External validation of the Memorial Sloan Kettering Cancer Center preoperative nomogram predicting lymph node invasion in a cohort of high-grade prostate cancer patients.

BACKGROUND: Commonly used preoperative nomograms predicting clinical and pathological outcomes in prostate cancer (PCa) patients have not been yet validated in high-grade only PCa patients. Our objective is to perform an external validation of the Memorial Sloan Kettering Cancer Center (MSKCC) preoperative nomogram as a predictor of lymph node invasion (LNI) in a cohort of high-grade PCa patients. METHODS: We included patients with high-grade PCa (Gleason ≥8) treated at our institution between 2011 and 2020 with radical prostatectomy and pelvic lymph node dissection without receiving neoadjuvant or adjuvant therapy. The area under the curve (AUC) of the receiver operator characteristic (ROC) was used to quantify the accuracy of the model to predict LNI. A calibration plot was used to evaluate the model's precision, and a decision curve analysis was computed to evaluate the net benefit associated with its use. This study was approved by our institution's ethics board. RESULTS: A total of 242 patients with a median age of 66 (60-71) years were included. LNI was observed in 70 (29%) patients with a mean of 16 (median = 15; range = 2-42) resected nodes. The MSKCC nomogram discriminative accuracy, as evaluated by the AUC-ROC was 79.0% (CI: [0.727-0.853]). CONCLUSION: The MSKCC preoperative nomogram is a good predictor of LNI and a useful tool associated with net clinical benefit in this patient population.

Value-based comparison of ambulatory children with respiratory diseases in an emergency department and a walk-in clinic: a retrospective cohort study in Québec, Canada.

OBJECTIVE: To compare health outcomes and costs given in the emergency department (ED) and walk-in clinics for ambulatory children presenting with acute respiratory diseases. DESIGN: A retrospective cohort study. SETTING: This study was conducted from April 2016 to March 2017 in one ED and one walk-in clinic. The ED is a paediatric tertiary care centre, and the clinic has access to lab tests and X-rays. PARTICIPANTS: Inclusion criteria were children: (1) aged from 2 to 17 years old and (2) discharged home with a diagnosis of upper respiratory tract infection (URTI), pneumonia or acute asthma. MAIN OUTCOME MEASURES: The primary outcome measure was the proportion of patients returning to any ED or clinic within 3 and 7 days of the index visit. The secondary outcome measures were the mean cost of care estimated using time-driven activity-based costing and the incidence of antibiotic prescription for URTI patients. RESULTS: We included 532 children seen in the ED and 201 seen in the walk-in clinic. The incidence of return visits at 3 and 7 days was 20.7% and 27.3% in the ED vs 6.5% and 11.4% in the clinic (adjusted relative risk at 3 days (aRR) (95% CI) 3.17 (1.77 to 5.66) and aRR at 7 days 2.24 (1.46 to 3.44)). The mean cost (95% CI) of care (CAD) at the index visit was $C96.68 (92.62 to 100.74) in the ED vs $C48.82 (45.47 to 52.16) in the clinic (mean difference (95% CI): 46.15 (41.29 to 51.02)). Antibiotic prescription for URTI was less common in the ED than in the clinic (1.5% vs 16.4%; aRR 0.10 (95% CI 0.03 to 0.32)). CONCLUSIONS: The incidence of return visits and cost of care were significantly higher in the ED, while antibiotic use for URTI was more frequent in the walk-in clinic. These data may help determine which setting offers the highest value to ambulatory children with acute respiratory conditions.

A value-based comparison of the management of respiratory diseases in walk-in clinics and emergency departments.

OBJECTIVES: Our aim was to compare some of the health outcomes and costs associated with value of care in emergency departments (ED) and walk-in clinics for ambulatory patients presenting with an acute respiratory disease. METHODS: A health records review was conducted from April 2016 through March 2017 in one ED and one walk-in clinic. Inclusion criteria were: (i) ambulatory patients at least 18 years old, (ii) discharged home with a diagnosis of upper respiratory tract infection (URTI), pneumonia, acute asthma, or acute exacerbation of chronic obstructive pulmonary disease. Primary outcome was the proportion of patients returning to any ED or walk-in clinic within three and seven days of the index visit. Secondary outcomes were the mean cost of care and the incidence of antibiotic prescription for URTI patients. The cost of care was estimated from the Ministry of Health's perspectives using time-driven activity-based costing. RESULTS: The ED group included 170 patients and the walk-in clinic group 326 patients. The return visit incidences at three and seven days were, respectively, 25.9% and 38.2% in the ED vs. 4.9% and 14.7% in the walk-in clinic (adjusted relative risk (arr) of 4.7 (95% CI 2.6-8.6) and 2.7 (1.9-3.9)). The mean cost ($Cdn) of the index visit care was 116.0 (106.3-125.7) in the ED vs. 62.5 (57.7-67.3) in the walk-in clinic (mean difference of 56.4 (45.7-67.1)). Antibiotic prescription for URTI was 5.6% in the ED vs. 24.7% in the walk-in clinic (arr 0.2, 0.01-0.6). CONCLUSIONS: This study is the first in a larger research program to compare the value of care between walk-in clinics and the ED. The potential advantages of walk-in clinics over EDs (lower costs, lower incidence of return visits) for ambulatory patients with respiratory diseases should be considered in healthcare planning.

