[Factors associated with the failure of medical treatment for ectopic pregnancy: case study conducted at the Yaoundé Gynaecology, Obstetrics and Pediatrics Hospital]. / Facteurs associés à l'échec du traitement médical de la grossesse extra-utérine: cas de l'Hôpital Gyneco-Obstétrique et Pédiatrique de Yaoundé.

Introduction: the purpose of this study was to identify factors associated with the failure of medical treatment for ectopic pregnancy (EP) in women at the Yaoundé Gynaecology, Obstetrics and Pediatrics Hospital. Methods: we conducted a case-control study using a retrospective data collection over a 10-year period from January 1st 2008 to December 31st 2017. Our study included all patients treated for EP; the study group was composed of patients in whom medical treatment had been unsuccessful while the control group was composed of patients in whom medical treatment had been successful. The variables studied were: socio-demographic, clinical, paraclinical and therapeutic features. Consecutive and complete sampling were used. Multivariate analysis was performed. Results: we enrolled 92 patients, including 23 cases and 69 controls. The variables associated with the failure of medical treatment for EP after univariate analysis were: initial ß-HCG (beta-human chorionic gonadotropin) level > 10000IU/L (OR=3.05; P=0.031), ß-HCG level on day 4 > 10000IU/L (OR=7.15;P=0.000), ß-HCG level on day 7 > 10000UI/L (OR=20; P=0.000), Fernandez score ≥ 13 (OR=3.09;P=0.020), the presence of fetal heart activity (OR=2.8; P=0.036), a history of voluntary abortion (OR=2.67;P=0.043) and primary level of education. (P=0.013). After multivariate analysis, predictors were: initial ß-HCG level>10000 IU/L (OR=8.97; P=0.004), ß-HCG level on day 4>10000 IU/L (OR=8.44;P= 0.007), Fernandez score ≥ 13 (OR=1.12;P=0.005), and the presence of fetal heart activity (OR=6.09;P=0,026). Conclusion: at the Yaoundé Gynaecology, Obstetrics and Pediatrics Hospital predictors of failure of medical treatment for EP were related to initial ß-HCG level and fetal viability.

Comparative analysis of two molecular tests for the detection of COVID-19 in Cameroon.

INTRODUCTION: COVID-19 equation in Cameroon is yet to be resolved. There is an urgent need for a rapid response strategy to the increasing demand of polymerase chain reaction (PCR) test results for both patients, travelers and competitors to various games. We assessed the diagnostic performance of the AmpliQuick® SARS-CoV-2 against the classic Reverse transcription polymerase chain reaction (RT-PCR). METHODS: a cross-sectional and comparative study was conducted from April 27th to May 29th, 2021 in the city of Douala, Cameroon. The samples consisted of any nasopharyngeal sample received at the Douala Gynaeco-Obstetrics and Pediatric Hospital molecular biology laboratory, regardless of its origin. Sociodemographic parameters (age, profession (footballers, travelers, other), matrimonial status, nationality), comorbidity and known status of COVID-19, were recorded at collection sites. The main collection sites were the Deido Health District and the Douala Gynaeco-Obstetric and Pediatric Hospital. We performed testing using AmpliQuick® SARS-CoV-2 and the classic RT-PCR (Da An Gene Co.Ltd) on each sample during the one month period. Analytical performance parameters were determined. To determine the sensitivity of both methods, the Bayesian latent class model was performed on the median with 95% confidence interval, with p≤0.05 as significant level, as well as Kappa (κ) agreement between tests. An ethical clearance was sought and obtained from the University of Douala Institutional Ethics Committee. RESULTS: a total of 1813 participants were enrolled, with the predominance of male (68.68%) and the age group 31 to 40 years old (31.33%). Most participants were married (53.46%) with only few with known COVID-19 status (5.47%). One thousand eight hundred and ten (1810) tests were performed by AMPLIQUICK® SARS-CoV-2 while only 1107 could be achieved with the classic RT-PCR. Over the study period, it was noted a drastic reduction in the time necessary to render results with the AMPLIQUICK® SARS-CoV-2 from 24 hours to 3 hours. The AMPLIQUICK® SARS-CoV-2 reduced technician hands-on time and its practicability was noticed based on the prefilled and ready-to-use microplates. A prevalence of 1.93% and 1.45% were obtained for AMPLIQUICK® SARS-CoV-2 and the classic RT-PCR respectively. This difference in the prevalence showed that AMPLIQUICK® SARS-CoV-2 (Sensitivity 83.5% [CI=64.6-95.2]) was more accurate than the classic RT-PCR (67.8% [CI=46.6-84.9]). CONCLUSION: it is time for a change of attitude to scale up the COVID-19 testing ability in Cameroon and the AMPLIQUICK® SARS-CoV-2 is an alternative diagnosis strategy which should help resolve the situation of timely and reliable results.

