The profile of patients with obstructive uropathy in Cameroon: case of the Douala General Hospital

Introduction: Obstructive uropathy can lead to irreversible kidney damage. The etiology largely determined by the patient's age can be benign or malignant. This study aimed at determining the profile and outcome of patients with obstructive uropathy in Cameroon. Methods: A cross sectional study carried out in the urology unit of the Douala General Hospital, including patients with a diagnosis of obstructive uropathy seen from January 2004 to December 2013. Clinical profile, treatment and outcome data were obtained from patients records. Results: Of the 229 patients included 69% were men, mean age 50 ±18 years. Associated comorbidities were hypertension, diabetes, and HIV. Mean haemoglobin 8,40±2,4g/dl, mean GFR 10,3 ±10ml/min, 94 (41%) patients needed emergency dialysis. Symptoms at presentation: asthenia (57%), anorexia (55%), loin pain (37%), vomiting (28%), oedema (20%), and anuria (15%). Urinary tract infection was present in 33 patients. Main aetiologies of obstruction: urolithiasis (35%), begnin prostatic hypertrophy (27%), prostatic cancer (12%), cervical cancer (16%), and congenital malformations (5%). Drainage was effective in 102 (45%) patients, 63 (28%) recovered completely, 91 (41%) were loss to follow up, 49 (22%) died and more women (p=0.02). Mortality was associated with prostatic cancer (p=0.000), cervical cancer (p=0.004) and radiotherapy (p=0.03). Conclusion: Patients with obstructive uropathy presented with significant impaired renal function. Main causes were urinary stones, prostatic hypertrophy, prostatic and cervical cancers. Renal recovery was poor, loss to follow up and mortality high. Specific strategies to target improvement in renal recovery and patient's survival are needed in this patient's group.Pan African Medical Journal 2016; 2

Maternal mortality in Cameroon: a university teaching hospital report

More than 550,000 women die yearly from pregnancy-related causes. Fifty percent (50%) of the world estimate of maternal deaths occur in sub-Saharan Africa alone. There is insufficient information on the risk factors of maternal mortality in Cameroon. This study aimed at establishing causes and risk factors of maternal mortality. This was a case-control study from 1st January, 2006 to 31st December, 2010 after National Ethical Committee Approval. Cases were maternal deaths; controls were women who delivered normally. Maternal deaths were obtained from the delivery room registers and in-patient registers. Controls for each case were two normal deliveries following identified maternal deaths on the same day. Variables considered were socio-demographic and reproductive health characteristics. Epi Info 3.5.1 was used for analysis. The mean MMR was 287.5/100,000 live births. Causes of deaths were: postpartum hemorrhage (229.2%), unsafe abortion (25%), ectopic pregnancy (12.5%), hypertension in pregnancy (8.3%), malaria (8.3%), anemia (8.3%), heart disease (4.2%), and pneumonia (4.2%), and placenta praevia (4.2%).Ages ranged from 18 to 41 years, with a mean of 27.7 ± 5.14 years. Lack of antenatal care was a risk factor for maternal death (OR=78.33; CI: (8.66- 1802.51)). The mean MMR from 2006 to 2010 was 287.5/100,000 live births. Most of the causes of maternal deaths were preventable. Lack of antenatal care was a risk factor for maternal mortality. Key words: Maternal mortality, causes, risk factors, Cameroon.Keywords: Pregnancy, maternal death, Yaoundé, Cameroon, causes, risk factor

Pattern of non-obstetric infectious recto-vaginal fistula: a case series and literature review in Cameroon, Central Africa

Background: Perineal infection is an uncommon cause of non-obstetrical recto-vaginal fistula (RVF) which is associated with HIV infection. Cameroon (Central Africa) is in the fistula belt but infectious RVFs have not yet been deeply studied in the country. We therefore sought to determine the pattern of non-obstetric infectious RVF in Cameroon.Methods: We carried out a cross-sectional and descriptive review of non-obstetric infectious RVFs managed at the Yaoundé University Teaching Hospital between January 1, 2009 and December 31, 2015. All complete files were included. The following data were retrieved: socio-demographics, characteristics of the RVF, management and outcome.Results: Five non-obstetrical and non-traumatic RVFs of which four were observed in HIV-infected patients were included. All those RVFs occurred spontaneously. The following predisposing factors were identified: perineal warts (one case out of five), perineal suppuration (two cases out of five), hemorrhoids (the HIV-negative patient), spinsterhood (all cases), unemployment (all cases). All HIV-patients were under anti-retroviral therapy (ART) with good immunological and clinical responses for three of them. Three of them underwent previous unsuccessful surgical cure. Management included ART, antibiotics and surgery. Surgical approaches were perineotomy alone or with martius’ flap, procto-perineotomy or trans-vaginal advancement flap. Outcome was satisfactory for all HIV patients (closure of fistula and fecal continence).Conclusions: Local infection is a rare cause of RVF which was associated with HIV in our series. Combined treatment including antibiotics, HAART and surgery gave good results

