Surgical training and capacity development in the South African internship programme.

Medical practitioners in South Africa manage a quadruple burden of disease. Junior doctors, who contribute significantly to the health workforce, must complete 2 years of internship training and 1 year of community service work in state health facilities after graduation to register as an independent medical practitioner. The aim of this article is to give a critical appraisal of the current national internship programme and why it was implemented, and outline suggestions for future changes. There is a compelling need to train competent, confident doctors while ensuring that the requirements and demands of our health system remain a central concern.

[Evolution of Uterine Ruptures at the Maternity of Ignace Deen National Hospital (Chu of Conakry)]. / Évolution des Ruptures Utérines à la Maternité de L'hôpital National Ignace Deen (Chu de Conakry).

Uterine rupture is a common obstetrical drama in our delivery rooms that has become exceptional in developed countries. In developing countries including Guinea, this tragedy is one of the major concerns of the obstetrician. The objectives of this work were: to evaluate the frequency of uterine rupture in the department, to describe the socio-demographic and clinical characteristics of the patients, to identify the factors favoring the occurrence of uterine rupture, to evaluate the maternal-fetal prognosis and propose a prevention strategy to reduce maternal and fetal morbidity and mortality by uterine rupture. This was a descriptive study with data collection in two phases, one retrospective lasting 18 months from July 1, 2017 to December 31, 2018 and the other prospective, lasting 18 months also from January 1, 2019 to June 30, 2020 both carried out at the maternity ward of the Ignace Deen National Hospital. We collected 84 cases of uterine rupture out of 18,790 deliveries, i.e. a frequency of 0.44%. During the same time 10,067 cesarean sections were realized, i.e. one laparotomy for uterine rupture for 120 cesarean sections. The average age of the patients was 28.14 years with a standard deviation of 2 years and the average profile is that of a housewife (51.8%), multiparous (44.6%), evacuated from peripheral maternity (85.5%) and having an insufficient number of antenatal consultations (82.6%). In 93.1% of cases, the uterine rupture had occurred in delivery centers, peripheral maternity hospitals and on the way, the uterine ruptures were mostly spontaneous (65.1%), and occurred in a healthy uterus (59.0%). Uterine rupture was more frequently complete (83.33%). Surgical treatment was more frequently conservative with hysterorrhaphy (88.1%). We recorded 12 maternal deaths, i.e. a case fatality rate of 14.6%. On admission, almost all of the women showed no signs of fetal life. To reduce the frequency of uterine ruptures, better organization of emergency obstetric and neonatal care and better screening for risk factors for obstructed labor during prenatal consultations should be encouraged.

[Socio-Anthropological Determinants of the High Prevalence of Obstetric Fistula in Guinea]. / Déterminants Socio-Anthropologiques de la Prévalence Élevée des Fistules Obstétricales en Guinée.

Objective: The purpose of this study was to analyse the socio-anthropological determinants (representations, beliefs, practices and perceptions of health services) of the high prevalence of obstetric fistulas in Guinea. Patients and methods: From January 15 to February 15, 2018, we carried out a qualitative study in three health centres (one urban and two rural). The study focused on biological mothers who attended the centres to get vaccinated their children. The data were collected by semi-structured individual interview. Results: None of the 42 respondents could link the occurrence of obstetric fistulas and obstructed labour. Participants at all three study sites believed that obstructed labour and obstetric fistula have a mystical origin. In Kissidougou, the respondents thought that obstructed labour and obstetric fistulas are caused either by soubaya, sorcery in Malinké or the evil spell korte in Malinké cast by an enemy, or the bad behaviour of the parturient which means either she practices adultery or if she behaves disrespectfully towards elders. In Dubréka, the respondents linked the occurrence of labour dystocia and obstetric fistula to witchcraft koromikhi in Sousou. In Labé, some respondents thought that obstructed labour and obstetric fistula are due to divine punishment in local dialect lette Allah when the woman does not respect her husband or has contracted the pregnancy out of the legal union. Others deemed that childbirth is difficult because of the narrowness of the delivery route in Fulani lawol ngol no faadhi in parturients who do not have sex during pregnancy or when the woman had not adequately had female circumcision, in local dialect o suuwaaki laabhi which means, part of the clitoris was left in place during the excision. The majority of respondents had a poor perception of health services (male staff, lack of privacy, poor hygiene, abuse). Several cultural practices (early wedlocks, genital mutilations, dietary restrictions, home deliveries) also induce obstetric fistulas. Conclusion: Respondents' cultural beliefs and practices regarding childbirth limit women's attendance at maternity hospitals during childbirth and favour obstetric fistulas.

