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IntroductionSub-Saharan Africa has the highest under-five mortality rate and is among the regions where people have the least access to adequate Water, Sanitation, and Hygiene (WASH) services. The work aimed to investigate the effects of WASH conditions faced by children on under-five mortality in Sub-Saharan Africa.MethodsWe carried out secondary analyses using the Demographic and Health Survey datasets of 30 countries in Sub-Saharan Africa. The study population consisted of children born within 5 years preceding the selected surveys. The dependent variable was the child’s status (1 = deceased versus 0 = alive) on the survey day. The individual WASH conditions in which children live were assessed in their immediate environment, i.e., at the level of their households of residence. The other explanatory variables were related to the child, mother, household, and environment. Following a description of the study variables, we identified the predictors of under-five mortality using a mixed logistic regression.ResultsThe analyses involved 303,985 children. Overall, 6.36% (95% CI = 6.24–6.49) of children died before their fifth birthday. The percentage of children living in households with access to individual basic WASH services was 58.15% (95% CI = 57.51–58.78), 28.18% (95% CI = 27.74–28.63), and 17.06% (95% CI = 16.71–17.41), respectively. Children living in households using unimproved water facilities (aOR = 1.10; 95% CI = 1.04–1.16) or surface water (aOR = 1.11; 95% CI = 1.03–1.20) were more likely to die before five than those coming from households with basic water facilities. The risk of under-five mortality was 11% higher for children living in households with limited sanitation facilities (aOR = 1.11; 95% CI = 1.04–1.18) than for those with basic sanitation services. We found no evidence to support a relationship between household access to hygiene services and under-five mortality.ConclusionInterventions to reduce under-five mortality should focus on strengthening access to basic water and sanitation services. Further studies are needed to investigate the contribution of access to basic hygiene services on under-five mortality.

Introduction: Because of the specificity of their care activities, hospital wastewater contains various contaminants such as germs, disinfectants, metals, pharmaceuticals and chemical reagents, potentially infectious or toxic, which can be harmful to living organisms, or create ecological damage. This study aimed to analyze the quality of wastewaters produced by university hospitals of Cotonou in Benin. Methods: We conduct an analytical cross-sectional study including 30 wastewater samples from selected hospitals. An analysis of variance was performed at the significance level of 0.05. Results: Microbiological analysis showed the presence of germs such as total coliform types, faecal coliforms, fecal streptococcus, staphylococcus, yeasts and Clostridium perfringens in hospital wastewater samples. There was a significant difference (p < 0.05) in the microbial loads of various germs, except staphylococcus, between hospitals. With regard to the physicochemical parameters, only the conductivity complied with the standards for the discharge of wastewater into the environment. A significant difference was noted between hospitals, for the electrical conductivity of wastewater (p < 0.05). The average levels of metals detected in the wastewaters were in line with Benin’s standards. There was no difference between the average concentrations of metals except for copper (p < 0.05). Conclusion: The wastewater produced by the university hospitals of Cotonou is of poor quality and therefore requires adequate prior treatment before discharge into the environment.

Healthcare-associated infections (HCAIs) remain a major public health concern. The aim of this study was to characterize potential pathogenic bacteria isolated in high-risk infectious services at the University Hospital Center of Suru-Lere in Benin. A cross-sectional, descriptive study was carried out on 215 samples with 8 air samples, 20 hand samples and 187 samples of medical-technical material. Genes for resistance to β-lactam antibiotics (blaTEM, blaSHV, blaCTX-M and blaOXA-1) were sought. The data were processed and analyzed using EPI Info version 3.5.4 software. A total of 10 bacterial species were identified. Of the 319 bacterial strains identified, Staphylococcus saprophyticus, Staphylococcus aureus and Enterococcus faecalis were predominant at 20.06%, 17.87% and 11.28% respectively. Antibiotic susceptibility showed that the majority of bacterial strains were multidrug-resistant. Of the 4 resistance genes sought, only the blaTEM and blaSHV genes were found. The poor microbiological quality observed in high-risk infectious services could be a risk factor for healthcare-associated infections. It is therefore useful to implement preventive measures in order to prevent or reduce the risk of healthcare-associated infections.

