Knowledge, attitudes and practices of contraception by HIV positive women followed in a Cameroon region with high illiteracy rate: A cross sectional study

Introduction: To evaluate the knowledge, attitude and practices of contraception by HIV positive women. Methods: This cross-sectional descriptive study was carried out in the Maroua Regional Hospital (Cameroon) from September 1st, 2012 to  February 28th, 2013. All HIV positive women aged between 15 and 49 years who were received in the HIV clinic were recruited. The variables recorded included maternal age, number of living children, marital status, religion, the educational level, and the use of antiretroviral treatment (HAART), the knowledge, attitude and practice of contraception. Analyses were done using SPSS 18.0. Fisher exact test was used for comparison. The level of significance was P<0.05.Results: A total of 200 HIV positive women were recruited and 98% knew at least one method of contraception The need of a contraceptive method was present in 84% of HIV positive women, as soon as the women were .30 years (OR 2.6, 95%CI 1.3-4.9), on HAART (OR 2.8, 95%CI 0.8-9.2), divorced (OR 1.7, 95%CI 0.8-3.7), had .3 living children (OR 1.2, 95%CI 0.6-2.4) and when the women were educated (OR 1.2, 95%CI 0.6-2.4). The rate of condom use was 50.7%. Conclusion: The knowledge of contraception as well as the contraception need among HIV positive women was high in this region despite high  illiteracy rate. Therefore, all contraceptive methods should be made  available to these women. Towards these women and their partner(s),  more emphasis should be made on the systematic condom use even when using other contraceptive methods (dual protection)

A case report of a giant fallopian tube leiomyoma mimicking a mesenteric tumor.

Leiomyomas are benign tumors usually found in the uterus although other organs such as the vagina and the ovaries can be involved. The most common etiology of tubal disorders is infection, but tubal leiomyomas remain a rare possibility. We hereby present a case-report of fallopian tube leiomyoma undiagnosed preoperatively despite the technological progress in radiologic imaging. The diagnosis was only made at laparotomy. In this case report, diagnostic measures and the difficulties encountered are discussed.KEY WORDS: Abdominal mass- Fallopian tube fibroid - Diagnosis

Triple Gestations in Two University Teaching Hospitals in Yaounde, Cameroon

The frequency of triplet pregnancies is increasing due to medically assisted reproduction. This retrospective study, carried out in 2 university hospitals in Yaounde (Cameroon) over a 6-year period, was done to evaluate the complications that occurred during triple pregnancies as well as the mode of delivery of triplets. A total of 43 cases were analyzed. The most common complications that occurred during pregnancy were preterm delivery and pre-eclampsia. Twenty seven women (62.8%) delivered vaginally and 16 (37.2%) were delivered by caesarean section with the most common indications being mal presentation and cord prolapse of the 1st triplet. In patients who have proper antepartum monitoring, it is possible to pre-select cases for trial of vaginal delivery because vaginal delivery is possible and carries no significant risk for the foetuses.Keywords triplet gestations; pre-eclampsia; premature delivery; vaginal delivery; caesarean sectio

Study of Perineal Tears During Delivery of Singletons in Cephalic Presentation

Background: Perineal lacerations are associated with short and long term maternal complications likeperineal pain and superficial dyspareunia and must be prevented.Aims: To look for risk factors in order to prevent themMethods: This retrospective study was conducted from the 1<sup>st</sup> of January to the 31<sup>st</sup> of December 2007in the maternity of the University Teaching Hospital Yaoundé (Cameroon). All cases of perineal tear that occurred during delivery of singletons in cephalic presentation were recruited. Our data were analysed using SPSS 12.0. The Student's t-test and the Fisher's exact test were used for comparison. The level of significance was 0.05.Results: The incidence of perineal tear was 13.5% (230/1695). Second degree perineal tears represented rd th 22.1% and 3 degree 01.3% of cases. No 4 degree perineal tear was observed. Risk factors for seconddegree perineal tears were nulliparity especially if maternal age was 27 and above, foetal weight = 3500 rd g, instrumental deliveries and deliveries of adolescents while that of 3 degree were forceps delivery (1case) and macrosomic babies (2) in patients of 27 and 29 years.Conclusion: In the above mentioned conditions, the perineum must be well protected and a mediolateral episiotomy must be done to prevent severe perineal tears if many risk factors are present.Keywords: Singletons in cephalic presentation- Perineal tears-Risk factors

