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Hematologic diseases are a significant part of health disorders in Benin. As an example, anemia is the second cause of hospitalization, measuring up to 7.9% all over the country (National Plan of Sanitary Development, 2009-2018). By contrast, there is only one active hematologist in the country. Thanks to two partnerships, on one hand between the health sciences faculty in Cotonou (Benin) and the medicine one in Tours (France), and on the other hand between the Beninese Blood Transfusion National Agency and the French Blood Establishment, a first blood transfusion and hematology formation was held in Cotonou on December 2014. Among other benefits, was created an hematology-transfusion network in order to facilitate relations between Beninese hospital doctors, with the support of the two French partner institutions. The article describes this progress., (Copyright © 2015 Elsevier Masson SAS. All rights reserved.)

Aim: The aim of this retrospective study was to evaluate the use and appropriateness of preventive measures for venous thrombosis among adult inpatients in a Benin teaching hospital., Patients and Methods: All patients were systematically enrolled. The risk of venous thrombosis was estimated according to international guidelines. Thromboembolic events were diagnosed using the Wells score and, when possible, by paraclinical investigations. The following variables were studied: the risk of venous thrombosis, the use and appropriateness of preventive measures, and the frequency of thromboembolic events. The data were analyzed with Epiinfo 6.04.fr and SPSS software, and significance was assumed at p=0.05., Results: The study population consisted of 487 patients recruited in four surgical wards, four general wards and one obstetric-gynecology ward. Mean age was 38.7+/-11.3 years and the sex ratio 0.51. The risk of thrombosis was considered low in 15% of patients, moderate in 60.8%, high in 21.1% and very high in 3.1%. Prophylactic measures were prescribed to 33.9% of the patients overall, 53.6% in the obstetric gynecology ward, 28.5% in the surgical wards and 12.9% in the general wards. The frequency of preventive measures rose with the level of risk (p<0.0001). Preventive measures consisted of passive mobilization, aspirin, enoxaparin and acenocoumarol. The prescriptions were appropriate in only 6% of cases. Among 198 patients who were monitored for two months after hospital discharge, 8% had a venous thromboembolic event. Such events were more frequent in the absence of prophylaxis (12% vs 3.3%, p=0.02)., Conclusion: The risk of venous thromboembolic is recognized but poorly managed in this Bénin teaching hospital.

Urban growth leads to the consumption of food outside the home, with the demand for street food coming particularly from school children. A survey of 240 primary school children aged 8 to 13 was carried out, by means of personal interviews. More than 90% were regularly given pocket money by their parents, and this money was used mainly for buying food from vendors inside or near their schools. Less than 20% of children ate breakfast at home before going to school. Food purchases occurred mostly before the end of school morning break and an average of 38 CFA Francs were spent on each purchase (7.6 US cents). A wide variety of foods were bought, mostly including cereals. This buying of food seems to be part of a family food strategy to reduce the preparation of breakfast at home. The combination of this demand, and the supply of food in schools provides a useful means for campaigns aimed at improving the quality of children's diets in the short and long term.

We studied an African population in Benin and discovered an unexpectedly high frequency (1.6%) of hereditary elliptocytosis (HE) among the 1447 subjects studied. In approximately two-thirds of HE individuals we identified molecular defects, primarily those in erythrocyte alpha-spectrin (dupL154, L260P and L207P mutations), as well as a novel mutation of erythrocyte beta-spectrin (beta-W2061R mutation). We also identified the genetic basis of a previously identified protein polymorphism of the alpha III domain of spectrin (R1331I mutation). The genetic background of HE in the African population was studied using a number of polymorphisms of the alpha-spectrin gene, including the alpha III domain polymorphism. These studies suggest that the HE mutations appear to have originated from separate genetic backgrounds in this population.

An epidemio-clinical study of Herpes Zoster in 39 healthy patients of Benin has permitted to the authors to evaluate the positive predictive value of Herpes Zoster for HIV infection on West Africa; and to compare it with results of central Africa. The mean age of patients is 34.74 years. The positive predictive value of Herpes Zoster for HIV infection is 41.02%. It is increased by the cranial site of Herpes Zoster.

The prevalence of malaria and the frequency of gene S were surveyed in two different regions of Benin, savana and coastal lacustrine regions. In both regions, prevalence of malaria was not significantly different between Hb AA people and Hb AS people. Gene S prevalence was not modified by age, excepted for Hb SS which was not found in people upper than 25 years. In holoendemic area, i.e. lacustrine region, means of P. falciparum parasitaemia were significantly lower in Hb AS children than in Hb AA children. Sickle cell trait did not reduce the prevalence of malaria but seemed to decrease the level of parasitaemia.

The origin of the beta C mutation was studied by characterizing nucleotide sequence polymorphisms on beta C chromosomes of patients from various African countries. In the majority of cases, the beta C mutation was found in linkage disequilibrium with a single chromosomal structure as defined by classical RFLP haplotypes, intergenic nucleotide sequence polymorphisms immediately upstream of the beta-globin gene, and intragenic beta-globin gene polymorphisms (frameworks). In addition, three atypical variant chromosomes carrying the beta C mutation were observed, and are most probably explained either by a meiotic recombination (two cases) or by one nucleotide substitution occurring in an unstable array of tandemly repeated sequences (one case). These data demonstrate the unicentric origin of the beta C mutation in central West Africa, with subsequent mutational modification in a small number of instances. The data also supports gene flow of the beta C chromosome from subsaharan Africa to North Africa.

