Community perception of the determinants of unmet needs of family planning among married women in Buea Health District, Southwest Region, Cameroon.

Introduction: in Cameroon, and more specifically in the Buea Health District of the Southwest Region, there are still a few unmet family planning needs. Many women desire to avoid getting pregnant, but do not use an effective form of birth control. A focus group discussion among married women in the Buea health district was necessary to explore the determinants of unmet family planning in order to promote access to and use of long-acting modern contraceptive methods because most research studies have only focused on the quantitative aspect. Methods: focus groups were held in the community and in the medical facilities as part of the study's qualitative exploratory strategy. To invite the participants, invitations were sent out. A qualitative survey of 10-12 respondents was carried out by the researcher, in each Focus Group the discussed topics included factors that encourage the use of FP methods, making the switch from traditional to modern FP methods, family planning methods decision-making, accessibility of FP in the context of the COVID-19 pandemic. Each focus group discussion lasted 1 hour 30 minutes, the perception was collected in an audiotape recorder and later transcript verbatim. The team conducted 10 Focus Group Discussion (FGD) (four of each of the topic areas). The FGD team provided participants with light refreshments. Results: a total of 10 focus groups were conducted, reaching a total participant of 107. The N-Vivo analysis software was used to analyze the data. The following are some of the key participant perceptions that have been reported. Perceptions of family planning; for health reasons as well as social expectations and pressures, having children earlier in marriage was a wise decision. While there are certain issues with having children early in life, such as the mother's maturity and financial stability, having a kid as soon as feasible is the best option. It is best to have children within the first two years of marriage, with a three-to-five-year gap between them. Reasons for changing from traditional to modern family planning; The most significant issues with current birth control techniques (such as condoms, pills (postinor-2), implants, injectables, and IUDs) are those that affect a woman's body. Regardless of the issues, they experience with contraception, there are some benefits to utilizing it. Both modern and classic FP methods have the potential to fail. Making family planning decisions; extended families, particularly mothers-in-law, have a strong influence on family planning and size decisions, and family members assist in resolving FP issues and challenges. Participants want to know about the adverse effects of current birth control techniques, especially in the long run, and how contraceptives affect a future pregnancy. Accessibility of FP in the context of the COVID-19 pandemic; participants have mixed perceptions of whether the COVID-19 context influences their accessibility to family planning. Conclusion: the focus groups demonstrated that participants have a nuanced and sophisticated awareness of pertinent topics that significantly impact them. While cultural and social conventions surrounding family planning difficulties and decision-making continue to put pressure on women, traditional and modern family planning methods are well-known. Participants also reported a strong desire to learn more about family planning alternatives, the effects of different methods on their bodies, and to have access to a wider selection of general and specialized family planning services. Fear was produced by the backdrop of COVID-19, but women are rapidly overcoming these fears to have access to family planning.

Adiponectin levels and its relation with insulin secretion and insulin sensitivity in a group of sub-Saharan African women with polycystic ovary syndrome.

OBJECTIVES: Low levels of adiponectin have been reported in Polycystic Ovary Syndrome (PCOS). In sub-Saharan Africa, little data are available on the topic. We aimed to investigate the levels of adiponectin and its relation with insulin secretion and insulin sensitivity in women with PCOS in Yaoundé, Cameroon. A comparative cross-sectional study was conducted in 32 women presenting PCOS and 32 controls matched for age and Body Mass Index. For each participant, adiponectin levels were measured. We estimated insulin sensitivity using Homeostasis model index (HOMA-IR) and insulin secretion with C-peptide levels. RESULTS: Women with PCOS had higher insulin secretion levels than controls (C-peptide: 4.98 ± 3.83 vs 3.25 ± 1.62 mUI/l; p = 0.02). Also, the HOMA-IR index was higher compared to that of women without PCOS (1.15 ± 0.90 vs 0.77 ± 0.38; p = 0.03) suggesting greater insulin resistance. The median [25th-75th percentile] values of adiponectin concentrations were similar between the two groups (22.68 [21.72-23.41] µg/ml vs 22.03 [21.40-22.93] µg/ml; p = 0.1). There was no association between insulin sensitivity and adiponectin levels in the PCOS group. PCOS is not associated with changes in adiponectin in a population of sub-Saharan African women. Further studies are needed to shed more light on this condition.

Inflammation and Insulin Resistance in a Group of Sub-Saharan African Women with Polycystic Ovary Syndrome.

