Dengue Immunological Markers Evolution at Saint Camille Hospital in Ouagadougou (HOSCO) Burkina Faso.

<b>Background and Objective:</b> Dengue is a remerging vector-borne viral disease in Burkina Faso since the outbreak of 2013 and requires special attention from health authorities. This study reports the prevalence of dengue fever serological markers (NS1Ag, IgM and IgG) and infection dynamic from January, 2018 to December, 2020 among patients tested for dengue infection at Saint Camille Hospital of Ouagadougou (HOSCO). <b>Materials and Methods:</b> The study population consisted of 6414 patients aged 0-97 years. Dengue virus infection was detected in serum or plasma using the SD bioline dengue duo rapid detection kit. <b>Results:</b> The prevalence of dengue NS1Ag was 2.25% (45/2003), 18.43% (501/2719) and 2.42% (38/1569) in the study population in 2018, 2019 and 2020, respectively. The age groups over 50 years and 15-20 years were significantly more infected compared to the group 21-30 years respectively in 2019 (p = 0.030) and 2020 (p = 0.035). Patients tested positive for at least one of these markers (NSlAg, IgG and IgM) represented 26.01% (521/2003) and 38.98% (1060/2719). The peak of infection during 2018 and 2019 was observed between October and November. The present study reports a high seroprevalence of acute dengue virus infection. The presence of NS1Ag, IgM and IgG in patients suggests an active circulation of the dengue virus in Ouagadougou. <b>Conclusion:</b> Data shows recurrent outbreaks of dengue infection in our country need strong surveillance and a suitable and affordable diagnostic system to clarify the burden, pinpoint the risk factors and for better case management.

Development and validation of the Flare-OA questionnaire for measuring flare in knee and hip osteoarthritis.

OBJECTIVE: Ability to assess flares in osteoarthritis (OA) of the knee and hip (KHOA) is important in clinical care and research. Using mixed methods, we developed a self-reported instrument measuring flare and assessed its psychometric properties. METHODS: We constructed questionnaire items from semi-structured interviews and a focus group (patients, clinicians) by using a dual-language (English-French) approach. A Delphi consensus method was used to select the most relevant items. Patients with OA from Australia, France and the United States completed the preliminary Flare-OA, HOOS, KOOS and Mini-OAKHQOL questionnaires online. We used a factor analysis and content approach to reduce items and determine structural validity. We tested the resulting questionnaire (score 0-100) for internal consistency, convergent and known-groups validity. RESULTS: Initially, 180 statements were generated and reduced to 33 items in five domains (response 0 = not at all, to 10 = absolutely) by Delphi consensus (50 patients, 116 professionals) and an expert meeting. After 398 patients (mean [SD] age 64 [8.5] years, 70.4% female, 86.7% knee OA) completed the questionnaire, it was reduced to 19 items by factor analysis and a content approach (RMSEA = 0.06; CFI = 0.96; TLI = 0.94). The Cronbach's alpha was >0.9 for the five domains and the whole questionnaire. Correlation coefficients between Flare-OA and other instrument scores were as predicted, supporting construct validity. The difference in Flare-OA score between patients with and without flare (31.8) largely exceeded 2 SEM (10.2). CONCLUSION: Flare-OA is a valid and reliable patient-reported instrument for assessing the occurrence and severity of flare in patients with KHOA in clinical research.

[Postpartum family planning at the district hospital of the commune II of Bamako, Mali]. / Planification familiale du postpartum a l'hopital de district de la commune II de Bamako, Mali.

Postpartum family planning is the prevention of pregnancy during the 12 months following childbirth. OBJECTIVE: To study the use of contraceptive methods in the postpartum period in the obstetrics gynecology department of the district hospital of the commune II of Bamako. MATERIALS AND METHODS: We conducted a descriptive and analytical cross-sectional study with prospective data collection from January 1, 2019 to December 31, 2020. All women who had given birth who had chosen and benefited from a contraceptive method were included. The statistical test used was Fisher's test with a significance level set at 5%. RESULTS: In 2 years, the contraceptive prevalence in the postpartum was 26.1%. More than 2/3 of counseling (61%) was done during prenatal consultations, 8% during the latency phase, 26% in the immediate postpartum and 5% during the postnatal visit. The most chosen methods were implants (47.1%), intrauterine device (29.6%), miro-progestin pills (12.5%), injectable progestogens (8%) and condoms (3.2%). CONCLUSION: Postpartum family planning contributes to increasing contraceptive prevalence.

La planification familiale du postpartum est la prévention des grossesses durant les 12 mois qui suivent l'accouchement. OBJECTIF: Etudier l'utilisation des méthodes contraceptives dans le postpartum dans le service de gynécologie obstétrique de l'hôpital de district de la commune II de Bamako. MATÉRIELS ET MÉTHODES: Nous avons mené une étude transversale descriptive et analytique avec collecte prospective des données du 1er janvier 2019 au 31 décembre 2020. Ont été incluses, toutes les accouchées ayant choisi et bénéficié d'une méthode contraceptive. Le test statistique utilisé a été le test de Fisher avec un seuil de significativité fixé à 5%. RÉSULTATS: En 2 ans, la prévalence contraceptive dans le postpartum était de 26,1%. Plus des 2/3 des counselings (61%) ont été faits lors des consultations prénatales, 8% pendant la phase de latence, 26% dans le postpartum immédiat et 5% lors de la visite postnatale. Les méthodes les plus choisies ont été les implants (47,1%), le dispositif intra-utérin (29,6%), les pilules miro-progestatives (12,5%), les progestatifs injectables (8%) et les préservatifs (3,2%). CONCLUSION: La planification familiale du postpartum contribue à augmenter la prévalence contraceptive.

[Infection with the Hepatitis B virus in pregnant women in the Gynecology and Obstetrics Department of the Gabriel Touré University Hospital Center]. / L'Infection par le virus de L'Hepatite B chez la femme enceinte dans le service de Gynecologie-Obstetrique du Centre Hospitalo-Universitaire Gabriel Toure.

