Problem of Invasive Cervical Cancer’s Management in the Obstetric Gynecologic Department of the National Hospital Donka, Conakry

Introduction: The objectives of this study were to describe the diagnostic and therapeutic aspects, identify problems and evaluate the survival rate of invasive cervical cancer patients. Patients and method: It was a retrospective descriptive study of 7 years from 1 January 2006 to 31 December 2012. Records of invasive cervical cancer were histologically confirmed. The clinical and therapeutic data collected were transferred to Epi info 7 and SSPS version 18 software with a significance level p as used to provide information on the vital condition after confidential agreement. Kaplan Meier was used to assess the overall survival rate. Results: Invasive cancer of the cervix was frequent (58.79%) with an annual median rate of 16.7%, with extremes of 5.8% and 20.6%. 88.70% of the patients was referred from regions of the country (54.02%);the median age was 50 years with extremes of 16 and 84 years and a peak of 29.6% between 35 and 44 years;76.20% were housewives;uneducated women were about 60.12%;Stage III was about 45.3%. Most of the patients were confirmed histologically after 30 days (68%). The means of treatment were surgery about 91 (29.26%), palliation 75 (24.12%), radiotherapy 59 (18.97%) and chemotherapy 41 (13.18%) with surgery (9, 65%) or radiotherapy (4.82%). The main complication was metrorrhagia, 164 cases (56.55%), with overall survival rate of 51.8% at 2 years and 5.1% at 5 years. Conclusion: Invasive cervical cancer in later stages is treated for low survival in the context of our work. Early detection and treatment of precancerous lesions would reduce the incidence and mortality of this cancer.

Clinical outcomes of triceps reflecting anconeus pedicle and olecranon osteotomy approach for distal humerus intercondylar fractures

BACKGROUND The preferred treatment for distal humeral intercondylar fractures is open reduction and internal fixation.While there is consensus about the posterior approach,several posterior approaches have been developed.It is debatable as to which approach is best.AIM To compare triceps reflecting anconeus pedicle(TRAP)and olecranon osteotomy approaches for internal fixation of distal humeral intercondylar fracture.METHODS In total,40 cases of Arbeitsgemeinschaft für Osteosynthesefragen/Association of the Study of Internal Fixation type C,closed,and Gustilo type I intercondylar humeral fractures were included.Patients ranged in age from 18 years to 70 years.The patients were randomized into two groups:TRAP group and olecranon osteotomy group,with 20 cases in each.All were followed up at 6 wk,3 months,6 months,and 12 months.Functional outcomes were measured in terms of flexion-extension arc,Disabilities of Arm,Shoulder and Hand score,and Mayo Elbow Performance Score.RESULTS The mean age was 43.2 years in the TRAP group and 37.5 years in the olecranon osteotomy group.The mean operative time and mean duration of hospital stay in the TRAP group were significantly higher than in the olecranon osteotomy group(119.5 vs 111.5 min and 9.85 vs 5.45 d,respectively).The mean arc of flexion-extension,Disabilities of Arm,Shoulder and Hand score,and Mayo Elbow Performance Score were comparable without any significant difference in the groups at the 12-month follow-up(107.0 vs 106.2,18.3 vs 15.7,and 84.2 vs 86.2,respectively).Ulnar paresthesia and superficial infections were comparable in both groups(2 cases vs 3 cases and 3 cases vs 2 cases,respectively).Hardware prominence was significantly higher in the olecranon osteotomy group,mostly due to tension band wiring.CONCLUSION Both approaches were equivalent,but there is a need for further study including higher numbers of subjects and longer study duration to prove the benefits of one approach over the other.

