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Mboussou F, Ndoula ST, Nembot R, Baonga SF, Njinkeu A, Njoh AA, Biey JNM, Kaba MII, Amani A, Farham B, Habimana P, Impouma B. Setting up a data system for monitoring malaria vaccine introduction readiness and uptake in 42 health districts in Cameroon. BMJ Glob Health 2024; 9:e015312. [PMID: 38580377 PMCID: PMC11002407 DOI: 10.1136/bmjgh-2024-015312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 03/14/2024] [Indexed: 04/07/2024] Open
Abstract
Three months after the first shipment of RTS,S1/AS01 vaccines, Cameroon started, on 22 January 2024, to roll out malaria vaccines in 42 districts among the most at risk for malaria. Cameroon adopted and implemented the World Health Organization (WHO) malaria vaccine readiness assessment tool to monitor the implementation of preintroduction activities at the district and national levels. One week before the start of the vaccine rollout, overall readiness was estimated at 89% at a national level with two out of the five components of readiness assessment surpassing 95% of performance (vaccine, cold chain and logistics and training) and three components between 80% and 95% (planning, monitoring and supervision, and advocacy, social mobilisation and communication). 'Vaccine, cold chain and logistics' was the component with the highest number of districts recording below 80% readiness. The South-West and North-West, two regions with a high level of insecurity, were the regions with the highest number of districts that recorded a readiness performance below 80% in the five components. To monitor progress in vaccine rollout daily, Cameroon piloted a system for capturing immunisation data by vaccination session coupled with an interactive dashboard using the R Shiny platform. In addition to displaying data on vaccine uptake, this dashboard allows the generation of the monthly immunisation report for all antigens, ensuring linkage to the regular immunisation data system based on the end-of-month reporting through District Health Information Software 2. Such a hybrid system complies with the malaria vaccine rollout principle of full integration into routine immunisation coupled with strengthened management of operations.
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Affiliation(s)
- Franck Mboussou
- Vaccine Preventable Diseases, World Health Organization Regional Office for Africa, Brazzaville, Congo
| | | | - Raoul Nembot
- Ministry of Public Health, Yaounde, Centre, Cameroon
| | | | - Arnaud Njinkeu
- World Health Organization Country Office for Cameroon, Yaounde, Cameroon
| | - Andreas Ateke Njoh
- Ministry of Public Health, Yaounde, Centre, Cameroon
- 4School of Global Health and Bioethics, Euclid University, Bangui, Central African Republic
| | - Joseph Nsiari-Muzeyi Biey
- Vaccine Preventable Diseases, World Health Organization Regional Office for Africa, Brazzaville, Congo
| | - Mohamed II Kaba
- World Health Organization Country Office for Cameroon, Yaounde, Cameroon
| | - Adidja Amani
- Vaccine Preventable Diseases, World Health Organization Regional Office for Africa, Brazzaville, Congo
| | - Bridget Farham
- Communicable and Non Communicable Disease Cluster, World Health Organization Regional Office for Africa, Brazzaville, Brazzaville, Congo
| | - Phanuel Habimana
- World Health Organization Country Office for Cameroon, Yaounde, Cameroon
| | - Benido Impouma
- Communicable and Non Communicable Disease Cluster, World Health Organization Regional Office for Africa, Brazzaville, Brazzaville, Congo
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OUÉDRAOGO TDA, BADOLO O, SAWADOGO Y. [Reduction in malaria case-fatality rate after implementation of an emergency plan for improved case management in the Bittou health district, Burkina Faso]. MEDECINE TROPICALE ET SANTE INTERNATIONALE 2024; 4:mtsi.v4i1.2024.495. [PMID: 38846124 PMCID: PMC11151928 DOI: 10.48327/mtsi.v4i1.2024.495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 01/31/2024] [Indexed: 06/09/2024]
Abstract
Objective To observe the evolution in malaria case-fatality rate among children under 5 years of age receiving care at the Bittou district hospital (CMA) after an improvement of the care practices. The management team implemented an emergency plan in 2016 with 5 components: i) health facilities staff sensitization to enable rapid referral of severe malaria cases to CMA; ii) reorganization of CMA paediatric emergencies to make a physician as the mainpoint of contact; iii) ensuring availability of supplies for severe malaria case management, including the availability of blood; iv) daily medical check-ups of hospitalized patients; v) reinforcement of clinical staff skills at all peripheral health facilities. At the same time were introduced i) free care for children under 5 years; ii) municipality involvement to finance ambulance fuel for the referrals of patients; iii) free blood collection in professional schools and soldiers; iv) a free telephone line between the health structures; v) presence of 5 medical doctors at the CMA. Material and methods Analysis of data collected from the statistical yearbooks of the Ministry of Health of Burkina Faso from 2014 to 2021. Results The malaria case-fatality rate (CFR) in under-five in the Bittou health district (1.39% and 1.52% in 2014 and 2015) was higher than the average for all districts in this region (1.08%). After implementation of the emergency plan, the malaria CFR in Bittou declined to 0% in 2016 and 2017, 0.2% in 2018, 0% in 2019, 0.07% in 2020 and 0.05% in 2021. The same trend was observed at the CMA level with 2.94% and 2.59% in 2014 and 2015, 0% in 2016 and 2017, 0.38% in 2018, 0% in 2019, then 0.17% and 0.47% in 2020 and 2021. Conclusion Malaria control remains a challenge in Burkina Faso. However, the improved malaria CFRs observed in Bittou show that effective involvement of health district teams could potentially contribute to substantial reductions in malaria case-fatality risk.
