Prevalence and characteristics of accidental perineal tears during childbirth in a communal medical center in Guinea-Conakry: a cross-sectional study

Background: Prevalence studies are still rare in sub-Saharan Africa on perineal tears. We conducted this cross-sectional study in a communal hospital in Guinea-Conakry, with the objective of this study was to determining the prevalence and characteristics of post-obstetric perineal lesions.Methods: All deliveries between March 1st and August 31st, 2014 were reviewed. We included in the analysis all the single deliveries with perineal tears. The Anglo-Saxon classification of perineal tears was used.Results: The prevalence of perineal tears was 5.7% with 5.4% benign lesions and 0.3% severe lesions. We did not register 4th degree lesions. The average age of parturient was 22 years. The majority (96.6%) of parturient had a history of genital mutilation and perineal scarring (60.3%).Conclusions: This prevalence appear low compared to those reported in other studies in Africa and point to the need for more sophisticated studies to have a better estimate of the prevalence of perineal tears in Guinea-Conakry

Evaluation du rôle managérial des surveillants de service dans l’amélioration continue de la qualité des soins dans quatre centres hospitaliers universitaires de Bamako

By analyzing the quality-of-care evaluation reports from the National Hospital Evaluation Agency in Mali from 2005 to 2018, we note that the quality of care constitutes a real public health problem. Due to the important place occupied by department supervisors in hospital management, the evaluation of the role of supervisors is essential in the continuous improvement of the quality of care. For this study, we asked ourselves the following research question: what is the managerial role of service supervisors in the continuous improvement of the quality of care in four University Hospital Centers in Bamako? We set the general objective of studying the managerial role of service supervisors in the continuous improvement of the quality of care in the four University Hospital Centers of Bamako. The research methodology adopted consisted of carrying out a non-experimental quantitative analytical study with a cross-sectional aim. We opted for the probability sampling method and the stratified technique. Our study population consisted of all supervisors from CHU-CNOS, GT, IOTA and Point “G” in Bamako. Information was collected from respondents using a questionnaire and a document processing grid. EPI Info software was used for data entry, then it was exported to Excel and SPSS for analyses. Anonymity and confidentiality were required during data collection. The results of our study reveal that in total, 84 service supervisors were included in this study with an average age of approximately 51 years and a male predominance of 57.14%. The managerial role of service supervisors is known to be played at 54.76%; the existing link between the managerial role and ACQ is estimated at only 32.28%. The contribution of supervisors in ACQ which consists of regular monitoring/evaluation of activities, having the availability and skills required for good coordination and identifying inadequacies and providing continuing training is estimated at 60.71%. The main bottleneck in the implementation of their functions is above all the lack of training, from which 98.18% of supervisors do not benefit and 98.36% work in unfavorable conditions. From the explanatory analysis, it appears that several roles are statistically significant in relation to ACQ at the 5% threshold, the p-value test = 0.147. Ultimately, we can therefore affirm that service supervisors know their managerial role in ACQ and are essential key players in ACQ in health establishments. Keywords: evaluation, managerial role, service supervisors, CQI, UHC, Bamako. Classification JEL : O24, MO21 Paper type : Empirical ResearchEn analysant les rapports d’évaluations de la qualité des soins de l’Agence Nationale d’Évaluation des Hôpitaux au Mali de 2005 à 2018, nous constatons la qualité des soins constitue un véritable problème de santé publique. En raison de la place importante qu’occupent les surveillants de service dans le management hospitalier, l’évaluation du rôle des surveillants s’avère prépondérante dans l’amélioration continue de la qualité des soins. Pour cette étude, nous nous sommes posé la question de recherche suivante : quel est le rôle managérial des surveillants de service dans l’amélioration continue de la qualité de soins dans quatre Centres Hospitaliers Universitaires de Bamako ? Nous avons fixé comme objectif général d’étudier le rôle managérial des surveillants de service dans l’amélioration continue de la qualité des soins dans les quatre Centres Hospitaliers Universitaires de Bamako. La méthodologie de recherche adoptée a consisté à faire une étude quantitative analytique non expérimentale à visée transversale. Nous avons opté pour la méthode d’échantillonnage probabiliste et la technique stratifiée. Notre population d’étude était constituée de tous les surveillants des CHU-CNOS, GT, IOTA et Point « G » de Bamako. Les informations étaient recueillies auprès des enquêtés à l’aide d’un questionnaire et d’une grille d’exploitation documentaire. Le logiciel EPI Info a été utilisé pour la saisie des données, puis celles-ci ont été exportées dans Excel et SPSS pour les analyses. L’anonymat et la confidentialité étaient requis lors de la collecte des données. Les résultats de notre étude révèlent qu’au total, 84 surveillants de service ont été inclus dans cette étude avec un âge moyen de 51 ans environ et prédominance masculine à 57.14%. Le rôle managérial des surveillants de service est connu joué à 54,76% ; le lien existant entre le rôle managérial et l’ACQ est évalué à 32,28% seulement. L’apport des surveillants dans l’ACQ qui consiste à faire un suivi/évaluation régulier des activités, avoir la disponibilité et la compétence requises pour une bonne coordination et identifier les insuffisances et faire la formation continue est estimé à 60,71%. Le principal goulot d’étranglement à la mise en œuvre de leurs fonctions est surtout le manque de formation dont 98,18% des surveillants n’en bénéficient pas et 98,36% travaillent dans des conditions peu favorables. De l’analyse explicative, il ressort que plusieurs rôles sont statistiquement significatifs en lien avec l’ACQ au seuil de 5%, le test de p-value = 0,147. En définitive, nous pouvons affirmer donc que les surveillants de service connaissent leur rôle managérial dans l’ACQ et sont des acteurs clefs incontournables de l’ACQ dans les établissements de santé.   Mots clés : évaluation, rôle managérial, surveillants de service, ACQ, CHU, Bamako. JEL Classification : O24, MO21 Type du papier : Recherche empiriqu

