Advanced in immunological monitoring of HIV infection: profile of immune cells and cytokines in people living with HIV-1 in Benin.

BACKGROUND: Immune cells and cytokines have been linked to viremia dynamic and immune status during HIV infection. They may serve as useful biomarkers in the monitoring of people living with HIV-1 (PLHIV-1). The present work was aimed to assess whether cytokines and immune cell profiles may help in the therapeutic follow-up of PLHIV-1. METHODS: Forty PLHIV-1 in treatment success (PLHIV-1s) and fifty PLHIV-1 in treatment failure (PLHIV-1f) followed at the University Hospital of Abomey-Calavi/Sô-Ava in Benin were enrolled. Twenty healthy persons were also recruited as control group. Circulating cytokines and immune cells were quantified respectively by ELISA and flow cytometry. RESULTS: PLHIV-1 exhibited low proportions of CD4 + T cells, NK, NKT, granulocytes, classical and non-classical monocytes, and high proportions of CD8 + T cells, particularly in the PLHIV-1f group, compared to control subjects. Eosinophils, neutrophils and B cell frequencies did not change between the study groups. Circulating IFN-γ decreased whereas IL-4 significantly increased in PLHIV-1s compared to PLHIV-1f and control subjects even though the HIV infection in PLHIV-1s downregulated the high Th1 phenotype observed in control subjects. However, Th1/Th2 ratio remained biased to a Th1 phenotype in PLHIV-1f, suggesting that high viral load may have maintained a potential pro-inflammatory status in these patients. Data on inflammatory cytokines showed that IL-6 and TNF-α concentrations were significantly higher in PLHIV-1s and PLHIV-1f groups than in control subjects. Significant high levels of IL-5 and IL-7 were observed in PLHIV-1f compared to controls whereas PLHIV-1s presented only a high level of IL-5. No change was observed in IL-13 levels between the study groups. CONCLUSION: Our study shows that, in addition to CD4/CD8 T cell ratio, NK and NKT cells along with IL-6, TNF-α, IL-5 and IL-7 cytokines could serve as valuable immunological biomarkers in the therapeutic monitoring of PLHIV-1 although a larger number of patients would be necessary to confirm these results.

Bioclinical features of haemophilia patients in Benin in 2023: Towards better care.

OBJECTIVE: To analyse the demographic, clinical and laboratory data of Beninese patients with haemophilia. METHOD: A prospective survey was conducted in three different hospitals of Benin from April 2021 to March 2022, to analyse clinical and biological features of patients with haemophilia previously diagnosed or identified based on personal/family history. RESULTS: A total of 101 patients were studied, 97 with haemophilia A and 4 with haemophilia B, including 26 new cases identified after family investigation. Their median age was 11 years, and the most frequent initial manifestations were cutaneous-mucosal haemorrhages (29.70%) and post-circumcision haemorrhages (25.74%). Previous joint bleedings were present in 77% of them, with an arthropathy in 65 cases, which particularly affected the knees (75%), elbows (41%) and ankles (29%). Factor VIII (FVIII) levels combined with activated partial thromboplastin time (APTT) values did not always enable, as would be expected, the distinction between severe and moderate haemophilia, since they were >1 IU/dl in 31 of 74 patients with APTT > 80 s, and between 1 and 2 IU/dl in 26 other cases with previous joint haemorrhages, including 18 with chronic arthropathy. Therefore, for these patients, severe haemophilia could not be excluded, and this uncertainty probably reflects technical difficulties affecting the pre-analytical and analytical stages of the APTT and FVIII/IX assays. CONCLUSION: Our study proved that haemophilia is a significant reality in Benin, but also remains under-diagnosed in some districts of the country. In addition, more reliable biological tests are needed in the future to better define the severity of the disease and improve treatment of patients.

Application of advanced very high-resolution radiometer (AVHRR)-based vegetation health indices for modelling and predicting malaria in Northern Benin, West Africa.

BACKGROUND: Vegetation health (VH) is a powerful characteristic for forecasting malaria incidence in regions where the disease is prevalent. This study aims to determine how vegetation health affects the prevalence of malaria and create seasonal weather forecasts using NOAA/AVHRR environmental satellite data that can be substituted for malaria epidemic forecasts. METHODS: Weekly advanced very high-resolution radiometer (AVHRR) data were retrieved from the NOAA satellite website from 2009 to 2021. The monthly number of malaria cases was collected from the Ministry of Health of Benin from 2009 to 2021 and matched with AVHRR data. Pearson correlation was calculated to investigate the impact of vegetation health on malaria transmission. Ordinary least squares (OLS), support vector machine (SVM) and principal component regression (PCR) were applied to forecast the monthly number of cases of malaria in Northern Benin. A random sample of proposed models was used to assess accuracy and bias. RESULTS: Estimates place the annual percentage rise in malaria cases at 9.07% over 2009-2021 period. Moisture (VCI) for weeks 19-21 predicts 75% of the number of malaria cases in the month of the start of high mosquito activities. Soil temperature (TCI) and vegetation health index (VHI) predicted one month earlier than the start of mosquito activities through transmission, 78% of monthly malaria incidence. CONCLUSIONS: SVM model D is more effective than OLS model A in the prediction of malaria incidence in Northern Benin. These models are a very useful tool for stakeholders looking to lessen the impact of malaria in Benin.

