Évaluation des performances des mutuelles de santé communautaire de Douala et Yaoundé, Cameroun.

INTRODUCTION: The longevity of Mutual Health Organization (MHOs) in Cameroon is not guarantee, and it tends to fail after a very short period of functioning. Very little studies talks about the performance of MHOs. Therefore, we will like to measure the financial, economic and mutualist satisfactory performance indicators in two community-based mutual health organizations. That is the Mutual health organization of Douala V (Musocom) and Yaoundé I (Mucamaadd). METHODOLOGY: It is a descriptive and analytical study in which sampling was conducted using a non-probability method using a self-administered questionnaire and evaluation grid. RESULTS: It revealed an overall satisfaction of 69%; an availability rate of management tools and activities of 85.5%; a solvency ratio of 34.2%; an expense coverage ratio of 37.4%; an equilibrium ratio of 50.9%; an operating expense ratio of 76% and a loss ratio of 133%. There is a significant association between beneficiary satisfaction and the fact of belonging to a household or small medium size enterprise, enrolling in groups of 6-11 people or > 22 people, being from the private sector or retired and having a salary > 100.000 frs (OR> 1 and P-Value < 0.05). DISCUSSION: The measure of Mutual health organization performance permitted to bring out difficulties, gaps in line with their professionalism, organization and technicality. The findings present a more significant measure of performance in Mucamaadd than in Musocom due to its constant ability in research of amelioration in rendering services.

Microbiological quality of water sources in the West region of Cameroon: quantitative detection of total coliforms using Micro Biological Survey method.

BACKGROUND: Adequate supply of safe drinking-water remains a critical issue in most developing countries. The whole western region of Cameroon doesn't have a sustainable continuous water supply system, which leads most people to use potentially contaminated water sources to meet their daily water needs. Previous, studies carried out in similar areas of Cameroon have highlighted the poor bacteriological quality of water sources used as drinking-water by the local populations. METHODS: This study used the Micro Biological Survey method, a rapid colorimetric test for the quantitative detection of Coliforms in water samples. 22 water sources (12 improved and 10 unimproved) were identified; 1 water sample of 50 ml was collected in sterile plastic tubes, immediately kept in a refrigerator box and transported to the laboratory for analysis. 1 ml of each sample was inoculated in the Coliforms Micro Biological Survey (Coli MBS) vials initially rehydrated with 10 ml of sterile distilled water. The Coli MBS vials were closed, shaken for about 30 s for homogenization and then incubated at 37 °C. From the initial red color of the Coli MBS vials, changes in color of the reaction vials were monitored at three different time intervals (12 h, 19 h and 24 h), corresponding to three levels of contamination. RESULTS: The average distance (8.7 m) of the latrines from the nearest water source was less than the minimal recommended distance (15 m) to ovoid external contamination. The pH of water samples ranged from 5.5 to 8.3 and the maximum temperature found (26 °C) was almost at level favorable to outbreaks of waterborne diseases such as cholera. The presence of Total Coliforms was detected in 90.91% of the samples. 40% of samples were positive 12 h after the analysis beginning. High level of contamination was observed in unimproved water sources, 50% after 12 h corresponding to Total Coliforms concentration of 10 < x < 103 CFU/ml and the other samples after 19 h (Total Coliforms concentration: 1 < x < 10 CFU/ml). CONCLUSION: This study revealed the poor microbiological quality of water used by local populations of our study sites. There is need to conduct further qualitative microbiology studies to isolate potential germs involved in outcome of diarrheal diseases.

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.

The problem of lost to follow-up of mother-child pairs enrolled in the PMTCT program in Dschang District Hospital-Cameroon.

