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Background: The current WHO-recommended rabies pre-exposure prophylaxis (PrEP) are two-visit vaccination schedules, but there are studies suggesting that single visit schedules might be sufficient to prime the immunity., Methods: A literature review was conducted to retrieve and summarize published data on single visit rabies PrEP. PubMed database was screened for articles published between January 1st, 2003 and December 31st, 2022. The bibliographies of the articles chosen to undergo full text review and of the current major WHO publications on rabies were searched to find additional references, regardless of publication date. The primary outcome was the percentage of subjects having received rabies PrEP on single visit schedules who achieved antibody levels ≥0.5 IU/mL one week after post-exposure prophylaxis (PEP), regardless of the PEP regimen., Results: 11 studies were selected for inclusion, totalling 935 subjects, of which 696 received a simulated PEP schedule. Of these 696, a serological test result on day 7 was available for 408 of them, and 406 subjects (99.51%) seroconverted after PEP without any difference regarding time delay between PrEP and PEP or the vaccination schedule used for PEP., Conclusion: Single visit PrEP schedules seem to confer sufficient protection in most healthy individuals without immunocompromised status if a booster PEP is administered after a suspected rabies exposure. Further studies in real-life settings and in different age categories are needed to confirm this finding, which may increase the availability of vaccines and thus the accessibility of PrEP for vulnerable populations., Competing Interests: Declaration of competing interest The authors declare no competing interests., (Copyright © 2023. Published by Elsevier Ltd.)

Background: In Benin, due to the unavailability of comprehensive data on road crashes, road safety policies are mainly based on partial statistics provided by the police. These remain unreliable in terms of injury severity and risk factors. This study aims to determine the factors influencing the severity of injuries after a road crash in Benin., Methods: The present nested case-control study, matched for age and sex, was based on a hospital cohort of road crash victims set up in five hospitals in Benin between July 2019 and January 2020. A sample of severely injured patients according to the Abbreviated Injury Scale (cases) was compared to non-severely injured patients (controls)., Results: The severe crash occurred mainly during the night between 8 p.m. and midnight (36.2% of cases vs . 24.4% of controls) and on main roads (57.8% of cases vs . 34.7% of controls). Factors associated with injury severity were the time of the crash: night between 8 p.m. and midnight [Adjusted Odd Ratio (AOR): 2.1; CI 95%: 1.4-3.2], major roads (national interstate roads and national roads) (AOR: 2.8; CI 95%: 2.0-4.0) and non-work-related travel (AOR: 1.8; CI 95%: 1.2-2.7)., Conclusions: Factors associated with road crash severity in Benin were night-time, main roads, and non-work related travel. Raising user awareness about compliance with traffic rules and improving public lighting, especially along main roads could help reduce the number of serious injuries., Competing Interests: Conflict of interest: the authors declare no potential conflict of interest. Ethical approval and consent to participate: this study was conducted according to the principles expressed in the Declaration of Helsinki. The protocol describing this study was approved by the Ethics Committee of the University of Parakou (Benin) under the reference 0182/CLERBUP/ P/SP/R/SA., (©Copyright: the Author(s).)

Background: In Benin, some riders of two-wheeled vehicles still do not wear helmets, the main protection against head injuries in road accidents. The objective of this study is to describe the characteristics of two-wheeled users, and to determine the factors influencing helmet use among this group., Methods: This is a prospective cross-sectional study of 977 two-wheeled road accident victims from a cohort. Proportions or means were calculated for the different variables. Statistical comparisons were made to test the association with helmet use. Logistic regression modelling was performed to identify factors associated with helmet use., Results: Among all subjects, 81.1% [CI 95% (78.5; 83.4)] wore a helmet. Factors explaining helmet use were female gender (OR = 2.8 [1.3-6.1]), purpose of trip (OR = 1.7 [1.1-2.6]), possession of health insurance (OR = 3.7 [1.3-10, 5]), having been driving for 15-20 years (OR = 2.6 [1.4-4.7]) or more than 20 years (OR = 3.4 [2.0-5.8]), good road conditions (OR = 3.1 [2.0-4.8]), and good visibility (OR = 1.9 [1.3-3.1])., Conclusion: The factors influencing helmet use are gender, reason for travel, length of time as a driver, possession of health insurance, conditions, and visibility of the road on which the subject are driving. These factors are related to experience and appropriation of the notion of risk, but also related to the environment. To increase helmet use among two-wheelers, helmet awareness should take into account the individual factors found in this study. Enforcement actions should be strengthened, and the quality of the roads improved., (© 2022. The Author(s).)

Purpose: Post-traumatic stress disorder (PTSD) is a frequent psychiatric complication in road accident survivors. However, it remains under-explored and is not taken into account in health policies in Benin. The purpose of this study was to determine the prevalence and risk factors of PTSD after a road traffic accident. This will help to improve its diagnosis and management in Benin hospitals., Materials and Methods: An institution-based cross-sectional study was conducted from November 2020 to January 2021. Consenting victims of road traffic accidents from three hospitals across Benin, aged 18 years and above, living in the south of the country, were administered various questionnaires at 12-month follow-up. Data on PTSD were collected using a pre-tested, structured and standardized post-traumatic stress disorder questionnaire, the PTSD Checklist (specific version) (PCL-S). A logistic regression model was fitted to identify factors associated with PTSD. An adjusted odds ratio (AOR) followed by a 95% confidence interval was calculated to determine the level of significance with a p-value less than 0.05., Results: Out of 865 patients in the cohort eligible for the 12-month follow-up, 734 (85%) participated in the study. The prevalence of PTSD was 26.43% (95% CI: 23.36-29.75). Factors associated with PTSD on multivariate analysis were female gender (adjusted odds ratio (AOR) = 2.14, 95% CI: 1.38-3.33), hospitalization (AOR = 1.87, 95% CI 1.21-2.89), negative impact of the accident on income (AOR = 4.22, 95% CI: 2.16-8.25), and no return to work (AOR = 3.17, 95% CI: 1.99-5.06)., Conclusion: The prevalence of PTSD is high in road accident survivors in Benin. The results of this study highlight the need for early diagnosis and a multidisciplinary approach to the management of PTSD patients in Benin's hospitals., Competing Interests: The authors report no conflicts of interest for this study/work., (© 2022 Daddah et al.)

