Détection et contrôle de l'hypertension artérielle dans une communauté péri-urbaine d'Afrique de l'Ouest.

INTRODUCTION: The detection of hypertension in African countries ranges from 15 to 40%, so more than half of hypertensive people are unaware of their condition. In Côte d’Ivoire, very little work on the detection of hypertension exists. PURPOSE OF RESEARCH: The objective was to analyze the detection and control of hypertension in the Ivorian peri-urban environment. RESULTS: Three hundred and sixty (360) participants were interviewed. Among them, 47.8% (172 participants) had their BP measured in the past 12 months. Sixty-seven individuals were classified as hypertensive of whom 30 had already been detected (44.8%). The control of hypertension was 60%. Higher probabilities of detection were associated with participation in physical activity (OR = 3.27 95% CI: 1.08-10.54). CONCLUSIONS: The detection of hypertension, although relatively high in Anonkoi 3, still concerned less than half of the hypertensives. Hence the interest in raising public awareness of systematic screening for hypertension.

Determinants of contraceptive use in Abidjan (Côte d'Ivoire).

In Côte d'Ivoire, contraceptive prevalence is low (21%). The search for determinants of contraceptive use could make it possible to redirect existing strategies. The objective is to identify the determinants of the use of contraception among women in Abidjan. A cross-sectional survey was conducted from May to June 2018 in the Dallas neighborhood of Adjamé municipal (Abidjan). Women of reproductive age (15 to 49 years old) were selected there. Sociodemographic, gyneco-obstetrical characteristics, educational level, attitudes and practices of women on contraception were collected. Univariate and multivariate analyzes were performed. A total of 301 women aged 29.34±8.98 years were selected. The proportion of women using modern contraception was 27.24%. In univariate analysis, the factors associated with use were: level of education (p=0.005), unwanted pregnancies (p=0.017), abortions (p<0.001), consultation of the gynecologist (p=0.003) or a family planning service (p=0.001). Hearing about contraception (p=0.043), knowing (p<0.001) and talking about it with their partner (p=0.027) was significantly associated with its use. In the multivariate analyses, the women who consulted a gynecologist and those who knew the contraceptive methods used them respectively 2 times more (OR= 2.16 [1.14-4.15], p=0.019) and 22 times more (OR= 22.38 [8.42-78.56], p<0.001). Women with primary school education used them significantly less (OR= 0.15 [0.05-0.41], p<0.001). Awareness, the gynecologist's consultation, and the level of education were the main determinants of contraceptive use. Also, it is necessary to adapt awareness messages to the characteristics of women.

Prevalence and Risks Factors of Prehypertension in Africa: A Systematic Review.

Background: Hypertension is one of the major factors for high mortality of adults in Africa. However, complications occur at lower values than those previously classified as hypertension. Thus, prehypertension is considered as a new category of hypertension and a major risk factor for developing clinical hypertension relative to those with normotension, it has been linked with increased future risk of hypertension as well as cardiovascular diseases. Objectives: The objective of this review was to determine prevalence of prehypertension and describe the associated factors of prehypertension in Africa during the past 10 years. Methods: We did a systematic review using the databases PubMed/Medline, and search engine google scholar. We selected sources of publications and conducted an analysis of articles. Keywords in English were: prehypertension, high normal blood pressure, high blood pressure, elevated blood pressure, Africa. Keywords in french were: préhypertension artérielle, préhypertension, pression artérielle normale haute, pression artérielle normale, Afrique. Mesh terms were: Prehypertension, Africa. Results: Twenty-seven articles were selected. Prevalence of prehypertension ranged from 2.5% to 34% in children and adolescents. In adults, prevalence varied from 32.9% to 56.8%. Several factors were associated with prehypertension in Africa. These factors included: age; sex; lifestyle such as smoking, alcohol consumption, low physical activity, overweight and obesity. There were also cardiometabolic factors and few others factors which were associated with prehypertension. Conclusion: This review allowed us to observe that the prevalence of prehypertension was variable according to age of the population and prehypertension is associated with several factors.

