The faces behind vaccination: unpacking the attitudes, knowledge, and practices of staff of Cameroon's Expanded program on Immunization.

BACKGROUND: Immunization is regarded as one of the most cost-effective public health interventions in global health. However, its cost-effectiveness depends greatly on the knowledge and skills of vaccinators. With the growing complexity of immunization programs, the need for a well-trained vaccination workforce cannot be overemphasized. In this study, we assessed the knowledge, attitudes, and practices among vaccination staff in Cameroon. METHODS: Through a descriptive cross-sectional design, we used structured questionnaires and observation guides to collect data from vaccination staff in health facilities that were selected by a multistage sampling method. Data were analyzed using STATA 13 software. RESULTS: Overall, we collected data from Expanded Program on Immunization focal staff in 265 health facilities across 68 health districts. Over half (53%) of the surveyed facilities were found in rural areas. Nearly two-thirds of health facilities had immunization focal staff with knowledge gaps for each of the four basic immunization indicators assessed. In other words, only 37% of staff knew how to estimate coverages, 36% knew how to inteprete the EPI monitoring curve, 35% knew how to prepare vaccine orders, and 37% knew how to estimate vaccine wastage. In terms of practices, staff waited for more than ten children to be present before opening a 20-dose vaccine vial in 63% of health facilities, and more than five children to be present before opening a 10-dose vaccine vial in 80% of surveyed facilities. Provision of vaccine-specific information (informing caregiver about vaccine received, explanation of benefits and potential side effects) during immunization sessions was suboptimal for the most part. CONCLUSION: This study suggests marked deficits in immunization knowledge among vaccination staff and exposes common attitudes and practices that could contribute to missed opportunities for vaccination and hinder vaccination coverage and equity in Cameroon. Our findings highlight the urgent need to invest in comprehensive capacity building of vaccination staff in Cameroon, especially now that the immunization program is becoming increasingly complex.

Assessment of immunization data management practices in Cameroon: unveiling potential barriers to immunization data quality.

BACKGROUND: One crucial obstacle to attaining universal immunization coverage in Sub-Saharan Africa is the paucity of timely and high-quality data. This challenge, in part, stems from the fact that many frontline immunization staff in this part of the world are commonly overburdened with multiple data-related responsibilities that often compete with their clinical tasks, which in turn could affect their data collection practices. This study assessed the data management practices of immunization staff and unveiled potential barriers impacting immunization data quality in Cameroon. METHODS: A descriptive cross-sectional study was conducted, involving health districts and health facilities in all 10 regions in Cameroon selected by a multi-stage sampling scheme. Structured questionnaires and observation checklists were used to collect data from Expanded Program of Immunization (EPI) staff, and data were analyzed using STATA VERSION 13.0 (StataCorp LP. 2015. College Station, TX). RESULTS: A total of 265 facilities in 68 health districts were assessed. There was limited availability of some data recording tools like vaccination cards (43%), maintenance registers (8%), and stock cards (57%) in most health facilities. Core data collection tools were incompletely filled in a significant proportion of facilities (37% for registers and 81% for tally sheets). Almost every health facility (89%) did not adhere to the recommendation of filling tally sheets during vaccination; the filling was instead done either before (51% of facilities) or after (25% of facilities) vaccinating several children. Moreso, about 8% of facilities did not collect data on vaccine administration. About a third of facilities did not collect data on stock levels (35%), vaccine storage temperatures (21%), and vaccine wastage (39%). CONCLUSION: Our findings unveil important gaps in data collection practices at the facility level that could adversely affect Cameroon's immunization data quality. It highlights the urgent need for systematic capacity building of frontline immunization staff on data management capacity, standardizing data management processes, and building systems that ensure constant availability of data recording tools at the facility level.

Prevalence and factors associated with overweight and obesity in selected health areas in a rural health district in Cameroon: a cross-sectional analysis.

