Management of asthma in Benin: the challenge of loss to follow-up.

SETTING: An asthma pilot project in Benin. OBJECTIVE: To assess the implementation of standard case management of asthma at three referral centres and three primary care centres. METHODS: The project began with local adaptation of international asthma guidelines, followed by situation analysis, pre-intervention, training and intervention. The initial dosage of inhaled beclometasone was determined by asthma severity. Outcome of treatment was assessed annually, starting from one year after enrolment. RESULTS: Of 103 asthma patients identified during situation analysis, only 11 (11%) were prescribed inhaled corticosteroids. After health worker training, a total of 430 asthma patients were identified in 2008, of whom 273 (63.5%) returned after initial management with 7-day oral prednisolone. Of the 273 patients, 261 (95.6%) had persistent asthma, 231 (86.2%) had peak flow measurement variability of ≥20%, and 155 (56.8%) had had one or more unplanned visits to health facilities in the previous year. Outcome at one year evaluation was as follows: 63 (24.1%) had improved, 48 (18.4%) remained stable, 14 (5.4%) were worse and 136 (52.4%) were lost to follow-up. CONCLUSION: It is feasible to train health workers to manage asthma patients in a standardised manner. However, a high proportion of patients were lost to follow-up during treatment.

Outcome of tuberculosis retreatment in routine conditions in Cotonou, Benin.

SETTING: National Tuberculosis Programme (NTP), Cotonou, Benin. OBJECTIVE: To study the patient characteristics and outcome of tuberculosis retreatment cases in a well-functioning NTP. METHODS: A retrospective, register-based study of all smear-positive pulmonary tuberculosis cases put on retreatment (2SERHZ/1ERHZ/5R3H3E3) between 1992 and 2001 in Cotonou. For comparison, information on new smear-positive cases in Cotonou in 1999 was entered and analysed. RESULTS: Of 8103 tuberculosis patients registered, 642 were put on retreatment. The analysis is mainly based on the 236 patients whose initial treatment regimen records were available (113 relapses, 84 failures, 39 returns after default). Most of the relapse (57%) and return after default (72%) cases were put on retreatment within 12 months after stopping their initial treatment. Overall, the retreatment results were satisfactory (78% success) and comparable with those of new cases (82%); the failure rates were low (3%), as were those for initial treatment (1%). There were more defaulters from retreatment among those who had already defaulted from initial treatment (21%). Treatment success rates were better among women than men. CONCLUSION: The standardised retreatment regimen is effective in Cotonou, probably because the NTP is functioning well, there are no drug shortages, drug taking is strictly supervised, and a good treatment plan is followed.

[Epidemiological observations on the first case of human paragonimiasis and potential intermediate hosts of Paragonimus sp. in Benin]. / Observations épidémiologiques sur le premier cas de paragonimose humaine et les hôtes intermédiaires potentiels de Paragonimus sp. au Bénin.

Parasitological investigations were carried out for four months in 1998 in two Beninese centres of pneumo-phtisiology (Akpakpa, at Cotonou, and Akron, at Porto-Novo) to detect the patients harbouring eggs of Paragonimus sp. amongst the persons consulting for tuberculosis and showing a broncho-pneumopathy without mycobacteria. Eggs of Paragonimus sp. were detected in the sputum of a single patient out of 369 persons examined (prevalence, 0.2%). This patient had eaten crabs in the months preceding the date of diagnosis. A treatment using praziquantel has improved clinical symptomatology and biological signs found in this patient. These studies have been completed by visiting markets located in the coastal plain of Benin to identify the crabs that were sold and to find metacercariae of Paragonimus sp. Negative results were obtained when 126 Cardisoma armatum ("hole crab") were dissected. In contrast, the dissection of 176 Callinectes marginatus ("swimming crab") was successful, with 5% of crabs harbouring metacercariae of probably Paragonimus sp. Further studies are necessary to confirm these first results and to determine the global prevalence of Paragonimus infection in these definitive and intermediary hosts.

La tuberculose extra-pulmonaire en milieu hospitalier au Benin : cas du Centre National Hospitalier de Pneumo-phtisiologie de Cotonou de 1986 a 1990

Une retrospective est faite au Centre National Hospitalier de Pneumo-phtisiologie de Cotonou (CNHPP-C) a propos de 112 cas de tuberculoses extra-pulmonaires notifies en 5 ans de 1986 a 1990. Les objectifs visent a etudier les aspects epidemiologiques; diagnostiques et therapeutiques de ces formes de la maladie. Les principaux resultats suivants ont ete obtenus: la frequence des tuberculoses extra-pulmonaires au CNHPP-C etait de 4;42 pour cent par rapport aux tuberculoses toutes formes; il existe probablement un sous-depistage; il existe un large eventail des tuberculoses extra-pulmonaires; mais les localisations les plus frequentes; par ordre de grandeur decroissante; sont le mal de POTT; les formes ganglionnaires et l'atteinte des sereuses; les criteres diagnostiques retenus s'appuient generalement sur des arguments de presomption a defaut de preuve histologique (les examens bacteriologiques etant presque toujours pris a defaut dans ces formes); la compliance des malades au traitement est faible; 50 pour cent environ des patients suivent une chimiotherapie durant le delai imparti et le traitement court ne parait pas corriger cette situation; contrairement a l'observation en ce qui concerne les tuberculoses pulmonaires a frottis positifs

[Initial resistance to streptomycin, isoniazid, rifampicin and ethambutol in bacillus-laden tuberculosis patients at the National Center of Pneumo-physiology at Cotonou (Benin)]. / Résistance initiale à la streptomycine, l'isoniazide, la rifampicine et l'éthambutol chez des malades tuberculeux bacillifères au Centre national de pneumo-phtisiologie à Cotonou (Bénin).

The authors are reporting results from a study about BK sensitivity among principal antituberculosis drugs in Benin Republic: 81.5% of them are susceptible for all specific antibiotics, 8.5% are offering resistance to INH and Streptomycin together. In this preliminary study no primitive resistance for RMP has been found.

[Mycobacterium fortuitum in a patient with human immunodeficiency syndrome (AIDS) in Benin)]. / Infection pulmonaire à Mycobactérium fortuitum chez un malade atteint du syndrome d'immunodéficience acquise humaine (SIDA) au Bénin.

The authors report a case of Mycobacterium Fortuitum infection in one AIDS patient. This case underlines the interest for the clinicians to investigate systematically a possible infection by Mycobacterium fortuitum in all AIDS patients with pulmonary tuberculosis.