Are multidisciplinary consultation meetings for prenatal diagnosis achievable in a low-income country? A descriptive cross-sectional survey in Benin.

Objective: The multidisciplinary antenatal diagnosis staff bring together practitioners who are involved in the management of the antenatal period at birth. This project was designed following the French experience to institute multidisciplinary consultation meetings for prenatal diagnosis (MCMPD) in Benin. Methods: This is a descriptive cross-sectional study examining the knowledge, attitudes, and practices of Beninese practitioners in the field of MCMPD to develop the pilot phase of the project. Results: We collected 108 participants from different specialties. Pediatricians and pediatric surgeons were in the majority at 23.9% and 16.5%, respectively. Sixty-seven percent of participants were from the public sector (n=75). One practitioner felt that it was not a good idea to implement these meetings. Almost all staff (96.2%) agreed that this meeting would have a positive impact on reducing neonatal mortality. Omphalocele (58.5%), spina bifida aperta (43.6%), and gastroschisis (34%) were the most commonly diagnosed antenatal conditions in Benin. No neonatal pathology required medical termination of the pregnancy according to 35.6% of the participants. Conclusions: The objective of reducing infant mortality due to medical and surgical pathologies is a noble one and deserves to be supported. This innovative project, developed through this study, the first of its kind in the subregion, will contribute inexorably to the achievement of the third Goal Sustainable Development.

Spontaneous enteroscrotal fistula following an incarcerated inguinal hernia in a neonate: Case report and literature review.

INTRODUCTION: In Africa, frequent delays in seeking medical attention due to cultural considerations and lack of financial support could explain some particular clinical presentations. An enteroscrotal fistula following an incarcerated inguinal hernia is a rare condition in neonates. PRESENTATION OF CASE: A 21-day-old infant was brought to our consultation for persistent stool discharge from the right scrotum for three days. The parents reported an inguinoscrotal swelling that had been evolving for ten days before admission and became painful two days later. He was diagnosed with a case of enteroscrotal fistula. After correction of electrolytes disorders, a laparotomy was performed through a right lower transverse incision. Operative findings were strangulated inguinal hernia with ileal perforation. Resection and end-to-end ileo-ileal anastomosis was performed. He was discharged from the hospital on the 6th post-operative day. No recurrence within the first year of follow-up. DISCUSSION: Thirteen cases have been reported in the literature until now. Most of them were from developing countries, including ours. CONCLUSION: Early seeking medical attention of incarcerated inguinal hernias is necessary to reduce their morbidity and mortality. Paediatricians should emphasize providing adequate information, education and communication during routine examinations of neonates. We advocate the popularization of universal health insurance to facilitate health care.

[Subtotal sternal agenesis with ectopia cordis: surgical management and long-term outcome (a case in Benin)]. / Agénésie sternale subtotale avec ectopia cordis: gestion chirurgicale et résultat à long terme (à propos d´un cas au Bénin).

Sternal agenesis as well as ectopia cordis are extremely rare congenital malformations. We here report a single case treated in the Department of Paediatric Surgery in Benin. The study involved a 3-year-old girl with congenital sternal agenesis associated with ectopia cordis; firstly, she underwent controlled healing. Then thoracoplasty was performed with favourable outcome. Long-term results are good. Now, she is 13 years old, is attending school and has a satisfactory clinical condition. This is one of the few cases reported in the literature. Optimal therapeutic management has been keeping the patient alive in West Africa.

Guided growth vs.Tibial osteotomy at early stage of Blount disease in squelletically immature patients.

BACKGROUND: There are no comparative study between guided growth and tibial osteotomy in early stage of Blount disease (BD) to our knowledge. The aim of this work was to compare the results of patients treated by these two techniques. METHOD: This was a retrospective, descriptive, and analytical study over a period of 5 years in including 17 children (24 Knees) with an early stage of infantile BD in two centers. Patient were classified in two groups: group 1(treated by guided growth), group 2 (treated by Tibial Osteotomy).Preoperative alignment analysis using the tibial femoral angle (HKA) and the proximal medial tibial mechanical angle (mMPTA) were compared with three measurements taken postoperatively in each of the groups. The mean variations of the angles were compared between the two groups. RESULTS: Socio-demographic characteristics were similar for the two groups. Median age at surgery was 6.5 ± 2.5 [3-9 years] in group 1 and 6.8 ± 2.9 years [3-9 years]. At a follow-up of 24 ± 3.5 months, the limb alignment was significantly corrected (1,03°/month) in group 1 (median HKA 144°-171°; p = 0,001; median MMPTA 78°-87°, p = 0,018), and in group 2 we observed at a follow-up of 23 ± 15 months a progressive loss (0,52°/month) of the correction obtained immediately postoperatively (median HKA 160°-176°(immediate post operative) to 165,5°; p = 0,31; median MMPTA = 78°-86° (immediate post operative) to 80,5°; p = 0,37).There was a statistically significant difference between the mean variation in HKA between the two groups (group 1 = 22,5; group 2 = 4,5, p = 0.00), as well as for MMPTA; (group 1 = 7; group 2 = 2,5, p = 0,023).The rate of correction was 78% in group 1 with no rebound at a median follow-up after removal of the material of 10 ± 2.4 months. Within group 2, the rate of correction was 10% with a recurrence rate of 60%. CONCLUSION: Guided growth appears to be the best treatment for early stage of BD in squelletically immature patients.