RéSUMé: OBJECTIFS: Notre objectif était de comparer certains des résultats sanitaires et des coûts associés à la valeur des soins dans les services d'urgence et les cliniques sans rendez-vous pour les patients ambulatoires souffrant d'une maladie respiratoire aiguë. MéTHODES: Une revue des dossiers médicaux a été réalisée d'avril 2016 à mars 2017 dans un service d'urgence et une clinique sans rendez-vous. Les critères d'inclusion étaient les suivants : (i) patients ambulatoires âgés d'au moins 18 ans, (ii) renvoyés chez eux avec un diagnostic d'infection des voies respiratoires supérieures (IVRS), de pneumonie, d'asthme aigu ou d'exacerbation aiguë de la maladie pulmonaire obstructive chronique. Le résultat primaire était la proportion de patients retournant à un service d'urgence ou à une clinique sans rendez-vous dans les trois et sept jours suivant la visite de référence. Les résultats secondaires étaient le coût moyen des soins et l'incidence de la prescription d'antibiotiques pour les patients atteints d'IVRS. Le coût des soins a été estimé à partir des perspectives du ministère de la santé, en utilisant la méthode de calcul des coûts par activité en fonction du temps. RéSULTATS: Le groupe des urgences comprenait 170 patients et le groupe des cliniques sans rendez-vous 326 patients. Les incidences des visites de retour à trois et sept jours étaient respectivement de 25,9 % et 38,2 % dans le service des urgences contre 4,9 % et 14,7 % à la clinique sans rendez-vous (risque relatif ajusté (arr) de 4,7 (IC à 95 % 2,6 à 8,6) et 2,7 (1,9-3,9)). Le coût moyen ($CAN) de la visite de référence était de 116,0 (106,3-125,7) aux urgences contre 62,5 (57,7-67,3) dans la clinique sans rendez-vous (différence moyenne de 56,4 (45,7-67,1)). La prescription d'antibiotiques pour l'IVRS était de 5,6 % aux urgences contre 24,7 % dans la clinique sans rendez-vous (arr 0,2, 0,01-0,6). CONCLUSIONS: Cette étude est la première d'un programme de recherche plus vaste visant à comparer la valeur des soins entre les cliniques sans rendez-vous et les urgences. Les avantages potentiels des cliniques sans rendez-vous par rapport aux services d'urgence (coûts moindres, incidence plus faible des visites de retour) pour les patients ambulatoires souffrant de maladies respiratoires devraient être pris en compte dans la planification des soins de santé.

Decline in clinical severity of Paget's disease of bone: Comparison between a contemporary cohort and a historical cohort.

