[Community health workers integration model in the National Health System (Benin, Togo)]. / Modèle d'intégration des agents de santé communautaire dans le système de santé (Bénin, Togo).

INTRODUCTION: At the international level, further reflection on the role of community health workers is in progress. The objective of this work is to develop a model of the integration of community health workers in the National Health System. METHOD: The study was conducted in Benin and Togo. It was a cluster survey that involved 385 Community Health Workers (CHW), 238 village heads, 92 health care managers selected responsibly, and 6150 households selected in a probabilistic manner. The analysis of the strengths, weaknesses, opportunities and threats of interventions under Community directives has contributed to the development of the model.Results : In both countries, community health reference materials existed, and 98.4% community health workers were trained before the beginning of the activities, and all have an intrinsic motivation for the work they do. Only 31.3% of households participated in the selection of community health workers in their locality. The absence of laws recognizing the work of the CHW is a threat to their integration into the healthcare system. The main elements proposed in the model are, the development of the status of community health workers, their remuneration on a budget managed by the health district and fed by several sources. CONCLUSION: Community Health Workers should not be a health care alternative, but an integral part of the national health system.

[Factors associated with the strength of organizational culture in a Beninese hospital]. / Facteurs associés à la force de la culture organisationnelle dans un hôpital du Bénin.

INTRODUCTION: Organizational culture, a frequently ignored concept, affects job satisfaction and productivity in organizations. OBJECTIVE: To determine the factors associated with the strength of organizational culture (OC) in Mono / Couffo regional hospital in Lokossa in Benin. METHODS: This cross-sectional and analytical study involved 121 workers of Mono/Couffo hospital in March 2015. Data on the strength of OC was collected using a questionnaire based on the validated tool proposed by Cameron and Quinn (2006). Logistic regression was performed to explore the nature of the relationship between the independent variables and OC using Odds ratios. RESULTS: 62% of the surveyed subjects had a positive perception of organizational culture. This perception was statistically associated with managerial factors (moral support of workers and type of relationship with the executive staff). The risk of perceiving a low strength of OC was sixfold higher OR = 3.78, 95% CI (1.08 - 13.22) among subjects who felt they did not have moral support from executive staff than in those who perceived this moral support. The risk of perceiving a weak OC was higher among subjects who considered relations with the staff to be uncordial [OR = 14.32, 95% CI (4.35 - 47.11)] compared to those who considered these relations to be cordial. CONCLUSION: Human resource management factors were more closely associated with the strength of organizational culture. Hospital managers should pay more attention to these factors in their hospitals to promote better institutional performance.

Estimation of allele-specific Ace-1 duplication in insecticide-resistant Anopheles mosquitoes from West Africa.

BACKGROUND: Identification of variation in Ace-1 copy number and G119S mutation genotype from samples of Anopheles gambiae and Anopheles coluzzii across West Africa are important diagnostics of carbamate and organophosphate resistance at population and individual levels. The most widespread and economical method, PCR-RFLP, suffers from an inability to discriminate true heterozygotes from heterozygotes with duplication. METHODS: In addition to PCR-RFLP, in this study three different molecular techniques were applied on the same mosquito specimens: TaqMan qPCR, qRTPCR and ddPCR. To group heterozygous individuals recorded from the PCR-RFLP analysis into different assumptive genotypes K-means clustering was applied on the Z-scores of data obtained from both the TaqMan and ddPCR methods. The qRTPCR analysis was used for absolute quantification of copy number variation. RESULTS: The results indicate that most heterozygotes are duplicated and that G119S mutation must now be regarded as a complex genotype ranging from primarily single-copy susceptible Glycine homozygotes to balanced and imbalanced heterozygotes, and multiply-amplified resistant Serine allele homozygotes. Whilst qRTPCR-based gene copy analysis suffers from some imprecision, it clearly illustrates differences in copy number among genotype groups identified by TaqMan or ddPCR. Based on TaqMan method properties, and by coupling TaqMan and ddPCR methods simultaneously on the same type of mosquito specimens, it demonstrated that the TaqMan genotype assays associated with the K-means clustering algorithm could provide a useful semi-quantitative estimate method to investigate the level of allele-specific duplication in mosquito populations. CONCLUSIONS: Ace-1 gene duplication is evidently far more complex in An. gambiae and An. coluzzii than the better-studied mosquito Culex quinquefasciatus, which consequently can no longer be considered an appropriate model for prediction of phenotypic consequences. These require urgent further evaluation in Anopheles. To maintain the sustained effectiveness carbamates and organophosphates as alternative products to pyrethroids for malaria vector control, monitoring of duplicated resistant alleles in natural populations is essential to guide the rational use of these insecticides.

