Hémorragie du post-partum immédiat : technique de méchage

Le Méchage intra-utérin (MIU) est une technique d'étape importante pour stopper l'Hémorragie du post-partum (HPP); il est pratiqué après l'inefficacité des moyens médicaux et avant l'étape chirurgicale. Les préalables pour une PEC efficace sont évoqués puis une description détaillée de la technique de méchage est faite, terminée par une étude portant sur 265 cas d'HPP sur 7 ans dont 119 cas de méchage. Avec 93,3% de taux de succès et un coût très faible, le MIU est très efficace dans la PEC de l'HPP. Aucune complication à court ou long terme n'est constatée dans la cohorte présentée. 58 cas de grossesses spontanées sont constatés par la suite

[The impact of urbanization on malaria infection rate and parasite density in children in the municipality of Yopougon, Abidjan (Côte d'Ivoire)]. / Impact de l'urbanisation sur l'indice plasmodique et les densités parasitaires chez les enfants de 0 à 5 ans dans la commune de Yopougon, Abidjan (Côte d'Ivoire).

From September 23-30, 2005, we conducted a cross-sectional study in six townships of Yopougon, a municipality of Abidjan. These townships were grouped in three levels of urbanization (village, precarious township, and residential township). The main objective of this survey was to determine the impact of urbanization on the malaria infection (parasite) rate and parasite density, and their consequences on the heterogeneity of malaria transmission in urban Abidjan. Specifically we compared these rates in all three urbanization levels, selecting two townships for each level to take environmental specificities observed from previous data into account. The study included 400 households per township. All children younger than 5 years in these households were included. Thick and thin blood smears were taken for each child on slides, and each slide was examined by microscope after staining. The malaria infection rate was 21.8%, indicating mesoendemic malaria. Its distribution varied significantly between the three urbanization levels. Malaria parasite densities also varied significantly between them. These results confirm the involvement of urbanization in the heterogeneity of malaria transmission in the city of Abidjan.

[Uterine packing efficacy in postpartum hemorrhage. About 99 cases. The experience of a French hospital level 2 A]. / Le méchage intra-utérin: utilité et place dans la prise en charge de l'hémorragie du post-partum immédiat. À propos de 99 cas. L'expérience d'un centre hospitalier français de niveau 2 A.

OBJECTIVE: To show place and usefulness of intra-uterine compression in management of post-partum haemorrhage (PPH). MATERIAL AND METHODS: Retrospective cohort study, monocentric, including all consecutive cases of PPH during four years in an obstetric department of level IIa. The compression technique was the use of intra-uterine meshes, and efficacy was defined as a total and immediate bleeding interruption. Apart of meshes, patients received sulprostone then ocytocine and antibiotics. RESULTS: The rate of PPH was 3.8% on 3913 deliveries. One hundred and fifty patients with PPH were managed following CNGOF guidelines. Ninety-nine patients were also treated with intra-uterine meshes during 24hours. The rate of mesh success was 91.9%. Sixty-two cases of subsequent pregnancies were also reported. CONCLUSION: In case of PPH, intra-uterine compression using meshes is simple, cheap and efficient. That technique could avoid the use of invasive surgical procedures and a safer post-natal transfer.

[Entomological evaluation of the risk of urban outbreak of yellow fever in 2008 in Abidjan, Côte d'Ivoire]. / Évaluation entomologique du risque d'épidémie urbaine de fièvre jaune survenue en 2008 dans le district d'Abidjan, Côte d'Ivoire.

In April 2008, seven years after the outbreak of 2001, Abidjan faced another epidemic of yellow fever. Three weeks after the case detected in the commune of Treichville at 28(th) of April 2008, two other cases were notified, the first one in Port-Bouet and the second one in Cocody located respectively in the south and north of the city of Abidjan. In order to determine a large-scale risk of urban yellow fever epidemic, epidemiological and entomological investigations were conducted by the Ministry of Health and Public Hygiene of Cote d'Ivoire with the support of the Global Outbreak Alert and Response Network. Entomological investigations revealed the predominance of Aedes ægypti, urban vector of yellow fever in neighborhood visited with larval density indices between 2 and 5, indicating the existence of a sufficient density of the vector for cause an explosion of the epidemic. In fact, the massive influx of people from inside cities towards Abidjan caused by the socio-political crisis occurred in the country in 2002, the deterioration of environment with the creation of more breeding sites of Ae. ægypti as corollary and the circulation of the virus at mosquito level were many factors favorable to the yellow fever outbreak in Abidjan city.

[Culex quinquefasciatus sensitivity to insecticides in relation to the urbanization level and sewage water in Yopougon, a township of Abidjan (Côte-d'Ivoire)]. / Sensibilité de Culex quinquefasciatus aux pyréthrinoïdes en relation avec le niveau d'urbanisation et l'évacuation des eaux usées dans la commune de Yopougon à Abidjan (Côte-d'Ivoire).

