Contraceptive use and determinants of unmet need for family planning; a cross sectional survey in the North West Region, Cameroon.

BACKGROUND: Reducing unmet need for family planning by increasing the rate of modern contraceptive use is indispensable if Cameroon must meet maternal mortality targets of the Sustainable Development Goals. The objective of this survey was to estimate the rate of contraceptive use and identify factors associated with unmet need for family planning in rural Cameroon. METHODS: It was conducted a community-based cross sectional survey from February to March 2016 targeting women in a union of the Wum Health District. Participants were included by cluster multistep sampling and data collected by trained surveyors using a pretested questionnaire. Data were analysed using Epi-Info version 3.5.4. The odds ratio was used as a measure of association between unmet need for family planning and selected covariates with the statistical significant threshold set at p ≤ 0.05. RESULTS: Among the 466 women included in the survey, 78.5% were legally married. The mean age of the participants was 28.7 ± 7.2 years with a mean number of years of cohabitation of 9.1 ± 7.4 years. A total of 438 women from the sample were evaluated for contraceptive use and unmet need for family planning. The rate of modern contraceptive use at the time of the survey was 13[10.1-16.6]% and about 5 in every 10 women had an unmet need for family planning (46.6[41.8-51.4]%) with 31.1% having an unmet need for spacing and 15.5% an unmet need for limiting births. The potential demand for contraception was estimated at 45.9% with only 39.8% of this demand met. When controlled for age, monthly revenue, occupation and partner's level of education, discussion of family planning within the couple (OR = 0.66[0.44-0.97], p-value = 0.032), and partner's approval of contraception (OR = 0.66[0.45-0.97], p-value = 0.035), were found to be significantly associated with decreasing unmet need for family planning. CONCLUSION: With the very low rates of modern contraceptive use and potential demand for contraception in the Wum Health District, the rate of unmet need for family planning is still very high. Non discussion of family planning within the couple, and disapproval of contraception by the partner are significantly associated with high unmet need for family planning. More of couple-based family planning interventions should be encouraged.

Contraceptive method mix and preference: A focus on long acting reversible contraception in Urban Cameroon.

INTRODUCTION: Meeting targets of the Sustainable Development Goals in the domain of maternal health and the Family Planning 2020 commitments for Cameroon requires an increased use of modern contraception. Long acting reversible contraceptives (LARCs) are methods which have been proven highly efficient with contraceptive failure rates of less than 1%. The objective of this survey was to determine the contraceptive method mix in the Biyem-Assi Health District and identify factors associated to the use of LARCs. METHODOLOGY: A cross-sectional community-based study was conducted from March 2015 to April 2015 targeting current female contraceptive users of childbearing age in the Biyem-Assi Health District. A multistep cluster sampling was used and data collected by trained surveyors using a pretested and validated questionnaire. Data were analysed using the statistical software Epi-Info version 3.5.4. Logistic regressions were used to identify associations between the use of LARCs and selected covariates and the strength of association measured with the odds ratio. RESULTS: A total of 437 eligible women were included in the survey. Their mean age was 26.7±5.8 years and 45.8% were in a union. The contraceptive method mix decreased in this order; male condoms (76.0%), female condoms (7.6%), oral contraceptive pills (5.0%), implants (4.6%), and intrauterine devices (3.4%) giving us a LARC rate of 8%. Only 54.0% and 46.9% of the participants reported to be knowledgeable of the implant and intrauterine device respectively. Their contraceptive choices were determined principally by perceived efficiency and accessibility. The major factor significantly associated to LARC use was the number of living children above 2 (AOR = 3.90[1.53-9.94], p-value = 0.004). Though not statistically significant, associations were found between LARC use and other factors like marital status, level of education, religion and future fertility desire. CONCLUSION: The rate of use of LARCs is still very low among these women. The number of living children is significantly associated with the use of LARCs. The local family planning policy makers should intensify sensitization on the benefits and side effects of modern contraception and LARCs in order to create more awareness and improve contraceptive uptake.

Streptococcus agalactiae prevalence and antimicrobial susceptibility pattern in vaginal and anorectal swabs of pregnant women at a tertiary hospital in Cameroon.

