Knowledge and Perceptions of Cervical Cancer Screening in Nhlambeni, Eswatini: Understanding Facilitators and Barriers for Prevention Interventions.

BACKGROUND: Cervical cancer (CC) is a leading cause of cancer mortality in Eswatini. Preventative programs are readily available at the primary health facilities. Recently, the Human Papilloma Virus (HPV) vaccine has been introduced targeting both in- and out-of-school girls ages between 9 and 14 years old. The government of Eswatini has integrated cervical cancer screening into existing services and health activities, especially in HIV clinics, however, the uptake of screening remains low. AIM: This study explored women's perceptions, knowledge, intervention strategies, facilitators and barriers to scaling up cervical cancer prevention in Nhlambeni community in Eswatini. METHODS: A qualitative approach was utilized for this study and key informant semi-structured interviews were conducted in November 2019. Purposive sampling was undertaken in this study and MAX QDA software was utilized for data analysis. RESULTS: In total, 19 key informants were enrolled, the participants were from public facilities 7(37%), non-governmental organization 9 (47%) and patients 3 (16%). The age range for participants was between 25 - 40 years. Five themes were inductive and deductive which included: current interventions that are targeted for cervical cancer screening, women's source of information about cervical cancer screening activities, what promotion strategies could increase cervical cancer screening, understanding about cervical cancer symptoms/diagnosis of cervical cancer and cultural beliefs and attitudes involved in cervical cancer screening activities. CONCLUSIONS: Despite limited knowledge of cervical cancer and misconceptions about screening, the concept of screening for prevention and providers' influence were motivators for participation in screening. Cervical cancer screen-and-treat programs should consider utilizing language that communicates the need for cervical cancer screening and treatment and utilize prevention concepts that may already be familiar to women living there. In order to enhance cervical cancer prevention initiatives, reduce the stigma associated with the disease, and boost cervical cancer screening rates, it is imperative that there be ongoing community education and engagement on cervical cancer, aimed at both men and women.

CONTEXTE: Le cancer du col de l'utérus (CCU) est une cause majeure de mortalité par cancer en Eswatini. Des programmes préventifs sont facilement disponibles dans les établissements de santé primaires. Récemment, le vaccin contre le virus du papillome humain (VPH) a été introduit, ciblant les filles scolarisées et non scolarisées âgées de 9 à 14 ans. Le gouvernement de l'Eswatini a intégré le dépistage du cancer du col de l'utérus dans les services existants et les activités de santé, notamment dans les cliniques VIH, mais l'adhésion au dépistage reste faible. OBJECTIF: Cette étude a exploré les perceptions des femmes, leurs connaissances, les stratégies d'intervention, les facilitateurs et les obstacles à la mise à l'échelle de la prévention du cancer du col de l'utérus dans la communauté de Nhlambeni en Eswatini. MÉTHODES: Une approche qualitative a été utilisée pour cette étude et des entretiens semi-structurés avec des informateurs clés ont été menés en novembre 2019. Un échantillonnage délibéré a été réalisé dans cette étude et le logiciel MAX QDA a été utilisé pour l'analyse des données. RÉSULTATS: Au total, 19 informateurs clés ont été enrôlés, provenant d'établissements publics (7, 37 %), d'organisations non gouvernementales (9, 47 %) et de patients (3, 16 %). La tranche d'âge des participants se situait entre 25 et 40 ans. Cinq thèmes, à la fois inductifs et déductifs, ont été identifiés, notamment : les interventions actuelles ciblées pour le dépistage du cancer du col de l'utérus, les sources d'information des femmes sur les activités de dépistage du cancer du col de l'utérus, les stratégies de promotion susceptibles d'augmenter le dépistage du cancer du col de l'utérus, la compréhension des symptômes du cancer du col de l'utérus/diagnostic du cancer du col de l'utérus et les croyances culturelles et attitudes impliquées dans les activités de dépistage du cancer du col de l'utérus. CONCLUSIONS: Malgré des connaissances limitées sur le cancer du col de l'utérus et des idées fausses sur le dépistage, le concept de dépistage préventif et l'influence des prestataires ont été des moteurs de la participation au dépistage. Les programmes de dépistage et de traitement du cancer du col de l'utérus devraient envisager d'utiliser un langage qui communique la nécessité du dépistage et du traitement du cancer du col de l'utérus et de mettre en œuvre des concepts de prévention qui peuvent déjà être familiers aux femmes vivant là-bas. Afin d'améliorer les initiatives de prévention du cancer du col de l'utérus, de réduire la stigmatisation associée à la maladie et d'augmenter les taux de dépistage du cancer du col de l'utérus, il est impératif de continuer à sensibiliser et à engager la communauté sur le cancer du col de l'utérus, à destination des hommes et des femmes. MOTS-CLÉS: Cancer du col de l'utérus, Dépistage, Connaissances, Interventions et perception.

