In total, 446 healthy individuals (240 in urban and 206 in rural environments, respectively) were selected from 96 households, based on cluster sampling of residential location. Demographic, sociological and environmental data were collected by face-to-face interviews using a standard questionnaire. Infection with Helicobacter pylori was assessed by detection of anti-H. pylori IgG serum antibodies. The prevalence of H. pylori antibodies was 75.4% in the urban population and 72.3% in rural (village) residents (p 0.459). No association was found between infection and age, gender, education level, size of household, economic activity or source of drinking water. The infection rate was higher in children whose parents were both infected, and also in children whose mother was infected (p < 0.001). By logistic regression analysis, the density of occupation of sleeping accommodation (more than three persons sharing a room; 95% odds ratio (OR) = 9.82 (4.13-23.31), p < 0.001), and the mother's status within the household (95% OR = 3.85 (1.53-9.67), p 0.003), were independent predictors for H. pylori infection. The 74% seroprevalence of H. pylori infection found in healthy Beninese individuals is similar to that reported previously from other parts of sub-Saharan Africa. Family contact with infected persons and crowded living conditions were associated with increased risk of infection. These findings are consistent with intra-familial H. pylori transmission and suggest that improvement of living conditions should be protective against infection.

Buruli Ulcer (BU) is a neglected infectious disease caused by Mycobacterium ulcerans that is responsible for severe necrotizing cutaneous lesions that may be associated with bone involvement. Clinical presentations of BU lesions are classically classified as papules, nodules, plaques and edematous infiltration, ulcer or osteomyelitis. Within these different clinical forms, lesions can be further classified as severe forms based on focality (multiple lesions), lesions’ size (>15cm diameter) or WHO Category (WHO Category 3 lesions). There are studies reporting an association between delay in seeking medical care and the development of ulcerative forms of BU or osteomyelitis, but the effect of time-delay on the emergence of lesions classified as severe has not been addressed. To address both issues, and in a cohort of laboratory-confirmed BU cases, 476 patients from a medical center in Allada, Benin, were studied. In this laboratory-confirmed cohort, we validated previous observations, demonstrating that time-delay is statistically related to the clinical form of BU. Indeed, for non-ulcerated forms (nodule, edema, and plaque) the median time-delay was 32.5 days (IQR 30.0–67.5), while for ulcerated forms it was 60 days (IQR 20.0–120.0) (p = 0.009), and for bone lesions, 365 days (IQR 228.0–548.0). On the other hand, we show here that time-delay is not associated with the more severe phenotypes of BU, such as multi-focal lesions (median 90 days; IQR 56–217.5; p = 0.09), larger lesions (diameter >15cm) (median 60 days; IQR 30–120; p = 0.92) or category 3 WHO classification (median 60 days; IQR 30–150; p = 0.20), when compared with unifocal (median 60 days; IQR 30–90), small lesions (diameter ≤15cm) (median 60 days; IQR 30–90), or WHO category 1+2 lesions (median 60 days; IQR 30–90), respectively. Our results demonstrate that after an initial period of progression towards ulceration or bone involvement, BU lesions become stable regarding size and focal/multi-focal progression. Therefore, in future studies on BU epidemiology, severe clinical forms should be systematically considered as distinct phenotypes of the same disease and thus subjected to specific risk factor investigation.

The recycling of electronic waste (e-waste) contaminates ecosystems with metals, though a compilation of data from across sites worldwide is lacking, without which evidence-based comparisons and conclusions cannot be realized. As such, here, a systematic review of the literature was conducted to identify peer-reviewed studies concerning e-waste sites (published between 2005 and 2017) that reported on the concentration of heavy metals (Cd, Hg, As, Pb and Cr) in soil, water and sediment. From 3063 papers identified, 59 studies from 11 countries meeting predefined criteria were included. Reported metal concentrations were summarized, and a narrative synthesis was performed. This review summarized 8286 measurements of the aforementioned metals in soils (5836), water (1347) and sediment (1103). More than 70% of the studies were conducted in Asia. In nearly all cases, the average metal concentrations in a particular medium from a given site were above guideline values; suggesting soils, water and sediment at, or near, e-waste recycling sites are contaminated. Across all media, concentrations of Pb were generally highest, followed by Cr, As, Cd and Hg. The synthesized information demonstrates that e-waste sites worldwide are contaminated with metals, that geographic data gaps exist, that the quality of most studies can be improved and that action is needed to help reduce such levels to protect human health and the environment.

BackgroundFree tuberculosis control fail to protect patients from substantial medical and non-medical expenditure, thus a greater degree of disaggregation of patient cost is needed to fully capture their context and inform policymaking.MethodsA retrospective cross-sectional study was conducted on a convenience sample of six health districts of Southern Benin. From August 2008 to February 2009, we recruited all smear-positive pulmonary tuberculosis patients treated under the national strategy in the selected districts. Direct out-of-pocket costs associated with tuberculosis, time delays, and care-seeking pattern were collected from symptom onset to end of treatment.ResultsPopulation description and outcome data were reported for 245 patients of whom 153 completed their care pathway. For them, the median overall direct cost was USD 183 per patient. Payments to traditional healers, self-medication drugs, travel, and food expenditures contributed largely to this cost burden. Patient, provider, and treatment delays were also reported. Pre-diagnosis and intensive treatment stages were the most critical stages, with median expenditure of USD 43 per patient and accounting for 38% and 29% of the overall direct cost, respectively. However, financial barriers differed depending on whether the patient lived in urban or rural areas.ConclusionsThis study delivers new evidence about bottlenecks encountered during the TB care pathway. Financial barriers to accessing the free-of-charge tuberculosis control strategy in Benin remain substantial for low-income households. Irregular time delays and hidden costs, often generated by multiple visits to various care providers, impair appropriate patient pathways. Particular attention should be paid to pre-diagnosis and intensive treatment. Cost assessment and combined targeted interventions embodied by a patient-centered approach on the specific critical stages would likely deliver better program outcomes.

BackgroundApplying the switch from presumptive treatment of malaria to new policies of anti-malarial prescriptions restricted to parasitologically-confirmed cases is a still unsolved challenge. Pragmatic studies can provide data on consequences of such a switch. In order to assess whether restricting anti-malarials to rapid diagnostic test (RDT)-confirmed cases in children of between five and 15 years of age is consistent with an adequate management of fevers, a school-based study was performed in Allada, Benin.MethodsChildren in the index group (with fever and a negative RDT) and the matched control group (without fever and a negative RDT) were not prescribed anti-malarials and actively followed-up during 14 days. Blood smears were collected at each assessment. Self-medication with chloroquine and quinine was assessed with blood spots. Malaria attacks during the follow-up were defined by persistent or recurrent fever concomitant to a positive malaria test.Results484 children were followed-up (242 in each group). At day 3, fever had disappeared in 94% of children from the index group. The incidence of malaria was similar (five cases in the index group and seven cases in the control group) between groups. Self-medication with chloroquine and quinine in this cohort was uncommon.ConclusionsApplying a policy of restricting anti-malarials to RDT-confirmed cases is consistent with an adequate management of fevers in this population. Further studies on the management of fever in younger children are of upmost importance.