Small Cell Neuroendocrine Carcinoma of the Vulva: Case Report and Literature Review

Background: Neuroendocrine neoplasms are those that develop from a neuroendocrine cell. They most commonly affect the lungs, gastrointestinal tract, and pancreas, being rare conditions in the female genital tract. When present, these neoplasms often manifest with nonspecific signs and symptoms such as pain, itching, swelling, single-focus lesions, bleeding, and enlargement of inguinal lymph nodes, in addition to the presence of progressively enlarging vulvar nodules. Consequently, the diagnostic investigation involves histopathological examination and confirmation through immunohistochemistry. Objective: To present a comprehensive understanding of this rarely studied pathology. The primary objective is to provide valuable insights that could aid in the future development of universally applicable treatment guidelines. Case Presentation: A 57-year-old female, with no prior comorbidities, menopause at 36, who presented with a left vulvar nodule accompanied by intense pain and swelling, later diagnosed with small cell neuroendocrine carcinoma in the vulva. Conclusion: This case report highlights the importance of enhancing our knowledge regarding small cell neuroendocrine carcinoma in the vulva, given its scarcity in medical literature. The information presented here underscores the need for standardized diagnostic and treatment approaches, paving the way for future consensus on managing this uncommon but challenging neoplasm.

EVALUATION ON QUALITY OF LIFE FOR GYNECOLOGIC CANCER PATIENTS

Objective: To compare the quality of life (QOL) for gynecologic cancer patients with different cancer sites and to assess the impact of patients’ characteristics, disease parameters, and treatments on the subscale and overall QOL. Methods: A prospective study was conducted including 146 gynecologic cancer patients. QOL data were collected using the general Functional Assessment of Cancer Therapy (FACT- G) QOL questionnaire. Results: Advanced stage patients showed significantly poor physical well-being, emotional well-being, and functional well-being, as compared with early stage patients. QOL was reported higher in older patients (P=0.03), patients above high school education (P=0.004), and patients with help at home (P=0.009). Conclusion: Patients with later stage, multi- modality therapy, poor education, and little social support have the most significant impairments and need more support.

Effect of age on body composition in healthy Beijing women

Objective:To explore the effect of age on body composition in healthy Beijing women. Methods:We measured body composition with dual-energy X-ray（GE Lunar Prodigy） in 316 healthy Beijing females aged 20 to 74 years（5-7 women per age）.Parameters provided by the software were as following:total body bone mineral content（BMC）,lean mass（LM）,fat mass and fat mass percentage（FM%）.Local regions measured included arm,leg,trunk,android region and gynoid region.Body mass index（BMI）,fat mass index（FMI）,free fat mass index（FFMI） and A/G were calculated.Volunteers were assigned to 6 groups according to age by every ten years a group. Results:BMC peaked during the 4th decade,LM peaked during the 5th decade,with a decline of 18.1%and 5.2%respectively at age 74 years.Total body fat mass and FM%showed a general increase with aging throughout the studied age range.Total body fat mass increased from（16±5） kg at age 20-29 years to（24±6）kg at age 70-74 years,while FM%increased from 31.3%to 39.5%.All local region FM%increased with aging at different extents. Android region FM%showed the largest raise extent（32.2%）.BMI increased gradually from 21.1 kg/m2 at age 20-29 years to 26.1 kg/m2 at age 70-74 years.FMI changed more obviously than FFMI.A/G increased from 0.85 at age 20-29 years to 1.02 at age 70-74 years.Different menstrual status in women of 40-59 years had obvious effect on A/G and BMC（P<0.05）,while it had no significant effect on BMI,body weight and waist circumference （P>0.05）. Conclusion:Aging has a great effect on body composition distribution in healthy Beijing women.

