AIM:To assess the predictive factors for in-hospital death after acute coronary syndromes (ACS) in Abidjan Heart Institute. PATIENTS AND METHODS:Observational prospective study from January, 2019 to December, 2023 using data from REgistre des syndromes coronAriens aigus de CôTe d'IVoire (REACTIV). Patients aged 18 years old and over admitted to the Intensive Care Unit (ICU) of the Abidjan Heart Institute for ACS were included. We collected socio-demographic, clinical, paraclinical and outcomes data. Predictive factors for in-hospital death were identified by multivariate analysis. RESULTS:Six hundred and sixty one (661) patients presented with ACS among the 3302 admitted to the ICU of the Abidjan Heart Institute, giving an overall prevalence of 20.0%. ACS occurred in relatively young patients, with a median age of 57 years [48-65] and a male predominance (sex ratio=2.86). Hypertension (55.6%), active smoking (33.4%) and diabetes (25.7%) were the most common cardiovascular risk factors. Median admission time was 24 [8-72]h. Overall in-hospital mortality was 9.5%, decreasing from 11.2% in 2019 to 5.0% in 2023. In multivariate analysis, age (RR 1.08; CI95% 1.05-1.12), diabetes (RR 1.9; CI95% 1.1-3.3), Killip class≥2 on admission (RR 3.5; CI95% 2.1-5.8) and severe ventricular rhythm disorder (RR 8.3; CI95% 3.3-20.4), were risk factors for in-hospital death. Percutaneous coronary intervention (PCI), performed in 56% of patients, was a protective factor (RR 0.4; CI95% 0.2-0.7). CONCLUSION:ACS, which is increasing our practice, is responsible for high mortality, with well-identified in-hospital death risk factors. PCI appeared to be a protective factor. The implementation of ACS management networks and improved technical facilities should help improve long-term outcomes.
RÉSUMÉIntroduction. Dans les zones d'endémie palustre comme la Côte d'Ivoire, le portage asymptomatique de Plasmodium demeure une réalité épidémiologique dont les conséquences sont peu élucidées, en particulier chez la femme enceinte. Cette étude avait pour but d'évaluer la prévalence du portage asymptomatique de Plasmodium spp chez les parturientes à la formation sanitaire et urbaine de Koko à Bouaké. Méthodes. Nous avons mené une étude transversale à visée analytique du 10 septembre au 27 octobre 2024 à la maternité de la formation sanitaire et urbaine de Koko, à Bouaké. Nous avons inclus 200 parturientes asymptomatiques. Une recherche de Plasmodium a été réalisée pour chaque parturiente par microscopie (goutte épaisse et frottis sanguin) et par test de diagnostic rapide (TDR), à partir d'un prélèvement veineux sur EDTA. Les données sociodémographiques, obstétricales et préventives ont été recueillies à l'aide d'une fiche d'enquête et analysées avec recherche des facteurs associés. Résultats. L'âge moyen des parturientes était de 26 ans (extrêmes : 16–42 ans). Une couverture d'au moins trois doses de sulfadoxine-pyriméthamine (SP) en traitement préventif intermittent (TPI) était rapportée par 65,5 % des parturientes. La prévalence du portage asymptomatique était de 2,5 %, avec une concordance totale entre goutte épaisse et TDR. La densité parasitaire moyenne était de 16 558 trophozoïtes/µL. Plasmodium falciparum était la seule espèce observée, sous forme exclusive de trophozoïtes. Le portage asymptomatique était associé à la non-utilisation de MILDA (p = 0,017). Aucun lien n'a été retrouvé avec l'antécédent gynécologique (gestité, parité). Conclusion. Le portage asymptomatique de Plasmodium constitue une réalité chez les parturientes à la maternité de Koko. Le renforcement de l'utilisation des MILDA et du TPI, ainsi que des études recourant à des techniques moléculaires plus sensibles, sont recommandés. ABSTRACT Introduction. In malaria-endemic areas such as Côte d'Ivoire, asymptomatic Plasmodium carriage remains an epidemiological reality whose consequences are poorly understood, particularly in pregnant women. This study aimed to assess the prevalence of asymptomatic Plasmodium spp carriage among parturients at the Koko urban health facility in Bouaké. Methods. We conducted an analytical cross-sectional study from 10 September to 27 October 2024 at the maternity unit of the Koko urban health facility in Bouaké. We included 200 asymptomatic parturients. Plasmodium detection was performed for each parturient by microscopy (thick smear and blood film) and rapid diagnostic test (RDT), from a venous sample on EDTA. Sociodemographic, obstetric, and preventive data were collected using a survey form and analysed with identification of associated factors. Results. The mean age of parturients was 26 years (range: 16–42 years). Coverage of at least three doses of sulfadoxine-pyrimethamine (SP) as intermittent preventive treatment (IPT) was reported by 65.5% of parturients. The prevalence of asymptomatic carriage was 2.5%, with total concordance between thick smear and RDT. Mean parasite density was 16,558 trophozoites/µL. Plasmodium falciparum was the only species observed, exclusively as trophozoites. Asymptomatic carriage was associated with non-use of ITNs (p = 0.017). No link was found with obstetric history (gravidity, parity). Conclusion. Asymptomatic Plasmodium carriage is a reality among parturients at the Koko maternity unit. Strengthening ITN use and IPT, as well as studies using more sensitive molecular techniques, are recommended.
