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Complications des Contraceptifs Réversibles à Longue Durée d’Action: A Propos de 21 Cas Colligés au Service de Gynécologie-Obstétrique du CHU Kara, Nord du Togo
Get PDFObjectif : Rapporter les complications des contraceptifs réversibles à longue durée d’action pour une meilleure pratique afin de favoriser l’adhésion des femmes à la contraception moderne.
Méthode : Il s’est agi d’une étude transversale et descriptive réalisée au service de gynécologie-obstétrique du centre hospitalier universitaire CHU) de Kara du 1er Août 2022 au 31 Juillet 2023. Cette étude a porté sur les complications des contraceptifs réversibles à longue durée d’action. Etaient inclues, toutes les femmes reçues pour complication d’insertion de contraceptifs réversibles à longue durée d’action et prises en charge dans le service.
Résultats : Vingt et un clientes porteuses de contraceptifs réversibles à longues durée d’action ont été enregistrés. Il s’agissait de 3 cas de dispositifs intra utérins (14,3%) et 18 cas d’implants (85,7%). L’âge moyen des clientes était de 26,7 ans avec des extrêmes de 20ans et 42ans. Elles étaient en majorité paucipares (52,5%) et revendeuses (47,6%). Les circonstances de découvertes étaient les douleurs abdominales pour les DIU, et les difficultés de retrait pour les implants. Il s’agissait de 3 cas de perforation utérine avec un DIU dans le ligament large, un dans l’épiploon et un abcès du cul de sac recto-utérin. Pour les implants, il s’agissait d’insertion intra musculaire (83,3%) et d’infection du site d’insertion (11,1%). Une prise en charge chirurgicale a été faite dans 90,5% des cas engendrant un coût financier de 143300 FCfa (241,6USD) en moyenne pour le DIU et 45000 FCfa (75,9USD) pour l’implant. L’évolution a été favorable chez toutes les clientes.
Conclusion : Les complications des contraceptifs réversibles à longue durée d’action sont dominées par les complications des implants. Elles ont occasionné des couts financiers aux clientes. Un renforcement de capacité des prestataires est nécessaire afin d’augmenter la prévalence contraceptive dans nos milieux.
Objective: The study aims was to report long-acting reversible contraceptives, for improving practices and encouraging women to use modern contraception.
Methodology : This was a cross-sectional, descriptive study carried out at obstetrics and gynecology department of Kara University Hospital from August 1, 2022 to July 31, 2023. All women treated in the department for complications of long-acting reversible contraceptives were included.
Results : Twenty-one cases were recorded. There were 3 cases of intrauterine devices (14.3%) and 18 cases of implants (85.7%). The average age of the clients was 26.7 years, with extremes of 20 and 42 years. They were mostly paucipara (52.5%) and resellers (47.6%). The circumstances of discovery were abdominal pain for IUDs, and abandonment for implants. There were two cases of uterine perforation with an IUD in the broad ligament, one in the omentum, and one case of abscess in the recto-uterine pouch. In the case of implants, these were intra-muscular insertion (83.3%) and infection of the insertion site (11.1%). Surgery was performed in 90.5% of cases, at an average cost of 143300 FCfa (241.6USD) for the IUD and 45000 FCfa (75.9USD) for the implant. The trend was favorable.
Conclusion : Complications of long-acting reversible contraceptives are dominated by implant complications. These have resulted in financial costs for clients. Capacity-building of providers is needed to increase contraceptive prevalence in our communities
Assessing the Relationship between Short Birth-to-Pregnancy Interval and the Maternal and Perinatal Outcomes among Multiparous Women in Northern Ghana
Get PDFIntroduction: The World Health Organization (WHO) recommends an optimal Birth-to-Pregnancy Interval (BPI) of 24-59 months, or a 33-month interval between two successive births, to reduce the risk of untoward maternal and newborn outcomes. Short Birth to Pregnancy Interval (SBPI) and unmet need for Family Planning (FP) are the major contributors to rapid population growth and increased maternal and newborn mortalities. The purpose of this study was to assess the adverse perinatal and maternal outcomes associated with SBPI among multiparous women in three municipalities of the Upper East Region (UER) of Ghana.
