Prise en Charge des Appendicites Compliquées de l’Adulte à l’Hôpital National de Niamey

            Objectif : rapporter les résultats de la prise en charge des appendicites compliquées chez l’adulte à l’Hôpital National de Niamey (HNN).   Résultats : Pendant  la période de l’étude 8127 urgences abdominales avaient été enregistrées dont 1837 d’origine appendiculaire, parmi lesquelles  512 étaient des appendicites compliquées, soit 6,3 % des urgences abdominales et 27,9 % de toutes les pathologies appendiculaires. Il s’agissait de 337 (65,8 %) hommes et 175 (34,2 %) femmes ; soit un sex ratio de 1,9. L’âge médian des patients était de 30 ans, avec 75% de patients d’âge inférieur ou égal à 40 ans (3è quartile=40 ans) ainsi que des extrêmes allant de 16 ans et de 90 ans. Le délai d’admission  médian était   de 5 jours (Q1=3, Q3=7) avec un taux de 49,6 %(n=254) de patients  admis après 48 heures. Les appendicites compliquées retrouvées étaient la péritonite appendiculaire dans 74 % des cas (n=379) suivie de l’abcès appendiculaire dans 21,5 % des cas (n=110) et du plastron appendiculaire dans 4,5%(n=23) des cas. La chirurgie était pratiquée dans  95,5% des cas (n = 489). La voie d’abord utilisée était la laparotomie médiane sus et sous ombilicale dans 81 % des cas (n=415) et l’incision de Mac Burney dans 14,5%(n=74). L’appendice était gangréné dans 95,7 % des cas (n=490) à l’exploration. Le geste  réalisé était l’appendicectomie dans 89,9 % des cas (n= 460).  L’étude rapporte que 93,3%(n=478) des patients avaient un séjour total (pré et postopératoire)  ≤ 10 jours avec des extrêmes allant d’un jour et de 76 jours d’hospitalisation. La morbimortalité globale était de 11,5 %(n= 59). La suppuration pariétale était retrouvée dans 10 % des cas (n= 51). La  mortalité  était de 1,5 % (n = 8) tous enregistrés parmi les cas de péritonite appendiculaire. Le séjour hospitalier total (initial et post-appendicectomie) variait de un(1) jour à 76 jours ; 93,36%(n=478) avaient un séjour ≤ 10 jours. La médiane de séjour hospitalier était de 14,5 jours ; 75% des patients passaient moins de 28 jours en hospitalisation (3è quartile=28 jours).  Conclusion : Les appendicites compliquées sont fréquentes à l’HNN avec une morbimortalité importante. Le retard de la prise en charge constitue un facteur influencant la survenue des complications.                 Objective : To report the results of the management of complicated appendicitis in adults at the National Hospital of Niamey (HNN). Patients and method: This was a 10-year retrospective, descriptive, and analytical study including all patients over 15 years of age who had been managed for complicated appendicitis at HNN. Results: During the study period, 8127 abdominal emergencies were recorded, of which 1837 were of appendicular origin, of which 512 were complicated appendicitis, i.e. 6.3% of abdominal emergencies and 27.9% of all appendicular pathologies. These were 337 (65.8%) men and 175 (34.2%) women; i.e. a sex ratio of 1.9. The median age of patients was 30 years, with 75% of patients less than or equal to 40 years of age (3rd quartile=40 years) as well as extremes ranging from 16 years to 90 years. The median time to admission was 5 days (Q1=3, Q3=7) with a rate of 49.6% (n=254) of patients admitted after 48 hours. Complicated appendicitis was appendicular peritonitis in 74% of cases (n=379) followed by appendicular abscess in 21.5% of cases (n=110) and appendicular plastron in 4.5% (n=23) of cases. Surgery was performed in 95.5% of cases (n = 489). The approach used was median laparotomy above and subumbilical laparotomy in 81% of cases (n=415) and Mac Burney incision in 14.5% (n=74). The appendix was gangrenous in 95.7% of cases (n=490) on exploration. Appendectomy was performed in 89.9% of cases (n=460).  The study reports that 93.3% (n=478) of patients had a total stay (pre and postoperative) ≤ 10 days with extremes ranging from one day and 76 days of hospitalization. Overall morbidity mortality was 11.5% (n=59). Parietal suppuration was found in 10% of cases (n=51). Mortality was 1.5% (n=8), all recorded among cases of appendicular peritonitis. Conclusion: Complicated appendicitis is common at NNH with significant morbidity mortality. Delayed treatment is a factor influencing the occurrence of complications.&nbsp

Utilisation of wastewater for fuel and fodder production and environmental and social benefits in semi-arid, peri-urban zones of sub-Saharan Africa. Fifth Annual Report: 1/12/2006 – 30/11/2007

