[Mortality of neonatal surgical emergencies at the Gynecology-Obstetric and Pediatric hospital of Yaounde, Cameroon]. / Mortalité des urgences chirurgicales néonatates à l'hôpital gynéco-obstétrique et pédiatrique de Yaoundé, Cameroun.

From July 2005 to November 2009, 38 neonates with surgical emergencies died in the neonatal unit of the Gyneco Obstetric and Pediatric Hospital Yaounde. The mortality rate of these emergencies was 43.1%, and those within the age group of 1 to 7 days were the most affected with a sex ratio of 1.2. The mean delay before consultation was 3.7 days. Half of the neonates had a birth weight of less than 2,500 g and 7 cases (18.4%) were premature. A medicalised ambulance was used for transfer to our unit in only half of the neonates. The main disorders were those affecting the digestive tract in 42.1% of our series. In 50% of our cases, there were associated malformations and 28 cases (73.7%) did not undergo surgery. Malnutrition and infection were the main complications in 60% of the cases. The authors discuss this deplorable situation and suggest recommendations for improvement.

[Results of the first three years of operation of the emergency medical assistance service (SAMU) in Yaounde, Cameroon]. / Bilan des trois premieres années d'activités du SAMU de Yaoundé (Cameroun).

PURPOSE: The purpose of this article is to present the results of a descriptive and retrospective study of the operations of the emergency medical assistance service (SAMU) in Yaounde, Cameroon. METHODS: Medical regulation and intervention records and monthly statistics forms were analysed for the period going from the creation of the SAMU in 2004 to March 2007. Study was limited to call reception, medical regulation, and extra-hospital and training activities. Study focused on operations and services. RESULTS: The SAMU in Cameroon is managed by a pilot committee presided by the Minister of Public Health and headed by a technical executive secretary. The single phone number to contact SAMU Yaoundé is 19 (119). When a call comes, the personnel on duty in the regulation room identifies the caller and either gives a non-medical response or transfers the call to an on-call emergency doctor who decides whether or not on-site intervention is required. In the 3-year study period, the SAMU received 50,822 calls per year (mean, 1694 +/- 2195). There were 1 596 prank calls (3.14%), 31 044 (61.08%) calls requesting non-medical information, and 2054 (4.04%) calls requiring on-site intervention. The number of calls decreased by 23% from the first to third year of operation. The number of on site-interventions carried out by Yaoundé SAMU was 578 in the first year, 651 in the second and 825 in the third year. A total of 1555 interventions were carried out including 142 that ended in no action and 107 that ended in late arrival. Road traffic accidents were the main reason for intervention. Only one training session was organised for the personnel during the first year of operations. CONCLUSION: The SAMU Yaoundé is based on the French model (on-site care). The number of calls has dropped from the first to third year but the number of prank calls has also decreased. Road traffic accidents accounted for most of the on-site interventions. Further work is needed to increase public awareness of the importance of the SAMU and to provide training for SAMU personnel.

[Management Of Undescended Testis In Children In Yaounde. A Report On 71 Cases]. / Prise En Charge Du Testicule Non Descendu Chez L'Enfant A Yaounde: A Propos De 71 Cas.

OBJECTIVE: The aim of this work was to describe the epidemiological, diagnostic and therapeutic aspects of undescended testicle in the of Pediatric Surgery service of the Yaoundé gyneco-obstetric and pediatric hospital. METHOD: Our study was retrospective, descriptive and analytical from June 2008 to December 2016; a period of 8 years and 6 months. Included in this study were records of pediatric patients aged 0 - 15 years who had been managed for an undescended testis in the Pediatric Surgery service of the Yaoundé gyneco-obstetric and pediatric hospital and followed up at our outpatient clinic. Data recorded included age, term of pregnancy at birth, time to presentation, presenting complaint, symptoms, location of the testis, surgical approach and procedure, complications and follow up. Open orchidopexy according to Surraco was the standard operation carried out for all our patients, a scrotal doppler ultrasound was systematic 30 days after the surgery and the child was scheduled for follow-up visits at 3, 6, 9 and 12 months postoperatively. RESULTS: Seventy-one patients were managed during the study period, giving a hospital frequency of 10 cases per annum. The average age of our patients was 5.8 years [1 day and 15 years]. The mean time to consultation was 4.5 years [1 day and 15 years]. Most patients consulted for absence of the testis (n = 62). All patients were full term births. Clinically, the undescended testis was categorized as: cryptorchidism (n = 45), ectopia testis (n = 2), intra-abdominal testis (n = 24), retractile testis (n = 7), vanishing testis (n = 4). The position of the undescended testis was: inguinal (n = 64), pelvic (n = 2) and abdominal (n = 5). Single stage open orchidopexy according to Surraco using an incision in the lower inguinal crease was performed in 66 cases (93%). Laparoscopy was used in 7% of cases for location of non-palpable testis. With a mean follow-up of 3 months, testicular atrophy was found in 5.6% of cases in our series.

