Cluster analysis of medical students' attitudes regarding people who use drugs: a first step to design a tailored education program.

INTRODUCTION: People with substance use disorder (SUD) deal with stigmatization in various areas of life, including healthcare system. In this study, we investigated the attitudes of final-year medical students towards SUD people and attempted to understand their influence. METHODS: We conducted a two-stage cluster analysis (hierarchical ascending classification followed by K-means clustering) based on the "beSAAS". We administrated this 23-item questionnaire to 923 final-year medical students in Belgium (response rate = 71,1%). Sociodemographic characteristics were compared between the clusters. RESULTS: Four clusters of students with specific characteristics were identified in this study. The first, "The Inclusives" (including 27,9% of respondents) had the least negative attitudes; they wanted to specialize mainly in psychiatry and gynecology. The second, "The Centrists" (23,6%) consisted mainly of male students. They had many private and professional experiences with substance use and considered themselves less healthy than others did. Most wanted to specialize in pediatrics and general practice. Their attitudes were slightly negative towards people with SUD. The third, "The Moralists" (27,6%), were mainly older, from non-European countries, had the least experience with substance use (or contact mainly in hospitals), had the less high mother's level of education and reported excellent health. They were heading toward other specialties. They had the most stereotypes and moralism, and less treatment optimism. The fourth, "The Specialist care-oriented" (20,8%), were the most in favor of specialized treatment. This group had a higher proportion of Belgian, females, and students who had specific contact with this population. They especially intended to specialize in internal medicine. CONCLUSION: This study revealed 4 profiles of medical students with different attitudes towards SUD people. "The Moralists", including more than a quarter of the respondents, were characterized by strong stereotypes and moralism and little treatment optimism. These clusters could contribute to the design of a learner-centered program aimed at addressing stigma within the main curriculum.

Factors influencing medical students' attitudes towards substance use during pregnancy.

BACKGROUND: People with substance use disorder, and pregnant women especially, are subject to a lot of stigmas, which can prevent optimal accessibility and quality of care. In this survey, we investigated attitudes of final year medical students regarding substance use during pregnancy and identified the factors that influence these attitudes. METHOD: This cross-sectional study was conducted in 2019 and 2020 in Belgium using the short version of the "Substance Abuse Attitude Survey" questionnaire. We focused on two items regarding punishment of substance use during pregnancy. We analysed the concordance between these two, their correlation with other items (e.g. stereotyping, morality, forced withdrawal, low treatment optimism) and the association between respondents' opinion on punishment and their sociodemographic data. RESULTS: The response rate was 65.2% (370/567 online and face-to face questionnaires). 19.2% of respondents were in favour of punishment for alcohol use (n = 353) and 15.1% for drug use (n = 356) during pregnancy. The agreement analysis between the two items showed that 14.3% of students were in favour of punishing both pregnant women who use drugs and those using alcohol. Respondents tended to be more in favour of punishment if they were male students, older, their mothers' had a lower education level or had no personal or family history of substance use. Attitudes appeared to be more punitive among students with limited contact with people with substance use disorder (i.e. none or limited to hospital). Students intending to specialise in internal medicine were more in favour of punishment of women whereas none of those intending to specialise in psychiatry were in favour. CONCLUSION: Our study shows that about 20% of surveyed medical students favoured punishing substance-using pregnant women. Awareness and training work seems to be necessary to ensure adequate care and support for this already vulnerable population.

Incidence of catastrophic expenditures linked to obstetric and neonatal care at 92 facilities in Lubumbashi, Democratic Republic of the Congo, 2015.

