Knowledge, Attitudes and Practices Among Adult Malaria Patients Co-Infected with Opportunistic Intestinal Coccidian Parasites in Fundong Health District, Northwest, Cameroon: A Cross Section Study Design

Introduction: Malaria and intestinal coccidian parasitic co-infections, are becoming a public health emergency affecting millions of people around the world. They are among the leading cause of socio-economic problems, long suffering and death especially in developing countries like Cameroon. Introducing new appropriate preventive and control measures to the population requires thorough assessment of community and patient-based knowledge, attitude and preventive practices towards malaria and pathogenic intestinal coccidian parasites is crucial. Our study aimed to describe knowledge, attitudes, and practices and the risk factors among adult malaria patients co-infected with intestinal parasitic infections in the Fundong Health District, a locality in the Northwest Region of Cameroon. Methods: This was a cross-sectional study carried out between February and December, 2022 involving sixteen (16) health facilities in Fundong Health district. A total number of 330 patients participated in the study. Normal saline wet mount and formol-ether concentration techniques were employed in coccidian parasitic detection. Blood samples were subjected to Giemsa stained and viewed microscopically to detect the Plasmodium parasites. Pretested structured questionnaires were administered to collect information on patient’s socio-demographic factors and determine patients’ knowledge, attitudes and practices towards malaria and intestinal coccidian parasites, as well as their prevention and control. The Pearson’s Chi-Square (χ2) and Student T-test were performed a part of the statistical analysis to check for associations between malaria, infection and between malaria-coccidian co-infection and demographic factors. Statistical significance was set a P-value<0.05. Results: Participants main sources of information on malaria were: Television (TV) and radio 111/330 (34%), community health workers 109/330 (33%), and Hospitals (37%). Participants had good knowledge of mosquito bite as the malaria transmission route, 296/330 (90%), night time is the frequent biting time for the mosquito 296/330(90%), dark corners 229 (69%) and dirty areas 175(53%) as mosquito resting places. Knowledge score was also good on cleaning of the house surroundings, 281/330(85%), clearing the bushes 180/330(55%), poor knowledge score on drainage of stagnant water113/330 (34%) as ways to prevent the mosquito from multiplying. Participants had good knowledge of insecticide treated bed nets 295/330 (89%) as the best way to prevent mosquito bites. However, participants also expressed poor knowledge on edges of the river or streams 7(20%), and animal shed 20/330 (6%) as mosquito hiding places, and Plasmodium specie as malaria causative agent 8/330 (2%) (P-value=0.011). Poor scores were recorded on knowledge of opportunistic intestinal coccidian parasites (19.4%) (P=0.427), and was significantly low on unsafe water (47.2%) (P-value=0.036) as possible transmission routes for coccidian parasites. The knowledge score was also low on the at-risk population for malaria and intestinal coccidian infection (31.9%) P-value=0.009. Participants who had poor knowledge about coccidian transmission routes were less likely to drink from protected water source with an odds of 0.713(95% CI: 0.297-1.711) P value=0.449, compared to those who were more knowledgeable and who were 2.981(95% CI: 1.367-6.115) P value=0.005, more likely to use protected source of drinking water. Participants who had hand washing facility in the household were 3.488 (1.760-6.912) value=0.001 times more likely have better knowledge of coccidian transmission routes compared to those who did not have 0.748 (95% CI: 0.406-1.376) P value=0.350. Poor knowledge score of poor hygiene as major cause of coccidian infection significantly associated with poor practice score of sometime or not at all disinfecting animal shed to prevent coccidian infection among study participants (P =0.039). Conclusion: The overall knowledge scores, attitude and practices level of participants towards malaria and opportunistic intestinal coccidian parasites were relatively good. A significant proportion of the participants still have misconceptions about cause, modes of transmission and practices towards malaria and coccidian prevention methods. A combined health education programmes for malaria and intestinal coccidian parasites aimed at raising community awareness needs to be evidence based and requires innovative approaches, to address the gaps identified in the study

