226 research outputs found
Incidence de l'epilepsie aprĂšs un accident vasculaire cerebral Ă Parakou en 2014
Introduction: les accidents vasculaires cérébraux (AVC) constituent une des principales causes acquises de l'épilepsie de l'adulte mais peu de données sont disponibles sur l'incidence de l'épilepsie aprÚs un AVC en Afrique. L'objectif de cette étude était d'estimer l'incidence de l'épilepsie chez les patients victimes d'AVC à Parakou.
Méthodes: il s'est agi d'une étude de type cohorte dynamique ayant inclus 203 patients victimes d'AVC et hospitalisés dans le service de neurologie du CHU de Parakou. Les patients aux antécédents d'épilepsie étaient exclus du suivi. Les patients étaient suivis sur une période de 21mois allant du 1er Janvier 2013 au 30 Septembre 2014. L'épilepsie était définie selon les critÚres de la Ligue Internationale contre l'Epilepsie.
Résultats: ils étaient ùgés de 18 à 99 ans avec une moyenne de 58,4 ans ± 14,2 ans. Le délai moyen de consultation aprÚs l'installation des symptÎmes était de 54,3h (+/-112,9h). Les AVC ischémiques représentaient 45,8%, les hémorragiques 31% et 23,2% d'indéterminés. L'incidence cumulée de l'épilepsie était de 17. La densité d'incidence de l'épilepsie était de 9,8 pour 100 personnes-années. Les facteurs associés à la survenue de l'épilepsie étaient le niveau d'instruction, la durée d'hospitalisation et le score de BARTHEL.
Conclusion: l'incidence de l'épilepsie reste trÚs élevée et la prise en compte des facteurs associés dans les stratégies de prise en charge pourrait permettre de réduire sa charge globale
Enquete sur la prevalence de la migraine chez lâadulte a titirou au Nord du Benin en 2017
Introduction: La migraine est une maladie neurologique frĂ©quente en population, source de handicap et classĂ©e 13Ăšme des affections les plus handicapantes par lâOMS. Lâobjectif de cette Ă©tude Ă©tait dâĂ©tudier la prĂ©valence de la migraine Ă Titirou en 2017. MĂ©thodes: Il sâest agi dâune Ă©tude transversale de type porte-Ă -porte menĂ©e sur 2065 sujets ĂągĂ©s de 18 Ă 65 ans. LâenquĂȘte a Ă©tĂ© effectuĂ©e sur une pĂ©riode de 4 mois allant du 10 avril au 05 aoĂ»t 2017. Les critĂšres diagnostiques de lâInternational Headache Society (IHS) de 2013 ont servi de base pour le diagnostic de la migraine. Les informations sociodĂ©mographiques, le poids et taille et les donnĂ©es relatives Ă la frĂ©quence et lâintensitĂ© des cĂ©phalĂ©es furent collectĂ©s. Les donnĂ©es ont Ă©tĂ© saisies, traitĂ©es et analysĂ©es grĂące au logiciel Epi Info version 2.2.0.165. RĂ©sultats: Il y avait une prĂ©dominance masculine avec un sex-ratio de 1,41. Les sujets Ă©taient ĂągĂ©s de 18 Ă 65 ans avec une moyenne dâĂąge de 31,87±8,37ans. La prĂ©valence des cĂ©phalĂ©es Ă©tait de 63,49%. La prĂ©valence de la migraine Ă Titirou Ă©tait de 3,82% [IC95% : (3,06%-4,72%)] (79 sur les 2065). Les facteurs associĂ©s Ă la migraine Ă©taient lâĂąge (p=0,0026), le sexe (p=0,0001), le niveau dâinstruction (p=0,0039), la profession (p<10-4 ) et lâindice de masse corporelle (p<10-4 ). LâintensitĂ© des cĂ©phalĂ©es Ă©tait modĂ©rĂ©e dans 44,30%, forte dans 51,90%, extrĂȘmement forte chez 3,80% des sujets. La plupart des migraineux (78,48%), avait moins de 5 crises par mois. La migraine avec aura reprĂ©sentait 49,4%. Les auras les plus observĂ©es Ă©taient les phosphĂšnes (34,18%), les scotomes (13,92%) et lâaura sensitive (13,92%). Les facteurs dĂ©clenchant les accĂšs Ă©taient le manque de sommeil (84,81%), la contrariĂ©tĂ© (68,35%) et le souci (62,03%). Conclusion : La migraine est assez frĂ©quente et sa prĂ©valence est comparable Ă celle rapportĂ©e dans la plupart des Ă©tudes en communautĂ© en Afrique.Mots clĂ©s: Migraine -PrĂ©valence-Adulte-Benin Introduction: The migraine is a common neurological disorder with a serious handicap and classified as the 13th disabling disease worldwide. The