What determines providers' stated preference for the treatment of uncomplicated malaria?

As agents for their patients, providers often make treatment decisions on behalf of patients, and their choices can affect health outcomes. However, providers operate within a network of relationships and are agents not only for their patients, but also other health sector actors, such as their employer, the Ministry of Health, and pharmaceutical suppliers. Providers' stated preferences for the treatment of uncomplicated malaria were examined to determine what factors predict their choice of treatment in the absence of information and institutional constraints, such as the stock of medicines or the patient's ability to pay. 518 providers working at non-profit health facilities and for-profit pharmacies and drug stores in Yaoundé and Bamenda in Cameroon and in Enugu State in Nigeria were surveyed between July and December 2009 to elicit the antimalarial they prefer to supply for uncomplicated malaria. Multilevel modelling was used to determine the effect of financial and non-financial incentives on their preference, while controlling for information and institutional constraints, and accounting for the clustering of providers within facilities and geographic areas. 69% of providers stated a preference for artemisinin-combination therapy (ACT), which is the recommended treatment for uncomplicated malaria in Cameroon and Nigeria. A preference for ACT was significantly associated with working at a for-profit facility, reporting that patients prefer ACT, and working at facilities that obtain antimalarials from drug company representatives. Preferences were similar among colleagues within a facility, and among providers working in the same locality. Knowing the government recommends ACT was a significant predictor, though having access to clinical guidelines was not sufficient. Providers are agents serving multiple principals and their preferences over alternative antimalarials were influenced by patients, drug company representatives, and other providers working at the same facility and in the local area. Efforts to disseminate drug policy should target the full range of actors involved in supplying drugs, including providers, employers, suppliers and local communities

Antibiogram of Klebsiella Pneumoniae Isolates from Buea, Cameroon.

A CAJM article on Antibiogram of Klebsiella pneumoniae pathogen in Buea, Cameroon.Klebsiella pneumoniae is an important human pathogen that has been associated in recent decades with nosocomial outbreaks.They are important opportunistic pathogens, commonly isolated from urinary tract infections, surgical wounds, nosocomial pneumonia and bloodstream infections. These organisms are also an important source of transferable antibiotic resistance, and several outbreaks caused by multiple resistant K. pneumoniae, especially the extended-spectrum B-lactamase-producing(ESBL) strains of the types TEM and SHV have been reported

Seasonal variation and prevalence of tuberculosis among health seekers in the south western Cameroon

Objectives: To determine the prevalence of tuberculosis (TB) in Fako health District, to assess the effects of seasonal variation on the incidence of TB in the study area and to use sentinel analysis to predict areas of greatest infection. Design: A prospective cross sectional study based on laboratory investigations. Setting: Fako health District, South Western Carneroon. Results: The prevalence of TB was 23.3%.Tuberculosis was significantly more prevalent in males (12.6%) as compared with females (10.7%) (P = 0.034). TB prevalence was significantly different between age groups, with the highest number of cases recorded in the age group 21-30 (P = 0.002). When the health areas were compared, TB prevalence varied significantly (P = 0.001), with Limbe Town recording the highest number of TB cases. We recorded more TB cases in the wet season compared with the dry season and the difference was statistically significant (P = 0.000). There was a significant drop in the prevalence of TB over the study period (P = 0.000). Conclusion: This study is the first to report on the effects of season on the prevalence of TB in Cameroon. These findings will therefore provide additional useful base line data for setting up TB control strategies in Cameroon. The East African Medical Journal Vol. 83 (11) 2006: pp. 588-59

Formulation of Functional Yogurt by Cofermentation of Milk and Papaya Fruit

This study was carried out to determine the potential of adding Fresh skinned papaya pulp (FSP) into yoghurt for the improvement of the functional properties of yoghurt and the resulting effects of adding PPF on the physicochemical and sensory properties of the product during a 30 days’ storage period at 6°C. Yoghurt samples A (Control), B, C, D and E were respectively produced at 0%, 5%, 10%, 15%, and 20% of milk incorporated with papaya fruit. Incorporation of PPF into the yogurt samples resulted in an increase in pH, proteins and carbohydrates and a reduction in titratable acidity as compared to the control. The microbial analysis showed no presence of coliform bacteria. The sensory evaluation result demonstrated significant differences in all the organoleptic attributes analyzed. Sample C with 10% incorporated papaya had the highest overall acceptability score

Evaluation de la chimiorésistance à la sulfadoxine-pyrimethamine et des mutations des gènes dihydrofolate réductase et dihydropteroate synthétase dans le district de santé de Ndu au nord-ouest, Cameroun

