Spontaneous Infection of Ascites Fluid at the National and University Hospital Hubert Koutoukou Maga in Cotonou: Prevalence and Associated Factors

Background: Spontaneous ascites fluid infection (SAFI) is an extremely serious and frequently encountered complication in cirrhotic patients. We aimed to determine the prevalence of SAFI and the factors associated with it in the largest hospital in Cotonou. Methods: This was a retrospective descriptive and analytical study conducted from January 2013 to July 2019, at the National and University Hospital Hubert Koutoukou Maga (CNHU-HKM) in Cotonou, Benin. All patients followed in the University Clinic of Hepato-Gastroenterology and diagnosed with SAFI were included. Results: Eighty-two patients were included, predominantly males (69.5%), with a mean age of 51.5 ± 14.5 years. Among them, 32 had SAFI, i.e., a prevalence of 39%. Of the 32 cases of SAFI, the culture of ascites fluid was positive in 6 cases (18.7%). The most frequent germ found in SAFI was Escherichia coli (5 patients, 83.3%). The factors associated with SAFI in this study were: abdominal pain (p = 0.004), increased bilirubinemia (p = 0.009), decreased prothrombin level 20 (p = 0.001). Conclusion: SAFI was common in cirrhotic patients in the department. Certain clinical and paraclinical factors were associated with it, as was the severity of cirrhosis. Early diagnosis and aetiological management of cirrhosis could reduce its frequency.

Irritable Bowel Syndrome in General Population of Cotonou: Prevalence and Associated Factors

Introduction: Irritable bowel syndrome (IBS) is a known public health burden in western countries while only a few studies have been published on this disease in Africa. The objective of this study was to determine the prevalence of IBS in the general adult population of Cotonou (Benin), its associated risk factors and its impact on patients’ daily life. Method: This was a descriptive and analytical cross-sectional study conducted over one month. Data was collected via a questionnaire. IBS was defined by the Rome IV criteria. Results: A total of 768 participants were included, with a male predominance (sex ratio 1.8). The mean age of the participants was 30.6 years, with extremes of 15 to 76 years. The prevalence of IBS in our study was 4.2%. IBS-D was the most common subtype (34.4%). IBS symptoms were influenced by diet (46.9%), stress (31.3%) and lack of sleep (15.6%). In the univariate analysis, the risk factors associated with IBS were: Dendi and Otamari ethnicity (p = 0.015), low level of education (p = 0.047), family history of IBS (p = 0.026), smoking (p Conclusion: Despite IBS frequency, patients with IBS rarely seek medical attention. The public should therefore be informed about this condition to reduce its impact on their daily life.

Updated Review on the Panorama of Liver Diseases in Benin

Introduction: The aim of this work was to take stock of the epidemiological aspects of liver diseases in Benin. Methods: Two methods were used: documentary research and collection of the position of gastroenterologists on the subject. For the literature search, the sources interviewed were Medline, African Journal On Line (AJOL), Google and Google scholar. Additional searches were made on the websites of European gastroenterology societies (AFEF, EASL). A collection of the opinions of gastroenterologists, most of them members of the Beninese Society of Hepato-gastroenterology was made. Results: From a nosological point of view, the most frequent and serious liver diseases in Benin are mainly infectious: viral hepatitis B and C (9.9% and 4.12% of the general population in 2013). Bacterial liver diseases (ascites fluid infections and tuberculosis of the liver) come in 3rd position after cirrhosis and hepatocellular carcinoma. Amoebic abscesses of the liver tend to regress. The toxic causes are dominated, in addition to alcoholic liver diseases (steatosis, cirrhosis), by drug lesions: two fatal cases of hepatotoxicity by artesunate-amodiaquine combination and asymptomatic and transient cytolysis in 23.8% of 63 children less than 5 years old treated with arthemether-lumefantrine combination have been described. Phytotherapy, alone or in combination with modern drugs, can in some cases be hepatotoxic. Plants with recognized medicinal virtues (may be harmful to the liver (Senna, Moringa oleifera, tamarind). Chronic aflatoxicoses secondary to the consumption of contaminated food (maize, cassava or peanuts) are relatively under-documented. Overload diseases (in particular alcoholic or non-alcoholic fatty liver) are on the increase (3.19% of 662 ultrasounds in 1995 against 14.5% of 411 in 2011 in Cotonou) partly due to the demographic and nutritional transition underway in Benin. These diseases, often blamed on spells cast, lead to hospital deaths from cirrhosis or hepatocellular carcinoma in young economically active subjects. Conclusion: Despite anti-infectious therapeutic advances, the prevention of toxic and metabolic hepatopathies is essential. Clinical research is crucial.

Typical Gastroesophageal Reflux Disease in the General Adult Population in Cotonou: Prevalence and Associated Socio-Demographic Factors

Introduction: Gastroesophageal Reflux Disease (GERD) is a common benign condition with a worldwide prevalence of between 5% and 45% in the adult population. Its prevalence in the general population is little known in Africa. The aim of this work was to study the prevalence of typical GERD in the general adult population of a large city and the associated socio-demographic factors. Patients and Methods: This was a prospectively collected, descriptive and analytical cross-sectional study that was conducted over a one-month period (June 2018). We included any person residing in the city of Cotonou for at least 6 months, aged 15 years or older, who had given consent for the study. The two-stage cluster sampling technique was used. The dependent variable was the typical gastroesophageal reflux defined by the heatburn-regurgitation association. Results: We had included 728 subjects. Of these, 255 had a typical GERD, i.e. a prevalence of 35%. The mean age of the respondents was 31.9 ± 13.2 years with extremes of 15 and 88 years. There were 379 men (52.1%) with a sex ratio of 1.08. The study population was represented respectively by artisans (29.3%), students (26.6%) and traders/dealers (20.3%). In terms of marital status, there were as many married and single subjects (48.2%). In addition, 47% of the study population had a body mass index of less than 25 kg/m2. In univariate analysis, the sociodemographic factors associated with typical GERD were: age (60 years and older): OR: 0.220 [95% CI 07 - 0.63], p = 0.005 and marital status divorced/separated/widowed: OR: 0.32 [0.11 - 0.97], p = 0.04. Older age and divorced/separated/widowed status appear to be protective of the occurrence of GERD. Conclusion: Typical GERD was common in the adult population of Cotonou. It readily affected young (under 60 years of age), single or married subjects.