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Affiliation(s)
| | - Ousmane BADOLO
- U.S. President's Malaria Initiative (PMI) Integrated Family Health Service Project
| | - Youssouf SAWADOGO
- U.S. President's Malaria Initiative (PMI) Integrated Family Health Service Project
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Ndoula ST, Mboussou F, Njoh AA, Nembot R, Baonga SF, Njinkeu A, Biey J, Kaba MII, Amani A, Farham B, Kouontchou Mimbe JC, Kouakam CA, Volkmann K, Dadjo CH, Habimana P, Impouma B. Malaria Vaccine Introduction in Cameroon: Early Results 30 Days into Rollout. Vaccines (Basel) 2024; 12:346. [PMID: 38675729 PMCID: PMC11055092 DOI: 10.3390/vaccines12040346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 03/14/2024] [Accepted: 03/19/2024] [Indexed: 04/28/2024] Open
Abstract
Cameroon introduced the malaria vaccine in its routine immunization program on 22 January 2024 in the 42 districts out of 200 that are among the most at risk of malaria. A cross-sectional analysis of the data on key vaccine events in the introduction roadmap and the vaccine uptake during the first 30 days was conducted. In addition to available gray literature related to the introduction of the malaria vaccine, data on the malaria vaccine uptake by vaccination session, collected through a digital platform, were analyzed. A total of 1893 reports were received from 22 January 2024 to 21 February 2024 from 766 health facilities (84% of overall completeness). Two regions out of ten recorded less than 80% completeness. As of 21 February 2024, 13,811 children had received the first dose of the malaria vaccine, including 7124 girls (51.6%) and 6687 boys (48.4%). In total, 36% of the children were vaccinated through outreach sessions, while 61.5% were vaccinated through sessions in fixed posts. The overall monthly immunization coverage with the first dose was 37%. Early results have shown positive attitudes towards and acceptance of malaria vaccines. Suboptimal completeness of data reporting and a low coverage highlight persistent gaps and challenges in the vaccine rollout.
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Affiliation(s)
- Shalom Tchokfe Ndoula
- Expanded Program on Immunization, Ministry of Public Health, Yaoundé P.O. Box 1937, Cameroon
| | - Frank Mboussou
- World Health Organization Regional Office for Africa, Brazzaville P.O. Box 06, Congo
| | - Andreas Ateke Njoh
- Expanded Program on Immunization, Ministry of Public Health, Yaoundé P.O. Box 1937, Cameroon
- School of Global Health and Bioethics, Euclid University, Bangui P.O. Box 157, Central African Republic
| | - Raoul Nembot
- Expanded Program on Immunization, Ministry of Public Health, Yaoundé P.O. Box 1937, Cameroon
| | | | - Arnaud Njinkeu
- World Health Organization Country Office, P.O. Box 155 Yaoundé, Cameroon
| | - Joseph Biey
- World Health Organization Regional Office for Africa, Brazzaville P.O. Box 06, Congo
| | - Mohamed II Kaba
- World Health Organization Country Office, P.O. Box 155 Yaoundé, Cameroon
| | - Adidja Amani
- World Health Organization Regional Office for Africa, Brazzaville P.O. Box 06, Congo
| | - Bridget Farham
- World Health Organization Regional Office for Africa, Brazzaville P.O. Box 06, Congo
| | | | - Christian Armel Kouakam
- Expanded Program on Immunization, Ministry of Public Health, Yaoundé P.O. Box 1937, Cameroon
| | - Konstantin Volkmann
- World Health Organization Regional Office for Africa, Brazzaville P.O. Box 06, Congo
| | - Crépin Hilaire Dadjo
- World Health Organization Regional Office for Africa, Brazzaville P.O. Box 06, Congo
| | - Phanuel Habimana
- World Health Organization Country Office, P.O. Box 155 Yaoundé, Cameroon
| | - Benido Impouma
- World Health Organization Regional Office for Africa, Brazzaville P.O. Box 06, Congo
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Hadjilaou A, Brandi J, Riehn M, Friese MA, Jacobs T. Pathogenetic mechanisms and treatment targets in cerebral malaria. Nat Rev Neurol 2023; 19:688-709. [PMID: 37857843 DOI: 10.1038/s41582-023-00881-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2023] [Indexed: 10/21/2023]
Abstract
Malaria, the most prevalent mosquito-borne infectious disease worldwide, has accompanied humanity for millennia and remains an important public health issue despite advances in its prevention and treatment. Most infections are asymptomatic, but a small percentage of individuals with a heavy parasite burden develop severe malaria, a group of clinical syndromes attributable to organ dysfunction. Cerebral malaria is an infrequent but life-threatening complication of severe malaria that presents as an acute cerebrovascular encephalopathy characterized by unarousable coma. Despite effective antiparasite drug treatment, 20% of patients with cerebral malaria die from this disease, and many survivors of cerebral malaria have neurocognitive impairment. Thus, an important unmet clinical need is to rapidly identify people with malaria who are at risk of developing cerebral malaria and to develop preventive, adjunctive and neuroprotective treatments for cerebral malaria. This Review describes important advances in the understanding of cerebral malaria over the past two decades and discusses how these mechanistic insights could be translated into new therapies.
