Key Informant Views of a Free Delivery and Caesarean Policy in Senegal

This article presents the findings of one component of an evaluation of the national policy for free deliveries and caesareans in Senegal. The policy was introduced in 2005 in five more deprived regions of the country. It aimed to reduce the financial barriers to using maternity services and to increase the number of facility-based deliveries. The findings are drawn from 54 semi-structured interviews with key informants who had technical and administrative or political responsibility for the policy at national, regional, district and health post level. These were carried out from November 2006 to January 2007. The evaluation findings emphasise the importance of careful planning and communication before a major national policy is implemented, and also of simple and clear definition of the package of ‘free’ services on offer. Long term investment in supply will also be needed to increase access for the most remote areas (Afr J Reprod Health 2008; 12[3]:93-112)

Assessment of Maternal Satisfaction with Facility-based Childbirth Care in the Rural Region of Tambacouda, Senegal

In Senegal, only 60% of mothers in rural areas deliver in health facilities. Mothers’ satisfaction with their facility-based childbirth experience is one of the factors in their choosing to deliver in such facilities in subsequent pregnancies. The objective of this study was to assess whether compliance with childbirth care based on the mothers’ perception of facility-based childbirth care contributes to the degree of maternal satisfaction. We conducted a secondary analysis of cross-sectional survey data collected from 259 mothers who had normal deliveries at facilities in rural areas of Senegal in 2011. The association between overall maternal satisfaction with childbirth care and 23 standard care survey items was assessed. The results showed that the degree of compliance with standard care and eight of 23 survey items were associated with maternal satisfaction. We conclude that to improve maternal satisfaction, facilities need to guarantee compliance with standard care. Keywords: facility-based childbirth care, maternal satisfaction, compliance standard care, Senegal, ruralAu Sénégal, seulement 60% des mères dans les zones rurales accouchent dans des établissements de santé. La satisfaction des mères avec leur expérience de l'accouchement en établissement de santé est l'un des facteurs dans leur choix d'accoucher dans des établissements pendant les grossesses ultérieures. L'objectif de cette étude était de vérifier si le respect des règles concernant les soins de l'accouchement basé sur la perception des mères contribue au degré de la satisfaction maternelle. Nous avons effectué une analyse secondaire des données de l'enquête transversales recueillies auprès de 259 mères qui ont eu des accouchements normaux dans les établissements dans les zones rurales du Sénégal en 2011. L'association entre la satisfaction maternelle globale des soins de l'accouchement et 23 éléments de l'enquête de soins standards a été évaluée. Les résultats ont montré que le niveau de conformité aux soins standards et huit questions parmi les 23 questions de l'enquête ont été associées à la satisfaction maternelle. Nous concluons que, pour améliorer la satisfaction maternelle, les établissements doivent garantir le respect de soins standard par toutes les mères. Mots-clés: accouchement soins à base d'installation, satisfaction maternelle, respect soins standard, Sénégal, rura

Key informant views of a free delivery and caesarean policy in Senegal

This article presents the findings of one component of an evaluation of the national policy for free deliveries and caesareans in Senegal. The policy was introduced in 2005 in five more deprived regions of the country. It aimed to reduce the financial barriers to using maternity services and to increase the number of facility-based deliveries. The findings are drawn from 54 semi-structured interviews with key informants who had technical and administrative or political responsibility for the policy at national, regional, district and health post level. These were carried out from November 2006 to January 2007. The evaluation findings emphasise the importance of careful planning and communication before a major national policy is implemented, and also of simple and clear definition of the package of 'free' services on offer. Long-term investment in supply will also be needed to increase access for the most remote areas.sch_iih12pub2709pub

Hepatocellular carcinoma associated with pregnancy about 2 cases at the gynecological and obstetrical clinic of the Aristide Le Dantec hospital, Dakar, Senegal

The objective of our study was to report 2 cases of hepatocellular carcinomas associated with pregnancy followed in our structure and to review the literature. Our patients were 30 and 37-year-old multi-gesture females with chronic unattended viral hepatitis B in whom the diagnosis of hepatocellular carcinoma was made in the third trimester of pregnancy at 31 weeks of amenorrhea and 4 days and at 32 weeks of amenorrhea after the incidental finding of tumor hepatomegaly on abdominal-pelvic ultrasound. The main clinical signs were jaundice and hepatomegaly and paraclinical signs were dominated by hepatic cytolysis and anemia in addition to ultrasound images. Follow-up of pregnancies revealed no particularities. A caesarean section was scheduled at 32 weeks of amenorrhea and 32 weeks of amenorrhea and 3 days allowing the birth of two preterm newborns weighing 1210 and 1500 gm with Apgar scores of 8-10/10 and 7-9/10 respectively at the fifth minute. The immediate post-operative follow-up was simple. However, the maternal-fetal prognosis was poor with the death of both patients in a multi-visceral failure table occurring respectively at 6 weeks and 3 weeks after caesarean section. The newborns had died 8 days after birth. Although rare, these two cases challenge any obstetrician to think about liver cancer in pregnant women, especially those with chronic hepatitis B. Ultrasound examination of the liver, or even better, the MRI, which is more efficient, in order to suspect early on a possible liver cancer. Indeed, early diagnosis and a thorough medical approach are essential for the treatment of HCC in pregnant patients

Are we ready to track climate-driven shifts in marine species across international boundaries? - A global survey of scientific bottom trawl data

Marine biota are redistributing at a rapid pace in response to climate change and shifting seascapes. While changes in fish populations and community structure threaten the sustainability of fisheries, our capacity to adapt by tracking and projecting marine species remains a challenge due to data discontinuities in biological observations, lack of data availability, and mismatch between data and real species distributions. To assess the extent of this challenge, we review the global status and accessibility of ongoing scientific bottom trawl surveys. In total, we gathered metadata for 283,925 samples from 95 surveys conducted regularly from 2001 to 2019. We identified that 59% of the metadata collected are not publicly available, highlighting that the availability of data is the most important challenge to assess species redistributions under global climate change. Given that the primary purpose of surveys is to provide independent data to inform stock assessment of commercially important populations, we further highlight that single surveys do not cover the full range of the main commercial demersal fish species. An average of 18 surveys is needed to cover at least 50% of species ranges, demonstrating the importance of combining multiple surveys to evaluate species range shifts. We assess the potential for combining surveys to track transboundary species redistributions and show that differences in sampling schemes and inconsistency in sampling can be overcome with spatio-temporal modeling to follow species density redistributions. In light of our global assessment, we establish a framework for improving the management and conservation of transboundary and migrating marine demersal species. We provide directions to improve data availability and encourage countries to share survey data, to assess species vulnerabilities, and to support management adaptation in a time of climate-driven ocean changes.En prensa6,86