Causes of Maternal Mortality According to Reports of Maternal Death Audits in the University Teaching Hospital Bogodogo (UTH-B) from January to December 2017

Objective: To study causes of maternal mortality according to reports of maternal death audits in the University Teaching Hospital Bogodogo (UTH-B) of Ouagadougou, Burkina Faso. Materials and Method: This was a prospective study that took place over a year from 1 January to 31 December 2017.? It concerned maternal deaths that occurred during this period in the obstetrics and gynecology department of the University Teaching Hospital Bogodogo (UTH-B). All maternal deaths were systematically audited by the audit committee;interviews with providers and families were sometimes conducted. The record books of all patients were analyzed by the audit committee;if necessary, interviews were conducted with care providers and families. The main information collected were recorded on individual files, entered and analyzed using the software Epi-info 7. Result: During the study period, we recorded 32 maternal deaths i.e., 587 per 100,000 live births. Deceased women under age 20 were the most numerous, followed by women aged 20 to 24. The death occurred in most cases in the puerperium in 69.80% of cases. Complications of pregnancy were the most incriminated causes in maternal deaths. Bleeding was the leading cause, accounting for 34.3%. They are followed by hypertensive disorders of pregnancy (21.8%) and infections (18.8%). In the contributing factors, resource factors were incriminated in 56.2% of cases, social factors in 43.7% of cases and medical factors in 25.4% of cases. Death was non-preventable in 76.2% of cases compared to 23.8% of preventable deaths. Conclusion: Maternal mortality is a major public health problem at the maternity hospital of the university hospital Yalgado Ouedraogo. Hemorrhage is the first cause of death. Hypertensive diseases are more and more worrying. Solutions must be found to improve the practice of audits in the obstetrics and gynecology department of UTH-B.

Quality Control of First Trimester Ultrasound Examinations in the Gynecology and Obstetrics Department of the University Teaching Hospital Yalgado Ouedraogo (UTH-YO) of Ouagadougou, Burkina Faso

Objective: To evaluate the quality of first trimester ultrasound examinations in patients consulting in the gynecology and obstetrics department at the University Teaching Hospital Yalgado Ouedraogo (UTH-YO) of Ouagadougou. Method: Our study took place from January 1st to March 31st 2017, in the department of Obstetrics and Gynecology of the University Teaching Hospital Yalgado Ouedraogo of Ouagadougou. This was a descriptive study on the records of the first trimester ultrasound of pregnancy, with analysis of the iconography. We used the criteria of the Technical Committee of Fetal Echography (TCFE) of France to analyse all the ultrasound reports brought by the patients. Results: Two hundred reports were collected in three months. In terms of ultrasound identification, only 2 reports out of 200 mentioned the brand and date of first circulation and 4 specified the type of device. The study of the quality of the appointment showed that only 52% of the ultrasounds had been performed at the right time, between 11SA - 14SA of amenorrhea. For the nuchal translucency quality, we rated by the Herman score, 41.67% of the scores were of “unacceptable” quality and only 58.33% were of “acceptable” quality we did not achieve “excellent” quality. The analysis of the biparietal diameter (BIP) cuts revealed that 1/4 only anatomical cuts had been well made. Analysis of the cranio caudal length (CCL) cuts showed that only 14.58% of the CCLs had been well done. Elements of early morphology had been explored to less than 5%. Conclusion: The results revealed the acceptable quality of the NC measurements, but a small proportion of NC achieved. The quality of the ultrasound, morphological analysis and biometrics period is not very acceptable.

Factors Associated with Prolonged Poor Glycemic Control in Type 2 Diabetes Mellitus (T2DM) Patients Followed in the Department of Internal Medicine at the Yalgado Ouedraogo Teaching Hospital, Ouagadougou (Burkina Faso)