Multifactor Regulation on Expressions of MMP-9 and TIMP-1 in Endometrial Stromal Cells

Objective To investigate the regulatory effect of multifactor on the matrix metalloproteinases-9 （MMP-9） and the tissue inhibitor of metalloproteinase-1 （TIMP-1） in endometrial stromal cells. Methods The endometrial stromal cells separated from the proliferative endometrial tissues were incubated with medium alone, 17-β estradiol （E2,10^-8 mol/L）, medroxyprogesterone acetate （MPA, 10^-6 mol/L）, E2（10^-8 mol/L）＋MPA （10^-6 mol/L）, E2 （10^-8 mol/L）＋MPA （10^-6 mol/L）＋RU486 （10^-5 mol/L） or HB-EGF （10 ng/ml） for 48 h respectively. The expressions of MMP-9 and TIMP-1 were detected by in situ hybridization, immunocytochemistry, reverse transcriptase-polymerase chain reaction （RT-PCR） and Western blotting. Results Compared with control group [mRNA, 0. 729 ± 0. 090 （MMP-9） and 1.056± 0.154 （TIMP-1）; protein, 0.545 ±0.086 （MMP-9） and 0.745 ±0.154 （TIMP-1）], expressions of MMP-9 and TIMP-1 in E2 alone, progestin alone or E2 combined with progestin group were respectively：mRNA, 0.413 ± 0.069, 0.402 ± 0.073 and 0.407 ± 0.039; 0.487 ± 0.093, 0.503 ± 0.093 and 0.468 ± 0.075：protein, 0.294 ± 0.076, 0.331 ±0.064 and 0.265 ±0.049; 0.425 ±0.085, 0.397 ±0.065 and 0.435 ± 0.099. RU486 weakened the expression level of down-regulation, while HB-EGF elevated the level of MMP-9 and TIMP-1 after 48 h treatment （mRNA, 0.955 ± 0.068 and 1.396 ± 0.238; protein, 0. 780 ± 0.109 and 0.985 ± 0.165）. Conclusions 1） Both E2 and progestin can down-regulate the expressions of MMP-9 and TIMP-1 in endometrial stromal cells, but RU486 can inhibit the effect. 2） HB-EGF can elevate the level of MMP-9 and TIMP-1. 3） E2, progestin and HB-EGF have effect on the ratio of MM-P/TIMP-1.

Cytogenetic and Clinical Analysis of 340 Chinese Patients with Primary Amenorrhea

Objective To analyze the relationship between karyotypes and clinic features of patients with primary amenorrhea.Methods G banding was done for 340 patients with primary amenorrhea to facilitate individual chromosome identification,and if specific staining for certain portions of the chromosome was necessary,C banding was used.The clinical data were recorded by physical examination and ultrasound scanning.Results Karyotype analysis of the 340 patients revealed that 180(52.94%) patients had normal female karyotypes and 160(47.06%) patients had abnormal karyotypes.The abnormal karyotypes included abnormal X chromosome(150 patients),mosaic X-Y chromosome(4 patients),abnormal autosome(5 patients),and X-autosome translocation(1 patient).The main clinical manifestations in patients with primary amenorrhea were primordial or absent uterus(95.9%),invisible secondary sex features(68.8%),little or absent ovary(62.6%),and short stature(30.0%).The incidence of short stature in patients with X chromosome aberration(46%,69/150) was significangly higher that in patients with 46,XX(9.44%,17/180) as well as 46,XY(6.67%,3/45;χ2=146.25,P=0.000).All primary amenorrhea patients with deletion or break-point at Xp11.1-11.4 were short statures.Conclusions One of the main reasons of primary amenorrhea is choromosome abnormality,especially heterosome abnormality.It implies the need to routinely screen chromosomal anomalies for such patients.There might be relationship between Xp11.1-11.4 integrity and height improvement.

Comparative study of the effects of three semen preparation media on semen analysis,DNA damage and protamine deficiency,and the correlation between DNA integrity and sperm parameters

