Publications by authors named "Yves Coppieters"

68 Publications

Correction to: Effects of implementing a postabortion care strategy in Kinshasa referral hospitals, Democratic Republic of the Congo.

Reprod Health 2021 Jul 22;18(1):155. Epub 2021 Jul 22.

Research Centre "Policies and Health Systems-International Health", School of Public Health, Université Libre de Bruxelles (ULB), Brussels, Belgium.

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http://dx.doi.org/10.1186/s12978-021-01205-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8299616PMC
July 2021

SARS-CoV-2 screening among people living in homeless shelters in Brussels, Belgium.

PLoS One 2021 15;16(6):e0252886. Epub 2021 Jun 15.

Research Center in Epidemiology, Biostatistics and Clinical Research, School of Public Health, Université Libre de Bruxelles (ULB), Brussels, Belgium.

Background: Subgroups of precarious populations such as homeless people are more exposed to infection and at higher risk of developing severe forms of COVID-19 compared to the general population. Many of the recommended prevention measures, such as social distancing and self-isolation, are not feasible for a population living in shelters characterised by physical proximity and a high population density. The objective of the study was to describe SARS-CoV-2 infection prevalence in homeless shelters in Brussels (Belgium), and to identify risk factors and infection control practices associated with SARS-CoV-2 positivity rates.

Methods: A total of 1994 adults were tested by quantitative PCR tests in 52 shelters in Brussels (Belgium) between April and June, 2020, in collaboration with Doctors of the World. SARS-CoV-2 prevalence is here described site by site, and we identify risk factors associated with SARS-CoV-2 positivity rates. We also investigate associations between seropositivity and reported symptoms.

Results: We found an overall prevalence of 4.6% for the period, and a cluster of high rates of SARS-CoV-2 positivity (20-30% in two shelters). Among homeless people, being under 40 years of age (OR (CI95%) 2.3 (1.2-4.4), p = 0.02), having access to urgent medical care (AMU) (OR(CI95%): 2.4 (1.4-4.4)], p = 0.02), and sharing a room with someone who tested positive (OR(CI95%): 5.3 (2.9-9.9), p<0.0001) were factors associated with SARS-CoV-2 positivity rates. 93% of those who tested positive were asymptomatic.

Conclusion: This study shows high rates of SARS-COV-2 infection positive tests in some shelters, with a high proportion of asymptomatic cases. The survey reveals how important testing and isolation measures are, together with actions taken by medical and social workers during the outbreak.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0252886PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8205130PMC
June 2021

[Current challenges in cancer care in Brussels-capital region: A qualitative study].

Bull Cancer 2021 Jul-Aug;108(7-8):705-717. Epub 2021 Jun 11.

Centre de recherche Politiques et systèmes de santé, École de Santé Publique, Université libre de Bruxelles (ULB), route de Lennik 808, 1070 Bruxelles, Belgique.

Cancer is a disease with multidimensional consequences accompanied by new challenges in order to guarantee optimal care involving physical, psychological and social consequences of the disease and his treatments. The objective of this study is to identify the main challenges encountered by different stakeholders around cancer, including patients, in Brussels. This qualitative study was carried out with various stakeholders in the field of oncology. The semi-structured interviews and focus groups were transcribed directly and the data collected was analysed manually. Healthcare professionals and patients face many challenges in the current context of oncology care. Communication difficulties can affect the therapeutic relationship and the sharing of complex information. The increasing complexity of therapeutic strategies complicates interprofessional collaborations and care coordination. In a context of early return home and home hospitalization in particular, continuity in care and collaboration between the different lines of care are crucial. Patients face a variety of challenges, such as managing long-term side effects and post-cancer difficulties, including redefining their social and professional identities. Finally, cancer involves financial toxicity and social inequalities in health are particularly marked. Cancer is a complex disease which management involves a growing number of caretakers. It is also frequently synonymous with disruption in the personal, social and professional life of patients. The emerging themes of this study are closely interconnected and communication seems to occupy a central place. A holistic approach to the individual and inter-professional interactions could guide future prospects for the overall management of this constantly changing field.
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http://dx.doi.org/10.1016/j.bulcan.2021.04.016DOI Listing
July 2021

Effect of wearing a helmet on the occurrence of head injuries in motorcycle riders in Benin: a case-control study.

Inj Epidemiol 2021 May 10;8(1):17. Epub 2021 May 10.

Ecole de Santé Publique, Université Libre de Bruxelles, Bruxelles, Belgium.

Background: In Benin, motorcycles are the main means of transport for road users and are involved in more than half of crashes. This study aims to determine the effect of wearing a helmet on reducing head injuries in road crashes in Benin.

Methods: This case-control study took place in 2020 and focused on road trauma victims. The sample, consisting of 242 cases (trauma victims with head injuries) for 484 controls (without head injuries), was drawn from a database of traffic crash victims recruited from five hospitals across the country from July 2019 to January 2020. Four groups of independent variables were studied: socio-demographic and economic variables, history, behavioural variables including helmet use and road-related and environmental variables. To assess the shape of the association between the independent variables and the dependent variable, a descending step-by-step binary logistic regression model was performed using an explanatory approach.

Results: Fewer of the subjects with a head injury were wearing a helmet at the time of the crash 69.8% (95% CI = 63.6-75.6) compared to those without a head injury 90.3% (95% CI = 87.3-92.8). Adjusting for the other variables, subjects not wearing helmets were at greater risk of head injuries (OR = 3.8, 95% CI (2.5-5.7)); the head injury rating was 1.9 (95% CI = 1.2-3.3) times higher in subjects who were fatigued during the crash than among those who were not and 2.0 (95% CI = 1.2-3.3) times higher in subjects with no medical history.

Conclusion: Failure to wear a helmet exposes motorcyclists to the risk of head injuries during crashes. It is important to increase awareness and better target such initiatives at the subjects most at risk.
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http://dx.doi.org/10.1186/s40621-021-00311-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8108325PMC
May 2021

Effects of implementing a postabortion care strategy in Kinshasa referral hospitals, Democratic Republic of the Congo.

Reprod Health 2021 Apr 7;18(1):76. Epub 2021 Apr 7.

Research Centre "Policies and Health Systems-International Health", School of Public Health, Université Libre de Bruxelles (ULB), Brussels, Belgium.

Objectives: To evaluate the effects of the implementation of a postabortion care (PAC) strategy in Kinshasa referral hospitals, this study analyzed the quality of postabortion care services, including postabortion contraception, and the duration of hospitalization.