Background: Achieving and maintaining glycemic targets are a challenge for health practitioners around the world. We aimed to study the factors associated with prolonged poor diabetes control in the cohort of T2DM patients monitored and treated in the Department of Internal Medicine at the Yalgado OUEDRAOGO Teaching Hospital in Ouagadougou in order to optimize therapeutic education in these patients. Methodology: This was a descriptive and analytical cross-sectional study combining retrospective data collection from the last year of patient follow-up and prospective collection of some information. The study included all diabetic patients, aged at least 18 years old, followed and treated in the Department of Internal Medicine at the Yalgado OUEDRAOGO Teaching Hospital between January 1, 2010 and December 31, 2018 following a systematic random sampling with a sampling step of 10. The variables collected were sociodemographic, anthropometric, lifestyle, cardiovascular risk factors and diabetes-related characteristics. To determine the risk factors associated with prolonged poor glycemic control, we performed modeling using logistic regression. All variables associated with prolonged poor glycemic control, in bivariate logistic regression with a p-value less than 0.20 were included in the full model. Later, we used a stepwise descending method to obtain the final model, which was then tested by a receiver operating characteristic (ROC) curve. The significance threshold was set at 5%. Raw and fitted Odds-Ratio (OR) and 95% confidence interval were presented. Results: 270 patients were included. Prolonged poor control of diabetes mellitus was observed in 73.70%. The mean age was 55.97 years (SD: ±11.52) and the sex ratio was 0.6 in favor of female. The mean time since diabetes mellitus diagnoses was 5.85 years (SD: ±5.15). A monthly gain of 92.62 USD (50.74%) for average diabetes mellitus care expenditures of 55.82 USD (SD: 28.25) was reported. An overweight (55.92%) and hypertension (41.85%) were reported. Diabetes mellitus was complicated in 68.15%. Patients were supported by their families in the management of their diabetes mellitus in 85.19%. In multivariate analysis with bivariate logistic regression, low level of formal education (OR = 8.34, 95% CI [1.97 - 35.22];p < 0.01), family support for diabetes mellitus management (OR = 0.65, 95% CI [0.45 - 0.94];p = 0.02), presence of abdominal obesity (OR = 2.27, 95% CI [1.08 - 4.77];p = 0.03), presence of a history of hospitalization (OR = 7.39, 95% CI [2.97 - 18.39];p < 0.01), poor adherence to antidiabetic treatment (OR = 2.97, 95% CI [1.42 - 6.18];p < 0.01), and the presence of microangiopathy (OR = 5.05, 95% CI [2.36 - 10.81];p < 0.01) were the factors independently associated with prolonged poor control of T2DM, with a ROC curve of 0.88, which reflects a very good sensitivity and specificity of these factors. Conclusion: The imbalance of T2DM is multifactorial. Lifestyle, family environment, and compliance seem to be essential to ensure good glycemic control. Healthcare practitioners should take these elements into account in their daily patient assessment. A predictive score would be a tool to help identify patients at risk of diabetes imbalance and would contribute to improving their management.

The Role of Ultrasound in the Diagnosis and Management of Trophoblastic Diseases (TMD) at the University Teaching Hospital Yalgado Ouedraogo (UTH-YO) of Ouagadougou

Objective: To describe the place of ultrasound in the diagnosis and management of Gestational Trophoblastic Diseases (GTD) at the Ouagadougou UTH-YO, Ouagadougou, Burkina Faso. Materials and Patients: It was a prospective and descriptive study over a 3-year period from 1 January 2015 to 31 December 2017. It took place in the gynecology and obstetrics department of at the University Teaching Hospital Yalgado Ouedraogo (UTH-YO) of Ouagadougou. Monitoring was based on clinical examination data, ultrasound and kinetics of β-gestational chorionic hormone (GCH) levels. Results: During the study period, we recorded 34 cases of trophoblastic diseases. The average age of the patients was 35 years with extremes of 22 and 52 years. Physical examination revealed a uterus larger than gestational age in 17 patients (56.67%) of cases. Eight (26.67%) patients were asymptomatic. The initial mean β-GCH was 453,747.8 IU/l with extremes of 5903 IU/l and 1,890,000 IU/l. Ultrasound was used to evoke the diagnosis in 23 patients, that to say 76.67% of the cases. Ultrasound identified 10 complete mole cases, 20 partial mole cases. For the 3 cases of invasive mole, pelvic ultrasound revealed heterogeneous intrauterine multi-vesicular images. In a case of choriocarcinoma, ultrasound found an enlarged uterus with a poorly limited intracavitary heterogeneous fundic image. Conclusion: This short series shows the central role of ultrasound in the diagnosis and follow-up of gestational trophoblastic diseases. Indeed, the sensitivity of ultrasound is excellent in the early diagnosis of complete moles. Ultrasonography remains a good examination choice for the diagnosis of gestational trophoblastic tumors despite their great polymorphism. The place of ultrasound in prognostic evaluation and treatment monitoring deserves to be studied by more important series.

