Contribution to the Study of the Incidence of Post-Streptococcal Complications in Republic Central African Republic from 2015 to 2018

Introduction: Acute rheumatic fever (AAR) is a non-suppurative complication of late infection by group A. Infections due to streptococci remain a public health problem in the Central African Republic. The present study aims to determine the incidence rate of AAR cases and its complications. Methodology: This was a retrospective and analytical study over a period of 4 years (from January 2015 to December 2018) at the National Laboratory of Clinical Biology and Public Health (LNBCSP) in Bangui. It focused on samples concerning the diagnosis of AAR and patient files seen in consultation in the capital’s reference health establishments. Laboratory registers and patient consultation files were used to collect data. They were entered into Excel 2010 to be analyzed with Epi Info 7. A univariate analysis by logistic regression, Ficher’s exact test, and chi2 at the 5% threshold (p Results: We analyzed 94 cases meeting Jones’s criteria. The ages of the patients ranged from 18 to 85 years (mean age 52 years and mode 45 years). The incidence rate of AAR for the female sex was higher than that of the male sex during the study period (p > 0.05). It went from 166.6 in 2015 to 200 in 2016 and 2018 cases of AAR per 1000 people per year. The average incidence rate was 296.18 cases of AAR per 1000 people per year. The average incidence rate was 223.5 cases of AAR per 1000 people per year for joint damage. Joint damage represented 80.85% (RR = 0.62;Chi2 = 4.88;95% CI [0.39-0.97];p Conclusion: The study allowed data on the impact rate and complications of the AAR in Bangui. Special attention to data management will help produce a complete result on the problem. Joint complications predominated. Sustaining an effective surveillance system and preventing infection would help reduce the risk of AAR occurrence.

Impact of a Mass Campaign on the Evolution of the Fourth Wave of the Covid-19 Pandemic in the Central African Republic

Objective: In the context of increasing cases despite vaccination campaigns, a survey was conducted in the Bangui population from January 17 to 26, 2022, to evaluate the strains of Severe Acute Respiratory Infection Coronavirus 2 (SARS-Cov-2) circulating in a healthy population. Materials and methods: This study was conducted by taking nasopharyngeal samples from randomly selected volunteers. Antigen detection was performed systematically, and RT-PCR was done on the positive samples. Results and discussion: We collected 2,554 samples. Thirty were found RT-PCR positive (1.2%) and sent for viral genome sequencing. Twenty-eight SARS-Cov-2 strains belonged to the Omicron type, and only 2 to the Delta type. Conclusion: Thus, infections were uncommon in the tested population, but the presence of Omicron and Delta types raises concerns that vaccination may not be effective in fighting the virus, and newly designed vaccines should be implemented to better protect the population at risk of infection and reinfection by these variants.

Contribution of Automated Antigen Tests, the LumiraDx Ag Test in the Response during the Second Wave of the COVID-19 Pandemic in Bangui

Context and objective: The COVID-19 pandemic has become a major public health problem and has mobilized many innovative means of diagnosis. The Central African Republic is not spared. The emergence of variants and their impact require health monitoring despite the obligation of vaccination. The purpose of this campaign was to determine the circulation of pending second-wave variants. Patients and Methods: A second mass screening campaign took place from 02 to 22 July 2021 in the main land and river entry points of Bangui (Exit North-PK12, Exit South-PK9, Port Beach) and at the LNBCSP. Antigenic and RT-PCR tests carried out on nasopharyngeal samples made it possible to select strains which were finally sequenced. Results: Of 2687 participants included in the study, 53 (1.97%) were positive for SARS-CoV-2. Thirteen (1.53%) were male and 40 (2.18%) female. The analyses carried out on the LumiraDx analyzer were positive for 109 samples against 53 on the RT-PCR. The prevalence was higher in the most tested age groups (30 to 50 years) with two clusters identified. B.1.617.2 (Delta) variants were predominant (57%). Conclusion: SARS-CoV-2 continues to circulate. The acquisition of automated antigenic tests (LumiraDx&#174) with sensitivity and specificity close to those of the reference test (RT-PCR) will allow better mass diagnosis for an optimization of the surveillance of COVID-19 in our countries with limited resources. The predominance of the B.1.617.2 (Delta) variant would suggest a third wave in the Central African Republic.