Presence of Plasmodium vivax in Anopheles gambiae and absence in other malaria vectors in Cove-Zagnanando-Ouinhi health zone in southern Benin, West Africa.

BACKGROUND: Malaria remains a major public health problem in sub-Saharan Africa, particularly in Benin. The present study aims to evaluate the different Plasmodium species transmitted by malaria vectors in the communes of Cove, Zagnanado and Ouinhi, Southern Benin. METHODS: The study was conducted between December 2021 and October 2022 in 60 villages spread over the three study communes. Adult mosquitoes were collected from four houses in each village using human landing catches (HLCs). After morphological identification, a subsample of Anopheles gambiae, Anopheles funestus and Anopheles nili was analysed by PCR to test for their infection to the different Plasmodium species. RESULTS: Anopheles gambiae was collected at higher frequency in all the three study communes, representing 93.5% (95% CI 92.9-94) of all collected mosquitoes (n = 10,465). In total, five molecular species were found, An. gambiae sensu stricto (s.s.) and Anopheles coluzzii of the Gambiae complex, An. funestus and Anopheles leesoni of the Funestus group, and An. nili s.s., the sole species of the Nili group. From the five molecular species, four (An. gambiae s.s., An. coluzzii, An. funestus s.s. and An. nili s.s.) were found to be infected. Plasmodium falciparum was the main Plasmodium species in the study area, followed by Plasmodium vivax and Plasmodium ovale. Only An. gambiae s.s. was infected with all three Plasmodium species, while An. coluzzii was infected with two species, P. falciparum and P. vivax. CONCLUSIONS: Plasmodium falciparum was the only species tested for in malaria vectors in Benin, and remains the only one against which most control tools are directed. It is, therefore, necessary that particular attention be paid to secondary Plasmodium species for an efficient control of the disease. The presence of P. vivax emphasizes the need for an update of case management for malaria.

Physico-chemical characterization of Anopheles gambiae s.l. breeding sites and kdr mutations in urban areas of Cotonou and Natitingou, Benin.

BACKGROUND: This study aimed to investigate the relationship between the physicochemical characteristics of An. gambiae s.s. and An. coluzzii breeding sites, the susceptibility profiles to commonly used insecticides in public health, and the underlying insecticide resistance mechanisms. METHODS: Anopheles breeding sites surveys were conducted in Cotonou and Natitingou in September 2020, January and August 2021. Physicochemical properties and bacterial loads were determined in individual breeding sites. The WHO susceptibility assays were carried out using the female of the emerging adult mosquitoes. Anopheles species were identified through PCR techniques. Kdr L1014F/S, N1575Y and G119S mutations were investigated using TaqMan genotyping assays. RESULTS: Molecular analysis showed that all mosquitoes analyzed in Cotonou were Anopheles coluzzii, while those of Natitingou were Anopheles gambiae s.s. Fecal coliforms were identified as playing a role in this distribution through their significant influence on the presence of An. coluzzii larvae. WHO susceptibility assay indicated a high level of resistance to deltamethrin in the two cities. The resistance levels to deltamethrin were higher in Cotonou (X2 = 31.689; DF = 1; P < 0.0001). There was a suspected resistance to bendiocarb in Cotonou, whereas the mosquito population in Natitingou was resistant. The kdr L1014F mutation was highly observed in both mosquito populations (frequence: 86-91%), while the Ace-1 mutation was found in a small proportion of mosquitoes. In Cotonou, salinity was the only recorded physicochemical parameter that significantly correlated with the resistance of Anopheles mosquitoes to deltamethrin (P < 0.05). In Natitingou, significant correlations were observed between the allelic frequencies of the kdr L1014F mutation and pH, conductivity, and TDS. CONCLUSION: These results indicate a high level of pyrethroid resistance in the anopheles populations of both Cotonou and Natitingou. Moreover, this study report the involvement of abiotic factors influencing Anopheles susceptibility profile.

Prognostic factors and overall survival of breast cancer in Benin: a hospital-based study.

