MosquirixTM malaria vaccine: an evaluation of patients' willingness to pay in Cameroon.

OBJECTIVES: The purpose of this study was to determine the average price that a patient living in Cameroon would be willing to pay for the MosquirixTM vaccine and the factors influencing the proposed price. STUDY DESIGN: Cross-sectional study Methods: Data were collected using a semi-open questionnaire in 5 hospitals in Cameroon. This study included all persons over 18 years who came for consultation in one of the 5 selected hospitals during the study period (from 02th to 14th April 2018 and from 02th to 22th July 2018). The factors associated with the price of the vaccine proposed by the patient were determined by linear multiple regression analysis. The average price was determined based on the patient's income and the percentage of that income proposed for the purchase of the vaccine. RESULTS: We collected data from 1,187 participants aged 18 to 80 years. The average price that Cameroonian patients were willing to pay for the MosquirixTM vaccine was 1,514±475 XAF (2.3±0.73 Euro). The minimum and maximum purchase price of the vaccine were 1,178 XAF (1.8 Euro) and 1,850 XAF (2.8 Euro) respectively. We also noted that patients were willing to spend an average of 1.34% of their income on the vaccine. This percentage of income was significantly (lt;0.001) associated with the respondents' income, the fact that they had been consulted at least once for malaria in the 12 months preceding the survey (lt;0.001) and the fact that the respondent had at least one under- five year child (lt;0.001). CONCLUSION: Factors associated with the average price are elements that should be strongly considered by policy makers to introduce this vaccine in Cameroon. This pilot study can serve as a framework for a potential national population-based study.

Impact and projections of the COVID-19 epidemic on attendance and routine vaccinations at a pediatric referral hospital in Cameroon.

BACKGROUND: At the beginning of March 2020, Cameroon experienced its first cases of infection with the new coronavirus (SARS-COV-2). Very quickly, there was a drop in the rate of hospital attendance. The purpose of this study was to observe the variations in the uptake of pediatric consultations and vaccinations in a pediatric hospital. METHODS: A descriptive and retrospective cross-sectional study was carried out using consultation and vaccination statistics from a pediatric hospital in the city of Yaoundé, political capital of Cameroon, from January 2016 to May 2020. Data were entered in Microsoft Excel and exported to R software (Version 3.3.3) for statistical analysis. First, time series raw data (before and after COVID-19) were plotted and the trend estimated by locally weighted scatterplot smoothing (LOWESS) methods. Then a classic seasonal decomposition was performed to distinguish between seasonal trends and irregular components using moving averages. The Webel-Ollech overall seasonality test (WO test) was also run to formally check for seasonality. The results of the study are presented as narrative tables and graphs. RESULTS: Following the partial confinement recommended by the government of Cameroon, the number of pediatric consultations decreased by 52% in April and by 34% in May 2020 compared with rates during the same periods in 2019 (P=0.00001). For antenatal visits, the rates dropped by 45% and 34%, respectively, in April and May 2020 compared with 2019. The demand for immunization services also declined. As a result, the demand for BCG vaccines, third-dose tracer vaccines (diphtheria, tetanus, pertussis), polio, and MMR in children as well as tetanus vaccines in childbearing women dropped significantly. CONCLUSION: The start of the COVID-19 pandemic was accompanied by a significant drop in consultation and vaccination activities. If no action is taken to correct this phenomenon, the ensuing months could be marked by a considerable increase in patients, sometimes suffering from vaccine-preventable diseases. The death rate could increase considerably in the pediatric population.

