Catherine Lambert, MD, defends a PhD thesis based on WFH Twinning experiences

Catherine Lambert, MD, recently defended a PhD thesis entitled “Non-substitutive strategies to improve hemophilia care in developing countries. Experience in Côte d’Ivoire.” The project was based on her experiences during the WFH Twinning program between the hemophilia treatment centre (HTC) of Yopougon in Abidjan, Côte d’Ivoire and the international HTC of the Cliniques universitaires Saint-Luc in Brussels, Belgium. Here, in Lambert’s own words, is an overview of her research and experiences in developing an approach and gathering data in the setting of a WFH twinning.

After being formally recognized and approved by the WFH HTC Twinning Committee in October 2014, a multidisciplinary Belgian team—made up of two hematologists, one physiotherapist, and a member of the hemostasis laboratory—was set up, and the first visit at the HTC of Yopougon took place in February 2016. At the end of the first twinning mission, the magnitude of the challenge appeared more evident. Hemophilia care in Côte d’Ivoire was—as it is the case in most developing countries—almost non-existent. Access to clotting factor concentrates (CFCs) was very limited and almost exclusively supplied by the WFH Humanitarian Aid Program.

While continuing the Twinning program, a research project was undertaken to further explore pathways to improve hemophilia care in Côte d’Ivoire, with a specific focus on locally-adapted, affordable and complementary non-substitutive strategies that could, in a second phase, contribute to setting up a favorable environment for optimizing the use of limited CFCs resources and novel therapies.

Without questioning the essential role of the CFCs—given their very limited availability and considering the local gaps in hemophilia management in Côte d’Ivoire—the team hypothesized that it was possible to improve hemophilia care in the country, and, by extension, to other developing countries, by using different and complementary non-substitutive (not based on replacement therapy) strategies.

This project aimed at performing an initial in-depth analysis of the condition of Ivoirian people with hemophilia (PWH) and carriers, and, as a second step, at developing, implementing and evaluating the impact of interventions (education and self-rehabilitation programs) appropriate to the local needs and the economic and socio-cultural context. In parallel, we sought to provide adapted tools to assess the outcomes of the actions and enable the participation in future international studies.

The thesis demonstrated the value of inexpensive tools, the positive impact of locally adapted non-substitutive approaches, and the feasibility of rigorous data collection and prospective high-quality studies in Côte d’Ivoire, and, by extrapolation, to other developing countries. In addition, the work illustrated the benefits and strengths of a multidisciplinary and comprehensive approach in the implementation of the WFH Twinning Program.

Prof. Catherine Lambert, MD, PhD
Hemostasis and Thrombosis Unit, Division of Hematology, Cliniques universitaires Saint-Luc, Université catholique de Louvain (UCLouvain), Brussels, Belgium

The thesis was defended at UCLouvain Brussels on September 1, 2020.
The full manuscript of is available on

  1. Lambert C, Meité N, Sanogo I, et al. Haemophilia in Côte d’Ivoire (the Ivory Coast) in 2017: Extensive data collection as part of the World Federation of Hemophilia’s twinning programme. Haemophilia, 2019 Mar;25(2):236-243.
  2. Lambert C, Meité N, Sanogo I, et al. Hemophilia carrier’s awareness, diagnosis, and management in emerging countries: a cross-sectional study in Côte d’Ivoire (Ivory Coast). Orphanet Journal of Rare Diseases, 2019 Feb 1;14(1):26.
  3. Lambert C, Lannoy N, Meité N, et al. Inhibitor epidemiology and genetic-related risk factors in people with haemophilia from Côte d’Ivoire. Haemophilia. 2020 Jan;26(1):79-85.
  4. Lambert C, Meité N, Sanogo I, et al. Development and evaluation of appropriate, culturally adapted educational tools for Ivoirian patients with haemophilia, haemophilia carriers and their families. Haemophilia. 2019;25(5):838-844.
  5. Lobet S, Meité, N, Koninckx M, et al. Implementation and assessment of a self‐ and community‐based rehabilitation programme in patients with haemophilia from Côte d’Ivoire. Haemophilia, 2019;25(5):859-866.
  6. Lambert C, Meité N, Sanogo I, et al. Cross-cultural adaptation and validation of the Canadian Haemophilia Outcomes-Kids’ Life Assessment Tool (CHO-KLAT) in Côte d’Ivoire (the Ivory Coast). Health Qual Life Outcomes. 2020 Mar 18;18(1):76.
  7. Lambert C, Meité N, Sanogo I, et al. Cross-cultural adaptation and validation of Haem-A-QoL in Côte d’Ivoire. Haemophilia. 2020 May;26(3):459-466.