Characteristics of obstetric urogenital fistulas in a regional teaching hospital in Burkina Faso: a retrospective cross-sectional study.

Introduction: Obstetric fistula (OF) remains a major public health problem in low-income countries. This study aimed to investigate the sociodemographic, clinical, and therapeutic characteristics of obstetric urogenital fistulas in a regional teaching hospital in Burkina Faso. Methods: a retrospective cross-sectional study from 1st January 2015 to 31st December 2019 included 50 women who underwent OF surgery repair in the regional teaching hospital of Ouahigouya in Burkina Faso. Case identification was completed by self-reported constant urine leakage and was confirmed by clinical assessment. Data on socio-demographic, clinical, and therapeutic characteristics have been collected from the hospital medical records and analyzed. Results: the mean age of the patients was 29.40 ± 9.4 years (range 15 -55 years). The majority of patients were in the age group between (15-25) years old (44%). Forty-three patients (86%) were residing in rural areas and forty-seven patients (94%) were housekeepers. Twenty-six patients (52%) were primiparous. The majority of patients had received no prenatal care 29 (58%). The majority of patients had a spontaneous vaginal delivery 36 (72%). The duration of labor was greater than 48 hours in 31 (62%) patients. Vesicovaginal fistulas (VVF) accounted for 80% of cases. Ten (20%) patients had previously undergone surgery for the same fistula. The mean size of the fistulas was 1.8±1.4 cm (range 0.5 - 6 cm). At three months of follow-up, the successful closure rate was 68%. Sixteen (32%) patients have experienced a failure of fistula closure. Conclusion: the majority of fistula survivors were women of reproductive age who were living in rural areas and housekeepers. Mothers having no antenatal care, and having prolonged labor were at increased risk of developing OF. The majority of fistulas were simple fistulas and the most common type of OF was VVF. Surgical outcomes showed a high failure rate.

Adult Granulosa Cell Tumor of the Testis: A case report and review of the literature.

Adult Granulosa Cell Tumor of the Testis (AGCTT) is a rare sex-cord stromal tumor. About 73 cases have been previously reported in the literature. We report a case of AGCTT in a 64 years old male, located in the left testis. We performed left radical inguinal orchiectomy. A sagittal section of orchiectomy specimen showed a solid yellowish-white mass measuring 1cm of long axis. On microscopic examination, we noted a well-limited tumor proliferation of solid architecture. The proliferation was made up of cells with scant cytoplasm and incised oval nuclei in a fibrous stroma. Rare Call-Exner bodies were noted.

Characteristics of Obstetric and Iatrogenic Urogenital Fistulas in Burkina Faso: A Cross-Sectional Study.

OBJECTIVE: To compare the sociodemographic, clinical, and therapeutic characteristics of obstetric urogenital fistulas (OF) and iatrogenic urogenital fistulas (IF) treated in seven centers in Burkina Faso. Material and Methods. We carried out a cross-sectional study over a seven years' period (January 1, 2010 to December 31, 2016). We considered as iatrogenic all urogenital fistulas (UGF) occurred after elective caesarean section, gynecologic surgery (hysterectomy, myomectomy, and prolapse repair), or induced abortion. UGF following vaginal delivery after prolonged labor without obstetric maneuvers or caesarean section were considered as obstetric. UGF caused by other mechanisms (emergency caesarian section, congenital, and traumatic) were excluded from this study. The statistical analysis was carried out using version 14 of the STATA software. A logistic regression model was used to compare the two groups. RESULTS: 310 cases of UGF were included. IF accounted for 25.8% (n = 80) versus 74.2% (n = 230) for OF. The median age was 35 years for IF and 35.38 years for OF. The vesicovaginal fistulas were predominant (74.5%) in the two groups. All circumferential fistulas were found in the OF group. OF were frequently associated with residence in rural areas (OR = 1.8; CI = [1.05-3.1]), low level of education (OR = 5.4; CI = [2.3-12.9]), and a height under 158 cm (OR = 3.4 CI = [1.7-6.6]). Vaginal sclerosis was less common among IF (OR = 2.2; CI = [1-4.6]). The failure of surgical treatment after 3 months was more associated with OF (OR = 4.7; CI = [1.1-20.5]). CONCLUSION: OF were the most common, frequently affecting short women living in rural area and with low level of schooling. Fistulas were also more severe in the OF group. IF gave better results after surgical repair.

