Can personalized digital counseling improve consumer search for modern contraceptive methods?

This paper analyzes a randomized controlled trial of a personalized digital counseling intervention addressing informational constraints and choice architecture, cross-randomized with discounts for long-acting reversible contraceptives (LARCs), such as intrauterine devices (IUDs). The counseling intervention encourages shared decision-making (SDM) using a tablet-based app, which provides a tailored ranking of modern methods to each client according to their elicited needs and preferences. Take-up of LARCs in the status quo regime at full price was 11%, which increased to 28% with discounts. SDM roughly tripled the share of clients adopting a LARC at full price to 35%, and discounts had no incremental impact in this group. Neither intervention affected the take-up of short-acting methods, such as the pill. Consistent with theoretical models of consumer search, SDM clients discussed more methods in depth, which led to higher adoption rates for second- or lower-ranked LARCs. Our findings suggest that low-cost individualized recommendations can potentially be as effective in increasing unfamiliar technology adoption as providing large subsidies.

[Factors associated with the failure of medical treatment for ectopic pregnancy: case study conducted at the Yaoundé Gynaecology, Obstetrics and Pediatrics Hospital]. / Facteurs associés à l'échec du traitement médical de la grossesse extra-utérine: cas de l'Hôpital Gyneco-Obstétrique et Pédiatrique de Yaoundé.

Introduction: the purpose of this study was to identify factors associated with the failure of medical treatment for ectopic pregnancy (EP) in women at the Yaoundé Gynaecology, Obstetrics and Pediatrics Hospital. Methods: we conducted a case-control study using a retrospective data collection over a 10-year period from January 1st 2008 to December 31st 2017. Our study included all patients treated for EP; the study group was composed of patients in whom medical treatment had been unsuccessful while the control group was composed of patients in whom medical treatment had been successful. The variables studied were: socio-demographic, clinical, paraclinical and therapeutic features. Consecutive and complete sampling were used. Multivariate analysis was performed. Results: we enrolled 92 patients, including 23 cases and 69 controls. The variables associated with the failure of medical treatment for EP after univariate analysis were: initial ß-HCG (beta-human chorionic gonadotropin) level > 10000IU/L (OR=3.05; P=0.031), ß-HCG level on day 4 > 10000IU/L (OR=7.15;P=0.000), ß-HCG level on day 7 > 10000UI/L (OR=20; P=0.000), Fernandez score ≥ 13 (OR=3.09;P=0.020), the presence of fetal heart activity (OR=2.8; P=0.036), a history of voluntary abortion (OR=2.67;P=0.043) and primary level of education. (P=0.013). After multivariate analysis, predictors were: initial ß-HCG level>10000 IU/L (OR=8.97; P=0.004), ß-HCG level on day 4>10000 IU/L (OR=8.44;P= 0.007), Fernandez score ≥ 13 (OR=1.12;P=0.005), and the presence of fetal heart activity (OR=6.09;P=0,026). Conclusion: at the Yaoundé Gynaecology, Obstetrics and Pediatrics Hospital predictors of failure of medical treatment for EP were related to initial ß-HCG level and fetal viability.

Adiponectin levels and its relation with insulin secretion and insulin sensitivity in a group of sub-Saharan African women with polycystic ovary syndrome.

OBJECTIVES: Low levels of adiponectin have been reported in Polycystic Ovary Syndrome (PCOS). In sub-Saharan Africa, little data are available on the topic. We aimed to investigate the levels of adiponectin and its relation with insulin secretion and insulin sensitivity in women with PCOS in Yaoundé, Cameroon. A comparative cross-sectional study was conducted in 32 women presenting PCOS and 32 controls matched for age and Body Mass Index. For each participant, adiponectin levels were measured. We estimated insulin sensitivity using Homeostasis model index (HOMA-IR) and insulin secretion with C-peptide levels. RESULTS: Women with PCOS had higher insulin secretion levels than controls (C-peptide: 4.98 ± 3.83 vs 3.25 ± 1.62 mUI/l; p = 0.02). Also, the HOMA-IR index was higher compared to that of women without PCOS (1.15 ± 0.90 vs 0.77 ± 0.38; p = 0.03) suggesting greater insulin resistance. The median [25th-75th percentile] values of adiponectin concentrations were similar between the two groups (22.68 [21.72-23.41] µg/ml vs 22.03 [21.40-22.93] µg/ml; p = 0.1). There was no association between insulin sensitivity and adiponectin levels in the PCOS group. PCOS is not associated with changes in adiponectin in a population of sub-Saharan African women. Further studies are needed to shed more light on this condition.

Inflammation and Insulin Resistance in a Group of Sub-Saharan African Women with Polycystic Ovary Syndrome.

