Determinants of survival of adolescents receiving antiretroviral therapy in the Centre Region of Cameroon: a multi-centered cohort-analysis.

BACKGROUND: In spite of the global decreasing mortality associated with HIV, adolescents living with HIV (ADLHIV) in sub-Saharan Africa still experience about 50% mortality rate. We sought to evaluate survival rates and determinants of mortality amongst ADLHIV receiving antiretroviral therapy (ART) in urban and rural settings. METHODS: A multi-centered, 10-year retrospective, cohort-study including ADLHIV on ART ≥ 6 months in the urban and rural settings of the Centre Region of Cameroon. Socio-demographic, clinical, biological, and therapeutic data were collected from files of ADLHIV. The Kaplan-Meier method was used to estimate survival probability after ART initiation; the log rank test used to compare survival curves between groups of variables; and the Cox proportional hazard model was used to identify the determinants of mortality. RESULTS: A total of 403 adolescents' records were retained; 340 (84%) were from the urban and 63 (16%) from the rural settings. The female to male ratio was 7:5; mean age (Standard deviation) was 14.1 (2.6) years; at baseline, 64.4% were at WHO clinical stages I/II, 34.9% had ≥ 500 CD4 cells/mm3, 91.1% were anemic, and the median [Inter Quartile Range] duration on ART was5.3 [0.5-16] years. The survival rate at 1, 5 and 10 years on ART was respectively 97.0%, 55.9% and 8.7%; with mean survival time of 5.8 years (95% CI 5.5-6.1). In bivariate analysis, living in the rural setting, non-disclosed HIV status, baseline CD4 count < 500 cells/mm3, not being exposed to nevirapine prophylaxis at birth and being horizontally infected were found to be the determinants of higher mortality with poor retention in care slightly associated with mortality. In multivariate analysis, living in rural settings, poor retention in care and anemia were independent predictors of mortality (p < 0.05). CONCLUSION: Although ADLHIV have good survival rate on ART after 1 year, we observe poor survival rates after 5 years and especially 10 years of treatment experience. Mitigating measures against poor survival should target those living in rural settings, anemic at baseline, or experiencing poor retention in care.

Programme quality indicators of HIV drug resistance among adolescents in urban versus rural settings of the centre region of Cameroon.

BACKGROUND: The high rate of mortality among HIV-vertically infected adolescents might be favoured by HIV drug resistance (HIVDR) emergence, which calls for timeous actions in this underserved population. We thus sought to evaluate program quality indicators (PQIs) of HIVDR among HIV-vertically infected adolescents on antiretroviral therapy (ART). METHODS: A study was conducted in the Centre region of Cameroon among adolescents (10-19 years) receiving ART in two urban (The Mother-Child Centre of the Chantal BIYA Foundation, the National Social Welfare Hospital) and three rural (Mfou District Hospital, Mbalmayo District Hospital and Nkomo Medical Center) health facilities. Following an exhaustive sampling from ART registers, patient medical files and pharmacy records, data was abstracted for seven PQIs: on-time drug pick-up; retention in care; pharmacy stock outs; dispensing practices; viral load coverage; viral suppression and adequate switch to second-line. Performance in PQIs was interpreted following the WHO-recommended thresholds (desirable, fair and/or poor); with p < 0.05 considered significant. RESULTS: Among 967 adolescents (888 urban versus 79 rural) registered in the study sites, validated data was available for 633 (554 in urban and 79 in rural). Performance in the urban vs. rural settings was respectively: on-time drug pick-up was significantly poorer in rural (79% vs. 46%, p = 0.00000006); retention in care was fair in urban (80% vs. 72%, p = 0.17); pharmacy stock outs was significantly higher in urban settings (92% vs. 50%, p = 0.004); dispensing practices was desirable (100% vs. 100%, p = 1.000); viral load coverage was desirable only in urban sites (84% vs. 37%, p < 0.0001); viral suppression was poor (33% vs. 53%, p = 0.08); adequate switch to second-line varied (38.1% vs. 100%, p = 0.384). CONCLUSION: Among adolescents on ART in Cameroon, dispensing practices are appropriate, while adherence to ART program and viral load coverage are better in urban settings. However, in both urban and rural settings, pharmacy stock outs, poor viral suppression and inadequate switch to second-line among adolescents require corrective public-health actions to limit HIVDR and to improve transition towards adult care in countries sharing similar programmatic features.