Background: The implementation of road safety interventions in many developing countries usually focuses on the behavior of users. In order to draw more attention on the role of road infrastructure and physical environment in road safety interventions, this study aims to analyze the environmental and road factors associated with the pedestrians involved in traffic crashes in Benin., Method: The method used was an analysis of national road crash statistics for the period 2008 to 2015. The information available included the circumstances surrounding the collision, the road infrastructure, the vehicles and the individuals involved. A multiple logistic regression was used to identify predictors of pedestrian mortality in traffic crashes., Results: During the period studied, 3760 crashes involved at least one pedestrian. The death rate among these pedestrians was 27.74% (CI 95%: 26.31-29.20). The mortality predictors were the area in which the crash occurred (OR = 4.94; CI 95%: 4.10-5.94), the day of the crash (OR = 2.17; CI 95%:1.34-3.52), light levels (OR = 1.30; CI 95%: 1.06-1.59), road classification (OR = 1.79; CI 95%: 1.46-2.20), the condition of the road surface (2.04, CI 95%: 1.41-2.95) and the position of the pedestrian during the crash (OR = 1.69; CI 95%: 1.19-2.38)., Conclusions: These results support the need for a holistic approach to interventions aiming to tackle deaths on roads. Interventions should integrate environmental factors for greater pedestrian safety around roads with appropriate signs, roads in good condition and awareness campaigns for a proper use of road infrastructures.

Purpose: The situation of road crashes-related deaths remains problematic in low-income countries. The present study aims at analyzing the first-aid knowledge and practices of professional motorcyclists (PMs) in the city of Cotonou in Benin., Materials and Methods: This is a cross-sectional analytical study conducted from 25 March to 19 April 2019 in Cotonou and concerned PMs registered in a fleet who gave their consent to participate in the study. The World Health Organization's two-stage adaptive cluster sampling technique was applied to select the eligible PMs while respecting the proportionality rate per fleet. A logistic regression analysis was done and the odds ratios were estimated with 95% confidence interval., Results: The 430 PMs surveyed were all middle-aged men with an average age of 38.38 (±8.70). Among them, 62.56% knew at least one of the emergency phone numbers for the ambulance, police or fire services and 49.53% of the PMs knew at least one of the 3 techniques evaluated. In addition, 33.23% of PMs who had witnessed at least an RC stated that they had alerted the emergency services, and 32.27% said they had helped the victims. The main reason given for the lack of initiative in RCs was lack of knowledge of the course of action to take (19.64%). The level of knowledge was associated with the level of education (AOR: 3.11; CI 95%: 1.79-5.43) and with the length of experience (AOR: 2.56; CI 95%: 1.58-4.18)., Conclusion: This study reveals that the level of knowledge and practice of PMs in the field of first aid in Cotonou is low and demonstrates the relevance and the need to include this target group in the first-aid chain for road crashes in Benin., Competing Interests: The authors report no conflicts of interest in this work., (© 2021 Glèlè-Ahanhanzo et al.)

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.

Many studies have shown a short-term association between NO 2 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 2 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 2 and cardiovascular disease. Apart from haemorrhagic stroke, the strongest association between NO 2 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 2 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., (Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.)

Background: Newborn hearing screening programs aim to lower the ages at audiological intervention among hearing-impaired children. In Wallonia and Brussels (Belgium), audiological intervention data are not collected in the screening program, and the ages at initiating audiological care have never been assessed. This study aimed to assess the evolution in the ages at initiating audiological intervention in the context of a newborn hearing screening program implementation., Methods: This population-based descriptive study used data from the Belgian healthcare billing database. The main outcomes were the children's ages at the initial audiological assessment, hearing-aid fitting, and cochlear implantation. Results were compared to the same outcomes from another Belgian regional program (Flanders) that was implemented one decade earlier. Annual birth cohorts from 2006 to 2011 were included in the study., Results: In Wallonia-Brussels, the median ages for all outcomes tended to decrease over time but remained higher than in Flanders for each birth cohort. For all outcomes except the hearing-aid fitting, differences in median ages between the two regions became less pronounced during the study period. In 2006, < 23% of the children from Wallonia-Brussels received any audiological care before the age of 12 months and these proportions were approximately 2-fold greater in the subsequent birth cohorts. For all outcomes, early care (< 12 months) was typically delivered less frequently in Wallonia-Brussels, compared to the delivery in Flanders. These region-specific differences exhibited a decreasing trend over time, and statistically significant differences were less common in the later birth cohorts., Conclusions: We conclude that the hearing screening program in Wallonia and Brussels promoted earlier audiological intervention among hearing-impaired children. However, milestones recommended by experts for an early intervention were not totally encountered. We also recommend collecting audiological intervention data as part of this program, which can facilitate more accurate and regular program evaluation.

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 3 in July and a maximum of 26.9 µg/m 3 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 2 and cardiovascular disease. Apart from haemorrhagic stroke, the strongest association between NO 2 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.