Knowledge, attitudes and practices regarding urinary schistosomiasis among adults in the Ekombe Bonji Health Area, Cameroon

Introduction: Urinary schistosomiasis (US) is endemic in Cameroon. Knowledge, attitudes and practices (KAP) are important aspects for control of the disease. However, data on these remain scanty. We aimed at evaluating knowledge, attitudes and practices regarding urinary schistosomiasis among adults in households in the Ekombe Bonji health area. Methods: A community-based, cross-sectional study was carried out at Ekombe Bonji health area from February to March, 2017, involving all 12 communities. A pre-tested questionnaire was used to assess knowledge, attitudes and practices regarding urinary schistosomiasis among 198 adults and to record their socio-demographic, environmental and clinical variables. Data were stored in Excel version 2013 and analysed using Stata version 14.2. Results: Of the 198 adults interviewed, only 35.4% had prior knowledge about urinary schistosomiasis. Among these, 94.3%, 74.3%, 57.7% knew the signs and symptoms, modes of transmission and preventive measures respectively. Only 14.3% knew the cause and treatment. 81.2% considered urinary schistosomiasis a serious disease and 77.1% believed it could be prevented, albeit, their practices to prevent infection were inadequate. Conclusion: Knowledge, attitudes and practices regarding urinary schistosomiasis among adults are inadequate, since most of them are not aware of the disease. Therefore, there is need for community-based interventions especially health education to effectively reduce the disease burden

Prevalence of onchocerciasis in the Fundong Health District, Cameroon after 6 years of continuous community-directed treatment with ivermectin

<0.001). The greatest rate of infection was found among farmers (2.5%) followed by students (0.7%) and businessmen (0.25%). CONCLUSION: This study shows that the study area is now hypo-endemic for onchocerciasis, following 6 years of continuous treatment with ivermectin. Careful monitoring of onchocerciasis should however be continued to avoid that the area returns to its initial hyper endemicity

Phenotypic and genotypic characterization of Neisseria gonorrhoeae isolates from Yaoundé, Cameroon, 2019 to 2020

This study investigated antimicrobial resistance (AMR) phenotypes and genotypes exhibited by Neisseria gonorrhoeae from Yaoundé, Cameroon. AMR to tetracycline, penicillin and ciprofloxacin was observed although none of the isolates had reduced susceptibility to azithromycin, cefixime or ceftriaxone. Whole genome sequence (WGS) data were obtained and, using a threshold of 300 or fewer locus differences in the N. gonorrhoeae core gene multilocus sequence typing (cgMLST) scheme, four distinct core genome lineages were identified. Publicly available WGS data from 1355 gonococci belonging to these four lineages were retrieved from the PubMLST database, allowing the Cameroonian isolates to be examined in the context of existing data and compared with related gonococci. Examination of AMR genotypes in this dataset found an association between the core genome and AMR with, for example, isolates belonging to the core genome group, Ng_cgc_300 : 21, possessing GyrA and ParC alleles with amino acid substitutions conferring high-level resistance to ciprofloxacin while lineages Ng_cgc_300 : 41 and Ng_cgc_300 : 243 were predicted to be susceptible to several antimicrobials. A core genome lineage, Ng_cgc_300 : 498, was observed which largely consisted of gonococci originating from Africa. Analyses from this study demonstrate the advantages of using the N. gonorrhoeae cgMLST scheme to find related gonococci to carry out genomic analyses that enhance our understanding of the population biology of this important pathogen

Variation in the immune responses against Plasmodium falciparum merozoite surface protein-1 and apical membrane antigen-1 in children residing in the different epidemiological strata of malaria in Cameroon

