Prevalence, Risk Factors and Outcome of Preterm Premature Rupture of Membranes at the Bamenda Regional Hospital

Background: Preterm premature rupture of membranes (PPROM) is one of the most common complications of pregnancy. It is one of the leading identifiable cause of preterm deliveries, and an important cause of maternal and perinatal morbidity and mortality. The aim of this study was to determine the prevalence of PPROM, to identify its associated factors and to evaluate the early outcome (within 72 hrs after delivery) following PPROM at the Bamenda Regional Hospital (BRH). Methods: A cross-sectional study was conducted in March and April 2020. Three hundred and eighty-seven women who delivered at the labour room of the BRH were included in this study. Interviewer-administered questionnaires were used to obtain data. The cases of PPROM were women who had lost amniotic fluid continuously before hospitalisation and whose gestational age was between 28 weeks + 0 days and 36 weeks + 6 days. Descriptive statistics followed by logistic regression analyses were conducted with level of significance set at p-value <0.05. Results: Among the 387 participants included in the study, 19 had PPROM giving a prevalence of 4.91%. Of 57 preterm deliveries, PPROM accounted for 33.33% (n = 19). The statistically significant independent factors associated with lower odds of PPROM were the age groups 20 - 29 years (aOR = 0.07, 95% CI: 0.01 - 0.42, p = 0.003) and ≥30 years (aOR = 0.01, 95% CI: 0.001 - 0.14, p = 0.001), and attending ANC ≥ 4 times (aOR = 0.23, 95% CI: 0.06 - 0.84, p = 0.026). Whereas, having a multiple pregnancy (aOR = 39.72, 95% CI: 7.19 - 219.33, p < 0.001), urinary tract infection during pregnancy (aOR = 104.86, 95% CI: 12.25 - 897.90, p < 0.001), genital tract infections during pregnancy (aOR = 17.34, 95% CI: 2.67 - 112.56, p = 0.003), and having a history of preterm delivery (aOR = 27.65, 95% CI: 1.76 - 434.15, p = 0.018) were associated with a higher likelihood of PPROM. The study revealed that 10.53% (n = 2) of women who had PPROM had an unfavourable outcome. Babies born by mothers who had PPROM were more likely to have an unfavourable outcome (OR = 14.44, 95% CI: 5.42 - 38.48, p < 0.001). Conclusion: Preterm premature rupture of membranes considerably causes perinatal morbidity and mortality, and thus optimum obstetric and medical care is essential for the reduction of the complications related to it.

Gender-Based Violence among Pregnant Women Consulting at the Antenatal Care Unit of the Bamenda Regional Hospital

Background: Gender-based violence is violence against men and women in which the woman is more likely to be the victim. Globally, one in every four women is physically or sexually abused during pregnancy. The main objective was to study gender-based violence among pregnant women attending antenatal care at the Bamenda Regional Hospital (BRH). Methods: We carried out a hospital-based cross-sectional study among 231 pregnant women at the antenatal care unit of the BRH from January to March 2018. The study included all women who gave a written informed consent. A questionnaire adapted from the WHO multi-country study was used to collect data on sociodemographic characteristics, aspects of gender-based violence (GBV), and data for other associated factors were collected by face-to-face interview. Data were analysed using SPSS version 23.0. Chi-square test and Fisher exact test were used to compare frequencies. Student t-test was used to compare means. Binary logistic regression analysis and multivariate analysis were used to eliminate confounders. The level of statistical significance was set at p < 0.05. Results: A total of 56.3% (n = 130) of pregnant women involved in the study were found to be survivors of GBV. Psychological trauma, physical assault and sexual violence were found in 47.2%, 30.2% and 19.9% respectively. Depression and anxiety were the most frequent clinical manifestations. Only 37.7% of the survivors sought management. The factors statistically associated with the occurrence of GBV were: for physical violence a partner that smokes;for sexual violence a history of sexual assault on the survivor as a child, a primary level of education of the partner, and a partner that is alcoholic;for psychological violence a history of sexual assault on the survivor as a child, a primary level of education of the partner, and a partner that is alcoholic. After adjusting for confounders, having a partner with only a primary education had a statistically significant association [3.610 (1.431 - 9.091), p = 0.007] with the occurrence of GBV. Conclusion: GBV is a key health risk among pregnant women consulting at the ANC unit of the Bamenda Regional Hospital and proper education of the partner is primordial in its prevention.

