[Psycho-social and economic reintegration of women operated for urogenital fistula]. / Réinsertion psycho-sociale et économique des femmes opérées pour fistules obstétricales et non obstétricales au Congo.

OBJECTIVE: To study the psycho-social and economic reintegration of women operated for genital fistula in Congo. MATERIAL AND METHODS: This was a descriptive observational study conducted in Brazzaville and Ewo, Republic of Congo, from April 1 to October 31, 2018. It included patients operated for genital fistula between 2008 and 2017. Variables of interest were socio-demographic, reproductive and clinical characteristics. The analysis was performed using the SPSS 20 software. RESULTS: The overall, 34 patients were studied, with age ranging from 29 to 65 years old with a median of 43 (39, 50) year. The context of fistula occurrence was obstetrical in 24 women (70%). The Practice of an income-generating activity before, during and after fistula was 76%; 32% and 64% (P=0.0007). Concerning the psychological status, in these women, self-esteem went from 26% to 73% (P=0.0003) and the prevalence of suicidal thoughts went from 29% before fistula treatment to 0% after (P=0.0009). The tendency to isolate themselves went from 44% before fistula cure to 3% after (P=0.00008). With regards to reproductive life, 54% of women had no desire for maternity and 17% did not have a desire of sexual intercourse. Only 26% of women benefited from the psychologist. Support. CONCLUSION: In this series, we observed a resumption of income-generating activities in women operated for a treatment of urogenital fistula and a psychological recovery with an increase in self-esteem and a decrease in suicidal thoughts. LEVEL OF EVIDENCE: 4.

Clinical Determinants of Vaginal and Abdominal Hysterectomy for Benign Conditions at the University Teaching Hospital, Yaounde-Cameroon.

Background: Little is known about training and the practice of vaginal hysterectomy in many sub-Saharan Africa countries. Objective: The aim of this study was to identify the clinical determinants of choice of hysterectomy route for benign conditions at the University Teaching Hospital in Yaoundé, Cameroon (UTHYC). Methods: This was a retrospective cross-sectional study at the UTHYC from January 1, 2000 to December 31, 2008. Non-emergency hysterectomies for benign conditions were divided into two surgical approaches: vaginal and abdominal. Patients' files and registers were used for data collection. Variables of interest were socio-demographic, reproductive health, and clinical characteristics, including indications and surgical route. Analysis was performed using Epi-Info version 3.5.1. Logistic regression analysis was conducted to determine the association between clinical variables and surgical routes. Odds ratios with their 95% confidence intervals (CI) were calculated. The level of significance was set up at P < 0.05. Results: One hundred and sixty-three women who underwent hysterectomy for benign conditions were included in the study. Thirty-seven (22.7%) were by vaginal route and 126 (77.3%) by abdominal route. Indications for hysterectomy were: cervical premalignant lesions, symptomatic uterine fibroids, prolapsed uterus, endometrial hyperplasia, recurrent cervical condyloma, and dysfunctional uterine bleeding. All 61 women with estimated uterine size of more than 12 weeks were operated on by abdominal route. At bivariate analysis, compared to women who had vaginal hysterectomy, factors associated with the choice of abdominal route were secondary/tertiary level of formal education, previous history of laparotomy/caesarean section, premenopausal status, age less than 50 years, and symptomatic uterine fibroids as surgical indication. At multivariate analysis, factors remaining independently associated with the choice of abdominal route were: age <50 years (AOR: 2.99 [1.9-4.71]), P < 0.001); previous laparotomy/cesarean section (AOR: 2.95[2.13-4.08], P = 0.001); premenopausal status (AOR: 1.55 [1.06-2.25]; P = 0.001); and myoma as surgical indication (AOR: 7.49.4[3.2-14.4]; P = 0.0001). Conclusion: Less than a quarter of hysterectomies for benign conditions were performed vaginally. All patients with uterine sizes larger than 12 weeks had laparotomy. The determinants of the choice of the abdominal route included age less than 50 years, previous laparotomy/caesarean section, premenopausal status, and fibroid as surgical indication.

