Clinical malaria among pregnant women on combined insecticide treated nets (ITNs) and intermittent preventive treatment (IPTp) with sulphadoxine-pyrimethamine in Yaounde, Cameroon.

BACKGROUND: Malaria remains a burden for pregnant women and the under 5. Intermittent preventive treatment of pregnant women (IPTp) for malaria with sulfadoxine - pyrimethamine (SP) has since replaced prophylaxis and legislation has been reinforced in the area of insecticide treated mosquito nets (ITNs) in Cameroon. Clinical malaria despite all these measures remains a problem. We compared the socio-obstetrical characteristics of women who developed clinical malaria and those who did not though in the same regimen. METHODS: A 5 - year nested cohort study (2007 - 2011 inclusive) at the tertiary level hospitals in Yaounde. Pregnant women who willingly accepted to participate in the study were enrolled at booking and three doses of SP were administered between 18 - 20 weeks of gestation, between 26-28 weeks and between 32 - 34 weeks. Those who developed clinical malaria were considered as cases and were compared for socio - obstetrical characteristics with those who did not. Venous blood was drawn from the women in both arms for parasite density estimation and identification and all the clinical cases were treated conventionally. RESULTS: Each arm had 166 cases and many women who developed clinical malaria were between 15 and 19 years (OR 5.5, 95% CI 3.9 - 5.3, p < 0.001). They were of low gravidity (OR 6.5, 95% CI 3.8 - 11.3, p < 0.001) as well as low parity (OR 4.6, 95% CI 2.7 - 7.9, p < 0.001). The cases were single women (OR 4.58, 95% CI 2.54 - 8.26, p < 0.001) and had attained only primary level of education (OR 4.6, 95% CI 2.8 - 7.9, p < 0.001). Gestational ages were between 20 to 30 weeks during clinical malaria (OR 6.8, 95% CI 4.1 - 11.7, p < 0.001). The time between the first and second dose of SP was longer than ten weeks in the cases (OR 5.5, 95% CI 3.2 - 9.3, p < 0.001) and parasite density was higher also among the cases (OR 6.9, 95% CI 5.9 - 12.1, p < 0.001). CONCLUSION: Long spacing between the first and second dose of SP seemed to be responsible for clinical malaria in the cases.

Acceptability of intrapartum HIV counselling and testing in Cameroon.

BACKGROUND: To assess the acceptability of intrapartum HIV testing and determine the prevalence of HIV among labouring women with unknown HIV status in Cameroon. METHOD: The study was conducted in four hospitals (two referral and two districts hospitals) in Cameroon. Labouring women with unknown HIV status were counselled and those who accepted were tested for HIV. RESULTS: A total of 2413 women were counselled and 2130 (88.3%) accepted to be tested for HIV. Of the 2130 women tested, 214 (10.1%) were HIV positive. Acceptability of HIV testing during labour was negatively associated with maternal age, parity and number of antenatal visits, but positively associated with level of education. HIV sero-status was positively associated with maternal age, parity, number of antenatal visits and level education. CONCLUSION: Acceptability of intrapartum HIV testing is high and the prevalence of HIV is also high among women with unknown HIV sero-status in Cameroon. We recommend an opt-out approach (where women are informed that HIV testing will be routine during labour if HIV status is unknown but each person may decline to be tested) for Cameroon and countries with similar social profiles.

Gynaecological morbidity among HIV positive pregnant women in Cameroon.

OBJECTIVE: To compare the prevalence of gynaecological conditions among HIV infected and non-infected pregnant women. METHODS: Two thousand and eight (2008) pregnant women were screened for HIV, lower genital tract infections and lower genital tract neoplasia at booking antenatal visit. RESULTS: About 10% (198/2008) were HIV positive. All lower genital tract infections except candidiasis were more prevalent among HIV positive compared to HIV negative women: vaginal candidiasis (36.9% vs 35.4%; p = 0.678), Trichomoniasis (21.2% vs 10.6%; p < 0.001), gonorrhoea (10.1% vs 2.5%; p < 0.001), bacterial vaginosis (21.2% vs 15.2%; p = 0.026), syphilis (35.9% vs 10.6%; p < 0.001), and Chlamydia trachomatis (38.4% vs 7.1%; p < 0.001). Similarly, HIV positive women more likely to have preinvasive cervical lesions: low-grade squamous intraepithelial lesion (SIL) (18.2% vs 4.4%; p < 0.001) and high-grade squamous intraepithelial lesion (12.1% vs 1.5%; p < 0.001). CONCLUSION: We conclude that (i) sexually transmitted infections (STIs) are common in both HIV positive and HIV negative pregnant women in Cameroon, and (ii) STIs and preinvasive cervical lesions are more prevalent in HIV-infected pregnant women compared to their non-infected compatriots. We recommend routine screening and treatment of STIs during antenatal care in Cameroon and other countries with similar social profiles.