"My right to walk, my right to live": pedestrian fatalities, roads and environmental features in Benin.

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.

Implementation of a model of awareness-raising for taxi motorcyclists in Benin in relation to helmet use: protocol for a quasi-experimental study.

BACKGROUND: In the large cities of Benin, motorcycle taxi drivers, mainly between the ages of 20 and 40, are particularly exposed to accidents due to their profession. User awareness, along with legislative reforms and enforcement measures, would reduce the incidence of crashes and injuries. This study aims to test the effectiveness of an awareness-raising model regarding helmet use for motorcycle taxi drivers. METHODS: This is a quasi-experimental study that will take place in the cities of Parakou (intervention group) and Porto Novo (control group). Over a three-month period, a package of awareness-raising activities will be implemented in the intervention area, targeting a group of motorcycle taxi drivers. The messages to be developed for awareness-raising will focus on the most frequently influencing factors, as identified by the baseline collection. These key messages will be disseminated through various tools and communication channels (banners, motorcycle stickers and motorcycle taxi uniforms, interactive sessions). Data will be collected prospectively via a self-reported questionnaire and observation, carried out before the intervention, at the end, and 6 months later. The data will relate to knowledge, attitudes and practices regarding helmet use. The analysis will compare the indicators between the groups, as well as between the pre- and post-intervention phase. The KoboCollect software will be used for data entry and processing, and Stata 15 will be used for data analysis. Chi-square or Fisher, Student's or Kruskal-Wallis tests will be used for the comparisons. The difference-in-difference method will be used to determine the specific effect of the awareness activities. DISCUSSION: This study will assess the contribution of awareness messages to changing the behaviour of motorcycle taxi drivers by determining the specific effect of the intervention.

Improving early audiological intervention via newborn hearing screening in Belgium.

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.

Concentration-response curve and cumulative effects between ozone and daily mortality: an analysis in Wallonia, Belgium.

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.

Short-term effects of air pollution on hospitalization for acute myocardial infarction: age effect on lag pattern.

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 NO2, PM10 and O3. 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 NO2 and PM10, 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 NO2 and AMI are higher compared to PM10. There are no associations between O3 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.

Pregnancy and childbirth after repair of obstetric fistula in sub-Saharan Africa: Scoping Review.

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.

A descriptive longitudinal study protocol: recurrence and pregnancy post-repair of obstetric fistula in Guinea.

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).

Organisation of newborn hearing screening programmes in the European Union: widely implemented, differently performed.

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.

Factors associated with the failure of obstetric fistula repair in Guinea: implications for practice.

BACKGROUND: The prevention and treatment of obstetric fistula still remains a concern and a challenge in low income countries. The objective of this study was to estimate the overall proportions of failure of fistula closure and incontinence among women undergoing repair for obstetric fistula in Guinea and identify its associated factors. METHODS: This was a retrospective cohort study using data extracted from medical records of fistula repairs between 1 January 2012 and 30 September 2013. The outcome was the failure of fistula closure and incontinence at hospital discharge evaluated by a dye test. A sub-sample of women with vesicovaginal fistula was used to identify the factors associated with these outcomes. RESULTS: Overall, 109 women out of 754 (14.5 %; 95 % CI:11.9-17.0) unsuccessful repaired fistula at discharge and 132 (17.5 %; 95 % CI:14.8-20.2) were not continent. Failure of fistula closure was associated with vaginal delivery (AOR: 1.9; 95 % CI: 1.0-3.6), partially (AOR: 2.0; 95 % CI: 1.1-5.6) or totally damaged urethra (AOR: 5.9; 95 % CI: 2.9-12.3) and surgical repair at Jean Paul II Hospital (AOR: 2.5; 95 % CI: 1.2-4.9). Women who had a partially damaged urethra (AOR: 2.5; 95 % CI: 1.5-4.4) or a totally damaged urethra (AOR: 6.3; 95 % CI: 3.0-13.0) were more likely to experience post-repair urinary incontinence than women who had their urethra intact. CONCLUSION: At programmatic level in Guinea, caution should be paid to the repair of women who present with a damaged urethra and those who delivered vaginally as they carry greater risks of experiencing a failure of fistula closure and incontinence.

Newborn hearing screening programme in Belgium: a consensus recommendation on risk factors.

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.

Comparison of four case-crossover study designs to analyze the association between air pollution exposure and acute myocardial infarction.

