Insecticide Resistance in Aedes aegypti Mosquitoes: Possible Detection of kdr F1534C, S989P, and V1016G Triple Mutation in Benin, West Africa.

Epidemics of arboviruses in general, and dengue fever in particular, are an increasing threat in areas where Aedes (Ae.) aegypti is present. The effectiveness of chemical control of Ae. aegypti is jeopardized by the increasing frequency of insecticide resistance. The aim of this study was to determine the susceptibility status of Ae. aegypti to public health insecticides and assess the underlying mechanisms driving insecticide resistance. Ae. aegypti eggs were collected in two study sites in the vicinity of houses for two weeks using gravid Aedes traps (GATs). After rearing the mosquitoes to adulthood, female Ae. aegypti were exposed to diagnostic doses of permethrin, deltamethrin and bendiocarb, using Centers for Disease Control and Prevention (CDC) bottle bioassays. Unexposed, un-engorged female Ae. aegypti were tested individually for mixed-function oxidase (MFO), glutathione-S-transferase (GST) and α and ß esterase activities. Finally, allele-specific PCR (AS-PCR) was used to detect possible kdr mutations (F1534C, S989P, and V1016G) in the voltage-gated sodium channel gene in insecticide-exposed Ae. aegypti. Most traps were oviposition positive; 93.2% and 97% of traps contained Ae. aegypti eggs in the 10ème arrondissement of Cotonou and in Godomey-Togoudo, respectively. Insecticide bioassays detected resistance to permethrin and deltamethrin in both study sites and complete susceptibility to bendiocarb. By comparison to the insecticide-susceptible Rockefeller strain, field Ae. aegypti populations had significantly higher levels of GSTs and significantly lower levels of α and ß esterases; there was no significant difference between levels of MFOs. AS-PCR genotyping revealed the possible presence of 3 kdr mutations (F1534C, S989P, and V1016G) at high frequencies; 80.9% (228/282) of the Ae. aegypti tested had at least 1 mutation, while the simultaneous presence of all 3 kdr mutations was identified in 13 resistant individuals. Study findings demonstrated phenotypic pyrethroid resistance, the over-expression of key detoxification enzymes, and the possible presence of several kdr mutations in Ae. aegypti populations, emphasizing the urgent need to implement vector control strategies targeting arbovirus vector species in Benin.

Apport de l'échographie dans le diagnostic des hépatopathies chez les patients souffrant de la polyarthrite rhumatoïde à Cotonou / Hospital frequency and contribution of ultrasound in the diagnosis of hepatopathy in patients suffering from rheumatoid arthritis in Cotonou

Introduction L'échographie, modalité plus accessible dans notre pays constitue une alternative incontournable au diagnostic des hépatopathies sur polyarthrite rhumatoïde (PR). L'objectif de ce travail était de déterminer les caractéristiques de ces hépatopathies ainsi que l'apport de l'échographie dans leur diagnostic au CNHU-HKM. Méthode Etude transversale descriptive et analytique portant sur les patients suivis pour une PR, vus en consultation dans le service de rhumatologie du CNHU-HKM, ayant bénéficié d'une échographie abdominale, pendant la période d'étude allant du 15 Juillet 2020 au 15 Octobre 2020. La prévalence, les caractéristiques clinico-biologiques et échographiques des hépatopathies ont été étudiées. Résultats Ont été colligés 42 sujets. la fréquence hospitalière des hépatopathies était de 40,5%. La sex-ratio était de 0,8 et l'âge moyen de 50,9 ans. Sur le plan clinique, des douleurs de l'hypocondre droit (9,5%) , une hépatomégalie (14,3%) et un syndrome métabolique (38%) avaient été trouvées. Une cytolyse hépatique était notée chez 01 patient ; l'Ag HBs positif chez 02 patients. A l'échographie une hépatomégalie (26,1%), une stéatose hépatique (16,7%) et un kyste hépatique (2,4%) étaient retrouvés. Les étiologies principales évoquées étaient : hépatomégalie isolée (41,2%), métabolique (35,5%) et virale ( 11,4%). Conclusion Les hépatopathies sur PR sont fréquentes. Le profil clinique n'est pas spécifique. L'échographie dans notre contexte constitue un moyen fondamental d'aide au diagnostic chez ces patients.

