Michèle Dramaix | Université libre de Bruxelles (original) (raw)
Papers by Michèle Dramaix
A randomized controlled trial was conducted in eastern Zaire to assess the effects of high dose v... more A randomized controlled trial was conducted in eastern Zaire to assess the effects of high dose vitamin A supplementation and regular deparasitation on the growth of 358 moderately malnourished preschool children, discharged from the hospital. The treatment groups received either vitamin A (60 mg of oily solution of retinyl palmitate, 30 mg if aged õ12 mo) every 6 mo or
American Journal of Clinical Nutrition
Evidence of the effectiveness of lipid-based ready-to-use complementary foods (RUCF) at improving... more Evidence of the effectiveness of lipid-based ready-to-use complementary foods (RUCF) at improving linear growth among infants aged 6-12 mo is scarce, and further work is warranted. The objective was to assess the effectiveness of a fortified soybean-maize-sorghum RUCF paste compared with a fortified corn soy blend (UNIMIX) porridge on the prevalence of underweight and stunting among infants in South Kivu Province, Democratic Republic of Congo. Infants were randomly assigned at 6 mo of age to receive either RUCF (n = 691) or UNIMIX (n = 692) for 6 mo. In addition to admission and monthly anthropometric measurements, hemoglobin, triglyceride, and cholesterol were measured at enrollment and at the end of the study. No significant differences in the prevalence of stunting (RUCF: 48.6%; UNIMIX: 46.4%; P = 0.31), the prevalence of underweight (RUCF: 20.4%; UNIMIX: 18.2%; P = 0.42), or weight gain (RUCF: 1.2 ± 0.7 kg; UNIMIX: 1.3 ± 0.7 kg; P = 0.08) were found. A small but statistically si...
Maternal & Child Nutrition, 2015
Community-based management of acute malnutrition (CMAM) is effective in treating acute malnutriti... more Community-based management of acute malnutrition (CMAM) is effective in treating acute malnutrition. However, post-discharge follow-up often lacks. We aimed at assessing the relapse rate and the associated factors in a CMAM programme in Burkina Faso. Discharged children from the community nutrition centre were requested to return at least every 3 months for follow-up. The data of recovered children (weight-for-height z-score ≥-2) who were discharged between July 2010 and June 2011 were collected in 45 villages, randomly selected out of 210 in January 2012. Sociodemographic data, economic variables, information on household food availability and the child's food consumption in the last 24 h were collected from the parents. A multivariate Cox proportional hazards regression was used to identify the factors associated to relapse. Of the 637 children, 14 (2.2%) died and 218 (34.2%) were lost to follow-up. The relapse rate [95% confidence interval] among the children who returned for follow-up was 15.4 [11.8-19.0] per 100 children-years. The associated factors to relapses in multivariate Cox regression model were mid-upper arm circumference (MUAC) at discharge below 125 mm, no oil/fat consumption during the last 24 h and incomplete vaccination. To limit relapses, CMAM programmes should avoid premature discharge before a MUAC of at least 125 mm. Nutrition education should emphasize fat/oil as inexpensive energy source for children. Promoting immunization is essential to promote child growth. Periodic monitoring of discharged children should be organized to detect earlier those who are at risk of relapse. The relapse rate should be a CMAM effectiveness indicator.
Revue d'Épidémiologie et de Santé Publique, 2007
International journal of obesity and related metabolic disorders : journal of the International Association for the Study of Obesity, 1998
To assess trends in average body mass index (BMI) and the prevalence of obesity between 1977 and ... more To assess trends in average body mass index (BMI) and the prevalence of obesity between 1977 and 1992, in middle-aged Belgian men at work. A subsample of men at work, aged 40-54 y extracted from the base-line data from four independent prospective studies, each representing a period (Physical Fitness Study (1977-1978), Belgian Interuniversity Research on Nutrition and Health (BIRNH) (1979-1984), Multinational Monitoring of Trends and Determinants in Cardiovascular Diseases (MONICA) (1986-1991) and ORCA (1992-1993)). Linear regression of the average body mass index (kg/m2) and logistic regression of the prevalence of obesity (BMI > or = 30kg/m2). Independent variables taken into account in multivariate analysis were: age, educational level, marital status and region. In this subsample of Belgian men at work, aged 40-54 y, prevalence of obesity increased from 9.2% in 1977-1978 to 14.5% in 1992-1993. This rise was present in each five-year age group, in both regions and in all educa...
