Referral Health Centers Research Articles

Botryomycoma of the Nasal Vestibule: A Case Report from the Commune VI Referral Health Center of the District of Bamako/Mali

Pyogenic granuloma or botryomycoma or lobular capillary hemangioma is a benign proliferation of capillaries, precisely skin and mucous membranes. This pathology is considered rare in terms of nasal cavities. But cases are increasingly related to literature. Thus, this study concerns a case sitting at the level of the nasal vestibule. He is an adult of 58 years and male sex, who came for consultation in the ENT department at the commune VI reference health center of the district of Bamako / Mali, presenting as a reason for consultation a right nasal obstruction. The interrogation revealed that the start dates back to about eight months and marked by a serous rhinorrhea and an associated homolateral epistaxis of headaches. No predisposing factor and no medico-surgical history has been found. The scanner allowed us to define the contours of the mass and to guide the therapeutic decision. The mass was completely removed surgically into endonasal without incidence. Histological examination of the surgical sample concluded that a lobular capillary hemangioma. The patient was followed for 2 years without recurrence or complications. Because of its rarity in our context, we recommend particular attention to ENT specialists to avoid confusion and allow more studies for more discussions in the literature.

Therapeutic and Prognostic Aspects of Acute Generalized Peritonitis at the Referral Health Center (CSRéf) of Ouélessébougou

Therapeutic and Prognostic Aspects of Acute Generalized Peritonitis at the Referral Health Center (CSRéf) of Ouélessébougou

Digestive Surgical Emergencies at Tominian: Therapeutic Aspects

Purpose: To describe the therapeutic aspects of digestive surgical emergencies at the Tominian referral health center. Methodology: This was a prospective cross-sectional study from December 1, 2022 to November 30, 2023, i.e. 12 months, in the general surgery department of Tominian CS Réf. We enumerated 116 patients during our study period, and included in this study all patients received and operated on for digestive surgical emergencies. The parameters studied were etiologies, duration of disease evolution, treatment and postoperative follow-up. Results: Digestive surgical emergencies (n=116) accounted for 22.97% of all procedures (n=505). Men accounted for 73.3% (n=85) and women 26.7% (n=31), with a sex ratio of 2.74. Mean age was 29.25 years, with extremes of 4 and 71 years. 61.2% (n=71) consulted between 49 and 72 hours of disease evolution. The main etiologies were acute appendicitis 47.4% (n=55), acute peritonitis 29.3% (n=34). The surgical procedures performed were appendectomy 47.4% (n=55), appendectomy + lavage 13.8% (n=16), perforation suture 12.9% (n=15). Postoperative follow-up was uncomplicated 87.9% (n=102), complicated by surgical site infection 7.8% (n=9). There were 3.4% (n=4) deaths. Hospital stay was 8 to 14 days in 49.1% of cases (n=57). Conclusion: Digestive surgical emergencies are numerous in Tominian. Their management requires multiple and varied therapeutic means, the rapid initiation of which guarantees a good oronostic outcome.

Maternal mortality in Eastern Democratic Republic of Congo: a 10-year multi-zonal institutional death review

BackgroundMaternal mortality (MM) remains a real scourge that hits hardest in the poorest regions of the world, particularly those affected by conflict. However, despite this worrying reality, few studies have been conducted about MM ratio in the Democratic Republic of Congo (DRC). The study aimed to describe the trends as well as the epidemiological profile and causes of reported institutional maternal deaths between 2013 and 2022 in Eastern DRC.MethodsA retrospective descriptive study was conducted between March 2023 and August 2023 in eight Health Zones (HZ), five in South Kivu Province (Mwana, Minova, Miti-Murhesa, Kamituga and Idjwi) and three in North Kivu Province (Kirotshe, Karisimbi and Kayna) in the eastern region of the DRC. Our study covers 242 health facilities: 168 health centers (HC), 16 referral health centers (RHCs),50 referral hospitals (RH) and 8 general referral hospitals (GRHs). Data from registers and medical records of maternal deaths recorded in these zones from 2013–2022 were extracted along with information on the number of deliveries and live births. Sociodemographic, clinical parameters, blood and ultrasound tests and suspected causes of death between provinces were assessed.ResultsIn total, we obtained 177 files on deceased women. Of these, 143 (80.8%) were retained for the present study, including 75 in the 3 HZs of North Kivu and 68 in the 5 HZs of South Kivu. From 2013 to 2022, study sites experienced two significant drops in maternal mortality ratio (MMR) (in 2015 and 2018), and a spike in 2016–2017. Nonetheless, the combined MMR (across study sites) started and ended the 10-year study period at approximately the same level (53 and 57 deaths per 100,000 live births in 2013 and 2022 respectively). Overall, 62,6% of the deaths were reported from secondary hospital. Most deaths were of married women in their thirties (93.5%). Almost half (47.8%) had not completed four antenatal consultations. The main direct causes of death were, in decreasing order of frequency: post-partum haemorrhage (55.2%), uterine rupture (14.0), hypertensive disorders (8.4%), abortion (7.7%) puerperal infections (2.8%) and placental abruption (0.7%). When comparing among provinces, reported abortion-related maternal mortality (14.1% vs 0%) was more frequent in North Kivu than in South Kivu.ConclusionThis study imperatively highlights the need for targeted interventions to reduce maternal mortality. By emphasizing the crucial importance of antenatal consultations, intrapartum/immediate post-partum care and quality of care, significant progress can be made in guaranteeing maternal health and reducing many avoidable deaths.