Iron absorption from three typical West African meals was measured in fourteen subjects using the extrinsic-tag technique with 59Fe and 55Fe. All meals consisted of maize as the staple food. Meals were prepared in Benin under realistic conditions from locally grown foods. Of the non-haem-Fe in the meals 39-73% did not exchange with the added inorganic radio-Fe tracer, depending on the degree of Fe contamination of meals. Non-haem-Fe absorption was low in each maize meal, but was even lower for those eaten with a vegetable sauce than for those eaten with a fish sauce. When haem-Fe absorption was included, 70.0-160 micrograms Fe was absorbed. Expressed on an energy basis, the bioavailable nutrient density was 3.2-7.0 micrograms/100 kJ (13.4-29.5 micrograms/100 kcal). These findings suggest that total Fe available in the typical diets of West African countries does not meet the physiological requirements of large proportions of the population.

A transversal survey has been performed in the Zou Province in the central part of Benin located in West Africa close to the western border of Nigeria. The Zou Province is an agricultural region which population is about 900,000. A randomised sample of 1936 people had been chosen according 1,984 census data. All the samples have been examined by ELISA Rapid Elavia Mixt (Pasteur Vaccin). All positive samples have been tested with both Elavia I and Elavia II (Pasteur Vaccin). 6.6% of sampled population show positive result for HIV1 in ELISA and 0.9% are positive in ELISA for HIV2. Age, sex and geographical distribution of ELISA positive samples is quite uniform. None of positive plasma in ELISA can be interpreted as positive in Western-Blot. The first hypothesis discussed by authors is possibility of serological conversion occurring at the time of the survey. If this unlikely hypothesis is confirmed it means that both viruses have recently and suddenly infected the Zou Province at various level of population and in all villages of the Province. A second hypothesis is that all plasma have antibodies for unidentified related virus which cross reacts with HIV1 or HIV2. A third hypothesis is that dysproteinaemia due to parasite or nutrition factors produce false positive reactions. This could explain such a positive reaction distribution among the whole population. So the last hypothesis must be considered with attention.

Patients with sickle cell anemia vary in the hematologic and clinical features of their disease, in part because of variability in the presence of linked and unlinked genes that modify the expression of the disease. The hemoglobin S gene is strongly linked to three different haplotypes of polymorphic endonuclease-restriction sites of the beta-like gene cluster (genes in the vicinity of the beta-globin gene)--one prevalent in Atlantic West Africa, another in central West Africa, and yet another in Bantu-speaking Africa (equatorial, East, and southern Africa). We have studied the differences in the hematologic characteristics of patients with sickle cell anemia from the first two geographical areas. We find that the Senegalese (Atlantic West Africa) patients have higher levels of hemoglobin F, a preponderance of G gamma chains in hemoglobin F, a lower proportion of very dense red cells, and a lower percentage of irreversibly sickled cells than those from Benin (central West Africa). We interpret these data to mean that the gamma-chain composition and the hemoglobin F level are haplotype linked and that the decrease in the percentage of dense cells and irreversibly sickled cells is secondary to the elevation in the hemoglobin F level. Patients with sickle cell anemia in the New World probably correspond to various combinations of these types, in addition to the still hematologically undefined haplotype associated with sickle cell anemia in the Bantu-speaking areas of Africa.

An assessment of iron and folic acid status, blood thick film and haemoglobin (Hb) electrophoresis was performed on 126 pregnant women (and their newborn infants) and in ninety-five menstruating women in Cotonou (Benin). Anaemia (according to the World Health Organization (1972] was observed in 55% of pregnant women and in 39% of menstruating women. Fe-deficiency was defined as a low serum ferritin concentration (12 micrograms/l or less), combined with a low transferrin saturation (less than 16%) or a high erythrocyte protoporphyrin level (more than 3 micrograms/g Hb), or both. A moderate elevation in the serum ferritin concentration (between 13 and 50 micrograms/l), associated with a low transferrin saturation or a high erythrocyte protoporphyrin level, or both, indicated Fe-deficiency in an inflammatory context. Fe-deficiency was present in 73% of pregnant women and in 41% of menstruating women. Folate deficiency (defined as erythrocyte folate below 160 micrograms/l) was observed in 45% of pregnant women. In pregnant women, anaemia was associated with Fe-deficiency in 83% of cases and with folate deficiency in 48% of cases. Haemoglobinopathies were mainly heterozygous and did not seem to contribute significantly to anaemia. Intensity of malaria was not related to Hb level, but Plasmodium falciparum was found in 99% of subjects. Hb concentration and mean corpuscular volume were significantly lower in babies born of Fe-deficient mothers than in babies born of Fe-sufficient mothers. Hb concentration in newborn infants was positively correlated with maternal serum ferritin.

We have studied the incidence of alpha-thalassemia in normal and SS individuals from Senegal, Benin, Upper Volta, and Central Republican Africa. The alpha thal gene frequency is not significantly different in the controls from the various populations and in the SS patients from Senegal. In contrast it is compatible with increased survival of SS patients in Benin, Upper Volta. The data suggest epistatic effects of other factors in the Senegalese population.

Iron status, folacin status, haemoglobinopathies, malarial infection and intestinal parasitosis frequencies were assessed in a representative sample of 586 subjects living in a rural district of South Benin. Anaemia according to WHO reference values for haemoglobin was observed in 42 per cent of subjects. The prevalence was higher in children and menstruating women. Iron deficiency, defined by two or more abnormal values in the four independent indicators of iron status used (transferrin saturation, erythrocyte protoporphyrin, serum ferritin, and mean corpuscular volume) was present in 30 per cent of subjects. Half of the anaemias were associated with iron deficiency. Folate deficiency was associated with anaemia in 20 per cent of subjects. Anaemia, iron and folacin status were not significantly related to the degree of malarial infection nor to the type of haemoglobin. Although hookworm infection was very common, there was no significant relationship between egg count and haemoglobin level or haematological parameters of iron and folacin status. The lack of correlation can be explained by the low wormload observed.