[Factors associated with psychoactive substance use among Beninese adolescents]. / Facteurs associés à l’'usage de substances psychoactives chez les adolescents au Bénin.

INTRODUCTION: Psychoactive substances use among adolescents is a serious public health problem, as it exposes them to risks and health hazards and can ultimately lead to dependence. The present study investigated the prevalence and factors associated with substance use in the Kpomassè Ouidah Tori-Bossito health area in Benin. METHODS: This was a cross-sectional study conducted from 1st May to 15 July 2014 in 451 adolescents aged 10 to 19 years selected by the cluster sampling technique. Data were collected using a questionnaire about the adolescents' individual, family and socio-environmental factors. Associated factors were investigated by backward stepwise logistic regression. RESULTS: Alcohol was the substance most commonly abused with a prevalence of 30.1%, followed by tobacco, with a prevalence of 21.7% and finally cannabis, cocaine or amphetamine with a prevalence of 13.9%. More than one in ten teenagers (16.6%) consumed two or three substances. Factors associated with alcohol misuse were male gender, the area of urban residence, being married, depression, search for pleasure, conflictual family relationships and having neighbours who drink alcohol. Significant risk factors for smoking were male gender, having a single parent or being an orphan, poor parental involvement in the child's education, smoking friends and neighbours. Cannabis, cocaine and amphetamine use was mostly associated with an urban residential environment, depression, conflictual family relationships and poor parental involvement in the child's education, drug use by the parents and illicit drug use by friends. CONCLUSION: These results show that psychoactive substance use is a public health problem in the Tori-Bossito Kpomassè Ouidah health area. Communication interventions for behaviour change, advocacy, and a better public understanding of the legislation on psychoactive substances should be conducted.

[Health workers' involvement for data quality improvement in Benin]. / Implication des agents de santé dans la conception des outils de collecte de données au Bénin.

OBJECTIVE: In developing countries, the poor quality of data derived from Health Information Systems constitutes a problem that limits use of these data and contributes to the recurrent difficulties of health system management. The low level of involvement of health workers directly responsible for data may contribute to this poor quality. This study documents a Health Information System collection tool design experience by health workers and assesses its effect on data quality. METHODS: Eighty health workers responsible for clinical statistics in public health centres participated in this study. The two tools used for clinical data collection were modified by a group of 6 volunteer health workers. Monitoring indicators, data entry time, percentage exhaustiveness and quality of data were assessed before and after using the new tools. Data were compared by Wilcoxon's test for paired data and Mc Nemar's chi-square test. RESULTS: Between the two assessments, the data entry time increased from 28.7 to 22.5 seconds by reported case (p=0.153), the exhaustiveness of the reports increased from 16% to 89% (p<0.001) and the proportion of reports with sufficient data quality increased from 18.8% to 45.8% (p=0.002). CONCLUSION: The positive course of the indicators shows that increased involvement of health workers in key stages such as the design of data collection tools can help improve data quality.

[Factors associated with the poor coverage of Intermittent Preventive Treatment in pregnant women in the Pobè-Adja-Ouèrè-Kétou health zone in Benin]. / Facteurs associés à la faible couverture du Traitement Préventif Intermittent chez les femmes enceintes de la zone sanitaire béninoise de Pobè-Adja-Ouèrè-Kétou.

