RESUMO
Our study aimed to assess the impact of free caesarean section on emergency obstetric care. This was a descriptive cross-sectional study that took place over a period of eight months during the period of June 1st, 2007 to January 31th, 2008. The study included 262 parturients admitted from August 1st, 2004 to July 31th, 2006. Among the 262 parturients 43.13% were recorded before and 56.87% after the implementation of the free of charge caesarean. Caesarean section was performed in 46.90% of parturients before and at 60.40% after the implementation of the free of charge caesarean. The age group 20 to 35 years was the most represented with 58.40%. Complications were present in 37.74% of women delivered by cesarean section before the implementation of the free of charge caesarean and in 20% after its implementation. The infection was seen in 70% of women delivered by cesarean section before the implementation of the free of charge caesarean and 61.11% after its implementation. Among deaths, 5.66% were recorded before and 1.11% after the implementation of the free of charge caesarean. The heavy bleeding was seen in 37.50% cases. Stillbirths recorded before the implementation of the free of charge caesarean were 62.83% and after its implementation, they were of 20.13%. In 18.81% of stillbirths were associated with fetopelvic disproportion.The implementation of the free of charge cesarean helped increase the frequency caesarean section and the reduction of stillbirth in the health district of San.
Notre étude avait pour but d'évaluer l'impact de la gratuité de la césarienne sur les soins obstétricaux d'urgence. Il s'agissait d'une étude transversale descriptive qui s'est déroulée sur huit mois du 1er juin 2007 au 31 janvier 2008. Etaient concernées par l'étude 262 parturientes admises du 1er Août 2004 au 31juillet 2006. Parmi les 262 parturientes 43,13% étaient enregistrés avant la gratuité et 56,87% après la gratuité. La césarienne était réalisée chez 46,90% des parturientes avant la gratuité et chez 60,40% après la gratuité. La tranche d'âge de 20 à 35 ans était la plus représentée avec 58,40%. Les complications étaient présentes chez 37,74% des femmes césarisées avant la gratuité et chez 20% après la gratuité. L'infection était retrouvée chez 70% des femmes césarisées avant la gratuité et 61,11% après la gratuité. Parmi les décès, 5,66% étaient enregistrés avant la gratuite et 1,11% après la gratuité. L'hémorragie était retrouvée dans 37,50% des cas. Les mort-nés enregistrés avant la gratuité étaient de 62,83% et après la gratuité, ils étaient de 20,13%. Dans 18,81% des cas, les mort-nés étaient liés à la disproportion fÅto-pelvienne. La gratuité de la césarienne a contribué à l'augmentation de la fréquence des césariennes et à la réduction de la mortinatalité dans le district sanitaire de San.
RESUMO
BACKGROUND: Mali is endemic for all five targeted major neglected tropical diseases (NTDs). As one of the five 'fast-track' countries supported with the United States Agency for International Development (USAID) funds, Mali started to integrate the activities of existing disease-specific national control programs on these diseases in 2007. The ultimate objectives are to eliminate lymphatic filariasis, onchocerciasis and trachoma as public health problems and to reduce morbidity caused by schistosomiasis and soil-transmitted helminthiasis through regular treatment to eligible populations, and the specific objectives were to achieve 80% program coverage and 100% geographical coverage yearly. The paper reports on the implementation of the integrated mass drug administration and the lessons learned. METHODOLOGY/PRINCIPAL FINDINGS: The integrated control program was led by the Ministry of Health and coordinated by the national NTD Control Program. The drug packages were designed according to the disease endemicity in each district and delivered through various platforms to eligible populations involving the primary health care system. Treatment data were recorded and reported by the community drug distributors. After a pilot implementation of integrated drug delivery in three regions in 2007, the treatment for all five targeted NTDs was steadily scaled up to 100% geographical coverage by 2009, and program coverage has since been maintained at a high level: over 85% for lymphatic filariasis, over 90% for onchocerciasis and soil-transmitted helminthiasis, around 90% in school-age children for schistosomiasis, and 76-97% for trachoma. Around 10 million people have received one or more drug packages each year since 2009. No severe cases of adverse effects were reported. CONCLUSIONS/SIGNIFICANCE: Mali has scaled up the drug treatment to national coverage through integrated drug delivery involving the primary health care system. The successes and lessons learned in Mali can be valuable assets to other countries starting up their own integrated national NTD control programs.
