Confounding influences of malnutrition and Plasmodium falciparum and Schistosoma haematobium infections on haematological parameters in school children in Muyuka, Cameroon.

BACKGROUND: School-aged children (SAC) are a high-risk demographic group for infectious diseases and malnutrition. The objective of this study was to assess the burden and the effect of Plasmodium falciparum and Schistosoma haematobium infections on the haematological indices in SAC and the confounding influence of malnutrition on the outcomes. METHODS: This cross-sectional study was conducted in SAC 4-14 years old living in Ikata, Bafia and Mile 14-Likoko in Muyuka, Cameroon. Anthropometric measures of malnutrition were obtained and blood samples collected were used for detection of malaria parasites by Giemsa-stained blood films using light microscopy and complete blood count analysis using an automated haematology analyser. Urine samples collected were used to detect micro haematuria with the aid of reagent strips and the eggs of S. haematobium by urine filtration technique. Multiple linear regression model was used to examine influence of independent variables on haematological parameters. RESULTS: Out of the 606 SAC examined, the prevalence of single infections with Plasmodium or S. haematobium and co-infection with both parasites was 16.2, 16.3 and 8.3%, respectively. Overall, malaria parasite (MP), urogenital schistosomiasis, malnutrition, anaemia, haematuria, microcytosis and thrombocytopenia was prevalent in 24.4, 24.6, 25.9, 74.4, 12.2, 45.4 and 11.1% of SAC, respectively. A significant linear decline (P = 0.023) in prevalence of P. falciparum infection with the severity of stunting was observed. Factors that significantly influenced haematological parameters included haemoglobin: age, stunting and MP; haematocrit: age and MP; white blood cell count: age; red blood cell count; age and MP; lymphocyte counts: stunting; mean cell volume: age; mean cell haemoglobin: age and stunting; mean cell haemoglobin concentration: sex, stunting and red cell distribution width-coefficient of variation: sex, age and stunting. CONCLUSIONS: Malnutrition, Plasmodium and S. haematobium infections are common while anaemia is a severe public health problem in Muyuka, Cameroon. The interaction between haematological parameters with malaria parasites as well as linear growth index was negative and other interactions indicate systemic inflammation. While findings provide contextual intervention targets to ensure the judicious use of the limited resources, there is need for regular monitoring and proper treatment to improve the health of the underserved population.

Burden of moderate to severe anaemia and severe stunting in children < 3 years in conflict-hit Mount Cameroon: a community based descriptive cross-sectional study.

BACKGROUND: Armed conflict is a significant social determinant of child health with nuanced effects. There is a dearth of knowledge on the public health issues facing vulnerable populations in conflict-stricken areas. The objective was to determine the prevalence and determinants of moderate to severe anaemia (MdSA) and severe stunting (SS) in children ≤3 years in conflict-hit Dibanda, Ekona and Muea in the Mount Cameroon area. METHODS: Haematological parameters were obtained using an automated haematology analyser while undernutrition indices standard deviation (SD) scores (z- scores), were computed based on the WHO growth reference curves for 649 children in a community based cross-sectional study in 2018. Binomial logistic regression models were used to evaluate the determinants of MdSA and SS against a set of predictor variables. RESULTS: Anaemia was prevalent in 84.0% (545) of the children with a majority having microcytic anaemia (59.3%). The prevalence of MdSA was 56.1% (364). Educational level of parents/caregiver (P <  0.001) and site (P = 0.043) had a significant negative effect on the occurrence of MdSA. Stunting, underweight and wasting occurred in 31.3, 13.1 and 6.3% of the children, respectively. Overall, SS was prevalent in 17.1% (111) of the children. The age groups (0.1-1.0 year, P = 0.042 and 1.1-2.0 years, P = 0.008), educational levels (no formal education, P <  0.001 and primary education P = 0.028) and SS (P = 0.035) were significant determinants of MdSA while MdSA (P = 0.035) was the only significant determinant of SS. On the contrary, age group 0.1-1 year (OR = 0.56, P = 0.043) and site (Dibanda, OR = 0.29, P = 0.001) demonstrated a significant protective effect against SS. CONCLUSIONS: Moderate to severe anaemia, severe stunting and wasting especially in children not breastfed at all are public health challenges in the conflict-hit area. There is a need for targeted intervention to control anaemia as well as increased awareness of exclusive breast feeding in conflict-hit areas to limit the burden of wasting and stunting.

Comparative analysis of IgG and IgG subclasses against Plasmodium falciparum MSP-119 in children from five contrasting bioecological zones of Cameroon.

