Analysis of chlorhexidine, antibiotics and bacterial community composition in water environments from Brazil, Cameroon and Madagascar during the COVID-19 pandemic

The widespread of chlorhexidine and antibiotics in the water bodies, which grew during the global COVID-19 pandemic, can increase the dispersion of antibiotic resistance. We assessed the occurrence of these pharmaceutical compounds as well as SARS-CoV-2 and analysed the bacterial community structure of hospital and urban wastewaters from Brazil, Cameroon, and Madagascar. Water and wastewater samples (n = 59) were collected between January-June 2022. Chlorhexidine, azithromycin, levofloxacin, ceftriaxone, gentamicin and meropenem were screened by Ultra-High-Performance Liquid Chromatography coupled with mass spectrometer. SARS-CoV-2 was detected based on the nucleocapsid gene (in Cameroon and Madagascar), and envelope and spike protein-encoding genes (in Brazil). The total community-DNA was extracted and used for bacterial community analysis based on the 16S rRNA gene. To unravel likely interaction between pharmaceutical compounds and/or SARS-CoV-2 with the water bacterial community, multivariate statistics were performed. Chlorhexidine was found in hospital wastewater effluent from Brazil with a maximum concentration value of 89.28 μg/L. Additionally, antibiotic residues such as azithromycin and levofloxacin were also present at concentrations between 0.32-7.37 μg/L and 0.11-118.91 μg/L, respectively. In Cameroon, azithromycin was the most found antibiotic present at concentrations from 1.14 to 1.21 μg/L. In Madagascar instead, ceftriaxone (0.68-11.53 μg/L) and levofloxacin (0.15-0.30 μg/L) were commonly found. The bacterial phyla statistically significant different (P < 0,05) among participating countries were Proteobacteria, Patescibacteria and Dependentiae which were mainly abundant in waters sampled in Africa and, other phyla such as Firmicutes, Campylobacterota and Fusobacteriota were more abundant in Brazil. The phylum Caldisericota was only found in raw hospital wastewater samples from Madagascar. The canonical correspondence analysis results suggest significant correlation of azithromycin, meropenem and levofloxacin with bacteria families such as Enterococcaceae, Flavobacteriaceae, Deinococcaceae, Thermacetogeniaceae and Desulfomonilaceae, Spirochaetaceae, Methanosaetaceae, Synergistaceae, respectively. Water samples were also positive for SARS-CoV-2 with the lowest number of hospitalized COVID-19 patients in Madagascar (n = 7) and Brazil (n = 30). Our work provides new data about the bacterial community profile and the presence of pharmaceutical compounds in the hospital effluents from Brazil, Cameroon, and Madagascar, whose limited information is available. These compounds can exacerbate the spreading of antibiotic resistance and therefore pose a risk to public health.

The internal transcribed spacer 1 sequence polymorphism brings updates to tsetse species distribution in the northern Cameroon: Importance in planning efficient vector control

Vector control remains one of the best strategies to prevent the transmission of trypanosome infections in humans and livestock and, thus, a good way to achieve the elimination of human African trypanosomiasis and animal African trypanosomiasis. A key prerequisite for the success of any vector control strategy is the accurate identification and correct mapping of tsetse species. In this work, we updated the tsetse fly species identification and distribution in many geographical areas in Cameroon. Tsetse flies were captured from six localities in Cameroon, and their species were morphologically identified. Thereafter, DNA was extracted from legs of each tsetse fly and the length polymorphism of internal transcribed spacer-1 (ITS1) region of each fly was investigated using PCR. ITS1 DNA fragments of each tsetse species were sequenced. The sequences obtained were analysed and compared to those available in GenBank. This enabled to confirm/infirm results of the morphologic identification and then, to establish the phylogenetic relationships between tsetse species. Morphologic features allowed to clearly distinguish all the tsetse species captured in the South Region of Cameroon, that is, Glossina palpalis palpalis, G. pallicera, G. caliginea and G. nigrofusca. In the northern area, G. morsitans submorsitans could also be distinguished from G. palpalis palpalis, G. tachinoides and G. fuscipes, but these three later could not be distinguished with routine morphological characters. The ITS1 length polymorphism was high among most of the studied species and allowed to identify the following similar species with a single PCR, that is, G. palpalis palpalis with 241 or 242 bp and G. tachinoides with 221 or 222 bp, G. fuscipes with 236 or 237 bp. We also updated the old distribution of tsetse species in the areas assessed, highlighting the presence of G. palpalis palpalis instead of G. fuscipes in Mbakaou, or in sympatry with G. morsitans submorsitans in Dodeo (northern Cameroon). This study confirms the presence of G. palpalis palpalis in the Adamawa Region of Cameroon. It highlights the limits of using morphological criteria to differentiate some tsetse species. Molecular tools based on the polymorphism of ITS1 of tsetse flies can differentiate tsetse species through a simple PCR before downstream analyses or vector control planning.

Cooking mode and ripening stage influence physicochemical and nutritional properties of boiled plantain pulps

BACKGROUND

Plantains are of major importance in the diet of many African populations. Plantains undergo many processing techniques at different ripening stages. Boiling is the most common method of processing plantains in Cameroonian households. The present study was undertaken to evaluate the effect of cooking mode and ripening stage on the physicochemical and nutritional parameters of two Musa genotypes. Fruits from genotypes, Batard and CARBAP K74, at three ripening stages (unripe, semi-ripe and ripe) were studied. Physicochemical and nutritional analyses were performed on raw and cooked pulps with and without peel at different cooking times (from 10 to 60 min).

RESULTS

Significant variations (P < 0.05) were observed in the parameters assessed during cooking at each ripening stage according to cooking time. Plantain pulps boiled with peel exhibited high firmness (0.7-1.7 kgf), high soluble solids (7.4-22.4°Brix) and high dry matter content (29.8-38.3%) at all ripening stages. This cooking method yielded high protein (3.0-4.8%), lipid (0.2-1.8%), total starch (32-73%) and total carbohydrate (18-32%) contents. Boiling with or without peel had no significant effect (P > 0.05) on the pH of Batard pulps, nor the ash content of the pulps of both genotypes.

CONCLUSION

Irrespective of the ripening stages used, during cooking by immersion in boiling water, cooking with peel best preserves the physicochemical and nutritional parameters of the analysed genotypes. © 2023 The Authors. Journal of The Science of Food and Agriculture published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry.

Drivers of consumer acceptability of cassava gari-eba food products across cultural and environmental settings using the triadic comparison of technologies approach (tricot)

BACKGROUND

Nigeria and Cameroon are multi-ethnic countries with diverse preferences for food characteristics. The present study aimed to inform cassava breeders on consumer-prioritized eba quality traits. Consumer testing was carried out using the triadic comparison of technologies (tricot). Diverse consumers in villages, towns and cities evaluated the overall acceptability of eba made from different cassava genotypes. Data from both countries were combined and linked to laboratory analyses of eba and the gari used to make it.

RESULTS

There is a strong preference for eba with higher cohesiveness and eba from gari with higher brightness and especially in Cameroon, with lower redness and yellowness. Relatively higher eba hardness and springiness values are preferred in the Nigerian locations, whereas lower values are preferred in Cameroon. Trends for solubility and swelling power of the gari differ between the two countries. The study also reveals that the older improved cassava genotype TMS30572 is a benchmark genotype with superior eba characteristics across different regions in Nigeria, whereas the recently released variety Game changer performs very well in Cameroon. In both locations, the recently released genotypes Obansanjo-2 and improved variety TM14F1278P0003 have good stability and overall acceptability for eba characteristics.

CONCLUSION

The wide acceptance of a single genotype across diverse geographical and cultural conditions in Nigeria, as well as three acceptable new improved varieties in both locations, indicates that consumers' preferences are surprisingly homogeneous for eba. This would enhance breeding efforts to develop varieties with wider acceptability and expand potential target areas for released varieties. © 2023 The Authors. Journal of The Science of Food and Agriculture published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry.

Varietal diversity as a lever for cassava variety development: exploring varietal complementarities in Cameroon

BACKGROUND

Cassava is an important crop for the survival of smallholder farmers in Cameroon. However, the cassava sector has a low production per unit area compared to the technological potential in this country. In this context, breeders have developed varieties based mainly on their potential in terms of yield and disease resistance. These varieties have been widely disseminated in Cameroon within the framework of development projects. However, these releases have not achieved the expected adoption and yield levels at the national level. Therefore, it appears important to rethink the determinants of dissemination with a broader examination of the cassava production system.

RESULTS

This paper analyses varietal complementarity as a key strategy in support of optimizing the experimental and continuous use of cassava varieties by farmers in the Central and Eastern regions of Cameroon. These two regions account for 50% of the country's production. A total of 111 semi-structured interviews were conducted with farmers selected through purposive sampling in four villages in Central and Eastern Cameroon where improved varieties have been disseminated. The research revealed four types of complementarity, related to use, crop management, risk management and cultural complementarity.

CONCLUSION

Our results argue for considering varietal complementarities practiced by farmers, within research and development programs to develop more effective breeding and dissemination approaches. © 2023 The Authors. Journal of The Science of Food and Agriculture published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry.

User preferences and consumer acceptability of boiled plantain in rural and urban localities in Cameroon

BACKGROUND

An understanding of the preferences of different stakeholders in the plantain value chain in rural and urban segments in Cameroon is important for the selection and adoption of new plantain cultivars. Boiled plantain is one of the most commonly consumed food products from this crop in Cameroon. Gendered food mapping and consumer testing with two plantain landraces (Batard and Big Ebanga) and a plantain-like hybrid (CARBAP K74) was carried out in rural and urban areas in the West and Littoral regions of Cameroon.