COVID-19 impact on gender-based violence among women in South Africa during lockdown: a narrative review.

COVID-19, first detected in Wuhan, China, in December 2019, was declared a global pandemic by the WHO following the rapid spread of cases worldwide. The pandemic resulted in governments enforcing nationwide lockdowns, halting economic activities except for essential services. This review aims to explore the impact of the COVID-19 pandemic on gender-based violence (GBV) among women in South Africa. The literature search for this review was limited to African peer-reviewed articles and studies published in English between March 2020 and July 2021. EBSCOhost (PubMed, EBSCOhost, APA PsycArticles, APA PsychINFO, Academic Search Ultimate, Africa-Wide Information, Sociology Source Ultimate, CAB Abstracts, CINAHL with full text, and MEDLINE) electronic database platforms and the Google Scholar search engine and bibliographies of identified sources were used to identify studies that are included in the review. 82 studies were identified for this review and 18 were included in the synthesis. Multiple factors contributed to the surge in GBV cases in South Africa, including alcohol availability and consumption, job losses, financial dependence, psychological distress, and emotional imbalances. Effective intervention strategies are proposed, calling for more research to better understand women's experiences of GBV during the COVID-19 pandemic.

Knowledge of malaria prevention among pregnant women and non-pregnant mothers of children aged under 5 years in Ibadan, South West Nigeria.

BACKGROUND: Adequate knowledge of malaria prevention and control can help in reducing the growing burden of malaria among vulnerable groups, particularly pregnant women and children aged under 5 years living in malaria endemic settings. Similar studies have been conducted but with less focus on these vulnerable groups. This study assessed knowledge of malaria prevention and control among the pregnant women and non-pregnant mothers of children aged under 5 years in Ibadan, Oyo State, South West Nigeria. METHODS: In this cross sectional study, data on socio-demographic, clinical and knowledge on malaria prevention was collected using interviewer administered questionnaires from consenting study participants attending Adeoyo maternity hospital between May and November 2016. Data was described using percentages and compared across the two maternal groups in the study population. Knowledge scoring from collected data was computed using the variables on causes, symptoms and prevention of malaria and thereafter dichotomised. Multivariate analyses were used to assess the interactive effect of socio demographic and clinical characteristics with malaria knowledge. Level of statistical significance was set at p < 0.05. RESULTS: Of the 1373 women in the study, 59.6% (818) were pregnant women while 40.4% (555) were mothers of children aged under 5 years. The respondents mean age was 29 years ± 5.2. A considerable proportion of both the pregnant women (n = 494, 60.4%) and the non-pregnant mothers of children aged under 5 years (n = 254, 45.8%) did not have correct knowledge on malaria prevention measures based on our assessment threshold (p < 0.001). Having a tertiary level education was associated with better knowledge on malaria (4.20 ± 1.18, F = 16.80, p < 0.001). Multivariate analyses showed that marital status, educational attainment, gravidity, and HIV status were significantly associated with knowledge of malaria prevention and control. CONCLUSION: The findings indicate that socio-demographic factors such as marital and educational status greatly influence knowledge on malaria prevention and control measures. Key health stakeholders and authorities need to implement strategies and direct resources to improve the knowledge of mothers on malaria prevention and control. This would stem the tides of malaria related deaths among pregnant women and children aged under 5 years.

