An Age-stratified, Randomized Immunogenicity Trial of Killed Oral Cholera Vaccine with Delayed Second Dose in Cameroon.

The recommended schedule for killed oral cholera vaccine (OCV) is two doses, 2 weeks apart. However, during vaccine campaigns, the second round is often delayed by several months. Because more information is needed to document antibody responses when the second dose is delayed, we conducted an open-label, phase 2, noninferiority clinical trial of OCV. One hundred eighty-six participants were randomized into three dose-interval groups (DIGs) to receive the second dose 2 weeks, 6 months, or 11.5 months after the first dose. The DIGs were stratified into three age strata: 1 to 4, 5 to 14, and > 14 years. Inaba and Ogawa vibriocidal titers were assessed before and after vaccination. The primary analysis was geometric mean titer (GMT) 2 weeks after the second dose. Data for primary analysis was available from 147 participants (54, 44, and 49 participants from the three DIGs respectively). Relative to the 2-week interval, groups receiving a delayed second dose had significantly higher GMTs after the second dose. Two weeks after the second dose, Inaba GMTs were 55.1 190.3, and 289.8 and Ogawa GMTs were 70.4, 134.5, and 302.4 for the three DIGs respectively. The elevated titers were brief, returning to lower levels within 3 months. We conclude that when the second dose of killed oral cholera vaccine was given after 6 or 11.5 months, vibriocidal titers were higher than when given after the standard period of 2 weeks. This provides reassurance that a delayed second dose does not compromise, but rather enhances, the serological response to the vaccine.

EPI immunization coverage, timeliness and dropout rate among children in a West Cameroon health district: a cross sectional study.

BACKGROUND: Monitoring of the expanded program on immunization's performance is not only limited to routine periodic reports but equally includes surveys. Based on unpublished national EPI surveillance data from the past 5 years in Cameroon, the Foumban health district has reported a high number of vaccine preventable disease suspected cases. Contradictory information on the immunization coverage in this district exists from both administrative data and published literature. As a result, the objective of this study was to estimate the immunization coverage and dropout rate in age group 12-23 months and timeliness in age group 0-59 months among children in Foumban Health District (Cameroon), in 2018. METHOD: This was a descriptive cross-sectional study targeting randomly selected children aged 0-59 months from Foumban health district. Data were collected by trained and supervised surveyors using a pretested questionnaire to describe the immunization coverage, timeliness and dropout rate in eighty clusters of about thirty buildings selected by stratified random sampling in July 2018. RESULTS: In total, 80 clusters covering 2121 buildings were selected and all were reached (100%). A total of 1549 (81.2%) households accepted to participate in the survey and 1430 children aged 0-59 months including 294 (20.6%) aged 12-23 months were enrolled into the study. Of these 1430 children, 427 [29.9 (27.4-32.2)%] aged 0-59 months were vaccinated with evidence. In the age group 12-23 months, the immunization coverage with evidence of BCG, DPT-Hi + Hb 3 and measles/rubella were 28.6(23.4-33.9)%, 22.8 (18.1-27.6)% and 14.3 (10.3-18.1)% respectively. Within age group 0-59 months; the proportion of children who missed their vaccination appointments increased from 23.3 to 31.7% for the vaccine planned at birth (BCG) and last vaccine planned (Measles/Rubella) for the EPI program respectively. In age group 12-23 months; the specific (DPT-Hi + Hb1-3) and general (BCG-Measles/Rubella) dropout rates of vaccination with evidence were 14.1 and 50.0% respectively. CONCLUSION: Documented immunization coverage, dropout rate and timeliness in Foumban Health district are lower than that targeted by the Cameroon EPI. Competent health authorities have to take necessary actions to ensure the implementation of national guidelines with regards to children access to immunization. Also, studies have to be conducted to identify determinants of low immunization coverage and delays in immunization schedules as well as high dropout rates.

