Management of community acquired pneumonia (CAP) in children: Clinical practice guidelines by the Paediatric Association of Nigeria (PAN

The Paediatric Association of Nigeria first published management guideline for community-acquired pneumonia in 2015 and covered available evidence at that time. This update represents a review of available recent evidence statements regarding the management of pneumonia in children, while at the same time incorporating relevant materials from the first edition of the guideline. The guideline is developed to assist clinicians in the care of children with CAP. The recommendations provided in this guideline may not be the only approach to management, since there are considerable variations among children in the clinical course of CAP.The goal of this guideline is to reduce morbidity and mortality rate of CAP in children by providing recommendations that may be relevant in assisting clinicians to make timely diagnosis and institute appropriate antibiotic therapy of children with CAP. Summarized below are recommendations made in the new 2021 CAP guideline. As part of the recommendations, the quality of the evidence is provided and the grade of the recommendation indicated.The details of the background, methods and evidence summaries that support each of these recommendations can be found in the full text of the guideline.

Use of laboratory test results in patient management by clinicians in Malawi

Background: Malawi has a high burden of infectious disease. The expansion of programmes targeting these diseases requires a strong laboratory infrastructure to support both diagnosis and treatment.Objectives: To assess the use of laboratory test results in patient management and to determine the requirements for improving laboratory services. Methods: A cross-sectional study was conducted in 2012 to survey practising clinicians.Two hospitals were purposively selected for observations of clinicians ordering laboratory tests. Twelve management-level key informants were interviewed. Descriptive statistics were conducted. Results: A total of 242 clinicians were identified and 216 (89%) were interviewed. Of these; 189 (87%) reported doubting laboratory test results at some point. Clinicians most often doubted the quality of haematology (67%); followed by malaria (53%) and CD4 (22%) test results. A total of 151 (70%) clinicians reported using laboratory tests results in patient management. Use of laboratory test results at all times in patient management varied by the type of health facility (P 0.001). Ninety-one percent of clinicians reported that laboratories required infrastructure improvement. During 97 observations of clinicians' use of laboratory test results; 80 tests were ordered; and 73 (91%) of these were used in patient management. Key informants reported that the quality of laboratory services was good and useful; but that services were often unavailable. Conclusion: Gaps in the public laboratory system were evident. Key recommendations to enhance the use of laboratory test results in patient management were to strengthen the supply chain; reduce turn-around times; improve the test menu and improve the laboratory infrastructure

Management of Mild to Moderate Acne Vulgaris

Acne is a chronic inflammatory disease of the pilosebaceous units. It is the most common diagnosis in dermatology and regularly affects adolescents and young adults. Acne can be mild; moderate or severe. Treatment includes topical keratolytics; topical retinoids; antibiotics; hormonal therapy and systemic retinoids in severe cases

Healthcare-Associated Infection in Burkina Faso: an Assessment in a District Hospital

In developing countries; few data are available on healthcare-associated infections. In Burkina Faso; there has been a failure to take into account risk management and patient safety in the quality assurance program. The main objective of our study was to carry out an assessment of healthcare-associated infection in a first level hospital. We conducted a crosssectional study in June 2011 in the care units of Ziniare District Hospital (Ziniare; Burkina Faso). The hospital has been divided in three components: i) hospital population (care providers; in-patients and patients' guardians); ii) healthcare and services organization; iii) hospital environment. We included: care providers of the clinical services; hospital inpatients and patients' guardians; hospitalization infrastructure and nursing units; and all the documents relating to standards and protocols. Data collection has been done by direct observation; interviews and biological samples taken at different settings. In hospital population; care providers and patients' guardians represented a high source of infection: adherence to hygiene practice on the part of care providers was low (12/19); and no patients' guardian experienced good conditions of staying in the hospital. In healthcare and services organization; healthcare waste management represented a high-risk source of infection. In hospital environment; hygiene level of the infrastructure in the hospital rooms was low (6.67). Prevalence of isolated bacteria was 71.8. Urinary-tract catheters infections were the most significant in our sample; followed by surgical-site infections. In total; 56.26(9/19) of germs were -Lactamase producers (ESBL). They were represented by Escherichia coli and Klebsiella pneumoniae. Our analysis identified clearly healthcare-associated infection as a problem in Ziniare district hospital. Hence; a national program of quality assurance in the hospitals should now integrate the risk infectious management of healthcare-associated infections

