Childbirth patterns after previous caesarean birth in sub-Saharan Africa: a retrospective analytical study in two referral hospitals in a semi-urban setting in Cameroon

Background: Rising rates of caesarean section (CS) predispose to uterine rupture (UR) during subsequent childbirths. Childbirth after previous CS has poorly been studied in rural Africa. Objective was to describe and analyse the patterns of childbirths after previous CS.Methods: A retrospective analytical study of facility-based deliveries after previous caesarean birth from January 1, 2019 to April 30, 2021 in Bafoussam, Cameroon. We included 416 files of women with previous CS for term singleton pregnancies. Statistics were computed with SPSS®.Results: Mean age and mean parity were 29.9±5.6 years and 3.2±1.4 respectively. Almost half of participants [199 (47.8%)] had had a previous vaginal birth. Antenatal care (ANC) providers were nurses/midwives and general practitioners for 232 (55.8%) and 77 (18.5%) women respectively. The route of delivery wasn’t chosen during ANC for 312 (75.0%) women and 99 (23.8%) of participants were referred during labour. Elective repeat CS was done for 92 (22.1%) women and 324 (77.9%) underwent trial of labour after CS (TOLAC) of whom 131 (40.4%) gave birth by vaginal route. Onset of labour was spontaneous in 304 (93.8%) cases. UR complicated 13 (4.0%) cases of TOLAC. Previous vaginal birth predicted successful TOLAC and referred parturients had higher risk of UR. There were 28 (8.6%) perinatal deaths and 1 (0.3%) maternal death.Conclusions: In our semi urban setting, deliveries after previous caesarean births are unplanned. The success rate of TOLAC is low with a high rate of complications. There is need to improve quality of ANC, birth care and post-natal care for women with previous CS

Title: Primary Dysmenorrhea: Associated Symptoms, Impact and Management among Females in the Menoua Division of the West Region of Cameroon. Cross-sectional Study Running Title: Primary Dysmenorrhea in the Menoua Division

Primary dysmenorrhea, or painful menstruation in the absence of pelvic pathology is a common and often debilitating gynecological condition that affects between 45% and 95% of women at reproductive age. The current study aimed to assess the prevalence of dysmenorrhea and associated menstrual symptoms and their self-management techniques among females. This cross-sectional study was conducted in the Menoua Division, which has six subdivisions namely: Fokoue, Dschang, NKongni, Penka Michel, Santchou and Fongo tongo .For this purpose, 668 women aged from 12 to 38 years were considered. A self-administered questionnaire was used to collect data. The main results revealed that dysmenorrhea was reported on almost two-thirds of the women (66.17%). In the 442 girls who reported dysmenorrhea Severe pain was reported by 20.71 % of respondents. More than one-third of the respondents (39.75%) reported using pain relief medications with 23.38 % of herbal medicine and 76.54 % of synthetic medicines. The gastrointestinal problems (diarrhoea and vomiting were the most common symptoms experienced. Less than 19.41% of respondents reported having consulted a doctor for their dysmenorrhea, while most of them consulted friends and family.Dysmenorrhea is a very common problem among university students. A number of symptoms were related to dysmenorrhea. Even though it is common, and may not have a pathological cause, few women seek medical advice. Increasing the awareness might help in relieving the burden of this common health problem

Pitfalls in Diagnosing Heterotopic Pregnancy in Sub-Saharan Africa: A Case Report at the Yaounde University Teaching Hospital (Cameroon).

Heterotopic pregnancy (HP) is a dizygotic twin pregnancy in which one gestational sac is intrauterine and the other is extrauterine. The prevalence of HP is unknown in Cameroon where the diagnosis is difficult and usually fortuitous like in other resource-poor settings. We herein depict pitfalls and delays in the diagnosis and management of a ruptured heterotopic pregnancy at the Yaounde University Teaching Hospital. After a wrong diagnosis and inadequate treatment, our patient presented at our emergency unit with severe pelvic pain and clinical signs of hemoperitoneum with shock. She underwent a total left salpingectomy through laparotomy. She had a complete spontaneous abortion five days after the surgery. Given that sonography is not routinely available in emergency departments in resource-poor settings, it may be relevant for practitioners to always bear HP in mind when facing ruptured ectopic pregnancies

Length of stay and determinants of early discharge after facility-based childbirth in Cameroon: analysis of the 2018 Demographic and Health Survey.

BACKGROUND: A minimum length of stay following facility birth is a prerequisite for women and newborns to receive the recommended monitoring and package of postnatal care. The first postnatal care guidelines in Cameroon were issued in 1998 but adherence to minimum length of stay has not been assessed thus far. The objective of this study was to estimate the average length of stay and identify determinants of early discharge after facility birth. METHODS: We analyzed the Cameroon 2018 Demographic and Health Survey. We included 4,567 women who had a live birth in a heath facility between 2013 and 2018. We calculated their median length of stay in hours by mode of birth and the proportion discharged early (length of stay < 24 h after vaginal birth or < 5 days after caesarean section). We assessed the association between sociodemographic, context-related, facility-related, obstetric and need-related factors and early discharge using bivariate and multivariable logistic regression. RESULTS: The median length of stay (inter quartile range) was 36 (9-84) hours after vaginal birth (n = 4,290) and 252 (132-300) hours after caesarean section (n = 277). We found that 28.8% of all women who gave birth in health facilities were discharged too early (29.7% of women with vaginal birth and 15.1% after a caesarean section). Factors which significantly predicted early discharge in multivariable regression were: maternal age < 20 years (compared to 20-29 years, aOR: 1.44; 95%CI 1.13-1.82), unemployment (aOR: 0.78; 95%CI: 0.63-0.96), non-Christian religions (aOR: 1.65; 95CI: 1.21-2.24), and region of residence-Northern zone aOR:9.95 (95%CI:6.53-15.17) and Forest zone aOR:2.51 (95%CI:1.79-3.53) compared to the country's capital cities (Douala or Yaounde). None of the obstetric characteristics was associated with early discharge. CONCLUSIONS: More than 1 in 4 women who gave birth in facilities in Cameroon were discharged too early; this mostly affected women following vaginal birth. The reasons leading to lack of adherence to postnatal care guidelines should be better understood and addressed to reduce preventable complications and provide better support to women and newborns during this critical period

