Analysis of blood transfusion requirements during the gravido-puerperal period in a hospital in Ouagadougou

This work was carried out with the aim to analyze the needs covered and not covered in blood during the gravid-postpartum period. This retrospective study covered the period from 1st January 2007 to December 31, 2009. It took into account the records of patients admitted to a direct or indirect obstetric causes, and has received an indication for transfusion. 450 patients had an indication for transfusion during the gravid-puerperal period. The main indications for transfusion were posed in front of 75.1% and 24.9% bleeding to chronic anemia. The rate of pre-transfusion hemoglobin averaged 5.7g/dl and 58.5% of women had a lower rate 6g/dl. Among the 450 women, 84.4% were transfused. The unmet need was 15.6%. The unavailability of blood was the main reason for unmet need (74.6%). Transfusion incidents or accidents were reported in 8.1%. The prognosis was better if breast coverage need for transfusion (p =0.00056), however, remained subject to a mortality of 4%. Blood transfusion, often essential to preserve the life of the mother and child must be more accessible while respecting the established protocols in order to limit the risks.Objectif : Ce travail a été réalisé dans l’objectif d’analyser les besoins couverts et non couverts en matière de transfusion sanguine au cours de la période gravio-puerpérale. Patientes et méthodes : Cette étude rétrospective portait sur la période du 1 janvier 2007 au 31 décembre 2009. Elle prenait en compte les dossiers des patientes admises pour une cause obstétricale directe ou indirecte et ayant bénéficié d’une indication de transfusion. Résultats : 450 patientes ont eu une indication de transfusion au cours de la période gravido-puerpérale. Les principales indications de transfusion étaient posées dans 75,1% devant l’hémorragie et dans 24,9% devant une anémie chronique. Le taux d’hémoglobine pré-transfusionnel était en moyenne de 5,7g /dl et 58,5% des femmes avaient un taux inférieur à 6g/dl. Parmi les 450 femmes, 84,4% ont été transfusées. Le besoin non couvert était de 15,6%. L’indisponibilité du sang était la principale raison du besoin non couvert (74,6%). Les  incidents ou accidents transfusionnels ont été relevés dans 8,1%. Le pronostic maternel était meilleur en cas de couverture du besoin transfusionnel (p=0,00056) cependant il restait grevé d’une mortalité de 4%. Discussion et conclusion : La transfusion sanguine, souvent indispensable pour préserver la vie de la mère et de son enfant se doit d’être plus accessible tout en respectant les protocoles établis afin d’en limiter les risques.Objetivo: Este estudio se realizó con el objetivo de analizar las necesidades de sangre cubiertas y no cubiertas durante el período gestacional y puerperal (inmediatamente posterior al parto). Pacientes y métodos: Este estudio retrospectivo cubrió el período transcurrido entre el 1 de enero de 2007 y el 31 de diciembre de 2009. Se utilizaron los historiales de pacientes admitidas directa o indirectamente por causas de obstetricia y a las que se les indicó una transfusión. Resultados: Se indicó una transfusión a 450 pacientes durante el período gestacional y puerperal. Las causas principales para indicar una transfusión fueron las hemorragias en un 75,1 % de los casos y la anemia crónica en un 24,9 % de los casos. Los niveles medios de hemoglobina antes de las transfusiones eran de 5,7 g/dl, y el 58,5 % de las mujeres tenían niveles inferiores a 6 g/dl. De las 450 pacientes, 84,4 % de ellas recibieron una transfusión. La tasa no atendida fue del 15,6 %, y la principal causa fue la no disponibilidad de sangre (74,6 %). En el 8,1 % de las transfusiones se produjo algún incidente o accidente. El pronóstico materno fue mejor cuando se cubrió la necesidad transfusional (p = 0,00056) sin embargo, se vio gravado con una mortalidad del 4 %. Debate y conclusión: Las transfusiones de sangre, a menudo esenciales para preservar la vida de madre e hijo, deben ser más accesibles aunque respetando siempre los protocolos establecidos para limitar sus riesgos

Mortality from external causes in Africa and Asia: evidence from INDEPTH Health and Demographic Surveillance System Sites.