BACKGROUND: Overweight and obesity are major public health problems worldwide, with projections suggesting a proportional increase in the number of affected individuals in developing countries by the year 2030. Evidence-based preventive strategies are needed to reduce the burden of overweight and obesity in developing countries. We assessed the prevalence of, and factors associated with overweight and obesity in selected health areas in West Cameroon. METHODS: Data were collected from a community-based cross-sectional study, involving the consecutive recruitment of participants aged 18 years or older. Overweight and obesity were defined according to the WHO classification. The statistical software R (version 3.5.1, The R Foundation for statistical computing, Vienna, Austria) was used for statistical analysis. Multivariable logistic regression analysis was used to assess independent factors associated with overweight and obesity, and obesity. RESULTS: Records of 485 participants were included for analysis. The age and sex-standardized prevalence of overweight, obesity, and overweight and obesity were 31.1% (95% CI, 27.0-35.2), 18.9% (95% CI, 14.9-22.9), and 50.1% (95% CI, 45.7-54.6), respectively. In multivariable analysis, being female (adjusted OR [aOR] = 2.79, 95% CI = 1.69-4.63), married (aOR = 3.90, 95% CI = 2.23-6.95), and having secondary or tertiary education (aOR = 3.27, 95% CI = 1.77-6.17) were associated with higher odds of overweight and obesity, while current smokers had lower odds of overweight and obesity (aOR = 0.37, 95% CI = 0.16-0.82) when compared to their respective counterpart. Compared to their respective reference categories, being female being (aOR = 3.74, 95% CI = 2.01-7.30), married (aOR = 2.58, 95% CI = 1.37-5.05) and having secondary or tertiary education (aOR = 2.03, 95% CI = 1.00-4.23) were associated with higher odds of obesity after adjustments for confounding. CONCLUSION: We observed a high prevalence of overweight and obesity in this study. The odds of overweight and obesity was higher in females, married participants, and those with higher levels of education. Community-based interventions to control overweight and obesity should consider targeting these groups.

Chronic kidney disease in Cameroon: a scoping review.

OBJECTIVES: This scoping review sought to summarize available data on the prevalence, associated factors, etiology, comorbidities, treatment, cost and mortality of chronic kidney disease (CKD) in Cameroon. METHODS: We searched PubMed, Scopus and African Journals Online from database inception to 31 March, 2020 to identify all studies published on the prevalence, associated factors, etiology, comorbidities, treatment, cost and mortality of CKD in Cameroon. RESULTS: Thirty studies were included. The prevalence of CKD varied from 3 to 14.1 and 10.0%-14.2% in rural and urban areas, respectively. The prevalence of CKD in patients with hypertension, diabetes mellitus, and human immunodeficiency virus was 12.4-50.0, 18.5%, and 3.0-47.2%, respectively. Hypertension (22.3-59.1%), chronic glomerulonephritis (15.8-56.2%), and diabetes mellitus (15.8-56.2%) were the most common causes of CKD. The cause was unknown in 13.5-17.0% of the cases. Advanced age, hypertension, diabetes mellitus, and obesity were frequent associated factors. Hemodialysis was the main treatment modality in patients with End Stage Renal Disease (ESRD). The monthly cost of management of non-dialyzed CKD was 163 US dollars. The one-year mortality rate of ESRD was 26.8-38.6%. CONCLUSION: Chronic kidney disease affects about one in 10 adults in the general population in Cameroon. Patients with hypertension, diabetes mellitus, and human immunodeficiency virus bear the greatest burden of CKD in Cameroon. Advanced age, hypertension, diabetes mellitus, and obesity are major factors associated with CKD. Chronic kidney disease in Cameroon is associated with high morbidity and mortality and huge economic cost on the patient.

Mortality analysis of burns in a developing country: a CAMEROONIAN experience.

BACKGROUND: Burns are a serious public health problem worldwide accounting for an estimated 265,000 deaths annually from fires alone. The vast majority (96%) of deaths from fire-related burns occur in low- and middle-income countries and burns are one of the leading causes of disability-adjusted life-years (DALYs) in the developing world. Most burn centres are situated in large cities and are inadequate for the high incidence of injuries. An 8 year review of 440 patients in the Douala General Hospital, showed that the majority of patients burned were males (n = 281, 68.9%), the mean age was 25.2 ± 17.77 years with an admission rate of 69.5% (306 patients). The modal and median age were 31.0 years and 25.0 years respectively, interquartile range (0.4-82). Majority of burns (n = 237, 53.9%) had burn surface area ≥ 10%, most burns were 2nd degree (n = 215, 48.9) and the commonest burn agents were flames (n = 170, 37.3%), electricity (n = 119, 26.3%) and water (n = 114, 25.2%). The paucity of data on burn mortality in Cameroon motivated this study and is aimed at determining the mortality rate, causes and factors associated with death of burnt patients in the burn unit of the Douala General Hospital (DGH). METHODS: It was a retrospective observational study carried out from the 1st of January 2008 to the 31st of December 2015 in the Burn Unit of the Douala General Hospital. An adapted questionnaire was used to collect demographic data, burn agents, burn depth; diagnostic delay, burn surface area, complications, comorbidity, mortality and its causes. Data was transferred to Microsoft Excel 2015 and the Statistical Package for Social Sciences (SPSS) version 20.0 for data analysis. RESULTS: During this 8 year period, 440 patients were studied and the mortality rate was 23.4% (103 patients). The fatal burn agents were, flames (n = 69, 67.0%), electricity (n = 15, 14.6%), water (n = 12, 11.6%), contact (n = 4, 3.9%), Oil (n = 2, 1.9%) and chemicals (n = 1, 1.0%). The causes of death were shock (n = 36, 35.0%), sepsis (n = 25, 24.3%), acute respiratory distress (n = 25, 24.3%), acute renal failure (n = 6, 5.8%), severe anaemia (n = 4, 3.9%) and unrecorded causes (n = 7, 6.7%). CONCLUSION: A quarter of all patients died mostly from flame burns and to a lesser extent, electricity and scalds. Increase in burn depth and burn surface area worsened the prognosis. Shock (the commonest cause of death), sepsis, acute respiratory distress, acute renal failure and wound infection were significantly associated with mortality.