Prevalence, Antimicrobial Susceptibility Pattern and Factors Associated with GBS Colonization in Pregnant Women at the Regional Hospital Bamenda (RHB)

Introduction: Maternal asymptomatic colonization with GBS (Group-B Streptococcus) has become a major cause of sepsis, meningitis and encephalopathy in neonates alongside premature births, stillbirths and post-natal infections. Routine screening of pregnant women for GBS carriage and antimicrobial susceptibility are therefore necessary. This study was aimed at evaluating the prevalence, antimicrobial susceptibility pattern and factors associated with GBS colonization in pregnant women at the Regional Hospital Bamenda (RHB). Materials and Methods: Vaginal and rectal swab samples were collected from 121 pregnant women in the 3rd trimester at the RHB from December 2017 to May 2018. Sociodemographic, obstetric and neonatal history and some clinical parameters were obtained through a questionnaire approach. Cultures for the isolation and identification of GBS from the samples were done and grouping as well as susceptibility testing of GBS isolates was done. Results: The colonisation rates were 5.8% (7), 1.7% (2) and 5.8% (7) for rectal, vaginal and concomitant recto-vaginal carriage. GBS was isolated in the vagina/rectum of 16 participants (13.2% prevalence). Of the 16 GBS strains used for in vitro susceptibility test, no resistance to ampicillin, oxacillin, amoxicillin-clavulanate, ceftriaxone, erythromycin, imipenem, aztreonam and clindamycin was recorded. 6.3% (1) of the strains had intermediate susceptibility to ampicillin and amoxicillin-clavulanic acid. Of the isolates examined, 37.5% (6), and 12.5% (2) were respectively sensitive to gentamycin and levofloxacin. Maternal overweight, HIV positive status, history of PROM and spontaneous abortion, presence of Gardnerella vaginalis and Candida albicans had a high rate of GBS colonization but only HIV positive status had a statistical significance (p = 0.01). Other microbes isolated were Gardnerella vaginalis (55.4%, 67), Candida albicans (40.5%, 49), and Candida spp (12.4%, 15). Conclusion: GBS prevalence was 13.2%. GBS had decreased susceptibility to some antibiotics. Only HIV positive status was significantly associated with GBS colonization.

Factors Associated with Postpartum Haemorrhage amongst Primigravidae Women;the Case of Two Hospitals within the Bamenda Health District

Background: Approximately 830 women die from pregnancy-related conditions daily with 99% of these maternal deaths occurring in low resource countries. Primary postpartum haemorrhage (PPH) accounts for 25.7% of maternal deaths in Africa. In Cameroon, postpartum hemorrhage remains the leading cause of maternal death, with little information on the primigravidae population compared to multigravida or multiparity. Objective: The aim of this study was to assess the factors associated with postpartum haemorrhage amongst primigravidae women giving birth in two hospitals within the Bamenda Health District. Methods: This study was a multicentric, non-randomized cross-sectional descriptive and analytic study. Of the 221 women interviewed regarding their willingness to participate in the study, 197 consented. Quantification of blood loss was done by visual estimate and with the assistance of the pathfinder international wall chart for visual estimation of blood loss. Data was collected using a structured questionnaire and analyzed using SPSS version 23. A P-value of <0.05 used to determine association between variables was considered statistically significant. Results: The prevalence of postpartum hemorrhage in primigravidae was 7.1%. The risk factors of postpartum hemorrhage were: induction of labour (P-value < 0.01), duration of labour (P-value < 0.01), augmentation (P-value < 0.05), mode of delivery (P-value < 0.01), and macrosomia (P-value < 0.01). The main causes of PPH were uterine atony and obstetrical lacerations (P value < 0.01). Management was mostly by the use of non-pharmacological and pharmacological measures. The main adverse outcomes were shock and severe anaemia, with one case of nearmiss recorded. No maternal death was recorded. Conclusion: The prevalence of postpartum hemorrhage amongst primigravidae was high. The main causes of post-partum hemorrhage were uterine atony and obstetric lacerations. PPH was associated with uterine hypotonia, retained products and genital lacerations. No maternal mortality was recorded. These findings highlight the pressing need for good quality em ergency obstetric care and the availability of more accurate techniques of postpartum blood loss measurement. Secondly, hospitals need blood banks to manage patients with severe hemorrhage.

