Factors associated with breast cancer occurrence before the age of 40 in Yaoundé

Background: In Cameroon, one third of breast cancers concern women less than 40 of age and young age appeared to be an independent predictor of adverse outcome. This study aimed to determine factors associated with the development of breast cancer before the age of 40 in Yaoundé.Methods: A case-control study was conducted for 7 months, from November 1st, 2016 to May 31st, 2017 at the General Hospital and the gyneco-obstetric and Paediatric Hospital of Yaoundé. Study compared the socio-demographic, clinical and lifestyle data of 50 women less than 40 of age with breast cancer (cases) with those of 200 women below 40 of age without breast cancer (controls). Descriptive statistics, bivariate and multivariate logistic regressions were performed to assess the socio-demographic, clinical and lifestyle data. Data were computed using the SPSS version 23.0 software. The significance threshold value was set at 0.05.Results: After multivariate analysis, the factors independently associated with the occurrence of breast cancer before the age of 40 were: age ≥ 30 (aOR = 2.05); family history of breast cancer (aOR = 8.65); parity ≥ 1 (aOR = 2.46); breastfeeding (aOR = 3.39); waist circumference ≥ 88 centimeters (cm) (aOR = 4.38); breast density ≥ 90                      (aOR = 2.89); physical activity ≤ 3 hours/week (aOR = 4.78). Conclusions: Breast cancer in women under 40 is associated with family history, reproductive life and women's lifestyles.  Breastfeeding more than 12 months, having a balanced diet, supplementary screening tests in women with dense breasts and practicing physical activity; would be  effective ways to prevent it in young women

Predictive factors for perinatal death in nuchal cord cases: a case control study

Background: Nuchal cord is a common occurrence at delivery and it is known to be associated with birth asphyxia and perinatal death. The objective of this study was to identify the predictive factors of perinatal death in the presence of nuchal cord.Methods: This was a case-control study carried out during the period from October 1st 2014 to April 30th 2015 in three hospitals of Yaoundé, Cameroon, involving 204 parturients whose babies presented with a nuchal cord at delivery.Results: After multivariate analysis, independent predictive factors for perinatal death in nuchal cord cases were: post-term (OR=209.70; CI= 3.09-14212.66), antepartum hemorrhage (OR=18.21; CI=1.47-224.78), fetal heart rate abnormalities during labor (OR=11.74; CI=1.33-103.37), augmentation of labor (OR=24.04; CI=1.85-311.52), second stage of labor lasting more than 30 minutes (OR=172.50; CI=20.60-1444.20) and tight nuchal cord at birth (OR=16.29; CI=2.07-127.87).Conclusions: We recommend the identification of predictive factors for perinatal death in cases of known or suspected nuchal cord in order to consider cesarean section to prevent adverse fetal outcomes

Risk factors of poor outcome of pregnancy and delivery in adolescents: a case-control study at the Yaounde Gynaeco-Obstetric and Pediatric Hospital

Background: Adolescence is a period of life between 10 and 19 years, marked by a state of psychological imbalance and immaturity of organs. The occurrence of pregnancy at this age group can cause social, psychological or obstetric problems (prematurity, unsafe abortion, obstructed labor).  The objective of this study was to identify the risk factors of poor outcome of pregnancy and delivery in adolescents.Methods: It was a case-control study with a retrolective data collection from January 1st, 2004 to December 31st, 2013 in the Yaounde Gynaeco-Obstetric and Pediatric Hospital. We included adolescent girls of 11 to 19 years old who delivered in the study site. We compared 128 adolescents of the case group who encountered poor outcome with 128 ones of the control groups with favorable outcome.Results: At univariate analysis, the number of antenatal care consultations less than four OR: Odds Ratio (OR= 2.44 [1.41-4.22]; P=0.000), the antenatal care consultations done out of our study site (OR= 1.65(95%CI: 1.00-2.70); p=0.003) and the uterine fundal height less than 33 cm at the time of childbirth (OR=1.80(95%CI:1.08-2.98); p=0.015) were identified as risk factors of poor outcome. After linear logistic regression analysis, the number of antenatal care less than four (OR=1.92(1.0-3.56); p=0.037) remained as independent risk factor of poor outcome.Conclusions: The number of antenatal visits less than four is an important risk factor of poor outcome of pregnancy and childbirth in adolescents at the Yaoundé gynaeco-obstetric and pediatric hospital

Kaolin consumption and outcome of surgery in women: a comparative study of 263 operations at the Yaoundé Gyneco-Obstetric and Pediatric Hospital

Background: Kaolin consumption is common in our sub-Saharan Africa. The objective of this study was to assess the effects of kaolin consumption on the outcome of surgery in women.Methods: It was a cohort study comparing the occurrence of complications during labor among 263 consecutively recruited women who underwent gynecologic or obstetric surgery at the Yaoundé Gyneco-Obstetric and Pediatric Hospital, Cameroon. Sixty of them (22.8%) declared kaolin consumption before surgery and 203 (77.2%) who denied having consumed kaolin before surgery.Results: Kaolin consumption was found to predispose to postsurgical infections (RR=3.03; IC=1.82-5.05).Conclusions: Kaolin geophagia should be identified before surgery to prevent related postsurgical infections. A systematic ban of kaolin consumption is also recommended.

