Abstracts -12th World Congress on Disaster and Emergency Medicine, Lyon, Francecaused by a bioterrorist could quickly become an international problem.

Context and objective. Data about the trends of maternal mortality are scarce in Sub-Saharan Africa. The present study aimed to determine the evolutionary trend of maternal mortality over time and identify the causes of death. Methods. This was a retrospective observational study carried out at the Constantine University Hospital involving data of maternal mortality recorded between January 1st, 2012 and December 31st, 2017. Results. Seventy maternal deaths were deplored. The maternal mortality ratio is 101.3 deaths per 100,000 live births. Obstetric hemorrhage and hypertensive disorders of pregnancy were the leading causes of death. Triennial analysis shows a significant decrease in mortality from hemorrhage and anesthesia complications. Conclusion. This study allows drawing up a profile of the causes of maternal mortality, the level of which remains worrying and require a global strategy. Contexte et objectifs. Les données sur la tendance de la mortalité maternelle sont fragmentaires en Afrique Subsaharienne. La présente étude avait pour objectif de faire une analyse triennale de l’évolution du taux de mortalité maternelle et identifier les causes de décès. Méthodes : Il s’agissait d’une étude observationnelle documentaire, sur la mortalité maternelle enregistrée ; au Centre hospitalo-universitaire de Constantine, entre le 1er Janvier 2012 et le 31 Décembre 2017. Résultats. Soixante-dix décès maternels ont été déplorés. Le taux de mortalité maternelle est de 101,3 décès pour 100 000 naissances vivantes. Les hémorragies obstétricales et les complications hypertensives de la grossesse sont les premières causes de mortalité. L’analyse des données triennales met en évidence une baisse importante de la mortalité par hémorragie et par complications de l’anesthésie. Conclusion. Cette étude a permis de dresser un profil des causes de la mortalité maternelle dont les niveaux restent inquiétants et requièrent une action globale.

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Background and objectivesHealth professionals must implement quality improvement initiatives in order to provide evidence for the delivery of quality care and to justify expenditure. Although this is possible in developed countries, developing countries with limited resources remain sceptical even though the introduction of standards would markedly improve quality and reduce wastage.To convince others of the need for standards, a research team decided to get to grips with quality management and opted to implement ISO 9001 requirements (version 2000) in a intensive care unit. They chose a key process in the delivery of care, namely, mechanical ventilation (MV). The objectives were: (i) to adapt ISO 9001 requirements to the delivery of care, (ii) to improve the quality of MV.ProgrammeWe used a ‘process approach’ in four steps: Drafting a description of the process of MV,Planning how MV should be carried out: establishing requirements and quality objectives, constructing quality indicators, drafting documents on quality and recording, and training of residents. We performed a first self-assessment of practice in July 2007 as well as a survey of the occurrence of five complications chosen as outcome indicators: ventilator-associated pneumonia (VAP), unplanned extubations, failed planned extubations, pneumothorax and ventilator failures during MV.Implementation of the protocols that we developed (October 2007),Regular monthly monitoring of indicators with a view to mastering and improving the process; a second self-assessment was performed 8 months later. ResultsIndicators improved after 14 months of monitoring. Compliance with criteria increased from 10% to 80% and cases of complications per 1000 ventilator days decreased from 42.88 to 16.8 cases for VAP (RR: 0.39, p=0?), from 10.9 to 4 for unplanned extubations (RR: 0.36, p=0.044), from 5.5 to 0.35 for pneumothorax (RR: 0.07, p=0.018) and from 9.12 to 1.1 for ventilator failures (RR: 0.12, p=0.003). However, failed planned extubations (% of patients extubated) increased from 25% to 21.8% (ns).Discussion and conclusionApart from a few paragraphs of Article 7 not applicable to the healthcare sector, all ISO 9001: 2000 requirements can be adapted to healthcare without the exclusions affecting conformity with ISO 9001:2000. Quality management led to a significant reduction in the complications of mechanical ventilation except for failed planned extubations. The improvement in quality of care was thus significant. Any inefficiencies and lack of resources of the health system are not an obstacle to applying quality management. On the contrary, this is fertile ground where small improvement actions can produce big results in terms of improving quality of care and resource utilisation.Contextes et objectifsLes professionnels de la santé doivent adopter des démarches qualité, dans le but de prouver l'assurance de la qualité des soins et de justifier les dépenses. Si la démarche est possible au niveau des pays développés, elle est l'objet de scepticisme au niveau des pays en d...