From administrative hospital management to performancebased management: Paradigm shift at the Yaoundé Gynaeco-Obstetric and Pediatric Hospital, Cameroon.

The Yaoundé Gynaeco-Obstetric and Pediatric Hospital (YGOPH) faced challenges of high debts and sub-optimal care delivery. Performance-Based-Management (PBM) provides an environment of checks and balances, increased transparency, competition and autonomy, thereby improving clinical as well as financial indicators. We describe the transition from resource-based to PBM at the YGOPH over a seven-year period. There was an increase of 4.5% in OB/GYN and 8.1% in prenatal consultations, 8.4% in C-sections, 6.1% of children vaccinated, and 30.5% of women seen for family planning, 51.1% of people living with the Human Immunodeficiency Virus on treatment and 29.4% of indigent patients. These results occurred in spite of a 14% reduction in staff. Annual revenue increased by 5.75%. The share of hospital income from care on overall hospital revenue increased from 55.11% to 60.00%. With this self-financing PBM model, the hospital remains a social, humane and financially viable structure delivering improved quality care.

Prevalence and factors associated with hypertension in primary school children, in the centre region of Cameroon.

BACKGROUND: There has been a progressive increase in hypertension among children and adolescents over the years. Hypertension in childhood is influenced by various risk factors including; childhood obesity, lifestyle and hereditary factors. This study is aimed at assessing the prevalence of hypertension and elevated blood pressure (BP); as well as the associated factors to hypertension among primary school children in a rural setting in the, Centre Region of Cameroon. METHODS: A cross sectional study was carried out from November 2017 to May 2018 in 13 primary schools in Mbankomo subdivision. A two staged cluster sampling technique was used to select participants: the first stage we conveniently selected 13 out of 71 (18%) primary schools in the study area by probability proportionate to size since the subdivision does not have an equal number of primary schools in the rural and semi-urban areas. In the second stage, we also used probability proportional to size to randomly select participants from the 13 clusters because the classes did not have equal number of students. We randomly selected 13% pupils enrolled in each class of the 13 schools. BP and anthropometric measurements were taken, together with socio-demographic characteristics, lifestyle and past history. RESULTS: The overall prevalence of hypertension among the 822 pupils sampled was 1.6% (with 1.5% in stage I and 0.1% in stage II) and that of elevated BP was 8.1%, with a systolic predominance of 1.6%. SBP and DBP had a significant positive correlation with age (r=0.17; P=0.000 and r=0.07; P=0.000 respectively) and BMI (r=0.18; P=0.000 and r=0.11; P=0.000 respectively). The associated risk factors for hypertension were: the pupil's age >10 years (95% CI: 1.2581-33.1841; P=0.0254), family history of overweight (95% CI: 1.6906-32.9401; P=0.008), and excess weight (95% CI: 2.5094-40.7063; P=0.0011), and being born at term (P=0.0004) as a protecting factor. CONCLUSIONS: This study revealed a high prevalence of hypertension among primary school children in rural areas, with a number of preventable risk factors. Considering the risk factors found, children should be educated on proper nutrition, and the need for physical exercises at home and in school to avoid overweight and obesity.

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.

Risk factors for premature births: a cross-sectional analysis of hospital records in a Cameroonian health facility.

The aim of this study was to investigate the risk factors for preterm births in the Yaounde Gynaeco-Obstetric and Pediatric Hospital in Cameroon, and to describe their outcomes. We conducted a cross-sectional analytical study of hospital records over eight years. The incidence of prematurity was 26.5 % of admissions over a period of 7 years 7 months. After controlling for confounding factors, we identified attending antenatal care visits in a health centre (Odds ratio [OR] 6.19; 95% Confidence interval [CI] 1.15 - 33.22; p = 0.033), having a urinary tract infection (OR 39.04; 95% CI 17.19 - 88.62; p < 0.001), multiple gestation (OR 3.82; 95% CI 2.68 - 5.43; p <0.001) and congenital malformations (OR 2.78; 95% CI 1.24 - 6.22; p = 0.013) increased the odds of preterm birth. On the other hand being a student mother (OR 0.44; 95% CI 0.20 - 0.98; p = 0.047), being married (OR 0.40 95% CI 0.19 - 0.84; p = 0.016) and more antenatal visits (OR 0.23; 95% CI 0.15 - 0.35; p <0.001) reduced the odds of preterm birth Neonatal mortality in these preterm neonates was 36.6%, in which 69% occurred in the early neonatal period. The main causes of death were neonatal infections (27.6%), neonatal asphyxia (11.9%) and congenital malformations (10.3%). We recommend enhanced prenatal care and management of pathologies which arise during pregnancy.