The community diagnosis is an essential approach to the resolution of health problems with the involvement of the communities concerned who become object and subject. Improvingmaternal and child health is a health pri...The community diagnosis is an essential approach to the resolution of health problems with the involvement of the communities concerned who become object and subject. Improvingmaternal and child health is a health priority for many developing countries, including Mali. The objective was to study the role of community-based diagnosis in improving maternal and child protection in a vulnerable urban community in a developing country. Methodology: This was a research-action integrating a community diagnosis conducted in March 2023. The involvement of several stakeholders, including social actors including ASACO, membership card holders, district chiefs, neighborhood delegates, local authorities, and health professionals, made it possible to provide curative, preventive and promotional care. The ASACOSEKA Health Area was used as a setting for the study. The methodology was the indicator approach, contact, document review, interview of CSCOM patients, observation of the structure, prioritization of problems, development of an action plan and restitution of the report. Results: The monograph consisted of describing the characteristics of the study setting. Indeed, the ASACOSEKASI area is located on the left bank of the Niger River, with a population of 34,497 inhabitants. The CSCOM presented to describe a medical unit, a maternity unit, a laboratory unit, an ultrasound room and a medication storage room. The main pathologies found were confirmed simple malaria (45.08%), high AKI: 20.43%, confirmed severe malaria: 19.85%, suspected diarrhoea: 3.43%, trauma related to road accidents: 3.36%, pregnancy-related disorders (1%). BCG, Penta3, VAR, and yellow fever vaccination rates were above 100%. It reflects the fact that the doses administered were higher than the target population. This was related to out-of-area vaccination and lost doses. CPN1, CPN4, tetanus vaccination (VAT2) and family planning (FP) consultations all have a proportion above 100%. Maternal care is increased by out-of-area patients, particularly from Guinea. NPC3 and CPON have a proportion of less than 100%. The target population did not follow policies, standards and procedures. Postpartum, women rarely came to the CPON. Local actions to combat malaria included cleaning up plots and neighbourhoods, weeding families and streets, cleaning gutters, spraying the roosts of the female Anopheles Beetle, sleeping in LLINs, organising chemoprophylaxis days, promoting the use of MS, and using curtains against vectors. Conclusion: The community was involved at all stages of this diagnosis, from design to implementation, as well as to the restitution of local solutions. Indeed, the community diagnosis has led to a resolution plan related to reproductive health.展开更多
<strong>Introduction</strong><span style="font-family:""><span style="font-family:Verdana;"><strong>:</strong> During childbirth by Caesarean, several types...<strong>Introduction</strong><span style="font-family:""><span style="font-family:Verdana;"><strong>:</strong> During childbirth by Caesarean, several types of anesthesia can be used. The Caesarean, the most practiced surgical delivery technique in obstetrics, has a risk for complications for both </span><span style="font-family:Verdana;">the pregnant</span><span style="font-family:Verdana;"> women and newborns. </span><b><span style="font-family:Verdana;">Objective: </span></b><span style="font-family:Verdana;">To evaluate the importance of the complications due to Caesarean in the Teaching hospital Gabriel Toure. </span><b><span style="font-family:Verdana;">Patient and Methods: </span></b><span style="font-family:Verdana;">We conducted a </span><span style="font-family:Verdana;">cross sectional</span><span style="font-family:Verdana;"> survey in the departments of </span><span style="font-family:Verdana;">intensive</span><span style="font-family:Verdana;"> care unit and gyneco-obstetric from January to August 2017 in the University hospital Gabriel Touré of Bamako. Our study population was pregnant women who gave birth to children by Caesarean. We included all cases of preventive and emergent Caesarean under loco-regional or general anesthesia. Data were compiled from the obstetrical files of the patients, the anesthetic consultation registry </span><span style="font-family:Verdana;">and</span><span style="font-family:Verdana;"> the </span><span style="font-family:Verdana;">databasis</span><span style="font-family:Verdana;"> of the department of gyneco-obstetric. The test of khi</span><sup><span style="font-family:Verdana;">2</span></sup><span style="font-family:Verdana;"> of Pearson was used for the comparison of our results with a value of p < 0.05 considered as statistically significant. </span><span style="font-family:Verdana;">The consent of the patients or parents was gotten. The survey didn’t include a potentially dangerous act. </span><b><span style="font-family:Verdana;">Results: </span></b><span style="font-family:Verdana;">During the study period, 1875 childbirths have been recorded of which 633 were by Caesarean (33.7%). We collected and analyzed 524 files of Caesarean. The mortality rate was 1.5% in pregnant women and 15% in newborns. The average age was 26.6 ± 6.9 </span><span style="font-family:Verdana;">ans</span><span style="font-family:Verdana;">. Pregnant women were referrals in 59.4% of the cases. The most frequent motive of referrals was high blood pressure and pregnancy in 66.6%. The Caesarean was indicated in most of the cases on </span><span style="font-family:Verdana;">previously</span><span style="font-family:Verdana;"> operated uterus in 22% and eclampsia was present in 14%. The