Study protocol for a two-site clinical trial to validate a smartphone-based artificial intelligence classifier identifying cervical precancer and cancer in HPV-positive women in Cameroon.

INTRODUCTION: Cervical cancer remains a major public health challenge in low- and middle-income countries (LMICs) due to financial and logistical issues. WHO recommendation for cervical cancer screening in LMICs includes HPV testing as primary screening followed by visual inspection with acetic acid (VIA) and treatment. However, VIA is a subjective procedure dependent on the healthcare provider's experience. Its accuracy can be improved by computer-aided detection techniques. Our aim is to assess the performance of a smartphone-based Automated VIA Classifier (AVC) relying on Artificial Intelligence to discriminate precancerous and cancerous lesions from normal cervical tissue. METHODS: The AVC study will be nested in an ongoing cervical cancer screening program called "3T-study" (for Test, Triage and Treat), including HPV self-sampling followed by VIA triage and treatment if needed. After application of acetic acid on the cervix, precancerous and cancerous cells whiten more rapidly than non-cancerous ones and their whiteness persists stronger overtime. The AVC relies on this key feature to determine whether the cervix is suspect for precancer or cancer. In order to train and validate the AVC, 6000 women aged 30 to 49 years meeting the inclusion criteria will be recruited on a voluntary basis, with an estimated 100 CIN2+, calculated using a confidence level of 95% and an estimated sensitivity of 90% +/-7% precision on either side. Diagnostic test performance of AVC test and two current standard tests (VIA and cytology) used routinely for triage will be evaluated and compared. Histopathological examination will serve as reference standard. Participants' and providers' acceptability of the technology will also be assessed. The study protocol was registered under ClinicalTrials.gov (number NCT04859530). EXPECTED RESULTS: The study will determine whether AVC test can be an effective method for cervical cancer screening in LMICs

An estimate of the number of tropical tree species

The high species richness of tropical forests has long been recognized, yet there remains substantial uncertainty regarding the actual number of tropical tree species. Using a pantropical tree inventory database from closed canopy forests, consisting of 657,630 trees belonging to 11,371 species, we use a fitted value of Fisher’s alpha and an approximate pantropical stem total to estimate the minimum number of tropical forest tree species to fall between ∼40,000 and ∼53,000, i.e. at the high end of previous estimates. Contrary to common assumption, the Indo-Pacific region was found to be as species-rich as the Neotropics, with both regions having a minimum of ∼19,000–25,000 tree species. Continental Africa is relatively depauperate with a minimum of ∼4,500–6,000 tree species. Very few species are shared among the African, American, and the Indo-Pacific regions. We provide a methodological framework for estimating species richness in trees that may help refine species richness estimates of tree-dependent taxa

Evenness mediates the global relationship between forest productivity and richness

1. Biodiversity is an important component of natural ecosystems, with higher species richness often correlating with an increase in ecosystem productivity. Yet, this relationship varies substantially across environments, typically becoming less pronounced at high levels of species richness. However, species richness alone cannot reflect all important properties of a community, including community evenness, which may mediate the relationship between biodiversity and productivity. If the evenness of a community correlates negatively with richness across forests globally, then a greater number of species may not always increase overall diversity and productivity of the system. Theoretical work and local empirical studies have shown that the effect of evenness on ecosystem functioning may be especially strong at high richness levels, yet the consistency of this remains untested at a global scale. 2. Here, we used a dataset of forests from across the globe, which includes composition, biomass accumulation and net primary productivity, to explore whether productivity correlates with community evenness and richness in a way that evenness appears to buffer the effect of richness. Specifically, we evaluated whether low levels of evenness in speciose communities correlate with the attenuation of the richness–productivity relationship. 3. We found that tree species richness and evenness are negatively correlated across forests globally, with highly speciose forests typically comprising a few dominant and many rare species. Furthermore, we found that the correlation between diversity and productivity changes with evenness: at low richness, uneven communities are more productive, while at high richness, even communities are more productive. 4. Synthesis. Collectively, these results demonstrate that evenness is an integral component of the relationship between biodiversity and productivity, and that the attenuating effect of richness on forest productivity might be partly explained by low evenness in speciose communities. Productivity generally increases with species richness, until reduced evenness limits the overall increases in community diversity. Our research suggests that evenness is a fundamental component of biodiversity–ecosystem function relationships, and is of critical importance for guiding conservation and sustainable ecosystem management decisions