International journal of obesity and related metabolic disorders : journal of the International Association for the Study of Obesity, 1998
To analyze the influence of socioeconomic status on the prevalence, evolution and incidence of ob... more To analyze the influence of socioeconomic status on the prevalence, evolution and incidence of obesity between the ages of 12 y and 15 y in Belgium. Retrospective cohort study. 2607 children from five social groups. The body mass index (BMI) measured during two school medical examinations carried out at an interval of two years between the ages of 12 y and 15 y. Between the ages of 12 y and 15 y the inverse relation between social status and the prevalence of obesity is accentuated in girls. The increasing divergence between social groups was a result both of the greater incidence of new cases of obesity and the reduced improvement rate in obesity already present in adolescents of lower social classes. Social inequalities in obesity increase during early adolescence. Preventive measures, targeting children of low socioeconomic status, should be put in place at this stage of life.
Civilisations, 2006
ABSTRACT Research activities are part of the cooperation model developed by the Cemubac. The foun... more ABSTRACT Research activities are part of the cooperation model developed by the Cemubac. The foundation for the research is based on strengthening the capacity of health systems and services resulting in the improvement of care offered to communities. The research (quantitative and qualitative) has a high participatory dimension and was able to develop thanks to partnerships with professionals and beneficiaries. It relies heavily on the implication of national public staff trained specifically for this work and on long-term presence in the area. The work in Kivu has continued over the past fifteen years despite a deteriorating social, economic and security context. As an organism for acquiring knowledge, the Cemubac’s work in Kivu is primarily geared towards improving health services.
Open Journal of Epidemiology, 2013
The American journal of tropical medicine and hygiene, 2004
This work compares the results of two epidemiologic and clinical surveys on the consequences of m... more This work compares the results of two epidemiologic and clinical surveys on the consequences of maternal chronic Trypanosoma cruzi infection. They were conducted in 1992-1994 and 1999-2001 in the same maternity clinic in Bolivia, a country highly endemic for infection with this parasite. In both surveys, the materno-fetal transmission of parasites occurred in 5-6% of the infected mothers. Maternal chronic T. cruzi infection had no effect on pregnancy outcome and health of newborns when there was no materno-fetal transmission of parasites. Comparisons between the older and the more recent surveys highlighted significant reductions in frequencies of symptomatic cases (from 54% to 45%), Apgar scores < 7, and low birth weights and prematurity (from 32-50% to 6-16%) among congenitally infected babies. Neonatal mortality related to congenital Chagas disease also decreased from 13% to 2% in the interval between both studies. These results suggest that the decrease in poverty that has oc...
Revue d'Épidémiologie et de Santé Publique, 2007
BackgroundThis study aimed to assess the prevention and treatment effectiveness of underweight in... more BackgroundThis study aimed to assess the prevention and treatment effectiveness of underweight in less than two years old children admitted in 2001 to community nutrition programme of Mono area in Benin.
Revue d'Épidémiologie et de Santé Publique, 2004
Background: This study aimed to assess the effectiveness of a protein-energetic malnutrition prev... more Background: This study aimed to assess the effectiveness of a protein-energetic malnutrition prevention and treatment community program on the nutritional status of 18 to 36-month-old children in the poor communities of the Mono Region in Benin.
Acta Medica Scandinavica, 2009
Comparison of the attack rates for acute myocardial infarction in two Belgian towns AMI attack ra... more Comparison of the attack rates for acute myocardial infarction in two Belgian towns AMI attack rates in two Belgian towns. Belgium is divided in two main regions: Flanders in the North with a Dutch-speaking population, and Wallonia in the South with a French-speaking community. From 1982 onwards, a register of acute myocardial infarction has been in operation in Ghent, a Flemish town, and in Charleroi in Wallonia, following the procedures of the MONICA (Multinational Monitoring of Trends and Determinants in Cardiovascular Diseases) study. Annual attack rates of myocardial infarction are presented for a 5-year period. During this period, the annual attack rates for men are 10-20% higher in Charleroi than Ghent. In women, the ratio between the two cities is less clear. The results of this community registers confirms the regional differences observed previously in Belgium using other epidemiological techniques.