Quality Control of Second Trimester Ultrasound Examinations in the Gynecology and Obstetrics Department of the University Teaching Hospital Yalgado Ouedraogo (UTH-YO) of Ouagadougou, Burkina Faso

Objective: To evaluate the quality of second trimester ultrasound examinations in patients consulting in the gynecology and obstetrics department at the University Teaching Hospital Yalgado Ouedraogo (UTH-YO) of Ouagadougou. Method: Our study took place from January 1st to March 31st 2017, in the department of Obstetrics and Gynecology of the University Teaching Hospital Yalgado Ouedraogo of Ouagadougou. This was a descriptive study on the records of the second trimester ultrasound of pregnancy, with analysis of the iconography. We used the criteria of the Technical Committee of Fetal Echography (TCFE) of France to analyse all the ultrasound reports brought by the patients. Results: Three hundred ultrasound reports were collected over three months. It revealed that, in terms of patient identification, 100% of the reports bore the surname and first name of the pregnant woman;88% and 94.67% of the ultrasound scans bore the surname and first name of the ultrasound specialist respectively. Only 2% presented the brand and type of ultrasound scanner. The study of the quality of the appointment showed that 52% of the ultrasounds had been performed at the right time, between 20 Gestational Age (GA) and 25 GA. For the quality of the iconography, referring to the recommendations of the Technical Committee of Fetal Echography (TCFE) of France and taking into account the data confirmed by the literature, we found that the quality was slightly acceptable either respectively for biometric and morphological sections. Conclusion: The quality of the ultrasound reports of the second trimester ultrasounds in patients consulting in the obstetrics and gynecology department of the University Hospital Yalgado OUEDRAOGO was not totally satisfactory.

Particularities of Pregnancy and Childbirth among Adolescents’ Girls in the University Teaching Hospital Yalgado Ouedraogo (UTH-YO) in Ouagadougou, Burkina Faso

Objectives: To study the particularities of pregnancy and childbirth among adolescent girls at the University Teaching Hospital Yalgado Ouedraogo (UTH-YO) of Ouagadougou. Patients and Method: This was a comparative, descriptive and analytical cross-sectional study conducted over a 6-month period on 138 adolescent girls and 276 adults who gave birth in the obstetrics and gynecology department of the University Teaching Hospital Yalgado Ouedraogo (UTH-YO) in Ouagadougou during the study period from May 1 to October 30, 2017. The statistical analysis had used the Chi square test and the strength of the association was appreciated by the Odds Ratio (OR). The significance threshold was set at 5%. Results: Adolescent girls had an average age of 17.04 ± 0.72 years and 64.49% were married. The majority came from urban areas and was educated. Housewives were more represented with 73.2% and 65.94% of adolescent girls were of low socio-economic status. Concerning the level of education, 48 (34.7%) were out of school, 57 (41.3%) had primary level, 32 (23.2%) secondary level and 1 (0.7%) higher level. Primigravida was the most numerous and only 39 adolescent girls used a contraceptive method. Malaria (p = 0.0247), preeclampsia (p = 0.0008) and anaemia (p = 0.0002) dominated pathologies during pregnancy in adolescent girls. The pelvis was borderline in 10.8% of adolescent girls. For newborns, teenage girls had a lower weight and an Apgar score of less than 7 higher. Perinatal mortality was higher (p = 0.0269). Postpartum outcomes were marked by complications with endometritis type (p = 0.0315) and higher maternal mortality (p = 0.0049). Conclusion: The teenagers’ pregnancy experience is marked by high maternal and perinatal morbidity and mortality. The promotion of contraception among adolescents should help to resolve this unpleasant situation.

