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Management of Obstetric Emergencies in a Tertiary Hospital in Cameroon: A Milestone for End of Preventable Maternal Deaths

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Open Journal of Obstetrics and Gynecology 2020年第12期10卷 1749-1762页

作者： Robert Tchounzou Theophile Nana Njamen Alphonse Nyong Ngalame Vanessa Baleba Inna Rakya Darolles Mwadjie Wekam André Gaetan Simo Wambo Humphry Neng Tatah diane estelle kamdem Moustapha Bilkissou Félix Adolphe Elong Dominique Djomo Tamchom Julie Ngo Batta Emile T. Mboudou Douala Gynaeco-Obstetric and Paediatric Hospital Douala Cameroon Faculty of Health Sciences University Buea Buea Cameroon Douala General Hospital Douala Cameroon Faculty of Medicine and Biomedical Sciences of Ngaoundere Garoua Cameroon Regional Hospital Limbe Limbe Cameroon Regional Hospital Buea Buea Cameroon Faculty of Medicine and Biomedical Sciences University of Yaounde I Yaounde Cameroon

Background: Maternal mortality was insufficiently reduced in Cameroon in 2015 despite the adoption of Millennium development goals. To tackle the situation and meet the sustainable Millennium goals target of 140/100,000 live births by 2030, the Government adopted the strategies of building reference hospitals where high quality obstetric care, timely and optimal management of obstetric emergencies will be offered. The objective of this study was to describe the patterns of obstetric emergencies in Douala Gynaeco-obstetric and Paediatric Hospital, evaluate the outcomes of their management and the contribution to maternal mortality. Patients and Methods: 418 patients with obstetric emergencies were included in a two-phase cross-sectional study. Data were retrieved from patients’ case notes during the retrospective phase and a questionnaire filled for each case received during the prospective phase. Patterns of obstetric emergencies were determined and for each, the following were analysed: patient managed in this hospital or referred from other hospitals, management according to hospital guidelines, timing of care, result of management (recovery with

关键词： Obstetric Emergencies Tertiary Hospital Maternal Outcome Maternal Death

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Contribution of Colposcopy in the Diagnosis of Precancerous Lesions of the Uterine Cervix at the Douala Gynaeco-Obstetric and Pediatric Hospital, Cameroon

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Open Journal of Obstetrics and Gynecology 2022年第10期12卷 1031-1041页

作者： diane estelle Modjo kamdem Alphonse Nyong Ngalame Inna Rakya Robert Tchounzou Darolles Wekam Mwadjie Humphry Tatah Neng Bilkissou Moustapha Julie Batta Patricia Metouom kamdem Charlotte Nguefack Tchente Emile Mboudou Douala Gynaeco-Obstetric and Pediatric Hospital Douala Cameroon Faculty of Health Sciences University of Buea Buea Cameroon Faculty of Medicine and Biomedical Sciences University of Garoua Garoua Cameroon Faculty of Medicine and Pharmaceutical Sciences University of Douala Douala Cameroon University of Pittsburg Medical Center-Mckeesport Pittsburg USA Faculty of Medicine and Biomedical Sciences University of Yaounde I Yaounde Cameroon

Introduction: Cervical cancer is a public health problem in Cameroon, due to low screening and late diagnosis. We sought to assess practice of colposcopy at the Douala Gyneco-Obstetric and Pediatric Hospital (DGOPH) in Cameroon and its contribution to the fight against cervical cancer in our context. Method: This is a retrospective cross-sectional study of 99 colposcopies after which 71 exploitable biopsies were retained at the Douala for a period of 1year (December 1, 2019-December 1, 2020). The nomenclature of the French Society of Colposcopy and Cervico-Vaginal Pathology (SFCPCV) was used. Results: Mean age of the participants was 44 years, mostly multiparous (80%). Cytological abnormalities were the main reference pattern. During the examination 22% of colposcopies were found to be normal, 37% of TAG 1-2A, 31% of TAG 2B-C, and 5% suspected of cancer. After histological analysis of biopsies guided by colposcopy, we found 42% (30/71) of Cervical Intraepithelial Neoplasia (CIN) 1, 15.5% (11/71) of CIN 2 - 3, and 24% (17/71) cancer. Upon analysis of the diagnosed CIN1/CIN2-3/Cancers, we noted a concordance with colposcopy in 62% (23/37), 37% (10/27) and 85% (6/7) respectively. Colposcopic performance in the detection of high-grade lesions and above was 36% (26/71), with a sensitivity of 92.86%, specificity 83.33%, PPV 78.79% and NPV 94.59%. Conclusion: Despite the difficult socioeconomic context, colposcopy retains all its importance in the diagnosis of precancerous lesions of the uterine cervix. With the imminent putting in place of a national health policy, the goals 90-70-90 by 2030 of the World Health Organization for the fight against cervical cancer can be achieved in our sub-Saharan African countries.