Les données cliniques sur la résistance au sulfadoxine-pyriméthamine(SP) sont peu précises dans plusieurs localités du Cameroun. En plus, très peu d’informations sont disponibles sur la corrélation entre les marqueurs moléculaires, la résistance et l’échec du traitement avec SP. Dans l’optique de mieux appréhender cette situation, nous avons entrepris d’évaluer l’efficacité du sulfadoxine-pyriméthamine (SP), ainsi que le potentiel des marqueurs moléculaires dans le suivi de la résistance dans trois sites du district de santé de Ndu. 296 patients de tout âge infectés par la forme non compliquée de Plasmodium falciparum ont été soumis à un traitement au SP pendant la période d’avril 2001 à novembre 2004, et les résultats évalués. Une évaluation des mutations des gènes de dihydrofolate réductase (dhfr) et  dihydroptéroate synthétase (dhps) du P. falciparum dans le sang de 100 patients d’âges inférieurs ou égaux à 10 ans a été effectuée le jour de leur admission en clinique. Les résultats obtenus indiquent 51,28% de patients qui donnent des réponses cliniques et parasitologiques adéquates, 33,33% d’échec thérapeutique précoce, 4,49% d’échec thérapeutique tardif, et 9,89% d’échec parasitologique tardif. Les mutations de la Gly437 ont été retrouvées dans 37% des échantillons. L’indice génotypique de resistance calculé suivant ce marqueur était de 0,76. Les mutations liées à la Asn108 ont été retrouvées dans 87% des échantillons, avec un indice génotypique de résistance de 1,79. En conclusion, il découle de nos résultats cliniques et moléculaires que la thérapie SP aurait un effet thérapeutique de courte durée dans le district de santé de Ndu. D’autre part, les génotypes mutants dhfr et dhps seraient des facteurs potentiels d’alerte précoce dans l’augmentation de la résistance au SP.Mots clés: Plasmodium falciparum, dhps, dhfr, marqueurs moléculaires, S

Economic evaluation of a cluster randomized trial of interventions to improve health workers' practice in diagnosing and treating uncomplicated malaria in Cameroon.

BACKGROUND: Malaria rapid diagnostic tests (RDTs) are a valid alternative to malaria testing with microscopy and are recommended for the testing of febrile patients before prescribing an antimalarial. There is a need for interventions to support the uptake of RDTs by health workers. OBJECTIVE: To evaluate the cost-effectiveness of introducing RDTs with basic or enhanced training in health facilities in which microscopy was available, compared with current practice. METHODS: A three-arm cluster randomized trial was conducted in 46 facilities in central and northwest Cameroon. Basic training had a practical session on RDTs and lectures on malaria treatment guidelines. Enhanced training included small-group activities designed to change health workers' practice and reduce the consumption of antimalarials among test-negative patients. The primary outcome was the proportion of febrile patients correctly treated: febrile patients should be tested for malaria, artemisinin combination therapy should be prescribed for confirmed cases, and no antimalarial should be prescribed for patients who are test-negative. Individual patient data were obtained from facility records and an exit survey. Costs were estimated from a societal perspective using project reports and patient exit data. The analysis used bivariate multilevel modeling and adjusted for imbalance in baseline covariates. RESULTS: Incremental cost per febrile patient correctly treated was $8.40 for the basic arm and$3.71 for the enhanced arm. On scale-up, it was estimated that RDTs with enhanced training would save $0.75 per additional febrile patient correctly treated. CONCLUSIONS: Introducing RDTs with enhanced training was more cost-effective than RDTs with basic training when each was compared with current practice

E. coli and Salmonella Contamination of Tomato Marketed and Consumed in Nairobi Metropolis

Tomato, a worldwide consumed commodity for its nutritive values can harbour Salmonella and E.coli. Tomato can contribute to diarrheal illnesses; and associated burden in households. Seasonal bacterial analyses to detect enterobacteria were conducted from January to June 2017 in Nairobi. The study shows that, the vegetable during the study period is 94% contaminated with E. coli and 28% with Salmonella. February had the highest contamination during the dry season (2.37 log10cfu.ml-1 >2; p≤ 0.05) and May (2.8 log10cfu.ml-1 >2; p≤ 0.05) the highest in wet season. Thus, seasons have influence on microbial contamination in tomato. Bacteria multiplication slows in dry period and increases in wet season. Increase of bacteria from March (end of dry season or beginning of rains) to high presence in May (end of rains) might come with more health concerns if attention is not paid to ready-to-eat vegetables. Consumers purchasing from open air markets seem more at risk of bacterial infection (Kangemi 1.84±0.159; Githurai 2.02±0.1815; Wakulima 1.97±0.24 of E. coli contamination) compared to those who use supermarkets (Nakumatt W. 1.54±0.134; Uchumi Sarit C. 1.27±0.105). Although most tomatoes were washed and cleaned, bacteria levels were still a threat to health. Surfactants from pesticides might contribute to tomatoes infection as they are able to wound skins of crops and open ways to bacterial contamination. With sudden bacterial increase in wet seasons (Kangemi 2.98±0.225kl; Githurai 2.75±0.157efghi; Wakulima 2.69±0.067ghijk; Nakumatt 1.78±0.092bcd; Uchumi 1.54±0.215cde), consumers might experience more symptoms of enteric bacteria. Special attention should be paid in wet times as best quality of tomato at sight is not necessarily safe for direct consumption without further processing. These findings might help in understanding why consumers of salad might be exposed to symptoms of enteric bacteria in wet times. Food handlers, health workers, consumers and policy designers should be informed of this risk. Keywords: E. coli, Salmonella spp, bacteria, season, contaminatio

