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Makali SL, St Louis P, Karemere H, Wautié A, Pavignani E, Eboma CM, Bigirinama R, Lembebu C, Porignon D, Balaluka GB, Donnen P, Paul E. Exploring the inherent resilience of health districts in a context of chronic armed conflict: a case study in Eastern Democratic Republic of the Congo. Health Res Policy Syst 2024; 22:175. [PMID: 39719595 DOI: 10.1186/s12961-024-01252-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2024] [Accepted: 11/16/2024] [Indexed: 12/26/2024] Open
Abstract
BACKGROUND In South Kivu (Eastern Democratic Republic of the Congo [DRC]), health districts (HDs) affected by chronic armed conflicts are devising coping mechanisms to continue offering healthcare services to the population. Nonetheless, this alone does not suffice to make them fully resilient to such conflicts. This study aims to explore the characteristics of these HDs' resilience. METHODS This study uses mixed methods (triangulation) and an extreme case study design to compare a HD with no history of armed conflict (Idjwi, Case 1) and another one experiencing armed conflict (Fizi, Case 2) in South Kivu. The Kruk et al. (BMJ 23:357, 2017) index was employed as a theoretical framework for exploring resilience characteristics. Qualitative data were collected through a document review using a pre-set review grid and semi-structured individual interviews with purposively sampled key stakeholders. They were subjected to deductive-inductive thematic analysis. Quantitative data were collected using a Likert scale questionnaire (administered to stakeholders in the selected HDs using non-probabilistic methods - purposive and snowball sampling). These data were subsequently analysed for comparative descriptive purposes. RESULTS Recurring short-term shocks as well as chronic stress factors whether or not linked to chronic armed conflicts were identified. According to most respondents (> 98%), essential components of a resilient HDs were prior knowledge of the strengths and weaknesses as well as the public health risk posed by the crisis (awareness), together with community and non-health actors' involvement during the crisis (Integration). Common resilience mechanisms (e.g. epidemic management plan, crisis management committee) were identified, and Case 2 implemented additional mechanisms, including DRC armed forces involvement, community healthcare sites and mobile clinics, specific warning system, and regular socio-demographic monitoring of displaced persons alongside promotion of activities for social cohesion strengthening. CONCLUSIONS For meaningful resilience to emerge, HDs must be better resourced in "normal" times. If this condition is fulfilled, quality of care could improve and spare capacity could be created to withstand disturbances.
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Ngaboyeka G, Bisimwa G, Neven A, Mwene-Batu P, Kambale R, Ongezi E, Chimanuka C, Ntagerwa J, Balolebwami S, Mulume F, Battisti O, Dramaix M, Donnen P. Arm circumference for age, arm circumference and weight-for-height z-score for the evaluation of severe acute malnutrition: a retrospective cohort study in eastern Democratic Republic of Congo. BMC Public Health 2024; 24:587. [PMID: 38395784 PMCID: PMC10885520 DOI: 10.1186/s12889-024-18083-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 02/12/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Little is known about the use of mid-upper arm circumference for age (MUACZ) for diagnosing of severe acute malnutrition (SAM) and its correlation with WHZ (weight-for-height Z-score) in an area endemic for severe acute malnutrition (SAM) and with a high prevalence of kwashiorkor. Our study aims to analyze the concordance between the diagnostic criteria of SAM in a region presenting these characteristics. METHODS We analyzed a database of children admitted from 1987 to 2008 for the management of SAM in Eastern Democratic Republic of Congo. Anthropometric indicators (z-score) were calculated and classified into 3 categories according to WHO standards. Cohen's kappa coefficient (κ) was calculated to assess the concordance between these indicators. RESULTS Out of the 9969 selected children aged 6 to 59 months, 30.2% had nutritional edema, 70.1% had a height-for-age (HAZ) z-score <-2, 11.5% WHZ<-3 z-score, 14.9% had a MUAC < 115 mm and 21.8% had a MUACZ <-3 z-score. With the classic combination WHZ and MUAC, 36% of children with SAM had both criteria at the same time and MUAC alone being the indicator that recruited more children with SAM (77%) compared with 65% with WHZ only. By replacing MUAC with MUACZ, 34% of SAM children fulfilled both criteria, WHZ and MUACZ. MUACZ alone recruited more children with SAM (88%) compared with 46% with WHZ alone. Considering these three indicators together, MUACZ remained the indicator that recruited more children with SAM (85%). WHZ and MUAC showed a moderate agreement [ κ (95% CI) = 0.408(0.392-0.424)], WHZ and MUACZ a weak agreement [ κ (95% CI) = 0.363(0.347-0.379)] and MUAC and MUACZ a good agreement [ κ (95% CI) = 0.604 (0.590-0.618)]. CONCLUSION Adjusting MUAC according to age improves its effectiveness in identifying severe acute malnutrition. With low concordance, MUAC and WHZ remain complementary in our context. MUACZ proves to be crucial, especially in the presence of kwashiorkor and chronic malnutrition, becoming a valuable tool for assessing severe acute malnutrition in our context.
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Lingani M, Zango SH, Valéa I, Samadoulougou S, Sanou MA, Sorgho H, Sawadogo E, Dramaix M, Donnen P, Annie R, Tinto H. Prevalence and determinants of anaemia among pregnant women in a high malaria transmission setting: a cross-sectional study in rural Burkina Faso. Pan Afr Med J 2024; 47:2. [PMID: 38371648 PMCID: PMC10870159 DOI: 10.11604/pamj.2024.47.2.40612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 10/21/2023] [Indexed: 02/20/2024] Open
Abstract
Introduction anemia, the commonest nutritional deficiency disorder among pregnant women in sub-Saharan Africa, is associated with severe peripartum complications. Its regular monitoring is necessary to timely inform clinical and preventive decision-making. The aim of this study was to assess the prevalence and determinants of anemia among pregnant women in rural areas of Burkina Faso. Methods between August 2019 and March 2020, a cross-sectional study was conducted to collect maternal sociodemographic, gynaeco-obstetric, and medical characteristics by face-to-face interview or by review of antenatal care books. In addition, maternal malaria was diagnosed by standard microscopy and the hemoglobin levels (Hb) measured by spectrophotometry. The proportion of anaemia (Hb<11.0 g/dL), moderate (7.0 Results of 594 pregnant women assessed, the mean hemoglobin level (± standard deviation) was 10.7 (±0.1) g/dL, and the prevalence of anemia was 54.4% (323/594). The proportion of moderate, and severe anemia among pregnant women was 49.2% (95% CI: 45.1%-53.2%), and 5.2% (95% CI: 3.7%-7.3%) respectively. Multivariate analysis showed that the young maternal age (<20 years old) (adjusted OR (aOR): 1.5, 95% CI: 1.1-2.3) and the presence of malaria (aOR: 2.0, 95% CI: 1.3-3.2) were independently associated with the presence of maternal anemia. Conclusion anemia remains common in the study setting and interventions to strengthen malaria prevention in pregnancy, particularly among young adolescent pregnant women, are required to prevent maternal anemia.
