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1.
Afr J Reprod Health ; 26(12s): 27-37, 2022 Dec.
Article in English | MEDLINE | ID: mdl-37585158

ABSTRACT

Despite commitments and interventions, Female Genital Mutilations (FGM) practice persists in West African countries. This research analyzes the effect of living conditions on FGM practice. Data were sourced from thirty-four demographic and health surveys conducted between 1995 and 2020 in 12 countries. The study sample consisted of 69,971 adolescent girls aged 15-19 years. Meta-regression analysis and binary logistic regression analyses showed the effect and relative contribution of study covariates on the phenomenon. The overall average prevalence of FGM is 40.7%, with a mixed effect of living conditions on FGM practice. The factors associated with FGM practice are, in order of importance, religion, level of education, ethnicity and place of residence. All factors have a direct effect on the studied phenomenon, and the level of education acts as an inhibiter of the effect of living conditions. The study suggests the need to strengthen the involvement of religious, traditional and community leaders in the definition and implementation of actions to combat FGM, as well as girl's education, especially by maintaining them in school till completion of at least secondary school.


Subject(s)
Circumcision, Female , Social Conditions , Female , Adolescent , Humans , Africa, Western , Demography , Genitalia , Prevalence
2.
BMJ Glob Health ; 3(1): e000537, 2018.
Article in English | MEDLINE | ID: mdl-29564156

ABSTRACT

BACKGROUND: In 2009, the Benin government introduced a user fee exemption policy for caesarean sections. We analyse this policy with regard to how the existing ideas and institutions related to user fees influenced key steps of the policy cycle and draw lessons that could inform the policy dialogue for universal health coverage in the West African region. METHODS: Following the policy stages model, we analyse the agenda setting, policy formulation and legitimation phase, and assess the implementation fidelity and policy results. We adopted an embedded case study design, using quantitative and qualitative data collected with 13 tools at the national level and in seven hospitals implementing the policy. RESULTS: We found that the initial political goal of the policy was not to reduce maternal mortality but to eliminate the detention in hospitals of mothers and newborns who cannot pay the user fees by exempting a comprehensive package of maternal health services. We found that the policy development process suffered from inadequate uptake of evidence and that the policy content and process were not completely in harmony with political and public health goals. The initial policy intention clashed with the neoliberal orientation of the political system, the fee recovery principles institutionalised since the Bamako Initiative and the prevailing ideas in favour of user fees. The policymakers did not take these entrenched factors into account. The resulting tension contributed to a benefit package covering only caesarean sections and to the variable implementation and effectiveness of the policy. CONCLUSION: The influence of organisational culture in the decision-making processes in the health sector is often ignored but must be considered in the design and implementation of any policy aimed at achieving universal health coverage in West African countries.

3.
Sante Publique ; 30(1): 115-124, 2018.
Article in French | MEDLINE | ID: mdl-29589683

ABSTRACT

INTRODUCTION: To determine the prevalence and determinants of coexistence of maternal overweight or obesity and stunted children (DBM / SCOM) in south-western Benin households. METHODS: This cross-sectional study was carried out in June 2015 on 357 mother-child pairs randomly selected by a two-stage sampling technique in the city of Comè and its surroundings. Data on socio-economic factors, family, health care, dietary quality were collected by questionnaires, observation and documentary review. Anthropometric measurements were performed in mothers and children. A logistic regression analysis model was used to search for determinants of the coexistence of the two aspects of malnutrition. RESULTS: 19.3% of mothers were overweight and 5.7% were obese. 46% of children were stunted. The prevalence of DBM / SCOM was 11.5%. The main factors associated with DBM/SCOM were the child's age, the mother's occupation, ethnicity, social status and educational level, and the size, economic level, transportation means and food insecurity of the household. CONCLUSION: A high frequency of the coexistence of maternal overweight or obesity and stunting was observed in Comè households. Interventions based on the identified determinants are needed to act simultaneously on the double burden of malnutrition in Comè.


