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.

Toward the elimination of hepatitis B: networking to promote the prevention of vertical transmission of hepatitis B virus through population-based interventions and multidisciplinary groups in Africa.

The WHO African Region had 81 million people with chronic hepatitis B in 2019, which remains a silent killer. Hepatitis B virus (HBV), hepatitis delta virus (HDV), and HIV can be transmitted from the mother to child. If the HBV infection is acquired at infancy, it may lead to chronic hepatitis B in 90% of the cases. WHO reports that 6.4 million children under 5 years live with chronic hepatitis B infection worldwide. The prevention of mother-to-child transmission (PMTCT) of HBV is therefore critical in the global elimination strategy of viral hepatitis as we take lessons from PMTCT of HIV programs in Africa. We sought to create a network of multidisciplinary professional and civil society volunteers with the vision to promote cost-effective, country-driven initiatives to prevent the MTCT of HBV in Africa. In 2018, the Mother-Infant Cohort Hepatitis B Network (MICHep B Network) with members from Cameroon, Zimbabwe, and the United Kingdom and later from Chad, Gabon, and Central African Republic was created. The long-term objectives of the network are to organize capacity-building and networking workshops, create awareness among pregnant women, their partners, and the community, promote the operational research on MTCT of HBV, and extend the network activities to other African countries. The Network organized in Cameroon, two "Knowledge, Attitude and Practice" (KAP) surveys, one in-depth interview of 45 health care workers which revealed a high acceptability of the hepatitis B vaccine by families, two in-person workshops in 2018 and 2019, and one virtual in 2021 with over 190 participants, as well as two workshops on grant writing, bioethics, and biostatistics of 30 postgraduate students. Two HBV seroprevalence studies in pregnant women were conducted in Cameroon and Zimbabwe, in which a prevalence of 5.8% and 2.7%, respectively, was reported. The results and recommendations from the MICHep B Network activities could be implemented in countries of the MICHep B Network and beyond, with the goal of providing free birth dose vaccine against hepatitis B in Africa.

Enhancing interventions for prevention of mother-to-child- transmission of hepatitis B virus.

Prevention of mother-to-child transmission of hepatitis B virus (HBV) infection is a cornerstone of efforts to support progress towards elimination of viral hepatitis. Current guidelines recommend maternal screening, antiviral therapy during the third trimester of high-risk pregnancies, universal and timely HBV birth dose vaccination, and post-exposure prophylaxis with hepatitis B immunoglobulin for selected neonates. However, serological and molecular diagnostic testing, treatment and HBV vaccination are not consistently deployed, particularly in many high endemicity settings, and models predict that global targets for reduction in paediatric incidence will not be met by 2030. In this article, we briefly summarise the evidence for current practice and use this as a basis to discuss areas in which prevention of mother-to-child transmission can potentially be enhanced. By reducing health inequities, enhancing pragmatic use of resources, filling data gaps, developing advocacy and education, and seeking consistent investment from multilateral agencies, significant advances can be made to further reduce vertical transmission events, with wide health, societal and economic benefits.

Stillbirths in Cameroon: an analysis of the 1998-2011 demographic and health surveys.

BACKGROUND: Many countries, including Cameroon, have found it challenging to estimate stillbirths, as there are limited available reports accurately. This analysis aimed to assess stillbirth rates and identify risk factors for stillbirth in Cameroon using successive Demographic and Health Survey data. METHODS: We conducted a cross-sectional analysis of data collected during the Demographic and Health Surveys of 1998, 2004, and 2011. Data were analyzed using SPSS 20.0. Logistic regressions were used to identify factors associated with stillbirth through odds ratios (ORs) at 95% confidence intervals (CI). Results were considered statistically significant at p-value less than 0.05. RESULTS: The crude stillbirth rate was 21.4 per 1,000 births in 2004 and 24 per 1,000 births in 2011, with respective standard errors of 1.8 and 1.3. The stillbirth rate increased with the mother's age (p < 0.001). The stillbirth rate reduction was prolonged between 1998 and 2011, with an annual reduction rate of 1.6%. The study observed that residing in rural areas, low socioeconomic status, and low level of education were risk factors associated with stillbirths. CONCLUSION: Cameroon's stillbirth rate remains very high, with a slow reduction rate over the last 20 years. Although some efforts are ongoing, there is still a long way forward to bend the curve for stillbirths in Cameroon; supplementary strategies must be designed and implemented, especially among rural women, the poor, and the less educated.

