Management of Acute Malnutrition in Children Aged 0 to 24 Months Boulbinet Health Center

Introduction: Malnutrition is a pathological state resulting from the relative deficiency or excess of one or more essential nutrients, whether manifested clinically or detected only by biochemical, anthropometric or physiological analyses. The overall objective was to assess the quality of management of acute malnutrition in children aged 0 - 24 months at the Boulbinet health center. Methodology: This was a prospective descriptive study lasting six (06) months from May 5 to October 5, 2018. The study included all children aged 0 to 24 months. Results: Acute malnutrition in children aged 0 - 24 months accounted for 2.11% of cases. The sex ratio was 1.41 in favor of males. The mean age of our patients was 5 months 7 days, with extremes of 1 month and 6 months. The majority came from Ra toma (40.24%). Exclusive breastfeeding was most common (54.02%). The main clinical signs were: pallor 49.42%, diarrhea 46.67, oral lesions37.96%. SAM represented 89.66% and MAM 10.34%. Most associated pathologies: anemia 49.42% and oral candidiasis 37.93%. In terms of outcome, we recorded 56.32% cures, 20.69% deaths, 18.39% dropouts and 4.60% cures. Conclusion: Improving the quality of care for malnourished children aged 0 - 24 months requires raising awareness among mothers and the general public of the consequences of malnutrition.

High Blood Pressure and Pregnancy: Epidemiological, Diagnostic, Therapeutic and Prognostic Aspects at the Maternity Unit of the Institute of Social Hygiene of Dakar (Senegal)

Objectives: To specify the epidemiological and clinical profile of the patients, to determine the methods of management and to evaluate the maternal and perinatal prognosis in the association of arterial hypertension and pregnancy (HTA) at the Institute of Social Hygiene of Dakar. Material and Methods: This was a retrospective, descriptive and analytical study on the management of the association of hypertension and pregnancy in the maternity ward of the Institute of Social Hygiene of Dakar between January 1st, 2019 and on December 31st, 2020. Results: During the study period, we recorded 326 cases of hypertension associated with pregnancy among the 4290 pregnant women, i.e. a frequency of 7.6%. The epidemiological profile of the patients was that of a woman with an average age of 29, nulliparous (48.2%), married (99.1%), at a low socioeconomic level (61.3%) and with a personal history preeclampsia (14.4%). Most patients (83.1%) were evacuated or referred with pre-ec- lampsia as the main reason (40.8%). The average gestational age was 37 weeks of amenorrhea (SA) with extremes of 20 SA 6 days and 41 SA 5 days. Term pregnancies were the most represented (76.7%). Prenatal follow-up (CPN) was carried out in 319 patients (97.8%) with an average number of CPN of 3 and extremes of 1 and 9. Severe diastolic and severe systolic hypertension concerned respectively 19.3% and 16, 9% of patients. One hundred and eighty patients (55.2%) presented with oliguria. Strip albuminuria was performed in 235 patients (72.1%). It found 3 or more crosses in 38.3% of cases. We recorded 53 cases of anemia (16.3%), 16 cases of significant proteinuria (5%), hepatic cytolysis in 22 patients (6.7%), thrombocytopenia in 37 patients (11.3%), and 43 cases of hyperuricaemia (13.2%). Obstetric ultrasound found 36 cases of severe oligohydramnios (11%), 8 twin pregnancies (2.4%) and an umbilical Doppler anomaly in 10 patients (3.1%). Pre-eclampsia was the most common clinical form (70.5%), followed by chronic hypertension (15.1%) and pregnancy-induced hypertension (14.4%). In our study, 32 patients (9.8%) had received resuscitation. The most used anti-hypertensives were alpha methyl-dopa (46.1%) and nicardipine (24.5%). The obstetrical treatment consisted of uterine evacuation which was most often done by caesarean section (63.1%). Maternal complications were dominated by retroplacental hematoma (16.3%) followed by eclampsia (7.4%) and HELLP syndrome (6.7%). We have not recorded any maternal deaths. Prematurity (19.3%) and intrauterine growth restriction (IUGR) (16.3%) were the most common perinatal complications. Severe and moderate neonatal asphyxia concerned respectively 14.8% and 14.4% of newborns. The birth weight was on average 2400 grams with extremes of 400 and 4500 grams. Low birth weight accounted for 49.5% of the sample. One hundred and twelve newborns (34.4%) were referred to neonatology most often for neonatal asphyxia (29.2%). We recorded 37 fetal deaths in utero (11.3%) and 10 neonatal deaths (3.1%), representing a perinatal mortality of 168.5 per 1000 live births. During the postnatal follow-up, we noted a normalization of the blood pressure figures in 98.8% of the patients. Contraception was instituted in 150 patients (46.1%). These were most often progestogen implants (32.2%) or intrauterine device (IUD) (11.7%). The choice of delivery route was significantly associated with the clinical form. Indeed, caesarean section was more frequent in case of preeclampsia compared to pregnancy-induced hypertension (p = 0.03). Maternal and perinatal complications such as HELLP syndrome (86.4%), PRH (64.2%), eclampsia (79.2%) and UFID (23.6%) were more frequent in cases severe preeclampsia (p = 0.028, p = 0.0001). Conclusion: The association of hypertension and pregnancy is frequent in our practice. Its prognosis is marked by the risk of prematurity, IUGR and maternal complications.

