Quality of maternal care in the hospital pyramid in Benin: Challenges and prospects / La qualité des soins maternels de la pyramide hospitalière au Bénin : défis et perspectives

Introduction: The quality of health care in general and that of maternal health in particular is an issue that concerns all countries, especially developing countries like Benin. Purpose of research: To assess the quality of care offered to mothers within the hospital pyramid in Benin. Results: Out of a total of 36 hospitals surveyed, nine (25%) did not have a neonatal unit. This study showed an overall fair quality in the area of maternal care with an average score of 3.6. Thus, the differences in the quality of this care obtained need significant improvement. Providers' satisfaction was acceptable unlike beneficiaries who expressed dissatisfaction. Conclusions: Most hospitals in Benin do not yet provide quality maternal care, which is effective, efficient, continuous, accessible, and safe. Evidence-based interventions that focus on the identified shortcomings will improve the quality of maternal health care in Benin's hospital pyramid.

Introduction: La qualité des soins de santé en général, et de la santé maternelle en particulier, est une question qui interpelle tous les pays, en l'occurrence ceux en voie de développement comme le Bénin. But de l'étude: Évaluer la qualité des soins offerts aux mères au niveau de la pyramide hospitalière au Bénin. Résultats: Sur un total de 36 hôpitaux enquêtés, neuf (25 %) ne disposaient pas d'une unité de néonatologie. Cette étude a montré globalement une qualité passable dans le domaine des soins maternels avec un score moyen de 3,6. Ainsi, les écarts de qualité de ces soins obtenus nécessitent des améliorations importantes. La satisfaction des prestataires était acceptable contrairement aux bénéficiaires qui ont manifesté une insatisfaction. Conclusions: La plupart des hôpitaux du Bénin n'assurent pas encore des soins maternels de qualité, c'est-à-dire des soins efficaces, efficients, continus, accessibles et garantissant la sécurité des patients. Des interventions probantes focalisées sur les dysfonctionnements identifiés permettront d'améliorer la qualité de la santé maternelle au niveau de la pyramide hospitalière du Bénin.

Impact of long-lasting, insecticidal nets on anaemia and prevalence of Plasmodium falciparum among children under five years in areas with highly resistant malaria vectors.

BACKGROUND: The widespread use of insecticide-treated nets (LLINs) leads to the development of vector resistance to insecticide. This resistance can reduce the effectiveness of LLIN-based interventions and perhaps reverse progress in reducing malaria morbidity. To prevent such difficulty, it is important to know the real impact of resistance in the effectiveness of mosquito nets. Therefore, an assessment of LLIN efficacy was conducted in malaria prevention among children in high and low resistance areas. METHODS: The study was conducted in four rural districts and included 32 villages categorized as low or high resistance areas in Plateau Department, south-western Benin. Larvae collection was conducted to measure vector susceptibility to deltamethrin and knockdown resistance (kdr) frequency. In each resistance area, around 500 children were selected to measure the prevalence of malaria infection as well as the prevalence of anaemia associated with the use of LLINs. RESULTS: Observed mortalities of Anopheles gambiae s.s population exposed to deltamethrin ranged from 19 to 96%. Knockdown resistance frequency was between 38 and 84%. The prevalence of malaria infection in children under five years was 22.4% (19.9-25.1). This prevalence was 17.3% (14.2-20.9) in areas of high resistance and 27.1% (23.5-31.1) in areas of low resistance (p=0.04). Eight on ten children that were aged six - 30 months against seven on ten of those aged 31-59 months were anaemic. The anaemia observed in the six to 30-month old children was significantly higher than in the 31-59 month old children (p=0.00) but no difference associated with resistance areas was observed (p=0.35). The net use rate was 71%. The risk of having malaria was significantly reduced (p<0.05) with LLIN use in both low and high resistance areas. The preventive effect of LLINs in high resistance areas was 60% (95% CI: 40-70), and was significantly higher than that observed in low resistance areas (p<0.05). CONCLUSION: The results of this study showed that the resistance of malaria vectors seems to date not have affected the impact of LLINs and the use of LLINs was highly associated with reduced malaria prevalence irrespective of resistance.

Lessons learnt in scaling up evidence-based comprehensive health sector responses addressing female genital mutilation in highly prevalent settings.

