Perinatal outcomes in women with lower-range elevated blood pressure and stage 1 hypertension: insights from the Kaya health and demographic surveillance system, Burkina Faso.

BACKGROUND: The impact of lower thresholds for elevated blood pressure (BP) on adverse perinatal outcomes has been poorly explored in sub-Saharan African populations. We aimed to explore the association between lower BP cutoffs (according to the 2017 American College of Cardiology/American Heart Association [ACC/AHA] criteria) and adverse perinatal outcomes in Kaya, Burkina Faso. METHODS: This retrospective cohort study included 2,232 women with singleton pregnancies between February and September 2021. BP was categorized according to the ACC/AHA criteria and applied throughout pregnancy. A multivariable Poisson regression model based on Generalized Estimating Equation with robust standard errors was used to evaluate the association between elevated BP, stage 1 hypertension, and adverse perinatal outcomes, controlling for maternal sociodemographic characteristics, parity, and the number of antenatal consultations, and the results were presented as adjusted risk ratios (aRRs) with corresponding 95% confidence intervals (CIs). RESULTS: Of the 2,232 women, 1000 (44.8%) were normotensive, 334 (14.9%) had elevated BP, 759 (34.0%) had stage 1 hypertension, and 139 (6.2%) had stage 2 hypertension. There was no significant association between elevated BP and adverse pregnancy outcomes. Compared to normotensive women, women with elevated BP had a 2.05-fold increased risk of delivery via caesarean section (aRR;2.05, 95%CI; 1.08-3.92), while those with stage 1 hypertension had a 1.41-fold increased risk of having low birth weight babies (aRR; 1.41, 95%CI; 1.06-1.86), and a 1.32-fold increased risk of having any maternal or neonatal adverse outcome (aRR; 1.32, 95%CI; 1.02-1.69). CONCLUSIONS: Our results suggest that the risk of adverse pregnancy outcomes is not increased with elevated BP. Proactive identification of pregnant women with stage 1 hypertension in Burkina Faso can improve hypertension management through enhanced clinical surveillance.

Sex-specific-evaluation of metabolic syndrome prevalence in Algeria: insights from the 2016-2017 non-communicable diseases risk factors survey.

Metabolic syndrome (MetS) is a core driver of cardiovascular diseases (CVD); however, to date, gender differences in MetS prevalence and its components have not been assessed in the Algerian adult general population. This study aimed to determine the gender differences in MetS prevalence and its components, in the general population of Algeria. Secondary analysis was performed on data from the Algerian 2016-2017 non-communicable disease risk factor survey. MetS was determined according to the harmonized Joint Interim Statement criteria. A Poisson regression model based on Generalised Estimating Equations was used to estimate the adjusted prevalence ratios (aPR) for the sex-specific factors associated with MetS. Overall, the prevalence of MetS was 34.0% (95% CI 32.4-35.6). MetS prevalence in women and men was 39.1% (95% CI 37.0-41.3) and 29.1% (95% CI 27.2-31.2), respectively. The most frequent triad was the clustering of abdominal obesity with low HDL-cholesterol and high blood pressure among women (8.9%; 95% CI [8.0-10.0]) and low HDL-cholesterol with high blood pressure and hyperglycaemia among men (5.2%; 95% CI [4.3-6.3]). Increasing age (aPR 3.21 [2.35-4.39] in men and aPR 3.47 [2.86-4.22] in women), cohabitation (aPR 1.14 [1.05-1.24]), women residing in urban areas (aPR 1.13 [1.01-1.26]), men with higher educational levels (aPR 1.39 [1.14-1.70]), and men with insufficient physical activity (aPR 1.16 [1.05-1.30]) were associated with higher risk of MetS. In this population-based study, one in three Algerian adults had MetS, and key components including abdominal obesity, low HDL-cholesterol, and high blood pressure, are very common, especially in women. Reinforcing interventions for weight management targeting married women living in urban areas and improving sufficient physical activity in men with higher socioeconomic status could provide maximal health gains and stem the CVD epidemic in Algeria.

Uptake of prevention of mother-to-child transmission cascade services in Burkina Faso between 2013 and 2020: are we on the right track?