BACKGROUND: Mortality from external causes, of all kinds, is an important component of overall mortality on a global basis. However, these deaths, like others in Africa and Asia, are often not counted or documented on an individual basis. Overviews of the state of external cause mortality in Africa and Asia are therefore based on uncertain information. The INDEPTH Network maintains longitudinal surveillance, including cause of death, at population sites across Africa and Asia, which offers important opportunities to document external cause mortality at the population level across a range of settings. OBJECTIVE: To describe patterns of mortality from external causes at INDEPTH Network sites across Africa and Asia, according to the WHO 2012 verbal autopsy (VA) cause categories. DESIGN: All deaths at INDEPTH sites are routinely registered and followed up with VA interviews. For this study, VA archives were transformed into the WHO 2012 VA standard format and processed using the InterVA-4 model to assign cause of death. Routine surveillance data also provide person-time denominators for mortality rates. RESULTS: A total of 5,884 deaths due to external causes were documented over 11,828,253 person-years. Approximately one-quarter of those deaths were to children younger than 15 years. Causes of death were dominated by childhood drowning in Bangladesh, and by transport-related deaths and intentional injuries elsewhere. Detailed mortality rates are presented by cause of death, age group, and sex. CONCLUSIONS: The patterns of external cause mortality found here generally corresponded with expectations and other sources of information, but they fill some important gaps in population-based mortality data. They provide an important source of information to inform potentially preventive intervention designs

Mortality from external causes in Africa and Asia: evidence from INDEPTH health and demographic surveillance system sites

This paper is part of the Special Issue: INDEPTH Network Cause-Specific MortalityMortality from external causes, of all kinds, is an important component of overall mortality on a global basis. However, these deaths, like others in Africa and Asia, are often not counted or documented on an individual basis. Overviews of the state of external cause mortality in Africa and Asia are therefore based on uncertain information. The INDEPTH Network maintains longitudinal surveillance, including cause of death, at population sites across Africa and Asia, which offers important opportunities to document external cause mortality at the population level across a range of settings.To describe patterns of mortality from external causes at INDEPTH Network sites across Africa and Asia, according to the WHO 2012 verbal autopsy (VA) cause categories.All deaths at INDEPTH sites are routinely registered and followed up with VA interviews. For this study, VA archives were transformed into the WHO 2012 VA standard format and processed using the InterVA-4 model to assign cause of death. Routine surveillance data also provide person-time denominators for mortality rates.A total of 5,884 deaths due to external causes were documented over 11,828,253 person-years. Approximately one-quarter of those deaths were to children younger than 15 years. Causes of death were dominated by childhood drowning in Bangladesh, and by transport-related deaths and intentional injuries elsewhere. Detailed mortality rates are presented by cause of death, age group, and sex.The patterns of external cause mortality found here generally corresponded with expectations and other sources of information, but they fill some important gaps in population-based mortality data. They provide an important source of information to inform potentially preventive intervention designs.P. Kim Streatfield ... Yohannes A. Melaku ... et. al

Adult non-communicable disease mortality in Africa and Asia: evidence from INDEPTH Health and Demographic Surveillance System sites