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Manzo ML, Doudou Halidou M, Dramaix Wilmet M, Donnen P. Trends in malnutrition among children under 5 in Niger: a retrospective analysis of demographic and nutrition surveys comparing 2008-2014 with 2015-2021. Public Health 2023; 225:151-159. [PMID: 37925840 DOI: 10.1016/j.puhe.2023.09.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 09/12/2023] [Accepted: 09/28/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVES For decades, Niger, a Sahelian country in Africa, has faced serious food and nutrition crises. Policies and strategies have been implemented by the Government, with the support of its partners, to address this public health problem. The current study was conducted to assess trends in malnutrition among children under 5 years of age. By comparing results from 2008 to 2014 with results from 2015 to 2021, this study aimed to check the efficacy of strategies and policies that were implemented to combat malnutrition. STUDY DESIGN Retrospective study. METHODS Data from the annual nutrition survey Standardized Monitoring and Assessment of Relief and Transitions and the Demographic and Health and Multiple Indicator Surveys were used. Meta-analyses were performed on the data as a whole and in each age group by time period. For analysis of age groups, the 95% confidence interval (CI) data were missing, thus an estimate was made from the 'design effect' calculated based on existing CIs. RESULTS Institutional arrangements had not changed from 2008 to 2014 to 2015-2021, and there were very few changes to existing strategies and policies. The prevalence of Global Acute Malnutrition and Global Chronic Malnutrition (GCM) both remained above critical thresholds for each year in both periods. GCM was above the emergency threshold for both periods, indicating that all regions of the country were affected by malnutrition. The most populated regions (40%) of Maradi and Zinder were the most affected by malnutrition. These two regions also had highest incidence of poverty and the least health service coverage. CONCLUSIONS Despite the implementation of various policies and strategies, the nutritional status of children under 5 remains an important public health problem.
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Bedha A, Shindano T, Hermans MP, Havelange V, Makali S, Minani J, Ngaboyeka G, Kunaba E, Donnen P, Dramaix M, Bisimwa G, Mwene-Batu P. Association between severe acute malnutrition in childhood and hematological disorders in adulthood: the Lwiro follow-up study in the Eastern Democratic Republic of the Congo. BMC Nutr 2023; 9:128. [PMID: 37951995 PMCID: PMC10638766 DOI: 10.1186/s40795-023-00783-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 10/19/2023] [Indexed: 11/14/2023] Open
Abstract
BACKGROUND Despite growing evidence on the short-term deleterious effects of severe acute malnutrition (SAM) in childhood on hematopoiesis, little is known about the long-term hematological effects of SAM in low-income countries (LICs). Our study explored the association between childhood SAM and hematological disorders in adults 11 to 30 years after post-SAM nutritional rehabilitation. METHODS This follow up study investigated 97 adults (mean age 32 years) treated for SAM during childhood in eastern Democratic Republic of the Congo (DRC) between 1988 and 2007. Participants were compared to 97 aged- and sex-matched adult controls living in the same community with no history of SAM. Outcomes of interest were hematological characteristics and disorders in adulthood, assessed by various biological markers. Logistic and linear regression models were used to estimate the association between SAM in childhood and risk of hematological abnormalities. RESULTS Compared to the unexposed, the exposed had higher mean white blood cells (/μl) [+ 840 (179 to 1501), p = 0.013], neutrophils [+ 504 (83 to 925), p = 0.019] and platelets (*103) [11.9 (8.1 to 17.9), p = 0.038] even after adjustment for food consumption in adulthood. No difference was observed in red blood cells (RBC), hemoglobin and erythrocytes parameters. With regard to the risk of hematological disorders, in contrast to the unexposed, exposed subjects had a risk of leukocytosis approximately three times higher [adjusted OR (95% CI): 2.98 (1.01 to 8.79), p = 0.048]. No difference was observed in terms of anemia, leukopenia, increased platelets and thrombocytopenia between the 2 groups. CONCLUSION Adults with a history of SAM in childhood have hematological characteristics that would be markers associated with chronic low-grade inflammatory or infectious diseases in an environment with no nutritional transition. Larger cohort studies with bone marrow analyses could provide further understanding of the impact of SAM on the overall hematological profile in adult life.
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Lwamushi SM, karemere H, Banywesize R, Eboma CM, Mwene-Batu P, Lembebu C, Ferrari G, Paul E, Balaluka GB, Donnen P. Adaptive Mechanisms of Health Zones to Chronic Traumatic Events in Eastern DRC: A Multiple Case Study. Int J Health Policy Manag 2023; 12:8001. [PMID: 38618784 PMCID: PMC10699820 DOI: 10.34172/ijhpm.2023.8001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 09/30/2023] [Indexed: 04/16/2024] Open
Abstract
BACKGROUND The Eastern part of the Democratic Republic of Congo (DRC) has been affected by armed conflict for several years. Despite the growing interest in the impact of these conflicts on health service utilisation, few studies have addressed the coping mechanisms of the health system. The purpose of this study is to describe the traumatic events and coping mechanisms used by the health zones (HZs) in conflict settings to maintain good performance. METHODS This multiple case study took place from July to October 2022 in four HZs in the South Kivu Province of DRC. HZs were classified into "cases" according to their conflict profile: accessible and stable (Case 1), accessible but remote (Case 2), unstable (Case 3), and intermediate (Case 4). Eight performance indicators and the amount of funding provided to the HZs by non-governmental organizations (NGOs) were recorded. A graph was created to compare their evolution from 2013 to 2018. A thematic analysis of qualitative data from individual interviews with selected health workers was conducted. RESULTS Both battle-related events (war and its effects) and non-battle-related events (epidemics, disasters, strikes) were recorded according to the case conflict-profile. Although the cases (3 and 4) most affected by armed conflicts occasionally performed better than the stable ones (1 and 2), their operational action plan was poorly carried out. The coping mechanisms developed in cases 3 and 4 were the deployment of military nurses in preventive and supervisory activities, the solicitations of subsidies from NGOs, the relocation of health care facilities and the implementation of negotiation strategies with the belligerents. CONCLUSION Armed conflict results in traumatic events that disrupt the execution of the operational action plan of HZs. The HZs' management team expertise, its strong leadership, and substantial financial support would enable this system to develop reliable and sustainable adaptive mechanisms.