[Evaluation of two COVID-19 antigenic diagnostic tests: BIOSYNEX® COVID-19 Ag BSS and BIOSYNEX® COVID-19 Ag + BSS compared to AmpliQuick® SARS-CoV-2 PCR]. / Evaluation de deux tests de diagnostic antigénique du COVID-19: BIOSYNEX® COVID-19 Ag BSS et BIOSYNEX® COVID-19 Ag+ BSS comparés à la PCR AmpliQuick® SARS-CoV-2.

INTRODUCTION: the COVID-19 pandemic causes biological diagnostic problems that remain relevant in low-income countries in general and in Cameroon in particular. Rapids tests that reliably detect SARS-CoV-2 virus antigen present themselves as an important alternative in several contexts. The objective of our study was to evaluate the diagnostic performance of two rapid diagnostic tests BIOSYNEX® COVID-19 Ag BSS and BIOSYNEX® COVID-19 Ag + BSS, compared to each other and to the AmpliQuick® SARS-CoV-2 PCR test. METHODS: a cross-sectional and comparative study was carried out from April 27 to May 29, 2021 in the city of Douala in Cameroon. The samples consisted of nasopharyngeal swabs received at the molecular biology laboratory of the Douala Gyneco-obstetric and pediatric hospital, whatever their origin. The socio-demographic parameters (age, profession, football players, travelers, others), marital status, nationality), comorbidity and known status of COVID-19, were recorded on the collection sites. The main collection sites were the Deïdo Health District and the Douala Gyneco-Obstetric and Pediatric Hospital. We performed the diagnosis of COVID-19 using the rapid diagnostic test (RDT) BIOSYNEX® COVID-19 Ag BSS and RDT BIOSYNEX® COVID-19 Ag + BSS compared to each other and to the AmpliQuick® SARS-CoV-2 polymerase chain reaction (PCR) test on each sample. Statistical analysis of the data was performed using Microsoft Excel and SPSS version 17 software. To determine the sensitivity of the two RDTs, the Bayesian latent class model was performed on the median with a 95% confidence interval with p<0.05 as the significant level. An ethical clearance was sought and obtained from the University of Douala Institutional Ethics Committee. RESULTS: a total of 1813 participants were included in our study, with a predominance of men (1226, 68.68 %) and the most represented age group was that of 31 to 40 years (568, 31.33 %). Most of the participants were married (888, 53.46%) and only a few had a known COVID-19 status (75, 5.47%). The two rapid tests on our study population show much closed COVID-19 prevalence values, respectively 2.03 for BIOSYNEX® COVID-19 Ag BSS and 2.17 for BIOSYNEX® COVID-19 Ag + BSS. RDT BIOSYNEX® COVID-19 Ag + BSS showed higher sensitivity 94.1% vs. 87.5% for RDT BIOSYNEX® COVID-19 Ag BSS with almost identical specificity 98.9% for RDT BIOSYNEX® COVID-19 Ag + BSS vs. 98.7% for RDT BIOSYNEX® COVID-19 Ag BSS compared to AmpliQuick® SARS-CoV-2. BIOSYNEX® COVID-19 Ag + BSS RDT showed a negative predictive value of 99.9% compared to BIOSYNEX® COVID-19 Ag BSS RDT. There is a 99.9% agreement between the RDT BIOSYNEX® COVID-19 Ag BSS and the RDT BIOSYNEX® COVID-19 Ag + BSS. Conclusion: the RDT BIOSYNEX®COVID-19 Ag + BSS and RDT BIOSYNEX® COVID-19 Ag BSS can be used for the diagnosis of SARS-CoV-2 and can have an important contribution in the context of mass screenings and screening in remote areas.

