Distribution épidémiologique de l’infection à VIH chez les femmes enceintes dans les dix régions du Cameroun et implications stratégiques pour les programmes de prévention

Introduction: le Cameroun se situe dans un contexte d'épidémie  généralisée du VIH. La sous-population des femmes enceintes, facilementaccessible au sein de la population générale, représente une cible  robante pour mener la surveillance du VIH et estimer l'évolution épidémiologique. L'objectif de notre étude était d'évaluer la distribution épidémiologique du VIH chez les femmes enceintes.Méthodes: étude transversale menée en 2012 chez 6521 femmes  enceintes (49,3% âgées de 15-24 ans) en première consultation prénatale (CPN1) dans 60 sites des 10 régions Camerounaises. L'algorithme en série a été utilisé pour le sérodiagnostic du VIH.Résultats: la prévalence du VIH était de 7,8% (508/6521), avec une  différence non significative (p=0,297) entre milieu rural (7,4%) et milieu urbain (8,1%). En zone rurale, cette prévalence variait de 0,7% à  l'Extrême-Nord à 11,8% au Sud. Cependant, en zone urbaine elle variait de 4% à l'Ouest à 11,1% au Sud-Ouest. Suivant l'âge, la prévalence était plus élevée (11,3%) chez les femmes de 35-39 ans. Suivant le niveau de scolarisation, la prévalence du VIH était plus faible (4,4%) chez celles non-scolarisées, et plus élevée (9,3%) chez celles ayant un niveau  primaire. Selon la profession, l'infection était plus élevée chez les  coiffeuses (15,5%), secrétaires (14,8%), commerçantes (12,9%) et  institutrices/enseignantes (10,8%). Conclusion: la prévalence du VIH reste élevée chez les femmes enceintes au Cameroun, sans distinction entre milieux rural et urbain. Les stratégies de prévention devraient s'orienter préférentiellement chez les femmes enceintes âgées, celles du niveau d'instruction primaire, et celles du  secteur des petites et moyennes entreprises

An investigation on the suitability of hydrated building lime from travertine limestone outcrop of Bogongo, South West of Cameroon

peer reviewedIn the present study, physico-chemical investigations were carried out on hydrated lime produced from the limestone of the travertine outcrop of Bogongo in the South West Region of Cameroon. The aim was to evaluate the suitability of that hydrated lime as building lime. The raw material was characterized and then fired at 900 °C. The fired product was hydrated, dried and also characterized. Chemical and mineralogical analyses, density, BET specific surface measurements and thermal analyses were performed. Results were compared to those for an EN 459-1 CL 90-S industrial commercial hydrated lime. It has been shown that, hydrated lime production using the raw material from the Bogongo travertine could yield products with almost similar physico-chemical properties compared to imported CL 90 S hydrated lime, thus could have positive consequence in the commercial exploitation of the Bogongo travertine limestone outcrop.11. Sustainable cities and communitie

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

Early Warning Indicators for HIV Drug Resistance in Cameroon during the Year 2010

BACKGROUND: Rapid scale-up of antiretroviral therapy (ART) in resource-limited settings is accompanied with an increasing risk of HIV drug resistance (HIVDR), which in turn could compromise the performance of national ART rollout programme. In order to sustain the effectiveness of ART in a resource-limited country like Cameroon, HIVDR early warning indicators (EWI) may provide relevant corrective measures to support the control and therapeutic management of AIDS. METHODS: A retrospective study was conducted in 2010 among 40 ART sites (12 Approved Treatment Centers and 28 Management Units) distributed over the 10 regions of Cameroon. Five standardized EWIs were selected for the evaluation using data from January through December, among which: (1) Good ARV prescribing practices: target = 100%; (2) Patient lost to follow-up: target ≤ 20%; (3) Patient retention on first line ART: target ≥ 70%; (4) On-time drug pick-up: target ≥ 90%; (5) ARV drug supply continuity: target = 100%. Analysis was performed using a Data Quality Assessment tool, following WHO protocol. RESULTS: THE NUMBER OF SITES ATTAINING THE REQUIRED PERFORMANCE ARE: 90% (36/40) for EWI(1), 20% (8/40) for EWI(2); 20% (8/40) for EWI(3); 0% (0/37) for EWI(4); and 45% (17/38) for EWI 5. ARV prescribing practices were in conformity with the national guidelines in almost all the sites, whereas patient adherence to ART (EWI(2), EWI(3), and EWI(4)) was very low. A high rate of patients was lost-to-follow-up and others failing first line ART before 12 months of initiation. Discontinuity in drug supply observed in about half of the sites may negatively impact ARV prescription and patient adherence. These poor ART performances may also be due to low number of trained staff and community disengagement. CONCLUSIONS: The poor performance of the national ART programme, due to patient non-adherence and drug stock outs, requires corrective measures to limit risks of HIVDR emergence in Cameroon