ART Patients' Satisfaction Level Regarding Comprehensive HIV and AIDS Care Management and Antiretroviral Treatment Programme in Pretoria

The purpose of this cross- sectional study was to investigate patients' satisfaction levels regarding access to; and quality of; comprehensive human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) care management and antiretroviral treatment programme (CCMT). A total of 402 patients were selected from three hospitals by stratified random sampling techniques. A self-administered questionnaire was used to assess patients' satisfaction levels. Almost all the patients ( 93) gave positive response towards access to CCMT services; and mentioned that the doctor was kind; polite; and showed them respect; the nurse was kind; polite; and showed them respect; doctors provided full attention during consultations; and they felt comfortable talking to the healthcare provider about their problems. More than a tenth (12) of the patients were dissatisfied with regard to privacy during consultation; and another 13 regarded the receptionist or booking clerk as unkind; impolite; disrespectful and unhelpful towards them. The majority ( 90) of the patients were very satisfied; or satisfied; with obtaining medication; with the explanation on how to take it; and with the counselling and privacy. Patients were mostly dissatisfied with HIV-specific material (19); assessment of financial status (19); and explanation of laboratory results (8). Access to; and quality of; the CCMT programme in the three hospitals in the Tshwane District is excellent; and in line with what has been prescribed in the operational plan. The availability of HIV-specific material has to be strengthened in order to help educate patients; so that they can better access healthcare facilities; and especially patients on the CCMT programme

Preparedness for Mass Casualties of Road Traffic Crashes in Uganda: Assessing the Surge Capacity of Highway General Hospitals

In Uganda; increase in human and vehicular populations against a non-expanding road infrastructure; breakdown in enforcement of traffic regulations and poor vehicle quality contribute to the high rate of casualties from road traffic crashes on highways; with over 2000 deaths per year. Highway hospitals should be the vanguard of preparedness to manage mass surgical casualties; to minimize road crash mortality. Objectives: To determine the capacity of Uganda's highway hospitals to manage mass surgical casualties. Methods: A descriptive; cross-sectional study of emergency surgical services of ten key highway general hospitals. Results: The hospitals had adequate capacity to manage uncomplicated solitary cases of injury. However; they had severe shortage of essential surgical equipment (9.6of expected). Staffing was poor (64.3of the recommended) and the staff lacked the life-saving surgical skills needed in a frontline hospital. There was perennial shortage of essential supplies e.g. blood; surgical gloves; intravenous fluids; oxygen and medicines. There was inadequate space for emergency surgery and only few staff members reside within easy reach for quick mobilization. Overall surge capacity was rated at below 50of what is required. Conclusion: Ugandan highway hospitals lack the technical and infrastructural capacity to handle mass casualties resulting from road traffic crashes. Surge capacity is below 50of that required to manage mass casualties. Recommendations: The key recommendations of this paper are: re-organisation of the outpatient departments to cater for mass emergency surgical cases; deployment of qualified surgeons in highway hospitals; training of hospital staff in life-saving surgical skills; targeted supervision of highway hospitals; training of managers in disaster preparedness; and improved funding for highway hospitals. THEME TWO: HOSPITALS

Focus Group Discussion with Private Sector Doctors in the eThekwini Metro of KwaZulu-Natal on the Management of HIV/AIDS Patients

Background: Highly active antiretroviral treatment (HAART) is essential in the treatment of HIV/AIDS; however; a holistic approach to HIV/AIDS management is important. This study was done to confirm the findings of two studies done previously in the eThekwini Metro of KwaZulu-Natal on private sector doctors' management of HIV-infected patients and to obtain morein in depth information about their nonpharmacological management of HIV-infected patients. Methods: Two focus group discussions were conducted amongst private sector doctors in the eThekwini Metro; after obtaining their consent. The focus group sessions were scripted; audio-taped and transcribed verbatim. Prevalent themes were identified and reported. Results: Eight doctors participated. Of the total patient population seen annually by the majority of the doctors; an average of 43.8 was HIV infected. Doctors in this study managed their patients both pharmacologically and nonpharmacologically. Seventy-five per cent of doctors indicated that the taste of medicine played an important role in nonadherence to treatment; but all agreed that cultural beliefs also influenced the patient's adherence to medication. Theft of medicines and the outof-stock situation prevented antiretroviral drug access; which impacted negatively on adherence. Five doctors mentioned that depressed patients abused alcohol; resulting in nonadherence. One doctor reported that he used the biopsychosocial approach to improve adherence in his patients. Doctors indicated that the disability grant given by the South African Government caused patients not to adhere to treatment in order to maintain a CD4 count of 200 or less so as to qualify for the grant. Conclusions: The study confirmed the previous study findings in that it showed that private sector doctors manage their HIV-infected patients both pharmacologically and nonpharmacologically. It further provided new and interesting information with regard to the nonpharmacological methods employed in HIV/AIDS management; that is the incorporation of cultural beliefs in the management of HIV-infected patients to improve adherence to treatment; and the role of the disability grant and pharmaceutical formulations in contributing to nonadherence by HIV-infected patients