Ultrasound, a more accessible modality in our country, is an essential alternative to the diagnosis of liver disease on rheumatoid arthritis (RA). The objective of this work was to determine the characteristics of these liver diseases as well as the contribution of ultrasound in their diagnosis in CNHU-HKM. Method Descriptive and analytical cross-sectional study of patients followed for RA, seen in consultation in the rheumatology department of the CNHU-HKM, who underwent an abdominal ultrasound, during the study period from July 15, 2020 to October 15, 2020. The prevalence, clinico-biological and ultrasound characteristics of liver disease were studied. Results A total of 42 subjects were collected. The hospital frequency of liver disease was 40.5%. The sex ratio was 0.8 and the mean age was 50.9 years. Clinically, right hypochondria pain (9.5%), hepatomegaly (14.3%) and metabolic syndrome (38%) were found. Hepatic cytolysis was noted in 01 patient; HBsAg positive in 02 patients. On ultrasound, hepatomegaly (26.1%), fatty liver disease (16.7%) and a liver cyst (2.4%) were found. The main etiologies were isolated hepatomegaly (41.2%), metabolic (35.5%) and viral (11.4%). Conclusion: Liver disease in RA patients is common. Ultrasound in our context is a fundamental means of aiding in the diagnosis of these patients

[LOWER DIGESTIVE HEMORRHAGE IN ADULTS IN COTONOU FROM 2017 TO 2022: EPIDEMIOLOGICAL, DIAGNOSTIC, THERAPEUTIC AND PROGNOSTIC ASPECTS]. / Les hémorragies digestives basses chez l'adulte à Cotonou de 2017 à 2022: aspects épidémiologiques, diagnostiques, thérapeutiques et pronostiques.

Introduction: L'objectif de ce travail était d'établir le profil épidémiologique, diagnostique, thérapeutique et pronostique des hémorragies digestives basses (HDB) à Cotonou. Méthode: Il s'agissait d'une étude rétrospective, descriptive sur une période de janvier 2017 à décembre 2022 dans deux unités d'endoscopies digestives à Cotonou. Elle avait porté sur les dossiers médicaux des patients admis pour HDB. Résultats: Au total 674 patients avaient été inclus, d'âge moyen 49,2 ± 2,5 ans, de sex-ratio à 2,0. L'hématochézie était le mode d'HDB le plus fréquent (94,4% ; n=636). La durée d'évolution des symptômes était inférieure à un mois chez la majorité des patients (50,6% ; n=365). L'HTA étaient l'antécédent le plus retrouvé (38,0% ; n=203). La majorité des patients avait réalisé l'endoscopie 48 h après leur première consultation (51,1% ; n=405). L'étiologie la plus fréquente était la maladie hémorroïdaire (35,9% ; n=621), suivie des polypes coliques (23,0% ; n=621). La ligature élastique était le moyen thérapeutique le plus utilisé dans les maladies hémorroïdaires (74,4% ; n=223) et la polypectomie endoscopique dans les cas de polypes (100% ; n=143). L'évolution était favorable dans la majorité des cas (90,0%; n=559) avec une récidive hémorragique dans 10,0% (n=56). La mortalité était de 2,7% (n=18). Conclusion: Les HDB sont fréquentes à Cotonou. Les moyens diagnostiques disponibles sont performants et la prise en charge est de bonne qualité dans les principaux centres de Cotonou. Mots clés: Hémorragies digestives basses, endoscopie, étiologies, Cotonou.

[Prevalence of viral hepatitis B and C in men who have sex with men enrolled in a demonstration study of pre-exposure prophylaxis for HIV in Cotonou, Benin]. / Prévalence des hépatites virales B et C chez les hommes ayant des rapports sexuels avec d'autres hommes mobilisés pour une étude de démonstration de la prophylaxie préexposition au VIH à Cotonou, au Bénin.

Introduction: men who have sex with men (MSM) are disproportionately affected by hepatitis B virus (HBV) and hepatitis C virus (HCV) worldwide. In Benin, there are no data on MSM. The purpose of this study was to estimate HBV and HCV prevalence and HBV-associated factors in MSM who were HIV negative. Methods: we conducted an analytical cross-sectional study. A two-degree random sampling was used to recruit 204 MSM. An immunochromatographic rapid test and enzyme immunoassays were used to detect HBV and HCV antigens/antibodies. Log-binomial regression was used to identify factors associated with HBV. Results: HbsAg positivity, history of hepatitis B infection and hepatitis C prevalences were 37.7%, 8.8 %, and 0.9 %, respectively. HBsAg positivity and history of hepatitis B were more prevalent in MSM aged ≥30 years compared to younger subjects: 16.7% versus 6.4% (p<0.0001) and 66.7% versus 28.8% (p<0.0001), respectively. Sexual intercourse under the effect of drug or alcohol and living in couple were also associated with HBV. conclusion: the prevalence of hepatitis C was low, but hepatitis B was common, especially among older MSM. Screening and vaccination against hepatitis B should be strengthened in this population.

