Chlamydia trachomatis -Specific Antibody Responses in Women in Cameroon With Secondary Infertility.

ABSTRACT: The contribution of chlamydia to secondary infertility in women is poorly understood. Among 404 female participants enrolled in a previous study in Cameroon, 142 had secondary infertility (cases) and 262 were pregnant with no history of infertility (controls) , Chlamydia trachomatis seropositivity was 92%. Seropositivity did not significantly differ by case/control status.

Assessing the determinants of Ebola virus disease transmission in Baka Community of the Tropical Rainforest of Cameroon.

BACKGROUND: Ebola virus disease (EVD) is a severe, often fatal illness in humans and nonhuman primates caused by the Ebola virus. The recently approved rVSV-EBOV vaccine is not available in many high-risk countries hence prevention is paramount. The design of effective prevention interventions requires an understanding of the factors that expose communities at risk. It was based on this that we investigated the Baka community of Abong-Mbang Health District in tropical rain forest of Cameroon. METHODS: A cross-sectional study was conducted with participants randomly selected from 13 villages in Abong-Mbang by multi-stage cluster sampling. A questionnaire was administered to them to collect demographic information, data on knowledge of EVD, their feeding and health-seeking behaviour. Data was analyzed using the chi-square test. Knowledge of EVD was assessed using an 8 item Morisky Scale. An adapted Threat Capability Basic Risk Assessment Guide was used to determine their risk of exposure to infection. RESULTS: A total of 510 participants, most of whom were hunters (31.4%), farmers (29.8%), and had primary education (62.7%), were included in this study. Although 83.3% participants had heard of EVD, most (71%) did not know its cause. Their source of information was mainly informal discussions in the community (49%). Misconceptions were identified with regards to the cause and mode of transmission. Only 43.1% accepted EVD could be transmitted from human-to-human. Generally, participants' knowledge of EVD was poor. Demographic factors such as level of education, occupation and ethnic group significantly affected knowledge of EVD. The majority of participants were at a very high risk of exposure to infection as they consumed various forms of bush meat and were involved in other risky practices such as scarification and touching of corpses. Although over half of participants seek medical care, most of them preferred traditional medicine. Socio-cultural and service-related factors were deterrent factors to medical care. CONCLUSION: Participants generally had poor knowledge of EVD and were at high risk of infection. We recommend rigorous sensitization campaigns in the study area to educate the population on EVD and clarify the misconceptions identified. EVD surveillance is recommended particularly as outbreaks have often been reported in the Congo Basin.

Prevalence, antimicrobial susceptibility pattern and associated risk factors for urinary tract infections in pregnant women attending ANC in some integrated health centers in the Buea Health District.

BACKGROUND: Urinary tract infections (UTIs) are the second most frequent infections after respiratory tract infections that affect humans, with over 150 million cases per year. The anatomy of the female urinary tract predisposes them to UTIs than men. More so, physiological and hormonal changes during pregnancy put pregnant woman at risk of UTIs. Untreated UTI(s) in pregnancy can be detrimental to both the mother and child causing preterm labour, low birth weight and pyelonephritis. The situation is worrisome because the infection can be asymptomatic. This study investigated the prevalence and risk factors for UTIs, diagnostic potential of dipstick analyses and antimicrobial susceptibility of uropathogens from pregnant women attending ANC in some Integrated Health Centers (IHCs) in Buea Health District (BHD). METHODS: A structured questionnaire was administered to consenting pregnant women at participating IHCs to collect data on demographic characteristics, risk factors and symptoms of UTI. Urine samples were collected for dipstick analysis and culture. Antibiograms were performed on the isolates by the disc diffusion method. A bivariate analysis was performed to investigate the association of the risk factors to UTI. Chi square (χ2) test, odds ratios with corresponding 95% confidence intervals were used to compare statistics and test for associations at a significant level of p ≤ 0.05. RESULTS: Of the 287 participants recruited, 89(31%) were positive for UTI. There were 150 women with no symptoms of which 43(28.7%) were positive for UTI. E. coli was the most frequent (43.2%) of the organisms implicated in bacteriuria. There was no significant association between the risk factors studied and UTI. Isolates were most sensitive to ciprofloxacin (73.5%) and gentamycin (73.5%) and resistant to ceftriaxone (70.6%) and tetracycline (64.7%). Nitrite test was highly specific (100%) for the diagnosis of UTI while leucocyte esterase was more sensitive (48.3%) than specific (44.9%). CONCLUSIONS: The prevalence of UTI in BHD was high. In conformity with previous findings in same area, there were no risk factors associated with UTI. We recommended a longitudinal study with a larger sample size to follow up the women to term in order to determine the gravity of this infection on pregnancy outcomes.