BACKGROUND: In Benin, a country in West Africa, breast cancer is the leading cancer in women, both in terms of incidence and mortality. However, evidence on the mortality of breast cancer and its associated factors is lacking in this country. Our aim was to describe and analyze the clinical, histopathological, and prognostic aspects of breast cancer in Benin. METHODS: A descriptive and analytical study was carried out at the CNHU-HKM and the CHU-MEL, two major tertiary referral hospitals for breast cancer management located in Cotonou, the capital city of Benin. All breast cancer medical records with histological evidence and immunohistochemistry studies were retrospectively collected between January 1, 2014, and September 30, 2020, in these two tertiary referral hospitals and analyzed in the current study. RESULTS: Finally, 319 medical records were included. The mean age at diagnosis was 48.74 years. The tumors were most frequently classified as T4 (47.6%) with lymph node involvement N2 (34.5%), and metastases were clinically noted in 21.9% of cases. Stage was reported in the medical records of 284 patients. Tumors were diagnosed at very late AJCC stages: stage III (47.5%) and stage IV (24.7%). Grades SBR 2 (49.2%) and SBR 3 (32.6%) were the most frequent grades. Triple-negative breast cancer (31.3%) was the most common molecular type. The overall 5-year survival was 48.49%. In multivariable analysis, the poor prognostic factors were lymph node invasion (HR = 2.63; p = 0.026; CI: [1.12, 6.17]), the presence of metastasis (HR = 3.64; p < 0.001); CI: [2.36, 5.62] and the immunohistochemical profile (HR = 1.29; p < 0.001; CI: [1.13, 1.48]). CONCLUSIONS: Breast cancer in Beninese is predominant in young adults and is often diagnosed at a late stage. The survival of breast cancer patients in Benin can be improved by enhancing early diagnosis and multidisciplinary management.

Towards an intelligent malaria outbreak warning model based intelligent malaria outbreak warning in the northern part of Benin, West Africa.

BACKGROUND: Malaria is one of the major vector-borne diseases most sensitive to climatic change in West Africa. The prevention and reduction of malaria are very difficult in Benin due to poverty, economic insatiability and the non control of environmental determinants. This study aims to develop an intelligent outbreak malaria early warning model driven by monthly time series climatic variables in the northern part of Benin. METHODS: Climate data from nine rain gauge stations and malaria incidence data from 2009 to 2021 were extracted from the National Meteorological Agency (METEO) and the Ministry of Health of Benin, respectively. Projected relative humidity and temperature were obtained from the coordinated regional downscaling experiment (CORDEX) simulations of the Rossby Centre Regional Atmospheric regional climate model (RCA4). A structural equation model was employed to determine the effects of climatic variables on malaria incidence. We developed an intelligent malaria early warning model to predict the prevalence of malaria using machine learning by applying three machine learning algorithms, including linear regression (LiR), support vector machine (SVM), and negative binomial regression (NBiR). RESULTS: Two ecological factors such as factor 1 (related to average mean relative humidity, average maximum relative humidity, and average maximal temperature) and factor 2 (related to average minimal temperature) affect the incidence of malaria. Support vector machine regression is the best-performing algorithm, predicting 82% of malaria incidence in the northern part of Benin. The projection reveals an increase in malaria incidence under RCP4.5 and RCP8.5 over the studied period. CONCLUSION: These results reveal that the northern part of Benin is at high risk of malaria, and specific malaria control programs are urged to reduce the risk of malaria.

Improving cancer incidence evaluation through local government area matching: a study of the Edo-Benin cancer registry in Nigeria.

BACKGROUND: Cancer registries in Nigeria, as well as in other sub-Saharan African countries, face challenges in adhering to international cancer registration standards. We aimed to improve cancer incidence estimation by identifying under-reporting of new cancers through matching patient-reported local government areas (LGAs) in Edo state, Nigeria, to their respective catchment populations. METHODS: Information on cancers was obtained from records of hospitals, medical clinics, pathology laboratories, and death certificates according to IARC guidelines. We utilized normalized scores to establish consistency in the number of cancers by calendar time, and standardized incidence ratios (SIR) to assess the variation in cancer incidence across LGAs compared to Edo state average. Subsequently, we estimated sex- and site-specific annual incidence using the average number of cancers from 2016 to 2018 and the predicted mid-year population in three LGAs. Age-standardization was performed using the direct method with the World Standard Population of 1966. RESULTS: The number of incident cancers consistent between 2016-2018 in Egor, Oredo, and Uhunmwonde showed a significantly increased SIR. From 2016 to 2018 in these three LGAs, 1,045 new cancers were reported, with 453 (42.4%) in males and 592 (57.6%) in females. The average annual age-standardized incidence rate (ASR) was 50.6 (95% CI: 45.2 - 56.6) per 105. In men, the highest incidence was prostate cancer (ASR: 22.4 per 105), and in women, it was breast cancer (ASR: 16.5 per 105), and cervical cancer (ASR: 12.0 per 105). Microscopically verified cancers accounted for 98.1%. CONCLUSIONS: We found lower age-standardized incidence rates than those reported earlier for the Edo state population. Collecting information on the local government areas of the cancers allows better matching with the respective target population. We recommend using LGA information to improve the evaluation of population-based cancer incidence in sub-Saharan countries.