BACKGROUND: Studies reporting the natural immune responses against malaria in children from different geographical settings in endemic areas are not readily available. This study was aimed at comparing the immune responses against Plasmodium falciparum MSP-119 antigen in children from five contrasting bioecological zones in Cameroon. METHODS: In a cross-sectional survey, children between 2 and 15 years, were enrolled from five ecological strata including the south Cameroonian equatorial forest, sudano-sahelian, high inland plateau, high western plateau, and the coastal strata. The children were screened for clinical malaria (defined by malaria parasitaemia ≥ 5000 parasites/µl plus axillary temperature ≥ 37.5 °C). Their antibody responses were measured against P. falciparum MSP-119 antigen using standard ELISA technique. RESULTS: In all, 415 children comprising 217 (52.3%) males participated. Total IgG and IgG1-IgG4 titres were observed to increase with age in all the strata except in the sudano-sahelian and high inland plateau strata. Total IgG and IgG1-IgG4 titres were significantly higher in the coastal strata and lowest in the high inland plateau (for IgG1 and IgG2) and sudano-sahelian strata (for IgG3 and IgG4). Titres of the cytophilic antibodies (IgG1 and IgG3) were significantly higher than the non-cytophilic antibodies (IgG2 and IgG4) in all the strata except in the sudano-sahelian and high inland plateau strata. Total IgG and IgG subclass titres were significantly higher in children positive for clinical malaria compared to negative children in all study sites except in the high western plateau and coastal (for IgG1 and IgG3), and the sudano-sahelian strata (for all antibodies). Furthermore, a significant positive correlation was observed between parasite density and IgG2 or IgG4 titres in all study sites except in the south Cameroonian equatorial forest and sudano-sahelian strata. CONCLUSIONS: This study showed that antibody responses against MSP-119 vary considerably in children from the different bioecological strata in Cameroon and could be linked to the differential exposure to malaria in the different strata. Furthermore, the rate of antibody acquisition was not observed to increase in an age-dependent manner in low transmission settings.

Variation in the immune responses against Plasmodium falciparum merozoite surface protein-1 and apical membrane antigen-1 in children residing in the different epidemiological strata of malaria in Cameroon.

BACKGROUND: Studies to assess the immune responses against malaria in Cameroonian children are limited. The purpose of this study was to assess the immune responses against Plasmodium falciparum merozoite surface protein-1 (MSP-119) and apical membrane antigen-1 (AMA-1) in children residing in the different epidemiological strata of malaria in Cameroon. METHODS: In a cross-sectional survey performed between April and July 2015, 602 children between 2 and 15 years (mean ± SD = 5.7 ± 3.7), comprising 319 (53%) males were enrolled from five epidemiological strata of malaria in Cameroon including: the sudano-sahelian (SS) strata, the high inland plateau (HIP) strata, the south Cameroonian equatorial forest (SCEF) strata, the high western plateau (HWP) strata, and the coastal (C) strata. The children were screened for clinical malaria (defined by malaria parasitaemia ≥ 5000 parasites/µl plus axillary temperature ≥ 37.5 °C). Their antibody responses were measured against P. falciparum MSP-119 and AMA-1 vaccine candidate antigens using standard ELISA technique. RESULTS: A majority of the participants were IgG responders 72.1% (95% CI 68.3-75.6). The proportion of responders was higher in females (p = 0.002) and in children aged 10 years and above (p = 0.005). The proportion of responders was highest in Limbe (C strata) and lowest in Ngaoundere (HIP strata) (p < 0.0001). Similarly, the mean IgG antibody levels were higher in children aged 10 years and above (p < 0.0001) and in Limbe (p = 0.001). The IgG antibody levels against AMA-1 were higher in females (p = 0.028), meanwhile no gender disparity was observed with MSP-1. Furthermore the risk of clinical malaria (p < 0.0001) and the mean parasite density (p = 0.035) were higher in IgG non-responders. CONCLUSION: A high proportion of IgG responders was observed in this study, suggesting a high degree exposure of the target population to malaria parasites. The immune responses varied considerably across the different strata: the highest levels observed in the C strata and the lowest in the HIP strata. Furthermore, malaria transmission in Cameroon could be categorized into two major groups based on the serological reaction of the children: the southern (comprising C and SCEF strata) and northern (comprising HWP, HIP and SS strata) groups. These findings may have significant implications in the design of future trials for evaluating malaria vaccine candidates in Cameroon.

Epidemiological and clinical profile of paediatric malaria: a cross sectional study performed on febrile children in five epidemiological strata of malaria in Cameroon.

BACKGROUND: In the wake of a decline in global malaria, it is imperative to describe the epidemiology of malaria in a country to inform control policies. The purpose of this study was to describe the epidemiological and clinical profile of paediatric malaria in five epidemiological strata of malaria in Cameroon including: the Sudano-sahelian (SS) strata, the High inland plateau (HIP) strata, the South Cameroonian Equatorial forest (SCEF) strata, the High western plateau (HWP) strata, and the Coastal (C) strata. METHODS: This study involved 1609 febrile children (≤15 years) recruited using reference hospitals in the five epidemiological strata. Baseline characteristics were determined; blood glucose level was measured by a glucometer, malaria parasitaemia was assessed by Giemsa microscopy, and complete blood count was performed using an automated hematology analyser. Severe malaria was assessed and categorized based on WHO criteria. RESULTS: An overall prevalence of 15.0% (95% CI: 13.3-16.9) for malaria was observed in this study. Malaria prevalence was significantly higher in children between 60 and 119 months (p < 0.001) and in Limbe (C strata) (p < 0.001). The overall rate of severe malaria (SM) attack in this study was 29.3%; SM was significantly higher in children below 60 months (p < 0.046). Although not significant, the rate of SM was highest in Maroua (SS strata) and lowest in Limbe in the C strata. The main clinical phenotypes of SM were hyperparasitaemia, severe malaria anaemia and impaired consciousness. The majority (73.2%) of SM cases were in group 1 of the WHO classification of severe malaria (i.e. the most severe form). The malaria case-fatality rate was 5.8%; this was higher in Ngaoundere (HIP strata) (p = 0.034). CONCLUSION: In this study, malaria prevalence decreased steadily northward, from the C strata in the South to the SS strata in the North of Cameroon, meanwhile the mortality rate associated with malaria increased in the same direction. On the contrary, the rate of severe malaria attack was similar across the different epidemiological strata. Immunoepidemiological studies will be required to shed more light on the observed trends.