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Hoogstoel F, Samadoulougou S, Diouf A, Savoye I, Donnen P, Van der Heyden J, Kirakoya-Samadoulougou F. Adherence to '5-2-1-0' guidelines and multiple risky behaviours among adolescents in nine sub-Saharan African countries: evidence from Global School-based Student Health Survey 2012-2017. BMJ Nutr Prev Health 2023; 6:91-99. [PMID: 37559967 PMCID: PMC10407405 DOI: 10.1136/bmjnph-2022-000488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 05/02/2023] [Indexed: 08/11/2023] Open
Abstract
OBJECTIVE Overweight and obesity constitute a new challenge in low-income and middle-countries. The obesity prevention programme, called '5-2-1-0', promotes healthy eating habits, physical activity and limited screen time among young people.This study aimed to assess adherence to the '5-2-1-0' recommendations and to study multiple risky behaviours among adolescents in nine countries in sub-Saharan Africa. METHODS Meta-analyses with a random effect were used to calculate overall prevalence. Non-random patterns of the co-occurrence of the four risky behaviours were explored using observed/expected prevalence ratios. Data came from the Global School-based Health Survey and 18 314 adolescents were considered. RESULTS Among the participants, 12.7% (95% CI 7.5% to 19.0%) had overweight and 3.2% (95% CI 1.1% to 6.1%) had obesity. In almost all countries studied, girls were more affected by overweight and obesity than boys.While only 0.2% (95% CI 0.1% to 0.4%) of the adolescents fully complied with the recommendations, 4.8% (95% CI 3.1% to 6.9%), 28.4% (95% CI 22.4% to 34.8%), 43.8% (95% CI 41.9% to 45.8%) and 17.0% (95% CI 11.8% to 23.0%), respectively, combined 1, 2, 3 and 4 risky behaviours among the four '5-2-1-0' criteria. The most observed combination was found for co-occurrence of three risky behaviours: insufficient fruit/vegetables consumption, physical activity and non-zero consumption of sugar-sweetened beverages. CONCLUSION In conclusion, the insufficient adherence to '5-2-1-0' recommendations and the high prevalence of the co-occurrence of risky behaviours underscore the need to strengthen health interventions and programmes to prevent obesity among adolescents in sub-Saharan Africa.
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Ngaboyeka G, Bisimwa G, Neven A, Mwene-Batu P, Kambale R, Kingwayi PP, Chiribagula C, Battisti O, Dramaix M, Donnen P. Association between diagnostic criteria for severe acute malnutrition and hospital mortality in children aged 6-59 months in the eastern Democratic Republic of Congo: the Lwiro cohort study. Front Nutr 2023; 10:1075800. [PMID: 37293673 PMCID: PMC10246449 DOI: 10.3389/fnut.2023.1075800] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 04/17/2023] [Indexed: 06/10/2023] Open
Abstract
Background Few studies have assessed the relationship between weight-for-height (WHZ) and mid-upper arm circumference (MUAC) with hospital mortality considering confounders. The particularity of MUAC for age (MUACZ) is less documented. Objective This study aims to investigate this relationship in a region endemic for severe acute malnutrition (SAM). Methods This is a retrospective cohort based on a database of children admitted from 1987 to 2008 in South Kivu, eastern DRC. Our outcome was hospital mortality. To estimate the strength of the association between mortality and nutritional indices, the relative risk (RR) with its 95% confidence interval (95% CI) was calculated. In addition to univariate analyses, we constructed multivariate models from binomial regression. Results A total of 9,969 children aged 6 to 59 months were selected with a median age of 23 months. 40.9% had SAM (according to the criteria WHZ < -3 and/or MUAC<115 mm and/or the presence of nutritional edema) including 30.2% with nutritional edema and 35.2% had both SAM and chronic malnutrition. The overall hospital mortality was 8.0% and was higher at the beginning of data collection (17.9% in 1987). In univariate analyses, children with a WHZ < -3 had a risk almost 3 times higher of dying than children without SAM. WHZ was more associated with in-hospital mortality than MUAC or MUACZ. Multivariate models confirmed the univariate results. The risk of death was also increased by the presence of edema. Conclusion In our study, WHZ was the indicator more associated with hospital death compared with MUAC or MUACZ. As such, we recommend that all criteria shall continue to be used for admission to therapeutic SAM programs. Efforts should be encouraged to find simple tools allowing the community to accurately measure WHZ and MUACZ.
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Lingani M, Zango SH, Valéa I, Samadoulougou S, Somé G, Sanou M, Kaboré B, Rouamba T, Sorgho H, Tahita MC, Derra K, Dramaix M, Tinto H, Donnen P, Robert A. Effects of maternal antenatal treatment with two doses of azithromycin added to monthly sulfadoxine-pyrimethamine for the prevention of low birth weight in Burkina Faso: an open-label randomized controlled trial. Malar J 2023; 22:101. [PMID: 36932435 PMCID: PMC10024378 DOI: 10.1186/s12936-023-04530-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 03/13/2023] [Indexed: 03/19/2023] Open
Abstract
BACKGROUND Exposure during pregnancy to malaria and sexually-transmitted infections is associated with adverse birth outcomes including low birth weight (LBW). This study aimed at assessing if the adjunction of two doses of azithromycin to sulfadoxine-pyrimethamine for the intermittent preventive treatment of malaria in pregnancy can reduce LBW. METHODS A two parallel-groups, open-label randomized controlled trial involving pregnant women (16 to 35 years of age and 12 to 24 weeks of gestation as confirmed by last menstrual period or fundal height) was conducted in rural Burkina Faso. Women were assigned in a 1:1 ratio either to use azithromycin (1 g daily for 2 days) during the second and third trimesters of pregnancy plus monthly sulfadoxine-pyrimethamine (1500/75 mg) (SPAZ) (intervention) or to continue using a monthly sulfadoxine-pyrimethamine (1500/75 mg) (SP) (control). Primary outcome was a LBW (birth weight measured within 24 h after birth < 2500 g). Secondary outcomes including stillbirth, preterm birth or miscarriage are reported together with safety data. RESULTS A total of 992 pregnant women underwent randomization (496 per group) and 898 (90.5%) valid birth weights were available (450 in SPAZ and 448 in SP). LBW incidence was 8.7% (39/450) in SPAZ and 9.4% (42/448) in controls (p-value = 0.79). Compared with controls, pregnant women with SPAZ showed a risk ratio (RR) of 1.16 (95% confidence interval (CI 0.64-2.08]) for preterm births, 0.75 (95% CI 0.17-3.35) for miscarriage and 0.64 (95% CI 0.25-1.64) for stillbirths. No treatment-related serious adverse events (SAEs) have been observed, and there was no significant difference in the number of SAEs (13.5% [67/496] in SPAZ, 16.7% [83/496] in SP, p-value = 0.18) or AEs (17.1% [85/496] in SPAZ, 18.8% [93/496] in SP, p-value = 0.56). CONCLUSION Adequate prevention regimen with monthly sulfadoxine-pyrimethamine given to all pregnant women has been proved to reduce the risk of LBW in malaria endemic areas. Adding azithromycin to the regimen does not offer further benefits, as far as women receive a malaria prevention regimen early enough during pregnancy. Trial registration Pan African Clinical Trial Registry ( https://pactr.samrc.ac.za/Search.aspx ): PACTR201808177464681. Registered 21 August 2018.
