Peripheral Health Facilities Research Articles

Notified dengue deaths in Myanmar (2017-18): profile and diagnosis delays

Background: Complications in dengue usually occur between day four and day six after fever onset. Hence, early diagnosis and haematological monitoring are vital. Among all hospital reported dengue deaths in Myanmar in 2017-18, we assessed the i) patient profile, ii) proportion of patients who arrived with a dengue diagnosis at admission and iii) delays in diagnosis after fever onset. Methods: This was a descriptive study involving secondary data. For all the notified deaths, death investigation forms were not available in prescribed format and therefore, data were extracted from hospital case records. Results: Of 304 deaths, 184 (60.5%) were female and 233 (76.6%) were less than 10 years old. Township level hospitals or below reported 36 deaths (11.8%) and the remaining deaths were from higher level facilities. Dengue was diagnosed before admission in 26 (8.5%) people and 169 (55.6%) were in shock at admission. Of 208 with date of fever onset recorded, the median diagnosis delay was four (interquartile range-IQR: 3, 5) days. Patient level delay (median three days) was a major contributor to the diagnosis delay. Conclusions: Most of the patients who died did not have a diagnosis of dengue before admission. This calls for an urgent review of health system preparedness in peripheral health facilities to suspect, diagnose, monitor, refer and treat dengue in children and patient level factors for better understanding of the reasons of delay. Timely filling of death investigation forms in a prescribed format and quarterly death reviews based on these is recommended.

Vasomotor rhinitis treated by application of silver nitrate in peripheral health care facility

Vasomotor rhinitis treated by application of silver nitrate in peripheral health care facility

Notified dengue deaths in Myanmar (2017-18): profile and diagnosis delays.

Background: Complications in dengue usually occur between day four and day six after fever onset. Hence, early diagnosis and haematological monitoring are vital. Among all hospital reported dengue deaths in Myanmar in 2017-18, we assessed the i) patient profile, ii) proportion of patients who arrived with a dengue diagnosis at admission and iii) delays in diagnosis after fever onset. Methods: This was a descriptive study involving secondary data. For all the notified deaths, death investigation forms were not available in prescribed format and therefore, data were extracted from hospital case records. Results: Of 304 deaths, 184 (60.5%) were female and 233 (76.6%) were less than 10 years old. Township level hospitals or below reported 36 deaths (11.8%) and the remaining deaths were from higher level facilities. Dengue was diagnosed before admission in 26 (8.5%) people and 169 (55.6%) were in shock at admission. Of 208 with date of fever onset recorded, the median diagnosis delay was four (interquartile range-IQR: 3, 5) days. Patient level delay (median three days) was a major contributor to the diagnosis delay. Conclusions: Most of the patients who died did not have a diagnosis of dengue before admission. This calls for an urgent review of health system preparedness in peripheral health facilities to suspect, diagnose, monitor, refer and treat dengue in children and patient level factors for better understanding of the reasons of delay. Timely filling of death investigation forms in a prescribed format and quarterly death reviews based on these is recommended.

The role of accountability in the performance of Jazia prime vendor system in Tanzania

BackgroundAccess to safe, effective, quality and affordable essential medicines for all is a central component of Universal Health Coverage (UHC). However, the availability of quality medicines in peripheral healthcare facilities is often limited. Several countries have developed integrated complementary pharmaceutical supply systems to address the shortage of medicines. Nevertheless, there is little evidence on how accountability contributes to the performance of such complementary pharmaceutical supply systems in low-income settings. The current study analyses how accountability mechanisms contributed to the performance of Jazia Prime Vendor System (Jazia PVS) in Tanzania.MethodsThe study analysed financial, performance and procedure accountability as defined in Boven’s accountability framework. We conducted 30 in-depth interviews (IDIs), seven group discussions (GD) and 14 focus group discussions (FGDs) in 2018 in four districts that implemented Jazia PVS. We used a deductive and inductive approach to develop the themes and framework analysis to summarize the data.ResultsThe study findings revealed that a number of accountability mechanisms implemented in conjunction with Jazia PVS contributed to the performance of Jazia PVS. These include inventory and financial auditing conducted by district pharmacists and the internal auditors, close monitoring of standard operating procedures by the prime vendor regional coordinating office and peer cascade coaching. Furthermore, the auditing activities allowed identifying challenges of delayed payment to the vendor and possible approaches for mitigation while peer cascade coaching played a crucial role in enabling staff at the primary facilities to improve skills to oversee and manage the medicines supply chain.ConclusionFinancial, performance and procedure accountability measures played an important role for the successful performance of Jazia PVS in Tanzania. The study highlights the need for capacity building linked to financial and supply management at lower level health facilities, including health facility governing committees, which are responsible for priority-setting and decision-making at facility level.

