Evolution and Risk Factors of Maternal Mortality in Cameroon: A Case Control Study

Background: Maternal mortality is still high in sub-Saharan Africa, especially in Cameroon where more efforts to reduce maternal mortality and provide universal access to reproductive health should be made. This study aims to see the evolution of maternal mortality and identify associated risk factors in Laquintinie hospital in Cameroon. Methods: A manual review of records for 166 maternal deaths (cases) and 322 controls was undertaken using a standard audit form. The sample included pregnant women aged 16 - 46 years admitted at the maternity of Laquintinie Hospital in Douala, Cameroon from January 2017 to December 2022. Software SSPS 3 and Logistic regression analysis were used to analyze data. Results: One hundred and sixty-six (166) maternal deaths were identified during the study period for 14,114 live births, representing a maternal mortality ratio of 1176/100,000 live births. Factors significantly associated with maternal mortality included: young age (15 - 24 years) (aOR 0.11, 95% CI 0.00 - 0.76, p = 0.037), Alcohol intake (aOR 22.79, 95% CI 1.04 - 501.3, p = 0.047), Abortion or ectopic pregnancy (aOR 61.53, 95% CI 1.29 - 2927.3, p = 0.037), having no antenatal visits (aOR 388.3 95% CI 5.6 - 2675.9, p = 0.006), being admitted with hemorrhage (aOR 343.7, 95% CI 16.2 - 7276.0, p ,713.0, 95% CI 128.2 - 5,989,223.3, p CI 0.00 - 0.18, p = 0.016). Conclusion: Despite slight decrease in maternal mortality, early diagnosis of pregnancy and good Antenatal care associated with maternal health education are important factors for reducing maternal mortality. Young women were the most affected. Singles, alcoholics, women with a no or only primary education level, and referred women represented the majority of deceased cases.

Adolescent Pregnancy: Epidemiological Survey in Schools and Obstetrical Outcomes in Douala (Cameroon)

Introduction: According to the World Health Organization (WHO), adolescence is the period of growth between 10 and 19 years of age. Complications from pregnancy are the second leading cause of death for adolescent girls aged 15 to 19 worldwide. Objective: In order to reduce the phenomenon of early pregnancy, we set out to determine its prevalence as well as its outcome among adolescent girls in secondary schools in the Douala 3rd district in Cameroon. Methodology: To achieve our objective, we conducted an analytical case-control study from November 08, 2018 to June 26, 2019, in ten secondary establishments in the Douala 3rd district. Included in the study were all adolescent girls, students in one of the secondary schools in the said district who agreed to participate in the study. Data analysis was done using SPSS 20.0 software. The significance threshold was set at p < 0.05. Results: A total of 445 adolescent girls were selected, including 89 cases and 356 controls. In 87.6% of the cases, the pregnancy was accidental and 58.4% used voluntary abortion. The univariate analysis of the results showed that the factor associated with the occurrence of teenage pregnancies was the age above 17 years (OR = 1.44;CI = 1.31 - 1.59) (p = 0.001). Conclusion: At the end of our study, it appeared that early pregnancies exist in Cameroonian schools with a high rate of 6.57% and an appeal to illegal abortion (62.9%).

HIV+ Status and Cervical Cancer: Cytological Aspects of Cervical Smear in Cameroon Setting

