Importance of screening for urinary tract infection in African Black diabetics

Urinary tract infections are common and often latent in diabetic patients. The objective of this study was to determinethe frequency of urinary tract infections and the organisms responsible.This is a descriptive type prospective study conducted in the Endocrinology and Diabetology ward of Donka UniversityHospital. All diabetic patients hospitalised from January 3rd to April 4th 2013 were included in the study.Two hundred and sixty-two diabetics had been screened, 64 (24.42%) had a urinary tract infection 41 women (64%)and 23 men (36%). The average age was 56.48 16.3 years with a range of 20-90 years. Urinary tract infections weremore frequent between the ages of 45 and 74 (67.20%). Sixty patients were married, four were single. Fifty-six patientswere type 2 diabetes against eight type I diabetes. Urine test strips showed 60 cases of pyuria, 36 cases of nitruria, 21cases of proteinuria and three cases of hematuria. Organisms identified were: Escherichia coli in 31 cases (48.43%): 25women and six men; Klebsiella pneumoniae in 14 cases (21.87%): nine women and five men; Staphylococcus aureusin 11 cases (17.18%): six women and five men; and Proteus mirabilis in eight cases (12.51%): two women and six men.The clinical manifestations were: asymptomatic bacteriuria in 57 cases (89.06%); acute cystitis in five cases (7.81%); andacute urethritis in two cases (3.13%).Urinary infection in African diabetics is very common. It requires a systematic screening with urine test strips becauseasymptomatic types are by far the most common. This would allow early treatment and avoid serious complications

Diagnosis and management of benign ovarian tumors at the Ignace Deen Maternity Hospital of Conakry University Hospital in Guinea

Background: Benign ovarian tumors are a common reason for consultation and intervention in gynecology. The objective of this was to describe the clinical, ultrasonographic, histological and therapeutic aspects of benign ovarian tumors in the department.Methods: This is a retrospective and descriptive study of three years and six months from January 1, 2016, to June 30, 2019, which focused on the records of women-operated during this period of benign ovarian tumors.Results: The incidence of benign ovarian tumors was 12.58%. The circumstances of discovery were dominated by disorders of the menstrual cycle (35.05%) followed by infertility (20.78%), the sensation of a pelvic mass (19.48%), and pelvic pain. (15.58%). The ultrasound report was in favor of a serous cyst in 74% of cases, a mucoid cyst in 14% of cases, a dermoid cyst in 9% and an endometriotic cyst in 3%. Histology revealed a serous cystadenoma in 70.13% of the cases, a mucinous cystadenoma in 16.88% of the cases, a mature poly tissue teratoma in 9.09% of the cases and an endometrial cyst in 3.90 % of the cases. Cystectomy was the most performed surgical procedure (71%).Conclusions: Benign ovarian tumors are common in our practice. The most common histological forms were serous and mucinous cystadenomas. Conservative treatment has been practiced in the majority of cases

A mixed-methods study of maternal health care utilisation in six referral hospitals in four sub-Saharan African countries before and during the COVID-19 pandemic.

INTRODUCTION: In sub-Saharan Africa, referral hospitals are important sources of key maternal health services, especially during a crisis such as the COVID-19 pandemic. This study prospectively assessed the effect of the COVID-19 pandemic on maternal health service utilisation in six large referral hospitals in Guinea, Nigeria, Tanzania and Uganda during the first year of the pandemic. METHODS: Mixed-methods design combining three data sources: (1) quantitative data based on routine antenatal, childbirth and postnatal care data collected March 2019-February 2021, (2) qualitative data from recurring rounds of semi-structured interviews conducted July 2020-February 2021 with 22 maternity skilled heath personnel exploring their perceptions of service utilisation and (3) timeline data of COVID-19 epidemiology, global, national and hospital-level events. Qualitative and quantitative data were analysed separately, framed based on the timeline analysis and triangulated when reporting. RESULTS: Three periods including a first wave, slow period and second wave were identified. Maternal health service utilisation was lower during the pandemic compared with the prepandemic year in all but one selected referral hospital. During the pandemic, service utilisation was particularly lower during the waves and higher or stable during the slow period. Fear of being infected in hospitals, lack of transportation, and even when available, high cost of transportation and service closures were key reasons affecting utilisation during the waves. However, community perception that the pandemic was over or insinuation by Government of the same appeared to stabilise use of referral hospitals for childbirth. CONCLUSION: Utilisation of maternal health services across the continuum of care varied through the different periods and across countries. In crisis situations such as COVID-19, restrictions and service closures need to be implemented with consideration given to alternative options for women to access and use services. Information on measures put in place for safe hospital use should be communicated to women

