Episiotomies During Deliveries of Singletons in Cephalic Presentation: The Incidence can be Reduced.

OBJECTIVES: To verify if episiotomy rate could be reduced without compromising materno-fetal well-being. MATERIAL AND METHODS: This retrospective study was conducted between January 1 and December 31, 2010 in the maternity unit of the University Teaching Hospital Yaoundé (Cameroon). All cases of singletons in cephalic presentation with episiotomies done or not done during deliveries were recruited. Data were analyzed by means of SPSS 12.0. The Fisher's exact test was used for comparison. The level of significance was 0.05. RESULTS: We performed 163 episiotomies (9.6 %). Main indications were rigid perineum, fetal weight ≥3,500 g, prolonged second stage of labor, and instrumental deliveries; 82.2 % of patients were nullipara. Mean 5th minute Apgar score was 9.2. Short term maternal complications were mainly perineal pain. Among fetuses delivered with or without episiotomy, no case of early neonatal death was recorded. CONCLUSIONS: The use of episiotomy can be reduced without increasing maternal and fetal morbidities.

Outcome of breech deliveries in cameroonian nulliparous women.

OBJECTIVE: To evaluate nulliparous breech delivery so as to determine prognostic factors for an unsafe vaginal delivery (VD). METHODS: This retrospective and descriptive study was carried out in the University Teaching Hospital Yaoundé-Cameroon, from January 1, 2005 to December 31, 2009. Files of 126 women with singletons in breech presentation and normal fetal heart beats at a gestational age ≥32 weeks were reviewed with a trial of VD ordered in 104. The parameters recorded were mother's age, gestational age, mode of delivery, birth weight, 5th minute Apgar scores, neonatal outcome, and use of episiotomy. RESULTS: The results showed that 84 (66.7 %) had a successful VD. Failure of VD or poor Apgar score after VD were observed if fetal weight ≥3,500 or <1,800 g, footling breech, maternal age >28 or <19 years, post term, and rigid cervix. CONCLUSIONS: Elective cesarean section should be systematic if the unsafe circumstances above mentioned are present.

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.

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.

Wealth and sexual behaviour among men in Cameroon.

BACKGROUND: The 2004 Demographic and Health Survey (DHS) in Cameroon revealed a higher prevalence of HIV in richest and most educated people than their poorest and least educated compatriots. It is not certain whether the higher prevalence results partly or wholly from wealthier people adopting more unsafe sexual behaviours, surviving longer due to greater access to treatment and care, or being exposed to unsafe injections or other HIV risk factors. As unsafe sex is currently believed to be the main driver of the HIV epidemic in sub-Saharan Africa, we designed this study to examine the association between wealth and sexual behaviour in Cameroon. METHODS: We analysed data from 4409 sexually active men aged 15-59 years who participated in the Cameroon DHS using logistic regression models, and have reported odds ratios (OR) with confidence intervals (CI). RESULTS: When we controlled for the potential confounding effects of marital status, place of residence, religion and age, men in the richest third of the population were less likely to have used a condom in the last sex with a non-spousal non-cohabiting partner (OR 0.43, 95% CI 0.32-0.56) and more likely to have had at least two concurrent sex partners in the last 12 months (OR 1.38, 95% CI 1.12-1.19) and more than five lifetime sex partners (OR 1.97, 95% CI 1.60-2.43). However, there was no difference between the richest and poorest men in the purchase of sexual services. Regarding education, men with secondary or higher education were less likely to have used a condom in the last sex with a non-spousal non-cohabiting partner (OR 0.24, 95% CI 0.16-0.38) and more likely to have started sexual activity at age 17 years or less (OR 2.73, 95% CI 2.10-3.56) and had more than five lifetime sexual partners (OR 2.59, 95% CI 2.02-3.31). There was no significant association between education and multiple concurrent sexual partnerships in the last 12 months or purchase of sexual services. CONCLUSION: Wealthy men in Cameroon are more likely to start sexual activity early and have both multiple concurrent and lifetime sex partners, and are less likely to (consistently) use a condom in sex with a non-spousal non-cohabiting partner. These unsafe sexual behaviours may explain the higher HIV prevalence among wealthier men in the country. While these findings do not suggest a redirection of HIV prevention efforts from the poor to the wealthy, they do call for efforts to ensure that HIV prevention messages get across all strata of society.