World Health Organization estimates indicate 216 million malaria episodes in 2010, including 81% in the African region. One of the recommended means of prevention in pregnant women is intermittent preventive treatment, until 2012, two doses of sulfadoxine/pyrimethamine or three doesfor a woman living with HIV In the Pobè-Adja-Ouèrè-Kétou health zone of Benin, coverage ofintermittent preventive treatment remains low (49% against a forecast of 80%) several years after implementation of this strategy. We conducted a cross-sectional study in June and July 2012 to identify factors associated with low intermittent preventive treatment coverage in this area. A total of 339 women were interviewed and 48% ofthem received less than two doses of sulfadoxine pyrimethamine during their prenatal consultations. The variables associated with low intermittent preventive treatment coverage were low antenatal care coverage (p < 0.001) and a prenatal consultation in the private sector (p = 0.039). In the light of our results, actions must be taken by this health zone to encourage women to complete the four visits during pregnancy.

[Health promotion and community-based approach to Buruli ulcer: results of a psychosocial- and behavioural survey in two villages in Benin]. / Promotion de la santé et approche communautaire de l'ulcère de Buruli: résultats d'une enquête psychosociocomportementale dans deux villages du Bénin.

INTRODUCTION: Buruli ulcer (BU) is an infectious disease caused by Mycobacterium ulcerans. Benin, one of the most severely affected countries, notified 365 cases in 2012. This article presents the results of a psychosocial and behavioural survey conducted in the context of a health promotion (HP) project with community participation. This paper describes the diagnosis, prevention, behaviours, as well as perceptions and experiences related to BU. METHODS: A cross-sectional study was conducted in two villages (Azonme, Houedota) of Benin Atlantic department. From 15 May to 19 June 2011, a volunteer survey was conducted with 15 former patients and 15 new patients, selected by purposive sampling and 30 randomly selected healthy individuals. Encoding and data analysis were performed with SPSS and Excel. RESULTS: Respondents were aged 11 to 100 years with a mean age of 36.63 years and 55% were men. More than 96% of respondents were aware of BU (symptoms, mode of transmission, prevention and treatment). % were familiar with the mode of transmission, but were not aware of preventive measures. Twenty-none of the 30 patients or former patients were treated in hospital. The attributed and perceived (including non-medical) causes of the disease were water (52), bacteria (17), bad luck (5). 92% of respondents were satisfied with the services of health professionals but proposed changes (46) concerning hospital accessibility and cost of care. DISCUSSION: These results show similarities and differences compared to those reported in the literature on the subject. These surveys were the basis for health promotion interventions with the participation of two communities.

[Exploratory analysis of work engagement: use of the Utrecht scale in Benin]. / Analyse exploratoire de l'engagement au travail: utilisation de l'echelle d'Utrecht au Bénin.

INTRODUCTION: Work engagement, an emerging concept in the field of positive psychology in the workplace is not well known in developing countries. Defined as a positive and and fulfilling mindset related to work, it recalls a positive attitude incentive of performance and need to be investigated. In the context of the socioeconomic crisis of health workers, and with the chronic issue of poor quality of data, this study was designed to identify the factors associated with work engagement among health workers. in charge of data collection in the Benin Routine Health Information System. METHODS: This study was a cross-sectional and analytical study targeting health workers in charge of data collection in public and private health centres. The dependent variable was work engagement and independent variables were sociodemographic and professional features, personal and professional resources and perception of technical factors. Logistic regression was used. The adequacy of the model was tested with the Hosmer-Lemeshow goodness of fit test. RESULTS: The results indicate that the level of work engagement is similar with that observed in previous studies. Predictors identified in logistic regression are perception of technical factors, location of the job, and personal resources, such as level of effort and overcommitment. DISCUSSION: This study identified factors associated with work engagement in a developing country, and adds to the knowledge concerning this new concept in Benin. The findings can contribute to research for improvement of human resources management in the health sector to achieve real performance and development.

[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.

[Quality of the contribution of community volunteers in Benin community-based IMCI]. / Qualité de l'apport des relais dans la PCIME-Communautaire au Bénin.

