Impact of Out-of-Pocket Fees on Under-5 Infant Mortality in Cameroon

Health facilities in Cameroon charge fees for treatment and services, which can affect health outcomes for those unable to pay for services. Some studies have shown that the removal of user fees had a positive impact on child health outcomes in selected African countries. The aim of this quantitative, cross-sectional study was to understand whether there is a link between out-of-pocket expenses and under-5 mortality in Cameron. The study was guided by the social ecological framework. Secondary data from the 2011 Cameroon Demographic Health Survey were used in the study. Chi-square, binary logistic regression, and multicollinearity analyses were used to analyze the data. Results indicated that out-of-pocket expenses were not associated with under-5 mortality when controlling for other significant variables. However, delivery in private hospitals, maternal age, and respondents from the Grassfield, the Bamilike/Bamoun, and the Kako/Meka/Pygmé ethnic group were associated with under-5 mortality. In addition, region was not found to be significantly associated with under-5 mortality when controlling for confounding variables. Based on the results, educating younger women, advocating for health coverage that will reduce barriers to accessing health services, and understanding the different culture of each ethnic group and region and how it may influence a woman’s ability to care for herself and her children are important for interventions to promote positive social change and to reduce under-5 mortality in Cameroon and meet the sustainable development goal of ensuring healthy lives and promote well-being for all at all ages

Novel inhibition mechanism and potent antiviral activity of translocation-deficient reverse transcriptase inhibitors [abstract]

Abstract only availableNucleoside RT inhibitors (NRTIs) are among the most potent anti-HIV agents and act as chain terminators because they lack a 3'OH. However, this feature can reduce affinity for RT compared to the analogous dNTP substrate, as well as reduced intracellular conversion to the active dNTP. To overcome this, it was shown that certain nucleosides that retain the 3'OH and have substitutions at the 4' ribose and 2 position of the base have exceptional antiviral properties. One of these compounds, 4'-ethynyl, 2-fluoro deoxy-adenosine (4'E-2FdA) is the most potent NRTI inhibitor against wild-type and multi-drug resistant HIV viruses described to date. We have recently reported that 4'E-2FdA acts as a chain terminator despite the presence of an accessible 3'OH. We show that after 4'E-2FdA-MP incorporation, RT does not bind the next incoming dNTP. We analyzed RT translocation on different sequences terminated with 4'E-2FdA-MP, and found that even at sequences when RT is naturally found post-translocated, the inhibitor prevents translocation. This decrease in translocation efficiency explains the reduced binding of the next incoming dNTP and the termination of elongation. While the inhibitor stabilizes the pre-translocated 4'E-2FdA-MP-terminated primer, the pyrophosphate-dependent excision rate of 4'E-2FdA-MP was not very high compared to ddAMP. In conclusion, this highly potent chain termination activity arises from difficulty of the primer 3'-terminus to translocate following incorporation of the compound, and not from simple steric hindrance due to the 4' substitution. Therefore, we propose that 4'E-2FdA is a Translocation-Deficient Reverse Transcriptase Inhibitor (TDRTI) that acts by a novel mechanism.NIH grant to S. Sarafiano