Determinants of the psychomotor development delay in children aged 12 to 59 months infected with HIV in Yaounde, Cameroon.

Introduction: children infected with HIV are at increased risk of impaired neurodevelopmental, due to several environmental factors. Methods: we conducted a cross-sectional analytical study on HIV-infected children aged 12 to 59 months, followed up in five hospitals in Yaounde, Cameroon. Sociodemographic, clinical, and biological variables as well as the antecedents were collected. Data analysis was performed using Statistical Package for the Social Sciences (SPSS) version 25 software. The Denver test was used to assess the psychomotor development of these children. Global psychomotor delay, defined as a global development quotient of less than 70 with an alteration in at least two of the four domains of the test, was retained as the primary endpoint. The significance threshold was set at 5%. Results: one hundred and eighty-one children were included in the study. The sex ratio was 0.6. The age range 48-59 months was the most represented. None of these children had a known chronic pathology other than HIV infection. The proportion of global psychomotor delay was 11.04%, with language (16%) and fine motor skills (16%) being the most affected domains of psychomotor development. The independent factors significantly associated with global psychomotor delay were birth weight below 2500 grams (OR= 17.61 [1.76-181.39], p= 0.022), growth retardation (OR= 17.64 [1.63-190.24], p= 0.018) and elevated viral load (OR= 22.75 [2.78-186.02], p= 0.004). Conclusion: psychomotor delay affects about one out of ten children living with HIV. Its occurrence is linked to various factors that must be taken into account in the development of public health policies in connection with the management of HIV infection in children.

Cryptococcal antigen carriage among HIV infected children aged 6 months to 15 years at Laquintinie Hospital in Douala.

BACKGROUND: Up to 15% of deaths of people living with HIV is attributable to meningeal cryptococcosis, with nearly 75% occuring in sub-Saharan Africa. Although rare in children, it is a major cause of morbidity and mortality in people living with HIV. A strong association between cryptococcal antigenemia and the development of meningeal cryptococcosis has been shown in adults. Thus, in 2018, the World Health Organization published an updated version of its guidelines for the diagnosis, prevention and management of cryptococcal infection in adults, adolescents and the HIV-infected child. GOAL: To determine the prevalence of cryptococcal antigenemia and to identify its determinants in children infected with HIV. METHODS: An analytical cross-sectional study was carried out at the approved treatment center of Laquintinie hospital in Douala over a period of 4 months. Children were recruited consecutively after informed parental consent. Cryptococcal antigenemia and CD4 assay were performed using a Cryptops® immunochromatographic rapid diagnostic test and flow cytometry, respectively. The data collected included the socio-demographic, clinical and paraclinical variables of the children, as well as their antecedents. Data analysis was performed using Epiinfo software version 3.1 and SPSS 21.0. The significance threshold was set at 5%. RESULTS: A total of 147 children were enrolled. The mean age was 9.8 ± 4.09 years. The majority were on antiretroviral therapy (142, 96.60%). Only 13 (8.80%) were in severe immunosuppression. No child showed signs of meningeal cryptococcosis. The prevalence of cryptococcal antigenemia was 6.12%. Severe immunosuppression [OR: 10.03 (1.52-65.91), p = 0.016] and contact with pigeons [OR: 9.76 (1.14-83.65), p = 0.037] were independent factors significantly associated with the carriage of the cryptococcal antigen. CONCLUSION: We recommend screening for cryptococcal antigenemia and routine treatment with fluconazole of all HIV positive children with cryptococcal antigen whether symptomatic or not.

[Determinants of survival of HIV-infected children aged 6 months to 15 years on follow-up in the town of Ebolowa, Cameroon from 2008 to 2018]. / Déterminants de la survie des enfants âgés de 6 mois à 15 ans, infectés par le VIH et suivis dans la ville d'Ebolowa au Cameroun de 2008 à 2018.

