Stillbirth rate and associated factors at the Bamenda Regional hospital, North-West region, Cameroon, from 2018 to 2022: a case control study.

BACKGROUND: Stillbirth is a common adverse pregnancy outcome worldwide, with an estimated 2.6 million stillbirths yearly. In Cameroon, the reported rate in 2015 was 19.6 per 1000 live births. Several risk factors have been described, but region-specific risk factors are not known in the northwest region of Cameroon. This study aims to determine the stillbirth rate and associated factors at the Bamenda Regional hospital, North-West region of Cameroon. MATERIALS AND METHODS: A Hospital-based case‒control study conducted from December 2022 to June 2023 on medical files from 2018 to 2022 at the Bamenda Regional Hospital. Cases were women with stillbirths that occurred at a gestational age of ≥ 28 weeks, while controls were women with livebirths matched in a 1:2 (1 case for 2 controls) ratio using maternal age. Sociodemographic, obstetric, medical, and neonatal factors were used as exposure variables. Multivariable logistic regression was used to determine adjusted odds ratios of exposure variables with 95% confidence intervals and a p value of < 0.05. RESULTS: A total of 12,980 births including 116 stillbirths giving a stillbirth rate of 8.9 per 1000 live births. A hundred cases and 200 controls were included. Factors associated with stillbirths after multivariable analysis include nulliparity (aOR = 3.89; 95% CI: 1.19-12.71; p = 0.025), not attending antenatal care (aOR = 104; 95% CI: 3.17-3472; p = 0.009), history of stillbirth (aOR = 44; 95% CI: 7-270; p < 0.0001), placenta abruption (aOR = 14; 95% CI: 2.4-84; p = 0.003), hypertensive disorder in pregnancy (aOR = 18; 95% CI: 3.4-98; p = 0.001), malaria (aOR = 8; 95% CI: 1.51-42; p = 0.015), alcohol consumption (aOR = 9; 95% CI: 1.72-50; p = 0.01), birth weight less than 2500 g (aOR = 16; 95% CI: 3.0-89; p = 0.001), and congenital malformations (aOR = 12.6; 95% CI: 1.06-149.7;p = 0.045). CONCLUSION: The stillbirth rate in BRH is 8.9 per 1000 live births. Associated factors for stillbirth include nulliparity, not attending antenatal care, history of stillbirth, placental abruption, hypertensive disorder in pregnancy, malaria, alcohol consumption, birth weight less than 2500 g, and congenital malformations. Close antenatal care follow-up of women with such associated factors is recommended.

A case of Mayer-Rokitansky-Küster-Hauser syndrome in a low-resource tertiary hospital in Douala, Cameroon.

The Mayer-Rokitansky-Küster-Hauser syndrome is the congenital absence or underdevelopment of the uterus and vagina even though the external genitalia, ovaries and ovarian function are normal. This condition is uncommon in Cameroon. A 23-year-old woman of the Fulbé tribe, a predominantly Islamic tribe of the northern part of Cameroon, complained of the absence of menstruation after age of puberty and lower abdominal pain occurring almost at the same period every month. She has been married polygamously for 10 years and has been having normal, satisfactory sexual intercourse. The sonographic and laparoscopic findings of this patient were consistent with Mayer-Rokitansky-Küster-Hauser syndrome. The patient was counseled for in vitro fertilization and surrogacy. Patients with Mayer-Rokitansky-Küster-Hauser syndrome typically present with primary amenorrhea during adolescence. With the existing medical technology in Cameroon, this condition is easily accessible in tertiary healthcare facilities. Patients with Mayer-Rokitansky-Küster-Hauser syndrome could become mothers through in vitro fertilization and surrogacy, but the cost is prohibitive in Cameroon.

