Uropathogens of Urinary Tract Infection in Pregnancy and Maternal-Fetal Outcomes at the Douala Referral Hospital, Cameroon: A Case-Control Study

Background: Urinary tract infection (UTI) is common in pregnancy and accounts for a high burden of maternal and perinatal morbidity/mortality and health expenditure. The burden of this condition has been understudied in Cameroon. We aimed to determine the uropathogens of urinary tract infection in pregnancy, and the maternal-fetal outcomes of UTI at the Douala Referral Hospital. Methods: We conducted an analytic matched case-control study of 206 pregnant women with evidence of urinary tract infection (103 cases) and those without (103 controls) who underwent antenatal care and gave birth at the DRH from January 2019 to April 2019. Socio-demographic, laboratory and maternal-fetal outcome data were collected using a pre-tested structured questionnaire and analyzed with SPSS version 23. Statistical significance was set at p < 0.05. Results: Escherichia coli (51.5%), Proteus mirabilis (15.5%), Staphylococcus aureus (11.7%) and Klebsiella sp. (6.8%) were the predominant uropathogens of UTI. Maternal outcomes of UTI were puerperal pyelonephritis (AOR 3.1;95% CI: 1.11 - 3.55, p = 0.0023), preterm labor (AOR 4.4;95% CI: 1.0 - 2.7, p = 0.008) and preterm birth (AOR 4.6;95% CI 1.9 - 22.9, p = 0.05). Furthermore, low birth weight (AOR 2.1;95% CI: 0.8 - 5.6, p = 0.05), neonatal infection (AOR 13;95% CI: 0.9 - 191.6, p = 0.04) and neonatal intensive care unit admission (AOR 2.5;95% CI: 1.7 - 3.6, p = 0.003) were fetal outcomes of UTI. Conclusion: Escherichia coli was the main uropathogenic agent of UTI during pregnancy. Maternal outcomes of UTI were puerperal pyelonephritis, preterm labor and delivery while fetal outcomes include: low-birth weight, neonatal infection and neonatal intensive care admission. Prompt diagnosis of this condition is the cornerstone to avoid adverse outcomes.

Findings of Hysterosalpingography in Women Who Underwent Gynaecologic Imaging in a Tertiary Hospital in Douala, Cameroon

Background: Hysterosalpingography (HSG) is the first-line investigation among infertile women in Cameroon. There is a dearth of studies on the use of HSG in Cameroon. The aim of this study was threefold: 1) to describe the indications;2) findings of hysterosalpingography and 3) factors associated with abnormal findings on HSG at the Douala General Hospital, Cameroon. Methods: We conducted a retrospective descriptive study of 242 files of patients who underwent hysterosalpingography at the Radiology Department of the Douala General Hospital from January 2012 to December 2016. We collected data on the sociodemographic, obstetric variables and indications of HSG using a pretested data collection form. We also interpreted HSG films during the study period. Data analysis was with EPI-INFO version 7. Results: The age range was 19 - 46 years with a mean age of 33.16 ± 5.45 years. Majority 138/242 (57.1%) were in the age group 30 - 40 years. The main indication of HSG was infertility 87.2% (211/242). Most of the cases 95.87% (232/242) had abnormal findings at HSG. Tubal and uterine abnormal findings made up 133/232 (57.3%), and 97/232 (41.81%) of cases, respectively. Tubal occlusion and hydrosalpinges were found in 99/232 (42.67%) and 19/232 (8.19%) while uterine fibroids and uterine synechiae were found in 57/232 (24.97%) and 30/232 (12.93%), respectively. The factors independently associated with abnormal findings at HSG were: a history of recurrent pregnancy loss (AOR 2.95;95% CI: 1.19 - 7.32, p = 0.02) and infertility (AOR 0.24;95% CI: 0.06 - 0.92, p = 0.038). Conclusions: Infertility constituted the main indication, with tubal occlusion resurging as the most common abnormal finding on hysterosalpingography in this study. A history of recurrent pregnancy loss and infertility were factors independently associated with abnormal findings on hysterosalpingography. Therefore, HSG should be associated with hysteroscopy for uterine pathology and laparoscopy or selective salpingography to decrease the false-positive results of tubal patency in infertile women in Cameroon.