[Study of factors associated with maternal mortality by the audit method in the Segou region]. / Etude des facteurs lies aux deces maternels par la methode d'audit a l'hopital nianankoro fomba de Segou.

INTRODUCTION: Maternal mortality remains a public health problem in developing countries, including Mali. Among the factors associated with maternal mortality are sociodemographic and economicfactors, but also dysfunctions related to the health care system. It is in this context that this study was conducted in the gynecology and obstetrics department of the Nianankoro Fomba Hospital in Ségou to determine the factors associated with maternal deaths by the audit method in the Segouregion. METHOD: It was a cross-sectional, descriptive and retrospective study that was conducted from January 2014 to December 2015. The data were captured and analyzed on Epi Info version 2003. RESULTS: The analysisincluded 41 auditeddeaths out of 79 maternaldeathsreportedduring the period, amaternalmortality rate of 51.90%. Direct obstetric causes accounted for the majority (51.23%). Of these causes hemorrhagewas the main with 17.08% followed by eclampsia (14.63%). 31.71% of deathswerepreventable. The main riskfactorsidentifiedwere: delayed care, referral / evacuationdelay, diagnostic errors (hospitallevel), non-availability of blood. CONCLUSION: Continueddeath audits at the healthfacilitylevelcouldbe an approach to improving the quality of care and reducingmaternal and perinataldeaths.

INTRODUCTION: La mortalité maternelle demeure un problème de santé publique dans les pays en voie de développement dont le Mali. Parmi les facteurs associés à la mortalité maternelle on peut citer notamment les facteurs sociodémographiques et économiques, mais aussi les dysfonctionnements liés au système de soins. C'est dans ce cadre que cette étude été menée dans le service de gynéco-obstétrique de l'hôpital Nianankoro Fomba de Ségou pour déterminer les facteurs associés aux décès maternels par la méthode d'audit dans la région de Ségou. MÉTHODE: Il s'agissait d'une étude transversale, descriptive et rétrospective qui a étéréaliséede janvier 2014 à décembre 2015. Les données ont été saisies et analysées sur Epi Info version 2003. RÉSULTATS: L'analyse a porté sur 41 décèsaudités sur 79 décès maternels notifiés au cours de la période, soit un taux de décès maternels audités de 51,90%.Les causes obstétricales directes étaient majoritaires (51,23%).Parmi ces causes l'hémorragieétait la principale avec 17,08% suivie de l'éclampsie (14,63%). 31,71% des décès étaient évitables.Les principaux facteurs de risques identifiés ont été :le retard de prise en charge, le retard de référence / évacuation, les erreurs de diagnostic (niveau hôpital), la non disponibilité du sang. CONCLUSION: La poursuite des audits des décès au niveau des établissements de santé pourrait être une approche d'amélioration de la qualité des soins et de réduction des décès maternels et périnatals.

Les ruptures traumatiques de l'uretre posterieur : analyse de 87 cas au CHU de Conakry

Objectif : Rapporter notre experience dans la prise en charge des ruptures traumatiques de l'uretre posterieur. Patients et methodes : Quatre-vingt-sept patients presentant une rupture traumatique de l'uretre posterieur ont ete traites dans le service d'Urologie-Andrologie du CHU de Conakry de janvier 1988 a decembre 2004. Le contexte traumatique a ete un accident de la voie publique dans 68 (78;2) cas et un accident de travail dans 19 (21;8) cas. Seuls 32 (36;8) des patients ont ete recus dans les 72 heures qui ont suivi le traumatisme; les autres ont ete recus au stade de stenose uretrale constituee. Une fracture du bassin a ete notee chez 56 (64;4) patients. La symptomatologie clinique etait dominee par la retention d'urine dans 62 (71;3); l'uretrorragie dans 59 (67;8) et l'hematome perineal dans 23 (26;4) cas. Resultats : Le traitement a consiste en un realignement sur sonde uretrale en urgence; une reparation uretrale en urgence differee entre le 8e et le 10e jour et une uretroplastie tardive selon qu'il s'agissait d'une rupture recente ou ancienne de l'uretre. Les resultats therapeutiques ont ete bons dans 32 (36;8) et moyens dans 39 (44;8) cas. Une dysfonction erectile a ete notee chez 19 (21;8) patientsConclusion : Le traitement des ruptures de l'uretre posterieur demeure controverse; cependant pour nous; l'uretrorraphie termino-terminale en urgence differee reste la methode therapeutique de choix dans notre contexte devant l'impossibilite de pouvoir realiser un realignement endoscopique et en l'absence de lesions associees severes. Devant des lesions associees graves la refection uretrale passe au second plan cedant la priorite aux lesions engageant le pronostic vital

[Thyroid surgery: experience of the surgical service Ignace Deen Central University Hospital in Conakry]. / La chirurgie thyroïdienne: experience du service de Chirujrgie Generale du CHU Ignace Deen de Conakry.

