HPV vaccination in Africa in the COVID-19 era: a cross-sectional survey of healthcare providers' knowledge, training, and recommendation practices.

Introduction: Although the burden of cervical cancer in Africa is highest, HPV vaccination coverage remains alarmingly low in this region. Providers' knowledge and recommendation are key drivers of HPV vaccination uptake. Yet, evidence about providers' knowledge and recommendation practices about the HPV vaccine against a backdrop of emerging vaccine hesitancy fueled by the COVID-19 pandemic is lacking in Africa. Methods: A cross-sectional study was conducted in 2021-2022 among healthcare providers involved in cervical cancer prevention activities in Africa. They were invited to report prior training, the availability of the HPV vaccine in their practice, whether they recommended the HPV vaccine, and, if not, the reasons for not recommending it. Their knowledge about the HPV vaccine was assessed through self-reporting (perceived knowledge) and with three pre-tested knowledge questions (measured knowledge). Results: Of the 153 providers from 23 African countries who responded to the survey (mean age: 38.5 years, SD: 10.1), 75 (54.0%) were female and 97 (63.4%) were based In countries with national HPV immunization programs. Overall, 57 (43.8%) reported having received prior training on HPV vaccine education/counseling, and 40 (37.4%) indicated that the HPV vaccine was available at the facility where they work. Most respondents (109, 83.2%) reported recommending the HPV vaccine in their practice. Vaccine unavailability (57.1%), lack of effective communication tools and informational material (28.6%), and need for adequate training (28.6%) were the most commonly reported reasons for not recommending the HPV vaccine. While 63 providers (52.9%) reported that their knowledge about HPV vaccination was adequate for their practice, only 9.9% responded correctly to the 3 knowledge questions. Conclusion: To increase HPV vaccination coverage and counter misinformation about this vaccine in Africa, adequate training of providers and culturally appropriate educational materials are needed to improve their knowledge of the HPV vaccine and to facilitate effective communication with their patients and the community.

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.

Explicative factors of occupational stress among caregivers in hospitals in Brazzaville: a cross-sectional analytical study.

Introduction: staff health represent a population particularly exposed to numerous psycho-social risks. The organization, pace and workload, as well as difficulties in terms of working equipment or personnel have been shown to be a source and consequences of work stress. The objective is to study the factors of stress experienced by health professionals working in district hospitals and to propose preventive actions to decision-makers. Methods: a cross-sectional analytical study carried out among caregivers in the hospitalization services of Brazzaville. The relationship between stress and certain characteristics of the participants was established using single and multiple logistic regressions taking into account potential confounding factors. For this purpose, Wald Chi-square tests were used as well as the odds ratio with their 95% confidence interval. Results: midwives have a higher probability of experiencing stress OR = 2.12 [1.13- 4.20] caregivers with less than 10 years of practice are less likely to experience work-related stress OR = 0.53 [0.28 - 0.96] than those with more than 10 years of practice, p = 0.040. After adjusting for possible confounding factors, caregivers who felt useful at work experienced about 5 times more stress odds ratio adjusted (ORa) = 4.69 [1.82 - 12.78] p = 0.002 than those who did not feel useful. Conclusion: the factors that influence stress among health workers are of a socio-professional nature, and related to the perception of working conditions. Some of them significantly increase the risk of experiencing work-related stress. Further studies are needed to better understand the consequences of occupational stress on the performance of caregivers.

Factors associated with birth preparedness and complication readiness among pregnant women attending government health facilities in the Bamenda Health District, Cameroon.

INTRODUCTION: birth preparedness and complication readiness (BPCR) intervention should greatly have an impact on the reduction of maternal mortality if implemented properly at all levels. Responsibility for BPCR must be shared among all safe motherhood stakeholders-because a coordinated effort is needed to reduce the delays that contribute to maternal and newborn deaths. This study aimed to assess the factors associated with birth preparedness and complication readiness among pregnant women attending government health facilities in the Bamenda Health District. METHODS: this was a cross-sectional analytic study. The study period was 30th October - 30th November, 2016. A total of 345 pregnant women of ≥ 32 weeks gestational age seen at the antenatal consultation (ANC) units were recruited. The dependent variable was birth preparedness and complication readiness while the independent variables were the socio-demographic and reproductive health characteristics. Frequency distributions were used to determine the awareness and practice and logistic regression at 95% confidence interval (CI) and p<0.05 to identify the factors that favour birth preparedness and complication readiness. RESULTS: the most likely factors that favour birth preparedness and complication readiness were monthly income (Odds Ratio (OR) = 2.94, (1.39, 6.25), p = 0.005) and the number of antenatal care visits (OR = 2.16, (1.18, 3.90), p = 0.013). CONCLUSION: majority of the women in this study were not prepared for birth/complications. The factors most associated with birth preparedness and complication readiness were monthly income and number of antenatal care visits.

