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Morbidity and Mortality of Newborns in a Context of Limited Resources in Tombouctou, Mali

Open Journal of Pediatrics 2024年第5期14卷 841-850页

作者： Kassogué Djibril Cissouma Assétou Kassogué Abdoulaye Boré Boubacar Sogoba Robert Diallo Zoumana Maiga Talfi Dolo Akoro Sogoba Seydou Touré Lahaou Maiga Mariam Samaké Alou Mariko Souleymane ongoiba oumar Sanogo oumar Traoré Bassirima Paediatrics Department Timbuktu Hospital Timbuktu Mali Paediatrics Department Sikasso Hospital Sikasso Mali Paediatrics Department Nianankoro Fomba Hospital Sgou Mali Department of Obstetrics and Gynaecology CHU du Point G Bamako Mali Department of Paediatrics Commune VI District Hospital Bamako Mali

Introduction: Worldwide, 2.3 million children died in the first 20 days after birth in 2022, according to the WHO. In Mali, according to the sixth Demographic and Health Survey, the neonatal mortality rate was estimated at 33% live births in 2018. The Timbuktu region had the highest neonatal mortality rate in the country with 44%. The objective of this work was to study the causes of neonatal morbidity and mortality and related factors in the paediatrics department of Timbuktu hospital. Materials and method: This was a descriptive, cross-sectional study conducted from 1 January to 31 December 2023 in the neonatology unit of the paediatrics department of Timbuktu hospital, including all newborns admitted to hospital. Results: Our study took place over 12 months, during which 618 admissions were made to the paediatric ward, including 244 newborns, i.e. 39.48%. The majority of newborns (86.5%) were admitted in the first week of life. The mean age was 3 days, with a sex ratio of 1.1 for males. Weight under 2500 g was 54.1% for an average weight of 2372 g. The main mode of admission was transfer from the hospital maternity unit (62%). The main reasons for admission were acute foetal distress (27.9%) and prematurity (26.2%). The average age of the mothers was 24, with extremes of 15 and 49. The mothers were housewives (87.3%), uneducated and primiparous (59% and 36.5% respectively);only 40.2% had made more than 3 antenatal care visits. Newborns born by vaginal delivery accounted for 80.7% and those born by caesarean section for 19.3%. The risk of infection was present in 52.5% of cases. The three leading causes of hospitalisation were birth asphyxia (40.2%), neonatal infection (32.4%) and prematurity (25%). The mortality rate was 21.7%. The main causes of death were prematurity (39.6%), birth asphyxia (32.1%) and neonatal infection (24.5%). Conclusion: Neonatal morbidity and mortality remain a concern in Timbuktu. Despite the unfavourable security situation, morbidity and

关键词： Morbidity Mortality Newborns Timbuktu

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Study of Factors Associated with Maternal Deaths at Timbuktu Hospital in Mali

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Open Journal of Obstetrics and Gynecology 2024年第9期14卷 1471-1487页

作者： Coulibaly Moussa Kassogué Djibril Samaké Alou Sy Ousmane Poda Ghislain Dolo Akoro Sogoba Seydou Cissouma Assetou Kassogué Abdoulaye Maiga Mariam Mariko Souleymane ongoiba oumar Traoré Bassirima Kané Babou Traoré Halima Taoudeni Regional Health Directorate Tombouctou Mali Department of Pediatrics Timbuktu Hospital Timbuktu Mali Department of Pediatrics District Hospital Commune VI Bamako Mali WHO Bamako Mali Department of Pediatrics CHU Point G Bamako Mali Department of Pediatrics Sikasso Hospital Sikasso Mali Department of Pediatrics Nianankoro Fomba Sgou Hospital Segou Mali

