Procréation au temps des antirétroviraux au Sénégal,représentations et pratiques des PVVIH et des professionnels de santé

This article describes and analyzes the attitudes towards the risk of sexual transmission of HIVand childbearing among PLHIV who have received antiretroviral therapy for ten years and the attitudes and representations of health care professionals who conduct their medical follow-up. The results highlight the contradictions between the magnitude of the social advantages of motherhood for women living with HIVand the reluctance among health care professionals to support them. In a context where the pressure to bear children is strong, the biomedical system that supports childbearing for PLHIVon ARVs should be readapted without failing to also address men living with HIV.     

La collecte de sang placentaire : du concept à la réalité

Cord blood units are now routinely used as an alternative source of haematopoietic stem cells from unrelated donors for allogeneic transplantation. In France, cord blood units are collected in a network of more than 70 maternity hospitals in relationship with 11 public cord blood banks part of the Réseau Français de Sang Placentaire. Unrelated cord blood unit donation is an altruistic act, anonymous and free. Donors are selected on medical criteria. Then, only cord blood unit containing more than 100 × 10⁷ total nucleated cells and more than 1.8 × 10⁶ CD34+ cells are cryopreserved according to Réseau Français de Sang Placentaire recommendations. Cord blood units qualification will be completed by viral and functional testings and the clinical outcome of the newborn child 6 weeks after the collection. Since the last 5 years, cord blood banking growing in France in order to enhance the French registry of volunteer donors by increasing both the number and diversity of the donors listed and make available cord blood banking for transplantation.     

Amélioration et optimisation du processus transfusionnel au Maroc : proposition d’une nouvelle organisation

Purpose of the studyPropose a new organization for the Moroccan blood transfusion system.Materials and methodsThrough an analysis of several aspects of the current organization, both qualitatively and quantitatively (Statistics 2011), it was found that several failures of the current system prevent them from achieving it's objectives and ensuring its responsibilities. Using multiple-criteria decision analysis (ELECTRE III), a new organization based on resources pooling is proposed. This new organization concerns the status of the National Blood Transfusion Center, donor management, the geographical location of the various regional centers, logistics, inventory management and the information system.ResultsWithin the new organization proposed, the number of regional Centers for blood transfusion is reduced from 16 to 7 in accordance with the existing constraints, while redefining the roles of each site. The aspects of inventory management, the information system, increasing the number of donors, the policy communication and marketing and cycle of blood collection and distribution are also redefined.ConclusionThis proposed new organization will provide decision makers with the necessary assistance for decision making, whit respect to the improvement of the entire system Moroccan blood transfusion system. And so help achieving the desired objectives on ensuring blood availability and it’ maximum safety. The simulation of this proposal should confirm the choice that was made. Further analysis of complementary aspects such as the financial aspect or human resources, would moreover contribute to refining this proposal.     

Pandémie grippale A/H5N1 et niveau de préparation du Niger: une étude sur les connaissances des soignants et l’organisation générale des soins

In industrialized countries, the emergence of potentially pandemic influenza virus has invited reactions consistent with the potential threat represented by these infectious agents. However, with globalization, controlling epidemics depends as much on an effective global coordination of control methods as on preparedness of northern and southern national health care systems, at the core of which are health care workers. Our study was conducted in the National Hospital of Niamey, the main Nigerian hospital. Its objective was to evaluate the knowledge of health care professionals regarding flu pandemic and control of infection. We interviewed 178 nursing staff, doctors and paramedics on the basis of a survey. This study - the first to our knowledge to explore these issues in the African context-revealed that caregivers have a rather good mastery of theoretical knowledge. Nevertheless, beyond theoretical knowledge, miscellaneous factors compromise the effectiveness of the health care structure. Some of them seem to occupy a critical position, particularly the absence of shared references among sanitary authorities and health care professionals, and the weaknesses of global coordination of preventive activities and case management.     

Pour une organisation transfusionnelle sécuritaire aux risques et coûts maîtrisés : l’expérience APHM–EFSAM

IntroductionBlood transfusion safety depends on strict compliance with each step of a process beginning with the order for labile blood products and related immunohematologic testing and ending with administration and follow-up of the receiver. This process is governed by stringent regulatory texts and guidelines. Despite precautions, processing errors are still reported. Analysis of incident reports shows that the most common cause involves patient identification and that most errors occur at two levels, i.e. the entry of patient information and management of multiple regulatory crosschecks and record-keeping using different systems.MethodThe purpose of this report is to describe the collaborative approach implemented by the Établissement français du Sang Alpes-Méditerranée (EFSAM) and the Assistance publique des Hôpitaux de Marseille (APHM) to secure the blood transfusion process and protect interfaces while simplifying and facilitating exchanges.ResultsClose cooperation has had a threefold impact with simplification of administration, improvement of experience feedback, and better management of test ordering. The organization implemented between the two institutions has minimized document redundancy and interfaces between immunohematologic testing and delivery. Collaboration based on experience feedback has improved the level of quality and cost control.ConclusionIn the domain of blood transfusion safety, the threshold of 10^?5 has been reached with regard to the risk of ABO errors in the distribution concentrated red cells (CRC). In addition, this collaborative organization has created further opportunity for improvement by deploying new methods to identify simplification measures and by controlling demand and usage.