Homocysteinemie et accidents vasculaires cerebraux ischemiques au chu campus de lome

L’hyperhomocystéinémie est un facteur de risque vasculaire indépendant et modifiable. Sa place dans les accidents vasculaires cérébraux ischémiques est mal connue en Afrique sub-saharienne.Objectifs Evaluer la prévalence et les facteurs de risque vasculaires associés à l’hyperhomocystéinémie chez des patients à la phase aigue d’une ischémie cérébrale. Methode Il s’agit d’une étude prospective réalisée pendant 12 mois dans le service de neurologie du CHU Campus, portant sur 145 malades victimes d’AVCI. ResultatsNous avions recensé 90 hommes et 55 femmes soit un sex-ratio de 1,6. L’homocystéinémie moyenne globale était de 19.33 μmol/l. L’homocystéinémie était normale chez 44.1 % des patients.L’hyperhomocystéinémie modérée avait été retrouvée chez 44.8 % des patients (n=65) et l’hyperhomocystéinémie intermédiaire chez 11 % (n=16). L’analyse multivariée entre la variable homocystéine (patients avec hyperhomocystéinémie, patients sans hyperhomocystéinémie) et les autres facteurs (sexe, âge, diabète et hypertension artérielle) ne révèle aucune corrélation significative. Enfin 84.9% de nos patients étaient hypertendus tandis que 15.1% présentaient l’hyperhomocystéinémie comme seul facteur de risque cérébro-vasculaire. Conclusion La présence de l’hyperhomocystéinémie chez 55.9 % des patients souffrant d’AVCI impose une prise encharge adéquate de ce facteur de risque vasculaire

Evaluation du statut nutritionnel et biologique d’un échantillon de personnes atteintes de glaucome à angle ouvert dans une population togolaise

Ce travail est une étude prospective menée d’octobre 2009 à juillet 2010. L’objectif a été d’évaluer dans un échantillon de population togolaise les facteurs biologiques et nutritionnels des patients atteints de glaucome à angle ouvert. L’étude a porté sur deux groupes d’individus des deux sexes : 35 patients ayant un glaucome à angle ouvert et 27 témoins. L’âge, le poids, la taille et l’IMC moyens ont été similaires entre les deux groupes. Les sujets ont tous subi le même bilan biologique. Le t-test a été utilisé pour l’évaluation statistique. Les résultats ont révélé que chez les patients, les taux moyens de glycémie, de cholestérol total, des triglycérides, de HDL-cholestérol et de LDL-cholestérol ont été plus élevés (p < 0,001) comparativement à ceux des témoins. Le taux moyen de la créatinine chez les patients a été similaire à celui des témoins. Il en est de même pour les taux moyens de la protidémie. En ce qui concerne les transaminases et la GGT, les taux moyens chez les patients ont été plus élevés que chez les témoins (p < 0,05). Il ressort de ces résultats que la glycémie, le cholestérol total, les HDL, les LDL, les triglycérides, les transaminases et la GGT pourraient être inclus dans les facteurs de risque du glaucome à angle ouvert. L’augmentation du taux de ces différents paramètres serait probablement d’origine alimentaire.Mots clés : Glaucome à angle ouvert, alimentation, bilan biologique

Traumatismes de L’Abdomen et du Périnée par Encornements de Bœufs au Centre Hospitalier Régional de Dapaong, Togo

