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.

Training needs of health researchers in research ethics in Cameroon: a cross-sectional study.

BACKGROUND: Researchers are responsible for the protection of health research participants. The purpose of this study was to identify and prioritize the training needs of researchers involved in human health research in Cameroon. METHODS: It was a cross-sectional study conducted in all the Cameroon regions in the last quarter of 2020. It targeted researchers involved in human health research selected by systematic stratified sampling from health and training institutions, and health facilities. Data were collected using a face-to-face administered questionnaire deployed in Smartphones via the ODK-collect. The distribution of participants' exposure to research ethics training was described as well as their knowledge on the related regulatory texts. A score was used to rank the training needs identified by the participants. RESULTS: Of 168 reached participants, 134 (79.76%) participated in the study. A total of 103 (76.87%) researchers reported having received training in human health research ethics and 98 (73.13%) perceived need of training in research ethics. Of those involved in clinical, vaccine, and field trials, 63.64, 33.33, 52.53% have been exposed respectively to related training regarding participants' protection. Having received at least one training in research ethics significantly increase the proportion of researchers systematically submitting application for ethical evaluation prior to implementation (OR = 3.20 (1.31-7.78)). Training priorities identified by researchers include: guidelines and regulations on health research ethics and research participant's protection in Cameroon, procedures for evaluating research protocols, protection of research participants in clinical trials, and fundamental ethics principles. CONCLUSION: The coverage of researchers in training regarding research participant protection remains limited in a number of areas including those related to clinical trial participant protection and research participant protection in Cameroon. Improving this coverage and addressing perceived needs of researchers are expected to contribute in improving their ability in playing their role in research participant protection.

Contrasting Epidemiology of Cholera in Bangladesh and Africa.

In Bangladesh and West Bengal cholera is seasonal, transmission occurs consistently annually. By contrast, in most African countries, cholera has inconsistent seasonal patterns and long periods without obvious transmission. Transmission patterns in Africa occur during intermittent outbreaks followed by elimination of that genetic lineage. Later another outbreak may occur because of reintroduction of new or evolved lineages from adjacent areas, often by human travelers. These then subsequently undergo subsequent elimination. The frequent elimination and reintroduction has several implications when planning for cholera's elimination including: a) reconsidering concepts of definition of elimination, b) stress on rapid detection and response to outbreaks, c) more effective use of oral cholera vaccine and WASH, d) need to readjust estimates of disease burden for Africa, e) re-examination of water as a reservoir for maintaining endemicity in Africa. This paper reviews major features of cholera's epidemiology in African countries which appear different from the Ganges Delta.

Characterization of Enteric Disease in Children by Use of a Low-Cost Specimen Preservation Method.

Diarrhea is a leading cause of death in children under five. Molecular methods exist for the rapid detection of enteric pathogens; however, the logistical costs of storing stool specimens limit applicability. We sought to demonstrate that dried specimens preserved using filter paper can be used to identify diarrheal diseases causing significant morbidity among children in resource-constrained countries. A substudy was nested into cholera surveillance in Cameroon. Enrollment criteria included enrollment between 1 August 2016 and 1 October 2018, age of <18 years, availability of a stool specimen, and having three or more loose stools within 24 h with the presence of dehydration and/or blood. A total of 7,227 persons were enrolled, of whom 2,746 met enrollment criteria and 337 were included in this analysis using the enteric TaqMan array card. Bacterial pathogens were compared to severity of diarrhea, age, and sex, among other variables. One hundred seven were positive for enterotoxigenic Escherichia coli, of which 40.2% (n = 43) had heat-labile enterotoxin (LT) and the heat-stable enterotoxin STh, 19.6% (n = 21) had LT and the heat-stable enterotoxin STp, and 49.5% (n = 53) had LT only. Major colonization factors (CFs) were present in 43.9% of enterotoxigenic E. coli (ETEC)-positive patients. Ninety-six were positive for Shigella, of whom 14 (14.6%) reported dysentery. Model-derived quantitative cutoffs identified 116 (34.4%) with one highly diarrhea-associated pathogen and 16 (4.7%) with two or more. Shigella and rotavirus were most strongly associated with diarrhea in children with mixed infections. Dried-filter-paper-preserved specimens eliminate the need for frozen stool specimens and will facilitate enteric surveillance and contribute to the understanding of disease burden, which is needed to guide vaccine development and introduction. This study confirms rotavirus, Shigella, and ETEC as major contributors to pediatric diarrheal disease in two regions of Cameroon.

