Availability, cost and affordability of essential cardiovascular disease medicines in the south west region of Cameroon: Preliminary findings from the Cameroon science for disease study.

BACKGROUND: More than 80% of premature deaths due to cardiovascular disease (CVD) occur in low- and middle-income countries. However, access to, and affordability of medications remain a challenge in these countries. OBJECTIVE: To assess the availability, cost and affordability of essential cardiovascular medicines in the South West region of Cameroon. METHODS: In an audit of 63 medicine outlets, twenty-six essential medicines were surveyed using the World Health Organisation (WHO) /Health Action International methodology. Availability, costs and the ratio of the median price to the international reference price were evaluated in public, confessional, private facility medicine outlets, and community pharmacies. Affordability was assessed by calculating the number of days' wages it will cost the lowest-paid unskilled government worker to purchase a month worth of chronic treatment. FINDINGS: Availability ranged from 25.3% (public facility outlets) to 49.2% (community pharmacies) for all medicines. This was higher in urban and semi-urban compared to rural outlets. Cost of medicines was highest in community pharmacies and lowest in public facility outlets. Aspirin, digoxin, furosemide, hydrochlorothiazide and nifedipine were affordable (cost a day's wage or less). Medicines for heart failure and dyslipidaemia (beta blockers, angiotensin converting enzyme inhibitors and statins) required 2-5 days and 6-13 days wages respectively for one month of chronic treatment. CONCLUSION: Overall availability of CVD essential medicines was lower than WHO recommendations, and medicines were largely unaffordable. While primary prevention is pivotal, improving availability and affordability of medicines especially for public facilities would provide additional benefit in curbing the CVD burden.

Late mortality after cardiac interventions over 10-year period in two Cameroonian government-owned hospitals.

BACKGROUND: Cardiac surgery is a growing activity in Sub-Saharan Africa, however, data related to long-term mortality are scarce. We aimed to analyze outcome data of cardiac interventions in two hospitals in Cameroon over 10 years' period. METHODS: we conducted a retrospective analytical and descriptive study at the Douala General Hospital and Yaoundé General Hospital. All patients operated between January 2007 and December 2017, or their families were contacted by phone between January and April 2018 for a free of charges medical examination. RESULTS: Of a total of 98 patients operated during the study period, 8 (8.2%) were lost to follow-up. Finally, 90 patients [49 (54.4%) women and 41 (45.6%)] men were included. The mean age was 49±22 years (range, 13-89 years). The surgical indications were valvular heart diseases in 37 (41.1%) cases, congenital heart diseases in 11 (12.2%) cases, chronic constrictive pericarditis in 4 (4.4%) cases, and intra cardiac tumor in 1 (1.1%) case. Valve replacement was the most common type of surgery carried out in 37 (41.1%) cases-mostly with mechanical prosthesis. Pacemaker-mostly dual-chambers were implanted in 36 (40.0%) patients. The median follow-up was 26 months. The overall late mortality was 5.7%, and the overall survival rates at 5 and 10 years were 95.5% and 94.4% respectively. The overall survival rates at 5 and 10 years for mechanical valve prosthesis were 93.3% and 90% respectively. The survival at 10 years was 100% for patients with bioprosthesis. The survival rates at 10 years were 94.1% and 100% respectively for dual and single chamber pacemaker. CONCLUSIONS: Long-term outcome of cardiac surgery in hospitals in Cameroon are acceptable with low mortality rate. However, outcome metrics beyond mortality should be implemented for a prospective data collection.

Prevalence and risk factors of peripheral artery disease in black Africans with HIV infection: a cross-sectional hospital-based study.