Introduction: Despite progress in universal health coverage, maternal mortality remains a concern for developing countries, including Mali. The problem is not due only to a lack of health services but to a combination of factors that need to be identified to give hope to women of childbearing age. Objective: Determine the factors associated with maternal mortality in the Timbuktu region of Mali. Methodology: Retrospective, descriptive, cross-sectional and analytical study from January 1, 2018 to December 31, 2022 using a questionnaire and an interview guide to determine the factors associated with maternal mortality in the Timbuktu region of Mali. Results: A total of 112 maternal deaths were recorded between 2018 and 2022. The average age of the women who died was 26 years (standard deviation 7.6 years). The 14 – 23-year-old age group is the most affected (43.8%). 66.1% of women came from rural areas. Illiteracy (77.7%), lack of ANC (54.5%), distance of households from health facilities (76%) and insecurity (52.7%) have been identified as factors contributing to maternal mortality. Conclusion: This study reported a high prevalence of maternal mortality rates that may be associated with women’s socioeconomic conditions. Actions must be developed to integrate CPN into an advanced strategy for women living in rural areas in Mali.

关键词： Maternal Mortality Timbuktu Hospital Mali

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Postpartum Family Planning at the Timbuktu Hospital in Mali

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Open Journal of Obstetrics and Gynecology 2024年第7期14卷 1074-1082页

作者： Kassogué Djibril Samaké Alou Dolo Akoro Sogoba Seydou Touré Lahaou Cissouma Assetou Kassogué Abdoulaye Maiga Mariam Mariko Souleymane Kantako Karamoko ongoiba oumar Sanogo Ooumar Traoré Bassirima Sidibé Idrissa Mandé Kassambara Youssouf Traoré Halima Timbuktu Hospital Bamako Mali Commune VI Bamako District Hospital Bamako Mali CHU Point G Bamako Bamako Mali Sikasso Hospital Bamako Mali Nianankoro Fomba Sgou Hospital Bamako Mali

Introduction: Postpartum family planning is the prevention of pregnancies during the 12 months following childbirth. Few studies have been devoted to postpartum family planning in Mali. Our work will contribute to reducing unmet need for family planning. Objective: To study the use of contraceptive methods in the postpartum period in the obstetrics and gynecology unit of Timbuktu hospital. Materials and Methods: This was a descriptive and analytical cross-sectional study with prospective collection of data from January 1, 2022 to December 31, 2023. All women who gave birth having chosen and benefited from a contraceptive method were included. The statistical test used was the Fisher test with a significance threshold fixed at 5%. Results: The frequency of contraception in the postpartum period was 17.03%. The average age of clients was 26.14% with extremes of 14 and 45 years. They were paupiparous at 56.4% with an inter-birth interval of less than 12 months at 12.3%. More than half of the counseling (58.5%) was done during postnatal visits. The methods chosen were implants at 48.1%, injectable progestins at 21.3%, intrauterine device at 14.7%, miro-progestin pills at 13.5%, tubal ligation at 1 .4% and condoms at 1%. The regular follow-up rate was 51.1% of cases and 25.6% had no follow-up. Conclusion: The overall rate of postpartum family planning of 17.08% remains low. Improving FP staff skills will reduce unmet needs and contribute to increasing contraceptive prevalence in Timbuktu.

关键词： Family Planning Postpartum Counseling Contraceptive Methods Timbuktu Hospital

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Epidemiology and Management of Heart Failure in the Medicine Department of Tombouctou Hospital

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World Journal of Cardiovascular Diseases 2023年第3期13卷 105-113页

作者： Bassirima Traoré Souleymane Mariko Samba Sidibé Karamoko Kantako Mariam Sako Massama Konaté Nouhoum Diallo Abdoul Karim Sacko Kalifa Diallo Youssouf Kassambara Djibril Kassogue oumar ongoiba oumar Sanogo Ichaka Menta Souleymane Coulibaly Department of Medicine Tombouctou Hospital Tombouctou Mali Department of Cardiology Point G University Hospital Bamako Mali Department of Cardiology Mali Hospital Bamako Mali Department of Cardiology CHU Gabriel TOURE Bamako Mali

