RESUMEN
BACKGROUND: Cameroon, a country in sub-Saharan Africa, ranks among the top 15 countries worldwide with the highest number of zero-dose (unvaccinated) children. Among other reasons, pockets of hard-to-reach communities that traditionally miss essential healthcare services, including childhood immunization, largely contribute to this sub-optimal vaccination coverage. This is the case of Manoka Health District (MHD), an archipelago district with a zero-dose proportion of 91.7%. High disease burdens such as malaria and water-borne diseases have forced the population to depend on herbalists and roadside drug vendors, eroding trust in the primary healthcare system and worsening vaccine hesitancy. This study, therefore, aims to describe how a project optimized vaccine demand generation in these hard-to-reach settlements using an integrated community health worker service delivery package developed using the Community-oriented primary healthcare (COPC) model. METHODOLOGY: This cross-sectional descriptive study was based on data collected from November 2021 to August 2022 in three project-implementing health areas (Kombo Moukoko, Kooh, and Toube) in the Manoka health district. Data was collected on the integrated health packages offered by Community Health Workers (CHWs). It comprised health education on malaria and water-borne diseases, screening for malaria using Rapid Diagnostic Test (RDT), treatment of under-5 for uncomplicated malaria and diarrhea, conduct of essential Antenatal Care (ANC) services, and vaccination counseling and referral in the three health areas. Microsoft Excel 2013 was used to analyze descriptive data and expressed results as percentages, with tables and column charts used for data visualization. All missing data were considered in the final analysis. RESULTS: Over 550 under-5 children and 187 pregnant women were identified to be in need of curative and preventive care services during the project period. About 81% of pregnant women received a minimum ANC package by CHWs, and 47% adhered to referrals to health facilities for continuous ANC and delivery. Half of the children under 5 with health issues were diagnosed and managed for uncomplicated malaria. Also, during home visits, 617 under-immunized and zero-dose children less than two years of age were identified, referred, and vaccinated either during an outreach program or at the nearest health post in a neighboring health area, representing about 64% (617/964) of under-2 children identified in these communities. There was a gradual increase from 0% vaccine acceptance post-referral in the first month to 47% after six months and 64% at one year of intervention. CONCLUSION: The use of the COPC model to co-develop integrated essential health service packages that meet the needs of communities showed value in building trust and increasing childhood immunization uptake in hard-to-reach communities.
RESUMEN
BACKGROUND: Tetanus constitutes a significant cause of death in sub-Saharan Africa, with case fatality rates as high as 64%, 47%, and 43.1% reported in Nigeria, Uganda, and Tanzania, respectively. However, the knowledge gap on factors that influence tetanus mortality still exists in Cameroon. OBJECTIVE: To identify the factors that influence the mortality of tetanus patients in three regional hospitals in the North West and South West Regions of Cameroon. METHODOLOGY: This was a 7-year retrospective case-series study. Socio-demographic and clinical data of tetanus cases admitted in Bamenda, Buea, and Limbe Regional Hospitals from January 2010 to March 2017 were collected and analysed. RESULTS: This study recorded 38 cases, but excluded five due to missing inpatient files. Of the 33 cases considered in this study, 27 (81.8%) were males. The mean age of the patients was 32 years. A tetanus mortality rate of 48.5% was recorded - thus, 16 tetanus-related deaths. Mortality was higher amongst patients with incubation periods less than 7 days; the onset of trismus and generalized spasms less than 8 days after exposure; the presence of autonomic dysfunction; the presence of respiratory dysfunction; application or introduction of local regimens, soil or animal waste at the portal of entry; delayed debridement greater than 2 days after onset of tetanus; and a severe clinical disease state. CONCLUSION: This study, therefore, highlights the need to ensure universal vaccination coverage for high-risk populations; males, active population (20-40 years), and farmers. More still, this study emphasizes the need to improve access and utilisation of mechanical ventilation in severe tetanus cases.
