Management de la Qualité à l’Hôpital de Ségou en 2018 (Mali)

Introduction : Les ‘‘5S-Kaizen-TQM’’ sont une démarche d’Assurance Qualité simple, peu onéreuse, innovante. Cette démarche initiée dans les services de Pédiatrie, de Gynéco-Obstétrique et Accueil des Urgences à l’Hôpital de Ségou en 2009, a ciblé à l’aide des 5S l’environnement de travail, le comportement du personnel, la satisfaction des clients, les indicateurs de soins. Le présent article vise à évaluer l’efficacité du management à travers la planification, l’organisation des ressources, la direction, le contrôle de la qualité. Méthodologie : Il s’agissait d’une étude transversale, descriptive. Les techniques de collecte de données ont été l’entretien individuel, l’observation et l’exploitation documentaire. Résultats : Les fonctions évaluées du Management ont été jugée satisfaisante avec 94% pour la planification, l’organisation des ressources (81%), la direction (88%), le contrôle (82%). Ces différentes composantes ont permis d’apprécier l’efficacité du Management à l’hôpital de Ségou, qui avec un score de 86,25% a été jugé efficace selon nos critères. Cependant, quelques insuffisances dont l’absence d’engagement formel, de document de politique de qualité, de mécanisme formel d’écoute du client, la faible fonctionnalité des organes consultatifs, la longue file d’attente au bureau des entrées ont été notées.  Conclusion : Face aux insuffisances constatées et en vue de pérenniser les acquis, il a été suggéré de renforcer l’effectif du personnel, élaborer une politique qualité, réduire le temps d’attente, instituer des mécanismes d’écoute des clients, renforcer les mesures de contrôle de la qualité à l’Hôpital de Ségou.   Introduction: "5S-Kaizen-TQM" is a simple, inexpensive and innovative Quality Assurance approach. Initiated in the Paediatrics, Gynaecology and Obstetrics and Emergency Departments at Ségou’s Hospital in 2009, this approach uses 5S to target the working environment, staff behaviour, customer satisfaction and care indicators. The aim of this article is to assess the effectiveness of management through planning, resource organisation, leadership and quality control. Methodology: This was a cross-sectional, descriptive study. Data collection techniques included individual interviews, observation and documentary analysis. Results: The management functions assessed were judged to be satisfactory, with 94% for planning, organisation of resources (81%), direction (88%) and control (82%). These different components made it possible to assess the effectiveness of management at Ségou Hospital, which, with a score of 86.25%, was judged to be effective according to our criteria. However, a number of shortcomings were noted, including the absence of a formal commitment, a quality policy document, a formal mechanism for listening to customers, the poor functioning of consultative bodies, and long queues at the admissions office.  Conclusion: In view of the shortcomings identified, and with a view to sustaining the gains made, it was suggested that the number of staff should be increased, a quality policy should be developed, waiting times should be reduced, mechanisms for listening to customers should be introduced, and quality control measures at Ségou Hospital should be strengthened

Management de la Qualité à l’Hôpital de Ségou en 2018 (Mali)

