Cholera in pregnant women: the 2012 epidemic at the reference center at the Donka National Hospital in Conakry.

Cholera is an epidemic diarrheal disease transmitted through the digestive tract; it can cause obstetric complications in pregnant women. The objective of this study was to describe the epidemiological, clinical, and therapeutic aspects of cholera in pregnant women, as well as its course, during the 2012 epidemic in Conakry. This retrospective, descriptive studied examined the records of this epidemic over a 7-month period (from May 15 to December 15, 2012). Of 2,808 cholera patients at our hospital, 80 were pregnant, that is, 2.85%. Their mean age was 30 years [range: 15-45 years], 94% were from Conakry (94%), and 69% were in the third trimester of pregnancy. Choleriform diarrhea and vomiting were the main signs, found respectively in 100% and 95% of the women; dehydration was mild for 16%, moderate for 45%, and severe for 39%. Support consisted of rehydration, by plans A (16%), B (45%) or C (39%) and antibiotic treatment based on erythromycin (85%), doxycycline (14%), or azithromycin (1%). Other drugs that were used included phloroglucinol-trimethylphloroglucinol (Spasfon(®)) for 45%, acetaminophen for 65%, and iron/folic acid for 1% of cases. The major obstetric complications were 4 intrauterine deaths (5%), 2 cases of threatened abortion (2%), 1 preterm delivery (1%), and 1 maternal death. The cholera outbreak in 2012 affected a large number of pregnant women in Conakry, most during their third trimester. The classic clinical manifestations were associated with obstetric complications and maternal-fetal risks.

La mortalité maternelle à l'hôpital régional de Kindia : facteurs épidémiologiques et axes stratégiques d'intervention

Objectifs. Calculer le ratio de la mortalité maternelle, identifier les caractéristiques épidémiologiques et proposer des axes stratégiques d'intervention. Méthodes. Il s'agit d'une étude descriptive et analytique à recrutement rétrospectif, réalisée du 1erJanvier 1998 au 31 Décembre 2001 à l'Hôpital Régional de Kindia (HRK). Elle a concerné tous les cas de décès maternels survenus au service de gynécologie obstétrique de l'Hôpital Régional de Kindia. Les caractéristiques épidémiologiques, la provenance, la période du décès et le caractère évitable ou non du décès ont été analysés. Le calcul statistique a été fait à l'aide du test de chi² avec une signifi cativité p < 0,05. Résultats. Il y a eu 128 cas de décès matériels pour 6586 naissances vivantes soit 1944 décès pour 100.000 nouveaux-nés. L'âge moyen de patientes était 28,2 ans avec un écart type de 10 ans et des extrêmes de 15 et 44 ans. Les patientes de la tranche d'âge 15-19 ans (31,3%) analphabètes (62,5%), primipares (42,9%), évacuées (76,6%) et celles n'ayant effectuées aucune CPN (56,3%) étaient les plus touchées. Conclusion. La réduction de la mortalité passerait par l'identification des causes de décès, l'offre des soins obstétricaux et néonataux d'urgences complets

[Intrapartum obstetrical transfers: sociodemographic, clinical and prognosistic aspects in Conakry, Guinea]. / Evacuations obstétricales intrapartum: aspects sociodémographique, clinique et pronostique à Conakry, Guinée.

The objectives of this descriptive prospective study were to determine the frequency of intrapartum obstetrical transfers, assess the sociodemographic profile of parturients requiring transfer, describe transfer modalities, and assess maternal and newborn outcomes. Study included all patients requiring intrepartum obstetrical transfer to the Ignace Deen University Hospital Gynecology Obstetrics Clinic in Conakry, Guinea from August 1st, 2009 to July 31st, 2010. Out of 3122 deliveries during the study period, intrapartum transfer was required in 220 cases, i.e. 7.05%. Mean patient age was 23.2 years (range, 14 to 44). The risk for intrapartum transfer was higher among multiparous or nulliparous women (incidence, 8.79%) and adolescents (incidence, 10%). Patients requiring transfer were mainly housewives (60%) and uneducated women (57.27%). Most had had an insufficient number (<4) of antenatal examinations (76.36%) and had been examined at peripheral maternity units (62.73%). In 175 cases (79.54%), patients were transferred by taxi. In 191 patients, treatment required surgery including 130 caesarian sections. There were 12 maternal deaths (5.45%) and 45 neonatal deaths out of 242 newborns including 22 twin deliveries (18.59%). Further work is necessary to improve referral and transfer at all levels of the health pyramid.

[Management of pre-term labor: use of nifedipine in Conakry, Guinea]. / Menaces d'accouchement prématuré: utilisation de la nifédipine à Conakry, Guinée.

This purpose of this prospective and descriptive study was to evaluate the utility of a calcium-channel inhibitor, i.e. nifedipine, for management of preterm labor in our work setting in terms of safety and cost-effectiveness in comparison with betamimetics classically used for this indication. Study was carried out over a six-month period in the department of Gynecology-Obstetrics Department of Ignace Deen National Hospital in Conakry, Guinea. Pregnant women meeting the following criteria were included: 28 to 33 weeks of amenorrhea, six days of hospitalization either for preterm labor or for another diagnosis that was associated with the occurrence of preterm labor during hospitalization, and absence of contraindications for tocolysis using nifedipine. A total of 42 women were included. Pregnancy was extended for more than 48 hours after the first dose of nifedipine in 86.8% of cases. Administration of nifedipine failed in 5 cases including one case in which it was necessary to change the tocolytic and 4 cases in which delivery occurred less than 48 hours after the first dose of nifedipine. In 68% of cases, 90 mg of nifedipine were sufficient to stop uterine contractions within 48 hours. In 39.5% of cases, no side effects were observed. Adverse effects in the other cases were dizziness (39.5%) and headache (18.4%). The mean term of delivery was 36 weeks +/- 5 days of amenorrhea with a mean extension of 6.2 weeks. Apgar score was low in 30.5% of the newborns and normal in 69.5%. One newborn (2.8%) died. The results of this study indicate that nifedipine is an effective, economical and safe drug for tocolysis and that it can be used as an alternative to betamimetis in countries with limited resources. An information campaign is needed to promote use of nifedipine as a tocolytic in obstetrical facilities of our country.

Ethnobotanical survey and antibacterial activity of some plants used in Guinean traditional medicine.

A total of 418 healers have been interviewed in Guinea, a coastal country of West Africa, ranging between 7 degrees 30 and 12 degrees 30 of northern latitude and 8 degrees and 15 degrees of western longitude. Plant species used by the local inhabitants to treat infectious diseases were identified using ethnobotanical, ethnographic and taxonomic methods. During these investigations, 218 plants were registered, of which the following were the most frequently used: Erythrina senegalensis, Bridelia ferruginea, Crossopteryx febrifuga, Ximenia americana, Annona senegalensis, Cochlospermum tinctorium, Cochlospermum planchonii, Lantana camara, Costus afer, Psidium guajava, Terminalia glaucescens, Uapaca somon and Swartzia madagascariensis. Most plants, and especially the leaves, were essentially used as a decoction. In order to assess antibacterial activity, 190 recipes were prepared and biologically tested, among which six showed activity (minimal inhibitory concentration<125 microg/ml) against Bacillus cereus, Mycobacterium fortuitum, Staphylococcus aureus, or Candida albicans, i.e., Entada africana, Chlorophora regia, Erythrina senegalensis, Harrisonia abyssinica, Uvaria tomentosa, and a mixture of six plants consisting of Swartzia madagascariensis, Isoberlinia doka, Annona senegalensis, Gardenia ternifolia, Terminalia glaucescens and Erythrina senegalensis.