Contexte: on sait peu de choses sur la formation et la pratique de l'hystérectomie vaginale dans de nombreux pays d'Afrique subsaharienne. Objectif: identifier les déterminants cliniques du choix de la voie d'hystérectomie pour des conditions bénignes au Centre Hospitalier Universitaire de Yaoundé, Cameroun (CHUYC). Méthodes: il s'agit d'une étude rétrospective transversale au CHU de Yaoundé de janvier 2000 au 31 décembre 2008. Les hystérectomies non urgentes pour des conditions bénignes ont été divisées en deux approches chirurgicales: vaginale et abdominale. Les dossiers et registres des patients ont été utilisés pour la collecte des données. Les variables d'intérêt étaient les caractéristiques socio-démographiques, de santé reproductive et cliniques, y compris les indications et la voie chirurgicale. L'analyse a été réalisée à l'aide d'Epi-Info version 3.5.1. Une analyse de régression logistique a été réalisée pour déterminer l'association entre les variables cliniques et la voie chirurgicale. Les Odds Ratios avec leurs Intervalles de Confiance (IC) à 95% ont été calculés. Le niveau de signification a été fixé à P < 0,05. Résultats: cent soixante-trois femmes ayant subi une hystérectomie pour des conditions bénignes ont été incluses dans l'étude. Trente-sept (22,7%) l'ont été par voie vaginale et 126 (77,3%) par voie abdominale. Les indications de l'hystérectomie étaient les suivantes: lésions cervicales prémalignes, fibromes utérins symptomatiques, utérus prolabé, hyperplasie endométriale, condylomes cervicaux récurrents et saignements utérins dysfonctionnels. Les 61 femmes dont la taille utérine estimée était supérieure à 12 semaines ont été opérées par voie abdominale. En analyse bivariée, par rapport aux femmes ayant subi une hystérectomie vaginale, les facteurs associés au choix de la voie abdominale étaient le niveau d'éducation formelle secondaire/tertiaire, les antécédents de laparotomie/césarienne, la préménopause, l'âge inférieur à 50 ans et les fibromes utérins symptomatiques comme indication chirurgicale. Lors de l'analyse multivariée, les facteurs restant indépendamment associés au choix de la voie abdominale étaient: l'âge <50 ans (AOR: 2,99 [1,9-4,71]), P < 0. 001); les antécédents de laparotomie/césarienne (AOR: 2,95 [2,13-4,08], P = 0,001); le statut de préménopause (AOR: 1,55 [1,06-2,25]; P = 0,001); et le myome comme indication chirurgicale (AOR: 7,49,4 [3,2-14,4]; P = 0,0001). Conclusion: moins d'un quart des hystérectomies pour des conditions bénignes ont été réalisées par voie vaginale. Toutes les patientes dont la taille de l'utérus était supérieure à douze semaines ont subi une laparotomie. Les déterminants du choix de la voie abdominale comprenaient l'âge de moins de 50 ans, les antécédents de laparotomie/césarienne, le statut de préménopause et le fibrome comme indication chirurgicale.

[Comparative study of the outcome of surgical management of vesico-vaginal fistulas with and without interposition of the Martius graft: A Cameroonian experience]. / Étude comparative du résultat de la cure des fistules vésico-vaginales avec et sans interposition du lambeau de Martius: une expérience camerounaise.