Objectives: Summary evidence of influenza vaccine effectiveness (IVE) against hospitalized influenza is lacking. We conducted a meta-analysis of studies reporting IVE against laboratory-confirmed hospitalized influenza among adults., Methods: We searched Pubmed (January 2009 to November 2016) for studies that used test-negative design (TND) to enrol patients hospitalized with influenza-associated conditions. Two independent authors selected relevant articles. We calculated pooled IVE against any and (sub)type specific influenza among all adults, and stratified by age group (18-64 and 65 years and above) using random-effects models., Results: We identified 3411 publications and 30 met our inclusion criteria. Between 2010-11 and 2014-15, the pooled seasonal IVE was 41% (95%CI:34;48) for any influenza (51% (95%CI:44;58) among people aged 18-64y and 37% (95%CI:30;44) among ≥65 years). IVE was 48% (95%CI:37;59),37% (95%CI:24;50) and 38% (95%CI:23;53) against influenza A(H1N1)pdm09, A(H3N2) and B, respectively. Among persons aged ≥65 year, IVE against A(H3N2) was 43% (95%CI:33;53) in seasons when circulating and vaccine strains were antigenically similar and 14% (95%CI:-3;30) when A(H3N2) variant viruses predominated., Conclusions: Influenza vaccines provided moderate protection against influenza-associated hospitalizations among adults. They seemed to provide low protection among elderly in seasons where vaccine and circulating A(H3N2) strains were antigenically variant., (Copyright © 2017 The British Infection Association. All rights reserved.)

The aim of the present study is to analyse the age effect on the lag patterns of relative risk of hospitalization for acute myocardial infarction and NO 2 , PM 10 and O 3 . Daily hospitalizations for AMI during the period 2008-2011 were extracted from administrative data. Analyses were performed using the quasi-Poisson regression model adjusted for seasonality, long-term trend, day of the week and temperature. We observed very different patterns depending on age. For NO 2 and PM 10 , the younger group (25-54 years) shows a more delayed effect in comparison with the two older age groups (55-64 and ≥ 65 years). Overall, the associations between NO 2 and AMI are higher compared to PM 10 . There are no associations between O 3 and AMI. This study indicates that age plays a major role in the lag pattern. Younger people have delayed effects, but they are nevertheless sensitive to air pollution.

Objective: To synthesise the evidence on pregnancy and childbirth after repair of obstetric fistula in sub-Saharan Africa and to identify the existing knowledge gaps., Methods: A scoping review of studies reporting on pregnancy and childbirth in women who underwent repair for obstetric fistula in sub-Saharan Africa was conducted. We searched relevant articles published between 1 January 1970 and 31 March 2016, without methodological or language restrictions, in electronic databases, general Internet sources and grey literature., Results: A total of 16 studies were included in the narrative synthesis. The findings indicate that many women in sub-Saharan Africa still desire to become pregnant after the repair of their obstetric fistula. The overall proportion of pregnancies after repair estimated in 11 studies was 17.4% (ranging from 2.5% to 40%). Among the 459 deliveries for which the mode of delivery was reported, 208 women (45.3%) delivered by elective caesarean section (CS), 176 women (38.4%) by emergency CS and 75 women (16.3%) by vaginal delivery. Recurrence of fistula was a common maternal complication in included studies while abortions/miscarriage, stillbirths and neonatal deaths were frequent foetal consequences. Vaginal delivery and emergency C-section were associated with increased risk of stillbirth, recurrence of the fistula or even maternal death., Conclusion: Women who get pregnant after repair of obstetric fistula carry a high risk for pregnancy complications. However, the current evidence does not provide precise estimates of the incidence of pregnancy and pregnancy outcomes post-repair. Therefore, studies clearly assessing these outcomes with the appropriate study designs are needed., (© 2016 John Wiley & Sons Ltd.)

Background: Obstetric fistula is a serious medical condition which affects women in low income countries. Despite the progress of research on fistula, there is little data on long term follow-up after surgical repair. The objective of this study is to analyse the factors associated with the recurrence of fistula and the outcomes of pregnancy following fistula repair in Guinea., Methods: A descriptive longitudinal study design will be used. The study will include women who underwent fistula repair between 2012 and 2015 at 3 fistula repair sites supported by the Fistula Care Project in Guinea (Kissidougou Prefectoral Hospital, Labé Regional Hospital and Jean Paul II Hospital of Conakry). Participants giving an informed consent after a home visit by the Fistula Counsellors will be interviewed for enrolment at least 3 months after hospital discharge The study enrolment period is January 1, 2012 - June 30, 2015. Participants will be followed-up until June 30, 2016 for a maximum follow up period of 48 months. The sample size is estimated at 364 women. The cumulative incidence rates of fistula recurrence and pregnancy post-repair will be calculated using Kaplan-Meier methods and the risk factor analyses will be performed using adjusted Cox regression. The outcomes of pregnancy will be analysed using proportions, the Pearson's Chi Square (χ2) and a logistic regression with associations reported as risk ratios with 95 % confidence intervals. All analyses will be done using STATA version 13 (STATA Corporation, College Station, TX, USA) with a level of significance set at P < 0.05., Discussion: This study will contribute to improving the prevention and management of obstetric fistula within the community and support advocacy efforts for the social reintegration of fistula patients into their communities. It will also guide policy makers and strategic planning for fistula programs., Trial Registration: ClinicalTrials.gov Identifier: NCT02686957 . Registered 12 February 2016 (Retrospectively registered).

