Philip Njotang Nana

Wealth and sexual behaviour among men in Cameroon

BackgroundThe 2004 Demographic and Health Survey (DHS) in Cameroon revealed a higher prevalence of HIV in richest and most educated people than their poorest and least educated compatriots. It is not certain whether the higher prevalence results partly or wholly from wealthier people adopting more unsafe sexual behaviours, surviving longer due to greater access to treatment and care, or being exposed to unsafe injections or other HIV risk factors. As unsafe sex is currently believed to be the main driver of the HIV epidemic in sub-Saharan Africa, we designed this study to examine the association between wealth and sexual behaviour in Cameroon.MethodsWe analysed data from 4409 sexually active men aged 15–59 years who participated in the Cameroon DHS using logistic regression models, and have reported odds ratios (OR) with confidence intervals (CI).ResultsWhen we controlled for the potential confounding effects of marital status, place of residence, religion and age, men in the richest third of the population were less likely to have used a condom in the last sex with a non-spousal non-cohabiting partner (OR 0.43, 95% CI 0.32–0.56) and more likely to have had at least two concurrent sex partners in the last 12 months (OR 1.38, 95% CI 1.12–1.19) and more than five lifetime sex partners (OR 1.97, 95% CI 1.60–2.43). However, there was no difference between the richest and poorest men in the purchase of sexual services. Regarding education, men with secondary or higher education were less likely to have used a condom in the last sex with a non-spousal non-cohabiting partner (OR 0.24, 95% CI 0.16–0.38) and more likely to have started sexual activity at age 17 years or less (OR 2.73, 95% CI 2.10–3.56) and had more than five lifetime sexual partners (OR 2.59, 95% CI 2.02–3.31). There was no significant association between education and multiple concurrent sexual partnerships in the last 12 months or purchase of sexual services.ConclusionWealthy men in Cameroon are more likely to start sexual activity early and have both multiple concurrent and lifetime sex partners, and are less likely to (consistently) use a condom in sex with a non-spousal non-cohabiting partner. These unsafe sexual behaviours may explain the higher HIV prevalence among wealthier men in the country. While these findings do not suggest a redirection of HIV prevention efforts from the poor to the wealthy, they do call for efforts to ensure that HIV prevention messages get across all strata of society.

Intimate partner violence and contraception use among women in Sub-Saharan Africa

To determine the association between contraceptive use and intimate partner violence (IPV) in Sub‐Saharan African women.

Gynaecological morbidity among HIV positive pregnant women in Cameroon

ObjectiveTo compare the prevalence of gynaecological conditions among HIV infected and non-infected pregnant women.MethodsTwo thousand and eight (2008) pregnant women were screened for HIV, lower genital tract infections and lower genital tract neoplasia at booking antenatal visit.ResultsAbout 10% (198/2008) were HIV positive. All lower genital tract infections except candidiasis were more prevalent among HIV positive compared to HIV negative women: vaginal candidiasis (36.9% vs 35.4%; p = 0.678), Trichomoniasis (21.2% vs 10.6%; p < 0.001), gonorrhoea (10.1% vs 2.5%; p < 0.001), bacterial vaginosis (21.2% vs 15.2%; p = 0.026), syphilis (35.9% vs 10.6%; p < 0.001), and Chlamydia trachomatis (38.4% vs 7.1%; p < 0.001). Similarly, HIV positive women more likely to have preinvasive cervical lesions: low-grade squamous intraepithelial lesion (SIL) (18.2% vs 4.4%; p < 0.001) and high-grade squamous intraepithelial lesion (12.1% vs 1.5%; p < 0.001).ConclusionWe conclude that (i) sexually transmitted infections (STIs) are common in both HIV positive and HIV negative pregnant women in Cameroon, and (ii) STIs and preinvasive cervical lesions are more prevalent in HIV-infected pregnant women compared to their non-infected compatriots. We recommend routine screening and treatment of STIs during antenatal care in Cameroon and other countries with similar social profiles.

