Evaluation of the Resuscitation of the Newborn in the Birth Room of the Maternity Ward of the Gynecology-Obstetrics Department of Reference Health Center (RHC) of the District V of Bamako, Mali

Birth is the transition from fetal life to ectopic life. This transition is usually smooth. Only 10% of newborns will need birth assistance. Successful resuscitation is linked to the skills of the health worker. It is to assess their skills that this work was undertaken with the objective of evaluating the practice of neonatal resuscitation in the delivery room of the RHC maternity hospital in District V of Bamako. Methodology: This was a descriptive cross-sectional study over a four-month period. We included in the study all live newborns who had a gestational age greater than or equal to 32 weeks and who had an Apgar score at the first minute of less than 7. At each birth, we observe the health agent responsible for the care of the newborn by observing the preparation of resuscitation and compliance with the neonatal resuscitation algorithm. We have excluded all newborns who met our inclusion criteria, were reanimated outside of our collection time and had visible or diagnosed anomalies or malformations in the prenatal period, and those whose parents refused to give their consent to participate in the study. Data were collected from the survey sheet and analyzed with the Statistical Package for Social Sciences (SPSS) software version 25. Results: We observed a 24.66% frequency of neonatal resuscitation. Pregnancies were too close in 15% (less than one year). Caesarean section delivery represented 34% of the sample. They were at term in 93% of cases. All newborns were well dried (98.5%), with wet linen change only at 49.5%. Apgar was less than 3 in 7.5% of newborns at first. The resuscitation needs were for the absence of a scream in 78.5% of cases and or heart rate Conclusion: The study evaluated neonatal resuscitation practices at a maternity hospital in Bamako, Mali. It found a 24.66% resuscitation rate, with a 95.5% success rate despite technical limitations. Most steps were correctly applied, though some improvements are needed in areas like preventing hypothermia and equipment preparation.

Evaluation of the Practice of Immediate Care for Newborns in the Obstetric Gynecology Department of the Gabriel Touré University Hospital of Bamako, Mali

The care provided in the neonatal period by caregivers in health facilities and by parents in the community is essential for the survival of the newborn. Our work aimed to assess the practice of essential care for newborns at the maternity hospital during the first six hours of life. Methodology: It was a cross-sectional study, which took place over a period of six months and fifteen days (from April 27 to November 12, 2020). We evaluated the practice of immediate care given to newborns over 32 weeks of amenorrhea by the health personnel involved against the recommendations of the World Health Organization (WHO) on essential newborn care (ENC). Results: Our study involved 422 live newborns, which represented 22% of all live births. The sex ratio was 1.2. The gestational age of newborns was 37 to 41Week of Amenorrhea (WA) in 69.2%. The majority of births were performed by doctors specializing in gynecology and obstetrics, or 66.4% of cases. Midwives provided care in 51.7% of cases. Out of 422 newborns, 408 were immediately dried, 96.7% of the time. Less than half (44.1% of newborns) had benefited from the late cord clamping. Eye care was administered to the vast majority of newborns (94.3% of cases). The breastfeeding technique was verified in only 2.8% of cases. Only 1.7% (7 newborns) were monitored during the first six hours of immediate postpartum. In the immediate post-partum period, 18 newborns had problems that required treatment. NNS were correctly administered in 39 newborns (9.2%). Conclusion: Our study shows inadequacies in the practice of essential care for newborns within our maternity. Thus, many newborns can be saved through the practice of essential newborn care (NHS) at different levels of the health pyramid.

Postoperative Complications in the General Surgery Department of the Cs Ref of Commune I of the District of Bamako Mali

