Traumatic Brain Injury in Cameroon: A Prospective Observational Study in a Level I Trauma Centre.

Background and Objective: About 14 million people will likely suffer a traumatic brain injury (TBI) per year by 2050 in sub-Saharan Africa. Studying TBI characteristics and their relation to outcomes can identify initiatives to improve TBI prevention and care. The objective of this study was to define the features and outcomes of TBI patients seen over a 1-year period in a level-I trauma centre in Cameroon. Materials and Methods: Data on demographics, causes, clinical aspects, and discharge status were collected over a period of 12 months. The Glasgow Outcome Scale-Extended (GOSE) and the Quality-of-Life Questionnaire after Brain Injury (QoLIBRI) were used to evaluate outcomes six months after TBI. Comparisons between two categorical variables were done using Pearson's chi-square test. Results: A total of 160 TBI patients participated in the study. The age group 15-45 years was most represented (78%). Males were more affected (90%). A low educational level was seen in 122 (76%) cases. Road traffic incidents (RTI) (85%), assaults (7.5%), and falls (2.5%) were the main causes of TBI, with professional bike riders being frequently involved (27%). Only 15 patients were transported to the hospital by ambulance, and 14 of these were from a referring hospital. CT-imaging was performed in 78% of cases, and intracranial traumatic abnormalities were identified in 64% of cases. Financial constraints (93%) was the main reason for not performing a CT scan. Forty-six (33%) patients were discharged against medical advice (DAMA) due to financial constraints. Mortality was 14% (22/160) and high in patients with severe TBI (46%). DAMA had poor outcomes with QoLIBRI. Only four patients received post-injury physical therapy services. Conclusions: TBI in Cameroon mainly results from RTIs and commonly affects young adult males. Lack of pre-hospital care, financial constraints limiting both CT scanning and medical care, and a lack of acute physiotherapy services likely influenced care and outcomes adversely.

Anaemia, iron deficiency and inflammation prevalence in children in the Mount Cameroon area and the contribution of inflammatory cytokines on haemoglobin and ferritin concentrations: a cross sectional study.

BACKGROUND: Iron deficiency (ID) and anaemia of inflammation (AI) coexist where infections and nutritional deficiencies are common. The aim of this study was to determine burden of ID, anaemia, inflammation and AI in children in malaria endemic Limbe, Mount Cameroon as well as decipher the contribution of some inflammatory cytokines on the concentration of haemoglobin and ferritin. METHODS: A total of 520 children aged ≤ 15 years old from the Limbe Health District (LHD) were randomly selected and examined in a cross-sectional study for iron deficiency, anaemia, inflammation and inflammation anaemia. Collected blood samples were used for full blood count and inflammatory marker analyses with the aid of a haemoanalyzer and ELISA machine, respectively. Spearman's rank correlation analysis was used to determine the correlation between cytokines and haemoglobin while multiple linear regression analysis was used to evaluate the effects of inflammatory cytokines on haemoglobin and ferritin concentrations. RESULTS: The overall prevalence of anaemia, ID, IDA, inflammation and AI were respectively, 67.5%, 34.6%, 12.9%, 63.1% and 30.2%. Children aged 12‒15 years (P = 0.001), enrolled from the community (P < 0.001), whose parents are civil servants (P < 0.001), living in a home with 6‒10 occupants (P = 0.016), afebrile (P < 0.001) and malaria negative (P = 0.007) had the highest prevalence of ID while, children ≤ 5 years old (P = 0.001), with a family size of 1‒5 occupants (P = 0.033) had the highest prevalence of AI. Haemoglobin concentration positively correlated with concentrations of IFN-γ (P < 0.001), TNF-α (0.045) and ferritin (P < 0.001) while a negative correlation was observed with IL-10 (P = 0.003). In the multiple linear regression analysis only IL-6 significantly (P = 0.030) influenced haemoglobin concentration. CONCLUSIONS: While IL-6 is of significance in the pathology of anaemia, iron deficiency and anaemia of inflammation are of moderate public health concerns in the Mount Cameroon area. Hence, appropriate intervention against anaemia, ID and AI should be directed at children ≤ 5 years and counterparts > 10 years old that bear the highest burden.

Malnutrition, anaemia and anisocytosis as public health problems among children ≤ 5 years living in malaria perennial transmission areas of Mount Cameroon: a cross sectional study.