Dysménorrhée chez les élèves et étudiantes à Yaoundé : facteurs associés et aspects socioculturels

Introduction.: la dysménorrhée est une situation fréquente chez les femmes en âge de procréer. Elle affecte la qualité de vie des filles et est la principale cause d'absentéismes scolaires chez les adolescentes. Notre étude avait pour objectif d'analyser les facteurs associés à la dysménorrhée et les aspects psychosociaux de la dysménorrhée chez les élèves et étudiantes à Yaoundé. Méthodologie. L'étude était transversale analytique, réalisée dans 2 établissements secondaires et un établissement supérieur de la ville de Yaoundé, du 1er Décembre 2017 au 30 Juin 2018 soit une durée de 6 mois. Étaient incluses toutes les élèves et étudiantes âgées de 15 ans et plus, ayant leurs menstruations et au moins un niveau d'instruction de la classe de seconde. L'échantillonnage était stratifié en grappe de 2 niveaux dans l'un des établissements et consécutif dans un autre. Le rapport de côte a été utilisé pour rechercher les associations entre les variables et la valeur P ˂ 0,05 était considérée significative. Résultats. Parmi les 1059 participantes, 800 avaient des dysménorrhées soit une prévalence de 75,5%. La moyenne d'âge était de 18,88 ± 3,62 ans avec des extrêmes allant de 15 à 45 ans. Les facteurs de risque de la dysménorrhée étaient : indépendamment associés aux dysménorrhées étaient les antécédents familiaux de dysménorrhée [OR (IC à 95%) : 4,20(3,02-5,83)] et le stress [OR (IC à 95%) : 2,16(1,55-3,02] ; tandis que la durée des règles ≤ 3 jours [OR (IC 95%) : 0,31(0,12-0,82)] est un facteur protecteur. La dysménorrhée était considérée comme un sujet tabou par 23,6 % des participantes. Conclusion. Les antécédents familiaux de dysménorrhée et le stress sont des facteurs de risque de la dysménorrhée. Certaines personnes affectées préfèrent ne pas en parler. Nous recommandons de sensibiliser les femmes sur la dysménorrhée et les aider à lutter contre le stress

Predictors of willingness to accept pre-marital HIV testing and intention to sero-sort marital partners; risks and consequences: Findings from a population-based study in Cameroon.

INTRODUCTION: The objectives of this study was to investigate and compare levels of acceptability of pre-marital HIV testing; and intention to sero-sort future marital and its associated factors among unmarried adults in two cities in Cameroon. METHODS: A population-based survey was conducted simultaneously in the cities of Kumba and Buea, located in the Southwest region of Cameroon. Data were collected from September to October 2016 by trained interviewers who administered questionnaires to eligible and consenting unmarried adults aged 21-35 years. Data were weighted and logistic regression analyses performed to identify significant predictors. The level of statistical significance was set at p< = 0.05. RESULTS: A total of 1,406 respondents (767 in Kumba and 639 in Buea) participated in the study. In the pooled sample, the median age of respondents was 26 years (IQR = 23-29) and over half (54.8%) were males. Over 90% of respondents in both cities indicated their willingness to accept pre-marital HIV testing. Respondents who had previously tested for HIV in Kumba (AOR = 7.87; 95%CI, 4.02-15.44) were significantly more likely to accept premarital HIV testing than those who had never tested for HIV. In Kumba, older age (AOR = 0.42; 95%CI, 0.18-0.96) and those unemployed (AOR = 0.22; 95% CI, 0.06-0.76) were significantly less likely to accept pre-marital HIV testing. In Buea males (AOR = 0.64 95% CI, 0.45-0.89) who would test HIV negative would be significantly less likely to accept to marry an HIV positive partner. In Buea, respondents who indicated a moderate risk of contracting HIV (AOR = 1.71; 95%CI, 1.09-2.66, p = 0.018) were significantly more likely to accept to marry an HIV positive partner. The major limitation of the study was that a hypothetical situation was used to ask respondents about their willingness to accept pre-marital HIV testing rather than actual HIV test acceptance. CONCLUSIONS: Most respondents expressed their willingness to undergo pre-marital HIV testing. However, majority of respondents who would test HIV negative would refuse to marry their partner who tests HIV positive. These findings suggest that interventions to reduce HIV infection and fight against stigma and discrimination should be reinforced at community level.

Socio-economic vulnerabilities and HIV: Drivers of transactional sex among female bar workers in Yaoundé, Cameroon.

