Journal Article > ResearchFull Text
Int J Infect Dis. 2022 September 1; Volume 122; 215-221.; DOI:10.1016/j.ijid.2022.05.039
Zheng Q, Luquero FJ, Ciglenecki I, Wamala JF, Abubakar A, et al.
Int J Infect Dis. 2022 September 1; Volume 122; 215-221.; DOI:10.1016/j.ijid.2022.05.039
BACKGROUND
Cholera remains a public health threat but is inequitably distributed across sub-Saharan Africa. Lack of standardized reporting and inconsistent outbreak definitions limit our understanding of cholera outbreak epidemiology.
METHODS
From a database of cholera incidence and mortality, we extracted data from sub-Saharan Africa and reconstructed outbreaks of suspected cholera starting in January 2010 to December 2019 based on location-specific average weekly incidence rate thresholds. We then described the distribution of key outbreak metrics.
RESULTS
We identified 999 suspected cholera outbreaks in 744 regions across 25 sub-Saharan African countries. The outbreak periods accounted for 1.8 billion person-months (2% of the total during this period) from January 2010 to January 2020. Among 692 outbreaks reported from second-level administrative units (e.g., districts), the median attack rate was 0.8 per 1000 people (interquartile range (IQR), 0.3-2.4 per 1000), the median epidemic duration was 13 weeks (IQR, 8-19), and the median early outbreak reproductive number was 1.8 (range, 1.1-3.5). Larger attack rates were associated with longer times to outbreak peak, longer epidemic durations, and lower case fatality risks.
CONCLUSIONS
This study provides a baseline from which the progress toward cholera control and essential statistics to inform outbreak management in sub-Saharan Africa can be monitored.
Cholera remains a public health threat but is inequitably distributed across sub-Saharan Africa. Lack of standardized reporting and inconsistent outbreak definitions limit our understanding of cholera outbreak epidemiology.
METHODS
From a database of cholera incidence and mortality, we extracted data from sub-Saharan Africa and reconstructed outbreaks of suspected cholera starting in January 2010 to December 2019 based on location-specific average weekly incidence rate thresholds. We then described the distribution of key outbreak metrics.
RESULTS
We identified 999 suspected cholera outbreaks in 744 regions across 25 sub-Saharan African countries. The outbreak periods accounted for 1.8 billion person-months (2% of the total during this period) from January 2010 to January 2020. Among 692 outbreaks reported from second-level administrative units (e.g., districts), the median attack rate was 0.8 per 1000 people (interquartile range (IQR), 0.3-2.4 per 1000), the median epidemic duration was 13 weeks (IQR, 8-19), and the median early outbreak reproductive number was 1.8 (range, 1.1-3.5). Larger attack rates were associated with longer times to outbreak peak, longer epidemic durations, and lower case fatality risks.
CONCLUSIONS
This study provides a baseline from which the progress toward cholera control and essential statistics to inform outbreak management in sub-Saharan Africa can be monitored.
Journal Article > ProtocolFull Text
PLOS One. 2023 March 30; Volume 18 (Issue 3); e0283643.; DOI:10.1371/journal.pone.0283643
Penfold S, Adegnika AA, Asogun D, Ayodeji O, Azuogu BN, et al.
PLOS One. 2023 March 30; Volume 18 (Issue 3); e0283643.; DOI:10.1371/journal.pone.0283643
BACKGROUND
Lassa fever (LF), a haemorrhagic illness caused by the Lassa fever virus (LASV), is endemic in West Africa and causes 5000 fatalities every year. The true prevalence and incidence rates of LF are unknown as infections are often asymptomatic, clinical presentations are varied, and surveillance systems are not robust. The aim of the Enable Lassa research programme is to estimate the incidences of LASV infection and LF disease in five West African countries. The core protocol described here harmonises key study components, such as eligibility criteria, case definitions, outcome measures, and laboratory tests, which will maximise the comparability of data for between-country analyses.
