Impact of adapted physical activity on blood pressure and hypertension control in the militaries of Kinshasa Garrison, Democratic Republic of Congo: A randomized controlled trial

Context and objective. Major handicap for operational conditioning of troops, hypertension requires innovative approaches for its prevention and management. The present study aimed to evaluate the impact of adapted physical activity (APA) on BP level of sedentary soldiers from Kinshasa garrison and the rate of hypertension control in those with high BP. Methods. Open, parallel randomized controlled trial carried out at Camp Lt-Colonel Kokolo (CVEC) from June 2016 to October 2017) in sedentary soldiers (57.6 %, hypertensives) allocated for 8 weeks to APA (n=119) or control (n=110). The randomization procedure used permuted blocks of four consecutive participants. The outcomes were baseline-adjusted betweengroup difference in BP level (all participants), in rate of BP control among hypertensives. Results. At the last available visit in 226 participants (119 vs 107), the baseline-adjusted BP difference between active and control group by intentionto-treat was 5.1 (95 % CI 1.2 -10.8)/3.0 (0.1-6.9) mmHg lower in the active group. The effect of APA was also significant across pre-specified categories of participants based on age, officers' rank, and hypertension status. Among 129 analyzed drug treated hypertensives (68 vs 61), the rate of BP control remained unchanged in the control group (43.8 to 44.3%) but increased (43.5% to 85.3 %) in the active group yielding a baseline-adjusted between group difference of 40.7 (32.2; 49.2) %. The probability to achieve hypertension control was greater (HR: 3.38 [95% CI: 1.48- 4.84] in the active group. PP analysis of 122 soldiers (80 vs 42) with data at all scheduled visits yielded confirmatory results for BP reduction and for hypertension control by APA. The changes in BP were positively correlated with concomitant reductions in heart rate. Conclusion. Exercise training induced a significant BP reduction in sedentary militaries and improved the control rate among those with drug treated hypertension

Audit of Diabetic Soft Tissue Infection and Foot Disease in Accra

BACKGROUND: Soft tissue infection and foot disease are well known complications among diabetes mellitus patients. With an increasing prevalence of diabetes mellitus in Africa; management of these complications is expected to become a major problem. OBJECTIVE: To audit the surgical management of diabetic soft tissue infection and foot disease over a two-year period in Accra; Ghana. METHODS: A prospective study of all patients admitted to the General Surgical Unit of the 37 Military Hospital between May 2005 and April 2007 was conducted. Diabetic patients with soft tissue infections and foot disease were selected for study. Doppler studies using a monopolar 8 MHz Nicolet vascular probe was used in assessing the ankle to brachial pressure index (ABPI). Patients were managed based on admitting diagnosis and outcomes were noted. RESULTS: Eighty (8.3) of 966 surgical patients had diabetes mellitus and soft tissue infection or foot disease. The peak age of presentation of diabetics with soft tissue infection or foot disease was 50-59 years. Diabetic foot disease (53.0) was the commonest followed by cellulitis of the leg and other soft tissue infections. Overall amputation rate was 33.3while mortality was 8.8. CONCLUSION: Foot infections; cellulitis; abscesses and gangrene are the common surgical complications of diabetes mellitus patients in Ghana. Abscess of the hand is the commonest non-foot soft tissue surgical complication and had good outcomes. Overall; females presented earlier and had better outcomes than males

Social Change and the Legal Construction of Child Soldier Recruitment in the Special Court for Sierra Leone

"Concern over the recruitment of child soldiers in armed conflicts has grown over the last decades. While public advocacy and media attention tend to focus public attention on the most egregious cases of child recruitment; emerging international law has actually had a more profound effect on the relationship between children and the military. What began as a relatively narrow concern with protecting children under 15 years old who served as combatants in armed forces and armed groups has evolved into an international effort to sever a broad range of connections between all persons under 18 years old and the military. Indeed; the entire legal concept of the ""child soldier"" has evolved to encompass a greater number of children engaged in a wider variety of activities than was previously the case.The drive to create a universal legal and moral standard has trumped any concerns about local understandings of child soldiers; which are treated not as legitimate expressions of local culture but rather as deviant and inhumane practices under international law. International humanitarian law is not merely ethnocentric; it is indeed intentionally ethnocentric. Its concern is not to respect local norms but rather to systematically alter them. The drafters who crafted the language of the first international treaty that barred the recruitment of children under 15 years old were keenly aware of significant cross-cultural variation in the ages of childhood; youth and adulthood. But their view that the participation of children and adolescents in combat was an ""inhumane practice"" made such considerations irrelevant. An examination of the development of international law and its application in Sierra Leone shows that as international law develops an increasingly expanded concept of the child soldier; the disjunction between the normative aspirations of law and the reality of local practice continues to grow."