Molecular epidemiology of noroviruses in children under 5 years of age with acute gastroenteritis in Yaoundé, Cameroon.

Norovirus is a common cause of acute gastroenteritis (AGE) among children in developing countries. Limited data on the prevalence and genetic variability of norovirus are available in Cameroon, where early childhood mortality due to AGE is common. We tested 902 fecal specimens from children younger than 5 years of age hospitalized with AGE between January 2010 and December 2013. Overall, 76 (8.4%) samples tested positive for norovirus, of which 83% (63/76) were among children below 12 months old. Most of the noroviruses detected were in children infected between July and December of each year. All norovirus-positive specimens were genotyped, with 80% (61/76) being GII.4 (three variants detected). Genotypes GI.2, GI.6, GII.1, GII.2, GII.3, GII.6, GII.16, GII.17, and GII.21 were also detected. Interestingly, GII.4 Sydney and GII.17 Kawasaki viruses were found as early as 2010, years before their emergence globally. This study suggests norovirus is a significant cause of moderate to severe gastroenteritis among young children in Cameroon. The results are important to highlight appropriate prevention and control strategies for reducing the burden of norovirus disease.

Prevalence of bacterial vaginosis and associated risk factors in pregnant women receiving antenatal care at the Kumba Health District (KHD), Cameroon.

BACKGROUND: Bacterial vaginosis (BV) is a common reproductive tract disorder in women of child bearing age, accounting for one third of vaginal infections. It is characterized by an increase in vaginal pH, decreased Lactobacilli, and overgrowth of facultative and anaerobic bacteria. Studies have consistently shown BV to be a risk factor for adverse obstetric and gynecological outcomes. BV is believed to play a critical role in the transmission of sexually transmitted infections. Its aetiology and risk factors are poorly understood. This study determined the prevalence and risk factors for BV among pregnant women in Kumba Health District (KHD) Cameroon to generate findings that could guide the design of interventions for prevention of infection and associated poor pregnancy outcomes. METHODS: A structured questionnaire was administered to 309 women seeking antenatal care (ANC) in three health facilities in KHD between May to July 2016, to capture data on demographic, gynecological and obstetric characteristics, and hygiene behavior. High vaginal swabs (HVS) collected from these women were gram stained, examined under a microscope and BV evaluated by Nugent scoring. Chi square (χ2) test was used to determine the relationship between BV and factors investigated. Statistical significance was set at p < 0.05. RESULTS: The prevalence of BV was 26.2%. Nine point 1 % of participants had a mixed infection with Candida. BV was higher (29.5%) in participants from the rural area (χ2 = 8.609. P = 0.014), those who did not use antibiotics (31.9%) prior to the study (χ2 = 12.893, P = 0.002) and women with no history of a genital tract infection (χ2 = 18.154, P = 0.001). There was a significant difference in prevalence with respect to gestation age (χ2 = 13.959, P = 0.007) with the highest occurring in women in the second trimester (31.7%). Women who practiced douching (χ2 = 23.935, P = 0.000) and those who did not wash pants with disinfectant (χ2 = 7.253, P = 0.027) had a high prevalence. CONCLUSION: BV could be a health concern among pregnant women in study area. BV prevalence was affected by some hygiene behaviors, socio-demographic and clinical factors. Screening and treatment of positive cases during antenatal visits to prevent adverse outcomes, as well as education of women on vaginal hygiene is highly recommended.

Antimicrobial resistance from a one health perspective in Cameroon: a systematic review and meta-analysis.

BACKGROUND: Antimicrobial resistance (AMR) is widely acknowledged as a global health problem, yet in many parts of the world its magnitude is not well elucidated. A baseline assessment of the AMR prevalence is a priority for implementation of laboratory-based AMR surveillance This review, focused on a One health approach, aimed at describing the current status of AMR in Cameroon. METHODS: PubMed, Google Scholar and African Journals Online databases were searched for articles published in English and French in accordance with the PRISMA guidelines. Retrieval and screening of article was done using a structured search string with strict inclusion/exclusion criteria. Free-text and grey literature were obtained by contacting the authors directly. The pooled prevalence and 95% confidence intervals were calculated for each pathogen-antibiotic pairs using random-effects models. RESULT: Amongst 97 full-text articles reviewed, 66 met the eligibility criteria. The studies originated from the Centre (24; 36.4%), South-West (16; 24.2%), West (13; 19.7%), Littoral (9; 13.6%) and other (4; 6.1%) regions of Cameroon. These studies reported AMR in human (45; 68.2%), animals (9; 13.6%) and the environment (12; 18.2%). Overall, 19 species of bacteria were tested against 48 antibiotics. These organisms were resistant to all classes of antibiotics and showed high levels of multidrug resistance. Escherichia coli, Klebsiella pneumoniae and Staphylococcus spp were reported in 23, 19 and 18 of the human studies and revealed multidrug resistance (MDR) rates of 47.1% [95% CI (37.3-57.2%)], 51.0% [95% CI (42.0-59.9)] and 45.2% [95% CI (38.0-54.7)], respectively. Salmonella spp was reported in 6 of the animal studies and showed a MDR rate of 46.2% [95% CI (39.2-53.5%)] while Staphylococcus spp in 8 of environment studies showed MDR rate of 67.1% [95% CI (55.2-77.2%)]. CONCLUSION: This review shows that resistance to commonly prescribed antibiotics in Cameroon is high. The findings emphasize the urgent need to address gaps in the standardization of AMR diagnostics, reporting and use of available information to optimize treatment guidelines for the arsenal of antibiotics. Effective AMR surveillance through continued data sharing, large-scale collaboration, and coordination of all stakeholders is essential to understand and manage the AMR national burden.