PURPOSE: The purpose of this study was to study hepatitis B virus infection in pregnant women. METHOD: This was a one-year descriptive cross-sectional study carried out in the Gynecology-Obstetrics Department of the Gabriel Touré University Hospital. RESULT: During this period, 796 pregnant people were seen in antenatal consultations. Ween rolled 500 pregnant women in whom the search for HBs Ag was carried out, a rate of 62.81%. Of these pregnant 85 had HBs Ag a prevalence of 17%. The average age of these women was 26.9±5.6 years. Our patients were paucipare sin 52.9%. Of these, 17.7% had a family history of chronic liver disease and 37.6% had once given birth in a referral health centre. Blood transfusion, polygamous focus and tattooing/scarification were the risk factors associated with HBs Ag carriage. Alarming clinical signs were absent in 95.2% of cases. Hepatic cytolysis and anaemia were foundin 28.8% and 76.3% of cases respectively; viral replication was observed in 13.6% of pregnant women with a high viral loadin 37.2%. Abdominal ultra sound was normal in 90.8% of cases and esophageal varices were present in 6% of women who performed eso-gastroduduedenal fibroscopy. Fibrosis was significant according to an APRI score in 3.4%. CONCLUSION: The prevalence of HBs A in pregnant women followed remains high.

BUT: Le but de cette étude était d'étudier l'infection par le virus de l'hépatite B chez la femme enceinte. METHODE: Il s'agissait d'une étude transversale descriptive sur un an réalisée au service de Gynécologie-Obstétrique du CHU Gabriel Touré. RESULTAT: Durant cette période, 796 gestantes ont été vues en consultation prénatale. Nous avons enrôlé 500 femmes enceintes chez qui la recherche de l'Ag HBs a été effectuée soit un taux de 62,81%. Parmi ces gestantes 85 avaient l'Ag HBs soit une prévalence de 17%.L'âge moyen de ces femmes était de 26,9±5,6 ans. Nos patientes étaient des paucipares dans 52,9%. Parmi elles 17,7% avaient un antécédent familial d'hépatopathie chronique et 37,6% avaient une fois accouché dans un centre de santé de référence. La transfusion sanguine, le foyer polygamique et le tatouage/scarification étaient les facteurs de risque associés au portage de l'Ag HBs. Les signes cliniques alarmants étaient absents chez 95,2% des cas. Une cytolyse hépatique et une anémie étaient retrouvées chez respectivement 28,8% et 76,3% des cas ; une réplication virale était observée chez 13,6% des gestantes avec une charge virale élevée chez 37,2%. L'échographie abdominale était normale dans 90,8% des cas et les varices œsophagiennes étaient présentes chez 6% des femmes ayant réalisé la fibroscopie œsogastroduodénale. La fibrose était significative selon un score APRI chez 3,4%. CONCLUSION: La prévalence de l'AgHBs chez les gestantes suivies reste élevée.

[Knowledge, attitudes and practices of Bamako media Men' on family planning]. / Connaissances, attitudes et pratiques des Hommes de medias de Bamako sur la planification familiale.

INTRODUCTION: Contraceptive prevalence is low in Mali. The information provided by the media men can help to increase or decrease the use of contraceptive methods. OBJECTIVE: To study the knowledge, attitudes and practices of Bamako media Men on family planning. MATERIAL AND METHODS: We carried out a descriptive cross-sectional study with prospective data collection from June 1 to August 30, 2019. It concerned journalists and presenters of 15 radio and 6 televisions in Bamako. RESULTS: During the 3 months, 615 media Men agreed to participate in this study. These are men and women from 36 to 45 years old in 37.2% of cases, married in 81.3% of cases. The radio with 85.5% was their main source of information on family planning. They all knew at least one contraceptive method. The best-known methods were pills (94.3%), injectables (57%) and implants (49.1%). They were in favor of the practice of family planning in 77.2% of cases, 76.9% had already used a method and 56.7% had already hosted a program on family planning. CONCLUSION: Media men are essential in the transmission of information. The quality of the information provided by these Media men can be influenced by their personal perceptions and attitudes. Their better involvement in the promotion of family planning can help to increase contraceptive prevalence.

INTRODUCTION: La prévalence contraceptive est faible au Mali. Les informations transmises par les Hommes de médias peuvent contribuer à augmenter ou à diminuer l'utilisation des méthodes contraceptives. OBJECTIF: Etudier les connaissances, attitudes et pratiques des Hommes de médias de Bamako sur la planification familiale. MATÉRIEL ET MÉTHODES: Nous avons réalisé une étude transversale descriptive avec collecte prospective des données du 1er juin au 30 août 2019. Elle a concerné les journalistes et les animateurs de 15 radios et 6 télévisions de Bamako. RÉSULTATS: Durant les 3 mois, 615 Hommes de médias de Bamako ont accepté de participer à cette étude. Il s'agissait d'hommes et de femmes âgés de 36 à 45 ans dans 37,2% des cas, mariés dans 81,3% des cas. La radio avec 85,5% était leur principale source d'information sur la planification familiale. Ils connaissaient tous au moins une méthode contraceptive. Les méthodes les plus connues étaient les pilules (94,3%), les injectables (57%) et les implants (49,1%). Ils étaient favorables à la pratique de la planification familiale dans 77,2% des cas, 76,9% avaient déjà utilisé une méthode et 56,7% avaient déjà animé une émission sur la planification familiale. CONCLUSION: Les Hommes de médias sont essentiels dans la transmission de l'information. La qualité de l'information fournie par ces Hommes de médias peut être influencée par leurs perceptions et attitudes personnelles. Leur meilleure implication dans la promotion de la planification familiale peut contribuer à augmenter la prévalence contraceptive.

