Childhood mortality among users and non-users of primary health care in a rural west African community.

To evaluate the effectiveness of primary health care (PHC) interventions implemented through the Pahou PHC Project, the utilization of PHC by 74 children aged 4 to 35 months who died in 1986 or 1987 was compared to that of 230 controls who survived and were individually matched by date of birth, sex and place of residence. The crude death rate was 35.9/1000/year. Measles vaccination before the first birthday significantly reduced the risk of mortality (Relative Risk/RR = 0.4). Children with less than 75% weight for age early in 1986 had an increased risk (RR = 4.3). Children who died had had significantly fewer contacts with the village health worker (VHW) in the last six months prior to death (RR = 0.3). A similar association was not observed for periods more than six months prior to death. Children who had more regular contact with the VHW throughout life were better protected than children for whom contact had been less systematic. We conclude that VHWs contribute to a better survival of young children through regular personal contact with the household.

PIP: Researchers analyzed the relationship between use of primary health care services and child mortality in 16 villages in the communes of Pahou and Avlekete on the Atlantic coast of Benin. The case control study included 74 4-35 month old children who died in 1986-1987 and 230 controls who survived. Overall child mortality stood at 35.9/1000/year. Fever and convulsions, presumably malaria, were the most likely cause of the majority of deaths (38 cases). No protective effect of a village health worker (VHW) visit in the 6 months before death occurred between fever and convulsion cases and other causes of death cases, however. VHWs had visited considerably more controls than cases in the 6 months prior to death (RR ..3; p.05). Indeed the greatest protective effect occurred in children who has been seen by VHWs had visited 71% of all children for a median of 4 visits each. Poor children were only slightly more likely to die than nonpoor children. Children whose weight for age was 75% of the standard for their age has a 4.26 relative risk (RR) of mortality (p.05). Further, when the researchers excluded cases who died within 3 months of the weight measurement, the RR remained high (2.9) and the association significant (p=.08). Measles vaccination between 9-12 months old significantly protected children against mortality (RR .36; p.05). On the other hand, diphtheria, tetanus, and pertussis vaccination did not have a significant protective effect. In conclusion, personal and household contact with a VHW and measles vaccination between 9-12 months improves child survival for 4-35 month old children.

Malaria morbidity and mortality in children under three years of age on the coast of Benin, West Africa.

Malaria morbidity and mortality were measured in a population of 1500 children under 3 years of age from April to December 1989. During monthly home visits, an average of 26 children in 1000 had fever, of whom 15 had parasitaemia. Children less than 6 months old had significantly fewer fever episodes, whether associated with parasitaemia or not. Overall, prevalence of fever with parasitaemia rose steadily from April to August, then decreased but reached a second peak in November. Peaks coincided with the 2 rainy seasons in April to June and September to October. Comparison with a control group demonstrated that children with parasitaemia exceeding 1000 infected red blood cells per microliter of blood had fever significantly more often than children with lower levels of parasitaemia. The average number of fever episodes per child per year was 2.4, and 33% of these were estimated to be caused by malaria. All cause mortality was 26/1000/year and the malaria mortality rate was 8/1000/year. Malaria deaths were most frequent in the second year of life.

An application of Ajzen's theory of planned behaviour to predict mothers' intention to use oral rehydration therapy in a rural area of Benin.

The aim of this study was to identify the psychological factors influencing mothers' intentions to use oral rehydration therapy (ORT) for the treatment of children's diarrhea in rural areas in South Benin. The subjects were 128 illiterate and animist mothers, selected at random in the areas of Pahou and Avlekete. Mothers were interviewed at home, using a pre-tested instrument investigating predictors of motivation as defined in Ajzen's theory of planned behaviour. The variables measured were intentions, attitudes, subjective social norm, perceived behavioural control and socio-demographic indicators. The regression of intention on all variables yielded an adjusted R2 of 0.40 (P < 0.0001), with perceived consequences of using ORT, perceived barriers to its use, and the zone of habitation being the significant predictors. The results suggest that the promotion of the use of ORT for treatment of diarrhea, in these areas, should be facilitated if the mothers perception of the advantages of using ORT is reinforced and if they have easier access to the health care services offered by local village health workers.