Risk Factors of Delivery by Caesarean Section in Cameroon (2003-2004): A Regional Hospital Report

We conducted this retrospective case-control study to identify possible risk factors of delivery through caesarean section in the Far North Region of Cameroon. Data was collected retrospectively from delivery room registers at the Provincial Hospital, Maroua, Cameroon from 01/01/2003 to 31/12/2004. The overall 125 eligible caesarean deliveries were compared with 244 women who delivered vaginally during the study period. The odds ratio as well as the 95% confidence interval was used to measure the relationship between maternal characteristic and risk of delivery by caesarean section. We found that the marital status is similar in the two study populations. Risk factors associated with cesarean section were: maternal age less than 17 years (OR 3.55, 95%CI: 1.46–8.64), maternal age over 39 years (OR 3.55, 95% CI: 1.17–10.75), nulliparity (OR 2.72, 95% CI: 1.59–4.66), grand multiparty (OR 3.43, 95% CI: 1.79–6.57), and macrosomia (OR 4.82, 95% CI: 1.49–16.44). There was a weak association with absent or poor. Caesarean delivery is associated with extreme ages of reproductive life, macrosomia, nulliparous and grand multiparous status. We strongly recommend that these factors be taken into consideration to strengthen the mother and child health programs in Cameroon and countries with similar socioeconomic profiles

The Risk of Adverse Maternal and Neonatal Outcomes in Cameroonian Primiparous Women Aged More Than 26 Years

Primiparas with advanced age are predisposed to adverse maternal and neonatal risks. The aim of this retrospective cohort study, conducted between January 1st and December 31st, 2004 in the maternity of the Yaounde University Teaching Hospital, Cameroon, was to identify from what age these adverse risks become significant in Cameroonian women. The medical files of 233 primiparae aged 26 and above (case) and that of 404 primiparae aged between 20 and 25 years (control) were reviewed and some data compared. Cesarean sections, instrumental deliveries, low Apgar scores at 5th minute and early neonatal death rates were significantly higher in primiparae aged 27 years and above. Hence, Cameroonian women should be enlightened about the risks of delaying first delivery. Furthermore, first pregnancies to be carried at term and first deliveries in women aged 27 and above shall be considered at high risk and consequently well followed.Keywords primiparas aged more than 26 years; soft tissue dystocia; increased cesarean section risk; poor neonatal outcom

Complications chirurgicales des avortements clandestins: a propos de 51 cas observés dans deux hôpitaux de Yaoundé.

Le but de cette étude était de décrire les complications des avortements provoqués dans la clandestinité et imposant un traitement chirurgical. Il s’agit d’une étude rétrospective transversale portant sur les malades opérés dans les services de Chirurgie de l’Hôpital central et du Centre Hospitalier Universitaire de Yaoundé du 1er Janvier 2004 au 31 Décembre 2008. Les variables d’étude étaient l’âge, le statut matrimonial, les antécédents gynécologiques, les antécédents d’avortement antérieur, le mode, l’indication chirurgicale et l’état général des patientes; les lésions découvertes en peropératoire, leur traitement et l’évolution postopératoire. Cinquante une patientes ont été retenues pour cette étude menée pendant une durée de quatre ans, soit une moyenne de 12,7 cas par an. L’âge des patientes variait entre 15 ans et 41 ans avec une moyenne de 30 ans; 33 patientes (64,7%) avaient un âge situé entre 15ans et 25 ans. 6 patientes (11,7%) étaient multipares et 4 patientes étaient primipares (7,8%). Treize patientes (25,42%) avaient déjà subi une interruption volontaire de grossesse sans complication. Quarante-neuf patientes (96%) étaient arrivées avec un tableau de péritonite ; 43 patientes (84,22%) étaient classées ASA III (American Association of Anesthesiologists). Les lésions chirurgicales étaient à type de perforations ou de déchirures utérines dans 20 cas (39,21%), annexielles dans 9cas (17,64%), digestives dans 16 cas (31,37%) et urinaires dans 4 cas. Le traitement a associé au traitement de la péritonite, les sutures utérines, digestives et vésicales ; les gestes d’exérèse comprenaient deux hystérectomies et cinq salpingectomies. Il a été réalisé des gestes de dérivation dont deux cystostomies et deux colostomies. La mortalité était de 15,6%. L’étude recommande une éducation des femmes en matière de contraception et de planning familial, et surtout une politique sociale permettant de réduire le nombre des avortements clandestins.MOTS CLES: Avortement clandestin- Complications - Chirurgie

Mort foetal intrapartum au Cameroun: Une analyse de deux hôpitaux de référence de Yaoundé, Cameroun.