[Epidemiology and prognosis of eclampsia in Bougouni]. / Epidemiologie et pronostic de l'eclampsie a Bougouni.

OBJECTIVES: The objectives were to describe the epidemiological and prognostic aspects of eclampsia in the Bougouni reference health center. METHODS: This was a transversal prospective, descriptive study from January 1 to December 31, 2015 in the gynecology-obstetrics department of Bougouni reference health center. Were included, all pregnant or postpartum women diagnosed with eclampsia during the study period. RESULTS: The frequency of eclampsia was 2.54%. They were adolescent girls in 50% of cases, primigest in 62.5% of cases, unschooled in 67.5% of cases, having not performed any antenatal care in 70% of cases. Eclampsia occurred in antepartum in 37.5% of cases, in 5% in perpartum and in 57.5% in postpartum. Therapeutically, nicardipine with 72.5% and nifedipine with 22.5% were the antihypertensive drugs used. As for anticonvulsants, magnesium sulfate (MgSO4) was used in 92.5% and diazepam in 7.5%. The maternal-fetal prognosis was marked by 2.5% of maternal death, 27% of prematurity and 27.5% of fetal death in utero. CONCLUSION: Eclampsia is a dreadful pathology with serious maternal and fetal complications.

OBJECTIFS: Les objectifs étaient de décrire les aspects épidémiologique et pronostique de l'éclampsie dans le centre de santé de référence de Bougouni. MÉTHODES: Il s'agissait d'une étude transversale prospective, descriptivedu 1er janvier au 31 décembre 2015 dans le service de gynécologie-obstétrique du centre de santé de référence de Bougouni. Ont été incluses, toutes les femmes enceintes ou les accouchées chez qui le diagnostic de crise d'éclampsie a été retenu pendant la période d'étude. RÉSULTATS: La fréquence de l'éclampsie a été de 2,54%. Il s'agissait d'adolescentes dans 50% des cas, primigestes dans 62,5% des cas, non scolarisées dans 67,5% des cas,n'ayant effectuées aucune consultation prénatale dans70% des cas. L'éclampsie est survenue en antépartumdans 37,5% des cas, dans 5% en perpartum et dans 57,5% en postpartum. Sur le plan thérapeutique, la nicardipine avec 72,5% et la nifédipine avec 22,5% ont été les antihypertenseurs utilisés. Quant aux anticonvulsivants, le sulfate de magnésium (MgSO4) a été utilisé dans 92,5% et le diazépam dans 7,5%. Le pronostic materno-fœtal a été marqué par 2,5% de décès maternel, 27% de prématurité et 27,5% de mort fœtale in-utéro. : L'éclampsie est une pathologie redoutable aux complications maternelles et fœtales graves.

[Spontaneous triple pregnancy on bicicatricial uterus in the referral health center of commune II of Bamako, Mali]. / Grossesse triple spontanee sur uterus bicicatriciel au centre de sante de reference de la commune II de Bamako, Mali.

The trimellar pregnancy on bicicatricial uterus is a rare situation. It can be associated with many maternal-fetal complications. Given these risks, some teams opt for an embryonic reduction. We report a case of spontaneous trimellar pregnancy on bicicatricial uterus. This was a 38 year-old patient, third pregnancy, second birth, 2 alive with a history of 2 caesareans. The evolution of the pregnancy was marked by a urinary tract infection at 34 weeks of gestation. The caesarean section performed at 36 weeks of gestation allowed the birth of 3 newborns, 2 of which were females in 2000 and 1900 grams, and one male weighing 2400 grams. The postpartum was marked by a rapidly resolved eclampsia crisis.

La survenue d'une grossesse triméllaire sur un utérus bicicatriciel est une situation rare. Elle peut être associée à de nombreuses complications materno-fœtales. Compte tenu de ces risques, certaines équipes optent pour une réduction embryonnaire. Nous rapportons un cas de grossesse triméllaire spontanée sur utérus bicicatriciel. Il s'agissait d'une patiente de 38 ans 3è geste, 2è pare avec 2 enfants vivants, ayant un antécédent de 2 césariennes. L'évolution de la grossesse a été marquée par une infection urinaire à 34 SA. La césarienne pratiquée à 36 SA a permit la naissance de 3 nouveaunés dont 2 de sexes féminins de 2000 et 1900g et un de sexe masculin pesant 2400g. Les suites de couches ont été marquées par une crise d'éclampsie rapidement résolue.

[Materno-Fetal Prognosis Of Anemia In Bougouni]. / Pronostic Materno-Fœtal De L'Anemie A Bougouni.

GOAL: The goal was to assess the maternal-fetal prognosis of anemia in pregnant women in the Bougouni reference health center. METHODS: We carried out a prospective descriptive and analytical cross-sectional study from January 1 to December 31, 2013 at the Bougouni reference health center. It covered all pregnant women with a hemoglobin level below 11g/dl regardless of the outcome of the pregnancy. RESULTS: The prevalence of anemia in pregnant women was 33.2%. They were women married to peasants in 88.6% of cases, unschooled in 93.2% of cases, having not done antenal care in 56.8% of cases. Malaria was the most common etiology in 75% of cases. Anemia was severe in 61.4% of cases. The maternal-fetal prognosis was dominated by 3.3% of maternal death, 12.5% of abortion, 7.6% of prematurity and 6.8% of fetal death in utero. CONCLUSION: Anemia in pregnant women is the source of many maternal-fetal complications.