Background: This paper focuses on describing the epidemilogical, lesional, and therapeutic aspects of abdomen and perineum bull horn trauma at Regional Hospital of Dapaong. Methodology: It is a descriptive retrospective study, which includes patientstreated for abdomen and perineum bullhorn trauma, in the surgery department of Regional Hospital of Dapaong from January 2016 to December 2018 (3 years). Results: 34 patients were treated for abdominal and perineal bullhorn injuries. They comprised of 31 men and 3 women, with an average age of 18.47 ± 16.14 years old (extremes: 6 and 70 years old). They were mainly less than 15 years old and were herd guards. The lesion report noted 9 cases of abdominal blunt trauma, 22 cases of abdominal wounds including 19 cases of penetrating wounds, and 3 cases of perineal wounds including 1 case of associated rectal lesion. Visceral lesions were varied and often associated. The care was mainly surgical. The short term evolution was marked by a local infection in 8 cases (23.5%). The prognosis was good in all cases. Conclusion: Bullhorn trauma is a frequent cause of abdomen and perineum injuries at Regional Hospital of Dapaong. The outcome after adequate care is often favourable. Objectifs: Décrire les aspects épidémiologiques, lésionnels et thérapeutiques destraumatismes de l’abdomen et du périnée par encornements de bœufs au Centre Hospitalier Régional de Dapaong. Méthodologie : Etude rétrospective descriptive incluant les dossiers des blessés de l’abdomen et du périnée par encornements de bœufs, pris en charge dans le service de chirurgie du CHR Dapaong, de Janvier 2016 à Décembre 2018 (3 ans). Résultats : Trente-quatre patients ont été pris en charge pour lésions traumatiques de l’abdomen et du périnée par coups de cornes de bœufs. Il s’agissait de 31 hommes et 3 femmes d’âge moyen de 18,47 ± 16,14 ans (extrêmes : 6 ans et 70 ans). La majorité des victimes avait moins de 15 ans, et était des gardes troupeaux. Le bilan lésionnel au niveau abdominal notait 9 cas de contusion et 22 cas de plaies dont 19 cas de plaies pénétrantes. Les lésions viscérales étaient variées et souvent associées. Au niveau périnéal, on notait 3 cas de plaies dont un cas de lésion rectale associée. La prise en charge était chirurgicale dans la majorité des cas. L’évolution à court terme était marquée par une infection locale dans 8 cas (23,5%). Le pronostic était bon dans tous les cas. Conclusion : Les encornements de bœufs constituent une cause fréquente de traumatismes de l’abdomen et du périnée au CHR Dapaong. L’évolution après prise en charge adéquate est souvent favorable

How well does LiST capture mortality by wealth quintile? A comparison of measured versus modelled mortality rates among children under-five in Bangladesh

Background In the absence of planned efforts to target the poor, child survival programs often favour the rich. Further evidence is needed urgently about which interventions and programme approaches are most effective in addressing inequities. The Lives Saved Tool (LiST) is available and can be used to model mortality levels across economic groups based on coverage levels for child survival interventions

Augmentation de la résistance aux antibiotiques des Entérobactéries isolées à l’Institut National d’Hygiène de Lomé de 2010 à 2017: Increase in antibiotic resistance of Enterobacteriaceae isolated at the National Institute of Hygiene of Lomé from 2010 to 2017

