Ici - Revue Médicale des Grands Lacs

Revue Médicale des Grands Lacs Vol6, No4, Déc 2015
1
EDITORIAL
Comme à l’accoutumée, le mois de décembre est réservé aux présen-
taons des vœux à tout ceux qui vous sont chers.
C’est pour cela que je prote de cee occasion pour remercier tous.
Là, je voudrai m’adresser d’abord à tous les auteurs qui ont envoyés
des manuscrits qui sont publiés, en cours de traitement et ceux qui
aendent. Du fond de mon cœur, je voudrai vous dire merci et vous
encourager à faire de même pour l’Année 2016.
Je voudrai ensuite me tourner vers la pete équipe de la Revue Médi-
cale des Grands Lacs (RMGL) qui se démène pour que tous les numé-
ros sortent à temps sans retard. Je voudrai vous dire merci pour tos
vos sacrices et privaons. Sans vous, la RMGL ne peut pas connaitre
ce développement.
Pour ce qui est de la publicaon online, il faut que vous soyez ras-
surés que nous sommes entrain de faire de notre mieux pour être à
jour. Pour le moment les arcles du journal commencent à paraitre
dans Google progressivement.
Pour y accéder Ouvre la fenêtre Google scholar en le tapant dans
google simple. Dès que la fenêtre est là, taper Grands Lacs Médical
journal et cliquer ok. Si l’arcle recherché est déjà indexé, l’auteur va
se rendre compte que son arcle est dans la série. D’autres peuvent
aller sur le site et cliquer sur google scholar dans le menu indexing/
abstracng et certains arcles directement indexés ou via Rese-
rachgate vont apparaitre.
Vous verrez que la façon de présenter nos noms trompe les robots et
ils indexent en donnant des prénoms et abréviaons des noms. Nous
commençons à inverser tous les noms et nous sommes obligés de
changer des petes histoires pour permere la reconnaissance par
les robots google scholar comme c’est une banque des données très
ulisées en Afrique.
Voici le bilan de ce qui a été publié en 2015 :
MARS 2015
9 arcles originaux
2 observaons cliniques
JUIN 2015
6 arcles originaux
4 observaons cliniques
SEPTEMBRE 2015
8arcles originaux
2 observaons cliniques
DECEMBRE 2015
9 arcles originaux
2 observaons cliniques
Il ya donc de l’avenir dans ce que vous faites et je voudrai terminer
en vous présentant meilleurs vœux de bonheur et de prospérité pour
2016. Bonnes fêtes de Noel et de Nouvel An 2016.
Prof. Dr. Ahuka Ona Longombe, MD, PhD, MHPE (Maastr)
Editeur en Chef
Revue Médicale des Grands Lacs

ROAD SAFETY IN CENTRAL AFRICA: A CALL TO ACTION
FOR HEALTHCARE PROVIDERS
Fischer JP, MPH1, Fischer PR, MD2
1. Pritzker School of Medicine, University of Chicago, Chicago, Illinois, USA
2. Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA
Correspondence to: Philip R Fischer, Pediatric and Adolescent Medicine Mayo Clinic
200 First Street SW
Rochester, Minnesota 55905 USA
Phone [phone]
Fax [phone]
Email scher[email protected]
Résumé
Accidents de la circulaon rouère (ACRs)
sont l'une des principales causes de décès
dans le monde, mais c’est aussi un problème
qui reçoit souvent trop peu d'aenon dans
le domaine de la santé. En raison de la crois-
sance économique et de populaon surve-
nant en Afrique centrale, la sécurité rouère
est devenue une queson parculièrement
pressante ici.
Diérents gouvernements ont un degré va-
riable de succès dans la lue contre les ACRs.
Au Rwanda, le gouvernement a créé des po-
liques qui ont considérablement réduit les
ACRs. Dans d'autres pays tels que l'Ouganda,
cependant, les gouvernements ont été in-
completement capables de luer ecace-
ment contre ce problème vaste et complexe.
