[Analyze of the performance of procurement and distribution system of antiretroviral, antituberculosis and antimalarials drugs in Benin in 2016]. / Analyse de la Performance du Système D'Approvisionnement et de Distribution des Antirétroviraux, Antituberculeux et Antipaludiques au Bénin en 2016.

OBJECTIVE: We aimed to analyze the performance of procurement and distribution system of antiretroviral, antituberculosis and antimalarial drugs in Benin. METHODS: We carried out a cross-sectional study in 2016. Data on the procurement, storage and distribution of drugs were collected by either individual interview or observation of storage sites at the central procurement center for essential medicines (CAME) in Benin. Compliance with the norms of the procurement and distribution of the products was appreciated. At the operational level, order satisfaction, drug expiry and stock status of the targeted health programs were measured based on the participants statements. RESULTS: Three workers of the CAME and 76 of health programs were surveyed. According to the norms, malfunctioning impaired the system of the procurement, storage and the distribution of the products. At the operational level, our study participants reported that antiretroviral drug orders were satisfied in 83%, drugs were distributed within three months of their expiration date in 26- 33%, and the CAME often ran out of antiretroviral drugs (stock-outs)in 69%. CONCLUSION: Malfunctioning impaired the system of the procurement, storage and the distribution of antiretroviral, antimalarial and antituberculosis drugs. These dysfunctions negatively affect the performance of the system.

OBJECTIF: Analyser la performance du système d'approvisionnement et de distribution des antirétroviraux, des antituberculeux et des antipaludiques au Bénin. MÉTHODES: L'étude transversale descriptive a été menée en 2016. Les informations sur l'approvisionnement, le stockage et la distribution des médicaments ont été collectées par entretien et observation des lieux de stockage à la centrale d'achat des médicaments essentiels (CAME). La conformité aux normes des composantes du système d'approvisionnement, de stockage et de distribution des produits a été appréciée. La satisfaction des commandes, la péremption des médicaments et l'état des stocks ont été évalués. RÉSULTATS: Trois responsables de la CAME et 76 acteurs des programmes de santé ont participé à l'étude. Des dysfonctionnements par rapport aux normes ont été notés dans les composantes du système d'approvisionnement, de stockage et de distribution des produits. Au niveau opérationnel, les commandes d'antirétroviraux étaient satisfaites selon 83% des enquêtés, les médicaments distribués étaient à moins de trois mois de la date de péremption selon 26 à 33% des participants et les ruptures de stocks d'antirétroviraux étaient signalées par 69%. CONCLUSION: Le système d'approvisionnement et de distribution des antirétroviraux, antipaludiques et antituberculeux comporte des dysfonctionnements qui impactent négativement sa performance.

[Relationship between changes in the prevalence of HIV infection in pregnant women from 2006 to 2015 and place of residence in Benin]. / Milieu de Résidence et Évolution de la Prévalence du VIH Chez les Gestantes de 2006 à 2015 au Bénin.

OBJECTIVE: We aimed to determine the relationship between changes in the prevalence of HIV infection in pregnant women from 2006 to 2015 and place of residence in Benin. METHODS: In a retrospective and analytical study, were viewed the reports of the annual surveys of HIV infection among pregnant women from 2006 to 2015 across the country. RESULTS: A total of 138,319 pregnant women participated in the annual HIV surveys from 2006 to 2015. The national prevalence of HIV infection among pregnant women between 2006 and 2015 was 2%. The prevalence of HIV infection from 2006 to 2015 in pregnant women increased significantly in departments of Mono (p = 0.001) and Donga (p = 0.001) and decreased in the departments of Collines (p = 0.000) and Couffo (p = 0.001) and in urban areas (p = 0.000). CONCLUSION: Changes in the prevalence of HIV infection among pregnant women between 2006 and 2015 varied across departments and according the urbanization of the residence. The National AIDS control program may take these results into account when planning interventions against HIV for optimal response against the pandemic infection.