BACKGROUND: The use of services to prevent mother-to-child transmission (PMTCT) of the human immunodeficiency virus (HIV) remains a serious challenge in sub-Saharan Africa. In the last decade, Burkina Faso has implemented numerous policies to increase the use of PMTCT services by pregnant women and their partners, as well as children. This study assesses trends in the uptake of PMTCT services in Burkina Faso from 2013 to 2020 in order to study the progress and gaps in achieving the national and international targets set for 2020. METHODS: A repeated cross-sectional analysis was performed using data extracted from district health information software version 2. Percentages were computed for each PMTCT indicator and comparisons between the years were made using a chi-square test for trends with a significance threshold of 5%. Regions were not compared with each other. RESULTS: The proportion of pregnant women who were tested and received their results significantly increased from 47.9% in 2013 to 84.6% in 2020 (p value < 0.001). Of the 13 regions in the country, only 1 region met the 95% national targets whereas, 6 regions met the 90% international targets for this indicator. The proportions of HIV-positive women receiving antiretroviral therapy (ART) increased from 90.8% in 2013 to 100% in 2020. In the same period, the proportion of exposed infants who received antiretroviral prophylaxis increased from 64.3% in 2013 to 86.8% in 2020. Only 3 regions reached the national and international targets for this indicator. A positive trend was also observed for the indicator related to screening at 2 months or later of exposed infants using Polymerase Chain Reaction (PCR) technic; with the rate rising from 7.4% in 2013 to 75.7% in 2020. However, for this indicator, the national and international targets were not achieved considering the national and regional settings. Concerning the women's partners, the proportion of those who tested for HIV increased from 0.9% in 2013 to 4.5% in 2020, with only 1 region that fully met the national target of 10% in 2020. The prevalence of HIV in this particular group was 0.5% in 2020. CONCLUSIONS: PMTCT indicators show an increase from 2013 to 2020 but with a strong disparity between regions. National and international targets have not been achieved for any indicator; except for those related to women receiving ART. Strengthening strategies to effectively engage women and their partners on the use of PMTCT cascade services could help reduce mother-to-child transmission in Burkina Faso.

Changes in ideal cardiovascular health among Malawian adults from 2009 to 2017.

Ideal Cardiovascular Health (CVH) is a concept defined by the American Heart Association (AHA) as part of its 2020 Impact Goals. Until now, changes in ideal CVH have been poorly evaluated in Sub-Saharan African populations. We aimed to investigate changes in the prevalence of ideal CVH and its components in a population of Malawian adults. Secondary analysis was done on cross-sectional data from 2009 to 2017, obtained from the Malawi STEPS surveys which included 5730 participants aged 25-64 years. CVH metrics categorized into "ideal (6-7 ideal metrics)", "intermediate (3-5 ideal metrics)" and "poor (0-2 ideal metrics)" were computed using blood pressure, body mass index (BMI), fasting glycaemia, fruit and vegetable intake, physical activity, smoking, and total cholesterol. Sampling weights were used to account for the sampling design, and all estimates were standardised by age and sex using the direct method. The mean participant age across both periods was 40.1 ± 12.4 years. The prevalence of meeting ≥ 6 ideal CVH metrics increased substantially from 9.4% in 2009 to 33.3% in 2017, whereas having ≤ 2 ideal CVH metrics decreased from 7.6% to 0.5% over this time. For the individual metrics, desirable levels of smoking, fruit and vegetable intake, physical activity, blood pressure (BP), total cholesterol and fasting glucose all increased during the study period whilst achievable levels of BMI (< 25 kg/m2) declined. From 2009 to 2017, the mean number of ideal CVH metrics was higher in women compared to men (from 2.1% to 5.1% vs 2.0% to 5.0%). However, poor levels of smoking and fruit and vegetable intake were higher in men compared to women (from 27.9% to 23.6% vs. 7.4%% to 1.9% , and from 33.7% to 42.9% vs 30.8% to 34.6%, respectively). Also, whilst achievable levels of BMI rose in men (from 84.4% to 86.2%) the proportion reduced in women (from 72.1% to 67.5% ). Overall, CVH improved in Malawian adults from 2009 to 2017 and was highest in women. However, the prevalence of poor fruit and vegetable intake, and poor smoking remained high in men whilst optimal levels of BMI was declined in women. To improve this situation, individual and population-based strategies that address body mass, smoking and fruit and vegetable intake are warranted for maximal health gains in stemming the development of cardiovascular events.