Postoperative complications represent important indicators for the quality of surgical care. The objectives of this work were to study post-operative complications in the general surgery department of the Cs ref of commune I in Mali, to determine the frequency of post-operative complications, to identify the factors of occurrence, to describe the clinical aspects, diagnostic and therapeutic in order to assess the additional cost linked to post-operative complications. This study was prospective, carried out in the general surgery department on 300 cases of surgical interventions. It covered all patients aged at least 15 years, operated on and hospitalized or not, and who presented complications during the 30 days postoperatively. Patients under the age of 15 were not included (our general surgery department is not a pediatric surgery department). We collected 300 patients among whom 199 (66.33%) were men and 101 (33.66%) women, i.e. a sex ratio = 1.9. The average age was 38 years with extremes of 15 and 87 years. The main initial diagnoses were: acute appendicitis, peritonitis, occlusions, wall hernias, hemorrhoids, uterine prolapse, uterine myomas, ovarian cysts and acute cholecystitis. Emergencies represented 43% (N = 129) of interventions with 6.98% post-operative complications (POC). Postoperative complications were dominated by surgical site infections, 75% of cases (N = 20), wall hemorrhage 5% (N = 1), testicular necrosis 5% (N = 1) and testicular calcification 5% (N = 1), wire rejection 5% (N = 1) and death 5% (N = 1). The management of postoperative complications was surgical in 95% and medical in 100%. Their occurrence extended the hospital stay by 3.65 days and increased the average cost of care by 60541.85 CFA francs. The mortality index lowered by efficient management of complications (IMAGE) calculated in relation to deaths was 95% of cases. Anemia, ASA score ≥ III, Alteimeir II and IV classes, duration of surgery and post-operative hospitalization were factors contributing to post-operative complications.

Clinical and Therapeutic Aspects of Inguinal Hernia in Children in the General Surgery Department of Reference Health Center in Commune I of Bamako Mali

Inguinal hernia in children is a congenital pathology in children linked to the persistence of the peritoneo-vaginal canal in children and the NüCK canal in girls;persisting into adulthood. This work aimed to study inguinal hernia in children in the general surgery department of the Reference Health Center of Commune I of the Bamako District;to determine the frequency of inguinal hernia;describe the epidemiological, clinical and therapeutic aspects of inguinal hernias and in order to evaluate the cost of treatment. This was a prospective study from April 2017 to March 2018 during which 60 children with an inguinal hernia were collected. Inguinal hernias in children represented 9.23% of patients operated on in the department. The average age was 59.23 months with extremes of one month and 180 months and a standard deviation of 49.23 years. The male sex was dominant with a sex ratio equal to 9:1. The notion of prematurity was found in 11.7% and was associated with a testicle not in place in 1.7% of cases. 41.7% of our patients were referred by a doctor and 66.7% of patients presented with painless, intermittent inguino-scrotal swelling (83.3% of cases). The hernia was discovered before one week of life in 50% of cases. Inguinal swelling was absent in 11.7% but observed intraoperatively. The inguinal hernia was unilateral in 91.7% of cases and 70% of hernias were discovered by the parents during pushing efforts. The inguinal hernia was located on the right in 61.7% of cases. The hernia swelling was soft, painless, impulsive and reducible in 78.3% of cases. The swelling was inguino-scrotal in 58.3% of cases. The hernia was simple in 95% of patients and hernial strangulation was observed in 3 cases or 5% of cases. 98.3% of patients were ASA I. The treatment was carried out openly in all our patients including closure of the vaginal peritoneal canal in 95% of cases under general anesthesia in 98.3% of cases. The morbidity rate was 8.4% (surgical site infection: 6.7% of cases and hematoma: 1.7%). The immediate consequences were simple in 96.6% of cases. No cases of recurrence occurred during the 6 months after the intervention. The average cost of care was estimated at 69,743 FCFA.

Factors Contributing to Contamination of Street Foods in Bamako, Mali

The World Health Organization states that foodborne diseases are a worldwide public health issue. Although street foods can provide nutritious and affordable ready-to-eat meals for city dwellers, their health risks can outweigh the benefits. A cross-sectional study was conducted in the Bamako district, focusing on street food vendors near schools, universities, extensive markets, administrative centers, and major roads. We aimed to sample fifty (50) sellers per municipality, making 300 sellers for the Bamako district. We developed a survey sheet to collect data, and six teams rotated between the municipalities each month. Before starting the collection, the teams were provided administrative papers approved by the municipal authority. The survey revealed three types of sales sites: fixed (65%), semi-fixed (30%), and mobile (4.40%). The proportion of sellers was 26.8%, 23.2%, 19.7%, and 4.2% in municipalities III, IV, and I. In municipalities I, II, III, IV, and VI, respectively, 92%, 95.70%, 93%, 87.2%, and 100% of the sellers were female. The age distribution of sellers was 65.63%, 46.81%, 40.82%, 38.30%, 36.17%, 36%, and 32% in the 25-34 and 35 - 44 age groups. Illiteracy rates were 59.20%, 61.70%, 55.30%, 75%, and 56% in municipalities I, II, III, IV, and VI, respectively. The study identified two categories of sellers: 48.3% in type 1 and 51.7% in type 2. The first category comprised 154 sellers, and the second 165 sellers. The survey found that 66.00%, 56.00%, 48.90%, 44.90%, 38.30%, and 34.40% of municipal V, VI, III, I, II, and IV sales sites were open-air. In municipality I, 63.30% of the sites were under hangars, while in municipalities II and IV, the corresponding percentages were 51.10% and 59.40%, respectively. Moreover, 46.00%, 31.90%, 31.30%, 30.60%, and 27.70% of the sites in municipalities VI, II, IV, I, and III were located next to gutters. In conclusion, this study identified several factors that could compromise the quality of street foods sold in the six municipalities of Bamako.