most consistently data on epidemiology of migraine are available in general population in Africa but not in northern Benin. We aimed to study the prevalence of migraine at Titirou in Parakou in 2017. Methods: This was a cross-sectional with door-to-door survey which included 2065 subjects aged 18 to 65 years. The survey was conducted over a period of 4 months from 10 April to 05 August 2017. The IHS diagnostic criteria of 2013 were used to define migraine. Socio-demographics information was collected. The data were analyzed using Epi Info 2.2.0.165.fr software. Results: There was a male predominance with 58.45% of men with sex ratio of 1.41. The mean age was 31.87 ± 8.37 years. The prevalence of headache was 63.49%. The prevalence of migraine in Titirou was 3.82% [95%CI: 3.06%-4.72%]. The associated factors were the age (p=0.00), the sex (p=0.00), level of education (p=0.00), occupation (p<10-4 ) and the body mass index (p<10-4 ). The migraine with aura represented 49.4%. The most type were visual aura (34.18%), sensitive aura (13.92%) and scotoma (13.92%).The intensity of headache was moderate in 44.30%, strong in 51.90%, extremely strong in 3.80% of subjects. The main triggering factors were lack of sleep (84.81%), annoyance (68.35%) and worry (62.03%). Conclusion: Migraine was more frequent in Parakou and this data are comparable to those reported elsewhere in sub-Saharan Africa.Key words: Headache, Migraine- Prevalence, epidemiology, Adult; Benin
Myasthenie auto-immune: diagnostic et prise en charge. A propos de six cas au Benin et au Gabon
La myasthĂ©nie est une maladie auto-immune qui se caractĂ©rise par une faiblesse musculaire fluctuante, sâaggravant Ă lâeffort et sâamĂ©liorant au repos, mettant en jeu le pronostic vital. Le polymorphisme clinique de cette affection rend souvent le diagnostic clinique difficile. Aussi le dosage des anticorps anti rĂ©cepteur dâacĂ©tylcholine (AC anti Rach) et lâENMG sont les principaux outils du diagnostic. Les auteurs rapportent 6 cas de myasthĂ©nie pour mettre en relief les difficultĂ©s de diagnostic et de prise en charge en Afrique subsaharienne.Mots clĂ©s: Ac anti-Rach, MyasthĂ©nie, Ă©lectromyogramme, AfriqueEnglish Title: Myasthenia autoimmune: diagnosis and management. About six cases in Benin and GabonEnglish AbstractMyasthenia is a life threatening autoimmune disease presenting varying degrees of muscle weakness becoming worse during effort and released by rest. Its clinical polymorphism makes difficult the diagnosis. The anti-AChR antibodies testing and EMNG are the main diagnostic tools. The authors report 6 cases of myasthenia to underline the difficulties regarding diagnosis and management of this disease in sub-Saharan Africa.Keywords: Anti-AChR antibodies, Myasthenia, Electromyogram, Afric
Lâinfection a virus de lâImmunodeficience Humaine (VIH), facteur predictif de gravite et de mortalite des accidents vasculaires cerebraux au Centre National Hospitalier et Universitaire-Hubert Koutoukou Maga (CNHU-HKM) de Cotonou, Benin
Introduction: Lâatteinte du systĂšme nerveux central est frĂ©quente et prĂ©coce au cours de lâinfection Ă VIH. Cependant, la survenue de lâaccident vasculaire cĂ©rĂ©bral (AVC) au cours de lâĂ©volution naturelle du VIH est peu documentĂ©e.Objectif: DĂ©terminer la prĂ©valence hospitaliĂšre du VIH chez les patients AVC et comparer les caractĂ©ristiques cliniques des AVC entre les sujets infectĂ©s et non infectĂ©s par le VIH.MĂ©thode: Etude transversale qui sâest dĂ©roulĂ©e au CNHU-HKM de janvier 2008 Ă dĂ©cembre 2011. Elle a portĂ© sur 432 sujets tous hĂ©tĂ©rosexuels, atteints dâAVC confirmĂ© par un scanner cĂ©rĂ©bral et ayant bĂ©nĂ©ficiĂ© dâune sĂ©rologie VIH. Deux groupes ont Ă©tĂ© constituĂ©s. Le groupe des sujets AVC infectĂ©s par le VIH (AVCVIH+) et le groupe des sujets AVC non infectĂ©s par le VIH (AVCVIH-). La gravitĂ© de lâAVC sur la base du score NIHSS Ă lâadmission et la mortalitĂ© Ă J30 ont Ă©tĂ© Ă©tudiĂ©es. Le logiciel Epi info a servi Ă lâanalyse des donnĂ©es.RĂ©sultats: La prĂ©valence hospitaliĂšre du VIH chez les patients atteints dâAVC Ă©tait de 26,1% (113/432). LâĂąge moyen des PVVIH Ă©tait de 43 ± 7 ans. Aucun dâeux ne se connaissait VIH+ avant lâadmission. La mĂ©diane des CD4  était basse : 119±36/mm3. Il nây a pas de diffĂ©rence significative entre les deux groupes pour ce qui concerne lâĂąge (p=0,08), le sexe (p=0,24), lâantĂ©cĂ©dent dâHTA (p=0,2), lâantĂ©cĂ©dent de diabĂšte (p=0,231). En revanche, lâAVC ischĂ©mique (67,3% vs 62,4% ; p=0,02) et la mortalitĂ© Ă J30 (23% vs 10,5% ; p=0,007) Ă©taient significativement plus Ă©levĂ©s chez les sujets VIH+ que les VIH-. De mĂȘme, lâAVC Ă lâadmission (NIHSS>13 ; p=0,002) Ă©tait plus grave dans le groupe AVCVIH+ que dans le groupe AVCVIH-. Le risque de faire un AVC est multipliĂ© par au moins 2 lorsque le sujet Ă©tait sĂ©ropositif que sĂ©ronĂ©gatif pour le VIH, tous autres facteurs Ă©tant Ă©gaux par ailleurs (RR=2,3).Conclusion: Ces rĂ©sultats suggĂšrent que lâAVC est frĂ©quent au cours de lâinfection Ă VIH et peut ĂȘtre son mode de rĂ©vĂ©lation. De mĂȘme, lâinfection Ă VIH apparait comme un facteur de risque de mauvais pronostic au cours de lâAVC.Mots clĂ©s: AVC, VIH, gravitĂ©, mortalitĂ©, BĂ©ninEnglish Title: Human Immunodeficiency Virus infection (HIV), stroke severity and mortality predictive indicator in centre national Hospitalier et Universitaire-Hubert Koutoukou Maga (CNHU-HKM) Cotonou, BeninEnglish AbstractIntroduction: During HIV infection, the central nervous system is frequently affected. However, the occurrence of stroke during the natural course of HIV is poorly documented.Objectives: To determine the prevalence rate of HIV among stroke patients and to compare the clinical characteristics of stroke in people with HIV and those HIV free.Method: A Cross-sectional study was conducted in the Neurology department of CNHU-HKM in Cotonou from January 2008 to December 2011. It involved 432 subjects all heterosexual, with stroke confirmed by brain CT scan and who underwent HIV test. Two groups were formed. The group of stroke subjects with HIV infection (AVCVIH +) and that of stroke subjects not infected by HIV (AVCVIH-). Stroke severity based on NIHSS score at admission and mortality at day 30 was studied. Epi Info was used for data analyses.Outcome: The prevalence rate of HIV among patients with stroke was 26.1% (113/432). The average age of HIVâs subjects was 43 ± 7 years. None of them knew prior to admission that their status was HIV +. The median CD4 count was low: 119 ± 36/mm3. There is no significant difference between the two groups regarding age (p = 0.08), sex (p = 0.24), hypertension history (p = 0.2), diabetes history (p = 0.231). However, ischemic stroke (67.3% vs. 62.4%, p = 0.02) and mortality at day 30 (23% vs. 10.5%, p = 0.007) were significantly higher among HIV + than HIV-. Similarly, stroke on admission (NIHSS> 13, p = 0.002) was more severe in the group AVCVIH + than in group-AVCVIH. The risk of stroke is multiplied by at least 2 when the subject was HIV+ compare to HIV-, all other factors being equal (RR = 2.3).Conclusion: These results prove that stroke is common during HIV infection and may be one of its revealing factor. Similarly, HIV infection is a risk factor of poor outcome during stroke.Keywords: Stroke, HIV, AVC, severity, mortality, Beni
Determinants of Adherence to Recommendations of the Dietary Approach to Stop Hypertension in Adults with Hypertension Treated in a Hospital in Benin