Adherence to the MDR-TB intensive phase treatment protocol amongst individuals followed up at central and peripheral health care facilities in Uganda - a descriptive study.

Following initiation of MDR-TB treatment, patients have a choice to receive follow up DOT supervision at either the central initiating facility or at a peripheral facility. We describe the adherence patterns of MDR-TB patients undergoing DOT supervision at the two health facility categories during intensive phase of treatment. We used a retrospective cohort of patients initiated on MDR TB treatment at Mulago National Referral Hospital between 2014 and 2016. We extracted data from the National Tuberculosis and Leprosy Program records and analysed these using STATA V14. Majority (84.01%) of the patients received their DOT supervision from the peripheral facilities. Males made up 62.1% of patients, and 91.2% had had their household contacts screened for MDR-TB. 26.5% of the patients on peripheral DOT supervision had good adherence to treatment protocol compared to 0% among patients on central initiating health facility DOT supervision. Among the patients with good adherence, 24.1% had contacts screened for MDR-TB as compared to 3.6% with poor adherence. More patients preferred MDR-TB DOT supervision at peripheral facilities, which had better adherence to the treatment protocol compared to the central initiating facility. Younger people and those with household contacts screened had better adherence to the treatment protocol, highlighting areas for targeted interventional programs for MDR-TB in resource limited settingsMore patients preferred MDR-TB DOT supervision at peripheral facilities, which had better adherence to the treatment protocol compared to the central initiating facility. Younger people and those with household contacts screened had better adherence to the treatment protocol, highlighting areas for targeted interventional programs for MDR-TB in resource limited settings.

Limitations to current methods to estimate cause of death: a validation study of a verbal autopsy model.

Background: Accurate information on causes of death (CoD) is essential to estimate burden of disease, track global progress, prioritize cost-effective interventions, and inform policies to reduce mortality. In low-income settings, where a significant proportion of deaths take place at home or in poorly-resourced peripheral health facilities, data on CoD often relies on verbal autopsies (VAs). Validations of VAs have been performed against clinical diagnosis, but never before against an acceptable gold standard: the complete diagnostic autopsy (CDA). Methods: We have validated a computer-coded verbal autopsy method -the InterVA- using individual and population metrics to determine CoD against the CDA, in 316 deceased patients of different age groups who died in a tertiary-level hospital in Maputo, Mozambique between 2013 and 2015. Results: We found a low agreement of the model across all age groups at the individual (kappa statistic ranging from -0.030 to 0.232, lowest in stillbirths and highest in adults) and population levels (chance-corrected cause-specific mortality fraction accuracy ranging from -1.00 to 0.62, lowest in stillbirths, highest in children). The sensitivity in identifying infectious diseases was low (0% for tuberculosis, diarrhea, and disseminated infections, 32% for HIV-related infections, 33% for malaria and 36% for pneumonia). Of maternal deaths, 26 were assigned to eclampsia but only four patients actually died of eclampsia. Conclusions: These findings do not lead to building confidence in current estimates of CoD. They also call to the need to implement autopsy methods where they may be feasible, and to improve the quality and performance of current VA techniques.