Methodology: We estimated the effects of the PAC strategy using a quasi-experimental study by evaluating the outcomes of 334 patients with the diagnosis of a complication of induced abortion admitted to 10 hospitals in which the PAC strategy was implemented compared to the same outcomes in 314 patients with the same diagnosis admitted to 10 control facilities from 01/01/2016 to 12/31/2018. In response to government policy, the PAC strategy included the treatment of abortion complications with recommended uterine evacuation technology, the family planning counseling and service provision, linkages with other reproductive health services, including STI evaluation and HIV counseling and/or referral for testing, and partnerships between providers and communities. The information was collected using a questionnaire and stored using open data kit software. We supplemented this information with data abstracted from patient records, facility registries of gynecological obstetrical emergencies, and family planning registries. We analyzed data and developed regression models using STATA15. Thus, we compared changes in use of specific treatments and duration of hospitalization using a "difference-in-differences" analysis.

Results: The implementation of PAC strategy in Kinshasa referral hospitals has resulted in the utilization of WHO recommended uterine evacuation method MVA (29.3% more in the experimental structures, p = 0.025), a significant decline in sharp-curettage (19.3% less, p = 0.132), and a decline in the duration of hospitalization of patients admitted for PAC (1 day less, p = 0.020). We did not observe any change in the use of PAC services, mortality, and the provision of post abortion contraception.

Conclusion: Despite significant improvement in the management of PAC, the uptake in WHO approved technology-namely MVA, and the duration of hospitalization, these outcomes while a significant improvement for DRC, indicate that additional quality improvement strategies for management of PAC and risk-mitigating strategies to reduce barriers to care are required.
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http://dx.doi.org/10.1186/s12978-021-01130-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8028186PMC
April 2021

HIV among men who have sex with men in the Caribbean: reaching the left behind.

Rev Panam Salud Publica 2021 8;45:e12. Epub 2021 Mar 8.

Université libre de Bruxelles Brussels Belgium Université libre de Bruxelles, Brussels, Belgium.

Objectives: To present the epidemiology, social and cultural factors driving the HIV epidemic among men who have sex with men (MSM) in the Caribbean region and to highlight the regional and national responses, and what remains to be addressed to close the gaps in order to ending AIDS by 2030.

Methods: A literature review was performed in the following databases: PubMed and Scopus. Articles published in the past 10 years were selected. The outcomes of interest were sociocultural risk factors, description of regional and national efforts and potential challenges and barriers to effective control of the epidemic among MSM. This report concentrates exclusively on publications related to MSM living in the Caribbean countries.

Results: 11 peer-reviewed studies, 9 grey literature reports and programme frameworks were thematically analysed. The prevalence of HIV among MSM is high and the rates also do vary among Caribbean countries. Several factors influence the epidemic among MSM in the Caribbean but stigma and discrimination underlie the social vulnerability and play a central role in driving the HIV epidemic.

Conclusions: To end the AIDS epidemic by 2030, MSM can no longer be kept unchecked in the era of the Sustainable Development Goals with the motto 'Leave no one behind'.
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http://dx.doi.org/10.26633/RPSP.2021.12DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7939031PMC
March 2021

Implementation of a model of awareness-raising for taxi motorcyclists in Benin in relation to helmet use: protocol for a quasi-experimental study.

BMC Public Health 2021 01 28;21(1):241. Epub 2021 Jan 28.

Ecole de Santé Publique, Université Libre de Bruxelles, Brussels, Belgium.

Background: In the large cities of Benin, motorcycle taxi drivers, mainly between the ages of 20 and 40, are particularly exposed to accidents due to their profession. User awareness, along with legislative reforms and enforcement measures, would reduce the incidence of crashes and injuries. This study aims to test the effectiveness of an awareness-raising model regarding helmet use for motorcycle taxi drivers.

Methods: This is a quasi-experimental study that will take place in the cities of Parakou (intervention group) and Porto Novo (control group). Over a three-month period, a package of awareness-raising activities will be implemented in the intervention area, targeting a group of motorcycle taxi drivers. The messages to be developed for awareness-raising will focus on the most frequently influencing factors, as identified by the baseline collection. These key messages will be disseminated through various tools and communication channels (banners, motorcycle stickers and motorcycle taxi uniforms, interactive sessions). Data will be collected prospectively via a self-reported questionnaire and observation, carried out before the intervention, at the end, and 6 months later. The data will relate to knowledge, attitudes and practices regarding helmet use. The analysis will compare the indicators between the groups, as well as between the pre- and post-intervention phase. The KoboCollect software will be used for data entry and processing, and Stata 15 will be used for data analysis. Chi-square or Fisher, Student's or Kruskal-Wallis tests will be used for the comparisons. The difference-in-difference method will be used to determine the specific effect of the awareness activities.

Discussion: This study will assess the contribution of awareness messages to changing the behaviour of motorcycle taxi drivers by determining the specific effect of the intervention.
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http://dx.doi.org/10.1186/s12889-021-10298-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7842175PMC
January 2021

Attitudes of medical students towards men who have sex with men living with HIV: implications for social accountability.

Int J Med Educ 2020 Oct 23;11:233-239. Epub 2020 Oct 23.

Health Systems and Policies, International Health, School of Public Health, Université libre de Bruxelles (ULB), Brussels, Belgium.

Objectives: To explore the attitudes that medical students in Haiti harbour toward Men who have Sex with Men living with HIV in order to better understand how stigma and other factors may impair healthcare, and to explore suggestions of opportunities in line with the values of social accountability.

Methods: This study employed a qualitative design by using a grounded theory approach regarding the context of Haiti. We used purposive sampling to select the 22 research participants. In-depth interviews were conducted, audio-recorded, transcribed and analyzed using an inductive content analysis approach.

Results: Although stigmatizing attitudes emerged through the findings, medical students expressed willingness to provide Men who have Sex with Men with adequate health services in relation to HIV care. Their expressions were based on the Men who have Sex with Men's comprehensive right to receive equitable care, the moral responsibility of healthcare professionals, their perception of health disparities and the HIV global risk reduction. Participants pointed out that the medical education curriculum did not consider sexual health and specificities of sexual minorities and suggested a more inclusive and socially accountable training based on equity and quality.

Conclusions: The students expressed favourable attitudes regarding health services to Men who have Sex with Men even though some layered stigmatizing attitudes emerged through the discussions. They all lacked skills on how to handle health specificities of sexual minorities. These findings recommend a revision of the medical education curriculum in regard to social accountability principles.
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http://dx.doi.org/10.5116/ijme.5f87.39c2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7882130PMC
October 2020

[Perceptions and attitudes of nurses on emotional and sexual lives of cancer patients].

Bull Cancer 2020 Dec 14;107(12):1233-1240. Epub 2020 Oct 14.