Abstract The dietary approach to stop hypertension (DASH) is an effective nutritional strategy to prevent and treat cardiovascular disease. Optimal benefit from dietary recommendations in management of hypertension depends on the compliance. This analytic cross sectional study aimed at establishing determinants of DASH among adults with hypertension treated at hospital in Benin. The study included 150 hypertensive adults selected during medical visit for blood pressure monitoring at hospital Saint-Luc in Cotonou from June 3 rd to July 1 st , 2014. Data on consumption of sodium, fruits and vegetables, alcohol, saturated and trans fat rich products were collected by questionnaire. A score of adherence to DASH was built. Determinants of adherence to DASH were identified using logistic regression model. Only 20% of subjects showed adherence to DASH. Better knowledge on hypertension OR=5.18 (95%IC 1.98-13.22) and healthy dietary habits and lifestyle prior to diagnosis of hypertension OR=4.26 (95%IC 1.67-13.18) increased the likelihood of adherence to dietary recommendations for hypertension management. Nutrition education and information of patients on hypertension and its complications during medical consultations may increase their adherence to dietary recommendations for management of the disease
Research protocol: essential stage of research process guaranteeing validity of results
La recherche scientifique est une activitĂ© obligatoire Ă tout enseignant Ă lâuniversitĂ©. Nous avons rĂ©alisĂ© ce travail de synthĂšse en apportant des innovations dans les composantes dâun protocole de recherche. Le but de notre travail est de rappeler aux chercheurs de tous les domaines, la dĂ©marche Ă suivre pour rĂ©diger un bon projet de recherche encore appelĂ© protocole de recherche. Un protocole de recherche complet doit contenir les onze composantes suivantes : le titre ; lâintroduction ; la problĂ©matique ; lâhypothĂšse ; les objectifs ; les gĂ©nĂ©ralitĂ©s ; la mĂ©thode ; le calendrier ; le budget ; la bibliographie et la mention des liens dâintĂ©rĂȘt. La mĂ©thode dâĂ©tude est la partie essentielle du protocole de recherche. En conclusion, tout chercheur doit maĂźtriser la procĂ©dure dâĂ©laboration dâun protocole de recherche lui permettant dâaboutir Ă des rĂ©sultats valides et de publier des articles scientifiques de bonne qualitĂ©.Scientific research is a compulsory activity for every university teacher. We realized this synthetic work by bringing innovations in research protocol components. The purpose of our work is to remind the searchers in all domains, the approach to be followed to draft a good research project also called research protocol. A complete research protocol has to include the eleven following components: title, introduction, problem, hypothesis, objectives, majorities, method, timetable, budget, bibliography and conflict of interests. The method of study is an essential part of the research protocol. As a conclusion, we can say every searcher should know and be able to elaborate a research protocol in order to obtain valid results and to publish quality scientific articles
Health system performance for people with diabetes in 28 low- and middle-income countries:A cross-sectional study of nationally representative surveys
International audienceThe prevalence of diabetes is increasing rapidly in low- and middle-income countries (LMICs), urgently requiring detailed evidence to guide the response of health systems to this epidemic. In an effort to understand at what step in the diabetes care continuum individuals are lost to care, and how this varies between countries and population groups, this study examined health system performance for diabetes among adults in 28 LMICs using a cascade of care approach
The state of hypertension care in 44 low-income and middle-income countries:a cross-sectional study of nationally representative individual-level data from 1·1 million adults