Obesity and postoperative outcomes of the patients with laparoscopic adrenalectomy: a systematic review and meta-analysis.

BACKGROUND: Studies have suggested differences in postoperative outcomes between patients with obesity and those without following adrenalectomy, but these remained to be ascertained with synthesis of available evidence. The aim of this systematic review and meta-analysis was to investigate the association between obesity and outcomes of patients after laparoscopic adrenalectomy. METHODS: We searched EMBASE, PubMed, Global Index Medicus, and Web of Science, without language restriction, to identify cohort studies published between January 1, 2000 and November 6, 2019. We considered studies with data comparing outcomes of adults with and without obesity after laparoscopic adrenalectomy. Random-effects meta-analysis was used to pool study-specific estimates. This review was registered with PROSPERO, CRD42018117070. RESULTS: Five studies with data on a pooled sample of 353 patients with obesity and 828 without were included in the meta-analysis. The risk of bias was moderate to low. We found no association between obesity and the various stages of postoperative complications: Clavien-Dindo grade 1 (OR = 1.57; 95%CI = 0.55-4.48; I2 = 44.6%), grade 2 (OR = 1.12; 95%CI = 0.54-2.32; I2 = 0.0%), grade 3 (OR = 1.79; 95%CI = 0.58-5.47; I2 = 0.0%;), grade 4 (OR = 0.43; 95%CI = 0.05-3.71; I2 = 0.0%), and grade 5 (death) (OR = 0.43; 95% CI = 0.02-14.31). Furthermore, no association was found between obesity and readmission rates (OR = 0.7; 95% CI = 0.13-3.62) and conversion of laparoscopic to open surgery (OR = 0.62; 95% CI = 0.16-2.34; I2 = 19.5%). CONCLUSIONS: This study suggests that obesity is not associated with complications following laparoscopic adrenalectomy. This meta-analysis might have been underpowered to detect a true association between obesity and patient outcome after laparoscopic adrenalectomy due to the small number of included studies. Larger studies are needed to clarify the role of obesity in patients undergoing laparoscopic adrenalectomy.

Factors Associated with the Prevalence of Cognitive Impairment in a Rural Elderly Cameroonian Population: A Community-Based Study in Sub-Saharan Africa.

BACKGROUND/AIMS: With rising elderly populations, age-related health problems such as cognitive impairment and dementia are major public health concerns. We sought to assess the prevalence of cognitive impairment and associated factors in rural elderly Cameroonians. METHODS: The Mini Mental State Examination was used to assess the cognitive function of participants randomly recruited during a house-to-house survey of the Batibo Health District. RESULTS: The prevalence of cognitive impairment in our study was 33.3%. Increasing age, female gender, being single, a lack of formal education, and higher systolic blood pressure values were significantly and independently associated with cognitive impairment. CONCLUSION: The identification of modifiable factors would inform evidence-based policy to decrease the health and social burdens of cognitive impairment and dementia in the elderly in rural Cameroon.

Grand multiparity in rural Cameroon: prevalence and adverse maternal and fetal delivery outcomes.