INTRODUCTION: survival of HIV-infected children is a challenge in developing countries. In Cameroon, HIV-related mortality among children under the age of 15 in 2018 was 20%. Paradoxically, the Southern Cameroon region, despite high seroprevalence among children (4.1%) and low antiretroviral therapy coverage (around 64%), is not among the regions of Cameroon most affected by HIV/AIDS-related pediatric mortality. The purpose of this study was to calculate survival rate and to identify its determinants in HIV-infected children aged 6 months-15 years. METHODS: we conducted a retrospective, prospective cohort study data-collection in three health care facilities specialized in treating HIV-positive children in Ebolowa, South Cameroon from January 2008 to December 2018. The study was conducted in two phases, a retrospective collection phase for the selection of medical records of HIV-positive children that met inclusion criteria in consultation registries and a prospective collection phase in which we collected information from parents about the future of children. Informed parental consent was obtained during this second phase. Socio-demographic, clinical, paramedical, therapeutic data as well as data about the future of children were collected. Mean survival time and factors associated with survival were determined using the Kaplan Meier model. Cox proportional hazards regression allowed for the identification of survival determinants. Evaluation criterion was the death. Significance level was set at 5%. RESULTS: a total of 186 patients were enrolled in the study: the average follow-up period was 18.5 months. Survival rate was 66.7%. The majority of deaths (67%) occurred before the sixth month of follow-up. After multivariate analysis, an age less than 2 years [aHR: 18.6 (6.48-53.59); p=0.001), severe anemia [aHR: 7.69 (1.02-57.9); p=0.04) and the presence of opportunistic infections [aHR: 4.52 (2.51-8.14); p=0.05] were independently and significantly associated with survival. CONCLUSION: in addition to early antiretroviral therapy, good clinical and paraclinical monitoring is needed to improve the survival of HIV-infected children.

'You just have to grin and bear' - emotional suppression among women in polygyny in Cameroon.

Polygyny is a matrimonial union in which a single man is simultaneously married to multiple wives. On a daily basis, women in polygynous unions suffer from financial, emotional and physical burdens. This study explores women's perceptions of this matrimonial regime and the factors influencing their sexual health decision-making in Cameroon. Drawing on interviews with twenty-three women aged 23 to 80 years living in polygynous unions, we explore women's daily life and perceptions on polygyny. Using content analysis, meaning units relating to respondents' experiences and perceptions were identified and condensed into codes and categories that were later grouped into themes. Five themes emerged - refusal and tolerance; heavy workload and responsibility; lack of power in sexual health decision-making; discrimination and unequal treatment of spouses; and emotional suppression. Women reported emotional suppression, limited rights, discrimination and poor living conditions as being the most significant problems that they encountered. Addressing the discrimination faced by women in polygynous unions will entail adopting and implementing laws to protect women's rights and promote their empowerment.

Blood Lead Levels among Children in Yaoundé Cameroon.

Blood lead levels (BLLs) are a useful indication of a population exposure to lead from environmental sources. No previous published study had reported BLLs in Cameroon. Our objective is to characterize exposure levels in children to inform policymakers of potential lead exposure sources. We tested the BLLs of 147 children aged 12 months to 6 years residing in Yaoundé, Cameroon, and conducted an extensive questionnaire with their parents or guardians to characterize potential exposure sources. The geometric mean BLL among this population was 8.0 µg/dl and arithmetic mean level was 8.7 µg/dl. These levels are more than sixfold higher than the geometric mean BLL reported in the U.S. and more than fivefold higher than those reported in France. In addition, 88% of the children tested had lead levels greater than 5 µg/dl. One limitation of the study is that the selection of the children sampled was not a random survey. The analysis of the responses to the questionnaire failed to uncover any specific exposure patterns. A statistically significant association was noted between the age of the child's home and the duration of exclusive breastfeeding with BLLs. The study points to a need for greater efforts to control sources of lead exposure in Cameroon.

Feasibility Study of HIV Sentinel Surveillance using PMTCT data in Cameroon: from Scientific Success to Programmatic Failure.

BACKGROUND: In low-income countries (LICs), HIV sentinel surveillance surveys (HIV-SSS) are recommended in between two demographic and health surveys, due to low-cost than the latter. Using the classical unlinked anonymous testing (UAT), HIV-SSS among pregnant women raised certain ethical and financial challenges. We therefore aimed at evaluating how to use prevention of mother-to-child transmission of HIV (PMTCT) routine data as an alternative approach for HIV-SSS in LICs. METHODS: A survey conducted through 2012 among first antenatal-care attendees (ANC1) in the ten regions of Cameroon. HIV testing was performed at PMTCT clinics as-per the national serial algorithm (rapid test), and PMTCT site laboratory (PMTCT-SL) performances were evaluated by comparison with results of the national reference laboratory (NRL), determined as the reference standard. RESULTS: Acceptance rate for HIV testing was 99%, for a total of 6521 ANC1 (49 · 3% aged 15-24) enrolled nationwide. Among 6103 eligible ANC1, sensitivity (using NRL testing as the reference standard) was 81 · 2%, ranging from 58 · 8% (South region) to 100% (West region); thus implying that 18 · 8% HIV-infected ANC1 declared HIV-negative at the PMTCT-SL were positive from NRL-results. Specificity was 99 · 3%, without significant disparity across sites. At population-level, this implies that every year in Cameroon, ~2,500 HIV-infected women are wrongly declared seronegative, while ~1,000 are wrongly declared seropositive. Only 44 · 4% (16/36) of evaluated laboratories reached the quality target of 80%. CONCLUSIONS: The study identified weaknesses in routine PMTCT HIV testing. As Cameroon transitions to using routine PMTCT data for HIV-SSS among pregnant women, there is need in optimizing quality system to ensure robust routine HIV testing for programmatic and surveillance purposes.

