Determinants of the decision to incision interval in case of emergency caesarean section in Yaoundé' hospitals.

Objective: To analyze the determinants of the decision to incision interval in case of emergency caesarean section in Yaoundé' hospitals. Methods: A prospective cross-sectional (affected / non-affected) study was conducted in four hospitals in Yaoundé between January and may 2017 after National Ethical Committee approval. The target population was women who benefited from emergency caesarean section during the study period. Crude Odds Ratio (OR) and adjusted odds ratio (AOR) with 95% Confidence Interval was used to appreciate the association between several characteristics and the risk for long decision-incision delay. Results: The overall cases of 165 emergency caesarean section were analyzed. The prevalence of emergency caesarean section performed within 30 minutes was 20%. Social factors associated with long delay to perform the emergency Caesarean section (> 30 minutes) were the primary level of education [ AOR: 3.63(2.44-5.41)], unemployment status [AOR: 5.17(2.95-8.95)]; and the absence of a parent at admission [AOR: 2.2(1.23-3.94)]. Medical factors associated with long delay from decision to incision were: use of spinal anesthesia in opposition to general anesthesia [AOR: 3.86(2.59-5.73)]; delay of transfer from emergency and the late provision of the operation supplies [AOR: 4.18(2.90-6.03)]. Conclusion: Few women benefit from the surgical intervention within a maximum of 30 minutes. Support measures for women presenting the indications for emergency caesarean sections in hospitals are essential to improve the decision-incision delay of the caesarean section emergency.

[Prevalence and factors associated with smoking among adults living in the Moungali district of Brazzaville in 2021]. / Prévalence et facteurs associés au tabagisme chez les adultes dans l'arrondissement de Moungali à Brazzaville en 2021.

Introduction: tobacco epidemic is a real public health problem in the world and in Africa. The purpose of this study was to estimate the prevalence and identify factors associated with smoking among adults living in the Moungali district. Methods: we conducted a cross-sectional analytical study of 800 adults. Two-stage random sampling was used to select subjects in the Moungali district, Brazzaville, in September 2021. Binary logistic regression using the ascending stepwise method allowed identification of the associated factors. The adjustment of the model was verified by the Hosmer Lomeshow test. Data were collected via the Kobo collect V1.30.1 app. and analyzed with the Stata 15.0 software. Results: smoking prevalence was 4.63%, 95% CI [3.37-6.31]. Males (AOR=8.36 95% CI [3.74-18.72], p-value < 0.0001), alcohol consumption (AOR=2.6 95% CI [1.11-6.11], p-value = 0.028), and professional activity (formal or informal sector) (AOR=3.91 95% CI [1.16-13.11], p-value = 0.027) were factors significantly associated with smoking. Conclusion: this study highlights that smoking is a stronger risk factor in men than in women. In addition, alcohol consumption and professional activity in the formal or informal sector are also factors associated with active smoking. Preventive actions focusing on these factors are necessary to effectively fight smoking in adults.

The Pattern of Cervical Cancer according to HIV Status in Yaoundé, Cameroon.

OBJECTIVE: To analyze the epidemiological aspects of invasive cervical cancer according to HIV status. METHODS: This was an historical cohort study from January 2010 to April 2017 in three hospitals at the Yaoundé city Capital, Cameroon, after the National Ethics Committee' approval. We included invasive cervical cancers with documented HIV status. Odds ratios and 95% confidence interval were calculated to assess the association between the different variables and HIV status. Survival was analyzed using the Kaplan-Meier. The level of significance was set up at <5%. RESULTS: Among the overall 213 cervical cancer patients, 56 were HIV+ (24.67%). Factors associated with positive HIV status were age below 40 (OR: 2.03 (1.38-2.67)), celibacy (OR: 2.88 (1.58-4.17)), nonmenopausal status (OR: 2.56 (1.36-3.75)), low parity, primiparity (OR: 2.59 (1.43-3.74)), and for parity with 2-4 children (OR: 2.24 (1.35-3.12)). Concerning the HIV+ patients, tumor was diagnosed late (stages III-IV) (OR: 2.70 (1.43-5.08)), undifferentiated (grade III) (OR: 7.69 (5.80-9.57)), with low median survival (9.83 months vs. 20.10 months). CONCLUSION: HIV is frequent among cervical cancer patients. In the HIV+ patients, the diagnosis was made at the advanced stage, cells were poorly differentiated, and the prognosis was worse.

Facteurs associés aux barrières d'accès au dépistage du cancer du col de l'utérus à Yaoundé.

