Effect of premature rupture of membranes on the maternal and fetal prognosis during childbirth at the gynecology-obstetrics department of the Matam Communal Medical Center, Conakry, Guinea

Background: Premature rupture of membranes (RPM) is defined by rupture of the amnion and chorion before entering labor within 24 hours leading to vaginal discharge of amniotic fluid without uterine contractions. Objective of this study was to improving the management of premature Ruptures of the membranes received in the service.Methods: This was a descriptive and analytical prospective study lasting six months from January 1 to June 30 2016.Results: During the study period, we collected 108 cases of RPM out of 1543 deliveries, representing a hospital frequency of 7%. RPM had more frequently concerned pregnant women aged 25-29 (37.04%), housewife (37.03%), primiparous (45.37%) and referral (52.78%). 95.37% were single pregnancies with cephalic presentation (80%) received between 37-42 weeks (84.26%). Management mainly consisted of antibiotic prophylaxis (100%), fetal pulmonary maturation and childbirth. The vagina was the main mode of delivery (62.04%). The maternal prognosis was dominated by chorioamnionitis (12.96%). The fetal one was made up of respiratory distress (40.71%) and prematurity (12.39%).Conclusions: RPM is frequent at the Matam municipal medical center. It is essential for its prevention to ensure health education of the population in general and genital hygiene in particular, to make a coherent prenatal follow-up while putting a particular accent on the detection and the treatment of genital infections

Plastic Surgery of Male External Genitalia after a Trauma Caused by a Mill in Rural Area

The trauma of the external genital organs is a common urological emergency that can affect the patient's functional and psychosocial prognosis as well as his family. We report a case of direct trauma of the external genitalia of a 27-year-old by a mill, requiring a recover plastic surgery in rural area. The examination at admission revealed a significant damage of penile and scrotal skin, denuding testes and cavernous bodies. A cover plastic surgery was performed. After a year of follow up, the outcome was good

Implementation of active management of the third period of childbirth for the prevention of immediate post-partum bleeding in four regional maternity hospitals of Conakry, Guinea

Background: The objective of this study was to determine the frequency, skills level of health care service providers; to identify complications and difficulties related to the implementation of AMTPC/GATPA.Methods: It was about prospective study, descriptive of 6 months (1st March to 31st August 2014) carried out in the maternity hospitals of Faranah, Kindia, Mamou and Nzérékoré. It concerned the parturient women who had recently given birth and the personnel that carried out AMTPC/GATPA in these hospitals.Results: During the study period of 1,254 out of 1,305 births had benefited of AMTPC/GATPA, a frequency of 96.1%. The midwives were the most represented personnel in the implementation of GATPA (44.1%). In 46.4% of the cases, the health care service providers acquired this competence from the initial training. The release was obtained in the first trial in 64.9% cases. The duration of implementation of GATPA was less than 5 minutes in 72.6% cases. The different stages were respected in 91.5% cases. Complications were dominated by retention of placental fragments (10.2%). Lack of oxytocin was the main difficulty (36.6%).Conclusions: The sustainability of this achievement would depend on the systematic and correct implementation of AMTPC/GATPA at all childbirth attendants and the effective management of oxytocin

Obstetric emergencies in the maternity ward of the Ignace Deen national hospital CHU of Conakry: sociodemographic, therapeutic and maternal fetal prognosis aspects

Background: Despite government efforts to reduce maternal mortality, the risk of a woman dying from obstetric complications is about one in six in the poorest regions of the world compared to one in thirty thousand in North Europe. The objective was therefore to describe the clinical socio-demographic aspects and to establish the maternal and fetal prognosis of obstetric emergencies.Methods: This was a descriptive cross-sectional prospective study over a 6-month period from January 1 to June 30, 2020 carried out at the maternity ward of the Ignace Deen national hospital (Conakry university hospital) in Guinea. The study looked at a continuous series of 662 obstetric emergency cases.Results: The frequency of admission of obstetric emergencies was 22.62%. They concerned young women (29.5 years old) on average, first-time mothers (53.32%), with low income professional activities, evacuated from a peripheral maternity unit (63.14%), no schooling (44.9%), married (92.3%), using the more often a means of public transport (66.5%) and whose pregnancies were poorly monitored (63.9%). Fetal emergencies were dominated by acute fetal distress (91.3%) and maternal emergencies were dominated by hypertensive emergencies (pre-eclampsia and eclampsia 37.44%) followed by hemorrhagic emergencies (last trimester hemorrhage and postpartum hemorrhage 34.34%). Pregnant and parturient women were more frequently admitted to labor (62.7%) and gave birth more frequently by caesarean section (86.70%). the staff reacted promptly to make a treatment decision in 75.5% of cases within fifteen minutes. emergency procedures were performed in less than fifteen minutes in almost all cases (97.4%), specific treatment was carried out in less than an hour in the majority of cases (68.3%). The maternal case fatality rate was 4.1% with the main cause of death being hemorrhagic shock of 51.8%. The stillbirth rate was 17.4%.Conclusions: The anticipation of emergency obstetric care (SOU) and close collaboration between the obstetrician, the anesthesiologist-resuscitator are essential in the management of obstetric emergencies

