Wording the trajectory of the three-year COVID-19 epidemic in a general population - Belgium.

The trajectory of COVID-19 epidemic waves in the general population of Belgium was analysed by defining quantitative criteria for epidemic waves from March 2020 to early 2023. Peaks and starting/ending times characterised nine waves numerated I to IX based on the daily reported incidence number (symbol INCID) and three "endemic" interval periods between the first four waves. The SIR compartmental model was applied to the first epidemic wave by fitting the daily prevalence pool (symbol I) calculated as the sum of the daily incidence rate and estimated number of subjects still infectious from the previous days. The basic reproductive number R0 was calculated based on the exponential growth rate during the early phase and on medical literature knowledge of the time of generation of SARS-CoV-2 infection. The first COVID-19 wave was well fitted by an open SIR model. According to this approach, dampened recurrent epidemic waves evolving through an endemic state would have been expected. This was not the case with the subsequent epidemic waves being characterised by new variants of concern (VOC). Evidence-based observations: 1) each epidemic wave affected less than a fifth of the general population; 2) the Vth epidemic wave (VOC Omicron) presented the greatest amplitude. The lack of recurrence of the same VOC during successive epidemic waves strongly suggests that a VOC has a limited persistence, disappearing from the population well before the expected proportion of the theoretical susceptible cohort being maximally infected. Fitting the theoretical SIR model, a limited persistence of VOCs in a population could explain that new VOCs replace old ones, even if the new VOC has a lower transmission rate than the preceding one. In conclusion, acquisition of potential defective mutations in VOC during an epidemic wave is a potential factor explaining the absence of resurgence of a same VOC during successive waves. Such an hypothesis is open to discussion and to rebuttal. A modified SIR model with epidemic waves of variable amplitude related not only to R0 and public health measures but also to acquisition of defective fitting in virus within a population should be tested.

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.

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.

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.

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.

Risk Factor Profile in Inpatients with School Refusal: a Dimensional Model.

BACKGROUND: School attendance problems have an impact on the social, academic, and professional development of young people. School refusal and truancy are described as school attendance problems. Clarifying the developmental trajectory of school refusal would allow a better understanding of the phenomenon including earlier detection and improved management. Following a dimensional model, we can consider school refusal as an internalizing problem and truancy as an externalizing problem implying the existence of different risk factor profiles. SUBJECT AND METHOD: We conducted a retrospective study on four groups of child and adolescent inpatients (school refusal (SR), truancy (TR), behavior disorder without deschooling (BD), and eating disorder (ED). Each subject was included in one of the groups based on a checklist criterion and the diagnoses made at the end of hospitalization. We then compared groups with descriptive statistics (Chi² and Fisher's exact test) to highlight the developmental trajectory and the possible risk factors profile in SR. RESULTS: Delayed language development, attachment disorder, attentional deficit and hyperactivity disorder, physical abuse, and substance abuse were predominantly reported in BD and TR. Learning disorders were mostly present in BD, TR, and SR. Family interactions were more violent and aggressive in BD and TR than in ED and SR. We observed more violent and conflictual relationships with peers in BD and TR. In SR, subjects seemed to experiment with more isolation and rejection. Behavioral disorder non-specified, ODD, and CD seemed more frequent in BD and TR. We found anxiety disorder and mood disorders more frequently in the SR group. CONCLUSION: Inpatients with severe SR are characterized by internalizing problems and difficulties in emotional dysregulation and problems socializing with peers. Inpatients with BD and TR were associated with externalizing problems and difficulties in behavioral regulation skills.

Low birth weight and its associated risk factors in a rural health district of Burkina Faso: a cross sectional study.

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.

Association of malaria and curable sexually transmitted infections with pregnancy outcomes in rural Burkina Faso.

