[Pregnancy and delivery among adolescents under 15: a study of 181 cases in French Guiana]

[Sexual intercourse among students in Matoto, Conakry, Guinea]

Introduction

The purpose of this study is to analyze the factors associated with sexual practices among adolescent students in Matoto, Conakry.

Methods

We conducted a cross-sectional, descriptive and analytical study of students aged 10-19 years attending colleges and high schools in Matoto, Conakry over a period of 3 months (1 March -31 May 2018).

Results

Out of 500 students surveyed, 226 (162 girls and 64 boys; 45.2%) reported having sexual intercourse. Condom was used by 16.4% of students and contraceptives by 35.4%. The rate of sexually transmitted infections was 23.5%. Among girls who had sexual intercourse, 32.1% had had at least one unintended pregnancy ending in clandestine abortion in 30.8% of cases. The factor associated with sexual practices among adolescents was night life (p = 0.000).

Conclusion

Sexual intercourse is frequent among adolescent students in Matoto. Condom and contraceptives are little used. In our study, night life was the principal factor associated with sexual practice.

Risk factors for premature birth in French Guiana: the importance of reducing health inequalities

OBJECTIVES

French Guiana has the highest birth rate in South America. This French territory also has the highest premature birth rate and perinatal mortality rate of all French territories. The objective was to determine the premature birth rate and to identify the prevalence of risk factors of premature birth in French Guiana.

METHODS

A retrospective study of all births in French Guiana was conducted between January 2013 and December 2014 using the computerized registry compiling all live births over 22 weeks of gestation on the territory.

RESULTS

During this period 12 983 live births were reported on the territory. 13.5% of newborns were born before 37 (1755/12 983). The study of the registry revealed that common sociodemographic risk factors of prematurity were present. In addition, past obstetrical history was also important: a scarred uterus increased the risk of prematurity adjusted odds ratio =1.4, 95%CI (1.2-1.6). Similarly, obstetrical surveillance, the absence of preparation for birth or of prenatal interview increased the risk of prematurity by 2.4 and 2.3, the excess fraction in the population was 69% and 72.2%, respectively.

CONCLUSIONS

Known classical risk factors are important. In the present study excess fractions were calculated in order to prioritize interventions to reduce the prematurity rate.

[Prevalence and factors associated with anemia in pregnant women attending the General Hospital in Douala]

INTRODUCTION

Anemia is a public health problem, prevalent among children and women of childbearing age. Our study aims to determine the prevalence and factors associated with anemia in pregnant women at Douala General Hospital.

METHODS

We conducted a cross sectional study from July 2012 to July 2013. All consenting pregnant women attending antenatal consultation and having undergone complete blood count (CBC) were included in the study. Sociodemographic characteristics, individual's obstetrical history and the results of the CBC were recorded on a pre tested data collection sheet. Anemia was defined according to the WHO criteria. After some descriptive statistics, we performed a bivariate analysis using the Chi-square test and Fisher exact probability test in order to determine the factors associated with anemia. P value <0.05 was considered significant.

RESULTS

A total of 415 pregnant women were enrolled in the study. Anemia prevalence was 39,8%. The average age was 29,89±4,835 years. The mean hemoglobin level was 10.93 ± 1.23. Normochromic normocytic anemia (53,3%) was prevalent. Anaemia was severe in 2,4% of cases. Anemia in pregnancy was significantly associated with a personal history of chronic diseases (P = 0.02) and of anemia in a previous pregnancy (P = 0.003). Anemia was more frequently observed during the 3rd trimester (P = 0.04) and breastfeeding played a protective role (P = 0.02).

CONCLUSION

The prevalence of anemia during pregnancy remains high. A better management of chronic diseases in pregnant women and of postpartum follow-up is necessary to treat anemia before a subsequent pregnancy.

Understanding sexual and reproductive health needs of adolescents: evidence from a formative evaluation in Wakiso district, Uganda

INTRODUCTION

Adolescents are frequently reluctant to seek sexual and reproductive health services (SRH). In Uganda, adolescent health and development is constrained by translation of the relevant policies to practice. Recent studies done in central Uganda have shown that there is need for a critical assessment of adolescent friendly services (AFS) to gain insights on current practice and inform future interventions. This study aimed to assess the sexual reproductive health needs of the adolescents and explored their attitudes towards current services available.

METHODS

A qualitative study was conducted in Wakiso district, central Uganda in September 2013.Twenty focus group discussions (FGDs) stratified by gender (10 out-of-school, and 10 in-school), were purposefully sampled. We used trained research assistants (moderator and note taker) who used a pretested FGD guide translated into the local language to collect data. All discussions were audio taped, and were transcribed verbatim before analysis. Thematic areas on; adolescent health problems, adolescent SRH needs, health seeking behaviour and attitudes towards services, and preferred services were explored. Data was analysed using atlas ti version 7 software.

RESULTS

Our results clearly show that adolescents have real SRH issues that need to be addressed. In and out-of-school adolescents had sexuality problems such as unwanted pregnancies, sexually transmitted infections (STIs), defilement, rape, substance abuse. Unique to the females was the issue of sexual advances by older men and adolescents. We further highlight RH needs which would be solved by establishing adolescent friendly clinics with standard recommended characteristics (sexuality information, friendly health providers, a range of good clinical services such as post abortion care etc.). With regard to health seeking behaviour, most adolescents do not take any action at first until disease severity increase.

