African experiences of laparoscopic hysterectomy about a continuous series of 52 cases by the same practitioner: indications, surgical procedures and complications

Background: Laparoscopy is a modern surgical technique that began in 1940 with Raoul Palmer. The present study aimed to analyse the results of a fifty-two-laparoscopic hysterectomy performed.Methods: A prospective study over a period of seven years from 1st January 2010 to 31st December 2015. A total of 52 patients who underwent a laparoscopic hysterectomy were recruited at the teaching hospital of Yopougon-Abidjan.Results: The mean age was 50.2 years (±3.9 years) (36-62 years). The average parity was 3. Few patients had undergone anterior pelvic surgery for either myomectomy or caesarean section. Uterine fibroid was the major surgical indication with a rate of 61.54%. The average size of the uterus was 12 cm (8-18 cm). Total hysterectomies type II and III with or without adnexectomy were essentially performed with rates of 28.85% and 32.69%, respectively. Sometimes it was associated with a lymphadenectomy or a colpo-suspension. The average length of a hysterectomy is 170 minutes (87-385 minutes). Four cases of laparo-conversions have been noted. Blood loss was approximately 95 ml (±12 ml) with a maximum of 300 ml. The complications were mainly two digestive wounds and a bladder fistula. The average length of hospital stay is three days apart from any complication.Conclusions: The laparoscopic approach is less painful, is associated with less blood loss, shorter hospital stay, faster recovery, fewer complications, and better care. A training period of surgeons associated with the equipment of the health structures is necessary to popularize this procedure surgical

Epidemiological, bacteriological profile and bacterial resistance of urinary tract infections at pregnant woman in prenatal consultation in African setting

Background: Urinary tract infection is a common pathology during pregnancy due to hormonal and morphological changes. Objective of this study was to improve management of urinary tract infection during prenatal care.Methods: A total of 987 pregnant women who have been in prenatal care have freely accepted to participate in cross-sectional study carried out from 1st May 2016 to 30th April 2017 at Yopougon University Hospital (Abidjan Côte d’Ivoire) were included. Patients were submitted to questionnaire by one of investigators for epidemiological component and then physical examination was carried out by her attending physician for clinical component. Then at laboratory urine was taken for culture after dipstick test.Results: Of the 987 patients included 9.4% had a urinary tract infection of which 81.7% were asymptomatic. Significant risk factors retained were existence of a history of urinary tract infection (OR=0.46; p=0,038) and gestational age of pregnancy (OR=0.44; p=0.05). Urine culture isolated germs were mainly Escherichia Coli (51.6%) and Klebsiella pneumoniaie (23.6%). These germs were all susceptible to cephalosporins. They had resistances of more than 50% to penicillins.Conclusions: Escherichia coli and Klebsiella pneumoniae are most common germs of urinary tract infections in pregnant women. Escherichia coli is not susceptible to penicillins with a resistance of 70% for penicillins except for clavulanic acid amoxicillin. It appears as first choice antibiotic for our prescriptions in case of probabilistic antibiotic therapy

Breast cancer in adolescent and young adult Ivory coast women: epidemiological and clinical features and molecular subdivision

Background: To describe the anatomy and clinical features and then determine the histological and molecular profile of Ivorian women under 40 years.Methods: This is a retrospective multi-centre study descriptive and analytic performed over a period of 20 months. It involved 76 women on 355 selected in the Ivoirian cancer registry. An additional immunohistochemical analysis to assess hormone receptors and HER overexpression in a single unit.Results: Adolescents and young adults represented 20.3% of women with breast cancer. The average age of women was 35 years. (∂=3.4 years, 95% CI=[2.6415 to 4.1785]). 15.8% of patients had a good socioeconomic level with a stable job, well paid and 28.9% had a university degree. The discovery circumstances were a breast nodule (53%) followed by locoregional complications (21%) and breast self-examination (20%). The consultation delay was less than three months in 34.2% of cases. 78% of cancers were diagnosed in stage II and III. The most common histological subtypes were respectively RP (+) / Her (-) (41%) followed by triple negative (30%).Conclusions: This study showed that 20,3% of women under 40 years. The most tumors were classified as stage II and III of tumors at diagnosis. the most common histologic subtypes are the Luminal A (41%) and triple-negative (30%). This disease is more aggressive with a poor prognosis in this age group