BACKGROUND: Malaria and curable sexually transmitted infections (STIs) are severe infections associated with poor pregnancy outcomes in sub-Saharan countries. These infections are responsible for low birth weight, preterm birth, and miscarriage. In Burkina Faso, many interventions recommended by the World Health Organization were implemented to control the impact of these infections. After decades of intervention, we assessed the impact of these infections on pregnancy outcomes in rural setting of Burkina Faso. METHODS: Antenatal care and delivery data of pregnant women attending health facilities in 2016 and 2017 were collected in two rural districts namely Nanoro and Yako, in Burkina Faso. Regression models with likelihood ratio test were used to assess the association between infections and pregnancy outcomes. RESULTS: During the two years, 31639 pregnant women received antenatal care. Malaria without STI, STI without malaria, and their coinfections were reported for 7359 (23.3%), 881 (2.8 %), and 388 (1.2%) women, respectively. Low birth weight, miscarriage, and stillbirth were observed in 2754 (10.5 %), 547 (2.0 %), and 373 (1.3 %) women, respectively. Our data did not show an association between low birth weight and malaria [Adjusted OR: 0.91 (0.78 - 1.07)], STIs [Adjusted OR: 0.74 (0.51 - 1.07)] and coinfection [Adjusted OR: 1.15 (0.75 - 1.78)]. Low birth weight was strongly associated with primigravidae [Adjusted OR: 3.53 (3.12 - 4.00)]. Both miscarriage and stillbirth were associated with malaria [Adjusted OR: 1.31 (1.07 - 1.59)], curable STI [Adjusted OR: 1.65 (1.06 - 2.59)], and coinfection [Adjusted OR: 2.00 (1.13 - 3.52)]. CONCLUSION: Poor pregnancy outcomes remained frequent in rural Burkina Faso. Malaria, curable STIs, and their coinfections were associated with both miscarriage and stillbirth in rural Burkina. More effort should be done to reduce the proportion of pregnancies lost associated with these curable infections by targeting interventions in primigravidae women.

Effects of implementing a postabortion care strategy in Kinshasa referral hospitals, Democratic Republic of the Congo.

OBJECTIVES: To evaluate the effects of the implementation of a postabortion care (PAC) strategy in Kinshasa referral hospitals, this study analyzed the quality of postabortion care services, including postabortion contraception, and the duration of hospitalization. METHODOLOGY: We estimated the effects of the PAC strategy using a quasi-experimental study by evaluating the outcomes of 334 patients with the diagnosis of a complication of induced abortion admitted to 10 hospitals in which the PAC strategy was implemented compared to the same outcomes in 314 patients with the same diagnosis admitted to 10 control facilities from 01/01/2016 to 12/31/2018. In response to government policy, the PAC strategy included the treatment of abortion complications with recommended uterine evacuation technology, the family planning counseling and service provision, linkages with other reproductive health services, including STI evaluation and HIV counseling and/or referral for testing, and partnerships between providers and communities. The information was collected using a questionnaire and stored using open data kit software. We supplemented this information with data abstracted from patient records, facility registries of gynecological obstetrical emergencies, and family planning registries. We analyzed data and developed regression models using STATA15. Thus, we compared changes in use of specific treatments and duration of hospitalization using a "difference-in-differences" analysis. RESULTS: The implementation of PAC strategy in Kinshasa referral hospitals has resulted in the utilization of WHO recommended uterine evacuation method MVA (29.3% more in the experimental structures, p = 0.025), a significant decline in sharp-curettage (19.3% less, p = 0.132), and a decline in the duration of hospitalization of patients admitted for PAC (1 day less, p = 0.020). We did not observe any change in the use of PAC services, mortality, and the provision of post abortion contraception. CONCLUSION: Despite significant improvement in the management of PAC, the uptake in WHO approved technology-namely MVA, and the duration of hospitalization, these outcomes while a significant improvement for DRC, indicate that additional quality improvement strategies for management of PAC and risk-mitigating strategies to reduce barriers to care are required.

Body composition and determinant factors among mother-child pairs (6-8 months) in rural areas of Senegal.

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.

Respiratory health and eruptions of the Nyiragongo and Nyamulagira volcanoes in the Democratic Republic of Congo: a time-series analysis.

