[Utilization of health services by mothers of children with fever in the south of Benin]. / Utilisation des services de santé par les mères des enfants fébriles au sud du Bénin.

In spite of preventives activities, malaria remained the most murderess tropical disease at less 5 years old child in Benin. However, few mothers in rural middle used modern cares services when their child are feverish. This paper aims to selected risk factors associated to the under-utilization of care services in child fever situation in Benin. We conducted a cross sectional study including 360 mothers recruited randomly in villages. From 76% of feverish child counted two last weeks preceding the survey, 6% of them used, in first intention, health centers. Relatives of the others child preferred self-medication (leaves infusion or drogues bought without medical prescription) despite their perception of child malaria fever severity. Multivariate analysis selected: expensively cares (OR = 1.47 IC = 0.95-2.25), mothers's perception (OR = 1.22 IC = 0.72-2.07), husband decision (OR = 1.59 IC = 1.36-1.91), inappropriateness of work schedules of the health services (OR = 3.19 IC = 1.41-7.02) and traditional relatives practices (OR = 1.31 IC = 1.00-1.68). After discussion of methodological limits, authors suggested reinforcement of the awareness of relatives on advantages of precocious modern cares, appropriate work schedules for rural population and promotion of the insecticide-impregnated bed nets for child.

Intrafamilial clustering and 4-year follow-up of asymptomatic human T-cell leukaemia virus type I (HTLV-I) infection in Benin (West Africa).

BACKGROUND: Few data exist concerning familial human T-cell leukaemia virus type I (HTLV-I) carrier states and transmission in African countries. Two previous surveys performed in Benin in 1989 and 1990 using a three-level cluster sampling method allowed us to identify HTLV-I positive subjects. The evolution of HTLV-I within the families of these subjects is described over a 4-year period, 1991-1995. METHODS: Since 1991, 37 HTLV-I seropositive subjects, six subjects with indeterminate Western-Blot pattern, and their relatives have been followed up once a year clinically and biologically. RESULTS: Twenty-three mothers in the study group gave birth to 27 children between 1991 and 1995. Among the 13 infants born to the 12 seropositive mothers, two seroconverted before their second birthday. One adult woman whose husband was seropositive developed seropositivity 4 years after marriage. In March 1992, a family case-control study (proband study) was conducted. A seroprevalence of 27.5% was found among 138 relatives of 32 infected subjects and 1.4% among 142 relatives of 32 control subjects. CONCLUSIONS: There is clearly an intrafamilial clustering of HTLV-I in Benin. The annual incidence density of HTLV-I in this cohort is estimated at 6 per thousand.

[Contact eczema and allergens: an analysis of the preliminary results of patch tests in the Dermatology Service of the National Hospital and University Center in Cotonou]. / Eczema de contact et allergenes: analyse des resultats preliminaires des tests epicutanes du Service de Dermatologie du Centre National Hospitalier et Universitaire (CNHU) de Cotonou.

About a preliminary study of patch-test in 39 cases of contact dermatitis with allergens of international Contact Dermatitis Research (ICDRG), the authors noted 27 (69.2%) positive patch-tests. Men are frequently exposed to formaldehyde and dichromate potassium. Women are more exposed to fragrance-mix and formaldehyde. Hand workers have the uppermost percentage of positive patch-test (90.9%). The authors observed also 16 cases of contact polysensitivity for at least two allergens.

[Student nurses' and nurse midwives' behavior concerning sexuality and prevention of sexually transmitted diseases in Cotonou (Benin)]. / Comportement des étudiants infirmiers et sages-femmes vis-à-vis de la sexualité et de la prévention des maladies sexuellement transmissibles à Cotonou (Bénin).

Sexually-transmitted diseases (STDs) remain a public health problem in Benin. However, few studies have focused on the future educators, the student nurses. We studied a cross-section of the population of student nurses at the Institut National Médico-Social at Cotonou in December, 1995. The aim of the study was to describe nurses' sexual behavior and their views on STD transmission and prevention. Information was obtained from 141 students by means of an anonymous questionnaire. We found that first sexual relationships often occurred at a young age (12 years old). Sexual relations generally began between 0.25 and 60 months after meeting the partner for the first time. Men were more likely to have multiple partners than women (P < 0.05). The students' views on STD transmission and the use of condoms indicated that they lacked information. About half the students said that they use condoms during sexual intercourse. We identified four groups of students, based on condom-use. This may make more effective student education possible in the future. We suggest improved education of student nurses, greater emphasis in the school curriculum on sexually-transmitted diseases and the creation of a counseling service at the Institute.

