Would you terminate a pregnancy affected by sickle cell disease? Analysis of views of patients in Cameroon.

Sickle cell disease (SCD) is a debilitating illness that affects quality of life and life expectancy for patients. In Cameroon, it is now possible to opt for termination of an affected pregnancy (TAP) where the fetus is found to be affected by SCD. Our earlier studies found that, contrary to the views of Cameroonian physicians, a majority of parents with their children suffering from SCD would choose to abort if the fetuses were found to be affected. What have not yet been investigated are the views of people suffering from/living with SCD. We used a quantitative sociological method, with administered structured questionnaires, to study the attitudes of adult patients suffering from SCD on prenatal genetic diagnosis (PND) and possible TAP. The majority of the 89 participants were urban dwellers (84.3%), women (57.3%), Christian (95.5%) and single (90.9%), with a secondary/tertiary education (79.5%). The majority (89.2%) would consider PND for SCD; almost half (48.5%) would reject TAP while 40.9% would consider it. Respondents who rejected TAP claimed mostly ethical reasons (78.1%) while those who found TAP acceptable cited fear of having an affected child (88.9%) and the poor quality of the affected child's health (81.5%). Cameroonian patients with SCD are generally supportive of PND and a remarkably high number of patients living with SCD reported that they would consider terminating a pregnancy based on their assessment of the future well-being of the child. Research is required to investigate the burden of SCD on families and their quality of life.

Psychosocial burden of sickle cell disease on parents with an affected child in Cameroon.

The chronicity of Sickle Cell Disease (SCD) could impair the quality of life of caregivers. We performed a quantitative study to assess various indices of psychosocial burden on Cameroonian parents (N = 130) with at least one living SCD-affected child. Demographic and medical information were obtained from the participants and the review of the patients' medical records. The survey instrument included a 38-item stress factors scale using Likert-type statements, evaluating general perceptions of stress and five main specific stressors: disease factors (clinical severity), hospital factors, financial factors, family factors (life/dynamic) and SCD-child factors (perceived quality of life). The items pertaining to burden involved four response options with increasing severity: 0, 1, 2 or 3. Descriptive statistics and non-parametric tests were used for analysis. Participants were typically aged 38 years, urban dwellers (89%), female (80%), married (60.2%), employed (61.7%) and had secondary/tertiary education (82%). Median age of SCD-affected children was 9 years. The median age at diagnosis of SCD was 6 months; 47.8% had more than 3 painful crises per year. The majority of participants (88.3%) experienced moderate to severe difficulty coping with SCD. On a 0-3 scale, median score of SCD clinical severity was the major factor to undermine the coping ability of parents (2.2); vaso-occlusive painful events (>3 per year) was the disease-related stressor that most impacted their coping ability. The family life dynamic was the least stressful (0.7). Unemployment affected all the stressors' categories. Stressors scores also increased with female, single, low education level, age of SCD-affected children or more than 3 children in the family. In Cameroon, there is an urgent need to implement practices that ensure affordable access to health-care and activities that would reduce SCD morbidity.

Psychosocial stressors of sickle cell disease on adult patients in Cameroon.

Sickle Cell Disease (SCD) is a debilitating illness that affects quality of life. Studies of the psychosocial burden of SCD on patients have been rarely reported in Africa. We used a quantitative method, with face-to-face administered questionnaires, to study indices of psychosocial stressors on adult SCD patients in Cameroon. The questionnaire included a 36-item stress factors scale evaluating general perceptions of stress and five main stressors' domain: disease factors, hospital factors, financial factors, family factors and quality of personal-life factors. Items pertaining to psychosocial stressors involved four response options with increasing severity: 0, 1, 2 or 3. Non-parametric tests were used for analysis. The majority of the 83 participants were urban dwellers, female, 20-30 years old, single, unemployed, with at least a secondary or tertiary education. Median age at diagnosis was 100 months; 47.8% had >3 painful vaso-oclusive crises annually. Only 4.8% had been treated with hydroxyurea. The majority reported moderate to severe difficulty coping with SCD. The "degree of clinical severity" category displayed the highest median score (2.0), while familial stressors showed the lowest (0.8). Being female, married, with low education level, an additional affected sibling and low direct income were significantly associated with specific stressors' categories. In Cameroon, there is an urgent need to implement policies that ensure affordable access to health-care and practices to reduce SCD morbidity and improve patients' quality of life.

Validation of a single-platform, volumetric, flow cytometry for CD4 T cell count monitoring in therapeutic mobile unit.