BACKGROUND: Anaemia, anisocytosis, malnutrition (especially stunting) are common health problems in developing countries with children being the most vulnerable. These conditions have negative impacts on human performance, growth and development, and can further be complicated if comorbidity exists within a holoendemic stratum with strong and perennial malaria parasite transmission such as the Mount Cameroon area. The study aimed at determining the prevalence and severity malnutrition, anaemia and anisocytosis in children ≤ 5 years, living in the conflict hit malaria perennial transmission zone of the Mount Cameroon area. METHOD: A cross-sectional community-based survey involving 628 children ≤ 5 years was conducted. Malaria parasitaemia was confirmed by Giemsa-stained microscopy and the density was log transformed. Haemoglobin (Hb), mean cell volume and red blood cell distribution width were estimated using an auto-haematology analyser and defined according to WHO standards. Anthropometric indices were analysed and compared with WHO growth reference standards using WHO Anthro software. RESULTS: Plasmodium infection, anaemia, microcytic anaemia, anisocytosis and stunting were prevalent in 36.0, 72.8, 30.1, 54.1 and 29.0% of the children, respectively. The ≤ 24 months children were more moderately stunted (14.7%), with higher prevalence of microcytic anaemia (38.8%) and anisocytosis (68.8%) (P < 0.002 and P < 0.001, respectively) when compared with the older children. The mean Hb level in the study population was 10.04 g/dL with children ≤ 24 months having the least mean haemoglobin level (9.69 g/dL) when compared with their older counterparts at P < 0.001. The odds of having anisocytosis were highest among children who were malnourished (OR = 4.66, P = 0.005), those infected with malaria parasites (OR = 1.85, P = 0.007), and whose parents had a primary (OR = 3.51, P = 0.002) and secondary levels of education (OR = 2.69, P = 0.017). CONCLUSION: Malaria, anaemia, anisocytosis and undernutrition still remain severe public health concerns among children ≤ 60 months in the Mount Cameroon area. This therefore emphasizes the need for the implementation of consistent policies, programmes and activities to avoid malaria, anaemia, anisocytosis and stunting in the paediatric age group.

Seroprevalence of Gestational and Neonatal Toxoplasmosis as well as Risk Factors in Yaoundé, Cameroon.

Background: Toxoplasmosis, caused by Toxoplasma gondii in pregnant women, is a significant public health problem due to risk of mother to child transmission. The aim of the study was to determine the seroprevalence of toxoplasmosis in pregnant women and corresponding cord blood among women attending Biyem-Assi and CASS Nkoldongo hospitals in Yaoundé, Cameroon. Methods: An institutional based cross-sectional study was conducted between June 2019 and May 2020 on 300 pregnant women from late second trimester to third trimester. A total of 259 cord blood samples were collected at birth from these women. Toxoplasma gondii-specific IgG and IgM antibodies in maternal and cord blood were detected using the Toxoplasma Enzyme Immunosorbent Assay kit, and potential risk factors captured through questionnaire were identified using binary logistic regression model. Statistical significance was measured at P < 0.05. Results: The overall seroprevalence of gestational and neonatal toxoplasmosis was 80% and 88%, respectively. IgG seropositivity was 72.7%, IgM only was 1.3% and cooccurrence of IgG/IgM was 6% amongst pregnant women. Out of 259 newborn cord bloods, 72.2% were positive for IgG only, 8.9% for IgM only, and 23.9% for both IgG/IgM. Pregnant women 15-24 years (AOR = 4.6, P = 0.011) and women with primary level of education (AOR = 3.9, P = 0.042) were significantly at risk of infection with Toxoplasma gondii. Conclusion: Gestational and neonatal toxoplasmosis appears to be more common with higher risk of infection in younger women and less educated women. Hence, these findings will serve as baseline data for further investigations on mother to child transmission of toxoplasmosis in Yaoundé and the need for reinforcement of pregnant women toxoplasmosis-related health measures.

Demographics, Causes, and Outcome of Traumatic Brain Injury among Trauma Cases in Cameroon: A Multi-Center Five Year's Retrospective Study.

Traumatic brain injury (TBI) is a huge public health challenge worldwide. Epidemiological monitoring is important to inform healthcare policy. We aimed at determining the prevalence, outcome, and causes of TBI in Cameroon by conducting a 5-year retrospective study in three referral trauma centers. Data on demographics, causes, injury mechanisms, clinical aspects, and discharge status were recorded. Comparisons between two categorical variables were done using Pearson's chi-square test or Fisher's exact test. A total of 6248 cases of TBI were identified of 18,151 trauma cases, yielding a prevalence of 34%. The number of TBI cases increased across the years (915 in 2016, 1406 in 2020). Demographic data and causes of TBI were available for 6248 subjects and detailed data on clinical characteristics on 2178 subjects. Median age was 30.0 (24.0, 41.0) years. Males were more affected (80%). Road traffic incidents (RTIs; 75%) was the main cause of TBI, with professional bike riders being more affected (17%). Computed tomography (CT) imaging was performed in 67.7% of cases. Of the 597 (27.4%) cases who did not undergo neuroimaging, 311 (52.1%) did not have neuroimaging performed because of financial constraints, among which 7% were severe TBI cases. A total of 341 (19.6%) patients were discharged against medical advice, of which 83% had financial limitations. Mortality was 10.3% (225 of 2178) in the overall population, but disproportionately high in patients with severe TBI (55%) compared to those in high-income settings (27%). TBI occurrence is high in Cameroon, and RTIs are the main causes. Disparities in care provision were identified as attributable to financial constraints regarding CT scanning and continuation of care. The data presented can inform preventive interventions to improve care provision and transport policies. Implementation of a universal health insurance may be expected to improve hospital care and reduce the adverse effects of TBI among Cameroonians.

Asymptomatic and sub-microscopic Plasmodium falciparum infection in children in the Mount Cameroon area: a cross-sectional study on altitudinal influence, haematological parameters and risk factors.