Evidence from nationally representative studies in low-income and middle-income countries (LMICs) on where in the hypertension care continuum patients are lost to care is sparse. This information, however, is essential for effective targeting of interventions by health services and monitoring progress in improving hypertension care. We aimed to determine the cascade of hypertension care in 44 LMICs-and its variation between countries and population groups-by dividing the progression in the care process, from need of care to successful treatment, into discrete stages and measuring the losses at each stage.
In this cross-sectional study, we pooled individual-level population-based data from 44 LMICs. We first searched for nationally representative datasets from the WHO Stepwise Approach to Surveillance (STEPS) from 2005 or later. If a STEPS dataset was not available for a LMIC (or we could not gain access to it), we conducted a systematic search for survey datasets; the inclusion criteria in these searches were that the survey was done in 2005 or later, was nationally representative for at least three 10-year age groups older than 15 years, included measured blood pressure data, and contained data on at least two hypertension care cascade steps. Hypertension was defined as a systolic blood pressure of at least 140 mm Hg, diastolic blood pressure of at least 90 mm Hg, or reported use of medication for hypertension. Among those with hypertension, we calculated the proportion of individuals who had ever had their blood pressure measured; had been diagnosed with hypertension; had been treated for hypertension; and had achieved control of their hypertension. We weighted countries proportionally to their population size when determining this hypertension care cascade at the global and regional level. We disaggregated the hypertension care cascade by age, sex, education, household wealth quintile, body-mass index, smoking status, country, and region. We used linear regression to predict, separately for each cascade step, a country's performance based on gross domestic product (GDP) per capita, allowing us to identify countries whose performance fell outside of the 95% prediction interval.
Our pooled dataset included 1â100â507 participants, of whom 192â441 (17·5%) had hypertension. Among those with hypertension, 73·6% of participants (95% CI 72·9-74·3) had ever had their blood pressure measured, 39·2% of participants (38·2-40·3) had been diagnosed with hypertension, 29·9% of participants (28·6-31·3) received treatment, and 10·3% of participants (9·6-11·0) achieved control of their hypertension. Countries in Latin America and the Caribbean generally achieved the best performance relative to their predicted performance based on GDP per capita, whereas countries in sub-Saharan Africa performed worst. Bangladesh, Brazil, Costa Rica, Ecuador, Kyrgyzstan, and Peru performed significantly better on all care cascade steps than predicted based on GDP per capita. Being a woman, older, more educated, wealthier, and not being a current smoker were all positively associated with attaining each of the four steps of the care cascade.
Our study provides important evidence for the design and targeting of health policies and service interventions for hypertension in LMICs. We show at what steps and for whom there are gaps in the hypertension care process in each of the 44 countries in our study. We also identified countries in each world region that perform better than expected from their economic development, which can direct policy makers to important policy lessons. Given the high disease burden caused by hypertension in LMICs, nationally representative hypertension care cascades, as constructed in this study, are an important measure of progress towards achieving universal health coverage.
Harvard McLennan Family Fund, Alexander von Humboldt Foundation
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