Vécu Psychologique De La Parturiente En Salle D’accouchement À La Maternité Du Centre Hospitalier Départemental Et Universitaire Du Borgou À Parakou (BENIN)

Objective: To study parturient women’s psychological real-life experience in the delivery room of CHUD-B maternity hospital. Patients and Methods: This study shows a descriptive cross-sectional study with an analytical aim and a prospective data collection. It involves 100 parturient women who had a vaginal delivery at the gynecology and obstetrics department of Departmental University Teaching Hospital of Borgou. It covered the period from June 11 th to August 11 th 2014. Results: The average age of the parturient women was 27 years old ± 5.55. The parturient women were predominantly Muslims (58%), married (48%), and out-of-school (36%). They had a monogamous relationship (77%) with their husbands (66%). Also, they had conflict with the people around them (22%). They were anxious (58%), distressed (27%), and timorous and restless (57%). The main reasons for stress noticed among these parturient women were related to the fear of stillbirth (82%), a malformed child (76%), an infected newborn baby (76%), obstetrical trauma in the newborn baby (58%), and the newborn baby’s sex (26%). Subsequently, the fears of the parturient women were: the cesarean section (64%), maternal death (58%), the pain of childbirth (48%), traumatic maternal injury (47%), post-partum hemorrhage (45%), and the inability to face childbirth (31%). The parturient women before getting into the delivery room confided in traditional religious authorities (36%) who were either healers or marabous, witch doctors, spiritual advisors, or Christian priests. Conclusion: Delivery causes anxiety among parturient women whose apprehensions were about the pain of childbirth, the unborn baby, and their own mental ability to overcome the trial

Influence Du Poids Maternel Sur L’evolution De La Grossesse Chez Les Gestantes Dans La Ville De Parakou En 2015 Au Benin

Introduction:The World Health Organization considers for many years obesity as a pandemic which affects as well the developed countries as the developing ones.The consequences of the overweight on the medical, gynaeco-obstetrical, and surgical plan are no longer demonstrating. Objective:The current paper aims to study the influence of the weight of the mother on the evolution of the pregnancy with the pregnant women in the town of Parakou. Material and methodologicalapproaches: It was about a descriptive transversal study for an analytical purpose with forecast data collection. It has been conducted on a period of six (06) months going from 23rd of February to 31st of August 2015 and had covered 272 pregnant women in the town of Parakou.The sampling probabilistic method has been used according to the survey technique. Results:The average age of the surveyed women was about 26, 1± 5, 8 years old with the extremes of 14 and 51 years old. The predominance of the overweight and the obesity with the pregnant women in Parakou was respectively about 34, 9% and 15, 8%. The diabetes pregnant woman, the exceeding of term and the macrosomy were statistically associated with obesity. The diabetes pregnant women, the exceeding of term, the resuscitation at birth were statistically associated with overweight. Conclusion: The fight against overweight is one of the great challenges of this century. It has some consequences on obstetrical plan. A planning of pregnancies with the patients of overweight would then permit a clear improvement of the undertaking of their social securitywithin the maternities and an improvement of the maternal, perinatal and neonatal indicators

A Randomized Controlled Phase Ib Trial of the Malaria Vaccine Candidate GMZ2 in African Children

BACKGROUND: GMZ2 is a fusion protein of Plasmodium falciparum merozoite surface protein 3 (MSP3) and glutamate rich protein (GLURP) that mediates an immune response against the blood stage of the parasite. Two previous phase I clinical trials, one in naïve European adults and one in malaria-exposed Gabonese adults showed that GMZ2 was well tolerated and immunogenic. Here, we present data on safety and immunogenicity of GMZ2 in one to five year old Gabonese children, a target population for future malaria vaccine efficacy trials. METHODOLOGY/PRINCIPAL FINDINGS: Thirty children one to five years of age were randomized to receive three doses of either 30 µg or 100 µg of GMZ2, or rabies vaccine. GMZ2, adjuvanted in aluminum hydroxide, was administered on Days 0, 28 and 56. All participants received a full course of their respective vaccination and were followed up for one year. Both 30 µg and 100 µg GMZ2 vaccine doses were well tolerated and induced antibodies and memory B-cells against GMZ2 as well as its antigenic constituents MSP3 and GLURP. After three doses of vaccine, the geometric mean concentration of antibodies to GMZ2 was 19-fold (95%CI: 11,34) higher in the 30 µg GMZ2 group than in the rabies vaccine controls, and 16-fold (7,36) higher in the 100 µg GMZ2 group than the rabies group. Geometric mean concentration of antibodies to MSP3 was 2.7-fold (1.6,4.6) higher in the 30 µg group than in the rabies group and 3.8-fold (1.5,9.6) higher in the 100 µg group. Memory B-cells against GMZ2 developed in both GMZ2 vaccinated groups. CONCLUSIONS/SIGNIFICANCE: Both 30 µg as well as 100 µg intramuscular GMZ2 are immunogenic, well tolerated, and safe in young, malaria-exposed Gabonese children. This result confirms previous findings in naïve and malaria-exposed adults and supports further clinical development of GMZ2. TRIAL REGISTRATION: ClinicalTrials.gov NCT00703066