This survey, conducted from July 2003 to June 2004, was to assess the variation of the level of sensitivity of Cx. quinquefasciatus to the pyrethroids recommended for the impregnation of the mosquito nets, in the township of Yopougon situated in the Northwest of Abidjan city in relation with the bed of a drainage channel of sewage water that passes through the township from the north to the south. Five districts have been chosen along this channel according to the level of urbanization, for the withdrawal of the pre-imaginal populations of Cx. quinquefasciatus in collections of stagnant sewage water of this township. The female Cx. quinquefasciatus aged three to five days from the exits of the insectarium have been exposed to papers impregnated with deltamethrin 0.05%, permethrin 1% and DDT 4% in view of the diagnosis of a possible resistance of these populations to these insecticides. The populations of Cx. quinquefasciatus proved to be resistant to the three insecticides used, in four districts. On the other hand, the population of Cx. quinquefasciatus from the district "Zone industrielle," situated upstream of the channel, proved to be sensitive to permethrin 1%, and a drastic decrease of sensitivity of the same mosquito has been observed with deltamethrin 0.05% and DDT 4%.

[Resistance of Anopheles gambiae s.l. to pyrethroids and DDT at Tiassalékro, an irrigated rice-growing village in the southern forest of Ivory Coast]. / Résistance d'Anopheles gambiae s.l. aux pyréthrinoïdes et au DDT à Tiassalékro, village de riziculture irriguée en zone sud forestière de Côte-d'Ivoire.

An assessment of the sensitivity of Anopheles gambiae s.l.to three pyrethroids (alphacypermethrin, permethrin, deltamethrin) and DDT has been carried out with a laboratory strain (Kisumu reference sensitive strain) and a wild strain (Tiassalékro strain) using larvae from an irrigated rice-growing area of Tiassalékro, located in the southern forest of Ivory Coast. The sensitivity tests were performed according to the standard WHO cylinder tests with adult female A. gambiae s.l. aged 2 to 4 days. The results showed that the strain of Tiassalékro is resistant to the three tested pyrethroids and DDT. The molecular forms M and S were identified, with a predominance of M form. The resistance mechanism involved is the Kdr mutation. In this region, control measures against malaria vectors by using bed nets impregnated with these insecticides or household sprays could be compromised.

[Micronecta sp (Corixidae) and Diplonychus sp (Belostomatidae), two aquatic Hemiptera hosts and/or potential vectors of Mycobacterium ulcerans (pathogenic agent of Buruli ulcer) in Cote d'Ivoire]. / Micronecta sp (Corixidae) et Diplonychus sp (Belostomatidae), deux hémiptères aquatiques hôtes et/ou vecteurs potentiels de Mycobacterium ulcerans agent pathogène de l'ulcère de Buruli en Côte d'Lvoire.

Buruli ulcer is currently a major public health problem in Côte d'Ivoire. It is a neglected tropical disease closely associated with aquatic environments. Aquatic insects of the Hemiptera order have been implicated in human transmission of Mycobacterium ulcerans, the pathogenic agent of Buruli ulcer. The purpose of this preliminary study using the polymerase chain reaction (PCR) method was to evaluate aquatic insects in Sokrogbo, a village in the Tiassalé sanitary district where Buruli ulcer is endemic. Findings identified two water bugs hosting Mycobacterium ulcerans, i.e., one of the Micronecta genus in the Corixidae family and another of the Diplonychus genus in the Belostomatidae family. The PCR technique used revealed the molecular signatures of M. ulcerans in tissue from these two insects. Based on these findings, these two water bugs can be considered as potential hosts and/or vectors of M. ulcerans in the study zone. Unlike Diplonychus sp., this is the first report to describe Micronecta sp as a host of M. ulcerans. Further investigation will be needed to assess the role of these two water bugs in human transmission of M. ulcerans in Côte d'Ivoire.

[Entomological investigations conducted around ten cases of yellow fever in 2009 in the Denguélé sanitary region, Côte-d'Ivoire]. / Investigations entomologiques menées autour de dix cas de fièvre jaune survenus en 2009 dans la région sanitaire du Denguélé, Côte-d'Ivoire.

