Patrick Makoutode

Objective: Constant availability of inpatient beds in an intensive care unit (ICU) is part of the resilience of health systems, especially in an emergency context, namely in public health. This study aims to appraise the management of inpatient waiting lines in the ICU of Hubert Koutoukou Maga National Hospital and University Center (CNHU-HKM) in Benin, in March-April 2022.Methods: This was an analytic cross-sectional study of inpatients or their relatives and staff, selected by convenience and reasoned choice, respectively, carried out from March 21 to April 15, 2022. Logistic regression was used to identify associated factors with queues management.Results: Altogether 55 patients were surveyed. On a daily basis, 13 ± 1 patients were hospitalized in 18 functional beds for 3 ± 1 admissions and 3 ± 1 discharges. The average bed occupancy rate was 89.8% ± 3.8%; the average waiting time before patient care was 3.6 ± 1.2 minutes and the traffic intensity were 0.03. Per hour, the odds of having a patient were 33.29%, with a 97% chance of a bed being occupied. The probability that an admitted patient would spend a whole week there was 37%. Only patient arrival flow was significantly associated with insufficient queuing management. There was also a lack of inpatient beds and technical boards. The construction of two wards and the installation of seven additional beds could improve queues management.Conclusions: The management of AF in our study site depends mainly on the daily flow of arriving patients, but also on the number of available hospital beds, the working organization and the existing technical and structural measures. Addressing these parameters will significantly improve the situation.

Malaria control is heavily reliant on insecticides, especially pyrethroids. Resistance of mosquitoes to insecticides may threaten the effectiveness of insecticide-based vector control and lead to a resurgence of malaria in Africa. In 21 villages in Southern Benin with high levels of insecticide resistance, the resistance status of local vectors was measured at the same time as the prevalence of malaria infection in resident children. Children who used LLINs had lower levels of malaria infection [odds ratio = 0.76 (95% CI 0.59, 0.98, p = 0.033)]. There was no evidence that the effectiveness of nets was different in high and low resistance locations (p = 0.513). There was no association between village level resistance and village level malaria prevalence (p = 0.999). LLINs continue to offer individual protection against malaria infection in an area of high resistance. Insecticide resistance is not a reason to stop efforts to increase coverage of LLINs in Africa.

Background: A recent school-based study in Benin showed that applying a policy of anti-malarial prescriptions restricted to parasitologically-confirmed cases on the management of fever is safe and feasible. Additional PCR data were analysed in order to touch patho-physiological issues, such as the usefulness of PCR in the management of malaria in an endemic area or the triggering of a malaria attack in children with submicroscopic malaria.Methods: PCR data were prospectively collected in the setting of an exposed (with fever)/non exposed (without fever) study design. All children had a negative malaria rapid diagnostic test (RDT) at baseline, were followed up to day 14 and did not receive drugs with anti-malarial activity. The index group was defined by children with fever at baseline and the control group by children without fever at baseline. Children with submicroscopic malaria in these two groups were defined by a positive PCR at baseline.Results: PCR was positive in 66 (27%) children of the index group and in 104 (44%) children of the control group respectively. The only significant factor positively related to PCR positivity at baseline was the clinical status (control group). When definition of malaria attacks included PCR results, no difference of malaria incidence was observed between the index and control groups, neither in the whole cohort, nor in children with submicroscopic malaria. The rate of undiagnosed malaria at baseline was estimated to 3.7% at baseline in the index group.Conclusions: Treating all children with fever and a positive PCR would have led to a significant increase of anti-malarial consumption, with few benefits in terms of clinical events. Non malarial fevers do not or do not frequently trigger malaria attacks in children with submicroscopic malaria.

Background: Applying 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. Methods: Children 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. Results: 484 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. Conclusions: Applying 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.