OBJECTIF: Déterminer la relation entre la tendance évolutive de la prévalence de l'infection au VIH chez les gestantes au Bénin de 2006­2015 et le milieu de résidence. MÉTHODES: L'étude rétrospective et analytique qui consistait en une exploitation des résultats des enquêtes annuelles de sérosurveillance de l'infection au VIH chez les gestantes menées de 2006 à 2015 dans les maternités sentinelles reparties sur l'ensemble du pays. RÉSULTATS: Un total de 138 319 gestantes ont participé aux des enquêtes annuelles de sérosurveillance de l'infection au VIH de 2006 à 2015. La prévalence nationale de l'infection à VIH chez les gestantes de 2006 à 2015 est de 2%. La tendance évolutive de 2006 à 2015 de l'infection à VIH est significativement croissante dans les départements du Mono (p=0,001), la Donga (p=0,001) et décroissante dans les Collines (p=0,000) et dans le Couffo (p=0,001) et en milieu urbain (p=0,000). CONCLUSION: L'évolution de la prévalence de l'infection à VIH chez les gestantes de 2006 à 2015 diffère selon les départements et l'urbanisation du milieu de résidence. Le Programme National de lutte contre le Sida doit tenir compte de ces disparités dans la planification des interventions de lutte aux fins de réponses optimales contre la pandémie.

Accessibility of cesarean deliveries in Benin.

To be used effectively, emergency obstetric and neonatal care must be available and accessible. This study sought to measure the accessibility of cesarean deliveries in Benin. Cross-sectional study of randomly selected women in each of the 12 obstetrics departments in Benin. Geographical accessibility was measured by estimating the distance between the parturientes residence and the hospital. Financial accessibility was the average direct cost of the cesarean delivery -the sum of medical and non-medical costs. The functionality of the referral system was assessed according to the conditions of referral of women referred for cesareans. The mean distance between women's homes and the hospital was 20.2 ± 22.3 kilometers. Of the 579 women, 63.0 % were referred from a peripheral health center to a hospital; the referral conditions were completed in the obstetric record for only half of them. The data sheet for the referral was completed for only 34.4 %; venous access had been placed in 28.5 %, and the patient was accompanied by medical personnel in only 1.7% of cases. The average direct cost of the cesarean to families was 36,782 ± 30,859 FCFA. Cesarean deliveries are now more accessible financially due to the policy of free access, but they remains geographically inaccessible, because of the long distances to be covered and the poor organization of referrals to ensure continuity of care.

[Health Ethics in Benin and HIV-AIDS : What are the stakes]. / Chapitre 5. L?éthique en santé au Bénin et le vih-sida : quels enjeux.

As part of the fight against HIV-AIDS, an effort was made at the ethical component, namely that there are legal texts, institutional and ethical. There are ethics committees (three) that give reasoned opinions on study protocols and are endeavoring to raise awareness of the actors. But we note that there is not yet a real ownership and adoption of ethical practice by them. This study targeted research projects on HIV-AIDS and centers supported PLHIV in order to analyze ethical issues : 1) the method of recruitment of participants and beneficiaries ; 2) obtaining informed consent from them ; 2) measures of confidentiality and anonymity ; 3) the integrity of staff of these projects and centers and conflicts of interest. A thematic analysis of data collected, which is done, after semi-structured interviews, helped to highlight the issues related to the recruitment process, obtaining informed consent, confidentiality measures and anonymity, integrity and Conflict of Interest. Let us remember that what is done, not done yet in the forms of art. Constant monitoring is called for, as leaders with ethics committees.They are supposed to play fully their roles.

[Quality of caesarean delivery: A cross-sectional study in 12 hospitals in Benin]. / La césarienne de qualité : étude transversale dans 12 hôpitaux au Bénin.

BACKGROUND: Caesarean section (CS) is a major obstetric intervention, widely recognized as an effective means to reduce maternal and perinatal mortality, when appropriately performed. CS numbers and rates are regularly published but quality is rarely taken into account. This study aims to describe the quality of caesarean delivery in selected hospitals in Benin. METHODS: A cross-sectional study was performed among women who had undergone a CS between 18 December 2013 and 8 February 2014 in one randomly selected hospital in each of the 12 administrative districts of Benin. The quality of CS was defined according to the analytical framework of Dujardin and Delvaux (1998) with its four pillars (access, diagnosis, procedure, postoperative care). Data were collected from hospital files and questionnaires from women and hospital directors. Data analysis was performed using Epi Info 3.5.1. RESULTS: Six hundred and thirty-two women delivered by CS during the period and 579 were eligible for the study. They were aged 26.5±6.3 years, 73.2% living more than 5km from the hospital, 63.0% referred to a health facility of whom 46.0% and 21.8% were transported by motorcycle and by ambulance respectively. The median expenditure by family was FCFA 30 000, ranging from 0 to FCFA 200 000. The admission examination was complete in 12.6% of women and the partograph used in 32.6%. The average CS rate was 37.6%, the average response time, 124minutes. Emergency CS was performed in 80.7%, for absolute maternal indications in 48.0% and under spinal anesthesia in 84.2% (98.3% of which were conducted by a nurse or midwife anesthetist). Maternal mortality was 2000 maternal deaths per 100 000 deliveries, while perinatal mortality was 7.4% (88.4% due to stillbirths). CONCLUSION: CS in Benin hospitals partially fulfilled quality criteria. However access to CS remains difficult and errors of diagnosis or excessive delay are too frequent. Quality CS is not yet a reality in Benin hospitals.