Management of Malaria in Pregnant Women at the Maternity Unit of the University Teaching Hospital Yalgado Ouedraogo (UTH-YO) in Ouagadougou: About Report on the Quality of Care

Objective: To do a report on the quality of the treatment of malaria in pregnant women at University Teaching Hospital Yalgado Ouedraogo (UTH-YO) in Ouagadougou. Materials and Methods: This was a descriptive cross-sectional study conducted from 29 July to 02 October 2016. The targets were pregnant women and gynecology and obstetrics service care providers. The study used an individual questionnaire administered and clinical parasitological research by the Rapid Diagnostic Test (RDT). Some information was verified in the patient’s prenatal consultation logbook. A total of 351 women and 44 providers participated in the study. The data was captured on a microcomputer and analyzed using Epi info version 7 software. Results: Regarding preventive measures, patients’ responses were correct for long-lasting impregnated mosquito net (LLIN) in 98.8% of cases and for intermittent preventive treatment (IPT) in 96.5% of cases. About providers, they had given a good answer in all cases for using LLIN and taking IPT. Regarding care providers’ knowledge of the clinical signs of malaria, fever was cited in 95.5% of cases for simple malaria and Frankish jaundice in 97.7% of cases for severe malaria. With regard to curative treatment, 77.3% of the care providers surveyed stated that quinine was the reference molecule for the treatment of simple malaria in pregnant women. In terms of the availability of inputs used for malaria management, our survey found no RDTs. Also, the only molecule available was quinine in its compressed and injectable forms. Conclusion: Care Providers’ and patients’ knowledge of malaria in the obstetrics and genecology department is quite satisfactory. However, some shortcomings were noted in the provision of screening and curative and preventive treatment. The elimination of malaria in our country will require joint efforts at all levels.

Hypothyroidism in Hospitals (Burkina Faso)

Background: The epidemiology of hypothyroidism has been characterized by an increase in its frequency, especially in females and the elderly. Our aim was to study hypothyroidism in hospitals in Ouagadougou. Material and Method: This was a cross-sectional descriptive study with retrospective data collection covering a period of four (04) years between January 1, 2015 and December 31, 2018. It included patients followed in the internal medicine departments of three (03) teaching hospitals in the city of Ouagadougou. Yalgado OUEDRAOGO, Bogodogo and Tengandogo Teaching Hospitals, were the study setting. Results: 120 cases of hypothyroidism were enrolled. The mean age of the patients was 45.7 years with a sex ratio of 0.26. The signs frequently reported were weight gain (28.3%), asthenia (15.8%), and myalgia (15%). TSHus was elevated in 99.2% of patients in our series. The T3L assay level was lowered in 40.9%, with an average of 2.2 ± 1.5 pg/ml. T4L was lowered in 68.2% with an average of 6.6 ± 4 pg/ml. Primary hypothyroidism accounted for 99.2% of the cases, of which iatrogenic hypothyroidism was the most frequent with 77.5% followed by Hashimoto’s thyroiditis with 9.2% of the cases. Hormonal balance was achieved in the majority of patients (59.2%) who received hormonal supplementation with levothyroxine at an average dose of 84.5 μg/day. Conclusion: Hypothyroidism is common in women in their forties. Iatrogenic hypothyroidism was the predominant etiology reported in Ouagadougou.

Episiotomy: Epidemiological Aspects, Indications and Prognosis in the Bogodogo Health District

Objectives: To study the epidemiological aspects, indications and short and medium term prognosis of episiotomy in the health district of Bogodogo in Ouagadougou, Burkina Faso. Materials and Method: It was a descriptive prospective study over 4 months from 1 July 2016 to 30 October 2016. It was conducted in 4 health facilities in the health district of Bogodogo in the city of Ouagadougou. The study concerned the patients who gave birth after 28 gestational age (GA) and more, vaginally with episiotomy, in the 4 health facilities and who were reviewed at the appointment of the 9th day and the 3rd month. The data were collected using a questionnaire developed for the purposes of the study, seized with a laptop, then analyzed using the Epi-info software in its 3.5.1 version of the Atlanta C.D.C. Statistical comparisons were made using the Pearson chi-square test, with a significance level of p 0.05. Results: The overall episiotomy rate was 22%. For follow-up, 248 patients were reviewed on the 9th day and 109 patients on the 3rd month. The average age of our patients was 23.1 years. The average number of pregnancies was 1.7 with nulliparous women predominating (60.5% of cases). Excision was associated with episiotomy in 92.3% of cases, with perineal narrowing in 82.5% of patients. The mediolateral episiotomy was the most performed, in 76.6% of patients. Vulvo-perineal stricture was the main indication (75% of cases). The experience during the episiotomy and the evolution following the immediate layer was marked by pain. Dyspareunia was the main difficulty in resuming sexual intercourse. Conclusion: The episiotomy rate in our study was 22%. A program of continuous improvement of the quality of care concerning episiotomy encompassing various actions (audits, training) could reduce the use of episiotomies.

