Amélioration des conditions d’hygiène et d’assainissement dans la commune de Zè au Bénin

La présente étude vise à évaluer les effets des interventions mises en œuvre de 2017 à 2018 relatives à la promotion de l'hygiène et de l'assainissement dans la commune de Zè. Réalisée en Septembre 2019, l’étude a mobilisé la recherche documentaire, l’observation et l’entretien. La collecte a été effectuée dans les arrondissements bénéficiaires des interventions et de celles non bénéficiaires. Les résultats après interventions montrent que la proportion des personnes ayant de bonnes pratiques d’hygiène et d’assainissement est passée de 31,01% à 73,08%. La proportion des groupements de femmes associés aux activités IEC/WASH est passée de 0% à 87%. Le taux de morbidité liée aux maladies hydro-fécales a régressé de 1,20% à 0,78%. La prévalence des géohelminthiases a diminué de 7,10% à 0,75%. Par ailleurs, l’observation a permis de constater la réduction de la défécation à l’air libre, la réduction de la distance séparant les ménages d’un point d’eau, la diminution de la corvée d’eau pour les femmes et les filles, la réduction de la prévalence des maladies courantes dans les localités bénéficiaires. Malgré les résultats positifs obtenus, il reste des défis à relever pour pérenniser les acquis et passer à l’échelle supérieure notamment l’implication effective des autorités locales dans le suivi des ouvrages d’hygiène et d’assainissement.   The study aims to assess the effects of the interventions implemented from 2017 to 2018 relating to the promotion of hygiene and sanitation in the municipality of Zè. Conducted in September 2019, the study involved documentary research, observation and interview. Collection was carried out in the districts benefiting from the interventions and those not benefiting. Postintervention results show that the proportion of people with good hygiene and sanitation practices increased from 31.01% to 73.08%. The proportion of women's groups involved in IEC / WASH activities increased from 0% to 87%. The morbidity rate linked to hydro-fecal diseases fell from 1.20% to 0.78%. The prevalence of soil-transmitted helminthiasis decreased from 7.10% to 0.75%. In addition, the observation made it possible to note the reduction in open defecation, the reduction in the distance separating households from a water point, the reduction in the drudgery of water for women and girls, reducing the prevalence of common diseases in beneficiary localities and empowering women in groups through the manufacture and sale of soap

Etat Des Lieux et Facteurs Associés en Matière D’eau, D’hygiène Et D’assainissement Dans la Commune d’Abomey-Calavi Au Bénin

Pour apprécier l’accès à l’eau, l’hygiène et à l’assainissement dans la commune d’Abomey-Calavi, un état des lieux a été réalisé et les facteurs associés en matière d’eau, d’hygiène et d’assainissement ont été étudiés. De mai 2016 à janvier 2017, une étude transversale et analytique a permis d’administrer un questionnaire structuré à 630 individus. SPSS et Epi Info ont servi à analyser les facteurs associés. Les focus groupes ont permis de collecter les données qualitatives au sein d’un arrondissement urbain et rural. Un échantillonnage par commodité a permis de sélectionner, à partir des ménages enquêtés, dix participants par arrondissement. La méthode de l’analyse du contenu a été utilisée pour traiter les données qualitatives. L’analyse des résultats obtenus révèle que 61,9% des ménages utilisent une source d’eau améliorée, 87,3% disposent d’installation d’assainissement améliorée, 58,3% et 4,03% disposant respectivement de toilette à chasse mécanique et de toilettes sèches ont une installation d’hygiène améliorée. Le milieu de résidence (OR : 0,3, IC 95% : [0,61-0,42]) explique l’état de la source d’eau de boisson. Le niveau d’instruction (OR : 1,18 ; IC 95% :[0,61-2,25]) et la source d’eau de boisson (OR, 5,62, IC 95% :[2,66-11,85]) expliquent l’état de l’hygiène. La dépense journalière (OR, 0,22, IC 95% : [0,11-0,42]), le milieu de résidence (OR : 0,05 ; IC 95% : [0,02-0,20]), le niveau d’instruction (OR, 0,27 ; IC 95% : [0,16-0,47]) et les traits caractéristiques du relief (OR, 0,27 ; IC 95% : [0,07-1,14]) expliquent l’état de l’assainissement. Il ressort de tout ce qui précède que l’accès à l’eau, l’hygiène et à l’assainissement est acceptable dans la commune d’Abomey-Calavi malgré les disparités entre milieu rural et urbain. Les facteurs associés sont : le niveau d’instruction, la source d’eau de boisson, le niveau économique, le milieu de résidence et les traits caractéristiques du relief. To appreciate the access to water, hygiene and sanitation in the commune of Abomey-Calavi, the inventory was carried out and the associated factors in terms of water, hygiene and sanitation have been studied. FromMay 2016 to January 2017, a cross-sectional and analytical study was used to administer a structured questionnaire to 630 individuals. SPSS and Epi Info were used to analyze the associated factors. The focus groups were used to collect qualitative data in an urban and rural district. A convenience sample were used to select, fromthe households surveyed, ten participants per district. The content analysis method was used to process the qualitative data. The analysis of the results obtained reveals that 61.9% of households use an improved water source, 87.3% have improved sanitation facilities, 58.3% and 4.03% have respectively a flush toilet and dry toilets have an improved hygiene facility. The place of residence (OR: 0.3, 95% CI: [0, 61-0, 42]) explains the state of the drinking water source. The level of education (OR: 1,18, 95% CI: :[0,61-2,25]) and the source of drinking water (OR, 5,62, 95% CI: [2,66-11,85]) explain the state of hygiene. Daily expenditure (OR, 0, 22, 95% CI: [0,11-0,42]), place of residence (OR: 0.05, 95% CI [0,02-0,20]), level of education (OR, 0.27, 95% CI: [0,16-0,47]) and the characteristics of the relief (OR, 0.27, 95% CI: [0,07-1,14]) explain the state of sanitation. From all the foregoing, it is clear that access to water, hygiene and sanitation is acceptable in the commune of Abomey-Calavi despite the disparities between rural and urban areas. Associated factors are: educational level, drinking water source, economic level, place of residence, and characteristics of relief