Sexual violence: epidemiological and clinical aspects and circumstances of occurrence among women seen at the Gynecology-Obstetrics department of the Ignace Deen National Hospital of Conakry University Hospital.

Sexual violence is widespread in the world and has a negative impact on women's mental, social, and physical well-being. The purpose of this study was to describe the epidemiological and clinical aspects of the occurrence of sexual violence among patients seen in the Gynecology-Obstetrics department at Ignace Deen National Hospital. This is a cross-sectional, descriptive, observational study of victims of sexual violence seen in the department, directly or on court orders, during the two-year period from May 1, 2016, to April 30, 2018. The data were analyzed with SPSS 16.0 software. Sexual violence accounted for 3.5% of all consultations in the department during the study period. They concerned adolescents (64.0%), females (97.1%), students (78.6%), and single individuals (95.7%). More than half of the sexual assaults were committed in the abuser's home (57.1%), by an assailant known to the victim (87.0%), at night (71.4%), by one person (85.7%), and during the weekend (60.0%). The lesions observed included vulvovaginitis (45.8%), vaginal tears (8.7%), facial bruises (8.7%), anal tears (4.4%), and ocular contusions (4.4%). The gynecological examination was normal in 21.4% of cases. Vaginal penetration was the sexual act practiced most often (88.4%) by aggressors, compared with acts of sodomy (4.3%). We noted 7.2% of fondling. Overall, 58.6% had previously had their hymen broken, and 34.3 very recently, while the hymen was intact in 7.1% of cases. The frequency of sexual violence is underestimated in our society. Its prevention involves its punishment, adequate medical care of victims, and improvement of the status of women.

Uterine rupture: socio-demographic aspects, etiology and therapy at the University Clinic of Gynecology and Obstetrics of the National Donka Hospital in Conakry University Hospital, Guinea.

Uterine rupture is an obstetric catastrophe that has become rare in developed countries. In developing countries, including Guinea, however, it remains a major concern of obstetricians. The objectives of this work were to calculate the frequency of uterine rupture in our département, describe the women's social and demographic characteristics, identify factors predisposing them to uterine rupture, describe its treatment, and assess maternal and fetal prognosis. Data for this descriptive study were collected in 2 phases, with a retrospective review of files covering the 3-year period from April 1, 2011, to March 31, 2014, followed by prospective data collection for the 6-month period from April 1 to September 30, 2014. This study of uterine rupture took place at the maternity unit of Donka National Hospital (CHU Conakry). We identified 98 cases of uterine rupture among 26 827 births, for a frequency of 0.36%. The women's mean age was 28.4 years (range: 16-43 years). The socio-demographic profile of the women admitted for uterine rupture was that of a housewife (50%), with two or three previous deliveries (41.84%), and who had no prenatal care (58.17%). Most of the ruptures took place in birthing centers, outlying maternity units, or during the journey to reach our reference department (87.16%). Most uterine ruptures were iatrogenic (69.38%) and occurred on an non cicatriciel uterus (62.24%). The rupture was most often complete. Most surgical treatment was conservative, by hysterorrhaphy (80.61%). Four women died, for a lethality rate of 4.80%. Almost all women were admitted without signs of fetal life. The role of uterine rupture in the obstetric activity in this service requires joint and urgent action by all stakeholders in the health system to combat this catastrophic complication that is evidence of a poor quality of obstetric care.

Household experience and costs of seeking measles vaccination in rural Guinea-Bissau.