Military Men and Sexual Practices: Discourses of `Othering' in Safer Sex in the Light of HIV/AIDS

Despite recent reports that there is increasing condom use; generally resistance to condom use is still high. This paper focuses on factors inhibiting condom use and explores issues of responsibility for safe sex practices to prevent infection among a group of 14 South African male soldiers. Military men are particularly vulnerable to HIV because of their working conditions; for example; working far from home and being among communities where they have greater economic and political power; as well as in relation to their identities and sexualities as men; and how that is exaggerated by the institutional framework of the military. The data in this paper were drawn from a larger qualitative study exploring a group of military men's narratives on their masculinity; sexuality; sexual relationships and HIV/AIDS. Semi-structured interviews were the main data collection method; and the interview transcripts were analysed primarily through interpretive discourse analysis. Findings of this study show that most participants used the socially desirable discourse that safe sex practices (specifically condom use) should be everybody's responsibility. However; there was also the discourse of the `other' responsible person; which was linked to gender; race; ethnicity; education and rank. The paper concludes with a recommendation that tackling HIV in the military needs to involve the rigorous examination of social factors such as gender; race and ethnicity

Epidemiologic and behavioral characterization of knowledge of condom use and modeling among military personnel

How accurately condoms are being used vary across populations and knowledge of the factors determining its proper use remains unclear. Knowledge of such differentials and determinants would aid in evaluating the contributions of condom use to HIV epidemic reduction. Baseline data from the Situationally Focused Individual HIV/AIDS intervention to promote HIV protective behavior among 2,213 Nigerian Military Personnel were analyzed. Educational status as a predictor variable was assessed using univariable and multivariable logistic regression model. Compared to those with less than high school education, those with high school and some college education were two times more likely to demonstrate knowledge of condom use and modeling, prevalence odds ratio (POR), 2.32, 95% Confidence Interval (CI)=1.60-3.37. After adjustment for the relevant covariates, higher education attainment was associated with nonsignificant 62% increase in knowledge and modeling, POR, 1.62, 95% CI=0.78-3.38. This study is indicative of low knowledge of condom use and modeling among the Nigerian military personnel; as well as a direct correlation between education attainment and knowledge of condom use and modeling

Morbi-mortalite des militaires a l'hopital militaire d'Abidjan; Cote d'Ivoire

L'objectif etait de preciser la morbi-mortalite des militaires a l'HMA. Il s'agit d'une retrospective realisee sur dossiers des patients hospitalises au service de medecine interne de l'Hopital Militaire d'Abidjan (HMA) du 1er janvier au 31 decembre 2004. Les 155 militaires inclus dans l'etude ont developpe 259 pathologies dont 208 pathologies medicales infectieuses (80;5); 48 medicales non infectieuses (18;5) et 3 pathologies chirurgicales (1). Les principales pathologies observees etaient l'infection a VIH (85 cas ; 42); la pneumopathie (40 cas ; 19); la toxoplasmose cerebrale (22 cas ; 10;5); le paludisme (18 cas ; 9) et la tuberculose (11 cas ; 5). Les causes directes de deces etaient la toxoplasmose cerebrale (32); une pneumopathie (28); la tuberculose (16) et le paludisme grave (12). La prevalence de l'infection a VIH chez les decedes etait de 76. La morbi-mortalite de militaires a l'HMA est essentiellement du fait de l'infection a VIH et ses complications. Des mesures de prevention specifiques devraient etre mises en oeuvre pour un controle efficace de cette epidemie

Evaluation de l'état vaccinal contre l'hépatite B et portage de l'Ag HBs chez les militaires Béninois en mission en Côte d'Ivoire

Introduction: le but de cette étude est de déterminer le taux de couverture vaccinale anti-virus de l'hépatite B (anti-VHB) et la prévalence de l'AgHBs chez les soldats béninois en mission extérieure en Côte d'Ivoire. Méthodes: cette étude transversale était réalisée au sein du bataillon béninois basé à Anankouakouté en Côte d'Ivoire. Les soldats de cette compagnie au décours d'une séance d'éducation sanitaire étaient soumis à un questionnaire sous forme d'interview. Il portait sur les données sociodémographiques, les facteurs de risques d'infection et les antécédents de vaccination contre l'hépatite B. Des prélèvements étaient faits à la recherche de l'Ag HBs et des anticorps antiHBs. En cas de positivité de l'Ag HBs, un complément de bilan était fait (alanines aminotransférase(ALAT), Ag HBe, AcantiHBe, AcAntiHBcIgM et ADN HBV par PCR). Résultats: cent soixante-quinze militaires ont participé à cette étude (âge médian 31ans avec des extrêmes entre 23 et 52 ans; sex-ratio 5,73). Des taux protecteurs d'Ac Anti HBs étaient notés chez 41 militaires (23,4%). Cette immunité était post hépatitique B (25 cas/41) et post vaccinale (16 cas/41). Dix-huit militaires (10,3%) avaient une infection en cours par le VHB (Ag HBs+). L'infection était chronique (IgM anti HBc-et anticorps anti-HBc totaux + dans 18cas/18). Parmi les militaires infectés, 4 avaient une élévation des aminotransferases, 4 un Ag HBe positif et 4 une virémie élevée (ADN VHB >2000UI/L). Conclusion: le portage de l'AgHBs chez les militaires Béninois en mission est élevé. La couverture vaccinale est faible. Des stratégies d'intervention sont préconisées pour traiter ceux qui répondent aux critères et vacciner les non immunisés