In November 2009, ten suspicious cases of yellow fever, including six deaths, were notified in the region of Denguélé, in the northwest of Côte-d'Ivoire. In order to evaluate the extent of yellow fever virus circulation and the risk for local people, a mission of entomological investigation was carried out by the Ministry of Health and Public Hygiene of Côte-d'Ivoire. Entomological investigations were conducted in the villages of confirmed cases (Banakoro and Tron-Touba) and the centers of consultation and hospitalization of cases during illness. Breteau index and recipient index were quasi nil. Aedes aegypti was absent among the captured mosquitoes. On the other hand, Aedes luteocephalus and Aedes opok were present at Banakoro and Tron-Touba with respective average biting rates of 0.8 and 0.6 bite/man/twilight. This situation of epidemic in the northwest of Côte-d'Ivoire could be explained by the deterioration of Denguélé region's health system which is a consequence of the war started in the country in 2002 and which has lowered the immunity of the population.

[Specific diversity and culicidian nuisance in the villages of N'gatty and Allaba in laguna area of Ivory Coast]. / Diversité spécifique et nuisance culicidienne dans les villages de N'gatty et d'Allaba en milieu côtier lagunaire de Côte-d'Ivoire.

Entomological surveys were undertaken between June and December 2006 in N'gatty and Allaba. These villages are located in southern Ivory Coast in a laguna area in Dabou department. In these villages, there are large swampy areas, which have caused the multiplication of anthropophilic Culicidae. Mosquitoes have been collected at preimaginal stage at the time of the larval prospecting and at adult stage through human landing catch. Larval collections have been made using the classic method of "dipping". Larvae have been identified to the genus level. Then, they have been bred in the laboratory to identify adults. Adults collection has been made once a month during three consecutive nights by human landing catch inside houses. Adults have been identified to the specific level. Eight genera of mosquitoes have been collected in these two villages: Aedes, Anopheles, Coquillettidia, Culex, Eretmapodites, Mansonia, Toxorhynchites and Uranotaenia. Twenty-four species have been listed during this stu y. The genus Mansonia is the most predominant with 86% (N = 15,811) and 80% (N = 1,385), respectively, in N'gatty and Allaba. The average biting rate per day varies between N'gatty and Allaba. It is estimated to 308 bites per human per night (b/h/n) in N'gatty and 72 b/h/n in Allaba. In these villages, mosquito nuisance is mainly due to Mansonia with 264 b/h/n and 58 b/h/n, respectively, in N'gatty and Allaba. However, Anopheles gambiae s.l. average rate was 12 b/h/n in N'gatty and 2 b/h/n in Allaba.

[Entomological investigation following the re-emergence of yellow fever in 2008 in Abidjan area (Côte d'Ivoire)]. / Investigation entomologique à la suite de la réémergence de la fièvre jaune en 2008 à Abidjan (Côte d'Ivoire).

In April 2008, Abidjan was again faced with another case of yellow fever after the epidemic of 2001 causing mass immunization campaign. In order to evaluate the extent of amaril virus circulation and the risk for local people, an entomological investigation was carried out by the Ministry of Health and Public Hygiene of Côte d'Ivoire. At "Entent" area of Treichville, Breteau index was estimated at 34, recipient index at 20% and house index at 25%. Those indexes were respectively 53, 21 and 31% at "Vridi canal" of Port Bouet. In the both neighborhood, Aedes aegypti accounted for more than 80% of mosquitoes caught and more than 90% of mosquitoes adults obtained from larval breeding. This new situation of epidemic risk could be explained by several factors including the reception of 70% of forced migration people caused by the crisis in the country occurred in 2002, the probable drop of preventive immunization, the environment deterioration creating of more breeding sites of Ae. aegypti.

[Malaria transmission in Tiassalékro, a irrigated rice growing village situated in the South forest area of Côte d'Ivoire]. / Transmission du paludisme a Tiassalèkro, village de riziculture irriguèe situé en zone sud forestière de Côte d'Ivoire.

A longitudinal entomological study was carried out from January to June 2007 in the rice-growing area of Tiassaékro, a village located in the forest, South of Côte d'Ivoire. The study was based on samples of mosquitoes caught on human volunteers indoors and outdoors. During the 6 months of the study 29481 female mosquitoes were caught. The average biting rate was 272.9 bites per man per night (b/m/n). An. gambiae was the most predominant with 79.1% of mosquitoes caught. The average biting rate of An. gambiae was of 216 b/m/n. The biting activity of this species was noticed between 8 p.m. and 6 a.m. The estimated average sporozoite index was 0.32% (n = 3423 dissected). The inoculation rate was 0.69 ib/m/n with the highest rate (1.99 ib//n) recorded in April. The entomological parameters of the transmission are influenced by the different stages of rice growing.

[Prescribing and drug utilization at community health centers]. / Pratiques de prescription dans les centres de sante communautaires (CSCOM) et utilisation des midicaments par les populations.

