Pascal Foumane

Background: Safe childbirth remains a daunting challenge, particularly in low-middle income countries, where most pregnancy-related deaths occur. Cameroon’s maternal mortality rate, estimated at 529 per 100,000 live births in 2017, is significantly high. The WHO Safe Childbirth Checklist (SCC) was designed to improve the quality of care provided to pregnant women during childbirth. The SCC was implemented at the Yaoundé Gynaeco-Obstetric and Paediatric Hospital to improve the quality of care during childbirth. Methods: This study was a retrospective study to determine the adoption rate of the SCC and its association with maternal (eclampsia, perineal tears, and postpartum haemorrhage) and neonatal (stillbirth, neonatal asphyxia and neonatal death) complications. Data were collected 6 months after the introduction of the SCC. Multivariate binary logistic regression was used to analyse the association between the use of the SCC and maternofoetal complications. Results: Out of 1611 deliveries conducted, 1001 records were found, giving a retrieval rate of 62%. Twenty-five records were excluded. During the study period, the checklists were used in 828 of 976 clinical notes, with an adoption rate of 84.8% and a utilization rate of 93.9% at 6 months. Severe preeclampsia/eclampsia was associated with the non-use of the SCC (2.1 vs 5.4%, p = 0.041). Stillbirth, neonatal asphyxia, and neonatal death rates were not significantly different between the checklist and non-checklist groups. However, for all neonatal outcomes, the proportion of complications was lower when the checklist was used. Conclusion: The use of the SCC was associated with significantly reduced pregnancy complications, especially for reducing the rates of severe pre-eclampsia/eclampsia. The use of the SCC increased to 93.9% of all deliveries within 6 months. We advocate for the use of the WHO Safe Childbirth Checklist in maternity units.

Background: The World Health Organization has warned against a dramatic impact of COVID-19 in sub-Saharan Africa unless adequate response strategies are implemented. Whatever the strategy, the role of health care workers is pivotal. We undertook this study to assess knowledge of COVID-19 and perception of the response to the pandemic among the staff of a regional hospital in charge of COVID-19 patients in West Cameroon. Methods: We used a convenience non probabilistic sampling method to carry out a survey with a self-administered questionnaire from April 14, 2020 to April 29, 2020 at the Bafoussam Regional Hospital (BRH). All the staff was invited to participate. Statistical analyses were done using Microsoft Excel 2010 and Epi-lnfo version 7.1.5.2 software. Results: Response rate was 76.1% (464/610). Mean age (SD) and average work experience (SD) were 35.0 (8.9) and 8.4 (7.4) years respectively. Sex ratio (M/F) was 101/356. Nursing and midwifery staff (56.8%) and in-patients units (49.94%) were predominant. Knowledge on origin and transmission of SARS-CoV-2 was poor but knowledge of clinical signs and the role of laboratory tests were good. 53.2% of respondents said all therapeutic regimens are only supportive and only a third of them trusted drugs recommended by health authorities. For 36.9% of respondents, herbal remedies can prevent/cure COVID-19. 70% of staffs felt they were not knowledgeable enough to handle COVID-19 cases. 85.6% of respondents thought the BRH had insufficient resources to adequately respond to COVID-19 and 55.6% were dissatisfied with its response to the pandemic (weaknesses: medicines/technologies (74.5%), service delivery (28.1%), human resource (10.9%)). 68% of staff felt insufficiently protected on duty and 76.5% reported that the pandemic significantly reduced non-COVID-19 services. 85.5% said they complied with preventive measures while in the community. For 44% of respondents Cameroonian regulations on COVID-19 corpses should be made more culture-sensitive. 51.2% of respondents were against vaccine trial in their community. Conclusion: Knowledge of COVID-19 was poor and perception of the response to the pandemic was unfavorable.