OBJECTIVES: Children younger than 12 months of age are eligible for childhood vaccines through the public health system in Guinea-Bissau. To limit open vial wastage, a restrictive vial opening policy has been implemented; 10-dose measles vaccine vials are only opened if six or more children aged 9-11 months are present at the vaccination post. Consequently, mothers who bring their child for measles vaccination can be told to return another day. We aimed to describe the household experience and estimate household costs of seeking measles vaccination in rural Guinea-Bissau. METHODS: Within a national sample of village clusters under demographic surveillance, we interviewed mothers of children aged 9-21 months about their experience with seeking measles vaccination. From information about time and money spent, we calculated household costs of seeking measles vaccination. RESULTS: We interviewed mothers of 1308 children of whom 1043 (80%) had sought measles vaccination at least once. Measles vaccination coverage was 70% (910/1308). Coverage decreased with increasing distance to the health centre. On average, mothers who had taken their child for vaccination took their child 1.4 times. Mean costs of achieving 70% coverage were 2.04 USD (SD 3.86) per child taken for vaccination. Half of the mothers spent more than 2 h seeking vaccination and 11% spent money on transportation. CONCLUSIONS: We found several indications of missed opportunities for measles vaccination resulting in suboptimal coverage. The household costs comprised 3.3% of the average monthly income and should be taken into account when assessing the costs of delivering vaccinations.

La mortalité maternelle à l'hôpital régional de Kindia : facteurs épidémiologiques et axes stratégiques d'intervention

Objectifs. Calculer le ratio de la mortalité maternelle, identifier les caractéristiques épidémiologiques et proposer des axes stratégiques d'intervention. Méthodes. Il s'agit d'une étude descriptive et analytique à recrutement rétrospectif, réalisée du 1erJanvier 1998 au 31 Décembre 2001 à l'Hôpital Régional de Kindia (HRK). Elle a concerné tous les cas de décès maternels survenus au service de gynécologie obstétrique de l'Hôpital Régional de Kindia. Les caractéristiques épidémiologiques, la provenance, la période du décès et le caractère évitable ou non du décès ont été analysés. Le calcul statistique a été fait à l'aide du test de chi² avec une signifi cativité p < 0,05. Résultats. Il y a eu 128 cas de décès matériels pour 6586 naissances vivantes soit 1944 décès pour 100.000 nouveaux-nés. L'âge moyen de patientes était 28,2 ans avec un écart type de 10 ans et des extrêmes de 15 et 44 ans. Les patientes de la tranche d'âge 15-19 ans (31,3%) analphabètes (62,5%), primipares (42,9%), évacuées (76,6%) et celles n'ayant effectuées aucune CPN (56,3%) étaient les plus touchées. Conclusion. La réduction de la mortalité passerait par l'identification des causes de décès, l'offre des soins obstétricaux et néonataux d'urgences complets

[Ectopic pregnancy at the Ignace Deen University Hospital in Conakry: epidemiologic, social, demographic, therapeutic, and prognostic aspects]. / Grossesse extra-utérine dans la clinique de gynécologie-obstétrique Ignace-Deen du CHU de Conakry Aspects épidémiologique, sociodémographique, thérapeutique et pronostique.

The objectives of this study were to calculate the frequency of ectopic pregnancy in the department, define its epidemiological, diagnostic, therapeutic, and prognostic aspects, and determine a clear therapeutic approach appropriate to our setting. In this prospective study, we compiled all cases of ectopic pregnancy seen in 2011 and 2012 in the obstetrics-gynecology department at Ignace Deen University Hospital in Conakry. Ectopic pregnancies represented 1.3% of all deliveries over this period. In the 111 cases in this population, women aged 30-34 years accounted for 31.5%, those pregnant for the first time 40.5%, nulliparous women 35.1%, married women 72.1%, those without schooling 43.2%), and those with a history of sexually transmitted infection 57.6% (these categories are not exclusive, and the same women may be included in several). Secondary amenorrhea with abdominopelvic pain and metrorrhagia was the reason for admission in 56.5% of cases. Ultrasound in early pregnancy is infrequent in Conakry. Almost all of our patients underwent emergency surgery (80.2%) More than half of the ectopic pregnancies were located in the ampulla of the uterine tubes (73.0%). There were three abdominal pregnancies and 2 ovarian. In all cases the treatment was surgical, most often salpingectomy. Postoperative complications occurred in 35.1% of cases, most often anemia (27.9% of all cases) requiring blood transfusion in 11.7% of all cases before, during, or after surgery. The maternal death rate was 1.8%. Ectopic pregnancy remains a major concern at Ignace Deen CHU. Reduction of its frequency requires increased population awareness of sexually transmitted infections and illegal abortions. Management should be prompt and appropriate.

