Implementing Quality Improvement Initiatives to Improve the Use of Adolescent- and Youth-Friendly Health Services in Zou, Benin.

INTRODUCTION: In Benin, the unmet need for family planning services is especially high for adolescent girls and youth aged 15-24 years. The Challenge Initiative (TCI) supported the health system to assess and improve the quality of adolescent and youth sexual reproductive health services and enhance contraceptive uptake in 65 service delivery points (SDPs) of the Zou department. PROGRAM DESCRIPTION: Between June 2019 and March 2021, TCI supported the health districts in Zou to train an assessment team to complete 3 cycles of quality assessments (QAs) using a QA checklist adapted to the local context. Based on assessment scores, the SDPs were categorized into poor, moderate, or good to excellent quality. The SDP managers developed remedial action plans after each cycle and for each SDP and followed up with supportive supervision. RESULTS: The first QA cycle showed that 52% of assessed SDPs achieved a good to excellent classification; by the second QA cycle, this reached 74%. However, the quality of adolescent- and youth-friendly health services regressed during the third QA cycle (during COVID-19 pandemic disruptions), when only 40% of SDPs achieved the good to excellent category. Between the first and second QA cycles, contraceptive uptake for adolescents and youth improved in the SDPs that had good or excellent quality of services, compared to the ones that were of lower quality (established significance level of 5% with a P value of .031). CONCLUSION: Further assessments could deepen our understanding of the internal and external factors that can affect service quality. The findings reinforce the importance of investing in quality improvement strategies to maximize the use of sexual and reproductive health services among adolescents and youth. They also underscore the need for a contextual and nuanced approach to ensure enduring results.

Women's empowerment, modern energy, and demand for maternal health services in Benin.

One of the major concerns for developing countries is improving the use of health services by the general population, and in particular, maternal and child health services. This concern reflects the Sustainable Development Goals 3, which aim to ensure the health and well-being of all by improving reproductive health, and especially maternal and child health. This study analyses the extent to which modern energies improve women's empowerment and the demand for maternal health services in a low income country. The empirical estimations were based on the 2017 Benin Demographic Health Survey data. We adopted the trivariate recursive probit modelling to find out the extent to which modern energies improve women's empowerment and the demand for maternal health services. The results revealed that the demand for maternal health services was significantly and positively associated with women's empowerment. Notably, being an empowered woman (social independence and decision-making) increases the chance of completing antenatal care visits. We further highlighted the importance of women's wealth in accessing maternal health services. To address maternal mortality in sub-Saharan African countries, policymakers should improve women's social independence, decision making power and attitude to violence by promoting access to modern energies such as electricity, Liquefied petroleum gas, and bio gas.

How do plant demographic and ecological traits combined with social dynamics and human traits affect woody plant selection for medicinal uses in Benin (West Africa)?

BACKGROUND: Several hypotheses have been used in ethnobotany to explain the plant's selection criteria by people for their daily needs. Thus, it is important to assess synergy and complementarity among them, especially, those concerning the plant use value, social dynamics and human traits. The study aims to (i) highlight people's socio-economic factors, and plant ecological traits that affect the plant use-availability dynamic (PUD); and (ii) assess the available species diversity effect on ethno-medicinal knowledge diversity in Benin. METHODS: Ethnobotanical interviews were carried out to quantify the importance of local species in different ecological zones of Benin with 590 traditional medicine actors. Vegetation surveys were done to assess species availability within 337 plots of 50 m x 40 m or 60 m x 30 m, depending on the climatic zone, for a total of 61.6 ha, established in 15 forests distributed within the 10 phytodistricts of Benin. The plant use availability hypothesis was quantified as a dynamic link between species use value and availability (PUD). A general and mixed linear models were used to assess the significance of each factor's effect on PUD. Pearson correlation test was applied on Shannon diversity index considering inventoried species in the field and those which were cited by people, for the available species diversity effect on ethno-medicinal knowledge diversity assessment. RESULTS: A hundred and twenty woody medicinal plants, mostly trees (68.33%), were sampled. Growth form and its interaction with phytodistrict have a significant effect (p: 0.005) on PUD. The less available trees were the most used in the phytodistricts 3, 4, 8 and 10. PUD varies significantly according to social factors (p: 0.007). Ethnicity, age and main activity were the most quoted social factors which influenced the PUD. Ethnicity and age have various effects considering the phytodistricts. Moreover, the influence of age changes following the main activity. Plant selection did not solely link to the surrounding diversity (r: - 0.293; p: 0.403). Within some phytodistricts, especially those of 3, 4, 8 and 10, the less available tree species were the most requested. CONCLUSION: It is urgent to reforest vegetation patches in some phytodistricts (3, 4, 8 and 10) of Benin with widely requested and no available species to avoid the extinction of their wild populations. This concerns Cassia sieberiana DC., Anonychium africanum (Guill. & Perr.) C. E.Hughes & G. P. Lewis, Pterocarpus erinaceus Poir., Cola millenii K. Schum., Azadirachta indica A. Juss., Khaya senegalensis (Desr.) A. Juss., Pseudocedrela kotschyi (Schweinf.) Harms, Treculia africana Decne. ex Trécul, Uapaca heudelotii Baill., Vitellaria paradoxa C. F. Gaertn., Kigelia africana (Lam.) Benth. and Newbouldia laevis (P. Beauv.) Seem. ex Bureau.

