Trends in the utilisation of skilled birth attendance among pregnant women in Benin, from 2001 to 2017-2018, and projections to 2030.

BACKGROUND: Skilled birth attendance during childbirth is known to promote better pregnancy outcomes as well as contribute to maternal and newborn survival. The study aimed to analyse the progress in the use of skilled birth attendance by pregnant women over the last two decades (2001 to 2017-2018) in Benin, and then to make projections to 2030. METHODS: A secondary analysis was made using Benin's Demographic and Health Survey (DHS) databases. The study population were i) women of 15-49 years of age who were successfully surveyed and usually resided in the households visited during DHS-II, DHS-III, DHS-IV and DHS-V, ii) and had had at least one live birth in the five years preceding each of these surveys. For each DHS, the corresponding proportion of births attended by skilled health personnel was determined. The study then generated the Annual Percent Change (APC) between each survey and globally, and projections were made to 2030. RESULTS: Nationally, the percentage of women who gave birth attended by skilled health personnel was 67.39% in 2001, 76.10% in 2006, 80.87% in 2011-2012, and 79.12% in 2017-2018; this represents an APC = 0.98% between 2001 and 2017-2018. If the historical rate of progression is maintained, it is expected that by 2030, 89.35% of pregnant women will be using skilled birth attendance services. CONCLUSION: Efforts are needed to understand the drivers of skilled birth attendance among pregnant women to adopt appropriate strategies.

Évaluation des capacités de détection des menaces infectieuses aux points d'entrée au Bénin.

BACKGROUND: The International Health Regulation requires countries to establish measures at border entry points to prevent the spread of infectious threats across borders. OBJECTIVE: This study assessed the capacity for the detection of infectious threats to global health security at entry points in Benin in 2021. METHODS: This cross-sectional and descriptive study was conducted at 17 borders. Collection techniques included individual interview, observation, and document exploitation. Each entry point capacity was rated good if the entry point met at least 80 % of input criteria and 80 % of process criteria and 80 % of output criteria. The overall detection capacity was rated good if at least 80% of entry points had good capacity. Otherwise, the capacity was deemed insufficient. RESULTS: The capacity for the detection of infectious threats at entry points in Benin was insufficient. There was no entry point (0.0%) that reach 80% of inputs criteria. 11.8% of them reached 80% of process criteria and 5.9% reached 80% of output criteria. There was no entry point with good detection capacity. The travelers’ screening was not systematic. Only 19.4% of human travelers, 12.8% of food loads and 0.1% of animals were screened the day before the survey. Two alerts among human travelers, four among animals and one food safety alerts were detected. Health teams were present in all designated entry points, but they were only focused on Covid-19. CONCLUSION: Strengthening the detection system and extending it to other threats is necessary to improve the detection capacity at entry points.

Perception des acteurs de l'approche « Une Seule Santé ¼ de la sécurité sanitaire mondiale au Bénin.

INTRODUCTION: The perception of human resources is essential for their commitment in strengthening health security. The study assessed the perception of the “one health” approach stakeholders on global health security in Benin. METHODS: The study was qualitative, cross-sectional and quantitative. Non-probability sampling method with purposive choice were used to select 55 actors from health, veterinary and environmental sectors, and from community. Individual interviews and three focus groups were used to collect data; The content analysis was used to perform thematic groupings. RESULTS: Respondents had a good knowledge of threats (73%), events (59%) and information mechanisms (68%). The health security environment was characterized by the absence of an integrated mechanism for information sharing, episodic and unbalanced collaboration, a difference between the level of organization of the sectors with health sector perceived as better organized by 92% of respondents. The environment is presented as the sector requiring major reinforcements. Community involvement was also episodic. The sectors were dependent on the partners. The community was not involved in setting priorities and lacked commitment to health security. The regulatory component is insufficient, and no law enshrines the international health regulations as a reference. For 60% of respondents, health security was a reality in Benin and 21% were satisfied with it. Respondents had a good perception of health security and its challenges in Benin. CONCLUSION: The strengthening of legislation and collaboration is necessary for the improvement of global health security in Benin.

Évaluation des capacités du système de laboratoires biologiques pour la détection des menaces infectieuses au Bénin.