[Epidemiological and histopathological aspects of sarcomas in Cotonou (Benin) from 2010 to 2020]. / Aspects épidémiologiques et histopathologiques des sarcomes à Cotonou (Bénin) de 2010 à 2020.

Aims: To study the epidemiological and histopathological characteristics of sarcomas. Procedure: This was a multi-center, descriptive, retrospective study realized over a 10-year period. We systematically recruited all medical reports of patients with histologically confirmed sarcoma. Results: 159 reports of sarcoma were retained. The average age was 38.9 years. There was a female predominance with a 0.9 estimated sex ratio. Soft tissue sarcomas were the most common (65.4%). The most frequent location was the lower limbs (30.2%). Conclusion: Better access to diagnosis would contribute to a better assessment of the burden of this pathology in Benin.

Genetic Characterization of Seoul Virus in the Seaport of Cotonou, Benin.

Seoul virus is a zoonotic pathogen carried by the brown rat Rattus norvegicus. Information on its circulation in Africa is limited. In this study, the virus was detected in 37.5% of brown rats captured in the Autonomous Port of Cotonou, Benin. Phylogenetic analyses place this virus in Seoul virus lineage 7.

Cultural Considerations for the Adaptation of a Diabetes Self-Management Education Program in Cotonou, Benin: Lessons Learned from a Qualitative Study.

Background: Type 2 diabetes (T2D) poses a disproportionate burden on Benin, West Africa. However, no diabetes intervention has yet been developed for Benin's contexts. This study aimed to explore specific cultural beliefs, attitudes, behaviors, and environmental factors to help adapt a diabetes self-management program to patients with T2D from Cotonou, in southern Benin. Methods: Qualitative data were collected through focus group discussions (FDGs) involving 32 patients with T2D, 16 academic partners, and 12 community partners. The FDGs were audio-recorded, transcribed verbatim from French to English, and then analyzed thematically with MAXQDA 2020. Results: Healthy food was challenging to obtain due to costs, seasonality, and distance from markets. Other issues discussed were fruits and vegetables as commodities for the poor, perceptions and stigmas surrounding the disease, and the financial burden of medical equipment and treatment. Information about local food selections and recipes as well as social support, particularly for physical activity, were identified, among other needs. When adapting the curriculum, gender dynamics and spirituality were suggested. Conclusions: The study demonstrates the need for culturally sensitive interventions and a motivation-based approach to health (spiritual and emotional support). It also lays the groundwork for addressing T2D contextually in Benin and similar sub-Saharan African countries.

[Members lymphedema in CNHU-HKM of Cotonou: Results of the rehabilitation treatment]. / Lymphoedemesdes membres au CNHU-HKM de Cotonou : Resultats du traitement reeducatif.

AIM: To report results of patients followed in physical medicine and rehabilitation (PMR) in CNHU-HKM of Cotonou. PATIENTS AND METHODS: Retrospective, transversal study, aimed to be descriptive and analytical type. Were enrolled, 39 files of patients treated in PMR / CNHU-HKM, from 1st January 2014 to 31st December 2018, for unilateral lymphedema, who had done beginning and ending evaluations. Were excluded, venous, systemic or lipid edema. The severity and the result of the sessions were assessed taking into account the reports of perimeters of the member segments. Factors associated with the result were sought, by the Mann-Whitney test. RESULTS: The localization of lymphedema was in thoracic and pelvic limbs, respectively in 64.1 and 35.9%. Were associated with the oedema functional difficulties (61.54%), muscle paresis (33.33%) and joint stiffness (30.77%). Patients benefited from 5 to 20 physiotherapy sessions. Has been associated with physiotherapy, the use of compression stockings (58.97%). The results have been satisfactory, mainly influenced by the development time. CONCLUSION: Satisfactory results in the physiotherapy management of lymphedema have been noted in our context, especially in patients seen early.

