Papers by Dismand Houinato
The Journal of Clinical Hypertension, 2015
The 24-hour urine collection method is considered the gold standard for the estimation of ingeste... more The 24-hour urine collection method is considered the gold standard for the estimation of ingested potassium and sodium. Because of the impracticalities of collecting all urine over a 24-hour period, spot urine is often used for epidemiological investigations. This study aims to assess the agreement between spot urine and 24-hour urine measurements to determine sodium and potassium intake. A total of 402 participants aged 25 to 64 years were randomly selected in South Benin. Spot urine was taken during the second urination of the day. Twenty-four-hour urine was also collected. Samples (2-mL) were taken and then stored at -20°C. The analysis was carried out using potentiometric dosage. The agreement between spot urine and 24-hour urine measurements was established using Bland-Altman plots. A total of 354 results were analyzed. Daily sodium chloride and potassium chloride urinary excretion means were 10.2±4.9 g/24 h and 2.9±1.4 g/24 h, respectively. Estimated daily sodium chloride and potassium chloride means from the spot urine were 10.7±7.0 g/24 h and 3.9±2.1 g/24 h, respectively. Concordance coefficients were 0.61 at d=-0.5 g, (d±2SD=-11 g and 10.1 g) for sodium chloride and 0.61 at d=-1 g, (d±2SD=-3.8 g and 1.8 g) for potassium chloride. Spot urine method is acceptable for estimating 24-hour urinary sodium and potassium excretion to assess sodium and potassium intake in a black population. However, the confidence interval for the mean difference, which is too large, makes the sodium chloride results inadmissible at a clinical level.
PLOS ONE, 2015
To describe and compare the prevalences of CVRF in urban and rural populations of Benin. Subjects... more To describe and compare the prevalences of CVRF in urban and rural populations of Benin. Subjects were drawn from participants in the Benin Steps survey, a nationwide cross-sectional study conducted in 2008 using the World Health Organisation (WHO) stepwise approach to surveillance of chronic disease risk factors. Subjects aged above 24 and below 65 years were recruited using a five-stage random sampling process within households. Sociodemographic data, behavioral data along with medical history of high blood pressure and diabetes mellitus were collected in Step 1. Anthropometric parameters and blood pressure were measured in Step 2. Blood glucose and cholesterol levels were measured in Step 3. CVRF were defined according to WHO criteria. The prevalences of CVRF were assessed and the relationships between each CVRF and the area of residence (urban or rural), were evaluated using multivariable logistic regression models. Of the 6762 subjects included in the study, 2271 were from urban areas and 4491 were from rural areas. High blood pressure was more prevalent in urban than in rural areas, 29.9% (95% confidence intervals (95% CI): 27.4, 32.5) and 27.5% (95% CI: 25.6, 29.5) respectively, p = 0.001 (p-value after adjustment for age and gender). Obesity was more prevalent in urban than in rural areas, 16.4% (95% CI: 14.4, 18.4) and 5.9% (95% CI: 5.1, 6.7), p<0.001. Diabetes was more prevalent in urban than in rural areas, 3.3% (95% CI: 2.1, 4.5) and 1.8% (95% CI: 1.2, 2.4), p = 0.004. Conversely, daily tobacco smoking was more prevalent in rural than in urban areas, 9.3% (95% CI: 8.1, 10.4) and 4.3% (95% CI: 3.1, 5.6), p<0.001. No differences in raised blood cholesterol were noted between the two groups. According to our data, CVRF are prevalent among adults in Benin, and variations between rural and urban populations are significant. It may be useful to take account of the heterogeneity in the prevalence of CVRF when planning and implementing preventive interventions.
Dementia and geriatric cognitive disorders, 2010
Data on dementia from low- and middle-income countries are still necessary to quantify the burden... more Data on dementia from low- and middle-income countries are still necessary to quantify the burden of this condition. This multicenter cross-sectional study aimed at estimating the prevalence of dementia in 2 large cities of Central Africa. General population door-to-door surveys were conducted in the districts of Bangui (Republic of Central Africa) and Brazzaville (Congo) in elderly aged ≥ 65 years. The subjects were screened with the Community Screening Interview for Dementia and the Five-Words Test. Diagnosis of dementia was made according to the DSM-IV criteria and to the clinical criteria proposed by the NINCDS-ADRDA for Alzheimer's disease. We enrolled 496 subjects in Bangui and 520 in Brazzaville. The prevalence of dementia was estimated at 8.1% (95% CI = 5.8-10.8) in Bangui and 6.7% (95% CI = 4.7-9.2) in Brazzaville. The prevalence of dementia in urban areas of Central Africa is close to those observed in high-income countries.