BACKGROUND: The Mount Cameroon area has experienced a 57.2% decline in confirmed malaria cases between 2006 and 2013 with the implementation of different control measures but, the disease is still of public health concern. The objective of the study was to assess the burden of asymptomatic and sub-microscopic Plasmodium infection, altitudinal influence on it, their effect on haematological parameters as well as identify the risk factors of infection. METHODOLOGY: A cross-sectional community-based survey involving 1319 children of both sexes aged 6 months to 14 years was conducted between July 2017 and May 2018. Malaria parasitaemia was confirmed by Giemsa-stained microscopy, sub-microscopic Plasmodium infection by 18S mRNA using nested PCR and full blood count analysis was done using an auto haematology analyser. RESULTS: Malaria parasite, asymptomatic malaria parasitaemia and sub-microscopic Plasmodium infection and anaemia were prevalent in 36.4%, 34.0%, 43.8% and 62.3% of the children, respectively. The risk of having sub-microscopic Plasmodium infection was highest in children 5‒9 (OR = 3.13, P < 0.001) and 10‒14 years of age (OR = 8.18, P < 0.001), non-insecticide treated net users (OR = 1.69, P < 0.04) and those anaemic (OR = 9.01, P < 0.001). Children with sub-microscopic infection had a significantly lower mean haemoglobin (9.86 ± 1.7 g/dL, P < 0.001), red blood cell counts (4.48 ± 1.1 × 1012/L, P < 0.001), haematocrit (31.92%, P < 0.001), mean corpuscular haemoglobin concentration (313.25 ± 47.36, P = 0.035) and platelet counts (280.83 ± 112.62, P < 0.001) than their negative counterparts. Children < 5 years old (73.8%), having asymptomatic (69.8%) and sub-microscopic Plasmodium infection (78.3%) as well as resident in the middle belt (72.7%) had a higher prevalence of anaemia than their peers. CONCLUSION: The meaningful individual-level heterogeneity in the burden of asymptomatic and sub-microscopic Plasmodium infection in addition to its corollary on haematological variables among children in the different attitudinal sites of the Mount Cameroon Region accentuate the need for strategic context specific planning of malaria control and preventative measures.

Urogenital schistosomiasis burden in school-aged children in Tiko, Cameroon: a cross-sectional study on prevalence, intensity, knowledge and risk factors.

BACKGROUND: This study aimed at determining urogenital schistosomiasis (UGS) prevalence, intensity, knowledge and risk factors in school-aged children (SAC) in the new endemic focus of Tiko, Cameroon. METHODS: A cross-sectional study including 389 SAC of both sexes aged 5-15 years was carried out between April and June 2018. A structured questionnaire was used to collect demographic data, clinical and predisposing factors. Urine sample collected was used to detect Schistosoma haematobium eggs by filtration technique and microhaematuria by Heme dipstick COMBI 11. Logistic regression model was used to determine risk factors of UGS. RESULTS: The overall prevalence of UGS was 37.0% (CI 32.4-41.9) and 32.6% (CI 28.2-37.5) were positive by egg excretion while 24.4% (CI 20.4-28.9) by haematuria. S. haematobium egg excretion and haematuria were significantly higher in males (P = 0.016; P = 0.049) and children 12-15 years old (P = 0.009; P = 0.002), respectively. The mean number of eggs per 10 mL of urine was 77.6 (10.2) and ranged from 2 to 400. The proportion of light intensity of infection was higher (67.7%, CI 59.2-75.2) with no significant differences by sex, age and residence. However, the older children were more heavily infected when compared to the younger children, who had more of light infection. Overall, the mean knowledge score 1.42 (CI 1.32-1.51) on a scale of 6, was poor and the proportion of good knowledge of the disease (23.14%, CI 19.2-27.6) was low. Stream water contact (AOR = 4.94; P = 0.001) was the only significant risk factor identified. CONCLUSION: Urogenital schistosomiasis is of public health concern among SAC in Tiko, Cameroon. Most participants have poor knowledge about the disease, hence education on vector-borne diseases and the avoidance of stream water contact should be implemented.

Insecticide-treated net ownership, utilization and knowledge of malaria in children residing in Batoke-Limbe, Mount Cameroon area: effect on malariometric and haematological indices.

BACKGROUND: Insecticide-treated nets (ITNs) are the most widely used interventions for malaria control in Africa. The aim of this study was to assess the ownership and utilization of ITNs and the knowledge of malaria and their effects on malariometric and haematological indices in children living in the Mount Cameroon area. METHODS: A community-based cross-sectional study involving a total of 405 children aged between 6 months and 14 years living in Batoke-Limbe was carried out between July and October 2017. A semi-structured questionnaire was used to document demographic status, knowledge on malaria and ITN ownership and usage. Venous blood sample was collected from each child to determine the prevalence and intensity of parasitaemia by Giemsa-stained microscopy and full blood count by auto haematology analysis to obtain white blood cell (WBC) and red blood cell (RBC) counts, haemoglobin (Hb) level, haematocrit (Hct), mean corpuscular volume (MCV), mean corpuscular haemoglobin (MCH) and mean corpuscular haemoglobin concentration (MCHC). A multilinear regression model was used to determine the relationship between haematological parameter as dependent variable and the independent variables. RESULTS: The overall prevalence of parasitaemia, anaemia, knowledge about malaria, ITN ownership, usage and effective usage was 46.7%, 54.7%, 40.7%, 78.8%, 50.9% and 29.9%, respectively. The prevalence of parasitaemia was significantly higher (P < 0.001) in children who ineffectively utilized ITNs (54.9%) than effective users (27.3%). Having knowledge of malaria, negatively correlated with WBC counts (P = 0.005), but positively correlated with Hb levels (P < 0.001), RBC counts (P < 0.001), Hct (P < 0.001), MCV (P < 0.001) and MCH (P < 0.001). ITN use positively correlated with WBC counts (P = 0.005) but negatively with Hb levels (P = 0.004), RBC counts (P = 0.006), and MCH (P < 0.001). Meanwhile, parasitaemia negatively correlated with Hb levels (P = 0.004), RBC counts (P = 0.01), Hct (P = 0.04) and MCHC (P = 0.015). CONCLUSION: There is need for more sensitization on the benefits of using the ITNs to meet up with the intended and expected impact of the free distribution of ITNs.

