Advances in pediatric anesthesia services over the past 10 years in French-speaking sub-Saharan Africa.

INTRODUCTION: To improve and maintain quality and safety in anesthesia, standards have been proposed regarding human resources, facilities and equipment, medications and intravenous fluids, monitoring, and the conduct of anesthesia. Compliance with these standards remains a challenge in French-speaking sub-Saharan Africa (SSA) and results in high morbidity and mortality particularly in children. This aim of this study was to assess the progress made in improving the pediatric anesthesia infrastructures, human resources, education, medications, and equipment in French-speaking SSA over the past 10 years (2013-2022). METHODS: This is a descriptive, multicenter, cross-sectional study with retrospective data collection, conducted from September 1 to November 5, 2023. Comparative data from 2012 to 2022 were collected through an online survey. Descriptive statistics were used to summarize data. RESULTS: Data were obtained from 12 countries out of 14. The number of hospitals providing pediatric surgery and anesthesia rose from 94 in 2012 to 142 in 2022 (+51%). The total number of physician anesthesiologists rose from 293 (0.1 physician anesthesiologists/100 000 inhabitants) in 2012 to 597 (0.2 physician anesthesiologists/100 000 inhabitants) in 2022 (+103.7%). Five (0.006 physician anesthesiologists/100 000 children) had completed a fellowship in pediatric anesthesia and intensive care in 2012, and 15 (0.01 physician anesthesiologists/100 000 children) in 2022 (+200%). Five physician anesthesiologists had an exclusive pediatric anesthesia practice in 2012, whereas they were 32 in 2022 (+540%). There is no specialized training in pediatric anesthesia and intensive care in any of these countries. Halothane was always available in 81.5% of the hospitals in 2012, and in 50.4% of the hospitals in 2022. Sevoflurane was always available in 5% of the hospitals in 2012, and in 36.2% in 2022. Morphine was always available in 32.2% in 2012, whereas it was available in 52.9% of them in 2022. Pediatric pulse oximeter sensors were available in 36% of the hospitals in 2012, and in 63.4% in 2022. Capnography was available in 5.3% of the hospitals in 2012, and in 48% in 2022. CONCLUSION: Progress have been made over the last 10 years in French-speaking SSA to improve infrastructures, human resources, education, medications, and equipment for pediatric anesthesia in French-speaking SSA. However, major efforts must be continued. Standards adapted to the local context should be formulated.

[Gestational diabetes revealed by inaugural diabetic ketoacidosis: about a case]. / Diabète gestationnel révélé par une acidocétose diabétique inaugural: à propos de un cas.

Ketoacidosis complicating gestational diabetes is rare and responsible for severe maternal-fetal mortality. It is an acute metabolic emergency whose management is multidisciplinary. Early diagnosis and treatment affect the vital prognosis of both the mother and the fetus. We report the case of a 27-year old pregnant woman at term, with a family history of diabetes, admitted to the emergency obstetric care with alertness problems associated with dyspnoea. The diagnosis of inaugural ketoacidosis decompensated due to severe malaria associated with gestational diabetes was retained on the basis of patient's medical history, of clinical examination and paraclinical assessment. The patient received insulin therapy, rehydration therapy, correction of electrolyte imbalance as well as antimalarial treatment. She underwent emergency cesarean section under general anesthesia and a dead-born macrosome macerated male fetus was extracted. Patient's evolution was favorable, with return of consciousness and standardization of biological parameters.

[Eclampsia at a teaching hospital in Ivory Coast: management, outcome and prognostic factors]. / Les éclampsies en centre hospitalier universitaire en Côte d'Ivoire: prise en charge, évolution et facteurs pronostics.

OBJECTIVE: To analyze the management and evolution of eclampsia in the intensive care units of Côte d'Ivoire. METHODOLOGY: Retrospective study undertaken in the intensive care units in the University Teaching Hospitals of Cocody and Yopougon from 2001 to 2006. Patients admitted to the intensive care unit for eclampsia were included in this study. The management and evolution (clinical condition at admission, medications used, type of delivery, type of anesthesia, mortality, sequellae, clinical evolution) were studied. Factors predicting mortality were identified with the calculation of odds ratio and confidence interval. The Chi-square of Mantel Haenszel was used with an alpha error = 5%. RESULTS: The study involved 313 patients with a mean age of 22.7 +/- 6.1 yr. Diazepam was the most frequently used anticonvulsant (50.5% of cases), and dihydralazine was the preferred anti-hypertensive agent (50.2%). Cesarean delivery occurred in 58.5% of cases and vaginal delivery in 41.5%. General anesthesia with intubation was used in 79% of Cesarean deliveries and spinal anaesthesia with bupivacaine 0.5% (dose: 10 in 12.5 mg) in 21%. Treatment was not followed regularly in 31.3% of cases. Maternal and perinatal mortality was 16% and 16.1%, respectively. Risk factors for mortality were: admission from outside of a university hospital, admission delay >12 hr, Glasgow score

[Antibiotherapy in osteoarticular infections in children suffering from hemoglobinopathy in the University Teaching Hospital of Yopougon]. / L'antibiothérapie dans les infections ostéo-articulaires chez l'enfant atteint d'hémoglobinopathie au CHU de Yopougon.

OBJECTIVE: The objective of this work was to evaluate antibiotherapy in osteo-articular infections found in children with henioglobinopathy, by identifying the antibiotics used and their mode of action. Their cost and efficacy were also assessed. MATERIALS AND METHOD: The study was retrospective and it took place in the haematology unit, the paediatric surgical department and the central pharmacy of the University Teaching Hospital of Yopougon from 1991 through 1998. Thirty-two medical records of children, carriers of osteo-articular infections (OAI), were selected. Amongst these patients, most of whom had sickle-cell anaemia (97%), 50% were homozygous. Osteomyelitis represented 78% of these infections (salmonella infections being the most frequent cause, amounting to 35%). RESULTS: Fifteen types of antibiotics amongst 57 from 5 families of drugs were used, with biotherapy (association of two drugs) being used in 69% of cases. The association of pefloxacine and netilmicine was the most frequently used and it was found to be the most expensive. The treatment was judged efficacious, with a satisfactory result in 75% of cases, based on the clinical criteria. DISCUSSION: Bitherapy is the type of treatment, which is often of concern to many authors and relies on the general consensus surrounding the most likely emergency treatment of osteo-articular infections. Certain particularities are worth mentioning regarding this utilisation: the multiplicity of the molecules due to frequent rupture of hospital stock; the use of fluoroquinolones exceptionally prescribed in children under 15. CONCLUSION: This antibiotherapy is justified owing to its efficacy on a sensitive issue concerning a pathology with grave sequellae, where long-term monitoring is necessary.