maternal mortality had occurred in </span><span style="font-family:Verdana;">a context</span><span style="font-family:Verdana;"> of hemorrhage in 50% of the cases. The factors of maternal </span><span style="font-family:Verdana;">morbi-mortality</span><span style="font-family:Verdana;"> were the mode of admission, iterative Caesarean, t surgeon, context of the Caesarean, realization of the anesthetic consultation </span><span style="font-family:Verdana;">and</span><span style="font-family:Verdana;"> the technic of anesthesia (p = 0.05). The factors of fetal mortality were the realization of </span><span style="font-family:Verdana;">endo-tracheal</span><span style="font-family:Verdana;"> intubation, technic of anesthesia, </span><span style="font-family:Verdana;">realization</span><span style="font-family:Verdana;"> of the anesthesia consultation, </span><span style="font-family:Verdana;">context</span><span style="font-family:Verdana;"> of the Caesarean, iterative Caesarean </span><span style="font-family:Verdana;">and</span><span style="font-family:Verdana;"> the mode of admission (p</span></span><span style="font-family:""><span style="font-family:Verdana;"> ≤ </span><span><span style="font-family:Verdana;">0.05). </span><b><span style="font-family:Verdana;">Conclusion: </span></b><span style="font-family:Verdana;">The </span><span style="font-family:Verdana;">caesarean</span><span style="font-family:Verdana;"> is associated with a high risk of maternal complications and a very important fetal mortality. The anesthesia consultation in the follow-up of pregnancy would reduce this high mortality.</span></span></span>展开更多
Sacrospinous fixation (SSF) or Richter’s intervention (RI) aims to treat genital prolapse by securing the posterior vaginal wall to the small sacrospinous ligament. It is performed by low approach and includes a diss...Sacrospinous fixation (SSF) or Richter’s intervention (RI) aims to treat genital prolapse by securing the posterior vaginal wall to the small sacrospinous ligament. It is performed by low approach and includes a dissection of the pararectal space, visual exposure of the sacrospinous ligament and a needle with strait needle holder with nonabsorbable threads. It is often associated with a more complex corrective procedure, including cystocele cure, vaginal hysterectomy and posterior myorrhaphy. The objective of this study is to report the results of SSF in the gynecology department of Hopital du Mali. A descriptive study was conducted from September 2014 to September 2015 concerning 37 patients operated on for uterine prolapse (UP). All patients with grade III UP were included in our study in whom a unilateral hysterectomy (UH) and sacrospinous fixation (SSF) were performed. All the patients were scheduled. Preoperatively they had benefited from an assessment and a pre-anesthetic consultation. Hospitalization of at least 24 hours prior to the operation was required. Postoperative follow-up was two years with a physical examination at 3 months, 9 months and 15 months, and phone calls between physical consultations. During the study period, we performed 37 RIs. The mean age of the patients was 48 years with extremes of 41 to 73 years. The large multiparity was found out in 35 cases (94.59%), the pauciparous were two with 3 deliveries for each. Long labor of more than 18 hours was found out in 9 patients (24.32%) and home delivery in 13 cases (35.13%). The duration of the occurrence of prolapse was at least two years and 35 patients were going through menopause. The type of anesthesia used for the surgery was spinal anesthesia for all patients. The average duration of the operation was 90 minutes. Complications occurred in three patients or 8.10% of cases, two cases of acute urine retention and one case of hematoma of the para-rectal space. The medium time of hospital stay was 5 days. The anatomical result was satisfactory in all patients. However, two patients presented with grade II rectocele one year after the operation. Sacrospinous fixation is a technique suitable for our patients who present with genital prolapse with extreme laxity of the suspension ligaments. Well done, it brings anatomical satisfaction and its complications are rare and slight.展开更多
<strong>Summary:</strong><span style="font-family:""><span style="font-family:Verdana;"> We attempted to determine the obstetric prognosis of women without antenatal ca...<strong>Summary:</strong><span style="font-family:""><span style="font-family:Verdana;"> We attempted to determine the obstetric prognosis of women without antenatal care in the Health District of Commune V of Bamako, Mali. </span><b><span style="font-family:Verdana;">Materials and Methods:</span></b><span style="font-family:Verdana;"> We undertook this retrospective case-control study from January 1 to March 31, 2017. Of all women having given birth to during this period in this district, we compared characteristics and obstetric outcomes between women without antenatal care (study group) vs. those with antenatal care (age/parity matched control). </span><b><span style="font-family:Verdana;">Results</span></b><span style="font-family:Verdana;">: 13.8% of women were without antenatal care (23.45 ± 9.56 years of age: 13 - 42). Study group (without antenatal care), compared with control, was significantly more likely to be household helpers (OR = 2.5 [2.0 - 3.4]) and single (OR = 2.3 [1.8 - 2.8]). Study group women were more significantly likely to have the following </span><span style="font-family:Verdana;">poor obstetric outcomes: premature rupture of the membranes, post-maturity, </span><span style="font-family:Verdana;">low birth weight, hypertensive disorders of pregnancy, uterine rupture, fetal death, anemia, fetal malposition, cesarean section, postpartum hemorrhage, puerperal infection and maternal death. Study group showed a higher risk of early neonatal death, low Apgar score, and transfer to Neonatology institute. </span><b><span style="font-family:Verdana;">Conclusion</span></b><span style="font-family:Verdana;">: In accordance with the previous reports in any other countries, no prenatal checkup causes higher poor outcome of both mothers and infants/neonates also in this area.</span></span>展开更多