Centre de recherches politiques et systèmes de santé, École de Santé Publique, Université libre de Bruxelles (ULB), route de Lennik 808, 1070 Bruxelles, Belgique.

Introduction: Despite the frequency of sexual issues during cancer care, the majority of nurses do not bring up the topic with their patients. The purpose of this study is to encourage nurses in oncology and hematology units on how to better participate in the assessment of the well-being of cancer patients as part of their sexual health.

Methods: Using an interview guide, we conducted a qualitative study by interviewing twenty nurses working in the Oncology and Hematology Units of four Belgian hospitals. The twenty semi-structured interviews were transcribed, and we performed a content analysis of the data collected.

Results: Sexuality is still a taboo topic, sexual dysfunction is undervalued, nurses lack knowledge on the topic which create many barriers to sexual health assessment. Obstacles are intrinsic or extrinsic towards nurses: prejudices, embarrassment, lack of evaluation tools, lack of support, resources, the environment is not always adequate. This is linked to the lack of knowledge of side effects of treatments, the lack of know-how, well-being and reflexivity. The assessment of sexual health is however part of their role. Nurses would like to have tools and better education to address the various shortcoming on how to address sexual health.

Conclusion: Nurses must acknowledge the existence of sexual health issues in cancer patients by rectifying their perceptions of sexuality, improving their knowledge and management of care, by addressing the issue of sexual health early enough.
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http://dx.doi.org/10.1016/j.bulcan.2020.06.012DOI Listing
December 2020

A realist systematic review of stigma reduction interventions for HIV prevention and care continuum outcomes among men who have sex with men.

Int J STD AIDS 2020 07;31(8):712-723

Health Systems and Policies - International Health, School of Public Health, Université Libre de Bruxelles (ULB), Brussels, Belgium.

While stigma associated with human immunodeficiency virus (HIV) infection among men who have sex with men (MSM) is well recognized, there remains relatively limited intervention data on effective stigma reduction strategies. This systematic review was conducted to highlight the mechanisms through which sexual and HIV stigma is reduced in relation to HIV prevention and care engagement. Search of PubMed and Scopus resulted in 11 tested interventions to include in our preliminary model constructed from programme frameworks and recommendations. We refined the preliminary programme theory to identify whether, why, or how mitigation strategies produce observed outcomes. Our review showed that the interventions produced stigma reduction through three groups of mechanisms: (1) Self-acceptance, leadership, and motivational activation for behaviour change from intrapersonal strategies, such as education and mobile health strategies, which intervene on internalized and anticipated stigma; (2) socialization, knowledge sharing, and social empowerment from interpersonal strategies, such as peer support and training for care providers; and (3) community introspection, self-reflection, and humanistic activation from structural strategies such as community leaders' sensitization, which intervene on both anticipated and enacted stigma. Interventions mechanisms act complementarily and can be activated in different contexts in which MSM exposed to and infected with HIV are living.
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http://dx.doi.org/10.1177/0956462420924984DOI Listing
July 2020

Can mutual health organisations influence the quality and the affordability of healthcare provision? The case of the Democratic Republic of Congo.

PLoS One 2020 16;15(4):e0231660. Epub 2020 Apr 16.

School of Public Health and Tropical Medicine, Global Community Health and Behavioral Sciences, Tulane University, New Orleans, LA, United States of America.

Background: In their mission to achieve better access to quality healthcare services, mutual health organisations (MHOs) are not limited to providing health insurance. As democratically controlled member organisations, MHOs aim to make people's voices heard. At national level, they seek involvement in the design of social protection policies; at local level, they seek to improve responsiveness of healthcare services to members' needs and expectations.

Methods: In this qualitative study, we investigated whether MHOs in the Democratic Republic of Congo (DRC) succeed in defending members' rights by improving healthcare quality while minimising expenses. The data originate from an earlier in-depth investigation conducted in the DRC in 2016 of the performance of 13 MHOs. We re-analysed this existing dataset and more specifically investigated actions that the MHOs undertook to improve quality and affordability of healthcare provision for their members, using a framework for analysis based on Hirschman's exit-voice theory. This framework distinguishes four mechanisms for MHO members to use in influencing providers: (1) 'exit' or 'voting with the feet'; (2) 'co-producing a long voice route' or imposing rules through strategic purchasing; (3) 'guarding over the long voice route of accountability' or pressuring authorities to regulate and enforce regulations; and (4) 'strengthening the short voice route' by transforming the power imbalance at the provider-patient interface.

Results: All studied MHOs used these four mechanisms to improve healthcare provision. Most healthcare providers, however, did not recognise their authority to do so. In the DRC, controlling quality and affordability of healthcare is firmly seen as a role for the health authorities, but the authorities only marginally take up this role. Under current circumstances, the power of MHOs in the DRC to enhance quality and affordability of healthcare is weak.

Conclusion: On their own, mutual health organisations in the DRC do not have sufficient power to influence the practices of healthcare providers. Greater responsiveness of the health services to MHO members requires cooperation of all actors involved in healthcare delivery to create an enabling environment where voices defending people's rights are heard.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0231660PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7162613PMC
July 2020

Prediction ability of vector species, environmental characteristics and socio-economic factors for malaria risk in Sub-Saharan African Countries.

Int J Environ Health Res 2020 Apr 12:1-16. Epub 2020 Apr 12.

Epidemiology, Biostatistics and Clinical Research Center, School of Public Health, Université Libre de Bruxelles (ULB), Campus Erasme, Brussels, Belgium.

Malaria remains a major public health problem, causing 435,000 deaths in 2017. The objective of this study was to estimate the prediction ability of vector species associated with the prediction power of environmental and socio-economic factors for malaria risk. Logistic regression was used for malaria risk estimation. A Radial Basis Function model was applied for estimating the predictive ability of  species, environmental and socio-economic factors. The lowest fever prevalence was found where  was dominant.  and  were the dominant species where prevalence of malaria was high. Altitude, country and vector species were the best predictive factors.  and  were most common in urban areas. This study will improve the prediction of malaria risk in targeted areas. We have observed how important it is to adapt health policies according to the dominant malaria vector in a region.
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http://dx.doi.org/10.1080/09603123.2020.1745763DOI Listing
April 2020

Integration of Human African Trypanosomiasis Control Activities into Primary Healthcare Services: A Scoping Review.

Am J Trop Med Hyg 2019 11;101(5):1114-1125

School of Public Health, Université Libre de Bruxelles (ULB), Brussels, Belgium.