INTRODUCTION: With the growing shortage of qualified healthcare professionals and the challenge of achieving the Millennium Development Goals, community participation has become an essential reality. In the Avrankou Adjarra Akpro-Missérété (3A) health zone of the Ouémé department, community volunteers are supported by UNICEF and the NGO Africare. The objective of this study was to assess the quality of the contribution of community volunteers to implementation of community-based integrated management of childhood illness (IMCI). METHODS: This cross-sectional, descriptive and analytical study was conducted in health zone 3A among 38 community volunteers and 331 mothers or carers of children under the age of five years, recruited exhaustively and randomly, respectively. Tools used for data collection were questionnaires, interview guides and survey sheets. RESULTS: 81.6% of community volunteers demonstrated appropriate behaviour in relation to the various professionals of community-based IMCI, with good motivation in 71.1% of cases and acceptable motivation in 28.9% of cases. Motivation was significantly correlated with the quality of the contribution of community volunteers to implementation of community IMCI (P = 0.0012). DISCUSSION: Motivation contributes to the quality of community volunteer input to COMMUNITY IMCI. This situation must be maintained by the combined efforts of all stakeholders involved in this strategy.

[Evaluation of free cesarean sections in Benin]. / Evaluation de la mise en oeuvre de la gratuité de la césarienne au Béenin.

INTRODUCTION: The Benin Government introduced free caesarean section in public hospitals in 2009 and a national agency was created to manage free caesarean section. METHODS: Three years after introduction of free caesarean section, we evaluated this measure in the Ouidah hospital area (HZO) by analysing the hospital structure, the implementation process and the results. RESULTS: This study showed the efficacy of free caesarean section, which has helped to increase the caesarean rate from 2.38% in 2009 to 3.48% in 2012, a caesarean section mortality rate of 0.99%, insufficient information for beneficiaries, some drugs are not covered by this measure, and additional costs must be paid by beneficiaries. DISCUSSION: These results indicate the need for a detailed cost analysis to adjust the unit cost for caesarean section. This type of evaluation should be performed in all public hospitals in the country to more clearly identify malfunctions.

[Factors associated with the quality of well water and the prevalence of waterborne diseases in the municipality of Abomey-Calavi in Benin]. / Facteurs associés à la qualité de l'eau de puits et prévalence des maladies hydriques dans la commune d'Abomey-Calavi (Bénin).

The objective of this work is to assess the factors associated with the water quality of household wells, suggest solutions to improve it, and study the prevalence of water-borne diseases in this community. The quality of well water and the prevalence of waterborne diseases in the municipality were studied by analysis of the microbiological indicators currently used to assess drinking-water quality and the retrospective study of waterborne diseases treated in the local health centres. The wells surveyed were contaminated by Escherichia coli, Klebsiella pneumonia, Staphylococcus aureus, Salmonella spp, Clostridium perfringens and fecal streptococci, at prevalences of 12.5, 12.2, 12.2, 12.1, 12 and 11.1%, respectively. The high rates of diarrhea, urinary infections, typhoid fever and abdominal pain found in the retrospective study were consistent with the results of the well-water quality assessment. These results showed that human activity has strongly influenced water quality, especially the lack of sanitation in the different districts and neighbourhoods. Other factors affecting the vulnerability of well water include poor waste management by households, the low depth of the water table, the nature of the soil, and the permeability of the aquifer used. Improvement in water quality, sanitation, and personal hygiene will make it possible to reduce considerably the propagation of these diseases and several others. It is therefore important to provide these populations with the necessary equipment for an adequate drinking water supply, but also to promote health education to avoid water pollution. The search for solutions to these problems will lead to a plan for future action.

[Assessment of the quality of response to the 2008 cholera outbreak in Contonou (Benin)]. / La riposte à l'épidémie de choléra de 2008 à Cotonou (Bénin).

To assess the quality of the response to the 2008 outbreak of cholera in Cotonou (Benin), this retrospective study focused on the health professionals managing the response, community leaders, cases of cholera found in homes and health service documents. The terms of reference used for the purposes of this assessment included the WHO recommendations and the rules set out in the national plan for the fight against epidemics. The resources and method used in this study complied with the norms specified in the plan, as did the epidemiologic follow-up. Community and family interventions concerned only a limited number of households in comparison with the total number of cases. Of the 402 cases diagnosed between July 28th and October 16th 2008, 384 cases were given treatment complying with the specified protocols, and just one death was recorded (hospital lethality 0.25%). The mean length of hospitalization was 2.43 days ± 1.16. Compliance with standard response procedures resulted in good quality care and very low lethality. The national plan of response to epidemics is therefore validated. An improved management of outbreaks requires national multi-sector coordination. Authorities in the following areas need to be involved: healthcare, environment, education, public administration and local communities.

