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Background: A global schools-based programme within the Global Campaign against Headache is estimating the burden of headache in children (6–11 years) and adolescents (12–17 years), cluster-sampling the world by conducting national studies in all world regions. Its purpose is to complement population-based studies in adults, adding to knowledge of the burden of headache and informing educational and health policies. This study in Benin was the third in the programme from sub-Saharan Africa (SSA). Methods: We followed the generic protocol for the global study. In a cross-sectional survey, the child and adolescent versions of the Headache-Attributed Restriction, Disability, Social Handicap and Impaired Participation (HARDSHIP) structured questionnaire were administered to pupils within their classes in 16 schools selected from across the country to be representative of its diversities. Headache diagnostic questions were based on ICHD-3 criteria but for the inclusion of undifferentiated headache (UdH). Results: Very large proportions of pupils were absent on the survey days. The sampled population defined by class registers totalled 11,802 pupils, of whom only 2,488 were present. A further 193 pupils (or their parents) declined the survey. The surveyed sampled (N = 2,295; males 1,156 [50.4%], females 1,139 [49.6%]) included 1,081 children (47.1%) and 1,214 adolescents (52.9%), with a non-participating proportion (193/2,488) of 7.8%. Headache ever was reported by 97.3% of the sample. Age- and gender-adjusted 1-year prevalences, according to responses given, were 53.4% for migraine (almost three quarters of this being probable migraine), 21.3% for tension-type headache, 8.2% for UdH, 1.0% for probable medication-overuse headache (pMOH) and 2.6% for other headache on ≥ 15 days/month (H15+). Both pMOH and other H15 + were substantially more prevalent among adolescents. Conclusion: The finding for migraine is anomalous, but, within this series of studies, the same was found in Zambia and similar in Ethiopia, both in SSA. While many cases identified as probable migraine, especially among children, might better have been diagnosed as UdH, the true prevalence of migraine almost certainly exceeds 21%. Regardless of diagnosis, headache is very common among children and adolescents in Benin. The study sounds an alarm with regard to pMOH as a developing problem pre-adulthood. [ABSTRACT FROM AUTHOR]

Background: Child abuse is a dominant public health concern that permeates race, varied social contexts and culture. Child abuse comprises any act of omission or commission perpetrated by a child's parent, caregiver, or other adult leading to harm, potential for, or any threat of harm to a child (below age 18), either intentional or unintentional. This subject has usually been explored by focusing on men. This study investigated the prevalence and social correlates of child abuse across seven countries in sub-Saharan Africa. Methods and materials: Data was obtained from Demographic and Health Surveys (DHS) conducted in seven countries in sub-Saharan Africa between 2013 and 2020. The outcome variable employed for this study was acts of child abuse (including shouting, striking, and slapping). Descriptive and inferential analyses were carried out. The descriptive analysis focused on the bivariate analysis between the country variable and the outcome variables. Multivariate analysis was, however, utilized to determine the relationship between the outcome variables and the respondents' explanatory variables, using a binary logistic regression model. The adjusted odds ratios for each variable were calculated using a 95% confidence range. Results: The proportion of women shouting at children was 72 percent. This ranged from 49.2 percent in Chad to 84.2 percent in Benin. The proportion of women striking children was 52.5 percent and this ranged from 37.1 percent in Chad to 63.8 percent in Benin. The odds of women striking their children was higher for those with children aged 10–14 (aOR = 1.18, CI = 1.03, 1.34), women with primary education (aOR = 1.25, CI = 1.17, 1.33), cohabiting women (aOR = 1.17, CI = 1.10, 1.25) and women who had experienced intimate partner violence (aOR = 1.06, CI = 1.00, 1.12). The odds of women shouting at their children was higher for those aged 30–34 years (aOR = 1.31, CI = 1.11, 1.55) and for working women (aOR = 1.43, 1.33, 1.56). The odds of women slapping their children was higher for those who justify wife-beating (aOR = 1.10, CI = 1.03, 1.16) and for women with richest wealth status (aOR = 1.25, CI = 1.17, 1.33). Conclusions: The findings show that it is imperative for the governments of the countries studied, especially those with high prevalence like Benin, to consider parent-friendly and culturally acceptable non-formal educational initiatives that will dissuade parents and guardians from abusing children. Possibly, legal reforms that sanction harsher punishments to perpetrators of child abuse may help make child abuse less attractive to parents and guardians. [ABSTRACT FROM AUTHOR]

Background: Pregnant women are a vulnerable population to COVID-19 given an increased susceptibility to severe SARS-CoV-2 infection and pregnancy complications. However, few SARS-CoV-2 serological surveys have been performed among this population to assess the extent of the infection in sub-Saharan countries. The objectives of this study were to determine SARS-CoV-2 seroprevalence among Beninese pregnant women, to identify spatial seropositivity clusters and to analyse factors associated with the infection. Methods: A cross-sectional study including women in their third trimester of pregnancy attending the antenatal care (ANC) clinics at Allada (south Benin) and Natitingou (north Benin) was conducted. Rapid diagnostic tests (RDT) for detection of IgG/IgM against the SARS-CoV-2 spike protein were performed using capillary blood. Seroprevalence of SARS-CoV-2 antibodies and associations between SARS-CoV-2 serostatus and maternal characteristics were analyzed by multivariate logistic regression. Spatial analyses were performed using the spatial scan statistics to identify spatial clusters of SARS-CoV-2 infection. Results: A total of 861 pregnant women were enrolled between May 4 and June 29, 2022. 58/861 (6.7%) participants reported having received COVID-19 vaccine. None of the participants had been diagnosed with COVID-19 during their pregnancy. SARS-CoV-2 antibodies were detected in 607/802 (75.7%; 95% CI 72.56%–78.62%) of unvaccinated participants. Several urban and rural spatial clusters of SARS-CoV-2 cases were identified in Allada and one urban spatial cluster was identified in Natitingou. Unvaccinated participants from Allada with at least one previous morbidity were at a three-times higher risk of presenting SARS-CoV-2 antibodies (OR = 2.89; 95%CI 1.19%-7.00%). Conclusion: Three out of four pregnant women had SARS-CoV-2 antibodies, suggesting a high virus circulation among pregnant women in Benin, while COVID-19 vaccination coverage was low. Pregnant women with comorbidities may be at increased risk of SARS-CoV-2 infection. This population should be prioritized for COVID-19 diagnosis and vaccination in order to prevent its deleterious effects. Trial registration: NCT06170320 (retrospectively registered on December 21, 2023). [ABSTRACT FROM AUTHOR]

Introduction: Managing soil fertility remains one of the major concerns of smallholder farmers in Sub-Saharan Africa (SSA). In order to understand the adoption potential of recommended practices to smallholders, this study aimed to characterize the resource availability, allocation and use patterns, and the soil fertility management practices in the maize farming system in northern Benin. Methods: A survey was conducted with 262 households randomly selected across three municipalities from three agro-ecological zones. Focus groups discussions and individual interviews were conducted with the household heads using an interview guide and a structured questionnaire respectively. The main data collected included (a) the socio-economic characteristics of households, (b) the main farm type and their characteristics and (c) the current soil fertility management strategies and the rationale behind. Results and discussion: The main soil fertility practices included the use of mineral fertilizer, manure, and crop residues application to plots. As a general trend, the rates of fertilizers applied by farmers [on average 132 ± 8.5 and 59 ± 5.8 kg ha-1 of Nitrogen-Phosphorus-Potassium (NPK) and urea] were below those recommended or required to ensure optimal maize yields. Five farm types corresponding to different resource endowments or wealth classes were identified. The scarce resource farms owned by the majority of poorer farmers use only small amounts of manure and fertilizer in their fields. Qualitative analysis indicated that farms have different constraints and opportunities to adopt newly proposed soil fertility management recommendations. Conclusion: Extension services and decision makers must target specific interventions for appropriation and sustainability of technologies to resource mostly the smallholder farmers. [ABSTRACT FROM AUTHOR]

Background: In Benin, a country in West Africa, breast cancer is the leading cancer in women, both in terms of incidence and mortality. However, evidence on the mortality of breast cancer and its associated factors is lacking in this country. Our aim was to describe and analyze the clinical, histopathological, and prognostic aspects of breast cancer in Benin. Methods: A descriptive and analytical study was carried out at the CNHU-HKM and the CHU-MEL, two major tertiary referral hospitals for breast cancer management located in Cotonou, the capital city of Benin. All breast cancer medical records with histological evidence and immunohistochemistry studies were retrospectively collected between January 1, 2014, and September 30, 2020, in these two tertiary referral hospitals and analyzed in the current study. Results: Finally, 319 medical records were included. The mean age at diagnosis was 48.74 years. The tumors were most frequently classified as T4 (47.6%) with lymph node involvement N2 (34.5%), and metastases were clinically noted in 21.9% of cases. Stage was reported in the medical records of 284 patients. Tumors were diagnosed at very late AJCC stages: stage III (47.5%) and stage IV (24.7%). Grades SBR 2 (49.2%) and SBR 3 (32.6%) were the most frequent grades. Triple-negative breast cancer (31.3%) was the most common molecular type. The overall 5-year survival was 48.49%. In multivariable analysis, the poor prognostic factors were lymph node invasion (HR = 2.63; p = 0.026; CI: [1.12, 6.17]), the presence of metastasis (HR = 3.64; p < 0.001); CI: [2.36, 5.62] and the immunohistochemical profile (HR = 1.29; p < 0.001; CI: [1.13, 1.48]). Conclusions: Breast cancer in Beninese is predominant in young adults and is often diagnosed at a late stage. The survival of breast cancer patients in Benin can be improved by enhancing early diagnosis and multidisciplinary management. [ABSTRACT FROM AUTHOR]

