Search

Background: Objective assessment of skills after training is essential for safe implementation of lung point-of-care ultrasound (POCUS). In low-and middle-income countries (LMIC) there is a need for assessment tools without onsite experts to scale up POCUS access. Our objective is to develop a web-based assessment tool and evaluate trainees across different countries and at different time points after initial lung POCUS training., Methods: We adapted the objective and validated lung ultrasound score (LUS-OSAUS) to a web-based tool with quiz and practical skills test. Trainees were evaluated after a short (4-day) standardized lung POCUS training and were classified in distinct groups according to (i) their geographical location (Benin vs. South-Africa) and (ii) time elapsed since training (Benin 0 months vs. Benin 6 months). The Benin 6 months group had minimal continuous education. Skills test images were read by two blinded experts. We report the overall success rates and then compare these rates based on location and timing since training, using the Fischer's exact test., Results: A total of 35 out of 43 participants completed the online LUS-OSAUS quiz and skills test. The overall success rate was 0.84 (95%CI 0.80-0.88), with lower success rates for "correct depth" 0.54 (0.37-0.71), "correct assessment of pleura" 0.63 (0.45-0.79) and "conclusion" 0.71 (0.54-0.85). There were no differences based on location, with respective rates of 0.86 (0.80-0.92) and 0.83 (0.75-0.91) (p-value = 0.125) for Benin and South Africa at 0 months, respectively. Similarly, there were no differences according to timing with success rates of 0.86 (0.80-0.92) and 0.82 (0.72-0.93) (p-value = 0.563) for Benin at 0 months and 6 months, respectively., Conclusion: Web-based objective and structured assessment of lung POCUS skills in LMIC following a short-standardized training is feasible and has a good overall success rate with consistent results across regions and up to 6 months after training given minimal continuous education. Overall, technical and POCUS-based clinical conclusion skills are the most difficult to acquire., (© 2024. The Author(s).)

Drug-resistant tuberculosis (DR-TB) poses a significant public health challenge, particularly in resource-limited settings. The prevalence and management of DR-TB in African countries require comprehensive strategies to improve patient outcomes and control the spread of the disease. Aggregated routine data (from 2018 to 2022) on multidrug-resistant TB (MDR-TB) were collected from the National TB Programs (NTPs) from all six countries. The diagnostic capacity for MDR-TB was globally insufficient. The system for collecting and transporting samples was sometimes inoperative. A total of 2353 cases of MDR-TB were reported, with 86.4% receiving treatment. The gap between the expected number of MDR-TB cases and the number reported per country varied from 51.5% to 88.0%, depending on the year. Fifty-two extensively drug-resistant (XDR) TB cases received treatment regimens over five years, with variations across countries. All patients received free follow-up examinations, nutritional and financial support for travel expenses to the outpatient care and treatment centers. The MDR-TB treatment success rates for all regimens between 2018 and 2021 ranged from 44.4 to 90.9%, varying by country and year. The information system relied on primary tools, reporting tools, and digital solutions. Progress has been made in MDR-TB management; however, challenges persist, necessitating resources to enhance access to rapid molecular screening tests.

The objective of this study was to assess tobacco use (TU) behaviors among newly diagnosed pulmonary TB (PTB) patients and identify associated factors in Benin and Burkina Faso. A cross-sectional study was conducted in 20 randomly selected TB clinics. To ensure a representative study cohort, clinics were stratified during the sampling process. PTB patients were consecutively sampled in 20 of the clinics between 1 December 2021 and 30 September 2022. The study population comprised individuals aged 15 years and above who were newly diagnosed with PTB. Among the 1399 registered PTB patients, 564 (40.3%) reported a history of TU, including 392 (28.0%) current tobacco users and 172 ex-tobacco users. Cigarettes emerged as the predominant form of TU (86.2%), followed by smokeless tobacco (6.4%), and chicha smoking (2.6%). Factors independently associated with tobacco use were male gender ( p < 0.001), being in Burkina Faso ( p < 0.001), and an age of 25-59 years ( p = 0.002). Our multicentric study reveals a substantial prevalence of tobacco use among TB patients, with cigarette smoking emerging as the predominant form. These findings underscore the imperative for implementing targeted cessation interventions within TB control programs. Special emphasis is warranted for male patients aged 25-59 years.