BACKGROUND: In the Democratic Republic of the Congo (DRC), more than 93% of users must pay out of pocket for care. Despite the risk of catastrophic expenditures (CE), 94% of births in Lubumbashi are attended by skilled personnel. We aimed to identify risk factors for CE associated with obstetric and neonatal care in this setting, to document coping mechanisms employed by households to pay the price of care, and to identify consequences of CE on households. METHODS: We used mixed methods and conducted both a cross-sectional study and a phenomenological study of women who delivered at 92 health care facilities in all 11 health zones of Lubumbashi. In April and May 2015 we followed 1,627 women and collected data on their health care and household expenses to determine whether they experienced CE, defined as payments that reached or exceeded 40% of a household's capacity to pay. Two months after discharge, we conducted semi-structured interviews with 58 women at their homes to assess the consequences of CE. RESULTS: In all, 261 of 1,627 (16.0%) women experienced CE. Whether a woman or her infant experienced complications was an important contributor to her risk of CE; poverty, younger age, being unmarried, and delivering in a parastatal facility or with more highly trained personnel also increased risk. Among a subset of women with CE interviewed 2 months after discharge, those who were in debt or who had lost their trading income or goods were unable to pay their rent, their children's school fees, or were obliged to reduce food consumption in the household; some had become victims of mistreatment such as verbal abuse, disputes with in-laws, denial of paternity, abandonment by partners, financial deprivation, even divorce. CONCLUSIONS: We found a higher proportion of CE than previously reported in the DRC or in other urban settings in Africa. We suggest that the government and funders in DRC support initiatives to put in place mutual-aid health risk pools and health insurance and introduce and institutionalize free maternal and infant care. We further suggest that the government ensure decent and regular payment of providers and improve the financing and functioning of health care facilities to improve the quality of care and alleviate the burden on users.

A comparison of exclusive breastfeeding in Belgian maternity facilities with and without Baby-friendly Hospital status.

A retrospective cross-sectional study was carried out in Wallonia (the southern region of Belgium) in which a 20-question breastfeeding (BF) module was included in an immunization survey. The purpose of this paper is to compare exclusive breastfeeding (EBF) prevalences and BF practices for mothers giving birth in Baby-friendly Hospital Initiative (BFHI) and non-BFHI maternity facilities. A total of 557 mothers responded to BF questions when their child was 18-24 months old; 26.7% of them delivered in a BFHI maternity facility. At discharge, a larger proportion of children were exclusively breastfed if they were born in a BFHI maternity facility (76.5% vs. 65.8%, p = .02). The median duration of EBF (15.0 vs. 12.9 weeks, p = .3), and the proportion of children exclusively breastfed at 5 months (16.8% vs 15.8%, p = 1.0) were similar in both groups. Few mothers knew that EBF was recommended for the first 6 months of life (28.6% in BFHI vs 23.1% in non-BFHI, p = .2). For most groups of the population examined, the rates of BF tended to be higher in BFHI facilities, but many differences were not significant. More specifically, BFHI seemed to boost BF practices among mothers more likely to breastfeed, but the Initiative did not seem to trigger enhanced BF practices in mothers traditionally less likely to breastfeed (except for indifferent/negative partner's attitude and mothers of Belgian origin). Influencing the BF practices of mothers less likely to breastfeed requires a special attention with complementary actions in maternity facilities as well as in community services.

Parental separation and behaviours that influence the health of infants aged 28 to 32 months: a cross-sectional study.

BACKGROUND: In Western countries, many children are affected by the separation of their parents. The study's main objective was to analyse the parental behaviours potentially influential for preschool children's health by family structure (parents together or separated). METHODS: We conducted a cross-sectional study based on data collected from examinations as part of free preventive medical consultations in the French Community of Belgium. During the assessment of 30,769 infants aged 28 to 32 months, information was collected on the parents' use of tobacco, brushing of the infant's teeth, being monitored by a dentist, and receiving vision screening. The chi2 test was applied and the odds ratios were derived to compare the two groups of children (exposed/not exposed to parental separation). Multivariate logistic regression analyses were used to adjust the effect of exposure. RESULTS: Nearly one in ten (9.8%) did not live with both parents under the same roof. Taking into account the social and cultural environment and other potential confounders at our disposal, we found that in the event of parental separation, behaviours differ in comparison with situations where parents live together; the adjusted odds ratios (ORs) (95% confidence interval) for the infant's exposure to tobacco, absence of teeth brushing, lack of monitoring by a dentist and absence of visual screening, were respectively 1.7 (1.2-2.0), 1.1 (0.9-1.2), 1.3 (1.1-1.6), 1.2 (1.1-1.2), and 1.2 (1.1-1.4). CONCLUSIONS: This study confirms the suspicion that parental separation is an independent risk factor for parental behaviours that negatively influence the infant's health. If these results are confirmed, this it could affect the work of the family doctors and paediatricians, especially in terms of family support and information to parents.

