Epidemiological Analysis of the 2019 Dracunculiasis Outbreak in the Liwi Area, Salamat Province (Chad): Evidence of the Role of Pets

Aims: Dracunculiasis is a neglected disease caused by a parasitic nematode, Dracunculus medinensis, also called the filaria of Medina. An outbreak of this disease occurred in the Salamat province in Chad in 2019, while the eradication of this disease worldwide was in its final stage. The outbreak occurred in the Bogam village (Liwi area), where this disease has never been reported in the past. The present work is aimed at identifying the factors that would have favored that outbreak, and the constraints that delay the eradication of dracunculiasis in Chad.&#x0D; Study Design: Retrospective study.&#x0D; Place and Duration of Study: The data retrospectively analyzed are those recorded during the census of patients by the Chadian National Guinea Worm Eradication Program (PEVG), from 2019 to 2020, and supplemented by those contained in the registers of previous years. The analyzes were carried out in N'Djamena, between July and November 2021, within the Laboratory of the Faculty of Medicine.&#x0D; Methodology: The census of patients was carried out during a survey from 2019 to 2020 by PEVG. These data have been supplemented by those contained in the registers of previous years. Data were first stored in a Microsoft (Excel 2007 Software) spreadsheet, then transferred to the SPSS version 20.0 Software, after removal of outliers and input errors. The Chi-Square test (χ2) made it possible to compare the percentages at the threshold of p&lt;0.005.&#x0D; Results: In summary it appeared that 52.4% of the patients were 5 to 20 years old, 62% were female, 90.48% lived in Bogam, 95.2% used dirty water from ponds and traditional wells, 33% were farmers, and 33% were breeders. In addition, most of the patients became infected between March and November 2018. The following risk factors combined could explain the Bogam 2019 dracunculiasis outbreak namely: cohabitation with infested pets coming into contact with water, the behavior of young and active people with respect to water, consumption of unhygienic water, gender, lack of containment of some patients that could enter water barefoot, period extending from April to September.&#x0D; Conclusion: This work highlighted the obvious role of pets as a reservoir on the one hand, and the effectiveness of the PEVG in the fight against dracunculiasis through a treatment protocol combining a wet bandage associated with oral diclofenac + amoxicillin + paracetamol.</jats:p

Management of COVID-19 Infection in a Context of Countries with Limited Resources: Case of the University Hospital Center of Renaissance (UHCR) in N’Djamena, Chad

Introduction: The aim of this study was to describe the clinical characteristics of patients admitted for Covid-19 in the department of Covid-19 of the University Hospital Center of Renaissance (UHCR) of N’Djamena in Chad. The pandemic of the sickness of Covid-19 constitutes a real public health problem in the world since its appearance in December 2019.&#x0D; Materials and Methods: This was an observational, transversal and descriptive study carried out from 19 March 2020 to 19 November 2021. All patients diagnosed with Covid-19, confirmed at least either by RT-PCR or chest computed tomography (CT) were included. The healing was defined through the disappearance of clinical signs and two negative RT-PCRs at 72 hours intervals.&#x0D; Results: Our study included 825 patients of which 613 (74.34%) men (sex ratio 2.9). Age Medium for patients was 50 ± 4 years with extreme ranging from 19 to 84 years old. Six hundred and thirty-three (76.70%) patients came directly from their residences. Respectively 82 and 71 were transferred from the provincial hospital of Farcha (9.9%) and from a private health structure (8.7%). Three hundred and thirteen patients had at least a comorbidity especially arterial hypertension (n = 173; 21%); the diabetes (n = 156; 19.7%); chronic renal failure (n = 28; 3.5%); heart disease (n =27; 3.3%) and obesity (n= 14; 1.6%), HIV infection (n = 9; 1.09%). five hundred and seventy-two (61.12%) patients performed the CT and all the RT-PCR. Four hundred and ninety-two patients (59.60%) presented severe forms of the disease, 160 (19.40%) were critical and 124 (15.10%) were moderates. The hospital lethality was 16.24% (n = 134). The treatment consisted in the administration of Hydroxychloroquine-Azythromycin in 99.4% of cases (n = 813) and by covid-organics in 0.6% of cases (n = 5).&#x0D; Conclusion: The infected patients with Covid-19 were admitted with the advance stage of the disease. Lethality was associate with the presence of comorbidities. The sensitization of the population on the importance of vaccination, barrier measures and recourse to care are necessary.</jats:p

The Prevalence of Rotavirus and Adenovirus in Children 0-5 years old Suffering from Acute Diarrhea in the University Hospital Center of Mother and Child (UHC-MC) in N’Djamena, Chad

Acute diarrhea is one of the leading causes of morbidity and mortality in children from 0-5 months old, especially in Africa and many developing countries. Rotavirus and Adenovirus have been recognized as the common pathogens for this public health problem. However, little or no investigation has been carried out on the two viruses in Chad. In view of this fact, we decided to study the prevalence of Rotavirus and Adenovirus in children suffering from acute diarrhea at the University Hospital Center of Mother and Child (UHC-MC). Fresh stool samples were collected from 440 children ages 0-5 years (225 females and 2015 males). They were brought for medical consultation from March 2019- September 2019 at the pediatric department. Specimens were analyzed and Rotavirus and Adenovirus were detected using Rapid Immunochromatographic Test kit (Vikia BioMerieux, France). Out of the 440 children examined, 228 had viral infection with a prevalence of 51.81%. Based on gender infection, females 140 (62.22%) were significantly more infected than males 88(40.93%). Prevalence of mono infection of Rotavirus in children 110 (48.24%) was higher than that of Adenovirus 74(32.45%). More males had Rotavirus infection 60(68.18%) than girls 50 (37.71%). Co-infection was found to be 44 (19.29%). Distribution of viral infection indicated that children between 6-11 months had the highest viral burden 101(77.69%). Among clinical symptoms recorded, dehydration was the highest in children 84(61.76%). Due to the high prevalence of Rotavirus and Adenovirus discovered, we suggest that vaccines for the two viruses should be included in the national immunization program.</jats:p