Using family planning service statistics to inform model-based estimates of modern contraceptive prevalence.

The annual assessment of Family Planning (FP) indicators, such as the modern contraceptive prevalence rate (mCPR), is a key component of monitoring and evaluating goals of global FP programs and initiatives. To that end, the Family Planning Estimation Model (FPEM) was developed with the aim of producing survey-informed estimates and projections of mCPR and other key FP indictors over time. With large-scale surveys being carried out on average every 3-5 years, data gaps since the most recent survey often exceed one year. As a result, survey-based estimates for the current year from FPEM are often based on projections that carry a larger uncertainty than data informed estimates. In order to bridge recent data gaps we consider the use of a measure, termed Estimated Modern Use (EMU), which has been derived from routinely collected family planning service statistics. However, EMU data come with known limitations, namely measurement errors which result in biases and additional variation with respect to survey-based estimates of mCPR. Here we present a data model for the incorporation of EMU data into FPEM, which accounts for these limitations. Based on known biases, we assume that only changes in EMU can inform FPEM estimates, while also taking inherent variation into account. The addition of this EMU data model to FPEM allows us to provide a secondary data source for informing and reducing uncertainty in current estimates of mCPR. We present model validations using a survey-only model as a baseline comparison and we illustrate the impact of including the EMU data model in FPEM. Results show that the inclusion of EMU data can change point-estimates of mCPR by up to 6.7 percentage points compared to using surveys only. Observed reductions in uncertainty were modest, with the width of uncertainty intervals being reduced by up to 2.7 percentage points.

[Using anthropology to improve newborn health care in Cameroon]. / Une anthropologie impliquée pour améliorer les soins aux nouveau-nés au Cameroun.

INTRODUCTION: Policy directions in the health sector are based on research which provides insight into implemented actions and helps to formulate improvement recommendations for health. In Cameroon, an innovative experience of anthropological research on newborn health was followed by a process of appropriating findings by the Ministry of Public Health aiming at improving the quality of care. We suggest reporting this Cameroonian experience of interdisciplinary collaboration and involved research. METHOD: Coinciding with the anthropological study on newborn care in hospital maternities and at home conducted by researchers in the field of anthropology from December 2016 to June 2017, a process of appropriating findings was carried out. This article accurately describes this process both at the peripheral level, during "reflexive returns" in investigated maternity hospitals, and at the central level within the framework of work conducted by the study's steering committee. It reports on the changes that have taken place as a result of the study both at the level of health structures and at the level of national policies and strategies with a view to improving the quality of newborns care. RESULTS: The output of this process is twofold. At the peripheral level, activities of "reflexive returns" led to in situ changes of some harmful practices detrimental to the survival of the newborn, such as inappropriate use of the cradle in the birth room and lack of knowledge relative to the fight against hypothermia through the practice of skin-to-skin contact. At central level, changes concerned communication and strengthening policies and strategies of newborn care. CONCLUSION: The contribution of anthropology in the production evidence-based data is of paramount importance for the implementation of strategies to improve the quality of neonatal care. It opens up new perspectives for the sustainable improvement of the quality of care for newborns.

[Factors associated to the coiling of umbilical cord: case-control study conducted in three hospitals in Yaoundé]. / Facteurs associés aux circulaires du cordon: étude cas-témoin dans trois hôpitaux de Yaoundé.

