An innovative approach in monitoring oral cholera vaccination campaign: integration of a between-round survey.

BACKGROUND: Monitoring and Evaluation (M&E) is essential in ensuring population's access to immunization. Surveys are part of this M&E approach but its timing limits the use of its results to improve the coverage of the evaluated campaign. An oral cholera vaccination campaign was organized in a health district of the Far North region of Cameroon and involved an innovative M&E approach. The aim of this project was to assess the feasibility and effect of using recommendations of a community-based immunization and communication coverage survey conducted after the first round of an OCV campaign on the coverage of the second-round of the campaign. METHODS: Two community-based surveys were included in the M&E plan and conducted at the end of each of the campaign rounds. Data were collected by trained and closely supervised surveyors and reported using smartphones. Key results of the first-round survey were disseminated to campaign implementing team prior to the second round. The two rounds of the pre-emptive campaign were organized by the Cameroon Ministry of Public Health and partners with a two-week interval in the Mogode Health District of the Far North region of Cameroon in May and June 2017. RESULTS: Of 120 targeted clusters, 119 (99.1%) and 117 (97.5%) were reached for the first and second rounds respectively. Among the Mogode population eligible for vaccination, the immunization coverage based on evidence (card or finger mark) were estimated at 81.0% in the first round and increased to 88.8% in the second round (X2=69.0 and p <0.00). For the second round, we estimated 80.1% and 4.3% of persons who were administered 2 doses and 1 dose of OCV with evidence respectively, and 3.8% of persons who have not been vaccinated. The distribution of campaign communication coverage per health area was shared with the campaign coordination team for better planning of the second round campaign activities. CONCLUSIONS: It is feasible to plan and implement coverage survey after first round OCV campaign and use its results for the better planning of the second round. For the present study, this is associated to the improvement of OCV coverage in the second-round vaccination. If this is persistent in other contexts, it may apply to improve coverage of any health campaign that is organized in more than one round.

Distribution of sources of household air pollution: a cross-sectional study in Cameroon.

BACKGROUND: Household air pollution (HAP) is a recognised risk factor for many diseases, including respiratory diseases, cardiovascular/circulatory disorders, adverse pregnancy outcomes and cataracts. Population exposure to biomass fuels, including wood, varies among countries and from one fuel source to the other. This study aimed to investigate the different sources of HAP in peri-urban and rural communities in Cameroon. METHODS: A cross-sectional survey was conducted in a representative sample of households from the Dschang Health District (DHD) region. This included 848 homes in which a range of fuels for cooking including biomass (firewood, charcoal, sawdust), kerosene and liquefied petroleum gas (LPG) were used both indoors and outdoors. RESULTS: Of the study households, 651 (77%) reported exclusive use of firewood and 141 (17%) reported using more than one source of fuel. Exclusive use of firewood was greater in rural communities (94%) than in peri-urban communities (38%). In peri-urban communities, use of multiple fuels including LPG, wood, sawdust and kerosene, was more common (44.75%). A total of 25.03% of households in both peri-urban and rural communities reported using bottled gas (or liquified petroleum gas (LPG) for cooking. Motivations for choice of fuel included, affordability, availability, rapidity, and cultural factors. CONCLUSION: Wood is the main cooking fuel in both peri-urban and rural communities in the Dschang Health District. Supporting households (especially those with limited resources) to adopt LPG equipment for cooking, and use in a more exclusive way is required to help reduce household air pollution.

EPI immunization coverage, timeliness and dropout rate among children in a West Cameroon health district: a cross sectional study.

