Severe Pregnancy Induced Hypertension, a Dreaded Complication in Semi-Urban Area in Fako Division, Cameroon? A Case – Control Study.

Introduction: Severe pregnancy-induced hypertension (severe pre-eclampsia and eclampsia) is a major cause of fetal and maternal morbidity and mortality. Pregnancy induced hypertension occurs in 7.7 – 8.2% of pregnancies and causes 17.5% of maternal deaths in Cameroon. However, few descriptive studies have been published in the last decade to demonstrate the gravity of adverse maternal and perinatal outcomes of these disorders in the Fako Division of the South West Region, Cameroon. Objectives: This study was aimed at determining the prevalence, risk factors and the maternal and perinatal outcomes associated with severe PIH in the two Regional Hospitals in the South West Region of Cameroon. Methods: This was a cross-sectional and case-control study conducted at the maternities of the two Regional Hospitals of the South West region. Of the 2112 files of parturients that had childbirth in these hospitals between 16th July 2013 and 16th January 2015, 94 case files were selected. These files were classified according to the National High Blood Pressure Education Program Working Group (2000) as severe preeclampsia (64 files) or eclampsia (30 files). A reference group of 188, age, gravidity and parity-matched parturients files with normal blood pressures (BPs) was also selected. Structured questionnaires were used to obtain demographic data, risk factors, gestational age, symptoms and signs of severity, neonatal and maternal morbidity and mortality. Data was analyzed using Epi InfoTM 7.0.8.3, odds ratios and their 95% confidence intervals were recorded and p<0.05 was considered statistically significant. Results: The prevalence of severe PIH was 5.02%. Parturients aged 21 – 25 years 30.9% (29) and primiparous 57.5% (54) were most affected. Severe PIH was associated with family history of chronic HBP [44.7% (42) versus14.9% (28)] and pre-tertiary level of education [62.8% (59) versus 44.2% (83)] both with p<0.001 and p≤0.031 respectively. The maternal mortality ratio in cases was 1887/100,000 live births but no maternal death occurred in the reference population. Severe PIH was associated with certain maternal outcomes, the most frequent being caesarean delivery [68.1% (64) versus 16.5% (31)], p<0.001. Others included visual impairment [11.7% (11) versus 0.0% (0)] and Placenta abruptio [5.3% (5) versus 0.0% (0)]. Similarly, severe PIH was associated with perinatal outcomes; low birth weight [50.0% (47) versus 10.6% (20)], prematurity [46.8% (44) versus 9.6% (19)] and perinatal death [27.7% (26) versus 5.3% (10)] all p≤0.001. Conclusion: The prevalence of severe PIH was high (5.02%). It was common in age group 21-25, primiparous and women with family history of chronic HBP and low level of Education. Parturients with a severe PIH had significantly more maternal and perinatal complications. These data suggest a gap in maternal health in Cameroon. Hence there is need to do complete evaluation (clinical and laboratory) to better assess patients; encourage early patient referral and prompt management of complications; more mid- wives and creation of adult and neonatal intensive care units in the Buea and Limbe Regional Hospitals.

In Vitro Antifungal Susceptibility Patterns of Candida Albicans from HIV and AIDS Patients Attending the Nylon Health District Hospital in Douala; Cameroon

HIV and AIDS are major public health problems in Cameroon where the HIV prevalence is 5.5. Candidiasis is the leading opportunistic mycosis in HIV and AIDS patients. The objective of this study was to determine the in vitro antifungal susceptibility pattern of Candida albicans in HIV and AIDS patients to eight antifungal agents in the Nylon Health District of Douala in Cameroon. Three hundred and four HIV and AIDS patients were recruited between March and August 2007 to participate in a cross-sectional study. All subjects who fulfilled the inclusion criteria were enrolled. Informed consent was obtained from all subjects before samples were collected. Three samples comprising oral swabs; vagina/urethra swabs and a mid-stream urine were collected from each subject. Specimens were cultured on sabouraud dextrose agar and C. albicans isolates were identified using the germ tube technique. The disk diffusion method was used for antifungal susceptibility testing using eight antifungal agents. The prevalence of candidiasis in the study population was 67.8 (95 CI: 62.5-73.1) and that of C. albicans was 42.8 (95 CI: 37.2-48.4). Oral swabs had the highest prevalence of C. albicans followed by vaginal/urethral samples (52.6 vs. 29.7) subjects had C. albicans infection at more than one collection site. There was a statistically significant difference in the infectivity of C. albicans with age; sex and site of infection (P0.05). C. albicans isolates were most sensitive to ketoconazole (80) followed by econazole (64.6) while fluconazole and 5-flurocytosin recorded the poorest sensitivities (22.9 vs 24.6; respectively). There was a statistically significant difference in the sensitivity pattern of antifungal agents with respect to the site of isolation of the organism (P0.05). Ketoconazole is the drug of choice for the treatment of C. albicans infection in HIV and AIDS patients in the Nylon Health District of Douala; Cameroon

Seroprevalence of Toxoplasma Gondii Infection among Pregnant Women in Cameroon

Toxoplasmosis is caused by an intracellular protozoan; Toxoplasma gondii; which has a wide geographical distribution. The congenital form results in a gestational form that can present a temporary parasiteamia that will infect the fetus. For this reason early diagnosis in pregnancy is highly desirable; allowing prompt intervention in cases of infection. The aim of this study was to determine the seroprevalence of Toxoplasma gondii antibodies among pregnant women attending the Douala General Hospital. The study was carried out between March and July 2009; whereby 110 pregnant women were tested for IgG and IgM antibodies and information about eating habits and hygienic conditions was collected using a questionnaire. These women's ages ranged from 20-44 years old with an average of 29.9 years; the overall IgG and IgM seroprevalence was 70and 2.73respectively. Seroprevalence was significantly high amongst women who ate raw vegetables (76.39; P0.05) and there was a significant trend towards a higher seroprevalence in women who did not have a good source of water (75.58; P0.05). This research showed that consumption raw vegetables and poor quality drinking water are two risk factors associated with Toxoplasma gondii infection amongst pregnant women attending the Douala General Hospital in Cameroon