BACKGROUND: The prevalence of peripheral artery disease (PAD) is not well known among HIV-infected patients in Africa. The aim of this study was to determine the prevalence and associated risk factors of PAD among HIV-infected patients at the Douala General Hospital (DGH). METHODS: This was a cross-sectional descriptive and analytic study between November 2015 and April 2016. We recruited patients aged ≥21 years, diagnosed with HIV infection, and who were receiving care at the DGH. We collected sociodemographic data and past medical history of patients. We measured their ankle-brachial index (ABI). We defined PAD as an ABI <0.9. We also measured their fasting blood glucose and lipid profile. RESULTS: We recruited 144 patients for this study. The mean age was 46±9 years, and 72.2% were females. Of which, 89% were on antiretroviral treatment (ARV). Their mean CD4+ T lymphocytes count was 451±306 cells/mm3. Their mean ABI was 1.12±0.17 and 1.07±0.11, respectively, on the left and right legs (P>0.05). The prevalence of PAD was 6.9% (95% CI: 3.4-12.4), and 60% of patients with PAD were symptomatic. After adjusting for age, sex and ARV, ARV treatment was protective (aOR: 0.18, [95% CI: 0.04-0.82], P=0.034), while WHO stages III or IV was associated with PAD (aOR: 11.1, [95% CI: 2.19-55.92], P=0.004). CONCLUSION: The prevalence of PAD was not as high as expected in this group of patients with high cardiovascular risk infected with HIV. Advanced HIV disease was associated with PAD, while ARV was protective.

Effects of phloroglucinol on the active phase of labour (EPAL trial): a single blinded randomised controlled trial in a tertiary hospital in sub-Sahara Africa.

INTRODUCTION: One of the most recognized factors of maternal and neonatal outcome pertaining to the peripartum period is the duration of labour. Finding a drug that will decrease the duration of labour with no effects on mother and foetus will be welcomed. Thereby in this study we aimed to evaluate the effects of phloroglucinol on the duration of the active phase of labour. METHODS: We did a single blinded placebo controlled randomised 1:1 parallel designed superiority trial between January and June 2017 in Douala general hospital. Participants greater than 18 years with singleton uncomplicated pregnancy who consented following randomisation, were administered either 80mg/8ml intravenous phloroglucinol or 8ml of sterile water when in active labour. The primary outcome was the duration of labour. Modified intention to treat analysis was done with the level of significance set at a p value of 0.05. RESULTS: 122 participants received the intervention. The mean total duration labour in the treatment and placebo group were 216.8 ± 38.7 and 358.5 ± 65.8 respectively (p value = 0.243). The mean duration of the active phase of labour in the treatment and placebo group were 183.0±35.6 and 316.0±52.2 respectively (p value = 0.046). The mean rate of cervical dilatation in the treatment and placebo group were 2.1 ± 0.4 and 1.3 ± 0.4 respectively (p value = 0.322). There was no difference in maternal and foetal outcomes between the two groups. CONCLUSION: Phloroglucinol shortens the duration of active phase of labour by about 2 hours (42%). It is safe to mother and baby and does not cause adverse foetal or maternal outcomes.

Arterial stiffness in black African ancestry patients with chronic kidney disease living in Cameroon.

BACKGROUND: Increased aortic pulse wave velocity (PWV), a direct measure of arterial stiffness (AS) is an independent predictor of cardiovascular events (CVEs) in chronic kidney disease (CKD) patients. This study assessed the patterns of PWV among Cameroonian patients with CKD in whom that marker of early vascular aging has not been explored so far. METHODS: We enrolled 150 Black African patients (mean age: 52±15 years, 56.7% males) with CKD in a cross-sectional study conducted at Douala General Hospital, Douala, Cameroon. Sociodemographic, anthropometric and biologic variables, blood pressure (BP) and PWV were recorded in all participants. Estimated aortic PWV was measured using a Mobil-O-Graph automatic brachial oscillometric device. RESULTS: PWV increased with aging (P<0.0001), and PWV adjusted for age, sex, body mass index and mean arterial BP (MAP) was higher in non-dialysed (n=90) than in hemodialysed (n=60) patients, even in pre-dialysis: 8.5±2.0 vs. 7.9±1.4 m/s (P=0.026); and in post-dialysis: 8.5±2.0 vs. 7.8±1.5 m/s (P=0.008). The mean PWV of all study participants was 8.2±1.8 m/s, with 61.3% of patients having a PWV ≥8.2 m/s, indicative of subclinical damage to the aorta, which was more pronounced in non-dialysis (67.8%) than in hemodialysis (53.3%) patients (P=0.033). Multivariable analysis performed in all participants revealed that advanced age, MAP and tobacco use were independently associated with PWV (all P<0.05). CONCLUSIONS: Our findings suggest increased AS in Cameroonian CKD non-dialyzed as compared to dialyzed patients. Slower PWV in patients on maintenance hemodialysis suggests improvement of aortic distensibility following dialysis. However, further large-scale studies are needed to confirm our findings and to improve understanding of the underlying mechanisms of arterial stiffening in black African ancestry patients with CKD.