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.

Evaluation of treatment response, drug resistance and HIV-1 variability among adolescents on first- and second-line antiretroviral therapy: a study protocol for a prospective observational study in the centre region of Cameroon (EDCTP READY-study).

BACKGROUND: Sub-Saharan Africa (SSA) alone has nine out of every 10 children living with HIV globally and monitoring in this setting remains suboptimal, even as these children grow older. With scalability of antiretroviral therapy (ART), several HIV-infected children are growing towards adolescence (over 2.1 million), with the potentials to reach adulthood. However, despite an overall reduction in HIV-related mortality, there are increasing deaths among adolescents living with HIV (ADLHIV), with limited evidence for improved policy-making. Of note, strategies for adolescent transition from pediatrics to adult-healthcare are critical to ensure successful treatment response and longer life expectancy. Interestingly, with uptakes in prevention of mother-to-child transmission, challenges in ART programs, and high viremia among children in SSA, the success rate of paediatric ART might be quickly jeopardised, with possible HIV-1 drug-resistance (HIVDR) emergence, especially after years of paediatric ART exposure. Therefore, monitoring ART response in adolescents and evaluating HIVDR patterns might limit disease progression and guide on subsequent ART options for SSA ADLHIV. OBJECTIVES: Among Cameroonian ADLHIV receiving ART, we shall evaluate the rate of immunovirologic failure, acquired HIVDR-associated mutations, HIV-1 subtype distribution, genetic variability in circulating (plasma) versus archived (cellular) viral strains, and HIVDR early warning indicators (EWIs) at different time-points. METHODS: A prospective and observational study will be conducted among 250 ADLHIV (10-19 years old) receiving ART in the centre region of Cameroon, and followed-up at 6 and 12 months after enrollment. Following consecutive sampling at enrolment, plasma viral load and CD4/CD8 count will be measured, and genotypic resistance testing (GRT) will be performed both in plasma and in buffy coat for participants experiencing virological failure (two consecutive viremia > = 1000 copies/ml). Plasma viral load and CD4/CD8 will be monitored for all participants at 6 and 12 months after enrolment. HIVDR-EWIs will be monitored and survival analysis performed during the 12 months follow-up. Primary outcomes are rates of virological failure, acquired-HIVDR, and mortality. DISCUSSION: Our findings will provide evidence-based recommendations to ensure successful transition from paediatrics to adult ART regimens and highlight further needs of active ART combinations, for reduced morbidity and mortality in populations of ADLHIV within SSA.

Feasibility and utility of active case finding of HIV-infected children and adolescents by provider-initiated testing and counselling: evidence from the Laquintinie hospital in Douala, Cameroon.

BACKGROUND: Universal HIV testing and treatment of infected children remain challenging in resource-limited settings (RLS), leading to undiagnosed children/adolescents and limited access to pediatric antiretroviral therapy (ART). Our objective was to evaluate the feasibility of active cases finding of HIV-infected children/adolescents by provider-initiated testing and counseling in a health facility. METHODS: A cross-sectional prospective study was conducted from January through April 2016 at 6 entry-points (inpatient, outpatient, neonatology, immunization/family planning, tuberculosis, day-care units) at the Laquintinie Hospital of Douala (LHD), Cameroon. At each entry-point, following counseling with consenting parents, children/adolescents (0-19 years old) with unknown HIV status were tested using the Rapid Diagnostic Test (RDT) (Determine®) and confirmed with a second RDT (Oraquick®) according to national guidelines. For children less than 18 months, PCR was performed to confirm every positive RDT. Community health workers linked infected participants by accompanying them from the entry-point to the treatment centre for an immediate ART initiation following the « test and treat ¼ strategy. Statistical analysis was performed, with p < 0.05 considered significant. RESULTS: Out of 3439 children seen at entry-points, 2107 had an unknown HIV status (61.3%) and HIV testing acceptance rate was 99.9% (2104). Their mean age was 2.1 (Sd = 2.96) years, with a sex ratio boy/girl of 6/5. HIV prevalence was 2.1% (44), without a significant difference between boys and girls (p = 0.081). High rates of HIV-infection were found among siblings/descendants (22.2%), TB treatment unit attendees (11.4%) and hospitalized children/adolescents (5.6%); p < 0.001. Up to 95.4% (42/44) of those infected children/adolescents were initiated on ART. Overall, 487 (23.2%) deaths were registered (122 per month) and among them, 7 (15.9%) were HIV-positive; mainly due to tuberculosis and malnutrition. CONCLUSION: The consistent rate of unknown HIV status among children/adolescents attending health facilities, the high acceptability rates of HIV testing and linkage to ART, underscore the feasibility and utility of an active case finding model, using multiple entry-points at the health facility, in achieving the 90-90-90 targets for paediatric HIV/AIDS in RLS.