BACKGROUND: Studies report high levels of inflammatory markers in women with polycystic ovary syndrome (PCOS), reflecting chronic low-grade inflammation. This inflammation is thought to be associated with insulin resistance. We aim to evaluate inflammatory markers [high sensitivity C reactive protein (CRP) and interleukin 6] and insulin resistance in women with PCOS in Yaoundé, Cameroon. METHODS: We conducted a comparative cross-sectional study including 32 women with PCOS aged between 18 and 44 years and 32 controls matched for age and body mass index (BMI). Homeostasis model assessment of insulin resistance (HOMA-IR) index calculated using C peptide levels was used to evaluate insulin resistance. Serum levels of high sensitivity CRP (hsCRP) and interleukin 6 (IL-6) were measured. Comparisons were made using the Student's T-test and non-parametric tests (Mann-Whitney U-test, Kruskal-Wallis test). RESULTS: We found that the median [25th-75th percentile] level of hsCRP was significantly higher in women with PCOS compared to the controls (0.63 [0.32-3.81] mg/L vs. 0.47 [0.15-1.04] mg/L; p=0.01), while IL-6 levels were not different (8.61 [4.1-33.79] pg/mL for PCOS vs. 8.80 [5.28-38.85] pg/mL for controls; p=0.51). We noted that women with PCOS had a higher HOMA-IR index (1.15±0.90 vs. 0.77±0.38; p=0.03). However, there was no correlation between hsCRP level and the HOMA-IR index (Spearman correlation coefficient=0.10; p=0.62). CONCLUSION: PCOS is associated with an increased level of hsCRP and insulin resistance in Cameroonian women. This exploratory study provides baseline evidence for larger-scale studies.

Induction of Labour in Advanced Abdominal Pregnancy with Fetal Demise due to Cord Round Neck: A Case Report of a Missed Diagnosis.

BACKGROUND: There are increasing reports of term live abdominal pregnancies even though the diagnosis of abdominal pregnancy is made preoperatively only in 45% of cases which partly explains the high maternal and perinatal morbidity and mortality associated with abdominal pregnancy. CASE REPORT: We report a rare case of misdiagnosed term abdominal pregnancy complicated by fetal demise due to cord round neck in a 29-year-old G3P2002 at 39-week and 1-day gestation. She noticed reduced fetal movements for which upon examination fetal death was diagnosed. Cervical ripening was started which eventually failed, and surgery was indicated. Findings were an abdominal pregnancy with a third-degree macerated fetus with cord round neck. She was discharged on day 8 postoperation to continue follow-up as an outpatient with regular ßHCG and ultrasound checks. CONCLUSION: This case illustrates the need to effectively confirm an intrauterine location of a pregnancy even in a case of fetal demise and the need to monitor for cord abnormalities in advanced abdominal pregnancy being managed expectantly.

The Relationship between Adiposity and Insulin Sensitivity in African Women Living with the Polycystic Ovarian Syndrome: A Clamp Study.

Objectives. We aimed to assess the variation of insulin sensitivity in relation to obesity in women living with PCOS in a sub-Sahara African setting. Methods. We studied body composition, insulin sensitivity, and resting energy expenditure in 14 PCOS patients (6 obese and 8 nonobese) compared to 10 matched nonobese non-PCOS subjects. Insulin sensitivity was assessed using the gold standard 80 mU/m(2)/min euglycemic-hyperinsulinemic clamp and resting energy expenditure was measured by indirect calorimetry. Results. Insulin sensitivity adjusted to lean mass was lowest in obese PCOS subjects and highest in healthy subjects (11.2 [10.1-12.4] versus 12.9 [12.1-13.8] versus 16.6 [13.8-17.9], p = 0.012); there was a tendency for resting energy expenditure adjusted for total body mass to decrease across the groups highest in obese PCOS subjects (1411 [1368-1613] versus 1274 [1174-1355] versus 1239 [1195-1454], p = 0.306). Conclusion. In this sub-Saharan population, insulin resistance is associated with PCOS per se but is further aggravated by obesity. Obesity did not seem to be explained by low resting energy expenditure suggesting that dietary intake may be a determinant of the obesity in this context.

[How do Cameroonian women experience their first gynecological examination? How can the procedure be modified to improve this experience?]. / Le vécu du premier examen gynécologique en milieu africain : cas du Cameroun Quels ajustements apporter à son déroulement pour un meilleur vécu ?

UNLABELLED: The gynecological examination is a key element in the diagnosis of the most genitourinary disorders. Improving how women experience the first gynecological examination (FGE) should have a significant impact on their perception of this examination and on their general feeling about it afterwards. OBJECTIVE: The aim of our study was to describe the general feeling of Cameroonian women towards the FGE and to identify the factors associated with negative feelings. METHODOLOGY: In this one-month survey study, we asked patients to complete a questionnaire about how they had experienced the FGE. The answers have been analyzed and the factors influencing the way they experience this examination determined. RESULTS: At the end of the FGE, 41.5% of the women had negative feelings, and 38.6% reported that the examination had been painful. The average age of women who experienced pain was younger than that of those who did not [19.4 vs 20.39 years, P = 0.029], as was that of women with negative feelings lower [19.41 vs 20.43 years, P = 0.024]. A negative experience was significantly associated with a painful examination [P≤0.001], an examiner not specialized in gynecology [P = 0.04], lack of information [P = 0.001], and lack of a separate room to undress [P = 0.038]. The rate of subsequent refusals of a gynecological examination was higher among women with a negative first experience [56.2% vs. 35.9%, P = 0.008]. CONCLUSION: The FGE is experienced by Cameroonian women as very difficult. Their feelings at the end of this examination significantly influences their behavior towards gynecological examinations in general.