[Hysterectomies at the Conakry university hospitals: social, demographic, and clinical characteristics, types, indications, surgical approaches, and prognosis]. / Les hystérectomies au CHU de Conakry : caractéristiques sociodémographiques et cliniques, types, indications, voies d'abord et pronostic.

The objectives of this study were to calculate the frequency of hysterectomies at the Conakry university hospitals (Donka Hospital and Ignace Deen Hospital), describe the women's social, demographic, and clinical characteristics, and identify the key indications, the surgical techniques used, and the prognosis. This was a 2-year descriptive study, retrospective for the first year (May 2011-April 2012) and prospective for the second (May 2012-April 2013), of 333 consecutive hysterectomies performed in the obstetrics and gynecology departments of these two hospitals. Hysterectomy is one of the surgical procedures most commonly performed in these departments (following cesarean deliveries), with frequency of 4.4% interventions. The profile of the women undergoing this surgery was that of a woman aged younger than 49 years (61%), married (75.7%), multiparous (33%), of childbearing age (61%), and with no history of abdominal or pelvic surgery (79.6%). Nearly all hysterectomies were total (95%, compared with 5% subtotal; the approach was abdominal in 82.25% of procedures and vaginal in 17.75%. The most common indication for surgery was uterine fibroids (39.6%), followed by genital prolapse (22.2%), and obstetric emergencies (17.8%). The average duration of surgery was 96 minutes for abdominal and 55 minutes for vaginal hysterectomies. The principal intraoperative complication was hemorrhage (12.31%), and the main postoperative complication parietal suppuration (21.02%). The average length of hospital stay was 10.3 days for abdominal hysterectomies and 7.15 days for vaginal procedures. We recorded 14 deaths for a lethality rate of 4.2%; most of these deaths were associated with hemorrhagic shock during or after an obstetric hysterectomy (93%). Hysterectomy remains a common intervention in developing countries. Its indications are common during the pregnancy and postpartum period, with high morbidity and mortality rates. Improving obstetric coverage could reduce its indications.

[Intrapartum obstetrical transfers: sociodemographic, clinical and prognosistic aspects in Conakry, Guinea]. / Evacuations obstétricales intrapartum: aspects sociodémographique, clinique et pronostique à Conakry, Guinée.

The objectives of this descriptive prospective study were to determine the frequency of intrapartum obstetrical transfers, assess the sociodemographic profile of parturients requiring transfer, describe transfer modalities, and assess maternal and newborn outcomes. Study included all patients requiring intrepartum obstetrical transfer to the Ignace Deen University Hospital Gynecology Obstetrics Clinic in Conakry, Guinea from August 1st, 2009 to July 31st, 2010. Out of 3122 deliveries during the study period, intrapartum transfer was required in 220 cases, i.e. 7.05%. Mean patient age was 23.2 years (range, 14 to 44). The risk for intrapartum transfer was higher among multiparous or nulliparous women (incidence, 8.79%) and adolescents (incidence, 10%). Patients requiring transfer were mainly housewives (60%) and uneducated women (57.27%). Most had had an insufficient number (<4) of antenatal examinations (76.36%) and had been examined at peripheral maternity units (62.73%). In 175 cases (79.54%), patients were transferred by taxi. In 191 patients, treatment required surgery including 130 caesarian sections. There were 12 maternal deaths (5.45%) and 45 neonatal deaths out of 242 newborns including 22 twin deliveries (18.59%). Further work is necessary to improve referral and transfer at all levels of the health pyramid.

[Etiological orientation from the analysis morphological and constitutional of urinary stones in Conakry]. / Orientation etiologique a partir de l'analyse morphologique et constitutionnelle des lithiases urinaires a Conakry.