Management of a post-coital recto vaginal fistula at the Douala Gyneco-Obstetric and Pediatric Hospital: a case report.

Recto vaginal fistula can be secondary to various and multiple causes. However, intercourse is an exceptional cause. The objective of this work is to expose its clinical, therapeutic and prognostic particularities. We report the case of rectovaginal fistula in a 29-year-old patient, following consensual sex. She underwent posterior colpoperineorraphy under spinal anesthesia, with a favorable outcome. Post-coital recto vaginal fistula is a stigmatizing pathology responsible for polymorphic complications. Prompt care can improve quality of life and the obstetrical prognosis of the patient.

Clinical presentation, risk factors and pathogens involved in bacteriuria of pregnant women attending antenatal clinic of 3 hospitals in a developing country: a cross sectional analytic study.

BACKGROUND: Pregnancy increases the risk of recurrent bacteriuria and acute pyelonephritis which is associated with significant maternal and fetal risks. The prevalence of bacteriuria varies worldwide. Clinical diagnosis is challenging since it is usually mistaken for normal physiological changes during pregnancy. This study aims to determine the prevalence, clinical presentation, risk factors and microorganism responsible for bacteriuria in pregnant women of Douala city, Cameroun. METHODS: A cross-sectional study was conducted in 3 hospitals of Douala from January to April 2015. We consecutively recruited all consented pregnant women aged 18 years and above attending antenatal clinics. Socio-demographic characteristics, medical and obstetrical past history, clinical signs and obstetric characteristics of the index pregnancy were collected. Thereafter, urine were collected aseptically and subjected to routine macroscopy, microscopy examination and culture. The culture was obtained by inoculation of 10 µl of urine on the appropriate medium. Identification of pathogens was done automatically using the VITEK2™ (BioMérieux- France). Data were processed using the Statistical Package for the Social Sciences (SPSS) 18. Statistics were descriptive and analytic; Odds ratios were calculated. Associations between variables and bacteriuria were conducted using the Chi squared test and the fisher exact probability. Associations with p-values < 0.05 were considered statistically significant. RESULTS: Overall, 354 pregnant women were enrolled with mean of age 28.18 ± 4.4. The prevalence of significant bacteriuria was 9.9% (35 out of 354). The prevalence of bacteriuria in women who were asymptomatic was 5.7%. Cystitis and pyelo-nephritis were observed in 3.6 and 0.6% respectively. The most commonly isolated organism was Escherichia coli (E. coli): 48.6%. History of Urinary Tract Infection (UTI) (p = 0.035, OR = 2.183, CI = 1.055-4.518) was significantly associated with bacteriuria. High level of education was protective. CONCLUSIONS: Bacteriuria was frequent in pregnant women and significantly increased with the past history of UTI and low level of education. Asymptomatic bacteriuria was more common. E coli was the most frequent uropathogen. Education and proper treatment of UTI should be provided to reduce the burden of this pathology in order to prevent its severe complications.

Facteurs associés au portage de l'Aghbs en grossesse dans un pays de haute endémicité : une étude cas-témoin

Objectif. L'objectif était d'évaluer les facteurs associés au portage de l'aghbs en grossesse afin d'identifier des cibles de prévention. Matériels et méthodes. Il s'agit d'une étude cas témoin réalisée dans trois hôpitaux universitaires de Douala et Yaoundé. Les cas étaient constitués de femmes enceintes avec une sérologie AgHBs positive. Nous avons recruté 121 femmes enceintes Ag HBs positifs et les avons appariées à 242 mères Ag HBs négatifs après régression logistique. Résultats. Les facteurs associés au portage de l'AgHBs en grossesses étaient l'union libre [OR : 5,01 IC 95% (2,51-10,02) p=0,001 ]; la religion pentecôtiste [OR 4,3 IC 95% (1,41-13,47) p=0,01]; les antécédents d'ictère [OR : 5,3 IC 95% (1,20-23,37) p=0,02 ]; de soins dentaires [OR : 2,4 IC 95% (2,26-4,96) p=0,01 ]; et de scarifications [OR 7,4 IC 95% (3,77-14,58) p=0,00], l'hépatite B dans l'entourage [OR : 4,86 IC 95% (1,20-19,65) p=0,02] et l'antécédent familial d'infection à l'hépatite B au premier degré [OR : 7,08 IC 95% (1,44-34,78) p=0,01]. Conclusion. Plusieurs facteurs associés à l'hépatite B en grossesse précédemment identifiés dans la littérature récente ont été retrouvés. Le rôle des congrégations pentecôtistes, donnée spécifique de notre travail reste à confirmer

Risk factors for ectopic pregnancy in a population of Cameroonian women: A case-control study.