INTRODUCTION: This study aimed to investigate whether Martius' graft has an effect on the outcome of the surgical management of genitourinary fistula. PATIENTS AND METHODS: This was a retrospective comparative study of all cases of genitourinary fistula that underwent curative surgery in two Cameroonian hospitals. Patients were all operated between January 2005 and July 2011 in the gynecology unit of the Maroua Regional Hospital and the University Hospital Centre of Yaoundé by a well-trained surgeon. The characteristics of women with fistulas operated without graft of Martius were compared with those of women operated with graft of Martius. RESULTS: Among the 81 genitourinary fistulas operated, 28 (34.6%) had benefited from graft of Martius. Depending on the characteristics of obstetric fistula, the two groups (that of patients who had a cure with, and that of patients who had a cure without interposition of graft of Martius) were similar: there was no difference in the proportion of rigid edges (89.3% vs. 73.6%, P=0.0989); in the proportion of vaginal flanges (78.6% vs. 60.4%, P=0.0986), in the proportion of cervical localization (42.9% vs. 28.3%, P=0.3762), in the proportion of fistulas with a size greater than 2 cm (64.3% vs. 39.6%, P=0.0702), nor in the proportion of recurrent fistulas (28.6% vs. 41.5%, P=0.2523) between the two groups. Similarly, both groups were comparable according to the results of surgery: there was no difference in the overall closure rate (85.7% vs. 79.2%, P=0.347) nor in the closure of fistula with continence (60.7% vs. 67.9%, P=0.260) between the two groups. The use of graft of Martius had no effect on the overall closure of genitourinary fistula in our series [OR: 1.57; 95% CI: 0.4 to 6.6; P=0.680]. CONCLUSION AND INTERPRETATION: The Martius graft does not seem to affect the outcome of the surgical management of genitourinary fistula. These results need to be confirmed by studies on a larger population.

Risk factors of delivery by caesarean section in cameroon (2003-2004): a regional hospital report.

We conducted this retrospective case-control study to identify possible risk factors of delivery through caesarean section in the Far North Region of Cameroon. Data was collected retrospectively from delivery room registers at the Provincial Hospital, Maroua, Cameroon from 01/01/2003 to 31/12/2004. The overall 125 eligible caesarean deliveries were compared with 244 women who delivered vaginally during the study period. The odds ratio as well as the 95% confidence interval was used to measure the relationship between maternal characteristic and risk of delivery by caesarean section. We found that the marital status is similar in the two study populations. Risk factors associated with cesarean section were: maternal age less than 17 years (OR 3.55, 95%CI: 1.46-8.64), maternal age over 39 years (OR 3.55, 95% CI: 1.17-10.75), nulliparity (OR 2.72, 95% CI: 1.59-4.66), grand multiparty (OR 3.43, 95% CI: 1.79-6.57), and macrosomia (OR 4.82, 95% CI: 1.49-16.44). There was a weak association with absent or poor. Caesarean delivery is associated with extreme ages of reproductive life, macrosomia, nulliparous and grand multiparous status. We strongly recommend that these factors be taken into consideration to strengthen the mother and child health programs in Cameroon and countries with similar socioeconomic profiles.

Conservative treatment of ectopic pregnancy in a sub-Saharan African setting.

In the sub-Saharan African setting, laparotomy for salpingectomy is the common method of treatment for ectopic pregnancy (EP). The objective of this retrospective study was to find out how common EP is treated conservatively in the Yaounde Gynaeco-Obstetric and Paediatric Hospital, Cameroon. Of the 281 patient files analysed, 126 patients (44.8%) were treated conservatively and successfully for EP. Of these, 86 (68.2%) had received conservative surgical treatment while 40 (31.8%) had non-surgical treatment. Salpingostomy was the conservative surgery for 79.1% of the cases. According to the publications available for the sub-Saharan setting, the rate of conservative management of EP at the Yaounde Gynaeco-Obstetric and Paediatric Hospital, Cameroon is high. We recommend that this rate should be improved so that, eventually, the conservative treatment methods of EP become routine.

Geographic Distribution of Childbirth among Adolescents in Cameroon from 2003 to 2005.