Antibiotic Resistance Profile of Serotypes of Streptococcus pneumoniae Strains in Bangui, from 2017 to 2022: Case of Serotype 1

Goals: The aim of this study was to determine the antibiotic resistance profile of serotypes of Streptococcus pneumoniae strains circulating in Bangui. Methodology: A prospective and analytical analysis was carried out at the National Laboratory of Clinical Biology and Public Health from 2017 to 2022. The strains came from our study on the contribution to the study of antibiotic sensitivity of Streptococcus pneumoniae strains. The multiplex PCR test was used for its cost-effectiveness in terms of amplifiers which can be purified in order to be sequenced. It also makes it possible to detect several germs as well as their serotypes. For a PCR reaction, several elements are involved in the reaction medium or Master Mix. These are the desoxyribonucleotides (dNTPs), the magnesium ions (MgCl2) and the primers. A set of 14 primers divided into 3 classes were used. Class 1 primers served as an internal control by targeting the cpsA gene. It is a highly conserved gene found in capsular loci characterized to date. The primers of the second class were used to target specific serotypes by specific reactions (out of six possibilities). The group reaction was carried out using the primers of the third class in order to carry out an initial screening of the samples and to classify the pneumococcal isolates. Related serotypes were grouped based on the amplification of common genes. Using the technique of electrophoresis on agarose gel and an ultraviolet radiation device, the migration bands are then visualized and analyzed. The data collected had been entered into Excel 2010 and analyzed with Epi info 7. The exact Fischer chi2 test at the 5% threshold, the relative risk and its 95% confidence interval were used to compare the proportions and determine the associations. Results: 187 antibiotic-resistant strains of Streptococcus pneumoniae were collected. The average frequency of serotypes 1, 9A, 4 and untypeable identified were 43.59%, 18.18%, 18.27% and 39.57% respectively. The frequency of serotype 1 was predominant for the age group over five years old with 56.88%. The male sex was predominant with 55.08% for serotype 1. Resistance to penicillin and gentamicin for serotype 1 during this study, for the age group under 5 years old, was 77%. For serotypes 19A and 4, tetracycline resistance was predominant with 20% for the age group under 5 years. The resistance to penicillin and gentamicin of non-typeable serotypes was 33% for the age group under 5 years old. For the age group over 5 years old, resistance to erythromycin predominated at 37%. The distribution of serotypes by sex depending on antibiotic resistance was variable. There was a statistically significant association between identified serotypes and antibiotic resistance (p Conclusion: The study determined serotypes 1, serotypes 19A, serotypes 4 and non-typeable serotypes. These results would be due to the quality of vaccination or poor protection of vaccines.

Mass Screening Using Antigenic and Molecular Diagnostic Tests of COVID-19 in Bangui at the Beginning of the Second Wave in July 2021

Objective: COVID-19 surveillance was established as early as March 2020 in the Central African Republic (CAR), after the WHO statement relating to the identification of several cases outside China. However, given the non-performing molecular biology technical platform in many developing countries in sub-Saharan Africa, the second wave promised to be surprising and formidable. In this context, a mass survey was launched in Bangui to determine the prevalence of COVID-19. Patients and Methods: From March 18 to April 2, 2021, a mass screening campaign took place in tourist places, companies and the main hospital infrastructures. Nasopharyngeal swab samples were collected from participants with and without symptoms of Influenza-like illness (ILI) and stored in VTM tubes. The Ag (COVID-19) and RT-PCR tests were carried out in Bangui at the LNBCSP. The sequencing of RT-PCR SARS-CoV-2 positives was carried out at the INRB. Results: We included 1480 participants of whom 33 (2.23%) were SARS-COV-2 positive, of whom 24 were male and 9 female. This sex difference was statistically significant (p = 0.012) as the sex ratio M/F was 1.09. Sampling sites located in the 1st arrondissement were the most prolific (p = 0.006) and were sequenced. In addition to the analysis of the 33 samples from the predefined sites under study, 17 control sequences from the provinces generated during the same period are added. We detected 2 Variants Of Concern (VOC) including the predominant B.1.620 (43.86%) followed by B.1.1.7 or Alpha (5.10%). Conclusion: The study showed the importance of surveillance and the availability of means of diagnosis of COVID-19. The identified risk factors were sex and sampling site. This study has shown the importance of setting up sentinel sites for COVID-19 surveillance in all regions of the country and the appropriate use of the anti-COVID-19 vaccine.

Contribution to the Study of Antibiotic Sensitivity of Streptococcus pneumoniae Strains in Spinal Cerebral Fluids in Bangui from 2017 to 2022