Background: Implementation of newborn hearing screening programmes is widely recommended and programme organisational designs may differ in practice. The objective of this article was to establish an overview of the newborn hearing screening programmes in the 28 countries of the European Union on four topics (policy-decision, financing, general designs, organisational features)., Methods: National or regional programme coordinators completed an online self-administered questionnaire focusing on protocol description and programme organisation., Results: Thirty-nine key informants, representing 24 countries, from national or regional levels completed the questionnaire. Newborn hearing screening programmes are or will be shortly implemented largely in the European Union countries. Levels of policy decision-making and organisational decisions are diverse (national, regional or combined). Designs of the programmes (number of steps before diagnosis referral, single or dual target group protocol) highly varied. However, common organisational elements were observed: hearing screening tests are often performed by nursing staff, in hospitals and early in life. This pattern does not apply when a screening protocol is specifically implemented for newborns with risk factor(s) for hearing impairment or admitted to neonatal intensive care units. Hearing test financing frequently involved public sources, including government and public health funds., Conclusion: Despite the same goal of early identification of hearing-impaired children, there is a high level of diversity in programmes, including policy decisions, financing, general designs and pragmatic organisational choices (e.g. professionals involved, location or time for screening, number of steps in the protocol). Further investigations should analyse these differences in relation to the programmes' contexts and outcomes., (© The Author 2016. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.)

Background: Despite being a well-documented phenomenon, gender differences in psychological health complaints in adolescence are poorly understood. The purpose of this study was to test factors related to well-being as explanatory factors of gender differences in psychological complaints (feeling low, irritability or bad temper, nervousness, and sleeping difficulties) in adolescence., Methods: This study was based on the 9(th) Health Behaviour in School-aged Children (HBSC) study, conducted in 2010 in the Wallonia-Brussels Federation, Belgium, on 9-24 year olds. Using logistic regression analyses, we studied gender differences in psychological complaints through well-being factors (life satisfaction, self-confidence, helplessness, and body image), across age categories, and examined the variation of female excess after taking into account each factor., Results: The four well-being factors together explained more than half of the female excess in feeling low. However, there were still significant gender differences in feeling low for children over 13. Among 13 to 15-year-olds, there were no gender differences in irritability after adjustment. An important decrease in gender differences in nervousness was observed in the multivariate analyses, although there was still significant female excess in nervousness increasing from 13 years old. After full adjustment, only gender differences in sleeping difficulties among 13-15-year-olds remained significant. For all psychological complaints studied, self-confidence caused the most important decrease in gender difference., Conclusions: This study showed that factors related to well-being could mediate the association between gender and psychological complaints, and pointed to the importance of taking into account well-being factors in the analyses of the aetiology of gender differences in psychological complaints. However, our results suggested that future research should explore additional explanations for gender differences in psychological complaints.

Background: Over time, the circumstances encountered in case of child mistreatment, can be quite complex and then, can lead to methodological questions for the analysis of the data. Based on data coming from 395 children hospitalized, alone (66.1 %) or in siblings (33.9 %), in a pediatric ward between 2007 and 2012 for mistreatment or because of a severe risk of mistreatment, the aims of this paper were to quantify the degree of similarity between sibling members, to study the differences between children hospitalized alone or with siblings and to compare four statistical methods (logistic regression and GEE, both without and with robust standard error) for the analyses of the associated factors of mistreatment., Results: Almost all intracluster correlation coefficients were large, meaning that the sibling's members have a higher degree of similarity between them. The odds ratios were not exactly the same between the two models and the robust standard errors where almost always higher than the model-based standard errors in both logistic and GEE models leading to wider confidence intervals., Conclusion: Because many of the intra-siblings correlations observed were relatively strong, the failure to take this cluster dependency into account had a substantial effect on the statistical analyses. Methods taking into account the cluster dependency are widely available in statistical software and strongly recommended.

Introduction: The objective of this study was to determine the source of health care funding for heads of households related to the management of severe malaria in children admitted to a Kinshasa reference hospital., Methods: This cross-sectional study was conducted on 1,350 hospitalised children under the age of 15 years treated for severe malaria in Kinshasa reference hospitals from January to November 2011 and the heads of households of these children., Results: Only 46% of heads of households reported having sufficient funds directly available in the household budget. The remaining 54% had to call upon external sources of funding (sale of assets, loans, pawning goods). The use of a loan tended to increase significantly mainly for households with a low (adjusted odds ratio = 6.2), and intermediate socioeconomic status (adjusted odds ratio = 3.8) and for households working in the informal sector (adjusted odds ratio = 2.5). Similarly, the sale of assets was more frequently reported for households working in the informal sector (adjusted odds ratio = 2.4) and for female heads of households (adjusted odds ratio = 3.9)., Conclusion: The management of severe malaria is a burden on household income. The majority of heads of households concerned needs to use external funding sources. A State subsidy for this management would help to reduce the risk of debt and sale of assets, especially for the poorest households.

Background: Understanding the risk factors for hearing loss is essential for designing the Belgian newborn hearing screening programme. Accordingly, they needed to be updated in accordance with current scientific knowledge. This study aimed to update the recommendations for the clinical management and follow-up of newborns with neonatal risk factors of hearing loss for the newborn screening programme in Belgium., Methods: A literature review was performed, and the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system assessment method was used to determine the level of evidence quality and strength of the recommendation for each risk factor. The state of scientific knowledge, levels of evidence quality, and graded recommendations were subsequently assessed using a three-round Delphi consensus process (two online questionnaires and one face-to-face meeting)., Results: Congenital infections (i.e., cytomegalovirus, toxoplasmosis, and syphilis), a family history of hearing loss, consanguinity in (grand)parents, malformation syndromes, and foetal alcohol syndrome presented a 'high' level of evidence quality as neonatal risk factors for hearing loss. Because of the sensitivity of auditory function to bilirubin toxicity, hyperbilirubinaemia was assessed at a 'moderate' level of evidence quality. In contrast, a very low birth weight, low Apgar score, and hospitalisation in the neonatal intensive care unit ranged from 'very low' to 'low' levels, and ototoxic drugs were evidenced as 'very low'. Possible explanations for these 'very low' and 'low' levels include the improved management of these health conditions or treatments, and methodological weaknesses such as confounding effects, which make it difficult to conclude on individual risk factors. In the recommendation statements, the experts emphasised avoiding unidentified neonatal hearing loss and opted to include risk factors for hearing loss even in cases with weak evidence. The panel also highlighted the cumulative effect of risk factors for hearing loss., Conclusions: We revised the recommendations for the clinical management and follow-up of newborns exhibiting neonatal risk factors for hearing loss on the basis of the aforementioned evidence-based approach and clinical experience from experts. The next step is the implementation of these findings in the Belgian screening programme.