Objective. To determine the frequency and the trend of adolescents (10-19 years) in childbirth within a period of 3 years in referral maternity units in Cameroon. Method. Descriptive and retrospective study for a 3-year period (2003-2005) in referral maternity units headed by a qualified Obstetrician-Gynecologist. We analyzed the trend and geographic distribution of 8222 adolescent deliveries over 3 years. Epi Info 3.5 software was used for data analysis. Chi square test for trend was used to assess the contribution of adolescent deliveries over years. The trend was considered significant if P < .05. Results. During the period of the study, there was a total of 8387 deliveries. We excluded 165 women because of lack of information about age. We therefore included a total of 8222 adolescent deliveries. Overall, the contribution of adolescents to deliveries ranged from 6.87% to 26.51%, depending on the region with a national mean of 14.23%. Adolescents aged 16 or less contributed to 2.82% of deliveries while those aged from 17 to 19 contributed to 11.41%. The contribution of adolescents to deliveries decreased significantly over 3 years (P < .0001). Conclusion. The study underscores the importance of Public Health programs in strengthening maternity services for adolescents in Cameroon while taking into consideration geographic differences.

Effectiveness of vaginal hysterectomy for benign conditions in semi-urban hospital: report from Maroua-Cameroon.

We assessed the effectiveness of vaginal hysterectomy for benign uterine conditions in Northern Cameroon. This is a case series study of 29 elective vaginal hysterectomies carried out between February 2005 and June 2007 in Maroua, Cameroon. Hysterocele was found as the only or associated indication in 17 (58.6%) patients, symptomatic uterine fibroids in 4 (13.8%) and other indications in 8 (27.6%) patients. The mean duration of the operation was 132 minutes and the mean blood loss at surgery was 150 ml. Twenty-five of the 28 (89.3%) women had less than seven days of hospitalisation. There was a negative correlation (r = -0.45, P = 0.015) between duration of the surgery and the order of operation. One urinary tract and one wound infection were observed. Two patients had conversion to laparotomy. This study has shown that vaginal hysterectomy is a safe and feasible method of hysterectomy in a semi-urban hospital.

[Knowledge, attitude and perception about obstetric fistula by Cameroonian women]. / Connaissance, attitude et perception vis-à-vis des fistules obstétricales par les femmes camerounaises Une enquête clinique conduite à Maroua, capitale de la province de l'extrême Nord du Cameroun.

INTRODUCTION: This study seeks to identify what the women who live in Maroua Cameroon know and think about obstetric fistula. POPULATION AND METHOD: It is a single hospital, cross-sectional, descriptive and comparative study. Ninety-nine women in the maternity service of the Maroua Provincial Hospital were interrogated on obstetric fistula between May and July 2005, by enquirers who were trained health agents using a questionnaire which required both closed and open answers. RESULTS: The women who had no previous knowledge of it were generally the illiterate (41.7% compared to 18.8%). More than a third of the women who had an idea of the fistula do not know that there is a surgical treatment for it. Whether they had the previous information on fistula or received it from us, one-tenth of the women suggested that suicide was the solution to fistula where as one-third of the women suggested that a patient suffering from fistula should be isolated. CONCLUSION AND INTERPRETATION: Illiteracy contributes significantly to the lack of knowledge of this affection. The population has a poor perception and a strong negative attitude towards obstetric fistula as they see isolation or suicide as the solution to it.

The attitude and knowledge of cervical cancer by Cameroonian women; a clinical survey conducted in Maroua, the capital of Far North Province of Cameroon.

This study was conducted to assess the knowledge, attitudes, and assumption of cervical cancer by women living in Maroua, the capital of the Far North Province of Cameroon. In a 1-month period, 171 women were surveyed as to their socioeconomic status, sexual habits, prior knowledge of cervical cancer, its prevention, and their attitudes toward cervical cancer. Of 171 women, 48 (28%) had prior knowledge of cervical cancer; they were classified as the "aware group" compared with 123 of 171 (72%) women who were uninformed about cervical cancer and they were classified as the "unaware group" (UG). The UG of women tended to be single mothers, illiterate, housewives, and had their first child before the age of 20 (P < 0.005). Despite the awareness of cervical cancer by 28% of women, only a minority of them, 4 of 48 (8.3%), underwent a preventative screening test. Only 71 of 171 (41.5%) women stated that they would be having a screening test in the future. The awareness of cervical cancer by women in Cameroon is still inadequate. Thus, to avoid deaths from cervical cancer, a curable and preventable disease, the need of an aggressive campaign to make Cameroonian women aware of cervical cancer and its prevention is needed.

