Robinson Mbu

Post-partum trend in blood pressure levels, renal function and proteinuria in women with severe preeclampsia and eclampsia in Sub-Saharan Africa: A 6-months cohort study

BackgroundPreeclampsia and eclampsia, which are the most frequent hypertensive disorders in pregnancy, are associated with renal involvements. We aimed to assess the time trend in blood pressure levels, renal function and proteinuria after delivery, and investigate their determinants in Cameroonian women with severe preeclampsia and eclampsia.MethodsThis was a prospective cohort study involving 54 women with severe preeclampsia and eclampsia, conducted between July 2010 and February 2012 at the central maternity unit of the Yaoundé Central Hospital. Clinical and laboratory parameters were recorded from day-1 to 6xa0months after delivery. Mixed-linear and logistic regression models were used to relate baseline and within follow-up levels of covariates, with changes in blood pressure levels, renal function and proteinuria, as well as persisting hypertension, renal failure and proteinuria.ResultsDuring follow-up, a significant improvement was observed in blood pressure, renal function and proteinuria (all pu2009<u20090.002). Thirteen (24.1%) patients with renal failure at delivery recovered completely within six weeks. Twenty-six (48.1%), 17 (31.5%) and 1 (1.8%) patients had persisting proteinuria at 6xa0weeks, 3xa0months and 6xa0months post-delivery, respectively. Corresponding figures for persisting hypertension were 23 (42.6%), 15 (27.8%) and 8 (14.8%). Advanced age, higher body mass index, low gestational age at delivery, low fetal birth weight, and proteinuria at delivery were the main risk factors for persisting hypertension at 3xa0months, meanwhile low fetal birth weight, severe preeclampsia and proteinuria at delivery were correlated with persisting proteinuria at 3xa0months. Advanced age and higher body mass index were the only determinants of the composite outcome of persisting hypertension or proteinuria at three and six months.ConclusionHypertension and proteinuria are very common beyond the postpartum period in Cameroonian women with severe preeclampsia and eclampsia. Long-term follow-up of these women will help preventing and controlling related complications.

Adolescent Deliveries in a Secondary-Level Care Hospital of Cameroon: A Retrospective Analysis of the Prevalence, 6-Year Trend, and Adverse Outcomes.

STUDY OBJECTIVEnAdolescents are generally ill-equipped to deal with the burden of a pregnancy. A high prevalence of adolescent pregnancies is among the indicators of limitations toward the achievement of the Millennium Development Goals in most developing countries. We sought to determine the prevalence, 6-year trend, and adverse outcomes of adolescent deliveries. We also tested whether being married decreased the risk of adverse fetal outcomes in these adolescents.nnnDESIGNnA 6-year retrospective register analysis.nnnSETTINGnBuea Regional Hospital.nnnPARTICIPANTSnBirth records from 2007 toxa02012.nnnINTERVENTIONSnNone.nnnMAIN OUTCOME MEASURESnPrevalence and 6-year trend in the rate of adolescent deliveries; adverse fetal outcomes.nnnRESULTSnThe overall prevalence of adolescent deliveries was 9.9% (491 of 4941). There was no significant change in the annual prevalence of adolescent deliveries over 6xa0years (P trendxa0=xa0.8). Adolescent pregnancies were at higher risk of preterm deliveries (deliveries at gestational age <37 completed weeks; odds ratio [OR], 1.7; 95% confidence interval [CI], 1.3-2.2; Pxa0<xa0.01), low birth weight (defined as birth weight <2600xa0g; OR, 1.8; 95% CI, 1.4-2.3; Pxa0<xa0.01), and neonatal asphyxia (OR, 1.4; 95% CI, 1.1-1.7; Pxa0<xa0.01). There was no significant difference in the frequency of adverse outcomes between married and single adolescents.nnnCONCLUSIONnOne of every 10 babies is born from adolescent mothers in the Buea Regional Hospital. Whether these mothers are married or not, their neonates are exposed to higher morbidity. This emphasizes the need for more adolescent-friendly public health policies geared toward reducing the prevalence of this condition to improve the chances of attaining the Millennium Development Goals in Cameroon.

Low birth weight in a sub-urban area of Cameroon: an analysis of the clinical cut-off, incidence, predictors and complications