Authors bring back their experience in surgery thyroïdienne patient sur192s admitted and operated in five years in tea service of General Surgery of him FALLEN Ignace Deen Conakry of. Thesis patients represented 3.13% of tea 6139 surgical interventions exercised during tea period of survey. It was about has retrospective survey of descriptive type going from January 1st, 1997 at 31 December 2001, structural one aspects epidemiological, clinic, therapeutic and histologique. Tea done operative gesture was 86 lefts loboisthmectomieseses (44.17%), 41 rights loboisthmectomieseses (21.35%), 58 thyroidectomies subtotales (30.21%), 7 thyroidectomieses total (3.65%). Tea gotten results were good in 99.48%. To slot of death has been recorded, representing 0.52%. Tea goalkeeper of tea survey was to appreciate results of surgery thyroidienne and to take out again elements of bad prognostication of this surgery in their service.

[Urologic complications of gynecologic surgery. Report of 16 cases]. / Les complications urologiques de la chirurgie gynécologique. A propos de 16 cas.

From 16 cases collected in eight years (January 1991-December 1999) in the I. Deen Teaching Hospital Department of Urology, the authors study the gynaecological and obstetric surgery urological complications. They noted that these complications interest in 80% of cases the 18-47 years old woman with a high parity in 70% of cases. Hysterectomy, whatever the indication is the main etiology: 62.50%, caeserean takes the second place with 25%. The anatomic lesions are ureteral in 68.75% of cases and bladder in 31.25%. In the 14 cases treated, in the department, uretero reimplantation has been done in 46.66%, bladder suture in 40% and nephrectomy in 6.66%. Thirteen women were healed and one died.

[Bladder diverticulosis at a urologic service of the Ignace Deen de Conakry teaching hospital. Retrospective study of 28 cases]. / Les diverticules de la vessie au service d'urologie du CHU Ignace Deen de Conakry. Etude rétrospective de 28 cas.

From January 1st 1993 to December 31st 1998, 28 cases of bladder diverticula have been collected in Ignace Deen teaching hospital department of urology. The purpose of authors is to study the epidemiological aspects of diverticula of the bladder. They noted that bladder diverticula in 96.40% of cases are male disease, diagnosed by cystography, intravenous urography, ultrasonography or cystoscopy in 86%; and the etiology of bladder diverticula is a prostatic tumor in 68% of cases. A diverticulectomy is done by open surgery, associated to relieving outlet obstruction in 42.90%.

[Early complications of transvesical prostatectomy for prostatic adenoma at the Conakry urologic department: report of 96 cases]. / Les complications précoces de l'adénomectomie prostatique transvésicale au service d'urologie de Conakry: à propos de 96 cas.

Hryntschak Technic is the most common method in the prostatic hyperplasia surgical treatment in the Ignace Deen Urological Department. The aim of the authors in this paper is to study the epidemiological aspects of hryntschak early complications from january 1994 to December 1998. They found, from 96 cases that 41.70% are specific complications and 58.30% are non specific complications. Wound infection (35.40%), bladder fistula (15.60%) and epididymitis (11.50%) are the most frequent complications. The 61 to 80 years old rural man, with a urethral catheter placed before operation is the first interested by Hryntschak early complications.

[Case report of acute intoxication from intravenous injection of petroleum] . / A propos d'un cas d'intoxication aiguë par injection intraveineuse directe de pétrole.

A 18-year-old patient injected intravenously 2.5 mL of paraffin oil into the right upper limb. It caused a local thrombophlebitis with a slow evolution. A collapsus occurred on the sixth day. The authors obtained a clinical recovery of the limb after heparine and oral anticoagulation.

The Bamako Initiative in Benin and Guinea: improving the effectiveness of primary health care.

The objective of the health system revitalization undergone in Benin and Guinea since 1986 is to improve the effectiveness of primary health care at the periphery. Second in a series of five, this article presents the results of an analysis of data from the health centres involved in the Bamako Initiative in Benin and Guinea since 1988. Data for the expanded programme of immunization, antenatal care and curative care, form the core of the analysis which confirms the improved effectiveness of primary health care at the peripheral level over a period of six years. The last available national data show a DPT3 immunization coverage of 80% in 1996 in Benin and 73% in 1995 in Guinea. In the Bamako Initiative health centres included in our analysis, the average immunization coverage, as measured by the adequate coverage indicator, increased from 19% to 58% in Benin and from less than 5% to 63% in Guinea between 1989 to 1993. Average antenatal care coverage has increased from 5% in Benin and 3% in Guinea to 43% in Benin and 51% Guinea. Utilization of coverage with curative care has increased from less than 0.05 visit per capita per year to 0.34 in Guinea and from 0.09 visit per capita per year to 0.24 in Benin. Further analysis attempts to uncover the reasons which underlie the different levels of effectiveness obtained in individual health centres. Monitoring and microplanning through a problem-solving approach permit a dynamic process of adaptation of strategies leading to a step by step increase of coverage over time. However, the geographical location of centres represents a constraint in that certain districts in both countries face accessibility problems. Outreach activities are shown to play an especially positive role in Guinea, in improving both immunization and antenatal care coverage.

[Carcinoma of the seminal vesicles. Apropos of a case]. / Carcinome des vésicules séminales. A propos d'un cas.

The authors report a rare case of carcinoma of the seminal vesicles, which, in their opinion, presents a two-fold interest: 1. A nosological interest, since in the event of a tumour of the prostatic urethra, a possible tumour of the seminal vesicles is seldom invoked. 2. The second interest is a clinical and semeiological one since the diagnosis was reached only after an explorative laparotomy was carried out, followed by a pathological examination.