Dans ces pays où les routes restent dange-
reusement non réglementées, il est impor-
tant que les médecins se joignent à la lue
pour des routes plus sûres. En tant que lea-
ders du domaine de la santé, les médecins
peuvent uliser leur inuence et leur exper-
se à plaider pour une plus grande eort des
policiens à améliorer le sécurité rouère,
d'éduquer leurs paents sur l'importance de
la sécurité rouère, et d’uliser la recherche
pour augmenter notre compréhension des
eets des ACRs. Le résultat ne sera pas seu-
lement les paents sains, mais une société
plus sécure et plus producve dans son en-
semble.
Mots clés : trauma, accidents du trac rou-
er, sécurité
Introduction
A
global epidemic is occurring. Killing
nearly as many people each year as
HIV, yet oen far less discussed within
the healthcare sector, road trac accidents
(RTAs) are the ninth leading cause of death
across the world, and the leading cause of
death among young people ages 15-29 years
old1,2.
RTAs caused 1.24 million deaths and billions
of dollars in added costs to governments and
healthcare providers in 20103. This situaon
is especially alarming in light of the fact that
many soluons already exist. From Brazil
to Vietnam, countries have implemented
simple, low-cost, and highly eecve po-
licies that have shown excing results4,5.
In spite of the importance of road safety
and the existence of eecve soluons,
the consequences of RTAs are projected to
worsen, becoming the h leading cause of
death by 203012. To respond to this, many
governments recently commied to impro-
ving road safety and, in partnership with the
World Health Organizaon (WHO), declared
a Decade of Acon for Road Safety in 2011-
2020, with the goal of reversing the trend of
increasing RTAs worldwide3.
Abstract
Road trac accidents (RTAs) are one of the
leading causes of death worldwide, but of-
ten receive too lile aenon in the health-
care eld. Due to the unique economic and
populaon growth occurring in central Afri-
ca, road safety has become a parcularly
pressing issue here. Dierent governments
have had varying degrees of success in com-
bang RTAs. In Rwanda, the government
has created policies that have dramacally
reduced RTAs. In other countries such as
Uganda, however, the governments alone
have been unable to successfully combat this
large and complex issue. In these countries
where roads remain dangerously unregu-
lated, it is important that physicians join in
the ght for safer roads. As leaders of the
healthcare eld, physicians can use their in-
uence and experse to advocate for more
involvement from policians in road safety,
educate their paents on the importance of
road safety, and use research to further our
understanding of the eects of RTAs. The
result will not only be healthier paents,
but a safer and more producve society as
a whole.
Key Words: trauma, trac accidents, safety
2
Great Lakes Medical Review Vol6, No4, Dec 2015

As this 10-year iniave passes its halfway
point, it is clear that much work remains to
be done.
In many countries, it is an unfortunate truth
that policy eorts alone are insucient to
stem the de of this epidemic and meet
the goal of the WHO’s iniave. It is there-
fore imperave that healthcare providers
ulize their unique resources to improve
road safety for their paents. Physicians are
well-posioned to not only save their own
paents’ lives, but also promote country-
wide road safety advancement. This paper
aims to outline the importance of road safety
in central Africa, discuss two unique case
studies of road safety policies, and highlight
opportunies for healthcare providers to im-
prove road safety.
Road Safety in Central Africa
Many African countries present a unique
set of opportunies and challenges in re-
gards to road safety. As countries have ex-
perienced growing economies, increased
resources, and booming populaon sizes,
road transportaon has experienced explo-
sive growth in recent years. This change has
occurred so quickly that in many countries,
safety structures have been unable to keep
pace. Public health educaon, road safety
policies, healthcare capacity for traumac
injuries, the availability of adequate safety
equipment, and other essenal components
of a safe transportaon sector have all been
unable to meet the ever-growing safety
needs in many African countries.
The results of this unfortunate combinaon
are dire. One study found that the risk of
dying as a result of an RTA in Africa was 24.1
deaths per 100,000 people, the highest of
any of the global regions studied6. In addi-
on, these RTAs aected far more than just
motor vehicle users- pedestrians accounted
for a full 37% of fatalies6. Not only do RTAs
cause so many deaths and injuries, they also
cause enough strain on developing econo-
mies to have signicant economic eects.