BUT: Rapporter les résultats des patients suivis en médecine physique et de réadaptation (MPR) au CNHU-HKM de Cotonou. PATIENTS ET MÉTHODES: Etude rétrospective, transversale de type descriptif et analytique. Ont été enrôlés, 39 dossiers de patients traités en MPR/CNHU-HKM, du 1er Janvier 2014 au 31 Décembre 2018, pour un lymphoedème unilatéral, ayant eu des évaluations de début et de fin de séances. Ont été exclus, les cas d'œdème veineux, systémique ou lipidique. La sévérité et le résultat des séances ont été appréciés en tenant compte des rapports des périmétries des segments de membre. Les facteurs associés au résultat ont été recherchés, par le test de Mann-Whitney. RÉSULTATS: La localisation du lymphoedème a été aux membres thoracique(s) et pelvien(s), respectivement dans 64,1 et 35,9%. Y étaient associées, des difficultés fonctionnelles (61,54%), parésie musculaire (33,33%) et raideur articulaire (30,77%). Les patients ont bénéficié de 5 à 20 séances de kinésithérapie. A été associée à la kinésithérapie, l'utilisation de bas de contention (58,97%). Les résultats ont été satisfaisants, influencés essentiellement par le délai d'évolution. CONCLUSION: Des résultats satisfaisants de la prise en charge kinésithérapique du lymphoedème ont été notés dans notre contexte, surtout chez les patients vus tôt.

Niveau de connaissance et conceptions d'une population urbaine au sud du Bénin sur les accidents vasculaires cérebraux / NA

Une meilleure connaissance sur les accidents vasculaires cérébraux (AVC) pourrait en améliorer la prévention. Objectif : Etudier le niveau de connaissance (NC) et la conception des sujets adultes de la ville de Cotonou, sur les AVC. Méthodologie : Il s'agit d'une étude transversale à visée descriptive et analytique, menée du 10 janvier au 27 avril 2018. L'échantillonnage était en grappes, ayant porté sur les sujets sans trouble psychiatrique connu, non professionnels de la santé et consentants à participer à l'étude dans cinq quartiers chacun de quatre arrondissements tirés au sort parmi les treize de la ville de Cotonou. Des propositions de réponses leur ont été faites concernant la définition, les manifestations, les facteurs de risque, la prévention, le traitement et le pronostic de l'AVC. De ces réponses aux questions, le NC des sujets a été catégorisé. Résultats : Il s'agissait de sujets scolarisés jusqu'au niveau universitaire (85,25%). Leur NC sur les AVC n'était pas bon (19,25%). Leurs sources d'informations sur les AVC étaient les médias (39,9%), parents et amis (34,3%). Leurs conceptions sur l'AVC étaient diverses : maladie dite spécifique aux riches (24,75%), aux adultes (20,75%) ; maladie due à la volonté de Dieu (17,75%), l'infidélité du (ou de la) conjoint(e) (8,75%), l'envoûtement (8,25%) ; maladie prévenue grâce à la foi en Dieu (30,5%), le respect des coutumes (10,5%) et traitée par les médicaments et tisanes (37%), les prières (33,75%). Les sujets avaient une attitude d'aide (80,8%), de compassion (67%) et de sympathie (63,5%) à l'endroit des victimes d'AVC. Le NC était associé à l'âge du sujet et sa capacité à identifier le cerveau comme organe affecté. Discussion-Conclusion : Des séances de communication pour un changement de comportement autour de l'AVC seront très utiles au Bénin.

Knowledge level and conceptions of an urban population in south of Benin about stroke Better knowledge about stroke could improve it prevention. Objective: To study the level of knowledge (LK) and the conception of adult subjects of Cotonou, on stroke. Methodology: This is a cross-sectional study with a descriptive and analytical aim, carried out from January 10 to April 27, 2018. The sampling was in clusters, focused on subjects without known psychiatric disorder, non-health professionals and who consented to participate to the study in five areas for each of four districts drawn at random from the thirteen districts of Cotonou. Proposals answers were made to them concerning definition, manifestations, risk factors, prevention, treatment and prognosis of stroke. From these answers to questions, the LK of subjects was categorized. Results: These were subjects educated up to university level (85.25%). Their LK on stroke was not good (19.25%). Their sources of information about stroke were medias (39.9%), parents and friends (34.3%). Their views on stroke were diverse: disease known as specific to rich persons (24.75%), to adults (20.75%); illness due to the will of God (17.75%), infidelity of spouse (8.75%), bewitchment (8.25%); disease prevented by the faith in God (30.5%), respect for customs (10.5%) and treated with medicines and herbal teas (37%), prayers (33.75%). Subjects had an attitude of help (80.8%), compassion (67%) and sympathy (63.5%) to victims of stroke. LK was associated with subject's age and ability to identify brain as the affected organ. Discussion-Conclusion: Communication sessions for behavior change concerning stroke will be very useful in Ben

Fibromyalgie en réeducation fonctionnelle à Cotonou: caractéristiques et vécu socio-professionnel des patients / NA