Prevalence of prolonged otitis media with effusion among 2 to 3 years old Cameroonian children in the era of 13-valent pneumococcal conjugate vaccines.

Objectives: There is data scarcity on the overall effects of pneumococcal conjugate vaccines (PCVs) on otitis media (OM) in low- and middle-income countries. The impact of the 13-valent PCV (PCV13) program on OM was evaluated in Cameroon where infant vaccination was implemented in July 2011 using a 3-dose primary series at 6, 10 and 14 weeks of age. Methods: Through community-based surveillance, we used a retrospective cohort study design to assess OM prevalence among PCV13-vaccinated children aged 24 to 36 months in 2015. This was compared with a 2013 age-matched cohort of PCV13-unvaccinated children. OM was diagnosed by clinical inspection for chronic suppurative OM (CSOM) and tympanometry for OM with effusion (OME). CSOM was defined as draining of the middle ear with duration of more than 2 weeks and prolonged OME was defined as a flat 'type B' tympanogram. PCV13-vaccinated and PCV13-unvaccinated cohorts were compared by calculating prevalence odds ratios for OM and baseline characteristics. Results: Altogether, 111 OM cases were identified; 42/433 (9.7%) in the PCV13-unvaccinated in 2013 and 69/413 (16.7%) in the PCV13-vaccinated cohort in 2015. In the 2013 baseline survey, 3/433 (0.7%) children were identified with unilateral CSOM compared to 9/413 (2.2%) in the PCV13-vaccinated cohort in 2015. Bilateral prolonged OME was diagnosed in 7/433 (1.6%) PCV13-unvaccinated children and in 12/413 (2.9%) in PCV13-vaccinated children. Proportions of children with unilateral prolonged OME were 31/433 (7.2%) in the PCV13-unvaccinated group compared with 48/413 (11.6%) in the PCV13-vaccinated group. Multivariate logistic regression analysis showed evidence that PCV13-vaccinated children in 2015 had 40% less risk of contracting OM compared to PCV13-unvaccinated children in 2013 (adjusted prevalence odds ratios = 0.60 [95% confidence interval: 0.38 to 0.94], P = 0.025). Additionally, attributable proportion estimates show that, 58% of OM infections among the PCV13-vaccinated group would still have occurred despite PCV13 vaccination. Conclusion: Our findings provide significant evidence on the effect of PCV13 in decreasing OM or OME among children in this age group. It also supports justification for government's continuation of PCV13 immunization program in the absence of GAVI's funding. Further research is needed to assess the long-term impact of the PCV13 program on in OM Cameroon.

Pubertal patterns in children with sickle cell anemia: A case-control study in Cameroon.