INTRODUCTION: The epidemiological profile of urinary stones varies from region of the world to another according to food habit and certain enviromental factors. The aim of our study was to establish an etiological approach of the urinary lithiasis collected in Conakry by morphological and constitutional analysis. MATERIALS AND METHODS: It was a prospective study from january 1 rst 2003 to january 1 rst 2004 concerning all the stones collected. They were analysed by binocular magnifying glass and infra red spectrophotometry of Fourier. RESULTS: During the period, 18 patients were observed (14 male, 4 femele) of 27.4 +/- 4 years old (from 2 to 69) living mainly in urban environment. From these patients 28 stones were collected; 12 spontaneously and 16 surgicaly. Their composition were whewellite (36%), struvite (29%), carbapatite (14%), urates (14%) and weddellite (7%). In Conakry stones come mainly from hyperoxaluria and urinary tract infection; hypercalciuria is uncomon. CONCLUSION: The urinary calculations examined among patients show in the adult a prevalence of elements in favour of a hyperoxalurie and a notable context of urinary infections in particular in the child; the pure hypercalciurie remains negligible in Conakry, we plan to lead a thorough work to the national scales.

[Apparent malformations in an African area: factors influencing consultation delay in pediatric surgery]. / Malformations apparentes en milieu Africain: facteurs du retard à la consultation en chirurgie pédiatrique.

AIM: To analyze the attitudes of the Guinean and of the Ivory Coast communities leading to delayed consultation despite apparent malformations in children. PATIENTS AND METHODS: From January 1, 2000 to December 31, 2002, we carried out a prospective investigation in the paediatric surgery units of the Donka teaching hospital (Conakry) and Cocody, Treichville and Yopougon (Abidjan) teaching hospital. One hundred and two children affected with apparent malformations were included. The studied variables were: age, sex, ethnos group, religion, socio-economic level and the cultural designs of the families. RESULTS: Sex ratio male/female was 1,5 and the average age at first consultation was 17 months. Seventy-six per cent of the children carrying apparent malformations at birth were seen at an age ranging from 1 to 30 months. Orthopaedic malformations were prominent (44%) and led especially to negative reactions of the entourage of the patients. Some religious beliefs took a part of the delayed consultation and impaired relationships between the 2 parents. The low socio-economic level (54%) was determining in the delayed consultation. The birth of a child with malformation in the malinké, akan krou community could be understood like a parchment from a god or a witchcraft. CONCLUSION: The contributive factors of the delay to the consultation of the children carrying apparent malformations in the communities Guinean and of the Ivory Coast are poverty, ignorance and some religious beliefs. Education and well understanding of these reasons in developing country should improve the acceptance and taking care of these children as well as the development of medical insurance system.

[Newborn emergencies in the Pediatric Surgery Service of CHU Donka]. / Les urgences chirurgicales neonatales dans le Service de Chirurgie Pediatrique du CHU Donka.

UNLABELLED: DRANK: The goal of this work is to determine the factors of surgical mortality in period neonatal and to emphasize the difficulties of the assumption of responsibility. MATERIALS AND METHODS: Retrospective study of 222 cases over 10 years from January 1992 to December 00 realized in the service of Paediatric surgery of the National Hospital Donka. We studied the age of the patients to the first consultation according to whether it is received before or after the 6th day of birth, the socio-economic level was appreciated according to the mode of dwelling, accessibility with drinking water and electricity, the diet, associated malformations, the postoperative results. RESULTS: In 10 years (January 1992 at December 2001), we recorded 222 surgical cases of newborn emergency interesting the digestive tract (27.48%), the abdominal wall (37.39%), the parts urogenital (2.25%) and neurological (32.88%). We noted a male prevalence of 64.41% and surgical newborn mortality was 29.28%. The delay with the consultation, poverty on the one hand and the lack of the means of reanimation, the insufficiency of qualified personnel, were the principal factors of risk in our series. CONCLUSION: The surgical newborn urgencies gather affections which require an immediate and adequate assumption of responsibility. The early diagnosis is a requirement; it must be done in the room of childbirth. The childbirth in residence, the ignorance of these affections by much of experts involves the delay with the consultation. The insufficiency of personnel qualified in paediatric surgery and infantile anaesthesia-reanimation, the poverty of the parents who must deal with the medical expenses of the new-born babies are as many factors which delay the time of intervention. The training of the specialists in paediatric anaesthesia-reanimation, the formation continues agents of health on all the levels on the tracking of the newborn urgencies, the creation of the centers of reanimation, the motivation of the personnel looking after in these structures and the intervention of the medical O.N.G. will be major assets to improve the assumption of responsibility and to decrease the death rate.