Contraceptive continuation and its determinants in Benin.

To understand better the rates of continuation of different contraceptive methods, a study in 12 family planning centers in Cotonou and Porto Novo, the two largest cities in Benin, was conducted. From January 1 to December 31, 1993, 944 questionnaires completed by new women acceptors of one of three methods of contraception (oral contraceptive, injection, or IUD) were analyzed. For all methods of contraception, the average length of follow-up was 9.5 months. From the start of the analysis, 44.4% (n = 419) of the women were regularly followed, 49.5% (n = 467) were not regularly followed, and 6.1% (n = 58) reported discontinuation of the method. One year after beginning the use of contraception, the cumulative proportion of women at risk of becoming pregnant, for all the methods together, was 42.0% (38.6-45.4%). Age was associated with the probability of abandoning oral contraception (p = 0.01). Three months after the start, the cumulative proportion of drop-out women having chosen oral contraceptive was 37.2% (22.8-51.6%) of the less than 20-year-olds, 19.0% (14.3-23.7%) of the 20- to 30-year-olds, and 23.4% (15.6-31.2%) of the over 30-year-olds. In contrast, drop-out was not associated with age for women using injection (p = 0.96) or the IUD (p = 0.47). Our results indicate a relatively high and rapid rate of discontinuation for modern contraceptive methods, particularly for young women having chosen oral contraceptive. This finding should incite the family planning educators to give more emphasis to the counseling programs, especially during the first three months.

[Incidence of and factors associated with primary cesarean section in Benin (Africa)]. / Incidence et facteurs associés à la césarienne primaire au Bénin (Afrique).

Among 3225 deliveries in two Cotonou public maternity units, 244 primary cesarean section were observed during July 1988 to December 1989. Primary cesarean section incidence varied according to indications, maternal parity and maternity care units. Foetal distress (65.9%), malpresentation and cephalopelvic disproportion (22.1%) were the dominant organic risk factors for the primary cesarean section. Multivariate stepwise logistic regression technique indicated that the most important indications for the practice in Cotonou were mainly organic risk factors, maternal height and parity as well as repeating stillborn history. Practician experiences (OR = 6.6) and foetal distress (OR = 9.3) in the decision making process were highly associated to cesarean section and differed between maternity units. Authors provided some suggestion for improving the practice of cesarean section in Cotonou and in Bénin.

[Influence of maternal weight on pregnancy outcome in Cotonou (Benin)]. / Influence du poids maternel sur l'évolution de la grossesse à Cotonou (Bénin).

To evaluate prevalence of obesity in pregnant women in Cotonou and to study the influence of obesity on pregnancy outcome, we analysed retrospectively obstetrical reports of 323 women delivered at the university clinic of gynecology and obstetrics during the year 1999. Prevalence of obesity was 18% among pregnant women and 30.6% of them were overweight. Medical complications of pregnancy were more frequent in obese women than in women with normal weight since obese women showed higher frequency of proteinuria (241% versus 10,5%, p<0.05) and high blood pressure (25.9% versus 4.5%, p<0.001). Diabetes mellitus was only present in obese women with a frequency of 5,2%. Compared with normal weight women, the obese ones showed a tendency to higher frequency of cesarean delivery (34.5% versus 21%), this difference being not statistically significant. Although there was a slightly higher number of reanimated infants in obese women, the difference was not significant. Six percent hypotrophic infants were observed in obese mothers versus 13.1% in mothers with normal weight (non significant) but it can be noticed that lean mothers showed statistically higher frequency of hypotrophic infants than normal weight mothers (33.3% versus 13.1%, p<0.01). This study shows that obesity in women represents, even in developing country, an obstetrical risk factor leading to high frequency of complications during pregnancy and needs the development of preventive actions.

[Obstetric complications of the first trimester in Western Africa]. / Complications obstétricales du premier trimestre en Afrique de l'Ouest.