Introduction: La résistance des Entérobactéries aux antibiotiques est un problème d’importance croissante en pratique médicale. L’objectif de cette étude était de déterminer le profil de résistance aux antibiotiques des Entérobactéries isolées à l’institut national d’hygiène (INH) de Lomé et d’analyser son évolution dans le temps. Méthodes: Il s’agissait d’une analyse rétrospective, sur une période de huit ans (2010-2017), portant sur l’ensemble des souches d’Entérobactéries isolées des prélèvements pathologiques analysés au laboratoire de bactériologie de l’INH. Résultats: Au total, 5910 Entérobactéries ont été isolées majoritairement des urines (59,59%), avec une prédominance d’Escherichia coli (63,93%) suivie de Klebsiella spp (22,86%). Entre 2010 et 2017, le taux de résistance des souches d’Escherichia coli a augmenté significativement de 18,69% à 39,26% (p< 0,0001) à la Ceftazidime ; de 1,68% à 40,22% à la Ceftriaxone (p< 0,0001) et de 42,37% à 63,23% (p< 0,0001) à la Ciprofloxacine. La résistance des souches de Klebsiella spp à la Ceftazidime a augmenté significativement de 25,26% à 42,54% (p< 0,0001) et celle à la Ceftriaxone de 2,17% à 41,79% (p< 0,0001) respectivement de 2010 à 2017. Conclusion: L’augmentation de la résistance des Entérobactéries aux antibiotiques et surtout l’évolution des résistances aux Céphalosporines de 3e Génération et aux Fluoroquinolones est un phénomène réel. Ceci exposera à des difficultés de prise en charge thérapeutique et nécessite la mise en place des dispositions idoines. Background: Antibiotic resistance in Enterobacteriaceae is a growing problem in medical practice. The objective of this study was to determine the antibiotic resistance profile of Enterobacteriaceae isolated at the National Institute of Hygiene (INH) of Lomé and to analyse its evolution over time. Method: This was a retrospective analysis, over a period of eight years (2010-2017), of all strains of Enterobacteriaceae isolated from pathological samples analysed in the bacteriology laboratory of the INH. Results: A total of 5910 Enterobacteriaceae were isolated mainly from urine (59.59%), with a predominance of Escherichia coli (63.93%) followed by Klebsiella spp (22.86%). Between 2010 and 2017, the resistance rate of Escherichia coli strains increased significantly from 18.69% to 39.26% (p<0.0001) to Ceftazidime; from 1.68% to 40.22% to Ceftriaxone (p<0.0001) and from 42.37% to 63.23% (p<0.0001) to Ciprofloxacin. Resistance of Klebsiella spp strains to Ceftazidime increased significantly from 25.26% to 42.54% (p< 0.0001) and to Ceftriaxone from 2.17% to 41.79% (p< 0.0001) respectively from 2010 to 2017. Conclusion: The increase in antibiotic resistance in Enterobacteriaceae and especially the evolution of resistance to 3rd generation cephalosporins and fluoroquinolones is a real phenomenon. This will lead to difficulties in therapeutic management and requires the implementation of appropriate measures

Integrated community case management in a peri-urban setting: a qualitative evaluation in Wakiso District, Uganda.

Integrated community case management (iCCM) strategies aim to reach poor communities by providing timely access to treatment for malaria, pneumonia and diarrhoea for children under 5 years of age. Community health workers, known as Village Health Teams (VHTs) in Uganda, have been shown to be effective in hard-to-reach, underserved areas, but there is little evidence to support iCCM as an appropriate strategy in non-rural contexts. This study aimed to inform future iCCM implementation by exploring caregiver and VHT member perceptions of the value and effectiveness of iCCM in peri-urban settings in Uganda.A qualitative evaluation was conducted in seven villages in Wakiso district, a rapidly urbanising area in central Uganda. Villages were purposively selected, spanning a range of peri-urban settlements experiencing rapid population change. In each village, rapid appraisal activities were undertaken separately with purposively selected caregivers (n = 85) and all iCCM-trained VHT members (n = 14), providing platforms for group discussions. Fifteen key informant interviews were also conducted with community leaders and VHT members. Thematic analysis was based on the 'Health Access Livelihoods Framework'.iCCM was perceived to facilitate timely treatment access and improve child health in peri-urban settings, often supplanting private clinics and traditional healers as first point of care. Relative to other health service providers, caregivers valued VHTs' free, proximal services, caring attitudes, perceived treatment quality, perceived competency and protocol use, and follow-up and referral services. VHT effectiveness was perceived to be restricted by inadequate diagnostics, limited newborn care, drug stockouts and VHT member absence - factors which drove utilisation of alternative providers. Low community engagement in VHT selection, lack of referral transport and poor availability of referral services also diminished perceived effectiveness. The iCCM strategy was widely perceived to result in economic savings and other livelihood benefits.In peri-urban areas, iCCM was perceived as an effective, well-utilised strategy, reflecting both VHT attributes and gaps in existing health services. Depending on health system resources and organisation, iCCM may be a useful transitional service delivery approach. Implementation in peri-urban areas should consider tailored community engagement strategies, adapted selection criteria, and assessment of population density to ensure sufficient coverage

