The Support Systems and Coping Strategies of Infertile Women Attending the Out-Patient Consultation Unit of CHRACERH Yaoundé, Cameroon: A Cross-Sectional Study

Background: Infertility is a complex disorder with significant psycho-social and economic consequences. It globally affects 10% - 15% of couples. In Cameroon, little is known about what women do to overcome the psychosocial aspects of the disease. Objectives: This study aimed to identify the support systems and coping strategies of infertile women attending the outpatient consultation unit of the Gynaecological Endoscopic Surgery and Reproductive Teaching Hospital (CHRACERH), Yaoundé, Cameroon. Methods: A hospital-based cross-sectional study was conducted from the 14th of March to the 6th of April 2023 at CHRACERH Yaoundé. A total of 190 participants were recruited using a convenience sampling method. Data regarding socio-demographic characteristics, support systems and coping strategies were collected using a pretested questionnaire. Descriptive and analytic statistics were conducted using SPSS version 25. Results: The mean age of participants was 39.52 ± 7.64 years. The majority 78.9% of participants were workers (public, private sector, or traders) and were Christians 95.8%. The most common source of psychological support was from family 76.8 and husbands 72.63%. Most of the participants 89.5% resorted to prayer and getting busy 48.4% as a coping strategy. There was no statistically significant relationship between coping strategies and psychological disorders p > 0.05. Conclusion: The main support system of participants was family, husband, and friends. Prayer, getting busy and adoption were the most common coping strategies. There is a need for the Ministry of Public Health and other stakeholders to put in place other support systems and coping strategies (FELICIA) used elsewhere and provide adequate health education and infection control to prevent infertility in Cameroon.

Breast Cancer Survival in Cameroon: Analysis of a Cohort of 404 Patients at the YaoundéGeneral Hospital

This study aimed to estimate the survival rate of breast cancer in a group of patients followed up at the Yaoundé General Hospital in Cameroon. A retrospective review of records of patients managed for breast cancer between 1995 and 2007 was carried out at the Yaoundé General Hospital. Survival analysis was carried out with survival defined as the time between the date of unequivocal diagnosis of cancer and the date of last follow-up or death. Survival curves were plotted in R.3.1.1 software. Mean age of the patients was 47.5 ± 12.36 years. Most of the patients (67.9%) presented with advanced breast cancer disease (stage III and IV). Overall patient survival rate was 30% at 5 years and 13.2% at 10 years. Median overall survival time was 2 (1.9 - 3) years. There was a correlation between survival and the stage of disease. The highest survival rates were recorded in stages I and II while the lowest rates were recorded in stage IV. There was no statistically significant difference in survival among the age groups (p = 0.15). Overall survival rates of breast cancer are 30% at 5 years and 13.2% at 10 years among Cameroonian patients and are lower compared with 90% and 82% respectively at 5 years and 10 years in some developed countries.

Management of Cervical Intra Epithelial Neoplasia by Loop Electrosurgical Excision Procedure in a Low Resource Country: An Experience from the YaoundéGeneral Hospital, Cameroon

Background: Cervical cancer is the third most common cancer worldwide, and 80% of cases occur in the developing world. A critical component of effective cervical cancer screening programs is the ability to offer women appropriate and effective treatment for cervical intra epithelial neoplasia (CIN). Objectives: This study aimed at assessing the primary experience of management of CIN by Loop Electrosurgical Excision Procedure (LEEP) in a low resource country. Methods: We carried out a descriptive cross sectional study at the Yaoundé General Hospital in Cameroon. Results: Twenty three cases of CIN were treated by LEEP. Mean age of patients was 40.5 ± 9.9 years. Six (26.1%) patients were infected by the Human Immunodeficiency Virus (HIV). LEEP was indicated in 21 (91.30%) cases for CIN2 and CIN3. The mean duration of the surgical procedure was 10 ± 3 minutes. There was one (4.3%) complication (persistent cervical bleeding). Surgical margins were negative for dysplasia or invasive carcinoma in 18 (78.26%) cases and non-applicable in 5 (21.73%) cases (thermal artefacts of margins and cervicitis without CIN). One patient with micro invasive carcinoma on post-operative histology was treated by total hysterectomy. Cervical cytology was normal at 6 months post LEEP for 15 cases out of 16 (93.8%) patients who performed the test. One woman achieved pregnancy and delivered a term baby. Conclusion: Treatment of CIN by LEEP is feasible, safe and effective in our setting.

Obstetrical and Perinatal Outcomes of Adolescent Pregnancies in Cameroon: A Retrospective Cohort Study at the YaoundéGeneral Hospital

Background: Adolescent pregnancy is a serious health and social problem worldwide as well as in Cameroon. The aim of this study was to determine the obstetrical and perinatal outcomes of nulliparous adolescent pregnancies in a reference hospital in Cameroon. Methods: A retrospective cohort study to compare the outcomes of nulliparous adolescent pregnancies to those of nulliparous women aged 20 to 25 years was carried out at the Yaoundé General Hospital between January 1993 and December 2012. Results: Adolescent deliveries represented 2.84% (331 deliveries) of all deliveries registered during the study period. The adolescent mothers had a significantly higher incidence of preeclampsia/eclampsia, preterm delivery and low birth weight babies (<2500 g) when compared to the control group (OR, 3.46;CI 95%, 1.46 - 8.18;OR, 1.94 CI 95%, 1.34 - 2.79;OR, 1.98, CI 95%, 1.39 - 2.46, respectively). However, placenta previa, abruptio placenta, episiotomy, cesarean section, vaginal instrumental delivery, perineal tears and post partum hemorrhage were not significantly different in the two groups. Furthermore, there was no statistically significant difference between the two groups regarding fetal distress, low Apgar score (st and 5th minutes), the rate of admission in the neonatal intensive care unit, stillbirth and neonatal death. Conclusion: Adolescent pregnancy is associated with an increased risk of preeclampsia/ eclampsia, preterm birth and low birth weight.