BACKGROUND: Puberty may be impaired in children with sickle cell anemia (SCA). Therefore, we aimed to explore the clinical and hormonal features of puberty in Cameroonian children. METHODS: In a case-control study, we included 64 children aged 8-18 years with SCA matched to healthy controls. We assessed height, weight, body mass index, body composition, and Tanner stages. Hormonal measurements included anti-mullerian hormone, follicle-stimulating hormone, luteinizing hormone, and sex hormones (estrogens/testosterone). We used the Mann-Whitney Wilcoxon test to compare the median values between cases and controls. We looked for associations between the severity criteria of SCA and delayed puberty through multivariate analysis. RESULTS: Delayed puberty was reported in 27.3% of girls and 10% of boys with SCA. The median age of menarche was delayed by 2 years compared to controls. SCA patients had a low lean body mass compared to controls (p = 0.03). Anti-mullerian hormone levels were significantly higher in boys with SCA than those of controls (45.9 ng/mL vs. 17.65 ng/mL; p = 0.018). A history of severe infection, acute chest syndrome, and low hemoglobin level was associated with delayed sexual maturation in children with SCA. CONCLUSION: Our study revealed delayed puberty in children with SCA. Moreover, puberty is affected by the severity of the disease. This highlights the importance of regular monitoring of puberty during the follow-up of these children.

Glucocorticoid dysfunction in children with severe malaria.

Introduction: Malaria remains a widespread health problem with a huge burden. Severe or complicated malaria is highly lethal and encompasses a variety of pathological processes, including immune activation, inflammation, and dysmetabolism. Previously, we showed that adrenal hormones, in particular glucocorticoids (GCs), play critical roles to maintain disease tolerance during Plasmodium infection in mice. Here, GC responses were studied in Cameroon in children with uncomplicated malaria (UM), severe malaria (SM) and asymptomatic controls (AC). Methods: To determine the sensitivity of leukocytes to GC signaling on a transcriptional level, we measured the ex vivo induction of glucocorticoid induced leucine zipper (GILZ) and FK506-binding protein 5 (FKBP5) by GCs in human and murine leukocytes. Targeted tracer metabolomics on peripheral blood mononuclear cells (PBMCs) was performed to detect metabolic changes induced by GCs. Results: Total cortisol levels increased in patients with clinical malaria compared to AC and were higher in the SM versus UM group, while cortisol binding globulin levels were unchanged and adrenocorticotropic hormone (ACTH) levels were heterogeneous. Induction of both GILZ and FKBP5 by GCs was significantly reduced in patients with clinical malaria compared to AC and in malaria-infected mice compared to uninfected controls. Increased activity in the pentose phosphate pathway was found in the patients, but this was not affected by ex vivo stimulation with physiological levels of hydrocortisone. Interestingly, hydrocortisone induced increased levels of cAMP in AC, but not in clinical malaria patients. Discussion: Altogether, this study shows that patients with SM have increased cortisol levels, but also a decreased sensitivity to GCs, which may clearly contribute to the severity of disease.

Antimicrobial stewardship in the era of the COVID-19 pandemic: A systematic review protocol on the opportunities and challenges for Sub-Saharan Africa.

BACKGROUND: Antimicrobial resistance (AMR) remains one of the leading threats to global public health and this may increase following COVID-19 pandemic. This is particularly the case in Africa where regulations on antimicrobial usage are weak. This protocol outlines the steps to undertake a systematic review to synthesize evidence on drivers of AMR and evaluate existing approaches to strengthening antimicrobial stewardship (AMS) programs in Sub-Saharan Africa (SSA). On the basis of the evidence generated from the evidence synthesis, the overarching goal of this work is to provide recommendations to support best practices in AMS implementation in SSA. METHODS: A systematic search will be conducted using the following databases: Global Health Library, PubMed, Cumulative Index to Nursing and Allied Health Literature, Scopus, Google Scholar, Global Health, Embase, African Journals Online Library, Web of Science, antimicrobial databases (WHO COVID-19, TrACSS, NDARO, and JPIAMR), and the Cochrane databases for systematic reviews. Studies will be included if they assess AMR and AMS in SSA from January 2000 to January 31, 2023. RESULTS: The primary outcomes will include the drivers of AMR and approaches to AMS implementation in SSA. The Preferred Reporting Items for Systematic Reviews and Meta-analyses will guide the reporting of this systematic review. CONCLUSIONS: The findings are expected to provide evidence on best practices and resource sharing for policy consideration to healthcare providers and other stakeholders both at the local and international levels. Additionally, the study seeks to establish drivers specific to AMR during the COVID-19 era in the SSA, for example, with the observed increasing trend of antimicrobial misuse during the first or second year of the pandemic may provide valuable insights for policy recommendation in preparedness and response measures to future pandemics. PROSPERO REGISTRATION NUMBER: CRD42022368853.