Journal of Infection and Public Health, 2014
This study aimed to estimate the incidence of catastrophic health expenditures faced by household... more This study aimed to estimate the incidence of catastrophic health expenditures faced by households in Kinshasa with children affected by severe malaria. A total of 1350 children below the age of 15 year who were hospitalized due to severe malaria were included in the study. We analyzed the incidence of households facing catastrophic expenditures according to two thresholds: 40% of the household&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s capacity to pay and 10% of the household&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s total consumption. Based on the &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;40% of the capacity to pay&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; threshold, the incidence of catastrophic health expenditures reached 81.1%, and this estimate reached 46.4% for the &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;10% above total consumption&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; threshold. Regarding the ≥40% capacity to pay threshold, the incidences of catastrophic expenditures was higher among households with children who were admitted to state hospitals (adjusted odds ratio [aOR] 3.7) and private hospitals (aOR 59.1), for poor households (aOR 13), for households with medium socioeconomic statuses (aOR 3.2), for female-headed households (aOR 2.9), for households with children affected by the neurological form (aOR 4.8) and respiratory distress (aOR 3.6), and for households who opted for a pre-hospital resort (aOR 2.7). Similar results were obtained when the 10% above the total consumption threshold was applied. Greater government financing of medical attention would lead to a reduction in the catastrophic health expenditures faced by the poorest households.
Tropical Medicine and Health, 2014
Background: In the Democratic Republic of Congo (DRC), few studies have focused on treatmentseeki... more Background: In the Democratic Republic of Congo (DRC), few studies have focused on treatmentseeking paths selected by caretakers for the management of severe childhood malaria in an urban environment. The present study aims at describing the treatment-seeking paths according to the characteristics of households, as well as the subsequent impact on pre-hospitalisation delay and malarial fatality and on the main syndromes associated with severe childhood malaria. Methods: This descriptive study included data collected at nine hospitals in Kinshasa between January and November 2011. A total of 1,350 children, under 15 years of age and hospitalised for severe malaria, were included in the study. Results: Regarding the management of malaria, 31.5% of households went directly to the health centre or hospital while 68.5% opted for self-medication, church and/or traditional healing therapy. The most frequent first-line option was self-medication, adopted by more than 61.5% of households. Nevertheless, rational self-medication using antimalarial drugs recommended by the WHO (artemisinin-based combinations) was reported for only 5.5% of children. Only 12.5% of households combined 2 or 3 traditional options. The following criteria influenced the choice of a modern vs. traditional path: household socioeconomic level, residential environment, maternal education level and religious beliefs. When caretakers opted for traditional healing therapy, the pre-hospitalisation delay was longer and the occurrence of respiratory distress, severe anaemia and mortality was higher. Conclusion: The implementation of a malaria action plan in the Democratic Republic of Congo should take into account the diversity and pluralistic character of treatment-seeking behaviours in order to promote the most appropriate options (hospital and rational self-medication) and to avoid detrimental outcomes.
Psychiatry Research, 1997
Unipolar and bipolar patients with a chronic illness pattern were investigated to evaluate the re... more Unipolar and bipolar patients with a chronic illness pattern were investigated to evaluate the relevance of clinical and psychosocial risk factors to predict subsequent recurrence. Self-esteem, social adjustment, social support and attributional style were assessed in 27 recovered bipolar patients, 24 recovered unipolar patients maintained on lithium or antidepressant prophylaxis and 26 healthy controls. They were further interviewed every 2
Journal of Hospital Infection, 2005
Tropical Medicine and International Health, 2004
During the 5-year period, 1997-2001, 1700 patients with a clinical diagnosis of Mycobacterium ulc... more During the 5-year period, 1997-2001, 1700 patients with a clinical diagnosis of Mycobacterium ulcerans disease [Buruli ulcer (BU)] were treated at the Centre Sanitaire et Nutritionnel Gbemoten, Zagnanado, Benin. The patients lived in the four regions of southern Benin: Atlantique, Mono, Oueme and Zou, with the largest number coming from the Zou Region where the centre is located. The median age of BU patients was 15 years (q1 ¼ 7, q3 ¼ 30). Lower limbs are involved 3.2 times more frequently than upper limbs in older patients and younger patients have the highest prevalence of multiple lesions. The latter are frequently associated with bone lesions. Specific detection rates for age and gender showed a distribution with maximum peaks in the 10-14 years group and among adults between 75 and 79 years. Over 59 years, males are more at risk of developing M. ulcerans disease than females. Children under 15 years represent the largest part of the BU disease burden and of the general population. The highest detection rates (per 100 000 population) were in the 75-79-year-old patients. The most likely explanation of this was reactivation of disease from a latent infection of M. ulcerans. Educational programmes should target especially these two groups of population at risk.
