RESUMO
BACKGROUND: In patients with severe neutropenia, infections can rapidly become serious and life-threatening. It is essential to understand whether pregnancy induces changes in neutrophil levels thereby posing an increased threat to the health of gravidae. METHODOLOGY: This cross-sectional study was conducted in San Health District (Mali) and involved pregnant women infected or not by malaria parasites and non-pregnant healthy volunteers. Subjects were categorized as having neutropenia, normal neutrophil levels, and neutrophilia regarding their neutrophil levels. A logistic regression analysis was performed to determine factors associated with neutrophil level variation in pregnant women. RESULTS: Whether or not the pregnant women were infected with malaria, 98 of the 202 cases (48.5%) showed neutrophilia. Surprisingly, 67 of the 71 cases of neutropenia (94.4%) observed in this study concerned healthy people who were not pregnant. The mean percentage of neutrophil levels was significantly (p < 0.001) lower (49.9%) in the first trimester compared to the second trimester of pregnancy (62.0%). A logistic regression model showed that compared to early pregnancy, the second (OR = 12.9, 95% CI 2.2-248.1, p = 0.018) and the third trimesters (OR = 13.7, 95% CI 2.3-257.5, p = 0.016) were strongly associated with the increase of neutrophil levels. CONCLUSIONS: Pregnancy can induce the production of mature neutrophils that are continually released into circulation. Neutrophil levels were lower during the first trimester of the pregnancy compared to the second and third trimesters, but not affected by the presence or absence of malaria infection.
Assuntos
Malária , Neutrófilos , Humanos , Feminino , Gravidez , Mali/epidemiologia , Estudos Transversais , Adulto , Adulto Jovem , Malária/sangue , Neutropenia/sangue , Adolescente , Complicações Infecciosas na Gravidez/sangue , Contagem de Leucócitos , Complicações Parasitárias na Gravidez/sangue , Complicações Parasitárias na Gravidez/epidemiologiaRESUMO
La performance des projets ou programmes se mesure le plus souvent, par rapport aux dimensions de l'efficacité, de l'efficience, de l'équité, de la recevabilité et de la transparence. Le but de cette étude était de mieux comprendre le processus du S&E de la Direction Générale de la Santé et de l'Hygiène Publique du Mali (DGSHP) et documenter les dysfonctionnements en vue de permettre aux décideurs d'apporter des solutions. Nos résultatsontmontré l'exactitude et la fiabilité des données du S&E de cette structure à travers la disponibilité de mécanismes de contrôle et de traitement des données. Cependant, dans le cadre de la cohérence organisationnelle des différents acteurs, il a été constaté un manque réel de cadre formel de concertation entre les acteurs pour mieux coordonner et harmoniser les activités. Concernant l'efficacité des activités, la majorité des acteurs interrogées pense que le niveau technique du personnel de suivi est faible surtout, au niveau des Directions régionales. En termes de l'adéquation entre les résultats obtenus et les moyens mis à disposition, 57% des répondants ne sont pas satisfaits de l'efficience des activités de S&E de la DGSHP. En conséquence, les autorités doivent envisager des solutions appropriées permettant de comblerces lacunes et d'améliorer la performance du processus de S&Ede la DGSHP.Mots clés: Stratégies, cohérence, performance, suivi et évaluation, santé
The performance of projects or programs is often measured through the dimensions of effectiveness, efficiency, equity, admissibility,and transparency. The purpose of this study was to better understand the monitoring and evaluation (M&E) process and to document dysfunctions toenable decision-makers of the General Direction of Health and Public Hygiene of Mali (DGSHP) to provide solutions. Our results of these surveys have shown the accuracy and reliability of the M&E data of this structure through the availability of control mechanisms and data processing. On the other hand, within the framework of the organizational coherence of the various actors, it was noted a real lack of formal framework of dialogue between the actors to better coordinate and harmonize the activities. Page 41of50RASPVolume 5, Issue1Concerning the effectiveness of the activities, the majority of the interviewed actors think that the technical level of the monitoring staff is low, especially at the level of the regional directions. In terms of the adequacy between the results obtained and the available means, 57% of respondents are not satisfied with the efficiency of the M&E activities of the DGSHP. Consequently, the authorities should consider appropriate solutions to fill the gaps and improve the performance of the M&E process of the DGSHP