Integration of Services for Victims of Child Sexual Abuse at the University Teaching Hospital One-Stop Centre

"Objective. To improve care of sexually abused children by establishment of a ""One Stop Centre"" at the University Teaching Hospital. Methodology. Prior to opening of the One Stop Centre; a management team comprising of clinical departmental heads and a technical group of professionals (health workers; police; psychosocial counselors lawyers and media) were put in place. The team evaluated and identified gaps and weaknesses on the management of sexually abused children prevailing in Zambia. A manual was produced which would be used to train all professionals manning a One Stop Centre. A team of consultants from abroad were identified to offer need based training activities and a database was developed. Results. A multidisciplinary team comprising of health workers; police and psychosocial counselors now man the centre. The centre is assisted by lawyers as and when required. UTH is offering training to other areas of the country to establish similar services by using a Trainer of Trainers model. A comprehensive database has been established for Lusaka province. Conclusion. For establishment of a One Stop Centre; there needs to be a core group comprising of managers as well as a technical team committed to the management and protection of sexually abused children."

Scaling up antiretroviral therapy for HIV-infected children in Côte d'Ivoire: determinants of survival and loss to programme

Objective: To investigate deaths and losses to follow-up in a programme designed to scale up antiretroviral therapy (ART) for HIV- infected children in Cote d'Ivoire. Methods Between 2004 and 2007; HIV-exposed children at 19 centres were offered free HIV serum tests (polymerase chain reaction tests in those aged 18 months) and ART. Computerized monitoring was used to determine: (i) the number of confirmed HIV infections; (ii) losses to the programme (i.e. death or loss to follow-up) before ART; (iii) mortality and loss-to-programme rates during 12 months of ART; and (iv) determinants of mortality and losses to the programme. Findings The analysis included 3876 ART-naive children. Of the 1766 with HIV-1 infections (17aged 18 months); 124 (7.0) died; 52 (2.9) left the programme; 354 (20) were lost to follow-up before ART; 259 (15) remained in care without ART; and 977 (55) started ART (median age: 63 months). The overall mortality rate during ART was significantly higher in the first 3 months than in months 4-12: 32.8 and 6.9 per 100 child-years of follow-up; respectively. Loss-to-programme rates were roughly double mortality rates and followed the same trend with duration of ART. Independent predictors of 12-month mortality on ART were pre-ART weight- for-age z-score -2; percentage of CD4+ T lymphocytes 10; World Health Organization HIV/AIDS clinical stage 3 or 4; and blood haemoglobin 8 g/dl. Conclusion The large-scale programme to scale up paediatric ART in Cote d'Ivoire was effective. However; ART was often given too late; and early mortality and losses to programme before and just after ART initiation were major problems

Prise en charge chirurgicale du cancer de l'ovaire au CHU de Brazzaville

Les cancers de l'ovaire sont ses maladies graves au pronostic souvent sombre. Ils occupent la premiere place parmi les causes de deces par cancer gynecologique. Au CHU de Brazzaville; ces cancers ont ete diagnostiques au stade avance d'ou les difficultes dans leur prise en charge chirurgicale. En consequence notre objectif a ete d'etudier la place et les caracteres de la chirurgie dans la prise en charge de ces cancers. En 11 annees (1er janvier 1998-31 decembre 2008) 9946 patientes ont ete operes dans notre servie dont 29 pour le cancer de l'ovaire soit 0;29. Parmi ces patientes 28 etaient a des stades avances (IIc; III et IV). La chirurgie radicale elargie avec curage a ete pratiquee dans 62;1des cas qui etaient aux stades II et IV. Nous avons enregistre 17 complications dont quatre deces aux 10eme et 18eme jours post-operatoires. La pratique des examens echographiques systematiques pourraient ameliorer les resultats du traitement chirurgical en proposant des gestes moins mutilants devant des stades moins avances