BACKGROUND: A mobile health unit may be useful to follow up adult and pediatric patients on antiretroviral treatment and living in remote areas devoid of laboratory facilities. The study evaluated the use of the simplified, robust, single-plateform, volumetric, pan-leucogating Auto40 flow cytometer (Apogee Flow Systems Ltd, Hemel Hempstead, UK) for CD4 T cell numeration in a mobile unit, compared against a reference flow cytometry method. METHODS: The therapeutic mobile unit of the Laboratoire National de Santé Hygiène Mobile, Yaoundé, Cameroon, was equipped with the Auto40. A FACSCalibur flow cytometer (Becton Dickinson Immuno-cytometry System, San Jose, CA, USA) was used as reference method. EDTA-blood samples from volunteers were first subjected to CD4 T cell count in the mobile unit, and an aliquot was sent within 4 hours to Centre International de Référence Chantal Biya, Yaoundé, for FACSCalibur assay. RESULTS: Two HIV screening campaigns with the mobile unit were organised in December 2009 and January 2010. The campaign in the suburb of Yaoundé which was 20 km from the reference laboratory included 188 volunteers comprising 93 children less than 5 years old. The campaign in Ambang Bikok (53 km far from Yaoundé) included 69 adult volunteers. In Yaoundé suburb, mean ± standard deviation (SD) CD4 T cell count was 996 ± 874 cells/µl by Auto40, and 989 ± 883 cells/µl by FACSCalibur; in Ambang Bikok, mean ± SD CD4 T cell count was 1041 ± 317 cells/µl by Auto40, and 1032 ± 294 cells/µl by FACSCalibur. Results by Auto40 and FACSCalibur were highly correlated in Yaoundé (r(2) = 0.982) as in Ambang Bikok (r(2) = 0.921). Bland-Altman analysis showed a close agreement between Auto40 and FACSCalibur results expressed in absolute count as in percentage in Yaoundé and Ambang Bikok. When pooling the 257 CD4 T cell count measurements, the Auto40 yielded a mean difference of +7.6 CD4 T cells/µl higher than by reference flow cytometry; and the sensitivity and specificity of Auto40 in enumerating absolute CD4 T cell counts of less than 200 cells/µl were 87% and 99%, respectively, and in enumerating absolute CD4 T cell counts of less than 350 cells/µl were 87% and 98%, respectively. The intrarun and interun precisions of the Auto40 assay assessed in the mobile unit were 5.5% and 7.9%, respectively. CONCLUSIONS: The Auto40 flow cytometer installed in a therapeutic mobile unit and operated far from its reference laboratory gave a perfect correlation with the reference method, and could be useful in carrying out immunological monitoring of HIV-infected patients living in areas without access to laboratory facilities.

Acceptability of prenatal diagnosis by a sample of parents of sickle cell anemia patients in Cameroon (sub-Saharan Africa).

Little is known about attitudes of parents of Sickle Cell Anemia patients in sub-Saharan Africa regarding prenatal genetic diagnosis and termination of an affected pregnancy. In this study, structured face-to-face interviews were conducted with a sample of 130 parents in Cameroon that had at least one living child with Sickle Cell Anemia. The majority of participants lived in urban areas (89%), were female (80%), Christian (93%), married (60.2%) in monogamous households (81.1%), were employed (61.7%), and had at least a secondary or tertiary education (82%). The majority of parents accepted the principle of prenatal genetic diagnosis for Sickle Cell Anemia (89.8%) and termination of pregnancy (62.5%). Acceptance of the principle of pregnancy termination increased with unemployment (p<.01) and single marital status (p<.05). The results of this study suggest Cameroonian parents with children affected with Sickle Cell Anemia generally accept the principles of prenatal diagnosis and in some cases termination of a pregnancy affected with Sickle Cell Anemia. Additional findings, policy and practice implications, and research recommendations are presented.

Knowledge, attitudes and practices with respect to epilepsy among student nurses and laboratory assistants in the South West Region of Cameroon.