INTRODUCTION: The purpose of this study was to examine the relationship between socio-demographic characteristics, risky sexual behaviour, alcohol use and transactional sex among female bar workers in Yaounde, Cameroon. MATERIALS AND METHODS: A cross-sectional survey was conducted among a representative sample of 410 female bar workers, recruited through a modified version of venue-based cluster sampling technique from May to June 2017. Transactional sex was defined as having received money/gifts in exchange for sex with any sexual partner in the past 12 months. Logistic regression models were performed to identify the factors associated with transactional sex. The level of statistical significance was set at p< = 0.05. RESULTS: About 14.9% (n = 61) of respondents reported to have engaged in transactional sex, 83.7% (n = 338) had multiple sexual partners at the time of the study, 14.4% (n = 55) had sex with one or more of their male customers in the past 6 months. Almost 73.4% (n = 301) reported alcohol use. Of these, 37.2% (n = 112) were frequent alcohol consumers. About 17.6% (n = 72) reported to have had unprotected sex under the influence of alcohol in the past 6 months. Multivariate logistic regression analysis showed that those who engaged in transactional sex were more likely to have had sex with a male customer in the past 6 months (aOR = 7.34; 95% CI, 3.63-16.98), had sex under the influence of alcohol in the past 6 months (aOR = 2.42; 95% CI, 1.18-4.96) and frequent alcohol consumers (aOR = 2.06; 95%CI, 1.04-4.10). Respondents who had their last sexual intercourse 4 weeks or more prior to the study (aOR = 0.26; 95% CI, 0.08-0.84) were less likely to have engaged in transactional sex. CONCLUSIONS: Our study concludes that female bar workers are exposed to male customers and engage in risky sexual practices including transaction sex. Most of them also consume alcohol which increases their risk of HIV and STI acquisition. They are a high-risk group that need to be targeted with HIV prevention interventions.

[Treatment of perineal wounds during the post partum period: evaluation of whether or not antibiotic should be systematically prescribed]. / Prise en charge des plaies du périnée en post partum: faut-il prescrire systématiquement un antibiotique?

INTRODUCTION: Genital tract integrity is not always mantained during childbirth. No treatment protocol for post-partum perineal wounds (tears and episiotomies) existed in our Department, thus their management depends upon clinician. This study aimed to establish the role of antibiotic in the treatment of post-partum perineal wounds as well as the impact of antibioprophylaxis on wound healing and on prevention of infectious complications after repair. METHODS: We conducted a prospective cohort study in the Department of Gynecology and Obstetrics at the Central Hospital of Yaoundé over a period of 6 months, from 1 January to 31 May 2016. Post-partum women with perineal tear and/or episiotomy were divided into two groups (A and B) and followed up. The group A was composed by 85 post-partum women under treatment protocol based on compresses soaked in Betadine® (placebo). The Group B (or test group) was composed of post-partum women who had received placebo plus antibiotic (oral amoxicillin/clavulanic acid 875 mg/125 mg twice a day for 05 days). Both groups were followed up on day 0, day 2 and day 9. Our criteria for the evaluation of treatment were: pain, infection, swelling, cleanliness of the wounds and average healing time. Data were collected and analyzed using the software Epidata analysis version 3.2 and STATA version 12.0 (Texas USA 2001). The correlations between the variables were identified by chi-square, odds ratio and p value (using any p-value ≤ 0.05 as statistical significance cut-off) according to the case. RESULTS: The average age was 26.32 ± 6.5 years, ranging between 15 and 43 years. Primiparous women accouted for 55.9% of the study population. At day 0 post-partum the main symptom was pain, without significant predominance of a group (OR = 0.9; CI = 0.14-7.19; p = 1). Swollen wounds were the second complaint, without significant variation between the two groups (OR = 1.69; CI = 0.88-3.24; p = 0.13). At day 0, day 2 and day 9 no significant variation was observed between the two treatment protocols with regard to the indicators analyzed: pain evolution, infection, swelling and average healing time. At day 9 the healing was complete in both groups and the two treatment protocols were shown to be equivalent in their effectiveness and prevention of infections. CONCLUSION: At the end of this study the two treatment protocols were shown to be equivalent. Antibiotics should not be prescribed for perineal wounds in order to contain the healthcare costs.