Introduction: The early detection of precancerous lesions being very important for the preventive management of cervical cancer, we felt it was important to identify these lesions on potential backgrounds including HIV-positive (HIV+) women to suggest control strategies of cervical cancer in Cameroon. Objective: To determine the prevalence of precancerous lesions in women infected with the human immunodeficiency virus (HIV), to investigate the determinants of the HIV and cervical cancer association, and to make recommendations regarding cervical cancer screening in these patients of the city of Douala. Methodology: Our study was a case-control cross-sectional study from July 2017 to December 2017 (6 months) including 108 women among which 34 HIV+ matched with 74 HIV-. HIV serology was done using the complete HIV enzygnost test. Cervical smears for cytological lesions were fixed to the cyto-fixator and then stained by the Papanicolaou technique and read under an optical microscope. The cervical smear slides for viral excretion were fixed with a methanol-acetone mixture of equal volume;HPV testing was done by the indirect immune-peroxidase technique using P16 protein. The excretion of HSV type 1 & 2 was investigated by the indirect immunofluorescence technique using the Simplex Virus type 1 & 2 Rabbit anti-Herpes from DAKO (France). Results: The two groups of women were compared with the chi square test with a significance threshold of P 0.05. The average age was 40.07 with extremes of 21 and 71 years and a standard deviation of 9.99. Of the 34 HIV+ patients, 23 had an abnormal cervix compared to 36 cases of abnormal cervix among HIV- with a statistically significant difference (P = 0.006649). 12 cases of dysplasia were observed in the 34 HIV+ women and distributed as follows: 0% of mild dysplasia, 18.92% of moderate dysplasia and 13.51% of severe dysplasia. In HIV- women we detected 6 cases of dysplasia including 1.35% of mild dysplasia, 4.05% of moderate dysplasia and 2.70% of severe dysplasia. Regarding HPV infection, we observed 21 cases of HPV among 34 HIV+ women (61.76%) against 23 cases in HIV-lesions remains high in HIV+ women, hence the need to include routine screening for precancerous lesions in all HIV+ women at all ages, as well as the routine search for HPV excretion in all those with cellular dysplasia.

Caesarean Section in African Setting: Current Situation, Problematic and Qualitative Approaches at Laquintinie Hospital (Douala, Cameroon)

Background: Quality control of care aims to reduce or eliminate unnecessary care and to improve the quality of those who are useful both in their indication and in their implementation. Objective: We conducted this study to assess the rate of caesarean section, the rate of irrelevant indications, materno-foetal morbidity and mortality, biases in the management in order to suggest corrective approaches. Methods: It was a cross-sectional study conducted in the gynaeco-obstetrics department of the Laquintinie Hospital of Douala over a period of 4 months from January 1 to April 30, 2017. We included all pregnant women who had a caesarean section and who gave consent to our study as well as new-borns from these caesareans. We excluded caesarean deliveries from other health structures and referred to Laquintinie Hospital due to morbid operative follow-up. The variables collected were grouped under 3 main headings: socio-demographic data, clinical data and post-operative follow-up. Results: A total of 281 caesarean sections were performed out of a total of 967 deliveries;a caesarean section rate of 29.06% in 4 months. After data mining, 250 caesarean sections were included in the study because 31 cases of caesarean deliveries were unusable. Referred pregnancies accounted for 46.8% of the total population and the most common reason for referral was stationary labour (23% of cases). All caesareans were performed by the gynaeco-obstetricians. Women who had caesarean deliveries were informed by the operator of the surgical procedure in 28.4% of cases and 27.6% were notified of the indication for surgery. The operative kit was present in 98% of cases. The operating room was available in 93% of cases. Caesareans were performed mostly in an emergency context (91.2%) with a median turnaround time of 214 minutes (3 h 56 mins). Mechanical dystocia was the major indication in our series (21.2%) and 29 indications were irrelevant (11.6%). Intraoperative complications occurred in 3.2% of cases. Overall maternal mortality (per- and post-operative) was 0.8% (2 cases). We recorded 15 neonatal deaths out of which 8 were still births. Regarding the postoperative period, 78% of the operated patients did not have a good immediate postoperative monitoring. The post-operative protocol was not respected in 17% of cases. Postoperative complications occurred in 21.6% of patients with first cause being infections (10.8% with 5.6% being parietal suppurations). Conclusion: The frequency of Caesarean sections at Laquintinie Hospital is above the World Health Organization’s recommendations of 5% - 15%. There is a very big delay in the execution time of emergency caesareans, far above the international standards despite the quasi-availability of operating kits and the operating theatre. The state of the premises reveals a sub-workforce creating work overload and therefore a demotivation of the staff leading to insufficient communication between the operator and operated, a lack of postoperative follow-up and significant neonatal morbidity and mortality. Hence the need to initiate a staff satisfaction survey.