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Affiliation(s)
- Alexandros Hadjilaou
- Protozoen Immunologie, Bernhard-Nocht-Institut für Tropenmedizin (BNITM), Hamburg, Germany.
- Institut für Neuroimmunologie und Multiple Sklerose, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany.
| | - Johannes Brandi
- Protozoen Immunologie, Bernhard-Nocht-Institut für Tropenmedizin (BNITM), Hamburg, Germany
| | - Mathias Riehn
- Protozoen Immunologie, Bernhard-Nocht-Institut für Tropenmedizin (BNITM), Hamburg, Germany
| | - Manuel A Friese
- Institut für Neuroimmunologie und Multiple Sklerose, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Jacobs
- Protozoen Immunologie, Bernhard-Nocht-Institut für Tropenmedizin (BNITM), Hamburg, Germany
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Lendongo Wombo JB, Ibinga E, Oyegue-Liabagui SL, Imboumy Limoukou RK, Okouga AP, Mounioko F, Maghendji-Nzondo S, Lekana-Douki JB, Ngoungou EB. Severe malaria in children and adolescents in Southeast Gabon. BMC Infect Dis 2023; 23:207. [PMID: 37024834 PMCID: PMC10080735 DOI: 10.1186/s12879-023-08133-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 03/02/2023] [Indexed: 04/08/2023] Open
Abstract
INTRODUCTION Malaria remains a significant public health problem in sub-Saharan Africa. Child mortality due to severe malaria remains high in developing countries despite improvements in malaria management and a better understanding of its pathophysiology. To address the lack of epidemiological studies on severe malaria in Gabon, this study describes the epidemiological aspects of severe malaria in rural, semi-rural, and urban areas of southeast Gabon. METHODS Demographic, clinical, and laboratory data for children and adolescents aged 0-18 years were collected in 2019 from hospital records at three health facilities in southeastern Gabon. The patients included in the study were positive for P falciparum malaria diagnosed by microscopy with at least one of the malaria severity criteria. RESULTS Severe malaria accounted for 18.8% (667/3552) of malaria cases. Children aged 0-5 years accounted for 71.8% (479/667) of all severe malaria cases. Adolescents over 15 years of age were the least affected by severe malaria with 4.2% (28/667). Across the study, severe anemia (49.0%, 327/667), convulsions (43.0%, 287/667), respiratory distress (5.1%, 34/667), and altered consciousness (4.8%, 32/667) were the most frequent clinical signs of severe malaria in children. Franceville was the locality most affected by severe malaria with 49.2% (328/667), followed by Koulamoutou with 42.0% (280/667) and Lastourville with 8.8% (59/667). Convulsions (50.6%, 166/328) and coma (6.1%, 20/328) were more frequent in children living in urban areas. In contrast, severe anemia (56.7%, 186/339) and jaundice (6.8%, 23/339) were more common in children living in semi-rural areas. CONCLUSION Severe malaria is more prevalent in urban areas in regions with a high malaria transmission intensity. However, in this study, the epidemiological characteristics of severe malaria were similar in the three settings (urban, rural, and semi-rural areas) despite different levels of urbanization. Nevertheless, the various signs of severity were more frequent in Franceville, an urban area. Children under 5 years of age remain the most vulnerable age group.
