Etude de la mortalite dans le service de eanimation de l\'hopital gyneco-obstetrique et pediatrique de Yaounde.

Le but de ce travail etait d\'etudier la mortalite dans le service de reanimation medico-chirurgicale de l\'Hopital Gyneco- Obstetrique et Pediatrique de Yaounde, afin de mettre en exergue les causes des deces, les imperfections de notre systeme et de proposer des solutions pour diminuer la mortalite dans notre formation sanitaire. Notre etude retrospective et descriptive a concerne les dossiers et fiches de soins journaliers de tous les patients admis dans le service de Janvier 2003 a Juin 2007. Les dossiers incomplets ont ete exclus de l\'etude. Les parametres etudies etaient l\'origine du patient, les moyens disponibles, la cause du deces, le moment du deces, l\'observance du traitement et les difficultes rencontrees. Le service comprend 7 salles d\'hospitalisation avec 32 lits, 8 respirateurs, 10 electrocardioscopes, 7 aspirateurs et un chariot d\'urgence. 4103 dossiers des patients admis dans le service pendant trois ans et demi ont ete etudies. L\'age moyen des patients etait de 34±4,3 ans. 51% patients venaient du bloc operatoire. 336 patients sont decedes en trois ans 6mois, soit un taux de mortalite de 8, I8%. Les etats septiques graves etaient la cause la frequente de deces avec 7% suivi du SIDA (13%) et des accidents vasculaires cerebraux. 55% des deces sont survenus entre 20 heures et 8heures du matin. Les principaux handicaps rencontres dans la prise en charge des patients en reanimation etaient : la mauvaise observance du traitement liee a l\'indigence et le deficit en personnel, et l\'insuffisance en materiel de monitorage. Nous concluons que la mortalite dans le service reste relativement elevee. Pour reduire cette mortalite il est indispensable d\'augmenter les effectifs, de renforcer l\'equipement du service en materiel de monitorage et de mettre sur pieds une politique d\'assurance maladie. The study was aimed at assessing the causes of mortality, identify lapses in the working system in the intensive care unit of the Yaounde Gyneco-Obstetric and Paediatric Hospital, and propose solutions to reduce it. It was a retrospective and descriptive study of files of patients admitted in this unit from January 2003 to June 2007. Incomplete files were excluded from the study and data collected included the patient\'s origin, equipment facilities, personnel, cause of death, time of death, administration of drugs and the difficulties encountered in patient management. The unit comprises 7 wards, 32 beds, 8 respirators, 10 electrocardioscopes, 7 aspirators and an emergency stretcher. The files of 4103 patients admitted over a period of three and a half years were studied. The mean age of the patients was 34±4.3 years and 5I% of them were just from the theatre. 336 patients died within this period, giving a mortality rate of 8.18%. Severe sepsis was the commonest cause of death within 7% of the patients, followed by HIV/AIDS (13%) and cardiovascular accidents. 55% of deaths occurred between 8p.m. and 8 a.m. The main handicaps encountered were inadequate administration of drugs because of inability to buy them, insufficient personnel and shortage of monitoring equipment. We thus conclude that there is a relatively high mortality rate in our intensive care unit. To reduce this mortality rate it is indispensable that the number of personnel be increased, provision of sufficient and adequate equipment facilities including those for monitoring, and instituting a health insurance system. Keywords : Intensive care unit - Patient management - Mortality - Causes. Clinics in Mother and Child Health Vol. 4 (2) 2007 pp. 737-740