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Copyright of Mali Médical is the property of Mali Medical, Faculte de Medecine, de Pharmacie et d'Odonto-stomatologie and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Mali Médical is the property of Mali Medical, Faculte de Medecine, de Pharmacie et d'Odonto-stomatologie and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

This study aimed to determine the distribution of Buruli ulcer (BU) in Lalo, one of the endemic districts of the Couffo department in Bénin. A total of 752 BU patients were detected in this district with 160 active and 592 inactive cases. The overall prevalence of BU in this district is 86.6 per 10 000 inhabitants, varying from 0 to 249/10 000 between sub-districts. At village level the prevalence varies between 0 and 561 cases per 10 000 inhabitants. Our findings confirm the large variation of distribution of the disease at the village level in endemic area. Children under 15 years are frequently affected. We also found a significant association between age and location of Buruli lesions. Further epidemiological and environmental studies are needed to identify the reasons for the extraordinary variation in BU distribution between villages from the same sub-district, and to confirm if it is associated with temporal variations. [ABSTRACT FROM AUTHOR]

Background: Liquid discharges from hospitals (effluents) threaten the environment and are now a central concern of all stakeholders in the health system and those in the protection of the environment. The management of effluents is a major problem in developing countries. The objective of this study was to assess the quality of effluent management at the level of university hospital centers (CHU) in the Littoral region in Benin., Methods: It was a cross-sectional, descriptive, evaluative study that took place in 2020 to assess the "structure", "process" and "results" components according to standard thresholds (Bad: < 60%; Acceptable: [60-80% [and Good: ≥ 80%)., Results: In all the CHUs, all the components, as well as the overall quality of the management of hospital effluents, had a score between 0 and 60%, with an assessment deemed bad. The poor quality of the process highlighted the non-compliance with standards relating to the management of hospital liquid discharges. Several factors linked to the "structure", "process" and "results" components at the same time explain this poor management of university hospitals effluents., Conclusion: These effluents discharged without prior treatment into wastewater could constitute a source of dissemination of potentially pathogenic microorganisms. It is therefore important to develop methods for treating these effluents before they are released into the natural environment., (© 2021. The Author(s).)

The objective of our study was to evaluate the medico-surgical management of Buruli ulcer (BU) in the BU Screening and Treatment Center (CDTUB) of Allada in Benin. This retrospective and descriptive study retrospectively reviewed records of patients seen from 2010 to 2014 at the CDTUB of Allada. It included patients diagnosed with BU according to WHO epidemiological and clinical criteria as well as laboratory results and who were treated according to WHO medical and surgical recommendations. In all, 274 patients were diagnosed and treated, 57.7% of them children younger than 15 years. Ulcerative lesions (189, 69%) and WHO category II lesions (144, 52.5%) predominated. All patients received dual antibiotic therapy and 43.4% (119) underwent surgery as well. Category III lesions and multifocal lesions required more surgery, whereas most category I lesions healed under medical treatment. The overall rate of healing was 92%: 53.3% for patients who received only antibiotic therapy and 38.7% for those who also had surgery. The median healing time was 13 weeks and ranged from 4 to 56 weeks. In the CDTUB of Allada, between 2010 and 2014, most patients were treated with antibiotic therapy alone, but a significant number still received surgery.

Early initiation to sexual intercourse increases the risk of sexually transmitted infections including HIV/AIDS and early or unwanted pregnancies. This study aimed identifying the factors associated with the early initiation to sexual intercourse among teenagers and young adults aged 10-24, in the south of Benin. A cross-sectional study was conducted in the south of Benin where 360 respondents were selected by random cluster sampling. Multiple logistic regressions was used to find related factors to early sexual intercourse. The significance level for the tests was of 5%. The average reported age of initiation to sexual intercourse was 14.75±2.18. Among the male teenagers and young adults, 41.11% had an early sexual intercourse against 20.24% for the female gender (P<10-3). The lack of communication between parents-teenagers (P=0.003), level of education of the father (P=0.021), exposure to pornographic movies (P=0.025), an adverse opinion on premarital sexual abstinence (P=0.026) were significantly associated with early sexual intercourse. Communication about health promotion for behavioural change may contribute to delay the age of sexual initiation., Competing Interests: Conflict of interest: the authors declare no conflict of interest.