A prospective and analytical study was carried out from January 2017 to Decem-ber 2022, at the National Laboratory of Clinical Biology and Public Health (LNBCSP) in Bangui. 352 samples of cerebrospinal fluid (CSF) were confirmed out of 2065, coming from the four hospitals in Bangui. This study aimed to evalu-ate the evolution of antibiotic sensitivity to strains of Streptococcus pneumoniae. CSF had been collected from patients who presented with meningeal syndromes. Based on the leukocyte count (White blood cells ≥ 5 mm3), an aliquot was trans-ferred to trans-isolate medium and sent to the LNBCSP for confirmatory testing, culture and determination of antibiotic sensitivity. The antibiotic sensitivity of Streptococcus pneumoniae strains was tested according to the methods recom-mended by the Antibiogram Committee of the French Society of Microbiology. The data collected was entered into Excel 2010 to be analyzed with Epi Info 7.2. Ficher’s exact test, chi2 at the 5% threshold (p < 0.05) was used to compare pro-portions and analyze associations between variables. The average sensitivity rate to β-lactams was 74.43%. The sensitivity rate of Fluoroquinolones was 54.54%. That of levofloxacin was 87%. The average rate of sensitivity to β-lactams for the age group under 5 years old was 79.25%. That of fluoroquinolones was 52.59%. Levofloxacin had 90.37%. The average sensitivity rate to β-lactams for the age group over 5 years old was 76.03%. Fluoroquinolones had 45.16%. Levofloxacin had 69.58%. The average sensitivity rate to β-lactams for males was 76.68%. Fluoroquinolones had 54.26%. That of levofloxacin was 83.40%. The sensitivity rate to β-lactams for females was 74.41%. That of fluoroquinolones was 51.16%. Levofloxacin had 67.44%. Cyclins had 28.68%. The study noted an association between age and sensitivity (p < 0.05;CI [1.05-2.57]). Strains of Streptococcus pneumoniae were always detected in the CSF. The average rate of sensitivity to macrolides was 36.93%;aminoglycosides 28.69%;phenicols 63.35%;sulfona-mides 39.2%. These results could suggest a reduced sensitivity to β lactams. .

Interruption of Yaws in Central African Republic: What Dose of Azithromycin and How Many Cycles of Mass Treatment?

Introduction: The WHO recommends mass administration of azithromycin 30 mg/kg to eradicate yaws and 20 mg/kg to eliminate trachoma. We evaluated the effectiveness of azithromycin at 20 and 30 mg/Kg, and the number of cycles of mass administration on the treatment and interruption of yaws transmission in the Mbaïki health district in the Central African Republic. Methods: Following a yaws prevalence survey, azithromycin was administered as a mass treatment in four yaws endemic communities in the Mbaïki health district. Azithromycin 30 mg/kg was administered in one cycle in Kenengué and three cycles spaced three months apart in Bambou. In Kapou and Bangui-Bouchia, azithromycin was administered at a dose of 20 mg/kg in one cycle and three cycles, respectively, spaced three months apart. Before the mass treatment round, confirmed yaw cases were selected and followed for seven months. The primary endpoint was serological cure seven months after the first treatment cycle. Secondary endpoints were clinical cure at four weeks after the first treatment cycle and serological cure at four months after the first treatment cycle. A non-inferiority margin (∆) of 10% was used. Results: A total of 92 participants aged 1 to 90 years, including 52 men, were included in the study. The frequently encountered skin lesions were ulcers (65.22%) and were localized to the lower limbs (59.78%). Clinical cure was not obtained in Bangui-Bouchia and Kapou (∆ = 17.1% and 30.8%). Serological cure at four and seven months was not obtained in Kapou (∆ equal to 17.9% and 13.8% respectively). Conclusion: This study confirms the effectiveness of azithromycin 30 mg/kg in a single dose for the treatment of yaws. However, the study suggests that for yaws eradication programs, two to three cycles of mass administration of azithromycin at 20 or 30 mg/kg spaced three months apart, with therapeutic coverage greater than 90% are essential.

Obstetrical Violence: Women’s Experience at the Maman Elisabeth Domitien University Hospital Centre

Introduction: Access to the best quality of obstetrical care sometimes conceals acts and behaviors that fail to respect women’s physical, mental and social integrity. These negative experiences are referred to as obstetrical violence. The aim of this study is to contribute to improving the quality of maternal health care. Patient and Method: This was a cross-sectional study with a quantitative component carried out in the obstetrics and gynecology department of the Maman Elisabeth Domitien University Hospital from November 1 to 30, 2024. All women in childbed seen for postnatal consultations within 42 days of delivery were included. Results: We included 109 women. Age ranged from 16 to 44 years with a mean of 26.9 (±6.02). The majority of women were living in common-law unions with 79.8% and 57.8% of mothers having a secondary education level. More than half of the participants (52.9%) said that they had not been prepared for childbirth during prenatal follow-up and 44.0% had not freely chosen their path of delivery. The vaginal route was the most observed route of delivery (97.3%). Of all vaginal deliveries, episiotomy was performed in 21.7% and uterine revision in 66.0%. For episiotomies, 26.1% of women in childbed were informed about its performance and 87.0% had had a bad experience with this event. For women who had undergone a uterine revision, 52.9% had been informed of its performance and 77.1% had a bad experience with the event. Women in childbed had been victims of inappropriate acts and verbal aggression in 18.4% and 14.7% respectively. Of all the participants, 45.0% said they had experienced the birth episode badly. Conclusion: This study has given us an idea of the subject. However, a large-scale study will enable us to understand the different facets of this subject.