Late presentation to HIV/AIDS care at the Douala general hospital, Cameroon: its associated factors, and consequences.

BACKGROUND: The introduction of anti-retroviral treatment (ART) has significantly reduced mortality and morbidity associated with HIV/AIDS. While treatment at early stages of the disease is related to a better prognosis, late presentation (LP) to care is harmful to the infected person, the society and is more costly. We aimed to describe late presentation to HIV care, its associated factors and consequences in patients followed up in a tertiary hospital in Cameroon. METHODS: We retrospectively assessed patients' files between 1996 and 2014 at the Douala general hospital (DGH) HIV treatment centre. Late presentation (LP) to HIV care was defined as a CD4+ T cell count< 350 cells/mm3 or advanced clinical stages of the disease (WHO stages 3/4) at first presentation for care. We used logistic regression to study factors associated with late presentation and assessed occurrence of opportunistic infections and mortality at 3, 6 and 12 months after presentation to care. RESULTS: Of 1866 files studied, mean age was 40 (SD: 10) years, median CD4+ T cell count was 147 (IQR: 63-270) cells/mm3, 58.2% were at HIV clinical stages 3 and 4. The prevalence of late presentation to HIV care was 89.7% (95% CI: 88.2-91.0%) and remained above 80% from 1996 to 2014. Circumstances of diagnosis: prevention of mother to child transmission program/blood donation (OR = 0.16, 95% CI 0.10-0.29), having a positive partner (OR = 0.16, 95%CI = 0.10-0.26), and routine screening (OR = 0.13, 95%CI = 0.10-0.19) reduced the odds of presenting late compared to clinical suspicion. Students had lower odds of presenting late compared to people who had an employment (OR = 0.50, 95%CI = 0.26-0.98). Calendar time OR = 1.64, 95% CI = 1.08-2.48 for ≥2010 vs. < 2005) increased the odds of late presentation. Mortality and opportunistic infections prevalence remained significantly higher in late presenters at 3, 6 and 12 months than in early presenters. CONCLUSION: Late presentation to HIV care is very high at the DGH and is related to poor outcome. More screening and sensitization campaigns should be carried out in the population to diagnose the disease at an earlier stage.

Multiple cerebral infarction revealing Takayasu's disease: a case report in a 32-year-old man from Cameroon, sub-Saharan Africa.

This case suggests that young patients with few vascular risk factors, and who present with acute stroke syndrome involving more than one vascular territory should be screened for an inflammatory or infectious cause.

Clinical, echocardiographic, and therapeutic aspects of congenital heart diseases of children at Douala General Hospital: A cross-sectional study in sub-Saharan Africa.