Background: Tuberculosis (TB) is a public health problem worldwide, particularly in resource-limited countries. It is considered a social disease with a medical component that persists over time due to several social determinants, most of which are closely linked to poverty and difficult socioeconomic conditions. The objective of this exploratory study is to describe the social protection interventions available for people with TB in Africa., Methods: Searches will be carried out systematically in MEDLINE (PubMed), Embase (Ovid), Web of Science, Scopus and The Cochrane Library, Africa-Wide Information (EBSCOhost), Google Scholar. Articles will be considered if they describe the social protection, successes and challenges associated with the implementation and delivery of social protection interventions offered to people with TB in African countries. Data from the grey literature will also be considered., Presentation of Results: We will present a narrative description highlighting the successes and challenges of the social protection interventions identified, and a synthesis accompanied by maps (Africa), figures or tables to summarize the data., Conclusion: This exploratory study will map the existing literature on social protection interventions for TB patients and guide future research to inform policy and practice decisions., Competing Interests: The Authors declare that no competing interest exists, (Copyright © 2024 by West African Journal of Medicine.)

Objectives: Owing to its ease-of-use and excellent diagnostic performance for the assessment of respiratory symptoms, point-of-care lung ultrasound (POC-LUS) has emerged as an attractive skill in resource-low settings, where limited access to specialist care and inconsistent radiology services erode health equity.To narrow down the research to practice gap, this study aims to gain in-depth insights in the perceptions on POC-LUS and computer-assisted POC-LUS for the diagnosis of lower respiratory tract infections (LRTIs) in a low-income and middle-income country (LMIC) of sub-Saharan Africa., Design and Setting: Qualitative study using face-to-face semi-structured interviews with three pneumologists and five general physicians in a tertiary centre for pneumology and tuberculosis in Benin, West Africa. The center hosts a prospective cohort study on the diagnostic performance of POC-LUS for LRTI. In this context, all participants started a POC-LUS training programme 6 months before the current study. Transcripts were coded by the interviewer, checked for intercoder reliability by an independent psychologist, compared and thematically summarised according to grounded theory methods., Results: Various barriers- and facilitators+ to POC-LUS implementation were identified related to four principal categories: (1) hospital setting (eg, lack of resources for device renewal or maintenance-, need for POC tests+), (2) physician's perceptions (eg, lack of opportunity to practice-, willingness to appropriate the technique+), (3) tool characteristics (eg, unclear lifespan-, expedited diagnosis+) and (4) patient's experience (no analogous image to keep-, reduction in costs+). Furthermore, all interviewees had positive attitudes towards computer-assisted POC-LUS., Conclusions: There is a clear need for POC affordable lung imaging techniques in LMIC and physicians are willing to implement POC-LUS to optimise the diagnostic approach of LRTI with an affordable tool. Successful integration of POC-LUS into clinical routine will require adequate responses to local challenges related to the lack of available maintenance resources and limited opportunity to supervised practice for physicians., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Context Bronchial cancer in a person under 30 years of age is quite rare. It generally occurs after 40 years of age following heavy smoking intoxication. We report a clinical case illustrating the early onset of a small cell lung carcinoma in young heavy smoker. CASE REPORT: A 30-year-old patient, current smoker for about 10 years (15 packs/year), consulted for a cough with haemoptotic sputum. Clinical and paraclinical examinations diagnosed small cell carcinoma of the right lung with some controlatéral metastatic nodules. . He was classified as stage T2bN2M1a. Unfortunately, due to lack of financial accessibility to suitable chemotherapy, the patient died after one month. CONCLUSION: Early-onset of bronchial carcinoma in young smokers calls for strengthened control of teenage tobacco use, especially in Africa, where the phenomenon has been taking on alarming proportions., (Copyright © 2022 SPLF. All rights reserved.)

Point-of-care ultrasound (POCUS) is an increasingly accessible skill, allowing for the decentralization of its use to nonspecialist healthcare workers to guide routine clinical decision-making. The advent of ultrasound-on-a-chip has transformed the technology into a portable mobile health device. Because of its high sensitivity to detect small consolidations, pleural effusions, and subpleural nodules, POCUS has recently been proposed as a sputum-free likely triage tool for tuberculosis (TB). To make an objective assessment of the potential and limitations of POCUS in routine TB management, we present a Strengths, Weaknesses, Opportunities and Threats (SWOT) analysis based on a review of the relevant literature and focusing on Sub-Saharan Africa (SSA). We identified numerous strengths and opportunities of POCUS for TB management, e.g., accessible, affordable, easy to use and maintain, expedited diagnosis, extrapulmonary TB detection, safer pleural/pericardial puncture, use in children/pregnant women/people living with HIV, targeted screening of TB contacts, monitoring TB sequelae, and creating artificial intelligence decision support. Weaknesses and external threats such as operator dependency, lack of visualization of central lung pathology, poor specificity, lack of impact assessments and data from SSA must be taken into consideration to ensure that the potential of the technology can be fully realized in research as in practice., (Copyright © 2022. Published by Elsevier Ltd.)