Background: Mortality from non-communicable diseases (NCDs) is a major global issue, as other categories of mortality have diminished and life expectancy has increased. The World Health Organization's Member States have called for a 25% reduction in premature NCD mortality by 2025, which can only be achieved by substantial reductions in risk factors and improvements in the management of chronic conditions. A high burden of NCD mortality among much older people, who have survived other hazards, is inevitable. The INDEPTH Network collects detailed individual data within defined Health and Demographic Surveillance sites. By registering deaths and carrying out verbal autopsies to determine cause of death across many such sites, using standardised methods, the Network seeks to generate population-based mortality statistics that are not otherwise available. Objective: To describe patterns of adult NCD mortality from INDEPTH Network sites across Africa and Asia, according to the WHO 2012 verbal autopsy (VA) cause categories, with separate consideration of premature (15–64 years) and older (65+ years) NCD mortality. Design: All adult deaths at INDEPTH sites are routinely registered and followed up with VA interviews. For this study, VA archives were transformed into the WHO 2012 VA standard format and processed using the InterVA-4 model to assign cause of death. Routine surveillance data also provide person-time denominators for mortality rates. Results: A total of 80,726 adult (over 15 years) deaths were documented over 7,423,497 person-years of observation. NCDs were attributed as the cause for 35.6% of these deaths. Slightly less than half of adult NCD deaths occurred in the 15–64 age group. Detailed results are presented by age and sex for leading causes of NCD mortality. Per-site rates of NCD mortality were significantly correlated with rates of HIV/AIDS-related mortality. Conclusions: These findings present important evidence on the distribution of NCD mortality across a wide range of African and Asian settings. This comes against a background of global concern about the burden of NCD mortality, especially among adults aged under 70, and provides an important baseline for future work.P. Kim Streatfield ... Yohannes A. Melaku ... et al

Adult non-communicable disease mortality in Africa and Asia: evidence from INDEPTH Health and Demographic Surveillance System sites.

BACKGROUND: Mortality from non-communicable diseases (NCDs) is a major global issue, as other categories of mortality have diminished and life expectancy has increased. The World Health Organization's Member States have called for a 25% reduction in premature NCD mortality by 2025, which can only be achieved by substantial reductions in risk factors and improvements in the management of chronic conditions. A high burden of NCD mortality among much older people, who have survived other hazards, is inevitable. The INDEPTH Network collects detailed individual data within defined Health and Demographic Surveillance sites. By registering deaths and carrying out verbal autopsies to determine cause of death across many such sites, using standardised methods, the Network seeks to generate population-based mortality statistics that are not otherwise available. OBJECTIVE: To describe patterns of adult NCD mortality from INDEPTH Network sites across Africa and Asia, according to the WHO 2012 verbal autopsy (VA) cause categories, with separate consideration of premature (15-64 years) and older (65+ years) NCD mortality. DESIGN: All adult deaths at INDEPTH sites are routinely registered and followed up with VA interviews. For this study, VA archives were transformed into the WHO 2012 VA standard format and processed using the InterVA-4 model to assign cause of death. Routine surveillance data also provide person-time denominators for mortality rates. RESULTS: A total of 80,726 adult (over 15 years) deaths were documented over 7,423,497 person-years of observation. NCDs were attributed as the cause for 35.6% of these deaths. Slightly less than half of adult NCD deaths occurred in the 15-64 age group. Detailed results are presented by age and sex for leading causes of NCD mortality. Per-site rates of NCD mortality were significantly correlated with rates of HIV/AIDS-related mortality. CONCLUSIONS: These findings present important evidence on the distribution of NCD mortality across a wide range of African and Asian settings. This comes against a background of global concern about the burden of NCD mortality, especially among adults aged under 70, and provides an important baseline for future work

Cause-specific childhood mortality in Africa and Asia: evidence from INDEPTH health and demographic surveillance system sites