HUBUNGAN SEKS BEBAS DENGAN KEJADIAN SIFILIS DI WILAYAH KERJA PUSKEMAS KOM YOS SUDARSO KOTA PONTIANAK

Syphilis, also known as "the lion king", is an STI (Sexually Transmitted Infection), a disease caused by infection with the Treponema Pallidum bacteria. It is chronic and chronic. This is a dangerous disease because it can attack all organs of the body. This research was conducted at the Kom Yos Sudarso Pontianak Community Health Center because the Community Health Center is a referral health center for syphilis examinations and the respondents were people who were caught by field officers who allowed free sex. This study aims to find out who suffers from syphilis among respondents who engage in casual sex, as well as finding out the percentage of syphilis incidents in people who engage in casual sex and to find out the relationship between casual sex and the incidence of syphilis in the work area of the Kom Yos Sudarso Community Health Center, Pontianak City. This research design uses cross sectional with random sampling technique. The samples used were 123 patient blood samples using the TP Rapid method. Based on the results of the research conducted, casual sex and the incidence of syphilis were obtained. The results of analysis using the chi square test using Continuity Correctionb obtained a value of p = 0.021 < 0.05, so HA was accepted so that there was a significant relationship between casual sex and the incidence of syphilis in the work area of the Community Health Center. Yos Sudarso, Pontianak City.

Essential surgery delivery in the Northern Kivu Province of the Democratic Republic of the Congo

IntroductionSurgical services are an essential part of a functional healthcare system, but the Lancet Commission of Global Surgery (LCoGS) indicators of surgical capacity such as perioperative workforce and surgical volume are unknown in many low- and middle-income countries (LMICs) including the Democratic Republic of Congo (DRC). We aimed to determine the surgical capacity and its associated factors within the DRC.MethodsHospitals were assessed in the North Kivu province of the DRC. Hospital characteristics and surgical rates were determined using the WHO-PGSSC hospital assessment tool and operating room (OR) registries. The primary outcome of interest was the number of Bellwether operations (i.e. Caesarean sections, laparotomies, and external fixation for bone fractures) per 100,000 people. Univariate and multiple linear regressions were performed. Primary predictors were the number of trained surgeons, anaesthesiologists, and obstetricians (SAOs) and the number of perioperative providers (including clinical officers and nurse anaesthetists) per 100,000 people.ResultsTwenty-eight hospitals in North Kivu were assessed over one year in 2021; 24 (86%) were first-level referral health centres while 4 (14%) were second-level referral hospitals. In total, 11,176 Bellwether procedures were performed in the region in one year. Rates per 100,000 people were 1,461 Bellwether surgical interventions, 1.05 SAOs, and 13.1 perioperative providers. In univariate linear regression analysis, each additional SAO added 239 additional cases annually (p = 0.023), while each additional perioperative provider added 110 cases annually (p < 0.001). In our multiple regression analysis adjusting for other hospital services, the association between workforce and Bellwether surgeries was no longer significant.ConclusionsThe surgical workforce in DRC did not meet the LCoGS benchmark of 20 SAOs per 100,000 people but was not an independent predictor of surgical capacity. Major investment is needed to simultaneously bolster healthcare facilities and increase surgical workforce training.

