[Study of the factors associated with the delay of health consultation of victims of rape in Senegal]. / Étude des facteurs associés au retard de consultation sanitaire des victimes de viols au Sénégal.

INTRODUCTION: Rape remains one of the most serious forms of sexual violence because of its negative impact on the physical and mental health of victims. The objective of this study is to identify the factors associated with the delay in rape victims seeking medical assistance from healthcare professionals in Senegal. METHODOLOGY: A retrospective, descriptive and analytical observation study was conducted. The study population consisted of all the court files of girls or women victims of rape recorded by the investigators at the 11 high courts of Senegal during the period from 2006 to 2015. An exhaustive recruitment of the full records of rape victims meeting the inclusion criteria were completed. The uni and multivariate analyses were carried out with Epi Info 2000 and R 2.2.9 software respectively. RESULTS: At the end of the collection, 1,037 cases of rape were included in the study population. The average age of the victims was 16.3±7.9 years (range 1-72). Minors (<18 years) accounted for 24.8 %. The median time from rape to consultation at a health facility was 24hours. Long delay in consultation (>24hours) was noted for 38.6 % of victims. Risk of late consultation after rape was higher among victims residing in the southern areas (ORaj=4.31 [1.15-16.14]), or northern areas (ORaj=4.22 [1.26-14.14]), who were major (ORaj=1.67 [1.04-2.68]) or married (ORaj=3.44 [1.58-7.5]) or who were pregnant after the aggression (ORaj=34.03 [15.47-74.85]) or had an abortion (ORaj=5.45 [1.04-24.47]). CONCLUSION: Medical and judicial assistance are more difficult if there is a long delay between the aggression and consultation. Thus, it is important for the health and judicial authorities to raise awareness about the harmful consequences of sexual violence, and to put forward the benefits of therapeutic care, compensation for the harm suffered by rape victims, as well as the availability of holistic care services 24hours a day.

Simulation training for emergency obstetric and neonatal care in Senegal preliminary results.

To describe a new training approach for emergency obstetric and neonatal care (EmONC) introduced in Senegal to strengthen the skills of healthcare providers. The approach was based on skills training according to the so-called "humanist" method and on "lifesaving skills". Simulated practice took place in the classroom through 13 clinical stations summarizing the clinical skills needed for EmONC. Evaluation took place in all phases, and the results were recorded in a database to document the progress of each learner. This approach was used to train 432 providers in 10 months and to document the increase in each participants' technical achievements. The combination of training with the "learning by doing" model ensured that providers learned and mastered all EmONC skills and reduced the missed learning opportunities observed in former EmONC training sessions. Assessing the impact of training on EmONC indicators and introducing this learning modality in basic training are the two major challenges we currently face.

La problematique des parturientes evacuees en zone rurale senegalaise : exemple du centre hospitalier de Ndioum

Objectifs : Decrire les difficultes rencontrees par les parturientes evacuees dans une zone rurale au Senegal. Methodologie : Etude prospective sur une periode de 12 mois allant de janvier a decembre 2011. Toutes les patientes evacuees vers la maternite. Resultats :La frequence des evacuations obstetricales etait de 31;2. Le nombre moyen de consultation prenatale etait de deux. Une femme sur 3 avait effectue plus de 4CPN (33;3). La grossesse etait a terme dans 83;6 des cas. La distance parcourue etait en moyenne de 48 Km avec des extremes de 1 a 200 km. L'evacuation etait faite au moyen d'une ambulance dans 69 des cas et celle-ci etait accompagnee par un prestataire non qualifie dans 92;7 des cas. La patiente etait vivante bien portante dans 98 des cas. L'enfant etait ne vivant bien portant dans 75;4. La duree de sejour moyenne etait de 2;6 jours avec des extremes de 1 et 12 jours. La contre-reference etait effectuee dans 97;3 des cas. Conclusion : Les resultats de notre etude nous permettent de confirmer malgre les ressources limitees; il est possible de prendre en charge et de reduire la morbidite et la mortalite des patientes evacuees. En effet nous preconisons de mettre en place un systeme de SAMU obstetrical en zone rurale afin de contribuer a la regulation des evacuations obstetricales; mais surtout de permettre aux patientes a faible revenu d'acceder au service

[Monitoring pregnancy of women with a previous cesarean delivery: qualitative aspects and prognostic implications]. / Suivi des grossesses sur utérus cicatriciel : aspects qualitatifs et implications pronostiques.

