Gregory Edie Halle-Ekane

Hepatitis B, HIV, and Syphilis Seroprevalence in Pregnant Women and Blood Donors in Cameroon

Objectives. We estimated seroprevalence and correlates of selected infections in pregnant women and blood donors in a resource-limited setting. Methods. We performed a cross-sectional analysis of laboratory seroprevalence data from pregnant women and voluntary blood donors from facilities in Cameroon in 2014. Rapid tests were performed to detect hepatitis B surface antigen, syphilis treponemal antibodies, and HIV-1/2 antibodies. Blood donations were also tested for hepatitis C and malaria. Results. The seroprevalence rates and ranges among 7069 pregnant women were hepatitis B 4.4% (1.1–9.6%), HIV 6% (3.0–10.2%), and syphilis 1.7% (1.3–3.8%) with significant variability among the sites. Correlates of infection in pregnancy in adjusted regression models included urban residence for hepatitis B (aOR 2.9, CI 1.6–5.4) and HIV (aOR 3.5, CI 1.9–6.7). Blood donor seroprevalence rates and ranges were hepatitis B 6.8% (5.0–8.8%), HIV 2.2% (1.4–2.8%), syphilis 4% (3.3–4.5%), malaria 1.9%, and hepatitis C 1.7% (0.5–2.5%). Conclusions. Hepatitis B, HIV, and syphilis infections are common among pregnant women and blood donors in Cameroon with higher rates in urban areas. Future interventions to reduce vertical transmission should include universal screening for these infections early in pregnancy and provision of effective prevention tools including the birth dose of univalent hepatitis B vaccine.

Estimating HIV Incidence during Pregnancy and Knowledge of Prevention of Mother-to-Child Transmission with an Ad Hoc Analysis of Potential Cofactors

Background. We determined the incidence of HIV seroconversion during the second and third trimesters of pregnancy and ad hoc potential cofactors associated with HIV seroconversion after having an HIV-negative result antenatally. We also studied knowledge of PMTCT among pregnant women in seven health facilities in Fako Division, South West Region, Cameroon. Method. During the period between September 12 and December 4, 2011, we recruited a cohort of 477 HIV-negative pregnant women by cluster sampling. Data collection was with a pretested interviewer-administered questionnaire. Sociodemographic information, knowledge of PMTCT, and methods of HIV prevention were obtained from the study population and we did Voluntary Counselling and Testing (VCT) for HIV. Results. The incidence rate of HIV seroconversion during pregnancy was 6.8/100 woman-years. Ninety percent of the participants did not use condoms throughout pregnancy but had a good knowledge of PMTCT of HIV. Only 31.9% of participants knew their HIV status before the booking visit and 33% did not know the HIV status of their partners. Conclusion. The incidence rate of HIV seroconversion in the Fako Division, Cameroon, was 6.8/100 woman-years. No risk factors associated with HIV seroconversion were identified among the study participants because of lack of power to do so.

Use of the Partogram in the Bamenda Health District, North-West Region, Cameroon: A Cross-Sectional Study

Background: The partogram is an effective instrument in the follow-up of labor. It enables timely diagnoses of abnormalities and helps in decision-making. Objectives: This study was carried out to 1) establish and compare the proportion of labor cases followed up with the partogram in primary and secondary healthcare facilities in the Bamenda Health District and 2) appraise the attitudes of the health workers towards the partogram and how those attitudes impact outcomes. Methods: A cross-sectional study was carried out in which 383 files were reviewed and 42 questionnaires were administered to health workers. The information extracted from the files focused mainly on the number of partograms used and the standard criteria under study were: cervical dilatation, station, the state of the amniotic fluid and maternal temperature monitored every four hours. Maternal blood pressure, pulse rate and Fetal Heart Rate (FHR) were monitored every hour. Each of the parameters was judged as correctly filled if they met the above criteria; as not correctly filled if the criteria were not met; and as not filled if no information was recorded. Statistical analysis was with Epi-InfoTM. Results: The results showed that 223(58.2%) deliveries were followed up with the partogram, only 4(1.0%) of which had all the parameters filled to standard. Two hundred and six (86.2%) deliveries in the Bamenda Regional Hospital and 17(11.8%) in the primary healthcare facilities were followed up with the partogram. Forty (95.2%) health workers agreed that the partogram was useful in following up labor. Conclusions: The health workers had a positive attitude towards the partogram, but on the whole it was incorrectly used. The instrument was for the most part unavailable, and even where it was, poor supervision and absence of guidelines on its use led to poor diagnoses. We recommend that supportive supervision and regular in-service training be encouraged; and that partograms and guidelines be made available.

A decision analytic model for prevention of hepatitis B virus infection in Sub‐Saharan Africa using birth‐dose vaccination

To compare prenatal maternal hepatitis B virus (HBV) screening and infant vaccination strategies to inform policy on HBV prevention in Sub‐Saharan Africa.