BACKGROUND: Grand multiparity is a major public health concern especially among developing countries and has been associated with higher risk of adverse maternal and fetal outcomes compared with women of lesser parity. There is a dearth of evidence on this subject in Cameroon, especially in the rural areas. We therefore carried out this study to document the prevalence and maternal and fetal delivery outcomes of grand multiparity in a rural Cameroonian setting. METHODS: We conducted a retrospective chart review of delivery records from two health facilities (the Oku District Hospital and Kevu Integrated Health Centre) in the Oku Health District over a period of eight years. Data was entered into and analyzed using Epi-Info version 7.0.8.3. The Chi-squared or Fisher's exact test was used to compare categorical variables. The threshold of statistical significance was set at 5%. RESULTS: A total of 1755 delivery records met our inclusion criteria. The overall prevalence of grand multiparity was 27.0%. We found no significant difference in the rate of selected maternal and fetal delivery outcomes between grand multiparous women and those with lesser parity (p-value> 0.05). However, grand multiparous women were less likely to develop second-fourth degree perineal tears compared to their counterparts with lesser parity (odds ratio = 0.3, 95% confidence interval = 0.2-0.7, p = 0.001). CONCLUSION: Our study depicts a high prevalence of grand multiparous delivery in this rural community. With the exception of severe perineal tear, grand multipara and their babies are as likely to develop adverse delivery outcomes as their counterparts with lesser parity. There is also the need to enhance existing government policies on reproductive health in rural areas.

Validation of Pediatric Weight Estimation Formulae in a Suburban Cameroonian Population: A Cross-sectional Study.

We assessed the accuracy of the Nelson, Best Guess and Advanced Pediatric Life Support (APLS) formulae in estimating weight in a suburban Cameroonian pediatric population, by conducting a cross-sectional study using 544 children aged 1 month to 12 years. Agreement between measured and estimated weight was poor for Nelson [concordance correlation coefficient (CCC) 0.89 (95% confidence interval (CI) 0.87-0.90)] and Best Guess [CCC 0.88 (95% CI 0.86-0.90)] formulae, and moderate for the APLS formula [CCC 0.92 (95% CI 0.90-0.93)]. On Bland-Altman analysis, all three methods had limits of agreement (APLS -42.2 to -45.6%, Best Guess -42.7 to -55.1%, Nelson -36.4 to -42.4%) above the -10 to -10% set as criteria for clinical agreement. Conclusively, the accuracy of all three formulae was clinically unacceptable in our study population, suggesting the need for studies aimed at deriving more accurate formulae adapted for use in our context.

Non-adherence to antihypertensive pharmacotherapy in Buea, Cameroon: a cross-sectional community-based study.

BACKGROUND: Hypertension is a challenging public health problem with a huge burden in the developing countries. Non-adherence to antihypertensive treatment is a big obstacle in blood pressure (BP) control and favours disease progression to complications. Our objectives were to determine the rate of non-adherence to antihypertensive pharmacotherapy, investigate factors associated with non-adherence, and to assess the association between non-adherence and BP control in the Buea Health District (BHD), Cameroon. METHODS: A community-based cross-sectional study using stratified cluster sampling was conducted in the BHD from November 2013 - March 2014. Eligible consenting adult participants had their BP measured and classified using the Joint National Committee VII criteria. The Morisky medication adherence scale was used to assess adherence to BP lowering medication. Multivariable logistic regression models were used to predict non-adherence. RESULTS: One hundred and eighty-three participants were recruited with mean age of 55.9 years. Overall, 67.7% (95% CI: 59.8-73.6%) of participants were non-adherent to their medications. After adjusting for age, sex and other covariates, forgetfulness (aOR = 7.9, 95%CI: 3.0-20.8), multiple daily doses (aOR = 2.5, 95%CI: 1.2-5.6), financial constraints (aOR = 2.8, 95%CI: 1.1-6.9) and adverse drug effects (aOR = 7.6, 95%CI: 1.7-33.0) independently predicted non-adherence to anti-hypertensive medication. BP was controlled in only 21.3% of participants and was better in those who were adherent to medication (47.5% versus 8.2%, p <  0.01). CONCLUSION: At least two of every three hypertensive patients in the Buea Health District are non-adherent to treatment. Forgetfulness, multiple daily doses of medication, financial constraints and medication adverse effects are the major predictors of non-adherence in hypertensive patients. These factors should be targeted to improve adherence and BP control, which will contribute to stem hypertension-related morbidity and mortality.

Low birthweight in rural Cameroon: an analysis of a cut-off value.

