The frequency and magnitude of growth failure in a group of HIV-infected children in Cameroon

Background: Growth impairment is a major manifestation of HIV infection in children and has been implicated as a major contributor to both morbidity and mortality. This study the first to be done in this setting, was aimed at comparing the growth of HIV infected children to that of noninfected children in two referral health facilities in Yaoundé, Cameroon. Methods: A prospective case control study was carried out on 39 HIV infected children in two referral hospitals and followed up for a period of 12 months. Anthropometric measurements were taken and the sociodemographic variables of mothers and infants noted. Thirty nine infected children (mean age 45.3 months ± 41.6 SD) were age and sex matched with 39 non-infected children (mean age 44.4 ± 40.7 months). Results: Out of the 39 infected children, 26 (66.7%) had at least one of the three anthropometric indices (weight for height, weight for age, height for age) Z scores less than -2. Throughout follow-up, 20.5% of the infected children were wasted (weight to height Z score < -2) versus none in the control group, 56.4% underweight (weight for age Z score < -2) in the infected versus 2.6% in the control group, and 51.3% stunted (height for age Z score < -2) in contrast to 5.1% in the control group. Conclusion: This study demonstrated that wasting; underweight and stunting are common findings in HIV- infected children, thus stressing the importance of anthropometry in the routine care of these children

Epidemiology and clinical characteristics of the Measles outbreak in the Nylon Health District, Douala Cameroon: a retrospective descriptive cross sectional study

Introduction: Measles is a public health problem especially in South Asia and Africa. Nylon Health District has experienced two measles outbreaks over a period of three years. We hereby describe the epidemiology and clinical characteristics of the outbreak of February 2011. Methods: A retrospective descriptive cross sectional study was conducted in November 2011. All suspected measles cases according to the World Health Organization case definition line listed in the district service were included. Data was analyzed using Epi Info version 3.5.3 for Windows and Microsoft Office Excel 2010. An epidemic curve was drawn and proportions per variable category were estimated and presented in frequency tables. Results: The outbreak started from the 4th to the 25th epidemiological week of 2011 with a peak on the 10th week after onset. The attack and case fatality rates were 34/100000 inhabitants and zero respectively. Females and infants aged 9-59 months represented 97(63.4%) and 75(49%) of cases respectively. Bonadiwoto health area alone had 81(52.9%) of cases. Of the 153 cases, only 34(22.2%) had a card-confirmed measles vaccination status. Active community surveillance permitted the identification of 42(27.5%) cases. Conclusion: Low measles vaccine coverage rate over the past years in the Nylon health district led to the accumulation of susceptible individuals which coupled with poor environmental conditions favoured inter-human spread of measles. Developing novel strategies to vaccinate every child, especially the Hard-to-Reach in the slums of the district will help to prevent future outbreaks. Pan African Medical Journal 2012; 13:6

Rappels vaccinaux hors programme élargi de vaccination dans deux écoles de l’éducation de base de Yaoundé, Cameroun

Introduction: L’absence des rappels vaccinaux est problématique dans les pays en développement où certaines maladies évitables par la vaccination font encore des victimes chez les enfants en raison d’une immunisation incomplète. L’identification des raisons de non rappel vaccinaux permettrait de proposer des solutions adaptées afin d’améliorer le statut vaccinal des enfants au-delà de 12 mois. Méthodes: Cette étude descriptive transversale avait pour objectif d’évaluer le taux de rappels vaccinaux des enfants au-delà de la cible du programme élargi de vaccination (PEV). Elle s’est déroulée de Septembre à Novembre 2009 dans deux écoles d’éducation de base de Yaoundé. L’échantillonnage était consécutif et limité aux élèves âgés de deux à sept ans possédant des carnets de vaccination. Par souci d’uniformité, nous n’avons pas analysé les rappels des vaccins contre l’hépatite B et l’haemophilus introduits tardivement au Cameroun. Résultats: L’étude a porté sur 310 élèves. La tranche d’âge de 2 à 4 ans représentait 69%. Seul 223 enfants (71,9 %) étaient correctement vaccinés. Quant aux rappels vaccinaux diphtérietétanos-coqueluche et poliomyélite, les couvertures étaient insignifiantes (2,7% et 0% respectivement pour la première et la deuxième dose). Les raisons évoquées étaient l’absence de sensibilisation des parents (50%), le prix élevé des vaccins (48,69%) et la désinformation (1,31%). Conclusion: Le recyclage du personnel de santé sur la vaccination est une nécessité. Les parents doivent être informés sur le déroulement, les prix et les lieux des rappels vaccinaux. La réduction des prix de vaccins faciliterait l’accès à une large tranche de la population.Key words: Vaccination, Programme Elargi de Vaccination, enfant, rappel, Cameroo

