Estimating the Prevalence of Cerebral Palsy in a Semi-Urban City in Benin: A Door-to-Door Community-Based Study.

INTRODUCTION: Cerebral palsy (CP) is the most common cause of pediatric motor disability. While epidemiological data are widespread in high-income countries, corresponding data in low-income countries in sub-Saharan Africa are still rare. This study aimed to estimate the prevalence of CP in Northern Benin, a French-speaking low-income country in sub-Saharan Africa. METHODS: This study was a community-based door-to-door study involving children younger than 18 years old, in Parakou, a semi-urban city in Benin. We used a two-stage procedure. The first one consisted on children screening to identify potential cases of CP. During the second stage, suspected children were examined by neurologists with high experience with CP. RESULTS: In total, 2,630 children were screened with 10 confirmed cases of CP, resulting in a crude prevalence (95% confidence interval) of 3.8 (1.4, 6.15) per 1,000 children. Of the 10 confirmed cases, six were younger than 5 years old, and five were male. Eight children over ten were spastic with six bilateral spastic subtype according to the Surveillance of Cerebral Palsy in Europe classification system. Seven children had a Gross Motor Function Classification System level III-V, and six were classified level III to V of the manual ability classification system. CONCLUSION: CP is highly prevalent in semi-urban area in Northern Benin. Large studies on potential risk factors are needed for the development of effective preventive strategies.

Informal Care Time and Costs of Dementia Care in Benin (West Africa).

BACKGROUND: Dementia is a growing global health challenge, with significant socioeconomic implications. This study examined the informal care duration and related costs along with the total cost of care for older individuals with dementia in Benin, West Africa, providing insights into a region with limited dementia research. METHODS: We conducted a cost-of-illness study in Benin. Both hospital and community recruitments were used to enroll adults aged ≥60 years and their primary caregivers. Structured questionnaire and validated tools were used to collect the demographic, clinical, healthcare resource utilization data as well as informal care duration. Replacement costs approach was performed to valuate informal care time. Official exchange rates from the World Bank were used to convert costs from local currency to purchasing power parities dollars (PPP$). RESULTS: Data from 135 individuals with varying dementia stages revealed that dementia places substantial caregiving demands, predominantly on women who provide up to 8 h of daily care. In 2021, the mean annual cost of dementia care was estimated to be PPP$ 2,399.66 ± 2,057.07. Informal care represented a significant portion of dementia expenses, up to 92% of the total care costs in this study. DISCUSSION: Policy interventions are urgently needed to address the dementia care challenges in Benin, especially because economic transitions and educational advancements may reduce the availability of informal caregivers. This emphasizes the vital role of informal caregivers and underscores the need of implementing dementia policies to support families facing the evolving challenges of dementia care.

High-intensity interval training is feasible, credible and clinically effective in the early subacute stroke stage in the low-income country of Benin.

High-intensity interval training (HIIT) has been shown to benefit stroke patients when implemented three months post-stroke. This study examined HIIT's feasibility and clinical effectiveness in the early post-stroke stage in Benin. This was a prospective interventional study comprising an HIIT programme executed on a recumbent bike, three times/week, 20-30 min/session for 6 weeks, added to a conventional physiotherapy. The primary outcomes were feasibility, credibility and expectancy assessed with credibility and expectancy questionnaire. A maximal exercise test, 6-min walking test (6MWT), 10-m walking test (10mWT), Berg balance scale (BBS) and five repetitions sit-to-stand test (5 R-STS) were performed before and after the training programme. Ten outpatients, with a median age [P25-P75]: 63.5[56.7-71.2] years; time since stroke: 15.0[9.7-21.0] days, started and completed all training sessions without serious adverse events. High scores were observed on the Credibility subscale at admission (27.0[25.7-27.0]), which remained so after intervention (26.5[25.7-27.0]). Expectancy subscale scores were high at admission (25.5[24.0-27.0]) and post-training (25.5[24.5-27.0]). Peak workload (p < 0.001), BBS (p < 0.001), 6MWT (p < 0.001), 10mWT (p < 0.001) and 5 R-STS (p = 0.004) were all improved. HIIT is feasible and safe in the early subacute post-stroke stage and is perceived by patients as highly credible, meeting their expectations of recovery.