Acceptability of intrapartum HIV counselling and testing in Cameroon

BackgroundTo assess the acceptability of intrapartum HIV testing and determine the prevalence of HIV among labouring women with unknown HIV status in Cameroon.MethodThe study was conducted in four hospitals (two referral and two districts hospitals) in Cameroon. Labouring women with unknown HIV status were counselled and those who accepted were tested for HIV.ResultsA total of 2413 women were counselled and 2130 (88.3%) accepted to be tested for HIV. Of the 2130 women tested, 214 (10.1%) were HIV positive. Acceptability of HIV testing during labour was negatively associated with maternal age, parity and number of antenatal visits, but positively associated with level of education. HIV sero-status was positively associated with maternal age, parity, number of antenatal visits and level education.ConclusionAcceptability of intrapartum HIV testing is high and the prevalence of HIV is also high among women with unknown HIV sero-status in Cameroon. We recommend an opt-out approach (where women are informed that HIV testing will be routine during labour if HIV status is unknown but each person may decline to be tested) for Cameroon and countries with similar social profiles.

Training health professionals in conducting maternal death reviews

In countries where maternal death review (MDR) sessions are proposed as an intervention to improve quality of obstetric care, training focuses on the theory behind this method. However, experience shows that health staff lack confidence to apply the theory if they have not attended a practical training session. To address this problem, a training curriculum based on the new guidelines from the FIGO Leadership in Obstetrics and Gynecology for Impact and Change (LOGIC) Initiative for preparing and conducting MDR sessions was designed and tested in Cameroon. This curriculum is competency‐based and consists primarily of practical individual or group exercises.

Abortions in Low Resource Countries

The tabulated estimates of the frequency of abortions by WHO (1994) showed that there were about 20 million illegal abortions performed each year and the greatest majority of these unsafe abortions occur in developing countries and particularly countries in which abortion law was restricted and illegal. Incidentally these were also the countries that presented a lack of supplies and commodities as well as insufficient trained personnel. In these countries many maternal deaths due to complications of abortions are either not registered or deliberately concealed. [2, 3, 4]

Rupture of the spleen due to domestic violence in pregnancy: a report of two cases.

accumulate a large amount of blood before obvious signs and symptoms of a haematoma can become apparent (Benrubi et al. 1987). The levator ani muscles divide the paravaginal space into an upper or supralevator fossa and a lower or infralevator fossa. A paravaginal haematoma is typically confined to either the upper or lower compartment (Melody 1955). A possible route of spread may occur through the lesser sciatic foramen towards the hip joint upward through the broad ligament through the pelvic side wall (Chatwani et al. 1992), as was the case in this patient. Anorectal tenesmus may result from extension of a haematoma into the ischiorectal fossa, although urinary retention may suggest spread ventrally into the paravesical space. (Melody 1955) The former probably contributed to this patient’s initial symptoms of backache and difficulty sitting down. A number of associated factors have also been recognised such as primiparity, operative delivery, large fetal weight, toxaemia, varicosities of the genital tract and prolonged second stage of labour. However, none of these factors were present in this case. Traction and rupture of paravaginal veins by the rapid oncoming presenting part has been reported as an aetiology (Melody 1955), which is probably the likely cause of haematoma formation in this case. The haematoma here was probably initiated in the infralevator space as suggested by the ecchymosis and swelling seen in the lower vagina on initial pelvic examination. It had also spread laterally into the left ischiorectal space, thus causing severe buttock pain. Inspite of draining the infralevator haematoma, it continued to spread to the supralevator space and subsequently into the broad ligament and paravesical tissues. This probably occurred due to the shearing of the rich vascular supply in the paravaginal space that was not apparent at the initial examination under anaesthesia. However, the extension of the haematoma was more easily appreciated during laparotomy and controlled at this stage. The objective of surgical treatment is to stop the pain caused by the haematoma, prevent further bleeding and tissue destruction and to minimise the risk of subsequent infection. If bleeding vessels have retracted or cannot be identified, the haematoma cavity should be tightly packed and although this was initially achieved with the Bakri balloon and gauze packing it was subsequently unsuccessful. In conclusion, the obstetrician should be aware that a paravaginal haematoma may occur after an uncomplicated delivery without any vaginal or perineal trauma. This may require an experienced operator to achieve haemostasis as bleeding can occasionally be catastrophic and requiring laparotomy as in this case. This is important in the current climate of ‘super specialisation’ of trainees in obstetrics and gynaecology where operators may not have the necessary surgical skills to tackle this kind of situation and hence additional help from other members of the obstetric and gynaecological team would be required.

