Track D Social Science, Human Rights and Political Science

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/138414/1/jia218442.pd

La morbidite infectieuse post-operatoire en chirurgie gynecoobstetrique au chu de yaounde.

En Afrique sub-saharienne où de nombreux travaux retrouvent encore une incidence élevée des complications infectieuses postopératoires, plusieurs zones d'ombre persistent ; aussi bien sur la morbidité liée à chaque type d'intervention que sur le profil des opérées présentant ces complications. Cette étude prospective a pour objectif de décrire la nature et la fréquence des différentes complications infectieuses postopératoires en chirurgie gynéco obstétrique au Centre Hospitalier et Universitaire de Yaoundé. Toutes les patientes ayant une indication de laparotomie ou d'hystérectomie vaginale ont été retenues. Ont été exclues de notre recrutement, les patientes présentant une infection préexistante et/ou une indication de minilaparotomie pour ligature des trompes ou coelioscopie. La prévalence des infections postopératoires était de 23,2% (35 cas dans notre série de 151 patientes). Les taux d'infection postopératoires les plus élevés ont été enregistrés après la myomectomie, l'hystérectomie abdominale et la césarienne (33%, 29% et 27% respectivement). L'augmentation de la durée du séjour et du coût de la prise en charge constituait la principale conséquence de l'infection postopératoire. La création d'un comité de lutte contre l'infection nosocomiale devrait permettre d'optimiser la lutte contre l'infection nosocomiale au niveau du bloc et surtout à l'échelle de l'hôpital.In sub-Saharan Africa, there is an increased incidence of postoperative infection in gynaecological and obstetrical surgical interventions. In the present study, we sought to describe the morbidity of post-operative infections at the University Teaching Hospital. This should prompt us to evaluate the efficiency of the fight against nosocomial infections in our surgical setting. To attain the aforementioned objectives, we carried out a prospective, descriptive, analytic survey from April to August 2006. All patients with an indication for laparotomy and per vaginal hysterectomy were included. We excluded all those with infectious conditions and those undergoing laparoscopic surgery and tube ligation. Patients were followed up during admission and after discharge. Our cohort consisted of 151 patients. The incidence of postoperative infections stood at 23.2% in this cohort. Postoperative infections were more frequent after myomectomy, hysterectomy and caesarean section. The risk of post-operative infection increased with the mean duration of the hospitalisation. We therefore recommend the creation of a committee for the fight against nosocomial infections in our hospitals. Keywords: Postoperative infections - Gynaecology and obstetrics - Antibioprophylaxis.Clinics in Mother and Child Health Vol. 4 (2) 2007 pp. 723-73

Etude de la mortalite dans le service de eanimation de l\'hopital gyneco-obstetrique et pediatrique de Yaounde.

Le but de ce travail était d\'étudier la mortalité dans le service de réanimation médico-chirurgicale de l\'Hôpital Gynéco- Obstétrique et Pédiatrique de Yaoundé, afin de mettre en exergue les causes des décès, les imperfections de notre système et de proposer des solutions pour diminuer la mortalité dans notre formation sanitaire. Notre étude rétrospective et descriptive a concerné les dossiers et fiches de soins journaliers de tous les patients admis dans le service de Janvier 2003 à Juin 2007. Les dossiers incomplets ont été exclus de l\'étude. Les paramètres étudiés étaient l\'origine du patient, les moyens disponibles, la cause du décès, le moment du décès, l\'observance du traitement et les difficultés rencontrées. Le service comprend 7 salles d\'hospitalisation avec 32 lits, 8 respirateurs, 10 électrocardioscopes, 7 aspirateurs et un chariot d\'urgence. 4103 dossiers des patients admis dans le service pendant trois ans et demi ont été étudiés. L\'age moyen des patients était de 34±4,3 ans. 51% patients venaient du bloc opératoire. 336 patients sont décédés en trois ans 6mois, soit un taux de mortalité de 8, I8%. Les états septiques graves étaient la cause la fréquente de décès avec 7% suivi du SIDA (13%) et des accidents vasculaires cérébraux. 55% des décès sont survenus entre 20 heures et 8heures du matin. Les principaux handicaps rencontrés dans la prise en charge des patients en réanimation étaient : la mauvaise observance du traitement liée à l\'indigence et le déficit en personnel, et l\'insuffisance en matériel de monitorage. Nous concluons que la mortalité dans le service reste relativement élevée. Pour réduire cette mortalité il est indispensable d\'augmenter les effectifs, de renforcer l\'équipement du service en matériel de monitorage et de mettre sur pieds une politique d\'assurance maladie.The study was aimed at assessing the causes of mortality, identify lapses in the working system in the intensive care unit of the Yaounde Gyneco-Obstetric and Paediatric Hospital, and propose solutions to reduce it. It was a retrospective and descriptive study of files of patients admitted in this unit from January 2003 to June 2007. Incomplete files were excluded from the study and data collected included the patient\'s origin, equipment facilities, personnel, cause of death, time of death, administration of drugs and the difficulties encountered in patient management. The unit comprises 7 wards, 32 beds, 8 respirators, 10 electrocardioscopes, 7 aspirators and an emergency stretcher. The files of 4103 patients admitted over a period of three and a half years were studied. The mean age of the patients was 34±4.3 years and 5I% of them were just from the theatre. 336 patients died within this period, giving a mortality rate of 8.18%. Severe sepsis was the commonest cause of death within 7% of the patients, followed by HIV/AIDS (13%) and cardiovascular accidents. 55% of deaths occurred between 8p.m. and 8 a.m. The main handicaps encountered were inadequate administration of drugs because of inability to buy them, insufficient personnel and shortage of monitoring equipment. We thus conclude that there is a relatively high mortality rate in our intensive care unit. To reduce this mortality rate it is indispensable that the number of personnel be increased, provision of sufficient and adequate equipment facilities including those for monitoring, and instituting a health insurance system. Keywords: Intensive care unit - Patient management - Mortality - Causes.Clinics in Mother and Child Health Vol. 4 (2) 2007 pp. 737-74

Chirurgie cardiaque au Cameroun. Résultats à un an de la phase pilote.