Genetic characterization of influenza B virus in Cameroon and high frequency of reassortant strains.

Influenza B is broadly divided into B/Victoria and B/Yamagata lineages based on its genetic and antigenic properties. We describe in this study the first report on genome characterization of type B influenza virus in the Cameroon National Influenza Center (NIC) between 2014 and 2017. Respiratory samples were collected as part of the influenza surveillance activity in the NIC. RNA products were tested for the presence of influenza using the CDC Influenza A/B typing panel. Thirty-five samples positive for influenza B were selected for sequencing three gene segments (HA, NA, and M) and phylogenetic trees were generated by MEGA version 6.0. Nucleotide phylogenetic analysis of the HA gene revealed the presence of three major clades among Cameroonian strains. All Victoria lineages grouped into B/Victoria clade 1A, while, Yamagata lineages grouped into Yamagata clade 2 (2014 strains) and Yamagata clade 3 (2015-2017). We observed a high frequency of reassortant viruses with Yamagata-like HA gene and Victoria-like NA gene (27.4%; 23/84). The results from this study confirm variations in the genome composition of type B influenza virus and emphasize on the relevance of molecular surveillance for spotting peculiar genetic variants of public health and clinical significance.

Knowledge, attitudes and practices regarding HIV/AIDS among senior secondary school students in Fako Division, South West Region, Cameroon.

BACKGROUND: Knowledge, attitudes and practices (KAPs) regarding HIV/AIDS is one of the corner stones in the fight against the disease. Youths are most vulnerable to infection because they engage in risky practices due to a lack of adequate information. Thus, evaluating their KAPs will help in designing appropriate prevention strategies. This study was aimed at assessing the KAPs of senior secondary school students in Fako Division, Cameroon, on HIV/AIDS. METHODS: This was a cross-sectional study carried out on 464 students aged 13-25 years, selected by systematic quota random sampling from some secondary schools in Fako, from April to June 2014, to evaluate their KAPs regarding HIV/AIDS. Participants were drawn from one secondary school in each of the four health districts in Fako. Pre-tested questionnaires were administered to the students to obtain information about their KAPs on HIV/AIDS. Data were analyzed using SPSS version 20.0. RESULTS: All respondents were aware of HIV/AIDS. Sources of information varied, the most common being sex education in school. The majority of participants demonstrated an adequate understanding of HIV transmission and prevention. However, misconceptions about routes of transmission were observed in 3.4 to 23.3 % of respondents. Risky behaviors were found among participants as about 60 % practice safe sex and 40 % reported not to. Up to 196 (42.2 %) respondents had a history of sexual intercourse of which 108 (56.25 %) had used a condom during their last three sexual encounters. About half of the respondents had negative views about HIV infected people. Students with medium (34.3 %) and high (62.1 %) levels of knowledge were more likely to display positive attitudes Although statistically not significant, we found that as knowledge increased the ability of respondents to report safer sex decreased (95 % CI, P = 0.922). CONCLUSIONS: Students had a satisfactory level of knowledge on HIV/AIDS prevention. Those with adequate knowledge were more likely to display positive attitudes towards PLHIV. Having adequate knowledge did not imply engaging in safe practices. This study none-the-less highlighted some misconceptions about HIV transmission, intolerant and discriminatory attitudes towards PLHIV, and risky sexual practices among study participants which can be corrected by reinforcing sex education curriculum as sex education in school was their main source of information on HIV/AIDS.

Water sources as reservoirs of Vibrio cholerae O1 and non-O1 strains in Bepanda, Douala (Cameroon): relationship between isolation and physico-chemical factors.