Malaria programme personnel's experiences, perceived barriers and facilitators to implementing malaria elimination strategy in South Africa.

BACKGROUND: South Africa has set an ambitious goal targeting to eliminate malaria by 2018, which is consistent with the United Nations Sustainable Development Goals' call to end the epidemic of malaria by 2030 across the globe. There are conflicting views regarding the feasibility of malaria elimination, and furthermore studies investigating malaria programme personnel's perspectives on strategy implementation are lacking. METHODS: The study was a cross-sectional survey conducted in 2014 through a face-to-face investigator-administered semi-structured questionnaire to all eligible and consenting malaria programme personnel (team leader to senior manager levels) in three malaria endemic provinces (KwaZulu-Natal, Mpumalanga, and Limpopo) of South Africa. RESULTS: The overall response rate was 88.6% (148/167) among all eligible malaria personnel. The mean age of participants was 47 years (SD 9.7, range 27-70), and the mean work experience of 19.4 years (SD 11.1, range 0-42). The majority were male (78.4%), and 66.9% had secondary level education. Awareness of the malaria elimination policy was high (99.3%), but 89% contended that they were never consulted when the policy was formulated and few had either seen (29.9%) or read (23%) the policy, either in full or in part. Having read the policy was positively associated with professional job designations (managers, EHPs and entomologists) (p = 0.010) and tertiary level education (p = 0.042). There was a sentiment that the policy was neither sufficiently disseminated to all key healthcare workers (76.4%) nor properly adapted (68.9%) for the local operational context in the elimination strategy. Most (89.1%) participants were not optimistic about eliminating malaria by 2018, as they viewed the elimination strategy in South Africa as too theoretical with unrealistic targets. Other identified barriers included inadequate resources (53.5%) and high cross-border movements (19.8%). CONCLUSIONS: Most participants were not positive that South Africa could achieve the malaria elimination goal by 2018, citing the high cross-border movements and lack of resources as key barriers. The National and relevant Provincial Departments of Health should consider investing more time and resources in further stakeholder engagement for more effective implementation of malaria elimination strategy in South Africa.

Mental health impact of COVID-19 on healthcare workers versus adults in Africa.

BACKGROUND: This review mapped the impact of the coronavirus disease 2019 (COVID-19) pandemic on the mental health of healthcare workers (HCWs) and the adult general population in Africa. AIM: The study focussed on anxiety, depression, post-traumatic stress disorder and suicide cases to determine the impact of COVID-19 on the mental health of the selected population. METHOD: A scoping review was conducted on relevant database and search engines. The search resulted in 143 studies. Five studies met the inclusion criteria for synthesis. RESULTS: Results indicated anxiety was more prevalent among HCWs as opposed to the adult general population, which was in the rise of suicide cases. Among HCWs, mental health was negatively impacted by the loss of their infected patients and concerns over infecting family members. The adult general population was impacted because of isolation and their fear of contracting the virus. CONCLUSION: The COVID-19 pandemic led to the increase of mental health issues among HCWs as evidenced by a high prevalence of anxiety compared to that of the adult general population. There was, however, a rise in depression and suicide cases among the adult general population.Contribution: This study will assist in adding more knowledge to build a robust and responsive strategy to mental health problems during and post-pandemics like COVID-19. Strategies that have appeared effective in combatting the impact of COVID-19 on mental health include support packages established for frontline HCWs such as social media online chat groups.

Chemical analysis and in vitro†UV-protection characteristics of clays traditionally used for sun protection in South Africa.

Clays have been used in southern Africa as photoprotectants by the indigenous people. Typically, two types of clay are used: one white in colour and the other red. In this work, the two clays were identified and characterized, and their in vitro SPF values measured. The clays afford a low SPF but offer broad-spectrum protection. No cutaneous side effects from the use of these clays are known. Further consideration should be given to the potential use of clays in sunscreen preparations.

Perceived Health System Challenges of Implementing Cross-Border Malaria Preventive Measures at Ports of Entry in KwaZulu-Natal.