Continuous assessment of cowpea [Vigna unguiculata L. Walp.] nutritional status using diagnosis and recommendation integrated system approach.

Cowpea is one of the widely cultivated and consumed grain legumes in Africa, but its production is hampered by soil fertility degradation on farms. Here, we assessed the spatial nutritional diagnosis of cowpea and the variability of their productivity using the diagnosis and recommendation integrated system (DRIS) and geostatistics tool. We achieved a sampling of 200 geo-referred points in cowpea farms in four communes of Benin. In addition, we determined grain yield and the content of N, P, K, Ca, Mg, and Zn in the leaves. From DRIS, the order of nutrient deficiency was as follows: P > K > Ca > Zn > N > Mg; P > K > Ca > N > Zn > Mg; N > Mg > Zn > K > P > Ca; P > Ca > K > N > Mg > Zn, at Dassa-Zoume, Glazoue, Ketou, and Ouesse, respectively. Sampling points were close enough to detect the spatial variability of the DRIS Index, mean of nutrient balance index (NBIm), and cowpea productivity (spatial dependence index ˃ 50%). The combined analysis of the cowpea relative yield and NBIm maps showed that the NBIm map effectively indicated the spatial distribution of cowpea productivity. The spatial variability of the DRIS index has provided an accurate guide to where adjustments to fertilization rates are needed.

Socioeconomic inequalities in modern contraceptive use among women in Benin: a decomposition analysis.

BACKGROUND: Contraceptive use is crucial to achieving Sustainable Development Goal 3. Evidence of socioeconomic inequality in the use of modern contraceptives is essential to address the developing inequality in its utilisation given the low prevalence of contraceptive use among women in Benin. This study examined the socioeconomic inequalities in modern contraceptive use among women in Benin. METHODS: We performed a cross-sectional analysis of the 2017-18 Benin Demographic and Health Survey data. A weighted sample of 7,360 sexually active women of reproductive age was included in the study. We used a concentration curve to plot the cumulative proportion of women using modern contraception. Decomposition analysis was conducted to determine factors accounting for the socioeconomic disparities in modern contraceptive use. RESULTS: We noted that the richest women had higher odds of modern contraceptive use (adjusted odds ratio [aOR] = 1.67, CI = 1.22-2.30) compared to the poorest women. Other factors that showed significant associations with modern contraception use were age, marital status, religious affiliation, employment status, parity, women's educational level, and ethnicity. We found that modern contraceptive use is highly concentrated among the rich, with rich women having a higher propensity of using modern contraception relative to the poor. Also, the disadvantaged to modern contraceptive use included the poor, those aged 45-49, married women, those working, those with four or more live births, rural residents, and women of Bariba and related ethnicity. Conversely, favourable concentration in modern contraceptive use was found among the rich, women aged 20-24, the divorced, women with two live births, the highly educated, those with media exposure, and women of Yoruba and related ethnicity. CONCLUSION: The study has shown that wealthy women are more likely to utilize contraceptives than the poor. This is because wealthy women could afford both the service itself and the travel costs to the health facility, hence overcoming any economic barriers to using modern contraception. Other factors such as age, marital status, religion, employment status, parity, mother's educational level, and ethnicity were associated with contraceptive use in Benin. The Benin government and other stakeholders should develop family planning intercession techniques that address both the supply and demand sides of the equation, with a focus on reaching the illiterate and under-resourced population without admittance to modern contraception.

Is Benin on track to reach universal household coverage of basic water, sanitation and hygiene services by 2030?