Road safety problems are esmated to cost
African governments between 0.8% and 9%
of their total GDPs3. This can be a devas-
tang loss for growing economies, and can
also divert investment away from other im-
portant sectors such as healthcare and edu-
caon.
The government response to the problem of
RTAs has varied greatly across countries. In
spite of the fact that the African Union set
a goal of reducing RTA fatalies by 50% by
2020, many countries have failed to create
policies that address the growing problem of
road safety6. A poignant and visible example
of the eects of high-quality road safety poli-
cies is the dierence in road safety between
Uganda and Rwanda.
Road Safety in Uganda and Rwanda
Although Uganda and Rwanda have expe-
rienced similar economic and populaon
growth rates during the past twenty years,
the safety of their roads have become vast-
ly dierent. Indeed, a trip to their capital
cies today reveals starkly dierent trac
condions. In the late 1990s, Uganda and
Rwanda both had similarly lethal roads and
a lack of safety infrastructure. In response,
both countries created several iniaves to
reduce RTAs. Their governments created
helmet laws for motorcycle users, enacted
speed limit laws, and made eorts to elimi-
nate police corrupon and increase enforce-
ment of trac laws7,8.
In Uganda, the complexity of road safety
proved to be too problemac, and many
of the government’s policies were not suc-
cessful. Bribery connued, enforcement of
many of the new laws lacked commitment,
and insucient eort was placed into educa-
ng the public about the importance of road
safety8. The Ugandan government con-
nued enacng new policies in subsequent
years to combat RTAs, but in spite of these
laudable eorts, the goal of creang safer
roads remained elusive. In fact, without ef-
fecve road safety policies, the number of
RTAs in Uganda has skyrocketed. From 1991
to 2007, Ugandans experienced an almost
four-fold increase in the number of road traf-
c deaths annually8. In 2010, almost 10,000
people died in Uganda as a result of RTAs,
which constutes a fatality rate of 28.9 per
100,000 populaon9.
This increased rate of RTAs has placed an
immense burden on physicians and hospi-
tals across the country. One hospital in Kam-
pala, Mulago Hospital, was even forced to
create an enre new ward to deal with the
overwhelming number of new trauma cases
from RTAs, parcularly those involving mo-
torcycle taxis10.
The story of road safety iniaves in Rwan-
da could not be more dierent. The go-
vernment of Rwanda implemented speed
limit laws, mandatory vehicle inspecon
laws, and motorcycle helmet laws in 20017.
These laws were similar in content to those
in Uganda. Unlike in Uganda, however, in-
creased funding was given for trac police,
who began strictly enforcing the new laws7.
An an-corrupon campaign within its po-
lice force was created, which resulted in the
ring of over 100 police ocers7. Also, in
2003, a naonal public awareness campaign
was conducted to increase educaon around
road safety issues7. As road trac deaths
were skyrockeng in Uganda during the ear-
ly 2000s, a decrease in road trac deaths of
30% was seen in Rwanda7. This change was
so dramac that it gained internaonal ac-
claim and was heralded as a successful exa-
mple for other countries to follow.
The story of the transformaon of Rwandan
roads highlights two key lessons. First, it re-
veals that it is not only possible, but very fea-
sible for a country to dramacally improve its
road safety. It is no longer acceptable to as-
sume that road safety is too big a problem to
solve; it has been done in Rwanda, and it can
be done elsewhere. Second, this example
highlights the importance of dedicaon and
commitment in improving road safety. The
government of Rwanda displayed an ad-
mirable level of willpower in achieving this
transformaon. The example of Uganda, on
the other hand, shows that simply creang
policies and laws without a high degree of
commitment may not improve roads. It re-
quires persistence and hard work over the
course of many years in order to see results.
Many countries lack the polical willpower
of the Rwandan government. That is, in
countries like Uganda, the Democrac Re-
public of the Congo, or the Central African
Republic, it can be much more dicult and
slow-going for governments to create po-
licies, pass laws, and provide funding. In
these countries, government iniave is not
enough. In order to achieve safer roads, it is
imperave that physicians join in this bale
and ght for the safety of their paents.