Viral Hepatitis C during a Screening Campaign in General Population of Benin: Seroprevalence and Associated Factors

Introduction: Hepatitis C is a global public health problem. The purpose of this study was to determine the prevalence and factors associated with hepatitis C virus (HCV) antibody carriage during mass screening in several localities throughout Benin. Methods: This was a descriptive and analytical cross-sectional study with prospective data collection. This collection took place from 20 to 28 July 2019 at a free voluntary hepatitis C screening organized in Benin by Rotary Clubs in 23 sites throughout the country. A rapid diagnostic orientation test was used for the detection of anti-HCV antibodies. Results: A total of 9035 voluntary participants were included, mostly of Beninese nationality (99.0%), with a median age of 27 years, of whom 51.1% (4619/9035) were single and mainly schoolchildren, pupils or students (37.9%;3426/9035). HCV seroprevalence was 1.0% (87/9035) [95% CI = 0.8% - 1.2%]. This infection was associated with age greater than 42 years (ORa = 2.71;95% CI: 1.06 - 6.95), p < 0.03, and history of diabetes (ORa = 3.9;95% CI: 1.9 - 7.6). Conclusion: HCV antibody seroprevalence is relatively low in the study population: 1%. Factors associated with HCV antibody carriage were age, occupation and diabetic history.

Treatment of Hepatitis C with Pegylated Interferon Alpha-2a and Ribavirin:Experience from Benin

Background: Viral hepatitis C (HCV) is common in Benin. Untreated, it can be complicated by cirrhosis and hepatocarcinoma, which are sources of death. The objectives of this work were twofold: 1) to evaluate the effectiveness and safety of treatment with classic dual interferon pegylated alpha-2a (IFN) and ribavirin therapy in Benin, and 2) to present problems related to financial accessibility to this treatment. Methods: This was a cross-sectional, descriptive and analytical study, with a retrospective collection of data from November 1, 2010 to December 31, 2015 and prospective collection from January 1, 2016 to July 31, 2016 (7 months). We included all patients treated with IFN + ribavirin for hepatitis C at CNHU/HKM. Sustained virological response (SVR) was defined as undetectable viral load C 6 months after stopping treatment. Safety was appreciated by the search for clinical and hematological adverse effects. Results: One hundred and six patients were followed for HCV, of whom 58 (54.7%) undergoing treatment (26 under standard dual therapy and 32 under direct-acting antivirals). Of the 26 patients under-conventional dual therapy, 12 (46.1%) were genotype 1, 13 (50%) genotype 2 and one (3.9%) genotype 4. In conventional dual therapy, SVR was achieved in 15 (57.7%) patients, including the genotype 4 patient, 4 out of 12 (33.3%) genotype 1 patients, and 10 out of 13 (76.9%) for genotype 2 patients. The most common side effects with this treatment were severe asthenia (23 cases), flu-like symptoms (22 cases), weight loss (21 cases) and neutropenia (22 cases), anemia and thrombocytopenia (20 of 26 cases). The overall cost of treatment per patient was 11,800,624 FCFA for genotypes 1 and 4;and 7,835,048 FCFA for genotype 2. Conclusion: The treatment of HCV with IFN + ribavirin in Benin is effective for genotype 2. But its adverse effects are manifold and its cost is high. The switch to direct-acting antivirals (more effective, better tolerated and less expensive) was therefore necessary.

Hepatitis D in Patients Infected with Hepatitis B Virus in Cotonou:Characteristics and Risk Factors

Introduction: Hepatitis D virus (HDV) is a satellite virus of hepatitis B virus (HBV). The purpose of this work was to describe the epidemiological, clinical and biological characteristics of HBV/HDV co-infection and the factors associated with this co-infection in Cotonou. Methods: This was a cross-sectional, descriptive study with prospective data collection. It took place from June to October 2016 at CNHU/HKM and the Atinkanmey Polyclinic in Cotonou. Subjects over 15 years of age with HBsAg and untreated for hepatitis were included consecutively. Sociodemographic, clinical and biological characteristics were collected for each patient using only a standardized questionnaire. Then, a blood sample was taken for the determination of anti-HDV antibodies as well as the viral load of HBV. Results: A total of 156 subjects were included, predominantly male (sex-ratio = 2), and of median age 36 years. The majority were monogamous married (50%) or single (41.7%), and were from south of Benin (84.6%). Most subjects were asymptomatic (49.4%). The prevalence of total HDV antibodies was 3.9% (6/156). In subjects with total HDV antibodies, the prevalence of HDV IgM was 33.3%. Origin in northern Benin appears to be a risk factor for HDV infection (p = 0.042). Similarly, married subjects were statistically more infected with HDV than unmarried subjects (p = 0.002). Conclusion: The prevalence of HDV infection varies according to the origin of the patients and their marital status.