METHOD
We are conducting a prospective cohort study in Benin, Guinea, Liberia, Nigeria (three sites), and Sierra Leone from 2020 to 2023, with 24 months of follow-up. Each site will assess the incidence of LASV infection, LF disease, or both. When both incidences are assessed the LASV cohort (n min = 1000 per site) will be drawn from the LF cohort (n min = 5000 per site). During recruitment participants will complete questionnaires on household composition, socioeconomic status, demographic characteristics, and LF history, and blood samples will be collected to determine IgG LASV serostatus. LF disease cohort participants will be contacted biweekly to identify acute febrile cases, from whom blood samples will be drawn to test for active LASV infection using RT-PCR. Symptom and treatment data will be abstracted from medical records of LF cases. LF survivors will be followed up after four months to assess sequelae, specifically sensorineural hearing loss. LASV infection cohort participants will be asked for a blood sample every six months to assess LASV serostatus (IgG and IgM).
DISCUSSION
Data on LASV infection and LF disease incidence in West Africa from this research programme will determine the feasibility of future Phase IIb or III clinical trials for LF vaccine candidates.
Lassa fever (LF), a haemorrhagic illness caused by the Lassa fever virus (LASV), is endemic in West Africa and causes 5000 fatalities every year. The true prevalence and incidence rates of LF are unknown as infections are often asymptomatic, clinical presentations are varied, and surveillance systems are not robust. The aim of the Enable Lassa research programme is to estimate the incidences of LASV infection and LF disease in five West African countries. The core protocol described here harmonises key study components, such as eligibility criteria, case definitions, outcome measures, and laboratory tests, which will maximise the comparability of data for between-country analyses.
METHOD
We are conducting a prospective cohort study in Benin, Guinea, Liberia, Nigeria (three sites), and Sierra Leone from 2020 to 2023, with 24 months of follow-up. Each site will assess the incidence of LASV infection, LF disease, or both. When both incidences are assessed the LASV cohort (n min = 1000 per site) will be drawn from the LF cohort (n min = 5000 per site). During recruitment participants will complete questionnaires on household composition, socioeconomic status, demographic characteristics, and LF history, and blood samples will be collected to determine IgG LASV serostatus. LF disease cohort participants will be contacted biweekly to identify acute febrile cases, from whom blood samples will be drawn to test for active LASV infection using RT-PCR. Symptom and treatment data will be abstracted from medical records of LF cases. LF survivors will be followed up after four months to assess sequelae, specifically sensorineural hearing loss. LASV infection cohort participants will be asked for a blood sample every six months to assess LASV serostatus (IgG and IgM).
DISCUSSION
Data on LASV infection and LF disease incidence in West Africa from this research programme will determine the feasibility of future Phase IIb or III clinical trials for LF vaccine candidates.
Conference Material > Abstract
Camacho A
Epicentre Scientific Day Paris 2023. 2023 June 8
BACKGROUND
Lassa fever (LF), a haemorrhagic illness caused by the Lassa fever virus (LASV), is endemic in West Africa causing an estimated 300 000 to 500 000 cases and 5 000 fatalities every year. Due to its pandemic potential, LF has been placed on the WHO's list of priority pathogens in order to speed up the development of a safe and effective vaccine. However, the design of successful vaccine trials depends on the true prevalence and incidence rates of LF, which are unknown as infections are often asymptomatic and clinical presentations are varied. The aim of the Enable Lassa research programme is to estimate the incidences of LASV infection and LF disease in five West African countries.
METHODS
We conducted a prospective cohort study in Benin, Guinea, Liberia, Nigeria (three sites), and Sierra Leone from 2020 to 2023, with 24 months of follow-up. Each site assessed the incidence of LASV infection, LF disease, or both. When both incidences are assessed the LASV cohort (n = 1 000 per site) was drawn from the LF cohort (n = 5 000 per site). During recruitment participants completed questionnaires on household composition, socioeconomic status, demographic characteristics, and LF history, and blood samples were collected to determine IgG LASV serostatus. LF disease cohort participants were contacted biweekly to identify acute febrile cases, from whom blood samples were drawn to test for active LASV infection using RT-PCR. LASV infection cohort participants were asked for a blood sample every six months to assess LASV IgG serostatus.