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Affiliation(s)
- Judicaël Boris Lendongo Wombo
- Department of Epidemiology, Biostatistics and Medical Informatic (DEBIM)/Research Unit in Epidemiology of Chronic Diseases and Environmental Health (UREMCSE), Faculty of Medicine, University of Health Sciences (USS), Owendo, Libreville, Gabon.
- Center of Epidemiology, Biostatistics, and Research Methodology-Gabon (CEBIMER-Gabon), Higher Institute of Medical Biology (ISBM), University of Health Sciences (USS), Owendo, Libreville, Gabon.
- Unit of Evolution, Epidemiology and Parasite Resistance (UNEEREP), Franceville Interdisciplinary Center for Medical Research (CIRMF), Franceville, Gabon.
- Central African Regional Doctoral School in Tropical Infectiology (ECODRAC), Franceville, Gabon.
- Centre Interdisciplinaire de Recherches Medicales de Franceville (CIRMF), Université des Sciences de la Santé (USS), Libreville, Gabon.
| | - Euloge Ibinga
- Department of Epidemiology, Biostatistics and Medical Informatic (DEBIM)/Research Unit in Epidemiology of Chronic Diseases and Environmental Health (UREMCSE), Faculty of Medicine, University of Health Sciences (USS), Owendo, Libreville, Gabon
- Center of Epidemiology, Biostatistics, and Research Methodology-Gabon (CEBIMER-Gabon), Higher Institute of Medical Biology (ISBM), University of Health Sciences (USS), Owendo, Libreville, Gabon
| | - Sandrine Lydie Oyegue-Liabagui
- Unit of Evolution, Epidemiology and Parasite Resistance (UNEEREP), Franceville Interdisciplinary Center for Medical Research (CIRMF), Franceville, Gabon
- Central African Regional Doctoral School in Tropical Infectiology (ECODRAC), Franceville, Gabon
- Department of Biology, Faculty of Science, Masuku University of Science and Technology (USTM), Franceville, Gabon
| | - Roméo Karl Imboumy Limoukou
- Unit of Evolution, Epidemiology and Parasite Resistance (UNEEREP), Franceville Interdisciplinary Center for Medical Research (CIRMF), Franceville, Gabon
| | - Alain Prince Okouga
- Unit of Evolution, Epidemiology and Parasite Resistance (UNEEREP), Franceville Interdisciplinary Center for Medical Research (CIRMF), Franceville, Gabon
| | - Franck Mounioko
- Centre Interdisciplinaire de Recherches Medicales de Franceville (CIRMF), Université des Sciences de la Santé (USS), Libreville, Gabon
- Department of Biology, Faculty of Science, Masuku University of Science and Technology (USTM), Franceville, Gabon
| | - Sydney Maghendji-Nzondo
- Department of Epidemiology, Biostatistics and Medical Informatic (DEBIM)/Research Unit in Epidemiology of Chronic Diseases and Environmental Health (UREMCSE), Faculty of Medicine, University of Health Sciences (USS), Owendo, Libreville, Gabon
- Center of Epidemiology, Biostatistics, and Research Methodology-Gabon (CEBIMER-Gabon), Higher Institute of Medical Biology (ISBM), University of Health Sciences (USS), Owendo, Libreville, Gabon
| | - Jean Bernard Lekana-Douki
- Unit of Evolution, Epidemiology and Parasite Resistance (UNEEREP), Franceville Interdisciplinary Center for Medical Research (CIRMF), Franceville, Gabon
- Department of Parasitology-Mycology, University of Health Sciences (USS), Libreville, Gabon
| | - Edgard Brice Ngoungou
- Department of Epidemiology, Biostatistics and Medical Informatic (DEBIM)/Research Unit in Epidemiology of Chronic Diseases and Environmental Health (UREMCSE), Faculty of Medicine, University of Health Sciences (USS), Owendo, Libreville, Gabon
- Center of Epidemiology, Biostatistics, and Research Methodology-Gabon (CEBIMER-Gabon), Higher Institute of Medical Biology (ISBM), University of Health Sciences (USS), Owendo, Libreville, Gabon
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Imboumy-Limoukou RK, Lendongo-Wombo JB, Nguimbyangue-Apangome AF, Biteghe Bi Essone JC, Mounioko F, Oyegue-Libagui LS, Ngoungou BE, Lekana-Douki JB. Severe malaria in Gabon: epidemiological, clinical and laboratory features in Amissa Bongo Hospital of Franceville. Malar J 2023; 22:88. [PMID: 36894964 PMCID: PMC9996888 DOI: 10.1186/s12936-023-04512-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 02/23/2023] [Indexed: 03/11/2023] Open
Abstract
BACKGROUND Malaria is the most deadly parasitic disease and continues to claim more than a half million of deaths across the world each year, mainly those of under-fives children in sub-Saharan Africa. The aim of this study was to determine the epidemiological, clinical and laboratory features of patients with severe malaria at the Centre Hospitalier Régional Amissa Bongo (CHRAB), a referral hospital in Franceville. METHODS It was an observational descriptive study conducted at CHRAB over 10 months. All admitted patients at the emergency ward of all ages presenting with positive test to falciparum malaria diagnosed by microscopy and rapid test with clinical signs of severe illness describe by World Health Organization were enrolled. RESULTS During this study, 1065 patients were tested positive for malaria, of them 220 had severe malaria. Three quarters (75.0%) were less than 5 years of age. The mean time to