Malaria control among children under five in sub-Saharan Africa: the role of empowerment and parents' participation besides the clinical strategies.

CONTEXT: Child malaria remains a vital concern in sub-Saharan Africa in spite of major efforts to control it. The widely advertised best curative and preventive measures are not always accessible. ISSUE: This article examines the extent to which parents' perceptions and representations are considered, including their empowerment and participation in interventions aimed at controlling child malaria. The effect of this is examined through a content analysis of articles selected in the PubMed and Wholis databases over the period of 1996 to 2005. This analysis was performed according to three predefined categories consistent with the three main health promotion strategies used in the WHO-AFRO region: (1) development of knowledge and skills; (2) creation of supportive environments; and (3) advocacy. LESSONS LEARNED: Successful interventions met the health promotion strategies wholly or partly. Although these interventions were sometimes incomplete, the development took into account people's perceptions and representations. The authors acted on the belief that empowerment of parents and their participation in the development of interventions to control child malaria, is likely to yield better results and assist in reducing the prevalence of malaria morbidity and mortality in children under 5 years.

[An action research network to improve the quality of tuberculosis care in West Africa]. / Améliorer la qualité des soins aux patients tuberculeux par la recherche-action en réseau. Une expérience en Afrique de l'Ouest.

BACKGROUND: Improvement in management systems for tuberculosis (TB) care is urgently needed in West Africa. In 2003, an experimental action research network began there, involving care providers, health system managers, and TB programme managers. Each project in all 6 countries used a "patient-centered" approach to improve tuberculosis case management. METHODS: The research teams included care providers, district medical officers, anthropologists and TB programme managers. Each research team conducted its project for a one-year period and then assessed its results. The specific problems identified were low TB detection rates (Burkina Faso, Côte d'Ivoire and Niger) and poor compliance among patients receiving treatment, including their ensuing loss to follow-up (Benin, Mali and Senegal). Investigators concluded that these weaknesses were due to the lack of access to care (geographical, financial and cultural), the complexity of the care system and the low quality of care. Solutions for all 6 countries aimed at improving access to high-quality care. RESULTS: One year after the experiment began, results varied from one country to another. In general, all participants understood the need to collaborate beyond national health systems because the problems from all 6 countries were quite similar. The research process led to better sharing of work between care providers and sometimes between care providers and TB patients. It provided participants with new concepts and a constant opportunity to implement them. These repeated meetings, however, keep care providers away from their offices. CONCLUSION: The research would have improved case management and care more effectively had the teams taken into account the psychological and sociological need of TB patients. A new regional dynamic has begun and must be pursued to help improve health care systems.

[Emergency obstetrical care in Benin referral hospitals: 'near miss' patients' views]. / La qualité de prise en charge des urgences obstétricales dans les maternités de référence au Bénin: le point de vue des "Echappées Belles" et leurs attentes.

OBJECTIVE: To evaluate emergency obstetric care and the perceptions and expectations of women who experienced 'near miss' events to improve maternal health in Benin. METHODS: Qualitative survey in seven hospitals at the three referral levels of the health pyramid from July to October 2003. We used two methods: 557 women with near miss events were interviewed in hospital and a standard questionnaire completed; then semi-structured individual interviews were conducted at home with 42 of these 557 women. RESULTS: Provided care, accommodation, facilities, costs and modalities of recovery, hygiene of the premises, dynamism, expertise, social support, behaviours and attitude of staff were the criteria used to express patients' satisfaction. Most women interviewed in hospital were happy with physical access, organization, functioning and environment. However, excessive costs and coercive recovery of the expenses, failure of the referral system, lack of empathy and discrimination of the nursing staff, lack of resources for emergencies, lack of hygiene and comfort of the premises were criticized by the women interviewed at home. CONCLUSION: The current maternal care system fails to effectively deal with obstetric complications. It needs to be better resourced, more easily available, cheaper and take into account the women's needs.

Prevalence and risk-factors for Helicobacter pylori infection in urban and rural Beninese populations.

