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.

Knowledge, attitudes and practices regarding depression among primary health care providers in Fako division, Cameroon.

BACKGROUND: Mental health and mental illness are often overlooked in the management of patients in our health services. Depression is a common mental disorder worldwide. Recognising and managing mental illnesses such as depression by primary health care providers (PHCPs) is crucial. This study describes the knowledge, attitudes and practices (KAP) of PHCPs regarding depression in Fako Division. METHODS: A cross-sectional study was conducted among PHCPs (general practitioners, nurses, pharmacy attendants and social workers) in public-owned health facilities in the four health districts in Fako Division. Participants were selected by a consecutive convenience sampling. A structured questionnaire including the Depression Attitude Questionnaire (DAQ) was used to collect information about their socio-demographic characteristics, professional qualifications and KAP about depression. RESULTS: The survey had a response rate of 56.7%. Most of the 226 participants (92.9%) were aware that depression needs medical intervention. Only 1.8% knew a standard tool used to diagnose depression. Two-thirds agreed that majority of the cases of depression encountered originate from recent misfortune. About 66% felt uncomfortable working with depressed patients. Also, 45.1% of PHCPs did not know if psychotropic drugs were available at pharmacies within their health area. Very few (15.2%) reported to have prescribed psychotropic drugs. Less than half (49.1%) of the participants had prior formal training in mental health. CONCLUSION: PHCPs in Fako Division tend to have limited knowledge and poor attitudes regarding depression. Practices towards diagnosis and management of depression tend to be inadequate. There is an urgent need to train PHCPs in mental health in general and depression diagnosis and management in particular.

Risk factors for acute respiratory infections in children under five years attending the Bamenda Regional Hospital in Cameroon.

BACKGROUND: Acute respiratory infections (ARI) are a leading cause of morbidity and mortality in under-five children worldwide. About 6.6 million children less than 5 years of age die every year in the world; 95% of them in low-income countries and one third of the total deaths is due to ARI. This study aimed at determining the proportion of acute respiratory infections and the associated risk factors in children under 5 years visiting the Bamenda Regional Hospital in Cameroon. METHODS: A cross-sectional analytic study involving 512 children under 5 years was carried out from December 2014 to February 2015. Participants were enrolled by a consecutive convenient sampling method. A structured questionnaire was used to collect clinical, socio-demographic and environmental data. Diagnosis of ARI was based on the revised WHO guidelines for diagnosing and management of childhood pneumonia. The data was analyzed using the statistical software EpiInfo™ version 7. RESULTS: The proportion of ARIs was 54.7% (280/512), while that of pneumonia was 22.3% (112/512). Risk factors associated with ARI were: HIV infection ORadj 2.76[1.05-7.25], poor maternal education (None or primary only) ORadj 2.80 [1.85-4.35], exposure to wood smoke ORadj 1.85 [1.22-2.78], passive smoking ORadj 3.58 [1.45-8.84] and contact with someone who has cough ORadj 3.37 [2.21-5.14]. Age, gender, immunization status, breastfeeding, nutritional status, fathers' education, parents' age, school attendance and overcrowding were not significantly associated with ARI. CONCLUSION: The proportion of ARI is high and is associated with HIV infection, poor maternal education, exposure to wood smoke, passive cigarette smoking, and contact with persons having a cough. Control programs should focus on diagnosis, treatment and prevention of ARIs.

A Retrospective One-Year Estimation of the Volume and Nature of Surgical and Anaesthetic Services Delivered to the Populations of the Fako Division of the South-West Region of Cameroon: An Urgent Call for Action.