Renoncement aux soins pour raisons financières des femmes d'un quartier périurbain d'Abidjan en Côte d'Ivoire.

INTRODUCTION: Cessation of care for financial reasons is an indicator of the affordability of care. OBJECTIVE: The objective of this work was to identify the determinants of the renunciation of care for financial reasons among women in a peri-urban area of Abidjan. METHOD: This cross-sectional study was conducted from March to May 2019 among women aged 18 years and over in Anonkoi 3 in the north of Abidjan. The socio-demographic, economic, health status and health care abandonment characteristics were collected using a questionnaire. The associations between the renunciation of care for financial reasons and women’s characteristics were measured using logistic regression models with a 5% risk. RESULTS: The sample consisted of 423 women with a median age of 28 ± 11 years. Only 30% of them had health insurance. The rate of financial reasons for discontinuing care was 59.1%. This renunciation was more pronounced for the purchase of drugs, biological examinations, dental care, and surgical procedures. The number of dependent (P = 0.035), young age (P ≤ 0.035), low level of education (P = 0.024), low level of income (P ≤ 0.004) and the absence of an associative life (P = 0.004) and perceived poor health (P = 0.021) were identified as determinants of the renunciation of care for financial reasons. CONCLUSION: Empowerment, literacy, health education for women and adherence to universal health coverage should help to remove the financial barrier to women’s access to care.

Personal hygiene in schools: retrospective survey in the northern part of Côte d'Ivoire.

INTRODUCTION: Students' personal hygiene helps maintain health and promote good academic performance. When health facilities are insufficient, this hygiene can be difficult to achieve. We wanted to analyse the determinants of personal hygiene in schools in the northern region of Côte d'Ivoire. METHODS: The retrospective cross-sectional study brings together data on 2,035 schoolchildren recruited from thirty schools in northern Côte d'Ivoire. Indexes on personal hygiene were constructed and analysed in comparison to the socio-demographic characteristics of students, homes and schools. They were analysed with R Software version 1.1.463, the χ2 test and a logistic regression model. RESULTS: Overall, the majority of students had good personal hygiene (82.75%) with an average personal hygiene score of 4.74 ± 1.36. The predictors of good personal hygiene among schoolchildren were female gender (OR = 1.5; 95% CI = 4.31-16.37), father's primary education level (OR = 1.55; 95% CI = 1.07-2.29), the father's income level above 60,000 FCFA (90 Euros) and modern housing (OR = 1.45; 95% CI = 1.05-2.03). However, the poor level of home sanitation resulted in poor personal hygiene among the students (OR = 0.34; 95% CI = 0.23-0.5). CONCLUSIONS: Measures to raise the standard of living of families and the provision of sanitary facilities in homes becomes necessary in order to improve students personal hygiene.

Obstacles socioculturels liés à l'utilisation de la contraception moderne en Côte d'Ivoire.

INTRODUCTION: In Côte d’Ivoire, national modern contraceptive prevalence remains low, at 21% in 2017.Purpose of research: The objective of this study was to identify socio-cultural obstacles related to the use of modern contraception among women of reproductive age. METHODS: We conducted a descriptive and qualitative study in Dallas, in the Adjamé commune, located in the center of Abidjan. The survey took place from 9th June to 7th July 2018. In addition, we conducted four focus groups with men over 20 years old, women of reproductive age between 15 and 49 years old, and two religious leaders recruited according to a reasoned sampling. Group discussion guides and individual interview guides were used as data collection tools. Moreover, we analyzed data after recording and transcribing, following a thematic content analysis. RESULTS: We interviewed thirty participants including 14 men, 14 women, and two religious leaders. The main obstacles described were the lack of reliable and adequate information, misconceptions about contraception, fear of side effects, illiteracy, male decision-making power, religious prohibitions, and the socio-cultural contradictions. To circumvent these obstacles, women secretly used contraceptives, thereby exposing themselves to social risks. CONCLUSION: Our study highlighted the persistence of socio-cultural practices. For that reason, taking into account people’s perceptions is necessary to improve the use of modern contraception at the community level.