Anal Pathologies during Pregnancy and Postpartum: Diagnosis and Treatment at the Kalaban Coro Referral Health Center

Pregnancy and childbirth are generally considered to be happy episodes in women's lives, these events can be marred by anal affections. The exact epidemiology of anal pathologies is difficult to define, due to the reluctance of patients to discuss their symptoms and to be examined. In most cases, their diagnosis is delayed and their management is inadequate or inappropriate. Aim: To study anal pathologies during gravido-puerperality at the CS Ref of Kalaban Coro. Methods: This was a single-center descriptive and analytical prospective study with prospective data survey at the CS Ref of Kalaban Coro. The study was conducted over a 9-month period from January 1 to September 30, 2019. Results: During the study period, we identified 151 pregnant women. Of these pregnants, 88 or 58.27% had anal pathology. The different anal pathologies encountered were, hemorrhoidal disease (30.68%), anal fissure (30.68%) and anal incontinence (27.27%). The offending factors were dominated by constipation, a newborn weight &gt; 3500g, a foetal expulsion time &gt; 20 minutes. The clinic was conducted by interrogation and proctological examination. Clinical signs were anal pain, rectorrhagia, and pruritus. Treatment primarily includes the regulation of intestinal transit and topical topicals, analgesics, and those that improve blood circulation (Veinobiase, Daflon).

Prevalence of Panton-Valentine leucocidin (pvl) and exfoliative toxin A (eta) gene within methicillin resistant and susceptible Staphylococcus aureus in an urban tertiary hospital: A molecular epidemiology pilot study

Background Staphylococcus aureus is well known to cause a multitude of clinical manifestations, from mild to severe bloodstream infections that could lead to death. Infections are common, either in community-acquired or hospital-acquired settings, and treatment remains a challenge due to methicillin-resistant Staphylococcus aureus (MRSA). The pathogenesis of S. aureus is mediated by several cell-surface and secreted virulence factors. The virulence factors discussed in this study are Panton-Valentine leucocidin (pvl) and exfoliative toxin A (eta). Identifying both pvl and eta gene may help in studying bacterial pathogenesis and biology thus creating possible therapeutic pathway or intervention. Our pilot study aimed to observe pvl and eta as virulence gene prevalence in a North Sumatera tertiary referral health center. Methods Our study was a descriptive-analytical observational study with a cross-sectional design in which we collected isolates over a single time period. The frequency of genes is reported as a percentage comparison between MRSA and methicillin-susceptible S. aureus (MSSA). Qualitative gene prevalence analysis was carried out using the polymerase chain reaction (PCR). Results Our results showed that from 38 MRSA sample isolates, 32 samples were found to be pvl-positive, or 84,3% of the total samples. From 40 MSSA sample isolates, one sample was found to be pvl-positive MSSA, or 97,5%. Regarding eta, from 38 MRSA sample isolates, 81,6% of the total sample did not have eta, while from 40 MSSA sample isolates, all samples were found to be positive for eta. We found that both pvl and eta were significantly more likely to be expressed in the MSSA strain. Conclusions Our study shows that pvl and eta are more likely expressed in MSSA strains than in MRSA strains in Indonesia.

Epidemiological Profiles of Acute Otitis Media at the Commune II Referral Health Center in the Bamako District

Acute otitis media is a very common condition in children under the age of 7, most of whom suffer their first episode before the first three years of life. Despite scientific advances in its therapeutic and preventive management, this condition remains frequent and cosmopolitan, particularly in otolaryngology (ENT) and pediatric wards. In view of the possibility of disabling complications, we set out to study the epidemiological and clinical profile of this condition for the first time in the ENT department of the Commune II Reference Health Centre in the District of Bamako, Mali. This is a descriptive, retrospective study, using routine consultation data from January to December 2022. Based on exhaustive sampling, we collected 568 cases of confirmed AOM, representing an incidence of 20.63%. Patient age ranged from 3 months to 83 years, with an average of 12.49 years. Overall, the 3-7 age groups predominated, with 30.63% of cases. However, patients under 2 years of age predominate in progressive forms of the various stages. This study shows that AOM is a frequent occurrence in our department, and highlights the need for good interdisciplinary networking between pediatricians and ENT specialists in the management of AOM, in order to avoid possible recurrences and functional sequelae.