<strong>Introduction:</strong> <span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">In sub-Saharan Africa...<strong>Introduction:</strong> <span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">In sub-Saharan Africa and Mali, young women who have had heart surgery want to become pregnant. The occurrence of pregnancy in these women who have had heart surgery is becoming more and more frequent in our country because of the persistence of acute</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">rheumatoid arthritis</span></span></span><span><span><span style="font-family:""> </span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">(RAA) and especially the increasingly easy access to heart surgery. </span><b><span style="font-family:Verdana;">General Objective:</span></b><span style="font-family:Verdana;"> To study the evolution of pregnancy and the prognosis of childbirth in women who have undergone heart surgery. </span><b><span style="font-family:Verdana;">Methodology:</span></b><span style="font-family:Verdana;"> This was a retrospective and descriptive study that took place over a period of five (5) years in the gynecology-obstetrics department of University Teaching Hospital (UTH) Gabriel Touré and the cardiology department of UTH Luxembourg. Was included in the study any pregnant woman admitted to the gynecology-obstetrics department of UTH Gabriel Touré and having a history of heart surgery. The variables studied were the socio-demographic characteristics, the type of heart disease, the management, the evolution of the pregnancy and the prognosis. Data was typed on word processor, Excel and analyzed on Epi info and SPSS. The Chi square or Fisher exact test (for the number </span><span style="font-family:Verdana;"><</span></span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">to 5</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">) and the relative risk (RR) with confidence interval (CI) to 95% were calculated. P was considered as significant if</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"><0.05</span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> Of the 13</span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">,</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">388 pregnant women admitted to the gynecology/obstetrics department of UTH Gabriel Touré, 20 pregnant women had a history of heart surgery (1.49‰). The average age was 26 years old. The main cardiac pathology was valvular heart disease supported in 80.00% by the placement of a prosthesis. During pregnancy follow-up, 55% of pregnant women were on Anti-Vitamin K (AVK). In 95.00% of cases, heart disease was asymptomatic. We reported a case (5.00%) of iterative cardiac decompensation, in wh</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">ich</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> cardiac ultrasound found a very arrhythmic heart, grade III mitral leak, and massive aortic leak. We did not find any case of prosthetic thrombosis. The abortion rate was 5.00%. The caesarean section rate was 31.60% and the instrumental extraction rate (forceps) was 23.10%. Newborns had a normal birth weight (68.40%), and were hypotrophic (15.80%) and premature (15.80%). In pregnant women on</span></span></span><span><span><span style="font-family:""> </span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">AVK, we reported 2 cases of fetal deaths in utero (10.00%). </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> Surgical treatment of operable heart disease is a real prophylaxis for gravidocardiac accidents. Pregnancy can be well tolerated in patients who underwent</span></span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">heart surgery with artificial heart valves.</span></span></span>展开更多
Every woman has the right to receive satisfactory quality prenatal care in reproductive health. Giving a life while remaining alive and without sequelae must be the slogan of any gynecologist - obstetrician and midwif...Every woman has the right to receive satisfactory quality prenatal care in reproductive health. Giving a life while remaining alive and without sequelae must be the slogan of any gynecologist - obstetrician and midwife, as well as any health worker. It was a descriptive cross-sectional study dealing with the evaluation of the quality of prenatal consultations at the Kadiolo referral health center (or RHC). Adevis Donabedian’s model for assessing the quality of care and services served as a benchmark. According to Donabedian quality means good technical care, with good interpersonal relationships, and adequate and comfortable premises. This study took place from April 24 to December 04, 2017 and aimed to assess the current level of the quality of prenatal consultations at the Kadiolo referral health center, to study the structures in place including infrastructure and personnel, to specify the procedures and to determine their results. This work has permitted us to classify the RHC of Kadiolo at level III with 85%, which means that the references evaluated were satisfactory, with the level of 75% to 94%. In terms of structure, a pricing system was deemed affordable by the opinion of pregnant women. The analysis of the level of the human dimension revealed that the health center was level III. The pregnant women were satisfied with the reception which was good in 76% of the cases, as well as with the quality of the respect of the privacy in 96% and confidentiality in 95%. Despite the satisfaction of pregnant women, gaps remain to be filled in concerning the quality of the services received at the Kadiolo referral health center so as to reach level IV.展开更多