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Ilboudo B, Savadogo LG, Traoré I, Meda CZ, Hervé H, Kinda M, Dramaix-Wilmet M, Donnen P. Effect of personalized home-based support for pregnant women on pregnancy outcomes: a cluster randomized trial. J Public Health Afr 2022; 13:1939. [PMID: 36277940 PMCID: PMC9585604 DOI: 10.4081/jphia.2022.1939] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 04/21/2022] [Indexed: 11/30/2022] Open
Abstract
Background Anemia during pregnancy has been linked to higher maternal and perinatal morbidity and mortality. The purpose of this study is to examine the impact of individualized home-based care for pregnant women on pregnancy outcomes. Methods This was a cluster-randomized experiment done in Burkina Faso's Sindou health area between 2015 and 2016. The intervention included a monthly home-based visit focused on nutritional counseling and pregnancy monitoring for pregnant women, and a training on nutrition for pregnant women, prevention of anemia in pregnancy, and management of anemia in pregnancy for health facility teams. In the control group, prenatal care was administered in accordance with national program guidelines. The primary outcome was the reported prevalence of anemia in pregnancy. The secondary outcomes of stillbirth, preterm birth, low birth weight, and abortion were evaluated using a difference in differences analysis and mixed models across the two groups. The sample consisted of 617 pregnant women, with 440 women assigned to the intervention group and 177 assigned to the control group. No maternal fatalities occurred in either group. The intervention decreased stillbirths by -1.6% (95% confidence interval: -3.1% to - 0.1%). It had no impact on the rates of low birth weight, premature birth, and abortion. Conclusion In rural Burkina Faso, personalized support of pregnant women at home, in conjunction with appropriate prenatal care, reduced stillbirths, but not the rates of low birth weight, preterm birth, or abortion.
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Lingani M, Zango SH, Valéa I, Sanou M, Ouoba S, Samadoulougou S, Robert A, Tinto H, Dramaix M, Donnen P. Prevalence and risk factors of malaria among first antenatal care attendees in rural Burkina Faso. Trop Med Health 2022; 50:49. [PMID: 35879789 PMCID: PMC9317114 DOI: 10.1186/s41182-022-00442-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 07/16/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The WHO recommends continuous surveillance of malaria in endemic countries to identify areas and populations most in need for targeted interventions. The aim of this study was to assess the prevalence of malaria and its associated factors among first antenatal care (ANC) attendees in rural Burkina Faso. METHODS A cross-sectional survey was conducted between August 2019 and September 2020 at the Yako health district and included 1067 first ANC attendees. Sociodemographic, gyneco-obstetric, and medical characteristics were collected. Malaria was diagnosed by standard microscopy and hemoglobin level was measured by spectrophotometry. A multivariate logistic regression analysis was used to identify factors associated with malaria infection. RESULTS Overall malaria infection prevalence was 16.1% (167/1039). Among malaria-positive women, the geometric mean parasite density was 1204 [95% confidence interval (CI) 934-1552] parasites/µL and the proportion of very low (1-199 parasites/µL), low (200-999 parasites/µL), medium (1000-9999 parasites/µL) and high (≥ 10,000 parasites/µL) parasite densities were 15.0%, 35.3%, 38.3% and 11.4%, respectively. Age < 20 years (adjusted odds ratio (aOR): 2.2; 95% CI 1.4-3.5), anemia (hemoglobin < 11 g/deciliter) (aOR: 3.4; 95% CI 2.2-5.5), the non-use of bed net (aOR: 1.8; 95% CI 1.1-2.8), and the absence of intermittent preventive treatment with sulfadoxine-pyrimethamine (aOR: 5.8; 95% CI 2.1-24.5) were positively associated with malaria infection. CONCLUSIONS The study showed that one out of six pregnant women had a microscopy-detected P. falciparum malaria infection at their first ANC visit. Strengthening malaria prevention strategies during the first ANC visit is needed to prevent unfavorable birth outcomes.
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Mwene-Batu P, Bisimwa G, Donnen P, Bisimwa J, Tshongo C, Dramaix M, Hermans MP, Briend A. Risk of Chronic Disease after an Episode of Marasmus, Kwashiorkor or Mixed-Type Severe Acute Malnutrition in the Democratic Republic of Congo: The Lwiro Follow-Up Study. Nutrients 2022; 14:2465. [PMID: 35745195 PMCID: PMC9229924 DOI: 10.3390/nu14122465] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 06/05/2022] [Accepted: 06/10/2022] [Indexed: 02/01/2023] Open
Abstract
Background: Long-term impact of different forms of severe acute malnutrition (SAM) in childhood on the emergence of noncommunicable diseases (NCDs) is poorly known. Aim: To explore the association between subtypes of SAM during childhood, NCDs, and cardiovascular risk factors (CVRFs) in young adults 11 to 30 years after post-SAM nutritional rehabilitation. Methods: In this follow-up study, we investigated 524 adults (mean age 22 years) treated for SAM during childhood in eastern Democratic Republic of the Congo (DRC) between 1988 and 2007. Among them, 142 had a history of marasmus, 175 of kwashiorkor, and 207 had mixed-form SAM. These participants were compared to 407 aged- and sex-matched control adults living in the same community without a history of SAM. Our outcomes of interest were cardiometabolic risk markers for NCDs. Logistic and linear regressions models were sued to estimate the association between subtype of SAM in childhood and risk of NCDs. Results: Compared to unexposed, former mixed-type SAM participants had a higher adjusted ORs of metabolic syndrome [2.68 (1.18; 8.07)], central obesity [1.89 (1.11; 3.21)] and low HDL-C (High-density lipoprotein cholesterol) [1.52 (1.08; 2.62)]. However, there was no difference between groups in terms of diabetes, high blood pressure, elevated LDL-C (low-density lipoprotein cholesterol) and hyper TG (hypertriglyceridemia) and overweightness. Former mixed-type SAM participants had higher mean fasting glucose [3.38 mg/dL (0.92; 7.7)], reduced muscle strength [−3.47 kg (−5.82; −1.11)] and smaller hip circumference [−2.27 cm (−4.24; −0.31)] compared to non-exposed. Regardless of subtypes, SAM-exposed participants had higher HbA1c than unexposed (p < 0.001). Those with a history of kwashiorkor had cardiometabolic and nutritional parameters almost superimposable to those of unexposed. Conclusion: The association between childhood SAM, prevalence of NCDs and their CVRFs in adulthood varies according to SAM subtypes, those with mixed form being most at risk. Multicenter studies on larger cohorts of older participants are needed to elucidate the impact of SAM subtypes on NCDs risk.