BACKGROUND: Studies report high levels of inflammatory markers in women with polycystic ovary syndrome (PCOS), reflecting chronic low-grade inflammation. This inflammation is thought to be associated with insulin resistance. We aim to evaluate inflammatory markers [high sensitivity C reactive protein (CRP) and interleukin 6] and insulin resistance in women with PCOS in Yaoundé, Cameroon. METHODS: We conducted a comparative cross-sectional study including 32 women with PCOS aged between 18 and 44 years and 32 controls matched for age and body mass index (BMI). Homeostasis model assessment of insulin resistance (HOMA-IR) index calculated using C peptide levels was used to evaluate insulin resistance. Serum levels of high sensitivity CRP (hsCRP) and interleukin 6 (IL-6) were measured. Comparisons were made using the Student's T-test and non-parametric tests (Mann-Whitney U-test, Kruskal-Wallis test). RESULTS: We found that the median [25th-75th percentile] level of hsCRP was significantly higher in women with PCOS compared to the controls (0.63 [0.32-3.81] mg/L vs. 0.47 [0.15-1.04] mg/L; p=0.01), while IL-6 levels were not different (8.61 [4.1-33.79] pg/mL for PCOS vs. 8.80 [5.28-38.85] pg/mL for controls; p=0.51). We noted that women with PCOS had a higher HOMA-IR index (1.15±0.90 vs. 0.77±0.38; p=0.03). However, there was no correlation between hsCRP level and the HOMA-IR index (Spearman correlation coefficient=0.10; p=0.62). CONCLUSION: PCOS is associated with an increased level of hsCRP and insulin resistance in Cameroonian women. This exploratory study provides baseline evidence for larger-scale studies.

[Epidemiological, clinical and therapeutic features of acute pelvic pain in female patients hospitalized in the Yaoundé Gynaecology-Obstetrics and Pediatrics Hospital]. / Aspects épidémiologiques, cliniques et thérapeutiques des algies pelviennes aiguës de la femme à l'Hôpital Gynéco-Obstétrique et Pédiatrique de Yaoundé (HGOPY).

INTRODUCTION: Acute pelvic pain is an important cause of morbi-mortality. The purpose of this study was to describe the epidemiological, clinical and therapeutic features of acute pelvic pain in Yaoundé. METHODS: We conducted a cross-sectional, descriptive study with collection of prospective data in the Department of Gynecology and Obstetrics at the Yaoundé Gynaecology-Obstetrics and Pediatrics Hospital over the period 1st April-31st July 2015. We included all female subjects admitted for pelvic pain whose course was less than one month and who agreed to participate in the study. All women who were in the third trimester of pregnancy or in the post-partum period were excluded. Epi info software, version 3.5.4 was used to analyze data. Data were shown as frequency and percentage. RESULTS: During the study period, a total of 5915 women presented to the Yaoundé Gynaecology-Obstetrics and Pediatrics Hospital, of whom 125 (2.11%) had acute pelvic pain. The average age of patients was 29.5 ± 6.9 years. Pain was caused by upper genital tract infections (36.8%) and ectopic pregnancy (18.4%). Most patients received medical treatment (92.8%), associated with antibiotics in 65.5% of cases, anti-inflammatory drugs in 56.9% of cases and analgesics in 39.7% of cases. Surgery was performed in 25 (20%) patients via laparotomy (80%) and coelioscopy (20%). Surgery was indicated in patients with ectopic pregnancy (76% of cases). Regression of pain was obtained in 99% of cases. CONCLUSION: Acute pelvic pain mainly affected young women with upper genital tract infections and ectopic pregnancy. In the case of ectopic pregnancy surgical treatment via laparotomy was the gold standard treatment.

Aspects épidémiologiques, cliniques et thérapeutiques des algies pelviennes aiguës de la femme à l'Hôpital Gynéco-Obstétrique et Pédiatrique de Yaoundé (HGOPY)