BACKGROUND: Cholera has been endemic in Douala since 1971. Most outbreaks start from Bepanda, an overcrowded neighbourhood with poor hygiene and sanitary conditions. We investigated water sources in Bepanda as reservoirs of Vibrio cholerae, the causative agent of cholera, determined its antibiotic susceptibility and some physico-chemical characteristics that could maintain the endemicity of this organism in Bepanda. METHODS: Three hundred and eighteen water samples collected from 45 wells, 8 taps and 1 stream from February to July 2009 were analyzed for V. cholerae using standard methods. Isolates were characterized morphologically, biochemically and serologically. The disc diffusion technique was employed to investigate antibiotic susceptibility. Differences in prevalence of organism between seasons were analysed. Correlation strength and direction of association between physico-chemical parameters and occurrence of V. cholerae was analyzed using the Kendall tau_b non-parametric correlation. This was further confirmed with the forward-stepwise binary logistic regression. RESULTS: Eighty-seven (27.4%) samples were positive for V. cholerae. Isolation was highest from wells. The organism was isolated in the rainy season and dry season but the frequency of isolation was significantly higher (χ2 = 7.009, df = 1, P = 0.008) in the rainy season. Of the 96 confirmed V. cholerae isolates, 32 (33.3%) belonged to serogroup O1 and 64 (66.6%) were serogroup non-O1/non-O139. Isolates from tap (municipal water) were non-O1/non-O139 strains. Salinity had a significant positive correlation with isolation in the dry season (+0.267, P = 0.015) and rainy season (+0.223, P = 0.028). The forward-stepwise method of binary logistic regression indicated that as pH (Wald = 11.753, df = 1), P = 0.001) increased, odds of isolation of V. cholerae also increased (B = 1.297, S.E = 0.378, Exp(B) = 3.657). All isolates were sensitive to ciprofloxacin and ofloxacin. Multi-drug resistance was predominant among the non-O1/non-O139 isolates. CONCLUSION: V. cholerae was found in wells and stream in both seasons. Cholera will continue to be a health threat in Bepanda if intervention measures to prevent outbreak are not implemented. Continuous monitoring of water sources in this and other cholera high-risk areas in Cameroon is necessary, for a better preparedness and control of cholera.

Exposure to bovine livestock and latent tuberculosis infection in children: Investigating the zoonotic tuberculosis potential in a large urban and peri-urban area of Cameroon.

Bovine tuberculosis (bTB), a neglected zoonotic disease, is endemic in cattle in many Sub-saharan African countries, yet its contribution to tuberculosis (TB) burden is understudied. Rapid urbanisation and increase in demand for animal proteins, including dairy products, increases the risk of spill over. This study compared the latent tuberculosis infection (LTBI) risk in children, a proxy-measure for recent TB infection, in children living in high cattle density areas to children from the general population in Cameroon. Cross-sectional study in the Centre Region of Cameroon in 2021, recruiting 160 children aged 2-15 years, stratified by exposure to livestock, people treated for pulmonary TB (PTB) and the general community. Veinous blood was tested for LTBI using QuantiFERON-TB Gold-Plus. Prevalence were calculated and the association to exposure and other risk factors investigated using logistic regression models. The crude LTBI prevalence were 8.2% in the general population, 7.3% in those exposed to cattle and 61% in pulmonary TB household contacts. After adjusting for confounding and sampling design, exposure to cattle and exposure to pulmonary TB were associated with higher risk of LTBI than the general population (respectively odds ratio (OR): 3.56, 95%CI: 0.34 to 37.03; and OR: 10.36, 95%CI: 3.13 to 34.21). Children frequently consuming cow milk had higher risk of LTBI (OR: 3.35; 95%CI 0.18 to 60.94). Despite limited statistical power, this study suggests that children exposed to cattle in a setting endemic for bTB had higher risk of LTBI, providing indirect evidence that Mycobacterium bovis may contribute to TB burden.

Methicillin-Resistant Staphylococcus aureus Carriage among Neonate Mothers, Healthcare Workers, and Environmental Samples in Neonatal Intensive Care Units: A Systematic Review.