Demographic and health community-based surveys to inform a malaria elimination project in Magude district, southern Mozambique

ObjectivesA Demographic and Health Platform was established in Magude in 2015, prior to the deployment of a project aiming to evaluate the feasibility of malaria elimination in southern Mozambique, named...

The time is now: expedited HIV differentiated service delivery during the COVID-19 pandemic.

The time is now: expedited HIV differentiated service delivery during the COVID-19 pandemic.

Effectiveness of Presumptive Treatment of Acute Febrile Illness With Doxycycline or Azithromycin in Preventing Acute Encephalitis Syndrome in Gorakhpur, India: A Cohort Study

To estimate effectiveness of presumptive doxycycline or azithromycin treatment in preventing progression of Acute Febrile Illness to Acute Encephalitis Syndrome in Gorakhpur. Prospective cohort study. Primary healthcare centers and Community healthcare centers of Gorakhpur district, Uttar Pradesh. Children aged 1 year to less than 15 years with fever of 3 days to less than 15 days duration attending three selected peripheral health facilities in Gorakhpur during August to October, 2018. 35 medical officers in three selected Primary Healthcare Centers/Community Healthcare centers were sensitized on the treatment strategy. After sensitization, study participants were enrolled and information about prescription of doxycycline or azithromycin was collected. Participants were telephonically followed-up to know their progression status from AFI to AES. Incidence of acute encephalitis syndrome among acute failure illness patients who received presumptive doxycycline or azithromycin treatment and those who did not receive this treatment. Of the enrolled 930 AFI patients, 801 (86%) were prescribed doxycycline or azithromycin and 725 (78%) could be telephonically followed-up. Progression to acute encephalitis syndrome was seen in 6 of the 621 patients who received presumptive treatment, and 5 of the 104 who did not receive the treatment. The relative risk of developing acute encephalitis syndrome among acute febrile illness patients who were prescribed presumptive treatment with doxycycline or azithromycin was 0.20 (95% CI: 0.06-0.65). The effectiveness of presumptive treatment with doxycycline or azithromycin strategy was 79.9% (95% CI: 35.4-94). PDA treatment to children presenting with fever in peripheral health facilities of the study blocks in Gorakhpur during August-November, 2018 had good effectiveness in preventing progression of acute febrile illness to acute encephalitis syndrome.

Factors Associated With Severe Maternal Outcomes at a Regional Referral Hospital in South-Western Uganda: A Case-Control Study

Background: The Sustainable Development Goal target is to reduce the global maternal mortality ratio to less than 70 per 100,000 live births by 2030. Maternal morbidity and mortality in sub-Saharan Africa remains high despite global efforts to reduce it. Severe maternal outcome studies offer a panoramic assessment of obstetric care. Objective: The study aimed at determining the factors associated with severe maternal outcomes among women admitted at the obstetrics and gynecology ward of Mbarara Regional Referral Hospital. Methods: In an unmatched case control (1:2) study conducted between February and May 2018, 162 pregnant women admitted on the obstetrics and gynecology ward of Mbarara Regional Referral Hospital, or who had delivered within the past 42 days were recruited. Near miss cases were defined based on the WHO criteria. Near-miss cases and events, maternal deaths and their causes were retrospectively reviewed. Three categories of risk factors (socio-demographic, obstetric and health system) were examined. P-values <0.05 were considered statistically significant. A multivariable logistic regression model was used to identify factors associated with severe maternal outcomes. All analyses were performed using Stata software (Version 12.0, StataCorp, and College Station, TX). Results: In the four-month period there were 2301 live births, there were 45 near miss cases and 9 maternal deaths resulting in a severe maternal outcome ratio of 23.5/1000 live births, maternal near miss ratio of 19.6/1,000 live births, maternal near-miss mortality ratio of 5 and mortality index of 16.7%. Severe obstetric hemorrhage (33%), ruptured uterus (27.8%), sepsis or severe systemic infection (16.7%) and hypertensive disorders in pregnancy (16.7%) were the direct causes of severe maternal outcomes. About seventy-seven percent (77.8%) of the mothers with severe maternal outcomes were referred in from the peripheral health facilities, with a 4-time risk increased risk of a severe maternal outcome (aOR, 4.00; 95 % CI, 1.84-6.66, p-<0.001). Conclusion: Of the severe maternal outcomes, direct causes were the most prevalent and most of which are preventable. Being referred in was significantly associated with severe maternal outcomes. The maternal near miss indicators indicate need for improved quality.