Audit of child and adolescent psychiatry in a teaching hospital in Nigeria: prevalence, pattern and implication for improved services

Objective. This study aimed to identify the socio-demographic characteristics; pattern of psychiatric disorders and management of children and adolescents before the setting up of a dedicated child and adolescent unit at the University of Ilorin Teaching Hospital; Ilorin; Nigeria.Method. A retrospective study; carried out at the Department of Behavioural Sciences of the hospital.Results. The age range of the 94 children seen was 7 - 19 years; with a mean of 16.38 years (standard deviation 2.49); 82 were aged 14 - 19 years and 17 7 - 13 years; while only 1 child was under 7 years old. The majority of the children lived with their parents in monogamous families with 5 or more children. The majority of the parents were educated and gainfully employed.The major diagnoses were schizophrenia (50); delirium (15) and seizure disorders (9). Of the patients 64 were managed as outpatients and 36 as inpatients. Drug therapy was involved in the majority of cases; and the most frequently prescribed medication was haloperidol; atypical antipsychotics such as risperidone being used in only 8 of cases.Most of the patients were referred from the primary care-associated departments of the hospital; i.e. the general outpatient department (40) and the internal medicine and paediatrics departments (29). Referrals from welfare; judicial and educational institutions were uncommon (3).Conclusion. The pattern of patient presentation and management had not changed to any great extent over the past two decades. The introduction of a child and adolescent psychiatric unit is expected to improve consultation/liaison psychiatry and also child psychiatric service delivery and research. Understanding of the prevalence and pattern of presentation of mental disorders and their management is also expected to help improve the strategic planning and organisation of the new clinic

Management of TB in the Private Sector in Khartoum; Sudan: Quality and Impact on TB Control

Introduction: Sudan has a large and growing private health sector. No survey was done in Sudan to show the extent of the use of private health care services by the population. Also precise data on tuberculosis (TB) diagnosis and treatment in the private sector are not available. Material and methods A facility-based cross-sectional survey was carried out during February2007-June 2007 in Khartoum state; whereby consented private physicians working in the all private clinics (n=110) were interviewed. Results This study showed that a large private sector exist in the country and deliver care to TB patients and reported the non-adherence of this sector to National Tuberculosis Program (NTP) guidelines. 59.1of the interviewed physicians correctly mentioned the TB treatment regimens; only 8(12.3) physicians that reported management of TB patients actually prescribed these regimens to their patients. Similarly; only 10(15.4) physicians requested sputum smear examination for TB diagnosis. Conclusion A considerable proportion of cases is inadequately managed by the private sector and is not notified to NTP. The information delivered by this study can be used to develop a workable Public-private mix (PPM) model with the private sector

Impact therapeutique de l'interferon alpha dans la prise en charge des patients atteints de leucemie myeloide chronique

Contexte : Dix annees apres l'utilisation de l'interferon alpha dans le traitement de la leucemie chronique; dans le service d'hematologie clinique du CHU de yopougon; nous faisons le point de cette therapeutique. Objectif : nous nous proposons a travers cette etude d'evaluer la reponse therapeutique des patients atteints de leucemie myeloide chronique en phase chronique et d'etudier l'impact de ce traitement sur la survie. Materiel et methodes : nous avons effectue une etude retrospective descriptive et analytique concernant 40 patients porteurs de leucemie myeloide chronique. Resultats : l'age moyen etait de 39.05 ans et le sex ratio de 0.9. Les patients ont beneficie dans 60du bras Hydroxyuree + Interferon alpha + Cytosine Arabinoside et dans 40de l'association Hydroxyuree + Interferon alpha. La reponse hematologique complete a ete observee dans 85.5des cas. La reponse cytogenetique a ete documentee seulement dans deux cas; et il s'agissait de reponses completes. Sur le plan evolutif; il a ete note 27.5de deces lies a une transformation blastique. Les effets secondaires ont ete marques par la survenue d'alopecie; d'herpes et de syndrome grippal. La mediane de survie observee etait de 68.233 mois soit 5.68 ans. L'age; le niveau socioeconomique; le delai de prise en charge; le protocole therapeutique; la duree du traitement; la compliance influencaient la reponse therapeutique. Conclusion : de nombreux facteurs influencent la reponse au traitement