OBJECTIVE: Group B Streptococcus (GBS) or Streptococcus agalactiae is part of the normal flora of the gut and genital tract, thus carrier pregnant women can transmit this germ to newborns which could cause early neonatal infection. In Cameroon, few studies have been conducted on GBS, thus this study sought to detect the rectal and vaginal colonization rates and the antibiotic susceptibility profile of the identified strains in pregnant women. We therefore conducted a cross-sectional study over a 6 months period analysing vaginal and anorectal samples obtained from 100 pregnant women. Cultures for the isolation of GBS were carried out according to standard microbiological methods and grouping done using the Pastorex strep Kit. All strains isolated were used for susceptibility test to various antibiotics as recommended by the French microbiology society, using the disk-diffusion method. RESULTS: The detected colonization rate was 14%. No resistance to ampicillin, oxacillin, amoxycillin-clavulanate, cefotaxime, pristinamycin, vancomycin and clindamycin was found. Just 12, 94 and 82% of strains showed sensitivity to gentamycin, erythromycin and cefoxitin respectively. This study therefore revealed that at least one out of every ten women is GBS colonized and strains showed uniform sensitivity to beta lactamines. However, decreased sensitivity to erythromycin was detected.

Quantification and factors associated with HIV-related stigma among persons living with HIV/AIDS on antiretroviral therapy at the HIV-day care unit of the Bamenda Regional Hospital, North West Region of Cameroon.

BACKGROUND: The Human Immunodeficiency Virus /Acquired Immune Deficiency Syndrome (HIV/AIDS) is not just a medical problem but its social impact is increasingly affecting its effective management. The fear of HIV-stigma constitutes a major barrier to HIV testing, prevention, uptake and adherence to antiretroviral therapy (ART). We aimed to quantify HIV-related stigma, and identify the factors associated with high HIV-related stigma among persons living with HIV and AIDS (PLHIVA) and on ART. METHODS: A hospital-based cross sectional analytic survey targeting PLHIVA on ART at the HIV-day care unit of the Bamenda Regional Hospital of Cameroon was conducted from February to April 2016. A total of 308 eligible and willing participants were consecutively included in the survey. Data were collected using a pretested questionnaire designed from the Berger HIV stigma scale and analyzed using Epi info 3.5.4. RESULTS: The mean age of the 308 participants was 40.1±10.2 years. The mean overall HIV/AIDS related stigma score was 88.3 ± 18.80 which corresponds to a moderate level of stigma according to the Berger stigma scale. Further analysis revealed that most participants suffered from moderate forms of the different subtypes of stigma including: personalized (49.8%), disclosure (66.4%), negative self-image (50.0%) and public attitude (52.1%) stigmatization. It was estimated that 62.7% (95% confidence interval [CI] = 57.8-68.9%) of the participants lived with high levels of HIV-related stigma. After controlling for gender, religion, age and occupation, level of education below tertiary (Adjusted Odds Ratio [AOR] = 0.70 [95% CI = 0.44-0.91]; p = 0.036) and a duration from diagnosis below 5 years (AOR = 1.74 [95% CI = 1.01-3.00]; p = 0.046) were significantly associated with high HIV-related stigma. CONCLUSION: About three out of every five PLHIVA receiving ART in Bamenda Regional Hospital still experience high levels of HIV-related stigma. This occurs more frequently in participants with low educational status, and who may have known their HIV status for less than 5 years. Anti-HIV-stigma programs in the North West Region need strengthening with intensified psychosocial follow-up of newly diagnosed cases.

Ruptured caesarean scar ectopic pregnancy: a diagnostic dilemma in a resource-limited setting.

