Buruli ulcer: Evaluation of its medical and surgical management at the Allada (Benin) Screening and Treatment Center, 2010-2014.

The objective of our study was to evaluate the medico-surgical management of Buruli ulcer (BU) in the BU Screening and Treatment Center (CDTUB) of Allada in Benin. This retrospective and descriptive study retrospectively reviewed records of patients seen from 2010 to 2014 at the CDTUB of Allada. It included patients diagnosed with BU according to WHO epidemiological and clinical criteria as well as laboratory results and who were treated according to WHO medical and surgical recommendations. In all, 274 patients were diagnosed and treated, 57.7% of them children younger than 15 years. Ulcerative lesions (189, 69%) and WHO category II lesions (144, 52.5%) predominated. All patients received dual antibiotic therapy and 43.4% (119) underwent surgery as well. Category III lesions and multifocal lesions required more surgery, whereas most category I lesions healed under medical treatment. The overall rate of healing was 92%: 53.3% for patients who received only antibiotic therapy and 38.7% for those who also had surgery. The median healing time was 13 weeks and ranged from 4 to 56 weeks. In the CDTUB of Allada, between 2010 and 2014, most patients were treated with antibiotic therapy alone, but a significant number still received surgery.

[Analyze of the performance of procurement and distribution system of antiretroviral, antituberculosis and antimalarials drugs in Benin in 2016]. / Analyse de la Performance du Système D'Approvisionnement et de Distribution des Antirétroviraux, Antituberculeux et Antipaludiques au Bénin en 2016.

OBJECTIVE: We aimed to analyze the performance of procurement and distribution system of antiretroviral, antituberculosis and antimalarial drugs in Benin. METHODS: We carried out a cross-sectional study in 2016. Data on the procurement, storage and distribution of drugs were collected by either individual interview or observation of storage sites at the central procurement center for essential medicines (CAME) in Benin. Compliance with the norms of the procurement and distribution of the products was appreciated. At the operational level, order satisfaction, drug expiry and stock status of the targeted health programs were measured based on the participants statements. RESULTS: Three workers of the CAME and 76 of health programs were surveyed. According to the norms, malfunctioning impaired the system of the procurement, storage and the distribution of the products. At the operational level, our study participants reported that antiretroviral drug orders were satisfied in 83%, drugs were distributed within three months of their expiration date in 26- 33%, and the CAME often ran out of antiretroviral drugs (stock-outs)in 69%. CONCLUSION: Malfunctioning impaired the system of the procurement, storage and the distribution of antiretroviral, antimalarial and antituberculosis drugs. These dysfunctions negatively affect the performance of the system.

OBJECTIF: Analyser la performance du système d'approvisionnement et de distribution des antirétroviraux, des antituberculeux et des antipaludiques au Bénin. MÉTHODES: L'étude transversale descriptive a été menée en 2016. Les informations sur l'approvisionnement, le stockage et la distribution des médicaments ont été collectées par entretien et observation des lieux de stockage à la centrale d'achat des médicaments essentiels (CAME). La conformité aux normes des composantes du système d'approvisionnement, de stockage et de distribution des produits a été appréciée. La satisfaction des commandes, la péremption des médicaments et l'état des stocks ont été évalués. RÉSULTATS: Trois responsables de la CAME et 76 acteurs des programmes de santé ont participé à l'étude. Des dysfonctionnements par rapport aux normes ont été notés dans les composantes du système d'approvisionnement, de stockage et de distribution des produits. Au niveau opérationnel, les commandes d'antirétroviraux étaient satisfaites selon 83% des enquêtés, les médicaments distribués étaient à moins de trois mois de la date de péremption selon 26 à 33% des participants et les ruptures de stocks d'antirétroviraux étaient signalées par 69%. CONCLUSION: Le système d'approvisionnement et de distribution des antirétroviraux, antipaludiques et antituberculeux comporte des dysfonctionnements qui impactent négativement sa performance.

[Relationship between changes in the prevalence of HIV infection in pregnant women from 2006 to 2015 and place of residence in Benin]. / Milieu de Résidence et Évolution de la Prévalence du VIH Chez les Gestantes de 2006 à 2015 au Bénin.

OBJECTIVE: We aimed to determine the relationship between changes in the prevalence of HIV infection in pregnant women from 2006 to 2015 and place of residence in Benin. METHODS: In a retrospective and analytical study, were viewed the reports of the annual surveys of HIV infection among pregnant women from 2006 to 2015 across the country. RESULTS: A total of 138,319 pregnant women participated in the annual HIV surveys from 2006 to 2015. The national prevalence of HIV infection among pregnant women between 2006 and 2015 was 2%. The prevalence of HIV infection from 2006 to 2015 in pregnant women increased significantly in departments of Mono (p = 0.001) and Donga (p = 0.001) and decreased in the departments of Collines (p = 0.000) and Couffo (p = 0.001) and in urban areas (p = 0.000). CONCLUSION: Changes in the prevalence of HIV infection among pregnant women between 2006 and 2015 varied across departments and according the urbanization of the residence. The National AIDS control program may take these results into account when planning interventions against HIV for optimal response against the pandemic infection.

