NSAID prescribing and adverse outcomes in common infections: a population-based cohort study.

OBJECTIVES: Infections in primary care are often treated with non-steroidal anti-inflammatory drugs (NSAIDs). This study evaluates whether NSAID prescribing is associated with adverse outcomes for respiratory (RTIs) or urinary track (UTI) infections. OBJECTIVES: To determine whether there is an association between NSAID prescribing and the rate of adverse outcomes for infections for individual consulting in primary care. DESIGN: Cohort study of electronic health records. SETTING: 87 general practices in the UK Clinical Practice Research Datalink GOLD. PARTICIPANTS: 142 925 patients consulting with RTI or UTI. PRIMARY AND SECONDARY OUTCOME MEASURES: Repeat consultations, hospitalisation or death within 30 days of the initial consultation for RTI or UTI. Poisson models estimated the associations between NSAID exposure and outcome. Rate ratios were adjusted for gender, age, ethnicity, deprivation, antibiotic use, seasonal influenza vaccination status, comorbidities and general practice. Since prescribing variations by practice are not explained by case mix-hence, less impacted by confounding by indication-both individual-level and practice-level analyses are included. RESULTS: There was an increase in hospital admission/death for acute NSAID prescriptions (RR 2.73, 95% CI 2.10 to 3.56) and repeated NSAID prescriptions (6.47, 4.46-9.39) in RTI patients, and for acute NSAID prescriptions for UTI (RR 3.03; 1.92 to 4.76). Practice-level analysis, controlling for practice population characteristics, found that for each percentage point increase in NSAID prescription, the percentages of hospital admission/death within 30 days increased by 0.32 percentage points (95% CI 0.16 to 0.47). CONCLUSIONS: In this non-randomised study, prescription of NSAIDs at consultations for RTI or UTIs in primary care is infrequent but may be associated with increased risk of hospital admission. This supports other observational and limited trial data that NSAID prescribing might be associated with worse outcomes following acute infection and should be prescribed with caution

Complementary feeding practices: determinants of dietary diversity and meal frequency among children aged 6–23 months in Southern Benin

Poor complementary feeding practices have detrimental effects on child growth, development and survival. This cross-sectional study in rural areas of southern Benin examined some determinants of complementary feeding practices using socioeconomic and dietary data collected among 1225 primary caregivers. Determinants of complementary feeding practices in the study areas are multidimensional and include many interacting factors such as socio-economic aspects, farming practices, household demographics, cultural practices and geography. Child age, diversity of food groups produced, income allocated to feeding, commune of residence, ethnicity, caregivers’ occupation, marital status and household size were identified as the main factors affecting complementary feeding practices. Food group diversification in farm-systems and overall social behavior and support as well as women’s empowerment are necessary to improve children’s diets. Reducing women’s workload through improved working conditions appears crucial to decrease time burdens and allow more time for child care. Multisectoral interventions should be embraced to improve complementary feeding practices in Benin

Caractérisation de l’alimentation des jeunes enfants âgés de 6 à 36 mois en milieu rural et urbain du Sud– Bénin