BACKGROUND: Caesarean scar pregnancy (CSP) remains a very rare form of ectopic pregnancy associated with serious life threatening obstetric complications and even death in case of late diagnosis and treatment. CASE PRESENTATION: We report a case of a ruptured caesarean scar pregnancy in a 29 year-old gravida 5, para 3 with a past obstetric history of two consecutive caesarean sections done 9 and 5 years ago respectively. The patient presented with intermittent lower abdominal pains on a 20 weeks gestation associated with mild epigastralgia and 2 previous episodes of mild pervaginal bleeding (2 and 1 months ago respectively before consultation) managed with injectable progesterone. Her evolution 4 h later was marked by an increase in the intensity of the abdominal pain, an unmeasurable blood pressure and a feeble pulse. Immediate paracentesis revealed 10 cc of fresh non coagulating blood. The diagnosis of ruptured ectopic pregnancy with abundant hemoperitoneum was considered and an emergency laparotomy with fluid and blood resuscitation was carried out. A midline laparotomy revealed a ruptured caesarean scar ectopic pregnancy with an abundant hemoperitoneum. Careful resection of the placenta and repair of the ruptured isthmic region of the uterus was carried out. Recovery after surgery was without complications and the patient was discharged on the 6th day following surgery. CONCLUSION: Caesarean scar pregnancy remains a very rare obstetric condition. Late diagnosis of this condition can be associated with serious life threatening obstetric complications. The rarity of the condition warrants a high index of suspicion among clinicians.

Determinants of modern contraceptive practice in Yaoundé-Cameroon: a community based cross sectional study.

BACKGROUND: Despite numerous efforts put in place to increase modern contraceptive use in Cameroon as a means to fight maternal and infant mortality, the prevalence of modern contraception has shown only a slow increase and maternal mortality is constantly rising. This paper attempts to identify barriers to contraceptive use in Biyem-Assi, Yaoundé-Cameroon so as to clearly define in which domain and how to intervene concerning contraceptive use in Cameroon. METHODS: It was a community-based cross sectional study involving a two-steps cluster sampling. Data were collected from November 2014 to April 2015 and analysis done with Epi-Info version 3.5.4. Association between contraceptive use and independent factors was estimated by calculating odds ratio (OR) and confidence interval at 95%. Significance of association in univariate analysis was estimated by calculating the p value with chi2 test. Potential confounder (pregnancy intention) controlled in a multiple logistic regression. RESULTS: A total of 613 sexually active women were enrolled into the study with a mean age of 27.2 (δ ± 6.2) years. Among the women, 293 (47.8%) were in a union and 530 (86.8%) of them had attended at least a secondary education. Also, 107 (17.5%) responded that their beliefs do not approve contraceptive use and 101 (16.6%) said their partners do not approve contraception. At the moment of data collection, 361 (58.9 [54.9-62.8] %) were currently using a modern contraceptive method. The rate of use of modern contraception was significantly lower in women in a union (OR 0.57, p = 0.0002) and in those with age greater than 30 years (OR 0.45, p = 0.0004). Conversely, the rate of use was significantly higher in women whose partners approved contraception (OR 4.14, p = 0.0000) or when family planning was discussed within the couple (OR 1.93, p = 0.0028). CONCLUSION: The rate of use of modern contraception in Biyem-Assi Health District is relatively high. Women in a union and those aged greater than 30 years turn to be less likely to use a contraceptive method than the rest of the population meanwhile women whose partner approve contraceptive-use or who discuss about family planning with their partners, are most likely to use a contraceptive method than others. To increase the rate of use of modern contraception in Yaoundé-Cameroon, interventions should target more of couples and not women alone.

Knowledge of women in family planning and future desire to use contraception: a cross sectional survey in Urban Cameroon.