CONCLUSIONS

Adolescents in Uganda have multiple sexual and reproductive health needs that require special focus through adolescent friendly services. This calls for resource support in terms of health provider training, information education and communication materials as well as involvement of key stakeholders that include parents, teachers and legislators.

Prevalence and risk factors of early onset of sexual intercourse in a random sample of a multiethnic adolescent population in French Guiana

French Guiana, a French overseas department in South America, has been classified epidemic for HIV. This territory is consisting of a very young population with almost 45% of them being younger than 20 years of age. Delaying the onset of first sexual intercourse (SI) is one of the major objectives to fight HIV infection in adolescents. The objective of this study is to identify the age of first SI and the risk factors of early onset. A behavioural surveillance survey among students living on the coastline and alongside the Maroni River was conducted in 2011/2012. A total of 1603 students filled out the survey. While 60% had already SI, the mean age of first intercourse was 12.1 years for boys and 13.9 years for girls. Accordingly, over 90% had a premature onset of SI. Risk factors are age, male gender, living alongside the Maroni River, another language than the French being mother tongue, not being religious, alcohol and cannabis consumption and a bad attitude towards condom use. Risk factors for girls are an older first sexual partner, having more than three lifetime sexual partners and condom rupture. Evidence-based implementation with respect of local and socio-demographic aspects is necessary to improve youths' appreciation of SI and related risk of sexual transmitted diseases.

A review of the risks and consequences of adolescent pregnancy

OBJECTIVE

To evaluate the risks and consequences of young maternal age on both the mother and the newborn.

STUDY DESIGN

A comprehensive literature review on the risks and consequences of adolescent pregnancy was performed.

RESULTS

Young maternal age is associated with an increased risk of maternal anemia, infections, eclampsia and preeclampsia, emergency cesarean delivery, postpartum depression and inadequate breastfeeding initiation. Infants of teenage mothers are more likely to be premature and have a low birth weight, and are at an increased risk for respiratory distress syndrome and autism later in life.

CONCLUSIONS

Adolescent pregnancy is a prevalent phenomenon associated with increased risks of both maternal and neonatal complications during and after pregnancy. Being aware of such adverse outcomes is imperative to improving prenatal and perinatal care. Pregnancy progression can also be influenced by the mother's culture, environment, and economic status; advancement in which may be a possible course for future improvement.

Screening for Chlamydia trachomatis, Neisseria gonorrhoeae, and Mycoplasma genitalium should it be integrated into routine pregnancy care in French young pregnant women?

Chlamydia trachomatis, Neisseria gonorrhoeae, and Mycoplasma genitalium screening during pregnancy is not performed routinely in France. We conducted the first prospective study in 1004 women attending for routine antenatal care to determine the prevalence and risk factors for these bacterial infections. The overall prevalence of C. trachomatis, N. gonorrhoeae, and M. genitalium infections was 2.5%, 0%, and 0.8%, respectively. In patients aged 18-24 years, the prevalence increased to 7.9% for C. trachomatis and to 2.4% for M. genitalium. C. trachomatis infection was associated with age ≤24 years or being single or having more than 5 sexual partners in a lifetime. M. genitalium infection was more frequent in patients aged ≤24 years or who had a history of abortion or their first sexual intercourse after 20 years of age. The high prevalence of C. trachomatis in pregnant women aged ≤24 years, mostly asymptomatic, suggests that systematic screening could be beneficial.

[Pregnancy management among teenagers under 15 years old: a multidisciplinary challenge]

OBJECTIVE

Pregnancy before 15 years old remains a troublesome issue for medical teams which are not used to working with adolescents. The aim of this work is to study the outcome of the pregnancies among very young adolescents, the psycho-social context, the medical management, the professionals involved in it and the follow-up after pregnancy.

MATERIALS AND METHODS

Retrospective analysis from four cases, in the university hospital of Rennes, during the year 2011.

RESULTS

All the pregnancies were terminated, half of them on a psychological indication. Three adolescents showed evidence of major psychological distress and two of them had a history of sexual abuse. The medical care was heterogeneous, from the first meet until the follow-up after pregnancy, including the medical abortion. A multidisciplinary teamwork was found in three of the four cases.

CONCLUSION

Pregnancy before the age of 15 years old is a rare event and often ends with a medical abortion. The medical management of those vulnerable adolescents is complex and requires a multidisciplinary team approach all along the follow-up. A national evaluation of clinical practice in this area seems to be needed.

Adolescent pregnancies and deliveries: problems encountered

Teenage pregnancies are increasing and need special attention. The aim of this retrospective study, conducted from 1 January 2004 to 31 December 2004 at the maternity department of the Yaoundé University Teaching Hospital, Cameroon, was to analyze the evolution of pregnancy and delivery in primiparous teenagers. The medical files of 190 teenagers and 403 patients aged between 20 and 25 years were analyzed and compared. Mean gestational age, the rate of pregnancy-induced hypertensive disease and the caesarean section rate were similar in both groups. However, there were a greater number of low Apgar scores, vaginal tears and instrumental deliveries in teenagers. Those aged 15 years or less had the additional risk of an increased rate of preterm labour, low birth weight and early neonatal death. Therefore, pregnancies and deliveries among teenagers, especially those aged 15 years or less, should be monitored regularly.