Migration of a Progestin Implant into a Pulmonary Artery: Observation of a Case at the Reference Health Center of Commune III of the District of Bamako in Mali

It was a 36-year-old patient, 5th Pregnancy, 5th Delivery, 4 live children, and I deceased, had a consultation in the department for the removal of implants. Questioning revealed that she had had the implant three years ago without medical follow-up. It was in view of the difficulties in extracting the capsule that the chest X-ray and CT scan carried out concluded that the implant had migrated into a branch of the left pulmonary artery. Therapeutic abstention has been the attitude of cardiovascular surgeons.

Review of Two Years of Surgical Activities of the General Surgery Department of the Reference Health Center of Commune I of Bamako Mali

The objectives of this work were to evaluate the surgical activities carried out in the general surgery department of the Reference Health Center of Commune I of Bamako, to describe the sociodemographic characteristics of the operated patients, to determine the main pathologies encountered and to evaluate qualitatively the result of the treatment. In order to improve performance, and the quality of care, and to identify common pathologies in the surgical department, we undertook a retrospective study on surgical activities from January 2009 to December 2010. At the end of this study, out of 474 men and 187 women (equal sex ratio 2.53);we were able to determine the frequency of surgical pathologies. Farmers, housewives and pupils/students were the most represented with 25.9% respectively;20% and 13.3%. The most frequently observed pathologies were wall hernia (44.8%), prostate adenoma (12%) and acute appendicitis (10.5%). The average length of hospitalization was 3.43 days. Infectious complications affected 25 patients (3.8% of cases) and a death rate of 0.45% (i.e. 3 patients). The average cost of care was 53,500 FCFA. Indeed, the reality of surgical practice in health centers was not the same because of the level of skills of practicing surgeons.

Chest Trauma at the Emergency Department of the Gabriel TouréUniversity Hospital Bamako, Mali

In Mali, chest injuries remain a real public health problem and are associated with heavy morbidity and mortality. Faced with a resurgence of urban civil violence and the explosion of road accidents, we decided to conduct this study in order to describe the epidemiological, clinical and therapeutic aspects of thoracic trauma in the emergency department. Method and Material: This is a descriptive prospective study over a period of one year in the emergency department of the CHU Gabriel Touré. Including all patients admitted for thoracic trauma. Analysis and Entry: Data were entered and analyzed on SPSS software version 20.0. The test was significant for a p value < 0.05. Results: We recorded 21,090 appeals in our structure among which 1284 patients were suspected of thoracic trauma. The diagnosis of thoracic trauma was retained in 119 (0.56%) patients. All patients were transported to the emergency room without prehospital medicalization. Clinical presentation was dominated by dyspnea in 54.6% of patients, however pain was the almost constant symptom in conscious victims. Various traumatic mechanisms had caused these lesions of the thorax, of which road traffic accidents represented half of the causes, followed by urban civil violence in 28.6% of patients. Landslides and falls from a great height were responsible for 19.5% of chest injuries. Open chest trauma was the type of lesion found in a third of the cases. This type of injury was exclusively due to blows and injuries during the brawls. Standard chest radiography was performed as the first intention in 60% of patients compared to 10.9% for the pleuropulmonary ultrasound. Thirteen patients required ventilatory assistance after orotracheal intubation. The average length of stay was 65.23 hours. During the period of our study, the overall mortality was 1.85% in the emergency departments with a lethality specific to chest trauma of 15%. Conclusion: Urban violence with its share of ballistic wounds determined the severity of this condition.