Impact des variables de la rémunération sur la performance des services de santé : cas du Centre Hospitalier Universitaire Professeur Bocar Sidy SALL de Kati

Dans le contexte actuel de compétitivité accrue et de performance organisationnelle soutenue, les pratiques de gestion des ressources humaines s’avèrent plus que jamais d’une importance capitale, dans la mesure où elles peuvent contribuer à améliorer la performance de l’entreprise. Les politiques de rémunération doivent également résoudre la question de savoir comment mettre en place un système qui soit suffisamment motivant. Pour aborder cette problématique, nous avons fixé comme objectif général d’étudier l’impact des variables de la rémunération sur la performance des personnels de santé au CHU de Kati. Nous avons mené une approche mixte à visée analytique non-expérimentale transversale. Nous avons opté les méthodes d’échantillonnage non probabiliste avec la technique par choix raisonné et probabiliste avec la technique de sondage aléatoire simple. Notre population d’étude était constituée des personnels de santé et des membres de la direction, aussi d’une exploitation documentaire. Les informations étaient recueillies à l’aide d’un questionnaire, d’un guide d’entretien semi-directif et d’une fiche d’exploitation documentaire. Les informations quantitatives étaient traitées par le logiciel EPI info version 7.2, puis celles-ci étaient exportées dans Excel et SPSS version 22.0.0 pour interprétation. L’analyse de contenu était adoptée pour l’approche qualitative en faisant la transcription manuelle par exposition des verbatim. Nos résultats sont issus de l’analyse univariée, bivariée et de contenu et ils supportent nos deux hypothèses. Nos résultats ont montré que 88,00% de personnels enquêtés ont identifié le salaire de base, les primes et les indemnités comme éléments de la rémunération (variables de pilotage) et 12% ont identifié l’assurance vie et santé comme variables d’action. Cependant, certains éléments des variables d’actions comme le logement, la dotation de moyens roulants, de téléphone et la promesse d’une récompense à la retraite sont connus mais ne sont pas pris en compte au CHU de Kati. Le niveau de performance des agents est positif de façon globale avec 88,35%. Il existe un lien statistiquement significatif entre les variables de la rémunération et la performance en moyenne à 30,95% dont la (P-value = 0,510). Les variables de la rémunération sont indéniablement un facteur de performance du personnel au CHU-BSSK. Avec une forte majorité, les salariés du CHU-BSSK considèrent qu’elles sont sources de motivation et de satisfaction, toute chose qui participe à l’amélioration de performance

Impact des formations sur la qualité des soins : cas de l’Hôpital Nianankoro Fomba de Ségou au Mali en 2022.