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.

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.

Poor knowledge of COVID-19 and unfavourable perception of the response to the pandemic by healthcare workers at the Bafoussam Regional Hospital (West Region-Cameroon).

INTRODUCTION: WHO warned against a dramatic impact of COVID-19 in Africa unless adequate response strategies are implemented. Whatever the strategy, the role of health staff is pivotal. Objective: Assess knowledge and perception of the response to COVID-19 among health staff. METHODS: we used a convenience non probabilistic sample to conduct a survey with a self-administered questionnaire from April 14 - 29, 2020 at the Bafoussam Regional Hospital (BRH). All the staff was invited to participate. Analyses were done with Microsoft Excel 2010 and Epi-Info version 7.1.5.2. RESULTS: response rate was 76.1% (464/610). Mean age (SD) was 35.0 (8.9) years. Sex ratio (M/F) was 101/356. Nursing/midwifery staff (56.8%) and in-patients units (49.94%) were predominant. Origin and transmission of SARS-CoV-2 were poorly known while knowledge of clinical signs and the role of laboratory tests were good. For 53.2% of respondents all therapeutic regimens are supportive and only 31.6% trusted state-recommended drugs. For 169 of respondents (36.9%), herbal remedies prevent/cure COVID-19. Seventy percent (70%) felt they were not knowledgeable enough to handle COVID-19 cases. Eighty-five point six percent (85.6%) thought the BRH had insufficient resources to fight COVID-19 and 55.6% were dissatisfied with its response (weaknesses: medicines/technologies (74.5%), service delivery (28.1%), staff (10.9%)). Sixty-eight percent (68%) reported insufficient protection on duty. Seventy-six point five percent (76.5%) reported a drop in non-COVID-19 services. Eighty-five point five (85.5%) percent said they complied with community preventive measures. For 44% of respondents, regulations on COVID-19 corpses should be made more culture-sensitive. Fifty one point two percent (51.2%) of respondents were against vaccine trial in their community. CONCLUSION: knowledge was poor and perception of the response to COVID-19 was unfavourable.

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.

Determinants to late antenatal clinic start among pregnant women: the case of Saint Elizabeth General Hospital, Shisong, Cameroon.

INTRODUCTION: To improve maternal health, barriers that limit access to quality maternal health services must be identified and addressed at all levels of the health system. The World Health Organisation (WHO) cites distance to health facility and inadequate health institutions as factors that prevent women from receiving or seeking care during pregnancy and childbirth. Specifically, we intended to determine factors associated with late start of late Antenatal Care (ANC) among pregnant women in the Saint Elizabeth General Hospital Shisong (SEGHS), Cameroon. METHODS: This was a cross sectional study carried out from the 24th October to 24th November 2016. A total of 602 pregnant women were recruited from ANC units of SEGHS and its satellite institutions. The outcome variable was gestational age at start of ANC (estimated by counting from last menstrual period to day of first ANC consultation) while the independent variables were individual, community and institutional factors. Data was analyzed using Epi info version 7. Chi square test was used to appreciate the influence of different variables on risk of late ANC initiation (> 14 weeks of pregnancy). The level of significance was set out at (p: < 0.05). RESULTS: Out of the 602 pregnant women included in our study, 75% initiated ANC late (after 14 weeks of pregnancy). Factors associated with late ANC start were; age (p = 0.001), level of education (p = 0.002), marital status (p = 0.016), religion (p = 0.034), parity (p = 0.001), having a source of income (p=0.001), cost of services (p = 0.010), distance to health facility (p = 0.021) and dissatisfaction with previous ANC services (p = 0.014). CONCLUSION: Cameroon is one of the countries with a high maternal mortality ratio. WHO estimated it to be 529 per 100000 live births in 2017. Prompt and adequate ANC services can improve on maternal and child outcomes of pregnancy. The results of this study suggest tackling issues related to cost of ANC services and improving geographical (distance) barrier to accessing ANC services (in addition to addressing other identified measures) may lead to an increase in pregnant women starting ANC early and thus potentially improve pregnancy outcomes.