Background: Methicillin-resistant Staphylococcus aureus (MRSA) is a significant cause of morbidity and mortality among neonates admitted to neonatal intensive care units (NICUs). The MRSA colonization of neonates, attributed to various sources, including mothers, healthcare workers, and environmental surfaces, can lead to severe infection, prolonged hospital stays, and even death, imposing substantial economic burdens. Given the pressing need to mitigate MRSA spread in these vulnerable environments, further examination of the subject is warranted. This systematic review is aimed at synthesizing available evidence on MRSA carriage proportions among mothers of newborns, healthcare workers, and environmental surfaces in NICUs. Methodology. We included observational studies published in English or French from database inception to March 21, 2023. These studies focused on MRSA in nonoutbreak NICU settings, encompassing healthy neonate mothers and healthcare workers, and environmental surfaces. Literature search involved systematic scanning of databases, including Medline, Embase, Web of Science, Global Health, and Global Index Medicus. The quality of the selected studies was assessed using the Hoy et al. critical appraisal scale. The extracted data were summarized to calculate the pooled proportion of MRSA positives, with a 95% confidence interval (CI) based on the DerSimonian and Laird random-effects model. Results: A total of 1891 articles were retrieved from which 16 studies were selected for inclusion. Most of the studies were from high-income countries. The pooled proportion of MRSA carriage among 821 neonate mothers across four countries was found to be 2.1% (95% CI: 0.3-5.1; I2 = 76.6%, 95% CI: 36.1-91.5). The proportion of MRSA carriage among 909 HCWs in eight countries was determined to be 9.5% (95% CI: 3.1-18.4; I2 = 91.7%, 95% CI: 87.1-94.6). The proportion of MRSA carriage among HCWs was highest in the Western Pacific Region, at 50.00% (95% CI: 23.71-76.29). In environmental specimens from five countries, a pooled proportion of 16.6% (95% CI: 3.5-36.0; I2 = 97.7%, 95% CI: 96.6-98.4) was found to be MRSA-positive. Conclusion: With a significant heterogeneity, our systematic review found high MRSA carriage rates in neonate mothers, healthcare workers, and across various environmental surfaces in NICUs, posing a potential risk of nosocomial infections. Urgent interventions, including regular screening and decolonization of MRSA carriers, reinforcing infection control measures, and enhancing cleaning and disinfection procedures within NICUs, are crucial. This trial is registered with CRD42023407114.

Multi-drug resistant toxigenic Vibrio cholerae O1 is persistent in water sources in New Bell-Douala, Cameroon.

BACKGROUND: Cholera has been endemic in Douala, since 1971 when it was first recorded in Cameroon. Outbreaks have often started in slum areas of the city including New Bell. Despite the devastating nature of outbreaks, always resulting in high mortality and morbidity, a paucity of information exists on the reservoirs of the causative agent, V. cholerae, and factors maintaining its persistence. This has complicated disease prevention, resulting in frequent outbreaks of cholera. We investigated water sources in New Bell for contamination with V. cholerae O1 with pathogenic potential, to highlight their role in disease transmission. Antibiotic susceptibility pattern of isolates and the environmental factors maintaining its persistence were investigated. METHOD: Water samples from various sources (taps, dug wells, streams) were analyzed for contamination with V. cholerae O1 using standard methods. Antibiotic susceptibility was determined by disc diffusion method. Pathogenic potential of isolates was determined by analyzing for genes for cholera toxin (ctx), toxin co-regulated pilus (tcpA), and zonula occludens toxin (zot) by PCR. Physico-chemical characteristics of water (pH, temperature and salinity) were investigated using standard methods. The Spearman's Rank correlation was used to analyze the relationship between physico-chemical factors and the occurrence of V. cholerae O1. Differences were considered significant at P≤0.05. RESULTS: Twenty-five V. cholerae O1 strains were isolated from stream and well samples in both dry and rainy seasons. Twenty-three (92%) isolates were multidrug resistant. All isolates had genes for at least one virulence factor. Cholera toxin gene was detected in 7 isolates. Of the 15 isolates positive for tcpA gene, two had Classical type tcpA while 13 had tcpA El Tor. All tcpA Classical positive isolates were positive for ctx gene. Isolates were grouped into nine genotypes based on the genes analyzed. pH and salinity significantly correlated with isolation of V. cholerae O1. CONCLUSION: Multidrug resistant Vibrio cholerae O1 with pathogenic potential is present in some wells and streams in study area. pH and salinity are among the factors maintaining the persistence of the organism. Findings indicate an urgent need for potable water supply in study area and in addition, regular disinfection of water from contaminated sources to prevent outbreak of cholera.

Assessment of the relationship between bacteriological quality of dug-wells, hygiene behaviour and well characteristics in two cholera endemic localities in Douala, Cameroon.

