Gwladys Nadia Gbaguidi

L’hypertension artérielle et l’asymétrie tensionnelles sont des troubles de la tension artérielle associés à un risque élevé de morbidité et de mortalité cardiovasculaire. Les données sur l’épidémiologie de ces facteurs de risques et leurs retentissements sont rares en ASS en particulier au Bénin. L’objectif de cette thèse était d’étudier l’importance des troubles tensionnels, leurs retentissements et leurs prises en charge en population rurale au Bénin. Cette thèse s’est appuyée sur les données de la cohorte TAnve HEalth Study. Il s’agit d’une cohorte cardiovasculaire mise en place dans les villages de Tanvè et Dékanmè au sud du Bénin depuis 2015. Elle inclut les adultes des deux villages ayant donné leur consentement pour participer à l’étude. Les prévalences de la fonction rénale anormale et de l’asymétrie tensionnelle ont été estimées. Les facteurs associés à ces troubles ont également été identifiés. Le recours aux soins a été évalué chez les personnes souffrant d’hypertension artérielle sévère ou autres maladies cardiovasculaires dans la cohorte. La prévalence de l’asymétrie tensionnelle a été estimée à 19% et celle de la fonction rénale anormale à 16%. L’hypertension artérielle et le diabète étaient les principaux facteurs associés à l’asymétrie tensionnelle et à la fonction rénale anormale. Nous avons observé un faible taux de recours aux soins chez les participants à la cohorte référés pour des maladies chroniques sévères. Ces résultats nous ont incités à élaborer un protocole interventionnel visant à améliorer le contrôle de l’hypertension artérielle chez les participants à la cohorte. Les troubles tensionnels sont fréquents dans notre population d’étude avec d’importants retentissements ; ceci conforte la nécessité de mettre en place des interventions efficaces pour contrôler l’hypertension artérielle qui est un facteur de risque modifiable.

Objectives: Inter-arm blood pressure difference (IABPD) can lead to underdiagnosis and poor management of hypertension, when not recognized and are associated with increased cardiovascular mortality and morbidity. However, the prevalence and associated risk factors of IABPD in sub-Saharan Africa are unknown. This study aims to determine the prevalence and associated risk factors of IABPD among Tanve Health Study (TAHES) participants, a cohort about cardiovascular diseases in a rural area in Benin. Methods: The cohort was conducted since 2015 among adults aged 25 years and over in Tanve village. Data were collected from February to March, 2020. Brachial blood pressure were recorded at rest on both arm with an electronic device. Systolic IABPD (sIABPD) was defined as the absolute value of the difference in systolic blood pressure between left and right arms ≥ 10 mmHg. A multivariate logistic regression models identified factors associated with sIABPD. Results: A total of 1,505 participants (women 59%) were included. The mean age was 45.08 ±15.65 years. The prevalence of sIABPD ≥ 10 mmHg was 19% (95%CI: 17–21). It was 19% (95%CI: 16–22) in men and 20% (95%CI: 17–22) in women. In final multivariable model, the probability of sIABPD ≥ 10 mmHg increased significantly with age (adjusted OR (aOR) = 1.1; 95%CI: 1.02–1.20 per 10-years), hypertension (aOR = 2.33; 95%CI: 1.77–3.07) and diabetes (aOR = 1.96; 95%CI: 1.09–3.53). Conclusion: Almost quarter of sample have a sIABPD ≥ 10 mmHg, with an increased risk with older age and hypertension and diabetes.