Epidemiology of alcohol use disorder in the general population of Togo and Benin: the ALCOTRANS study.

INTRODUCTION: Access to data concerning mental health, particularly alcohol use disorders (AUD), in sub-Saharan Africa is very limited. This study aimed to estimate AUD prevalence and identify the associated factors in Togo and Benin. METHODS: A cross-sectional study was conducted between April and May 2022, targeting individuals aged 18 years and above in the Yoto commune of Togo and the Lalo commune of Benin. Subjects were recruited using a multi-stage random sampling technique. AUD diagnoses were made using the MINI adapted to DSM-5 criteria. Our study collected sociodemographic information, data on psychiatric comorbidities, stigmatization, and assessed cravings, using a series of scales. The association between AUD and various factors was analyzed using multivariable logistic regression. RESULTS: In Togo, 55 of the 445 people investigated had AUD (12.4%; [95% CI: 9.5-15.7%]). Among them, 39 (70.9%) had severe AUD and the main associated comorbidities were suicidal risk (36.4%), and major depressive disorder (16.4%). Associated factors with AUD were male gender (aOR: 11.3; [95% CI: 4.8-26.7]), a higher Hamilton Depression Rating Scale (HDRS) score (aOR: 1.2; [95% CI: 1.1-1.3]) and a lower Stigma score measured by the Explanatory Model Interview Catalogue (EMIC) (aOR: 0.9; [95% CI: 0.8-0.9). The stigma scores reflect perceived societal stigma towards individuals with AUD. In Benin, 38 of the 435 people investigated had AUD (8.7%; [95% CI: 6.4-11.7]), and the main associated comorbidities were suicidal risk (18.4%), tobacco use disorder (13.2%) and major depressive episode (16.4%). Associated factors with AUD were male gender (aOR: 6.4; [95% CI: 2.4-17.0]), major depressive disorder (aOR: 21.0; [95% CI: 1.5-289.8]), suicidal risk (aOR: 3.7; [95% CI: 1.2-11.3]), a lower Frontal Assessment Battery (FAB) score (aOR:0.8; [95% CI: 0.8-0.9]) and a lower perceived stigma score (by EMIC )(aOR: 0.9; [95% CI: 0.8-0.9]). CONCLUSION: In these communes of Togo and Benin, AUD prevalence is notably high. A deeper understanding of the disease and its local determinants, paired with effective prevention campaigns, could mitigate its impact on both countries.

Palliative care progress in Benin: a situation analysis using the WHO development indicators.

CONTEXT: Palliative care (PC) in most African countries remains under-assessed. Benin has piloted the implementation of a set of indicators proposed by the WHO to measure PC development. OBJECTIVES: To examine the current status of PC in Benin. METHODS: A workshop with stakeholders was organized to assess the WHO indicators in the Beninese context. Indicators were rated based on relevance and feasibility, data sources were agreed upon, and a survey was adapted. Data were collected between March and May 2023. RESULTS: There is emerging community involvement in PC through the presence of patients' rights promoters, as well as a political commitment expressed in the National PC strategy, the inclusion of PC services in the list of basic health services, and an assigned national authority -within the Ministry of Health-responsible for PC. Although no PC-oriented research has been documented, the celebration of the National PC Conference represents the first step to ground PC delivery in evidence. The reported annual consumption of opioids is 0.18 (ME) milligrams per capita, 34% of healthcare establishments have essential medicines for pain and PC, and 16.5% of patients with palliative needs have access to oral morphine. To date, no medical or paramedical schools offer PC training, and there is no official specialization in palliative medicine for doctors. PC is provided by 11 specialist teams (0.08/100,000 inhabitants), none of which provides pediatric care. CONCLUSION: Despite growing political, professional, and community commitments to palliative care, there are challenges in education, research, essential medicines, and access to PC services.

Knowledge, attitudes and practices of general practitioners on peripheral neuropathies in Benin in 2021.