Confounding influences of malnutrition and Plasmodium falciparum and Schistosoma haematobium infections on haematological parameters in school children in Muyuka, Cameroon.

BACKGROUND: School-aged children (SAC) are a high-risk demographic group for infectious diseases and malnutrition. The objective of this study was to assess the burden and the effect of Plasmodium falciparum and Schistosoma haematobium infections on the haematological indices in SAC and the confounding influence of malnutrition on the outcomes. METHODS: This cross-sectional study was conducted in SAC 4-14 years old living in Ikata, Bafia and Mile 14-Likoko in Muyuka, Cameroon. Anthropometric measures of malnutrition were obtained and blood samples collected were used for detection of malaria parasites by Giemsa-stained blood films using light microscopy and complete blood count analysis using an automated haematology analyser. Urine samples collected were used to detect micro haematuria with the aid of reagent strips and the eggs of S. haematobium by urine filtration technique. Multiple linear regression model was used to examine influence of independent variables on haematological parameters. RESULTS: Out of the 606 SAC examined, the prevalence of single infections with Plasmodium or S. haematobium and co-infection with both parasites was 16.2, 16.3 and 8.3%, respectively. Overall, malaria parasite (MP), urogenital schistosomiasis, malnutrition, anaemia, haematuria, microcytosis and thrombocytopenia was prevalent in 24.4, 24.6, 25.9, 74.4, 12.2, 45.4 and 11.1% of SAC, respectively. A significant linear decline (P = 0.023) in prevalence of P. falciparum infection with the severity of stunting was observed. Factors that significantly influenced haematological parameters included haemoglobin: age, stunting and MP; haematocrit: age and MP; white blood cell count: age; red blood cell count; age and MP; lymphocyte counts: stunting; mean cell volume: age; mean cell haemoglobin: age and stunting; mean cell haemoglobin concentration: sex, stunting and red cell distribution width-coefficient of variation: sex, age and stunting. CONCLUSIONS: Malnutrition, Plasmodium and S. haematobium infections are common while anaemia is a severe public health problem in Muyuka, Cameroon. The interaction between haematological parameters with malaria parasites as well as linear growth index was negative and other interactions indicate systemic inflammation. While findings provide contextual intervention targets to ensure the judicious use of the limited resources, there is need for regular monitoring and proper treatment to improve the health of the underserved population.

Polyparasitism with Schistosoma haematobium, Plasmodium and soil-transmitted helminths in school-aged children in Muyuka-Cameroon following implementation of control measures: a cross sectional study.

BACKGROUND: Despite the ubiquity of polyparasitism, its health impacts have been inadequately studied. The aim of this study was to determine the prevalence and determinants of polyparasitism with Schistosoma haematobium, Plasmodium and soil-transmitted helminths (STH) following sustained control measures, as well as evaluate the outcomes and clinical correlates of infection in school-aged children (SAC) living in the schistosomiasis endemic focus of Muyuka-Cameroon. METHODS: In a cross-sectional study, urine, blood and stool samples were each collected from SAC (4-14 years) selected at random between March and June 2015. Microhaematuria in urine was detected using reagent strip and S. haematobium ova by filtration/microscopy methods. Plasmodium was detected using Giemsa-stained blood films and complete blood count was obtained using an auto-haematology analyser. STH in stool was detected by the Kato-Katz method. Categorical and continuous variables were compared as required, Kappa value estimated and the adjusted odds ratio (aOR) in the multivariate analysis was used to evaluate association of the risk factors with infection. RESULTS: Out of the 638 SAC examined, single infection was prevalent in 33.4% while polyparasitism was 19.9%. Prevalence of S. haematobium + Plasmodium was 7.8%; S. haematobium + STH was 0.8%; Plasmodium + STH was 0.8%; while S. haematobium + Plasmodium + STH was 0.9%. Higher preponderance of S. haematobium + Plasmodium infection occurred in females, those from Likoko, did not use potable water, practiced bathing in stream and carried out open defecation than their equivalents. However, being female (aOR = 2.38, P = 0.009) was the only significant risk factor identified. Anaemia was a common morbidity (74.3%) with a slight agreement with microscopy in predicting S. haematobium and Plasmodium infections. The sensitivity and specificity of haematuria (13.0%) in predicting S. haematobium infection was 46.5% and 100% with a moderate agreement with microscopy. Co-infection with S. haematobium and malaria parasite was significantly associated with threefold odds of history of fever in the last three days. CONCLUSIONS: Polyparasitism is a public health problem in Muyuka with females most at risk. Anaemia prevalence is exacerbated in co- and triple-infections and together with a history of fever are of value in predicting polyparasitism.

