Under-Five Mortality in Buea Health District, Southwest Cameroon: Evidence from a Community-Based Birth Cohort Study of Rate, Causes, and Age-Specific Patterns.

BACKGROUND: Updating the knowledge base on the causes and patterns of under-five mortality (U5M) is crucial for the design of suitable interventions to improve survival of children under five. OBJECTIVES: To assess the rate, causes, and age-specific patterns of U5M in Buea Health District, Cameroon. METHODS: A retrospective cohort study involving 2000 randomly selected households was conducted. Live births registered between September 2004 and September 2009 were recorded. The under-five mortality rate (U5MR) was defined by the number of deaths that occurred on or before 5 years of age per 1000 live births. Causes of death were assigned using the InterVA-4 software. RESULTS: A total of 2210 live births were recorded. There were 92 deaths, and the U5MR was 42 per 1000 live births. The mean age at death was 11 ± 15.9 months. The most frequent causes of death were neonatal causes (37%), malaria (28%), and pneumonia (15%). Deaths during infancy accounted for 64.1% of U5M, with 43.5% neonatal (86% occurring within the first 24 hours of life) and 20.7% postneonatal. The main causes of death in infancy were birth asphyxia (37.5%), pneumonia (17.5%), complications of prematurity (10%), and malaria (10%). Child deaths accounted for 35.8% of U5M. Malaria, pneumonia, and diarrhoeal illnesses accounted for the majority of child deaths. CONCLUSIONS: Almost half of U5M occurred during the neonatal period. Improvements in intrapartum care and the prevention and effective treatment of neonatal conditions, malaria, and pneumonia could considerably reduce U5M in Buea.

Factors Associated with the Prevalence of Cognitive Impairment in a Rural Elderly Cameroonian Population: A Community-Based Study in Sub-Saharan Africa.

BACKGROUND/AIMS: With rising elderly populations, age-related health problems such as cognitive impairment and dementia are major public health concerns. We sought to assess the prevalence of cognitive impairment and associated factors in rural elderly Cameroonians. METHODS: The Mini Mental State Examination was used to assess the cognitive function of participants randomly recruited during a house-to-house survey of the Batibo Health District. RESULTS: The prevalence of cognitive impairment in our study was 33.3%. Increasing age, female gender, being single, a lack of formal education, and higher systolic blood pressure values were significantly and independently associated with cognitive impairment. CONCLUSION: The identification of modifiable factors would inform evidence-based policy to decrease the health and social burdens of cognitive impairment and dementia in the elderly in rural Cameroon.

Knowledge, attitudes and practices regarding depression among primary health care providers in Fako division, Cameroon.

BACKGROUND: Mental health and mental illness are often overlooked in the management of patients in our health services. Depression is a common mental disorder worldwide. Recognising and managing mental illnesses such as depression by primary health care providers (PHCPs) is crucial. This study describes the knowledge, attitudes and practices (KAP) of PHCPs regarding depression in Fako Division. METHODS: A cross-sectional study was conducted among PHCPs (general practitioners, nurses, pharmacy attendants and social workers) in public-owned health facilities in the four health districts in Fako Division. Participants were selected by a consecutive convenience sampling. A structured questionnaire including the Depression Attitude Questionnaire (DAQ) was used to collect information about their socio-demographic characteristics, professional qualifications and KAP about depression. RESULTS: The survey had a response rate of 56.7%. Most of the 226 participants (92.9%) were aware that depression needs medical intervention. Only 1.8% knew a standard tool used to diagnose depression. Two-thirds agreed that majority of the cases of depression encountered originate from recent misfortune. About 66% felt uncomfortable working with depressed patients. Also, 45.1% of PHCPs did not know if psychotropic drugs were available at pharmacies within their health area. Very few (15.2%) reported to have prescribed psychotropic drugs. Less than half (49.1%) of the participants had prior formal training in mental health. CONCLUSION: PHCPs in Fako Division tend to have limited knowledge and poor attitudes regarding depression. Practices towards diagnosis and management of depression tend to be inadequate. There is an urgent need to train PHCPs in mental health in general and depression diagnosis and management in particular.

Risk factors for acute respiratory infections in children under five years attending the Bamenda Regional Hospital in Cameroon.