A mixed-methods study of maternal health care utilisation in six referral hospitals in four sub-Saharan African countries before and during the COVID-19 pandemic

Introduction In sub-Saharan Africa, referral hospitals are important sources of key maternal health services, especially during a crisis such as the COVID-19 pandemic. This study prospectively assessed the effect of the COVID-19 pandemic on maternal health service utilisation in six large referral hospitals in Guinea, Nigeria, Tanzania and Uganda during the first year of the pandemic. Methods Mixed-methods design combining three data sources: (1) quantitative data based on routine antenatal, childbirth and postnatal care data collected March 2019–February 2021, (2) qualitative data from recurring rounds of semi-structured interviews conducted July 2020–February 2021 with 22 maternity skilled heath personnel exploring their perceptions of service utilisation and (3) timeline data of COVID-19 epidemiology, global, national and hospital-level events. Qualitative and quantitative data were analysed separately, framed based on the timeline analysis and triangulated when reporting. Results Three periods including a first wave, slow period and second wave were identified. Maternal health service utilisation was lower during the pandemic compared with the prepandemic year in all but one selected referral hospital. During the pandemic, service utilisation was particularly lower during the waves and higher or stable during the slow period. Fear of being infected in hospitals, lack of transportation, and even when available, high cost of transportation and service closures were key reasons affecting utilisation during the waves. However, community perception that the pandemic was over or insinuation by Government of the same appeared to stabilise use of referral hospitals for childbirth. Conclusion Utilisation of maternal health services across the continuum of care varied through the different periods and across countries. In crisis situations such as COVID-19, restrictions and service closures need to be implemented with consideration given to alternative options for women to access and use services. Information on measures put in place for safe hospital use should be communicated to women

‘We are not going to shut down, because we cannot postpone pregnancy’: a mixed-methods study of the provision of maternal healthcare in six referral maternity wards in four sub-Saharan African countries during the COVID-19 pandemic

Introduction Referral hospitals in sub-Saharan Africa are located in crowded urban areas, which were often epicentres of the COVID-19 pandemic. This paper prospectively assesses how maternal healthcare was provided in six referral hospitals in Guinea, Nigeria, Tanzania and Uganda during the first year of the COVID-19 pandemic. Methods Mixed-methods design using three data sources: (1) qualitative data from repeated rounds of semi-structured interviews conducted between July 2020 and February 2021 with 22 maternity skilled heath personnel (SHP) on perceptions of care provision; (2) quantitative monthly routine data on caesarean section and labour induction from March 2019 to February 2021; and (3) timeline data of COVID-19 epidemiology, national and hospital-level events. Qualitative and quantitative data were analysed separately, framed based on timeline analysis, and triangulated during reporting. Results We identified three periods: first wave, slow period and second wave. The first wave was challenging for SHP given little knowledge about COVID-19, lack of infection prevention and control training, and difficulties reaching workplace. Challenges that persisted beyond the first wave were shortage of personal protective equipment and no rapid testing for women suspected with COVID-19. We noted no change in the proportion of caesarean sections during the pandemic, and a small increase in the proportion of labour inductions. All hospitals arranged isolation areas for women suspected/confirmed with COVID-19 and three hospitals provided care to women with suspected/confirmed COVID-19. Breastfeeding was not discouraged and newborns were not separated from mothers confirmed with COVID-19. Care provision was maintained through dedication of SHP, support from hospital management and remote communication between SHP. Conclusion Routine maternal care provision was maintained in referral hospitals, despite first wave challenges. Referral hospitals and SHP contributed to guideline development for pregnant women suspected/confirmed with COVID-19. Maternity SHP, women and pregnancy must always be included in priority setting when responding to health system shocks, including outbreaks

The respective fields of the regulatory and legislative power in the Republic of Guinea through the French model

