[Morbidity and mortality related to obstetrical transfers in the Bouafle health district of Ivory Coast]. / Morbidité et mortalité liées aux transferts obstétricaux dans le district sanitaire de Bouaflé en Côte d'Ivoire.

During one year of observation, the reference hospital of the sanitary district Bouaflé received 112 women evacuated by peripheral structures. 90.2% of the average women who were 25.8 +/- 7.4 years old had been evacuated before their delivery. Their evacuation was mainly due to dystocia (56.2% of cases) post partum haemorrhage (5.4%) and amniotic infection (4.5%). The reasons of the evacuation did not correspond to the admission diagnosis in 45.5% of the case (51/112). The differences that could be observed concerned dystocia and ruptures of the uterus of which 2 cases out of 9 had been diagnosed before their evacuation. During the study, it was noticed the deaths of 4 mothers and 55 babies. These deaths registered most among the evacuees having used public transportation, having received less than 3 prenatal consultations, multiparous (Chi 2 = 10.32; p = 0.04) and having run more than 30 kilometers.

Haematological characteristics and HIV status of pregnant women in Abidjan, Côte d'Ivoire, 1995-96.

To describe the haematological profile of pregnant women and to compare these characteristics according to HIV serostatus in Abidjan, Côte d'Ivoire, a cross-sectional study was made in the context of a research intervention programme to reduce mother-to-child transmission (MTCT) of HIV (ANRS 049 trial). HIV testing was systematically proposed to pregnant women attending the mother and child health clinic of a community health centre. Blood samples were tested for HIV antibodies using Genelavia and Peptilav. The haematological parameters were measured with a Coulter counter. From May 1995 to March 1996, 1646 pregnant women accepted HIV testing and had a full blood count available. The prevalence of HIV infection was 12.0% (n = 197). The prevalence of anaemia (haemoglobin [Hb] < 11 g/dL) was 70.1%, n = 1155 (95% confidence interval 68-72%) and significantly higher in HIV+ (81.7%, n = 161) than in HIV- women (68.9%, n = 994) (P < 0.001). Severe anaemia (Hb < 7 g/dL) was present in 1.9% of the women (n = 31), 4.6% (n = 9) in HIV+ and 1.5% (n = 22) in HIV- women (P < 0.001). HIV infection, primigravidae and secundigravidae were factors independently associated with anaemia. Anaemia was highly prevalent in this population while severe anaemia was rare. HIV infection was a contributor to anaemia in pregnancy. As zidovudine, with its known haematological toxicity, has recently been introduced to prevent MTCT of HIV in developing countries, screening HIV+ women for severe anaemia is necessary.

[Towards a lower maternity risk]. / Pour une maternite a moindre risque

PIP: Pregnant women delivering in Sub-Saharan Africa (SSA) are dying from causes that are related to poverty rather than to ignorance: 1) hemorrhages; 2) infections due to the lack of sanitary conditions; 3) toxemia; 4) anemia resulting from malnutrition, intestinal parasites and malaria; and 5) too many pregnancies that are too closely spaced. Additional institutional problems are the lack of adequate health facilities, especially for maternity; the lack of personnel and services in the rural areas, and when they do exist, underutilization because of the of lack equipment, supplies and drugs, burdening the patient with such purchases. Pregnant women do not get prenatal care because health personnel are badly trained, they do not speak local languages nor know the local customs and their training is inadequate to provide crisis- intervention. The situation in the urban areas is somewhat better, with more than 2/3 of pregnant women getting prenatal care and delivering in maternity hospitals. However, the logistical problems are growing with up to 50 patients delivering per day, coupled with an insufficient number of badly trained health personnel and the unacceptable sanitary conditions in the hospitals. This situation had let to the inability of staff to diagnose and survey patients with pregnancy complications, the lack of professional assistance during deliveries, the lack of adequate health facilities and equipment to treat emergencies and the lack of ambulances to transport critical patients. The solutions require building maternity centers that are decentralized (near to people's homes in the villages) and near to hospitals; training traditional birth attendants in public health practices that are also practical for their own environments; increasing prenatal care in health centers and through home visits and providing post-partum follow-up visits that include family planning.^ieng