BACKGROUND: Acute respiratory infections (ARI) are a leading cause of morbidity and mortality in under-five children worldwide. About 6.6 million children less than 5 years of age die every year in the world; 95% of them in low-income countries and one third of the total deaths is due to ARI. This study aimed at determining the proportion of acute respiratory infections and the associated risk factors in children under 5 years visiting the Bamenda Regional Hospital in Cameroon. METHODS: A cross-sectional analytic study involving 512 children under 5 years was carried out from December 2014 to February 2015. Participants were enrolled by a consecutive convenient sampling method. A structured questionnaire was used to collect clinical, socio-demographic and environmental data. Diagnosis of ARI was based on the revised WHO guidelines for diagnosing and management of childhood pneumonia. The data was analyzed using the statistical software EpiInfo™ version 7. RESULTS: The proportion of ARIs was 54.7% (280/512), while that of pneumonia was 22.3% (112/512). Risk factors associated with ARI were: HIV infection ORadj 2.76[1.05-7.25], poor maternal education (None or primary only) ORadj 2.80 [1.85-4.35], exposure to wood smoke ORadj 1.85 [1.22-2.78], passive smoking ORadj 3.58 [1.45-8.84] and contact with someone who has cough ORadj 3.37 [2.21-5.14]. Age, gender, immunization status, breastfeeding, nutritional status, fathers' education, parents' age, school attendance and overcrowding were not significantly associated with ARI. CONCLUSION: The proportion of ARI is high and is associated with HIV infection, poor maternal education, exposure to wood smoke, passive cigarette smoking, and contact with persons having a cough. Control programs should focus on diagnosis, treatment and prevention of ARIs.

Strategies for developing sustainable health research capacity in low and middle-income countries: a prospective, qualitative study investigating the barriers and enablers to locally led clinical trial conduct in Ethiopia, Cameroon and Sri Lanka.

OBJECTIVES: In 2013, the WHO stated that unless low-income and middle-income countries (LMICs) become producers of research, health goals would be hard to achieve. Among the capacities required to build a local evidence base, ability to conduct clinical trials is important. There is no evidence-based guidance for the best ways to develop locally led trial capacity. This research aims to identify the barriers and enablers to locally led clinical trial conduct in LMICs and determine strategies for their sustainable development. DESIGN: Prospective, multiple case study design consisting of interviews (n=34), focus group discussions (n=13) and process mapping exercises (n=10). SETTING: Case studies took place in Ethiopia (2011), Cameroon (2012) and Sri Lanka (2013). PARTICIPANTS: Local health researchers with previous experiences of clinical trials or stakeholders with an interest in trials were purposively selected through registration searches and snowball sampling (n=100). PRIMARY AND SECONDARY OUTCOME MEASURES: Discussion notes and transcripts were analysed using thematic coding analysis. Key themes and mechanisms were identified. RESULTS: Institutions and individuals were variably successful at conducting trials, but there were strong commonalities in the barriers and enablers across all levels and functions of the research systems. Transferable mechanisms were summarised into the necessary conditions for trial undertaking, which included: awareness of research, motivation, knowledge and technical skills, leadership capabilities, forming collaborations, inclusive trial operations, policy relevance and uptake and macro and institutional strengthening. CONCLUSIONS: Barriers and enablers to locally led trial undertaking exist at all levels and functions of LMIC research systems. Establishing the necessary conditions to facilitate this research will require multiple, coordinated interventions that seek to resolve them in a systemic manner. The strategies presented in the discussion provide an evidence-based framework for a self-sustaining capacity development approach. This represents an important contribution to the literature that will be relevant for research funders, users and producers.

A Retrospective One-Year Estimation of the Volume and Nature of Surgical and Anaesthetic Services Delivered to the Populations of the Fako Division of the South-West Region of Cameroon: An Urgent Call for Action.