Maternal and Perinatal Complications of Severe Preeclampsia in Three Referral Hospitals in Yaoundé, Cameroon

Objective: The aim of this study was to determine maternal and perinatal complications of pregnancies complicated by severe preeclampsia in three tertiary care centers in Cameroon. Methods: We carried out a descriptive cross sectional study from the 1st of June 2012 to the 31th of June 2014, among pregnant women with severe preeclampsia followed up in three tertiary level hospitals in Yaoundé, Cameroon: the Yaoundé General Hospital, the Yaoundé Central Hospital, and the Yaoundé University Hospital. Statistical analysis was performed using EPI 3.5.5. Data were described as means ± standard deviation, percentages and numbers. Chi-square and Fisher exact tests were used where appropriate. Results: Of the 2500 deliveries registered during the study period, 111 cases (8.49%) were managed as severe preeclampsia. Four patients refused to participate and were excluded from the study. Most of these patients were non workers (58.0%), pauciparous (61.7%) and young (median age of 27.47 years ± 6.46). Eclampsia (12.14%), abruptio placentae (11.21%) and hypertensive retinopathy (7.47%) were the most frequent maternal complications. Two cases (1.86%) of maternal deaths occurred in patients who had eclampsia. Prematurity (48.6%), intra uterine fetal death (13.1%) and oligoamnios (11.2%) were the most frequent fetal complications. All four neonatal deaths occurred in women in whom the diagnosis of severe preeclampsia was done between 28 and 33 weeks of gestation. Conclusion: Pregnancies complicated by severe preeclampsia had significantly high maternal and perinatal morbidity and mortality in Cameroon. The complications of severe preeclampsia can be prevented by more widespread use of antenatal care, education of primary medical care personnel, prompt diagnosis of high-risk patients and timely referral to tertiary medical centers.

Contribution of Laparoscopy in the Management of Female Infertility in Low Resource Countries: A Review of 208 Cases at the YaoundéGeneral Hospital, Cameroon

Background: Infertility is a global problem, but the highest prevalence is in low resource countries, particularly in sub-Saharan Africa where tubal damage following pelvic infection is the commonest cause. Objectives: This study aimed to assess contribution of laparoscopy as a diagnostic and therapeutic tool in infertile women in our setting. Methods: A descriptive review of complete medical records of 208 women who underwent laparoscopy at the Gynaecology Unit of Yaoundé General Hospital from December 2007 to December 2012. Results: Two hundred and eight women were enrolled in this study. Mean age was 32.6 ± 11.25 years. Infertility was secondary in 71.6% of cases;125 (60.1%) women were married and 116 (55.8%) had a positive serology of Chlamydia trachomatis infection. The most frequent findings during diagnostic laparoscopy were: pelvic adhesions (83.7%), hydrosalpinx (21.6%), pyosalpinx (4.8%), perihepatic adhesions (25.5%), uterine fibromas (22.6%), pelvic endometriosis (13%) and ovarian abnormalities (10.1%). The surgical procedures during laparoscopy were: adhesiolysis (79.7%), tuboplasty (35.0%), salpingectomy (8.2%), ovarian cystectomy (5.8%) and myomectomy (1.9%). Three (1.4%) cases of uterine perforation and 1 (0.5%) case of laparoscopy conversion to laparotomy were observed. Conclusion: Diagnostic laparoscopy revealed that tubal lesions and pelvic adhesions were still the major causes of female infertility in developing countries. Adhesiolysis and tuboplasty were the most frequently performed surgical procedures during laparoscopy. Therefore, training in endoscopic surgery should be regarded as an important issue in developing countries.

Voluntary Induced Abortion in Cameroon: Prevalence, Reasons, and Complications

In Cameroon, induced abortion is permitted when a woman’s life is at risk, to preserve her physical and mental health and on the grounds of rape or incest. Objectives: The aim of this study was to determine the prevalence, reasons and complications of voluntary induced abortion among women attending the obstetrics and gynecology services in an urban area, Yaoundé and in a rural area, Wum in Cameroon. Methods: We carried out a cross sectional study, with 509 women recruited between August 1, 2011 and December 31, 2011 in three health facilities in Cameroon. We appreciated the frequency, complications and reasons for Voluntary induced abortions. Results: The prevalence of voluntary induced abortion was 26.3% (134/509) globally;25.6% (65/254) in urban area and 27.1% (69/255) in rural area. One hundred and eleven (83%) cases of induced abortions were carried out in a health structure and 23 (17%) cases in private homes. Medical doctors and nurses were the most frequent abortion providers in both urban (84.7%) as well as rural setting (77.2%). The three main reasons for induced abortion were to pursue their studies (34.3%), not yet married (22.6%) and fear of parents (13.9%). Complications were reported by 20% (27/134) of respondents who had carried out voluntary induced abortion. Excessive bleeding was the most reported complication (70.4%). Conclusion: Despite its illegality in Cameroon, the prevalence of voluntary induced abortion was high in this study.