RESULTS

Plantain users in these two regions were categorized into producers, traders, processors, and consumers. Preferences indicated that raw plantain should bear long and large fruits, with heavy bunches, and an orange pulp color, whereas boiled plantain should present with a yellow color and a soft and mealy pulp, with a good plantain aroma. Batard and Big Ebanga were liked moderately by consumers, whereas CARBAP K74 was liked slightly. CARBAP K74 was on par with Batard and Big Ebanga for some attributes, except for color and sweetness.

CONCLUSION

More emphasis should be given to attributes such as color, firmness, and taste for the development of new plantain clones to be adopted by end users consuming boiled green plantain. © 2023 The Authors. Journal of The Science of Food and Agriculture published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry.

Influence of contrasting cultivation altitudes on the physicochemical, digestive, and functional properties of four Musa starches produced in Cameroon

BACKGROUND

Bananas and plantains are important food sources for many people in the world. Their high starch content places them among the highest energy providers. This study aimed to determine the effects of altitude on banana starch properties in Cameroon. A dessert banana, a cooking banana, a plantain cultivar, and a plantain-like hybrid were grown at low and high altitudes (respectively at 80 m and 1300 m above sea level).

RESULTS

Starch analyses showed an increase in moisture and pH values against a drop in total titratable acidity and dry matter content with respect to altitude. Amylose content, as well as water absorption capacity, oil absorption capacity and syneresis of high-altitude plantain and plantain-like hybrid, were significantly higher. Starch digestibility was low and ranged between 13.4% and 37.9% after 2 h of incubation. High-altitude plantain starches contained more amylose and were more resistant to enzymatic hydrolysis.

CONCLUSION

Starches from CARBAP K74 and Kelong mekintu, grown at high altitude, showed good water and oil absorption capacities, low digestibility, and high resistance. The adequate properties of these banana starches predispose them for use as thickeners and gelling agents as well as ingredients for the formulation of low-calorie foods. This study highlights the importance of altitude when discussing banana and plantain starch properties. © 2023 The Authors. Journal of The Science of Food and Agriculture published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry.

Genetic and environmental effects on processing productivity and food product yield: drudgery of women's work

BACKGROUND

Cassava processing is a crucial source of livelihood for rural farmers and processors in Nigeria and Cameroon. This study investigated the varietal effect on the processing productivity of women farmer processors within their working environment and compared this with the food product quality as evaluated by the processors and the field yield. Field trials were established in Nigeria (Benue and Osun state) and Cameroon (Littoral region). Eight cassava genotypes were evaluated. These eight varieties included newly bred genotypes, commercial checks and varieties provided and preferred by the processors. The roots of these genotypes were harvested and processed into gari and eba by processors. The time of each processing step was recorded. Processors assessed the quality of the roots and food products using pairwise ranking.

RESULTS

In the field trials in Cameroon and Nigeria (Benue state), the newly bred genotypes showed superior performance in terms of dry matter content and fresh and dry yield. During processing, genotypes showed significant variation for most assessed parameters in both countries. Some newly bred varieties exhibited lower productivity that can make them more prone to drudgery than the local commercial checks and the varieties provided and preferred by the processors. Newly bred varieties were mostly ranked higher or equal to processors' preferred varieties concerning fresh root and food product quality. In the Cameroon location there were significant varietal differences in processing productivity and drudgery index which suggest that the particular processing methods there - such as pressing methods and fermentation time - cause these varietal differences to matter more.

CONCLUSIONS

The varieties that were tested were observed to differ in yield, product quality, processing productivity, and potential drudgery levels. Some breeders' germplasms displayed a combination of increased yields and good product quality and good processor productivity. Those varieties that showed low processor productivity should be avoided during selection to avoid increased labour burden and associated drudgery of women processors. Further research is recommended to enhance food product color, latent culinary qualities, and processing productivity of newly bred varieties to improve acceptability and reduce processing drudgery for women. © 2023 The Authors. Journal of The Science of Food and Agriculture published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry.

Irvingia gabonensis baill. (African Mango): A comprehensive review of its ethnopharmacological significance, unveiling its long-standing history and therapeutic potential

ETHNOPHARMACOLOGICAL RELEVANCE

Irvingia gabonensis (Aubry-Lecomte ex O'Rorke) Baill. (IG) is a multipurpose tree native to tropical Africa such as Equatorial Guinea, Nigeria, Gabon, and Cameroon with high ethnomedicinal values.

AIM OF THE STUDY

This review emphasizes the ethnopharmacological significance, phytochemical, and functional properties of African mango, focusing on its potential for human health and industrial applications.

MATERIALS AND METHODS

Literature published on IG was traced by different databases, including the Egyptian Knowledge Bank database (EKB), ScienceDirect, PubMed, Google Scholars, Research Gate, Web of Science, Elsevier, and Scopus. Numerous keywords were used to achieve an inclusive search in the databases, like 'African Mango', 'Bush Mango', 'Irvingia gabonensis', 'Wild Mango', 'Dika Nut', 'Phytochemistry', 'Traditional uses', 'Functional foods', 'Polyphenols', 'Ogbono', 'Ellagic acid and its derivatives', and 'Pharmacological activities'.

RESULTS

Different parts of IG have been employed in traditional medicine and recorded a great success. The ripe fruit pulp was consumed fresh or processed into juice and wine documented for anti-diarrheal, anti-diabetic, anti-ulcer, hepatoprotective, antimicrobial, and anti-inflammatory properties. The kernels, which are widely traded and incorporated into traditional dishes, remain an integral part of culinary traditions. Seeds have folkloric uses for weight loss and are popular as blood thinners and anti-diabetics. Where the bark is reported for dysentery, colic, scabies, toothache, and various skin conditions. In Senegal, the stem bark is employed for gonorrhea, hepatic disorders, and gastrointestinal ailments. The leaves possess the potential to enhance renal and hepatic functions, safeguarding these vital organs against the detrimental effects of toxic substances. Pulp is rich in vitamin C, carbohydrates, and proteins. Oil is the major constituent of the seed, which is mainly composed of myristic and lauric acids. The defatted extracts are characterized by flavonoid glycosides and ellagic acid derivatives. Despite their widespread use, IG extracts are still inadequately characterized phytochemically and merit further investigation within the realm of scientific research. Encouragingly, toxicity studies have demonstrated the relative safety of IG extract at the administered doses.

CONCLUSION

The review extends our knowledge of the health benefits of IG, where these effects could be attributed to the phytochemicals present.

The shifts in intergenerational relations in Cameroon and their potential impact on the health of older adults

INTRODUCTION

Africa is experiencing a gradual demographic shift due to rising life expectancy and increasing urbanisation. In sub-Saharan Africa, elderly individuals typically reside with their children. The rise in life expectancy by almost a decade and the prevalence of precarious living conditions raise concerns about the sustainability of the healthcare system, which has traditionally relied on intergenerational solidarity.

METHODS

The research aims to analyse the evolving role of older adults in Cameroonian society and to examine the potential impact of this change on intergenerational relationships and the health of older adults. A qualitative methodology was employed, using intergenerational focus groups in Cameroon.

RESULTS

Traditionally, older adults held a central role in knowledge transmission through discourse. However, the modernisation of society is challenging this position.The emergence of new technologies, particularly communication tools, is leading to a questioning of older adults' experiential knowledge. Societal changes are contributing to a decline in respect for older adults in discourse. Older adults deplore these societal changes and fear for their place in society while young people are questioning the central role of older people in society.

DISCUSSION

These changes could reduce the sense of usefulness of older people, with negative consequences for their health. Several studies have highlighted the impacts of ageism on the health of older adults in industrialised countries. However, there are little data on the impact of the marginalisation of older adults on their health in industrialising societies. Further research is needed to study the impact on the health of older adults.

Challenging diagnosis of Plasmodium ovale malaria in a Colombian traveler: the importance of including P. ovale wallikeri in molecular screening

This study reports a challenging diagnosis of Plasmodium ovale malaria in a Colombian citizen returning from Cameroon. Initial microscopy screenings conducted at two private hospitals yielded conflicting results, with the first showing negative smears and the second diagnosing P. vivax. Subsequent microscopy examinations at two government laboratories identified P. ovale, although the routine species-specific PCR strategy was negative. PCR confirmation was finally obtained when P. ovale wallikeri primers were used. Although P. ovale is not frequently found in Colombia, there is a clear need to include both P. ovale curtisi and P. ovale wallikeri in the molecular diagnostic strategy. Such need stems primarily from their extended latency period, which affects travelers, the increasing number of African migrants, and the importance of accurately mapping the distribution of Plasmodium species in Colombia.

Functional availability of medical oxygen for the management of hypoxaemia in Cameroon: A nationwide facility-based cross-sectional survey

Background

Medical oxygen is essential for managing hypoxaemia, which has a multifactorial origin, including acute and chronic lung diseases such as pneumonia, asthma, and severe malaria. The coronavirus disease 2019 (COVID-19) revealed substantial gaps in the availability and accessibility of safe medical oxygen, especially in low- and middle-income countries (LMICs). This study aimed to assess the availability and sources, as well as the barriers to the availability of functional medical oxygen in hospitals in Cameroon.

Methods

This was a nationwide cross-sectional descriptive study conducted from 26 March to 1 June 2021. Using a convenient sampling technique, we sampled accredited public and private COVID-19 treatment centres in all ten regions in Cameroon. Representatives from the selected hospitals were provided with a pre-designed questionnaire assessing the availability, type, and state of medical oxygen in their facilities. All analyses were performed using R.