Introduction Patient satisfaction is a quality of care measure and reveals patients’ appreciation of healthcare delivery. We sought to measure patient satisfaction following major gynaecological surgeries in 2 University Teaching Hospitals in Yaounde, Cameroon.Methods Ours was a cross-sectional, prospective study over 9 months (October 1 st 2018, to June 30 th 2018) at the Yaounde Gynaeco-Obstetric and Paediatric Hospital (YGOPH) and the Yaounde Central Hospital (YCH). By administering a modified Surgical Satisfaction Questionnaire (SSQ-8) via phone call 6 months after surgery we appreciated and scored key aspects linked to patient satisfaction, and obtained information on post-operative complications. Data was analysed using Microsoft Excel 18 and SPSS 21 setting significance at p<0.05.Results We recruited 72 patients aged 24 to 68 years. Our participants had a mean satisfaction score of 26 ± 7.854 (59.7% satisfied and 40.3% dissatisfied). All aspects tested on the SSQ-8 questionnaire influenced patient satisfaction. Patients who said they were satisfied with pain control after surgery (OR=0.207 CI=0.070–0.609, P=0,003), and with surgical results in the SSQ-8 questionnaire (OR=0.053, CI=0.011–0.254, P<0.001) achieved statistically significant post-operative satisfaction. Contrarily, patients who were dissatisfied with surgery results (OR=132.000, CI=15.256-114.131, P< 0.001) and those who developed complications (OR=7.922, CI=2.241 – 28.004, P<0.001) were significantly dissatisfied with surgery. Additionally, 47.2% declared a poor post-operative current health status versus 52.8% who claimed a good post-operative current health status. Following multivariate analysis, satisfaction with the results of surgery (aOR= 0.071, CI=0.008–0.657, P= 0.020) and the occurrence of complications (aOR=7.284, CI=1.146 – 46.273, P=0.035) were the main determinants of patient satisfaction. Patient current health status evolved similarly to patient satisfaction and especially by satisfaction with time taken to resume work (aOR=0.039, CI=0.004-0.398, P=0.006) and pre-operative exercise routine (aOR=0.038, CI=0.002–0.678, P-value=0026).Conclusion Patient satisfaction with elective gynaecological surgery is low and determined by post-operative experiences and the occurrence of complications. Also, patient self-reported current health status tends to evolve similarly to satisfaction following surgery.

Uterine fibroids are the most common uterine tumours in females of reproductive age. During pregnancy, uterine fibroids may be complicated by aseptic necrobiosis. We herein report an ambiguous clinical presentation of uterine fibroids in pregnancy and discuss the diagnostic challenges encountered in our resource-constraint setting. A term pregnant Cameroonian woman was admitted to our maternity unit with clinical findings suggestive of a strangulated umbilical hernia. She underwent an emergency caesarean section which fortuitously revealed aseptic necrobiosis of a uterine fibroid, managed within the same surgical intervention by myomectomy. Her post-operative course was uneventful. The authors highlight the need for a high index of suspicion by healthcare providers, as well as the need for a multidisciplinary approach for a favourable maternal and foetal outcome.

Congenital uterine anomalies like bicornis or bicornuate uterus are relatively rare in sub-Saharan Africa. They are associated with an increased rate of spontaneous abortion, preterm delivery, and infertility. The occurrence of bicornis bicollis uterus with unilateral cervical atresia is exceptional and its management is controversial. We hereby report a rare cause of chronic pelvic pain in a Cameroonian teenager due to unilateral obstructive hematometra and hematosalpinx in the non-communicating horn of a bicornis bicollis uterus. A 13-year-old premenarchal non-virgin female presented with chronic and severe cyclical crampy pelvic pain. On clinical examination, she had a perforated hymen, a single vagina, and one uterine cervix. A two-dimensional pelvic ultrasonography revealed hematometra but missed out the underlying anomaly. Failure to drain the hematometra by serial cervical dilatations prompted an exploratory laparotomy which revealed: bicornis bicollis uterus with a right rudimentary uterine horn communicating with the vagina and a left non-communicating uterine horn distended by hematometra due to a homolateral cervical atresia. She underwent utero-vaginal canalization and a left hemi-hysterotomy with drainage of the hematometra. The postoperative period was uneventful. Regular cyclic menses occurred thereafter beginning at the first postoperative month. She had complete resolution of symptoms without recurrence after six months. Due to the risk of compromised fertility from bicornis uterus and the diagnostic challenges akin to resource-limited settings, we highlight the need for a high index of suspicion by healthcare providers when faced with chronic pelvic pain in premenarchal adolescents.

