[Reduction Of Maternal And Neonatal Mortality Due To Free Caesarean In Segou's Nianankoro Fomba Hospital In Mali]. / Reduction De La Mortalite Maternelle Et Neonatale Par La Gratuite De La Cesarienne A L'Hopital Nianankoro Fomba De Segou Au Mali.

INTRODUCTION: Emergency obstetrical treatment influences maternal and neonatal mortality and so the government of the republic of Mali decided on June 23, 2005 to establish a free caesarean policy in public health establishments. After 3 years and half, we evaluated the impact of the policy on maternal and neonatal mortality. METHOD: A comparative transversal study was conducted. The data of women who had a caesarean performed in the Segou regional hospital covering the span of 5 years (18 months before the policy and 42 following the new law) was collected. The data was analyzed using the Info 6.4 software. We employed a Pearson's Chi-2 with significance set at p<0.05. RESULTS: Frequency of the caesarean increased following the policy to 25.48 % in 2008 versus 9.33 % in 2004 (p=0.0067). Maternal mortality rate was improved: 3.85 % in 2004 versus 0.23 % in 2008. The rate of neonatal mortality in the same period dropped from 25.39 % to 9.36 % (p=0.021). CONCLUSION: It is noted that the free caesarean policy enabled an increase in the number of caesareans performed and a significant reduction in maternal and neonatal mortality rates.

INTRODUCTION: La prise en charge rapide des urgences obstétricales influence le pronostic maternel et fœtal. C'est pourquoi le Gouvernement de la République du Mali a décidé le 23 juin 2005 d'instaurer la gratuité de la césarienne dans les établissements sanitaires publics. Après une période de 3 ans et demi, nous avons évalué l'impact de la césarienne gratuite sur la mortalité maternelle et néonatale. MÉTHODE: Il s'agissait d'une étude transversale comparative portant sur les femmes chez qui une césarienne a été réalisée dans le service. Les données de l'admission à la sortie de l'hôpital ont été collectées.L'étude s'est déroulée à l'hôpital régional de Ségou du 1er Janvier 2004 au 31 Décembre 2008 soit 18 mois avant la gratuité et 42 mois courant la gratuité. Il s'agit d'un hôpital de deuxième référence qui reçoit les évacuations des centres de 1er et de 2ème niveau relevant de sa circonscription. Les données ont été saisies et analysées sur le logiciel Epi info 6.4. Le test statistique utilisé est le Chi-2 de Pearson et le seuil de significativité est fixé à p< 0,05. RÉSULTATS: La fréquence de la césarienne était de 25,48% en 2008 versus 9,33% en 2004 (p= 0,0067). Le taux de mortalité maternelle était passé de 3,85% en 2004 à 0,23% en 2008, tandis que celui de mortinaissance était passé de 25,39% à 9,36%(p= 0,021). Quant au taux de mortalité néonatale, il était de 2,05% en 2008 versus 13,23% en 2004, 9,68% du 1er janvier au 23 Juin 2005 ; 5,98% durant le reste de l'année 2005, 2,26% en 2006 et 2,32% en 2007. CONCLUSION: Au terme de notre étude, nous avons constaté que la gratuité de césarienne a permis non seulement d'augmenter le nombre total de césarienne, mais aussi d'améliorer significativement le pronostic maternel et néonatal.

[Prevention of mother to child HIV transmission in an African hospital, Bamako-Mali]. / Prevention De La Transmission Mere Enfant Du Vih En Milieu Hospitalier Africain, Bamako-Mali.