Circadian Rhythm of Childbirths and Maternal and Neonatal Prognosis at the YaoundéCentral Hospital

Background: The circadian variation of childbirths has been described by several authors around the globe. De Graaf showed that hospital childbirths at night were associated with increased perinatal mortality and adverse perinatal outcome. To improve obstetric care, we carried out this study to evaluate the circadian rhythm of childbirths and to assess the outcome following variations in the time of childbirths during the day. Methods: It was a cross-sectional descriptive study at the Yaoundé Central Hospital (YCH), over a two years period. We collected data from files of women who delivered from the 1st of January 2017 to 31st December 2018. We included files of women who delivered at least at 28 weeks of pregnancy. We excluded files of those who delivered by elective caesarean section, those whose hour of delivery was not noted and those who delivered before reaching the hospital. Sociodemographic, obstetrical characteristics, and immediate prognosis were recorded. Data were entered into excel, then analysed with SPSS v23 software. Tools used to appreciate our results were means, median, number, percentage, P, and OR with its 95% confidence interval. The difference in p is significant if p is less than 5%. Results: We analyzed 6041 files bearing the time of birth. Childbirths took place at all hours of the day, but the times of the day where the highest numbers of births were recorded were 10, 11, 12, 13 (that’s 1pm), 14 (that’s 2 pm), 15 (that’s 3 pm), 16 (that’s 4 pm), 17 (that’s 5 pm) and 23 (that’s 11 pm) hours, with respectively 224 (3.7%), 277 (4.6%), 256 (4.2%), 265 (4.4%), 207 (3.4%), 255 (4.2%), 228 (3.8%), 216 (3.6%) and 226 (3.7%) births. The peak of births was at 11 am while the time of day where the lowest number of births was recorded was 6 pm, with 175 (2.9%) births. The mean age of participants was 27.34 ± 6.03 years with extremes of 13 and 49, with 87.6% between 20 to 39 years. Sociodemographic characteristics of participants, prematurity and bleeding during delivery, had no dependence on the time of delivery. Perineal tear, duration of observation, Apgar score of the newborn, birthweight, delivery mode, health personnel who performed the delivery, and episiotomyseemed to be influenced by the time of delivery. Daily shifts were not independently associated with the poor Apgar score (0 - 6) at 5 mins, when adjusted for all other factors (p = 0.109). Conclusion: Childbirths were more frequent between 10 am and 5 pm. The period where episiotomy was most performed is the same as when there was macrosomia childbirth. Tears of the perineum are more frequent between 2 pm and 10 pm. There was no independent association between Daily shifts and poor Apgar score. The poor APGAR score would be more related to low birth weight.

Evaluation of the Implementation of the WHO’s 2010 Guide on Prevention of Mother To-Child Transmission (PMTCT) of HIV/Aids: Case of Two Hospitals in Yaoundé

Introduction: The prevalence of HIV infection amongst pregnant women in Cameroon is 5.6%. Mother-to-child transmission is a major expansion factor. In 2010, Cameroon adopted new strategies pegged to WHO guidelines. Objectives: The objective of this study was to evaluate the implementation of the new guidelines of prevention of mother to-child transmission (PMTCT) of HIV in the Yaoundé Central Hospital and the Yaoundé Teaching Hospital. Methodology: It was a cross sectional descriptive and prospective study over a period of 6 months in Yaoundé. It included all HIV-positive women, doing their antenatal care in the above cited hospitals, and having given their consent. The studied variables included socio demographic features, obstetrical history, the antenatal care, the initiation of anti retroviral (ARV) drugs, the ARV regimen, the number of years on ARV drugs, the mode of delivery and the mother and child outcome. The data was collected using a pre-tested questionnaire. They were obtained by interview of the seropositive pregnant women. Data were analysed using Epi info 3.5.3. Results: We performed 3104 antenatal consultations and 287 women were recruited in the study. The prevalence of HIV infection was 9.24%. The mean age of women was 28.77 (SD: 5.13) years. The women were aged between 20 and 29 years in 51.20%. Amongst the 156 women who knew their status before pregnancy, 109 (70.50%) had their first ANC in the first trimester. All were managed according to the 2010 WHO recommendations on PMTCT of HIV. Amongst the women unaware of their status, 25.20% had their booking ANC in the first trimester, 25.14% started ARVs at 14 weeks, 69.46% at 28 weeks. We had 125 live births, 84.8% by vaginal route, neonatal prophylaxis in all babies was effective. Conclusion: PMTCT of HIV is available and guidelines are well applied in Yaoundé. Late treatment initiation still remains a problem to optimize care.