Materials and Methods: We employed a cross-sectional design conducted among 904 women aged 15-49 attending Antenatal Care (ANC) clinics in three municipalities in the UER who had at least two successive live births prior to data collection. A multistage cluster sampling technique was employed to recruit respondents for this study. This was conducted in four steps. Out of the 46 health facilities, we randomly selected 25 respondents using the systematic random selection method. Data was collected using a structured questionnaire, incorporated into the electronic data collection tool (Kobo collect), and administered by trained research assistants. Birth interval was categorized according to the WHO’s classification: <24 months as SBPI, 24-≥59 months as Optimal Birth to Pregnancy Interval (OBPI), and >59 months as Long Birth to Pregnancy Interval (LBPI).
Results: Of the 904 respondents, the majority (56.2%) had an OBPI, while 36.9% had a SBPI. Factors that influenced SBPI were parity, mode of delivery, and the educational status of woman’s partner. Participants with a higher parity (≥5 children) had 0.67 times the potential of spacing their births (AOR 0.67; 95% CI 0.46-0.98; p = 0.040). Women who experienced a Caesarean Section (CS) delivery were 3.28 times more likely to have LBPI (AOR 3.28; 95% CI 1.02–10.62; p=0.047). Respondents whose partners had secondary education had a 1.87 chance (AOR 2.07; 95% CI 1.09–3.96; p=0.027) of spacing their births. The birth complications reported were retained products of conception (41.9%), pregnancy-induced hypertension (27.9%), postpartum hemorrhage (11.6%), obstructed labor (10.5%), sepsis (38.1%), neonatal jaundice (23.8%), low birth weight (19%), and preterm birth (14.3%).
Conclusion: A significant proportion of the participants in this study reported having a short duration between the birth of one child and the conception of the next. This was associated with various adverse maternal and perinatal outcomes, such as birth complications and mortalities. The study emphasizes the need for health professionals to address challenges in contraceptive uptake, especially among multiparous women, and promote optimal birth spacing to improve maternal and perinatal outcomes
Mortalité des Patients Hémodialysés Chroniques au Bénin : Une Etude Rétrospective sur 6 Ans
Get PDFIntroduction: La dialyse est l’une des dernières alternatives dans l’arsenal thérapeutique, capable de maintenir en vie un patient insuffisant rénale chronique terminale. Avant la mise en place de la dialyse au Benin l’insuffisance rénale chronique terminale était systématiquement mortelle. Cette étude avait pour objectif de mettre à jour les données épidémiologiques sur les hémodialysés, la mortalité due à l’insuffisance rénale chronique terminale au CHUD du Borgou Alibori et les facteurs associés à la mortalité due hémodialysés.
Cadre et méthodes d’étude : Elle a été réalisée dans le service de néphrologie dudit hôpital. Il s’agissait d’une étude transversale, descriptive à visée analytique qui s’est déroulé du 25 décembre 2022 au 15 mars 2023 et a porté sur les données de 2017 à 2022. Elle a concerné 95 dossiers de patients hémodialysés recruté par commodité et répondant aux critères d’inclusion. Le traitement et l’analyse des données a été faite avec le logiciel SPSS 26.
Résultats: Le taux de mortalité était de 80% des hémodialysés. L’âge médian des patients était de 44 ans. Les prédicteurs potentiel de la mortalité des hémodialysés du service de néphrologie du CHUD/B-A étaient le travail en indépendant et secteur informel (p=0,004), le faible revenu mensuel (p=0,017), l’hypoglycémie (p=0,011), un nombre élevé de médicament (p=0,004), la mauvaise observance thérapeutique (p=0,003) et un court séjour en dialyse (p<0,000).