Background: Data on the prevalence of sleep-disordered breathing (SDB) in the African general population are scarce, and a better understanding is urgently needed. Our study aimed to objectively determine the prevalence of, and factors associated with, SDB in a large sample in Benin, west Africa., Methods: In the Benin Society and Sleep (BeSAS) cross-sectional study, participants aged 25 years and older were recruited from both urban and rural areas. Rural participants were recruited from Tanve, a village located 200 km north of Cotonou, and urban participants were recruited from Cotonou. The participants underwent respiratory polygraphy at home using a type-3 device that measures airflow through a nasal pressure sensor, respiratory effort (thoracic movement), and pulse oximetry. Clinical and morphometric data were also collected. SDB severity categories were defined according to the apnoea-hypopnoea index (AHI), with mild-to-severe SDB (AHI ≥5/h), moderate-to-severe SDB (AHI ≥15/h), and severe SDB (AHI ≥30/h)., Findings: The study was completed from April 4, 2018 to Jan 15, 2021. Of 2909 participants recruited in the BeSAS study, 2168 (74·5%) underwent respiratory polygraphy. For the 1810 participants with complete polygraphic data (mean age 46 years, SD 15; 1163 [64·2%] women), the prevalence of mild-to-severe SDB (AHI ≥5/h) was 43·2% (95% CI 40·9-45·5), of moderate-to-severe SDB (AHI ≥15/h) was 11·6% (10·2-13·1), and of severe SDB (AHI ≥30/h) was 2·7% (2·0-3·5). Factors independently associated with SDB were advanced age, male sex, large neck circumference, abdominal obesity, overweight or obesity, and snoring. After multivariable adjustment, severe SDB was independently associated with hypertension in women (odds ratio 3·99, 95% CI 1·04-15·33; p trend =0·044), but not in men (odds ratio 0·67, 0·22-2·05; P trend =0·63)., Interpretation: The BeSAS study provides the first large-scale objective evaluation of SDB prevalence and associated factors in Africa. The high prevalence of SDB identified should stimulate the development of public health policies to prevent and treat this condition in African countries., Funding: Ligue Pulmonaire Vaudoise, Switzerland., Competing Interests: Declaration of interests RH is member of the medical advisory board of Dreem and Nightbalance (Philips) and received honorariums, grants, or speakers' fees from ResMed, Jazz, Inspire, Philips, and Dreem. All the other authors declare no competing interests., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Introduction: Exposure to electrical and electronic equipment waste (e-waste) has become a growing health concern. The objective of this study was to measure the effect of exposure to e-waste on respiratory symptoms and on lung function parameters in workers involved in informal recycling activities in Cotonou city, Benin., Methods: This was a cross-sectional study, in which exposed e-waste workers in Cotonou city were randomly selected. A matching nonexposed group based on age and sex was recruited from the general population. Respiratory symptoms were investigated using a questionnaire adapted from the British Medical Research Council's standardized respiratory questionnaire. Participants underwent lung function test using a portable spirometer (MIR SPIROBANK). Data were analyzed with STATA version 15 software., Results: The overall prevalence of respiratory symptoms in e-waste workers was statistically higher in the exposed group (33.1% vs. 21.6%; p = 0.027). Chest tightness (11.8% vs. 2.1%; p = 0.003) and breathlessness (6.8% vs. 1.4%; p = 0.018) were the most reported symptoms by e-waste workers. Lung function testing showed a higher proportion of disorders among e-waste workers (25.0% vs. 14.9%, p = 0.029), with a higher proportion of probable restrictive (10.8% vs. 2.7, p = 0.005) and mixed (4.1% vs. 0%, p = 0.013) ventilatory disorders. Handling or working with e-waste was found associated with a significant reduction in forced expiratory volume in one second (FEV1) by 0.4 L (95% CI: 0.3-0.6) and forced vital capacity (FVC) by 0.75 L (95% CI: 0.6-0.9) after adjustment for age, BMI, smoking habits, asthma history, and daily income., Conclusion: Work involving e-waste is associated with a higher prevalence of respiratory symptoms and with an increased risk of FEV1 and FVC decline, as well as of lung function impairment, particularly of restrictive disorders. Further studies to better clarify this association are needed. Awareness on this major public health threat should be raised in other sub-Saharan and Asian urban areas., Competing Interests: The authors have no conflict of interest to declare., (Copyright © 2022 Ablo Prudence Wachinou et al.)