Human African trypanosomiasis (HAT) also known as sleeping sickness is targeted for elimination as a public health problem by 2020 and elimination of infection by 2030. Although the number of reported cases is decreasing globally, integration of HAT control activities into primary healthcare services is endorsed to expand surveillance and control. However, this integration process faces several challenges in the field. This literature review analyzes what is known about integrated HAT control to guide the integration process in an era of HAT elimination. We carried out a scoping review by searching PubMed and Google Scholar data bases as well as gray literature documents resulting in 25 documents included for analysis. The main reasons in favor to integrate HAT control were related to coverage, cost, quality of service, or sustainability. There were three categories of factors influencing the integration process: 1) the clinical evolution of HAT, 2) the organization of health services, and 3) the diagnostic and therapeutic tools. There is a consensus that both active and passive approaches to HAT case detection and surveillance need to be combined, in a context-sensitive way. However, apart from some documentation about the constraints faced by local health services, there is little evidence on how this synergy is best achieved.
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http://dx.doi.org/10.4269/ajtmh.19-0232DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6838596PMC
November 2019

Analysis of severe adverse effects following community-based ivermectin treatment in the Democratic Republic of Congo.

BMC Pharmacol Toxicol 2019 08 16;20(1):49. Epub 2019 Aug 16.

School of Public Health, Université Libre de Bruxelles (ULB), Route de Lennik numéro 808 à 1070, Brussels, Belgium.

Background: The progress of mass, community-directed, treatment with ivermectin (CDTI) for onchocerciasis control was disrupted by severe adverse effects (SAE) in the Democratic Republic of Congo (DRC). The study aimed at determining the frequency of post-CDTI SAE as well as factors associated with the occurrence of SAE.

Methods: Our retrospective study relied on SAE collection cards, as archived by the DRC Ministry of Health, and compiled for people who benefited from ivermectin treatment then further developed SAE. The study included 945 post-CDTI SAE recorded in DRC between 2003 and 2017. These cases occurred in 15 projects out of 22 projects implemented in the country. All cards were reviewed and analysed.

Results: Between the years 2003 and 2017, the total average population treated was around 15,552,588 among which 945 cases of SAE were registered in DR Congo, i.e. 6 cases of SAE for 100,000 persons treated per year. 55 deaths related to post-CDTI SAE were recorded, which represents 5.8% of all cases of SAE. Non-neurological SAE were dominated by severe headaches (74.8%), myalgia (64.0%) and arthralgia (62.7%). Neurological SAE were mainly coma (94.1%), motor deficit (75.4%) and palpebral subconjunctival haemorrhages (38.8%). Factors associated with the occurrence of SAE were: male, age over 18 years old, alcohol consumption, hemp intake and the presence of loiasis. The study also highlighted weaknesses of the National Program for Onchocerciasis Control (NPOC)  in terms of awareness campaigns among the population.

Conclusion: Co-endemicity of loiasis and onchocerciasis is one of the key factors responsible for the occurrence of SAE following ivermectin treatment. Mobilization of resources necessary to the appropriate management of SAE and awareness of populations are essential to achieve onchocerciasis control in DRC.
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http://dx.doi.org/10.1186/s40360-019-0327-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6697993PMC
August 2019

Enjeux de la planification publique participative d'un Plan régional de promotion de la santé dans le contexte institutionnel belge.

Glob Health Promot 2020 Jun 2;27(2):131-138. Epub 2019 Aug 2.

Centre de recherche Politiques et systèmes de Santé, Ecole de Santé Publique, Université Libre de Bruxelles (ULB), Bruxelles, Belgique.

Définir un cadre de prévention et de promotion de la santé est un enjeu majeur par la Région wallonne qui a hérité depuis 2014 de ces compétences. Une première partie d'un Plan Prévention et Promotion de la Santé a été élaborée en 2017, permettant de définir les priorités régionales en santé. L'objectif de cet article est de présenter le processus de construction pour ses composantes opérationnelles et de discuter des enjeux de l'implémentation d'un tel cadre d'action sur un plan politique et de démarche participative. En prenant appui sur la première partie du Plan, l'administration régionale a identifié 11 groupes de travail thématiques qui ont rassemblé plus de 150 partenaires. Un guide méthodologique développe les chaines « objectifs de santé-objectifs spécifiques-actions » désirées, le cadre de priorisation des actions basé sur des critères de pertinence, de cohérence et de faisabilité ainsi que sur la prise en compte d'objectifs plus transversaux. Le Plan opérationnel repose sur des valeurs et des principes qui constituent les fondements des pratiques des acteurs. La proposition de programmation est structurée en 6 axes qui comportent un complément au diagnostic de situation, des principes d'intervention et une programmation opérationnelle. Il a aussi été élaboré un cadre d'implémentation, de gestion et de suivi, d'évaluation et de mise à jour du Plan. Le temps politique n'est pas le même que le temps nécessaire à une planification de qualité. Ce travail de programmation, basé sur des dimensions participatives, a été incomplet de par les limites du processus qui ont influencé les contenus. Bien que les propositions soient en majorité issues d'actions existantes, il faut souligner que les participants ont vu dans le Plan l'opportunité d'innover et de pallier certains manques ressentis actuellement en Wallonie en termes de prévention et de promotion de la santé.
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http://dx.doi.org/10.1177/1757975919840663DOI Listing
June 2020

Community Participation in and Perception of Community-Directed Treatment with Ivermectin in Kinshasa, DRC.

Trop Med Infect Dis 2019 Jul 19;4(3). Epub 2019 Jul 19.

School of Public Health, Université Libre de Bruxelles (ULB), Route de Lennik 808, 1070 Brussels, Belgium.

The success of community-directed treatment with Ivermectin (CDTI) depends on active community participation. We conducted a case study nested in a cross-sectional study in the Binza Ozone Health Zone (ZS) in Kinshasa, Democratic Republic of Congo, in order to investigate community's knowledges and perceptions of onchocerciasis and on all CDTI's aspects. We interviewed 106 people aged 20 and over, purposively selected, through eight individual interviews and 12 focus groups. Themes used for collecting data were drawn for the Health Belief Model and data were analyzed using a deductive thematic approach. The term onchocerciasis was unknown to participants who called it "Mbitiri", the little black fly, in their local language. This disease is seen as curse put on the sufferer by a witch and perceived as a threat because of the "Mbitiri" bites. The afflicted participants were reluctant to seek treatment and preferred traditional practitioners or healers. CDTI is considered devastating because of adverse effects of ivermectin as well as inefficient after occurrence of deaths. This explains the low level of community adhesion and participation to this strategy. Recruitment procedures for community distributors are poorly understood and awareness and health education campaigns are either non-existent or rarely carried out. Nevertheless, the latter should be regularly done.
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http://dx.doi.org/10.3390/tropicalmed4030109DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6789872PMC
July 2019

Passive Screening and Diagnosis of Sleeping Sickness with New Tools in Primary Health Services: An Operational Research.