BACKGROUND: Monitoring of the expanded program on immunization's performance is not only limited to routine periodic reports but equally includes surveys. Based on unpublished national EPI surveillance data from the past 5 years in Cameroon, the Foumban health district has reported a high number of vaccine preventable disease suspected cases. Contradictory information on the immunization coverage in this district exists from both administrative data and published literature. As a result, the objective of this study was to estimate the immunization coverage and dropout rate in age group 12-23 months and timeliness in age group 0-59 months among children in Foumban Health District (Cameroon), in 2018. METHOD: This was a descriptive cross-sectional study targeting randomly selected children aged 0-59 months from Foumban health district. Data were collected by trained and supervised surveyors using a pretested questionnaire to describe the immunization coverage, timeliness and dropout rate in eighty clusters of about thirty buildings selected by stratified random sampling in July 2018. RESULTS: In total, 80 clusters covering 2121 buildings were selected and all were reached (100%). A total of 1549 (81.2%) households accepted to participate in the survey and 1430 children aged 0-59 months including 294 (20.6%) aged 12-23 months were enrolled into the study. Of these 1430 children, 427 [29.9 (27.4-32.2)%] aged 0-59 months were vaccinated with evidence. In the age group 12-23 months, the immunization coverage with evidence of BCG, DPT-Hi + Hb 3 and measles/rubella were 28.6(23.4-33.9)%, 22.8 (18.1-27.6)% and 14.3 (10.3-18.1)% respectively. Within age group 0-59 months; the proportion of children who missed their vaccination appointments increased from 23.3 to 31.7% for the vaccine planned at birth (BCG) and last vaccine planned (Measles/Rubella) for the EPI program respectively. In age group 12-23 months; the specific (DPT-Hi + Hb1-3) and general (BCG-Measles/Rubella) dropout rates of vaccination with evidence were 14.1 and 50.0% respectively. CONCLUSION: Documented immunization coverage, dropout rate and timeliness in Foumban Health district are lower than that targeted by the Cameroon EPI. Competent health authorities have to take necessary actions to ensure the implementation of national guidelines with regards to children access to immunization. Also, studies have to be conducted to identify determinants of low immunization coverage and delays in immunization schedules as well as high dropout rates.

Health facility preparedness for cholera outbreak response in four cholera-prone districts in Cameroon: a cross sectional study.

BACKGROUND: The risk of cholera outbreak remains high in Cameroon. This is because of the persistent cholera outbreaks in neighboring countries coupled with the poor hygiene and sanitation conditions in Cameroon. The objective of this study was to assess the readiness of health facilities to respond to cholera outbreak in four cholera-prone districts in Cameroon. METHODOLOGY: A cross-sectional study was conducted targeting all health facilities in four health districts, labeled as cholera hotspots in Cameroon in August 2016. Data collection was done by interview with a questionnaire and by observation regarding the availability of resources and materials for surveillance and case management, access to water, hygiene, and sanitation. Data analysis was descriptive with STATA 11. PRINCIPAL FINDINGS: A total of 134 health facilities were evaluated, most of which (108/134[81%]) were urban facilities. The preparedness regarding surveillance was limited with 13 (50%) health facilities in the Far North and 22(20%) in the Littoral having cholera case definition guide. ORS for Case management was present in 8(31%) health facilities in the Far North and in 94(87%) facilities in the littoral. Less than half of the health facilities had a hand washing protocol and 7(5.1%) did not have any source of drinking water or relied on unimproved sources like lake. A total of 4(3.0%) health facilities, all in the Far North region, did not have a toilet. CONCLUSIONS: The level of preparedness of health facilities in Cameroon for cholera outbreak response presents a lot of weaknesses. These are present in terms of lack of basic surveillance and case management materials and resources, low access to WaSH. If not addressed now, these facilities might not be able to play their role in case there is an outbreak and might even turn to be transmission milieus.

Innovative approach in assessing the children's immunization status when it cannot be documented.

During surveys, it is recommended that children immunization status should be based on immunization documents. It has been noted that in some communities, a number of children are claimed to be vaccinated but have no evidence of vaccination. This work is proposed to estimate routine immunization coverage in children based on both documented vaccination and the tracking of undocumented immunization. It was a community-based survey targeting children aged 0-59 months in which the immunization status of children was assessed based on vaccination documents and based on a questionnaire tracking immunization sites and period for children with undocumented vaccination. The vaccination coverage and completeness were estimated from data collected in immunization cards and re-estimated after tracking the immunization status of children with no immunization cards. Of 1435 children reached in households, 1430 (99.7%) were included. Of 1072 children aged 12-59 months, 194 (18.1%) received DPT-Hi+Hb 3 with evidence and 399 (37.2%) with evidence and tracking. In the same age group, the dropout rate from DPT-Hi+Hb 1 (157 doses administered) to DPT-Hi+Hb 3 (127 doses administered) with evidence was 19.1% and 42.4% with evidence and tracking. The tracking of immunization status in children with no evidence of vaccination allows to determine their immunization status and to improve the reliability of the estimated vaccination coverage. This strategy could be adopted to be part of the planning and implementation of vaccination coverage surveys of EPI vaccines.