INTRODUCTION: With the end of the Millennium Agenda, the United Nations Member States adopted the Sustainable Development Agenda in 2015. This new agenda identifies 17 Sustainable Development Goals (SDGs) and 169 targets for 2030, including Water, Sanitation and Hygiene (WASH). OBJECTIVE: To study the evolution of household access to WASH services over the last two decades in Benin and make projections for 2030. METHODS: In this study, secondary analyses were performed using the datasets of the Demographic and Health Surveys in Benin from 2001 to 2017-2018. The statistical unit was the household. The achievement of the WASH SDGs targets was monitored through the proportion of households using individual basic WASH services, the proportion of households using surface water for drinking, and the proportion of households practising open defecation. The study generated Annual Percentage Changes (APCs) for outcome variables. Based on the APCs between 2001 and 2017-2018, projections were made for 2030. RESULTS: From 2001 to 2017-2018, household access to individual basic WASH services increased from 50.54% to 63.98% (APC = +1.44%), 5.39% to 13.29% (APC = +5.62%), and 2.12% to 10.11% (APC = +9.92%), respectively. At the same time, the prevalence of surface water consumption and open defecation among households decreased from 10.54% to 5.84% (APC = -3.52%) and 67.03% to 53.91% (APC = -1.31%), respectively. If the trend observed between 2001 and 2017-2018 remains unchanged, the national coverage of households with basic individual WASH services would be 76.50%, 26.33% and 10.51%, respectively, by 2030. The prevalence of surface water consumption and open defecation among households would be 3.73% and 45.71%, respectively, by 2030. CONCLUSION: Benin achieved significant progress in household coverage of adequate WASH services over the last two decades. However, progress appears insufficient to achieve universal coverage of households with basic WASH services, and eliminate surface water consumption and open defecation by 2030. There is a need to strengthen research into the drivers of household access to adequate WASH services.

Socio-economic determinants of healthy behaviours among primary schoolchildren and adolescents in Lokossa district of southern Benin.

BACKGROUND: There is little information regarding fruit and vegetable (FV) intake and physical activity (PA) among schoolchildren in Benin. In this study we evaluated the differences in breakfast eating, FV consumption and PA according to socio-economic (SE) determinants in primary schoolchildren. METHODS: A cross-sectional study using a probabilistic sample of 612 students (8-17 y of age) from 26 primary schools was done between December 2018 and January 2019. The association was estimated by logistic regression analyses. RESULTS: Of all students, 53% were physically inactive, 60% took breakfast <5 d/week, 84% irregularly ate fruits and 68% irregularly ate vegetables. Younger students (8-10 y) take breakfast regularly and older ones (>15 y) were physically more active. The probability of regular breakfast and fruit consumption were significantly higher in children of educated parents (p<0.01 and p<0.001, respectively) compared with children of non-educated parents. Medium SE status was associated with regular breakfast intake, whereas high SE status was associated with higher fruit intake and lower physical activity compared with low SE status (p<0.001). There was no association between breakfast eating, FV intake, PA and the body mass index. CONCLUSIONS: Findings emphasize the need for interventions to promote healthy eating behaviours in primary schoolchildren and their family environments.

Association between women's empowerment and diarrhoea in children under five years: evidence from the 2017/18 Benin Demographic and Health Survey.

Globally, diarrhoea is the third leading cause of death for under five-children. Women's empowerment can significantly reduce under-five mortality due to diarrhoea. This study investigated the association between women's empowerment and childhood diarrhoea in Benin using data from the 2017/18 Benin Demographic and Health Survey. A total of 7979 currently married women were included in the study. A logistic regression model was used to control for possible confounders. The prevalence of diarrhoea among children under five years of age was 13.6%. About 36.3% of the currently married women decided either alone or together with their husband on their own health, purchase of large household items and visiting family/relatives. Close to 65.4% of currently married women disagreed with all five reasons to justify wife-beating. The children of mothers who had decision-making power were less likely to have diarrhoea (aOR = 0.74, 95% CI: 0.57-0.96) than the children of mothers who had no decision-making power. Moreover, the children of mothers who disagreed with all five reasons to justify wife-beating (aOR = 0.79, 95% CI: 0.65-0.96) were less likely to have diarrhoea than the children of mothers who accepted wife-beating as a part of life. Women's age, educational level, wealth index and region were associated with childhood diarrhoea in Benin. The role of women's empowerment, as determined by decision-making power and wife-beating attitude, was found to be significantly associated with the risk of childhood diarrhoea in Benin, after adjusting for other variables. Therefore, it is essential for policymakers in Benin to reinforce strategies and interventions focusing on women's empowerment to avert childhood mortality caused by diarrhoea. This includes improving household economic status, women's education and decision-making power and enhancing awareness of women's human and democratic rights.