Gastrointestinal Parasitosis in the Population of the City of N’Djamena [Chad]: Causes of Their Persistence

In tropical areas gastrointestinal parasitosis are constantly changing in frequency and the large number of asymptomatic carriers continue to be a public health problem. This study was carried out during the last trimester of 2019 in the city of N’Djamena (Chad). This work was designed to take a stock of the overall level of carriage of parasitic infections of the population of the city. Our study sample was made up of 366 individuals whose age varied from 1 to 77 years. Each subject included in this study benefited from parasitological stool analysis using three methods. The method of direct observation in physiological water, the method of concentration in formalin-ether and that of Kato Katz. The results obtained showed that 222 subjects were carriers of at least one species of parasite, or either a global infection rate of 60.66%. Ten species of gastrointestinal parasites were identified of which three species of protozoa: Entamoeba histolytica/dispar (34.70 %), Giardia intestinalis (3.55%), Entamoeba coli (0.55%) and seven species of helminths: Hymenolepis nana (18.85%), Ascaris lumbricoides (9.29%), Taenia saginata (8.20%), Hymenolepis diminuta (2.19%), Schiotosoma mansoni (0.27%), Heterophyes hetrophyses (0.55%) and Enterobius vermicularis (0.27%). In N’Djamena the parasitism of those investigated was mainly (45.63%) monospecific and poly-specific (bi-and tri-specific) in 15.03% of the causes while 39.34% of persons examined were free from all forms of protozoa and helminths. The epidemiology of pathogenic forms was linked to a lack of hygiene especially ignorance of the risk of faecal peril. It is therefore important to strengthen the health education of the population in this city in particular and throughout the country in general.</jats:p

Virological response, HIV-1 drug resistance mutations and genetic diversity among patients on first-line antiretroviral therapy in N'Djamena, Chad: Findings from a cross-sectional study

Background: The national antiretroviral therapy in the Republic of Chad provides free of charge antiretroviral regimens and therapeutic monitoring for patients receiving antiretroviral therapy nationwide. For a successful programmatic uptake, these efforts merit to be supported by thorough assessments of antiretroviral therapy response and HIV-1 drug resistance surveillance, especially with risks of cross-resistance due to the gradual stavudine phasing out in such national settings. We therefore evaluated the virological response to antiretroviral therapy, HIV-1 drug resistance emergence and circulating HIV-1 clades in a Chad context. A cross-sectional and prospective study was conducted among 116 patients (41 [δ ± 6.87] years, 59% female) receiving first-line antiretroviral therapy for ≥ 6 months in Ndjamena, Chad, in 2011-2012, enrolled consecutively. To ensure accuracy, plasma viral load was concomitantly measured using Abbott Real-Time and Cobas AmpliPrep/TaqMan (v2.0), and virological failure defined as ≥ 1000 HIV-1 RNA copies/ml. Plasma from patients experiencing virological failure were processed for sequencing of HIV-1 protease-reverse transcriptase using the ANRS-AC.11 resistance testing protocol; drug resistant mutations were interpreted using the ANRS-AC11 algorithm; and phylogenetic analysis was performed using MEGA.v.6. Results: Majority of patients was receiving zidovudine plus lamivudine plus nevirapine (46%), stavudine plus lamivudine plus nevirapine (41%) and tenofovir plus emtricitabine plus efavirenz (11%), for a median time-on-treatment of 5 [IQR 4-7] years. The rate of virological failure was 43% (50/116), with 86% (43/50) sequencing performance. Overall, 32% (37/116) patients presented ≥ one major drug resistant mutation(s), with 29% (34/116) to nucleos(t)ide reverse transcriptase inhibitors (67% [29/43] M184V/I, 30% [13/43] T215Y/F, 19% [8/43] V75A/F/I/L/M, 9% [4/43] K70P/R/W, 9% [4/43] K219E/N/Q and 5% [2/43] A62V); 86% (37/43) to non-nulceos(t)ide reverse transcriptase inhibitors (30% [13/43] K103N/S/E, 26% [11/43] Y181C/V/F/L, 2% [1/43] L100I, 2% [1/43] F227L, 2% [1/43] P225H); and 2% (1/43) to protease inhibitors (M46I, I54V, V82S). Six HIV-1 subtypes were found: 30% circulating recombinant form (CRF02-AG), 30% J, 16% G, 9% A, 9% D, 5% F. Conclusions: In Chad, almost half of patients are failing first-line antiretroviral therapy after 5 years, with considerable drug resistant mutations at failure. Absence of K65R supports the use of tenofovir-containing regimens as preferred first-line and as suitable drug for second-line combinations, in this setting with significant HIV-1 genetic diversity. © 2017 The Author(s)