Knowledge, attitudes and practices of general practitioners on peripheral neuropathies in Benin in 2021.

PURPOSE: First healthcare actors in neurological diseases management, General Practitioners (GPs) still limited in the assessment of Peripheral Neuropathies (PN). This study assesses the knowledge, attitudes, practices (KAP) of GPs on PN in Benin in 2021 and identifying associated factors to low KAP. MATERIALS AND METHODS: It was a cross-sectional study conducted from 20 November 2020 to 30 June 2021 which included GPs registered in the National Order of Physicians in Benin and interns in last year of medical studies (MS). An overall KAP score of 24 points was derived. KAP levels were low (score < 17), medium (17 to 19) and high (score ≥ 20). Multivariable regression models were performed to identify factors associated with low KAP. RESULTS: 645/1,066 participants (60.5%) were included in the study with median age 28 years [Interquartile range IQR: 26-30 years], and 442 (68.5%) were male. The KAP level was low in 70.1%. 16.7% had a low knowledge of polyneuropathy manifestations, 35% perceived PN as an incurable disease. Lack of knowledge on PN before MS (adjusted Odds-ratio aOR = 1.6 [95% confidence interval CI: 1.1-2.3]), and no postgraduate training on PN (aOR = 1.8 [95% CI: 1.--3.0]) were associated with low overall KAP level. Working in rural area (aOR = 0.4 [95%CI: 0.2-0.7]), and being an intern (aOR = 0.6 [95%CI: 0.4-0.9]) were associated with better overall KAP level. CONCLUSION: This study highlights the need for better training with strong emphasis on PN during the MS and the organization of postgraduate training for GPs; the cornerstone for improving the management of PN in Benin.

The prevalence and demographic associations of headache in the adult population of Benin: a cross-sectional population-based study.

BACKGROUND: The Global Burden of Disease (GBD) study is increasingly well informed with regard to headache disorders, but sub-Saharan Africa (SSA) remains one of the large regions of the world with limited data directly derived from population-based studies. The Global Campaign against Headache has conducted three studies in this region: Ethiopia in the east, Zambia in the south and Cameroon in Central SSA. Here we report a similar study in Benin, the first from West SSA. METHODS: We used the same methods and questionnaire, applying cluster-randomized sampling in three regions of the country, randomly selecting households in each region, visiting these unannounced and randomly selecting one adult member (aged 18-65 years) of each household. The HARDSHIP structured questionnaire, translated into Central African French, was administered face-to-face by trained interviewers. Demographic enquiry was followed by diagnostic questions based on ICHD-3 criteria. RESULTS: From 2,550 households with eligible members, we recruited 2,400 participants (participating proportion 94.1%). Headache ever was reported by almost all (95.2%), this being the lifetime prevalence. Headache in the last year was reported by 74.9%. Age-, gender- and habitation-adjusted estimates of 1-year prevalence were 72.9% for all headache, 21.2% for migraine (including definite and probable), 43.1% for TTH (also including definite and probable), 4.5% for probable medication-overuse (pMOH) and 3.1% for other headache on ≥ 15 days/month. One-day (point) prevalence of headache was 14.8% according to reported headache on the day preceding interview. CONCLUSIONS: Overall, these findings are evidence that headache disorders are very common in Benin, a low-income country. The prevalence of pMOH, well above the estimated global mean of 1-2%, is evidence that poverty is not a bar to medication overuse. The findings are very much the same as those in a similar study in its near neighbour, Cameroon. With regard to migraine, they are reasonably in accord with two of three earlier studies in selected Beninese populations, which did not take account of probable migraine. This study adds to the hitherto limited knowledge of headache in SSA.