BUT: Le but de ce travail était de décrire les aspects épidémiologiques, diagnostiques et thérapeutiques du testicule non descendu dans le Service de Chirurgie Pédiatrique de l'hôpital gynéco-obstétrique et pédiatrique de Yaoundé (HGOPY). PATIENTS ET MÉTHODE: Notre étude a été rétrospective et descriptive de Juin 2008 à Décembre 2016; soit une période de 8 ans et 6 mois dans le Service de Chirurgie Pédiatrique de l'hôpital gynéco-obstétrique et pédiatrique de Yaoundé. Ont été inclus dans cette étude, les dossiers des patients pédiatriques d'âge 10 ­ 15 ans ayant présenté un testicule non descendu pris en charge à HGOPY et revus en consultation.Les paramètres étudiés étaient: âge, terme, délai de consultation, motif de consultation, tableau clinique, topographie du testicule, voie d'abord, geste réalisé, morbidité, recul. L'abaissement testiculaire selon Surraco avait été de mise chez tous nos patients, une échographie doppler scrotale était systématique à J 30 post opératoire et l'enfant était revu en consultation de contrôle à 3 mois, 6 mois, 9 mois et 12 mois. RÉSULTATS: Soixante-onze patients ont été colligés et traités pendant la période d'étude, soit une fréquence annuelle de 10 cas. L'âge moyen de nos patients était de 5,8 ans [1 jour et 15 ans]. Le délai moyen de consultation était de 4,5 ans [1 jour et 15 ans]. L'absence de testicule était le principal motif de consultation (n=62). Tous les patients étaient nés à terme. Les tableaux cliniques étaient les suivant: testicule cryptorchide (n=45), testicule ectopique (n=2), testicule intra-abdominal (n=24), testicule oscillant (n=7), testicule évanescent ou « vanishing testis ¼ (n=4). La topographie du testicule non descendu a été: inguinale (n=64), pelvienne (n=2), abdominal (n=5). La voie d'abord a été inguinale dans un pli abdominal inférieur dans 66 cas (93%) et coelioscopique dans 7% des cas. Les gestes réalisés ont été dominés par l'abaissement testiculaire avec orchidopexie. Avec un recul moyen de 3 mois l'atrophie testiculaire a représenté 5,6% de notre série.

[Are health care facilities in Cameroon compatible with rational management of emergency patients?]. / La carte sanitaire au Cameroun est-elle compatible avec une prise en charge rationnelle des urgences?

The aim of this month-long cross sectional study was to evaluate the preparedness of health care institutions in Cameroon to provide rational management of emergency patients. During January 2002 a survey was carried out to list all health care institutions offering emergency care services and to determine their other departments and available equipment and staff. A total of 144 institutions with emergency care facilities were found including 12 central reference hospitals and 123 district hospitals equipped to provide primary emergency care. In relation to a population of 15 million inhabitants, the ratio was one reference hospital for 104180 inhabitants and one district hospital for 100,000 inhabitants. None of the services involved in emergency management had facilities for emergency treatment on an outpatient basis. Regarding hospital-based services, an emergency ward was available at the 12 central reference hospitals for a ratio of one ward for 1,250,000 inhabitants. This ratio was 10 times higher than in France in 1994. Almost all major equipment and trained personnel for emergency care medicine were concentrated at the central reference hospitals but these resources were insufficient to organize round-the-clock services except at a single site. The findings of this survey indicate that the distribution of health care facilities in Cameroon was relatively adequate in relation to population density but that equipment and human resources were still insufficient to provide rational management of emergency patients.

[Emergency medical training: the future of emergency care in Africa?]. / Capacite de medecine d'urgence: avenir des urgences en Afrique?