Histo-epidemiological aspects of gynecological and breast cancers at the University Teaching Hospital of Yaoundé.

INTRODUCTION: Cancer is a public health problem that affect women more than men. The aim of the study was to describe the epidemiological and histopathological features of gynecological malignancies in the city of Yaoundé, Cameroon. METHODS: This was a descriptive cross-sectional study of histologically proven gynecological cancers over a 10-year period (2008-2017) in the Gynecology and Pathological Anatomy Departments of the University Teaching Hospital of Yaoundé. RESULTS: A total of 682 cancers were identified among which, 342 gynecological cancers, for an overall frequency of 50.1% and an annual frequency of 34.2 cases on average. There was a trend suggesting an increase annual frequency over time. The cervix was the most frequent location with 182 cases (53.2%); followed by breast with 96 cases (28.1%); endometrium with 33 cases (9.7%) and ovaries 15 cases (4.4%). These patients were on average 51.9±13.7 years old, mostly housewives (56.8%), married (60.4%), multiparous (61.3%) and referred (62.6%). Histopathologically, cervical cancer was predominantly squamous cell carcinoma (86.8%), invasive (80.9%) and well differentiated (45.5%). For breast cancers, the majority were ductal carcinomas (78.1%), invasive (92%), and histological grade SBR II (50.6%). The most common histopathological types of endometrial and ovarian cancer were adenocarcinoma (72.2%) and serous cystadenocarcinoma (46.7%), respectively. CONCLUSION: Gynecological cancers are common. Screening is expected to increase at 30 years for cervical cancer and start at age 40 with mammography for breast cancer.

[Distribution and therapeutic path of patients with stroke admitted to Hospital]. / Distribution et itinéraire thérapeutique des patients reçus pour accident vasculaire cérébral à l'Hôpital Régional de Bafoussam, Cameroun.

INTRODUCTION: The prevalence of strokes is continuously growing in Africa. Morbidity and mortality related to this disease depend on patients management in the community and health care facilities (FOSAs). The purpose of this study was to describe the outcome and the therapeutic path of patients with stroke admitted to the Bafoussam Regional Hospital (BRH). METHODS: We conducted a cohort non-controlled study of patients who were diagnosed with stroke. Data were collected using two tools such as an anonymous questionnaire among patients or on their pre-hospital management and a grid for the collection of data on patient's outcome during hospitalization. Data were analyzed by describing the frequency distribution of the sources and types of supports solicited prior to and during hospitalization as well as that of patients' outcome at the end of hospitalization including the incidence of complications. RESULTS: A total of 46 patients were included in this study, with an average age of 62 years: 27(58.7%) were women and 37 (80.4%) were referred to other FOSAs. Four (8.7%) patients had taken products before their hospitalization; 2(4.3%) patients had taken a traditional product. Thirty-six (78.3%) patients had a cardiovascular history, of whom 22 with high blood pressure. Ten days after hospitalization, 32 (69.6%) patients resumed their autonomy and 5(10.9%) died. CONCLUSION: Few patients used non-medical treatments before their arrival to hospital. Most of them underwent care in time, but the rate of hospital complications and deaths were high. A study should be conducted to determine the factors contributing to high rate of complications and death in patients hospitalized for stroke at the BRH.

[Profile and antibiotic susceptibility pattern of bacterial pathogens associated with diarrheas in patients presenting at the Kousseri Regional Hospital Anne, Far North, Cameroon]. / Profil et antibiosensibilité des bactéries pathogènes associées aux diarrhées chez les patients consultant à l'Hôpital Régional Annexe de Kousseri, Extrême-Nord Cameroun.