The obstetrical complications affecting women in Benin, Senegal and Ivory Coast during the first trimester of pregnancy were studied. Information about the 345 women included in the study was collected from registers maintained by the eight participating maternity units. The most frequent complications observed were spontaneous abortions (50% of admissions), complications of induced abortions (34%), and ectopic pregnancy (8%). Overall, the patients appear to have gained rapid access to care: two thirds of the women underwent interventions on the day of admission. Nevertheless, there were three maternal deaths, two of which followed induced abortion complications.

[Management of ectopic pregnancies at the university clinic of gynecology and obstetrics in Cotonou (Benin)]. / Prise en charge de la grossesse extra-utérine à la Clinique universitaire de gynécologie et d'obstétrique de Cotonou (Bénin).

In 1993 and 1994, there were 223 cases of ectopic pregnancy, resolved by surgery, at the University Clinic of Gynecology and Obstetrics of the National Teaching Hospital in Cotonou. This represents 4.57% of the number of deliveries. The study of 204 cases reveals the following characteristics: (i) There are clinical signs: pelvic pains and/or metrorrhagia in 97% of cases; (ii) Diagnosis was often late with a hemoperitoneum and required major intervention (salpingectomy). Ultrasound scanning allowed accurate diagnosis in 30.39% of cases. Celioscopy was necessary in 3.92% of cases; (iii) The life prognosis is usually good (1 death in 204 cases; i.e. 0.49%). The functional prognosis is difficult to estimate. The evolution of medical techniques, with the help of ultrasound scans facilitates early diagnosis and application of modern less traumatic therapies such as endoscopic surgery and conservative treatment.

[Types of hypertension in pregnant women of Benin admitted to the National University Hospital of Cotonou]. / Les différents types d'hypertension artérielle chez les femmes enceintes béninoises admises au CNHU de Cotonou.

We carried out a retrospective and prospective study between January 1995 and August 1996, of pregnant women with high blood pressure. The aim of this work was to determine the prevalence of each type of hypertension according to the classification of the American College of Obstetricians and Gynecologists (ACOG) and to evaluate the prognosis for the mother and child. The prevalence of hypertension in pregnancy was found to be 7.65%. A family history of hypertension, obesity and a personal history of hypertension in pregnancy were all risk factors. Severe hypertension (diastolic blood pressure (DBP) > 110 mm Hg) affected 59.4% of the women. Chronic hypertension occurred in 41.51% of cases, preeclampsia in 26.41% of cases, associated preeclampsia in 18.87% of cases and isolated hypertension in 13.21% of cases. Eclampsia (70.6%) was the principal maternal complication in this study population. Fifty-four of the women gave birth to normal babies, 21 to hypotrophic babies, 15 gave birth prematurely and 3 had miscarriages. Six of the seven deaths involved women with DBP above 110 mm Hg.

HYSTEROSALPINGOGRAPHY AND LAPAROSCOPY IN EVALUATING FALLOPIAN TUBES IN THE MANAGEMENT OF INFERTILITY IN COTONOU, BENIN REPUBLIC.

INTRODUCTION: Hysterosalpingography, along with laparoscoy, are the most requested examinations for tubal factor exploration for infertility, in developing countries. OBJECTIVE: To compare the results of hysperosalpingography and laparoscopy in patients assessed for infertility. PATIENTS & METHODS: This was a 5 years retrospective, descriptive study done at the Obstetrics and Gynecology Clinic of the HKM Centre, National University Hospital. All the patients admitted for infertility of tubal origin were included. These included 96 patients who had undergone hysterosalpingography followed by laparoscopy. The analysis was done with the SPSS version 12.0.1. RESULT: The mean age of the patients was 33.3 years. Infertility was primary in 66.3% of cases and secondary in 33.7% of cases and the average duration was 48.9 months. Hysterosalpingography diagnosed 9.37% of proximal tubal obstruction while laparoscopy diagnosed same in 17.71%. Besides pelvic adhesive bands seen in 33.33% of cases, laparoscopy was able to visualize patent tubes with some pathology in 11.46%, and pelvic endometriosis in 6.25% of cases. CONCLUSION: The results of HSG and those of laparoscopy are complementary in tubal infertility evaluation. While HSG seems to be reliable when the tubes are patent, laparoscopy helps to reveal false tubal obstructions observed with HSG, and also helps in the diagnosis of pelvic adhesive bands and endometriosis.

