Treatment of retinoblastoma in Sub-Saharan Africa: Experience of the paediatric oncology unit at Gabriel Toure Teaching Hospital and the Institute of African Tropical Ophthalmology, Bamako, Mali.

BACKGROUND: Retinoblastoma (Rb) is the most common intraocular primary malignancy in children. In industrialised countries, the cure rate is about 95%. We present the results of a prospective study on the management of Rb in the paediatric oncology unit of Gabriel Touré Teaching Hospital and African Institute of Tropical Ophthalmology, from November 1, 2011 to December 31, 2015. PROCEDURE: The aims of this prospective study were to evaluate the treatment of localised Rb, ocular prosthesis after enucleation, conservative management for bilateral Rb as well as survival rates in all patients. Patients with early stage Rb at diagnosis were included. The treatment was performed according to the retinoblastoma treatment guidelines of the French-African Paediatric Oncology Group. RESULTS: Eighty-eight patients were included in the study. Sex ratio was 1:1 (M = 44, F = 44). Median age at diagnosis was 3 years (range: 2 months-5 years). Unilateral intraocular Rb was predominant (n = 50; 56.8%). Conservative treatments were performed on nine eyes in nine patients. Overall survival and event-free survival of the entire cohort at the end of 4 years were 73% (95% CI 60.8-81.2%) and 59% (95% CI 47.9-69.5%), respectively, with a median follow-up of 3.7 years (0.1-5.6 years). In conclusion, early enucleation in early stage of Rb can improve outcomes in resource-limited countries. Delayed enucleation and refusal of adherence to treatment are still major concerns and remain a barrier to improving overall patient survival.

[National reference unit of neonatology: state of play]. / Unit6é de néonatologie de référence nationale du Mali: état des lieux.

BACKGROUND: The neonatal mortality rate in Mali is one of the highest in the world. Only one national reference neonatology unit is available in the country. AIM: To describe the time-course of morbidity, mortality, staff and accommodation facilities from 2008 to 2009 in Mali's unique national reference neonatology unit. METHODS: This descriptive and cross-sectional study was conducted in the neonatology unit of Gabriel Touré Teaching Hospital, Bamako. Data concerning staff number of admissions, sex ratio, diseases, patients outcome, capacity and length-of-stay were compiled for the period from 1st January 2008 to 31 December 2012. RESULTS: Medical staff increased from one to three in 2009 and the number of nurses and midwives decreased from 16 to 14 with an average number of beds of 44. The mean number of hospitalizations per year was 3,900 (range: 3667-4585) with 14% of in-born deliveries and a mean length-of-stay of 3.7 days. Prematurity birth asphyxia and infection represented 80.5% of reasons for admission and 79.5% of deaths. The mortality rate varied from 28.5% to 36.8% with an annual mean of 33.2%. The diseases associated with the highest mortality were tetanus (60.8%), prematurity (42.7%), birth asphyxia (29.4%) and infection (25.7%). CONCLUSION: Neonatal mortality remains very high in Mali. Health authorities should take measures to decentralize the care of sick newborns in order to reduce neonatal mortality in Mali.