Background: Tuberculosis remains an important cause of morbidity and mortality, and rapid molecular assays provide information on both the detection of the Mycobacterium tuberculosis complex and rifampicin resistance. Objective: To describe Xpert MTB/RIF findings at the Tuberculosis Diagnosis and Treatment Center of the Abidjan Military Hospital during 2024. Methods: This retrospective, descriptive study reviewed 400 eligible laboratory testing records from 1 January to 31 December 2024. Age, sex, specimen type, and Xpert MTB/RIF results were summarised. Results: MTB was detected in 97 of 400 tests (24.25%), and was not detected in 303 (75.75%). The reported mean age was 37.7 years; 64.8% of the tested population was male. Sputum specimens accounted for 361 (90.25%) tests and gastric specimens for 39 (9.75%). Among the 97 MTB-positive tests, rifampicin resistance was detected in nine (9.28%). Conclusion: Approximately one-quarter of Xpert tests in this hospital sample detected MTB, and rifampicin resistance was detected in nine MTB-positive results. These findings describe a selected laboratory population and do not establish multidrug-resistant tuberculosis or community prevalence.
RÉSUMÉIntroduction. Le paludisme reste un problème majeur de santé publique en Côte d'Ivoire. Sa prise en charge repose sur une confirmation parasitologique, un traitement adapté à la forme clinique et un suivi structuré. Nous avons évalué les pratiques diagnostiques, thérapeutiques et de suivi dans deux centres de santé urbains de Yopougon, ainsi que la connaissance et la disponibilité des directives nationales chez les médecins généralistes. Méthodes. Nous avons mené une étude prospective, observationnelle et analytique de septembre 2024 à janvier 2025 dans les centres de santé de Wassakara et de Toit rouge. Le volet prescripteurs incluait exhaustivement les médecins généralistes exerçant dans ces structures. Le volet patients incluait consécutivement les patients chez lesquels un diagnostic de paludisme simple ou grave avait été retenu, confirmé biologiquement ou fondé sur des arguments cliniques. Les variables étudiées étaient épidémiologiques, diagnostiques, thérapeutiques et évolutives. Les proportions ont été comparées par le test du chi carré au seuil de 5 %. Résultats. Seize médecins généralistes et 310 patients ont été inclus. Tous les médecins déclaraient connaître les directives nationales, mais seuls 8 (50,0 %) les avaient à disposition sur leur lieu de consultation. Une confirmation parasitologique n'a été demandée que chez 119 patients (38,4 %) : test de diagnostic rapide chez 91 patients (29,4 %), goutte épaisse associée ou non à un frottis sanguin chez 28 patients (9,0 %). Les 191 patients restants (61,6 %) ont été traités sans confirmation biologique. Une combinaison thérapeutique à base d'artémisinine a été prescrite chez 263 des 276 cas de paludisme simple (95,3 %). Cinq patients atteints de paludisme simple ont reçu de l'artéméther injectable. Aucun des 23 patients atteints de paludisme grave n'a reçu d'artésunate injectable, traitement de première intention recommandé par l'OMS. Une antibiothérapie a été associée aux antipaludiques chez 155 patients (50,0 %) et un rendez-vous de contrôle n'a été donné qu'à 78 patients (25,2 %). Conclusion. La prise en charge se caractérise par un recours insuffisant à la confirmation parasitologique, une prescription fréquente d'antibiotiques et un suivi peu structuré. Le renforcement du diagnostic, des outils d'aide à la décision et de la supervision formative est nécessaire.ABSTRACT Introduction. Malaria remains a major public health problem in Côte d'Ivoire. Its management relies on parasitological confirmation, treatment adapted to the clinical form and structured follow-up. We assessed diagnostic, therapeutic and follow-up practices in two urban health centres in Yopougon, together with general practitioners' knowledge and availability of national guidelines. Methods. We conducted a prospective, observational and analytical study from September 