Hyperglycemia leads to serious damage to the body, especially the blood vessels and nerves. This study aimed to determine the prevalence and factors associated with hyperglycemia in a rural population of Tanvè and Dékanmey in Benin in 2019. This was a cross-sectional, descriptive and analytical study, nested in the Tanvè Health Study (TAHES) cohort. It covered all residents of the villages of Tanvè and Dékanmey, aged 25 years and above, and having given their written consent. Data were collected in the households during the fourth annual monitoring visit in 2019 using the WHO STEPS Wise approach. Hyperglycemia was defined as a fasting capillary blood glucose value ≥ 110 mg/dL. Data were analyzed with R Studio software version 3.5.1. A total of 1331 subjects were included in the study with a 60% female predominance and a sex ratio (male/female) of 0.7. The median age was 40 years (Q1 = 32 years; Q3 = 53 years) with a range of 25 and 98 years. The prevalence of hyperglycemia was 4.6%. In multivariate analysis, advanced age (AOR = 1.03; 95%CI = 1.02–1.73; p = 0.004), male sex (AOR = 2.93; 95%CI = 1.49–5.84; p = 0.023), monthly income> 105,000 FCFA (AOR = 2.63; 95%CI = 1.24–5.63; p = 0.030), abdominal obesity (AOR = 2.80; 95%CI = 1.29–6.16; p = 0.007, and obesity (AOR = 1.68; 95%CI = 0.75–3.59; p = 0.004) were statistically associated with hyperglycemia. The prevalence of hyperglycemia is not negligible in rural areas in Benin. Our study found that older age, male gender, high income, abdominal obesity, and obesity are determining factors in its occurrence.

Background: The global burden of kidney disease has increased in recent years worldwide. Risk factors for kidney disease are common in Africa, but data on their prevalence are lacking. This study aims to determine the prevalence of abnormal kidney function and associated factors among participants included in the TAnve HEalth Study (TAHES) cohort in Benin. Methods: This was a cross-sectional study nested within the TAHES cohort. It was carried out in 2019, among TAHES participants aged 25 years and above, living in Tanvè and Dékanmè, two villages located in southwestern Benin. Data on risk factors were collected using the World Health Organization’s STEPS questionnaire. Anthropometric measurements and capillary creatinine measurements were performed. Abnormal kidney function was defined as a low glomerular filtration rate (< 60 mL/min/1.73 m2). Results: Creatinine was measured among 1360 out of the 1583 participants in the cohort in 2019. The median age was 39 [32–53]. The prevalence of abnormal kidney function was 16.10%; 95%CI = [14.15–18.05]. The results of the multivariate logistic regression showed that the probability of abnormal kidney function increased significantly with age (adjusted OR (aOR) = 2.75; 95%CI = [1.83–4.14]), female gender (aOR = 2; 95%CI = [1.37–2.91]), hypertension (aOR = 1.54; 95%CI = [1.12–2.13]), high body mass index (aOR = 1, 56; 95%CI = [1.12–2.17]) and hyperglycemia (aOR = 2.86; 95%CI = [1.68–4.88]). Conclusion: The prevalence of abnormal kidney function was high. These data should guide national authorities and help to raise community awareness of the benefits of early detection of this condition.

Introduction: La fréquence de l’insuffisance rénale chronique (IRC) a augmenté ces dernières années dans le monde. Au Bénin, peu d’études sont disponibles en population générale. L’objectif de l’étude était de décrire la prévalence et les facteurs associés à l’IRC dans une population rurale au Bénin. Description: Cette étude transversale nichée dans la cohorte « Tanve Health Study » (TAHES) a été réalisée en 2019, auprès d’adultes âgés de 25 ans et plus, résidant à Tanvè et Dékanmè, deux villages situés au sud-ouest du Bénin. Le protocole STEPS proposé par l’OMS a été utilisé avec recueil de données d’interrogatoire, morphologiques et biologiques. En complément le dosage de la créatinine capillaire a été réalisé (OMS, 2005). Méthodes: L’IRC a été définie par un débit de filtration glomérulaire (DFG) estimé par l’équation MDRD < 60 mL/min/1,73 m². Une régression logistique multivariée a permis d’identifier les facteurs associés à l’IRC. Résultats: La créatinine a été dosée chez 1360 parmi les 1584 participants à la cohorte. L’âge médian des sujets était de 39 ans (intervalle interquartile : [32–53]). La prévalence de l’IRC était de 16,1 % (intervalle de confiance 95 % : [14,15–18,05]) avec une prédominance chez le sexe féminin (77,3 %). Environ 2 % des participants avaient un débit de filtration glomérulaire < 30 mL/min. L’IRC était associé au sexe féminin (OR ajusté [ORa] = 1,98 ; p < 0,001), l’âge ≥ 60 ans (OR ajusté = 2,75 ; p < 0,001), l’hypertension (ORa = 1,56 ; p = 0,007), l’indice de masse corporelle élevé (ORa = 1,56 ; p = 0,009) et l’hyperglycémie (ORa = 2,88 ; p < 0,001). Conclusion: En population générale rurale d’Afrique subsaharienne la prévalence de l’IRC est élevée. L’IRC est associé à la présence de chiffres tensionnels et de glycémie hauts, désordres le plus souvent méconnus et rarement contrôlés dans cette population. Ces données supportent le développement d’interventions pour la prévention et la détection précoce de cette affection.

