A Review of Maternal Deaths at Douala General Hospital, Cameroon: The Referral System and Other Contributing Factors

Ekane, Gregory Edie Halle; Mangala, Fulbert George Nkwele; Egbe, Thomas Obinchemti; Nguefack, Charlotte Tchuente; Njamen, Théophile Nana; Kamgaing, Jacques Tsingaing; Priso, E Belley

doi:10.9734/ijtdh/2015/18111

Cited by 4 publications

(3 citation statements)

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“…8 In Cameroon, a lot of work has been done in Maternal deaths surveillance, however, little has been documented for the purpose of disseminating the progress and lessons learned. Previous research has focused on clinical reviews and the identification of clinical factors associated with deaths, [9][10][11] with limited information on maternal death surveillance activities especially those conducted at subnational levels (regional and district). 12 This article, therefore, seeks to describe the implementation of Maternal death surveillance and Response (MDSR) system in the Center Region, summarizing the key achievements, challenges, lessons learned, and proposing recommendations for informed decision making and health system strengthening.…”

Section: Problem Statement and Justificationmentioning

confidence: 99%

Strengthening Maternal Death Surveillance Systems for Evidence-Based Decision Making in Sub-Saharan Africa: The Case of the Center Region in Cameroon

et al. 2021

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Background: The article seeks to document the experience of implementing Maternal Death Surveillance and Response (MDSR) in the Center Region of Cameroon. The paper raises awareness on the need for implementing MDSR, shares progress and lessons learned and reflects on the implications for public health practice. Methods: A desk research involving the collection and analysis of secondary data using tables with specific themes in excel, following the review of existing resources at the Regional Delegation of Public Health-Center from the year 2016 to 2019. Results: The findings depict the existence of MDSR policies and sub-regional committees. Although, the number of regional maternal death notifications increased from 19 to 188 deaths between 2016 and 2019, the implementation of death review recommendations was only estimated at 10% in 2019. While 66% of deaths occurred in Yaoundé, 72% of these were deaths reported to have occurred in tertiary institutions out of which 75% were attributed to late referrals. Hemorrhage constituted 70/144 (48.6%) of the known direct causes of death. Maternal death related co-factors such as the use of partograph during labor had a high non-response rate (84%) and represents a weakness in the data set. Conclusion and Global Health Implications: Across the board, stakeholder engagement towards MDSR was increased through continuous awareness-raising, dissemination of surveillance tools, the institutionalization of the District Health Information Software (DHIS 2) and the “No Name No Blame” policy. However, the reporting and investigation of deaths for informed decisions remain a daunting challenge. For a resource-scarce setting with limited access to blood banks, the application of life-saving cost-effective interventions such as the use of partographs and the institution of a functional referral system among health units is likely to curb the occurrence of deaths from hemorrhage and other underlying causes. The success of these will require a robust strengthening of the health system. Copyright © 2021 Bongajum, et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License CC BY 4.0.

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Section: Problem Statement and Justificationmentioning

confidence: 99%

Strengthening Maternal Death Surveillance Systems for Evidence-Based Decision Making in Sub-Saharan Africa: The Case of the Center Region in Cameroon

et al. 2021

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“…However, they are subject to taxation which seems paradoxical. These IHCs, despite their limited technical facilities, generally provide a wide range of services, integrating antenatal consultations and childbirths services [13,14]. Antenatal consultations (ANC) are an essential aspect for the prevention of HIV transmission from mother to child (PMTCT), since it represents a critical entry point into the PMTCT cascade [15,16].…”

Section: Introductionmentioning

confidence: 99%

“…the referral of the cases practiced in our context was limited to a verbal referral; consisting of a recommendation in which the provider gives just the name of the health facilities, preferably public, where the patient can ensure the continuum of care. This type of verbal and general referral is widely practiced by informal care providers[13,14]. In Cameroon a review of maternal deaths at Douala General hospital highlighted that all references made by IHCs were verbal without any documentation.…”

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confidence: 99%

Current state of prevention of mother-to-child transmission of HIV in informal health centers in Douala and Ebolowa, Cameroon