The Prevalence, Risk Factors, and Bacterial Profile of Cesarean Surgical Site Infections at a University Teaching Hospital in South Western Uganda

Introduction: The single most important risk factor for post-partum maternal infection is Cesarean section (C/S) with a 5-20-fold greater risk for infection compared to a vaginal delivery. Post Cesarean wound infection is diagnosed in 2.5 to 16 percent of patients. Early wound infections (in the first 24 to 48 hours) are usually due to group A or B beta-hemolytic streptococcus and are characterized by high fever and cellulitis while later infections are likely due to Staphylococcus epidermises or aureus, Escherichia coli, or Proteus species. Objectives: To determine the prevalence, risk factors and bacterial profile of wound sepsis following Cesarean at Mbarara Regional Referral Hospital (MRRH). Methods: A cross sectional study of mothers who delivered by Cesarean at MRRH was conducted. Mothers were recruited consecutively until the sample size was achieved. The main dependent variable was wound sepsis confirmed by a positive culture for microorganisms. Results: Of the 359 mothers recruited in the study, 54 (15.5%) developed Cesarean wound sepsis. The risk factors associated with post Cesarean wound sepsis were severe anemia, lack of preoperative antibiotics use, poor antenatal attendance, mothers referred from peripheral health facilities, abnormal Body Mass Index (BMI), diabetes mellitus, more than five vaginal examinations, prolonged rupture of membranes before C/S, and prolonged labour. Staphylococcus aureus was isolated in 48.2% of all the septic cases and most of the bacterial isolates were susceptible to ceftriaxone, ceftazidime, ciprofloxacin and nalidixic acid and resistant to penicillin. Conclusion: The prevalence of post Cesarean wound sepsis is high with staphylococcus aureus being the most common bacteria isolated in infected wounds. Most of the bacteria were susceptible to third generation cephalosporins and quinolones. Antibiotics use was protective against developing wound sepsis.

Newborn Service Readiness of Primary Level Health Facilities of Eastern Mountain Region of Nepal.

Newborn service readiness is facility's observed capacity to provide newborn services and a pre-requisite for quality. Newborn services are priority program of government and efforts are focused on infrastructure and supplies at peripheral health facilities. Study describes health facility readiness for newborn services in four domains of general requirements, equipment, medicines and commodities, and staffing and guidelines. Convergent parallel mixed method using concurrent triangulation was done in public health facilities providing institutional deliveries of two randomly selected districts- Taplejung and Solukhumbu of Eastern Mountain Region of Nepal. Face to face interview and observation of facilities were done using structured questionnaire and checklist; in-depth interviews were done using interview guideline from November 2016 to January 2017. Ethical clearance was taken. Descriptive analysis and deductive thematic analysis were done. Mean score of newborn service readiness was 68.7±7.1 with range from 53.3 to 81.4 out of 100. Domains of general requirement, equipment, medicine and commodity, supervision, staffing and guideline were assessed. The gaps identified in general requirements were availability of uninterrupted power supply, means of communication and referral vehicle. Clean wrappers and heater for room temperature maintenance were identified during interviews to be part of the readiness. All health facilities had trained staff while retention of skill was of concern. There was felt need of enforcing adequate training coverage to suffice the need of human resources in remote. Efforts of improving transportation, heater for room temperature maintenance, trainings with skill retention strategy, utilization of guidelines, availability of skilled birth attendance could result increased and improved newborn service readiness.

Digital Hemoglobinometers as Point-of-Care Testing Devices for Hemoglobin Estimation: A Validation Study from India.