Objectives: We sought to evaluate the yield, cost, feasibility, and acceptability of routine tuberculosis (TB) screening of pregnant women in Cotonou, Benin., Design: Mixed-methods, cross-sectional study with a cost assessment., Setting: Eight participating health facilities in Cotonou, Benin., Participants: Consecutive pregnant women presenting for antenatal care at any participating site who were not in labor or currently being treated for TB from April 2017 to April 2018., Interventions: Screening for the presence of TB symptoms by midwives and Xpert MTB/RIF for those with cough for at least two weeks. Semi-structured interviews with 14 midwives and 16 pregnant women about experiences with TB screening., Primary and Secondary Outcome Measures: Proportion of pregnant women with cough of at least two weeks and/or microbiologically confirmed TB. The cost per pregnant woman screened and per TB case diagnosed in 2019 USD from the health system perspective., Results: Out of 4,070 pregnant women enrolled in the study, 94 (2.3%) had a cough for at least two weeks at the time of screening. The average (standard deviation) age of symptomatic women was 26 ± 5 years and 5 (5.3%) had HIV. Among the 94 symptomatic women, 2 (2.3%) had microbiologically confirmed TB for a TB prevalence of 49 per 100,000 (95% CI: 6 to 177 per 100,000) among pregnant women enrolled in the study. The average cost to screen one pregnant woman for TB was $1.12 USD and the cost per TB case diagnosed was $2271 USD. Thematic analysis suggested knowledge of TB complications in pregnancy was low, but that routine TB screening was acceptable to both midwives and pregnant women., Conclusion: Enhanced screening for TB among pregnant women is feasible, acceptable, and inexpensive per woman screened, however in this setting has suboptimal yield even if it can contribute to enhance TB case finding., Competing Interests: CSM is currently a staff member of the World Health Organization; the author alone is responsible for the views expressed in this publication and they do not necessarily represent the decisions, policy or views of the WHO.

Objectives: Obstructive sleep apnea (OSA) is an underdiagnosed chronic respiratory disease, causing excessive daytime sleepiness (EDS) and road traffic accidents (RTA). This study aimed to determine the risk of OSA among taxi-motorbike drivers (TMD) and factors associated with RTA in Parakou, Benin., Methods: A cross-sectional comparative study was carried out between July and September 2020, including 225 TMD and 450 motorbike drivers other than TMD (non-TMD). A multiple logistic regression was then performed to determine factors associated with RTA., Results: The mean age of participants was 38.2 ± 10.2 and 36.6 ±10.9 years, respectively, for TMD and non-TMD ( p = .048). The average daily working time was 10.7 ± 2.3H and 9.1±3.5H, respectively, for TMD and non-TMD ( p < .001). Average sleeping time was comparable in both groups (7.5±1.4H vs 7.4±1.4H; p = .415). TMD significantly more complained of non-restorative sleep (38.7% vs 18.4%; p < .001) but less of EDS (20.0% vs 28.7%; p = .015). Abdominal obesity predominated in TMD (13.8% vs 4.4%; p < .001). An increased risk of OSA (NoSAS score ≥8) was diagnosed in 25.8% TMD and 26.7% non-TMD ( p = .805). Overall, 25.8% of TMD and 18.4% of non-TMD ( p = .027) reported at least one RTA in the last 12 months. After adjusted analysis, the unique factor associated with RTA was a daily sleeping pills consumption (aOR=2.2; 95%CI = 1.2-3.8; p = .006)., Conclusion: There is need to improve systematic screening and diagnosis of OSA in both TMD and non-TMD and reinforce the regulation and consumption of sleeping pills.

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., (Copyright: Serge Ade et al.)

Purpose: To determine the prevalence of sleep-related disorders, poor sleeping, and factors associated with poor sleep quality among inhabitants of Parakou, Benin., Methods: This was a cross-sectional study conducted from April-August 2018 on 930 randomly selected adults (age ≥ 18 years). Using the Pittsburg Sleep Quality Index, the Insomnia Severity Index, and the Epworth Sleepiness Scale, subjects were questioned on their sleep, on parasomnias, and on movement-related sleep disorders., Results: Overall, the prevalence of insomnia was 22% (95% CI, 19.1-24.4) and severe insomnia was 0.8%. The prevalence of excessive daytime sleepiness was 15% (95% CI, 12.5-17.0). Daily nightmares (2%) and rhythmic movements (6%) were those most commonly reported among parasomnias and movement-related sleep disorders. No major differences were found between men and women. The prevalence of poor sleeping (PSQI > 5) was 39% (95%CI, 36.3-42.5). Adjusted analyses showed a higher risk of poor sleeping in those aged 45-54 years (aOR = 1.78, p = 0.032) or ≥ 55 years (aOR = 3.61, p < 0.001), those overweight or obese (aOR = 1.53, p = 0.007), those underweight (aOR = 2.90, p = 0.030), and among females (aOR = 1.84, p < 0.001). Being divorced was associated with a lower risk of poor sleeping (aOR = 0.18, p = 0.036). Poor sleepers were more commonly found among those who had excessive daytime sleepiness (65% versus 36%, p < 0.001) and insomnia (86% versus 27%, p < 0.001)., Conclusion: Sleep-related disorders were common in Parakou city, Benin, with four out of ten persons having poor sleep quality. There is a need to improve the management of sleep-related disorders and promote better sleep practices for the community., (© 2021. The Author(s), under exclusive licence to Springer Nature Switzerland AG part of Springer Nature.)

