Postpartum Contraceptive Use In Parakou (A City In Northern Benin) In 2018: A Community Based Cross-Sectional Study.

BACKGROUND: Over 30% of maternal deaths and 10% of infant deaths are avoidable if couples space out births at intervals of 2 years or greater. This study aimed to identify factors associated with contraceptive use in the postpartum period. METHODS: This was a cross-sectional study among postpartum women living in Parakou. Participants were selected using a two-stage sampling method. Postpartum contraceptive use was defined as the use of at least one contraceptive method at the time of the survey. Independent variables included socio demographic and reproductive history. For the analysis we performed a multiple logistic regression and we calculated odds ratios with 95% confidence intervals. RESULTS: The study included 453 postpartum women. Among the participants, 59 (13%) were using a contraceptive method. Injectable contraceptives were the most common method used (25.4%). Factors associated with contraceptive use in the postpartum period included history of contraceptive use (AOR=9.4; p<0.001), resumption of sexual intercourse (AOR=5.7; p<0.001), discussion with partner about contraceptive method (AOR=5.7; p=0.005), need of partner's approval before adopting a contraceptive method (AOR=0.4; p=0.014) and counseling during pregnancy, in the delivery room, and during postnatal visits (AOR=2.7; p=0.019). CONCLUSION: The prevalence of contraceptive use during the postpartum period remains low. Interventions should be designed with a focus on the associated factors in order to increase postpartum contraceptive use in Parakou.

Facteurs pronostiques de la pré-éclampsie sévère à la maternité universitaire de Porto-Novo au Bénin

Objectif : Analyser les facteurs pronostiques de la pré-éclampsie sévère. Patientes et Méthodes : Il s'est agi d'une étude prospective et analytique qui a concerné toutes les femmes diagnostiquées prééclampsie sévère et prises en charge à la maternité du Centre Hospitalier Universitaire de Porto-Novo du 1er Juillet 2014 au 30 juin 2016. Résultats : La fréquence de la pré-éclampsie sévère était de 4,8% des accouchements. Le pronostic maternel était plus mauvais chez les gestantes référées des formations sanitaires périphériques, en cas de pression artérielle diastolique ≥ 110 mm Hg et/oualbuminurie ≥ 3 croix. La morbidité maternelle était marquée par l'éclampsie (36,8%) et l'hématome rétroplacentaire (1,8%). Le pronostic périnatal était grevé d'une morbidité dominée par la prématurité induite (39,3%) et la détresse néonatale immédiate (30,5%). Ce pronostic périnatal était mauvais chez les gestantes ayant une pression artérielle diastolique ≥ 110 mm Hg et/ou une albuminurie ≥ 3 croix et/ou une uricémie ≥ 100 mg/l. Conclusion : La pression artérielle diastolique ≥ 110 mm Hg, l'albuminurie ≥ 3 croix et l'uricémie ≥ 100 mg/l ont constitué des facteurs de mauvais pronostic de la pré-éclampsie sévère dans notre étude

High seroprevalence of chikungunya virus antibodies among pregnant women living in an urban area in Benin, West Africa.

The aim of this study was to investigate the seroprevalence of antichikungunya virus (anti-CHIKV) antibodies in pregnant women living in an urban area of Benin (West Africa). Results were obtained by screening sera collected in 2006 and 2007 with enzyme-linked immunosorbent assay (ELISA) for anti-CHIKV immunoglobulin G (IgG) and IgM. Positive results were confirmed by indirect immunofluorescence test and microneutralization assay. We found that a large proportion (36.1%) of pregnant women living in Cotonou had specific IgG against CHIKV, indicating a high seroprevalence of the infection in urban southern Benin, whereas no active cases of CHIKV infection were detected.

[Epidemiology of the gynecological and mammary cancer to the HOMEL and in the CUGO Cotonou, Bénin]. / Épidémiologie des cancers gynécologiques et mammaires à l'hôpital de la Mère et de l'Enfant-Lagune (HOMEL) et à la clinique universitaire de gynécologie et d'obstétrique (CUGO) de Cotonou, Bénin.

INTRODUCTION: The gynecological and mammary cancers constitute a major preoccupation for the international community because they represent an important cause of mortality and morbidity among women. However, their systematic tracking is not always current in our countries of the south. This survey aims to evaluate the epidemiological features of these cancers in hospital-academic environment in Cotonou. METHOD: It is a retrospective survey with a structural descriptive and analytic aim during a period of 9 years, from January 1st, 2000 to December 31, 2008. RESULTS: On 210 cases of recorded gynecological and mammary cancers during this period, the cancer of the breast comes at the first rank with 44,3% of the cases. The cancer of the cervix represents 26,7% of the cases followed by the cancer of the ovaries (18,6%) and the cancer of the endometrium (9,5%). The cancers of the vulva and the vagina are weakly represented. The delay of consultation after the apparition of the first signs in our series is most often included between 1 and 6 months (32,2%) but goes also beyond 3 years (26,1%). The cancer of the cervix and the endometrium are found in most aged women, whereas the cancer of the breast covers all ages. Most cancers (65%) are diagnosed at an advanced stage (III stage or IV). The different anatomopathological types that are found more frequently are the ductal invasive carcinoma (33%) for the breast, the squamous cell carcinoma for cervix (62%) and the endometrioid adenocarcinoma for the endometrium (30%). The costly management of the cancers reduces the therapeutic possibilities, leading to 42% of survival at 5 years. CONCLUSION: In our survey, it comes out again that the screening of gynecological cancers is not well organized in our country as well as the health education of the woman and reproduction. It appears appropriate to set in motion a management program of the cancers in our country what would allow an early screening and appropriate management.