INTRODUCTION: The coiling of umbilical cord is the winding of the umbilical cord around a part of the fetal body once or several times. It is the most common abnormality of the cord, its prevalence varies according to the authors from 5.7% to 35.1%. In 2011, the rate of perinatal mortality due to the coiling of umbilical cord in Cameroun was 6.1%. However factors associated to it are little known in our context. Our purpose was to determine factors associated to the coiling of umbilical cord in three hospitals in Yaoundé. METHODS: We conducted an analytical case-control study in the Maternity Unit at the Central Hospital of Yaoundé, the University Teaching Hospital of Yaoundé and the Social and Health Nkoldongo Animation Center over a period of 4 months. The study-group composed of newborns with coiling of umbilical cord was compared with two control groups (newborns without coiling of umbilical cord). All the fetuses were cephalic at delivery (singleton pregnancies at term). Pre-established technical data sheets were filled with data collected and analyzed based on the Microsoft Excel 2017 and SPSS software Version 23. The parameters used for the analysis were the average age, standard deviation and frequency, the raw odds ratio (OR) and/or adjusted (aOR) with their 95% confidence interval. P was considered significant for any value less than 5. RESULTS: Out of a total of 3,300 deliveries, 500 newborns (15.15%) had coiling of umbilical cord. All the coils were around the neck. We retained and studied 136 newborns with coiling of umbilical cord (study group) vs 272 newborns without coiling of umbilical cord (control group). Factors independently associated with coiling were non editable: length of the cord = 70cm (ORa = 32 CI = 17.5-35 p = 0.02), male sex (ORa = 67.09 CI = 22.31 - 97.46 P = 0.001), APGAR score 5th minute <7 (ORa =76.98 CI = 2.19 - 27.05 P=0.017) and modifiable factors were gestational age = 42WA (ORa = 15.15 CI = 6.14-18.2 P = 0.001). CONCLUSION: The coiling of umbilical cord is a frequent cord abnormality. We suggest to the decision-makers to increase awareness among health workers and the population on the importance of ultrasound scan of the third trimester in order to detect coiling of umbilical cord and implement appropriate manage newborns. Clinicians should avoid as much as possible post-term pregnancy.

Une anthropologie impliquée pour améliorer les soins aux nouveau-nés au Cameroun.

INTRODUCTION: Policy directions in the health sector are based on research which provides insight into implemented actions and helps to formulate improvement recommendations for health. In Cameroon, an innovative experience of anthropological research on newborn health was followed by a process of appropriating findings by the Ministry of Public Health aiming at improving the quality of care. We suggest reporting this Cameroonian experience of interdisciplinary collaboration and involved research. METHOD: Coinciding with the anthropological study on newborn care in hospital maternities and at home conducted by researchers in the field of anthropology from December 2016 to June 2017, a process of appropriating findings was carried out. This article accurately describes this process both at the peripheral level, during "reflexive returns" in investigated maternity hospitals, and at the central level within the framework of work conducted by the study's steering committee. It reports on the changes that have taken place as a result of the study both at the level of health structures and at the level of national policies and strategies with a view to improving the quality of newborns care. RESULTS: The output of this process is twofold. At the peripheral level, activities of "reflexive returns" led to in situ changes of some harmful practices detrimental to the survival of the newborn, such as inappropriate use of the cradle in the birth room and lack of knowledge relative to the fight against hypothermia through the practice of skin-to-skin contact. At central level, changes concerned communication and strengthening policies and strategies of newborn care. CONCLUSION: The contribution of anthropology in the production evidence-based data is of paramount importance for the implementation of strategies to improve the quality of neonatal care. It opens up new perspectives for the sustainable improvement of the quality of care for newborns.

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

Rates of HBV, HCV, HDV and HIV type 1 among pregnant women and HIV type 1 drug resistance-associated mutations in breastfeeding women on antiretroviral therapy.

BACKGROUND: HBV, HCV, HDV and HIV are blood borne and can be transmitted from mother-to-child. Reports of HBV infection rates show up to 11.9% in Cameroon while for HCV, the rate is less than 2%. More so, as pregnant women get enrolled in the HIV PMTCT Programme and stay in the care continuum, selection of HIV-1 drug resistant strains is evident. We sought to determine the seroprevalence of HBV, HCV, HDV and HIV among pregnant women, assess their knowledge, attitudes and practices on transmission and prevention of HBV infection, and determine HIV drug resistance profile of breastfeeding women. METHODS: A serosurvey of HBV, HCV, HDV and HIV was carried out among 1005 pregnant women in Yaounde, Cameroon. In 40 HIV-infected breastfeeding women enrolled in the PMTCT Programme, HIV-1 genotypes and HIV-1 resistance to NRTIs, NNRTIs and PIs, were determined by phylogeny and the Stanford University HIV Drug Resistance interpretation tool, respectively. RESULTS: Among the pregnant women, the rates of HIV-1, HBV, HCV and HDV infections were 8.5, 6.4, 0.8 and 4.0%, respectively. About 5.9% of the women knew their HBV status before pregnancy unlike 63.7% who knew their HIV status. Although 83.3% reported that vaccination against HBV infection is a method of prevention, and 47.1% knew that HBV could be transmitted from mother-to-child, only 2.5% had received the Hepatitis B vaccine. Of the 40 women on antiretroviral therapy (ART), 9 had at least one major resistance-associated mutation (RAM, 22.5%) to NRTI, NNRTI or PI. Of these M184 V (12.5%), K70R (10.0%), K103 N (12.5%), Y181C (10.0%), M46 L (2.5%) and L90 M (2.5%) were most frequently identified, suggesting resistance to lamivudine, nevirapine, efavirenz and zidovudine. Eighty four percent were infected with HIV-1 recombinant strains with CRF02_AG predominating (50%). CONCLUSIONS: The rates of HBV and HIV-1 infections point to the need for early diagnosis of these viruses during pregnancy and referral to care services in order to minimize the risk of MTCT. Furthermore, our results would be useful for evaluating the HIV PMTCT Programme and Treatment Guidelines for Cameroon.