RESULTS
Interim results were obtained in October 2022 using partial data. We focus here on the Nigeria-Edo cohort with a follow-up period of 22 months and 3 serological time-points available (T0, T6, T12). We found a baseline seroprevalence of 43% (95% CI: 42% - 45%), an incidence rate of LASV infection of 13% (10% - 16%) and an incidence rate of LF disease of 0.2% (0.1% - 0.3%). These results suggest that LASV infection is common, but LF disease is rare in hotspot communities. Furthermore, our results suggest that pre-exposure to LASV may temporarily reduce the risk of LF disease. Finally, we found evidence that children may be at greater risk of LF disease than adults due to lower pre-exposure.
CONCLUSION
This is the first epidemiological study to measure the incidence of LF disease and LASV infection in West Africa. The estimates will serve as a basis for the design of future vaccine efficacy trials. The interim results, although limited due to partial data, already suggest that a large sample of several tens of thousands of participants will be required and that children should be included, provided that the candidate vaccine is safe and immunogenic in this group.
KEY MESSAGE
Incidence of Lassa fever is needed to inform vaccine trials. Preliminary results show frequent infections but rare disease, suggesting the need for large vaccine trials.
This abstract is not to be quoted for publication.
Lassa fever (LF), a haemorrhagic illness caused by the Lassa fever virus (LASV), is endemic in West Africa causing an estimated 300 000 to 500 000 cases and 5 000 fatalities every year. Due to its pandemic potential, LF has been placed on the WHO's list of priority pathogens in order to speed up the development of a safe and effective vaccine. However, the design of successful vaccine trials depends on the true prevalence and incidence rates of LF, which are unknown as infections are often asymptomatic and clinical presentations are varied. The aim of the Enable Lassa research programme is to estimate the incidences of LASV infection and LF disease in five West African countries.
METHODS
We conducted a prospective cohort study in Benin, Guinea, Liberia, Nigeria (three sites), and Sierra Leone from 2020 to 2023, with 24 months of follow-up. Each site assessed the incidence of LASV infection, LF disease, or both. When both incidences are assessed the LASV cohort (n = 1 000 per site) was drawn from the LF cohort (n = 5 000 per site). During recruitment participants completed questionnaires on household composition, socioeconomic status, demographic characteristics, and LF history, and blood samples were collected to determine IgG LASV serostatus. LF disease cohort participants were contacted biweekly to identify acute febrile cases, from whom blood samples were drawn to test for active LASV infection using RT-PCR. LASV infection cohort participants were asked for a blood sample every six months to assess LASV IgG serostatus.
RESULTS
Interim results were obtained in October 2022 using partial data. We focus here on the Nigeria-Edo cohort with a follow-up period of 22 months and 3 serological time-points available (T0, T6, T12). We found a baseline seroprevalence of 43% (95% CI: 42% - 45%), an incidence rate of LASV infection of 13% (10% - 16%) and an incidence rate of LF disease of 0.2% (0.1% - 0.3%). These results suggest that LASV infection is common, but LF disease is rare in hotspot communities. Furthermore, our results suggest that pre-exposure to LASV may temporarily reduce the risk of LF disease. Finally, we found evidence that children may be at greater risk of LF disease than adults due to lower pre-exposure.
CONCLUSION
This is the first epidemiological study to measure the incidence of LF disease and LASV infection in West Africa. The estimates will serve as a basis for the design of future vaccine efficacy trials. The interim results, although limited due to partial data, already suggest that a large sample of several tens of thousands of participants will be required and that children should be included, provided that the candidate vaccine is safe and immunogenic in this group.
KEY MESSAGE
Incidence of Lassa fever is needed to inform vaccine trials. Preliminary results show frequent infections but rare disease, suggesting the need for large vaccine trials.
This abstract is not to be quoted for publication.