Despite the potential of agriculture to reduce unemployment in sub-Saharan Africa, research on agricultural entrepreneurship is scarce, especially regarding the entrepreneurs' motivations. The aim of this research is to examine the intensity of necessity and opportunity motivations among agricultural entrepreneurs and the influence of socioeconomic characteristics, personality, and environmental factors. Hence, the study reports a survey of 819 agricultural entrepreneurs in Benin and uses multinomial logistic regressions. Most agricultural entrepreneurs are moderately necessity-driven (76%); the remainder includes highly necessity-driven entrepreneurs (4%), moderately opportunity-driven entrepreneurs (6%), and highly opportunity-driven entrepreneurs (14%). Those displaying higher intensity of necessity motivations can be at any education level, are former employees, are less proactive, less optimistic, and operate in the services sector. In contrast, highly opportunity-driven entrepreneurs are likely to have received a university education and agricultural professional training, operate in the services sector, and have better access to finance and technologies. This study advances the push-pull theory by revealing a richer set of entrepreneurial motivations beyond the simplistic dichotomic view. Hence, policymakers could devise entrepreneurship strategies and programs that consider the diverse motivations of entrepreneurs and the influencing factors to move them toward increased opportunity entrepreneurship. [ABSTRACT FROM AUTHOR]

Malaria is one of the greatest public health challenges in sub-Saharan Africa. Benin records malaria as the leading cause of mortality and morbidity. This study aims to analyze the climate and examine the relationship between the incidence of malaria and climatic variables in Northern Benin. The precipitation concentration index (PCI), Pettit test, Mann Kendall (MK) test, and Sen's slope method estimates were used to analyze the trends of temperature, rainfall, and rainfall intensity using monthly data from 1991 to 2021 at two meteorological stations and nine rain gauge stations in northern Benin. Pearson correlation tests, principal component analysis, and plots were computed to determine the relationship between malaria incidence and climatic variables over 2009–2021. Total precipitation and rainfall intensity are decreasing. The temperature showed a positive trend with an increase in the monthly and annual temperature. Monthly rainfall; minimal, maximal, and mean; relative humidity; and mean and maximal temperature have a significant positive correlation with malaria incidence. A range of 80–220 mm of precipitation, 25–35°C of temperature, 55–85% of relative humidity, and 1.6–2.7 m/s of wind speed is suitable for the transmission of malaria. Maximal temperature and relative humidity may have a large influence on how much malaria spreads in Northern Benin. These factors could help to develop a malaria early warning system in the study area. [ABSTRACT FROM AUTHOR]

The paper examines the effect of a primary education program in Benin on women's marital outcomes. The study leverages a sharp increase in the construction of schools in the 1990s to assess the causal impact of an increase in primary-school supply on primary-school attendance, employment, marital outcomes, and experience and tolerance of intimate partner violence (IPV). Using quasi-experimental geographical and historical variations in the number of schools built, the results indicate that in rural areas the school building program increased the probability of attending primary school and increased the age at marriage and at first child. It decreased the probability that women find domestic violence justified and that they experience emotional IPV. The effects are driven by women's own increase in education rather than their husbands'. [ABSTRACT FROM AUTHOR]

Introduction: Accurate assessments of vector occurrence and abundance, particularly in widespread vector-borne diseases such as malaria, are crucial for the efficient deployment of disease surveillance and control interventions. Although previous studies have explored the benefits of adaptive sampling for identifying disease hotspots (mostly through simulations), limited research has been conducted on field surveillance of malaria vectors. Methods: We developed and implemented an adaptive spatial sampling design in southwestern Benin, specifically targeting potential and uncertain Anopheles gambiae hotspots, a major malaria vector in sub-Saharan Africa. The first phase of our proposed design involved delineating ecological zones and employing a proportional lattice with close pairs sampling design to maximize spatial coverage, representativeness of ecological zones, and account for spatial dependence in mosquito counts. In the second phase, we employed a spatial adaptive sampling design focusing on high-risk areas with the greatest uncertainty. Results: The adaptive spatial sampling design resulted in a reduced sample size from the fi rst phase, leading to improved predictions for both out-of-sample and training data. Collections of Anopheles gambiae in high-risk and low-uncertainty areas were nearly tripled compared to those in high-risk and high-uncertainty areas. However, the overall model uncertainty increased. Discussion: While the adaptive sampling design allowed for increased collections of Anopheles gambiae mosquitoes with a reduced sample size, it also led to a general increase in uncertainty, highlighting the potential tradeoffs in multi-criteria adaptive sampling designs. It is imperative that future research focuses on understanding these trade-offs to expedite effective malaria control and elimination efforts. [ABSTRACT FROM AUTHOR]

Background: Malaria remains a major public health problem in sub-Saharan Africa, particularly in Benin. The present study aims to evaluate the different Plasmodium species transmitted by malaria vectors in the communes of Cove, Zagnanado and Ouinhi, Southern Benin. Methods: The study was conducted between December 2021 and October 2022 in 60 villages spread over the three study communes. Adult mosquitoes were collected from four houses in each village using human landing catches (HLCs). After morphological identification, a subsample of Anopheles gambiae, Anopheles funestus and Anopheles nili was analysed by PCR to test for their infection to the different Plasmodium species. Results: Anopheles gambiae was collected at higher frequency in all the three study communes, representing 93.5% (95% CI 92.9–94) of all collected mosquitoes (n = 10,465). In total, five molecular species were found, An. gambiae sensu stricto (s.s.) and Anopheles coluzzii of the Gambiae complex, An. funestus and Anopheles leesoni of the Funestus group, and An. nili s.s., the sole species of the Nili group. From the five molecular species, four (An. gambiae s.s., An. coluzzii, An. funestus s.s. and An. nili s.s.) were found to be infected. Plasmodium falciparum was the main Plasmodium species in the study area, followed by Plasmodium vivax and Plasmodium ovale. Only An. gambiae s.s. was infected with all three Plasmodium species, while An. coluzzii was infected with two species, P. falciparum and P. vivax. Conclusions: Plasmodium falciparum was the only species tested for in malaria vectors in Benin, and remains the only one against which most control tools are directed. It is, therefore, necessary that particular attention be paid to secondary Plasmodium species for an efficient control of the disease. The presence of P. vivax emphasizes the need for an update of case management for malaria. [ABSTRACT FROM AUTHOR]

Background: Anaemia has become a major public health concern among women in Sub-Saharan Africa (SSA). However, little is known about the spatial disparities in anaemia prevalence and their associated factors among pregnant women in the region. This study analysed the spatial disparities in anaemia and their associated factors among pregnant women in rural and urban settings in SSA. Methods: This is a secondary analysis of the most recent demographic and health surveys of 26 countries in SSA. Spatial autocorrelation and hotspot assessment were conducted, while a multivariate logistic regression model was used to identify demographic factors associated with anaemia. Results: Anaemia was reported among ~50% of pregnant women in urban and rural areas of SSA. The hotspot analysis identified the West African sub-region as having a higher concentration of anaemia cases in rural settings. In urban areas, the odds of anaemia were significantly higher among pregnant women in their second trimester (Adjusted OR = 2.39, CI = 1.99, 2.76). On the other hand, pregnant women in their third trimester (Adjusted OR = 1.98, CI = 1.77, 2.22) and those who had taken intestinal parasite drugs (Adjusted OR = 1.12 CI = 1.02, 1.23) had a higher likelihood of having anaemia in rural areas. Pregnant women aged 35–39 years (Adjusted OR = 0.52, CI = 0.33, 0.81) and those aged 40–44 years (Adjusted OR = 0.69, CI = 0.50, 0.95) had a lesser likelihood of having anaemia compared to women aged 15–19 years in urban and rural areas respectively. Compared to Congo DR, Benin (OR = 2.22, CI = 1.51, 3.28) and Mali (OR = 3.71, CI = 2.73, 5.05) had higher odds of anaemia in urban and rural areas respectively. Conclusions: Spatial disparities in anaemia persist among pregnant women in rural and urban settings in SSA. Prevailing spatial variations in anaemia may be addressed by specialised interventions considering the contextual residential settings and socio-economic factors highlighted in this study. [ABSTRACT FROM AUTHOR]

The major challenges of maize production and productivity in Sub-Saharan Africa (SSA) include Striga hermonthica infestation, recurrent drought, and low soil nitrogen (low N). This study assessed the following: (i) accelerated genetic advancements in grain yield and other measured traits of early-maturing maize hybrids, (ii) ideal test environments for selecting early-maturing multiple-stress tolerant hybrids, and (iii) high-yielding and stable hybrids across multiple-stress and non-stress environments. Fifty-four hybrids developed during three periods of genetic enhancement (2008–2010, 2011–2013, and 2014–2016) were evaluated in Nigeria, The Republic of Benin, and Ghana under multiple stressors (Striga infestation, managed drought, and Low N) and non-stress environments from 2017 to 2019. Under multiple-stress and non-stress environments, annual genetic gains from selection in grain yield of 84.72 kg ha−1 (4.05%) and 61 kg ha−1 (1.56%), respectively, were recorded. Three mega-environments were identified across 14 stress environments. Abuja was identified as an ideal test environment for selecting superior hybrids. The hybrid TZdEI 352 × TZEI 355 developed during period 3 was the most outstanding under multiple-stress and non-stress environments. On-farm testing of this hybrid is required to verify its superior performance for commercialization in SSA. Considerable progress has been made in the genetic improvement of early-maturing maize hybrids for tolerance of multiple stressors and high yield. The identified core testing sites of this study could be used to enhance the testing and selection of promising hybrids. [ABSTRACT FROM AUTHOR]

