In-Field Implementation of Near-Infrared Quantitative Methods for Analysis of Medicines in Tropical Environments.

Near-infrared (NIR) spectroscopy is actually a well-established technique that demonstrates its performance in the frame of detection of poor-quality medicines. The use of low-cost handheld NIR spectrophotometers in low-resource contexts can allow an inexpensive and more rapid detection compared to laboratory methods. Considering these points, it was decided to develop, validate, and transfer methods for the quantification of ciprofloxacin and metronidazole tablet samples using a NIR handheld spectrophotometer in transmission mode (NIR-M-T1) coupled to chemometrics such as partial least squares regression (PLSR) algorithm. All of the models were validated with the total error approach using an accuracy profile as a decision tool, with ±10% specifications and a risk α set at 5%. Quantitative PLSR models were first validated in Belgium, which is a temperate oceanic climate zone. Second, they were transferred to Cameroon, a tropical climate zone, where issues regarding the prediction of new validation series with the initial models were highlighted. Two augmentation strategies were then envisaged to make the predictive models robust to environmental conditions, incorporating the potential variability linked to environmental effects in the initial calibration sets. The resulting models were then used for in-field analysis of ciprofloxacin and metronidazole tablet samples collected in three cities in Cameroon. The contents results obtained for each sample with the two strategies were close and not statistically different. Nevertheless, the first one is easier to implement and the second is the best regarding model diagnostic measures and accuracy profiles. Two samples were found to be noncompliant in terms of content, and these results were confirmed using high-performance liquid chromatography taken as the reference method.

Evaluation of the Antimicrobial Resistance Surveillance System in Sentinel Sites in Cameroon.

Background The purpose of antimicrobial resistance (AMR) surveillance is to guide clinical decision-making, characterize trends in resistance infections, and provide epidemiological data to study the impact of AMR on health and the effectiveness of control measures in health facilities and the community. To do this, regular and relevant assessments of standardized AMR surveillance systems are essential to prioritize threats and improve their performance and cost-effectiveness. The scarcity of data and the absence of a local and national strategy on the surveillance of antibiotic resistance in Sub-Saharan Africa and even more so in Cameroon do not allow an effective response to be carried out against the scourge. This gap led us to conduct a study on the evaluation of the attributes of the antibiotic resistance surveillance system in Cameroon. Methodology We conducted a descriptive, cross-sectional study over a period of one year from January to December 2021. The study was conducted in the sentinel sites of surveillance in Cameroon, namely, those of the Centre, South-West, Littoral, and North regions. Using structured questionnaires and a pre-established and pre-tested interview guide, we collected data that allowed us to assess a surveillance system's quantitative and qualitative attributes according to the CDC guidelines. Scores were assigned based on the different questionnaires to assess the attributes of the AMR surveillance system. Results Of the evaluated attributes, it appears that although the system is useful (88.9%, i.e., a score of 2), and has good completeness of data transmission (98.9%, i.e., a score of 3), it is not simple (64.3%, i.e., a score of 1), not stable (58.6%, i.e., a score of 1), not acceptable (58.6%, i.e., a score of 1), and presents poor data quality (11.05%, a score of 1). Conclusions The AMR surveillance system in Cameroon is useful with good completeness. However, many other attributes have poor performance, indicating the importance of improving the antimicrobial surveillance system.

Antibiotic consumption history of patients in a referred laboratory in Yaounde.

Background: Regulation of antibiotic prescription and consumption remains a major public health burden in low- and middle- income countries. Objective: This study aimed to describe the antibiotic consumption of patients who had a positive antibiotic culture in a reference laboratory. Methods: A retrospective descriptive study was conducted among 113 participants with positive antibiograms with a documented history of antibiotics intake at the Yaoundé University Teaching Hospital in Cameroon between January 2016 and June 2021. Data were stored and analyzed using the Census and Survey Processing System version 7.3 and Statistical Package for Social Science version 25.0. Descriptive statistics were used to estimate the indicators. Results: Of the 113 patients enrolled, 105 had a history of drug use; 56 participants (53.3%) had taken at least 2 antibiotics prior to sampling. Cephalosporins were the most consumed antibiotics (41%), followed by nitroimidazols (28.6%) and penicillins (28.6%). According to the World Health Organization classification, 55 (52.4%) took major priority antibiotics. Conclusion: We are on the alert and there is an urgent need to raise awareness among clinicians and patients alike by providing them with good clinical practice guidelines.

Poor-Quality Medicines in Cameroon: A Critical Review.

Poor-quality medicines are the cause of many public health and socioeconomic problems. We conducted a review to acquire an overview of the situation concerning such medicines in Cameroon. Different searches were performed on databases from several websites of the WHO, the Ministry of Public Health of Cameroon, the Anti-Counterfeit Medicine Research Institute, the Global Pharma Health Fund, and the Infectious Disease Data Observatory. We identified 92 publications comprised of 19 peer-reviewed studies and 73 alerts. Based on studies completed, 1,664 samples were analyzed, and the prevalence of substandard and falsified (SF) medicines could be estimated for 1,440 samples. A total of 67.5% of these samples were collected from the informal sector, 20.9% from the formal sector, and 11.6% from both sectors. We found a prevalence of SF medicines across the peer-reviewed studies of 26.9%, whereas most of the SF medicines belonged to the anti-infective class. The problem of SF medicines is not studied sufficiently in Cameroon; therefore, efforts should be made to conduct adequate studies in terms of representativity and methodology.

Knowledge, practices and attitudes on antibiotics use in Cameroon: Self-medication and prescription survey among children, adolescents and adults in private pharmacies.

Benefits of antibiotics are threatened by the self-medication, people's lack of knowledge and inappropriate use of antibiotics, especially in developing countries. This study was designed to determine knowledge; attitudes and practices toward antibiotics use in an urban community, and evaluate the factors that are associated with antibiotic use. Between January and March 2015, a cross sectional and prospective study was conducted in all pharmacies within the Douala IV health district, Cameroon. Anonymous interviews including both open and closed ended questions were conducted in participants selected by convenience sampling Descriptive and logistic regression analysis were performed using StataSE11 software (version 11 SE) and R software (version 3.1.1) in data analysis. Overall 402 (33.7%) of 1,192 customers purchased antibiotics and of these, 47% bought antibiotics without a prescription. 60.7% of purchased antibiotics was for adult 'patients and around 60% of parents carried out self-medication on their children. The vast majority reported that all microbes can be treated with antibiotics (88.3%). The belief that antibiotics are appropriate for bacterial infections was more common among those with a higher level education (OR = 4.03, 95%CI:1.89-8.57, p<0.0001) and among public/private servants (OR = 2.47, 95%CI:1.21-5.08, p = 0.013). Physicians provide less explanations about antibiotics are and their potential side effects than the pharmacy auxiliaries (OR = 0.205, 95%CI = 0.09-0.46, p<0.0001), but more than pharmacists (OR = 3.692, 95%CI:1.44-9.25, p = 0.005). Indications on antibiotics use were 7 times more given to customers with a prescription compared to those without a prescription (OR = 7.37, 95% CI = 2.13-25.43, p = 0.002). Adult male (OR = 2.32, 95%CI:1.24-4.34, p = 0.009) and higher education (OR = 2.05, 95%CI:1.08-3.89, p = 0.027) were significantly associated with self-medication. Misuse, little "practical knowledge" and high self-medication confirm the unsatisfactory prescription and dispensing practices of the antibiotics in our country. These results highlight the important of the development and implementation appropriate guidelines for the responsible use of antibiotics for health care providers and health education targeting community members themselves.