Bayesian spatial modelling of malaria burden in two contrasted eco-epidemiological facies in Benin (West Africa): call for localized interventions.

BACKGROUND: Despite a global decrease in malaria burden worldwide, malaria remains a major public health concern, especially in Benin children, the most vulnerable group. A better understanding of malaria's spatial and age-dependent characteristics can help provide durable disease control and elimination. This study aimed to analyze the spatial distribution of Plasmodium falciparum malaria infection and disease among children under five years of age in Benin, West Africa. METHODS: A cross-sectional epidemiological and clinical survey was conducted using parasitological examination and rapid diagnostic tests (RDT) in Benin. Interviews were done with 10,367 children from 72 villages across two health districts in Benin. The prevalence of infection and clinical cases was estimated according to age. A Bayesian spatial binomial model was used to estimate the prevalence of malaria infection, and clinical cases were adjusted for environmental and demographic covariates. It was implemented in R using Integrated Nested Laplace Approximations (INLA) and Stochastic Partial Differentiation Equations (SPDE) techniques. RESULTS: The prevalence of P. falciparum infection was moderate in the south (34.6%) of Benin and high in the northern region (77.5%). In the south, the prevalence of P. falciparum infection and clinical malaria cases were similar according to age. In northern Benin children under six months of age were less frequently infected than children aged 6-11, 12-23, 24-60 months, (p < 0.0001) and had the lowest risk of malaria cases compared to the other age groups (6-12), (13-23) and (24-60): OR = 3.66 [2.21-6.05], OR = 3.66 [2.21-6.04], and OR = 2.83 [1.77-4.54] respectively (p < 0.0001). Spatial model prediction showed more heterogeneity in the south than in the north but a higher risk of malaria infection and clinical cases in the north than in the south. CONCLUSION: Integrated and periodic risk mapping of Plasmodium falciparum infection and clinical cases will make interventions more evidence-based by showing progress or a lack in malaria control.

[Factors associated with obesity in a sedentary activity user group at the Dantokpa market (Benin).] / Facteurs associés à l'obésité au sein d'un groupe d'usagers du marché Dantokpa (Bénin).

OBJECTIVE: To study obesity prevalence and associated factors in sedentary activity users at the Dantokpa market, Cotonou. METHOD: From October to November 2016, 460 subjects were selected by stratified survey. Anthropometric data and information regarding knowledge and practices of the subjects related to obesity were collected by a questionnaire. The factors associated with obesity were researched by a logistic regression model. RESULTS: The obesity prevalence was 35.7%. It was more predominant in women (P < 0.0001) and those aged between 38-57 years (P < 0.0001). Insufficient or false knowledge and insufficient or bad practices concerning obesity cohabited among Dantokpa market sedentary users. The obesity associated factors were the sex (OR = 2.3; P < 0.006), the age of 38 to 57 years (2.3; P = 0.014), marital status (2.5; P = 0.003), knowledge of physical incapacity as a consequence of obesity (1.8; P < 0.0001), daily sedentary duration between three and seven hours (18.0; P < 0.0001) and more than seven hours (85.1; P < 0.0001), family childbirth circumstances (1.9; P = 0.002) revenue increasing circumstances (3.1; P = 0.001) and sleep duration (2.01; P = 0.003). CONCLUSION: This study suggests the necessity for the implementation of strategies including notably physical activities and knowledge about obesity in order to reduce obesity prevalence in Dantokpa market sedentary activity users.

[Knowledge, attitudes and practices of emergency contraception among female students at Parakou University (Benin)]. / Connaissances, attitudes et pratiques de la contraception d'urgence chez les étudiantes à l'Université de Parakou (Bénin).

OBJECTIVE: This study was designed to assess emergency contraception knowledge, attitude and practices among female students at Parakou University. METHODS: A descriptive cross-sectional survey was conducted on 570 female students recruited after cluster sampling in the various university departments. A predefined questionnaire was used to interview students after they consented to participate in the survey. The data collected were analysed by Epi Info software and variables were compared by Chi-square test with a limit of significance of 5%. RESULTS: More than half of the students (51%) were familiar with the emergency contraception method and had been informed by friends and the media. Only 18% of them had already used this method at least once following unprotected sexual intercourse. Most of them were under the age of 24 and reported having irregular sexual partners. CONCLUSION: Students were familiar with and had easy access to the method. However, repeated use of this method highlights the need for better information of these students concerning classical methods of contraception. An awareness campaign should be conducted on the campus in order to reduce the currently high rate of non-medical clandestine abortion.