Satisfaction of Patients Operated on and Hospitalized in the Surgery Department of the Referral Health Center of Commune I in the District of Bamako (Resource-Limited Health District)

Satisfaction of Patients Operated on and Hospitalized in the Surgery Department of the Referral Health Center of Commune I in the District of Bamako (Resource-Limited Health District)

Prevalence of Panton-Valentine leucocidin (pvl) and exfoliative toxin A (eta) gene within methicillin resistant and sensitive Staphylococcus aureus in an urban tertiary referral hospital: A molecular epidemiology pilot study

Background: Staphylococcus aureus is well known to cause a multitude of clinical manifestations, from mild to severe bloodstream infections that could lead to death. Infections are common, either in community-acquired or hospital-acquired settings, and treatment remains a challenge due to methicillin-resistant Staphylococcus aureus (MRSA). The pathogenesis of S. aureus is mediated by several cell-surface and secreted virulence factors. The virulence factors discussed in this study are Panton-Valentine leucocidin (pvl) and exfoliative toxin A (eta). Our pilot study aimed to observe pvl and eta as virulence gene prevalence in a North Sumatera tertiary referral health center. Methods: Our study was a descriptive-analytical observational study with a cross-sectional design in which we collected isolates over a single time period. The frequency of genes is reported as a percentage comparison between MRSA and methicillin-sensitive S. aureus (MSSA). Qualitative gene prevalence analysis was carried out using the polymerase chain reaction (PCR). Results: Our results showed that from 38 MRSA sample isolates, six samples were found to be pvl-negative, or 15.7% of the total samples. From 40 MSSA sample isolates, one sample was found to be pvl-negative MSSA, or 0.025%. Regarding eta, from 38 MRSA sample isolates, 18.4% of the total sample did not have eta, while from 40 MSSA sample isolates, all samples were found to be positive for eta. We found that both pvl and eta were significantly more likely to be expressed in the MSSA strain. Conclusions: Our study shows that pvl and eta are more likely expressed in MSSA strains than in MRSA strains in Indonesia.

Global neurosurgery: Reflections on myelomeningocele in the Zanzibar archipelago (Tanzania)

ObjectiveOur main goal was to describe the general characteristics and demographic data of myelomeningocele (MMC) patients at Mnazi Mmoja Surgical NED Institute (MMSNI) in Zanzibar and to assess the clinical characteristics and medium-term result-impact of the implemented health care measures. MethodsThis is a retrospective study on 41 MMC patients treated at the MMSNI in Zanzibar (Tanzania) from September 2016 to September 2018. Patient demographics, prenatal care, clinical and radiographic characteristics, surgical management and nursing care, and clinical outcomes were abstracted. ResultsThe mean age of the patients was 6.1 ± 4.6 days, and 53.7% were males. A total of 51.2% came from Zanzibar, 39% to Pemba, and 9.8% from mainland Tanzania. Maternal ultrasound checkups revealed hydrocephalus in 18.7% of the cases. 85.4% of the newborns were operated on. Surgical wound infection was the most frequent complication (28.6%). A significantly higher risk of complications was observed in children from Pemba Island (p = 0.046) and those born by vaginal delivery (p = 0.694), particularly infections. During follow-up, 48.57% of the patients presented with infantile hydrocephalus and in the majority of them, a ventriculoperitoneal shunt was inserted. ConclusionsProper prenatal care with early diagnosis, together with the neurosurgical and nursing standard of care in a specialized institution, are all essential to increase the chances of successful treatment of newborns harboring MMC and is one of the main goals pursued in the MMSNI, as the only referral public health center with locally trained health personnel in Zanzibar archipelago.

Completeness and legibility of obstetric referral documents from peripheral public health facilities to a tertiary care facility in North India- a cross-sectional study

IntroductionIncomplete information in the referral letters may result in a delayed diagnosis, polypharmacy, and wasteful duplication of laboratory testing, which negatively impact patient care. The aim of the present study was to assess the quality (completeness and legibility) of obstetric referral documents sent by health personnel of lower-level public health facilities to a tertiary health care facility. MethodologyA cross-sectional study was conducted among 675 pregnant women referred to a tertiary care centre from public health facilities of Lucknow and other districts of the state of Uttar Pradesh, from October 2019 to September 2020. Systematic random sampling was used to select the study participants. Data was analysed using Statistical Package Social Sciences 24 and presented as frequencies, percentages, and graphs. A p-value <0.05 was considered statistically significant. ResultsAbout two-third (377/622) of the referrals had the information on the pre-referral treatment but it was not readable in (127/269) of those forms. Less than half (269/622) referral letters had information for the medication dosage but in only (142/269), it was clearly written. First referral unit-community health centres scored less for quality of referral letter in comparison to non-first referral unit-community health centres. ConclusionThe study concluded that there was poor documentation of the referral letters at all levels of healthcare facilities. Health personnel need to be sensitized for importance of completeness of information in the referral letters to improve the treatment as well as the outcome.