High rates of lost to follow-up (LTFU) in the Prevention of Mother-To-Child Transmission of HIV (PMTCT) programs in Cameroon will only contribute in hindering the successful implementation of the program. The objective of this study was to determine the reasons of LTFU of mother-child pairs enrolled in the PMTCT program in Dschang District Hospital (DDH): Cameroon. Methods: A retrospective cohort study was carried out in HIV+ exposed children delivered in the DDH from1st Jan 2012 - 31st Dec 2014, who were greater than or equal to 18 months at the study period (1st August - 30th September 2016) and whose mothers were enrolled in the PMTCT program for at least 3 months. Children were considered LTFU if they did not return to the hospital for the establishment of their HIV status at 18 months. A complementary cross-sectional study was done whereby a structured questionnaire was administered to the LTFU group via telephone calls, in order to determine the causes of LTFU. Data was collected from hospital registers and analyses done using Epi info 7.1.3.3 software. Results: A total of 141 mother-child pairs were eligible for the study, 76 were reachable via phone calls and 36 (47.37%) met the case definition of LTFU. Out of the 36 (47.37%) children LTFU, lack of information, 19(65.52%); lack of support from male partners, 4(11.11%); Poor behavior of health personnel, 2 (5.56%); forgetfulness, negligence/time wasting, unavailability of results, fear of child being infected, and family problems were all listed at equal proportions of, 3(6.90%) as well as financial problem, 1 (2.78%) were all causes of LTFU identified in this study.

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.

Molecular evidence of Plasmodium vivax infection in Duffy negative symptomatic individuals from Dschang, West Cameroon.

BACKGROUND: Plasmodium vivax infection is known to be rare in West/Central Africa, the most accepted explanation being the lack of expression of erythroid Duffy antigen in the local human populations. Duffy negativity prevents the parasite to exploit the entry mechanism on the red blood cell surface. However, there are a growing number of reported vivax infections in Duffy-negative individuals. Data on P. vivax circulation in Cameroon are limited. The aim of the study was to evaluate the P. vivax presence, and its association with the Duffy genotype in West Cameroon. RESULTS: Overall, 484 blood samples were collected consecutively from febrile outpatients attending the Dschang's Hospital (West Cameroon) during a 3-months period. Plasmodium vivax infection was detected by PCR in 5.6% (n = 27/484) of the cases, representing 38.6% (n = 27/70) of all Plasmodium infections detected. All P. vivax infected individuals showed a Duffy-negative genotype, and the frequency of Duffy-positive individuals in the whole tested population was 1.7%. CONCLUSIONS: The results of this study confirm the circulation of P. vivax in Cameroon, as well as that the lack of expression of Duffy-antigen does not confer full protection against vivax malaria acquisition.

[The burden of disability in Cameroon]. / Il peso della disabilità in Camerun.

AIM: Rehabilitation services for disabled persons are lacking in countries with limited economic resources. Reliable and objective data are needed to plan for their implementation and to determine the burden of disability in these countries. METHODS: A descriptive cross-sectional study conducted in June 2013 among people living in Dschang Health District, in the West region of Cameroon, to collect information about socio-demographic aspects of physically disabled subjects and health determinants of disabilities. Data was collected using a standard questionnaire in French. RESULTS: In total, 159 physically disabled subjects were enrolled in the study. Mean age was 36 years [± SD 17.26], 55.9% of subjects were female, and 33.8% had a low educational-level. The most frequently reported disabilities were orthopaedic problems (mainly fractures) [45.8%], infectious diseases [29.1%]), and neurological disabilities (mainly hemiplegia [33.3%], hemiparesis [23.8%], and monoplegia [23.8%]). The main causes of disability were trauma due to traffic accidents (17.8%) and inappropriate medical interventions (14.5%). Disability was related to age and 50% of participants experienced social discrimination. Disabled subjects with low-incomes (from 50.000 to 200.000 XAF) were required to pay for rehabilitative care (XAF 10.000 to 100.000), and up to 83% had appealed for improved quality of Rehabilitation Medicine. CONCLUSION: Although Law n. 83/013 for the protection of persons with disabilities in Cameroon dates back to 1983, the results of this study show that disabled people, and children in particular, are still marginalized, vulnerable and have little chance of recovery. Therefore, there is a clear need to improve the quality and availability of rehabilitative care services , with programmatic interventions that ensure implementation of existing laws, improve access to rehabilitative services, provide disabled persons with the necessary specialty medical products, and eliminate barriers to their social participation.