Predictive factors for orchiectomy in adult's spermatic cord torsion: a case-control study.

BACKGROUND: Spermatic cord torsion (SCT) is a surgical emergency. Any delay in diagnosis or treatment may compromise the vital and functional prognosis of the testicle. The orchiectomy rate remains very high in the literature; it can even reach 50 % in certain series. Several factors have been reported in the literature as being significantly correlated with the risk of orchiectomy: duration of symptoms, the number of turns, the younger ages, etc. The objective of this study has been to analyse the predictive factors of orchiectomy in adult SCT in our context. RESULTS: During the study period, 74 cases of SCT were included. Orchidopexy was performed in 43.2 % (32/74) versus orchiectomy in 56.8 % (42/74) of cases. The patients' median age was 22 years (interquartile range (IQR) = 18-26.75 years). The duration of symptoms (p = 0.009), the previous medical management (p < 0.001), performing a scrotal ultrasonography (p = 0.004) were statistically significant at univariate analysis. On multivariate analysis only the previous medical management was statistically significant (p = 0.017). CONCLUSIONS: The orchiectomy rate was very high in our cohort. The previous medical management was the only significant predictive factor of orchiectomy on multivariate analysis. Our findings demonstrated that the delay in diagnosis is the determining factor in testicular loss in our context.

RéSUMé: CONTEXTE: La torsion du cordon spermatique est une urgence chirurgicale. Tout retard dans le diagnostic ou le traitement peut compromettre le pronostic vital et fonctionnel du testicule. Le taux d'orchidectomie reste très élevé dans la littérature;il peut même atteindre 50 % dans certaines séries. Plusieurs facteurs ont été rapportés dans la littérature comme étant significativement corrélés au risque d'orchidectomie. L'objectif de cette étude était d'analyser les facteurs prédictifs d'orchidectomie dans la torsion du cordon spermatique de l'adulte dans notre contexte. RéSULTATS: Durant la période d'étude 74 patients ont été inclus. Une orchidopexie a été réalisée dans 43,2 % (32/74) des cas et une orchidectomie dans 56,8 %(42/74) des cas. L'âge médian des patients était de 22 ans (écart interquartile=18-26,75 ans). La durée des symptômes (p = 0,009), la prise en charge médicale antérieure(p<0,001), la réalisation d'une échographie des bourses (p = 0,004) étaient significativement corrélées au risque d'orchidectomie à l'analyse univariée. A l'analyse multivariée, seule la prise en charge médicale antérieure était significativement corrélée au risque d'orchidectomie (p=0.017). CONCLUSION: Le taux d'orchidectomie était très élevé dans notre cohorte. La prise en charge médicale antérieure était le seul facteur prédictif significatif de l'orchidectomie à l'analyse multivariée. Nos résultats ont montré que le retard diagnostic est le facteur déterminant de la perte testiculaire dans notre contexte. MOTS CLéS: Torsion du cordon spermatique, Orchidectomie, Orchidopexie, Facteurs prédictifs, Urgence chirurgicale.

Prostate Cancer Presenting with Parietal Bone Metastasis.

Bone metastases from prostate cancer are very common. They are usually located on the axial skeleton. However, cranial bone metastases especially to the parietal bone are rare. We report a case of metastatic prostate cancer presenting with left parietal bone metastasis in a patient with no urological symptoms or signs. We should consider prostate cancer in any man above 60 years presenting unusual bone lesions.

Performance-based financing to increase utilization of maternal health services: Evidence from Burkina Faso.

Performance-based financing (PBF) programs are increasingly implemented in low and middle-income countries to improve health service quality and utilization. In April 2011, a PBF pilot program was launched in Boulsa, Leo and Titao districts in Burkina Faso with the objective of increasing the provision and quality of maternal health services. We evaluate the impact of this program using facility-level administrative data from the national health management information system (HMIS). Primary outcomes were the number of antenatal care visits, the proportion of antenatal care visits that occurred during the first trimester of pregnancy, the number of institutional deliveries and the number of postnatal care visits. To assess program impact we use a difference-in-differences approach, comparing changes in health service provision post-introduction with changes in matched comparison areas. All models were estimated using ordinary least squares (OLS) regression models with standard errors clustered at the facility level. On average, PBF facilities had 2.3 more antenatal care visits (95% CI [0.446-4.225]), 2.1 more deliveries (95% CI [0.034-4.069]) and 9.5 more postnatal care visits (95% CI [6.099, 12.903]) each month after the introduction of PBF. Compared to the service provision levels prior to the interventions, this implies a relative increase of 27.7 percent for ANC, of 9.2 percent for deliveries, and of 118.7 percent for postnatal care. Given the positive results observed during the pre-pilot period and the limited resources available in the health sector, the PBF program in Burkina Faso may be a low-cost, high impact intervention to improve maternal and child health.