INTRODUCTION: Several studies report that only 10% of Cameroonian women at risk have ever been screened for this disease. OBJECTIVE: This study aims to analyze the factors explaining the difficulties in accessing screening for cervical cancer in Yaoundé, Cameroon. METHODOLOGY: This was an analytical cross-sectional study (participed/not participated), conducted from May 1 to August 10, 2020. The study population was made up of two groups (i.e. women without a history of screening; women who benefited from at least one screening session). Data collection was carried out at the gynecology-obstetrics department in two hospitals in Yaoundé (University hospital center and the obstetrics-gynecology and pediatric hospital). Variables were collected using a pre-tested and validated questionnaire. Data were analyzed using SPSS version 20 software. Simple and multiple logistic regression analysis was performed to assess the influence of different variables on the risk of not participating in screening. A difference was considered significant if P < 5%. RESULTS: Out of 300 women interviewed, 150 had never participated in screening (50%). In multivariate analysis, the factors associated with difficulties in accessing cervical cancer screening were, level of primary education (58,33% vs. 41,67%, [AOR: 5.12 (3.42-7.65)]), lack of employment (69,74% vs. 30,26%, [AOR: 5.44 (3.32-8.92)]), insufficient knowledge (78,64% vs. 21,36%; [AOR: 7.11(5.70-8.88)]) and unfavourable attitude (85,71% vs. 14,29%, [AOR: 5.58 (4.41-7.06)]). CONCLUSION: There are many factors associated with not being screened. It is therefore necessary to develop strategies to improve access to cervical cancer screening services in Cameroon.

Knowledge, attitudes and practices among Brazzaville midwives on cervical cancer screening.

INTRODUCTION: cervical cancer is an illness that causes 250,000 deaths worldwide. Data on Health professional's skills is highly important for the elaboration of prevention strategies. Objective: assess the knowledge, attitudes and practices (KAP) among Brazzaville midwives on cervical cancer screening. METHODS: analytical KAP Study, from May 2nd to August 10th 2018. Participants are midwives working in the Gynaecology-Obstetrics departments of six hospitals in Brazzaville (Republic of Congo). Variables were related to their socio-demographic and occupational characteristics, as well as to their knowledge, attitudes and practices. Analyses were done using the Epi Info 7.2.2.6 software. Frequencies, central trend parameters, as well as rib ratios were calculated. Pearson, Fisher and Wald statistical tests with a significance level of 5% where used. RESULTS: the study included 114 midwives aged 43.07 (± 7.40) years. They had an unsatisfactory level of knowledge (59.64%), favourable attitudes (92.98%) and poor practices (71.05%). The factors linked with best (satisfactory) knowledge were, seniority at workplace (10-27 years) [29.31%] vs. 51, 79%; OR; 2.59 (1.19-5.60)] and age (42-60 years) [31.81% vs. 52.08%; OR 2.32 (1.08-5.01)]. The best knowledge were related to the best practices (good) [16.18% vs. 47.83%; OR a = 2.95 (1.87-4.67)]; Midwives attitudes seem to not impact on their practices (p = 0.53). CONCLUSION: Brazzaville midwives have little knowledge and practices on cervical cancer screening. Therefore, the need of training them and equipping cervical cancer screening.

Dysfonctionnements du processus d'évacuation sanitaire hors de la République du Congo de 2014 à 2017.

BACKGROUND: Medical evacuation is the transfer of a patient from a health institution to another for more appropriate care. The medical evacuation process is framed by legal texts. Dysfunctions are still possible. OBJECTIVE: The aim of this article is to study the medical evacuation process in order to identify possible dysfunctions. METHODS: A cross-sectional qualitative study was conducted from December 2017 to August 2018. We recruited 11 people according to saturation principles. They were all involved in the medical evacuation process. Data were collected according to an interview guide and recorded using a Dictaphone. Data analysis consisted of gathering the information extracted from the verbatim. RESULTS: Dysfunctions were noted in the doctor’s decisions for a possible evacuation, the constitution of the medical evacuation file and the signature of the clinical observation by the doctors. Irregularity in the Medical Evacuation Board meetings was also noted, leading to inappropriate decision-making. We found the absence of inter-sectorial collaboration in evacuation, leading to poor follow-up of transferred patients. We also found the payment for hospitalization and medical care in private accounts instead of selected hospitals’ accounts as stated in the evacuation guide. CONCLUSION: The medical evacuation process in the Republic of Congo suffers from many irregularities including the doctor’s decision, administrative and financial decisions, as well as the follow-up of patient in the host country and in the hospital abroad.