The aims of this study were: (1) to investigate the relationship between pre-delivery hemoglobin (Hb) concentration and the outcome of the pregnancy for the mother and child and (2) to assess the extent to which the pallor of the conjunctiva indicates severe anemia in pregnancy (Hb < 7 g/dl). We carried out a prospective study in 1995, in the maternity department of the National Sourô Sanou Hospital (Bobo-Dioulasso, Burkina Faso). Women arriving to give birth at the maternity unit gave verbal consent and underwent a physical examination including the assessment of conjunctiva coloration. Finger-prick blood samples were taken from all the women selected and Hb was determined with a portable hemoglobin meter (HemoCue AB, Sweden). For each woman, information about age, obstetric history, the condition of mother and child at admission and delivery and any post-delivery complications in the first 48 hours was collected before discharge from the maternity unit, 3 to 5 days after the delivery. Women with multiple pregnancies were excluded from the study and 247 women were included overall. Endometriosis was observed in only three cases. Three women died, two due to septic shock. The third woman died from hypovolemic shock. The Hb concentrations of these women were 8 g/dl, 10.2 g/dl and 2.6 g/dl respectively. The mean Hb concentration for our population was 10.1 g/dl (SD = 2.08), with 165 women (67%) having less than 11 g Hb/dl. Forty-one women (17%) had less than 9 g Hb/dl and 16 (6%) had less than 7 g Hb/dl. Severe maternal anemia and pallor of the conjunctiva were significantly associated with pre-term delivery and perinatal death, but not with low birth weight. The sensitivity of the pallor of the conjunctiva for detection of severe maternal anemia was 87%, and its specificity was 88%. We found no evidence that maternal Hb levels of 9 to 10.9 g/dl were associated with a high risk of poor pregnancy outcome for either the mother or the child, although women with such levels of Hb are classed as anemic by the World Health Organization criteria. These results show that poor pregnancy outcome is associated with severe maternal anemia. Examination of the coloration of the conjunctiva is a suitable and affordable screening method for the detection of severe anemia. Mothers with severe anemia present with signs and symptoms of anemia and could therefore be given iron treatment to improve their health. This demonstrates the importance of nutritional intervention during pregnancy.
Background: Intussusception is a common cause of acute intestinal obstruction in children. This study reports our experience in the management of childhood intussusception at children's hospital, Donka, in Conakary.
Patients and Methods: This was a retrospective study of children treated for intussusception at children's hospital, Donka, in Conakary from January 1993 to June 2003.
Results: There were 37 children in this study (M:F= 1.3: 1). Intussusception accounted for 4.60% of all abdominal emergencies in the paediatric surgery arm of the children hospital Donka in Conakry within the period. There was 56.76% male preponderance. Majority (86.48%) presented late, resulting in delayed intervention. Fifteen out of the 37 children presented after one week of onset of illness. All the patients presented with abdominal pain. Abdominal mass was palpable in 12 (32.4%) patients while four (10.8%) patients presented with prolapsed intussusception through the rectum. Majority of the intussusceptions in this study were of idiopathic origin. Seventy three percent (27) of the intussusceptions were of ileo-caeco-colic type. The average length of the intussuscepiens was estimated at 20 cm. The mortality rate was high (35.13%); the mortality was higher before the age of one year.
Conclusion: Children with intussusception presented late in our hospital, with a high mortality rate especially in infants. Ignorance and poverty may be contributory factors.
Keywords : Intussusception, children, classification, mortality African Journal of Paediatric Surgery Vol. 3 (1) 2006: pp. 1-3
We conducted a retrospective study that included patients with erythrocyte and hemolytic pathology justifying a splenectomy and patients presenting splenic trauma for which hemostasis splenectomy is required. We performed 27 total splenectomy in which 26 are by laparotomy (92.86%) and 1 by laparoscopy (3.57%). A partial splenectomy was performed by laparoscopy. The morbidity was marked by 2 cases of infectious syndrome and 1 case severe anemia. The mortality was 7.14% (n = 2). Splenectomy is part of the therapeutic arsenal for benign or malignant hematological disorders that constitute the main indication for elective splenectomy. Splenectomy was one of the most common operations in abdominal surgery. During the past decade, an increased rate of late complications, specially septic and thromboembolic complications are well documented. The risk is related to the indication of splenectomy, and is less than 1% in adults without immunodeficiency. However, these overwhelming postsplenectomy infections are associated with a high mortality rate. The best treatment of these infections is preventive measures which are based on vaccination and education of asplenic patients.
From 155 cases of uterus rupture observed during 5 years at the CHU of Donka (Conakry), the authors are reminding: a) the high frequency of this obstetrical emergency: 0.74% of child births and 12.76% of the extractions by caesarean section: b) the high rate of maternal mortality: 25.16%. They insist on: 1. The important role of some parameters: socio economic conditions, lack of an appropriate infrastructure and of a qualified staff leading to a lack of obstetrical observation, parity, age of pregnant women, way of recruiting.... 2. The necessity to apply a correct supervision of the pregnant women and of delivery by establishing a good system of prenatal examination. The therapeutic problems, including the future of the mother and of the child are discussed, insisting on the necessity of the chirurgical celerity in case of dystocia.
We conducted a retrospective study of all hysterectomies performed in our setting over a two year period (1995-1996). The objective was double: define the indications and precise the outcome. A total of 141 cases were recorded. The main characteristics of the patients were the following: a mean age of 38 years, mean gravidity and parity of 5 and an average number of living children of 3. Hysterectomy was performed by the abdominal route in 86.52% of the cases. The main indications were: uterine rupture (39.71%), uterine myoma (25.53%), genital prolapse (19.89%) and cervix cancer (7.09%). Adnexectomy was associated in 51 cases and it was bilateral in 22 cases. The following complications occurred: 5 deaths, 8 wound abcess, 2 bladder injury, 1 ureter injury and 1 case of post-operative hemorragea.
Acute Cholecystitis is uncommon in children. This study reports our experience of acute cholecystitis in children. It is a retrospective study of all the
children managed in the National Hospital of Donka (Conakry), within a 6-year period (January 1998 to December 2003). The data analyzed included age, clinical features, laboratory features and outcome ofmanagement. There were 58 patients with acute cholecystitis, (M:F=2:1). The most common causes of acute cholecystitis were Salmonella typhi organisms in 36 patients followed by stones in 8. Thirty four patientswere treated non-operatively but cholecystectomy was carried out in 24 patients. The mortality ratewas 10.34%. Salmonella and stones are the most common causes of childhood acute cholecystitis in Guinea Conakry. Acute cholecystitis is associated with significant mortality in
children. Keywords : Acalculus cholecystitis, Salmonella typhi,
calculus cholecystitis. African Journal of Paediatric Surgery Vol. 4 (2) 2007: pp. 79-81
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