consultation was 3.5 ± 1 days. The most frequent signs of severity on admission were dominated by neurological disorders 92.27% (prostration 58.6% and convulsion 24.1%), followed by severe anemia 72.7%, hyperlactatemia 54.6%, jaundice 25% and respiratory distress 21.82%.The other forms such as hypoglycemia, haemoglobinuria, renal failure were found in low proportions < 10%. Twenty-one patients died, coma (aOR = 15.54, CI 5.43-44.41, p < 0.01), hypoglycemia (aOR = 15.37, CI 2.17-65.3, p < 0.01), respiratory distress (aOR = 3.85, CI 1.53-9.73, p = 0.004) and abnormal bleeding (aOR = 16.42, CI 3.57-104.73, p = 0.003) were identified as independent predictors of a fatal outcome. Anemia was associated with decreased mortality. CONCLUSION Severe malaria remains a public health problem affecting mostly children under 5 years. Classification of malaria helps identify the most severely ill patients and aids early and appropriate management of the severe malaria cases.
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Affiliation(s)
- Roméo Karl Imboumy-Limoukou
- Unité Ecologie Evolution et Résistances Parasitaires (UNEEREP), Centre International de Recherches Médicales de Francevillev, BP 769, Franceville, Gabon.
| | - Judicael Boris Lendongo-Wombo
- Unité Ecologie Evolution et Résistances Parasitaires (UNEEREP), Centre International de Recherches Médicales de Francevillev, BP 769, Franceville, Gabon.,Ecole Doctorale Régionale d'Afrique Centrale en Infectiologie Tropicale (ECODRAC), Université Des Sciences Et Techniques de Masuku, BP 876, Franceville, Gabon.,Département d'épidémiologie, Biostatistiques Et Informatique Médicale, Université Des Sciences de La Santé (USS), BP 18231, Libreville, Gabon
| | - Andhra Fecilia Nguimbyangue-Apangome
- Unité Ecologie Evolution et Résistances Parasitaires (UNEEREP), Centre International de Recherches Médicales de Francevillev, BP 769, Franceville, Gabon
| | - Jean-Claude Biteghe Bi Essone
- Unité Ecologie Evolution et Résistances Parasitaires (UNEEREP), Centre International de Recherches Médicales de Francevillev, BP 769, Franceville, Gabon
| | - Franck Mounioko
- Unité Ecologie Evolution et Résistances Parasitaires (UNEEREP), Centre International de Recherches Médicales de Francevillev, BP 769, Franceville, Gabon.,Département de Biologie, Université Des Sciences Et Techniques de Masuku (USTM), BP 901, Franceville, Gabon
| | - Lydie Sandrine Oyegue-Libagui
- Unité Ecologie Evolution et Résistances Parasitaires (UNEEREP), Centre International de Recherches Médicales de Francevillev, BP 769, Franceville, Gabon.,Ecole Doctorale Régionale d'Afrique Centrale en Infectiologie Tropicale (ECODRAC), Université Des Sciences Et Techniques de Masuku, BP 876, Franceville, Gabon.,Département de Biologie, Université Des Sciences Et Techniques de Masuku (USTM), BP 901, Franceville, Gabon
| | - Brice Edgar Ngoungou
- Département d'épidémiologie, Biostatistiques Et Informatique Médicale, Université Des Sciences de La Santé (USS), BP 18231, Libreville, Gabon
| | - Jean-Bernard Lekana-Douki
- Unité Ecologie Evolution et Résistances Parasitaires (UNEEREP), Centre International de Recherches Médicales de Francevillev, BP 769, Franceville, Gabon.,Département de Parasitologie-Mycologie, Université Des Sciences de La Santé, BP 18231, Libreville, Gabon
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Sarfo JO, Amoadu M, Kordorwu PY, Adams AK, Gyan TB, Osman AG, Asiedu I, Ansah EW. Malaria amongst children under five in sub-Saharan Africa: a scoping review of prevalence, risk factors and preventive interventions. Eur J Med Res 2023; 28:80. [PMID: 36800986 PMCID: PMC9936673 DOI: 10.1186/s40001-023-01046-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 02/06/2023] [Indexed: 02/19/2023] Open
Abstract
INTRODUCTION Africa has a higher burden of malaria-related cases and deaths globally. Children under five accounted for over two-thirds of all malaria deaths in sub-Saharan Africa (SSA). This scoping review aims to map evidence of the prevalence, contextual factors and health education interventions of malaria amongst children under 5 years (UN5) in SSA. METHOD Four main databases (PubMed, Central, Dimensions and JSTOR) produced 27,841 records of literature. Additional searches in Google, Google Scholar and institutional repositories produced 37 records. Finally, 255 full-text records were further screened, and 100 records were used for this review. RESULTS Low or no formal education, poverty or low income and rural areas are risk factors for malaria amongst UN5. Evidence on age and malnutrition as risk factors for malaria in UN5 is inconsistent and inconclusive. Furthermore, the poor housing system in SSA and the unavailability of electricity in rural areas and unclean water make UN5 more susceptible to malaria. Health education and promotion interventions have significantly reduced the malaria burden on UN5 in SSA. CONCLUSION Well-planned and resourced health education and promotion interventions that focus on prevention, testing and treatment of malaria could reduce malaria burden amongst UN5 in SSA.