Depuis son indépendance de la France le 02 octobre 1958, la Guinée connait sa troisième République. A l’instar des deux précédentes, le fonctionnement des pouvoirs sous la troisième République se caractérise par plusieurs dysfonctionnements dont le non-respect des prescriptions constitutionnelles. Cela entraine une domination prononcée des autres pouvoirs par l’exécutif et plus spécialement par le Président de la République. Aussi bien sur le plan de la production normative que sur le plan de l’exécution des normes, le Président de la République est la pierre angulaire du système. Dans ce contexte, l’évolution constitutionnelle réalisée en 2010 s’apparente plus à un échec. À l’instar de celles qui l’ont précédé, elle n’a pas permis d’atténuer l’hyper puissance de l’exécutif. Dès lors, il importe d’explorer et d’expérimenter de nouvelles approches qui prennent davantage en compte les insuffisances révélées par la pratique institutionnelle. Ainsi, il convient d’engager le système politique guinéen vers : plus d’indépendance des organes juridictionnels, une réorganisation du Parlement par la consécration de nouveaux droits à l’opposition parlementaire notamment en matière de contrôle, une plus grande sensibilisation/responsabilisation des acteurs institutionnels sur les dangers liés au non-respect des prévisions constitutionnelles, une meilleure affirmation du rôle du Premier ministre notamment en matière d’exécution des lois, une consécration de nouveaux outils au profit des structures juridictionnelles censées garantir le respect du principe de la séparation et de l’équilibre des pouvoirs, et surtout la prise en compte des aspects socioculturels dans le nouveau contrat social à élaborer.Since its independence from France on October 2, 1958, Guinea has known its third Republic. Following the example of the previous two Republics, the functioning of powers under the third Republic is characterized by several dysfunctions, including the non-compliance with constitutional requirements. This leads to a pronounced domination of other powers by the executive and more especially by the President of the Republic. Both in terms of normative production and in terms of the execution of legal provisions, the President of the Republic is the cornerstone of the system. In this context, the constitutional evolution achieved in 2010 looks more like a failure. Like those which preceded it, it did not make it possible to attenuate the hyper power of the executive. It is therefore important to explore and experiment with new approaches that take more into account the shortcomings revealed by the institutional practice. Thus, the Guinean political system should be committed to : more independence of the judicial bodies, a reorganization of Parliament by the consecration of new rights to the parliamentary opposition, particularly in terms of control, greater awareness/empowerment of institutional bodies on the dangers linked to non-compliance with constitutional provisions, a better affirmation of the role of the Prime Minister, particularly in terms of law enforcement, a consecration of new tools for the benefit of the jurisdictional structures supposed to guarantee the respect of the principle of separation and the balance of powers, and above all, the coverage of socio-cultural aspects in the new social contract to be drawn up

Perspectives and experiences of healthcare providers on the response to the COVID-19 pandemic in three maternal and neonatal referral hospitals in Guinea in 2020: a qualitative study

Abstract Background The COVID-19 pandemic has adversely affected access to essential healthcare services. This study aimed to explore healthcare providers’ perceptions and experiences of the response to the COVID-19 pandemic in three referral maternal and neonatal hospitals in Guinea. Methods We conducted a longitudinal qualitative study between June and December 2020 in two maternities and one neonatology referral ward in Conakry and Mamou. Participants were purposively recruited to capture diversity of professional cadres, seniority, and gender. Four rounds of in-depth interviews (46 in-depth interviews with 18 respondents) were conducted in each study site, using a semi-structured interview guide that was iteratively adapted. We used both deductive and inductive approaches and an iterative process for content analysis. Results We identified four themes and related sub-themes presented according to whether they were common or specific to the study sites, namely: 1) coping strategies & care reorganization, which include reducing staffing levels, maintaining essential healthcare services, suspension of staff daily meetings, insertion of a new information system for providers, and co-management with COVID-19 treatment center for caesarean section cases among women who tested positive for COVID-19; 2) healthcare providers’ behavior adaptations during the response, including infection prevention and control measures on the wards and how COVID-19-related information influenced providers’ daily work; 3) difficulties encountered by providers, in particular unavailability of personal protective equipment (PPE), lack of financial motivation, and difficulties reducing crowding in the wards; 4) providers perceptions of healthcare service use, for instance their fear during COVID-19 response and perceived increase in severity of complications received and COVID-19 cases among providers and parents of newborns. Conclusion This study provides insights needed to be considered to improve the preparedness and response of healthcare facilities and care providers to future health emergencies in similar contexts