High Urban-Rural Inequities of Abdominal Obesity in Malawi: Insights from the 2009 and 2017 Malawi Noncommunicable Disease Risk Factors Surveys.

Geographical disparities in abdominal obesity (AO) exist in low-income countries due to major demographic and structural changes in urban and rural areas. We aimed to investigate differences in the urban-rural prevalence of AO in the Malawi population between 2009 and 2017. We conducted a secondary analysis of data from the Malawi 2009 and 2017 STEPS surveys. AO (primary outcome) and very high waist circumference (secondary outcome) were defined using WHO criteria. Prevalence estimates of AO and very high waist circumference (WC) were standardized by age and sex using the age and sex structure of the adult population in Malawi provided by the 2018 census. A modified Poisson regression analysis adjusted for sociodemographic covariates was performed to compare the outcomes between the two groups (urban versus rural). In total, 4708 adults in 2009 and 3054 adults in 2017 aged 25-64 were included in the study. In 2009, the age-sex standardized prevalence of AO was higher in urban than rural areas (40.9% vs 22.0%; adjusted prevalence ratio [aPR], 1.51; 95% confidence interval [CI], 1.36-1.67; p < 0.001). There was no significant trend for closing this gap in 2017 (urban 37.0% and rural 21.4%; aPR, 1.48; 95% CI, 1.23-1.77; p < 0.001). This urban-rural gap remained and was slightly wider when considering the 'very high WC' threshold in 2009 (17.0% vs. 7.1%; aPR, 1.98; 95%CI, 1.58-2.47; p < 0.001); and in 2017 (21.4% vs. 8.3%; aPR, 2.03; 95%CI, 1.56-2.62; p < 0.001). Significant urban-rural differences exist in the prevalence of AO and very high WC in Malawi, and the gap has not improved over the last eight years. More effective weight management strategies should be promoted to reduce health care disparities in Malawi, particularly in urban areas.

Adherence to HIV Antiretroviral Therapy Among Pregnant and Breastfeeding Women, Non-Pregnant Women, and Men in Burkina Faso: Nationwide Analysis 2019-2020.

Background: Since the scale-up of antiretroviral therapy (ART) services in Burkina-Faso, achieving an AIDS-free generation depends on optimal ART adherence. However, no data exists on the population group differences on the level of ART adherence in Burkina-Faso. This study analyzes ART adherence among pregnant-and breastfeeding-women, non-pregnant women, and men in Burkina-Faso. Methods: From December 2019 to March 2020, a cross-sectional study among adult HIV-infected patients in Burkina-Faso, belonging either to the active file or the Prevention of Mother-To-Child Transmission programs was conducted. An analysis was performed and adherence was measured based on the number of times, patients did not meet the number of doses prescribed and did not take the ART treatment in the month prior to the survey. Logistic-regression models were used to identify factors associated with poor ART adherence and the adjusted odds ratios (aORs) with their 95% confidence intervals (95% CI) were reported. Results: The prevalence of good adherence was higher in the group of pregnant-and breastfeeding-women (86.6%, n = 112) compared to the other groups (73.1%, n=1017 in non-pregnant women and 72.0%, n = 318 in men). No association was found between ART adherence and the socio-demographic, clinical, and therapeutic characteristics of pregnant-and breastfeeding-women and men groups. However, non-pregnant women with a high level of education (aOR = 1.70; 95% CI: 1.16-2.49), having ever belonged to a support group (aOR= 1.47; 95% CI: 1.07-2.04), not having income-generating occupations (aOR= 1.53; 95% CI: 1.11-2.12), and in advanced clinical stage (aOR= 1.42; 95% CI: 1.06-1.91) were more susceptible to have poor adherence compared to their pairs. Conclusion: Findings showed a large difference in ART adherence among pregnant-and breastfeeding-women, non-pregnant women and men and highlight the need for differentiated healthcare delivery according to population while specifically considering addressing the interest in early initiation of treatment and the benefit of support groups meeting.

National levels, changes and correlates of ideal cardiovascular health among Beninese adults: evidence from the 2008 to 2015 STEPS surveys.