BACKGROUND: Surgery-related conditions account for the majority of admissions in primary referral hospitals in Sub-Saharan Africa. The role of surgery in the reduction of global disease burden is well recognized, but there is a great qualitative and quantitative disparity in the delivery of surgical and anaesthetic services between countries. This study aims at estimating the nature and volume of surgery delivered in an entire administrative division of Cameroon. METHODS: In this retrospective survey conducted during the year 2013, we used a standard tool to analyse the infrastructure and human resources involved in the delivery of surgical and anaesthetic services in the Fako division in the south-west region of Cameroon. We also estimated the nature and volume of surgical services as a rate per catchment population. RESULTS: Public, private and mission hospital contributed equally to the delivery of surgical services in the Fako. For every 100,000 people, there were <5 operative rooms. A total of 2460 surgical interventions were performed by 2.2 surgeons, 1.1 gynaecologists and 0.3 anaesthetists. These surgical interventions consisted mostly of minor and emergency procedures. Neurosurgery, paediatric, thoracic and endocrine surgery were almost non-existent. CONCLUSIONS: The volume of surgery delivered in the Fako is far below the minimum rates required to meet up with the most basic requirements of the populations. It is likely that most of these surgical needs are left unattended. A community-based assessment of unmet surgical needs is necessary to accurately estimate the magnitude of the problem and guide surgical capacity improvements.

Onychomycosis in diabetic patients in Fako Division of Cameroon: prevalence, causative agents, associated factors and antifungal sensitivity patterns.

BACKGROUND: Onychomycosis is an infection of the nail unit by a fungus. This is a very common infection amongst diabetics. Its occurrence among diabetics in Fako division is unknown. In this study we provide information on the characteristics of onychomycosis in diabetics in Fako division, Cameroon. METHODS: A cross-sectional descriptive and analytical hospital-based study was conducted in two diabetic clinics in the Buea and Limbe regional hospitals. We recruited 152 consenting diabetics into the study. Demographic, behavioural, and clinical data of patients were obtained through the use of structured questionnaires. Toenail, finger nail, skin scrapings and nail clippings were collected from participants, KOH mounts were prepared and observed under the microscope and cultured on Sabouraud Dextrose Agar supplemented with chloramphenicol to isolate causative fungi. Identification of isolates was done to species level using the cello tape flag method and slide culture. The presence of a dermatophyte by either microscopy or culture or both methods was considered positive for onychomycosis. Antifungal susceptibility testing was carried out using selected antifungals by the Kirby-Bauer disk diffusion method on Sabouraud Dextrose Agar. RESULTS: Clinical onychomycosis was found in 77 of the 152 diabetics tested giving a prevalence of 50.7% (95% CI 42.4-58.9) in diabetics in Fako. No socio-demographic or clinical factor studied was significantly associated with onychomycosis. Trichophyton rubrum was the most common isolate (62%). Other isolates included Trichophyton metagraphyte (22%) and Trichophyton tonsurans (16%). Dermatophytes were sensitive to miconazole (66%), amphotericin B (19%) and ketoconazole (14%). CONCLUSION: Onychomycosis is common in diabetics in Fako signifying the need for regular screening by either microscopy or culture. Infected nails could be treated with miconazole.

Prevalence, characteristics and correlates of enteric pathogenic protozoa in drinking water sources in Molyko and Bomaka, Cameroon: a cross-sectional study.

BACKGROUND: Access to potable water remains a major challenge particularly in resource-limited settings. Although the potential contaminants of water are varied, enteric pathogenic protozoa are known to cause waterborne diseases greatly. This study aimed at investigating the prevalence, characteristics and correlates of enteric pathogenic protozoa in drinking water sources in Buea, Cameroon. METHODS: A cross-sectional study was conducted using 155 water samples collected from various drinking sources (boreholes, springs, taps and wells). Each sample was subjected to physicochemical examinations (pH, turbidity, odour and sliminess) and parasitological analysis (wet mount, modified Ziehl-Neelsen stain) to determine the presence of enteric pathogenic protozoa. A data collection tool was used to note characteristics of collected samples and the data was analysed using EPI-INFO Version 3.5.3. RESULTS: The overall prevalence of enteric pathogenic protozoa in water sources was 62.6 %. Eight species of enteric protozoa were observed with Cryptosporidium parvum being the most predominant (45.8 %). Spring water was the most contaminated source with enteric protozoa (85.7 %) while pipe borne water had all eight species of protozoa identified. A pH of 6 was the only significant factor associated with the prevalence of these pathogens in water sources. CONCLUSION: The prevalence of enteric protozoa in water sources in Molyko and Bomaka is high, spring water is the most contaminated water source and Cryptosporidium parvum is the most common protozoa contaminating water. A water pH of 6 is associated to the prevalence of protozoa. Community members need to be educated to treat water before drinking to avoid infection by enteric protozoa in water and further studies with larger samples of water need to be conducted to find other correlates of the presence of protozoa in water.

