Prognostic factors and overall survival of breast cancer in Benin: a hospital-based study.

BACKGROUND: In Benin, a country in West Africa, breast cancer is the leading cancer in women, both in terms of incidence and mortality. However, evidence on the mortality of breast cancer and its associated factors is lacking in this country. Our aim was to describe and analyze the clinical, histopathological, and prognostic aspects of breast cancer in Benin. METHODS: A descriptive and analytical study was carried out at the CNHU-HKM and the CHU-MEL, two major tertiary referral hospitals for breast cancer management located in Cotonou, the capital city of Benin. All breast cancer medical records with histological evidence and immunohistochemistry studies were retrospectively collected between January 1, 2014, and September 30, 2020, in these two tertiary referral hospitals and analyzed in the current study. RESULTS: Finally, 319 medical records were included. The mean age at diagnosis was 48.74 years. The tumors were most frequently classified as T4 (47.6%) with lymph node involvement N2 (34.5%), and metastases were clinically noted in 21.9% of cases. Stage was reported in the medical records of 284 patients. Tumors were diagnosed at very late AJCC stages: stage III (47.5%) and stage IV (24.7%). Grades SBR 2 (49.2%) and SBR 3 (32.6%) were the most frequent grades. Triple-negative breast cancer (31.3%) was the most common molecular type. The overall 5-year survival was 48.49%. In multivariable analysis, the poor prognostic factors were lymph node invasion (HR = 2.63; p = 0.026; CI: [1.12, 6.17]), the presence of metastasis (HR = 3.64; p < 0.001); CI: [2.36, 5.62] and the immunohistochemical profile (HR = 1.29; p < 0.001; CI: [1.13, 1.48]). CONCLUSIONS: Breast cancer in Beninese is predominant in young adults and is often diagnosed at a late stage. The survival of breast cancer patients in Benin can be improved by enhancing early diagnosis and multidisciplinary management.

[Prevention and factors associated with anti-HCV carriage in pregnant women living in Cotonou]. / Prévalence et facteurs associés au portage des anticorps anti-VHC chez des femmes enceintes à Cotonou.

INTRODUCTION: hepatitis C is an infection which can be passed from mother to child. The purpose of this study was to investigate the prevalence of colonization by anti-HCV antibodies in pregnant women living in Cotonou and to identify factors associated with it. METHODS: we conducted a cross-sectional study of 253 pregnant women admitted for prenatal care in four major maternity hospitals in Cotonou (Benin) from 01/06/2018 to 01/09/2018. Anti-HCV antibodies were detected using rapid diagnostic tests. A venous blood sample was collected from pregnant women tested positive for anti-HCV before confirmatory serological tests and screening tests for gestational diabetes. RESULTS: the prevalence of anti-HCV antibodies was 1.2% (3/253 pregnant women). Factors associated with HCV carriage couldn't be identified given the low number of positive cases. However, pregnant women who were carriers of hepatitis C antibodies had higher mean age (32 ± 3) compared to the remainder of the population (29.58 ± 5.5). Potential risk factors for HCV infection were scarifications, piercing, tattooing, sharing of manicure equipment, a history of surgery and blood transfusions. The prevalence of gestational diabetes in our study population was 7.9% (20/253). No association was found between gestational diabetes and hepatitis C. CONCLUSION: the prevalence of anti-HCV antibodies in pregnant women living in Cotonou was low. A national-level study is needed to identify factors associated with this infection.

Caesarean section in Benin and Mali: increased recourse to technology due to suffering and under-resourced facilities.

In line with policies to combat maternal mortality, the medicalization of childbirth is increasing in low-income countries, while access to healthcare services remains difficult for many women. High caesarean section rates have been documented recently in hospitals in Mali and Benin, illustrating an a-priori paradoxical situation, compared with low caesarean section rates in the population. Through a qualitative approach, this article aims to describe the practice of caesarean section in maternity wards in Bamako and Cotonou. Workshops with obstetricians and midwives; participant observation inside labour rooms; and in-depth interviews with caregivers, patients and policy makers have indicated increased recourse to caesarean section due to women's and caregivers' suffering and under-resourced facilities. Within these procedures, two types of caesarean section were documented: 'maternal distress caesarean section' and 'preventive caesarean section'. The main reasons for these caesarean sections are maternal fear and pain, and a lack of resources. Inadequately resourced facilities lead to staff suffering and ethical breakdowns, and encourage the inappropriate use of technology. The policy of access to free caesarean section procedures exacerbates the issue of non-medically-justified caesarean sections in these countries. The overuse of caesarean section is particularly alarming in countries with high fertility as it constitutes a danger to both mothers and babies in the short and long term. Currently, conditions are in place in Benin and Mali for an increase in non-medically-justified caesarean sections. In the short term, such an increase could constitute a new burden for these two sub-Saharan countries, where maternal mortality is high.

Why are caesarean section rates so high in facilities in Mali and Benin?

OBJECTIVE: To assess new estimates of caesarean section (c-section) rates in facilities in two sub-Saharan countries using the Robson classification. METHODS: This study is a retrospective study. Workshops were organized in Mali and Benin in 2017 to train health care professionals in the use of the Robson classification. Nine health facilities in Mali and Benin were selected to participate in the study. Data for deliveries performed in 2014, 2015, and 2016 were included. RESULTS: A total of 12,472 deliveries were included. The overall c-section rate was high in facilities in both countries: 31.0% in Mali and 43.9% in Benin. Women classified as high-risk (groups 6-10) were small relative contributors to the overall c-section rate (19.3% in Mali and 25.3% in Benin), while low-risk women (groups 1-4) were high relative contributors (55.4% in Mali and 45.2% in Benin). C-section rates in women who had undergone a previous c-section were especially high in both countries (84.0% in Mali; 82.5% in Benin). This group was the largest contributor to the overall c-section rates in both countries. CONCLUSIONS: We found high c-section rates in facilities in Mali and Benin, particularly for low-risk women and for women with a previous c-section. Further investigations should be carried out to understand why the c-section rates are so high in these facilities. Strategies must be implemented to avoid unnecessary c-sections, which potentially lead to further complications, particularly in countries with high fertility rates.