Dismand Houinato

Sociocultural and psychological features of perceived stigma reported by people with epilepsy in Benin

Purpose:  Stigma is a major burden of epilepsy. In sub‐Saharan Africa the few studies that addressed epilepsy stigma emphasize enacted, rather than perceived, stigma. This inattention may compromise clinical management and delay help seeking, thereby contributing to the treatment gap. We assessed perceived stigma and identified sociocultural and psychological factors explaining greater stigma among people with epilepsy (PWE) in Benin.

Link between Epilepsy and Malnutrition in a Rural Area of Benin

Summary:  Purpose: Epilepsy and malnutrition are both important public health problems in sub‐Saharan Africa. A relationship between epilepsy and malnutrition has been suspected for many years. Our objective was to investigate the association between epilepsy and malnutrition in Djidja, Benin.

Migraine Among University Students in Cotonou (Benin)

Background.— Few data are available on migraine among students in Africa. The aim of this study was to estimate the prevalence of migraine and describe its clinical features and associated conditions among students of the Faculty of Health Sciences of Abomey‐Calavi University, in Cotonou, Benin.

Prevalence of dementia among elderly people living in Cotonou, an urban area of Benin (West Africa)

Background/Aims: The population of Benin is, like those of most developing countries, aging; dementia is therefore a major concern. Our goal was to estimate the prevalence of dementia in an elderly population living in urban Benin. Methods: In a cross-sectional community-based study, people aged 65 years and above were screened using the Community Screening Interview for Dementia and the Five-Word Test. Results: The prevalence of dementia was 3.7% (95% CI 2.6–4.8) overall. The figure increased with age and was higher among women than men. Conclusion: Dementia was slightly more prevalent than previously reported in a rural area of Benin, but the rate was similar to that recorded in other cities in developing countries.

Prevalence of hypertension and associated risk factors in Benin.

BACKGROUND Hypertension is one of the main risk factors of cardiovascular diseases. There has been a lack of data on this risk factor in the general population in Benin. The aim of this study was to determine the prevalence of hypertension and identify the associated risk factors in Benin. METHODS A cross-sectional study was conducted from July to August 2008 in Benins 12 departments. The questionnaire and anthropometric measurements of the World Health Organization STEPWISE survey were used. The sample included 6853 subjects 25-64 years of age, randomly selected by five-stage random sampling. Blood pressure was measured using standard procedures. Data was processed and analyzed using EPI DATA and STATA 9.2 software. Prevalence levels were compared using Pearsons chi(2) and means with the Student t-test. Univariate and multivariate regression analysis, taking the sampling method into account, was used to identify risk factors. RESULTS The sample comprised 49.5% females, the 25- to 34-year-old age group was the largest, and the mean age was 42.7±12.4 years. The prevalence of hypertension was 27.9% [95% CI: 26.3-29.5%], 77.5% of the subjects were unaware of their high blood pressure, and 81.6% had not taken their drugs two weeks before the survey. Prevalence of known hypertension was 6.9%, prevalence of treated hypertension 4.8%, and prevalence of controlled hypertension 1.9%. Age and obesity were significantly associated with hypertension. Department and profession were not associated with hypertension. CONCLUSION This study showed a high prevalence of hypertension in the general population in Benin. Better management of this risk factor will contribute to reducing morbidity and mortality due to cardiovascular diseases.

Magnitude of cardiovascular risk factors in rural and urban areas in Benin: findings from a nationwide steps survey.

Data on variations in the frequency of cardiovascular risk factors (CVRF) in sub-Saharan populations are limited, particularly with regard to Benin. Objective To describe and compare the prevalences of CVRF in urban and rural populations of Benin. Methods Subjects were drawn from participants in the Benin Steps survey, a nationwide cross-sectional study conducted in 2008 using the World Health Organisation (WHO) stepwise approach to surveillance of chronic disease risk factors. Subjects aged above 24 and below 65 years were recruited using a five-stage random sampling process within households. Sociodemographic data, behavioral data along with medical history of high blood pressure and diabetes mellitus were collected in Step 1. Anthropometric parameters and blood pressure were measured in Step 2. Blood glucose and cholesterol levels were measured in Step 3. CVRF were defined according to WHO criteria. The prevalences of CVRF were assessed and the relationships between each CVRF and the area of residence (urban or rural), were evaluated using multivariable logistic regression models. Results Of the 6762 subjects included in the study, 2271 were from urban areas and 4491 were from rural areas. High blood pressure was more prevalent in urban than in rural areas, 29.9% (95% confidence intervals (95% CI): 27.4, 32.5) and 27.5% (95% CI: 25.6, 29.5) respectively, p = 0.001 (p-value after adjustment for age and gender). Obesity was more prevalent in urban than in rural areas, 16.4% (95% CI: 14.4, 18.4) and 5.9% (95% CI: 5.1, 6.7), p<0.001. Diabetes was more prevalent in urban than in rural areas, 3.3% (95% CI: 2.1, 4.5) and 1.8% (95% CI: 1.2, 2.4), p = 0.004. Conversely, daily tobacco smoking was more prevalent in rural than in urban areas, 9.3% (95% CI: 8.1, 10.4) and 4.3% (95% CI: 3.1, 5.6), p<0.001. No differences in raised blood cholesterol were noted between the two groups. Conclusion According to our data, CVRF are prevalent among adults in Benin, and variations between rural and urban populations are significant. It may be useful to take account of the heterogeneity in the prevalence of CVRF when planning and implementing preventive interventions.