Introduction: les algies pelviennes aiguës sont responsables d'une morbi-mortalité importante. L'objectif de ce travail était de décrire leurs aspects épidémiologiques, cliniques et thérapeutiques à Yaoundé.Méthodes: nous avons mené une étude transversale descriptive avec collecte prospective des données au Service de Gynécologie-Obstétrique de l'Hôpital Gynéco-Obstétrique et Pédiatrique de Yaoundé du 1er avril au 31 juillet 2015. Nous avons inclus toutes les femmes admises pour douleur pelvienne dont l'évolution était inférieure à un mois et ayant accepté de participer à l'étude. Nous avons exclu les femmes qui étaient au troisième trimestre de grossesse ou en post-partum. Le logiciel Epi info version 3.5.4 a servi à l'analyse des données. Ces données ont été présentées sous forme de fréquence et de pourcentage.Résultats: au total 5915 femmes ont consulté pendant la période de l'étude dont 125(2,11%) étaient des algies pelviennes aiguës. La moyenne d'âge était de 29,5 ± 6,9 ans. Les étiologies des douleurs étaient les infections génitales hautes (36,8%) et la grossesse extra-utérine (18,4%). Le traitement surtout médical (92,8%), associait antibiotiques (65,5%), anti-inflammatoires (56,9%) et antalgiques (39,7%). La chirurgie a été réalisée chez 25(20%) patientes par laparotomie (80%) et cœlioscopie (20%)L'indication chirurgicale était la grossesse extra-utérine dans 76% des cas. La régression de la douleur était obtenue chez 99% des cas. Conclusion: les d'algies pelviennes aigues survenaient chez les femmes jeunes, dues aux infections génitales hautes et à la grossesse extra-utérine étaient principalement. En cas de grossesse extra-utérine le traitement chirurgical était surtout la laparotomie

Assessment of adherence to iron supplementation among pregnant women in the Yaounde gynaeco-obstetric and paediatric hospital.

INTRODUCTION: Anemia is a global problem affecting 41.8% of pregnant women. Iron deficiency is the leading cause during pregnancy. Its prevalence among Cameroonian pregnant women was estimated at 50.9% in 2004. Few studies have evaluated women's adherence to iron supplementation prescribed during pregnancy. We carried this study in order to evaluate the rate of adherence to iron supplementation and its determinants during pregnancy. METHODS: The study was cross-sectional descriptive, on postpartum women at the Gynaeco-Obstetric and Pediatric Hospital of Yaoundé during three months. Adherence was measured using the 8-item Morisky Medication Adherence Scale (MMAS-8). The total score was classified as low, moderate and high adherence. RESULTS: For a total of 304 recruited women, 16.4% were highly compliant, 27.6% moderately compliant, while 56% were low compliant with iron supplementation during pregnancy. The reasons for non-adherence were side effects (19.7%), forgetting (70.1%) and inaccessibility of iron supplements (20.1%). Up to 85 (or 28%) women found it boring to take medication daily. Women with no side effects were about thrice most likely to adhere to the iron supplementation than those with side effects: OR = 3.73 [2.43-5.71]; P = 0.04. Women aged 25 years and above were more likely to be non-compliant to iron supplementation than those youngers: OR = 0.40 [0.31-0.88]; P = 0.02. CONCLUSION: To improve adherence to antenatal iron supplementation, it is important to increase communication for behavior change and counseling before or during antenatal care. Forgetting being the main reason for non-adherence, women should keep their iron in a place of easy access.

[Vaginal birth after previous cesarean section in low-resource countries: healthcare chain and materno-fetal follow-up]. / Accouchement sur utérus cicatriciel dans les pays à faibles ressources: circuit de prise en charge et devenir materno-fœtal.

The rate of uterine scars, an established risk factor for obstetric morbidity, is increasing worldwide. In developing countries, spontaneous uterine ruptures may constitute 87.4% of cases. Tratment is a problem in modern obstetrics, in particular in these countries. This study aims to describe healthcare chain and materno-fetal follow-up of post-partum women with uterine scar in three university hospitals in the city of Yaoundé in order to highlight morbidity management problems in low-resource countries at the dawn of sustainable development goals. We conducted a cross-sectional descriptive study based on the collection of prospective data over a period of six months in 2014. The study included all consenting post-partum women with uterine scar, having given birth to a gestational at a gestational age greater than or equal to a total of 28 weeks of amenorrhea. The sampling was consecutive and exhaustive. Chi square test statistic was applied in all research areas, with a reliability threshold of p≤ 0.05. Data on 252 women with uterine scars, reflecting a rate of 8% (252/3145), were collected during the study period. Prenatal consultations were performed by inadequate staff in an inadequate sanitary structure in 30% of cases. Women were referred due to delivery complications after first admission to an inadequate sanitary structure in 25% of cases (6 uterine ruptures and 7 dead fetus before admission). There was indication for cesarean section/laparotomy on admission in 39% of cases; the rate of vaginal delivery was of 23%; there was indication for trial of scar in 30% of cases, with a success rate of 76.3%. Vaginal delivery was related to parity, a history of vaginal delivery, fetal macrosomia and was inversely related to the number of scars. Maternal mortality was zero and cesarean section was related to materno-fetal morbidity. The poor quality of prenatal consultations and the management of delivery are the main determinants of problems during vaginal birth after cesarean section in our environment. The establishment of a system facilitating access to skilled health care practitioners/adequate health care facilities for pregnant women with uterine scar would improve the prognosis of post-partum women with uterine scar.