OBJECTIVE: This study was designed as part of a series of studies mandated by the Cameroon Ministry of Public Health (National Epilepsy Control Program) to obtain new data for improvement of the epilepsy teaching program in schools training health personnel in the South West Region of Cameroon. METHOD: A 12-item semistructured questionnaire was self-administered to 340 student nurses and laboratory assistants in five training schools for health personnel in the South West Region of Cameroon. RESULTS: All of them had heard about epilepsy, 86.5% knew someone with epilepsy, 88.5% had witnessed a seizure, but only 48.8% had read about epilepsy. About 33% and 52% would, respectively, object to their children associating with and marrying people with epilepsy (PWE). About 15.3% believed that epilepsy is a form of insanity, 10% thought epilepsy is contagious, 67.4% (P<0.001) would recommend medical treatment for epilepsy, 22% would offer prayers only, and 6% would recommend traditional medicine. Independent predictors of attitudes were: acquaintance with someone with epilepsy, knowledge of the cause of epilepsy, the belief that epilepsy is contagious or is a form of insanity, being male, and being in the first year of studies. CONCLUSION: The knowledge level in this student sample is high, but the relatively low proportion of respondents who have read about epilepsy suggests that the observed high level of awareness of epilepsy may be from knowledge gained in the community; thus, there exist knowledge gaps. Therefore, a teaching course on epilepsy needs to be introduced into the curriculum of these training schools as early as the first year of studies. The course content must take into account the belief and value systems of the community and address misconceptions about epilepsy.

Knowledge, attitudes and practice with respect to epilepsy among secondary school students in the Kumbo West Health District - North West Region- Cameroon.

BACKGROUND: The main goal of this study was to obtain baseline data on awareness and attitudes and practices with respect to epilepsy among secondary school students. METHODS: We interviewed a total of 659 students from three randomly selected secondary schools in the Kumbo West Health District, using a 12-item questionnaire in English. RESULTS: About 94.7% had heard about epilepsy, 25.8% had read on the subject, 55.2% knew someone with epilepsy and 77.7% had witnessed a seizure. While 37.9% of students would object to association with people with epilepsy (PWE), 47.8% would object to marriage with PWE. About 77.2% would offer equal employment to PWE although 72.7% believed there were jobs not suitable for PWE. Up to 58% of our sample thought epilepsy is contagious and about 62.2% of them declared that epilepsy is curable. Respectively 65%, 9%, and 30% would recommend a medical doctor, a traditional healer and God's help for treatment of epilepsy. Independent determinants of attitudes were found to be: the belief that epilepsy is a form of insanity or is contagious, having witnessed a seizure, being female, being a Christian and having a higher level of education. CONCLUSION: There was a high level of awareness on epilepsy and the negative attitudes observed among these students were better than those reported in the same community. The determinants of negative attitudes were found to be diversified, confirming our hypothesis of variation, and our data further suggest that the interplay between these factors may be more complex than generally thought. This requires further qualitative study.

Public awareness, perceptions, and attitudes with respect to epilepsy in Ebolowa and Sangmelima--Urban Cameroon.

Within the framework of a series of studies mandated by the Ministry of Public Health of Cameroon to obtain baseline data for an epilepsy education program adapted to our communities, we interviewed 456 subjects without epilepsy in the Ebolowa Regional and Sangmelima District Hospitals. We found that 99.6 and 72.6% had heard or knew a person or people with epilepsy (PWE) and 76.8% had seen a seizure. About 58% of respondents would offer equal employment opportunities to PWE; 39.6% and 33.6% would respectively object to their children associating with or marrying PWE; 13% associated epilepsy with insanity and witchcraft, whereas 82.5% would recommend modern treatment for epilepsy. Predictors of negative attitudes were the beliefs that epilepsy is hereditary (26.3%) and epilepsy is a form of insanity (13%). Familiarity with epilepsy in Ebolowa and Sangmelima is high, and attitudes toward PWE are better there than in other areas of Cameroon. These results demonstrate a regional variation in public awareness and attitudes toward epilepsy and suggest that urban populations may constitute targets as well as channels for epilepsy sensitization campaigns in Cameroon.

A survey of public knowledge, attitudes, and practices with respect to epilepsy in Badissa village, centre region of Cameroon.

OBJECTIVE: The aim of this study was to assess knowledge, attitudes, and practices (KAP) with respect to epilepsy in Badissa, as part of a series of studies mandated by the Cameroon Ministry of Public Health. METHOD: We interviewed 164 subjects face-to-face during a door-to-door survey. RESULTS: All of the subjects had heard about epilepsy; 98.8% knew at least one patient with epilepsy, and 97.6% had seen at least one epileptic seizure. With respect to attitudes, 16% and 32% would respectively prevent their children from associating with and marrying, people with epilepsy; 55.5% would offer people with epilepsy equal employment. The independent determinants of attitudes were the belief that epilepsy is a form of insanity (P=0.004) or is caused by a mental illness (P=0.003), having read about epilepsy (P=0.018), and being married (P=0.007). CONCLUSIONS: Our study demonstrates a high level of awareness and fairly good knowledge of epilepsy, a lower level of misconceptions, and better attitudes, in the study area confirming our hypothesis of a regional variation in these characteristics. This model of care may be useful in scaling up the epilepsy education program in Cameroon.

