Modélisation du cadre conceptuel d'avis de recommandation pour la vaccination des enfants aux décideurs béninois.

The coverage of immunization against avoidable disease in the Republic of Benin as in other West African countries, is declining nowadays. To sustain the government effort, National Immunization Technical Advisory Groups (NITAG) were created technically and funded by the West African health organization (WAHO) and Preventive Medicine Agency in countries of the Economic Community of West African States (ECOWAS) including the Republic of Benin. The variation in experts' methods of analyzing evidence sometimes results in risk error and lack of statistical power. This situation does not allow for the comparison of the scientific validity of certain recommendations made to policy makers, due to the lack of a rigorous framework. The aim of this paper is to design an improved framework to be used in the Republic of Benin in order to encourage a more harmonized approach based on evidence used by expert consultative committees. This framework shows four fundamental scientific steps including a Ministerial referral procedure, recommendation framework, evidence-based data collection, model analyses appropriate for expert advice on vaccines and child immunization, as well as three administrative steps including scientific discussion and work meetings without forgetting ethical aspects.

[Modelization of recommendation framework advice for children immunization to Beninese decision makers] / Modélisation du cadre conceptuel d'avis de recommandation pour la vaccination des enfants aux décideurs béninois.

The coverage of immunization against avoidable disease in the Republic of Benin as in other West African countries, is declining nowadays. To sustain the government effort, National Immunization Technical Advisory Groups (NITAG) were created technically and funded by the West African health organization (WAHO) and Preventive Medicine Agency in countries of the Economic Community of West African States (ECOWAS) including the Republic of Benin. The variation in experts’ methods of analyzing evidence sometimes results in risk error and lack of statistical power. This situation does not allow for the comparison of the scientific validity of certain recommendations made to policy makers, due to the lack of a rigorous framework. The aim of this paper is to design an improved framework to be used in the Republic of Benin in order to encourage a more harmonized approach based on evidence used by expert consultative committees. This framework shows four fundamental scientific steps including a Ministerial referral procedure, recommendation framework, evidence-based data collection, model analyses appropriate for expert advice on vaccines and child immunization, as well as three administrative steps including scientific discussion and work meetings without forgetting ethical aspects.

[Modelization of recommendation framework advice for children immunization to Beninese decision makers]. / Modélisation du cadre conceptuel d'avis de recommandation pour la vaccination des enfants aux décideurs béninois.

The coverage of immunization against avoidable disease in the Republic of Benin as in other West African countries, is declining nowadays. To sustain the government effort, National Immunization Technical Advisory Groups (NITAG) were created technically and funded by the West African health organization (WAHO) and Preventive Medicine Agency in countries of the Economic Community of West African States (ECOWAS) including the Republic of Benin. The variation in experts’ methods of analyzing evidence sometimes results in risk error and lack of statistical power. This situation does not allow for the comparison of the scientific validity of certain recommendations made to policy makers, due to the lack of a rigorous framework. The aim of this paper is to design an improved framework to be used in the Republic of Benin in order to encourage a more harmonized approach based on evidence used by expert consultative committees. This framework shows four fundamental scientific steps including a Ministerial referral procedure, recommendation framework, evidence-based data collection, model analyses appropriate for expert advice on vaccines and child immunization, as well as three administrative steps including scientific discussion and work meetings without forgetting ethical aspects.

[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.

Determinants of parents' reticence toward vaccination in urban areas in Benin (West Africa).

BACKGROUND: Despite the efforts of health authorities, vaccination coverage of targeted child populations is still poor in many regions. Parents' reticence has been identified as one cause of this situation. However, there is little data to explain the phenomenon that could support decision-making. OBJECTIVE: The objective of the study was to uncover the determinants of this reticence toward vaccination among the religious population of the cities of Parakou and Cotonou in Benin. METHODS: This was an exploratory study using a qualitative survey of 12 pastors and 30 faithful from churches that are vaccination-reticent and a control group of the same number of faithful belonging to other churches, all Christian. Individual and group interviews were carried out in the local language using a pre-established and pre-tested guide. The data collected underwent discourse content analysis focused on specific themes. RESULTS: Analysis of the data reveals an erroneous perception of child vaccination. Those who are reticent say vaccination goes against the will of God, that it is a poison from the "white witch doctor", and that those who vaccinate their children are committing a sin. Members of the control group argued against this, but without conviction. They adhere to the principle of obedience to authority, a biblical precept invoked when the vaccinators oblige them to vaccinate their children. Other factors were identified that could explain the reticence, such as the tactlessness of the vaccinators, parents' previous experiences and false rumours about vaccination. CONCLUSION: The reasons for reticence are mainly related to parents' beliefs in religious principles that are sometimes poorly understood. To limit the spread of this phenomenon, more detailed information and negotiation between the health authorities and the pastors of these churches are essential. ABSTRACT IN FRENCH: See the full article online for a translation of this abstract in French.

[Antenatal care utilization and unfavourable pregnancy outcome trends in Benin (Africa)]. / Tendence de l'utilisation des soins prénatals et des issues défavorables de grossesses au Bénin (Afrique).

Antenatal care was an efficient preventive strategy for decreasing unfavorable pregnancy outcome incidence. Its appropriate utilisation remained the priority of Benin Health authorities following the Bamako Initiatives; but little research was undertaken on its effectiveness. This study proposes to describe the trends of unfavorable pregnancy outcome and antenatal care utilization. To that end, we collected and analysed retrospectively the data stored from 1993 to 1997 in the Heath Ministry data bank (339 maternity units). We observed an increase of antenatal care utilization (31 to 42%), the progressive high level of the maternal mortality ratios (245 to 322 per million), intrapartum foetal death (31 to 41%) and neonatal mortality ratios (11 to 12%). We also observed in the regional areas, a positive high variability of unfavourable pregnancy and antenatal care utilization (p=0.00). The authors insist on the improvement of care quality through the reinforcement of caregivers' training followed by extensive research on antenatal care quality.

[Meningococcal meningitis epidemics in Benin]. / Epidémies de méningite à méningocoque au Bénin.

Epidemics of meningococcal meningitis are common in several African countries, including Benin. In northern Benin, part of the "meningitis belt", incidence has been increasing over the past decade, and lethality is high. The A and C serogroups are the primary causal agents. Recently, the appearance of the W135 strain in bordering countries induced considerable fear and necessitated more rigorous epidemiological surveillance in the north. Little epidemiologic information on the course and trends of these epidemics is available. The goal of this article is to describe the pattern of these outbreaks in two northern districts -- Atacora and Donga -- based on a retrospective collection and analysis of data from 16 health centres over the four-year period of 1998 through 2001. Crude incidence rates increased from 85 to 567 per 100,000 in Atacora and 71 to 619 per 100,000 in Donga. The fatality rate is higher in Donga (3.1%) than Atacora (2.7%). The epidemic pattern is bimodal in Atacora and unimodal in Donga, although they appear to have a common source. Comparison of the trends in the two districts indicated no significant differences (p>0.05). The authors suggest that epidemiological data be collected and updated routinely, that vaccination against the A and C serogroups be reinforced while awaiting a vaccine against W135, and that epidemiological surveillance be intensified, in Donga and especially along the border area between Atacora and Togo.