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Voluntary Induced Abortion in Cameroon: Prevalence, Reasons, and Complications

Open Journal of Obstetrics and Gynecology 2015年第9期5卷 475-480页

作者： Jean Dupont Kemfang Ngowa Humphry Tatah Neng Joel Fokom Domgue Christiane Jivir Nsahlai Jean Marie Kasia Obstetrics and Gynecology Unit Yaoundé General Hospital Yaoundé Cameroon Department of Obstetrics and Gynecology Faculty of Medicine and Biomedical Sciences University of Yaoundé I Ya-oundé Cameroon

In Cameroon, induced abortion is permitted when a woman’s life is at risk, to preserve her physical and mental health and on the grounds of rape or incest. Objectives: The aim of this study was to determine the prevalence, reasons and complications of voluntary induced abortion among women attending the obstetrics and gynecology services in an urban area, Yaoundé and in a rural area, Wum in Cameroon. Methods: We carried out a cross sectional study, with 509 women recruited between August 1, 2011 and December 31, 2011 in three health facilities in Cameroon. We appreciated the frequency, complications and reasons for Voluntary induced abortions. Results: The prevalence of voluntary induced abortion was 26.3% (134/509) globally;25.6% (65/254) in urban area and 27.1% (69/255) in rural area. One hundred and eleven (83%) cases of induced abortions were carried out in a health structure and 23 (17%) cases in private homes. Medical doctors and nurses were the most frequent abortion providers in both urban (84.7%) as well as rural setting (77.2%). The three main reasons for induced abortion were to pursue their studies (34.3%), not yet married (22.6%) and fear of parents (13.9%). Complications were reported by 20% (27/134) of respondents who had carried out voluntary induced abortion. Excessive bleeding was the most reported complication (70.4%). Conclusion: Despite its illegality in Cameroon, the prevalence of voluntary induced abortion was high in this study.

关键词： Induced Abortion Unsafe Abortion Voluntary Abortion Voluntary Induced Abortion

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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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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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Immuno-Histochemical Profile of Breast Cancers at the General Hospital of Douala-Cameroon

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Open Journal of Obstetrics and Gynecology 2023年第8期13卷 1377-1388页

作者： Ekono Michel Roger Guy Ngaha Yaneu Junie neng humphry tatah Messakop Yannick Azoumbou Mefant Thérèse Ze Ngbwa Mimi Flore Essome Henri Essola Basile Engbang Jean-Paul Tchente Nguefack Charlotte Faculty of Medicine and Pharmaceutical Sciences University of Douala Douala Cameroon Department of Obstetrics and Gynecology Ebolowa Regional Hospital Ebolowa Cameroon Faculty of Health Sciences University of Buea Buea Cameroon

Introduction: The aim of the study was to describe the immunohistochemical aspects of breast cancers at Douala General Hospital, Cameroon. Methodology: This was a descriptive study with retrospective data collection, conducted from January 1st 2010 and December 31st 2019. It was focused on histologically proven breast cancers followed up at Douala General Hospital. Results: We collected 285 cases of breast cancer, all female, representing an annual frequency of 28.5 cases. The mean age of the patients was 48 ± 13 years. The most frequent histological form was infiltrating ductal carcinoma (83.9%), with grade II predominating (38.6%). Immunohistochemical analyses were performed on 89 patients (31.23%). The triple-negative subtype was the most common class (35.95%), followed by Luminal A (32.60);Human Epidermal Receptor 2-class and Luminal B tumors were observed at a frequency of 13.48% each. Treatment consisted mainly of surgery (78.60%) combined with chemotherapy (65.97%) and/or radiotherapy (63.16%). Hormonal treatment was used in only 10.18% of patients. Targeted therapy was exceptional (4%). Conclusion: Triple-negative phenotype is the most common. However, potentially hormone-sensitive tumors account for almost half of all patients, who are relatively young. Individualized treatments are rare. It is important to systematize these analyses for all breast cancers, with a view to appropriate management in our environment.

关键词： Breast Cancer Immunohistochemistry Douala General Hospital of Cameroon

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Prevalence, Indications and Morbidity of Caesarean Sections in a Referral Hospital of the Health Voucher Program: The Case of Garoua Regional Hospital in the Northern Region of Cameroon

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Open Journal of Obstetrics and Gynecology 2023年第12期13卷 1949-1964页

作者： Mbarnjuk Aoudi Stéphane Kabko Mbargang Georges Ngalame Alphonse Nyong Ourtchingh Clovis Mangala Nkwele Fulbert Anicet Gakdang Ladibe Tameh Theodore Yangsi neng humphry tatah Koudjou Blaise Halle-Ekane Gregory Edie Department of Gynecology & Obstetrics Faculty of Medicine and Biomedical Sciences University of Garoua Garoua Cameroon Gynecology & Obstetrics Unit Garoua General Hospital Garoua Cameroon Department of Surgery and Specialties Faculty of Health Sciences University of Buea Buea Cameroon Douala Gyneco-Obstetric and Pediatric Hospital Faculty of Health Sciences (FHS) University of Buea Buea Cameroon Gynecology & Obstetrics Unit Maroua Regional Hospital Maroua Cameroon Nkongsamba Regional Hospital Faculty of Medicine and Pharmaceutical Sciences University of Douala Douala Cameroon Faculty of Medicine and Biomedical Sciences University of Yaoundé 1 Yaoundé Cameroon Nkongsamba Regional Hospital Faculty of Health Sciences University of Bamenda Bamenda Cameroon Douala General Hospital Dean Faculty of Health Sciences (FHS) University of Buea Buea Cameroon

