Performance d'un hôpital de zone sanitaire au Benin : un exemple de modèle d'évaluation

Abstract Introduction: Premier niveau de référence de la pyramide sanitaire du Bénin, les hôpitaux de zone sanitaire s'acquittent de leurs missions dan

Performance d’un hôpital de zone sanitaire au Benin : un exemple de modèle d’évaluation

Introduction: Premier niveau de référence de la pyramide sanitaire du Bénin, les hôpitaux de zone  sanitaire s’acquittent de leurs missions dans un contexte difficile. L’objectif de la présente étude a été d’évaluer la performance de l’hôpital de la zone sanitaire de Comè en 2013. Méthodes: L’étude était transversale, descriptive et évaluative. Les services retenus ont été  sélectionnés par choix raisonné du fait de leur contribution au paquet d’activités de l’hôpital. Les clients externes et internes ont été sélectionnés par commodité. Les membres du conseil de gestion de l’hôpitalde zone, les responsables d’organisation à base communautaire, les partenaires techniques et financiers ainsi que des chefs d’arrondissement ont été sélectionné par choix raisonné. La performance de l’hôpital a été mesurée à travers trois critères que sont la qualité des prestations, leur équité d’accès et leur pérennité. L’analyse des données a été faite sur la base de critères en utilisant une cotation analytique puis temporelle. Résultats: La performance de l’hôpital de la zone sanitaire de Comè était très faible au premier semestre 2013 avec une qualité des prestations cotée à 35%, une équité d’accès cotée à 50% et une pérennité des actions cotée à 11%. Seul le niveau d’application de la fonction gouvernance était moyen. La méconnaissance des attributions des représentants de la communauté dans les instances de l’hôpital a constitué une limite à leur implication dans l’exercice des fonctions de l’hôpital. Les partenaires  techniques et financiers ont participé au renforcement institutionnel de l’hôpital en termes d’amélioration du plateau technique.Conclusion: L’application des fonctions de l’hôpital et une meilleure implication de la communauté ainsi que des partenaires contribueront à l’amélioration de la performance de l’hôpital de la zone sanitaire de Comè.Key words: Evaluation, performance, fonctions, hôpita

Effect of prenatal micronutrient-fortified balanced energy-protein supplementation on maternal and newborn body composition : a sub-study from the MISAME-III randomized controlled efficacy trial in rural Burkina Faso

Background: Micronutrient-fortified balanced energy-protein (BEP) supplements are promising interventions to prevent intrauterine growth retardation in low- and middle-income countries. On the other hand, one concern with blanket prenatal supplementation programs using energy-dense supplements is that they could lead to more maternal and/or infant overweight. However, evidence is lacking on the potential effect of BEP on maternal and offspring body composition. This study evaluates the effects of micronutrient-fortified BEP supplementation during pregnancy on body composition of mothers and their newborns in rural Burkina Faso. Methods and findings: The MISAME-III study is an open label individually randomized controlled trial where pregnant women (n = 1,897) of gestational age <21 weeks received either a combination of micronutrient-fortified BEP and iron-folic acid (IFA) tablets (i.e., intervention) or IFA alone (i.e., control). The prenatal phase of the MISAME-III study was conducted between the first enrollment in October 2019 and the last delivery in August 2021. In a sub-study nested under the MISAME-III trial, we evaluated anthropometry and body composition in newborns who were born starting from 17 November 2020 (n: control = 368 and intervention = 352) and their mothers (n: control = 185 and intervention = 186). Primary study outcomes were newborn and maternal fat-free mass (FFMI) and fat-mass (FMI) indices. We used the deuterium dilution method to determine FFMI and FMI and %FFM and %FM of total body weight within 1 month postpartum. Our main analysis followed a modified intention-to-treat approach by analyzing all subjects with body composition data available. Univariable and multivariable linear regression models were fitted to compare the intervention and control arms, with adjusted models included baseline maternal age, height, arm fat index, hemoglobin concentration and primiparity, household size, wealth and food security indices, and newborn age (days). At study enrollment, the mean ± SD maternal age was 24.8 ± 6.13 years and body mass index (BMI) was 22.1 ± 3.02 kg/m2 with 7.05% of the mothers were underweight and 11.5% were overweight. Prenatal micronutrient-fortified BEP supplementation resulted in a significantly higher FFMI in mothers (MD (mean difference): 0.45; 95% CI (confidence interval): 0.05, 0.84; P = 0.026) and newborns (MD: 0.28; 95% CI: 0.06, 0.50; P = 0.012), whereas no statistically significant effects were found on FMI. The effect of micronutrient-fortified BEP on maternal FFMI was greater among mothers from food secure households and among those with a better nutritional status (BMI ≥21.0 kg/m2 or mid-upper arm circumference (MUAC) ≥23 cm). Key limitations of the study are the relatively high degree of missing data (approximately 18%), the lack of baseline maternal body composition values, and the lack of follow-up body composition measurements to evaluate any long-term effects. Conclusions: Micronutrient-fortified BEP supplementation during pregnancy can increase maternal and newborn FFMI, without significant effects on FMI