[Epidemiological, clinical and therapeutic features of acute pelvic pain in female patients hospitalized in the Yaoundé Gynaecology-Obstetrics and Pediatrics Hospital]. / Aspects épidémiologiques, cliniques et thérapeutiques des algies pelviennes aiguës de la femme à l'Hôpital Gynéco-Obstétrique et Pédiatrique de Yaoundé (HGOPY).

INTRODUCTION: Acute pelvic pain is an important cause of morbi-mortality. The purpose of this study was to describe the epidemiological, clinical and therapeutic features of acute pelvic pain in Yaoundé. METHODS: We conducted a cross-sectional, descriptive study with collection of prospective data in the Department of Gynecology and Obstetrics at the Yaoundé Gynaecology-Obstetrics and Pediatrics Hospital over the period 1st April-31st July 2015. We included all female subjects admitted for pelvic pain whose course was less than one month and who agreed to participate in the study. All women who were in the third trimester of pregnancy or in the post-partum period were excluded. Epi info software, version 3.5.4 was used to analyze data. Data were shown as frequency and percentage. RESULTS: During the study period, a total of 5915 women presented to the Yaoundé Gynaecology-Obstetrics and Pediatrics Hospital, of whom 125 (2.11%) had acute pelvic pain. The average age of patients was 29.5 ± 6.9 years. Pain was caused by upper genital tract infections (36.8%) and ectopic pregnancy (18.4%). Most patients received medical treatment (92.8%), associated with antibiotics in 65.5% of cases, anti-inflammatory drugs in 56.9% of cases and analgesics in 39.7% of cases. Surgery was performed in 25 (20%) patients via laparotomy (80%) and coelioscopy (20%). Surgery was indicated in patients with ectopic pregnancy (76% of cases). Regression of pain was obtained in 99% of cases. CONCLUSION: Acute pelvic pain mainly affected young women with upper genital tract infections and ectopic pregnancy. In the case of ectopic pregnancy surgical treatment via laparotomy was the gold standard treatment.

Determinants of Noncompletion of the Third Dose of Tetanus Toxoid Vaccine in Pregnant Women in Dschang Health District, Cameroon.

Introduction. Tetanus vaccination plays an important role in the fight against neonatal mortality. Our study aimed to determine the noncompletion rate of the 3rd dose of tetanus toxoid vaccine (TTV) and to analyze the associated factors in pregnant women. METHODS: This was a cross-sectional study conducted in 2 hospitals of Dschang Health District and targeting all women at least in their second gestation coming for antenatal consultation. Upon informed consent by the participant, a prepared questionnaire was administered. The collected data was analyzed using SPSS v22.0 with results presented in means and proportions. Logistic regression was used at two levels to identify independently associated factors for noncompletion of the third dose of TTV with a significance set at 5%. RESULTS: A total of 380 pregnant women were recruited in this study of mean age 27 ± 5.2 yrs, 70% being married, more than 80% having at least secondary education, and 31.8% of them being students. It was noted that 172 (45.26%) of these women had not received the third dose of TTV. The analysis of the adjusted effects showed that not going to postnatal consultation (aOR = 6.75; 3.98-11.49, p < 0.0001), not accompanying her baby to vaccination (aOR = 3.784; 1.803-7.942, p < 0.0001), not accompanying her baby to vaccination (aOR = 3.784; 1.803-7.942, p < 0.0001), not accompanying her baby to vaccination (aOR = 3.784; 1.803-7.942. CONCLUSION: Tetanus vaccination coverage is not yet optimal in Dschang Health District and is associated with marital status as well as postgestational behavior of the mothers. There is thus the need to put in place strategies that will provide social support to single mothers as well as encourage women to attend postnatal consultation and to accompany their own children for vaccination. Furthermore, community-based vaccination could capture some of the lost women thus optimizing the overall vaccination coverage.