Neuroscience & Medicine, 2014
Introduction: Cognitive disorders frequency arising after a cardio-cerebral vascular disease (str... more Introduction: Cognitive disorders frequency arising after a cardio-cerebral vascular disease (stroke) is currently on the rise due to the ageing population and the increase in the number of survivors after stroke occurrence. Objective: Determining post-stroke cognitive decline and identifying associated factors. Method: It consists in a cross-sectional, prospective, descriptive and analytical study which was conducted from April 1 to August 31, 2013 in the Neurology Department of CNHU-HKM in Cotonou. The study involved 100 patients who have known stroke for at least the past 6 months and were all admitted and discharged later on. The disease survivors were re-contacted and examined again at home or at hospital. The cognitive decline (CD) was estimated by using a modified and adapted MMSE to suit our cultural era. Results: All patients were aged 58.9 years ± 13.6 years. Sex-ratio was 1.4. Cognitive decline frequency was 20%. Post-stroke cognitive decline frequency per sex was 11.6% and 8.4% respectively for females and males. Ischemia stroke patients had a higher cognitive decline (22.5%). 58.3% had severe CD. Moreover the CD frequency increased with time, from 16.7% in a year to 50% in 3 years. Total MMSE varied from 6 to 23 with 21 as median. From the unvaried analysis, the presence of sphincter disorders .00], p = 0.003) was associated with cognitive decline. From multi-varied analysis, the sole presence of convulsive attacks (11.5 [1.79 -73.58], p = 0.01) was individually associated with post-stroke cognitive decline. Conclusion: This study reveals the importance of CD after stroke. The occurrence of convulsions at stroke acute stage is a prognostic factor of CD medium or long-term occurrence. The overall coverage improvement depends on the integration of these data in stroke reach-out programs.
Pan African Medical Journal, 2013
Environment International, 2014
The Borgou region of northern Benin is a major cotton producing area and consistently uses higher... more The Borgou region of northern Benin is a major cotton producing area and consistently uses higher amounts of pesticides than other areas of the country. Organochlorine pesticides (OCPs), poorly handled, have been widely used and are still illegally present. We therefore hypothesized that serum OCP levels would be high in Borgou. As part of a case-control study on diabetes status and pesticide exposure, we measured the distribution of serum concentrations of 14 OCPs by gas chromatography with mass spectrometry. A sample of 118 diabetic subjects was selected using a four-stage cluster sampling with 54.2% of men and 45.8% of women; 43% lived in urban areas, 14.4% were obese and 39.8% had high economic status. The four detected OCPs were p,p'-DDT, p,p'-DDE, β-HCH and trans-nonachlor with respective geometric means (geometric standard deviation) of 497.1 (4.5), 20.6 (7.9), 2.9 (3.4), and 2.0 (2.3) ng/g of total serum lipids. OCP levels were significantly higher in obese, wealthier and more educated subjects and in those living in urban areas as compared to the other groups, particularly for p,p'-DDE, p,p'-DDT and β-HCH. Levels of DDT and DDE were higher than reported in other countries where DDT is no longer permitted. The low DDT/DDE ratio of 0.05 suggests past human exposure through food contamination. There is thus a need to reinforce governmental regulations for a more responsible use of pesticides in the country, in order to reduce health risks associated with persistent organic pollutants.
Tropical Medicine & International Health, 2007
Transactions of the Royal Society of Tropical Medicine and Hygiene, 1998
We report the results of a seroepidemiological study on the prevalence of cysticercosis in B&in. ... more We report the results of a seroepidemiological study on the prevalence of cysticercosis in B&in. Cluster sampling at 3 levels was performed in the 6 dipartements (Atacora, Borgou, Zou, Mono, Atlantique and Oueme) and 2625 serum samples, from 1329 adult females and 1296 adult males, were collected. Antibodies against Taenia solium cysticerci were first searched for by enzyme-linked immunosorbent assay and the 41 seropositive samples were then examined by enzyme-linked electroimmunotransfer blot assay (EI-TB).Thirty-five samples gave positive results in the EITB.The overall seroprevalence of cysticercosis was therefore 1.3% (95% confidence interval [95% CI] 0.9-1.9).The seroprevalence was 1.9% in males (95% CI 1.2-2.7) and 0.8% (95% CI 0.4-1.5) in females (PcO.05). A progressive increase in seroprevalence with increasing age was found. The highest seroprevalences were observed in Atacora and Atlantique, 2 non-Muslim dipartements (3.3% and 3.0%, respectively). This study demonstrated the public health importance of cysticercosis in B&in.