Introduction : Les ‘‘5S-Kaizen-TQM’’ sont une démarche d’Assurance Qualité simple, peu onéreuse, innovante. Cette démarche initiée dans les services de Pédiatrie, de Gynéco-Obstétrique et Accueil des Urgences à l’Hôpital de Ségou en 2009, a ciblé à l’aide des 5S l’environnement de travail, le comportement du personnel, la satisfaction des clients, les indicateurs de soins. Le présent article vise à évaluer l’efficacité du management à travers la planification, l’organisation des ressources, la direction, le contrôle de la qualité. Méthodologie : Il s’agissait d’une étude transversale, descriptive. Les techniques de collecte de données ont été l’entretien individuel, l’observation et l’exploitation documentaire. Résultats : Les fonctions évaluées du Management ont été jugée satisfaisante avec 94% pour la planification, l’organisation des ressources (81%), la direction (88%), le contrôle (82%). Ces différentes composantes ont permis d’apprécier l’efficacité du Management à l’hôpital de Ségou, qui avec un score de 86,25% a été jugé efficace selon nos critères. Cependant, quelques insuffisances dont l’absence d’engagement formel, de document de politique de qualité, de mécanisme formel d’écoute du client, la faible fonctionnalité des organes consultatifs, la longue file d’attente au bureau des entrées ont été notées.  Conclusion : Face aux insuffisances constatées et en vue de pérenniser les acquis, il a été suggéré de renforcer l’effectif du personnel, élaborer une politique qualité, réduire le temps d’attente, instituer des mécanismes d’écoute des clients, renforcer les mesures de contrôle de la qualité à l’Hôpital de Ségou.   Introduction: "5S-Kaizen-TQM" is a simple, inexpensive and innovative Quality Assurance approach. Initiated in the Paediatrics, Gynaecology and Obstetrics and Emergency Departments at Ségou’s Hospital in 2009, this approach uses 5S to target the working environment, staff behaviour, customer satisfaction and care indicators. The aim of this article is to assess the effectiveness of management through planning, resource organisation, leadership and quality control. Methodology: This was a cross-sectional, descriptive study. Data collection techniques included individual interviews, observation and documentary analysis. Results: The management functions assessed were judged to be satisfactory, with 94% for planning, organisation of resources (81%), direction (88%) and control (82%). These different components made it possible to assess the effectiveness of management at Ségou Hospital, which, with a score of 86.25%, was judged to be effective according to our criteria. However, a number of shortcomings were noted, including the absence of a formal commitment, a quality policy document, a formal mechanism for listening to customers, the poor functioning of consultative bodies, and long queues at the admissions office.  Conclusion: In view of the shortcomings identified, and with a view to sustaining the gains made, it was suggested that the number of staff should be increased, a quality policy should be developed, waiting times should be reduced, mechanisms for listening to customers should be introduced, and quality control measures at Ségou Hospital should be strengthened

Évaluation de la Satisfaction des Usagers du Service des Urgences de l'Hôpital Mère-Enfant le Luxembourg de Bamako au Mali, en 2019

Introduction : L’évaluation de lasatisfaction des usagers est un élément essentiel de la qualité des soins et prestation d’un hôpital. Cette étude visait à évaluer la satisfaction des usagers du service des urgences au Centre Hospitalier Universitaire le Luxembourg de Bamako, Mali, en 2019 en vue d’améliorer la qualité de la prise en charge. Méthodes : Il s’agissait d’une étude descriptive, transversaleayant ciblé les patients ou accompagnants en consultation ouhospitalisé dans ledit service. La collecte des données, réalisée du 02 mai au 23 août 2019, a utilisé un questionnaire administré auxusagers dans le service ou à la sortie, en mode face à face, après leur consentement éclairé. Résultats : Sur les 138 usagers enquêtés, 68,84 était de sexe féminin, 73,19% avait plus de 50 ans, 96,38% scolarisés et 35,51% étaient des ménagères. Ils étaient satisfaits à 72,97% des prestations reçues.Le principal motif de satisfaction était la rapidité de la prise en charge(p=0,037). Chez les non satisfaits (27,03%), les motifs incriminés étaient le long temps d’attente (63,37%), la non disponibilité des médicaments (30,43%), le coût élevé des prestations (28,99%) et l’exiguïté des locaux (26,21%).  Conclusion : Malgré certaines insuffisances du service des urgences du CHU le Luxembourg, le bon accueil et la prise en charge rapide sont les éléments clés associés à la satisfaction du patient.   Introduction:The evaluation of user satisfaction is an essential element of the quality of care and delivery of a hospital. This study aimed to assess the satisfaction of users of the emergency department at the Center Hospitalier Universitaire le Luxembourg in Bamako, Mali, in 2019 with a view to improving the quality of care. Methods:This was a descriptive, cross-sectional study that targeted patients or caregivers in consultation or hospitalized in the said service. Data collection, carried out from May 2 to August 23, 2019, used a questionnaire administered to users in the service or at the exit, in face-to-face mode, after their informed consent. Results:Of the 138 users surveyed, 68.84 were female, 73.19% were over 50 years old, 96.38% were educated and 35.51% were housewives. They were 72.97% satisfied with the services received. The main reason for satisfaction was the speed of treatment (p=0.037). Among those not satisfied (27.03%), the reasons incriminated were the long waiting time (63.37%), the unavailability of drugs (30.43%), the high cost of services (28.99%) and the small size of the premises (26.21%). Conclusion:Despite certain shortcomings of the emergency department of the CHU Luxembourg, good reception and rapid treatment are the key elements associated with patient satisfaction

