[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.

[Epidemiologic and medico-clinical aspects of the cholera outbreak in the Littoral department of Benin in 2008]. / Aspects épidémiologiques et médico-cliniques de l'épidémie de choléra dans le département du Littoral au Bénin en 2008.

OBJECTIVE: The purpose of this study was to determine epidemiological and medico-clinical features of the cholera outbreak that occurred in the Littoral department of Benin in 2008. METHODS: This cross-sectional descriptive analytic study was based on review of a total of 404 patient files. Study data included patient identity, clinical and therapeutic features and treatment outcome. Ten randomly selected patients participated in a focus group discussion. Decision-makers in charge of managing the outbreak and medical personnel that provided care were thoroughly debriefed and 10 affected areas were visited. Data were analyzed using EPI INFO 3.3.2 and EXCEL 2007. RESULTS: The outbreak started in Cotonou on 26 July 2008 and lasted for 21 weeks. Mean patient age was 23.72 +/- 14.80 years. Attack rates per district ranged from 15.86 to 172.98 per 100.000. Attack rates in Agbodjèdo, Hlacomey and Enagnon districts were significantly higher (p<10(-4)) than in other districts. The case fatality rate was 0.24 per 100. Crowded living conditions along the banks of the Cotonou lagoon along with poor sanitation and inadequate drinking water supply explain the endemicity of cholera in Cotonou. Vibrio cholerae O:1 was detected in 19 out of 36 stool samples. All strains were sensitive to ciprofloxacine but resistant to cotrimoxazole. Diarrhea was a consistent feature in all patients, along with vomiting in 88.11% and severe dehydration in 39.35%. Treatment involved oral rehydration, parenteral rehydration and antibiotherapy in 99.50%, 85% and 97.77% patients respectively. Antibiotherapy consisted of doxycycline for adult cases and amoxicilline for pregnant women and children. The duration of stay at the treatment center was significantly longer for patients with severe dehydration (p<10(-4)). CONCLUSION: Enhancing basic sanitation and access to drinking water and intensifying information campaigns on the need for healthy living behavior especially in districts located near the banks of Cotonou lagoon are needed to improve cholera prevention in the Littoral department in Benin.

Evaluation de la performance de la surveillance intégrée de la maladie et de la riposte dans la zone sanitaire Ouidah-Kpomassè-Tori-Bossito, au Bénin / NA

Introduction : La Surveillance Intégrée des Maladies et Riposte est une stratégie initiée en 1998 par le Bureau Régional de l'Organisation mondiale de la Santé pour l'Afrique, pour renforcer la capacité des pays africains à mener des activités de surveillance des maladies transmissibles et réagir efficacement face aux situations d'urgence sanitaire. L'objectif de la présente étude était d'évaluer la performance de la surveillance intégrée des maladies et riposte dans la zone sanitaire Ouidah-Kpomassè-Tori-Bossito en 2020. Méthodes : Il s'agissait d'une étude évaluative, ayant porté sur les formations sanitaires et le personnel impliqué dans la surveillance épidémiologique, sélectionnés respectivement par choix aléatoire simple et par choix raisonné. La performance de la surveillance intégrée des maladies et riposte a été appréciée par les éléments constitutifs des composantes "structure", "processus", "résultats" conformément au modèle de Donabedian et selon l'échelle de Varkevisser. Résultats: Au total 19 formations sanitaires et 19 agents de santé ont été inclus dans l'étude. La performance de la surveillance intégrée des maladies et riposte était moyenne, avec un bon niveau de la composante "structure" et un niveau moyen pour les composantes "processus" et "résultats". D'importantes insuffisances avaient été observées sur les fonctions confirmation, analyse, rétro-information et complétude des rapports. Conclusion: La performance de la surveillance intégrée des maladies et riposte nécessite une amélioration en vue d'une riposte appropriée face aux urgences de santé publique dans la zone sanitaire et une résilience du système de santé. Mots-clés: Performance, surveillance intégrée des maladies et riposte

Introduction: Integrated Disease Surveillance and Response is a strategy initiated in 1998 by the World Health Organization Regional Office for Africa, to strengthen the capacity of African countries to conduct communicable disease surveillance and response activities. effectively in health emergencies. The objective of this study was to assess the performance of integrated disease surveillance and response in the Ouidah-Kpomassè-Tori-Bossito health zone in 2020. Methods: This was an evaluative study, having focused on health facilities and personnel involved in epidemiological surveillance, selected respectively by simple random choice and by reasoned choice. The performance of the integrated disease surveillance and response was assessed by the constituent elements of the components "structure", "process", "results" in accordance with the Donabedian model and according to the Varkevisser scale. Results: A total of 19 health facilities and 19 health workers were included in the study. The performance of integrated disease surveillance and response was average, with a good level of the "structure" component and an average level for the "process" and "outcome" components. Significant shortcomings were observed in the confirmation, analysis, feedback and completeness of reports functions. Conclusion: The performance of integrated disease surveillance and response requires improvement for an appropriate response to public health emergencies in the health zone and health system resilience

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.