Determinants of retention in HIV antiretroviral treatment (ART) in the Cameroon International epidemiology Database to Evaluate AIDS (IeDEA) study clinics: the context of the HIV treat all strategy in Cameroon

Introduction: retaining patients in antiretroviral treatment (ART) is essential for successful outcomes. Unfortunately, Cameroon continues to report suboptimal ART retention. This study focused on identifying determinants of ART retention in three HIV clinics in Cameroon within the HIV treat all context. Methods: a medical chart review of 423 subjects who initiated ART between July and September 2016 in the Limbe, Bamenda and Jamot Hospitals. Patients' sociodemographic and clinical characteristics and ART retention data were abstracted using structured paper forms. Chi square test was used to assess bivariate associations. Logistic regression was used to adjust for confounders. P-value was set at <0.05 at 95% confidence interval. Results: the mean age was 40±11 years, and 65.1% were females. Antiretroviral treatment retention after 24 months was 309/392(78.83%) and 30/423(7.1%) were transferred-out, 11/423(2.6%) reported dead and 73/423(17.3%) lost to follow-up. HIV status disclosure (AOR 0.16 95% CI: 0.05-0.51, p<0.01) and age group 31-50 years (AOR 3.63, 95% CI:1.04-12.59, P= 0.04) were associated with lower and higher ART retention respectively. Conclusion: about a quarter of the participants were not retained in ART after 24 months. Patient-level factors determined ART retention. These factors should be considered in designing strategies to improve ART retention. More research is needed to identify other determinants of ART retention under the HIV treat all strategy

Perceptions of antenatal care services by pregnant women attending government health centres in the Buea Health District, Cameroon: a cross sectional study

Introduction: User’sperception of quality of ANC services crucially impacts continuity of use of these services and hence pregnancy outcome. However in our community, ANC user’s perceptions of quality are not known. Methods: An observational analytic cross-sectional study was carried out amongst pregnant women attending selected government health centres in the Buea Health District. We recruited 385 consenting pregnant women for the study. Demographic and clinical data were collected using structured questionnaires. The data was entered into Microsoft Excel and exported toEpi-Info (Version 3.5.1) for analysis. Results: Geographical accessibility and perceived quality of care were the predominantreasons for choosing or changing a site for ANC. One third of respondents (30.1%) attended a health centre out of their catchment health area with Buea Town health centre receiving the highest proportion of women out of the health area (56.8% of attendees). Knowledge about antenatal care varied and majority of respondents (96.4%) were satisfied with the antenatal services received. However, there were elements of dissatisfaction with health centre services, poor sitting facilities, amenities, few health education talks and poor nursing skills. High educational level (high school and university) (X2 = 8.714; p = 0.01) and first time pregnancy(X2= 4.217; p= 0.04) were significantly associated with poorsatisfaction. Conclusion: Policy makers should implement changes in the health care delivery system taking into account the users’ preferences, more so in the light of increasing female education in Cameroon.Keywords: Antenatal care, perception, choice of site, satisfaction, Cameroo

Evaluation of quality of life and associated factors among HIV patients on antiretroviral therapy in North West region of Cameroon

Background: There is evidence that Quality of Life (QoL) of People Living with HIV/AIDS (PLHIV) has a significant role in ART retention, treatment adherence, and survival. As a result, QoL is becoming increasingly important for policymakers, program implementers, and researchers. However, factors associated with QoL, in a culturally diverse country like Cameroon are unknown. Objective: We aimed to assess the QoL of PLHIV on ART and assess the extent to which physical, psychosocial, environmental, and spiritual factors drive QoL. Method: A cross-sectional study was conducted among 394 PLHIV aged >21 in North-West Cameroon from April to July 2019. Data were collected using WHO-QOL BREF questionnaire. Descriptive statistics, bivariate, and multivariate linear regression analyses were performed. Results: Majority (34.5%) of participants were in the age range of 41-50, with 73% females. The average QoL of the respondents was \u201cgood\u201d with mean score of 3.57 on 5 and 71.4% agreed to have satisfactory QoL. Bivariate regression analyses revealed that all six proposed predictors were significantly associated with QoL. Psychological factors made the greatest impact (\u3b2 = 0.213; p<0.003), followed by physical factors (\u3b2 = 0.19; p<0.001). Conclusion: PLHIV fairly agreed to have good QoL. The QoL was driven by mainly psychological and physical factors and not level of independence. However, the mean score perceptions for the investigated domains were low. Mental health services should consider these predictors when designing strategies to improve the QoL of PLHIV. While this study provides useful insights, other possible drivers of QoL among PLHIV should be investigated

Epidemiology and surgical management of breast cancer in gynecological department of Douala General Hospital