INTRODUCTION: Cardiovascular diseases in pediatric pathologies have emerged in the recent years in sub-Saharan Africa (SSA), with congenital heart diseases (CHDs) being the most frequent. Unfortunately, their diagnosis is usually delayed, thereby increasing childhood morbidity and mortality. OBJECTIVES: Describe the clinical, echocardiographic, and therapeutic aspects of CHDs of children at Douala General Hospital. METHODS: We carried out a cross-sectional descriptive study over a 10-year period, from January 2006 to December 2015. Files and reports of cardiac ultrasounds of patients aged ≤ 15 years were reviewed. RESULTS: We reviewed the medical records of 1616 children, of which 370 (22.9%) had CHD. The age range was 1 day to 15 years, with a mean of 26 months. Heart murmur was the most frequent clinical sign, seen in 72.3% of the cases. CHD with left-to-right shunt was seen in 61.8%, with ventricular septal defect being the most common (29.8% of all cases). The second most common CHDs were those due to obstruction (20.4%), mainly pulmonary stenosis (19.6% of all cases). Cyanogenic CHDs accounted for 17.8% of cases, dominated by tetralogy of Fallot (7.4% of all cases). Indications for surgical treatment was found in 171 (46.2%) patients, but due to financial constraints, only 48 (28.1%) patients were operated. Among those who underwent surgery, 66.7% were operated abroad, and Humanitarian organizations financed the surgical management of 58.3% of those operated. CONCLUSIONS: CHDs are seen in one out of five children seen in the pediatric cardiology unit of our Hospital for suspected heart disease. Most cases are diagnosed late in life as toddlers. The rate of surgical correction remains low due to financial constraints, with most cases operated abroad with the assistance of Humanitarian organizations.

Prevalence and risk factors of chronic kidney disease in newly diagnosed and untreated hypertensive patients in cameroon: A cross-sectional study.

Chronic kidney disease (CKD) has emerged as a worldwide problem and is a major cause for comorbidity in hypertensive patients. In an attempt to enhance awareness and to help in establishing preventive measures and care, it is necessary to describe CKD among newly diagnosed and untreated hypertensive patients. We conducted a cross-sectional study to describe the characteristics of CKD among newly diagnosed, treatment naïve, hypertensive patients in four health-care centers in the city of Douala, Cameroon. Sociodemographic and biological data were collected and serum creatinine was measured by enzymatic - colorimetric methods. We calculated estimated glomerular filtration rate (eGFR) by the Modification of Diet in Renal Disease equation and described CKD as eGFR <60 mL/min/1.73 m2. Logistic regression was further used to develop early clues of association. We included 839 newly diagnosed hypertensive treatment naïve patients, among which 412 (49.1%) men. The mean [±standard deviation (SD)] age was 51 (±11) years and was higher among those with CKD. Seventy-six had a family history of hypertension and 65 were known diabetic patients. Mean (±SD) eGFR was 94.4 (±33.3) mL/min and the prevalence of CKD was 12.4% (104/839). From multivariate logistic regression, age >55 years [OR: 5.29 (3.33-8.42)], obesity [OR: 0.15 (0.10-0.26)], kalemia [OR: 1.33 (1.03-1.72)] were independently associated to CKD. CKD is a common condition in newly diagnosed and untreated hypertensive patients in Cameroon. Individuals with hypertension should be carefully evaluated for the presence of CKD, especially those with decreased GFR.

Malnutrition in patients admitted to the medical wards of the Douala General Hospital: a cross-sectional study.

