Incidence, risk factors, clinical presentation and treatment of ectopic pregnancy in the Limbe and Buea Regional Hospitals in Cameroon

Introduction: ectopic pregnancy (EP) is the leading cause of maternal mortality in the first trimester of pregnancy in our environment. This study aimed at evaluating the incidence, risk factors, clinical presentation and treatment of ectopic pregnancy in the Limbe and Buea Regional Hospitals in Cameroon. Methods: this was a retrospective nested case control study carried out from December 2006 to December 2016. A ratio for control vs cases of 3:1 was obtained. Any pregnancy implanted outside the normal uterine cavity was considered as an ectopic pregnancy. Student's t-test was used to compare continuous variables and Pearson's Chi-square test for categorical variables. The association between EP and the demographical and clinical variables was estimated using logistic regression. Statistical significance was set at p-values<0.05.Results: a total of 247 cases of EP were registered out of 17221 deliveries giving an incidence of 1.43% in ten years. History of pelvic inflammatory disease (OR = 3.10, CI (1.76-5.44), p < 0.001), previous EP (OR = 10.22, CI (2.61-14.82), p < 0.001), History of induced abortion (OR = 2.68, CI (3.32-9.73), p< 0.001), history of adnexa surgery (OR = 4.37, CI (2.17-10.32), p < 0.001) and history of appendectomy (OR = 2.16, CI (0.99-6.64) p< 0.001), were also found to be associated with increased risk of EP. More than five percent (5.52%) of the patients were in shock at presentation. Diagnosis was confirmed mainly by use of ultrasound (78.53%) and treatment was principally by laparotomy (97.55%) with salpingectomy (95.60%). Most (90.18%) of ectopic pregnancies were ruptured at presentation. Only 2.45% of cases were manage medically with the use of methotrexate. Conclusion: the incidence of ectopic pregnancy (EP) in our environment is within the global range (hospital-based incidence of 1.43%) and is rising. Late presentation, lack of modern diagnostic and management tools have made laparotomy with salpingectomy the principal method of management of ectopic pregnancy in our environment

Prevalence of bacterial vaginosis and associated risk factors in pregnant women receiving antenatal care at the Kumba Health District (KHD), Cameroon.

BACKGROUND: Bacterial vaginosis (BV) is a common reproductive tract disorder in women of child bearing age, accounting for one third of vaginal infections. It is characterized by an increase in vaginal pH, decreased Lactobacilli, and overgrowth of facultative and anaerobic bacteria. Studies have consistently shown BV to be a risk factor for adverse obstetric and gynecological outcomes. BV is believed to play a critical role in the transmission of sexually transmitted infections. Its aetiology and risk factors are poorly understood. This study determined the prevalence and risk factors for BV among pregnant women in Kumba Health District (KHD) Cameroon to generate findings that could guide the design of interventions for prevention of infection and associated poor pregnancy outcomes. METHODS: A structured questionnaire was administered to 309 women seeking antenatal care (ANC) in three health facilities in KHD between May to July 2016, to capture data on demographic, gynecological and obstetric characteristics, and hygiene behavior. High vaginal swabs (HVS) collected from these women were gram stained, examined under a microscope and BV evaluated by Nugent scoring. Chi square (χ2) test was used to determine the relationship between BV and factors investigated. Statistical significance was set at p < 0.05. RESULTS: The prevalence of BV was 26.2%. Nine point 1 % of participants had a mixed infection with Candida. BV was higher (29.5%) in participants from the rural area (χ2 = 8.609. P = 0.014), those who did not use antibiotics (31.9%) prior to the study (χ2 = 12.893, P = 0.002) and women with no history of a genital tract infection (χ2 = 18.154, P = 0.001). There was a significant difference in prevalence with respect to gestation age (χ2 = 13.959, P = 0.007) with the highest occurring in women in the second trimester (31.7%). Women who practiced douching (χ2 = 23.935, P = 0.000) and those who did not wash pants with disinfectant (χ2 = 7.253, P = 0.027) had a high prevalence. CONCLUSION: BV could be a health concern among pregnant women in study area. BV prevalence was affected by some hygiene behaviors, socio-demographic and clinical factors. Screening and treatment of positive cases during antenatal visits to prevent adverse outcomes, as well as education of women on vaginal hygiene is highly recommended.