Global progress on the elimination of viral hepatitis as a major public health threat: An analysis of WHO Member State responses 2017.

In 2016, the World Health Assembly passed a resolution to eliminate viral hepatitis as a public health threat by 2030. We aimed to examine the status of the global viral hepatitis response. METHODS: In 2017, the World Health Organization (WHO) asked the Ministries of Health in all 194 Member States to complete a Country Profile on Viral Hepatitis policy uptake indicators, covering national plans/funding, engagement of civil society, testing guidance, access to treatment, and strategic information. RESULTS: Of 194 Member States, 135 (70%) responded, accounting for 87% of the global population infected with hepatitis B virus (HBV) and/or C virus (HCV). Of those responding, 84 (62%) had developed a national plan, of which, 49 (58%) had dedicated funding, and 62 (46%) had engaged with civil society; those engaged with civil society were more likely to have a funded plan than others (52% vs. 23%, p = 0.001). Guidance on testing pregnant women (for HBV) and people who inject drugs (for HCV) was available in 70% and 46% of Member States, respectively; 59% and 38% of Member States reported universal access to optimal therapies for HBV and HCV, respectively. CONCLUSIONS: Most people living with hepatitis B and C reside in a country with a national hepatitis strategy. Governments who engaged with civil society were more advanced in their response. Member States need to finance these national strategies and ensure that those affected have access to hepatitis services as part of efforts to achieve universal health coverage. LAY SUMMARY: The World Health Organization's goal to eliminate viral hepatitis as a public health threat by 2030 requires global action. Our results indicate that progress is being made by countries to scale-up national planning efforts; however, our results also highlight important gaps in current policies.

Factors influencing the performance of routine immunization in urban areas: A comparative case study of two cities in Cameroon: Douala and Yaoundé.

Urban areas are often omitted from investigations on immunization because the published literature tends to focus on rural settings. The two largest cities in Cameroon - Douala and Yaoundé - are the main drivers of the high number of unvaccinated children in Cameroon. The objective of our study was to identify the factors influencing vaccine incompleteness in Douala and Yaoundé in children (12-23 months of age). We conducted a community-based cross-sectional study using concomitant mixed methods (qualitative and quantitative) with an explanatory aim. The study was conducted in three health districts in each city between March and April 2016. The number of nonvaccinated and incompletely vaccinated children was higher in Yaoundé (3.1% and 40.3%, respectively) than in Douala (0.7% and 10.1%, respectively). The most frequent reason for nonvaccination was related to the parent/guardian not knowing the consequences of not being vaccinated and lack of money. According to the explanatory model, nonvaccination in both cities was associated with the following issues: (1) perceived high visibility of the health district office in terms of vaccination, (2) the shortage of health personnel in immunization centers, (3) attending a private health facility, (4) average or poor behavior of health personnel at immunization centers, and (5) poor knowledge of vaccine-preventable diseases. This mixed-methods study illustrates how inadequacies of the health district framework within urban areas are fueling poor performance of routine immunization in Cameroon. Further research should inform the development of community-centered vaccination services that are most needed, especially in rapidly urbanizing sub-Saharan Africa.

Strong decrease in streptomycin-resistance and absence of XDR 12 years after the Reorganization of the National Tuberculosis Control Program in the Central Region of Cameroon.

BACKGROUND: In the 1990s, resistance rates of 15% for streptomycin-resistance and 0.6% for multidrug-resistance (MDR) were reported from the Central Region of Cameroon. This work assesses drug resistant tuberculosis in this region 12 years after reorganization of the National Tuberculosis Control Program (NTCP). METHODS: This cross-sectional study was conducted from April 2010 to March 2011 in Jamot Hospital in Yaoundé, Cameroon. Only patients with smear positive pulmonary tuberculosis were included. Sputa were cultured and subsequently underwent drug susceptibility testing (DST). All consenting individuals were tested for their HIV status. RESULTS: A total of 665 smear positive pulmonary tuberculosis patients were enrolled. The HIV prevalence was 28.5% (95%CI [25.2-32.1]). Of the 582 sputa that grew Mycobacterium tuberculosis complex species, DST results were obtained for 576. The overall resistance rate was 10.9% (63/576). The overall resistance rates for single drug resistance were: isoniazid-resistance 4.7% (27/576), streptomycin-resistance 3.3% (19/576), rifampicin-resistance 0.2% (1/576), kanamycin-resistance 0.2% (1/576) and ofloxacin-resistance 0.2% (1/576). The MDR rate was 1.1% (6/576) and no extensively drug resistant tuberculosis (XDR) was detected. CONCLUSIONS: The data show that reorganization of the NTCP resulted in a strong decrease in streptomycin-resistance and suggest that it prevented the emergence of XDR in the Central Region of Cameroon.