Sexual activity of adolescent school girls in an urban secondary school in cameroon.

BACKGROUND: The objective of this study was to describe the extent of sexual activity in adolescent school girls. METHODS: This was a cross-sectional study with prolective collection of data carried out at Lycée General Leclerc, Yaounde (Cameroon), from October 1 to November 30, 2011. Heterosexual coitus was considered as sexual activity. A pretested self-administered questionnaire was proposed to all consenting girl students aged 10 to 19 years. The data were analyzed using Epi Info 3.2.1 and Microsoft Excel 2007 software. RESULTS: Of the 2660 students who responded to the questionnaire, 21.3% (566) admitted being sexually active. Out of these, 64.3% (364) were aged between 10 and 16 years at their first heterosexual contact. The mean age at the first sexual intercourse was 15.3 years. Although 56.4% (319) of the sexually active respondents had only one sexual partner, 43.6% (247) of them had at least two partners. Sexual activity was occasional in 71.4% of those being sexually active. Meanwhile, 52.1% (295) of the sexually active adolescent girls used condoms during sexual intercourse, 41.5% (235) did so occasionally, and 6.4% (36) had regular unprotected sex. CONCLUSION: More than one-fifth of adolescent girls were sexually active in this study. Sexual intercourse started mostly at the age of 16 or less, and it was mostly occasional. Half of the cases had multiple sexual partners, and half were not using condoms during sexual intercourse. We, thus, recommend the implementation of interventions aimed at delaying the age of the first sexual intercourse and accessibility of condoms to students in this setting.

Efficacite de la polyvidone Iodee a 2;5 dans la prevention de l' ophtalmie neonatale a Yaounde; Cameroun

Objectif: Determiner l'efficacite de la polyvidone a 2;5 comparativement aux collyres usuels dans la prevention de l'ophtalmie neonatale a Yaounde. Materiels et methodes : Il s'agissait d'un essai clinique randomise realise dans deux formations sanitaires a Yaounde d'Octobre 2009 a Mars 2010. Cinq cent nouveau-nes dont les meres avaient donne leur consentement verbal etaient recrutes. Les donnees portaient sur les caracteristiques sociodemographiques; l'histoire obstetricale et les parametres anthropometriques du nouveau-ne. L'intervention consistait en une application oculaire a la naissance de polyvidone iodee a 2;5 ou de collyres usuels. Les nouveau-nes etaient suivis pendant trois jours a l'hopital puis par relance telephonique pour la survenue de conjonctivite. La clairance ethique etait obtenue du Comite National d'Ethique. L'analyse des donnees s'etait faite a l'aide du logiciel Epi-Info 3.5.1. Le seuil de significativite etait de 0;05. Resultats : Sur les 245 nouveau-nes du groupe polyvidone iodee a 2;5 et les 244 du groupe collyres usuels; le nombre d'ophtalmie neonatale etait identique soit 3 (1;2) respectivement (p=0;65). Le Klebsiella pneumoniae; l'Acinetobacter calcoaceticus et le Streptococcus pneumoniae etaient les germes isoles. Conclusion : L'efficacite de la polyvidone iodee a 2;5 a ete comparable a celle des collyres usuels dans la prevention de l'ophtalmie neonatale. Elle serait a recommander vu son faible prix

Competence of health care providers on care of newborns at birth in a level-1 health facility in Yaoundé, Cameroon.

INTRODUCTION: This is an observational study which was carried out at a level one health facility in Yaoundé from June to July 2009. The aim was to evaluate the competence of health care providers towards newborns' care at birth METHODS: Ten health care providers took care of three hundred and thirty-five pregnant women who were enrolled for the study after informed verbal consent in the delivery room. RESULTS: Out of 340 offspring delivered and taken care of, 179 (52.6%) were male and 161 (47.4%) were female. Only two out of ten health workers had a WHO Essential Newborn Care (ENC) training. None of them had received any refresher course for the past two years. The mean gestational age of women was 39.5 ± 3.5 weeks. Resuscitation was carried out on 21 (6.2%) of the newborns including 7 (33.3%) who had birth asphyxia. Health care providers scored 100% in performing the following tasks: warming up the baby, applying eye drops, injecting vitamin K, identifying the neonate, searching for any apparent life threatening congenital malformations, preventing for infection after procedures and initiating breastfeeding. The score was 24% at neonatal resuscitation tasks. Low level of education was associated with poor competence on applying ENC tasks (p<0.001). Lack of WHO ENC training was associated with poor competence on ENC tasks (p<0.001) and poor skills on resuscitation (p=0.03). CONCLUSION: There is a need to reinforce the capacity of health care providers by training in WHO ENC course with emphasis on providing skills on resuscitation in order to reduce the burden of neonatal intrapartum-related deaths.