Journal Article > ResearchFull Text
Public Health Action. 2013 March 21; Volume 3 (Issue 1); 15-9.; DOI:10.5588/pha.12.0055
Ade S, Harries AD, Trebucq A, Hinderaker SG, Ade G, et al.
Public Health Action. 2013 March 21; Volume 3 (Issue 1); 15-9.; DOI:10.5588/pha.12.0055
SETTING
The National Tuberculosis Programme (NTP) and the paediatric ward of the General Hospital (GH), Cotonou, Benin.
OBJECTIVE
To describe the burden of tuberculosis (TB), characteristics and outcomes among children treated in Cotonou from 2009 to 2011.
DESIGN
Cross-sectional cohort study consisting of a retrospective record review of all children with TB aged <15 years.
RESULTS
From 2009 to 2011, 182 children with TB were diagnosed and treated (4.5% of total cases), 153 (84%) by the NTP and 29 (16%) by the GH; the latter were not notified to the NTP. The incidence rate of notified TB cases was between 8 and 13 per 100 000 population, and was higher in children aged >5 years. Of 167 children tested, 29% were HIV-positive. Treatment success was 72% overall, with success rates of 86%, 62% and 74%, respectively, among sputum smear-positive, sputum smear-negative and extra-pulmonary patients. Treatment success rates were lower in children with sputum smear-negative TB (62%) and those with HIV infection (58%).
CONCLUSION
The number of children being treated for TB is low, and younger children in particular are underdiagnosed. There is a need to improve the diagnosis of childhood TB, especially among younger children, and to improve treatment outcomes among HIV-TB infected children, with better follow-up and monitoring.
The National Tuberculosis Programme (NTP) and the paediatric ward of the General Hospital (GH), Cotonou, Benin.
OBJECTIVE
To describe the burden of tuberculosis (TB), characteristics and outcomes among children treated in Cotonou from 2009 to 2011.
DESIGN
Cross-sectional cohort study consisting of a retrospective record review of all children with TB aged <15 years.
RESULTS
From 2009 to 2011, 182 children with TB were diagnosed and treated (4.5% of total cases), 153 (84%) by the NTP and 29 (16%) by the GH; the latter were not notified to the NTP. The incidence rate of notified TB cases was between 8 and 13 per 100 000 population, and was higher in children aged >5 years. Of 167 children tested, 29% were HIV-positive. Treatment success was 72% overall, with success rates of 86%, 62% and 74%, respectively, among sputum smear-positive, sputum smear-negative and extra-pulmonary patients. Treatment success rates were lower in children with sputum smear-negative TB (62%) and those with HIV infection (58%).
CONCLUSION
The number of children being treated for TB is low, and younger children in particular are underdiagnosed. There is a need to improve the diagnosis of childhood TB, especially among younger children, and to improve treatment outcomes among HIV-TB infected children, with better follow-up and monitoring.
Journal Article > ResearchFull Text
BMC Pediatr. 2010 May 1; Volume 125 (Issue 5); DOI:10.1542/peds.2009-1062
Sauvageot D, Schaefer MM, Olson D, Pujades-Rodriguez M, O'Brien DP
BMC Pediatr. 2010 May 1; Volume 125 (Issue 5); DOI:10.1542/peds.2009-1062
OBJECTIVE: We describe medium-term outcomes for young children receiving antiretroviral therapy (ART) in resource-limited countries. METHODS: Analyses were conducted on surveillance data for children <5 years of age receiving ART (initiated April 2002 to January 2008) in 48 HIV/AIDS treatment programs in Africa and Asia. Primary outcome measures were probability of remaining in care, probability of developing World Health Organization stage 4 clinical events, rate of switching to second-line ART, and drug toxicity, compared at 6, 12, 24, and 36 months of ART. RESULTS: Of 3936 children (90% in Africa) initiating ART, 9% were <12 months, 50% were 12 to 35 months, and 41% were 36 to 59 months of age. The median time of ART was 10.5 months. Probabilities of remaining in care after 12, 24, and 36 months of ART were 0.85, 0.80, and 0.75, respectively. Compared with children 36 to 59 months of age at ART initiation, probabilities of remaining in care were significantly lower for children <12 months of age. Overall, 55% and 69% of deaths and losses to follow-up occurred in the first 3 and 6 months of ART, respectively. Probabilities of developing stage 4 clinical events after 12, 24, and 36 months of ART were 0.03, 0.06, and 0.09, respectively. Only 33 subjects (0.8%) switched to second-line regimens, and 151 (3.8%) experienced severe drug toxicities. CONCLUSIONS: Large-scale ART for children <5 years of age in resource-limited settings is feasible, with encouraging clinical outcomes, but efforts should be increased to improve early HIV diagnosis and treatment.