BACKGROUND: Surgery-related conditions account for the majority of admissions in primary referral hospitals in Sub-Saharan Africa. The role of surgery in the reduction of global disease burden is well recognized, but there is a great qualitative and quantitative disparity in the delivery of surgical and anaesthetic services between countries. This study aims at estimating the nature and volume of surgery delivered in an entire administrative division of Cameroon. METHODS: In this retrospective survey conducted during the year 2013, we used a standard tool to analyse the infrastructure and human resources involved in the delivery of surgical and anaesthetic services in the Fako division in the south-west region of Cameroon. We also estimated the nature and volume of surgical services as a rate per catchment population. RESULTS: Public, private and mission hospital contributed equally to the delivery of surgical services in the Fako. For every 100,000 people, there were <5 operative rooms. A total of 2460 surgical interventions were performed by 2.2 surgeons, 1.1 gynaecologists and 0.3 anaesthetists. These surgical interventions consisted mostly of minor and emergency procedures. Neurosurgery, paediatric, thoracic and endocrine surgery were almost non-existent. CONCLUSIONS: The volume of surgery delivered in the Fako is far below the minimum rates required to meet up with the most basic requirements of the populations. It is likely that most of these surgical needs are left unattended. A community-based assessment of unmet surgical needs is necessary to accurately estimate the magnitude of the problem and guide surgical capacity improvements.

Prevalence, characteristics and correlates of enteric pathogenic protozoa in drinking water sources in Molyko and Bomaka, Cameroon: a cross-sectional study.

BACKGROUND: Access to potable water remains a major challenge particularly in resource-limited settings. Although the potential contaminants of water are varied, enteric pathogenic protozoa are known to cause waterborne diseases greatly. This study aimed at investigating the prevalence, characteristics and correlates of enteric pathogenic protozoa in drinking water sources in Buea, Cameroon. METHODS: A cross-sectional study was conducted using 155 water samples collected from various drinking sources (boreholes, springs, taps and wells). Each sample was subjected to physicochemical examinations (pH, turbidity, odour and sliminess) and parasitological analysis (wet mount, modified Ziehl-Neelsen stain) to determine the presence of enteric pathogenic protozoa. A data collection tool was used to note characteristics of collected samples and the data was analysed using EPI-INFO Version 3.5.3. RESULTS: The overall prevalence of enteric pathogenic protozoa in water sources was 62.6 %. Eight species of enteric protozoa were observed with Cryptosporidium parvum being the most predominant (45.8 %). Spring water was the most contaminated source with enteric protozoa (85.7 %) while pipe borne water had all eight species of protozoa identified. A pH of 6 was the only significant factor associated with the prevalence of these pathogens in water sources. CONCLUSION: The prevalence of enteric protozoa in water sources in Molyko and Bomaka is high, spring water is the most contaminated water source and Cryptosporidium parvum is the most common protozoa contaminating water. A water pH of 6 is associated to the prevalence of protozoa. Community members need to be educated to treat water before drinking to avoid infection by enteric protozoa in water and further studies with larger samples of water need to be conducted to find other correlates of the presence of protozoa in water.

Clients' satisfaction with HIV treatment services in Bamenda, Cameroon: a cross-sectional study.

BACKGROUND: Clients have explicit desires or requests for services when visiting hospitals; inadequate discovery of their needs may result in dissatisfaction. Patient satisfaction influences retention in HIV care, adherence to HAART and serves as determinant to HIV suppression. This study's objectives were to quantify clients' satisfaction with HIV services in Bamenda and determine relationship between satisfaction and clients' socio-demographic/structural characteristics. METHODS: A cross-sectional study was conducted on HIV-positive patients followed-up, on treatment and who consulted in the Bamenda Regional Hospital treatment centre between July and August 2014. Participants consent was sought and data collected on client's level of satisfaction to staff-patient-communication, staff attitudes, privacy and confidentiality and staffing and amenities situations in the hospital. Data was collected using a structured questionnaire interviewer-administered by investigator and trained health personnel. Collected data was analyzed using Epi Info version 3.5.4 and clients' satisfaction measured using frequencies and percentages. RESULTS: A total of 384 participants took part in this study and their median age was 37 years (IQR: 29-46). Two hundred and seventy-four (71.4 %) participants were females. Overall satisfaction with HIV services was 91.2 % and participants reported less satisfaction with overall staffing and amenities situation of the centre (3.6 %). In the multivariate analysis, only being female, employed and perceiving high number of nurses working at the treatment centre remained significant predictors of overall satisfaction with HIV services. CONCLUSION: A high proportion of participants expressed satisfaction with HIV services. However, some dissatisfaction is masked in this high satisfaction level. This dissatisfaction underscores need to improve staff attitudes, staff-patient-communication, employ more staff and build better patient facilities. Future studies need to focus on assessing long-term progression of satisfaction levels with services and determinants of satisfaction involving larger samples in many treatment centres.