BACKGROUND: European and Australian studies have reported a decrease in the prevalence, incidence and clinical severity of Paget's disease of bone (PDB). There are no studies on the current clinical characteristics of PDB in Quebec, Canada. AIMS: The purpose of this study was to describe the characteristics of unrelated patients with PDB diagnosed after the year 2000 in our region and to compare them to a historical cohort diagnosed before 2000. METHODS: In this retrospective descriptive cohort study, socio-demographic data and clinical characteristics for the contemporary cohort were collected from electronic medical records of patients with PDB followed at our university hospital. For the historical cohort, the same data were collected from the research files of PDB participants in our research program. Inclusion criteria were: age > 18 years, having PDB diagnosed by a rheumatologist, and being followed in our hospital. Exclusion criteria were: having a relative with PDB participating in this study. Variables were reported as mean, standard deviation, frequency and percentage. Chi-square tests were used to compare categorical variables. Continuous values were compared with Wilcoxon-Mann-Whitney tests. Unadjusted p-values and adjusted p-values with the Bonferroni correction method were calculated. A p-value <0.05 was considered statistically significant. RESULTS: Among the 195 patients with PDB in the contemporary cohort, 53.3 % were men, 60.5 % had monostotic involvement, 14.2 % were symptomatic at diagnosis. In comparison to the historical cohort of 173 patients, patients in the contemporary cohort were older at diagnosis (68.7  10.7 vs. 58.5  10.1; p < 0.0001) and had less family history of PDB (13.8 % vs. 33.6 %; p = 0.0024). They also had lower total alkaline phosphatase levels at diagnosis (118.0 (85.0-184.0)) vs. 184.0 (115.0-312.0)); p = 0.0006), a lower pagetic bone number (1.0 (1.0-3.0) vs. 2.0 (1.0-5.0); p < 0.0001), lower pagetic bone fractures (6.7 % vs. 36.7 %; p = 0.0078) and lower bone deformities (13.0 % vs. 54.0 %; p < 0.0001). There was no significant difference for pagetic bone pain (52.0 % vs. 52.6 %; p = 1.0000), percentage of patients who had orthopedic surgery related to PDB complications (8.8 % vs. 28.6 %; p = 1.0000), secondary osteoarthritis (43.0 % vs. 51.6 %; p = 1.0000), and hearing impairment (51.9 % vs. 61.1 %; p = 0.1000). CONCLUSION: The contemporary cohort is characterized by an older age at diagnosis, a majority of monostotic disease and fewer complications of PDB. This decline in clinical severity of PDB in Quebec is consistent with studies reported in other countries.

Randomized controlled trial (RCT) comparing ultrasound-guided pudendal nerve block with ultrasound-guided penile nerve block for analgesia during pediatric circumcision.

INTRODUCTION: Optimal analgesia for circumcision is still debated. The dorsal penile nerve block has been shown to be superior to topical and caudal analgesia. Recently, the ultrasound-guided pudendal nerve block (group pudendal) has been popularized. This randomized, blinded clinical trial compared group pudendal with ultrasound-guided dorsal penile nerve block (group penile) under general anesthesia for pediatric circumcision. METHODS: Prepubertal males aged 1-12 years undergoing elective circumcision were randomized to either group. The primary outcome was postoperative face, legs, activity, cry, consolability (FLACC) scores. Our secondary outcomes included parent's postoperative pain measure, analgesic consumption during the first 24 hours, surgeon's and parent's satisfaction, time to perform the block, hemodynamic changes intraoperatively and total time in postanesthesia care unit and until discharge. RESULTS: A total of 155 patients were included for analysis (77 in group pudendal and 78 in group penile). Mean age was 7.3 years old. FLACC scores were not statistically different between groups (p=0.19-0.97). Surgeon satisfaction was higher with group pudendal (90.8% vs 56.6% optimal, p<0.01). Intraoperative hemodynamic changes (>20% rise of heart rate or blood pressure) were higher in group pudendal (33.8% vs 9.0%, p<0.01) as was intraoperative fentanyl use (1.3 vs 1.0 µg/kg, p<0.01). Other secondary outcomes were not statistically different. DISCUSSION: Both ultrasound-guided blocks, performed under general anesthesia, provide equivalent postoperative analgesia for pediatric circumcision as evidenced by low pain scores and opioid consumption. Surgeon satisfaction was higher in the pudendal group. TRIAL REGISTRATION NUMBER: NCT03914365.

Post-procedural bleeding rate and haemostatic treatment use for dental procedures before and after the implementation of a standardized protocol for people with inherited bleeding disorders.

INTRODUCTION: Persons with inherited bleeding disorders are at a substantial risk of bleeding following dental procedures. AIM: To compare the outcomes and use of haemostatic treatment pre- and post-implementation of a standardized protocol for dental procedures at a Hemophilia Treatment Centre. METHODS: We conducted a retrospective cohort study of outpatient and inpatient dental procedures and maxillofacial surgeries sustained by people with bleeding disorders treated at a comprehensive Hemophilia Treatment Centre (2013-2020), comparing patients' outcomes before and after the introduction of the protocol in 2018. The protocol, built using a multidisciplinary approach, suggested haemostatic treatment based on the invasiveness of the dental procedure and the proposed anaesthesia. Our primary outcome was the rate of procedural bleeding leading to medical or dental reintervention within 10 days. Secondary outcomes included the use of systemic haemostatic treatment and treatment-related adverse effects. RESULTS: Overall, 137 dental procedures in 95 patients (median age: 29 years; 78% males; 74% haemophilia, 14% von Willebrand disease, 12% other disorders) were included. Seventeen procedural bleedings were reported (12.4%). Procedural bleeding occurred in 14.8% and 8.9% of patients in the control and intervention groups (p = .304). No major bleeding occurred. Tranexamic acid was used more consistently after protocol implementation (72.8% vs. 89.3%, p = .019), while factor concentrates use decreased (65.4% vs. 44.6%, p = .016), and desmopressin use remained constant (46.4% vs. 32.1%, p = .100). No treatment-related adverse effects were reported. CONCLUSION: The use of a standardized protocol increased the use of tranexamic acid, with a nonstatistically significant reduction in procedural bleeding rate.

