Pulmonary tuberculosis in the central prison of Douala, Cameroon

Objective: To determine the prevalence of and factors associated with pulmonary tuberculosis (PTB) in an urban prison in sub-Saharan Africa.Design: A cross-sectional survey. Setting: The Central Prison of Douala, Cameroon. Results: Two thousand four hundred and seventy four (87.4%) out of 2830 inmates underwent screening. Twenty seven (1.1%) of the inmates were under treatment for smear-positive PTB on commencement of the survey while 60 (2.4%) were diagnosed with smear and/or culture-positive PTB during the active case finding, resulting in a point prevalence of PTB of 3.5%. HIV seroprevalence in inmates without clinical signs of PTB was 111/1067 (10.4%) while it amounted to 6/24 (25%) in PTB patients. In multiple stepwise regression analysis, a low BMl, a prison stay of ≤12 months, and a history of previous incarceration were positively associated with PTB. Conclusion: The study results confirm the high prevalence rates of PTB in prison populations and underscore the need for urgent preventive measures. East African Medical Journal Vol. 83(1) 2006: 25-3

Caractérisation hydrologique, morpho-métrique et physicochimique d’un hydrosystème urbain : le lac municipal d’Ebolowa (Sud-Cameroun)

La dégradation de la qualité des eaux de surface, constitue l’un des problèmes environnementaux majeurs auquel l’humanité est confrontée. Elle se caractérise par l'asphyxie des écosystèmes aquatiques, conséquence de la prolifération anarchique des algues qui consomment tout l'oxygène nécessaire à la vie de ces écosystèmes. Au Cameroun, de nombreuses sources de pollution des eaux ont été identifiées, mais l'absence d’une véritable stratégie de gestion des déchets est à l’origine de la dégradation de la qualité des eaux de surface. Dans l’optique d’évaluer le Lac Municipal d’Ebolowa (LME) sur les plans hydrologique, morphométrique et physicochimique, une étude a été menée de février à juillet 2012. L’échantillonnage s’est fait à une fréquence bimensuelle, entre la surface et 0.5 m de profondeur au niveau de trois points: S1 situé à quelques mètres de l’entrée des eaux de la rivière Mfoumou dans le LME, S2 situé au centre du LME à quelques mètres de son exutoire et S3 situé à quelques mètres de l’entrée des eaux de la rivière Bengo’o. Ces échantillons prélevés dans des bouteilles en plastique, sont transportés au laboratoire et analysés suivant des techniques appropriées. Les résultats obtenus mettent en évidence une diminution de la profondeur et de la superficie du LME, un débit spécifique moyen de 0,28 m3/s, une transparence n’excédant pas les 50 cm et un temps de renouvellement des eaux largement inférieur à une année. Ces résultats montrent que le LME se dégrade au fil des années, et se trouve au stade actuel d’hypereutrophie, conséquence de l’absence d’une politique de restauration développée et mise en œuvre par les autorités de la ville. En effet, aucune disposition particulière n’a été prise par les autorités en charge de la gestion du LME, pour y empêcher le déversement des déchets provenant à la fois du Marché Central, et des différentes structures qui le jouxtent. Au contraire, on assiste à Ebolowa à une augmentation des activités génératrices de déchets contribuant à aggraver la dégradation de ce lac. Cette situation laisse présager qu’à terme, on pourrait assister à une disparition totale de ce lac, ce qui ne serait pas nouveau car, des lacs de ce type ont déjà connu le même sort dans d’autres villes camerounaises (Bertoua et Yaoundé).Mots-clés : pollution, qualité des eaux, hypereutrophe, lac municipal d’Ebolowa.Hydrological, morphometrical and hydrochemical characterization of an urban hydrosystem: the Ebolowa municipal lake (South-Cameroon)Humanity is facing an important environmental problem, the degradation of surface waters quality, characterized by the asphyxia of aquatic ecosystems, as a result of the uncontrolled proliferation of algae that consume all oxygen necessary for the life of these ecosystems. In Cameroon many sources of water pollution have been identified but, the lack of a clearly defined wastes management strategy is the major reason of surface waters quality degradation. In order to evaluate the Ebolowa Municipal Lake (EML), hydrological, morphometrical and physicochemical parameters were studied from February to July 2012. Samples was collected twice a month, between the surface and 0.5 m depth at three sampling points : S1 located at few meters of the entrance of Mfoumou river waters; S2 located in the center of EML a few meters from its outlet and S3 located at few meters of the entrance of Bengo'o river waters in EML. Those samples were collected in plastic bottles, transported to the laboratory and analyzed with appropriate techniques. It appears from the results that the EML depth and area are continuously decreasing. The average specific flow is 0.28 m3/s, transparency is not exceeding 50 cm and the waters renewal time is below one year. According to these results, the quality of EML water is getting more and more degraded, and is currently in a hyper-eutrophic stage as a result of the absence of a restoration policy developed and implemented by Ebolowa city authorities. Unfortunately, No specific decisions have been taken by those authorities in order to prevent the discharge of wastes coming both from the Central Market and different structures situated around the lake. Instead, increase of waste generating activities in Ebolowa is contributing to the degradation of the lake. This suggests that there could be a total disappearance of the lake in the future, a situation which has been noticed in others lakes located in Cameroonian cities (Bertoua and Yaounde).Keywords : pollution, water quality, hyper-eutrophic, Ebolowa municipal lake