Background : International Health Regulations require countries to establish laboratory systems for rapid and safe confirmation of public health emergencies.Objective : This study assessed the capacity of the National Laboratory System for the detection of infectious threats to global health security in Benin.Method : The study was descriptive, cross-sectional, and evaluative. The targets were laboratories performing the confirmation of infectious threats. The sampling method was non-probabilistic with the reasoned choice of 74 laboratories. Four collection tools were used. The World Health Organization’s laboratory assessment tool for health facilities was used to assess the national public health laboratory. The assessment was based on the capacities of peripheric laboratories and of the national reference laboratory. The capacity was rated good if at least 80% of peripheric laboratories met at least 80% of the criteria and if the national public health laboratory had an average indicator of at least 80%. Otherwise, the capacity was rated insufficient.Results : The national laboratory system capacity was insufficient. Only 54% of peripheric laboratories had good capacity. The national reference laboratory had an average indicator of 71%. In this reference laboratory, specimen collection and transport, laboratory testing performance, consumables and reagents, and public health functions had the best scores, above 80%. Biorisk management, organization and management, and documents had the lowest scores. In peripheric laboratories, the testing performance was the only domain with good capacity.Conclusion : To ensure effective Global Health Security in Benin, a National Laboratory System capacity improvement strategic plan need to be developed and implemented.

Implementation of a model of awareness-raising for taxi motorcyclists in Benin in relation to helmet use: protocol for a quasi-experimental study.

BACKGROUND: In the large cities of Benin, motorcycle taxi drivers, mainly between the ages of 20 and 40, are particularly exposed to accidents due to their profession. User awareness, along with legislative reforms and enforcement measures, would reduce the incidence of crashes and injuries. This study aims to test the effectiveness of an awareness-raising model regarding helmet use for motorcycle taxi drivers. METHODS: This is a quasi-experimental study that will take place in the cities of Parakou (intervention group) and Porto Novo (control group). Over a three-month period, a package of awareness-raising activities will be implemented in the intervention area, targeting a group of motorcycle taxi drivers. The messages to be developed for awareness-raising will focus on the most frequently influencing factors, as identified by the baseline collection. These key messages will be disseminated through various tools and communication channels (banners, motorcycle stickers and motorcycle taxi uniforms, interactive sessions). Data will be collected prospectively via a self-reported questionnaire and observation, carried out before the intervention, at the end, and 6 months later. The data will relate to knowledge, attitudes and practices regarding helmet use. The analysis will compare the indicators between the groups, as well as between the pre- and post-intervention phase. The KoboCollect software will be used for data entry and processing, and Stata 15 will be used for data analysis. Chi-square or Fisher, Student's or Kruskal-Wallis tests will be used for the comparisons. The difference-in-difference method will be used to determine the specific effect of the awareness activities. DISCUSSION: This study will assess the contribution of awareness messages to changing the behaviour of motorcycle taxi drivers by determining the specific effect of the intervention.

Prevalence of Dementia among Well-Educated Old-Age Pensioners in Parakou (Benin) in 2014.

INTRODUCTION: The number of people living with dementia is growing worldwide and most rapidly in low- and middle-income countries. Little is known about dementia in Benin. We estimated the prevalence of dementia among retired people in Parakou, a northern city in Benin, and then assessed associated factors. METHODS: A cross-sectional study was performed in Parakou from July to August 2014. Participants were recruited at 2 centers, the National Center of Social Security and the Public Treasury of Benin. Participants with cognitive impairment were defined as having a low cognitive score (<7) for the brief version of the Community Screening Interview for Dementia and were invited to neurological examination. DSM-IV-TR criteria were used to diagnose dementia and the HACHINSKI score was used to differentiate dementia subtypes. A logistic regression model was performed to identify factors associated with dementia. RESULTS: Overall, 440 retired people were included in the study. They were mainly male (92.3%) and their mean age was 64.9 ± 6.0 years. The prevalence of cognitive impairment was 7.7% (95% CI 5.2-10.2). Fourteen participants were diagnosed with dementia, representing a prevalence of 3.2% (95% CI 1.5-4.8). Alzheimer disease was the most frequent subtype (64.3%), followed by vascular dementia (21.4%). Retired people diagnosed with dementia were all men and were aged between 61 and 71 years. Most of them were living alone. The main factors associated with dementia were older age, low fruit and vegetables consumption, and living alone. DISCUSSION: This study showed a low prevalence of dementia among retired older people in Benin. Despite this, greater attention must be given to the potential burden dementia places on families for better care, before the expected aging of the population becomes more significant.

