Interest of seroprevalence surveys for the epidemiological surveillance of the SARS-CoV-2 pandemic in African populations: Insights from the ARIACOV project in Benin.

BACKGROUND: Many SARS-CoV-2 seroprevalence surveys since the end of 2020 have disqualified the first misconception that Africa had been spared by the pandemic. Through the analysis of three SARS-CoV-2 seroprevalence surveys carried out in Benin as part of the ARIACOV project, we argue that the integration of epidemiological serosurveillance of the SARS-CoV-2 infection in the national surveillance packages would be of great use to refine the understanding of the COVID-19 pandemic in Africa. METHODS: We carried out three repeated cross-sectional surveys in Benin: two in Cotonou, the economic capital in March and May 2021, and one in Natitingou, a semi-rural city in the north of the country in August 2021. Total and weighted-by-age-group seroprevalences were estimated and the risk factors for SARS-CoV-2 infection were assessed by multivariate logistic regression. RESULTS: In Cotonou, a slight increase in overall age-standardised SARS-CoV-2 seroprevalence from 29.77% (95% CI: 23.12%-37.41%) at the first survey to 34.86% (95% CI: 31.57%-38.30%) at the second survey was observed. In Natitingou, the globally adjusted seroprevalence was 33.34% (95% CI: 27.75%-39.44%). A trend of high risk for SARS-CoV 2 seropositivity was observed in adults over 40 versus the young (less than 18 years old) during the first survey in Cotonou but no longer in the second survey. CONCLUSIONS: Our results show that, however, rapid organisation of preventive measures aimed at breaking the chains of transmission, they were ultimately unable to prevent a wide spread of the virus in the population. Routine serological surveillance on strategic sentinel sites and/or populations could constitute a cost-effective compromise to better anticipate the onset of new waves and define public health strategies.

Emergence of SARS-CoV-2 Delta Variant, Benin, May-July 2021.

Severe acute respiratory syndrome coronavirus 2 Delta variant epidemiology in Africa is unknown. We found Delta variant was introduced in Benin during April-May 2021 and became predominant within 2 months, after which a steep increase in reported coronavirus disease incidence occurred. Benin might require increased nonpharmaceutical interventions and vaccination coverage.

Limited Specificity of Serologic Tests for SARS-CoV-2 Antibody Detection, Benin.

We used commercially available ELISAs to test 68 samples from coronavirus disease cases and prepandemic controls from Benin. We noted <25% false-positive results among controls, likely due to unspecific immune responses elicited by acute malaria. Serologic tests must be carefully evaluated to assess coronavirus disease spread and immunity in tropical regions.

Mutations Associated with SARS-CoV-2 Variants of Concern, Benin, Early 2021.

Intense transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in Africa might promote emergence of variants. We describe 10 SARS-CoV-2 lineages in Benin during early 2021 that harbored mutations associated with variants of concern. Benin-derived SARS-CoV-2 strains were more efficiently neutralized by antibodies derived from vaccinees than patients, warranting accelerated vaccination in Africa.

Possible effect of maternal safe food preparation behavior on child malnutrition in Benin, Africa.

BACKGROUND: In many developing countries, faulty complementary feeding practises and frequently contaminated foods are contributing factors to child malnutrition. The aims of this study were to evaluate the nutrition status of, and clarify the maternal safe food preparation behaviors associated with malnutrition in, children aged <5 years in Cotonou, Benin. METHODS: This study targeted 300 mother-child pairs visiting the University Hospital of Mother and Child Cotonou Lagoon. Mothers were interviewed using a structured questionnaire. Child height/length and weight measurements were determined and Z-scores were calculated using the 2006 World Health Organization Child Growth Standards. Children with Z-score < -2 were considered to have stunting or be underweight. On logistic regression analysis, significant variables on bivariate analysis, the associations of which were clarified in previous studies, were established as independent variables. Approximately 80% of the children who participated in this study were aged < 1 year. Being underweight was analyzed as a dependent variable. RESULTS: Regarding nutrition status, 11.0% of the children had stunting and 14.7% were underweight. On logistic regression analysis, underweight was correlated significantly with birthweight. As a remarkable point, food refrigeration was statistically significant. Food refrigeration can possibly be regarded as a maternal safe food preparation behavior. CONCLUSIONS: Maternal safe food preparation behaviors can prevent child malnutrition, even after considering biological and socioeconomic factors.