L’insuffisance de ressources humaines qualifiées pour la santé est devenue une préoccupation dans tous les systèmes de santé à travers le monde. Pour atteindre l’objectif principal qui est la qualité des soins, les organismes internationaux recommandent de renforcer le principal acteur qui est le capital humain en traçant des stratégies de développement des ressources humaines en santé. Notre étude avait pour objectif principal d’analyser l’impact des formations reçues par le personnel de l’Hôpital Nianankoro FOMBA de Ségou sur la qualité des soins. Il s’agit d’une recherche transversale à visée analytique avec une méthode mixte (quantitative et qualitative) et un positionnement épistémologique positiviste. Nous avons opté pour les méthodes d’échantillonnage non probabiliste avec la technique par choix raisonné pour l’aspect qualitatif et probabiliste avec la technique de sondage aléatoire simple pour l’aspect quantitatif. a concerné 03 responsables, 168 agents de santé et 100 usagers. Les techniques de collecte des données ont été les entretiens, l’administration de questionnaire, l’exploitation de documents et l’observation. Pour les données qualitatives, nous avons procédé à une analyse de contenu. Quant aux données quantitatives, une analyse statistique avec le logiciel SPSS Statistiques Version 20.0 a été faite. Les résultats de l’étude ont montré que parmi les types de formations continues, le perfectionnement était le plus suivi par les agents  soit 50%, le niveau de qualité des soins était bon soit 60,55%.Il existait un lien un lien statistiquement significatif  entre les formations reçues et la qualité des soins  au seuil de 5% le p-value =0,03 inferieur 0,05

Management of pre-eclampsia and its complications in the department of gynecology and obstetrics at Donka national hospital Conakry, Guinea

Background: Vascular-renal syndrome, also known as pre-eclampsia, is a condition specific to pregnancy, usually occurring in the last trimester of pregnancy. Pregnant women are sometimes at risk of unpredictable obstetrical complications such as: hemorrhage, kidney failure, HELLP syndrome, sometimes even brain damage requiring prompt care and multidisciplinary collaboration. Vascular-renal syndromes are the third leading cause of maternal death and also the world's leading cause of perinatal death. Objectives of this study were to analyse the management of vascular-renal syndromes. Calculate their frequency, describe the sociodemographic characteristics of patients, describe the clinical and biological signs of patients, evaluate the maternal-fetal prognosis.Methods: The study was conducted in the department of obstetrics and gynecology of Donka National Hospital. It was a prospective, descriptive, cross-sectional, 6-month study from March 1st to August 31st, 2015, of pregnant women with pre-eclampsia.Results: The study included 217 cases of pre-eclampsia out of a total of 3054 patients, i.e. a proportion of 7.10%. The proportion of pre-eclampsia was high in patients aged between 15 and 19 years, housewife, married, primary. The predisposing factors were primigestitis, obesity and twinkling. The clinic was dominated by headaches and visual disturbances. Severe preeclampsia in 78.49%, eclampsia in 21.65% or simple hypertension in 1.75%. Maternal and fetal complications were dominated by eclampsia 26.26%, PPH (2.63%), eclamptic coma (0.46%), acute fetal distress 27.19%, and fetal death in utero (11.40%). In order to improve maternal and fetal prognosis it is necessary to provide multidisciplinary care, which unfortunately is not always available in our context.Conclusions: Obstetric emergency is a frequent situation for which a better management would improve the maternal-fetal prognosis