Background: It is yet a controversy subject whether low birth weight and infant death are associated to human immunodeficiency virus-1 infection. Objective: To appreciate association between low birth weights, mother ...Background: It is yet a controversy subject whether low birth weight and infant death are associated to human immunodeficiency virus-1 infection. Objective: To appreciate association between low birth weights, mother to child HIV transmission and infant mortality in HIV-1 infected pregnant women delivering between 2011 and 2016. Materials: We conducted 6 years cohort study in urban Mali. Outcome included preterm delivery, small for gestational age, infant survival status and HIV transmission. Comparison concerned women clinical WHO stage, mother viro-immunological status, and newborn anthropometric parameters. Results: HIV-1 infected women who delivered low birth weight newborn were 20.9% (111/531) versus 16.5% (1910/11.546) in HIV negative patients (p = 0.016). CD4 T cell counts low than 350 T cells count were strongly associated to LBW (p = 0.000;RR = 3.03;95% CI [1.89 - 3.16]). There is no significant association between ART that was initiated during pregnancy (p = 0.061, RR = 0.02;CI 95% (1.02 - 1.99)) or during delivery (p = 0.571;RR = 1.01;CI 95% (0.10 - 3.02)) and LBW delivery. In multivariate analysis ART regimens containing protease inhibitor (PI) were lone regimens associated with LBW ((p = 0.030;RR = 1.001;95% confidence interval [1.28 - 3.80]). Very low birth weight was statistically associated to women HIV infection (adjusted relative risk, 2.02;p = 0.000;95% confidence interval (2.17 - 4.10)). There is no significant difference between mother to child HIV transmission rate in the two HIV-infected pregnant women (10 infected children in group 2: MTCT rate 4.5%) and 3 infected children in group 1 (MTCT rate: 2.7%) (p = 0.56;RR, 0.59;CI 95% (0.18 - 4.39)). In multivariate analysis, LBW was associated with infant death (p = 0.001;RR = 2.04;CI 95% [1.04 - 5.05]). The median weight of infant at the moment of death in group 1 was 851 g (IQR: 520 - 1833 g). Significant relationship was found between infant death among LBW newborn with mother WHO stage 2 (p = 0.004;adjusted RR = 3.22;CI 95% [2.25 - 6.00]), CD4 T cells count 3 (p = 0.005;RR = 2.81;CI 95% [1.20 - 4.11]), PI regimens (p = 0.030;RR = 1.00;CI 95% [1.28 - 3.80]). Conclusion: We confirm increased risk of low birth weight and mother HIV-1 infection and we identified strongest association between mortality in infant born to HIV-1 infected mother and LBW.展开更多
This study on Menstrual Hygiene Management (MHM) was carried out in two secondary schools in the Bamako district, “Chaine Grise” and “Cheick Modibo Diarra” located respectively on the right bank and the left bank ...This study on Menstrual Hygiene Management (MHM) was carried out in two secondary schools in the Bamako district, “Chaine Grise” and “Cheick Modibo Diarra” located respectively on the right bank and the left bank depending on the geographic position of the Niger river. This work took place over a period of 6 months from January 2019 to June 2019. The objective of this study was to study menstrual hygiene management in school?setting for girls aged 16 to 18 in two secondary schools in Bamako. It was a transversal and qualitative description. The study population consists of girls aged 16 to 18 years enrolled in one of the selected secondary schools.?At the end of this study, we arrived at the following results:?*50% of the girls in our study have poor knowledge about menstruation;?*10% of girls miss school at least one day a month during menstruation;?*90% of girls use hygienic cotton to absorb menstrual blood;?*90% of the sources of supply for hygienic products are?mothers.?The unsanitary conditions of the toilets, lack of light and the non-separation of the toilets according to gender guidelines were found in 99% of the cases: *99% of girls say that the poor state of health infrastructures was one of the causes of genital infections linked to poor management of menstrual hygiene;?*lack of water in the toilets (99%). Through these results, we conclude that,?in our context,?menstruation remains a taboo and shameful subject for girls. In addition, some of their menstrual hygiene practices are a real danger to their health.展开更多
Introduction: High grade dysplasia of the cervix has a high incidence and can progress to cervical cancer. The aim was to study cofactors associated with high-grade cervical dysplasia. Methodology: This was a retrospe...Introduction: High grade dysplasia of the cervix has a high incidence and can progress to cervical cancer. The aim was to study cofactors associated with high-grade cervical dysplasia. Methodology: This was a retrospective case-control study without matching. Women with high grade dysplasia were the cases while those with a normal screening test represented the controls. The study took place at the Gabriel Touré University Hospital Center in Bamako. We included 351 cases and 420 controls. The capture and analysis were performed using the SPSS 20 software. A univariate and multivariate logistic regression analysis was performed for the analysis of risk cofactors. The statistical tests used were the odds ratio and its confidence interval and the statistical significance threshold was set at p Results: In univariate analysis, the co-factors statistically significantly associated with the occurrence of high-grade dysplasia were parity 0.6 (0.5 - 0.9), gestational 0.7 (0.5 - 0.9), smoking of the spouse 3.4 (1.1 - 11.3), the non-schooling 1.4 (1.2 - 2.1). In multivariate analysis after adjusting for confounding factors, two co-factors have significantly increased the risk of high-grade dysplasia: lack of schooling 1.4 (1.2 - 2.0) and polygamy 1.5 (1.4 - 2.5). Conclusion: At the end of this study, polygamy and lack of schooling were the main risk factors. The prevention of cervical cancer will go through the education of girls and women as well as communication for behavioral change and social change.展开更多