Differential protein expression profiles between Plasmodium falciparum parasites isolated from subjects presenting with pregnancy-associated malaria and uncomplicated malaria in Benin.

BACKGROUND: Plasmodium falciparum is responsible for severe malaria, including pregnancy-associated malaria (PAM). During intra-erythrocytic maturation, the infected erythrocyte (iE) membrane is modified by insertion of parasite-derived proteins, primarily consisting of variant surface antigens such as P. falciparum erythrocyte membrane protein-1. METHODS: To identify new PAM-specific parasite membrane proteins, we conducted a mass spectrometry-based proteomic study and compared the protein expression profiles of 10 PAM and 10 uncomplicated malaria (UM) samples. RESULTS: We focused on the 454/1139 membrane-associated and hypothetical proteins for comparative analysis. Using filter-based feature-selection methods combined with supervised data analysis, we identified a subset of 53 proteins that distinguished PAM and UM samples. Up to 19/20 samples were correctly assigned to their respective clinical group. A hierarchical clustering analysis of these 53 proteins based on the similarity of their expression profiles revealed 2 main clusters of 40 and 13 proteins that were under- or over-expressed, respectively, in PAM. CONCLUSIONS: VAR2CSA is identified and associated with PAM, validating our experimental approach. Other PAM-predictive proteins included PFI1785w, PF14_0018, PFB0115w, PFF0325c, and PFA_0410w. These proteomics data demonstrate the involvement of selected proteins in the pathophysiology of PAM, providing new insights for the definition of potential new targets for a vaccine against PAM.

Assessment of COVID-19 Vaccine Acceptance and Its Associated Factors during the Crisis: A Community-Based Cross-Sectional Study in Benin.

BACKGROUND: Having a maximum number of people vaccinated was the objective to control the COVID-19 pandemic. We report in this manuscript the factors associated with the willingness to be vaccinated against COVID-19 during the pandemic period. METHODS: From April to May 2022, a community-based cross-sectional survey was performed. Participants were randomly selected from four districts in Benin (taking into account the COVID-19 prevalence). Mixed-effect logistic regression models were used to identify the variables associated with COVID-19 vaccine acceptance. RESULTS: A total of 2069 participants were included. The proportion of vaccine acceptance was 43.3%. A total of 24.2% were vaccinated and showed proof of vaccination. The population's request for vaccination was higher after the third epidemic wave. The district of residence, the education level, a fear of being infected, the channel of information, poor medical conditions, a good knowledge of the transmission mode and symptoms, and good behaviors were significantly associated with vaccine acceptance. CONCLUSION: The overall acceptance of the COVID-19 vaccine in the Beninese population was relatively high. However, vaccine campaigns in areas with a low acceptance as well as the disclosure of information, particularly on our knowledge of the disease and the safety, side effects, and effectiveness of the COVID-19 vaccines, should be strengthened with adapted and consistent messages.

[Delivery in free position perhaps a solution to change delivery in traditional position in delivery rooms in Africa: results of a prospective study in Cotonou in Bénin]. / L'accouchement en position libre peut-il être une solution de rechange à l'accouchement en position classique dans les salles de naissance en Afrique : résultats d'une étude. prospective à Cotonou au Bénin