Reproducibility of the 75 g oral glucose tolerance test for the diagnosis of gestational diabetes mellitus in a sub-Saharan African population.

OBJECTIVE: To evaluate the reproducibility of the 75 g oral glucose tolerance test and factors associated with non-reproducible results in Cameroonian pregnant women. RESULTS: Twenty-seven of the 84 participants (32.1%) who did the first oral glucose tolerance test were diagnosed with gestational diabetes mellitus. There was no difference between the means of the glycaemic responses at T0 (p = 0.64), T30 (p = 0.08), T60 (p = 0.86), T90 (p = 0.51), and T120 (p = 0.34) between the two oral glucose tolerance test. Age (p = 0.001) and BMI (p = 0.001) were significantly associated with non-reproducible results. The reproducibility of the oral glucose tolerance test in this study was 74.2%, and the kappa statistic's 0.46. In conclusion, the results of the oral glucose tolerance test were reproducible in only 74.2% of pregnant women in this study. This highlights that a single oral glucose tolerance test for the diagnosis of gestational diabetes mellitus should be interpreted with caution.

Gynaecological laparoscopic surgery: eight years experience in the Yaoundé Gynaeco-Obstetric and Paediatric Hospital, Cameroon.

This is a retrospective analysis of eight years of gynaecological laparoscopic surgery in a resource-limited setting. All gynaecological patients managed by laparoscopy at the Yaoundé Gynaeco-Obstetric and Paediatric Hospital from 1 January 2004 to 30 November 2011 were included. Amongst the 9194 gynaecological surgeries performed during the study period, 6.9% (633) were done by laparoscopy. Most of the women underwent an operative laparoscopy (568/592; 95.9%). The most common indication was infertility (415/592; 70.1%). Diagnostic laparoscopies were mostly indicated for chronic pelvic pain (18/24; 75%). The most common surgical finding was tubo-peritoneal adhesions (412/592; 69.6%). A total of 35 patients (35/592; 5.9%) had at least one complication. The mean duration of hospitalization was 3.4 ±1.8 days. The general uptake of gynaecological laparoscopic surgery is low in our setting. The laparoscopic complication rate of 5.9% is encouraging.

Sexual activity during pregnancy and prognosis of labor in Cameroonian women: a cohort study.

OBJECTIVE: Our aim was to assess the effects of sexual activity during pregnancy on the prognosis of labor. METHODS: It was a prospective cohort study of labor comparing 72 women declaring unprotected vaginal sexual intercourse after 37 weeks of pregnancy consecutively recruited to 72 women claiming no sexual contact after 37 weeks of pregnancy also consecutively recruited. RESULTS: The sexually active group at term were significantly involved in more frequent heterosexual intercourse after 28 weeks pregnancy and before term (RR = 37.8; CI = 19.8-515.4). Women sexually active were significantly admitted during the active phase of labor (RR = 2.4; IC = 1.6-5.3), with the fetal head at station 0 and more (RR = 1.5; CI = 1.3-5.2). They significantly had a shorter active phase (RR = 1.7; CI = 1.5-3.7) and a shorter second stage (RR = 1.5; CI = 1.2-3.3). They significantly had a normal pattern of labor (RR = 2.1; CI = 1.2-5.3), a higher rate of spontaneous deliveries (RR = 2.1; CI = 1.5-4.5), a lower rate of caesarean sections (RR = 0.46; CI = 0.1-0.8) and needed less oxytocin usage before expulsion (RR = 0.5; CI = 0.2-0.7). CONCLUSION: Sexual activity during pregnancy improves the prognosis of labor in Cameroonian women. In the absence of contraindications, consented unprotected heterosexual intercourse should be promoted in pregnant women.

Best practice guidelines for stroke in Cameroon: An innovative and participatory knowledge translation project.

BACKGROUND: Although the adherence to stroke guidelines in high-income countries has been shown to be associated with improved patient outcomes, the research, development and implementation of rehabilitation related guidelines in African countries is lacking. OBJECTIVES: The purpose of this article is to describe how a group of front-line practitioners collaborated with academics and students to develop best practice guidelines (BPG) for the management and rehabilitation of stroke in adult patients in Cameroon. METHOD: A working group was established and adapted internationally recognised processes for the development of best practice guidelines. The group determined the scope of the guidelines, documented current practices, and critically appraised evidence to develop guidelines relevant to the Cameroon context. RESULTS: The primary result of this project is best practice guidelines which provided an overview of the provision of stroke rehabilitation services in the region, and made 83 practice recommendations to improve these services. We also report on the successes and challenges encountered during the process, and the working group's recommendations aimed at encouraging others to consider similar projects. CONCLUSION: This project demonstrated that there is interest and capacity for improving stroke rehabilitation practices and for stroke guideline development in Africa.