Challenges and Solutions for Functional Neurosurgery in Developing Countries.

Functional neurosurgery techniques remain integral to the neurosurgical treatment armamentarium but data on global implementation remains scarce. In comparison to high-income countries (HIC), low- and middle-income countries (LMIC) suffer from an increased prevalence of diseases like epilepsy, which may be amenable to functional techniques, and therefore, LMIC may benefit from an increased utilization of these treatment modalities. However, functional techniques tend to be expensive and thus difficult to implement in the LMIC setting. A review was performed to assess the current status of functional neurosurgical techniques in LMIC as a starting point for future initiatives. For methodology, a review of the current body of literature on functional neurosurgery in LMIC was conducted through the United States National Library of Medicine Pubmed search engine. Search terms included "functional neurosurgery," "developing countries," "low and middle income," and other related terms. It was found that though five billion people lack access to safe surgical care, the burden of disease amenable to treatment with functional neurosurgical procedures remains unknown. Increasingly, reports of successful, long-term, international neurosurgical collaborations are being reported, but reports in the sub-field of functional neurosurgery are lacking. In conclusion, awareness of global surgical disparities has increased dramatically while global guidelines for functional techniques are currently lacking. A concerted effort can harness these techniques for wider practice. Partnerships between centers in LMIC and HIC are making progress to better understand the burden of disease in LMIC and to create context-specific solutions for practice in the LMIC setting, but more collaborations are warranted

The burden of high blood pressure and related risk factors in urban Sub-Saharan Africa: Evidences from Douala in Cameroon

Objective: To provide the current burden of high blood pressure and related risk factors in urban setting in Cameroon. Methods:We used the WHO STEPS approach for Surveillance of non-communicable diseases and their risk factors to collect data from 2,559 adults aged 15-99 years, residing at Cite des Palmiers in Douala, Cameroon. Results: The level of education was low with up to 60% of participants totalizing less than primary school. Smoking habits were 6 times more frequent in men (

Teenage childbearing and school dropout in a sample of 18,791 single mothers in Cameroon

Background: Adolescent childbearing increases the risk of adverse health and social consequences including school dropout (SDO). However, it remains unclear why some teenage mothers drop out of school and others do not, especially in sub-Saharan Africa settings. We aimed to investigate the background and behavioral characteristics of single mothers, associated with school dropout in a sample of 18,791 Cameroonian girls, who had their first child during adolescence. Methods: We used data from a national registry of single mothers, collected during the years 2005–2008 and 2010–2011. Both bivariate analysis and logistic binary regression models were used to explore the relationship between adolescence motherhood and SDO controlling for a range of socio-economic, family, sexual and health seeking behavior characteristics. Results: Among the 18,791 single mothers, 41.6% had dropped out of school because of pregnancy. The multivariable regression model showed that SDO was more common in those who were evicted from their parental home (aOR: 1.85; 95% CI: 1.69–2.04), those who declared having other single mothers in their family (aOR: 1.16; 95% CI 1.08–1.25) and in mothers who had their first child before 15. Using modern contraceptive methods, having declared no sexual partner during the last year and having less than 2 children were associated with a reduced likelihood of school dropout. Conclusions: Strong social support is essential to ensure school continuity in this vulnerable population. Dropping out of school may put the teenage mother more at risk of unsafe health behaviour and new pregnancies

Dissecting IoT Device Provisioning Process

We examine in detail the provisioning process used by many common, consumer-grade Internet of Things (IoT) devices. We find that this provisioning process involves the IoT device, the vendor's cloud-based server, and a vendor-provided mobile app. In order to better understand this process, we develop two toolkits. IoT-Dissect I enables us to decrypt and examine the messages exchanged between the IoT device and the vendor's server, and between the vendor's server and a vendor-provided mobile app. IoT-Dissect II permits us to reverse engineer the vendor's mobile app and observe its operation in detail. We find several potential security issues with the provisioning process and recommend ways to mitigate these potential problems. Further, based on these observations, we conclude that it is likely feasible to construct a vendor-agnostic IoT home gateway that will automate this largely manual provisioning process, isolate IoT devices on their own network, and perhaps open the tight association between an IoT device and the vendor's server.Comment: 7 pages, 11 figure

Long term effect of municipal solid waste amendment on soil heavy metal content of sites used for periurban agriculture in Ngaoundere, Cameroon