Sources, pollution, and ecological risk assessment of polycyclic aromatic hydrocarbons (PAHs) in Porto-Novo Lagoon, Benin Republic.

The Porto-Novo Lagoon is influenced by agricultural discharges and human activities. In order to evaluate the impact of wastes and human activities on Porto-Novo Lagoon, the sources and ecological risks of sixteen polycyclic aromatic hydrocarbons (PAHs) were assessed. The physicochemical and biological parameters of the water were also determined. The result showed that between the sampling sites, the mean concentration of dissolved oxygen ranged from 4.8 ± 0.5 to 5.1 ± 0.2 mg/L; biochemical oxygen demand varied from 12.6 ± 2.0 to 77.9 ± 81.9 mg/L; biological oxygen demand ranged from 2.8 ± 2.6 to 5.6 ± 0.9 mg/L; total phosphorus varied between 4.7 ± 2.7 and 15.3 ± 9.5 mg/L; total dissolved solids ranged from 183.0 ± 115.8 to 337.5 ± 413.3 mg/L, and Escherichia coli varied from 495.0 ± 542.9 to 1920.0 ± 2676.5 UFC/100 mL. Water parameter values obtained were not within World Health Organization (WHO)-recommended limits except pH and TDS. Total PAHs (∑PAHs) concentration varied from 38.8 to 123.9 mg/L. The mean ∑PAH concentration was 83.2 ± 20.3 mg/L. Benzo[b]fluoranthene, benzo[g,h,i]perylene, and benzo[k]fluoranthene were the most dominant PAHs and contributed to 55.9%, 15.3%, and 4.5% of the ∑PAHs concentration, respectively. Douane-Tokpa and Djassin recorded the lowest and highest concentrations. PAHs of four to six rings were the most abundant across the sampling sites. Naphthalene showed the lowest risk in the lagoon. Acenaphthene showed low risk at Djassin, while Indeno(1,2,3 cd)pyrene showed low risk at Benin Industry Body Fat. Except for those that were not detected, all the PAHs at individual or complex mixture levels showed high risk at all the sites. The highest total concentration was recorded in Djassin followed by Beaurivage. The high level of PAHs pollution was attributed to both human and goods traffic, runoff, and the complex hotels close to the lagoon. Molecular diagnostic ratios and principal component analysis suggest that the target hydrocarbons were from both petrogenic and pyrogenic sources with predomination of vehicular emission and coal/woods combustion. ∑LWM/HWM confirmed also the predominance of pyrolytic sources of PAHs in Porto-Novo Lagoon. The predominance of the vehicular emission may be due to the position of the complex Porto-Novo Lagoon-Nokoué Lake which is between the two big cities of the country.

[Assessment of a therapeutic protocol for the management of snakebite envenomations in Benin]. / Évaluation d'un protocole de traitement des envenimations ophidiennes au Bénin.

Introduction: Snakebite envenomation is a major public health issue in Sub-Saharan Africa (SSA). Antivenoms are the only etiological treatment. However, the dose recommended by the manufacturer (2 vials renewed every 2 hours in case of persistent bleeding) is usually not applied due to the high cost which is borne only by the patient. Based on clinical presentation, we evaluated the administration of a single vial on admission (instead of 2 vials), which corresponds to the therapeutic protocol used in current practice in most health centers in Benin and beyond in SSA. Renewal of antivenom followed manufacturer's recommendation. Material and method: The study took place in a first referral hospital in Tanguiéta, North Benin. All envenomed patients received a slow intravenous vial of Inoserp® Pan-Africa (IPA) upon arrival. A clinical assessment identical to that of inclusion was carried out 2, 4, 6, 12 and 24 hours later to assess the tolerance and efficacy of the IPA, as well as the need to readminister the antivenom. The occurrence, persistence or worsening of clinical hemorrhages or neurological disorders, the latter reflecting envenomation by elapids, systematically led to the injection of 2 or 4 vials of IPA, respectively. Signs of intolerance were sought before and after each administration of antivenom, then 2 weeks to 1 month after treatment, in order to estimate the incidence of adverse effects attributable to the antivenom. Efficacy of IPA was assessed by cessation of bleeding and/or normalization of whole blood coagulation test (WBCT) within 24 hours of initial administration. Results: The study took place from July 31 to October 31, 2019. We received 53 cases of snakebites of which 43 were included. The median age was 21 [IQR: 18-31] years and the sex ratio (M/F) was 1.5. Farmers were the majority (48%). The median time to admission was 1 [IQR: 0-2] day. On admission, 32 patients (74%) presented hemostasis disorders marked by bleeding and/or abnormal WBCT. None of the patients showed neurological symptoms. The median time to normalization of WBCT was 24 [IQR: 4-72] hours. The median time to stop bleeding was 6 [IQR: 4-12] hours. In 3 of the 11 patients whose bleeding had stopped at H2, a recurrence occurred within the following 24 hours. In addition, 3 patients presented with late bleeding 24 hours after admission. Two patients (5%) died as a result of envenomation. Discussion/conclusion: The simplified protocol represents a significant saving in the number of vials used, i.e. 1.8±0.4 vials per patient instead of the 2.4±0.2 which would have been necessary in these same patients treated according to the standard protocol (p = 2.6·10-4). However, in comparison with the results obtained during the previous clinical study, the cessation of bleeding is delayed, as is the normalization of the WBCT at the different follow-up times. In addition, the number of re-administrations of antivenom after H2 is higher in the light protocol than in the standard one, respectively 13 patients out of 43 treated versus 4 patients out of 59 (p = 0.006). There was no significant difference between the incidence of signs of early antivenom intolerance in this study compared to the previous one (16% and 11%, respectively; p = 0.79). This delay can put up to a third of patients at risk of complications. Despite its effectiveness and the antivenom savings made, it does not seem reasonable to recommend it.