Introduction: A higher number of ideal cardiovascular health (CVH) metrics is associated with a lower risk of cardiovascular-related and all-cause mortality. However, the change in CVH metrics has rarely been studied in sub-Saharan Africa. We investigated the level and changes of CVH metrics and their correlates among Beninese adults between 2008 and 2015. Methods: Secondary analysis was performed on data obtained from Benin's 2008 and 2015 WHO Stepwise surveys (STEPS). In total, 3617 and 3768 participants aged 25-64 years were included from both surveys, respectively. CVH metrics were assessed using the American Heart Association definition, which categorised smoking, fruit and vegetable consumption, physical activity, body mass index (BMI), blood pressure (BP), total cholesterol (TC) and glycaemia into 'ideal', 'intermediate' and 'poor' CVH. The prevalence of ideal CVH metrics was standardised using the age and sex structure of the 2013 population census. Results: Few participants met all seven ideal CVH metrics, and ideal CVH significantly declined between 2008 and 2015 (7.1% (95% CI 6.1% to 8.1%) and 1.2% (95% CI 0.8% to 1.5%), respectively). The level of poor smoking (8.0% (95% CI 7.1% to 8.9%) and 5.6% (95% CI 4.8% to 6.3%)) had decreased, whereas that of poor BP (25.9% (95% CI 24.5% to 27.4%) and 32.0% (95% CI 30.0% to 33.5%)), poor total cholesterol (1.5% (95% CI 1.0% to 1.9%) and 5.5% (95% CI 4.8% to 6.2%)) and poor fruit and vegetable consumption (34.2% (95% CI 32.4% to 35.9%) and 51.4% (95% CI 49.8% to 53.0%)) significantly increased. Rural residents and young adults (25-34 years) had better CVH metrics. Conclusion: The proportion of adults with ideal CVH status was low and declined significantly between 2008 and 2015 in Benin, emphasising the need for primordial prevention targeting urban areas and older people to reduce the burden of cardiovascular disease risk factors.

Association between measures of adiposity and blood pressure levels in adult Cameroonians.

INTRODUCTION: Several anthropometric measurements are variably recommended to assess adiposity in routine practice, with less agreement on their comparative performance. We assessed and compared the relationship of seven anthropometric measures of adiposity-waist circumference (WC), waist-to-height ratio (WHtR), Body Mass Index (BMI), Ponderal Index (PI), Conicity Index (C index), A Body Shape Index (ABSI), and Body Roundness Index (BRI)-with blood pressure (BP) levels and prevalent hypertension in adult Cameroonians. METHODS: Data were collected as Cameroon's contribution to the global May Measurement Month 2017(MMM17) survey. Participants were nonpregnant adults, who had no BP measurement in the past year and with no prior hypertension diagnosis. Hypertension was defined as systolic BP ≥140 mm Hg and/or diastolic ≥90 mm Hg. Odds ratios (ORs) for the presence of hypertension per 1 SD increase in each adiposity metrics were estimated in separate logistic regression models. Assessment and comparison of discrimination used the area under the receiver operating characteristics curve (AUC) and nonparametric methods. RESULTS: We included 14 424 participants (8210 [58.25%] female; 39.84 ± 14.33 years). There was a graded association between measures of adiposity and prevalent screen-detected (newly diagnosed) hypertension, with effect sizes being mostly within the same range across measures of adiposity. AUC for hypertension prediction ranged from 0.709 with PI to 0.721 with BRI for single measures, and from 0.736 to 0.739 with combinations of measures of adiposity. CONCLUSION: WC, WHtR, and BRI were strongly associated with BP and better predicted prevalent hypertension, with effects enhanced with the inclusion of BMI.

Occurrence and challenges in the management of severe chronic plaque type psoriasis in a limited resourced setting: a case report.

Plaque-type psoriasis is a major dermatosis with significant effects on quality of life. Case complexity is often high in low-resourced settings such as in Africa where the incidence has been on the rise. Despite major advancements and newer therapeutic modalities over the last decade, an insight into the real-life, day to day challenges in low resourced settings reveal an interplay between the difficulty in obtaining these drugs and use of alternative traditional indigenous agents. We report the case of a 50 year old immunocompetent male who presented with chronic and extensive well demarcated plaques covered with silver-white scales occupying about 61% of his body surface area. Patient was however lost to follow up for about 8 months during which time, the lesions responded to some unknown homemade indigenous medications which was preferred to a systemic medication. Paramount importance on proper counselling and the need to retain patients in care is warranted by physicians and allied health personnel. Also, incentives aimed at subsidizing the newer systemic agents for patients in low resourced cohorts will go a long way to combat this multi-faceted disorder which is often unrecognized and under diagnosed.