Introduction: Contingency measures taken by governments with movement restrictions during the COVID-19 pandemic may create difficulties in conducting some field activities for TB control especially the supervision of Basic Management Units (BMUs). We described in this paper an innovative initiative to conduct remote supervision (Esupervision) using Information and Communication Technology tools., Setting and Method: This initiative was conducted in Benin Republic. To carry out the activity, we used smartphone, WhatsApp® for messaging, CamScanner for scanning (both free applications); and internet connection. BMUs were asked to scan their reports and all necessary documents and sent them by WhatsApp® after scanning. On the day planned for the supervision, the supervisors of each section (clinic, laboratory, food delivery supervision) calls the BMUs health professionals via WhatsApp® video to conduct the activity according to the National Tuberculosis Programme guidelines., Results: Overall, all the main objectives of a supervision were achieved despite some difficulties mainly related to the quality of internet connection. The reports from the different sections were validated for each BMU. For the laboratory activities, general aspects as well as the stock of reagents were evaluated; microcopy fields with an ordinary microscope were visualized. The management of tuberculosis patients was assessed by visualizing the results of bacteriological exams, treatment records, and stocks of medicines., Conclusion: Even though, this activity will probably not replace the traditional face-to-face supervision, it could be used in settings where movements are restricted for several reasons including COVID-19 pandemic, conflicts and natural disasters., Competing Interests: The Authors declare that no competing interest exists, (Copyright © 2021 by West African Journal of Medicine.)

Background: The diagnosis of tuberculosis (TB) using smear microscopy has been based on testing two specimens: one spot and one early morning sputa. Recently, the World Health Organization (WHO) has recommended to replace, whenever possible, microscopy with GeneXpert® MTB/RIF performed on a single specimen. However, as the bacterial load is higher in early morning specimens than in spot specimens, one could expect lower sensitivity of GeneXpert® MTB/RIF performed only on spot specimens. In this study, we compared results of GeneXpert® MTB/RIF on spot specimens versus early morning specimens, under programmatic conditions in Cotonou, Benin., Methods: From June to September 2018, all sputa received from presumptive TB patients at the Supranational Reference Laboratory for Tuberculosis of Cotonou were included in the study. From each patient, two specimens were collected (one spot and one early morning) and GeneXpert® MTB/RIF was performed on both specimens., Results: In total, 886 participants were included in the study, of whom 737 provided both sputa and 149 (16.8%) gave only the spot specimen. For the 737 participants who provided both sputa, GeneXpert® MTB/RIF was positive for both specimens in 152 participants; for three participants GeneXpert® MTB/RIF was positive on spot specimen but negative on morning specimen while for another three, the test was positive on morning specimen but negative on spot specimen. The overall percentage of agreement was excellent (99.2%) with a positive and negative percent agreement greater than 98%., Conclusion: For TB diagnosis under programmatic conditions in Cotonou, GeneXpert® MTB/RIF in spot specimens gave similar results with the test in morning specimens. Performing GeneXpert® MTB/RIF in both specimens did not significantly increase the number of cases detected. To avoid losing patients from the diagnostic cascade, it is preferable to test sputa produced at the time of the first visit at the health center., (© 2021. The Author(s).)

Background and Objectives . There is a dearth of information on asthma among bakers in low-income settings. The objectives of this study were to determine (i) the prevalence of asthma symptoms, (ii) factors associated with probable occupational asthma (OA), and (iii) work habits that might lead to a dusty workplace environment, Parakou, Benin. Materials and Methods . This was a mixed methods (cross-sectional quantitative and qualitative) study carried out between March and September 2018., Results: Of 210 employees/apprentices in 26 bakeries, 190 (91.48%) were included in the study: median age was 25.50 (IQR = 22 - 32) years, 157 (82.63%) were aged <40 years, and the male-to-female ratio was 26.14. Of these, 111 (58.42%) worked in a salted bread and 79 (41.58%) in a sweet bread bakery. An asthma history was reported by 3.68%. Symptoms consistent with asthma, work-related asthma, OA, and work-aggravated asthma were found in 13.68%, 12.63%, 10%, and 2.63%, respectively. Asthma confirmation was obtained in 15.79% of bakers with probable OA and in 23.08% of all bakers with suspected asthma. A history of allergic rhinoconjunctivitis was associated with probable OA (aOR = 106; 95%CI = 17.79 - 2093; p < 0.001). Of the 24 bakers with probable work-related asthma, 3 (12.50%) were prescribed a short-acting beta2-agonist and 2 (8.33%) an inhaled corticosteroid. No worker had had a systematically planned annual medical visit; some habits at work were identified as leading to flour and dust suspension at the workplace., Conclusion: Clinical manifestations of OA were common among bakers in Parakou and were associated with allergic rhinoconjunctivitis. There is a need to improve technical preventive measures and treatment, as well as to institute systematic medical visits for these workers., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2020 Serge Ade et al.)