Conference Material > Video (talk)
Camacho A
Epicentre Scientific Day Paris 2023. 2023 June 8
English
Français
Journal Article > ResearchAbstract
J Acquir Immune Defic Syndr. 2013 April 15; Volume 62 (Issue 5); DOI:10.1097/QAI.0b013e3182821821
Gabillard D, Lewden C, Ndoye I, Moh R, Segeral O, et al.
J Acquir Immune Defic Syndr. 2013 April 15; Volume 62 (Issue 5); DOI:10.1097/QAI.0b013e3182821821
In resource-limited countries, estimating CD4-specific incidence rates of mortality and morbidity among patients receiving antiretroviral therapy (ART) may help assess the effectiveness of care and treatment programmes, identify program weaknesses, and inform decisions.
Conference Material > Video (talk)
Le Hesran JY
MSF Scientific Day International 2023. 2023 June 7; DOI:10.57740/z1bg-qm74
Conference Material > Slide Presentation
Le Hesran JY, Hémadou A, Adamou R, Razack M, Tahar R, et al.
MSF Scientific Day International 2023. 2023 June 7
English
Français
Conference Material > Abstract
Le Hesran JY, Hémadou A, Adamou R, Razack M, Tahar R, et al.
MSF Scientific Day International 2023. 2023 June 7; DOI:10.57740/yf11-d204
English
Français
INTRODUCTION
From 2000 to 2015, overall mortality from malaria halved. But since then, mortality rates have stagnated and even risen again in some African countries. It has been suggested that one reason for this increase in child mortality may be due to delayed treatment seeking while parents first attempt self-medication. However, the reality may be more complex. We investigated care pathways, from the onset of a child’s symptoms of severe malaria to hospital admission.
METHODS
Our study took a combined approach, including quantitative and qualitative components. We analysed questionnaires with information on the different stages of the care pathways used by parents of children up to five years who were hospitalised for severe malaria from three hospitals in Cotonou (n=58). We carried out semi-structured interviews to better understand the parents’ approaches to care (n=10).
ETHICS
This study was given a favourable opinion by the National Committee of Ethics for Health Research, Ministry of Health, Republic of Benin (Opinion No. 50 dated 25 October 2017).
RESULTS
The mean age of the children was 33 months and of the accompanying parent was 35 years. The average time from first symptom to hospitalisation was 6 days (min2-max15). Almost all parents (95%) first carried out self-medication, mainly with paracetamol, sometimes associated with herbal teas. Faced with a deterioration in the child’s health, 80% of families then attended a health centre. In many cases, further delays to seeking care at hospitals was due to a poor communication between healthcare professionals and parents and the difficulty of raising the money needed for treatment. Families visited up to three different health centres successively before going to hospital. Going to hospital represents a “catastrophic expense” for the household. Parents must find the necessary funds, and in some cases take out a loan, thus delaying treatment. On arrival at the hospital, the child’s health is seriously deteriorated, explaining the high case-fatality rate of more than 30% in intensive care units.
CONCLUSION
In this study, the cost of care, particularly hospital-based care, is the primary cause of delayed access to appropriate treatment. WHO and the Global Fund propose a malaria control strategy based on prevention (mosquito nets) and early intervention. No provision is made for severe malaria. To reduce child mortality from malaria, it is essential that a third component is added to this strategy, namely the provision of free care for children diagnosed with severe malaria.
CONFLICTS OF INTEREST
None declared.
