Reference Physiological Ranges for Serum Biochemical Parameters among Healthy Cameroonians to Support HIV Vaccine and Related Clinical Trials

Background: A valid scientific evaluation of the efficacy of HIV vaccines or antiretroviral drugs includes measurement of changes in physiological parameters of subjects from known established baseline reference ranges. This study was designed to establish reference ranges for biochemical parameters among healthy adult Cameroonians to support planned HIV Vaccine clinical trials and scaling up of ARV drugs among AIDS patients.Methods: After informed consent, blood and urine samples were collected from a total of 576 adult Cameroonians and analyzed for the presence of underlying pathologies that may affect biochemical parameters. Samples from 501 of them were found eligible for the determination of reference biochemical parameters. After complete assay, the data were subjected to both parametric and non parametric statistics for analyses with 2.5 and 97.5 percentiles considered as the lower and upper limits of reference ranges.Results: There were 331(66.1%) males and 170(33.9) females, with 359(71.7%) and 142(28.3) of them residing in the urban and rural areas respectively. Statistically significant differences (P<0.05) were observed in the following biochemical parameters between urban and rural participants: AST, ALT, alkaline phosphatase, creatinine, total protein, albumin, triglyceride, total cholesterol, and the bilirubins. When the data were regrouped into sex, there were statistically significant differences (P<0.05) in the following parameters between males and females: AST, ALT, creatinine, albumin, triglyceride, total cholesterol, and direct bilirubin.Conclusion: The present study shows that sex and geographic location have significant impact on reference physiological biochemical parameters of healthy, adult Cameroonians; hence this should be taken into consideration when monitoring participants either during HIV Vaccine clinical trials or on antiretroviral (ARV) drugs treatment.Key Words: Normal Biochemical Ranges, Health Adult Cameroonians

The WOMAN trial: clinical and contextual factors surrounding the deaths of 483 women following post-partum haemorrhage in developing countries.

BACKGROUND: Post-partum haemorrhage (PPH) is a leading cause of maternal death worldwide. The WOMAN trial assessed the effects of tranexamic acid (TXA) on death and surgical morbidity in women with PPH. The trial recorded 483 maternal deaths. We report the circumstances of the women who died. METHODS: The WOMAN trial recruited 20,060 women with a clinical diagnosis of PPH after a vaginal birth or caesarean section. We randomly allocated women to receive TXA or placebo. When a woman died, we asked participating clinicians to report the cause of death and to provide a short narrative of the events surrounding the death. We collated and edited for clarity the narrative data. RESULTS: Case fatality rates were 3.0% in Africa and 1.7% in Asia. Nearly three quarters of deaths were within 3 h of delivery and 91% of these deaths were from bleeding. Women who delivered outside a participating hospital (12%) were three times more likely to die (OR = 3.12, 95%CI 2.55-3.81) than those who delivered in hospital. Blood was often unavailable due to shortages or because relatives could not afford to buy it. Clinicians highlighted late presentation, maternal anaemia and poor infrastructure as key contributory factors. CONCLUSIONS: Although TXA use reduces bleeding deaths by almost one third, mortality rates similar to those in high income countries will not be achieved without tackling late presentation, maternal anaemia, availability of blood for transfusion and poor infrastructure

A new initiative for the development of new diagnostic tests for human African trypanosomiasis

Human African trypanosomiasis is a threat to millions of people living in sub-Saharan countries and is fatal unless treated. At present, the serological and parasitological tests used in the field for diagnosis of sleeping sickness have low specificity and sensitivity. There is clearly an urgent need for accurate tools for both diagnosis and staging of the disease. The Foundation for Innovative New Diagnostics and the World Health Organization have announced that they will collaborate to develop and evaluate new diagnostic tests for human African trypanosomiasis

Reference Physiological Ranges for Serum Biochemical Parameters among Healthy Cameroonians to Support HIV Vaccine and Related Clinical Trials

Background: A valid scienti\ufb01c evaluation of the e\ufb03cacy of HIV vaccines or antiretroviral drugs includes measurement of changes in physiological parameters of subjects from known established baseline reference ranges. This study was designed to establish reference ranges for biochemical parameters among healthy adult Cameroonians to support planned HIV Vaccine clinical trials and scaling up of ARV drugs among AIDS patients. Methods: After informed consent, blood and urine samples were collected from a total of 576 adult Cameroonians and analyzed for the presence of underlying pathologies that may a\ufb00ect biochemical parameters. Samples from 501 of them were found eligible for the determination of reference biochemical parameters. After complete assay, the data were subjected to both parametric and non parametric statistics for analyses with 2.5 and 97.5 percentiles considered as the lower and upper limits of reference ranges. Results: There were 331 (66.1%) males and 170 (33.9) females, with 359 (71.7%) and 142 (28.3%) of them residing in the urban and rural areas respectively. Statistically signi\ufb01cant di\ufb00erences (P<0.05) were observed in the following biochemical parameters between urban and rural participants: AST, ALT, alkaline phosphatase, creatinine, total protein, albumin, triglyceride, total cholesterol, and the bilirubins. When the data were regrouped into sex, there were statistically signi\ufb01cant di\ufb00erences (P<0.05) in the following parameters between males and females: AST, ALT, creatinine, albumin, triglyceride, total cholesterol, and direct bilirubin. Conclusion: The present study shows that sex and geographic location have signi\ufb01cant impact on reference physiological biochemical parameters of healthy, adult Cameroonians; hence this should be taken into consideration when monitoring participants either during HIV Vaccine clinical trials or on antiretroviral (ARV) drugs treatment

