Bayesian spatial modelling of malaria burden in two contrasted eco-epidemiological facies in Benin (West Africa): call for localized interventions

Background

Despite a global decrease in malaria burden worldwide, malaria remains a major public health concern, especially in Benin children, the most vulnerable group. A better understanding of malaria’s spatial and age-dependent characteristics can help provide durable disease control and elimination. This study aimed to analyze the spatial distribution of Plasmodium falciparum malaria infection and disease among children under five years of age in Benin, West Africa.

Methods

A cross-sectional epidemiological and clinical survey was conducted using parasitological examination and rapid diagnostic tests (RDT) in Benin. Interviews were done with 10,367 children from 72 villages across two health districts in Benin. The prevalence of infection and clinical cases was estimated according to age. A Bayesian spatial binomial model was used to estimate the prevalence of malaria infection, and clinical cases were adjusted for environmental and demographic covariates. It was implemented in R using Integrated Nested Laplace Approximations (INLA) and Stochastic Partial Differentiation Equations (SPDE) techniques.

Results

The prevalence of P. falciparum infection was moderate in the south (34.6%) of Benin and high in the northern region (77.5%). In the south, the prevalence of P. falciparum infection and clinical malaria cases were similar according to age. In northern Benin children under six months of age were less frequently infected than children aged 6–11, 12–23, 24–60 months, (p < 0.0001) and had the lowest risk of malaria cases compared to the other age groups (6–12), (13–23) and (24–60): OR = 3.66 [2.21–6.05], OR = 3.66 [2.21–6.04], and OR = 2.83 [1.77–4.54] respectively (p < 0.0001). Spatial model prediction showed more heterogeneity in the south than in the north but a higher risk of malaria infection and clinical cases in the north than in the south.

Conclusion

Integrated and periodic risk mapping of Plasmodium falciparum infection and clinical cases will make interventions more evidence-based by showing progress or a lack in malaria control.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-14032-9.

[Factors associated with obesity in a sedentary activity user group at the Dantokpa market (Benin).]

OBJECTIVE

To study obesity prevalence and associated factors in sedentary activity users at the Dantokpa market, Cotonou.

METHOD

From October to November 2016, 460&#160;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&#160;&lt;&#160;0.0001) and those aged between 38-57&#160;years (P&#160;&lt;&#160;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&#160;=&#160;2.3; P&#160;&lt; 0.006), the age of 38 to 57&#160;years (2.3; P&#160;=&#160;0.014), marital status (2.5; P&#160;=&#160;0.003), knowledge of physical incapacity as a consequence of obesity (1.8; P&#160;&lt;&#160;0.0001), daily sedentary duration between three and seven hours (18.0; P&#160;&lt;&#160;0.0001) and more than seven hours (85.1; P&#160;&lt;&#160;0.0001), family childbirth circumstances (1.9; P&#160;=&#160;0.002) revenue increasing circumstances (3.1; P&#160;=&#160;0.001) and sleep duration (2.01; P&#160;=&#160;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.

Poor maternal anthropometric characteristics and newborns' birth weight and length: a cross-sectional study in Benin

Background

Maternal undernutrition is known to negatively impact newborns' birth weight and length, but this finding is poorly documented in the Beninese population. This study aimed to assess the effect of maternal anthropometry on mean birth weight and length in a Beninese cohort of newborns.

Methods

A cross-sectional study was carried out in Tori Bossito, Republic of Benin. Pregnant women attending maternity wards between June 2007 and July 2008 were recruited. At delivery the women's characteristics, including weight and height, were gathered and newborns' birth weights and lengths were measured. Statistical analysis was performed using multiple linear regression.

Results

A total of 526 mother-infant pairs were enrolled; 29.8% of women had low weight status and 26.2% had short stature (<155 cm). The mean birth weight was 2985 g (standard deviation [SD] 384) the mean birth length was 48.7 cm (SD 2.2). Maternal low weight status (coefficient=-151.81, p<0.001) and short stature (coefficient=-135.49, p<0.001) reduced the mean birth weight. Similar results were found for mean birth length, which was decreased by maternal low weight status (coefficient=-0.42, p=0.04) and short stature (coefficient=-0.51, p=0.01).

Conclusion

Maternal undernutrition expressed by low anthropometry remains problematic in the Beninese population and induces transmission of malnutrition. Nutritional interventions are required to break this vicious cycle.