BACKGROUND: Access to potable water is grossly inadequate in Douala-Cameroon. The situation is worse in slum areas, compelling inhabitants to obtain water from sources of doubtful quality. This has contributed to frequent outbreaks of water-borne diseases particularly cholera, which results in severe morbidity and mortality. Shallow wells are a major source of water in these areas. We analyzed the influence of some factors on the bacteriological quality of well water in Bepanda and New Bell, cholera endemic localities in Douala to generate data that would serve as basis for strengthening of water and health policies. METHODS: Questionnaires were administered to inhabitants of study sites to appraise their hygiene and sanitation practices, and level of awareness of waterborne diseases. The bacteriological quality of water was determined by investigating bacterial indicators of water quality. Relationship between well characteristics and bacteriological quality of water was determined using χ² test. The Kendall tau_b nonparametric correlation was used to measure the strength of association between well characteristics and bacteriological parameters. Statistics were discussed at 95% confidence level. Antibiotic susceptibility of isolates was investigated by the Kirby-Bauer and broth dilution techniques. Multidrug resistant species were tested for extended ß-lactamase production potential. RESULTS: Inhabitants demonstrated adequate knowledge of waterborne diseases but employed inappropriate method (table salt) for well disinfection. Well construction and location violated guidelines. Indicator bacterial counts greatly exceeded the WHO guidelines. Variation in bacteriologic parameters between sites was not significant (P > 0.05) since well characteristics and hygiene and sanitary practices were similar. Differences in bacteriologic quality with respect to state of well, and presence of molded casing and lid, and height of casing were not significant (P > 0.05). Well distance from sanitary structure negatively correlated with bacteriological characteristics indicating it could be a major contributory factor to poor water quality. Bacteria isolated were predominantly enteric organisms. Ciprofloxacin was the most active agent. Extended ß-lactamase producers were detected among Salmonella species, Citrobacter fruendii and E. coli. CONCLUSION: Poor well location, construction, and hygiene and sanitary practices were among the factors affecting water quality. There is an urgent need for education of inhabitants on effective water disinfection strategies and for regular monitoring of wells.

A mapping review of methicillin-resistant Staphylococcus aureus proportions, genetic diversity, and antimicrobial resistance patterns in Cameroon.

BACKGROUND: The emergence of methicillin-resistant Staphylococcus aureus (MRSA) has increased and poses a significant threat to human and animal health in Cameroon and the world at large. MRSA strains have infiltrated various settings, including hospitals, communities, and livestock, contributing to increased morbidity, treatment costs, and mortality. This evidence synthesis aims to understand MRSA prevalence, resistance patterns, and genetic characterization in Cameroon. METHODS: The methodology was consistent with the PRISMA 2020 guidelines. Studies of any design containing scientific data on MRSA prevalence, genetic diversity, and antimicrobial resistance patterns in Cameroon were eligible for inclusion, with no restrictions on language or publication date. The search involved a comprehensive search strategy in several databases including Medline, Embase, Global Health, Web of Science, African Index Medicus, and African Journal Online. The risk of bias in the included studies was assessed using the Hoy et al tool, and the results were synthesized and presented in narrative synthesis and/or tables and graphs. RESULTS: The systematic review analyzed 24 studies, mostly conducted after 2010, in various settings in Cameroon. The studies, characterized by moderate to low bias, revealed a wide prevalence of MRSA ranging from 1.9% to 46.8%, with considerable variation based on demographic and environmental factors. Animal (0.2%), food (3.2% to 15.4%), and environmental samples (0.0% to 34.6%) also showed a varied prevalence of MRSA. The genetic diversity of MRSA was heterogeneous, with different virulence gene profiles and clonal lineages identified in various populations and sample types. Antimicrobial resistance rates showed great variability in the different regions of Cameroon, with notable antibiotic resistance recorded for the beta-lactam, fluoroquinolone, glycopeptide, lincosamide, and macrolide families. CONCLUSION: This study highlights the significant variability in MRSA prevalence, genetic diversity, and antimicrobial resistance patterns in Cameroon, and emphasizes the pressing need for comprehensive antimicrobial stewardship strategies in the country.

Association between Chlamydia trachomatis, Neisseria gonorrhea, Mycoplasma genitalium, and Trichomonas vaginalis and Secondary Infertility in Cameroon: A case-control study.

OBJECTIVE: Data on the prevalence and etiology of infertility in Africa are limited. Secondary infertility is particularly common, defined as the inability of a woman to conceive for at least one year following a full-term pregnancy. We describe a prospective study conducted in Cameroon designed to test the hypothesis of an association between common treatable sexually transmitted infections (STI): Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), Mycoplasma genitalium (MG), and Trichomonas vaginalis (TV) and secondary infertility in women. METHODS: In this case-control study, we enrolled women in Fako Division, Cameroon between November 2017 and December 2018 with secondary infertility (cases) or current pregnancy (controls). We conducted a baseline survey to collect sociodemographic, and sexual and medical history information. Nucleic acid amplification testing using Aptima (Hologic, San Diego, CA, US) was performed on endocervical swabs for CT, NG, MG, and TV. Multivariable logistic regression was used to assess the relationship between active STI and secondary infertility. RESULTS: A total of 416 women were enrolled: 151 cases and 265 controls. Compared to controls, cases were older (median age 32 vs 27 years) and had more lifetime sexual partners (median 4 vs 3) (p<0.001). Cases were more likely to report dyspareunia, abnormal menses, prior miscarriage, and ectopic pregnancy (all p<0.05). STI positivity was not significantly different among cases and controls (2.7% vs 5.4% for CT, 1.3% vs 2.9% for NG, 6.0% vs 7.0% for MG, respectively), with the exception of TV which was more common in pregnant controls (0.7% vs 5%; p = 0.02). CONCLUSION: Study findings did not support an association between active STI and secondary infertility in Cameroon. Given high rates of pre-existing tubal damage, routine STI screening and treatment in younger women may be more impactful than costly STI testing during infertility assessments.