Asthme et déjections de chauves souris au quartier Bastos de Yaoundé

OBJECTIFS: Une enquête au sein des populations de ce quartier de Yaoundé a révélé en 2009 une prévalence de 36% de signes de l'asthme parmi ses habitants (crises dyspnéiques paroxystiques, rhinites, éternuements, sifflement respiratoire). Ce quartier est densément peuplé de chauves-souris. Le but de notre étude est d'une part de confirmer le taux élevé de l'asthme par une épreuve fonctionnelle simple et de rechercher d'autre part d'éventuels rapports entre l'asthme et les chauves-souris dont les fèces polluent l'environnement immédiat. MÉTHODES Il s'agit d'une enquête basée sur la mesure du DEP (Débit Expiratoire de Pointe) à l'aide du peakflowmètre de Wright. Deux quartiers, Bastos et Ngousso ont été revisités comme en 2009. Une épreuve de peakflowmétrie a été réalisée dans les 2 quartiers (Bastos peuplé de chauve-souris et ayant présenté le plus de signes d'asthme: 36% en 1999). Le quartier Ngousso, non peuplé de chauves-souris, n'a présenté que 2,4% de signes d'asthme en 1999. Cinquante sujets ont été sélectionnés avec leur consentement dans chacun des 2 quartiers pour l'épreuve de peakflowmétrie. La fourchette d'âges pour nos 2 échantillons a ciblé des sujets de 15 à 75 ans. Ce choix était basé sur la capacité de bien exécuter 2 tests peakflowmétriques. Le premier suivi d'une inhalation de 3 bouffées de salbutamol, puis le second 5 minutes plus tard. RÉSULTATS: 45 habitants sur les 50 de Bastos (90%) reconnaissent la présence des chauves-souris dans leur quartier. Seulement 2 de Ngousso (4%) ont pu le faire. Il existe une différence sur ce fait entre les 2 quartiers (p<0.0001). 35 habitants de Bastos (70%) savent reconnaître les déjections de chauves-souris contre (2%) à Ngousso. cette connaissance est significativement différente dans les 2 quartiers (p<0.0001). La variation du DEP (Débit Expiratoire de Pointe) a été franche chez 16 sujets de Bastos versus 2 asthmatiques connus de Ngousso. La prévalence de l'asthme est de 32% à Bastos versus 4% à Ngousso (p<0.0001). CONCLUSION: La prévalence de l'asthme est plus élevée dans le quartier Bastos densément peuplé de chauves-souris. La pollution de l'environnement par les déjections disséminées des chauves-souris autour des habitations y jouerait un rôle. Les déjections de chauves-souris seraient un facteur favorisant de l'asthme. Elles constituent depuis le guano, un milieu favorable de culture des champignons où pousse principalement Mycoplasma capsulatum qui est très allergisant et connu comme facteur déclenchant. Les acariens qui sont une cause bien connue de l'asthme sont également véhiculés par les chauves-souris qui s'infestent depuis leurs fientes en milieu humide. Une étude plus étroite reliant la présence des chauves-souris dans la maison (plafond par exemple) et l'asthme devra être envisagée pour plus de pertinence de notre observation

Potential of Spirulina Platensis as a Nutritional Supplement in Malnourished HIV-Infected Adults in Sub-Saharan Africa: A Randomised, Single-Blind Study.

BACKGROUND: Malnutrition is a major global public health issue and its impact on communities and individuals is more dramatic in Sub-Saharan Africa, where it is compounded by widespread poverty and generalized high prevalence of human immunodeficiency virus (HIV). Therefore, malnutrition should be addressed through a multisectorial approach, and malnourished individuals should have access to nutritional rehabilitation molecules that are affordable, accessible, rich in nutrient and efficient. We thus assessed the efficacy of two affordable and accessible nutritional supplements, spirulina platensis versus soya beans among malnourished HIV-infected adults. METHODS: Undernourished patients, naïve of, but eligible to antiretroviral treatment (ART), aged 18 to 35 years were enrolled and randomly assigned to two groups. The first group received spirulina (Group A) as food supplement and the second received soya beans (Group B). Patients were initiated ART simultaneously with supplements. Food supplements were auto-administered daily, the quantity being calculated according to weight to provide 1.5 g/kg body weight of proteins with 25% from supplements (spirulina and soya beans). Patients were monitored at baseline and followed-up during twelve weeks for anthropometric parameters, body composition, haemoglobin and serum albumin, CD4 count and viral load. RESULTS: Fifty-two patients were enrolled (Group A: 26 and Group B: 26). The mean age was 26.4 ± 4.9 years (Group A) and 28.7 ± 4.8 (Group B) with no significant difference between groups (P = 0.10). After 12 weeks, weight and BMI significantly improved in both groups (P < 0.001 within each group). The mean gain in weight and BMI in Group A and B were 4.8 vs. 6.5 kg, (P = 0.68) and 1.3 vs. 1.90 Kg/m(2), (P = 0.82) respectively. In terms of body composition, fat free mass (FFM) did not significantly increase within each group (40.5 vs. 42.2 Kg, P = 0.56 for Group A; 39.2 vs. 39.0 Kg, P = 0.22 for Group B). But when compared between the two groups at the end of the trial, FFM was significantly higher in the spirulina group (42.2 vs. 39.0 Kg, P = 0.01). The haemoglobin level rose significantly within groups (P < 0.001 for each group) with no difference between groups (P = 0.77). Serum albumin level did not increase significantly within groups (P < 0.90 vs. P < 0.82) with no difference between groups (P = 0.39). The increase in CD4 cell count within groups was significant (P < 0.01 in both groups), with a significantly higher CD4 count in the spirulina group compared to subjects on soya beans at the end of the study (P = 0.02). Within each group, HIV viral load significantly reduced at the end of the study (P < 0.001 and P = 0.04 for spirulina and soya beans groups respectively). Between the groups, the viral load was similar at baseline but significantly reduced in the spirulina group at the end of the study (P = 0.02). CONCLUSION: We therefore conclude in this preliminary study, firstly, that both spirulina and soja improve on nutritional status of malnourished HIV-infected patients but in terms of quality of nutritional improvement, subjects on spirulina were better off than subjects on soya beans. Secondly, nutritional rehabilitation improves on immune status with a consequent drop in viral load but further investigations on the antiviral effects of this alga and its clinical implications are strongly needed.