Le tetanos chez le grand enfant dans un hôpital pédiatrique à Yaoundé, Cameroun

Le tétanos est évitable par la vaccination, mais peut survenir en cas d'une immunisation incomplète. Nous avons mené une étude sur les dossiers médicaux des enfants admis pour tétanos entre 2008-2009 au Centre Mère et Enfant de la Fondation Chantal BIYA à Yaoundé. Le but était d'analyser les circonstances de survenue et les manifestations cliniques du tétanos chez le grand enfant, afin de proposer des stratégies de prévention adaptées au contexte camerounais. Le statut vaccinal était inconnu chez un patient, les autres (80%) n'avaient pas reçu de rappel vaccinal. Les portes d'entrée étaient les plaies aux membres, l'une était secondaire à une injection médicamenteuse. Tous ont présenté le tétanos généralisé. Le décès était survenu chez un patient. Le tétanos n'est pas rare chez le grand enfant au Cameroun. Il se dégage ainsi la problématique des rappels vaccinaux

Hospital-based Surveillance Provides Insights Into the Etiology of Pediatric Bacterial Meningitis in Yaoundé, Cameroon, in the Post-Vaccine Era.

BACKGROUND:Meningitis is endemic to regions of Cameroon outside the meningitis belt including the capital city, Yaoundé. Through surveillance, we studied the etiology and molecular epidemiology of pediatric bacterial meningitis in Yaoundé from 2010 to 2016. METHODS:Lumbar puncture was performed on 5958 suspected meningitis cases; 765 specimens were further tested by culture, latex agglutination, and/or polymerase chain reaction (PCR). Serotyping/grouping, antimicrobial susceptibility testing, and/or whole genome sequencing were performed where applicable. RESULTS:The leading pathogens detected among the 126 confirmed cases were Streptococcus pneumoniae (93 [73.8%]), Haemophilus influenzae (18 [14.3%]), and Neisseria meningitidis (15 [11.9%]). We identified more vaccine serotypes (19 [61%]) than nonvaccine serotypes (12 [39%]); however, in the latter years non-pneumococcal conjugate vaccine serotypes were more common. Whole genome data on 29 S. pneumoniae isolates identified related strains (<30 single-nucleotide polymorphism difference). All but 1 of the genomes harbored a resistance genotype to at least 1 antibiotic, and vaccine serotypes harbored more resistance genes than nonvaccine serotypes (P < .05). Of 9 cases of H. influenzae, 8 were type b (Hib) and 1 was type f. However, the cases of Hib were either in unvaccinated individuals or children who had not yet received all 3 doses. We were unable to serogroup the N. meningitidis cases by PCR. CONCLUSIONS:Streptococcus pneumoniae remains a leading cause of pediatric bacterial meningitis, and nonvaccine serotypes may play a bigger role in disease etiology in the postvaccine era. There is evidence of Hib disease among children in Cameroon, which warrants further investigation

Epidemiology of rubella infection in Cameroon : a 7-year experience of measles and rubella case-based surveillance, 2008–2014

CITATION: Nimpa Mengouo, M. et al. 2017. Epidemiology of rubella infection in Cameroon: a 7-year experience of measles and rubella case-based surveillance, 2008–2014. BMJ Open, 7(4):e012959. doi:10.1136/bmjopen-2016-012959.The original publication is available at https://bmjopen.bmj.com/Objective The aim of this study was to estimate the proportion of rubella disease in a measles case-based surveillance in Cameroon prior to rubella vaccine introduction into the national immunisation programme. Design This was a cross-sectional study for rubella infection in Cameroon for the period 2008 to 2014. Setting Patients suspected with measles from the 10 regions of Cameroon were recruited according to the WHO measles case definition and were tested for rubella IgM antibodies accompanied with the case report/investigation forms. Participants All persons with rash and fever within 14 days of onset of rash according to the standard WHO African Regional Office (WHO/AFRO) case definition for a suspected measles case. Outcome measures Descriptive analyses and simple logistic regressions were performed. OR were estimated. Results A total of 9907 serum samples from people with fever and rash were received in the laboratory from 2008 to 2014. A total of 7489 (75.59%) measles-negative samples were tested for rubella; 699 (9.3%) were positive for rubella IgM antibodies. Logistic regression analysis was done using IgM antibodies detection as the outcome variable. Age, sex and setting were explanatory variables. Logistic regression analysis revealed that, comparing the proportion of rubella IgM seropositivity status by age, the association to a positive rubella IgM increased with age from 1 to 4 years (OR 7.11; 95% CI 4.35 to 12.41; p<0.0001), through 5 to 9 years (OR 13.07; 95% CI 7.93 to 22.93; p<0.001), to 10 to 14 years of age (OR 13.86; 95% CI 8.06 to 25.12; p<0.001). Persons aged ≥15 years were also more likely to have rubella infection than children under one (OR 3.69; 95% CI 1.85 to 7.48; p=0.0001). There were also significant associations with sex, with males being less associated to a positive rubella serology than females (OR 1.33; 95% CI 1.14 to 1.56; p=0.0001). No statistically significant difference in proportion of rubella cases was observed between urban and rural populations (OR 1.11; 95% CI 0.94 to 1.31; p=0.208). Conclusions This study reveals that rubella virus circulates in Cameroon, with important number of cases in children under 15 years. This finding supports the planned introduction of rubella-containing vaccines into the Expanded Program on Immunization.publishers versio