[Quality assessment of refocused antenatal care services at the district hospital of Suru-Léré in Benin]. / Evaluation de la qualité des services de consultation prénatale recentrée à l'hôpital de district de suru-Léré au Bénin.

INTRODUCTION: Antenatal care service, one of the interventions of public health, has been recognized as one of the pillars for the reduction of maternal and neonatal mortality. It has been revised in recent years and a new model of its contents has been submitted by WHO. Considering the complexity of its implementation, it is useful to periodically assess the performance of antenatal services with the view of their improvement. METHODS: An evaluative study was thus carried out in one health district hospital in Benin; the care staff attitudes and practices were analyzed on 80 pregnant women admitted in the antenatal care as well as services organization, care environment and satisfaction of these women. The performance was appreciated on the basis of hundred criteria. RESULTS: The overall performance of antenatal services through the inputs, procedures and satisfaction of the pregnant women, was considered to be satisfactory. The services organization, health care environment, patient reception and interpersonal communication were the elements which showed deficiencies. CONCLUSION: Improvement will have to be carried out based on shortcomings identified, by the planners, organizers and staff in order to reinforce the hospital's performance on antenatal services.

[Coverage, mapping and barriers to complete vaccination for age among children under 5 years in 2021: case of Adjara-Hounvè and Ahouicodji villages in southern Benin]. / Couverture, cartographie et barrières à la vaccination complète pour l'âge chez les enfants de moins de cinq ans en 2021 : cas des localités d'Adjara-Hounvè et Ahouicodji au sud du Bénin.

Background: Vaccination is a protective measure against infectious diseases and remains one of the best investments in public health. Some African countries are still struggling to reach the required child immunization coverage. Several factors are responsible for limiting immunization coverage. Most of the factors considered to limit immunization coverage are related to the health system. In addition, inaccessibility to care, especially during the critical period of the Covid-19 pandemic, greatly reduced vaccination coverage rates. In Benin, several vaccines are included in the Expanded Programme on Immunization or are administered as part of routine immunization. However, cases of non-compliance with the vaccine and persistent flaccid paralysis are still recorded in the commune of Ouidah in southern Benin. The aim of this study was to investigate the coverage and factors associated with full immunization for age in children aged 0-5 years. Methods: A cross-sectional survey was conducted from August to October 2021 in two villages (Adjara-Hounvè and Ahouicodji) in southern Benin. All the households were included. The survey regarded children under 5 for whom a vaccination record was presented. A couple child/mother was recruited after informed consent of the mother and her child. An univariate analysis followed by a multivariate analysis was performed by using a logistic regression model to identify the variables that influence vaccine completeness. Spatial description of vaccine completeness was performed using the kriging method using ArcGIS 10.8 mapping software. Results. Of the 414 mothers surveyed, 57.49% had an immunization card, from which information was collected. Of the 238 children recruited, 141 were in Adjara-Hounvè and 97 in Ahouicodji. Of the 238 children with an immunization card, 20.6% were fully immunized for their age. All children received Baccille Calmette Guérin vaccine at birth. Since poliomyelitis, pentavalent, pneumococcal conjugate, and rotavirus are three-dose vaccines, the percentage of children who received these vaccines decreased as the number of doses increased: 96.6%, 88.2%, 78.1% and 72.3% for the four doses of polio respectively. According to 53.4% of the respondents the reception at the vaccination site was poor, and according to 70.3% of them waiting time for vaccination sessions was long. Several reasons justified the absence of complete vaccination for the age of the children: vaccination site too far from the place of residence (59.54%), lack of financial means (29.78%) and the mother's ignorance (12.76%). Education level "primary" vs "none" (ORa = 3.32; CI95% 1.07-10.25), occupation "health staff" vs "housewife" (ORa = 21.18; CI95% 3.07-145.94), mothers' knowledge of Expanded Programme on Immunization diseases (ORa = 2, 20; CI95% 1.03-4.68) and children's age 0-2 months vs ≥ 16 months (ORa = 8.53; CI95% 2.52-28.85) and 9-15 months vs ≥ 16 months (ORa = 2.99; CI95% 1.24-7.23) increased complete immunization status for age. The homogeneity of behaviour related to age-complete immunization coverage in children under 5 years was evident at mapping. Conclusion: Age-complete immunization coverage in children under 5 years of age is very low, with a spatial homogeneity in community immunization uptake behaviour. Age-complete immunization coverage is an innovative indicator that can contribute to achieving age-specific immunization targets.