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Murhima’Alika CC, Balolebwami Zigabe S, Bahati Lufungulo Y, Mwene-Batu Lyabayungu P, Garhalangwa Mayeri D, Gaylord AN, Dramaix M, Donnen P, Bisimwa Balaluka G. Nutritional and health status of a cohort of school-age children born to mothers treated for severe acute malnutrition in their childhood in The Democratic Republic of Congo. PLoS One 2022; 17:e0269527. [PMID: 35671275 PMCID: PMC9173626 DOI: 10.1371/journal.pone.0269527] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 05/20/2022] [Indexed: 11/28/2022] Open
Abstract
Background Malnutrition is a public health problem, but outside the theoretical framework, little is known about the concrete intergenerational effects of malnutrition. Objective The objective of this study is to compare the nutritional status and health indicators of school children born to mothers who were treated for severe acute malnutrition (SAM). Methodology The study took place in Miti-Murhesa health zone in the Democratic Republic of Congo. This is a cohort study assessing the nutritional and health status of school children born to mothers who had been treated for SAM, based on WHZ or edema, in Lwiro hospital between 1988–2002 compared to children born to mothers who were not exposed to SAM. Stunting and thinness were evaluated by Height for Age Z-score (HAZ) and Body Mass Index by Age criteria (BMIAZ) respectively. On admission, blood samples were taken to assess anemia, HIV serology, hemogram and others biological indicators. Stool’s examinations were conducted by using Olympus optical microscope. Parametric and non-parametric tests were applied to compare the different variables in two groups. Results We identified 106 children aged 5–16 years (103 exposed and 58 unexposed) and we received 83.5% and 91.4% children respectively for anthropometric parameters. The mean of age was 7.9 ± 2.4 year in exposed group and 7.4 ± 2.1 year in unexposed group (p = 0.26). The prevalence of stunting was 68.3% in the exposed group and 67.3% in the unexposed group (p = 0.90). The prevalence of thinness was 12.8% in the exposed group and 9.6% in the unexposed group (p = 0.57). The biological profile (glycemia, urea, creatinine and hemogram) and the prevalence of intestinal parasites were similar in the two groups. Conclusion In this sample, in a malnutrition-endemic area, there was no statistically significant difference in nutrition and health indicators between school children born to mothers exposed to SAM and their community controls.
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Lingani M, Zango SH, Valéa I, Somé G, Sanou M, Samadoulougou SO, Ouoba S, Rouamba E, Robert A, Dramaix M, Donnen P, Tinto H. Low birth weight and its associated risk factors in a rural health district of Burkina Faso: a cross sectional study. BMC Pregnancy Childbirth 2022; 22:228. [PMID: 35313840 PMCID: PMC8935822 DOI: 10.1186/s12884-022-04554-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 03/09/2022] [Indexed: 12/30/2022] Open
Abstract
Background Low birth weight (LBW) is a major factor of neonate mortality that particularly affects developing countries. However, the scarcity of data to support decision making to reduce LBW occurrence is a major obstacle in sub-Saharan Africa. The aim of this research was to determine the prevalence and associated factors of LBW at the Yako health district in a rural area of Burkina Faso. Methods A cross sectional survey was conducted at four peripheral health centers among mothers and their newly delivered babies. The mothers’ socio-demographic and obstetrical characteristics were collected by face-to-face interview or by review of antenatal care books. Maternal malaria was tested by standard microscopy and neonates’ birth weights were documented. Multivariate logistic regression was used to determine factors associated with LBW. A p-value < 0.05 was considered statistically significant. Results Of 600 neonates examined, the prevalence of low birth weight was 11.0%. Adjustment for socio-demographic characteristic, medical conditions, obstetrical history, malaria prevention measures by multivariate logistic regression found that being a primigravid mother (aOR = 1.8, [95% CI: 1.1–3.0]), the presence of malaria infection (aOR = 1.9, [95% CI: 1.1–3.5]), the uptake of less than three doses of sulfadoxine-pyrimethamine for the intermittent preventive treatment of malaria in pregnancy (IPTp-SP) (aOR = 2.2, [95% CI: 1.3–3.9]), the presence of maternal fever at the time of delivery (aOR = 2.8, [95% CI: 1.5–5.3]) and being a female neonate (aOR = 1.9, [95% CI: 1.1–3.3]) were independently associated with an increased risk of LBW occurrence. The number of antenatal visits performed by the mother during her pregnancy did not provide any direct protection for low birth weight. Conclusion The prevalence of LBW remained high in the study area. Maternal malaria, fever and low uptake of sulfadoxine-pyrimethamine doses were significantly associated with LBW and should be adequately addressed by public health interventions.
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Kpoda HB, Savadogo LG, Samadoulougou DR, Traoré IT, Somda SM, Lemogoum D, Sombié I, Millogo A, Dramaix M, Donnen P. Prognostic factors of the lethality of stroke at the Sourô Sanou University Teaching Hospital (CHUSS) of Burkina Faso. Cerebrovasc Dis Extra 2022; 12:36-46. [PMID: 35235929 PMCID: PMC9149345 DOI: 10.1159/000523888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 02/25/2022] [Indexed: 11/22/2022] Open
Abstract
Introduction Stroke is a major public health concern. It is a frequent pathology, 80% of which is of ischemic origin. Approximately 86% of all stroke deaths worldwide occur in low- and middle-income countries. The objective of this study was to investigate prognostic factors for in hospital lethality of stroke cases admitted in a public university hospital in Burkina Faso. Methods This was a retrospective cohort study with a descriptive and analytical aim on adults admitted for a stroke confirmed by a brain scan at the Sourô Sanou University Teaching Hospital (CHUSS) of Bobo-Dioulasso over the period from January 1, 2009, to December 31, 2013. Results The proportion of cases confirmed by the brain CT scan was 32% of all patients admitted for stroke in the CHUSS. The overall case fatality was 27.6%. This lethality was more pronounced in patients with hemorrhagic stroke (35.8%) compared to patients with ischemic stroke (22.4%). Median survival was higher in patients with ischemic stroke than those with hemorrhagic one (36 and 25 days, respectively) with a statistically significant difference (p value = 0.001). In multivariate analysis and hemorrhagic stroke (hazard ratio [HR]: 2.25; CI 95%: 1.41–3.61), an altered state of consciousness (HR: 1.90; CI 95%: 1.20–2.99) and the presence of central facial paralysis (HR: 1.67; CI 95%: 1.04–2.67) are factors that increased significantly the lethality. Conclusion The study has identified three prognostic factors of lethality that are the hemorrhagic stroke type, the altered state of consciousness, and the central facial paralysis. Given the high case fatality, it is important to develop and implement effective prevention and management strategies adapted to the resources for the optimal control of stroke in Africa.
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Lingani M, Zango SH, Valéa I, Bonko MDA, Samadoulougou SO, Rouamba T, Tahita MC, Sanou M, Robert A, Tinto H, Donnen P, Dramaix M. Malaria and curable sexually transmitted and reproductive tract coinfection among pregnant women in rural Burkina Faso. Trop Med Health 2021; 49:90. [PMID: 34736524 PMCID: PMC8567650 DOI: 10.1186/s41182-021-00381-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 10/27/2021] [Indexed: 11/11/2022] Open
Abstract
Background Malaria and sexually transmitted/reproductive tract infections (STI/RTI) are leading and preventable causes of low birthweight in sub-Saharan Africa. Reducing their impact on pregnancy outcomes requires efficient interventions that can be easily integrated into the antenatal care package. The paucity of data on malaria and STI/RTI coinfection, however, limits efforts to control these infections. This study aimed to determine the prevalence and associated factors of malaria and STI/RTI coinfection among pregnant women in rural Burkina Faso.