INTRODUCTION: In most of the health facilities in Cameroon, the management of patients with diarrhea is based on presumptive diagnosis due to limited laboratory resources. This study aimed to determine germs profile and their susceptibility to antibiotics usually prescribed against pathogenic bacteria associated with diarrheas at the Kousseri Regional Hospital Annex from July to October 2015. METHODS: We conducted a descriptive and cross-sectional study of all consenting individual presenting with diarrhea to the Kousseri Regional Hospital Annex during the study period. Stool samples were collected from each patient. Patient data were collected via anonymous questionnaire with face to face interview. Each stool sample was grown on media for enterobacteria and analyzed following the standard stool culture method. The sensitivity of the isolated strains to the most frequently prescribed antibiotics was assessed and the proportions of patients with each pathogen germ and of germ sensitive to each antibiotic were estimated. RESULTS: Out of 150 patients with diarrhea included in the study 45(30.0%) had enteropathogenic bacteria, of which 37(82.2%) in children aged 0-5 years. Escherichia coli was the the most common bacterium(30 cases, 66%) followed by Salmonella spp(7 cases, 16%), Vibrio spp,(5 cases, 11%), Aeromonas spp(2 cases, 4%), and Shigella spp(1 cases, 2%). Susceptibility tests were performed which showed that 17(56.7%), 14(46.7%) and 5(16.7%) E. coli were susceptible to ciprofloxacin, ceftriaxone, cotrimoxazole respectively; 4(57.14%), 2(28.57%) Salmonella spp. were susceptible to ceftriaxone and cotrimoxazole respectively. CONCLUSION: Nearly a third of the cases of diarrheas at the Kousseri Regional Hospital Annex in the season of rain were associated with at least a pathogenic bacterium. The susceptibility of isolated germs to commonly prescribed antibiotics was very limited. Health staff in the facilities in the extreme north of Cameroon prescribe antibiotic against diarrheas on the basis of presumptive diagnosis. Hence, the necessity to implement a system for the monitoring of the associated germ profile and of their susceptibility to commonly prescribed antibiotics.

Distribution et itinéraire thérapeutique des patients reçus pour accident vasculaire cérébral à l'hôpital régional de Bafoussam, Cameroun

Introduction: l'incidence des accidents vasculaires cérébraux (AVC) est sans cesse croissante en Afrique. La morbidité et la mortalité liées à cette maladie dépendent de la prise en charge des patients aussi bien en communauté que dans les formations sanitaires (FOSA). L'objectif était de Décrire la distribution de l'évolution et l'itinéraire thérapeutique des patients reçus pour AVC à l'hôpital régional de Bafoussam (HRB). Méthodes: il s'agissait d'une étude de cohorte non contrôlée ciblant les patients qui ont été diagnostiqués pour AVC. Les données étaient collectées à l'aide de deux outils dont un questionnaire anonyme adressé au patient ou à son garde sur la prise en charge pré-hospitalière du patient et une grille pour la collecte des données sur les documents de suivi du patient pendant son hospitalisation.Les données ont été analysées en décrivant la distribution des fréquences des sources et types de soins sollicitées avant et pendant l'hospitalisation ainsi que celle de l'évolution à la fin de l'hospitalisation y compris l'incidence des complications. Résultats: au total 46 patients ont été inclus dans cette étude avec un âge moyen de 62 ans. Vingt- sept 27 soit 58,7% étaient des femmes et 37 soit 80,4% étaient référés d'autres FOSA. 4(8,7%) patients avaient pris des produits avant leur hospitalisation dont 2(4,3%) un produit traditionnel.36 (78,3%) patients avaient des antécédents cardiovasculaires dont 22 cas connus d'hypertension artérielle. A la sortie après 10 jours d'hospitalisation, 32 (69,6%) avaient repris leur autonomie et 5 (10,9%) patients étaient décédés. Conclusion: peu de patients recourent aux soins non médicalisés avant l'arrivée à l'hôpital. La plupart bénéficient des soins dans les délais requis mais les taux de complications et de décès hospitaliers restent élevés. Une étude devrait être faite pour déterminer les facteurs contribuant à un taux élevé de complications et de décès chez les patients hospitalisés pour AVC à l'HRB