Acute Pneumonia Characteristics in Children under Five Years of Age in Bamako, Mali

Pneumonia is the most common cause of mortality in child under five years of age. The objective of the study was to assess socio-demographic and clinical characteristics of children under 5 hospitalized for pneumonia. Material and method: We conducted a 6 months prospective study from June 1st, 2016 to December 31st, 2016 in the general pediatric service in the Pediatric Department of Gabriel Touré Teaching Hospital in Bamako, the capital city of Mali. Result: We have selected 63 cases of pneumonia according to our definition criteria, i.e. 2.2% of hospitalizations for children aged 1 to 59 months. The average age was 14 months. Infants under 2 years accounted for 82.53%. The sex ratio was 1.2. Seventy eight percent came from an unfavorable socio-economic background. The majority of mothers were uneducated (71.42%). Breastfeeding was exclusive up to 6 months in 50.79% of patients. Vaccination according to the national program was not up to date in 27% of patients. The average consultation time was 18 days. On admission, 81% of the patients had a fever, 93.64% had a tachypnea and 58.73% had crackling rales at pulmonary auscultation. Hypoxemia was present in 58.73%. Severe anemia was present in 79.36%. Radiologically, opacity was found in 42 patients (66.66%). The blood culture was positive in 8.3%. Beta-lactams were first-line prescribed in all patients. The case fatality rate was 9.52%. The factors associated with mortality were age less than 14 months (p = 0.08), adverse socio-economic conditions (p = 0.0003) and the presence of hypoxemia at the entrance (p = 0.01). Conclusion: Pneumonia remains major cause of morbidity and mortality in our context. Emphasis should be put on preventive measures.

Profile of Urinary Tract Infections in the Elderly in the Internal Medicine Department of the University Hospital Center of Point G, Bamako, Mali

Introduction: Urinary tract infections (UTI) are frequent and of polymorphous clinical symptomatology in elderly subjects both in and out of hospital. In Mali, to our knowledge, no study concerning UTIs in the elderly has been conducted, hence the interest in this innovative work. Objectives: To determine the prevalence and clinical and paraclinical aspects of urinary tract infections in the elderly. Materials and Methods: This was a prospective descriptive and cross-sectional study from September 1, 2013 to August 31, 2014, i.e. duration of 12 months. All patients aged 65 years and over, hospitalized or ambulatory in the internal medicine department with a documented urinary tract infection were included. Results: We collected and examined 194 patients. The cytobacteriological study of urine (CBSU) was positive in 28 patients, i.e. a prevalence of 14.43%. The male sex represented 59.8% of the cases, the sex ratio was equal to 1.46. The age groups between 65 - 69 and 70 - 74 years were the most affected, respectively 28.57% and 39.28%. The main clinical signs were: asthenia, anorexia, dependence, fever, urinary burning, dysuria. Hospitalization was associated with urinary tract infection with P = 0.01. The group of enterobacteria were incriminated in 75% of cases. Escherichia coli, Klebsiella pneumoniae and Pseudomonas aeruginosa represented 39.28%, 14.28% and 10.71% of cases. Urinary tract infections were represented by pyelonephritis, acute prostatitis, orchi-epididymitis and simple cystitis. Conclusion: Urinary tract infection is frequent in the elderly, its clinical presentation is polymorphic and enterobacteria are the most incriminated group of bacteria.

Systemic Lupus Erythematosus Complicated by Pericarditis: A Case Report from the Guindo Clinic in Bamako, Mali

Juvenile systemic lupus erythematosus is a rare entity, affecting children under 16 years of age. Girls are more often affected than boys and the female predominance increases significantly with age. The initial manifestations are highly variable with an insidious and progressive onset. Non-specific symptoms include fever, anorexia, weight loss and asthenia. Pericarditis is the most common cardiac manifestation in systemic lupus erythematosus (SLE), occurring in 10% to 40% of cases. The biological elements of the diagnosis and follow-up of pediatric SLE are identical to those of adults and are based on regular measurement of complement, native anti-DNA antibodies, and inflammatory findings. Treatment is essentially based on corticosteroid therapy.