Emergency obstetric and neonatal care availability, use, and quality: a cross-sectional study in the city of Lubumbashi, Democratic Republic of the Congo, 2011.

BACKGROUND: While emergency obstetric and neonatal care (EmONC) is a proxy indicator for monitoring maternal and perinatal mortalities, in Democratic Republic of the Congo (DRC), data on this care is rarely available. In the city of Lubumbashi, the second largest in DRC with an estimated population of 1.5 million, the availability, use and quality of EmONC are not known. This study aimed to assess these elements in Lubumbashi. METHODS: This cross-sectional survey was conducted in April and May 2011. Fifty-three of the 180 health facilities that provide maternity care in Lubumbashi were included in this study. Only health facilities with at least six deliveries per month over the course of 2010 were included. The availability, use and quality of EmONC at each level of the health care system were assessed according to the WHO standards. RESULTS: The availability of EmONC in Lubumbashi falls short of WHO standards. In this study, we found one facility providing Comprehensive EmONC (CEmONC) for a catchment area of 918,819 inhabitants. Apart from the tertiary hospital (Sendwe), no other facility provided all the basic emergency obstetric and neonatal care (BEmONC) signal functions. However, all had carried out at least one of the nine signal functions during the 3 months preceding our survey: 73.6% of 53 facilities had administered parenteral antibiotics, 79.2% had systematically offered oxytocics, 39.6% had administered magnesium sulfate, 73.6% had manually evacuated placentas, 81.1% had removed retained placenta products, 54.7% had revived newborns, 35.8% had performed caesarean sections, and 47.2% had performed blood transfusions. Function 6, vaginal delivery assisted by ventouse or forceps, was performed in only two (3.8%) facilities. If this signal function was not taken into account in our assessment of EmONC availability, there would be five facilities providing CEmONC for 918,819 inhabitants, rather than one. In 2010, all the women in the surveyed facilities with obstetric complications delivered in facilities that had carried out at least one signal function in the 3 months before our survey; 7.0% of these women delivered in the facility which provided CEmONC. Mortality due to direct obstetric causes was 3.9% in the health facility that provided CEmONC. The intrapartum mortality was also high in this facility (5.1%). None of the maternity ward managers in any of the facilities surveyed had received training on the EmONC package. Essential supplies and equipment for performing certain EmONC functions were not available in all the surveyed facilities. CONCLUSION: Audits of maternal and neonatal deaths and near-misses should be established and used as a basis for monitoring the quality of care in Lubumbashi. To reduce maternal and perinatal mortality, it is essential that staff skills regarding EmONC be strengthened, the availability of supplies and equipment be increased, and that care processes be standardized in all health facilities in Lubumbashi.

Impact of Moringa oleifera lam. Leaf powder supplementation versus nutritional counseling on the body mass index and immune response of HIV patients on antiretroviral therapy: a single-blind randomized control trial.