Viral suppression in adults, adolescents and children receiving antiretroviral therapy in Cameroon: Adolescents at high risk of virological failure in the era of "test and treat"

Background: After the launching of the "Test &amp; Treat" strategy and the wider accessibility to viral load (VL), evaluating virological success (VS) would help in meeting the UNAIDS targets by 2020 in Cameroon.Setting and methods: Cross-sectional study conducted in the Chantal BIYA International Reference Centre for research on HIV/AIDS prevention and management (CIRCB), Yaounde, Cameroon; data generated between October 2016 and August 2017 amongst adults, adolescents and children at 12, 24, 36 and &gt;= 48 months on ART. VS was defined as &lt; 1000 copies/mL of blood plasma and controlled viremia as VL &lt; 50 copies/mL. Data were analysed by SPSS; p &lt; 0.05 considered as significant.Results: 1946 patients (70% female) were enrolled (1800 adults, 105 adolescents, 41 children); 1841 were on NNRTI-based and 105 on PI-based therapy; with 346 patients at M12, 270 at M24, 205 at M36 and 1125 at &gt;= M48. The median (IQR) duration on was 48 months (24-48). Overall, VS was 79.4% (95% CI 77.6-81.2) and 67.1% (95% CI 64.9-69.1) had controlled viral replication. On NNRTI-based, VS was 79.9% vs. 71.4% on PIs-based, p = 0.003. By ART duration, VS was 84.1% (M12), 85.9% (M24), 75.1% (M36) and 77.2% (&gt;= M48), p = 0.001. By age, VS was 75.6% (children), 53.3% (adolescents) and 81.1% (adults), p &lt; 0.001.Conclusions: In this sub-population of patients receiving ART in Cameroon, about 80% might be experiencing VS, with declining performance at adolescence, with NNRTI-based regimens, and as from 36 months on ART. Thus, improving VS may require an adapted adherence support mechanism, especially for adolescents with long-term treatment in resource-limited settings

Alarming rates of virological failure and HIV-1 drug resistance amongst adolescents living with perinatal HIV in both urban and rural settings: evidence from the EDCTP READY-study in Cameroon

Objectives: Adolescents living with perinatal HIV infection (ALPHI) experience persistently high mortality rates, particularly in resource-limited settings. It is therefore clinically important for us to understand the therapeutic response, acquired HIV drug resistance (HIVDR) and associated factors among ALPHI, according to geographical location. Methods: A study was conducted among consenting ALPHI in two urban and two rural health facilities in the Centre Region of Cameroon. World Health Organization (WHO) clinical staging, self-reported adherence, HIVDR early warning indicators (EWIs), immunological status (CD4 count) and plasma viral load (VL) were assessed. For those experiencing virological failure (VF, VL&nbsp;≥&nbsp;1000 copies/mL), HIVDR testing was performed and interpreted using the Stanford HIV Drug Resistance Database v.8.9-1. Results: Of the 270 participants, most were on nonnucleoside reverse transcriptase inhibitor (NNRTI)-based regimens (61.7% urban vs. 82.2% rural), and about one-third were poorly adherent (30.1% vs. 35.1%). Clinical failure rates (WHO-stage III/IV) in both settings were&nbsp;&lt;&nbsp;15%. In urban settings, the immunological failure (IF) rate (CD4 &nbsp;&lt;&nbsp;250 cells/μL) was 15.8%, statistically associated with late adolescence, female gender and poor adherence. The VF rate was 34.2%, statistically associated with poor adherence and NNRTI-based antiretroviral therapy. In the rural context, the IF rate was 26.9% and the VF rate was 52.7%, both statistically associated with advanced clinical stages. HIVDR rate was over 90% in both settings. EWIs were delayed drug pick-up, drug stock-outs and suboptimal viral suppression. Conclusions: Poor adherence, late adolescent age, female gender and advanced clinical staging worsen IF. The VF rate is high and consistent with the presence of HIVDR in both settings, driven by poor adherence, NNRTI-based regimen and advanced clinical staging

Assessing the potential impact of disruptions due to COVID-19 on HIV among key and lower-risk populations in the largest cities of Cameroon and Benin