Public Health Nutrition, 2007
Objectives: To evaluate the prevalence and identify some predictors of misreporting in an elderly... more Objectives: To evaluate the prevalence and identify some predictors of misreporting in an elderly Belgian population and to assess the effect of underreporting on estimated intakes of macronutrients and foods. Design: A 1-day food record was completed by 2083 adult men and women aged 65 years or more. Individuals whose energy intake was lower than 0.90 £ BMR (basal metabolic rate) were defined as underreporters. Overreporting was defined as energy intake greater than 2 £ BMR. Results: Underreporting and overreporting occurred in 13.6% and 7.9% of food records, respectively. Results from logistic regression models indicated that gender and body mass index (BMI) were predictors of misreporting. Whereas women were more likely to underreport energy intake, the prevalence of overreporting was higher in men. Underreporting was more prevalent among obese people and overreporting more prevalent in normal-weight subjects. Smoking status and education level did not predict underreporting; however, overreporting was more likely to occur in more highly educated subjects. A cultural difference in reporting of nutrient intakes was also found, with the percentage of underreporters being higher among Walloons compared with Flemish. Conclusion: BMI seemed to be one of the most important factors in misreporting. This calls for special attention when dietary surveys are performed on obese or lean people.
Psychotherapy and Psychosomatics, 1980
Two cohorts of Belgian bank clerks were observed during 10 years, with follow-up examinations at ... more Two cohorts of Belgian bank clerks were observed during 10 years, with follow-up examinations at 5 and 10 years. Cohort I consisted of 447 males, aged 40-59, free of coronary heart disease at entry. They belong to a private bank whereas the 768 males of cohort II work in semipublic savings bank. 5 and 10 years' incidence of new "hard' coronary events (sudden deaths, myocardial infarction fatal or nonfatal) were significantly higher for cohort I as compared to cohort II. These differences are not explained through the major coronary risk factors introduced in a multiple logistic function, as expected hard events in cohort I were 50% higher than predicted by the MLF computed for cohort II.
Preventive Medicine, 1995
A randomized controlled trial was conducted in eastern Zaire to assess the effects of high dose v... more A randomized controlled trial was conducted in eastern Zaire to assess the effects of high dose vitamin A supplementation and regular deparasitation on the growth of 358 moderately malnourished preschool children, discharged from the hospital. The treatment groups received either vitamin A (60 mg of oily solution of retinyl palmitate, 30 mg if aged õ12 mo) every 6 mo or
American Journal of Clinical Nutrition
Evidence of the effectiveness of lipid-based ready-to-use complementary foods (RUCF) at improving... more Evidence of the effectiveness of lipid-based ready-to-use complementary foods (RUCF) at improving linear growth among infants aged 6-12 mo is scarce, and further work is warranted. The objective was to assess the effectiveness of a fortified soybean-maize-sorghum RUCF paste compared with a fortified corn soy blend (UNIMIX) porridge on the prevalence of underweight and stunting among infants in South Kivu Province, Democratic Republic of Congo. Infants were randomly assigned at 6 mo of age to receive either RUCF (n = 691) or UNIMIX (n = 692) for 6 mo. In addition to admission and monthly anthropometric measurements, hemoglobin, triglyceride, and cholesterol were measured at enrollment and at the end of the study. No significant differences in the prevalence of stunting (RUCF: 48.6%; UNIMIX: 46.4%; P = 0.31), the prevalence of underweight (RUCF: 20.4%; UNIMIX: 18.2%; P = 0.42), or weight gain (RUCF: 1.2 ± 0.7 kg; UNIMIX: 1.3 ± 0.7 kg; P = 0.08) were found. A small but statistically si...