Poor Acceptability of Female Condom by Young Cameroonians: an Unmet Programmatic Agenda for HIV Prevention.

BACKGROUND: An important component of the response to the AIDS epidemic is the prevention of HIV infection and other sexually transmitted diseases through the use of condoms. In order to enhance HIV prevention programs and minimize the occurrence of unwanted pregnancies, female condoms have been introduced within the community, with the ultimate goal of reducing vulnerability of women. The success of such a program depends on its acceptance by the target population. METHODS: A survey was conducted among 426 respondents from different regions of Cameroon, to evaluate their perception of HIV/AIDS and their level of acceptance of condom usage in general, and female condom use in particular. RESULTS: Respondents were young adults residing in seven regions of Cameroon (86.4% west, 6.5% Littoral, 3% Centre and 4.1% Adamawa, East, Far-North and North-West). Mean age was 22.6 years; 57% were male, 95% were single, and 77% were university educated. Overall, 76% of participants reported using condoms, though 48% complained of decreased sexual satisfaction. Interestingly, awareness regarding female condoms was 74.5% and 88.5% in men and women respectively, however only 8% and 9.9% respectively reported having ever used them. Respondents generally learnt about sexual education through broadcasting media (~90%). CONCLUSION: In this sexually active Cameroonian population, the rate of acceptance or use of female condom remains very low, even among women. Strategies to increase awareness of female condoms among young women, their benefits and correct use, are needed.

Nutrition Habits and Health Outcomes of Breastfeeding HIV-positive mothers in the Dschang Health District, West Region Cameroon.

BACKGROUND: Amongst the different at-risk periods for mother-to-child HIV transmission that is, during pregnancy, labor and delivery and breastfeeding, much care and attention needs to be given, not only to the child as concerns its feeding options, but also to the mother. The aim of this study was to determine the nutritional habits and health outcomes of HIV-positive breastfeeding mothers in the Dschang Health District, in the context of prevention of mother-to-child transmission (PMTCT) activities. METHODS: A cross-sectional study was carried out from September 2014 to February 2015, at the Dschang District Day Care Hospital. A standard questionnaire was administered by face-to-face interview to 56 breastfeeding HIV-positive mothers. Anthropometric parameters of the mothers were measured (weight and height), and a physical check-up performed, with examination of the mothers' conjunctiva and palms. Clinical status was determined by anemia test using the Tallquist hemoglobin test. Data collected were analyzed using Epi Info version 7.1.3.3 and Excel 2013. RESULTS: The mean age of participants was 33 years. Most women ate three meals per day (53.6%, n=30/56), while 26,8% (15/56) ate two. Staples (27.27%) and fruits (33.68%) were found to be the most consumed foods per week and green leafy and yellow vegetables the least consumed (13.74%). Body mass index was used to evaluate the nutritional status of participating women: 26.9% (n=14/52) were in the normal range of weight, slightly more than half were overweight (51.9%, n=27/52) and 21.2% (n=11/52) were obese. All mothers were on antiretroviral therapy (ART). Recent CD4 count results were available for about half of the women and the mean was 293 cells/mmc (range 97-798). Physical checkup showed that 64.3% (n=36/56) and 67.9% (n=38/56) of women respectively had moderately colored conjunctiva and palms, while 10.7% (n=6/56) and 12.5% (n=7/56) respectively had pale conjunctiva and palms, considered to be clinical signs of anemia. About 74.1% (n=40/54) of the women were borderline anemic, 24.1% (n=13/54) had frank anemia and only 1.9% (n=1/54) had normal blood counts. CONCLUSION: Nutrition habits amongst HIV-positive breastfeeding women of the Dschang Health District were not optimal and contributed a great deal to the poor health outcomes observed in the PMTCT study. Nutritional education should be offered in addition to ART, to help women make better nutrition choices to meet body needs and improve health.