Low birth weight in a sub-urban area of Cameroon: an analysis of the clinical cut-off, incidence, predictors and complications.

BACKGROUND: The World Health Organisation recommends that each country adopts its own cut-off value of low birth weight (LBW) for clinical use. The aims of this study were to establish a clinical cut-off point for LBW and to determine its incidence, predictors and complications in a sub-urban area's hospital of Cameroon. METHODS: We conducted a study in two phases: a 6-year retrospective phase during which we collected demographic and clinical information from the records of the maternity of the Buea Regional Hospital (BRH) and a 3-month prospective phase during which data were collected from consenting pregnant women using a structured questionnaire, and newborns were examined and followed after birth. RESULTS: A total of 4941 records were reviewed during the retrospective phase and the 10(th) centile of birth weights was 2600 g. In the 200 pregnant women enrolled during the prospective phase, using this cut-off yielded an incidence of LBW of 19.0 %. Independent predictors of LBW were preterm delivery, hypertensive disorders in pregnancy, HIV infection, maternal age >36 years, maternal height <150 cm and pre-delivery BMI < 25 kg/m(2). Neonates with LBW were more likely to have neonatal asphyxia, foetal distress, respiratory distress and neonatal death. CONCLUSIONS: Our results suggest that newborns under 2600 g have LBW in sub-urban Cameroon. They represent one out of every five babies, and they deserve close care. Preventive measures targeting the predictors described here are warranted to reduce the incidence and complications. Similar studies in urban areas are required in order to generalize the results.

Assessing the risk factors of cholera epidemic in the Buea Health District of Cameroon.

BACKGROUND: Cholera is an acute diarrheal disease caused by the bacterium, Vibrio cholerae. A cholera epidemic occurred in Cameroon in 2010. After a cholera-free period at the end of 2010, new cases started appearing in early 2011. The disease affected 23,152 people and killed 843, with the South West Region registering 336 cases and 13 deaths. Hence, we assessed the risk factors of cholera epidemic in the Buea Health District to provide evidence-based cholera guidelines. METHODS: We conducted an unmatched case-control study. Cases were identified from health facility records and controls were neighbours of the cases in the same community. We interviewed 135 participants on socio-economic, household hygiene, food and water exposures practices using a semi-structured questionnaire. Data was analyzed using STATA. Fisher exact test and logistic regression were computed. P < 0.05 was considered to be statistically significant. RESULTS: The 135 participants included 34 (25.2 %) cholera cases and 101 (74.8 %) controls. More females [78 (57.8 %)] participated in the study. Ages ranged from 1 year 3 months to 72 years; with a mean of 29.86 (±14.51) years. The cholera attack rate was 0.03 % with no fatality. Most participants [129 (99.2 %)] had heard of cholera. Poor hygienic practices [77 (59.2 %)] and contaminated water sources [54 (41.5 %)] were the main reported transmission routes of cholera. Good hygienic practices [108 (83.1 %)] were the main preventive methods of cholera in both cases [23 (76.6 %)] and controls [85 (85.0 %)]. Logistic regression analysis showed age below 21 years (OR = 1.72, 95 % CI: 0.73-4.06, p = 0.251), eating outside the home (OR = 1.06, CI: 0.46-2.43, p = 1.00) and poor food preservation method (OR = 9.20, CI: 3.67-23.08, p < 0.0001) were independent risk factors of cholera. Also, irregular water supply (OR = 0.66, 95 % CI: 0.30-1.43, p = 0.320), poor kitchen facility (OR = 0.60, CI: 0.16-2.23, p = 0.560), lack of home toilet (OR = 0.69, CI: 0.25-1.86, p = 0.490), and education below tertiary (OR = 0.87, 95 % CI: 0.36-2.11, p = 0.818) were independent protective factors for the occurrence of cholera. CONCLUSION: There was a good knowledge of cholera among participants. Poor food preservation method was a significant independent risk factor of cholera. Improvement in hygiene and sanitation conditions and water infrastructural development is crucial to combating the epidemic.