Physiotherapy practices in acute and sub-acute stroke in a low resource country: A prospective observational study in Benin.

BACKGROUND AND OBJECTIVE: Physiotherapy is highly recommended for early recovery from stroke. This study aimed to document physiotherapy practices for people with acute and early sub-acute stroke in Benin. METHODS: In this prospective observational study, physiotherapists working with acute stroke people documented the content of their treatment from six hospitals in Benin during the first session, at 2-week, and 1-month post-stroke with a standardized physiotherapy documentation form. We used the motricity index (MI) and trunk control test (TCT) to assess impairments, and the 10-meter walk test (10mWT), functional independence measure (FIM), walking, stair climbing, and dressing upper body subscales were used for activity limitations. RESULTS: Fifteen physiotherapists (60 % male, mean±SD age=31.3±5.8 years) recorded treatment sessions for 77 stroke participants (53.2 % male, mean±SD age=57.7±12.5 years). Physiotherapists focused on conventional physiotherapy approaches, including musculoskeletal (67 % of pre-functional activity time) and neuromuscular (53 % of sitting activity time) interventions. A significant difference was found between the therapy time delivered for people with mild, moderate, and severe stroke (p < 0.001). The MI (p= 0.033) and TCT (p= 0.002) measures showed significant improvement at 2-week and 1-month (p< 0.001) post-stroke, while 10mWT, FIM walking, stair climbing, and dressing upper body items significantly increased at 1-month (p< 0.001) but not at 2-week post-stroke. CONCLUSION: Physiotherapists working with acute stroke patients in Benin mainly use conventional neuromuscular and musculoskeletal interventions. In contrast, aerobic exercises were rarely employed regardless of stroke severity. Furthermore, our findings showed that the volume of physiotherapy sessions varied by stroke severity.

Prevalence and biopsychosocial factors associated with chronic low back pain in urban and rural communities in Western Africa: a population-based door-to-door survey in Benin.

PURPOSE: This study aimed to assess the prevalence of chronic low back pain (CLBP) and related biopsychosocial factors in urban and rural communities in Benin. METHODS: This is a population-based observational cross-sectional survey. An interviewer-administered electronic questionnaire was used to collect information on demographic, socio-economic, behavioral, and psychological factors relating to CLBP risk factors and medical history of participants. The numeric pain rating scale and the Beck Depression Inventory were used to assess pain intensity and the level of depression, respectively. Bivariate analyses were performed to investigate the association between sociodemographic, behavioral, and psychological factors and CLBP. Sequential multiple regression analyses were subsequently performed to predict the occurrence of CLBP. RESULTS: A total of 4320 participants, with a mean age ± SD of 32.9 ± 13.1 years, of which 40.7% were females and 50.1% from an urban area, were enrolled in the study. We found a global prevalence rate of CLBP of 35.5% [95% CI 34.1-36.9%]. The prevalence in urban areas was 30.68% [95% CI 28.9-32.8%]) while 40.2% was found in rural areas [95% CI 38.1-42.2%]). Age (p < 0.001), level of education (p = 0.046), marital status (p < 0.001), working status (p < 0.003), tobacco use (p < 0.016) and regular physical activity (p < 0.011) were associated with CLBP. In urban areas, only the level of education was able to predict the prevalence of CLBP (R2 = 61%). In rural areas, CLBP was predicted by age, marital and working status (R2 = 89%). CONCLUSIONS: This study showed a high prevalence of CLBP among urban and rural communities in Benin. Age, level of education, marital status, and working status were significantly associated with CLBP in Benin.

Knowledge of Stroke Risk Factors and Signs in Parakou, a Northern City of Benin in West Africa.

