HIV testing, HIV status and outcomes of treatment for tuberculosis in a major diagnosis and treatment centre in Yaounde, Cameroon: a retrospective cohort study

BACKGROUND:Human immuno-deficiency virus (HIV) infection and tuberculosis are common and often co-occurring conditions in sub-Saharan Africa (SSA). We investigated the effects of HIV testing and HIV status on the outcomes of tuberculosis treatment in a major diagnosis and treatment centre in Yaounde, Cameroon. METHODS: Participants were 1647 adults with tuberculosis registered at the Yaounde Jamot's Hospital between January and December 2009. Multinomial logistic regression models were used to relate HIV testing and HIV status to the outcomes of tuberculosis treatment during follow-up, with adjustment for potential covariates. RESULTS: Mean age of participants was 35.5 years (standard deviation: 13.2) and 938 (57%) were men. Clinical forms of tuberculosis were: smear-positive (73.8%), smear-negative (9.4%) and extra-pulmonary (16.8%). Outcomes of tuberculosis treatment were: cure/completion (68.1%), failure (0.4%), default (20.1%), death (5.2%) and transfer (6.3%). Using cure/completion as reference, not testing for HIV was associated with adjusted odds ratio of 2.30 (95% confidence interval: 1.65-3.21), 2.26 (1.29-3.97) and 2.69 (1.62-4.46) for the risk of failure/default, death and transfer respectively. The equivalents for a positive test among those tested (1419 participants) were 1.19 (0.88-1.59), 6.35 (3.53-11.45) and 1.14 (0.69-1.86). CONCLUSIONS: Non-consent for HIV testing in this setting is associated with all unfavourable outcomes of tuberculosis treatment. However been tested positive was the strongest predictor of fatal outcome. Efforts are needed both to improve acceptance of HIV testing among patients with tuberculosis and optimise the care of those tested positive

WHO recommended collaborative TB/HIV activities: evaluation of implementation and performance in a rural district hospital in Cameroon

2% (n=77) respectively regarding HIV testing among TB patients and antiretroviral therapy coverage in TB/HIV co-infected patients. Provision of isoniazid preventive therapy (IPT) was inexistent in this hospital due mainly to the lack of tuberculin skin test and isoniazid tablets. The prevalence of HIV among TB patients in this rural locality was 53%. This prevalence was 55% in females and 44% in males (p=0.19). CONCLUSION: The implementation of collaborative TB/HIV activities in BDH was effective only regarding activities to reduce the burden of HIV among TB patients. There is urgent need to strengthen the capacity of this rural health facility in providing IPT services

Thoracocentèse versus drainage thoracique percutané dans le traitement des empyèmes thoraciques non tuberculeux de grande abondance: étude prospective et comparative préliminaire

Introduction: L'objectif de ce travail était de comparer l'efficacité de la thoracocentèse répétée versus le drainage thoracique percutané chez les malades adultes souffrant d'empyème thoracique de grande abondance. Méthodes: Dans cette étude prospective et comparative, 32 patients adultes atteints d'empyèmes thoraciques de grande abondance, répartis en 12 patients dans le groupe thoracocentèse répétée et 20 patients dans le groupe drainage thoracique percutané ont été inclus. Le principal critère de comparaison était la proportion de patients des deux groupes qui étaient décédés dans le service ou transférés en chirurgie (évolution défavorable). Les critères sécondaires de comparaison étaient la durée d'hospitalisation et les complications liées à chacune de ces deux techniques. Résultats: Les caractéristiques des malades à l'entrée étaient superposables dans les deux groupes. L'évolution défavorable était notée chez 3(25%) malades du groupe thoracocentèse et chez 5(25%) malades du groupe drainage thoracique (P=1,000). L'échec de la thoracocentèse était noté dans 3 cas et l'échec du drainage thoracique dans 4 cas. Un (5%) patient était décédé dans le groupe drainage et aucun patient n'était décédé dans le groupe thoracocentèse. La durée moyenne d'hospitalisation était de 31,7±22,7 jours chez les patients traités par thoracocentèse versus 29,4±16,7 jours chez les patients traités par drainage thoracique (P=0,768). Les complications liées à ces techniques étaient retrouvées chez 4(20%) malades traités par drainage et chez 1(8,3%) malade traité par thoracocentèse (P= 0,626). Conclusion: La thoracocentèse répétée et le drainage thoracique percutané paraissent avoir un taux d'échec et de complications similaire dans le traitement des empyèmes pleuraux de grande abondance.Pan African Medical Journal 2012; 13:1