BACKGROUND: Low birthweight (LBW) is a major predictor of early neonatal mortality which disproportionately affects low-income countries. WHO recommends regional definitions for LBW to prevent misclassifications and ensure appropriate care of babies with LBW. We conducted this study to define a clinical cut-off for LBW, and to determine the predictors and adverse foetal outcomes of LBW babies in a rural sub-division in Cameroon. METHODS: We conducted a retrospective register analysis of 1787 singleton deliveries in two health facilities in the Northwest Region of Cameroon. Records with no birthweight or birthweight less than 1000 g, babies born before arrival, multiple deliveries and deliveries before 28 weeks gestation were excluded from this study. The 10th percentile of birthweights was computed to obtain a statistical cut-off value for the LBW. To assess the clinical significance of the newly defined cut-off value, we compared the prevalence of adverse foetal outcomes between LBW (birthweight <10th percentile) and heavier babies (birthweight ≥10th percentile) in our study population. RESULTS: The 10th percentile of the birthweights was 2700 g. Preterm delivery was the lone predictor of LBW (aOR = 2.0, 95% CI = 1.3-3.1; p = 0.001). LBW babies were more likely to be stillborn (OR = 9.6; 95% CI = 4.2-21.6; p < 0.001) or asphyxiated at the 5th minute (OR = 2.0; 95% CI = 1.2-3.3; p = 0.006), compared with heavier babies. Also, 6.1% of babies who had a birthweight between 2500 and 2700 g were more likely to be stillborn compared to heavier babies. CONCLUSION: This study suggests that the clinical cut-off for LBW in this rural community is 2700 g; with 6.1% of babies born with LBW probably receiving inadequate care as the traditional cut-off value of 2500 g proposed by WHO is still used to define LBW in our setting. Further studies are necessary to define a national cut-off value for harmonisation of LBW definitions in the country to prevent misclassifications and ensure appropriate neonatal care.

Quantification and factors associated with HIV-related stigma among persons living with HIV/AIDS on antiretroviral therapy at the HIV-day care unit of the Bamenda Regional Hospital, North West Region of Cameroon.

BACKGROUND: The Human Immunodeficiency Virus /Acquired Immune Deficiency Syndrome (HIV/AIDS) is not just a medical problem but its social impact is increasingly affecting its effective management. The fear of HIV-stigma constitutes a major barrier to HIV testing, prevention, uptake and adherence to antiretroviral therapy (ART). We aimed to quantify HIV-related stigma, and identify the factors associated with high HIV-related stigma among persons living with HIV and AIDS (PLHIVA) and on ART. METHODS: A hospital-based cross sectional analytic survey targeting PLHIVA on ART at the HIV-day care unit of the Bamenda Regional Hospital of Cameroon was conducted from February to April 2016. A total of 308 eligible and willing participants were consecutively included in the survey. Data were collected using a pretested questionnaire designed from the Berger HIV stigma scale and analyzed using Epi info 3.5.4. RESULTS: The mean age of the 308 participants was 40.1±10.2 years. The mean overall HIV/AIDS related stigma score was 88.3 ± 18.80 which corresponds to a moderate level of stigma according to the Berger stigma scale. Further analysis revealed that most participants suffered from moderate forms of the different subtypes of stigma including: personalized (49.8%), disclosure (66.4%), negative self-image (50.0%) and public attitude (52.1%) stigmatization. It was estimated that 62.7% (95% confidence interval [CI] = 57.8-68.9%) of the participants lived with high levels of HIV-related stigma. After controlling for gender, religion, age and occupation, level of education below tertiary (Adjusted Odds Ratio [AOR] = 0.70 [95% CI = 0.44-0.91]; p = 0.036) and a duration from diagnosis below 5 years (AOR = 1.74 [95% CI = 1.01-3.00]; p = 0.046) were significantly associated with high HIV-related stigma. CONCLUSION: About three out of every five PLHIVA receiving ART in Bamenda Regional Hospital still experience high levels of HIV-related stigma. This occurs more frequently in participants with low educational status, and who may have known their HIV status for less than 5 years. Anti-HIV-stigma programs in the North West Region need strengthening with intensified psychosocial follow-up of newly diagnosed cases.

Risk factors of lower limb cellulitis in a level-two healthcare facility in Cameroon: a case-control study.

