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.

“FISH VERTEBRA” about 3 Sickle Cell Patients Followed at Laquintinie Hospital, Douala

Vertebral involvement in particular is common in sickle cell patients. We report 3 cases of “fish vertebra” fractures in sickle cell patients aged 16, 18, and 24 years old respectively at Laquintinie Hospital, Douala. When the vertebral fractures were diagnosed, the 3 patients had back pain and kyphosis deformities of the dorsal spine. Treatment with an infusion of biphosphonates (zoledronic acid at a dose of 0.5 mg·per·kg) was offered to all three patients. Two out of three patients received treatment with biphosphonates with a successful outcome. Profound vitamin D deficiency is associated with increased bone remodeling and a history of fractures. In sickle cell anemia, vertebral fractures may also result from bone fragility, which is often overlooked as aseptic osteonecrosis and osteomyelitis, which are very often suspected.

Spontaneous Abortions in the Second Trimester of Pregnancy: Research and Analysis of Factors Associated at Laquintinie Hospital in Douala

Introduction: Spontaneous abortion of the second trimester is an interruption of pregnancy with complete expulsion or not of the product of conception between 15 and 28 weeks of pregnancy without any maneuvers. The objective of our study was to determine the factors associated with second trimester spontaneous abortions at Laquintinie Hospital in Douala. Methodology for this purpose: We conducted a case-control study from January to May 2019 on pregnant women who may or may not have had spontaneous second trimester abortions. Results: In total we recorded 1609 pregnancies and recruited 184 patients, including 46 cases and 138 controls;which gave a frequency of spontaneous abortion in the second trimester of pregnancy of 2.85%. A correlative analysis showed that spontaneous abortions in the second trimester were associated with housewife status (OR = 2.89;CI = 1.21 - 6.79;p = 0.010), gestation > 5 (OR = 4.09;CI = 1.02 - 17.66;p = 0.040), multiparity (OR = 3.81;CI = 1.59 - 9.16;p = 0.002), history of endouterine maneuvers (OR = 5.64;CI = 2.43 - 13 .03;p = 0.000), malaria in pregnancy (OR = 3.99;CI = 1.1 - 14.76;p = 0.030), incompleteness on the second trimester ultrasound (OR = 2.37;CI = 1.18 - 4.70;p = 0.010), jolts when traveling (OR = 46.04;CI = 17.29 - 123.66;p = 0.000), long car journeys (OR = 7.05;CI = 1.99 - 27.77;p = 0.000). After logistic regression eliminating the confounding factors, only the following were associated with abortions: Multiparity (OR = 13.90;CI = 2.96 - 65.18;p = 0.000), endo uterine maneuvers (OR = 3.69;CI = 1. 01 - 13.44;p = 0.047), jolts when traveling (OR = 72.63;CI = 19.47 - 270.96;p = 0.000), long car journeys (OR = 15.41;CI = 2.7 - 85, 95;p = 0.000). Conclusion: Our study reveals that a set of factors contribute to the occurrence of spontaneous abortions in the second trimester of pregnancy in our context.

Rib Osteosynthesis for Sub-Acute Management of a Flail Chest in a Tertiary Centre in a Low-Middle Income Country of Sub-Saharan Africa: Case Report at Douala Laquintinie Hospital

Background: Costal fracture surgical is still a debate, therefore we shall select between early and delay surgical management. Case Report: We are reporting two cases of post road traffic clash delay ribs fractures osteosynthesis involving a 63-year-old man with multistage fractures on the left and pulmonary pinning of one of the costal arches, complicated by a homolateral haemothorax and a 41-year-old man with a bilateral flail chest. Conclusion: The simple postoperative course and the immediate postoperative improvement in the patient’s clinical respiratory condition enabled us to discuss the time frame for management, in this case the indication for early or later surgery.