A prospective pilot cohort analysis of crash characteristics and pattern of injuries in riders and pillion passengers involved in motorcycle crashes in an urban area in Cameroon: lessons for prevention.

BACKGROUND: Low and middle-income countries carry over ninety per cent of the burden of injury related mortality and disability. Motorcycles are gradually becoming a major mode of transportation in Cameroon and other African countries in the absence of an organized public transport. Consequently, the contribution of motorcycle crash to injury-related deaths seems to be on the rise. Currently, data addressing motorcycle crash characteristics, pattern, and severity of motorcycle-related injuries in Cameroon are scarce. We hypothesised that head and limb injuries are the most frequent cause of morbidity and mortality and equally affect riders and pillion passengers. METHODS: This hospital-based prospective pilot cohort analysis involving 405 motorcycle crashes and 621 injury victims was conducted in Laquintinie Hospital, a large centre located in an urban area in Cameroon. All motorcycle riders and passengers received in the emergency department over a 4 months period with an injury following a traffic related crash were included. Crash characteristics and type, anatomical location and severity of injuries were recorded and analysed comparing the pattern of injuries between riders and pillion passengers involved in motorcyclecrashes. This pilot analysis is expected to propose a snapshot of motorcycle injuries in Douala and will be followed by a larger analysis over a longer period. RESULTS: We recorded a majority of motorcycle versus car and motorcycle versus motorcycle collisions. Most of these crashes occurred over the week-end and in the night. Helmet use was almost inexistent. We observed that females aged above 40 years represented the majority of pillion passengers. This accounted for the sex-ratio of 1.1/1. A total of 1311 injuries were identified in our patients, giving a mean of 2.1 injuries per victim. The head and the limbs were the most affected anatomical areas. Riders carried a higher risk of sustaining an injury to head and neck than pillion passengers. Riders and pillion passengers carried equal risk of injury to the lower limbs. Emergency room mortality was 4.3 % and riders were more likely to die than pillion passengers. CONCLUSION: This study has identified females aged above 40 years as a special vulnerable group in Douala. It also carries strong messages useful for the implementation of preventive measures and management of patients injured in motorcycle-related crash in general.

Feasibility, safety, acceptability, and preliminary efficacy of measurement-based care depression treatment for HIV patients in Bamenda, Cameroon.

Depression affects 18-30 % of HIV-infected patients in Africa and is associated with greater stigma, lower antiretroviral adherence, and faster disease progression. However, the region's health system capacity to effectively identify and treat depression is limited. Task-shifting models may help address this large mental health treatment gap. Measurement-Based Care (MBC) is a task-shifting model in which a Depression Care Manager guides a non-psychiatric (e.g., HIV) provider in prescribing and managing antidepressant treatment. We adapted MBC for depressed HIV-infected patients in Cameroon and completed a pilot study to assess feasibility, safety, acceptability, and preliminary efficacy. We enrolled 55 participants; all started amitriptyline 25-50 mg daily at baseline. By 12 weeks, most remained at 50 mg daily (range 25-125 mg). Median (interquartile range) PHQ-9 depressive severity scores declined from 13 (12-16) (baseline) to 2 (0-3) (week 12); 87 % achieved depression remission (PHQ-9 <5) by 12 weeks. Intervention fidelity was high: HIV providers followed MBC recommendations at 96 % of encounters. Most divergences reflected a failure to increase dose when indicated. No serious and few bothersome side effects were reported. Most suicidality (prevalence 62 % at baseline; 8 % at 12 weeks) was either passive or low-risk. Participant satisfaction was high (100 %), and most participants (89 %) indicated willingness to pay for medications if MBC were implemented in routine care. The adapted MBC intervention demonstrated high feasibility, safety, acceptability, and preliminary efficacy in this uncontrolled pilot study. Further research should assess whether MBC could improve adherence and HIV outcomes in this setting.

