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

Association of respiratory symptoms and lung function with occupation in the multinational Burden of Obstructive Lung Disease (BOLD) study

Background Chronic obstructive pulmonary disease has been associated with exposures in the workplace. We aimed to assess the association of respiratory symptoms and lung function with occupation in the Burden of Obstructive Lung Disease study. Methods We analysed cross-sectional data from 28 823 adults (≥40 years) in 34 countries. We considered 11 occupations and grouped them by likelihood of exposure to organic dusts, inorganic dusts and fumes. The association of chronic cough, chronic phlegm, wheeze, dyspnoea, forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1)/FVC with occupation was assessed, per study site, using multivariable regression. These estimates were then meta-analysed. Sensitivity analyses explored differences between sexes and gross national income. Results Overall, working in settings with potentially high exposure to dusts or fumes was associated with respiratory symptoms but not lung function differences. The most common occupation was farming. Compared to people not working in any of the 11 considered occupations, those who were farmers for ≥20 years were more likely to have chronic cough (OR 1.52, 95% CI 1.19–1.94), wheeze (OR 1.37, 95% CI 1.16–1.63) and dyspnoea (OR 1.83, 95% CI 1.53–2.20), but not lower FVC (β=0.02 L, 95% CI −0.02–0.06 L) or lower FEV1/FVC (β=0.04%, 95% CI −0.49–0.58%). Some findings differed by sex and gross national income. Conclusion At a population level, the occupational exposures considered in this study do not appear to be major determinants of differences in lung function, although they are associated with more respiratory symptoms. Because not all work settings were included in this study, respiratory surveillance should still be encouraged among high-risk dusty and fume job workers, especially in low- and middle-income countries.publishedVersio

Prevalence of chronic cough, its risk factors and population attributable risk in the Burden of Obstructive Lung Disease (BOLD) study: a multinational cross-sectional study

© 2024 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/)Background: Chronic cough is a common respiratory symptom with an impact on daily activities and quality of life. Global prevalence data are scarce and derive mainly from European and Asian countries and studies with outcomes other than chronic cough. In this study, we aimed to estimate the prevalence of chronic cough across a large number of study sites as well as to identify its main risk factors using a standardised protocol and definition. Methods: We analysed cross-sectional data from 33,983 adults (≥40 years), recruited between Jan 2, 2003 and Dec 26, 2016, in 41 sites (34 countries) from the Burden of Obstructive Lung Disease (BOLD) study. We estimated the prevalence of chronic cough for each site accounting for sampling design. To identify risk factors, we conducted multivariable logistic regression analysis within each site and then pooled estimates using random-effects meta-analysis. We also calculated the population attributable risk (PAR) associated with each of the identifed risk factors. Findings: The prevalence of chronic cough varied from 3% in India (rural Pune) to 24% in the United States of America (Lexington,KY). Chronic cough was more common among females, both current and passive smokers, those working in a dusty job, those with a history of tuberculosis, those who were obese, those with a low level of education and those with hypertension or airflow limitation. The most influential risk factors were current smoking and working in a dusty job. Interpretation: Our findings suggested that the prevalence of chronic cough varies widely across sites in different world regions. Cigarette smoking and exposure to dust in the workplace are its major risk factors.info:eu-repo/semantics/publishedVersio

Prevalence of chronic cough, its risk factors and population attributable risk in the Burden of Obstructive Lung Disease (BOLD) study: a multinational cross-sectional study

Background: Chronic cough is a common respiratory symptom with an impact on daily activities and quality of life. Global prevalence data are scarce and derive mainly from European and Asian countries and studies with outcomes other than chronic cough. In this study, we aimed to estimate the prevalence of chronic cough across a large number of study sites as well as to identify its main risk factors using a standardized protocol and definition. Methods: We analyzed cross-sectional data from 33,983 adults (≥40 years), recruited between Jan 2, 2003 and Dec 26, 2016, in 41 sites (34 countries) from the Burden of Obstructive Lung Disease (BOLD) study. We estimated the prevalence of chronic cough for each site accounting for sampling design. To identify risk factors, we conducted multivariable logistic regression analysis within each site and then pooled estimates using random-effects meta-analysis. We also calculated the population-attributable risk (PAR) associated with each of the identified risk factors. Findings: The prevalence of chronic cough varied from 3% in India (rural Pune) to 24% in the United States of America (Lexington, KY). Chronic cough was more common among females, both current and passive smokers, those working in a dusty job, those with a history of tuberculosis, those who were obese, those with a low level of education, and those with hypertension or airflow limitation. The most influential risk factors were current smoking and working in a dusty job. Interpretation: Our findings suggested that the prevalence of chronic cough varies widely across sites in different world regions. Cigarette smoking and exposure to dust in the workplace are its major risk factors.info:eu-repo/semantics/publishedVersio