Ovarian Cancer: Clinical, Therapeutic and Prognostic Aspects at the University Hospital Center of Conakry in Guinea

Background: Ovarian cancer is the seventh most common cancer in women in the world and is the leading cause of death among gynecological cancers. Objective: The objective of this study was to describe the clinical, therapeutic and prognostic aspects of ovarian cancer in the both Gynecology-Obstetrics departments Donka and Ignace Deen of the Conakry University Hospital. Methods: This was a retrospective, descriptive study lasting 12 years from January 1, 2011 to December 31, 2022, covering the files of patients treated for ovarian cancer in the both Gynecology-Obstetrics departments Donka and Ignace Deen. The study focused on the epidemiological, clinical, histological and therapeutic aspects of the disease. Results: In total, 135 files of patients with ovarian cancer were collected out of the 3821 files of gynecological pathologies recorded in the two departments during the study period, either a frequency of 3.5%. Among gynecological and breast cancers, ovarian cancer represented 9.1%. The average age of the patients was 46.3± 17.8 years and the average parity was 4 ± 3. The revealing clinical signs were dominated by pelvic pain (92.6%) and increased abdominal volume (53.3%). The diagnosis of the disease was made mainly at stages III and IV (71.9%). The most common histological type was serous papillary adenocarcinoma (57.0%). Exclusive surgical treatment was performed in 8.1% of patients, surgery combined with chemotherapy in 63.0% of patients and exclusive chemotherapy in 11.1% of patients. After an average follow-up of 42 months, 29 patients out of the 96 operated on were alive (30.2%), 51 had died (53.1%) and 16 patients were lost to follow-up (16.7%). Conclusion: Ovarian cancer is the third most common cancer in both departments. Diagnosis is often late and the prognosis is poor.

Outcome of Acute Kidney Injury in Pregnancy in N’Djamena, Chad

Introduction: Acute kidney injury (AKI) is a relatively rare but serious complication during pregnancy. It is often the consequence of a delay or poor management of a given complication that constitutes as a public health problem in developing countries. The objective of our study was to determine the epidemiological, diagnostic, therapeutic and evolutionary aspects of obstetric acute kidney injury in Chad. Methodology: This was a cross-sectional study with descriptive and analytical aims over a period of 6 months from June 1, 2020 to November 30, 2020 and conducted in the Gyneco-Obstetric Emergency Department of the Mother and Child University Hospital in N’Djamena. All patients admitted for obstetric AKI and requiring hemodialysis were referred to the Nephrology Department of the Renaissance University Hospital. AKI was defined according to the KDIGO 2012 classification. All pregnant women with more than 20 weeks of gestation until immediately postpartum who were admitted for acute kidney injury were included in the study. Results: During our work, 1238 patients were collected. Among them, 56 cases of obstetric AKI were included, representing a hospital prevalence of 4.5%. The average age was 26.1 ± 5.8 years (16 and 37 years). The majority of our patients were primigravidas which was 42%, rural women represented 35.7% of our sample and nearly 67.8% of pregnancies did not benefit from regular prenatal consultation. AKI during the 3rd trimester was found in 42.9% of cases. Oligo-anuria was present in 28.6% of cases. Acute tubular necrosis was found in 52 cases. It was secondary to preeclampsia in 60.7%, to HELLP syndrome in 17.9% and to a hemorrhagic delivery complicating a retroplacental hematoma in 7.1%. According to the KDIGO 2012 classification, Stages 1, 2 and 3 represented 32%, 23% and 25% of cases, respectively. Hemodialysis was initiated in 1/4 of cases. Recovery of renal function was complete in 78.6% of cases and partial in 7.1%. We recorded eight (14.3%) maternal deaths and twenty-four cases of in-utero fetal death. The average length of hospital stay was 9.21 ± 5 days (2 and 20 days). Conclusion: Obstetric AKI remains a serious complication of pregnancy and postpartum. Despite the good renal prognosis, severe preeclampsia is the main cause. Prevention through monitoring pregnancies would be the most effective measure.

