[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.

La granulomatose éosinophilique avec polyangéite à propos de deux cas Ouest-Africains

La granulomatose éosinophilique avec polyangéite (GEPA) ou syndrome de Churg-Strauss, est une vascularite rare décrite pour la première fois par Jacob Churg et Lotte Strauss en 1951. Elle est rencontrée le plus souvent chez l'adulte jeune et reste exceptionnelle chez les enfants. Le diagnostic de la GEPA associe un asthme grave, une hyperéosinophilie (sanguine et tissulaire) et la présence d'atteintes viscérales intéressant au moins deux organes extra pulmonaire. L'hyperéosinophilie associée peut faire évoquer des étiologies parasitaires en milieu tropical. Nous rapportons deux cas de GEPA dans un hôpital ouest-africain

[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, management and ethnobotanical investigation of hypertension in two Guinean urban districts.

ETHNOPHARMACOLOGICAL RELEVANCE: Hypertension is an important public health challenge in low- and middle-income countries, and in many African countries including Guinea medicinal plants are still widely used for its treatment. MATERIALS AND METHODS: The objective of this study was to determine the prevalence of hypertension in two Guinean urban districts (Pounthioun and Dowsare), to describe its management and to collect information on traditional herbal remedies. A total of 316 participants entered the study, 28.2% (89/316) men and 71.8% (227/316) women. Of these, 181 were from Dowsare (50 men and 131 women) and 135 from Pounthioun (39 men and 96 women). The mean age of subjects was 40.8 ±â€¯14.0 years (range18 - 88years), while the majority of subjects (63.3% or 200/316) were 45-74 years old. RESULTS: The overall prevalence of hypertension was 44.9% (142/316): 46.4% (84/181) from Dowsare and 43.0% (58/135) from Pounthioun. Ethnobotanical investigations among hypertensive patients led to the collection of 15 plant species, among which Hymenocardia acida leaves and Uapaca togoensis stem bark were the most cited. Phytochemical investigation of these two plant species led to the isolation and identification of isovitexin and isoorientin from H. acida, and betulinic acid and lupeol from U. togoensis. CONCLUSION: The presence of these constituents in Hymenocardia acida leaves and Uapaca togoensis stem bark may at least in part support their traditional use against hypertension in Guinea.

Ethnomedical and ethnobotanical investigations on the response capacities of Guinean traditional health practioners in the management of outbreaks of infectious diseases: The case of the Ebola virus epidemic.

ETHNOPHARMACOLOGICAL RELEVANCE: The recent outbreak of Ebola virus infections has mostly remained confined to the West African countries Guinea-Conakry, Sierra-Leone and Liberia. Due to intense national and international mobilizations, a significant reduction in Ebola virus transmission has been recorded. While international efforts focus on new vaccines, medicines and diagnostics, no coherent national or international approach exists to integrate the potential of the traditional health practitioners (THPs) in the management of infectious diseases epidemics. Nevertheless, the first contact of most of the Ebola infected patients is with the THPs since the symptoms are similar to those of common traditionally treated diseases or symptoms such as malaria, hemorrhagic syndrome, typhoid or other gastrointestinal diseases, fever and vomiting. MATERIALS AND METHODS: In an ethnomedical survey conducted in the 4 main Guinean regions contacts were established with a total of 113 THPs. The socio-demographic characteristics, the professional status and the traditional perception of Ebola Virus Disease (EVD) were recorded. RESULTS: The traditional treatment of the main symptoms was based on 47 vegetal recipes which were focused on the treatment of diarrhea (22 recipes), fever (22 recipes), vomiting (2 recipes), external antiseptic (2 recipes), hemorrhagic syndrome (2 recipes), convulsion and dysentery (one recipe each). An ethnobotanical survey led to the collection of 54 plant species from which 44 identified belonging to 26 families. The most represented families were Euphorbiaceae, Caesalpiniaceae and Rubiaceae. Literature data on the twelve most cited plant species tends to corroborate their traditional use and to highlight their pharmacological potential. CONCLUSIONS: It is worth to document all available knowledge on the traditional management of EVD-like symptoms in order to evaluate systematically the anti-Ebola potential of Guinean plant species.

Ethnobotanical survey on medicinal plants used by Guinean traditional healers in the treatment of malaria.

ETHNOPHARMACOLOGICAL RELEVANCE: The objective of the present study was to collect and document information on herbal remedies traditionally used for the treatment of malaria in Guinea. MATERIALS AND METHODS: The survey was carried out from May 2008 to September 2010 and targeted traditional medical practitioners and herbalists. The questionnaire and oral interviews were based on the standardized model which was prepared by the "Centre de Recherche et de Valorisation des Plantes Médicinales (CRVPM) - Dubréka". RESULTS AND DISCUSSION: A total of 258 people (141 males and 117 females) from which 150 traditional healers and 108 herbalists were interviewed. The age of informants ranged from 28 to 82 years old. 57% (149/258) of the interviewees were more than 50 years old. The respondents had good knowledge of the symptoms of malaria, and a fairly good understanding of the causes. One hundred thirteen plant species were recorded, out of which 109 were identified. They belonged to 84 genera and 46 families. The most frequently cited plants were Vismia guineensis, Parkia biglobosa, Nauclea latifolia, Harungana madagascariensis, Terminalia macroptera, Crossopteryx febrifuga, Terminalia albida, Annona senegalensis, and Nauclea pobeguinii. The leaves were most frequently used (80/113 species), followed by stem bark (38/113 species) and roots (4/113 species). The remedies were mostly prepared by decoction (111 species), followed by maceration (seven species). Only one species was prepared by infusion. CONCLUSION: The present study showed that traditional healers in Guinea have a consistent knowledge of antimalarial plants. Further research should be carried out to compare the anti-malarial activity of the different species, and to check if their use against malaria can be scientifically validated.

