Facteurs de fidélisation dans la mutuelle de santé de Kisantu en République démocratique du Congo.

INTRODUCTION: Some African countries have initiated mutual health insurance to improve access to health care, However, most of these initiatives have not succeeded in covering the majority of the population, nor in securing long-term loyalty. Considering that very few studies, if not none, allude to the Democratic Republic of Congo (DRC), this study aims to determine the explanatory factors for both loyalty and non-loyalty within the Kisantu health mutual insurance in DRC and to identify any specific factors in the urban-rural Congolese context. PURPOSE OF RESEARCH: We conducted a five-year prospective study, starting in 2013, among 320 households, selected among a cohort of 2202 households. Using the SPSS® 21.0 software, the association between loyalty and socio-demographic, socioeconomic variables and the degree of satisfaction with insurance products, as well as the motivations with respect to targeted loyalty, was sought. RESULTS: Thus, we found that the sociodemographic characteristics were not associated with loyalty of payments. In contrast, statistically significant relations were found between loyalty and socioeconomic characteristics, including occupation, estimated income, as the motivations expressed with regard to loyalty (P ≤ 0.001). In a logistic regression model, occupation, estimated household income of $100 or above were twice more likely to be loyal than those with an income below $100. Protection by income has not been identified as a predictor in the studies included in our survey of the literature, but it proved to be significantly associated with loyalty in the present study. On the other hand, beyond the fidelity factors observed in this study, aspects relating to the management of mutual health insurance, which have appeared as predictors in other contexts, are not identified as such in our community. CONCLUSIONS: In an urban - rural context in DR Congo where the majority of the population has a low and unstable income, and considering the low amount of contribution to the Kisantu health mutual, 4.2% of the median household income, it will be necessary therefore rethink the place of health spending in households and the extension of solidarity in the form of uniform or income-based contributions.

Differences in tumor-associated protein levels among middle-age Flemish women in association with area of residence and exposure to pollutants.

We measured tumor-associated proteins (TAPs) and pollutants in blood, serum, and urine of 200 nonsmoking women 50-65 years of age, residing in the rural municipality of Peer or in Hoboken or Wilrijk, industrial suburbs of Antwerp, Belgium. Persons with occupational exposures or commuting to other towns were excluded. Residents from Hoboken had significantly higher levels of blood lead and serum zinc and polychlorinated biphenyls. Surprisingly, residents of Peer had significantly higher levels of serum cadmium, dioxin-like activity in blood fat, and urinary 1-hydroxypyrene. For 5 of the 12 TAPs assessed in this study, we observed significant differences in serum levels among residents of the three municipalities after adjusting for personal or lifestyle parameters. Although we found levels of internal exposure to pollutants to be quite homogeneous in Flanders, we found significantly higher levels of TAPs only in the industrial suburbs. In multiple regression with all 29 available personal, lifestyle, and internal exposure parameters, blood lead levels showed a positive association with serum levels of anti-p53, carcino-embryonic antigen (CEA), and tissue polypeptide-specific antigen (TPS) and with an index for mean TAP level (I(tap)); dioxin-like activity in serum and serum copper showed a positive association with serum CA 125 (cancer antigen 125); and serum zinc showed a positive association with serum levels of c-erbB-2 ectodomain and TPS. An index of internal exposure showed a positive association with serum levels of both CEA and anti-p53 and with I(tap). This study provides some evidence that levels of internal exposure such as those present in Flanders, in particular concerning lead, are indeed associated with biologic effects.

Quality assessment of oral anticoagulation in Belgium, as practiced by a group of general practitioners.