Introduction: Heart failure is a complex syndrome and very frequently observed and secondary to the outcome of many advanced heart diseases. It is made up of a set of symptoms that reflect the tissue and visceral consequences of heart failure. The objective was to determine the hospital prevalence and to describe the management of heart failure in the medical department of Tombouctou hospital in Mali. Methods: This is a descriptive cross-sectional study with retrospective data collection, carried out over 24 months and involving the analysis of 266 records of patients hospitalized for heart failure. Results: The frequency of heart failure was 17.6% with a female predominance. The average age was 48 years with extremes of 16 and 90 years. Cardiovascular risk factors were dominated by high blood pressure with 38%. Global heart failure was the mode of discovery in 72.2% of cases. The etiologies were dominated by hypertensive dilated cardiomyopathy in 36.8% and peripartum cardiomyopathy in 32% of cases. The majority of our patients benefited from diuretic treatment, i.e. 95.9% frequency;with a favorable evolution in 96.2% of cases. We recorded 10 deaths, i.e. a lethality of 3.7%. We report some difficulties encountered during our security study because Tombouctou is a war zone and the lack of a technical platform for biology such as (BNP or NT-proBNP). Conclusion: Heart failure is a real public health problem. Its prevalence is increasing due to the aging of the population and especially the poor management of arterial hypertension in our context.

关键词： Heart Failure Epidemiology Etiology Treatment Tombouctou Hospital

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Digestive Surgical Emergencies at the Commune II Reference Health Centre in the District of Bamako

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Surgical Science 2022年第5期13卷 258-264页

作者： Idrissa Tounkara Abdoulaye Diarra Amadou Traore Boubacar Karembe Sayon Diakite Konimba Keita oumar ongoiba Madiassa Konate Seydou Sangare Bakary Coulibaly Bakary Tientigui Dembele Adegne Togo Reference Health Center of the Municipality II Bamako Mali Hospital-University Center of Kati Kati Mali University Hospital Gabriel Touré Bamako Mali Reference Health Center of the Municipality III Bamako Mali Timbuktu Regional Hospital Timbuktu Mali

We conducted a prospective descriptive study from January 1 to December 31, 2018 with the objectives of determining the frequency of digestive surgical emergencies, describing the clinical and para-clinical aspects of the management of digestive surgical emergencies, evaluating the therapeutic aspect of digestive surgical emergencies and analysing the post-operative follow-up of patients operated on in emergencies. We counted 120 patients operated on for digestive surgical emergencies, which corresponds to 5.80% of all consultations and 44.80% of all surgical interventions. The male sex was the most represented with a ratio of 1.80. The average age was 27.5 years. The majority of patients were from Bamako. Abdominal pain was the reason for consultation in 80% of cases. The diagnosis was essentially clinical and paraclinical in doubtful cases. These included ultrasound, unprepared abdomen and sometimes abdominal CT scans. Acute appendicitis was the most common pathology with 42.5%. General anaesthesia and spinal anaesthesia were used with 50% each. The majority of patients were operated on between 30 minutes and 12 hours after their admission to the department (71.7%). Acute peritonitis accounted for 67% of deaths from sepsis. The surgical technique was decided according to the pathology and the surgeon’s choice. The postoperative course was simple in the majority of cases. The prognosis is good when the management is early. The treatment is medical-surgical.

关键词： Surgical Emergencies Digestive Tract General Surgery CSRéf CII

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Acute Appendicities in the Reference Health Center of Municipality II of Bamako District

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Surgical Science 2022年第5期13卷 251-257页

作者： Idrissa Tounkara Boubacar Karembe Sayon Diakite Abdoulaye Diarra Amadou Traore Konimba Keita oumar ongoiba Madiassa Konate Moussa L. Coulibaly Bakary Coulibaly Bakary Tientigui Dembele Adegne Togo Reference Health Center of the Municipality II Bamako Mali Reference Health Center of the Municipality III Bamako Mali University Hospital of Kati Kati Mali University Hospital Gabriel Touré Bamako Mali Timbuktu Regional Hospital Timbuktu Mali