BUT: Le but était d'évaluer le pronostic materno-fœtal de l'anémie chez la femme enceinte dans le centre de santé de référence de Bougouni. MÉTHODES: Nous avons réalisé une étude transversale prospective descriptive et analytique du 1er janvier au 31 décembre 2013 au centre de santé de référence de Bougouni. Elle a porté sur toutes les femmes enceintes ayant un taux d'hémoglobine inférieur à 11g/dl quelle que soit l'issue de la grossesse. RÉSULTATS: La prévalence de l'anémie chez les femmes enceintes a été de 33,2%. Il s'agissait de femmes mariées à des paysans dans 88,6% des cas, analphabètes dans 93,2% des cas, n'ayant pas fait de consultations prénatales dans 56,8% des cas. Le paludisme a été l'étiologie la plus fréquente dans 75% des cas. L'anémie était sévère dans 61,4% des cas. Le pronostic materno-fœtal a été dominé par 3,3% de décès maternel, 12,5% d'avortement, 7,6% de prématurité et 6,8% de mort fœtale in utéro. CONCLUSION: L'anémie chez la femme enceinte est pourvoyeuse de nombreuses complications materno-fœtales.

[Pregnancy And Delivery In The Large Multiparous In The Reference Health Center Of Commune II Of Bamako, Mali]. / Grossesse Et Accouchement Chez La Grande Multipare Au Centre De Sante De Reference De La Commune II De Bamako, Mali.

AIM: The aim was to compare the maternal-fetal prognosis of pregnancies in large multiparous with that of other parities. MATERIALS AND METHODS: We conducted a case-control study from March 1st, 2014 to February 1st, 2015. It concerned all parturients admitted in our service during the study period. We have chosen 1 case for 2 witnesses. All the large multiparous were included as cases and as witnesses the primiparous, the pauciparous and the multiparous who gave birth just before and after the case. The statistical test was the Chi2 with a significance level at 5%. RESULTS: The frequency of pregnancy in the large multiparous was 4.93%. They were housewives in 84% of cases, unschooled in 74.7% of cases. The maternal-fetal outcome was dominated by uterine rupture in 0.6% of cases, immediate postpartum hemorrhage in 9.8% of cases, vicious presentations in 5.5% of cases and cord prolapse in 6.8% of cases. CONCLUSION: Large multiparity is common in our practice. It is a high-risk pregnancy because of its many maternal-fetal complications.

BUT: Le but était de comparer le pronostic materno-fœtal des grossesses chez les grandes multipares à celui des autres parités. MATÉRIELS ET MÉTHODES: Nous avons réalisé une étude cas-témoins du 1er mars 2014 au 1er février 2015. Elle a concerné toutes les parturientes admises dans le service pendant la période d'étude. Nous avons choisi 1 cas pour 2 témoins. Ont été incluses comme cas toutes les grandes multipares et comme témoins les primipares, les paucipares et les multipares ayant accouchées juste avant et juste après le cas. Le test statistique utilisé a été le Chi2 avec un seuil de significativité fixé à 5%. RÉSULTATS: La fréquence de la grossesse chez la grande multipare était de 4,93%. Il s'agissait de femmes au foyer dans 84% des cas, non scolarisées dans 74,7% des cas. Le pronostic materno-fœtal a été dominé par la rupture utérine dans 0,6% des cas, l'hémorragie de la délivrance dans 9,8% des cas, les présentations vicieuses dans 5,5% des cas et la procidence du cordon dans 6,8% des cas. CONCLUSION: La grande multiparité est fréquente dans notre pratique. C'est une grossesse à haut risque à cause de ses nombreuses complications materno-fœtales.

[Infections associated with the care in the department of gynecology - obstetrics of the University Hospital Center Gabriel Touré]. / Les infections associees aux soins dans le departement de gynecologie ­ obstetrique du Centre Hospitalier Universitaire Gabriel Toure de bamako, mali.

OBJECTIF: the purpose of this work was to study the infections associated with the care in the department of gynecology - obstetrics of the University Hospital Center Gabriel Touré (CHU G. Touré). PATIENTS AND METHODS: This was an epidemiological, descriptive, and analytical study carried out in the gynecology-obstetrics department of G. Touré University Hospital, from April 11, 2016 to August 29, 2016 (4 monthset 18 days), with a prospective collection of data that focused on the characteristics clinical and laboratory-based care-associated infections in patients during their hospitalization. Included in the study were all hospitalized patients (operated or not) in the gynecology obstetrics department, who agreed to participate in the study. The criteria used to diagnose the infection associated with care were those of the CDC Atlanta and making a thick drop in our context. Operative wound monitoring was performed until the 30th postoperative day. RESULTS: We recorded 200 patients, including 138 operated and 62 nonoperated patients, of which 30 patients developed a care-associated infection at a rate of 15%. The mean age of the patients who presented an infection was 32.52 years ± 13.36 years against 29.36 years ± 10.28 years for the patients who did not present the infection. Seven point five percent of the evacuees had an infection associated with care. The most common types of infections were surgical site infection with 56.60% followed by malaria with 23.30% and urinary tract infection with 20.00%. Escherichia coli and Acinetobacter baumaniiwere the most recovered germs. Isolated organisms were 100% resistant to Amoxicillin, 88.88% were resistant to Ciprofloxacin and 77.77% were resistant to Amoxicillin + Clavulanic acid. The average duration of hospitalization for patients who developed the infection was 14.70 days with extremes of 5 and 46 days. The mortality rate was 1.50%. The average cost of management of patients who developed the infection was 119837 FCFA; the extremes were 17750 and 825750 FCFA and the standard deviation of 174998 CFA francs. CONCLUSION: the infections associated with the care remain frequent in our service and dominated by the infections of the operating site. The isolated organisms were all 100% resistant to Amoxicillin in 88.88% Ciprofloxacin.