This paper documents the additional spending that is required for sub-Saharan Africa (SSA) to achieve meaningful progress in Sustainable Development Goals (SDGs) by 2030. Benin and Rwanda are presented in detail through case studies. The main lessons are (i) average additional spending across SSA is significant, at 19% of GDP in 2030; (ii) countries must prioritize their development objectives according to their capacity to deliver satisfactory outcomes, (iii) financing strategies should articulate multiple sources given the scale of additional spending, and (iv) strong national ownership of SDGs is key and should be reflected in long-term development plans and medium-term policy commitments. [ABSTRACT FROM AUTHOR]

Background. Malaria is a global public health concern, mainly occurring in sub-Saharan Africa. Children infected with malaria are more likely to develop severe disease, which can be fatal. During COVID-19 in 2020, diagnosing and treating malaria became difficult. We analyzed the clinical characteristics and laboratory indicators of children with severe malaria in Benin to provide important information for designing effective prevention and treatment strategies to manage pediatric cases. Methods. Clinical characteristics of pediatric patients with severe malaria admitted to two hospitals in Benin (Central Hospital of Lokossa and Regional Hospital of Natitingou, located ∼650 kilometers apart) were collected from January to December 2020. Patients were grouped according to age (group A: 4–12 months old, group B: 13–36 months old, and group C: 37–60 months old), and clinical and laboratory indicators were compared. The incidences of severe pediatric malaria in both hospitals in 2020 were calculated. Inclusion, exclusion, and blood transfusion criteria were identified. Results. We analyzed 236 pediatric cases. The main clinical symptoms among all patients were severe anemia, vomiting, prostration, poor appetite, dysphoria, and dyspnea. Over 50% of patients in group A experienced vomiting and severe anemia. Most patients in group B had severe anemia and prostration. Delirium affected significantly more patients in group C than in groups A and B. In group C, the hemoglobin and hematocrit levels were significantly higher p < 0.05 , and the leukocyte count was significantly lower p < 0.01 than in groups A and B. Parasitemia was significantly higher in group C than in group A p < 0.01 . Twelve deaths occurred. Conclusions. Severe pediatric malaria is seasonal in Benin. The situation in children under 5 years old is poor. The main problems are severe disease conditions and high fatality rates. Effective approaches such as prevention and early and appropriate treatment are necessary to reduce the malaria burden in pediatric patients. [ABSTRACT FROM AUTHOR]

Introduction: Since many countries in sub‐Saharan Africa are willing to implement HIV oral pre‐exposure prophylaxis (PrEP) for men who have sex with men (MSM), data are needed to assess its feasibility and relevance in real life. The study objectives were to assess drug uptake, adherence, condom use and number of sexual partners, HIV incidence and trends in the prevalence of gonorrhoea and chlamydia. Methods: In this oral PrEP demonstration study conducted prospectively in Benin, a combination of tenofovir disoproxil fumarate‐TDF 300 mg and emtricitabine‐FTC 200 mg (TDF‐FTC) was offered daily or on‐demand to MSM. Participants were recruited from 24 August to 24 November 2020 and followed over 12 months. At enrolment, month‐6 and month‐12, participants answered to a face‐to‐face questionnaire, underwent a physical examination and provided blood samples for HIV, gonorrhoea and chlamydia. Results: Overall, 204 HIV‐negative men initiated PrEP. The majority of them (80%) started with daily PrEP. Retention rates at month‐3, 6, 9 and 12 were 96%, 88%, 86% and 85%, respectively. At month‐6 and month‐12, respectively, 49% and 51% of the men on daily PrEP achieved perfect adherence (self‐reported), that is seven pills taken during the last week. For event‐driven PrEP, the corresponding proportions for perfect adherence (last seven at‐risk sexual episodes covered) were 81% and 80%, respectively. The mean number (standard deviation) of male sexual partners over the last 6 months was 2.1 (1.70) at baseline and 1.5 (1.27) at month‐12 (p‐value for trend <0.001). Consistent condom use during the last 6 months was 34% (enrolment), 37% (month‐6) and 36% (month‐12). Three HIV seroconversions (2‐daily and 1‐event‐driven) were recorded. Crude HIV incidence (95% confidence interval) was 1.53 (0.31−4.50)/100 person‐years. Neisseria gonorrhoeae and/or Chlamydia trachomatis prevalence at the anal and/or pharyngeal and/or urethral sites was 28% at baseline and 18% at month‐12 (p‐value = 0.017). Conclusions: In West Africa, oral PrEP introduction in routine practice as a component of a holistic HIV prevention package is feasible and may not result in a significant increase in condomless sex among MSM. Since HIV incidence was still higher, additional interventions, such as culturally tailored adherence counselling, may be needed to optimize the benefits of PrEP. [ABSTRACT FROM AUTHOR]

Background: Having a maximum number of people vaccinated was the objective to control the COVID-19 pandemic. We report in this manuscript the factors associated with the willingness to be vaccinated against COVID-19 during the pandemic period. Methods: From April to May 2022, a community-based cross-sectional survey was performed. Participants were randomly selected from four districts in Benin (taking into account the COVID-19 prevalence). Mixed-effect logistic regression models were used to identify the variables associated with COVID-19 vaccine acceptance. Results: A total of 2069 participants were included. The proportion of vaccine acceptance was 43.3%. A total of 24.2% were vaccinated and showed proof of vaccination. The population's request for vaccination was higher after the third epidemic wave. The district of residence, the education level, a fear of being infected, the channel of information, poor medical conditions, a good knowledge of the transmission mode and symptoms, and good behaviors were significantly associated with vaccine acceptance. Conclusion: The overall acceptance of the COVID-19 vaccine in the Beninese population was relatively high. However, vaccine campaigns in areas with a low acceptance as well as the disclosure of information, particularly on our knowledge of the disease and the safety, side effects, and effectiveness of the COVID-19 vaccines, should be strengthened with adapted and consistent messages. [ABSTRACT FROM AUTHOR]

• Important diversity was observed between and within the natural populations of Vitex doniana in Benin. • Most of dendrometric traits were correlated to leaf and fruit-related traits. • Field observations and transect walks revealed highly fragmented natural populations due to intense human activities. Vitex doniana is an important but endangered multipurpose wild fruit tree species well known in Sub-Saharan Africa, particularly in Benin. The present study assessed its current conservation status and morphological diversity within its natural populations in Benin. The study was conducted in 28 villages well distributed in 5 districts in southern Benin. The in-situ conservation status was assessed through direct field observations and transect walks. A total of 125 randomly selected trees were characterized using 13 quantitative morphological descriptors. Our results showed high morphological variability among trees based on the traits such as trunk circumference, crown attributes and diameter of leaf petiole. Positively significant correlations were found between most dendrometric parameters and leaf and fruit-related traits. The cluster analysis classified natural populations into three phenotypic groups, with the Cluster 2 encompassing the best accessions showing the greatest height, trunk diameter and the largest crown but with leaves moderate in size. However, the transect analysis performed revealed highly fragmented natural populations due to intense human activities. Therefore, awareness needs to be raised to protect this species and there is also an urgent need to develop domestication, breeding schemes and in-situ conservation programs dedicated to this species. [ABSTRACT FROM AUTHOR]

New classes of long-lasting insecticidal nets (LLINs) combining mixtures of insecticides with different modes of action could put malaria control back on track after rebounds in transmission across sub-Saharan Africa. We evaluated the relative efficacy of pyriproxyfen-pyrethroid LLINs and chlorfenapyr-pyrethroid LLINs compared with standard LLINs against malaria transmission in an area of high pyrethroid resistance in Benin. We conducted a cluster-randomised, superiority trial in Zou Department, Benin. Clusters were villages or groups of villages with a minimum of 100 houses. We used restricted randomisation to randomly assign 60 clusters to one of three LLIN groups (1:1:1): to receive nets containing either pyriproxyfen and alpha-cypermethrin (pyrethroid), chlorfenapyr and alpha-cypermethrin, or alpha-cypermethrin only (reference). Households received one LLIN for every two people. The field team, laboratory staff, analyses team, and community members were masked to the group allocation. The primary outcome was malaria case incidence measured over 2 years after net distribution in a cohort of children aged 6 months–10 years, in the intention-to-treat population. This study is ongoing and is registered with ClinicalTrials.gov , NCT03931473. Between May 23 and June 24, 2019, 53 854 households and 216 289 inhabitants were accounted for in the initial census and included in the study. Between March 19 and 22, 2020, 115 323 LLINs were distributed to 54 030 households in an updated census. A cross-sectional survey showed that study LLIN usage was highest at 9 months after distribution (5532 [76·8%] of 7206 participants), but decreased by 24 months (4032 [60·6%] of 6654). Mean malaria incidence over 2 years after LLIN distribution was 1·03 cases per child-year (95% CI 0·96–1·09) in the pyrethroid-only LLIN reference group, 0·84 cases per child-year (0·78–0·90) in the pyriproxyfen-pyrethroid LLIN group (hazard ratio [HR] 0·86, 95% CI 0·65–1·14; p=0·28), and 0·56 cases per child-year (0·51–0·61) in the chlorfenapyr-pyrethroid LLIN group (HR 0·54, 95% CI 0·42–0·70; p<0·0001). Over 2 years, chlorfenapyr-pyrethroid LLINs provided greater protection from malaria than pyrethroid-only LLINs in an area with pyrethroid-resistant mosquitoes. Pyriproxyfen-pyrethroid LLINs conferred protection similar to pyrethroid-only LLINs. These findings provide crucial second-trial evidence to enable WHO to make policy recommendations on these new LLIN classes. This study confirms the importance of chlorfenapyr as an LLIN treatment to control malaria in areas with pyrethroid-resistant vectors. However, an arsenal of new active ingredients is required for successful long-term resistance management, and additional innovations, including pyriproxyfen, need to be further investigated for effective vector control strategies. UNITAID, The Global Fund. [ABSTRACT FROM AUTHOR]