Tuberculosis incidence in Cameroonian prisons: A 1-year prospective study

Background. Tuberculosis (TB) transmission in prisons is reported to be high worldwide. However, a recent systematic review identified only 19 published studies reporting TB incidence in prisons, most of them from the last century and only one from sub-Saharan Africa. Objectives. To assess the persisting risk of smear-positive pulmonary tuberculosis (PTB) among prison populations benefiting from a comprehensive TB/HIV control programme in Cameroon compared with that in the community. Methods. This descriptive and prospective study evaluated PTB incidence rates over a 1-year period. The study population was inmates of 10 major prisons, sampled by convenience, comprising about 45% of the country’s prison population. As PTB incident cases, all prisoners with incident PTB after a prison stay of ≥90 days were considered. The prison TB incidence rate was compared with that of the corresponding male population. Results. The mean annual PTB incidence in Cameroonian prisons in this study was 1 700 cases in 100 000 person-years at risk, the incidence rate ratio being 9.4 (95% confidence interval 8.1 - 10.9).Conclusion. Findings suggest that internationally recommended prison TB control measures alone may not help protect prisoners from within-prison spread of TB. Imprisonment policies and conditions therefore require fundamental changes.

Evaluation of the single platform Muse® Auto CD4/CD4 % system in Cameroon

Background: according to who revised guidelines for scaling up antiretroviral therapy (ART) in adults and children living in resource-limited settings, there is an urgent need for laboratory monitoring, including the numeration of CD4 T cells.Objective: the study compared the muse® auto CD4/CD4% System for CD4 t cell enumeration in absolute counts and in percentages, to the Guava® AutoD4/CD4% System.Design: This was a prospective study using adults, adolescents, children and infant’s samples.Setting: The Centre International de Diagnostic Medical (CIDM), Yaounde, a research laboratory devoted to HIV screening and monitoring affiliated to the University of Yaounde I.Subjects: K3-EDTA-blood samples from 111 patients (77 adults, 12 adolescents, 18 children and 4 infants) were collected and tested. All participants signed an informed consent form whereas the guardian and parent of children signed the assent form.Results: the absolute CD4 t lymphocyte counts as well as the percentage CD4 lymphocyte of the Muse® AutoCD4/CD4% and GuavaAutoCD4/CD4% Systems, were highly correlated with an interclass correlation coefficient of 0.997 (95%CI: 0.996-0.998) and 0.991 (95% CI: 0.987-0.994) respectively. The Bland-Altman analysis limits of agreement were -5.79 cells/μl (95%CI: [-97.77; 86.19]) for the absolute CD4 T lymphocyte counts and -1.93 (95%CI: [-7.29; – 3.43]) for CD4 T lymphocyte percentage. The numbers of outliers were similar (6/111=5.41%) both for CD4 T lymphocyte counts and percentage. In addition, Cohen’s Kappa ranged from 0.95 to 1 according to CD4 T lymphocyte counts thresholds (p<0.001), showing agreement between both methods. Conclusion: this study demonstrates that the muse™ auto CD4/CD4% system constitutes a promising system for CD4 t cell counting comparable to existing reference methods, and should facilitate wider access to CD4 T cell enumeration for adults and children with HIV infection living in resource-limited countries

Diminishing benefits of urban living for children and adolescents’ growth and development