Malaria, helminths, co-infection and anaemia in a cohort of children from Mutengene, south western Cameroon.

BACKGROUND: Malaria and helminthiases frequently co-infect the same individuals in endemic zones. Plasmodium falciparum and helminth infections have long been recognized as major contributors to anaemia in endemic countries. Several studies have explored the influence of helminth infections on the course of malaria in humans but how these parasites interact within co-infected individuals remains controversial. METHODS: In a community-based longitudinal study from March 2011 to February 2012, the clinical and malaria parasitaemia status of a cohort of 357 children aged 6 months to 10 years living in Mutengene, south-western region of Cameroon, was monitored. Following the determination of baseline malaria/helminths status and haemoglobin levels, the incidence of malaria and anaemia status was determined in a 12 months longitudinal study by both active and passive case detection. RESULTS: Among all the children who completed the study, 32.5 % (116/357) of them had at least one malaria episode. The mean (±SEM) number of malaria attacks per year was 1.44 ± 0.062 (range: 1-4 episodes) with the highest incidence of episodes occuring during the rainy season months of March-October. Children <5 years old were exposed to more malaria attacks [OR = 2.34, 95 % CI (1.15-4.75), p = 0.019] and were also more susceptible to anaemia [OR = 2.24, 95 % CI (1.85-4.23), p = 0.013] compared to older children (5-10 years old). Likewise children with malaria episodes [OR = 4.45, 95 % CI (1.66-11.94), p = 0.003] as well as those with asymptomatic parasitaemia [OR = 2.41, 95 % CI (1.58-3.69) p < 0.001] were susceptible to anaemia compared to their malaria parasitaemia negative counterparts. Considering children infected with Plasmodium alone as the reference, children infected with helminths alone were associated with protection from anaemia [OR = 0.357, 95 % CI (0.141-0.901), p = 0.029]. The mean haemoglobin level (g/dl) of participants co-infected with Plasmodium and helminths was higher (p = 0.006) compared to participants infected with Plasmodium or helminths alone. CONCLUSION: Children below 5 years of age were more susceptible to malaria and anaemia. The high prevalence of anaemia in this community was largely due to malaria parasitaemia. Malaria and helminths co-infection was protective against anaemia.

Influence of Plasmodium gametocyte carriage on the prevalence of fever, splenomegaly and cardiovascular parameters in children less than 15 years in the Mount Cameroon area: cross sectional study.

BACKGROUND: Cardiovascular parameters can be impaired by repeated infections with P. falciparum. This study aimed at investigating the influence of gametocyte carriage on; the prevalence of fever and splenomegaly, blood pressure, heart rate and haematological indices in children <15 years, in the Mount Cameroon area. METHODS: A cross-sectional study was carried out, from February to July 2013. A child with axillary body temperature ≥37.5 °C was considered febrile and splenomegaly was investigated by palpation. Systolic and diastolic blood pressures as well as heart rate were assessed by non-invasive methods. Malaria parasites were detected and density assessed from Giemsa-stained thin and thick blood films. An auto haematology analyser was used to obtain complete blood count values such as haemoglobin (Hb), haematocrit (Hct), red blood cell (RBC) and white blood cell (WBC) counts, mean corpuscular volume (MCV), mean corpuscular haemoglobin concentration (MCHC), and mean corpuscular haemoglobin (MCH). Univariate analyses were used to examine influence of gametocyte carriage on fever and splenomegaly while, multiple linear regression models were used to evaluate influence of independent variables on the dependent variables. RESULTS: Of a total of 454 children examined, malaria parasitaemia, fever, splenomegaly and gametocyte carriage were detected in 36.6, 21.6, 14.3 and 7.3 % of them respectively. Children who were asexual parasite and gametocyte positive (ASP + Gam Pos) had significantly highest (P = 0.03, P = 0.002) prevalence of fever and splenomegaly (39.4 %, 33.3 %) respectively than their aparasitaemic (AP) and asexual parasite positive (ASP Pos) equivalents (19.0 %, 10.9 % and 22.8 %, 16.9 % respectively). The presence of asexual malaria parasitaemia significantly influenced the MCV (P = 0.03), MCH (P = 0.03) and heart beats /min (0.03) while gametocytaemia significantly influenced the Hb (P < 0.001), Hct (P < 0.001), RBC (P < 0.001) and systolic blood pressure (P < 0.05). CONCLUSION: Gametocyte carriage significantly influenced the prevalence of fever, splenomegaly and some cardiovascular indices. In effect, children concurrently having asexual parasitaemia and gametocytes had significantly lower, Hct, Hb levels, RBC and platelet counts and systolic blood pressure.

