Impacts of common staff on indicators of sanitary evacuation: experience of the gynecology service of Treichville Teaching Hospital

Background: In order to improve the quality of care for patients discharged in our department, since 1996 we have initiated monthly meetings called "common staffs", with the heads of the peripheral maternities who evacuate patients, during which we analyse reference indicators and the SONUs. The objective of this study was to describe the impact of the common staff on the indicators of the reference.Methods: We carried out a retrospective cross-sectional study on the balance sheets of the common staff over the 20 years of practice.Results: In 20 years, 132 meetings were organized, during which 24,337 files were analyzed. In 1996 the indicators of evacuations were at alarming levels: the time taken between the diagnosis and the decision to evacuate was long (more than 1 hour in 83.4%), 73% of the evacuation records were poorly informed, the majority evacuations were by non-medical vehicle (54.8%), pre-discharge management was incorrect in several patients (47%), and maternal and fetal lethality were high (5% and 10%, respectively). Over time, these indicators have improved and have had a favourable impact on maternal and fetal mortality rates, which have gradually decreased. At the same time, the results of the last three years of the evacuees coming from the maternities who do not participate in our staffs, shows that the indicators are still alarming, at levels where we were at the beginning of common staffs.Conclusions: The joint staff proved to be a good practice to promote in the Gynecology and Obstetrics Departments. It helped to improve the quality of care for referred patients

Maternal mortality in the context of political free health care on pregnancy and birth to the Treichville teaching hospital, Abidjan-Côte d’Ivoire

Background: Maternal mortality continues to be a drama in the countries of Sub Saharan Africa. Despite the efforts of the world through the millennium development goals (MDGs) 5 and 6, the situation remains very worrying in this region. If in developed countries, maternal mortality is an indicator of the quality of obstetric care, for poor countries, it is an indicator of social and economic development.Methods: Our study was designed to assess the impact of free support of pregnancy and childbirth on maternal mortality at treichville teaching hospital in Abidjan. We conducted a retrospective descriptive study of deaths of our service over the period September 2012 to August 2013 taking into account the hospital data.Results: During this period, we recorded 32 deaths per 3173 live births. Eight out of ten patients were younger than 35 years. And half had no education. 93.75% of patients were evacuated to another structure and more than half of the deaths occurred less than two hours after admission to our service. Bleeding causes dominate with 37.50% of postpartum haemorrhage.Conclusions: Maternal death rates in our service remain high despite the policy of free care and factors of this mortality remain unchanged for decades

Panorama of fetal malformations at the maternity of Treichville teaching hospital (Abidjan - Côte d’Ivoire)

Background: Congenital malformation is responsible for spontaneous abortion, the birth of a child born dead or a child with disabilities that can lead to long-term disability and have a detrimental impact on the individual, his family and society. The etiologies are diverse. The discovery in our maternity is not rare. The absence and high cost of these prenatal diagnostic are a brake on the detection of congenital malformations. It is these various malformations diagnosed in the ante natal and at birth in our service that we describe in this work which aims to make their panorama.Methods: The purpose of this cross-sectional and descriptive study curried out between 1 January 2003 and 31 December 2013 (10 years) was to describe the various congenital malformations observed at the maternity of the Gynecology and Obstetrics ward of the Treichville University Hospital Center and to identify the socio-demographic characteristics of mothers. This study concerned all women who had given birth at the Treichville University Hospital Center and whose child had a malformation.Results: During the period, 151 parturients gave birth to at least one child with a congenital malformation and among 30,698 newborns, 161 newborns (0.52%) had a malformation. Pregnant women were between 20 and 30 years old (66%), were primiparous in 46.4% of the cases, and 41.7% were housewives. The malformations were isolated in 101 newborns (62.4%), multiple in 60 newborns (37.6%), and dominated by those of the osteoarticular system and the nervous system. Fetal malformations had a poor prognosis in 77 cases (48%) and the fetus was stillborn in 44 cases (27%).Conclusions: Congenital malformations are a reality at the maternity clinic at Treichville. In our countries, the ultrasound stays a fundamental element for the congenital diagnosis of the malformations. A good training of the doctors in prenatal diagnosis is also necessary to make of good diagnoses who will allow a better care of new-born

Review of mastectomy in the department of gynecology at the Treichville teaching hospital, Abidjan-Cote d’Ivoire