[Community health workers integration model in the National Health System (Benin, Togo)]. / Modèle d'intégration des agents de santé communautaire dans le système de santé (Bénin, Togo).

INTRODUCTION: At the international level, further reflection on the role of community health workers is in progress. The objective of this work is to develop a model of the integration of community health workers in the National Health System. METHOD: The study was conducted in Benin and Togo. It was a cluster survey that involved 385 Community Health Workers (CHW), 238 village heads, 92 health care managers selected responsibly, and 6150 households selected in a probabilistic manner. The analysis of the strengths, weaknesses, opportunities and threats of interventions under Community directives has contributed to the development of the model.Results : In both countries, community health reference materials existed, and 98.4% community health workers were trained before the beginning of the activities, and all have an intrinsic motivation for the work they do. Only 31.3% of households participated in the selection of community health workers in their locality. The absence of laws recognizing the work of the CHW is a threat to their integration into the healthcare system. The main elements proposed in the model are, the development of the status of community health workers, their remuneration on a budget managed by the health district and fed by several sources. CONCLUSION: Community Health Workers should not be a health care alternative, but an integral part of the national health system.

[Factors associated with obesity in a sedentary activity user group at the Dantokpa market (Benin).] / Facteurs associés à l'obésité au sein d'un groupe d'usagers du marché Dantokpa (Bénin).

OBJECTIVE: To study obesity prevalence and associated factors in sedentary activity users at the Dantokpa market, Cotonou. METHOD: From October to November 2016, 460 subjects were selected by stratified survey. Anthropometric data and information regarding knowledge and practices of the subjects related to obesity were collected by a questionnaire. The factors associated with obesity were researched by a logistic regression model. RESULTS: The obesity prevalence was 35.7%. It was more predominant in women (P < 0.0001) and those aged between 38-57 years (P < 0.0001). Insufficient or false knowledge and insufficient or bad practices concerning obesity cohabited among Dantokpa market sedentary users. The obesity associated factors were the sex (OR = 2.3; P < 0.006), the age of 38 to 57 years (2.3; P = 0.014), marital status (2.5; P = 0.003), knowledge of physical incapacity as a consequence of obesity (1.8; P < 0.0001), daily sedentary duration between three and seven hours (18.0; P < 0.0001) and more than seven hours (85.1; P < 0.0001), family childbirth circumstances (1.9; P = 0.002) revenue increasing circumstances (3.1; P = 0.001) and sleep duration (2.01; P = 0.003). CONCLUSION: This study suggests the necessity for the implementation of strategies including notably physical activities and knowledge about obesity in order to reduce obesity prevalence in Dantokpa market sedentary activity users.

[Occupational risk factors and perceptions of air pollution by motorcycle taxi drivers in Cotonou, Benin]. / Facteurs de risque professionnel et perceptions de la pollution de l'air chez les taxis motoristes à Cotonou, Bénin.

INTRODUCTION: Motorcycle taxis occupy a major place in urban transport. Motorcycle taxi drivers are exposed to occupational risk factors (ORF) including air pollution. The objective of this study was to evaluate these ORF among motorcycle taxi drivers and their perceptions of air pollution. METHODS: This mixed study was conducted on motorcycle taxi drivers in Cotonou. The qualitative study was based on focus groups concerning 16 items from the Participatory Occupational Risk Screening Guide (DEPARIS) until saturation and after triangulation of data. The quantitative study consisted of administering a questionnaire addressing socioeconomic and demographic characteristics, cardiopulmonary diseases, and perception of air -pollution risk factors among 397 Cotonou motorcycle taxi drivers. RESULTS: Drivers perceived poor road conditions, effort and handling, and lack of social security as unsatisfactory ORF. Their mean age was 40.95 ± 8.75 years and 45.84% had primary -education. They had been working as motorcycle taxi drivers for an average of 134.95 ± 101.53 months with an average income of FCFA 3138 ± 1238. These occupational factors were significantly associated with cardiopulmonary disorders, observed in 63.2% of drivers. Less than 1/3 of drivers felt that air pollution affected their personal health. CONCLUSION: Motorcycle taxi drivers have a poor perception of ORF and the severity of exposure to air pollution in this occupation. There is a need to take action to promote the health of this population.