Results

In total, 114 hospitals were included in this study, with functional medical oxygen available in 65% (74/114) of the hospitals. About 85% (23/27) of the reference hospitals and only 59% (51/87) of the district hospitals had available functional medical oxygen. Compared to district hospitals, reference hospitals were more likely to have central oxygen units (reference vs. district: 10 vs. 0%), oxygen cylinders (74 vs. 42%), and oxygen concentrators (79 vs. 51%). The most common barriers to the availability of medical oxygen were inadequate oxygen supply to meet needs (district vs. reference hospitals: 55 vs. 30%), long delays in oxygen bottle refills (51 vs. 49%), and long distances from oxygen suppliers (57 vs. 49%).

Conclusions

The availability of medical oxygen in hospitals in Cameroon is suboptimal and more limited in districts compared to reference hospitals. The cost of medical oxygen, delays related to refills and supplies, and long distances from medical sources were the most common barriers to availability in Cameroon.

Cosmic-ray exposure assessment using particle and heavy ion transport code system: case study Douala-Cameroon

According to UNSCEAR, cosmic radiation contributes to ~16% (0.39 mSv/y) of the total dose received by the public at sea level. The exposure to cosmic rays at a specific location is therefore a non-negligible parameter that contributes to the assessment of the overall public exposure to radiation. In this study, simulations were conducted with the Particle and Heavy Ion Transport code System, a Monte Carlo code, to determine the fluxes and effective dose due to cosmic rays received by the population of Douala. In minimum solar activity, the total effective dose considering the contribution of neutron, muon+, muon-, electron, positron and photon, was found to be 0.31 ± 0.02 mSv/y at the ground level. For maximum solar activity, it was found to be 0.27 ± 0.02 mSv/y at ground level. During maximum solar activity, galactic cosmic rays are reduced by solar flares and winds, resulting in an increase in the solar cosmic-ray component and a decrease in the galactic cosmic-ray component on Earth. This ultimately leads to a decrease in the total cosmic radiation on Earth. These results were found to be smaller than the UNSCEAR values, thus suggesting a good estimation for the population of Douala city located near the equatorial line. In fact, the cosmic radiation is more deflected at the equator than near the pole. Muons+ were found to be the main contributors to human exposure to cosmic radiation at ground level, with ~38% of the total effective dose due to cosmic exposure. However, electrons and positrons were found to be the less contributors to cosmic radiation exposure. As regards the obtained results, the population of Douala is not significantly exposed to cosmic radiation.

Does health voucher intervention increase antenatal consultations and skilled birth attendances in Cameroon? Results from an interrupted time series analysis

BACKGROUND

Limited access to health services during the antenatal period and during childbirth, due to financial barriers, is an obstacle to reducing maternal and child mortality. To improve the use of health services in the three regions of Cameroon, which have the worst reproductive, maternal, neonatal, child and adolescent health indicators, a health voucher project aiming to reduce financial barriers has been progressively implemented since 2015 in these three regions. Our research aimed to assess the impact of the voucher scheme on first antenatal consultation (ANC) and skilled birth attendance (SBA).

METHODS

Routine aggregated data by month over the period January 2013 to May 2018 for each of the 33 and 37 health facilities included in the study sample were used to measure the effect of the voucher project on the first ANC and SBA, respectively. We estimated changes attributable to the intervention in terms of the levels of outcome indicators immediately after the start of the project and over time using an interrupted time series regression. A meta-analysis was used to obtain the overall estimates.

RESULTS

Overall, the voucher project contributed to an immediate and statistically significant increase, one month after the start of the project, in the monthly number of ANCs (by 26%) and the monthly number of SBAs (by 57%). Compared to the period before the start of the project, a statistically significant monthly increase was observed during the project implementation for SBAs but not for the first ANCs. The results at the level of health facilities (HFs) were mixed. Some HFs experienced an improvement, while others were faced with the status quo or a decrease.

CONCLUSIONS

Unlike SBAs, the voucher project in Cameroon had mixed results in improving first ANCs. These limited effects were likely the consequence of poor design and implementation challenges.

Rationalizing artemisinin-based combination therapies use for treatment of uncomplicated malaria: A situation analysis in health facilities and private pharmacies of Douala 5e-Cameroon

Artemisinin-based combination therapies (ACTs) represent one of the mainstays of malaria control. Despite evidence of the risk of ACTs resistant infections in resource-limited countries, studies on the rational use of ACTs to inform interventions and prevent their emergence and/or spread are limited. The aim of this study was designed to analyze practices toward ACTs use for treating the treatment of uncomplicated malaria (UM) in an urban community. Between November 2015 and April 2016, a cross-sectional and prospective study was conducted in the 6 health facilities and all pharmacies in the Douala 5e subdivision, Cameroon. Anonymous interviews including both open- and closed-ended questions were conducted with selected participants among drug prescribers, patients attending the health facilities, and customers visiting the pharmacies. Data analysis was performed using StataSE11 software (version 11 SE). A total of 41 prescribers were included in the study. All were aware of national treatment guidelines, but 37.7% reported not waiting for test results before prescribing an antimalarial drug, and the main reason being stock-outs at health facilities. Likewise, artemether+lumefantrine/AL (81%) and dihydroartemisinin+piperaquine (63.5%) were the most commonly used first- and second-line drugs respectively. Biological tests were requested in 99.2% (128/129) of patients in health facilities, 60.0% (74) were performed and 6.2% were rationally managed. Overall 266 (35%) of 760 customers purchased antimalarial drugs, of these, 261 (98.1%) agreed to participate and of these, 69.4% purchased antimalarial drugs without a prescription. ACTs accounted for 90.0% of antimalarials purchased from pharmacies, of which AL was the most commonly prescribed antimalarial drug (67.1%), and only 19.5% of patients were appropriately dispensed. The current data suggest a gap between the knowledge and practices of prescribers as well as patients and customers misconceptions regarding the use of ACTs in Douala 5e subdivision. Despite government efforts to increase public awareness regarding the use of ACTs as first-line treatment for UM, our findings point out a critical need for the development, implementation and scaling-up of control strategies and continuing health education for better use of ACTs (prescription and dispensing) in Cameroon.

Comparison of standard and modified human landing catching techniques for blackfly collection

BACKGROUND

Human landing catches (HLCs) are required to collect blackflies for entomological evaluation to verify onchocerciasis elimination. However, there are ethical concerns regarding exposure of vector collectors to infectious blackflies and safer alternative methods are needed. This study evaluated a modified HLC technique where collectors wore coloured trousers (blue, black or blue-black), protecting them from bites during fly collection, and their performance was compared with the standard.

METHODS

The study was conducted in Makouopsap, Cameroon, in the Massangam health district for 4 months. Four collector pairs-one 'standard' (bare-legged) and three modified-were placed 50 m apart along known breeding sites on the Mbam and Nja Rivers. Collections were performed from 07:00 to 17:00 h, 4 d/month. Hourly rates of flies caught were analysed using a negative binomial generalised linear model to explore associations between flies caught and collection techniques and seasons.

RESULTS

Overall, 17 246 blackflies were caught. There was no significant statistical difference in the number of blackflies and parous flies caught between black trousers and the standard. Thus there is a strong indication that wearing black trousers is a viable non-inferior alternative to the standard HLC.

CONCLUSIONS

Further studies are needed to confirm generalisability in different ecozones and transmission environments and among different blackfly species.

Factors associated with sensitisation to selected aero-allergens in children and adolescents with asthma followed up at Laquintinie Hospital Douala, Cameroon

INTRODUCTION

In spite of the substantial impact of pediatric asthma on healthcare resources, there is a notable dearth of research focusing on allergen sensitization specifically in children and adolescents with asthma in Cameroon, with existing studies primarily concentrating on adult populations. We, therefore, set out to determine factors associated with sensitization to selected aero-allergens in children and adolescents with asthma followed up at Laquintinie Hospital Douala, Cameroon.

METHODOLOGY

We conducted a cross-sectional analytical study on patients aged 2-17 years followed up for pediatric asthma at Laquintinie Hospital Douala for 8 months (January to August 2023). Skin prick tests were performed using selected standardized aeroallergens extracts. Factors associated with sensitization were determined using multivariable logistic regression analysis. The threshold for significance was set at p < .05.

RESULTS

In total, 126 children and adolescents with asthma were recruited, 50.79% of whom were male with an average age of 8.00 ± 3.99 years. Eight out of 10 patients (83.52%) were sensitized to common aero-allergens (20.59% monosensitized and 79.41% polysensitized). The most common aero-allergens found were the dust mites Dermatophagoïdes pteronyssinus (81.37%), Blomia tropicalis (67.64%) and Dermatophagoïdes farinae (52.94%) followed by Blatella species (25.49%). The factors independently associated with sensitization in our population were the personal history of allergic rhinitis in the patient [adjusted odds ratio, aOR: 4.07 (95% confidence interval, CI: 1.41-11.76), b = 0.54, p = .009], chest tightness at rest [aOR: 5.92 (95% CI: 1.08-32.38), b = 0.87, p = .040), and age above 5 years [aOR: 4.65 (95% CI: 1.47-14.69), b = 0.59, p = .009).

CONCLUSION

Sensitization to multiple aeroallergens is common in children and adolescents with asthma, especially for dust mites and cockroaches. Factors associated with sensitization are patients aged >5 years, chest tightness at rest, and a personal history of allergic rhinitis.

Anti-Shigella and antioxidant-based screening of some Cameroonian medicinal plants, UHPLC-LIT-MS/MS fingerprints, and prediction of pharmacokinetic and drug-likeness properties of identified chemicals

ETHNOPHARMACOLOGICAL RELEVANCE

Shigella infection is a public health problem responsible for approximately 700,000 deaths annually. The management of this disease is impaired by the emergence of multidrug-resistant Shigella species, highlighting the urgent need to search for alternative treatment options. In this regard, investigating medicinal plants traditionally used for the treatment of dysentery, diarrheal infections, and/or associated symptoms in endemic regions might provide an opportunity to identify phytochemicals that could be further used as a basis for the development of future anti-shigella drug candidates.