First North American experience of propiverine use in children with overactive bladder.

INTRODUCTION: In 2017, propiverine was approved in Canada for overactive bladder (OAB) in adults and children. There is, however, scarce data on its efficacy and tolerability in the pediatric population. Our primary objective was to assess the efficacy and tolerability of propiverine as a treatment for pediatric OAB. Our secondary objective was to compare propiverine to molecules already investigated in historical cohorts. METHODS: We conducted a retrospective analysis of a prospectively maintained database and reviewed 58 patients who received propiverine since 2017. Efficacy and tolerability were assessed through voiding diaries, postvoid residuals (PVR), changes in the number of incontinence and urgency episodes (grade 1 to 3), and on reported adverse events. RESULTS: In total, 58 patients (37 boys) initiated treatment at a mean age of 9.5±3.2 years. Patients were on propiverine for an average of 15.9±12.4 months. Mean bladder capacity increased from 120 ml to 216 ml, and % expected bladder capacity (%EBC) increased from 37% to 59%. The average increased rate of %EBC was 0.5% per month (p<0.001). Of the 58 patients, eight stopped the medication completely without symptom recurrence, 21 were still on medication, and six were on dose-tapering. Due to side effects, seven interrupted their treatment. Compared to molecules used in our service, propiverine offered comparable efficacy and tolerability. Our study had limitations, including the absence of a placebo group and its retrospective design. CONCLUSIONS: Propiverine appears to be an efficient and safe option for treating OAB in children and is approved as such.

Effects of omega-3 fatty acids supplementation on perioperative blood loss and complications after radical prostatectomy.

BACKGROUND AND AIMS: Many dietary supplements, including omega-3 fatty acids (ω3), are suspected to affect blood coagulation and platelet function. Despite no clinical evidence, discontinuation is recommended before radical prostatectomy. However, long-chain ω3 (LCω3) appear beneficial against prostate cancer progression. Here, we aim to determine the effect of LCω3 supplements on perioperative bleeding, hemoglobin, platelets, and postoperative complications after radical prostatectomy. METHODS: This is a planned exploratory analysis of 130 patients diagnosed with prostate cancer grade group 2 or greater enrolled in a randomized controlled trial (NCT02333435) testing the effects of LCω3, on prostate cancer biological and pathological outcomes at radical prostatectomy as main outcomes. The LCω3 intervention (MAG-EPA 3 g daily) or equivalent placebo was given 4-10 weeks prior to radical prostatectomy. An intention-to-treat analysis approach was used with bi-variate statistical testing of bleeding and complications outcomes. We also estimated the difference between groups using linear regression and non-parametric quantile regression models. All models were adjusted for confounding variables selected on clinical relevance. RESULTS: We found no clinically significant effect of LCω3 versus placebo on perioperative bleeding, laboratory tests or postoperative complications. In contrast, as expected, we found a significant increase in perioperative bleeding in open retropubic radical prostatectomy compared to robot-assisted radical prostatectomy (adjusted difference 115.8 mL, p = 0.04). CONCLUSIONS: Our results suggest that ω3 supplements can be safely taken before radical prostatectomy without increasing surgical bleeding risk. These findings are relevant since ω3 may beneficially affect prostate cancer evolution.

Comparison of the Accuracy of INTERGROWTH-21 and Hadlock Ultrasound Formulae for Fetal Weight Prediction.