Caesarean delivery in the Limbé and the Buea regional hospitals, Cameroon: frequency, indications and outcomes.

INTRODUCTION: Neonatal outcomes can be directly and indirectly affected by caesarean delivery (CD). Data on CD rates in semi-urban and rural hospitals in resource-limited settings are scarce and yet are needed to better guide the care of women and neonates in these settings. we carried out this study to determine the frequency of CD, its indications and the frequency of the various adverse neonatal outcomes (ANO) in the Limbe Regional Hospital (LRH) and the Buea Regional Hospital (BRH), Cameroon. We also assessed the relationship between the indication for CD and ANO in the said hospitals. METHODS: This was a hospital-based retrospective and prospective cross-sectional study using descriptive and analytic methods conducted in the LRH and the BRH maternity units within a nine months period in 2015. Informed consent was obtainedfrom mothers of the neonates. Data analyses were performed using Epi-Info 3.5.4 software. RESULTS: We recruited 199 neonates born through CD. The prevalence of CD was 13.3% with cephalopelvic disproportion (CPD) being the most frequent (32.2%) indication for CD. There were 52 (26.1%) ANO following CD and respiratory distress was the most common 24 (46.2%) of all ANO. Emergency indications for CD were associated with more ANO 49 (34.5%) as compared to elective indications for CD 3 (5.3%) [p-value<0.001]. We noted a significant association between indications for CD and the various type of ANO, with CPD having the worse prognostic neonatal outcomes 30.8% [p-value=0.02]. CONCLUSION: The prevalence of ANO associated with CD in our hospitals was high with a worrying prognosis. While the exact reasons are unknown, the creation of well-equipped neonatal units with trained staff, may contribute to reduce neonatal morbidity and fatalities. Furthermore, the association of CPD to worse prognostic neonatal outcomes calls for clinicians, to consider additional management options, such as antibiotic prophylaxis and oxygen therapy to the neonates, prior to CD.

Clients' satisfaction with HIV treatment services in Bamenda, Cameroon: a cross-sectional study.

BACKGROUND: Clients have explicit desires or requests for services when visiting hospitals; inadequate discovery of their needs may result in dissatisfaction. Patient satisfaction influences retention in HIV care, adherence to HAART and serves as determinant to HIV suppression. This study's objectives were to quantify clients' satisfaction with HIV services in Bamenda and determine relationship between satisfaction and clients' socio-demographic/structural characteristics. METHODS: A cross-sectional study was conducted on HIV-positive patients followed-up, on treatment and who consulted in the Bamenda Regional Hospital treatment centre between July and August 2014. Participants consent was sought and data collected on client's level of satisfaction to staff-patient-communication, staff attitudes, privacy and confidentiality and staffing and amenities situations in the hospital. Data was collected using a structured questionnaire interviewer-administered by investigator and trained health personnel. Collected data was analyzed using Epi Info version 3.5.4 and clients' satisfaction measured using frequencies and percentages. RESULTS: A total of 384 participants took part in this study and their median age was 37 years (IQR: 29-46). Two hundred and seventy-four (71.4 %) participants were females. Overall satisfaction with HIV services was 91.2 % and participants reported less satisfaction with overall staffing and amenities situation of the centre (3.6 %). In the multivariate analysis, only being female, employed and perceiving high number of nurses working at the treatment centre remained significant predictors of overall satisfaction with HIV services. CONCLUSION: A high proportion of participants expressed satisfaction with HIV services. However, some dissatisfaction is masked in this high satisfaction level. This dissatisfaction underscores need to improve staff attitudes, staff-patient-communication, employ more staff and build better patient facilities. Future studies need to focus on assessing long-term progression of satisfaction levels with services and determinants of satisfaction involving larger samples in many treatment centres.

High birth weight in a suburban hospital in Cameroon: an analysis of the clinical cut-off, prevalence, predictors and adverse outcomes.