AIM OF THE STUDY

This study was designed to investigate the anti-shigella and antioxidant-based ethnopharmacological potency of some Cameroonian medicinal plants with an emphasis on pharmacokinetic properties of the identified chemical pharmacophore.

MATERIALS AND METHODS

Briefly, plant species were selected and collected based on their ethnopharmacological uses and information reported in the literature. Crude aqueous, ethanolic, methanolic, and hydroethanolic (30:70, v/v) extracts from these plants were prepared and then screened for their anti-Shigella activity against four Shigella strains and cytotoxicity against Vero and Raw cell lines using microdilution and resazurin-based methods, respectively. The antioxidant activities of potent extracts were evaluated using DPPH, ABTS, NO, and FRAP scavenging assays. The chemical profile of potent extracts was performed using the UHPLC-LIT-MS/MS and the pharmacokinetic properties, druglikeness, and likely molecular targets of the chemical scaffolds identified were predicted using SwissADME and SwissTargetPredictor.

RESULTS

Thirty-nine (39) plants belonging to 26 plant families were harvested. Out of the 228 extracts tested, 18 extracts originating from 6 plants (15.38 %) were active (MICs 250-1000 μg/mL) and nontoxic toward Vero (CC50 129.25-684.55 μg/mL) and Raw cell lines (CC50 336.20 to >1000 μg/mL). Six potent extracts from the two plants exhibited moderate to potent DPPH (SC50 8.870-54.410 μg/mL), ABTS (SC50 12.020-27.36 μg/mL), and NO (SC50 0.02-195.85 μg/mL) scavenging activities. Later, these extracts showed interesting ferric iron-reducing power (1.28-12.14 μg equivalent NH2OH/g of extract). The shortest onset of action time (4 and 6 h) observed following inhibition kinetics studies was observed with extracts BFSHE, PMSE, and PMSM. The UHPLC-LIT-MS/MS and some databases (Mass Spectral Library (NIST 14), Human Metabolome Database (HMD), MassBank, SuperNatural 3.0, The Food Database (FooDB), and Chemical Entities of Biological Interest (ChEBI)) allowed the annotation of 18 and 17 metabolites in the extracts from stem bark of P. macrophylla and B. ferruginea respectively. Pharmacokinetic prediction of these chemicals showed that compound 6 (4,6a-bis(Hydroxymethyl)-9a-methyl-3-oxo-1a,1b,3,5,6,6a,7a,9a-octahydrobis (oxireno)[2',3':5,6; 2″,3'':9,10]cyclodeca[1,2-b]furan-5-yl methacrylate), compound 8 (Corynoxeine), and compounds 35 (Stachybotrydial acetate) demonstrated acceptable druglike and pharmacokinetic properties and might act through inhibition of kinase, transferase, protease, oxidoreductase, and family AG protein-linked receptors.

CONCLUSION

The findings from this investigation demonstrated that Cameroonian medicinal plants are suitable reservoirs of anti-Shigella and antioxidant agents with good drug candidate properties.

Factors influencing integration of mental health screening and treatment at HIV clinic settings in Cameroon: a qualitative study of health providers' perspectives

BACKGROUND

Mental disorders are common among people with HIV (PWH) and are associated with poor HIV outcomes. Despite high unmet mental health needs among PWH, use of evidence-based mental health screening and treatment protocols remains limited at HIV treatment facilities across low-resource settings. Integrating mental health services into HIV care can reduce this gap. This study's objective was to explore factors that influence integration of mental health screening and treatment into HIV clinics in Cameroon.

METHODS

We analyzed 14 in-depth interviews with clinic staff supporting PWH at three urban HIV treatment clinics in Cameroon. Interviews focused on current processes, barriers and facilitators, and types of support needed to integrate mental health care into HIV care. Interviews were recorded and transcribed. French transcripts were translated into English. We used thematic analysis to identify factors that influence integration of mental health screening and treatment into HIV care in these settings. Ethical review boards in the United States and Cameroon approved this study.

RESULTS

Respondents discussed a lack of standardized mental health screening processes in HIV treatment facilities and generally felt ill-equipped to conduct mental health screening. Low community awareness about mental disorders, mental health-related stigma, limited physical space, and high clinic volume affected providers' ability to screen clients for mental disorders. Providers indicated that better coordination and communication were needed to support client referral to mental health care. Despite these barriers, providers were motivated to screen clients for mental disorders and believed that mental health service provision could improve quality of HIV care and treatment outcomes. All providers interviewed said they would feel more confident screening for mental disorders with additional training and resources. Providers recommended community sensitization, training or hiring additional staff, improved coordination to manage referrals, and leadership buy-in at multiple levels of the health system to support sustainable integration of mental health screening and treatment into HIV clinics in Cameroon.

CONCLUSIONS

Providers reported enthusiasm to integrate mental health services into HIV care but need more support and training to do so in an effective and sustainable manner.

Pheromone traps and climate variations influence populations of Sahlbergella singularis (Hemiptera: Miridae) and associated damage of cocoa in Cameroon

Knowledge of insect pest ecology and biology is important for maximizing crop protection and reducing crop losses. Currently, we lack an efficient control program for the cocoa mirid Sahlbergella singularis Haglund (Hemiptera: Miridae), the principal insect pest of cocoa in West and Central Africa. A 2-yr study was conducted in 11 plantations across Ayos and Konye, two of the largest cocoa growing areas of Cameroon. We evaluated the effects of mirid sex pheromone and climatic variations on mirid population dynamics and their associated cocoa damage. Sex pheromone traps caught 1.5-fold higher mirids in Ayos than in Konye, with more overall counts in 2015 than in 2016. Cocoa pod counts were also significantly higher in 2015 than in 2016 and were negatively correlated with temperature and relative humidity. In both localities, mirid populations and associated cocoa pod damage were suppressed in plantations where sex pheromone traps were used. Damage incidence was positively correlated with mirid counts, confirming that the cocoa pod is the preferential site for mirid feeding and reproduction. As such, damage incidence could be used as proxy for comparative mirid population level due to the mirid's cryptic habit. Of the recorded weather variables, only relative humidity was correlated (negatively) with damage severity. Our data on the relationships between damage caused by mirids and their population dynamics and sex pheromone trap catches suggest that an effective control strategy using mass trapping could be developed for mirid management in cocoa plantations.

Setting up a data system for monitoring malaria vaccine introduction readiness and uptake in 42 health districts in Cameroon

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.

Psychometric properties of the French version of the Kogan's Attitudes toward Older People scale: A cross-sectional study conducted on Cameroonian nursing students

To determine the psychometric properties of a French version of the KOP scale on Cameroonian French-speaking nursing students.

A cross-sectional study was conducted where a self-administered questionnaire in French was given to a convenience sample of 296 nursing students registered for three different nursing programs.

The French version of the KOP scale demonstrated moderate psychometric properties. The internal consistency, indicated by the Cronbach's alpha, was moderate, while the explanatory factor analysis showed two factor loadings, which explained 58.44% of the total variance.

CONCLUSION

The French version of the KOP scale can be a useful tool for studies in French-speaking African countries to assess the degree of ageism toward older adults. It is suggested that the original KOP scale be retranslated by African translators and administered to larger French-speaking populations in other countries.

Vertical stratification and defensive traits of caterpillars against parasitoids in a lowland tropical forest in Cameroon

Insect herbivores and their parasitoids play a crucial role in terrestrial trophic interactions in tropical forests. These interactions occur across the entire vertical gradient of the forest. This study compares how caterpillar communities, and their parasitism rates, vary across vertical strata and between caterpillar defensive strategies in a semi deciduous tropical forest in Nditam, Cameroon. Within a 0.1 ha plot, all trees with a diameter at breast height (DBH) ≥ 5 cm were felled and systematically searched for caterpillars. We divided the entire vertical gradient of the forest into eight, five-metre strata. All caterpillars were assigned to a stratum based on their collection height, reared, identified, and classified into one of three defensive traits: aposematic, cryptic and shelter-building. Caterpillar species richness and diversity showed a midstory peak, whereas density followed the opposite pattern, decreasing in the midstory and then increasing towards the highest strata. This trend was driven by some highly dense shelter-building caterpillars in the upper canopy. Specialisation indices indicated decreasing levels of caterpillar generality with increasing height, a midstory peak in vulnerability, and increasing connectance towards the upper canopy, although the latter was likely driven by decreasing network size. Both aposematic and shelter-building caterpillars had significantly higher parasitism rates than cryptic caterpillars. Our results highlight nuanced changes in caterpillar communities across forest strata and provide evidence that defences strategies are important indicators of parasitism rates in caterpillars and that both aposematic and shelter-building caterpillars could be considered a "safe haven" for parasitoids.

Antibiotic Residues in Foods of Animal Origin in Cameroon: Prevalence, Consumers' Risk Perceptions, and attitudes

The use of antibiotics in food animals and the nonobservance of the withdrawal period might result in the accumulation and persistence of residues in foods. The contamination of foods by antibiotic residues might induce health risks including allergy, gastrointestinal dysbiosis, antimicrobial resistance, and cancer to consumers. Therefore, this study was initiated to investigate the presence of antibiotic residues in raw eggs, raw milk, and beef collected at the wholesale and retail points in the three major cities of Cameroon and consumers' perceptions of the risk of antibiotic residues in foods. Qualitative antibiotic residue kits (PremiTest® and Delvotest®) were used to screen 407 samples of foods collected in markets of three towns (Ngaoundéré, Yaoundé, and Douala) in Cameroon. A structured questionnaire was used to evaluate the knowledge and attitudes of 1462 consumers toward microbial drug residues in foods of animal origin. Prevalence of residues of 70.55%, 17.39%, and 69.63% for beef, eggs, and milk, respectively, was observed. More than 1/3 of the respondents believed that the consumption of contaminated foods with antibiotic residues is a risk to their health and thought that allergies and intoxication they often experience are related to the consumption of contaminated foods. Most of them showed their willingness to pay more to acquire quality foods, free from antibiotic residues.