BACKGROUND: Malnutrition is common in acutely ill patients occurring in 30-50% of hospitalized patients. Awareness and screening for malnutrition is lacking in most health institutions in sub-Saharan Africa. This study aimed at screening for malnutrition using anthropometric and laboratory indices in patients admitted to the internal medicine wards. METHODS: A cross-sectional study. We screened for malnutrition in 251 consecutive patients admitted from January to March 2013 in the internal medicine wards. Malnutrition defined as body mass index (BMI) less than 18.5 kg/m2 and/or mid upper arm circumference (MUAC) less than 22 cm in women and 23 cm in men. Weight loss greater than 10% in the last 6 months prior to admission, relevant laboratory data, diagnosis at discharge and length of hospital stay (LOS) were also recorded. RESULTS: Mean age was 47 (SD 16) years. 52.6% were male. Mean BMI was 24.44 (SD 5.79) kg/m2 and MUAC was 27.8 (SD 5.0) cm. Median LOS was 7 (IQR 5-12) days. 42.4% of patients reported weight loss greater than 10% in the 6 months before hospitalization. MUAC and BMI correlated significantly (r = 0.78; p < 0.0001) and malnutrition by the two methods showed moderate agreement (κ = 0.56; p < 0.0001). Using the two methods in combination, the prevalence of malnutrition was 19.34% (35/251). Blood albumin and hemoglobin were significantly lower in malnourished patients. Malnourished patients had a significantly longer LOS (p = 0.019) when compared to those with no malnutrition. Malnutrition was most common amongst patients with malignancy. CONCLUSION: Malnutrition is common in patients admitted to the medical wards of the Douala General Hospital. Nutritional screening and assessment should be integrated in the care package of all admitted patients.

Glucose homeostasis abnormalities among Cameroon patients with newly diagnosed hypertension.

The authors assessed the frequency of glucose homeostasis abnormalities among 839 Cameroonians with newly diagnosed hypertension (mean age: 50.8±11 years; 49.9% female) in a cross-sectional survey conducted at the Douala General Hospital, Douala, Cameroon. In all participants, blood pressure, fasting plasma glucose (FPG), and lipids were recorded. Impaired fasting glycemia was described as an FPG level between 100 and 125 mg/dL and provisional diabetes as an FPG level ≥126 mg/dL. The FPG was 101±30 mg/dL. The overall proportion of abnormal glucose homeostasis was 38.3%, while 7.7% of patients (n=65) had known diabetes. A total of 23.7% (n=199) had impaired fasting glycemia and 6.8% (n=57) had provisional diabetes. Multivariable logistic regression revealed that male sex (odds ratio [OR], 1.53; 95% confidence interval [CI], 1.15-2.06), age older than 55 years (OR, 1.55; 95% CI, 1.15-2.09), and low-density lipoprotein cholesterol >1 g/L (OR, 1.34; 95% CI, 1.00-1.82) were independently associated with abnormal glucose homeostasis (all P<.05). Glucose homeostasis abnormalities are highly prevalent among Cameroonian patients with newly diagnosed hypertension.

Outcome of permanent vascular access for haemodialysis in patients with end-stage renal disease in Cameroon: results from the pilot experience of the Douala general hospital.

Background Chronic Kidney disease is a major health problem in the world. Native arteriovenous Fistula (AVF) is well established as the best vascular access for haemodialysis. Little is known about the outcome of AVF in sub-Saharan Africa. We aim to analyze the outcome of patients undergoing AVF creation during the pilot program established at the Douala general hospital (DGH). Method This was hospital-based, longitudinal study with a retrospective phase (April 2010-January 2014) and a prospective phase (January 2014-April 2014). All consecutive patients operated for AVF creation were included in this study. Socio-demographics data, functionality, and complications were analyzed. Results Eighty-one patients including 52 men were enrolled in this study (49 prospectively and 32 retrospectively). The mean age was 52, 3 years (range 18-81 years). Hypertension (66, 7%), diabetes (17, 3%), and HIV (8, 6%) were the most observed co-morbidities. About 96.3% of AVF were native and 3.7% were prosthetic graft. Radiocephalic AVF was performed at a rate of 77.8%. The primary function rate was 97.7% and the mean follow-up period 43.4 weeks. The overall rate of complications was 44.4% of whom 30.5% were early, 30.5% secondary, and 39% lasted. The treatment of these complications was conservative in 48.7% of cases. Conclusions The results of the pilot program of AVF creation at the DGH are encouraging. However, the sustainability of this project requires human capacity building.

Prevalence and factors associated with hyperuricaemia in newly diagnosed and untreated hypertensives in a sub-Saharan African setting.

