Pan African Medical Journal最新文献

Introduction: post-abortion contraception, when administered before hospital discharge, effectively prevents unintended pregnancies and subsequent abortions. This study assessed the proportion of healthcare providers offering post-abortion contraceptive services in the Mfoundi Division of Cameroon and identified factors influencing these practices.

Methods: we conducted a hospital-based cross-sectional study among 332 healthcare providers offering post-abortion care from 21 health facilities (10 private and 11 public) in the Mfoundi Division. Using a non-probabilistic sampling method, we selected two-thirds of participants from public facilities and one-third from private facilities. A pretested structured questionnaire was used for data collection, and SPSS 23.0. For data analysis. Binary logistic regression (p<0.05) determined associated factors.

Results: among the participants were obstetricians/gynecologists (4.9%), midwives (44.6%), nurses (27.7%), general practitioners (9.6%), junior residents (6.9%), and senior residents (4.2%). We had 81.63% offering post-abortion contraceptive counseling, whereas 33.1% offered contraceptive methods prior to hospital discharge. Post abortion contraceptive counseling was associated with training on family planning (OR 3.8, p<0.001) and on post-abortion care (PAC) (OR 4.5, p=0.002). The non-availability of contraceptives (OR 0.18, p<0.001), knowing the importance of contraceptives during PAC (OR 2.6, p<=0.001), being an obstetrician/gynecologist (OR 1.3, p=0.012), family planning training (OR 3.8, p=0.003), and the availability of protocols (OR 2.8, p<0.001) were associated with post-abortion contraceptives provision.

Conclusion: these results highlight the necessity of enhancing the post-abortion contraceptive practices in health facilities.

Introduction: diabetes in children and adolescents is a major concern in Africa, due to challenges in management and treatment adherence, with the risk of early onset of complications in this population. The purpose of this study was to provide an overview of the population of diabetic children and adolescents followed at CHUL.

Methods: we conducted a cross-sectional study from January 2020 to December 2023. It included children and adolescents under 19 years of age hospitalised in the Endocrinology Department of CHUL.

Results: during the study period, 114 patients under the age of 19 were hospitalised, representing a hospital frequency of 8%. Female predominance was noted (F/M sex ratio 0.67). The mean age was 13.08 ± 4.14 years, with extremes ranging from 3 months to 19 years. The mean age at diagnosis was 10.96 ± 4.29 years, 64.04% had health insurance, and 67.55% had a secondary education level. Diabetic ketoacidosis accounted for 64.91% of cases; polyuria and polydipsia were the most frequent signs, and 54.38% of patients tested positive for autoantibodies. Ketoacidosis decompensations were frequent (29%). Mortality accounted for 3.5% of cases.

Conclusion: diabetes in children and adolescents is not a rare condition in Libreville. It appears to affect girls more frequently. The most common complication is ketoacidosis. Mortality is low; however, the high rate of rehospitalisations raises the issue of therapeutic education and transition in our population of young diabetic patients.

Borderline ovarian Brenner tumor (BOT-B) accounts for less than 2% of all ovarian neoplasms. It is typically unilateral and large, with non-specific imaging features. Synchronous extra-ovarian neoplasia is rarely documented. A 47-year-old gravida 2, para 2 woman presented with intermenstrual bleeding and lower abdominal discomfort. Transvaginal ultrasound and pelvic magnetic resonance imaging (MRI) revealed a 9 cm right adnexal complex mass without ascites or elevated serum tumor markers. Intraoperative findings identified bilateral, firm, lobulated ovarian tumors (right: 5 cm; left: 7 cm) and an inflamed, hydropic appendix. Frozen section analysis of the left ovary indicated a borderline Brenner tumor with focal atypia; carcinoma could not be ruled out. Following informed consent, the patient underwent laparoscopic bilateral salpingo-oophorectomy, appendicectomy, omentectomy, and peritoneal biopsy. Final histopathology confirmed bilateral BOT-B without stromal invasion and a synchronous low-grade appendiceal mucinous neoplasm (LAMN) with negative margins. No adjuvant chemotherapy was administered. Imaging at three-month follow-up showed no evidence of recurrence. This represents the first reported case of synchronous bilateral BOT-B and LAMN. It highlights the following: i) the critical importance of comprehensive surgical exploration for atypical adnexal masses; ii) that BOT-B can present bilaterally and at a smaller size than classically described; and iii) that complete, conservative fertility-sparing surgery with strict adherence to a tumor-free technique is an adequate management strategy for borderline Brenner tumors, associated with excellent short-term outcomes.

Acute bronchiolitis is the most common viral lower respiratory tract infection in infants, with an annual incidence of 3-5% in children under 12 months, peaking between 2 and 6 months of age. Respiratory syncytial virus (RSV) is responsible for 50-80% of cases. Although generally benign, bronchiolitis may be complicated by spontaneous pneumothorax, which is reported in only 0.5-2% of hospitalized infants, making it a rare but potentially life-threatening event. We report the case of an 11-month-old female infant with a family history of maternal asthma, admitted for acute respiratory distress during a second episode of bronchiolitis. Examination revealed tachypnea, wheezing, and retractions. RSV infection was confirmed by polymerase chain reaction. Imaging showed a moderate left-sided pneumothorax with partial atelectasis. Conservative management with oxygen, nebulized salbutamol, and intravenous corticosteroids led to full recovery without invasive intervention. This rare case emphasizes the importance of considering pneumothorax in bronchiolitis with sudden deterioration. In stable infants, conservative treatment may be sufficient.

