Integrated approach in the management of skin NTDs: Situational analysis of the integrated screening campaigns of skin diseases (leprosy, Buruli ulcer and yaws) in three health districts of Côte d’Ivoire

Abstract

BackgroundNeglected Tropical Diseases (NTDs) comprise 20 communicable diseases that are prevalent in rural poor and remote communities with less access to the health system. For an effective and efficient control, the WHO recommends to affected countries the implementation of integrated control interventions that take into account the different co-endemic NTDs in the same community. However, implementing these integrated interventions involving several diseases with different etiologies, requiring different control approaches and driven by different vertical programs remains a challenge. We report here the results and lessons learned from a pilot test of this integrated approach based on integrated screening of skin diseases in three co-endemic health districts of Côte d'Ivoire, a West African country endemic for Buruli ulcer, leprosy and yaw three skin NTDs. MethodThis cross-sectional study took place from April 2016 to March 2017 in 3 Districts of Côte d’Ivoire co-endemic for BU, leprosy and yaws. It was carried out in 6 stages: identification of potentially co-endemic communities; stakeholder training; social mobilization; mobile medical consultations; case detection and management; and a review meeting.ResultsIn total, 2310 persons were screened with skin diseases. Among them, 07 cases were diagnosed as Buruli ulcer. There were 30 leprosy cases and 15 yaws detected. Other types of ulcerations and skin conditions have been identified and represent the majority of cases detected. We learned from this pilot experience that integration can be successfully implemented in co-endemic communities in Côte d’Ivoire. Health workers are motivated and available to implement integrated interventions instead of interventions focused on a single disease. However, it is essential to provide capacity building, a minimum of drugs and consumables for the care of the patients detected, as well as follow up of detected patients including those with other skin conditions.ConclusionsThe results of this study show that the integration of activities can be successfully implemented in co-endemic communities under the condition of a staff capacity building and a minimal care of the detected patients.

Micronutrient-deficient diets and possible environmental enteric dysfunction in Buruli ulcer endemic communities in Ghana: lower dietary diversity and reduced serum zinc and vitamin C implicate micronutrient status a possible susceptibility factor

“…Despite these limitations, these findings align with two recent independent reports of BU patients in Côte d'Ivoire [96,97]. While there was no information on controls, in one study, 51 BU patients also ate predominantly starchy foods and minimal proteins; indeed, dairy products, fruits, vegetables, and vegetable oils were consumed by only 8% of the cases [97]. Their food choices were found to be influenced by societal norms where food types were prohibited in their communities, including certain animal and plant proteins, vegetables, and fruits.…”

“…Despite these limitations, these findings align with two recent independent reports of BU patients in Côte d'Ivoire [96,97]. While there was no information on controls, in one study, 51 BU patients also ate predominantly starchy foods and minimal proteins; indeed, dairy products, fruits, vegetables, and vegetable oils were consumed by only 8% of the cases [97].…”

“…However, in a subset of these patients and similar to here, zinc was found to be below normal levels in all BU patients [96]. Importantly, nutritional assistance provided at one health centre significantly improved wound healing alongside marked improvement in anthropometrics and anaemia compared to another where no nutritional support was included in BU patients' management package [97]. Taken together, the findings strongly support large scale randomised control studies for nutritional intervention in at-risk communities for BU and nutritional support for all BU patients, alongside a detailed assessment of the prevalence of EED and how this may influence susceptibility to BU and other NTDs.…”

“…Their food choices were found to be influenced by societal norms where food types were prohibited in their communities, including certain animal and plant proteins, vegetables, and fruits. Being underweight tended to be higher in Côte d'Ivoire vs Ghanaian BU cases (33-53% vs 19-23%), and acute malnutrition was also reported [97]. Interestingly, CRP levels >20 mg/L were reported in 7-20% of the cases, suggesting that EED may be more prevalent in Côte d'Ivoire.…”