La fibromyalgie est une affection de douleur chronique, peu connue sous les tropiques. Elle pourrait altérer le vécu quotidien des patients. Objectif : Présenter les caractéristiques des cas de fibromyalgie suivis en Médecine Physique et de Réadaptation au CNHU-HKM de Cotonou, de même que le retentissement socio-professionnel noté chez ces patients. Méthode : Etude transversale de type descriptif ayant porté sur 60 patients diagnostiqués fibromyalgiques selon les critères de l'ACR 1990 et suivis en rééducation fonctionnelle du CNHU-HKM du 31 décembre 2009 au 30 Avril 2015. Ces patients ont été réévalués du 31 octobre 2014 au 30 Avril 2015 avec l'auto-questionnaire de Dallas pour apprécier le retentissement socio-professionnel de leur affection. Résultats : L'âge moyen des patients a été de 48,55 ans. Il s'agissait de 91,7% de femmes. La douleur était de type variable. Sa durée d'évolution était en moyenne de 89,38±74,77 mois. Elle était d'installation progressive (73,4%), intermittente (50%) et d'intensité au moins forte (88,4%). Des points douloureux spécifiques ont été identifiés dans notre série. La principale étiologie évoquée par les patients était la dépression et l'anxiété (95%). Un important retentissement des activités quotidiennes, professionnelles et des interactions sociales a été noté chez la majorité des patients. Conclusion : Les répercussions de la fibromyalgie sur les patients sont assez marquées. Il paraît judicieux d'associer à la rééducation un accompagnement psycho-social chez ces patients.

[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.

[Epidemiology of primitive digestive cancers in adult in three specialized health centers in Cotonou (Benin Republic)]. / Épidémiologie des cancers digestifs primitifs de l'adulte dans trois centres sanitaires spécialisés de Cotonou (République du Bénin).

Health research studies are increasingly focusing on digestive cancers because of their increasing frequency and severity. The objective of this work was to study the epidemiological aspects of primary digestive cancers in adults in three hospital centers in the commune of Cotonou. A total of 676 cases of digestive cancers were identified out of 25,093 patients received during the study period (2.7%). The mean age was 54 ± 14.1 years: [16-96] and the sex ratio was 2:1. The most frequent cancers were those of the liver (259; 38.3%) and colon-rectum (154; 22.8%). The next most common cancers in descending order were gastric cancer (12%), esophageal cancer (11.4%), pancreatic cancer (11.4%), anal cancer (1.9%), hail cancer (1.5%) and biliary cancer (0.7%). The average time to visit was 9 months. The main risk factors found were viral hepatitis B and C, alcoholism, diabetes, obesity, colonic polyps, smoking, excessive consumption of salt and dietary nitrates. Lethality was 58.4%, with cancers of the liver, colon-rectum, pancreas, and esophagus in descending order of mortality. The average overall survival was 10 months. Digestive cancers most often affect people in their fifties, who are usually men in Cotonou. They are dominated by liver cancer and colorectal cancer. Modifiable risk factors are often found. The control of these factors and early diagnosis could help improve the survival of patients affected.

L'objectif de ce travail était d'étudier les aspects épidémiologiques des cancers digestifs primitifs chez l'adulte dans trois centres hospitaliers de la commune de Cotonou. Il s'agissait d'une étude transversale descriptive et analytique, ayant comporté deux phases de recueil de données, l'une rétrospective sur neuf ans et l'autre prospective sur dix mois. Elle a porté sur les patients présentant un cancer digestif pris en charge dans trois centres hospitaliers de la commune de Cotonou au Bénin. Au total, 676 cas de cancers digestifs ont été répertoriés sur 25 093 patients reçus au cours de la période d'étude, soit 2,7 %. L'âge moyen était de 54 ± 14,1 ans : [16­96], et le sex-ratio était de 2:1. Les cancers les plus fréquents étaient ceux du foie (259 ; 38,3 %) et du côlon-rectum (154 ; 22,8 %). Venaient ensuite dans l'ordre décroissant le cancer gastrique (12 %), le cancer oesophagien (11,4 %), le cancer pancréatique (11,4 %), le cancer anal (1,9 %), le cancer grêlique (1,5 %) et le cancer biliaire (0,7 %). Le délai moyen de consultation était de neuf mois. Les principaux facteurs de risque trouvés étaient les hépatites virales B et C, l'alcoolisme, le diabète, l'obésité, les polypes coliques, le tabagisme, la consommation excessive de sel et nitrates alimentaires. La létalité était de 58,4 %, avec dans l'ordre décroissant de mortalité les cancers du foie, du côlonrectum, du pancréas et de l'oesophage. La moyenne de survie globale était de dix mois. Les cancers digestifs touchent le plus souvent des sujets de la cinquantaine, volontiers de sexe masculin à Cotonou. Ils sont dominés par le cancer du foie et le cancer colorectal. Des facteurs de risque modifiables sont souvent retrouvés. Le contrôle de ces facteurs et le diagnostic précoce pourraient contribuer à améliorer la survie des patients atteints.

