PURPOSE The project aimed to implement pilot screening and treatment services for cervical cancer integrated with existing primary health centers (PHCs) in Benin, Cote d'Ivoire, and Senegal and evaluate these services using implementation research outcomes such as reach, effectiveness, adoption, and acceptability. MATERIALS AND METHODS The Ministry of Health in each country took the lead in setting up a stakeholder's group that designed a protocol tailored to the local context. The target age was 25-49 years in Benin and Cote d'Ivoire and 30-49 years in Senegal. Visual inspection with acetic acid (VIA) was the screening test, and thermal ablation (TA) was the ablative treatment of choice in all. The Ministry in each country identified 4-5 PHCs to set up screening and ablation services and one higher-level center for colposcopy referral. After a master-trainer led training program, nurses, midwives, or general practitioners screened opportunistically the eligible women attending the clinics. The VIA-positive women eligible for ablation were offered immediate treatment. RESULTS Between May 2018 and January 2021, 16,530 women were screened opportunistically. VIA positivity was 8.1% with huge variability within and between countries. Sixty-one percent of all VIA-positive cases were eligible for immediate TA, and 88% of them accepted same-day treatment. Compliance to TA at PHCs was 99%. Majority of women treated with TA complained of minor side effects. Significant dropouts occurred as the women were referred to colposcopy clinics. CONCLUSION Opportunistic screening provided as part of routine PHC service can screen many women and treat a significant proportion of screen-positive women with TA with minimal side effects. Primary concerns are the hard-to-reach women who remain out of opportunistic screening coverage and noncompliance of the screen-positive women referred to higher-level centers.
Introduction: Spontaneous fertility after myomectomy for pregnancy desire remains a concern. Objective: Appreciate spontaneous fertility after a myomectomy for pregnancy desire. Methods: This was a descriptive and analytical study to collect retrospective data on cases of myomectomy pregnancy desire realised between 2016 and 2020 in the university maternity wards of Cotonou. All myomectomy records for desire for pregnancy were identified. The post myomectomie fertility related data and the clinical characteristics influencing the occurrence of pregnancy and its outcome after myomectomy were analyzed with regard to the rules of professional conduct and ethics. Results: On 188 myomectomies performed for desire of pregnancy, 102 had been analyzed. The mean age was 34 years ± 5.7. Nulligest and nulliparous were the most numerous in the respective proportions of 39.2% and 71.6%, and 16.7% (n=17) had a history of polymyomectomy. Fertility after myomectomy was observed in 16.7% (n=17) of cases. The mean time to return to fertility (pregnancy) after myomectomy was 27 months. Alcohol addiction (p=0.00), gestality (p=0.01), myoma size (p=0.00) and adenomyosis (p=0.00) had an negative impact on the time to onset pregnancy after myomectomy. Of 17 pregnancies recorded after myomectomy, 11 (64.7%) progressed normally with term delivery and 5 spontaneous abortions (29.4%) were recorded. One (1) pregnancy was ongoing at the time of the survey. Planned caesarean section (n=9) was the most frequent mode of delivery. Eleven (11) newborns were welcomed and the diaper suites were simple. Conclusion: Spontaneous fertility after myomectomy remains low in our series. Factors with a negative impact on fertility must be taken into account.
Objectives: Describe the prognosis and profile of the retro placental hematoma(RPH) at CUAB for a better organization of care. Methods: This is a descriptive retrospective study, carried out in the obstetric gynecology service of the CUAB over a 12-months period from January to December 2019. It focused on the complet medical records of patients. Were included pregnant in the third trimester in whom the diagnosis was made either by clinical examination and/or by ultrasound and confirmed by the presence of placental cups. Data entry and analysis were carried out by EPI Data and EPI Info software. Strict compliance with ethical rules and standards has been observed. Results: The RPH in 2019 represented 2,70 % of childbirth at CUAB. The RPH victims were young multiparous women, with an average age of 29 years, housewives, of Bariba or Dendi ethnicity with a history of preeclampsia, diabetes and sickle cell disease. They were referred for irregular uterine bleeding (97,8%), lumbar and pelvic pain (72,3%), suspected RPH (48,9%) or death in utero (46,8%). The clinical pictures were often typical and the forms with coagulation disorders represented (25,5%). Anemia was the main morbidity and found in 80% of cases. Prematurity (32-36 AW and 6 days) was 74,5%. The maternal case-fatality ratio was 6% and the perinatal case-fatality ratio was 68%. Neonatal mortality was proportional to the weight of the cups. Conclusion: Mortality from RPH was high in northern Benin. The victims were nulliparous or multiparous young people of Bariba or Dendi ethnicity with a history of vasculo-renal syndromes or referred diabetes.
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