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.

Biomedical research ethics in Cameroon: a survey to assess training needs of medical residents and students.

BACKGROUND: Training curricula in research ethics for potential and future researchers should be implemented and constantly updated. This requires data regarding training needs. METHODS: We conducted a cross-sectional survey on residents, fifth and sixth-year medical students registered in the 2006-2007 academic year at the Faculty of Medicine and Biomedical Sciences (FMBS) of the University of Yaounde 1, Cameroon. RESULTS: Two-fifths (40.4%) of respondents (response rate 70.9%) reported training in research ethics. Less than half were aware of specific regulatory texts relevant to research ethics. Among those who reported conducting a research project 66.7% declared having obtained informed consent from participants and 32.9% having submitted their protocol to an Ethics Review Committee. Participants identified training priorities in research ethics and responsibilities of key actors in the protection of research participants. CONCLUSION: There is a need to improve the training and attitude of medical students and residents in order to prepare them to respect and protect research participants.

Incidence and types of adverse events during mass vaccination campaign with the meningococcal a conjugate vaccine (MENAFRIVAC™) in Cameroon.

PURPOSE: A new vaccine against meningitis A was introduced in Africa meningitis belt in 2010. This study was planned to describe the incidence and types of adverse events following immunization (AEFIs) with a new conjugate vaccine against meningitis A (MenAfrivac™) in a Cameroonian vaccination campaign. METHODS: The campaign was conducted in Adamawa and North West regions in December 2012 and the AEFIs enhanced surveillance from December 2012 to January 2013. Incidence rates (IR) of overall and serious AEFIs were estimated as well as AEFI incidence rates by type, age group and region. AEFI symptoms were aggregated in System Organ Class (SOC). RESULTS: Of 2 093 381 persons vaccinated, 1352 AEFIs were reported. Of these, 228 (16.9%) were excluded because of not meeting inclusion criteria and 1124 (83.1%) included (IR: 53.7/100 000 doses administered/8 weeks). Of the 82 serious AEFIs reported, 52 (63.2%) met the case definition. 23 (28.1%) were investigated, of which 4 (17.4%) were probably vaccine product-related reactions (IR: 0.2/100 000 doses administered/8 weeks). Fever was the most common reported AEFI with 626 cases (IR: 31.4/100 000 doses administered/8 weeks). The proportion of people with the SOC "Gastrointestinal disorders" was significantly lower in ages 5-15 and 16-29 years than 1-4 years [aRR = 0.63(0.42-0.93) and 0.54(0.36-0.81) respectively]. CONCLUSION: Incidence and types of AEFI reported during MenAfriVacTM vaccination campaign organized in Cameroon in 2012 did not suggest concern regarding the vaccine safety. Differences in frequency of AEFIs types per age group could guide the monitoring of AEFIs frequency in future campaigns. Efforts are needed to improve the investigation rate of serious AEFIs. Copyright © 2016 John Wiley & Sons, Ltd.

The expanded program on immunization service delivery in the Dschang health district, west region of Cameroon: a cross sectional survey.

BACKGROUND: Vaccination is the most effective intervention strategy, and the provision of vaccination at fixed posts and outreach posts is a backbone of a sustainable vaccination system in developing countries. Access to immunization services is still limited in Cameroon. Several health districts in the west region have recorded new epidemic outbreaks, including the occurrence of a wild polio virus epidemic outbreak in 2013. The aim of this study was to assess immunization service delivery in one of the largest health districts in the west region of Cameroon; the Dschang Health district. METHODS: It was a cross sectional study conducted in 2013, in 42 health facilities covering 18 health areas in the Dschang Health District. Data were collected with questionnaires administered to health personnel face to face and an observation grid was used to assess resources and tools. Data were entered and analyzed in Epi Info. RESULTS: A total of 42 health facilities were assessed and 77 health personnel were interviewed. Overall, 29 (69.0 %) health facilities organized one vaccination session monthly, 2 (4.8 %) organized an outreach within the last 3 months prior to the study, 15 (35.7 %) did not have a vaccination micro plan, 24 (32.9 %) health personnel had not been supervised for at least the last 6 months prior to the study, 7 (16.7 %) health facilities did not have a functional refrigerator, 1 (2.4 %) did not have a vaccine carrier, 23 (54.8 %) did not have a means of transport (vehicle or motorcycle) and 12 (28.6 %) did not have an EPI guideline. The knowledge of health personnel on vaccine and cold chain management, and on diseases of the EPI under epidemiological surveillance was found to be limited. CONCLUSION: The frequency and strategic provision of immunization services in the Dschang Health district is inadequate. Resource availability for an adequate provision of immunization services is insufficient. The knowledge of health personnel on vaccine management, cold chain management and on diseases under surveillance by the EPI is limited.

