Knowledge, attitudes, and practices of Cameroonian physicians with regards to acute pain management in the emergency department: a multicenter cross-sectional study.

INTRODUCTION: Pain is the most frequent presenting complaint in patients consulting or admitted to the emergency department (ED). Thus, its acute management is often done by physicians working in the ED. These clinicians are often general practitioners and not emergency medicine physicians in resource-poor settings. Hence, a mastery of pain management by these physicians may be important in relieving acute pain. We aimed to assess the knowledge, to determine the attitudes and practices of physicians in the management of pain in EDs of Cameroon. METHODS: We carried out a prospective cross-sectional study over 4 months in the year 2018. We enrolled all consenting physicians who were neither emergency medicine doctors nor anesthesiologists working at the EDs of five tertiary hospitals of Cameroon. Using a validated and pretested structured questionnaire, data on the knowledge, attitudes, and practices of acute pain management at the ED by these clinicians were studied. We used an externally validated score to assess the knowledge as either poor, insufficient, moderate or good. RESULTS: A total of 58 physicians were included; 18 interns or residents and 39 general practitioners. Their mean age was 28.6 ± 3 years and their average number of years of practice was 2.9 years. The level of knowledge was rated "poor" in 77.6% of physicians. Being a general practitioner was significantly associated with a poor level of knowledge (p = 0.02; OR = 5.1). We found a negative and significant correlation between knowledge and years of practice (p = 0.04; r2 = 0.06). More than three-quarter (82.8%) of participants used a pain scale to evaluate the severity of pain. The most used scale was the Visual Analog Scale (56.9%). The most frequently used analgesic was paracetamol (98.3%), although only 3.5% of physicians correctly knew its half-life, delay of onset of action and duration of action. CONCLUSION: These findings suggest that physicians in EDs of Cameroon have poor knowledge and suboptimal practices in pain management. General practice and a greater number of professional experience seemed to favour these attitudes. Overall, there is an urgent need for refresher courses in acute pain management for physicians working in these resource-limited EDs.

Effects of phloroglucinol on the active phase of labour (EPAL trial): a single blinded randomised controlled trial in a tertiary hospital in sub-Sahara Africa.

INTRODUCTION: One of the most recognized factors of maternal and neonatal outcome pertaining to the peripartum period is the duration of labour. Finding a drug that will decrease the duration of labour with no effects on mother and foetus will be welcomed. Thereby in this study we aimed to evaluate the effects of phloroglucinol on the duration of the active phase of labour. METHODS: We did a single blinded placebo controlled randomised 1:1 parallel designed superiority trial between January and June 2017 in Douala general hospital. Participants greater than 18 years with singleton uncomplicated pregnancy who consented following randomisation, were administered either 80mg/8ml intravenous phloroglucinol or 8ml of sterile water when in active labour. The primary outcome was the duration of labour. Modified intention to treat analysis was done with the level of significance set at a p value of 0.05. RESULTS: 122 participants received the intervention. The mean total duration labour in the treatment and placebo group were 216.8 ± 38.7 and 358.5 ± 65.8 respectively (p value = 0.243). The mean duration of the active phase of labour in the treatment and placebo group were 183.0±35.6 and 316.0±52.2 respectively (p value = 0.046). The mean rate of cervical dilatation in the treatment and placebo group were 2.1 ± 0.4 and 1.3 ± 0.4 respectively (p value = 0.322). There was no difference in maternal and foetal outcomes between the two groups. CONCLUSION: Phloroglucinol shortens the duration of active phase of labour by about 2 hours (42%). It is safe to mother and baby and does not cause adverse foetal or maternal outcomes.

A cohort analysis of neonatal hospital mortality rate and predictors of neonatal mortality in a sub-urban hospital of Cameroon.

BACKGROUND: In Cameroon, sustainable effort needs to be done to reduce the current neonatal mortality rate from 21 deaths per 1000 live births to the global target of fewer than ten deaths per 1000 live births by 2035. We aimed to determine the neonatal hospital mortality rate and predictors of neonatal hospital mortality (NHM) in a major referral sub-urban hospital of Cameroon in a bit to formulate interventions to curb this burden. METHODS: This was a prospective cohort study consecutively enrolling all neonates admitted into the neonatology unit of the Bamenda Regional Hospital (BRH) from November 2015 to February 2016. Through interviewed questionnaires to parents and physical examination of neonates, we studied socio-demographic characteristics, antenatal history, intrapartum history and clinical findings of neonates. Neonates further underwent relevant laboratory investigations for diagnosis. All neonates were followed up till 28 days after the post-menstrual term for the neonatal outcomes. Multiple logistic regression was used to determine predictors of NHM. RESULTS: We enrolled 332 out of 337 neonates admitted to the neonatology unit of BRH during the study period. Fifty-three percent (53%) were males. Their mean gestational age and birth weight were 36.9 ± 3.9 weeks and 2677.2 ± 923 g, respectively. The main causes of neonatal admissions were complications of preterm birth (32.2%), neonatal infections (31.3%), and birth asphyxia (14.5%). The neonatal hospital mortality rate was 15.7%. NHM was related to complications of preterm birth (69%), birth asphyxia (23%) and neonatal infections (6%). A five-minute Apgar score less than seven was the only predictor of NHM (aOR: 16.41; CI 95%: 6.35-42.47; p < 0.01). CONCLUSION: Neonatal mortality still remains a significant health problem in sub-urban Cameroon, mainly as a result of three pathologies; complications of preterm birth, birth asphyxia, and infections. There is an urgent need to revamp the current health policies through the improvement of antenatal care, skilled birth attendants, neonatal resuscitation, timely detection and treatment of complications of preterm births, birth asphyxia, and infections.