Female genital mutilation (FGM) affects over 200 million girls and women. Its health complications include acute and potentially lifelong urogenital, reproductive, physical, mental health complications with estimated health treatment costs of US$1.4 billion per year. Moreover, there is a concerning rise in the trend of FGM medicalisation with almost one in five FGM cases being performed by a health worker.The WHO developed several evidence-based resources to apply a comprehensive health approach to strengthen FGM prevention and care services. However, there has been limited uptake of this comprehensive approach in FGM prevalent settings. To address this, a three-step multicountry participatory process was used to engage health sector players from FGM prevalent settings to develop comprehensive action plans, implement foundational activities and harness the learnings to inform subsequent planning and implementation. Support to adapt evidence-based resources and seed funding were also provided to initiate foundational activities that had potential for scale up.A total of 15 countries participated in this three-step this approach between 2018 and 2022. Ten countries developed comprehensive national action plans and eight WHO resources were adapted for foundational activities.This scale up approach can be strengthened by increasing the frequency of multicountry experience sharing meetings, identifying in-country champions to continuously advocate for FGM integration within (public and private) health services and securing stable funding to implement foundational activities. Documentation of each country's experience as case studies including monitoring and evaluation are essential to expand the learning and quality of the health interventions addressing FGM.

Bendiocarb, a potential alternative against pyrethroid resistant Anopheles gambiae in Benin, West Africa.

BACKGROUND: Anopheles gambiae, the main malaria vector in Benin has developed high level of resistance to pyrethroid insecticides, which is a serious concern to the future use of long-lasting insecticidal nets (LLIN) and indoor residual spraying (IRS). In this context, one of the pathways available for malaria vector control would be to investigate alternative classes of insecticides with different mode of action than that of pyrethroids. The goal of this study was to evaluate under field conditions the efficacy of a carbamate (bendiocarb) and an organophosphate (fenitrothion) against pyrethroid-resistant An. gambiae s.s. METHODS: Wild populations and females from laboratory colonies of five days old An. gambiae were bio-assayed during this study. Two pyrethroids (deltamethrin and alphacypermethrin), an organophosphate (fenitrothion), a carbamate (bendiocarb) and a mixture of an organophosphate (chlorpyriphos + a pyrethroid deltamethrin) were compared in experimental huts as IRS treatments. Insecticides were applied in the huts using a hand-operated compression sprayer. The deterrency, exophily, blood feeding rate and mortality induced by these insecticides against An. gambiae were compared to the untreated control huts. RESULTS: Deltamethrin, alphacypermethrin and bendiocarb treatment significantly reduced mosquito entry into the huts (p < 0.05) compared to untreated huts. Blood feeding rates in huts treated with fenitrothion and the mixture chlorpyriphos/deltamethrin were reduced from 10.95% respectively to 3.7% and 4.47% three months after treatment and from 10.20% to 4.4% and 2.04% four months after treatment. Exophily rates in huts with deltamethrin, alphacypermethrin and the mixture chlorpyriphos/deltamethrin were significantly higher than in the huts with fenitrothion. Deltamethrin and alphacypermethrin had the lowest mortality rate while fenitrothion killed 100% of An. gambiae (in the first month) and 77.8% (in the fourth month). Bendiocarb and the mixture chlorpyriphos/deltamethrin mortality rates ranged from 97.9 to 100% the first month and 77.7-88% the third month respectively. CONCLUSION: After four months, fenitrothion, bendiocarb and the mixture chlorpyriphos/deltamethrin performed effectively against pyrethroid-resistant Anopheles. These results showed that bendiocarb could be recommended as an effective insecticide for use in IRS operations in Benin, particularly as the mixture chlorpyriphos/deltamethrin does not have WHOPES authorization and complaints were mentioned by the sleepers about the safety and smell of fenitrothion.

Insecticide resistance status in Anopheles gambiae in southern Benin.

BACKGROUND: The emergence of pyrethroid resistance in Anopheles gambiae has become a serious concern to the future success of malaria control. In Benin, the National Malaria Control Programme has recently planned to scaling up long-lasting insecticidal nets (LLINs) and indoor residual spraying (IRS) for malaria prevention. It is, therefore, crucial to monitor the level and type of insecticide resistance in An. gambiae, particularly in southern Benin where reduced efficacy of insecticide-treated nets (ITNs) and IRS has previously been reported. METHODS: The protocol was based on mosquito collection during both dry and rainy seasons across forty districts selected in southern Benin. Bioassay were performed on adults collected from the field to assess the susceptibility of malaria vectors to insecticide-impregnated papers (permethrin 0.75%, delthamethrin 0.05%, DDT 4%, and bendiocarb 0.1%) following WHOPES guidelines. The species within An. gambiae complex, molecular form and presence of kdr and ace-1 mutations were determined by PCR. RESULTS: Strong resistance to permethrin and DDT was found in An. gambiae populations from southern Benin, except in Aglangandan where mosquitoes were fully susceptible (mortality 100%) to all insecticides tested. PCR showed the presence of two sub-species of An. gambiae, namely An. gambiae s.s, and Anopheles melas, with a predominance for An. gambiae s.s (98%). The molecular M form of An. gambiae was predominant in southern Benin (97%). The kdr mutation was detected in all districts at various frequency (1% to 95%) whereas the Ace-1 mutation was found at a very low frequency (