The epidemiological status of urogenital schistosomiasis among reproductive aged individuals in the Tiko Health Area- a semi-urban setting in the Mount Cameroon area.

BACKGROUND: Urogenital schistosomiasis (UGS) caused by S. haematobium has enormous reproductive health consequences including infertility. Reproductive aged individuals are a neglected group and not included in control programs in Cameroon. This study investigated the prevalence and severity of S. haematobium infection in the context of gender and socio-economic structures that shape behaviour among reproductive aged individuals living in Tiko, a semi-urban setting, Cameroon. METHODOLOGY/PRINCIPAL FINDINGS: A cross-sectional study was carried out in the Tiko Health District (THD) between May to September 2019. Consenting individuals were enrolled using a convenient sampling technique and administered a semi-structured questionnaire to document data on socio-demographic and stream contact behaviour. A urine sample was collected and screened for the presence of S. haematobium ova using reagent strips, filtration and microscopy. The overall prevalence of S. haematobium infection was 22.8% (95% CL: 19.27-26.73) with geometric mean egg load of 18.74 (range: 1-1600) per 10ml of urine. Younger age group (15 - 20years) (OR: 5.13; 95% CL: 1.35-19.42), male (OR: 2.60 3.07; 95% CL: 1.54-4.40) and awareness of UGS (OR: 1.73; 95% CL: 1.02-2.95) were associated with higher odds of exposure to infection. Significantly higher intensity of infection was seen in males, singles and in the age group 15-30 years. It is worth noting that males carried out more activities which entailed longer duration in streams. CONCLUSION/SIGNIFICANCE: The prevalence obtained shows that Tiko is a moderate-risk area for UGS with underlying morbidity-inducing infection intensity. The severity of the infection is more in males. Awareness of the disease is not enough to protect these communities from infection, but provision of public infrastructures and health education will limit contact with infested water and thus curtail the infection. There is an urgent need to involve all age groups in control programs.

Malaria and intestinal parasite co-infection and its association with anaemia among people living with HIV in Buea, Southwest Cameroon: A community-based retrospective cohort study.

BACKGROUND: Both malaria and intestinal parasites are endemic in Cameroon, and their co-infection can be of great impact on anaemia among people living with HIV (PLWH). This community-based retrospective cohort study determined the prevalence and association of infections with anaemia in PLWH and HIV-negative individuals in Buea, Cameroon from March to August 2019. METHODS: The study population comprised of 190 PLWH and 216 consenting HIV-negative individuals from the Buea community. Participants were examined clinically, the collected blood sample was used for malaria parasite (MP) detection, HIV diagnosis and haemoglobin (Hb) measurement while stool samples were examined for the detection of intestinal parasites (IPs). Proportions were compared using Pearson's Chi-square test and association of anaemia with independent variables was evaluated using logistic regression analysis. RESULTS: Out of the 406 participants, MP, IPs and MP/IP co-infection prevalences were 15.5%, 13.0% and 3.0% respectively. PLWH had a higher prevalence of MP (16.3%, P = 0.17), IPs (23.7%, P ˂ 0.001) and MP/IPs co-infection (3.7%, P = 0.04) when compared with HIV-negative participants. Similarly, PLWH had significantly lower mean haemoglobin value (11.10 ± 1.54 g/dL) than their HIV-negative counterparts (12.45 ± 2.06 g/dL). Also, PLWH co-infected with MP and IPs were observed to have a significantly lower mean haemoglobin value (10.6 ± 1.21 g/dL). PLWH had a significantly (P ˂ 0.001) higher prevalence of mild (56.8%), moderate (18.4%) and severe (1.6%) anaemia when compared with HIV-negative counterparts. The significant risk factors associated with anaemia included being febrile (P = 0.03), MP-infected only (P = 0.001), HIV-infected only (P < 0.001), having dual (P < 0.001) or triple-infections (P = 0.03). CONCLUSION: Malaria and intestinal parasites remain public health concerns among PLWH and anaemia as a serious haematological abnormality gets exacerbated even with the viral load suppression. Hence, routine medical check-ups among PLWH are recommended.

Burden of moderate to severe anaemia and severe stunting in children < 3 years in conflict-hit Mount Cameroon: a community based descriptive cross-sectional study.

BACKGROUND: Armed conflict is a significant social determinant of child health with nuanced effects. There is a dearth of knowledge on the public health issues facing vulnerable populations in conflict-stricken areas. The objective was to determine the prevalence and determinants of moderate to severe anaemia (MdSA) and severe stunting (SS) in children ≤3 years in conflict-hit Dibanda, Ekona and Muea in the Mount Cameroon area. METHODS: Haematological parameters were obtained using an automated haematology analyser while undernutrition indices standard deviation (SD) scores (z- scores), were computed based on the WHO growth reference curves for 649 children in a community based cross-sectional study in 2018. Binomial logistic regression models were used to evaluate the determinants of MdSA and SS against a set of predictor variables. RESULTS: Anaemia was prevalent in 84.0% (545) of the children with a majority having microcytic anaemia (59.3%). The prevalence of MdSA was 56.1% (364). Educational level of parents/caregiver (P <  0.001) and site (P = 0.043) had a significant negative effect on the occurrence of MdSA. Stunting, underweight and wasting occurred in 31.3, 13.1 and 6.3% of the children, respectively. Overall, SS was prevalent in 17.1% (111) of the children. The age groups (0.1-1.0 year, P = 0.042 and 1.1-2.0 years, P = 0.008), educational levels (no formal education, P <  0.001 and primary education P = 0.028) and SS (P = 0.035) were significant determinants of MdSA while MdSA (P = 0.035) was the only significant determinant of SS. On the contrary, age group 0.1-1 year (OR = 0.56, P = 0.043) and site (Dibanda, OR = 0.29, P = 0.001) demonstrated a significant protective effect against SS. CONCLUSIONS: Moderate to severe anaemia, severe stunting and wasting especially in children not breastfed at all are public health challenges in the conflict-hit area. There is a need for targeted intervention to control anaemia as well as increased awareness of exclusive breast feeding in conflict-hit areas to limit the burden of wasting and stunting.

