Takayasu's arteritis in an adult female from Cameroon: diagnosis via Doppler echocardiography

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Cardiovascular risk factors awareness and prevalence among primary care physicians: an insight from the West region Awareness Initiative Survey to fight cardiovascular disease (WAIT-CVD) in Cameroon

BACKGROUND: Data on the frequency and awareness of cardiovascular risk factors in practicing doctors are lacking in Cameroon. This study reports on the prevalence of cardiovascular risk factors in primary care physicians (PCPs) at the forefront for the fight against chronic diseases, and the implications for cardiovascular disease prevention and management. METHODS: We carried out a cross-sectional study in the west region of Cameroon. Participants were recruited from 111 PCPs who lived and worked in the region at the time of the study. Data were collected on designed questionnaires adapted from the WHO STEPS approach in two steps, and a nurse-led examination was performed. RESULTS: Sixty five (65) consenting doctors, aged 39.1 (SD 8.9) years, with 45 (69.2 %) males, were included. Self-reported hypertension rate was 4.6 % (n = 3). The frequency of pre-hypertension was 21.5 % (n = 14) and of hypertension was 26.2 % (n = 17). Self-reported diabetes rate was 3.1 % (n = 2). The frequency of overweight was 46.2 % (n = 30), and obesity was 23.1 % (n = 15). Eight (12.3 %) participants were smokers, 25 (38.5 %) had excessive alcohol consumption (more than two drinks per day for men and one drink per day for women) and 54 (83.1 %) practiced physical exercise, although below the recommendations. Positive family history any CVD was reported in 52.4 % (39.4–65.1). Up to 35.4 % (23.9–48.2) have never done their lipid profile test. There was no difference in cardiovascular risk factors between males and females, except for systolic blood pressure (p < 0.001) and diastolic blood pressure (p = 0.002) that were higher in males. No significant difference was noted in the other risk profiles and the rate of awareness between sexes. CONCLUSION: There are high prevalence of cardiovascular risk factors with low awareness among PCPs in the West region of Cameroon. This is alarming as doctors at the fore front for the fight against cardiovascular diseases are not aware of their own risk profile. There is need for more awareness programs targeting doctors so as to prevent a sick population with sick doctors

Neurological complications of sickle cell disease in Africa: protocol for a systematic review

INTRODUCTION: Sickle cell disease (SCD) is highly prevalent in Africa. Considered as a public health problem, it is associated with high morbidity and mortality. Neurological complications of SCD can cause significant disability with important socioeconomic and psychological impact on the patients and their families, and can even lead to death if not properly managed. There are important knowledge gaps regarding the burden of neurological complications of SCD in African populations. We propose to conduct the first systematic review to summarise the epidemiological data available on neurological complications of SCD in Africa. METHODS AND ANALYSIS: We will search PubMed, MEDLINE, EMBASE and the African Index Medicus from 1 January 1950 to 31 May 2016 for studies of neurological complications of SCD in Africa. After study selection, full-text paper acquisition, data extraction and synthesis, we will assess all studies for quality, risk of bias and heterogeneity. Appropriate methods of meta-analysis will be used to pool prevalence estimates from studies with similar features, globally and in major subgroups. This protocol complies with the 2015 Preferred Reporting Items for Systematic reviews and Meta-Analysis protocols (PRISMA-P) guidelines. ETHICS AND DISSEMINATION: The proposed study will use published data. Therefore, there is no requirement for ethical approval. This review is expected to provide relevant data to help quantify the burden of neurological complications of SCD in African populations, inform policymakers and identify further research topics. The final report of the systematic review will be published in a peer-reviewed journal and presented at conferences. REVIEW REGISTRATION NUMBER: CRD42016039574

What is the best strategy for the prevention of transfusion-transmitted malaria in sub-Saharan African countries where malaria is endemic?