Infect Dis Ther 2019 Sep 15;8(3):353-367. Epub 2019 Jul 15.

Faculty of Medicine & School of Public Health, University of Lubumbashi, Lubumbashi, Democratic Republic of the Congo.

Introduction: The integration of human African trypanosomiasis (HAT) activities into primary health services is gaining importance as a result of the decreasing incidence of HAT and the ongoing developments of new screening and diagnostic tools. In the Democratic Republic of Congo, this integration process faces multiple challenges. We initiated an operational research project to document drivers and bottlenecks of the process.

Methods: Three health districts piloted the integration of HAT screening and diagnosis into primary health services. We analysed the outcome indicators of this intervention and conducted in-depth interviews with health care providers, seropositives, community health workers and HD management team members. Our thematic interview guide focused on factors facilitating and impeding the integration of HAT screening.

Results: The study showed a HAT-RDT-positive rate of 2.2% in Yasa Bonga, 2.9% in Kongolo and 3% in Bibanga, while the proportion of reported seropositives that received confirmatory examinations was 76%, 45.6% and 68%, respectively. Qualitative analyses indicated that some seropositives were unable to access the confirmation facility. The main reasons that were given included distance, RDT rupture, lack of basic screening equipment and financial barriers (additional hospital fees not included in free treatment course), fear of lumbar puncture and the perception of HAT as a disease of supernatural origin.

Conclusion: Passive screening using HAT RDTs in primary health services inevitably has some limitations. However, regarding the epidemiological context and some obstacles to integrated implementation, this cannot on its own be a relevant alternative to the elimination of HAT by 2020.

Funding: We acknowledge the agency that provided financial support for this study, the Belgian Development Cooperation. The funder had no role in the study design, data collection and analysis, decision to publish or preparation of the manuscript. Philippe Mulenga received financial support thanks to a doctoral grant from the Belgian Development Cooperation under the FA4 agreement. Funding for the study and Rapid Service Fees was provided by the Epidemiology and Tropical Diseases Unit of the Institute of Tropical Medicine, Antwerp.
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http://dx.doi.org/10.1007/s40121-019-0253-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6702524PMC
September 2019

Review of the National Program for Onchocerciasis Control in the Democratic Republic of the Congo.

Trop Med Infect Dis 2019 Jun 13;4(2). Epub 2019 Jun 13.

Ecole de Santé Publique, Université Libre de Bruxelles (ULB), Route de Lennik 808, 1070 Brussels, Belgium.

Here, we review all data available at the Ministry of Public Health in order to describe the history of the National Program for Onchocerciasis Control (NPOC) in the Democratic Republic of the Congo (DRC). Discovered in 1903, the disease is endemic in all provinces. Ivermectin was introduced in 1987 as clinical treatment, then as mass treatment in 1989. Created in 1996, the NPOC is based on community-directed treatment with ivermectin (CDTI). In 1999, rapid epidemiological mapping for onchocerciasis surveys were launched to determine the mass treatment areas called "CDTI Projects". CDTI started in 2001 and certain projects were stopped in 2005 following the occurrence of serious adverse events. Surveys coupled with rapid assessment procedures for loiasis and onchocerciasis rapid epidemiological assessment were launched to identify the areas of treatment for onchocerciasis and loiasis. In 2006, CDTI began again until closure of the activities of African Program for Onchocerciasis Control (APOC) in 2015. In 2016, the National Program for Neglected Tropical Diseases Control using Preventive Chemotherapy (PNMTN-CP) was launched to replace NPOC. Onchocerciasis and CDTI are little known by the population. The objective of eliminating onchocerciasis by 2025 will not be achieved due to the poor results of the NPOC. The reform of strategies for eliminating this disease is strongly recommended.
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http://dx.doi.org/10.3390/tropicalmed4020092DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6631401PMC
June 2019

Extent of induced abortions and occurrence of complications in Kinshasa, Democratic Republic of the Congo.

Reprod Health 2019 May 8;16(1):49. Epub 2019 May 8.

Research Centre "Policies and Health Systems - International Health", School of Public Health, Université libre de Bruxelles (ULB), Brussel, Belgium.

Background: Due to a lack of relevant data on induced abortions in the Democratic Republic of the Congo (DRC) as well as the persistence of maternal deaths in the country, this study aims to analyse the extent of induced abortions and occurrence of complications in Kinshasa.

Methodology: This cross-sectional study was conducted with a sample of 460 women who were interviewed about their experiences as females, and provided information of 1444 women of childbearing age living in Kinshasa. Respondents' households were selected to represent the five types of residential quarters in Kinshasa, differentiated by cultural, socioeconomic, and infrastructural characteristics. Information was collected using a survey form and analyzed.

Results: Among all confidantes included in the study, 5.5% (95% CI: 4.4-6.8%) had induced abortions during 2015, a rate of 55.0 abortions per 1000 women of childbearing age. This practice was significantly performed amongst single/separated/divorced women; those without formal education, or primary-school education, and women who consumed excessive alcohol. Most abortions were induced by the administration of high doses of medication, by the women themselves or by health workers. A percentage of 51.9% (95%CI: 40.4-63.3%) of induced abortions led to complications, which were predominantly haemorrhagic. Moreover, 39% of patients had a complication for which they sought care, and of whom 12.5% had genital trauma or uterine perforation/intestinal necrosis.

Conclusion: Induced abortion is a public health problem in Kinshasa due to its frequency of practice, the complications that occur, and the absence of major surgeries in the health care package offered by the health centres or dispensaries that also provide the treatment of some serious complications. Thus, there is a need to focus on the enhancement of the health care package offered by health centres to include appropriate measures in favour of maternal health.
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http://dx.doi.org/10.1186/s12978-019-0727-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6505176PMC
May 2019

Integration of Human African Trypanosomiasis Control Activities into Primary Health Services in the Democratic Republic of the Congo: A Qualitative Study of Stakeholder Perceptions.

Am J Trop Med Hyg 2019 04;100(4):899-906

National Program for the Control of Human African Trypanosomiasis, Kinshasa, DRC.