OBJECTIVE: To identify the risk factors for ectopic pregnancy (EP) in a population of Cameroonian women. SAMPLE AND METHODS: We performed a matched case-control study; 88 women with diagnosed EP (cases), and 176 women with first trimester intrauterine pregnancy (IUP) (controls), who underwent questionnaires. Odds Ratio (OR) and 95% confidence intervals (CIs) were calculated and adjusted for potential confounding factors via multivariate logistic regression analysis. RESULTS: Of the fifteen identified risk factors, 4 were independently associated with increased odds of EP: prior pelvic inflammatory disease (PID) (adjusted odds ratio [AOR] 13.18; 95% CI 6.19-27.42), followed by current use of levonorgestrel-only pills for emergency contraception (LNG-EC) (AOR 10.15; 95% CI 2.21-46.56), previous use of depot medroxyprogesterone acetate (DMPA) (AOR 3.01; 95% CI 1.04-8.69) and smoking at the time of conception (AOR 2.68; 95% CI 1.12-6.40). CONCLUSION: The present study confirms the wide variety of EP's risk factors. Moreover, some new findings including current use of LNG-EC, previous use of DMPA, smoking at the time of conception are noteworthy. Thus, in our limited resources country where prevention remains the cornerstone for reducing EP chances of occurrence, clinicians should do enough counselling, especially to women with known risk factors. The necessity to facilitate access to more equipment to enable early diagnosis of EP is very crucial and should be seriously considered, in order to reduce the burden of EP in Cameroonian women.

Comparison of materno-fetal predictors and short-term outcomes between early and late onset pre-eclampsia in the low-income setting of Douala, Cameroon.

OBJECTIVE: To describe and compare materno-fetal predictors and short-term outcomes of early onset pre-eclampsia (EOPE) and late onset pre-eclampsia (LOPE) in Douala, Cameroon. METHODS: The present prospective hospital-based cross-sectional study included women with pre-eclampsia attending obstetric units at four hospitals in Douala between December 1, 2016, and April 30, 2017. To determine maternal predictors, sociodemographic and medical data were recorded using a pretested questionnaire. Pregnancy outcomes, and maternal and fetal adverse events were recorded. Univariate and multivariate logistic regression analyses were used to examine associations. RESULTS: Of 170 participants, 58 (34.1%) had EOPE and 112 (65.9%) had LOPE. EOPE was associated with higher incidences of chronic hypertension (P=0.027) and history of pre-eclampsia (P=0.003) compared with LOPE. Higher incidences of nulliparity and a different partner from prior pregnancy (P=0.024) were associated with LOPE. Women with EOPE had higher odds of acute kidney injury (odds ratio [OR] 6.67, 95% confidence interval [CI] 1.73-25.73) and HELLP (hemolysis, elevated liver enzyme, low platelets) syndrome (OR 10.47, 95% CI 1.19-91.9), and lower odds of deliveries without perinatal adverse events (OR 0.19, 95% CI 0.09-0.38), compared with patients with LOPE. CONCLUSION: In the low-income setting of Douala, there was a higher rate of LOPE than EOPE. Factors associated with EOPE and LOPE varied, and outcomes were worse for women with EOPE.

Maternal and neonatal outcomes of vaginal breech delivery for singleton term pregnancies in a carefully selected Cameroonian population: a cohort study.

