La recherche en santé

Les activités de recherche font partie du modèle de coopération développé par le Cemubac. Les fondements de la recherche sont établis sur le renforcement du fonctionnement des systèmes et des services de santé aboutissant à l’amélioration de la qualité des prestations offertes aux communautés. Qu’elle soit quantitative ou qualitative, cette recherche à composante participative élevée a pu se développer à la faveur d’un partenariat établi avec les acteurs, qu’ils soient professionnels ou bénéficiaires. Elle s’appuie largement sur une implication de cadres institutionnels formés à cet effet et repose sur une présence inscrite dans la durée. La recherche menée au Kivu a été conduite depuis plus de quinze ans dans un climat de dégradation de l’environnement économique, social et surtout sécuritaire. Appareil d’acquisition de connaissances, la recherche développée au Kivu reste avant tout orientée vers l’amélioration de l’offre des services.Research activities are part of the cooperation model developed by the Cemubac. The foundation for the research is based on strengthening the capacity of health systems and services resulting in the improvement of care offered to communities. The research (quantitative and qualitative) has a high participatory dimension and was able to develop thanks to partnerships with professionals and beneficiaries. It relies heavily on the implication of national public staff trained specifically for this work and on long-term presence in the area. The work in Kivu has continued over the past fifteen years despite a deteriorating social, economic and security context. As an organism for acquiring knowledge, the Cemubac’s work in Kivu is primarily geared towards improving health services

Profil comparatif et évolutif des personnes infectées par le virus de l’immunodéficience humaine traitées aux antirétroviraux à Kinshasa, République Démocratique du Congo

Introduction: a trithérapie (ARV) introduite en R.D.Congo en 1996, a permis l´amélioration substantielle de la qualité de vie des PVVIH et a réduit la morbimortalité liée au sida en R.D. Congo. L'objectif de cette étude est de présenter le profil épidémiologique comparatif, clinique, ainsi que l'évolution anthropométrique des PVVIH sous ARV à Kinshasa. Méthodes: étude de cohorte sur 438 PVVIH, de 18 ans et plus, suivies entre mai 2010 à 2011 à Amo Congo à Kinshasa. Une comparaison a été faite entre les patients suivis pendant un an et ceux perdus de vue. Le Chi carré de Mc Nemar et l'analyse de variance pour mesures répétées ont été appliqués pour étudier l'évolution. Résultats: près 12 mois de suivi, 11,4% de patients ont été perdus de vue. Parmi eux, on observait des proportions significativement plus élevées de personnes de niveau socioéconomique bas, d'indice de masse corporelle (IMC) bas, présentant de l'anorexie, des affections opportunistes. Les proportions de patients aux stades OMS 3 & 4 et naïfs étaient également significativement plus élevées et la durée sous ARV plus courte. Les gains moyens des paramètres anthropométriques au 12ème mois, étaient importants : de 3,6 [3,2 - 4,0] kg pour le poids, 1,8 (1,4 - 2,3) cm pour le périmètre abdominal, 0,9 (0,8 - 1,2) cm pour le périmètre brachial, 1,4 (1,2 - 1,5) kg/m2 pour l'IMC. La proportion de patients avec un IMC <18,5 kg/m2 a significativement plus baissé entre l'admission et le 12ème mois parmi les patients sans stomatite que parmi ceux avec stomatite. L'IMC moyen évoluait significativement différemment entre l'admission et le 12ème mois selon l'âge et la taille de ménage. Conclusion: les facteurs fragilisant la rétention des patients sous antirétroviraux et une évolution progressive de l'état nutritionnel ont été observés

Eff ect of pentavalent rotavirus vaccine introduction on hospital admissions for diarrhoea and rotavirus in children in Rwanda: a time-series analysis