Adherence to antidiabetic medication and factors associated with non-adherence among patients with type-2 diabetes mellitus in two regional hospitals in Cameroon.

BACKGROUND: Diabetes mellitus is a growing cause of disease burden globally. Its management is multifaceted, and adherence to pharmacotherapy is known to play a significant role in glycaemic control. Data on medication adherence among affected patients is unknown in Cameroon. In this study, the level of adherence and factors influencing non-adherence to antidiabetic medication among patients with type-2 diabetes was assessed. METHODS: A hospital-based cross-sectional study among adult patients receiving care in the diabetic clinics of the Limbe and Bamenda Regional Hospitals in Cameroon was conducted. Medication adherence was assessed using the Medication Compliance Questionnaire (MCQ). Factors associated with non-adherence to medication were determined using basic and adjusted multivariable logistic regression models. RESULTS: A total of 195 patients with type 2 diabetes were recruited. The prevalence of non-adherence to medication was 54.4% [95% confidence interval (CI): 47.1-61.5%]. In multivariable analysis, age > 60 years (aO.R. = 0.48, 95% CI: 0.25-0.94), alcohol consumption (aO.R. = 2.13, 95% CI: 1.10-4.14) and insulin alone therapy (aO.R. = 2.85, 95% CI: 1.01-8.08) were associated with non-adherence. Patients attributed their non-adherence to forgetfulness (55.6%), lack of finances (38.2%) and disappearance of symptoms (14.2%). CONCLUSIONS: Adherence to anti-diabetic medication is poor in this study with more than half of participants being non-adherent. Urgent interventions are required to tackle this problem in combined efforts to stem this looming diabetes epidemic.

Helicobacter pylori infection among patients presenting with dyspepsia at a primary care setting in Cameroon: seroprevalence, five-year trend and predictors.

BACKGROUND: Almost half the world's population is infected with Helicobacter pylori (H. pylori) with the highest reported prevalence from Africa. This infection is associated with several morbid gastrointestinal conditions. Understanding the trends in seroprevalence and the factors associated with H. pylori seropositivity in dyspeptic persons can provide a guide for public health policies. METHODS: This was a retrospective study, carried out with outpatient records of Wum District Hospital (WDH) from January 2012 to December 2016. We reviewed records of all patients for whom a H. pylori serology test was requested. The Cochran-Armitage trend test and multiple regression models were used to explore seroprevalence trends and predictors of seropositivity respectively. RESULTS: We included 451 records, 63.6% (n = 287) were female. The mean age of the study population was 40.7 years, and the overall H. pylori seroprevalence was 51.5% (95% CI: 47-56%). The use of recommended eradication regimen appears to be low and declining. On average, H. pylori seroprevalence declined by 6.8% annually (p < 0.0001). Occupational status independently predicted seropositivity, with students having lower odds of being seropositive than employed persons (aOR = 0.09, 95% CI: 0.02-0.49, p = 0.016). CONCLUSION: Despite decreasing trends, the seroprevalence of Helicobacter pylori infection is high in dyspeptic patients attending this primary care setting. Improving living standards and establishing national guidelines for eradication can possibly aid the control of this infection.

Development of the certificate course in the management of hypertension in Africa (CCMH-Africa): proceedings of the first continental faculty meeting, Nairobi, Kenya, 25-26 February 2018.

BACKGROUND: In response to the call by the World Health Organisation to reduce premature deaths from non-communicable diseases by 25% by the year 2025 (25×25), the Pan-African Society of Cardiology (PASCAR), in partnership with several organisations, including the World Heart Federation, have developed an urgent 10-point action plan to improve detection, treatment and control of hypertension in Africa. Priority six of this action plan is to promote a task-shifting/task-sharing approach in the management of hypertension. AIM: This capacity-building initiative aims to enhance the knowledge, skills and core competences of primary healthcare physicians in the management of hypertension and related complications. METHODS: In a collaborative approach with the International Society of Hypertension, the British and Irish Hypertension Society, the Public Health Foundation of India and the Centre for Chronic Disease Control, the PASCAR hypertension taskforce held a continental faculty meeting in Kenya on 25 and 26 February 2018 to review and discuss a process of effective contextualisation and implementation of the Indian hypertension management course on the African continent. RESULTS: A tailored African course in terms of evidence-based learning, up-to-date curriculum and on-the-job training was developed with a robust monitoring and evaluation strategy. The course will be offered on a modular basis with a judicious mix of case studies, group discussions and contact sessions, with great flexibility to accommodate participants' queries. CONCLUSIONS: Hypertension affects millions of people in Africa and if left untreated is a major cause of heart disease, kidney disease and stroke. CCMH-Africa will train in the next 10 years, 25 000 certified general physicians and 50 000 nurses, capable of adequately managing uncomplicated hypertension, thereby freeing the few available specialists to focus on severe or complicated cases.