Plasmodium falciparum merozoite surface protein 1 block 2 gene polymorphism in field isolates along the slope of mount Cameroon: a cross - sectional study.

BACKGROUND: Malaria remains a major global health burden despite the intensification of control efforts, due partly to the lack of an effective vaccine. Information on genetic diversity in natural parasite populations constitutes a major impediment to vaccine development efforts and is limited in some endemic settings. The present study characterized diversity by investigating msp1 block 2 polymorphisms and the relationship between the allele families with ethnodemographic indices and clinical phenotype. METHOD: Individuals with asymptomatic parasitaemia (AP) or uncomplicated malaria (UM) were enrolled from rural, semi-rural and semi-urban localities at varying altitudes along the slope of mount Cameroon. P. falciparum malaria parasitaemic blood screened by light microscopy was depleted of leucocytes using CF11 cellulose columns and the parasite DNA genotyped by nested PCR. RESULTS: Length polymorphism was assessed in 151 field isolates revealing 64 (5) and 274 (22) distinct recombinant and major msp1 allelic fragments (genotypes) respectively. All family specific allelic types (K1, MAD20 and RO33) as well as MR were observed in the different locations, with K1 being most abundant. Eighty seven (60 %) of individuals harbored more than one parasite clone, with a significant proportion (p = 0.009) in rural compared to other settings. AP individuals had higher (p = 0.007) K1 allele frequencies but lower (p = 0.003) mean multiplicity of genotypes per infection (2.00 ± 0.98 vs. 2.56 ± 1.17) compared to UM patients. CONCLUSIONS: These results indicate enormous diversity of P. falciparum in the area and suggests that allele specificity and complexity may be relevant for the progression to symptomatic disease.

Nutritional status of children in a malaria meso endemic area: cross sectional study on prevalence, intensity, predictors, influence on malaria parasitaemia and anaemia severity.

BACKGROUND: The contradictory results on the interaction between nutritional status and malaria warrants further investigation in various epidemiological settings, to assert the antagonistic or synergistic relationship. This study examines the prevalence, severity and predictors of malnutrition and its influence on malaria parasitaemia and anaemia severity in children in the Mount Cameroon area. METHODS: A cross-sectional study involving 454 children ≤ 14 years was carried out from February to May 2013 in Muea community. Anthropometric measures of malnutrition (z-scores < -2 standard deviations below mean) were obtained and spleen size assessed. The prevalence and density of malaria parasites were determined and haemoglobin concentration and white blood cell count obtained using an automated haematology analyzer. Univariate and multivariate analyses were used to evaluate influence of malnutrition on anaemia, malaria parasitaemia and predictors respectively. RESULTS: The overall prevalence of malnutrition was 22.8 %, with stunting being the most common form (17.1 %), followed by underweight (8.2 %) and wasting (5.5 %). Stunting was significantly higher (P < 0.01) in males (23.1 %) than in females (11.9 %). The prevalence of malnutrition was significantly highest (P = 0.03) in children ≤5 years old (29.5 %) than their counterparts. Severe stunting, wasting and underweight were prevalent in 4.9 %, 1.6 % and 1.8 % of the children respectively. Clinical malaria parasitaemia was significantly higher (P = 0.01) in children who were stunted (16.9 %) and underweight (21.6 %) than their normal counterparts (7.5 %; 8.2 % respectively). The model demonstrated sex (P = 0.006) and age group 1.1-3 years (P = 0.03) as significant predictors of malnutrition. In children who were malaria parasite negative, the prevalence of anaemia as well as severities were significantly higher (P = 0.04 and P = 0.001 respectively) in those malnourished. CONCLUSIONS: The presence of stunting in the community significantly augmented the prevalence and clinical presentation of Plasmodium infection. Malnutrition enhanced the severity of anaemia in malaria parasite negative children hence, their health and growth potential needs to be improved upon.

Variation in malariometric and red cell indices in children in the Mount Cameroon area following enhanced malaria control measures: evidence from a repeated cross-sectional study.