Knowledge and perceptions towards malaria prevention among vulnerable groups in the Buea Health District, Cameroon.

BACKGROUND: Malaria is a public health problem especially in vulnerable groups such as pregnant women and children under five years in Cameroon including the Buea Health District (BHD). Misconceptions concerning it exist. This study assessed the level of knowledge and perceptions towards malaria control among pregnant women and mothers/caretakers of under-fives in the BHD. METHODS: A community-based cross-sectional study was conducted in the BHD in August, 2011 in five health areas. A questionnaire was used to collect data on demographic variables, knowledge and perceptions towards malaria control from 443 respondents aged 15-73 years. RESULTS: Of the 443 respondents interviewed, 99% had heard about malaria. Awareness of malaria was similar in rural (98.04%) and urban (98.97%) areas. The health facility was the most popular source of information (74%). The radio, television, tracts/posters and the community relay agents (CRAs) all informed significantly higher proportions of respondents in the urban than rural communities (P < 0.05). Overall, 92% of respondents had the right perception of malaria and 88% knew at least one correct sign/symptom of malaria. The most recognised sign of malaria was fever. When all aspects of malaria were considered, majority (88%) of respondents had good levels of knowledge on malaria. The level of good knowledge in respondents with ≥ secondary school education (91%) was significantly higher (P = 0.01) than in those with ≤ primary school level (83%). Overall, 99% had heard about insecticide treated nets (ITNs); 99% perceived ITNs as a good means to prevent malaria; most respondents (57%) used ITNs mainly for protection against mosquito bites while 48% used them for protection against malaria. CONCLUSION: Respondents with no formal education had a poor level of knowledge on malaria. Hence, new strategies for sensitization messages involving their active participation need to be developed.

Prevalence, characteristics and correlates of a positive-dementia screen in patients on antiretroviral therapy in Bamenda, Cameroon: a cross-sectional study.

BACKGROUND: In this study we assess the prevalence, characteristics as well as socio-demographic and clinical correlates of a positive screen for HIV-associated dementia in a group of patients on antiretroviral therapy (ART) in Bamenda, Cameroon. METHODS: In a cross-sectional study, a structured questionnaire was used to collect data on 400 patients attending the Bamenda Regional Hospital AIDS-treatment Centre. Patients were assessed for neurocognitive function using the International HIV Dementia Scale (IHDS) to assess finger-tapping (FT), alternating hand sequence (AHS) and a 4-word recall (4WR), each scored on a maximum of four. RESULTS: A total of 297 (74%) participants were females. The total IHDS score ranged from 6-12 with a mean of 9.02 and 85% of subjects screened positive for dementia (≤10 on IHDS). Participants performed worst in the AHS assessment with a mean of 2.25 (IQR: 2-3). In multivariable analyses, screening positive for dementia was significantly associated with having primary education or less (aOR: 8.33, 95%CI: 3.85, 16.67), and having HIV symptoms (aOR: 12.16, 95%CI: 3.08, 48.05). CONCLUSIONS: A very high proportion of patients on ART screened positive for dementia using the IHDS. This could potentially be an indication of a high prevalence of HIV-associated neurocognitive disorders in this population and or a poor performance of the IHDS in patients on ART. Future studies will need to assess the validity of the IHDS in this population of patients on ART and also evaluate long term outcomes in patients with positive dementia screens.

Pattern of surgical practice in a regional hospital in Cameroon and implications for training.