Background In May, 2012, Rwanda became the fi rst low-income African country to introduce pentavalent rotavirus vaccine into its routine national immunisation programme. Although the potential health benefi ts of rotavirus vaccination are huge in low-income African countries that account for more than half the global deaths from rotavirus, concerns remain about the performance of oral rotavirus vaccines in these challenging settings. Methods We conducted a time-series analysis to examine trends in admissions to hospital for non-bloody diarrhoea in children younger than 5 years in Rwanda between Jan 1, 2009, and Dec 31, 2014, using monthly discharge data from the Health Management Information System. Additionally, we reviewed the registries in the paediatric wards at six hospitals from 2009 to 2014 and abstracted the number of total admissions and admissions for diarrhoea in children younger than 5 years by admission month and age group. We studied trends in admissions specifi c to rotavirus at one hospital that had undertaken active rotavirus surveillance from 2011 to 2014. We assessed changes in rotavirus epidemiology by use of data from eight active surveillance hospitals. Findings Compared with the 2009–11 prevaccine baseline, hospital admissions for non-bloody diarrhoea captured by the Health Management Information System fell by 17–29% from a pre-vaccine median of 4051 to 2881 in 2013 and 3371 in 2014, admissions for acute gastroenteritis captured in paediatric ward registries decreased by 48–49%, and admissions specifi c to rotavirus captured by active surveillance fell by 61–70%. The greatest eff ect was recorded in children age-eligible to be vaccinated, but we noted a decrease in the proportion of children with diarrhoea testing positive for rotavirus in almost every age group. Interpretation The number of admissions to hospital for diarrhoea and rotavirus in Rwanda fell substantially after rotavirus vaccine implementation, including among older children age-ineligible for vaccination, suggesting indirect protection through reduced transmission of rotavirus. These data highlight the benefi ts of routine vaccination against rotavirus in low-income settings

Community volunteers can improve breastfeeding among children under six months of age in the Democratic Republic of Congo crisis

<p>Abstract</p> <p>Background</p> <p>Malnutrition is a major public health problem in developing countries and exclusive breastfeeding is an efficient strategy that can be used to prevent malnutrition and reduce child mortality. The objective of this study is to evaluate the effectiveness of community volunteers in promoting exclusive breastfeeding from birth in an area of endemic malnutrition.</p> <p>Methods</p> <p>This evaluation analyzed the impact of the community-based nutrition project in Katana health district of the Democratic Republic of Congo from 2004 to 2006. Each of the villages in this sector had a nutritional village committee made up of five members responsible for continuously working to raise awareness of the importance of exclusive breastfeeding from birth among pregnant women and community leaders in their respective villages. The program worked with community volunteers with a mean age of 37 years, most of whom were married (86%). Eighty percent of the community volunteers had completed secondary school or a higher level of education. Data related to the period of exclusive breastfeeding and to the number of visits made to the health services for 208 children. The data were compared with data from 178 infants collected from another health sector, which had never developed a community-based nutrition program.</p> <p>Results</p> <p>The duration of exclusive breastfeeding from birth (median, range) was 6 months (2 to 7) in the intervention area compared with 4 months (1 to 6) in the comparison area (p < 0.001). The proportion of infants receiving exclusive breastfeeding at six months of age was higher in the intervention area than in the comparison area: 57.7% (95% Confidence Interval, CI, 50.9 to 64.5) versus 2.7% (95%CI, 1.1 to 6.6) (p < 0.001). The intervention group had a higher mean weight at 12 months (standard deviation): 8.42 kg (1.41) compared to 7.97 kg (1.02), although this difference was not statistically significant (p = 0.055).</p> <p>Conclusions</p> <p>The promotion of breastfeeding by community volunteers in an area of endemic malnutrition in rural Democratic Republic of Congo increased the duration of exclusive breastfeeding from birth.</p

Malaria and Iron Load at the First Antenatal Visit in the Rural South Kivu, Democratic Republic of the Congo: Is Iron Supplementation Safe or Could It Be Harmful?