Outcomes of Twin Delivery at the Bamenda Health District, North West Region Cameroon

Introduction: Multiple gestations or multiple pregnancies occur when two or more fetuses are conceived at the same time in the same woman. Therefore, a twin pregnancy is defined as the simultaneous development of two fetuses in the same woman. It can either be a monozygotic or dizygotic pregnancy. Twin pregnancy is considered a high-risk pregnancy with variable incidence and outcomes worldwide. The adverse maternal and fetal outcomes of twin deliveries have not yet been investigated in our setting. Objectives: The main objective of this study was to evaluate the outcomes of twin deliveries at the Bamenda Health District. Methods: This was a hospital-based, cross-sectional analytic study done at the Bamenda Health District in three selected hospitals (Bamenda Regional Hospital, CMA Nkwen, and IHC Azire) from the 1st of January to the 10th of May 2018. 55 women with twin pregnancies and 55 women with singleton pregnancies at gestational ages of 28 completed weeks and above who came for delivery and who consented to the study were included. A face-to-face interview-administered questionnaire was used to obtain sociodemographic characteristics;a venous blood sample was collected from the mothers before and after delivery to determine the estimated blood loss based on haemoglobin level. The partogram was opened from 4 cm cervical dilatation for those who came in the first stage of labour and the mode of delivery was recorded. After delivery, outcome variables were 1st, 5th, and 10th min Apgar score, birth weight, and gestational age. Data were entered in CSPro 7.1 and exported to IBM SPSS version 23.0 for analysis. All variables with p < 0.05 were statistically significant, OR and 95% CI were calculated for all outcome variables to measure the association with twin deliveries. Results: During the study period, we included 110 participants (55 twin mothers and 55 singleton mothers). Women with twin gestations were mostly aged between 25 and 34 years with a mean maternal age of 28.6 ± 5.8 years, more than half (60%) of them were multiparous with family histories of twin, and business was their main occupation (58.2%). The prevalence of twin gestations at the Bamenda Health District was 2.8%. As compared to singleton deliveries, twin deliveries were associated with adverse fetal outcomes such as prematurity (born before 37 completed weeks) which was about 6 times higher among twins than singleton babies (OR: 5.6, 95% CI: 2.2 - 14.3, p th min) that was 15 times higher in twin than singleton births (OR: 15.3, 95% CI: 2 - 116.6, p < 0.001) and low birth weight (birth weight grams) that was 15.6 times increased in twin than singleton births (OR: 15.6, 95% CI: 3.6 - 67.8, p < 0.001). There were 5.5 times increased cesarean sections among women with twin pregnancies compared to women with singleton pregnancies (OR: 5.5, 95% CI: 2.2 - 13.9, p < 0.001). There was no association between twin delivery and postpartum haemorrhage (p > 0.05). Conclusion: Twin deliveries were associated with adverse fetal outcomes (prematurity, birth asphyxia, and low birth weight) in the three health facilities where we carried out the study. Cesarean section was higher among women with twin gestations compared to women with singleton gestations.

Primary Dysmenorrhea;Prevalence, Treatment Practices and Impact among High School Students in 2 Secondary Schools in Bafoussam

Background: Primary dysmenorrhea is defined as pelvic pain during menstrual flow in the absence of a pelvic pathology. It is one of the most common gynaecological complaints worldwide and the most common cause of school and work absenteeism among menstruating females. In adolescent students the impact includes reduced attention in class, inability to study at home, school absenteeism among others. Yet these students have to study at the same pace as their peers, raising the concern of whether the problems caused by primary dysmenorrhea have an effect on academic their academic performance. Aim: Determine the prevalence, treatment practices and impact of primary dysmenorrhea on the studies of post-pubertal high school students in Bafoussam. Method: We conducted a cross-sectional descriptive and analytic study design using a two-stage sampling method;the first stage was by convenience to choose the school, and the second stage was consecutive to recruit the students. Data was collected using a semi-structured pretested self-report and anonymous questionnaire. Analysis was done using software IBM®SPSS statistics version 23 for windows. Categorical variables were summarised in to frequencies and percentages while the comparison of categorical variables was done using a Chi-square test, and a p-value ≤ 0.05 was considered to be statistically significant. Results: our sample size was 898 and the mean age of our respondents (±SD) was 17.6 (±1.6) years. The prevalence of primary dysmenorrhea was 71.9%, with 11.6% mild pain, 52.5% moderate pain and 35.9% severe pain on a visual analogue scale. Over 38% did not attempt pain-relieving measures while others took analgesics, traditional preparations, heat packs among others. Among these students, 39% reported school absenteeism due to pain, other impacts were decreased attention in class, inability to study at home during pain and punishment from school authorities for failing to fulfil certain duties like assignments not done or absenteeism because of pain. Though a greater proportion of students without dysmenorrhea had pass scores than their counterparts, the difference was not statistically significant. Conclusion: Given these findings, school officials may benefit from considering dysmenorrhea in the context of improving their school attendance rates and academic performance of their students.