The main goal of emergency medicine training is to teach the wide range of sciences and skills necessary to recognize and stabilize emergency situations. Emergency medicine training has proven highly effective in developed countries especially with regard to organization of survival medicine. This type of training is especially important in sub-Saharan Africa where there is a severe shortage of intensive care specialists and an almost total lack of other personnel qualified to manage life-threatening trauma and disease. Starting with the 1998 Nsam fire disaster in Yaounde, a number of situations have confirmed the seriously deficient state of resources for handling emergencies in Cameroon. In view of this situation a two-year study program in emergency medicine was proposed and introduced at the School of Medicine and Biomedical Sciences of the University of Yaounde I during the 2000/2001 academic year. The curriculum includes eight 40-hour didactic course modules and 800 hours of hands-on work in local hospitals and in France. Students undergo regular assessment of their scientific knowledge and practical competencies after each module. As additional prerequisites for the diploma, they must be certified in first aid and rescue and present a research paper. Despite the lack of faculty and teaching materials, this program is expected to increase the number of emergency medical care providers and improve access to high-quality emergency care services.

[Risk factors and prognosis of emergency cesarean delivery at the Yaoundé Women's and Children's Hospital, Cameroon]. / Facteurs de risque et pronostic des césariennes d'urgence à l'hôpital gynéco-obstétrique et pédiatrique de Yaoundé (Cameroun).

OBJECTIVE: To identify the risk factors for emergency cesarean deliveries and assess the effects of the emergency situation on maternal and fetal prognosis. METHODS: This retrospective cohort study compared emergency and elective cesarean deliveries performed at the Yaoundé Women's and Children's Hospital in Cameroon, analyzing socioeconomic variables, the indications for surgery, and complications for mother and child. RESULTS: Risk factors predisposing to emergency cesareans were: age <20 years, not having a salaried job, unmarried status, no university-level education, referral from other health facilities, primiparity, prenatal care in a health center or in a district hospital, prenatal care by a nurse, and preadmission rupture of membranes. Emergency cesareans increased the mothers risk of general anesthesia, unavailability of standard preoperative work-up during surgery, infection, and a longer hospital stay. Babies born by emergency cesarean delivery had a higher risk of admission to the neonatology unit, neonatal asphyxia, neonatal infection, preterm birth, and perinatal death. CONCLUSION: In our setting, lack of reproductive experience (primiparity), low socioeconomic level, poor prenatal care, and preadmission rupture of membranes were risk factors for emergency cesarean deliveries. The emergency situation exposes mother and child to a significant risk of morbidity and mortality.

Anthropometric measurements in a newborn population in west Africa: a reliable and simple tool for the identification of infants at risk for early postnatal morbidity.

The predictive value of anthropometric measurements in the identification of infants at risk for early postnatal morbidity was assessed in a cohort of 490 neonates born in Yaoundé, Cameroon. Mid-arm circumference (MAC), head circumference, weight, and length were measured within 6 hours of birth, and the gestational age, individual MAC/head circumference ratio, and individual ponderal index were calculated. A detailed questionnaire on gestational medical history was also obtained from the mothers. All infants were then closely monitored during the first 72 hours after delivery for the appearance of symptoms requiring medical intervention and treated accordingly. Low birth weight (LBW) was observed in 37.75%, prematurity in 25.5%, and small size for gestational age in 14.1% of the neonates. Gestational medical problems were reported by 44.3% of the mothers; malaria was the most frequent. Early postnatal morbidity was observed in 26% of the infants; infection (53%), respiratory distress (26%), hypoglycemia (26%), and convulsions (11.7%) accounted for most of the problems. The MAC correlated best of all variables with birth weight (r = 0.91); a value of less than or equal to 9.5 cm had a 93% sensitivity and a 90.5% specificity in the prediction of LBW. An MAC cutoff value of less than or equal to 9.5 cm was also the best of all variables in the prediction of early postnatal morbidity, and 85.2% sensitivity and 74.3% specificity were achieved. We conclude that in developing countries, where scales are not always available and the overburdened maternity wards cannot allow for medical surveillance of every infant, the MAC can be used in the estimation of birth weight. Moreover, an appropriately calculated cutoff value of MAC may serve as a reliable indicator of LBW and of infants at risk for early postnatal morbidity.