[Factors associated with the quality of sterilization of surgical drapes at the National Hospital University Hubert Koutoukou Maga of Cotonou]. / Facteurs associés à la qualité de la stérilisation du linge opératoire au Centre National Hospitalier Universitaire Hubert Koutoukou MAGA de Cotonou.

INTRODUCTION: The sterilization of surgical drapes plays an important role in preventing infections associated with treatments. At the CNHU-HKM, sterilization procedure for drapes encounters problems. The purpose of this study was to examine the factors associated with the quality of sterilization of surgical drapes at the CNHU-HKM. METHODS: We conducted a cross-sectional, descriptive and analytical study focusing on 20 sterile surgical drapes, 41 agents were involved in the management of drapes and 55 members of the surgical team. The probabilistic method was used for sterile surgical drapes, the non-probabilistic method for the others. Pearson's Chi-square Test and logistic regression were used to find the association, with a significant threshold and a p<0.05. RESULTS: Eighty six point forty six percent of subjects were males with an average age of 42 years. The quality of the process of sterilization of the operative drapes was not good in the two departments responsible for processing the drapes. Bacteriological analysis showed that, out of 20 sterile surgical drapes, 9 had Acinetobacter spp. a multidrug-resistant germ causing nosocomial infections. Multivariate analysis showed that professional experience (p=0.015) and quality control of the procedure (p=0.034) were statistically associated with the quality of sterilization. CONCLUSION: The presence of Acinetobacter spp. on the sterilized drapes demonstrates that sterilization of drapes at the CNHU-HKM is of poor quality. Measures strengthening the skills of providers are necessary to improve the quality of sterilization procedures.

Migraine among university students in Cotonou (Benin).

BACKGROUND: Few data are available on migraine among students in Africa. The aim of this study was to estimate the prevalence of migraine and describe its clinical features and associated conditions among students of the Faculty of Health Sciences of Abomey-Calavi University, in Cotonou, Benin. METHODS: A cross-sectional study was prospectively conducted during the academic year 2002-2003 and included 336 students selected using systematic random sampling. Migraine was defined according International Headache Society criteria 1988. RESULTS: The lifetime prevalence of migraine was 11.3% (95% CI: 8.2-15.3%). The prevalence was significantly higher in females (18.3%) than males (6.8%), in married-widowed (30.4%) than single (9.9%). The mean age at onset of the disease was 15.0 years +/- 2.5. Migraine without aura was the more frequent form (57.9%). The mean attack frequency per month was 3.8 (+/-3.4) and the peak attack duration was between 4 and 6 hours. Psychological tiredness was the most frequent triggering factors (92.1%). The factors associated with migraine in multivariate analysis were female sex (OR = 2.6 [95% CI: 1.2-5.3]), single marital status (OR = 3.7 [95% CI: 1.2-11.9]) and presence of a family history of headache (OR = 2.9 [95% CI: 1.0-8.1]) CONCLUSION: Migraine was frequent in students in Cotonou (Benin) compared with other studies in Africa.

[Nosocomial urinary tract and surgical site infection rates in the Maternity Ward at the General Referral Hospital in Katuba, Lubumbashi, Democratic Republic of the Congo]. / L'incidence des infections nosocomiales urinaires et des sites opératoires dans la maternité de l'Hôpital Général de Référence de Katuba à Lubumbashi en République Démocratique du Congo.