2024 to January 2025 in the Wassakara and Toit rouge health centres. The prescriber component exhaustively included all general practitioners working in these facilities. The patient component consecutively included patients in whom a diagnosis of uncomplicated or severe malaria had been made, whether biologically confirmed or based on clinical grounds. Variables covered epidemiological, diagnostic, therapeutic and outcome data. Proportions were compared using the chi-square test at the 5% threshold. Results. Sixteen general practitioners and 310 patients were included. All physicians reported knowing the national guidelines, but only 8 (50.0%) had them available at the point of care. Parasitological confirmation was requested in only 119 patients (38.4%): rapid diagnostic test in 91 patients (29.4%), thick film with or without blood smear in 28 patients (9.0%). The remaining 191 patients (61.6%) were treated without biological confirmation. Artemisinin-based combination therapy was prescribed in 263 of 276 uncomplicated malaria cases (95.3%). Five patients with uncomplicated malaria received injectable artemether. None of the 23 patients with severe malaria received injectable artesunate, the WHO first-line recommendation. Antibiotics were co-prescribed in 155 patients (50.0%) and a follow-up appointment was given to only 78 patients (25.2%). Conclusion. Management was characterised by insufficient use of parasitological confirmation, frequent antibiotic co-prescription and unstructured follow-up. Strengthening diagnostics, decision-support tools and formative supervision is needed.
Introduction:Sickle cell disease leads to numerous complications that require frequent medical care. This study aimed to analyze the care pathway of children with severe sickle cell syndrome who were admitted to the pediatric emergency department at Cocody University Hospital. The goal was to identify factors associated with delayed consultation and promote the early and appropriate management of complications. Methodology:This retrospective descriptive study was conducted in the pediatrics department at Cocody University Hospital from January 1 to December 31, 2024. Children with major sickle cell syndrome and a known electrophoretic profile who were hospitalized for an acute complication of the disease were included in the study. The care pathway was analyzed. Data were entered and analyzed using Excel software. Fisher's exact test was used to compare proportions, setting the significance threshold at 5% (p < 0.05). Results:Of the 800 admissions, 60 children with major sickle cell disease were included, representing a hospital prevalence of 7.5%. The mean age was 5.38 years, ranging from six months to 14 years. The sex ratio was 1.07. Fifty percent of the patients were diagnosed before the age of two, often due to clinical manifestations such as anemia (35%), vaso-occlusive crises (18.3%), and hand-foot syndrome (16.7%). The mean age at diagnosis was 1.8 years ± 8.9, ranging from three months to 12 years. Follow-up was inadequate in 61.7% of cases. In 68.3% of cases, vaccination status was incomplete or undocumented. Patients were referred from a health center in 50% of cases. Of those who received treatment prior to referral, 73.3% were included in the study. The most commonly prescribed drug classes in the outpatient setting were analgesics/antipyretics, antimalarials, and antibiotics, accounting for 63.3%, 23.3%, and 60% of cases, respectively. Delayed consultation was observed in 71.7% of cases and was associated with unfavorable socioeconomic status (p = 0.036), self-medication (p = 0.023), use of traditional medicine (p = 0.02), poor follow-up quality (p < 10-3), and taking analgesics at home (p < 10-3). Conclusion:This study highlights several shortcomings in the care pathway for children with sickle cell disease, particularly delays in seeking medical consultation linked to socioeconomic and cultural factors. A more structured, educational approach to care is essential to improving their prognosis.