Dynamics of Antibodies to Ebolaviruses in an Eidolon helvum Bat Colony in Cameroon.

The ecology of ebolaviruses is still poorly understood and the role of bats in outbreaks needs to be further clarified. Straw-colored fruit bats (Eidolon helvum) are the most common fruit bats in Africa and antibodies to ebolaviruses have been documented in this species. Between December 2018 and November 2019, samples were collected at approximately monthly intervals in roosting and feeding sites from 820 bats from an Eidolon helvum colony. Dried blood spots (DBS) were tested for antibodies to Zaire, Sudan, and Bundibugyo ebolaviruses. The proportion of samples reactive with GP antigens increased significantly with age from 0-9/220 (0-4.1%) in juveniles to 26-158/225 (11.6-70.2%) in immature adults and 10-225/372 (2.7-60.5%) in adult bats. Antibody responses were lower in lactating females. Viral RNA was not detected in 456 swab samples collected from 152 juvenile and 214 immature adult bats. Overall, our study shows that antibody levels increase in young bats suggesting that seroconversion to Ebola or related viruses occurs in older juvenile and immature adult bats. Multiple year monitoring would be needed to confirm this trend. Knowledge of the periods of the year with the highest risk of Ebolavirus circulation can guide the implementation of strategies to mitigate spill-over events.

Predictors of Urinary Tract Infections in Children and Antibiotic Susceptibility Pattern in the Buea Health District, South West Region, Cameroon.

Urinary tract infections (UTI) are among the most common pediatric infections and if not promptly diagnosed and treated, it could cause long term complications. Worldwide and in Cameroon, little attention has been paid to this growing problem in the pediatric population. Identification of risk factors will contribute significantly to prevention. A cross-sectional case-control study was carried out in children ≤ 15 years to identify the risk factors of UTI, etiologic agents, and their antibiotic susceptibility. Samples (urine) were collected from in and outpatients with symptoms of UTI attending two health facilities in Buea. Controls were age- and sex-matched children in the community and those visiting these health facilities for unrelated reasons. Samples were analyzed by microscopy, culture, and antibiotic susceptibility of bacteria isolates tested by the disc diffusion technique. Questionnaires were administered to collect sociodemographic, clinical characteristics and data on risk factors. Odds ratios and bivariate and multivariate analyses were used to assess the relationship between predictors (symptoms and risk factors) and UTI. P < 0.05 was considered significant. A total of 405 participants (200 cases and 205 controls) were investigated. UTI prevalence was 12% in cases. From the UTI cases, bacteria was the major cause of infection, with E. coli (39.4%) predominating. Parasitic organisms, Trichomonas vaginalis (0.5%) and Schistosoma spp (0.5%), and yeast (6%) were also detected. Urinary urgency (F = 4.98, P = 0.027) and back pain (F = 12.37, P = 0.001) were associated to UTI following bivariate analysis. These parameters could be used to predict UTI in the pediatric population in the study area. Third generation cephalosporins: ceftriaxone (90.1%) and cefadroxil (85.4%) were the most effective and thus recommended for treatment.

Pathogenic Potential and Antimicrobial Resistance Profile of Staphylococcus aureus in Milk and Beef from the Northwest and Southwest Regions of Cameroon.