Impact of operational effectiveness of long-lasting insecticidal nets (LLINs) on malaria transmission in pyrethroid-resistant areas.

BACKGROUND: A dynamic study on the transmission of malaria was conducted in two areas (R⁺ area: Low resistance area; R⁺⁺⁺ area: High resistance area) in the department of Plateau in South Eastern Benin, where the population is protected by Long Lasting Insecticidal Nets (LLINs). The aim of this study was to determine if the resistance of malaria vectors to insecticides has an impact on their behavior and on the effectiveness of LLINs in the reduction of malaria transmission. METHODS: Populations of Anopheles gambiae s.l. were sampled monthly by human landing catch in the two areas to evaluate human biting rates (HBR). Collected mosquitoes were identified morphologically and female Anopheles mosquitoes were tested for the presence of Plasmodium falciparum antigen as assessed using ELISA. The entomological inoculation rate (EIR) was also calculated (EIR = HBR x sporozoitic index [S]). We estimated the parity rate by dissecting the females of An. gambiae. Finally, window catch and spray catch were conducted in order to assess the blood feeding rate and the exophily rate of vectors. RESULTS: After 6 months of tracking the mosquito's behavior in contact with the LLINs (Olyset) in R⁺⁺⁺ and R⁺ areas, the entomological indicators of the transmission of malaria (parity rate and sporozoitic index) were similar in the two areas. Also, An. gambiae populations showed the same susceptibility to P. falciparum in both R⁺ and R⁺⁺⁺ areas. The EIR and the exophily rate are higher in R⁺ area than in R⁺⁺⁺ area. But the blood-feeding rate is lower in R⁺ area comparing to R⁺⁺⁺. CONCLUSION: The highest entomological inoculation rate observed in R⁺ area is mostly due to the strong aggressive density of An. gambiae recorded in one of the study localities. On the other hand, the highest exophily rate and the low blood-feeding rate recorded in R⁺ area compared to R⁺⁺⁺ area are not due to the resistance status of An. gambiae, but due to the differences in distribution and availability of breeding sites for Anopheles mosquitoes between areas. However, this phenomenon is not related to the resistance status, but is related to the environment instead.

Impact of land-use on malaria transmission in the Plateau region, southeastern Benin.

BACKGROUND: The goal of the study is to investigate if local agricultural practices have an impact on malaria transmission in four villages located in the same geographical area within a radius of 15 kilometers. Among the villages, one (Itassoumba) is characterized by the presence of a large market garden and fishpond basins, the three others (Itakpako, Djohounkollé and Ko-koumolou) are characterized by traditional food-producing agriculture. METHODS: Malaria transmission was evaluated using human-landing catches, both indoors and outdoors, two nights per month for 12 months. Field collected females An. gambiae s.l. were exposed for 1 hour to 0.75% permethrin and 0.05% deltamethrin using WHO insecticide susceptibility test kits and procedures. The presence of the kdr mutation was analyzed by PCR. RESULTS: Anopheles gambiae s.s form M (93.65%), was identified as the main malaria vector. Its susceptibility level to pyrethroids was the same (p > 0.05) in all villages. kdr mutation frequencies are 81.08 in Itakpako, 85 in Itassoumba, 79.73 in Djohounkollé and 86.84 in Ko-Koumolou (p = 0.63). The entomological inoculation rate ranged from 9.62 to 21.65 infected bites of An. gambiae per human per year in Djohounkollé, Itakpako and Ko-Koumolou against 1159.62 in Itassoumba (p < 0.0001). CONCLUSION: The level of resistance of An. gambiae to pyrethroids was the same in the four villages. The heterogeneous character of malaria epidemiology was confirmed. The creation of fishponds basins and the development of market-gardening activities increased drastically the malaria transmission in Itassoumba.