PURPOSE: First healthcare actors in neurological diseases management, General Practitioners (GPs) still limited in the assessment of Peripheral Neuropathies (PN). This study assesses the knowledge, attitudes, practices (KAP) of GPs on PN in Benin in 2021 and identifying associated factors to low KAP. MATERIALS AND METHODS: It was a cross-sectional study conducted from 20 November 2020 to 30 June 2021 which included GPs registered in the National Order of Physicians in Benin and interns in last year of medical studies (MS). An overall KAP score of 24 points was derived. KAP levels were low (score < 17), medium (17 to 19) and high (score ≥ 20). Multivariable regression models were performed to identify factors associated with low KAP. RESULTS: 645/1,066 participants (60.5%) were included in the study with median age 28 years [Interquartile range IQR: 26-30 years], and 442 (68.5%) were male. The KAP level was low in 70.1%. 16.7% had a low knowledge of polyneuropathy manifestations, 35% perceived PN as an incurable disease. Lack of knowledge on PN before MS (adjusted Odds-ratio aOR = 1.6 [95% confidence interval CI: 1.1-2.3]), and no postgraduate training on PN (aOR = 1.8 [95% CI: 1.--3.0]) were associated with low overall KAP level. Working in rural area (aOR = 0.4 [95%CI: 0.2-0.7]), and being an intern (aOR = 0.6 [95%CI: 0.4-0.9]) were associated with better overall KAP level. CONCLUSION: This study highlights the need for better training with strong emphasis on PN during the MS and the organization of postgraduate training for GPs; the cornerstone for improving the management of PN in Benin.

Looted artifacts and museums' perpetuation of imperialism and racism: Implications for the importance of preserving cultural heritage.

In the midst of recent protests and antiracism movements following the death of George Floyd in May of 2020 and other Black, Indigenous, and people of Color (BIPOC) murdered in the United States by police violence, protestors and advocates around the world recognized the need for Western governments and other institutions to reckon with their own imperial history-to acknowledge the linkage between the slave trade, colonialism, and racism in their countries. This recognition led to the tearing down of statues depicting racist colonial leaders and calling for museums who have perpetuated imperialism and racism through their acceptance and display of looted artifacts to return them. This article sought to answer the question posed in the call for papers, can the many manifestations of racism be effectively dealt with in our society if the status quo is unwilling to engage with the issues, address them, and relinquish power. Further the author argues that cultural looting has its roots in colonialism and racism and discusses implications of the linkage between one's stolen cultural heritage and individual and community well-being. Answers to the question include both yes, manifestations of racism can be addressed, and no, they cannot be addressed when institutions and governments refuse to engage, address the issue and do not relinquish power. The article also includes the author's thoughts on using a living heritage approach to preserve cultural heritage and offers suggestions that community psychologists, advocates and activists can help to decolonize museums as part of the broader social and racial justice movement.

The prevalence and demographic associations of headache in the adult population of Benin: a cross-sectional population-based study.

BACKGROUND: The Global Burden of Disease (GBD) study is increasingly well informed with regard to headache disorders, but sub-Saharan Africa (SSA) remains one of the large regions of the world with limited data directly derived from population-based studies. The Global Campaign against Headache has conducted three studies in this region: Ethiopia in the east, Zambia in the south and Cameroon in Central SSA. Here we report a similar study in Benin, the first from West SSA. METHODS: We used the same methods and questionnaire, applying cluster-randomized sampling in three regions of the country, randomly selecting households in each region, visiting these unannounced and randomly selecting one adult member (aged 18-65 years) of each household. The HARDSHIP structured questionnaire, translated into Central African French, was administered face-to-face by trained interviewers. Demographic enquiry was followed by diagnostic questions based on ICHD-3 criteria. RESULTS: From 2,550 households with eligible members, we recruited 2,400 participants (participating proportion 94.1%). Headache ever was reported by almost all (95.2%), this being the lifetime prevalence. Headache in the last year was reported by 74.9%. Age-, gender- and habitation-adjusted estimates of 1-year prevalence were 72.9% for all headache, 21.2% for migraine (including definite and probable), 43.1% for TTH (also including definite and probable), 4.5% for probable medication-overuse (pMOH) and 3.1% for other headache on ≥ 15 days/month. One-day (point) prevalence of headache was 14.8% according to reported headache on the day preceding interview. CONCLUSIONS: Overall, these findings are evidence that headache disorders are very common in Benin, a low-income country. The prevalence of pMOH, well above the estimated global mean of 1-2%, is evidence that poverty is not a bar to medication overuse. The findings are very much the same as those in a similar study in its near neighbour, Cameroon. With regard to migraine, they are reasonably in accord with two of three earlier studies in selected Beninese populations, which did not take account of probable migraine. This study adds to the hitherto limited knowledge of headache in SSA.

An Overview of 10 Years of Activity of a Molecular Laboratory for Buruli Ulcer Diagnosis at a Field Hospital in Benin.