Research for Health Care and Policy on HIV/AIDS: proceedings of the third edition of the Cameroon HIV Research (CAM-HERO) 2022, Kribi, Cameroon, from 1st to 3rd December 2022.

Cameroon is committed to reaching HIV epidemic control through coordinated efforts by the Ministry of Public Health, the National AIDS Control Committee, bilateral/multilateral institutions and implementing partners. The third edition of the Cameroon HIV Research Forum (CAM-HERO) was held in Kribi from December 1st to 3rd, 2022, with the theme "Research for Health Care and Policy on HIV/AIDS." The conference brought together local and international scientists and clinicians, policymakers, and regulatory authorities to 1) disseminate HIV research findings and HIV policy; 2) foster operational research collaboration; 3) build research capacity through training on basics of research methods and CAM-HERO young investigator Awards; and 4) initiate a guideline for promoting HIV/AIDS research in Cameroon. The main activities included training on research methodology and basic principles in bioethics, presentations of selected abstracts, and awards for top research. A total of 35 abstracts (16 oral presentations, 16 posters, and 3 late-breaker-abstracts) were selected for presentation following a rigorous review. The conference ended with evidence-based recommendations and a way-forward statement for the development of a National Guide for HIV/AIDS research in Cameroon, with the aim of improving the quality and quantity of research agenda and projects nationwide.

Tracking Demographic Movements and Immunization Status to Improve Children's Access to Immunization: Field-Based Randomized Controlled Trial.

BACKGROUND: Countries' Expanded Program on Immunization (EPI) contribute to the reduction of mortality and morbidity, but access to these vaccines remains limited in most low-income countries. OBJECTIVE: We aim to assess whether involving community volunteers (CVs) to track children's vaccination status and demographic movements and using recorded data to plan catch-up immunization sessions can improve children's vaccination timeliness, completeness, and coverage. METHODS: This was a field-based randomized controlled trial and communities of the Foumban health district in West Cameroon were allocated to intervention or control groups. In the intervention group, a CV per community was trained to visit households monthly for a year to assess and record in a register, details of EPI-targeted children, their demographic movements and immunization status. The scanned recorded pages were sent to the health center immunization team through WhatsApp and used to organize monthly community catch-up immunization sessions. In the control group, EPI vaccination sessions were routinely conducted. Surveys were conducted at 6 and 12 months from the beginning of the intervention in both study groups to assess and compare immunization timeliness, coverage, and completeness. RESULTS: Overall, 30 buildings per cluster were surveyed at midline and endline. Of the 633 and 729 visited households in the intervention group at midline and endline, 630 (99.5%) and 718 (98.4%), respectively, consented to participate. In the control group, 507 and 651 households were visited and 505 (99.6%) and 636 (97.7%), respectively, consented to participate. At 12 months intervention, the month one timeliness of bacille Calmette-Guerin (BCG) vaccine did not increase in the intervention group compared with the control group for the age groups 0-11 months (adjusted odds ratio [aOR] 1.1, 95% CI 0.7-1.8) and 0-59 months (aOR 1.1, 95% CI 0.9-1.4), and significantly increased for the first-year BCG vaccine administration for the age group 0-23 months (aOR 1.5, 95% CI 1.1-2.2). The coverage of diphtheria-pertussis-tetanus and hepatitis B+Hemophilus influenzae type B (DPT-Hi +Hb) dose 3 (aOR 2.0, 95% CI 1.5-2.7) and of DPT-Hi+Hb dose 1 (aOR 1.8, 95% CI 1.4-2.4) vaccines increased significantly in the intervention group compared with the control group in the age groups 12-59 months and 12-23 months, respectively. Specific (DPT-Hi+Hb dose 1 to DPT-Hi+Hb dose 3: aOR 1.9, 95% CI 1.4-2.6) and general (BCG to measles: aOR 1.5, 95% CI 1.1-2.1) vaccine completeness increased significantly in the intervention group compared with the control group. CONCLUSIONS: Findings support that involving CVs to track children's vaccination status and demographic movements and using recorded data to plan catch-up immunization sessions improve children's vaccination timeliness, completeness, and coverage. This strategy should be adopted to improve access to vaccination for EPI target populations and the consistency verified in other contexts. TRIAL REGISTRATION: Pan African Clinical Trials Registry PACTR201808527428720; https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=3548.

Tracking Demographic Movements and Immunization Status to Improve Children's Access to Immunization (TDM-IAI): Protocol for a Field-Based Randomized Controlled Trial.

