The effect of protecting women against economic shocks to fight HIV in Cameroon, Africa: The POWER randomised controlled trial.

BACKGROUND: Women in sub-Saharan Africa are disproportionately affected by the HIV epidemic. Young women are twice as likely to be living with HIV as men of the same age and account for 64% of new HIV infections among young people. Many studies suggest that financial needs, alongside biological susceptibility, are a leading cause of the gender disparity in HIV acquisition. New robust evidence suggests women adopt risky sexual behaviours to cope with economic shocks, the sudden decreases in household's income or consumption power, enhancing our understanding of the link between poverty and HIV. We investigated if health insurance protects against economic shocks, reducing the need for vulnerable women to engage in risky sexual behaviours and reducing HIV and sexually transmitted infection (STI) incidence. METHOD AND FINDINGS: We conducted a randomised controlled trial to test the effectiveness of a formal shock coping strategy to prevent HIV among women at high risk of HIV (registration number: ISRCTN 22516548). Between June and August 2021, we recruited 1,508 adolescent girls and women over age 15 years who were involved in transactional sex (n = 753) or commercial sex (n = 755), using snowball sampling. Participants were randomly assigned (1:1) to receive free health insurance for themselves and their economic dependents for 12 months either at the beginning of the study (intervention; n = 579; commercial sex n = 289, transactional sex n = 290) from November 2021 or at the end of the study 12 months later (control; n = 568; commercial sex n = 290, transactional sex n = 278). We collected data on socioeconomic characteristics of participants. Primary outcomes included incidence of HIV and STIs and were measured at baseline, 6 months after randomisation, and 12 months after randomisation. We found that study participants who engaged in transactional sex and were assigned to the intervention group were less likely to become infected with HIV post-intervention (combined result of 6 months post-intervention or 12 months post-intervention, depending on the follow-up data available; odds ratio (OR) = 0.109 (95% confidence interval (CI) [0.014, 0.870]); p = 0.036). There was no evidence of a reduction in HIV incidence among women and girls involved in commercial sex. There was also no effect on STI acquisition among both strata of high-risk sexual activity. The main limitations of this study were the challenges of collecting reliable STI incidence data and the low incidence of HIV in women and girls involved in commercial sex, which might have prevented detection of study effects. CONCLUSION: The study provides to our knowledge the first evidence of the effectiveness of a formal shock coping strategy for HIV prevention among women who engage in transactional sex in Africa, reinforcing the importance of structural interventions to prevent HIV. TRIAL REGISTRATION: The trial was registered with the ISRCTN Registry: ISRCTN 22516548. Registered on 31 July 2021.

Factors associated with the occurrence of maternal deaths in the West Region between 2020 - 2022: case control study.

WHO defines maternal mortality as any death of a woman occurring during pregnancy or within 42 days of its termination or after delivery. Our aim was to study the factors associated with the occurrence of maternal deaths in the West Region of Cameroon between 2020 and 2022. This was a case-control study. Cases consisted of maternal deaths that occurred during the study period. The controls for their part were made up of women who normally gave birth in the same health facilities from which the cases came and during the same period as the cases. The only exposure criterion being the status of death. The data useful for our investigation were collected respectively with the investigation sheets, audit reports and via interviews with the heads of the health facilities where the maternal deaths occurred with a view to considerably reducing information bias. Analysis were done with IBM-SPSS 25 and RStudio 2023.03.0. The West Region of Cameroon recorded 161 maternal deaths between 2020 and 2022. 67% of them were housewives. The most frequently identified causes were haemorrhage (ante-, per- and post-partum), followed far behind by complications and sepsis, with respective 42.2%, 12.4% and 10.6%. Slightly more than one child out of 10 had an abnormal presentation. Nearly 50% had a short labor (less than 10 hours), the partograph was used in 38% of the women, and the GATP practiced in 50.1% of them. Abnormal presentation of the fetus (aOR = 2.7 (95% CI: 1.4 - 5.1), p=0.002), failure to use the partograph (aOR = 4.4 (95% CI: 2 .6 - 7.4), p<0.001), the fact of not having an economic activity (aOR = 1.7 (95% CI: 1.0 - 2.7), p = 0.033), the fact of having taken less than 2 doses of VAT ( aOR = 2.8 (95% CI: 1.8 - 4.4), p<0.001) and the absence of practice of GATP (aOR = 1.6 (CI 95%: 1.0 - 2.6), p=0.040) were identified as factors that significantly favored the occurrence of maternal deaths. Several factors negatively influence the occurrence of maternal deaths in the West Region. Operational strategies such as continuous training of maternity ward staff, and the establishment of systematic maternal death audits and review meetings should be implemented to reduce and control these risk factors.