Delay in sputum smear conversion and outcomes of smear-positive tuberculosis patients: a retrospective cohort study in Bafoussam, Cameroon.

BACKGROUND: In limited resource settings, sputum smear conversion at the end of the intensive phase of tuberculosis treatment is an indicator not only of patients' response to treatment, but also of anti-tuberculosis program performance. The objective of this study was to identify factors associated to sputum smear non-conversion at the end of the intensive phase of treatment, and the effect of smear non-conversion on the outcome of smear-positive pulmonary tuberculosis patients. METHOD: This retrospective cohort study was carried out on data of patients treated in the Diagnostic and Treatment Centre of Baleng, West-Cameroon from 2006 to 2012. Logistic regression models were used to evaluate the association of socio-demographic and clinical factors with delay in sputum smear conversion, and the association of this delay with treatment outcomes. RESULT: Out of 1425 smear-positive pulmonary tuberculosis patients treated during the study period, 1286 (90.2%) were included in the analysis. Ninety four (7.3% CI: 6.0- 8.9) patients were identified as non-converted at the end of the intensive phase of treatment. Pre-treatment smears graded 2+ and 3+ were independently associated to delay in smear conversion (p<0.01). Years of treatment ranging from 2009 to 2012 were also associated to delay in smear conversion (p<0.02). Delay in smear conversion was significantly associated to failure [Adjusted Odd Ratio (AOR):12.4 (Confidence Interval: CI 4.0- 39.0)] and death, AOR: 3.6 (CI 1.5- 9.0). CONCLUSION: Heavy initial bacillary load and treatment years ranging from 2009 to 2012 were associated to sputum smear non-conversion at the end of the intensive phase of TB treatment. Also, delay in smear conversion was associated to unfavorable treatment outcomes. Patients with heavy initial bacillary load should thus be closely monitored and studies done to identify reasons for the high proportion of non-conversion among patients treated between 2009 and 2012.

Assessing the detection, reporting and investigation of adverse events in clinical trial protocols implemented in Cameroon: a documentary review of clinical trial protocols.

BACKGROUND: International guidelines recommend ethical and scientific quality standards for managing and reporting adverse events occurring during clinical trials to competent research ethics committees and regulatory authorities. The purpose of this study was to determine whether clinical trial protocols in Cameroon are developed in line with national requirements and international guidelines as far as detecting, reporting and investigating of adverse events is concerned. METHODS: It was a documentary review of all approved clinical trial protocols that were submitted at the Cameroon National Ethics Committee for evaluation from 1997 through 2012. Data were extracted using a preconceived and validated grid. Protocol review process targeted the title, abstract, objectives, methodology, resources, and the chapter on safety. RESULTS: In total, 106 (4.9 %) clinical trial protocols were identified from 2173 protocols seen in the archive and 104 (4.8 %) included for review. Seventy six (73.1 %) trials did not include the surveillance of adverse events as part of their objective. A total of 91 (87.5 %) protocols did not budget for adverse event surveillance, 76 (73.1 %) did not have a data safety management board (DSMB), 11(10.6 %) included insurance for participants, 47 (45.2 %) did not include a case definition for serious adverse events, 33 (31.7 %) described procedures to detect adverse events, 33 (31.7 %) described procedure for reporting and 22 (21.2 %) described procedure for investigating adverse events. DISCUSSIONS: Most clinical trial protocols in Cameroon are developed to focus on benefits and pay little attention to harms. The development of national guidelines can improve the surveillance of adverse events in clinical trial research conducted in Cameroon. Adverse events surveillance tools and a budget are critical for an adequate planning for adverse event surveillance when developing trial protocols. CONCLUSION: Clinical trial protocols submitted in the Cameroon National Ethics Committee do not adequately plan to assess adverse events in clinical trial protocols. In order to improve on the safety of participants and marketed drug, there is a need to develop national guidelines for clinical trials by the government, and to improve evaluation procedures and monitoring of ongoing trials by the ethics committee.

Factors associated with the uptake of intermittent preventive treatment for malaria during pregnancy in Cameroon: An analysis of data from the 2018 Cameroon Demographic and Health Survey.