Active Management of the Third Period of Childbirth at (AMTPC) the Reference Health Center of the Commune VI of the District of Bamako

Aims: this study aimed at contributing to the improvement of the quality of the practice of the AMTPC and the prevention of the occurrence of postpartum hemorrhages that we carried out in the delivery room of the commune VI of the district of Bamako. Patients and Methods: This was a cross-sectional study, on 407 parturients and 30 agents in charge of assisted deliveries. Results: Among these birth attendants surveyed, 7 (23%) had no training in AMTPC. The number of gestures required for the correct practice of the AMTPC for a parturient was estimated at 34 divided into 5 stages, only the closing stage was correctly done (94.1%) with a score higher than normal (80 %). The scores for the correct practice of the 4 other stages were insufficient: preparation (58.2%), delivery (62.4%), uterine massages (19.7%), examination of the genital canal (30%) are below the national standard (80%). Conclusion: The practice of the AMTPC is systematic in the delivery room of the referral health center of Commune VI. However, the quality of the AMTPC remains insufficient in the delivery room since among the five stages evaluated, only that of the fence was correctly practiced.

High stress related to COVID-19 among health workers in the Plateau Central healthcare region (BURKINA FASO): a cross-sectional study.

The COVID-19 pandemic challenged the mental wellbeing of health workers. The objective of this study was to assess health workers' perceived stress during the response to COVID-19 in the Central Plateau region (Burkina Faso). We conducted a cross-sectional study of health workers in the Central Plateau health region from September 20 to October 20, 2021. Agents' perceived stress was assessed by the Perceived Stress Scale (PSS-10). Factors associated with high stress (PSS-10 score ≥ 27) were identified by logistic regression. A total of 272 officers participated in the survey. The mean PSS-10 score was 29.3 points (standard deviation: 6.2). Three out of ten agents (68%) had a high level of stress. The main sources of stress were the risk of being exposed to contamination (70%) and being the source of contamination (78%). Working at the referral health center [adjusted odds ratio (aOR): 2.29; 95% confidence interval (95% CI): 1.19-4.41], the hospital as the main source of COVID-19 information (aOR: 1.17; 95% CI: 1.01-3.04), fear of COVID-19 patients being managed at one's center (aOR: 1.8; 95% CI: 1.06-3.07) were factors associated with high health worker stress levels during the first wave of COVID-19. The COVID-19 pandemic caused high stress among health care workers in Burkina Faso. Psychological support for health center workers in responding to future epidemics would improve their mental health.

COVID-19 Traveler Policy in Migrant Worker: How it Helped Shape Distinct Clusters During the Early Phases of the Pandemic

Though COVID-19 caught healthcare authorities worldwide off guard, several countries successfully dampened the morbidity and mortality curve by imposing strict biosecurity protocols. We would like to observe the effect of healthcare policies enforced in correlation to the formation of new clusters during early phases of the pandemic, thereby providing statistical justification for laws enforced by authorities. With access to medical records from Udayana University Hospital, a tertiary COVID-19 referral health center, we then observe epidemiological data of patients admitted and their admission date in correlation to dates where major changes in national COVID-19 protocols were established. We found a double distinctive curve that is mainly made of two distinct demographic groups: migrant workers and private employees. We found that during March 2020, when strict travel protocols are yet to be imposed, the viral introduction was mostly carried by returning migrant workers. Sporadic cases emerged, though soon vanishing due to the enforcement of quarantine protocols. Subsequently, in June 2020, a work-from-office setting was adopted, where some offices perform at a capacity higher than allowed. This incites the formation of new office-linked clusters. After this period, no recognizable pattern found due to massive local transmission affecting all layers of society. However, it can be concluded that COVID-19 law does shape the curve, and strict protocols may end the pandemic sooner.&#x0D; Keywords: COVID-19, Migrant Workers, Health Policy, Private Employee