Semen samples collected from 28 male partners of infertile couples were divided into three equal aliquots and prepared with three selected media,such as PureSperm （Nidacon,Gothenburg,Sweden）,Sil-Select Plus^TM （Fertipro,Beemem,Belgium） and SpermGrad^TM（Vitrolife,Gothenburg,Sweden）. The differences in mean percentages of semen parameters were assessed by repeated measures analysis. Correlations of sperm DNA damage,as measured by terminal deoxynucleotidyl transferase dUTP nick end labeling （TUNEL） assay,and of protamine deficiency,as measured by chromomycin A3 （CMA3） staining with sperm parameters,were determined by Pearson＇s correlation. After preparation with all three media,sperm concentrations decreased （P〈0.05） while percentages of sperm with normal morphology increased （P〈0.05）. Percentages of sperm motility,rapid motility and progressive motile concentration （PMC） increased （P〈0.05） for each ofthese parameters,PureSperm preparation gave the best results （P〈0.05）. The percentage of DNA damage decreased in the PureSperm and Sil-Select Plus preparations （17.9% and 31.3%,respectively,P〈0.05） and increased in the SpermGrad preparation （56.3%,P〈0.05）. Protamine deficiency also decreased in all three kinds of media,59.3%,47.7% and 40.3% for PureSperm,Sil-Select Plus and SpermGrad preparations,respectively （P〈0.05）. The percentage of DNA-damaged sperm was negatively correlated with the percentages of sperm motility,rapid motility and PMC,but was positively correlated with static motility （P〈0.05）. This comparative study and correlation analysis revealed that PureSperm preparation yielded sperm with the best motility and the lowest percentage of protamine deficiency. The Sil-Select Plus preparation yielded sperm with the lowest amount of DNA damage. The SpermGrad preparation had a high percentage of sperm with normal morphology,but also had the highest percentage of sperm with DNA damage. Sperm DNA damage was correlated with percentages of sperm motility,rapid motility,static motility and PMC.

The expression of Hoxa10 and its regulation by sex steroids andHB-EGF at the time of implantation in the human endometrium

Objective:The aim of this study was to determine the expression of Hoxa 10 in endometrium during the menstrual cycle and their response to sex steroids and HB-EGF.Methods:Forty endometrial samples from regularly cycling women were studied.The endometrial epithelial(EEC)and stromal(ESC)cells isolated by collagenase Ⅰ digestion and mechanical dissociation was cultured from every sample.The endometrial stromal cells(ESC)were incubated with 17-beta estradiol(10-8mol/L),medroxyprogesterone acetate(MPA)(10-6mol/L),RU486(10-8mol/L)or HB-EGF(10ng/ml)for 48 hours respectively.The expression of Hoxa10 mRNA was demonstrated by reverse transcription-polymerase chain reaction(RT-PCR).Result:Hoxa10 showed a regulated cycle phase-dependent expression pattern in stromal cells and epithelial cells.Hoxa10 expression dramatically increased during the midsecretory phase of the menstrual cycle,at the time of implantation.The expression of Hoxa10 in cultured endometrial stromal cells was stimulated by estrogen,progesterone and HB-EGF.Conclusion:The cycle phase-specific expression of Hoxa10 and up-regulated by sex steroids and HB-EGF suggests a tight regulation and establishing conditions necessary for implantation.

Dermoid Ovarian Cyst Complicated with Torsion in a Girl of 11 Years Old at the Teaching Hospital Sanou Souro of Bobo-Dioulasso (Burkina Faso): About an Observation and Review of the Literature

The dermoid ovarian is an organic mild tumor. It can be revealed by an adnexal torsion which constitutes a gynecological emergency that can bring into play in a short term after the functional prognosis. We are reporting an observed case in an 11-year-old teenager who is in times peri-pubertal. The patient was presenting a painful abdomino-pelvic syndrome and a pelvic mass at the physical examination. The ultrasound was showing a right cyst mass with a right moderated hydronephrosis. A right adnexectomy was realized. The histological test after excision of the adnexal was showing a mature cystic teratoma of the right ovary with a congestive and edematous tubal fragment.

