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.

Modelling groundwater pollutant transfer mineral micropollutants in a multi-layered aquifer in Burkina Faso (West African Sahel).

In Burkina Faso, human activities around water points in rural areas affect groundwater resources, which become unfit for consumption. Nearly 33.5% of boreholes are subject to point source pollution. The assessment of the evolution of such pollution should be monitored to assess groundwater quality. In addition, withdrawals for irrigation alone are estimated at 85%, i.e. 46% of the water demand, heightening the deterioration in quality while creating depression zones further leading to an increase in recharge. It is therefore critical to understand the evolution and fate of the transfer of pollutants in such environments. In this study, we aimed to model the transfer of pollutant and predict the future state of pollution using the MT3D-USGS Groundwater Solute Transport Simulator code through the Groundwater Modelling Software (GMS) over the period 2012-2062 (50 years). A mathematical model is further developed through inferential statistics and used as a surrogate model for comparison. The results showed that deterioration in water quality was more attributable to withdrawals, especially for Cyanide (Cn) and Arsenic (As). A rather slow degradation is reported for Lead (Pb), which extends over 22 km, and Fluoride (F), which extends from 4 to 10 km due to localized recharge. A faster degradation for Cn over a distance of 2-16 km and as from 3 to 11 km is also observed because of the geological setting of the subsoil. These results might assist decision-makers for the quantitative and qualitative management of groundwater resources, and the management of the basement aquifer in the area through the establishment of protection zones.

Management of Gustilo type IIIB open tibial shaft fractures with limited resources: experience from an African trauma center.

PURPOSE: We sought to evaluate the management of Gustilo type IIIB open tibia diaphyseal fractures in an African trauma center with respect to soft tissue defect management and bone union achievement. Functional outcome assessment was the secondary objective. METHODS: A retrospective review was conducted including patients treated for open tibia fractures requiring flap coverage between 2007 and 2011. As plastic surgeons were lacking in availability, all procedures were performed by orthopedic surgeons trained in completing nonmicrosurgical flap transfers. RESULTS: Twenty-seven patients with a mean age of 36 years were included. Although the mean time to debridement was 11 h, early infection occurred in 16 (59%) patients. The mean time to flap coverage was 27 days. Among the 29 primary local flap transfers performed, only 4 failed. Secondary amputation was required in one patient after flap failure. Bone reconstruction procedures were required in nine patients and were performed after a mean period of 97 days. At the mean follow-up time of 13 months, 23 (88%) of the 26 remaining fractures had united. There were three septic nonunions and two cases of chronic osteomyelitis. Functional result was negatively influenced by the soft tissue defect area and low-quality flap coverage. CONCLUSIONS: To our knowledge, this is the first series reporting flap reconstructions performed by orthopedic surgeons for Gustilo type IIIB tibia fractures in an African hospital. Local pedicled flap transfers permitted the achievement of soft tissue coverage and bone union in most cases. Subsequent bone grafting was required in one-third of the cases.

Soft tissue reconstruction in the leg by orthopedic surgeons: Practices at an African trauma center.

INTRODUCTION: Soft-tissue coverage is a crucial step when treating open tibial fractures, which is often performed by orthopedic surgeons in a low resource setting. The objective of this study was to analyze the use of non-microsurgical flaps to treat such injuries in a West African trauma center. HYPOTHESIS: Pedicled flaps are reliable procedures that can be used by any orthopedic surgeon for soft-tissue coverage in the leg. METHODS: A retrospective study was conducted including patients treated between 2007 and 2011 for open tibial fractures or posttraumatic sequelae requiring flap coverage. Early flap necrosis and skin viability at the last follow-up were evaluated. RESULTS: Fifty-five patients with mean age 34 years were included. They had 57 soft-tissue defects requiring flap reconstruction, 36 of which were infected. In total, 62 pedicled flaps were performed: 12 muscular flaps and 50 fasciocutaneous flaps, including 40 rotational flaps and 10 island flaps. The short-term result was successful in 55 flaps (89%). Seven flaps had partial or complete necrosis, including three soleus flaps and three lateral supramalleolar rotational flaps. At the average follow-up of 9 months, skin viability was inferior in the posttraumatic sequelae group and seemed to be altered by primary bone infection. CONCLUSION: Soft-tissue coverage in the leg can be reliably achieved by orthopedic surgeons using simple and robust flaps that do not require pedicle dissection. Surgeon training in basic flap surgery is essential and still inadequate in emerging countries. LEVEL OF EVIDENCE: IV, Retrospective study.