SMS reminders to improve the tuberculosis cure rate in developing countries (TB-SMS Cameroon): a protocol of a randomised control study.

BACKGROUND: Tuberculosis is a public health problem in Cameroon, just like in many other countries in the world. The National Tuberculosis Control Programme (PNLT) put in place by the state, aims to fight tuberculosis through the implementation of international directives (Directly Observed Treatment Short, DOTS). Despite the deployment of this strategy across the world, its implementation is difficult in the context of low-resource countries. Some expected results are not achieved. In Cameroon, the cure rate for patients with sputum positive pulmonary tuberculosis (TPM+) after 6 months is only about 65%, 20% below the target. This is mainly due to poor patient adherence to treatment. By relying on the potential of mobile Health, the objective of this study is to evaluate the effect of SMS reminders on the cure rate of TPM + patients, measured using 6-month bacilloscopy. METHODS/DESIGN: This is a blinded, randomised controlled multicentre study carried out in Cameroon. The research hypothesis is that sending daily SMS messages to remind patients to take their prescribed tuberculosis medication, together with the standard DOTS strategy, will increase the cure rate from 65% (control group: DOTS, no SMS intervention) to 85% (intervention group: DOTS, with SMS intervention) in a group of new TPM + patients. In accordance with each treatment centre, the participants will be randomly allocated into the two groups using a computer program: the intervention group and the control group. A member of the research team will send daily SMS messages. Study data will be collected by health professionals involved in the care of patients. Data analysis will be done by the intention-to-treat method. DISCUSSION: The achieving of expected outcomes by the PNLT through implementation of DOTS requires several challenges. Although it has been demonstrated that the DOTS strategy is effective in the fight against tuberculosis, its application remains difficult in developing countries. This study explores the potential of mHealth to support DOTS strategy. It will gather new evidence on the effectiveness of mHealth-based interventions and SMS reminders in the improvement of treatment adherence and the cure rate of tuberculosis patients, especially in a low-resource country such as Cameroon. TRIAL REGISTRATION: The trial is registered on the Pan-African Clinical Trials Registry (http://www.pactr.org) under unique identification number: PACTR201307000583416.

Assessment of organizational measures to prevent nosocomial tuberculosis in health facilities of 4 sub-Saharan countries in 2010.

BACKGROUND: The prevention of tuberculosis (TB) transmission in healthcare settings is a major issue, particularly because of the interaction between human immunodeficiency virus and TB and the emergence of multidrug-resistant TB. SETTING: Healthcare facilities involved in TB management in 4 African countries (Benin, Cameroon, Cote d'Ivoire, and Togo). METHODS: A questionnaire was developed by representatives of the 4 countries to evaluate the organizational measures implemented in facilities involved in TB management. On-site visits were performed between July 2010 and July 2011. RESULTS: A total of 115 facilities, including 10 university hospitals and 92 basic management units, were visited. None had a TB infection control plan, and only 5.2% provided education for staff about nosocomial TB. Overall, 48.3% of the facilities performed triage of suspected TB cases on hospital arrival or admission, 89.6% provided education for TB cases on cough etiquette, 20.0% segregated smear-positive TB cases, and 15.7% segregated previously treated cases. A total of 15.5% of the facilities registered TB among staff, for a global prevalence rate of 348 cases per 100,000 staff members. CONCLUSION: This survey identified simple and mostly costless administrative measures to be urgently implemented at the local level to prevent nosocomial TB, such as staff education, triage on admission, and segregation of previously treated patients.