In the framework of implementation of his national program for control and prevention of cardiovascular diseases, Cameroonian government has set up a cardiac surgery project. We report in this manuscript results of one year follow up of the patients operated during the pilot phase. From September 22 till 26, 2008, 11 patients have been operated in Cameroun. Surgical procedures were 5 mitral mechanic valve replacement, 2 aortic mechanic valve replacement, 1 atrial septal defect closure, 2 pace maker implantation. No intrahospital death was observed. One patient died at 11th month after the operation due to mitral valve thrombosis and attributed to lack of compliance. One patient presented low cardiac output, pneumonia and a pleural effusion. 2 patients presented 2 minor complications consisting of pericarditis and superficial wound infection. The results of the pilot phase of cardiac surgery in Cameroon are effective. However, the sustainability of the program require human, material capacity building, and funding mechanism as well.English AbstractJournal Articleinfo:eu-repo/semantics/publishe

The ASOS Surgical Risk Calculator: development and validation of a tool for identifying African surgical patients at risk of severe postoperative complications

Background: The African Surgical Outcomes Study (ASOS) showed that surgical patients in Africa have a mortality twice the global average. Existing risk assessment tools are not valid for use in this population because the pattern of risk for poor outcomes differs from high-income countries. The objective of this study was to derive and validate a simple, preoperative risk stratification tool to identify African surgical patients at risk for in-hospital postoperative mortality and severe complications. Methods: ASOS was a 7-day prospective cohort study of adult patients undergoing surgery in Africa. The ASOS Surgical Risk Calculator was constructed with a multivariable logistic regression model for the outcome of in-hospital mortality and severe postoperative complications. The following preoperative risk factors were entered into the model; age, sex, smoking status, ASA physical status, preoperative chronic comorbid conditions, indication for surgery, urgency, severity, and type of surgery. Results: The model was derived from 8799 patients from 168 African hospitals. The composite outcome of severe postoperative complications and death occurred in 423/8799 (4.8%) patients. The ASOS Surgical Risk Calculator includes the following risk factors: age, ASA physical status, indication for surgery, urgency, severity, and type of surgery. The model showed good discrimination with an area under the receiver operating characteristic curve of 0.805 and good calibration with c-statistic corrected for optimism of 0.784. Conclusions: This simple preoperative risk calculator could be used to identify high-risk surgical patients in African hospitals and facilitate increased postoperative surveillance. © 2018 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.Medical Research Council of South Africa gran

Maternal and neonatal outcomes after caesarean delivery in the African Surgical Outcomes Study: a 7-day prospective observational cohort study.

BACKGROUND: Maternal and neonatal mortality is high in Africa, but few large, prospective studies have been done to investigate the risk factors associated with these poor maternal and neonatal outcomes. METHODS: A 7-day, international, prospective, observational cohort study was done in patients having caesarean delivery in 183 hospitals across 22 countries in Africa. The inclusion criteria were all consecutive patients (aged ≥18 years) admitted to participating centres having elective and non-elective caesarean delivery during the 7-day study cohort period. To ensure a representative sample, each hospital had to provide data for 90% of the eligible patients during the recruitment week. The primary outcome was in-hospital maternal mortality and complications, which were assessed by local investigators. The study was registered on the South African National Health Research Database, number KZ_2015RP7_22, and on ClinicalTrials.gov, number NCT03044899. FINDINGS: Between February, 2016, and May, 2016, 3792 patients were recruited from hospitals across Africa. 3685 were included in the postoperative complications analysis (107 missing data) and 3684 were included in the maternal mortality analysis (108 missing data). These hospitals had a combined number of specialist surgeons, obstetricians, and anaesthetists totalling 0·7 per 100 000 population (IQR 0·2-2·0). Maternal mortality was 20 (0·5%) of 3684 patients (95% CI 0·3-0·8). Complications occurred in 633 (17·4%) of 3636 mothers (16·2-18·6), which were predominantly severe intraoperative and postoperative bleeding (136 [3·8%] of 3612 mothers). Maternal mortality was independently associated with a preoperative presentation of placenta praevia, placental abruption, ruptured uterus, antepartum haemorrhage (odds ratio 4·47 [95% CI 1·46-13·65]), and perioperative severe obstetric haemorrhage (5·87 [1·99-17·34]) or anaesthesia complications (11·47 (1·20-109·20]). Neonatal mortality was 153 (4·4%) of 3506 infants (95% CI 3·7-5·0). INTERPRETATION: Maternal mortality after caesarean delivery in Africa is 50 times higher than that of high-income countries and is driven by peripartum haemorrhage and anaesthesia complications. Neonatal mortality is double the global average. Early identification and appropriate management of mothers at risk of peripartum haemorrhage might improve maternal and neonatal outcomes in Africa. FUNDING: Medical Research Council of South Africa.Medical Research Council of South Africa