Subject(s)
Growth Disorders/epidemiology , Mothers , Obesity/epidemiology , Overweight/epidemiology , Adolescent , Adult , Benin/epidemiology , Child, Preschool , Cross-Sectional Studies , Female , Humans , Middle Aged , Prevalence , Young Adult
4.
Malar J ; 16(1): 225, 2017 05 26.
Article in English | MEDLINE | ID: mdl-28549431

ABSTRACT

BACKGROUND: Malaria control is heavily reliant on insecticides, especially pyrethroids. Resistance of mosquitoes to insecticides may threaten the effectiveness of insecticide-based vector control and lead to a resurgence of malaria in Africa. METHODS: In 21 villages in Southern Benin with high levels of insecticide resistance, the resistance status of local vectors was measured at the same time as the prevalence of malaria infection in resident children. RESULTS: Children who used LLINs had lower levels of malaria infection [odds ratio = 0.76 (95% CI 0.59, 0.98, p = 0.033)]. There was no evidence that the effectiveness of nets was different in high and low resistance locations (p = 0.513). There was no association between village level resistance and village level malaria prevalence (p = 0.999). CONCLUSIONS: LLINs continue to offer individual protection against malaria infection in an area of high resistance. Insecticide resistance is not a reason to stop efforts to increase coverage of LLINs in Africa.


Subject(s)
Anopheles , Insecticide Resistance , Insecticide-Treated Bednets , Malaria/prevention & control , Mosquito Control , Mosquito Vectors , Animals , Anopheles/drug effects , Benin , Female , Mosquito Vectors/drug effects
5.
Health Policy Plan ; 32(2): 236-247, 2017 03 01.
Article in English | MEDLINE | ID: mdl-28207057

ABSTRACT

Many countries, especially in Africa, have in recent years introduced fee exemptions or subsidies targeting deliveries and emergency obstetric care. A number of aspects of these policies have been studied but there are few studies which look at how staff have been affected and how they have responded. This article focuses on this question, comparing data from Benin, Burkina Faso, Mali and Morocco. It is nested in wider evaluation of the policies. The article analyses responses to a health worker survey, carried out in 2012 on 683 health staff (doctors, nurses, midwives and others such as auxiliaries) across the four countries. The survey focused on working hours, workloads, pay, motivation and perceptions of the policies, as well as reported changes in workload and remuneration over the period of policy introduction. Self-reported staff output ratios suggest that midwives are over-worked across all settings, but facility data presents lower estimates, making it hard to judge the adequacy of workforces. Staff are generally positive about the policies' effects on the health system (increasing supervised delivery rates, benefiting the poor, improving access to medicines and supplies and improving quality of care). In personal terms, staff in Mali and Burkina Faso report increased satisfaction with work as a result of the policies, while in Benin, there is little change and in Morocco a deterioration (which correlated with recommendations about extending exemption policies in future). Awareness of policies was high amongst staff but only a small minority had received any written guides or training on policy implementation. It is crucial that planned health financing changes engage with their implications for staffing­estimating whether specific cadres can absorb increase demand, for example, as well as how to engage them in the policy implementation such that their personal needs are met and their professionalism enhanced.


Subject(s)
Delivery, Obstetric/economics , Health Personnel/economics , Health Policy/economics , Workload , Adolescent , Adult , Africa , Aged , Cesarean Section/economics , Female , Health Personnel/psychology , Health Workforce/economics , Humans , Job Satisfaction , Male , Middle Aged , Motivation , Obstetrics , Surveys and Questionnaires
6.
Malar J ; 9: 224, 2010 Aug 06.
Article in English | MEDLINE | ID: mdl-20691048