BACKGROUND: Cellulitis is a common infection of the skin and subcutaneous tissues. It is associated with significant morbidity from necrosectomies and amputations especially in sub-Saharan Africa. We aimed at identifying the risk factors and burden of lower limb cellulitis to inform preventive strategies in Cameroon. METHODS: This was a hospital-based case-control study carried out in the Bamenda Regional Hospital (BRH) between September 2015 and August 2016. Cases were defined as consenting adults admitted to the surgical unit who presented with a localised area of lower limb erythema, warmth, oedema and pain, associated with fever (temperature ≥ 38 °C) and/or chills of sudden onset. Controls were adults hospitalised for diseases other than cellulitis, necrotising fasciitis, myositis, abscess or other variants of dermo-hypodermitis. Cases and controls were matched (1:2) for age and sex. RESULTS: Of the 183 participants (61 cases of cellulitis and 122 controls) included in the study, the median age was 52 years [Interquartile range (IQR): 32.5-74.5]. After controlling for potential confounders, obesity [adjusted odds ratio (AOR) = 4.7, 95% CI (1.5-14.7); p = 0.009], history of skin disruption [AOR = 12.4 (3.9-39.1); p < 0.001], and presence of toe-web intertrigo [AOR = 51.4 (11.7-225.6); p < 0.001] were significantly associated with cellulitis. Median hospital stay was longer (14 days [IQR: 6-28]) in cases compared to the controls (3 days [IQR: 2-7]). Among the cases, Streptococci species were the most frequent (n = 50, 82%) isolated germ followed by staphylococci species (n = 9, 15%). Patients with cellulitis were more likely to undergo necrosectomy (OR: 21.2; 95% CI: 7.6-59.2). Toe-web intertrigo had the highest (48.9%) population attributable risk for cellulitis, followed by history of disruption of skin barrier (37.8%) and obesity (20.6%). CONCLUSION: This study showed a high disease burden among patients with cellulitis. While risk factors identified are similar to prior literature, this study provides a contextual evidence-base for clinicians in this region to be more aggressive in management of these risk factors to prevent disease progression and development of cellulitis.

Adolescent deliveries in rural Cameroon: an 8-year trend, prevalence and adverse maternofoetal outcomes.

BACKGROUND: Adolescent deliveries remain a global public health concern especially in low- and middle-income countries where 95% of these deliveries occur. In Cameroon, adolescent pregnancies have a high disease burden due to their association with adverse pregnancy outcomes. We sought to evaluate the prevalence, trend and adverse maternofoetal outcomes of adolescent deliveries in a rural community in Cameroon. METHOD: We carried out a retrospective register analysis of 1803 singleton deliveries in two health facilities located in the Oku sub-division over an 8-year period (2009 to 2016). We excluded: records without maternal age, babies born before arrival, birthweights less than 1000 g, multiple deliveries and deliveries before 28 weeks gestation. Data analysis was done using Epi info 7.0.8.3. The Fisher's exact test was used to compare categorical variables, while the chi-square test for trends was used to determine time trends. P-values below 5% were considered statistically significant. RESULTS: The 8-year prevalence of adolescent deliveries was 20.4% (95% CI = 18.6-22.4) with a significant, downward trend between 2009 and 2016 (P trend = 0.05). Second-fourth degree perineal tears were more likely to complicate adolescent (Age < 20 years) deliveries compared with their adult (Age ≥ 20 years) counterparts (OR = 2.9; 95% CI = 1.8-4.7; p < 0.001). Also, babies born to adolescent mothers were more likely to have a low birthweight (OR = 1.7; 95% CI = 1.1-2.6; p = 0.009) and be asphyxiated at the fifth minute of life (OR = 3.2; 95% CI = 1.9-5.5; p < 0.001). Over an eight-year period, the downward trend in the prevalence of adolescent deliveries was associated with a significant decrease in the trend of neonatal asphyxia at the fifth minute. Married adolescents and their babies were as likely to develop the complications of adolescent delivery such as second-fourth degree perineal tears (OR = 0.8; 95% CI = 0.4-1.6; p = 0.456), low birthweight (OR = 2.1; 95% CI = 0.9-4.7; p = 0.070) and fifth minute neonatal asphyxia (OR = 0.9; 95% CI = 0.4-2.0; p = 0.832) as single adolescents and their babies. CONCLUSION: The prevalence of adolescent deliveries in this rural community is high with one of every five babies born to an adolescent mother. Despite the downward trend indicating a decrease in adolescent deliveries, our study demonstrates the need to reinforce and effectively apply existing government-based public health programme to target key indicators of adolescent pregnancy in Cameroon.

Deployment of vaccine cold chain equipment in resource-limited settings: lessons from the Gavi Cold Chain Optimization Platform in Cameroon.