Malaria in pregnancy is a major public health concern that contributes to a significant increase in maternal and child mortality and morbidity. Intermittent preventive treatment of malaria during pregnancy using sulfadoxine-pyrimethamine (IPTp-SP) is a key intervention recommended by the World Health Organization (WHO) and implemented in Cameroon to reduce the morbidity associated with malaria during pregnancy. This study aimed to assess the distribution of the poor uptake of IPTp-SP (i.e. fewer than three doses) in Cameroon and the factors associated. We conducted a secondary analysis of data extracted from the 2018 Cameroon Demographic and Health Survey. Data was collected using a face-to-face questionnaire administered to mothers with at least one child under the age of five. The participants were selected using a two-stage stratified sampling process. We estimated the frequencies of mothers receiving fewer than three doses of IPTp-SP. Multilevel logistic regression modeling was used to assess the associations between key suspected determinants and uptake of fewer than three doses of IPTp-SP. Crude and adjusted Odds-Ratio (ORs) were estimated. A total of 13,527 women of childbearing age were interviewed, of whom 5,528 (40.9%) met our selection criteria. Among them, 845 (15.3%) women had no antenatal consultation (ANC) visit, 1,109 (20%) had 1-3 visits, 3,379 (61.1%) had 4-7 visits, and only 195 (3.5%) had at least eight visits. Moreover, 3,398 (61.5%, CI: 60.2-62.8) had received fewer than three doses of IPTp-SP. Our findings show that the predictors of poor uptake of IPTp-SP include attending the first ANC visit after the third month of pregnancy (aOR = 1.52, CI: 1.30-1.77), attending fewer than four ANC visits (aOR = 1.29, CI: 1.06-1.56), and not being attended to by a healthcare professional during the prenatal period (aOR = 4.63, CI: 2.81-7.64). Residing in the Sahelian regions was not increasing the risk of poor IPTp-SP uptake on its own but was positively modifying the effect of not being attended by a healthcare professional (p < 0.001). We did not find a significant association between a higher level of education and the uptake of IPTp-SP (aOR = 1.10, CI: 0.90-1.32). Nearly two third of the pregnant women in Cameroon have a poor uptake of IPTp-SP. Interventions focused on ANC provision ought to be explored and tested to address this gap, with priority assigned to the Sahelian region.

Research Ethics in Training Curricula of Cameroon Health Training Institutions: A Cross-Sectional Study.

Introduction The quality of protection for research participants in Africa is still marked by the lack of trained actors in this area. The study was conducted to assess the availability of health research ethics in the curricula of health-related sciences training institutions in Cameroon. Methods The study involved a cross-sectional analysis to describe the training curricula on research ethics in health training institutions in Cameroon. Data were collected using a structured questionnaire that was administered face to face to the heads of institutions in late 2020. Results Twenty-one health training institutions were identified, and 18 (85.71%) participated. Health research ethics courses were present in the curricula of 16 (88.88%) of the institutions. Lectures were either a standalone module or part of a module in 14 (77.78%) institutions. The three first topics covered in the courses were the fundamental principles of ethics, the role of the ethics committee in the protection of research participants, and respect for research participants. A total of 14 (77.78%) institutions declared ethical clearance mandatory before the implementation of students' thesis protocols. Eight (50.00%) training institutions declared having at least one qualified lecturer to deliver training in research ethics evaluation. The organization of the training of lecturers in delivering lectures on research ethics was declared to be the main assistance needed. Conclusions The delivery of research ethics education in Cameroon's healthcare institutions is still limited by the fact that it does not cover all eligible populations, is not standardized, and does not yet promote the practice of requiring all student protocols to undergo preethical review prior to implementation. These points should be taken into account by the authorities in charge.

The Polio Vaccination Status of Non-polio Acute Flaccid Paralysis Cases in the Far North Region of Cameroon: A Five-Year Retrospective Study From 2015 to 2019.