BACKGROUND: Few studies have evaluated the link between hyperuricaemia and cardiovascular disease in sub-Saharan Africa. AIMS: To assess the prevalence of and factors associated with hyperuricaemia among newly diagnosed treatment-naïve hypertensive patients in sub-Saharan Africa. METHODS: We performed a community-based cross-sectional study from January to December 2012 in Douala, Cameroon (Central Africa). We enrolled newly diagnosed treatment-naïve hypertensive patients, and excluded those with gout or a history of gout. Serum uric acid concentrations were measured by enzymatic colourimetric methods, and hyperuricaemia was defined as a serum uric acid concentration>70IU/mL. Fasting blood sugar concentrations, serum creatinine concentrations and lipid profiles were also measured. Logistic regression was used to study factors associated with hyperuricaemia. RESULTS: We included 839 newly diagnosed treatment-naïve hypertensive patients (427 women and 412 men; mean age 51±11 years; mean serum uric acid concentration 60.5±16.5IU/L). The prevalence of hyperuricaemia was 31.8% (95% confidence interval [CI] 28.7-34.9) and did not differ by sex (132 women vs. 135 men; P=0.56). Multivariable logistic regression identified age>55 years (adjusted odds ratio [AOR] 1.65, 95% CI 1.12-2.29), family history of hypertension (AOR 1.65, 95% CI 1.01-2.67), waist circumference>102cm in men or>88cm in women (AOR 1.60, 95% CI 1.12-2.29), low-density lipoprotein cholesterol>1g/L (AOR 1.33, 95% CI 0.97-1.82) and triglycerides>1.5g/L (AOR 1.63, 95% CI 1.01-2.65) as independently associated with hyperuricaemia. CONCLUSION: Hyperuricaemia is common among newly diagnosed treatment-naïve hypertensive patients in sub-Saharan Africa and is associated with some components of the metabolic syndrome.

Hyperuricaemia in patients with type 2 diabetes in a tertiary healthcare centre in sub-Saharan Africa: prevalence and determinants.

Hyperuricaemia in type 2 diabetes mellitus (T2DM) has been less well investigated in sub-Saharan Africans. Our study of 438 patients found that alcohol intake, body mass index ≥25 kg/m2, hydrochlorothiazide use, statin use, diabetic retinopathy and glomerular filtration rate <60 mL/min/1.73m2 were independently positively associated with hyperuricaemia; whereas smoking reduced this risk. Hyperuricaemia is strongly associated with some modifiable factors, diabetic complications and certain drugs. Our results suggest that further studies should evaluate the potential cost-benefit of screening for hyperuricaemia in type 2 diabetes.

The way forward for clinical research in Cameroon: first scientific and research day in Douala, 2014.

There is a huge need for health research to support contextually relevant health service and policy solutions to better the health of populations in sub-Saharan Africa. This need contrasts with the very timid engagement of healthcare practitioners in research in the region.It is against this background that the Douala General Hospital (a tertiary-care hospital in Cameroon), under the stewardship of its chief executive officer, organised the first annual scientific and research day in October 2014. This maiden event saw the participation of local research leaders and the eminent director of the South African Hatter Institute for Cardiovascular Research in Africa, who co-chaired the event. The aim was to educate students, clinicians and junior researchers on the importance of clinical research and evidence-based medicine around the leading theme of the event: action for clinical research and good medical practice.Several abstracts were presented, covering various aspects of medicine, including cardiology, rheumatology, paediatrics, pulmonology, HIV medicine, and obstetrics and gynaecology, together with key lectures on cardiac disease and pregnancy, and plenary sessions on research methodology, scientific writing and publishing. It is hoped that this event will enhance clinical research and the dissemination of research findings to improve evidence-based clinical practice in the country.