A Case of Cerebral Aspergillosis in a Patient with Chronic Lymphoid Leukemia

Cerebral aspergillosis commonly affects immunocompromised hosts, primarily patients on immunosuppressive therapy and those with acquired or immunodeficient states such as AIDS. We report a case of cerebral aspergillosis in a 39-year-old woman with a history of treated chronic lymphocytic leukemia (CLL). Multiple fragments of fixed tissues with formalin were freshly sent to the laboratory. An extemporaneous examination was performed by spreading. The rest of the sample was embedded in paraffin and studied according to the standard histological method with special stains and an immunohistochemical study. A microscopic observation showed abundant clusters of tangled mycelial filaments, Grocott+. At the edge, a nervous tissue was observed remodeled by an abundant inflammatory infiltrate consisting essentially of small lymphocytes and plasma cells. Additional immunohistochemistry was performed using anti-CD20, anti-CD3, anti-CD5, anti-CD23, anti-Bcl2, anti-Ki67, anti-IgD and anti-Kappa and Lamda antibodies. All taken together there were no further founding in support of a secondary localization of CLL. Cerebral aspergillosis is quite rare and often occurs in a context of immunosuppression. This case indicates the importance of a close collaboration between clinicians and pathologists for optimal patient care.

Imaging Findings of Children Stroke in Burkina Faso and Etiological Approach

Introduction: Stroke is defined as a sudden onset focal neurological deficit of presumed vascular origin. Although it is essentially adult and elderly condition, stroke can occur in children. Their diagnosis essentially radiological is based on two main imaging modalities namely Computed Tomography (CT) and/or Magnetic Resonance Imaging (MRI). Our study aimed to study radiological features of stroke in children with an etiologic approach in three health facilities of Ouagadougou. Material and Method: We conducted a retrospective study with descriptive focus during 11-year period from January 1st, 2006 to September 1st, 2017 among children aged between 02 months and 16 years who underwent brain CT scan and/or MRI;in whom diagnosis of stroke had been established in radiology department of Yalgado Ouedraogo Teaching Hospital (CHU-YO), Schiphra Methodist Medical Center (CM Schipphra) and Saint Camille Hospital of Ouagadougou (HOSCO). Results: 40 cases of pediatric stroke were collected including 23 at HOSCO, 15 at CHU-YO and 03 at CM Schipphra. Mean age was 6.45 years, with extremes of 2 months and 192 months. Unilateral contralateral motor weakness was the most common clinical presentation (32.5%) followed by seizures (17.5%). Ischemic stroke dominated in 82.5% of cases. Sino-venous thrombosis was rare and suspected in only one case. Sylvian artery was mostly affected in ischemic stroke for 56.25% of patients. The main etiologic factors found were hematologic (67.50%) then infectious factors (25%). Sickle cell disease was always incriminated in hematologic factor. Homozygous SS patients were the most numerous (82%). Conclusion: Stroke diagnosis in children is based on etiologic investigation, biology with a major role of medical imaging. Sickle cell disease accounts a lot in occurrence of stroke in children in our context.

