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.

[Community organizations and fighting STDs, HIV and AIDS in Montreal: lessons for sub-Saharan Africa]. / Les organismes communautaires et la lutte contre les IST/VIH/sida à Montréal : quelles leçons pour les pays africains au sud du Sahara ?

UNLABELLED: The HIV/AIDS pandemic is one of the most important public health problems in the world. In Benin as elsewhere in Africa, the combination of some sociological and sociocultural factors with socio-economic realities have led this pandemic to progress faster in some farming regions than in urban areas. This survey was performed during a three-month internship researching community-based organizations in Montreal that care for HIV/AIDS patients. OBJECTIVES: to analyse the actions taken by community-based organisations to combat this pandemic and point out the strengths and weaknesses of this system; - to draw useful lessons to apply in Africa. METHOD: more than one hundred organisations play a direct or indirect role in the combat against HIV/AIDS in the city ofMontreal. The choice of organisations to visit was determined by their interest for HIV/AIDS prevention and treatment or for the struggle against social exclusion. After a visit and guided tour of the premises of each organisation, one of its officials was interviewed for 20 to 30 minutes (according to a semi-structured outline, appendix 2. The data were analysed manually. RESULTS: the survey showed that even in high-income countries, the same risk behaviors, equally influenced by poverty, social exclusion andvulnerability, lead to this disease. Further, its chronic nature, related to essentially permanent antiretroviral treatments makes it harder for vulnerable groups to maintain healthy behaviours. The concentration of disease in vulnerable groups gives a false sense of security to most of the population, which does not feel concerned, ignores messages intended to raise awareness, and does not participate in voluntary screening. The organisations and actors involved, with the support of public health facilities, battle this vulnerability while providing information and resources to the target groups to help them protect themselves better. This struggle thus remains too focused on these target groups. Efforts must be made to make the discourse on AIDS legible to broader populations, for the borderlines between these target groups and the rest of the population is very fuzzy. Discussion and lessons: This analysis of the process of fighting HIV/AIDS inMontreal identified some positive experiences that can inspire concrete actions in African setting. One is the experience of the Farha Foundation, an organisation specialized in community fund-raising, which puts its collections at the disposal of other community organisations, and is independent, receiving no funding from local, provincial or federal public authorities. Transposition of this experience to Africa would require contextualisation and would need to mobilize the resources of not only the local community but also the national and international communities. The "Ruban en route" organization provides useful awareness programs for the young, visiting primary and secondary schools to debate HIV/AIDS issues with students with games, and demonstrating condom use. In the African context, given the limited educational system and the extent of school quitting, such an organisation would need to find a means to reach young apprentices and young farmers in informal structures. Action Séro Zero and Stella target male homosexuals and sex workers, respectively, and work to have their rights recognized by the community. The application of their policies would not be possible in our societies, for sociocultural reasons. Instead efforts must be directed toward making the community understand the need to encourage and tolerate recognition and aid for prostitutes, for the good of all. To a lesser degree, the experience of "Spectre de rue" with the TAPAJ project (Travail Alternatif Payé A la Journée or alternative work paid daily) is also importable, although only in urban environments where "street kids" are an important phenomenon. In some cities, where their number is increasing, this activity can be connected to an organisation working on awareness campaigns among the young. Contact with these street children should help them to become more socialized and to find the means to earn their living more legally. Finally, the usefulness of providing anti-retroviral treatment to people living with HIV is the most important lesson we learned during our Montreal stay. This very useful experience will nonetheless be very difficult to undertake in a rural African environment. Indeed, making antiretroviral cocktails available to patients might risk consuming the quasi-totality of the budget available for prevention. Work on this aspect is possible only if the local, national and international community mobilizes to provide the resources necessary. The international community is, however, starting to do so, by means of the Global Fund, to fight malaria, HIV/AIDS and tuberculosis. This survey has thus allowed us to learn some useful means of combatting AIDS in Africa.

[Prevention of mother-to-child transmission of HIV: reviewing a programme in Benin.]. / La prévention de la transmission du VIH de la mère à l'enfant : état des lieux au Bénin.

This article reviews the prevention of mother-to-child HIV transmission programme (PMTCT) in Benin. A survey was conducted in the 56 PMTCT sites of the country among health providers and beneficiaries. 39,000 pregnant women were tested per year in these sites (3.9% were HIV-positive) and 1,120 infected women have received the protocol (single-dose nevirapine), which corresponds to a national coverage rate of 16%. The investigation revealed shortcomings of the programme, notably the variation in the cost of prenatal consultations, HIV tests were frequently out of stock, lack of adherence to PMTCT recommendations and neglect of concern for the future of mothers and their children, supervision was not sufficiently pragmatic and PMTCT lacked linkages with the maternal and child health programme. This context should be taken into consideration when discussing the extension of PMTCT to new sites and the introduction of more active antiretroviral regimen.