INTRODUCTION: We aimed to determine knowledge of stroke risk factors and signs in an urban population of northern Benin. METHODS: A door-to-door purposeful sampling survey was conducted in resident population (age ≥15 years) of the district of Titirou in the city of Parakou (N = 255,478) in Benin between March 15 and July 15, 2016. In-person interviews were conducted with data collection on structured questionnaires with close and open questions, according to standard definitions. Multivariable logistic regression was used to assess predictors of good knowledge, defined by provision of a correct response in pre-defined set of questions on stroke risk factors and warning signs. RESULTS: Of 4,671 participants (mean age 27.7 ± 12.9 years; females 50.6%), only 404 (8.6%) knew at least 1 stroke risk factor. Knowledge level of stroke risk factors (odds ratio, 95% confidence interval) was related to age (1.37, 1.27-1.48), level of education (2.54, 1.73-3.72), and family history of stroke (3.01, 2.08-4.26). Only 230 (4.9%) were able to cite at least 1 stroke symptom, and this knowledge was great with increasing age (1.04, 1.02-1.06), family (3.63, 2.41-5.49) and personal history of stroke (3.71, 1.86-7.42), and high level of education (4.35, 2.68-7.07). CONCLUSION: Knowledge of stroke risk factors and signs is low in northern Benin. Greater public education and awareness campaigns are required to address the burden of stroke.

Sleep-related disorders and sleep quality among adults living in Parakou, a sub-Saharan African city.

PURPOSE: To determine the prevalence of sleep-related disorders, poor sleeping, and factors associated with poor sleep quality among inhabitants of Parakou, Benin. METHODS: This was a cross-sectional study conducted from April-August 2018 on 930 randomly selected adults (age ≥ 18 years). Using the Pittsburg Sleep Quality Index, the Insomnia Severity Index, and the Epworth Sleepiness Scale, subjects were questioned on their sleep, on parasomnias, and on movement-related sleep disorders. RESULTS: Overall, the prevalence of insomnia was 22% (95% CI, 19.1-24.4) and severe insomnia was 0.8%. The prevalence of excessive daytime sleepiness was 15% (95% CI, 12.5-17.0). Daily nightmares (2%) and rhythmic movements (6%) were those most commonly reported among parasomnias and movement-related sleep disorders. No major differences were found between men and women. The prevalence of poor sleeping (PSQI > 5) was 39% (95%CI, 36.3-42.5). Adjusted analyses showed a higher risk of poor sleeping in those aged 45-54 years (aOR = 1.78, p = 0.032) or ≥ 55 years (aOR = 3.61, p < 0.001), those overweight or obese (aOR = 1.53, p = 0.007), those underweight (aOR = 2.90, p = 0.030), and among females (aOR = 1.84, p < 0.001). Being divorced was associated with a lower risk of poor sleeping (aOR = 0.18, p = 0.036). Poor sleepers were more commonly found among those who had excessive daytime sleepiness (65% versus 36%, p < 0.001) and insomnia (86% versus 27%, p < 0.001). CONCLUSION: Sleep-related disorders were common in Parakou city, Benin, with four out of ten persons having poor sleep quality. There is a need to improve the management of sleep-related disorders and promote better sleep practices for the community.

Prevalence of Dementia among Well-Educated Old-Age Pensioners in Parakou (Benin) in 2014.