OBJECTIVE: To compare the accuracy of INTERGROWTH-21 (IG-21) versus Hadlock1 formulae for birth weight prediction on third-trimester ultrasound in a North American population. METHODS: This single-centre retrospective cohort study included all pregnant patients who had a third-trimester ultrasound between 340 and 366 weeks gestation and delivered a term singleton at our maternal-fetal medicine reference centre between April 1 and July 30, 2019. Estimated ultrasound fetal weight was calculated with both Hadlock1 and IG-21 formulae for each fetus, then reported on a centile curve to adjust for gestational age at delivery, and compared with the actual birth weight. RESULTS: The cohort included 600 women. The IG-21 formula had a comparable accuracy to Hadlock1 with mean absolute percentage errors (MAPEs) of 8.64 and 8.86, respectively (P = 0.191). Success rate, defined by a <10% discrepancy range of the actual birth weight, was significantly higher for IG-21 than for Hadlock1 (67.5% vs. 64.3%; P = 0.044). CONCLUSION: Our results do not support the superiority of IG-21 to Hadlock1. There is a need for continued research to improve birth weight prediction with the ultimate objective of increasing the detection of small for gestation age and macrosomic fetuses.

Can a Low Sperm Concentration without Assessing Motility Confirm Vasectomy Success? A Retrospective Descriptive Study.

PURPOSE: A fresh post-vasectomy semen analysis showing 100,000 nonmotile sperm/mL or less confirms sterility. Mailed sample or self-testing at home with SpermCheck® Vasectomy decreases the inconvenience of producing a fresh sample, but without assessing motility. We evaluated if there is a sperm concentration under which no motile sperm are observed that could fortify the use of these alternatives. MATERIALS AND METHODS: We conducted a study of post-vasectomy semen analyses performed at the andrology laboratory of the Quebec City university hospital, Canada. Sperm concentration and motility were assessed on fresh noncentrifuged 10 µL samples at 400× magnification. We calculated the proportion of post-vasectomy semen analysis showing motile sperm according to sperm concentration for all and first prescribed post-vasectomy semen analysis by the 5 physicians who performed the most vasectomies. RESULTS: We identified 6,492 post-vasectomy semen analyses prescribed by 169 physicians. The 5 vasectomists prescribed 95.6% (6,204) of the post-vasectomy semen analyses; 96.1% (5,965) were first tests. We observed motility in all sperm concentration strata but it decreased with lower concentrations. At the first post-vasectomy semen analysis, among patients with less than 1 million, 250,000 and 100,000 sperm/mL, 0.5% (27/5,842) and 0.3% (19/5,760 and 17/5,725) had motility, respectively. CONCLUSIONS: If the first post-vasectomy semen analysis on a mailed sample shows less than 1 million sperm/mL, we recommend requesting an additional mailed sample instead of a fresh sample. SpermCheck Vasectomy could falsely indicate a successful vasectomy in a very small proportion of cases. The optimal post-vasectomy semen analysis strategy must involve shared decision making, balancing the inconvenience of providing a fresh sample with the risk of a false-negative result.

Outcomes of Diabetic Foot Ulcers in a Tertiary Referral Interdisciplinary Clinic: A Retrospective Canadian Study.

OBJECTIVES: The objectives of this work were to evaluate demographic data, healing rate, recurrence rate, amputation rate and death rate of patients with diabetic foot ulcers (DFUs) treated in a Québec outpatient diabetic foot ulcer multidisciplinary clinic. Another objective was to determine factors associated with higher ulcer recurrence. METHODS: We conducted a retrospective cohort study of adults with diabetes with a DFU referred to a Québec City diabetic foot clinic between December 1, 2013 and May 1, 2019. The primary outcome was recurrence rate at 6 months after first ulcer healing. We also evaluated the recurrence rate at 12 months, mean and median time for ulcer healing, mean and median time before recurrence after first ulcer healing, amputation rate, mortality rate and factors associated with DFU recurrence. RESULTS: Of the 85 patients included in the study, 26 (37.1%) and 36 (54.4%) had DFU recurrence at 6 months and 12 months, respectively, after first ulcer healing. Mean healing time from first consultation in the ulcer clinic was 19.64±21.02 weeks. Of the patients, 36.9% patients underwent lower limb amputation and 30.6% died during follow up. Both previous history of a DFU before first consultation and amputation after first DFU consultation were statistically significant risk factors for DFU recurrence at 12 months. CONCLUSIONS: DFU recurrence was significantly higher in patients with a past history of DFU before the first one evaluated in the diabetic foot clinic and a previous history of amputation. Thus, systematic follow up should be done specifically with these patients.

A Sequential Two-Step Cell-Based Assay Predicts Immunosuppression-Related Adverse Events.