Sensitisation to Blattella germanica among adults with asthma in Yaounde, Cameroon: a cross-sectional study

BACKGROUND: German cockroach or Blattella germanica is commonly found in homes across the inter-tropical region. The contribution of sensitisation to Blattella germanica in people with asthma in sub-Saharan Africa has not received attention. The aim of this study was to assess the prevalence and investigate the predicting factors of sensitisation to Blattella germanica in patients with asthma in Yaounde, Cameroon. METHODS: This was a cross-sectional study conducted between January 2012 and June 2013. All patients (aged 15years and above) with asthma, receiving care at the Yaounde Jamot Hospital and the CEDIMER medical practice during the study period and who had received a prick skin testing for perennial aeroallergens were included in the study. RESULTS: The final sample comprised 184 patients including 123 (66.8%) women. The median age (25th-75th percentiles) was 38 (24-54) years. Prick skin test for Blattella germanica was positive in 47 (25.5%) patients. Sensitisation to Blattella germanica was associated with a sensitisation to mite in 41 (87.2%) patients, a sensitisation to Alternaria in 18 (38.3%) patients, and a sensitisation to cat or dog dander in 7 (14.9%) patients. Independent predicting factors of a sensitisation to Blattella germanica were the sensitisation to Blomia tropicalis [adjusted odd ratio (95% confidence interval) 4.10 (1.67-10.04), p=0.002] and sensitisation to Alternaria [3.67 (1.53-7.46), p=0.003]. CONCLUSIONS: Sensitisation to Blattella germanica is present in about a quarter of adult patients with asthma in Yaounde. Sensitisation to Alternaria and Blomia tropicalis appears to be a powerful predicting factor of sensitisation to Blattella germanica in this setting

Prevalence and correlates of depressive symptoms in HIV-positive patients: a cross-sectional study among newly diagnosed patients in Yaoundé, Cameroon

BACKGROUND: Depression is one of the most common neuropsychiatric complications of HIV disease, and in turn it is associated with worse HIV-related outcomes. Data on depression among HIV-infected patients in Cameroon are scarce. In this study, we report the prevalence and correlates of depressive symptoms among newly diagnosed HIV-infected patients in Yaoundé, Cameroon. METHODS: Interviews were conducted with 100 newly diagnosed HIV-infected patients at three referral hospitals of Yaoundé. Depression was assessed using the nine-item Patient Health Questionnaire (PHQ-9). A positive depression screen was defined as PHQ-9 score greater than 9. RESULTS: The overall prevalence of depressive symptoms was 63% (95% CI: 53.2 to 71.8), the majority having symptoms corresponding to moderate depression. Multiple logistic regression analysis showed that probable depressed patients were more likely than those who were not depressed to have had experience of alcohol abuse (OR: 19.03, 95% CI 3.11-375.85; p = 0.0083), and a 100 CD4 cells/mm3 fewer was associated with a 2.9 times increase of the odds of probable depression (95% CI 1.88-4.84; p < 0.0001). CONCLUSIONS: Our findings indicate a high prevalence of depressive symptoms in newly diagnosed HIV-infected patients in our setting, and their association with alcohol abuse and severe immunosuppression. This study also highlights the necessity to integrate mental health interventions into routine HIV clinical care in Cameroon

