RESUMO
BACKGROUND: The COVID-19 pandemic has been associated with significant psychological and social distress worldwide. We investigated fear and depression among adults in Cameroon during different phases of the COVID-19 outbreak. METHODS: An online survey was conducted in Cameroon from June-December 2020 using a structured questionnaire. Socio-demographic data and information regarding COVID-19 history were obtained. Fear and depressive symptoms were assessed using the Fear of COVID-19 score (FCV-19S) and the Patient Health Questionnaire (PHQ-9), respectively. Responses were clustered in weeks to better appreciate their evolution over time. RESULTS: Overall, 7381 responses from all ten regions of Cameroon were analysed (median age: 30 years, 73.3% male). The prevalence of depression (PHQ-9 score ≥ 10) was 8.4%, and that of high fear of COVID-19 (FCV-19S scores ≥19) was 57.4%. These rates were similar across genders, age-groups, and region of residence. While mean weekly PHQ-9 scores remained fairly stable throughout the study period (range: 2.53-3.21; p = 0.101), mean FCV-19S scores were highest during the early weeks but decreased significantly thereafter (from 20.31 to 18.34; p < 0.001). Multivariate analyses revealed that having a postgraduate degree, a history of quarantine, flu-like symptoms during the past 14 days, and higher FCV-19S scores were associated with more severe depressive symptoms, while obtaining COVID-19 information from various sources reduced the odds for depression. CONCLUSION: Depression amidst the COVID-19 crisis is less prevalent in Cameroon than in other countries. Prompt and widespread dissemination of adequate COVID-19 information may reduce the risks for depression by dispelling fear and anxiety among Cameroonians.
Assuntos
COVID-19 , Pandemias , Adulto , Camarões/epidemiologia , Depressão/epidemiologia , Medo , Feminino , Humanos , Masculino , SARS-CoV-2RESUMO
BACKGROUND: Epilepsy affects at least 50 million individuals worldwide, especially in sub-Saharan Africa (sSA). Cognitive impairment is common in people with epilepsy (PWE) yet, little is known on the burden of cognitive impairment in people with epilepsy in sSA. This study was thus designed to assess cognitive impairment in PWE or epilepsy-associated neurocognitive disorders (EAND) in a rural population in Cameroon. METHODS: This was a case-control study including PWE and age/sex-matched healthy controls from July to September 2017 in Bilomo, a village in the Mbam and Kim Division. The Montreal Cognitive Assessment (MoCA), International HIV Dementia Scale (IHDS), Dubois' Five Word testing, Frontal Assessment Battery (FAB), Isaac's Set Test and the Clock drawing test were administered to the study participants to evaluate global and specific cognitive functions. RESULTS: Eighty participants were included (40 cases and 40 controls) with a mean age of 25.78â¯years. Using the MoCA, 87.5% of cases had cognitive impairment, against 37.5% of controls (pâ¯<â¯0.001; OR 11.67; CI 3.40-45.09). Using the IHDS, the prevalence of global cognitive impairment was 84.6% among the cases against 40% for the controls (pâ¯=â¯<0.001; OR 7.07; CI 2.29-29.19). Specifically, executive function deficits (92.5% of cases vs 40.0% of controls pâ¯=â¯<0.001 ORâ¯=â¯18.50 CI; 4.48-105.08) and decreased verbal fluency (100% of cases against 45% of controls pâ¯<â¯0.001) were the most affected cognitive domains. Longer duration of epilepsy and higher seizure frequency were associated with global cognitive impairment. Low level of education was associated with both decreased verbal fluency and executive dysfunction while a longer stay in Bilomo correlated with poor results on the Isaac's Set Test. CONCLUSION: The prevalence of cognitive impairment appears to be much higher in PWE in the Mbam valley, particularly decreased executive function and verbal fluency, than in people without epilepsy. Longer disease duration, higher seizure frequency, low level of education and length of stay in Bilomo are associated with poorer cognitive performance. More studies are needed to refine evaluation tools to better characterize and manage EAND in sSA.