Association between mental disorders with detectable viral load and poor adherence to antiretroviral therapy among adolescents infected with Human Immunodeficiency Virus on follow-up at Chantal Biya Foundation, Cameroon

INTRODUCTION

Perinatally HIV-Infected Adolescents (HIVIA) are more likely to have mental health problems than their uninfected peers. In resource-limited settings, mental health disorders are rarely taken into account in the care offered to HIVIA and have an impact on their routine follow-up. The objective of this study was to assess the baseline socio-demographic factors and mental health conditions associated with detectable viral load or poor ART adherence in HIVIA on ART followed at the Mother and Child Centre of the Chantal Biya Foundation in Yaoundé (CME-FCB), Cameroon.

METHODS

A cross-sectional study was conducted in HIVIA aged 10 to 19 years, followed at CME-FCB during the period from December 2021 to March 2022. Sociodemographic, clinical, and mental characteristics were collected using a structured questionnaire administered face-to-face by trained healthcare providers. The primary outcome was viral load ≥ 40 copies/mL in HIVIA on ART for at least six months. The secondary outcome was poor ART adherence, defined as ≥ 1 missed dose of antiretroviral therapy within the last past three days. The main exposure variables were mental health disorders, including the level of anxiety, depression and low self-esteem.

RESULTS

In total, 302 adolescents were interviewed, 159 (52.7 %) were girls and median age was 15.2 years (IQR: 12.0-17.5). Having missed at least 1 dose of ART drugs during the last 3 days before screening concerned 53 (35.0 %) cases. Of the 247 adolescents with an available viral load (VL) in the last 12 months prior to screening, 33 (26.7 %) had a VL ≥ 40 copies/mL. Among participating adolescents, 29.1 % presented with high or very high anxiety, 26.5 % with severe depression, 36.4 % with history of suicidal ideation, and 20.5 % low self-esteem. Low self-esteem was strongly associated with a higher risk of poor ART adherence (adjusted odds ratio(aOR) (95 % confidence interval (95 %CI)): 2.2 (1.1-4.3); p = 0.022). Living with the father (aOR (95 %CI): 0.6 (0.3-1.1); p = 0.085) or in a household with a televisor (aOR (95 %CI): 0.5 (0.2-1.1); p = 0.069) were slightly associated with a lower risk of poor adherence to ART. Having both parents alive (aOR (95 %CI): 0.4 (0.2-0.9); p = 0.031) or receiving ART with efavirenz or dolutegravir (aOR (95 %CI): 0.5 (0.2-0.9); p = 0.047) was strongly associated with a lower likelihood of having a detectable VL. Moreover, detectable viral load was slightly less frequent in adolescents whose household was equipped with a television (p = 0.084) or who were completely disclosed for HIV status (p = 0.070).

CONCLUSION

This study found that co-morbid low self-esteem had higher odds of poor ART adherence in HIVIA. Moreover, both poor ART adherence, and detectable viral load were associated with impaired life conditions in HIVIA.

Acceptability, feasibility and potential of an intervention using secret Facebook groups to complement existing HIV prevention strategies among female sex workers in Cameroon, a randomized pilot study

This randomized pilot project evaluated an intervention promoting health care literacy around HIV, pre-exposure prophylaxis (PrEP), and stigma reduction using private social media groups that complemented existing HIV prevention services among female sex workers (FSWs) in Cameroon. The intervention was 12 HIV and sexual health videos tailored to FSWs that were released over 8 weeks through a secret Facebook group platform. In-person surveys were administered before, after the intervention, and three months later. No HIV seroconversions were detected; all participants completed follow-up and agreed to recommend the intervention to a coworker. Although the intervention was assessed to be acceptable and feasible to implement, poor internet connectivity was a key barrier. In time-series analysis, the intervention group participants reported improved PrEP interest, PrEP knowledge, and condom use along with reduced PrEP and HIV-related stigma, but no impact on sex-work related stigma or social cohesion. Similar results occurred in the control group. Cross-contamination and small pilot study size might have hindered the ability to detect the differential impact of this intervention. As communications technology increases in Cameroon, it is essential to learn more about FSWs preferences on the use of social media platforms for HIV prevention strategies.

The effects of education intervention on the knowledge of some reproductive health issues amongst secondary school students in Douala IV Municipality, Cameroon

This study aimed to determine the effects of education intervention on the knowledge of some reproductive health issues amongst secondary school students. It was longitudinal and interventional study carried out in two phases. Participants were adolescents and young adults randomly selected from secondary establishments using a Probability Proportional to Size sampling method. In phase 1, data were obtained by the use of questionnaire and analyzed using Epi-Info 6.04 and SPSS version 17.0. Education intervention was utilized in 3 randomly selected schools (experiment), but not in 3 others (control). Phase 2 carried out 6 months after the end of the first intervention consisted of collecting baseline data. There was a significant association between knowledge on unintended pregnancy and STIs mainly with type of establishment, class, age group, sex, religion (p<0.001 respectively) and being sexually active (p=0.016). There was a significant increase of awareness in the experimental schools (34.1% vs 76.5%, p<0.0001), but not in the control schools (34.5% vs 35.5%, p>0.10). Health education had a significant impact on the knowledge of participants. We recommend reproductive health education through the framework of school to be used as a national policy in African developing countries.

Assessment of Evidence-Based Practice (EBP) among physiotherapists in Cameroon: a cross-sectional survey

BACKGROUND

Evidence-Based Practice (EBP) is reported to ease effective and adequate decision making for all works of life including health professionals. Investigating the level of implementation of EBP among physiotherapists helps to identify barriers and propose solutions for its extensive implementation. Despite available data on EBP elsewhere, it remains limited or non-existent in Cameroon. This study was designed to establish the current state of EBP among physiotherapists in Cameroon, by assessing knowledge, practice, and barriers to its implementation.

METHODS

A cross-sectional survey was conducted online among French- and English-speaking physiotherapists in Cameroon over a period of six months from April to July 2023, using the EBP2 questionnaire. This enabled us to collect socio-demographic data from participants and information on their knowledge, understanding and practice of EBP and possible barriers to EBP according to 5 domains (Confidence, Relevance, Terminology, Practice, Compatibility) scored out of 100. Data were analysed using IBM SPSS 25.0 software and Pearson correlations (95% CI) and significance (p < 0.05).

RESULTS

A total of 110 physiotherapists practising in the 10 regions of Cameroon participated in the study. The majority were male (54.5%), the median age was 34 years (age range 20 to 50), the median year of graduation was 2019 (range 2004 to max 2022) with 72.7% never having knowledge or training in EBP. Participants scored below 50/100 for 3 domains (confidence, relevance, and compatibility) showing poor general knowledge and understanding of EBP, although they generally had a positive attitude towards EBP. The use of EBP in practice was low (26.3/100 SD. 6.5), despite that they appeared to have a good understanding of research terminology (55.4 SD. 17.2). Level of study of participants did not appear to significantly influence domain scores (P > 0.05). The main barriers to practice were lack of time (75.1%), workload (66%), cost of access to information resources like databases for seek informations about recent support protocols (60%), ease of access to computers (49%), and lack of resources or skills (49%).

CONCLUSION

Physiotherapists in Cameroon have a poor knowledge of EBP and a low level of practice of EBP, despite an overall positive attitude towards it. These results could inform stakeholders of higher education on the need to improve training of physiotherapy students in the domain of EBP in Physiotherapy. Also, it will help in raising the level of scientific research and promoting the implementation of EBP in Cameroon.

Perioperative outcomes of the surgical management of achalasia in two tertiary Cameroonian hospitals: a cohort study

INTRODUCTION

Achalasia is a rare esophageal disease with potentially lethal complications. Knowledge of the outcomes of the different surgical treatment modalities for achalasia by Heller's cardiomyotomy (HCM) helps to choose the safest and most effective option. However, data on the management of achalsia using a Heller myotomy is limited in Africa. Thus, our aim was to determine the perioperative morbidity, mortality and short-term functional outcomes of HCM in Cameroon.

METHODOLOGY

We conducted a cohort study throughout a 10-year chart review of patients who underwent HCM for achalasia and were followed up postoperatively for at least three months at two tertiary health centers in Cameroon. We analyzed demographic data, preoperative clinical and imaging data, treatment details, and outcomes at three to twelve months after HCM using the Eckardt score.

RESULTS

We enrolled 29 patients with achalasia having a mean age of 24 ± 16 years and predominantly females (M/F of 1/3.8). The mean symptom duration was 51 ± 20 months. In 80% of cases, the diagnosis was made through a conventional x-ray contrast imaging or "barium swallow test" (93%) and/or an upper gastrointestinal endoscopy (86%). The gold standard diagnostic method via esophageal manometry was unavailable. Preoperatievly, all patients had symptoms suggestive of an active achalasia. HCM was performed via laparotomy in 75% as opposed to 25% laparoscopic HCM procedures. Dor's anterior partial fundoplication was the main anti-reflux procedure performed (59%). Mucosal perforations were the only intraoperative complications in eight patients (2 during laparoscopy vs. 6 during laparotomy; p > 0.5) and were managed successfully by simple sutures. Postoperative complications were non-severe and occurred in 10% of patients all operated via laparotomy. The mean postoperative length of hospital stay was 7 ± 3 days for laparotomy vs. 5 ± 2 days for laparoscopy; p > 0.5. The perioperative mortality rate was nil. Overall, the short-term postoperative functional outcome was rated excellent; average Eckardt score of 1.5 ± 0.5 (vs. preoperative Eckardt Score of 9 ± 1; p < 0.0001).