Primary fibromatosis of the breast in a 13 years old girl

The mammary fibromatosis is a rare clinical entity. The etiopathogeny remains unclear. The clinical and radiological characteristics of this injury are often worrying within the main differential diagnosis of the mammary carcinoma;however only the histological examination can confirm the diagnosis. It is characterized by a strictly local evolution with an infiltration and recidivism tendancy without giving metastasis. The treatment is basically surgical. We report here-with an observed case of 13-year-old girl, presenting with a huge tumor located in the left breast with ulceration of the nipple-areolar plate. The diagnosis is confirmed by the histological study. The treatment consisted of a mastectomy. Suites are simple. In view of the clinical evidence of the literature, we call back the difficulties of management of this tumor.

Acute Genital Peritonitis in Brazzaville, Congo

Genital peritonitis is rare in daily surgical practice in Congo-Brazzaville. Clandestine abortions are incriminated. The purpose of the study is to analyze the epidemiological, etiological, diagnostic and therapeutic aspects of genital peritonitis. A retrospective and case series study was realized in departments of Digestive Surgery and Gynecology-Obstetrics of the University Hospital of Brazzaville. The inclusion criteria for the diagnosis of peritonitis were abdominal pain, fever, transit disturbances and signs of peritoneal irritation. The parameters studied were: age, etiological circumstances, anatomical lesions, type of surgical treatment and evolution. During the study period (July 1, 2015-December 31, 2017), 306 patients were admitted to both departments for acute generalized peritonitis. Among them, a genital cause was incriminated in 18 (5.9%) patients. The mean age was 27.6 ± 3.1 years. At the parity and gestational level, 93% of patients had at least two pregnancies, but not more than the second trimester. In addition, 50% of the patients had an induced miscarriage, due to uterine and intestinal lesions. Induced miscarriages accounted for half of etiological circumstances. Physical examination of the abdomen revealed abdominal contracture in 61.1% of cases. Main visceral lesions were uterine perforation (55.5%) followed by rupture of tubo-ovarian abscess (38.9%). The operative follow-up was simple in 83.33% of cases. In conclusion, genital peritonitis remains unfrequented. Median laparotomy has been the main therapeutic approach in our context where emergency laparoscopic surgery is not yet common.

The Rate of Caesarean Sections in Burkina Faso’s Regional and University Hospitals According to the Classification System of Robson’s Ten Groups

Background: Quality assurance in labor and delivery is needed. The method must be simple and consistent, and be of universal value. The 10-Group Classification System is a simple method providing a common starting point for further detailed analysis within which all perinatal events and outcomes can be measured and compared. Objective: The purpose of this study was to analyze cesarean section (CS) rates using the classification system of Robson’s ten groups and to identify the main contributors to the overall CS rate in Burkina Faso’s regional and university hospitals. Materials and Method: A cross-sectional study with retrospective collection was carried out. All women who gave birth between July 1, 2017 and June 30, 2018, in the Regional Hospital Centres (RHC) and University Hospital Centres (UHC) of Burkina Faso were classified according to the Robson ten-group method. The overall CS rates and in each Robson group were calculated, as well as the contribution of each group to the overall CS rate. Results: The CS rate was 26.5% (8543 out of 32,240 deliveries) during the study period. nulliparous women with single term pregnancy in cephalic presentation during spontaneous labour (group 1), multiparous women with single pregnancy in cephalic presentation, gestational age ≥37SA, spontaneous labour (group 3) and multiparous women with previous CS (group 5) were the main contributors (67.7%) to the overall CS rate. In addition, we observed a variation in CS rates between different hospitals, especially among women with full-term pregnancies in cephalic presentation without previous CS (groups 1 to 4), showing large differences in emergency obstetric and neonatal care across the country. Conclusions: Women in groups 1, 3 and 5 were the most important contributors to the overall CS rate in Burkina Faso. It appears that efforts to reduce the overall rate of CS should focus on vaginal delivery on the scarred uterus, reduction of CS rates in nulliparous women with full-term pregnancy in cephalic presentation (groups 1) and proper monitoring of multiparous women with full-term pregnancy in spontaneous labour (group 3).