OBJECTIF: Déterminer la relation entre la tendance évolutive de la prévalence de l'infection au VIH chez les gestantes au Bénin de 2006­2015 et le milieu de résidence. MÉTHODES: L'étude rétrospective et analytique qui consistait en une exploitation des résultats des enquêtes annuelles de sérosurveillance de l'infection au VIH chez les gestantes menées de 2006 à 2015 dans les maternités sentinelles reparties sur l'ensemble du pays. RÉSULTATS: Un total de 138 319 gestantes ont participé aux des enquêtes annuelles de sérosurveillance de l'infection au VIH de 2006 à 2015. La prévalence nationale de l'infection à VIH chez les gestantes de 2006 à 2015 est de 2%. La tendance évolutive de 2006 à 2015 de l'infection à VIH est significativement croissante dans les départements du Mono (p=0,001), la Donga (p=0,001) et décroissante dans les Collines (p=0,000) et dans le Couffo (p=0,001) et en milieu urbain (p=0,000). CONCLUSION: L'évolution de la prévalence de l'infection à VIH chez les gestantes de 2006 à 2015 diffère selon les départements et l'urbanisation du milieu de résidence. Le Programme National de lutte contre le Sida doit tenir compte de ces disparités dans la planification des interventions de lutte aux fins de réponses optimales contre la pandémie.

Accessibility of cesarean deliveries in Benin.

To be used effectively, emergency obstetric and neonatal care must be available and accessible. This study sought to measure the accessibility of cesarean deliveries in Benin. Cross-sectional study of randomly selected women in each of the 12 obstetrics departments in Benin. Geographical accessibility was measured by estimating the distance between the parturientes residence and the hospital. Financial accessibility was the average direct cost of the cesarean delivery -the sum of medical and non-medical costs. The functionality of the referral system was assessed according to the conditions of referral of women referred for cesareans. The mean distance between women's homes and the hospital was 20.2 ± 22.3 kilometers. Of the 579 women, 63.0 % were referred from a peripheral health center to a hospital; the referral conditions were completed in the obstetric record for only half of them. The data sheet for the referral was completed for only 34.4 %; venous access had been placed in 28.5 %, and the patient was accompanied by medical personnel in only 1.7% of cases. The average direct cost of the cesarean to families was 36,782 ± 30,859 FCFA. Cesarean deliveries are now more accessible financially due to the policy of free access, but they remains geographically inaccessible, because of the long distances to be covered and the poor organization of referrals to ensure continuity of care.

[Distribution of Buruli ulcer in the Zè district of Benin]. / Distribution spatiale de l'ulcère de Buruli dans la commune de Zê (Bénin).

The goals of this cross-sectional study conducted in the Zè district of Benin were to determine the overall distribution and prevalence of Buruli ulcer (BU) and to identify environmental and behavioral risk factors. A total of 425 current or previous BU patients from the study district were included. Data was obtained by direct observation, semi-structured interviews, and document review. The main findings can be summarized as follows. The overall prevalence of BU in the Zè district in 2006 was 52 cases per 10000 inhabitants. The prevalence of current and previous cases was 28.1 and 23.9 per 10 000 inhabitants respectively. The distribution of BU within the district was highly variable from one subdistrict to another and from one village to another within the same subdistrict. The subdistricts showing the highest and lowest endemicity were Djigbé with 265 cases per 10 000 inhabitants and Koundokpoé with 3 cases per 10 000 inhabitants respectively. Proximity of the hamlets to water bodies was a risk factor for the disease.

[Surveillance system for Buruli ulcer in Benin: results after four years]. / Mise en place d'un système de surveillance de l'ulcère de Buruli au Bénin: point de 4 années de surveillance.

Infection by Mycobacterium ulcerans, commonly known as Buruli ulcer (BU), is an emerging infectious disease in some African countries, including Benin. A national BU control program has been organised since 1997. One of its main objectives is to organise a system of BU surveillance, based on the BU02 data collection form developed by the World Health Organization. This surveillance system has allowed the National BU program to collect suitable data for more than 3,793 patients. This article assesses data collection in Benin and demonstrates its suitability and high quality.

[Distribution of Mycobacterium ulcerans (Buruli ulcer) in the district of Lalo in Benin]. / Distribution de l'infection a Mycobacterium ulcerans (Ulcere de Buruli dans la commune de Lalo au Benin.

This study aimed to determine the distribution of Buruli ulcer (BU) in Lalo, one of the endemic districts of the Couffo department in Bénin. A total of 752 BU patients were detected in this district with 160 active and 592 inactive cases. The overall prevalence of BU in this district is 86.6 per 10,000 inhabitants, varying from 0 to 249/10,000 between sub-districts. At village level the prevalence varies between 0 and 561 cases per 10,000 inhabitants. Our findings confirm the large variation of distribution of the disease at the village level in endemic area. Children under 15 years are frequently affected. We also found a significant association between age and location of Buruli lesions. Further epidemiological and environmental studies are needed to identify the reasons for the extraordinary variation in BU distribution between villages from the same sub-district, and to confirm if it is associated with temporal variations.