Piloting development of species conservation action plans in Guinea

Conservation action plans need to be devised and implemented if we are to reduce the extinction risk faced by globally threatened plants. However, most plant species categorized as threatened globally on the IUCN Red List lack conservation action plans. In West Africa, Guinea is one of the most diverse countries in terms of botanical species. In total, 273 plant species in Guinea have been assessed as being threatened globally, reflecting increasing pressure from the extractive industry and a growing population requiring food and fuel. In parallel with the implementation of an Important Plant Area programme in Guinea, we developed conservation action plans for 20 threatened plant species through a pilot study. We outline the methods we used and demonstrate the importance of adopting a collaborative approach and having up-to-date field information. The need for such plans is urgent, with recent estimates suggesting that one-third of African plants are threatened with extinction. Based on our experience with the first 20 conservation action plans for Guinea species, we suggest that the preparation of multi-species conservation action plans would be an efficient use of the limited resources available for species conservation

'We are not going to shut down, because we cannot postpone pregnancy': a mixed-methods study of the provision of maternal healthcare in six referral maternity wards in four sub-Saharan African countries during the COVID-19 pandemic.

INTRODUCTION: Referral hospitals in sub-Saharan Africa are located in crowded urban areas, which were often epicentres of the COVID-19 pandemic. This paper prospectively assesses how maternal healthcare was provided in six referral hospitals in Guinea, Nigeria, Tanzania and Uganda during the first year of the COVID-19 pandemic. METHODS: Mixed-methods design using three data sources: (1) qualitative data from repeated rounds of semi-structured interviews conducted between July 2020 and February 2021 with 22 maternity skilled heath personnel (SHP) on perceptions of care provision; (2) quantitative monthly routine data on caesarean section and labour induction from March 2019 to February 2021; and (3) timeline data of COVID-19 epidemiology, national and hospital-level events. Qualitative and quantitative data were analysed separately, framed based on timeline analysis, and triangulated during reporting. RESULTS: We identified three periods: first wave, slow period and second wave. The first wave was challenging for SHP given little knowledge about COVID-19, lack of infection prevention and control training, and difficulties reaching workplace. Challenges that persisted beyond the first wave were shortage of personal protective equipment and no rapid testing for women suspected with COVID-19. We noted no change in the proportion of caesarean sections during the pandemic, and a small increase in the proportion of labour inductions. All hospitals arranged isolation areas for women suspected/confirmed with COVID-19 and three hospitals provided care to women with suspected/confirmed COVID-19. Breastfeeding was not discouraged and newborns were not separated from mothers confirmed with COVID-19. Care provision was maintained through dedication of SHP, support from hospital management and remote communication between SHP. CONCLUSION: Routine maternal care provision was maintained in referral hospitals, despite first wave challenges. Referral hospitals and SHP contributed to guideline development for pregnant women suspected/confirmed with COVID-19. Maternity SHP, women and pregnancy must always be included in priority setting when responding to health system shocks, including outbreaks

Obstetric referrals, complications and health outcomes in maternity wards of large hospitals during the COVID-19 pandemic: a mixed methods study of six hospitals in Guinea, Nigeria, Uganda and Tanzania

Objectives The COVID-19 pandemic affected provision and use of maternal health services. This study describes changes in obstetric complications, referrals, stillbirths and maternal deaths during the first year of the pandemic and elucidates pathways to these changes.Design Prospective observational mixed-methods study, combining monthly routine data (March 2019–February 2021) and qualitative data from prospective semi-structured interviews. Data were analysed separately, triangulated during synthesis and presented along three country-specific pandemic periods: first wave, slow period and second wave.Setting Six referral maternities in four sub-Saharan African countries: Guinea, Nigeria, Tanzania and Uganda.Participants 22 skilled health personnel (SHP) working in the maternity wards of various cadres and seniority levels.Results Percentages of obstetric complications were constant in four of the six hospitals. The percentage of obstetric referrals received was stable in Guinea and increased at various times in other hospitals. SHP reported unpredictability in the number of referrals due to changing referral networks. All six hospitals registered a slight increase in stillbirths during the study period, the highest increase (by 30%–40%) was observed in Uganda. Four hospitals registered increases in facility maternal mortality ratio; the highest increase was in Guinea (by 158%), which had a relatively mild COVID-19 epidemic. These increases were not due to mortality among women with COVID-19. The main pathways leading to these trends were delayed care utilisation and disruptions in accessing care, including sub-optimal referral linkages and health service closures.Conclusions Maternal and perinatal survival was negatively affected in referral hospitals in sub-Saharan Africa during COVID-19. Routine data systems in referral hospitals must be fully used as they hold potential in informing adaptations of maternal care services. If combined with information on women’s and care providers’ needs, this can contribute to ensuring continuation of essential care provision during emergency