INTRODUCTION: In Intertropical Africa hospitalized patients are exposed to a risk of nosocomial infections. The dearth of published data on this subject limits the descriptive analysis of the situation. This study aimed to determine the incidence, the germs responsible for these infections and the risk factors of nosocomial infections in the Maternity Ward at the General Referral Hospital in Katuba, Lubumbashi, Democratic Republic of the Congo. METHODS: We conducted a descriptive, longitudinal study from 1 October 2014 to 1 January 2015. Our study population consisted of 207 women who had been hospitalized in the Maternity Ward at the General Referral Hospital in Katuba. We carried out a comprehensive data collection. RESULTS: Nosocomial infection rate accounted for 15.5%. Parturient women who had been hospitalized for more than three days were three times more likely to develop a nosocomial infection (p=0.003), while those who had had a complicated delivery were four times more likely to be at risk of developing nosocomial infection (p = 0.000). Escherichia coli was the most isolated causative agent (38.1%), followed by Citrobacter freundi (23.8%), Acinobacter baumani (.18, 2%), Staphylococcus aureus (18.2%), Enterococcus aureus (14.3%) and Pseudomonas aeroginosa (9.1%). Ampicillin was the most prescribed antibiotic, to which isolated microbes were resistant. CONCLUSION: It is necessary to improve hospital hygiene and to conduct further study to examine the similarity between germs strains in the environment and those in biological fluids.

Genetic Variation in Autophagy-Related Genes Influences the Risk and Phenotype of Buruli Ulcer.

INTRODUCTION: Buruli ulcer (BU) is a severe necrotizing human skin disease caused by Mycobacterium ulcerans. Clinically, presentation is a sum of these diverse pathogenic hits subjected to critical immune-regulatory mechanisms. Among them, autophagy has been demonstrated as a cellular process of critical importance. Since microtubules and dynein are affected by mycolactone, the critical pathogenic exotoxin produced by M. ulcerans, cytoskeleton-related changes might potentially impair the autophagic process and impact the risk and progression of infection. OBJECTIVE: Genetic variants in the autophagy-related genes NOD2, PARK2 and ATG16L1 has been associated with susceptibility to mycobacterial diseases. Here, we investigated their association with BU risk, its severe phenotypes and its progression to an ulcerative form. METHODS: Genetic variants were genotyped using KASPar chemistry in 208 BU patients (70.2% with an ulcerative form and 28% in severe WHO category 3 phenotype) and 300 healthy endemic controls. RESULTS: The rs1333955 SNP in PARK2 was significantly associated with increased susceptibility to BU [odds ratio (OR), 1.43; P = 0.05]. In addition, both the rs9302752 and rs2066842 SNPs in NOD2 gee significantly increased the predisposition of patients to develop category 3 (OR, 2.23; P = 0.02; and OR 12.7; P = 0.03, respectively, whereas the rs2241880 SNP in ATG16L1 was found to significantly protect patients from presenting the ulcer phenotype (OR, 0.35; P = 0.02). CONCLUSION: Our findings indicate that specific genetic variants in autophagy-related genes influence susceptibility to the development of BU and its progression to severe phenotypes.

Data quality assessment in the routine health information system: an application of the Lot Quality Assurance Sampling in Benin.

Health information systems in developing countries are often faulted for the poor quality of the data generated and for the insufficient means implemented to improve system performance. This study examined data quality in the Routine Health Information System in Benin in 2012 and carried out a cross-sectional evaluation of the quality of the data using the Lot Quality Assurance Sampling method. The results confirm the insufficient quality of the data based on three criteria: completeness, reliability and accuracy. However, differences can be seen as the shortcomings are less significant for financial data and for immunization data. The method is simple, fast and can be proposed for current use at operational level as a data quality control tool during the production stage.

An ace-1 gene duplication resorbs the fitness cost associated with resistance in Anopheles gambiae, the main malaria mosquito.

Widespread resistance to pyrethroids threatens malaria control in Africa. Consequently, several countries switched to carbamates and organophophates insecticides for indoor residual spraying. However, a mutation in the ace-1 gene conferring resistance to these compounds (ace-1(R) allele), is already present. Furthermore, a duplicated allele (ace-1(D)) recently appeared; characterizing its selective advantage is mandatory to evaluate the threat. Our data revealed that a unique duplication event, pairing a susceptible and a resistant copy of the ace-1 gene spread through West Africa. Further investigations revealed that, while ace-1(D) confers less resistance than ace-1(R), the high fitness cost associated with ace-1(R) is almost completely suppressed by the duplication for all traits studied. ace-1 duplication thus represents a permanent heterozygote phenotype, selected, and thus spreading, due to the mosaic nature of mosquito control. It provides malaria mosquito with a new evolutionary path that could hamper resistance management.

[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.