Évaluation de la Satisfaction des Usagers du Service des Urgences de l'Hôpital Mère-Enfant le Luxembourg de Bamako au Mali, en 2019

Introduction : L’évaluation de lasatisfaction des usagers est un élément essentiel de la qualité des soins et prestation d’un hôpital. Cette étude visait à évaluer la satisfaction des usagers du service des urgences au Centre Hospitalier Universitaire le Luxembourg de Bamako, Mali, en 2019 en vue d’améliorer la qualité de la prise en charge. Méthodes : Il s’agissait d’une étude descriptive, transversaleayant ciblé les patients ou accompagnants en consultation ouhospitalisé dans ledit service. La collecte des données, réalisée du 02 mai au 23 août 2019, a utilisé un questionnaire administré auxusagers dans le service ou à la sortie, en mode face à face, après leur consentement éclairé. Résultats : Sur les 138 usagers enquêtés, 68,84 était de sexe féminin, 73,19% avait plus de 50 ans, 96,38% scolarisés et 35,51% étaient des ménagères. Ils étaient satisfaits à 72,97% des prestations reçues.Le principal motif de satisfaction était la rapidité de la prise en charge(p=0,037). Chez les non satisfaits (27,03%), les motifs incriminés étaient le long temps d’attente (63,37%), la non disponibilité des médicaments (30,43%), le coût élevé des prestations (28,99%) et l’exiguïté des locaux (26,21%).  Conclusion : Malgré certaines insuffisances du service des urgences du CHU le Luxembourg, le bon accueil et la prise en charge rapide sont les éléments clés associés à la satisfaction du patient.   Introduction:The evaluation of user satisfaction is an essential element of the quality of care and delivery of a hospital. This study aimed to assess the satisfaction of users of the emergency department at the Center Hospitalier Universitaire le Luxembourg in Bamako, Mali, in 2019 with a view to improving the quality of care. Methods:This was a descriptive, cross-sectional study that targeted patients or caregivers in consultation or hospitalized in the said service. Data collection, carried out from May 2 to August 23, 2019, used a questionnaire administered to users in the service or at the exit, in face-to-face mode, after their informed consent. Results:Of the 138 users surveyed, 68.84 were female, 73.19% were over 50 years old, 96.38% were educated and 35.51% were housewives. They were 72.97% satisfied with the services received. The main reason for satisfaction was the speed of treatment (p=0.037). Among those not satisfied (27.03%), the reasons incriminated were the long waiting time (63.37%), the unavailability of drugs (30.43%), the high cost of services (28.99%) and the small size of the premises (26.21%). Conclusion:Despite certain shortcomings of the emergency department of the CHU Luxembourg, good reception and rapid treatment are the key elements associated with patient satisfaction