Developing and implementing National Health Insurance: learnings from the first try in Benin.

In 2008, Benin government launched a national health insurance scheme, but this had been suspended in 2017. We aim to understand how existing ideas and institutions, stakeholders' behaviour and their interests shaped policy-making process and policy content, from its launch to its suspension. METHODS: We used a case study design, framed by the policy triangle of Walt and Gilson. We collected data through document review, quantitative data extraction from routine information, and interviews with 20 key informants. We performed a content analysis using both complementarily deductive and inductive analysis. RESULTS: This study confirms the keen interest for national health insurance scheme in Benin among various stakeholders. Compared with user fee exemption policies, it is considered as more sustainable, with a more reliable financing, and a greater likelihood to facilitate population's access to quality healthcare without financial hardships.Exempting the poor from paying health insurance premiums was however considered as an equitable mean to facilitate the extension of the health insurance to informal sector workers.The whole arrangements failed to deliver appropriate skills, tools, coordination and incentives to drive the policy implementers to make individual and organisational changes necessary to adjust to the objectives and values of the reform. These deficiencies compromised the implementation fidelity with unintended effects such as low subscription rate, low services utilisation and sustainability threats. CONCLUSION: Supporting countries in documenting policy processes will ease learning across their tries for progressing towards Universal Health Coverage, as more than one try will be necessary.

Assessment of phenotypic diversity within Goliath chickens population in Benin.

Goliath chickens are a new strain of poultry that originated in the department of Zou, commune of Agbangnizoun in the Republic of Benin. The characteristics of this chicken strain have not been well studied. The purpose of this study was to characterize the phenotypic diversity of Goliath chickens in departments of Zou and Couffo. A total of 140 birds made up of 92 females and 48 males were sampled using 18 morphological descriptors. The results showed a wide variation in plumage colour within overall population with the most dominant being black (18.57%), white (17.14%) and red (16.43%). Black (21.74%) and white (20.65%) plumage dominated in females and red in males (35.42%). Coloured beaks and shanks were common in both chicken sexes. Yellow eyes were more common in females (63.04%), while red eyes were the most prevalent in males (43.75%). Comb and wattle colours were red in both sexes. Morphometrically, sexual dimorphism is very marked most of the body measurements with male birds being significantly superior. The average body weight was 3.26 kg in males and 2.78 kg in females. The population was clustered in three morphotypes according to the gradient size. Chickens from Bohicon and Agbangnizoun on the one hand, and those from Zagnanado and Toviklin on the other, formed groups 1 and 2, respectively, while group 3 included individuals from Djidja. 77.96% of observed diversity was due to variation between individuals. Molecular characterization is recommended for a thorough knowledge of the Goliath chicken strain of Benin.

Assessment of the nutritional status and dietary intake of women of childbearing age in the city of Comè, Benin.