[Epidemiological, clinical and therapeutic aspects of supposed benign ovarian tumors at the Central Hospital of Yaoundé]. / Aspects épidémiologiques, cliniques et thérapeutiques des tumeurs ovariennes présumées bénignes à l'Hôpital Central de Yaoundé.

INTRODUCTION: Supposed benign ovarian tumors (SBOT) are considered one of the most frequent reasons for gynecological consultation and one of the most common indications for gynecological surgery. METHODS: We conducted a retrospective descriptive study in the Department of Obstetrics and Gynecology at the Central Hospital of Yaoundé. We carried out a 6-month study, over a five-year period, from 1 January 2010 to 31 December 2014. The study population consisted of all patients undergoing surgery for the treatment of supposed benign ovarian tumor during the study period. RESULTS: The mean age was 29.33 ± 6.83 with a minimum age of 20 years and a maximum age of 48 years. The most represented age range was 21-25 years. The reason for consultation was pelvic pain in 93.90% of the cases. Eleven patients were pregnant women (33.3% of our study population) and 72.70% were in their first trimester. SBOTs in our series were: cyst rupture (36.40%), ovarian torsion (adnexal torsion) (27.30%), voluminous ovarian cyst (21.20%) intracystic haemorrhage (15.20% ). 26 (78.78%) patients were treated conservatively. However, adnexectomy was performed in 5 out of 9 patients with ovarian torsion. CONCLUSION: Complex SBOTs can occur in our mids, especially in patients of reproductive age. Late diagnosis, especially in the case of ovarian torsion, obliges to perform radical procedure with deleterious effects upon the patient. Laparoscopy is the most recommended surgical procedure if the technical equipment is available because it reduces the risk of complications.

Associations of body mass index and gestational weight gain with term pregnancy outcomes in urban Cameroon: a retrospective cohort study in a tertiary hospital.

BACKGROUND: Obesity is a rising public health issue worldwide. Guidelines regarding maternal body mass index (BMI) and gestational weight gain (GWG) are missing in Cameroon where maternal mortality rate remains very high. We hypothesized that obesity and inappropriate GWG are associated with poor pregnancy outcomes. We aimed at assessing associations of BMI and GWG with pregnancy outcomes. METHODS: This was a retrospective cohort study at the Yaoundé Central Hospital. We included women with term singleton deliveries in the post-partum ward. The World Health Organisation classification of BMI and the United States Institute Of Medicine (IOM) categories of GWG were used to stratify participants. Poor maternal outcome was defined by the occurence of caesarean section, preeclampsia or obstetrical haemorrhage. Poor perinatal outcome was defined by the occurence of perinatal death, admission in intensive care unit, low birth weight, macrosomia or fifth minute Apgar score <7. Multiple logistic regressions were used to calculate unadjusted and adjusted Odds Ratios (uOR, aOR) for poor maternal outcome (PMO) and for poor perinatal outcome (PPO) in each category of BMI and GWG. Adjustment was done for age, scarred uterus, sickle cell disease, malaria, human immunodeficiency virus (HIV) infection, parity and smoking. RESULTS: Of the 462 participants, 17 (4 %) were underweight (BMI < 18.5), 228 (49 %) had normal pre-pregnancy BMI, 152 (33 %) were overweight (25 ≤ BMI < 30) and 65 (14 %) were obese (BMI ≥ 30). Following the IOM recommendations, GWG was normal for 186 (40 %) participants, less than recommended for 131 (28 %) and above the recommended norms for 145 (32 %). GWG above the IOM recommendation was significantly associated with PMO (aOR: 1.7, 95 % CI 1.1-2.8). GWG less than the IOM recommended values, overweight and obesity were not significantly associated with poor pregnancy outcomes. CONCLUSION: While waiting for local recommendations for GWG, the IOM recommendations can be used for Cameroonian women as far as maternal outcome is concerned. Unlike in studies in different ethnic and racial groups, abnormal BMI was not associated with poor pregnancy outcomes in our cohort of Cameroonian women.