BACKGROUND: In Cameroon, the coverage, completeness, and timeliness of the Expanded Programme on Immunization (EPI) vaccines administration in children have remained heterogeneous and below the national and districts targets in several districts. In an effort to solve this problem, many interventions have been tested but none has shown significant improvement of the situation. OBJECTIVE: This trial aims to test whether involving Community Volunteers to assess children vaccination status and demographic movements and using recorded data to plan catch-up immunization sessions can improve children vaccination timeliness, completeness and coverage. METHODS: Communities of the Foumban Health district, West region of Cameroon will be selected and assigned to either intervention or control groups using a restricted randomization of 2. In the intervention group, one Community Volunteer per community will be trained to visit households and record EPI-targeted children in a register, record their demographic movements, and assess their immunization status monthly for a year. The information recorded will be snapped and sent to the competent health center immunization team through WhatsApp. These will be used to plan and implement monthly community catch up immunization sessions in collaboration with the community volunteer. In the control group, the routine immunization sessions will be conducted with health centers organizing either weekly vaccination sessions for communities situated not farther than 5 kilometers away from the health facility or monthly vaccination sessions in communities situated more than 5 kilometers away from the health center. Baseline, mid-term and end-line surveys will be conducted to assess and compare immunization coverage, timeliness, and completeness. RESULTS: Funded in 2018, data collection started in 2018 and has been completed. Data analysis and reporting are ongoing. CONCLUSIONS: This trial is expecting to test an innovative approach to improving children's immunization timeliness, completeness and coverage of immunization by tracking EPI targeted population vaccination status and denominator at household level and building collaboration between the community and health facilities vaccination teams to organize monthly community-based response vaccination sessions. This intervention is expected to improve children sustainable access to EPI vaccination as it offers assessing and responding to their immunization needs at monthly basis using low cost local human resources. TRIAL REGISTRATION: Pan African Clinical Trials Registry ID PACTR201808527428720; tinyurl.com/u058qnse. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/21734.

[Profile and antibiotic susceptibility pattern of bacterial pathogens associated with diarrheas in patients presenting at the Kousseri Regional Hospital Anne, Far North, Cameroon]. / Profil et antibiosensibilité des bactéries pathogènes associées aux diarrhées chez les patients consultant à l'Hôpital Régional Annexe de Kousseri, Extrême-Nord Cameroun.

INTRODUCTION: In most of the health facilities in Cameroon, the management of patients with diarrhea is based on presumptive diagnosis due to limited laboratory resources. This study aimed to determine germs profile and their susceptibility to antibiotics usually prescribed against pathogenic bacteria associated with diarrheas at the Kousseri Regional Hospital Annex from July to October 2015. METHODS: We conducted a descriptive and cross-sectional study of all consenting individual presenting with diarrhea to the Kousseri Regional Hospital Annex during the study period. Stool samples were collected from each patient. Patient data were collected via anonymous questionnaire with face to face interview. Each stool sample was grown on media for enterobacteria and analyzed following the standard stool culture method. The sensitivity of the isolated strains to the most frequently prescribed antibiotics was assessed and the proportions of patients with each pathogen germ and of germ sensitive to each antibiotic were estimated. RESULTS: Out of 150 patients with diarrhea included in the study 45(30.0%) had enteropathogenic bacteria, of which 37(82.2%) in children aged 0-5 years. Escherichia coli was the the most common bacterium(30 cases, 66%) followed by Salmonella spp(7 cases, 16%), Vibrio spp,(5 cases, 11%), Aeromonas spp(2 cases, 4%), and Shigella spp(1 cases, 2%). Susceptibility tests were performed which showed that 17(56.7%), 14(46.7%) and 5(16.7%) E. coli were susceptible to ciprofloxacin, ceftriaxone, cotrimoxazole respectively; 4(57.14%), 2(28.57%) Salmonella spp. were susceptible to ceftriaxone and cotrimoxazole respectively. CONCLUSION: Nearly a third of the cases of diarrheas at the Kousseri Regional Hospital Annex in the season of rain were associated with at least a pathogenic bacterium. The susceptibility of isolated germs to commonly prescribed antibiotics was very limited. Health staff in the facilities in the extreme north of Cameroon prescribe antibiotic against diarrheas on the basis of presumptive diagnosis. Hence, the necessity to implement a system for the monitoring of the associated germ profile and of their susceptibility to commonly prescribed antibiotics.