Poor maternal anthropometric characteristics and newborns' birth weight and length: a cross-sectional study in Benin.

Background: Maternal undernutrition is known to negatively impact newborns' birth weight and length, but this finding is poorly documented in the Beninese population. This study aimed to assess the effect of maternal anthropometry on mean birth weight and length in a Beninese cohort of newborns. Methods: A cross-sectional study was carried out in Tori Bossito, Republic of Benin. Pregnant women attending maternity wards between June 2007 and July 2008 were recruited. At delivery the women's characteristics, including weight and height, were gathered and newborns' birth weights and lengths were measured. Statistical analysis was performed using multiple linear regression. Results: A total of 526 mother-infant pairs were enrolled; 29.8% of women had low weight status and 26.2% had short stature (<155 cm). The mean birth weight was 2985 g (standard deviation [SD] 384) the mean birth length was 48.7 cm (SD 2.2). Maternal low weight status (coefficient=-151.81, p<0.001) and short stature (coefficient=-135.49, p<0.001) reduced the mean birth weight. Similar results were found for mean birth length, which was decreased by maternal low weight status (coefficient=-0.42, p=0.04) and short stature (coefficient=-0.51, p=0.01). Conclusion: Maternal undernutrition expressed by low anthropometry remains problematic in the Beninese population and induces transmission of malnutrition. Nutritional interventions are required to break this vicious cycle.

[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.

Prévalence et description des pratiques d'allaitement maternel exclusif dans une zone semi-rurale au sud du Bénin

Introduction : Dans un contexte de non atteinte des recommandations de l'OMS et de l'UNICEF con-cernant l'allaitement maternel exclusif, cette étude avait pour objectif de décrire les pratiques et habi-tudes d'allaitement maternel dans une population semi-rurale au sud du Bénin. Matériel et méthode : Cette enquête s'est déroulée à Sèmè-Kpodji située à 15 km au sud-est de la capitale Porto-Novo. Les pratiques d'allaitement maternel exclusif de 0 à 6 mois ont été observées et notées chez 339 femmes ayant accouché entre janvier 2015 et janvier 2016. Résultats : La plupart des enfants (71,40%) ont été mis au sein dès la première de vie ; l'âge moyen de sevrage était de 4,5 mois. Le taux d'allaitement maternel exclusif était de 53,9% et a diminué pro-gressivement en fonction de l'âge de l'enfant. Les taux d'allaitement maternel prédominant et complété ont varié de 25,4% à 49,6% et de 0 à 40,7% respectivement. La durée moyenne des tétées est passée de 24,1 à 15,1 minutes et la fréquence des repas de 9,5 à 6,4 repas par jour. Conclusion : Cette enquête confirme la nécessité de continuer les interventions de santé publique visant à promouvoir l'allaitement maternel exclusif afin d'améliorer les indicateurs de santé materno-infantile

Prévalence des accidents d'exposition au sang et facteurs associés chez les professionnels de santé à l'hôpital de zone de Menontin, Bénin

Introduction: Les accidents d'exposition au sang (AES) constituent une réelle préoccupation pour les professionnels de santé à cause de la gravité des affections qu'ils engendrent. La présente étude a été menée pour évaluer la fréquence des accidents d'exposition au sang (AES) au sein du personnel de l'hôpital de zone de Mènontin et les facteurs qui lui sont associés. Méthode d'étude : Enquête descriptive transversale et analytique incluant 90 agents de santé. Le recueil des données a été fait sur la base d'un questionnaire anonyme et de deux grilles d'observation. Le questionnaire a été remis à chaque agent de santé volontaire après explication des objectifs de l'étude. Une visite de tous les services a été réalisée pour compléter les grilles d'observation. Résultats : L'âge moyen de notre échantillonnage est de 37 ans ± 10. Les femmes ont représentées dans 70% de notre échantillonnage et le sexe ratio est de 0,42.Les infirmiers (32,2%), les techniciens de laboratoire (25,56%) et les aidessoignants (16,7%) étaient les classes professionnelles plus représentées. La fréquence des AES chez les professionnels de santé à l'hôpital de zone de Mènontin est de 40%. Les types d'AES les plus fréquents sont les piqures (44,4%), les projections sur muqueuse (25%) et les coupures (16,7%).le sang a été impliqué dans 86,11% des cas. Les mécanismes de survenue des AES répertoriés étaient essentiellement le recapuchonnage (66,7%) et l'élimination de déchets (25%). L'absence de formation sur les AES et de port de gants influence significativement la survenue des AES. Les AES n'ont pas été déclarés dans 66,7% des cas. Les mesures de prévention et de prise en charge des AES sont inexistantes au sein de l'hôpital de zone de Mènontin. Conclusion : Des séances de sensibilisation du personnel sur les risques liés aux AES s'imposent en vue de leur prévention