Low use of artemisinin-based combination therapy for febrile children under five and barriers to correct fever management in Benin: a decade after WHO recommendation

Background

Artemisinin-based combination therapy (ACT), used to treat uncomplicated malaria cases, is one of the main strategies of malaria control and elimination. One of the main objectives of the Benin National Malaria Control Program’s (NMCP) strategic plan is to ensure that at least 80% of uncomplicated malaria is treated with ACT within 24 h. Therefore, it was of great interest to measure whether the country case management of fever amongst children under five, adhered to the NMCP’s strategic plan and look into the barriers to the use of ACT.

Methods

A cross-sectional survey based on a cluster and multi-stage sampling was conducted in two rural health districts in Benin. We recruited 768 and 594 children under five years were included in the northern and in the southern respectively. Data was collected on the general use of ACT and on the correct use of ACT that adheres to the NMCP’s strategy, as well as the barriers that prevent the proper management of fever amongst children. To assess the certain predictors of ACT usage, logistic regression was used, while taking into account the cluster random effect.

Results

Among febrile children aged 6 to 59 months, 20.7% in the south and 33.9% in north received ACT. The correct use of ACT, was very low, 5.8% and in southern and 8.6% northern areas. Caregivers who received information on ACT were 3.13 time more likely in the south and 2.98 time more likely in the north to give ACT to their feverish child, PPR = 3.13[1.72–4.15] and PPR = 2.98 [2.72–3.11] respectively. Chloroquine and quinine, other malaria treatments not recommended by NMCP, were still being used in both areas: 12.3 and 3.3% in the south and 11.4 and 3.0% in the north.

Conclusion

In Benin, the use and the correct use of ACT for febrile children remains low. The study also showed that having received information about the use of ACT is positively associated with the use of ACT. This point highlights the fact that efforts may not have been sufficiently integrated with social communication, which should be based on the behavioural determinants of populations.

Electronic supplementary material

The online version of this article (10.1186/s12889-018-5077-6) contains supplementary material, which is available to authorized users.

[Analyze of the performance of procurement and distribution system of antiretroviral, antituberculosis and antimalarials drugs in Benin in 2016]

OBJECTIVE

We aimed to analyze the performance of procurement and distribution system of antiretroviral, antituberculosis and antimalarial drugs in Benin.

METHODS

We carried out a cross-sectional study in 2016. Data on the procurement, storage and distribution of drugs were collected by either individual interview or observation of storage sites at the central procurement center for essential medicines (CAME) in Benin. Compliance with the norms of the procurement and distribution of the products was appreciated. At the operational level, order satisfaction, drug expiry and stock status of the targeted health programs were measured based on the participants statements.

RESULTS

Three workers of the CAME and 76 of health programs were surveyed. According to the norms, malfunctioning impaired the system of the procurement, storage and the distribution of the products. At the operational level, our study participants reported that antiretroviral drug orders were satisfied in 83%, drugs were distributed within three months of their expiration date in 26- 33%, and the CAME often ran out of antiretroviral drugs (stock-outs)in 69%.

CONCLUSION

Malfunctioning impaired the system of the procurement, storage and the distribution of antiretroviral, antimalarial and antituberculosis drugs. These dysfunctions negatively affect the performance of the system.

[Relationship between changes in the prevalence of HIV infection in pregnant women from 2006 to 2015 and place of residence in Benin]

OBJECTIVE

We aimed to determine the relationship between changes in the prevalence of HIV infection in pregnant women from 2006 to 2015 and place of residence in Benin.

METHODS

In a retrospective and analytical study, were viewed the reports of the annual surveys of HIV infection among pregnant women from 2006 to 2015 across the country.

RESULTS

A total of 138,319 pregnant women participated in the annual HIV surveys from 2006 to 2015. The national prevalence of HIV infection among pregnant women between 2006 and 2015 was 2%. The prevalence of HIV infection from 2006 to 2015 in pregnant women increased significantly in departments of Mono (p = 0.001) and Donga (p = 0.001) and decreased in the departments of Collines (p = 0.000) and Couffo (p = 0.001) and in urban areas (p = 0.000).

CONCLUSION

Changes in the prevalence of HIV infection among pregnant women between 2006 and 2015 varied across departments and according the urbanization of the residence. The National AIDS control program may take these results into account when planning interventions against HIV for optimal response against the pandemic infection.

[Knowledge, attitudes and practices of emergency contraception among female students at Parakou University (Benin)]

OBJECTIVE

This study was designed to assess emergency contraception knowledge, attitude and practices among female students at Parakou University.

METHODS

A descriptive cross-sectional survey was conducted on 570 female students recruited after cluster sampling in the various university departments. A predefined questionnaire was used to interview students after they consented to participate in the survey. The data collected were analysed by Epi Info software and variables were compared by Chi-square test with a limit of significance of 5%.