BACKGROUND AND OBJECTIVES: Vaginal breech delivery (VBD) is known to be associated with more perinatal and maternal complications. Very few studies on the subject have been carried out in poor-resource settings. The aim of this study was to determine maternal and neonatal outcomes in carefully selected cases of VBD for singleton term pregnancies in a tertiary centre in Cameroon. DESIGN: A retrospective cohort study. SETTING: A tertiary hospital in Yaounde, Cameroon. PARTICIPANTS: Cases of VBD of newborns weighing 2500-3500 g were matched in a ratio of 1:4 to consecutive vaginal cephalic deliveries (VCDs) of newborns weighing 2500-3500 g over a 5-year period. Both groups were matched for maternal age and parity. We excluded cases of multiple gestations, footling breech, clinically inadequate maternal pelvis, preterm delivery, post-term pregnancies, fetal demise prior to the onset of labour, placenta praevia and fetal anomaly incompatible with vaginal delivery. OUTCOME MEASURES: Neonatal and maternal adverse outcomes of VBD observed till 6 weeks after delivery analysed using Bonferroni correction. RESULTS: Fifty-three (53) VBDs were matched against 212 VCD. Unlike women who had VCD, those who underwent VBD were more likely to have prolonged labour (OR 8.05; 95% CI 3.00 to 11.47; P<0.001), and their newborns were more likely to suffer from birth asphyxia (OR 10.24; 95% CI 4.92 to 21.31; P<0.001). CONCLUSION: The study infers a strong association between VBD of singleton term pregnancies and maternofetal morbidity when specific protocols are applied. This, however, failed to translate into higher differences in perinatal mortality. This finding does not discount the role of VBD in low-income countries, but we emphasise the need for specific precautions like close monitoring of labour and adequate anticipation for neonatal resuscitation in order to reduce these complications.

Uterus preserving surgery versus hysterectomy in the treatment of refractory postpartum haemorrhage in two tertiary maternity units in Cameroon: a cohort analysis of perioperative outcomes.

BACKGROUND: Little evidence exists on the efficacy and safety of the different surgical techniques used in the treatment of postpartum haemorrhage (PPH). We aimed to compare uterus preserving surgery (UPS) versus hysterectomy for refractory PPH in terms of perioperative outcomes in a sub-Saharan African country with a known high maternal mortality ratio due to PPH. METHODS: This was a retrospective cohort study comparing the perioperative outcomes of all women managed by UPS (defined as surgical interventions geared at achieving haemostasis while conserving the uterus) versus hysterectomy (defined as surgical resection of the uterus to achieve haemostasis) for PPH refractory to standard medical management in two tertiary hospitals in Cameroon from January 2004 to December 2014. We excluded patients who underwent hysterectomy after failure of UPS. Comparison was done using the Chi-square test or Fisher exact test where appropriate. Bonferroni adjustment of the p-value was performed in order to reduce the chance of obtaining false-positive results. RESULTS: We included 24 cases of UPS against 36 cases of hysterectomy. The indications of surgery were dominated by uterine rupture and uterine atony in both groups. Types of UPS performed were seven bilateral hypogastric artery ligations, seven hysterorraphies, six bilateral uterine artery ligations, three B-Lynch sutures and one Tsirulnikov triple ligation with an overall uterine salvage rate of 83.3%. Types of hysterectomies were 26 subtotal hysterectomies and 10 total hysterectomies. UPS was associated with maternal deaths (RR: 2.3; 95% CI: 1.38-3.93.; p: 0.0015) and postoperative infections (RR: 1.96; 95% CI: 1.1-3.49; p: 0.0215). The association of UPS with maternal death was not attenuated after Bonferroni correction. Hysterectomy had no statistically significant adverse outcome. CONCLUSION: Hysterectomy is safer than UPS in the management of intractable PPH in our setting. The choice of UPS as first-line surgical management of PPH in resource-limited settings should entail diligent anticipation of these adverse maternal outcomes in order to lessen the perioperative burden of PPH.

Evaluation of patients' satisfaction after laparoscopic surgery in a tertiary hospital in Cameroon (Africa).