Objectif: La période d’alimentation complémentaire est une période critique pour la croissance de l’enfant. Cette étude vise à décrire l’alimentation des jeunes enfants âgés de 6 à 36 mois en milieu rural et urbain du Sud-Bénin.Méthodologie et Résultats: Une enquête transversale a été menée sur 600 mères ayant des enfants âgés de 6 à 36 mois dans les zones rurales et urbaines du sud-Bénin, où la prévalence de la malnutrition chronique est élevée (prévalence variant de 40 % à 43 %). Les caractéristiques socio-économiques de la population, les connaissances (définition correcte de l'alimentation complémentaire) et les pratiques (âge d'introduction de l'aliment de complément, les caractéristiques des aliments de complément) ont été documentées. L'analyse en composante principale a été utilisée pour identifier les associations entre les caractéristiques socioéconomiques de la population et les pratiques d’alimentation des jeunes enfants de 6 à 36 mois. Dans l’ensemble, 65% des mères méconnaissent la notion d’alimentation complémentaire. L’introduction précoce des aliments de complément est observée dans 48.5% des cas. La bouillie dans 99.16% des cas est le premier aliment de complément donné aux enfants. Globalement, 67% des mères utilisent des bouillies locales, peu enrichies avec des matières protéiques. La consommation de bouillie issue des farines infantiles vendues dans le commerce est associée au milieu urbain alors que la bouillie locale est associée au milieu rural.Conclusion et application des résultats: Les bouillies locales sont peu enrichies avec des matières protéiques et les fréquences de consommation journalière sont faibles. Ces résultats révèlent l’importance d’améliorer les procédés et formulations traditionnelles des bouillies, stratégies endogènes durables qui méritent d’être encouragées par l’éducation nutritionnelle pour la production de bouillies enrichies à haute valeur nutritionnelle avec des matières premières locales accessibles pour couvrir les besoins nutritionnels et énergétiques des jeunes enfants, gage d’une croissance optimale.Mots clés: Alimentation, enfants de 6 à 36 mois, bouillies, BéninEnglish Title: Characterization of the feeding of young children aged 6 to 36 months in rural and urban areas of the South BeninEnglish AbstractObjective: The period of complementary feeding is a critical period for the growth of the child. This study aims to describe the feeding of young children aged 6 to 36 months in rural and urban areas of the South Benin.Methodology and Results: A cross sectional survey was conducted on 600 mothers having children aged 6 to 36 months in rural and urban areas of the South Benin, where the prevalence of chronic malnutrition is high (prevalence between 40% to 43%). The socio economics data, knowledge (correct definition of complementary feeding) and practices (age of introduction of Complementary Foods, characteristics of Complementary Foods) were collected. Analysis of principal component was used to identify the associations between the socio economics data and feeding practices for 6 to 36 months’ young children. About, 65% of mothers ignore the concept of complementary feeding. The early introduction of complementary foods was observed in 48.5% of cases. Porridge in 99.16% of cases is the first complementary food given to children. Overall, 67% of mothers use local porridges slightly enriched with protein feeds. Porridge based on commercial infant flour consumption is associated with the urban area while local porridge is associated with rural areas.Conclusion and application and results: Local porridge is poorly enriched with protein feeds in rural areas and the frequencies of daily consumption are low. These results reveal the importance of improving the processes and traditional formulations of local porridges. Sustainable strategies that need to be encouraged by mothers ‘nutritional education for the production of enriched porridges with high nutritional value and local raw materials accessible in order to cover the nutritional requirements and energy need of young children, pledge of an optimal growth.Keywords: feeding, children of 6 to 36 months, porridges, Beni

Weight Loss and Nutritional Status of 6-59 Months Children after Positive Deviance/Hearth Approach in Southern Benin Rural Area: Associated Factors to Later Underweight

Aims: To appreciate the evolution of weight gain by malnourished children and factors associated to children underweight after the Positive Deviance/Hearth sessions. Study Design: Longitudinal study. Place and Duration of Study: Districts Ze and Lalo (Southern Benin), from May to August 2014 Methodology: This study was conducted on 98 children aged of 6-59 months who fully participated in Positive Deviance/Hearth (PD/H). During one month, four measurements of weight have been taken on the 77th, 84th, 91th, and 98th day after the beginning of PD/H. Questionnaire was administered to mother on environmental, hygiene practices, and food accessibility of household. Relation among factors of food accessibility, household hygiene, and child nutritional status was sought by an Analysis of Factorial Components. Results: The children who participated in 12 days of PD/H gained significantly 0.63 kg and 1.13 kg of weight in Lalo and Ze respectively (P<.001). From the 12th to 77th day after the end of PD/H, we noticed a significant weight loss from 10.54 to 10.09 kg in Ze and from 9.75 to 9.19 Kg in Lalo (P=.003). Prevalence of underweight children on the 77th day was 45.8% with 12.5% of severe case and 63.5% with 18.9% of severe case in Lalo and Ze, respectively. The severe underweight children were characterized by households where i) it rarely arrived to be without food ii) one member rarely have a day without eaten but iii) the drinking water is from well. Conclusion: On the 77th day after the PD/H, the children of our study had weight loss. Food accessibility and household hygiene are mainly the limited factors that could explain the degradation of the nutritional status of children and high prevalence of underweight. This first study conducted in Benin on PD/H approach is more exploratory and helps to appreciate this approach efficacy and sustainability