BACKGROUND:  The Expanded Program on Immunization (EPI) of Cameroon contributes to the reduction of polio, but the rate of non-polio acute flaccid paralysis (NPAFP) is still high. The aim of this study was to describe the immunization profile of NPAFP cases and the performance of polio surveillance in the Far North Region of Cameroon between 2015 and 2019. METHODS: A retrospective secondary data analysis was conducted using the national EPI and regional AFP surveillance case-based database from 2015 to 2019. Analyses were carried out using Epi-Info statistical software (version 7) (Centers for Disease Control and Prevention, Atlanta, GA). RESULTS: The surveillance network of the region reported 848 cases of NPAFP between 2015 and 2019. The sex distribution of the AFP cases revealed that 43.3% were females and 56.7% were males. Cases with AFP aged less than five years accounted for the largest proportion of cases (67.2%). Overall, 733/848 (86.4%) of the AFP cases received at least three doses of the oral polio vaccine (OPV). The AFP detection rate substantially increased in the region after the introduction of community-based surveillance in 2016. The mean NPAFP level during the study period was 7.3/100,000 children aged less than 15 years. The mean proportion of AFP cases with two adequate stools was 668/848 (78.7%), and the mean proportion of stools to the national reference laboratory within three days was 466/848 (54.9%). CONCLUSION: Only 86.4% of AFP cases received three or more doses of OPV required for immunization. The stool specimen management indices were not good enough to confirm that no case of poliovirus was missed in the laboratory. To strengthen the country's polio-free status, surveillance should be strengthened in least-performing health districts to improve the quality of AFP case investigations after detection.

Acceptability and Feasibility of Human Papillomavirus Vaccine Introduction in Cameroon: A Mixed-Methods Study.

INTRODUCTION: Human papillomaviruses (HPV) are responsible for sexually transmitted infections, and some of these viruses have oncogenic potential. The HPV vaccine is due to be introduced in Cameroon in September 2019. Our study looked at the knowledge, perceptions, and attitudes of the population and healthcare professionals regarding cervical cancer and its vaccine prevention. This approach provides a solid basis for, among other things, developing a clear communication strategy for the introduction of the vaccine. OBJECTIVE: This study aimed to assess the feasibility and acceptability of introducing the HPV vaccine in Cameroon among key stakeholders including health workers and parents. METHODS: From March to May 2019, we conducted a qualitative and quantitative descriptive study in six health districts in the Centre Region. A total of 257 study participants were recruited, including 168 parents and 89 health professionals; 60 interviews were also conducted, 30 with parents and 30 with health professionals. The quantitative data collected were analyzed using IBM SPSS Statistics for Windows, Version 20.0 (Released 2011; IBM Corp., Armonk, New York, United States); for the qualitative analysis, we carried out repeated readings of the transcribed interviews. This work enabled us to identify the significant themes emerging from the interviewees' discourse. RESULTS: The vast majority of healthcare professionals claim to be aware of cervical cancer (93.3%), but only 15.7% of female healthcare professionals claim to have ever carried out a screening test. A significant proportion of these professionals have actual experience of cervical cancer. Among parents, knowledge of this cancer also appears to be relatively high for a lay audience (54.2%), with a low screening rate (7.1%). Awareness of the HPV vaccine as a cervical cancer prevention tool was very low: 14.9% among parents and 44.9% among healthcare professionals. In addition, we found that information about the existence of an HPV vaccine was still very low among parents (83.9% had never heard of it); 43.8% of healthcare professionals had been informed about the vaccine at their training school. As regards acceptance of the HPV vaccine, the quantitative and qualitative results point in the same direction. The majority of parents are in favor of a campaign and access to this new vaccine via the Expanded Program on Immunization (EPI). However, many of them (94.6%) explained that they wanted more information before making a decision. CONCLUSION: Informing and raising public awareness of cervical cancer, the HPV vaccine, and vaccine safety are essential measures to encourage public support for the HPV vaccination campaign.

Long-Lasting Insecticidal Net Ownership and Use in Mogode Health District, Cameroon.

BACKGROUND: Cameroon is a malaria-endemic country. Many control strategies including long-lasting insecticidal nets (LLIN) have been proposed to reduce the burden of malaria. The World Health Organization aims to achieve at least 80% of people sleeping under a LLIN. This study assessed the ownership and use of LLNs in the Mogode Health District (MHD). METHODS: A community-based cross-sectional study was conducted in MHD in September 2021. Data on ownership and LLINs use were collected using structured questionnaires following the Roll Back Malaria guidelines. Univariate and multivariate analyses were performed to assess the determinants of ownership and failure to LLIN use. RESULTS:  A total of 332 households were included from eight health areas. The proportion of households with at least one LLIN was 72.0% (238). However, 232 (70.0%) reported having used LLIN (sleeping under LLIN the previous night). Household heads with higher education were six times more likely to have owned LLINs than those with no education (adjusted odds ratio (AOR)=6.8; confidence interval (CI) 1.5, 31.0, p< 0.05). Additionally, household heads between the ages of 36-50 were 4.2 times (AOR= 4.2, CI 1.3-13.8, p< 0.05) likely to fail to use LLINs in households. However, households where heads had secondary education (AOR= 0.2, CI 0.1-0.6, p< 0.05), were negatively associated with failure to use LLINs. CONCLUSION: Ownership and use of LLINs in MHD remain challenging. Therefore, this finding will contribute to improving recommendations and updating strategies such as targeted messages aimed at raising awareness of malaria during mass LLIN distribution campaigns.