Health information systems in developing countries are often faulted for the poor quality of the data generated and for the insufficient means implemented to improve system performance. This study examined data quality in the Routine Health Information System in Benin in 2012 and carried out a cross-sectional evaluation of the quality of the data using the Lot Quality Assurance Sampling method. The results confirm the insufficient quality of the data based on three criteria: completeness, reliability and accuracy. However, differences can be seen as the shortcomings are less significant for financial data and for immunization data. The method is simple, fast and can be proposed for current use at operational level as a data quality control tool during the production stage., (Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2014; all rights reserved.)

Background: In the Democratic Republic of Congo (DRC), few studies have focused on treatment-seeking 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.

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's capacity to pay and 10% of the household's total consumption. Based on the '40% of the capacity to pay' threshold, the incidence of catastrophic health expenditures reached 81.1%, and this estimate reached 46.4% for the '10% above total consumption' 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., (Copyright © 2014 King Saud Bin Abdulaziz University for Health Sciences. Published by Elsevier Ltd. All rights reserved.)

Outdoor air pollution is increasingly considered as a serious threat for cardiovascular diseases (CVD). The aim of this study is to investigate the association between outdoor pollutants and cardiovascular diseases among adults in Lebanon and to examine the possible moderator effect of cigarette smoking status on this association. A multicenter case-control study was conducted between October 2011 and October 2012. Cases were hospitalized patients diagnosed with CVD by a cardiologist while the control group subjects were free of any cardiac diseases. Information on sociodemographic characteristics, tobacco consumption, self-rated global health, pollution exposure, and other risk factors was collected using a questionnaire. The results of the logistic regression revealed that living near busy highway (OR 5.04, 95% CI (4.44-12.85), P < 0.001) and close to local diesel generator (OR 4.76, 95% CI (2.07-10.91), P < 0.001) was significantly associated with CVD. The association between the CVD and exposure to outside pollutants differed by cigarette smoking status. A clear difference was noted between nonsmokers and current smokers OR 4.6, 95% CI (1.10-19.25) and OR 10.11, 95% CI (7.33-20.23), respectively. Forthcoming studies are needed to clarify the potential link between outdoor air pollution and cardiovascular diseases in Lebanon. Public health interventions must be implemented to reduce air pollution and to improve air quality.

Introduction: Malaria remains a real problem of public health. Its hospital care generates important expenditures for affected households. The present study aimed to estimate direct and indirect costs of severe child malaria in reference hospitals in Kinshasa., Methodology: This prospective study included 1,350 children under 15 years of age suffering from severe malaria. The study was performed between 1 January and 30 November, 2011. Data were collected in nine reference hospitals. The studied parameters were direct pre-hospital costs, direct hospital costs, and indirect costs. Costs were assessed from the household point of view., Results: Median costs associated with the disease ranged from 114 USD in confessional hospitals to 173 USD in state hospitals and 308 USD in private hospitals. Direct pre-hospital median costs ranged between 3 and 11 USD. Direct hospital costs reached 72 USD in confessional hospitals, 139 USD in state hospitals, and 254 USD in private hospitals. Indirect costs ranged from 22 USD in state hospitals to 30 USD in confessional hospitals and 46 USD in private hospitals, regardless of the status of the accompanying parent or guardian. Factors explaining the variability of costs were the neurological form of malaria, indirect recourse to hospital, socioeconomic level, type of prescribing person, child's status upon leaving the hospital, and child's transfusion status., Conclusions: The care of severe child malaria appeared to be expensive in private and state hospitals. A state subsidy of health care and regulation of the private sector would contribute to the reduction of malaria's financial impact.

Objective: To present the outcomes of the newborn hearing screening program in Belgium (French-speaking area) since its implementation and to analyze its evolution between 2007 and 2012 in the neonatal population without reported risk factors for hearing loss., Methods: The study was descriptive and based on a retrospective analysis of six annual databases (2007-2012) from the newborn hearing screening program. The main outcomes were identified: prevalence of reported hearing impairment; coverage rates (first and second test, follow-up); proportions of conclusive screening tests; referral rate. Each outcome was presented for the six years and by year of birth. Chi-squares were used to study differences in the various outcomes according to time., Results: Over the six years, 264,508 newborns were considered as eligible for the screening. Hearing impairment was confirmed in 1.41‰ (n = 374) of them, with significant disparities from year to year, between 0.67‰ and 1.94‰. Analysis of the screening process showed that only 92.71% (n = 245,219) of the eligible newborns underwent a first hearing test. This coverage rate varied greatly over time: at the beginning, less than 90% of the newborns had a first test and it rose to almost 95%. After the two screening steps, 2.40% (n = 6340) of the newborns were referred to an ENT doctor; the referral rate slightly decreased during the first years of the program and then stabilized around 2.4%. Over the period, only 62.21% of the referred newborns had a follow-up; the follow-up rate was particularly low for the first year (44.91%) and then strongly increased (+19.52% in 2008) but never exceeded 70%., Conclusions: Outcome measures for the newborn hearing screening program in Belgium are lower than the benchmarks released by the Joint Committee on Infant Hearing. Nevertheless, the evolution of the outcome measures since the implementation of the program has been positive, particularly during the first years. At some point, most of the outcome measures decreased or at least did not change any further. The motivation and commitment of the professionals have to be supported in a variety of ways to improve outcome measures and thus, the quality of the program., (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)