LE BUT: de ce travail était d'étudier les infections associées aux soins dans le département de gynécologie ­obstétrique du Centre Hospitalier Universitaire Gabriel Touré (CHU G. Touré). PATIENTES ET MÉTHODES: Il s'agissait d'une étude épidémiologique, descriptive, analytique réalisée dans le département de gynécologie ­obstétrique du CHU G. Touré, allant du 11 Avril 2016 au 29 Août 2016 (4 mois et 18 jours) à collecte prospective des données qui a porté sur les caractéristiques cliniques et biologiques des infections associées aux soins chez les patientes au cours de leur hospitalisation. Etaient incluses dans l'étude toutes les patientes hospitalisées (opérées ou non) dans le service de gynécologie obstétrique, et qui ont accepté de participer à l'étude.Les critères utilisés pour le diagnostic de l'infection associée aux soins étaient ceux du CDC d'Atlanta et la réalisation d'une goutte épaisse dans notre contexte. Une surveillance des plaies opératoires a été faite jusqu'au 30ème jour post-opératoire. RÉSULTATS: Nous avons enregistrés 200 patientes dont 138 opérées et 62 non opérées parmi lesquelles 30 patientes ont développé une infection associée aux soins soit un taux de 15%. L'âge moyen des patientes ayant présenté une infection a été 32,52 ans ±13,36 ans contre 29.36 ans ±10,28 ans pour les patientes n'ayant pas présenté l'infection. Sept virgule cinq pourcent des patientes évacuées ont présenté une infection associée aux soins. Les types d'infections les plus retrouvés étaient l'infection du site opératoire avec 56,60% suivie du paludisme avec 23,30% et l'infection urinaire avec 20,00%. L'Escherichia coli et l'Acinetobacterbaumanii ont été les germes les plus retrouvés. Les germes isolés étaient dans 100% des cas résistants à l'Amoxicilline, dans 88,88% des cas résistants à la Ciprofloxacine et dans 77.77% des cas résistants à l'Amoxicilline +Acide clavulanique. La durée moyenne d'hospitalisation des patientes ayant développé l'infection a été 14,70 jours avec des extrêmes de 5 et 46 jours.Le taux de mortalité a été de 1,50%. Le coût moyen de prise en charge des patientes ayant développé l'infection a été 119837 FCFA ; les extrêmes ont été 17750 et 825750 FCFA et l'écart type de 174998 francs CFA. CONCLUSION: les infections associées aux soins restent fréquentes dans notre service et dominées par les infections du site opératoire. Les germes isolés étaient tous résistants dans 100% cas à l'Amoxicilline dans 88,88% cas à la Ciprofloxacine.

[Pregnancy and delivery for women aged 40 years and over at the reference health center of commune II of Bamako district, Mali]. / Grossesses et accouchements chez les femmes de 40 ans et plus au centre de sante de reference de la commune II du district de Bamako, Mali.

GOAL: The aim of this study was to compare the maternal-fetal prognosis of pregnancies at 40 years of age and above with that of pregnancies obtained before 40 years of age in the obstetric gynecology department of the reference health center of commune II of Bamako district. MATERIALS AND METHODS: This was a prospective cohort study that was conducted at the maternity ward of Reference Health Center of Commune II of Bamako district from 1st January to 31 December 2012. Were included in our study as patients exposed, all the pregnant women of 40 years and over and as unexposed patients, pregnant women aged 20-39 who gave birth in our service. Teenage pregnancies were not included in this study. The statistical tests used were Pearson's Khi2 and Fisher's test with a significance level of 5%. RESULTS: The frequency of pregnancy among women aged 40 and over was 1.68%. These were large multiparas unschooled patients in 60% of cases, with hypertension in 6.7% of cases. Pregnancy in her patients was associated with a high rate of caesarean section in 16.7% of cases, term overrun in 6.7% of cases, seat presentation in 6.7% of cases, macrosomia in 6.7% of cases and fetal malformation in 1.7% of cases. CONCLUSION: Slight account of its many maternal-fetal complications, pregnancies in women 40 years and older deserve special attention.

BUT: Le but de cette étude était de comparer le pronostic materno-foetal des grossesses chez les patientes de 40 ans et plus à celui des grossesses conçues avant 40 ans dans le service de gynécologie obstétrique du centre de santé de référence de la commune II de Bamako. MATÉRIELS ET MÉTHODES: Il s'agissait d'une étude prospective de Cohorte qui s'est déroulée à la maternité du Centre de Santé de Référence de la Commune II du 1er janvier au 31décembre 2012. Ont été incluses dans notre étude comme patientes exposées toutes les gestantes de 40 ans et plus et comme patientes non exposées les gestantes de 20-39 ans ayant accouchées dans notre service. N'ont pas été retenues dans cette étude, les grossesses chez les adolescentes. Les tests statistiques utilisés ont été le Khi2 de Pearson et le test de Fisher avec un seuil de significativité à 5%. RÉSULTATS: La fréquence de la grossesse chez les femmes de 40 ans et plus était de 1,68%. Il s'agissait de grandes multipares non scolarisées dans 60% des cas, présentant une HTA dans 6,7% des cas. La grossesse chez ces patientes a été associée à un taux élevé de césarienne dans 16,7% des cas, de dépassement de terme dans 6,7% des cas, de présentation du siège dans 6,7% des cas, de macrosomie dans 6,7% des cas et de malformation foetale dans 1,7% des cas. CONCLUSION: Compte ténu de ses nombreuses complications materno-foetales, les grossesses chez les femmes de 40 ans et plus méritent une attention particulière.

[Prevalence and risk factors for sickle retinopathy in a sub-Saharan comprehensive Sickle Cell Center]. / Prévalence et facteurs de risque de la rétinopathie drépanocytaire dans un centre de suivi drépanocytaire d'Afrique subsaharienne.

