Skin wounds in a rural setting of Côte d’Ivoire: Population-based assessment of the burden and clinical epidemiology

Abstract

Background Data on the burden and clinical epidemiology of skin wounds in rural sub-Saharan Africa is scant. The scale of the problem including preventable progression to chronic wounds, disability and systemic complications is largely unaddressed. Methods We conducted a cross-sectional study combining active (household-based survey) and passive case finding (health services-based survey) to determine the burden and clinical epidemiology of wounds within the Taabo Health and Demographic Surveillance System (HDSS) in rural Côte d’Ivoire. Patients identified with wounds received free care and were invited to participate in the wound management study simultaneously carried out in the survey area. The data were analysed for wound prevalence, stratified by wound and patient characteristics. Results 3842 HDSS-registered persons were surveyed. Overall wound prevalence derived from combined active and passive case finding was 13.0%. 74.1% (403/544) of patients were below the age of 15 years. Most frequent aetiologies were mechanical trauma (85.3%), furuncles (5.1%), burns (2.9%) and Buruli ulcer (2.2%). Most wounds were acute and smaller than 5 cm2 in size. 22.0% (176/799) of wounds showed evidence of secondary bacterial infection. 35.5% (22/62) of chronic wounds had persisted entirely neglected for years. Buruli ulcer prevalence was 2.3 per 1000 individuals and considerably higher than expected from an annual incidence of 0.01 per 1000 individuals as reported by WHO for Côte d’Ivoire at the time of the study. Conclusions Skin wounds are highly prevalent in rural West Africa, where they represent a widely neglected problem. The HDSS-based survey with combined active and passive case finding adopted in this study provides a better estimate than school- and health institution-based surveys which underestimate the frequency of skin wounds and, particularly, of neglected tropical diseases of the skin, such as Buruli ulcer and yaws. A comparison with country-specific WHO data suggests underreporting of Buruli ulcer cases. Trial registration Registration at ClinicalTrials.gov NCT03957447.

Community-based wound management in a rural setting of Côte d’Ivoire

“…Between May 2 nd , 2019, and March 4 th , 2020, 561 patients were enrolled into the wound management study, 410 during combined active and passive case finding, 151 during passive case finding only [ 13 ]. The dataset was finalized on March 4 th , 2021.…”

“…We conducted a prospective observational study on community-based wound management at three levels (community, health centre, district hospital) in the Ahondo Health Area, Tiassalé district, Côte d’Ivoire which is part of Taabo Health and Demographic Surveillance System (HDSS) [ 10 – 12 ]. The setting is described in detail in [ 13 ].…”

“…We carried out a cross-sectional study combining active (household-based survey) and passive case finding (health services-based survey) in the same area to determine the prevalence and clinical epidemiology of wounds in a rural community of Côte d’Ivoire [ 13 ].…”

“…Clinical data were collected at each visit. Data collected and diagnostic criteria are described in detail in [ 13 ]. A reduced data set was collected in the community by CHWs (simple wounds).…”

“…Presumptive diagnoses were regularly reviewed at follow-ups of the wounds. In case of treatment failure, the cause of treatment failure was analysed and it was decided if the current diagnosis could be maintained, but treatment had to be adapted / reinforced / intensified or both the diagnosis and treatment had to be revised [ 13 ].…”