Case based measles surveillance performance in 2010, littoral region of Cameroon

The Littoral region of Cameroon met most of its routine immunization and surveillance objectives in 2010 but has not reiterated such a performance since then. We describe the casebased measles surveillance performance of 2010 by person, place, time and determine measles surveillance system delays. Descriptive statistics were performed using Epi Info 3.5.3. There were 130 suspected measles cases investigated by 17 (89.5%) health districts, 83 (64%) males and 99 (76%) ≤5 years. At least 4 cases were investigated per month with a peak of 23 cases in June. About 67 (51.5%) patients visited a hospital more than 48 h after disease onset, 34 (26.2%) health facilities informed the district service late after receiving a suspected case and 65 (50%) samples got to the reference laboratory more than 24 h after reception by the specimen collection centre. More than 2 discarded measles/100,000 population were investigated but with health facilities, specimen collection centre and patients’ ability to seek healthcare delays. All specimens got to the reference laboratory within 72 h. Patients’ health seeking behavior need to be improved and personnel involved in surveillance sensitized on timeliness

Assessing the causes of under-five mortality and proportion associated with pneumococcal diseases in Cameroon. A case-finding retrospective observational study: 2006-2012

<div><p>Background</p><p>Vital registration data outlining causes of deaths (CoD) are important for a sustainable health system, targeted interventions and other relevant policies. There is data paucity on vital registration systems in developing countries. We assessed the leading causes and proportions of under-five deaths, and particularly those related to pneumococcal infections in Yaoundé, Cameroon, using hospital registration data.</p><p>Methods</p><p>A retrospective case-finding observational study design was used to access and identify data on 817 death cases in children under-five years of age recorded in health facilities in Yaoundé, within the period January 1, 2006 and December 31, 2012. Patients’ files were randomly selected and needed information including demographic data, date of admission, clinical and laboratory diagnosis, principal and/or underlying causes of death were abstracted into structured case report forms. The International Classification of Diseases and Clinical Modifications 10^th revision (ICD-10-CM) codes (ICD10Data.com 2017 edition) were used to classify the different CoD, retrospectively. Ascertainment of CoD was based on medical report and estimates were done using the Kaplan-Meier procedure and descriptive statistics.</p><p>Results</p><p>Of the 817 death records assessed, malaria was the leading CoD and was responsible for 17.5% of cases. Meningitis was the second largest CoD with 11.0%; followed by sepsis (10.0%), <i>Streptococcus pneumoniae</i> infections (8.3%), malnutrition (8.3%), gastro-enteritis / diarrhoea (6.2%), anaemia (6.1%) and HIV (3.5%), respectively.</p><p>Conclusion</p><p>The main CoD in this population are either treatable or vaccine-preventable; a trend consistent with previous reports across developing countries. Besides, the health effects from non-communicable infections should not be neglected. Therefore, scaling-up measures to reduce causes of under-five deaths will demand sustainable efforts to enhance both treatment and disease prevention strategies, to avoid a decline in the progress towards reducing under-five deaths by 2/3 from the 1990 baseline.</p></div

Vaccination of infants aged 0 to 11 months at the Yaounde Gynaeco-obstetric and pediatric hospital in Cameroon: how complete and how timely?

Abstract Background Vaccination is a major, but simple and cost effective public health intervention in the prevention of infectious diseases, especially in children. Nowadays, many children still miss scheduled vaccines in the Extended Program of Immunization (EPI) or are being vaccinated after the recommended ages.This study was aimed at assessing vaccination completeness and timeliness in children aged 0 to 11 months attending the vaccination clinic of the Yaounde Gynaeco-Obstetric and Pediatric Hospital. Methods This was an observational cross-sectional study over a period of 3 months (1st February to 30th April 2016). 400 mothers were interviewed and their children’s vaccination booklets analyzed. Information on the children and the parents was collected using a pretested questionnaire. Data analysis was done using SPSS version 20 software. Bivariate and multivariate analysis with logistic regression was done to assess the determinants of completeness and timeliness. Results A total of 400 mother-infant pairs were sampled. The vaccination completeness rate was 96.3%. This rate varied between 99.50% for BCG and 94.36% for IPV. Most of the children were born at the Yaounde Gynaeco-Obstetric and Pediatric hospital where they were regularly receiving their vaccines. The proportion of correctly vaccinated infants was 73.3%. The most differed vaccines were BCG, PCV13 and IPV. Factors influencing immunization completeness were the father’s profession and the mother’s level of education. Conclusions Despite the high immunization coverage, some children did not complete their EPI vaccines and many of them took at least one vaccine after the recommended age

Bacterial meningitis and pneumococcal serotype distribution in children in cameroon

Acute bacterial meningitis causes a substantial number of deaths in Cameroon. Among 170 children with acute meningitis, 112 were positive for a bacterial pathogen when tested using polymerase chain reaction amplification, and Streptococcus pneumoniae accounted for 57.1% of cases. Pneumococcal serotype coverage by 13-valent pneumococcal conjugate vaccine was 62.1%. This study shows that in Cameroon, 13-valent pneumococcal conjugate vaccine coverage is less than what is estimated for other African countries