Conclusión: Le projet d’assurance pour le renforcement du capital humain est une porte de sortie pour diminuer la mortalité de l’hémodialyse ainsi que le renforcement de la lutte contre les MNT.
Introduction: Dialysis is one of the last alternatives in the therapeutic arsenal, capable of keeping a patient with chronic end-stage renal disease alive. Before the introduction of dialysis in Benin, end-stage renal disease was systematically fatal. The aim of this study was to update epidemiological data on hemodialysis patients, mortality due to end-stage renal failure at the CHUD du Borgou Alibori, and factors associated with mortality due to hemodialysis.
Study setting and methods: The study was carried out in the hospital's nephrology department. It was a cross-sectional, descriptive study with analytical aims that ran from December 25, 2022 to March 15, 2023 and covered data from 2017 to 2022. It involved 95 hemodialysis patient records recruited by convenience and meeting the inclusion criteria. Data processing and analysis was performed using SPSS 26 software.
Results: The mortality rate was 80% for hemodialysis patients. The median age of patients was 44 years. Potential predictors of mortality in hemodialysis patients at the CHUD/B-A nephrology department were self-employment and informal sector (p=0.004), low monthly income (p=0.017), hypoglycemia (p=0.011), high number of medications (p=0.004), poor compliance (p=0.003) and short dialysis stay (p<0.000).
Conclusion: The insurance project for strengthening human capital is a way out to reduce hemodialysis mortality and strengthen the fight against NCDs
La Prévalence des Pathologies Thyroïdiennes chez le Sujet Âgé au Service de Médecine Interne de l’Hôpital National Donka
Get PDFIntroduction : Le vieillissement est associé à des modifications complexes de la fonction thyroïdienne qui interviennent à plusieurs niveaux de régulation. La sécrétion des hormones thyroïdiennes est en général dans les limites inférieures des valeurs usuelles.
Méthodes : Il s’agissait d’une étude rétrospective à visée descriptive et analytique menée du 1er janvier 2013 au 31 décembre 2022 (soit 10 ans). L’étude était réalisée au service de médecine interne de l’hôpital national Donka (Guinée). Elle a porté sur les sujets âgés de 60 ans et plus suivis pour une pathologie thyroïdienne.
Résultats : Durand la période d’étude nous avons colligé 88 cas de dysthyroïdies soit une prévalence de 17,95 %. Il y avait une prédominance féminine (56 cas) avec un sex ratio H/F de 0,57. L’âge moyen était de 64,5 ans (extrêmes de 60 et 85 ans). Les circonstances de diagnostic de la maladie thyroïdienne étaient principalement un goitre (59,1%), une exophtalmie (9,1%), une compression cervicale (25%), une cardiothyréose (5,7 %). Les principales manifestations de la thyrotoxicose étaient l’amaigrissement (17%), les palpitations (29,5%) et la fatigabilité (34,1%). Les signes d’hypothyroïdie prédominants étaient la constipation (17%) et le syndrome myxœdémateux (3,4%). L’hyperthyroïdie a été rencontrée chez 13,64% des patients, contre 29,54% de cas d’hypothyroïdie. L’échographie cervicale thyroïdienne avait retrouvé 36 cas de goitre diffus (40,9%), 18 cas de goitre multinodulaire (20,45%), 17 cas de nodule unique (19,31%). Les principales étiologies étaient la maladie de Basedow (11,4%), le goitre multinodulaire (46,6%), la thyroïdite de Hashimoto (17%), un goitre simple (5,7%). La thyroïdectomie avait concerné 33 patients (37,5%). Deux cas de décès étaient enregistrés en rapport avec une cardiothyréose.
Conclusion : Les dysthyroïdies sont fréquentes chez le sujet âgé au CHU de Conakry et un dosage hormonal au moindre doute afin d’instaurer le traitement adéquat à temps serait requis afin de prévenir les complications.
Introduction:
The aging is associated with complex changes in thyroid function that occur at several levels of regulation. Thyroid hormone secretion is generally within the lower limits of usual values.
