Epidemiolocal and clinical aspects of infectious dermatoses in a general hospital in Côte d’Ivoire- sub-Saharan Africa
Kassi K*1, Allou AS, Kouassi KA1, Kouame K1, Kouassi I2, Ahogo KC2, Kourouma HS2, Ecra EJ2, Gbery IP3, Kaloga M3, Sangare A3
Corresponding author: Dermatology and Infectiology unit, Department of medicine and specialties, training and research unit of medical sciences, university of Felix Houphouet Boigny of Abidjan/Côte d’Ivoire. Email: firstname.lastname@example.org/ email@example.com
Skin diseases represent major health care problems in tropical countries where their prevalence is about 30% of all consultation in rural areas . In Côte d’Ivoire, the health care system was organized in three levels in the public sector:-the primary or peripheral level including rural and urban health care centers and the community base health care centers; the secondary level including general and regional hospitals; the tertiary level including specialized national institutes and the teaching hospitals.
In the economic capital of côte d’Ivoire, the hospital prevalence of dermatoses in a primary health care center was 15%, of them we reported 92% cases of infectious dermatoses . These dermatoses were treated by none dermatologists in 90% of cases. What was the real situation in the secondary health care center? Here is the question that we try to answer.
It was a descriptive and analytical cross sectional study of all cases of infectious dermatoses observed in consultation the general hospital during the time period of 6 months, from February 17th to August 17th, 2016. The study was conducted in the general hospital located of the northern part of Abidjan, which population was estimated about 338000 peoples . All patients of any ages and sex who consulted for infectious dermatoses were included. Data were collected on a paper sheet of survey including sociodemographic characteristics (age, sex, education level, profession) and clinical parameters. Diagnosis was made based on clinical and epidemiological characteristics.
Statistical analysis was made by Epi info 6.04. Graphic, diagrams and tables were made using software Excel 2007 and Khi2 test was used to compare frequencies with a base line of P <0,05.
We recorded 1196 cases of dermatoses, of them 400 cases of infectious dermatoses in 33.44 % of cases.
Women were the most observed in 54.5% of cases, with a sex ratio of 0.83. The average age was 17 year varied from 2 months to 77 years. The ages from 0 to 9 years were the most represented in 48.25 % of cases (figure 1) Patients who had primary education level and those none educated were the most observed in 26.8% and 26.3 of case, respectively.
Parents in charge of and patients who had 100000 to 150000f CFA per month were the most represented in 29.25% of cases , and in 9.5 % of cases their income per month was less than 50000f CFA.
Infectious dermatoses were mostly pruritus in 80.75 % of cases. Pain was present in 10% of cases and burning feeling in 0.5% of cases (n=400). Pustular (41.5%) and vesicular (13.3%) lesions were the most observed. Head was the most location of lesions in 32.5% of cases, followed by trunk (19%) and upper limbs (17.5%). The average length of evolution was 9 days (varied from 1 to 60days). In 47.75% of cases, lesion evolved less than 7 days. Bacterial dermatoses were the most frequents in 50.5% of cases, followed by fungal skin infections in 25.75% of cases (Table 1). Folliculitis represented 59.90 % of bacterial dermatoses, followed by impetigo (31.20%). Dermatophytoses were the most observed fungal dermatoses in 35.92% of cases, followed by pityriasis versicolor in 34.95% of cases. Scabies was the most frequent parasitic dermatoses in 80.56% of cases. Varicella in 60.87% and herpes zoster in 29.09of cases were the most viral dermatoses reported in our series.
The hospital prevalence (33.44%) of infectious dermatoses reported in our series was less than those of other dermatoses. Because, these infectious dermatoses were mostly treated in primary health care centers, due to availability of anti-infectious drugs and their usage by health practitioners . The majority of diagnosis was made on clinical basis and depended on the dermatological expertise of health practitioners . The preponderance of bacterial dermatoses mostly in infant is linked to poor individual hygiene and dirty environment. This observation could be explained by the fact that the high proportion of our patients belong to age group under 14 years. This category of patients needs parents’ supervision for good bathing. Our finding corroborated with previous study reporting that: in many developing countries of tropical regions, in particular in sub-Saharan Africa, the prevalence of pyoderma varies from 5 to 10% and varies from 1 to 2% for scabies in young populations .
In our series, we reported that the occurrence of infectious dermatoses was linked to age. Some scholars reported that pyoderma and scabies were more frequent in infant and teenagers than in adults [6, 7]. In our series, we reported 14 varicella cases in patient aged under 40 year old, of them 9 cases aged fewer than 15 year old (65%). Previous studies showed that varicella was considered as child dermatosis [8, 9].
Meanwhile, herpes zoster occurred in adult, mostly in geriatric patients . In our series, 4 from 6 cases were observed in adult women aged more than 40 year old. In fact, in Abidjan, economic capital of Côte d’Ivoire more than 47% of the population are young, and those who are aged under 30 year old represent 72%. Among them, we fund West African communities who live in crowded areas where, there is lack of sanitary infrastructures, no pure water, and no access to health care, added to difficulty to take care of household trashes. In addition, promiscuity also favored the inter-personal transmission of infectious dermatoses. We also know that infectious dermatoses are all contagious (scabies, impetigo and fungal infection) [6, 9]. The other risk factors of these infectious dermatoses could be climate. In fact, hot and wet climatic conditions favored the pyoderma, superficial fungal infections and scabies . Skin trauma was reported as risk factor for pyoderma et also erysipelas, mostly located on limbs . Insect bites in infant sometimes lead to prurigo. The high frequency of women in our series could be explained by the fact that women care about aesthetical aspect of the body, reason why they consult dermatologist more than men . Besides, another risk factor cited in sub-Saharan Africa, in particular in Côte d’Ivoire was skin whitening practice (25% to 77.3%) . And people practicing this phenomenon are aged between 20 and 40 year old. Skin whitening could lead to many complications such as, promote or to get worse skin infections in 60-70% of cases. The products mostly for this practice were corticosteroids and hydroquinone [12, 15-19]. For real efficacy on infectious dermatoses, we need to eliminate all risk factor-related. And, it is recognized that poverty deprives individuals of the freedom to satisfy basic needs and rights. This includes freedom to enjoy clean water or sanitary facilities and good accommodations or houses or remedies for illnesses. In this pathway, 12 global public health priorities were advised to be adopted including, to integrate dermatological activities in developing countries into the general health care system not only at the secondary and tertiary care levels but also at the primary and the secondary health care levels, as outlined at the Alma Ata conference . Therefore, a national dermatology training section’s program should be held in Côte d’Ivoire, as it was done in Mali , especially in secondary health care level (general and regional hospitals)
Our series showed that infectious dermatoses were frequents in consultation in secondary hospital in Côte d’Ivoire. The age between 0 and 9 years were most concerned and female were most observed. The infectious dermatoses mostly reported in our study were pyodermitis, scabies and dermatophytoses. The risk factors reported were weak hygienic environment, promiscuity, the climate and skin whitening.
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