The case-crossover design is frequently used for analyzing the acute health effects of air pollution. Nevertheless, only a few studies compared different methods for selecting control periods. In this study, the bidirectional method and three time-stratified methods were used to estimate the association between air pollution and acute myocardial infarction (AMI) in Charleroi, Belgium, during 1999-2008. The strongest associations between air pollution and AMI were observed for PM10 and NO(2) during the warm period, OR = 1.095 (95 % CI: 1.003-1.169) and OR = 1.120 (95 % CI: 1.001-1.255), respectively. The results of this study reinforce the evidence of the acute effects of air pollution on AMI, especially during the warm season. This study suggests that the different methods of case-crossover study design are suitable to studying the association between acute events and air pollution. The temperature-stratified design is useful to exclude temperature as a potential confounder.

[Funding of the management of severe malaria in children by Kinshasa households (Democratic Republic of Congo)]. / Financement de la prise en charge du paludisme grave de l’'enfant par les ménages à Kinshasa, République Démocratique du Congo.

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.

Day-of-the-week variations in myocardial infarction onset over a 27-year period: the importance of age and other risk factors.

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.

Putting newborn hearing screening on the political agenda in Belgium: local initiatives toward a community programme - a qualitative study.

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.

Single visit rabies pre-exposure prophylaxis: A literature review.

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.

Prevalence of fatigue while driving among two-wheeled vehicle drivers and associated factors: Exploratory approach from secondary analysis based on hospital data, Benin.

Fatigue while driving is one of the risk factors of road crashes. It's still poorly considered in interventions because of insufficient literature. In addition, the literature on this issue doesn't focus on two-wheelers, the most frequent users in the Benin context. The study examined the prevalence of fatigue while driving among two-wheeled vehicle drivers and the related factors. It's a secondary baseline data analysis from a cohort of road crash victims recruited from five hospitals in Benin. Data were collected from July 2019 to January 2020. Patients who identified themselves as drivers during the accident were included. Data on individual characteristics, including fatigue status in the moments preceding the collision, and other risk factors and environmental settings, were extracted. We used multivariate logistic regression. Among the respondents, 12.20% (95% CI=10.20-14.53) reported fatigue in the moments preceding the collision. The odds of fatigue while driving were significantly higher in male drivers (aOR=3.60; 95% CI=1.08-11.98), during professional trips (aOR=2.09; 95% CI=1.30-3.37), in non-helmet wearers (aOR=1.85; 95% CI=1.09-3.13), in users of stimulants (aOR=3.13; 95% CI=1.50-6.54), in those with a history of chronic diseases (aOR=1.95; 95% CI=1.16-3.27), at dusk (aOR=4.22; 95% CI=2.22-8.02), at night (aOR=6.90; 95% CI=3.95-12.05), and on Inter-State National Roads (aOR=2.01; 95% CI=1.18-3.43). Fatigue is a risk factor for road crashes in Benin, associated with other risk factors that highlight particularly vulnerable profiles and groups. Integrating prevention policies based on these cumulative risk factors will result in efficiency improvements.

Understanding the factors of road crash severity in Benin: a matched case-control study.

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.

Prevalence and Risk Factors of Post-Traumatic Stress Disorder in Survivors of a Cohort of Road Accident Victims in Benin: Results of a 12-Month Cross-Sectional Study.

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.

Helmet Use Among Two-Wheeler Riders' Road Accident Victims in Benin.

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% [CI95% (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.

Referral conditions for severe road traffic injuries and their influence on the occurrence of hospital deaths in Benin.

Road traffic accidents are the leading cause of death by trauma. Delays in in first aid due, inter alia, to the long time to transfer traffic accident victims to hospital and the lack of pre-hospital emergency care, contribute to the increase in hospital mortality. This study aims to analyse the referral conditions for severe road traffic injuries and to assess their effect on the occurrence of hospital deaths in Benin. This is an analytical prospective cohort study conducted in road accident victims with a severe injury. Four groups of factors were studied: referral conditions, sociodemographic and victim-specific characteristics, factors related to the accident environment, and factors related to health services. A top-down binary stepwise logistic regression was the basis for the analyses. Nine point eight percent of severe trauma patients died after hospital admission (7.0-13.5). Associated factors were referral time greater than 1 hour (RR=5.7 [1.5-20.9]), transport to hospital by ambulance (RR=4.8 [1.3-17.3]) and by the police or fire department (RR=7.4 [1.8-29.7]), not wearing protective equipment (RR=4.5 [1.4-15.0]), head injuries (RR=34.8 [8.7-139.6]), and no upper extremity injuries (RR=20.1 [2.3-177.1]). To reduce the risk of hospital death in severe road traffic injuries, it is important to ensure rapid and medicalized referral of severe trauma patients in Benin.