Methods: This was a retrospective study with descriptive and analytical aims carried out from January 1, 2013 to December 31, 2022 (i.e. 10 years). The study was carried out in the internal medicine department of the Donka national hospital (Guinea). It focused on subjects aged 60 and over followed for thyroid pathology.
Results: During the study period we collected 88 cases of dysthyroidism, representing a prevalence of 17.95%. There was a female predominance (56 cases) with a M/F sex ratio of 0.57. The average age was 64.5 years (range 60 and 85 years). The circumstances of diagnosis of thyroid disease were mainly goiter (59.1%), exophthalmos (9.1%), cervical compression (25%), cardiothyreosis (5.7%). The main manifestations of thyrotoxicosis were weight loss (17%), palpitations (29.5%), and fatigability (34.1%). The predominant signs of hypothyroidism were constipation (17%) and myxedematous syndrome (3.4%). Hyperthyroidism was encountered in 13.64% of patients, compared to 29.54% cases of hypothyroidism. Cervical thyroid ultrasound found 36 cases of diffuse goiter (40.9%), 18 cases of multinodular goiter (20.45%), 17 cases of single nodule (19.31%). The main etiologies were Graves' disease (11.4%), multinodular goiter (46.6%), Hashimoto's thyroiditis (17%), simple goiter (5.7%). Thyroidectomy involved 33 patients (37.5%). Two cases of death were recorded in connection with cardiothyreosis.
Conclusion: Dysthyroidism is common in the elderly at the Conakry University Hospital and a hormonal dosage if there is the slightest doubt in order to initiate the appropriate treatment in time would be required in order to prevent complications
Rethinking Our Classrooms: Teachers’ Perceptions on Integrating Transferable Skills in the Classrooms to Create an Active Learning Environment
Get PDFDespite many efforts to promote transferable skills development, it remains a challenge for Higher Education Institutions (HEIs) and schools. To improve education practices and meet the challenges of an ever-changing environment, it is vital to introduce a paradigm shift in education. In light of this, it is significant to identify and implement the teaching strategies that facilitate transferable skills development. There has long been a controversy over the traditional pedagogical style of lecture delivery as opposed to an active learning environment in which learners are engaged in the learning process itself. The paper sheds light on various ways of integrating transferable skills in the classroom. It examines diverse methods, teaching/learning strategies, and educational tools that aim at promoting a learner-centered learning environment, to ensure the development of transferable skills, such as critical thinking, teamwork, communication, collaboration, creativity, research skills, etc. Creating such a learning environment stimulates students' interests, engagement, and motivation. Consequently, it overviews a practical application of some activities and strategies that can activate the skills as well as reveals the results of findings that showed teachers’ perception regarding a practical application of some methods and strategies to enhance transferable skills. This research is significant by identifying the indicators of an active learning environment, which encourage educators to reimagine their classrooms and implement innovative teaching practices
Play-Based Learning: Benefits and Challenges of its Implementation
Get PDFThis study explores how Eritrean pre-school educators viewed and conceptualized play-based learning (PBL), the benefits, and challenges of its implementation. A semi-structured interview was conducted with nine teachers, six principals, and two pre-primary education curriculum developers. Interviews were thematically analyzed. The study found discrepancies between participants’ views and their implementation. Our findings indicate that most of the participants viewed PBL as incorporating both free-play and guided play. However, the result of this study revealed that free play cannot effectively be used as an instrument to teach lessons that have specific academic objectives such as numeracy and literacy skills. Besides, the researchers sought to investigate the actual practices of PBL and the study found that majority of educators were placed at the Child Adult Involvement Continuum extremes, free-play, and direct instruction. Furthermore, the result revealed that various challenges were teachers face as they try to implement PBL, but the most common barrier discussed by interviewees was the lack of awareness of parents and principals towards PBL. Finally, the study concluded that the reason teachers lie at the two extremes of the Child Adults Involvement Continuum could be due to their views towards PBL, and its benefits and the challenges they face in implementing it