Methods A cross-sectional survey was conducted among 402 pregnant women attending antenatal clinics at the Yako health district. Sociodemographic and behavioral data were collected, and pregnant women were tested for peripheral malaria by microscopy. Hemoglobin levels were also measured by spectrophotometry and curable bacterial STI/RTI were tested on cervico-vaginal swabs using rapid diagnostic test for chlamydia and syphilis, and Gram staining for bacterial vaginosis. A multivariate logistic regression model was used to assess the association of malaria and STI/RTI coinfection with the characteristics of included pregnant women.
Results The prevalence of malaria and at least one STI/RTI coinfection was 12.9% (95% confidence interval, CI: [9.8–16.7]), malaria and bacterial vaginosis coinfection was 12.2% (95% CI: [9.3–15.9]), malaria and chlamydial coinfection was 1.6% (95% CI: [0.6–3.8]). No coinfection was reported for malaria and syphilis. The individual prevalence was 17.2%, 7.2%, 0.6%, 67.7% and 73.3%, respectively, for malaria infection, chlamydia, syphilis, bacterial vaginosis and STI/RTI combination. Only 10% of coinfections were symptomatic, and thus, 90% of women with coinfection would have been missed by the symptoms-based diagnostic approach. In the multivariate analysis, the first pregnancy (aOR = 2.4 [95% CI: 1.2–4.7]) was the only factor significantly associated with malaria and STI/RTI coinfection. Clinical symptoms were not associated with malaria and STI/RTI coinfection. Conclusion The prevalence of malaria and curable STI/RTI coinfection was high among pregnant women. The poor performance of the clinical symptoms to predict coinfection suggests that alternative interventions are needed.
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Lingani M, Zango SH, Valéa I, Valia D, Sanou M, Samandoulougou SO, Robert A, Tinto H, Dramaix M, Donnen P. Magnitude of low birthweight in malaria endemic settings of Nanoro, rural Burkina Faso: a secondary data analysis. Sci Rep 2021; 11:21332. [PMID: 34716389 PMCID: PMC8556330 DOI: 10.1038/s41598-021-00881-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 10/15/2021] [Indexed: 12/02/2022] Open
Abstract
Low birthweight (LBW) is a worldwide problem that particularly affects developing countries. However, limited information is available on its magnitude in rural area of Burkina Faso. This study aimed to estimate the prevalence of low birthweight and to identify its associated factors in Nanoro health district. A secondary analysis of data collected during a cross-sectional survey was conducted to assess the prevalence of low birthweight in Nanoro health and demographic surveillance system area (HDSS). Maternal characteristics extracted from antenatal care books or by interview, completed by malaria diagnosis were examined through a multi-level logistic regression to estimate odd-ratios of association with low birthweight. Significance level was set at 5%. Of the 291 neonates examined, the prevalence of low birthweight was 12%. After adjustment for socio-demographic, obstetric and malaria prevention variables, being primigravid (OR = 8.84, [95% CI: 3.72-21.01]), or multigravid with history of stillbirth (OR = 5.03, [95% CI: 1.54-16.40]), as well as the lack of long-lasting insecticide treated bed net use by the mother the night preceding the admission for delivery (OR = 2.5, [95% CI: 1.1-5.9]) were significantly associated with neonate low birthweight. The number of antenatal visits however did not confer any direct benefit on birthweight status within this study area. The prevalence of low birthweight was high in the study area and represents an important public health problem in Burkina Faso. In light of these results, a redefinition of the content of the antenatal care package is needed.
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Murhima’Alika CC, Balemba GM, Lyabayungu PMB, Mulume’oderhwa GM, Munthali G, Owino V, Tambwe AM, Dramaix M, Donnen P, Balaluka GB. Human Milk output among mothers previously treated for severe acute malnutrition in childhood in Democratic Republic of Congo. BMC Nutr 2021; 7:61. [PMID: 34689835 PMCID: PMC8543795 DOI: 10.1186/s40795-021-00467-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 07/15/2021] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Malnutrition is a public health problem, as wasting affects 7.5% of children worldwide. The harmful effects of severe acute malnutrition (SAM) can last a lifetime, but how SAM in childhood affects later breastfeeding ability is not clear. In the present study, we assessed the human milk output and body composition among mothers with a history of childhood SAM. METHODS This retrospective cohort study was carried out in Miti-Murhesa Health Zone (Democratic Republic of Congo) from January 15 to March 17, 2020. We selected lactating mothers with breastfed infants aged 2-12 months. Two categories of mothers were included: those who had been treated for SAM during their childhood (years 1988-2003; n = 39) and a community control with no history of SAM (n = 40). The weight, height, and mid-upper arm circumference were measured and body mass index (BMI) calculated as weight/height2. Body composition and human milk output were assessed using standard deuterium dilution methods. Student t and chi2 tests ware applied to compare two groups. RESULTS The mean age ± standard deviation of the mothers was 24.4 ± 5.1 and 26.0 ± 6.1 years for the SAM and control groups, respectively (p = 0.186). The age of their infants was 5.4 ± 2.3 months in both groups (p = 0.962). In the SAM and control groups, the mean maternal BMI was 23.8 ± 2.3 and 23.6 ± 3.7 kg/m2 (p = 0.849), mean Fat Mass 27.1% ± 5.0 and 27.1% ± 5.8% (p = 0.708), and the mean Fat Free mass 72.9% ± 5.0 and 72.9% ± 5.8% (p = 0.998), respectively. Human milk output was 833.7 ± 152.1 g/d in SAM group and 827.4 ± 171.4 g/d in the control group (p = 0.864). CONCLUSIONS We found no significant difference in human milk output and body composition in mothers treated for SAM during childhood compared to community controls.
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Mwene-Batu P, Wells J, Maheshe G, Hermans MP, Kalumuna E, Ngaboyeka G, Chimanuka C, Owino VO, Macq J, Lukula M, Dramaix M, Donnen P, Bisimwa G. Body composition of adults with a history of severe acute malnutrition during childhood using the deuterium dilution method in eastern DR Congo: the Lwiro Cohort Study. Am J Clin Nutr 2021; 114:2052-2059. [PMID: 34582550 PMCID: PMC8634579 DOI: 10.1093/ajcn/nqab293] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 08/12/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Few studies have evaluated the body composition (BC) of adults who suffered from severe acute malnutrition (SAM) during childhood, a population at risk of long-term noncommunicable diseases. OBJECTIVE We performed an observational cohort study to evaluate BC in a group of young adults aged 11-30 y after nutritional rehabilitation for SAM, in the Democratic Republic of the Congo (DRC). METHODS We evaluated 151 adults in eastern DRC who were treated for SAM during childhood between 1988 and 2007. They were compared with 120 aged- and sex-matched control adults living in the same community who had not been exposed to malnutrition as children. The main variables of interest were the different compartments of adult BC (fat-free mass [FFM], fat mass [FM], and 2 indices of height-normalized BC: FFM index [FFMI] and FM index [FMI]) measured by deuterium dilution. RESULTS The mean age in both groups was 23 y, and females represented 49% and 56% of the exposed and nonexposed groups, respectively. SAM-exposed males had lower mean ± SD weight (53.6 ± 6.4 compared with 56.4 ± 7.9 kg, P = 0.029) and lower height (159.9 ± 6.6 compared with 163.6 ± 6.7 cm, P = 0.003) compared to unexposed males. SAM-exposed subjects had less FFM (-1.56 kg [-2.93, -0.20]; P = 0.024) but this observation was more marked in males (45.4 ± 5.4 compared with 48.2 ± 6.9 kg, P = 0.01) than in females. No differences in FM were noted between SAM-exposed and unexposed subjects. Adjusting for height, FFMI and FMI showed no difference between SAM-exposed and unexposed in either sex. CONCLUSION SAM during childhood is associated with reduced FFM in adulthood which is probably due to a shorter height.
