Edgard-Marius Ouendo

Background: In Benin, two third of health facilities experienced stockouts for at least one tracer product, revealing persistent weaknesses in supply chain management. To address this, the Couffo department adopted the PUSH model in one health zone while maintaining the PULL model in another. Objective: This study aimed to evaluate the technical contributions of the PUSH model to health product supply chain performance through a comparative analysis of both logistics models. Methods: A descriptive cross-sectional study with an evaluative and analytical purpose was conducted across 32 public health facilities in the Couffo department from September 2024 to February 2025. Data on inputs, processes, and outcomes were collected via observations, interviews, and documentary review, then analysed using the Varkevisser scale and comparative statistical tests (Chi-squared, Fisher's exact, Student's t-test) at the 5% significance threshold. Results: The PUSH model demonstrated higher overall performance (86.13% vs. 71.0%). Stockout frequency was significantly lower (31.48% vs. 68.52%; OR=0.21; p<0.001), delivery lead times shorter (8.2 vs. 20.9 days), and distribution (93.3% vs. 36.1%) and quality assurance scores (100% vs. 66.6%) substantially higher. Conclusion: The PUSH model significantly improves supply chain efficiency. Its gradual extension, supported by appropriate technical and financial assistance, is recommended to sustain universal access to quality health products in Benin.

Introduction: Malaria remains a major public health problem in Benin, especially among children under five, despite the implementation of proven prevention and management strategies. Given the persistent malaria burden, this study was conducted to analyse the knowledge and practices of mothers of under-five children regarding malaria, as well as the determinants of formal healthcare-seeking. Methods: This was a cross-sectional analytical study conducted among mothers of under-five children, selected from three villages in the commune of Zogbodomey, Benin. Data collected from mothers using a digitised questionnaire were used to classify knowledge, attitudes and practices as "good" or "insufficient" based on the mean scores obtained. Determinants of healthcare-seeking were explored using univariate and multivariate regression at a 5% significance level. Results: The majority of the 208 mothers (92.79%) had good knowledge about malaria, and 100% exhibited positive attitudes towards its prevention. However, only 66.83% actually adopted good practices. After adjustment, the variables that remained significantly associated with healthcare-seeking were: knowledge of malaria transmission modes (OR= 4.64; 95% CI= [1.03-20.90]), and mother’s occupation such as trader (OR=0.37; 95% CI= [0.18-0.75]), farmer (OR= 0.27; 95% CI= [0.09-0.82]) and craftswoman (OR= 0.23; 95% CI= [0.08-0.65]). Conclusion: Although the overall level of knowledge and attitudes among mothers is satisfactory, it does not yet translate into sustained, positive practices against malaria. Strengthening health education and promoting continuous behavioural support appear essential to enhance malaria control for children under five in Benin.

The initial program theory (IPT) is a core element of realist evaluation. An IPT presents a hypothesis about how, for whom, why, and in what contexts an intervention is effective. Despite their importance within realist studies, methodological guidance on how to develop an IPT is relatively scarce. We describe the methodological process of eliciting an IPT of facility-based maternal death reviews (FbMDRs), a multicomponent intervention to improve the quality of maternal care. We used a four-step approach to elicit the IPT through a combination of literature review, document review, and in-depth interviews with key stakeholders while drawing on the experience of the research team. The literature and document reviews enabled us to identify facilitators and barriers influencing the functioning of FbMDRs. We used the causal pathway approach to deconstruct the maternal death review procedure and we elicited a causal explanation for each component on the basis of the results of the document review, the literature review and key respondent interviews. We organised stakeholder consultations that provided insights of key actors and validated its real-world relevance. We discuss the challenges encountered during its development and the lessons learned. The challenges include the fact that maternal death reviews are multicomponent interventions, for which a ‘simple’ programme theory cannot be defined, the positionality of the research team, and the visual representation of a programme theory with multiple components.

INTRODUCTION: Le financement bas