BACKGROUND: Childhood mortality, particularly in the first 5 years of life, is a major global concern and the target of Millennium Development Goal 4. Although the majority of childhood deaths occur in Africa and Asia, these are also the regions where such deaths are least likely to be registered. The INDEPTH Network works to alleviate this problem by collating detailed individual data from defined Health and Demographic Surveillance sites. By registering deaths and carrying out verbal autopsies to determine cause of death across many such sites, using standardised methods, the Network seeks to generate population-based mortality statistics that are not otherwise available. OBJECTIVE: To present a description of cause-specific mortality rates and fractions over the first 15 years of life as documented by INDEPTH Network sites in sub-Saharan Africa and south-east Asia. DESIGN: All childhood deaths at INDEPTH sites are routinely registered and followed up with verbal autopsy (VA) interviews. For this study, VA archives were transformed into the WHO 2012 VA standard format and processed using the InterVA-4 model to assign cause of death. Routine surveillance data also provided person-time denominators for mortality rates. Cause-specific mortality rates and cause-specific mortality fractions are presented according to WHO 2012 VA cause groups for neonatal, infant, 1-4 year and 5-14 year age groups. RESULTS: A total of 28,751 childhood deaths were documented during 4,387,824 person-years over 18 sites. Infant mortality ranged from 11 to 78 per 1,000 live births, with under-5 mortality from 15 to 152 per 1,000 live births. Sites in Vietnam and Kenya accounted for the lowest and highest mortality rates reported. CONCLUSIONS: Many children continue to die from relatively preventable causes, particularly in areas with high rates of malaria and HIV/AIDS. Neonatal mortality persists at relatively high, and perhaps sometimes under-documented, rates. External causes of death are a significant childhood problem in some settings.P. Kim Streatfield ... Yohannes A. Melaku ... et al

Incidence, caractéristiques et facteurs de risque des douleurs chroniques postcésariennes à l’hôpital Yalgado Ouédraogo au Burkina Faso

OBJECTIF : Étudier l’incidence, les caractéristiques et facteurs de risque des douleurs chroniques postcésariennes (DCPC) à l’hôpital Yalgado. PATIENTES ET MÉTHODES : Un questionnaire était administré par appel téléphonique à 204 patientes aux sixième, neuvième et douzième mois après une césarienne. Les questions portaient sur la présence de douleurs cicatricielles, leurs caractéristiques et leurs répercussions sur la vie des patientes. L’enrôlement s’est fait durant la consultation du 45e jour postopératoire, a duré deux mois, et les données cliniques, chirurgicales et anesthésiques étaient recueillies rétrospectivement. Le questionnaire de suivi de la douleur leur a été expliqué pendant l’enrôlement, puis ultérieurement administré par le même enquêteur. Après une analyse descriptive de la population étudiée avec Epi Info version 3.3.1, une comparaison des patientes avec et sans DCPC était effectuée afin de mettre en évidence les facteurs de risque. RÉSULTATS : Sur 204 patientes incluses, 113 (55,4 %) ont terminé l’étude et 91 patientes ont été perdues de vue. Au total, 72 femmes (63,7 %) ont rapporté des DCPC à un moment ou l’autre de leur suivi. Les perdues de vue étaient comparables aux patientes suivies. La fréquence des DCPC diminuait au fil du temps, passant de 63,7 % à six mois (15,2 % de douleur modérée à sévère) à 52,21 % au neuvième mois et 38,9 % au 12e mois (4,5 % de douleur modérée à sévère). Le jeune âge (OR: 1,48, p = 0,002), l’antécédent de césarienne (OR: 2,94; p = 0,01), les chirurgiens en formation (OR: 4,15, p = 0,05), l’incision Pfannenstiel (OR: 5,96, p = 0,001), l’anesthésie générale (OR: 3,21, p = 0,03) sont les facteurs de risque associés à des DCPC, alors que la rachianesthésie (OR: 0,4, p = 0,009) protégeait contre la DCPC. L’intensité médiane était de 1,7 au sixième mois, de 1,03 au neuvième mois et de 0,85 au 12e mois. La douleur était modérée dans 51,38 % des cas au sixième mois contre 18,18 % au 12e mois. La douleur était intermittente (59,7 %) ou permanente (16,6 %) au sixième mois versus respectivement 86,3 et 4,5 % au 12e mois. L’intensité de la douleur diminuait dans le temps. La majorité des femmes (89,2 %) s’automédiquaient, et 3,2 % ont présenté des troubles du sommeil. CONCLUSION : Les DCPC sont fréquentes dans notre série et souffrent d’un manque de prise en charge médicale.[The Incidence, Characteristics and Risk Factors of Chronic Post-Caesarean Pain at Yalgado Ouédraogo Hospital in Burkina Faso] AIM: To study the incidence, characteristics and risk factors of chronic post-Caesarean pain (CPCP) at Yalgado Hospital. PATIENTS AND METHODS: A survey was conducted via telephone of 204 patients at 6, 9 and 12 months after a Caesarean section. The questions focused on the presence of scar pain, its characteristics and the subsequent repercussions on patients’ lives. Enrolment was carried out during the postoperative day 45 consultation; it lasted for two months and clinical, surgical and anaesthetic data was collected retrospectively. The pain follow-up questionnaire was explained during enrolment, then subsequently delivered by the same person. After a descriptive analysis of the population studied was conducted with ÉpiInfo™ version 3.3.1, a comparison of patients with and without CPCP was made in order to highlight any risk factors. RESULTS: Of the 204 patients included, 113 (55.4%) completed the study and 91 patients were lost to follow-up. A total of 72 women (63.7%) reported CPCP at one point or another during their follow-up. The patients lost to follow-up were comparable to those who received follow-up. The frequency of CPCP decreased over time, falling from 63.7% at 6 months (15.2% had moderate to severe pain) to 52.21% at month 9 and 38.9% at month 12 (4.5% with moderate to severe pain). Young age (OR: 1.48, P = 0.002), previous Caesarean (OR: 2.94, P = 0.01), trainee surgeons (OR: 4.15, P = 0.05), a Pfannenstiel incision (OR: 5.96, P = 0.001), and general anaesthesia (OR: 3.21, P = 0.03) are risk factors associated with CPCP, whereas spinal anaesthesia (OR: 0.4, P = 0.009) protected against CPCP. The median pain intensity was 1.7 at month 6, 1.03 at month 9 and 0.85 at month 12. The pain was moderate for 51.38% at month 6, compared with 18.18% at month 12. Pain was intermittent (59.7%) or permanent (16.6%) at month 6, versus 86.3% and 4.5% respectively at month 12. The intensity of the pain decreased over time. The majority of the women (89.2%) self-medicated, and 3.2% had sleep-related difficulties. CONCLUSION: CPCP is a common experience in our series, and suffers from a lack of medical car

