[Access to the management of HIV infected children: Overview of the healthcare supply in Cameroon in 2014]. / Accès à la prise en charge de l'infection VIH pédiatrique ­ État des lieux de l'offre des soins au Cameroun en 2014.

BACKGROUND: In Cameroon in 2012, the proportion (15%) of children eligible for antiretroviral treatment (ART) was one of the lowest among the 21 Global Fund priority countries. The objective of this study was to carry out a situational analysis of the existing care offer for pediatric HIV in Cameroon. METHODS: A descriptive cross-sectional study was conducted over a 4-month period (April to August 2014) in 12 healthcare facilities in 7 regions of Cameroon selected by systematic sampling. The data were collected in a self-administered questionnaire filled out by the caregiving and administrative personnel included in the study. RESULTS: All in all, 142 persons in charge of pediatric HIV treatment were included in the study, of whom 115 were working at the operational level: 59 (51.2%) health personnel, 44 (38.3%) community agents and 12 (10.4%) department heads; the other 27 exercised responsibilities at the regional (19) and the local (8) levels. An overwhelming majority of the caregivers involved in pediatric VIH treatment were nurses, a factor necessitating the delegation of medical tasks institutionalized in Cameroon. Few standardized nationwide documents take into account these treatment modalities. Inadequate dissemination of the documents at all levels of the healthcare pyramid may justify the non-compliance with the care protocols that has been observed in the training programs dedicated to the subject. CONCLUSION: The updating and large-scale dissemination of standardized nationwide documents taking into account the specificities of HIV-infected children are required to improve implementation at the operational level of the Cameroonian healthcare system of the existing guidelines for pediatric HIV treatment.

Epidemiology of malignant hemopathies recorded in hospitals in Cameroon.

Data about malignant blood diseases are sparse in Cameroon. Their epidemiology was studied in patients at the General Hospital of Douala (GHD) and the Yaoundé Central Hospital (CHY) from 2004 through 2014. The variables we studied were social and demographic (age, sex, occupation, marital status), clinical (reasons for consultation, clinical signs, year of diagnosis), and biological (blood count, myelogram and blood smear, immunophenotyping, biopsy, and cytogenetics). In all, 4409 files were reviewed and 454 cases identified, documented and confirmed (248 in GHD and 206 in CHY). The prevalence of malignant blood diseases was 10.4%. The patients' mean age was 44.3 ± 19 [range : 1-80] years and the M/F sex ratio 1.4/1. In 32.2% of the cases, the patient consulted because of a tumor. The most frequent malignant blood diseases, in decreasing order, were non-Hodgkin's lymphoma (31.1%), chronic myeloid leukemia (21.4%), chronic lymphoid leukemia (12.6%), multiple myeloma (11.2%), acute lymphoblastic leukemia (7.4%), and acute myeloblastic leukemia (6.4%). Their incidence by age group showed that acute lymphoblastic leukemia was most common among children (20%), and chronic myeloid leukemia among young adults (28.9%). The main hemogram abnormalities were anemia (73.7%), hyperleukocytosis (57.3%), and thrombopenia (39.2%). Various types of malignant blood diseases thus exist in the hospital environment in Cameroon, and their forms are underdiagnosed.

[Molecular markers of Plasmodium falciparum drug resistance]. / Marqueurs moléculaires des résistances de Plasmodium falciparum aux antipaludiques.

The main Plasmodium falciparum genes known to be associated with drug resistance are pfcrt, pfmdr1, pfdhfr pfdhps, pfcytb, pfmrp, pfnhe1, pfmdt, pfserca and pftetQ. Molecular markers for resistance to chloroquine, amodiaquine, mefloquine, sulfadoxine-pyrimethamine, cycloguanil and atovaquone have been validated and used to predict the parasitological and clinical efficacy of these drugs (i.e. based on in vivo tests). These molecular markers have numerous advantages. They allow evaluation of large series of samples in less time than in vivo tests. Collection, transport and storage of samples are much easier than for in vitro tests. These markers can be used for epidemiological monitoring of resistance for an entire country as well as for prediction of therapeutic outcome for a single individual. Development of high-throughput molecular biology techniques, availability of the nucleotidic sequences of P. falciparum genomes, and close collaboration between fundamental researcher workers, clinical practitioners, and officials in charge of the national malaria control programs are major assets in the research and development of molecular markers for P. falciparum resistance to antimalarial drugs.

[Distinguishing Plasmodium falciparum populations for clinical research]. / Distinguer les populations de Plasmodium falciparum en recherche clinique.

The genetic diversity of Plasmodium falciparum is generally high. Study of this diversity is useful to differentiate the strains present in an individual before and after malaria treatment or to check if several individuals have been infected by the same parasites. Interpretation of the in vivo test recommended by the WHO to evaluate antimalarial drug efficacy requires distinguishing recrudescence from new infection when recurrent parasitemia suggests the possibility of therapeutic failure and antimalaria resistance. For this purpose, molecular biology techniques such as nested-PCRs are becoming increasingly available and can now be used in most endemic areas. An effort has been made to standardize P. falciparum genotyping carried out to distinguish recrudescence from new infection. Standardization has focused not only on genotyping methods but also on interpretation criteria. Compliance with these recommendations should improve the quality of clinical research and allow comparison of data from different centers.