Maternal mortality in Maroua Provincial Hospital, Cameroon (2003-2005)

Background: In September 2000, the Heads of States of the 191 countries of the United Nations approved the Millennium Declaration in which reduction of pregnancy-related deaths to a quarter by 2015 was one of its goals. However, before the middle of the first decade of this millennium, there were no reports on the status of maternal mortality in Maroua, Cameroon.Objective: The aim of this study was to establish baseline data on maternal mortality for future evaluation of pregnancy-related mortality trends in this city. Subjects and Methods: Maternal deaths that occurred from 2003 to 2005 in Maroua City, Cameroon,were analyzed. Mortality ratios were determined by comparing the number of the deaths related to pregnancy with that of women with safe deliveries. Mortality risks were determined by comparing the characteristics of women with pregnancy-related deaths to those of women with safe deliveries. Results: The overall maternal mortality ratio was 1266 maternal deaths per 100 000 live births. The leading causes of death were hypertension (17.5%), obstetric infections (14.3%), uterine rupture(14.3%), anaemia (12.7%) and HIV complications (9.5%). Among the women who died, 28.6% were teenagers and 14.3% were at their sixth delivery (or above). Compared with women aged 20 to 24 years, those aged 25 to 29 years were more than twice as likely to die from pregnancy-related causes (HR: 2.34; CI: 1.07,5.08; p = 0.029). A similar trend was also found in those aged 30 to 34 years (HR: 2.26; CI: 1.02,5.00; p = 0.042). Conclusion: The findings suggest that Maternal Mortality Ratio in Maroua, City, Cameroon, is veryhigh. Since most of the causes of death were preventable, we propose that the current maternal and Family Planning strategies be reviewed with the view to reducing the current trend. Such a strategy would enable the Maroua city to meet the Millennium goals by 2015.

Antecedentes: En septiembre del 2000, los Jefes de Estado de 191 países de la Naciones Unidas, aprobaron la Declaración del Milenio, una de cuyas metas es la reducción hasta una cuarta parte, de las muertes relacionadas con el embarazo, para el año 2015. Sin embargo, antes de mediados de la primera década de este milenio, no habia reportes sobre el estado de la mortalidad materna en Maroua, Camerún. Objetivo: El objetivo de este estudio fue establecer los datos preliminares comparativos de referenciasobre la mortalidad materna para la evaluación futura de las tendencias de la mortalidad en relación con el embarazo en esta ciudad. Sujetos y Métodos: Se analizaron las muertes maternas ocurridas del 2003 al 2005 en la ciudad de Maroua, Camerún. Las tasas de mortalidad fueron determinadas comparando el número de muertesrelacionadas con el embarazo, con el número de mujeres que tuvieron partos seguros. Los riesgos de mortalidad fueron determinados comparando las características de mujeres que murieron por causas asociadas al embarazo, con mujeres que tuvieron partos seguros. Resultados: La tasa general de mortalidad materna fue de 1266 muertes maternas por cada 100 000nacidos vivos. Las causas principales de muerte fueron: hipertensión (17.5%), infecciones obstétricas (14.3%), ruptura uterina (14.3%), anemia (12.7%) y complicaciones por VIH (9.5%). De las mujeres que murieron, 28.6% eran adolescentes y 14.3% estaban en su sexto parto (o por encima). En comparación con las mujeres de 20 a 24 años de edad, las de 25 a 29 años presentaban una probabilidad dos veces mayor de morir por causas relacionadas con el embarazo (HR: 2.34; CI: 1.07, 5.08; p =0.029). Una tendencia similar se halló también en las mujeres de 30 a 34 años de edad (HR: 2.26; CI: 1.02, 5.00; p = 0.042). Conclusión: Los hallazgos sugieren que la tasa de mortalidad maternal en la ciudad de Maroua,Camerún, es muy alta...

