Strengthening Maternal Death Surveillance Systems for Evidence-Based Decision Making in Sub-Saharan Africa: The Case of the Center Region in Cameroon.

BACKGROUND: The article seeks to document the experience of implementing Maternal Death Surveillance and Response (MDSR) in the Center Region of Cameroon. The paper raises awareness on the need for implementing MDSR, shares progress and lessons learned and reflects on the implications for public health practice. METHODS: A desk research involving the collection and analysis of secondary data using tables with specific themes in excel, following the review of existing resources at the Regional Delegation of Public Health-Center from the year 2016 to 2019. RESULTS: The findings depict the existence of MDSR policies and sub-regional committees. Although, the number of regional maternal death notifications increased from 19 to 188 deaths between 2016 and 2019, the implementation of death review recommendations was only estimated at 10% in 2019. While 66% of deaths occurred in Yaoundé, 72% of these were deaths reported to have occurred in tertiary institutions out of which 75% were attributed to late referrals. Hemorrhage constituted 70/144 (48.6%) of the known direct causes of death. Maternal death related co-factors such as the use of partograph during labor had a high non-response rate (84%) and represents a weakness in the data set. CONCLUSION AND GLOBAL HEALTH IMPLICATIONS: Across the board, stakeholder engagement towards MDSR was increased through continuous awareness-raising, dissemination of surveillance tools, the institutionalization of the District Health Information Software (DHIS 2) and the "No Name No Blame" policy. However, the reporting and investigation of deaths for informed decisions remain a daunting challenge. For a resource-scarce setting with limited access to blood banks, the application of life-saving cost-effective interventions such as the use of partographs and the institution of a functional referral system among health units is likely to curb the occurrence of deaths from hemorrhage and other underlying causes. The success of these will require a robust strengthening of the health system.

Clinical profile and factors associated with COVID-19 in Yaounde, Cameroon: A prospective cohort study.

BACKGROUND: A year after the COVID-19 pandemic started, there are still few scientific reports on COVID-19 in Africa. This study explores the clinical profiles and factors associated with COVID-19 in Cameroon. MATERIALS AND METHODS: In this prospective cohort study, we followed patients admitted for suspicion of COVID-19 at Djoungolo Hospital between 01st April and 31st July 2020. Patients were categorised by age groups and disease severity: mild (symptomatic without clinical signs of pneumonia), moderate (with clinical signs of pneumonia without respiratory distress) and severe cases (clinical signs of pneumonia and respiratory distress not requiring invasive ventilation). Demographic information and clinical features were summarised. Multivariable analysis was performed to predict risk. FINDINGS: A total of 313 patients were admitted during the study period; 259 were confirmed cases of COVID-19 by Polymerase Chain Reaction (PCR). Among the confirmed cases, the male group aged 40 to 49 years (13.9%) was predominant. Disease severity ranged from mild (26.2%; n = 68) to moderate (59%; n = 153) to severe (14.7%; n = 38); the case fatality rate was 1% (n = 4). Dysgusia (46%; n = 119) and hyposmia/anosmia (37.8%; n = 98) were common features of COVID-19. Nearly one-third of patients had comorbidities (29%; n = 53), of which hypertension was the most common (18.9%; n = 49). Participation in mass gatherings (Odds Ratio (OR) = 2.37; P = 0.03) and dysgusia (OR = 2.09, P = 0.02) were predictive of diagnosis of COVID-19. Age groups 60 to 69 (OR = 7.41; P = 0.0001), 50 to 59 (OR = 4.09; P = 0.03), 40 to 49 (OR = 4.54; P = 0.01), male gender (OR = 2.53; P = 0.04), diabetes (OR = 4.05; P = 0.01), HIV infection (OR = 5.57; P = 0.03), lung disease (OR = 6.29; P = 0.01), dyspnoea (OR = 3.70; P = 0.008) and fatigue (OR = 3.35; P = 0.02) significantly predicted COVID-19 severity. CONCLUSIONS: Most COVID-19 cases in this study were benign with low fatality. Age (40-70), male gender, HIV infection, lung disease, dyspnoea and fatigue are associated with severe COVID-19. Such findings may guide public health decision-making.

Evaluation of emergency obstetric and neonatal care services in Kumba Health District, Southwest region, Cameroon (2011-2014): a before-after study.

BACKGROUND: There is uncertainty regarding the status of emergency obstetric and neonatal care (EmONC) in the Cameroonian context where maternal and neonatal mortality are persistently high. This study sought to evaluate the coverage, functionality and quality of EmONC services in Kumba health district (KHD), the largest health district in Southwest Cameroon.. METHODS: A retrospective study of routine EmONC data for the periods 1 January 2011 to 31 December 2012 (when EmONC was being introduced) and 1 January 2013 to 31 December 2014 (when EmONC was fully instituted) was conducted. Coverage, functionality and quality of EmONC services were graded as per United Nations (UN) standards. Data was analysed using Epi-Info version 7 statistical software. RESULTS: Among the 31 health facilities in KHD, 12 (39%) had been delivering EmONC services. Three (25%) of these were geographically inaccessible Among the 9 facilities that were assessed, 4 facilities (44%) performed designated signal functions, with 2 being comprehensive (CEmONC) and 2 basic (BEmONC). These exceeded the required minimum of 2.8 EmONC facilities/500000, 0.6 CEmONC facilities/500000 and 2.2 BEmONC facilities/500000, with reference to an estimated KHD population of 265,071. The signal functions that were least likely to be performed were neonatal resuscitation, manual evacuation of retained products and use of anticonvulsants. In 2011-2012, the facilities performed 35% of expected deliveries. This dropped to 28% in 2013-2014. Caesarean sections as a proportion of expected deliveries remained very low: 1.5% in 2010-2011 and 3.6% in 2013-2014. In 2011-2012, met needs were 6.8% and increased to 7.3% in 2013-2014. Direct obstetric fatality rates increased from 8 to 11% (p = 0.64). Intrapartum and very early neonatal deaths increased from 4.% to 7 (p = 0.89). CONCLUSION: Major gaps were observed in the performance of signal functions as well as the quality and utilization of EmONC. While the results of this study seem to indicate the need to sustainably scale up the utilization of quality EmONC, the interpretations of our findings require consideration of improvements in reporting of mortality data associated with the introduction of EmONC as well as dynamics in country-specific maternal health policies and the potential influence of these policies on EmONC indicators.