The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance

INTRODUCTION Investment in Africa over the past year with regard to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing has led to a massive increase in the number of sequences, which, to date, exceeds 100,000 sequences generated to track the pandemic on the continent. These sequences have profoundly affected how public health officials in Africa have navigated the COVID-19 pandemic. RATIONALE We demonstrate how the first 100,000 SARS-CoV-2 sequences from Africa have helped monitor the epidemic on the continent, how genomic surveillance expanded over the course of the pandemic, and how we adapted our sequencing methods to deal with an evolving virus. Finally, we also examine how viral lineages have spread across the continent in a phylogeographic framework to gain insights into the underlying temporal and spatial transmission dynamics for several variants of concern (VOCs). RESULTS Our results indicate that the number of countries in Africa that can sequence the virus within their own borders is growing and that this is coupled with a shorter turnaround time from the time of sampling to sequence submission. Ongoing evolution necessitated the continual updating of primer sets, and, as a result, eight primer sets were designed in tandem with viral evolution and used to ensure effective sequencing of the virus. The pandemic unfolded through multiple waves of infection that were each driven by distinct genetic lineages, with B.1-like ancestral strains associated with the first pandemic wave of infections in 2020. Successive waves on the continent were fueled by different VOCs, with Alpha and Beta cocirculating in distinct spatial patterns during the second wave and Delta and Omicron affecting the whole continent during the third and fourth waves, respectively. Phylogeographic reconstruction points toward distinct differences in viral importation and exportation patterns associated with the Alpha, Beta, Delta, and Omicron variants and subvariants, when considering both Africa versus the rest of the world and viral dissemination within the continent. Our epidemiological and phylogenetic inferences therefore underscore the heterogeneous nature of the pandemic on the continent and highlight key insights and challenges, for instance, recognizing the limitations of low testing proportions. We also highlight the early warning capacity that genomic surveillance in Africa has had for the rest of the world with the detection of new lineages and variants, the most recent being the characterization of various Omicron subvariants. CONCLUSION Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve. This is important not only to help combat SARS-CoV-2 on the continent but also because it can be used as a platform to help address the many emerging and reemerging infectious disease threats in Africa. In particular, capacity building for local sequencing within countries or within the continent should be prioritized because this is generally associated with shorter turnaround times, providing the most benefit to local public health authorities tasked with pandemic response and mitigation and allowing for the fastest reaction to localized outbreaks. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century

Epidemiologie du prolapsus genital

La genèse du prolapsus génital est multifactorielle et des évènements individuels vont influencer l’apparition du prolapsus chez la femme. L’étude du profil épidémiologique des femmes victimes de prolapsus génital permet d’étudier tous les facteurs pour mieux conseiller et rassurer les femmes dans la prévention et la prise en charge de cette pathologie.Objectifs. Déterminer le profil épidémiologique des patientes victimes de prolapsus au service de gynécologie de l’hôpital du Mali.Matériel et méthode. Il s’agissait d’une étude transversale à visée descriptive à collecte prospective du 1er janvier au 31 décembre 2019. Nous avons inclus tous les cas de prolapsus génital diagnostiqué en dehors de la grossesse et dans les trois premiers mois du post-partum. L’interrogatoire a permis de préciser le moment d’apparition et l’examen physique d’identifier le type du prolapsus.Résultats : Nous avons enregistré 35 cas de prolapsus sur 267 interventions chirurgicales soit 13,10%. Les patientes en âge de procréer étaient de 21 (60%) versus patientes en ménopause 14 (40%). L’âge moyen était de 44,74 ans avec des extrêmes de 17 et 80 ans, La majorité des patientes était des femmes au foyer 29 cas (82,86%). Le milieu de résidence était rural ou urbain dans respectivement 20 cas (57,14%) et 15 cas (42,86%). La parité moyenne était de 5,22 % avec 45,71% de grandes multipares, 25,71% de paucipares et 20% de multipares. Les femmes mariées ont représenté 65% des cas. La durée d’apparition du prolapsus était en moyenne de trois ans. Les principaux antécédents retrouvés étaient la macrosomie 2 cas (5,71%), la déchirure du périnée 2 cas (5,71%) et la césarienne 1 cas (2,86%). Selon la classification de Baden, 23 patientes avaient un prolapsus de grade 3 (65,71%). Les organes participant au prolapsus étaient l’utérus et la vessie simultanément dans 19 cas (54,29%), la vessie seule dans 6 cas (17,14%), la vessie et le rectum 4 cas (11,43%).Conclusion : le prolapsus génital est fréquent chez la multipare avec une prédominance du grade 3 English title: Epidemiology of genital prolapse The genesis of genital prolapse is multifactorial and individual events will influence the onset of prolapse in women. The study of the epidemiological profile of women victims of genital prolapse makes it possible to study all the factors to better advise and reassure women in the prevention and management of this pathology.Goals. To determine the epidemiological profile of patients suffering from prolapse in the gynecology department of the hospital in Mali.Material and method. This was a descriptive cross-sectional study with prospective collection from January 1 to December 31, 2019. We included all cases of genital prolapse diagnosed outside pregnancy and in the first three months postpartum. The questioning clarified the time of onset and the physical examination identified the type of prolapse.Results: We recorded 35 cases of prolapse out of 267 surgical procedures, (13.10%). Patients of childbearing age were 21 (60%) versus menopausal 14 (40%). The mean age was 44.74 years with extremes of 17 and 80 years. The majority of patients were housewives in 29 cases (82.86%). The place of residence was rural or urban in respectively 20 cases (57.14%) and 15 cases (42.86%). The average parity was 5.22% with 45.71% large multiparas, 25.71% pauciparas and 20% multiparas. Married women accounted for 65% of cases. The duration of the onset of prolapse was on average three years. The main antecedents found were macrosomia 2 cases (5.71%), perineum tear 2 cases (5.71%) and cesarean section 1 case (2.86%). According to Baden's classification, 23 patients had grade 3 prolapse (65.71%). The organs participating in the prolapse were the uterus and bladder simultaneously in 19 cases (54.29%), the bladder alone in 6 cases (17.14%), and the bladder and rectum in 4 cases (11.43%).Conclusion: genital prolapse is frequent in multipara with a predominance of grade