Introduction: Breast cancer is one of the most common gynecological cancers in our environment. Douala General Hospital (DGH) is one of the two main centers in Cameroon, where the cancerous patient can receive multidisciplinary management including radiotherapy. Methods: The aim of our study was to describe the epidemiological, clinical profile and surgical management of patients with breast cancer in gynecological department of DGH. Results: A total of 42 patients were recruited in our department within a period of 3 years (from November 2006 to October 2009). The mean age was 46 years (range: 29-73 years). Characteristics of our study group were as followed: female sex (100%); breast feeding (95.245%); familial history of breast cancer (7.14%); 14.29% of patients were nulliparous and 19.05% primiparous. The main mode of discovering the disease was auto examination (92.86%). The clinical tumor size ranges from 2cm to 20cm with a mean of 6.83cm. Patients were then mostly diagnosed at stage III (54.76%) of the WHO classification. Only 2.38% were diagnosed at stage I. The main method of diagnosis was breast fine needle aspiration. Neo adjuvant treatment was administered in 78.57% of patients and the main surgical treatment was mastectomy (92.86%). Many patients are still followed up (59.52%), but we already had a mortality rate of 14.29% at the end of December 2010. We had no feedback for 26.19% of the study group. Conclusion: Breast cancer is generally diagnosed in advanced stage in our milieu; there is therefore a need for generalized sensitization of the population.Pan African Medical Journal 2012; 13:3

Incidence, risk factors, clinical presentation and treatment of ectopic pregnancy in the Limbe and Buea Regional Hospitals in Cameroon

INTRODUCTION : ectopic pregnancy (EP) is the leading cause of maternal mortality in the first trimester of pregnancy in our environment. This study aimed at evaluating the incidence, risk factors, clinical presentation and treatment of ectopic pregnancy in the Limbe and Buea Regional Hospitals in Cameroon. METHODS : this was a retrospective nested case control study carried out from December 2006 to December 2016. A ratio for control vs cases of 3:1 was obtained. Any pregnancy implanted outside the normal uterine cavity was considered as an ectopic pregnancy. Student's t-test was used to compare continuous variables and Pearson's Chi-square test for categorical variables. The association between EP and the demographical and clinical variables was estimated using logistic regression. Statistical significance was set at p-values<0.05. RESULTS : a total of 247 cases of EP were registered out of 17221 deliveries giving an incidence of 1.43% in ten years. History of pelvic inflammatory disease (OR = 3.10, CI (1.76-5.44), p < 0.001), previous EP (OR = 10.22, CI (2.61-14.82), p < 0.001), History of induced abortion (OR = 2.68, CI (3.32-9.73), p< 0.001), history of adnexa surgery (OR = 4.37, CI (2.17-10.32), p < 0.001) and history of appendectomy (OR = 2.16, CI (0.99-6.64) p< 0.001), were also found to be associated with increased risk of EP. More than five percent (5.52%) of the patients were in shock at presentation. Diagnosis was confirmed mainly by use of ultrasound (78.53%) and treatment was principally by laparotomy (97.55%) with salpingectomy (95.60%). Most (90.18%) of ectopic pregnancies were ruptured at presentation. Only 2.45% of cases were manage medically with the use of methotrexate. CONCLUSION : the incidence of ectopic pregnancy (EP) in our environment is within the global range (hospital-based incidence of 1.43%) and is rising. Late presentation, lack of modern diagnostic and management tools have made laparotomy with salpingectomy the principal method of management of ectopic pregnancy in our environment.http://www.clinical-medicine.panafrican-med-journal.comam2021School of Health Systems and Public Health (SHSPH

Predictors of antiretroviral therapy interruptions and factors influencing return to care at the Nkolndongo Health District, Cameroon

Background: Antiretroviral therapy is a lifelong commitment that requires consistent intake of tablets to optimize health outcomes, attain and maintain viral suppression. Objective: We aimed to elicit predictors of treatment interruption amongst PLHIV and identify motivating factors influencing return to care. Method: We conducted a cross-sectional study using a mixed-method approach in four hospitals in Yaound\ue9. Sociodemographic and clinical data were collected from ART registers. Using purposeful sampling, thirteen participants were enrolled for interviews. Quantitative data were analyzed using Epi-Info and Atlas-TI for qualitative analysis. Ethical clearance approved by CBCHS-IRB. Results: A total of 271 participants records were assessed. The mean age was 33 years (SD\ub111years). Private facilities CASS and CMNB registered respectively 53 (19.6%) and 14 (5.2%) participants while CMA Nkomo and IPC had 114 (42.1%) and 90 (33.2%) participants. Most participants (75.3%) were females [OR 1.14; CI 0.78-1.66] compare with males. 78% had no viral load test results. Transport cost and stigmatization constituted the most prominent predictors of treatment interruption (47.5%) and (10.5%) respectively. Belief in the discovery of an eminent HIV cure and the desire to raise offspring motivated 30% and 61%, respectively to resume treatment. Conclusion: Structural barriers like exposed health facility, and dispensing ARVs in open spaces stigmatizes clients and increases odds of attrition. Attrition of patients on ART will be minimized through implementation of client centered approaches like multiplying proxy ART pick points, devolving stable clients to community ARV model