Introduction: over nutrition and undernutrition problems affect many women of childbearing age in Benin. The inadequacy of the diet is the major reason. The objective of this study is to assess their nutritional status and diet in Comè, a city with the highest proportions of adverse neonatal outcomes in the Mono regional department of Benin in 2015. Methods: data were collected in June 2017 in a cross-sectional survey with a two-stage random sampling of non-pregnant or lactating women aged 15-49 years. Their sociodemographic characteristics, diet and nutritional status were reported and explored through descriptive and bivariate analysis. Results: the prevalence of underweight was 9.5% and overweight (overweight and obese) was 31.7%. The dietary diversity score was low for 47.9% of them. Compared to the Recommended Dietary Allowances, the energy and protein intakes were insufficient for 78.7% and 11.8% respectively. None of them had an energy-balanced diet according to the energy distribution between macronutrients after normalization of intakes. The contribution of carbohydrates was high in 99.1%, low in 96.2% for fats and adequate in 60.2% for proteins. Conclusion: these results reiterate the importance of developing nutritional interventions to improve the nutritional status and the diet of women of childbearing age in Benin. Periodically national food surveys must be conducted to evaluate their real nutritional intakes and promote better nutrition.

Costs of community-wide mass drug administration and school-based deworming for soil-transmitted helminths: evidence from a randomised controlled trial in Benin, India and Malawi.

OBJECTIVES: Current guidelines for the control of soil-transmitted helminths (STH) recommend deworming children and other high-risk groups, primarily using school-based deworming (SBD) programmes. However, targeting individuals of all ages through community-wide mass drug administration (cMDA) may interrupt STH transmission in some settings. We compared the costs of cMDA to SBD to inform decision-making about future updates to STH policy. DESIGN: We conducted activity-based microcosting of cMDA and SBD for 2 years in Benin, India and Malawi within an ongoing cMDA trial. SETTING: Field sites and collaborating research institutions. PRIMARY AND SECONDARY OUTCOMES: We calculated total financial and opportunity costs and costs per treatment administered (unit costs in 2019 USD ($)) from the service provider perspective, including costs related to community drug distributors and other volunteers. RESULTS: On average, cMDA unit costs were more expensive than SBD in India ($1.17 vs $0.72) and Malawi ($2.26 vs $1.69), and comparable in Benin ($2.45 vs $2.47). cMDA was more expensive than SBD in part because most costs (~60%) were 'supportive costs' needed to deliver treatment with high coverage, such as additional supervision and electronic data capture. A smaller fraction of cMDA costs (~30%) was routine expenditures (eg, drug distributor allowances). The remaining cMDA costs (~10%) were opportunity costs of staff and volunteer time. A larger percentage of SBD costs was opportunity costs for teachers and other government staff (between ~25% and 75%). Unit costs varied over time and were sensitive to the number of treatments administered. CONCLUSIONS: cMDA was generally more expensive than SBD. Accounting for local staff time (volunteers, teachers, health workers) in community programmes is important and drives higher cost estimates than commonly recognised in the literature. Costs may be lower outside of a trial setting, given a reduction in supportive costs used to drive higher treatment coverage and economies of scale. TRIAL REGISTRATION NUMBER: NCT03014167.

Assessment of the Quality of Injectable Antibiotics in Benin.

Substandard and falsified medicines are an enormous threat to global health. Poor quality antibiotic preparations contribute to the development of antimicrobial resistance. In surgery, where the occurrence of healthcare-associated infections is high, healthcare teams need to rely on the quality of antibiotic prophylaxis to prevent infections. We assessed the quality of antibiotics used for surgical infection prophylaxis in Benin. Thirty-three samples were collected from six hospitals located in various departments in Benin. The antibiotics (powders for injection: amoxicillin + clavulanic acid, ampicillin, ceftriaxone; solutions for injection: ciprofloxacin, gentamicin, metronidazole) were assessed using visual inspection, pharmacotechnical tests (including uniformity of mass, pH measure, sterility test, and active pharmaceutical ingredient identification), and assay tests (including a simple analytical method thin layer chromatography) and complex analytical techniques (ultraviolet-visible spectrophotometry, high-performance liquid chromatography-diode-array detection, conductometry). Because the material needed for the methods recommended by the pharmacopeias to assess the dosage of gentamicin was not available, we developed and validated a conductometry method. Results showed that 97% (n = 32) of the samples passed visual inspection; 100% (n = 33) of the samples passed the pharmacotechnical tests, identification of active ingredients, and sterility test; 88% (n = 29) passed the test for percentage of active pharmaceutical ingredients. Overall, 15% of the samples did not pass the quality test (3% on visual inspection and 12% for excess active ingredients). Although most of the samples passed the quality tests, it appears important to perform routine quality control for intravenous medicines.

Saharan Dust and Childhood Respiratory Symptoms in Benin.