BACKGROUND: Nyamulagira and Nyiragongo are active volcanoes situated close to Goma (North Kivu, Democratic Republic of Congo). These volcanoes are among the most prolific sources of volcanic SO2 pollution on earth. OBJECTIVE: We investigated the possible spatiotemporal relationships between volcanic degassing represented by eruptive emissions of SO2 that occurred between 2000 and 2010, and the incidence of acute respiratory symptoms (ARS) in populations living in areas up to more than 100 km from the volcanoes. METHODOLOGY: The total flux of SO2 emitted during eruptions since 2000 and the average spatial distribution of the volcanic plume (2004-2008) were based on publicly available remote sensing data. The monthly numbers of adults and children reporting acute respiratory symptoms were extracted from health data collected routinely by selected local health centres and hospitals between 2000 and 2010. The monthly numbers of persons with ARS recorded during or after eruptions were compared with those recorded before eruptions, using negative binomial regression models allowing the calculation of incidence rate ratios (IRR) and their 95% confidence intervals. We first compared years with and without eruptions and then considered shorter time-windows (months). RESULTS: In the investigated area, ARS were the second most frequent cause of medical visits (12.2%, n = 3.2 million cases), after malaria (32.3%, n = 8.4 million cases). SO2 emissions gradually increased 30 to 50 times in 2010 compared to 2002. Taking 1999 as a reference, the IRR for ARS increased three-fold between 2000 [0.9 (0.8, 1.1)] and 2009 [2.8 (2.2, 3.7)]. Although the incidence of ARS appeared to increase after some eruptions, especially in areas close (< 26 km) to the volcanoes, we did not find a consistent temporal association between the yearly incidence of ARS and volcanic eruptions when considering the entire observation period. When we analysed shorter time-windows (6 months in the year preceding an eruption), we observed increased ARS incidences in eruptive months, except in 2010. IRRs were increased for centres situated close to volcanoes (< 26 km) in 2001 and 2002. CONCLUSION: ARS incident cases increased over the years in populations living around the Nyamulagira and Nyiragongo volcanoes, but we found no consistent evidence for an association between the yearly incidence of ARS and volcanic eruptions or the intensity of SO2 emissions, possibly because of interference with man-made events, including massive population displacements caused by insecurity in the area. Nevertheless, some evidence was found for increased incidence of ARS following eruptions, especially in areas close to volcanoes. Assessing personal, ground level exposure to SO2 and particulates with adequate controlling for confounding, such as viral and other infections, could clarify the contribution, if any, of volcanic emissions of SO2 to the high burden of respiratory diseases in this region.

Food consumption and undernutrition variations among mothers during the post-harvest and lean seasons in Amoron'i Mania Region, Madagascar.

BACKGROUND: Seasonal variation affects nutrition particularly in contexts where people's food consumption depends on their production of food. Assessing the effect of the season on nutrition status can help us to identify strategies to address undernutrition. This study aims to measure the variations in food consumption and the incidence of undernutrition according to season, and to identify the factors associated with the incidence of undernutrition. METHODS: A cohort study was conducted among 608 mothers aged between 18 and 45 years living in the Amoron'i Mania Region of Madagascar. Inclusion in the study occurred during the post-harvest season, and mothers were followed until the end of the next lean period (7 months). A dichotomous variable of the frequency of consumption of various foods was used to establish variation in food consumption. Body Mass Index < 18.5 kg/m2 and Middle Upper Arm Circumference < 220 mm were used to measure incidence of undernutrition. A generalized linear model was used to identify factors associated with the incidence of undernutrition and to derive relative risks. RESULTS: During the lean season, the frequency of consumption of leafy green vegetables, peanuts, fish, and eggs decreased significantly. In contrast, the frequency of fruit, legumes, and non-leafy green vegetables consumption increased significantly. The prevalence of undernutrition (based on the BMI and/or MUAC) among mothers increased from 19.6% in the post-harvest period to 27.1% in the lean period (p < 0.001). The incidence of undernutrition (based on the BMI and/or MUAC) during the follow-up was 12.2%. The factors related to undernutrition were low and medium score of movable property possession (Adjusted RR = 3.26 [1.33-7.94] and Adjusted RR = 2.48 [1.01-6.10]), no toilet (Adjusted RR = 1.76 [1.07-2.91]), and pregnancy (Adjusted RR = 2.92 [1.42-6.04]) (based on the MUAC only for pregnancy). CONCLUSION: This study highlights the variation in the frequency and type of food consumption and subsequent deterioration in mothers' nutritional status during the lean season. Economic, hygiene, and reproductive factors were associated with undernutrition. Analyzing the existing interventions to fight maternal undernutrition is necessary to determine whether or not seasonality is considered and addressed.