Human African trypanosomiasis is close to elimination in several countries in sub-Saharan Africa. The diagnosis and treatment is currently rapidly being integrated into first-line health services. We aimed to document the perspective of stakeholders on this integration process. We conducted 12 focus groups with communities in three health zones of the Democratic Republic of the Congo and held 32 interviews with health-care providers, managers, policy makers, and public health experts. The topic guide focused on enabling and blocking factors related to the integrated diagnosis and treatment approach. The data were analyzed with NVivo (QSR International, Melbourne, Australia) using a thematic analysis process. The results showed that the community mostly welcomed integrated care for diagnosis and treatment of sleeping sickness, as they value the proximity of first-line health services, but feared possible financial barriers. Health-care professionals thought integration contributed to the elimination goal but identified several implementation challenges, such as the lack of skills, equipment, motivation and financial resources in these basic health services. Patients often use multiple therapeutic itineraries that do not necessarily lead them to health centers where screening is available. Financial barriers are important, as health care is not free in first-line health centers, in contrast to the population screening campaigns. Communities and providers signal several challenges regarding the integration process. To succeed, the required training of health professionals, as well as staff deployment and remuneration policy and the financial barriers in the primary care system need to be addressed, to ensure coverage for those most in need.
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http://dx.doi.org/10.4269/ajtmh.18-0382DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6447127PMC
April 2019

Untreated villages and factors associated with the absence of Community-Directed Treatment with Ivermectin (CDTI) in DRC.

J Infect Dev Ctries 2018 09 30;12(9):771-779. Epub 2018 Sep 30.

Université Libre de Bruxelles (ULB), Brussels, Belgium.

Introduction: The African Programme for Onchocerciasis Control (APOC), the main objective of which was the Community-Directed Treatment with Ivermectin (CDTI), was closed by the end of 2015. The purpose of this study was to describe untreated villages in DRC and to assess the factors associated with the absence of CDTI in endemic villages, between 2001 and 2014.

Methodology: This retrospective study was descriptive. Several annual technical reports of the National Onchocerciasis Task Force (NOTF) and national technical reports of CDTI projects were analysed; 21 projects implemented to control the disease were considered, representing the coverage of 42,778 endemic villages. Data were collected over a 3 month-period, between October and December 2016.

Results: Only 15,700 endemic villages were not treated through an annual CDT with Mectizan, i.e. 36.7%. The population at risk totalled 29,712,381 individuals and 7,681,995 of them were not treated, i.e. 25.9%. Eight projects recorded high proportions of untreated villages, i.e. 7,100 endemic entities (16.6%). Factors independently associated with non-treatment were the fear of serious side effects (adjusted OR: 10.6; 95% CI: 4.5-27.7), supply impaired by insecurity (adjusted OR: 15.9; 95% CI: 6.7-41.4) and geographical inaccessibility (adjusted OR: 19; 95% CI: 6.9-63.9).

Conclusion: After 15 CDTI-cycles in DRC, the mean geographical coverage and therapeutic coverage rates reached 63.3% and 74.1%, respectively. The 2025 target of onchocerciasis eradication, as advocated by APOC, will not be reached. Untreated areas are partly responsible for such results. Many weaknesses persist in the National Program for Onchocerciasis Control (NPOC) and new strategies of disease control should be investigated.
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http://dx.doi.org/10.3855/jidc.9881DOI Listing
September 2018

Analysis of induced abortion-related complications in women admitted to referral health facilities in Kinshasa, Democratic Republic of the Congo.

PLoS One 2018 30;13(8):e0203186. Epub 2018 Aug 30.

Research Centre "Policies and Health Systems-International Health", School of Public Health, Université libre de Bruxelles (ULB), Brussels, Belgium.

Background: Due to a lack of relevant data on induced abortions in the Democratic Republic of the Congo (DRC), as well as the persistence of maternal deaths in the country, this study aims to analyze the extent and characteristics of induced abortion-related complications in women who were admitted to referral health facilities in Kinshasa, including the duration of hospitalization, the mortality rate due to induced abortion complications and their characteristics, and the deaths that occurred after two days of hospitalization.

Methods: This is a cross-sectional study on 843 obstetric and gynecological patients who were admitted as emergency cases to five referral health facilities in Kinshasa during 2014. These facilities were selected as being representative of five types of districts in Kinshasa, according to their cultural, socioeconomic, and infrastructural characteristics. Patient data were collected from patient records and analyzed.

Results: From the 843 patients admitted to receive obstetric and gynecological emergency care services in 2014 at the health facilities surveyed, 14.7% (95% CI: 12.4-17.3%) had complications due to induced abortion. These complications were significantly diagnosed in adolescents (p = 0.003) and in single, separated, divorced, or widowed women (p = 0.03). The median duration of hospitalization was nine days, and this period of time was significantly longer for the patients who underwent surgery for pelvic peritonitis due to uterine perforation compared with the patients who underwent Caesarean section/hysterectomy. Furthermore, it was significantly longer for the patients who were treated for other induced-abortion related complications compared with patients treated for spontaneous abortion. The mortality rate related to induced abortions was 5.6% (95% CI: 2.3-11.3%), with an increase in risk of death in the presence of a postabortive pelvic peritonitis-type complication; 42.9% of deaths occurred after two days of hospitalization.

Conclusion: The complications of induced abortions are a major public health problem due to their frequency among patients admitted to Kinshasa's referral health facilities, their mortality, and their poor medical management. Therefore, there is a need to understand the reason for its poor medical management in order to provide an adequate intervention program.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0203186PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6117020PMC
February 2019

Analysis of induced abortion-related complications in women admitted to the Kinshasa reference general hospital: a tertiary health facility, Democratic Republic of the Congo.

Reprod Health 2018 Jul 6;15(1):123. Epub 2018 Jul 6.

Research Centre "Policies and Health Systems - International Health", School of Public Health, Université libre de Bruxelles (ULB), Brussel, Belgium.

Background: Due to a lack of relevant data on induced abortions in the Democratic Republic of the Congo (DRC) as well as the persistence of maternal deaths in the country, this study aims to analyse the induced abortion-related complications in women who were admitted to the Kinshasa Reference General Hospital (KRGH).

Methods: This is a cross-sectional study on 368 obstetric and gynecological patients who were admitted, as emergency cases, to the KRGH during 2014. This health facility was selected because it is a tertiary health facility with an obstetric and gynecological emergency unit most used in the city of Kinshasa. Patient data were collected from patient records and analyzed.

Results: From the 368 patients admitted to receive obstetric and gynecological emergency care services in 2014 at the KRGH, 12.2% (95% CI: 9.1-16.1%) had complications due to induced abortion that was significantly diagnosed to adolescents (p <  0.001), single or separated or divorced women or widow(p <  0.001), and to patients with history of one or several induced abortions(p <  0.001). The median duration of hospitalization was ten days and this period of time was significantly longer for the patients who underwent surgery for pelvic peritonitis due to uterine perforation(p <  0.001) compared with the group of patients who underwent Caesarean section/hysterectomy. The mortality rate related to them is 37.8% (95% CI: 23.8-53.5%) with an increase of risk of death in the presence of a post-abortive pelvic peritonitis-type complication, 56.3% of deaths occurred after two days of hospitalization.