Epidemioclinical Profile and Immediate Outcome of Low Birth Weight at the Reference Health Center in Commune VI of the District of Bamako, Mali

Introduction: Low birth weight is responsible for 9.1 million child deaths each year worldwide. It is the leading cause of perinatal and infant mortality. The objective of this work was to determine the epidemio-clinical profile as well as the future of low birth weight at the Reference Health Center of commune VI in the district of Bamako, Mali. Methods: Our study was descriptive and prospective over a year from April 1, 2018 to March 31, 2019. Data were taken from hospital records and newborn referral/evacuation forms. Data processing was performed using Epi Info software version 3.5.4 and Word. Results: The frequency of low birth weight was 34.94%. Multiparity accounted for 47.84%, sex ratio was 0.93, maternal arterial hypertension was present in 41.66%, genitourinary infection was in 58.37% and delivery was by low way in 86.12%. The majority of newborns had a gestational age between 28SA-33SA (56.52%) and a weight between 1501-1999 grams (47.36%). Mortality accounted for 18.66%. Conclusion: Low birth weight is common in our settings with modifiable risk factors. Practitioners must play on them to minimize its importance.

Inguinal Hernia in Adults: Diagnostic and Therapeutic Aspects at Cs Ref CI Bamako Mali

The inguinal hernia is a very frequent surgical pathology in the world and it represents 95% of the hernias of the groin. This work aimed to determine the frequency of inguinal hernias, describe the clinical and therapeutic aspects of inguinal hernias, describe the morbidity and mortality related to inguinal hernias and evaluate the cost of treatment. Our study was conducted from January 2010 to December 2010 in the general surgery department of the Reference Health Center of Commune I in the district of Bamako. We collected 130 cases of inguinal hernias with a sex ratio of 15.25 in favor of the male sex. The mean age was 48.02 years (standard deviation: 17.53 years). Strangulated inguinal hernias accounted for 4.9% of abdominal surgical emergencies and 14.6% of all operated inguinal hernias. More than half of the patients (82%) were operated under local anesthesia. Clinical signs were marked by painless or irreducibly painful inguinal swelling. The diagnosis was clinical in all patients. Some patients benefited from a minimum blood assessment (rhesus grouping, glycaemia, hemoglobin level and hematocrit). The Shouldice technique was performed in 68% of patients. One case of organ resection was performed, i.e. 0.8% of cases. Morbidity was 4.6% due to wall abscess;0.8% scrotal hematoma type. We have not recorded any recurrence or death.

Knowledge of Health Professionals on Essential Newborn Care in Bamako, Mali

Despite existing policies on training health professionnels in essential newborn care (ENC), neonatal mortality still remains high in Mali. Our work aimed to assess the level of knowledge of health staff about ENC. Material and methods: From March 20th to April 20th, 2016, we interviewed newborn care providers at the six reference health centers and the Gabriel Touré University Hospital Center in Bamako. Results: In total, we interviewed 407 newborn care providers with a sex ratio of 0.52. Interviewees had over five years work experience in 62.1%. They considered a low Apgar score as an indication for neonatal resuscitation in 89%, regardless of profile (p = 0.1583). They knew the good aspiration technique in 54%, with nurses and midwives more knowledgeable (p ) of the reference health centers (p = 0.0000). The interviewees knew the indication and rate of ventilation in 30.2% and 16.0%, respectively. About one third (34%) thought oxygen administration should be systematic during ventilation. The knowledge level on ventilation was the lowest in the group of general practitioners (p = 0.0063 for oxygen indication and p for the technique). Knowledge level for other ENC components (temperature maintenance, eyes care, breastfeeding) were higher. The knowledge of the delay of the breasting did not correlated with either the profile (p = 0.0857) or the place of practice. The knowledge of the first bath was dependent on both the professional profile (p = 0.0002) and the reference level (p = 0.0238). Conclusion: The level of knowledge of health professionnels on ENC should be improved. This will involve the integration of ENC in initial training curricula along with an appropriate continuing training policy thereafter.