Bacterial reservoirs in a health care environment: case of the Douala general Hospital, Cameroon

Background:Health care acquired infections are a major cause of morbidity and mortality in hospitals. There is very little documentation of this important problem in our resource limited setting. The aim of our study was to identify bacterial reservoirs and microorganisms with the potential of nosocomial infections in our health care environment Methods:Bacteriological samples from the air; surfaces; equipment; personnel and patients from six units of the Douala General Hospital; Cameroon were collected for culture according to standardised collection; culture and germs identification techniques. of all collected samples were contaminated with pathogenic bacteria. These included 83.3 of air samples and 100; 54.1and 48.7of specimens respectively. The same bacteria found on the hands of nursing personnel were same as on both surfaces and equipment. The intensive care and neonatal units were the most contaminated with 100 positive cultures. The sterilization unit was bacteria free

Tuberculous meningitis: presentation, diagnosis and outcome in hiv-infected patients at the douala general hospital, cameroon: a cross sectional study.

INTRODUCTION: Tuberculous meningitis (TBM) the most fatal presentation of tuberculosis (TB) especially in HIV-infected patients is a real diagnostic and therapeutic challenge worldwide. In Cameroon where HIV and TB are amongst the leading public health problems, the magnitude of TBM has not been defined. Therefore, the objective of this cross sectional study was to describe the presentation and in-hospital outcome of TBM among HIV patients in Douala as well as its diagnostic difficulties. METHODS: We did a clinical case note analysis of all HIV-1 infected patients treated for TBM in the Internal medicine unit of the Douala General Hospital, between January 1st 2004 and December 31st 2009. The diagnosis of TBM was made using clinical, laboratory [cerebrospinal fluid (CSF) analysis] and/or brain computerised tomographic (CT) scan features. RESULTS: During the study period, 8% (54/672) of HIV-infected patients had TBM. Their mean age was 40.3 ± 12.7 years. The main presenting complaint was headache in 74.1% (40/54) of patients. Their median CD4 cell count was 16 cells/mm3 (IQR: 10 - 34). CSF analysis showed median protein levels of 1.7 g/l (IQR: 1.3 - 2.2), median glucose level of 0.4 g/l (IQR: 0.3 - 0.5) and median white cell count (WCC) count of 21 cells/ml (IQR: 12 - 45) of which mononuclear cells were predominant in 74% of CSF. Acid fast bacilli were found in 1.9% (1/54) of CSF samples. On CT scan hydrocephalus was the main finding in 70.6% (24/34) of patients. In hospital case fatality was 79.6% (43/54). CONCLUSION: TBM is a common complication in HIV-infected patients in Douala with high case fatality. Its presumptive diagnosis reposes mostly on CSF analysis, so clinicians caring for HIV patients should not hesitate to do lumbar taps in the presence of symptoms of central nervous system disease.

Toxoplasma encephalitis in HIV/AIDS patients admitted to the Douala general hospital between 2004 and 2009: a cross sectional study.

BACKGROUND: It is estimated that about a third of the world's population is chronically infected with Toxoplasma gondii. Toxoplasma encephalitis (TE), which occurs as a reactivation of quiescent chronic infection, is one of the leading causes of central nervous system (CNS) infection in AIDS. Its diagnosis in most centres still remains difficult. We opted to describe the clinical and radiological features of TE as well as in-hospital outcome and its associated factors. METHODS: We carried out a cross sectional study on the clinical case notes of adult patients admitted and treated for TE at the Douala General Hospital, Cameroon between January 1st 2004 to December 31st 2009. RESULTS: Of 672 patients admitted during the study period, 14.4% (97/672) had TE. The mean age was 36.9 ± 14.1 years and the median CD4 cell count was 68/mm3 (IQR): 43 - 103). Headache and fever were the most common presenting symptoms in 92.8% (90/97) and 87.6% (85/97) of patients. Annular contrast enhanced lesions were the most common brain scan finding in 81.4% (79/97) of patients. In-hospital mortality was 29.9% (29/97). Altered sensorium, presence of focal signs, neck stiffness and low CD4 cell count were factors associated with mortality. Adjusting for low CD4 count, altered sensorium remained strongly associated with fatality, adjusted odd ratio (AOR) 3.5 (95% CI 1.2 - 10.5). CONCLUSION: Toxoplasma encephalitis is common among AIDS patients in Douala. Its high case fatality warrants adequate and compliant prophylactic therapy in severely immune depressed patients as well as early initiation of antiretroviral therapy in HIV-infected patients.