Cohort Profile: Burden of Obstructive Lung Disease (BOLD) study

The Burden of Obstructive Lung Disease (BOLD) study was established to assess the prevalence of chronic airflow obstruction, a key characteristic of chronic obstructive pulmonary disease, and its risk factors in adults (≥40 years) from general populations across the world. The baseline study was conducted between 2003 and 2016, in 41 sites across Africa, Asia, Europe, North America, the Caribbean and Oceania, and collected high-quality pre- and post-bronchodilator spirometry from 28 828 participants. The follow-up study was conducted between 2019 and 2021, in 18 sites across Africa, Asia, Europe and the Caribbean. At baseline, there were in these sites 12 502 participants with high-quality spirometry. A total of 6452 were followed up, with 5936 completing the study core questionnaire. Of these, 4044 also provided high-quality pre- and post-bronchodilator spirometry. On both occasions, the core questionnaire covered information on respiratory symptoms, doctor diagnoses, health care use, medication use and ealth status, as well as potential risk factors. Information on occupation, environmental exposures and diet was also collected

Whole-Genome Sequencing-Based Screening of MRSA in Patients and Healthcare Workers in Public Hospitals in Benin

Methicillin-resistant Staphylococcus aureus (MRSA) constitutes a serious public health concern, with a considerable impact on patients’ health, and substantial healthcare costs. In this study, patients and healthcare workers (HCWs) from six public hospitals in Benin were screened for MRSA. Strains were identified as MRSA using conventional microbiological methods in Benin, and confirmed using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry in Belgium. Whole-genome sequencing (WGS) was used on the confirmed MRSA isolates, to characterize their genomic content and study their relatedness. Amongst the 305 isolates (304 wound swabs and 61 nasal swabs) that were collected from patients and HCWs, we detected 32 and 15 cases of MRSA, respectively. From this collection, 27 high-quality WGS datasets were obtained, which carried numerous genes and mutations associated with antimicrobial resistance. The mecA gene was detected in all the sequenced isolates. These isolates were assigned to five sequence types (STs), with ST8 (55.56%, n = 15/27), ST152 (18.52%, n = 5/27), and ST121 (18.52%, n = 5/27) being the most common. These 27 isolates carried multiple virulence genes, including the genes encoding the Panton–Valentine leukocidin toxin (48.15%, n = 13/27), and the tst gene (29.63%, n = 8/27), associated with toxic shock syndrome. This study highlights the need to implement a multimodal strategy for reducing the risk of the cross-transmission of MRSA in hospitals

Characteristics and outcomes of an international cohort of 600 000 hospitalized patients with COVID-19

Background: We describe demographic features, treatments and clinical outcomes in the International Severe Acute Respiratory and emerging Infection Consortium (ISARIC) COVID-19 cohort, one of the world’s largest international, standardized data sets concerning hospitalized patients. Methods: The data set analysed includes COVID-19 patients hospitalized between January 2020 and January 2022 in 52 countries. We investigated how symptoms on admission, co-morbidities, risk factors and treatments varied by age, sex and other characteristics. We used Cox regression models to investigate associations between demographics, symptoms, co-morbidities and other factors with risk of death, admission to an intensive care unit (ICU) and invasive mechanical ventilation (IMV). Results: Data were available for 689 572 patients with laboratory-confirmed (91.1%) or clinically diagnosed (8.9%) SARS-CoV-2 infection from 52 countries. Age [adjusted hazard ratio per 10 years 1.49 (95% CI 1.48, 1.49)] and male sex [1.23 (1.21, 1.24)] were associated with a higher risk of death. Rates of admission to an ICU and use of IMV increased with age up to age 60 years then dropped. Symptoms, co-morbidities and treatments varied by age and had varied associations with clinical outcomes. The case-fatality ratio varied by country partly due to differences in the clinical characteristics of recruited patients and was on average 21.5%. Conclusions: Age was the strongest determinant of risk of death, with a ~30-fold difference between the oldest and youngest groups; each of the co-morbidities included was associated with up to an almost 2-fold increase in risk. Smoking and obesity were also associated with a higher risk of death. The size of our international database and the standardized data collection method make this study a comprehensive international description of COVID-19 clinical features. Our findings may inform strategies that involve prioritization of patients hospitalized with COVID-19 who have a higher risk of death