An assessment of the impact of amendment using untreated municipal solid wastes on the trace element contents of periurban areas soils was carried out in  Ngaoundere. Waste samples were collected in November and soil samples were collected in November, January, April and July. Heavy metal total concentrations in urban wastes differed significantly among sites and ranged from 0.48 to 7.64 mg/kg for Cd, 38.3 to 236 mg/kg for Cu, 44.06 to 58.03 mg/kg for Ni, 117 to 528 mg/kg for Pb and 270 to 2110 mg/kg for Zn. These levels were out of the critical level for agricultural use at Camp prison (for Pb and Zn), Norvegien (for Cd, Cu and Zn), and Sabongari Gare site (for Cd, Cu and Zn). The levels of Ni in urban wastes from all sites and the levels of all heavy metals in urban wastes from Douze Poteaux site were lower than the critical level. The results revealed that the soil total  concentrations of Cu, Zn, Cd and Pb were below the typical agricultural soil critical level for the soil control and out of the critical level for amended soils. The levels of Ni were found to be within the normal range at all sites. The highest available  concentration of Zn (139.17 mg/kg) was found in November, Fe (843.23 mg/kg) and Pb (38.82 mg/kg) in January and Cu (19.09 mg/kg) and Ni (8.98 mg/kg) in July.  The available concentrations of Cd did not differ among periods. The highest   bioavailable factor (BF) of Zn, Ni and Pb was found at Douze Poteaux site and of Cd and Cu at Sabongari Gare site.Key words: Heavy metals, soils, municipal solid wastes, amendment, bioavailability factor

Setting-up nurse-led pilot clinics for the management of non-communicable diseases at primary health care level in resource-limited settings of Africa

Background: This article describes the setting-up process for nurse-led pilot clinics for the management of four chronic diseases: asthma, type 2 diabetes mellitus, epilepsy and hypertension at the primary health care level in urban and rural Cameroon. Methods: The Biyem-Assi urban and the Bafut rural health districts in Cameroon served as settings for this study. International and local guidelines were identified and adapted to the country’s circumstances. Training and follow-up tools were developed and nurses trained by experienced physicians in the management of the four conditions. Basic diagnostic and follow-up materials were provided and relevant essential drugs made available. Results: Forty six nurses attended six training courses. By the second year of activity, three and four clinics were operational in the urban and the rural areas respectively. By then, 925 patients had been registered in the clinics. This represented a 68.5% increase from the first year. While the rural clinics relied mainly on essential drugs for their prescriptions, a prescription pattern combining generic and proprietary drugs was observed in the urban clinics. Conclusion: In the quest for cost-effective health care for NCD in sub-Saharan Africa, rethinking health workforce and service delivery has relevance. Nurse-led clinics, algorithm driven service delivery stands as alternatives to overcome the shortage of trained physicians and other issues relating to access to care

Hypertension, Diabetes Mellitus and Task Shifting in Their Management in Sub-Saharan Africa

Chronic diseases are becoming increasingly important in sub-Saharan Africa (SSA). The current density and distribution of health workforce suggest that SSA cannot respond to the growing demand for chronic disease care, together with the frequent infectious diseases. Innovative approaches are therefore needed to rapidly expand the health workforce. In this article, we discuss the evidences in support of nurse-led strategies for chronic disease management in SSA, with a focus on hypertension and diabetes mellitus

Association between socioeconomic status and adiposity in urban Cameroon

Background As the relation between socioeconomic status (SES) and obesity may depend on the stage of development of a country, this relation is assessed in adults from urban Cameroon. Methods A sample comprising 1530 women and 1301 men aged 25 years and above, from 1897 households in the Biyem-Assi health area in the capital of Cameroon, Yaoundé, were interviewed about their household amenities, occupation, and education. Weight, height, and waist circumference were measured and subjects were classified as obese if their BMI ≥ 30 kg/m2 or overweight if BMI was between 25.0 and 29.9 kg/m2. Abdominal obesity was defined by a waist circumference ≥80 cm in women and ≥94 cm in men. Results Of the sample studied 33% of women and 30% of men were overweight (P < 0.08), whereas 22% of women and 7% of men were obese (P < 0.001). Abdominal obesity was present in 67% of women and 18% of men (P < 0.001). After adjusting for age, leisure time physical activity, alcohol consumption, and tobacco smoking, the prevalence of overweight + obesity, obesity, and abdominal obesity increased with quartiles of household amenities in both genders and with occupational level in men. Conclusion SES is positively associated with adiposity in urban Cameroon after adjusting for confounding factor

Setting-up nurse-led pilot clinics for the management of non-communicable diseases at primary health care level in resource-limited settings of Africa

BACKGROUND: This article describes the setting-up process for nurse-led pilot clinics for the management of four chronic diseases: asthma, type 2 diabetes mellitus, epilepsy and hypertension at the primary health care level in urban and rural Cameroon. METHODS: The Biyem-Assi urban and the Bafut rural health districts in Cameroon served as settings for this study. International and local guidelines were identified and adapted to the country's; circumstances. Training and follow-up tools were developed and nurses trained by experienced physicians in the management of the four conditions. Basic diagnostic and follow-up materials were provided and relevant essential drugs made available. RESULTS: Forty six nurses attended six training courses. By the second year of activity, three and four clinics were operational in the urban and the rural areas respectively. By then, 925 patients had been registered in the clinics. This represented a 68.5% increase from the first year. While the rural clinics relied mainly on essential drugs for their prescriptions, a prescription pattern combining generic and proprietary drugs was observed in the urban clinics. CONCLUSION: In the quest for cost-effective health care for NCD in sub-Saharan Africa, rethinking health workforce and service delivery has relevance. Nurse-led clinics, algorithm driven service delivery stands as alternatives to overcome the shortage of trained physicians and other issues relating to access to care