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Mwene-Batu P, Bisimwa G, Ngaboyeka G, Dramaix M, Macq J, Hermans MP, Lemogoum D, Donnen P. Severe acute malnutrition in childhood, chronic diseases, and human capital in adulthood in the Democratic Republic of Congo: the Lwiro Cohort Study. Am J Clin Nutr 2021; 114:70-79. [PMID: 33826712 PMCID: PMC8246611 DOI: 10.1093/ajcn/nqab034] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 01/29/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Little is known about the long-term outcome of children treated for severe acute malnutrition (SAM) after nutritional rehabilitation. OBJECTIVES To explore the association between SAM in childhood, noncommunicable diseases (NCDs), and low human capital in adulthood. METHODS We identified 524 adults (median age: 22 y) who were treated for SAM during childhood in Eastern Democratic Republic of Congo between 1988 and 2007. They were compared with 407 community unexposed age- and sex-matched subjects with no history of SAM. The variables of interest were cardiometabolic risk markers for NCDs and human capital. For the comparison, we used linear and logistic regressions to estimate the association between SAM in childhood and the risk of NCDs and ordinal logistic regression for the human capital. RESULTS Compared with unexposed subjects, the exposed participants had a higher waist circumference [1.2 (0.02, 2.3) cm; P = 0.015], and a larger waist-to-height ratio [0.01 (0.01, 0.02) cm; P < 0.001]. On the other hand, they had a smaller hip circumference [-1.5 (-2.6, -0.5) cm; P = 0.021]. Regarding cardiometabolic markers for NCDs, apart from a higher glycated hemoglobin (HbA1c) [0.4 (0.2, 0.6); P < 0.001], no difference was observed in other cardiometabolic markers for NCD between the 2 groups. Compared with unexposed participants, exposed participants had a higher risk of metabolic syndrome (crude OR: 2.35; 95% CI: 1.22, 4.54; P = 0.010) and visceral obesity [adjusted OR: 1.44 (1.09, 1.89); P = 0.001]. The prevalence of hypertension, diabetes, overweight, and dyslipidaemia was similar in both groups. Last, the proportion of malnutrition survivors with higher socioeconomic status level was lower. CONCLUSION SAM during childhood was associated with a high risk of NCDs and lower human capital in adulthood. Thus, policymakers and funders seeking to fight the global spread of NCDs in adults in low-resource settings should consider the long-term benefit of reducing childhood SAM as a preventive measure to reduce the socioeconomic burden attributable to NCDs.
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Ilboudo B, Savadogo LGB, Traoré I, Meda CZ, Kinda M, Sombié I, Dramaix-Wilmet M, Donnen P. Effect of Personalized Support at Home on the Prevalence of Anemia in Pregnancy in Burkina Faso: A Cluster Randomized Trial. Am J Trop Med Hyg 2021; 105:207-216. [PMID: 34097646 DOI: 10.4269/ajtmh.20-1043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 03/01/2021] [Indexed: 11/07/2022] Open
Abstract
Burkina Faso has high prevalence of anemia in pregnancy (hemoglobin < 11 g/dL), despite the implementation of the WHO recommended guidelines. This study aimed to test the effects of personalized support for pregnant women at home on the trend of anemia prevalence in pregnancy. A cluster randomized trial was conducted from January 2015 to August 2016 at Sindou health district in Burkina Faso. Data were collected from 617 women in their first or second trimester of pregnancy, including 440 and 177 women in the intervention and control groups, respectively. The intervention consisted of a monthly home-based visit to the pregnant woman, focusing on nutritional counseling and pregnancy management, alongside an improvement antenatal visit quality. Compared with the prevalence of anemia in pregnancy in the control group [64.0% (95% confidence interval [CI]: 52.1-74.4%)], that of the intervention group was significantly lower from the fifth home visit onward [36.8% (95% CI: 32.1-41.8%)] (P < 0.001). The adjusted difference-in-differences in anemia prevalence between the two groups was -19.8% (95% CI: -30.2% to -9.4%) for women who received more than four home visits (P < 0.001). The corresponding difference in hemoglobin levels was 0.644 g/dL (95% CI: 0.309-0.167; P < 0.001). Personalized support for pregnant women at home, combined with appropriate antenatal care, can significantly reduce anemia prevalence during pregnancy in rural Burkina Faso.
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Negatou M, Ouedraogo M, Donnen P, Paul E, Samadoulougou S, Kirakoya-Samadoulougou F. Care-Seeking for Fever for Children Under the Age of Five Before and After the Free Healthcare Initiative in Burkina Faso: Evidence from Three Population-Based Surveys. Risk Manag Healthc Policy 2021; 14:2065-2077. [PMID: 34040469 PMCID: PMC8141396 DOI: 10.2147/rmhp.s297983] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 04/14/2021] [Indexed: 11/25/2022] Open
Abstract
Background In 2016, a free healthcare policy (FHP) was implemented in Burkina Faso for children under the age of five. In our study, we aimed to determine the prevalence of care-seeking for a fever in children under the age of five before and after the implementation of the FHP and to analyze the determinants of not seeking care under the FHP. Methods The data of three nationally representative surveys were used to evaluate the trends of the prevalence of care-seeking. We performed a modified Poisson regression using a generalized estimating equation to determine the factors associated with not seeking care. Results The prevalence for care seeking increased from 57.5% (95% CI, 54.2–60.8) in 2014 to 72.3% (95% CI, 68.1–76.2) in 2017. Children from the poor quintile were less likely to seek care when compared to children from the poorest quintile (prevalence ratio (PR) = 0.7 (95% CI, 0.5–0.9)). Caregivers who did not have messages regarding malaria in the past six months were more likely not to seek care (PR = 0.8 (95% CI, 0.7–0.9)). Caregivers of children aged 36–59 months were more likely not to seek care compared to those aged <12 months (PR = 1.6 (95% CI, 1.2–2.1)). Children from the Boucle du Mouhoun region (PR = 1.9 (95% CI, 1.2–3.2)) and the Centre-Est region (PR = 1.9 (95% CI, 1.2–3.0)) were more likely not to seek care compared to children from the Sud Ouest region. Conclusion Our study showed an increase in the prevalence of care-seeking after the implementation of the FHP. Even if this is encouraging, these findings highlight the critical importance of non-financial barriers to care-seeking. Maintaining FHP and tackling the barriers should be considered by policy makers to increase care-seeking.