OBJECTIVE: In Belgium oral anticoagulation therapy is mainly supervised by general practitioners (GPs). This study aims to evaluate the quality of management of oral anticoagulation by Belgian GPs and to verify the relation between time in range and a set of potentially influencing co-variables. METHODS: In a retrospective cross-sectional study, involving 66 GP-practices, the INR-values obtained over a 6-month period were analysed. All INR-values were determined by a single clinical laboratory and additional medical information was provided by the GPs. Linear mixed models have been used to model the patient-specific percentage INR in target as a function of different co-variables. RESULTS: 737 patients were included in the study. Patients who underwent a surgical intervention with an interruption of the anticoagulation during the study were excluded. Patients were only included after the initial starting-up period. 5890 INR-values were obtained. A total of 92,566 days of therapy was evaluated. 50% of the day values were within 0.5 INR-units from target (and 66% within 0.75 INR-units from target). In a multiple regression model, a significant relation between the percentage of time in range and the target INR (2.5 or 3.5) and the gender of the patient was shown. The incidence rate for major bleeding was 5.5/100 patient years (and 3.5/100 patient years for thrombo-embolic events). CONCLUSION: The quality of management of oral anticoagulation by the GPs in Belgium is suboptimal. It is unknown whether interventions such as guidelines, feedback, point-of-care monitoring and computer-assisted anticoagulation monitoring could improve the results.

The Belgian Improvement Study on Oral Anticoagulation Therapy: a randomized clinical trial.

AIMS: In Belgium, general practitioners (GPs) mainly manage oral anticoagulation therapy. To improve the quality of oral anticoagulation management by GPs and to compare different models and interventions, a randomized clinical trial was performed. METHODS AND RESULTS: Stratified randomization divided 66 GP-practices into four groups. A 6-month retrospective analysis assessed the baseline quality. In the prospective study, each group received education on oral anticoagulation, anticoagulation files, and patient information booklets (groups A, B, C, and D). Group B additionally received feedback every 2 months on their anticoagulation performance; group C determined the international normalized ratio (INR) with a CoaguChek device in the doctor's office or at the patient's home; and group D received Dawn AC computer assisted advice for adapting oral anticoagulation. For the different groups, the time spent in target INR range (Rosendaal's method) and adverse events related to anticoagulation were determined and compared with the same quality indicators at baseline. There was a significant increase in per cent of time within 0.5 INR from target, from 49.5% at baseline to 60% after implementing the different interventions. However, neither the per cent in target range nor the event rates differed among the four groups. CONCLUSION: The interventions significantly improved the quality of management of oral anticoagulation by Belgian GPs, mainly as a result of an education and support programme.

Differences in HPRT mutant frequency among middle-aged Flemish women in association with area of residence and blood lead levels.

Biomarkers were measured in residents of Wilrijk and Hoboken, industrial suburbs of the city of Antwerp, and of Peer, a rural municipality in Flanders, Belgium. Persons with known occupational exposures to toxic compounds or commuting over long distances were excluded. Here, we report the hypoxanthine phosphoribosyltransferase gene (HPRT) variant frequencies for 99 non-smoking women aged 50-65 years. HPRT values above the detection limit (V(fpos) values) were observed for 43 subjects (21 from Peer, 22 from Antwerp). The median (10th to 90th percentiles) HPRT variant frequency (V(fpos)) in peripheral lymphocytes was 9.59 (3.44-56.99) for Peer and 3.57 (1.57-13.96) for Antwerp. The V(fpos) value was significantly higher in Peer than in Antwerp, both in terms of crude data (p=0.011) and after correction for age, level of education, smoking status, serum level of selenium and body mass index through analysis of covariance (p=0.011). For the total study population, serum lead concentration showed a non-significant positive correlation with lnV(fpos). In addition, subjects with a blood lead concentration above the median tended to have higher V(fpos) values (9.45x10(-6) for 'high' group versus 5.21x10(-6) for 'low' group; p=0.077 after correction for confounding). Subjects with a serum selenium level above the median tended to have lower V(fpos) values (4.99x10(-6) for 'high' group versus 9.83x10(-6) for 'low' group; p=0.051 after correction for confounding). These data are consistent with an indirect genotoxic effect of lead and with an antimutagenic effect of selenium.