Little evidence exists on the efficacy and safety of the different surgical techniques used in the treatment of postpartum haemorrhage (PPH). We aimed to compare uterus preserving surgery (UPS) versus hysterectomy for refractory PPH in terms of perioperative outcomes in a sub-Saharan African country with a known high maternal mortality ratio due to PPH. This was a retrospective cohort study comparing the perioperative outcomes of all women managed by UPS (defined as surgical interventions geared at achieving haemostasis while conserving the uterus) versus hysterectomy (defined as surgical resection of the uterus to achieve haemostasis) for PPH refractory to standard medical management in two tertiary hospitals in Cameroon from January 2004 to December 2014. We excluded patients who underwent hysterectomy after failure of UPS. Comparison was done using the Chi-square test or Fisher exact test where appropriate. Bonferroni adjustment of the p-value was performed in order to reduce the chance of obtaining false-positive results. We included 24 cases of UPS against 36 cases of hysterectomy. The indications of surgery were dominated by uterine rupture and uterine atony in both groups. Types of UPS performed were seven bilateral hypogastric artery ligations, seven hysterorraphies, six bilateral uterine artery ligations, three B-Lynch sutures and one Tsirulnikov triple ligation with an overall uterine salvage rate of 83.3%. Types of hysterectomies were 26 subtotal hysterectomies and 10 total hysterectomies. UPS was associated with maternal deaths (RR: 2.3; 95% CI: 1.38–3.93.; p: 0.0015) and postoperative infections (RR: 1.96; 95% CI: 1.1–3.49; p: 0.0215). The association of UPS with maternal death was not attenuated after Bonferroni correction. Hysterectomy had no statistically significant adverse outcome. Hysterectomy is safer than UPS in the management of intractable PPH in our setting. The choice of UPS as first-line surgical management of PPH in resource-limited settings should entail diligent anticipation of these adverse maternal outcomes in order to lessen the perioperative burden of PPH.

This is a retrospective analysis of eight years of gynaecological laparoscopic surgery in a resource-limited setting. All gynaecological patients managed by laparoscopy at the Yaoundé Gynaeco-Obstetric and Paediatric Hospital from 1 January 2004 to 30 November 2011 were included. Amongst the 9194 gynaecological surgeries performed during the study period, 6.9% (633) were done by laparoscopy. Most of the women underwent an operative laparoscopy (568/592; 95.9%). The most common indication was infertility (415/592; 70.1%). Diagnostic laparoscopies were mostly indicated for chronic pelvic pain (18/24; 75%). The most common surgical finding was tubo-peritoneal adhesions (412/592; 69.6%). A total of 35 patients (35/592; 5.9%) had at least one complication. The mean duration of hospitalization was 3.4 ±1.8 days. The general uptake of gynaecological laparoscopic surgery is low in our setting. The laparoscopic complication rate of 5.9% is encouraging.

Objective: Our aim was to assess the effects of sexual activity during pregnancy on the prognosis of labor. Methods: It was a prospective cohort study of labor comparing 72 women declaring unprotected vaginal sexual intercourse after 37 weeks of pregnancy consecutively recruited to 72 women claiming no sexual contact after 37 weeks of pregnancy also consecutively recruited. Results: The sexually active group at term were significantly involved in more frequent heterosexual intercourse after 28 weeks pregnancy and before term (RR = 37.8; CI = 19.8–515.4). Women sexually active were significantly admitted during the active phase of labor (RR = 2.4; IC = 1.6–5.3), with the fetal head at station 0 and more (RR = 1.5; CI = 1.3-5.2). They significantly had a shorter active phase (RR = 1.7; CI = 1.5–3.7) and a shorter second stage (RR = 1.5; CI = 1.2–3.3). They significantly had a normal pattern of labor (RR = 2.1; CI = 1.2–5.3), a higher rate of spontaneous deliveries (RR = 2.1; CI = 1.5–4.5), a lower rate of caesarean sections (RR = 0.46; CI = 0.1–0.8) and needed less oxytocin usage before expulsion (RR = 0.5; CI = 0.2–0.7). Conclusion: Sexual activity during pregnancy improves the prognosis of labor in Cameroonian women. In the absence of contraindications, consented unprotected heterosexual intercourse should be promoted in pregnant women.

As far as we know, the accuracy of clinical judgment in diagnosing uterine cervical polyps has not been assessed in sub-Saharan Africa. Our objective was to discover the positive predictive value (PPV) of clinical judgment in the diagnosis of cervical polyps. This is a retrospective descriptive study of 192 patients, carried out by the Departments of Pathology and Gynaecology of the Yaoundé Gynaeco-Obstetric and Paediatric Hospital, Cameroon. The diagnosis of cervical polyp was confirmed by histopathology examination in 169 patients, giving a PPV rate of 88.0%. The PPV of clinical judgment in the diagnosis of cervical polyps is acceptable in our setting but the frequency of premalignant and malignant lesions encountered is too high (10.4%), even in the presence of a confirmed cervical polyp (8.9%). Even in areas where there are limited resources, we recommend a systematic histopathology examination of any clinically suspected cervical polyp.