le risque de fibrose hépatique avancée chez les femmes coinfectées VIH-VHC. Enfin l’un des résultats marquant de la relation entre VHC et risque d’obésité qui est connue est que la guérison augmente davantage ce risque sur le long terme. Conclusion : Des interventions pour modifier certains styles de vie et comportements ont le potentiel de diminuer le risque de survenue ou d’aggravation de comorbidités, en particulier après la guérison VHC, un événement désormais atteignable pour tous les patients coinfectés.Objectives: The main objectives of this thesis are: 1) analysis of the evolution of the epidemiological profile of co-infected HIV-HCV patients initiating the treatment of hepatitis C; 2) assessment of the impact of health behaviors and lifestyles on the clinical course of the diseaseResults: I was able to highlight that the profile of co-infected HIV-HCV patients initiating treatment for hepatitis C has changed in France with the evolution of treatments.My work has shown that, in HIV-HCV coinfected patients, high coffee consumption (3 cups per day or more) decreases the risk of advanced liver fibrosis. This beneficial effect of coffee is also observed in co-infected HIV-HCV patients with high alcohol consumption. In addition, my work has shown a dose-dependent relationship between the frequency of cocoa consumption and the reduced risk of advanced liver fibrosis in coinfected HIV-HCV patients. Furthermore, my analyzes did not reveal a significant effect of coffee consumption on the risk of advanced liver fibrosis in coinfected HIV-HCV women. Finally, one of the striking results of the relationship between HCV and known risk of obesity is that healing increases this risk in the long term.Conclusion: Interventions to modify certain lifestyles and behaviors have the potential to reduce the risk of developing or worsening comorbidities, particularly after HCV healing, an event now achievable for all co-infected patients

Prevalence and risk factors of anemia in children aged from 6 to 59 months in Togo: analysis from Togo demographic and health survey data, 2013–2014

Abstract Background Anemia in children continues to be a major public health challenge in developing countries and particularly in Sub-Saharan Africa. Anemia has serious consequences on the growth and development of the children in the early stages of life. This study aimed to determine the prevalence and associated factors of anemia among children from 6 to 59 months in Togo. Methods Data from the Togo Demographic and Health Survey 2013–2014 were used for this study. This nationally representative survey provided data on a wide range of indicators such as mother and child health, nutrition and other characteristics. Anemia status was determined using hemoglobin level (Hb < 11.0 g/dl), and the weighted prevalence of childhood anemia along with 95% confidence intervals were provided. Data were analyzed using logistic regression models to estimate odds ratios (OR) and their 95% confidence intervals (95% CI) for associated factors. Results Two thousand eight hundred ninety children aged 6–59 months were included in this analysis. The weighted prevalence of anemia was 70.9% [95% CI = 68.8–73.1] with 2.6% [95% CI = 2.0–3.3] of severe anemia among these children. In the multivariate analysis, the adjusted odds ratio (aOR) for anemia was 0.33 [95% CI = 0.26–0.42] in children aged from 24 to 42 months and 0.22 [95% CI = 0.17–0.29] in children aged from 43 to 59 months. Children’s malaria status was strongly associated to childhood anemia with an aOR of 3.03 [95% CI = 2.49–3.68]. The secondary level of education and more for the mother was associated to childhood anemia with an aOR of 0.67 [95% CI = 0.52–0.86]. The aOR for children whose mother had anemia was 1.62 [95% CI = 1.30–2.02]. Conclusion This study has highlighted the high prevalence of childhood anemia in Togo and revealed that younger children and maternal anemia were positively associated to childhood anemia whereas age of children and high level of maternal education were negatively associated to childhood anemia

Diversité floristique et structure des formations végétales dans le district phytogéographique du Borgou-nord au Bénin (secteur de l’arrondissement de Bagou)

International audienceLes formations végétales naturelles connaissent d’importants changements physionomiques sous l’effet des pressions anthropiques dans larégion soudanienne au Bénin. L’objectif de cette recherche est d’analyser la diversité floristique et la structure des formations végétales naturelles de l’Arrondissement de Bagou dans le district phytogéographique du Borgou-Nord. Les inventaires phytosociologique et forestier ont été les principales méthodes utilisées. Ces inventaires ont été réalisés dans 52 placeaux de 30 m de côté. Les paramètres dendrométriques et de diversité floristique ont été calculés par groupement végétal. Au total, 171 espèces végétales ont été inventoriées dont 64 espèces ligneuses et 107 espèces herbacées réparties en 135 genres et 56 familles. La richesse spécifique varie en moyenne entre 13 et 29 espèces par placeau. L’indice de diversité de Shannon varie de 1,3 bit à 3 bits. Les valeurs de l’indice de diversité de Margalef évoluent entre 1 et 1,7 traduisant ainsi une diversité globalement faible pour tous les groupements végétaux. Les structures en classes de circonférence présentent toutes une distribution asymétrique positive, caractéristique des individus jeunes ou de faibles circonférences. La densité moyenne varie entre 123 tiges/ha et 233 tiges/ha. Les phanérophytes et les thérophytes sont les formes de vie les plus abondantes et dominantes alors que les espèces soudaniennes sont les types phytogéographiques les plus abondants et dominants. La végétation naturelle garde encore ses spécificités phytogéographiques malgré son état de dégradation révélé par les différentsindices

CARTOGRAPHIE DES CHANGEMENTS SPATIO- TEMPORELS DE L'OCCUPATION DES TERRES DANS LA FORET CLASSEE DE WARI-MARO AU CENTRE-BENIN

International audienc