INTRODUCTION: In most of Africa's birthing units, women are often forbidden to stand during labour and delivery. This study aimed to determine the effect of a freely vertical position (standing,sitting, crouching) compared with the traditional supine position on the course of delivery and on perinatal and maternal outcomes(including the satisfaction level of mothers).Methods: We compared a group of 490 women who chose to deliver in a freely vertical position with 490 women who delivered in a traditional position, at the Hopital de Ia mere et de l'enfant Lagune of Cotonou, from January 1, 2009, to December 31,2011. Variables studied include length of labour, type of delivery,frequency of episiotomy, fetal and neonatal well-being indices(fetal heart rate, Apgar score, resuscitation), and postnatal maternal outcomes (perineal tears, hemorrhagic complications),including maternal satisfaction. Descriptive analysis includes comparisons between those two groups.Results: Both groups had similar maternal (25 years old) and gestational (39 weeks) ages. The "Choice of position" group had a greater number of nulliparous women (53% vs. 40%,P < 0.001) and a higher educational level (high-school diploma and postgraduate training: 77.5% vs. 45.1 %; P < 0.001 ). The average length of the active phase was shortened by 20 minutes in women who freely chose their delivery position (P < 0.01 ).Moreover, these women experienced spontaneous delivery in higher numbers, with 10 times fewer assisted deliveries (0.4%vs. 4.3%; P < 0.01) and two times fewer episiotomy interventions(3.5% vs. 8.0%; P < 0.01) than their counterparts. When women freely choose their delivery position, there are close to three times fewer cases of fetal heart rate anomalies and meconium liquor (2.9% vs. 8.9%; P < 0.01 and 0.4% vs. 1.4%; P < 0.01 ).Perineal and cervical tears are rare and occur in similar numbers in both groups, and the same can be said of cases of postpartum hemorrhage. The number of satisfied mothers is higher in the"Choice of position" group (87.0% vs. 61.2%; P < 0.01 ).Conclusion: The choice of a freely vertical position seems to be an efficient and safe option during labour and delivery, and is more satisfying for mothers.

An Observational Laboratory-Based Assessment of SARS-CoV-2 Molecular Diagnostics in Benin, Western Africa.

Information on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spread in Africa is limited by insufficient diagnostic capacity. Here, we assessed the coronavirus disease (COVID-19)-related diagnostic workload during the onset of the pandemic in the central laboratory of Benin, Western Africa; characterized 12 SARS-CoV-2 genomes from returning travelers; and validated the Da An RT-PCR-based diagnostic kit that is widely used across Africa. We found a 15-fold increase in the monthly laboratory workload due to COVID-19, dealt with at the cost of routine activities. Genomic surveillance showed near-simultaneous introduction of distinct SARS-CoV-2 lineages termed A.4 and B.1, including the D614G spike protein variant potentially associated with higher transmissibility from travelers from six different European and African countries during March-April 2020. We decoded the target regions within the ORF1ab and N genes of the Da An dual-target kit by MinION-based amplicon sequencing. Despite relatively high similarity between SARS-CoV-2 and endemic human coronaviruses (HCoVs) within the ORF1ab target domain, no cross-detection of high-titered cell culture supernatants of HCoVs was observed, suggesting high analytical specificity. The Da An kit was highly sensitive, detecting 3.2 to 9.0 copies of target-specific in vitro transcripts/reaction. Although discrepant test results were observed in low-titered clinical samples, clinical sensitivity of the Da An kit was at least comparable to that of commercial kits from affluent settings. In sum, virologic diagnostics are achievable in a resource-limited setting, but unprecedented pressure resulting from COVID-19-related diagnostics requires rapid and sustainable support of national and supranational stakeholders addressing limited laboratory capacity.IMPORTANCE Months after the start of the COVID-19 pandemic, case numbers from Africa are surprisingly low, potentially because the number of SARS-CoV-2 tests performed in Africa is lower than in other regions. Here, we show an overload of COVID-19-related diagnostics in the central laboratory of Benin, Western Africa, with a stagnating average number of positive samples irrespective of daily sample counts. SARS-CoV-2 genomic surveillance confirmed a high genomic diversity in Benin introduced by travelers returning from Europe and other African countries, including early circulation of the D614G spike mutation associated with potentially higher transmissibility. We validated a widely used RT-PCR kit donated by the Chinese Jack Ma Foundation and confirmed high analytical specificity and clinical sensitivity equivalent to tests used in affluent settings. Our assessment shows that although achievable in an African setting, the burden from COVID-19-related diagnostics on national reference laboratories is very high.

Uterine balloon tamponade as an adjunct to misoprostol for the treatment of uncontrolled postpartum haemorrhage: a randomised controlled trial in Benin and Mali.