Background: The Kingdon model, based on the convergence of three streams (problem, policy, and politics) and the opening of a policy window, analyses the process by which a health issue is placed on the political agenda. We used this model to document the political agenda-setting process of the newborn hearing screening programme in Belgium., Methods: A qualitative study based on a document review and on semi-directed interviews was carried out. The interviews were conducted with nine people who had played a role in putting the issue in question on the political agenda, and the documents reviewed included scientific literature and internal reports and publications from the newborn hearing screening programme. The thematic analysis of the data collected was carried out on the basis of the Kingdon model's three streams., Results: The political agenda-setting of this screening programme was based on many factors. The problem stream included factors external to the context under study, such as the technological developments and the contribution of the scientific literature which led to the recommendation to provide newborn hearing screening. The two other streams (policy and politics) covered factors internal to the Belgian context. The fact that it was locally feasible with financial support, the network of doctors convinced of the need for newborn hearing screening, the drafting of various proposals, and the search for financing were all part of the policy stream. The Belgian political context and the policy opportunities concerning preventive medicine were identified as significant factors in the third stream. When these three streams converged, a policy window opened, allowing newborn hearing screening onto the political agenda and enabling the policy decision for its introduction., Conclusions: The advantage of applying the Kingdon model in our approach was the ability to demonstrate the political agenda-setting process, using the three streams. This made it possible to identify the many factors involved in the process. However, the roles of the stakeholders and of the context were somewhat inexplicit in this model.

Introduction: The aim of this study was to analyze the day-of-the-week variations of acute myocardial infarction (AMI) over a 27-year period. The effects of sex, age, history of AMI, hypertension, fatality, and temporal changes over the 27-year period were also investigated., Methods: The Charleroi register of ischemic cardiopathies is the oldest register of infarctions in the French-speaking community of Belgium and is one of the very rare registers that can track trends over 27 years. The analyses presented in our study relate only to patients in the 25- to 69-year age range over time from 1983 to 2009. The χ2 test for goodness of fit was used to test the difference among the frequencies of AMI events over 7 days during the week., Results: Data from 9732 cases of AMI were analyzed. Overall, there was a significant day-of-the-week variation (P<.001), with an excess of AMI observed on Mondays (n=1495) and a minimum on Saturdays (n=1259), corresponding to a relative increase in AMI of 18.2% over the 2 days. The Monday peak is more pronounced for the 35- to 44-year (P=.045) age bracket than for the 45- to 54-year (P=.27) and the 55- to 64-year (P=.032) brackets. The cases with (n=2713) and without (n=4931) arterial hypertension exhibited the same day-of-the-week variation. In contrast, the cases with antecedent AMI (n=1888) exhibited a less pronounced excess of MI incidence on Mondays compared with the cases without antecedent (n=5970)., Conclusions: The present study demonstrates that there is a marked incidence peak in AMI on Mondays. This peak is similar for men and women but varies according to age. The Monday peak is not observed in subjects previously admitted for AMI or in fatal cases. The organization of the emergency medical services could take into account the day-of-the-week pattern of AMI to adapt emergency medical service capacity to needs., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Objectives: Investigating injuries in terms of occurrences and patient and hospital stay characteristics., Methods: 17370 stays, with at least one E code, were investigated based on data from 13 Belgian hospitals. Pearson's chi-square and Kruskal-Wallis tests were used to assess the variations between distributions of the investigated factors according to the injury's types., Results: Major injuries were accidental falls, transport injuries, and self-inflicted injuries. There were more men in the transport injuries group and the accidental falls group was older. For the transport injuries, there were more arrivals with the support of a mobile intensive care unit and/or a paramedic intervention team and a general practitioner was more implicated for the accidental falls. In three-quarters of cases, it was a primary diagnostic related to injury and poisoning which was made. The median length of stay was nearly equal to one week and for accidental falls, this value is three times higher. The median cost, from the social security point of view, for all injuries was equal to € 1377 and there was a higher median cost within the falls group., Conclusion: This study based on hospitals data provides important information both on factors associated with and on hospital costs generated by injuries.

Self-rated health is a frequently used measure, notably in the field of gerontology. Different authors have studied factors that can influence self-rated health among older persons and, according to studies, the factors taken into account and their influence vary. This article aims at synthesising the biomedical literature, published since 1993, on factors that influence self-rated health of non-institutionalised older persons aged 65 years and over, with a focus on cross-sectional quantitative studies. Of the 1801 articles that were identified by our search strategy in the Medline database, 22 were retained. The proportion of older persons assessing their health positively ranged, depending on the studies, from 48.4% to 78.0%. Fifteen studies out of 22 investigated what was rather associated with an unfavourable self-rated health. Two studies took into account only one kind of independent variables. In more than half of the studies, 1 to several variables belonging to at least 3 kinds of independent variables were associated with self-rated health in multivariable analysis. The associations between these different kinds of independent variables considered (sociodemographic characteristics - morbidity - functional status - mental health - social support - other variables) and self-rated health are here presented and synthesized. This work shows that the factors that influence self-rated health among older people, factors measured differently according to authors, are varied and belong to different domains. These domains include morbidity, functional status, as well as sociodemographic characteristics, mental health, certain aspects of social support and other kinds of factors.