RESULTS

More than half of the students (51%) were familiar with the emergency contraception method and had been informed by friends and the media. Only 18% of them had already used this method at least once following unprotected sexual intercourse. Most of them were under the age of 24 and reported having irregular sexual partners.

CONCLUSION

Students were familiar with and had easy access to the method. However, repeated use of this method highlights the need for better information of these students concerning classical methods of contraception. An awareness campaign should be conducted on the campus in order to reduce the currently high rate of non-medical clandestine abortion.

[Quality assessment of refocused antenatal care services at the district hospital of Suru-Léré in Benin]

INTRODUCTION

Antenatal care service, one of the interventions of public health, has been recognized as one of the pillars for the reduction of maternal and neonatal mortality. It has been revised in recent years and a new model of its contents has been submitted by WHO. Considering the complexity of its implementation, it is useful to periodically assess the performance of antenatal services with the view of their improvement.

METHODS

An evaluative study was thus carried out in one health district hospital in Benin; the care staff attitudes and practices were analyzed on 80 pregnant women admitted in the antenatal care as well as services organization, care environment and satisfaction of these women. The performance was appreciated on the basis of hundred criteria.

RESULTS

The overall performance of antenatal services through the inputs, procedures and satisfaction of the pregnant women, was considered to be satisfactory. The services organization, health care environment, patient reception and interpersonal communication were the elements which showed deficiencies.

CONCLUSION

Improvement will have to be carried out based on shortcomings identified, by the planners, organizers and staff in order to reinforce the hospital's performance on antenatal services.

Primary antibiotic resistance and effectiveness of Helicobacter pylori triple therapy in ulcero-inflammatory pathologies of the upper digestive tract

OBJECTIVES

To determine firstly, the rates of primary antimicrobial resistance for Helicobacter pylori-associated upper-digestive lesions in relation to the success rate of triple therapy; and secondly, the performance of HpSA stool antigen detection test for control of eradication after treatment.

METHODS

Prospective open study of 436 patients who underwent upper-digestive tract endoscopy with biopsies for histological examination and culture between January 1 and July 31, 2002 at a University hospital in Brussels, Belgium. The primary resistance to antibiotics of H. pylori isolates was determined by disc diffusion method. Seventy of 164 infected patients agreed to be included in the treatment study with standard triple therapy with amoxicillin + clarithromycin + omeprazole adjusted on the basis of antibiogram results. Control of eradication was tested by 14C-Urea breath test and H. pylori Stool Antigen test (HpSA test).

RESULTS

Primary resistance to clarithromycin and metronidazole was observed in 3% and 31% of the isolates, respectively. No primary resistance to amoxicillin and tetracycline was observed. By intention to treat analysis, H. pylori was eradicated in 56 (80%) patients included in the therapeutic study. Three (4%) patients were lost to follow-up. The rate of eradication failure was 20% (14/70), included 11 cases documented by a positive control test (14C-Urea breath test). In comparison with 14C-Urea breath test, the H. pylori Stool Antigen test showed a sensitivity of 100%, a specificity of 91%, PPV of 69%, and NPV of 100%.

CONCLUSION

Standard triple therapy achieved 80% bacterial eradication in this patient population with a low prevalence of H. pylori primary antibiotic resistance. Our data confirm that the H. pylori Stool Antigen test displays a diagnostic performance similar to the breath test for control of eradication.

Evaluation of stool antigen detection for diagnosis of Helicobacter pylori infection in adults

OBJECTIVE

The aims of this study were to evaluate the performance of Helicobacter pylori stool antigen test in the diagnosis of H. pylori infection.

METHOD

The study included 63 out patients attending the ULB-Lothier Clinic between January 1 and July 31, 2002. They underwent an upper endoscopy, as well as biopsies for histological examination and for culture of H. pylori. Stool samples of these patients were collected either the day of the endoscopy or within 24 hours and tested for H. pylori antigen (HpSA Test)

RESULTS

The mean age of study patients included 29 men and 34 women was 51(+/- :16) years. H. pylori infection was detected in 29 cases (46 %) by culture and histology, and in 31 cases (49.2 %) by detection of the antigen in the feces. In 27 patients, all methods were positive whereas 5 in they provided discrepant results. Compared to the reference methods (culture and histology), the HpSA test had a sensitivity of 96.5% and a specificity of 91.2%. PPV of 90.3% and NPV of 96.8%.

CONCLUSION

The good correlation found between the results of the HpSA test and the methods based on endoscopy supports its use as an alternative to invasive methods of diagnosis of H. pylori infection and therapeutic follow-up.