Objective: We aimed to determine the relationship between changes in the prevalence of HIV infection in pregnant women from 2006 to 2015 and place of residence in Benin., Methods: In a retrospective and analytical study, were viewed the reports of the annual surveys of HIV infection among pregnant women from 2006 to 2015 across the country., Results: A total of 138,319 pregnant women participated in the annual HIV surveys from 2006 to 2015. The national prevalence of HIV infection among pregnant women between 2006 and 2015 was 2%. The prevalence of HIV infection from 2006 to 2015 in pregnant women increased significantly in departments of Mono (p = 0.001) and Donga (p = 0.001) and decreased in the departments of Collines (p = 0.000) and Couffo (p = 0.001) and in urban areas (p = 0.000)., Conclusion: Changes in the prevalence of HIV infection among pregnant women between 2006 and 2015 varied across departments and according the urbanization of the residence. The National AIDS control program may take these results into account when planning interventions against HIV for optimal response against the pandemic infection., (Le comitée de rédaction se réserve le droit de revoyer aux auteurs avant toute soumission à l'avis des lecteurs les manuscrits qui ne seraient pas conformes à ces modalités de présentation. En outre il leur conseille de sonserver un examplaire du manuscrit, des figures et des tableaux.)

Objective: We aimed to analyze the performance of procurement and distribution system of antiretroviral, antituberculosis and antimalarial drugs in Benin., Methods: We carried out a cross-sectional study in 2016. Data on the procurement, storage and distribution of drugs were collected by either individual interview or observation of storage sites at the central procurement center for essential medicines (CAME) in Benin. Compliance with the norms of the procurement and distribution of the products was appreciated. At the operational level, order satisfaction, drug expiry and stock status of the targeted health programs were measured based on the participants statements., Results: Three workers of the CAME and 76 of health programs were surveyed. According to the norms, malfunctioning impaired the system of the procurement, storage and the distribution of the products. At the operational level, our study participants reported that antiretroviral drug orders were satisfied in 83%, drugs were distributed within three months of their expiration date in 26- 33%, and the CAME often ran out of antiretroviral drugs (stock-outs)in 69%., Conclusion: Malfunctioning impaired the system of the procurement, storage and the distribution of antiretroviral, antimalarial and antituberculosis drugs. These dysfunctions negatively affect the performance of the system., (Le comitée de rédaction se réserve le droit de revoyer aux auteurs avant toute soumission à l'avis des lecteurs les manuscrits qui ne seraient pas conformes à ces modalités de présentation. En outre il leur conseille de sonserver un examplaire du manuscrit, des figures et des tableaux.)

Background: Buruli ulcer (BU) is an infectious disease caused by Mycobacterium ulcerans and considered the third most prevalent mycobacterial disease in humans. Secondary bacterial infections in open BU lesions are the main cause of pain, delayed healing and systemic illness, resulting in prolonged hospital stay. Thus, understanding the diversity of bacteria, termed the microbiome, in these open lesions is important for proper treatment. However, adequately studying the human microbiome in a clinical setting can prove difficult when investigating a neglected tropical skin disease due to its rarity and the setting., Methodology/principal Findings: Using 16S rRNA sequencing, we determined the microbial composition of 5 BU lesions, 3 non-BU lesions and 3 healthy skin samples. Although no significant differences in diversity were found between BU and non-BU lesions, the former were characterized by an increase of Bacteroidetes compared to the non-BU wounds and the BU lesions also contained significantly more obligate anaerobes. With this molecular-based study, we were also able to detect bacteria that were missed by culture-based methods in previous BU studies., Conclusions/significance: Our study suggests that BU may lead to changes in the skin bacterial community within the lesions. However, in order to determine if such changes hold true across all BU cases and are either a cause or consequence of a specific wound environment, further microbiome studies are necessary. Such skin microbiome analysis requires large sample sizes and lesions from the same body site in many patients, both of which can be difficult for a rare disease. Our study proposes a pipeline for such studies and highlights several drawbacks that must be considered if microbiome analysis is to be utilized for neglected tropical diseases.