BACKGROUND AND AIMS: High birth weight (HBW) increases the risk of maternal and fetal morbidity and mortality. Its prevalence and adverse outcomes may be reduced if risk factors are identified and managed during pregnancy. The cut-off value for HBW remains debatable. The objectives of this study were to identify the optimal cut-off value and determine the prevalence, predictors and adverse outcomes of HBW in a suburban area of Cameroon. DESIGN: A 6-year retrospective register analysis and a 3-month prospective phase. SETTING: A secondary care level (regional) hospital in the city of Buea (southwest region of Cameroon). PARTICIPANTS: Women who delivered in this hospital over a 6-year period (retrospective phase) and consenting pregnant mothers and their infants (singletons, born at >28 weeks gestation) (prospective phase). OUTCOME MEASURES: 90th centile of birth weights; prevalence of HBW defined as birth weight above the 90th centile; sociodemographic, maternal and obstetrical factors associated with HBW; maternal and neonatal adverse outcomes of HBW. RESULTS: Of the 4941 newborns reviewed in registers, the 90th centile of birth weights was 3850 g. Using this new cut-off, we obtained a prevalence of 14.0% for HBW in the 200 newborns included in the prospective phase. This was significantly higher than the prevalence (9.5%) yielded when the traditional cut-off of 4000 g was used (p=0.003). None of the factors assessed was independently associated with HBW. Newborns with HBW were more likely to have shoulder dystocia (p<0.01), and their mothers more likely to suffer from prolonged labour (p=0.01) and postpartum haemorrhage (p<0.01). CONCLUSIONS: The results of this study suggest that the cut-off for HBW in this population should be 3850 g. Thus, 3 of every 10 babies born with HBW in this hospital are likely not receiving optimal postnatal care because 4000 g is currently used to qualify for additional support.

Adolescent Deliveries in a Secondary-Level Care Hospital of Cameroon: A Retrospective Analysis of the Prevalence, 6-Year Trend, and Adverse Outcomes.

STUDY OBJECTIVE: Adolescents are generally ill-equipped to deal with the burden of a pregnancy. A high prevalence of adolescent pregnancies is among the indicators of limitations toward the achievement of the Millennium Development Goals in most developing countries. We sought to determine the prevalence, 6-year trend, and adverse outcomes of adolescent deliveries. We also tested whether being married decreased the risk of adverse fetal outcomes in these adolescents. DESIGN: A 6-year retrospective register analysis. SETTING: Buea Regional Hospital. PARTICIPANTS: Birth records from 2007 to 2012. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Prevalence and 6-year trend in the rate of adolescent deliveries; adverse fetal outcomes. RESULTS: The overall prevalence of adolescent deliveries was 9.9% (491 of 4941). There was no significant change in the annual prevalence of adolescent deliveries over 6 years (P trend = .8). Adolescent pregnancies were at higher risk of preterm deliveries (deliveries at gestational age <37 completed weeks; odds ratio [OR], 1.7; 95% confidence interval [CI], 1.3-2.2; P < .01), low birth weight (defined as birth weight <2600 g; OR, 1.8; 95% CI, 1.4-2.3; P < .01), and neonatal asphyxia (OR, 1.4; 95% CI, 1.1-1.7; P < .01). There was no significant difference in the frequency of adverse outcomes between married and single adolescents. CONCLUSION: One of every 10 babies is born from adolescent mothers in the Buea Regional Hospital. Whether these mothers are married or not, their neonates are exposed to higher morbidity. This emphasizes the need for more adolescent-friendly public health policies geared toward reducing the prevalence of this condition to improve the chances of attaining the Millennium Development Goals in Cameroon.

A Comparison of the Diabetes Risk Score in HIV/AIDS Patients on Highly Active Antiretroviral Therapy (HAART) and HAART-Naïve Patients at the Limbe Regional Hospital, Cameroon.