Background: Due to epidemiological transitions, Sub-Saharan Africa is facing a growing burden of non-communicable diseases, including cardiovascular diseases (CVDs). Among their risk factors, hypertension is a major determinant of CVDs, but the prevalence and level of awareness and management of this condition are poorly studied in African populations. The aim of this study was to determine the prevalence of hypertension and identify its associated risk factors as well as the awareness and management of this condition in a community-dwelling cohort in Benin. Methods: A cross-sectional door-to-door study was conducted in the population over the age of 25 years in Tanve, a rural setting in Benin. The questionnaire and anthropometric measurements of the World Health Organization STEPWISE survey were used. Blood pressure was measured using standard procedures. Results: The sample included 1777 subjects (60.9% females, mean age was 42.5 ± 16.5 years). The prevalence of hypertension was 32.9%, similar in men (32.8%) and women (33.0%, p = 0.9342). Age and obesity were significantly associated with hypertension. Less than half (42%) of hypertensive people were aware about their condition and only 46.3% of them were treated. Awareness ratios differed between men and women (respectively 32.9% vs. 47.5%; p = 0.0039) and was not influenced by age, education, occupation, marital status or income. Female sex was the only factor associated with better controlled HTN, independent of socio-economic parameters. Conclusion: This large population-based study confirms the high prevalence, low awareness, and low control of hypertension in men and women in sub-Saharan Africa. Only half of the populations with hypertension are aware of their hypertension, indicating a high burden of undiagnosed and un-controlled high blood pressure in these populations.

In France, benzodiazepine anxiolytics and z-hypnotics (zolpidem and zopiclone) account for the largest share of road traffic crash risk attributable to exposure to prescription drugs. The aim of this study was to monitor the evolution of the use of these prescription drugs and their association with crash risk over a period that began before the implementation of a color-graded pictogram system printed on prescription drug boxes. Data from three French national databases were extracted and linked: the national health care insurance database, police reports, and the national police database of injurious crashes. Drivers involved in an injurious crash in France, from July 2005 to December 2015, and identified by their national identifier were included. The association with crash risk was estimated using a responsibility analysis comparing the use of benzodiazepines and z-hypnotics among drivers responsible or not for the crash. A total of 97,936 responsible and 103,522 non-responsible drivers involved in an injurious crash were included. The proportion of drivers exposed to benzodiazepine anxiolytics or z-hypnotics remained stable among responsible and non-responsible drivers. Among controls from the general population, the proportion of exposed individuals tended to increase. The association with crash risk remained almost constant over the study period. The odds-ratio for benzodiazepines ranged between 1.42 [1.24–1.62] at the beginning of the study period and 1.27 [1.09–1.47] at the end. Given the increase in exposure in the control group from the general population, the stability of exposure for responsible and non-responsible drivers can be interpreted as a relative effectiveness of the pictogram on driver exposure levels. On the other hand, while the intrinsic effect of a prescription drug cannot be modified, a decrease in risk could have been expected if drivers adapted their behavior as promoted by the pictogram. Our results therefore suggest that no significant change occurred in driving behaviors or consumption patterns.