The Problem of Traditional African Pharmacopoeia in Obstetrics: Use of Plants for Utero-Tonic Purposes and Materno-Fetal Outcome in Douala (Cameroon)

Introduction: The use of traditional preparations for the induction or acceleration of labor remains a common practice in our country in particular and in Africa in general with sometimes derogatory outcomes for the mother and the fetus. Goal: The objective was to assess immediate maternal and neonatal outcomes in women who reported having used the traditional pharmacopoeia for utero-tonic purposes. Methodology: We conducted a multi-centric cross- sectional study with prospective data collection in the maternities of the Laquintinie Hospital, Bonassama District and Nylon Hospitals. It took place over a period of seven months, from 1st October 2016 to 31st April 2017. This included all women who reported having used the unconventional pharmacopoeia for utero-tonic purposes before or after contractions started. The student and Chi-square tests were interpreted at the statistical threshold of 5% and the 95% confidence intervals. Results: We recruited 168 cases, 68.5% of the 245 women interviewed. The mean age was 27.1 ± 0.41 years;55% of our respondents had a secondary level of education;80% of them were admitted at term and 43% were multiparous. Nulliparity predisposed to traditional pharmacopoeia use (RR = 1.55, CI = 0.79 - 3.03) but primiparity reduced this risk (RR = 0.4, CI = 0.24 - 0.926). Stimulation of labor was the first indication in 85% of women, the rectal evacuation enema was the main route used (67%). The majority of plants used were those of the families Asteraceae, Anthericaceae, and Malvaceae. In per partum, 42% had a brilliant dilatation;there was a statistically significant association between the occurrence of dynamic dystocia (CI = 0.28 - 1.54, p = 0.006) and the risk of perineal tear (RR = 3.13, CI = 1.68 - 5.85;p = 0.007). The APGAR score at 5 min of life was less than 7 in 64% of cases (p = 0.027). The caesarean section rate was 69%. Conclusion: Traditional products with uterotonic effects are frequently used and unregulated with its corollary of materno-fetal complications.

The Use of Visual Tests in the Screening Strategy of Cervical Dysplasies and Cervical Cancer at the Laquintinie Hospital Douala, Cameroon: A Cross-Sectional Study

Introduction: The prevalence of cervical cancer in Cameroon is 80.73/100,000 women, with an estimated incidence of 40/100,000 women-years. It is a real public health problem. There is no systematic and effective screening program for cervical cancer in our country, despite the advent of visual tests that are simple to use, low cost, and adapted to the modest income of our social groups. Objectives: We aimed at determining the usefulness and place of visual tests in screening for cervical dysplasia and cervical cancer for its implementation at the Laquintinie Hospital Douala, Cameroon. Methods: We conducted a prospective analytic cross-sectional study of cervical dysplasia and cervical cancer screening by visual testing at the Laquintinie Hospital Douala from December 1, 2016 to March 31, 2017. Data collection was by consecutive non-probabilistic method and consenting sexually active women older than 21 years were enrolled for study. Data analysis was with Epi InfoTM version 7. Associations were done with the Chi square, student t-test and Fischer’s exact test where appropriate. Bivariate and multivariate analysis was done and reported as odd ratios, adjusted odd ratios and 95% confidence intervals. Statistical significance was set at P 0.05. Results: We received 1590 women, of whom 1506 (94.7%) screened for dysplastic lesions and cervical cancer during the study period. The results obtained were: 1417 (94.1%) had a normal result;64 (4.2%) had a positive visual test (TV+);and 25 (1.7%) visual tests were inconclusive (TV-nC). Of the 64 women whose visual tests were positive, 15 (23.5%) were HIV+. We performed 80 colposcopies and biopsies, including 61 women with positive visual tests and 19 non-conclusive visual tests. Among women with TV+, we found 06 cancers (squamous cell carcinoma: 05, adenocarcinoma: 01) and 05 dysplasias (CIN1: 04, CIN3: 01). Histological examination in women with TV-nC revealed 02 dysplasias (CIN1: 02). Half of the women with cervical cancer were HIV+. In our series, the prevalence of cervical dysplasia and cervical cancer was respectively 05 per 1000 women and 04 per 1000 women. The early onsets of sexual intercourse and co-infection with HIV were the main factors associated. Visual tests were very sensitive (84.62%), but with a relatively low specificity (25.37%). Conclusion: Visual tests prove to be a useful tool for mass screening of precancerous and cancerous lesions of the cervix in view of its sensitivity, cost and performance.