Role of Caspase and MMPs in Amniochorionic during PROM

Objective To study the role of cysteine aspartic acid-specific protease-3 （caspase-3）, matrix metalloproteinase-2 （MMP-2） and tissue inhibitor of matrix metallo proteinase- 2 （TIMP-2） in human amniochorionic membranes during premature rupture of human fetal membranes （PROM）. Methods Amniochorionic membranes were collected from the following groups of women： women with spontaneous PROM （n =8）, women with normal labor in term after vaginal delivery（n=8） and women undergoing elective repeat cesarean section （C-section） before the onset of labor and who had no complications of pregnancy （n=8）. Caspase-3 peptides were studies with use of immunohistochemistry. Messenger ribonucleic acid （mRNA） expression for MMP-2 and its specific inhibitors TIMP-2 was studied with use of reverse transcriptase-polymerase chain reaction （RT-PCR）. Results 1） The expressions of Caspase-3 peptides were 62.86 ± 3.83% in PROM group, 42.33 ± 2.99% in vaginal delivery group, and 20.97±2.94% in C- section group. There were statistically significant changes among the three groups （P〈0.05）. lmmunohistochemistry demonstrated the presence of Caspase-3 in the amniotic epithelial cells and chorionic cytotrophoblast cells. 2） The expressions of MMP-2 were 84. 92 ± 3.68% in PROM group, 32.65 ± 2.34% in vaginal delivery group, and 30. 65 ± 2. 77% in C-section group. There were statistically significant changes between PROM and C-section group （P〈0. 05）. 3） The expressions of TIMP-2 were 42. O1 ± 12.17% in PROM group, 73.01 ± 14.82% in vaginal delivery group, and 88.47 ± 6.51% in C- section group. There were statistically significant changes among the three groups （p〈0.05）. Conclusion Caspase-3 gene expressed more in PROM than in comparative group, which caused human fetal membranes cell apoptosis increased. The expression MMP-2 increased and TIMP-2 dropped in PROM, which can increase the ECM decomposing. Cell apoptosis increased and extra cellular matrix degradation dropped, which may cause weakening of the membrane＇s elasticity and tenacity, then lead to PROM.

Genistein improves the vaginal epithelium thickness in a rat model of vaginal atrophy through modulation of hormone and heat shock protein 70 levels

Objective: To investigate whether administration of genistein can improve hormonal changes [estradiol and follicle stimulating hormone (FSH)] , heat shock protein 70 (Hsp70) expression, and thickness of vaginal epithelial cells in a rat model of vaginal atrophy. Methods: Twenty-five multiparous female rats were divided into five groups, namely the control group (without ovariectomy), the ovariectomy only group, and the ovariectomy groups 1, 2 and 3 receiving genistein at the doses of 0.045, 0.090 and 0.180 mg/kg body weight/day, respectively. Estradiol, FSH, and Hsp70 expression were analyzed by using the immunoassay technique. Analysis of the thickness of the vaginal epithelium was performed by histology. Results: Ovariectomy significantly decreased estradiol levels compared to the control group (P<0.05). All doses of genistein significantly increased levels of estradiol in rats with vaginal atrophy compared to the ovariectomy only group (P<0.05). Ovariectomy significantly increased FSH levels compared to the control group (P<0.05). All three doses of genistein restored FSH levels comparable to those in the control group (P>0.05). Ovariectomy significantly increased parabasal cell Hsp70 expression compared to the control group (P<0.05). Of all the genistein doses, only the dose at 0.045 mg/kg body weight/day restored the expression of Hsp70 to levels in the control group (P>0.05). Conclusions: Genistein is able to increase the thickness of the vaginal epithelium through hormone modulation and cellular stress suppression. Genistein is beneficial in the form of a herbal or alternative food for improvement of vaginal atrophy due to menopause.