Background: Cross-border movements, especially from a malaria-endemic neighbour, contribute to importation of malaria, as they provide favourable conditions for malaria transmission in the receiving country. In the KwaZulu-Natal (KZN) province of South Africa (SA), the uMkhanyakude district is one of the endemic malaria areas where the borders are characterised by frequent cross-border movements of travellers coming into the province, mostly from Mozambique. Many studies have suggested that regional efforts through the implementation of cross-border measures are needed in both the high- and low-endemic countries to effectively address imported malaria. The implementation of cross-border measures to prevent imported malaria has led to a significant decline in malaria cases in KZN and SA; however, those measures are subjected to various challenges. Objective: This study sought to determine the health system challenges of implementing cross-border preventive measures for imported malaria at the Kosi Bay, Kwaphuza and Golela ports of entry in KZN. Methods: This inquiry consisted of a mixed methods approach, of which the qualitative component is reported here. In-depth interviews were conducted with four purposively selected health officers working at the legal and illegal ports of entry of the KZN province. Data were coded manually and then analysed using thematic data and descriptive analyses. Results: This study identified operational and prevention challenges. The related operational challenges included travellers' non-disclosure and refusal, uncontrolled cross-border movements and poor coverage as well as shortage of staff. The prevention challenges included lack of novelty in the existing cross-border preventive measures, insecurity and illegal migration. Concerning travellers' non-disclosure and refusal to cooperate, these issues occur at the legal ports of entry of Kosi Bay and Golela, where travellers were less cooperative in disclosing their health-related information to health border officers. They were more eager to cross and attend to their business. The findings revealed a lack of new ideas in the existing cross-border measures for the prevention of imported malaria, which some scientists considered as the reason for the failure of the elimination efforts in SA. Because of the porous borders and the shortage of staff to cover all the uncontrolled entries, travellers constantly crossed without any hindrances. Porous borders exposed the people living at the border areas and travellers to insecurity, promoted criminal activities and encouraged illegal migration. Conclusion: Cross-border malaria preventive measures are meant to contribute to decreased travel-related disease. Failure to attain this purpose must be carefully examined and mitigation strategies implemented. The study revealed the challenges of implementing cross-border measures at the KZN ports of entry of Kosi Bay, Kwaphuza and Golela. The challenges occurred at the operational and prevention levels, which, if not effectively addressed, could impede the decrease of imported malaria in the malaria-endemic district of KZN and SA in general.

Effects of COVID-19 on malaria elimination initiatives in sub-Saharan Africa: a scoping review protocol.

INTRODUCTION: The occurrence of the COVID-19 pandemic significantly impacted health systems, resulting in varied outcomes of different variables in terms of health. Due to the nature of the causative organism that is spread mainly in the air, the disease rapidly spread to numerous countries, leading to a series of mitigation measures being proposed and implemented, including but not limited to travel restrictions, decongesting and in some instances closure of workplaces and schools and banning of social gatherings. This could have negatively impacted implementing strategies meant to ensure the effective management of malaria, hoping to eliminate it in different countries in sub-Saharan Africa (SSA). This review seeks to explore the effect of the COVID-19 pandemic on malaria elimination initiatives in SSA. METHODS AND ANALYSIS: An exploratory scoping review will be conducted on literature (searched using keywords and a search strategy) sources published in English on Web of Science, Cochrane Library, PUBMED, Dimensions, ProQuest, Scopus and African Journals Online. These would then be imported to Rayyan Software for screening for possible inclusion. The JBI Guidelines on Reviews, Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist would guide the data collection, extraction and analysis from the accessed literature. Furthermore, charting, trends and developing themes would ensure the findings are presented comprehensively and yet understandable. The data collection and analysis process leading to the final submission of a review paper to a journal will be conducted from September 2023 to February 2024. ETHICS AND DISSEMINATION: An application for ethical approval was lodged with the Health Sciences Research Ethics Committee at the University of the Free State in Bloemfontein, South Africa. This ethics committee granted ethics clearance (ethics number: UFS-HSD2022/1754). Results will be communicated through peer-reviewed publications, presentations, conferences, workshops and other means and forums to reach the critical stakeholders.

Community Health Worker programmes' integration into national health systems: Scoping review.