Aspects épidémiologiques, cliniques et thérapeutiques des algies pelviennes aiguës de la femme à l'Hôpital Gynéco-Obstétrique et Pédiatrique de Yaoundé (HGOPY)

Introduction: les algies pelviennes aiguës sont responsables d'une morbi-mortalité importante. L'objectif de ce travail était de décrire leurs aspects épidémiologiques, cliniques et thérapeutiques à Yaoundé.Méthodes: nous avons mené une étude transversale descriptive avec collecte prospective des données au Service de Gynécologie-Obstétrique de l'Hôpital Gynéco-Obstétrique et Pédiatrique de Yaoundé du 1er avril au 31 juillet 2015. Nous avons inclus toutes les femmes admises pour douleur pelvienne dont l'évolution était inférieure à un mois et ayant accepté de participer à l'étude. Nous avons exclu les femmes qui étaient au troisième trimestre de grossesse ou en post-partum. Le logiciel Epi info version 3.5.4 a servi à l'analyse des données. Ces données ont été présentées sous forme de fréquence et de pourcentage.Résultats: au total 5915 femmes ont consulté pendant la période de l'étude dont 125(2,11%) étaient des algies pelviennes aiguës. La moyenne d'âge était de 29,5 ± 6,9 ans. Les étiologies des douleurs étaient les infections génitales hautes (36,8%) et la grossesse extra-utérine (18,4%). Le traitement surtout médical (92,8%), associait antibiotiques (65,5%), anti-inflammatoires (56,9%) et antalgiques (39,7%). La chirurgie a été réalisée chez 25(20%) patientes par laparotomie (80%) et cœlioscopie (20%)L'indication chirurgicale était la grossesse extra-utérine dans 76% des cas. La régression de la douleur était obtenue chez 99% des cas. Conclusion: les d'algies pelviennes aigues survenaient chez les femmes jeunes, dues aux infections génitales hautes et à la grossesse extra-utérine étaient principalement. En cas de grossesse extra-utérine le traitement chirurgical était surtout la laparotomie

Factor associated with progression to chronic arterial hypertension in women with preeclampsia in Yaoundé, Cameroon.

INTRODUCTION: Hypertensive diseases in pregnancy are the leading medical problem during pregnancy. Some of the women affected remain hypertensive after pregnancy and the post-partum period. This study aimed to assess the factors associated to the persistence of hypertension after preeclampsia. METHODS: This was a retrospective cohort study which included all women who had preeclampsia. The minimal follow-up period was 12 months. We excluded from the study all women who had superimposed preeclampsia. Sociodemographic data and past history were recorded and a physical exam was performed for all participants. Multivariate logistic regression was used to determine factors independently associated to the persistence of hypertension. RESULTS: Our cohort consisted of 136 women. The mean follow-up period was 3.7 years. Thirty two women (23.53%) remained hypertensive. This represented an incidence rate of 2.85% per year. Old age (≥ 40 years), housewife occupation, multigravidity (> 4), onset of preeclampsia before 34 weeks' gestation, obesity and the presence of hypertension in siblings were factors independently associated to persistent hypertension. CONCLUSION: Many women affected by preeclampsia remain hypertensive after pregnancy. It is important to provide adequate follow-up for this patients in order to intervene on the factors leading to this outcome.

Awareness and practice of birth preparedness and complication readiness among pregnant women in the Bamenda Health District, Cameroon.

BACKGROUND: Birth preparedness and complication readiness has as goal to reduce maternal and neonatal mortality. This concept developed by the organizations of the United Nations permits pregnant women and their families seek health care without delay in case of obstetric complications and delivery. Though its benefits have been proven in several countries, little is known of this in Cameroon and specifically in the North West Region. Therefore, the intention of the study was to assess the awareness and practice of birth preparedness and complication readiness in this health district. METHODS: This was a facility-based cross sectional study carried out in the Bamenda health district of the North West Region, Cameroon. Three hundred forty-five pregnant women of ≥32 weeks gestational age seen at the antenatal consultation units were recruited. The dependent variable was birth preparedness and complication readiness while the independent variables were the socio-demographic and reproductive health characteristics. Data collected was analyzed with SPSS and Microsoft excel. Frequency distributions were used to determine the awareness and practice of birth preparedness and complication readiness. RESULTS: Of the 345 pregnant women included in this study, 159(46.1%) were aware of birth preparedness and complication readiness. The practice of birth preparedness and complication readiness was unsatisfactory as only 65(18.8%) were considered prepared. CONCLUSION: Education and counselling on birth preparedness and complication readiness is not made available to the pregnant women resulting in poor knowledge. Thus, reflected in the low practice of preparation for birth and its complication observed.