Background/objectives: The French-speaking Community of Belgium has set up a register of ischaemic cardiopathies (1983-2007). The aim consists in analyzing the evolution of fatal and non-fatal acute coronary events rates as well as the 28 days case fatality on a 25-year period and examine sex differences in lethality., Methods: This register assures a standardized procedure according to the MONICA criteria. For each period, we present attack rates and trends analysis. Hospital lethality takes again in-patients and community lethality is calculated starting from all the cases., Results: The total attack rate is rather stable between 1983 and 2007 for women (from 12 to 19 per 10,000 residents). For men, there is a distinct decline of the total attack rate since 1991 till 1993 (63 to 43 per 10,000 residents). We systematically observe a reduction in risk between men and women according to the age. For each 5-year period, this risk decreases significantly with age and this difference is strongest during the periods 1993-1997 and 1998-2002. The analysis shows also a significant decline in lethality between the 1983-1987 and 1993-1997 periods. Among women, lethality is systematically higher than in men in spite of the presence or the absence of antecedents of myocardial infarction., Conclusions: Favourable evolutions in the attack rates of acute coronary events in the study population appear clearly on the 25-year period of observation. The whole lethality rates decreased during the first 15 years of the register; after that, it stabilized., (Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.)

Background/objectives: To describe the evolution of the therapeutic practices over 10 years of follow-up of acute myocardial infarction (AMI) in Charleroi and to analyse the factors influencing the choice of treatments and the mortality of these patients., Methods: The Charleroi register of ischaemic cardiopathies is the oldest register of infarctions in the French-speaking community of Belgium and is one of the very rare registers that allows identifying tendencies over 25 years. Analyses presented hereafter relate only patients in the 25-69-year age range over time from 1998 to 2007. The data were analysed in five periods of 2 years. Treatment evolutions over time were analysed using chi-squared tests for trend and logistic regression analyses identify factors influencing the type of treatment., Results: The present study shows a marked increase in the utilization of percutaneous transluminal coronary angioplasty (PTCA) between 1998-1999 and 2006-2007. The use of thrombolytic agents on approximately one-third of the patients treated remained fairly stable between 1998 and 2007. A lower proportion of patients with a history of AMI received thrombolytic agents. Thrombolysis seems beneficial for men and without effect for women. The use of β-blockers continued to increase until the 2000-2001 period and remained fairly stable for the two following periods. 42% of patients were administered three medications (angiotensin-converting enzyme inhibitors, antiplatelet drugs, and β-blockers). Association of PTCA with antiplatelet drugs, β-blockers, and thrombolysis was observed for 58.7, 50.6, and 25.7%, respectively. These associations were still observed after adjustment for gender, age, and comorbidity. The factors associated with fatality were specifically old-aged patients, antecedents of diabetes, hypercholesterolaemia and oral antiplatelet drugs, and β-blockers therapies and PTCA., Conclusions: The evolution of the therapeutic data on AMI in this register confirms the use and the efficacy of thrombolytic therapy. PTCA becomes the main coronary reperfusion treatment with less risk of bleeding. Angiotensin-converting enzyme inhibitors were without effect on mortality.

Objectives: This article aims at describing, in a Belgian town, the frequency of the fear of falling and of subsequent activity restriction among non-institutionalised people aged 65 years and over, and at identifying persons affected by these two issues., Methods: Cross-sectional survey conducted in Fontaine l'Evêque (Belgium) in 2006, using a self-administered questionnaire., Results: The participants could fill in the questionnaire on their own or with the help of a third party if needed. The latter were not taken into account in this article. Analyses covered 419 questionnaires. Fear of falling and activity restriction were reported by, respectively, 59.1% and 33.2% of participants. They were more frequent among fallers but also affected non-fallers. In logistic regression analyses: gender, the fact of living alone and the number of falls were significantly associated with fear of falling; gender, age and the number of falls were significantly associated with activity restriction., Conclusions: Our study, despite various limitations, shows the importance of fear of falling and of subsequent activity restriction among older people, among fallers as well as among non-fallers. It also provides information, though limited, concerning persons affected by these two issues in Belgium, and in other contexts as well. Given the ageing of our populations, it is important to take these problems into account when caring for older people.

Background: The study of vitamin D status at population level gained relevance since vitamin D deficiency was recently suggested to trigger chronic disease., Aim of the Study: We aimed to describe vitamin D status, its association with bone and mineral metabolism and risk factors for deficiency in adults over 40 years in Belgium., Methods: We conducted a cross-sectional survey in a stratified random sample of 401 subjects aged between 40 and 60 years living in Brussels, and drawn from 4 different ethnic backgrounds: autochthonous Belgian, Moroccan, Turkish and Congolese. 25-Hydroxyvitamin D (25OHD), parathyroid hormone (PTH), osteocalcin, C-telopeptide and bone mineral density was measured., Results: Three-hundred and six subjects (77%) showed 25OHD concentrations below 50 nmol/l,135 (34%) below 25 nmol/l and 18 (5%) below 12.5 nmol/l. The proportion of subjects with vitamin D deficiency was four times greater amongst those of Moroccan or Turkish descent compared with those of Congolese or Belgian descent. Moroccan subjects showed a significant higher PTH and bone marker concentrations compared to Belgian. Ethnicity, season and sex were independently associated with vitamin D deficiency in multivariate analysis., Conclusion: The prevalence of vitamin D deficiency is very high amongst the adult population of Brussels but immigrants are at greater risk. Given the established link between population health and adequate vitamin D status, a policy of vitamin D supplementation should be considered in these risk groups.