INTRODUCTION: Retinopathy is a chronic complication with severe functional consequences in patients with sickle cell disease. Its prevalence is not well known in sub-Saharan Africa because of the absence of screening. We report here the results of a routine screening for sickle retinopathy in a Comprehensive Sickle Cell Center in Sub-Saharan Africa. METHODS: Screening of sickle retinopathy was carried out in all sickle cell patients aged 10 and over, followed between 2010 and 2012. Retinopathy was screened by dilated indirect fundoscopic examination and retinal angiography, if necessary. The gender, age and hematological parameters of patients with sickle retinopathy were compared with those of controls randomly selected from the cohort of sickle cell patients without retinopathy followed during the same period. RESULTS: The overall prevalence of sickle cell retinopathy was 8.8% (142/1604): 12.4% (91/731) in SC, 5.2% (38/734) in SS, 9.4% (5/53) in Sß°-thalassemia patients and 9.3% (8/86) in Sß+-thalassemia patients. Proliferative retinopathy was more common in SC patients (P<0.01). High levels of hemoglobin or of hematocrit were associated with retinopathy in all patients and with proliferative retinopathy in SC patients. In SS or Sß0thalassemia patients, high leukocyte count was associated with proliferative retinopathy. Low fetal hemoglobin level was associated with retinopathy in all groups. CONCLUSION: The prevalence of sickle cell retinopathy is high and negatively associated to the level of fetal hemoglobin. The efficiency of a routine screening for sickle cell retinopathy must be assessed in Africa as well as the benefit of phlebotomy and hydroxyurea therapy as a preventive treatments.

[Caesarean at the Gabriel Touré University Hospital of Bamako: factors of morbi-mortality]. / Facteurs de morbi-mortalite de la Cesarienne au Centre Hospitalo-Universitaire Gabriel Toure de Bamako.

INTRODUCTION: Following the progress made regarding anesthesia reanimation, caesarean have become a much safer procedure. However, factors of mobi-mortality are still numerous. The main objective of this study was to analyze the factors of morbi-mortality arising during a caesarean. PATIENT AND METHOD: A retrospective cross-sectional study was conducted from January 2007 to December 2011 in the gynecology-obstetric and anesthesia reanimation services of the Gabriel TOURE University Hospital. The analysis looked at the medical files of women undergoing a caesarean and hospitalized in the gynecology-obstetric and anesthesia reanimation services. Data analysis was carried out with SPSS.19 (Statistical Package for Social Sciences) and the Epiinfo.7 softwares. Chi2 tests were performed to compare frequencies where a value of p≤0.05 was considered statistically significant. RESULTS: 269 medical files were analysed. Mean age was of 28.46 ± 6.702. The most frequent peroperative morbidity factors were cardiovascular. Death rate was of 5.2%. The most frequent cause of these deaths was eclampsia. Factors influencing morbi-mortalities were iterative caesareans and urgency of the caesarean. The evacuated mothers had presented complications in 37.3% of cases. CONCLUSION: The caesarean is a procedure that is not sufficiently safe in our services and there are a lot of factors of mobi-mortality.

INTRODUCTION: La sécurité au cours de la césarienne est devenue très grande grâce aux progrès de l'anesthésie réanimation. Cependant les facteurs de mobi-mortalité sont nombreux. Le but de ce travail était d'étudier les facteurs de morbi-mortalité au cours de la césarienne. PATIENTES ET MÉTHODE: Il s'agissait d'une étude transversale rétrospective de janvier 2007 à décembre 2011 dans les services de gynéco-obstétrique et d'anesthésie réanimation du centre hospitalier universitaire Gabriel TOURE. Elle a porté sur les dossiers des parturientes césarisées et hospitalisées dans les services de gynéco-obstétrique et d'anesthésie réanimation. L'analyse des données a été faite à l'aide du logiciel SPSS.19 (Statistical package for Social Sciences) et l'Epiinfo.7. Le test de khi2 était utilisé pour comparer les fréquences avec une valeur de p ≤ 0,05 considérée comme significative. RÉSULTATS: Le nombre de dossiers analysés était de 269. L'âge moyen était de 28,46 ± 6,702. Les événements morbides per opératoires fréquents étaient cardio-vasculaires. Le taux de létalité était de 5,2 %. La cause la plus fréquente des décès était l'éclampsie. Les facteurs de morbi-mortalités retrouvés ont été la césarienne itérative, le contexte urgent de la césarienne. Les parturientes évacuées avaient présenté une complication dans 37,3% des cas. CONCLUSION: La césarienne est un acte qui n'est pas suffisamment sûr dans notre structure. Les facteurs de mobi-mortalité sont nombreux.

Effects of climatological parameters in modeling and forecasting seasonal influenza transmission in Abidjan, Cote d'Ivoire.

BACKGROUND: In temperate regions, influenza epidemics occur in the winter and correlate with certain climatological parameters. In African tropical regions, the effects of climatological parameters on influenza epidemics are not well defined. This study aims to identify and model the effects of climatological parameters on seasonal influenza activity in Abidjan, Cote d'Ivoire. METHODS: We studied the effects of weekly rainfall, humidity, and temperature on laboratory-confirmed influenza cases in Abidjan from 2007 to 2010. We used the Box-Jenkins method with the autoregressive integrated moving average (ARIMA) process to create models using data from 2007-2010 and to assess the predictive value of best model on data from 2011 to 2012. RESULTS: The weekly number of influenza cases showed significant cross-correlation with certain prior weeks for both rainfall, and relative humidity. The best fitting multivariate model (ARIMAX (2,0,0) _RF) included the number of influenza cases during 1-week and 2-weeks prior, and the rainfall during the current week and 5-weeks prior. The performance of this model showed an increase of >3 % for Akaike Information Criterion (AIC) and 2.5 % for Bayesian Information Criterion (BIC) compared to the reference univariate ARIMA (2,0,0). The prediction of the weekly number of influenza cases during 2011-2012 with the best fitting multivariate model (ARIMAX (2,0,0) _RF), showed that the observed values were within the 95 % confidence interval of the predicted values during 97 of 104 weeks. CONCLUSION: Including rainfall increases the performances of fitted and predicted models. The timing of influenza in Abidjan can be partially explained by rainfall influence, in a setting with little change in temperature throughout the year. These findings can help clinicians to anticipate influenza cases during the rainy season by implementing preventive measures.