Intramuscular Artesunate for Severe Malaria in African Children: A Multicenter Randomized Controlled Trial.

BACKGROUND: Current artesunate (ARS) regimens for severe malaria are complex. Once daily intramuscular (i.m.) injection for 3 d would be simpler and more appropriate for remote health facilities than the current WHO-recommended regimen of five intravenous (i.v.) or i.m. injections over 4 d. We compared both a three-dose i.m. and a three-dose i.v. parenteral ARS regimen with the standard five-dose regimen using a non-inferiority design (with non-inferiority margins of 10%). METHODS AND FINDINGS: This randomized controlled trial included children (0.5-10 y) with severe malaria at seven sites in five African countries to assess whether the efficacy of simplified three-dose regimens is non-inferior to a five-dose regimen. We randomly allocated 1,047 children to receive a total dose of 12 mg/kg ARS as either a control regimen of five i.m. injections of 2.4 mg/kg (at 0, 12, 24, 48, and 72 h) (n = 348) or three injections of 4 mg/kg (at 0, 24, and 48 h) either i.m. (n = 348) or i.v. (n = 351), both of which were the intervention arms. The primary endpoint was the proportion of children with ≥ 99% reduction in parasitemia at 24 h from admission values, measured by microscopists who were blinded to the group allocations. Primary analysis was performed on the per-protocol population, which was 96% of the intention-to-treat population. Secondary analyses included an analysis of host and parasite genotypes as risks for prolongation of parasite clearance kinetics, measured every 6 h, and a Kaplan-Meier analysis to compare parasite clearance kinetics between treatment groups. A post hoc analysis was performed for delayed anemia, defined as hemoglobin ≤ 7 g/dl 7 d or more after admission. The per-protocol population was 1,002 children (five-dose i.m.: n = 331; three-dose i.m.: n = 338; three-dose i.v.: n = 333); 139 participants were lost to follow-up. In the three-dose i.m. arm, 265/338 (78%) children had a ≥ 99% reduction in parasitemia at 24 h compared to 263/331 (79%) receiving the five-dose i.m. regimen, showing non-inferiority of the simplified three-dose regimen to the conventional five-dose regimen (95% CI -7, 5; p = 0.02). In the three-dose i.v. arm, 246/333 (74%) children had ≥ 99% reduction in parasitemia at 24 h; hence, non-inferiority of this regimen to the five-dose control regimen was not shown (95% CI -12, 1; p = 0.24). Delayed parasite clearance was associated with the N86YPfmdr1 genotype. In a post hoc analysis, 192/885 (22%) children developed delayed anemia, an adverse event associated with increased leukocyte counts. There was no observed difference in delayed anemia between treatment arms. A potential limitation of the study is its open-label design, although the primary outcome measures were assessed in a blinded manner. CONCLUSIONS: A simplified three-dose i.m. regimen for severe malaria in African children is non-inferior to the more complex WHO-recommended regimen. Parenteral ARS is associated with a risk of delayed anemia in African children. TRIAL REGISTRATION: Pan African Clinical Trials Registry PACTR201102000277177