The impact of sexual activity during the third trimester of pregnancy on labor outcome in nulliparous women

Background: In the environment, there’s not enough studies on the effects of sexual activity during pregnancy on labor outcome, especially for nulliparous women. The aim was to assess the effects of sexual activity during the third term of pregnancy on the outcome of labor in nulliparous women.Methods: A prospective cohort study on labor was carried out for 11 months at the labor ward of the Yaoundé gynaeco-obstetric and pediatric Hospital. In this study compared women were exposed to at least one unprotected sexual intercourse with vaginal ejaculation per week during the third trimester of pregnancy (exposed group), to those who had less than one unprotected sexual intercourse per week (non-exposed group).Results: Of the 1123 primiparous women who gave birth within the study period, 426 consented to enroll in the study. Amongst these women, 186 women in the exposed group compared to 240 women in the non-exposed group. Intercourse during pregnancy predisposed on arrival into the labor ward to a Bishop’s score ≥7 (RR = 1.94; CI = 1.63-2.3) and within the course of labor to a spontaneous per vaginal delivery (RR = 1.18; CI = 1.06-1.31) and an active phase duration <6 hours (RR = 1.52; CI = 1.36-1.7). Furthermore, sexual intercourse during pregnancy protected against labor induction (RR = 0.21; CI = 0.12-0.36), dystocia (RR = 0.36; CI =  0.27-0.49), cesarean section (RR = 0.29; CI = 0.15-0.55), episiotomy (RR = 0.56; CI = 0.36-0.87) and an Apgar  score <7 at the first minute of birth (RR = 0.31; CI = 0.14-0.7).Conclusions: Sexual activity during pregnancy improves the prognosis of labor in primiparous women. In the absence of contraindications, consented unprotected heterosexual vaginal intercourse should be promoted in nulliparous women

Risk factors of maternity blues after caesarean section in Yaoundé, Cameroon: a case-control analysis

Background: Maternity blues is the most precocious and common mental derangement of the puerperium. Our objective was to identify its risk factors in women delivered by cesarean section.Methods: This was a case-control study carried out from January 10th to April 10th 2015 in two referral hospitals of Yaoundé, Cameroon, involving 321 women delivered by cesarean section, 107 of which presented maternity blues.Results: After multivariate analysis, independent risk factors for maternity blues after cesarean section were: low socio-economic level (OR=3.62; CI=1.35-9.70), personal history of depression (OR=4.36; CI=1.13-16.81), difficulties caring for the baby (OR=3.40; CI=1.12-10.27) and having felt depressed or anxious during pregnancy (OR=6.61; CI=3.05-14.31).Conclusions: Women with identifiable risk factors for maternity blues should be followed up closely after cesarean deliveries

Epidemiology of ectopic pregnancy at Laquintinie Douala hospital (Cameroon): prevalence survey, clinical profile, therapeutic and transfusion issues

Background: Pregnancy is a serious pathology of the first trimester of pregnancy and is the leading cause of death. The objective of our work was to determine the hospital prevalence of ectopic pregnancy (EP), to describe the epidemiological, clinical and therapeutic profile given the often-haemorrhagic context at Laquintinie Hospital in Douala.Methods: We carried out a retrospective study over 10 years, from January 1st, 2007 to December 31st, 2016, using the operating theatre registers and the files of patients admitted during this period for ectopic pregnancy in the gynaecology and obstetrics department of the Laquintinie Hospital in Douala.Results: A total of 905 cases of EP for 32,595 deliveries were recorded, for an overall incidence of 2.8%. EP mainly affected the age group of 25 to 35 (60.6%), single people (57.9%) and housewives (46.6%). The risk factors found were similar to those of cervical cancer, namely multiple sexual partners (80.4%), the precocity of sexual intercourse under 18 years (54.1%) and sexually transmitted infections (52.5%). The symptomatic triad (pelvic pain, amenorrhea and metrorrhagia) was found in 46.1% of cases with a respective order of frequency of 96.9%, 77.3% and 63.6% The management was essentially surgical by radical laparotomy (97% of cases). Two of the 07 deaths were due to religious considerations.Conclusions: EP remains a frequent pathology in our environment with a heavy toll of tubal amputations and death

Facteurs prédictifs de l’échec du Traitement Préventif Intermittent du paludisme à la sulfadoxine – pyriméthamine (TPIp-SP) dans une population de femmes enceintes à Yaoundé