[Historical cohort study of delivery in women of forty years of age and older]. / Etude cohorte historique de l'accouchement a 40 ans et plus a Yaoundé-Cameroun.

In a recent study at the Yaounde-Cameroon University Teaching Hospital, we found that delivery at extreme ages of reproductive health was associated with increased foetal and maternal risks. However we were not able to evaluate the impact of advanced age on exposure do different risks observed. The purpose of this study was to test the hypothesis that deliveries of women aged 40 years and above were associated with increased risk. Data collection was retrospective from delivery room registers at the Yaoundé University Teaching Hospital Between 01/01/1991 - 31/12/2000. The deliveries of 180 women in their forties were compared with those of 532 women in their twenties. The software EPI Info 6 and SPSS were used in analysis. At unvaried analysis, the risk of delivery by caesarean section for women in their forties (16.1%) was significantly high compared to women in their twenties (10.0%), (HR: 1.7; 95% CI: 1.1-2.8; p = 0.027). After adjustment for different factors associated with the occurrence of delivery by caesarean section, its risk for women aged 40 and above remained significantly increased (HR: 1.7; 95% CI: 1.0-2.9; p = 0.039). Similar observation was found for stillbirth with 11.7% by women aged 40 and above compared to 5.8% by women in their twenties (HR: 2.1; 95% CI: 1.1-3.9; p = 0.011). After adjustment for different factors associated with mortinatality, its occurrence remained significantly increased at age 40 and above (HR: 1.9; 95% CI: 1.1-3.6; p = 0.032). Women aged 40 years and above had an increased risk of stillbirth and delivery by caesarean section than those in their twenties. Studies are needed to establish the exact causes of these risks and evaluate management options in these women.

Maternal mortality in Maroua Provincial Hospital, Cameroon (2003-2005).

BACKGROUND: In September 2000, the Heads of States of the 191 countries of the United Nations approved the Millennium Declaration in which reduction of pregnancy-related deaths to a quarter by 2015 was one of its goals. However, before the middle of the first decade of this millennium, there were no reports on the status of maternal mortality in Maroua, Cameroon. OBJECTIVE: The aim of this study was to establish baseline data on maternal mortality for future evaluation of pregnancy-related mortality trends in this city. SUBJECTS AND METHODS: Maternal deaths that occurred from 2003 to 2005 in Maroua City, Cameroon, were analyzed. Mortality ratios were determined by comparing the number of the deaths related to pregnancy with that of women with safe deliveries. Mortality risks were determined by comparing the characteristics of women with pregnancy-related deaths to those of women with safe deliveries. RESULTS: The overall maternal mortality ratio was 1266 maternal deaths per 100,000 live births. The leading causes of death were hypertension (17.5%), obstetric infections (14.3%), uterine rupture (14.3%), anaemia (12.7%) and HIV complications (9.5%). Among the women who died, 28.6% were teenagers and 14.3% were at their sixth delivery (or above). Compared with women aged 20 to 24 years, those aged 25 to 29 years were more than twice as likely to die from pregnancy-related causes (HR: 2.34; CI: 1.07,5.08; p = 0.029). A similar trend was also found in those aged 30 to 34 years (HR: 2.26; CI: 1.02,5.00; p = 0.042). CONCLUSION: The findings suggest that Maternal Mortality Ratio in Maroua, City Cameroon, is very high. Since most of the causes of death were preventable, we propose that the current maternal and Family Planning strategies be reviewed with the view to reducing the current trend. Such a strategy would enable the Maroua city to meet the Millennium goals by 2015.