The Role of Physicians in Creang Safer
Roads
Although a physician’s primary responsibility
is to the treatment of disease in individual
paents, physicians are uniquely posioned
to help prevent injury and death not only in
their own paents, but in society as a whole.
Indeed, beer prevenon is oen the most
eecve means of improving the health of
individual paents. Physicians have the op-
portunity to improve road safety by acvely
engaging in three key acvies: polical ad-
vocacy, public health educaon, and road
safety research.
The history of road safety in Rwanda shows
that dramac improvement of road safety is
possible if enough polical interest exists.
Physicians have an opportunity to use their
posion to put pressure on policians to
strive to make roads safer. This advocacy
could create the polical will necessary to
properly nance and implement eecve
road safety policies. Physicians can write
and call their local policians encouraging
them to take road safety seriously, and ex-
plaining the benets of eecve road safety
projects. They can also write leers to local
newspapers pushing for more acon on road
safety.
Revue Médicale des Grands Lacs Vol6, No4, Déc 2015
3

In the same way that a physician may en-
courage a diabec paent to connue taking
their medicaons, physicians should encou-
rage all of their paents to engage in healthy
road safety behaviors. During medical visits,
physicians should educate their paents on
the importance of using seatbelts, of cau-
ous driving habits, of helmet use on mo-
torcycles (even when riding on motorcycle
taxis), of refraining from walking on roads
or crossing busy streets unsafely, and other
habits that can prevent injury and death. Pe-
rhaps if physicians wrote just as many “pres-
cripons” for helmets as for pain medicaon,
roads could become much safer.
Finally, the more we understand about the
eects of RTAs in local areas, the beer we
can address them. Physicians should engage
in research on RTAs and share these results
in journals such as this one. Projects can be
completed studying the rates of specic inju-
ries following RTAs, the outcomes of specic
treatments and accident response methods,
or the prevalence of RTAs in specic areas.
These projects will shed light on how to best
address the problem of road safety in speci-
c areas and to tailor responses to the needs
of each individual locaon.
Conclusion
It is likely that everyone reading this has ex-
perienced the eects of RTAs in some way,
from an injured family member to even the
death of a paent. Thinking of these people,
it is easy to understand that RTAs harm the
health of populaons in profound ways. As
leaders of the healthcare eld, it is impor-
tant that physicians join in the ght for safer
roads. Physicians can use their inuence and
experse to advocate for more involvement
from policians in road safety, educate their
paents on the importance of road safety,
and use research to further our understan-
ding of the eects of RTAs. By contribung
in these ways, physicians can inuence the
course of society to avoid the history of road
safety in Uganda and follow the path set out
in Rwanda, where hospitals no longer need
dedicated wards for RTAs, physicians are no
longer overburdened by treatment of broken
bones and traumac injuries, and paents
live healthier, safer lives.
Bibliographie
1. World Health Organizaon. Global status
report on road safety: me for acon [In-
ternet]. 2009;Available from: www.who.
int/violence_
2. World Health Organizaon. The Global
Burden of Disease: 2004 update [Inter-
net]. 2008. Available from: hp://www.
who.int/healthinfo/global_burden_di-
sease/2004_report_update/en/index.
html
3. World Health Organizaon. Global status
report on road safety 2013: supporng a
decade of acon [Internet]. 2013;Avai-
lable from: hp://www.who.int/vio-
lence_injury_prevention/road_safety_
status/2013/en/
4. Bishai D, Asiimwe B, Abbas S, Hyder a a,
Bazeyo W. Cost-eecveness of trac
enforcement: case study from Uganda.
Inj Prev 2008;14(4):223–7.
5. Esperato A, Bishai D, Hyder A a. Projec-
ng the Health and Economic Impact of
Road Safety Iniaves: A Case Study of
a Mul-country Project. Trac Inj Prev
2012;13(sup1):82–9.
6. Peden M, Kobusingye O MM. Africa’s
roads – the deadliest in the world. S Afr
Med J 2013;103(4):228–9.