[Prevalence of induced abortions and family planning in Benin]. / Prévalence des interruptions de grossesse et de la régulation des naissances au Bénin.

OBJECTIVE: Our purpose was to determine the extent of induced abortion as a practice of family planning. STUDY DESIGN: Benin regional public and private records from 1990 to 1994 were used to examine frequencies of induced abortion and contraceptive utilization and describe trends. Descriptive statistics such as variation coefficient and chi 2 were use to compare inter-regional prevalence. RESULTS: Prevalence of induced abortion was 1.5/1000 delivery and that of contraceptive use 11.4/1000. From 1990 to 1994 prevalence of induced abortion and of contraceptive use increased significantly (p < 0.05). Similar trends were observed for inter-regional contraceptive use. CONCLUSION: Findings suggest that increasing use of contraceptives did not lead to decreased induced abortion prevalence in Benin. They may help decision makers to reinforce sensibilization about the danger of induced abortion.

Seroepidemiological study of retroviruses (HTLV-I/II, HIV-1, HIV-2) in the Department of Atacora, northern Benin.

A seroepidemiological survey to determine the prevalence of retrovirus infection (HTLV-I/II, HIV-1, HIV-2) by representative sampling of the general population in the Department of Atacora in north-western Benin is reported. The seroprevalence rate of HTLV-I in this sample was at 1.86% (95% CI 1.20-2.52%). This is in agreement with prevalence rates reported from neighbouring countries of the sub-region. No sera were found positive for HTLV-II. Seropositivity to HIV-1 was 0.3%; HIV-2 seropositivity was not encountered.

Apport de l'ELISA et du Test Immunoblot deuxieme generation dans le diagnostic des hepatopathies virales C : a propos de 13 cas colliges au C.N.H.U. de Cotonou

Treize patients presentant une hepathopathie ont ete soumis au depistage des marqueurs seriques du virus de l'hepatite C (VHC) par la methode ELISA suivie de la confirmation par un test immunoblot de deuxieme generation. Cinq patients sur les treize etaient porteurs d'anticorps specifiques anti-VHC. Ce resultat preliminaire suggere que le VHC jouerait un role non negligeable dans le developpement des hepatopathies au Benin

[Is there a relationship between a history of spontaneous abortion and low birthweight in Cotonou (West Africa)?]. / Existe-t-il une relation entre l'antécédent de fausse couche spontanée et les naissances de petit poids à Cotonou (Afrique de l'Ouest)?

In Benin, as in other African countries, low birthweight infants is a major health problem with poorly understood causes. In a case-control study of 2114 mothers recruited before discharge from the "Lagune" maternity ward at Cotonou, we examined the relationship between spontaneous abortion and low birthweight infants in women who delivered between 15 June 1990 and 20 July 1991. Information was obtained by interview then on the basis of hospital files. The results indicated that there was no association between spontaneous abortion and premature birth: OR = 1.00 (95% CI = 0.61-1.56). Likewise, the relationship between a past history of spontaneous abortion and intrauterine growth retardation was not significant: OR = 1.19 (95% CI = 0.83-1.71). Adjustment with characteristics of the mothers did not improve the correlations. It is concluded that there is no relationship between a past history of spontaneous abortion and low birthweight.

PIP: Researchers analyzed data on 2114 mothers who delivered at Lagune Maternity Hospital in Cotonou, Benin, to examine the relationship between premature birth, intrauterine growth retardation (IUGR), and history of spontaneous abortion. There was no statistically significant correlation between premature birth and history of spontaneous abortion (odds ratio [OR] = 1). Initiation of prenatal care after the first trimester was significantly associated with an increased risk of premature birth (OR = 1.27). There was no statistically significant correlation between term IUGR births and history of spontaneous abortion (OR = 1.19), even if a woman had a history of habitual abortion (OR = 1.22). Maternal weight less than 50 kg and initiation of prenatal care beyond the first trimester were associated with an increased risk of a term IUGR birth (OR = 1.75 and 1.27, respectively). These results indicate that a history of spontaneous abortion does not increase the risk of low birth weight whether it be caused by premature birth or IUGR.

[Intra-family transmission of human T-cell lymphotropic virus-1 (HTLV-1) in a cohort of HTLV-1-positive patients (Bénin)]. / Transmission intra-familiale du virus lymphotrope pour les cellules T humaines type 1 (HTLV-1) dans une cohorte de sujets HTLV-1 positifs (Bénin).