Oncogenic Human Papillomavirus Infection and Genotype Characterization among Women in Orodara, Western Burkina Faso.

BACKGROUND AND OBJECTIVE: Cervical cancer usually occurs several years after persistent infection with oncogenic or high-risk human papillomavirus. The objective of this study was to determine carriage of 14 genotypes of high-risk human papillomavirus among women at Orodara and then characterize the genotypes found in these women. MATERIALS AND METHODS: From June to July 2015, 120 women from the general population were recruited in the health district of Orodara. They voluntarily agreed to participate in the study. Endocervical samples were taken from these women prior to screening for precancerous lesions by visual inspection with acetic acid and lugol's iodine. Identification of high-risk human papillomavirus genotype was done using real-time PCR. RESULTS: High-risk human papillomavirus prevalence was 38.3% and the most common genotypes were HPV 52 (25.4%), HPV 33 (20.6%) and HPV 59 (11.1%). The HPV 66 was also identified with a prevalence of 9.5%. CONCLUSION: The HPV 16 and HPV 18 which are frequently associated with cancer worldwide were not found among the most frequent oncogenic HPV in women in Orodara.

Bridgehead invasion of a monomorphic plant pathogenic bacterium: Xanthomonas citri pv. citri, an emerging citrus pathogen in Mali and Burkina Faso.

Molecular epidemiology studies further our understanding of migrations of phytopathogenic bacteria, the major determining factor in their emergence. Asiatic citrus canker, caused by Xanthomonas citri pv. citri, was recently reported in Mali and Burkina Faso, a region remote from other contaminated areas. To identify the origin and pathways of these emergences, we used two sets of markers, minisatellites and microsatellites, for investigating different evolutionary scales. Minisatellite typing suggested the introduction of two groups of strains in Mali (DAPC 1 and DAPC 2), consistent with microsatellite typing. DAPC 2 was restricted to Bamako district, whereas DAPC 1 strains were found much more invasive. The latter strains formed a major clonal complex based on microsatellite data with the primary and secondary founders detected in commercial citrus nurseries and orchards. This suggests that human activities played a major role in the spread of DAPC 1 strains via the movement of contaminated propagative material, further supported by the frequent lack of differentiation between populations from geographically distant nurseries and orchards. Approximate Bayesian Computation analyses supported the hypothesis that strains from Burkina Faso resulted from a bridgehead invasion from Mali. Multi-locus variable number of tandem repeat analysis and Approximate Bayesian Computation are useful for understanding invasion routes and pathways of monomorphic bacterial pathogens.

[Problem of the referral-for-referral system of obstetrical emergencies and the community involvement in the Bamako district]. / Problematique du systeme de reference-contre-reference des urgences obstetricales et l'implication des communautes dans le district de Bamako.

AIMS: This study aims to evaluate the difficulties of the referral-for-referral system in the V municipality sanitary district of Bamako. PATIENTS AND METHOD: A descriptive cross-sectional study was carried out from 5th September to 5th November 2011 in the sanitary district of the V municipality in Bamako. Included in the study were patients referred or evacuated for obstetrical care in the health center during the period of study. Not included were the patients referred or evacuated from other sanitary districts and patients referred or evacuated or self-referred for no obstetrical reasons. Data was recorded on the Excel 8.0 software and analyzed on the software packages Epi info 3.5.3 and STATA. RESULTS: During the period of study we recorded 1824 deliveries among which 180 fit the inclusion criteria. During our study 92.2% of references were adequate; 78.3% were justified and 72.2% were opportune. Only the sanitary district of the V Municipality had paid its quotation due at the time of the study. CONCLUSION: Our study showed that inadequate logistics and the lack of involvement of communities hamper the proper functioning of the referral system.

BUT: Cette étude a pour but d'évaluer les difficultés du système de référence contre-référence dans le district sanitaire de la Commune V de Bamako. PATIENTS ET MÉTHODES: C'est une étude transversale descriptive du 05 septembre au 05 novembre 2011dans le district sanitaire de la Commune V de Bamako. Ont été incluses les patientes référées ou évacuées pour des soins obstétricaux pendant la période d'étude. N'ont pas été inclues les patientes venant d'autres aires et structures de santé ou venues d'elles-mêmes. La saisie des données a été effectuée sur Excel 8.0 puis analysées sur les logiciels Epi info3.5.3 et STATA. RÉSULTATS: Durant la période d'étude nous avons enregistré 1824 cas d'accouchements parmi lesquelles 180 répondaient aux critères d'inclusion. Au cours de notre étude 92,2% des références étaient adéquates ; 78,3 % étaient justifiées et 72,2 % étaient opportunes. Par ailleurs seul le centre de référence de la commune V avait payé sa quote-part pendant la période de l'étude. CONCLUSION: Notre étude a montré que l'insuffisance des moyens logistiques et la non implication des communautés handicapent le fonctionnement du système de référence dans la commune V du District de Bamako.

[Reduction Of Maternal And Neonatal Mortality Due To Free Caesarean In Segou's Nianankoro Fomba Hospital In Mali]. / Reduction De La Mortalite Maternelle Et Neonatale Par La Gratuite De La Cesarienne A L'Hopital Nianankoro Fomba De Segou Au Mali.

INTRODUCTION: Emergency obstetrical treatment influences maternal and neonatal mortality and so the government of the republic of Mali decided on June 23, 2005 to establish a free caesarean policy in public health establishments. After 3 years and half, we evaluated the impact of the policy on maternal and neonatal mortality. METHOD: A comparative transversal study was conducted. The data of women who had a caesarean performed in the Segou regional hospital covering the span of 5 years (18 months before the policy and 42 following the new law) was collected. The data was analyzed using the Info 6.4 software. We employed a Pearson's Chi-2 with significance set at p<0.05. RESULTS: Frequency of the caesarean increased following the policy to 25.48 % in 2008 versus 9.33 % in 2004 (p=0.0067). Maternal mortality rate was improved: 3.85 % in 2004 versus 0.23 % in 2008. The rate of neonatal mortality in the same period dropped from 25.39 % to 9.36 % (p=0.021). CONCLUSION: It is noted that the free caesarean policy enabled an increase in the number of caesareans performed and a significant reduction in maternal and neonatal mortality rates.

