Impact de la loi portant sur l'obligation du port du casque à Cotonou sur les traumatismes crânio-encéphaliques

Le 2 août 2014, la loi sur le port obligatoire du casque pour les motocyclistes est entrée en application dans sa phase répressive à Cotonou. Ce travail a pour but d'évaluer l'impact de cette loi sur la fréquence, la morbidité, la mortalité et le coût de la prise en charge des Traumatisés Crânio-Encéphaliques au Centre National Hospitalier Universitaire Hubert Koutoukou Maga (CNHU/HKM) de Cotonou.Une étude prospective sur les facteurs socioéconomiques des TCE avait été initiée du 1er au 31 décembre 2014. C'est durant cette enquête, que la loi sur le port obligatoire du casque par les motocyclistes est entrée en application dans sa phase répressive. Nous avons déduit de cette enquête cette étude comparative, entre le 1er janvier et le 31 juillet 2014 puis entre le 2 août 2014 et le 31 décembre 2014. Parmi les 461 cas d'accidents de la voie publique, 347 (75,27%) étaient des accidents de moto dont 283 (81,55%) touchaient des conducteurs et 63 (18,15%) des passagers. La fréquence du port du casque, parmi les victimes de Traumatismes Crâniens Encéphaliques (TCE), a significativement augmenté de 2,3% à 34,5%. Après l'entrée en vigueur de la loi, On a observé une diminution de la fréquence des TCE de 55,54% mais la fréquence de la gravité et de la mortalité était comparable.Les accidents de moto étaient la cause majeure des TCE admis aux CNHU/HKM. La loi sur le port du casque par les motocyclistes a permis de réduire de façon significative la fréquence des TCE. Mais l'impact sur la mortalité des TCE reste faible

Anesthesiologists' demography in French-speaking Sub-Saharan Africa: the impact of fifteen years of Belgo-Beninese cooperation.

Belgium has been collaborating with the French-speaking University of Abomey-Calavi in Cotonou (Republic of Benin) for 15 years to train anesthesiologists for Sub-Saharan French-speaking African countries. At the end of the nineties, Sub-Saharan Africa was the only part of the world with a decreasing number of anesthesiologists. Thanks to various financial supports coming mainly from Belgian governmental cooperation funds, the program has been successful in reversing the demographic trend and even started a multiplying effect through the creation of schools for nurse-anesthetists, and through the creation of new training centers for physician anesthesiologists. Sixty-nine anesthesiologists from 13 countries graduated from Cotonou, 59 (85.5%) of whom actually choose to work in Africa. At least 40 of them teach anesthesia, playing a key role in the creation of new schools and training centers.

[Early resumption of food intake after cesarean section in black African women: liquid versus solid food]. / Reprise précoce de l'alimentation après césarienne chez la femme noire africaine : alimentation liquide versus alimentation solide.

OBJECTIVE: The purpose of this study was to compare the effects of early resumption of solid versus liquid food intake after emergency cesarean section in black African women, in terms of gastrointestinal complications and maternal satisfaction. PATIENTS AND METHOD: A total of 120 patients were randomly distributed into two groups of 60 each. In group L, liquid food intake in the form of sweetened citronella drink was allowed at will starting 6 six hours after the procedure but no solid food was allowed for 24 hours. In group S, normal solid food intake was resumed six hours after the procedure. The two study groups were not significantly different with regard to age, medical history, ASA class, obstetrical status, indications for cesarean section, anesthetic protocol, mean procedural duration, and postoperative analgesia. Study variables included tolerance of food intake, gastro-intestinal complications, time necessary to resume full activity and patient satisfaction. RESULTS: Overall, 6% of patients reported complications involving nausea, vomiting and bloating. There was no statistical difference between the two groups. Normal intestinal transit resumed earlier in group S but the difference was not significant. Auscultation of the abdomen at 16 hours after the procedure demonstrated presence of peristalsis in 59 patients in group S and 51 in group L (p = 0.008). The maternal satisfaction rate was 92% in group S and 43% in group L (p <0.01). All dissatisfied patients said that they would opt for solid food in case of future cesarean. CONCLUSION: Early solid food intake after cesarean in black African women is as well tolerated as early liquid feeding. Resumption of solid food intake allows earlier rehabilitation and improves patient satisfaction.

[Early outcome of digestive surgery in a tropical setting]. / Evolution post-opératoire précoce en chirurgie digestive en milieu tropic.