Obstetrical complications among adolescent girls at the maternity ward of Ignace Deen National Hospital

Background: The objective of this study was to highlight obstetrical complications that occurred among adolescent girls who delivered at the ward and to identify factors associated with the occurrence of such complications.Methods: This was a prospective study of descriptive and analytical type extending over a period of one year from September 1, 2016 to August 31, 2017 carried out at the maternity ward of Ignace Deen National Hospital at Conakry Teaching Hospital (CHU). It covered a continuous series of 1034 deliveries among adolescent girls.Results: The frequency of childbirth among adolescent girls was 16.7%. The main complications identified were dystocia, severe preeclampsia, eclampsia, retroplacental hematoma, placenta previa, uterine rupture, severe anemia, postpartum hemorrhage and puerperal endometritis. These complications occurred among adolescent girls aged 18 to 19, christian, skin and pelvic bones secondary school or university students. Factors associated with such complications were the marital status (p=0.010), the gestational age (p=0.012), the number of prenatal consultations (p=0.001), the place of prenatal consultation (p=0.001), the reason for admission (p=0.000) and the mode of admission (p=0.000).Conclusions: Childbirth among adolescent girls is frequent in this context; complications are numerous but they are preventable in the vast majority of cases

Systèmes d'information géographique participatifs (SIG-P) dans la gestion des ressources naturelles et la sécurité alimentaire en Afrique : études de cas - Bénin, Kenya, Malawi, Rwanda, Sénégal, Tunisie; rapport technique final

En Afrique, la gouvernance des ressources naturelles fait l’objet de difficultés voire de conflits aux conséquences parfois désastreuses. Une gouvernance vertueuse nécessite une réelle participation des populations aux processus décisionnels. Elle exige des connaissances spécifiques du milieu et un dispositif de communication et d’information adapté. C’est dans cette perspective que la problématique des SIG-P a été soulevée comme axe central en matière de recherche de solutions aux problèmes posés dans le cadre du programme ICT4D (Information and communication technologies for development). Cinq études de cas ont été réalisés en rapport avec l’utilisation des SIG-P dans la gestion des ressources naturelles : (i) adaptation au changement climatique (Malawi) ; (ii) gestion communautaire des ressources forestières (Kenya et Rwanda) ; (iii) gestion des ressources en eau (Bénin) ; (iv) valorisation des savoirs traditionnels dans l’irrigation (Tunisie); et (v) sécurisation des droits fonciers (Sénégal). Construite suivant les principes essentiels de la recherche académique, notamment la théorisation et l’expérimentation critique, la méthodologie allie une combinaison de recherches, d’actions de renforcement de capacités et de partage des connaissances. Le programme a participé à l’amélioration des compétences de gestion en privilégiant une approche de formation pratique reposant sur l’utilisation directe des systèmes d’information qui sont conçus. Il a su apporter une contribution certaine à la réflexion stratégique autour des modalités d’intégration des outils numériques, en particulier les SIG-P, dans la gouvernance des ressources naturelles

Plastron appendiculaire: intervention en urgence ou différée: à propos d’une série de 27 cas dans la clinique chirurgicale de l’Hôpital Aristide Le Dantec