Maternal & Child Nutrition, 2015
Community-based management of acute malnutrition (CMAM) is effective in treating acute malnutriti... more Community-based management of acute malnutrition (CMAM) is effective in treating acute malnutrition. However, post-discharge follow-up often lacks. We aimed at assessing the relapse rate and the associated factors in a CMAM programme in Burkina Faso. Discharged children from the community nutrition centre were requested to return at least every 3 months for follow-up. The data of recovered children (weight-for-height z-score ≥-2) who were discharged between July 2010 and June 2011 were collected in 45 villages, randomly selected out of 210 in January 2012. Sociodemographic data, economic variables, information on household food availability and the child&amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s food consumption in the last 24 h were collected from the parents. A multivariate Cox proportional hazards regression was used to identify the factors associated to relapse. Of the 637 children, 14 (2.2%) died and 218 (34.2%) were lost to follow-up. The relapse rate [95% confidence interval] among the children who returned for follow-up was 15.4 [11.8-19.0] per 100 children-years. The associated factors to relapses in multivariate Cox regression model were mid-upper arm circumference (MUAC) at discharge below 125 mm, no oil/fat consumption during the last 24 h and incomplete vaccination. To limit relapses, CMAM programmes should avoid premature discharge before a MUAC of at least 125 mm. Nutrition education should emphasize fat/oil as inexpensive energy source for children. Promoting immunization is essential to promote child growth. Periodic monitoring of discharged children should be organized to detect earlier those who are at risk of relapse. The relapse rate should be a CMAM effectiveness indicator.
Revue d'Épidémiologie et de Santé Publique, 2007
International journal of obesity and related metabolic disorders : journal of the International Association for the Study of Obesity, 1998
To assess trends in average body mass index (BMI) and the prevalence of obesity between 1977 and ... more To assess trends in average body mass index (BMI) and the prevalence of obesity between 1977 and 1992, in middle-aged Belgian men at work. A subsample of men at work, aged 40-54 y extracted from the base-line data from four independent prospective studies, each representing a period (Physical Fitness Study (1977-1978), Belgian Interuniversity Research on Nutrition and Health (BIRNH) (1979-1984), Multinational Monitoring of Trends and Determinants in Cardiovascular Diseases (MONICA) (1986-1991) and ORCA (1992-1993)). Linear regression of the average body mass index (kg/m2) and logistic regression of the prevalence of obesity (BMI > or = 30kg/m2). Independent variables taken into account in multivariate analysis were: age, educational level, marital status and region. In this subsample of Belgian men at work, aged 40-54 y, prevalence of obesity increased from 9.2% in 1977-1978 to 14.5% in 1992-1993. This rise was present in each five-year age group, in both regions and in all educa...
International journal of obesity and related metabolic disorders : journal of the International Association for the Study of Obesity, 1998
To analyze the influence of socioeconomic status on the prevalence, evolution and incidence of ob... more To analyze the influence of socioeconomic status on the prevalence, evolution and incidence of obesity between the ages of 12 y and 15 y in Belgium. Retrospective cohort study. 2607 children from five social groups. The body mass index (BMI) measured during two school medical examinations carried out at an interval of two years between the ages of 12 y and 15 y. Between the ages of 12 y and 15 y the inverse relation between social status and the prevalence of obesity is accentuated in girls. The increasing divergence between social groups was a result both of the greater incidence of new cases of obesity and the reduced improvement rate in obesity already present in adolescents of lower social classes. Social inequalities in obesity increase during early adolescence. Preventive measures, targeting children of low socioeconomic status, should be put in place at this stage of life.
Civilisations, 2006
ABSTRACT Research activities are part of the cooperation model developed by the Cemubac. The foun... more ABSTRACT Research activities are part of the cooperation model developed by the Cemubac. The foundation for the research is based on strengthening the capacity of health systems and services resulting in the improvement of care offered to communities. The research (quantitative and qualitative) has a high participatory dimension and was able to develop thanks to partnerships with professionals and beneficiaries. It relies heavily on the implication of national public staff trained specifically for this work and on long-term presence in the area. The work in Kivu has continued over the past fifteen years despite a deteriorating social, economic and security context. As an organism for acquiring knowledge, the Cemubac’s work in Kivu is primarily geared towards improving health services.
Open Journal of Epidemiology, 2013
The American journal of tropical medicine and hygiene, 2004
This work compares the results of two epidemiologic and clinical surveys on the consequences of m... more This work compares the results of two epidemiologic and clinical surveys on the consequences of maternal chronic Trypanosoma cruzi infection. They were conducted in 1992-1994 and 1999-2001 in the same maternity clinic in Bolivia, a country highly endemic for infection with this parasite. In both surveys, the materno-fetal transmission of parasites occurred in 5-6% of the infected mothers. Maternal chronic T. cruzi infection had no effect on pregnancy outcome and health of newborns when there was no materno-fetal transmission of parasites. Comparisons between the older and the more recent surveys highlighted significant reductions in frequencies of symptomatic cases (from 54% to 45%), Apgar scores < 7, and low birth weights and prematurity (from 32-50% to 6-16%) among congenitally infected babies. Neonatal mortality related to congenital Chagas disease also decreased from 13% to 2% in the interval between both studies. These results suggest that the decrease in poverty that has oc...