Background: The intention of becoming pregnant has an evident impact on the prenatal and postnatal period. For female sex workers (FSWs) in West Africa, among whom pregnancies are frequent as are HIV and sexually transmitted infections, a better understanding of their pregnancy intention and its influence on pregnancy occurrence could help prevent unwanted pregnancies and adverse effects on wanted pregnancies. Methods: We recruited 330 FSWs in Benin and 322 in Mali and followed them for 12 months. We evaluated their pregnancy intention at recruitment and 6-month follow-up, using a multidimensional prospective measure that we developed. We assessed pregnancy occurrence with a pregnancy test and a retrospective questionnaire at 6 and 12 months. A Cox proportional hazard model was used to estimate the association between intention and pregnancy. We carried out an analysis to take losses to follow-up into account using the inverse of probability of censoring weights and a cluster analysis to corroborate that the multidimensional measure of pregnancy intention fitted the data. Results: 407 FSWs were included in the first 6-month analysis and 284 at 12 months. Mean age was 30.9 years. The pregnancy intention distribution was similar between the two periods: 15.2% in the first period and 16.3% in the second had a positive intention. One out of four were ambivalent and almost 60% (57.7% and 56.3%) had a negative intention. For 38.2% of the FSWs, the intention changed between the two periods. The global incidence rate (to first event) was 19.1 pregnancies per 100 person-years. There was a borderline significant trend (p = 0.0529) of decreased pregnancy incidence with decreasing intention. Compared to positive intention, the adjusted hazard ratio (aHR) for ambivalent and negative intentions were 0.71 [95% confidence interval (95% CI) 0.32–1.60] and 0.46 (95% CI 0.21–1.01), respectively. Conclusion: The level of pregnancy intention influences its occurrence among FSWs and nearly one out of six wants a baby despite working in the sex trade. Programmatically, early identification of these women could facilitate provision of quality antenatal and postnatal care. Given other health risks associated with sex work this care may decrease potential risks of adverse maternal, fetal and neonatal outcomes. [ABSTRACT FROM AUTHOR]

In sub-Saharan Africa, where the professional insertion of graduates remains a major challenge, entrepreneurship represents an alternative to youth unemployment. This study investigates the predictors of agribusiness entrepreneurial intentions amongst undergraduate agricultural students in the Republic of Benin. A sample of 351 final year agricultural students was selected from universities. The data were collected through structured questionnaire and analyzed using descriptive statistics and a binary logistic regression. The findings showed that 44.16% of respondents were willing to start their own agribusiness venture after graduation with a preference for agro-processing enterprises (35.48%) and crop production enterprises (26.45%). The significant factors that influence agricultural students' entrepreneurial intention in agribusiness were age, their major field of study, type of university attended, previous experience in agribusiness, a role model as a friend, and perception of agribusiness environment. The study suggests the establishment of clubs for agribusiness entrepreneurship in agricultural faculties and universities; showcasing of young entrepreneurs in agribusiness through national competitions, and events, such as "Agri-Enterprise Week" at universities, inviting young agribusiness entrepreneurs to share their experiences with the students in the next generation as guests lecturer; and the creation by the government of a conducive agribusiness environment for youth graduates. In the light of these insights, several paths for future research emerge. [ABSTRACT FROM AUTHOR]

The characterization of wind speed distribution and the optimal assessment of wind energy potential are critical factors in selecting a suitable site for wind power plants (WPP). The Weibull distribution law has been used extensively to analyze the wind characteristics of candidate WPP sites, and to estimate the available and deliverable energy. This paper presents a comparative study of five wind energy resource assessment methods as they applied to the context of wind sites in West Sub-Saharan Africa. We investigated three numerical approaches, namely, the adaptive neuro-fuzzy inference system (ANFIS), the multilayer perceptron method (MLP), and support vector regression (SVR), to derive the distribution law of wind speeds and to optimally quantify the corresponding wind energy potential. Next, we compared these three approaches to two well-known Weibull distribution law-based methods: the empirical method of Justus (EMJ) and the maximum likelihood method (MLM). Case study results indicated that the neural network-based methods, ANFIS and MLP, yielded the most accurate distribution fits and wind energy potential estimates, and consequently, are the most recommended methods for the wind sites in Togo and Benin. The orders of magnitude of the root mean squared error (RMSE) in estimating the recoverable energy using ANFIS were, respectively, 10-4 and 10-5 for Lomé and Cotonou, while MLP achieved an RMSE order of magnitude of 10-3 for both sites. [ABSTRACT FROM AUTHOR]

Air pollution is a major global public health issue causing considerable morbidity and mortality. Measuring levels of air pollutants and facilitating access to the data has been identified as a pathway to raise awareness and initiate dialogue between relevant stakeholders. Low-and middle-income countries (LMICs) urgently need simple, low-cost approaches to generate such data, especially in settings with no or unreliable data. We established a network of easy-to-use low-cost air quality sensors (PurpleAir-II-SD) to monitor fine particulate matter (PM2.5) concentrations at 15 sites, in 11 cities across eight sub-Saharan Africa (sSA) countries between February 2020 and January 2021. Annual PM2.5 concentrations, seasonal and temporal variability were determined. Time trends were modelled using harmonic regression. Annual PM2.5 concentrations ranged between 10 and 116 µg/m3 across study sites, exceeding the current WHO annual mean guideline level of 5 µg/m3. The largest degree of seasonal variation was seen in Nigeria, where seven sites showed higher PM2.5 levels during the dry than during the wet season. Other countries with less pronounced dry/wet season variations were Benin (20 µg/m3 versus 5 µg/m3), Uganda (50 µg/m3 versus 45 µg/m3), Sukuta (Gambia) (20 µg/m3 versus 15 µg/m3) and Kenya (30 µg/m3 versus 25 µg/m3). Diurnal variation was observed across all sites, with two daily PM2.5 peaks at about 06:00 and 18:00 local time. We identified high levels of air pollution in the 11 African cities included in this study. This calls for effective control measures to protect the health of African urban populations. The PM2.5 peaks around 'rush hour' suggest traffic-related emissions should be a particular area for attention. [ABSTRACT FROM AUTHOR]

Background Long-acting reversible contraceptives (LARCs) are associated with high efficacy rates and continuity of use. Based on the foregoing, we sought to examine the prevalence and factors associated with LARC use among sexually active women in 26 countries in sub-Saharan Africa(SSA). Methods Secondary data from Demographic and Health Surveys conducted in 26 countries in SSA between January 2010 and December 2019 were pooled and analysed. A total of 56 067 sexually active women 15–49 y of age met the inclusion criteria. Bivariate and multivariate regression analyses were performed to examine the association between selected factors and the use of LARCs in SSA. Results were presented as crude odds ratios and adjusted odds ratios (aORs) with statistical precision at <0.05. Results The prevalence of LARC use was 21.73%, ranging from 1.94% in Namibia to 54.96% in Benin. Sexually active women with secondary or higher education (aOR 1.19 [95% confidence interval {CI} 1.08 to 1.32]), those cohabiting (aOR 1.25 [95% CI 1.06 to 1.47]) and those with four or more children (aOR 2.22 [95% CI 1.78 to 2.78]) were more likely to use LARCs compared with those without education, never married and with no biological child. Conclusions The use of LARCs in the 26 countries in SSA was relatively low. Hence, the identified contributory factors of LARC use should be tackled with appropriate interventions. These include continuous campaigns on the efficacy of LARCs in reducing unintended pregnancy, maternal mortality and morbidity. [ABSTRACT FROM AUTHOR]

Objectives: Inter-arm blood pressure difference (IABPD) can lead to underdiagnosis and poor management of hypertension, when not recognized and are associated with increased cardiovascular mortality and morbidity. However, the prevalence and associated risk factors of IABPD in sub-Saharan Africa are unknown. This study aims to determine the prevalence and associated risk factors of IABPD among Tanve Health Study (TAHES) participants, a cohort about cardiovascular diseases in a rural area in Benin. Methods: The cohort was conducted since 2015 among adults aged 25 years and over in Tanve village. Data were collected from February to March, 2020. Brachial blood pressure were recorded at rest on both arm with an electronic device. Systolic IABPD (sIABPD) was defined as the absolute value of the difference in systolic blood pressure between left and right arms ≥ 10 mmHg. A multivariate logistic regression models identified factors associated with sIABPD. Results: A total of 1,505 participants (women 59%) were included. The mean age was 45.08 ±15.65 years. The prevalence of sIABPD ≥ 10 mmHg was 19% (95%CI: 17–21). It was 19% (95%CI: 16–22) in men and 20% (95%CI: 17–22) in women. In final multivariable model, the probability of sIABPD ≥ 10 mmHg increased significantly with age (adjusted OR (aOR) = 1.1; 95%CI: 1.02–1.20 per 10-years), hypertension (aOR = 2.33; 95%CI: 1.77–3.07) and diabetes (aOR = 1.96; 95%CI: 1.09–3.53). Conclusion: Almost quarter of sample have a sIABPD ≥ 10 mmHg, with an increased risk with older age and hypertension and diabetes. [ABSTRACT FROM AUTHOR]