BACKGROUND: Following enhanced malaria control measures, such as nationwide free distribution of insecticide-treated bed nets (ITN) by the government of Cameroon, its impact on malariometric and red cell indices in children ≤14 years in Muea, in the Mount Cameroon area was evaluated. METHODS: Two cross-sectional studies were conducted during the malaria transmission season (March-July) in 2006 (baseline) and 2013 (follow-up), respectively. The investigative methods included the use of a questionnaire to assess ITN use and coverage, clinical evaluation and laboratory investigations. Blood sample collected from each child was used for the preparation of blood films for detection of malaria parasites and density as well as full blood count determination using standard procedures and also an automated haematology analyzer. RESULTS: The majority of children (81.5%) possessed an ITN in 2013. The proportion of effective users of ITN increased significantly from 20.9% (CI = 17.3-25%) in 2006 to 35.2% (CI = 31-39.7%) in 2013. The highest relative risk reduction in prevalence during the follow-up study was observed in malaria anaemia (79%, CI = 58.0-69.1% [69.1 to 14.5%]), followed by gametocytaemia (71.6%, CI = 58.9-80.3% [25.6 to 7.3%]), anaemia (64%, CI = 58.0-69.1% [80.1 to 28.9%]), and malaria parasitaemia (57.2%, CI = 51.4-62.3% [85.4 to 36.6%]). In the baseline survey, the prevalence of splenomegaly was significantly highest (χ2 = 18.3, P <0.001) in the youngest group of children while in the follow-up study, it was highest in the oldest (χ2 = 6.03, P = 0.049). The overall prevalence of mild, moderate and severe anaemia in the study population at baseline (59.6, 14.9, 6.3%) decreased significantly (P <0.001) to 24.4, 2.7 and 1.3%, respectively during the follow-up with the highest relative risk reduction in prevalence occurring in moderate anaemia (82.1%, CI = 67.3-90.2% [14.9 to 2.7%]). Microcytic anaemia also decreased significantly (P <0.001) from 56 to 7.7% during the follow-up survey. CONCLUSION: Following interventions, anaemia (moderate to severe) was a more sensitive measure to changes in malaria exposure and children between 11-14 years of age experienced a significant increase in malaria-related morbidity.

Molecular typing reveals substantial Plasmodium vivax infection in asymptomatic adults in a rural area of Cameroon.

BACKGROUND: Malaria in Cameroon is due to infections by Plasmodium falciparum and, to a lesser extent, Plasmodium malariae and Plasmodium ovale, but rarely Plasmodium vivax. A recent report suggested "Plasmodium vivax-like" infections around the study area that remained unconfirmed. Therefore, molecular and antigenic typing was used to investigate the prevalence of P. vivax and Duffy in asymptomatic adults resident in Bolifamba. METHODS: A cross-sectional study was conducted from July 2008 to October 2009. The status of all parasite species was determined by nested PCR in 269 blood samples collected. The P. falciparum and P. vivax anti-MSP/CSP antibody status of each subject was also determined qualitatively by a rapid card assay. Parasite DNA was extracted from a sample infected with three parasite species, purified and sequenced. The Duffy antigen status of 12 subjects infected with P. vivax was also determined by sequencing. In silico web-based tools were used to analyse sequence data for similarities and matches to reference sequences in public DNA databases. RESULTS: The overall malaria parasite prevalence in 269 individuals was 32.3% (87) as determined by PCR. Remarkably, 14.9% (13/87) of infections were caused either exclusively or concomitantly by P. vivax, established both by PCR and microscopic examination of blood smears, in individuals both positive (50%, 6/12) and negative (50%, 6/12) for the Duffy receptor. A triple infection by P. falciparum, P. vivax and P. malariae, was detected in one infected individual. Anti-MSP/CSP antibodies were detected in 72.1% (194/269) of samples, indicating high and continuous exposure to infection through mosquito bites. DISCUSSION: These data provide the first molecular evidence of P. vivax in Duffy positive and negative Cameroonians and suggest that there may be a significant prevalence of P. vivax infection than expected in the study area. Whether the P. vivax cases were imported or due to expansion of a founder effect was not investigated. Notwithstanding, the presence of P. vivax may complicate control efforts if these parasites become hypnozoitic or latent as the liver stage. CONCLUSIONS: These data strongly suggest that P. vivax is endemic to the south-west region of Cameroon and should be taken into account when designing malaria control strategies.

A longitudinal study on anaemia in children with Plasmodium falciparum infection in the Mount Cameroon region: prevalence, risk factors and perceptions by caregivers.

BACKGROUND: In heavily endemic malaria areas, it is almost inevitable that malarial infection will be associated with anaemia, although malaria may not be the prime cause of it. Anaemia is a major public health problem in Cameroon. We hypothesized that, factors other than falciparum malaria account for anaemia in the study area. METHODS: A longitudinal study was conducted among 351 Plasmodium falciparum positive children to determine the prevalence, risk factors and the perception of anaemia by the caregivers in a semi-rural community. The investigative methods included the use of a structured questionnaire, clinical evaluation and laboratory investigations. RESULTS: At enrolment the overall prevalence of anaemia as assessed by Hb concentration (Hb < 11 g/dl) was 80.3% (282). Following treatment the prevalence of persistent anaemia was 6% and 46.2% of the children achieved haematological recovery by day 42. Exploratory multiple linear regression analysis showed the following; parasitaemia density (P < 0.01), enlarged spleen (P < 0.05), duration of fever > 2 days (P < 0.01), high white blood cell count (P < 0.001), sex (P < 0.05), iron status indicators (ferritin and transferrin) (P < 0.001), level of education of the caregiver (P < 0.05), management of onset of malaria by caregiver (P < 0.005) and wasting (P < 0.05) to be risk factors for anaemia in children with falciparum infection. Approximately 75.5% (265) of the caregivers had some knowledge about anaemia. CONCLUSION: The identified risk factors revealed the important contributors to the pathogenesis of anaemia in the Mount Cameroon region. Control efforts should therefore be directed towards proper health education emphasizing on proper health seeking behaviour and attitudes of the population.