Mineral dust is one of the largest natural constituents of coarse particulate matter (PM10). Most of these dust emissions originate from northern Africa, and several hundred tera-grams of dust are emitted annually from this region. Previous evidence has linked dust PM10 to adverse respiratory outcomes in children. However, most of these studies have been from high-income countries (HICs) or examined dust from other regions of the world, mainly Asia. Evidence from low-to-middle-income countries (LMICs) in Africa is scarce. Respiratory infections are one of the leading causes of under-five mortality across the globe. However, there is a poignant disparity in studies examining these outcomes in children in the region where most dust is emitted. This study linked remotely sensed satellite data to a nationally representative survey to examine acute exposure to dust in children living in Benin using a time-stratified case-crossover analysis. We identified acute effects of exposure to dust and increased risk of cough in children under five. The effect of increased risk is strongest within two weeks of exposure and dissipates by four weeks. Children living in rural areas and households with lower income had a greater risk of adverse respiratory outcomes when exposed to dust. We could elucidate the specific period and conditions of increased risk for respiratory problems in children living in Benin.

The power of women's and men's Social Networks to catalyse normative and behavioural change: evaluation of an intervention addressing Unmet need for Family Planning in Benin.

BACKGROUND: In Benin, despite good knowledge and availability, modern contraceptive prevalence remains relatively low, and the unmet need for family planning is relatively high. This is partly due to insufficient attention to socio-normative barriers that influence need and method use. Applying social network theory, Tékponon Jikuagou (TJ) aims to reduce socio-normative barriers preventing modern contraceptive use in rural Benin. After community identification, TJ trains influential network actors who encourage critical dialogue about unmet need, family planning, gender, and other social norms within their networks, complemented by radio and services linkages. This paper evaluates TJ's effectiveness and how intervention components affect intermediate and primary FP outcomes. METHODS: We report findings from pre/post-intervention cross-sectional research with a comparison group conducted at baseline with 1,043 women and 1,030 men, and 14 months later at endline with 1,046 women and 1,045 men. Using sex-stratified models, we assessed balance across intervention and comparison groups on background characteristics using Pearson's chi-square tests of independence; performed bivariate tests of independence to assess differences between baseline to endline on intermediate outcomes and primary FP outcomes; used logistic regression to examine the effect of intervention components on intermediate and primary FP outcomes. RESULTS: Statistically significant improvements in primary outcomes: women's intentions to use modern contraception, achieve met need, and reduce perceived met need. The fourth primary outcome, actual use, showed substantial gains, although not statistically significant. Men's achievement of met FP need and reduced perceived met need were also statistically significant. Assessing intermediate outcomes at individual, couple, normative-network levels, TJ led to statistically significant increases in couple and network communication on fertility desires and family planning use and self-efficacy and confidence to access services. Both women and men showed significant shifts in the acceptability of discussing FP in public. Results for other indicators of norms change were inconsistent. CONCLUSIONS: An easy-to-implement, short-duration, gender-equitable social network intervention with a limited set of network actors, TJ effectively decreases social and normative barriers preventing women and men from seeking and using FP services. Results support the broader use of innovative social and behaviour change strategies that diffuse family planning ideas through social networks, diminish normative and communication barriers, and catalyse modern family planning use.

In many places with relatively low family planning use, insufficient program attention is paid to socio-normative barriers that influence need and method use. TJ catalyses women and men's social networks to spread new ideas and break communication and other social barriers that prevent women and men with unmet needs ­ people who wish to space their next birth but are not using effective family planning methods - from acting on their desires. A rigorous evaluation of the approach in rural Benin showed after only 14 months, TJ led to statistically significant improvements in intention to use contraception and met need. While showing substantial gains, women's use of contraception was not statistically significant.TJ increased women's and men's partner and network communication on fertility desires and family planning use and individual self-efficacy and confidence to act on intentions to address unmet need. The network influence on family planning use was equally significant. TJ led to new ideas within communities/social networks, including the perception that one's social networks approve of FP. Women and men who report that their network approves of FP were significantly more likely to discuss method use with their partners and seek services. TJ led to new perceptions that one's networks support FP.TJ represents an underused strategy for social and behaviour change. The social network approach encourages addressing the often-neglected social factors that stop women and men from acting on their desires to space births and use modern family planning methods.

[Assessment of road safety intervention implementation in Benin in 2019]. / Évaluation de la mise en œuvre de la sécurité routière au Bénin en 2019.

