Association entre l’activité physique et la préhypertension/hypertension artérielle chez les adolescents

Introduction : L’hypertension artérielle est un problème majeur de santé publique. Dans la population adulte, environ 1,56 milliard sera atteint de cette pathologie en 2025 si rien n’est fait. Une brève période d’hypertension au cours du jeune âge augmente les risques d’hypertension à l’âge adulte. Agir positivement sur les facteurs de risque modifiables permet une meilleure prévention. La pratique de l’activité physique est depuis longtemps reconnue comme un moyen efficace de prévention chez les adultes. Objectif : L’objectif de la présente recherche est d’étudier entre l’association longitudinale de l’activité physique et la préhypertension/hypertension artérielle chez les adolescents. Méthode: La pression artérielle a été mesurée trois fois par des techniciens qualifiés durant les cinq premières années de suivi (1999-2005) chez 638 filles et 586 garçons de l’étude NICO. Une tension artérielle comprise entre le 90e et le 95e percentile en fonction de l’âge et du sexe est définie comme une préhypertension et celle située au-dessus du 95e percentile comme une hypertension. Chaque 3 mois, ces adolescents ont fourni des informations concernant leur pratique d’activité physique. L’association de l’activité physique et la préhypertension/hypertension artérielle chez les garçons et chez les filles a été estimé à l’aide de modèles marginaux. Résultats : Les analyses révèlent que chez les filles, la majorité des indicateurs d’activité physique étudiés apparait protectrice contre le développement de la préhypertension/hypertension artérielle et les résultats sont statistiquement significatifs sauf pour l’activité physique légère (ratio de cotes (RC) (95% intervalle de confiance) = 0,98 (0,86-1,12). Le RC de l’activité physique modérée est de 0,89 (0,80-0,98), celui de l’activité physique vigoureuse de 0,80 (0,65-0,98), celui de l’activité physique modérée à vigoureuse de 0,89 (0,81-0,98) et celui de la fréquence de l’activité physique = 0,78 (0,68-0,91). Aucun indicateur d’activité physique n’est statistiquement significatif chez les garçons. Conclusion: La pratique d’activité physique modérée ou modérée à vigoureuse est associée la préhypertension/hypertension artérielle uniquement chez les filles.Introduction: Hypertension is a major public health problem. If no action is taken, 1.56 billion adults will be diagnosed with this pathology by 2025. Even a brief period of hypertension at a young age increases the risk of hypertension in adulthood. Preventive intervention targeting modifiable risk factors is a viable route to better prevention, and the practice of physical activity has long been recognized as an effective means of preventing hypertension in adults. Objective: The objective of this research is to assess the longitudinal association between physical activity and prehypertension/hypertension in adolescents. Method: Blood pressure was measured three times by trained technicians during the first five years of follow-up (1999-2005) in 638 girls and 586 boys participating in the Nicotine Dependence in Teens (NDIT) Study. BP between the age- and sex-specific 90th and 95th percentile was defined as prehypertension; BP above the 95th percentile was defined as hypertension. Every three months, adolescents provided data on their practice of physical activity. The association between physical activity and prehypertension/hypertension among boys and girls was estimated using marginal models. Results: In girls, all physical activity indicators except light physical activity (odds ratio (OR) (95% confidence interval) = 0.98 (0.86-1.12)) were statistically significantly protective against prehypertension/hypertension; OR for moderate physical activity = 0.89 (0.80-0.98); OR for vigorous physical activity = 0.80 (0.65-0.98); OR for moderate-to-vigorous physical activity = 0.89 (0.81-0.98); OR for frequency of physical activity = 0.78 (0.68-0.91). None of the physical activity indicators were significant among boys. Conclusion: The practice of moderate or moderate-to-vigorous physical activity is associated with protection against prehypertension/hypertension, in girls but not boys

What happens when performance-based financing meets free healthcare? Evidence from an interrupted time-series analysis.