BACKGROUND: Surgeons are scarce in African countries. There is still a need to rely on general practitioners to perform a number of selected procedures. Their training needs to take these facts into consideration. The aim of this study was to evaluate the pattern of surgical procedures performed in a level III institution in an African city. We then analyzed the implications for training. METHODS: This descriptive retrospective study was conducted at the Regional Hospital, Limbe in Cameroon. This hospital had just been selected as the main training hospital for a newly created medical school. The postoperative notes of all procedures performed over 1 year were used to assess exposure of fourth-year medical students to various procedures and how much they matched their educational objectives. RESULTS: A total of 1,351 procedures were carried out during the study period, including 620 major and 731 minor procedures. Most procedures (84 %) were carried out by a trained specialist. The most frequently performed procedures were cesarean section (n = 131), circumcision (n = 148), laparotomy for various indications (n = 144), appendectomy (n = 81), and hernia repair (n = 81). Analysis of exposure of students to procedures indicated adequate exposure to cesarean section and some selected abdominal procedures. CONCLUSIONS: If students are trained only in our institution, they are likely to perform appendectomy, cesarean section, and hernia repair correctly. Their skills in common orthopedic procedures are likely to be poor. There is need to continue prospects to identify other institutions with a more comprehensive pattern of activities to ensure proper training for students.

Prevalence, severity, and duration of thrombocytopenia among HIV patients in the era of highly active antiretroviral therapy.

Thrombocytopenia is a clinically relevant outcome in HIV. However, the epidemiology of this condition, including frequency, severity, and duration, has not been well-characterized in the era of highly active antiretroviral therapy (HAART). In this study, we describe the epidemiology of thrombocytopenia using two methods. We conducted a systematic review of the literature published between 1997 and 2009 to characterize the frequency of thrombocytopenia in different populations in the HAART era. Secondly, we examined the frequency, severity, and duration of thrombocytopenia among HIV patients in the Collaborations in HIV Outcomes Research/US (CHORUS) Cohort from 1997 to 2006 and among HIV patients participating in GlaxoSmithKline HIV Clinical Trials between 1996 and 2004. Prevalence estimates of thrombocytopenia (<150 000 platelets/µl) in the literature varied greatly but were generally above 10%. The thrombocytopenia prevalence estimates in the CHORUS Cohort and the HIV Clinical Trials were both 14%. In the CHORUS Cohort, the platelet count was ≤50 000/µl among 3.1% and ≤30 000/µl among 1.7%; in the HIV clinical trials database, the platelet count was ≤50 000/µl among 1.3% and ≤30 000/µl among 0.67%. Duration of severe thrombocytopenia varied greatly, with the medium duration to ≥75 000 platelets/µl taking 147 days in the CHORUS Cohort and 33 days in the HIV clinical trials database. Among 111 patients with severe thrombocytopenia in the CHORUS Cohort, 23% never achieved a higher platelet count over follow-up. In conclusion, while the prevalence of severe thrombocytopenia was low, it occurred at levels associated with bleeding and was persistent among a small proportion of patients despite receipt of HAART.

Under-Five Mortality in Buea Health District, Southwest Cameroon: Evidence from a Community-Based Birth Cohort Study of Rate, Causes, and Age-Specific Patterns.

BACKGROUND: Updating the knowledge base on the causes and patterns of under-five mortality (U5M) is crucial for the design of suitable interventions to improve survival of children under five. OBJECTIVES: To assess the rate, causes, and age-specific patterns of U5M in Buea Health District, Cameroon. METHODS: A retrospective cohort study involving 2000 randomly selected households was conducted. Live births registered between September 2004 and September 2009 were recorded. The under-five mortality rate (U5MR) was defined by the number of deaths that occurred on or before 5 years of age per 1000 live births. Causes of death were assigned using the InterVA-4 software. RESULTS: A total of 2210 live births were recorded. There were 92 deaths, and the U5MR was 42 per 1000 live births. The mean age at death was 11 ± 15.9 months. The most frequent causes of death were neonatal causes (37%), malaria (28%), and pneumonia (15%). Deaths during infancy accounted for 64.1% of U5M, with 43.5% neonatal (86% occurring within the first 24 hours of life) and 20.7% postneonatal. The main causes of death in infancy were birth asphyxia (37.5%), pneumonia (17.5%), complications of prematurity (10%), and malaria (10%). Child deaths accounted for 35.8% of U5M. Malaria, pneumonia, and diarrhoeal illnesses accounted for the majority of child deaths. CONCLUSIONS: Almost half of U5M occurred during the neonatal period. Improvements in intrapartum care and the prevention and effective treatment of neonatal conditions, malaria, and pneumonia could considerably reduce U5M in Buea.