Background: Hepatitis B is a vaccine-preventable liver infection caused by the hepatitis B virus. The study aimed to determine the prevalence and associated factors of hepatitis B infection in adolescents and youth attending secondary school in Cove, urban area in Benin. Methods: From 4th to 10th February 2018, a cross-sectional survey was conducted among adolescents and youth aged 15 to 24 years old. Subjects were randomly selected. Hepatitis B surface antigenaemia (HBsAg) was assayed in blood using rapid enzyme-linked immunosorbent assay kits. Univariate and multivariate analyses were performed. Results: Two hundred adolescents and youth were recruited. The seroprevalence of hepatitis B virus infection was 18.50%. According to the multivariate logistic regression model, being infected by hepatitis B was 4.32 times higher in the age group of 15 - 19 years old than in 20 - 24 years age group (PR = 4.32 95% CI [1.51 - 12.34], p = 0.0063). Similarly, students who had not been aware of hepatitis B were more infected than those who were sensitized (PR = 14.60 [95% CI 4.98 - 4.27], p = 0.0001). With regard to lifestyle, individuals with tattoos or piercings were 8.60 times more likely to have been infected by HBV than those without tattoos or piercings, (PR = 8.60; 95% CI [3.41 - 21.70], p < 0.0001). Conclusion: The seroprevalence of hepatitis B among adolescents and youth attending secondary school was high. Regular screening of HVB infection status should be included in school health services in Benin. Awareness campaigns and health education on HVB transmission and prevention should be promoted and strengthened.

Staphylococcus spp. is most often implicated in nosocomial infections. The objective of this study is to evaluate the susceptibility to antibiotics and the biofilm formation capacity of staphylococci species isolated from surfaces and medicotechnical materials at the university hospital center of Abomey-Calavi/Sô-Ava in Benin. Samples were collected according to ISO/DIS14698-1 standard from the surfaces and medicotechnical materials by the dry swab method. The isolation of Staphylococcus strains was performed on Chapman agar, and their identification was performed using microscopic and biochemical methods. The susceptibility of Staphylococcus isolates to antibiotics was evaluated by the disc diffusion method according to EUCAST and CLSI recommendations. The biofilm formation was qualitatively assessed using microplates. Of the 128 surfaces and medicotechnical material samples analyzed, 77% were contaminated with Staphylococcus spp. Thirteen species of Staphylococcus were isolated in different proportions but the pediatric department was the most contaminated (33%) by S. aureus. Resistance to antibiotics considerably varies according to the species of Staphylococcus. However, antibiotics such as chloramphenicol and vancomycin are the most effective on S. aureus, whereas coagulase-negative staphylococci developed less resistance to gentamycin and ciprofloxacin. The biofilm test reveals that 37% of our isolated strains were biofilm formers. Although regular monitoring of hospital hygiene is crucial, the optimal use of antibiotics is a cornerstone of reducing antimicrobial resistance.

Les effluents générés par les activités hospitalières présentent un danger potentiel pour la santé et l’environnement. L’objectif de cette étude était d’étudier la qualité physico-chimique et toxicologique des effluents produits par les Centres Hospitaliers et Universitaires du département du Littoral. Il s’agissait d’une étude transversale descriptive et analytique sur 60 prélèvements d’effluents hospitaliers provenant des stations d’épuration et des fosses septiques. Les échantillons ont été prélevés dans des bouteilles en plastique de 1,5 litre. Les valeurs moyennes des paramètres avec leurs déviations standards ont été calculées. Une analyse en composante principale a été réalisée. Les paramètres physico-chimiques mesurés et comparés aux normes de rejets des polluants dans l’environnement montraient qu’en dehors du pH, de la température et de la conductivité qui étaient conformes aux normes, tous les autres paramètres présentaient des valeurs supérieures aux normes de rejet. Le potentiel hydrogène, la température et la conductivité mesurés sont respectivement en moyenne de 7,14 ; 24,52 °C et 1243,37 μS/Cm. Les teneurs moyennes en oxygène dissous, en ammonium et en phosphore sont respectivement de 1,29 mg/L, 47,21 mg/L et 33,18 mg/L. La demande biochimique en oxygène est de 86,33 mgO2/L et la demande chimique en oxygène de 164,54 mgO2/L. Les concentrations moyennes du plomb et du cadmium étaient respectivement de 0,53 mg/L et 0,08 mg/L. Ces effluents présentent donc des risques sanitaires et environnementaux. Il apparait alors plus que nécessaire de développer des méthodes de traitement de ces effluents avant leur rejet dans le milieu naturel.Mots clés : Effluents hospitaliers, qualité chimique, risques sanitaires et environnementaux, Bénin. English Title: Physicochemical and toxicological characterization of the effluents of the Hospital and University Centers of the Littoral Department of BeninEffluents generated by hospital activities present a potential danger to health and the environment. The objective was to study the physico-chemical and toxicological quality of the effluents produced by the Hospital and University Centers of the Littoral Department. It was a descriptive and analytical cross-sectional study of 60 samples of hospital effluents from sewage treatment plants and septic tanks. Samples were taken from 1.5 liter plastic bottles. The average values of the parameters with their standard deviations were calculated. A principal component analysis was performed. The physicochemical parameters measured and compared to environmental pollutant release standards showed that, except for the pH, temperature and conductivity that were in compliance with the standards, all other parameters had values that exceeded rejection. The hydrogen potential, the temperature and the conductivity measured are, on average, 7.14, 24.52 °C and 1243.37 μS/cm. The average dissolved oxygen, ammonium and phosphorus contents are respectively 1.29 mg/L, 47.21 mg/L and 33.18 mg/L. The biochemical oxygen demand is 86.33 mgO2/L and the chemical oxygen demand is 164.54 mgO2/L. Mean concentrations of lead and cadmium were 0.53 mg/L and 0.08 mg/L, respectively. These effluents therefore present health and environmental risks. It appears then more than necessary to develop methods of treating these effluents before their release into the natural environment.Keywords: Hospital effluents, chemical quality, health and environmental risks, Benin.