An analysis of social dimensions of podoconiosis and leprosy on affected households in endemic health districts of the North West Region of Cameroon.

Background: Podoconiosis and leprosy are Neglected Tropical Diseases associated with low quality of life, social stigma and isolation of affected people and families. Despite the substantial social burden it imposes, podoconiosis has largely been ignored in the global health literature until recently unlike leprosy. This study assessed and compared the quality of life and social impact of podoconiosis with that of leprosy among affected households and neighborhoods in North West Cameroon. Methods: A comparative cross-sectional design was used. Eighty-six households: 43 podoconiosis and 43 leprosy, plus household neighbours were enrolled from July and August 2015 from three health districts. Podoconiosis patients living in households within Batibo and Ndop health districts were sequentially sampled using a list of confirmed podoconioisis cases from previous studies. Leprosy patients living within communities in Mejang Health Area were sequentially sampled using the Mbingo treatment center register. WHO BREF tool was used to assess quality of life. Franklin Stigma Scale was adapted to assess felt and enacted stigma. Mann-Whitney U test was used to compare differences in stigma and QoL. Results: Physical domain showed a significant difference in the distribution in quality of life between groups (p < 0.05, median:70; U:635, r = 0.2). Overall enacted stigma revealed significant differences with p < 0.05 and r = 0.4. Overall stigma from family members (median:17, U:627 and r = 0.3) and neighbours (median:67, U:336 and r = 0.5) showed significant differences with p < 0.05 in the distribution of scores for both diseases. Sex and age showed significant associations with QoL and stigma. Conclusion: This study reveals the quality of life and stigma associated with podoconiosis on affected households to be comparable to that experienced by households with a leprosy patient. There is need for intensified preventive, management and control schemes to fight podoconiosis in Cameroon, just like leprosy.

Epidemiological factors associated with HBV infection and uptake of testing in south west region of Cameroon: What can be done to scale up HBV testing in our setting?

Hepatitis B infection affects millions of people globally, partly due to its high degree of transmissibility and asymptomatic nature. This study was aimed at identifying prevailing epidemiological factors associated with HBV infection and testing uptake in the South West region of Cameroon. This hospital-based case-control study enrolled HBV infected participants and "healthy" controls ≥18 years old. Venous blood collected from participants was used to conduct HBV panel test (HBsAg, anti-HBs, HBeAg, anti-HBe, anti-HBc). Data on demographic and behavioral risk factors as well as reasons for taking the HBV test for the first time were collected using a questionnaire. A total of 424 participants were enrolled (212 "healthy" controls and 212 HBV infected cases). Male sex (odds ratio [OR] = 2.08, p = 0.010), ≤ secondary education level (OR = 4.83, p<0.001), low-income level (OR = 3.79, p<0.001), rural settlement (OR = 2.17, p = 0.031), history of sexually transmitted infections (STI) (OR = 4.24, p<0.001) and ignorance of sexual partners HBsAg status (OR = 2.70, p = 0.003) all had an independent and significant association with HBV infection. Top 3 reasons for doing HBsAg test were free screening (40.3%), blood donation (15.0%) and administrative requirements (14.9%). HBV testing uptake and early detection can be improved if more sensitization and free/opportunistic screenings are implemented. A significant drop in the cost of HBV test could encourage more people to get tested.

Enteric viruses in healthy children in Cameroon: viral load and genotyping of norovirus strains.

Data regarding prevalence of noroviruses (NoVs) among asymptomatic persons are scarce. The current study carried out on samples from Cameroon describes the asymptomatic shedding of NoVs and other enteric viruses in healthy children and in adults infected with HIV but lacking symptoms of gastroenteritis. Enteric viruses were common with a prevalence of 53.7% in the children, and 35.5% in the adult participants. Multiple enteric viruses (2-5 agents) were detected in fecal samples from 65% of the children, and co-infection with NoV was demonstrated in almost all cases of multiple infections. NoV viral loads in the healthy children were within disease causing range and significantly higher than those observed in the adults (P < 0.01). Sequencing and genotyping of NoV strains by phylogeny showed a marked diversity within two distinct genogroups, GI and GII, and strains clustered with genotypes GI.3, GII.17, GII.8, and GII.4. Genetic similarities to recent outbreak strains from other continents suggest a rapid circulation of NoVs that includes healthy children, who may constitute a reservoir for pathogenic NoVs.

Polyparasitism with Schistosoma haematobium, Plasmodium and soil-transmitted helminths in school-aged children in Muyuka-Cameroon following implementation of control measures: a cross sectional study.