7. Brown H. Rwanda’s road-safety transfor-
maon. Bull World Health Organ [Inter-
net] 2007 [cited 2015 Jun 26];85(6):421–
500. Available from: hp://www.who.
int/bulletin/volumes/85/6/07-010607/
en/
8. World Health Organizaon. Road safety
status: Uganda [Internet]. 2007 [cited
2015 Jun 26];Available from: hp://
www.who.int/violence_injury_preven-
tion/road_safety_status/country_pro-
les/uganda.pdf
9. Global Health Observatory. Road trac
deaths: Data by country [Internet]. Glob.
Heal. Obs. Data Repos. [cited 2015 Jun
26];Available from: hp://apps.who.int/
gho/data/node.main.A997
10. Nakiyimba G. Boda-Boda: Uganda’s
silent killer [Internet]. RFI, 25 March.
2012 [cited 2015 Jun 26];Available
from: hp://www.english.r.fr/afri-
ca/20120325-boda-boda-ride-silent-kil-
ler-uganda
LES EPISTAXIS RECIDIVANTES BENIGNES DE L’ENFANT EN
MILIEU TROPICAL : Facteurs étiologiques et attitudes
thérapeutiques.
SACKO HB1, Dembélé RK2, Diallo AO2, Coulibaly MS3, Telly N3
1MD, CES et PhD, Médecin-Chef de l’Unité ORL du Centre de santé de référence de la commune IV du District de Bamako - MALI.
2Assistant médical ORL
3Médecins praciens
Responsable de l’arcle : Dr Sacko HB BP 2324 Bamako Mali, [email protected]
Résumé
INTRODUCTION
L’épistaxis est l’une des urgences les plus fré-
quentes des voies aérodigesves supérieures
chez l’enfant. Plusieurs facteurs peuvent fa-
voriser la survenue de l’épistaxis récidivante
chez l’enfant en milieu tropical. Les plus fré-
quentes sont : aléas climaques, maladies
infeceuses et parasitaires, anémie.
BUT
Idener les diérents facteurs éologiques
et passer en revue les atudes thérapeu-
ques de l’épistaxis récidivante chez l’enfant
dans notre unité.
MATERIELS ET METHODES
L’étude a été réalisée de janvier 2009 à sep-
tembre 2011 dans l’unité ORL du centre de
santé de référence de la commune IV du
district de Bamako et a porté sur 116 jeunes
paents.
Ont été inclus dans l’étude tous les jeunes
paents âgés de 0 à 15 ans avec épistaxis
d’origine non traumaque ou iatrogène
La rhinoscopie a permis d’examiner les
fosses nasales en précisant le siège du sai-
gnement et l’aspect de la muqueuse nasale.
Un bilan biologique a été demandé selon les
cas d’épistaxis.
4
Great Lakes Medical Review Vol6, No4, Dec 2015

RESULTATS
Une prédominance du sexe masculin a été
notée (60,34%). La moyenne d’âge des pa-
ents était de 7,79 ans avec des extrêmes
allant de 1 à 15 ans. Le saignement provenait
surtout du ers antérieur de la cloison 90 cas
(77,58%). Le saignement était bilatéral dans
68 cas (58,62%).La rhinite subatrophique
82 cas (70,69%) et l’anémie 20 cas (17,25%)
ont constué les principaux facteurs éolo-
giques. Les soluons salines et l’applicaon
de pommade à base de vitamine A ont per-
mis une maîtrise de l’épistaxis dans 76 cas
(65,52%). Le tamponnement du nez a été
rarement eectué : 14 cas (12,05%).
CONCLUSION
Les épistaxis récidivantes de l’enfant en mi-
lieu tropical sont fréquentes. L’atrophie de la
muqueuse nasale liée aux aléas climaques
est un facteur éologique prépondérant.
Mots-clés : épistaxis récidivante - rhinite su-
batrophique - enfant - milieu tropical.
Summary
INTRODUCTION
Epistaxis in children is one of the most com-
mon emergencies of the upper aerodigesve
tract. Several factors can contribute to the
occurrence of recurrent epistaxis in children:
climac condions, infecous and parasic
diseases, anemia.
AIM
To idenfy the dierent eologies and to re-
view the therapeuc atudes for the recur-
rent epistaxis in children in our unit.