Buruli Ulcer Surveillance, Benin, 2003–2005

We reviewed Buruli ulcer (BU) surveillance in Benin, using the World Health Organization BU02 form. We report results of reliable routine data collected on 2,598 new and recurrent cases from 2003 through 2005

Genetic Susceptibility and Predictors of Paradoxical Reactions in Buruli Ulcer

Buruli ulcer (BU) is the third most frequent mycobacterial disease in immunocompetent persons after tuberculosis and leprosy. During the last decade, eight weeks of antimicrobial treatment has become the standard of care. This treatment may be accompanied by transient clinical deterioration, known as paradoxical reaction. We investigate the incidence and the risks factors associated with paradoxical reaction in BU.The lesion size of participants was assessed by careful palpation and recorded by serial acetate sheet tracings. For every time point, surface area was compared with the previous assessment. All patients received antimicrobial treatment for 8 weeks. Serum concentration of 25-hydroxyvitamin D, the primary indicator of vitamin D status, was determined in duplex for blood samples at baseline by a radioimmunoassay. We genotyped four polymorphisms in the SLC11A1 gene, previously associated with susceptibility to BU. For testing the association of genetic variants with paradoxical responses, we used a binary logistic regression analysis with the occurrence of a paradoxical response as the dependent variable.Paradoxical reaction occurred in 22% of the patients; the reaction was significantly associated with trunk localization (p = .039 by Χ(2)), larger lesions (p = .021 by Χ(2)) and genetic factors. The polymorphisms 3'UTR TGTG ins/ins (OR 7.19, p < .001) had a higher risk for developing paradoxical reaction compared to ins/del or del/del polymorphisms.Paradoxical reactions are common in BU. They are associated with trunk localization, larger lesions and polymorphisms in the SLC11A1 gene

Histopathological Changes and Clinical Responses of Buruli Ulcer Plaque Lesions during Chemotherapy: A Role for Surgical Removal of Necrotic Tissue?

The tropical necrotizing skin disease Buruli ulcer (BU) caused by Mycobacterium ulcerans is associated with extensive tissue destruction and local immunosuppression caused by the macrolide exotoxin mycolactone. Chemotherapy with a combination of rifampicin and streptomycin for 8 weeks is the currently recommended treatment for all types of BU lesions, including both ulcerative and non-ulcerative stages (plaques, nodules and edema). Our histopathological analysis of twelve BU plaque lesions revealed extensive destruction of sub-cutaneous tissue. This frequently led to ulceration during antibiotic treatment. This should not be mistaken as a failure of the antimycobacterial chemotherapy, since we found no evidence for the persistence of active infection foci. Large necrotic areas were found to persist even after completion of antibiotic treatment. These may disturb wound healing and the role of wound debridement should therefore be formally tested in a clinical trial setting