Water supply, sanitation and health risks in Douala 5 municipality, Cameroon.

BACKGROUND: In the poor zones of sub-Saharan Africa, the conventional drinking water network is very weak. The populations use alternative groundwater sources which are wells and springs. However, because of urbanization, the groundwater sources are degrading gradually making pure, safe, healthy and odourless drinking water a matter of deep concern. There are many pollutants in groundwater due to seepage of organic and inorganic pollutants, heavy metals as well as microbiological contamination. This study was carried out in October 2012 and aimed to analyze the practices and behaviors of populations related to water supply that may constitute potential risks of microbiological contamination and emergence of waterborne diseases. METHOD: This study was carried out on a sample of 285 households, distributed in twelve principal quarters of the Douala V municipality in Cameroon. After data collection through the questionnaires, the selection of vulnerable quarters was done by the tabulation of some specific results on the questionnaire. The microbiological analysis was carried out using an innovative rapid test called "Micro Biological Survey (MBS)" that has been developed and patented by MBS srl, a recent spin-off of the University of Roma Tre. RESULT: We found out that 42.30% of households used water from drilled wells (forages), 33.80% from Cameroon National Water Company (CDE) distribution network, 9.50% from spring, and 9.40% used other source of water such as buying industrial mineral water. However, it should be noted that, as dangerous as it may be, wells ("puits" in French) water is used as permanent source of drinking water by 5% of households. In general, 63.2% of households affirmed not to have benefited the fitting of public water point. Moreover, among the quarters were the households affirmed to have benefited from the development of a public water point, 52.5% of these water point were no longer functional. From the obtained data we have assessed that 83% of wells analyzed are faecally contaminated and all the forages analyzed (100%) are not contaminated. The most affected people by water-related diseases are children under 5 years (43%). CONCLUSION: We highly recommend the City Council of Douala V to restrict the use of the contaminated wells and provide alternative water sources such as forages for public use and to ensure that microbiological quality of the new and already existing water sources is controlled regularly by the Technical Service.

Knowledge, attitudes and practices on HIV / AIDS in the south region of Cameroon: case of the town of Kribi.

The aim of our study was to assess knowledge, attitudes, and practices (KAP) regarding HIV/AIDS in the city of Kribi, southern region of Cameroon. In November 2012, a questionnaire composed of 20 items was administered by trained staff from the Biomedical Sciences Department of the University of Dschang to 200 students selected from four population groups: high school students, local traders, tourism personnel (staff of bars, restaurants, hotels, nightclubs), and motorcycle taxi drivers. A cluster sampling method was used to select the first three groups while motorcycle taxi drivers were selected by the method of all comers. KAP regarding HIV/AIDS was found to be fragmentary in the studied population. Only 6.5% systematically uses condoms, 59% believe that AIDS can be cured by traditional medicine and religious faith and 40.9% developed stigmatizing behaviour toward HIV infected people. Among participants there is a wide discrepancy between knowledge and social behaviours toward HIV/AIDS. Strategic and continuous awareness campaigns that are culturally and socially tailored are urgently needed.

Microbiological quality and genotoxicity of domestic water sources: A combined approach using Micro Biological Survey method and mutagenesis assay (micronucleus test) in root tips of Vicia faba in the West region of Cameroon.