CONCLUSION

Achalasia is diagnosed late in this resource-limited setting. HCM yields satisfactory outcomes, especially via laparoscopic management. An improvement in diagnostic esophageal manometry and mini-invasive surgical infrastructure and the required surgical training/skills are needed for optimal achalasia care.

Snakebites in Cameroon: Tolerance of a Snake Antivenom (Inoserp™ PAN-AFRICA) in Africa in Real-Life Conditions

Snakebite envenomation (SBE) is a public health issue in sub-Saharan countries. Antivenom is the only etiological treatment. Excellent tolerance is essential in managing SBE successfully. This study aimed to evaluate tolerance of InoserpTM PAN-AFRICA (IPA). It was conducted on fourteen sites across Cameroon. IPA was administered intravenously and repeated at the same dose every two hours if needed. Early and late tolerance was assessed by the onset of clinical signs within two hours and at a visit two weeks or more after the first IPA administration, respectively. Over 20 months, 447 patients presenting with a snakebite were included. One dose of IPA was administered to 361 patients and repeated at least once in 106 patients. No significant difference was shown between the proportion of adverse events in patients who received IPA (266/361, 73.7%) and those who did not (69/85, 81.2%) (p = 0.95). Adverse reactions, probably attributable to IPA, were identified in four (1.1%) patients, including one severe (angioedema) and three mild. All these reactions resolved favorably. None of the serious adverse events observed in twelve patients were attributed to IPA. No signs of late intolerance were observed in 302 patients. Tolerance appears to be satisfactory. The availability of effective and well-tolerated antivenoms would reduce the duration of treatment and prevent most disabilities and/or deaths.

Accurate and reproducible enumeration of CD4 T cell counts and Hemoglobin levels using a point of care system: Comparison with conventional laboratory based testing systems in a clinical reference laboratory in Cameroon

BACKGROUND

Measurements of CD4 T cells and hemoglobin (Hb) are conventionally used to determine the immunological state and disease progression for HIV-infected patients. We obtained a small lightweight point-of-care device, the BD FACSPrestoTM in order to demonstrate its ability to deliver CD4 and Hb analysis in comparison with two larger clinical machines the BDFACSCantoTM analyzer and Sysmex XN 1000 haematology analyzer. The advantages of using the POC device include access to HIV patient data in remote and in resource limited settings.

METHOD

The analytical performance of the BD FACSPrestoTM, compared with the FACSCantoTM II flow cytometer and the Sysmex XN 1000 haematology analyzer was evaluated by testing 241 routine clinical specimens collected in EDTA tubes from patients attending the Immunology and Microbiology laboratory of Chantal BIYA International Reference Centre (Yaounde, Cameroon) between January and May 2016.

RESULTS

The mean in absolute counts and percentage of CD4 T cells was 606 cells/mL and 25% respectively via the FACSPrestoTM, and 574 cells/mL and 24% respectively via the BD FACSCantoTM II. The mean concentration of Hb levels was 11.90 on the Sysmex XN 1000 and 11.45 via the BD FACSPrestoTM, A high correlation (R2 = 0.95, P < 0.001) of Hb level measurements was noted between the BD FACSPrestoTM and Sysmex XN 1000 hematology analyzer. Overall, a Bland-Altman plot of the differences between the two methods showed an excellent agreement for absolute and percentage CD4 counts and hemoglobin measurements between POC and conventional methods evaluated here. Furthermore, the study demonstrated the ease of use of the BD FACSPrestoTM POC technology in remote areas.

CONCLUSION

The BD FACPrestoTM is a suitable tool for CD4 enumeration in resource-limited settings, specifically providing a deployable, reliable POC testing option. The BD FACSPrestoTM performed appropriately in comparison to the conventional reference standard technologies. The BD FACSPrestoTM, system provides accurate, reliable, precise CD4/%CD4/Hb results on venous blood sampling. The data showed good agreement between the BD FACSPrestoTM, BD FACSCantoTM II and Sysmex XN 1000 XN 1000 systems.

Type 1 diabetes care delivery in Yaoundé, Cameroon: Social and political representations

BACKGROUND

 Increasing chronic diseases challenges the health systems of low- and middle-income countries, including Cameroon. Type 1 diabetes (T1D), among the most common chronic diseases in children, poses particular care delivery challenges.

AIM

 We examined social representations of patients' roles and implementation of T1D care among political decision-makers, healthcare providers and patients within families.

SETTING

 The study was conducted in Yaoundé, Cameroon.

METHODS

 Eighty-two individuals were included in the study. The authors conducted semi-structured interviews with policy makers (n = 5), healthcare professionals (n = 7) and patients 'parents (n = 20). Questionnaires were administered to paediatric patients with T1D (n = 50). The authors also observed care delivery at a referral hospital and at a T1D-focused non-governmental organisation over 15 days. Data were analysed using thematic content analysis and descriptive statistics.

RESULTS

 Cameroonian health policy portrays patients with T1D as passive recipients of care. While many practitioners recognised the complex social and economic determinants of adherence to T1D care, in practice interactions focused on specific biomedical issues and offered brief guidance. Cultural barriers and policy implementation challenges prevent patients and their families from being fully active participants in care. Parents and children prefer an ongoing relationship with a single clinician and interactions with other patients and families.

CONCLUSION

 Patients and families mobilise experience and lay knowledge to complement biomedical knowledge, but top-down policy and clinical practice limit their active engagement in T1D care.Contribution: Children with T1D and their families, policy makers, healthcare professionals, and civil society have new opportunities to contribute to person-centred care, as advocated by the Sustainable Development Goals.

The effects of nutrition and health education on the nutritional status of internally displaced schoolchildren in Cameroon: a randomised controlled trial

Lack of nutrition knowledge and poor dietary practices have profound adverse implications on nutritional status particularly among displaced children. Evidence of the effectiveness of nutrition education interventions in improving the nutritional status of internally displaced schoolchildren in Cameroon is scarce. The study objective was to assess the effects of nutrition education on the nutritional status of internally displaced schoolchildren in the West and Littoral Regions of Cameroon. A pre-test-post-test randomised experimental study design was used with an experimental and control group of 160 children from ten primary schools and their caregivers. Anthropometric, biochemical, and clinical signs of malnutrition, dietary, and health status of the children were evaluated, and the caregiver's nutrition knowledge was assessed in both groups at baseline and end-line with the aid of standard anthropometric and biochemical equipment and recorded in pretested questionnaires. Nutrition education was carried out only with the caregivers of children in the test group. In the test group, significant beneficial outcomes were noticed only for Bitot's spot (p = 0.047), pallor (0.025), frequency of consumption of fruits (p = 0.002) and vegetables (p = 0.036), caregiver's nutrition knowledge (p = 0.000), all health-seeking practices of the children (p < 0.05) except immunisation (p = 0.957). No significant change was seen in any of the parameters studied among the participants in the control group. Nutrition education alone was not effective in improving the nutritional status of the children and should be implemented together with other food-based nutrition interventions to improve the nutritional status of internally displaced schoolchildren in the West and Littoral Regions of Cameroon.

Current knowledge of human Mpox viral infection among healthcare workers in Cameroon calls for capacity-strengthening for pandemic preparedness

Introduction

An increased incidence of human Monkeypox (Mpox) cases was recently observed worldwide, including in Cameroon. To ensure efficient preparedness and interventions in the health system, we sought to assess the knowledge of Mpox's transmission, prevention, and response among healthcare workers (HCWs) in Cameroon.

Methods

A cross-sectional online survey was conducted among HCWs in Cameroon using 21-item questions adapted from the United States Centers for Disease Control and Prevention (US-CDC) standard questionnaire on Mpox. The overall knowledge of Mpox was assessed by cumulative score and categorized as excellent (≥80%, 17/21) or good (≥70%, ≥15/21) knowledge. The regression analysis was used to identify the predictors of Mpox knowledge.

Results

The survey enrolled 377 participants, but only responses from 342 participants were analyzed. Overall, 50.6% were female participants, and 59.6% aged 30 years or younger. The majority of the participants were medical doctors (50.3%); most worked in central-level hospitals (25.1%) and had 1-5 years of experience (70.7%). A total of up to 92.7% were aware of Mpox, with social media (58.7%) and radio/television (49.2%) as the main sources. The mean knowledge score was 14.0 ± 3.0 (4 to 20), with only 12.9% having excellent knowledge (≥80%) and 42.1% having good knowledge of Mpox. Younger age (26-30 years old) was associated with good knowledge, while workplace type was associated with excellent knowledge of Mpox (aOR [95% CI]: 4.01 [1.43-11.24]). Knowledge of treatment/management of Mpox was generally poor across the different professional categories.

Conclusion

Knowledge of Mpox among HCWs is substandard across different professionals. Thus, for optimal preparedness and immediate interventions for Mpox and similar emerging pathogens, capacity-strengthening programs should be organized for HCWs while encouraging scientific literature and organizational social media websites.

Burkitt lymphoma: The effect of age, sex and delay to diagnosis on treatment completion and outcome of treatment in 934 Patients in Cameroon

INTRODUCTION

The role of age and sex in the presentation and outcome of endemic Burkitt lymphoma (BL) has not been studied recently. This study analysed these factors in 934 patients with BL who had received cyclophosphamide and intrathecal methotrexate as treatment.

METHODS

Records of 934 children diagnosed with BL from 2004 to 2015 were obtained from our Paediatric Oncology Networked Database (POND) cancer registry. Age at diagnosis, sex, disease stage, time to diagnosis, delay in diagnosis, completion of treatment, rate of abandonment, and one-year survival rates were recorded and statistically analysed.