OBJECTIVE: The study aims to assess the level of implementation of road safety interventions in Benin. METHOD: The research is based on an evaluative study of road safety aimed to analyze the implementation and logic of road safety interventions, conducted in Benin in 2019. It combined a review of the gray literature and a qualitative component. The data were collected through documents and interviews in structures involved in road safety management. RESULTS: Road safety was a national priority with one lead institution and several structures involved. There was a lack of consensus among stakeholders, insufficient framework documents, resources, legislative texts, and study data. Few roads were in good condition and very few allowed the separation of two-wheeled vehicles. The vehicle fleet was outdated. Various activities were carried out to raise awareness, to educate the population and to enforce the texts but they were insufficient and poorly coordinated. Reference hospitals had the minimum service to deal with trauma cases. The interventions had not yet resulted in a reduction in the number of injuries and fatalities by accidents, which was increasing. CONCLUSION: Benin has made great efforts in the area of road safety. However, there are still some shortcomings to take into account.

Food and medicinal uses of Annona senegalensis Pers.: a country-wide assessment of traditional theoretical knowledge and actual uses in Benin, West Africa.

BACKGROUND: The growing interest for more natural products in food and health industries has led to increasing research on traditional knowledge related to plants. While theoretical knowledge (TK) on the uses of a species informs on the wide spectrum of potential uses of that species, actual uses (AU) highlight their potential being actually used. Distinguishing between the two is important when reporting ethnobotanical studies. However, studies often equated AU and TK, sometimes misleading conclusions, and decision-making. This study assessed TK, AU, and difference between TK and AU of Annona senegalensis and how each is related to factors such as age, sex, sociolinguistic group, and main activity in Benin republic. METHODS: Data were collected through semi-structured individual interviews (n = 755) and analyzed using among others, relative frequency of citation (RFC), and use-value (UV). RESULTS: A total of 168 theoretical uses were recorded but only 92 were "actually" practiced, of which four were food and 88 medicinal uses. TK and AU were positively correlated. As expected, TK was also significantly higher than AU, indicating that some potential uses of the species are still not valued. Sociolinguistic group and main activity, not age and sex, were the main factors influencing TK, AU, and difference between TK and AU. The highest TK was found with Bariba sociolinguistic group and the highest AU with Otamari. Fruits (100%) and flowers (10%) were the most used organs for food, while leaves (40%) and roots (7%) were mostly used for medicinal purposes. The most common food uses were consumption of the ripe fruits (100%), and food seasoning with flowers (10%). The most cited diseases were malaria (28%) and intestinal worms (8%). CONCLUSIONS: The study illustrated the importance of differentiating between TK and AU. It documented  the wide range of the uses of A. senegalensis, while highlighting its most common uses, and the need to better valorize and sustainably manage the species.

Prevalence, acceptability, and cost of routine screening for pulmonary tuberculosis among pregnant women in Cotonou, Benin.

OBJECTIVES: We sought to evaluate the yield, cost, feasibility, and acceptability of routine tuberculosis (TB) screening of pregnant women in Cotonou, Benin. DESIGN: Mixed-methods, cross-sectional study with a cost assessment. SETTING: Eight participating health facilities in Cotonou, Benin. PARTICIPANTS: Consecutive pregnant women presenting for antenatal care at any participating site who were not in labor or currently being treated for TB from April 2017 to April 2018. INTERVENTIONS: Screening for the presence of TB symptoms by midwives and Xpert MTB/RIF for those with cough for at least two weeks. Semi-structured interviews with 14 midwives and 16 pregnant women about experiences with TB screening. PRIMARY AND SECONDARY OUTCOME MEASURES: Proportion of pregnant women with cough of at least two weeks and/or microbiologically confirmed TB. The cost per pregnant woman screened and per TB case diagnosed in 2019 USD from the health system perspective. RESULTS: Out of 4,070 pregnant women enrolled in the study, 94 (2.3%) had a cough for at least two weeks at the time of screening. The average (standard deviation) age of symptomatic women was 26 ± 5 years and 5 (5.3%) had HIV. Among the 94 symptomatic women, 2 (2.3%) had microbiologically confirmed TB for a TB prevalence of 49 per 100,000 (95% CI: 6 to 177 per 100,000) among pregnant women enrolled in the study. The average cost to screen one pregnant woman for TB was $1.12 USD and the cost per TB case diagnosed was $2271 USD. Thematic analysis suggested knowledge of TB complications in pregnancy was low, but that routine TB screening was acceptable to both midwives and pregnant women. CONCLUSION: Enhanced screening for TB among pregnant women is feasible, acceptable, and inexpensive per woman screened, however in this setting has suboptimal yield even if it can contribute to enhance TB case finding.