Allergies respiratoires professionnelles liées à l'exposition à la poussière de farine de blé: cas de 05 boulangeries de la ville de Porto-novo

Objectif : Prévenir les allergies respiratoires professionnelles chez les travailleurs exposés à la poussière de farine de blé dans les boulangeries de la ville de Porto-Novo. Méthode : Il s'est agi d'une étude transversale descriptive conduite d'Octobre à Décembre 2014 dans 5 boulangeries de la ville de Porto-Novo. A travers un échantillonnage à deux degrés, nous avons sélectionné d'une part de façon aléatoire 5 boulangeries des 32 de la ville et d'autre part de façon exhaustive recruter 51 travailleurs des 5 boulangeries. Il a été procédé à un examen physique (auscultation pulmonaire et examen oto-rhinolaryngologique) systématique de tous les travailleurs interviewés. Analyse des données : Les données ont été enregistrées et analysées avec le logiciel EPI info version 3.5.3. Les résultats obtenus ont été compilés dans des tableaux de fréquence simple. Résultats : La grande majorité des travailleurs sont de sexe masculin (90,2%). La plupart des travailleurs ont un âge compris dans la tranche de 31 et 50 ans (47,1%) et une ancienneté comprise entre 1 à 9 ans (47,2%). Les travailleurs sont concentrés au niveau des postes de : façonnage (68,7%), pétrissage (49,1%) et enfournage (39,2%). Les procédés et pratiques générateurs d'importantes poussières selon les travailleurs sont : le fleurage (88%), la vidange des sacs à farine dans le pétrin (80%), l'usage du balai pour le nettoyage (41,2%) et le pétrissage (19,6).. Les symptômes respiratoires dont se plaignent souvent les travailleurs sont : éternuement (82,4%), rhume/écoulement nasal (58,8%), toux (37%) et bronchorrhée (27,5%). Ces symptômes apparaissent chez les travailleurs le plus souvent après un délai d'exposition compris entre 1 et 9 ans et plus de la moitié des cas (57,1%) dans la tranche d'âge de 31-50ans. 2/3 des cas d'asthme sont survenus chez les travailleurs dans cette fourchette d'âge. Conclusion : La farine est désormais reconnue comme étant le premier allergène professionnel. Il s'avère important d'adopter une démarche de prévention adéquate du risque qu'elle constitue afin de garantir la santé et la sécurité aux travailleurs

Primary antibiotic resistance and effectiveness of Helicobacter pylori triple therapy in ulcero-inflammatory pathologies of the upper digestive tract.

OBJECTIVES: To determine firstly, the rates of primary antimicrobial resistance for Helicobacter pylori-associated upper-digestive lesions in relation to the success rate of triple therapy; and secondly, the performance of HpSA stool antigen detection test for control of eradication after treatment. METHODS: Prospective open study of 436 patients who underwent upper-digestive tract endoscopy with biopsies for histological examination and culture between January 1 and July 31, 2002 at a University hospital in Brussels, Belgium. The primary resistance to antibiotics of H. pylori isolates was determined by disc diffusion method. Seventy of 164 infected patients agreed to be included in the treatment study with standard triple therapy with amoxicillin + clarithromycin + omeprazole adjusted on the basis of antibiogram results. Control of eradication was tested by 14C-Urea breath test and H. pylori Stool Antigen test (HpSA test). RESULTS: Primary resistance to clarithromycin and metronidazole was observed in 3% and 31% of the isolates, respectively. No primary resistance to amoxicillin and tetracycline was observed. By intention to treat analysis, H. pylori was eradicated in 56 (80%) patients included in the therapeutic study. Three (4%) patients were lost to follow-up. The rate of eradication failure was 20% (14/70), included 11 cases documented by a positive control test (14C-Urea breath test). In comparison with 14C-Urea breath test, the H. pylori Stool Antigen test showed a sensitivity of 100%, a specificity of 91%, PPV of 69%, and NPV of 100%. CONCLUSION: Standard triple therapy achieved 80% bacterial eradication in this patient population with a low prevalence of H. pylori primary antibiotic resistance. Our data confirm that the H. pylori Stool Antigen test displays a diagnostic performance similar to the breath test for control of eradication.