Ivermectin-induced fixed drug eruption in an elderly Cameroonian: a case report.

BACKGROUND: Cutaneous adverse reactions to medications are extremely common and display characteristic clinical morphology. A fixed drug eruption is a cutaneous adverse drug reaction due to type IV or delayed cell-mediated hypersensitivity. Ivermectin, a broad-spectrum anti-parasitic compound, has been an essential component of public health campaigns targeting the control of two devastating neglected tropical diseases: onchocerciasis (river blindness) and lymphatic filariasis. CASE PRESENTATION: We report the case of a 75-year-old Cameroonian man of the Bamileke ancestry who developed multiple fixed drug eruptions a few hours following ivermectin intake that worsened with repeated drug consumption. Discontinuation of the drug, counselling, systemic steroids, and orally administered antihistamines were the treatment modalities employed. Marked regression of the lesions ensued with residual hyperpigmentation and dyschromia. CONCLUSION: Keen observation on the part of physicians is mandatory during the administration of ivermectin for quick recognition and prevention of this adverse drug reaction.

Non-adherence to antihypertensive pharmacotherapy in Buea, Cameroon: a cross-sectional community-based study.

BACKGROUND: Hypertension is a challenging public health problem with a huge burden in the developing countries. Non-adherence to antihypertensive treatment is a big obstacle in blood pressure (BP) control and favours disease progression to complications. Our objectives were to determine the rate of non-adherence to antihypertensive pharmacotherapy, investigate factors associated with non-adherence, and to assess the association between non-adherence and BP control in the Buea Health District (BHD), Cameroon. METHODS: A community-based cross-sectional study using stratified cluster sampling was conducted in the BHD from November 2013 - March 2014. Eligible consenting adult participants had their BP measured and classified using the Joint National Committee VII criteria. The Morisky medication adherence scale was used to assess adherence to BP lowering medication. Multivariable logistic regression models were used to predict non-adherence. RESULTS: One hundred and eighty-three participants were recruited with mean age of 55.9 years. Overall, 67.7% (95% CI: 59.8-73.6%) of participants were non-adherent to their medications. After adjusting for age, sex and other covariates, forgetfulness (aOR = 7.9, 95%CI: 3.0-20.8), multiple daily doses (aOR = 2.5, 95%CI: 1.2-5.6), financial constraints (aOR = 2.8, 95%CI: 1.1-6.9) and adverse drug effects (aOR = 7.6, 95%CI: 1.7-33.0) independently predicted non-adherence to anti-hypertensive medication. BP was controlled in only 21.3% of participants and was better in those who were adherent to medication (47.5% versus 8.2%, p <  0.01). CONCLUSION: At least two of every three hypertensive patients in the Buea Health District are non-adherent to treatment. Forgetfulness, multiple daily doses of medication, financial constraints and medication adverse effects are the major predictors of non-adherence in hypertensive patients. These factors should be targeted to improve adherence and BP control, which will contribute to stem hypertension-related morbidity and mortality.

Acute blindness as a presenting sign of childhood endemic Burkitt's lymphoma in Cameroon: a case report.