Evaluation de la satisfaction des accouchées du service de gynécologie obstétrique du Centre Hospitalier Départemental du Borgou de Parakou (Bénin)

Introduction : La satisfaction des patients est une composante essentielle de la qualité des soins. Cependant, l'évaluation de la satisfaction est une pratique presque inexistante dans les établissements de santé au Bénin. L'objectif de cette étude était de mesurer la satisfaction des bénéficiaires de l'offre de soins lié à l'accouchement au Centre Hospitalier Départemental du Borgou (CHD-B).Patientes et méthodes : nous avons réalisé une étude transversale à visée descriptive et analytique du 2 juin au 15 septembre 2014. Elle a concerné 180 accouchées, recrutées de façon systématique avec un pas de sondage égale à 2. Les données ont été collectées grâce à des entrevues individuelles associées à l'exploitation des dossiers des patientes. Résultats : Le taux de satisfaction pour l'accouchement en général a été de 73,89%. Ce taux était plus élevé en cas d'accouchement par césarienne (78,05%) que par voie basse (68,37%). Les patientes ont été satisfaites de l'accueil (78%), du délai d'attente aux urgences (87,83%) et de la régularité des soins (74%). Par contre elles ont été insatisfaites des conditions de séjour (47,32%), de la restauration (53,09%) et de la prise en charge de la douleur (35,9%). Les accouchées disent n'avoir pas été informées sur leur état de santé (66,67%) ni sur celui de leur enfant (68,33%). Les facteurs associés à la satisfaction des accouchées ont été la parité, le niveau intellectuel et socio-économique et les interventions par voie basse. Conclusion : Les patientes étaient satisfaites des soins liés à l'accouchement au CHD-B. Il a été possible d'identifier certains facteurs qui influencent la satisfaction des accouchées

Newborn screening for sickle cell disease in the Republic of Benin.

AIMS: To develop a strategy for neonatal screening of sickle cell disease (SCD) and effective enrollment of affected neonates in a comprehensive follow-up programme adapted to the socioeconomic conditions, health structures and cultural background of an African setting. METHODS: The strategy implemented at the two largest maternity services of Cotonou, the economic capital of the Republic of Benin, involves a team of specifically trained midwives, first to identify pregnant women at risk, and second to provide active and repeated information and sensitisation to these women to encourage voluntary demand for newborn screening and enrollment in the follow-up programme. RESULTS: Among the consecutive pregnant women studied (about 3000), 79.5% of the informed women at risk for fetal SCD asked for testing of their offspring, 85.2% of the newborns who tested positive were enrolled in the programme, and more than 80% were still being followed up after 5 years. The under-five mortality rate in this series was 15.5 per 10,000, a figure that is 10 times lower than the general rate recorded in the Republic of Benin. CONCLUSIONS: The results demonstrate that this specifically tailored strategy is relevant to this setting, given the unique conditions of this African country.

Africa: time for action.

PIP: In sub-Saharan Africa, the maternal mortality ratio has remained a constant 500 deaths/100,000 live births despite increased efforts to address the problem since the launch of the Safe Motherhood Initiative in 1987. This situation is caused by 1) a poor referral system with little or no transportation, a lack of care during transport, and a lack of drugs for emergency treatment; 2) a low level of contraceptive availability and consequent use; 3) a high number of abortions with fatal complications; and 4) inadequate provision of adequate quality obstetric care. Research has indicated that countries with an annual per capita income of only $200 have succeeded in substantially reducing maternal mortality. Thus, maternal mortality is more closely linked to poor organization of services than to a lack of national resources. It is time for women and the whole of civil society to engage in advocacy activities of behalf of safe motherhood so that decision-makers will provide the necessary resources.^ieng

Family planning in Benin--knowledge, attitudes and practice.

"This article will deal with the family planning situation in Benin, more precisely [with] the level of knowledge, attitudes and practice (KAP) concerning modern contraceptive methods, and the hope for a successful family planning programme in Benin. We will look at studies which have already been done and we will also present some promising results of an experimental study which we carried out [in 1990]...." The period studied is from 1979 to 1991.