Prévalence de l’anémie chez les enfants malnutris de 6 à 59 mois hospitalisés au CHD/Zou-Collines dans le plateau d’Abomey (Centre du Bénin)

L’anémie constitue un grand problème de santé publique associée à un risque accru de morbidité et de mortalité, surtout pour les femmes  enceintes et les jeunes enfants. L’objectif de cette étude est de cerner la prévalence de l’anémie chez les enfants de moins de 5 ans malnutris hospitalisés dans le service de pédiatrie du Centre Hospitalier  Départemental/Zou-Collines. Il s’agit d’une étude prospective, descriptive et analytique sur une période de six (6) mois porté sur 251 enfants malnutris hospitalisés et leurs mères. Il ressort de notre étude que 41,43% des enfants sont anémiés et que la prévalence de l’anémie est beaucoup plus  remarquable chez les enfants de moins 24 mois. Par ailleurs, 55,8% des enfants souffrent d’une anémie sévère. La principale cause de l’anémie reste la carence en  fer (78,80%). La mauvaise pratique de sevrage, l’insuffisance de consommation des aliments riches en fer biodisponible et des fruits seraient les facteurs mis en  cause dans l’avènement de l’anémie nutritionnelle au sein de la population étudiée. Il urge de mener des stratégies de lutte préventive en matière de soins de santé  primaire, d’intensification des campagnes d’information, d’éducation et de sensibilisation des populations par rapport aux pratiques  d’allaitement maternel  exclusif, à la diversification alimentaire et de conseil aux mères sur les avantages des surveillances pédiatriques.Mots clés : Bénin, enfants malnutris, anémie, carence en fer, pratique de sevrage

Prevalence de la malnutrition aigue chez les enfants de moins de cinq ans dans la plaine de Pendjari au nordouest du Benin

L’évaluation de l’état nutritionnel de 600 enfants de moins de 5 ans à prédominance féminine (sex-ratio 1,1) de la plaine de Pendjari (Tanguiéta, Matéri et Cobly) et l’analyse des réponses aux questions à l’endroit de leurs mères respectives, ont permis de mieux apprécier la situation nutritionnelle des enfants de cette zone d’étude et d’identifier les déterminants associés à cette malnutrition. Il ressort de cette étude que 53% des enfants ont un retard de croissance 34% souffrent de la  malnutrition aigüe globale et 86% ont une insuffisance pondérale. 91,2%  des enfants enquêtés reçoivent une alimentation complémentaire  inadéquate à base de céréales. ; 41,6% des domiciles dans lesquels vivent les ménages des enfants sont à une distance de 5 km des centres de santé, la totalité des mères des enfants n’ont aucun niveau  d’instruction. D’après nos résultats, la mauvaise pratique de sevrage, les maladies et le faible niveau d’instruction des mères sont les déterminants associés de la malnutrition observée au sein de la population d’étude dans cette zone de nord-ouest du Bénin.Mots clés : plaine de Pendjari, malnutrition aigue globale, retard de croissance, insuffisance pondérale, sevrage The estimate of the nutritional state of 600 children under five in the Pendjari plain (Tanguiéta, Matéri et Cobly) and the analysis of the answers to the questions asked to their respective mothers have permitted to better appreciate the nutritional situation of the children in the investigation zone and to identify the determinants which are associated to that 53% of the children suffer from slow development, 34% suffer fromacute global malnutrition and 86% suffer from insufficient indices to weight. 91.2% of the inquired children receive an inadequate complementary feeding based on cereals. According to our results, the wrong weaning practices, the diseases, the consumption of familial diet poor in nutritious substances and the low level of education are the factors that favour the malnutrition of children under five in that zone of Benin’s North-west.Keywords: Pendjari plain, acute global malnutrition, slow development, insufficient indice to weight, weaning

Climate vulnerability mapping: A systematic review and future prospects

Maps synthesizing climate, biophysical and socioeconomic data have become part of the standard tool-kit for communicating the risks of climate change to society. Vulnerability maps are used to direct attention to geographic areas where impacts on society are expected to be greatest and that may therefore require adaptation interventions. Under the Green Climate Fund and other bilateral climate adaptation funding mechanisms, donors are investing billions of dollars of adaptation funds, often with guidance from modelling results, visualized and communicated through maps and spatial decision support tools. This paper presents the results of a systematic review of 84 studies that map social vulnerability to climate impacts. These assessments are compiled by interdisciplinary teams of researchers, span many regions, range in scale from local to global, and vary in terms of frameworks, data, methods, and thematic foci. The goal is to identify common approaches to mapping, evaluate their strengths and limitations, and offer recommendations and future directions for the field. The systematic review finds some convergence around common frameworks developed by the Intergovernmental Panel on Climate Change, frequent use of linear index aggregation, and common approaches to the selection and use of climate and socioeconomic data. Further, it identifies limitations such as a lack of future climate and socioeconomic projections in many studies, insufficient characterization of uncertainty, challenges in map validation, and insufficient engagement with policy audiences for those studies that purport to be policy relevant. Finally, it provides recommendations for addressing the identified shortcomings

PrEP implementation research in Africa: what is new?