Intra uterine device migration is a relatively rare event. The migration of the IUD in the surrounded viscera can be managed by endoscopy approach. Objectives: We reported our experience to determine the epidemiologic...Intra uterine device migration is a relatively rare event. The migration of the IUD in the surrounded viscera can be managed by endoscopy approach. Objectives: We reported our experience to determine the epidemiologic characteristics of patients that presented migrated IUD, to report clinical aspects and describe the laparoscopic management. Method: We conducted a descriptive and prospective survey from January 1st, 2014 to October 31, 2016. That survey took place in the department of gynecology and obstetrics of Point G Teaching hospital, Bamako, Mali. Population study concerned patients with intra uterine device complications. Statistic tests used have been X2 or Fisher test according their application conditions. P Results: Seventeen patients were included. Mean age of patients is 29 years with extremes of 13 years and 44 years. The main reference incitement of patients were perforation of the uterus and pelvis pain (27.8% for each), misplaced IUD (22.3%). Complications observed were intra uterine device migrated in to the bladder (1 case), in the abdomen (10 cases), in the ovary (2 cases) and in the uterine tuba (1 case). Three perforations were done without migration in to surrounded viscera. We used endoscopic surgery among all of them. But in one case we switched endoscopy method in to laparotomy because of important intra peritoneal bleeding to end the management of the patient. No death occurred and mean duration of the stay of hospitalization was 2 days. Conclusion: IUD migration is a scarce event. All the surrounded viscera can be the site of its migration. The management of that complication is usually done by endoscopy method.展开更多
文摘The community diagnosis is an essential approach to the resolution of health problems with the involvement of the communities concerned who become object and subject. Improvingmaternal and child health is a health priority for many developing countries, including Mali. The objective was to study the role of community-based diagnosis in improving maternal and child protection in a vulnerable urban community in a developing country. Methodology: This was a research-action integrating a community diagnosis conducted in March 2023. The involvement of several stakeholders, including social actors including ASACO, membership card holders, district chiefs, neighborhood delegates, local authorities, and health professionals, made it possible to provide curative, preventive and promotional care. The ASACOSEKA Health Area was used as a setting for the study. The methodology was the indicator approach, contact, document review, interview of CSCOM patients, observation of the structure, prioritization of problems, development of an action plan and restitution of the report. Results: The monograph consisted of describing the characteristics of the study setting. Indeed, the ASACOSEKASI area is located on the left bank of the Niger River, with a population of 34,497 inhabitants. The CSCOM presented to describe a medical unit, a maternity unit, a laboratory unit, an ultrasound room and a medication storage room. The main pathologies found were confirmed simple malaria (45.08%), high AKI: 20.43%, confirmed severe malaria: 19.85%, suspected diarrhoea: 3.43%, trauma related to road accidents: 3.36%, pregnancy-related disorders (1%). BCG, Penta3, VAR, and yellow fever vaccination rates were above 100%. It reflects the fact that the doses administered were higher than the target population. This was related to out-of-area vaccination and lost doses. CPN1, CPN4, tetanus vaccination (VAT2) and family planning (FP) consultations all have a proportion above 100%. Maternal care is increased by out-of-area patients, particularly from Guinea. NPC3 and CPON have a proportion of less than 100%. The target population did not follow policies, standards and procedures. Postpartum, women rarely came to the CPON. Local actions to combat malaria included cleaning up plots and neighbourhoods, weeding families and streets, cleaning gutters, spraying the roosts of the female Anopheles Beetle, sleeping in LLINs, organising chemoprophylaxis days, promoting the use of MS, and using curtains against vectors. Conclusion: The community was involved at all stages of this diagnosis, from design to implementation, as well as to the restitution of local solutions. Indeed, the community diagnosis has led to a resolution plan related to reproductive health.
文摘<strong>Introduction</strong><span style="font-family:""><span style="font-family:Verdana;"><strong>:</strong> During childbirth by Caesarean, several types of anesthesia can be used. The Caesarean, the most practiced surgical delivery technique in obstetrics, has a risk for complications for both </span><span style="font-family:Verdana;">the pregnant</span><span style="font-family:Verdana;"> women and newborns. </span><b><span style="font-family:Verdana;">Objective: </span></b><span style="font-family:Verdana;">To evaluate the importance of the complications due to Caesarean in the Teaching hospital Gabriel Toure. </span><b><span style="font-family:Verdana;">Patient and Methods: </span></b><span style="font-family:Verdana;">We conducted a </span><span style="font-family:Verdana;">cross sectional</span><span style="font-family:Verdana;"> survey in the departments of </span><span