ABSTRACT

BACKGROUND: A recent school-based study in Benin showed that applying a policy of anti-malarial prescriptions restricted to parasitologically-confirmed cases on the management of fever is safe and feasible. Additional PCR data were analysed in order to touch patho-physiological issues, such as the usefulness of PCR in the management of malaria in an endemic area or the triggering of a malaria attack in children with submicroscopic malaria. METHODS: PCR data were prospectively collected in the setting of an exposed (with fever)/non exposed (without fever) study design. All children had a negative malaria rapid diagnostic test (RDT) at baseline, were followed up to day 14 and did not receive drugs with anti-malarial activity. The index group was defined by children with fever at baseline and the control group by children without fever at baseline. Children with submicroscopic malaria in these two groups were defined by a positive PCR at baseline. RESULTS: PCR was positive in 66 (27%) children of the index group and in 104 (44%) children of the control group respectively. The only significant factor positively related to PCR positivity at baseline was the clinical status (control group). When definition of malaria attacks included PCR results, no difference of malaria incidence was observed between the index and control groups, neither in the whole cohort, nor in children with submicroscopic malaria. The rate of undiagnosed malaria at baseline was estimated to 3.7% at baseline in the index group. CONCLUSIONS: Treating all children with fever and a positive PCR would have led to a significant increase of anti-malarial consumption, with few benefits in terms of clinical events. Non malarial fevers do not or do not frequently trigger malaria attacks in children with submicroscopic malaria.


Subject(s)
Fever/etiology , Malaria, Falciparum/diagnosis , Parasitemia/diagnosis , Plasmodium falciparum/isolation & purification , Polymerase Chain Reaction/methods , Antimalarials/economics , Antimalarials/therapeutic use , Benin/epidemiology , Case-Control Studies , Child , Cost-Benefit Analysis , Diagnostic Tests, Routine/methods , Female , Fever/epidemiology , Follow-Up Studies , Humans , Incidence , Malaria, Falciparum/complications , Malaria, Falciparum/drug therapy , Malaria, Falciparum/epidemiology , Malaria, Falciparum/parasitology , Male , Microscopy , Parasitemia/epidemiology , Prospective Studies
7.
Malar J ; 9: 104, 2010 Apr 21.
Article in English | MEDLINE | ID: mdl-20406492

ABSTRACT

BACKGROUND: Applying the switch from presumptive treatment of malaria to new policies of anti-malarial prescriptions restricted to parasitologically-confirmed cases is a still unsolved challenge. Pragmatic studies can provide data on consequences of such a switch. In order to assess whether restricting anti-malarials to rapid diagnostic test (RDT)-confirmed cases in children of between five and 15 years of age is consistent with an adequate management of fevers, a school-based study was performed in Allada, Benin. METHODS: Children in the index group (with fever and a negative RDT) and the matched control group (without fever and a negative RDT) were not prescribed anti-malarials and actively followed-up during 14 days. Blood smears were collected at each assessment. Self-medication with chloroquine and quinine was assessed with blood spots. Malaria attacks during the follow-up were defined by persistent or recurrent fever concomitant to a positive malaria test. RESULTS: 484 children were followed-up (242 in each group). At day 3, fever had disappeared in 94% of children from the index group. The incidence of malaria was similar (five cases in the index group and seven cases in the control group) between groups. Self-medication with chloroquine and quinine in this cohort was uncommon. CONCLUSIONS: Applying a policy of restricting anti-malarials to RDT-confirmed cases is consistent with an adequate management of fevers in this population. Further studies on the management of fever in younger children are of upmost importance.


Subject(s)
Antimalarials/therapeutic use , Fever/etiology , Malaria, Falciparum/diagnosis , Malaria, Falciparum/drug therapy , Parasitemia/diagnosis , Plasmodium falciparum/isolation & purification , Benin , Body Temperature , Case-Control Studies , Child , Child, Preschool , Female , Fever/drug therapy , Fever/epidemiology , Follow-Up Studies , Humans , Malaria, Falciparum/epidemiology , Malaria, Falciparum/parasitology , Male , Microscopy , Parasitemia/drug therapy , Prospective Studies
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