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The management of preterm births remains a major challenge in Madagascar, given the lack of equipped facilities in rural areas, and the absence of precise data concerning the incidence of such births. The World Health Organization (WHO) recommends the kangaroo method (skin-to-skin contact) for the management of preterm infants. In this article, we examine the conditions for success and the obstacles facing kangaroo care in community settings in Madagascar. We performed a qualitative research, collecting data from the districts of Antananarivo and Mahajanga in 2021. In total, 54 semi-structured interviews and two focus group sessions were conducted with the parents of preterm infants and healthcare professionals. The obstacles identified by the research included incomplete and inaccurate knowledge, leading to heterogeneity in the practice of kangaroo care: arbitrary duration, lack of kangaroo care at night, exclusive breastfeeding, and only partially practiced skin-to-skin contact. We found that the conditions for success depended on: (1) the healthcare system, (2) local interpretations of pregnancy, and (3) the structure of the infant’s family. Failings of the medical system, cultural habits going against kangaroo care, and “nuclear” and/or “single parent” family structures undermine the application of this practice, jeopardizing upscaling efforts. We hope that the results of this research will guide community strategies for the management of preterm infants and kangaroo care.

Dermatofibrosarcoma protuberans (DFSP) is a rare, slow-growing mesenchymal neoplasm of the dermis and subcutaneous tissues that has a low- to intermediate-grade malignancy. DFSP commonly involves the trunk and extremities, and very rarely the breast skin, mimicking a primary breast neoplasm with few reported cases in the literature. we report a 35-year old female patient who was referred to the royal hospital, Muscat, Oman in 2017, with a two-year history of a slow growing left breast lump. assessment of the breasts with mammography revealed a lobulated lesion in the left-upper-inner quadrant with neither microcalcification nor architectural distortion, mimicking a benign lesion. however, on ultrasound, the lesion had suspicious features with increased vascularity and hence, it was categorised as breast imaging reporting and data system (BIRAD) IV. the patient underwent left breast wide local excision and the histopathological diagnosis was dermatofibrosarcoma protuberans.

30-day re-admission rate is a performance indicator used to reflect adverse events and complications of treatment. High rates could indicate poor quality of care and clinical incompetence. The study aims to measure a 30-day readmission rate as a performance indicator of the quality of elective surgical inpatient care at teaching hospitals, and to determine predictors and reasons of readmission. This is a retrospective cohort study and conducted in some surgical departments. Target populations were patients that underwent any of the elective operations, and readmitted for unplanned related reasons within 30-days for four consecutive years (2006-2009). However, patients not readmitted were those that underwent any of the elective operations and not readmitted within 30-days. Data were extracted from the computerized and paper medical records. Multivariate regression analysis determines predictors of readmission (rate of 20.4 %) on preoperative and postoperative length of stay >3 days. Hence, major operation and lack of discharge plan for follow up. However, co morbidities other than diabetes mellitus and hypertension were protective. Majority of reasons of readmission were infection, then bleeding. The hospital should manage pre and post operative stay properly, emphasize the role of discharge plan and apply infection control surveillance. يعد معدل إعادة الدخول للمستشفى خلال 30 يوما مؤشرا لتقييم الأداء الذى يعكس السلبيات و المضاعفات. و يشير ارتفاع هذا المعدل لسوء جودة الرعاية و الكفاءة السريرية. و تهدف الدراسة لقياس معدل إعادة الدخول للمستشفى خلال 30 يوما لمرضى الجراحات غير العاجلة بالمستشفى التعليمي و معرفة عوامل الخطورة و أسباب إعادة الدخول للمستشفى. و قد صممت دراسة كوهرت بأثر رجعي و نفذت ببعض أقسام الجراحة. و الفئة المستهدفة هي المرضى الذين تمت لهم جراحات غير عاجلة و تمت إعادة دخولهم للمستشفى خلال 30 يوما لأسباب متعلقة بسبب الدخول و غير مخطط لها و ذلك خلال 4 سنوات متتالية من 2006-2009 م. وقد تم أيضا دراسة المرضى الذين أجريت لهم جراحات غير عاجلة و لكن لم يتم إعادة دخولهم خلال 30 يوما. و قد استخرجت البيانات من نظام إدارة المعلومات الصحية و السجلات الورقية. استخدم انحدار اللوجستي المتعدد لتحديد عوامل الخطورة للعودة للمستشفى. و كان معدل الدخول 20.4% و عوامل الخطورة : مدة الإقامة بالمستشفى قبل و بعد الجراحة أكثر من 3 أيام، و إجراء الجراحات الكبيرة، و عدم وجود خطة متابعة للمريض عند الخروج. من ناحية أخرى وجد أن الأمراض المصاحبة غير الداء السكري و ارتفاع ضغط الدم يقلل من العودة للمستشفى. و وجد أن معظم أسباب العودة هي العدوى ثم النزيف. فعلى المستشفى أن تقوم بتحسين خدمات المرضى خلال الإقامة قبل و بعد الجراحة. و تأكيد دور خطة المتابعة عند الخروج، و تطبيق برنامج لمكافحة العدوى.