Introduction:India has launched Anemia Mukt Bharat (AMB) strategy in 2018, to deal with the high burden of anemia in the country. Point-of-care testing (POCT) of anemia using digital hemoglobinometers and treatment is one of the primary interventions under AMB. This study aimed to determine the diagnostic validity of digital hemoglobinometers (TrueHb and HemoCue 301) for screening of anemia compared to hematology analyzer.Methodology:A hospital-based, cross-sectional study was conducted among pregnant women attending antenatal clinics of a selected primary health center and subdivisional hospital of Haryana, India, during January 2019. Hemoglobin (Hb) levels of the pregnant women were estimated in digital hemoglobinometers using capillary blood samples and hematology analyzer using venous blood samples. Bias, limits of agreement (LOA), and validity of digital hemoglobinometers were assessed against a hematology analyzer.Results:A total of 110 pregnant women were included. Bias (LOA) in Hb values estimated using digital hemoglobinometers was −0.09 g/dL (−1.97 to 1.80 ) for HemoCue301 and −0.04 g/dL (−1.69 to 1.60) for TrueHb compared to the hematology analyzer. HemoCue® 301 (sensitivity: 86% and specificity: 83%) had relatively higher sensitivity and specificity compared to TrueHb (sensitivity: 78.9% and specificity: 81%).Conclusions:Digital hemoglobinometers have high sensitivity and specificity. Thus, these can be a potential POCTs for screening of anemia in peripheral health facilities. Further studies are required to establish the validity of the digital hemoglobinometers at community settings.

Determinants for accessing emergency obstetric care services at peripheral health facilities in a block of Wardha district, Maharashtra: A qualitative study

Background: In India, emergency obstetric care (EmOC) services were started under RCH-II program (2004) with the goal to reduce maternal mortality ratio <100/lakh live births and increase institutional deliveries to at least 80% by 2010. Implemented strategy was to enhance availability and accesses to EmOC services. Objective: This study was conducted in one of the blocks of Wardha district in Maharashtra to understand the accessibility for providing EmOC services at primary health center and rural hospital in the last 1 year. Materials and Methods: This cross-sectional qualitative study was conducted from May 2018 to October 2018. Data were collected by key informant interviews of service providers. Notes were transcribed and then translated into English. Respondents' verbatim that is significant and illustrative as per the theme of the study was used for analysis. Results: Equipment and drugs essential for EmOC were available; however, most of these were underutilized due to lack of skill in selected facilities. Basic EmOC training pattern was found inadequate in duration and practical skill. Training and recruitment of staff constantly were observed challenging for higher stakeholders. Of all EmOC signal functions, only parental antibiotics, oxytocics, and assisted vaginal delivery (episiotomy) were provided. Conclusion: Although building infrastructure, drugs, equipment, and transportation facilities were accessible, needy women may fail to receive timely and quality EmOC, due to lack of trained staff, low confidence, and lack of motivation in managing obstetric emergencies.

Validation of an indigenous assay for rapid molecular detection of rifampicin resistance in presumptive multidrug-resistant pulmonary tuberculosis patients.