Comparison of 8 weeks standard treatment (rifampicin plus clarithromycin) vs. 4 weeks standard plus amoxicillin/clavulanate treatment [RC8 vs. RCA4] to shorten Buruli ulcer disease therapy (the BLMs4BU trial): study protocol for a randomized controlled multi-centre trial in Benin

Background Buruli ulcer (BU) is a neglected tropical disease caused by Mycobacterium ulcerans that affects skin, soft tissues, and bones, causing long-term morbidity, stigma, and disability. The recommended treatment for BU requires 8 weeks of daily rifampicin and clarithromycin together with wound care, physiotherapy, and sometimes tissue grafting and surgery. Recovery can take up to 1 year, and it may pose an unbearable financial burden to the household. Recent in vitro studies demonstrated that beta-lactams combined with rifampicin and clarithromycin are synergistic against M. ulcerans. Consequently, inclusion of amoxicillin/clavulanate in a triple oral therapy may potentially improve and shorten the healing process. The BLMs4BU trial aims to assess whether co-administration of amoxicillin/clavulanate with rifampicin and clarithromycin could reduce BU treatment from 8 to 4 weeks. Methods We propose a randomized, controlled, open-label, parallel-group, non-inferiority phase II, multi-centre trial in Benin with participants stratified according to BU category lesions and randomized to two oral regimens: (i) Standard: rifampicin plus clarithromycin therapy for 8 weeks; and (ii) Investigational: standard plus amoxicillin/clavulanate for 4 weeks. The primary efficacy outcome will be lesion healing without recurrence and without excision surgery 12 months after start of treatment (i.e. cure rate). Seventy clinically diagnosed BU patients will be recruited per arm. Patients will be followed up over 12 months and managed according to standard clinical care procedures. Decision for excision surgery will be delayed to 14 weeks after start of treatment. Two sub-studies will also be performed: a pharmacokinetic and a microbiology study. Discussion If successful, this study will create a new paradigm for BU treatment, which could inform World Health Organization policy and practice. A shortened, highly effective, all-oral regimen will improve care of BU patients and will lead to a decrease in hospitalization-related expenses and indirect and social costs and improve treatment adherence. This trial may also provide information on treatment shortening strategies for other mycobacterial infections (tuberculosis, leprosy, or non-tuberculous mycobacteria infections)

Contribution of the community health volunteers in the control of buruli ulcer in Bénin

Buruli ulcer (BU) is a neglected tropical disease caused by Mycobacterium ulcerans. Usually BU begins as a painless nodule, plaque or edema, ultimately developing into an ulcer. The high number of patients presenting with ulcers in an advanced stage is striking. Such late presentation will complicate treatment and have long-term disabilities as a consequence. The disease is mainly endemic in West Africa. The primary strategy for control of this disease is early detection using community village volunteers.In this retrospective, observational study, information regarding Buruli ulcer patients that reported to one of the four BU centers in Bénin between January 2008 and December 2010 was collected using the WHO/BU01 forms. Information used from these forms included general characteristics of the patient, the results of diagnostic tests, the presence of functional limitations at start of treatment, lesion size, patient delay and the referral system. The role of the different referral systems on the stage of disease at presentation in the hospital was analyzed by a logistic regression analysis. About a quarter of the patients (26.5%) were referred to the hospital by the community health volunteers. In our data set, patients referred to the hospital by community health volunteers appeared to be in an earlier stage of disease than patients referred by other methods, but after adjustment by the regression analysis for the health center, this effect could no longer be seen. The Polymerase Chain Reaction (PCR) for IS2404 positivity rate among patients referred by the community health volunteers was not systematically lower than in patients referred by other systems.This study clarifies the role played by community health volunteers in Bénin, and shows that they play an important role in the control of BU

Family Relationship, Water Contact and Occurrence of Buruli Ulcer in Benin

Mycobacterium ulcerans disease (Buruli ulcer) is the most widespread mycobacterial disease in the world after leprosy and tuberculosis. How M. ulcerans is introduced into the skin of humans remains unclear, but it appears that individuals living in the same environment may have different susceptibilities. This case control study aims to determine whether frequent contacts with natural water sources, family relationship or the practice of consanguineous marriages are associated with the occurrence of Buruli ulcer (BU). The study involved 416 participants, of which 104 BU-confirmed cases and 312 age, gender and village of residence matched controls (persons who had no signs or symptoms of active or inactive BU). The results confirmed that contact with natural water sources is a risk factor. Furthermore, it suggests that a combination of genetic factors may constitute risk factors for the development of BU, possibly by influencing the type of immune response in the individual, and, consequently, the development of BU infection per se and its different clinical forms. These findings may be of major therapeutic interest