Background: The COVID-19 pandemic indirectly impacts HIV epidemiology in Central/West Africa. We estimated the potential impact of COVID-19-related disruptions to HIV prevention/treatment services and sexual partnerships on HIV incidence and HIV-related deaths among key populations including female sex workers (FSW), their clients, men who have sex with men (MSM), and overall. Setting: Yaoundé (Cameroon) and Cotonou (Benin). Methods: We used mathematical models of HIV calibrated to city- and risk-population-specific demographic/behavioural/epidemic data. We estimated the relative change in 1-year HIV incidence and HIV-related deaths for various disruption scenarios of HIV prevention/treatment services and decreased casual/commercial partnerships, compared to a scenario without COVID-19. Results: A 50% reduction in condom use in all partnerships over 6 months would increase 1-year HIV incidence by 39%, 42%, 31% and 23% among MSM, FSW, clients, and overall in Yaoundé respectively, and 69%, 49% and 23% among FSW, clients and overall respectively in Cotonou. Combining a 6-month interruption of ART initiation and 50% reduction in HIV prevention/treatment use would increase HIV incidence by 50% and HIV-related deaths by 20%. This increase in HIV infections would be halved by a simultaneous 50% reduction in casual and commercial partnerships. Conclusions: Reductions in condom use following COVID-19 would increase infections among key populations disproportionately, particularly FSW in Cotonou, who need uninterrupted condom provision. Disruptions in HIV prevention/treatment services have the biggest impacts on HIV infections and deaths overall, only partially mitigated by equal reductions in casual/commercial sexual partnerships. Maintaining ART provision must be prioritised to minimise short-term excess HIV-related deaths

The severity of rheumatoid arthritis at the first rheumatology consultation and factors associated with initial structural damage in sub Saharan patients

Background: The severity of Rheumatoid Arthritis (RA) at diagnosis has not been fully described in sub-Saharan Africa in recent years, nor have been the factors associated with it.Objective: The aim of this study was to determine the frequency of severe RA at the first rheumatology consultation and assess the factors associated with this early severity.Design: This was a retrospective study.Methods: The study was carried out in the rheumatology service of the Yaoundé Central Hospital, Cameroon. Files (one patient = one file) of patients diagnosed with RA during January 2004-May 2018 were included. RA severity was defined by the presence of at least one of these markers: Disease Activity Score-28 with Erythrocyte Sedimentation Rate (DAS28-ESR) &gt; 5.1, initial structural damage on hand X-rays which was defined by a Larsen score ≥ 2 per joint and the presence of Rheumatoid Factor (RF) and/or Anticitrullinated Protein Antibodies (ACPA). Files with no information to assess disease severity at the time of diagnosis were excluded. Data were analyzed with Epi-info version 7.0. Statistical significance was set at p-values less than 0.05.Results: Forty-nine patients were included. Their mean age was 48 ± 14 years. Eighty percent of them were females. Sixty-seven percent had established RA, 33% had early-stage RA and two patients had ever smoked. None of them had received biological diseasemodifying antirheumatic drugs. RA was severe in 82% of patients, with DAS28- ESR &gt; 5.1 in 71%, positivity of at least one autoantibody found in 63% to 82%, and initial structural damage found in 55% of them. Initial structural damage was only associated with the presence of ≥ 10 swollen joint counts.Conclusions: RA was severe from the onset in most patients and structural damage was associated with the presence of ≥ 10 swollen joint counts. Key words: Rheumatoid arthritis, Severity, Initial presentation, Structural damage, Sub-Saharan Africa

Ethnobotanical survey of wild edible plants used by Baka people in southeastern Cameroon

Forest inhabitants worldwide, and indigenous people especially, have depended for generations on plants and animals harvested in these ecosystems. A number of Baka hunter-gatherer populations in south-eastern Cameroon became sedentarised in the 1950s, but still rely on hunting and gathering to meet their basic needs. The use of wild edible plants (WEP) by these communities remains largely undocumented. In this study, we record the diversity of WEP used by Baka people in dense rainforests in the Mintom region. The area still contains relatively undisturbed forest expanses, just south of the Dja Biosphere Reserve, one of the most important protected areas in the Congo Basin. We conducted two ethnobotanical surveys in 2019 in four villages on the Mintom road. In the first survey, we interviewed a total of 73 individuals to determine WEP usage. In our second survey, we specifically quantified WEP harvested and consumed daily in a number of households over a 2-week period during the major rainy season, when use of forest products is highest. Specimens of all recorded plants were collected and identified at the National Herbarium of Cameroon. We documented 88 plant species and 119 unique species/plant organ/recipes in 1519 different citations. A total of 61 genera and 43 families were noted. Excluding 14 unidentified wild yam species, 17 WEP species had not been reported in previous ethnobotanical surveys of the Baka. Our results showed that cultivated starchy plant foods make up a significant proportion of our study population’s daily nutritional intake. A high diversity of WEP is consumed by the studied Baka communities. The study area is likely to be significant in terms of WEP diversity since 18 out of the 30 “key” non-timber forest products, NTFP, in Cameroon were mentioned. Documentation of the use of WEP by indigenous communities is vital to ensure the continuity of traditional knowledge and future food security