Clinical, biochemical, and biomolecular aspects of congenital adrenal hyperplasia in a group of Cameroonian children and adolescents.

OBJECTIVES: Congenital adrenal hyperplasia (CAH) remains one of the most challenging endocrine disorders to diagnose, manage, and treat, especially in Africa where there is lack of neonatal screening program, and limited access to care. Data on biomolecular anomaly are sparse, therefore type of mutations are unknown, increasing management challenges and genetic counseling. The present study aims to describe clinical, biomolecular aspects of a group of Cameroonian patients. METHODS: We did an observational retrospective study at the pediatric endocrinology unit of the Mother and Child Centre of the Chantal Biya Foundation in Yaounde from May 2013 to December 2019, including all patients diagnosed with CAH. RESULTS: We consecutively included 31 patients aged less than 21 years, diagnosed CAH. Median age at diagnosis was 1.71 years (IQR 0.08-2.57 years). Abnormal genitalia was the main complain in 48.4%(n=15). The most prevalent genetic anomaly found in our study population (n=24) was on CYP11, found in 16 patients (66.6%) followed by CYP21A2 mutation found in 8 patients. Homozygous mutation of p.Q356X was found in half of patients with 11 hydroxylase deficiency. This mutation was mostly found in people from semi-Bantu tribes, declared non consanguineous. CONCLUSIONS: 11 hydroxylase deficiency is the most prevalent form of CAH found in this group of Cameroonian children.

Does HIV infection affect growth and puberty of Cameroonian children?

OBJECTIVES: This study aimed to describe growth and pubertal development of adolescents with HIV infection under highly active antiretroviral therapy (HAART) in Cameroon. DESIGN: Through an observational study, we included 74 adolescents aged 9-17 years who were taking HAART and had attended two care units in Cameroon for at least 6 months. Weight and height were measured and transferred to 2007 WHO curves for 5- to 19-year-olds. Stunting was defined by a height for age z-score less than -2 standard deviations. Wasting was defined by a BMI z-score for age less than -2 standard deviations. Pubertal development was assessed using Tanner stages. We looked into the association between HIV infection characteristics, HAART regimen, and growth/puberty abnormalities with multivariate analysis. The Mann-Whitney U-test was used to compare median values with a p-value ≤0.05. RESULTS: The median age was 13 (11.2-14.7) years. Stunting affected 44% of the children. Wasting affected 9.7% of the adolescents. The age at onset of puberty was in the normal range in both boys and girls. Adolescents aged 12-14 years (OR 3.4 [95% CI, 1.3-8.8], p=0.012) with a past history of opportunistic infection and taking HAART with protease inhibitors were more likely to have stunting. CONCLUSION: In the Cameroonian setting, growth was mainly affected by stunting, but pubertal development was normal in all patients. This may reflect the benefits of HAART in children with HIV infection.

[Mortality pattern in children aged 3-59 months hospitalized in the Intensive Care Unit at a Paediatric Center in Yaounde-Cameroon]. / Profil des décès survenus chez les enfants âgés de 3 à 59 mois dans l'unité des soins intensifs d'un centre pédiatrique à Yaoundé-Cameroun.