Knowledge and Attitudes of Population Living in Rural and Semi-Rural Areas towards Covid-19 :Case of the Menoua Division, Cameroon.

BACKGROUND: The pandemic situation the world is facing caused by the new SARS-Cov-2 continues to evolve and still represent a real problem. With more than eight thousand reported cases infection, Cameroon stands as the seventh most affected country in Africa. Prevention remains the best way to fight against this zoonosis. However, the limited information available about this infection is a great barrier to stopping the propagation of the virus within the population, especially in rural and semi-rural areas, where the lack of financial and material resources is a reality. This study aimed to assessing Awareness and attitudes of the population of the Menoua Division on COVID-19 infection. METHODS: A cross-sectional study was conducted from March 9 to April 15 2020 amongst the populations of rural and semi-rural areas of the Menoua Division. Data were collected using a questionnaire administered face to face to each participant. The analysis was carried out using the Statistical Analysis System software (SAS version 9.4). The significance threshold was set at a P value of less than 0.05. RESULTS: A total of 434 participants of which male majority (sex ratio 1.07) were included in this study. The most represented age group was [21 - 40] years old representing 40.29% of the participants. Approximately all participants (98.57%) were aware of the world emergency state due to Coronavirus. 75.56%, 91% and 90.93% of the participants knew respectively that having close contacts, kissing and touching the face with the hands could favor the transmission of the virus. However, nearly 91.14% were not aware of the clinical symptoms of the disease. Moreover, 85.02% responded that they would not be able to comply with the confinement measures if they were applied at national level. The level of awareness varied significantly according to the occupation (p=0.038) and the educational level (p<0.001)of the participants. CONCLUSION: The average level of awareness of the population of the Menoua Division on COVID-19 infection was relatively low. Overcoming this pandemic disease means ensuring the flow of the correct information towards the population. Community outreach activities focus on clinical manifestations and what to do in case of COVID-19 infection as well as material and financial support should be help the population to protect themselves effectively against pandemic, particularly in rural areas and surrounding.

Knowledge on STIs / HIV / AIDS, Stigma-Discrimination and sexual behaviors AMONG students of the University of Dschang, in Cameroon.

This study reports the results of a survey conducted among students of the University of Dschang, on STI/HIV/AIDS, the Stigma-Discrimination pair and sexual behaviors. METHODS: This was a descriptive cross-sectional study conducted during the months of January and February 2017. We collected data by a face to face questionnaire administered to students of the University of Dschang. The codification, process and analysis have been done using the software EPI-Info 7.3.1.1, with the threshold of significance set at 0.05. RESULTS: A total of 520 individuals participated in this survey, with more than half (62.7%, n = 326/520) aged between 20-30 years, with a male/female sex ratio of 1,031. The vast majority (83%, n = 418/520) of them were in the undergraduate cycle. The main modes of transmission cited included: the combination of items such as blood transfusion / soiled objects / Mother-to-child transmission/ unprotected sex for 36.3% of respondents (n = 186/516) although 21.9 % (n = 112/516) of them admitted not knowing any modes of transmission of STIs / HIV. Also, 74.2% (n = 386/520) of respondents were sexually active, with the estimated age of sex debut being over 18 years (53.9%; 208/386) for half of them. Of the 36.2% (n = 186/514) respondents who reported knowing someone with STI / HIV and AIDS, the first feeling they had with regards to them was pity (86.6%; n = 386/446), followed by fear in 11.7% (n = 52/446) of respondents but yet 40.2% (n = 208/518) admitted they have never heard of discrimination. CONCLUSION: Stigma and discrimination in the student milieu remains a major barrier to students' development who, becoming sexually active at a very early age, are more exposed to the risk of contracting STI / HIV. Sensitization actions should be implemented within university campuses and reproductive health courses for young adults, included in the academic curriculum for a significant reduction in the number of new infections.