Introduction: Of the two million new HIV infections in adults in 2014, 70% occurred in sub-Saharan Africa. Several African countries have already approved guidelines for pre-exposure prophylaxis (PrEP) for individuals at substantial risk of HIV as part of combination HIV prevention but key questions remain about how to identify and deliver PrEP to those at greatest need. Throughout the continent, individuals in sero-discordant relationships, and members of key populations (sex workers, men who have sex with men (MSM), transgender women and injection drug users) are likely to benefit from the availability of PrEP. In addition, adolescent girls and young women (AGYW) are at substantial risk in some parts of the continent. It has been estimated that at least three million individuals in Africa are likely to be eligible for PrEP according to WHO's criteria. Tens of demonstration projects are planned or underway across the continent among a range of countries, populations and delivery settings. Discussion: In each of the target populations, there are overarching issues related to (i) creating demand for PrEP, (ii) addressing supply-side issues and (iii) providing appropriate and tailored adherence support. Critical for creating demand for PrEP is the normalization of HIV prevention. Community-level interventions which engage opinion leaders as well as empowerment interventions for those at highest risk will be key. Critical to supply of PrEP is that services are accessible for all, including for stigmatized populations. Establishing accessible integrated services provides the opportunity to address other public health priorities including the unmet need for HIV testing, contraception and sexually transmitted infections treatment. National policies need to include minimum standards for training and quality assurance for PrEP implementation and to address supply chain issues. Adherence support needs to recognize that social and structural factors are likely to have an important influence. Combining interventions that build self-efficacy, empowerment and social cohesion, with evidence-based individualized adherence support for PrEP, are most likely to be effective. Conclusions: Efficacy of tenfovir-based PrEP is proven but many issues related to implementation remain unclear. Here, we have summarized some of the important implementation questions that need to be assessed as PrEP is rolled out across Africa

Adaptation of the Wound Healing Questionnaire universal-reporter outcome measure for use in global surgery trials (TALON-1 study): mixed-methods study and Rasch analysis

BackgroundThe Bluebelle Wound Healing Questionnaire (WHQ) is a universal-reporter outcome measure developed in the UK for remote detection of surgical-site infection after abdominal surgery. This study aimed to explore cross-cultural equivalence, acceptability, and content validity of the WHQ for use across low- and middle-income countries, and to make recommendations for its adaptation.MethodsThis was a mixed-methods study within a trial (SWAT) embedded in an international randomized trial, conducted according to best practice guidelines, and co-produced with community and patient partners (TALON-1). Structured interviews and focus groups were used to gather data regarding cross-cultural, cross-contextual equivalence of the individual items and scale, and conduct a translatability assessment. Translation was completed into five languages in accordance with Mapi recommendations. Next, data from a prospective cohort (SWAT) were interpreted using Rasch analysis to explore scaling and measurement properties of the WHQ. Finally, qualitative and quantitative data were triangulated using a modified, exploratory, instrumental design model.ResultsIn the qualitative phase, 10 structured interviews and six focus groups took place with a total of 47 investigators across six countries. Themes related to comprehension, response mapping, retrieval, and judgement were identified with rich cross-cultural insights. In the quantitative phase, an exploratory Rasch model was fitted to data from 537 patients (369 excluding extremes). Owing to the number of extreme (floor) values, the overall level of power was low. The single WHQ scale satisfied tests of unidimensionality, indicating validity of the ordinal total WHQ score. There was significant overall model misfit of five items (5, 9, 14, 15, 16) and local dependency in 11 item pairs. The person separation index was estimated as 0.48 suggesting weak discrimination between classes, whereas Cronbach's α was high at 0.86. Triangulation of qualitative data with the Rasch analysis supported recommendations for cross-cultural adaptation of the WHQ items 1 (redness), 3 (clear fluid), 7 (deep wound opening), 10 (pain), 11 (fever), 15 (antibiotics), 16 (debridement), 18 (drainage), and 19 (reoperation). Changes to three item response categories (1, not at all; 2, a little; 3, a lot) were adopted for symptom items 1 to 10, and two categories (0, no; 1, yes) for item 11 (fever).ConclusionThis study made recommendations for cross-cultural adaptation of the WHQ for use in global surgical research and practice, using co-produced mixed-methods data from three continents. Translations are now available for implementation into remote wound assessment pathways