Revue d'Épidémiologie et de Santé Publique, 2007
BackgroundThis study aimed to assess the prevention and treatment effectiveness of underweight in... more BackgroundThis study aimed to assess the prevention and treatment effectiveness of underweight in less than two years old children admitted in 2001 to community nutrition programme of Mono area in Benin.
Revue d'Épidémiologie et de Santé Publique, 2004
Background: This study aimed to assess the effectiveness of a protein-energetic malnutrition prev... more Background: This study aimed to assess the effectiveness of a protein-energetic malnutrition prevention and treatment community program on the nutritional status of 18 to 36-month-old children in the poor communities of the Mono Region in Benin.
Acta Medica Scandinavica, 2009
Comparison of the attack rates for acute myocardial infarction in two Belgian towns AMI attack ra... more Comparison of the attack rates for acute myocardial infarction in two Belgian towns AMI attack rates in two Belgian towns. Belgium is divided in two main regions: Flanders in the North with a Dutch-speaking population, and Wallonia in the South with a French-speaking community. From 1982 onwards, a register of acute myocardial infarction has been in operation in Ghent, a Flemish town, and in Charleroi in Wallonia, following the procedures of the MONICA (Multinational Monitoring of Trends and Determinants in Cardiovascular Diseases) study. Annual attack rates of myocardial infarction are presented for a 5-year period. During this period, the annual attack rates for men are 10-20% higher in Charleroi than Ghent. In women, the ratio between the two cities is less clear. The results of this community registers confirms the regional differences observed previously in Belgium using other epidemiological techniques.
Journal of Infection and Public Health, 2014
This study aimed to estimate the incidence of catastrophic health expenditures faced by household... more This study aimed to estimate the incidence of catastrophic health expenditures faced by households in Kinshasa with children affected by severe malaria. A total of 1350 children below the age of 15 year who were hospitalized due to severe malaria were included in the study. We analyzed the incidence of households facing catastrophic expenditures according to two thresholds: 40% of the household&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s capacity to pay and 10% of the household&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s total consumption. Based on the &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;40% of the capacity to pay&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; threshold, the incidence of catastrophic health expenditures reached 81.1%, and this estimate reached 46.4% for the &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;10% above total consumption&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; threshold. Regarding the ≥40% capacity to pay threshold, the incidences of catastrophic expenditures was higher among households with children who were admitted to state hospitals (adjusted odds ratio [aOR] 3.7) and private hospitals (aOR 59.1), for poor households (aOR 13), for households with medium socioeconomic statuses (aOR 3.2), for female-headed households (aOR 2.9), for households with children affected by the neurological form (aOR 4.8) and respiratory distress (aOR 3.6), and for households who opted for a pre-hospital resort (aOR 2.7). Similar results were obtained when the 10% above the total consumption threshold was applied. Greater government financing of medical attention would lead to a reduction in the catastrophic health expenditures faced by the poorest households.
Tropical Medicine and Health, 2014
Background: In the Democratic Republic of Congo (DRC), few studies have focused on treatmentseeki... more Background: In the Democratic Republic of Congo (DRC), few studies have focused on treatmentseeking paths selected by caretakers for the management of severe childhood malaria in an urban environment. The present study aims at describing the treatment-seeking paths according to the characteristics of households, as well as the subsequent impact on pre-hospitalisation delay and malarial fatality and on the main syndromes associated with severe childhood malaria. Methods: This descriptive study included data collected at nine hospitals in Kinshasa between January and November 2011. A total of 1,350 children, under 15 years of age and hospitalised for severe malaria, were included in the study. Results: Regarding the management of malaria, 31.5% of households went directly to the health centre or hospital while 68.5% opted for self-medication, church and/or traditional healing therapy. The most frequent first-line option was self-medication, adopted by more than 61.5% of households. Nevertheless, rational self-medication using antimalarial drugs recommended by the WHO (artemisinin-based combinations) was reported for only 5.5% of children. Only 12.5% of households combined 2 or 3 traditional options. The following criteria influenced the choice of a modern vs. traditional path: household socioeconomic level, residential environment, maternal education level and religious beliefs. When caretakers opted for traditional healing therapy, the pre-hospitalisation delay was longer and the occurrence of respiratory distress, severe anaemia and mortality was higher. Conclusion: The implementation of a malaria action plan in the Democratic Republic of Congo should take into account the diversity and pluralistic character of treatment-seeking behaviours in order to promote the most appropriate options (hospital and rational self-medication) and to avoid detrimental outcomes.