Caesarean section (CS) is a surgical procedure performed to remove a fetus from the mother’s uterus through an incision on the abdominal wall, then on the uterine wall. The indications of CS vary not only between countries, but also from one hospital to another and from one team to another within the same hospital. Despite advances in asepsis and anesthesia/resuscitation technics, there are still complications of varying severity inherent to the gravid-puerperal state on one hand and the technics used on the other, irrespective of the operative indication. Thus, the present study was carried out with the objectives of determining the prevalence, identifying the indications, and evaluating the morbidity linked to caesarean sections in our environment. Cameroon has also set up a health voucher program in its northern region, aimed at reducing maternal and fetus morbidity and mortality. The program aims to improve financial access in antenatal care and deliveries, including caesarean sections, in this low-income region of the country. We conducted a descriptive cross-sectional study with retrospective data collection, from February 1, 2022, to May 31, 2022. We included all women who gave birth by caesarean section. In our study series, out of 905 parturient admissions into the Department of Obstetrics and Gynecology, 226 were caesarian cases. The overall frequency of CS during our study period was 25%. Fetal indications were dominated by cephalopelvic disproportion and non-reassuring fetal heart in 17.3% and 13.7% of cases respectively. Intraoperative complications were dominated by hemorrhage (15.5%). In our study, we noted an 11.1% of prevalence perinatal mortality. Cameroon is a low-income country with limited financial resources, especially in the Northern region. The health voucher program has improved financial access to caesarean sections for parturient in northern Cameroon, and consequently to emergency obstetric and neonatal care.

关键词： Caesarean Section Health Voucher Cephalon-Pelvic Disproportion Hemorrhage

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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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Radical Hysterectomy in Cervical Cancer: Patients’ Epidemiological and Clinical Profiles and Perioperative Outcome in Two Referral Hospitals in Cameroon

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Open Journal of Obstetrics and Gynecology 2024年第3期14卷 466-479页

作者： Théophile Njamen Nana Robert Tchounzou Fulbert Nkwele Mangala Alphonse Ngalame Henri Essome Sedrick Tiokeng Sidonie Noa Ananga Andrew Tassang Humphry Tatah Neng Isaac Mboh Eyong Gaetan Andre Wambo Simo Felix Adolphe Elong Fidelia Kobenge Mbi Junior Cédric Nana Njamen Charlotte Tchente Nguefack Thomas Obinchemti Egbe Gregory Ekane Halle Emile Telesphore Mboudou Marcellin Ngowe Ngowe Department of Obstetrics and Gynaecology Douala General Hospital Douala Cameroon Department of Obstetrics and Gynaecology Faculty of Health Sciences University of Buea Buea Cameroon Department of Obstetrics and Gynaecology Douala Gynaeco-Obstetric and Pediatric Hospital Douala Cameroon Department of Surgery and Specialties Faculty of Medicine and Pharmaceutical Sciences University of Douala Douala Cameroon Department of Pathology Douala General Hospital Douala Cameroon Faculté Des Sciences De La Santé Université Joseph Kizerbo Ouagadougou Burkina Faso

Background: Cervical cancer (CC) is one of the most frequent cancers and the leading cause of death from gynecological cancer in Low and middle income countries, Cameroon inclusive. Surgery is the primary treatment modality when the disease is diagnosed at early stage. Radical hysterectomy in cervical cancer has not been evaluated in recent years in Cameroon. The purpose of this study is thus to evaluate the epidemiological and clinical features and short term outcomes of patients who underwent surgery. Patients and methods: This retrospective study was conducted at the Douala Gynaeco-obstetric and Pediatric Hospital and the Douala General Hospital. Cervical cancer patients who underwent Radical hysterectomy between January 2015 and December 2020 were included. A pre-established data collection tool was used to record socio-demographic, clinical and outcomes information from patients’ files;additional outcome information was obtained from phone calls. Descriptive analysis was done using the SPSS version 26. Bivariate analysis was used to determine associations between disease and patients characteristics and occurrence of adverse postoperative outcome. P value of 0.05 was considered. Results: Sixty one patients were enrolled. Their ages ranged from 33 to 74 years with a mean age of 51.95 ± 10.29 years. Over 85% of women were married, 65.57% were unemployed and 86.88% were multiparous. Only 28% had never done cervical cancer screening. Most patients had stage IB1 to IB2 stage disease (57.1%). Less than 9% underwent radical hysterectomy and 8 of those (13.11%) suffered intraoperative complications. Twenty-five patients (40.98%) presented immediate and short term complications. There was no significant association between the disease or patients’ characteristics and adverse outcomes. Conclusion: Cervical cancer patients are relatively young in our settings and only 9% of them reach the hospital at early stage. Postoperative adverse outcomes rate is higher than that reported in the literature. Sensitization on screen

关键词： Cervical Cancer Radical Hysterectomy Epidemiological and Clinical Profiles Outcomes Cameroon

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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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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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