Pregnancy Preferences in Females of Reproductive Age with Sickle Cell Disease at Laquintinie Hospital: A Cross-Sectional Analysis

Introduction: Females with sickle cell disease (SCD), despite having a delayed pubertal development, are subject to many worries relating to their abilities to conceive, their capacity to maintain a maternofetal-risk-free pregnancy till term and give birth to healthy children without sickle cell disease. Knowing that unplanned pregnancies are more likely to increase maternofetal morbidity and mortality, we sought out to explore the pregnancy preferences in female patients with sickle cell disease to promote healthy conception and childbirth in this vulnerable population. Methodology: We conducted a cross-sectional study involving female patients of child-bearing age with sickle cell disease followed at Laquintinie Hospital Douala or who were members of a local sickle cell association. Pregnancy preferences were determined using the Desire to Avoid Pregnancy (DAP) scale. Factors associated with pregnancy preferences were determined using multivariable linear regression model. Threshold for significance was set at p Results: Seventy-seven patients were included with a mean age of 24.71 ± 5.53 years. Forty patients (51.95%) had one sexual partner and thirteen women (32.5%) used contraceptive methods. Most patients (46.0%) responded “Strongly Agree” or “Agree” to the statement “it would be a good thing for me if I became pregnant in the next 3 months”. The mean DAP score was 1.63 ± 0.91 [1.28 ± 0.82 in those who had a sexual partner and 1.99 ± 0.86 in those who had no sexual partner]. Factors that were positively associated with DAP score were students (b = 0.32, 95% CI [0.21, 0.95], p = 0.003), monthly income ≥ 100,000 FCFA (b = 0.24, 95% CI [0.07, 0.81], p = 0.022), and not having a sexual partner (b = 0.26, 95% CI [0.11, 0.85], p = 0.012). Conclusion: Most female patients with SCD have a low desire to avoid pregnancy. This is especially true for patients who are not students, have a partner and have a low monthly income.

Parent-Reported Reasons for Loss-to-Follow Up in Patients Hospitalized at the Neonatology Unit at Laquintinie

Introduction: Despite the known benefits of newborn follow-up clinics, attendance has historically been difficult. Infants with reported follow-up difficulty have a greater incidence of severe sensorimotor and cognitive deficits and poorer access to early intervention programs. Our objective was to determine the parent-reported reasons for loss-to-follow up in patients hospitalised at the neonatology unit of Laquintinie Hospital. Methodology: We carried out a cross-sectional study through phone interviews with parents/caregivers of patients hospitalised at Laquintinie over a 2-year period from 1st January 2021 to 31st December 2022. A non-standardised structured interview guide was used for data collection. Loss-to-follow up referred to absence to at least one visit as recorded in the neonatal follow-up chart. All necessary administrative and ethical considerations were duly respected. Results: Most neonates were born through vaginal delivery (n = 313, 69.45%). The neonates were admitted at a median gestational age of 33 weeks (Q1-Q3;32 - 35) and the median duration of hospitalisation was 12 days (Q1 - Q3;8 - 18). A total of 23 neonates had died at the time of interview giving a mortality rate of 5.1%. The three most reported reasons for loss-to-follow-up was lack of money (n = 310, 68.13%), assumption that follow-up had ended (n = 37, 8.13%), and newborn that died (n = 23, 5.1%). Conclusion: This study highlights the significant impact of financial constraints and absence of a robust follow-up system on poor uptake of neonatal follow-up post-discharge in resource limited settings like Cameroon. Our results serve as advocacy for national health insurance especially in neonates.

Profile of Full-Term Births in Maternity Wards of Public Hospitals in Douala Cameroon

Introduction: Pregnancy as much as childbirth constitutes a risky situation, potentially fraught with sometimes dramatic complications: maternal death. Objective: We conducted this study with the aim of establishing the profile of those giving birth in our context with the aim to anticipate operationally in the future on morbidity but more on maternal deaths. Methodology: We conducted, using a structured questionnaire, a prospective descriptive study in representative maternity wards in the city of Douala;the study variables were socio-economic, anthropometric, obstetrical and clinical. Statistical analyses were carried out with CS Pro 7.3 and SPSS version 25.0 software. The Student, Chi-square and Fischer tests were used to compare the means of the variables and the percentages. Results: We recruited 305 births for our study. The average age of our births was 28.7 years ± 6.1 with an average height of 161.6 cm ± 5.06;an average body mass index at the start of pregnancy of 28.0 kilograms/square meter and 31.3 kilograms/square meter at delivery;the average weight gain was 8.4 g ± 5.37;an average gestation of 2.84±1.90;an average parity of 2.2 ± 2.1 with an average birth interval of 27.7 months ± 23.7. The average gestational age was 39.2 weeks ± 1.21 with pregnancy pathology dominated by malaria;85.9% began their prenatal follow-up before the 14th week of amenorrhea. Conclusion: The profile of childbirth in urban Cameroon does not seem potentially dystocic compared to that of the same regional and racial area.