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Mwene-Batu P, Lemogoum D, de le Hoye L, Bisimwa G, Hermans MP, Minani J, Amani G, Mateso GQ, Cikomola JC, Dramaix M, Donnen P. Association between severe acute malnutrition during childhood and blood pressure during adulthood in the eastern Democratic Republic of the Congo: the Lwiro cohort study. BMC Public Health 2021; 21:847. [PMID: 33933039 PMCID: PMC8088659 DOI: 10.1186/s12889-021-10908-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 04/23/2021] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Little is known about the long-term outcomes of Severe Acute Malnutrition (SAM) during childhood. As such, this study aims to explore the association between childhood SAM and blood pressure (BP) in adulthood in a context without nutrition transition. METHODOLOGY We identified 524 adults (Median age: 22 years) who were treated for SAM during childhood in Eastern DRC between 1988 and 2007. They were compared with 407 age-and-sex matched subjects with no history of SAM in the community. The variables examined for this study were the systolic (SBP), diastolic (DBP), mean (MBP) blood pressure (BP) and pulse pressure (PP), as well as high blood pressure (HBP) defined as BP ≥ 140/90 mmHg and/or use of BP-lowering drug(s) in adulthood. For comparison, linear and logistic regression models were used for analysing continuous and dichotomous variables, respectively. RESULTS Of the 524 exposed located, 145 were selected according to age. A total of 97 unexposed were recruited. Compared to unexposed, exposed had slightly higher SBP and PP after adjusting for occupation, body mass index (BMI) and food consumption [SBP = 1.4 mmHg (- 2.2, 4.8) and PP = 2.6 mmHg (- 0.3, 6.0)]. However, their DBP was lower than that of the unexposed [- 1.6 mmHg (- 4.6, 1.5)]. MBP and creatinine levels were similar between the two groups. The prevalence of HBP adjusted for age was higher among exposed than unexposed (9.7% vs 5.3%). In addition, the odds of having HBP was higher among exposed than unexposed, however the observed difference was not statistically significant [Odds Ratio (OR) 1.9 (0.7, 5.6)]. Finally, using multiple regression analysis, although the effect was not significant, SAM was a major contributor to HBP [adjusted OR 3.1 (0.9,10.9), p = 0.064], while only male gender and higher BMI (overweight/obesity) emerged as independent predictors of HBP among this young study population. CONCLUSIONS This study suggests that an episode of SAM in childhood has a weak impact on BP variability in young Congolese adults (from DRC) living in an environment without nutrition transition. However, people who experienced a period of SAM tended to have a higher prevalence of HBP and a much higher risk of developing HBP than unexposed. Additional multicentre studies involving a larger cohort would provide greater understanding of the impact of SAM on the overall risk of BP disorders during adulthood.
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Ilboudo B, Traoré I, Méda CZ, Hien A, Kinda M, Dramaix-Wilmet M, Savadogo GBL, Donnen P. Prevalence and factors associated with anaemia in pregnant women in Cascades Region of Burkina Faso in 2012. Pan Afr Med J 2021; 38:361. [PMID: 34367440 PMCID: PMC8308920 DOI: 10.11604/pamj.2021.38.361.26612] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 04/05/2021] [Indexed: 11/20/2022] Open
Abstract
Introduction anaemia in pregnancy is a public health concern in Burkina Faso. This study aims at identifying the factors associated with the prevalence of anaemia in pregnant women at a regional level in Burkina Faso. Methods we conducted a cross-sectional study in the region called “Cascades”, located at the Western part of Burkina Faso. The study population included all pregnant women who attended antenatal care clinics in all public peripheral health facilities (districts) between May and June 2012 and agreed to participate in the study. They provided blood sample from which we measured the haemoglobin concentration using the Hemocue® system. The factors associated with anaemia in the study population were identified through multiple logistic regressions. Results the prevalence (95% CI) of anaemia in pregnancy in the Cascades region was 58.9% (56.6% - 61.2%). Anaemia in pregnancy was more common in district of Banfora (OR = 1.40; 95% CI: 1.07-1.83), among housewives (OR = 2.96; 95% CI: 1.10-8.0), in the Mossi ethnic group (OR = 1.39; 95% CI: 1.04-1.85) and among the wives of farmers and artisans (OR = 2.55; 95% CI: 1.59-4.07). Anaemia in pregnancy was less frequent among women who drank local beer (OR = 0.68; 95% CI: 0.49-0.94). Conclusion the prevalence of anaemia in pregnancy is high in Burkina Faso. Improving women's income level may contribute to reduce it. Further studies are needed to elucidate the link between the consumption of local beer, the local diet practices and anaemia in pregnant women.
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Badiane A, Diouf A, Sylla PMDD, Cissé NS, Idohou-Dossou N, Dramaix M, Wade S, Donnen P. Body composition and determinant factors among mother-child pairs (6-8 months) in rural areas of Senegal. MATERNAL AND CHILD NUTRITION 2021; 17:e13174. [PMID: 33719201 PMCID: PMC8189237 DOI: 10.1111/mcn.13174] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 02/03/2021] [Accepted: 02/09/2021] [Indexed: 11/30/2022]
Abstract
This cross-sectional study was conducted to determine the association between selected characteristics and body composition of mothers and children in early life. This study included 213 mother-child pairs 6 to 8 months involving in the cohort study of the Research and Development Project conducted in Kaffrine district. The main outcomes were fat-free mass (FFM) and body fat (BF), measured using deuterium dilution method and anthropometry. Independent variables were sociodemographic, dietary diversity and health characteristics. Descriptive, correlation, bivariate and multiple regression analyses were conducted. According to body mass index (BMI), 23% of mothers were underweight, 12% were overweight/obese and 11% had excess BF. Four per cent of children were below -2 weight-for-length z-score (WLZ), 10% were below -2 length-for-age z-score (LAZ) and 40% had excess BF. Maternal FFM was positively correlated with child FFM (r = 0.25, P = 0.002). Similarly, mothers' BMI, FFM and BF were significantly and positively correlated with children's LAZ. Stepwise regression showed an increased association between minimum dietary diversity (MDD) and WLZ score, FFM and BF of children. Among mothers, being employee and doing reproductive health care were determinants of higher BMI, FFM and BF. This study found a strong association between maternal and child body composition in early life. Adequate diet is the main determinant of children nutritional status. Among the mothers, having a job and doing primary health care seem to be beneficial for the nutritional status. Improvement of women's empowerment, quality of health care and dietary diversity could have a positive impact on maternal and child nutrition.
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