BACKGROUND: Highly active antiretroviral therapy (HAART) has been associated with dysglycaemia. However, there is scarce data on the risk of developing diabetes mellitus (DM) in HIV/AIDS patients in Africa. OBJECTIVES: Primarily to quantify and compare the risk of having diabetes mellitus in HIV/AIDS patients on HAART and HAART-naïve patients in Limbe, Cameroon; and secondarily to determine if there is an association between HAART and increased DM risk. METHODS: A cross-sectional study was conducted at the Limbe Regional Hospital HIV treatment center between April and June 2013, involving 200 HIV/AIDS patients (100 on first-line HAART regimens for at least 12 months matched by age and gender to 100 HAART-naïve patients). The Diabetes Risk Score (DRS) was calculated using a clinically validated model based on routinely recorded primary care parameters. A DRS ≥ 7% was considered as indicative of an increased risk of developing DM. RESULTS: The median DRS was significantly higher in patients on HAART (2.30%) than in HAART-naïve patients (1.62%), p = 0.002. The prevalence of the increased DM risk (DRS ≥ 7%) was significantly higher in patients on HAART, 31% (95% CI: 22.13-41.03) than in HAART-naïve patients, 17% (95% CI: 10.23-25.82), p = 0.020. HAART was significantly associated with an increased DM risk, the odds ratio of the HAART group compared to the HAART-naïve group was 2.19 (95% CI: 1.12-4.30, p = 0.020). However, no association was found after adjusting for BMI-defined overweight, hypertension, age, sex, family history of DM and smoking (Odds ratio = 1.22, 95% CI: 0.42-3.59, p = 0.708). Higher BMI and hypertension accounted for the increased risk of DM in patients on HAART. Also, more than 82% of the participants were receiving or had ever used Zidovudine based HAART regimens. CONCLUSION: HIV/AIDS patients on HAART could be at a greater risk of having DM than HAART-naïve patients as a result of the effect of HAART on risk factors of DM such as BMI and blood pressure.

Prevalence of Hypertension in HIV/AIDS Patients on Highly Active Antiretroviral Therapy (HAART) Compared with HAART-Naïve Patients at the Limbe Regional Hospital, Cameroon.

BACKGROUND: Highly active antiretroviral therapy (HAART) has greatly reduced the morbidity and mortality of HIV/AIDS patients but has also been associated with increased metabolic complications and cardiovascular diseases. Data on the association between HAART and hypertension (HTN) in Africa are scarce. OBJECTIVES: Primarily to compare the prevalence of HTN in HIV/AIDS patients on HAART and HAART-naïve patients in Limbe, Cameroon; and secondarily to assess other socio-demographic and clinical factors associated with HTN in this population. METHODS: A cross-sectional study was conducted at the Limbe Regional Hospital HIV treatment center between April and June 2013, involving 200 HIV/AIDS patients (100 on first-line HAART regimens for at least 12 months matched by age and sex to 100 HAART-naïve patients). HTN was defined as a systolic blood pressure (BP) ≥ 140 mmHg and/or diastolic BP ≥ 90 mmHg. RESULTS: The prevalence of HTN in patients on HAART was twice (38%; 95% CI: 28.5-48.3) that of the HAART-naïve patients (19%; 95% CI, 11.8-28.1), p = 0.003. In multivariate analyses adjusted for age, gender, smoking, family history of HTN, and BMI-defined overweight, HAART was associated with HTN, the adjusted odds ratio of the HAART-treated versus HAART-naïve group was 2.20 (95% CI: 1.07-4.52), p = 0.032. HTN was associated with older age and male gender, in the HAART group and with BMI-defined overweight in the HAART-naïve group. CONCLUSION: The prevalence of hypertension in HIV/AIDS patients in Limbe stands out to be elevated, higher in patients on HAART compared to those not on treatment. Blood pressure and cardiovascular risk factors should be routinely monitored. Other factors such as diet, weight control and physical exercise should also be considered.

Hypertension, an Emerging Problem in Rural Cameroon: Prevalence, Risk Factors, and Control.

Background. Despite the increasing trends suggesting that hypertension is a growing public health problem in developing countries, studies on its prevalence, associated risk factors, and extent of blood pressure control have been inequitably done in urban and rural communities in these countries. We therefore aimed to determine the prevalence of hypertension and extent of blood pressure control in rural Cameroon. Methods. This was a community-based cross-sectional study conducted in rural Cameroon (the Moliwe Health Area). Participants aged 21 years and above were recruited by a probability proportional to size multistage sampling method, using systematic sampling for household selection and random sampling for participant selection. Blood pressure, weight, and height were measured by standard methods. Hypertension was defined as BP ≥ 140/90 mmHg. Results. The prevalence of hypertension among the 733 participants recruited was 31.1% (95% CI: 27.8-34.6) and 71% (95% CI: 58.7-81.7) of these hypertensive patients were newly diagnosed. Only 21.2% (95% CI: 12.1-33.3) of known hypertensives had a well controlled BP. Age, obesity, low educational status, and being married were associated with HTN after adjusting for confounders. Conclusions. The high prevalence of hypertension and inadequate BP control among known hypertensives in rural Cameroon warrants greater sensitization and regular screening to reduce hypertension-related morbidity and mortality.