关键词： Colposcopy Cervix Dysplasia Cancer DGOPH

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Materno-Fetal Outcomes of COVID-19 Infected Pregnant Women Managed at the Douala Gyneco-Obstetric and Pediatric Hospital—Cameroon

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Open Journal of Obstetrics and Gynecology 2020年第9期10卷 1279-1294页

作者： Alphonse Nyong Ngalame Humphry Tatah Neng Rakya Inna Dominique Tamchom Djomo diane estelle Modjo kamdem Bilkissou Moustapha Julie Ngo Batta Diomede Njinkui Noukeu Dominique Enyama Rodrigue Tiokeng Yannick Onana Yves Moumbe Martial Zanga Jules Fils Ndongo Armand Kamga Robert Tchounzou Ultrich Keumayou Lemone Chingnabo Toudjirob Djiallati Emmanuel Passoret Estella Toyoum Ramadji Jean Blaise Ebimbe Servais Albert F. Bagnaka Eloumou Darolles Wekam Mwadjie Guy Pascal Ngaba Emile Telesphore Mboudou Gynecology and Obstetrics Unit Douala Gyneco-Obstetric and Pediatric Hospital Douala Cameroon Faculty of Medicine and Biomedical Sciences University of Ngaoundere Ngaoundere Cameroon Faculty of Medicine and Pharmaceutical Sciences University of Dschang Dschang Cameroon Faculty of Medicine and Biomedical Sciences University of Yaounde I Yaounde Cameroon Faculty of Health Sciences University of Buea Buea Cameroon Faculty of Medicine and Pharmaceutical Sciences University of Douala Douala Cameroon

Introduction: The first case of the novel coronavirus (COVID-19) pandemic in Cameroon was confirmed on March 6, 2020. Though widely considered that pregnant women are more susceptible to respiratory tract infections, the available body of literature on the effect of COVID-19 on pregnancy outcomes is shy from being conclusive. In Cameroon, the Douala Gyneco-Obstetric and Pediatric Hospital (DGOPH) was one of the main frontline tertiary health facilities for the management of severe forms of the disease. After four months of managing COVID-19 cases in the general population and especially in pregnant women at the DGOPH, we decided to take a stop, analyze our findings from the patients managed in order to drive future policies and clinical practices via informed decisions. Overall objective: To describe and understand the clinical burden of patients managed for COVID-19 in pregnancy or post-partum at the DGOPH. Methodology: Cross-sectional and descriptive study covering four months—March 24th to July 24th 2020 at DGOPH. Using a pretested questionnaire, we systematically enrolled all patients who fulfilled the inclusion criteria, with analysis done using proportions from an excel spreadsheet. Results: A total of 18 on the 301 pregnant women consulted

关键词： COVID-19 DGOPH Pregnancy Outcome Mortality

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Covid-19 in Pregnancy: Cases of Women Managed in the City of Douala-Cameroon

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Open Journal of Obstetrics and Gynecology 2022年第10期12卷 1019-1030页

作者： Bilkissou Moustapha Alphonse Nyong Ngalame Charlotte Nguefack Tchente Frederic Victor Okala Kingsley Ombaku Humphry Tatah Neng diane kamdem Ngo Batta Julie Nkendo Sandrine Darolles Mwadjie Emile Telesphore Mboudou Douala Gynaeco-Obstetric and Pediatric Hospital Douala Cameroon Faculty of Medicine and Pharmaceutical Sciences University of Douala Douala Cameroon Faculty of Health Sciences University of Buea Buea Cameroon Douala General Hospital Douala Cameroon Faculty of Medicine and Biomedical Sciences University of Yaounde I Yaounde Cameroon