Differential influence of race and environment on indeterminate reactivities to non-treponemal and treponemal antigens by immuno-chromatographic dual syphilis rapid test.

INTRODUCTION: Syphilis rapid test results may be influenced by numerous environmental and genetic factors. METHODS: The proportion of false positive syphilis non-treponemal (NT) and treponemal (T) test results using immuno-chromatographic dual syphilis rapid test on serum from Cameroonian blacks (n=103) versus French blacks (n=104) or French caucasians (n=51), all HIV-negative and free of clinical syphilis, was examined. RESULTS: Black individuals in Cameroon had a significantly higher frequency of false positive NT or T tests than black individuals in France. black individuals in France had a higher frequency of indeterminate NT tests as compared to caucasians in France. CONCLUSION: Both racial and environmental factors may affect immuno-chromatographic dual syphilis rapid testing.

Prevalence of maternal HIV infection and knowledge on mother-to-child transmission of HIV and its prevention among antenatal care attendees in a rural area in northwest Cameroon.

BACKGROUND: In 2010, an estimated 141 new HIV infections occurred per day in Cameroon and reports suggest an upsurge of these rates by 2020 if current trends continue. Mother-to-child transmission (MTCT) of HIV is a major public health challenge, and maternal knowledge on HIV transmission during pregnancy and its prevention is important in curtailing paediatric HIV acquisition. OBJECTIVES: We aimed at establishing the prevalence of maternal HIV infection as well as assessing knowledge on HIV, MTCT and prevention of MTCT (PMTCT) of HIV among pregnant women in a rural area of Cameroon. METHODS: This study was conducted in two phases: a 29 month retrospective analysis of 1866 deliveries within three rural health facilities in the Babessi sub-division, Northwest Cameroon and a 1 month prospective phase wherein 150 consenting pregnant women attending antenatal care (ANC) at the study centres were consecutively recruited. RESULTS: Overall, the prevalence of maternal HIV infection was 5.0% (100/2016). All (100%) of the interviewed pregnant women were aware of HIV infection and most (76.7%) had adequate knowledge on its routes of transmission. Meanwhile, only 79.3% (119/150) of them were aware of MTCT with slightly above a third (37.0%) having adequate knowledge on the periods of transmission. The proportions of women correctly stating: during pregnancy, during labour/delivery and during breastfeeding as possible periods of MTCT of HIV were 63.0%, 60.5% and 89.1% respectively. A majority (76.3%) of these women had inadequate knowledge on PMTCT of HIV. CONCLUSION: The overall prevalence of maternal HIV warrants strengthening of current intervention strategies including scaling-up of PMTCT measures. Among others, intensification of HIV-related ANC services to improve the pregnant women's awareness and knowledge on MTCT and its prevention are vital steps in curbing the growing burden of paediatric HIV.

Knowledge and utilization of the partograph: A cross-sectional survey among obstetric care providers in urban referral public health institutions in northwest and southwest Cameroon.

BACKGROUND: The enormous challenge to maternal well-being with associated maternal wastages during labour has remained an unsurmountable problem in Cameroon which reflects the current high maternal mortality rate. Evidence abounds that cost-effective and affordable health interventions like the use of the partograph will contribute to curb the alarming number of intrapartum maternal deaths. However, little is known about the level of knowledge and utilization of this simple life-saving tool in the North-and South-West Regions, Cameroon. METHODS: Using a self-administered structured questionnaire, a cross-sectional study was conducted from January 4th-March 25th 2016 among non-physician obstetric care providers (OCPs) across urban public health institutions in these regions. Logistic regression models were used to identify factors associated with good knowledge and routine utilization of the partograph. RESULTS: Of the 79 eligible participants, 71 (89.9%) took part in the study. The mean age of the respondents was 37.9±10.0 years with majority being female (85.9%). Less than one-third (29.6%) of the respondents had good knowledge on the partograph and only 23 (32.4%) routinely used it in monitoring labour. OCPs working in Maternal and Infant Welfare Clinics were about 4 times more likely than those working in Regional/District Hospitals to have good knowledge on the partograph [AOR = 3.88 (95% CI:1.07-14.04)], p = 0.04. Little or no knowledge of the partograph and poor staff strength in the study centres were factors militating against its routine use. CONCLUSIONS: The knowledge and use of the partograph in this study is sub-optimal. Regular in-service training of OCPs superimposed with periodic workshops and seminars, provision of reasonable staff numbers, and mandatory institutional policies on routine use of the partograph are recommended as vital first steps towards ensuring the safety of women in labour in the North-and South-West Regions of Cameroon.