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.

An assessment of antiretroviral drug initiation to pregnant women of unknown HIV status during labour and delivery in Cameroon.

BACKGROUND: Evidence from previous research has shown that antiretroviral (ARV) drug initiation to seropositive pregnant women could significantly contribute to eliminating new paediatric infections even when started during labour and delivery. This study therefore seeks to assess missed opportunities for ARV initiation during this critical period of pregnancy to improve outcomes of the prevention of mother-to-child transmission (PMTCT) programmes in Cameroon. METHODS: A retrospective study was conducted on the 2014 PMTCT data for labour and delivery among pregnant women of unknown HIV status within health facilities in six regions of Cameroon (428 eligible facilities). Outcomes were summarised using (relative) frequencies. ARV initiations for eligible facilities were stratified per region and per facility type (public and private facilities). Initiation to ARV was reported using odds ratios and 95% confidence intervals. RESULTS: An average of 14.6% of the 9 170 pregnant women presenting with unknown HIV status at labour and delivery, were diagnosed HIV-positive. A cumulative average from the six regions revealed that only half (51.4%) of these seropositive women received an ARV regimen. The findings from the North-West region depict 100% initiation to ARV among the study population. The odds of ARV initiation in the study population was more likely in the public health facilities than the private facilities for five regions, excluding the North-West (odds ratio of 1.35 [1.07, 170]). CONCLUSION: A significant portion of women do not receive the care required, especially in private health facilities. Evidence from the results in the North West region suggest that processes to address health system barriers to improve PMTCT uptake are feasible in Cameroon.

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.

Evaluation of the offer of family planning services in a rural area of the Bamboutos division in the west region of Cameroon: a cross sectional study

Background and aim. The rate of utilization of contraceptive methods in Cameroon is low. The western region has a high fecundicity index and among the women in union using any contraception (30.2%), only 32.5% of them are using a modern method. This study aimed at improving the offer of family planning (FP) services by identifying factors limiting its expansion. Methods. We conducted a descriptive cross-sectional study from 1st January to 31st December 2011 in the Bamboutous health district of the West region of Cameroon. We included exhaustively public and private health institutions. The characteristics of health institutions, providers and various FP services offered were obtained from registers and interview of health care providers. Data was analyzed using Epi info software version 3.5.1. Results. Of the 68 health facilities in the Bamboutous health district, 25 (36.8%) offered FP services. Among them, 18 were public (72%), 21(84%) had been existing for over 5-years period and the service offer was integrated (88%). There was often no pipe-borne water (72%). Eighteen of 25 FP institutions had no personnel who had ever received any formal training in FP (72%). Unmet contraceptive need was estimated at 34.7%. The different contraceptive methods received by women were more often injectables (37.3%) and implants (12.6%). Male condom represents 30.8%. Conclusion. The health services in the Bamboutous division are poorly furnished with FP activities in spite of met-needs of 65.3%. Improving on the service offer for FP as well as the training of health care providers is highly recommended

Use of a social media network to reduce early neonatal mortality: a preliminary report from a quality improvement project in Yaoundé, Cameroon.