Radio-Histopathological Aspects of Breast Nodules in a Sub-Saharan African City (Ouagadougou, Burkina Faso)

Objective: To determine the diagnostic contribution of breast microbiopsy percutaneously under ultrasound guidance. Methodology: Retrospective descriptive study conducted from January 2014 to October 2017. The included patients had an ultrasound-guided breast microbiopsy after a mammographic and ultrasound scan. The variables collected were gender, age, nodule size, ACR classification and anatomopathologic diagnosis. Results: 347 nodules were explored in 313 patients. There were 300 women (95.85%) and 13 men (4.15%), a gender ratio of 23.07. The average age was 44.64 ± 14.18 years. The average size of the nodules was 30.33 ± 19.58 mm. There were 53.89% ACR4 grade nodules, 48% ACR5 nodules and 32.28% ACR3 nodules. 86.49% of ACR3 nodules were benign and 97.92% of ACR5 nodules were actually malignant. Malignant tumors accounted for 50.29% of the nodules and were dominated by invasive breast carcinomas in 98.26%. The average age of patients with malignant tumors was 49.15 ± 11.55 years. 16% of patients with malignancy were aged under 40 years old. Conclusion: The diagnostic yield was satisfactory and there was a good correlation between the rate of malignant and benign lesions and the positive predictive values of malignancy in the literature.

Performance of the Finnish Diabetes Risk Score (FINDRISC) in the Identification of Dysglycemia in an Urban Population in Ouagadougou (Burkina Faso)

Background: Diabetes mellitus is a real public health problem worldwide and is growing in developing countries. Our aim was to determine the prevalence of undiagnosed type 2 diabetes mellitus (T2DM) and to evaluate the performance of the Finnish Diabetes Risk Score (FINDRISC) questionnaire to identify type 2 diabetics in the urban population of Ouagadougou, Burkina Faso. Methodology: This was a cross-sectional study among volunteers aged 18 years and older recruited systematically from November 11 to 16, 2019, in the city of Ouagadougou, Burkina Faso, FINDRISC score was used. Analysis of the Receiver Operating Characteristic (ROC) curve was used to study the diagnostic performance of FINDRISC for the identification of type 2 diabetics. The optimal threshold was determined by the sum of the highest sensitivity and specificity. Multivariate logistic regression was used to analyze the association of each variable used in the calculation of the FINDRISC score. Results: A total of 1276 individuals were included in the analyses, of which 667 (52.27%) were women. The average age was 34.16 years (SD: ±12.42). The prevalence of T2DM was 10.74%. The mean FINDRISC score was 5.85 (SD: ±4.31). The majority (58.54%) of individuals had a low risk of diabetes according to the FINDRISC score 0 - 7, while 3.61% had a score ≥ 15. The FINDRISC score showed good performance (AUC = 0.70) in identifying undiagnosed type 2 diabetics. However, the variables in the score that best predicted the likelihood of being diabetic were age (p < 0.001), daily physical activity (p = 0.004), use of antihypertensive medication (p = 0.007) and waist circumference (p < 0.001). The optimal cut-off score ≥ 7 was the best predictor of the likelihood of having T2DM. Conclusion: The Finnish Risk Score (FINDRISC) is a good predictor of the risk of dysglycemia in Burkina Faso. It is a score to be promoted in daily clinical practice because it is easy to use, affordable and non-invasive. Further studies are needed to make modifications to the FINDRISC questionnaire in case it is applied to other ethnic groups.

Diagnostic Input of Specialized Radiographic Examinations in Pediatric Setting in Ouagadougou (Burkina Faso)

Context: In spite of the development of cross-sectional medical imaging and endoscopy means, the prescription of specialized radiographic examinations is still relevant in the pediatric environment in our country. Objective: Show the contribution of specialized radiographic examinations performed in pediatric settings. Methodology: This was a retrospective descriptive study implemented over a five year-period, from June 10th, 2014 to June 10th, 2019 within the radiology department of Charles De Gaulle Pediatric Teaching Hospital in Ouagadougou. This study included the results of 192 specialized radiographic examinations collected within the concerned department. Results: The average age of the patients was 4.21 years with extremes of 8 days and 15 years. Infants (29 days to 24 months) were the predominant age group with a rate of 53.13% (n = 102 patients). Boys represented 76.51% of the sample with a sex ratio estimated at 3.25. Specialized radiographic examinations represented 0.46% of the overall imaging examinations and 0.72% of radiographic examinations performed during the study period. 67.19% of pathological examinations were reported. Colonic enema and retrograde urethrocystography (RUC) were the most performed examinations respectively accounting for 33.34% and 27.6%. The radiographic findings were consistent with the diagnostic hypotheses in 41.6% of cases. Conclusion: Specialized radiographic examinations keep their place in the exploration of several pathologies in pediatric settings.