Liver Abscesses in General Surgery at CsRef CI in Bamako Mali

Liver abscesses correspond to a newly formed cavity created by necrosis of the liver parenchyma induced by the pathogen. The aim of the present work was to study liver abscesses;determine the frequency;describe the clinical and paraclinical aspects, therapeutic and evolutionary modalities;determine the follow-up of treatment in order to assess the cost of treatment in the Reference Health Center of Commune I of Bamako in Mali. This prospective study, involving 30 cases of liver abscess, took place over a period of 24 months from January 2015 to December 2016 in the general surgery department of the Cs Ref of commune I. The liver abscess is very often the consequence of amoebiasis which is rampant in the underprivileged population and it remains topical in surgical practice in Mali. Our hospital frequency was 0.081% with an average age of 34.40 years and extremes of 16 and 61 years;a sex ratio of 2.3 in favor of men. The main clinical signs were fever (56.7%), hepatalgia (73.3%) and hepatomegaly (26.7%). Hepatic collections objectified on abdominal ultrasound were located in the right lobe in 70% of cases and unique in 62%. Amebic serology carried out in 100% was negative in 20%;10% of cases had undergone surgical treatment. The consequences were simple for all our patients. The average cost of care, approximately 100,000 FCFA, was significantly higher than the minimum wage (28,460 FCFA) in Mali.

Community-Based Diagnosis for the Improvement of Maternal and Child Protection in the ASACOSEKASI Health Area in the Urban Area of Bamako (Mali)

The community diagnosis is an essential approach to the resolution of health problems with the involvement of the communities concerned who become object and subject. Improvingmaternal and child health is a health priority for many developing countries, including Mali. The objective was to study the role of community-based diagnosis in improving maternal and child protection in a vulnerable urban community in a developing country. Methodology: This was a research-action integrating a community diagnosis conducted in March 2023. The involvement of several stakeholders, including social actors including ASACO, membership card holders, district chiefs, neighborhood delegates, local authorities, and health professionals, made it possible to provide curative, preventive and promotional care. The ASACOSEKA Health Area was used as a setting for the study. The methodology was the indicator approach, contact, document review, interview of CSCOM patients, observation of the structure, prioritization of problems, development of an action plan and restitution of the report. Results: The monograph consisted of describing the characteristics of the study setting. Indeed, the ASACOSEKASI area is located on the left bank of the Niger River, with a population of 34,497 inhabitants. The CSCOM presented to describe a medical unit, a maternity unit, a laboratory unit, an ultrasound room and a medication storage room. The main pathologies found were confirmed simple malaria (45.08%), high AKI: 20.43%, confirmed severe malaria: 19.85%, suspected diarrhoea: 3.43%, trauma related to road accidents: 3.36%, pregnancy-related disorders (1%). BCG, Penta3, VAR, and yellow fever vaccination rates were above 100%. It reflects the fact that the doses administered were higher than the target population. This was related to out-of-area vaccination and lost doses. CPN1, CPN4, tetanus vaccination (VAT2) and family planning (FP) consultations all have a proportion above 100%. Maternal care is increased by out-of-area patients, particularly from Guinea. NPC3 and CPON have a proportion of less than 100%. The target population did not follow policies, standards and procedures. Postpartum, women rarely came to the CPON. Local actions to combat malaria included cleaning up plots and neighbourhoods, weeding families and streets, cleaning gutters, spraying the roosts of the female Anopheles Beetle, sleeping in LLINs, organising chemoprophylaxis days, promoting the use of MS, and using curtains against vectors. Conclusion: The community was involved at all stages of this diagnosis, from design to implementation, as well as to the restitution of local solutions. Indeed, the community diagnosis has led to a resolution plan related to reproductive health.

ECG and Echocardiography Findings: A Comparative Study between Sportive and Sedentary Female Patients (Bamako, Mali)

Objective: To study cardiovascular cardiac and echocardiographic features in high-level footballers and sedentary women in Bamako. Materials and Methods: This was a cross-sectional study conducted in Bamako from April 2015 to March 2016 among 14 to 35 years old high-level footballers and a group of untrained women. Data including socio-demographic, physical examination, ECG record and echocardiogram was inserted in Microsoft Excel and analyzed with IBM SPSS. Chi Square and Fisher statistical tests were used to compare our results. The significance level was p 0.05. Results: Forty-three female subjects, 51% being sedentary were recruited. Mean age, weight and height were significantly higher in sportswomen than in sedentary women with respectively p of <0.0001, 0.003 and 0.036. Bradycardia was found in sports subjects in 28.6% and sedentary tachycardia in 18.2%. Left ventricular hypertrophy and dilatation and left atrial dilatation were predominant in sportswomen. Conclusion: Bradycardia, left ventricle hypertrophy and dilatation were found more in sportswomen. These changes acquired through physical training are aspects of cardiac adaptation that we found in our sample. Other aspects were not found probably due to the small size of the sample.