BACKGROUND: To achieve effective antiretroviral therapy (ART) outcomes, adherence to an antiretroviral regimen and a good immunometabolic response are essential. Food insecurity can act as a real barrier to adherence to both of these factors. Many people living with human immunodeficiency virus (PLHIV) treated with ART in the Democratic Republic of the Congo (DRC) are faced with nutritional challenges. A significant proportion are affected by under nutrition, which frequently leads to therapeutic failure. Some HIV care facilities recommend supplementation with Moringa oleifera (M.O.) Lam. leaf powder to combat marginal and major nutritional deficiencies. This study aims to assess the impact of M.O. Lam. leaf powder supplementation compared to nutritional counseling on the nutritional and immune status of PLHIV treated with ART. METHODS: A single-blind randomized control trial was carried out from May to September 2013 at an outpatient clinic for HIV-infected patients in Kinshasa (DRC). Sixty adult patients who were at stable HIV/AIDS clinical staging 2, 3 or 4 according to the World Health Organization (WHO), and were undergoing ART were recruited. After random allocation, 30 patients in the Moringa intervention group (MG) received the M.O. Lam. leaf powder daily over 6 months, and 30 in the control group (CG) received nutritional counseling over the same period. Changes in the body mass index (BMI) were measured monthly and biological parameters were measured upon admission and at the end of the study for the patients in both groups. RESULTS: The two study groups were similar in terms of long-term nutritional exposure, sociodemographic, socioeconomic, clinical, and biological features. At 6 months follow-up, patients in the MG exhibited a significantly greater increase in BMI and albumin levels than those in the CG. The interaction between the sociodemographic, clinical, and biological characteristics of patients in the two groups was not significant, with the exception of professional activity. CONCLUSIONS: Under medical supervision, M.O. Lam. leaf powder supplementation may represent a readily available and effective local solution to improve the nutritional intake and nutritional status of PLHIV undergoing ART. TRIAL REGISTRATION: The study was retrospectively registered in the Pan African Clinical Trial Registry on 15 May 2015, no. PACTR201505001076143.

Better than nothing? maternal, newborn, and child health services and perinatal mortality, Lubumbashi, democratic republic of the Congo: a cohort study.

BACKGROUND: The Democratic Republic of Congo (DRC) has a high rate of perinatal mortality (PMR), and health measures that could reduce this high rate of mortality are not accessible to all women. Where they are in place, their quality is not optimal. This study was initiated to assess the relationship between these suboptimal maternal, newborn and child health (MNCH) services and perinatal mortality (PM) in Lubumbashi, DRC's second-largest city. METHODS: We conducted a prospective cohort study, comparing women who had no, low, moderate, or high numbers of antenatal care (ANC) visits; three different levels of delivery care; and who did or did not attend postnatal care (PNC). Women were followed for 50 days after delivery, with PM as the primary endpoint. RESULTS: Uptake of recommended prenatal interventions was between 11-43% among ANC attenders, regardless of the frequency of their visits. PM was 26 per 1000. ANC attendance was associated with PM. Newborns of mothers who had the lowest attendance had a mortality two times higher than newborns of women who had not attended ANC (low visits: adjusted odds ratio (aOR) = 2.2; 95% confidence interval (CI) = 1.4-3.8). However, moderate (aOR = 1.4; 95% CI =0.7-2.2) and high (aOR = 1.3; 95% CI 0.7-2.2) attendance were not statistically significantly associated with PM. PNC attendance was not significantly associated with lower PM (relative risk 0.4, 95% CI 0.1-2.6). Emergency obstetric and newborn care (EmONC) was significantly associated with a reduction in mortality (aOR = 0.2; 95% CI = 0.2-0.8), with an 84.4% reduction among newborns at risk, and an overall reduction in mortality of 10% for all births. CONCLUSION: Perinatal mortality was high among the infants of women in the cohort under study (26 per 1000 live births). Availability of MNCH, specifically EmONC, was associated with lower perinatal mortality, and if this association is causal, might avert 84.4% of perinatal deaths among newborns at high-risk.

Parental separation: a risk for the psychomotor development of children aged 28 to 32 months? A cross-sectional study.