Introduction: The objective of this study was to determine the prevalence and to assess the control of asthma among students at the faculty of medicine of the university of Parakou in Benin., Methods: This cross-sectional study was carried out between January and November 2017. The Asthma Screening Questionnaire (ASQ) was filled out by medical students, followed by the Asthma Control Test questionnaire for those who were suspected of having clinical asthma (ASQ≥4). All students with clinical asthma or with a history of asthma were invited to perform a spirometry test., Results: Overall, 837 (73.7%) students out of 1136 were included. The prevalence was 9.1% for ever diagnosed asthma, 14% for clinical asthma and 5.3% for confirmed asthma. Among 761 students, without a previous asthma diagnosis, 10.4% had clinical asthma and 3.3% a confirmed asthma. Female sex (aOR=2.1; 95%CI =1.0-4.1), a previous diagnosis of asthma (aOR=7; 95% CI=3.2-15.2) and allergic rhinitis (aOR=3.9; 95% CI=1.9-7.8) were associated with confirmed asthma. Asthma symptoms were controlled in 92 (78.6%) students, partly controlled in 20 (17.1%), and not controlled in 5 (4.3%)., Conclusion: Clinical manifestations of asthma are frequent among medical students at Parakou. Some are not well controlled, suggesting a need for greater awareness and an improvement in clinical follow-up., (Copyright © 2019 SPLF. Published by Elsevier Masson SAS. All rights reserved.)

Introduction: In tropical Africa, allergies are not well documented. The objective of this work was to evaluate, by two methods, the sensitization to mites in children followed for respiratory allergy., Methods: Skin prick-test and IgE assay by REAST test with 3 mites: Dermatophagoides pteronyssinus (D. pteronyssinus), Dermatophagoides farinae (D. farinae) and Blomia tropicalis (B. tropicalis) were carried out in children from 3 to 15 years followed up for asthma and/or allergic rhinitis. The positive results of the two tests were compared., Results: Of the 130 (100%) children included, all eligible for the assay, 119 (91.5%) had the prick-test. The mean age and sex ratio (M/F) were 7±1 year, and 1.6. The association of rhinitis and asthma was the most frequent and found in 66 (55.6%). The sensitivity frequencies for the prick-test and assay were respectively 79% versus 36.1% for B. tropicalis, 71.4% versus 33.4% for D. pteronyssinus and 38.7% versus 37.8% for D. farinae. A moderate correlation between mean papule diameter and mean IgE concentration was observed., Conclusion: In African tropical environments, dust mite sensitization in children followed for respiratory allergy is frequent, with the order of frequency being: B. tropicalis, D. pteronyssinus, and D. farinae. The prick-test had better sensitivity than the assay for its evaluation., (Copyright © 2018 SPLF. Published by Elsevier Masson SAS. All rights reserved.)

Setting: National teaching hospital for the management of respiratory diseases, Cotonou, Benin., Objective: 1) To estimate the prevalence of lung function impairment (LFI) and associated factors in patients cured of pulmonary tuberculosis (PTB); and 2) to determine the link between human immunodeficiency virus (HIV) infection and LFI occurrence., Design: We performed a cross-sectional study in cured patients with smear-positive TB (PTB+) treated between 2012 and 2015. We recruited two control groups of 70 HIV-infected (HIV+/TB-) and 70 HIV-negative participants without TB (HIV-/TB-). We performed spirometry in all participants to identify LFI (obstructive, restrictive or mixed) and the 6-min walk test (6-MWT) in PTB+ participants. We assessed the factors associated with LFI using logistic regression., Results: Of 4711 subjects with PTB, 241 were contacted and 189 were included. The median age was 37 years; 128 (68.0%) were male. Overall, 85 cured PTB+ patients had LFI (45.0%). Extent of initial radiological lesions, time between symptom onset and treatment, and female sex were independently associated with LFI. Fifty-five (29.1%) cured PTB+ patients had an abnormal 6-MWT; those with LFI had a higher risk of poor exercise tolerance (OR 2.23; interquartile range 1.16-4.30). We did not find any association between HIV infection and LFI., Conclusion: LFI is very common in cured PTB+ patients from Benin and significantly impacts exercise tolerance.