Background: Mastectomy plays a key role in the management of breast cancer in our regions of sub-Saharan Africa. Because the advanced forms represent the essential stages of the diagnosis and some therapeutic means remain unavailable. Objective of this study was to report the experience of the practice of mastectomy in the treatment of breast cancer in our service.Methods: This is a retrospective and prospective, descriptive study conducted from January 1, 2013 to May 31, 2017 (age 05) at the University Hospital of Treichville involving 56 breast cancer patients who had undergone a mastectomy.Results: The frequency of the mastectomy was 28.5% and the average age of our patients was 48 years old. The majority of patients had an average socio-economic level (66%). 85.6% of our cancers discovered at advanced stages (T3 and T4). Adenocarcinoma accounted for 96% and infiltrating ductal carcinoma 82% of adenocarcinoma.Patey mastectomy associated with axillary dissection was performed in 96.4% and simple mastectomy in 3.5%. The results of axillary dissection reported lymph node invasion in 38 patients; With an average number of lymph nodes taken from 6.1 and an average number of ganglia affected is 3. Neoadjuvant chemotherapy was administered in 96.4% and adjuvant chemotherapy in 91%. Radiotherapy was performed in 34%. Complications were dominated by lymphoceles in 34% of cases. The 5-year survival of patients operating in the service is 37.8%.Conclusions: Mastectomy is at the forefront of breast cancer surgery in our service. She is supervised by chemotherapy. Radiotherapy remains inaccessible for most patients. Early detection would lead to conservative treatment and a reduction in the postoperative complication rate

Facteurs Associés À L’usage Du Préservatif Dans Le Foyer Conjugal Chez Les Personnes Vivant Avec Le VIH Suivies Sur Un Site À Abidjan

L’infection à VIH en Côte d’Ivoire constitue une épidémie généralisée. En 2017 la prévalence était estimée à 2.8% et les nouvelles infections atteignaient le nombre de 29800. La transmission hétérosexuelle est de loin la plus importante. Les facteurs associés à la pratique du sexe sans condom sont nombreux. A l’opposé, on ne connaît pas les facteurs qui favorisent l’usage régulier du préservatif dans le foyer conjugal. L’objectif de cette étude était de décrire les facteurs associés à l’usage régulier du préservatif dans la sexualité intraconjugale chez les patients infectés par le VIH et sous traitement ARV. Une enquête quantitative transversale descriptive a été menée sur 6 mois continus du 1er décembre 2017 au 31 mai 2018 à l’INHP. Etaient enrôlées à tout venant, les personnes vivant avec le VIH suivies sur le site et ayant donné leur consentement écrit. Les variables étudiées ont été réparties en groupes de caractéristiques individuelles, de situation matrimoniale, de reproduction, de durée de suivi, de divulgation du statut, de comportement sexuel dans le foyer, d’acceptabilité du préservatif. L’analyse des données a été faite avec le logiciel EPI INFO Version 3.5.4/2012. Les fréquences et les proportions des variables ont été calculées et le degré de signification a été déterminé. 102 personnes de la file active sous traitement ARV ont été enrôlées. La moyenne d’âge était 40 ans avec un âge médian de 39 ans. 55,9% des patients étaient en union dont 63,6% vivaient toujours avec leur même partenaire depuis leur dépistage. 61,8% des patients ont partagé leur statut à leur partenaire sexuel. Les couples sérodifférents représentaient 39%. Dans le foyer, les rapports sexuels continuent d’être pratiqués chez 72% des personnes. Le préservatif était utilisé régulièrement chez 53,5% durant les 6 derniers mois. Le fait d’être célibataire ou d’être informé du statut partenaire ou d’avoir une différence de statut était plus associé à l’utilisation constante du préservatif ; cependant aucune variable n’est significativement liée à un usage régulier du préservatif. Les PVVIH qui sont éduquées au port de préservatif, l’introduisent dans leur relation sexuelle intraconjugale. L’usage du préservatif serait plutôt déterminé par les problèmes et les besoins des individus qui l’utilisent. La difficulté de son utilisation régulière résulterait de la complexité et de la variabilité de ces problèmes et besoins vécus ou ressentis par les usagers. HIV infection in Côte d'Ivoire is a generalized epidemic. In 2017 the prevalence was estimated at 2.8% and new infections were 29,800. Heterosexual transmission is by far the most important. In contrast, the factors that promote regular condom use in the marital home are not known.The objective of this study was to describe the factors associated with consistent condom use in intramarital sexuality among PLWH infection and ARV treatment. A descriptive cross-sectional quantitative survey was conducted over 6 consecutive months from December 1st, 2017 to May 31st, 2018 at the INHP. All PLWH who had been followed up and gave their written consent were enrolled. The variables studied were divided into groups of individual characteristics, marital status, children’s needs, duration of follow-up, disclosure of status, sexual behaviour in the home, condom acceptability. The data analysis was done with the software Epi Info 3.5.4/2012. Frequencies and proportions of the variables were determined and the degree of significance have been determined. 102 PLWHIV treated with ARV were enrolled. The average age was 40 years with a median age of 39 years. 55.9% of patients were in a relationship, 63.6% of whom were still living with their same partner since their screening. 61.8% of people shared their status with their sexual partner. Serodiscordant couples accounted for 39%. In the household, sexual intercourse continues to be practised in 72% of people. The condom was used regularly in 53.5% during the last 6 months. The condom was used regularly in 53.5%. Being single or being informed of partner status or having a status difference was more associated with consistent condom use; however, no variable is significantly related to consistent condom use. People living with HIV who are educated to condom use, introduce it into their intramarital sex. But its regular use is peppered with many difficulties. . Condom use would rather be determined by the problems and needs of the individuals who use it. The difficulty of its regular use would result from the complexity and variability of these problems and needs experienced or felt by the users