INTRODUCTION: The number of people living with dementia is growing worldwide and most rapidly in low- and middle-income countries. Little is known about dementia in Benin. We estimated the prevalence of dementia among retired people in Parakou, a northern city in Benin, and then assessed associated factors. METHODS: A cross-sectional study was performed in Parakou from July to August 2014. Participants were recruited at 2 centers, the National Center of Social Security and the Public Treasury of Benin. Participants with cognitive impairment were defined as having a low cognitive score (<7) for the brief version of the Community Screening Interview for Dementia and were invited to neurological examination. DSM-IV-TR criteria were used to diagnose dementia and the HACHINSKI score was used to differentiate dementia subtypes. A logistic regression model was performed to identify factors associated with dementia. RESULTS: Overall, 440 retired people were included in the study. They were mainly male (92.3%) and their mean age was 64.9 ± 6.0 years. The prevalence of cognitive impairment was 7.7% (95% CI 5.2-10.2). Fourteen participants were diagnosed with dementia, representing a prevalence of 3.2% (95% CI 1.5-4.8). Alzheimer disease was the most frequent subtype (64.3%), followed by vascular dementia (21.4%). Retired people diagnosed with dementia were all men and were aged between 61 and 71 years. Most of them were living alone. The main factors associated with dementia were older age, low fruit and vegetables consumption, and living alone. DISCUSSION: This study showed a low prevalence of dementia among retired older people in Benin. Despite this, greater attention must be given to the potential burden dementia places on families for better care, before the expected aging of the population becomes more significant.

Long-Term Mortality of Stroke Survivors in Parakou: 5-Year Follow-Up.

BACKGROUND: The burden of stroke is high in Africa, but few data are available on the long-term outcome of strokes in this area. AIM: We aimed to study the long-term outcome of stroke survivors in Parakou from 2012 to 2018. METHODS OF STUDY: It was a cohort study and included 247 stroke patients admitted to the University Hospital of Parakou from January 1, 2012 to April 30, 2018. Each patient was followed up for at least 1 year. The modified RANKIN scale was used to evaluate patients. Verbal autopsy was used to ascertain the cause of death. The survival probability was estimated using the Kaplan-Meier method. Predictors of mortality were estimated using the Cox proportional model and the hazard ratio (HR) and their 95% confidence intervals were determined. The data were analyzed using Stata Software. RESULTS: The mean age was 58.1 ± 13.4 years with a sex ratio of 1.12. Among stroke survivors, the mortality was 10.1% at 3 months, 11.7% at 6 months, 15.4% at 1 year, 21.5% at 3 years, and 23.5% at 5 years. The probability of survival after a stroke was 66.5% at 5 years. Factors associated with mortality were age with adjusted HR 1.4 (1.2-1.7) for each 10 years, male sex with aHR 2.3 (1.2-4.6), history of hypertension with aHR 2.0 (1.0-4.1) and the severity of the initial neurological impairment National Institute of Health Stroke Scale with aHR 1.1 (1.0-1.2) for each 1 point. The main causes of death were recurrent stroke, infectious diseases, and cardiac disease. The proportion of patients with functional disability was 53.8% at 1 year. The quality of life was generally impaired in terms of physical health, personal environment, and finances. CONCLUSIONS: The long-term prognosis of stroke patients in Parakou is poor. It requires urgent action to reduce this burden.

Determinants of Social Participation at 1, 3, and 6 Months Poststroke in Benin.

OBJECTIVE: To build a model of prediction of social participation of community-dwelling stroke survivors in Benin at 1 month, 3 months, and 6 months. DESIGN: An observational study with evaluations at 1 month, 3 months, and 6 months poststroke. Correlational analyses and multivariate linear regressions were performed. SETTING: Outpatient rehabilitation centers in Benin. PARTICIPANTS: A volunteer sample of 91 stroke patients was enrolled at baseline; 64 (70%) patients completed all the study (N=64): 70% male and 52% right hemiparesis. INTERVENTION: Not applicable. MAIN OUTCOME MEASURES: Participants were evaluated with the Participation Measurement Scale, ACTIVLIM-Stroke (activities of daily living [ADL]), Stroke Impairment Assessment Set, 6-minute walk test, Hospital Anxiety and Depression Scale, and the modified Rankin Scale. RESULTS: The significant predictors of social participation after controlling the confounders were the following: at 1 month ADL (0.4 [0.3, 0.6]) and depression (‒0.6 [‒0.8, ‒0.2]) with total model R2=0.44; at 3 months ADL (0.58 [0.4, 0.7]) and depression (‒0.58 [‒0.5, ‒0.7]) with total model R2=0.65; and at 6 months ADL (0.31 [0.2, 0.5]), impairments (‒0.82 [‒0.5, ‒0.7]), and depression (‒0.94 [‒0.8, ‒0.2]) with total model R2=0.78. CONCLUSIONS: Using socioculturally tailored tools, the present study identified ADL performance (ACTIVLIM-Stroke), depression (Hospital Anxiety Depression Scale), and overall impairments (Stroke Impairment Assessment Set) as the significant determinants of social participation (Participation Measurement Scale) poststroke in Benin. These findings will be a valuable resource for rehabilitation stakeholders in evaluating interventions, programs, and policies designed to encourage social participation for stroke patients.