Assuntos
Epilepsia , Oncocercose , Adulto , África Subsaariana , Camarões/epidemiologia , Estudos de Casos e Controles , Epilepsia/epidemiologia , Epilepsia/etiologia , Humanos , Transtornos Neurocognitivos , Testes Neuropsicológicos , População RuralRESUMO
BACKGROUND: A high prevalence of epilepsy has been observed in several onchocerciasis-endemic countries, including Cameroon. However, little is known on the clinical presentations of the affected persons with epilepsy (PWE). A community-based study was conducted with the aim of describing the spectrum of seizures in selected onchocerciasis-endemic villages in Cameroon and documenting relevant medical history in patients with onchocerciasis-associated epilepsy (OAE). METHODS: We carried out door-to-door surveys in 5 onchocerciasis-endemic villages in Cameroon and recruited all consenting PWE. Epilepsy was diagnosed using a 2-step approach consisting of the administration of a standardized 5-item questionnaire followed by confirmation of the suspected cases by a neurologist. Onchocerciasis-associated epilepsy was defined as ≥2 seizures without an obvious cause, starting between the ages of 3-18â¯years in previously healthy persons having resided for at least 3â¯years in an onchocerciasis-endemic area. Ivermectin use by PWE was verified. Seizure history, relevant past medical, and family history, as well as neurological findings, were noted. RESULTS: In all, 156 PWE were recruited in the 5 villages. The modal age group for epilepsy onset was 10-14â¯years. The diagnostic criteria for OAE were met by 93.2% of the PWE. Participants had one or more of the following seizure types: generalized tonic-clonic seizures (89.1%), absences (38.5%), nodding (21.8%), focal nonmotor (7.7%), and focal motor seizures (1.9%). One case (0.6%) with the "Nakalanga syndrome" was identified. More than half (56.4%) of PWE had at least one seizure per month. In one village, 56.2% of PWE had onchocercal skin lesions. CONCLUSION: People with epilepsy in onchocerciasis-endemic villages in Cameroon present with a wide clinical spectrum including nodding seizures and Nakalanga features. A great majority of participants met the diagnostic criteria for OAE, suggesting that better onchocerciasis control could prevent new cases. Epilepsy management algorithms in these areas must be adjusted to reflect the varied seizure types.
Assuntos
Epilepsia/diagnóstico , Epilepsia/epidemiologia , Oncocercose/diagnóstico , Oncocercose/epidemiologia , Adolescente , Adulto , Algoritmos , Camarões/epidemiologia , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Anamnese/métodos , Pessoa de Meia-Idade , Prevalência , Inquéritos e Questionários , Adulto JovemRESUMO
This case suggests that clinicians should consider seizures as a differential diagnosis of paroxystic cough with loss of consciousness. Focal cortical dysplasia should equally be screened for with magnetic resonance imaging (MRI) scans even in adults with epilepsy in sub-Saharan Africa.