In spite of the wide attention performance-based financing (PBF) has received over the past decade, no evidence is available on its impacts on quantity and mix of service provision nor on its interaction with parallel health financing interventions. Our study aimed to examine the PBF impact on quantity and mix of service provision in Burkina Faso, while accounting for the parallel introduction of a free healthcare policy. We used Health Management Information System data from 838 primary-level health facilities across 24 districts and relied on an interrupted time-series analysis with independent controls. We placed two interruptions, one to account for PBF and one to account for the free healthcare policy. In the period before the free healthcare policy, PBF produced significant but modest increases across a wide range of maternal and child services, but a significant decrease in child immunization coverage. In the period after the introduction of the free healthcare policy, PBF did not affect service provision in intervention compared with control facilities, possibly indicating a saturation effect. Our findings indicate that PBF can produce modest increases in service provision, without altering the overall service mix. Our findings, however, also indicate that the introduction of other health financing reforms can quickly crowd out the effects produced by PBF. Further qualitative research is required to understand what factors allow healthcare providers to increase the provision of some, but not all services and how they react to the joint implementation of PBF and free health care

Qualitative evaluation of a knowledge transfer training programme in maternal and child health in Burkina Faso, West Africa

The study evaluated a first session of the knowledge transfer training programme organised for Ministry of Health workers in the area of maternal and child health in Burkina Faso. The objective was to obtain the participant’s perceptive for improving the training programme. A qualitative study was conducted during and after the first training session, using the four levels of Kirkpatrick training evaluation framework. A group discussion was organised with 17 participants during the training and a few weeks after the first training session, 11 of them were interviewed again. A thematic analysis of the transcribed interviews was done in line with the objectives of the evaluation. We noted that the participants had a good impression of the training, in relation to their expectations, the adequacy and quality of the teaching. The 11 post-training interviewees stated that they had acquired knowledge and skills relevant to their work. Using the learner's behavioural change model, three groups emerged as a result of the  training. The first group expressed intent to use the knowledge gained, the second group set conditions for the effective application of the knowledge acquired, including the enabling professional environment. While the third group felt that despite the knowledge and skills they had acquired, they would need assistance with the applying the skills at their jobs. In conclusion, the training improved the capacity and skills of health workers, but an enabling professional environment and support will facilitate the application of knowledge. Keywords: Qualitative evaluation, Knowledge Transfer, Maternal and Child Healt

Malaria in Burkina Faso: A comprehensive analysis of spatiotemporal distribution of incidence and environmental drivers, and implications for control strategies

International audienceBackground The number of malaria cases worldwide has increased, with over 241 million cases and 69,000 more deaths in 2020 compared to 2019. Burkina Faso recorded over 11 million malaria cases in 2020, resulting in nearly 4,000 deaths. The overall incidence of malaria in Burkina Faso has been steadily increasing since 2016. This study investigates the spatiotemporal pattern and environmental and meteorological determinants of malaria incidence in Burkina Faso. Methods We described the temporal dynamics of malaria cases by detecting the transmission periods and the evolution trend from 2013 to 2018. We detected hotspots using spatial scan statistics. We assessed different environmental zones through a hierarchical clustering and analyzed the environmental and climatic data to identify their association with malaria incidence at the national and at the district’s levels through generalized additive models. We also assessed the time lag between malaria peaks onset and the rainfall at the district level. The environmental and climatic data were synthetized into indicators. Results The study found that malaria incidence had a seasonal pattern, with high transmission occurring during the rainy seasons. We also found an increasing trend in the incidence. The highest-risk districts for malaria incidence were identified, with a significant expansion of high-risk areas from less than half of the districts in 2013–2014 to nearly 90% of the districts in 2017–2018. We identified three classes of health districts based on environmental and climatic data, with the northern, south-western, and western districts forming separate clusters. Additionally, we found that the time lag between malaria peaks onset and the rainfall at the district level varied from 7 weeks to 17 weeks with a median at 10 weeks. Environmental and climatic factors have been found to be associated with the number of cases both at global and districts levels. Conclusion The study provides important insights into the environmental and spatiotemporal patterns of malaria in Burkina Faso by assessing the spatio temporal dynamics of Malaria cases but also linking those dynamics to the environmental and climatic factors. The findings highlight the importance of targeted control strategies to reduce the burden of malaria in high-risk areas as we found that Malaria epidemiology is complex and linked to many factors that make some regions more at risk than others