Measuring Participation After Stroke in Africa: Development of the Participation Measurement Scale.

OBJECTIVE: To develop a valid stroke-specific tool, named the Participation Measurement Scale (PM-Scale), for the measurement of participation after stroke. DESIGN: Observational study and questionnaire development. SETTING: Outpatient rehabilitation centers. PARTICIPANTS: Patients with stroke (N=276; mean age, 58.5±11.1y; 57% men). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Participants completed a 100-item experimental questionnaire of the PM-Scale. Items were scored as "not at all," "weakly," or "strongly." The Hospital Anxiety and Depression Scale was used to evaluate depression, and the modified Rankin Scale was used to categorize the severity of disability on the basis of observation. RESULTS: After successive Rasch analyses using unrestricted partial credit parameterization, a valid, unidimensional, and linear 22-item scale for the measurement of participation was constructed. All 22 items fulfilled the measurement requirements of overall and individual item and person fits, category discrimination, invariance, and local response independence. The PM-Scale showed good internal consistency (person separation index, .93). The test-retest reliability of item difficulty hierarchy (r=.96; P<.001) and patient location (r=.99; P<.001) were excellent. This patient-based scale covers all 9 International Classification of Functioning, Disability and Health domains of participation. CONCLUSIONS: The PM-Scale has good psychometric qualities and provides accurate measures of participation in patients with stroke in Africa.

Prevalence and correlates of depressive symptoms among undergraduate health science students at the University of Parakou, Benin.

OBJECTIVES: Research on psychological distress in African students is scarce. This study aimed at exploring the epidemiology (prevalence and correlates) of depressive symptoms among undergraduate health sciences students at the University of Parakou (Benin). METHODS: We conducted a cross-sectional survey from June to July 2022 at the University of Parakou, the second-largest university in the Republic of Benin. Depressive symptoms were assessed using the Patient Health Questionnaire depression scale (PHQ-9). Information on several independent factors was collected and their associations with depressive symptoms were investigated using logistic regression models. RESULTS: Data from 560 students were analyzed (mean age: 21.3± 2.3 years, 60 % were male, and 50.4 % were registered in the first year of study). The overall prevalence of depressive symptoms was 39.1 % [95 % CI: 35.2 %-43.1 %]. Moderate and severe depressive symptoms were observed in 15.3 % and 1.8 % of participants, respectively. In the multivariable model, being aged 21-23 (adjusted Odds Ratio=1.8, p-value: 0.007), a female (aOR=1.5, p-value: 0.050), a medical student (aOR=2.9, p-value: <0.001), a public health student (aOR=3.6, p-value: <0.001), belonging to households with higher incomes (aOR= 2.4, p<0.001), and experiencing stress (aOR=1.5, p-value: 0.048) independently increased the probability of having depressive symptoms. However, having support from close relatives (aOR= 0.5, p-value: 0.026) was associated with a lower probability of depressive symptoms. CONCLUSIONS: Our findings revealed a high prevalence of depressive symptoms among undergraduate health science students. Given the correlates identified, actions to promote coping skills in stress and encourage more parental support may be real avenues likely to help reduce the frequency and consequences of depressive symptoms.