Background: Top-soil microbiomes make a vital contribution to the Earth's ecology and harbor an extraordinarily high biodiversity. They are also key players in many ecosystem services, particularly in arid regions of the globe such as the African continent. While several recent studies have documented patterns in global soil microbial ecology, these are largely biased towards widely studied regions and rely on models to interpolate the microbial diversity of other regions where there is low data coverage. This is the case for sub-Saharan Africa, where the number of regional microbial studies is very low in comparison to other continents. Results: The aim of this study was to conduct an extensive biogeographical survey of sub-Saharan Africa's top-soil microbiomes, with a specific focus on investigating the environmental drivers of microbial ecology across the region. In this study, we sampled 810 sample sites across 9 sub-Saharan African countries and used taxonomic barcoding to profile the microbial ecology of these regions. Our results showed that the sub-Saharan nations included in the study harbor qualitatively distinguishable soil microbiomes. In addition, using soil chemistry and climatic data extracted from the same sites, we demonstrated that the top-soil microbiome is shaped by a broad range of environmental factors, most notably pH, precipitation, and temperature. Through the use of structural equation modeling, we also developed a model to predict how soil microbial biodiversity in sub-Saharan Africa might be affected by future climate change scenarios. This model predicted that the soil microbial biodiversity of countries such as Kenya will be negatively affected by increased temperatures and decreased precipitation, while the fungal biodiversity of Benin will benefit from the increase in annual precipitation. Conclusion: This study represents the most extensive biogeographical survey of sub-Saharan top-soil microbiomes to date. Importantly, this study has allowed us to identify countries in sub-Saharan Africa that might be particularly vulnerable to losses in soil microbial ecology and productivity due to climate change. Considering the reliance of many economies in the region on rain-fed agriculture, this study provides crucial information to support conservation efforts in the countries that will be most heavily impacted by climate change. 7-56gN9kgY7V6d-qS7zN26 Video Abstract [ABSTRACT FROM AUTHOR]

This project aims to assess and analyse the perception and impact of the COVID-19 pandemic in Benin. The applied research methodology was interdisciplinary and combined field studies that used ethnographic and social research methods with coding and data analysis, leading to theoretical dilemmas, which were analysed from the viewpoint of bioethical reflection. Furthermore, biomedical engineering approaches were used to assess the preparedness to COVID-19. Despite the preparedness to COVID-19 due to the promoted governmental measures, a peculiar management of the pandemic emerged. The latter, although noteworthy, did not overcome the typical challenges of medical locations in low-resource settings. This, together with the controversial spread of information and local beliefs, caused significant economic and social consequences, exceeding the benefits related to the containment of the virus. This research highlights how the emotion of fear, in this specific situation, was herald of dramatic consequences, rather than having a heuristic and empowering effect. [ABSTRACT FROM AUTHOR]

We examine if having legal documentation of one's property rights reduces women's tolerance of intimate partner violence (IPV) in eight countries in Sub‐Saharan Africa. Whilst property titling may have numerous benefits, decreased justification of IPV does not appear to consistently be one of those benefits. Results indicate that out of eight countries examined, only in Ethiopia and Benin did inclusion of women's names on property titles reduce acceptance of IPV. Our findings reinforce the notion that context matters. Whilst in some countries, policies that promote titling may have positive spillover effects, in other contexts, property titling simply is not enough to counter traditional beliefs that IPV is socially acceptable. [ABSTRACT FROM AUTHOR]

Simple Summary: The detection of fall armyworm (FAW) Spodoptera frugiperda (J.E. Smith, 1797) (Lepidoptera: Noctuidae) in 2016 attacking maize fields in central and west Africa indicated the need to increase the knowledge on the pest host plants and natural enemies adapting to it. A field survey was conducted for two years (from June 2018 to January 2020) to determine host plant and parasitoid records variations across seasons (maize growing and off-seasons) in selected sites in southern and central Benin. A total of eleven new host plant species were reported for the first time, including grasses. The survey revealed seven parasitoid species belonging to four families, namely Platygastridae, Braconidae, Ichneumonidae and Tachinidae, associated with FAW on maize and alternative host plants. The most abundant parasitoid species found was the egg parasitoid Telenomus remus (Nixon) (Hymenoptera: Platygastridae). The study provides crucial information for understanding the bioecology of the pest and for its long-term management using natural enemies. Fall armyworm (FAW) Spodoptera frugiperda (J.E. Smith, 1797) (Lepidoptera: Noctuidae) was recorded for the first time in 2016 attacking maize fields in central and west Africa. Soon after, several other regions and countries have reported the pest in almost the entire sub-Saharan Africa. In the present study, we assumed that (i) a variety of alternative plant species host FAW, especially during maize off-season, (ii) a wide range of local parasitoids have adapted to FAW and (iii) parasitoid species composition and abundance vary across seasons. During a two-year survey (from June 2018 to January 2020), parasitoids and alternative host plants were identified from maize and vegetable production sites, along streams and lowlands, on garbage dumps and old maize fields in southern and partly in the central part of Benin during both maize growing- and off-season. A total of eleven new host plant species were reported for the first time, including Cymbopogon citratus (de Candolle) Stapf (cultivated lemon grass), Bulbostylis coleotricha (A. Richard) Clarke and Pennisetum macrourum von Trinius (wild). The survey revealed seven parasitoid species belonging to four families, namely Platygastridae, Braconidae, Ichneumonidae, and Tachinidae associated with FAW on maize and alternative host plants. The most abundant parasitoid species across seasons was the egg parasitoid Telenomus remus (Nixon) (Hymenoptera: Platygastridae). These findings demonstrate FAW capability to be active during the maize off-season in the selected agro-ecologies and provide baseline information for classical and augmentative biocontrol efforts. [ABSTRACT FROM AUTHOR]

The African weaver ant Oecophylla longinoda builds woven leaf nests inside tree canopies and is a major conservation biocontrol agent in sub‐Saharan Africa. Weaver ant colonies provide well‐protected and resource‐rich environments for many associated trophobionts, thereby boosting their establishment on host plants.There is very little published literature on O. longinoda, their hosts plants and their associated trophobionts in West Africa. These tri‐trophic interactions were studied over a period of four consecutive years (2010–2013) from south to north Benin.Our fieldwork revealed that all O. longinoda colonies were consistently associated with trophobionts. Oecophylla longinoda nests were recorded on 82 plant species belonging to 30 families, with 35 associated trophobiont species representing 11 families.Among cultivated plants, Mangifera indica was the most common species hosting O. longinoda, while Sarcocephalus latifolius the most frequent native one. Among trophobionts, Parasaissetia nigra, Udinia catori, Udinia farquharsoni (Coccidae) and Stictococcus sjostedti (Stictococcidae) were the most common hemipterans associated with O. longinoda.We identified a wide range of host plants that could be preserved (or planted) to promote the establishment of weaver ants to control different insect pests in fruit plantations in sub‐Saharan Africa. When planted around fruit plantations with their nests and tended hemipterans, these host plants could facilitate biocontrol of mango fruit flies (Tephritidae) and cashew bugs (Coreidae, Miridae), by O. longinoda in the fruit plantations. [ABSTRACT FROM AUTHOR]

A recent meta-analysis identified factor structures in IQ-test results from non-western nations similar to those found in samples from western countries, with mostly strong loadings on a general factor. In this study, we identified the factor structure on Raven's Standard Progressive Matrices Plus (SPM+) in two samples of school children from Benin (n = 3 560) and Djibouti (n = 2 768). The SPM+ gained good overall reliabilities in both countries (Cronbach's α = 0.87 for the total samples). However, although Raven's Matrices are assumed by many authors as a good instrument of "g", neither exploratory nor confirmatory factor analyses were able to identify a general factor explaining more than 30% of the total variance. In contrast, our results suggest a three or more factors solution. Doubt regarding the suitability of this test for determining intelligence in sub-Saharan African countries is caused by three factors: (i) decreasing reliability; (ii) increasing number of identified factors when including items with a higher level of difficulty; and (iii) a lack of factor congruence between the two samples. [ABSTRACT FROM AUTHOR]

Social relationships are widely recognized in the achievement of competitive advantages and performance in small-scale farms, particularly in Sub-Saharan Africa. But two questions remain poorly elucidated. What are the specific practices leading to the development of social relationship among small-scale farmers? And what form of social relationship is privileged according to the business context? This paper contributes to this debate by adopting an inductive approach based on an in-depth case study. Empirical data are collected through individual and group interviews with small-scale farmers of Indigenous Leafy Vegetables (ILV) in Benin. Findings support that, in order to improve their competitive advantage and better commercialize their products, small-scale farmers invest in activities that lead to the loyalty or diversification of social ties. When the farmers operate in a low-demand environment, competitive advantage is provided by the loyalty of social ties. When they operate in high-demand environment, they diversify social ties. The implications of these results are that whereas customers' loyalty provides a competitive advantage to farmers in the area where local demand is weak, investment in social network diversification provides a competitive advantage to farmers where strong local demand is evident. [ABSTRACT FROM AUTHOR]