African experience of hysterosalpingography abnormalities tubes management by laparoscopy in infertile women

Background: Infertility affects about 80 million people worldwide and one in ten couples. The objective of this study was to report our experience of the contribution of laparoscopy in the diagnostic and prognostic approach of fallopian tubes pathology in infertile women in sub-Saharan Africa.Methods: We conducted a retrospective study in the Gynecology and Obstetrics unit of Yopougon Teaching Hospital over a 2-year period (January 1, 2017 to December 31, 2018) which included 49 cases of tubo-peritoneal infertility diagnosed by hysterosalpingography (HSG) then laparoscopy procedure.Results: The average age was 33 years old.  30.6 % were single. 75% had secondary infertility. 59.2% had a medical history of abortion. Pelvic Inflammatory Disease and pelvic surgery accounted 84.2% and 49 respectively. Laparoscopy showed a predominance of distal tubal damage (66.6%) whose 47% hydrosalpinx. Bilateral tubal patency was demonstrated in 77.5% of our patients during laparoscopy procedure. We observed a sensitivity, a specificity, and a concordance laparoscopy / HSG of 63.6%, 80% 63.1% respectively. Laparoscopy also allowed therapeutic procedures such as adhesiolysis or tubal plasty in 22 patients (44.89% of our cases). At the end of laparoscopy procedure, 35 patients (71.42%) were turned towards IVF.Conclusions: Laparoscopy allows an assessment of tubal abnormalities revealed by hysterosalpingography and the fertility prognostic as well as better therapeutic approach in management of tubal infertility

Analyse du coût economique direct du cancer du sein en Côte d’ivoire en 2022

The management of breast cancer is a major economic burden in countries with limited resources. The aim was to estimate the direct medical costs of patients treated for breast cancer in the Ivory Coast. A cross-sectional study was designed and carried out in the main referral health facilities for gynaecology-obstetrics and oncology in the Ivory Coast. The study included patients with histologically confirmed breast cancer. Data were collected from medical records and patient interviews. A total of 102 patients at different stages of the disease were included in the study. Costs increase in advanced stages. Chemotherapy was the main cost factor ($3,121 per patient), followed by radiotherapy ($1,714). Women with breast cancer faced an estimated average cost of $442 (ranging from$322 to $933). The cost of radiotherapy was also exorbitant ($1,714 per patient). Surgery was the least expensive treatment ($1,416). The average total cost of radiological examinations and laboratory tests was$304 and $247 respectively. Follow-up care was estimated at$631. This study provides an insightful analysis that will serve as a basis for further economic evaluation and could also be useful to healthcare decision-makers for inclusion in the national health coverage plan.La prise en charge du cancer du sein constitue un fardeau économique important dans les pays à ressources limitées. L’objectif était d’estimer les coûts médicaux directs des patientes suivies pour un cancer du sein en côte d’ivoire Une étude transversale a été conçue et réalisée dans les principales structures sanitaires de référence en gynécologie-obstétrique et en oncologie en Côte d'Ivoire. L’étude incluait les patientes avec un cancer du sein confirmé par l'histologie. Les données ont été recueillies à partir des dossiers médicaux et des entretiens avec les patientes. Au total, 102 patientes à différents stades de la maladie ont été incluses dans l'étude. Les coûts augmentent aux stades avancés. La chimiothérapie était le principal facteur de coût (3 121 $par patiente) avant la radiothérapie (1 714$). Les femmes atteintes d'un cancer du sein ont dû faire face à un coût moyen estimé à 442 $(allant de 322$ à 933 $). Le coût de la radiothérapie était également exorbitant (1 714$ par patient). La chirurgie était le traitement le moins onéreux (1 416 dollars). Le coût total moyen des examens radiologiques et des tests de laboratoire s'élevait respectivement à 304 et 247 dollars. Les soins de suivi ont été estimés à 631 dollars. Cette étude fournit une analyse perspicace qui servira de base à une évaluation économique plus poussée et pourrait également être utile aux décideurs en matière de santé pour l'inclure dans le plan national de couverture de la santé