BACKGROUND: The rate of modern contraceptive use will be on an increase and maternal mortality on a decrease if women had a good knowledge on family planning and its methods. This survey was designed to evaluate the knowledge and determine the future desires to use contraception among women in Urban Cameroon. METHODS: We conducted a cross sectional community based survey from March 2015 to April 2015 targeting women of childbearing age in the Biyem-Assi Health District. Participants were included using a multistep cluster sampling and the data collected face to face by well-trained surveyors using a pretested and validated questionnaire. The data were then analysed using the statistical software Epi-Info version 3.5.4. Proportions and their 95 % confidence intervals were calculated and in a multiple logistic regression model with threshold of significance set at p value ≤0.05, the odds ratio was used as the measure of association between selected covariates and future desire to use contraception. RESULTS: Among the 712 women included in the survey, the mean age was 27.5 ± 6.5 years. A good proportion (95.6 %) identified contraception as used to prevent unwanted pregnancy and this showed an increasing trend with increasing level of education. Also, 77.5 % thought that contraception should be used by all sexually active women. The most cited contraceptive methods were; condom 689 (96.8 %), oral pills 507 (71.2 %), and implants 390 (54.8 %). Their main sources of information were the health personnel (47.7 %) and the school (23.6 %). It was estimated that 31.0 [25.5-37.0] % of current contraceptive non-users had no desire of adopting a contraceptive method in the future. With the level of education, age, and marital status controlled, the number of unplanned pregnancies more than 3 (OR 0.66 [0.45-0.97], p = 0.035), and past adoption of more than 2 modern contraceptive methods (OR 0.45 [0.21-0.97], p = 0.041) were statistically significantly associated to decreased desire to adopt contraception in the future. The level of knowledge showed an association though not statistically significant with future desire to use contraception (OR 0.80 [0.47-1.37], p = 0.061). CONCLUSION: The knowledge of women of childbearing in the Biyem-Assi Health District was relatively high but still unsatisfactory. The proportion of contraceptive non users who have no desire of adopting any contraceptive method in future is still unacceptably high. Policy makers should improve on their strategies while empowering the health personnel and working in collaboration with the education ministries.

[Factors associated with the failure of Intermittent Preventive Treatment for malaria among pregnant women in Yaounde]. / Facteurs prédictifs de l'échec du Traitement Préventif Intermittent du paludisme à la sulfadoxine - pyriméthamine (TPIp-SP) dans une population de femmes enceintes à Yaoundé.

INTRODUCTION: Intermittent preventive treatment with sulfadoxine-pyrimethamine (IPTp-SP) is recommended for malaria prevention during pregnancy. We investigated factors associated with the failure of this strategy. METHODS: We conducted a case-control study in two health care facilities in Yaounde, from 1 May 2014 to 30 April 2015. Pregnant women treated with IPTp-SP, hospitalized for malaria and having a positive Rapid Diagnostic Test (RDT) result (case-subjects) were compared to pregnant women treated with IPTp-SP having a negative RDT result (control-subjects). Epi Info 7 software and SPSS 18.0 software were used with P< 0.05 as significance threshold. RESULTS: We recruited 234 subjects, 109 (46.6%) case-subjects and 125 control-subjects (53.4%). The associated factors found were: prematurity (P=0.03; OR=1.15; IC= 0.32 - 4.10), the non-use of LLIN (P=0.006; OR= 2.31; IC= 1.26 - 4.25), a history of hospitalization for malaria (P=0.007; OR= 2.19; IC= 1.23 - 3.89), IPTp-SP administration after 28 gestational weeks (P=0.001, OR= 3.55; IC= 1.7 - 7.61). After logistic regression, prematurity (P=0.024; OR=2.01; IC=1.1-3.7) and a history of hospitalization for malaria (P=0.001; OR=2.83; IC=1.50-5.4) remained associated with IPTp-SP failure. CONCLUSION: A history of hospitalization for malaria and prematurity are independent predictor of IPTp-SP failure.

Determinants of unmet need for family planning among women in Urban Cameroon: a cross sectional survey in the Biyem-Assi Health District, Yaoundé.

BACKGROUND: With the unacceptably high level of unmet need for family planning in Sub-Saharan Africa, reducing unmet need is paramount in the fight against the high levels of induced abortions, maternal and neonatal morbi-mortality. A clear understanding of the determinants of unmet need for family planning is indispensable in this light. The objective of this study was to determine the prevalence of unmet need for family planning in Urban Cameroon while identifying major determinants of unmet need among women in a union in Urban Cameroon. METHODS: A community based cross sectional study was conducted from March 2015 to April 2015 during which 370 women in a union were recruited using cluster multistep sampling in the Biyem-Assi Health District, Yaounde. Data were collected using a pretested and validated questionnaire. Proportions and their 95% confidence intervals were calculated with the Westoff/DHS method used to estimate unmet need for family planning and the odds ratio used as measure of association with statistical significant threshold set at p-value ≤ 0.05. RESULTS: Of the 370 eligible women included, the mean age was 29.9 ± 6.8 years, and 61.1% were married. The prevalence of unmet need for family planning was 20.4 (16.4-24.8)% with 14.2 (11.2-18.7)% having an unmet need for spacing and 6.2 (3.6-8.7)% an unmet need for limiting. Husband's approval of contraception had a statistically significant protective association with unmet need (AOR = 0.52 [0.30-0.92], p = 0.023), and discussion about family planning within the couple had a highly statistically significant protective association with unmet need (AOR = 0.39 [0.21-0.69], p = 0.001). The major reason for non-use of contraception among women with unmet need was the fear of side effects. CONCLUSION: The prevalence of unmet need of family planning among women in the Biyem-Assi Health District remains high. Husband's approval of contraception and couples' discussion about family planning are two major factors to be considered when planning interventions to reduce unmet need for family planning. Family planning activities focused on couples or including men could be useful in reducing the rate of unmet need in Cameroon.