******
INTRODUCTION
Entre 2000 et 2015, la mortalité d’ensemble due au paludisme a baissé de moitié, mais, depuis 2015, les taux de mortalité stagnent, voir remontent dans certains pays africains. Une des raisons invoquées face à l’augmentation de la mortalité infantile est que les parents ont d’abord recours à l’automédication avant de consulter. Toutefois, la réalité pourrait être plus complexe. Pour expliquer ce retard de prise en charge adaptée et essayer de proposer de nouvelles stratégies, nous avons enquêté sur l’itinéraire thérapeutique suivi par des familles, des premiers symptômes jusqu’à l’admission de l’enfant à l’hôpital pour paludisme grave
METHODE
Notre enquête combine une double approche, quantitative et qualitative. Nous avons recueilli 58 questionnaires détaillés sur les différentes étapes de recours aux soins auprès de parents d’enfants jusqu’à l’âge de 5 ans hospitalisés pour paludisme grave dans 3 hôpitaux de Cotonou et réalisé 10 entretiens semidirigés afin de mieux comprendre les logiques de soins suivies par les parents.
ETHIQUE
Cette enquête a reçu un avis éthique favorable du comité National d’éthique pour la Recherche en Santé, Ministère de la Santé, République du Bénin (avis n°50 du 25 octobre 2017)
RESULTATS
L’âge moyen des enfants était de 33 mois (IC 29-37) et l’âge du parent accompagnateur de 35 ans (IC 32-37). Le délai moyen entre le premier symptôme et l’hospitalisation était de 6 jours (min2-max15). La quasi-totalité (95%) des parents ont pratiqué l’automédication en première intention avec principalement du paracétamol, parfois associé à des tisanes. Devant l’aggravation de l’état de l’enfant, 80% des familles ont d’abord consulté dans un centre de santé. Très souvent, le manque de communication entre soignants et soignés et la difficulté de réunir l’argent nécessaire aux soins ont retardé une prise en charge correcte. Il y a eu jusqu’à 3 visites successives dans différents centres de santé avant l’arrivée à l’hôpital. Mais aller à l’hôpital représente une “dépense catastrophique” pour le foyer. Les parents doivent alors trouver les ressources financières, voire faire un emprunt, ce qui retarde la prise en charge. A l’arrivée à l’hôpital, la santé de l’enfant est très dégradée ce qui explique le fort taux de létalité qui dépasse les 30% dans les services de réanimation.
CONCLUSION
L’étude montre clairement que le coût des soins, notamment à l’hôpital, est la première cause d’un accès tardif à des soins adaptés. L’OMS et le Fond Mondial proposent une stratégie de lutte basée sur la prévention (moustiquaire) ou la prise en charge précoce des cas. Rien n’est prévu en cas de paludisme grave. Pour baisser la mortalité infantile due au paludisme, il est urgent de prévoir un troisième volet à la lutte en instaurant une prise en charge gratuite des enfants diagnostiqués avec un paludisme grave.
CONFLITS D'INTERET
Aucun
From 2000 to 2015, overall mortality from malaria halved. But since then, mortality rates have stagnated and even risen again in some African countries. It has been suggested that one reason for this increase in child mortality may be due to delayed treatment seeking while parents first attempt self-medication. However, the reality may be more complex. We investigated care pathways, from the onset of a child’s symptoms of severe malaria to hospital admission.
METHODS
Our study took a combined approach, including quantitative and qualitative components. We analysed questionnaires with information on the different stages of the care pathways used by parents of children up to five years who were hospitalised for severe malaria from three hospitals in Cotonou (n=58). We carried out semi-structured interviews to better understand the parents’ approaches to care (n=10).
ETHICS
This study was given a favourable opinion by the National Committee of Ethics for Health Research, Ministry of Health, Republic of Benin (Opinion No. 50 dated 25 October 2017).