Optimal growth and development in childhood and adolescence is crucial for lifelong health and well-being1–6. Here we used data from 2,325 population-based studies, with measurements of height and weight from 71 million participants, to report the height and body-mass index (BMI) of children and adolescents aged 5–19 years on the basis of rural and urban place of residence in 200 countries and territories from 1990 to 2020. In 1990, children and adolescents residing in cities were taller than their rural counterparts in all but a few high-income countries. By 2020, the urban height advantage became smaller in most countries, and in many high-income western countries it reversed into a small urban-based disadvantage. The exception was for boys in most countries in sub-Saharan Africa and in some countries in Oceania, south Asia and the region of central Asia, Middle East and north Africa. In these countries, successive cohorts of boys from rural places either did not gain height or possibly became shorter, and hence fell further behind their urban peers. The difference between the age-standardized mean BMI of children in urban and rural areas was <1.1 kg m–2 in the vast majority of countries. Within this small range, BMI increased slightly more in cities than in rural areas, except in south Asia, sub-Saharan Africa and some countries in central and eastern Europe. Our results show that in much of the world, the growth and developmental advantages of living in cities have diminished in the twenty-first century, whereas in much of sub-Saharan Africa they have amplified

Heterogeneous contributions of change in population distribution of body mass index to change in obesity and underweight

From 1985 to 2016, the prevalence of underweight decreased, and that of obesity and severe obesity increased, in most regions, with significant variation in the magnitude of these changes across regions. We investigated how much change in mean body mass index (BMI) explains changes in the prevalence of underweight, obesity, and severe obesity in different regions using data from 2896 population-based studies with 187 million participants. Changes in the prevalence of underweight and total obesity, and to a lesser extent severe obesity, are largely driven by shifts in the distribution of BMI, with smaller contributions from changes in the shape of the distribution. In East and Southeast Asia and sub-Saharan Africa, the underweight tail of the BMI distribution was left behind as the distribution shifted. There is a need for policies that address all forms of malnutrition by making healthy foods accessible and affordable, while restricting unhealthy foods through fiscal and regulatory restrictions

Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants

Background Hypertension can be detected at the primary health-care level and low-cost treatments can effectively control hypertension. We aimed to measure the prevalence of hypertension and progress in its detection, treatment, and control from 1990 to 2019 for 200 countries and territories. Methods We used data from 1990 to 2019 on people aged 30-79 years from population-representative studies with measurement of blood pressure and data on blood pressure treatment. We defined hypertension as having systolic blood pressure 140 mm Hg or greater, diastolic blood pressure 90 mm Hg or greater, or taking medication for hypertension. We applied a Bayesian hierarchical model to estimate the prevalence of hypertension and the proportion of people with hypertension who had a previous diagnosis (detection), who were taking medication for hypertension (treatment), and whose hypertension was controlled to below 140/90 mm Hg (control). The model allowed for trends over time to be non-linear and to vary by age. Findings The number of people aged 30-79 years with hypertension doubled from 1990 to 2019, from 331 (95% credible interval 306-359) million women and 317 (292-344) million men in 1990 to 626 (584-668) million women and 652 (604-698) million men in 2019, despite stable global age-standardised prevalence. In 2019, age-standardised hypertension prevalence was lowest in Canada and Peru for both men and women; in Taiwan, South Korea, Japan, and some countries in western Europe including Switzerland, Spain, and the UK for women; and in several low-income and middle-income countries such as Eritrea, Bangladesh, Ethiopia, and Solomon Islands for men. Hypertension prevalence surpassed 50% for women in two countries and men in nine countries, in central and eastern Europe, central Asia, Oceania, and Latin America. Globally, 59% (55-62) of women and 49% (46-52) of men with hypertension reported a previous diagnosis of hypertension in 2019, and 47% (43-51) of women and 38% (35-41) of men were treated. Control rates among people with hypertension in 2019 were 23% (20-27) for women and 18% (16-21) for men. In 2019, treatment and control rates were highest in South Korea, Canada, and Iceland (treatment >70%; control >50%), followed by the USA, Costa Rica, Germany, Portugal, and Taiwan. Treatment rates were less than 25% for women and less than 20% for men in Nepal, Indonesia, and some countries in sub-Saharan Africa and Oceania. Control rates were below 10% for women and men in these countries and for men in some countries in north Africa, central and south Asia, and eastern Europe. Treatment and control rates have improved in most countries since 1990, but we found little change in most countries in sub-Saharan Africa and Oceania. Improvements were largest in high-income countries, central Europe, and some upper-middle-income and recently high-income countries including Costa Rica, Taiwan, Kazakhstan, South Africa, Brazil, Chile, Turkey, and Iran. Interpretation Improvements in the detection, treatment, and control of hypertension have varied substantially across countries, with some middle-income countries now outperforming most high-income nations. The dual approach of reducing hypertension prevalence through primary prevention and enhancing its treatment and control is achievable not only in high-income countries but also in low-income and middle-income settings. Copyright (C) 2021 World Health Organization; licensee Elsevier