Staphylococcus aureus is a major foodborne pathogen and commensal of the skin and mucous membranes of animals and humans. Its virulence relies on the production of a variety of toxins resistant to denaturing conditions. Increasing reports of S. aureus food poisoning and contamination of foods of animal origin elsewhere necessitates the investigation of these foods in Cameroon, to implement safety measures. This cross-sectional study evaluated S. aureus contamination in milk and beef in the Northwest and Southwest Regions of Cameroon, where cow milk is usually not pasteurized before consumption, and beef is the main source of protein. The distribution of antibiotic-resistant isolates and those with enterotoxin-producing potential was also investigated to provide data of public health and food safety benefit. S. aureus was isolated from 39 raw milk and 250 beef samples by standard methods. Confirmation of isolates was by PCR to detect the nuc gene. S. aureus was investigated for classical staphylococcal enterotoxin (SE) genes (sea, seb, sec, sed, and see) by PCR. Their susceptibility to 9 antibiotics was tested by the disk diffusion method. The chi-square test was used to compare the contamination of samples, antibiotic resistance, and the distribution of SE genes. S. aureus was isolated from 11.1% of samples. Contamination was higher in milk (48%) than in beef (5.2%) (P < 0.001). The sea was the most frequently (90%) harboured gene. A large proportion of isolates (88%) harboured more than one virulence gene. Isolates were generally resistant to erythromycin (82%), vancomycin (80%), tetracycline (76%), and oxacillin (74%). Multidrug resistance (MDR) was common (92%). Milk and beef samples in study area were contaminated with MDR enterotoxigenic S. aureus strains and may constitute a potential hazard to consumers. Thus, the need for implementation of proper hygienic measures when handling these products and pasteurization of milk cannot be overemphasized.

Phenotypic characterization of human pathogenic bacteria in fish from the coastal waters of South West Cameroon: public health implications.

Increasing economic and recreational opportunities, attractive scenery and a perception of a better quality of life are luring people to the coast. Unfortunately, these activities together with the commensurate increase in population in the area inevitably result in pollution of coastal waters with excessive microorganisms and other pollutants. Microbial pollutants not only contaminate the coastal water but also aquatic food sources, thus posing a health risk to consumers. Fish is a major source of protein in Cameroon, especially in the coastal areas. In this study, we investigated the microbiological quality of fish from the Limbe and Tiko beaches in South West Cameroon from May to October 2007. We isolated human pathogenic bacteria from three anatomic sites (skin, gills, intestine) of 50 fish (150 specimens) and investigated their susceptibility patterns to a battery of antibiotics. Data were analyzed statistically using chi2 with significance set at p < .05. Eleven bacterial species were identified, including Escherichia coli type 1 (20.8%), Citrobacter fruendii (16.4%), Proteus vulgaris (13%), Klebsiella pneumoniae (12.1%), Klebsiella ozaenae (7.7%), Enterobacter cloacae (7.2%), Klebsiella oxytoca (5.8%), Serratia marcescens (4.8%), Serratia odorifera (4.8%), Hafnia alvei (4.4%) and Proteus penneri (2.9%). More contaminated fish were found at Limbe beach than at Tiko beach (61.4% versus 38.6%, respectively (p < .05)). When ranking contamination with respect to anatomic site, skin was the most contaminated (40.6%) specimen and gills the least (28.5%). Ciprofloxacillin, ofloxacillin, and cotrimoxazole were the most effective antibiotics against all isolates, exhibiting 100% sensitivity. Almost half of the isolates (45.7%) were resistant to ampicillin. The results of our study demonstrate that fish from the coastal waters of South West Cameroon are a source of human pathogenic and opportunistic bacteria; hence this finding has public health implications.

Phenotypic characterization of Salmonella typhimurium isolates from food-animals and abattoir drains in Buea, Cameroon.

Salmonella spp. have been extensively incriminated worldwide as common causes of bacterial gastroenteritis in humans, with food-animals serving as important reservoirs. The study was aimed at investigating cattle and pigs slaughtered in Buea as reservoirs of Salmonella Typhimurium and the susceptibility of isolates to antibiotics. In total, 230 specimens (comprising 50 each from the rectum, ileum, and gall bladder of cattle; and 10 each from same anatomical sites of pigs and 50 from abattoir drains) were analyzed for Salmonella using the standard microbiological, biochemical and serological techniques. Antibiotic susceptibility of the isolates was determined by the Kirby-Bauer disc-diffusion test. The isolates were characterized into biotypes using the API 20E kit, and results were analyzed using the chi-square test. Seventy-five (32.6%) of the 230 specimens were positive for S. Typhimurium, with pigs and abattoir drains presenting the highest level of isolation (40%). Biochemical typing grouped the isolates into five biotypes. Biotype I was the most prevalent (30.6%) while biotype IV was the least prevalent (9.3%) and was absent in samples from pigs. Antibiotic susceptibility studies revealed 14 antibiotypes based on antibiotics used in the study. The predominant antibiotype AMX DOX CEF was recorded in 13 (17.3%) of the isolates. Multidrug resistance (to four or more antibiotics) was recorded in 50.7% (38/75) of the isolates. The most active drugs were ciprofloxacin (98.6%), ofloxacin (93.3%), amikacin (90.6%), and gentamicin (84%). All the isolates (100%) were resistant to tetracycline and ampicillin. Cattle and pigs were found to be reservoirs of S. Typhimurium in the environment of Buea, Cameroon, implying that foods from these sources, if not properly handled, could serve as vehicles for its transmission to humans.