Le but de notre étude était d’évaluer les résultats du traitement chirurgicale du plastron appendiculaire après appendicectomie différée ou immédiate. Il s’agit d’une étude rétrospective de type descriptif allant de Janvier 2000 au 31 Décembre 2007 portant sur 27 patients reçus et traités pour plastron appendiculaire. Le diagnostic était clinique par la présence d’une masse à la fosse iliaque droite, échographique, ou per opératoire. Tous les patients opérés en urgence ont été classés dans le groupe I et ceux opérés à froid, groupe II. Nous avons noté 18 hommes et 9 femmes avec un sex-ratio homme /femme = 3. L’âge moyen de nos patients était de 33 ans avec des extrêmes de 19 et 57 ans. Les signes cliniques étaient dominés par la douleur à la fosse iliaque droite et la fièvre respectivement 25 (92,6%) et 15 (55,6%) des cas. Dans le groupe I, l’appendicectomie n’a pu être réalisée pour 7 patients (n = 15) dû aux difficultés opératoires. Dans les autres cas, l’appendicectomie était possible au prix de l’élargissement de l’incision de Mac Burney et une durée de séjour plus longue. Le groupe II a concerné 12 patients (n = 12) avec 9 abords laparoscopiques et dans 3 cas, la voie de Mac Burney a été empruntée. Trois cas d’adhérences péritonéales ont été notés lors de la coelioscopie. L’appendicectomie à froid du plastron appendiculaire est un procédé sûr et efficace. Elle permet d’éviter les cicatrices inesthétiques et les fistules digestives iatrogènes. L’appendicectomie immédiate doit être abandonnée chez les patients porteurs de plastron appendiculaire car elle engendre beaucoup de morbidité

Quantifying the value of viral genomics when inferring who infected whom in the 2014–16 Ebola virus outbreak in Guinea

Transmission trees can be established through detailed contact histories, statistical or phylogenetic inference, or a combination of methods. Each approach has its limitations, and the extent to which they succeed in revealing a 'true' transmission history remains unclear. In this study, we compared the transmission trees obtained through contact tracing investigations and various inference methods to identify the contribution and value of each approach. We studied eighty-six sequenced cases reported in Guinea between March and November 2015. Contact tracing investigations classified these cases into eight independent transmission chains. We inferred the transmission history from the genetic sequences of the cases (phylogenetic approach), their onset date (epidemiological approach), and a combination of both (combined approach). The inferred transmission trees were then compared to those from the contact tracing investigations. Inference methods using individual data sources (i.e. the phylogenetic analysis and the epidemiological approach) were insufficiently informative to accurately reconstruct the transmission trees and the direction of transmission. The combined approach was able to identify a reduced pool of infectors for each case and highlight likely connections among chains classified as independent by the contact tracing investigations. Overall, the transmissions identified by the contact tracing investigations agreed with the evolutionary history of the viral genomes, even though some cases appeared to be misclassified. Therefore, collecting genetic sequences during outbreak is key to supplement the information contained in contact tracing investigations. Although none of the methods we used could identify one unique infector per case, the combined approach highlighted the added value of mixing epidemiological and genetic information to reconstruct who infected whom

Major Reduction in Anti-Malarial Drug Consumption in Senegal after Nation-Wide Introduction of Malaria Rapid Diagnostic Tests

BACKGROUND: While WHO recently recommended universal parasitological confirmation of suspected malaria prior to treatment, debate has continued as to whether wide-scale use of rapid diagnostic tests (RDTs) can achieve this goal. Adherence of health service personnel to RDT results has been poor in some settings, with little impact on anti-malarial drug consumption. The Senegal national malaria control programme introduced universal parasite-based diagnosis using malaria RDTs from late 2007 in all public health facilities. This paper assesses the impact of this programme on anti-malarial drug consumption and disease reporting. METHODS AND FINDINGS: Nationally-collated programme data from 2007 to 2009 including malaria diagnostic outcomes, prescription of artemisinin-based combination therapy (ACT) and consumption of RDTs in public health facilities, were reviewed and compared. Against a marked seasonal variation in all-cause out-patient visits, non-malarial fever and confirmed malaria, parasite-based diagnosis increased nationally from 3.9% of reported malaria-like febrile illness to 86.0% over a 3 year period. The prescription of ACT dropped throughout this period from 72.9% of malaria-like febrile illness to 31.5%, reaching close equivalence to confirmed malaria (29.9% of 584,873 suspect fever cases). An estimated 516,576 courses of inappropriate ACT prescription were averted. CONCLUSIONS: The data indicate high adherence of anti-malarial prescribing practice to RDT results after an initial run-in period. The large reduction in ACT consumption enabled by the move from symptom-based to parasite-based diagnosis demonstrates that effective roll-out and use of malaria RDTs is achievable on a national scale through well planned and structured implementation. While more detailed information on management of parasite-negative cases is required at point of care level to assess overall cost-benefits to the health sector, considerable cost-savings were achieved in ACT procurement. Programmes need to be allowed flexibility in management of these funds to address increases in other programmatic costs that may accrue from improved diagnosis of febrile disease