Amboua-Schouamé

Bigna

SCHOUAME

et al. 2022

Preprint

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Background : Informal health care providers are key actors for health care provision in developing countries for poor populations. Thus, in Cameroon, in 2017, there were more than 3,000 Informal Health facilities. In a context of elimination of mother-to-child transmission of HIV, we describe the offer of Prevention of Mother to Child Transmission of HIV (PMTCT) in informal health centers. Methods : This two-phase cross-sectional study was carried out in two cities in Cameroon notably Douala and Ebolowa. The first step was conducted from March 2019 to July 2019 in 110 informal health centers and the second from August 2019 to January 2020 with 183 Health Providers in these informal health centers. Standardized questionnaires were administered. Data collected were entered in kobo Collect software. Descriptive statistics and logistic regression at a level of significance of 5% were used. Results : Of the 110 informal health centers, 109 integrated HIV testing into the antenatal check-up package. Among them, 43% (47/109) reported giving antiretroviral treatment to HIV infected pregnant women, while the remaining referred them to formal HIV care centers. Regarding delivery services, 52% (53/101) of those who offered them referred HIV exposed newborn for further PMTCT care. Knowledge of PMTCT was insufficient among 51% (94/183) of health providers and 90% (165/183) had insufficient PMTCT practices. Health providers with no PMTCT experience were more likely to have insufficient knowledge of PMTCT (aOR= 32.04, 95%CI: 6.29 to 163.10, p<0.001) whereas, those without any formal PMTCT training were more at risk of having insufficient knowledge (aOR= 3.02, 95%CI: 1.06 to 8.64, p=0.03) and insufficient practices (OR= 4.35, 95%CI: 1.44 to 13.09, p=0.009) towards PMTCT. Conclusion : Given their proximity to the populations and the PMTCT activities they conduct most often; particular attention should be paid to PMTCT in informal health centers.

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General versus regional anaesthesia for caesarean section indicated for acute foetal distress: a retrospective cohort study

Metogo

Nana

Ngongheh³

et al. 2021

BMC Anesthesiol

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Background Acute foetal distress (AFD) is a life-threatening foetal condition complicating 2% of all pregnancies and accounting for 8.9% of caesarean sections (CS) especially in developing nations. Despite the severity of the problem, no evidence exists as to the safest anaesthetic technique for the mother and foetus couple undergoing CS for AFD. We aimed to compare general anaesthesia (GA) versus regional (spinal and epidural) anaesthesia in terms of their perioperative maternal and foetal outcomes. Methods We carried out a retrospective cohort study by reviewing the medical records of all women who underwent CS indicated for AFD between 2015 to 2018 at the Douala General Hospital, Cameroon. Medical records of neonates were also reviewed. We sought to investigate the association between GA, and regional anaesthesia administered during CS for AFD and foetal and maternal outcomes. The threshold of statistical significance was set at 0.05. Results We enrolled the medical records of 117 pregnant women who underwent CS indicated for AFD. Their mean age and mean gestational age were 30.5 ± 4.8 years and 40 weeks respectively. Eighty-three (70.9%), 29 (24.8%) and 05 (4.3%) pregnant women underwent CS under SA, GA and EA respectively. Neonates delivered by CS under GA were more likely to have a significantly low APGAR score at both the 1st (RR = 1.93, p = 0.014) and third-minute (RR = 2.52, p = 0.012) and to be resuscitated at birth (RR = 2.15, p = 0.015). Past CS, FHR pattern on CTG didn’t affect these results in multivariate analysis. Adverse maternal outcomes are shown to be higher following SA when compared to GA. Conclusion The study infers an association between CS performed for AFD under GA and foetal morbidity. This, however, failed to translate into a difference in perinatal mortality when comparing GA vs RA. This finding does not discount the role of GA, but we emphasize the need for specific precautions like adequate anticipation for neonatal resuscitation to reduce neonatal complications associated with CS performed for AFD under GA.

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A Review of Maternal Deaths at Douala General Hospital, Cameroon: The Referral System and Other Contributing Factors

Cited by 4 publications

References 0 publications

Strengthening Maternal Death Surveillance Systems for Evidence-Based Decision Making in Sub-Saharan Africa: The Case of the Center Region in Cameroon

Strengthening Maternal Death Surveillance Systems for Evidence-Based Decision Making in Sub-Saharan Africa: The Case of the Center Region in Cameroon

Current state of prevention of mother-to-child transmission of HIV in informal health centers in Douala and Ebolowa, Cameroon

General versus regional anaesthesia for caesarean section indicated for acute foetal distress: a retrospective cohort study

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