Evaluation de la qualité de la tenue des dossiers médicaux des patientes en gynécologie et en obstétrique dans un Centre hospitalier universitaire de référence, Burkina Faso

Le dossier médical du patient est indissociable de la pratique médicale. Cette étude a pour objectif d’évaluer la qualité des dossiers médicaux des patientes en Gynécologie et Obstétrique au CHU Yalgado Ouédraogo de Ouagadougou. Il s’est agi d’une étude transversale à visée descriptive. Un échantillon de 200 dossiers médicaux a été constitué par tirage aléatoire à partir des numéros d’enregistrement des patientes à l’admission. La grille d’évaluation utilisée a été inspirée de celle de l’Agence Nationale d’Accréditation et d’Evaluation en Santé qui comporte plusieurs critères. Les dossiers correspondant aux numéros tirés ont été retrouvés dans 72,5 % des cas. Ils étaient en bon état dans 76,6 % des cas. L’identité des patientes étaient notés dans tous les dossiers. Ils comportaient l’identité des prestataires dans 52,4 % des cas. Le diagnostic principal était précisé dans 99,3 % des dossiers. Les médicaments administrés étaient notifiés dans 8,3 % des cas. Le partographe était rempli dans 44,4 % des cas. La date et l’heure de sortie étaient notées dans 6,2 % des dossiers et le résumé de sortie était fait dans aucun cas. L’audit des dossiers médicaux montre des insuffisances dans sa tenue. Une sensibilisation des prestataires et la pratique régulière des audits s’avèrent nécessaires pour améliorer la qualité de la tenue des dossiers médicaux. L’informatisation du dossier patient et la mise en place d’un système d’archives centrales au CHU sont à promouvoir.Mots-clés : Evaluation ; Qualité ; Tenue ; Dossier médical ; Gynécologie-obstétrique