[Capacity of response of the health system to the expectations of populations in zones exposed to results-based financing in Benin in 2015]. / Capacité de réponse du système de santé aux attentes des populations dans les zones exposées au financement basé sur les résultats au Bénin en 2015.

Introduction: The increased use of results-based financing (RBF) services was the basis for this study designed to evaluate the contribution of RBF to the capacity of response of the health system to the population's expectations. Methods: This study, conducted in six Benin health zones randomly selected in two strata exposed to RBF (FBR_PRPSS and FBR_PASS) and one zone not exposed to RBF (Non_FBR), examined the seven dimensions of reactivity. A score, followed by weighting of their attributes, was used to calculate the index of reactivity (IR). Results: Sixty-seven health care units and 653 people were observed and interviewed. The FBR_PRPSS and FBR_PASS strata, managed by the new provisions of RBF, displayed good performances for the "rapidity of management" (70% and 80%) and "quality of the health care environment" dimensions, with a more marked improvement for the PRPSS model, which provides greater resources. Poor access to social welfare networks in the three strata led to renouncing of health care. The capacity of response to expectations was moderate and similar in the Non_FBR (IR = 0.53), FBR_PASS (IR = 0.62) and FBR_PRPSS (IR = 0.61) strata (p > 0.05). Conclusion: The FBR_PRPSS and FBR_PASS models have a non-significant effect on the capacity of response. Their success probably depends on the health system context, the combination of targeted interventions, such as universal health insurance, but also the importance and the use of the new resources that they provide.

[Quality of the contribution of community volunteers in Benin community-based IMCI]. / Qualité de l'apport des relais dans la PCIME-Communautaire au Bénin.

INTRODUCTION: With the growing shortage of qualified healthcare professionals and the challenge of achieving the Millennium Development Goals, community participation has become an essential reality. In the Avrankou Adjarra Akpro-Missérété (3A) health zone of the Ouémé department, community volunteers are supported by UNICEF and the NGO Africare. The objective of this study was to assess the quality of the contribution of community volunteers to implementation of community-based integrated management of childhood illness (IMCI). METHODS: This cross-sectional, descriptive and analytical study was conducted in health zone 3A among 38 community volunteers and 331 mothers or carers of children under the age of five years, recruited exhaustively and randomly, respectively. Tools used for data collection were questionnaires, interview guides and survey sheets. RESULTS: 81.6% of community volunteers demonstrated appropriate behaviour in relation to the various professionals of community-based IMCI, with good motivation in 71.1% of cases and acceptable motivation in 28.9% of cases. Motivation was significantly correlated with the quality of the contribution of community volunteers to implementation of community IMCI (P = 0.0012). DISCUSSION: Motivation contributes to the quality of community volunteer input to COMMUNITY IMCI. This situation must be maintained by the combined efforts of all stakeholders involved in this strategy.

Situation analysis of urogenital bilharzia in West Africa (2010-2021) and control strategies and prospects: systematic review and meta-analysis.

Schistosomes are parasitic diseases caused by flatworms (schistosomes or bilharzia), transmitted in the urine or in the faeces, and involving intermediate hosts (freshwater molluscs). Their recrudescence in endemic areas is no longer in question and remains a crucial public health problem in the world in general and in West Africa in particular. In order to eradicate bilharzia, many control strategies and policies have been implemented on both sides. The objective of this systematic literature review is to synthesize the existing evidence on control strategies implemented by West African countries. To achieve this, data were collected from PubMed, Direct Science, Web of Sciences, Google Scholar, PloS and Banque de Données de Santé Publique (BDSP), using appropriate keywords. Academic articles and theses written in French or English that evaluated the analysis of a bilharzia situation in West Africa were selected. Sixteen scientific papers were selected for the study, ten of which were used for a meta-analysis. The systematic review revealed that bilharzia is still an endemic disease in West Africa. Clearly, it continues to wreak havoc on the population, especially among school children. Rural areas are the most affected by the disease. Strategies to control bilharzia are based on preventive and curative treatment of the infection with chemotherapy and vector control of soil molluscs (host and vector of bilharzia eggs). Praziquantel is the main known antibilharzian. Also, the species most frequently found in analyses are S. haematobiumand S. mansonii. This review has allowed to evaluate the control strategies carried out and to deduce the strengths and weaknesses, in order to define the perspectives for the efficiency of the anti-bilharzia control for the eradication of bilharzia in the endemic zones of West Africa.