Background & objectives:There is a need for an affordable, easy, high-sensitivity test usable at the peripheral health facility for diagnosis of drug-resistant (DR) tuberculosis (TB) to interrupt disease transmission. Nucleic acid amplification tests (NAATs) for early detection of DR-TB are ideal to bring testing near to the patient. Truenat™ MTB (Mycobacterium tuberculosis) and Truenat™ MTB-RIF (rifampicin) is an indigenous chip-based real-time polymerase chain reaction (PCR) based test for detection of multidrug-resistant (MDR) TB. The test involves extraction of DNA using automated, battery operated Trueprep instrument and real-time PCR performed on the Truelab analyzer. We report here multicentric validation of Truenat MTB-RIF for detection of DR-TB in suspected DR-TB patients.Methods:Consecutive patients aged 18-65 yr, with symptoms suggestive of TB and with a history of previous treatment, reporting to the National TB Elimination Programme (NTEP) clinics under four national institutes, namely AIIMS (All India Institute of Medical Sciences, New Delhi), NITRD (National Institute of Tuberculosis and Respiratory Diseases, New Delhi), NIRT (National Institute for Research in Tuberculosis, Chennai) and ICMR-National JALMA Institute for Leprosy and other Mycobacterial Diseases, Agra, were included in the study. Two sputum samples (one spot and one morning) were collected from each patient, after obtaining informed written consent. The samples were subjected to smear, GeneXpert and MGIT 960 culture (and drug susceptibility testing to RIF) (surrogate for MDR-TB) to serve as reference tests. The samples were coded to ensure blinding and subjected to Truenat MTB-RIF. Truenat MTB-RIF Version 1.5 was used for testing 1084 samples for RIF resistance, while Version 2.0 was used to test another 1201 samples.Results:Truenat MTB-RIF Version 1.5 in comparison with comprehensive laboratory reference standards yielded sensitivity and specificity of 76.2 and 94.7 per cent, respectively for the detection of RIF resistance in 1084 samples, collected across four sites. Based on the analysis of discordant samples, Version 2.0 of Truenat was developed by the manufacturer and this was further tested on additional 1201 samples, yielding a sensitivity of 87.5 per cent and specificity of 99.5 per cent.Interpretation & conclusions:Multicentric trial of Truenat™ MTB-RIF demonstrated a great potential of this point of care NAAT for detection of MDR-TB. The test would be useful in limited resource settings and inaccessible areas without need for any additional infrastructure.

Telemedicine: A Paradigm Shift in Healthcare in the wake of COVID-19 in India

The COVID-19 pandemic has severely affected the delivery of essential healthcare services in India. The massive disruption of the routine healthcare services had been circumvented to a certain extent with the application of telemedicine. In the wake of the COVID-19 pandemic, the Government of India has issued regulatory guidelines and approved Registered Medical Practitioners (RMP) to adopt the usage of teleconsultation service which can be real-time or asynchronous to minimise the risk of disease transmission. The commentary provides an in-depth review of the regulatory guidelines implemented by the Government of India and discusses the inherent structural and fundamental challenges associated with its wide scale adoption, accessibility, and utilisation. Though the Government of India had issued national guidelines to promote safe and effective usage of telemedicine practice, there remains certain primary structural, technical and institutional challenges regarding expansion of uninterrupted services to periurban and rural peripheral health facilities and its nationwide sustainability. The article demands the attention of the policymakers and relevant stakeholders to identify the inherent bottlenecks intrinsic to the guidelines and amend the regulatory framework accordingly to ensure its long-term sustainability.

Training of health workers for Maternal Death Surveillance and Response program in India: knowledge assessment and analytical evaluation

Background & aim: Most maternal mortalities are preventable; however, there are significant regional and global disparities in this regard. Maternal Death Surveillance and Response (MDSR) launched in India is a continuous cycle of identification, notification, and review of maternal mortalities to improve the quality of care and prevent future deaths. The Ministry of Health and Family Welfare in India conducted five national capacity-building workshops for MDSR during October 2017 and February 2018 with the objective of training medical doctors as future trainers and developing competency-based skills for each component of the program. Methods: A training evaluation study was carried out on 144 workshop participants. Workshop outcomes in terms of trainees’ knowledge were assessed using a 20-item pre-post questionnaire and skill evaluations through group work. The data were analyzed using SPSS software (version 25). The difference in proportions was ascertained using the Chi-square test. Results: The mean score of the participants (n=144) increased from 13.2±2.3 in the pretest to 17±1.9 in the posttest (maximum score: 20). Themes generated during community and facility review sessions indicated the need for the capacity building of peripheral health facilities, sensitization for mandatory birth preparedness, complication readiness of all pregnant mothers by the frontline health workers, and regional-level MDSR training of all stakeholders involved in maternal mortality reporting. Conclusion: Training sessions were effective in the skill development of the participants in understanding the structure and function of the MDSR program.