Influence of malaria, soil-transmitted helminths and malnutrition on haemoglobin level among school-aged children in Muyuka, Southwest Cameroon: A cross-sectional study on outcomes.

BACKGROUND: The health of school-aged children (SAC) is often compromised by malaria parasitaemia (MP), soil-transmitted helminths (STH), and malnutrition in the tropics. The aim of this study was to determine the prevalence and influence of MP, STH and malnutrition on haemoglobin (Hb) levels as well as identify its predictors. METHODS: This cross-sectional study was carried out in SAC (4-14 years) in Owe, Mpundu and Meanja villages in Muyuka, Southwest Cameroon. Hb concentration was measured using a URIT-12 Hb meter while MP and STH were determined by Giemsa staining of blood films and Kato-Katz technique respectively. Anthropometric measures (weight, height and mid upper arm circumference (MUAC)) of malnutrition (z-scores of <-2 standard deviations below mean) were obtained by standard methods. Categorical and continuous variables were compared appropriately, and multiple linear regression model was used to determine predictors of Hb level. RESULTS: The prevalence of MP, STH, anaemia and malnutrition in the 401 SAC examined were 33.9%, 2.2%, 75.3% and 24.4% respectively. The prevalence of MP varied significantly with locality (P = 0.031). Stunting occurred commonly (23.7%) and was significantly higher in males (28.6%), children 11-14 years old (38.3%) and those of Meanja locality (47.4%) than their counterparts. Significantly higher prevalence of anaemia was observed in children of Meanja (89.5%) and those both MP positive and malnourished (86.2%). Moderate anaemia occurred commonly (60.6%) and children ≤6 years old had significantly (P = 0.034) higher prevalence (75.0%). Mean Hb level varied significantly (P = 0.004) with age and those ≤6 years old infected with MP had significantly (P = 0.022) lower values. Significant predictors of Hb levels were the MUAC (P <0.001) and the MP status (P = 0.035). Based on the Hb level (>11g/dL) and the absence of MP, STH and malnutrition, 13.7% of the SAC were considered as healthy. CONCLUSIONS: The health of a majority of SAC is compromised by malaria, helminthiasis, malnutrition and other conditions not investigated. Anaemia is of major public health concern hence, intervention programmes that integrate malaria control with improvement of educational levels especially on proper nutrition and health care practices are desirable.

Malaria parasite prevalence and Haematological parameters in HIV seropositive patients attending the regional hospital Limbe, Cameroon: a hospital-based cross-sectional study.

BACKGROUND: Malaria and the human immunodeficiency virus (HIV) infection constitute public health problems in Cameroon including the South West Region (SWR). This study determined the prevalence of malaria parasites and haematological abnormalities in HIV positive patients in Limbe, Cameroon from April-July 2014. METHODS: The study was cross-sectional and involved 411 participants who were administered structured questionnaires to record socio-demographic and clinical data. Three hundred and nine (309) HIV positive patients and one hundred and two (102) HIV negative individuals were examined clinically and venous blood collected for malaria parasite detection, HIV infection diagnosis and full blood count analysis. RESULTS: Overall malaria parasite prevalence was 14.1% (58/411). This prevalence was significantly higher (P <  0.001) in the HIV negative participants (33.3%, 34/102) compared to the HIV positive patients (7.8%, 24/309). Amongst HIV positive participants, malaria parasite prevalence was significantly higher in female patients (P = 0.003), febrile patients (P <  0.001), anaemic patients (P = 0.015) and in patients who were not on antiretroviral treatment (ART) (P = 0.03) when compared with their respective counterparts. Among the HIV negative group, though not significant, malaria parasite prevalence was higher in females, febrile and anaemic patients when compared with their respective counterparts. Overall anaemia prevalence was 52.1% (214/309) and was significantly higher (P = 0.004) in HIV positive patients (56%, 173) than in HIV negative participants (40.2%, 41). Malaria/HIV co-infected patients had a significantly lower mean value of Hb (P = 0.002), RBC (P = 0.002) and Hct (P = 0.001) when compared with HIV-infected patients. CONCLUSION: HIV negative participants had a higher prevalence of malaria parasites than their HIV positive counterparts. Anaemia prevalence was higher in HIV positive patients than in HIV negative participants. Malaria/HIV co-infected patients presented with more red blood cell abnormalities than HIV-infected patients.

Influence of infant feeding practices on the occurrence of malnutrition, malaria and anaemia in children ≤5 years in the Mount Cameroon area: A cross sectional study.