Buruli ulcer (BU) is a neglected tropical disease caused by Mycobacterium ulcerans. Early diagnosis is crucial to prevent morbidity. In November 2012, a field laboratory fully equipped for the rapid on-site quantitative PCR (qPCR) diagnosis of M. ulcerans was established at the Buruli ulcer treatment center (CDTLUB) center in Pobè Benin, a region where BU is endemic. We describe its first 10 years of activity and its gradual evolution into an expert laboratory for BU diagnosis. From 2012 to 2022, the laboratory analyzed 3,018 samples from patients attending consultations for suspected BU at the CDTLUB in Pobè. Ziehl-Neelsen staining and qPCR targeting the IS2404 sequence were performed. Since 2019, the laboratory has also received and analyzed 570 samples from other centers. The laboratory confirmed the diagnosis of BU by qPCR for 39.7% samples: M. ulcerans DNA was detected in 34.7% of swabs, 47.2% of all fine needle aspiration samples (FNA) and 44.6% of all skin biopsy specimens. Positive Ziehl-Neelsen staining results were obtained for 19.0% samples. Bacterial load, estimated by qPCR, was significantly greater for the Ziehl-Neelsen-positive samples than for Ziehl-Neelsen-negative samples, and detection rates were highest for FNA samples. Overall, 26.3% of the samples received from other centers were positive for BU. Most of these samples were sent by the CDTLUBs of Lalo, Allada, and Zagnanado, Benin. The establishment of the laboratory in the CDTLUB of Pobè has been a huge success. Optimal patient care depends on the close proximity of a molecular biology structure to BU treatment centers. Finally, FNA should be promoted among caregivers. IMPORTANCE Here, we describe the first 10 years of activity at a field laboratory established at the Buruli ulcer treatment center (CDTLUB) in Pobè, Benin, a country in which Mycobacterium ulcerans is endemic. Between 2012 and 2022, the laboratory analyzed 3,018 samples from patients consulting the CDTLUB of Pobè with a suspected clinical BU. Ziehl-Neelsen staining and qPCR targeting the IS2404 sequence were performed. In total, 39.7% of samples tested positive by qPCR and 19.0% tested positive by Ziehl-Neelsen staining. Detection rates were highest for FNA samples, and the bacterial loads estimated by qPCR were significantly higher for Ziehl-Neelsen-positive samples than for Ziehl-Neelsen-negative samples. Since 2019, the laboratory has also analyzed 570 samples received from outside the CDTLUB of Pobè, 26.3% of which were positive for BU. Most of these samples were sent by the CDTLUBs of Lalo, Allada, and Zagnanado in Benin. The establishment of the laboratory in the CDTLUB of Pobè has been a huge success, with major benefits for both the medical staff and patients. Our findings illustrate that the usefulness and feasibility of having a diagnostic center in rural Africa, where the disease is endemic, is a key part of optimal patient care, and that FNA should be promoted to increase detection rates.

Prevalence of parvovirus B19 antibodies in pregnant women in northern Benin.

OBJECTIVES: Parvovirus B19 (B19V) infection in pregnancy is generally asymptomatic, but in about 3% it can cause complications, including miscarriage, severe foetal anaemia and foetal hydrops. The seroprevalence in pregnancy ranges from 20% to 82% in Africa, but there are no data for Benin. We therefore retrospectively assessed the seroprevalence of B19V in pregnant women attending the Saint Jean de Dieu Hospital in Tanguiéta, a rural district of Atacora, in northern Benin. METHODS: We searched for anti-B19V immunoglobulin M (IgM) and immunoglobulin G (IgG) antibodies in 227 sequential sera from as many women (mean age 26.3 years, range: 16-41) of whom 30 were in the first trimester, 66 in the second and 131 in the third. Samples that tested positive for IgM were analysed with an immunoblot test and the viral genome (DNA-B19V) was searched for using a polymerase chain reaction. RESULTS: Of the 227 women, 153 (67.4%) were positive for IgG anti-B19V, 7 (3.1%) for IgM and 73 (32.2%) were non-immune. Six IgM-positive women were also IgG positive. The difference in IgG seroprevalence between trimesters or ages was not statistically significant. Of the seven IgM-positive samples, three were confirmed positive by immunoblot (of which two were DNA-B19V positive), three were indeterminate (DNA-B19V negative) and one was negative (DNA-B19V negative). Of the three women with confirmed positive IgM, two were in the third trimester and one in the second trimester of pregnancy. CONCLUSIONS: The seroprevalence of anti-B19V IgG among pregnant women in Benin is high and in line with those reported in some African countries. IgM seroprevalence is also similar to that described in some African countries in non-epidemic periods. The low viral load observed depicts non-acute infections, but it is difficult to establish the precise time of the infection, especially for women tested in the second or third trimester of pregnancy, when the observed viremia could be a sign of an acute infection that occurred in the previous trimester. Consequently, clinical follow-up and further investigations to highlight possible foetal consequences are indicated.

Attitudes and prevention towards malaria in the context of COVID-19 pandemic in urban community in Benin, West Africa.

