The Problem of Traditional African Pharmacopoeia in Obstetrics: Use of Plants for Utero-Tonic Purposes and Materno-Fetal Outcome in Douala (Cameroon)

摘要

Introduction: The use of traditional preparations for the induction or acceleration of labor remains a common practice in our country in particular and in Africa in general with sometimes derogatory outcomes for the mother and the fetus. Goal: The objective was to assess immediate maternal and neonatal outcomes in women who reported having used the traditional pharmacopoeia for utero-tonic purposes. Methodology: We conducted a multi-centric cross- sectional study with prospective data collection in the maternities of the Laquintinie Hospital, Bonassama District and Nylon Hospitals. It took place over a period of seven months, from 1st October 2016 to 31st April 2017. This included all women who reported having used the unconventional pharmacopoeia for utero-tonic purposes before or after contractions started. The student and Chi-square tests were interpreted at the statistical threshold of 5% and the 95% confidence intervals. Results: We recruited 168 cases, 68.5% of the 245 women interviewed. The mean age was 27.1 ± 0.41 years;55% of our respondents had a secondary level of education;80% of them were admitted at term and 43% were multiparous. Nulliparity predisposed to traditional pharmacopoeia use (RR = 1.55, CI = 0.79 - 3.03) but primiparity reduced this risk (RR = 0.4, CI = 0.24 - 0.926). Stimulation of labor was the first indication in 85% of women, the rectal evacuation enema was the main route used (67%). The majority of plants used were those of the families Asteraceae, Anthericaceae, and Malvaceae. In per partum, 42% had a brilliant dilatation;there was a statistically significant association between the occurrence of dynamic dystocia (CI = 0.28 - 1.54, p = 0.006) and the risk of perineal tear (RR = 3.13, CI = 1.68 - 5.85;p = 0.007). The APGAR score at 5 min of life was less than 7 in 64% of cases (p = 0.027). The caesarean section rate was 69%. Conclusion: Traditional products with uterotonic effects are frequently used and unregulated with its corollary of materno-fetal complications.