Introduction: In spite of free caesarean section applied in Benin since 2009, high rates of stillborn babies continue to be recorded. This study aimed to determine the factors associated with post-caesarean stillborn in Benin., Methods: Cross-sectional study that covered all women who have delivered by caesarean from December 2013 to February 2014 in twelve hospitals chosen by simple random selection in each of the twelve departments of Benin. Data collected by chart review have been analyzed using the statistical software Epi info 3.5.1. Univariate analysis and multivariable logistic regression were used to identify factors associated with post-caesarean stillbirth at the significance threshold of 5%., Results: There were 66 stillborn per 1,000 births of which 58% died before admission to hospital. The risk factors identified were the reference (p = 0.0011), general anesthesia (p = 0.0371), the low birth weight (p = 0.0001), the retro-placental hematoma (p = 0.0083), and the umbilical cord prolapse (p = 0.0229). Acute fetal distress (p = 0.0308) and anesthesia administered by an anesthetist nurse or midwife (p = 0.0337) were protective factors., Conclusion: The majority of cases, in utero death occurred before admission to hospital. Strengthening antenatal refocused consultation, a better access to quality obstetric care and the grant of all obstetric care could reduce stillbirths from caesarean sections in Benin., Competing Interests: Authors declared they have no competing interests.

Introduction: The management of health information is a key pillar in both emergencies reception and handling facilities, given the strategic position and the potential of these facilities within hospitals, and in the monitoring of public health and epidemiology. With the technological revolution, computerization made the information systems evolve in emergency departments, especially in developed countries, with improved performance in terms of care quality, productivity and patient satisfaction. This study analyses the situation of Benin in this field, through the case of the Academic Clinic of Emergency Department of the National University Teaching Hospital of Cotonou, the national reference hospital., Methods: The study is cross-sectional and evaluative. Collection techniques are literature review and structured interviews. The components rated are resources, indicators, data sources, data management and the use-dissemination of the information through a model adapted from Health Metrics Network framework. We used quantitative and qualitative analysis., Results: The absence of a regulatory framework restricts the operation of the system in all components and accounts for the lack and inadequacy of the dedicated resources., Conclusion: Dedication of more resources for this system for crucial needs such as computerization requires sensitization and greater awareness of the administrative authorities about the fact that an effective health information management system is of prime importance in this type of facility., Competing Interests: The authors declare no competing interests.

Background: Buruli ulcer (BU) is described as a relatively painless condition; however clinical observations reveal that patients do experience pain during their treatment. Knowledge on current pain assessment and treatment in BU is necessary to develop and implement a future guideline on pain management in BU., Methodology: A mixed methods approach was used, consisting of information retrieved from medical records on prescribed pain medication from Ghana and Benin, and semi-structured interviews with health care personnel (HCP) from Ghana on pain perceptions, assessment and treatment. Medical records (n = 149) of patients treated between 2008 and 2012 were collected between November 2012 and August 2013. Interviews (n = 11) were audio-taped, transcribed verbatim and qualitatively analyzed., Principal Findings: In 113 (84%) of the 135 included records, pain medication, mostly simple analgesics, was prescribed. In 48% of the prescriptions, an indication was not documented. HCP reported that advanced BU could be painful, especially after wound care and after a skin graft. They reported not be trained in the assessment of mild pain. Pain recognition was perceived as difficult, as patients were said to suppress or to exaggerate pain, and to have different expectations regarding acceptable pain levels. HCP reported a fear of side effects of pain medication, shortage and irregularities in the supply of pain medication, and time constraints among medical doctors for pain management., Conclusions: Professionals perceived BU disease as potentially painful, and predominantly focused on severe pain. Our study suggests that pain in BU deserves attention and should be integrated in current treatment.