The transmission of malaria by blood transfusion was one of the first recorded incidents of transfusion-transmitted infections (TTIs). Although the World Health Organization (WHO) recommends that blood for transfusion should be screened for TTIs, malaria screening is not performed in most malaria-endemic countries in sub-Saharan Africa (SSA). The transfusion of infected red blood cells may lead to severe post-transfusion clinical manifestations of malaria, which could be rapidly fatal. Ensuring that blood supply in endemic countries is free from malaria is highly problematical, as most of the donors may potentially harbour low levels of malaria parasites. Pre-transfusion screening within endemic settings has been identified as a cost-effective option for prevention of transfusion-transmitted malaria (TTM). But currently, there is no screening method that is practical, affordable and suitably sensitive for use by blood banks in SSA. Even if this method was available, rejection of malaria-positive donors would considerably jeopardize the blood supply and increase morbidity and mortality, especially among pregnant women and children who top the scale of blood transfusion users in SSA. In this context, the systematic prophylaxis of recipients with anti-malarials could constitute a good alternative, as it prevents any deferral of donor units as well as the occurrence of TTM. With the on-going programme, namely the Affordable Medicine Facility - Malaria, there is an increase in the availability of low-priced artemisinin-based combination therapy that can be used for systematic prophylaxis. It appears nonetheless an urgent need to conduct cost-benefit studies in order to evaluate each of the TTM preventive methods. This approach could permit the design and implementation of an evidence-based measure of TTM prevention in SSA, advocating thereby its widespread use in the region

Early mortality during initial treatment of tuberculosis in patients co-infected with HIV at the Yaoundé Central Hospital, Cameroon : an 8-year retrospective cohort study (2006-2013)

BACKGROUND: Understanding contributors to mortality during the initial phase of tuberculosis (TB) treatment in patients co-infected with HIV would guide targeted interventions to improve survival. The aim of this study was to ascertain the incidence of death during the initial 2 months (new cases) and 3 months (retreatment cases) of TB treatment and to assess correlates of mortality in HIV co-infected patients. METHODS: We conducted a hospital-based retrospective cohort study from January 2006 to December 2013 at Yaoundé Central Hospital, Cameroon. We reviewed medical records to identify co-infected TB/HIV inpatients aged 15 years and older who died during TB treatment. Death was defined as any death occurring during TB treatment, as per World Health Organization recommendations. We collected socio-demographic, clinical and laboratory data. We conducted multivariable logistic binary regression analysis to identify factors associated with death during the intensive phase of TB treatment. Magnitudes of associations were expressed by adjusted odds ratio (a OR ) with 95% confidence interval. A p value < 0.05 was considered statistically significant. RESULTS: The 99 patients enrolled had a mean age of 39.5 (standard deviation 10.9) years and 53% were male. Patients were followed for 276.3 person-months of observation (PMO). Forty nine patients were died during intensive phase of TB treatment. Death incidence during the intensive phase of TB treatment was 32.2 per 100 PMO. Having a non-AIDS comorbidity (a OR 2.47, 95%CI 1.22-5.02, p = 0.012), having extra-pulmonary TB (a OR 1.89, 95%CI 1.05-3.43, p = 0.035), and one year increase in duration of known HIV infection (aOR 1.23, 95%CI 1.004-1.49) were independently associated with death during the intensive phase of TB treatment. CONCLUSIONS: Mortality incidence during intensive phase of TB treatment was high among TB/HIV co-infected patients during TB treatment; and strongly associated with extra pulmonary TB suggesting advanced stage of immunosuppression and non-AIDS comorbidities. Early HIV diagnosis and care and good management of non-comorbidities can reduce this incidence

Effect of low-dose spironolactone on resistant hypertension in type 2 diabetes mellitus: a randomized controlled trial in a sub-Saharan African population

BACKGROUND: Low-dose spironolactone has been proven to be effective for resistant hypertension in the general population, but this has yet to be confirmed in type 2 diabetic (T2DM) patients. We assessed the efficacy of a low-dose spironolactone on resistant hypertension in a sub-Saharan African population of T2DM patients from Cameroon. METHODS: This was a four-week single blinded randomized controlled trial in 17 subjects presenting with resistant hypertension in specialized diabetes care units in Cameroon. They were randomly assigned to treatment with a daily 25 mg of spironolactone (n = 9) or to an alternative antihypertensive regimen (n = 8), on top of any ongoing regimen and prevailing lifestyle prescriptions. They were seen at the start of the treatment, then 2 and 4 weeks later. The primary outcome was change in office and self-measured blood pressure (BP) during follow-up, and secondary outcomes were changes in serum potassium, sodium, and creatinine levels. RESULTS: Compared with alternative treatment, low-dose spironolactone was associated with significant decrease in office systolic BP (−33 vs. −14 mmHg; p = 0.024), and in diastolic BP (−14 vs. −5 mmHg; p = 0.006). After 1 month of spironolactone, all the patients were controlled based on BP below 130/80 mmHg, with significant office BP reduction from 158 ± 17/86 ± 11 to 125 ± 11/72 ± 8, vs. 158 ± 8/94 ± 8 to 144 ± 17/89 ± 12 mmHg in the alternative treatment group. There was no significant variation in sodium and creatinine levels in both groups, but a mild increase of potassium levels in the spironolactone group. INTERPRETATION: Add-on low-dose spironolactone was effective in reducing BP to optimal levels in T2DM Cameroonian patients despite mild increase in serum potassium. Trial registration ClinicalTrials.gov Identifier NCT02426099. Date of registration April 201

