Assessment of Post-abortion Care Services in Two Health Facilities in Conakry, Guinea

High quality post-abortion care (PAC) is needed to curb maternal deaths by providing effective treatment and preventing future unintended pregnancies through PAC family planning. This study aimed at assessing PAC services with a focus on women‘s satisfaction with care they received in two health facilities in Conakry. We conducted a cross-sectional mixed method study with 426 PAC clients from March 1st to August 31st, 2014. Data analyses were performed using Stata software version 14 for quantitative data and using a thematic approach for qualitative data. Overall, 92.5% of women were satisfied with PAC services they received. The short waiting time (< 30 min), the appropriate management of pain during the treatment, the affordable cost of the treatment, the confidentiality of services, the good patient-provider interaction and the cleanliness of the premises were factors statistically significantly associated with the satisfaction of women (P-value ˂ 0.001). This study showed a high rate ofwomen‘s satisfaction. Nevertheless, health authorities should assure a regular follow-up on the application of official prices for the treatment of PAC patients; and providers should further consider aspects such as pain management during treatment, confidentiality of services, patient-provider interaction for optimal satisfaction of clients with PAC services. Keywords: Assessment, Post-abortion care, Health facilities, GuineaDes soins post-avortement (SAA) de haute qualité sont nécessaires pour réduire les décès maternels en fournissant un traitement efficace et en prévenant les futures grossesses non désirées grâce à la planification familiale après-avortement. Cette étude visait à évaluer les services de SAA en mettant l'accent sur la satisfaction des femmes à l'égard des soins qu'elles ont reçus dans deux établissements de santé à Conakry. Nous avons mené une étude transversale à méthodes mixtes auprès de 426 clientes de SAA du 1er mars au 31 août 2014. Les analyses de données ont été réalisées à l'aide du logiciel Stata version 14 pour les données quantitatives et en utilisant une approche thématique pour les données qualitatives. Dans l'ensemble, 92,5% des femmes étaient satisfaites des services de SAA qu'elles ont reçus. Le temps d'attente court (<30 min), la gestion appropriée de la douleur pendant le traitement, le coût abordable du traitement, la confidentialité des services, la bonne interaction patiente -prestataire et la propreté des locaux étaient des facteurs statistiquement significativement associés à la satisfaction des femmes (valeur P ˂0,001). Cette étude a montré un taux élevé de satisfaction des femmes. Néanmoins, les autorités sanitaires devraient assurer un suivi régulier de l'application des prix officiels pour le traitement des patientes de SAA; et les prestataires devraient en outre prendre en compte des aspects tels que la gestion de la douleur pendant le traitement, la confidentialité des services, l'interaction patiente-prestataire pour une satisfaction optimale des clientes à l‘égard des services de SAA. Mots-clés: Évaluation, Soins post-avortement, Établissements de santé, Guiné

A semimechanistic pharmacokinetic-enzyme turnover model for rifampin autoinduction in adult tuberculosis patients.

The currently recommended doses of rifampin are believed to be at the lower end of the dose-response curve. Rifampin induces its own metabolism, although the effect of dose on the extent of autoinduction is not known. This study aimed to investigate rifampin autoinduction using a semimechanistic pharmacokinetic-enzyme turnover model. Four different structural basic models were explored to assess whether different scaling methods affected the final covariate selection procedure. Covariates were selected by using a linearized approach. The final model included the allometric scaling of oral clearance and apparent volume of distribution. Although HIV infection was associated with a 30% increase in the apparent volume of distribution, simulations demonstrated that the effect of HIV on rifampin exposure was slight. Model-based simulations showed close-to-maximum induction achieved after 450-mg daily dosing, since negligible increases in oral clearance were observed following the 600-mg/day regimen. Thus, dosing above 600 mg/day is unlikely to result in higher magnitudes of autoinduction. In a typical 55-kg male without HIV infection, the oral clearance, which was 7.76 liters · h⁻¹ at the first dose, increased 1.82- and 1.85-fold at steady state after daily dosing with 450 and 600 mg, respectively. Corresponding reductions of 41 and 42%, respectively, in the area under the concentration-versus-time curve from 0 to 24 h were estimated. The turnover of the inducible process was estimated to have a half-life of approximately 8 days in a typical patient. Assuming 5 half-lives to steady state, this corresponds to a duration of approximately 40 days to reach the induced state for rifampin autoinduction

Evaluation of initial and steady-state gatifloxacin pharmacokinetics and dose in pulmonary tuberculosis patients by using monte carlo simulations.

A 4-month regimen of gatifloxacin with rifampin, isoniazid, and pyrazinamide is being evaluated for the treatment of tuberculosis in a phase 3 randomized controlled trial (OFLOTUB). A prior single-dose study found that gatifloxacin exposure increased by 14% in the combination. The aims of the study are to evaluate the initial and steady-state pharmacokinetics of gatifloxacin when daily doses are given to patients with newly diagnosed drug-sensitive pulmonary tuberculosis as part of a combination regimen and to evaluate the gatifloxacin dose with respect to the probability of attaining a pharmacokinetic/pharmacodynamic target. We describe the population pharmacokinetics of gatifloxacin from the first dose to a median of 28 days in 169 adults enrolled in the OFLOTUB trial in Benin, Guinea, Senegal, and South Africa. The probability of achieving a ratio of ≥125 for the area under the concentration time curve to infinity (AUC0-∞) for the free fraction of gatifloxacin over the MIC (fAUC/MIC) was investigated using Monte Carlo simulations. The median AUC0-∞ of 41.2 μg · h/ml decreased on average by 14.3% (90% confidence interval [CI], -90.5% to +61.5%) following multiple 400-mg daily doses. At steady state, 90% of patients achieved an fAUC/MIC of ≥125 only when the MIC was <0.125 μg/ml. We conclude that systemic exposure to gatifloxacin declines with repeated daily 400-mg doses when used together with rifampin, isoniazid, and pyrazinamide, thus compensating for any initial increase in gatifloxacin levels due to a drug interaction. (The OFLOTUB study has been registered at ClinicalTrials.gov under registration no. NCT00216385.)

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