Fight against Breast Cancer in Cameroon: Cross-Views of the Knowledge of the Female Population of Douala Hospitals

Introduction: Breast cancer in women is a global scourge due to its frequency and high fatality rate. If screening has made it possible to considerably reduce its incidence and its mortality in developed countries, in our developing countries, it remains frequent with a still high mortality due to ignorance, late and non-systematized screening. Research Question: Can female health caregivers be incorporated into a breast cancer screening awareness team? Objective: It aimed at evaluating the knowledge of female health caregivers in Douala hospitals, added to that of female users on breast cancer screening for their efficient operationalization in this procedure. Methodology: This was a comparative cross-sectional study for analytical purposes for a period of 07 months from January 15 to July 15, 2020 conducted by means of a structured and pre-tested questionnaire after informed consent obtained from the participants received in the consultation units of these hospitals. The study variables were socio-demographic and cognitive. The data collected were entered and analyzed using SPSS 23.0 software (statistical package for social sciences) with a significance level established for a value of p Results: We retained 1000 women fulfilling our inclusion criteria, including 818 users and 182 health caregivers, i.e. an average ratio of 4 users for 1 caregiver. The average age of the users was 31.03 ± 11.31 years and that of the caregiver was 29.54 ± 8.14 years (with extremes of 15 and 67 years identical in the two groups) with a respective median of 29 and 28 years old. Good knowledge was significantly associated with level of education (secondary OR = 0.38, p = 0.03 and University OR = 0.22, p = 0.001) with a predominance of good knowledge among care givers (83.5%) against 56.2% among users. The association between caregiver and good knowledge appeared to be statistically significant (OR = 0.25;p < 0.0001). In general, the association of users and poor knowledge carried a 4 times higher risk (OR: 3.94 (2.6 - 5.97) p Conclusion: At the end of our study, it appeared that female health caregivers had good knowledge and could therefore be enrolled in breast cancer screening awareness strategies.

Draft of an Anthropometric Reference System for Full-Term Cameroonian Newborns: Prospective Study with Analytical Aim in the Maternity Wards of Douala

Introduction: Anthropometry applied to newborns is a reliable indicator of the quality of fetal growth. The latter is influenced by genetic, racial and nutritional factors varying from one population to another, explaining why a standard cannot be applied to all populations. Research question: should the Caucasian frame of reference be dogmatically applied in our African context? Multicenter studies are therefore necessary;hence the interest of this work, the main objective of which was to describe the anthropometric profile of full-term newborns in the city of Douala. Methodology: We carried out a cross-sectional study with an analytical aim and prospective data collection in the maternity wards of the Douala General Hospital, Laquintinie Hospital, District hospitals of Deido, Nylon and Bonassama over a period of 4 months (January to April 2020). We were interested in any newborn, born alive, vaginally or by cesarean section, seen in the first 24 hours from a full-term single-fetal pregnancy whose mother had given consent. We excluded newborns whose term was unclear and those with congenital malformations or signs of embryo-foetopathy. Data collection was done using structured and pre-tested survey sheets. The study variables were obstetric and anthropometric. Statistical analyzes were carried out with CS Pro 7.3 and SPSS version 25.0 software. The Student, Chi-square and Fischer tests were used to compare the means of the variables, the percentages with a significance threshold P value Results: During the study period, 305 full-term newborns were included, divided into 172 boys and 133 girls. The average anthropometric parameters of the full-term newborn in the city of Douala were: average weight: 3305 grams, average height: 49.8 centimeters, average head circumference: 34.6 centimeters, average upper arm circumference: 11.3 centimeters, circumference average thoracic: 32.8 centimeters. The percentile distribution showed a 10th percentile at 2656 grams and a 90th percentile at 3966 grams for weight defining the limits for small-for-gestational-age neonates and macrosomes. Conclusion: The anthropometric data of the full-term newborn in the city of Douala were: an average weight of 3305.4 grams, an average height of 49.8 centimeters, an average head circumference of 34.2 centimeters, an average upper arm circumference of 11.3 centimeters, and an average thoracic circumference of 32.8 centimeters with higher valuesin male newborns.