BackgroundThe World Health Organisation recommends that each country adopts its own cut-off value of low birth weight (LBW) for clinical use. The aims of this study were to establish a clinical cut-off point for LBW and to determine its incidence, predictors and complications in a sub-urban area’s hospital of Cameroon.MethodsWe conducted a study in two phases: a 6-year retrospective phase during which we collected demographic and clinical information from the records of the maternity of the Buea Regional Hospital (BRH) and a 3-month prospective phase during which data were collected from consenting pregnant women using a structured questionnaire, and newborns were examined and followed after birth.ResultsA total of 4941 records were reviewed during the retrospective phase and the 10th centile of birth weights was 2600xa0g. In the 200 pregnant women enrolled during the prospective phase, using this cut-off yielded an incidence of LBW of 19.0xa0%. Independent predictors of LBW were preterm delivery, hypertensive disorders in pregnancy, HIV infection, maternal age >36xa0years, maternal height <150xa0cm and pre-delivery BMIu2009<u200925xa0kg/m2. Neonates with LBW were more likely to have neonatal asphyxia, foetal distress, respiratory distress and neonatal death.ConclusionsOur results suggest that newborns under 2600xa0g have LBW in sub-urban Cameroon. They represent one out of every five babies, and they deserve close care. Preventive measures targeting the predictors described here are warranted to reduce the incidence and complications. Similar studies in urban areas are required in order to generalize the results.

High birth weight in a suburban hospital in Cameroon: an analysis of the clinical cut-off, prevalence, predictors and adverse outcomes

Background and aims High birth weight (HBW) increases the risk of maternal and fetal morbidity and mortality. Its prevalence and adverse outcomes may be reduced if risk factors are identified and managed during pregnancy. The cut-off value for HBW remains debatable. The objectives of this study were to identify the optimal cut-off value and determine the prevalence, predictors and adverse outcomes of HBW in a suburban area of Cameroon. Design A 6-year retrospective register analysis and a 3-month prospective phase. Setting A secondary care level (regional) hospital in the city of Buea (southwest region of Cameroon). Participants Women who delivered in this hospital over a 6-year period (retrospective phase) and consenting pregnant mothers and their infants (singletons, born at >28u2005weeks gestation) (prospective phase). Outcome measures 90th centile of birth weights; prevalence of HBW defined as birth weight above the 90th centile; sociodemographic, maternal and obstetrical factors associated with HBW; maternal and neonatal adverse outcomes of HBW. Results Of the 4941 newborns reviewed in registers, the 90th centile of birth weights was 3850u2005g. Using this new cut-off, we obtained a prevalence of 14.0% for HBW in the 200 newborns included in the prospective phase. This was significantly higher than the prevalence (9.5%) yielded when the traditional cut-off of 4000u2005g was used (p=0.003). None of the factors assessed was independently associated with HBW. Newborns with HBW were more likely to have shoulder dystocia (p<0.01), and their mothers more likely to suffer from prolonged labour (p=0.01) and postpartum haemorrhage (p<0.01). Conclusions The results of this study suggest that the cut-off for HBW in this population should be 3850u2005g. Thus, 3 of every 10 babies born with HBW in this hospital are likely not receiving optimal postnatal care because 4000u2005g is currently used to qualify for additional support.

Clinical malaria among pregnant women on combined insecticide treated nets (ITNs) and intermittent preventive treatment (IPTp) with sulphadoxine-pyrimethamine in Yaounde, Cameroon

BackgroundMalaria remains a burden for pregnant women and the under 5. Intermittent preventive treatment of pregnant women (IPTp) for malaria with sulfadoxine – pyrimethamine (SP) has since replaced prophylaxis and legislation has been reinforced in the area of insecticide treated mosquito nets (ITNs) in Cameroon. Clinical malaria despite all these measures remains a problem. We compared the socio-obstetrical characteristics of women who developed clinical malaria and those who did not though in the same regimen.MethodsA 5 – year nested cohort study (2007 – 2011 inclusive) at the tertiary level hospitals in Yaounde. Pregnant women who willingly accepted to participate in the study were enrolled at booking and three doses of SP were administered between 18 – 20 weeks of gestation, between 26–28 weeks and between 32 – 34 weeks. Those who developed clinical malaria were considered as cases and were compared for socio – obstetrical characteristics with those who did not. Venous blood was drawn from the women in both arms for parasite density estimation and identification and all the clinical cases were treated conventionally.ResultsEach arm had 166 cases and many women who developed clinical malaria were between 15 and 19xa0years (OR 5.5, 95% CI 3.9 – 5.3, pu2009<u20090.001). They were of low gravidity (OR 6.5, 95% CI 3.8 – 11.3, pu2009<u20090.001) as well as low parity (OR 4.6, 95% CI 2.7 – 7.9, pu2009<u20090.001). The cases were single women (OR 4.58, 95% CI 2.54 – 8.26, pu2009<u20090.001) and had attained only primary level of education (OR 4.6, 95% CI 2.8 – 7.9, pu2009<u20090.001). Gestational ages were between 20 to 30xa0weeks during clinical malaria (OR 6.8, 95% CI 4.1 – 11.7, pu2009<u20090.001). The time between the first and second dose of SP was longer than ten weeks in the cases (OR 5.5, 95% CI 3.2 – 9.3, pu2009<u20090.001) and parasite density was higher also among the cases (OR 6.9, 95% CI 5.9 – 12.1, pu2009<u20090.001).ConclusionLong spacing between the first and second dose of SP seemed to be responsible for clinical malaria in the cases.