Performance of Djallonké sheep under an extensive system of production in Faranah, Guinea.

A total of 147 ewes, 4 rams and 188 lambs of their progeny of the Djallonké breed of sheep were used to study the factors affecting reproductive and growth traits and the causes of lamb mortality. Data on ewes were collected during a 12-month period, while those on the lambs born to 123 of the ewes were collected until they were 12 months of age. The average fertility and abortion rates were 0.84 and 0.09. The fertility rate increased and the abortion rate decreased with increasing age of the ewes (p<0.05). The number of lambs born per ewe joined, litter weight at birth per ewe joined and litter weight at weaning per ewe joined were 1.28, 3.5 kg and 17 kg, respectively. The average numbers of lambs born per ewe, lambs born alive per ewe, lambs born dead per ewe and lambs per ewe that died between birth and weaning were 1.53, 1.43, 0.03 and 0.3, respectively. The age of the ewes significantly (p<0.05) affected all these traits except the number of dead lambs and the index of fertility (94%). The age of the ewes significantly (p<0.05) affected the birth weight and the weight at 6 and 12 months of age, whereas the lambing season significantly (p<0.05) affected all the growth traits studied. The type of birth was the most important source of variation in body weights of lambs. Sex had no significant (p>0.05) effect on the growth traits studied. The complex 'starvation-bad management-light body weight at birth' caused 48% of the lamb mortality between birth and weaning, while diarrhoea, pneumonia and internal and external parasites caused approximately 52% of the lamb mortality over the same period. The seasonal raw mortality rate of the lambs before weaning was highest in the humid season.

La place de la sequestrectomie osseuse dans les osteomyelites chroniques de l'enfant: experience de 10 ans a l'Hopital Pediatrique d'Owendo de Libreville (Gabon)

Sur une serie de 36 cas d'osteomyelites chroniques de l'enfant; 69;4 per cent etaient drepanocytaires; 30;6 per cent non drepanocytaires. Tous presentaient des sequestres osseux. A leur propos; une analyse des donnees epidemiologiques; topographiques; enfin une reflexion sur la conduite du traitement est proposee pour eviter de creer les conditions d'une pseudathrose. La radiographie standard nous est apparue suffisante pour decider du moment de la sequestrectomie; le plus tard possible

[Prolapse of the urethral mucosa in girls. Apropos of 9 cases]. / Le prolapsus de la muqueuse urétrale chez la fille. A propos de 9 cas.

The authors briefly report some clinical aspects of this dystrophy which, although more commonly seen in Negroes, can also be found in Caucasians. It is important to be able to identify it not to be impressed by this vulvar mass which so easily bleeds when touched.

[Malignant lymphoma or Burkitt's tumor. Apropos of 2 cases]. / Le lymphome malin ou tumeur de Burkitt. A propos de 2 observations.

Two cases of Burkitt's tumor treated in the Pediatric Hospital, Owendo, Libreville are discussed. The tumors were of the maxillofacial type, and remission by chemotherapy was obtained for a period of between 6 to 8 months. After this length of time, and in spite of spectacular local results, metastases developed and led to a fatal outcome. Cyclophosphamide chemotherapy is effective locally, but does not prevent recurrence.

[The Lockhart-Mummery technique in the treatment of the total rectal prolapse among children. Concerning 25 cases (author's transl)]. / La technique de Lockhart-Mummery dans le traitement du prolapsus rectal total de l'enfant. A propos de 25 observations.

A variant of Lockhart-Mummery's technique is proposed. Packing retrorectal space by Spongel instead of the vaseline gauze, the post-operative care is simplified and the delay of hospitalisation really shortened. This technique has been always efficient in 25 cases.