[Delivery in free position perhaps a solution to change delivery in traditional position in delivery rooms in Africa: results of a prospective study in Cotonou in Bénin]. / L'accouchement en position libre peut-il être une solution de rechange à l'accouchement en position classique dans les salles de naissance en Afrique : résultats d'une étude. prospective à Cotonou au Bénin

INTRODUCTION: In most of Africa's birthing units, women are often forbidden to stand during labour and delivery. This study aimed to determine the effect of a freely vertical position (standing,sitting, crouching) compared with the traditional supine position on the course of delivery and on perinatal and maternal outcomes(including the satisfaction level of mothers).Methods: We compared a group of 490 women who chose to deliver in a freely vertical position with 490 women who delivered in a traditional position, at the Hopital de Ia mere et de l'enfant Lagune of Cotonou, from January 1, 2009, to December 31,2011. Variables studied include length of labour, type of delivery,frequency of episiotomy, fetal and neonatal well-being indices(fetal heart rate, Apgar score, resuscitation), and postnatal maternal outcomes (perineal tears, hemorrhagic complications),including maternal satisfaction. Descriptive analysis includes comparisons between those two groups.Results: Both groups had similar maternal (25 years old) and gestational (39 weeks) ages. The "Choice of position" group had a greater number of nulliparous women (53% vs. 40%,P < 0.001) and a higher educational level (high-school diploma and postgraduate training: 77.5% vs. 45.1 %; P < 0.001 ). The average length of the active phase was shortened by 20 minutes in women who freely chose their delivery position (P < 0.01 ).Moreover, these women experienced spontaneous delivery in higher numbers, with 10 times fewer assisted deliveries (0.4%vs. 4.3%; P < 0.01) and two times fewer episiotomy interventions(3.5% vs. 8.0%; P < 0.01) than their counterparts. When women freely choose their delivery position, there are close to three times fewer cases of fetal heart rate anomalies and meconium liquor (2.9% vs. 8.9%; P < 0.01 and 0.4% vs. 1.4%; P < 0.01 ).Perineal and cervical tears are rare and occur in similar numbers in both groups, and the same can be said of cases of postpartum hemorrhage. The number of satisfied mothers is higher in the"Choice of position" group (87.0% vs. 61.2%; P < 0.01 ).Conclusion: The choice of a freely vertical position seems to be an efficient and safe option during labour and delivery, and is more satisfying for mothers.

Placental malaria-associated suppression of parasite-specific immune response in neonates has no major impact on systemic CD4 T cell homeostasis.

In areas where Plasmodium falciparum is endemic, pregnancy is associated with accumulation of infected red blood cells (RBCs) in the placenta, a condition referred to as placental malaria (PM). Infants born to PM-positive mothers are at an increased risk of malaria, which is putatively related to the transplacental passage of parasite-derived antigens, with consequent tolerization of the fetal immune system. Here we addressed the impact of PM on the regulation of neonatal T cell responses. We found that the frequency of regulatory CD25(+) CD127(-/low) Foxp3(+) CD4(+) T cells was significantly decreased in neonates born to mothers with high levels of P. falciparum-induced placental inflammation, consisting mainly of primigravid mothers. However, at the individual level, the ratio between regulatory and effector (CD25(+) CD127(+) Foxp3(-)) CD4(+) T cells was unaffected by PM. In addition, parasite-induced CD4(+) T cell activation and production of interleukin-6 (IL-6), tumor necrosis factor alpha (TNF-α), and IL-10 were strongly reduced in neonates born to PM-positive mothers. Thus, our results show that active PM at delivery is associated with a marked suppression of P. falciparum-specific cellular neonatal immune responses, affecting secretion of both pro- and anti-inflammatory cytokines. Additionally, our results suggest that, as in adults, effector and regulatory CD4(+) T cell populations are tightly coregulated in all neonates, irrespective of the maternal infection status.

Plasmodium falciparum exposure in utero, maternal age and parity influence the innate activation of foetal antigen presenting cells.

BACKGROUND: Malaria in pregnancy is associated with immunological abnormalities in the newborns, such as hampered T-helper 1 responses and increased T-regulatory responses, while the effect of maternal Plasmodium falciparum infection on foetal innate immunity is still controversial. MATERIALS AND METHODS: The immunophenotype and cytokine release by dendritic cells (DC) and monocytes were evaluated in cord blood from 59 Beninese women with or without malaria infection by using flow cytometry. RESULTS: Accumulation of malaria pigment in placenta was associated with a partial maturation of cord blood myeloid and plasmacytoid DC, as reflected by an up-regulated expression of the major histocompatibility complex class II molecules, but not CD86 molecules. Cells of newborns of mothers with malaria pigment in their placenta also exhibited significantly increased cytokine responses upon TLR9 stimulation. In addition, maternal age and parity influenced the absolute numbers and activation status of cord blood antigen-presenting cells. Lastly, maternal age, but not parity, influenced TLR3, 4 and 9 responses in cord blood cells. DISCUSSION: Our findings support the view that placental parasitization, as indicated by the presence of malaria pigment in placental leukocytes, is significantly associated with partial maturation of different DC subsets and also to slightly increased responses to TLR9 ligand in cord blood. Additionally, other factors, such as maternal age and parity should be taken into consideration when analysing foetal/neonatal innate immune responses. CONCLUSION: These data advocate a possible mechanism by which PAM may modulate foetal/neonatal innate immunity.