Prevention of mother-to-child transmission activities after one-off clinical mentorship training in selected health facilities, Zimbabwe: 2014-2018

This was a cross-sectional study describing HIV testing uptake and ART initiation for pregnant women and HIV-exposed infants after one-off clinical mentorship training in 2013 for nurses in 56 peripheral health-facilities, Zimbabwe. Between 2014-2018, 92% of 106411 pregnant women were HIV tested and 98% of HIV-positive women initiated antiretroviral therapy (ART). There were 15846 HIV-exposed infants, of whom 96% had dried blood spots collected for virologic diagnosis and 51% of those diagnosed HIV-positive initiated ART. In conclusion, this one-off clinical mentorship training in 2013 was associated with consistently high HIV testing and ART initiation in pregnant women and their children.

Subcutaneous Metastasis of Cancer of the Endometrium

Cancer of the endometrium is the third most common gynecological malignancy after cancer of the cervix and ovary in Kenya. Subcutaneous metastasis is unusual site for endometrial cancer. Few cases of cutaneous and subcutaneous metastases from cancer of endometrium have been reported in the literature. The main areas of cutaneous and subcutaneous metastases are abdominal, perineal surfaces, skin and toes. Disseminated lesions are associated with hematogenous spread, while some occur via lymphatic spread or contiguity. We present a case of a 45-year-old female, Para 5 + 0, who presented to our gynecologic oncology clinic in July 2017. The patient was referred from a peripheral health facility for chemotherapy following radical hysterectomy in May 2017 for endometrial cancer. Histology results of the specimen taken during surgery showed endometrial Ca stage 2, grade 3. The patient developed a swelling on the right leg 6 months after completion of 6 cycles of carboplatin and paclitaxel. Biopsy from the leg showed features consistent with metastatic endometrioid adenocarcinoma. The patient was started on pegylated liposomal doxorubicin. Local radiation of the metastatic subcutaneous lesion was also done. Cutaneous and subcutaneous metastases from cancer of the endometrium are rare. We recommend histologic evaluation of subcutaneous masses developing in patients with endometrial cancer or in those suspected to have endometrial cancer.

Eclampsia in African Milieu, Yaounde-Cameroon: epidemiology, seasonal variations and treatment regimen

Background: In our context, eclampsia is a major cause of maternal death. Patients are often sent to referral hospitals for optimal care because of the scarcity of resources in peripheral health facilities. We study characteristics of eclampsia the Yaounde Gynaeco-Obstetric and Paediatric Hospital (YGOPH) in order to prioritize our resources. Methodology: We carried out a retrospective cross-sectional descriptive study from December 2017 to April 2018 at YGOPH. All women managed for eclampsia over the preceding 10 years, from May 1st 2008 to April 30th 2018, were included in the study. We evaluated the seasons of disease occurrence, socio-demographic and clinical characteristics on admission and treatment regimen. We analysed our data using Epi info 7.0. Results: The frequency of eclampsia was 0.96% (151/25680). The mean age of patients was 23.95±6,02 years. Singles (73.5%), housewives (40.4%) and nulliparous patients (54.9%) were the most represented. The disease occurred more frequently during the major rainy season (43.7%). Patients were most often referred cases (70.2%). Eclampsia occurred mostly antepartally (70.3%). Hypertension was most often severe (83.45%). Nicardipine was the most used antihypertensive medication (76.8%) and magnesium sulphate was the anti-convulsant of choice (98.0%). The majority of women delivered by caesarean section (77.8%). HELLP syndrome was the most common maternal complication (9.9%), while prematurity was the most frequent fetal complication (58.9%). The maternal and neonatal mortality rates were 8.6% and 24.4%, respectively. Conclusion: Eclampsia remains an important cause for concern as it results in non-negligible morbidity and mortality. It is therefore important to promote and reinforce antenatal care for pregnant women while taking into consideration the seasonal variations of the disease.