The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance

INTRODUCTION Investment in Africa over the past year with regard to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing has led to a massive increase in the number of sequences, which, to date, exceeds 100,000 sequences generated to track the pandemic on the continent. These sequences have profoundly affected how public health officials in Africa have navigated the COVID-19 pandemic. RATIONALE We demonstrate how the first 100,000 SARS-CoV-2 sequences from Africa have helped monitor the epidemic on the continent, how genomic surveillance expanded over the course of the pandemic, and how we adapted our sequencing methods to deal with an evolving virus. Finally, we also examine how viral lineages have spread across the continent in a phylogeographic framework to gain insights into the underlying temporal and spatial transmission dynamics for several variants of concern (VOCs). RESULTS Our results indicate that the number of countries in Africa that can sequence the virus within their own borders is growing and that this is coupled with a shorter turnaround time from the time of sampling to sequence submission. Ongoing evolution necessitated the continual updating of primer sets, and, as a result, eight primer sets were designed in tandem with viral evolution and used to ensure effective sequencing of the virus. The pandemic unfolded through multiple waves of infection that were each driven by distinct genetic lineages, with B.1-like ancestral strains associated with the first pandemic wave of infections in 2020. Successive waves on the continent were fueled by different VOCs, with Alpha and Beta cocirculating in distinct spatial patterns during the second wave and Delta and Omicron affecting the whole continent during the third and fourth waves, respectively. Phylogeographic reconstruction points toward distinct differences in viral importation and exportation patterns associated with the Alpha, Beta, Delta, and Omicron variants and subvariants, when considering both Africa versus the rest of the world and viral dissemination within the continent. Our epidemiological and phylogenetic inferences therefore underscore the heterogeneous nature of the pandemic on the continent and highlight key insights and challenges, for instance, recognizing the limitations of low testing proportions. We also highlight the early warning capacity that genomic surveillance in Africa has had for the rest of the world with the detection of new lineages and variants, the most recent being the characterization of various Omicron subvariants. CONCLUSION Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve. This is important not only to help combat SARS-CoV-2 on the continent but also because it can be used as a platform to help address the many emerging and reemerging infectious disease threats in Africa. In particular, capacity building for local sequencing within countries or within the continent should be prioritized because this is generally associated with shorter turnaround times, providing the most benefit to local public health authorities tasked with pandemic response and mitigation and allowing for the fastest reaction to localized outbreaks. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century

Initial management of postpartum hemorrhage: A cohort study in Benin and Mali

International audienceObjective To determine the components of initial management associated with a decreased risk of severe postpartum hemorrhage (PPH) in Benin and Mali. Methods A cohort study was conducted between May 2013 and September 2014 that included all women who delivered vaginally in seven participating centers and who presented excessive bleeding after birth. Severe PPH was defined as PPH that required surgical treatment (vascular ligature and/or hysterectomy), and/or blood transfusion, and/or transfer to an intensive care unit, and/or an outcome of maternal death. Logistic regression was used to identify the components of initial PPH management that were associated with severe PPH, adjusting for case mix. Results A total of 223 women presented a primary PPH presumably caused by uterine atony. Among those, 88 (39.5%) had severe PPH. Nearly one-third of women (30.4%) had a late injection of oxytocin (> 10 minutes) after PPH diagnosis or no injection. Oxytocin injection within 10 minutes after the PPH diagnosis was significantly associated with a decreased risk of severe PPH (adjusted OR = 0.3; 95% CI, 0.14–0.77). Conclusion Decrease in the delays in oxytocin administration is a key determinant to improve maternal outcomes related to PPH in this context

Assessment of COVID-19 Vaccine Acceptance and Its Associated Factors during the Crisis: A Community-Based Cross-Sectional Study in Benin

Background: Having a maximum number of people vaccinated was the objective to control the COVID-19 pandemic. We report in this manuscript the factors associated with the willingness to be vaccinated against COVID-19 during the pandemic period. Methods: From April to May 2022, a community-based cross-sectional survey was performed. Participants were randomly selected from four districts in Benin (taking into account the COVID-19 prevalence). Mixed-effect logistic regression models were used to identify the variables associated with COVID-19 vaccine acceptance. Results: A total of 2069 participants were included. The proportion of vaccine acceptance was 43.3%. A total of 24.2% were vaccinated and showed proof of vaccination. The population’s request for vaccination was higher after the third epidemic wave. The district of residence, the education level, a fear of being infected, the channel of information, poor medical conditions, a good knowledge of the transmission mode and symptoms, and good behaviors were significantly associated with vaccine acceptance. Conclusion: The overall acceptance of the COVID-19 vaccine in the Beninese population was relatively high. However, vaccine campaigns in areas with a low acceptance as well as the disclosure of information, particularly on our knowledge of the disease and the safety, side effects, and effectiveness of the COVID-19 vaccines, should be strengthened with adapted and consistent messages