Histo-epidemiological aspects of gynecological and breast cancers at the University Teaching Hospital of Yaoundé.

INTRODUCTION: Cancer is a public health problem that affect women more than men. The aim of the study was to describe the epidemiological and histopathological features of gynecological malignancies in the city of Yaoundé, Cameroon. METHODS: This was a descriptive cross-sectional study of histologically proven gynecological cancers over a 10-year period (2008-2017) in the Gynecology and Pathological Anatomy Departments of the University Teaching Hospital of Yaoundé. RESULTS: A total of 682 cancers were identified among which, 342 gynecological cancers, for an overall frequency of 50.1% and an annual frequency of 34.2 cases on average. There was a trend suggesting an increase annual frequency over time. The cervix was the most frequent location with 182 cases (53.2%); followed by breast with 96 cases (28.1%); endometrium with 33 cases (9.7%) and ovaries 15 cases (4.4%). These patients were on average 51.9±13.7 years old, mostly housewives (56.8%), married (60.4%), multiparous (61.3%) and referred (62.6%). Histopathologically, cervical cancer was predominantly squamous cell carcinoma (86.8%), invasive (80.9%) and well differentiated (45.5%). For breast cancers, the majority were ductal carcinomas (78.1%), invasive (92%), and histological grade SBR II (50.6%). The most common histopathological types of endometrial and ovarian cancer were adenocarcinoma (72.2%) and serous cystadenocarcinoma (46.7%), respectively. CONCLUSION: Gynecological cancers are common. Screening is expected to increase at 30 years for cervical cancer and start at age 40 with mammography for breast cancer.

The Mode of delivery of grand multiparous with post-cesarean single uterine scar in low resources settings: A retrospective cohort study.

The prevalence of post-caesarean scar uterus, the most important risk factor of uterine rupture is increasing globally. Grand multiparity can also increase the risk of uterine rupture. The issue of grand multiparous with single post caesarean scar is poorly investigated. OBJECTIVES: The purpose of this study was to assess the factors associated with the mode of delivery of grand multiparous with post caesarean single uterine scar in low resources settings. PATIENTS AND METHOD: It was a retrospective cohort study conducted from the 1st January to the 31st of May 2016, in three university teaching hospitals of the university of Yaoundé I in Cameroon. Grand multiparous (GMP) defined as parity ≥5 with single post-caesarean lower segment uterine scar admitted at a gestational age of 37 completed weeks and above were compared to grand multiparous without scar uterus at term. GMP with unknown scar were excluded. The mode of delivery and materno-fetal and neonatal outcome were investigated. RESULTS: We included 33 GMP with single lower segment uterine scar and 120 GMP without uterine scar. Induction of labor and acute fetal distress were not related to having a scar or not in grand GMP, but augmentation of labor was less likely to be conducted in case of GMP with scar uterus(p = 0.08). The frequency of vaginal delivery was 75.8 and 87.5% in grand multiparous with and without uterine scar respectively (OR 0.17-1.16; P = 0.085), with one case of instrumental delivery in scarless group. However, single scar multiparity status increased by 2.42 folds the risk of delivery by caesarian section (P = 0.066). Cephalo-pelvic disproportion increased the indication of caesarian section by 12-fold in the GMP with scar group (p = 0.031), but mechanical dystocia related indications (CPD, macrosomia,) were present in only 4 cases out of 8 caesarian sections in the exposed group. The Apgar score at the fifth minute was better in the GMP with scar group. (p = 0.037). CONCLUSION: Grand multiparous with single post-cesarean uterine scar should be given a chance of vaginal delivery in the absence added feto-maternal morbidity.

Benefit of Watching a Live Visual Inspection of the Cervix With Acetic Acid and Lugol Iodine on Women's Anxiety: Randomized Controlled Trial of an Educational Intervention Conducted in a Low-Resource Setting.