OBJECTIVES: To assess the quality of prenatal monitoring of pregnant women with a previous cesarean delivery and determine the maternal and neonatal prognosis in an African setting. PATIENTS AND METHODS: This prospective, descriptive, and analytical study took place at Roi Baudouin Health Center in Dakar (Senegal) and examined the records of women giving birth from November 1, 2009 to August 31, 2010. It included all women admitted for delivery at 22 weeks of gestation or more, with at least one previous cesarean, and a prenatal consultation record booklet. Women with uterine scars from a gynecological intervention were excluded. The study included a qualitative analysis of the record booklets and an interview of patients. RESULTS: Women with previous cesareans accounted for 12.5% of all women giving birth during the study period. The average age of the women in our study was 28 years, their mean parity was 3, and their mean number of prenatal examinations 3 (range: 1 to 5). Most prenatal care was provided by midwives (95.1%). The clinical characteristics were rarely completed. Not all women had undergone the laboratory tests required, and fewer than half (40.7%) had had a third-trimester ultrasound. In all, 109 (28.1%) had been referred to the hospital as an appropriate structure for their delivery. Complications of labor were observed in 28.3% of the cases. In 73% of these cases, women had repeat cesareans; 26% had vaginal deliveries. The performance of the recommended prenatal check-up was significantly correlated to how early prenatal care began (p = 0.001) and the level of the structure providing prenatal care (p = 0.027). CONCLUSION: Reducing maternal and fetal morbidity and mortality due to uterine scars requires that women be made aware of the relevant issues and that healthcare providers refer them appropriately and early.

Gestational trophoblastic neoplasia after achieving a nondetectable serum human chorionic gonadotrophin level.

OBJECTIVE: To determine the risk of recurrent trophoblastic disease after normalisation of human chorionic gonadotrophin (hCG) levels in women with hydatidiform mole. DESIGN: A retrospective review of data from a national gestational trophoblastic disease centre. SETTING: The Trophoblastic Disease Unit, Dakar, Senegal. SAMPLE: Women with pregnancies affected by hydatidiform mole registered between 2006 and 2012. METHODS: The women were followed up in accordance with the hospital protocol 'Score de Dakar'. For women who progressed to gestational trophoblastic neoplasia (GTN) the time to onset of GTN, treatment and evolution were evaluated. The rate of evolution to GTN after normalisation of hCG was determined. MAIN OUTCOME MEASURES: Rate of occurrence of GTN after chemotherapy for hydatidiform mole. RESULTS: Five hundred and thirty-one women were diagnosed to have molar pregnancies. According to the hospital's protocol, 107 (20.2%) of these had chemotherapy and 224 (42.2%) had prophylactic chemotherapy. Five hundred and thirteen women (96.4%; 95% confidence interval [95% CI] 95.05-98.14%) achieved remission. Eighteen women (3.4%; 95% CI 1.86-4.94%) developed GTN (11 before remission and seven after remission). Seven women out of the 18 developed GTN after hCG normalisation (1.3%). Five of these seven were diagnosed beyond the recommended period of follow up. The mean interval to diagnosis of GTN was 18.7 months. These seven women underwent combination chemotherapy: five achieved complete remission whereas two died from GTN. CONCLUSIONS: Cytotoxic therapy for hydatidiform mole does not prevent GTN, it delays its diagnosis and promotes GTN after normalisation of hCG.

[Surgical treatment of clitoral cysts complicating female genital mutilation]. / Traitement chirurgical des kystes clitoridiens compliquant des mutilations génitales féminines.

We report the surgical management of eight vulvar tumors occurred at the waning of female genital mutilation practiced in childhood. Patients were aged 19 to 38 years. It was essentially excision type 2. Surgical excision of the labia minora with a refund without clitoral plasty gave satisfactory aesthetic and functional results. Histological examination of these tumors showed a single cyst containing keratin without inflammatory reaction.

[Consequences of hysterectomy at the national- hospital of Pikine in Dakar]. / Conséquences de l'hystérectomie àu centre hospitalier national de Pikine a Dakar.