Selon le rapport de l’organisation mondiale de la santé sur l’Afrique, 4.1% de nouveau nés meurent avant d’être nés, 37% de ces décès surviennent pendant le travail. Nous avons engagé ce travail afin d’identifier les facteurs de risque de mortalité intrapartum dans notre milieu. Dans une étude cas- témoins réalisée du 1er octobre 2000 au 31 septembre 2001 au centre hospitalier universitaire de Yaoundé (CHUY) et à l’hôpital central de Yaoundé (HCY) L’analyse des données a été faite avec le logiciel EPI-info 6. Nous avons utilisé le rapport de cote pour apprécier l’impact des différentes variables sur le risque de décès intrapartum. Quatre vingt six décès foetaux intrapartum ont été observés dans les deux hôpitaux durant la période de l’étude, soit une prévalence de 1,8 pour 100 naissances. Nous avons identifié 5 principaux facteurs de risque de mortalité foetale intrapartale : les hémorragies antépartum (OR=15,14, IC à 95%. [1.96 -322.72]; P=0.00081), la preéclampsie /éclampsie (OR=13,78, IC à 95%. [1.77 - 295.41] ; P= 0.0015); le travail stationnaire (OR=6,21 IC à 95%. [1.86- 22.91]; P= 0.00043); la souffrance foetale (OR=5,53, IC à 95%. [1.07-38.31].IC à 95% P= 0.0166) ; patiente référée d’une autre formation sanitaire (OR=4,81[IC à 95%. [2.39-9.91]; P= 0.0000015). Des actions spécifiques sont nécessaires pour permettre de reconnaître rapidement les facteurs de risque de mort foetale intrapartum et assurer une prise en charge rapide et efficace.MOTS CLES: Foetus - Mort intrapartum - Yaoundé - Cameroun

Efficacy of highly active triple antiretroviral therapy in preventing mother-to-child HIV transmission in the university teaching hospitals in Yaounde, Cameroom

Paediatric HIV-infection rates remain high in Cameroon in spite of the various existing preventive strategies. This study will provide scientific evidence that HIV-infected pregnant women receiving highly active triple antiretroviral therapy would be expected to have significantly lower viral loads and a lower risk of HIV mother-to-child transmission (MTCT) without scheduled Caesarean section. We enrolled 90 newly diagnosed HIV-infected pregnant women who accepted to participate in the study from the 4 Teaching Hospitals in Yaoundé between January 1, 2006 and December 31, 2008. In addition to routine antenatal care, they received two types of potent triple antiretroviral regimens depending on their initial CD4 counts. Drug efficacy and safety were assessed by CD4 count, viral load, liver enzymes level, fasting blood sugar level, blood urea and haemoglobin concentration level before and after treatment and the paediatric seroprevalence rate. Highly active triple antiretroviral therapy was associated with maternal immunological improvement, statistically significant reduction of maternal viral load (P< 0.05) with resultant low paediatric HIV infection rate (1.1%) and minimal maternal biological impairment. Short courses of highly active triple antiretroviral therapy to prevent HIV MTCT is therefore not only efficacious compared to other treatment options like monotherapy, bitherapy, and bitherapy associated with scheduled caesarean section, but also safe and should constitute the mainstay intervention strategy.KEY WORDS: HIV MTCT- Triple antiretroviral therapy- Adverse effects - Paediatric HIV infection rate

Rupture of a previously scarred uterus during second trimester misoprostol-induced labour for a missed abortion: A case report

Misoprostol is useful in ripening the cervix prior to mid-trimester termination of pregnancy. It is particularly indicated in cases of missed abortions whether the uterus is scarred or not. The procedure is safe in the majority of cases. We present a case of uterine rupture during induction of labour with vaginal misoprostol for a missed abortion at 23 weeks gestation in a woman with one previous lower segment caesarean scar. We decided to present this case in order to alert practitioners that although the practice is safe in the majority of cases, there are risks of uterine rupture. Clinics in Mother and Child Health Vol. 3(1) 2006: 501-50