Conclusion: The complications of induced abortions are a major public health problem due to its frequency among patients admitted to the KRGH, as well as the poor medical management, and mortality percentage related to them. Therefore, there is a need to understand the reason for the poor medical management to fill in and provide an adequate intervention package.
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http://dx.doi.org/10.1186/s12978-018-0563-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6035432PMC
July 2018

Data on short-term effect of nitrogen dioxide on cardiovascular health in Wallonia, Belgium.

Data Brief 2018 Apr 1;17:172-179. Epub 2018 Jan 1.

Centre de Recherche Epidémiologie, Biostatistiques, Recherche Clinique, School of Public Health, Université Libre de Bruxelles (U.L.B.), Route de Lennik 808, CP 596, 1070 Brussels, Belgium.

Data presented in this article are related to the research paper entitled "Short-term effects of nitrogen dioxide on hospital admissions for cardiovascular disease in Wallonia, Belgium." (Collart et al., in press) [1]. Nitrogen dioxide concentrations showed a strong seasonal pattern with higher levels in the cold period than in the warm period. A minimum of 13.1 µg/m in July and a maximum of 26.9 µg/m in January were observed. The coldest months are December, January and February and the hottest months are June, July and August. Temperature and nitrogen dioxide were negatively correlated in the cold period and positively correlated in the warm period. For the period 2008-2011 there were 113 147 hospital admissions for cardiovascular disease. Forty-five percent of patients were women and 66.5% were 65 and older. Heart rhythm disorders account for the majority of hospital admissions for cardiovascular disease. Our data confirms the existence of an association between NO and cardiovascular disease. Apart from haemorrhagic stroke, the strongest association between NO concentrations and number of hospital admissions is observed at lag 0. For haemorrhagic stroke, the association is strongest with a delay of 2 days. All associations calculated without stratification are statistically significant and range from an excess relative risk of 2.8% for myocardial infarction to 4.9% for haemorrhagic strokes.
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http://dx.doi.org/10.1016/j.dib.2017.12.056DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5988012PMC
April 2018

Simplified antibiotic regimens for treating neonates and young infants with severe infections in the Democratic Republic of Congo: a comparative efficacy trial.

Matern Health Neonatol Perinatol 2018 18;4. Epub 2018 Apr 18.

2University of North Carolina at Chapel Hill, Chapel Hill, NC USA.

Background: One-quarter of neonatal and infant deaths are due to infection, and the majority of these deaths occur in developing countries. Standard treatment for infection, which includes parenteral treatment only, is often not available in low-resource settings. Infant mortality will not be reduced in developing countries without a reduction in deaths due to infection. We participated in a multi-site trial that demonstrated the effectiveness of three simplified antibiotic regimens compared to standard treatment (The AFRINEST Trial: parent study). For this report, we examined the site-specific data for the Democratic Republic Congo (DRC), the most impoverished of the countries that participated in the study, to determine if outcomes in the DRC were similar to outcomes across all sites.

Methods: The parent study was an individually randomized, open-label, equivalence trial. Infants with clinical signs of severe infection were randomized to receive one of four regimens: 1) injectable penicillin-gentamicin for 7 days (standard therapy; regimen A), 2) injectable gentamicin and oral amoxicillin for 7 days (regimen B), 3) injectable penicillin-gentamicin for 2 days then oral amoxicillin for 5 days (regimen C), or 4) injectable gentamicin for 2 days and oral amoxicillin for 5 days (regimen D). In the DRC, we enrolled 574 infants, of whom 560 met the per-protocol criteria for analysis of treatment effect. The main outcome was treatment failure within the first week of enrollment.

Results: Treatment failure occurred in 52 (9.3%) infants: 17 (11.6%) with the referent treatment regimen, 13 (9.6%) with regimen B (risk difference [RD] -2.0%; CI -9.2% to 5.2%), 13 (9.0%) with regimen C (RD -2.6%; CI -9.6% to 4.4%), and 9 (6.7%) with regimen D (RD -5.0%; CI -11.7% to 1.7%).

Conclusion: As in the parent study, the risk difference between each of the experimental treatments and the reference treatment suggests equivalence. These findings suggest that the conclusion from the parent study, that a simplified antibiotic regimen can be used for the community-based management of possible severe infection in young infants where referral to a hospital for standard care is often not possible, is true in the DRC. We speculate that the widespread use of a simplified, community-based treatment could result in increased coverage with treatment and improved survival in poor areas.

Trial Registration: ACTRN12610000286044 on April 9, 2010.
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http://dx.doi.org/10.1186/s40748-018-0076-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5905162PMC
April 2018

Concentration-response curve and cumulative effects between ozone and daily mortality: an analysis in Wallonia, Belgium.

Int J Environ Health Res 2018 Apr 22;28(2):147-158. Epub 2018 Mar 22.

a Centre de recherche Epidémiologie, biostatistiques, recherche clinique , School of Public Health, Université Libre de Bruxelles (U.L.B.) , Brussels , Belgium.

Many studies have shown an association between ozone and mortality. However, little data is available on the cumulative effects of ozone on health. A time-series analysis using a Poisson regression was used to measure the impact of ozone on non-traumatic mortality in Wallonia over the period 2000-2012. Initially, a single-lag model was tested. Then a distributed-lag non-linear model was used in order to verify the cumulative effects of ozone on mortality. Our study confirms the existence of an association between ozone and mortality. The linear model without threshold shows a higher sensitivity in persons aged 75 and over (ERR = 0.7, 95 % CI: 0.4; 1.0 %) compared to younger people (ages 25-74) (ERR = 0.2, 95 % CI: - 0.2; 0.6 %). Taking cumulative effects into account, men and women aged 25-74 have an ozone sensitivity equivalent to those over 75.
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http://dx.doi.org/10.1080/09603123.2018.1453050DOI Listing
April 2018

[Development of a French-language online health policy course: an international collaboration].

Sante Publique 2017 Nov-Dec;29(6):821-827

Objective: To present the process and challenges of developing an online competency-based course on public health policy using a collaborative international approach.

Methods: Five public health experts, supported by an expert in educational technology, adopted a rigorous approach to the development of the course: a needs analysis, identification of objectives and competencies, development of a pedagogical scenario for each module and target, choice of teaching methods and learning activities, material to be identified or developed, and the responsibilities and tasks involved.