Buruli ulcer (BU) is a necrotizing skin disease caused by Mycobacterium ulcerans. People living in remote areas in tropical Sub Saharan Africa are mostly affected. Wound care is an important component of BU management; this often needs to be extended for months after the initial antibiotic treatment. BU is reported in the literature as being painless, however clinical observations revealed that some patients experienced pain during wound care. This was the first study on pain intensity during and after wound care in BU patients and factors associated with pain. In Ghana and Benin, 52 BU patients above 5 years of age and their relatives were included between December 2012 and May 2014. Information on pain intensity during and after wound care was obtained during two consecutive weeks using the Wong-Baker Pain Scale. Median pain intensity during wound care was in the lower range (Mdn = 2, CV = 1), but severe pain (score > 6) was reported in nearly 30% of the patients. Nevertheless, only one patient received pain medication. Pain declined over time to low scores 2 hours after treatment. Factors associated with higher self-reported pain scores were; male gender, fear prior to treatment, pain during the night prior to treatment, and pain caused by cleaning the wound. The general idea that BU is painless is incorrect for the wound care procedure. This procedural pain deserves attention and appropriate intervention.

Buruli ulcer is an indolent, slowly progressing necrotizing disease of the skin caused by infection with Mycobacterium ulcerans. In the present study, we applied a redesigned technique to a vast panel of M. ulcerans disease isolates and clinical samples originating from multiple African disease foci in order to (i) gain fundamental insights into the population structure and evolutionary history of the pathogen and (ii) disentangle the phylogeographic relationships within the genetically conserved cluster of African M. ulcerans. Our analyses identified 23 different African insertion sequence element single nucleotide polymorphism (ISE-SNP) types that dominate in different areas where Buruli ulcer is endemic. These ISE-SNP types appear to be the initial stages of clonal diversification from a common, possibly ancestral ISE-SNP type. ISE-SNP types were found unevenly distributed over the greater West African hydrological drainage basins. Our findings suggest that geographical barriers bordering the basins to some extent prevented bacterial gene flow between basins and that this resulted in independent focal transmission clusters associated with the hydrological drainage areas. Different phylogenetic methods yielded two well-supported sister clades within the African ISE-SNP types. The ISE-SNP types from the "pan-African clade" were found to be widespread throughout Africa, while the ISE-SNP types of the "Gabonese/Cameroonian clade" were much rarer and found in a more restricted area, which suggested that the latter clade evolved more recently. Additionally, the Gabonese/Cameroonian clade was found to form a strongly supported monophyletic group with Papua New Guinean ISE-SNP type 8, which is unrelated to other Southeast Asian ISE-SNP types.

We compared two DNA extraction methods (a semiautomated method using a Maxwell kit and a modified Boom method) and three amplification procedures (a single-step PCR, a nested PCR, and a real-time quantitative PCR) on 74 surgical tissue specimens from patients with clinically suspected Buruli ulcer. All of these procedures were compared before and after decontamination. We observed that, among the procedures tested, real-time PCR after the modified Boom extraction method or a single-run PCR assay after the Maxwell 16 extraction method, performed on nondecontaminated suspensions, are the best for the molecular diagnosis of Mycobacterium ulcerans disease.