Le Rôle de l’Identification chez l’Adolescent Exposé à la Violence Conjugale au Cameroun
Get PDFLa violence conjugale au Cameroun est un fléau qui va grandissant mais, curieusement, vécue dans nombreuse famille comme une banalité. Malheureusement, cette violence entre les parents (verbale, physique, psychologique, économique et spirituelle) se pratique en présence des adolescents. Cette présence des adolescents va créer chez eux de la souffrance psychologique. Cette souffrance va être par la suite évacuée par l’appareil psychique. C’est dans cette mouvance que notre étude s’intéresse au processus d’évacuation de la souffrance psychique chez l’adolescent exposé à la violence conjugale. La méthode clinique a été utilisé comme méthode de recherche. Les entretiens ont été fait auprès de trois adolescents fréquemment exposés à la violence conjugale au Cameroun. Les données recueillies auprès des sujets ont été analysées à travers l’analyse thématique de contenu suivant l’approche psychanalytique. Il ressort des entretiens semi-directifs que l’adolescents camerounais exposé à la violence conjugale est atteint sur son psychisme. Cependant, ces adolescents face à cette adversité, ont mobilisé de l’énergie psychique basé sur l’identification aux pairs non exposés à la violence conjugale pour évacuer la souffrance psychique. Le fait pour l’adolescent de s’identifier aux pairs non exposés, va restaurer l’équilibre psychique.
Marital violence in Cameroon is a growing scourge but, curiously, experienced in many families as a banality. Unfortunately, this violence between parents (verbal, physical, psychological, economic and spiritual) is practiced in the presence of adolescents. This presence of adolescents will create psychological suffering for them. This suffering will subsequently be evacuated by the psychic. It is in this movement that our study focuses on the process of evacuating psychological suffering in adolescents exposed to marital violence. The clinical method was used as a research method. The interviews were carried out with three adolescents frequently exposed to marital violence in Cameroon. The data collected from the subjects were analyzed through thematic content analysis following the psychoanalytic approach. It appears from the interviews semi-structured that Cameroonian adolescents exposed to marital violence are affected on their psychic. However, these adolescents, faced with this adversity, mobilized psychic energy based on identification with peers not exposed to marital violence to relieve psychological suffering. The fact that the adolescent identifies with unexposed peers will restore psychological balance
Traitement Chirurgical des Tumeurs Osseuses à Cellules Géantes au Centre Hospitalier Universitaire de Reference Nationale de N’Djamena (CHU-RN) à Propos de Cinq (5) Cas
Get PDFLes tumeurs à cellules géantes (TCG) sont des tumeurs assez rares et représentent 5 à 10 % de l'ensemble des tumeurs primitives. Elles constituent une entité anatomo-clinique et radiologique particulière observée essentiellement chez le sujet jeune entre 20 et 40 ans. Elles apparaissent comme des lésions lytiques expansives de siège habituellement métaphysoépiphysaire des os longs. Leur traitement reste controversé en raison du taux important de récidive. Tout de même la chirurgie reste capitale. Nous rapportons cinq cas de tumeurs osseuses à cellules géantes opérées au travers desquels seront discutées les difficultés diagnostiques et thérapeutiques. Les tumeurs osseuses à cellules géantes (TCG) sont des tumeurs rares et souvent bénignes. Leur traitement est essentiellement chirurgical.
The giant cell tumours (GCTs) are fairly rare tumours, accounting for 5 to 10% of all primary tumours. They constitute a anatomo-clinical and radiological entity observed essentially in young subjects young subjects between the ages of 20 and 40. They appear as expansive lytic lesions, usually metaphyseal in the long bones.Their treatment remains controversial due to the high rate of recurrence. All surgery remains essential. We report five cases of giant cell bone tumours, and discuss the diagnostic and therapeutic diagnostic and therapeutic difficulties. Giant cell tumours (GCTs) are rare and often benign tumours. often benign tumours. Their treatment is essentially surgical treatment