Intensity and frequency of physical activity and high blood pressure in adolescents: A longitudinal study

Despite limited evidence on the association between physical activity (PA) and blood pressure (BP) in youth, experts recommend that adolescents engage regularly in moderate-to-vigorous PA. We examined the relationships between PA intensity and frequency and the likelihood of having high BP in a population-based cohort of adolescents from Montreal, Canada. PA was self-reported every 3 months from grade 7 to 11, and BP was measured at ages 12.8, 15.2, and 17.0 years on average. We analyzed data from 993 participants (mean [SD] age = 16.0 [1.0], 51.6% female) with BP data at ages 15.2 and/or 17.0 years, using pooled ordinal logistic regression. BP (normal/elevated/hypertensive range) was the outcome, and past-year PA intensity and frequency were potential predictors. Eight percent of participants had elevated BP (120-129/ \u3c 80), and 3.2% had BP in the hypertensive range ( \u3e /=130/ \u3e /=80). Participants engaged in a median (interquartile range) of 7.0 (4.5, 9.3) and 5.5 (2, 10.8) moderate and vigorous PA sessions/week, respectively. After adjusting for age, sex, mother\u27s education, use of alcohol and cigarette consumption, engaging in PA more intense than light during the previous year was associated with a lower odds of having BP in the hypertensive range (ORs [95% CIs] = 0.93 [0.88, 0.97] to 0.97 [0.94, 0.99]). The relationships were not altered by adjusting for BMI. Our findings support recommendations that adolescents engage in at least moderate PA on a regular basis to prevent development of BP in the hypertensive range

Spatio-temporal analysis and prediction of malaria cases using remote sensing meteorological data in Diébougou health district, Burkina Faso, 2016–2017

International audienceMalaria control and prevention programs are more efficient and cost-effective when they target hotspots or select the best periods of year to implement interventions. This study aimed to identify the spatial distribution of malaria hotspots at the village level in Diébougou health district, Burkina Faso, and to model the temporal dynamics of malaria cases as a function of meteorological conditions and of the distance between villages and health centres (HCs). Case data for 27 villages were collected in 13 HCs. Meteorological data were obtained through remote sensing. Two synthetic meteorological indicators (SMIs) were created to summarize meteorological variables. Spatial hotspots were detected using the Kulldorf scanning method. A General Additive Model was used to determine the time lag between cases and SMIs and to evaluate the effect of SMIs and distance to HC on the temporal evolution of malaria cases. The multivariate model was fitted with data from the epidemic year to predict the number of cases in the following outbreak. Overall, the incidence rate in the area was 429.13 cases per 1000 person-year with important spatial and temporal heterogeneities. Four spatial hotspots, involving 7 of the 27 villages, were detected, for an incidence rate of 854.02 cases per 1000 person-year. The hotspot with the highest risk (relative risk = 4.06) consisted of a single village, with an incidence rate of 1750.75 cases per 1000 person-years. The multivariate analysis found greater variability in incidence between HCs than between villages linked to the same HC. The time lag that generated the better predictions of cases was 9 weeks for SMI1 (positively correlated with precipitation variables) and 16 weeks for SMI2 (positively correlated with temperature variables. The prediction followed the overall pattern of the time series of reported cases and predicted the onset of the following outbreak with a precision of less than 3 weeks. This analysis of malaria cases in Diébougou health district, Burkina Faso, provides a powerful prospective method for identifying and predicting high-risk areas and high-transmission periods that could be targeted in future malaria control and prevention campaigns

Impact of seasonal malaria chemoprevention on prevalence of malaria infection in malaria indicator surveys in Burkina Faso and Nigeria.

