Optimization of the emergency obstetric and neonatal care network in Benin through expert-based sub-national prioritizations.

Introduction: To reduce maternal mortality by 2030, Benin needs to implement strategies for improving access to high quality emergency obstetric and neonatal care (EmONC). This study applies an expert-based approach using sub-national travel specificities to identify and prioritize a network of EmONC maternities that maximizes both population coverage and functionality. Methods: We conducted a series of workshops involving international, national, and department experts in maternal health to prioritize a set of EmONC facilities that meet international standards. Geographical accessibility modeling was used together with EmONC availability to inform the process. For women in need of EmONC, experts provided insights into travel characteristics (i.e., modes and speeds of travel) specific to each department, enabling more realistic travel times estimates modelled with the AccessMod software. Results: The prioritization approach resulted in the selection of 109 EmONC maternities from an initial group of 125 designated maternities. The national coverage of the population living within an hour's drive of the nearest EmONC maternity increased slightly from 92.6% to 94.1% after prioritization. This increase in coverage was achieved by selecting maternities with sufficient obstetrical activities to be upgraded to EmONC maternities in the Plateau and Atlantique departments. Conclusion: The prioritization approach enabled Benin to achieve the minimum EmONC availability, while ensuring very good geographical accessibility to the prioritized network. Limited human and financial resources can now be targetted towards a smaller number of EmONC facilities to make them fully functioning in the medium-term. By implementing this strategy, Benin aims to reduce maternal mortality rates and deliver effective, high-quality obstetric and neonatal care, especially during emergencies.

The Foreign Oligochaete Species Quistadrilus multisetosus (Smith, 1900) in Lake Geneva: Morphological and Molecular Characterization and Environmental Influences on Its Distribution.

The presence of the oligochaete species Quistadrilus multisetosus (Smith, 1900) originating from North America has been mentioned for several decades in Europe, the Middle East and Russia. Its distribution and abundance in Europe is still unknown but it can be considered as potentially invasive. This species was recently discovered in Lake Geneva (Switzerland/France) and three other Swiss lakes. The aims of the present work are to report its repartition and abundance in Lake Geneva, to study its ecology and to determine its invasive potential in this lake. We also provide an identification key for correctly differentiating Q. multisetosus from the closely related species Spirosperma ferox Eisen, 1879 and Embolocephalus velutinus (Grube, 1879), and study the phylogenetic position of Q. multisetosus within several Tubificinae lineages based on the cytochrome c oxidase (COI) marker. Twenty-eight sites have been monitored since 2009 in Lake Geneva. In several sites, the COI sequence corresponding to this species was also searched for in sediment samples using high-throughput sequencing. In addition, we examined specimens collected in this lake before 2009 likely to belong to Q. multisetosus and to have been misidentified. We found that Q. multisetosus was only present in the lake downstream of a wastewater treatment plant and a combined sewer overflow in the Vidy Bay (near Lausanne) and at a site located nearby. These results confirmed the high tolerance of this species to organic matter pollution. Q. multisetosus was already present in this location in 1974 (misidentified as Spirosperma ferox), which suggests that Q. multisetosus has a limited capacity to disseminate in this lake. However, we recommend continuing monitoring its presence in Lake Geneva in the future, especially in the context of warming of waters that could contribute to the expansion of this species.

Spatial access inequities and childhood immunisation uptake in Kenya.

BACKGROUND: Poor access to immunisation services remains a major barrier to achieving equity and expanding vaccination coverage in many sub-Saharan African countries. In Kenya, the extent to which spatial access affects immunisation coverage is not well understood. The aim of this study was to quantify spatial accessibility to immunising health facilities and determine its influence on immunisation uptake in Kenya while controlling for potential confounders. METHODS: Spatial databases of immunising facilities, road network, land use and elevation were used within a cost friction algorithim to estimate the travel time to immunising health facilities. Two travel scenarios were evaluated; (1) Walking only and (2) Optimistic scenario combining walking and motorized transport. Mean travel time to health facilities and proportions of the total population living within 1-h to the nearest immunising health facility were computed. Data from a nationally representative cross-sectional survey (KDHS 2014), was used to estimate the effect of mean travel time at survey cluster units for both fully immunised status and third dose of diphtheria-tetanus-pertussis (DPT3) vaccine using multi-level logistic regression models. RESULTS: Nationally, the mean travel time to immunising health facilities was 63 and 40 min using the walking and the optimistic travel scenarios respectively. Seventy five percent of the total population were within one-hour of walking to an immunising health facility while 93% were within one-hour considering the optimistic scenario. There were substantial variations across the country with 62%(29/47) and 34%(16/47) of the counties with < 90% of the population within one-hour from an immunising health facility using scenarios 1 and 2 respectively. Travel times > 1-h were significantly associated with low immunisation coverage in the univariate analysis for both fully immunised status and DPT3 vaccine. Children living more than 2-h were significantly less likely to be fully immunised [AOR:0.56(0.33-0.94) and receive DPT3 [AOR:0.51(0.21-0.92) after controlling for household wealth, mother's highest education level, parity and urban/rural residence. CONCLUSION: Travel time to immunising health facilities is a barrier to uptake of childhood vaccines in regions with suboptimal accessibility (> 2-h). Strategies that address access barriers in the hardest to reach communities are needed to enhance equitable access to immunisation services in Kenya.

A web platform for landuse, climate, demography, hydrology and beach erosion in the Black Sea catchment.

The Black Sea catchment (BSC) is facing important demographic, climatic and landuse changes that may increase pollution, vulnerability and scarcity of water resources, as well as beach erosion through sea level rise. Limited access to reliable time-series monitoring data from environmental, statistical, and socio-economical sources is a major barrier to policy development and decision-making. To address these issues, a web-based platform was developed to enable discovery and access to key environmental information for the region. This platform covers: landuse, climate, and demographic scenarios; hydrology and related water vulnerability and scarcity; as well as beach erosion. Each data set has been obtained with state-of-the-art modelling tools from available monitoring data using appropriate validation methods. These analyses were conducted using global and regional data sets. The data sets are intended for national to regional assessments, for instance for prioritizing environmental protection projects and investments. Together they form a unique set of information, which lay out future plausible change scenarios for the BSC, both for scientific and policy purposes.