INTRODUCTION: mortality risk is high at the Intensive Care Units (ICU) in developing countries. We here report the deaths occurred in the ICU at the Mother and Child Center in Yaounde, Cameroon. METHODS: we conducted a retrospective study on the clinical, socio-demographic features, the therapeutic strategy as well as some of the factors associated with deaths occurred in 200 patients aged 3-59 months between 2010 and 2014. RESULTS: out of 2675 patients included in the study, 1807 were aged 3-59 months and 303 died. The overall and cause-specific mortality rate in this age group was 11.3% and 16.7% respectively. Most patients (152/200; 76.0%) died within 24 months and the median admission time was 7 days. More than half of patients (57.0%) presented to a health center and only 66 (33.0%) presented to a referral hospital. Severe malaria (41.5%), pneumonia (22.7%) and gastroenteritis (27.8%) were the most common diseases. Malnutrition and HIV/AIDS were the underlying causes of death in 23.0% and 20.5% of patients respectively. Gastroenteritis multiplied the risk of death of approximately 6 times (OR = 5.76; p = 0.000) in patients affected by malnutrition and HIV infection. Deaths mainly occurred (90.0%) within 72 hours of admission. CONCLUSION: despite limited resources, some diseases could have been easily treated avoiding complications which require reanimation. It is essential to intensify the fight against malaria, HIV infection and malnutrition.

Prevalence of pneumococcal nasopharyngeal colonization and serotypes circulating in Cameroonian children after the 13-valent pneumococcal conjugate vaccine introduction.

BACKGROUND: Streptococcus pneumoniae remains a major contributor to childhood infections and deaths globally. In Cameroon, the 13-valent pneumococcal conjugate vaccine (PCV13) was introduced in July 2011, using a 3-dose Expanded programme on immunization (EPI) schedule administered to infants at 6, 10 and 14 weeks of age. To evaluate PCV13 effects, we assessed pneumococcal nasopharyngeal colonization and serotype distribution among Cameroonian children after PCV13 introduction. METHODS: Nasopharyngeal (NP) swabs were collected from eligible children aged 24-36 months in two cross-sectional surveys conducted from March to July: in 2013 (PCV13-unvaccinated), and in 2015 (PCV13-vaccinated). Using a systematic World Health Organization (WHO) cluster coverage sampling technique in 40 communities, NP swabs collected were processed following WHO recommendations. Standard bacterial culture techniques were used for the isolation of S. pneumoniae from gentamicin-blood agar plates and identification using optochin susceptibility testing. Serotyping was performed using sequential multiplex polymerase chain reaction, supplemented with Quellung test. RESULTS: Among the PCV13-vaccinated children, overall pneumococcal carriage prevalence was 61.8% (426/689) and PCV13 vaccine-type carriage prevalence was 18.0% (123/689). Eleven out of the 13 vaccine serotypes were detected in the vaccinated children. The most common serotypes were 19F (4.5%, 31/689) and 15B/C (7.3%, 50/689). CONCLUSION: In Cameroon, four years after infant vaccination nearly all of the PCV13-serotypes continued to circulate in the population. This suggests that the direct and indirect effects of the vaccination programme have not resulted in expected low levels of vaccine-type transmission. Continuous monitoring is needed to assess the long term effects of the PCV13 on nasopharyngeal carriage and disease.

Malnutrition among HIV infected children under 5 years of age at the Laquintinie hospital Douala, Cameroon.

INTRODUCTION: The aim of this study was to assess the prevalence of malnutrition among HIV infected children under five years of age followed up at the Laquintinie Hospital Douala (LHD). METHODS: Medical records of children aged 13 days-59 months enrolled at initiation of antiretroviral treatment in the Day Care Unit/LHD, were reviewed for a period of 14 years (from 2002 to 2015). We used standard Z-scores, with cut-off point of <-2 SD to define low height-for-age (HAZ), low weight-for-height (WHZ) and low weight-for-age (WAZ). Factors associated with malnutrition were assessed according to World Health Organization (WHO) criteria. RESULTS: Overall, 217 medical records were included and 52.5% were records of boys. The median weight, height and age of the children was 9.5 kg (range: 2.5-20), 76 cm (range: 46- 117) and 22 months (range: 0.03-59), respectively. The overall prevalence of malnutrition among HIV-infected children was 68.7%; 63.6% were stunted (HAZ<-2), 37.8% were underweight (WAZ<-2) and 18.4 % were wasted (WHZ<-2). Severe and advanced immunological stages of HIV according to WHO were found in 42.4%, (39/92) and 17.4%, (16/92) of children respectively, and most of them (21.7%) were aged 12-36 months. The overall prevalence of anemia, oropharyngeal candidiasis and pulmonary tuberculosis were 34.6%, 12% and 8.8%, respectively. Oropharyngeal candidiasis was a risk factor independently associated with severe underweight and wasting (OR = 4.9, 95% CI: 1.8-13.5, p = 0.002) and (OR = 5.1, 95% CI: 1.5-17.1, p = 0.007). CONCLUSION: HIV infection negatively affects the nutritional status of children under five years of age. Early detection of malnutrition is necessary and adequate nutrition should be integrated into the management of pediatric HIV.