BACKGROUND: In 2012, the WHO issued a policy recommendation for the use of seasonal malaria chemoprevention (SMC) to children 3–59 months in areas of highly seasonal malaria transmission. Clinical trials have found SMC to prevent around 75% of clinical malaria. Impact under routine programmatic conditions has been assessed during research studies but there is a need to identify sustainable methods to monitor impact using routinely collected data. METHODS: Data from Demographic Health Surveys were merged with rainfall, geographical and programme data in Burkina Faso (2010, 2014, 2017) and Nigeria (2010, 2015, 2018) to assess impact of SMC. We conducted mixed-effects logistic regression to predict presence of malaria infection in children aged 6–59 months (rapid diagnostic test (RDT) and microscopy, separately). RESULTS: We found strong evidence that SMC administration decreases odds of malaria measured by RDT during SMC programmes, after controlling for seasonal factors, age, sex, net use and other variables (Burkina Faso OR 0.28, 95% CI 0.21 to 0.37, p<0.001; Nigeria OR 0.40, 95% CI 0.30 to 0.55, p<0.001). The odds of malaria were lower up to 2 months post-SMC in Burkina Faso (1-month post-SMC: OR 0.29, 95% CI 0.12 to 0.72, p=0.01; 2 months post-SMC: OR: 0.33, 95% CI 0.17 to 0.64, p<0.001). The odds of malaria were lower up to 1 month post-SMC in Nigeria but was not statistically significant (1-month post-SMC 0.49, 95% CI 0.23 to 1.05, p=0.07). A similar but weaker effect was seen for microscopy (Burkina Faso OR 0.38, 95% CI 0.29 to 0.52, p<0.001; Nigeria OR 0.53, 95% CI 0.38 to 0.76, p<0.001). CONCLUSIONS: Impact of SMC can be detected in reduced prevalence of malaria from data collected through household surveys if conducted during SMC administration or within 2 months afterwards. Such evidence could contribute to broader evaluation of impact of SMC programmes

Enhanced effect of seasonal malaria chemoprevention when coupled with nutrients supplementation for preventing malaria in children under 5 years old in Burkina Faso: a randomized open label trial

Background In rural African settings, most of the children under the coverage of Seasonal Malaria Chemoprevention (SMC) are also undernourished at the time of SMC delivery, justifying the need for packaging malarial and nutritional interventions. This study aimed at assessing the impact of SMC by coupling the intervention with nutrients supplementation for preventing malaria in children less than 5 years old in Burkina Faso.Methods A randomized trial was carried out between July 2020 and June 2021 in the health district of Nanoro, Burkina Faso. Children (n = 1059) under SMC coverage were randomly assigned to one of the three study arms SMC + Vitamin A (SMC-A, n = 353) or SMC + Vitamin A + Zinc (SMC-AZc, n = 353) or SMC + Vitamin A + PlumpyDoz(tm) (SMC-APd, n = 353)-a medium quantity—lipid-based nutrient supplement (MQ-LNS). Children were followed up for one year that included an active follow-up period of 6 months with scheduled monthly home visits followed by 6 months passive follow-up. At each visit, capillary blood sample was collected for malaria diagnosis by rapid diagnosis test (RDT).Results Adding nutritional supplements to SMC had an effect on the incidence of malaria. A reduction of 23% (adjusted IRR = 0.77 (95%CI 0.61–0.97) in the odds of having uncomplicated malaria in SMC-APd arm but not with SMC-AZc arm adjusted IRR = 0.82 (95%CI 0.65–1.04) compare to control arm was observed. A reduction of 52%, adjusted IRR = 0.48 (95%CI 0.23–0.98) in the odds of having severe malaria was observed in SMC-APd arm compared to control arm. Besides the effect on malaria, this combined strategy had an effect on all-cause morbidity. More specifically, a reduction of morbidity odds of 24%, adjusted IRR = 0.76 (95%CI 0.60–0.94) in SMC-APd arm compared to control arm was observed. Unlike clinical episodes, no effect of nutrient supplementation on cross sectional asymptomatic infections was observed.Conclusion Adding nutritional supplements to SMC significantly increases the impact of this intervention for preventing children from malaria and other childhood infections. Trial registration : NCT04238845