Abstract Background Studies to assess the immune responses against malaria in Cameroonian children are limited. The purpose of this study was to assess the immune responses against Plasmodium falciparum merozoite surface protein-1 (MSP-119) and apical membrane antigen-1 (AMA-1) in children residing in the different epidemiological strata of malaria in Cameroon. Methods In a cross-sectional survey performed between April and July 2015, 602 children between 2 and 15 years (mean ± SD = 5.7 ± 3.7), comprising 319 (53%) males were enrolled from five epidemiological strata of malaria in Cameroon including: the sudano-sahelian (SS) strata, the high inland plateau (HIP) strata, the south Cameroonian equatorial forest (SCEF) strata, the high western plateau (HWP) strata, and the coastal (C) strata. The children were screened for clinical malaria (defined by malaria parasitaemia ≥ 5000 parasites/µl plus axillary temperature ≥ 37.5 °C). Their antibody responses were measured against P. falciparum MSP-119 and AMA-1 vaccine candidate antigens using standard ELISA technique. Results A majority of the participants were IgG responders 72.1% (95% CI 68.3–75.6). The proportion of responders was higher in females (p = 0.002) and in children aged 10 years and above (p = 0.005). The proportion of responders was highest in Limbe (C strata) and lowest in Ngaoundere (HIP strata) (p < 0.0001). Similarly, the mean IgG antibody levels were higher in children aged 10 years and above (p < 0.0001) and in Limbe (p = 0.001). The IgG antibody levels against AMA-1 were higher in females (p = 0.028), meanwhile no gender disparity was observed with MSP-1. Furthermore the risk of clinical malaria (p < 0.0001) and the mean parasite density (p = 0.035) were higher in IgG non-responders. Conclusion A high proportion of IgG responders was observed in this study, suggesting a high degree exposure of the target population to malaria parasites. The immune responses varied considerably across the different strata: the highest levels observed in the C strata and the lowest in the HIP strata. Furthermore, malaria transmission in Cameroon could be categorized into two major groups based on the serological reaction of the children: the southern (comprising C and SCEF strata) and northern (comprising HWP, HIP and SS strata) groups. These findings may have significant implications in the design of future trials for evaluating malaria vaccine candidates in Cameroon

Epidemiological and clinical profile of paediatric malaria: a cross sectional study performed on febrile children in five epidemiological strata of malaria in Cameroon

Abstract Background In the wake of a decline in global malaria, it is imperative to describe the epidemiology of malaria in a country to inform control policies. The purpose of this study was to describe the epidemiological and clinical profile of paediatric malaria in five epidemiological strata of malaria in Cameroon including: the Sudano-sahelian (SS) strata, the High inland plateau (HIP) strata, the South Cameroonian Equatorial forest (SCEF) strata, the High western plateau (HWP) strata, and the Coastal (C) strata. Methods This study involved 1609 febrile children (≤15 years) recruited using reference hospitals in the five epidemiological strata. Baseline characteristics were determined; blood glucose level was measured by a glucometer, malaria parasitaemia was assessed by Giemsa microscopy, and complete blood count was performed using an automated hematology analyser. Severe malaria was assessed and categorized based on WHO criteria. Results An overall prevalence of 15.0% (95% CI: 13.3–16.9) for malaria was observed in this study. Malaria prevalence was significantly higher in children between 60 and 119 months (p < 0.001) and in Limbe (C strata) (p < 0.001). The overall rate of severe malaria (SM) attack in this study was 29.3%; SM was significantly higher in children below 60 months (p < 0.046). Although not significant, the rate of SM was highest in Maroua (SS strata) and lowest in Limbe in the C strata. The main clinical phenotypes of SM were hyperparasitaemia, severe malaria anaemia and impaired consciousness. The majority (73.2%) of SM cases were in group 1 of the WHO classification of severe malaria (i.e. the most severe form). The malaria case-fatality rate was 5.8%; this was higher in Ngaoundere (HIP strata) (p = 0.034). Conclusion In this study, malaria prevalence decreased steadily northward, from the C strata in the South to the SS strata in the North of Cameroon, meanwhile the mortality rate associated with malaria increased in the same direction. On the contrary, the rate of severe malaria attack was similar across the different epidemiological strata. Immunoepidemiological studies will be required to shed more light on the observed trends