BACKGROUND: Community health worker (CHW) programmes, when adequately integrated into mainstream health systems, can provide a viable, affordable and sustainable path to strengthened health systems that better meets demands for improved child health, especially in resource-constrained settings. However, studies that report on how CHW programmes are integrated into respective health systems in sub-Saharan Africa (SSA) are missing. AIM: This review presents evidence on CHW programmes' integration into National Health Systems for improved health outcomes in SSA. SETTING: Sub-Saharan Africa. METHOD: Six CHW programmes representing three sub-Saharan regions (West, East, and Southern Africa) were purposively selected based on their deemed integration into respective National Health Systems. A database search of literature limited to the identified programmes was then conducted. Screening and literature selection was guided a scoping review framework. Abstracted data were synthesised and presented in a narrative form. RESULTS: A total of 42 publications met the inclusion criteria. Reviewed papers had an even focus on all six CHW programmes integration components. Although some similarities were observed, evidence of integration on most CHW programme integration components varied across countries. The linkage of CHW programmes to respective health systems runs across all reviewed countries. Some CHW programme components such as CHW recruitment, education and certification, service delivery, supervision, information management, and equipment and supplies are integrated into the health systems differently across the region. CONCLUSION: Different approaches to the integration of all the components depict complexity in the field of CHW programme integration in the region.Contribution: The study presents synthesized evidence on CHW programmes integration into national health systems in SSA.

Socio-economic predictors of uptake of malaria interventions among pregnant women and mothers of under 5 children in Oyo State, Nigeria: a cross-sectional study.

Introduction: socio-economic status (SES), especially for women, influence access to care. This study aimed to determine the relationship between SES and uptake of malaria intervention by pregnant women and non-pregnant mothers of children under 5 years old in Ibadan, Oyo state, Nigeria. Methods: this cross-sectional study was conducted at Adeoyo teaching hospital located in Ibadan, Nigeria. The hospital-based study population included consenting mothers. Data were collected using an interviewer-administered modified validated demographic health survey questionnaire. The statistical analysis involved both descriptive (mean, count, frequency) and inferential statistics (Chi-square, logistic regression). Level of statistical significance was set at 0.05. Results: mean age of the study´s total of 1373 respondents was 29 years (SD: 5.2). Of these, 60% (818) were pregnant. The non-pregnant mothers of children under five years old showed a significantly increased odds (OR: 7.55, 95% CI: 3.81, 14.93) for the uptake of malaria intervention. Within the low SES category, women aged 35 years and above were significantly less likely to utilize malaria intervention (OR=0.08; 95% CI: 0.01-0.46; p=0.005) compared to those younger. In the middle SES, women who have one or two children were 3.51 times more likely than women with three or more children to utilize malaria intervention (OR=3.51; 95% CI: 1.67-7.37; p=0.001). Conclusion: the findings provide evidence that age, maternal grouping, and parity within the SES category can significantly impact on uptake of malaria interventions. There is a need for strategies to boost the SES of women because they play significant roles in the wellbeing of members of the home.

Status of malaria and its implications for elimination in an endemic province of South Africa: retrospective analysis.

South Africa set a target to eliminate malaria by 2018. Kwa-Zulu-Natal (KZN) province was earmarked to reach the elimination goal first. However, recent evidence suggests that the province has not yet achieved the elimination goal. This study set out to assess the status of malaria in KZN province of South Africa and its implications for elimination. Using retrospective analysis, the study quantified and described 5 787 cases of malaria for the years 2010-2019 in KZN province of South Africa. Data on reported malaria cases were obtained from the Malaria Information System of the KZN Provincial Department of Health. More than 65% of the cases came from male patients aged 16 years and above. A high number of cases were reported in the years 2014, 2017 and 2018. More than 40% of the cases were imported from countries outside of South Africa. The study confirms an increase in malaria cases, especially during the elimination year. The imported malaria cases and other related factors pose a threat to achieving the elimination goal. The KZN province needs to strengthen elimination efforts, including strategies to prevent imported malaria cases to achieve the new elimination goal.

Knowledge, attitudes and practices of cervical cancer screening among rural women in KwaZulu-Natal, South Africa.