RESUMO
BACKGROUND: Sleep apnea syndrome (SAS), a growing public health threat, is an emerging condition in sub-Saharan Africa (SSA). Related SSA studies have so far used an incomplete definition. This study is aimed at assessing SAS using an American Academy of Sleep Medicine (AASM) complete definition and at exploring its relationship with comorbidities, among patients hospitalized in a Cameroonian tertiary hospital. METHODS: This cross-sectional study was conducted in cardiology, endocrinology, and neurology departments of the Yaoundé Central Hospital. Patients aged 21 and above were consecutively invited, and some of them were randomly selected to undergo a full night record using a portable sleep monitoring device, to diagnose sleep-disordered breathing (SDB). SAS was defined as an apnea - hypopnea index (AHI) ≥ 5/h, associated with either excessive daytime sleepiness or at least 3 compatible symptoms. Moderate to severe SAS (MS-SAS) stood for an AHI ≥ 15/h. We used chi-square or Fisher tests to compare SAS and non-SAS groups. Findings. One hundred and eleven patients presented a valid sleep monitoring report. Their mean age ± standard deviation (range) was 58 ± 12.5 (28-87) years, and 53.2% were female. The prevalence (95% confident interval (CI)) of SAS was 55.0 (45.7, 64.2)% and the one of MS-SAS 34.2 (25.4, 43.1)%. The obstructive pattern (90.2% of SAS and 86.8% of MS-SAS) was predominant. The prevalence of SAS among specific comorbidities ranged from 52.2% to 75.0%. Compared to SAS free patients, more SAS patients presented with hypertension (75.4% vs. 48.0%, p = 0.005%), history of stroke (36.7% vs. 32.0%, p = 0.756), cardiac failure (23.0% vs. 12.0%, p = 0.213), and combined cardiovascular comorbidity (80.3% vs. 52.0%, p = 0.003). Similar results were observed for MS-SAS. Metabolic and neuropsychiatric comorbidities did not differ between SAS and SAS-free patients. CONCLUSION: The SAS diagnosed using modified AASM definition showed high prevalence among patients hospitalized for acute medical conditions, as it was found with SDB. Unlike HIV infection, metabolic and brain conditions, cardiovascular comorbidities (hypertension and cardiac failure) were significantly more prevalent in SAS patients.
RESUMO
OBJECTIVE: Epilepsy is highly prevalent in onchocerciasis-endemic African regions. Various types of epilepsy have been described in such regions based essentially on clinical characteristics. METHODS: We conducted a clinical, neurophysiological and neuropsychological study of epilepsy in the onchocerciasis-endemic region of Ntui, Sanaga-Mbam area, Cameroon. RESULTS: One hundred and eighty-seven persons with presumed epilepsy were recruited in an epilepsy clinic in Ntui. Epilepsy was clinically confirmed in 144 (79%) subjects, 69 (46.0%) of them met the onchocerciasis-associated epilepsy (OAE) criteria, and 51 of 106 tested (48.1%) presented Ov16 antibodies. Electroencephalograms (EEG) were recorded in 91 participants, of which 36 (33%) were considered abnormal and 27 of 36 (75%) revealed bifrontotemporal spike and slow waves. Concerning the neuropsychological evaluation, 29% showed severe global cognitive impairment, 28% severe episodic memory impairment, and 66% severe frontal cognitive impairment. Half of the persons with epilepsy (PWE) suffered from a mental disorder. SIGNIFICANCE: In PWE in the Sanaga-Mbam area in Cameroon, we observed EEG patterns similar to those described among persons with OAE, including nodding syndrome in other onchocerciasis-endemic areas. Most PWE presented with severe cognitive impairment. We hypothesize that onchocerciasis may induce neurocognitive disorders and epilepsy via a mechanism that involves mainly the frontal and temporal regions of the brain.
Assuntos
Epilepsia , Síndrome do Cabeceio , Oncocercose , Camarões/epidemiologia , Eletroencefalografia , Epilepsia/epidemiologia , Humanos , Oncocercose/complicações , Oncocercose/epidemiologiaRESUMO
We reported recently that the elevated plus maze is a good tool for evaluating cognitive and motor functional changes in gamma-irradiated rats as a model for new drug evaluation and monitoring. The capacity of Garcinia kola to mitigate radiation-induced brain injury is currently unknown. We therefore assessed the effects of the neuroprotective medicinal plant Garcinia kola, on the cognitive and motor changes in this murine model of acute radiation syndrome. Wistar rats exposed once to an ionizing dose of Tc99m-generated Gamma radiation were treated with an ethyl acetate fraction of methanolic extract of Garcinia kola seeds (content of 100 mg/kg of extract) for 9 weeks. Cognitive and motor function indicators were assessed in the elevated plus maze in these animals and compared with irradiated control groups (vitamin C- and vehicle-treated groups) and the non-irradiated control rats. The irradiated control group displayed cachexia, shaggy and dirty fur, porphyrin deposits around eyes, decreased exploratory activity, reduced social interactions and a loss of thigmotaxis revealed by a marked decrease in rearing episodes and stretch attend posture episodes close to the walls of elevated plus maze closed arm, an increased central platform time, and decreases in open arm time and entries. This group further displayed a decrease in head dips and grooming episodes. Treatment with Garcinia kola, and in a lesser extent vitamin C, significantly prevented the body weight loss (P < 0.001) and mitigated the development of elevated plus maze signs of cognitive and motor affections observed in the irradiated control group (P < 0.05). Altogether, our data suggest for the first time that Garcinia kola seeds have protective properties against the development of cognitive and motor decline in the acute radiation syndrome-like context. Future studies are warranted to characterize the molecular mechanisms and neuronal networks of this action.