How risky are second trimester clandestine abortions in Cameroon: a retrospective descriptive study.

BACKGROUND: Complications of clandestine abortions increase with gestational age. The aim of this study was to identify complications of second trimester clandestine abortions (STA) and those of first trimester clandestine abortions (FTA). METHODS: This retrospective descriptive study was conducted between March 1st and August 31st, 2012 in the University Teaching Hospital and the Central Hospital, Yaoundé (Cameroon). The files of women with clandestine abortions carried out outside our units, but received in our settings for some complications were reviewed. Variables studied were maternal age, parity, marital status, gestational age at the time of abortion, the abortion provider and the method used, the duration of antibiotic coverage, the time interval between abortion and consultation, the complications presented and the duration of hospital stay. Data of 20 women with STA (≥13 weeks 1 day) and those of 74 women with FTA (≤13 complete weeks) were analyzed and compared. The t-test was used to compare continuous variables. P value <0.05 was considered statistically significant. RESULTS: Women with STA had high parities (P = 0.0011). STAs were mostly performed by nurses and were usually done by dilatation and curettage or dilatation and evacuation, manual vacuum aspiration, intramuscular injection of an unspecified medication, transcervical foreign body insertion, amniotomy and misoprostol. STA complications were severe anemia, hypovolemic shock, uterine perforation and maternal death. CONCLUSIONS: Clandestine abortions, especially second trimester abortions, are associated with risks of maternal morbidity and mortality especially when done by nurses. Therefore, women should seek for help directly from trained health personnel (Gynecologists & Obstetricians). Moreover, nurses should be trained in uterine evacuation procedures. They should also refer women who want to carry out STA to Gynecologists and Obstetricians. Finally, to reduce the prevalence of abortion in general, the government should make contraception available to all women, as well as use public media to sensitize women on the dangers of abortion and on the need to use family planning services.

Clinical malaria among pregnant women on combined insecticide treated nets (ITNs) and intermittent preventive treatment (IPTp) with sulphadoxine-pyrimethamine in Yaounde, Cameroon.

BACKGROUND: Malaria remains a burden for pregnant women and the under 5. Intermittent preventive treatment of pregnant women (IPTp) for malaria with sulfadoxine - pyrimethamine (SP) has since replaced prophylaxis and legislation has been reinforced in the area of insecticide treated mosquito nets (ITNs) in Cameroon. Clinical malaria despite all these measures remains a problem. We compared the socio-obstetrical characteristics of women who developed clinical malaria and those who did not though in the same regimen. METHODS: A 5 - year nested cohort study (2007 - 2011 inclusive) at the tertiary level hospitals in Yaounde. Pregnant women who willingly accepted to participate in the study were enrolled at booking and three doses of SP were administered between 18 - 20 weeks of gestation, between 26-28 weeks and between 32 - 34 weeks. Those who developed clinical malaria were considered as cases and were compared for socio - obstetrical characteristics with those who did not. Venous blood was drawn from the women in both arms for parasite density estimation and identification and all the clinical cases were treated conventionally. RESULTS: Each arm had 166 cases and many women who developed clinical malaria were between 15 and 19 years (OR 5.5, 95% CI 3.9 - 5.3, p < 0.001). They were of low gravidity (OR 6.5, 95% CI 3.8 - 11.3, p < 0.001) as well as low parity (OR 4.6, 95% CI 2.7 - 7.9, p < 0.001). The cases were single women (OR 4.58, 95% CI 2.54 - 8.26, p < 0.001) and had attained only primary level of education (OR 4.6, 95% CI 2.8 - 7.9, p < 0.001). Gestational ages were between 20 to 30 weeks during clinical malaria (OR 6.8, 95% CI 4.1 - 11.7, p < 0.001). The time between the first and second dose of SP was longer than ten weeks in the cases (OR 5.5, 95% CI 3.2 - 9.3, p < 0.001) and parasite density was higher also among the cases (OR 6.9, 95% CI 5.9 - 12.1, p < 0.001). CONCLUSION: Long spacing between the first and second dose of SP seemed to be responsible for clinical malaria in the cases.

