Epidemiology of onchocerciasis-associated epilepsy in the Mbam and Sanaga river valleys of Cameroon: impact of more than 13 years of ivermectin.

BACKGROUND: A high epilepsy prevalence has been reported in several onchocerciasis-endemic villages along the Mbam and Sanaga river valleys in Cameroon, including Bilomo and Kelleng. We sought to determine the prevalence of epilepsy in these two villages following more than 13 years of community-directed treatment with ivermectin (CDTI). METHODS: Door-to-door surveys were performed on the entire resident population in the villages in August 2017 and January 2018. Epilepsy was diagnosed using a 2-step approach: administration of a standardized 5-item questionnaire followed by confirmation by a neurologist. Previously published diagnostic criteria for onchocerciasis-associated epilepsy (OAE) were used. Ov16 serology was done for children aged 7-10 years to assess onchocerciasis transmission. Findings were compared with previous data from these two villages. RESULTS: A total of 1525 individuals (1321 in Bilomo and 204 in Kelleng) in 233 households were surveyed in both villages. The crude prevalence of epilepsy was 4.6% in Bilomo (2017) and 7.8% in Kelleng (2018), including 12 (15.6% of cases) persons with epilepsy (PWE) with nodding seizures. The age and sex-standardized prevalence in Kelleng decreased from 13.5% in 2004 to 9.3% in 2018 (P < 0.001). The median age of PWE shifted from 17 (IQR: 12-22) years to 24 (IQR: 20-30) years in Bilomo (P < 0.001); and slightly from 24 (IQR: 14-34) years to 28 (IQR: 21.25-36.75) years in Kelleng (P = 0.112). Furthermore, 47.6% of all tested children between 7 and 10 years had Ov16 antibodies. CONCLUSIONS: There is a decrease in epilepsy prevalence after 13 years and more of CDTI in both villages. The age-shift observed in PWE suggests that ivermectin may prevent OAE in younger residents. Ov16 seropositivity in children indicates ongoing onchocerciasis transmission possibly due to suboptimal control measures. Our findings support the existence of OAE in Cameroon and highlight the need to strengthen onchocerciasis elimination programs.

Hypertension in Cameroon associated with high likelihood of obstructive sleep apnea: a pilot study.

BACKGROUND: Although disordered sleep patterns predispose to hypertension (HTN), little is known on the effect of the latter on sleep patterns in sub-Saharan Africa. This study therefore sought to generate preliminary data on the likelihood (risk) of Obstructive sleep apnea (OSA) in hypertensive patients, with the aid of sleep questionnaires. METHODS: This case-control study, age-and-sex-matched HTN patients with normotensive participants, and compared sleep patterns in either group determined with the aid of the Berlin Questionnaire (BQ) and Epworth Sleepiness Scale (ESS). RESULTS: Overall, 50 HTN and 54 age- and sex-matched normotensive participants were enrolled. The prevalence of snoring was higher in participants with hypertension compared to normotensives (58.0% versus 44.0% respectively), though not significantly, (p = 0.167). However, the hypertensive cases (aged on average 54.78 ± 8.79 years and with mean duration since diagnosis of 4.46 ± 4.36 years) had a significantly higher likelihood of Obstructive Sleep Apnea (OSA) than the controls (aOR = 5.03; 95% CI, 1.90-13.33, p = 0.001) and but no significant resulting daytime sleepiness (p = 0.421). There was no clear trend observed between both the risk of OSA and daytime sleepiness and HTN severity. Although not significant, participants with controlled hypertension had lower rates of risk of OSA compared to those with uncontrolled HTN (50.0% versus 63.2%, p = 0.718). CONCLUSIONS: Preliminary findings of this study (the first of its kind in Cameroon) suggests that hypertension is positively associated with likelihood of OSA in Cameroon. Further studies are required to investigate this further and the role of sleep questionnaires in our setting, cheap and easy to use tools which can be used to identify early, patients with hypertension in need for further sleep investigations. This will contribute to improving their quality of life and adherence to anti-hypertension treatment.

Dyslipidemia in Patients with a Cardiovascular Risk and Disease at the University Teaching Hospital of Yaoundé, Cameroon.