Psychiatry Research, 1997
Unipolar and bipolar patients with a chronic illness pattern were investigated to evaluate the re... more Unipolar and bipolar patients with a chronic illness pattern were investigated to evaluate the relevance of clinical and psychosocial risk factors to predict subsequent recurrence. Self-esteem, social adjustment, social support and attributional style were assessed in 27 recovered bipolar patients, 24 recovered unipolar patients maintained on lithium or antidepressant prophylaxis and 26 healthy controls. They were further interviewed every 2
Journal of Hospital Infection, 2005
Tropical Medicine and International Health, 2004
During the 5-year period, 1997-2001, 1700 patients with a clinical diagnosis of Mycobacterium ulc... more During the 5-year period, 1997-2001, 1700 patients with a clinical diagnosis of Mycobacterium ulcerans disease [Buruli ulcer (BU)] were treated at the Centre Sanitaire et Nutritionnel Gbemoten, Zagnanado, Benin. The patients lived in the four regions of southern Benin: Atlantique, Mono, Oueme and Zou, with the largest number coming from the Zou Region where the centre is located. The median age of BU patients was 15 years (q1 ¼ 7, q3 ¼ 30). Lower limbs are involved 3.2 times more frequently than upper limbs in older patients and younger patients have the highest prevalence of multiple lesions. The latter are frequently associated with bone lesions. Specific detection rates for age and gender showed a distribution with maximum peaks in the 10-14 years group and among adults between 75 and 79 years. Over 59 years, males are more at risk of developing M. ulcerans disease than females. Children under 15 years represent the largest part of the BU disease burden and of the general population. The highest detection rates (per 100 000 population) were in the 75-79-year-old patients. The most likely explanation of this was reactivation of disease from a latent infection of M. ulcerans. Educational programmes should target especially these two groups of population at risk.
Public Health Nutrition, 2007
Objectives: To evaluate the prevalence and identify some predictors of misreporting in an elderly... more Objectives: To evaluate the prevalence and identify some predictors of misreporting in an elderly Belgian population and to assess the effect of underreporting on estimated intakes of macronutrients and foods. Design: A 1-day food record was completed by 2083 adult men and women aged 65 years or more. Individuals whose energy intake was lower than 0.90 £ BMR (basal metabolic rate) were defined as underreporters. Overreporting was defined as energy intake greater than 2 £ BMR. Results: Underreporting and overreporting occurred in 13.6% and 7.9% of food records, respectively. Results from logistic regression models indicated that gender and body mass index (BMI) were predictors of misreporting. Whereas women were more likely to underreport energy intake, the prevalence of overreporting was higher in men. Underreporting was more prevalent among obese people and overreporting more prevalent in normal-weight subjects. Smoking status and education level did not predict underreporting; however, overreporting was more likely to occur in more highly educated subjects. A cultural difference in reporting of nutrient intakes was also found, with the percentage of underreporters being higher among Walloons compared with Flemish. Conclusion: BMI seemed to be one of the most important factors in misreporting. This calls for special attention when dietary surveys are performed on obese or lean people.
Psychotherapy and Psychosomatics, 1980
Two cohorts of Belgian bank clerks were observed during 10 years, with follow-up examinations at ... more Two cohorts of Belgian bank clerks were observed during 10 years, with follow-up examinations at 5 and 10 years. Cohort I consisted of 447 males, aged 40-59, free of coronary heart disease at entry. They belong to a private bank whereas the 768 males of cohort II work in semipublic savings bank. 5 and 10 years' incidence of new "hard' coronary events (sudden deaths, myocardial infarction fatal or nonfatal) were significantly higher for cohort I as compared to cohort II. These differences are not explained through the major coronary risk factors introduced in a multiple logistic function, as expected hard events in cohort I were 50% higher than predicted by the MLF computed for cohort II.
Preventive Medicine, 1995