Aspects évolutifs de la maladie cirrhotique dans un service d'hépato gastro-entérologie au Mali

Le but principal de notre étude était d'évaluer l'évolution de la maladie cirrhotique à un an de suivi. Il s'agissait d'une étude prospective et longitudinale de Janvier 2005 à Décembre 2006 dans le service d'Hépato Gastroentérologie du CHU Gabriel TOURE. Les malades ont bénéficié d'un suivi d'un an au cours duquel ils ont été vus en consultation tous les 3 mois. Au terme de l'étude 57 malades ont été colligés. L'âge moyen des patients était de 41,5 + 15,3 ans. L'ascite a été le motif de consultation dans près de la moitié des cas (49,1%). L'ascite et l'ictère étaient les signes les plus retrouvés à l'examen physique avec respectivement 70,2% et 54,4%. L'apparition ou l'aggravation d'une ascite a été la complication la plus retrouvée au cours de l'année avec 67,5% des cas (p = 0,002). La mortalité globale a été de 82,5% et surtout élevée au cours des trois premiers mois, due en majorité au CHC, à l'hémorragie digestive et l'encéphalopathie hépatique avec respectivement 33,3%, 27,3% et 15,2%. La douleur abdominale, l'ascite et l'ictère ont une valeur prédictive de mortalité élevée (p compris entre 3.10 -3 et 10 -7). Une consultation précoce, une observance thérapeutique et une prise en charge correcte des complications de la cirrhose pourraient réduire cette mortalité

Review of Obstetrics Genito-urinary Fistulae in the University of Calabar Teaching Hospital Calabar; Nigeria

Obstetric fistulae with Urinary incontinence are one of the most distressing maternal morbidities. It is associated with physical and social deprivation such as wife abandonment and violent reactions against the victims particularly in the developing countries of the world. To study the demographic and reproductive profiles as well as management of patientswith obstetric fistulae inUCTH;Calabar;Nigeria. Afiver-year retrospective study of case records of 37 patients managed inMaternity Annex of University of Calabar Teaching Hospital; Calabar Nigeria for obstetric genito-urinary fistulae was carried out. One in every 122 parturients during the period had fistula. Eleven (29.7) were teenagers. Many patients weremarried (54.1); nulliparous (59.4); come from low socioeconomic class (72.9) and did not utilize modern obstetric facilities properly. Many cases resulted from prolonged obstructed labour (51.4) and 70.2presented with total incontinence of urine. Eighteen (48.7)were diagnosed within 6 month of delivery. Themain types encountered includedwere vesico-vaginal (34.4) or complex (10.8) fistulaewho were manage conservatively (21.6) or with bladder repairs. Majority (29.7) were referred for further treatment. Parturient in Calabar still suffer from this age long obstetric morbidity mainly due to poor utilization of modern obstetric care facilities. Results of treatment are largely unsatisfactory; therefore resources should be channeled towards prevention

Management of Febrile Neutropenia in Patients Receiving Chemotherapy for Solid Tumors: a Retrospective Study of Twenty Cases from the Radiotherapy Centre; Accra; Ghana

BACKGROUND: One in ten patients on anticancer medication will develop febrile neutropenia irrespective of tumour type. There is need to protect our patients from this fatal condition while optimising chemotherapy. This may be difficult for a poor country. OBJECTIVE: To assess the management of cancer patients with febrile neutropenia in a low resource setting. METHODS: Records of 20 cancer patients with febrile neutropenia (FN) over a three-year period were retrospectively analysed. Data retrieved included age; sex; type of cancer and number of cycles of chemotherapy taken. Other parameters included initial temperature; site of infection; absolute neutrophil count (ANC) at presentation and antibiotic choice. Use of antifungal drugs; duration of fever and overall treatment outcome were also assessed. RESULTS: The male : female ratio was 3:2 with a median age of 24 years (range: 15 - 68 years); and a mean temperature of 38.8 oC (range 38.0-39.8 0C). Mean absolute neutrophil count was 0.2 x 109 (range: 0.0 to 0.6 x 109). Thirteen (65) received Cisplatin; five (25) received Adriamycin; two (10) received Paclitaxel or Cyclophosphomide-Methotrexate-5; Fluorouracil (CMF). Ten(50) developed FN with the first cycle of chemotherapy; and six(30) in the second cycle. Twelve (60) had oral infection; four(20) had gastroenteritis and single episodes of respiratory and urinary tract infections. Eleven (55); received Ceftriaxone and Gentamycin; five (25) cases received Levofloxacin or ciprofloxacin and Amoxicillin/clavunate + metronidazole; two cases(10); Ceftazidime and Gentamycin; two cases(10) received Meropenem. Twelve (60) patients had antifungal therapy for oral candidiassis. Eight (40) patients received growth factors. The mean fever duration was 4.5 days (range 1-10 days). Two (10) of the patients died. CONCLUSION: Febrile neutropenia in resource limited countries can be managed with good history and physical examination skills. Aminoglycosides are important components of empiric treatment in Ghana