Diminishing benefits of urban living for children and adolescents’ growth and development

Optimal growth and development in childhood and adolescence is crucial for lifelong health and well-being1–6. Here we used data from 2,325 population-based studies, with measurements of height and weight from 71 million participants, to report the height and body-mass index (BMI) of children and adolescents aged 5–19 years on the basis of rural and urban place of residence in 200 countries and territories from 1990 to 2020. In 1990, children and adolescents residing in cities were taller than their rural counterparts in all but a few high-income&nbsp;countries. By 2020, the urban height advantage became smaller in most countries, and in many high-income western countries it reversed into a small urban-based disadvantage. The exception was for boys in most countries in sub-Saharan Africa and in some countries in Oceania, south Asia and the region of central Asia, Middle East and north Africa. In these countries, successive cohorts of boys from rural places either did not gain height or possibly became shorter, and hence fell further behind their urban peers. The difference between the age-standardized mean BMI of children in urban and rural areas was &lt;1.1 kg m–2 in the vast majority of&nbsp;countries. Within this small range, BMI increased slightly more in cities than in rural areas, except in south Asia, sub-Saharan Africa and some countries in central and eastern Europe. Our results show that in much of the world, the growth and developmental advantages of living in cities have diminished in the twenty-first century, whereas in much of sub-Saharan Africa they have amplified

Height and body-mass index trajectories of school-aged children and adolescents from 1985 to 2019 in 200 countries and territories: a pooled analysis of 2181 population-based studies with 65 million participants

Summary Background Comparable global data on health and nutrition of school-aged children and adolescents are scarce. We aimed to estimate age trajectories and time trends in mean height and mean body-mass index (BMI), which measures weight gain beyond what is expected from height gain, for school-aged children and adolescents. Methods For this pooled analysis, we used a database of cardiometabolic risk factors collated by the Non-Communicable Disease Risk Factor Collaboration. We applied a Bayesian hierarchical model to estimate trends from 1985 to 2019 in mean height and mean BMI in 1-year age groups for ages 5–19 years. The model allowed for non-linear changes over time in mean height and mean BMI and for non-linear changes with age of children and adolescents, including periods of rapid growth during adolescence. Findings We pooled data from 2181 population-based studies, with measurements of height and weight in 65 million participants in 200 countries and territories. In 2019, we estimated a difference of 20 cm or higher in mean height of 19-year-old adolescents between countries with the tallest populations (the Netherlands, Montenegro, Estonia, and Bosnia and Herzegovina for boys; and the Netherlands, Montenegro, Denmark, and Iceland for girls) and those with the shortest populations (Timor-Leste, Laos, Solomon Islands, and Papua New Guinea for boys; and Guatemala, Bangladesh, Nepal, and Timor-Leste for girls). In the same year, the difference between the highest mean BMI (in Pacific island countries, Kuwait, Bahrain, The Bahamas, Chile, the USA, and New Zealand for both boys and girls and in South Africa for girls) and lowest mean BMI (in India, Bangladesh, Timor-Leste, Ethiopia, and Chad for boys and girls; and in Japan and Romania for girls) was approximately 9–10 kg/m2. In some countries, children aged 5 years started with healthier height or BMI than the global median and, in some cases, as healthy as the best performing countries, but they became progressively less healthy compared with their comparators as they grew older by not growing as tall (eg, boys in Austria and Barbados, and girls in Belgium and Puerto Rico) or gaining too much weight for their height (eg, girls and boys in Kuwait, Bahrain, Fiji, Jamaica, and Mexico; and girls in South Africa and New Zealand). In other countries, growing children overtook the height of their comparators (eg, Latvia, Czech Republic, Morocco, and Iran) or curbed their weight gain (eg, Italy, France, and Croatia) in late childhood and adolescence. When changes in both height and BMI were considered, girls in South Korea, Vietnam, Saudi Arabia, Turkey, and some central Asian countries (eg, Armenia and Azerbaijan), and boys in central and western Europe (eg, Portugal, Denmark, Poland, and Montenegro) had the healthiest changes in anthropometric status over the past 3·5 decades because, compared with children and adolescents in other countries, they had a much larger gain in height than they did in BMI. The unhealthiest changes—gaining too little height, too much weight for their height compared with children in other countries, or both—occurred in many countries in sub-Saharan Africa, New Zealand, and the USA for boys and girls; in Malaysia and some Pacific island nations for boys; and in Mexico for girls. Interpretation The height and BMI trajectories over age and time of school-aged children and adolescents are highly variable across countries, which indicates heterogeneous nutritional quality and lifelong health advantages and risks