Agnon Ayelola Koffi Balogou

Prevalence of cardiovascular risk factors in an urban area of Togo: a WHO STEPS-wise approach in Lome, Togo

Objective To determine the prevalence of hypertension and other cardiovascular risk factors in the general adult population of Lome. Methods A cross-sectional household survey was conducted in Lome from October 2009 to January 2010, which focused on hypertension and other cardiovascular risk factors in 2 000 subjects 18 years and older. The World Health Organisation’s STEPS-wise approach on non-communicable diseases was used. During the first session, blood pressure (BP) was measured on three successive occasions, one minute apart, and the mean was recorded. A second measurement session was done three weeks later in patients with BP ≥ 140/90 mmHg during the first session. Hypertension was defined as BP > 140/90 mmHg after the second session, or on antihypertensive treatment. The other risk factors were studied by clinical and blood analysis. Results We found 532 hypertensive patients out of a total of 2 000 subjects. The prevalence of hypertension was 26.6%. The mean age of hypertensive patients was 45 ± 10 years, ranging from 18 to 98 years. The prevalence of other cardiovascular risk factors was: stress (43%), sedentary lifestyle (41%), hypercholesterolaemia (26%), obesity (25.2%), hypertriglyceridaemia (21%), smoking (9.3%), alcohol use (11%) and diabetes (7.3%). Conclusions The prevalence of hypertension and other cardiovascular risk factors in the population of Lome is high. These findings should draw the attention of authorities to define a national policy to combat hypertension and other cardiovascular risk factors.

Clinical features and prognosis of amyotrophic lateral sclerosis in Africa: the TROPALS study

Objective We describe and compare the sociodemographic and clinical features, treatments, and prognoses and survival times of patients with amyotrophic lateral sclerosis (ALS) in Africa. Methodology We conducted a multicentre, hospital-based cohort study in Africa. Patients with ALS diagnosed in the neurology departments of participating hospitals from 2005 to 2017 were included. Subgroup analysis was performed by subcontinent. Survival analyses were conducted using the Cox proportional hazards model. Results Nine centres from eight African countries participated. A total of 185 patients with ALS were included: 114 from Northern Africa, 41 from Western Africa and 30 from Southern Africa. A male predominance (male to female ratio 2.9) was evident. The median age at onset was 53.0 years (IQR 44.5–64.0 years). The onset was bulbar in 22.7%. Only 47 patients (26.3%) received riluzole, mainly in Northern and Western Africa. The median survival from the time of diagnosis was 14.0 months (95% CI 10.7 to 17.2 months). The median survival was longer in Northern Africa (19.0 months, 95% CI 10.8 to 27.2 months) than in Western (4.0 months, 95% CI 0.8 to 7.1 months) and Southern (11.0 months, 95% CI 5.6 to 16.4 months) Africa (Breslow test, p<0.0001). Both subcontinental location and riluzole treatment independently affected survival. Conclusion More African patients with ALS were male and younger and exhibited a lower proportion of bulbar onset compared with patients with ALS from Western nations. Survival was consistent with that in Western registers but far shorter than what would be expected for young patients with ALS. The research improves our understanding of the disease in Africa.

Preliminary report of Tropals study — A survey of amyotrophic lateral sclerosis in Africa

Background: Epidemiological studies of Amyotrophic Lateral Sclerosis (ALS) in the tropics are rare and their methodologies, heterogeneous. Many questions arise as regards the characteristics of this disease in the tropics, especially in Africa.Objective: Describe sociodemographical and clinical characteristics of ALS patients diagnosed in Africa.Patients and methods/material and methods: TROPALS (http://www.tropals.unilim.fr/) is a multicentre observational cohort study. A shared methodology and an online data base that allows centers to collect data in a standardized and homogeneous way.Results: 40 patients have been included to date in 5 centers (Benin, Mauritania, Senegal, Togo, Tunisia), 3 other centers are open (Burkina Faso, Gabon, Mali) and 6 are about to be open.Mean age at diagnosis was 51.9 ± 13.5 years (2 cases less than 25 years), male/female sex ratio was 2.4.First symptoms were mostly spinal (72.5%) and 80% (n = 32/40) of patients had Electroneuromyography for diagnosis purpose. At this time mean ALS FRS R was 32.1 ± 10.5 and 75% of patients presented atypical symptoms (mostly dysautonomic or sphincter problems).After diagnosis, 97.4% of patients were prescribed an occidental treatment: Rilutek® (n = 12), physiotherapy (n = 17), or symptomatic treatment (n = 12). 21.6% of patients used a “traditional treatment” based on infusion-decoction for 2 of them and of unknown type for 6 patients.Conclusion: More inclusions are needed to produce precise estimations. Follow-up data are currently being collected. Tropals study will allow us to improve the description of ALS characteristic prognosis of patients and comprehension of the disease in this continent.

Transe et épilepsie en milieu tamberma au Togo. Études cliniques, électroencéphalographiques et neuropsychologiques de six cas d’odueri (« celles qui tombent »)

Il n’est pas toujours facile de distinguer les vraies crises epileptiques des comportements cliniques spectaculaires, les deux pouvant etre associes ou non. Notre etude avait pour objectif de determiner si les transes que presentaient certaines femmes au cours des rites funeraires etaient en rapport avec des crises epileptiques. Materiels et methodes. Une enquete neuroepidemiologique sur l’epilepsie en milieu tamberma au Togo, menee du 30 novembre 2001 au 29 janvier 2002, a recense 6 femmes qui entraient en transe et tombaient (odueri) lors des rites funeraires (tibenti). Elles ont beneficie d’un examen clinique, neuropsychologique, electroencephalographique et ont ete suivies pendant 5 ans. Resultats. Leur âge moyen etait de 31 ± 12,4 ans ; 5 d’entre elles ne savaient ni lire ni ecrire ; toutes avaient des activites professionnelles et etaient animistes. L’examen clinique et les EEG etaient normaux. Pendant 5 ans, aucune modification clinique ni electroencephalographique n’a ete notee.Elles presentaient 4 fois plus de troubles anxieux severes et 2 fois plus de troubles depressifs severes que les temoins. Conclusion. Des investigations cliniques, electroencephalographiques et un suivi sur une longue periode permettent de distinguer une crise epileptique d’une transe.