Incidence and predictors of death among adult patients treated for tuberculosis in two regions of Cameroon: 2010 to 2015

Objectives: Mortality during tuberculosis (TB) remains high in Africa. The purpose of our study was to determine the incidence and predictors of death during TB treatment in Cameroon.Materials and Methods: Data of subjects aged ≥15 years were retrospectively extracted from registers in all TB diagnostic and treatment centers in the Western and Northern regions of Cameroon from 2010 to 2015. Cox regression models were used to determine predictors of death during TB treatment.Results: Of the 19,681 patients included, 12,541 (63.7%) were male and their median age (25th-75th percentile) was 34 (26–45) years. The cumulative incidence (95% confidence interval [CI]) of death during TB treatment was 8.0% (7.5–8.5%). The predictors (hazard ratios [95% CI]) of death were: Age &gt;34 years (1.479 [1.295–1.688], P &lt; 0.001), female sex (1.471 [1.286–1.683], P &lt; 0.001), extra-pulmonary TB (1.723 [1.466–2.026], P &lt; 0.001), human immunodeficiency virus infection (3.739 [3.269–4.276], P &lt; 001]), TB treatment in the Western region (2.241 [1.815–2.768], P &lt; 0.001), treatment before 2012 (1.215 [1.073–1.376], P = 0.002)and low body weight (1st quartile and 2nd quartile) (2.568 [2.133–3.092], [P &lt; 0.001]) and (1.569 [1.298–1.896], P &lt; 0.001) respectively.Conclusion: The incidence of death during TB was relatively high in the Western and Northern regions of Cameroon. Recognition of these persons at greatest risk may improve care and reduce death durinng TB treatment

Prison health services across ten central prisons in Cameroon

Background. In 2021, Cameroon held approximately 26,300 inmates in 84 prisons. The Ministry of Justice manages health services in prisons. Conclusive data concerning health care in prisons are lacking. Herein, we present the results of an assessment of health care provision and delivery in 10 central prisons. Methods. We adopted mixed methods, including document review, observations, interviews with the Ministry of Justice and prison facility officials, and inmate focus group discussions (FGDs). The 6 building blocks of the World Health Organization’s health system framework guided the data collection. Moreover, we collected data on imprisonment conditions. Ministerial authorisation and verbal informed consent were obtained for all activities. Results. There were a total of 17,126 inmates, with the prison populations ranging from 353 inmates to 4,576 inmates. The majority of prisons were characterised by huge overcrowding (mean 301%). The 10 central prisons operated infirmaries with insufficient space and equipment. Compared with the civilian health sector, the numeric ratio of paramedical personnel/inmates was favourable, (1:3.4 vs 1:0.5 p. 1,000 pop, respectively). Recent admissions were screened for the coronavirus disease 2019, tuberculosis (TB), and human immunodeficiency virus (HIV). Moreover, the inmates were diagnosed for current pathologies and lesions. For the treatment of chronic diseases and medical emergencies, the prison health services bridged service gaps on a case-by-case basis through informal arrangements with the civilian health sector. The service quality control was limited to those performed by the TB and HIV/acquired immune deficiency syndrome control programmes. Health data was collected and transmitted with a multitude of data collection tools, without standardisation and systematic verification. The primarily reported problems comprised the scarcity of resources and the absence of an effective oversight of resource management and service quality performance entailing governance problems. Participants in FDGs esteemed the quality of treatment as poor unless paid for in cash, and denounced severe difficulties for access to care outside the prisons when required. Conclusion. For meeting the standard minimum rules for the treatment of inmates, prison health care in Cameroon should fill the crucial gaps involving imprisonment conditions, access to health services, and accountability. Regarding chronic underfunding, intensifying collaboration with the civil health sector may partially address the problem

Parental and child-level predictors of HIV testing uptake, seropositivity and treatment initiation among children and adolescents in Cameroon