Suicidal Behaviours in Sickle Cell Patients at the Douala Sickle Cell Care Centre in Cameroon

Introduction: Sickle cell anaemia is a hereditary disease that combines physical and psychological manifestations, including suicidal tendencies. So far, to our knowledge, no study has been conducted on suicidal behaviours among people with sickle cell disease in Cameroon. This is what justifies our study on the prevalence and factors related to suicidal behaviors in our study population. Methods: We conducted a cross-sectional, analytical study of 171 sickle cell patients aged from 12 years upwards who came to the sickle cell disease care service of the Laquintinie Hospital in Douala, over a period of 6 months, that is, from 1 January to 31 June 2022. Data were collected using a structured questionnaire with questions on suicidal behaviours based on the “MINI” (Mini International Neuropsychiatric Interview). The data were processed using the SPSS 26.0 software. The related factors were studied in both a bivariate and multivariate analysis. Results: Female sickle cell patients accounted for 60.2% of the sample. The mean age was 23.36 ± 8.42 years. Suicidal ideation was prevalent in 56% of cases and 13% attempted suicide. The factors most associated with suicidal ideation were: primary level of education (OR = 0.08 (0.09 - 0.79);p = 0.03), feeling unworthy of life (OR = 0.40 (0.08 - 1.96);p = 0.02), not often being considered by those around them (OR = 2.97 (1.26 - 6.99);p = 0.01), lack of family support (OR = 0.34 (0.15 - 0.77);p = 0.01). Meanwhile, the factors associated with suicide attempts were: the fact of being rarely exposed to suicide-related media (OR = 4.17 (1.40 - 71.80);p = 0.03), and a constant feeling of sadness when returning home (OR = 18.02 (1.59 - 20.55);p = 0.01). Conclusion: More than half of sickle cell patients had had suicidal thoughts and 1/6 had made at least one suicide attempt, women and young adults being the most concerned. It is therefore necessary to ensure optimum psychological care for patients with sickle cell disease.

Co-Morbidities Associated with Prematurity in Two Referral Hospitals in Cameroon

Introduction: Prematurity is the leading cause of neonatal death in Africa. More than a million children die each year due to co-morbidities related to prematurity. In addition to being one of the causes of neonatal deaths, the health problems associated with prematurity can also lead to severe lifelong impairment in those who survive. Objectives: This paper aims to determine the epidemiology and identify co-morbidities of prematurity in the neonatology units of the Douala General Hospital (DGH) and the Laquintinie Hospital of Douala (LHD). Patients and Methodology: We conducted an analytical retrospective cohort study from January 2015 to January 2018 in the neonatology department of the GDH and the LHD, which are considered reference hospitals for the management of preterm babies in Cameroon. We included all newborns aged less than 37 weeks admitted to the neonatology units of the GDH and the LHD. The descriptive component was based on the analysis of quantitative variables using measures of central tendency. The analytical component was evaluated using Spearman correlations and the Chi-square and Fisher tests. Simple and multiple logistic regressions measured factors predictive of mortality. The Kaplan Meier survival curve used the Log Rank test and significance at p ≤ 0.05. Results: We recorded 908 preterm newborns in neonatal service and 1,124 preterm deliveries in maternity, representing an incidence of 32.5% in neonatal unit and 10.6% in maternity. 51% of whom were girls, given a sex ratio M/F of 0.9. Hypertension was the main prenatal pathology (9.1%), while premature rupture of membranes: PROM (35.5%) and eclampsia/pre-eclampsia (18.6%) were the most common obstetrical pathologies. 75.9% of deliveries were vaginal with 65.2% being performed in our referral hospitals. Gestational age ranged from 22 to 36 weeks, with a mean of 32.4 weeks. Late preterm birth rate was 53.7%, and birth weight varied between 590 and 3200 g with an average of 1747 ± 479 g. The percentage of low birth weight (1500 - 2499 g) preterm infants was predominant (65.3%), and the intrauterine growth restriction (IUGR) was estimated to be 12.4%. The majority (96.7%) had pathologies in the neonatal period, the most common being neonatal infection (86.9%). The case-fatality rate was 27.4%, compared to 72.6% live births. Factors influencing mortality are risk of premature labour, gestational age ≤ 32 SA, premature birth in hospitals other than our two referral hospitals, birth weight ≤ 1500 g, Apgar at the 10th minute, late secondary anaemia, hospital resuscitation, oxygen therapy, and duration of hospitalization Conclusion: The incidence of prematurity and the mortality rate remains high in neonatal units in Cameroon. Adequate monitoring of pregnancies and management of preterm infants remains a challenge in our context.