Background: Mycobacterium ulcerans is the causative agent of Buruli ulcer (BU). In West Africa there is an association between BU and residence in low-lying rural villages where aquatic sources are plentiful. Infection occurs through unknown environmental exposure; human-to-human infection is rare. Molecular evidence for M. ulcerans in environmental samples is well documented, but the association of M. ulcerans in the environment with Buruli ulcer has not been studied in West Africa in an area with accurate case data., Methodology/principal Finding: Environmental samples were collected from twenty-five villages in three communes of Benin. Sites sampled included 12 BU endemic villages within the Ouheme and Couffo River drainages and 13 villages near the Mono River and along the coast or ridge where BU has never been identified. Triplicate water filtrand samples from major water sources and samples from three dominant aquatic plant species were collected. Detection of M. ulcerans was based on quantitative polymerase chain reaction. Results show a significant association between M. ulcerans in environmental samples and Buruli ulcer cases in a village (p = 0.0001). A "dose response" was observed in that increasing numbers of M. ulceran- positive environmental samples were associated with increasing prevalence of BU cases (R(2) = 0.586)., Conclusions/significance: This study provides the first spatial data on the overlap of M. ulcerans in the environment and BU cases in Benin where case data are based on active surveillance. The study also provides the first evidence on M. ulcerans in well-defined non-endemic sites. Most environmental pathogens are more broadly distributed in the environment than in human populations. The congruence of M. ulcerans in the environment and human infection raises the possibility that humans play a role in the ecology of M. ulcerans. Methods developed could be useful for identifying new areas where humans may be at high risk for BU.

Background: Buruli Ulcer (BU) is a severe cutaneous and subcutaneous disease due to Mycobacterium ulcerans infection, mainly distributed in sub-Saharan Africa and tropical areas. The role of T helper (TH) cytokines in the development and clinical course of the disease has been previously studied by investigating the in vitro immune response of lymphocytes from affected patients and immunohistochemical analyses of bioptic samples., Methods: TH cytokine levels (IFNγ, TNF-α, IL-2, IL-10, IL-4, IL-5, IL-17) were evaluated in serum of 34 Beninese subjects by cytofluorimetric and immunoenzymatic assays: 16 patients affected with active BU, 4 patients who had healed after specific therapy, and 14 matched controls., Results: Levels of IFNγ were higher in patients with late BU (>2 months from onset) and healed patients than in controls, and in ulcerative than in pre-ulcerative patients. Analysis of 4 patients with "late" disease evaluated both at the beginning of antibiotic therapy and 6 months later showed that IFNγ levels were always lower in the second evaluation. By contrast, no differences were found in levels of the other cytokines., Conclusions: IFNγ production is low in early BU, and increases in late BU and healing, suggesting a role of this cytokine in infection clearance. Moreover, evaluation of IFNγ serum levels may be a useful tool to monitor the immune response during the BU course., (© 2010 The International Society of Dermatology.)

The goals of this cross-sectional study conducted in the Zè district of Benin were to determine the overall distribution and prevalence of Buruli ulcer (BU) and to identify environmental and behavioral risk factors. A total of 425 current or previous BU patients from the study district were included. Data was obtained by direct observation, semi-structured interviews, and document review. The main findings can be summarized as follows. The overall prevalence of BU in the Zè district in 2006 was 52 cases per 10000 inhabitants. The prevalence of current and previous cases was 28.1 and 23.9 per 10 000 inhabitants respectively. The distribution of BU within the district was highly variable from one subdistrict to another and from one village to another within the same subdistrict. The subdistricts showing the highest and lowest endemicity were Djigbé with 265 cases per 10 000 inhabitants and Koundokpoé with 3 cases per 10 000 inhabitants respectively. Proximity of the hamlets to water bodies was a risk factor for the disease.

Almost half of patients have functional limitations after treatment of Buruli ulcer disease. Antibiotic treatment (along with surgery) was introduced in the National Program for Buruli ulcer in Benin in 2005. The aim of this study was to compare functional limitations in patients who were treated by antibiotics, surgery, or both, using a validated questionnaire. One hundred seventy-nine former patients in Lalo, Benin were retrieved and interviewed in their village. Hospital records were used to gather data about size of lesion at presentation and treatment provided. No significant differences in resulting functional limitations were found between the different treatments. Larger lesions (> 15 cm cross-sectional diameter) at presentation; lesions on a joint, muscular atrophy, and amputation were all associated with a higher risk for functional limitations. Advantages of antibiotic treatment may involve other domains, like costs of treatment or a change in help-seeking behavior.