Background Malaria in pregnancy (MiP) contributes significantly to infant mortality rates in sub-Saharan Africa and has consequences on survivors, such as preterm birth and low birth weight. However, its impact on long-term neurocognitive development in children remains unknown. Methods Our prospective cohort included pregnant women and their live-born singletons from the Malaria in Pregnancy Preventive Alternative Drugs clinical trial. MiP was assessed using microscopy and real-time quantitative polymerase chain reaction (qPCR). Neurocognitive development in children was assessed using the Mullen Scales of Early Learning and the Kaufman Assessment Battery for Children, 2nd edition (KABC-II), at 1 and 6 years of age, respectively. Results Of 493 pregnant women, 196 (40%) were infected with malaria at least once: 121 (31%) with placental malaria diagnosed by qPCR. Multiple linear regression B-coefficients showed that impaired gross motor scores were associated with MiP at least once (−2.55; confidence interval [95% CI]: −5.15, 0.05), placental malaria by qPCR (−4.95; 95% CI: −7.65, −2.24), and high parasite density at delivery (−1.92; 95% CI: −3.86, 0.02) after adjustment. Malaria and high parasite density at the second antenatal care visit were associated with lower KABC-II Non-Verbal Index scores at 6 years (−2.57 [95% CI: −4.86, −0.28] and −1.91 [−3.51, −0.32]), respectively. Conclusions This prospective cohort study provides evidence that MiP, particularly late term, could have important negative consequences on child development at 1 and 6 years of age. Mechanisms behind this association must be further investigated and diagnostic methods in low-income countries should be strengthened to provide adequate treatment. Clinical Trials Registration NCT00811421. [ABSTRACT FROM AUTHOR]

Most youths in developing countries leave school with only a general academic education level, slowing down their transition to the labour market. We analyse whether work experience during school can ease youth transition to first job in Benin. Using data from the 2014 School‐to‐Work Transition Survey (SWTS), we estimate a three‐equation model to control for endogenous treatment assignment and sample selection and a hazard frailty model. We find that working while studying eases transition from school to first job. However, these findings were significant only for men and youth who left school with at least a secondary education. [ABSTRACT FROM AUTHOR]

Introduction: Identifying and understanding the factors associated with homebirths can contribute to improving maternal and child health and achieving the Sustainable Development Goals (SDGs). This study aimed to perform a comparative analysis of the factors associated with homebirths in Benin and Mali. Method: This study is based on the most recent data from the Demographic Health Surveys conducted in Mali and Benin in 2018. The dependent variable was homebirth, and the explanatory variables were the individual characteristics of the woman, the distance to the health center, the place of residence, the number of prenatal consultations had, the frequency of media exposure, and the use of the Internet. The primary survey unit (PSU) was considered in the analysis to measure the effect of context on the choice of the place of delivery. Further, descriptive statistics and multilevel logistic regression analysis were used in the study. Results: Educational level was associated with homebirth in Benin and Mali; Women with either no education or primary education are more likely to give birth at home. Women who didn't live close to a health facility were more likely to give birth at home than those who didn't face this problem in both countries. Not making visits for antenatal care (ANC) increases the odds of having a homebirth by 31.3 times (CI = 24.10-40.70) in Benin and 12.91 times (CI = 10.21-16.33) in Mali. Similarly, women who went on 1-2 ANC visits were more likely to give birth at home compared with women who made five or more ANC visits in both countries. The number of children per woman was also a significant factor in both countries. Women who often or regularly paid attention to the media messages were less likely to give birth at home compared with those who did not follow relevant media inputs (aOR = 0.42 [CI = 0.26-0.67] in Benin and aOR = 0.65 [CI = 0.50-0.85] in Mali). Conclusion: Increasing the demand and uptake of women's health services by improving the availability and quality of services and establishing community health centers could help reduce the incidence of homebirths that can be risky and, thus, combat maternal and infant mortality. [ABSTRACT FROM AUTHOR]

Background: Although global surveillance of antimicrobial resistance (AMR) is considered key in the containment of AMR, data from low- and middle-income countries, especially from sub-Saharan Africa, are scarce. This study describes epidemiology of bloodstream infections and antimicrobial resistance rates in a secondary care hospital in Benin.Methods: Blood cultures were sampled, according to predefined indications, in BacT/ALERT FA Plus and PF Plus (bioMérieux, Marcy-l'Etoile, France) blood culture bottles (BCB) in a district hospital (Boko hospital) and to a lesser extent in the University hospital of Parakou. These BCB were incubated for 7 days in a standard incubator and twice daily inspected for visual signs of growth. Isolates retrieved from the BCB were processed locally and later shipped to Belgium for reference identification [matrix-assisted laser desorption/ionization time-of-flight spectrometry (MALDI-TOF)] and antibiotic susceptibility testing (disk diffusion and E-tests).Results: From October 2017 to February 2020, 3353 BCB were sampled, corresponding to 3140 blood cultures (212 cultures consisting of  > 1 BCB) and 3082 suspected bloodstream infection (BSI) episodes. Most of these cultures (n = 2471; 78.7%) were sampled in children < 15 years of age. Pathogens were recovered from 383 (12.4%) cultures, corresponding to 381 confirmed BSI. 340 of these pathogens were available and confirmed by reference identification. The most common pathogens were Klebsiella pneumoniae (n = 53; 15.6%), Salmonella Typhi (n = 52; 15.3%) and Staphylococcus aureus (n = 46; 13.5%). AMR rates were high among Enterobacterales, with resistance to third-generation cephalosporins in 77.6% of K. pneumoniae isolates (n = 58), 12.8% of Escherichia coli isolates (n = 49) and 70.5% of Enterobacter cloacae isolates (n = 44). Carbapenemase production was detected in 2 Escherichia coli and 2 Enterobacter cloacae isolates, all of which were of the New Delhi metallo-beta lactamase type. Methicillin resistance was present in 22.4% of S. aureus isolates (n = 49).Conclusion: Blood cultures were successfully implemented in a district hospital in Benin, especially among the pediatric patient population. Unexpectedly high rates of AMR among Gram-negative bacteria against commonly used antibiotics were found, demonstrating the clinical and scientific importance of clinical bacteriology laboratories at this level of care. [ABSTRACT FROM AUTHOR]

Background: Globally distributed with variable prevalence depending on geography, toxoplasmosis is a zoonosis caused by an obligate intracellular protozoan parasite, Toxoplasma gondii. This disease is usually benign but poses a risk for immunocompromised people and for newborns of mothers with a primary infection during pregnancy because of the risk of congenital toxoplasmosis (CT). CT can cause severe damage to fetuses-newborns. To our knowledge, no study has been conducted in sub-Saharan Africa on toxoplasmosis seroprevalence, seroconversion and CT in a large longitudinal cohort and furthermore, no observation has been made of potential relationships with malaria. Methods: We performed a retrospective toxoplasmosis serological study using available samples from a large cohort of 1,037 pregnant women who were enrolled in a malaria follow-up during the 2008–2010 period in a rural area in Benin. We also used some existing data to investigate potential relationships between the maternal toxoplasmosis serological status and recorded malaria infections. Results: Toxoplasmosis seroprevalence, seroconversion and CT rates were 52.6%, 3.4% and 0.2%, respectively, reflecting the population situation of toxoplasmosis, without targeted medical intervention. The education level influences the toxoplasmosis serological status of women, with women with little or no formal education have greater immunity than others. Surprisingly, toxoplasmosis seropositive pregnant women tended to present lower malaria infection during pregnancy (number) or at delivery (presence) and to have lower IgG levels to Plasmodium falciparum Apical Membrane Antigen 1, compared to toxoplasmosis seronegative women. Conclusions: The high toxoplasmosis seroprevalence indicates that prevention against this parasite remains important to deploy and must be accessible and understandable to and for all individuals (educated and non-educated). A potential protective role against malaria conferred by a preexisting toxoplasmosis infection needs to be explored more precisely to examine the environmental, parasitic and/or immune aspects. [ABSTRACT FROM AUTHOR]

Socio-demographic factors are often responsible for the persistent neglect of orphan crops such as Kersting's groundnut (Macrotyloma geocarpum) in sub-Saharan Africa. The objective of this study was to investigate the influence of socio-demographic factors on production of Kersting's groundnut (KG), as a basis for informing policy and development efforts in Benin. Data were collected from 305 randomly selected respondents from three major KG growing areas of Benin (Zou, Collines and Plateau). Descriptive statistics, analysis of variance, ordered logit models and Kendall's coefficient of concordance were used to analyse data, rank and prioritise production constraints across sociodemographic clusters. Factors such as land tenure, farm size, farming experience, education level, age and location had significant positive influence on cultivated KG plot size. Similarly, gender, education level and membership to cooperative groups had positive effects on farmer-reported yield. Furthermore, location in the department of Zou had a negative effect on reported yield. Production activities (sowing and harvesting) were significantly influenced by gender and education level. The most significant constraints were damage due to transhumance, lack of quality seed, changing rainfall patterns, production complexity and poor access to credit and land. Strategic actions for boosting KG productivity should include use of improved varieties, sustainable seed system, appropriate crop management practices, and improved access to credit. [ABSTRACT FROM AUTHOR]