Enquete CAP des menages sur la prise en charge de l'enfant drepanocytaire a Bamako

La drepanocytose constitue de nos jours un probleme majeur de sante publique. On trouve 5 a 20 de porteurs de cette maladie en Afrique de l'Ouest et jusqu'a 40chez certaines ethnies d'Afrique Centrale (Congo; Zaire) et du Nigeria (Begue). Au Mali sa prevalence est estimee a 12 avec 3pour la forme homozygote. C'est une maladie connue et bien documentee sur le plan scientifique et sa prise en charge est de mieux en mieux codifiee de nos jours; ce qui contribue a l'amelioration de la qualite de la vie. Face a cette situation; le CREDOS a initie cette etude dans l'objectif d'evaluer les connaissances des meres pour une meilleure prise en charge de la drepano- cytose dans les menages. Il s'agit d'une etude transversale a passage unique realisee au niveau des menages dans 6 communes du district de Bamako. Nous avons enquete 360 parents d'enfants ages de 0 a 5 ans; qui ont ete interroges selon la methode de sondage en grappes. L'etude a permis de montrer que 95;8des meres enquetees connaissent la drepanocytose. Par ailleurs 63;9des meres ne connaissent pas les complications de la drepanocytose et 58les causes. En cas de decouverte de la drepanocytose; 58;3des meres ont declare vouloir recourir a une structure sanitaire en premiere intention; 18;3a l'automedication et 13;9aux guerisseurs traditionnels. Devant une crise drepanocytaire 56ont declare avoir recours a la medecine moderne contre 15;2aux traditherapeutes. L'implication des menages dans la prise en charge de l'enfant drepanocytose souffre d'une connaissance limitee de la cause; des signes cliniques; des complications de cette maladie par les parents. Pour une meilleure connaissance de cette pathologie par les familles; l'information; l'education des populations a travers des messages IEC sont necessaires

Le cancer du col de l'uterus : aspects epidemiologiques et prise en charge en milieu africain

Objectifs : Ameliorer la prise en charge et le pronostic du cancer du col de l'uterus en milieu africain. Materiels et methodes : Il s'agissait d'une etude retrospective et descriptive realisee dans le service de gynecologie et d'obstetrique du CHU de Cocody. Elle s'est deroulee sur cinq ans; du 1er Janvier 2002 au 31 Decembre 2006. Elle a portee sur 171 cas de cancer du col de l'uterus histologiquement confirme. Resultats: La frequence du cancer du col de l'uterus dans cette etude etait de 1;7. La moyenne d'age des patientes etait de 48;5 ans. Elles avaient un age compris entre 41 et 50 ans dans 38;6des cas. Les multipares representaient 73;1avec une majorite de 38;6pour 7 enfants et plus. Le milieu socioeconomique etait bas (72). Les patientes mariees et divorcees representaient 63;2. La precocite des rapports sexuels et le multipartenariat sexuel etait respectivement de 77;2et 73;2. Elles avaient un antecedent d'infection sexuellement transmissible dans 70;2des cas. Le bilan d'extension a ete limite aux moyens de nos patientes. Les stades operables representaient 19;3et les stades tardifs 57;9. Seulement 8;8de nos patientes ont ete operees. Le cout theorique moyen du traitement chirurgical a ete de 298. 203 F CFA. Conclusion : Il apparait urgent que pour ameliorer la prise en charge des patientes; de lutter efficacement contre la recrudescence des facteurs de risque et d'ameliorer le plateau diagnostic et therapeutique