Invasive punch or incisional skin biopsy specimens are currently employed for the bacteriological confirmation of the clinical diagnosis of Buruli ulcer (BU), a cutaneous infectious disease caused by Mycobacterium ulcerans. The efficacy of fine-needle aspirates (FNA) using fine-gauge needles (23G by 25 mm) for the laboratory confirmation of BU was compared with that of skin tissue fragments obtained in parallel by excision or punch biopsy. In three BU treatment centers in Benin, both types of diagnostic material were obtained from 33 clinically suspected cases of BU and subjected to the same laboratory analyses: i.e., direct smear examination, IS2404 PCR, and in vitro culture. Twenty-three patients, demonstrating 17 ulcerative and 6 nonulcerative lesions, were positive by at least two tests and were therefore confirmed to have active BU. A total of 68 aspirates and 68 parallel tissue specimens were available from these confirmed patients. When comparing the sensitivities of the three confirmation tests between FNA and tissue specimens, the latter yielded more positive results, but only for PCR was this significant. When only nonulcerative BU lesions were considered, however, the sensitivities of the confirmation tests using FNA and tissue specimens were not significantly different. Our results show that the minimally invasive FNA technique offers enough sensitivity to be used for the diagnosis of BU in nonulcerative lesions.

We used ultrasonography to evaluate the nature and the extent of subcutaneous damage provoked by Mycobacterium ulcerans (M. ulcerans) and to investigate the possible involvement of the tributary lymph nodes during the various stages of progression of Buruli ulcer. Nineteen patients affected by M. ulcerans infection in Benin, West Africa, were studied. Ultrasonography was performed on all subjects, except one, at the site of nonulcerated lesions and/or at perilesional site. The tributary lymph nodes were also studied in six patients. Ultrasound (US) evaluation was carried out using a 10 MHz linear probe and all lesions were compared with the homologous unaffected controlateral site. The ultrasonography showed relevant alterations at the dermo-hypodermic level, in agreement with histological specimens. In the active forms of the disease, these alterations are characterized by significant oedematous imbibition of the adipose tissue and necrosis (adiponecrosis) that leads to varying irregularities in the echogenicity of the hypodermis, which is generally thicker. In agreement with the clinical examination, the lymph nodes in six patients evaluated, despite their possible histological involvement with necrotic phenomena described in literature in M. ulcerans infection, did not display significant alterations visible by ultrasonography. The US scanning we have performed is the first use of this technique for M. ulcerans infection. We have shown that it can reveal the subcutaneous depth and the peripheral extent of the pathological process and it is particularly useful for monitoring the efficacy of or resistance to antibiotic treatment, especially in extensive ulcero-oedomatose forms. Such monitoring offers also a useful guide to the surgeon allowing the reduction or postponement of the removal of the large cutaneous areas that were carried out until recently.

To optimize Buruli ulcer (BU) microscopic diagnosis, we compared two smear preparation methods from tissue specimens: smears made with tissue suspension after grinding and smears made directly with unground tissue. We also compared two smear staining methods: auramine and Ziehl-Neelsen (ZN). IS 2404-PCR was used as reference method. One hundred and thirty-one surgical tissue specimens from patients suspected of having BU were analyzed. Both smear preparation methods and both staining methods were equivalent in any combination. Thus we recommend ZN stained smears of unground tissue for peripheral treatment centres.

Infection by Mycobacterium ulcerans, commonly known as Buruli ulcer (BU), is an emerging infectious disease in some African countries, including Benin. A national BU control program has been organised since 1997. One of its main objectives is to organise a system of BU surveillance, based on the BU02 data collection form developed by the World Health Organization. This surveillance system has allowed the National BU program to collect suitable data for more than 3,793 patients. This article assesses data collection in Benin and demonstrates its suitability and high quality.