The Relationship between Adiposity and Insulin Sensitivity in African Women Living with the Polycystic Ovarian Syndrome: A Clamp Study.

Objectives. We aimed to assess the variation of insulin sensitivity in relation to obesity in women living with PCOS in a sub-Sahara African setting. Methods. We studied body composition, insulin sensitivity, and resting energy expenditure in 14 PCOS patients (6 obese and 8 nonobese) compared to 10 matched nonobese non-PCOS subjects. Insulin sensitivity was assessed using the gold standard 80 mU/m(2)/min euglycemic-hyperinsulinemic clamp and resting energy expenditure was measured by indirect calorimetry. Results. Insulin sensitivity adjusted to lean mass was lowest in obese PCOS subjects and highest in healthy subjects (11.2 [10.1-12.4] versus 12.9 [12.1-13.8] versus 16.6 [13.8-17.9], p = 0.012); there was a tendency for resting energy expenditure adjusted for total body mass to decrease across the groups highest in obese PCOS subjects (1411 [1368-1613] versus 1274 [1174-1355] versus 1239 [1195-1454], p = 0.306). Conclusion. In this sub-Saharan population, insulin resistance is associated with PCOS per se but is further aggravated by obesity. Obesity did not seem to be explained by low resting energy expenditure suggesting that dietary intake may be a determinant of the obesity in this context.

Conjoined twins in Cameroon: issues inherent in diagnosis and management in the African context.

Conjoined twins represent one of the rarest forms of congenital abnormalities. We present a case of conjoined twins delivered at born in the Yaounde Gynaeco-Obstetric and Pediatric Hospital in Cameroon. They were joined at the chest and abdomen, and had one functional heart. The outcome was fatal on the seventh day of life, despite appropriate reanimation measures. This case highlights the difficulties inherent in the diagnosis and management of conjoined twins in low resource settings.

Adverse perinatal outcomes of adolescent pregnancies in Cameroon.

BACKGROUND: There are geographic variations in fetal outcomes of adolescent pregnancies because of socio-economic differences between regions and countries. The aim of our study was to determine adverse fetal outcomes associated with adolescent pregnancies in Cameroon. METHODS: A cross-sectional study to compare the outcomes of 268 singleton, adolescent pregnancies with 832 controls, delivered in four referral hospitals in Yaounde (Cameroon), between November 2004 and April 2005. RESULTS: The adverse fetal outcomes related to adolescent pregnancies were low birth weight (<2,500 g) (odds ratios [OR], 1.71; confidence interval [CI], 1.15-2.50), premature babies (<37 weeks) (OR, 1.77; CI, 1.24-2.52) and early neonatal death (OR, 2.18; CI, 1.04-4.48). The rates of stillbirth and intrauterine growth retardation were not significantly higher among adolescents. Adverse maternal outcome associated with adolescent pregnancies were eclampsia (OR, 3.18; CI, 1.21-8.32), preeclampsia (OR, 1.99; CI, 1.24-3.15), perineal tear (OR, 1.45; CI, 1.06-1.99) and episiotomy (OR, 1.82; CI, 1.20-2.73). Caesarean delivery, instrumental delivery and premature rupture of membranes were not significantly associated with adolescent pregnancy. Maternal factors associated with adverse fetal outcome in adolescents were maternal age, number of prenatal visits <4, and the state of being unemployed. CONCLUSION: Adolescent pregnancies are associated with both adverse fetal and maternal outcomes in Cameroon. Improving compliance with prenatal care could significantly reduce the frequency of adverse fetal outcomes in adolescent populations in Cameroon.

Safety and acceptability of 6% cellulose sulfate vaginal gel applied four times per day for 14 days.

BACKGROUND: Six percent cellulose sulfate (CS) is a vaginal gel that has been in development as a microbicide. STUDY DESIGN: This was a single-center, multi-dose, Phase I, placebo-controlled, randomized, fully masked study conducted in Yaoundé, Cameroon, and involving sexually active women at low risk for sexually transmitted infections (STIs). METHODS: The study assessed the effect of CS and K-Y Jelly applied vaginally four times per day, for 14 consecutive days, on genital epithelial disruption, candidiasis and bacterial vaginosis (BV). Acceptability of the products was also assessed. Twenty-seven women were enrolled in each treatment group. RESULTS: Two (7.4%) of the women in each group developed genital epithelial disruption. One (3.7%) of the women in each group developed candidiasis, and one (3.7%) of the K-Y users developed BV. One (3.7%) of the CS users said she would not buy her product for pregnancy prevention but would for STI prevention. All the remaining women indicated they would buy their product for both indications. CONCLUSION: The results suggest that the safety and acceptability of 6% CS gel are comparable to that of K-Y Jelly.

A survey of knowledge, attitudes and practice of emergency contraception among university students in Cameroon.

BACKGROUND: Unsafe abortion is a major public health problem in low-and-middle income countries. Young and unmarried women constitute a high risk group for unsafe abortions. It has been estimated that widespread use of emergency contraception may significantly reduce the number of abortion-related morbidity and mortality. The purpose of this study was to evaluate the knowledge, attitudes and experiences on emergency contraceptive pills by the university students in Cameroon in order to develop and refine a national health programme for reducing unwanted pregnancies and their associated morbidity and mortality. METHODS: A convenient sample of 700 students of the University of Buea (Cameroon) was selected for the study. Data was collected by a self-administered, anonymous and pre-tested questionnaire. RESULTS: The response rate was 94.9% (664/700). General level of awareness of emergency contraceptive pills was 63.0% (418/664). However, knowledge of the general features of emergency contraceptive pills was low and misinformation was high among these students. Knowledge differed according to the source of information: informal source was associated with misinformation, while medical and informational sources were associated with better knowledge. Although the students generally had positive attitudes regarding emergency contraceptive pills, up to 65.0% (465/664) believed that emergency contraceptive pills were unsafe. Those with adequate knowledge generally showed favourable attitudes with regards to emergency contraceptive pills (Mann-Whitney U = 2592.5, p = 0.000). Forty-nine students (7.4%) had used emergency contraceptive pills themselves or had a partner who had used them. CONCLUSION: Awareness of emergency contraception pills by Cameroonian students is low and the method is still underused. Strategies to promote use of emergency contraception should be focused on spreading accurate information through medical and informational sources, which have been found to be reliable and associated with good knowledge on emergency contraceptive pills.