Low Birth Weight in Cameroon: Research and Analysis of Factors Associated with Their Occurrence in Douala Maternity Wards

Introduction: Low birth weight (LBW) is defined by the World Health Organization (WHO) as a birth weight strictly below 2500 g, whatever the term of pregnancy. It constitutes a major public health problem, both in developed and developing countries, due to its magnitude and its strong association with infant morbidity and mortality. Main objective was to study the factors associated with the occurrence of small-for-gestational-age newborns in Douala. Methodology: We carried out a cross-sectional analytical study with prospective data collection using a technical pretested sheet in the maternity wards of the Douala General Hospital, the Laquintinie Hospital, and the District hospitals of Deido, Nylon and Bonassama over a period of 4 months (January to April 2020). We were interested in any newborn, born alive, vaginally or by cesarean section, of low weight, seen in the first 24 hours from a full-term single-fetal pregnancy whose mother had given her consent. Our sampling was consecutive and non-exhaustive. We excluded newborns whose term was unclear and those with congenital malformations or signs of embryo-foetopathy. Data collection was done using survey sheets. Statistical analyzes were carried out with CS Pro 7.3 and SPSS version 25.0 software. The Student, Chi-square and Fischer tests were used to compare the means of the variables, the percentages with a significance threshold P value Results: During the study period, 305 full-term newborns were included, divided into 172 boys and 133 girls. The percentage of small-for-gestational-age newborns was 9.8%;after multivariate analysis by logistic regression to eliminate confounding factors, we found maternal factors associated with small for gestational age newborns;maternal age less than 20 years, primiparity, gestational age (37 - 38), a delay in prenatal visits greater than 14 weeks, anemia in pregnancy, positive toxoplasmosis serology in pregnancy, a body mass index of Conclusion: Our study revealed the potential determinants of low birth weight at term in the Cameroonian urban context and specifically in Douala.

Epidemiological Profile of Pediatric Vital Emergencies at Laquintinie Hospital of Douala, Cameroon

Introduction: In the absence of health coverage in resource limited-settings, life-saving pediatric emergencies remain a challenge. The objective of our study was to describe the epidemiological profile of life-threatening pediatric emergencies at Laquintinie Hospital in Douala (HLD). Methods: A cross-sectional study was carried out for a period of 3 months, from March to May 2017 in the pediatric emergency unit of HLD enrolling all children presenting a life-threatening emergency on admission. Local emergency kits and an internal deferred cost recovery voucher or “green voucher” were used to facilitate access to care for children on admission. The socio-demographic, clinical, therapeutic and evolutionary characteristics were collected and analyzed using SPSS software version 20.0. Results: A total of 135 children were enrolled and the sex ratio was 1.54. The mean age was 3.8 years ± 4.05 and 80.7% of the children were under 5 years old. The majority of children (82.9%) admitted to the emergency room came from peripheral health structures. The hospital prevalence of life-saving emergencies was 42.4%. The mean time to consultation after the onset of symptoms was 5.9 days and 66.0% of admissions were made during the 3 p.m. to 8 a.m. time slot. More than 4/5 of emergencies were neurological, respiratory and cardio-circulatory emergencies representing 35.6% and 18.5% respectively. Severe malaria accounted 31.9% of the etiologies, bronchopneumopathies and meningo-encephalitis were involved in 18.5% and 17.8% of cases respectively. Patients were managed within 30 minutes of admission in 75.6% of cases and 52.6% of them received a “green voucher”. The average length of stay in the emergency room was 6 days. The death rate from life-threatening emergencies was 17.8% and represented 61.5% of total deaths recorded in pediatric emergencies. Conclusion: The profile of life-threatening emergencies at the HLD was that of a child under 5 years old, coming from a peripheral health facility and presenting a neurological emergency.