A Multi-Omics and Human Biomonitoring Approach to Assessing the Effectiveness of Fortified Balanced Energy–Protein Supplementation on Maternal and Newborn Health in Burkina Faso: A Study Protocol

Fortified balanced energy–protein (BEP) supplementation is a promising intervention for improving maternal health, birth outcomes and infant growth in low- and middle-income countries. This nested biospecimen sub-study aimed to evaluate the physiological effect of multi-micronutrient-fortified BEP supplementation on pregnant and lactating women and their infants. Pregnant women (15–40 years) received either fortified BEP and iron–folic acid (IFA) (intervention) or IFA only (control) throughout pregnancy. The same women were concurrently randomized to receive either a fortified BEP supplement during the first 6 months postpartum in combination with IFA for the first 6 weeks (i.e., intervention) or the postnatal standard of care, which comprised IFA alone for 6 weeks postpartum (i.e., control). Biological specimens were collected at different timepoints. Multi-omics profiles will be characterized to assess the mediating effect of BEP supplementation on the different trial arms and its effect on maternal health, as well as birth and infant growth outcomes. The mediating effect of the exposome in the relationship between BEP supplementation and maternal health, birth outcomes and infant growth were characterized via biomonitoring markers of air pollution, mycotoxins and environmental contaminants. The results will provide holistic insight into the granular physiological effects of prenatal and postnatal BEP supplementation

Tandem repeats as genotyping tools for understanding the genetic structure and epidemiology of #Xanthomonas citri# pv. #citri#

International audienceMultiLocus Variable number of tandem repeat Analysis (MLVA) has been extensively used to examine epidemiological and evolutionary issues on monomorphic human pathogenic bacteria. MLVA is gaining popularity on agriculturally important bacterial plant pathogens as a tool to improve our understanding of their epidemiology. Xanthomonas citri pv. citri, the causal agent of Asiatic citrus canker, is a quarantine organism in several countries and a major threat for the citrus industry worldwide. We screened the genomes of X. citri pv. citri strain IAPAR 306 and of phylogenetically related strains for tandem repeats. Two MLVA schemes targeting minisatellites and microsatellites, respectively, were developed to assess the diversity of this monomorphic bacterium at various spatio-temporal scales. Microsatellites are useful for outbreak investigation. In contrast, minisatellites were used to decipher the global diversity of X. citri pv. citri and revealed four pathotype-specific lineages based on Discriminant Analysis of Principal Components (DAPC). A single lineage (DAPC1) comprised strains that were implicated in the major geographical expansion of X. citri pv. citri during the 20th century. When applied to the analysis of the emergence of in Africa, minisatellites revealed the presence of two different genetic lineages in addition to DAPC1 on this continent, consistent with SNP data derived from draft genome sequences. Using bacterial populations collected in two neighboring Western African countries, Mali and Burkina Faso, we applied these two genotyping schemes to investigate the origin and pathways of these emergences. Minisatellite and SNP data suggested the introduction of two groups of strains in Mali (DAPC1 and DAPC2). DAPC2 was restricted to Bamako district, whereas DAPC1 strains were found much more invasive. The latter strains formed a major clonal complex based on microsatellite data. This suggests that human activities played a major role in the spread of DAPC1 strains via the movement of contaminated propagative material, further supported by the low differentiation between populations from geographically distant nurseries and orchards and the fact that many nursery strains were assigned to the primary or secondary founder haplotypes identified in the minimum spanning tree. Approximate Bayesian Computation analyses supported the hypothesis that strains from Burkina Faso resulted from a bridgehead invasion from Mali. The new minisatellite scheme represents an opportunity for international X. citri pv. citri genotyping and data sharing. The data generated in this study was deposited in the Xanthomonas citri genotyping database (http://www.biopred.net/MLVA/). (Texte intégral