Effect of performance based financing home visiting on the use of modern methods of contraception in the kumbo east health district, Cameroon.

BACKGROUND: The use of modern methods of contraception (MMC) as defined by the World Health Organization still remains a challenge in most of Sub-Saharan Africa. Performance Based Financing (PBF) home visit was introduced in 2012 to increase the use of those modern methods in the Kumbo East Health District (KEHD), Cameroon.We determined the utilization rates of MMC in areas in the KEHD with PBF home visits compared with those areas with no home visits. METHODS: This was a cross sectional study carried out in the KEHD during the period February 1 to May 31, 2015. A multistage cluster sampling method was used to recruit 262 and 221 women aged 15-49 years in the intervention and nonintervention health areas, respectively. A structured, closed ended questionnaire was used. RESULTS: The average age of women was similar in both groups 30.40 (SD 8.57); median 30 years in the intervention group and 30.49 (SD 7.84); median 30 years in controls. Most participants in the intervention health area (60.3 %) used modern methods of contraception compared to 46.6 % of those in the control group (aOR: 1.75 %; 95 % CI: 1.212.53) and the most commonly used MMC was medroxyprogesterone in the intervention group and condoms in the control area. CONCLUSION: Utilization of MMC was significantly higher in the area with PBF home visits than in areas without that service. While this indicates that the intervention has benefit, there may be other contributing factors.

Assessing the risk factors of cholera epidemic in the Buea Health District of Cameroon.

BACKGROUND: Cholera is an acute diarrheal disease caused by the bacterium, Vibrio cholerae. A cholera epidemic occurred in Cameroon in 2010. After a cholera-free period at the end of 2010, new cases started appearing in early 2011. The disease affected 23,152 people and killed 843, with the South West Region registering 336 cases and 13 deaths. Hence, we assessed the risk factors of cholera epidemic in the Buea Health District to provide evidence-based cholera guidelines. METHODS: We conducted an unmatched case-control study. Cases were identified from health facility records and controls were neighbours of the cases in the same community. We interviewed 135 participants on socio-economic, household hygiene, food and water exposures practices using a semi-structured questionnaire. Data was analyzed using STATA. Fisher exact test and logistic regression were computed. P < 0.05 was considered to be statistically significant. RESULTS: The 135 participants included 34 (25.2 %) cholera cases and 101 (74.8 %) controls. More females [78 (57.8 %)] participated in the study. Ages ranged from 1 year 3 months to 72 years; with a mean of 29.86 (±14.51) years. The cholera attack rate was 0.03 % with no fatality. Most participants [129 (99.2 %)] had heard of cholera. Poor hygienic practices [77 (59.2 %)] and contaminated water sources [54 (41.5 %)] were the main reported transmission routes of cholera. Good hygienic practices [108 (83.1 %)] were the main preventive methods of cholera in both cases [23 (76.6 %)] and controls [85 (85.0 %)]. Logistic regression analysis showed age below 21 years (OR = 1.72, 95 % CI: 0.73-4.06, p = 0.251), eating outside the home (OR = 1.06, CI: 0.46-2.43, p = 1.00) and poor food preservation method (OR = 9.20, CI: 3.67-23.08, p < 0.0001) were independent risk factors of cholera. Also, irregular water supply (OR = 0.66, 95 % CI: 0.30-1.43, p = 0.320), poor kitchen facility (OR = 0.60, CI: 0.16-2.23, p = 0.560), lack of home toilet (OR = 0.69, CI: 0.25-1.86, p = 0.490), and education below tertiary (OR = 0.87, 95 % CI: 0.36-2.11, p = 0.818) were independent protective factors for the occurrence of cholera. CONCLUSION: There was a good knowledge of cholera among participants. Poor food preservation method was a significant independent risk factor of cholera. Improvement in hygiene and sanitation conditions and water infrastructural development is crucial to combating the epidemic.