We investigated the relationship between malaria infection and iron status in 531 pregnant women in South Kivu, Democratic Republic of the Congo. Sociodemographic data, information on morbidity, and clinical data were collected. A blood sample was collected at the first antenatal visit to diagnose malaria and measure serum ferritin (SF), soluble transferrin receptor, C-reactive protein, and α1-acid-glycoprotein. Malaria prevalence was 7.5%. Median (interquartile range) SF (adjusted for inflammation) was significantly higher in malaria-infected (82.9 μg/L [56.3-130.4]) than in non-infected (39.8 μg/L [23.6-60.8]) women (P < 0.001). Similarly, estimated mean body iron store was higher in malaria-infected women (P < 0.001). Malaria was significantly and independently associated with high levels of SF. Efforts to improve malaria prevention while correcting iron deficiency and anemia during pregnancy are warranted

Association between diagnostic criteria for severe acute malnutrition and hospital mortality in children aged 6-59 months in th eastern Democratic Republic of Congo: the Lwiro cohort study

peer reviewe

The Economic Burden Attributable to a Child’s Inpatient Admission for Diarrheal Disease in Rwanda

Background: Diarrhea is one of the leading causes of childhood morbidity and mortality. Hospitalization for diarrhea can pose a significant burden to health systems and households. The objective of this study was to estimate the economic burden attributable to hospitalization for diarrhea among children less than five years old in Rwanda. These data can be used by decision-makers to assess the impact of interventions that reduce diarrhea morbidity, including rotavirus vaccine introduction. Methods: This was a prospective costing study where medical records and hospital bills for children admitted with diarrhea at three hospitals were collected to estimate resource use and costs. Hospital length of stay was calculated from medical records. Costs incurred during the hospitalization were abstracted from the hospital bills. Interviews with the child’s caregivers provided data to estimate household costs which included transport costs and lost income. The portion of medical costs borne by insurance and household were reported separately. Annual economic burden before and after rotavirus vaccine introduction was estimated by multiplying the reported number of diarrhea hospitalizations in public health centers and district hospitals by the estimated economic burden per hospitalization. All costs are presented in 2014 US$. Results: Costs for 203 children were analyzed. Approximately 93$44.22 ± $23.74 and the total economic burden was$101, of which 65% was borne by the household. For households in the lowest income quintile, the household costs were 110% of their monthly income. The annual economic burden to Rwanda attributable to diarrhea hospitalizations ranged from $1.3 million to$1.7 million before rotavirus vaccine introduction. Conclusion: Households often bear the largest share of the economic burden attributable to diarrhea hospitalization and the burden can be substantial, especially for households in the lowest income quintile

Definition and characterization of localised meningitis epidemics in Burkina Faso: a longitudinal retrospective study

<p>Abstract</p> <p>Background</p> <p>The epidemiology of meningococcal meningitis in the African meningitis belt is characterised by seasonality, localised epidemics and epidemic waves. To facilitate research and surveillance, we aimed to develop a definition for localised epidemics to be used in real-time surveillance based on weekly case reports at the health centre level.</p> <p>Methods</p> <p>We used national routine surveillance data on suspected meningitis from January 2004 to December 2008 in six health districts in western and central Burkina Faso. We evaluated eight thresholds composed of weekly incidence rates at health centre level for their performance in predicting annual incidences of 0.4%and 0.8% in health centre areas. The eventually chosen definition was used to describe the spatiotemporal epidemiology and size of localised meningitis epidemics during the included district years.</p> <p>Results</p> <p>Among eight weekly thresholds evaluated, a weekly incidence rate of 75 cases per 100,000 inhabitants during at least two consecutive weeks with at least 5 cases per week had 100% sensitivity and 98% specificity for predicting an annual incidence of at least 0.8% in health centres. Using this definition, localised epidemics were identified in all but one years during 2004-2008, concerned less than 10% of the districts' population and often were geographically dispersed. Where sufficient laboratory data were available, localised epidemics were exclusively due to meningococci.</p> <p>Conclusions</p> <p>This definition of localised epidemics a the health centre level will be useful for risk factor and modelling studies to understand the meningitis belt phenomenon and help documenting vaccine impact against epidemic meningitis where no widespread laboratory surveillance exists for quantifying disease reduction after vaccination.</p

Towards a Metropolitan City Centre for Brussels

Between 2015 and 2020, the city centre of Brussels witnessed the creation of its first major pedestrian zone, one of the largest urban projects in recent decades. Has the Brussels city centre finally done away with the car hegemony? Can the city centre be extended to become the centre of the Brussels metropolis where everyone can find his or her own place? This book presents scientific background to the issue and brings together in words and images the research carried out over the past four years by the Brussels Centre Observatory