Background: There is a growing body of evidence positioning targeted provider-initiated testing and counselling (tPITC, also known as index case testing) as a promising HIV case-finding and linkage strategy among children and adolescents. However, the effectiveness and efficiency of this strategy is limited by low HIV testing uptake and case detection rates. Despite this fact, there is very little literature on factors associated with HIV testing uptake, HIV seropositivity and ART-enrolment in tPITC implementation among African children. This study aims to bridge this information gap and contribute in improving the effectiveness and efficiency of tPITC among children and adolescents in Cameroon and beyond. Methods In three ART clinics where tPITC was previously inexistent, we introduced the routine implementation of this strategy by inviting parents living with HIV/AIDS in care to have their biological children (6 weeks-19 years) HIV-tested. Children of consenting parents were HIV-tested;those testing positive were enrolled on ART. Parental and child-level characteristics associated with HIV testing uptake, seropositivity and ART-enrollment were assessed using bivariate and multivariate regression analysis at 5% significance level. Results We enrolled 1,236 parents, through whom 1,990 children/adolescents were recruited for HIV testing. Among enrolled parents, 46.2% (571/1,236) had at least one child tested, and 6.8% (39/571) of these parents had at least one HIV-positive child. Among enrolled children/adolescents, 56.7% (1,129/1,990) tested for HIV and 3.5% (40/1129) tested HIV-positive. Parental predictors of HIV testing uptake among children/adolescents were sex, occupation and duration on ART: female [aOR = 1.6 (1.1-2.5)], office workers/students [aOR = 2.0 (1.2-3.3)], and parents with ART duration > 5 years [aOR = 2.0 (1.3-2.9)] had significantly higher odds to test a child than male, farmers/traders, and parents with ART duration 15 years. Parents of children identified as HIV-positive were more likely to be female, aged 40-60 years, farmers/traders, widows/divorcees and not on ART. Children found HIV-positive and who were ART-enrolled were more likely to be female and aged 5-9 years. However, none of the above-mentioned associations was statistically significant. Conclusions: Parents who were male, farmers/traders, and on ART for. 5 years were less likely to test their children for HIV. Also, adolescents 10-19 years old were less likely to be tested. Therefore, these groups should be targeted with intensive counseling and follow-up to facilitate optimal testing uptake. No association was found between parental or child-level characteristics and HIV seropositivity among tested children. This finding prompts for further research to investigate approaches to better identify and target HIV testing to children/adolescents with the highest likelihood of HIV seropositivity

Assessment of asthma control using asthma control test in chest clinics in Cameroon: a cross-sectional study

Introduction: The goal of asthma treatment is to obtain and maintain a good control of symptoms. Investigating factors associated with inadequately control asthma could help in strategies to improve asthma control. This study aimed to determine the prevalence and factors associated with inadequately controlled asthma in asthma patients under chest specialist care. Methods: A cross-sectional study was conducted from November 2012 to May 2013. Physician-diagnosed asthma patients aged 12 years and above were included. A questionnaire was used to collect demographic data, comorbidities, and medical history of asthma. Asthma control was assessed using the Asthma Control Test (ACT), with a score less than 20 for inadequately controlled asthma and a score greater or equal to 20 for controlled asthma. A multivariate analysis was used to identify factors associated with inadequately controlled asthma. Results: Overall, 243 patients were included in this study. Asthma was controlled in 141 patients (58%) and inadequately controlled in 102 (42%). The mean duration of asthma was 8 years with an interquartile range of 4 and 18 years. Forty-three participants (17.7%) were not under any controller medication while the mean ACT score was 19.3 ± 4.6. Independent associations were found between inadequately controlled asthma and female gender (OR 1.91; 95% CI 1.06-3.47) and obesity (OR 1.81; 1.01-3.27). Conclusion: Asthma remains poorly controlled in a large proportion of asthma patients under specialist care in Cameroon. Educational programs for asthma patients targeting women and based on weight loss for obese patients may help in improving the control of asthma.Pan African Medical Journal 2016; 2