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Numbers of total hip and knee arthroplasties are increasing on a regular basis. Clinical pathways tend to shorten the duration of hospitalization in acute care after surgery. Therefore, the preoperative preparation of the patient and his abilities for postoperative rehabilitation should be carefully addressed. Before the surgical intervention, it is recommended that the patient receives an educational program and a physical preparation. After the surgical intervention, the patient can benefit from a home-based rehabilitation program supervised by a physiotherapist, if there were no preoperative reasons for prolonging the hospital stay and if the surgery took place without complications. Some patients may benefit from postsurgical rehabilitation in a specialized locomotor rehabilitation long-stay care unit. The indications for inpatient multidisciplinary rehabilitation are : two simultaneous arthroplasties, revision of a previous hip or knee arthroplasty, postsurgical complications, advanced age, comorbidities influencing the rehabilitation process, social difficulties, necessity for adaptation of the environment, insufficient or unadapted out-patient (para)medical care. The goals of the rehabilitation treatment depend on the patient's characteristics and environment, on the properties of the prosthesis and on the postsurgical complications. The functional prognosis of a total joint arthroplasty of the knee or hip is excellent, provided that there are no post-surgical complications and that the patient benefits from adequate rehabilitation therapy. The present paper describes the different phases of rehabilitation treatment and the general and specific complications of total hip and knee arthroplasties that may influence the rehabilitation outcome.

Stroke is a major health problem. The incidence of stroke in Belgium is estimated at 18,875 cases per year. Primary care needs to be fast in order to reduce mortality and disability. The European recommendations for the management of stroke are the following: 1) stroke patients should be treated in specialized stroke units. Therefore, suspected stroke victims should be transported without delay to the nearest medical centre with an available stroke unit, or to a hospital providing organized acute stroke care if a stroke unit is not available; 2) stroke should be considered as a medical emergency requiring fast management. Once stroke symptoms are suspected, patients or their proxies should call emergency transportation or a similar system; 3) Stroke Unit should provide co-ordinated multidisciplinary care by medical, nursing and therapy staff who specialize in stroke care. Treating patient in a specialized stroke unit allows reducing the mortality by 20% and improving the functional outcome of patients, regardless of age and/or stroke severity. Once the diagnosis of stroke is confirmed, causes and mechanisms should be clarified in order to prevent the recurrence of stroke. In case of ischemic stroke, less than 3 hours after the first symptoms, thrombolysis (which is the only curative treatment at present) may be proposed to the patient. The aims of neurological rehabilitation after stroke are: a) to enable the patient to recover a satisfactory quality of life considering the patient's status and environmental factors; b) to coordinate all means to prevent (or minimize) the inevitable functional, physical, psychological, social consequences and economic impairment caused by disability (activity limitation). These objectives are pursued by stimulating maximally the residual abilities of the patient.

This report addresses the subject of health for all in Djibouti. It examines the political involvement in favour of health for all and describes the existing health system. The support accorded to the strategy of developing health for all in Djibouti is described, and the constraints and problems encountered are discussed.