The use of video job-aids to improve the quality of seasonal malaria chemoprevention delivery

Mobile phones are increasingly used in community health programmes, but the use of video job-aids that can be displayed on smart phones has not been widely exploited. We investigated the use of video job-aids to support the delivery of seasonal malaria chemoprevention (SMC) in countries in West and Central Africa. The study was prompted by the need for training tools that could be used in a socially distanced manner during the COVID-19 pandemic. Animated videos were developed in English, French, Portuguese, Fula and Hausa, illustrating key steps for administering SMC safely, including wearing masks, washing hands, and social distancing. Through a consultative process with the national malaria programmes of countries using SMC, successive versions of the script and videos were reviewed to ensure accurate and relevant content. Online workshops were held with programme managers to plan how to use the videos in SMC staff training and supervision, and the use of the videos was evaluated in Guinea through focus groups and in-depth interviews with drug distributors and other staff involved in SMC delivery and through direct observations of SMC administration. Programme managers found the videos useful as they reinforce messages, can be viewed at any time and repeatedly, and when used during training sessions, provide a focus of discussion and support for trainers and help retain messages. Managers requested that local specificities of SMC delivery in their setting be included in tailored versions of the video for their country, and videos were required to be narrated in a variety of local languages. In Guinea, SMC drug distributors found the video covered the all the essential steps and found the video easy to understand. However, not all key messages were followed as some of the safety measures, social distancing and wearing masks, were perceived by some as creating mistrust amongst communities. Video job-aids can potentially provide an efficient means of reaching large numbers of drug distributors with guidance for safe and effective distribution of SMC. Not all distributors use android phones, but SMC programmes are increasingly providing drug distributors with android devices to track delivery, and personal ownership of smartphones in sub-Saharan Africa is growing. The use of video job-aids for community health workers to improve the quality delivery of SMC, or of other primary health care interventions, should be more widely evaluated

The use of video job-aids to improve the quality of seasonal malaria chemoprevention delivery

Mobile phones are increasingly used in community health programmes, but the use of video job-aids that can be displayed on smart phones has not been widely exploited. We investigated the use of video job-aids to support the delivery of seasonal malaria chemoprevention (SMC) in countries in West and Central Africa. The study was prompted by the need for training tools that could be used in a socially distanced manner during the COVID-19 pandemic. Animated videos were developed in English, French, Portuguese, Fula and Hausa, illustrating key steps for administering SMC safely, including wearing masks, washing hands, and social distancing. Through a consultative process with the national malaria programmes of countries using SMC, successive versions of the script and videos were reviewed to ensure accurate and relevant content. Online workshops were held with programme managers to plan how to use the videos in SMC staff training and supervision, and the use of the videos was evaluated in Guinea through focus groups and in-depth interviews with drug distributors and other staff involved in SMC delivery and through direct observations of SMC administration. Programme managers found the videos useful as they reinforce messages, can be viewed at any time and repeatedly, and when used during training sessions, provide a focus of discussion and support for trainers and help retain messages. Managers requested that local specificities of SMC delivery in their setting be included in tailored versions of the video for their country, and videos were required to be narrated in a variety of local languages. In Guinea, SMC drug distributors found the video covered the all the essential steps and found the video easy to understand. However, not all key messages were followed as some of the safety measures, social distancing and wearing masks, were perceived by some as creating mistrust amongst communities. Video job-aids can potentially provide an efficient means of reaching large numbers of drug distributors with guidance for safe and effective distribution of SMC. Not all distributors use android phones, but SMC programmes are increasingly providing drug distributors with android devices to track delivery, and personal ownership of smartphones in sub-Saharan Africa is growing. The use of video job-aids for community health workers to improve the quality delivery of SMC, or of other primary health care interventions, should be more widely evaluated