Relationships between cardiorespiratory fitness, physical activity practices, and functional outcomes one-year post-stroke in northern Benin: A case-control study.

BACKGROUND: Currently, little is known on the relationships between cardiorespiratory fitness (CF), physical activity (PA), and functional outcomes after stroke, especially in low- and middle-income countries. OBJECTIVES: We examine the relationships between CF, PA, and functional outcomes in one-year poststroke in Benin, a lower middle-income country. METHODS: A case-control study was carried out in northern Benin. Twenty-one participants with chronic strokes were matched to 42 controls according to sex and age. PA patterns and associated energy expenditure (EE) were assessed with a BodyMedia's senseWear armband. CF was evaluated with the Physical Working Capacity at 75% of the predicted maximal heart rate index. The functional outcomes were evaluated using the modified Rankin scale (mRS) and the ACTIVLIM-Stroke scale. RESULTS: Both people with stroke and the healthy pairs spent much time in sedentary behavior (median [P25; P75]: 672 [460; 793] min vs 515 [287; 666] min, p = 0.006). Although people with chronic stroke performed fewer steps compared to healthy controls (median: 2767 vs 5524, p = 0.005), results showed that total EE was not statistically significant in either group (median: 7166 Kcal vs 8245 Kcal, p = 0.07). In addition, the mRS score (r = 0.47, p = 0.033) and the ACTIVLIM-Stroke measure (r = 0.52, p = 0.016) were moderately associated with the CF index of people with chronic stroke. CONCLUSION: The study showed clear trends for lower levels of PA in both people with chronic stroke and health controls. A correlation exists between CF, disability, and functional outcomes among stroke patients.

Physical Activity Level, Barriers, and Facilitators for Exercise Engagement for Chronic Community-Dwelling Stroke Survivors in Low-Income Settings: A Cross-Sectional Study in Benin.

After a stroke incident, physical inactivity is common. People with stroke may perceive several barriers to performing physical activity (PA). This study aimed to document the PA level and understand the barriers and facilitators to engaging in PA for community-dwelling stroke survivors in Benin, a lower middle-income country. A cross-sectional study was conducted in three hospitals in Benin. Levels of PA were recorded by means of the Benin version of the International Physical Activity Questionnaire long form (IPAQ-LF-Benin), which is validated for stroke survivors in Benin. The perceived exercise facilitators and barriers were assessed by the Stroke Exercise Preference Inventory-13 (SEPI-13). A descriptive analysis and associations were performed with a Confidence Interval of 95% and <0.05 level of significance. A total of 87 participants (52 men, mean age of 53 ± 10 years, mean time after a stroke of 11 (IQR: 15) months and an average of 264.5 ± 178.9 m as distance on the 6 min walking test (6MWT) were included. Overall, stroke survivors in Benin reached a total PA of 985.5 (IQR: 2520) metabolic equivalent (METs)-minutes per week and were least active at work, domestic, and leisure domains with 0 MET-minutes per week. The overview of PA level showed that 52.9% of participants performed low PA intensity. However, 41.4% performed moderate PA or walking per day for at least five days per week. Important perceived barriers were lack of information (45.3%), hard-to-start exercise (39.5%), and travelling to places to exercise (29.9%). The preference for exercise was with family or friends, outdoors, for relaxation or enjoyment (90.2%), and receiving feedback (78.3%). Several socio-demographic, clinical, and community factors were significantly associated with moderate or intense PA (p < 0.05) in stroke survivors in this study. Our findings show that the PA level among chronic stroke survivors in Benin is overall too low relative to their walking capacity. Cultural factors in terms of the overprotection of the patients by their entourage and/or the low health literacy of populations to understand the effect of PA on their health may play a role. There is a need for new approaches that consider the individual barriers and facilitators to exercise.

Lifestyle Modifications for Migraine Management.

