Cervical Cancer in Cameroon: A Three Pronged Approach to Increase Awareness, Vaccination, Screening and Treatment

Problem: Cameroon has a disproportionately high burden of cervical cancer due to low awareness that the disease is preventable with prophylactic vaccines, lack of screening and treatment of pre-cancerous lesions, and high prevalence of human immunodeficiency virus (HIV). Between 2007-2013, the Cameroon Baptist Convention Health Services (CBCHS) devised three programs to: (1) increase awareness about cervical cancer; (2) immunize girls aged 9-13 years against human papilloma virus (HPV); and (3) conduct cervical cancer screening and treatment. Approaches: In collaboration with clinicians and researchers at University of Massachusetts and Northeastern University, CBCHS conducted education programs about HPV vaccine and cervical cancer for parents, adolescents, health care workers, and community members. The HPV vaccination demonstration project was implemented in three settings: schools, healthcare facilities, and in communities. CBCHS conducted cervical cancer screening in six sites using a “see and treat approach”. Findings: Following approval by the Ministry of Health, CBCHS nurses educated girls, parents, and communities about HPV, cervical cancer, and HPV vaccine through multimedia coverage. A total of 6,851, 6,517 and 5,876 girls were immunized with first, second and third doses, respectively. Achieving an 84.6% 3-dose completion rate. Since 2007, 30,617 women have been screened with visual inspection with acetic acid and digital cervicography. Women with precancerous lesions were treated with cryotherapy or loop electrical excision procedure. Lesions suspicious for cancer were biopsied for histology. Of those screened, 3,015 (10%) self reported HIV-positivity, 19,837 (64%) were HIV-negative, and the HIV status of the remaining women was unreported (25%). The percentage of HIV infected women diagnosed with cancer was consistently higher than the percentage of HIV uninfected women diagnosed with cancer. Lessons Learned: The project demonstrated that, with adequate education of stakeholders, HPV vaccination and cervical cancer screening programs are acceptable and feasible methods to improve cervical cancer outcomes in Cameroon

Zoonotic disease research in East Africa

Abstract Background The East African region is endemic with multiple zoonotic diseases and is one of the hotspots for emerging infectious zoonotic diseases with reported multiple outbreaks of epidemic diseases such as Ebola, Marburg and Rift Valley Fever. Here we present a systematic assessment of published research on zoonotic diseases in the region and thesis research in Kenya to understand the regional research focus and trends in publications, and estimate proportion of theses research transitioning to peer-reviewed journal publications. Methods We searched PubMed, Google Scholar and African Journals Online databases for publications on 36 zoonotic diseases identified to have occurred in the East Africa countries of Burundi, Ethiopia, Kenya, Tanzania, Rwanda and Uganda, for the period between 1920 and 2017. We searched libraries and queried online repositories for masters and PhD theses on these diseases produced between 1970 and 2016 in five universities and two research institutions in Kenya. Results We identified 771 journal articles on 22, and 168 theses on 21 of the 36 zoonotic diseases investigated. Research on zoonotic diseases increased exponentially with the last 10 years of our study period contributing more than half of all publications 460 (60%) and theses 102 (61%) retrieved. Endemic diseases were the most studied accounting for 656 (85%) and 150 (89%) of the publication and theses studies respectively, with publications on epidemic diseases associated with outbreaks reported in the region or elsewhere. Epidemiological studies were the most common study types but limited to cross-sectional studies while socio-economics were the least studied. Only 11% of the theses research transitioned to peer-review publications, taking an average of 2.5 years from theses production to manuscript publication. Conclusion Our findings demonstrate increased attention to zoonotic diseases in East Africa but reveal the need to expand the scope, focus and quality of studies to adequately address the public health, social and economic threats posed by zoonoses

Evaluating tannery wastewater treatment performance based on physicochemical and microbiological characteristics: An Ethiopian case study

Tanneries are an important industrial sector in Ethiopia; consequently, gaps in wastewater treatment process performance need to be identified as the country increases its emphasis on compliance. A case study was conducted to evaluate physicochemical and microbial water quality at a tannery near Addis Ababa. The treatment process was designed for the following: sulfide oxidation; biological oxygen demand reduction; and chromium removal. While some of Ethiopia’s standards for industrial wastewater treatment were met through treatment, effluent COD, sulfide, total nitrogen, and total chromium guidelines were not. 16S rRNA gene analysis was used to evaluate the microbial community composition across the treatment train. The results show that common ruminant phyla were dominant throughout, with Firmicutes and Bacteroidetes comprising 77% to 82% relative abundance. The Firmicutes Clostridium increased consistently in relative abundance with treatment, comprising 39% to 61% of the total bacterial community in the effluent. Improved treatment is needed to meet environmental and public health goals.Practitioner PointsCase Study of tannery wastewater treatment in Ethiopia shows ineffective treatment of chemical pollutants.Microbiological pollutants from tannery wastewater systems can introduce agents of importance to public healthThe microbiological composition of tannery influent, mixed liquor and effluent contains mostly four bacterial phyla lead by Firmicutes.Most pathogenic bacterial genera found in the tannery wastewater treatment system became a decreasing percentage of the total population.Clostridium comprises up to 61% of the effluent bacterial population and deserves further evaluation to better understand the consequences of its dominance.Chemical and microbiological characteristics across a tannery wastewater treatment system in EthiopiaPeer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/167775/1/wer1364.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/167775/2/wer1364_am.pd