OBJECTIVE: The purpose of this report was to describe early outcome of surgical management of digestive disease in a tropical setting. Study design. This retrospective, descriptive study was carried out in Benin over the three-year period from January 1, 2002 to December 31, 2004. PATIENTS AND METHODS: A total of 613 patients admitted to the intensive care unit (ICU) following surgical treatment for digestive disease were studied. Data were collected on cards from ICU patient admission records, duty register, and patient charts. The data obtained by exact transcription from cards was entered into the Epidata 3.02 software package and analyzed using the Stata 8.0 software package. RESULTS: Patients undergoing surgery for digestive disease accounted for 32% of admissions to the ICU during the study period. Mean patient age was 30 years (range, 1 day to 85 years). Surgery was carried out under emergency conditions in 510 patients and elective conditions in 103. The most common surgical indications were peritonitis, acute bowel occlusion, and malignant tumors. Overall postoperative morbidity was 25.8% with a strong male prevalence (27.6% after emergency procedures and 16.5% after elective procedures). Most complications (74.7%) occurred within 4 days after the procedure. Complications rare occurred after the 6th post-operative day. Overall mortality was 13% (13.3% after emergency procedures and 11.6% after elective surgery). The most frequent cause of death was sepsis. In the vast majority of the cases (78.7%) death occurred in the first 72 hours. CONCLUSION: Post-operative morbidity and mortality remain high in our ICU especially after surgical management of digestive disease. Although this finding is correlated with inadequate technical and human resources, it is mainly due to delayed treatment or slow evacuation time with most patients being admitted in extremely critical condition. Elective surgery was usually performed on patients presenting advanced-stage malignancy. Delayed management with subsequent deterioration of the patient's clinical state was frequently due to prior treatment by practitioners of traditional medicine.

Prévention des infections au cours des activités de bloc opératoire dans les maternités de référence au sud du Benin

L'infection represente la troisieme cause de deces maternel au Benin. Elle est cependant evitable dans nos maternites. Qu'en est-il de sa prevention dans les maternites au sud du Benin. Cette etude est prospective; descriptive et transversale du 1er janvier au 31 mars 2004. Nous avons observe 183 prestataires : Le port de blouse de bloc operatoire; de calot et de bavette n'est effectif que dans 30;1des circonstances ou ils sont recommandes. Le niveau de pratique d'antisepsie est bon a 55;2.La proce- dure de decontamination est bonne a 97;8.La sterilisation est mal realisee par 65;1des prestataires. Le niveau de bonne pratique de prevention des infections dans les maternites est bas; 16;0des prestataires dans les maternites visitees. Il apparait necessaire de developper un programme national de prevention des infections et de creer dans chaque hopital un comite de lutte contre les infections nosocomiales

[Geoclimatology and severity of snake bite envenomations in Benin]. / Géoclimatologie et sévérité des envenimations par morsure de serpent au Bénin.

Envenomations following snakebite are common in Benin where they constitute, particularly in certain areas, a significant problem for the local populations and health workers. The present epidemiological study describes the snakebite envenomations which occurred in 18 medical centres of the country (6 departmental hospitals and 12 provincial hospitals). The studied variables were: prevalence, length of hospitalisation, major complications, quality of therapeutic management and development of the disease according to area. The study covered a period from April 2000 to March 2001. 486 cases of snakebite necessitating hospitalisation were notified including 413 (85%) in the two northern departments: Atacora and Borgou. Males were largely predominant (90%) and patients under 40 years were the most numerous (82%). The dry season seemed a period of higher risk (75% of the cases). The delay between the bite and admission to hospital, studied for 120 patients in the area of Atacora (North-West Benin), was relatively long: the average was 4 days, with extremes ranging from 10 hours to 21 days. This delay explained the severity of the complications diagnosed. They can be listed according to decreasing frequency: shock, coagulopathy, acute renal failure, respiratory distress. Less than 20% of the patients could benefit from antivenom. Management in emergency care units was impossible in most cases, none of the medical centres (except in Porto-Novo, the capital) having an intensive care unit with artificial ventilation available. Average mortality was 22%. Poisonous snakebites remain serious in Benin, mainly in the northern part of the Country. Access to health care and the quality of the management must be improved. This will require significant efforts from health workers, medical authorities as well as the local population. It is urgent to plan a national therapeutic consensus to reduce the high mortality due to snakebites.

[Creation of emergency care services in developing countries: luxury or necessity?]. / Creer un service d'aide medicale d'urgence dans un pays en developpement: luxe ou necessite?

Organization of emergency care services prior to hospital admission has progressed at a satisfactory pace in developed countries. A performance model in this field is the French emergency service called service d'aide médicale d'urgence (SAMU). Socioeconomic conditions prevailing in developing countries have pushed authorities to give priority to preventive medicine. However numerous patients especially young people and women during childbirth die as a result of inadequate facilities for transportation from hospitals and dwellings in outlying areas to major medical centers where the best medical equipment and staff are available. As a result, it may be asked if emergency care services is really a luxury. The authors base their conclusion on analysis of the conditions and outcome of emergency patient care in three African countries in which it is essentially a requirement.