BACKGROUND: The COVID-19 pandemic and its damages have severely impacted the global healthcare system even in countries with the best systems. In sub-Saharan Africa (SSA), it could worsen the malaria situation in endemic countries such as Benin. This study was conducted to describe the potential effects of the pandemic on urban dwellers attitudes, prevention and treatment against malaria in four major cities of Benin. METHODS: A cross-sectional questionnaire survey was conducted in Cotonou, Bohicon, Parakou and Natitingou, four urban cities of Benin. A total of 800 randomly selected households were interviewed. The questionnaire consisted of four parts: sociodemographic characteristics, knowledge, attitude, and practice. Descriptive statistics and binomial logistic regression analysis were used in the statistical analysis. RESULTS: More than 90% of the participants interviewed had a good level of knowledge about the transmission and prevention of malaria in the cities surveyed. In contrast, low proportions of participants reported visiting health-care facilities when they suspected malaria. Compared to the proportions observed at Parakou and Natitingou, the low proportion of participants was statistically significant at Cotonou (Parakou: X2 = 31.345, df = 1, P < 0.0001; Natitingou: X2 = 17.471, df = 1, P < 0.0001). Among the reasons for not seeking care, these related to COVID-19 were the most mentioned. Moreover, the good education level of the participants was one of the factors associated with the non-use of healthcare facilities due to over-knowledgeable about Covid-19, which might have increased the fear to go to the health facilities. Finally, high proportions of self-medication practice were mentioned with high use of malaria drugs to treat both malaria and to protect against COVID-19. CONCLUSIONS: The data show a negative impact of COVID-19 on visits to healthcare facilities for malarial treatment and malaria drugs usage by the population. It is, therefore, necessary to rebuild malaria programmes by integrating measures adapted to health crises such as the COVID-19 pandemic.

Vectorial competence, insecticide resistance in Anopheles funestus and operational implications for malaria vector control strategies in Benin Republic.

The primary reason for the failure of malaria vector control across endemic regions is the widespread insecticide resistance observed in Anopheles vectors. The most dominant African vectors of malaria parasites are Anopheles gambiae and Anopheles funestus mosquitoes. These species often exhibit divergent behaviours and adaptive changes underscoring the importance of deploying active and effective measures in their control. Unlike An. gambiae, An. funestus mosquitoes are poorly studied in Benin Republic. However, recent reports indicated that An. funestus can adapt and colonize various ecological niches owing to its resistance against insecticides and adaptation to changing breeding habitats. Unfortunately, scientific investigations on the contribution of An. funestus to malaria transmission, their susceptibility to insecticide and resistance mechanism developed are currently insufficient for the design of better control strategies. In an attempt to gather valuable information on An. funestus, the present review examines the progress made on this malaria vector species in Benin Republic and highlights future research perspectives on insecticide resistance profiles and related mechanisms, as well as new potential control strategies against An. funestus. Literature analysis revealed that An. funestus is distributed all over the country, although present in low density compared to other dominant malaria vectors. Interestingly, An. funestus is being found in abundance during the dry seasons, suggesting an adaptation to desiccation. Among the An. funestus group, only An. funestus sensu stricto (s.s.) and Anopheles leesoni were found in the country with An. funestus s.s. being the most abundant species. Furthermore, An. funestus s.s. is the only one species in the group contributing to malaria transmission and have adapted biting times that allow them to bite at dawn. In addition, across the country, An. funestus were found resistant to pyrethroid insecticides used for bed nets impregnation and also resistant to bendiocarb which is currently being introduced in indoor residual spraying formulation in malaria endemic regions. All these findings highlight the challenges faced in controlling this malaria vector. Therefore, advancing the knowledge of vectorial competence of An. funestus, understanding the dynamics of insecticide resistance in this malaria vector, and exploring alternative vector control measures, are critical for sustainable malaria control efforts in Benin Republic.

Using antenatal care as a platform for malaria surveillance data collection: study protocol.

BACKGROUND: While many malaria-endemic countries have health management information systems that can measure and report malaria trends in a timely manner, these routine systems have limitations. Periodic community cross-sectional household surveys are used to estimate malaria prevalence and intervention coverage but lack geographic granularity and are resource intensive. Incorporating malaria testing for all women at their first antenatal care (ANC) visit (i.e., ANC1) could provide a more timely and granular source of data for monitoring trends in malaria burden and intervention coverage. This article describes a protocol designed to assess if ANC-based surveillance could be a pragmatic tool to monitor malaria. METHODS: This is an observational, cross-sectional study conducted in Benin, Burkina Faso, Mozambique, Nigeria, Tanzania, and Zambia. Pregnant women attending ANC1 in selected health facilities will be tested for malaria infection by rapid diagnostic test and administered a brief questionnaire to capture key indicators of malaria control intervention coverage and care-seeking behaviour. In each location, contemporaneous cross-sectional household surveys will be leveraged to assess correlations between estimates obtained using each method, and the use of ANC data as a tool to track trends in malaria burden and intervention coverage will be validated. RESULTS: This study will assess malaria prevalence at ANC1 aggregated at health facility and district levels, and by gravidity relative to current pregnancy (i.e., gravida 1, gravida 2, and gravida 3 +). ANC1 malaria prevalence will be presented as monthly trends. Additionally, correlation between ANC1 and household survey-derived estimates of malaria prevalence, bed net ownership and use, and care-seeking will be assessed. CONCLUSION: ANC1-based surveillance has the potential to provide a cost-effective, localized measure of malaria prevalence that is representative of the general population and useful for tracking monthly changes in parasite prevalence, as well as providing population-representative estimates of intervention coverage and care-seeking behavior. This study will evaluate the representativeness of these measures and collect information on operational feasibility, usefulness for programmatic decision-making, and potential for scale-up of malaria ANC1 surveillance.