Impacts of common staff on indicators of sanitary evacuation: experience of the gynecology service of Treichville Teaching Hospital

Background: In order to improve the quality of care for patients discharged in our department, since 1996 we have initiated monthly meetings called "common staffs", with the heads of the peripheral maternities who evacuate patients, during which we analyse reference indicators and the SONUs. The objective of this study was to describe the impact of the common staff on the indicators of the reference.Methods: We carried out a retrospective cross-sectional study on the balance sheets of the common staff over the 20 years of practice.Results: In 20 years, 132 meetings were organized, during which 24,337 files were analyzed. In 1996 the indicators of evacuations were at alarming levels: the time taken between the diagnosis and the decision to evacuate was long (more than 1 hour in 83.4%), 73% of the evacuation records were poorly informed, the majority evacuations were by non-medical vehicle (54.8%), pre-discharge management was incorrect in several patients (47%), and maternal and fetal lethality were high (5% and 10%, respectively). Over time, these indicators have improved and have had a favourable impact on maternal and fetal mortality rates, which have gradually decreased. At the same time, the results of the last three years of the evacuees coming from the maternities who do not participate in our staffs, shows that the indicators are still alarming, at levels where we were at the beginning of common staffs.Conclusions: The joint staff proved to be a good practice to promote in the Gynecology and Obstetrics Departments. It helped to improve the quality of care for referred patients

Review of mastectomy in the department of gynecology at the Treichville teaching hospital, Abidjan-Cote d’Ivoire

Background: Mastectomy plays a key role in the management of breast cancer in our regions of sub-Saharan Africa. Because the advanced forms represent the essential stages of the diagnosis and some therapeutic means remain unavailable. Objective of this study was to report the experience of the practice of mastectomy in the treatment of breast cancer in our service.Methods: This is a retrospective and prospective, descriptive study conducted from January 1, 2013 to May 31, 2017 (age 05) at the University Hospital of Treichville involving 56 breast cancer patients who had undergone a mastectomy.Results: The frequency of the mastectomy was 28.5% and the average age of our patients was 48 years old. The majority of patients had an average socio-economic level (66%). 85.6% of our cancers discovered at advanced stages (T3 and T4). Adenocarcinoma accounted for 96% and infiltrating ductal carcinoma 82% of adenocarcinoma.Patey mastectomy associated with axillary dissection was performed in 96.4% and simple mastectomy in 3.5%. The results of axillary dissection reported lymph node invasion in 38 patients; With an average number of lymph nodes taken from 6.1 and an average number of ganglia affected is 3. Neoadjuvant chemotherapy was administered in 96.4% and adjuvant chemotherapy in 91%. Radiotherapy was performed in 34%. Complications were dominated by lymphoceles in 34% of cases. The 5-year survival of patients operating in the service is 37.8%.Conclusions: Mastectomy is at the forefront of breast cancer surgery in our service. She is supervised by chemotherapy. Radiotherapy remains inaccessible for most patients. Early detection would lead to conservative treatment and a reduction in the postoperative complication rate