BACKGROUND: The objective of this study was to evaluate the influence of different infant feeding habits on the occurrence of malnutrition, Plasmodium falciparum parasitaemia and anaemia in children ≤5 years in the Mount Cameroon area. METHODOLOGY: A total of 1227 children ≤5 years of age were recruited in a descriptive cross-sectional study. Socio demographic data and information on the different infant feeding habits was obtained by the use of semi-structured questionnaire. Nutritional status was assessed by the use of anthropometric measurements. Plasmodium was detected by light microscopy and haemoglobin was measured by use of an auto-haematology analyser. Anaemia as well as its severity was classified based on WHO standards. The associations between variables were assessed using logistic regression analysis. RESULTS: The prevalence of exclusive breast feeding (EBF) was 22.6%, mixed feeding (MF) was 60.1% and those not breastfed (NBF) at all was 17.3%. The prevalence of malnutrition, P. falciparum parasitaemia and anaemia was 32.6%, 30.4% and 77.3% respectively. Children who had EBF had significantly lower (P <0.001) prevalence of malaria parasite (16.2%) than those NBF at all (61.3%). The prevalence of anaemia was significantly higher (P <0.001) in children who had MF (80.5%) while, severe and moderate anaemia was highest in those NBF at all (6.6%, 67.1% respectively; P = 0.029) than their counterparts. The significant predictors of anaemia were age group (P <0.001), marital status (P <0.001) and educational level of parent (P <0.001), that for malaria parasitaemia was infant feeding habit (MF: P< 0.001 and NBF: P <0.001) and malnutrition was age group (≤2 years: P <0.008 and 2.1-4.0 years: P = 0.028). CONCLUSION: The infant feeding habit significantly influenced the occurrence of malaria parasite infection and not malnutrition and anaemia, hence EBF should be encouraged in malaria endemic zones.

Prevalence and Risk Factors Associated with S. haematobium Egg Excretion during the Dry Season, Six Months following Mass Distribution of Praziquantel (PZQ) in 2017 in the Bafia Health Area, South West Region Cameroon: A Cross-Sectional Study.

BACKGROUND: A selective population mass drug administration of PZQ involving school-aged children was carried out in the Bafia Health Area in April 2017. This study investigated the prevalence, intensity, and factors associated with S. haematobium egg excretion in this foci during the dry season, six months after the chemotherapy campaign. METHODS: A cross-sectional study including 1001 consenting individuals (aged 3-62 years) was carried out in three localities (Ikata, Bafia, and Munyenge) in the Bafia Health Area between November 2017 and January 2018. Information on sociodemographic, stream usage, and contact behaviour was documented. Schistosoma haematobium ova in urine were detected using membrane filtration technique. RESULTS: The prevalence of S. haematobium egg excretion was 8% with a higher level recorded in Munyenge (13.2%) than Ikata (7.5%) and Bafia (2.8%). The difference was significant (p < 0.001). Equally, Munyenge had the highest infection intensity (36.36 range: 2-200) when compared with Ikata (16.25 range: 2-57) and Bafia (8.0 range: 0-8). Although the age group (5-15 years) was significantly (p < 0.001) associated with more exposure to infested water, this group was less likely (OR: 0.42 95% CI: 0.19-0.91) associated with S. haematobium egg excretion. The risk of egg excretion increased by 4.79 times (95% CI: 2.20-10.41) and 3.68 times (95% CI: 1.59-8.54) among residents in Munyenge and Ikata, respectively. Similarly, frequency to the stream (> thrice/day) was significantly higher (χ 2 = 58.73; p < 0.001) in Munyenge. Frequent contact (three visits/day) with stream correlated with highest odds of egg excretion (OR: 8.43 95% CI: 3.71-19.13). CONCLUSION: The prevalence of S. haematobium egg excretion was low during the dry season. This was most likely attributed to the preventive campaign with PZQ and may parallel low transmission potentials in infested waters during this period.

Concurrence of CareStart™ Malaria HRP2 RDT with microscopy in population screening for Plasmodium falciparum infection in the Mount Cameroon area: predictors for RDT positivity.

BACKGROUND: Malaria remains a diagnostic challenge in many endemic communities. Although rapid diagnostic tests (RDTs) are presently widely used for malaria diagnosis, there is a dearth of information on post-marketing surveillance on its efficacy in Cameroon. The present study evaluated the performance characteristics of CareStart™ Malaria HRP2 (histidine-rich protein 2) antigen (Ag) RDT in diagnosing Plasmodium falciparum infection in the Mount Cameroon area and predictors associated with RDT positivity. METHODS: The CareStart™ Malaria HRP2 Plasmodium falciparum (G0141) Ag RDT was evaluated in a cross-sectional community-based survey involving 491 children of both sexes aged 6 months to 14 years between April and May 2018. Malaria parasitaemia was confirmed by light microscopy. Sensitivity (Se), specificity (Sp), positive (PPV) and negative (NPV) predictive values of the RDT, and the corresponding accuracy and Kappa value (κ) were determined using microscopy as the gold standard. Haemoglobin (Hb) concentration was obtained using an auto-haematology analyser. Results were compared using the chi-square test and associations between predictor variables, and RDT results were assessed using logistic regression analysis. RESULTS: Microscopically confirmed malaria parasite prevalence was 27.7%, and geometric mean density was 187 parasites/µL of blood (range 70-1162). Se, Sp, PPV, NPV and accuracy were 82.4, 76.6, 57.4, 91.9 and 78.2%, respectively. Sensitivity depended on parasitaemia and reached 96.1% at densities ≥ 200 parasites/µL of blood. The accuracy of malaria parasitaemia (as assessed by the area under the receiver operating characteristic curve) to predict malaria by RDT was 75.4% (95% CI 70.6-80.1). The agreement between microscopy and RDT was moderate (κ = 0.52). RDT positivity was significantly associated with fever (P < 0.001), children less than 5 years (P = 0.02), history of fever within a month (P < 0.001) and anaemia (P = 0.002). CONCLUSION: The overall concurrence of CareStart™ Malaria HRP2 pf Ag RDT with microscopy in the detection of P. falciparum infection is moderate and is most useful at parasitaemia ≥ 200 parasites/µL of blood and presentation with fever. While RDT is effective as a diagnostic test for confirmation of clinical cases of malaria, its applications in population screening with a higher proportion of asymptomatic cases are limited.