Introduction: The effluents generated by hospital activities pose a potential danger to health and the environment. This study aimed to study the microbiological quality of the effluents produced by the university and hospital centres of Littoral department. Methods: This was a descriptive cross-sectional study of 60 samples of hospital effluents from sewage treatment plants and septic tanks carried out during the period from April to June 2019. Samples at the station were made at the entrance and exit of the station. Samples for microbiological analysis were collected in pre-sterilized 500 mL glass bottles. Samples were kept between at 2°C - 8°C and in the dark to ensure satisfactory preservation. ANOVA one-way analysis of variance was performed for each microbiological parameter and principal component analysis (PCA) was also performed. Results: The bacteriological analyses carried out on the 60 samples taken showed a significant microbiological load. In fact, the bacteriological parameters measured and compared to the pollutant release standards in the environment show that the number of germs identified is above the recommended guideline values. The average values for total coliforms, faecal coliforms, faecal streptococci and staphylococci were: 3.91 × 105 UFC/100 mL, 0.52 × 105 UFC/100 mL, 3.92 × 105 UFC/100 mL and 1.36 × 105 UFC/100 mL, respectively. The most isolated bacteria were: Klebsiella pneumoniae, Klebsiella oxytoca, Escherichia coli, Enterococcus faecalis, Enterobacter cloacae, Pseudomonas horizyhabitans, Staphylococcus aureus and Staphylococcus saprophyticus. Most strains were resistant to at least 3 families of antibiotics (beta-lactams, aminoglycosides and fluoroquinolones). Conclusion: These effluents therefore present health and environmental risks. It is of utmost importance to develop methods for the treatment of these effluents before their release into the natural environment.

Background: Bacterial meningitis is an inflammation of the meninges caused mainly by three bacterial species Neisseria meningitidis, Streptococcus pneumoniae and Haemophilus influenzae that are transmitted by nasopharyngeal secretions emitted by carriers. Meningitis is a public health problem in Benin, like all countries in the African meningitis belt. This study aims to analyze the epidemiological surveillance data of meningitis in Benin from 2016 to 2018. Methods: Each suspect case of meningitis was recorded and Cerebrospinal Fluid (CSF) samples were collected. CSF collection was accompanied by the Integrated Disease Surveillance and Response form. This sheet provides information on the patient’s social-demographic and epidemiological data. CSF specimens were sent to the laboratory for analysis and identification (Gram stain, biochemical parameters, and latex agglutination test) of pathogens according to the WHO standards. Results: Of the 2992 patients with suspected meningitis, 2893 were hospitalized with a death rate of 9.4% (281/2992). The sex ratio of registered patients was 1.29 in favor of men. The median age was 4 years (min: 0; max: 90). Patients younger than five years were the most represented (44.8%). During the study period, there was a decrease in the incidence of meningitis per 100,000 inhabitants (6.3 to 3.2 from 2016 to 2018). Of 2928 CSF samples collected we were able to identify 899 pathogenic bacterial species. The most represented species are S. pneumoniae (63.4%), N. meningitidis (24.4%) and H. influenzae (12.2%). Conclusion: The burden of disease is disproportionate in the northern departments as in others. The frequency of bacterial meningitis in the northern region increased during the study period. However, deaths have been recorded in the departments of the South (“Atlantic”, “Plateau”). This suggests an improvement in epidemiological surveillance and case management throughout the national territory.