BACKGROUND: In Western countries, about a quarter of children are affected by parental separation and a number of authors have previously investigated how familial structure impacts children's health. The purpose of the work: to analyze the psychomotor development of children aged 28 to 32 months based on family structure (parents together or separated), independently of the influence of socio-economic environment that is well documented. To analyse the psychomotor development of children younger than 3 years based on family structure (parents together or separated) independently of the influence of socio-economic environment that is well documented. METHODS: Cross-sectional study by examination of 28 871 children as part of a free preventive medicine consultation. The data came from an assessment conducted 28 to 32 months after birth during which information was collected about the psychomotor development: to perform a standing jump, dress themselves, draw a vertical line and circle, use the "I" pronoun, build a three-word sentence, and say their first name RESULTS: Ten percent of the children had separated parents. Compared to parents who were together, when adjusting for the socioeconomic environment, as well as all potential confounders, the adjusted odds ratios (ORs) (95 % confidence interval [CI]) for children with separated parents, in terms of their ability to perform a standing jump, dress themselves, and draw a vertical line and circle were respectively 0.9 (0.7-1.1), 1.1 (0.9-1.2), 1.3 (1.1-1.4) and 1.2 (1.1-1.4). The adjusted ORs (95 % CI) for children's inability to say the "I" pronoun, build a three-word sentence, and say their first name were respectively 1.2 (1.1-1.3), 1.3 (1.2-1.5), and 1.2 (0.9-1.5). CONCLUSIONS: After adjusting for sociocultural factors and other potential confounders, we observed that the children exhibited slower progression in psychomotor development, especially in language and graphic abilities when their parents were separated. While the implications of our study are somewhat limited, they do provide us with the necessary arguments enabling us to set up a prospective cohort study. Such a study should be able to better assess the impact of parental separation on the child's development, confirming our preliminary results.

Not living with both parents is associated with more health- and developmental problems in infants aged 7 to 11 months: a cross sectional study.

BACKGROUND: In Western countries, many children are affected by the separation of their parents. Our main objective was to assess the possible impact of parental separation family structure on certain aspects of somatic health in low-age children. METHODS: We conducted a cross-sectional study based on data collected in the framework of free preventive medicine consultations in the French Community of Belgium. The data was derived from assessments conducted, between 2006 and 2012, on children 7 to 11 months after birth during which information of 79701 infants was collected regarding the risk of sudden infant death, psychomotor development, and development in terms of height and weight. The main outcome measures were: episode of risk of sudden infant death, polysomnography, home monitoring, psychomotor development, and body mass index. RESULTS: The parents of 6.6% of the infants were separated. We established multivariable models, based on the presence or absence of confounders. The adjusted ORs (95% CI) of symptoms perceived as frightening, notably at night, of a prescription for a polysomnography, of an abnormal polysomnography result, and of follow-up by home monitoring were thus respectively 1.3 (1.1-1.6), 1.1 (0.9-1.3), 1.8 (1.3-2.4), and 1.3 (1.1-1.6). The adjusted ORs (95% CI) for psychomotor delay and for a body mass index above the 97(th) percentile were respectively 1.3 (1.0-1.6) and 1.2 (1.1-1.3) in the event of separation. CONCLUSIONS: This study confirms the possibility that not living with both parents is an independent risk factor for the somatic health and psychomotor development of infants. This observation should be verified because it would have a major impact on the actions of family doctors and other first-line healthcare providers, in particular with regard to information and targeted prevention.

Assessing the economic burden of illness for tuberculosis patients in Benin: determinants and consequences of catastrophic health expenditures and inequities.