Vaginal delivery after caesarean section: a propective study of 146 cases.

We report on a series of 146 cases of vaginal delivery after previous Caesarean section conducted between 1993 and 2002 at the University Teaching Hospital, Yaounde (Cameroon). During the period under review 945 cases of Caesarean section were done out of a total of 9 439 deliveries (10 %). Delivery was spontaneous in 141 cases whereas in 5 cases it was assisted by vacuum extraction. In 13 cases Caesarean section was carried out after failure of trial of labour. Maternal mortality, resulting from pulmonary embolism, was observed in 1 case. We conclude that strict selection of patients who had previous Caesarean section for trial of labour renders vaginal delivery a safe alternative to Caesarean section.

Prevention of mother-to-child transmission of HIV in Cameroon: experiences from the University Teaching Hospital in Yaounde (Cameroon).

OBJECTIVE: The aim of this study was to assess the effectiveness of nevirapine (NVP) in the prevention of mother-to-child transmission (MTVT) of HIV-1 in children in the Yaounde University Teaching Hospital, Cameroon. METHODS: This was a prospective and descriptive hospital-based study in which pre-counselled HIV-infected pregnant women who gave their consent were included. At the onset of labour a single dose of 200 mg oral NVP was administered to each woman. Their newborns were also given 2 mg/kg of oral NVP syrup within 72 hours of their birth. These NVP-treated babies were assessed at 6 weeks, 6 months and between 15 and 18 months for viral load levels, using a branched DNA technology. Viral load levels were classified as undetectable (< 50 copies/ml); intermediate (50-3 500 cp/ml) or high (> 3 500 cp/ml). RESULTS: Of the 350 women screened for HIV 22 (6.3 %) were positive for HIV-1, but only 18 children were duly tested until 18 months. Viral load levels were undetectable at 6 weeks in 61.1 % of the children; intermediate in 38.9 % and no child had a high VL (> 3 500 cp/ml). At 6 months 5 of 7 children with intermediate levels had dropped to undetectable levels. By 15-18 months, a total of 16 children (88.9 %) had undetectable levels while 2 children (11.1 %) with detectable levels were confirmed to be HIV positive using ELISA test and immunoblot analysis. CONCLUSIONS: We conclude that the rate of HIV-1 MTCT with NVP is about 11 % in CHU Yaounde.

[Delivery outcome of adolescents in Far North Cameroon]. / Accouchement des adolescentes à l'Extrême Nord du Cameroun: des proportions inadmissibles!

UNLABELLED: Delivery in teenager is associated with increased risk. The aim of this study was to evaluate the contribution of teenagers (10-19 years or less) to the total number of deliveries over a 10 year period in the Maroua provincial hospital (Cameroon) This was a retrospective study. The deliveries of 3.328 teenagers were analysed as far as their contribution to the deliveries is concerned and how this contribution changed with time from 01/01/1995 to 31/12/2004 at the Provincial Hospital Maroua (Cameroon). Analyses were performed using Excel and Epi Info 6. The chietaiota2 tests of the tendency, taking in account all ten age groups, was used to appreciate the phenomenon over time. This trend was considered significant if p<0.05. RESULTS: During the study period 13.026 women delivered, 489 cases were excluded because the age was not specified. Finally, 3.328 teenagers were analysed out of a total of 12537 cases, as far as their contribution to the number of deliveries from 1995 to 2004 in the Maroua provincial hospital. Teenagers contributed for 26,54% of total deliveries in Maroua Provincial Hospital, (Cameroon). Teenagers of 16 and less contributed for 7,58%, and those aged 17 to 19 years contributed for 18,25%. We found out that the trend over the study period, has not changed (p>0.05). This study emphasizes the need of redynamisation of adolescents health services in Extreme North Cameroon. Studies should be done to determine the impact of young age on the delivery outcome.

[Outcome of delivery at extreme ages of reproductive life]. / Devenir de l'accouchement aux âges extrêmes de la vie reproductive.