Epidemio-Clinical Approach and Prognosis of Teenage Delivery in the Commune VI Du District of Bamako in Mali

Objective: To describe the epidemiological aspects, clinical characteristics, aspects of childbirth and to determine the maternal and perinatal prognosis during the delivery of adolescent girls at the reference health centre of commune VI of the district of Bamako in Mali. Materials and Methods: This was a descriptive, cross-sectional, analytical case-control study from January 1 to December 31, 2018, or 12 months with prospective data collection. Results: During the study period from January 01 to December 31, 2018, we recorded 1768 teenage deliveries out of a total of 9012 deliveries, a frequency of 19.61%. The average age of the cases was 17.4 ± 1 years. Single adolescent girls accounted for 14.67% (OR = 3.05, P = 0.001) unintended pregnancies (11.67% vs. 2.3%;P = 0.000007;OR = 5.52), the non-completion of the antenatal consultation (14.67% vs. 5.33%;P = 0.0001;preterm births (14.33% vs. 7.67%);P = 0.01;OR = 2.5), anaemia (7.33% vs. 3%;P = 0.009;OR = 2.01), instrumental extractions (P = 0.00008, OR = 2.87), perineal tears (P = 0.0016;OR = 3.05), mechanical dystocies (P = 0.0039);low birth weights (P = 0.039;OR = 2.2) were found to be significantly higher in adolescent girls than adults. Conclusion: Teenage versus adult births are associated with many more maternal-fetal complications.

Risk Factors for Birth Asphyxia in Togo: A Case-Control Study

Background: Birth Asphyxia (BA) is one of the leading causes of neonatal death in developing countries. In Togo, 30.55% of neonatal deaths were related to BA and caused by several risk factors. The purpose of this piece of work is to analyse the antepartum, intrapartum, and foetal risk factors of BA. Methods: This is a case control study, conducted from 1st December 2019 to 28th February 2020 in obstetrics wards and at neonatal intensive care of paediatric ward at the Sylvanus Olympio university teaching hospital (CHU-SO) in Lomé, Togo. Neonates diagnosed with BA (Apgar score < 7 at 5th minute) were considered as “cases” (N = 200) while neonates born either with normal vaginal delivery or by cesarean section having no abnormality were considered as “control” (N = 200). Results: The prevalence rate of BA was 9.13%. Age (p = 0.0391), gravidity (p = 0.0040), type of facility for prenatal follow-up (p < 0.0001), use of Long-lasting impregnated mosquito nets (LLIN) (p < 0.0001), notion of maternal fever (p < 0.0001) and chronic pathology (p < 0.0001) were related to occurrence of BA. Significant antepartum risk factors observed were age < 25 years (OR = 1.15;CI 95% [0.66 - 1.98], p = 0.0391), primigravidity (OR = 1.82;95% CI [0.86 - 3.85], 0.0040), prenatal follow-up in a private one (OR = 1.62;CI95% [1.03 - 12.55], p < 0.0001), non-use of LLIN (OR = 2.50;CI 95% [1.61 - 3.88], p < 0.0001), maternal fever (OR = 3.73;CI 95% [2.33 - 5.97], p < 0.0001) and existence of maternal chronic pathology (OR = 36.0, 95% [4.94 - 262.60], p < 0.0001). Significant intrapartum risk factors were PRM (OR = 7.89;CI 95% [2.62 - 14.02], p < 0.0001), abnormal AF (OR = 5.40;CI 95% [2.57 - 11.38],], p < 0.0001), long labour (OR = 2.11;CI 95% [1.34 - 3.34],], p = 0.0004), use of oxytocin (OR = 2.14;CI 95% [1.38 - 3.32], p = 0.0003), and spontaneous vaginal (OR = 1.76;CI 95% [1.14 - 2.72,], p = 0.0008]). Significant Foetal risk factors were male gender (OR = 1.55;CI 95% [1.03 - 2.33], p = 0.0423), preterm babies (OR = 8.83;CI 95% [3.79 - 20.60], p < 0.0001) and baby birth weight < 2500 gr (OR = 2.96;CI 95% [1.82 - 4.79], p < 0.0001). The Sarnat score had shown anoxo-ischemic encephalopathy stage III (19.00%), corresponding to 87.80% of case fatality rate (p < 0.0001). Conclusion: Various risk factors lead to BA in Lomé. Early identification of high-risk cases with improved antenatal and perinatal care can decrease the high mortality of BA in Togo.