This was a prospective study from January 2019 to December 2019 in the reference health center of municipality II of the Bamako district. During this period, we operated on 73 patients for acute appendicitis, including 51 men and 22 women, for a sex ratio of 1.7. The average age was 25.5 with extremes of 1 and 40 years. Abdominal pain was the main reason for consultation. The physical signs were dominated by the positivity of the Blumberg sign in 97.3% of the cases, the defense of the right iliac fossa in 79.5%, and the Rovsing sign in 61.6% of the cases. This physical examination made it possible to make the diagnosis in the majority of cases. In the face of some doubtful cases, we requested an abdominal ultrasound. Locoregional anesthesia was the most used anesthesia technique at 72.6%. The classic anterograde appendectomy with stump burial by Mac Burney was the most commonly used technique, respectively. The postoperative consequences were straightforward in 87.6%. Anatomopathology examination was performed on 69 surgical specimens and 4 appendectomy specimens were not subjected to an anatomo-pathological examination. Phlegmonous appendicitis was the most common at 63% of cases. Appendicitis remains the most common surgical emergency in a community setting. The early diagnosis and the speed of treatment guarantee improvements in the prognosis. The treatment is mainly surgical.

关键词： Acute Appendicitis Clinical Aspects Appendectomy Postoperative Effects

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Clinical and Therapeutic Aspects of Inguinal Hernia at the Reference Health Centre of Commune II of the District of Bamako

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Surgical Science 2022年第5期13卷 265-271页

作者： Idrissa Tounkara Boubacar Karembe Souleymane Thiam Sayon Diakite Abdoulaye Diarra Amadou Traore Konimba Keita oumar ongoiba Moussa Sanogo Moussa L. Coulibaly Bakary Tientigui Dembele Adégné Togo Reference Health Center of Commune II Bamako Mali Commune III Reference Health Centre Bamako Mali University Hospital Center of Gao Gao Mali University Hospital Center of Kati Kati Mali University Hospital of Gabriel Touré Bamako Mali Regional Hospital of Tombouctou Tombouctou Mali

Objective: To study the diagnostic and therapeutic aspects of uncomplicated inguinal hernias in the general surgery unit of CSRéf CII. Method: This was a prospective, descriptive, single-centre study from 1 January 2016 to 31 December 2016 of 84 patients operated on for inguinal hernias in the general surgery unit of CSRéf CII. Results: Inguinal hernia accounted for 8% of surgical consultations and hernia repair accounted for 30.22% of surgical procedures. Hernia repair accounted for 30.22% of surgical procedures. The male sex was the most represented with a ratio of 7.40. The average age of our patients was 43.19 years. Recurrence occurred in 10% of cases. The right side was most affected in 71.43% of cases, 19.05% on the left side in;it was bilateral in 09.52%. Local anaesthesia was used in 67.86% of our patients, general anaesthesia in 13.09% of cases and locoregional anaesthesia in 19.05% of cases. The hernia was external oblique in 75% of cases. Shouldice’s technique was the most used with 88%;Bassini’s technique was used in 7% and Mac Vay’s in 5% of cases. The postoperative course was simple in 96.43% of cases, with an early postoperative morbidity rate of 3.57%, one case of wall abscess and two cases of parietal haematoma. No deaths were observed during our study. Conclusion: The new methods of tension-free cure should be used more and more by our users in our facilities.

关键词： Inguinal Hernias Strangulation Management CSRéf CII

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Diverticular Fistula of the Female Urethra on Lithiasis at the District Health Center (CSREF) in Communeii, Bamako, Mali

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Surgical Science 2019年第3期10卷 83-88页

作者： Tounkara Idrissa Diarra Abdoulaye Traoré Amadou Coulibaly B. Bakary Kanté Abdoulaye Dembélé Dabéré Ives Thiam Souleymane Ouattara Kassoum Kanté Lassana Konate Madiassa Koné Assitan ongoiba oumar Sangaré Modibo Dembélé Bakary Tiètiki Diakité Ibrahim Sidibé Yoro Bah Amadou Coulibaly Yakaria Togo Adégné Diallo Gangaly Chirurgie générale du Centre de santé de référence de la commune II de Bamako Mali Chirurgie générale du Centre Hospitalier Universitaire de Kati Mali Chirurgie générale Centre Hospitalier Universitaire Gabriel TOURE de Bamako Mali Chirurgie générale du Centre Hospitalier Universitaire du POINT G de Bamako Mali Hopital régional de Gao Mali Hopital régional de Tombouctou Mali