Prevalence and Risk Factors of Post-Traumatic Stress Disorder in Survivors of a Cohort of Road Accident Victims in Benin: Results of a 12-Month Cross-Sectional Study.

Purpose: Post-traumatic stress disorder (PTSD) is a frequent psychiatric complication in road accident survivors. However, it remains under-explored and is not taken into account in health policies in Benin. The purpose of this study was to determine the prevalence and risk factors of PTSD after a road traffic accident. This will help to improve its diagnosis and management in Benin hospitals. Materials and Methods: An institution-based cross-sectional study was conducted from November 2020 to January 2021. Consenting victims of road traffic accidents from three hospitals across Benin, aged 18 years and above, living in the south of the country, were administered various questionnaires at 12-month follow-up. Data on PTSD were collected using a pre-tested, structured and standardized post-traumatic stress disorder questionnaire, the PTSD Checklist (specific version) (PCL-S). A logistic regression model was fitted to identify factors associated with PTSD. An adjusted odds ratio (AOR) followed by a 95% confidence interval was calculated to determine the level of significance with a p-value less than 0.05. Results: Out of 865 patients in the cohort eligible for the 12-month follow-up, 734 (85%) participated in the study. The prevalence of PTSD was 26.43% (95% CI: 23.36-29.75). Factors associated with PTSD on multivariate analysis were female gender (adjusted odds ratio (AOR) = 2.14, 95% CI: 1.38-3.33), hospitalization (AOR = 1.87, 95% CI 1.21-2.89), negative impact of the accident on income (AOR = 4.22, 95% CI: 2.16-8.25), and no return to work (AOR = 3.17, 95% CI: 1.99-5.06). Conclusion: The prevalence of PTSD is high in road accident survivors in Benin. The results of this study highlight the need for early diagnosis and a multidisciplinary approach to the management of PTSD patients in Benin's hospitals.

Referral conditions for severe road traffic injuries and their influence on the occurrence of hospital deaths in Benin.

Road traffic accidents are the leading cause of death by trauma. Delays in in first aid due, inter alia, to the long time to transfer traffic accident victims to hospital and the lack of pre-hospital emergency care, contribute to the increase in hospital mortality. This study aims to analyse the referral conditions for severe road traffic injuries and to assess their effect on the occurrence of hospital deaths in Benin. This is an analytical prospective cohort study conducted in road accident victims with a severe injury. Four groups of factors were studied: referral conditions, sociodemographic and victim-specific characteristics, factors related to the accident environment, and factors related to health services. A top-down binary stepwise logistic regression was the basis for the analyses. Nine point eight percent of severe trauma patients died after hospital admission (7.0-13.5). Associated factors were referral time greater than 1 hour (RR=5.7 [1.5-20.9]), transport to hospital by ambulance (RR=4.8 [1.3-17.3]) and by the police or fire department (RR=7.4 [1.8-29.7]), not wearing protective equipment (RR=4.5 [1.4-15.0]), head injuries (RR=34.8 [8.7-139.6]), and no upper extremity injuries (RR=20.1 [2.3-177.1]). To reduce the risk of hospital death in severe road traffic injuries, it is important to ensure rapid and medicalized referral of severe trauma patients in Benin.

Can Professional Motorcyclists Be an Asset in the Immediate Post-Crash Care System in Benin? Baseline of Knowledge and Practices in the City of Cotonou (Benin).