Prevalence and factors associated with dysmenorrhea in women at child bearing age in the Dschang Health District, West-Cameroon.

INTRODUCTION: dysmenorrhea is a painful phenomenon at the pelvis region preceding or following menstruation. Dysmenorrhea accounts among the most frequent problem of women at child bearing age and affects 45% to 95% of them. According to the WHO, 16.8 to 81% of women are affected by dysmenorrhea. The present study was carried out at the Dschang Health District in order to determine the prevalence of dysmenorrhea and associated factors among women at child bearing age. METHODS: a transversal community-based study was carried out from March to June 2018. Information regarding socio-demographic features, prevalence, factors associated with the dysmenorrhea and the effect of dysmenorrhea on daily activities were collected using structured questionnaire and data were analyzed using Epi Info version 7.1.3.3 Software. RESULTS: a total of 637 women aged 12 to 50 years were interviewed in the present study. The mean body mass index was 25.94 with an average weight of 66.41 kilogram. Fifty six point twenty percent (56.20%) of participants had dysmenorrhea. From all risks factors fund only the normal body mass index (OR = 3.08, P-value = 0.01) having a significant association with the occurrence of dysmenorrhea. Daily activities were affected in 73.25% of participants dysmenorrheic and those who had some episodes of dysmenorrhea. CONCLUSION: the present study showed that more than a half of respondents were dysmenorrheic and several factors were associated with this pathology. This study also suggests that dysmenorrhea have a negative impact on the daily activities of women at child bearing age.

[Access to safe drinking water and sanitation: a case study at the district community, in Douala V (Cameroon)]. / Accès à l'eau potable et à l'assainissement: cas de la commune d'arrondissement de Douala V (Cameroun).

INTRODUCTION: Access to drinking water and sanitation has been a long-standing issue between many States. However, it represents a daily struggle for hundreds of thousands of city dwellers who live mainly in the developing countries. The government of Cameroon with the assistance of providers of funds have implemented strategies to make sanitation and access to safe drinking water a reality. We have therefore decided to assess sanitation and access to drinking water in Douala V sub division. METHOD: We conducted a cross-sectional descriptive study from May to June 2018. We used a two-stage random sampling. Data were collected using a questionnaire. The analysis was conducted using Epi Info Version 7.1.3.3. RESULTS: Our study shows that 22.47% of subjects discharged waters into the natural environment after use. Then, 65,55% (493/752) of households consumed borehole water; 53.69% of households rode between 1 to 5 km, 49.25% walked more than 15 minutes to collect water and 85,50% of households did not use a water treatment method. Only 14.49% of subjects used a water treatment method. No household used solar water disinfection (SODIS); 2/752 households (0.26%) had no latrine. Most of the households (54.52%; 410/752) discharged domestic wastes onto the street. CONCLUSION: The creation of decentralized units: the drillings, waste disposal systems and water treatment education to meet basic needs are essential.

[Knowledge, attitudes and practices of women of childbearing age with regards to cervical cancer preventive measures in the MIFI health district, Cameroon]. / Connaissances, attitudes et pratiques des femmes en âge de procréer du District de Santé de la Mifi sur la prévention du cancer du col de l'utérus, Cameroun.

INTRODUCTION: This study aims to describe knowledge, attitudes and practices of women of childbearing age with regards to cervical cancer preventive measures. METHODS: We conducted a cross-sectional descriptive study among women of childbearing age. Data were collected using a face to face questionnaire and were analyzed using Epi Info 7.1.3.3 software calculating a confidence interval of 95%. RESULTS: Our study highligts that 78.11%(464/594) of women were aware of the existence of cervical cancer. However 58.59% and 60.27% of women were not aware of any risk factor and preventive measure respectively. Only 7% of these women were aware of the existence of vaccine. With regard to their attitude, 31.31% (186/594) of women had already wished for information on cervical cancer preventive measures, 26.94% (160/594) had taken the initiative to undergo screening test and only 7.41% (44/594) had undergone screening test. Difficulty most commonly mentioned was the lack of information (69.82%) while the most commonly cited awareness-raising tools were the media (75.9%). CONCLUSION: Despite the good knowledge on the existence of cervical cancer, the level of information about risk factors and preventive measures remains weak. Awareness program should be focused on risk factors, preventive measures and on the implementation of screening campaigns. These informations can be used to improve planning approach to prevention.