The Place of Blood Transfusion in the Management of Obstetric Emergencies in the Gynaecology and Obstetrics Department of the Reference Health Center of Fana (Mali)

This is a prospective and descriptive study carried out at the gynecology and obstetrics department of the reference health center of Fana from 01 May 2019 to 30 November or 7 months. The main objective was to study the role of blood transfusion in the management of obstetric emergencies. During the study period we recorded 434 cases of obstetric emergencies of which 116 cases required an emergency blood transfusion or 26.73%. The most frequently found indications for blood transfusion are hemorrhages of the immediate postpartum 46.6% followed by severe malaria on pregnancy 27.6%. Blood remains the most prescribed and available Labile blood product in the department. Maternal prognosis was improved in 92.2%.

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.

Pregnancies without Prenatal Care in the Health District of Commune V in Bamako: Obstetrical Prognosis

Summary: We attempted to determine the obstetric prognosis of women without antenatal care in the Health District of Commune V of Bamako, Mali. Materials and Methods: We undertook this retrospective case-control study from January 1 to March 31, 2017. Of all women having given birth to during this period in this district, we compared characteristics and obstetric outcomes between women without antenatal care (study group) vs. those with antenatal care (age/parity matched control). Results: 13.8% of women were without antenatal care (23.45 ± 9.56 years of age: 13 - 42). Study group (without antenatal care), compared with control, was significantly more likely to be household helpers (OR = 2.5 [2.0 - 3.4]) and single (OR = 2.3 [1.8 - 2.8]). Study group women were more significantly likely to have the following poor obstetric outcomes: premature rupture of the membranes, post-maturity, low birth weight, hypertensive disorders of pregnancy, uterine rupture, fetal death, anemia, fetal malposition, cesarean section, postpartum hemorrhage, puerperal infection and maternal death. Study group showed a higher risk of early neonatal death, low Apgar score, and transfer to Neonatology institute. Conclusion: In accordance with the previous reports in any other countries, no prenatal checkup causes higher poor outcome of both mothers and infants/neonates also in this area.