MATERIALS AND METHODS
The study was conducted from January 2009
to September 2011 in the ENT unit of refe-
rence of commune IV of the Bamako district
health center and involved 116 young pa-
ents.
Were included in the study all young paents
aged 0-15 years with epistaxis from no trau-
mac or iatrogenic origin.
The rhinoscopy allowed examining the nasal
specifying site of bleeding and aspect of the
nasal mucosa. A biological assessment re-
quested in cases of epistaxis.
RESULTS
A predominance of the male was observed
(60.34%). The average age of the paents was
7.79 years with extremes ranging from 1 to
15 years. The bleeding came especially from
the third anterior wall 90 (77.58%) cases. The
bleeding was bilateral in 68 cases (58.62%).
Subatrophic rhinis 82 cases (70.69%) and
anemia 20 cases (17.25%) have constuted
the main eological factors. Saline soluons
and the applicaon of ointment of vitamin A
allowed control of epistaxis in 76 (65.52%)
cases. Tamponade of the nose was rarely
carried out 14 cases (12.05%).
CONCLUSION
Recurrent nosebleeds of the child in a tro-
pical environment are frequent. Atrophy of
nasal mucosa related to climac condions
is an important eological factor.
Key-words: recurrent epistaxis - Subatro-
phic rhinis - children - tropics.
Introduction
L’épistaxis est l’une des urgences les plus
fréquentes des voies aérodigesves su-
périeures chez l’enfant[1, 2, 3, 4, 5]. Cee
fréquence s’explique par l’hypervascularisa-
on des fosses nasales [6, 7,8, 9].L’épistaxis
récidivante constue souvent un stress non
seulement pour l’enfant, mais également
pour son entourage immédiat (parents). Plu-
sieurs facteurs peuvent favoriser la survenue
de l’épistaxis récidivante chez l’enfant en
milieu tropical: aléas climaques, maladies
infeceuses et parasitaires, anémie, graage
des fosses nasales et autres [1, 10, 8, 11].
L’objecf de ce travail était d’idener les
diérents facteurs éologiques et de pas-
ser en revue les atudes thérapeuques
de l’épistaxis récidivante chez l’enfant dans
notre unité.
II. MATERIEL ET METHODES
L’étude a été réalisée de janvier 2009 à sep-
tembre 2011 dans l’unité ORL du centre de
santé de référence de la commune IV du
district de Bamako et a porté sur 116 jeunes
paents.
Ont été inclus dans l’étude tous les jeunes
paents âgés de 0 à 15 ans avec épistaxis
d’origine non traumaque ou iatrogène.
Les paents présentant un saignement du
nez d’origine traumaque ou iatrogène (in-
tervenon chirurgicale sur le nez ou ses cavi-
tés annexes) ont été exclus de l’étude.
La rhinoscopie a permis d’examiner les
fosses nasales en précisant le siège du sai-
gnement et l’aspect de la muqueuse nasale.
Un bilan biologique a été demandé selon les
cas d’épistaxis.
Résultats
1. Réparon selon, l’âge et le sexe
Tableau 1 : La réparon des paents selon l’âge et le sexe
Une prédominance du sexe masculin a été notée (60,34%). La
moyenne d’âge des paents était de 7,79 ans avec des extrêmes al-
lant de 1 à 15 ans.
2. Localisaons du saignement
Tableau 2 : Les sites du saignement
Le saignement provenait surtout du ers antérieur de la cloison 90
cas (77,58%). Le saignement était bilatéral dans 68 cas (58,62%).
AGE GARCONS FILLES
Nombre % Nombre %
1-3 12 17,14 48,70
4-6 10 14,29 16 34,79
7-9 22 31,42 12 26,08
10-12 16 22,86 12 26,08
12-15 10 14,29 2 4,35
TOTAL 70 100,00 46 100,00
Localisaon Nombre %
Tiers antérieur de la cloison 90 77,58
Tiers postérieur de la cloison 16 13,80
Toute la muqueuse de la cloison 86,90
Tiers moyen de la cloison 2 1,72
TOTAL 116 100,00
Revue Médicale des Grands Lacs Vol6, No4, Déc 2015
5