Introduction: Le traitement préventif intermittent à la sulfadoxine-pyriméthamine (TPIp-SP) est recommandé pour prévenir le paludisme pendant la grossesse. Nous avons recherché les facteurs associés à l'échec de cette stratégie. Méthodes: Nous avons mené une étude cas - témoins dans deux formations sanitaires de Yaoundé, du 1er Mai 2014 au 30 Avril 2015. Les femmes enceintes sous TPIp-SP hospitalisées pour paludisme ayant un Test de Diagnostic Rapide (TDR) positif (cas) étaient comparées aux femmes enceintes sous TPIp-SP ayant un TDR négatif (témoins). Les logiciels Epi info 7 et SPSS 18.0 ont été utilisés avec P&lt;0,05 comme seuil de significativité. Résultats: Nous avons recruté 234 sujets, 109 cas (46,6%) et 125 témoins (53,4%). Les facteurs associés retrouvés étaient : la primiparité (P=0,03 ; OR=1,15; IC= 0,32 - 4,10), la non utilisation de la MILDA (P=0,006 ; OR= 2,31 ; IC= 1,26 - 4,25), un antécédent d'hospitalisation pour paludisme (P=0,007 ; OR= 2,19 ; IC= 1,23 - 3,89), le début de la TPIp-SP après la 28ème semaine de grossesse (P=0,001, OR= 3,55; IC= 1,7 - 7,61). Après régression logistique, la primiparité (P=0,024 ; OR=2,01 ; IC=1,1-3,7) et un antécédent d'hospitalisation pour paludisme (P=0,001 ; OR=2,83 ; IC=1,50-5,4) restaient associés à l'échec du TPIp-SP. Conclusion: Un antécédent d'hospitalisation pour accès palustre et la primiparité sont des facteurs prédictifs indépendants de l'échec de la TPIp-SP.Pan African Medical Journal 2016; 2

Assessment of labor and delivery in pregnant women on sulfadoxine-pyrimethamine regimen in Yaoundé gynaeco-obstetric and paediatric hospital: a comparative study of 313 cases

Background: Malaria is still a major public health problem in sub-Saharan Africa. The aim was to determine the prevalence of malaria infection at the onset of labor and the resulting complications.Methods: We carried out a five-month cross-sectional study at the Yaoundé Gyneco-Obstetric and Pediatric Hospital.  We used results from the rapid diagnostic test (RDT) to compare two groups of pregnant women admitted into the labor room. Women who tested positive were assigned to the exposed group versus negative to the non-exposed group. Independent factors associated with malaria infection were investigated by the logistic regression method.Results: Up to 79.6% (249/313) of women had received the sulfadoxin-pyrimethamine regimen with 32.9% (82/249) receiving at least 3 doses.  Malaria infection was detected in 32.2% (101/313) of women. Only 14.9% (15/101) of the exposed group had received 3 doses of SP versus 31.6% (67/212) of the non-exposed group. After univariate analysis, malaria infection at the onset of labor was associated to premature rupture of membranes (OR=1.39; CI=1.01-1.94), fever during labor (OR=73.37; CI=64.80-681.95), non-reassuring fetal status (OR=2.08; CI=1.36-3.20), low birth weight (OR=1.65; CI=1.23-4.13), prematurity (OR=2.79; CI=2.12-367), a poor Apgar score at the 1st minute and postpartum fever (OR=3.19; CI=2.56-4.00). Linear logistic regression indicated that the occurrence of fever during labor (aOR=63.09), and low Apgar score at the first minute (aOR=6.27) remained significant and malaria infection was significantly associated to the single marital status (aOR=2.56) and a history of malaria during the current pregnancy (aOR=2.56).Conclusions: Systematic RDTs is thus recommended at the last antenatal consultation to avoid identified complications

Descriptive analysis of 192 cases of breast cancer occurring before age 40 in Yaounde, Cameroon

Background: Breast cancer is today a global health problem. With 1,671,149 new cases diagnosed in 2012, it is the most common female cancer in the world and accounts for 11.9% of all cancers and it affects more people than prostate cancer. In 2008, The United States statistics showed that, for all cancer that affect women before 40 years, more than 40% of them concerned the breast. The aim of this study was to describe the clinical, histopathological and therapeutic aspects of breast cancer in women under 40 years of age in Yaoundé.Methods: This was a retrospective study with data collected from 192 medical case files of women treated over a period of 12 years, from January 2004 to December 2015 at the Yaounde General Hospital and the Yaounde Gyneco-Obstetric and Pediatric Hospital. Microsoft Epi Info version 3.4.5 and SPSS version 20.0 softwares were used for data analysis.Results: From 2004 to 2015, 1489 cases of breast cancer were treated in both hospitals. Of these, 462 women were less than 40 years old, representing a proportion of 31.0%. The mean age at diagnosis was 33.5±5.0 years and 17.7% of women had a family history of breast cancer. The average time before an initial consultation was 6.7±6.6 months.  Most cases were classified as T4 (46.1%). The most common histological type was ductal carcinoma (87.4%). Grades SBR II and SBR III were predominant (76.4%). Axillary dissection (64.4%) and neoadjuvant chemotherapy (43.9%) were the main therapeutic modalities. The overall survival rate at 5 years was 51.2%. Five-year survival rates with no local recurrence and no metastatic occurrence were 35.8% and 43.2% respectively.Conclusions: Breast cancer largely affects women under the age of 40 and is often discovered late, at an advanced stage. The prognosis appears poor. Only screening could facilitate diagnosis at an early stage of the disease for better outcomes