Analyse du coût economique direct du cancer du sein en Côte d’ivoire en 2022

The management of breast cancer is a major economic burden in countries with limited resources. The aim was to estimate the direct medical costs of patients treated for breast cancer in the Ivory Coast. A cross-sectional study was designed and carried out in the main referral health facilities for gynaecology-obstetrics and oncology in the Ivory Coast. The study included patients with histologically confirmed breast cancer. Data were collected from medical records and patient interviews. A total of 102 patients at different stages of the disease were included in the study. Costs increase in advanced stages. Chemotherapy was the main cost factor ($3,121 per patient), followed by radiotherapy ($1,714). Women with breast cancer faced an estimated average cost of $442 (ranging from$322 to $933). The cost of radiotherapy was also exorbitant ($1,714 per patient). Surgery was the least expensive treatment ($1,416). The average total cost of radiological examinations and laboratory tests was$304 and $247 respectively. Follow-up care was estimated at$631. This study provides an insightful analysis that will serve as a basis for further economic evaluation and could also be useful to healthcare decision-makers for inclusion in the national health coverage plan.La prise en charge du cancer du sein constitue un fardeau économique important dans les pays à ressources limitées. L’objectif était d’estimer les coûts médicaux directs des patientes suivies pour un cancer du sein en côte d’ivoire Une étude transversale a été conçue et réalisée dans les principales structures sanitaires de référence en gynécologie-obstétrique et en oncologie en Côte d'Ivoire. L’étude incluait les patientes avec un cancer du sein confirmé par l'histologie. Les données ont été recueillies à partir des dossiers médicaux et des entretiens avec les patientes. Au total, 102 patientes à différents stades de la maladie ont été incluses dans l'étude. Les coûts augmentent aux stades avancés. La chimiothérapie était le principal facteur de coût (3 121 $par patiente) avant la radiothérapie (1 714$). Les femmes atteintes d'un cancer du sein ont dû faire face à un coût moyen estimé à 442 $(allant de 322$ à 933 $). Le coût de la radiothérapie était également exorbitant (1 714$ par patient). La chirurgie était le traitement le moins onéreux (1 416 dollars). Le coût total moyen des examens radiologiques et des tests de laboratoire s'élevait respectivement à 304 et 247 dollars. Les soins de suivi ont été estimés à 631 dollars. Cette étude fournit une analyse perspicace qui servira de base à une évaluation économique plus poussée et pourrait également être utile aux décideurs en matière de santé pour l'inclure dans le plan national de couverture de la santé

Challenges in integrating cervical cancer screening in HIV care clinics in West Africa: a pilot study in Abidjan, Côte d’Ivoire

International audiencen.

Barriers and facilitators in cervical cancer screening uptake in Abidjan, Cote d'Ivoire in 2018: a cross-sectional study