Objective: To determine the epidemiological, diagnostic and evolutives features of tuberculosis (TB) in older subjects in Benin., Patients and Methods: This was a retrospective cohort study of adults TB patients (age≥15 years) who were notified at all the Basic Management Units (BMU) in Benin from January 1st, 2013 to December 31st. Older subjects (age≥60 years) were compared to those less than 60 years named young subjects. The threshold of significance was set at 5%., Results: The analysis was carried out on 6531 cases adults cases notified during the period. 601 (9.2%) were 60 years old or above. The case notification rate (CNR) in elders was more than twice the CNR in young people (68 cases vs. 31 cases per 100,000 population). Older subjects were less often infected with HIV (9.3%) than young's (16.7%), P<0.0001. In new bacteriologically confirmed pulmonary TB negative for HIV, unfavorable treatment outcomes were more frequent in older subjects than in young subjects with more deaths (7.5% vs. 3.0%). On the other hand, in bacteriological confirmed TB seropositive for HIV and all the other cases, treatment outcomes were comparable between the two groups., Conclusion: The high CNR and the high death rate in older subjects should plead for a specific care for an adapted management of TB case in this group., (Copyright © 2018 Elsevier Masson SAS. All rights reserved.)

The objective of this work was to describe the profile of routinely managed tuberculosis patients whose sputum smear did not become negative after the initial phase of anti-tuberculous treatment and to analyze the factors associated with this. With this aim a cross-sectional, retrospective, descriptive and analytical study was carried out in a population of adults with pulmonary tuberculosis (PTB) between 2013 and 2014 in three cities in southern Benin (Cotonou, Porto-Novo and Abomey). The data of the patients who did not convert (PTB +) were compared with those who did (PTB-). A multivariate logistic regression analysis was performed. In 1989 (94%) of the cases, 305 (15.3%) were TPB+ with significant differences between the cities. The mean age was 38±13 years vs 34±12 years, respectively, for PTB+and PTB -, P=0.091. At the end of the multivariate analysis, the factors associated with non-conversion were: high bacillary load (≥10 AFB/microscopic field) at diagnosis, HIV+status, and adverse outcome at the end of anti-tuberculous treatment. These patients should be monitored carefully., (Copyright © 2017 SPLF. Published by Elsevier Masson SAS. All rights reserved.)

The textile industry sector occupies a prominent place in the economy of Benin. It exposes workers to several occupational risks, including exposure to cotton dust. To assess the effect of exposure to cotton dust on the health of workers, this study was initiated and conducted in a Beninese cotton industry company. The objective of the study was to evaluate the respiratory disorders among the textile workers exposed to cotton dust and the cross-sectional study involved 656 subjects exposed to cotton dust and 113 non-exposed subjects. The methods used are mainly based on a survey using a questionnaire of organic dust designed by the International Commission of Occupational Health (ICOH); and on the measures of lung function parameters (FEV₁ and FVC). The main results of the different analyzes revealed that subjects exposed to cotton dust have more respiratory symptoms than unexposed subjects (36.9% vs. 21.2%). The prevalence of chronic cough, expectorations, dyspnoea, asthma and chronic bronchitis are 16.8%, 9.8%, 17.3%, 2.6%, and 5.9% respectively among the exposed versus 2.6%, 0.8%, 16.8%, 0% and 0.8% among the unexposed subjects. The prevalence of byssinosis is 44.01%.The prevalence of symptoms is dependent on the sector of activity and the age of the subject. These results should encourage medical interventions and technical prevention especially since the textile industry occupies an important place in the Benin's economy., Competing Interests: None.

Introduction: Motorcycle taxi driving is common in many African cities. This study tested whether this occupation is associated with more respiratory disorders in a context of widespread urban air pollution with an improved methodology., Methods: In a cross sectional study we compared 85 male motorcycle taxi drivers in the capital city of the Republic of Benin (Cotonou) with an age and neighborhood matched control group. All participants carried a portable carbon monoxide data logger for 8 hours per day to assess exposure to air pollution. Respiratory symptoms were obtained using a standardized questionnaire and pulmonary function was assessed by spirometry., Results: The two groups did not differ significantly (p>0.10) in their age, height, educational level, and exposures to smoke from biomass fuels and tobacco products. The taxi drivers were exposed to higher mean (SD) levels of carbon monoxide (7.6±4.9ppmvs. 5.4±3.8ppm p=0.001). They reported more phlegm and tended to have slightly lower levels of lung function, although these differences were not statistically significant., Conclusion: In this cross sectional study of young motorcycle taxi drivers with substantial exposure to urban traffic and a matched control group, we found no evidence for respiratory impairment. A follow-up of such study population with other pollution exposure surrogate and other clinical endpoint may provide a more robust conclusion regarding the exposure response in this professional group., (Copyright © 2016 Elsevier B.V. All rights reserved.)