Migraine is a disabling disease that inflicts a heavy burden on individuals who suffer from it. Significant advances are being made in understanding the pathophysiology and treatment of the disease. The role of lifestyle modifications has become increasingly predominant. We reviewed the current and available data on the role of a healthy lifestyle in the management of migraine. Physical activity, management of obesity, a healthy diet, and a better lifestyle, such as adequate sleep and avoidance of drug abuse, significantly contribute to reducing the frequency and severity of attacks. It is important to consider these factors in the overall management strategies for migraine sufferers.

Prevalence and factors associated with stroke risk factors in an urban community of Parakou, Northern Benin, 2016.

Sub-Saharan Africa faces a heavy burden of stroke due to the growth of its risk factors. We aimed to estimate the prevalence of stroke risk factors and identify the factors associated with metabolic risk factors in the district of Titirou, in Parakou (northern Benin) in 2016. A cross-sectional study was conducted. It included people aged at least 15 years, living in Titirou for at least 6 months, and who had given their written consent to participate in the study. A door-to-door survey was performed from 15 march to 15 July 2016 in each neighborhood until the pre-determined number was reached. Sociodemographic data, medical histories, anthropometric and blood pressure measures were recorded using the WHO STEPS approach. The prevalence of stroke risk factors was calculated, and a multivariable logistic regression was done to identify the factors associated with metabolic risk factors for stroke. A total of 4671 participants were included with a mean age of 27.7±12.9 years and a sex ratio of 0.98. Concerning the behavioral risk factors for stroke, 17.2% were alcohol consumers, 3.5% were smokers, 21.5% had low fruit and vegetable intake, and 51.1% had low physical activity practice. The prevalence of metabolic risk factors for stroke was respectively of 8.7% for obesity, 7.1% for high blood pressure, 1.7% for self-reported diabetes, and 2.2% for dyslipidemia. Age (p<0.001), sex (p<0.001), marital status (p<0.001) and professional occupation (p = 0.010) were associated with obesity. Age was also associated with high blood pressure (p<0.001) and diabetes (p<0.001). Dyslipidemia varied according to smoking (p = 0.033) and low physical activity practice (p = 0.003). The study revealed a significant prevalence of some stroke risk factors. Targeted local interventions for primary prevention of stroke should be promoted in this community.

[Peripheral neuropathies and factors associated in chronic hemodialysis patients in Benin]. / Neuropathies périphériques et facteurs associés chez les hémodialysés chroniques du Bénin.

INTRODUCTION: Peripheral neuropathies, in hemodialysis patients, are frequent. OBJECTIVE: To study peripheral neuropathies in the population of chronic hemodialysis patients in Benin. METHODS: This was a descriptive and analytical cross-sectional study conducted from April 1st to July 31st, 2017 in the hemodialysis units of the two public dialysis centers in Benin. Recruitment was exhaustive with inclusion of all patients with hemodialysis for more than 3months, aged at least 18years and consenting. The diagnosis of peripheral neuropathy was based on the presence of sensory-motor and/or vegetative disorders associated with amyotrophy, abolition or reduction of osteotendinous reflexes and absence of central signs. RESULTS: A total of 189 hemodialysis patients were included in the two public hemodialysis centers of Benin, 180 at the CNHU-HKM and 9 at the CHUD/BA. The mean age was 50.23±13.31years with extremes from 20 to 85 years and a sex ratio of 1.59. The overall frequency of peripheral neuropathy was 59.26%, including polyneuropathies (72.32%), unifocal mononeuropathies (10.71%), polyradiculoneuropathies (9.82%), and multiple mononeuropathies (7.14%). The associated factor in multivariate analysis was socioeconomic level (P=0.001; OR 39.41; 95% CI 4.81-322.64). CONCLUSION: Peripheral neuropathy is frequent in chronic hemodialysis patients in Benin, requiring early detection and management.