Introduction: cervical cancer continues to be a major cause of morbidity and mortality among women in the developing world. Despite the national cervical cancer screening programme, findings show low levels of knowledge and practices of cervical cancer screening among rural women in South Africa (SA). The purpose of this study was to determine the knowledge, attitudes and practices of cervical cancer screening among rural women in KwaZulu-Natal, SA. Methods: an observational cross-sectional study was performed. The study was conducted at three rural clinics. A systematic sampling technique was used to select 283 women, aged 18-65 years. Data were collected using a standardised structured self-administered questionnaire. Data were analysed using descriptive and analytic statistics. Results: findings showed a high level of awareness of cervical cancer (93.3%, n=264) and the Pap smear test (95.1%, n=269). Knowledge of cervical cancer-associated factors, symptoms, screening methods and treatment was poor (28.0%, n=79). An overwhelming majority (81.8%, n=231) displayed a positive attitude towards cervical cancer screening. The practice of cervical cancer screening was fairly good (66.8%, n=189). The results showed that socio-demographics were not statistically significantly associated with knowledge of cervical cancer and cervical cancer screening. Conclusion: despite the inadequate knowledge of women, attitudes towards cervical cancer and screening were generally positive. Health care practitioners are encouraged to focus not only on creating awareness but also on improving knowledge so as women will not only undergo screening but appreciate the importance of cervical cancer screening.

Prevalence of cervical abnormalities among rural women in KwaZulu-Natal, South Africa.

Introduction: despite the availability of screening facilities in South Africa, cervical cancer prevalence and mortality is still high. Most women present to the health facilities at an advanced stage of disease. This study aimed to determine the prevalence of cervical abnormalities using the revised Bethesda System among rural women in KwaZulu-Natal, South Africa. Methods: this was a cross-sectional descriptive study using a retrospective medical record review method to collect data on Pap smears from three rural clinics in KwaZulu-Natal. Clinical data and cytology reports were obtained for the years January 2016 to January 2019. Women aged 18-65 years were included. Results: of 246 randomly-selected medical records, 245 Pap smears were analysed. Half (47.8%) of the women were in the age group 30-44 years. HIV, as a risk factor, was found in 41.2% of the women. A total of 48.6% Pap smears were negative for malignancy. Of the 49.8% abnormal screened results, 25.7% women had low-grade squamous intraepithelial lesion, 13.9% high-grade squamous intraepithelial lesion (HSIL), 8.6% atypical squamous cells of undetermined significance, and 1.6% squamous cell carcinoma (SCC). All SCC cases were found in HIV-infected patients. HSIL and SCC were less common among patients younger than 30 years. Conclusion: this study´s results accentuate the importance of well-organised cervical screening programmes. Cervical screening, through Pap smears, is a useful, non-invasive and cost-effective method for early detection of pre-invasive lesions. Women, especially those over 30 years, should be educated on the importance of Pap smears and encouraged to uptake the test.

Capacity Development of Research Ethics Administrators: Scoping Review.

Capacity development of research ethics committees is generally limited to members, and seldom includes administrators. This study sought to map the capacity development efforts of research ethics administrators. A scoping review was conducted. The literature search yielded 92 potentially relevant records, and further screening yielded 22 studies. The 22 studies were extracted and synthesized; two studies spoke directly on administrators' capacity development, while the remaining 20 focused on the capacity development of committees or of committee members. The two studies which spoke directly on administrators reported about two capacity development efforts targeting administrators in Africa, namely the African Conference for Administrators of Research Ethics Committees, and the West African Bioethics Training Program.

A Survey to Determine the Capacity Development Needs of Research Ethics Committee Administrators in South Africa.

Most capacity development efforts for research ethics committees focus on committee members and little on ethics administrators. Increasing studies mandate the focus on administrators' capacity development needs to enable adequate and effective committee support. This study investigated current responsibilities, training requirements, and administrator role needs. An online cross-sectional survey was conducted among administrators from 62 National Health Research Ethics Council-registered research ethics committees in South Africa. In total, 36 administrators completed the questionnaire. Results show that, in addition to administration, they perform managerial, review process and guidance-advisory tasks. Nearly 49% indicated only having received informal research ethics-related training, not targeted formal training, with 81% of the informal training being through workshops. Research ethics administrators' responsibilities have evolved to complex tasks requiring targeted capacity development efforts.