Background: In the "Centre National Hospitalier de Pneumo-Phtisiologie" of Cotonou, Benin, little is known about the characteristics of patients who have not attended their scheduled appointment, the results of tracing and the possible benefits on improving treatment outcomes. This study aimed to determine the contribution of tracing activities for those who missed scheduled appointments towards a successful treatment outcome., Methods: A retrospective cohort study was carried out among all smear-positive pulmonary tuberculosis patients treated between January and September 2013. Data on demographic and diagnostic characteristics and treatment outcomes were accessed from tuberculosis registers and treatment cards. Information on those who missed their scheduled appointments was collected from the tracing tuberculosis register. A univariate analysis was performed to explore factors associated with missing a scheduled appointment., Results: Of 457 patients (410 new smear-positive and 47 retreatment tuberculosis), 37 (8%) missed one or more of their appointments with a total of 44 episodes of missed appointments. The 3.5th (32%) and 5th (43%) month appointments were the ones most likely to be missed. Being male was associated with a higher risk of missing appointments (RR = 4.2; 95% CI = 1.5-11.8, p = 0.004) while having HIV infection was associated with a lower risk (RR = 0.3, 95% CI = 0.1-0.9, p = 0.03). Principal reasons for missed appointments were travelling outside Cotonou (34%) and feeling better (21%). In 24 (55%) of these 44 episodes of missed appointments, contact was made with the patient who returned to the programme. These follow-up activities increased the treatment success by 4%., Conclusion: In Cotonou, Benin, less than 10% of tuberculosis patients miss at least one of their scheduled appointments. Tracing activities increase the treatment success rate by 4% and current on-going practices in the Programme need to be endorsed and encouraged.

Objective. To determine among retreatment tuberculosis patients in Benin baseline characteristics, culture, and drug sensitivity testing (DST) results and treatment outcomes. Materials and Methods. A retrospective national cohort study of all retreatment tuberculosis patients in Benin in 2013 using registers and treatment cards. Results. Of 3957 patients with tuberculosis, 241 (6%) were retreatment cases. Compared to new pulmonary bacteriologically confirmed tuberculosis (NPBCT) patients, there were significantly higher numbers of males (P = 0.04), patients from "Atlantique-Littoral" (P = 0.006), patients aged 45-64 years (P = 0.007), and HIV-positive patients (P = 0.04) among those retreated. Overall, 171 (71%) patients submitted sputum for DST, of whom (163) 95% were positive for Mycobacterium tuberculosis on Xpert MTB/RIF and/or culture and 17 (10%) were rifampicin resistant (9 with MDR-TB and 8 monoresistant to rifampicin). For those without MDR-TB (n = 224), treatment success was 93%. Worse outcomes occurred in those with unknown HIV status (RR: 0.27; 0.05-1.45; P < 0.01) while better outcomes occurred in those who relapsed (RR: 1.06, 95 CI: 1.02-1.10, P = 0.04). Conclusion. In 2013, a high proportion of retreatment patients received DST. Treatment success was good although more needs to be done to systematically increase the final follow-up smear examination. Reasons of high losses to follow-up from "Oueme-Plateau" should be investigated.

Rationale: The sensitisation profile to airborne allergens of asthma patients followed in Benin is not known., Patients and Methods: A descriptive cross-sectional study was conducted from April to June 2013 at the hospital reference centre. A prick-test was performed in all adults with asthma consulting during this period. The standardized allergenic extracts tested were: mites (Dermatophagoides pteronyssinus [DP], Dermatophagoides farinae [DF] and Blomia tropicalis [BT]), cockroaches, 5 different grasses, Alternaria, dogs and cats. The test was positive when the diameter of the wheal was more than half that of the positive control and/or when the diameter of the wheal was ≥3mm than the negative control., Results: Of the 253 asthmatics tested, 247 (97.6%) had at least one positive skin reaction. The average age was 44 years, the sex ratio was 0.81. Sensitization to mites was the most frequent (99.6%), followed by cockroaches (71.3%), 5 grasses (71.3%), Alternaria (71%), dog (68%) and cat (63.6%). The average number of sensitivities was 5±2., Conclusion: Asthmatics monitored in Cotonou have multiple sensitisations dominated by mites., (Copyright © 2014 SPLF. Published by Elsevier Masson SAS. All rights reserved.)