BACKGROUND: Women undergoing pelvic examination for cervical cancer screening can experience periprocedural anxiety. OBJECTIVE: The aim of this study was to assess the anxiety level experienced by women undergoing a visual inspection with acetic acid and Lugol iodine (VIA and VILI) examination, with or without watching the procedure on a digital screen. METHODS: This prospective randomized study took place in the district of Dschang, Cameroon. A previous cervical cancer screening campaign tested women aged between 30 and 49 years for human papillomavirus (HPV). HPV-positive women were invited for the 12-month follow-up control visit, including a VIA/VILI examination. During that visit, we recruited women to participate in this study. Before the examination, participants were randomized in a 1:1 ratio to a control group (CG) and an intervention group (IG). Women in both groups underwent a pelvic examination and were verbally informed about the steps undertaken during the gynecological examination. The IG could also watch it live on a tablet screen. Women's anxiety was assessed before and immediately after the examination, using the Spielberger State-Trait Anxiety Inventory (STAI). A paired t test was used to compare the mean STAI score for each question before and after VIA/VILI while a nonpaired, 2-sided t test was used to compare the mean differences of the STAI score between the 2 study groups. RESULTS: A total of 122 women were randomized in the study; 4 of them were excluded as they did not undergo the pelvic examination, did not answer to the second STAI questionnaire because of personal reasons, or the cervix could not be properly visualized. Thus, the final sample size consisted of 118 patients of whom 58 women were assigned to the CG and 60 to the IG. The mean age was 39.1 (SD 5.2) years. Before the examination, the mean (SD) STAI score was 33.6 (SD 10.9) in the CG and 36.4 (SD 11.8) in the IG (P=.17). The STAI score after pelvic examination was significantly reduced for both groups (CG: 29.3 [SD 11.2]; IG: 28.5 [SD 12.0]). Overall, the difference of the STAI scores before and after the pelvic examination was lower in the CG (4.2 [SD 9.0]) than in the IG (7.9 [SD 14.3]), although the difference was not significant (P=.10). However, the women's emotional state, such as I feel secure and I feel strained, was improved in the IG as compared with the CG (CG: P=.01; IG: P=.007). CONCLUSIONS: Watching the VIA/VILI procedure in real time improved the women's emotional state but did not reduce the periprocedural anxiety measured by the STAI score. Furthermore, larger studies should assess women's satisfaction with watching their pelvic examination in real time to determine whether this tool could be included in VIA/VILI routine practice. TRIAL REGISTRATION: ClinicalTrials.gov NCT02945111; http://clinicaltrials.gov/ct2/show/NCT02945111.

Residual or Recurrent Precancerous Lesions After Treatment of Cervical Lesions in Human Immunodeficiency Virus-infected Women: A Systematic Review and Meta-analysis of Treatment Failure.

BACKGROUND: Screening and treating premalignant cervical lesions (cervical intraepithelial neoplasia 2+ [CIN2+]) is an effective way to prevent cervical cancer, and recommendations exist for the monitoring of treatment success. Yet, there is no specific recommendation for human immunodeficiency virus (HIV)-infected women, who are at a known, increased risk of cervical cancer. METHODS: A systematic review was performed by searching MEDLINE, EMBASE, and Web of Science for studies published from January 1980 through May 2018. Eligible studies described the prevalence of histologically- and/or cytologically-defined lesions in HIV-infected women at least 6 months post-treatment. The primary endpoint was treatment failure, defined as the presence of residual and/or recurrent high-grade CIN2+/high-grade squamous intraepithelial lesions post-treatment. The pooled prevalence in HIV-infected women and the odds ratios (ORs) for HIV-infected compared to HIV-uninfected women were estimated using random-effects models. RESULTS: Among 40 eligible studies, the pooled prevalence of treatment failure in HIV-infected women was 21.4% (95% confidence interval [CI] 15.8-27.0). There was no significant difference in the treatment failure prevalence for cryotherapy (13.9%, 95% CI 6.1-21.6) versus loop electrosurgical excision procedure (13.8%, 95% CI 8.9-18.7; P = .9), but the treatment failure prevalence was significantly higher in women with positive (47.2%, 95% CI 22.0-74.0) than with negative (19.4%, 95% CI 11.8-30.2) excision margin (OR 3.4, 95% CI 1.5-7.7). Treatment failure was significantly increased in HIV-infected versus HIV-uninfected women, both overall (OR 2.7, 95% CI 2.0-3.5) and in all sub-group analyses. CONCLUSIONS: There is strong evidence for an increased risk of treatment failure in HIV-infected women, in comparison to their HIV-negative counterparts. The only significant predictor of treatment failure in HIV-infected women was a positive margin status, but further data is needed on long-term outcomes after ablative treatment in HIV-infected women.