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.

[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.