Health insurance-related disparities in colorectal cancer screening in Virginia.

BACKGROUND: Colorectal cancer (CRC) screening rates remain low in the United States. The effect of health insurance on CRC screening is not clear. We assessed the association between having health insurance and being screened for CRC and the factors that modify this association. METHODS: We used data from the 2005 Virginia Behavioral Risk Factor Surveillance System to evaluate the association of self-reported insurance coverage on self-reported CRC screening among all men and women ages > or =50 years (N = 2,887). Prevalence odds ratios (POR) were estimated using unconditional logistic regression. All covariates were assessed for potential effect measure modification and confounding. All analyses accounted for the Behavioral Risk Factor Surveillance System complex survey sampling design. RESULTS: Overall, participants who reported having insurance coverage were more than twice as likely to report being screened for CRC compared with those who reported having none [crude POR, 2.16; 95% confidence interval (95% CI), 1.26-3.68]. This relationship differed between men and women (POR(males), 3.37; 95% CI, 1.63-6.96; POR(females), 1.46; 95% CI, 0.74-2.89). After adjusting for age and income, self-reported insurance coverage had a positive association with report of being screened among men (POR, 2.02; 95% CI, 0.96-4.23) but not among women (POR, 0.81; 95% CI, 0.34-1.93). CONCLUSIONS: Men who reported having health insurance were more likely to report having CRC screening than those who reported not having insurance coverage. However, this effect was not observed in women. These findings, if confirmed in other study populations, indicate that improving CRC screening coverage may require not only insurance status specifications but also gender-explicit considerations.

Potential impact of infant feeding recommendations on mortality and HIV-infection in children born to HIV-infected mothers in Africa: a simulation.

BACKGROUND: Although breast-feeding accounts for 15-20% of mother-to-child transmission (MTCT) of HIV, it is not prohibited in some developing countries because of the higher mortality associated with not breast-feeding. We assessed the potential impact, on HIV infection and infant mortality, of a recommendation for shorter durations of exclusive breast-feeding (EBF) and poor compliance to these recommendations. METHODS: We developed a deterministic mathematical model using primarily parameters from published studies conducted in Uganda or Kenya and took into account non-compliance resulting in mixed-feeding practices. Outcomes included the number of children HIV-infected and/or dead (cumulative mortality) at 2 years following each of 6 scenarios of infant-feeding recommendations in children born to HIV-infected women: Exclusive replacement-feeding (ERF) with 100% compliance, EBF for 6 months with 100% compliance, EBF for 4 months with 100% compliance, ERF with 70% compliance, EBF for 6 months with 85% compliance, EBF for 4 months with 85% compliance RESULTS: In the base model, reducing the duration of EBF from 6 to 4 months reduced HIV infection by 11.8% while increasing mortality by 0.4%. Mixed-feeding in 15% of the infants increased HIV infection and mortality respectively by 2.1% and 0.5% when EBF for 6 months was recommended; and by 1.7% and 0.3% when EBF for 4 months was recommended. In sensitivity analysis, recommending EBF resulted in the least cumulative mortality when the a) mortality in replacement-fed infants was greater than 50 per 1000 person-years, b) rate of infection in exclusively breast-fed infants was less than 2 per 1000 breast-fed infants per week, c) rate of progression from HIV to AIDS was less than 15 per 1000 infected infants per week, or d) mortality due to HIV/AIDS was less than 200 per 1000 infants with HIV/AIDS per year. CONCLUSION: Recommending shorter durations of breast-feeding in infants born to HIV-infected women in these settings may substantially reduce infant HIV infection but not mortality. When EBF for shorter durations is recommended, lower mortality could be achieved by a simultaneous reduction in the rate of progression from HIV to AIDS and or HIV/AIDS mortality, achievable by the use of HAART in infants.