Revue Neurologique, 2010
Limoges, IFR 145 GEIST, institut de neuroépidémiologie et de neurologie tropicale, Limoges, Franc... more Limoges, IFR 145 GEIST, institut de neuroépidémiologie et de neurologie tropicale, Limoges, France r e v u e n e u r o l o g i q u e 1 6 6 ( 2 0 1 0 ) 8 8 2 -8 9 3 i n f o a r t i c l e Historique de l'article : Reçu le 10 mars 2010 Reçu sous la forme ré visé e le 25 avril 2010 Accepté le 21 juin 2010 Mots clés : Accidents vasculaires cé ré braux Prise en charge Pré vention Afrique subsaharienne Keywords: Stroke Management Secondary prevention Sub-Saharan Africa r é s u m é
Neuroepidemiology, 2012
Studies on the knowledge of stroke, its related risk factors and warning symptoms in the populati... more Studies on the knowledge of stroke, its related risk factors and warning symptoms in the populations of Sub-Saharan Africa are scarce. No study has been performed in Benin until now. A door-to-door survey was performed in two districts of Cotonou with a broad socioeconomic range. 15,155 individuals aged ≥15 years were interviewed using a semi-structured questionnaire adapted from previous reports. 15,155 individuals consented to participate in the survey. 14.1% correctly identified the brain as the affected organ in stroke. The most commonly identified risk factor was hypertension (34.5%). The most often cited warning signs of stroke were paralysis and hemiplegia (34.4%). Relatives were the major source of information about stroke (25.1%). In multivariate analysis, age, education level, occupation, self-reported risk factors of stroke, overweight and obesity were associated with at least one correct response to the questionnaire about stroke risk factors or symptoms. The awareness of stroke, and its risk factors and symptoms is low in Cotonou. The results suggest that specific education programs may improve people's knowledge of stroke and their awareness of related risk factors in Sub-Saharan African countries.
Neuroepidemiology, 2011
Background/Aims: The population of Benin is, like those of most developing countries, aging; deme... more Background/Aims: The population of Benin is, like those of most developing countries, aging; dementia is therefore a major concern. Our goal was to estimate the prevalence of dementia in an elderly population living in urban Benin. Methods: In a cross-sectional community-based study, people aged 65 years and above were screened using the Community Screening Interview for Dementia and the Five-Word Test. Results: The prevalence of dementia was 3.7% (95% CI 2.6-4.8) overall. The figure increased with age and was higher among women than men. Conclusion: Dementia was slightly more prevalent than previously reported in a rural area of Benin, but the rate was similar to that recorded in other cities in developing countries.
Neuroepidemiology, 2010
excellent concordance. The graph of Bland and Altman did not demonstrate any systematic error of ... more excellent concordance. The graph of Bland and Altman did not demonstrate any systematic error of estimation. Conclusion: The development of similar tools in other parts of Africa and developing countries may improve the quality of information collected in epidemiological studies and thereby enhance the accuracy of the results of studies conducted on age-related disorders such as dementia.
Journal of Clinical Epidemiology, 2002
HTLV-I is heterogeneously distributed in Sub-Saharan Africa. Traditional survey methods as cluste... more HTLV-I is heterogeneously distributed in Sub-Saharan Africa. Traditional survey methods as cluster sampling could provide information for a country or region of interest. However, they cannot identify small areas with higher prevalences of infection to help in the health policy planning. Identification of such areas could be done by a Lot Quality Assurance Sampling (LQAS) method, which is currently used in industry to identify a poor performance in assembly lines. The LQAS method was used in Atacora (Northern Benin) between March and May 1998 to identify areas with a HTLV-I seroprevalence higher than 4%. Sixty-five subjects were randomly selected in each of 36 communes (lots) of this department. Lots were classified as unacceptable when the sample contained at least one positive subject. The LQAS method identified 25 (69.4 %) communes with a prevalence higher than 4%. Using stratified sampling theory, the overall HTLV-I seroprevalence was 4.5% (95% CI: 3.6-5.4%). These data show the interest of LQAS method application under field conditions to detect clusters of infection.
Headache: The Journal of Head and Face Pain, 2009
Few data are available on migraine among students in Africa. The aim of this study was to estimat... more Few data are available on migraine among students in Africa. The aim of this study was to estimate the prevalence of migraine and describe its clinical features and associated conditions among students of the Faculty of Health Sciences of Abomey-Calavi University, in Cotonou, Benin. A cross-sectional study was prospectively conducted during the academic year 2002-2003 and included 336 students selected using systematic random sampling. Migraine was defined according International Headache Society criteria 1988. The lifetime prevalence of migraine was 11.3% (95% CI: 8.2-15.3%). The prevalence was significantly higher in females (18.3%) than males (6.8%), in married-widowed (30.4%) than single (9.9%). The mean age at onset of the disease was 15.0 years +/- 2.5. Migraine without aura was the more frequent form (57.9%). The mean attack frequency per month was 3.8 (+/-3.4) and the peak attack duration was between 4 and 6 hours. Psychological tiredness was the most frequent triggering factors (92.1%). The factors associated with migraine in multivariate analysis were female sex (OR = 2.6 [95% CI: 1.2-5.3]), single marital status (OR = 3.7 [95% CI: 1.2-11.9]) and presence of a family history of headache (OR = 2.9 [95% CI: 1.0-8.1]) Migraine was frequent in students in Cotonou (Benin) compared with other studies in Africa.