Clandestine abortion causing uterine perforation and bowel infarction in a rural area: a case report and brief review.

BACKGROUND: An unsafe abortion is defined as a procedure for terminating an unintended pregnancy carried out either by a person lacking the necessary skills or in an environment that does not conform to minimal medical standards or both. Majority of these unsafe abortions are carried out in rural areas of developing countries, usually by unskilled persons who do not have proper knowledge of the anatomy of reproductive organs and in unhygienic environments thus leading to various complications. CASE PRESENTATION: We discuss the case of a 21 year old female who presented in septic shock after she underwent an unsafe abortion of an 11 weeks pregnancy with uterine wall perforation and bowel injury that required resection. CONCLUSION: Unsafe abortion is an important public health problem which accounts for a significant cause of maternal mortality and morbidity in resource poor countries. A high index of suspicion of clandestine abortion with ensuing complications should prevail when faced with a woman of child bearing age with the triad of vaginal bleeding, amenorrhea and pelvic sepsis.

Foreign body in the appendix presenting as acute appendicitis: a case report.

BACKGROUND: Foreign bodies are a rare cause of appendicitis. In most instances, ingested foreign bodies pass through the alimentary tract asymptomatically. However, those that enter the lumen of the vermiform appendix may not be able to re-enter the colon and may initiate an inflammatory process. We report a case of acute appendicitis induced by an unusual foreign body. CASE PRESENTATION: A 26-year-old Sub-Saharan woman presented with right iliac fossa pain and tenderness. She underwent an open appendectomy which revealed a condom fragment within the appendiceal lumen. A detailed retrospective history confirmed accidental ingestion of the condom 2 weeks prior to onset of symptoms. CONCLUSIONS: Although a rare finding, a variety of foreign bodies can be lodged in the appendix and may instigate an inflammatory process. There is a need to increase awareness of the potential dangers of ingested foreign bodies.

Determination of chemical composition of gall bladder stones: basis for treatment strategies in patients from Yaounde, Cameroon.

AIM: Gallstone disease is increasing in sub-saharan Africa (SSA). In the west, the majority of stones can be dissolved with bile salts, since the major component is cholesterol. This medical therapy is expensive and not readily accessible to poor populations of SSA. It was therefore necessary to analyze the chemical composition of biliary stones in a group of patients, so as to make the case for introducing bile salt therapy in SSA. METHODS: All patients with symptomatic gallstones were recruited in the study. All stones removed during cholecystectomy were sent to Houston for x-ray diffraction analysis. Data on age, sex, serum cholesterol, and the percentage by weight of cholesterol, calcium carbonate, and amorphous material in each stone was entered into a pre-established proforma. Frequencies of the major components of the stones were determined. RESULTS: Sixteen women and ten men aged between 27 and 73 (mean 44.9) years provided stones for the study. The majority of patients (65.38%) had stones with less than 25% of cholesterol. Amorphous material made up more than 50% and 100% of stones from 16 (61.53%) and 9 (34.61%) patients respectively. CONCLUSION: Cholesterol is present in small amounts in a minority of gallstones in Yaounde. Dissolution of gallstones with bile salts is unlikely to be successful.

Knowledge and attitudes concerning medical genetics amongst physicians and medical students in Cameroon (sub-Saharan Africa).

PURPOSE: Little is known about physician's knowledge of, and attitudes toward genetics in sub-Saharan Africa. METHODS: Survey of 101 pre-clinical, 95 clinical medical students, and 110 physicians, in Cameroon. RESULTS: The awareness of DNA diagnosis was poor: 0, 2.2, and 1.2%, respectively, for sickle cell anemia. The majority of the respondents considered genetic counseling as indispensable (97.6, 98.9 and 100%); and prenatal diagnosis as acceptable. The acceptance of medical abortion increased with the level of medical education (62.6, 74.7 and 90.7%). Sickle cell anemia was considered as a "serious disease" by a greater majority of respondents than Down syndrome (P < 0.001). But, in all three groups, the acceptance of termination of affected pregnancy "if the respondent's own child was affected" was lower for sickle cell anemia than Down syndrome (22.4 versus 40.2%, 10.8 versus 29.3% and 36.1 versus 70.4%). CONCLUSIONS: The data suggest a poor knowledge of genetic tests among medical students and physicians. This cohort appears to accept the principles of medical genetics. Our data emphasized a need to introduce genetics and to develop research on its ethical and social implications in Cameroon.