Malaria parasitaemia, anaemia and malnutrition in children less than 15 years residing in different altitudes along the slope of Mount Cameroon: prevalence, intensity and risk factors.

BACKGROUND: Malaria, anaemia and malnutrition are frequently co-existing diseases that cause significant morbidity and mortality particularly among children. This study measured the prevalence, intensity and evaluated risk factors for malaria parasitaemia, anaemia and malnutrition among children living at low versus high altitude settings in the Mount Cameroon area. METHODS: A cross-sectional community based survey involving 828 children aged 6 months to 14 years was conducted between July and November 2017. Malaria parasitaemia was confirmed by light microscopy, haemoglobin concentration was measured using an auto haematology analyser, nutritional status was determined from the anthropometric measurements collected, and socioeconomic status related variables by the use of questionnaire. Anaemia and malnutrition were defined according to World Health Organization standards. Associations between predictor variables and primary outcomes were assessed using logistic regression analysis. RESULTS: Malaria parasite and anaemia were prevalent in 41.7% and 56.2% of the children, respectively while, malnutrition prevalence was 34.8% with wasting, underweight and stunting occurring in 25.7%, 19.9% and 23.7% of them respectively. Overall malaria parasite geometric mean density was 413/µL of blood (range 100-27,060). The odds of having malaria parasitaemia was highest in children 5-9 years of age [odd ratio (OR) = 1.69, P = 0.006], living in lowland (OR = 1.48, P = 0.008) as well as those whose domestic water was collected from an open source (streams/springs) (OR = 1.81, P = 0.005) than their counterparts. Being < 5 years (OR = 3.15, P = < 0.001) or 5-9 years (OR = 2.20, P < 0.001) of age, having malaria parasite (OR = 2.07, P = < 0.001) and fever in the past 2 days (OR = 1.52, P < 0.04) were identified as significant risk factors of anaemia while the age group < 5 years was the only significant risk (OR = 3.09, P = < 0.001) associated with malnutrition. CONCLUSION: While age specific attention should be given in the control of malaria (5-9 years), anaemia (< 10 years) and malnutrition (< 5 years), the existing malaria control programmes should be revised to integrate anaemia and malnutrition control strategies so as to improve upon the health of the children.

Efficacy and safety of praziquantel against Schistosoma haematobium in the Ikata-Likoko area of southwest Cameroon.

BACKGROUND: Schistosomiasis remains a parasitic infection of public health importance especially in Africa south of the Sahara including Cameroon. Chemotherapy using praziquantel has been the most effective and widespread control measure used. However, there are reports of reduced efficacy of the drug. The aim of this study was to assess the efficacy and safety of praziquantel against Schistosoma haematobium among infected individuals in the Ikata-Likoko area of southwest Cameroon. Following a baseline study, S. haematobium egg load was determined using the urine filtration technique and microscopy. Participants were treated with a unique dose of praziquantel of 40 mg/Kg body weight. A control test was carried out on the 42nd day post-treatment to determine the proportion of positive participants with viable eggs (cure rate) and the egg loads. The egg loads obtained during the control and at baseline were used to calculate the egg reduction rate (ERR) used as the main indicator of praziquantel efficacy according to the WHO, 2013 protocol. RESULTS: At baseline, the prevalence of S. haematobium was 34.3% (177/516). Out of these a total of 174 participants aged between 4 and 76 years were recruited into the study. A total of 130 participants came for follow up on day 42. Among them, 22.3% (29) were positive for eggs of S. haematobium but none of the eggs were viable giving a cure rate of 100%. The overall mean egg load per 10 mL (MEL/10 mL) of urine reduced from 31 (1-400) at baseline to 6.0 (1-35) on day 42. The overall ERR was reduced (80.3%). However, the efficacy was satisfactory (ERR ≥ 90%) in females, children ˂ 5 years, and some localities and for individuals with heavy infection intensity. Fifteen (8.6%) of the participants presented minor adverse events including abdominal disorders, headache and vomiting but did not last for more than 24 h. CONCLUSIONS: Treatment with praziquantel was efficacious and safe showing reduction in prevalence as well as mean egg load in some individuals with few adverse events recorded. The distribution of praziquantel in the area should be extended to other age groups and not just school-age children. A study with multiple drug doses and longer period of evaluation could reveal more information on praziquantel efficacy in the area.