We are reporting the results of a familial study carried out in Benin in March 1994 within a cohort of HTLV-1 positive subjects. This study aims at appraising the different modes of intra-familial transmission of this retrovirus. The study has included 212 persons: 33 seropositive subjects (identified during two previous seroprevalence surveys and followed up since 1991), and 179 members of their families. Blood specimens have been taken from each of these subjects. Sera have been screened for HTLV-1 antibodies by ELISA test and positive results confirmed by Western blot test. Out of 18 children born during the follow up period, 2 cases of seroconversion have been observed. One case of seroconversion has also been noted among the 17 couples in which either of the spouses is seropositive. Among the 136 children of the cohort: 17.8% of them are HTLV-1 positive when both parents are seropositive 26.1% if the mother only is seropositive and 0% if the father only is seropositive. The incidence rate in this cohort is estimated to be 0.43%. These data relative to the intra-familial transmission of HTLV-1 in Benin appear to be consistent with those previously reported in Japan.

[Pregnancies complicated by hemorrhage and birth of low birth weight infants in Cotonou (Benin)]. / Grossesses compliquées d'hémorragie et naissances d'enfants de faible poids à Cotonou (Bénin).

The effect of bleeding during pregnancy on the outcome remains unclear. Nevertheless, some of these pregnancies go to term, raising the question of the effects on the new-born infant. The data concerning a possible correlation with low birth weight are ambiguous. Furthermore, there are few studies of this issue in developing countries. We studied 2168 women giving birth to single children chosen at random in two maternity services in Cotonou (Benin) in 1990. Data was collected by two trained midwives interviewing the women and from the medical files 24 hours after delivery. One hundred and thirty seven mothers (6.2%) reported bleeding during pregnancy. Multivariate statistical analysis indicated that this was associated with preterm birth of low birth weight infants: OR = 4.09 (2.2-7.6) for bleeding during the first trimester, OR = 2.29 (1.1-6.9) during the second and OR = 4.79 (2.1-11.9) during the third. Only bleeding during the third trimester correlated with a significant retardation of intrauterine growth [OR = 2.33 (1.4-7.3)] according to model fitting. Thus, despite possible bias in this retrospective study, bleeding during pregnancy appears to be a predictor of low birth weight in Cotonou (West Africa).

Detection des anticorps anti-VIH dans la salive: etude preliminaire

Nous avons examine parallelement le sang et la salive de 129 personnes par 4 tests de depistage du VIH. Les tests utilises sont: l'immunocapture Wellcozyme HIV1-HIV2; le Wellcozyme HIV1-HIV2; le Serodia HIV et le Combotest HIV1-HIV2. Nous avons observe des reactions faussement negatives dans les salives de personnes seropositives. L'importance de la fausse negativite varie selon la trousse et la methode utilisees. Dans les tests executes sur salive; l'immunocapture Wellcozyme est le plus sensible des 4 tests. Il pourrait etre utilise dans le cadre d'une enquete epidemiologique

[Plasmodium falciparum or P. malariae parasitemia in carriers of sickle cell trait in various Benin biotypes]. / Parasitémies à Plasmodium falciparum ou P. malariae chez les porteurs du trait drépanocytaire dans différents biotopes du Bénin.

The prevalence of malaria and the frequency of gene S were surveyed in two different regions of Benin, savana and coastal lacustrine regions. In both regions, prevalence of malaria was not significantly different between Hb AA people and Hb AS people. Gene S prevalence was not modified by age, excepted for Hb SS which was not found in people upper than 25 years. In holoendemic area, i.e. lacustrine region, means of P. falciparum parasitaemia were significantly lower in Hb AS children than in Hb AA children. Sickle cell trait did not reduce the prevalence of malaria but seemed to decrease the level of parasitaemia.

Le tetanos chez l'enfant : aspects epidemiologique; clinique et therapeutique : a propos de 784 cas

Toxi-infection tres meurtriere; le tetanos demeure une calamite chez l'enfant dans les pays en voie de developpement. A partir de 784 cas observes sur 10 ans a la clinique de pediatrie de Cotonou; les auteurs font le point sur l'epidemiologie; les aspects cliniques et therapeutiques du tetanos. La frequence est de 2;36 pour cent des hospitalisations. Le tetanos atteint surtout les nouveau-nes et les enfants de 5 a 10 ans provenant des milieux socio-economiques defavorises. A defaut de l'arsenal therapeutique moderne rencontre dans les pays developpes la seule solution pour les pays en developpement pour reduire l'incidence du tetanos est la vaccination. Ceci explique la baisse reguliere de la prevalence du tetanos depuis l'institution du programme elargi de vaccination

Seroepidemiology of human T-cell lymphotropic virus type I/II in Benin (West Africa).