OBJECTIVES: To inform policy-making, we measured the risk, causes and consequences of catastrophic expenditures for tuberculosis and investigated potential inequities. METHODS: Between August 2008 and February 2009, a cross-sectional study was conducted among all (245) smear-positive pulmonary tuberculosis patients of six health districts from southern Benin. A standardised survey questionnaire covered the period of time elapsing from onset of tuberculosis symptoms to completion of treatment. Total direct cost exceeding the conventional 10% threshold of annual income was defined as catastrophic and used as principal outcome in a multivariable logistic regression. A sensitivity analysis was performed while varying the thresholds. RESULTS: A pure gradient of direct costs of tuberculosis in relation to income was observed. Incidence (78.1%) and intensity (14.8%) of catastrophic expenditure were high; varying thresholds was insensitive to the intensity. Incurring catastrophic expenditure was independently associated with lower- and middle-income quintiles (adjusted odd ratio (aOR) = 36.2, 95% CI [12.3-106.3] and aOR = 6.4 [2.8-14.6]), adverse pre-diagnosis stage (aOR = 5.4 [2.2-13.3]) and less education (aOR = 4.1[1.9-8.7]). Households incurred important days lost due to TB, indebtedness (37.1%), dissaving (51.0%) and other coping strategies (52.7%). CONCLUSIONS: Catastrophic direct costs and substantial indirect and coping costs may persist under the 'free' tuberculosis diagnosis and treatment strategy, as well as inequities in financial hardship.

[Incidence of rubella in 2010-2012 in Kinshasa, Democratic Republic of Congo: data from the measles case-based surveillance system]. / Fréquence de la rubéole a Kinshasa de 2010 a 2012, République Démocratique du Congo (RDC): données issues du système de surveillance de la rougeole.

INTRODUCTION: No surveillance system or survey data on the congenital rubella syndrome are available in the Democratic Republic of Congo. This article describes the incidence of primary rubella infection between 2010 and 2012 based on the measles case-based surveillance system in Kinshasa. METHODS: Suspected cases of measles notified in Kinshasa between 2010 and 2012 were retrospectively analyzed. RESULTS: From January 2010 to December 2012, 1,892 suspected cases of measles were reported, and 1013 serum samples were collected according to the surveillance standard and analyzed in the laboratory. There were more cases of confirmed rubella than measles among the investigated cases. The proportion of confirmed cases of rubella has increased significantly over the last 3 years. The proportion of affected individuals of childbearing age was 15.4%, with a female predominance in this age-group. CONCLUSION: The Democratic Republic of Congo should consider revising the definition of cases used in the measles surveillance system in order to take into account the incidence of measle, establish sentinel sites for surveillance of CRS and use measles eradication activities and other mass activities to introduce rubella vaccination.

[Self-medication among patients admitted to the emergency department of Kinshasa University Hospital]. / L'automédication chez des patients reçus aux urgences médicales des cliniques Universitaires de Kinshasa.

A cross-sectional descriptive study was conducted at Kinshasa University Hospital (KUH) to determine the prevalence of self-medication among patients admitted to KUH and to identify commonly used drugs. 391 patients aged 14 to 92 years admitted to the KUH emergency department between 15 January and 15 February 2011 were included in the study. 233 patients out of a total of 391 (59.6%) used self-medication between the onset of symptoms and the visit to KUH. The number of drugs used ranged from 1 to 7. Of the 233 patients who practiced self-medication, 224 (96.1%) used pharmaceutical drugs alone, 4 (1.7%) used traditional African remedies alone, 1 (0.4%) used Chinese medicine alone, and 4 (1.7%) combined pharmaceutical drugs with traditional African remedies. Analgesics and antipyretics (44.3%), non-steroidal anti-inflammatory drugs (NSAIDs) (26.3%), antimalarials (20.6%) and antibacterials (12.3%) were the most commonly used pharmaceutical drugs. Paracetamol was the most commonly used analgesic and antipyretic (89.1%). Among NSAIDs, diclofenac (65%) was the most widely used. Artemisinin-based combination drugs (40.4%) were the most commonly used antimalarials, with lumefantrine being the most common. The most widely reported antibacterials were betalactam antibiotics (ampicillin and amoxicillin) (42.9%). The results show that self-medication, based mainly on commonly prescribed pharmaceutical drugs, appears to be a common therapeutic option before seeking hospital care and may be a major threat to individual and community health.