HIV-Associated Central Nervous System Disease in Patients Admitted at the Douala General Hospital between 2004 and 2009: A Retrospective Study.

Background. Studies on HIV-associated central nervous system (CNS) diseases in Cameroon are rare. The aim of this study was to describe the clinical presentation, identify aetiological factors, and determine predictors of mortality in HIV patients with CNS disease. Methods. From January 1, 2004 and December 31, 2009, we did at the Douala General Hospital a clinical case note review of 672 admitted adult (age ≥ 18 years) HIV-1 patients, and 44.6% (300/672) of whom were diagnosed and treated for HIV-associated CNS disease. Results. The mean age of the study population was 38.1 ± 13.5 years, and median CD4 count was 49 cells/mm(3) (interquartile range (QR): 17-90). The most common clinical presentations were headache (83%), focal signs (40.6%), and fever (37.7%). Toxoplasma encephalitis and cryptococcal meningitis were the leading aetiologies of HIV-associated CNS disease in 32.3% and 25% of patients, respectively. Overall mortality was 49%. Primary central nervous system lymphoma (PCNSL) and bacterial meningitis had the highest case fatality rates of 100% followed by tuberculous meningitis (79.8%). Low CD4 count was an independent predictor of fatality (AOR: 3.2, 95%CI: 2.0-5.2). Conclusions. HIV-associated CNS disease is common in Douala. CNS symptoms in HIV patients need urgent investigation because of their association with diseases of high case fatality.

HIV-associated sensory neuropathy in HIV-1 infected patients at the Douala General Hospital in Cameroon: a cross-sectional study.

BACKGROUND: Peripheral neuropathy (PN) which is the most common neurological complication of HIV infection is under recognised and undertreated especially in resource limited settings. This ailment which has a negative impact on the quality of life of HIV/AIDS patients exists in different clinical patterns of which HIV-associated Sensory neuropathy (HIV-SN) is the most common affecting up to two thirds of patients with advanced disease in some settings. In Cameroon where HIV is a major public health problem, the burden of HIV-SN has not yet been well defined. METHODS: Using the Brief Peripheral Neuropathy Screening (BPNS) tool validated by the AIDS Clinical Trial Group (ACTG) we carried out a cross sectional study to determine the prevalence of HIV-SN and its associated factors among HIV-1 patients at the Douala General Hospital between 1st July and 31st October 2011. HIV-SN was defined as the presence of neuropathic symptoms and at least an abnormal perception of vibrations of a 128Hz tuning fork on the great toe or abnormal ankle reflexes or both and expressed as a percentage of the study population. RESULTS: Out of 295 patients studied, 21% had HIV-SN. In HIV-SN patients the median duration of HIV infection was 79.8 months (IQR 46 - 107.5) and their median CD4 count 153cells/µL (IQR 80 - 280). Patient recall and clinical chart review showed that, 83.9% had neuropathic symptoms prior to HAART initiation and 16.1% after HAART initiation. Low CD4 count, history of alcohol intake and history of anti-tuberculosis treatment were strongly associated with HIV-SN (AOR 2.5, 2.8 and 2.9 respectively). CONCLUSIONS: HIV-SN is common among patients with advanced HIV infection in Cameroon. This simple diagnostic tool (BPNS) should therefore be routinely used to detect those with HIV-SN or at risk so as to minimise the negative impact it has on their quality of life.