BACKGROUND: Perinatal networks have yielded substantial contribution in decreasing the neonatal mortality rate. We present here the process of implementation of a perinatal network in Yaoundé (Cameroon) based on the WhatsApp messenger application as well as some preliminary results and achievements. METHODS: In December 2016, the Yaoundé Perinatal Network was launched, regrouping a multidisciplinary team of health professionals dealing with perinatal care in Yaoundé, Cameroon. The network takes advantage of WhatsApp facilities and is coordinated by 5 administrators. One of their main duties is to have a twice-daily updated status of the available equipment (incubators, oxygen and phototherapy) and bed capacities across the Yaoundé pediatric units. Once a request is sent through the network, other members react, either by giving advice or by telling where the desired equipment or expertise is available at that moment. Then, the baby is immediately prepared for transfer, occurring once the receiving pediatric unit has attested that it is already prepared to receive the new patient. RESULTS: From December 18, 2016 to July 31, 2017, 139 members representing all the principal maternities and tertiary pediatric units in Yaoundé were already included in the network. The network permitted instant sharing of knowledge and information between its members for an optimal delivery of care. Two hundred and seventeen neonates were transferred using the network; the median time of response after a request had been sent was 19.5 min and the delay in transferring a neonate averaged 70 min. CONCLUSION: Taking account of the preliminary promising notes, there is hope that the Yaoundé Perinatal Network will help to reduce neonatal mortality in our context. Lessons learned from its implementation will serve to replicate this innovative health action in other towns of the country. Moreover, this experience could be a source of inspiration for other countries facing similar challenges.

Cesarean sections in a secondary level care hospital of Cameroon: an analysis of their six-year trends and adverse neonatal outcomes.

BACKGROUND: The objectives of this study were to determine the trends of CS in a regional hospital in Cameroon and to explore its association with adverse neonatal outcomes. METHODS: The study was conducted in the Buea Regional Hospital (BRH), Cameroon. A 6-year retrospective records analysis was used to determine the trends in rates of CS and neonatal adverse outcomes. In a 3-month prospective phase, indications of CS were identified. RESULTS: Of a total of 4941 records reviewed from the year 2007 to 2012, the overall CS rate was 20.4%. The rates increased from 17.1% in 2007 to 20.9% in 2012, with a peak of 22.7% in 2011, but this time-trend was not significant (p-trend =0.06). Three of the 25 cases of CS (12%) in the prospective phase were done at the request of mothers. The odds of having a low first minute APGAR (APGAR <7) in neonates born from CS were higher than in neonates born from a normal delivery (OR = 6.6 and 95% CI 5.7-7.7; p < 0.01). CONCLUSION: One out of every five women give birth through a CS in the BRH. This rate of CS is relatively high for a suburban population in a developing country. Strategies to reduce these rates should be investigated and instituted in the BRH to reduce health expenditures.

[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.

High birth weight in a suburban hospital in Cameroon: an analysis of the clinical cut-off, prevalence, predictors and adverse outcomes.

BACKGROUND AND AIMS: High birth weight (HBW) increases the risk of maternal and fetal morbidity and mortality. Its prevalence and adverse outcomes may be reduced if risk factors are identified and managed during pregnancy. The cut-off value for HBW remains debatable. The objectives of this study were to identify the optimal cut-off value and determine the prevalence, predictors and adverse outcomes of HBW in a suburban area of Cameroon. DESIGN: A 6-year retrospective register analysis and a 3-month prospective phase. SETTING: A secondary care level (regional) hospital in the city of Buea (southwest region of Cameroon). PARTICIPANTS: Women who delivered in this hospital over a 6-year period (retrospective phase) and consenting pregnant mothers and their infants (singletons, born at >28 weeks gestation) (prospective phase). OUTCOME MEASURES: 90th centile of birth weights; prevalence of HBW defined as birth weight above the 90th centile; sociodemographic, maternal and obstetrical factors associated with HBW; maternal and neonatal adverse outcomes of HBW. RESULTS: Of the 4941 newborns reviewed in registers, the 90th centile of birth weights was 3850 g. Using this new cut-off, we obtained a prevalence of 14.0% for HBW in the 200 newborns included in the prospective phase. This was significantly higher than the prevalence (9.5%) yielded when the traditional cut-off of 4000 g was used (p=0.003). None of the factors assessed was independently associated with HBW. Newborns with HBW were more likely to have shoulder dystocia (p<0.01), and their mothers more likely to suffer from prolonged labour (p=0.01) and postpartum haemorrhage (p<0.01). CONCLUSIONS: The results of this study suggest that the cut-off for HBW in this population should be 3850 g. Thus, 3 of every 10 babies born with HBW in this hospital are likely not receiving optimal postnatal care because 4000 g is currently used to qualify for additional support.