style="font-family:Verdana;">intensive</span><span style="font-family:Verdana;"> care unit and gyneco-obstetric from January to August 2017 in the University hospital Gabriel Touré of Bamako. Our study population was pregnant women who gave birth to children by Caesarean. We included all cases of preventive and emergent Caesarean under loco-regional or general anesthesia. Data were compiled from the obstetrical files of the patients, the anesthetic consultation registry </span><span style="font-family:Verdana;">and</span><span style="font-family:Verdana;"> the </span><span style="font-family:Verdana;">databasis</span><span style="font-family:Verdana;"> of the department of gyneco-obstetric. The test of khi</span><sup><span style="font-family:Verdana;">2</span></sup><span style="font-family:Verdana;"> of Pearson was used for the comparison of our results with a value of p < 0.05 considered as statistically significant. </span><span style="font-family:Verdana;">The consent of the patients or parents was gotten. The survey didn’t include a potentially dangerous act. </span><b><span style="font-family:Verdana;">Results: </span></b><span style="font-family:Verdana;">During the study period, 1875 childbirths have been recorded of which 633 were by Caesarean (33.7%). We collected and analyzed 524 files of Caesarean. The mortality rate was 1.5% in pregnant women and 15% in newborns. The average age was 26.6 ± 6.9 </span><span style="font-family:Verdana;">ans</span><span style="font-family:Verdana;">. Pregnant women were referrals in 59.4% of the cases. The most frequent motive of referrals was high blood pressure and pregnancy in 66.6%. The Caesarean was indicated in most of the cases on </span><span style="font-family:Verdana;">previously</span><span style="font-family:Verdana;"> operated uterus in 22% and eclampsia was present in 14%. The maternal mortality had occurred in </span><span style="font-family:Verdana;">a context</span><span style="font-family:Verdana;"> of hemorrhage in 50% of the cases. The factors of maternal </span><span style="font-family:Verdana;">morbi-mortality</span><span style="font-family:Verdana;"> were the mode of admission, iterative Caesarean, t surgeon, context of the Caesarean, realization of the anesthetic consultation </span><span style="font-family:Verdana;">and</span><span style="font-family:Verdana;"> the technic of anesthesia (p = 0.05). The factors of fetal mortality were the realization of </span><span style="font-family:Verdana;">endo-tracheal</span><span style="font-family:Verdana;"> intubation, technic of anesthesia, </span><span style="font-family:Verdana;">realization</span><span style="font-family:Verdana;"> of the anesthesia consultation, </span><span style="font-family:Verdana;">context</span><span style="font-family:Verdana;"> of the Caesarean, iterative Caesarean </span><span style="font-family:Verdana;">and</span><span style="font-family:Verdana;"> the mode of admission (p</span></span><span style="font-family:""><span style="font-family:Verdana;"> ≤ </span><span><span style="font-family:Verdana;">0.05). </span><b><span style="font-family:Verdana;">Conclusion: </span></b><span style="font-family:Verdana;">The </span><span style="font-family:Verdana;">caesarean</span><span style="font-family:Verdana;"> is associated with a high risk of maternal complications and a very important fetal mortality. The anesthesia consultation in the follow-up of pregnancy would reduce this high mortality.</span></span></span>
文摘Sacrospinous fixation (SSF) or Richter’s intervention (RI) aims to treat genital prolapse by securing the posterior vaginal wall to the small sacrospinous ligament. It is performed by low approach and includes a dissection of the pararectal space, visual exposure of the sacrospinous ligament and a needle with strait needle holder with nonabsorbable threads. It is often associated with a more complex corrective procedure, including cystocele cure, vaginal hysterectomy and posterior myorrhaphy. The objective of this study is to report the results of SSF in the gynecology department of Hopital du Mali. A descriptive study was conducted from September 2014 to September 2015 concerning 37 patients operated on for uterine prolapse (UP). All patients with grade III UP were included in our study in whom a unilateral hysterectomy (UH) and sacrospinous fixation (SSF) were performed. All the patients were scheduled. Preoperatively they had benefited from an assessment and a pre-anesthetic consultation. Hospitalization of at least 24 hours prior to the operation was required. Postoperative follow-up was two years with a physical examination at 3 months, 9 months and 15 months, and phone calls between physical consultations. During the study period, we performed 37 RIs. The mean age of the patients was 48 years with extremes of 41 to 73 years. The large multiparity was found out in 35 cases (94.59%), the pauciparous were two with 3 deliveries for each. Long labor of more than 18 hours was found out in 9 patients (24.32%) and home delivery in 13 cases (35.13%). The duration of the occurrence of prolapse was at least two years and 35 patients were going through menopause. The type of anesthesia used for the surgery was spinal anesthesia for all patients. The average duration of the operation was 90 minutes. Complications occurred in three patients or 8.10% of cases, two cases of acute urine retention and one case of hematoma of the para-rectal space. The medium time of hospital stay was 5 days. The anatomical result was satisfactory in all patients. However, two patients presented with grade II rectocele one year after the operation. Sacrospinous fixation is a technique suitable for our patients who present with genital prolapse with extreme laxity of the suspension ligaments. Well done, it brings anatomical satisfaction and its complications are rare and slight.