In 1988-1989, a national survey was conducted in Benin to determine the distribution of HTLV-I infection in a representative sample of adult individuals. This study comprised 2625 healthy subjects recruited in the six provinces of Benin and 1300 blood donors from Cotonou and from the other five provinces. Sera were screened for HTLV-I antibody by both immunofluorescence (IF) and enzyme immunoassay (EIA). Sera positive or doubtful by at least one technique were further analyzed by Western blot and radioimmunoprecipitation assay (RIPA) when indeterminate. Samples were considered as positive if they reacted with two gene products. No blood donor was positive. Over the 2625 subjects, 39 (1.5%) were positive. We observed a statistical difference between male and female (1%, 2%, p less than 0.05). A difference was also observed according to the areas studied: the HTLV-I antibody rate increased from coastal (0.3%) to northern (5.4%) provinces. HTLV-I seroprevalence increased significantly with age. This survey shows that HTLV-I infection exists in Benin but varies according to regions.

PIP: Researchers enrolled 2625 15 years old healthy individuals from the general population and 1300 blood donors of Benin to determine the extent of HTLV-I infection in Benin. They followed the recommended laboratory techniques of the US Public Health Service Working Group (1988). No blood donors were HTLV-I seropositive. The sera of 1.5% of the general population sample tested positive for HTLV-I. This rate was comparable to other western African countries. A significantly higher percentage of females were seropositive than males (2% vs. 1%; p.05), especially among the rural population (2.6% vs. 0.6%). No significant difference in seroprevalence existed between urban and rural areas overall (1.3% vs. 1.7%) and between urban males and females (1.4% vs. 1.1%), however. Further HTLV-I seroprevalence increased significantly as one went from south to north (0.6% in the 3 south coastal provinces, 1.1% in the central province, and 3.2% in the 2 northern provinces; p.001). In fact, the northern province of Atakora had the highest HTLV-I seroprevalence rate (5.4%), especially among females (p.0005), and was significantly higher than the other provinces (p.001). Research have since begun in several villages in Atakora to detect possible clusters and analyze associations between HTLV-I seroprevalence and life style, environmental and geographic factors, and concomitant infections such as filariasis. Seroprevalence also increased with age. For example, 0.4% of males 30 years old had HTLV-I antibodies compared to 1.8% of those 30 years old (p.02). In addition, 0.4% of females 20 years old had HTLV-I antibodies compared to 2.4% of those 30 years old (p.05). The researchers noted that other epidemiologic studies in Benin have begun to assess the prevalence of tropical spastic paraparesis with or without the association of HTLV-I and adult T-cell leukemia.

Iron absorption from typical West African meals containing contaminating Fe.

Iron absorption from three typical West African meals was measured in fourteen subjects using the extrinsic-tag technique with 59Fe and 55Fe. All meals consisted of maize as the staple food. Meals were prepared in Benin under realistic conditions from locally grown foods. Of the non-haem-Fe in the meals 39-73% did not exchange with the added inorganic radio-Fe tracer, depending on the degree of Fe contamination of meals. Non-haem-Fe absorption was low in each maize meal, but was even lower for those eaten with a vegetable sauce than for those eaten with a fish sauce. When haem-Fe absorption was included, 70.0-160 micrograms Fe was absorbed. Expressed on an energy basis, the bioavailable nutrient density was 3.2-7.0 micrograms/100 kJ (13.4-29.5 micrograms/100 kcal). These findings suggest that total Fe available in the typical diets of West African countries does not meet the physiological requirements of large proportions of the population.

[Evaluation survey of the acceptability of the condom in Benin (Come district)]. / Enquete d'evaluation de l'acceptabilite du preservatif masculin au Benin (district de Come).

