[Extension of cervix cancer screening by visual methods to the community health centres in the district of Bamako]. / Extension du depistage du cancer du col uterin par inspection visuelle aux centres de sante communautaires du district de Bamako.

Cervix cancer remains a public health problem in developing countries. These results are an assessment for multicentric study based on visual inspection of the cervix after application of acetiq acid (VIA) and lugol's iodine (VILI). The aim of this study is to determine the feasibility and the impact of this screening in the community health centres "CSCOM" in the district of Bamako. It was a prospective and multicentric study through 8 CSCOM, 3 Reference Centres "CSRéf", Hôpital Gabriel Touré (HGT) and National Institute of Public Health (INRSP) in Bamako. During 28 months, 5016 women aged through 25-49 years were screened. After their consent and questionnaire filling, the patient is comfortably settled for visual test. The repartition of screened patients by health level is: CSCOM (19.24% : 965/5016), CSRéf (48.64% : 2440/5016), HGT (32.12% : 1611/5016). In general, the positivity of tests was: 5.2% (VIA) and 6.8% (VILI). The positive women at the CSCOM level were oriented to the CSRéf or the HGT for the colposcopy, possible biopsy or care. At all 177 biopsies were done, and histological diagnosis were: 67 dysplasias, 3 early invasive carcinomas, 69 invasive carcinomas and 38 inflammatory metaplasic lesions or nonconclusives aspects. Patients with dysplasias or cancers were treated by cryotherapy, loop electrosurgical excision procedure (LEEP), cold-knife conization or surgery. This study showed that screening of cervical cancer by visual inspection is workable at CSCOM level. We wish a large diffusion of the method to the whole of the country.

Extension du depistage du cancer du col uterin par inspection visuelle aux centres de sante communautaire du District de Bamako

Le cancer du col de l'uterus demeure un probleme de sante publique dans les pays en developpement. Le present travail constitue un bilan d'une etude multicentrique basee sur l'inspection visuelle du col apres application d'acide acetique (IVA) et de lugol (IVL). L'objectif assigne a ce travail est de determiner la faisabilite et l'impact de ce depistage au niveau des centres de sante communautaires du district de Bamako. Il s'agissait d'une etude prospective multicentrique a travers 8 CSCOM; 3 Centres de Sante de Reference (CSRef); l'Hopital Gabriel Toure (HGT) et l'Institut National de Recherche en Sante Publique (INRSP) de Bamako. Sur une periode de 28 mois; 5016 femmes agees de 25 a 49 ans ont ete depistees. Apres un consentement eclaire; la fiche d'enquete est remplie. La patiente etait confortablement installee sur une table gynecologique pour le depistage. La repartition des femmes depistees selon le niveau de la pyramide sanitaire se fait comme suit : CSCOM (19;24: 965/5016); CSRef (48;64: 2440/5016); HGT (32;12: 1611/5016). De facon generale; la positivite des tests etait la suivante : 5;2pour l'IVA et 6;8pour l'IVL. Les femmes positives au niveau des CSCOM etaient orientees vers un CSRef ou l'HGT pour la colposcopie; une biopsie eventuelle et la prise en charge. Sur 177 biopsies effectuees; les diagnostics suivants ont ete observes : 67 dysplasies; 3 carcinomes micro-invasifs; 69 carcinomes invasifs et 38 lesions inflammatoires; metaplasiques ou non concluantes. Les patientes presentant des lesions dysplasiques ou tumorales ont ete traitees par cryotherapie; conisation; resection a l'anse diathermique ou par la chirurgie. Ce travail montre que le depistage du cancer du col par les methodes visuelles est realisable au niveau des CSCOM. Nous recommandons une large diffusion de la methode sur tout le territoire national

[Frequency of cord prolapse: etiological factors and fetal prognosis in 47 cases in a health center]. / La procidence du cordon: facteurs etiologiques et pronostic foetal a propos de 47 cas colliges dans un centre de sante de reference.

UNLABELLED: Cord prolapse constitute an imprevisible accident of the period of labor and an important cause of perinatal mortality. The aim of our study was to determine the frequency of cord prolapse, its etiological factors and to evaluate fetal prognosis. MATERIAL AND METHODS: Our study was done in the department of obstetric and gynecology of the Treichville university teaching hospital. It is a descriptive prospective study that covers 4 years period, from January 1st 1997 to December 31st 2000. RESULTS: We did record 16.924 deliveries with 47 cases of cord prolapse representing a frequency of 0.28% The influencial factors for occurrence of cord prolapse were: prematurity, multiple pregnancy, dystocic presentations and spontaneous rupture of membranes. 28% of our patients had pregnancy not at term. Twin pregnancies represented 23.4% and in 91% of the cases, prolapsed concerned the second twin. Our rate of cord prolapse associated with vertex presentation was 23.4%; 42.5% in breech and 12.8% in the case of shoulder presentation. Spontaneous rupture of membranes was the most frequent type. In 61.7% of the cases, the delivery was done by caesarian section. Cord prolapse was greatly lethal for the fetus with 36.2% of death occurring before the 5th minute of life. CONCLUSION: Umbilical cord prolapse is a grave obstetrical complication that compromises fetal prognosis.