Effect of premature rupture of membranes on the maternal and fetal prognosis during childbirth at the gynecology-obstetrics department of the Matam Communal Medical Center, Conakry, Guinea

Background: Premature rupture of membranes (RPM) is defined by rupture of the amnion and chorion before entering labor within 24 hours leading to vaginal discharge of amniotic fluid without uterine contractions. Objective of this study was to improving the management of premature Ruptures of the membranes received in the service.Methods: This was a descriptive and analytical prospective study lasting six months from January 1 to June 30 2016.Results: During the study period, we collected 108 cases of RPM out of 1543 deliveries, representing a hospital frequency of 7%. RPM had more frequently concerned pregnant women aged 25-29 (37.04%), housewife (37.03%), primiparous (45.37%) and referral (52.78%). 95.37% were single pregnancies with cephalic presentation (80%) received between 37-42 weeks (84.26%). Management mainly consisted of antibiotic prophylaxis (100%), fetal pulmonary maturation and childbirth. The vagina was the main mode of delivery (62.04%). The maternal prognosis was dominated by chorioamnionitis (12.96%). The fetal one was made up of respiratory distress (40.71%) and prematurity (12.39%).Conclusions: RPM is frequent at the Matam municipal medical center. It is essential for its prevention to ensure health education of the population in general and genital hygiene in particular, to make a coherent prenatal follow-up while putting a particular accent on the detection and the treatment of genital infections

Improving early infant diagnosis for HIV-exposed infants using unmanned aerial vehicles for blood sample transportation in Conakry, Guinea: a comparative cost-effectiveness analysis

Background: Early infant diagnosis (EID) for HIV-exposed infants is essential due to high mortality during the first months of their lives. In Conakry (Guinea), timely EID is difficult as traffic congestion prevents the rapid transport of blood samples to the central laboratory. We investigated the cost-effectiveness of transporting EID blood samples by unmanned aerial vehicles (UAV), also known as drones. Methods and findings: Using Monte Carlo simulations, we conducted a cost-effectiveness comparative analysis between EID blood samples transportation by on-demand UAV transportation versus the baseline scenario (ie, van with irregular collection schedules) and compared with a hypothetic on-demand motorcycle transportation system. Incremental cost-effectiveness ratio (ICER) per life-year gained was computed. Simulation models included parameters such as consultation timing (eg, time of arrival), motorcycle and UAV characteristics, weather and traffic conditions. Over the 5-year period programme, the UAV and motorcycle strategies were able to save a cumulative additional 834.8 life-years (585.1–1084.5) and 794.7 life-years (550.3–1039.0), respectively, compared with the baseline scenario. The ICER per life-year gained found were US$535 for the UAV strategy versus baseline scenario, US$504 for the motorcycle strategy versus baseline scenario and US$1137 per additional life-year gained for the UAV versus motorcycle strategy. Respectively, those ICERs represented 44.8$1194. Conclusion: Compared with the baseline strategy, both transportation of EID blood samples by UAVs or motorcycles had a cost per additional life-year gained below half of the national GDP per capita and could be seen as cost-effective in Conakry. A UAV strategy can save more lives than a motorcycle one although the cost needed per additional life-year gained might need to consider alongside budget impact and feasibility considerations

Concordance of vaccination status and associated factors with incomplete vaccination: a household survey in the health district of Segou, Mali, 2019