PIP: 250 males aged 15-50 years in the district of Come, Benin, were surveyed in March 1989 for this study of the acceptability of condoms. The survey was part of a program to improve AIDS-prevention strategies. The district of Come is located on an important international highway near the border with Togo. The adolescent population is large and sexually active. The questionnaire was self-administered by respondents literate in French and was administered by interviews for illiterate respondents. The sample was systematically selected from electoral and secondary school lists. Among the 246 respondents completing the survey, 54.4% were married, 43.9% were single, and 1.63% were divorced. 255 of subjects reported having had acute urethritis of venereal origin at least once during the 2 years preceding the survey. 100 reported using some means of protection during intercourse and 146 (59.3%) did not. Only 6 of the 246 had not been informed of the protective benefits of the condom. Among the 146 not using any protection, 24 cited as the reason decrease of pleasure, 20 difficulty of acquisition, 6 lack of knowledge of condoms, 10 belief that the partner was healthy, 4 fear of condom failure, and 82 no reason. 88 of the 100 reporting they used protection used condoms alone or with spermicide. The others used spermicidal creams such as Neo-Sampoon. Among the 88 using condoms, 22 did so regularly, 20 from time to time, and 46 rarely. 14 of 46 single men and 8 of 40 married men reported using condoms regularly. 77.2% of the condom users had secondary educations and 15.9% had university educations. 76 of the 88 experienced annoyances during condom use, with 23 citing lack of contact with the partner, 17 decreased experienced tearing of a condom, 4 developed infections despite condom use, and 2 complained of the frustration of their partners because of delayed ejaculation. 30% obtained their condoms in pharmacies and 70% did so at family planning or health centers.^ieng

[Development of chemoresistance of Plasmodium falciparum to chloroquine and mefloquine in Benin between 1980 and 1989]. / Evolution de la chimiosensibilité de Plasmodium falciparum à la chloroquine et à la méfloquine au Bénin entre 1980 et 1989.

Resistance of P. falciparum to chloroquine has been notified in 1986 in non-immune visitors. Authors organized surveys of in vivo and in vitro tests to follow evolution of the phenomena. The increase in number of P. falciparum strains resistant to chloroquine was sudden in 1986 but stopped to rise from this date, and even seemed to decrease gently. The geographical distribution of the resistance, restricted to the region of Cotonou, could be explained by illegitimate chloroquine distribution. But authors propose further investigations on relations between chloroquine resistant strains and the 3 anopheles species involved in malaria transmission in Benin. Resistance to mefloquine is rare in Cotonou region, but higher in rural zone.

[In vivo amodiaquine sensitivity of Plasmodium falciparum in the town of Cotonou and in the vicinity (Bénin)]. / Sensibilité in vivo du Plasmodium falciparum à l'amodiaquine dans la ville de Cotonou et ses environs (Bénin).

In the coastal area of Benin, where chloroquine resistant Plasmodium falciparum strains occur, 152 children in the Guezo military camp (Cotonou) and 448 children in a fishermen village (Ekpe), on the southern bank of lake Nokoue, are examined. The falciparum malaria infected children (29 and 135 respectively) have received 35 mg/kg body weight of amodiaquine (Flavoquine) divided in three consecutive daily doses. Only one child among the 69 treated having a parasitemia higher than 1,000/mm3 failed to be cured. The amodiaquine tolerance is excellent for, respectively, 64% and 72% of the children. Minor side-effects are rapidly regressive. The frequency of conjonctival hyperhemia as an amodiaquine side-effect is nevertheless relatively high (14.7%) in the children regularly treated with this drug, e.g. those of the military camp, while it is rare (0.8%) in others, e.g. in the fishermen village children where amodiaquine is unusual as an antimalarial medicine.

[Prevalence of HIV-1 and HIV-2 antibodies in rural areas of Benin]. / Prévalence des anticorps VIH1 et VIH2 au Bénin en milieu rural.

A transversal survey has been performed in the Zou Province in the central part of Benin located in West Africa close to the western border of Nigeria. The Zou Province is an agricultural region which population is about 900,000. A randomised sample of 1936 people had been chosen according 1,984 census data. All the samples have been examined by ELISA Rapid Elavia Mixt (Pasteur Vaccin). All positive samples have been tested with both Elavia I and Elavia II (Pasteur Vaccin). 6.6% of sampled population show positive result for HIV1 in ELISA and 0.9% are positive in ELISA for HIV2. Age, sex and geographical distribution of ELISA positive samples is quite uniform. None of positive plasma in ELISA can be interpreted as positive in Western-Blot. The first hypothesis discussed by authors is possibility of serological conversion occurring at the time of the survey. If this unlikely hypothesis is confirmed it means that both viruses have recently and suddenly infected the Zou Province at various level of population and in all villages of the Province. A second hypothesis is that all plasma have antibodies for unidentified related virus which cross reacts with HIV1 or HIV2. A third hypothesis is that dysproteinaemia due to parasite or nutrition factors produce false positive reactions. This could explain such a positive reaction distribution among the whole population. So the last hypothesis must be considered with attention.