The prevalence of otitis media in 2-3 year old Cameroonian children estimated by tympanometry.

BACKGROUND: Acute otitis media is a common illness in children under-five years of age and associated with major health care resources in high-income countries. However, there is paucity of data on its epidemiology and clinical presentation in low-income countries. We estimated the prevalence of otitis media and assessed risk factors among children in Cameroon. METHODS: A community-based cross-sectional prevalence study of otitis media (OM) was performed on randomly selected children aged 2-3 years in Yaoundé, Cameroon from March to June 2013. OM was assessed by clinical inspection for chronic suppurative otitis media (CSOM) and tympanometry for otitis media with effusion (OME). CSOM was defined as draining of the middle ear with duration of more than two weeks and OME was defined as a flat 'type B' tympanogram. RESULTS: Out of 529 children enrolled in the study, 433 (56% males) subjects with available tympanograms were evaluated. Altogether, 9.7% (42/433) of children met the case definition of CSOM, OME or its complications. This consisted of 3 (0.7%) children identified with unilateral CSOM; 7 (1.6%) children with bilateral OME; 31 (7.2%) with unilateral OME and 1 (0.2%) subject with unilateral dry tympanic membrane perforation. Logistic regression analyses showed statistically significant association between OM and parental reporting of "current symptoms of upper respiratory tract infections", Prevalence Odds Ratio (POR) = 3.71; 95% CI = 1.69-8.14). CONCLUSION: As many as two out of a hundred children between the ages of 2-3 years were affected by significant middle ear disease i.e. CSOM or bilateral OME. These data could be useful as a baseline for estimating the impact of pneumococcal conjugate vaccines (PCV13) introduced in July 2011 for infants in Cameroon.

Risks associated with mother-to-child transmission of HIV infection.

Nguefack F, Koki-Ndombo P, Ngoh R, Soh Fru F, Kinkela MN, Chiabi A. Risks associated with mother-to-child transmission of HIV infection. Turk J Pediatr 2017; 59: 426-433. Early infant diagnosis (EID) permits the detection of Human Immunodeficiency Virus (HIV) infection in exposed children from 4-6 weeks by polymerase chain reaction (PCR). The aim of this study was to assess some maternal and infant characteristics associated with HIV infected children in an EID program. A retrospective study was performed using records of HIV exposed children enrolled in the EID program from 2009 to 2013. Patients recruited were from various health structures and at different clinical stages; some for the Prevention of Mother-to-Child Transmission (PMTCT) follow up, others with signs of HIV infection. Data was collected from completed hospital records of children aged 6 weeks to 18 months containing at least two PCR, one PCR and one serologic test, or one PCR test and viral load. HIV infection was considered if one of the of tests was positive. In all, 130 (5.3%) exposed children with only one positive PCR test, and 1,442 (59%) others with information lacking in their record were excluded. A total 107 out of 871 infants enrolled (12.2%) were infected. Only, 32.7% of the mothers were on antiretroviral therapy (ART). Of these, 53.3% had their first PCR performed between 6 weeks and 6 months. Children were less likely to be HIV infected when their mothers received antiretroviral (ARV) (OR=0.15, 95% CI 0.07-0.30, P=0.000). Factors associated with HIV infection in the children were the lack of ARV prophylaxis (OR=2.07, 95%CI 1.05-4.09, P=0.035) and having mixed feeding (OR=3.91, 95% CI 1.66-9.24, P=0.002) in multivariate analysis. The high rate of infection associated with the maternal and infant correlates of HIV infected children would result from the poor implementation of the PMTCT. Systematic screening of pregnant and breastfeeding women should be reinforced and the lifelong ARVs for PMTCT (Option B+) be promoted.

