Trends of and factors associated with cesarean section related surgical site infections in Guinea

Since the adoption of free obstetric care policy in Guinea in 2011, no study has examined the surgical site infections in maternity facilities. The objective of this study was to assess the trends of and factors associated with surgical site infection following cesarean section in Guinean maternity facilities from 2013 to 2015. This was a retrospective cohort study using routine medical data from ten facilities. Overall, the incidence of surgical site infections following cesarean section showed a declining trend across the three periods (10% in 2013, 7% in 2014 and 5% in 2015, P<0.001). Women who underwent cesarean section in 2014 (AOR: 0.70; 95%CI: 0.57-0.84) and 2015 (AOR: 0.43; 95%CI: 0.34-0.55) were less likely to develop surgical site infections during hospital stay than women operated in 2013. In the contrary, women with comorbidities were more likely to experience surgical site infection (AOR: 1.54; 95% CI: 1.25-1.90) than those who did not have comorbidities. The reductions achieved in 2014 and 2015 (during the Ebola outbreak) should be sustained in the post-Ebola context

Maternal and child health services in the context of the ebola virus disease: health care workers' knowledge, attitudes and practices in rural Guinea

The objective of this study was to document maternal and child health care workers' knowledge, attitudes and practices on service delivery before, during and after the 2014 EVD outbreak in rural Guinea. We conducted a descriptive cross-sectional study in ten health districts between October and December 2015, using a standardized self-administered questionnaire. Overall 299 CHWs (94% response rate) participated in the study, including nurses/health technicians (49%), midwives (23%), managers (16%) and physicians (12%). Prior to the EVD outbreak, 87% of CHWs directly engaged in managing febrile cases within the facility, while the majority (89% and 63%) referred such cases to another facility and/or EVD treatment centre during and after the EVD outbreak, respectively. Compared to the period before the EVD outbreak when approximately half of CHWs (49%) reported systematically measuring body temperature prior to providing any care to patients, most CHWs reported doing so during (98%) and after the EVD outbreak (88%). The main challenges encountered were the lack of capacity to screen for EVD cases within the facility (39%) and the lack of relevant equipment (10%). The majority (91%) of HCWs reported a decrease in the use of services during the EVD outbreak while an increase was reported by 72% of respondents in the period following the EVD outbreak. Infection prevention and control measures established during the EVD outbreak have substantially improved self-reported provider practices for maternal and child health services in rural Guinea. However, more efforts are needed to maintain and sustain the gain achieved

SNPs on ABC Transporters and in vivo Malaria Parasite Non Clearance after Chloroquine Treatment in Malian Children.

Background: pfcrt K76T mutation was demonstrated to play a central role in the P. falciparum resistance to chloroquine. Aim: To find any association between mutant alleles of pfcrt K76T, pfmdr1 N86Y, pfG30 and pfG47 and the in vivo parasite non clearance after chloroquine treatment in Mali. Methodology: We carried out a chloroquine efficacy study in 196 children suffering from uncomplicated malaria in a rural village of Kollé, Mali, using WHO protocol. Subjects were treated with standard dose of chloroquine and followed for 14 days. Parasite DNA was extracted from finger prick blood blotted onto filter paper and genotypes were analyzed by different PCR methods. Results: The mutant alleles pfcrt 76T and pfmdr1 86Y were associated with parasite non clearance with p=0.00001 and 0.03 respectively. However, the association of SNPs on pfG30 and pfG47 genes with parasite non clearance was not statistically significant, p =0.43 and 0.57 respectively. The logistic regression analysis showed that the mutant allele pfmdr186Y contributed positively to the pfcrt 76T parasites non clearance (p=0.02). Conclusion: These findings have shown that pfcrt76T and pfmdr1 86Y alleles are associated with the in vivo parasite non clearance, but not SNPs on the new putative transporters genes.