Prevalence and correlates of HIV-risky sexual behaviors among students attending the Medical and Social Welfare Center of the University of Maroua, Cameroon

BACKGROUND: Data on sexual behaviors in Cameroonian youths are needed to design and implement effective preventive strategies against HIV/AIDS. This study aimed at assessing sociodemographic and religious factors associated with sexual behaviors among university students in Cameroon. METHODS: In 2011, 411 university students were surveyed by a self-administered questionnaire at the Medical and Social Welfare Center of the University of Maroua. Logistic regression analyses were used to determine correlates of sexual behaviors. RESULTS: 80.8 % of students were sexually active. The mean age at sexual debut was 18.1 years (SD = 3.1). The frequency of premarital sex was 92.8 %. Pornography viewing [adjusted odds ratio (aOR): 4.0, 95 % CI 2.1–7.6; p < 0.0001] and an increased age of 1 year (aOR: 1.3, 95 % CI 2.0–7.6; p < 0.0001) were significantly associated with having previously had sex. The likelihood to have a lower (<18) age at sexual debut was increased by male gender (aOR: 2.5, 95 % CI 1.7–5; p < 0.001), and urban origin (aOR: 2.9, 95 % CI 1.5–5.7; p < 0.01). The probability to have a high number (#3) of lifetime sexual partners was increased by age (aOR: 1.1, 95 % CI 1.0–1.2; p < 0.001), pornography viewing (aOR: 4.3, 95 % CI 1.9–9.5; p < 0.001), an early sexual debut (aOR: 2.8, 95 % CI 1.6–5.0; p < 0.001), having had occasional sexual partners (aOR: 7.0, 95 % CI 3.7–13.1; p < 0.0001), and was decreased by Muslim religious affiliation (aOR: 0.2, 95 % CI 0.1–0.9; p < 0.05). Having had casual sexual partners was associated with less inconsistent condom use (aOR: 0.5, 95 % CI 0.2–0.9; p < 0.05). CONCLUSIONS: Our findings indicate that there is an alarming level of risky sexual behaviors among the study population. Strong and efficient measures should be undertaken to handle such harmful behaviors, this for the prevention and control of HIV/AIDS and other STIs in this vulnerable population

Maternal hyperglycemia during labor and related immediate post-partum maternal and perinatal outcomes at the Yaoundé Central Hospital, Cameroon

Abstract Background Data on the prevalence and complications of gestational diabetes are very scarce in Cameroon. The aim of this study was to evaluate the uptake of screening for gestational diabetes and assess the immediate post-partum outcome of hyperglycemic parturient mothers and perinatal outcome of their babies. Methods A prospective cohort study was held at the Maternity of the Yaoundé Central Hospital from March to June 2013. One hundred volunteer women in labor without overt diabetes mellitus and having fasted for 8 to 12 h were recruited. No intervention was given. A clinical examination was done and capillary glucose recorded. Parturient women were categorized into two groups (hyperglycemic and non-hyperglycemic subjects) based on glycemia results interpreted according to the International Association of Diabetes and Pregnancy Study Groups. Mothers’ clinical examination was repeated and neonates examined immediately after delivery. Perinatal outcomes associated with maternal hyperglycemia during labor were assessed using relative risks. A p value <0.05 was considered statistically significant. Results One hundred women with a mean age of 27 (SD 6) years were recruited. Of them, 22 (22 %) had already been screened for gestational diabetes at baseline. Thirty-one (31 %) were diagnosed with hyperglycemia during labor, and this condition was highly associated with macrosomia in neonates (RR = 8.9, 95 % CI 2.70–29.32; p < 0.001). Other complications associated with maternal hyperglycemia during labor were perineal tears, cesarean section, and intrauterine fetal death, though the association was not statistically significant. Conclusions The main finding of this study is that maternal hyperglycemia during labor is highly associated with macrosomia in neonates. About a third of mothers were concerned with hyperglycemia during labor, and gestational diabetes was insufficiently screened in this series