Knowledge and Attitudes of Pregnant Mothers towards Maternal Dietary Practices During Pregnancy at the Etoug-Ebe Baptist Hospital Yaounde

BACKGROUND AND PURPOSE. Poor dietary practices have been observed among the pregnant mothers receiving antenatal care services (ANC) at the Etoug-Ebe Baptist Hospital Yauonde (EBHY); despite routine nutrition education provided to these mothers and their apparent knowledge and approval of the importance of nutrition in pregnancy. We explored the nutritional knowledge and dietary practices of pregnant mothers receiving ANC at the EBHY in order to identify the correlation between their nutrition knowledge and dietary practices.MATERIALS AND METHODS. A cross sectional descriptive survey was done on 100 randomly selected pregnant mothers. An interviewer-administered structured questionnaire was used to collect data. Statistical analysis was done using the SPSS computer package (Version 19.) Data comparison was done by Chi Square (?2) test with P 0.05 considered statistically significant and a 95 % confidence level (CI) computed.RESULTS. Sixty seven percent of mothers were married. Seventy one percent were literate; 51% had no stable jobs and 39% of their husbands were unemployed. Seventy one percent of respondents belonged to families with monthly income of less than 100;000FCFA and 56% of them had 5 or more household members. Ninety two percent of mothers had knowledge on good maternal nutrition before pregnancy. Seventy three percent of mothers cited the correct components of a balanced diet and their food sources (81%); however; 29% had aversion towards foods rich in protein and other important nutrients. Thirty eight percent of mothers knew that they should eat 3 main meals a day; but only 22% of them practiced it. Sixty five percent of mothers were aware that 'calaba chalk' (dry clay) was harmful and prohibited in pregnancy; yet 85% consumed it. Sixty eight percent did not have Knowledge about the risk of overfeeding in pregnancy. Sixty five percent had awareness that some foods items are potentially harmful in pregnancy but did not know what to avoid. Advanced maternal age; education level; parity and monthly family income were apparently positively associated with nutrition knowledge but there was no significant difference (p0.05).Cultures and taboos exempted mothers from eating meat from wild animals; chicken; sea fish; sweet things; food partly eaten by animals; sugar cane; mud fish and 'porrished' cocoyam.CONCLUSION. Pregnant mothers in Yaounde have satisfactory knowledge on adequate nutrition in pregnancy; but with significant gaps and difficulty in translating knowledge into practice. Maternal dietary habits are greatly influenced by hormonal changes in pregnancy; socio- economic status; food taboos and cultural beliefs; thus making it difficult to practice the nutrition advice they receive. Adequate multiple dietary supplementation should accompany nutrition advice as an integral part of ANC. Health policies that address cultural taboos should be instituted in favour of pregnancy nutrition

A rare tumour of the vulva: a case report of a vulva angioneurofibroma hamartoma in a Cameroonian woman.

We present the case of a rare vulva tumour, in a 33 years Cameroonian old woman and managed in Obstetrics and Gynecology Unit of Yaoundé Central Hospital in Cameroon. It was a painless pedunculated vulva tumour which developed over a period of six months. This gigantic rapidly growing tumour, was treated with simple surgical resection. After surgical resection, histology confirmed an angioneurofibroma hamartoma. There has been no recurrence and presently the patient is symptom-free.