Low birth weight in a sub-urban area of Cameroon: an analysis of the clinical cut-off, incidence, predictors and complications.

BACKGROUND: The World Health Organisation recommends that each country adopts its own cut-off value of low birth weight (LBW) for clinical use. The aims of this study were to establish a clinical cut-off point for LBW and to determine its incidence, predictors and complications in a sub-urban area's hospital of Cameroon. METHODS: We conducted a study in two phases: a 6-year retrospective phase during which we collected demographic and clinical information from the records of the maternity of the Buea Regional Hospital (BRH) and a 3-month prospective phase during which data were collected from consenting pregnant women using a structured questionnaire, and newborns were examined and followed after birth. RESULTS: A total of 4941 records were reviewed during the retrospective phase and the 10(th) centile of birth weights was 2600 g. In the 200 pregnant women enrolled during the prospective phase, using this cut-off yielded an incidence of LBW of 19.0 %. Independent predictors of LBW were preterm delivery, hypertensive disorders in pregnancy, HIV infection, maternal age >36 years, maternal height <150 cm and pre-delivery BMI < 25 kg/m(2). Neonates with LBW were more likely to have neonatal asphyxia, foetal distress, respiratory distress and neonatal death. CONCLUSIONS: Our results suggest that newborns under 2600 g have LBW in sub-urban Cameroon. They represent one out of every five babies, and they deserve close care. Preventive measures targeting the predictors described here are warranted to reduce the incidence and complications. Similar studies in urban areas are required in order to generalize the results.

Changes in HIV Outcomes Following Depression Care in a Resource-Limited Setting: Results from a Pilot Study in Bamenda, Cameroon.

BACKGROUND: Little is known about how improved depression care affects HIV-related outcomes in Africa. In a sample of depressed HIV patients in a low income, sub-Saharan country, we explored how implementing measurement-based antidepressant care (MBC) affected HIV outcomes over 4 months of antidepressant treatment. METHODS: As part of a project adapting MBC for use in Cameroon, we enrolled 41 depressed HIV patients on antiretroviral therapy in a pilot study in which a depression care manager (DCM) provided an outpatient HIV clinician with evidence-based decision support for antidepressant treatment. Acute depression management was provided for the first 12 weeks, with DCM contact every 2 weeks and HIV clinician appointments every 4 weeks. We measured HIV clinical and psychiatric outcomes at 4 months. RESULTS: Participants were moderately depressed at baseline (mean Patient Health Questionnaire [PHQ] score = 14.4, range 13.1, 15.6). All HIV clinical outcomes improved by four month follow-up: mean (range) CD4 count improved from 436 (2, 860) to 452 (132, 876), mean (range) log-viral load decreased from 4.02 (3.86, 4.17) to 3.15 (2.81, 3.49), the proportion with virologic suppression improved from 0% to 18%, mean (range) HIV symptoms decreased from 6.4 (5.5, 7.3) to 3.1 (2.5, 3.7), the proportion reporting good or excellent health improved from 18% to 70%, and the proportion reporting any missed ARV doses in the past month decreased from 73% to 55%. Concurrently, psychiatric measures improved. The mean (range) PHQ score decreased from 14.4 (13.1, 15.6) to 1.6 (0.8, 2.4) and 90% achieved depression remission, while mean maladaptive coping style scores decreased and mean adaptive coping scores and self-efficacy scores improved. CONCLUSION: In this pilot study of an evidence-based depression treatment intervention for HIV-infected patients in Cameroon, a number of HIV behavioral and non-behavioral health outcomes improved over 4 months of effective depression treatment. These data are consistent with the hypothesis that better depression care can lead to improved HIV outcomes.

Delayed diagnosis of lymph node tuberculosis: time-honored importance of a thorough clinical examination, Cameroon.

History taking and physical examination is the cornerstone of medical diagnosis as will lead to correct diagnosis 90% of the time. We report a case of a 30-year-old black African man with lymph node tuberculosis diagnosed one year and six months later after onset of symptoms and signs. Clinicians especially those in resource-limited settings should go in for thorough history taking and complete physical examination which is the basis for correct clinical diagnosis, will provide valuable guide in deciding which tests to order and thus laboratory tests done for confirmatory purposes and also, has a cost-effective benefit for the patient.