BACKGROUND: Deliveries in adolescents and in elderly are separately known as associated with high foetal and maternal risks. The purpose of this study was to test the hypothesis that the outcome of deliveries might be comparable in these distinct age groups. POPULATION AND METHODS: The deliveries of 99 adolescents aged 16 and under were compared with that of 183 women aged 40 years and above with respect to complications of the delivery and the outcome of pregnancy. Data collection was retrospective using delivery room registers from 01/01/1991 to 31/12/2000. RESULTS: Some risks were comparable in both groups as delivery by caesarean section, intra uterine growth retardation, and stillbirth. Other risks were significantly higher in teenagers as post-term delivery, premature delivery, and neonatal foetal distress. The risk of macrosomia was significantly higher in aged women. CONCLUSION: There are risks that are similar in both extremes of age. Other risks are higher particularly in teenagers or in aged women. A common prenatal care unit can be used for these two categories of population, but a few different practices will have to be considered according to the specific age group.

Positive peritoneal cytology in early-stage endometrial cancer does not influence prognosis.

The aim of this study was to assess the prognostic importance of positive peritoneal cytology in early-stage endometrial cancer. All 278 stage I and 53 stage IIIA (without cervical involvement) endometrial cancer patients operated between 1980 and 1996, recorded at the Geneva Cancer registry, were included. Stage IIIA cancers were recategorised into 'cytological' stage IIIA (positive peritoneal cytology alone, n=33) and 'histological' stage IIIA (serosal or adnexal infiltration, n=20). Survival rates were analysed by Kaplan-Meier method and compared using log-rank test. The prognostic importance of cytology was analysed using a Cox model, accounting for other prognostic factors. The 5-year disease-specific survival of cytological stage IIIA cancer was similar to stage I (91 vs 92%) and better than histological stage IIIA cancer (50%, P<0.001). After adjustment for age, myometrial invasion, differentiation and radiotherapy, cytological stage IIIA patients were still at similar risk to die from endometrial cancer compared to stage I patients (hazard ratio (HR) 0.7, 95% confidence interval (CI): 0.18-2.3), while histological stage IIIA patients were at a four-fold increased risk to die from their disease (HR 4.2, 95% CI: 1.7-10.3). This population-based study shows that positive peritoneal cytology in itself has no impact on survival of patients with localised endometrial cancer. Based on the present and previous studies, FIGO (Fédération Internationale de Gynécologie et d'Obstétrique) might consider reviewing its classification system.

Impact of peritoneal cytology on survival of endometrial cancer patients treated with surgery and radiotherapy.

Stage IIIA endometrial cancer includes patients with serosal or adnexal invasion and patients with positive peritoneal cytology only. In this study, we assessed the impact of peritoneal cytology on endometrial cancer survival. All endometrial cancer patients receiving surgery and radiotherapy at the Geneva University Hospitals between 1980 and 1993 were included. Stage IIIA cancers were categorised into 'cytological' stage IIIA (only positive peritoneal cytology) and 'histological' stage IIIA (serosal or adnexal infiltration). Survival rates were analysed by Kaplan-Meier method and compared using log-rank test. The prognostic importance of peritoneal cytology was analysed by multivariate regression analysis. This study included 170 endometrial cancers (112 stage I, 17 cytological stage IIIA, 18 histological stage IIIA, 9 stage IIIB+). Disease-specific survival of cytological stage IIIA was not different from stage I (94 vs 88% respectively, P=0.5) but better than histological stage IIIA (94 vs 51% respectively, P<0.01). Histological stage IIIA patients were at increased risk to die from cancer compared to stage I patients (HR 2.7, 95% CI 1.0-7.7), while cytological stage IIIA patients were not (HR 0.3, 95% CI 0.3-2.0). Cytological stage IIIA endometrial cancer has similar prognosis as stage l and better prognosis than histological stage IIIA. Additional research, definitively separating stage and cytology is warranted.