Potential of Terpenoid Bioactive Compound Isolated from Papua Ant Nest as an Alternative Ovarian Cancer Treatment

Objectives: The purpose of this study was to determine anticancer activity of terpenoid bioactive compound isolated from Papua ant nest on ovarian cancer cells in vitro. Methods: This was a laboratory experimental study which aims to determine the potential of the terpenoid bioactive compound isolated from Papua ant nest to inhibit the growth and induce apoptotic process on ovarian cancer cells (SKO-3) in vitro. Result: Terpenoid had capability to inhibit the growth of ovarian cancer cell line (SKO-3) in vitro, with IC50 of 481 ug/ml at 48 hours and 463 ug/ml at 48 hours, respectively. At a concentration of 600 ug/ml, terpenoid was able to induce apoptotic process on ovarian cancer cell lines in vitro with the apoptotic index of 30% at 24 hours, 35% at 48 hours and 37% at 72 hours, respectively. Conclusion: Terpenoid bioactive compound isolated from Papua ant nest had the ability to inhibit the growth and was able to induce apoptotic process on ovarian cancer cell lines (SKO-3) in vitro.

Attitudes, Practices and Factors Affecting the Use of the Partogram by Professionals Attending to Women in Labour and Delivery in the Bafut Health District

Introduction: Given that the provision of care to the childbirth process is not purely in the hands of educated and trained midwives, the competency in application of midwifery tools may be inadequate and consequently affect the quality of care. The Partogram is the single most important tool which has been scientifically proven to reduce maternal and foetal morbidity and mortality. Though important, many healthcare providers do not use it regularly in the monitoring of labour. Objectives: Our objectives were to determine the attitudes, practices, proportion of parturients monitored using a Partogram and the factors limiting the use of the Partogram by professionals attending to women in labour and delivery (PAWLD) in the Bafut Health District. Methods: This was a cross-sectional study carried out amongst 65 Professionals attending to women in labour and delivery in the Bafut Health District that lasted 6 months. All the data were collected by our self. First through a face to face interview with a questionnaire, secondly with an observational guide used to assess Partograms filled and lastly using delivery registers to obtain the proportion of parturients monitored with a Partogram. The data analysis was done using the statistic software Epi Info version 7 and Microsoft Excel. Results: This study revealed that 47 (72.3%) of participants had good attitudes, 34 (52%) had good practices, 375 (79.3%) parturients were monitored using a Partogram, and the lack of in-service training, low number of staff and poor knowledge on Partogram use were identified as the main limiting factors to the use of the Partogram. Being a health assistant was statistically significantly associated with having a poor practice with a p-value of 0.047 and odds ratio 5.33 [1.03 - 26.45] we obtained just 1 (1.54%) filled according to the WHO standards. Conclusions and Recommendations: In the Bafut Health District, 7 out of 10 PAWLDs have a positive attitude towards the use of the Partogram, while a poor practice is predominant as a result 4 out of 5 deliveries were monitored using a Partogram with only 1.54% of the Partograms filled according to WHO standards. The lack of in-service training, lack of PAWLD and poor knowledge on Partogram usage are the major drawbacks to the use of the Partogram. We therefore recommend that continues medical education (CME) be organised on the use of the Partogram.

Study of the Active Management of the Third Stage of Labor (AMTSL) in Four Maternity Hospitals in the Commune of Kara (Togo)

Introduction: Active management of the third period of labor (AMTSL) significantly prevents postpartum hemorrhage onset. Objective: To assess the practice of AMTSL in four maternity in the commune of Kara (Kara University Hospital Center, Kara Tomdè Regional Hospital Center, SOS Kara Mother-Child Hospital, and Adabaweré Peripheral Care Unit). Method: This was a cross-sectional descriptive study over four months, from January 28 to May 28, 2019. Two questionnaires were used for data collection: an observation and evaluation grid AMTSL practice and a questionnaire for providers. The grid was designed and adapted to the RPC repository model for emergency obstetric and neonatal care in Africa 2018. The data was processed using the Epi Info 7 software. Results: During the study period, 528 parturients were identified and 30 providers surveyed. No provider had received ongoing training in AMTSL. The practice of AMTSL was systematic at each delivery. The practice was correct in 45.8%. Factors associated with incorrect practice were relationship between caregiver-patient (p = 0.0005), placental examination (p = 0.0003), postpartum monitoring (p = 0.0001). Conclusion and Suggestion: The practice of AMTSL is systematic, but it was incorrect regardless of the provider’s qualification. Continuing education on AMTSL is necessary to prevent postpartum hemorrhage.