Results: The 2-credit (90-hour) graduate course consists of six modules including an integration module. The modules start with a variety of case studies: tobacco law (neutral packaging), supervised injection sites, housing, integrated services for the frail elderly, a prevention programme for mothers from disadvantaged backgrounds, and the obligatory use of bicycle helmets. In modules 1, 3, 4 and 5, students learn about different stages of the public policy development process: emergence, formulation and adoption, implementation and evaluation. Module 2 focuses on the importance of values and ideologies in public policy. The integration module allows the students to apply the knowledge learned and addresses the role of experts in public policy and ethical considerations.

Conclusion: The course has been integrated into the graduate programmes of the participating universities and allows students to follow, at a distance, an innovative training programme.
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http://dx.doi.org/10.3917/spub.176.0821DOI Listing
April 2018

Short-term effects of nitrogen dioxide on hospital admissions for cardiovascular disease in Wallonia, Belgium.

Int J Cardiol 2018 Mar 24;255:231-236. Epub 2017 Dec 24.

Centre de recherche Epidémiologie, Biostatistiques, Recherche Clinique, School of Public Health, Université Libre de Bruxelles (U.L.B.), Route de Lennik 808, CP 596, 1070 Brussels, Belgium.

Many studies have shown a short-term association between NO and cardiovascular disease. However, few data are available on the delay between exposure and a health-related event. The aim of the present study is to determine the strength of association between NO and cardiovascular health in Wallonia for the period 2008-2011. This study also seeks to evaluate the effects of age, gender, season and temperature on this association. The effect of the delay between exposure and health-related event was also investigated. The daily numbers of hospital admissions for arrhythmia, acute myocardial infarction, ischemic and haemorrhagic stroke were taken from a register kept by Belgian hospitals. Analyses were performed using the quasi-Poisson regression model adjusted for seasonality, long-term trend, day of the week, and temperature. Our study confirms the existence of an association between NO and cardiovascular disease. Apart from haemorrhagic stroke, the strongest association between NO concentrations and number of hospital admissions is observed at lag 0. For haemorrhagic stroke, the association is strongest with a delay of 2days. All associations calculated without stratification are statistically significant and range from an excess relative risk of 2.8% for myocardial infarction to 4.9% for haemorrhagic strokes. The results of this study reinforce the evidence of the short-term effects of NO on hospital admissions for cardiovascular disease. The different delay between exposure and health-related event for haemorrhagic stroke compared to ischemic stroke suggests different mechanisms of action.
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http://dx.doi.org/10.1016/j.ijcard.2017.12.058DOI Listing
March 2018

Task shifting in the management of hypertension in Kinshasa, Democratic Republic of Congo: a cross-sectional study.

BMC Health Serv Res 2017 Dec 4;17(Suppl 2):698. Epub 2017 Dec 4.

School of Public Health, Université libre de Bruxelles, Brussels, Belgium.

Background: The Democratic Republic of the Congo (DRC) is characterized by a high prevalence of hypertension (HTN) and a high proportion of uncontrolled HTN, which is indicative of poor HTN management. Effective management of HTN in the African region is challenging due to limited resources, particularly human resources for health. To address the shortage of health workers, the World Health Organization (WHO) recommends task shifting for better disease management and treatment. Although task shifting from doctors to nurses is being implemented in the DRC, there are no studies, to the best of our knowledge, that document the association between task shifting and HTN control. The aim of this study was to investigate the association between task shifting and HTN control in Kinshasa, DRC.

Methods: We conducted a cross-sectional study in Kinshasa from December 2015 to January 2016 in five general referral hospitals (GRHs) and nine health centers (HCs). A total of 260 hypertensive patients participated in the study. Sociodemographic, clinical, health care costs and perceived health care quality assessment data were collected using a structured questionnaire. To examine the association between task shifting and HTN control, we assessed differences between GRH and HC patients using bivariate and multivariate analyses.

Results: Almost half the patients were female (53.1%), patients' mean age was 59.5 ± 11.4 years. Over three-fourths of patients had uncontrolled HTN. There was no significant difference in the proportion of GRH and HC patients with uncontrolled HTN (76.2% vs 77.7%, p = 0.771). Uncontrolled HTN was associated with co-morbidity (OR = 10.3; 95% CI: 3.8-28.3) and the type of antihypertensive drug used (OR = 4.6; 95% CI: 1.3-16.1). The mean healthcare costs in the GRHs were significantly higher than costs in the HCs (US$ 34.2 ± US$3.34 versus US$ 7.7 ± US$ 0.6, respectively).

Conclusion: Uncontrolled HTN was not associated with the type of health facility. This finding suggests that the management of HTN at primary healthcare level might be just as effective as at secondary level. However, the high proportion of patients with uncontrolled HTN underscores the need for HTN management guidelines at all healthcare levels.
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http://dx.doi.org/10.1186/s12913-017-2645-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5773873PMC
December 2017

Prescription of Antibiotics to Treat Gonorrhoea in General Practice in Flanders 2009-2013: A Registry-Based Retrospective Cohort Study.

J Sex Transm Dis 2017 31;2017:1860542. Epub 2017 Jul 31.

Université libre de Bruxelles (ULB), School of Public Health, Epidemiology, Biostatistics, and Clinical Research (Research Center 2) and Health Policies and Systems-International Health (Research Center 3), Campus Erasme, Bâtiment A, CP 594, route de Lennik 808, 1070 Brussels, Belgium.

Background: General practitioners (GPs) as a group have been identified as playing an important role in gonorrhoea management in Flanders. Belgian guidelines recommended ceftriaxone or alternatively spectinomycin from 2008 onwards and azithromycin combination therapy since 2012.

Objectives: This study investigates to which extent contemporary gonorrhoea treatment guidelines were followed.

Methods: A retrospective cohort study (2009-2013) of antibiotic prescriptions for gonorrhoea cases registered in the Flemish Intego general practice database was carried out. The database is based on electronic health record routine registration by over 90 GPs using the software programme Medidoc.

Results: Ninety-one gonorrhoea cases with ten chlamydia and one genital trichomonas coinfections in 90 patients were registered between 2009 and 2013. The proportion of cases with ceftriaxone and/or spectinomycin prescriptions rose from 13% (two of 15 cases) in 2009 to 56% (nine of 16 cases) in 2013. Combination therapy of ceftriaxone and/or spectinomycin together with azithromycin rose from 0 of 15 cases (0%) in 2009 to 7 of 16 cases (44%) in 2013.

Conclusion: Although numbers are small, the results suggest that gonorrhoea therapy guideline adherence improved between 2009 and 2013.
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http://dx.doi.org/10.1155/2017/1860542DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5555009PMC
July 2017
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