Prevalence of abdominal obesity and its correlates among adults in a peri-urban population of West Africa.

INTRODUCTION: Prevalence of abdominal obesity dramatically increases both in developed countries and in developing countries. In several regions in Africa, obesity (especially abdominal) is seen as a sign of affluence, dignity and respect. The objective of this study was to determine prevalence of abdominal obesity and seek some factors associated in a peri-urban population of West Africa. METHODS: During April-May 2014, a cross-sectional study was conducted in Anonkoi 3, a neighborhood of Abidjan (Ivory Coast). Adults of 18 years old and over, not bedridden were included. Sampling was done in two stages. First, we selected the households. Then in each household we randomly chose one adult. Abdominal obesity was measured using a measuring tape and defined by waist circumference ratio (TT) to hip circumference (TH) greater or equal to 0.80 in women and greater or equal to 0.95 in men. Data from sociodemographic, corpulence, socioeconomic level, food habit, level of physical activity and blood pressure were analyzed. Univariate analysis using the Pearson KHI-square test at a significance level of 0.05 and a logistic regression was performed. RESULTS: We visited 486 households in which 486 people aged 36.1 ± 12.83 years agreed to participate in the study. Prevalence of abdominal obesity was 50.8%. Those aged 30-45 years, women, couples, those with a primary level of education, the poor, people with high blood pressure, subjects less active and obese (general obesity) had more abdominal obesity. After logistic regression, individuals aged 30-45 years (adjusted OR = 2.35; p = 0.004) and 45 years and older (adjusted OR = 3.18; p = 0.001); females (adjusted OR = 49.05; p = 0.000); hypertension (adjusted OR = 2.26; p = 0.014) and obesity (OR = 2.94; p = 0.009). CONCLUSION: This work allowed us to estimate a relatively high prevalence of abdominal obesity in a peri-urban African population.

Diabetic and cardiovascular patients' willingness to pay for upcoming national health insurance scheme in Côte d'Ivoire.

BACKGROUND: Côte d'Ivoire's current health care financing system results from successive reforms undertaken with government funding and international support. The country is moving towards a national compulsory health insurance scheme. This context offered an opportunity to study additional features of health insurance's potential market in Sub-Sahara Africa developing economy. This study examined patients' willingness to pay in order to get access to health care when it is needed. METHODS: A cross-sectional study was carried out in four tertiary level teaching hospitals from October to December 2017. These hospitals are located in Bouake (service of cardiology) and in Abidjan (two services of Endocrinology-Diabetology and Institute of Cardiology). Monthly willingness to pay was elicited using the contingent valuation method through a bidding game pre-tested interviewer-administered questionnaire. Multinomial logistic regression analysis was performed to predict participants' willingness to pay. RESULTS: Out of 450 participants included in the analysis, 22.2% were not willing to pay at least 4.5 euros per month while 7.6%, 26.9%, 29.6%, 5.3% and 8.4% stated to be willing to pay 4.5, 7.5, 15, 30, and 45 euros per month, respectively. Males were 2.3 and 2.5 times more likely to be willing to pay 4.5 or 7.5 and 30 or 45 euros, respectively. However, there was no statistically significant difference between males and females who stated being willing to pay a premium of 15 euros per month as compared to the participants in the reference modality, below 4.5 euros. CONCLUSIONS: The findings indicated that the amount that participants were willing to pay is consistent with other previously elicited. The association of sex with the willingness to pay suggested what might influence the acceptability of and the contribution to the upcoming compulsory health insurance scheme. These pointed out that some market features have to be understood for a successful implementation of this social health insurance scheme.