Scorpion envenoming in the north of Mali (West Africa): epidemiological, clinical and therapeutic aspects.

Scorpion envenomation remains a poorly known problem in sub-Saharan Africa, particularly in Mali, where the incidence is high in Northern area of the country (Sahara desert). We conducted a prospective study in two district health centers, Kidal and Tessalit (North-east of Mali), to describe the epidemiological, clinical and therapeutic features of scorpion stings. This study consisted of an exhaustive follow-up from admission to discharge of all patients stung by scorpions. Of a total of 282 cases recorded during one year, 207 (73.4%) occurred in Kidal, and the remaining 75 (26.6%) took place in Tessalit. The annual incidence was significantly higher in Tessalit (437 cases/100,000 population/year) than in Kidal (243 cases/100,000 population/year) (p < 10⁻6). Two hundred two (71.6%) stings occurred inside human dwellings, 142 (50.4%) during sleeping/resting, especially in August. One hundred ninety-one (67.7%) were on the lower extremities. Nocturnal stings, 168 (59.6%), occurred more often than diurnal stings, 114 (40.4%). Most patients, 163 (57.8%), were admitted less than 1 h after being stung. Local pain at the sting site was the common primary complaint. However, moderate and severe clinical signs were significantly higher in children than in adults (p < 0.05). The death rate (3.9%) was higher in children (3.5%) than in adults (0.3%) (p = 8.10⁻6; RR = 0.90 [IC: 0.84-0.06]). Of the 22 scorpion species identified, 13 (59.1%) were Leiurus quinquestriiatus, 8 (36.4%) were Androctonus amoreuxi, and 1 (4.5%) specimen was Buthiscus bicalcaratus. From these species, L. quinquestriiatus and A. amoreuxi were responsible of stings. The medical treatment was only symptomatic, and one hundred twenty-eight (45.3%) patients received traditional remedies before seeking medical attention. Our findings suggest that scorpion stings are common in the north of Mali and are a significant threat to human health.

[Morbidity and mortality in the pediatric service at Gabriel Toure's University Hospital in Mali]. / Morbidite et Mortalite dans le Service de Pediatrie du Chu Gabriel Toure au Mali.

The aim of this work was to study morbidity and mortality before implementing the setting up of the pediatric service of Bamako. Involved in the study were all the children hospitalized during 12 months that is a total of 2000 cases among which 57.3% boys and 42.8% girls. Our study indicated that only 25% of children (509/2000) were referred. The most encountered pathologies were : malaria 898 (44.9%), ARI 528 (26.4%), diarrhea 224 (11.2%), malnutrition 269 (13.4%) and anemia 239 (11.9%). Mortality rate in hospital was 7.1 % and the main causes of deaths were : malaria (23.9% of death cases), diarrhea (20.4%) and malnutrition (31.7%). Thus we have recorded 8.3% of deaths for a period of resort beyond 3 days, compare to 3.3 % for a resort of less than 24 hours. (x² = 8.10, p= 0.017 ). The pediatric service operated as a center for first contact. In the framework of the establishment of this project, organizational efforts should allow to receive only referred cases.

[Knowledge, attitudes, and practices of adolescents in an urban school environment in Bamako, Mali, around family planning, sexually transmitted infections, and AIDS]. / Connaissances et pratiques des eleves d'un lycee de Bamako en matiere de contraception et prevention des ist.

We undertook a study amongst adolescents from Mabile High School in Bamako, Mali. The goal of the study was to determine the knowledge, attitudes and practices of high school students around STI/AIDS and family planning. It was a transversal study using a stratified sampling method. A total of 322 students between ten and 19 years of age were included in the study (191 boys, 131 girls) This study demonstrates that high school students do not often family planning services (only 13.4% of those who knew of the existence of such used them). The method of contraception most often used is still the condom (92.5%). HIV is the most well know STI (97.5%) followed by gonorrhea (45%). An absence of communication between adolescents and their parents around family planning and STI/AIDS was apparent in that information was most often received on these topics through the media (96.3% for family planning, 97.5% for AIDS) followed by friends (72.4% for family planning and 81.7% for AIDS). 59.3% of the students are sexually active. Of sexually active students, 41.3% have had sexual relations with a casual partner and 75.9% with at last two partners. Given their high number of partners and a lack of systematic condom usage, it is apparent that sexually active high school students practice high risk sexual behaviors. It is therefore crucial to develop methods to lead to an improvement in behaviors amongst adolescents.

Les appendicites aigues de l'enfant a l'Hopital Gabriel Toure: a propos de 20 cas

L'appendicite aigue est une pathologie d'urgence chirurgicale assez frequente chez l'enfant qui pose un probleme de diagnostic et exige une prise en charge adequate. L'etude a pour objectifs de determiner la frequence des appendicites aigues par rapport aux autres urgences chirurgicales abdominales de l'enfant et de degager les facteurs pronostiques afin de preconiser des solutions visant a ameliorer le pronostic vital. Il s'agit d'une etude prospective qui a porte sur les enfants ages de 0 a 15 ans. Dans les resultats on note que: les appendicites aigues constituent la seconde cause des urgences chirurgicales abdominales chez les enfants apres les occlusions intestinales ; - elles augmentent de frequence avec l'age ; - le sexe n'a aucune influence sur la frequence ; - la guerison a ete obtenue chez tous les malades apres appendicectomie precoce ; - la constatation de 13 cas d'appendicite perforee revelee sous forme de peritonite montre le risque evolutif de l'affection. Les appendicites aigues constituent une urgence chirugicale abdominale frequente surtout chez le grand enfant et son pronostic est favorable si l'intervention chirurgicale est faite precocement