INTRODUCTION: Access to laparoscopy is low in Cameroon where customers' satisfaction has not been reported so far. We assessed patients' satisfaction with the process of care during laparoscopic surgery in a new tertiary hospital. METHODS: A questionnaire was addressed to consenting patients (guardians for patients under 18) with complete medical records who underwent laparoscopy at the Douala Gynaeco-Obstetric and Paediatric Hospital (Cameroon) from November 1, 2015 to July 31, 2016. The following modified Likert's scale was used to assess satisfaction: very weak: 0-2.5; weak 2.6-5; good: 5.1-7.5; very good: 7.6-10. Only descriptive statistics were used. RESULTS: Response rate was 90% (45/50). Of the 45 respondents, 39 (86.7%) were female, 14(31.1%) were referred and 39 (86.7%) paid by direct cash deposit. Mean age was 36.8±11.9 years. Laparoscopies were carried out in emergency for 3 (6.7%) patients. Digestive abnormalities indicated 13 (28.9%) laparoscopies while gynaecologic diseases accounted for 32 (71.1%) cases. Perception of the overall care process was good with a mean satisfaction score of 6.8 ± 1.4. Scores in categories were: 0% (Very weak); 13.3% (weak); 57.8% (good) and 28.9% (very good). Specifically mean satisfaction scores were: 7.8 ± 1.0 with doctors' care; 7.1 ± 1.3 with hospital administration; 7.0 ± 1.2 with nursing and 4.7 ± 1.4 with the costs. Main complaints were: long waiting time (73.3%), constraining geographical access (66.7%) and expensiveness (48.9%). CONCLUSION: Patients were globally satisfied with the process of care but financial and geographical barriers should be addressed.

[Prognosis of referred patients with an obstetric emergency at the Yaoundé Gynaecology, Obstetrics and Pediatrics Hospital]. / Pronostic des références obstétricales à l'Hôpital Gynéco-Obstétrique et Pédiatrique de Yaoundé (HGOPY).

INTRODUCTION: The impact of referred patients with an obstetric emergency due to complications is not yet known. This study aimed to identify the complications associated with obstetric emergency in referred patients in Yaoundé. METHODS: We conducted a cross-sectional descriptive and analytical study at the Yaoundé Gynaecology, Obstetrics and Pediatrics Hospital from 1 February to 31 July 2015. We compared the women referred to the Emergency Department with the non-referred women and their newborns respectively. Consecutive and comprehensive sampling technique was used for early analysis of the sociodemographic, obstetric and neonatal features. Chi-squared tests and Fisher exact probability test helped to compare the qualitative variables. Logistic regression analysis helped to eliminate the confounding factors. The significant level was set at p < 0.05. RESULTS: After multivariate analysis, statistically significant obstetric complications in referred patients were: premature rupture of membranes (adjusted OR = 9.37, CI 95%: 2,52-66,98, p = 0.002); preterm birth (adjusted OR = 4.14 (1,88-9,16; p < 0.001) and death after severe neonatal asphyxia (adjusted OR = 6.48 (1,17-35,80); p = 0.032). CONCLUSION: Premature rupture of the membranes, preterm birth and death after severe neonatal asphyxia are the complications associated with obstetric emergency in referred patients in Yaoundé.

Pronostic des références obstétricales à l'Hôpital Gynéco-Obstétrique et Pédiatrique de Yaoundé (HGOPY)

Introduction: l'impact des références sur la survenue des complications obstétricales n'est pas encore connu. Notre but était d'identifier les complications associées aux références obstétricales à Yaoundé.Méthodes: il s'agissait d'une étude transversale descriptive et analytique du 1er Février au 31 Juillet 2015 à l'Hôpital Gynéco-Obstétrique et Pédiatrique de Yaoundé, ayant comparé les femmes référées aux non référées et leurs nouveau-nés respectifs. L'échantillonnage était consécutif et exhaustif pour l'analyse des caractéristiques sociodémographiques, obstétricales et néonatales précoces. Les tests de Chi carré et exact de Fisher ont aidé à comparer les variables qualitatives. L'analyse par régression logistique a permis d'éliminer les facteurs confondants. P était significatif si p < 0,05.Résultats: après analyse multi variée, les complications obstétricales statistiquement significatives chez les patientes référées étaient: la rupture prématurée des membranes (OR ajusté = 9,37, IC95%: 2,52-66,98, p = 0,002); la prématurité (OR ajusté = 4,14 (1,88-9,16; P < 0,001) et le décès après asphyxie néonatale sévère (OR ajusté = 6,48 (1,17-35,80); P = 0,032).Conclusion: la rupture prématurée des membranes, la prématurité et le décès après asphyxie néonatale sévère sont les complications associées aux références obstétricales à Yaoundé

[Factors associated with the failure of Intermittent Preventive Treatment for malaria among pregnant women in Yaounde]. / Facteurs prédictifs de l'échec du Traitement Préventif Intermittent du paludisme à la sulfadoxine - pyriméthamine (TPIp-SP) dans une population de femmes enceintes à Yaoundé.