RESUMO
Since March 2020, the Cameroonian government implemented nationwide measures to stall COVID-19 transmission. However, little is known about how well these unprecedented measures are being observed as the pandemic evolves. We conducted a six-month online survey to assess the preventive behaviour of Cameroonian adults during the COVID-19 outbreak. A five-point adherence score was constructed based on self-reported observance of the following preventive measures: physical distancing, face mask use, hand hygiene, not touching one's face, and covering the mouth when coughing or sneezing. Predictors of adherence were investigated using ordinal logistic regression models. Of the 7381 responses received from all ten regions, 73.3% were from male respondents and overall mean age was 32.8 ± 10.8 years. Overall mean adherence score was 3.96 ± 1.11 on a scale of 0-5. Mean weekly adherence scores were initially high, but gradually decreased over time accompanied by increasing incidence of COVID-19 during the last study weeks. Predictors for higher adherence included higher age, receiving COVID-19 information from health personnel, and agreeing with the necessity of lockdown measures. Meanwhile, experiencing flu-like symptoms was associated with poor adherence. Continuous observance of preventive measures should be encouraged among Cameroonians in the medium- to long-term to avoid a resurgence in COVID-19 infections.
Assuntos
COVID-19 , Adulto , Camarões/epidemiologia , Controle de Doenças Transmissíveis , Estudos Transversais , Humanos , Masculino , SARS-CoV-2 , Inquéritos e Questionários , Adulto JovemRESUMO
OBJECTIVE: This study was designed as part of a series of studies mandated by the Cameroon Ministry of Public Health (National Epilepsy Control Program) to obtain new data for improvement of the epilepsy teaching program in schools training health personnel in the South West Region of Cameroon. METHOD: A 12-item semistructured questionnaire was self-administered to 340 student nurses and laboratory assistants in five training schools for health personnel in the South West Region of Cameroon. RESULTS: All of them had heard about epilepsy, 86.5% knew someone with epilepsy, 88.5% had witnessed a seizure, but only 48.8% had read about epilepsy. About 33% and 52% would, respectively, object to their children associating with and marrying people with epilepsy (PWE). About 15.3% believed that epilepsy is a form of insanity, 10% thought epilepsy is contagious, 67.4% (P<0.001) would recommend medical treatment for epilepsy, 22% would offer prayers only, and 6% would recommend traditional medicine. Independent predictors of attitudes were: acquaintance with someone with epilepsy, knowledge of the cause of epilepsy, the belief that epilepsy is contagious or is a form of insanity, being male, and being in the first year of studies. CONCLUSION: The knowledge level in this student sample is high, but the relatively low proportion of respondents who have read about epilepsy suggests that the observed high level of awareness of epilepsy may be from knowledge gained in the community; thus, there exist knowledge gaps. Therefore, a teaching course on epilepsy needs to be introduced into the curriculum of these training schools as early as the first year of studies. The course content must take into account the belief and value systems of the community and address misconceptions about epilepsy.