Epilepsia, 2010
Purpose: Stigma is a major burden of epilepsy. In sub-Saharan Africa the few studies that address... more Purpose: Stigma is a major burden of epilepsy. In sub-Saharan Africa the few studies that addressed epilepsy stigma emphasize enacted, rather than perceived, stigma. This inattention may compromise clinical management and delay help seeking, thereby contributing to the treatment gap. We assessed perceived stigma and identified sociocultural and psychological factors explaining greater stigma among people with epilepsy (PWE) in Benin. Methods: PWE included in this study were ascertained using a door-to-door survey in the general population in a Beninese rural area. We applied both qualitative and quantitative research methods to assess stigma and patient's experience and beliefs. An Explanatory Model Interview Catalogue (EMIC) and verbally administered questionnaires provided data for demographic, clinical, and sociocultural features. Sociocultural features were evaluated in terms of illness-related experience and sociocultural representations of epilepsy. Depression and anxiety were also screened. Results: Eighty PWE were included. About 68.7% reported feeling stigmatized. Multivariate regression revealed that factors independently associated with perceived stigma were experience of social isolation (p < 0.001), experience of marital problems (p < 0.01), and presence of anxiety disorder (p < 0.01). Discussion: Perceived stigma is an important issue in epilepsy in Benin. Social factors seem to be more influential than sociocultural representation of epilepsy. Insofar as research is needed in other African countries to determine the nature and relevant features of stigma to improve treatment and control.
Epilepsia, 2011
Epilepsy is a frequent chronic neurologic disorder that affects nearly 70 million people worldwid... more Epilepsy is a frequent chronic neurologic disorder that affects nearly 70 million people worldwide. The majority of people with epilepsy live in developing countries, where epilepsy remains a major public health problem. Wide prevalence differences exist among various populations across sub-Saharan Africa, Latin America, and Asia. In particular, prevalence is lower in Southeast Asia than in sub-Saharan Africa and Latin America. Methodologic problems alone do not seem to explain these differences shown in recent review papers. The distribution of numerous risk or etiologic factors such as infectious diseases with neurologic sequel, head injuries, or genetic factors could explain these differences. Stigmatization of people with epilepsy could lead to underestimating the prevalence of epilepsy, even in well-conducted studies. It is important to standardize the process of epidemiologic monitoring of epilepsy in order to improve the reliability in data comparison. Understanding the reasons for these differences is a crucial issue for eventually raising new hypotheses or prevention strategies.
Epilepsia, 2013
Epilepsy is a major clinical and social issue in Africa. This study was conducted to estimate the... more Epilepsy is a major clinical and social issue in Africa. This study was conducted to estimate the prevalence, incidence, mortality, and therapeutic outcome in rural Djidja in Benin. This was a two-phase study with a cross-sectional phase and 18 months of follow-up. In the first phase, information was obtained using door-to-door surveys, reports from key informants, and medical sources. People were interviewed using a validated screening questionnaire for epilepsy in tropical regions. The diagnosis of epilepsy was confirmed by a neurologist. We used a capture-recapture method to estimate the number of people with epilepsy (PWE). PWE were followed every month for 18 months after the cross-sectional survey. We asked the health services, the general population, and village leaders in the study area to identify suspected cases of epilepsy occurring during the follow-up. New cases were updated every month after confirmation. Antiepileptic drugs were prescribed to PWE. We surveyed 11,668 subjects (male-to-female ratio 0.9) and identified 123 PWE, yielding a prevalence of 10.5 per 1,000 (95% confidence interval (CI) 8.8-12.6/1,000). Combining the three sources, we found 148 PWE and a prevalence of 12.7 per 1,000 (95% CI 10.7-14.9/1,000). After application of the capture-recapture method, the prevalence was estimated to be as high as 38.4 per 1,000 (95% CI 34.9-41.9/1,000). The cumulative incidence was 104.2 per 100,000 and the mean annual incidence was 69.4 per 100,000. The mean annual mortality was 20.8 per 1,000. After treatment, 45% of PWE had total seizure remission and 35% had a decrease in the number of seizures. This study shows that door-to-door survey findings could be improved by using information from other sources. The follow-up suggests that epilepsy could be controlled. Continuous drug delivery and regular follow-up are key.
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Papers by Dismand Houinato