Trichomonas vaginalis infection in male sexual partners: implications for diagnosis, treatment, and prevention.

BACKGROUND: Trichomonas vaginalis causes a common sexually transmitted infection (STI) in women, yet trichomoniasis in male sexual partners is not well recognized. Nucleic acid amplification tests can increase detection of T. vaginalis in men compared with culture. METHODS: We conducted a prospective, multicenter study to evaluate T. vaginalis infection among male partners of women with trichomoniasis and factors associated with infection by recruiting patients from 3 public clinics in the United States. Male partners were tested for concordant T. vaginalis infection, defined as a positive urethral culture, urine culture, or urine polymerase chain reaction (PCR) result. A subset of men also provided a semen sample for T. vaginalis culture and PCR. Factors associated with concordant infection were determined from bivariable and multivariable analyses. RESULTS: We enrolled 540 women with trichomoniasis (diagnosed using wet mount microscopy and/or culture) and 261 (48.4%) of their male partners. T. vaginalis infection was detected in 177 (71.7%) of 256 male partners (95% confidence interval [CI], 66.0%-77.3%), of whom 136 (77.3%) were asymptomatic. A vaginal pH of >4.5 in a woman was independently associated with infection in the male partner (adjusted odds ratio, 2.5; 95% CI, 1.0-6.3). Younger male age (20-29 and 30-39 years) was also found to be an independent risk factor for concordant trichomoniasis. CONCLUSIONS: The majority of male partners of women with trichomoniasis were infected; however, few factors predicted infection. T. vaginalis causes a highly prevalent STI, necessitating vastly improved partner management, application of sensitive nucleic-acid based testing, and better clinical recognition.

Strategies for developing sustainable health research capacity in low and middle-income countries: a prospective, qualitative study investigating the barriers and enablers to locally led clinical trial conduct in Ethiopia, Cameroon and Sri Lanka.

OBJECTIVES: In 2013, the WHO stated that unless low-income and middle-income countries (LMICs) become producers of research, health goals would be hard to achieve. Among the capacities required to build a local evidence base, ability to conduct clinical trials is important. There is no evidence-based guidance for the best ways to develop locally led trial capacity. This research aims to identify the barriers and enablers to locally led clinical trial conduct in LMICs and determine strategies for their sustainable development. DESIGN: Prospective, multiple case study design consisting of interviews (n=34), focus group discussions (n=13) and process mapping exercises (n=10). SETTING: Case studies took place in Ethiopia (2011), Cameroon (2012) and Sri Lanka (2013). PARTICIPANTS: Local health researchers with previous experiences of clinical trials or stakeholders with an interest in trials were purposively selected through registration searches and snowball sampling (n=100). PRIMARY AND SECONDARY OUTCOME MEASURES: Discussion notes and transcripts were analysed using thematic coding analysis. Key themes and mechanisms were identified. RESULTS: Institutions and individuals were variably successful at conducting trials, but there were strong commonalities in the barriers and enablers across all levels and functions of the research systems. Transferable mechanisms were summarised into the necessary conditions for trial undertaking, which included: awareness of research, motivation, knowledge and technical skills, leadership capabilities, forming collaborations, inclusive trial operations, policy relevance and uptake and macro and institutional strengthening. CONCLUSIONS: Barriers and enablers to locally led trial undertaking exist at all levels and functions of LMIC research systems. Establishing the necessary conditions to facilitate this research will require multiple, coordinated interventions that seek to resolve them in a systemic manner. The strategies presented in the discussion provide an evidence-based framework for a self-sustaining capacity development approach. This represents an important contribution to the literature that will be relevant for research funders, users and producers.