Competence of health care providers on care of newborns at birth in a level-1 health facility in Yaoundé, Cameroon

This is an observational study which was carried out at a level one health facility in Yaoundé from June to July 2009. The aim was to evaluate the competence of health care providers towards newborns' care at birth Methods Ten health care providers took care of three hundred and thirty-five pregnant women who were enrolled for the study after informed verbal consent in the delivery room. Results Out of 340 offspring delivered and taken care of, 179 (52.6%) were male and 161 (47.4%) were female. Only two out of ten health workers had a WHO Essential Newborn Care (ENC) training. None of them had received any refresher course for the past two years. The mean gestational age of women was 39.5±3.5 weeks. Resuscitation was carried out on 21 (6.2%) of the newborns including 7 (33.3%) who had birth asphyxia. Health care providers scored 100% in performing the following tasks: warming up the baby, applying eye drops, injecting vitamin K, identifying the neonate, searching for any apparent life threatening congenital malformations, preventing for infection after procedures and initiating breastfeeding. The score was 24% at neonatal resuscitation tasks. Low level of education was associated with poor competence on applying ENC tasks (p<0.001). Lack of WHO ENC training was associated with poor competence on ENC tasks (p<0.001) and poor skills on resuscitation (p=0.03). Conclusion There is a need to reinforce the capacity of health care providers by training in WHO ENC course with emphasis on providing skills on resuscitation in order to reduce the burden of neonatal intrapartum-related deaths

HIV exposure and related newborn morbidity and mortality in the University Teaching Hospital of Yaoundé, Cameroon.

INTRODUCTION: Few studies have established the role of maternal HIV infection on neonatal disease and death. In order to determine whether neonatal morbidity and mortality were associated to maternal HIV infection, a case-control study was conducted in the neonatal unit of the University Teaching Hospital of Yaoundé from July 2006 to December 2007. METHODS: Babies born from HIV positive mothers were recruited as cases. For each case, two babies born from HIV negative mothers were selected as controls. Informed verbal consent was obtained from the mother before inclusion of the newborn in the study. Information on demographics, history of pregnancy, diseases and outcome of the newborns were extracted from patients' files. The distribution of these parameters between cases and control was analyzed using chi-square. Association of demographics, clinical and paraclinical parameters with mortality was explored using univariate analysis and logistic regression. Data were analyzed using Epi Info version 3.5.1 Windows. RESULTS: Out of 240 newborns enrolled, 80 were cases and were 160 controls. The mean age of cases was 1.69±2.73 days compared to 1.46±2.36 days for controls (p=0.26). Cases significantly differed from controls on mother's marital status (p=0.02), level of education (p<0.001), number of prenatal consultations (p<0.001), anemia chemoprophylaxis (p=0.01) and drug abuse (p<0.001). Cases and controls were similar for prematurity, respiratory distress, sepsis, meningitis and urinary tract infection. The death rate was identical in both groups (p=0.52). Using Univariate analysis, risk factors associated to mortality in both groups were prematurity (p<0.001) and low birth weight (p<0.001). CONCLUSION: This study showed no statistical difference in morbidity and mortality between newborns from HIV positive and HIV negative mothers.

[Anhidrotic ectodermal dysplasia: report of one case at Mother and Child Center of Chantal Biya Foundation, Yaounde, Cameroon]. / La dysplasie ectodermique anhydrotique : à propos d'un cas au Centre Mère et Enfant de la Fondation Chantal Biya, Yaoundé, Cameroun.

Ectodermal dysplasia are rare genetic diseases characterized by the absence or dysplasia of some tissues of ectodermal origin. We present a case of a young boy seen at the age of seven and a half years for late eruption of teeth, morphologic abnormalities of the teeth and a feeling of exaggerated heat. The diagnosis of anhidrotic ectodermal dysplasia was discussed. The absence of sweat glands on the skin biopsy slides was in favor of the diagnosis. Dental prostheses were put in place which the aim of permitting the child to eat normally and have a better self image.