Burden of malaria during pregnancy at the time of IPTp/SP implementation in Gabon.

The new recommendations to prevent malaria in pregnant women have recently been implemented in Gabon. There is little information on the pregnancy indicators that are useful for their evaluation. A cross-sectional study for the assessment of the prevalence of peripheral, placental, and cord malaria and anemia among delivering women was performed at the largest public hospital of Gabon. Malaria prevalence was 34.4%, 53.6%, and 18.2% for maternal peripheral, placental, and cord blood respectively, with no difference between primigravidae and multigravidae. Submicroscopic infections were frequent and concerned all the positive cord samples. Maternal peripheral, late placental, and cord infections were all associated with a reduced mean birth weight in primigravidae (P = 0.02). Anemia prevalence was 53%, low birth rate was 13%, and prematurity was 25%. The use of intermittent preventive treatment with sulfadoxine-pyrimethamine (greater than or equal to one dose) combined with bed net was associated with a reduction in infection only in multigravidae and with a reduced risk of maternal anemia.

[Maternal mortality in Libreville, Gabon: assessment and challenges]. / Mortalité maternelle à Libreville (Gabon): état des lieux et défis à relever en 2006.

OBJECTIVE: To analyze the course over time of the rates and causes of maternal mortality in Libreville, Gabon. MATERIAL AND METHODS: This prospective descriptive study covers the 6-year period from January 1, 2001, to December 31, 2006. It was performed at the Libreville Hospital Center (LCH) maternity ward, the leading obstetrical care facility in the country. A maternal mortality registry began recording deaths on January 1, 2001. All maternal deaths are listed there, and a department meeting focusing on the death is organized after each. In this study, we analysed the epidemiologic characteristics, circumstances and cause of each death. RESULTS: In all, 136 women died. Their mean age was 25 +/- 5 years with a range of 16 to 41 years. Mean parity was 4 +/- 3, and ranged from 1 to 7. Most of the women were not employed (86%), but had at least some secondary schooling (88%). There were 126 cases (93%) of intrapartum deaths. They occurred more often at night (72% versus 28% during the day) and during the week (77% versus 23% on weekends). The maternal mortality rate was cut in half between 2000 and 2006 (p<0.005), dropping from 444 to 248 per 100 000 live births. Hemorrhages and eclampsia were the two principal causes of mortality. CONCLUSION: Faster access to care and improvement in the quality of emergency obstetrical care are essential conditions for reducing maternal mortality.

[Audit of the severe obstetrical morbidity (near miss) in Gabon]. / Audit de la morbidité obstétricale grave (near miss) au Gabon.

OBJECTIVE: To examine "near-miss" cases to identify the weak points of our department. MATERIAL AND METHODS: This prospective study took place at the Libreville Hospital Maternity Center for six months, from 1 June to 31 December 2006. It included all pregnant women with a severe obstetrical complication (uterine haemorrhage with signs of shock, eclampsia, severe infection) or whose condition required a major intervention to prevent death. The quality of these patients' management was studied from their arrival in the department to their discharge. RESULTS: The prevalence of near-misses was of 3.15%, that is, 137 cases among 4350 deliveries. Ruptured ectopic pregnancies, haemorrhage following clandestine elective abortions, and post-partum haemorrhages (third stage of delivery) were the three primary causes for near misses. Almost 40% of these women waited more than 45 minutes before seeing any qualified personnel. Once the patient was seen, clinical examinations were impossible for 22% because of the lack of the appropriate material. The average time to surgery was 5 hours and 15 minutes. The lack of sterilized surgical linens was one of the major causes of delay in surgical management. CONCLUSION: The number of patients seeking care in our department, relative to the staff resources, makes it difficult to optimise the quality of emergency obstetric care.

[Nonpalpable breast lesions: correlation of the BI-RADS classification and histologic findings]. / Corrélation radio-histologique des lésions mammaires infracliniques à partir de la classification BI-RADS (étude gabonaise).

UNLABELLED: Diagnosis of nonpalpable breast lesions too often requires a breast biopsy or tumorectomy. OBJECTIVE: To validate the American College of Radiology (ACR) classification and lexicon using a standardized description to improve the uniformity of management of abnormal mammographic lesions and reduce the number of unnecessary tumorectomies. MATERIAL AND METHODS: This prospective study was conducted in Libreville Hospital Center over a 4-year period and compared the histologic results of 150 nonpalpable masses identified by mammography and their ACR classification to assess the correlation between the radiographic and histologic findings. RESULTS: There were 90 cases (60%) of ACR2 lesions, 28 cases (18%) of ACR3, 6 cases (4%) of ACR4 and 26 cases (17%) of ACR5 lesions. Histologic results showed that 3% of the ACR2 lesions were malignant, 11% of the ACR3, 67% of the ACR4 and 92% of the ACR5 lesions. CONCLUSION: The correlations showed that the ACR classification was highly reliable for ACR2 and ACR5 lesions and makes it possible to optimize their treatment. ACR3 and ACR4 lesions must be watched carefully.