Immunosuppressants are associated with serious and often life-threatening adverse effects. To optimize immunotherapy, a tool that measures the immune reserve is necessary. We validated that a cell-based assay that measures TNF-α production by CD14+16+ intermediate monocytes following stimulation with EBV peptides has high sensitivity for the detection of over-immunosuppression (OIS) events. To develop a sequential, two-step assay with high specificity, we used PBMCs from kidney recipients (n = 87). Patients were classified as cases or controls, according to the occurrence of opportunistic infection, recurring bacterial infections, or de novo neoplasia. Patients who tested positive in the first step were randomly allocated to a training or a testing set for the development of the second step. In the discovery phase, an assay based on the examination of early mature B (eBm5) cells was able to discriminate OIS patients from controls with a specificity of 88%. The testing set also revealed a specificity of 88%. The interassay coefficient of variability between the experiments was 6.1%. Stratified analyses showed good diagnostic accuracy across tertiles of age and time posttransplant. In the adjusted model, the risk of OIS was more than 12 times higher in patients classified as positive than in those who tested negative (adjusted hazard ratio, 12.2; 95% confidence interval: 4.3-34.6). This sequential cell-based assay, which examines the monocyte and eBm5 cell response to EBV peptides, may be useful for identifying OIS in immunosuppressed patients.

First-Degree Relatives Screening of Patients with Bicuspid Aortic Valve: Effectiveness and Feasibility in Pediatric Cardiology Daily Practice.

Bicuspid aortic valve (BAV) is the most common congenital heart disease. Since heritability is suspected, actual guidelines recommend to perform an echocardiographic assessment for first-degree relatives (FDR) of patient with BAV. This study aimed to assess the effectiveness and the feasibility of the current guidelines for the screening of FDR of patient with BAV in a pediatric cardiology daily practice. Consecutive patients with BAV and their FDR were prospectively included from January 2015 to March 2018 at Centre Hospitalier Universitaire de Laval, Quebec City (Canada). Data were retrospectively collected and analyzed. A total of 713 FDR of 213 consecutives index cases [median age: 11 (6-20) years] were studied. Up to 32 (6.6%) FDR had a BAV and 26 (5.4%) had an aortic valve dysfunction. A total of 14 (2.9%) FDR had an ascending aorta dilatation according to Z-score including 6 (1.2%) patients with an ascending aorta ≥ 45 mm. No statistically significant differences regarding BAV, aortic valve dysfunction and ascending aorta dilatation prevalence were identified between generations. Screening was done in 482 (67.6%), prescribed but not done in 134 (19%), not prescribed in 92 (13%) and declined in 5 (1%) FDR. The prevalence of BAV in FDR was similar to prospective adult studies and supports actual guidelines in pediatric cardiology practice. Ascending aorta dilatation was rare in our young population. Exhaustiveness and additional burden to implement current guidelines remain a challenge in daily practice.

FACTORS ASSOCIATED WITH THE UPTAKE OF SODIUM DICHLOROISOCYANURATE (NADCC) TABLETS AS HOUSEHOLD WATER-TREATMENT PRODUCT AMONG CAREGIVERS OF CHILDREN UNDER FIVE IN BENIN, WEST AFRICA.

Improving access to safe drinking water is a critical step in mitigating diarrheal diseases that affect millions of children under 5 years throughout the developing world each year. While the delivery of safe water is out of the reach of many countries, the utilization of Sodium dichloroisocyanurate (NaDCC) is a proven cost-effective alternative to prevent diarrhea caused by waterborne pathogens. However, its uptake remains low in many developing countries, such as the Republic of Benin. This study examines the trends and the determinants of NaDCC uptake in Benin. Population Services International and its affiliate conducted two multistage household surveys among caregivers of children under five in Benin to examine the practices towards diarrheal disease in children under five and identify the factors associated with the use of NaDCC in this population. 2912 respondents/caregivers of children under five were interviewed in 2009 versus 3196 in 2011. The proportion of caregivers who reported ever treating water with NaDCC increased from 5.8% in 2009 to 11.5% in 2011, p < 0.001. The logistic regression model showed that caregivers who knew places that sell NaDCC in the community; those who felt capable of utilizing NADCC correctly to treat drinking water as well as caregivers who reported to be Muslim were more likely than their counterparts to use NaDCC as water treatment product. In order to increase the use of NADCC among caregivers, the Government of Benin and its development partners should focus not only on making NADCC available in the community and informing the community members about the different points of sale, but also in building up the capacity and confidence of caregivers in utilizing it.