Emergence in Western African countries of MDR-TB, focus on Côte d'Ivoire

Abstract

Tuberculosis (TB) is responsible for a high mortality rate (2.5%) worldwide, mainly in developing countries with a high prevalence of human immunodeficiency virus (HIV). The emergence of multiresistant strains of TB poses an extreme risk for TB outbreaks and highlights the need for global TB control strategies. Among Western African countries, Côte d'Ivoire (CI) represents a specific example of a country with great potential to prevent TB. Specifically, CI has a promising healthcare system for monitoring diseases, including vaccination programs. However, military and political conflict in CI favors the spread of infectious diseases, TB being among the most devastating. Compilation of the studies identifying common causes of TB would be extremely beneficial for the development of treatment and prevention strategies. Therefore, the purpose of this comprehensive review is to evaluate the epidemiology of TB in CI, describe the factors involved in pathogenesis, and suggest simple and applicable prevention strategies.

Figure 1

The evolution of confirmed TB, MDR-TB, and TB/HIV coinfected cases in Côte d'Ivoire. (a) Each year TB cases are notified. The total number of diagnosed TB cases has increase since 1990, (b) the number of coinfected TB/HIV patients and deaths as result of TB in PLHIV, and (c) the raise may be due to the targets, implementation of LPAs, and EXPAND TB in general.

Figure 2

Major focus areas of the NTP in Côte d'Ivoire and supporting organizations. CNACI: National Antituberculosis Committee of Côte d'Ivoire; COLTMR: Tuberculosis and Respiratory Illness Organizational Collective; ESTHER: French Group for In-Network Hospital Treatment Solidarity; GDF: Global Tuberculosis Drug Facility; GFATM: Global Fund to control AIDS, Tuberculosis and Malaria; CIGO: the Côte d'Ivoire Government; ICRC: International Committee of the Red Cross; NTP: National Tuberculosis control Program; PEPFAR: President's Emergency Plan For AIDS Relief; PSP: Public Health Pharmacy; UNHCR: United Nations High Commissioner for Refugees; Union or precedently IUATLD: International Union Against Tuberculosis and Lung Disease; and WHO: the World Health Organization. CI depends heavily on external organizations for financial aid to combat the spread of TB.

Figure 3

Organization of diagnostic tuberculosis laboratories in Côte d'Ivoire. CIGO has constructed a network of laboratories for TB diagnosis, treatment, and monitoring. This network is organized in three tiers: central level, national laboratory for TB; intermediate level, anti-TB center laboratories; and peripheral level, diagnostic and treatment center laboratories.