Kangaroo mother care: EN-BIRTH multi-country validation study

Background Kangaroo mother care (KMC) reduces mortality among stable neonates ≤2000 g. Lack of data tracking coverage and quality of KMC in both surveys and routine information systems impedes scale-up. This paper evaluates KMC measurement as part of the Every Newborn Birth Indicators Research Tracking in Hospitals (EN-BIRTH) study. Methods The EN-BIRTH observational mixed-methods study was conducted in five hospitals in Bangladesh, Nepal and Tanzania from 2017 to 2018. Clinical observers collected time-stamped data as gold standard for mother-baby pairs in KMC wards/corners. To assess accuracy, we compared routine register-recorded and women’s exit survey-reported coverage to observed data, using different recommended denominator options (≤2000 g and ≤ 2499 g). We analysed gaps in quality of provision and experience of KMC. In the Tanzanian hospitals, we assessed daily skin-to-skin duration/dose and feeding frequency. Qualitative data were collected from health workers and data collectors regarding barriers and enablers to routine register design, filling and use. Results Among 840 mother-baby pairs, compared to observed 100% coverage, both exit-survey reported (99.9%) and register-recorded coverage (92.9%) were highly valid measures with high sensitivity. KMC specific registers outperformed general registers. Enablers to register recording included perceptions of data usefulness, while barriers included duplication of data elements and overburdened health workers. Gaps in KMC quality were identified for position components including wearing a hat. In Temeke Tanzania, 10.6% of babies received daily KMC skin-to-skin duration/dose of ≥20 h and a further 75.3% received 12–19 h. Regular feeding ≥8 times/day was observed for 36.5% babies in Temeke Tanzania and 14.6% in Muhimbili Tanzania. Cup-feeding was the predominant assisted feeding method. Family support during admission was variable, grandmothers co-provided KMC more often in Bangladesh. No facility arrangements for other family members were reported by 45% of women at exit survey. Conclusions Routine hospital KMC register data have potential to track coverage from hospital KMC wards/corners. Women accurately reported KMC at exit survey and evaluation for population-based surveys could be considered. Measurement of content, quality and experience of KMC need consensus on definitions. Prioritising further KMC measurement research is important so that high quality data can be used to accelerate scale-up of high impact care for the most vulnerable

National health policy-makers’ views on the clarity and utility of Countdown to 2015 country profiles and reports: findings from two exploratory qualitative studies

Background: The use of sets of indicators to assess progress has become commonplace in the global health arena. Exploratory research has suggested that indicators used for global monitoring purposes can play a role in national policy-making, however, the mechanisms through which this occurs are poorly understood. This article reports findings from two qualitative studies that aimed to explore national policy-makers’ interpretation and use of indicators from country profiles and reports developed by Countdown to 2015. Methods: An initial study aimed at exploring comprehension of Countdown data was conducted at the 2010 joint Women Deliver/Countdown conference. A second study was conducted at the 64th World Health Assembly in 2011, specifically targeting national policy-makers. Semi-structured interviews were carried out with 29 and 22 participants, respectively, at each event. Participants were asked about their understanding of specific graphs and indicators used or proposed for use in Countdown country profiles, and their perception of how such data can inform national policy-making. Responses were categorised using a framework analysis. Results: Respondents in both studies acknowledged the importance of the profiles for tracking progress on key health indicators in and across countries, noting that they could be used to highlight changes in coverage, possible directions for future policy, for lobbying finance ministers to increase resources for health, and to stimulate competition between neighbouring or socioeconomically similar countries. However, some respondents raised questions about discrepancies between global estimates and data produced by national governments, and some struggled to understand the profile graphs shown in the absence of explanatory text. Some respondents reported that use of Countdown data in national policy-making was constrained by limited awareness of the initiative, insufficient detail in the country profiles to inform policy, and the absence of indicators felt to be more appropriate to their own country contexts. Conclusions: The two studies emphasise the need for country consultations to ensure that national policy-makers understand how to interpret and use tools like the Countdown profile for planning purposes. They make clear the value of qualitative research for refining tools used to promote accountability, and the need for country level Countdown-like processes