BACKGROUND: Lack of or use of suboptimal cold chain equipment (CCE) is a major barrier to optimal immunization coverage and equity. Gavi established the CCE optimization platform (CCEOP) in 2015 to help eligible countries modernize their cold chain systems. However, there are limited data on CCE deployment at country level. We present lessons learnt from deploying CCE from the Gavi CCEOP in Cameroon. METHODS: This cross-sectional study collected data on the number of days items of CCE spent at each point on their trajectory from the entry port to 62 randomly selected health facilities in Cameroon. RESULTS: Once equipment arrived at the entry port, it took 10 d for customs clearance, 2 d from customs clearance to warehousing and 257 d (>9 mo) from the warehouse to facilities. Upon arrival at the facilities, it took a median of 53 (range 0-395) d from installation to final commissioning: most of the days (median=210) were spent between installation and final commissioning. The major causes of delays included insufficient coordination and communication across all levels, poor documentation and final commissioning. CONCLUSION: Early engagement on customs clearance, strengthening coordination and communication, ensuring proper documentation, as well as eliminating final commissioning, could significantly improve implementation of the program.

Factors associated with COVID-19 vaccine hesitancy among healthcare workers in Cameroon and Nigeria: a web-based cross-sectional study.

BACKGROUND: This study investigated the determinants of coronavirus disease 2019 (COVID-19) vaccine hesitancy among healthcare workers (HCWs) in Cameroon and Nigeria. METHODS: This analytic cross-sectional study was conducted from May to June 2021, including consenting HCWs aged ≥18 y identified using snowball sampling. Vaccine hesitancy was defined as indecisiveness or unwillingness to receive the COVID-19 vaccine. Multilevel logistic regression yielded adjusted ORs (aORs) for vaccine hesitancy. RESULTS: We included a total of 598 (about 60% women) participants. Little or no trust in the approved COVID-19 vaccines (aOR=2.28, 95% CI 1.24 to 4.20), lower perception of the importance of the vaccine on their personal health (5.26, 2.38 to 11.6), greater concerns about vaccine-related adverse effects (3.45, 1.83 to 6.47) and uncertainty about colleagues' acceptability of the vaccine (2.98, 1.62 to 5.48) were associated with higher odds of vaccine hesitancy. In addition, participants with chronic disease (aOR=0.34, 95% CI 0.12 to 0.97) and higher levels of concerns about getting COVID-19 (0.40, 0.18 to 0.87) were less likely to be hesitant to receive the COVID-19 vaccine. CONCLUSIONS: COVID-19 vaccine hesitancy among HCWs in this study was high and broadly determined by the perceived risk of COVID-19 and COVID-19 vaccines on personal health, mistrust in COVID-19 vaccines and uncertainty about colleagues' vaccine acceptability.

Effectiveness of linkage to care and prevention interventions following HIV self-testing: a global systematic review and meta-analysis protocol.

INTRODUCTION: Early identification of persons living with HIV (PLWH) is crucial to institute timely treatment to prevent HIV-related morbidity and mortality. The convenience, flexibility and confidentiality of HIV self-testing enhance the acceptability of HIV testing and early detection of PLWH. However, persons who tested positive after a self-test are more likely to present late for treatment. This review seeks to evaluate the effectiveness of interventions to improve linkage to care and prevention after self-testing. METHODS AND ANALYSIS: We will search PubMed, Embase, Web of Science, Cochrane Library, PsycInfo, Global Health Library, ClinicalTrials.gov and current controlled trials for all randomised and non-randomised studies published from 1 January 2010 to 31 July 2022 without language restriction. Two review authors will independently screen and select articles (based on the eligibility criteria for this review), extract data and assess the risk of bias in the included studies. Study-specific estimates will be converted to log risk ratios and weighted by the inverse of the variance of the log risk ratio before pooling into a fixed-effect model. The Cochrane's Q χ2 test and the I2 statistic will be used to assess and quantify heterogeneity in the included studies, respectively. The Egger's test and funnel plots will be used to assess publication bias. Sensitivity analysis will be conducted using leave-one-out analysis to assess the impact of outliers on the overall summary intervention effect. ETHICS AND DISSEMINATION: No ethical clearance is needed for the current study as it will be based on already published articles. We will publish the findings of this study in international peer-reviewed journals and present them at conferences.

Resting heart rate and risk of left and right heart failure in 0.5 million Chinese adults.