Exploratory Factor Analysis of a French Adapted Version of the Substance Abuse Attitude Survey among Medical Students in Belgium.

To evaluate the impact of a new Substance Use Disorder (SUD) education program on medical students' attitudes, we selected the Substance Abuse Attitude Survey (SAAS) questionnaire, which we adapted to our curriculum and cultural context. To validate this adapted version, we conducted an exploratory factor analysis following the administration of our 29-item bSAAS questionnaire to 657 medical students in Belgium (response rate: 71.1%). Twenty-three items correlated to three factors; namely, "Stereotypes and moralism", "Treatment optimism" and "Specialized treatment" were retained (70% of total variance explained, Cronbach's alpha = 0.80) and constituted the new questionnaire called beSAAS. The factor "Specialized treatment" stood out from previous studies, which could be explained by our target population and the impact of the formal, informal and hidden curricula in medical education. This study was able to highlight certain factors influencing stereotypical representations such as age, gender, origin, personal or professional experience with substance use. Our study allowed us to retain the beSAAS as a good questionnaire to evaluate SUD stigma and highlighted interesting findings to improve SUD training in medicine. Further studies are needed to complete its validity and reliability.

Definition and characterization of localised meningitis epidemics in Burkina Faso: a longitudinal retrospective study.

BACKGROUND: The epidemiology of meningococcal meningitis in the African meningitis belt is characterised by seasonality, localised epidemics and epidemic waves. To facilitate research and surveillance, we aimed to develop a definition for localised epidemics to be used in real-time surveillance based on weekly case reports at the health centre level. METHODS: We used national routine surveillance data on suspected meningitis from January 2004 to December 2008 in six health districts in western and central Burkina Faso. We evaluated eight thresholds composed of weekly incidence rates at health centre level for their performance in predicting annual incidences of 0.4%and 0.8% in health centre areas. The eventually chosen definition was used to describe the spatiotemporal epidemiology and size of localised meningitis epidemics during the included district years. RESULTS: Among eight weekly thresholds evaluated, a weekly incidence rate of 75 cases per 100,000 inhabitants during at least two consecutive weeks with at least 5 cases per week had 100% sensitivity and 98% specificity for predicting an annual incidence of at least 0.8% in health centres. Using this definition, localised epidemics were identified in all but one years during 2004-2008, concerned less than 10% of the districts' population and often were geographically dispersed. Where sufficient laboratory data were available, localised epidemics were exclusively due to meningococci. CONCLUSIONS: This definition of localised epidemics a the health centre level will be useful for risk factor and modelling studies to understand the meningitis belt phenomenon and help documenting vaccine impact against epidemic meningitis where no widespread laboratory surveillance exists for quantifying disease reduction after vaccination.

Growth, nutritional status, and signs of rickets in 0-5-year-old children in a Kashin-Beck disease endemic area of Central Tibet.

UNLABELLED: In order to describe the growth of 0-5-year-old Tibetan children living in a Kashin-Beck disease (KBD) endemic rural area and to examine the relationship between anthropometric indicators and clinical signs of rickets, we analyzed the baseline data of a cohort of 668 children enrolled in a prospective program of calcium and vitamin D supplementation. Tibetan children suffer from growth retardation. Z score of weight-for-age, height-for-age, weight-for-height was below -2 in 32.5%, 27.7%, and 12.1% of the children, respectively. Clinical signs of severe rickets are highly prevalent. Underweight, stunting, and clinical rickets increases with age. Prevalence of malnutrition was higher in the presence of signs of rickets. The proportion of children with a head circumference Z score < -2 was lowest when signs of rickets were observed. CONCLUSION: Stunting and underweight are frequent and probably associated with rickets.

Determinants of maternal health services utilization in urban settings of the Democratic Republic of Congo--a case study of Lubumbashi City.