Pyronaridine–artesunate or dihydroartemisinin–piperaquine versus current first-line therapies for repeated treatment of uncomplicated malaria: a randomised, multicentre, open-label, longitudinal, controlled, phase 3b/4 trial

International audienc

Clinical Outcomes during Treatment Interruptions in Human Immunodeficiency Virus-Hepatitis B Virus Co-infected Patients from Sub-Saharan Africa

Antiretroviral treatment (ART) interruptions increase the risk of severe morbidity/mortality in human immunodeficiency virus (HIV)-infected individuals from subSaharan Africa. We aimed to determine whether the risk is further increased among HIV-hepatitis B virus (HBV) co-infected patients in this setting. In this sub-analysis of a randomized-control trial, 632 participants from Côte d'Ivoire randomized to receive continuous-ART (C-ART), structured ART interruptions of 2-months off, 4-months on (2/4-ART), and CD4-guided ART interruptions (CD4GT, interruption at 350/mm3 and reintroduction at 250/mm3) were analyzed. Incidence rates (IR) of serious HIV- and non-HIV-related morbidity were compared between patients stratified on hepatitis B surface antigen (HBsAg) status. Overall, 65 (10.3%) were HBsAg-positive, 29 (44.6%) of whom had HBV-DNA levels > 10,000 copies/mL. After a median 2.0 year (range = 0.2-3.1) followup, 3 1 serious HIV-related events occurred in 101 HIV mono-infected and 15 HIV-HBV co-infected patients (IR = 10.0 versus 13.2/100 person/years, respectively, P = 0.3), whereas the highest incidence was observed in co-infected patients with baseline HBV-replication > 10,000 copies/mL (IR = 24.0/100 person/years, P versus HIV mono-infected = 0.002). Incidence of bacterial infections was also highest in the co-infected group with HBV-replication > 10,000 copies/mL (IR = 12.9 versus 3.3/100 person/years in HIV mono-infected patients, P = 0.001). The relative effect of CD4GT or 2/4-ART versus C-ART was not different between infection groups (P for interaction = 0.4). No increase in the incidence of non-HIV-related morbidity was observed for co-infected patients (P = 0.5), even at HBV-replication levels > 10,000 copies/mL (P = 0.7). In conclusion, co-infected patients with elevated HBV-replication at ART-initiation are more susceptible to HIV-related morbidity, especially invasive bacterial diseases, during treatment interruption