文摘<strong>Summary:</strong><span style="font-family:""><span style="font-family:Verdana;"> We attempted to determine the obstetric prognosis of women without antenatal care in the Health District of Commune V of Bamako, Mali. </span><b><span style="font-family:Verdana;">Materials and Methods:</span></b><span style="font-family:Verdana;"> We undertook this retrospective case-control study from January 1 to March 31, 2017. Of all women having given birth to during this period in this district, we compared characteristics and obstetric outcomes between women without antenatal care (study group) vs. those with antenatal care (age/parity matched control). </span><b><span style="font-family:Verdana;">Results</span></b><span style="font-family:Verdana;">: 13.8% of women were without antenatal care (23.45 ± 9.56 years of age: 13 - 42). Study group (without antenatal care), compared with control, was significantly more likely to be household helpers (OR = 2.5 [2.0 - 3.4]) and single (OR = 2.3 [1.8 - 2.8]). Study group women were more significantly likely to have the following </span><span style="font-family:Verdana;">poor obstetric outcomes: premature rupture of the membranes, post-maturity, </span><span style="font-family:Verdana;">low birth weight, hypertensive disorders of pregnancy, uterine rupture, fetal death, anemia, fetal malposition, cesarean section, postpartum hemorrhage, puerperal infection and maternal death. Study group showed a higher risk of early neonatal death, low Apgar score, and transfer to Neonatology institute. </span><b><span style="font-family:Verdana;">Conclusion</span></b><span style="font-family:Verdana;">: In accordance with the previous reports in any other countries, no prenatal checkup causes higher poor outcome of both mothers and infants/neonates also in this area.</span></span>
文摘<strong>Introduction:</strong> <span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">In sub-Saharan Africa and Mali, young women who have had heart surgery want to become pregnant. The occurrence of pregnancy in these women who have had heart surgery is becoming more and more frequent in our country because of the persistence of acute</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">rheumatoid arthritis</span></span></span><span><span><span style="font-family:""> </span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">(RAA) and especially the increasingly easy access to heart surgery. </span><b><span style="font-family:Verdana;">General Objective:</span></b><span style="font-family:Verdana;"> To study the evolution of pregnancy and the prognosis of childbirth in women who have undergone heart surgery. </span><b><span style="font-family:Verdana;">Methodology:</span></b><span style="font-family:Verdana;"> This was a retrospective and descriptive study that took place over a period of five (5) years in the gynecology-obstetrics department of University Teaching Hospital (UTH) Gabriel Touré and the cardiology department of UTH Luxembourg. Was included in the study any pregnant woman admitted to the gynecology-obstetrics department of UTH Gabriel Touré and having a history of heart surgery. The variables studied were the socio-demographic characteristics, the type of heart disease, the management, the evolution of the pregnancy and the prognosis. Data was typed on word processor, Excel and analyzed on Epi info and SPSS. The Chi square or Fisher exact test (for the number </span><span style="font-family:Verdana;"><</span></span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">to 5</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">) and the relative risk (RR) with confidence interval (CI) to 95% were calculated. P was considered as significant if</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"><0.05</span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> Of the 13</span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">,</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">388 pregnant women admitted to the gynecology/obstetrics department of UTH Gabriel Touré, 20 pregnant women had a history of heart surgery (1.49‰). The average age was 26 years old. The main cardiac pathology was valvular heart disease supported in 80.00% by the placement of a prosthesis. During pregnancy follow-up, 55% of pregnant women were on Anti-Vitamin K (AVK). In 95.00% of cases, heart disease was asymptomatic. We reported a case (5.00%) of iterative cardiac decompensation, in wh</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">ich</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> cardiac ultrasound found a very arrhythmic heart, grade III mitral leak, and massive aortic leak. We did not find any case of prosthetic thrombosis. The abortion rate was 5.00%. The caesarean section rate was 31.60% and the instrumental extraction rate (forceps) was 23.10%. Newborns had a normal birth weight (68.40%), and were hypotrophic (15.80%) and premature (15.80%). In pregnant women on</span></span></span><span><span><span style="font-family:""> </span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">AVK, we reported 2 cases of fetal deaths in utero (10.00%). </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> Surgical treatment of operable heart disease is a real prophylaxis for gravidocardiac accidents. Pregnancy can be well tolerated in patients who underwent</span></span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">heart surgery with artificial heart valves.</span></span></span>
文摘Every woman has the right to receive satisfactory quality prenatal care in reproductive health. Giving a life while remaining alive and without sequelae must be the slogan of any gynecologist - obstetrician and midwife, as well as any health worker. It was a descriptive cross-sectional study dealing with the evaluation of the quality of prenatal consultations at the Kadiolo referral health center (or RHC). Adevis Donabedian’s model for assessing the quality of care and services served as a benchmark. According to Donabedian quality means good technical care, with good interpersonal relationships, and adequate and comfortable premises. This study took place from April 24 to December 04, 2017 and aimed to assess the current level of the quality of prenatal consultations at the Kadiolo referral health center, to study the structures in place including infrastructure and personnel, to specify the procedures and to determine their results. This work has permitted us to classify the RHC of Kadiolo at level III with 85%, which means that the references evaluated were satisfactory, with the level of 75% to 94%. In terms of structure, a pricing system was deemed affordable by the opinion of pregnant women. The analysis of the level of the human dimension revealed that the health center was level III. The pregnant women were satisfied with the reception which was good in 76% of the cases, as well as with the quality of the respect of the privacy in 96% and confidentiality in 95%. Despite the satisfaction of pregnant women, gaps remain to be filled in concerning the quality of the services received at the Kadiolo referral health center so as to reach level IV.