Health systems strengthening through policy-level integration of community health worker programs into national health systems for improved health outcomes - scorecard metrics validation: A bifactor structural equation model approach.

Background: Subsequent to the demonstrated potential of community health workers (CHWs) in strengthening health systems to improve health outcomes, recent literature has defined context and guidelines for integrating CHW programs into mainstream health systems. However, quantitative measures for assessing the extent of CHW program integration into national health systems need to be developed. The purpose of this study was to validate a newly developed scale, Community Health Worker Program Integration Scorecard Metrics (CHWP-ISM), for assessing the degree of integration of CHW programs into national health systems in Sub-Saharan Africa (SSA). Methods: Data obtained through a pilot study involving a purposively selected sample of 41 participants selected from populations involved in CHW programs work in selected countries of SSA formed the basis of a 31-item bifactor model. Data were collected between June and December 2019. By applying a latent variable approach implemented with structural equation modeling, data analysis was mainly done using the R statistical environment, applying factor analysis procedures. Results: Dimensionality, construct validity, and the CHWP-ISM scale's internal consistency were assessed. Confirmatory factor analysis of the CHW-ISM bifactor model supported a co-occurring CHW integration general factor and six unique domain-specific factors. Both the comparative fit index (CFI) and Tucker-Lewis Index (TLI) fit indices were above 0.9, while the root mean square of the residuals (RMSR) was 0.02. Cronbach's alpha (α), Guttman 6 (Lambda 6), and Omega total (ωt) were above 0.8, indicating good scale reliability. Conclusion: Statistical significance of the bifactor model suggests that CHW integration has to be examined using factors that reflect a single common underlying integration construct, as well as factors that reflect unique variances for the identified six subject-specific domains. The validated CHWP-ISM could be useful to inform policy advisers, health systems, donors, non-governmental organizations, and other CHW program stakeholders with guidance on how to quantitatively assess the integration status of different components of CHW programs into respective critical functions of the health system. Improved integration could increase CHW program functionality, which could in turn strengthen the healthcare systems to improve health outcomes in the region.

Barriers towards the Prevention and Treatment of Malaria among Pregnant Women at the Nkwen Health Center Bamenda, Cameroon.

Malaria remains an important public health problem such that, assessing the challenges experienced among pregnant women (vulnerable) with the uptake of malaria prevention methods and treatment is pertinent. This hospital-based cross-sectional descriptive study that was carried out at a Medicalized Health Center in Nkwen, Cameroon, sought to assess the barriers to malaria prevention faced by 51 pregnant women who attended antenatal clinic (ANC). Over 88% of participants were 15-30 years old. All participants knew at least one symptom of malaria, with 20% of them confirmed to have taken intermittent preventive treatment in pregnancy (IPTp) and 53% reported using insecticide-treated bed net (ITN). Educating pregnant women and their spouses on the uptake of IPTp and the use of ITN is a key strategy to curb its high malaria morbidity and mortality rates.

Scorecard metrics for assessing the extent of integration of community health worker programmes into national health systems.

BACKGROUND: The effectiveness of community health workers (CHWs) in delivering community-based preventive services is often curtailed by inadequate or complete lack of integration of the CHW programmes into national health systems. Although literature has defined the context and guidelines for integrating CHW programmes into health systems, indicators to quantitatively assess the extent of integration are inadequately addressed. AIM: This article presents an integration scale - CHW Programme Integration Scorecard Metrics (CHWP-ISM) - for measuring the extent of CHW programme integration into national health systems. SETTING: Literature review and policy documents were focused on sub-Saharan Africa, while interview participants were drawn from six African countries. METHODS: A deductive-inductive approach to item and measurement scale development was employed. Information obtained from a combination of diverse literature sources, subject matter expert (SME) interviews and documentary abstraction from publicly available policy documents advised item generation for the proposed CHWP-ISM. The study qualitatively captured the sectoral CHW integration, thematically analysed the data and culminated in the quantitative integration metrics. RESULTS: Analysis of the responses from six SMEs and abstraction from policy documents resulted in the compilation of metrics with a total of 100 indicators for the CHWP-ISM scale that could be used to assess the level of CHW programmes integration into national health systems. The indicators were categorised along the six World Health Organization's (WHO) health systems building blocks. Subject matter expert responses corresponded well with abstracted results from the 18 country CHW programmes, indicating content validity. CONCLUSION: The proposed scorecard metrics can be used to quantitatively rate the extent of CHW programmes integration into health systems, in an attempt to strengthen health systems to improve health outcomes.