Objectives: To develop a Healthy Food and Nutrient Index (HFNI) and to relate this index to the all cause mortality observed in two Belgian communities., Design: Using the 10-years follow-up mortality data from the 'Belgian Inter-university Research on Nutrition and Health' (BIRNH) study, the association of a Healthy Food and Nutrient Index (HFNI) and all cause mortality was investigated in 5,887 men and 5,306 women aged 25-74 years. The HFNI was developed on the basis of the national dietary guidelines. The higher the index the more the diet can be considered to conform to the recommendations., Results: After adjustment for classic all cause mortality risk factors, HFNI was related with mortality for men. A decrease in risk of death is noted from Quartile 1 to Quartile 4. Among the women, HFNI remains non-significant. The ability of the models (with and without HFNI) to discriminate the living and the dead was evaluated by constructing a receiver operating characteristic (ROC) curves. For all models, areas under the Roc curves were between 0.80 and 0.85 indicating that all models discriminate well alive subjects of deceased. However, comparison of the areas under the ROC curves of the models without HFNI with the ROC areas of the models with HFNI showed no improvement in our ability to discriminate between the living and the dead., Conclusion: Although it is not demonstrated in our study, we think that the overall approach offers an opportunity to improve our understanding of the role of diet in the risks of morbidity or mortality associated with the overall dietary pattern rather than some individual foods and nutrients.

Human resources in health care system in sub-Saharan Africa are generally picturing a lack of adequacy between expected skills from the professionals and health care needs expressed by the populations. It is, however, possible to analyse these various lacks of adequacy related to human resource management and their determinants to enhance the effectiveness of the health care system. From two projects focused on nurse professionals within the health care system in Central Africa, we present an analytic grid for adequacy levels looking into the following aspects:- adequacy between skills-based profiles for health system professionals, quality of care and service delivery (health care system /medical standards), needs and expectations from the populations,- adequacy between allocation of health system professionals, quality of care and services delivered (health care system /medical standards), needs and expectations from the populations,- adequacy between human resource management within health care system and medical standards,- adequacy between human resource management within education/teaching/training and needs from health care system and education sectors,- adequacy between basic and on-going education and realities of tasks expected and implemented by different categories of professionals within the health care system body,- adequacy between intentions for initial and on-going trainings and teaching programs in health sciences for trainers (teachers/supervisors/health care system professionals/ directors (teaching managers) of schools...). This tool is necessary for decision-makers as well as for health care system professionals who share common objectives for changes at each level of intervention within the health system. Setting this adequacy implies interdisciplinary and participative approaches for concerned actors in order to provide an overall vision of a more broaden system than health district, small island with self-rationality, and in which they operate.

BACKGROUND: The problem of training human resources in health is a real concern in public health in Central Africa. What can be changed in order to train more competent health professionals? This is of utmost importance in primary health care. METHODS: Taking into account the level of training of secondary-level nurses in the Democratic Republic of the Congo (DRC), a systemic approach, based on the PRECEDE PROCEED model of analysis, led to a better understanding of the educational determinants and of the factors favourable to a better match between training in health sciences and the expected competences of the health professionals. This article must be read on two complementary levels: one reading, focused on the methodological process, should allow our findings to be transferred to other problems (adaptation of a health promotion model to the educational sphere). The other reading, revolving around the specific theme and results, should provide a frame of reference and specific avenues for action to improve human resources in the health field (using the results of its application in health science teaching in the DRC). RESULTS: The results show that it is important to start this training with a global and integrated approach shared by all the actors. The strategies of action entail the need for an approach taking into account all the aspects, i.e. sociological, educational, medical and public health. CONCLUSIONS: The analysis of the results shows that one cannot bring any change without integrated strategies of action and a multidisciplinary approach that includes all the complex determinants of health behaviour, and to do it within the organization of local structures and institutions in the ministry of health in the DRC.

Objectives: To measure GPs' and paediatricians' expectations, attitudes, priorities and demands in the area of promoting safety and preventing accidents in the home involving children under 15 years of age., Methods: A phone survey of a random sample of GPs and paediatricians in the French-speaking community of Belgium (Wallonia and Brussels) conducted in the course of September and October 2000., Results: Close to two-thirds of the physicians surveyed stated that they had been contacted at least once in the 2 weeks preceding the survey to handle an injury. Of the physicians, 80% mention accident prevention after a childhood injury, but only 46% mention it during a routine consultation (whatever the reason of the latter may be). The main obstacles to mentioning prevention during routine consultation put forward by the interviewees are: 1) reasons for consultations that do not permit such an approach (79%); 2) the fact that injuries are not priorities for them (66%); 3) the lack of interesting materials to provide the subject with documentation (63%); 4) the unsuitability of the place where the contact occurs for such discussion, given the time required (56%); 5) insufficient information on the subject (41%); and 6) the patient's lack of interest (39%). An overwhelming majority (98%) nevertheless feel that they have a role to play in preventing children's accidents in the home, with 72.5% seeing this as informative (recommendation on safety rules). More than two-thirds of the respondents feel that they have enough requisite information to play such a role. Those who declare that they have not enough information (34%) proposed some priority subjects about which they would like to find information or additional information to be more effective in preventing accidents. The information needs mentioned most frequently were a systematic review of the risks, of the effective prevention strategies and epidemiological data., Conclusions: The present study clearly reveals the interest of physicians for accident prevention and puts forward the current obstacles to offering prevention advice during routine consultation. The obstacles mentioned are fairly comparable to those mentioned in other studies, namely, because the reason for the visit does not give such an opening, the lack of appropriate materials and information, the lack of time, the patient's lack of interest, the fact that the issue is not a priority, etc. The problem of lack of priority for certain practitioners underlines the importance of making accident mortality and morbidity statistics available to doctors in order to improve their perception of the magnitude of the problem. The lack of interesting education materials and useful information seems to be a major reason for their failure to carry out such prevention work successfully. These factors should thus be taken into account when developing any policy and/or programme aimed at 'using' GPs and paediatricians in the prevention strategies that are adopted.