In total, 446 healthy individuals (240 in urban and 206 in rural environments, respectively) were selected from 96 households, based on cluster sampling of residential location. Demographic, sociological and environmental data were collected by face-to-face interviews using a standard questionnaire. Infection with Helicobacter pylori was assessed by detection of anti-H. pylori IgG serum antibodies. The prevalence of H. pylori antibodies was 75.4% in the urban population and 72.3% in rural (village) residents (p 0.459). No association was found between infection and age, gender, education level, size of household, economic activity or source of drinking water. The infection rate was higher in children whose parents were both infected, and also in children whose mother was infected (p < 0.001). By logistic regression analysis, the density of occupation of sleeping accommodation (more than three persons sharing a room; 95% odds ratio (OR) = 9.82 (4.13-23.31), p < 0.001), and the mother's status within the household (95% OR = 3.85 (1.53-9.67), p 0.003), were independent predictors for H. pylori infection. The 74% seroprevalence of H. pylori infection found in healthy Beninese individuals is similar to that reported previously from other parts of sub-Saharan Africa. Family contact with infected persons and crowded living conditions were associated with increased risk of infection. These findings are consistent with intra-familial H. pylori transmission and suggest that improvement of living conditions should be protective against infection.

[Infant malnutrition and associated maternal factors in a secondary city south of Benin, Ouidah]. / Malnutrition infantile et facteurs maternels associés dans une ville secondaire au sud du Bénin, Ouidah.

BACKGROUND: The aim of this study was to find the needs and priorities for interventions to improve children's nutritional state in a secondary city in Bénin. It addressed the issues of the magnitude and distribution of infant malnutrition and related maternal factors. It also aimed to identify an easy to use and low cost, but valid, technique to diagnose malnutrition in children. METHOD: First of all, the prevalence of infant malnutrition was assessed with a representative sample of 492 children aged less than 36 months, in all four communities of the city. Then the sensitivity and specificity of arm circumference were studied and the associations between the children's anthropometric indices were assessed. Secondly in a sub-group of 200 couples of mothers and children, an analysis was conducted to show the links between the indices of mothers' nutritional status, some of their social and economical variables, and the children's anthropometric indices. RESULTS: The prevalences of wasting and stunting and all other forms confounded among children aged 0-3 years were respectively 5.7%, 22% and 25.9%. They represented 44.7% for the arm circumference. Wasting was more prevalent among children aged 6-23 months (9.6%) than those aged less than 6 months (1.1%) and those of 24 to 36 months (5.2%). The boys had a higher prevalence of stunting (25.1%; p = 0.049) than the girls (18.1%). The correlation between children arm circumference and their indices weight/height, weight/age and height/age were all significant (p < 0.001), but they were higher for weight/age (r = 0.48) and weight/height (r = 0.36) than for height/age (r = 0.30). Low, but significant correlation (r ranged from 0.17 to 0.25) were observed between anthropometric indices of mothers and children. Mothers' instruction level had a tendency to be associated positively and significantly with children z-score weight/height. The effect of socio-economic level on children's nutritional status was significant only at p < 0.10. Unlike the condition observed in the big cities of under-developed countries in general, the central area of Ouidah was more affected by infant malnutrition than peripheral area recently urbanized. CONCLUSIONS: Infant malnutrition appears to be a really public health problem in this town and children at weaning age are more affected. The interventions to improve children's nutritional status must concern, not only children with malnutrition, but also their mothers. Those interventions must also improve mother's knowledge and practices about weaning foods and their instruction and socioeconomic levels. The cut-off-point 12.5 cm of arm circumference seems to be more appropriate to diagnose wasting among children aged less than 12 months; 13.5 cm is better for 12-36 months aged children.

[Work schedule management in the health institutions of Abomey-Calavi (Benin)]. / Gestion du temps de travail dans les formations sanitaires de la sous-préfecture d'Abomey-Calavi (Bénin).

Work time management of the health personnel of the health institutions in the sub-prefecture of Abomey-Calavi (Benin) This study was carried out with a sample size of 130, comprising health personnel, patients, members of management committees and twelve health institutions of the subprefecture of Abomey-Calavi. The survey was carried out through observation, one-on-one interviews and consultation of documents. The results reveal that work time is poorly managed in almost all of the programmes surveyed. There exist long waiting lines in almost all the health programmes. On average, the traffic report per service is 82 and 10 out of 12 of the programmes investigated do not have an agenda of activities.