SARS-CoV-2 active infection and antibodies amongst health personnel during the outbreak in Cameroon: Strengthening the health system for response to future public health emergencies.

BACKGROUND: Health personnel (HP) are on the frontlines during response to public health emergencies like COVID-19. This risk of exposure suggests the need for safety in responding to any pandemic. Therefore, to ascertain the rate of SARS-CoV-2 infection and immunity, and their determinants amongst HP become relevant. METHODS: A cross sectional health facility-based study was carried-out amongst HP in the Centre Region of Cameroon from 1st February to 30th June 2021. Characteristics and access to preventive tools were collected using face-to-face administered questionnaire. Nasopharyngeal swabs and whole blood were collected for PCR, IgG and IgM testing respectively. STATA version 17 software was used for data analysis. Determinants of COVID-19 infection were explored by estimating crude and adjusted Odd Ratio. RESULTS: Out of 510 HP reached, 458 were enrolled with mean age of 35 (±10) years. Thirty-four (7.4%) were PCR-positive to SARS-CoV-2 with 73.5% being clinicians versus 9 (26.4%) non-clinicians (p = 0.05). Sero-positivity to SARS-CoV-2 IgG/IgM was 40.2% (184/458), with 84.2% being clinicians versus 29 (15.8%) non-clinicians (p = 0.733). Amongst the 34 HP with PCR-positivity, 16 (47%) had no antibodies, while, 15 (44%) were IgG only. An estimate of HP (43.7%) had at least an evidence of PCR, IgG or IgM contact to COVID-19. Determinants of PCR-positivity was being clinical staff (AOR = 0.29, P = 0.039); and that of IgG/IgM were being non clinical staff (AOR = 0.41, p = 0.018) and regular use of face masks (AOR = 0.44, p = 0.001). HP trained on IPC (24%) were mainly from peripheral level (74.7%, p = 0.002). CONCLUSION: Active infections were within the range of pandemic control (<10%). However, around two-fifths of participants have had contact with the virus, indicating that HP remains a population at risk of COVID-19 and other similarly-transmitted epidemic prone diseases, and also an important source of transmission. There is need of vaccine to achieve protectiveness, and optimal response also requires capacity building to improve the health system when challenged by a future pandemic.

Timeliness and missed opportunities for vaccination among children aged 0 to 23 months in Dschang health district, West region, Cameroon: A cross-sectional survey.

Missed opportunities for vaccination (MOV) reflect quality of immunization service. The objective of this study was to assess vaccination timeliness, prevalence, and characteristics of MOVs among children aged 0-23 months, as well as knowledge, attitude and practice of health workers towards immunization. An exit interview method was used to select caregivers and health personnel. Selection took place in 26 health facilities within 14 health areas in the Dshcang Health district. Data were collected using two face-to-face questionnaires adapted from the World Health Organization (WHO) tools. We conducted an evaluation of all free vaccines in the Expanded Programme on Immunisation (EPI). We studied timeliness, assessed MOV, and knowledge, behaviour and attitude of health workers on immunization. Basic statistical tests were used to study the association between MOV and socio demographic characteristics. A total of 363 children aged 0 to 23 months were surveyed. A total of 88 (91.66%) of health personnel agreed to participate in our study. A total of 298 (82.1%) children had vaccination cards with dates, leading to 18% not completely vaccinated. Vaccination timeliness ranged from 20% to 77%. Overall MOV estimated was 23.83%, range from 0% to 16.4% among all vaccines. Among health workers, 70.45% (62/88) had insufficient knowledge on vaccination, 73.86% assessed the vaccination status of children during any routine visit and 74% ask parents to bring the child's vaccination record to any health facility visit. The study highlighted presence of MOV among children. Strategies for remedying this includes strengthening parents' knowledge, organizing refresher courses for health workers on vaccination, and systematically assessing children's vaccination status.