OBJECTIVES: To compare the shape and strength of the associations of resting heart rate (RHR) with incident heart failure (HF) and pulmonary heart disease (PHD) in Chinese adults. METHODS: The prospective China Kadoorie Biobank recruited >0.5 million adults from 10 geographically diverse regions (5 urban, 5 rural) of China during 2004-2008. After an 11-year follow-up, 6082 incident cases of HF and 5572 cases of PHD, were recorded among 491 785 participants with no prior history of heart disease or use of beta-blockers at baseline. Cox regression yielded HRs for each disease associated with usual RHR after adjustment for confounding factors. RESULTS: The mean (SD) baseline RHR was 79 (12) (men 78 (12); women 80 (11)) bpm, and these decreased with increasing age (by about 1 bpm per 10 years). Usual RHR showed J-shaped associations with HF and log-linear associations PHD. For HF, each 10 bpm higher usual RHR was associated with an adjusted HR of 1.25 (95% CI 1.17 to 1.34) for RHR>75 bpm. For PHD, each 10 bpm higher RHR was associated with HR of 1.74 (1.67-1.81) across the full range of usual RHR. For HF at RHR>75 bpm but not PHD, the HRs per 10 bpm higher RHR were approximately halved by further adjustment for diabetes and hypertension. CONCLUSIONS: RHR was strongly positively associated with PHD throughout the range studied, but was only associated with HF at RHR>75 bpm, and the strength of the associations with HF were only one-third of those with PHD.

Community engagement in research in sub-Saharan Africa: approaches, barriers, facilitators, ethical considerations and the role of gender - a systematic review protocol.

INTRODUCTION: Meaningful community engagement (CE) is increasingly being considered the major determinant of successful research, innovation and intervention uptake. Community leaders, policy makers and funders have expressed the need to engage communities in research. CE in research empowers the host community to participate in addressing its own health needs and health disparities while ensuring that researchers understand community priorities. Thus, appropriate CE opens a unique way to promote coproduction, coimplementation and coevaluation, which may strengthen both the sense of inclusion, ownership and the effectiveness of the research life-cycle. The aim of this review is to synthesise available evidence on how to engage communities in research in a gender-sensitive, ethical, culture-appropriate and sustainable way in sub-Saharan Africa (SSA). This protocol has been developed following the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols and follows the guidance provided by the Cochrane Handbook for Systematic Reviews. METHODS AND ANALYSIS: A combination of key text words and medical subject headings such as 'Community Engagement' or 'Community Involvement' will be used to search 009 databases for all literature published between 1 January 2000 and 31 July 2021. Citations retrieved from database searches will be exported into EndNote X9 to remove duplicate citations and imported into Rayyan QCRI for screening. Two independent reviewers will conduct the screening and data extraction process. Disagreements between review authors will be resolved through discussions, consensus a third reviewer serving as a tiebreaker. The risk of bias will be assessed using the 10-item Joanna Briggs Institute Critical Appraisal Checklist for Qualitative Research. The three-staged process described by Thomas and Harden will be used for the thematic and narrative synthesis of findings. ETHICS AND DISSEMINATION: This is a systematic review which uses already collected data thus ethical approval not required. Findings will be published in an open access peer-reviewed journal and presented in relevant conferences and workshops. PROSPERO REGISTRATION NUMBER: This protocol has been submitted for registration in PROSPERO and has been published under registration number CRD42021282503 .

Burden of atrial fibrillation among adults with heart failure in sub-Saharan Africa: a systematic review and meta-analysis.

OBJECTIVES: This study aimed to estimate the prevalence of atrial fibrillation (AF) in adults with heart failure (HF) and summarise the all-cause mortality ratio among adult patients with coexisting HF and AF in sub-Saharan Africa (SSA). SETTING: This was a systematic review and meta-analysis of cross-sectional and cohort studies with primary data on the prevalence and incidence of AF among patients with HF and the all-cause mortality ratio among patients with HF and AF in SSA. We combined text words and MeSH terms to search MEDLINE, PubMed and Global Health Library through Ovid SP, African Journals Online and African Index Medicus from database inception to 10 November 2021. Random-effects meta-analysis was used to estimate pooled prevalence. PRIMARY OUTCOME MEASURES: The prevalence and incidence of AF among patients with HF, and the all-cause mortality ratio among patients with HF and AF. RESULTS: Twenty-seven of the 1902 records retrieved from database searches were included in the review, totalling 9987 patients with HF. The pooled prevalence of AF among patients with HF was 15.6% (95% CI 12.0% to 19.6%). At six months, the all-cause mortality was 18.4% (95% CI 13.1% to 23.6%) in a multinational registry and 67.7% (95% CI 51.1% to 74.3%) in one study in Tanzania. The one-year mortality was 48.6% (95% CI 32.5% to 64.7%) in a study in the Democratic Republic of Congo. We did not find any study reporting the incidence of AF in HF. CONCLUSION: AF is common among patients with HF in SSA, and patients with AF and HF have poor survival. There is an urgent need for large-scale population-based prospective data to reliably estimate the prevalence, incidence and risk of mortality of AF among HF patients in SSA to better understand the burden of AF in patients with HF in the region. PROSPERO REGISTRATION NUMBER: CRD42018087564.