BACKGROUND: Endemic Burkitt's lymphoma is found predominantly in malaria holoendemic zones, typically in the tropical rain forest of Africa. It usually presents as an extra-nodal tumour in children and young adults with predilection for jaws and soft tissues of the abdomen. Clinical features depend on the primary tumour site, extent of the disease and histologic subtype. Acute blindness as a presentation sign is rare. CASE PRESENTATION: A 13 year old African female presented to our facility with a 3 week history of painful abdominal distention, and loss of vision of the left eye. On examination, there was a huge abdominopelvic mass, left breast mass and complete blindness of the left eye associated with mydriatic pupils non-responsive to light. An abdominal ultrasound showed a huge hypoechoic mass arising from the pelvis and protruding into the abdomen. The jaws, teeth and maxilla were all normal. A fine needle aspiration done was negative for malignant cells. A presumptive diagnosis of Burkitt's lymphoma was made on clinical grounds and abdominal ultrasound findings. The patient was immediately placed on chemotherapy and responded well to treatment with remission of the tumour but persistence of left eye blindness. CONCLUSION: Acute blindness can be the presenting sign of Burkitt's lymphoma in a patient with neither jaw nor maxillary swelling. Primary healthcare providers in low income settings require a high index of suspicion when faced with such atypical presentations. This emphasizes the need for thorough physical examination, and when possible, the clinical utility of ultrasonography for suspicious abdominal masses in the absence of state-of the art diagnostic tools for early diagnosis and treatment, which is critical for survival and to improve quality of life.

Occurrence of anembryonic pregnancy with use of levonorgestrel subdermal implant (JADELLE®): a case report.

BACKGROUND: Progestin-only subdermal implants are one of the most effective contraceptive methods. Anembryonic pregnancy is not reported as a possible outcome in cases of contraceptive failure of these products. We present a rare case of anembryonic pregnancy occurring in a woman with levonorgestrel-releasing implant (JADELLE®). CASE PRESENTATION: A 31-year-old Cameroonian (black African) housewife with a JADELLE® implant for 13 months, consulted at our hospital for a 1-month history of pelvic pain, prolonged menstrual bleeding, and spotting. She had a last normal menstrual period 8 weeks 1 day prior to presentation. On examination, there was suprapubic tenderness and blood trickling from her cervix. Despite a negative qualitative urine pregnancy test, an empty intrauterine gestational sac with mean sac diameter of 28 mm was visualized on pelvic ultrasound. Dilation and curettage with suction was done and she had complete relief from symptoms. CONCLUSION: This case report highlights the possibility of anembryonic pregnancy occurring in women using the levonorgestrel-releasing subdermal implant (JADELLE®).

Severe eye complications from toxic epidermal necrolysis following initiation of Nevirapine based HAART regimen in a child with HIV infection: a case from Cameroon.

BACKGROUND: Toxic epidermal necrolysis (TEN) is a rare life threatening dermatological disorder characterized by extensive epidermal detachment and erosion of mucous membranes. It is typically a side effect of some medications. Nevirapine, a nonnucleoside reverse transcriptase inhibitor (NNRTI) is one of the frequently used components of highly active antiretroviral therapy (HAART). Skin rash is its common adverse reaction, usually mild and rarely progressing to TEN. Ophthalmic involvement is common as well but rarely progresses to blindness especially in the pediatric population. CASE PRESENTATION: We report the case of a 3 year 5 month old child diagnosed with HIV who developed TEN 8 days after starting a Nevirapine based HAART regimen. Drug withdrawal and supportive treatment alone were the modalities employed to achieve complete re-epithelization of lesions. Patient was lost to follow-up 6 months after being in care and was only seen 3 years later with total loss of vision. CONCLUSION: Blindness, though rare, can be a long-term complication of TEN in children especially with HIV infection. Physicians and patient caregivers should closely monitor these patients, especially during their early stages of treatment amongst others for development of adverse drug reactions. Long-term retention in care is pivotal for identification and prompt management of ocular and other chronic complications, albeit recognizing management challenges in low resourced settings.

Why do pregnant women present late for their first antenatal care consultation in Cameroon?