Outcome of deliveries among adolescent girls at the Yaoundé central hospital.

BACKGROUND: Adolescent pregnancies are a growing public health problem in Cameroon. We sought to study the outcome of such pregnancies, in order to inform public health action. METHODS: A cross-sectional analysis of 5997 deliveries which compared the outcome of deliveries in adolescent (10-19 years old) pregnant women registered at the Yaoundé Central Hospital between 2008 and 2010 to that of their non-adolescent adult (≥ 20 years old) counterparts. Variables used for comparison included socio-demographic and obstetric characteristics of parturients, referral status, and maternal and fetal outcomes. Predictors of maternal and of perinatal mortality were determined through binomial logistic modeling. RESULTS: Adolescent deliveries represented 9.3% (560) of all pregnancies registered. Adolescent pregnancies had significantly higher rates of both gestational duration extremes: preterm as well as post-term deliveries (29.3% versus 24.5%, p = 0.041 OR 1.28 95% CI 1.01-1.62 and 4.9 versus 2.4%, p = 0.014 OR 2.11 95% CI 1.46-3.87 respectively). Both groups did not differ significantly with respect to mean blood loss, rates of cesarean or instrumental deliveries. Adolescent deliveries however required significantly twice as many episiotomies (OR 2.15 95% CI 1.59-2.90). The likelihood of perineal tears in the adolescent group was significantly higher than that in the adult group on assuming episiotomies done would have been tears if they had not been carried out (OR 1.45 95% CI 1.16-1.82). Adolescent parturients had a higher likelihood of apparent fetal death at birth as well as perinatal fetal death after resuscitation efforts (AOR 1.75 95% CI 1.25-2.47 and AOR 1.69 95% CI 1.17-2.45 respectively).Comparisons of pregnancy outcomes between early (10-14 years), middle (15-17 years) and late adolescence (18-19 years) found no significant differences. Predictors of maternal death included having been referred, having had ≥5 deliveries and preterm deliveries. These were also predictors of perinatal death, as well as being a single mother, primiparous, and multiple gestations. CONCLUSIONS: Adolescent pregnancies in Cameroon compared to those in adults are associated with poorer outcomes. There is need for adolescent-specific services to prevent teenage pregnancies as well as interventions to prevent and manage the above mentioned predictors of in-facility maternal and perinatal mortality.

Sexual activity of adolescent school girls in an urban secondary school in cameroon.

BACKGROUND: The objective of this study was to describe the extent of sexual activity in adolescent school girls. METHODS: This was a cross-sectional study with prolective collection of data carried out at Lycée General Leclerc, Yaounde (Cameroon), from October 1 to November 30, 2011. Heterosexual coitus was considered as sexual activity. A pretested self-administered questionnaire was proposed to all consenting girl students aged 10 to 19 years. The data were analyzed using Epi Info 3.2.1 and Microsoft Excel 2007 software. RESULTS: Of the 2660 students who responded to the questionnaire, 21.3% (566) admitted being sexually active. Out of these, 64.3% (364) were aged between 10 and 16 years at their first heterosexual contact. The mean age at the first sexual intercourse was 15.3 years. Although 56.4% (319) of the sexually active respondents had only one sexual partner, 43.6% (247) of them had at least two partners. Sexual activity was occasional in 71.4% of those being sexually active. Meanwhile, 52.1% (295) of the sexually active adolescent girls used condoms during sexual intercourse, 41.5% (235) did so occasionally, and 6.4% (36) had regular unprotected sex. CONCLUSION: More than one-fifth of adolescent girls were sexually active in this study. Sexual intercourse started mostly at the age of 16 or less, and it was mostly occasional. Half of the cases had multiple sexual partners, and half were not using condoms during sexual intercourse. We, thus, recommend the implementation of interventions aimed at delaying the age of the first sexual intercourse and accessibility of condoms to students in this setting.