Assessing the susceptibility and efficacy of traditional neurotoxic (pyrethroid) and new-generation insecticides (chlorfenapyr, clothianidin, and pyriproxyfen), on wild pyrethroid-resistant populations of Anopheles gambiae from southern Benin.

BACKGROUND: The objective of this study was to determine the susceptibility of wild Anopheles gambiae sensu lato (s.l.) from southern Benin to the new insecticides (chlorfenapyr (CFP), pyriproxyfen (PPF), and clothianidin (CTD)) and assess the efficacy of insecticide-treated bed nets (ITNs) that contain these new products. METHODS: Wild An. gambiae from the Benin communes of Allada, Ifangni, Akpro-Missérété, and Porto-Novo were tested for their susceptibility to CFP and PPF using the WHO bottle tests, and pyrethroids (alpha-cypermethrin, deltamethrin, and permethrin) and CTD using WHO tube tests. WHO cone tests were used to evaluate the efficacy of Interceptor® (which contains alpha-cypermethrin (ACM) only), Interceptor® G2, (CFP + ACM), and Royal Guard® nets (PPF + ACM). The ovaries of blood-fed An. gambiae from Ifangni exposed to a new PPF net were dissected, and egg development status was examined using Christopher's stages to determine the fertility status of the mosquitoes. Using a standardized protocol, the oviposition rate and oviposition inhibition rate were calculated from live blood-fed An. gambiae placed in oviposition chambers after exposure to PPF. RESULTS: In all four mosquito populations, pyrethroid mortality ranged from 5 to 80%, while chlorfenapyr and clothianidin mortality ranged from 98 to 100%. At Ifangni, all mosquitoes exposed to Royal Guard® nets were infertile (100%) while the majority (74.9%) of mosquitoes exposed to Interceptor® nets had fully developed their eggs to Christopher's stage V. The oviposition inhibition rate after exposure of the mosquitoes to the PPF was 99% for the wild population of An. gambiae s.l. and the susceptible laboratory strain, An. gambiae sensu stricto (Kisumu). CONCLUSIONS: The results of this study suggest that pyrethroid-resistant An. gambiae from the selected communes in southern Benin are susceptible to chlorfenapyr, clothianidin, and pyriproxyfen. In addition, based on bioassay results, new and unused Interceptor® G2 and Royal Guard® nets were effective on Ifangni's mosquito populations. Despite the availability of new effective insecticides, continued vigilance is needed in Benin. Therefore, monitoring of resistance to these insecticides will continue to periodically update the Benin national insecticide resistance database and management plan.

Serological diagnosis of toxoplasmosis in pregnancy: comparison between a manual commercial ELISA assay and the automated VIDAS® kit.

Knowledge of the toxoplasmosis serological status in pregnant women is important to allow adequate management for the prevention of congenital toxoplasmosis of those who are not immunized. Serological screening is generally carried out using commercial kits to determine the presence or absence of immunoglobulins M or G in the maternal blood. Robust results are therefore needed. We evaluated the performances of a commercial ELISA assay composed of several recombinant parasite antigens and of a commercial assay using parasite lysate to determine the serological status against Toxoplasma gondii of African pregnant women. A recruitment of 106 pregnant women during their third trimester of pregnancy was carried out in Benin. Serologies were performed with recomWell Toxoplasma IgM and IgG kits. Subsequently, the serological assays were carried out by an automaton method with the VIDAS® TOXO IgM and IgG II kits. Here we compared recomWell Toxoplasma to VIDAS® TOXO results. Reproducibility tests of the recomWell kits were assessed following the discrepancies observed in the results. Of 106 plasmas tested, 47 showed anti-T. gondii IgG (44.3%), including 5 with IgM and high IgG avidity (4.7%). Of the two techniques, VIDAS® TOXO was more robust and specific for IgG while the recomWell Toxoplasma gave more false positive results. The combination of several techniques for the determination of serological toxoplasmosis status remains relevant. Methods using native proteins are closer to the reality of the environment. Therefore, kits using recombinant proteins should be tested on highly geographically diverse populations to refine their composition.