Background: Insufficient reductions in maternal and neonatal deaths and stillbirths in the past decade are a deterrence to achieving the Sustainable Development Goal 3. The majority of deaths occur during the intrapartum and immediate postnatal period. Overcoming the knowledge-do-gap to ensure implementation of known evidence-based interventions during this period has the potential to avert at least 2.5 million deaths in mothers and their offspring annually. This paper describes a study protocol for implementing and evaluating a multi-faceted health care system intervention to strengthen the implementation of evidence-based interventions and responsive care during this crucial period.Methods: This is a cluster randomised stepped-wedge trial with a nested realist process evaluation across 16 hospitals in Benin, Malawi, Tanzania and Uganda. The ALERT intervention will include four main components: i) end-user participation through narratives of women, families and midwifery providers to ensure co-design of the intervention; ii) competency-based training; iii) quality improvement supported by data from a clinical perinatal e-registry and iv) empowerment and leadership mentoring of maternity unit leaders complemented by district based bi-annual coordination and accountability meetings. The trial's primary outcome is in-facility perinatal (stillbirths and early neonatal) mortality, in which we expect a 25% reduction. A perinatal e-registry will be implemented to monitor the trial. Our nested realist process evaluation will help to understand what works, for whom, and under which conditions. We will apply a gender lens to explore constraints to the provision of evidence-based care by health workers providing maternity services. An economic evaluation will assess the scalability and cost-effectiveness of ALERT intervention.Discussion: There is evidence that each of the ALERT intervention components improves health providers' practices and has modest to moderate effects. We aim to test if the innovative packaging, including addressing specific health systems constraints in these settings, will have a synergistic effect and produce more considerable perinatal mortality reductions.Trial Registration: Pan African Clinical Trial Registry ( www.pactr.org ): PACTR202006793783148. Registered on 17th June 2020. [ABSTRACT FROM AUTHOR]

Background Harmful maternal and neonatal health outcomes result from malaria in pregnancy, the prevention of which primarily relies on intermittent preventive treatment in pregnancy (IPTp) with sulfadoxine-pyrimethamine (SP). The World Health Organization recommends IPTp-SP in sub-Saharan Africa, but implementation is highly heterogeneous and often suboptimal in terms of the number of doses and their timing. In this study, we assessed the impact of this heterogeneity on malaria in pregnancy, mainly with respect to submicroscopic Plasmodium falciparum infections. Methods We used data from 273 Beninese women followed throughout pregnancy. Screening for P. falciparum infections, using both microscopy-based and polymerase chain reaction (PCR)–based methods, was performed monthly, and information on IPTp-SP doses was collected. Gestational age was estimated by repeated ultrasound scans. Using a negative binomial model, we investigated the effect of IPTp-SP doses and timing after 17 weeks of gestation on the number of P. falciparum infections, focusing on submicroscopic infections detectable only by PCR. Results At least 2 IPTp-SP doses were taken by 77.3% of the women. The median gestational age at the first IPTp-SP dose was 22 weeks. A late first IPTp-SP dose (>21.2 weeks) was marginally associated with an increased number of P. falciparum infections (adjusted incidence rate ratio [aIRR] = 1.3; P  = .098). The number of IPTp-SP doses was not associated with the number of submicroscopic infections (aIRR = 1.2, P  = .543). Conclusions A late first IPTp-SP dose failed to provide optimal protection against P. falciparum , especially submicroscopic infections. This highlights the need for a new antimalarial drug for IPTp that could be taken early in pregnancy. [ABSTRACT FROM AUTHOR]

Background: Patient autonomy is central to the provision of respectful maternity care. Enabling women to make decisions free of discrimination and coercion, and respecting their privacy and confidentiality can contribute to positive childbirth experiences. This study aimed to deepen the understanding of how patient autonomy is reflected through social practices during intrapartum care in Benin., Methods: Semi-structured interviews with women and midwives, a focus-group discussion with women's birth companions, and non-participant observations in the delivery room were conducted within the frame of the ALERT research project. This study analysed data through a reflexive thematic analysis approach, in line with Braun and Clarke., Results: We identified two themes and five sub-themes. Patient autonomy was systemically suppressed over the course of birth as a result of the conditions of care provision, various forms of coercion and women's surrendering of their autonomy. Women used other care practices, such as alternative medicine and spiritual care, to counteract experiences of limited autonomy during intrapartum care., Conclusions: The results pointed to women's experiences of limited patient autonomy and their use of alternative and spiritual care practices to reclaim their patient autonomy. This study identified spiritual autonomy as an emergent dimension of patient autonomy. Increasing women's autonomy during childbirth may improve their experiences of childbirth, and the provision of quality and respectful maternity care., (© 2024. The Author(s).)

Objectives: Research on psychological distress in African students is scarce. This study aimed at exploring the epidemiology (prevalence and correlates) of depressive symptoms among undergraduate health sciences students at the University of Parakou (Benin)., Methods: We conducted a cross-sectional survey from June to July 2022 at the University of Parakou, the second-largest university in the Republic of Benin. Depressive symptoms were assessed using the Patient Health Questionnaire depression scale (PHQ-9). Information on several independent factors was collected and their associations with depressive symptoms were investigated using logistic regression models., Results: Data from 560 students were analyzed (mean age: 21.3± 2.3 years, 60 % were male, and 50.4 % were registered in the first year of study). The overall prevalence of depressive symptoms was 39.1 % [95 % CI: 35.2 %-43.1 %]. Moderate and severe depressive symptoms were observed in 15.3 % and 1.8 % of participants, respectively. In the multivariable model, being aged 21-23 (adjusted Odds Ratio=1.8, p-value: 0.007), a female (aOR=1.5, p-value: 0.050), a medical student (aOR=2.9, p-value: <0.001), a public health student (aOR=3.6, p-value: <0.001), belonging to households with higher incomes (aOR= 2.4, p<0.001), and experiencing stress (aOR=1.5, p-value: 0.048) independently increased the probability of having depressive symptoms. However, having support from close relatives (aOR= 0.5, p-value: 0.026) was associated with a lower probability of depressive symptoms., Conclusions: Our findings revealed a high prevalence of depressive symptoms among undergraduate health science students. Given the correlates identified, actions to promote coping skills in stress and encourage more parental support may be real avenues likely to help reduce the frequency and consequences of depressive symptoms., Competing Interests: Declaration of competing interest The authors report no competing interests to declare., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

Entrepreneurship in the sub-Saharan African agricultural sector has been growing in recent years because of increasing unemployment and underemployment. In Benin, policies and programs are encouraging individuals to start their own agribusinesses. To further sharpen these policies and programs to improve agricultural entrepreneurship's contribution to the economy, it is essential to avail information on the entrepreneurs, their businesses, and the typologies of agribusinesses. Such information is limited, which reduces the ability to develop evidence-informed policies and programs. This research aims to fill the gaps by describing the features of agricultural entrepreneurs in Benin. A random sample of819 agricultural entrepreneurs was used, and data were collected on entrepreneurs and their businesses. Descriptive analysis and hierarchical clustering of principal components were performed. The study found that women's participation in agricultural entrepreneurship in terms of new business formation is still low. Also, the agricultural entrepreneurs are more driven by necessity than opportunity, although they have a highly positive personality, mainly in terms of optimism and risk. At the enterprise level, most agribusinesses have been in operation for more than three years, but only one out of ten entrepreneurs felt that their business was at a mature phase. The research also evidenced that informality in the agribusiness sector is high because almost half of the agribusinesses were not registered with any formal governmental entity, and only three out of ten complied with tax regulations. Agricultural entrepreneurs were active in knowledge networks to expand their activities and improve their performance. Three categories of agribusiness were defined with the cluster analysis: 'informal agribusinesses' essentially built for profit, not registered, and owned by not highly educated adult entrepreneurs; 'professional new agribusinesses' were mainly operated by young entrepreneurs with a university education and agricultural professional training; and 'mature agribusinesses' were mostly formally registered and owned by highly educated entrepreneurs. This research will be instrumental for policymakers and practitioners to better understand agricultural entrepreneurship and improve its economic outcomes. It provides a strong evidence base to support the ongoing motivation of policymakers to provide solutions to unemployment and underemployment through agricultural entrepreneurship. [ABSTRACT FROM AUTHOR]

Introduction: diabetes mellitus (DM) and Obstructive Sleep Apnea (OSA) are two major and interconnected non-communicable diseases. Both negatively impact on sleep quality. This study aimed to determine among persons with type 2 DM, the proportions at high risk of OSA and of self-reported poor sleep quality along with their associated-factors in Parakou city, Benin. Methods: this was a cross-sectional prospective study of 100% (n=383) outpatient adults with type 2 DM, conducted between April and August 2019 in the three top centres managing diabetic persons in Parakou city. They were interviewed, examined and investigated using capillary fasting blood glucose tests. The STOP-Bang Questionnaire (SBQ) was used to determine the risk of OSA. Results: overall, their mean age was 57.37 (11.45) years. They were 61.62% (n=236) females and 38.38% (n=147) males. Sleep duration was insufficient in 26.89% (n=103). Nocturia was reported in 49.35% (n=189). The risk of OSA was high in 14.10% (n=54), intermediate in 24.80% (n=95) and low in 61.10% (n=234). Friedman Position Tongue Grade 3 (Adjusted Odds Ratio, aOR=2.48; 95%CI=1.11 - 5.55; p=0.025) and 4 (aOR=4.65; 95%CI=1.26 - 15.90; p=0.015) were independently associated with a high risk of OSA. The prevalence of reported poor sleep quality was 27.42% (n=105). Female gender (aOR=2.08; 95%CI=1.18-3.83; p=0.014), diabetic foot (aOR=5.07; 95%CI=1.15-23.63; p=0.031), nocturia (aOR=1.96; 95%CI=1.18-3.29; p=0.010), tiredness (aOR=2.77; 95%CI=1.26-6.23; p=0.012) and a high risk of OSA (aOR=3.31; 95%CI=1.28-8.93; p=0.015) were independently associated with a greater risk of reported poor sleep quality. Conclusion: in Parakou, the proportions of patients with type 2 DM at increased risk of OSA and with poor quality of sleep are relatively high. There is need for better systematic screening of OSA in persons with DM. [ABSTRACT FROM AUTHOR]