A cohort analysis of neonatal hospital mortality rate and predictors of neonatal mortality in a sub-urban hospital of Cameroon.

BACKGROUND: In Cameroon, sustainable effort needs to be done to reduce the current neonatal mortality rate from 21 deaths per 1000 live births to the global target of fewer than ten deaths per 1000 live births by 2035. We aimed to determine the neonatal hospital mortality rate and predictors of neonatal hospital mortality (NHM) in a major referral sub-urban hospital of Cameroon in a bit to formulate interventions to curb this burden. METHODS: This was a prospective cohort study consecutively enrolling all neonates admitted into the neonatology unit of the Bamenda Regional Hospital (BRH) from November 2015 to February 2016. Through interviewed questionnaires to parents and physical examination of neonates, we studied socio-demographic characteristics, antenatal history, intrapartum history and clinical findings of neonates. Neonates further underwent relevant laboratory investigations for diagnosis. All neonates were followed up till 28 days after the post-menstrual term for the neonatal outcomes. Multiple logistic regression was used to determine predictors of NHM. RESULTS: We enrolled 332 out of 337 neonates admitted to the neonatology unit of BRH during the study period. Fifty-three percent (53%) were males. Their mean gestational age and birth weight were 36.9 ± 3.9 weeks and 2677.2 ± 923 g, respectively. The main causes of neonatal admissions were complications of preterm birth (32.2%), neonatal infections (31.3%), and birth asphyxia (14.5%). The neonatal hospital mortality rate was 15.7%. NHM was related to complications of preterm birth (69%), birth asphyxia (23%) and neonatal infections (6%). A five-minute Apgar score less than seven was the only predictor of NHM (aOR: 16.41; CI 95%: 6.35-42.47; p < 0.01). CONCLUSION: Neonatal mortality still remains a significant health problem in sub-urban Cameroon, mainly as a result of three pathologies; complications of preterm birth, birth asphyxia, and infections. There is an urgent need to revamp the current health policies through the improvement of antenatal care, skilled birth attendants, neonatal resuscitation, timely detection and treatment of complications of preterm births, birth asphyxia, and infections.

Pre-vaccine circulating group a rotavirus strains in under 5 years children with acute diarrhea during 1999-2013 in Cameroon.

The aim of this review was to assess all the studies on rotavirus G and P characterization during the pre-vaccine period (1999-2013) in Cameroon to have a better basis for post-vaccine introduction evaluations. A retrospective study was done through a comprehensive review of published (PubMed, Google Scholar) and accessible unpublished data on rotavirus G and P genotypes circulating in five regions of Cameroon. Descriptive data were expressed as frequencies tables and proportions. A total of 1844 rotavirus positive cases were analyzed. In all, 1534 strains were characterized for the P (VP4) specificity. Six different VP4 genotypes were observed, including P [4], P [6], P [8], P [9], P [10] and P [14]. The most predominant P genotypes were P [8] at 42.6%, and P [6] at 37.9%. Mixed infections were observed at 5.3%, whereas 4.1% of the strains were P non-typeable. A total of 1518 rotavirus strains were characterized for the G (VP7) specificity. VP7 genotypes G1, G2, G3, G4, G5, G6, G8, G9, G10 and G12 were observed. G1 (35.3%), G3 (19.5%), G2 (14.9%) and G12 (10.1%) were the predominant G genotypes while G5 and G10 were least prevalent at 0.06% each. Approximately 5.1% of all strains were G non-typeable whereas 5.3% were mixed G genotypes. A total of 1472 strains were characterized for both G and P genes, from which 38 different G-P combinations were observed. Overall, G1P [8] (22%) was identified as the predominant rotavirus strain circulating in Cameroon followed by G3P [6] (15%). In conclusion, we observed that the genotypes identified in Cameroon during 1999-2013 were partially covered by the two WHO recommended rotavirus vaccines. This review provides comprehensive up-to-date information on rotavirus strain surveillance in Cameroon during the pre-vaccination era.