BACKGROUND: The use of maternal health services, known as an indirect indicator of perinatal death, is still unknown in Lubumbashi. The present study was therefore undertaken in order to determine the factors that influence the use of mother and child healthcare services in Lubumbashi, Democratic Republic of the Congo. METHODS: This was transversal study of women residing in Lubumbashi who had delivered between January and December 2009. In total, 1762 women were sampled from households using indicator cluster surveys in all health zones. Antenatal consultations (ANC), delivery assisted by qualified healthcare personnel (and delivery in a healthcare facility) as well as postnatal consultations (PNC) were dependent variables of study. The factors determining non-use of maternal healthcare services were researched via logistic regression with a 5% materiality threshold. RESULTS: The use of maternal healthcare services was variable; 92.6% of women had attended ANC at least once, 93.8% of women had delivered at a healthcare facility, 97.2% had delivered in the presence of qualified healthcare personnel, while the rate of caesarean section was 4.5%. Only 34.6% postnatal women had attended PNC by 42 days after delivery. During these ANC visits, only 60.6% received at least one dose of vaccine, while 38.1% received Mebendazole, 35.6% iron, 32.7% at least one dose of SulfadoxinePyrimethamine, 29.2% folic acid, 15.5% screening for HIV and 12.8% an insecticide treated net.In comparison to women that had had two or three deliveries before, primiparous and grand multiparous women were twice as likely not to use ANC during their pregnancy. Women who had unplanned pregnancies were also more likely not to use ANC or PNC than those who had planned pregnancies alone or with their partner. The women who had not used ANC were also more likely not to use PNC. The women who had had a trouble-free delivery were more likely not to use PNC than those who had complications when delivering. CONCLUSION: In Lubumbashi, a significant proportion of women continue not to make use of healthcare services during pregnancy, as well as during and after childbirth. Women giving birth for the first time, those who have already given birth many times, and women with an unwanted pregnancy, made less use of ANC. Moreover, women who had not gone for ANC rarely came back for postnatal consultations, even if they had given birth at a healthcare facility. Similarly, those who gave birth without complications, less frequently made use of postnatal consultations. As with ANCs, women with unwanted pregnancies rarely went for postnatal visits.In addition to measures aimed at reinforcing women's autonomy, efforts are also needed to reinforce and improve the information given to women of childbearing age, as well as communication between the healthcare system and the community, and participation from the community, since this will contribute to raising awareness of safe motherhood and the use of such services, including family planning.

[Determinants of adherence to treatment for uncomplicated malaria in northeastern Democratic Republic of Congo]. / Facteurs d'adhésion au traitement recommandé pour le paludisme simple au Nord-Est de la République Démocratique du Congo.

The purpose of this study was to identify the determinants of adherence to malaria treatment (co-blistered AS-AQ) among health care providers, medicine sellers and patients in the northeastern region of the Democratic Republic of Congo. A cross-sectional study was carried out on health care providers, medicine sellers and patients in 13 health zones between March and June 2009. Only 69% of the cases of uncomplicated malaria were treated with AS-AQ, including 62.3% of cases treated using the correct dosages. The availability of AS-AQ, the intention to prescribe AS-AQ, longer consultations, providing explanations to patients, working in rural areas, training on the new policy, and the availability of treatment guidelines were found to be significantly associated with treatment adherence among health care providers. The limited availability of AS-AQ, the adverse effects of the treatment, the use of low-quality AS-AQ and the availability of cheap illegal antimalarial drugs were the main factors associated with non-adherence. Among patients, non-adherence was related to the perceived adverse effects of malaria treatment. The results suggest that improving the?accessibility and quality of AS-AQ and the quality of communication with patients, the provision of appropriate training to healthcare providers, the provision of treatment guidelines and appropriate supervision are needed to promote the use of AS-AQ.

Effect of personalized home-based support for pregnant women on pregnancy outcomes: a cluster randomized trial.

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.