Introduction: hepatitis C is a public health problem worldwide, in particular in sub-Saharan Africa. The purpose of this study is to determine the seroprevalence of hepatitis C virus antibodies and associated factors during a voluntary general population screening program in Benin. Method: we conducted a descriptive and analytical cross-sectional study in 4 big cities of 4 different departments in Benin in July 2016. All volunteers of all ages, residing in these targeted cities, who gave their informed consent were included in the study. ImuMed HCV Rapid Diagnostic Test (Healgen Scientific LLC, USA) was used. Logistic regression analysis was also used to identify factors associated with hepatitis C virus infection. Results: a total of 2809 volunteers with an average age of 25.9 ± 16.5 years (ranging from 0 to 86 years) were included in the study; 53.9% (1514/2809) of them were men and 46.1% (1295/2809) were women. More than half of the study population consisted of single (59.1%; 1612/2726); 41.3% (1074/2809) were pupils or students. VHC Seroprevalence was 1.5% (42/2809). In multivariate analysis, the variables significantly associated with anti-HCV carriage were: be 60 years old and older (aOR: 46.9, 95% CI 10.2-216.0; p<0.0001) and a history of alcoholism (aOR: 6.3; 95% CI 95% 3.3-12.1; p < 0.0001). Conclusion: in the general population, the seroprevalence of anti-HCV antibodies was 1.5%. HCV infection mainly occurred in people aged 60 years and older and in those with a history of alcoholism. [ABSTRACT FROM AUTHOR]

The decline of soil fertility is a major constraint which results in lower levels of crop productivity, agricultural development and food security in Sub-Saharan Africa. This study is the first to perform a focalized investigation on the most interesting technological profiles to offer to each category of producers in Benin agricultural development hubs (ADHs) using the stated preference method, more precisely, the improved choice experiment method. The investigation focused on 1047 sampled plots from 962 randomly selected producers in villages of the Smallholder Agricultural Productivity Enhancement Program in Sub-Saharan Africa of the ADHs. An analysis of the experimental choice data with the endogenous attribute attendance and the latent class models was carried out to account for the attribute non-attendance phenomenon and the heterogeneity of the producers' preferences. However, three classes of producer with different socio-economic, demographic, and soil physicochemical characteristics were identified. Thus, the heterogeneity of preferences was correlated with the attributes linked to the cost, sustainability, and frequency of plot maintenance. All producers, regardless of the ADHs, had a strong attachment to accessibility of technologies with short time restoration of soil fertility, and the ability to obtain additional benefits. These latest attributes, added to that relating to cost, tended to have a low probability of rejection in the decision-making process. These results have implications for local decision-makers facing the complex problem of resolving land degradation and local economic development challenges. The generalizability of these findings provides useful insight and direction for future studies in Sub-Saharan Africa. [ABSTRACT FROM AUTHOR]

Background: Cervical cancer (CC) is the most common female cancer in many countries of sub‐Saharan Africa (SSA). We assessed treatment guideline adherence and its association with overall survival (OS). Methods: Our observational study covered nine population‐based cancer registries in eight countries: Benin, Ethiopia, Ivory Coast, Kenya, Mali, Mozambique, Uganda, and Zimbabwe. Random samples of 44–125 patients diagnosed from 2010 to 2016 were selected in each. Cancer‐directed therapy (CDT) was evaluated for degree of adherence to National Comprehensive Cancer Network (U.S.) Guidelines. Results: Of 632 patients, 15.8% received CDT with curative potential: 5.2% guideline‐adherent, 2.4% with minor deviations, and 8.2% with major deviations. CDT was not documented or was without curative potential in 22%; 15.7% were diagnosed with International Federation of Gynecology and Obstetrics (FIGO) stage IV disease. Adherence was not assessed in 46.9% (no stage or follow‐up documented, 11.9%, or records not traced, 35.1%). The largest share of guideline‐adherent CDT was observed in Nairobi (49%) and the smallest in Maputo (4%). In patients with FIGO stage I–III disease (n = 190), minor and major guideline deviations were associated with impaired OS (hazard rate ratio [HRR], 1.73; 95% confidence interval [CI], 0.36–8.37; HRR, 1.97; CI, 0.59–6.56, respectively). CDT without curative potential (HRR, 3.88; CI, 1.19–12.71) and no CDT (HRR, 9.43; CI, 3.03–29.33) showed substantially worse survival. Conclusion: We found that only one in six patients with cervical cancer in SSA received CDT with curative potential. At least one‐fifth and possibly up to two‐thirds of women never accessed CDT, despite curable disease, resulting in impaired OS. Investments into more radiotherapy, chemotherapy, and surgical training could change the fatal outcomes of many patients. Implications for Practice: Despite evidence‐based interventions including guideline‐adherent treatment for cervical cancer (CC), there is huge disparity in survival across the globe. This comprehensive multinational population‐based registry study aimed to assess the status quo of presentation, treatment guideline adherence, and survival in eight countries. Patients across sub‐Saharan Africa present in late stages, and treatment guideline adherence is remarkably low. Both factors were associated with unfavorable survival. This report warns about the inability of most women with cervical cancer in sub‐Saharan Africa to access timely and high‐quality diagnostic and treatment services, serving as guidance to institutions and policy makers. With regard to clinical practice, there might be cancer‐directed treatment options that, although not fully guideline adherent, have relevant survival benefit. Others should perhaps not be chosen even under resource‐constrained circumstances. With a multinational collection of registry data and multimodal evaluation of degree of therapy guideline adherence, this study adds population‐based evidence on the status of cervical cancer care and outcomes in the setting of sub‐Saharan Africa. [ABSTRACT FROM AUTHOR]

Innovating is vital to farmers in sub-Saharan Africa, to adapt to challenges and benefit from opportunities. Stakeholders' decisions to engage in innovation programmes are influenced by their perceptions. This article uses the Q-method application to investigate these perceptions along the swine value chain in Benin. Fifty-five statements were established with local stakeholders and then graded by 25 interviewees on an 11-grade scale. Three main discourses were identified: an optimistic discourse tied to an endogenous vision of innovation, and a pessimistic one to a top-down, exogenous vision. A third discourse highlighted more nuanced redistributive effects of innovation. Innovation platform projects, stimulating local innovation, should rest on and reinforce the first optimistic discourse. [ABSTRACT FROM AUTHOR]

Background: An estimated 30% of women in Sub-Saharan Africa suffer from soil-transmitted helminth infection during pregnancy (SHIP), which has been shown to increase risk of pre-term birth, low birth weight, and maternal anemia. A previous study in Benin found that SHIP was associated with impaired cognitive and gross motor development scores in 635 one-year-old children. The objective of the present study was to follow children prospectively to investigate whether the association between SHIP and child neurocognitive and behavioral development persisted at age six. Principal findings: Our prospective child cohort included 487 live-born singletons of pregnant women enrolled in the Malaria in Pregnancy Preventive Alternative Drugs clinical trial in Allada, Benin. SHIP was assessed at three antenatal visits (ANVs) through collection and testing of stool samples. Neurocognitive and behavioral development was assessed in six-year-old children by trained investigators using the Kaufman Assessment Battery for Children 2nd edition and the parent-reported Strengths and Difficulties Questionnaire (SDQ). Multiple linear regression models generated coefficients and 95% confidence intervals and potential mediating factors were tested. Prevalence of SHIP was 13% at the 1st ANV, 9% at the 2nd ANV, and 1% at delivery. SHIP was not associated with low neurocognitive scores in children at six years. Higher SDQ internalizing scores, indicating increased emotional impairments in children, were associated with helminth infection at the 2nd ANV/delivery 1.07 (95% CI 0.15, 2.00) and at least once during pregnancy 0.79 (95% CI 0.12, 1.46) in adjusted models. Mediation analysis did not reveal significant indirect effects of several mediators on this association. Conclusions: Our study shows that while SHIP is not associated with impaired long-term neurocognitive development, infections may have significant negative impacts on emotional development in six-year-old children. SHIP remains a critical public health issue, and adequate prevention and treatment protocols should be enforced in low- and middle-income countries. Author summary: Soil-transmitted helminth infections impact 1.5 billion individuals, primarily in low- and middle- income countries, each year and contribute to malnutrition, anemia, and impaired neurocognitive development in children. However, these infections in pregnancy and their impact on offspring have been less studied. One previous study found associations between soil-transmitted helminth infection during pregnancy and impaired cognitive functioning in offspring one year after birth. The current study aimed to follow these children prospectively until six years in order to confirm whether these associations persisted or not. Infections during pregnancy were no longer associated with cognitive or motor functioning in children; however, infections were associated with impaired behavioral development. Animal-based models have hypothesized maternal inflammation and poor birth outcomes to be the mechanisms behind this relationship; however, our findings did not support these mechanisms. This is one of very few prospective cohort studies in Sub-Saharan Africa to investigate these associations, and more research is needed to corroborate results. Limitations include limited power and the possibility that results are due to chance from multiple statistical tests. Adequate and accessible prevention and treatment efforts in pregnancy and childhood should be provided to populations in low- and middle- income countries at high risk of infection. [ABSTRACT FROM AUTHOR]

Training videos are extension tools that help to compensate for the low ratio of extensionists to farmers in most developing countries. This article reports on a study that aimed to understand the effects of images and languages used in a video on farmers' learning. The research involved 135 rice farmers in Benin Republic, and found that videos in the local language significantly improved assimilation and understanding. Repeated screenings increase farmers' learning, regardless of the language used, as videos allow learning from images. Farmers' associations and peer groups ensure better appropriation and dissemination of the knowledge gained from the videos by providing frameworks for discussion. [ABSTRACT FROM AUTHOR]