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Affiliation(s)
- Jacob Owusu Sarfo
- grid.413081.f0000 0001 2322 8567University of Cape Coast, Cape Coast, Ghana
| | | | - Peace Yaa Kordorwu
- grid.413081.f0000 0001 2322 8567University of Cape Coast, Cape Coast, Ghana
| | - Abdul Karim Adams
- grid.413081.f0000 0001 2322 8567University of Cape Coast, Cape Coast, Ghana
| | | | - Abdul-Ganiyu Osman
- grid.413081.f0000 0001 2322 8567University of Cape Coast, Cape Coast, Ghana
| | - Immanuel Asiedu
- grid.413081.f0000 0001 2322 8567University of Cape Coast, Cape Coast, Ghana
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8
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Chi NN, Nyasa RB, Jane-Francis A. Knowledge, attitude and practices of community health workers on managing and preventing childhood malaria and diarrhea in Fako Division, South West Region, Cameroon; A mixed method study. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001093. [PMID: 36962984 PMCID: PMC10021294 DOI: 10.1371/journal.pgph.0001093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 01/21/2023] [Indexed: 02/25/2023]
Abstract
In developing countries, childhood malaria and diarrhea are among the 5 leading causes of death among children under five years; the use of community health workers (CHWs) to manage these diseases has shown some degree of success. A descriptive cross-sectional study was conducted to assess knowledge, attitude and practices (KAP) of CHWs on the management and prevention of childhood malaria and diarrhea in Fako Division, South-West Region, Cameroon. A pretested questionnaire was administered to eighty CHWs in Fako Division. Three focus group discussions (FGDs) were conducted with 29 CHWs. The Chi-Square and Spearman Correlation tests were used to investigate the association between socio-demographic characteristics with CHWs' KAP on childhood malaria and diarrhea management and prevention. A total of 52.5% of the participants had good knowledge, negative attitudes (65.0%), and carried out poor practices (60.0%) on the management and prevention of childhood malaria. Up to 8.75% CHWs did not know the first-line antimalarial drug used in Cameroon. More than half (57.5%) of participants had poor knowledge, 70.0% had a negative attitude and 82.25% carried out good practices on the management and prevention of childhood diarrhea. 47.6% of CHWs used a mixture of guava leaves and 'masepo' (Ocimum gratissimum) as treatment for childhood diarrhea. Level of education (p = 0.028) and Health District (p = 0.026) were significantly associated with practices on management and prevention of childhood diarrhea. CHWs had inadequate knowledge, poor attitude, and practices on childhood malaria management. Even though a majority of CHWs carried out good practices for diarrhea management, their knowledge and attitude were poor. Therefore, there is a need for training to improve CHWs' knowledge, attitude and practices on childhood malaria and diarrhea management.