OBJECTIVE: To assess the effectiveness of low-cost uterine tamponade as an adjunct to misoprostol for the treatment of uncontrolled postpartum haemorrhage (PPH) in low-resource settings. DESIGN: Randomised controlled trial. SETTING: Seven healthcare facilities in Cotonou, Benin and Bamako, Mali. POPULATION: Women delivering vaginally who had clinically diagnosed PPH that was suspected to be due to uterine atony, who were unresponsive to oxytocin and who needed additional uterotonics. METHODS: Women were randomly assigned to receive uterine balloon tamponade with a condom-catheter device or no tamponade; both groups were also given intrarectal or sublingual misoprostol. MAIN OUTCOME MEASURE: Proportion of women with invasive surgery or who died before hospital discharge. RESULTS: The proportion of primary composite outcome did not differ significantly between the tamponade arm (16%; 9/57) and the standard second line treatment arm (7%; 4/59): relative risk 2.33 (95% CI 0.76 to 7.14, p=0.238). A significantly increased proportion of women with tamponade and misoprostol versus misoprostol alone had total blood loss more than 1000 mL: relative risk 1.52 (95% CI 1.15 to 2.00, p=0.01). Case fatality rate was higher in the tamponade group (10%; 6/57) than in the control group (2%; 1/59) (p=0.059). TRIAL REGISTRATION NUMBER: ISRCT Registry Number 01202389; Post-results.

[Severe acute pancreatitis during pregnancy among black African women: about a case]. / Pancréatite aiguë sévère sur grossesse chez le noir Africain: à propos d'un cas.

Acute pancreatitis is rare during pregnancy. It is associated with high maternofoetal mortality. It is mainly caused by biliary lithiasis but, in many cases, the cause of acute pancreatitis is undetermined. We here report the case of a 37-year old patient presenting with acute pancreatitis revealed by acute febrile bowel obstruction at 29 weeks of amenorrhea. The diagnosis was made during surgery. The patient had a miscarriage in the postoperative period. She died on the 8th postoperative day.

Initial management of postpartum hemorrhage: A cohort study in Benin and Mali.

OBJECTIVE: To determine the components of initial management associated with a decreased risk of severe postpartum hemorrhage (PPH) in Benin and Mali. METHODS: A cohort study was conducted between May 2013 and September 2014 that included all women who delivered vaginally in seven participating centers and who presented excessive bleeding after birth. Severe PPH was defined as PPH that required surgical treatment (vascular ligature and/or hysterectomy), and/or blood transfusion, and/or transfer to an intensive care unit, and/or an outcome of maternal death. Logistic regression was used to identify the components of initial PPH management that were associated with severe PPH, adjusting for case mix. RESULTS: A total of 223 women presented a primary PPH presumably caused by uterine atony. Among those, 88 (39.5%) had severe PPH. Nearly one-third of women (30.4%) had a late injection of oxytocin (>10 minutes) after PPH diagnosis or no injection. Oxytocin injection within 10 minutes after the PPH diagnosis was significantly associated with a decreased risk of severe PPH (adjusted OR=0.3; 95% CI, 0.14-0.77). CONCLUSION: Decrease in the delays in oxytocin administration is a key determinant to improve maternal outcomes related to PPH in this context.

Introduction of misoprostol for the treatment of incomplete abortion beyond 12 weeks of pregnancy in Benin.

Improving the care of women who have undergone a spontaneous or induced abortion is an important step in reducing abortion-related morbidity and mortality. Both the International Federation of Gynecology and Obstetrics (FIGO) and the World Health Organization recommend the use of manual vacuum aspiration (MVA) and misoprostol rather than sharp curettage to treat incomplete abortion. MVA was introduced into the public healthcare service in Benin in 2006 and since 2008 misoprostol has been available in 3 large maternity hospitals. The present study opted to use an oral dose of 800 µg and not to limit to pregnancies of up to 12 weeks, but to include women with second trimester abortions. After 5 years, results show that around three-quarters of the women treated with misoprostol at 13-18 weeks of pregnancy required MVA to complete uterine evacuation and approximately one-quarter had severe bleeding, confirming that the indication of misoprostol for incomplete abortion should be limited to pregnancies of up to 12 weeks.