INTRODUCTION: Intermittent preventive treatment with sulfadoxine-pyrimethamine (IPTp-SP) is recommended for malaria prevention during pregnancy. We investigated factors associated with the failure of this strategy. METHODS: We conducted a case-control study in two health care facilities in Yaounde, from 1 May 2014 to 30 April 2015. Pregnant women treated with IPTp-SP, hospitalized for malaria and having a positive Rapid Diagnostic Test (RDT) result (case-subjects) were compared to pregnant women treated with IPTp-SP having a negative RDT result (control-subjects). Epi Info 7 software and SPSS 18.0 software were used with P< 0.05 as significance threshold. RESULTS: We recruited 234 subjects, 109 (46.6%) case-subjects and 125 control-subjects (53.4%). The associated factors found were: prematurity (P=0.03; OR=1.15; IC= 0.32 - 4.10), the non-use of LLIN (P=0.006; OR= 2.31; IC= 1.26 - 4.25), a history of hospitalization for malaria (P=0.007; OR= 2.19; IC= 1.23 - 3.89), IPTp-SP administration after 28 gestational weeks (P=0.001, OR= 3.55; IC= 1.7 - 7.61). After logistic regression, prematurity (P=0.024; OR=2.01; IC=1.1-3.7) and a history of hospitalization for malaria (P=0.001; OR=2.83; IC=1.50-5.4) remained associated with IPTp-SP failure. CONCLUSION: A history of hospitalization for malaria and prematurity are independent predictor of IPTp-SP failure.

Fertility after ectopic pregnancy in a district hospital in Cameroon.

OBJECTIVE: To assess spontaneous conception after an ectopic pregnancy (EP) in a rural area of a low-resource country. METHODS: The present prospective cohort study enrolled patients aged 15-45 years who were treated for EP at Sangmelima District Hospital, Cameroon, between January 2006 and December 2008. All patients who wished to become pregnant in the future were included and followed up from treatment for EP either until termination of a subsequent pregnancy or for 3 years if they did not become pregnant, whichever came first. Patients who were followed up for less than 18 months without a pregnancy were excluded from analysis. RESULTS: The final analysis included 56 women, of whom 23 (41%) became pregnant (21 [38%] had intrauterine pregnancies, 2 [4%] EPs). The mean interval between treatment for EP and first conception was 11.82±7.46 months. In multivariate analysis, absence of contralateral adnexal pathology was significantly associated with higher fertility (hazard ratio 9.00, 95% confidence interval 1.48-54.67; P=0.017). CONCLUSION: Fertility after EP in a rural area of Cameroon was found to be low, but recurrence of EP was rare.

Etiologies de la mortalite maternelle a l'hopital gyneco-obstetrique et pediatrique de Yaounde: une serie de 58 deces

Objectifs: L'objectif de ce travail etait d'analyser les etiologies des deces maternels survenant dans un hopital de niveau tertiaire. Methodologie: Il s'agit d'une etude transversale avec collecte des donnees retrolective des deces maternels ayant eu lieu a l'Hopital Gyneco-Obstetrique et Pediatrique de Yaounde du 1er Janvier 2007 au 31 Decembre 2010. Tous les cas de deces maternels conformes a la definition de l'Organisation Mondiale de la Sante ont ete inclus. Les donnees ont ete analysees par les logiciels informatiques Epi info 3.5.1 et Excel 2007. Resultats: Cinquante-huit (58) deces maternels ont ete identifies pendant la periode de l'etude. Les principales causes de mortalite maternelle etaient : l'hypertension (22;4%); le VIH/SIDA (19;0%); les avortements septiques (17;2%); les hemorragies (13;8%); les cancers (10;3%) et la septicemie du post-partum (8;6%). Conclusion: L'hypertension; le VIH; et les avortements septiques sont les principales causes de mortalite dans cet hopital de niveau tertiaire. Les hemorragies ne sont responsables que d'une faible proportion des deces maternels. Nous recommandons la mise en place d'interventions visant a prevenir les deces maternels dus a l'hypertension en grossesse; a l'infection au VIH et aux avortements septiques. D'autre part; une politique hospitaliere basee sur la mise a disposition; sans frais exigibles en urgence; des paquets minimum pour les interventions obstetricales; de poches de sang et des equipes chirurgicales et anesthesiques; pourrait reduire efficacement la part des hemorragies dans la survenue des deces maternels en Afrique subsaharienne