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Affiliation(s)
- Ndum Naomi Chi
- Department of Microbiology and Parasitology, University of Buea, Buea, Cameroon
| | - Raymond Babila Nyasa
- Department of Microbiology and Parasitology, University of Buea, Buea, Cameroon
- Faculty of Science, Biotechnology Unit, University of Buea, Buea, South West Region, Cameroon
| | - Akoachere Jane-Francis
- Department of Microbiology and Parasitology, University of Buea, Buea, Cameroon
- Faculty of Science, Department of Microbiology and Parasitology, University of Buea, Buea, Cameroon
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Kruger M, van Elsland SL, Afungchwi GM, Bardin R, Njodzeka B, Kouya F, Nfor P, Nana P, Wharin P, Hesseling PB. Outcome of retinoblastoma treatment protocol in Cameroon as per SIOP-PODC recommendation for a low-income setting. Pediatr Blood Cancer 2022; 69:e29642. [PMID: 35403812 DOI: 10.1002/pbc.29642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 01/27/2022] [Accepted: 02/07/2022] [Indexed: 11/12/2022]
Abstract
INTRODUCTION The International Society of Paediatric Oncology-Paediatric Oncology in Developing Countries (SIOP-PODC) group recommended graduated-intensity retinoblastoma treatment for children in low- and middle-income countries with limited local resources. AIM The aim was to improve outcome of children with retinoblastoma by means of a treatment protocol for low-income settings as recommended by the SIOP-PODC recommendation in Cameroon. METHODS Children diagnosed with retinoblastoma between 2012 and 2016 were treated in two Baptist Mission hospitals in Cameroon, staging according to the International Retinoblastoma Staging System. Treatment included local therapy and combination chemotherapy (vincristine, cyclophosphamide, and doxorubicin) with or without surgery as per SIOP-PODC guidelines for low-income countries. Endpoint was survival at 24 months. Kaplan-Meier curves with log-rank (Mantel-Cox) chi-square (χ2 ) with respective p-values were prepared. RESULTS Eighty-two children were included, of whom 79.3% had unilateral disease. The majority were males (61.0%) with median age 24 months (range 1-112 months; standard deviation [SD] 19). Limited disease was diagnosed in 58.5%, metastatic disease in 35.4%, and unknown stage in 6.1%. Overall survival (OS) was 50.0% at 24 months post diagnosis, but 68.8% for limited disease. Estimated cumulative survival at 24 months was 0.528 (standard error [SE] 0.056). Causes of death included disease progression/relapses (60.5%), neutropenic sepsis (15.9%), unknown causes (18.4%), unrelated infection (2.6%), and death post surgery (2.6%). Stage was significantly associated with OS (p < .001). CONCLUSION Stage was the most significant factor for good OS and demonstrated the efficacy and feasibility of the SIOP-PODC-proposed management guidelines for retinoblastoma in a lower middle-income setting.
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Affiliation(s)
- Mariana Kruger
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Sabine L van Elsland
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Glenn M Afungchwi
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa.,Cameroon Baptist Convention Health Services, Mbingo Baptist Hospital and Baptist Hospital Mutengene, Mutengene, Cameroon
| | - Richard Bardin
- Cameroon Baptist Convention Health Services, Mbingo Baptist Hospital and Baptist Hospital Mutengene, Mutengene, Cameroon
| | - Bernard Njodzeka
- Cameroon Baptist Convention Health Services, Mbingo Baptist Hospital and Baptist Hospital Mutengene, Mutengene, Cameroon
| | - Francine Kouya
- Cameroon Baptist Convention Health Services, Mbingo Baptist Hospital and Baptist Hospital Mutengene, Mutengene, Cameroon
| | - Patience Nfor
- Cameroon Baptist Convention Health Services, Mbingo Baptist Hospital and Baptist Hospital Mutengene, Mutengene, Cameroon
| | - Philippa Nana
- Cameroon Baptist Convention Health Services, Mbingo Baptist Hospital and Baptist Hospital Mutengene, Mutengene, Cameroon
| | - Paul Wharin
- Beryl Thyer Memorial Africa Trust, Warkton, UK
| | - Peter B Hesseling
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
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10
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Chelo D, Nguefack F, Enyama D, Nansseu R, Feudjo Tefoueyet G, Mbassi Awa HD, Mekone Nkwelle I, Nguefack-Tsague G, Ndenbe P, Koki Ndombo PO. Impact and projections of the COVID-19 epidemic on attendance and routine vaccinations at a pediatric referral hospital in Cameroon. Arch Pediatr 2021; 28:441-450. [PMID: 34140219 PMCID: PMC8188383 DOI: 10.1016/j.arcped.2021.05.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 03/05/2021] [Accepted: 05/16/2021] [Indexed: 12/23/2022]
Abstract
Background At the beginning of March 2020, Cameroon experienced its first cases of infection with the new coronavirus (SARS-COV-2). Very quickly, there was a drop in the rate of hospital attendance. The purpose of this study was to observe the variations in the uptake of pediatric consultations and vaccinations in a pediatric hospital. Methods A descriptive and retrospective cross-sectional study was carried out using consultation and vaccination statistics from a pediatric hospital in the city of Yaoundé, political capital of Cameroon, from January 2016 to May 2020. Data were entered in Microsoft Excel and exported to R software (Version 3.3.3) for statistical analysis. First, time series raw data (before and after COVID-19) were plotted and the trend estimated by locally weighted scatterplot smoothing (LOWESS) methods. Then a classic seasonal decomposition was performed to distinguish between seasonal trends and irregular components using moving averages. The Webel–Ollech overall seasonality test (WO test) was also run to formally check for seasonality. The results of the study are presented as narrative tables and graphs. Results Following the partial confinement recommended by the government of Cameroon, the number of pediatric consultations decreased by 52% in April and by 34% in May 2020 compared with rates during the same periods in 2019 (P = 0.00001). For antenatal visits, the rates dropped by 45% and 34%, respectively, in April and May 2020 compared with 2019. The demand for immunization services also declined. As a result, the demand for BCG vaccines, third-dose tracer vaccines (diphtheria, tetanus, pertussis), polio, and MMR in children as well as tetanus vaccines in childbearing women dropped significantly. Conclusion The start of the COVID-19 pandemic was accompanied by a significant drop in consultation and vaccination activities. If no action is taken to correct this phenomenon, the ensuing months could be marked by a considerable increase in patients, sometimes suffering from vaccine-preventable diseases. The death rate could increase considerably in the pediatric population.