Assuntos
Epilepsia/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Pessoal de Laboratório Médico/psicologia , Estudantes de Enfermagem/psicologia , Adulto , Camarões/epidemiologia , Distribuição de Qui-Quadrado , Epilepsia/epidemiologia , Feminino , Inquéritos Epidemiológicos , Humanos , Masculino , Valor Preditivo dos Testes , Reconhecimento Psicológico , Autoimagem , Inquéritos e Questionários , Adulto JovemRESUMO
BACKGROUND: Experimental models are needed to better understand the pathophysiology of neurodegenerative diseases to develop novel therapeutics. The neuropathology and clinical signs of acute radiation syndrome resemble those of neurodegenerative conditions. We characterized elevated plus maze (EPM) indicators of cognitive and motor impairment in rats exposed to brain-damaging doses of gamma radiation to develop a model for neurological component of the acute radiation syndrome. MATERIALS AND METHODS: Technetium 99 m was administered once through tail vein to male Wistar rats to reach an absorbed dose of Gamma radiation of 667 mGy (66.7Rad). Animal performance in the EPM was assessed every 14 days. Rats were observed for 9 weeks for the occurrence of systemic and neurological signs. Comparisons were done between irradiated and nonirradiated rats, and in each group with baseline performance. RESULTS: EPM indicators of cognitive and motor impairment, anxiety, and depression were observed concomitantly and increased with the severity of acute radiation syndrome-like systemic and neurological signs. Alterations in EPM indicators appeared 3 weeks postirradiation and their severity increased with time. Notably, arm transitions and the distance covered in the maze were decreased (-56.71% and -73.62%, P < 0.001), as well as open arm entries and time spent in open arms (-77.78% and -76.19%, P < 0.05) and the indicator of thigmotaxis rearing (-92.45, P < 0.001). CONCLUSIONS: Our results suggest that irradiated rat performance in the EPM paradigm reflects disease severity and could be used to perform both acute and subchronic pharmacological studies in acute radiation syndrome-like diseases in rats.
RESUMO
BACKGROUND: A high epilepsy prevalence has been reported in several onchocerciasis-endemic villages along the Mbam and Sanaga river valleys in Cameroon, including Bilomo and Kelleng. We sought to determine the prevalence of epilepsy in these two villages following more than 13 years of community-directed treatment with ivermectin (CDTI). METHODS: Door-to-door surveys were performed on the entire resident population in the villages in August 2017 and January 2018. Epilepsy was diagnosed using a 2-step approach: administration of a standardized 5-item questionnaire followed by confirmation by a neurologist. Previously published diagnostic criteria for onchocerciasis-associated epilepsy (OAE) were used. Ov16 serology was done for children aged 7-10 years to assess onchocerciasis transmission. Findings were compared with previous data from these two villages. RESULTS: A total of 1525 individuals (1321 in Bilomo and 204 in Kelleng) in 233 households were surveyed in both villages. The crude prevalence of epilepsy was 4.6% in Bilomo (2017) and 7.8% in Kelleng (2018), including 12 (15.6% of cases) persons with epilepsy (PWE) with nodding seizures. The age and sex-standardized prevalence in Kelleng decreased from 13.5% in 2004 to 9.3% in 2018 (P < 0.001). The median age of PWE shifted from 17 (IQR: 12-22) years to 24 (IQR: 20-30) years in Bilomo (P < 0.001); and slightly from 24 (IQR: 14-34) years to 28 (IQR: 21.25-36.75) years in Kelleng (P = 0.112). Furthermore, 47.6% of all tested children between 7 and 10 years had Ov16 antibodies. CONCLUSIONS: There is a decrease in epilepsy prevalence after 13 years and more of CDTI in both villages. The age-shift observed in PWE suggests that ivermectin may prevent OAE in younger residents. Ov16 seropositivity in children indicates ongoing onchocerciasis transmission possibly due to suboptimal control measures. Our findings support the existence of OAE in Cameroon and highlight the need to strengthen onchocerciasis elimination programs.