Gynaecological laparoscopic surgery: eight years experience in the Yaoundé Gynaeco-Obstetric and Paediatric Hospital, Cameroon.

This is a retrospective analysis of eight years of gynaecological laparoscopic surgery in a resource-limited setting. All gynaecological patients managed by laparoscopy at the Yaoundé Gynaeco-Obstetric and Paediatric Hospital from 1 January 2004 to 30 November 2011 were included. Amongst the 9194 gynaecological surgeries performed during the study period, 6.9% (633) were done by laparoscopy. Most of the women underwent an operative laparoscopy (568/592; 95.9%). The most common indication was infertility (415/592; 70.1%). Diagnostic laparoscopies were mostly indicated for chronic pelvic pain (18/24; 75%). The most common surgical finding was tubo-peritoneal adhesions (412/592; 69.6%). A total of 35 patients (35/592; 5.9%) had at least one complication. The mean duration of hospitalization was 3.4 ±1.8 days. The general uptake of gynaecological laparoscopic surgery is low in our setting. The laparoscopic complication rate of 5.9% is encouraging.

Sexual activity during pregnancy and prognosis of labor in Cameroonian women: a cohort study.

OBJECTIVE: Our aim was to assess the effects of sexual activity during pregnancy on the prognosis of labor. METHODS: It was a prospective cohort study of labor comparing 72 women declaring unprotected vaginal sexual intercourse after 37 weeks of pregnancy consecutively recruited to 72 women claiming no sexual contact after 37 weeks of pregnancy also consecutively recruited. RESULTS: The sexually active group at term were significantly involved in more frequent heterosexual intercourse after 28 weeks pregnancy and before term (RR = 37.8; CI = 19.8-515.4). Women sexually active were significantly admitted during the active phase of labor (RR = 2.4; IC = 1.6-5.3), with the fetal head at station 0 and more (RR = 1.5; CI = 1.3-5.2). They significantly had a shorter active phase (RR = 1.7; CI = 1.5-3.7) and a shorter second stage (RR = 1.5; CI = 1.2-3.3). They significantly had a normal pattern of labor (RR = 2.1; CI = 1.2-5.3), a higher rate of spontaneous deliveries (RR = 2.1; CI = 1.5-4.5), a lower rate of caesarean sections (RR = 0.46; CI = 0.1-0.8) and needed less oxytocin usage before expulsion (RR = 0.5; CI = 0.2-0.7). CONCLUSION: Sexual activity during pregnancy improves the prognosis of labor in Cameroonian women. In the absence of contraindications, consented unprotected heterosexual intercourse should be promoted in pregnant women.

The diagnosis of uterine cervical polyps in a low resource setting: the positive predictive value of clinical judgment--a series of 192 cases at the Yaounde Gynaeco-Obstetric and Paediatric Hospital, Cameroon.

As far as we know, the accuracy of clinical judgment in diagnosing uterine cervical polyps has not been assessed in sub-Saharan Africa. Our objective was to discover the positive predictive value (PPV) of clinical judgment in the diagnosis of cervical polyps. This is a retrospective descriptive study of 192 patients, carried out by the Departments of Pathology and Gynaecology of the Yaoundé Gynaeco-Obstetric and Paediatric Hospital, Cameroon. The diagnosis of cervical polyp was confirmed by histopathology examination in 169 patients, giving a PPV rate of 88.0%. The PPV of clinical judgment in the diagnosis of cervical polyps is acceptable in our setting but the frequency of premalignant and malignant lesions encountered is too high (10.4%), even in the presence of a confirmed cervical polyp (8.9%). Even in areas where there are limited resources, we recommend a systematic histopathology examination of any clinically suspected cervical polyp.