BACKGROUNDS: Cervical cancer (CC) incidence remains unacceptably high in Côte d'Ivoire. In an effort to prevent this malignant condition, a national CC screening program has been scaled up in the country. This study aimed at assessing CC screening uptake and its associated factors in Abidjan in 2018. METHODS: A cross-sectional survey was conducted from July to September 2018 in the main healthcare facilities of three randomly selected out of the eight health districts of Abidjan. During the study period, a standardized questionnaire was administrated by research assistants to all women aged 25 to 55 years old, attending the three participating facilities. Demographics, knowledge on CC, personal history of CC screening and reasons for not attending CC screening were collected. A logistic regression model was computed to document factors associated with reported CC screening uptake. RESULTS: A total of 1158 women with a median age of 32 years (IQR [27-36]), including 364 (31.4%) with no formal education were included. Of those participants, 786 (67.9%) had ever heard about CC. CC screening uptake at least once was reported by 7.5% [95% CI: 6.0-9.0] participants. In multivariable analysis, being ≥45 years (aOR: 6.2 [2.3-17.2]), having a university level (aOR: 2.8 [1.2-6.6]) (versus non formal education) and access to mass campaign information (aOR: 18.2 [8.5-39.1]) were associated with a reported CC screening uptake. The main reported barriers to CC screening were unawareness towards CC screening (75.5%), negligence (20.5%), fear of CC detection (3.9%) and fear of additional costs (3.3%). CONCLUSION: CC screening uptake remains low despite current initiatives to support awareness and prevention in Abidjan. Awareness campaigns need to be massively increased with the adjunction of tailored messages based on the level of women's education to enhance the CC screening coverage and reach the WHO goal of CC elimination by 2030

18-Month Effectiveness of Short-Course Antiretroviral Regimens Combined with Alternatives to Breastfeeding to Prevent HIV Mother-to-Child Transmission

OBJECTIVE: We assessed the 18-month effectiveness of short-course (sc) antiretroviral peripartum regimens combined with alternatives to prolonged breastfeeding to prevent mother-to-child transmission (MTCT) of HIV-1 in Abidjan, Côte d'Ivoire. METHODOLOGY: HIV-1 infected pregnant women received from >/=32-36 weeks of gestation scZidovudine (ZDV)+/-Lamivudine (3TC)+single-dose Nevirapine (sdNVP) at delivery within the ANRS 1201/1202 DITRAME-Plus cohort (2001-2003). Neonates received a sdNVP+7-day ZDV prophylaxis. Two infant-feeding interventions were systematically offered free of charge: formula-feeding or exclusive shortened breastfeeding with early cessation from four months. The reference group was the ANRS 049a DITRAME cohort (1994-2000) exposed to scZDV from 36 weeks, then to prolonged breastfeeding. Pediatric HIV infection was defined by a positive plasma HIV-1 RNA at any age, or if aged >/=18 months, a positive HIV-1 serology. Turnbull estimates of cumulative transmission risks (CTR) and effectiveness (HIV-free survival) were compared by exposure group using a Cox model. FINDINGS: Among 926 live-born children enrolled, 107 (11.6%) were HIV-infected at 18 months. CTRs were 22.3% (95% confidence interval[CI]:16-30%) in the 238 ZDV long-term breastfed reference group, 15.9% (CI:10-27%) in the 169 ZDV+sdNVP shortened breastfed group; 9.4% (CI:6-14%) in the 195 ZDV+sdNVP formula-fed group; 6.8% (CI:4-11%) in the 198 ZDV+3TC+sdNVP shortened breastfed group, and 5.6% (CI:2-10%) in the 126 ZDV+3TC+sdNVP formula-fed group. Each combination had a significantly higher effectiveness than the ZDV long-term breastfed group except for ZDV+sdNVP shortened breastfed children, ranging from 51% (CI:20-70%) for ZDV+sdNVP formula fed children to 63% (CI:40-80%) for ZDV+3TC+NVPsd shortened breastfed children, after adjustment for maternal eligibility for antiretroviral therapy (ART), home delivery and low birth-weight. Substantial MTCT risk reductions are reachable in Africa, even in short-term breastfed children. The two sc antiretroviral combinations associated to any of the two infant feeding interventions, formula-feeding and shortened breastfeeding, reduce significantly MTCT with long-term benefit until age 18 months and without increasing mortality