Anxiété et dépression chez les épileptiques en population générale au Bénin (Afrique de l’Ouest)

Resume Afin d’evaluer la prevalence de la depression et de l’anxiete parmi les epileptiques et de les comparer a une population temoin, une enquete cas-temoin transversale utilisant l’echelle d’anxiete et de depression de Goldberg a ete conduite au Benin (Afrique de l’Ouest) aupres de 98 epileptiques âges de 18 ans et plus, ainsi que 98 temoins apparies selon le sexe, l’âge (± 10 ans) et le milieu de vie. L’âge moyen est de 32,6 ans ± 11,5 et le sex-ratio 1,28. 93 % des personnes interrogees vivent en famille, sont mariees ou vivent maritalement (temoins : 98,2 % ; cas : 87,9 %) ; 57,4 % sont maries (temoins : 70 % ; cas : 44 %) ; 97 % des epileptiques affirment avoir eu une crise dans les deux annees precedant l’enquete ; 48 % en ont eu 2 a 5 et 41,5 %, plus de 10. Il n’y a pas de correlation significative entre la frequence des crises et le niveau d’anxiete et de depression, en revanche la presence d’un traitement antiepileptique (77,5 %) diminue l’anxiete et la depression. Les epileptiques presentent plus souvent une anxiete severe (79,8 %) ou une depression severe (89,6 %) que les temoins (12,3 % et 46,9 %) (p

Undue regulatory control on phenobarbital : an important yet overlooked reason for the epilepsy treatment gap

Epilepsy is a major chronic noncommunicable neurologic disorder. Although a simple, safe, efficacious, and low-cost treatment has been available for nearly 100 years, the treatment gap remains disturbingly high in many low- and middle-income countries (LMICs).[1] Treatment gap is generally defined as a “difference between the number of people with active epilepsy and the number being appropriately treated.” There are many reasons for this treatment gap; one important reason is an overly restrictive regulation on barbiturates such as phenobarbital (PB). These restrictive regulations deserve a wider and open discussion, even though epileptologists and others are intensely engaged on reducing the epilepsy treatment gap. With this article, we provide our viewpoint with an aim of raising an extremely important issue: undue regulatory restriction on phenobarbital, an essential lifesaving antiepileptic drug (AED).

[Management of stroke in sub-Saharan Africa: current issues] : Prise en charge des accidents vasculaires cérébraux en Afrique subsaharienne

In sub-Saharan Africa, stroke is likely to present an increasingly important public health problem with a larger relative share of overall morbidity and mortality. Overall, sub-Saharan Health Care is characterized by a lack of human resources, lack of facilities for special investigations, and especially an absence of specific programs addressing the prevention of cardiovascular conditions. Current data on the epidemiology of stroke in sub-Saharan Africa, although sparse and fragmentary, indicate a comparatively high incidence of cerebral hemorrhage associated with high blood pressure, while ischemic stroke in black Africans still appears to be related primarily to small artery disease, HIV infection, and sickle cell disease. With urbanization, the role of large-vessel atherosclerosis is increasing. It is thus essential to coordinate government funding, health care professionals and development agencies to address this rising health problem. Access to health care needs to be better structured, and screening programs should be developed in order to identify and treat vascular risk factors. Improved training of health care professionals is also required in the areas of prevention, diagnosis and management of stroke. Implementation of best-practice recommendations for the management of stroke adapted to the specificities and resources of African countries would help rationalize the scarce resources currently available.

Interest of LQAS method in a survey of HTLV-I infection in Benin (West Africa)

HTLV-I is heterogeneously distributed in Sub-Saharan Africa. Traditional survey methods as cluster sampling could provide information for a country or region of interest. However, they cannot identify small areas with higher prevalences of infection to help in the health policy planning. Identification of such areas could be done by a Lot Quality Assurance Sampling (LQAS) method, which is currently used in industry to identify a poor performance in assembly lines. The LQAS method was used in Atacora (Northern Benin) between March and May 1998 to identify areas with a HTLV-I seroprevalence higher than 4%. Sixty-five subjects were randomly selected in each of 36 communes (lots) of this department. Lots were classified as unacceptable when the sample contained at least one positive subject. The LQAS method identified 25 (69.4 %) communes with a prevalence higher than 4%. Using stratified sampling theory, the overall HTLV-I seroprevalence was 4.5% (95% CI: 3.6-5.4%). These data show the interest of LQAS method application under field conditions to detect clusters of infection.