A Four-Year Hospital-Based Retrospective Study of the Predictors of Tuberculosis in People Living with HIV and Receiving Care at Bamenda Regional Hospital, Cameroon.

BACKGROUND: Tuberculosis (TB) and Human Immunodeficiency Virus (HIV) co-infections place immense burdens on healthcare systems with particularly diagnostic and therapeutic challenges. TB is high among opportunistic diseases and the most leading cause of death among patients with HIV/AIDS. HIV infection is the most-known risk factor for Mycobacterium tuberculosis infection and progression to active disease, which increases the risk of latent TB reactivation by 20-fold. We present a four-year descriptive analysis of TB in people living with HIV in the Bamenda Regional Hospital (BRH) from 2012-2016. METHODS: This was a hospital-based descriptive chart review. We conducted manual reviews of medical records of HIV/TB co-infected patients from June 2017-July 2017 at BRH's AIDS Treatment Centre, North West region of Cameroon. Socio-demographic and clinical characteristics of cases were captured using a pre-tested data collection sheet and analyzed with Statistical Package for Social Sciences (SPSS) software, version 25. RESULTS: Out of the 1078 HIV patients, 36.5% (393) of them were diagnosed with TB; 75% (808) of the People living with HIV (PLWHIV) were active; among the remaining 25%, 10.2% were bedridden, 13.0% were jobless, and 1.8% were retired. The greater proportion of the participants were females 65.5% (705). CONCLUSION AND GLOBAL HEALTH IMPLICATIONS: The baseline anemia, smoking tobacco, drinking alcohol, detectable (≥50copies/mL), CD4 count ≤ 200cells/µl and gender of the PLWHIV were associated with the incidence of TB. We recommend early diagnosis and treatment of anemia, modification of patient's lifestyle, and strengthening of immunization programs to reduce the risk of TB occurrence among HIV-infected people.

Prevalence of onchocerciasis, attitudes and practices and the treatment coverage after 15 years of mass drug administration with ivermectin in the Tombel Health District, Cameroon.

INTRODUCTION: Onchocerciasis is an infection caused by Onchocerca volvulus. It affects 37 million people of which 99% are in Africa. This study assessed the prevalence of onchocerciasis after 15 years of mass drug administration with ivermectin. METHODS: This was a population based cross sectional study. Questionnaires covering participants' identity and attitudes and practices of community respondents towards ivermectin were administered. The treatment coverage was obtained by review of records of mass drug administration from 1999 to 2015. The epidemiological evaluation of infection status was done by parasitological examination of skin snips and nodule palpation in individuals in five health areas of the district. RESULTS: A total of 400 participants were randomly selected. Of these, 56.0% were males, 62.0% single, 59.5% farmers and 98.0% Christians. Participants with good attitudes towards community directed treatment with ivermectin made up 80.5% while 47.8% of the participants had good practice. The highest treatment coverage achieved was 88.0% in 2010 while lowest was 57.0% in 2002. Less than 2% had microfilaria and 6.0% had nodules. There was no statistically significant difference in the prevalence of microfilaria with respect to age. There was a statistically significant difference in the distribution of nodules (χ2=73.6, p=0.001) among the different age groups. The greatest rate of infection (2.1%) was among farmers. CONCLUSION: This study showed that the prevalence reduced compared to other prevalence studies in Cameroon. The study area was hypo-endemic for onchocerciasis.