INTRODUCTION: La prise en charge rapide des urgences obstétricales influence le pronostic maternel et fœtal. C'est pourquoi le Gouvernement de la République du Mali a décidé le 23 juin 2005 d'instaurer la gratuité de la césarienne dans les établissements sanitaires publics. Après une période de 3 ans et demi, nous avons évalué l'impact de la césarienne gratuite sur la mortalité maternelle et néonatale. MÉTHODE: Il s'agissait d'une étude transversale comparative portant sur les femmes chez qui une césarienne a été réalisée dans le service. Les données de l'admission à la sortie de l'hôpital ont été collectées.L'étude s'est déroulée à l'hôpital régional de Ségou du 1er Janvier 2004 au 31 Décembre 2008 soit 18 mois avant la gratuité et 42 mois courant la gratuité. Il s'agit d'un hôpital de deuxième référence qui reçoit les évacuations des centres de 1er et de 2ème niveau relevant de sa circonscription. Les données ont été saisies et analysées sur le logiciel Epi info 6.4. Le test statistique utilisé est le Chi-2 de Pearson et le seuil de significativité est fixé à p< 0,05. RÉSULTATS: La fréquence de la césarienne était de 25,48% en 2008 versus 9,33% en 2004 (p= 0,0067). Le taux de mortalité maternelle était passé de 3,85% en 2004 à 0,23% en 2008, tandis que celui de mortinaissance était passé de 25,39% à 9,36%(p= 0,021). Quant au taux de mortalité néonatale, il était de 2,05% en 2008 versus 13,23% en 2004, 9,68% du 1er janvier au 23 Juin 2005 ; 5,98% durant le reste de l'année 2005, 2,26% en 2006 et 2,32% en 2007. CONCLUSION: Au terme de notre étude, nous avons constaté que la gratuité de césarienne a permis non seulement d'augmenter le nombre total de césarienne, mais aussi d'améliorer significativement le pronostic maternel et néonatal.

First Report in Mali of Xanthomonas citri pv. mangiferaeindicae Causing Mango Bacterial Canker on Mangifera indica.

Bacterial canker (or black spot) of mango caused by Xanthomonas citri pv. mangiferaeindicae is an important disease in tropical and subtropical areas (1). X. citri pv. mangiferaeindicae can cause severe infection in a wide range of mango cultivars and induces raised, angular, black leaf lesions, sometimes with a chlorotic halo. Severe leaf infection may result in abscission. Fruit symptoms appear as small, water-soaked spots on the lenticels that later become star shaped, erumpent, and exude an infectious gum. Often, a "tear stain" infection pattern is observed on the fruit. Severe fruit infections cause premature drop. Twig cankers are potential sources of inoculum and weaken branch resistance to winds. Yield loss up to 85% has been reported at grove scale for susceptible cultivars (1). Suspected leaf lesions of bacterial canker were collected in July 2010 from mango trees in four, six, and three localities of the Koulikoro, Sikasso, and Bougouni provinces of Mali, respectively (i.e., the major mango-growing areas in this country). Nonpigmented Xanthomonas-like colonies were isolated on KC semiselective medium (3). Twenty-two strains from Mali were identified as X. citri pv. mangiferaeindicae based on IS1595-ligation-mediated PCR (4) and they produced fingerprints fully identical to that of strains isolated from Ghana and Burkina Faso. Five Malian strains (LH409, LH410, LH414, LH415-3, and LH418) were compared by multilocus sequence analysis (MLSA) to the type strain of X. citri and the pathotype strain of several X. citri pathovars, including pvs. anacardii and mangiferaeindicae. This assay targeted the atpD, dnaK, efp, and gyrB genes, as described previously (2). Nucleotide sequences were 100% identical to those of the pathotype strain of X. citri pv. mangiferaeindicae whatever the gene assayed, but differed from any other assayed X. citri pathovar. Leaves of mango cv. Maison Rouge from the youngest vegetative flush were infiltrated (10 inoculation sites per leaf for three replicate leaves on different plants per bacterial strain) with the same five strains from Mali. Bacterial suspensions (~1 × 105 CFU/ml) were prepared in 10 mM Tris buffer (pH 7.2) from 16-h-old cultures on YPGA (7 g of yeast, 7 g of peptone, 7 g of glucose, and 18 g of agar/liter, pH 7.2). The negative control treatment consisted of three leaves infiltrated with sterile Tris buffer (10 sites per leaf). Plants were incubated in a growth chamber at 30 ± 1°C by day and 26 ± 1°C by night (12-h/12-h day/night cycle) at 80 ± 5% relative humidity. All leaves inoculated with the Malian strains showed typical symptoms of bacterial canker a week after inoculation. No lesions were recorded from the negative controls. One month after inoculation, mean X. citri pv. mangiferaeindicae population sizes ranging from 5 × 106 to 1 × 107 CFU/lesion were recovered from leaf lesions, typical of a compatible interaction (1). To our knowledge, this is the first report of the disease in Mali. Investigations from local growers suggest that the disease may have been present for some years in Mali but likely less than a decade. A high disease incidence and severity were observed, suggesting the suitability of environmental conditions in this region for the development of mango bacterial canker. References: (1) N. Ah-You et al. Phytopathology 97:1568, 2007. (2) L. Bui Thi Ngoc et al. Int. J. Syst. Evol. Microbiol. 60:515, 2010. (3) O. Pruvost et al. J. Appl. Microbiol. 99:803, 2005. (4) O. Pruvost et al. Phytopathology 101:887, 2011.