AIM: Pregnant women HIV infection has main risk the contamination of newborn. MTCT actions permit to reduce that risk. MATERIAL AND METHODS: Our survey has been realized in Gabriel Touré teaching hospital gynecology and obstetrics and pediatric departments. It is about an observational prospective and descriptive survey that spreads on a period from January 2005 to December 2008. Has been included in the study all the HIV positive pregnant women followed in our service and their babies that had received ARV prophylaxis and 18 months of life serology. RESULTS: We recorded 211 HIV positive pregnant women on a total of 9291 childbirths (2.27%). We noted 90.52% of HIV-1 vs 7.11% of type 2. The mother treatment consisted in a tri therapy in 77.25 vs 0.47% of bi anti retroviral and 22.28% of mono anti retro viral therapy. Maternal viral load was undetectable at the moment of delivery in 78.20% of cases. We noted vaginal delivery in 84.36% vs 15.64% of caesarean section. Newborns respectively received 67.32%; 4.88% and 22.92% of bi, tri and mono therapy. They formula-fed in 98.98%. The mother to child HIV transmission rate was 1.98%. CONCLUSION: HIV prevalence in pregnant patients is relatively height. HARRT in HIV positive mothers associated to bi therapy and formula feeding to their infants permit to obtain low vertical HIV transmission rate.

[Clinical and medico - legal aspects of sexual aggressions at Gabriel Toure teaching hospital]. / Aspects Cliniques et Medico-Legaux des Agressions Sexuelles au CHU Gabriel Toure.

AIM: The sexual aggressions pose an important medico - legal problem. The implication of several services is often indispensable to determine the future of this aggression. Our survey objectives were to determine epidemiological and clinical characteristics of sexual aggressions and to specify the judicial continuations. MATERIAL AND METHODS: We did historical cohort survey while recruiting all cases of consultation in the service for sexual aggressions. This survey spreads on a period of 60 months going from January 2004 to December 2008. A systematic health evaluation (HIV test, vaginal screeming, lever inflammatory deseases) is asked to every sexual abuse patients.Data have been recorded from patients' clinical files, cards of requisition and accounts returned of verbal suit of auditions and police custodies. khi 2 test has been used to appreciate relationship between variables, significativity doorstep P value < 5%. RESULTS: The sexual aggression frequency in relation to admissions to emergencies is 3.12%. The age group <15 years were the more represented with 59.18%. The police authority referred the patients with a requisition in 65.17% of cases (p<0,005). Presumed aggressor was known by the patient in 63.67% of cases (p<5%) and in 72.28% of cases the aggression has been made by night (p=0,001) It was about one aggressor in 65.54% of cases; they were 2 and 3 numbers in 17.23%. (p=0,002). We noted a sexual penetration notion in 80.52% of cases against 19.48% of sexual attouchements. The threat has been noted in any case: 40.82% by weapon and 30.71% by stroke of point. More of the half of the patients (60.30%) had had sexual intercourse before the aggression. The clinic exam was normal in 76.40% of cases (P<5%). The main types of lesions were: hymeneal injuries (13.48%), vulva injuries (7.87%). The judicial continuations have been marked by 10.48% of condemnations, 46.06% of acquittal and 40.06% of friendly regulation (P<5%). CONCLUSION: The number of sexual aggressions, although under valued, is raised in our country. The collaboration between the judicial, police and medical services should permit to reduce the frequency of these aggressions.

Cancer du col uterin et infection a VIH au CHU Gabriel Toure

Notre etude avait pour but de : determiner la frequence relative de l'association du cancer invasif du col uterin et infection par le virus de l'immunodeficience humaine (VIH); donner les caracteristiques socio-demographiques et le pronostic de cette association morbide. Il s'est agi d'une etude prospective comparative realisee dans le service de Gynecologie Obstetrique du CHU Gabriel Toure de Bamako au Mali; du 1er juin 2007 au 31 Aout 2008; soit quinze mois. Toutes les malades atteintes de cancer de col uterin histologiquement confirme ont subi la recherche de l'infection a VIH et ont reparties en deux groupes / VIH+ et VIH-. Les patientes ont ete comparees par l'intermediaire du test de Kh2 et le risque relatif ete evalue. 33;1de cancer du col uterin etaient associes a l'infection a VIH. Les facteurs de risque identifies transmises. Les stades avances etaient proportionnellement les plus associes a l'infection a VIH; au virus de l'herpes et au taux bas de CD4. Nous avons tire de ces constatations que le depistage systematique associe aux mesures preventives de lutte contre le VIH; reduiront la frequence de cette morbide association