RESULTS

The male to female ratio of 1.41 for the study population of 934. The median delay from onset of symptoms to diagnosis was 31 days. The St Jude stage distribution was I = 6.4%, II = 5.9%, III = 71.5% and IV = 16.2%. Significantly more patients presented with stage III disease in age groups 5-9 and 10-14 years than 0-4 years. The overall 1-year survival rate was 53.45%, respectively 77.1% for stage I, 67.9% for stage II, 55.1% for stage III and 32.4% for stage IV disease (p<0.001). There was no significant difference in survival by sex and age group.

CONCLUSION

Patients aged under 5 years presented with less-advanced disease, but survival was not affected by age. Sex did not influence delay to diagnosis and overall survival. The long delay between the onset of symptoms and diagnosis emphasises the need for interventions to achieve an earlier diagnosis and a better survival rate.

Impact of pesticides exposure on Archachatina marginata snails in four Cameroon monomodal rainforest sites

Cameroon monomodal rainforest zone has a strong agricultural activity and is therefore exposed to pesticides. Furthermore, the area possesses climatic factors that favor the growth of Achatinadea snails known as African giant snails, a delicacy for the local population. The present study aimed to evaluate pesticides contamination (less vs more exposed areas) through assessment of exposure and impact on Achatinadea snails. Achatinadea snails were collected within intensive agricultural areas (Njombe and Kribi rural) and in areas with less agricultural activity (Ebodje and Dibombari). Collection was performed at night between July and September 2020 using an adapted square kilometer method. Type, number, weight, and size of the collected snails were analyzed and compared using Welsh's One-way Analysis of variance (ANOVA). After removing the soft part from the shell, the presence of pesticides was determined using mass spectrometry. Histological analysis of kidney and ovo-testis was performed using eosin-hematoxylin staining. Results showed that the main variety of snails collected are Archachatina marginata. In areas with less agricultural activity, snails are bigger than those from more agricultural areas heavily using pesticides. Furthermore, pesticides detection showed that glyphosate, but not metalaxyl, is present in animals coming from all the collection sites. Cypermethrin was found in all the samples except in those from Dibombari. Histology revealed that the structure of the kidney and ovo-testis of snails from more exposed areas is impaired. In conclusion, this study revealed that some pesticides are transferred to snail and impair the structure of important organs.

Estimation of diagnostic reference levels for pediatric head computed tomography in Yaoundé

The diagnostic reference levels (DRLs) are determined from dosimetry studies to compare and manage patient doses in medical imaging procedures. The aim of this work was to establish the first DRLs for pediatric patients during the most common computed tomography (CT) procedures in Yaoundé, Cameroon during routine head CT examinations to know how to improve our clinical practice tomorrow. The sample was classified per age group: ≤ 1-, 1-5-, 5-10- and 10-15-y-old. The retrospective study was used. The proposed DRLs were defined as 75th percentile of the median values of the distributions. In terms of Volume CT Dose Index (CTDIvol) and dose length product (DLP), the DRLs obtained for the ages groups were: 28.6 mGy and 545.8 mGy.cm, 32.6 mGy and 735 mGy.cm, 37.1 mGy and 761.6 mGy.cm and 44.2 mGy and 1081.2 mGy.cm, respectively. DRLs in Yaoundé for DLP were higher than those of comparison literatures. The Yaoundé CTDIvol was higher than the comparison literatures except for the IAEA (2015) values for the three older age groups. The DRLs reported in Yaoundé were compared to Morocco 2020, Switzerland 2018, IAEA 2015 and Iran 2020 values. The estimation of this first DRL for pediatric head CT scan in Yaoundé must be a starting point to spread this investigation towards other examinations and imaging modalities across the country. Therefore, optimization of the CT scan procedures and orderly updates of local DRLs are necessary to improve radioprotection.

Adult mosquitoes of the sibling species Anopheles gambiae and Anopheles coluzzii exhibit contrasting patterns of susceptibility to four neonicotinoid insecticides along an urban-to-rural gradient in Yaoundé, Cameroon

BACKGROUND

Neonicotinoids are potential alternatives for controlling pyrethroid-resistant mosquitoes, but their efficacy against malaria vector populations of sub-Saharan Africa has yet to be investigated. The aim of the present study was to test the efficacy of four neonicotinoids against adult populations of the sibling species Anopheles gambiae and Anopheles coluzzii sampled along an urban-to-rural gradient.

METHODS

The lethal toxicity of three active ingredients for adults of two susceptible Anopheles strains was assessed using concentration-response assays, and their discriminating concentrations were calculated. The discriminating concentrations were then used to test the susceptibility of An. gambiae and An. coluzzii mosquitoes collected from urban, suburban and rural areas of Yaoundé, Cameroon, to acetamiprid, imidacloprid, clothianidin and thiamethoxam.

RESULTS

Lethal concentrations of neonicotinoids were relatively high suggesting that this class of insecticides has low toxicity against Anopheles mosquitoes. Reduced susceptibility to the four neonicotinoids tested was detected in An. gambiae populations collected from rural and suburban areas. By contrast, adults of An. coluzzii that occurred in urbanized settings were susceptible to neonicotinoids except acetamiprid for which 80% mortality was obtained within 72 h of insecticide exposure. The cytochrome inhibitor, piperonyl butoxide (PBO), significantly enhanced the activity of clothianidin and acetamiprid against An. gambiae mosquitoes.

CONCLUSIONS

These findings corroborate susceptibility profiles observed in larvae and highlight a significant variation in tolerance to neonicotinoids between An. gambiae and An. coluzzii populations from Yaoundé. Further studies are needed to disentangle the role of exposure to agricultural pesticides and of cross-resistance mechanisms in the development of neonicotinoid resistance in some Anopheles species.

Susceptibility of Mangifera indica (Sapindales: Anacardiaceae) cultivars to fruit flies (Diptera: Tephritidae) in 2 agroecological zones of Cameroon

The Sudano-Sahelian and the high Guinea savannahs agroecological zones of Cameroon are suitable for the full development of tree crops, including mango. Unfortunately, fresh fruits exported to local and international markets are frequently rejected due to the presence of fruit fly larvae (Diptera: Tephritidae), resulting in drastic income losses and overuse of chemical control products. To promote sustainable management strategies, a 2-yr study (2020-2021) was conducted in 4 and 3 mixed orchards, respectively. Attacked mangoes showing signs of fruit fly damage were collected and taken to the laboratory to rear and identify fruit flies. Repeated grafting and agroclimatic differences were responsible for dissimilarities between the 2 zones, with 18 and 16 cultivars, respectively. From 2,857 attacked mangoes, 26,707 fruit flies belonging to 4 species were identified: Bactrocera dorsalis, Ceratitis cosyra, Ceratitis fasciventris, and Ceratitis anonae. Climate change was the factor determining the distribution of the 2 most important mango fruit flies: B. dorsalis was a wetland species (dominance/occurrence > 70%), while C. cosyra was a dry-land species (dominance/occurrence > 75%). Both species were responsible for high levels of infestations. Bactrocera dorsalis preferred 3 mango cultivars, namely Palmer and Smith in Zone 1, and Ifack 1 in Zone 2 (infestation > 20 individuals/100 g of mango). The host-plant spectrum of C. cosyra was modified by alternative host plants. Both C. fasciventris and C. anonae were rare. Findings from this study could guide researchers in the development of monitoring tools for fruit fly populations and, subsequently, in reducing the damage they cause to mangoes.

Freshwater macroinvertebrates along the Nigeria-Cameroon border enhance the conservation value of the lower Guinea forest biodiversity hotspot

In Nigeria and tropical Africa, the bias towards the protection of natural sites on account of terrestrial biodiversity or their resultant ecosystem services has led to a considerably low number of freshwater conservation studies in the region. To close this gap, six lotic freshwater systems in three different natural sites (Obudu Mountains, Agbokim Waterfalls, and Cross River National Park) along the Cameroon border of Nigeria were evaluated for the biodiversity of macroinvertebrates and some aspects of water quality in December 2021 and March 2022. Among other macroinvertebrate-related indices, the community conservation index (CCI), which considers the presence of threatened, rare, and notable species, was used for the conservation evaluation of the freshwater systems. The Ephemeroptera-Plecoptera-Trichoptera (EPT) species were notably rich at the sites, with over 12 species each at the Afundu Stream, Kwa River, Cataract Stream, and Agbokim River. All of the sites had a very high conservation value, according to the CCI, which was greater than 20. Some Obudu sites (Grotto and Becheve streams), despite having fewer EPT taxa, had higher CCI than the Kwa or Agbokim River. This was due to the presence of the endangered damselflies (Africocypha centripunctata and Allocnemis vicki) at the Obudu sites and a rare mayfly species in Nigeria (Tricorythus tinctus), which was reported at Agbokim and Kwa Rivers. The presence of a notable damselfly genus (Pentaphlebia) at the Afundu stream of the Obudu Mountains also raises some hope that the critically endangered damselfly (Pentaphlebia gamblesi), whose adult was last seen in 1973, could still be alive at the site. Canonical Correspondence Analysis revealed that the proportion of scrapers had a strong association with high BOD and EC in Agbokim River, while the Becheve and Grotto streams which had high vegetal cover was positively associated with shredders. Also, increasing DO in Afundu Stream, Kwa River and Cataract Stream was positively associated with EPT richness. This study revealed that more freshwater ecological studies need to be conducted at isolated natural sites and protected areas in Africa. Findings from such studies have implications for preserving freshwater ecosystems of high conservation value from the various threats that characterize the Anthropocene.