PURPOSE: The situation of road crashes-related deaths remains problematic in low-income countries. The present study aims at analyzing the first-aid knowledge and practices of professional motorcyclists (PMs) in the city of Cotonou in Benin. MATERIALS AND METHODS: This is a cross-sectional analytical study conducted from 25 March to 19 April 2019 in Cotonou and concerned PMs registered in a fleet who gave their consent to participate in the study. The World Health Organization's two-stage adaptive cluster sampling technique was applied to select the eligible PMs while respecting the proportionality rate per fleet. A logistic regression analysis was done and the odds ratios were estimated with 95% confidence interval. RESULTS: The 430 PMs surveyed were all middle-aged men with an average age of 38.38 (±8.70). Among them, 62.56% knew at least one of the emergency phone numbers for the ambulance, police or fire services and 49.53% of the PMs knew at least one of the 3 techniques evaluated. In addition, 33.23% of PMs who had witnessed at least an RC stated that they had alerted the emergency services, and 32.27% said they had helped the victims. The main reason given for the lack of initiative in RCs was lack of knowledge of the course of action to take (19.64%). The level of knowledge was associated with the level of education (AOR: 3.11; CI 95%: 1.79-5.43) and with the length of experience (AOR: 2.56; CI 95%: 1.58-4.18). CONCLUSION: This study reveals that the level of knowledge and practice of PMs in the field of first aid in Cotonou is low and demonstrates the relevance and the need to include this target group in the first-aid chain for road crashes in Benin.

Prevalence and Factors Associated With Surgical Site Infections in the University Clinics of Traumatology and Urology of the National University Hospital Centre Hubert Koutoukou Maga in Cotonou.

Objectives: Study the prevalence and factors associated with the occurrence of surgical site infections in University Clinics of Trauma-Orthopedics, Reconstructive Surgery and Urology in a developing country. Methods: This was a retrospective descriptive and analytical study of 384 people operated on during the period of 2019. Logistic regression was used to study the factors associated with surgical site infections. The associations between the dependent variable and the other variables were assessed by the odds ratio (OR) followed by their 95% confidence interval. Results: The prevalence of surgical site infections was 7.81% CI 95% = (5.12-10.51). The factors linked to the surgical site infections in the studied population were the patient's admission method [OR = 2.74; 95% CI = (1.08-6.95)] and the length of the postoperative stay [OR = 8.75; 95% CI = (2.83-26.98)]. The interview and direct observation identified health care system dysfunctions, medical errors, patient monitoring and financial unavailability as factors that could favor the onset of surgical site infections. Conclusion: Interventions should be focused on the factors identified for the effective management of operated patients.

COVID-19 pandemic in Economic Community of West African States (ECOWAS) region: implication for capacity strengthening at Point of Entry.

Free movement between countries without a visa is allowed within the 15-country Economic Community of West African States (ECOWAS) region. However, little information is available across the region on the International Health Regulation (IHR 2005) capacities at points of entry (PoE) to detect and respond appropriately to public health emergencies such as Coronavirus Disease 2019 (COVID-19). ECOWAS and the member states can better tailor border health measures across the region by understanding public health strengths and priorities for improvement at PoEs. A comprehensive literature review was combined with a self-assessment of capacities at PoEs across the fifteen member states from February to July 2020. For the assessment, the member states completed an adapted World Health Organization (WHO) self-assessment checklist by classifying capacity for seven domains as fully, partially, or not implemented. The team implemented three focus group discussion (FGD) sessions and 13 key informant interviews (KII) with national-level border health stakeholders. Univariate analysis was used to summarize the assessment data and detailed content analysis was applied to evaluate FGD and KII results. Of the 15 member states, 3 (20%) are landlocked; 3 (20%) have more than one seaport. Eleven (73%) countries have 1 designated airport, 3 (20%) have two airports, and only one country (6.7%) has three airports. Two hundred and seventy-eight designated ground crossings were identified in 12 countries (80%). Strengths across the PoE were existence of decrees and ministerial acts in some ECOWAS countries and establishment of national taskforces for the COVID-19 response at PoE in ECOWAS. Major challenges were porous borders, poor intersectoral coordination, lack of harmonized traveler screening measures, shortage of staff, and inadequate financial resources. Despite all these challenges, there are opportunities such as leveraging the regional cross-border poliomyelitis coordination and control mechanism, and existence of networks of infection prevention and control specialists and field epidemiologists. However, political instabilities in some countries pose a threat to government commitments to PoE activities. The capacity to respond to public health emergencies at PoE in the ECOWAS region is still below IHR standard. Public health capacities at a majority of IHR-designated PoE in the 15-country region do not meet required core capacities standards.

Environmental Heavy Metal Contamination from Electronic Waste (E-Waste) Recycling Activities Worldwide: A Systematic Review from 2005 to 2017.