[Sexual Behaviours at Risk of HIV Infection among Male to Female Transgender People in Benin]. / Comportements sexuels à risque d'infection à VIH chez les transgenres homme vers femme au Bénin.

Transgender people are a population vulnerable to the human immunodeficiency virus (HIV) due to frequent adoption of risky sexual behaviours. To reorient prevention interventions in this population, this study aims to identify factors associated with high-risk sexual behaviours. It's a cross-sectional study. The subjects were recruited by driven respondents sampling throughout the country in December 2017. They included subjects who identified themselves as Male to Female transgender and who adopted such an image. The data were collected by questionnaire. The variables were multi-partnership and condom use during sex. Proportion comparisons were made with Pearson's Chi2 test and multiple logistic modeling was performed. The prevalence of multipartnership was 83.85% and the prevalence of condom use during last intercourse was 92.41%. Sexual risk behaviours were associated with age (P = 0.004), occupation (P = 0.000), education level (P = 0.025), family and friends' attitudes towards transgender status (P = 0.044) and HIV prevention knowledge level (P < 0.05). The factors identified should be integrated into transgender interventions in Benin with a focus on improving knowledge in HIV prevention.

Pour réorienter les interventions de prévention à l'attention des transgenres homme vers femme, cette étude vise à identifier les facteurs associés à leurs comportements sexuels à risque d'infection au virus de l'immunodéficience humaine (VIH). L'étude était transversale avec un recrutement par technique en boule de neige, réalisée en décembre 2017. Les variables d'intérêt étaient le multipartenariat sexuel et l'utilisation du préservatif lors des rapports sexuels. Une modélisation logistique multiple a été faite. La prévalence du multipartenariat était de 83,8 % et celle de l'utilisation du préservatif lors du dernier rapport sexuel de 92,4 %. Les comportements sexuels à risque étaient associés à l'âge (p = 0,004), à la profession (p = 0,000), au niveau d'instruction (p = 0,025), à l'attitude de l'entourage face au statut de transgenre (p = 0,044) et au niveau de connaissance en matière de prévention du VIH (p < 0,05). Les facteurs identifiés sont des pistes à intégrer dans les interventions pour les transgenres au Bénin avec un accent sur l'amélioration de la connaissance en prévention du VIH.

Examining internal migration effects on short versus long interbirth intervals in Cotonou, Benin Republic.

BACKGROUND: The literature on migration-fertility relationship uses various measures of fertility, such as fertility rates, actual fertility and family size preferences. This study introduces a different measure-interbirth intervals over women's reproductive years-to examine how internal migration is associated with short interbirth intervals (less than 24 months) and long interbirth intervals (greater than 60 months) in Cotonou, the largest city of Benin Republic. METHODS: The paper uses primary data on 2852 live births to 1659 women aged 15-49 years from the 2018 Fertility and Migration Survey in Cotonou. Competing-risks models were fitted for the analysis. RESULTS: Nineteen percent of live births were of short interbirth intervals and 16% were of long interbirth intervals. The prevalence of short interbirth intervals was higher among migrants who spent less than 5 years in Cotonou (29%) than among non-migrants (19%) and earlier migrants (18%). Non-migrants had the highest proportion of long interbirth intervals (19%). Within the first 5 years following the migration to Cotonou, migrants had higher subhazard ratio (SHR) of short interbirth intervals (SHR: 1.71, 95% CI: 1.33-2.21) and lower SHR of long interbirth intervals (SHR: 0.64, 95% CI: 0.47-0.87) than non-migrants. This association holds after controlling for socioeconomic characteristics-but with a slightly reduced gap between migrants who spent less than 5 years in Cotonou and non-migrants. Afterwards and irrespective of women's socioeconomic backgrounds, migrants who spent 5 or more years in Cotonou and non-migrants had similar risks of short and long interbirth intervals. Finally, from 5 years of stay in Cotonou, migrants for reasons other than school or job were less likely to experience short interbirth intervals (SHR: 0.65, 95% CI: 0.46-0.98 for migrants who spent 5-10 years in Cotonou, and SHR: 0.74, 95% CI: 0.54-1.02 for migrants who spent more than 10 years in Cotonou) than non-migrants. CONCLUSION: Family planning programmes should mainly target migrants in the early years after their arrival in Cotonou. Moreover, non-migrants need to be sensitised on the adverse health outcomes of long interbirth intervals.

