To study the epidemiological and medico-legal aspects of occupational accidents and illnesses contracted in the workplace among public sector employees in Côte d’Ivoire from 2017 to 2021.

1) To determine the prevalence of accidents and illnesses acquired in service among public sector employees from 2017 to 2021.

2) Describe the nature of the injuries caused by these occupational accidents and illnesses among these workers from 2017 to 2021.

3) To analyze the professional and medico-legal consequences of injuries among these workers from 2017 to 2021.

We encountered administrative difficulties (administrative delays) in obtaining authorization for investigations and accessing files. Information bias must be considered in this study; in particular, the health council’s records of workplace accidents and occupational diseases were incomplete. Similarly, the local legal framework relating to occupational risk management in the civil service remains insufficient.

We analyzed 227 cases of occupational injuries reviewed by the health council over a five-year period, from 2017 to 2021. The annual number of reports during this period ranged from 25 to 68, with an average of 45. Only two cases of occupational illness were reported over these five years. According to the Occupational Risks Department of the Ministry of Civil Service, 134 occupational injuries were recorded between 2009 and 2013. No occupational illnesses were reported ( Table 1 ).

In a previous study conducted over a 5-year period (1995-1999), Wognin and col. Observed an even lower reporting rate, encompassing 46 cases of occupational injury, including 1 case of illness [3] . We can observe a gradual increase in the reporting rate of occupational injuries. This increase is probably due to certain measures taken by the ILO in terms of prevention, such as the establishment of the World Day for Safety and Health at Work, which has been celebrated every April 28 since 2002, and the African Day for the Prevention of Occupational Risks, which is held on April 30 each year. These days aim to raise public awareness on issues of safety and health at work and to promote programs for the prevention of occupational accidents and diseases.

However, this rate remains due, on the one hand, to the numerous occupational risks to which civil servants and state agents are exposed in the exercise of their functions and, on the other hand, to the number of civil servants which, all jobs combined and as of December 31, 2020, was 237,483 [14] ( Table 2 ). The high cost of medical examinations necessary for the diagnosis of occupational diseases, the absence of a legal definition and a table of occupational diseases specific to the civil service, could also reasonably constitute an obstacle to the constitution of disease recognition files. The victims, relatively young, had an average age of 37.22 ± 6.1 years, unlike Kassi [15] in 2008 and Wognin et al. [16] in 2019 whose study population had an average age of 45.9 ± 10.54 years and 42.3 ± 9.2 years respectively ( Table 1 ).

Induced lesions predominated in subjects whose age ranged between 36 and 55 years (78.3%) with a male preponderance (85.9%, a sex ratio of 6.09). This result is in accordance with the structure of the population of civil servants and state agents in 2020 where men are the most represented with a sex ratio of 1.84 [17] . The low number of women at work is highlighted by the International Labor Organization, although the gap between the activity rate of men and women is clearly declining worldwide [14] . This male dominance was described by Ayélo et al. who reported a male preeminence of 83.3%; the most represented age group was 30 - 40 years (40%) ( Table 1 ).

Conversely, Akasson A. in a study carried out on medical staff at the health council, observed a female predominance (57.60%) probably due to the high number of midwives [18] . This reflects a variability in the predominance linked to gender probably influenced by the profession concerned. Most of the victims who consulted the health council in our study resided in the city of Abidjan (57.7%). Similarly, Akasson A [17] in 2001 also noted that the regional directorate of Abidjan brought together the largest number of health workers requesting the health council. This observation seems normal because the city of Abidjan contains the majority of civil servants and state agents. The health sector was the most affected by these occupational risks with 53.3% of injuries, nurses, the most affected professional category (44.5%). These results are superimposable with those of a Tunisian study conducted from 2012 to 2019 in which the health sector represented 56% of victims of occupational diseases and the nursing profession, the most represented professional category (34.3%) [19] . Akasson A. in 2001 observed that nurses are the medical personnel who mostly consult the health council [17] ( Table 2 ).

This predominance of nurses is consistent with the results of a study by the Ministry of Public Health (7625 nurses and midwives, compared to 1420 doctors) [20] . Indeed, medical or paramedical activity is correlated with a set of risks, in particular the risk of infection due to contact with patients and various biological fluids and tissues [21] [22] . Furthermore, health personnel seem better informed about the existence of the health council. Based on the rules of ethics, fraternity and mutual assistance, medical certificates are often issued to them free of charge.