Summary Report Since the beginning of the contract, the results achieved are as follows: Work package 1 Water treatment and irrigation Sites for waste water treatment plants and irrigation systems were identified and the systems have been constructed in Burkina Faso, Mali and Niger. Progress was slower than planned for a variety of reasons, including delays to obtaining permits for construction, delays associated with importation and shipping of components and delays in purchase of expensive items due to cash flow problems. Staff have been trained in how to use and maintain the systems. Some modifications and refinements and repairs have been necessary, but systems are functioning in each country. The irrigation sites were characterised in advance of tree planting, and soil and water analyses are being conducted regularly. Work package 2 Tree growth and management Tree species with potential for use in irrigated conditions in each country were identified and experimental designs for these trials were produced. Some species are being used in common in all three countries. Nursery screening trials were conducted and plants were then out planted to the irrigation sites. Trees have grown quickly under the irrigated conditions and many species are performing well. Few problems have been detected. Species which were selected for their performance in the nursery are not necessarily the best performers in the field plots. In this year, biomass production has been determined and the effects of coppicing at 2 different heights on regrowth have been assessed. Work package 3 Tree water use and soil water status Staff in all three countries with irrigation systems have received training in the use of sap flow, soil water and associated measuring equipment. In Mali, considerable variation between tree species in soil water use has been noted, together with differential effects according to the inoculation history of the plants. Acacia angustissima appears to have particularly high water use and is easily water-stressed, whereas A. mangium appears to be more robust in its performance. Even with irrigation, tree water use is declining by the late morning, indicating stomatal closure. In Burkina Faso, L. hybrid showed the highest transpiration rate (1.09 L cm-2 day-1), followed by L. leucocephala (0.93 L cm-2 day-1), G. sepium (0.93 L cm-2 day-1) and A. angustissima (0.61 L cm-2 day-1). Gliricidia did not show morning stomatal closure, whereas Acacia and the Leucaenas did. Stomatal closure was especially marked with Acacia angustissima, confirming the results previously obtained in Mali. The long term use of physiological equipment under tropical conditions has proved difficult as the equipment is not particularly robust. Work package 4 Microsymbionts and N fixation Working in controlled glasshouse conditions, using sterilised soil media, the UK partner has identified considerable variation in effectiveness of different mycorrhizal strains on different tree species. After the initial screening phase, selected tree species were taken on to the second phase of the study in which plant response to simulated irrigation water is being measured. Uninoculated plants grew very poorly irrespective of whether they are receiving the simulated irrigation water or not. The response of inoculated plants to irrigation varied with inoculant and tree species. Initially, nursery and field studies in Mali, Niger and Burkina Faso gave much less clear results. However, assessments during this final year of the project have demonstrated positive effects of inoculation on tree growth in Mali and Niger. These observations are reinforced by molecular studies, using strain-specific probes for nodule analysis, which have been successfully tested against the inoculants, studies on samples collected from the field experiments in Mali suggest that the inoculant strains are absent – other types are present. This suggests that either the original inoculation was unsuccessful, or that the inoculants have been out-competed by indigenous strains. Work package 5 Economics and quality of produce Questionnaires have been developed by the partner in Niger, in collaboration with other partners. All countries have now completed their surveys, which have generated a considerable amount of useful information about fuel wood and fodder supplies. For Ouagadougou (population 960000 in 2000), it is estimated that 225,004 tons of fuel wood and 6708 tons of charcoal per year are transported to the city. The average price of firewood was approximately 21 F CFA per kg, and charcoal was 60 – 110 F CFA per kg. Sellers can achieve a substantial income from sales. The large quantities of fuel imported into Ouagadougou highlight the pressure on fuel resources. This is further indicated by the observations in Niger, where wood cutters cut an average of 27 steres per month, and each village can have 40 – 80 woodcutters. In Mali, annual wood fuel consumption averages about 0.5 ton per capita, and collection of a cart load of wood can involve a journey of 30 km and 3 days. Increasing numbers of grazing cattle are creating conflicts between different land uses. Assessments of fuel wood quality and palatability to animals have been made in Mali. Work package 6 Soil and plant nutrition Nutrient contents of irrigation water and soil nutrient status are being monitored at each site. In Mali, studies showed that pesticide levels were not significant, but that there was sometimes a build up of ammonium and turbidity in water flowing out of the plantation. In Burkina Faso microbiological analyses showed that the water treatment was successful in reducing levels of bacteria. Analyses have continued in all countries and no problems have been detected. Work package 7 Planting stock quality Studies have been conducted in Burkina Faso and Mali. Using various parameters of planting stock quality (shoot: root ratio, sturdiness quotient, Dickson’s Quality Index), considerable variations in quality have been identified, between species, production methods and between partners testing the same species. In Burkina Faso, a previous pot experiment was planted out. Previous effects of inoculation, substrate and pot size were no longer evident, however there was considerable variation between species in growth. At the time of planting, there were considerable differences in shoot: root ratios between species. Work package 8 Pest monitoring and management Studies in Mali have highlighted attack by termites on Leucaena and Calliandra, causing death of experimental trees, and the susceptibility of Acacia angustissima to prolonged flooding