Objective. To determine the frequency of lipid abnormalities in patients with a cardiovascular risk and disease at the University Teaching Hospital (UTH) of Yaoundé. Materials and Methods. We conducted a cross-sectional study from 1 March to 31 May 2015 at the UTH of Yaoundé. We included all patients seen in the outpatient department with a diagnosis of a cardiovascular disease or a risk factor for cardiovascular disease. Patients who accepted to participate in the study were asked to answer a questionnaire; after that a blood sample was taken for lipid profile. An informed consent was signed by all the participants and the study has received approval from the national ethic committee. Results. We recruited 264 patients of which 119 were men and 145 were women with a sex ratio of 0.82. Mean age was 61.36 years. The frequency of lipid profiles abnormalities was as follows: low HDL cholesterol (44.3%), hypertriglyceridemia (18.9%), high LDL cholesterol (3.8%), and high total cholesterol 3.4%). Hypertriglyceridemia was strongly associated with type 2 diabetes mellitus. Conclusion. Low levels of HDL cholesterol and hypertriglyceridemia are more prevalent in our study population. More studies are needed to confirm this finding in our environment.

Depressive symptoms in HIV-infected and seronegative control subjects in Cameroon: Effect of age, education and gender.

Depression is a leading cause of HIV/AIDS disease burden; it worsens health outcomes and quality of life. Addressing this problem requires accurate quantification of the extra burden of depression to HIV/AIDS in a given population, and knowledge of the baseline depression prevalence in the general population. There has been no previous study of depression in the general Cameroonian population. The current study attempts to address that important need. We used the Beck Depression Inventory-II to assess the prevalence and severity of depressive symptoms in 270 HIV-infected and seronegative Cameroonians. Univariate analyses showed a trend toward higher depressive symptoms among cases, compared to controls (p = 0.055), and among older subjects (>40 years), compared to younger subjects (≤40 years) (p = 0.059). Analysis of depression severity showed that 33.73% of cases had moderate-to-severe depressive symptoms, compared to 19.8% of controls (p<0.01). However, multivariable negative binomial regression analyses showed no effect of age, HIV status, CD4 levels, viral loads, ART, or opportunistic infections on the risk of depressive symptoms. Both univariate and multivariable regression analyses showed significantly higher risk of depressive symptoms among females compared to males; this was significant for both female controls and female cases. Female cases had significantly higher CD4 cell counts and lower viral loads, compared to males. Both univariate and multivariable regression analyses showed that lower education (≤10 years) was associated with increased risk of depressive symptoms. This study shows a high prevalence of depressive symptoms among seronegative controls and HIV-infected Cameroonians. Integrating care for mental disorders such as depression into primary health care and existing HIV/AIDS treatment programs in Cameroon may improve the wellbeing of the general population and could lower the HIV/AIDS burden.

Prevalence and correlates of depressive symptoms in HIV-positive patients: a cross-sectional study among newly diagnosed patients in Yaoundé, Cameroon.

BACKGROUND: Depression is one of the most common neuropsychiatric complications of HIV disease, and in turn it is associated with worse HIV-related outcomes. Data on depression among HIV-infected patients in Cameroon are scarce. In this study, we report the prevalence and correlates of depressive symptoms among newly diagnosed HIV-infected patients in Yaoundé, Cameroon. METHODS: Interviews were conducted with 100 newly diagnosed HIV-infected patients at three referral hospitals of Yaoundé. Depression was assessed using the nine-item Patient Health Questionnaire (PHQ-9). A positive depression screen was defined as PHQ-9 score greater than 9. RESULTS: The overall prevalence of depressive symptoms was 63% (95% CI: 53.2 to 71.8), the majority having symptoms corresponding to moderate depression. Multiple logistic regression analysis showed that probable depressed patients were more likely than those who were not depressed to have had experience of alcohol abuse (OR: 19.03, 95% CI 3.11-375.85; p = 0.0083), and a 100 CD4 cells/mm3 fewer was associated with a 2.9 times increase of the odds of probable depression (95% CI 1.88-4.84; p < 0.0001). CONCLUSIONS: Our findings indicate a high prevalence of depressive symptoms in newly diagnosed HIV-infected patients in our setting, and their association with alcohol abuse and severe immunosuppression. This study also highlights the necessity to integrate mental health interventions into routine HIV clinical care in Cameroon.