Vascular dysfunction in patients with type 2 diabetes mellitus

Background: Type 2 diabetic mellitus (T2DM) is an emerging global pandemic which is associated with lots of co-morbidities and reported vascular dysfunctions. T2DM associated vascular dysfunctions leads to vasculopathy in the form of altered peripheral vascular dynamics. Cold stress test (CST) is a reliable sympathetic reactivity test used for assessing vascular dysfunctions. In this study we are trying to quantify vascular dysfunctions in T2DM patients non invasively by various parameters of photoplethysmography (PPG) of cold stress test.Methods: Case control study had done in referral health center AIIMS, Raipur. Parameters are recorded by finger-PPG before, during and after CST (1 min) in 2 groups, control (n = 20 healthy volunteers) and case (n = 20 diagnosed T2DM patients).Results: Due to cold stress, PPG parameter peak amplitude was significantly decreased in both healthy and T2DM groups (&lt;i&gt;p&lt;/i&gt; &lt;0.001 and &lt;i&gt;p&lt;/i&gt; &lt;0.001, respectively). However, recovery trend of amplitude was significantly slow in T2DM compared to healthy subjects. Another PPG parameter peak to peak interval was significantly higher in healthy group compared to T2DM patients.Conclusions: This study showed that T2DM patients has significant deranged pulse volume parameters like amplitude and peak to peak interval can be used to objectively quantify the vasculopathy in T2DM patients by using sympathetic reactivity to cold stress.

Utility of Direct Specimen Sequencing in Addition to Conventional Testing in Management of Infections in an Urban Referral Health Center.

Direct specimen sequencing (DSS) offers the promise of enhanced pathogen detection and disease diagnosis. A single healthcare network, retrospective chart review over a 3-year period was completed for all cases in which DSS was submitted, in addition to conventional testing (CT) for workup of an infectious disease. We sought to compare results (concordance and discordance) from these 2 techniques in order to evaluate any additional yield from DSS over CT. Additionally, we calculated mean turnaround time (TAT) and average cost for obtaining DSS on all specimens. A total of 23 patients' specimens were sent for DSS. DSS and CT concordance occurred in 91% (21/23) of cases. DSS testing was able to identify specific pathogens in 17.4% (4/23) of patients, out of which 4% (1/23) were discordant. The respective mean TAT and total cost per specimen for DSS were 6 days and $821.52 (range $573-$1590), respectively. In our limited cohort of patients, there was significant concordance between the 2 testing modalities primarily due to negative tests. DSS did not provide significant additional yield in the infectious diagnosis in our cohort compared to CT. Short TAT may provide advantage in the detection of fastidious organisms, but high cost remains a limitation. Larger sample size may reveal a clinically meaningful difference.

The effect of instructing mothers in attachment behaviors on short-term health outcomes of premature infants in NICU.

The birth of a pre-mature infant and subsequent hospitalization and separation from the family can impair maternal and neonatal attachment and quality of maternal care. This study aimed to assess the effect of instructing mothers in attachment behaviors on short-term health outcomes of pre-mature infants admitted to neonatal intensive care units (NICUs). In this quasi experimental study, 80 mothers of pre-mature infants who were admitted to NICUs at two referral health centers in northern Iran were studied in two groups in 2018. Attachment behaviors were taught to mothers in the test group during four consecutive sessions. Mother-infant attachment behaviors were evaluated at both the beginning and the end of this study using a checklist derived from Avant's Maternal Attachment Assessment Strategy. Moreover, infants' short-term health consequences were investigated in two groups. SPSS 18 statistical software was used for data analysis. On average, it took respectively 34.90 ± 12/65 and 31/15 ± 14/35 days for the infants in the control and the intervention group to reach full oral feeding and 38/5 (38/4-42/11) and 37 (31/85-42/14) days to gain the minimum weight required for discharge. Moreover, the mean length of stay for the infants in the control and the intervention group was 41/80 ± 13/86 and 39/02 ± 16/01 days, respectively (P > 0/05). Instructing mothers in attachment behaviors clinically improved short-term health-related outcomes. Hence, this intervention is recommended to be incorporated in the care program for mothers with pre-mature infants.

Quality of Antenatal Care at the Referral Health Center of the Fourth Commune of Bamako District

Purpose: To contribute to the improvement of the quality of prenatal consultation at the reference health center of the commune IV of the district of Bamako. Patients Methods: This was a qualitative cross-sectional study to assess the quality of prenatal consultation that took place from December 1, 2017 to January 31, 2018. It included 139 pregnant women whose consultations were monitored by the investigator and then the women were interviewed upon discharge from the facility to collect their opinions on the services they received. Results: The age group of 20 to 29 years was the most represented with 60.44%. In our study, 50% of our patients were managed by midwives. Among the antecedents constituting the risk factors sought in pregnant women, scar uterus was more frequent with 33.93% followed by arterial hypertension with 14.28% and multiparity with 7.14%. Conclusion: This study shows that the evaluation of the quality of services is an absolute necessity for the improvement of services in integrated reproductive health care centers.