RESULTS
The mean age of the children was 33 months and of the accompanying parent was 35 years. The average time from first symptom to hospitalisation was 6 days (min2-max15). Almost all parents (95%) first carried out self-medication, mainly with paracetamol, sometimes associated with herbal teas. Faced with a deterioration in the child’s health, 80% of families then attended a health centre. In many cases, further delays to seeking care at hospitals was due to a poor communication between healthcare professionals and parents and the difficulty of raising the money needed for treatment. Families visited up to three different health centres successively before going to hospital. Going to hospital represents a “catastrophic expense” for the household. Parents must find the necessary funds, and in some cases take out a loan, thus delaying treatment. On arrival at the hospital, the child’s health is seriously deteriorated, explaining the high case-fatality rate of more than 30% in intensive care units.
CONCLUSION
In this study, the cost of care, particularly hospital-based care, is the primary cause of delayed access to appropriate treatment. WHO and the Global Fund propose a malaria control strategy based on prevention (mosquito nets) and early intervention. No provision is made for severe malaria. To reduce child mortality from malaria, it is essential that a third component is added to this strategy, namely the provision of free care for children diagnosed with severe malaria.
CONFLICTS OF INTEREST
None declared.
******
INTRODUCTION
Entre 2000 et 2015, la mortalité d’ensemble due au paludisme a baissé de moitié, mais, depuis 2015, les taux de mortalité stagnent, voir remontent dans certains pays africains. Une des raisons invoquées face à l’augmentation de la mortalité infantile est que les parents ont d’abord recours à l’automédication avant de consulter. Toutefois, la réalité pourrait être plus complexe. Pour expliquer ce retard de prise en charge adaptée et essayer de proposer de nouvelles stratégies, nous avons enquêté sur l’itinéraire thérapeutique suivi par des familles, des premiers symptômes jusqu’à l’admission de l’enfant à l’hôpital pour paludisme grave
METHODE
Notre enquête combine une double approche, quantitative et qualitative. Nous avons recueilli 58 questionnaires détaillés sur les différentes étapes de recours aux soins auprès de parents d’enfants jusqu’à l’âge de 5 ans hospitalisés pour paludisme grave dans 3 hôpitaux de Cotonou et réalisé 10 entretiens semidirigés afin de mieux comprendre les logiques de soins suivies par les parents.
ETHIQUE
Cette enquête a reçu un avis éthique favorable du comité National d’éthique pour la Recherche en Santé, Ministère de la Santé, République du Bénin (avis n°50 du 25 octobre 2017)
RESULTATS
L’âge moyen des enfants était de 33 mois (IC 29-37) et l’âge du parent accompagnateur de 35 ans (IC 32-37). Le délai moyen entre le premier symptôme et l’hospitalisation était de 6 jours (min2-max15). La quasi-totalité (95%) des parents ont pratiqué l’automédication en première intention avec principalement du paracétamol, parfois associé à des tisanes. Devant l’aggravation de l’état de l’enfant, 80% des familles ont d’abord consulté dans un centre de santé. Très souvent, le manque de communication entre soignants et soignés et la difficulté de réunir l’argent nécessaire aux soins ont retardé une prise en charge correcte. Il y a eu jusqu’à 3 visites successives dans différents centres de santé avant l’arrivée à l’hôpital. Mais aller à l’hôpital représente une “dépense catastrophique” pour le foyer. Les parents doivent alors trouver les ressources financières, voire faire un emprunt, ce qui retarde la prise en charge. A l’arrivée à l’hôpital, la santé de l’enfant est très dégradée ce qui explique le fort taux de létalité qui dépasse les 30% dans les services de réanimation.
CONCLUSION
L’étude montre clairement que le coût des soins, notamment à l’hôpital, est la première cause d’un accès tardif à des soins adaptés. L’OMS et le Fond Mondial proposent une stratégie de lutte basée sur la prévention (moustiquaire) ou la prise en charge précoce des cas. Rien n’est prévu en cas de paludisme grave. Pour baisser la mortalité infantile due au paludisme, il est urgent de prévoir un troisième volet à la lutte en instaurant une prise en charge gratuite des enfants diagnostiqués avec un paludisme grave.
CONFLITS D'INTERET
Aucun