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

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

Distal sensory polyneuropathy among HIV-infected patients at Parakou University Hospital, Benin, 2011

International audienceDistal sensory polyneuropathy (DSP) is the most frequent neurological complication among HIV patients, and its risk increases with use of highly active antiretroviral therapy (HAART). We aimed to assess the prevalence of DSP and the factors associated with it among HIV-infected outpatients treated at Parakou University Hospital. This cross-sectional study took place from April 15 to July 15, 2011, and included 262 patients. All patients underwent a neurological examination by two neurologists with training and clinical experience in these examinations and in the Brief Peripheral Neuropathy Screening (BPNS), which was the primary tool used here. Data from nutritional status (body mass index: BMI), social and demographic information, HAART status, and CD4 count were recorded. The factors associated with DSP were studied with multivariate analysis, using a logistic regression model and a significance level of 0.05. The study included 60 men (22.9 %). Patients' ages ranged from 16 to 74 years and averaged 36.8±10 years. All patients but one patient were infected by HIV type 1 only; that one was coinfected by types 1 and 2. The mean BMI was 22.5+/-4.2 kg/m2. In all, 213 (81.3 %) received HAART, and the mean CD4 count was 355.0 cells/mm3+/-236.1. The prevalence of DSP was 42.4 %. The factors associated with it on univariate analysis were age, marital status, HAART status, duration of HIV infection, and duration of HAART. Only advanced age (OR 1.8, 95 % CI 1.1-5.3) and HAART use (OR 2.3, 95 % CI 1.5-4.9) were associated with DSP in the multivariate analysis. The main symptoms were paresthesia (numbness:75.7%; burning: 39.6%; pins and needles sensation 32.4 %) and pain (23.4 %). Vibration perception at the toes was missing or reduced for 84.4 %. According to the sensory symptoms grade, 93.7 % of patients were classified in Grades 2 or 3. This study showed that the prevalence of DSP is high and that it is associated with age and HAART

Carbapenem-Resistant Organisms Isolated in Surgical Site Infections in Benin: A Public Health Problem

An alarming worldwide increase in antimicrobial resistance is complicating the management of surgical site infections (SSIs), especially in low-middle income countries. The main objective of this study was to describe the pattern of carbapenem-resistant bacteria in hospitalized patients and to highlight the challenge of their detection in Benin. We collected pus samples from patients suspected to have SSIs in hospitals. After bacterial identification by MALDI-TOF mass spectrometry, antimicrobial susceptibility was performed according to the Kirby–Bauer method. Carbapenemresistant strains were characterized using, successively, the Modified Hodge Test (MHT), the RESIST-5 O.K.N.V.I: a multiplex lateral flow and finally the polymerase chain reaction. Six isolates were resistant to three tested carbapenems and almost all antibiotics we tested but remained susceptible to amikacin. Four (66.7%) of them harbored some ESBL genes (blaCTX-M-1 and blaTEM-1). The MHT was positive for Carbapenems but not for Pseudomonas aeruginosa and Acinetobacter baumannii. As surgical antimicrobial prophylaxis, five of the six patients received ceftriaxone. The following carbapenems genes were identified: bla OXA-48(33.3%, n = 2), blaNDM (33.3%, n = 2) and blaVIM (33.3%, n = 2). These findings indicate a need for local and national antimicrobial resistance surveillance and the strengthening of antimicrobial stewardship programs in the country

Measuring subjective flood resilience in suburban Dakar : a before-after evaluation of the "Live with water" project

In the last decade, sub-Saharan African countries have taken various measures to plan for and adapt to floods in order to reduce exposure and its impacts on human health, livelihoods and infrastructure. Measuring the effects of such initiatives on social resilience is challenging as it requires to combine multiple variables and indicators that embrace thematic, spatial and temporal dimensions inherent to the resilience thinking and concept. In this research, we apply a before-after-control-intervention (BACI) evaluation to empirically measure the impacts of the “Live with Water” (LWW) project on suburban households in Dakar, Senegal. We developed a resilience index that combines anticipatory, adaptive and absorptive capacity – considered as structural dimensions – with the concept of transformative capacity – considered as a temporal reconfiguration of the first three dimensions. Our finding let us estimate that the project increased the absorptive and the anticipatory capacities by 10.61% and 4.61%, respectively. However, adaptive capacity remained unchanged. This may be explained by the fact that the programme was more successful in building drainage and physical infrastructures, rather than improving multi-level organisations and strategies to cope with existing flood events. Further flood resilience program should better combine engineering approaches with institutional change and livelihood support to poor urban dwellers

Antimicrobial resistance in hospitalized surgical patients: a silently emerging public health concern in Benin.

BACKGROUND: Surgical site infections are related to high morbidity, mortality and healthcare costs. Because the emergence of multidrug-resistant bacteria in hospitals is becoming a worldwide challenge for surgeons who treat healthcare-associated infections, we wished to identify the causative agents involved in these infections and the rate of multidrug-resistant bacteria in six public hospitals in Benin. METHODS: Using standard microbiological procedures, we processed pus specimens collected from obstetrics and gastrointestinal surgery wards. Mass spectrometry (MALDI-TOF) was used for confirmation. For the antibiotic susceptibility test, we first used the Kirby-Bauer disk diffusion method. The secondary test (by microdilution) used the Beckton Dickinson Phoenix automated system (Becton Dickinson Diagnostic, USA). RESULTS: We included 304 patients, whose median length of stay was 9 days. A total of 259 wound swabs (85.2%) had positive aerobic bacterial growth. In obstetrics, S. aureus (28.5%, n = 42) was the most common isolate. In contrast, Gram-negative bacteria (GNB) were predominant in gastrointestinal surgery, the most dominant being E.coli (38.4%, n = 31). Overall, 90.8% (n = 208) of aerobic bacteria were multidrug resistant. Two-thirds of S. aureus (65.3%, n = 32) were methicillin-resistant Staphylococcus aureus (MRSA), three of which carried both MRSA and induced clindamycin resistance (ICR). GNB showed high resistance to ceftazidime, ceftriaxone and cefepime. Extended-spectrum beta-lactamases were presented by 69.4% of E.coli (n = 43/62) and 83.3% of K. pneumoniae (n = 25/30). Overall, twelve Gram-negative bacteria (5.24%) showed resistance to at least one carbapenem. No isolates showed a wild-type susceptible phenotype. CONCLUSION: This study shows the alarming prevalence of multidrug-resistant organisms from surgical site infections in Benin hospitals. To reduce the spread of such bacteria in Benin, periodic surveillance of surgical site infections and strict adherence to good hand-hygiene practice are essential

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