The diverticulum of the female urethra or sub-urethral pouch is in the form of a cul-de-sac lined with mucous membrane through the muscular layer of the urethra. Thus, it is a site of stasis, urinary infection, formation of calculus or even malignant tumor. The diverticula of the urethra or sub-urethral pouches in women have a prevalence of 0.5% to 6% depending on the series. We report the case of a 61-year-old patient operated for a diverticulum on fistulized urethra complicated lithiasis. Our patient had five pregnancies and five births when she consulted for dysuria, urinary burns evolving since a year. The urogenital examination revealed a partially stenotic urethral meatus and a 3-cm large fistulized intravaginal peri-urethral mass allowing urine leak. The mass was painful and hard at palpation. We performed transvaginal diverticulectomy. The follow-up was simple and the probe was removed two weeks after the surgery. An atomo-pathological examination of the resected diverticulum concluded an aspect compatible with lithiasis urethritis.

关键词： Diverticulum Urethral Fistula Lithiasis Bamako

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Primitive Umbilical Endometriosis in a Young Woman at the District Health Center (CSREF) in Commune II in Bamako

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Surgical Science 2019年第3期10卷 89-93页

Umbilical endometriosis, also called Villar’s nodule, has rarely been described in the literature. It represents only 0.5% to 1% of all cases of endometriosis. We report a case in a 28-year-old nulligest, nulliparous woman who consulted at the CSREF CII in Bamako. The diagnosis was suspected with the presence of umbilical swelling with cyclic, painful, dark hemorrhage of firm consistency. We performed an omphalectomy with an uncomplicated postoperative course. She was released from the hospital three days post-surgery. Anatomo-pathological examination of the resected specimen confirmed the diagnosis of umbilical endometriosis.

关键词： Umbilical Endometriosis Young Woman Bamako Mali

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Epidemiological and Histopathological Aspect of Precancerous and Cancerous Lesions of the Cervix in the Health District of Commune 5 of Bamako, the CHU of Point “G” and the Gabriel TouréUniversity Hospital of Bamako in Mali

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Journal of Cancer Therapy 2020年第9期11卷 561-570页

作者： Soumana oumar Traoré Saleck Doumbia Cheickna Sylla Saoudatou Tall Ibrahima Tegueté Ichiaka Djibo Faissif Kouyaté Issa ongoiba Youssouf Traore oumar Moussokoro Traore Niani Mounkoro Mamadou Traore Faculty of Medicine and Odontostomatology University of Science and Technology Bamako Mali Department of Gynecology and Obstetrics Reference Health Centre of Commune V Bamako Mali Department of Obstetrics and Gynecology Koutiala Reference Health Centre Sikasso Mali Department of Gynecology and Obstetrics Gabriel Touré University Hospital Bamako Mali

Objective: The aim was to take stock of the screening and treatment of precancerous and cancerous lesions of the cervix in the health district of commune V of Bamako, the “G” point and the Gabriel Touré University Hospital in Bamako, Mali. Patients and Methods: This was a descriptive, cross-sectional, analytical study with retrospective and prospective data collection over an 8-year period from January 1, 2010 to December 31, 2017. This was a multi-center study. Results: From January 1, 2010 to December 31, 2017, 42,492 women were screened, representing a frequency of 24.30%. The median age of the women screened was 32 years;25% were under the age of 25. Three-fourth of the women screened was in the 20 - 49 age group. Of the 22,842 women screened, 90.1% of them had a normal col to IVA/IVL. However, 4.1% of cervical positivity had with acetic acid and 5.1% of positivity to Lugol. 0.7% of the women screened clinically had cancerous lesions. Histologically, 96.5% of the women screened had a normal cervix with benign lesions. For pathological histological findings, we noted 2.6% of precancerous lesions and 0.8% of squamous cell carcinomas and

关键词： Epidemiology Histology Precancerous and Cancerous Lesions of the Cervix

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