Knowledge, attitudes and practices of contraceptive methods among students in public and private high schools in Cameroon

The use of contraceptive methods is still a controversial subject in the societies of developing countries. This study aims to assess the knowledge, attitudes, and practices of contraceptive methods among students, aged 15 to 25 years, in public and private schools in the district of Bonaberi, Douala, Cameroon. This research was modeled on the pattern of descriptive study. The population in this study was composed of students (N = 1649) from the five public and private high schools of Bonaberi, Cameroon. The sample size of this study was 379 students. These data were collected in person by the researcher between 1 and 30, June 2022. The data collection tools are the student information form, the Knowledge and Practices of Contraceptive Methods Questionnaire, and the Contraceptive Attitude Scale (CAS). The data of this study were analyzed using descriptive statistics tests, Kruskal-Wallis Test, Pearson Chi-Square, Kolmogorov-Smirnoff, Student's T-Test, Mann-Whitney Test, and the One-way ANOVA. It was found that almost half (45.91 percent) of students were 19-22 years old, 59.1 percent of them were male, and almost half (49.3 percent) of them were sexually active. Currently, the male condom is the most commonly used and known method of contraception among students. It was determined that students take an average of 3.406 points from the total score of CAS. This result indicated a positive attitude toward contraceptive methods. There were no statistically significant differences in contraceptive attitudes according to gender, religion, or sexual activity. There was a statistically significant difference in contraceptive attitudes according to marital status and age. It is recommended to provide family planning counseling services in these schools in order to increase the use of effective methods and provide students with a reliable source of information on contraceptive methods.

Cameroon's slow fertility transition: A gender perspective

We interrogate the proposition that men's attitudes have constrained the fertility transition in Cameroon, where fertility remains high and contraceptive use low despite much socio-economic progress. We use five Demographic and Health Surveys to compare trends in desired family size among young women and men and analyse matched monogamous couple data from the two most recent surveys to examine wives' and husbands' desires to stop childbearing and their relative influence on current contraceptive use. In 2018, average desired family size was 5.6 and 5.1, for young men and women respectively, and this difference (half a child) has not changed since 1998. Among matched couples, the proportions wanting to stop childbearing were similar in wives and their husbands, but wives perceived husbands to be much more pronatalist than themselves. Surprisingly, men's own reported preferences were more closely associated with contraceptive use than wives' perceptions of husbands' preferences. We discerned little evidence that men's attitudes have impeded reproductive change.

Building capacity for point of care alcohol-based handrub (ABHR) and hand hygiene compliance among health care workers in the rural maternity and surgical units of a hospital in Cameroon

BACKGROUND

Hand hygiene (HH) is challenging in health care, but particularly in resource-limited settings due to a lack of training, resources, and infrastructure. This study aimed to evaluate the implementation of wall-mounted alcohol-based handrub (ABHR) at the point of care (POC) on HH compliance among health care workers in a Cameroon hospital.

METHODS

It was a three-stage before and after study. The first stage involved baseline collection of ABHR utilization and HH compliance data. The second stage included the implementation of ABHR at the POC, supported by an implementation strategy involving HH training, monitoring and feedback, and HH champions. The third stage involved postimplementation data collection on ABHR use and HH compliance.

RESULTS

5,214 HH opportunities were evaluated. HH compliance significantly increased from 33.3% (baseline) to 83.1% (implementation stage) (P < .001) and to 87.2% (postimplementation stage) (P < .001). Weekly ABHR usage increased significantly during implementation (5,670 ml), compared to baseline, (1242.5 ml, P = .001), and remained high in postimplementation (7,740 ml).

CONCLUSIONS

Continuous availability of ABHR at POC, supported by implementation strategy, significantly increased HH compliance and ABHR use. Learning from this study could be used to implement ABHR at POC in other facilities.

The global atlas of edible insects: analysis of diversity and commonality contributing to food systems and sustainability

The future of the food system on the planet is increasingly facing uncertainties that are attributable to population growth and a surge in demand for nutritious food. Traditional agricultural practices are poised to place strain on production, as well as natural resources and ecosystem services provided, particularly under a changing climate. Given their remarkable attributes, including a low environmental footprint, high food conversion ratio, rapid growth and nutritional values, edible insects can play a vital role in the global food system. Nonetheless, substantial knowledge gaps persist regarding their diversity, global distribution, and shared characteristics across regions, potentially impeding effective scaling and access to edible insects. Therefore, we compiled and analysed the fragmented database on edible insects and identified potential drivers that elucidate insect consumption, globally, focusing on promoting a sustainable food system. We collated data from various sources, including the literature for a list of edible insect species, the Global Biodiversity Information Facility and iNaturalist for the geographical presence of edible insects, the Copernicus Land Service library for Global Land Cover, and FAOSTAT for population, income, and nutritional security parameters. Subsequently, we performed a series of analytics at the country, regional and continental levels. Our study identifies 2205 insect species, consumed across 128 countries globally. Among continents, Asia has the highest number of edible insects (932 species), followed by North America (mainly Mexico) and Africa. The countries with the highest consumption of insects are Mexico (450 species), Thailand (272 species), India (262 species), DRC (255 species), China (235 species), Brazil (140 species), Japan (123 species), and Cameroon (100 species). Our study also revealed some common and specific practices related to edible insect access and utilisation among countries and regions. Although insect consumption is often rooted in cultural practices, it exhibits correlations with land cover, the geographical presence of potentially edible insects, the size of a country's population, and income levels. The practice of eating insects is linked to the culture of people in Africa, Asia, and Latin America, while increased consciousness and the need for food sustainability are driving most of the European countries to evaluate eating insects. Therefore, edible insects are becoming an increasingly significant part of the future of planetary food systems. Therefore, more proactive efforts are required to promote them for their effective contribution to achieving sustainable food production.

Availability of the current and future water resources in Equatorial Central Africa: case of the Nyong forest catchment in Cameroon

To anticipate disasters (drought, floods, etc.) caused by environmental forcing and reduce their impacts on its fragile economy, sub-Saharan Africa needs a good knowledge of the availability of current water resources and reliable hydroclimatic forecasts. This study has an objective to quantify the availability of water resources in the Nyong basin and predict its future evolution (2024-2050). For this, the SWAT (Soil and Water Assessment Tool) model was used. The performance of this model is satisfactory in calibration (2001-2005) and validation (2006-2010), with R2, NSE, and KGE greater than 0.64. Biases of - 11.8% and - 13.9% in calibration and validation also attest to this good performance. In the investigated basin, infiltration (GW_RCH), evapotranspiration (ETP), surface runoff (SURQ), and water yield (WYLD) are greater in the East, probably due to more abundant rainfall in this part. The flows and sediment load (SED) are greater in the middle zone and in the Southwest of the basin, certainly because of the flat topography of this part, which corresponds to the valley floor. Two climate models (CCCma and REMO) predict a decline in water resources in this basin, and two others (HIRHAM5 and RCA4) are the opposite. However, based on a statistical study carried out over the historical period (2001-2005), the CCCma model seems the most reliable. It forecasts a drop in precipitation and runoff, which do not exceed - 19% and - 18%, respectively, whatever the emission scenario (RCP4.5 or RCP8.5). Climate variability (CV) is the only forcing whose impact is visible in the dynamics of current and future flows, due to the modest current (increase of + 102 km2 in builds and roads) and future (increase of + 114 km2 in builds and roads) changes observed in the evolution of land use and land cover (LULC). The results of this study could contribute to improving water resource management in the basin studied and the region.

Histoplasmosis peritonitis in an immunocompetent patient: case report

Histoplasmosis is a fungal infection most frequently seen in immunocompromised patients. It is endemic in Central and South America and in Africa. The infection is usually asymptomatic in a healthy individual. Extrapulmonary dissemination can be seen in immunocompromised hosts. Gastrointestinal manifestations frequently involve the terminal ileum and cecum, mimicking Crohn's disease or malignancy. We describe the case of a 36-year-old healthy man from Cameroon, living in Switzerland for 13 years and without any medical nor surgical history, who presented peritonitis not responding to antibiotics. CT-scan showed bowel obstruction and signs of peritonitis. We opted for an explorative laparoscopy, which was converted to laparotomy with extensive adhesiolysis. Diagnostic of histoplasmosis was confirmed by histology and PCR analysis on biopsy. To our knowledge, this is the first described case of peritonitis as main outcome of a disseminated histoplasmosis involving the peritoneum in an immunocompetent patient.

The management of rare disease patients from a grassroot perspective: the role of patients' organizations in the global recognition of rare diseases in Cameroon

Introduction

rare diseases (RD) are extremely complex health conditions. Persons affected by these conditions in Cameroon are often neglected in society and health systems through the inexistence of policies and programs. In Cameroon, there exists no program or policy conceived to address their needs in terms of access to quality health care, timely and reliable diagnosis, treatments, education, etc. The consequence is that persons living with a RD (PLWRD) and their families do not participate in social life. The unique fate of PLWRD reveals that the principle of social justice and equity is flawed in Cameroon. However, patients, in order to survive in society, rely on patients' organizations (PO) to improve their quality of life (QoL) and advocate for a better consideration in the society. The aim of this paper is to highlight how initiatives from a grassroot perspective like POs can inform decision-makers to address the needs of PLWRD and their families.

Methods

the study associated a systematic literature review and semi-structured interviews with parents of children suffering from a RD and who are members of a PO. Through the systematic literature review we highlighted the impact POs have in the development of research on RDs, patient literacy, patient empowerment and advocacy while semi-structured interviews brought out the needs of patients and their families.

Results

findings, on the one hand show that, in Cameroon PLWRD face a number of challenges like the incurability of their condition, catastrophic medical expenses, stigmatization and marginalization, etc. and though in POs their QoL still remains poor. On the other hand, where POs are empowered they are key actors in research on RDs and help decision-makers on having a better insight into the type of RD that exists across a geographical area, the sociodemographic profile of patients, etc. for a better management of PLWRD.

Conclusion

the study suggests that the ministry of public health should create a network with existing RD POs to adequately meet the needs of PLWRD.