Prevalence of Iron Deficiency Anemia among Moroccan Pregnant Women

Background: Iron deficiency anemia in pregnant women is a serious public health problem, especially in developing countries. Aim: The objective of this study is to determine the prevalence of iron deficiency anemia and its associated factors during pregnancy in the south of Morocco. Methods: A cross-sectional study was carried in the regional Hospital Center Hassan II (RHC) from April to august 2021 in all the pregnant women coming for consultation in the maternity service. 500 pregnant women were randomly recruited for the study. A complete blood count and serum ferritin was performed in every case. They have been the subjects of a questionnaire containing their background and health data. The analysis of our data was done by the IBM SPSS Statistics 25 software. Results: The prevalence of iron deficiency anemia was 20% with a CI of (44.7% - 53.5%). The most affected age group was 25 to 35 years with a rate of 42.86%. The majority of women had mild anemia (84.61%) followed by moderate anemia (11.54%) and severe anemia (3.85%). 57.14% of the anemic pregnant women were primigravida. The results of serum ferritin made it possible to identify 70% of women deficient, with a dominance of normocytic normochromic anemia. The influence of geographic origin and place of birth was not significant. Conclusion: The prevalence of iron deficiency anemia is more or less low in our study. However, there is a high prevalence of iron deficiency and anemia during pregnancy. Statistically, there was no significant association between iron deficiency anemia and the various parameters studied, such as age, parity, origin and place of birth.

The Effect of Training and Consultancy on the Knowledge Level and Health Belief regarding the Cervical Cancer Screenings, and Participation in Screenings

Background/Aim: The purpose of this study was to examine the effect of training and consultancy on women’s knowledge level and health belief regarding the cervical cancer screenings and their participation in screenings. Materials and Methods: The study is designed as pre-experiment with one group pretest-posttest. The sample group of the study consists of 66 women. The data were collected between March and June 2011. “Personal Information Form”, “Information Form of Cervical Cancer Screenings”, “Health Belief Model Scale for Cervical Cancer and Pap Smear Test”, and “Assessment Form Concerning Taking the Pap Smear Test” were used to collect the data. Results: It was determined that at the end of all trainings, 45.5% of women took the relevant test. Among those who participated in the Pap Smear screening, the training and consultancy had an effect of 100%, booklets 100% and telephone calls 25%. The training and consultancy increased the perception of “benefit and motivation” regarding the Pap Smear test and Pap Smear decreased the perception of “barriers”. Regarding the cervical cancer, it decreased the perception of “regard/seriousness”, “susceptibility” and “health motivation”. Conclusions: It was concluded that training and consultancy change the health beliefs regarding cervical cancer screenings, increase the participation in screenings and consequently, contribute to early diagnosis.

Causes of Maternal Mortality in 2020 in the Kara Region (Togo)

Objective: Determine the maternal mortality rate, the epidemiological profile, the causes of death and the dysfunctions noted. Patients and method: This was a cross-sectional and descriptive study from January 1 to December 31, 2020. All maternal deaths during pregnancy or within 42 days after its termination fitting the World Health Organisation definition criteria that occurred in the seven districts of Kara region were included. The data were processed using Excel microsoft. Results: A total of 41 maternal deaths occurred among 23,456 live births, accounting for a maternal mortality ratio of 174.8 deaths per 100,000 live births. The followings were observed: the average age of 30 years;88% married;39% multiparous;78% housewives without income; 5% students. Hemorrhage, preeclampsia, and complications of abortion were the main direct obstetric causes, while anemia was the main indirect obstetric cause. Factors related to deaths were inadequate quality of health care and lack of universal health insurance. The various maternal death audit reports found that 94.4% of deaths were preventable. Conclusion: Most maternal deaths would be prevented in the Kara region if women during pregnancy and the postpartum period received quality health care and the community was involved in decision-making about their health.