文摘Background: It is yet a controversy subject whether low birth weight and infant death are associated to human immunodeficiency virus-1 infection. Objective: To appreciate association between low birth weights, mother to child HIV transmission and infant mortality in HIV-1 infected pregnant women delivering between 2011 and 2016. Materials: We conducted 6 years cohort study in urban Mali. Outcome included preterm delivery, small for gestational age, infant survival status and HIV transmission. Comparison concerned women clinical WHO stage, mother viro-immunological status, and newborn anthropometric parameters. Results: HIV-1 infected women who delivered low birth weight newborn were 20.9% (111/531) versus 16.5% (1910/11.546) in HIV negative patients (p = 0.016). CD4 T cell counts low than 350 T cells count were strongly associated to LBW (p = 0.000;RR = 3.03;95% CI [1.89 - 3.16]). There is no significant association between ART that was initiated during pregnancy (p = 0.061, RR = 0.02;CI 95% (1.02 - 1.99)) or during delivery (p = 0.571;RR = 1.01;CI 95% (0.10 - 3.02)) and LBW delivery. In multivariate analysis ART regimens containing protease inhibitor (PI) were lone regimens associated with LBW ((p = 0.030;RR = 1.001;95% confidence interval [1.28 - 3.80]). Very low birth weight was statistically associated to women HIV infection (adjusted relative risk, 2.02;p = 0.000;95% confidence interval (2.17 - 4.10)). There is no significant difference between mother to child HIV transmission rate in the two HIV-infected pregnant women (10 infected children in group 2: MTCT rate 4.5%) and 3 infected children in group 1 (MTCT rate: 2.7%) (p = 0.56;RR, 0.59;CI 95% (0.18 - 4.39)). In multivariate analysis, LBW was associated with infant death (p = 0.001;RR = 2.04;CI 95% [1.04 - 5.05]). The median weight of infant at the moment of death in group 1 was 851 g (IQR: 520 - 1833 g). Significant relationship was found between infant death among LBW newborn with mother WHO stage 2 (p = 0.004;adjusted RR = 3.22;CI 95% [2.25 - 6.00]), CD4 T cells count 3 (p = 0.005;RR = 2.81;CI 95% [1.20 - 4.11]), PI regimens (p = 0.030;RR = 1.00;CI 95% [1.28 - 3.80]). Conclusion: We confirm increased risk of low birth weight and mother HIV-1 infection and we identified strongest association between mortality in infant born to HIV-1 infected mother and LBW.
文摘This study on Menstrual Hygiene Management (MHM) was carried out in two secondary schools in the Bamako district, “Chaine Grise” and “Cheick Modibo Diarra” located respectively on the right bank and the left bank depending on the geographic position of the Niger river. This work took place over a period of 6 months from January 2019 to June 2019. The objective of this study was to study menstrual hygiene management in school?setting for girls aged 16 to 18 in two secondary schools in Bamako. It was a transversal and qualitative description. The study population consists of girls aged 16 to 18 years enrolled in one of the selected secondary schools.?At the end of this study, we arrived at the following results:?*50% of the girls in our study have poor knowledge about menstruation;?*10% of girls miss school at least one day a month during menstruation;?*90% of girls use hygienic cotton to absorb menstrual blood;?*90% of the sources of supply for hygienic products are?mothers.?The unsanitary conditions of the toilets, lack of light and the non-separation of the toilets according to gender guidelines were found in 99% of the cases: *99% of girls say that the poor state of health infrastructures was one of the causes of genital infections linked to poor management of menstrual hygiene;?*lack of water in the toilets (99%). Through these results, we conclude that,?in our context,?menstruation remains a taboo and shameful subject for girls. In addition, some of their menstrual hygiene practices are a real danger to their health.
文摘Introduction: High grade dysplasia of the cervix has a high incidence and can progress to cervical cancer. The aim was to study cofactors associated with high-grade cervical dysplasia. Methodology: This was a retrospective case-control study without matching. Women with high grade dysplasia were the cases while those with a normal screening test represented the controls. The study took place at the Gabriel Touré University Hospital Center in Bamako. We included 351 cases and 420 controls. The capture and analysis were performed using the SPSS 20 software. A univariate and multivariate logistic regression analysis was performed for the analysis of risk cofactors. The statistical tests used were the odds ratio and its confidence interval and the statistical significance threshold was set at p Results: In univariate analysis, the co-factors statistically significantly associated with the occurrence of high-grade dysplasia were parity 0.6 (0.5 - 0.9), gestational 0.7 (0.5 - 0.9), smoking of the spouse 3.4 (1.1 - 11.3), the non-schooling 1.4 (1.2 - 2.1). In multivariate analysis after adjusting for confounding factors, two co-factors have significantly increased the risk of high-grade dysplasia: lack of schooling 1.4 (1.2 - 2.0) and polygamy 1.5 (1.4 - 2.5). Conclusion: At the end of this study, polygamy and lack of schooling were the main risk factors. The prevention of cervical cancer will go through the education of girls and women as well as communication for behavioral change and social change.
文摘Intra uterine device migration is a relatively rare event. The migration of the IUD in the surrounded viscera can be managed by endoscopy approach. Objectives: We reported our experience to determine the epidemiologic characteristics of patients that presented migrated IUD, to report clinical aspects and describe the laparoscopic management. Method: We conducted a descriptive and prospective survey from January 1st, 2014 to October 31, 2016. That survey took place in the department of gynecology and obstetrics of Point G Teaching hospital, Bamako, Mali. Population study concerned patients with intra uterine device complications. Statistic tests used have been X2 or Fisher test according their application conditions. P Results: Seventeen patients were included. Mean age of patients is 29 years with extremes of 13 years and 44 years. The main reference incitement of patients were perforation of the uterus and pelvis pain (27.8% for each), misplaced IUD (22.3%). Complications observed were intra uterine device migrated in to the bladder (1 case), in the abdomen (10 cases), in the ovary (2 cases) and in the uterine tuba (1 case). Three perforations were done without migration in to surrounded viscera. We used endoscopic surgery among all of them. But in one case we switched endoscopy method in to laparotomy because of important intra peritoneal bleeding to end the management of the patient. No death occurred and mean duration of the stay of hospitalization was 2 days. Conclusion: IUD migration is a scarce event. All the surrounded viscera can be the site of its migration. The management of that complication is usually done by endoscopy method.
