Introduction: Maternal death or maternal mortality is "the death of a woman occurring during pregnancy or within 42 days of termination, regardless of duration or location, for any specific cause or aggravated by pregnancy or its management, but neither accidental nor fortuitous. Methods: This was a descriptive and analytical cross-sectional study carried out from January 1 st , 2021 to April 30 th , 2022 at the Obstetrics Gynecology Clinic of the Sylvanus Olympio University Hospital Center (SOUHC). Results: we noted 86 cases of maternal deaths after referral/evacuation i.e. a maternal mortality rate hospital of 555 maternal deaths per 100,000 LB. The average age of the patients was 31.1 ± 6.3 years with extremes of 15 and 45 years. In 33.7% of cases our patients were resellers. Multiparas represented 33.7% of the sample, they had performed less than three antenatal consultations. Postpartum hemorrhage was the reference reason in 33.7%. In 74.4% of cases, the patients referred had arrived by taxi. In 87.9% of cases, the patients had died of direct obstetric causes. Immediate postpartum hemorrhage accounted for 44.6% of cases and anemia, 36.4%. There is a statistically significant association between the availability of blood product and the avoidability of maternal death after obstetrical referral and/or evacuation (p value = 0.0188 < 0.05). Conclusion: Determining responsibility for maternal death is not always easy. There is an urgent need to strengthen the policy of reducing maternal mortality in Togo. This remains possible by developing communication strategies and a solid referral/counter-referral system.
Introduction: With 11.7% new cases worldwide in 2020, female breast cancer is not only the first among gynaecological cancers, it is also the first cancer worldwide. Also, disease stage during diagnosis is an important cost predicting factor. Methods: It was a transversal descriptive study carried out in the Obstetrics and Gynaecology unit of the Sylvanus Olympio University Hospital (SO UH) and in the International Cancer Centre of Lome (ICCL) during July and august of the year 2022. Results: Only 146 patients were enrolled in our study, with a participation rate of 30.87%. The mean age of the patients was 48.9 ± 11.7 years with extremes of 25 and 77 years. Fifty one patients (39%) were resellers. Sixty four patients (43.8%) attended secondary education. The median cost of breast cancer diagnosis was 182080 FCFA ]55680; 487680] FCFA. The median cost of chemotherapy was 1640790 FCFA ]199820; 5208885] FCFA. The median cost of surgical treatment of breast cancer was 230 320 FCFA ]135240; 368060] FCFA. The median cost of hormonal treatment was 206200 FCFA ]36750; 494850] FCFA. The median cost of radiotherapy was 1 765 000 FCFA ]1715000; 2030 000] FCFA. Of the 146 patients, 46 had not undergone any other complementary tests apart from diagnostic tests. The median cost of the tests carried out as part of the pre-therapeutic assessment and follow-up was 21 500 FCFA (0; 824 760] FCFA. The direct medical cost of breast cancer management was 119200 FCFA [36616- 1604669] FCFA for patients with health insurance (17.1% of patients). Conclusion: The direct medical cost of breast cancer treatment is higher than the average household income in Togo. The question of what measures could be taken to increase adherence to treatment by patients living with this cancer and to reduce the large number of long-lost patients is still pending.
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