Introduction: The SARS-COV-2 virus has been responsible for a health crisis in pregnancy, causing severe acute respiratory distress syndrome. Materno-foetal complications can be observed. Taking into account the materno-foetal risks associated with COVID-19 infection in pregnant women and the low sample size of the first publication in Cameroon, we considered it necessary to conduct an in-depth study on the maternal and foetal prognosis of this condition in pregnant women in three hospitals in Douala. Materials and Methods: We conducted a cross-sectional survey with retrospective data collection in the three state tertiary and reference hospitals in Douala (DGOPH, DGH and DLH) from November 1, 2021 to April 30 2022 after obtaining ethical and administrative clearances. All records of COVID-19 pregnant women confirmed by reverse transcription polymerase chain reaction (RT PCR) or COVID-19 rapid diagnostic test (COVID RDT) were included. The survey form contained socio-demographic data, clinical and para-clinical characteristics, management and materno-foetal outcome. SPSS.26 and Microsoft Excel 2016 software were used to analyze the data, and a logistic regression model was used to look for associations between the variables. Results: We found in total 96 files that met our inclusion criteria. The most represented sector of activity was the unemployed (44.46%). Patients with a secondary level of education constituted the majority with 47% (45). The main comorbidity found was diabetes (27.2%). The most frequent symptom was fever, found in 87 patients (90.1%). In our series, a chest CT scan was performed in 50 patients. Caesarean section was the most common mode of delivery (58.3%). We recorded 15.6% of maternal deaths, mainly in patients admitted to intensive care. Factors associated with maternal death were: Maternal diabetes, high LDH and D-dimer levels, and 75% lung involvement on chest CT scan. Oxygen saturation > 94% on admission was a protective factor. Regarding fetal and neonatal outcomes, we registered 30.

关键词： COVID-19 Clinical Para-Clinical Materno-Foetal Outcomes Pregnant Women

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Improving Post Abortion Care (PAC) Delivery in Sub-Saharan Africa: A Literature Review

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Open Journal of Obstetrics and Gynecology 2020年第9期10卷 1295-1306页

作者： Alphonse Nyong Ngalame Robert Tchounzou Humphry Tatah Neng Fulbert George Nkwele Mangala Rakya Inna diane Modjo kamdem Bilkissou Moustapha Julius Sama Dohbit Eugene Justine Kongnyuy Claude Ndoua Noa Benova Lenka Gregory Ekane Halle Darolles Wekam Mwadjie Therese Delvaux Emile Telesphore Mboudou Gynecology & Obstetrics Unit Douala Gyneco-Obstetric and Pediatric Hospital (DGOPH) Douala Cameroon Faculty of Health Sciences (FHS) University of Buea Buea Cameroon Faculty of Medicine and Pharmaceutical Sciences University of Douala Douala Cameroon Faculty of Medicine and Biomedical Sciences (FMBS) University of Ngaoundere Ngaoundere Cameroon Faculty of Medicine and Biomedical Sciences (FMBS) University of Yaounde I Yaounde Cameroon United Nations Population Fund (UNFPA) Bamako Mali Institute of Tropical Medicine (ITM) Antwerpen Belgium

Saharan Africa (SSA) contributes 29% of the global unsafe abortions with 62% of abortion-related deaths. This is due to restrictive abortion laws, low quality post abortion care (PAC) and inadequate access to effective modern contraception. The overall objective was to review current literature on PAC in SSA and make recommendations for improvement especially in Cameroon. A literature review was conducted on PAC in SSA published during 2000-2018. The following databases were searched: MEDLINE, POPLINE, COCHRANE Library, African Index Medicus and GOOGLE Scholar. Thirty articles were reviewed from 16 countries ranging from observational studies to systematic reviews with meta-analysis. Major outcomes: 1) Manual vacuum aspiration (MVA) and misoprostol are equally safe and effective. 2) There is comparable effectiveness between physicians and trained mid-level cadres in PAC management. 3) PAC contraception uptake was increased when offered immediately before patient leaves the facility. 4) Gaps to PAC service use include inadequate access, low quality care and less adolescent-friendly environment. Task shifting of PAC to trained mid-level staff, decentralization of medical PAC using misoprostol, offering post abortion counselling and contraception to clients before leaving the health facility, encouraging linkage and provider-community partnership in PAC and reinforcement of advocacy for less restrictive abortion laws in Cameroon are recommended.

关键词： Post Abortion Care (PAC) Misoprostol Contraception Midlevel Cadres Sub-Saharan Africa

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