Disaster prevention, disaster preparedness and local community resilience within the context of disaster risk management in Cameroon

Cameroon was one of the 57 countries that participated in the Global Network of Civil Society Organizations for Disaster Reduction (GNDR) Views from the Frontline (VFL) 2013 project on everyday disasters, community resilience and disaster preparedness. Working with 6 other civil society organizations, Geotechnology, Environmental Assessment and Disaster Risk Reduction administered 400 questionnaires to frontliners in 7 administrative regions of the country on 14 disaster indicators that assessed the underlying causes of disasters and the level of preparedness and resilience of the communities. Scores from the 89% of informants who responded show that Cameroon occupied the 43rd position globally, was 15th out of the 23 African countries, and was 7th out of the 9 West African countries surveyed. Cameroon average scores for all 14 indicators were lower (poorer) than the West African average, suggesting that a lot more effort is needed in managing disaster risks in the country, i.e., reducing vulnerabilities and increasing preparedness and resilience. At the national level, the Center and Adamaoua Regions recorded the lowest scores of the survey. Above-average scores recorded for some indicators in the Southwest, Northwest and Far North Regions are interpreted to be due to disaster prevention activities like monitoring via early warning systems, resilience building and outreach exercises carried out for disasters like landslides, floods, gas explosions from lakes, and volcanic eruptions, in these areas. Cameroon presently has many laws relating to disaster risk management matters, but an analysis of how the laws are applied shows that the expected results have not been attained, mainly because of over-centralization and a reactive, rather than a proactive approach to disaster risk management. Given her current disaster risk profile, Cameroon has to increase research, better manage, and make disaster risks a central tenet in her development project decision-making, if the goal earmarked in her development vision to become a newly industrialized country by 2035 has to be realized. We propose the creation of an autonomous statutory National Disaster Risk Management Agency which will have a local community-driven bottom-top approach to disaster risk management, and disseminate appropriately tailored disaster risk information to promote a proactive community-based resilience and disaster prevention framework. This will fulfill the post-2015 Sendai framework priority of action No. 2 (strengthening disaster risk governance to manage disaster risk) and appropriately prepare Cameroon to face the challenges of the Sustainable Development Goals (SDGs)

Rituximab vs ocrelizumab in relapsing-remitting multiple sclerosis

IMPORTANCE Ocrelizumab, a humanized monoclonal antibody targeted against CD20+ B cells, reduces the frequency of relapses by 46% and disability worsening by 40% compared with interferon beta 1a in relapsing-remitting multiple sclerosis (MS). Rituximab, a chimeric monoclonal anti-CD20 agent, is often prescribed as an off-label alternative to ocrelizumab. OBJECTIVE To evaluate whether the effectiveness of rituximab is noninferior to ocrelizumab in relapsing-remitting MS. DESIGN, SETTING, AND PARTICIPANTS This was an observational cohort study conducted between January 2015 and March 2021. Patients were included in the treatment group for the duration of study therapy and were recruited from the MSBase registry and Danish MS Registry (DMSR). Included patients had a history of relapsing-remitting MS treated with ocrelizumab or rituximab, a minimum 6 months of follow-up, and sufficient data to calculate the propensity score. Patients with comparable baseline characteristics were 1:6 matched with propensity score on age, sex, MS duration, disability (Expanded Disability Status Scale), prior relapse rate, prior therapy, disease activity (relapses, disability accumulation, or both), magnetic resonance imaging lesion burden (missing values imputed), and country. EXPOSURE Treatment with ocrelizumab or rituximab after 2015. MAIN OUTCOMES AND MEASURES Noninferiority comparison of annualized rate of relapses (ARRs), with a prespecified noninferiority margin of 1.63 rate ratio. Secondary end points were relapse and 6-month confirmed disability accumulation in pairwise-censored groups. RESULTS Of the 6027 patients with MS who were treated with ocrelizumab or rituximab, a total of 1613 (mean [SD] age; 42.0 [10.8] years; 1089 female [68%]) fulfilled the inclusion criteria and were included in the analysis (898 MSBase, 715 DMSR). A total of 710 patients treated with ocrelizumab (414 MSBase, 296 DMSR) were matched with 186 patients treated with rituximab (110 MSBase, 76 DMSR). Over a pairwise censored mean (SD) follow-up of 1.4 (0.7) years, the ARR ratio was higher in patients treated with rituximab than in those treated with ocrelizumab (rate ratio, 1.8; 95% CI, 1.4-2.4; ARR, 0.20 vs 0.09; P < .001). The cumulative hazard of relapses was higher among patients treated with rituximab than those treated with ocrelizumab (hazard ratio, 2.1; 95% CI, 1.5-3.0). No difference in the risk of disability accumulation was observed between groups. Results were confirmed in sensitivity analyses. CONCLUSION In this noninferiority comparative effectiveness observational cohort study, results did not show noninferiority of treatment with rituximab compared with ocrelizumab. As administered in everyday practice, rituximab was associated with a higher risk of relapses than ocrelizumab. The efficacy of rituximab and ocrelizumab administered at uniform doses and intervals is being further evaluated in randomized noninferiority clinical trials