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Affiliation(s)
- D Chelo
- Mother and Child Center Chantal BIYA Foundation, Yaoundé, Cameroon; Department of Pediatrics, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon.
| | - F Nguefack
- Department of Pediatrics, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | - D Enyama
- Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon
| | - R Nansseu
- Department of Public Health, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | - G Feudjo Tefoueyet
- Department of Public Health, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | - H D Mbassi Awa
- Mother and Child Center Chantal BIYA Foundation, Yaoundé, Cameroon; Department of Pediatrics, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | - I Mekone Nkwelle
- Department of Pediatrics, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | - G Nguefack-Tsague
- Department of Public Health, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | - P Ndenbe
- Department of Pediatrics, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | - P O Koki Ndombo
- Mother and Child Center Chantal BIYA Foundation, Yaoundé, Cameroon; Department of Pediatrics, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
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11
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Chelo D, Mekone Nkwelle I, Nguefack F, Mbassi Awa HD, Enyama D, Nguefack S, Noukeu Njinkui D, Tony Nengom J, Nguefack-Tsague G, Koki Ndombo PO. Decrease in Hospitalizations and Increase in Deaths during the Covid-19 Epidemic in a Pediatric Hospital, Yaounde-Cameroon and Prediction for the Coming Months. Fetal Pediatr Pathol 2021; 40:18-31. [PMID: 33078968 DOI: 10.1080/15513815.2020.1831664] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
The COVID-19 pandemic reached Cameroon in March, 2020. The aim of this study was to unveil the consequences of this pandemic on hospitalizations and on mortality in a pediatric hospital. Methods: A descriptive and retrospective cross-sectional study was carried out using hospitalization and death statistics collected from a pediatric hospital. We compared the data before and after the pandemic and made predictions for the next 12 months. Results: A drastic drop in hospitalizations was noted coinciding with the partial lockdown in Cameroon. Paradoxically, at the same time, the number of deaths per month doubled though the causes remained the same as in the past. Conclusion: The COVID-19 pandemic was marked by drop in hospitalizations and paradoxically, an increase in child mortality. These deaths were probably due not to SARS-Cov-2 infection, but rather due to the usual illnesses whose management was delayed, a probable consequence of the confinement.
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Affiliation(s)
- David Chelo
- Mother and Child Center, Chantal BIYA Foundation, Yaoundé, Cameroon.,Department de Pediatrics, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaounde, Cameroon
| | - Isabelle Mekone Nkwelle
- Department de Pediatrics, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaounde, Cameroon
| | - Félicitée Nguefack
- Department de Pediatrics, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaounde, Cameroon
| | - Hubert Désiré Mbassi Awa
- Mother and Child Center, Chantal BIYA Foundation, Yaoundé, Cameroon.,Department de Pediatrics, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaounde, Cameroon
| | - Dominique Enyama
- Faculty de Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroun
| | - Séraphin Nguefack
- Department de Pediatrics, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaounde, Cameroon
| | - Diomède Noukeu Njinkui
- Faculty de Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroun
| | - Jocelyn Tony Nengom
- Mother and Child Center, Chantal BIYA Foundation, Yaoundé, Cameroon.,Department de Pediatrics, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaounde, Cameroon
| | - Georges Nguefack-Tsague
- Department of Public Health, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | - Paul Olivier Koki Ndombo
- Mother and Child Center, Chantal BIYA Foundation, Yaoundé, Cameroon.,Department de Pediatrics, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaounde, Cameroon
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