Genital Mycoplasmas in Women Attending the Yaounde University Teaching Hospital in Cameroon

Genital mycoplasmas are implicated in pelvic inflammatory diseases; puerperal infection; septic abortions; low birth weight; nongonococcal urethritis and prostatitis as well as spontaneous abortion and infertility in women. There is paucity of data on colonisation of genital mycoplasma in women and their drug sensitivity patterns. The aim of our study was to determine the prevalence of genital mycoplasmas (Ureaplasma urealiticum and Mycoplasma hominis) infection and their drug sensitivity patterns in women. A mycofast kit was used for biochemical determination of mycoplasma infection in 100 randomly selected female patients aged 19-57 years; attending the University of Yaounde Teaching Hospital (UYTH) from March to June 2010. Informed consent was sought and gained before samples were collected. Genital mycoplasmas were found in 65 patients (65) [95CI=55.7-74.3] and distributed as 41 (41) [95CI=31.4-50.6] for U. urealiticum and 4 (4) [95CI=0.20-7.8] for M. hominis while there was co-infection in 20 women (20) [95CI=12.16-27.84]. In our study; 57 (57) [95CI=47.3- 67] had other organisms; which included C. albicans (19 [19]); G. vaginalis (35 [35]) and T. vaginalis (3 [3]). Among the 65 women with genital mycoplasma; the highest co-infection was with G. vaginalis (33.8). Pristinamycine was the most effective antibiotic (92) and sulfamethoxazole the most resistant (8) antibiotic to genital mycoplasmas. We concluded that genital mycoplasma is a problem in Cameroon and infected women should be treated together with their partners

Social Stigma as an Epidemiological Determinant for Leprosy Elimination in Cameroon

Leprosy has been eliminated as a public health problem in most countries of the world according to the WHO; but the social stigma to the disease is still very high. The present study was performed to investigate the role of social stigma as a determinant for leprosy elimination in a leprosy endemic region of Cameroon. Focus group discussions; in-depth interviews and structured questionnaires were used to investigate leprosy social stigma among lepers; their contacts and a control group consisting of patients attending a health facility for reasons other than leprosy. Informed consent was sought and gained prior to starting the study. Focus group discussions and in-depth interviews identified three types of stigma: lack of self-esteem; tribal stigma and complete rejection by society. From the 480 structured questionnaires administered; there were overall positive attitudes to lepers among the study population and within the divisions (P=0.0). The proportion of participants that felt sympathetic with deformed lepers was 78.1[95confidence interval (CI): 74.4-81.8] from a total of 480. Three hundred and ninety nine (83.1) respondents indicated that they could share a meal or drink at the same table with a deformed leper (95CI: 79.7-86.5). Four hundred and three (83.9) participants indicated that they could have a handshake and embrace a deformed leper (95CI: 80.7-87.3). A total of 85.2(95.0CI: 81.9-88.4) participants affirmed that they could move with a deformed leper to the market or church. A high proportion of 71.5(95.0CI: 67.5-75.5) participants stated that they could offer a job to a deformed leper. The results indicate that Menchum division had the lowest mean score of 3.3 on positive attitudes to leprosy compared with Mezam (4.1) and Boyo (4.8) divisions. The high proportion of positive attitudes among the participants and in different divisions is a positive indicator that the elimination of leprosy social stigma is progressing in the right direction. Quantification of stigma to assess the elimination struggle is a new research area in public health

Operational barriers to the implementation of multidrug therapy and leprosy elimination in Cameroon.

Background: The World Health Organization targeted to eliminate leprosy from the world with multidrug therapy (MDT) by 2000. But, leprosy remains a problem in Essimbiland of Menchum Division of Cameroon, with a prevalence of 1.7/10,000 and high rate of case detection in children. Aims: To assess knowledge and practices on the cure of leprosy, treatment duration, drug availability and problems faced by leprosy patients acquiring drugs in order to enhance MDT implementation and leprosy elimination in Menchum and Boyo divisions. Methods: Observational study in which a structured questionnaire was administered to leprosy patients, their contacts and a control group. Results: 480 respondents were interviewed and 405 (84.8%) (95% confidence interval [CI]: 81.6-87.2%) knew that leprosy can be cured. These respondents comprised 166 (92.2%) of 180 contacts, 129 (93.5%) of 138 patients and 110 (67.9%) of 162 controls. Two hundred and fourteen (44.6%) (95% CI: 40.1-48.9%) respondents knew that leprosy treatment is free, comprising of 110 (51.4%) patients, 99 (46.3%) contacts and five (2.3%) controls. A statistically significant difference in the knowledge on free treatment of leprosy was found to exist between leprosy patients, contacts and controls, with leprosy patients having a better knowledge (79.71%) (95% CI: 73-86.42%), followed by contacts (55.0%) (95% CI: 47.73-62.26%) and controls (3.1%) (95% CI: 0.43-5.77%) (P = 0.00). Pertinent problems faced by patients in getting MDT included distant health facilities and poor road network (91[19.0%]), lack of confidence in treatment (56 [11.7%]), MDT shortage (45 [9.4%]), few health facilities (52 [10.8%]), gratification demands (25 [5.2%]), disturbance from other illnesses (24 [5.0]), ignorance (21 [4.4%]) and poor relationship with nurses (24 [5.0%]). Conclusion: Patients still face problems in getting free MDT. Better MDT implementation and leprosy elimination strategies are proposed.