For other civil servants, these elements often constituted real difficulties to overcome, the cost would seem prohibitive. The main injuries induced during accidents were dominated by fractures (58.6%) and open wounds (30.8%) ( Figure 1 ). However, in Belgium, the Medex study noted a frequency of superficial wounds, a result that corresponds to the ILO classification which places superficial traumatic injuries and open wounds at the top of injuries due to work accidents [23] . The frequency of fracture injuries in our study would be due to the importance of road traffic accidents (77.1%) ( Table 3 ). According to Ngaroua D. et al. in Cameroon, 37.5% of 232 patients hospitalized in the surgical department during the period from May 1 to July 31, 2014, were victims of a road traffic accident (RTA). Fractures constituted 67.8% of the induced traumas [24] . In Côte d’Ivoire, the issue of road traffic accidents, due to the severity of morbidity and mortality, is a priority public health concern. The State has made it a matter of governmental prevention by organizing extensive awareness programs in 2024. Moreover, measures aimed at reducing RTAs (Road Traffic Accidents) have been taken, notably speed limits under video surveillance, the introduction of points-based licenses, and the strengthening of the requirements for obtaining driver’s licenses. However, road insecurity remains a concern with the emergence of motorcycle taxis, tricycles, and new private transport companies whose operators do not benefit from adequate training ( Table 4 ).

Studies conducted in Africa report that road accidents predominate in the occurrence of traumatic injuries with prevalences that differ depending on the country and the locality studied [25] . These data raise the issue of road safety, in particular the non-compliance with the highway code and the use of motorcycles without appropriate protection [26] [27] . The occupational diseases diagnosed during this period were exclusively pulmonary diseases, or 0.9%. According to CNAM statistics, the most common recognized occupational diseases in 2018 were musculoskeletal disorders (MSDs), respiratory diseases, and occupational deafness [28] . These occupational accidents and illnesses impacted the lives of the affected workers. Many returned to their jobs (77.1%) ( Table 5 ). Significantly higher rates were found in similar studies conducted in the private sector by Duquesnoy et al. and Manou, who observed 93% and 96% return to work, respectively [29] [30] . Indeed, this high return-to-work rate does not always correspond to the level of functional recovery achieved. This return, often anticipated, can be explained by the difficult socioeconomic context, the drying up of financial resources, the loss of benefits related to the practice of one’s profession, as well as legal restraints.

The results of the impact of these risks on the workplace cannot be analyzed objectively given the large number of files not containing these details (43.6%) ( Figure 2 and Figure 3 ), probably linked to poor file management (poorly completed files). However, it is important to emphasize the proportion of deaths (3.1%). A much higher proportion had been observed in previous years by Wognin et al. (17.4%) [3] . By comparison, the private sector records approximately 31 deaths each year for 5500 accidents, or a proportion of 0.56%. On analysis, the 225 accidents notified correspond to clearly serious and fatal injuries ( Table 4 ). Given the complexity of the procedure, the administrative delays in processing files (1 meeting per year for the reform commission) and the low level of benefits allocated, most victims give up. Minor illnesses and accidents are therefore excluded. All victims were granted temporary total incapacity for work ( Table 6 ). The duration of these incapacities was specified in 94.7% of cases and varied between 10 and 229 days; the average was 63.79 days.

This result appears to be contrary to that of the Medex study on work accidents among Belgian civil servants; the author estimates that the vast majority of work accidents (80%) result in temporary incapacity for work of less than 30 days and are consolidated [22] . The vast majority of injuries were fractures (58.6%) ( Table 4 ). in our series, unlike the Medex study where the most frequent injuries were superficial wounds and dislocations [22] . Our results are justified by the fact that the fracture generally consolidates within 6 weeks ( Table 7 ). Furthermore, Chahnez M et al. in Tunisia, found that the duration of total temporary incapacity for work had a very variable distribution from one medical certificate to another, in accordance with our study where the standard deviation of the mean was 48.66 [30] . It was considered inadequate for the injuries described in 2.9% of cases. The duration of total temporary incapacity for work is based solely on clinical examination data ( Table 8 ). It is independent of the circumstances of the traumatic event (accident, assault, etc.). There is currently no objective assessment scale for total temporary incapacity for work available to physicians when drafting the initial medical certificate of assault and battery. This could explain the significant discrepancies between these incapacity ratings attributed by physicians for the same injuries. All victims presented with sequelae. The most common were stiffness (48.9%), intermittent pain (43.61%), limping (9.69%), and trophic disorders (6.61%). These were the classic broken bones after-effects.

Since the presence of after-effects is the criterion for awarding permanent partial disabilities, all victims benefited from them. The victims of work accidents and occupational diseases included in our study were compensated in 100% of cases.

Workplace accidents and occupational diseases remain a real occupational and public health problem. They affect a large number of workers in all sectors of activity. The reporting rate for occupational risks in the public administration remains low compared to the private sector, although it has improved considerably over the past two decades. The processes complexity, administrative delays, the injuries total cost covered by the victim themselves, and the low level of benefits allocated, negatively influence the reporting of occupational injuries in the public sector.

Furthermore, a significant number of public sector jobs expose employees to the risk of injuries and occupational illnesses. Notwithstanding the importance of prevention, the administration must increase its efforts to simplify records and raise awareness among civil servants about the procedures for reporting these diseases. It is desirable to increase the level of knowledge of civil servants and government employees about the procedures for reporting occupational injuries in the public administration. Indeed, work on this topic would be very similar to our own, whose interest lies in prevention.