The WHO recommendation of home fortification of foods with multiple-micronutrient powders in children under 2 years of age and its effectiveness on anaemia and weight: a pragmatic cluster-randomized controlled trial.

OBJECTIVE: To assess under real community settings the effectiveness of the WHO strategy of home fortification of foods (HFF) with multiple-micronutrient powders on Hb change, anaemia and weight in children. DESIGN: A pragmatic cluster-randomized controlled trial. SETTING: Forty villages in the Nioro Circle in Mali and 722 children aged 6-23 months were randomized to the intervention or control group. The intervention consisted of a daily dose of multiple-micronutrient powder for 3 months; in the control group, no supplement was given. In both groups, mothers received group education on child complementary feeding. Changes in weight, Hb concentration and anaemia were assessed as primary outcomes at baseline and 3 months. The HFF effect was determined using regression analyses and quantile regression with standard errors taking account of the cluster design. SUBJECTS: Children aged 6-23 months. RESULTS: Overall prevalence of anaemia in the sample was high: 90 %. HFF provided a modest but statistically significant Hb change v. no intervention (0·50 v. 0·09 g/dl, P=0·023). Prevalence of anaemia changed little: 91·3-85·8 % (P=0·04) in the intervention group v. 88·1-87·5 % % (P=0·86) in the control group. Proportion of severe anaemia was reduced by 84 % (from 9·8 to 1·6 %) in the intervention group, but increased in the control group (from 8·5 to 10·8 %). No effect was observed on weight. CONCLUSIONS: The WHO HFF strategy to fight anaemia showed a modest change on Hb concentration and significantly reduced the rate of severe anaemia.

Contraception determinants in youths of Sierra Leone are largely behavioral.

BACKGROUND: Sexual initiation occurs early in Sierra Leone. This study aims to analyze the determinants of condom and/or contraceptive use among a representative sample of young persons (10 to 24 years) in Sierra Leone. METHODS: This is a secondary analysis of data from a study conducted to monitor the implementation of a UNFPA package of interventions directed to improve SRH in young people of Sierra Leone. This assessment was conducted in 2016 at the end of the Ebola outbreak. In consequence, determinants linked to healthy lifestyle behaviors and UNFPA interventions were explored in addition to the usual determinants: socio demographic and sexual lifestyle. This study is a household quantitative survey with open ended questions used to illustrate and complete the analysis. RESULTS: A total of 1409 young people were interviewed: of these, 216 boys and 381 girls were sexually active. Those who were pregnant or wished for pregnancy were excluded, leaving 194 boys and 268 girls for the analysis of determinants. The proportion of young people using neither condom nor other contraception at their last sexual intercourse in the whole sample was 40.5% and there was no statistically significant difference between boys and girls (42.3 vs 39.2; P = 0.504). Determinants were assessed and, after multivariable analysis, results differed between boys and girls and showed the importance of behavioral aspects. Four determinants were common to boys and girls: literacy, distance, negotiation capacity and hand washing. However, the distance factor for girls was to the health facility and for boys it was to school. Three more determinants remained in the boy's model: sleeping under a bednet, number of sexual partners and knowledge of contraceptive methods. Opinions about condoms and contraception revealed important barriers; opposition to contraceptive use was the main reason for non-use for both boys and girls, while lack of access was an important reason for boys. CONCLUSION: There is a need to reach out to the 40% of young people who are sexually active and neither pregnant nor with pregnancy desire, and are not using condom or contraception.

Concentration-response curve and cumulative effects between ozone and daily mortality: an analysis in Wallonia, Belgium.

Many studies have shown an association between ozone and mortality. However, little data is available on the cumulative effects of ozone on health. A time-series analysis using a Poisson regression was used to measure the impact of ozone on non-traumatic mortality in Wallonia over the period 2000-2012. Initially, a single-lag model was tested. Then a distributed-lag non-linear model was used in order to verify the cumulative effects of ozone on mortality. Our study confirms the existence of an association between ozone and mortality. The linear model without threshold shows a higher sensitivity in persons aged 75 and over (ERR = 0.7, 95 % CI: 0.4; 1.0 %) compared to younger people (ages 25-74) (ERR = 0.2, 95 % CI: - 0.2; 0.6 %). Taking cumulative effects into account, men and women aged 25-74 have an ozone sensitivity equivalent to those over 75.