Monitoring Frequency of Haemoglobin, Calcium and Phosphorus and the Impact on Correction in Patients on Maintenance Haemodialysis in Douala-Cameroon

Background: There is scarcity of data on the actual frequency of routine blood work-up for patients on maintenance haemodialysis and how this affects the achievement of therapeutic goals in sub-Saharan Africa. This study aimed to review these in a referral hospital in Cameroon. Methods: A prospective hospital-based cohort study carried out from November 2019 to April 2020 including patients on maintenance haemodialysis in Douala general hospital. Patients were followed during 6 months to determine the frequency of monitoring of haemoglobin, serum calcium and phosphorus. Targeted values for haemoglobin were ≥10 g/dL, 80 - 100 mg/L for serum calcium and 25 - 45 mg/L for serum phosphorus. Pearson correlation test was used to define the correlation between monitoring frequencies and blood values at the end of the study. Results: For all 154 patients included in the study, the median frequency of monitoring for haemoglobin was once every 8 week (IQR: 6 - 12) and once every 12 weeks (IQR: 8 - 24) for serum calcium and phosphorus. The proportion of patients who achieved haemoglobin, serum calcium and phosphorus targets at the end of the study were 27.4%, 63% and 74% respectively. No correlation was found between the frequency of monitoring and the haemoglobin, serum phosphorus and calcium levels at the end of the study. Conclusion: The frequency of monitoring of serum haemoglobin, calcium and phosphorus by patients in this study was low with a high prevalence of patients not achieving target value.

Attitudes, Practices and Factors Affecting the Use of the Partogram by Professionals Attending to Women in Labour and Delivery in the Bafut Health District

Introduction: Given that the provision of care to the childbirth process is not purely in the hands of educated and trained midwives, the competency in application of midwifery tools may be inadequate and consequently affect the quality of care. The Partogram is the single most important tool which has been scientifically proven to reduce maternal and foetal morbidity and mortality. Though important, many healthcare providers do not use it regularly in the monitoring of labour. Objectives: Our objectives were to determine the attitudes, practices, proportion of parturients monitored using a Partogram and the factors limiting the use of the Partogram by professionals attending to women in labour and delivery (PAWLD) in the Bafut Health District. Methods: This was a cross-sectional study carried out amongst 65 Professionals attending to women in labour and delivery in the Bafut Health District that lasted 6 months. All the data were collected by our self. First through a face to face interview with a questionnaire, secondly with an observational guide used to assess Partograms filled and lastly using delivery registers to obtain the proportion of parturients monitored with a Partogram. The data analysis was done using the statistic software Epi Info version 7 and Microsoft Excel. Results: This study revealed that 47 (72.3%) of participants had good attitudes, 34 (52%) had good practices, 375 (79.3%) parturients were monitored using a Partogram, and the lack of in-service training, low number of staff and poor knowledge on Partogram use were identified as the main limiting factors to the use of the Partogram. Being a health assistant was statistically significantly associated with having a poor practice with a p-value of 0.047 and odds ratio 5.33 [1.03 - 26.45] we obtained just 1 (1.54%) filled according to the WHO standards. Conclusions and Recommendations: In the Bafut Health District, 7 out of 10 PAWLDs have a positive attitude towards the use of the Partogram, while a poor practice is predominant as a result 4 out of 5 deliveries were monitored using a Partogram with only 1.54% of the Partograms filled according to WHO standards. The lack of in-service training, lack of PAWLD and poor knowledge on Partogram usage are the major drawbacks to the use of the Partogram. We therefore recommend that continues medical education (CME) be organised on the use of the Partogram.