The recycling of electronic waste (e-waste) contaminates ecosystems with metals, though a compilation of data from across sites worldwide is lacking, without which evidence-based comparisons and conclusions cannot be realized. As such, here, a systematic review of the literature was conducted to identify peer-reviewed studies concerning e-waste sites (published between 2005 and 2017) that reported on the concentration of heavy metals (Cd, Hg, As, Pb and Cr) in soil, water and sediment. From 3063 papers identified, 59 studies from 11 countries meeting predefined criteria were included. Reported metal concentrations were summarized, and a narrative synthesis was performed. This review summarized 8286 measurements of the aforementioned metals in soils (5836), water (1347) and sediment (1103). More than 70% of the studies were conducted in Asia. In nearly all cases, the average metal concentrations in a particular medium from a given site were above guideline values; suggesting soils, water and sediment at, or near, e-waste recycling sites are contaminated. Across all media, concentrations of Pb were generally highest, followed by Cr, As, Cd and Hg. The synthesized information demonstrates that e-waste sites worldwide are contaminated with metals, that geographic data gaps exist, that the quality of most studies can be improved and that action is needed to help reduce such levels to protect human health and the environment.

Operationalizing the ECOWAS regional one health coordination mechanism (2016-2019): Scoping review on progress, challenges and way forward.

Based on recommendations from two consultative meetings held in Dakar, Senegal (2016) and Abuja, Nigeria (2017) the Economic Community of West African States (ECOWAS) implemented a Regional One Health Coordination Mechanism (R-OHCM). This study analyzed the process, challenges and gaps in operationalizing the R-OHCM in West Africa. We utilized a scoping review to assess five dimensions of the operation of an R-OHCM based on political commitment, institutional structure, management and coordination capacity, joint planning and implementation, as well as technical and financial resources. Information was gathered through a desk review, interview of key informants, and the viewpoints of relevant stakeholders from ECOWAS region during a regional One Health technical meeting in Lomé, Togo in October 2019. It was found that political commitment at regional meetings and the countries adoption of regional frameworks were key strengths of the R-OHCM, although there are continued challenges with commitment, sustainability, and variability of awareness about One Health approach. ECOWAS formulated regional strategic documents and operationalized the One Health secretariat for strengthening coordination. The R-OHCM has technical working groups however, there is need for engagement of more specialized workforce and a harmonized reporting structure. Furthermore, inadequate focus on operational research, and weak national OHCM are identified as main gaps. Finally, the support of technical and financial partners will help to address the lack of funding which limits the implementation of the R-OHCM. West Africa has demonstrated profound effort in adopting the One Health approach at regional level but is presently deterred by challenges such as limited skilled One Health workforce, especially in the animal and environmental health sectors, and access to quality of One Health surveillance.

Strengthening Applied Epidemiology in West Africa: Progress, Gaps, and Advancing a Regional Strategy to Improve Health Security.

The ability to prevent, promptly detect, and appropriately respond to a public health threat is essential for health security. Field epidemiology training has helped increase the quality and quantity of the public health workforce to strengthen disease surveillance, outbreak preparedness and response, and general public health capacity. We conducted a desk review on the status of the Field Epidemiology and Laboratory Training Program model in 16 countries in West Africa. We also developed a questionnaire and shared it with West African Health Organization (WAHO) member states to document their experiences and the status of training in their countries. WAHO organized a regional 3-day consultative meeting with major stakeholders in the region to examine progress, gaps, and challenges, and outline a roadmap to strengthen the Field Epidemiology and Laboratory Training Program. Stakeholders shared their experiences, engaged in discussions to identify strengths and gaps, and made plans on a way forward. Member states are at different levels of implementing field epidemiology and laboratory training programs in their countries, and, therefore, major gaps remain in the number and distribution of trained epidemiologists throughout West Africa. Member states implement different variants of the program and in some instances the same cadre of health workers are trained in different but comparable programs with different funding streams. Two member states had not begun implementing the training program. Developing regional centers of excellence was recommended in the long term while collaboration among member states to train the required number of epidemiologists to fill the acute needs could be helpful in the short and medium term. Curriculum harmonization and expansion, deployment and use of trained epidemiologists, accreditation of training institutions, and generation of indigenous funding streams are recommended to improve the Field Epidemiology and Laboratory Training Program in West Africa.