Short-term effects of air pollution on hospitalization for acute myocardial infarction: age effect on lag pattern.

The aim of the present study is to analyse the age effect on the lag patterns of relative risk of hospitalization for acute myocardial infarction and NO2, PM10 and O3. Daily hospitalizations for AMI during the period 2008-2011 were extracted from administrative data. Analyses were performed using the quasi-Poisson regression model adjusted for seasonality, long-term trend, day of the week and temperature. We observed very different patterns depending on age. For NO2 and PM10, the younger group (25-54 years) shows a more delayed effect in comparison with the two older age groups (55-64 and ≥ 65 years). Overall, the associations between NO2 and AMI are higher compared to PM10. There are no associations between O3 and AMI. This study indicates that age plays a major role in the lag pattern. Younger people have delayed effects, but they are nevertheless sensitive to air pollution.

Relapses from acute malnutrition and related factors in a community-based management programme in Burkina Faso.

Community-based management of acute malnutrition (CMAM) is effective in treating acute malnutrition. However, post-discharge follow-up often lacks. We aimed at assessing the relapse rate and the associated factors in a CMAM programme in Burkina Faso. Discharged children from the community nutrition centre were requested to return at least every 3 months for follow-up. The data of recovered children (weight-for-height z-score ≥-2) who were discharged between July 2010 and June 2011 were collected in 45 villages, randomly selected out of 210 in January 2012. Sociodemographic data, economic variables, information on household food availability and the child's food consumption in the last 24 h were collected from the parents. A multivariate Cox proportional hazards regression was used to identify the factors associated to relapse. Of the 637 children, 14 (2.2%) died and 218 (34.2%) were lost to follow-up. The relapse rate [95% confidence interval] among the children who returned for follow-up was 15.4 [11.8-19.0] per 100 children-years. The associated factors to relapses in multivariate Cox regression model were mid-upper arm circumference (MUAC) at discharge below 125 mm, no oil/fat consumption during the last 24 h and incomplete vaccination. To limit relapses, CMAM programmes should avoid premature discharge before a MUAC of at least 125 mm. Nutrition education should emphasize fat/oil as inexpensive energy source for children. Promoting immunization is essential to promote child growth. Periodic monitoring of discharged children should be organized to detect earlier those who are at risk of relapse. The relapse rate should be a CMAM effectiveness indicator.

[Funding of the management of severe malaria in children by Kinshasa households (Democratic Republic of Congo)]. / Financement de la prise en charge du paludisme grave de l’'enfant par les ménages à Kinshasa, République Démocratique du Congo.

INTRODUCTION: The objective of this study was to determine the source of health care funding for heads of households related to the management of severe malaria in children admitted to a Kinshasa reference hospital. METHODS: This cross-sectional study was conducted on 1,350 hospitalised children under the age of 15 years treated for severe malaria in Kinshasa reference hospitals from January to November 2011 and the heads of households of these children. RESULTS: Only 46% of heads of households reported having sufficient funds directly available in the household budget. The remaining 54% had to call upon external sources of funding (sale of assets, loans, pawning goods). The use of a loan tended to increase significantly mainly for households with a low (adjusted odds ratio = 6.2), and intermediate socioeconomic status (adjusted odds ratio = 3.8) and for households working in the informal sector (adjusted odds ratio = 2.5). Similarly, the sale of assets was more frequently reported for households working in the informal sector (adjusted odds ratio = 2.4) and for female heads of households (adjusted odds ratio = 3.9). CONCLUSION: The management of severe malaria is a burden on household income. The majority of heads of households concerned needs to use external funding sources. A State subsidy for this management would help to reduce the risk of debt and sale of assets, especially for the poorest households.

[Health workers' involvement for data quality improvement in Benin]. / Implication des agents de santé dans la conception des outils de collecte de données au Bénin.