Predominance of N-acetyl transferase 2 slow acetylator alleles in children less than ten years experiencing adverse treatment events following artemisinin-based combination therapy in North and South West Regions of Cameroon

The human N-acetyltransferase II (NAT2) gene may vary between individuals resulting in variability in the incidence of adverse drug reactions. We set out in this adhoc analysis to determine the distribution of allele frequencies of NAT2 gene variants among children less than ten years treated with artemisinin-based combinations in Cameroon. Children with uncomplicated malaria were deparasitized with artemisinin based combination therapy (artesunate amodiaquine, dihydroartemisinin-piperaquine and artemether-lumefantrine) and followed up for 42 days and adverse events recorded. Blood was spotted on filter paper prior to drug administration for DNA extraction by chelex method. Standard nested PCR followed by restriction enzyme analysis with KpnI, TaqI, and BamHI for detection of polymorphisms in the NAT2 was performed. Allelic frequencies and acetylator phenotypes were compared between participants with or without adverse drug events. The prevalence of slow, intermediate and fast acetylators was 54, 34 and 12% respectively. Significant clustering of mutant alleles (NAT2*5, NAT2*6 and NAT2*7) occurred among those who experienced skin rash and tiredness (OR = 5.765, P = 0.046) (OR = 13.280, P = 0.020). No significant difference was observed between fast and slow acetylators with respect to the development of other recorded adverse events. Overall, producers of the slow acetylator alleles were more likely to develop any adverse events (OR = 8.286, P = 0.017) during the study period. Mutant alleles of the wild type NAT2*4 associated with the slow acetylator phenotype were the most predominant NAT2 allelic type and individuals with the phenotype were more likely to develop adverse events to ACTs.Keywords: N-Acetyltransferase 2, Artemisinin based combination therapy, adverse events, slow acetylators, allel

Physical, nutritional, and sensory quality of rice-based biscuits fortified with safou (Dacryodes edulis) fruit powder

The reduction of postharvest losses in rice and safou is imperative to increase productivity in their respective value chains. In this study, fine broken rice grains were used to produce rice flour and subsequently rice‐based biscuits. The biscuits were further fortified with safou powder, and the physical, nutritional, and sensory quality and stability during storage of the different types of biscuits were analyzed using standard methods. Fine or nonsandy biscuits had peak particle size of 500 µm, while medium (slightly sandy) and large (sandy) biscuits had peak particle sizes of 1,000 µm and 1,400 µm, respectively. The hardness varied from 5.7 ± 2.3 N for biscuits with large particles to 16.1 ± 4.4 N for biscuits with fine particles. Fortification of biscuits with sour safou increased the protein and amino acid content of the biscuits. Tryptophan was absent in both safou and the biscuits produced. There was an increase in phosphorus, potassium, calcium, magnesium, copper, iron, manganese, and aluminum following fortification with safou. Nonsandy biscuits dissolved faster in the mouth (melt) during consumption than the other biscuits although most of the biscuits were perceived to be low in melting and buttery. Nonsandy biscuits were rated as “very good,” while slightly sandy and sandy were rated as “good.” Safou rice‐based biscuits were perceived as “very good,” while simple rice biscuits were perceived as “good.” Fortification of rice biscuits with safou increased the protein, essential amino acid, and mineral contents of the biscuits with very appreciable taste. These biscuits can be used to help fight protein, iron, and zinc malnutrition and in mitigating postharvest losses of underutilized broken rice and safou especially sour safou

Performance of rapid subtyping tools used for the classification of HIV type 1 recombinants isolated from selected countries in west and central Africa

HIV-1 genetic diversity in sub-Saharan Africa is broad and the AIDS epidemic is driven predominantly by recombinants in Central and West Africa. The classification of HIV-1 strains is therefore necessary to understand diagnostic efficiency, individual treatment responses as well as options for designing vaccines and antiretroviral (ARV) treatment guidelines. More so, accurate subtyping of a partial or full genome would represent the population dynamics of HIV and provide evidence for designing surveillance strategies within a geographic region. Evaluating the performance of rapid subtyping tools with options that incorporate phylogeny could be fast, more user-friendly and of high performance. A total of 570 HIV-1 partial sequences from Cameroon, Angola, Democratic Republic of Congo, Gabon and Senegal were obtained from the Los Alamos National Library (LANL) HIV Sequence Database. Phylogeny was performed using MEGA v6 and the results were used to evaluate the performance of eleven different rapid HIV-1 subtyping tools: REGA v2, REGA v3, NCBI, Stanford HIVDB, SUDI, Geno2Pheno, Euresist, STAR, jpHMM, COMET and SCUEAL. The performance of these subtyping tools differed among HIV-1 clades and across different viral genes. NCBI and SUDI showed the highest performance in subtyping. The discordance observed between the rapid subtyping tools and phylogeny implies that phylogenetic analysis is still the more suitable method for HIV-1 classification. However, the need to update the reference datasets of the subtyping tools, and validate algorithms for rapid subtyping and quality control is imperative as this information is relevant for clinical use and policymaking to the AIDS response.Keywords: HIV, phylogeny, performance, subtyping tools, algorith