Introduction: the region of Segou recorded 36.8% of children were incompletely vaccinated in 2018. In 2019, the district of Segou was one of the districts with the lowest vaccination coverage in the region, with 85.1% coverage for the three doses of the pentavalent vaccine and 85.4% for the measles vaccine. This study was initiated to better understand this low vaccination coverage, in the absence of specific studies on vaccination coverage in the district of Segou. Methods: a prospective cross-sectional study was conducted from May to August 2020 with 30 clusters. We performed Kappa coefficient, bivariate, and multiple logistic regression analysis. Results: findings showed that 18.46% (101/547) [15.44-21.93] of children were incompletely vaccinated. Mothers correctly reported the vaccination status of their children in 67.30% of cases (Kappa coefficient). Uneducated (OR[IC95%]=2.13[1.30-3.50]), living in rural area (OR[IC95%]=2.07[1.23-3.47]), lack of knowledge of Expanded Program on Immunization (EPI) target diseases (OR[IC95%]=2.37[1.52-3.68]), lack of knowledge of vaccination schedule (OR[IC95%]=3.33[1.90-5.81]) and lack of knowledge of the importance of vaccination (OR[IC95%]=3.6[2.35-6.32]) were associated with incomplete vaccination. In multivariate analysis, uneducated (ORa[IC95%>]=1.68[1.004-2.810]) and lack of knowledge of the importance of vaccination were associated with incomplete vaccination (ORa[IC95%]=3.40[2.049-5.649]). Conclusion: findings showed a good concordance of the vaccination status. Living in a rural area, no education, lack of the knowledge of EPI target diseases, lack of the knowledge of vaccination schedule and lack of knowledge of the importance of vaccination were associated with incomplete vaccination

Prevalence and factors associated with maternal and neonatal sepsis in sub-Saharan Africa: a systematic review and meta-analysis

ObjectivesThis study aimed to determine the prevalence and factors associated with maternal and neonatal sepsis in sub-Saharan Africa.MethodsThis systematic review and meta-analysis used the PRISMA guideline on sepsis data in sub-Saharan Africa. The bibliographic search was carried out on the following databases: Medline/PubMed, Cochrane Library, African Index Medicus, and Google Scholar. Additionally, the reference lists of the included studies were screened for potentially relevant studies. The last search was conducted on 15 October 2022. The Joanna Briggs Institute quality assessment checklist was applied for critical appraisal. Estimates of the prevalence of maternal and neonatal sepsis were pooled using a random-effects meta-analysis model. Heterogeneity between studies was estimated using the Q statistic and the I2 statistic. The funnel plot and Egger’s regression test were used to assess the publication bias.ResultsA total of 39 studies were included in our review: 32 studies on neonatal sepsis and 7 studies on maternal sepsis. The overall pooled prevalence of maternal and neonatal sepsis in Sub-Saharan Africa was 19.21% (95% CI, 11.46–26.97) and 36.02% (CI: 26.68–45.36), respectively. The meta-analyses revealed that Apgar score < 7 (OR: 2.4, 95% CI: 1.6–3.5), meconium in the amniotic fluid (OR: 2.9, 95% CI: 1.8–4.5), prolonged rupture of membranes >12 h (OR: 2.8, 95% CI: 1.9–4.1), male sex (OR: 1.2, 95% CI: 1.1–1.4), intrapartum fever (OR: 2.4, 95% CI: 1.5–3.7), and history of urinary tract infection in the mother (OR: 2.7, 95% CI: 1.4–5.2) are factors associated with neonatal sepsis. Rural residence (OR: 2.3, 95% CI: 1.01–10.9), parity (OR: 0.5, 95% CI: 0.3–0.7), prolonged labor (OR: 3.4, 95% CI: 1.6–6.9), and multiple digital vaginal examinations (OR: 4.4, 95% CI: 1.3–14.3) were significantly associated with maternal sepsis.ConclusionThe prevalence of maternal and neonatal sepsis was high in sub-Saharan Africa. Multiple factors associated with neonatal and maternal sepsis were identified. These factors could help in the prevention and development of strategies to combat maternal and neonatal sepsis. Given the high risk of bias and high heterogeneity, further high-quality research is needed in the sub-Saharan African context, including a meta-analysis of individual data.Systematic review registration: PROSPERO (ID: CRD42022382050)

Resurgence of Ebola Virus Disease in Guinea Linked to a Survivor With Virus Persistence in Seminal Fluid for More Than 500 Days.

We report on an Ebola virus disease (EVD) survivor who showed Ebola virus in seminal fluid 531 days after onset of disease. The persisting virus was sexually transmitted in February 2016, about 470 days after onset of symptoms, and caused a new cluster of EVD in Guinea and Liberia