Quality of maternal care in the hospital pyramid in Benin: Challenges and prospects / La qualité des soins maternels de la pyramide hospitalière au Bénin : défis et perspectives

Introduction: The quality of health care in general and that of maternal health in particular is an issue that concerns all countries, especially developing countries like Benin. Purpose of research: To assess the quality of care offered to mothers within the hospital pyramid in Benin. Results: Out of a total of 36 hospitals surveyed, nine (25%) did not have a neonatal unit. This study showed an overall fair quality in the area of maternal care with an average score of 3.6. Thus, the differences in the quality of this care obtained need significant improvement. Providers' satisfaction was acceptable unlike beneficiaries who expressed dissatisfaction. Conclusions: Most hospitals in Benin do not yet provide quality maternal care, which is effective, efficient, continuous, accessible, and safe. Evidence-based interventions that focus on the identified shortcomings will improve the quality of maternal health care in Benin's hospital pyramid.

Introduction: La qualité des soins de santé en général, et de la santé maternelle en particulier, est une question qui interpelle tous les pays, en l'occurrence ceux en voie de développement comme le Bénin. But de l'étude: Évaluer la qualité des soins offerts aux mères au niveau de la pyramide hospitalière au Bénin. Résultats: Sur un total de 36 hôpitaux enquêtés, neuf (25 %) ne disposaient pas d'une unité de néonatologie. Cette étude a montré globalement une qualité passable dans le domaine des soins maternels avec un score moyen de 3,6. Ainsi, les écarts de qualité de ces soins obtenus nécessitent des améliorations importantes. La satisfaction des prestataires était acceptable contrairement aux bénéficiaires qui ont manifesté une insatisfaction. Conclusions: La plupart des hôpitaux du Bénin n'assurent pas encore des soins maternels de qualité, c'est-à-dire des soins efficaces, efficients, continus, accessibles et garantissant la sécurité des patients. Des interventions probantes focalisées sur les dysfonctionnements identifiés permettront d'améliorer la qualité de la santé maternelle au niveau de la pyramide hospitalière du Bénin.

A Prospective Epidemiological Survey of Paediatric Trauma in Africa: A Cross-Sectional Study.

BACKGROUND: Trauma is a leading cause of morbidity and mortality in children worldwide. There is a need for development and provision of efficient paediatric trauma services based on adequate information and funding which are lacking in low- and middle-income countries. AIMS: This study was carried out to assess the scale of the problem, identify the most common causes of trauma in Pan African Paediatric Surgical Association (PAPSA) zone and to define the limiting factors for provision of the necessary services required to reduce the potential mortality and disability. MATERIALS AND METHODS: Data were collected through an electronic form sent out in PAPSA platform. Members were requested to provide prospective data on all paediatric major trauma admitted to or seen at their health facilities between the beginning of April 2019 and the end of June 2020. Hospital location, child's age, gender, type of injury, mechanism of injury, severity, initial management, method of transport, time to arrive to hospital, availability of surgical specialities, length of hospital stay and injury outcome were analysed. RESULTS: There were 531 entries. The mean age was 3.53 years and median age 1.34 years. Male-to-female ratio was 2:1. The leading causes for injuries were falls 194 (36.53%) and motor vehicle crashes (MVCs) 176 (33.15%) followed by obstetrical 42 (7.9%), thermal 27 (5.1%) and domestic injuries 22 (4.1%). The most common injuries were limb fractures 181 (34.1%) and traumatic brain injury 111 (20.9%). Public and private transport were used in 313 (58.9%), while ambulance service was used in only 54 (10.1%). Distances to a health facility varied between 1 and 157 km. 70.2% of cases did not receive any primary care, while definitive care was received in 95.5% of the cases. Outcome was full recovery in 90.6% of patients, morbidity in 8.1% and a mortality rate of 1.3%. CONCLUSIONS: Most of the injuries were in the under 5-year age group. The two main causes of trauma in children in this study were the falls from height and MVCs. Long distance travels to reach health-care facilities were noticeable in this study, together with substantial lack of adequate ambulance facilities and shortage in necessary subspecialty services such as neurosurgical, orthopaedics and rehabilitation. Implementing proposed recommendations can reduce the burden.

Pediatric anesthesia in developing countries: experience in the two main university hospitals of Benin in West Africa.

AIMS: To describe the practice of pediatric anesthesia in the main University Hospitals in Benin. PATIENTS AND METHODS: We conduct a retrospective study involving 512 children at the 'Centre National Hospitalier et Universitaire' and the 'Hôpital de la Mère et de l'Enfant Lagune' in Cotonou. All children less than 15 years of age undergoing surgery from January to December 2007 were included. Patient demographics, anesthetic technique, perioperative monitoring and complications were analyzed. RESULTS: General anesthesia was used in 94% of children. Regional anesthesia was used in 1.7% of children at CNHU and 17% of children at Hôpital de la Mère et de l'Enfant Lagune. Inhalational induction was the commonest technique used. Halothane was the only inhalational agent available for induction. Seventy-two percent of children having general anesthesia were intubated. Muscle relaxation was used in 48% of cases, only with pancuronium. The available perioperative monitoring equipment was not used regularly. All children having general anesthesia breathed spontaneously with manual assistance. There were eight cardiac arrests recorded, giving an incidence of 156 cardiac arrests per 10,000 anesthetics. Hypoxia was the commonest cause of cardiac arrest. The mortality associated with cardiac arrest was very high (62%). There were three prognostic factors that predicted a poor outcome: age <1 year, emergency surgery and an ASA score of three or more. CONCLUSION: Pediatric anesthesia in the two University Hospitals is far from satisfactory. Morbidity and mortality are unacceptably high. Suggestions are made to improve the safety of children undergoing anesthesia.

[Tethered cord syndrome in children: about a case]. / Syndrome de la moelle attachée chez l'enfant: à propos d'un cas.

Tethered cord syndrome is a spectrum of neurological symptoms due to a constant or intermittent axial traction of the terminal cone of the spinal cord, fixed in abnormal caudal position. It is a rare congenital lesion whose symptoms can be observed only in adulthood. We report the case of a 10-year-old boy with tethered cord syndrome discovered due to bladder and anal incontinence and confirmed by lumbosacral magnetic resonance imaging. He underwent neurosurgical release of the terminal cone by posterior approach. Evolution was marked by improvement of sphincteric disorders. This case study has been followed by a literature review on this subject. This case study highlights the role of magnetic resonance imaging (MRI) in the diagnosis of this disorder.