The rationalization of the prescription and the good use of the drugs generally constitute a major problem in the health facilities. The present survey led in November 2002 in Mali assessed the practices of prescription and the use of the drugs by the populations. The indicators of drugs use rational have been measured from 600 drawn prescriptions randomly select at the level of 20 community health center (CSCOM) retained at random in the regions of Ségou, Sikasso, Mopti and the District of Bamako. The means of drugs by order (2.8), the percentages of prescription with antibiotic (61.6%) and injectable drugs (35%) are raised in relation to the normative values of WHO (Wold Health Organization). The rate of conformity to the treatments standardized estimated on exploitation of consultations registers in the centers is estimated to 0.5% for the simple diarrhoea, 13.5% for the acute respiratory infections (ARI) without pneumonia and 60.5% for the pneumonia. On 293 patients in the households our survey permitted to estimate to 84.6% the observance of the treatment by the persons having bought the prescribed drugs totality. The percentage of antibiotics prescription and injectable drugs, and the big insufficiency in the non respect of the treatment standard constitutes some practices potentially to high risk justifying the necessity of an urgent training to the rational prescription.

[Systematic serologic detection of treponema at the antivenereal centre of the National Institute of Public Health in Abidjan (Côte-d'Ivoire), from 1994 to 1999]. / Dépistage systématique sérologique des tréponé- matoses au dispensaire antivénérien (DAV) de l'Ins- titut national d'hygiène publique (INHP) d'Abidjan (Côte-d'Ivoire) de 1994 a 1999.

We conducted a medical records review on 11,662 patients consulting the antivenereal clinic of Treichville from 1994 to 1999. The main objective of the study was to analyse the data from systematic screening of syphilis in this specialized centre for sexual transmitted infection. The results of this study were: 162 (1.39%) patients had active syphilis; we noticed a decreasing incidence of syphilis during the last six years, 98.77% of the patients had symptoms of sexual transmitted diseases that did not directly evoke syphilis. In summary we can say that syphilis remains an important problem in the sexually transmitted infections consultation. The screening of syphilis must continue and needs to be extended to other services, because of the high frequency of asymptomatic forms and the existence of severe complications.

[Impact of aerial mosquito control on populations of Aedes aegypti in two communities of Abidjan]. / Impact de la demoustication sur les populations d'Aedes aegypti de deux communes de la ville d'Abidjan.

INTRODUCTION: From May 2nd to 13th 1997, an aerial mosquito control took place in Abidjan. This mosquitoes control has been undertaken by the municipality. He made two Ultra Low Volume (ULV) applications of d eltamethrine (K O thrineR). The second application took place one week after the first one. Each application used 2g per ha of deltamethrine diluted with gasoil. MATERIALS AND METHOD: We evaluated the impact of this mosquitoes control on Aedes aegypti populations in two districts : Port-Bouët and Yopougon. We compared the bite number per person and per day obtained by catching mosquitoes on human from 16 pm to midnight. RESULTS: We thus captured 308 females of mosquitoes with 33% of Aedes aegypti representing 5.58 bites per person and per day in Port-Bouët and 2.5 bites per person and per day in yopougon. We noticed that 49% of Aedes aegypti live and bite inside. The bite number per person and per day has been reduce to 37.5% after treatment in Port-Bouët and to 66% in Yopougon. But we noted that five days after treatment the bite number per person and per day was the same level before the treatment. Aerial application of insecticide has more impact on Aedes aegypti population biting outside than the population biting inside. CONCLUSION: Aerial application of insecticide reduces the bite number of mosquitoes per person and per day and in particular of Aedes aegypti but this reduction does not last long. This reduction is better on outside population than the inside one; so bio ecology studies are required before aerial application of insecticide.

[Detection and management of the yellow fever epidemic in the Ivory Coast, 2001]. / Detection et gestion de l'epidemie de fievre jaune en Cote d'Ivoire, 2001.

From March to December 2001, an outbreak of yellow fever was observed in Cote d'Ivoire. Sentinel surveillance for hemorrhagic fever allowed detection of the first case in the Duekoue health district in the heavily wooded western part of the country. A weekly reporting system was established. For each suspected case recorded and reported to the Epidemiological Surveillance Department at the National Institute of Public Hygiene, a sample was collected and sent for confirmation at the Pasteur Institute of the Cote d'Ivoire. The outbreak progressed from West to East reaching Abidjan, the economic capital of the country located in the southeast. The epidemic emergency plan consisted of setting up a crisis committee to implement epidemiological, entomological and virological surveillance, mass vaccination campaigns in areas around confirmed cases, and vector control. A total of 280 cases were reported including 32 confirmed cases and 6 deaths. Eleven out of 62 districts were affected with most cases occurring in cities with more than 10000 inhabitants. Over 3.7 million persons were vaccinated for an overall coverage of 92.2% in the areas where campaigns were carried out. As a result of this outbreak, surveillance for potentially epidemic diseases has been reinforced and surveillance of viral transmission is now being considered. A vaccination program for adults has also been established.