BACKGROUND: Despite the ubiquity of polyparasitism, its health impacts have been inadequately studied. The aim of this study was to determine the prevalence and determinants of polyparasitism with Schistosoma haematobium, Plasmodium and soil-transmitted helminths (STH) following sustained control measures, as well as evaluate the outcomes and clinical correlates of infection in school-aged children (SAC) living in the schistosomiasis endemic focus of Muyuka-Cameroon. METHODS: In a cross-sectional study, urine, blood and stool samples were each collected from SAC (4-14 years) selected at random between March and June 2015. Microhaematuria in urine was detected using reagent strip and S. haematobium ova by filtration/microscopy methods. Plasmodium was detected using Giemsa-stained blood films and complete blood count was obtained using an auto-haematology analyser. STH in stool was detected by the Kato-Katz method. Categorical and continuous variables were compared as required, Kappa value estimated and the adjusted odds ratio (aOR) in the multivariate analysis was used to evaluate association of the risk factors with infection. RESULTS: Out of the 638 SAC examined, single infection was prevalent in 33.4% while polyparasitism was 19.9%. Prevalence of S. haematobium + Plasmodium was 7.8%; S. haematobium + STH was 0.8%; Plasmodium + STH was 0.8%; while S. haematobium + Plasmodium + STH was 0.9%. Higher preponderance of S. haematobium + Plasmodium infection occurred in females, those from Likoko, did not use potable water, practiced bathing in stream and carried out open defecation than their equivalents. However, being female (aOR = 2.38, P = 0.009) was the only significant risk factor identified. Anaemia was a common morbidity (74.3%) with a slight agreement with microscopy in predicting S. haematobium and Plasmodium infections. The sensitivity and specificity of haematuria (13.0%) in predicting S. haematobium infection was 46.5% and 100% with a moderate agreement with microscopy. Co-infection with S. haematobium and malaria parasite was significantly associated with threefold odds of history of fever in the last three days. CONCLUSIONS: Polyparasitism is a public health problem in Muyuka with females most at risk. Anaemia prevalence is exacerbated in co- and triple-infections and together with a history of fever are of value in predicting polyparasitism.

Knowledge, attitudes and perceptions regarding malaria: a cross-sectional study in pregnant women attending antenatal care in the New-Bell district hospital, Douala, Cameroon.

INTRODUCTION: malaria remains a major public health problem in Cameroon. For a successful malaria control, there is a need to evaluate the level of awareness, attitude and perception of people living in malaria endemic areas such as the swampy littoral region of Cameroon. METHODS: this was a descriptive cross-sectional study targeting pregnant women attending ANC in the New-Bell District Hospital. Data was collected with a semi-structured questionnaire on demographic characteristics as well as knowledge, attitudes and practices regarding malaria. RESULTS: two hundred and six pregnant women were enrolled in the study, all of them had heard on malaria in the past, with hospitals and television been the most known information dissemination channels. Only 60.2% of them own and used a LLINs with only 51.6% of owners treating the net. CONCLUSION: respondents with no education had poor knowledge on malaria. There is a need to improve education on malaria with active participation of women and improve malaria surveillance that will lead to malaria eradication.

Genetic diversity and antiretroviral resistance-associated mutation profile of treated and naive HIV-1 infected patients from the Northwest and Southwest regions of Cameroon.

BACKGROUND: Antiretroviral therapy (ART) has improved the survival of HIV infected persons. However, rapid scale-up of ART and the high HIV-1 genetic variability, has greatly influenced the emergence of drug-resistant strains. This constitutes a potential threat to achieving the UNAIDS' 90-90-90 goals by 2020. We investigated the prevalent HIV-1 genotypes, drug resistance-associated mutations and assessed some predictors of the occurrence of these mutations. METHODS: This was a hospital-based cross-sectional study conducted between October 2010 and June 2012. Participants were consecutively enrolled from selected HIV treatment centers of the Southwest and Northwest regions of Cameroon. Viral load was determined with the automated Abbott Real-time HIV-1 m2000rt System. HIV genotyping and antiretroviral resistance mutations analysis were performed using Bayer's HIV-1 TRUGENE™ Genotyping Kit and OpenGene DNA Sequencing system. The drug resistance mutation was interpreted with the Stanford HIV database. Epidemiological data were obtained using pre-tested semi-structured questionnaires. RESULTS: Of the 387 participants, 239 were successfully genotyped. The median age of these participants was 33 years (interquartile range, IQR: 28-40 years), and a majority (65.7%) were female. A total of 29.3% of the participants were receiving ART. The median duration of ART was 10.5 months (IQR: 4-17.25 months). The median CD4 count and log10 viral load of study participants were 353.5 cells/ml (IQR:145-471) and 4.89 copies/ml (IQR: 3.91-5.55) respectively. CRF02 (A/G) (69%) was the most prevalent subtype followed by G (8.2%) and F (6.7%). Overall, resistance mutations were present in 37.1% of ART-experienced and 10.7% of ART-naive patients. Nucleoside reverse transcriptase inhibitors (NRTI) mutations occurred in 30% of ART-experienced and 2.4% of ART-naïve patients, while non-nucleoside reverse transcriptase inhibitors (NNRTI) mutations occurred in 34.2% of ART-experienced and 10.1% of -naïve patients. M184V (8.4%, 20/239) and K103N (5.4%, 13/239) were the most prevalent mutations. Major protease inhibitor mutations occurred in 3 (1.3%) out of the 239 sequences. The duration of ART independently predicted the occurrence of resistance mutation among ART-experienced patients. CONCLUSION: The high resistance to NNRTIs, which are the main support to the backbone (NRTIs) first-line antiretroviral regimen in Cameroon, has prompted the need to rollout an integrase strand transfer inhibitor regimen (containing Dolutegravir) with a higher genetic barrier to resistance as the preferred first line regimen.