Maternal and Fetal Outcomes Following Labour at Term in Singleton Pregnancies with Meconium-Stained Amniotic Fluid: A Prospective Cohort Study

Background: Meconium stained amniotic fluid (MSAF) is frequently encountered in obstetric practice. Literature on the subject is still poorly documented in the African setting. Objective: The aim of this study was to determine the maternal and fetal outcomes in case of meconium stained amniotic fluid observed during term labour. Materials and Methods: We conducted a prospective cohort study enrolling all consenting pregnant women with term singleton fetus in cephalic presentation admitted for labour with ruptured fetal membranes in the maternity units of the Yaounde Central Hospital (YCH) and the Yaounde Gynaeco-Obstetric and Pediatric Hospital (YGOPH) of Cameroon between December 2014 and April 2015. The exposed grouped was considered as participants having MSAF, while the non-exposed group comprised those with clear amniotic fluid (CAF). The two groups were monitored during labor using the WHO partograph, and then followed up till 72 hours after delivery. Variables studied included the colour and texture of amniotic fluid as well as maternal and fetal complications. Data was analyzed using Epi-info version 3.5.4. The chi-square and Fischer’s exact tests were appropriately used to compare the two groups. A p-value less than 5% was considered statistically significant. Results: 2376 vaginal deliveries were recorded during the study period among which MSAF was observed in 265 cases, hence a prevalence rate of MSAF of 11.15%. Among these cases of MSAF, 52.1% was thick meconium and 47.9% was light meconium. Maternal morbidity was high in the group with MSAF; these included: Higher proportions of caesarean delivery (RR = 2.35 p < 10-4) and prolonged labor (RR = 3 p < 10-4). In this same group, the incidences of chorioamnionitis and puerperal sepsis were low (0.94% and 0.70% respectively), although there was a three-fold higher risk that was not statistically significant (RR = 3, P = 0.31). Fetal and neonatal outcomes were poorer in the MSAF group compared to the CAF group. The complications included fetal heart rate abnormalities, low Apgar score at the 5th minute, need for neonatal resuscitation, neonatal asphyxia and neonatal infection which were significantly higher in the MSAF group (all p < 0.05). Meconium aspiration syndrome (MAS) was found in 2.34% of MSAF cases. Perinatal mortality was 2.34% and all cases of death occurred in the thick MSAF group. Conclusion: MSAF observed during labour is associated with increased perinatal morbidity and mortality. Its detection during labor should strongly indicate very rigorous intra partum and postpartum monitoring. This will ensure optimal management and reduction in the risks of complications.

GAD-7 and PHQ-9 measurement of perinatal anxiety and depression in women with hypertensive disorders of pregnancy in Yaounde, Cameroon

Worldwide, millions of pregnant women are identified as being at high risk for obstetrical complications yearly. Mental health is fundamental to health and pregnancy and the puerperium is at times sufficiently stressful to provoke exacerbation, recurrence or new onset of mental illness thereby leading to complications. Hence maternal perinatal health has enormous consequences for the wellbeing of the mother, her baby and the family.4 Because perinatal anxiety and depression could lead to serious consequences including poor obstetric and neonatal outcome, the American College of Obstetricians and Gynecologists (ACOG) recommends that women be screened during pregnancy. The Royal College of Obstetricians and Gynecologists equally recommends ABSTRACT