Impact of Therapeutic Education on the Viral Load of HIV Infected Children and Adolescents on Antiretroviral Therapy at the Douala Laquintinie Hospital, Cameroon

Introduction: One of the biggest challenges for HIV-infected adolescents on antiretroviral therapy (ART) is the long-term maintenance of viral suppression, which is the third 90% goal of UNAIDS. Therapeutic Education (TE), process of acquiring abilities and skills that help the patient to live optimally with his illness is one of the strategies that contribute to the achievement of viral suppression through the therapeutic adhesion contract and the follow-up of the patient. The aim of this study was to evaluate the impact of TE on the virologic response of children and adolescents aged 8 - 19 under ART and followed up at the Laquintinie Hospital of Douala (LHD). Method: A cross-sectional study was conducted at the Pediatric Unit of the HIV/AIDS Accredited Treatment Center (ATC) at LHD from February to May 2016. Children and adolescents aged 8 to 19 years on ART, followed in ATC/LHD whose parents had agreed to participate in the study, and who had achieved at least one viral load before and after initiation of TE, were recruited consecutively during routine medical follow-up. Data were collected from patients’ medical records and questionnaires administered to study participants. Results: A total of 198 children and adolescents were included in this study with an average age of 14 years (&plusmn;3). In this study population, 86.1% of children aged 8 - 10 years had acquired knowledge of the importance of taking medications, 95.4% and 97.3% of adolescents aged 11 - 14 years and 15 - 19 years had knowledge of medication schedules respectively. Among children and adolescents with undetectable viral load prior to initiation of TE, 76.5% maintained an undetectable viral load after initiation of TE. In addition, 72.3% of those whose viral load was detectable before initiation of TE had acquired an undetectable or decreasing viral load after initiation of TE. The only exposure factor significantly associated with maintaining undetectable viral load after initiation of TE was having less than 10 TE sessions (p = 0.02). Conclusion: The virologic response appears to be better in subjects who acquire skills faster through TE and therefore require fewer learning sessions to adapt. In addition, TE effectively contributes to achieving the third 90% goal of UNAIDS.

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.

COVID-19 in Blood Donors at Laquintinie Hospital in Douala during the Third Wave: A Cross Sectional Study

This study was conducted at Laquintinie Hospital during the period between September 2021 and April 2022. The total number of cases who came to donate blood was 150 donors aged 18 to 60 years;48 were excluded for several reasons. Several examinations were conducted for participants that were accepted for a study (n = 102 [2 (2.0%) were women and 100 (98.0%) men]), the prevalence of SARS-CoV-2 in nasopharyngeal samples was 11.8%. The mean CD4 count was 763.23 ± 194.61 cells/μl with endpoints [250 - 1400] cells/μl. IgG antibodies were present in 62.75% of cases. No statistically significant relation was found between SARS-CoV-2 carriage and IgG level or CD4 level (p = 0.850 & 0.056). Concerning the blood group, 57.3% (58) of the donors were of blood group O Rhesus positive;19.4% (20) of blood type A Rhesus positive;and 2.9% were of blood group A Rhesus negative. Pupils and students represented 35.3% of our population, followed by employees at 25.5%. The SARS-CoV-2 positivity rate was 11.8% (n = 12). The transfusion transmitted infections (TTI) rate was 12.8% with 1.2% (1) positive HIV serologies, 5.8% (6) positive for HBsAg, 3.9% (4) for HCVAb, and 1.9% (2) positive TPA.

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.

Cryptoccocal Neuromeningitis in Immunocompetent Infant in Bonassama District Hospital, Douala: A Case Report

Cryptococcosis is rare in children. We report a case of cryptococcal meningitis in an infant whose mother works as a poultry farmer (chicken farm). The infant was received in the context of fever with convulsions. We performed a lumbar puncture and started antibiotic treatment. Cerebrospinal fluid (CSF) analysis was performed including Indian ink staining. CSF results showed the presence of yeast and we replaced antibiotics with fluconazol-based treatment. After the loss of sight and the appearance of a motor deficit, a brain scan was performed showing cerebral edema. Several lumbar punctures were performed for 02 weeks until partial recovery of visual acuity and motor deficit. This case highlights the importance of taking into account the patient’s history when making the diagnosis. In our case, the working conditions and the employment of the mother guided the realization of the Indian ink coloring of the CSF. Treatment with fluconazol continued for 22 weeks with a completely regained visual acuity and gradual improvement in motor deficit despite limited resources.

