Epidemiological Aspect of the Activities Carried Out in the Urology and Andrology Department of the Central Hospital of Yaounde during the Covid 19 Period

Introduction

The measures imposed by the health crisis caused by COVID-19 are unprecedented, due to the rapid spread of the virus [1, 2]. The COVID-19 pandemic has therefore led to the reorganisation of health systems worldwide [3] to the extent that in some countries elective surgery has been suspended. Puliatti S, et al. [4] in his study, said that all elective surgeries have to be postponed in areas with high COVID-19 workloads, due to the limited availability of ventilators, workforce and hospital beds [5] but also because studies have suggested a significant risk associated with elective surgery in the context of COVID-19 (A retrospective cohort study of 34 asymptomatic patients who underwent elective surgery during the incubation period of COVID-19 reported that 44% required intensive care and 20% died [6]. However, surgery should be considered for urological emergencies, for example, high-grade malignancies and unstable trauma patients. All healthcare workers, including urologists, should adopt sufficient protective strategies to guard against infection when dealing with patients with COVID-19 [5]. On the other hand, Alexandre Ingels argues that surgical activities should be maintained in view of this risk [7]. According to a study conducted in France, urological surgical activity was strongly impacted by the COVID-19 pandemic [5].

However, the number of medical and paramedical staff has decreased. In Cameroon, in terms of protection, there was a lack of everything, especially FFP2/FFP3/N95 masks, forcing health workers to obtain them at their own expense, to use on-board resources or to engage in dangerous recycling practices that are not supervised and do not respect their safety. In order to find solutions to this pandemic, African countries, including Cameroon, have been looking for local solutions, including traditional pharmacopoeia [8]. Binyom PR, et al. [9], in 2021, in their work on the impact of covid-19 on surgical activities in confessional hospitals in Cameroon showed a decrease in hospital attendance and that awareness of covid-19 is necessary to reduce the psychosis of the populations attending surgical services. It should be noted that his work covered the years 2018, 2019, 2020 [8]. This work does not show the state of surgical practice in Cameroon after COVID-19 [9]. Cameroon has been one of the African countries with a high infection rate [10]. As there is no epidemiological study on the impact of COVID-19 on urological activities before, during and after the COVID-19 period, it was decided to study the epidemiological profile of the urology and andrology department of the Yaoundé Central Hospital during the COVID-19 pandemic.

Materials and Methods

This was an observational, retrospective and mono- centric study that took place in the Urology and Andrology Department of Yaounde Central Hospital over a three-year period from 2019 to 2022. The study population consisted of all records of individuals admitted to the Urology and Andrology Department of Yaounde Central Hospital. The Urology and Andrology Department of the Yaounde Central Hospital used to have 5 urologists and 18 nurses but the staff has decreased considerably since the COVID-19 pandemic either due to health reorganisation or staff infections with COVID-19. Within the department, there is a surgical activity and a medical and hospital activity.

All patients admitted to the Urology and Andrology Department of the Yaounde Central Hospital were included in the study, regardless of their pathology. Any patient whose records were incomplete was not included. The variables used were demographic factors (age, sex, ethnic origin, and profession), reason for hospitalisation and diagnosis. The patient records collected were separated into three groups. The first group of patients consisted of records of patients admitted in 2019, the second group included records of patients admitted during the year 2020 in the midst of the COVID-19 pandemic, which was marked by a lockdown from March to May 2020 and the reorganisation of the health system, and the third group included records of patients admitted in 2021, which is a period marked by better management of the health crisis, with no return to lockdowns, and a decrease in the number of COVID-19 patients. The collected data were studied with SPSS20.

Results

Throughout the study, 429 records were collected after excluding 67 incomplete records. This Figure 1 shows that attendance has decreased slightly during the pandemic context at COVID-19. But in 2021, the number of patients received was higher than before the pandemic.

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This result shows that the average age of the patients received remained similar before and during the COVID-19 pandemic, and also in the year following the COVID-19 confinements (Table 1) [6].

The rate of children hospitalised decreased slightly with the pandemic but increased in 2021, while the rate of adults decreased in 2021 (Table 2).

The number of patients coming for consultation has remained similar for all periods, but there is an increase in male consultations and a decrease in female consultations in 2021 (Table 3).

This table shows that the majority of patients received come from the central and western regions of the country in all periods. The percentages remained similar in all three periods. No foreigners were received at the height of the pandemic (Table 4).

Serving civil servants and retired civil servants were the most common occupations during the Covid-19 pandemic. However, during the COVID-19 pandemic, the most common occupation other than those mentioned above was that of tradesmen and farmers. It can also be seen that hospital admissions of people working on their own account or on behalf of another person increased over time (Table 5).

Surgical cases were the main hospital admission even in the year when the COVID-19 pandemic started. Surgical activity remained the most important part of the hospital practice despite the COVID-19 pandemic (Table 6).

In 2019, in adult surgery, Trans urethral resection of the prostate followed by the cure of varicocele was the most common procedure. In children’s surgery, hydrocele cure was the most common procedure, followed by testicular lowering for cryptorchidism and hypospadias cure. In 2020, in adult surgery, varicocele cure followed by Trans urethral resection of the prostate was the most common. In children’s surgery, testicular abduction for cryptorchidism was the most common procedure, followed by hydrocele cure. In 2021, surgical activity predominated. In adult surgery, Trans urethral resection of the prostate followed by the cure of varicocele was the most common. As for paediatric surgery, testicular lowering for cryptorchidism was the most common procedure, followed by hydrocele and hypospadias cure. The surgical activity has rather increased over time while the rate of urological emergencies has rather decreased (Table 7).

Discussion

There are a low number of patients admitted to hospital in 2020. These figures were revised upwards in 2021. These results show that the single containment that took place from March to May 2020 in Cameroon had an impact on the rate of patient admission to the ward. This is confirmed by the increase in the number of patients in 2021, while the pandemic is not over. This is in line with the study by Quaglio G, et al. [11] who concluded that the pandemic has led to a reduction in the use of health services in sub-Saharan Africa [6].

Conclusion

The COVID-19 pandemic had an impact on the rate of patients coming for consultation when a health system was sought to overcome it. The population that presented during the pandemic was a young population, originating from Central and Western Cameroon and the majority was civil servants. As for the functioning of the service, the surgical activity was the most practiced (elective surgery) and there was a progressive increase in paediatric surgery despite the COVID-19 pandemic.