Introduction: updating epidemiological and clinical data on people living with HIV (PLHIV) is essential to optimize strategies for prevention, screening, and clinical management. This study aimed to determine the prevalence of HIV infection and assess its impact on clinical outcomes among patients admitted to the general intensive care unit (ICU) at Laquintinie Hospital in Douala (HLD).

Methods: we conducted a cross-sectional descriptive study involving 179 patients admitted to the ICU of HLD. Sociodemographic, clinical, and biological data were collected using a structured questionnaire and analyzed using R software. Univariate and multivariable logistic regression analyses were performed to identify factors associated with mortality.

Results: the prevalence of HIV-1 infection was 26.3% (n= 47). The mean age of patients was 41.23 ± 7.2 years (range: 25-89), with HIV-negative patients more frequently aged over 65 years: 22.0% (n= 29) versus 8.5% (n= 4) among HIV-positive patients (p= .002). Males accounted for 52.0% (n = 93) of the overall population, while females were predominant in the HIV-positive group: 61.7% (n= 29) versus 43.2% (n= 57) in HIV-negative patients (p= .029). Unemployment was the most common occupational status at 52.0% (n = 93), with no significant difference by HIV status (p = .70); secondary education level was also common (50.3%, n= 90). Clinically, coma was the main reason for ICU admission (72.1%, n = 129). Compared to HIV-negative patients, HIV-positive patients more frequently presented with severe dehydration (10.6%, n= 5 vs 3.0%, n= 4; p=.04), severe anemia (36.2%, n= 17 vs 19.7%, n= 26; p= .02), and sepsis (44.7%, n= 21 vs 16.7%, n= 22; p < .001); meningoencephalitis (48.9%, n = 23) and pneumonia (23.4%, n= 11) were also more common. Overall mortality was 29.1% (n= 52), nearly twice as high among HIV-positive patients (44.7%, n = 21) compared to HIV-negative patients (23.5%, n= 31). In multivariable logistic regression, three factors were independently associated with mortality: severe anemia (aOR = 7.90; 95% CI: 1.52-50.8; p = .019), sepsis (aOR = 5.53; 95% CI: 1.06-36.0; p= .040), and pneumonia (aOR= 5.53; 95% CI: 1.06-36.0; p= .040).

Conclusion: our findings indicate that, among patients admitted to the ICU, HIV infection presence of severe anemia, sepsis, was associated with a more severe clinical profile and higher mortality, particularly in the presence of severe anemia, sepsis, or pneumonia.

Introduction: the financial obligations that come with the implementation of a system that will ensure equitable access to healthcare are an important consideration to realise the national health insurance (NHI). The aim of this manuscript was to evaluate whether there is sufficient policy consensus in finding innovative and sustainable ways to address the healthcare finance fundamentals of the NHI.

Methods: a descriptive, experimental quantitative study employing a 5-point Likert scale questionnaire was used to collect the data. The participants were drawn from individuals and stakeholders who interact with and/or are in the employment of the organisations concerned with healthcare regulation and service delivery.

Results: the study found that the funding initiatives employing budget prioritization for healthcare reforms (76%), reducing reliance on payroll taxes (68%), and permitting the private insurance to play a role (62%) were preferred; however, 70% of the respondents were opposed to new payroll taxes. The study found that 64% endorsed supply-side policies for benefit package expansion, 60% supported capping health expenditure and restricting catastrophic co-payments, and 77% favoured prioritizing primary care and cost-effective services. There was limited support (42%) for the consolidation of medical aids, and opinions were divided on maintaining multiple risk pools. There was consensus across occupational groups on NHI funding (P = 0.603) but marked differences by occupation for "getting more value for money" (P = 0.041) and "pooling and redistribution of resources" (P = 0.032), particularly between leadership/governance and information/research-service delivery roles. Correlation analysis showed the three main subthemes had moderate positive relationships (r = 0.34-0.66), suggesting that challenges or improvements in one area are likely to impact others.

Conclusion: these findings highlight a critical need for nuanced, occupation-sensitive approaches to policy development and implementation, given the fact that there are divergent views on funding policies.

Introduction: the Angiotensin-Converting Enzyme (ACE) is a critical enzyme in the renin-angiotensin system and influences neurotransmitter regulation, including dopamine. Previous studies have suggested a potential association between ACE gene polymorphisms and psychiatric disorders, including schizophrenia. This study aimed to investigate the association between the insertion/deletion (I/D) polymorphism in the ACE gene and schizophrenia in an Eastern Algerian population.

Methods: a case-control study was conducted involving 157 schizophrenia patients and 222 healthy controls. Deoxyribonucleic acid (DNA) was extracted from peripheral blood using the salting-out method, and the ACE I/D polymorphism was genotyped using the polymerase chain reaction (PCR) technique. Statistical analyses were performed using SPSS version 26.0.

Results: no significant association was observed between the ACE I/D polymorphism and schizophrenia. Compared to the DD genotype, the ID genotype showed OR = 0.84 (95% CI: 0.47-1.50, P = 0.66), and the II genotype OR = 0.47 (95% CI: 0.05-4.54, P = 0.66). The I allele was also not significantly associated (OR = 0.80, 95% CI: 0.47-1.33, P = 0.38). Dominant, over-dominant, and recessive models showed no significant results.

Conclusion: these findings suggest that the ACE I/D polymorphism does not contribute to the genetic susceptibility to schizophrenia in this population. Further research with larger sample sizes and consideration of gene-environment interactions is needed to provide deeper insights into the role of ACE in schizophrenia.