Designing User-Friendly Grids for the Gender-Specification of Rural, Semi-Urban, and Urban School Toilets in West Africa: Lessons from the Republic of Benin

Gender equity, quality education, and sanitation in rural and urban areas are widely considered as development imperatives. However, while many countries of the world are already far with the gendering of their schools’ toilets, most others still tend to systematically construct the same number of toilet cabins for female and male students, often ignoring specific needs associated with biophysical differences and disabilities among the students. This poor gendering of school toilets prevailed in the Republic of Benin until 2013, when, within the framework of the Pluriannual Water and Sanitation Programme (PPEA phase 2) funded by the Netherlands’ Ministry of Cooperation through its Embassy in the Republic of Benin, the Directorate of Hygiene and Sanitation of the Ministry of Public Health in collaboration with Water and Sanitation for Africa Agency, decided to launch a study for gender and disability specific toilets in primary and secondary schools. This original paper discusses the process towards the design of norms and grids for the calculation of toilet cabins and urinals needs of primary and secondary school students of rural, semi-urban, urban, Sahelian, Sudanian, lake, and coastal areas of the Republic of Benin. The study took place in four steps. The first step consisted of identifying key factors that affect the use of school toilets by students, especially female and disabled students. The second step consisted of observing and recording the use of school toilets by students, and building on those observations and records to estimate the number of toilet cabins and urinals required per agroecological and sociocultural area. The third step built on the results from the first and second steps to design simplified grids that allow sanitation and schools’ decision-makers to easily and quickly calculate the number of toilet cabins and urinals required for the target schools, per gender and disability. The fourth step consisted of building the capacities of potential users of the grids, for their relevant use. The findings indicate a variation of needs among primary and secondary schools, and the study zones, due to sociocultural and development differences. The grids have been in use in Benin since 2016 and it has easily helped to calculate gender-specific toilet needs in the study areas. After five years of use, their performance requires to be assessed for further adaptations. A further paper will report on the performance of these grids

Designing User-Friendly Grids for the Gender-Specification of Rural, Semi-Urban, and Urban School Toilets in West Africa: Lessons from the Republic of Benin

Gender equity, quality education, and sanitation in rural and urban areas are widely considered as development imperatives. However, while many countries of the world are already far with the gendering of their schools’ toilets, most others still tend to systematically construct the same number of toilet cabins for female and male students, often ignoring specific needs associated with biophysical differences and disabilities among the students. This poor gendering of school toilets prevailed in the Republic of Benin until 2013, when, within the framework of the Pluriannual Water and Sanitation Programme (PPEA phase 2) funded by the Netherlands’ Ministry of Cooperation through its Embassy in the Republic of Benin, the Directorate of Hygiene and Sanitation of the Ministry of Public Health in collaboration with Water and Sanitation for Africa Agency, decided to launch a study for gender and disability specific toilets in primary and secondary schools. This original paper discusses the process towards the design of norms and grids for the calculation of toilet cabins and urinals needs of primary and secondary school students of rural, semi-urban, urban, Sahelian, Sudanian, lake, and coastal areas of the Republic of Benin. The study took place in four steps. The first step consisted of identifying key factors that affect the use of school toilets by students, especially female and disabled students. The second step consisted of observing and recording the use of school toilets by students, and building on those observations and records to estimate the number of toilet cabins and urinals required per agroecological and sociocultural area. The third step built on the results from the first and second steps to design simplified grids that allow sanitation and schools’ decision-makers to easily and quickly calculate the number of toilet cabins and urinals required for the target schools, per gender and disability. The fourth step consisted of building the capacities of potential users of the grids, for their relevant use. The findings indicate a variation of needs among primary and secondary schools, and the study zones, due to sociocultural and development differences. The grids have been in use in Benin since 2016 and it has easily helped to calculate gender-specific toilet needs in the study areas. After five years of use, their performance requires to be assessed for further adaptations. A further paper will report on the performance of these grids

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