Monitoring the performance of the Expanded Program on Immunization: the case of Burkina Faso.

BACKGROUND: The greatest challenge facing expanded programs on immunization in general, and in Burkina Faso in particular, lies in their capacity to achieve and sustain levels of immunization coverage that will ensure effective protection of children. This article aims to demonstrate that full immunization coverage of children, which is the primary indicator for monitoring national immunization programs, is sufficient neither to evaluate their performance adequately, nor to help identify the broad strategies that must be implemented to improve their performance. Other dimensions of performance, notably adherence to the vaccination schedule and the efficacy of the approaches used to reach all the children (targeting) must also be considered. METHODS: The study was carried out using data from surveys carried out in Burkina Faso: the 1993, 1998 and 2003 Demographic and Health Surveys and the 2003 national Survey of Immunization Coverage. Essentially, we described levels of immunization coverage and their trends according to the indicators considered. Performance differences are illustrated by amplitudes and maximum/minimum ratios. RESULTS: The health regions' performances vary according to whether they are evaluated on the basis of full immunization coverage or vaccination status of children who have not completed their vaccinations. The health regions encompass a variety of realities, and efforts of substantially different intensity would be required to reach all the target populations. CONCLUSION: Decision-making can be improved by integrating a tripartite view of performance that includes full immunization coverage, adherence to the vaccination schedule (timely coverage), and the status of children who are not fully vaccinated. With such an approach, interventions can be better targeted. It provides information on the quality and timeliness of vaccination and identifies the efforts required to meet the objectives of full immunization coverage. ABSTRACT IN FRENCH: See the full article online for a translation of this abstract in French.

System-level determinants of immunization coverage disparities among health districts in Burkina Faso: a multiple case study.

BACKGROUND: Despite rapid and tangible progress in vaccine coverage and in premature mortality rates registered in sub-Saharan Africa, inequities to access remain firmly entrenched, large pockets of low vaccination coverage persist, and coverage often varies considerably across regions, districts, and health facilities' areas of responsibility. This paper focuses on system-related factors that can explain disparities in immunization coverage among districts in Burkina Faso. METHODS: A multiple-case study was conducted of six districts representative of different immunization trends and overall performance. A participative process that involved local experts and key actors led to a focus on key factors that could possibly determine the efficiency and efficacy of district vaccination services: occurrence of disease outbreaks and immunization days, overall district management performance, resources available for vaccination services, and institutional elements. The methodology, geared toward reconstructing the evolution of vaccine services performance from 2000 to 2006, is based on data from documents and from individual and group interviews in each of the six health districts. The process of interpreting results brought together the field personnel and the research team. RESULTS: The districts that perform best are those that assemble a set of favourable conditions. However, the leadership of the district medical officer (DMO) appears to be the main conduit and the rallying point for these conditions. Typically, strong leadership that is recognized by the field teams ensures smooth operation of the vaccination services, promotes the emergence of new initiatives and offers some protection against risks related to outbreaks of epidemics or supplementary activities that can hinder routine functioning. The same is true for the ability of nurse managers and their teams to cope with new situations (epidemics, shortages of certain stocks). CONCLUSION: The discourse on factors that determine the performance or breakdown of local health care systems in lower and middle income countries remains largely concentrated on technocratic and financial considerations, targeting institutional reforms, availability of resources, or accessibility of health services. The leadership role of those responsible for the district, and more broadly, of those we label "the human factor", in the performance of local health care systems is mentioned only marginally. This study shows that strong and committed leadership promotes an effective mobilization of teams and creates the conditions for good performance in districts, even when they have only limited access to supports provided by external partners. ABSTRACT IN FRENCH: See the full article online for a translation of this abstract in French.