BACKGROUND: Early initiation of antenatal care visits is an essential component of services to improving maternal and new born health. The Cameroonian Demographic and Health Survey conducted in 2011 indicated that only 34% of pregnant women start antenatal care in the first trimester. However, detailed study to identify factors associated with late initiation of care has not been conducted in Cameroon. The aim of this study was to assess the prevalence of late booking first ANC visit amongst attendance of first ANC and the determinants of late first ANC in Douala general hospital. METHODS: It was a cross sectional analytic study over the period of 5 months in Douala general hospital. The study subjects were pregnant women visiting the facilities for the first time during the index pregnancy. Data were collected using pre-tested questionnaire. Logistic regression analysis was done to identify factors associated with late first ANC with the level of significance set at 0.05. RESULTS: A total of 293 women participated in the study; 129 (44.0%) of them came for their first ANC visit late, after 12 weeks of gestation. Most common reasons for coming late for first ANC were financial constraints (34.5%, 45) and long distance to the hospital (34.5%, 45). Factors associated with late start of first ANC after logistic regression were: family size greater than 4 (OR = 2, 95% CI = 1.25-3.19, p value = 0.004), long distance to the hospital (OR = 1.84, 95% CI = 1.1-3.07, p value = 0.02) and low monthly income level less than 200US dollars (OR = 3.2, 95% CI = 1.33-3.54, p value = 0.002). CONCLUSION: About half of pregnant women do not start ANC early in the first trimester largely due to large family size, low monthly income and long distance to the hospital.

Population awareness of cardiovascular disease and its risk factors in Buea, Cameroon.

BACKGROUND: Adequate awareness of cardiovascular diseases (CVD) and their risk factors may help reduce the population's exposure to modifiable risk factors and thereby contribute to prevention and control strategies. There is limited data on knowledge among the general population in sub-Saharan Africa regarding CVD and risk factors. We aimed to assess the population awareness (and associated factors) of CVD types and risk factors in Buea, Cameroon. METHODS: This was a community-based cross-sectional study conducted in 2016 among randomly selected adults (>18 years). Data on socio-demographic characteristics, knowledge about CVD types, their risk factors and warning signs for CVD events (stroke and heart attack) were acquired using a self-administered questionnaire. Logistic regression analysis was used to investigate factors associated with moderate-to-good knowledge. RESULTS: Of the 1162 participants (61.7% women, mean age 32 years), 52.5% had overall poor knowledge (mean score 12.1 on total of 25) on CVD with only about a quarter correctly identifying types of CVD. Overall, 36, 63 and 45% were unaware of CVD risk factors, warning signs of heart attack and stroke respectively. In multivariable analysis; high level of education (aOR = 2.26 (1.69-3.02), p < 0.0001), high monthly income (aOR = 1.64 (1.07-2.51), p = 0.023), having a family history of CVD (aOR = 1.59 (1.21-2.09), p = 0.001) and being a former smoker (aOR = 1.11 (1.02-1.95), p = 0.043) were associated with moderate-to-good knowledge. CONCLUSIONS: There exists a significant gap in population awareness about CVDs in Cameroon and this is similar to previous reports. Cost-effective community health education interventions taking into account socioeconomic status may be beneficial in this setting.

Awareness and low uptake of post exposure prophylaxis for HIV among clinical medical students in a high endemicity setting.

BACKGROUND: Adequate knowledge and practices on post exposure prophylaxis (PEP) for HIV among health care providers are crucial for HIV prevention. However there is limited data on PEP knowledge and practice from developing countries where the burden of HIV infection continues to increase. We assessed the knowledge of clinical medical students on PEP, their practices in response to occupational exposure to HIV, as well as the determinants of good knowledge on PEP. METHODS: A cross-sectional study was conducted in November 2014 involving 154 consecutively recruited clinical medical students (4(th)-6(th) year undergraduates). Data were acquired using a structured questionnaire. Knowledge on PEP was assessed using a questionnaire comprising 25 questions and categorized as: good (20 or more correct answers), moderate (13-19 correct answers) and poor (12 or fewer correct answers). RESULTS: For the 154 students included (57.8 % being male), the mean age was 23.2 ± 2.4 years, and 89 % had heard about PEP for HIV. The majority of students had moderate (61.7 %) and poor (32.5 %) knowledge on PEP. Overall knowledge score increased with increasing level of studies (p < 0.05). Only 10 (6.5 %) had had previous training on PEP, most of whom were senior level students (p = 0.01). Fifty-four students (35.1 %) knew the appropriate duration of PEP and this awareness increased with level of studies (p = 0.001). Of the 81 (52.6 %) who reported occupational exposure to HIV in the past, only 4 (4.9 %) received PEP. CONCLUSIONS: Overall, knowledge on PEP among clinical medical students in this setting was non-optimal with very low uptake PEP. Intensification of HIV curricula to involve PEP as well as continuous medical education programs and workshops are potential avenues to improve awareness in this vulnerable population.