Prevalence du bronchospasme induit par l'exercice (BIE) dans un echantillon randomise de 73 recrues des Forces Armees Nationales de Cote d'Ivoire

OBJECTIFS: Afin de verifier l'hypothese selon laquelle le climat chaud et humide protegerait contres la survenue du bronchospasme induit par l'exercice (BIE); notre etude avait pour but de determiner la prevalence du BIE chez les recrues vivant et exercant sous un climat tropical humide comme celui de la Cote d'Ivoire. MATERIEL ET METHODE: Notre enquete prospective a visee epidemiologique etait de type transversal. Elle avait ete effectuee de juin 2001 a mars 2002 entre 7h30 et 12 h a une temperature ambiante et une humidite relative variant respectivement de 24 a 41oC et de 96 a 70pour cent. Elle avait concerne un echantillon randomise de 73 recrues issues des quatre ecoles de formation militaire des FANCI. Apres avoir repondu a un questionnaire auto administre; chaque recrue equipee d'un cardio-frequence metre; avait realise sans echauffement prealable une course libre sur terrain plat pendant 8 mn. Les parametres ventilatoires etaient evalues avant et immediatement apres l'effort; puis aux 3eme; 5eme; 10eme; 15eme; 20eme et 30eme minutes de la periode de recuperation. Le seuil de positivite du test etait fixe a 10pour cent de chute du VEMS post-exercice. RESULTATS: Selon le questionnaire; aucune des recrues n'etait asthmatique connue. En revanche; apres le test de provocation bronchique a l'effort; 15 recrues soit 20.50pour cent etaient diagnostiquees BIE positif alors que leurs parametres ventilatoires de repos etaient egaux a ceux des sujets BIE negatif La chute du VEMS post-exercice chez les recrues BIE positif apparaissait precocement dans les 15 premieres minutes de la periode de recuperation. COMMENTAIRES: Cette etude effectuee chez des recrues non asthmatiques vivant et exercant en zone tropicale humide; montrait une prevalence du BIE aussi elevee que celle de nombreuses etudes menees en climat froid et sec. Ce resultat n'etait donc pas en faveur du caractere protecteur de l'air chaud et humide contre la survenue du BlE tel que suggere par plusieurs auteurs

HIV/AIDS Counselling in the Ugandan Army: Does it Promote Behaviour Change?

Soldiers are at high risk of HIV/AIDS but do not have access to counselling and education. Project: An HIV/AIDS outreach program targeting soldiers; their familieis and neighbouring communities for counselling and HIV/AIDS education using trained Counsellors and Health Educators was initiated. There strategies used were: group counselling; sensitization; training of peer educators; recration and education through post-test clubs; condom supply and food aid supply. Results: After mobilisation; sensitisation and training of peer educators soldiers came up for counselling and testing. Within 1 1/2 years 2;478 people had come up for pre-test counselling; of these 2;230 people (90) had turned up for post-test counselling; 1;561 people (70) had registered as post-test club members; 248 people (10) had received pre-test counselling but had not gone for testing. 1980 people had requested for counselling yet to be offered. There has been notable behavior change among people counselled indicated through increased demand for condoms; people willing to educate others and bring them for testing and self-confessed behavior change by post-test club members. Lessons learned: HIV/AIDS counselling and education appears to reinforce social norms related to safer sex behaviour and this is an important base for influencing behaviour change. (Source: Int-Conf-AIDS. 1996 Jul. 7-12; 11(2):360 (abstract no. Th.C.4682)

Problemes de prise en charge des seropositifs et des malades du SIDA : a propos d'une enquete en milieu militaire burkinabe aupres de 297 sujets

Il ressort de cette enquete que les militaires interroges sont dans la majorite des cas favorables aux tests de depistage volontaire accompagnes d'une revelation du diagnostic. les auteurs en deduisent qu'une bonne preparation psychologique devrait permettre de realiser cette annonce de seropositivite; etape initiale de toute mesure de prevention pour ces patients. En effet; il apparait dans l'enquete que meme s'ils sont favorables au depistage; le 1/3 des sujets interroges ne changent pas de comportement (port de capotes) et n'informent leurs partenaires de leur seropositivite. Par ailleurs des mesures d'isolement des malades du sida et de controle aux frontieres; ainsi que le rapatriement des etrangers seropositifs sont jusqu'a present preconises. Ceci doit inciter selon les auteurs; a mener des campagnes de sensibilisation encore plus soutenues dans le but de mieux informer le public

Health aspects of repatriation of ex-soldiers

The general condition of the soldiers upon arrival at the shelter camps was poor. The post war conditions and physical exhaustion resulting from the movements had created a state of stress in most of the groups. Poor nutritional status was also noticed. Those who were suffering from war wounds were not few in number

Condom use among soldiers in Tug-Argan and Arakan Baracks [sic]; Zambia

The study explored the patterns of condoms use among soldiers. A sample of 200 soldiers was randomly selected from Tug-Argan and Arrakan Barracks. The study revealed that respondents had adequate knowledge of AIDS. However respondents who claimed to be condom users did not use condoms during all casual sexual intercourse