The public health problems in Benin come from various angles. Domestic water has a fundamental role in households, but these sources are exposed to contamination by biological and physico-chemical pollutants. As a solution, household water purification devices such as ceramic filters can be used. “Filtre Songhaï” is a ceramic filter, simple and easy to use, marketed in Benin. This study’s object is to analyze the use of the “Filtre Songhaï” in the treatment of water for domestic use in a peri-urban area in Porto-Novo (Benin). Collective well and a pond from in the 5th district of Porto-Novo served as a source of sample collection. The physico-chemical and bacteriological parameters were measured before and after filtration. The results showed that the use of filters has allowed for a reduction of 97.5% for total coliform in the well water and 99.05% for water from the lagoon. The reduction is 100% for Escherichia coli and fecal streptococci in both cases. Considering the reliability and accessibility due to the lifetime use of “filtre Songhai”, this device can be proposed to households for drinking water, particularly for children below five years old the most vulnerable to water-borne diseases. At the end of this study, it arises that the use of the “Filtre Songhaï” allows a significant improvement of the mi-crobiological properties of water. Later research is needed to improve the speed of filtration of the “Filtre Song-haï”. Research is still necessary to refine the filtration time of this device.

Aims: The aim of our work was, on the one hand, to evaluate the risk factors for infectious contamination in hospital environments and, on the other hand, to carry out a microbiological control of surfaces at the Abomey-Calavi / So-Ava hospital in Benin. Methodology: The risk factors were evaluated using structured interviews based on the questionnaire. Fifty-five health care workers were surveyed and the questionnaire focused on: i) knowledge of care-associated infections and risk factors, ii) services most affected by care-associated infections and iii) origin of care-associated infections. For the microbial quality control of medical surfaces and materials, samples were collected by the dry swab method and the microbial isolation was carried out on Chapman and EMB agar plates. The biochemical analyses were carried out for the confirmations. Results: Out of 55 respondents, the 93% think that bacterial germs are often involved in care-associated infections. In addition, 80% of respondents believe that the healthcare environment may be the source of care-associated infections. Regarding the microbiological quality of the surfaces, out of 96 samples collected, 77% were contaminated with Staphylococcus spp and 30% with Enterobacteria. Concerning units’ contamination, the highest prevalence was observed in paediatrics with 92% of samples contaminated with Staphylococcus spp followed by the operating theatre (87%). Conclusion: It is clear from our work that hygiene managers must carry out preventive and corrective actions for the respect of the principles of hygiene. It would also be important to conduct regular microbiological monitoring of surfaces to identify any contamination.

BackgroundLiquid discharges from hospitals (effluents) threaten the environment and are now a central concern of all stakeholders in the health system and those in the protection of the environment. The management of effluents is a major problem in developing countries. The objective of this study was to assess the quality of effluent management at the level of university hospital centers (CHU) in the Littoral region in Benin.MethodsIt was a cross-sectional, descriptive, evaluative study that took place in 2020 to assess the “structure”, “process” and “results” components according to standard thresholds (Bad: ResultsIn all the CHUs, all the components, as well as the overall quality of the management of hospital effluents, had a score between 0 and 60%, with an assessment deemed bad. The poor quality of the process highlighted the non-compliance with standards relating to the management of hospital liquid discharges. Several factors linked to the “structure”, “process” and “results” components at the same time explain this poor management of university hospitals effluents.ConclusionThese effluents discharged without prior treatment into wastewater could constitute a source of dissemination of potentially pathogenic microorganisms. It is therefore important to develop methods for treating these effluents before they are released into the natural environment.