BACKGROUND: Despite the frequency of hysterectomy, several studies have reported physical and psychological sequelae of this intervention. BUT: To evaluate the consequences of hysterectomy, their level of importance and how patients experience hysterectomy. METHODS: That is a prospective study of 70 patients who underwent a hysterectomy from January 2009 to June 2011 at Pikine National Hospital. The experience of hysterectomy was determined by the physical and psychosocial felt after surgery. RESULTS: Hysterectomy represented 5.9 % of gynecological surgical activities. The indications were dominated by myoma (57.1%). Hysterectomy was performed abdominally in 78.6% of cases and associated with bilateral salpingo-oophorectomy in 87% of cases. After surgery, new symptoms appeared: hot flushes, night sweats, urinary incontinence and urge incontinence in respectively 65.7%, 54.3%, 7.1% and 11.4% of patients. A proportion of 45.6% of them had resumed sexual activity after 90 days. The fear of pain at the time of intercourse was expressed in 55.7% of cases. A decrease in the frequency of sexual intercourse was found in 54.3% of patients. A drop of pleasure during sex was expressed in 38.6% of patients. Psychological effects were also reported by patients: decreased confidence in 31.4% of patients, feeling of being rejected by her husband in 5.7% of cases, sensation of mutilation in 24.3% of cases. CONCLUSION: Physical and psychological postoperative impacts of hysterectomy are real. Adequate accompanying measures are necessary, in addition to preoperative preparation, to allow patients to improve the experience of hysterectomy.

[Trancesarean intra-uterine device. Pilot study performed at Dakar teaching hospital]. / Dispositif intra-utérin mis en place en cours de césarienne. Étude pilote réalisée au centre hospitalier universitaire de Dakar.

OBJECTIVES: To demonstrate the feasibility of copper IUD insertion following cesarean deliveries and assess its safety. PATIENTS AND METHODS: This is a prospective pilot study at Pikine national hospital from February 15 to November 15, 2012. Were evaluated the efficacy, incidence and spectrum of complications and continuation rates. RESULTS: Fifty-nine subjects were enrolled and 46 received an IUD. The average age of patients was 28 years. No patient had previously used IUDs. Forty-four patients (97.5%) were returned to the first follow-up visit at the first month, 41 patients (89.1%) at the second visit and 39 patients (86.9%) at the third visit. The rate of lost sight was 8.7%. Pain and bleeding were reported rarely: 2.3% at the first month, 4.9% at the third month and 7.7% at the sixth month for the bleeding and 6.8% at the first month, 2.4% at the third month and 2% at the sixth month for pain. The rate of expulsion was 2.2%. CONCLUSION: The insertion of the IUD following cesarean delivery has an acceptable rate of expulsion and no increased rate of adverse effects. This technique should be popularized.

[Intussusception in children: about 20 cases]. / Invagination intestinale de l'enfant a propos de 20 cas.

The authors report on a retrospective study 20 cases of intussusception in senegalese children. The diagnosis is essentially clinical. In difficult cases plane abdominal X-rays, barium meal and echography are indispensable exams. In our context the diagnosis is most of the time late and it is due to the unknown nature of the affection and early consultation to the traditional practitionners. The lateness of the diagnosis leads to the lateness of the management. This explains the importance of intestinal necrosis noticed in our serie and the high mortality rate which is 10%. The authors suggest recommendations to ameliorate the prognosis of this ailment which is good elsewhere.

[Burn-induced contraction cicatrix in children. Review of 79 cases]. / Les cicatrices rétractiles de la main brûlée chez l'enfant. Une revue de 79 cas.

Post-burn flexion contractures of the hands are evaluated in this retrospective study concerning eighty-six hands of seventy-nine children in the pediatric surgery unit of the University hospital of Dakar from 1971 to 1995. A peak frequency was found among 2-months-old males. Fire (flames or embers) is the most frequent etiology (49.5%). The initial treatment of these burns is more often inadequate because it is performed in dispensaries (small clinics) or at home and then causes severe sequelae. Among the methods of treatment, excision with graft gives the best results in short flexion contractures. Isolated Z plasty can be used successfully. Our follow-up is short (6 months) but the results are relatively good. Among the factors influencing the results, the seriousness of the lesions, the type of surgical treatment, immobilization and physiotherapy are the most significant.