Associations of body mass index and gestational weight gain with term pregnancy outcomes in urban Cameroon: a retrospective cohort study in a tertiary hospital

BackgroundObesity is a rising public health issue worldwide. Guidelines regarding maternal body mass index (BMI) and gestational weight gain (GWG) are missing in Cameroon where maternal mortality rate remains very high. We hypothesized that obesity and inappropriate GWG are associated with poor pregnancy outcomes. We aimed at assessing associations of BMI and GWG with pregnancy outcomes.MethodsThis was a retrospective cohort study at the Yaoundé Central Hospital. We included women with term singleton deliveries in the post-partum ward. The World Health Organisation classification of BMI and the United States Institute Of Medicine (IOM) categories of GWG were used to stratify participants. Poor maternal outcome was defined by the occurence of caesarean section, preeclampsia or obstetrical haemorrhage. Poor perinatal outcome was defined by the occurence of perinatal death, admission in intensive care unit, low birth weight, macrosomia or fifth minute Apgar scorexa0<7. Multiple logistic regressions were used to calculate unadjusted and adjusted Odds Ratios (uOR, aOR) for poor maternal outcome (PMO) and for poor perinatal outcome (PPO) in each category of BMI and GWG. Adjustment was done for age, scarred uterus, sickle cell disease, malaria, human immunodeficiency virus (HIV) infection, parity and smoking.ResultsOf the 462 participants, 17 (4xa0%) were underweight (BMIxa0<xa018.5), 228 (49xa0%) had normal pre-pregnancy BMI, 152 (33xa0%) were overweight (25xa0≤xa0BMIxa0<xa030) and 65 (14xa0%) were obese (BMIxa0≥xa030). Following the IOM recommendations, GWG was normal for 186 (40xa0%) participants, less than recommended for 131 (28xa0%) and above the recommended norms for 145 (32xa0%). GWG above the IOM recommendation was significantly associated with PMO (aOR: 1.7, 95xa0% CI 1.1–2.8). GWG less than the IOM recommended values, overweight and obesity were not significantly associated with poor pregnancy outcomes.ConclusionWhile waiting for local recommendations for GWG, the IOM recommendations can be used for Cameroonian women as far as maternal outcome is concerned. Unlike in studies in different ethnic and racial groups, abnormal BMI was not associated with poor pregnancy outcomes in our cohort of Cameroonian women.

Students’ perspectives on research and assessment of a model template designed to guide beginners in research in a medical school in Cameroon

BackgroundResearch activities for medical students and residents (trainees) are expected to serve as a foundation for the acquisition of basic research skills. Some medical schools therefore recommend research work as partial requirement for certification. However medical trainees have many difficulties concerning research, for which reason potential remedial strategies need to be constantly developed and tested. The views of medical trainees are assessed followed by their use and appraisal of a novel “self-help” tool designed for the purposes of this study with potential for improvement and a wider application.MethodsThis study was a cross-sectional survey of volunteering final-year medical students and residents of a medical school in Cameroon.ResultsThis study surveyed the opinions of a total of 120 volunteers of which 82 (68%) were medical students. Three out of 82 (4%) medical students reported they had participated in research activities with a publication versus 10 out of 38 residents (26%). The reported difficulties in research for these trainees included referencing of material (84%), writing a research proposal (79%), searching for literature (73%) and knowledge of applicable statistical tests (72%) amongst others. All participants declared the “self-help” tool was simple to use, guided them to think and better understand their research focus.ConclusionMedical trainees require much assistance on research and some “self-help” tools such as the template used in this study might be a useful adjunct to didactic lectures.

Cesarean sections in a secondary level care hospital of Cameroon: an analysis of their six-year trends and adverse neonatal outcomes

BackgroundThe objectives of this study were to determine the trends of CS in a regional hospital in Cameroon and to explore its association with adverse neonatal outcomes.MethodsThe study was conducted in the Buea Regional Hospital (BRH), Cameroon. A 6-year retrospective records analysis was used to determine the trends in rates of CS and neonatal adverse outcomes. In a 3-month prospective phase, indications of CS were identified.ResultsOf a total of 4941 records reviewed from the year 2007 to 2012, the overall CS rate was 20.4%. The rates increased from 17.1% in 2007 to 20.9% in 2012, with a peak of 22.7% in 2011, but this time-trend was not significant (p-trend =0.06). Three of the 25 cases of CS (12%) in the prospective phase were done at the request of mothers. The odds of having a low first minute APGAR (APGAR <7) in neonates born from CS were higher than in neonates born from a normal delivery (ORxa0=xa06.6 and 95% CI 5.7–7.7; pxa0<xa00.01).ConclusionOne out of every five women give birth through a CS in the BRH. This rate of CS is relatively high for a suburban population in a developing country. Strategies to reduce these rates should be investigated and instituted in the BRH to reduce health expenditures.