Traditional Medicine: Past, present and future research and development prospects and integration in the National Health System of Cameroon

Traditional medicine refers to health practices, approaches, knowledge and beliefs incorporating plant, animal and mineral based medicines, spiritual therapies, manual techniques and exercises, applied singularly or in combination to treat, diagnose and prevent illnesses or maintain well-being. In the last decade traditional medicine has become very popular in Cameroon, partly due to the long unsustainable economic situation in the country. The high cost of drugs and increase in drug resistance to common diseases like malaria, bacteria infections and other sexually transmitted diseases has caused the therapeutic approach to alternative traditional medicine as an option for concerted search for new chemical entities (NCE). The World Health Organisation (WHO) in collaboration with the Cameroon Government has put in place a strategic platform for the practice and development of TM in Cameroon. This platform aims at harmonizing the traditional medicine practice in the country, create a synergy between TM and modern medicine and to institutionalize a more harmonized integrated TM practices by the year 2012 in Cameroon. An overview of the practice of TM past, present and future perspectives that underpins the role in sustainable poverty alleviation has been discussed. This study gives an insight into the  strategic plan and road map set up by the Government of Cameroon for the organisational framework and research platform for the practice and development of TM, and the global partnership involving the management of TM in the country.Key words: Tradttional medicine, Cameroon

TRADITIONAL MEDICINE: PAST, PRESENT AND FUTURE RESEARCH AND DEVELOPMENT PROSPECTS AND INTEGRATION IN THE NATIONAL HEALTH SYSTEM OF CAMEROON.

Traditional medicine refers to health practices, approaches, knowledge and beliefs incorporating plant, animal and mineral based medicines, spiritual therapies, manual techniques and exercises, applied singularly or in combination to treat, diagnose and prevent illnesses or maintain well-being. In the last decade traditional medicine has become very popular in Cameroon, partly due to the long unsustainable economic situation in the country. The high cost of drugs and increase in drug resistance to common diseases like malaria, bacteria infections and other sexually transmitted diseases has caused the therapeutic approach to alternative traditional medicine as an option for concerted search for new chemical entities (NCE). The World Health Organisation (WHO) in collaboration with the Cameroon Government has put in place a strategic platform for the practice and development of TM in Cameroon. This platform aims at harmonizing the traditional medicine practice in the country, create a synergy between TM and modern medicine and to institutionalize a more harmonized integrated TM practices by the year 2012 in Cameroon. An overview of the practice of TM past, present and future perspectives that underpins the role in sustainable poverty alleviation has been discussed. This study gives an insight into the strategic plan and road map set up by the Government of Cameroon for the organisational framework and research platform for the practice and development of TM, and the global partnership involving the management of TM in the country

Challenges towards the elimination of Human African Trypanosomiasis in the sleeping sickness focus of Campo in southern Cameroon

The sleeping sickness focus of Campo lies along the Atlantic coast and extends along the Ntem River, which constitutes the Cameroonian and Equatorial Guinean border. It is a hypo-endemic focus with the disease prevalence varying from 0.3 to 0.86% during the last few decades. Investigations on animal reservoirs revealed a prevalence of Trypanosoma brucei gambiense of 0.6% in wild animals and 4.83% in domestic animals of this focus. From 2001 to 2012, about 19 931 tsetse were collected in this focus and five tsetse species including Glossina palpalis palpalis, G. pallicera, G. nigrofusca, G. tabaniformis and G. caliginea were identified. The analysis of blood meals of these flies showed that they feed on human, pig, goat, sheep, and wild animals such as antelope, duiker, wild pig, turtle and snake. The percentage of blood meals taken on these hosts varies according to sampling periods. For instance, 6.8% of blood meals from pig were reported in 2004 and 22% in 2008. This variation is subjected to considerable evolutions because the Campo HAT focus is submitted to socio-economic mutations including the reopening of a new wood company, the construction of autonomous port at "Kribi" as well as the dam at "Memve ele". These activities will bring more that 3000 inhabitants around Campo and induce the deforestation for the implementation of farmlands as well as breeding of domestic animals. Such mutations have impacts on the transmission and the epidemiology of sleeping sickness due to the modification of the fauna composition, the nutritional behavior of tsetse, the zoophilic/anthropophilic index. To achieve the elimination goal in the sleeping sickness focus of Campo, we report in this paper the current epidemiological situation of the disease, the research findings of the last decades notably on the population genetics of trypanosomes, the modifications of nutritional behavior of tsetse, the prevalence of T. b. gambiense in humans, domestic and wild animals. An overview on the types of mutations occurring in the region has been raised and a discussion on the strategies that can be implemented to achieve the elimination of the disease has been made