Predictors of Infant Hepatitis B Immunization in Cameroon: Data to Inform Implementation of a Hepatitis B Birth Dose

Background: Although most African countries offer hepatitis B immunization through a 3-dose vaccine series recommended at 6, 10 and 14 weeks of age, very few provide birth dose vaccination. In support of Cameroon’s national plan to implement the birth dose vaccine in 2017, we investigated predictors of infant hepatitis B virus (HBV) vaccination under the current program. Methods: Using the 2011 Demographic Health Survey in Cameroon, we identified women with at least one living child (age 12–60 months) and information about the hepatitis B vaccine series. Vaccination rates were calculated, and logistic regression modeling was used to identify factors associated with 3-dose series completion. Changes over time were assessed with linear logistic model. Results: Among 4594 mothers analyzed, 66.7% (95% confidence interval [CI]: 64.1–69.3) of infants completed the hepatitis B vaccine series; however, an average 4-week delay in series initiation was noted with median dose timing at 10, 14 and 19 weeks of age. Predictors of series completion included facility delivery (adjusted odds ratio [aOR]: 2.1; 95% CI: 1.7–2.6), household wealth (aOR: 1.9; 95% CI: 1.2–3.1 comparing the highest and lowest quintiles), Christian religion (aOR: 1.8; 95% CI: 1.3–2.5 compared with Muslim religion) and older maternal age (aOR: 1.4; 95% CI: 1.2–1.7 for 10 year units). Conclusions: Birth dose vaccination to reduce vertical and early childhood transmission of hepatitis B may overcome some of the obstacles to timely and complete HBV immunization in Cameroon. Increased awareness of HBV is needed among pregnant women and high-risk groups about vertical transmission, the importance of facility delivery and the effectiveness of prevention beginning with monovalent HBV vaccination at birth.

Determinants of Maternal Mortality in Mezam Division in the North West Region of Cameroon: A Community-based Case Control Study

Background: Since 2008, an average of 358,000 women die annually worldwide of pregnancyrelated causes. About 99% of these deaths occur in developing countries, 43% of which occur in Sub-Saharan Africa alone. In Cameroon, the rate has increased from 669 maternal deaths/100,000 live births in 2005 to 1000/100,000 live births in 2010. Socio-economic, cultural, and obstetric factors have been found to account for this jump. Objectives: The aims of this study were 1) to identify the causes, both direct and indirect, of maternal mortality, 2) to investigate the factors associated with maternal deaths, and 3) to describe Original Research Article Egbe et al.; IJTDH, 15(2): 1-15, 2016; Article no.IJTDH.24927 2 the age distribution of maternal mortality in Mezam Division in the North West Region of Cameroon. Materials and Methods: We carried out a retrospective, community-based case-control study from January 1, 2011 to November 30, 2014 on 89 maternal deaths (cases), and 178 women who survived delivery (controls). Cases were identified with the aid of key community leaders. A questionnaire for maternal death review or verbal autopsy was administered and controls effected among the sisters or neighbours of the cases. Microsoft Excel, Epi Info and InterVA-4 were used for data analysis. Results: A total of 89 maternal deaths (cases) were identified during the study period, sixty-nine (77.53%) of which were from direct causes, mainly post-partum haemorrhage (30.43%), unsafe abortion (26.09%), and hypertensive disorders of pregnancy (14.49%); 21.35% from indirect causes, while 1.12% were incidental deaths, mainly severe malaria (5.6%), HIV/AIDS (5.6%). Among the risk factors of maternal death were inadequate antenatal care (RR=1.87: 95% CI; 1.332.63, P=0.0003), pre-existing co-morbidities (RR=1.45: 95% CI; 1.03-2.03, P =0.03), place of delivery(RR= 2.44: 95% CI; 1.79-3.32,P<0.0001), healthcare provider qualification(RR= 2.87: 95% CI 2.17-3.79; P<0.0001), and delays in arrival at health facilities(RR=1.420: 95% CI 1.01-2.0; P=0.04). The peak age of maternal death ranged from 20-24 years (24.72%). Conclusion: Post-partum haemorrhage, unsafe abortion and hypertensive disorders of pregnancy were the leading causes of maternal death. Effectively combating the factors associated with maternal deaths will reduce if not eliminate maternal morbidity.

Quality of Antenatal Care and Outcome of Pregnancy in a Semi-Urban Area in Fako Division, Cameroon: A Cross-Sectional Study

1Department of Surgery and Obstetrics-Gynecology, Faculty of Health Sciences, University of Buea, P.O Box 12, Buea, Cameroon 2Department of Obstetrics and Gynecology, Buea Regional Hospital, P.O Box 32, Buea, Cameroon 3Faculty of Medicine and Biomedical Sciences, University of Yaounde 1, Yaounde, Cameroon 4Department of Public Health and Hygiene, Faculty of Health Sciences, University of Buea, P.O Box 12, Buea, Cameroon 5Department of Obstetrics and Gynecology, Limbe Regional Hospital, Limbe, Cameroon 6Department of Public Health and Hygiene, Faculty of Health Sciences, University of Buea, P.O Box 12, Buea, Cameroon 7Department of Surgery and Obstetrics-Gynecology, Faculty of Health Sciences, University of Buea, P.O Box 12, Buea, Cameroon *Corresponding author Gregory Edie Halle-Ekane, MD Department of Surgery and Obstetrics-Gynecology Faculty of Health Sciences University of Buea P.O Box 12 Buea, Cameroon Tel. +(237) 699934402 E-mail: hallegregory@yahoo.fr

The Effect of Performance-based Financing of Home Visitation in Overcoming Barriers to the Use of Modern Methods of Contraception in the Kumbo East Health District, Cameroon

Background: The use of modern methods of contraception (MMC) still remains a challenge in much of Sub-Saharan Africa including Cameroon. Performance-based Financing (PBF) home visitation was introduced in the Kumbo East Health District (KEHD), Cameroon, to increase the use of modern methods of contraception. Original Research Article