Determinants of the decision to incision interval in case of emergency caesarean section in Yaoundé' hospitals.

Objective: To analyze the determinants of the decision to incision interval in case of emergency caesarean section in Yaoundé' hospitals. Methods: A prospective cross-sectional (affected / non-affected) study was conducted in four hospitals in Yaoundé between January and may 2017 after National Ethical Committee approval. The target population was women who benefited from emergency caesarean section during the study period. Crude Odds Ratio (OR) and adjusted odds ratio (AOR) with 95% Confidence Interval was used to appreciate the association between several characteristics and the risk for long decision-incision delay. Results: The overall cases of 165 emergency caesarean section were analyzed. The prevalence of emergency caesarean section performed within 30 minutes was 20%. Social factors associated with long delay to perform the emergency Caesarean section (> 30 minutes) were the primary level of education [ AOR: 3.63(2.44-5.41)], unemployment status [AOR: 5.17(2.95-8.95)]; and the absence of a parent at admission [AOR: 2.2(1.23-3.94)]. Medical factors associated with long delay from decision to incision were: use of spinal anesthesia in opposition to general anesthesia [AOR: 3.86(2.59-5.73)]; delay of transfer from emergency and the late provision of the operation supplies [AOR: 4.18(2.90-6.03)]. Conclusion: Few women benefit from the surgical intervention within a maximum of 30 minutes. Support measures for women presenting the indications for emergency caesarean sections in hospitals are essential to improve the decision-incision delay of the caesarean section emergency.

Suspected Plasmodium falciparum resistance to artesunate in Cameroon: A case report.

Malaria in pregnancy is associated with adverse maternal and perinatal outcomes. The first-line treatment for severe malaria in the second and third trimesters of pregnancy is parenteral artesunate, according to WHO recommendations. Resistance of Plasmodium falciparum to artesunate has not yet been noted in our country. We report a case highly suspicious of such. A pregnant woman presented with the clinical signs of malaria. After paraclinical confirmation of the diagnosis, she was admitted and injectable artesunate was given for 72 h at the recommended dosage, with antipyretic without any improvement. Artesunate was therefore replaced by parenteral quinine, with favourable evolution. Resistance of Plasmodium falciparum to artesunate might be present in our country. This patient provides a warning about possible artesunate resistance, and this calls for careful monitoring of other cases of malaria been treated with this drug to ascertain the possibility of resistant cases.

Influence of the human immunodeficiency virus on cervical precancerous lesions.

OBJECTIVE: To study the influence of HIV status on the occurrence of cervical precancerous lesions (CPL). METHODS: This analytical cross-sectional study was carried out between December 1, 2019 and May 31, 2020. All women with documented HIV status screened for CPL with biopsies performed were recruited. The main variables recorded included maternal age, educational level, number of sexual partners, age at first sexual intercourse, smoking, alcohol consumption, HIV status, CD4 count, and cervical biopsy result. Fisher exact test and Student's t test were used for comparison. A p value <0.05 was considered statistically significant. RESULTS: Concerning women attending our screening units, CPL was more frequent among those living with HIV/AIDS (20/92; 21.7%) than among those not living with HIV/AIDS (29/290; 10.0%) (p = 0.004). As regards women living with HIV/AIDS, those with a CD4 count below 350/mL were more at risk of having a CPL (odds ratio [OR] 21.39, 95% confidence interval [CI] 5.60-81.56, p Ë‚ 0.001). High-grade lesions (cervical intraepithelial neoplasia Stage 2 or 3) were more often found in women living with HIV/AIDS (OR 3.83, 95% CI 1.09-13.45, p = 0.033). CONCLUSION: More attention should be paid to women living with HIV/AIDS, especially those with CD4 count less than 350/mL, who should be screened more often with biopsy frequently conducted if indicated.

Facteurs associés aux barrières d'accès au dépistage du cancer du col de l'utérus à Yaoundé.

INTRODUCTION: Several studies report that only 10% of Cameroonian women at risk have ever been screened for this disease. OBJECTIVE: This study aims to analyze the factors explaining the difficulties in accessing screening for cervical cancer in Yaoundé, Cameroon. METHODOLOGY: This was an analytical cross-sectional study (participed/not participated), conducted from May 1 to August 10, 2020. The study population was made up of two groups (i.e. women without a history of screening; women who benefited from at least one screening session). Data collection was carried out at the gynecology-obstetrics department in two hospitals in Yaoundé (University hospital center and the obstetrics-gynecology and pediatric hospital). Variables were collected using a pre-tested and validated questionnaire. Data were analyzed using SPSS version 20 software. Simple and multiple logistic regression analysis was performed to assess the influence of different variables on the risk of not participating in screening. A difference was considered significant if P < 5%. RESULTS: Out of 300 women interviewed, 150 had never participated in screening (50%). In multivariate analysis, the factors associated with difficulties in accessing cervical cancer screening were, level of primary education (58,33% vs. 41,67%, [AOR: 5.12 (3.42-7.65)]), lack of employment (69,74% vs. 30,26%, [AOR: 5.44 (3.32-8.92)]), insufficient knowledge (78,64% vs. 21,36%; [AOR: 7.11(5.70-8.88)]) and unfavourable attitude (85,71% vs. 14,29%, [AOR: 5.58 (4.41-7.06)]). CONCLUSION: There are many factors associated with not being screened. It is therefore necessary to develop strategies to improve access to cervical cancer screening services in Cameroon.

Maternal mortality in Cameroon: a university teaching hospital report.

More than 550,000 women die yearly from pregnancy-related causes. Fifty percent (50%) of the world estimate of maternal deaths occur in sub-Saharan Africa alone. There is insufficient information on the risk factors of maternal mortality in Cameroon. This study aimed at establishing causes and risk factors of maternal mortality. This was a case-control study from 1st January, 2006 to 31st December, 2010 after National Ethical Committee Approval. Cases were maternal deaths; controls were women who delivered normally. Maternal deaths were obtained from the delivery room registers and in-patient registers. Controls for each case were two normal deliveries following identified maternal deaths on the same day. Variables considered were socio-demographic and reproductive health characteristics. Epi Info 3.5.1 was used for analysis. The mean MMR was 287.5/100,000 live births. Causes of deaths were: postpartum hemorrhage (229.2%), unsafe abortion (25%), ectopic pregnancy (12.5%), hypertension in pregnancy (8.3%), malaria (8.3%), anemia (8.3%), heart disease (4.2%), and pneumonia (4.2%), and placenta praevia (4.2%). Ages ranged from 18 to 41 years, with a mean of 27.7 ± 5.14 years. Lack of antenatal care was a risk factor for maternal death (OR=78.33; CI: (8.66- 1802.51)). The mean MMR from 2006 to 2010 was 287.5/100,000 live births. Most of the causes of maternal deaths were preventable. Lack of antenatal care was a risk factor for maternal mortality. Key words: Maternal mortality, causes, risk factors, Cameroon.