HBV Transmission Risk Assessment in Healthcare Workers, Household and Sexual Contacts of HBV Infected Patients in the Southwest Region of Cameroon.

OBJECTIVES: Hepatitis B virus (HBV) is known to be highly transmissible via the body fluids of an infected person. We investigated the transmission risks, awareness, and prevalence among healthcare workers (HCWs), household contacts (HHCs), and sexual partners (SPs) of HBV infected individuals. METHODS: We conducted a cross-sectional study of HCWs, HBV infected individuals as well as their corresponding HHCs and SPs. Data related to some transmission risks and HBV awareness was obtained from each participant using a questionnaire. Blood samples were collected from each participant and tested for hepatitis B surface antigen (HBsAg), hepatitis B e-antigen, and anti-hepatitis B core (anti-HBc). HBV viral load measurement was done for the HBV infected participants. RESULTS: A total of 596 participants were enrolled (127 HCWs, 128 HHCs, 138 SPs, and 203 HBV infected participants). HHCs (odds ratio (OR): 3.85, confidence interval (CI): 1.89-7.81), and SPs (OR: 3.04, CI: 1.51-6.17) were more associated with HBsAg/anti-HBc positivity compared to HCWs. Age, years spent with HBV infected partner, unprotected sex, and marriage were not identified as risk factors for HBV sexual transmission but cohabiting with an HBV infected SP was significantly (p = 0.005) associated with transmission (OR: 3.56, CI: 1.46-8.72). Female HHCs (OR: 2.48, CI: 1.06-5.80) and SPs (OR: 2.64, CI: 0.95-7.30) were more associated with HBsAg/anti-HBc positivity. The mean viral load (log IU) of HBV infected individuals (3.9±2.0) with HBsAg positive SPs was significantly higher than that of HBV infected individuals (2.8±1.0) with HBsAg negative SPs (p < 0.001). CONCLUSIONS: HHCs and SPs of HBV infected patients are more associated with HBV infection compared to HCWs. Horizontal transmission can as well be implicated among SPs since unprotected sex was not identified as a risk factor for transmission, but cohabitation was. Prompt management and preventive measures could be implemented if HHCs and SPs of HBV infected patients are identified, sensitized, and screened.

Vaccine uptake and immune responses to HBV infection amongst vaccinated and non-vaccinated healthcare workers, household and sexual contacts to chronically infected HBV individuals in the South West Region of Cameroon.

BACKGROUND: HBV infection affects about 257 million people globally and Sub-Saharan Africa has the highest burden. The disease still constitutes a major public health problem despite the advent of preventive measures like the HBV vaccine. This study was aimed at identifying factors that influence vaccine uptake and the efficacy of administered vaccines among people at high risk of HBV infection. METHODS: This was a cross-sectional study conducted between January 2016 and December 2017. A pretested semi-structured questionnaire was used to capture information on sociodemographic and vaccination status from healthcare workers, household and sexual contacts to HBV infected people. HBV serological panel as well as quantitative anti-HBs ELISA test was done for all participants. Additional information was obtained from the institutions that administered the vaccines. RESULTS: A total of 265 participants with a mean age of 32.1±8.7 were enrolled. Eighty (30.2%) of them had received at least 1 dose of the HBV vaccine while 185 (69.8%) were unvaccinated. Healthcare workers were the most vaccinated (37%). Ignorance, negligence, fear of injection and the cost of the vaccine all contributed to poor vaccine uptake in the study population. Natural immunity was seen in 9 (3.4%) of the participants. Only 64.9% of the vaccinated participants attained the desirable level of anti-HBs (≥10mIU/ml) 1-2 months after ≥ 3 doses of the vaccine. Age, gender, obesity, alcohol and smoking were not significantly associated with poor immune responses. No standardized protocol was followed by the institutions administering the vaccine. CONCLUSION: This study revealed very poor vaccine uptake and poor immune responses to the HBV vaccine in the study population and this should urge the health sector in Cameroon to intensify their sensitization on HBV vaccine, standardize the protocol for storing and administering the vaccine, subsidize the cost of the vaccine especially amongst healthcare workers and encourage anti-HBs post vaccination testing.