[Rare location of tuberculosis: endometrial tuberculosis]. / Une localisation rare de la tuberculose: la tuberculose endométriale.

Tuberculosis is a public health problem, especially in the developing countries. Bacillary pulmonary tuberculosis is the most common form of tuberculosis while genital tuberculosis is rare and underdiagnosed. We here report a case of endometrial tuberculosis. The study involved a 72-year old female patient with SC hemoglobinopathy consulting her gynecologist because of chronic leukorrhea. Cytobacteriologic assessment of vaginal swabs showed Streptococcus agalactatiae. Despite suitable antibiotic therapy, the evolution was marked by the persistence of leukorrhea. Pelvic ultrasonography objectified thickened endometrium, appearing as hyperechoic at the base of the uterus. This was suggestive of endometrial cancer. Anatomo-pathological examination of endometrial curettage samples showed granulomatous endometritis suggesting follicular tuberculosis. Outcome was favorable under antituberculosis treatment. In TB endemic areas, genital tuberculosis is not exceptional and should be suspected in patients with chronic leukorrhea despite suitable treatment.

[Functional constipation in the general population of Cotonou (Benin): clinical features and factors influencing dietary behaviours]. / Constipation fonctionnelle en population générale à Cotonou (Bénin): aspects cliniques et influence des facteurs nutritionnels.

INTRODUCTION: Constipation is rare in sub-Saharan Africa, due to the high intake of dietary fiber. The purpose of this work was to describe the different clinical features of functional constipation in the general population in Cotonou and to determine the impact of diet on its occurrence. METHODS: This study was conducted from July to August 2017. Subjects were considered affected by functional constipation when criteria for Rome IV or Bristol stool scale were completed. RESULTS: In total, 1058 participants were enrolled: (574 men, sex-ratio 1.2; average age 29 years). The prevalence of functional constipation was 24.2% (Rome IV) and 20.4% (Bristol stool scale). Clinical manifestations were dominated by the emission of hard or fragmented stools (90.6%), pushing efforts during defecation (78.9%), and feeling of incomplete evacuation (76.2%). Dietary habits among people affected by constipation were: at breakfast, maize meal + donut/peanuts (39.1%), lunch, corn dough (38.7%), at dinner, corn dough (57.4%), and as a snack banana (35.5%). There was no statistically significant relationship between constipation and morning meal (p=0.09), lunch meal (p=0.901), snack (p=0.09) or dinner (p=0.75) respectively. CONCLUSION: The emission of hard or fragmented stools was the most common clinical manifestation among people affected by constipation living in Cotonou. Dietary habits do not influence the occurrence of functional constipation in our case series.

Home treatment and use of informal market of pharmaceutical drugs for the management of paediatric malaria in Cotonou, Benin.

BACKGROUND: Malaria is the main cause of hospital admissions in Benin and a leading cause of death in childhood. Beside consultations, various studies have underlined the management of the disease through home treatment. The medicines used can be purchased in informal market of pharmaceutical drugs (IMPD) without prescription or any involvement of healthcare professional. Pharmaceutical drugs are sold by informal private vendors, who operate at any time in the immediate environment of the patients. The present study was conducted in Cotonou to study the health-seeking behaviour of caregivers to treat malaria in children under 12 years old. Factors associated with malaria home treatment and drugs purchase in IMPD were studied. METHODS: A cross-sectional study was carried out among 340 children's caregivers who were interviewed about their socio-demographic characteristics and their care-seeking behaviour during the most recent episode of malaria in their children under 12. Medicines used and purchase place were also collected. Multivariate logistic regression model was used to determine factors associated with malaria home treatment and drug purchase in IMPD. RESULTS: Beyond all the 340 caregivers, 116 (34%) consulted healthcare professional, 224 (66%) home treat the children, among whom 207 (61%) gave pharmaceutical drugs and 17 (5%) gave traditional remedies to children. Malaria home treatment was associated with family size, health insurance (OR = 0.396, 95% CI 0.169-0.928), and wealth quintiles where home treatment was less used by the richest (OR = 0.199, 95% CI 0.0676-0.522) compared to those in the poorest quintile. The caregivers age group 30-39 years was associated to the use of IMPD (OR = 0.383, 95% CI 0.152-0.964), the most economically wealthy people were less likely to use IMPD (wealth quintile richest: OR = 0.239, 95% CI 0.064-0.887; wealth quintile fourth OR = 0.271, 95% CI 0.100-0.735) compared to those in the poorest quintile. All caregivers who benefited from health insurance did not use IMPD. CONCLUSION: This study highlights the link between worse economic conditions and accessibility to medical care as one of the main factors of malaria home treatment and drug purchase in IMPD, even if those two phenomena need to be understood apart.