Pour apprecier l’acces a l’eau, l’hygiene et a l’assainissement dans la commune d’Abomey-Calavi, un etat des lieux a ete realise et les facteurs associes en matiere d’eau, d’hygiene et d’assainissement ont ete etudies. De mai 2016 a janvier 2017, une etude transversale et analytique a permis d’administrer un questionnaire structure a 630 individus. SPSS et Epi Info ont servi a analyser les facteurs associes. Les focus groupes ont permis de collecter les donnees qualitatives au sein d’un arrondissement urbain et rural. Un echantillonnage par commodite a permis de selectionner, a partir des menages enquetes, dix participants par arrondissement. La methode de l’analyse du contenu a ete utilisee pour traiter les donnees qualitatives. L’analyse des resultats obtenus revele que 61,9% des menages utilisent une source d’eau amelioree, 87,3% disposent d’installation d’assainissement amelioree, 58,3% et 4,03% disposant respectivement de toilette a chasse mecanique et de toilettes seches ont une installation d’hygiene amelioree. Le milieu de residence (OR : 0,3, IC 95% : [0,61-0,42]) explique l’etat de la source d’eau de boisson. Le niveau d’instruction (OR : 1,18 ; IC 95% :[0,61-2,25]) et la source d’eau de boisson (OR, 5,62, IC 95% :[2,66-11,85]) expliquent l’etat de l’hygiene. La depense journaliere (OR, 0,22, IC 95% : [0,11-0,42]), le milieu de residence (OR : 0,05 ; IC 95% : [0,02-0,20]), le niveau d’instruction (OR, 0,27 ; IC 95% : [0,16-0,47]) et les traits caracteristiques du relief (OR, 0,27 ; IC 95% : [0,07-1,14]) expliquent l’etat de l’assainissement. Il ressort de tout ce qui precede que l’acces a l’eau, l’hygiene et a l’assainissement est acceptable dans la commune d’Abomey-Calavi malgre les disparites entre milieu rural et urbain. Les facteurs associes sont : le niveau d’instruction, la source d’eau de boisson, le niveau economique, le milieu de residence et les traits caracteristiques du relief. To appreciate the access to water, hygiene and sanitation in the commune of Abomey-Calavi, the inventory was carried out and the associated factors in terms of water, hygiene and sanitation have been studied. FromMay 2016 to January 2017, a cross-sectional and analytical study was used to administer a structured questionnaire to 630 individuals. SPSS and Epi Info were used to analyze the associated factors. The focus groups were used to collect qualitative data in an urban and rural district. A convenience sample were used to select, fromthe households surveyed, ten participants per district. The content analysis method was used to process the qualitative data. The analysis of the results obtained reveals that 61.9% of households use an improved water source, 87.3% have improved sanitation facilities, 58.3% and 4.03% have respectively a flush toilet and dry toilets have an improved hygiene facility. The place of residence (OR: 0.3, 95% CI: [0, 61-0, 42]) explains the state of the drinking water source. The level of education (OR: 1,18, 95% CI: :[0,61-2,25]) and the source of drinking water (OR, 5,62, 95% CI: [2,66-11,85]) explain the state of hygiene. Daily expenditure (OR, 0, 22, 95% CI: [0,11-0,42]), place of residence (OR: 0.05, 95% CI [0,02-0,20]), level of education (OR, 0.27, 95% CI: [0,16-0,47]) and the characteristics of the relief (OR, 0.27, 95% CI: [0,07-1,14]) explain the state of sanitation. From all the foregoing, it is clear that access to water, hygiene and sanitation is acceptable in the commune of Abomey-Calavi despite the disparities between rural and urban areas. Associated factors are: educational level, drinking water source, economic level, place of residence, and characteristics of relief.

Introduction The sterilization of surgical drapes plays an important role in preventing infections associated with treatments. At the CNHU-HKM, sterilization procedure for drapes encounters problems. The purpose of this study was to examine the factors associated with the quality of sterilization of surgical drapes at the CNHU-HKM. Methods We conducted a cross-sectional, descriptive and analytical study focusing on 20 sterile surgical drapes, 41 agents were involved in the management of drapes and 55 members of the surgical team. The probabilistic method was used for sterile surgical drapes, the non-probabilistic method for the others. Pearson's Chi-square Test and logistic regression were used to find the association, with a significant threshold and a p Results Eighty six point forty six percent of subjects were males with an average age of 42 years. The quality of the process of sterilization of the operative drapes was not good in the two departments responsible for processing the drapes. Bacteriological analysis showed that, out of 20 sterile surgical drapes, 9 had Acinetobacter spp. a multidrug-resistant germ causing nosocomial infections. Multivariate analysis showed that professional experience (p=0.015) and quality control of the procedure (p=0.034) were statistically associated with the quality of sterilization. Conclusion The presence of Acinetobacter spp. on the sterilized drapes demonstrates that sterilization of drapes at the CNHU-HKM is of poor quality. Measures strengthening the skills of providers are necessary to improve the quality of sterilization procedures.