OBJECTIVE: In developing countries, the poor quality of data derived from Health Information Systems constitutes a problem that limits use of these data and contributes to the recurrent difficulties of health system management. The low level of involvement of health workers directly responsible for data may contribute to this poor quality. This study documents a Health Information System collection tool design experience by health workers and assesses its effect on data quality. METHODS: Eighty health workers responsible for clinical statistics in public health centres participated in this study. The two tools used for clinical data collection were modified by a group of 6 volunteer health workers. Monitoring indicators, data entry time, percentage exhaustiveness and quality of data were assessed before and after using the new tools. Data were compared by Wilcoxon's test for paired data and Mc Nemar's chi-square test. RESULTS: Between the two assessments, the data entry time increased from 28.7 to 22.5 seconds by reported case (p=0.153), the exhaustiveness of the reports increased from 16% to 89% (p<0.001) and the proportion of reports with sufficient data quality increased from 18.8% to 45.8% (p=0.002). CONCLUSION: The positive course of the indicators shows that increased involvement of health workers in key stages such as the design of data collection tools can help improve data quality.

Fluid intake survey among schoolchildren in Belgium.

BACKGROUND: In childhood, inadequate fluid intakes can lead on the short term, to reduced physical and cognitive performances. However, few data are available on the fluid intake among schoolchildren in Belgium. The main aim of this study is to evaluate total fluid intake provided by different types of beverages in a sample of Belgian schoolchildren, in order to assess the percentage of individuals complying with the European Food Safety Authority recommendations for total fluid intake. A secondary aim was to characterize the study population in terms of determinants of the total fluid intake requirements. METHODS: A child friendly "fluids and liquid food" diary was used to prospectively record the volume and frequency of beverage consumption over 7 days from 1045 schoolchildren. This diary also recorded the practice of physical activity. An adequate fluid intake was defined as an intake ≥ 75% of the age-specific adequate intake recommended by the EFSA. RESULTS: The median (P25-P75) of habitual daily fluid intake was 864 (608-1104) ml/day, with 355 (194-579) coming from drinking water. This habitual daily fluid intake varied significantly among the three investigated EFSA groups (girls and boys aged from 8 years, girls from 9 to 13 and boys from 9 to 13), except for the drinking water (P = 0.906). The highest medians of fruit juice, sugar-sweetened beverages and milk and derivatives were found among boys of 9-13. Only 9.5% of the children had an adequate fluid intake, with a value of 19.2% among the 8 years old girls and boys, 7.0% among girls of 9-13 and 8.4% among boys of 9-13. In the whole sample, 27.7% of the children declared to drink less than 3-4x/day, 56% drunk water less than 2x/day and 7.7% drunk no water at all. Every day, 27.1% and 34.1% of the children drank respectively one fruit juice and one sugar-sweetened beverage. CONCLUSION: Belgian schoolchildren have an inadequate total fluid intake. Given the potential health consequences, interventions involving parents and school environment to promote water consumption seem pertinent.

[Exploratory analysis of work engagement: use of the Utrecht scale in Benin]. / Analyse exploratoire de l'engagement au travail: utilisation de l'echelle d'Utrecht au Bénin.

INTRODUCTION: Work engagement, an emerging concept in the field of positive psychology in the workplace is not well known in developing countries. Defined as a positive and and fulfilling mindset related to work, it recalls a positive attitude incentive of performance and need to be investigated. In the context of the socioeconomic crisis of health workers, and with the chronic issue of poor quality of data, this study was designed to identify the factors associated with work engagement among health workers. in charge of data collection in the Benin Routine Health Information System. METHODS: This study was a cross-sectional and analytical study targeting health workers in charge of data collection in public and private health centres. The dependent variable was work engagement and independent variables were sociodemographic and professional features, personal and professional resources and perception of technical factors. Logistic regression was used. The adequacy of the model was tested with the Hosmer-Lemeshow goodness of fit test. RESULTS: The results indicate that the level of work engagement is similar with that observed in previous studies. Predictors identified in logistic regression are perception of technical factors, location of the job, and personal resources, such as level of effort and overcommitment. DISCUSSION: This study identified factors associated with work engagement in a developing country, and adds to the knowledge concerning this new concept in Benin. The findings can contribute to research for improvement of human resources management in the health sector to achieve real performance and development.