Diverticular Fistula of the Female Urethra on Lithiasis at the District Health Center (CSREF) in Communeii, Bamako, Mali

The diverticulum of the female urethra or sub-urethral pouch is in the form of a cul-de-sac lined with mucous membrane through the muscular layer of the urethra. Thus, it is a site of stasis, urinary infection, formation of calculus or even malignant tumor. The diverticula of the urethra or sub-urethral pouches in women have a prevalence of 0.5% to 6% depending on the series. We report the case of a 61-year-old patient operated for a diverticulum on fistulized urethra complicated lithiasis. Our patient had five pregnancies and five births when she consulted for dysuria, urinary burns evolving since a year. The urogenital examination revealed a partially stenotic urethral meatus and a 3-cm large fistulized intravaginal peri-urethral mass allowing urine leak. The mass was painful and hard at palpation. We performed transvaginal diverticulectomy. The follow-up was simple and the probe was removed two weeks after the surgery. An atomo-pathological examination of the resected diverticulum concluded an aspect compatible with lithiasis urethritis.

Hypertension (HTN) Knowledge and with Its Associated Factors: About 456 Outpatients Seen in Cardiology Department in University Hospital (UH) Gabriel Touré—Bamako (Mali)

Background: High Blood Pressure (HBP) is high prevalent among adult population in Bamako, but little is known about factors associated with knowledge. Methods: It was a cross-sectional study involving patients aged 15 years and more with a first classification in normal blood pressure (HTN-) and high blood pressure (HTN+), and Second classification inpatients without knowledge (who answered No) (K-) and patients with knowledge (who answered Yes) (K+). A logistic regression was performed to look up predictors among different variables. Results: The sample involved 456 patients with a mean age of 51.39 years and 65.1% of female. The age group 45 - 59 years old made 32.5% and unschooled patients 60.3%. Patients with HBP accounted for 69.7% and those reporting to know about it 67.3%. HTN- and HTN+ differed significantly except for HR, height, sex and level of schooling. HBP prevalence increased with age up to 74 years. Regarding knowledge, sex, age group and number of FDRs did not differ significantly. High education level and duration of HBP was predictive of knowledge with an OR of 1.186 [CI 0.058 - 0.796] and 1.192 [CI 0.332 - 4.275] respectively. Conclusions: Our study provided data on HBP knowledge among outpatients with high educational level and HBP duration associated with better knowledge on HBP.

Epidemiological and Clinical Study of Cardiac Diseases in the Pediatric Department of the University Hospital Gabriel Touré(UH GT), Bamako (Mali)

Introduction: Children’s heart disease is a major public health problem in developing countries and especially in Mali. The purpose of our work was to determine frequency, different types of heart disease and their short term evolution in the pediatric department. Methods: We performed a retrospective study among children aged 0 to 15 years, hospitalized in the pediatric department from January to December 2015 and whose diagnosis was confirmed using trans-thoracic echocardiography. Results: We included 103 cases of heart disease out of a total of 8613 admissions in the pediatric department, giving an hospital prevalence of 1.2%. Mean age was 4.1 years (from 1 day to 15 years) and children under 5 years were the most affected with 73.80% of cases. Male predominance was noted (sex ratio = 1.2). Respiratory distress was the most common circumstance of discovery (93.20%). Cardiac murmur and tachycardia were the most common cardiac signs with respectively 88.35% and 83.50%. Congenital heart disease accounted for 70.87% and was dominated by ventricular septal defect (VSD) with 30.13%. Acquired heart disease (29.13% of the sample) was dominated by mitral regurgitation (MR) with 56.67%. Mortality rate was 31.9% for congenital heart disease and 11.1% for acquired heart disease. Conclusion: children’s heart disease is responsible for high mortality. Early detection improves the management of this pathology, which remains frequent.