At least 2.1 billion people around the world use contaminated drinking water, causing 485,000 diarrheal deaths each year, mostly among children under 5 years old. A study conducted 10 years ago in Bafoussam (West Cameroon) recorded concentrations of bacteria among surface and groundwater. High levels of bicarbonates, phosphates, chlorides and suspended matters were also found. The aim of this study was to assess the microbiological and chemical qualities of domestic water sources in 5 localities of the West region of Cameroon. Water samples from 22 water sources (wells, springs, water drilling and river) were aseptically collected in plastic bottles and transferred in 50 ml sterile tubes. For chlorinated water sources, 1 ml of Thiosulfate was added to the water sample; immediately placed in an ice box and transported to the laboratory for analysis. Water temperature and pH were measured on site. The microbiological quality of water was determined by testing Total Coliforms (TC) using the Micro Biological Survey method. 1 ml of each water sample was inoculated in the MBS vial initially rehydrated with 10 ml of sterile distilled water. The initial color of the vials is red. Color changes were monitored at three different time intervals (12h, 19h and 24h), corresponding to three levels of contamination. The chemical quality of water was assessed using micronucleus (MN) test in selected Vicia faba seeds secondary root tips permanently mounted in Dibutylphthalate Polystyrene Xylene mountant for histology after 72 hours of direct exposition in water samples and in dark. The mitotic indices and MN frequencies were evaluated in 10 root tips per site analysing 5000 cells per tip. Statistical analyses were done using Stata IC/15.0 software. The Student t-test was used for mean comparison and the significance level was set at 1%. The majority of samples were collected from wells (63.6%). The mean water pH ranged from 5.5 to 8.3 and the temperature varied from 23 to 26°C. A very high concentration of TC [>103 CFU/ml] was found in 8 (36.4%) samples. 10 (45.5%) and 2 (9.1%) samples turned yellow at 19 and 24 hours respectively after incubation corresponding to TC concentration of [10

Plasmodium vivax Infections Detected in a Large Number of Febrile Duffy-Negative Africans in Dschang, Cameroon.

The Duffy blood group is a critical receptor for Plasmodium vivax (P. vivax) invasion of red blood cells, and consequently, P. vivax infections were considered rare in sub-Saharan Africa where the prevalence of Duffy-negativity is high. However, recently, P. vivax infections have been found in Duffy-negative Africans throughout the malaria transmission area of sub-Saharan Africa, raising important questions concerning the molecular composition of these P. vivax clones and the red blood cell receptors that facilitate their invasion. Here, we describe an unusually high number of P. vivax infections in febrile Duffy-negative Africans in Dschang, Cameroon (177 of 500 outpatients), as compared with Santchou (two of 400 outpatients) and Kyé-ossi (two of 101 outpatients), in other areas in Cameroon. In the discussion, we speculate on the possible reasons why Dschang might account for the unusually large numbers of P. vivax infections in Duffy-negative individuals living there.

Low vaccine coverage among children born to HIV infected women in Niamey, Niger.

BACKGROUND: The effect of mother's HIV-status on child vaccination is an important public health issue in countries with high HIV prevalence. We conducted a study in a primary healthcare center located in Niamey, the capital of Niger, which offers free of charge services to HIV positive and/or underprivileged mothers, with the aim of assessing: 1) vaccination coverage for children 0-36 months old, born to HIV-infected mothers, and 2) the impact of maternal HIV status on child vaccination. METHODS: Mothers of children less than 36 months old attending the center were interviewed, to collect information on vaccines administered to their child, and family's socio-demographic characteristics. RESULTS: Overall, 502 children were investigated. Children of HIV-seropositive mothers were less likely to receive follow up vaccinations for Diphtheria-Tetanus-Pertussis (DTP) than those of HIV-seronegative mothers, with a prevalence ratio (PR) of 2.03 (95%CI: 1.58-2.61). Children born to HIV-seropositive mothers were less likely to miss vaccination for MMR than those born to HIV negative mothers, with a RR of 0.46 (95%CI: 0.30-0.72). CONCLUSIONS: Vaccine coverage among children born to HIV infected mothers was rather low. It is important to favor access to vaccination programs in this population.