ABSTRACT
Since the following days of independences, the Senegalese army mission has mainly consisted in defending the national territory integrity and in ensuring the protection of the populations and their goods. In the public health system, thanks to the quality of its human resources the army intervenes specifically at every level of the health care structure. The mission assigned to the Senegalese army health unit is therefore multidimensional. In 2001, the operational budget of the army health services is estimated at 177 millions CFA F (265500 euros), its medical consumption at 212 millions CFA F (323 000 Euros) and its health expenditure at 385 millions CFA F (585 000 euros). The army supports the government health policies in different ways: on the one hand, availability of the ministry of health staff, on the other hand, the direct involvement in health care and the implementation of the national and international health programmes.
Subject(s)
Health Policy , Military Medicine , Budgets , Education, Medical/organization & administration , Health Promotion , Health Services/economics , Health Services Administration , International Cooperation , Military Medicine/economics , National Health Programs/organization & administration , Public Health Administration/economics , Research/organization & administration , SenegalABSTRACT
OBJECTIVES: It's a retrospective study in order to determine the epidemiology of neonatal bacterial infection and to evaluate the efficiency of the antibiotic protocol in University Teaching Hospital in Dakar. MATERIAL AND METHODES: From January 1st 1997 to December 31st 1998 we have registered 7461 live births, samples of blood are taken from 2312 new-born baby and they received antibiotherapy (beta-lactamine + gentamycin) at the first day based on infections risk evaluated by anamnestic criterias. The treatment is seven to one days long, the antibiotic was adapted according to the antibiogram result. RESULTS: The neonatal infection diagnosis is confirmed in 246 cases, about 33 per 1000 live births or 10.6% of newborn babies having on antibiotherapy. Most current risk factors are premature rupture of membranes (85%) and neonatal suffering (87.8%). Isolated gerras are: Klebsiella pneumoniae (61.5%), Enterobacteria (11.5 Staphylococcus (8.7%), colibacille (6%), Streptococcus (5.5%), Enterococcus (4.1%) and Pseudomonas (2.7%). Most of these germs are resistant to antibiotics currently used in first intention (ampicillin, cefotaxim, gentamycin), in particularly 95% of Klebsiella. Most efficient antibiotics are amikacin, colistin, ceftriaxon and ciprofloxacine. Deaths occurs in 48 cases with 36 in early neonatal period, 79% of mortality rate related to infection by Klebsiella. CONCLUSION: First intention antibiotherapy must be always adapted to the bacterial ecology evolution and must be more selective by using major infections risk factors. We promote early infection diagnosis by using biologic markers which reference is represented by C Reactive Protein.
Subject(s)
Bacterial Infections/epidemiology , Hospitals, University , Anti-Bacterial Agents/therapeutic use , Bacterial Infections/drug therapy , Bacterial Infections/microbiology , Drug Resistance, Microbial , Enterobacter/isolation & purification , Enterococcus/isolation & purification , Female , Fetal Membranes, Premature Rupture , Gentamicins/therapeutic use , Humans , Infant, Newborn , Klebsiella pneumoniae/isolation & purification , Lactams , Pregnancy , Prognosis , Pseudomonas/isolation & purification , Retrospective Studies , Risk Factors , Senegal/epidemiology , Staphylococcus/isolation & purification , Streptococcus/isolation & purificationABSTRACT
Uterine rupture is a complication occurring mostly during labour. Spontaneous rupture on gravid uterus is rare. We report the 1st case observed on a scarred uterus in 32 week gestation in Gyn/Obs clinique at Dakar University Hospital. Favorable factors found were: segmento-corporeal scar time, poor technical repair. Then, we pose the problems of follow up of these pregnancy involving scarred uterus and discuss the interest of evaluating prognosis of the quality of the uterine scar.