Diagnosis and Treatment of Digestive Emergencies in Two Hospitals in Douala (Cameroon)

Background: Gastrointestinal tract (GIT) surgical emergencies represent a significant amount within surgical pathologies, in Africa and throughout the world. Our study was aimed to assess the etiological, therapeutic and prognostic aspects of GIT surgical emergencies in patients from two hospitals in Douala, Cameroon. Patients and Method: A longitudinal prospective study was conducted from December 2018 to May 2019, including 203 patients of all ages and both sexes who presented with a GIT surgical emergency in any clinical form, and who underwent surgery within one of our hospitals. We collected patients’ parameters through a survey, from complete history to clinical examination, then followed them up from surgery to post-operative time. Gathered information was analyzed by IBM Statistical Package for Social Science (SPSS) 23.0 software version. Results: GIT surgical emergencies accounted for 27.5% of all surgical emergencies. Our target population included 55.2% (n = 112) of men, and 44.8% (n = 91) of women, observing a sex-ratio of 1.23. The mean age of the patients was 36.3 ± 17.1 years, with extreme values of 6 months and 86 years. Abdominal pain was the most common symptom, vomiting and lack of bowel movement or gas pass, were the main associated symptoms in 27.6% and 16.7% of cases, respectively. Etiologically, leading pathologies were intestinal obstruction (32.0%, 64 cases), acute appendicitis (24.6%, 50 cases), then came peritononitis and abdominal trauma with respectively 22.7% (46 cases) and 21.7% (43 cases). Most patients underwent surgery within 24 hour. Laparotomy was the primary method used in 90.6%, and laparoscopy (9.4%). Post-operative suture breakage and parietal suppuration were the most common complications post-operatively. Totally, the overall morbidity and mortality rates were respectively 8.9% and 0.98% among our patients. Conclusion: Acute surgical abdomens occupy an important place in surgical pathology because of their frequency. They have various aetiologies and require a diagnostic evaluation and multidisciplinary management without delay.

Antibiotics Susceptibility Profile of Staphylococcus aureus Clinical Isolates Collected in Hospitals in the City of Douala (Cameroon)

Introduction: Staphylococcus aureus is one of the most important agents involved in community and hospital-acquired infections. Due to the multi-drug resistance of strains to antibiotics, treatment to eradicate it is becoming more difficult and poses a global public health problem. Methodology: This was a cross-sectional study conducted from March to August 2020 in hospitals in the city of Douala, including all S. aureus isolates from diagnostic samples. Strain identification and antibiotic susceptibility testing were performed using the Vitek2 CompactTM (BioMerieux). Results: During the study period, 136 non-repetitive S. aureus strains were identified with a high frequency of methicillin-resistant S. aureus of 78.7%. The majority of the strains originated from the Douala General Hospital (66.9%) and was most frequently isolated from blood culture samples (55.1%). The study of biochemical characteristics showed that most of the strains identified had between 87% and 99% homology with the reference strain. The most active antibiotics were Quinupristin/Dalfopristin (94.2%), Linezolid (87.8%) and Vancomycin (84.2%). Methicillin resistance was associated with decreased susceptibility of S. aureus to other antibiotics such as Gentamycin (44.9%), Erythromycin (38.2%), Tetracycline (38.3%), Trimethoprim (21.4%), Ciprofloxacin (19.1%) and Levofloxacin (24.0%). Inducible MLSb and constitutive resistance phenotypes were identified with 26.7% and 22.8% respectively. Conclusion: The sensitivity of S. aureus strains differs from one antibiotic family to another, and remains good for molecules that are not available in our context. The high frequency of Methicillin-Resistant S. aureus shows the continuous progression of multi-resistant strains of S. aureus and their decreased sensitivity to usual antibiotics becomes more and more alarming.