Fréquence et déterminants de la dénutrition post-opératoire en chirurgie viscérale au Centre National Hospitalier et Universitaire Koutoucou Hubert Maga, Cotonou: Frequency and determinants of post-operative undernutrition in patients undergoing visceral surgery at the University Hospital Centre Koutoucou Hubert Maga, Cotonou.

This study aims to determine the frequency and identify the factors associated with undernutrition among patients undergoing visceral surgery in 2014. We conducted a cross-sectional, descriptive and analytical study over the period September 11, 2014-December 11, 2014. The study population comprised patients who had undergone visceral surgery at the National University Hospital Centre Koutoucou Hubert MAGA, Cotonou. Undernutrition is defined as a body mass index less than 18.5 kg/m2. A total of 90 patients were included in the study, 57,78% (52 patients) were male. The average age of patients was 55±6,32 years. Undernutrition was found in 42 patients (46.67%). The factors associated with undernutrition in postoperative patients were: age greater than or equal to 50 years, low level of protein, water and energy intake, diarrhea, cancer, digestive system surgery, emergency surgery, significant weight loss and hyperleukocytosis. Undernutrition is common in postoperative patients. Hence the importance of nutritional screening and of early treatment.

[Clinical profile and factors associated with irritable bowel syndrome among medical students in Cotonou (Benin)]. / Profil clinique et facteurs associés au syndrome de l'intestin irritable chez les étudiants en médecine à Cotonou, Bénin.

INTRODUCTION: irritable bowel syndrome (IBS) is a common disorder that often results in general medicine and gastroenterology consultations. This study aims to determine IBS prevalence, to describe its clinical features, to determine its associated factors as well as its impact on the education among medical students in Cotonou. METHODS: We conducted a cross-sectional, descriptive and analytical study on medical students over the period 1 August-29 September 2017. The diagnostic criteria were: Rome IV, Bristol scale, Cungi scale and HADS score. Data analysis was performed using SPSS 20.0 software. RESULTS: Out of 315 students included in the study, 44 (14%) had IBS. The factors associated with IBS were female gender (OR [CI 95%] = 2.4 [1.2 - 4.7]; p = 0.00), regular consumption of fatty foods (OR [CI 95%] = 2.0 [1.1 - 3.9]; p = 0.03), high to severe levels of stress (OR [CI 95%] = 2.2 [1.1 - 4.7]; p= 0.02) and moderate to severe state of anxiety (OR [CI 95%] = 1.9 [0.9 - 3.6]; p= 0.04). IBS-related absenteeism was rare (1 case; 2.3%). CONCLUSION: IBS is common among medical students in Cotonou. The identified modifiable factors associated with IBS were stress, anxiety and regular consumption of fatty foods. No appreciable impact on the education was reported.

Therapeutic status of HIV-infected patients with at least 5 years of follow-up for antiretroviral therapy in a resource-limited setting: the experience of the CNHU ambulatory treatment center in Cotonou, Benin.

OBJECTIVES: The aim of this study was to describe the therapeutic situation of patients who had been followed up for antiretroviral therapy for at least 5 years. PATIENTS AND METHODS: A retrospective and descriptive study reviewed records of the historical cohort of adults infected with HIV in the national and teaching hospital at Cotonou from January 2, 2002, to March 31, 2013. It included all patients with follow-up for ART for at least five years. Immunological success was defined as a CD4 count above 350 cells/µl at the last test during the study period, and therapeutic success by viral load determined to be undetectable at its last measurement. Data were extracted from the updated ESOPE. STATA 11 software was used for data analysis. RESULTS: In March 2013, 979 patients, accounting for 27.1% of the overall cohort at the site, had been followed up for at least 5 years for ART. Their mean age was 38.1 ± 9.6 years and the sex-ratio (M/F) was 0.7. Analysis showed that 12.3% had been lost to follow-up, 2.3% had died, and 83.6% remained in treatment. The mean CD4 count at treatment initiation was 113.4±90.7 cells/µl, at 5 years 566.6±355.2 cells/µl, and at 10 years, 557.5±311.2 cells/µl. More than half (56.1%) of patients were treated with a first-line ART combination. Immunological success was reported for 63.2% of the patients. Of the 144 patients with a last viral load available, the therapeutic success rate was 76.4%. The probability of survival was 0.95 at 5 years and 0.91 at 10 years. CONCLUSION: Improving the quality and continuity of care can help to ensure short-term survival for PLHIV under a first-line ART treatment in resource-limited countries.