Practices Regarding the Use of Antimalarial Medications among Inhabitants of the Buea Health District, Southwestern Cameroon: Implications for Malaria Treatment Policy

Background: Malaria treatment policy recommends continuous monitoring and reporting of therapeutic efficacy of antimalarial medications for early detection of resistant strains. Patient adherence to policies regarding the use of antimalarial medications is critical to success of global malaria elimination. This study assessed the practices regarding the use of antimalarial medications in the Buea Health District, Southwest Cameroon. Methods: A descriptive cross-sectional survey of a random sample of 495 people living in the district with episodes of malaria in the last one year prior to the study was conducted between February and August, 2015. Questionnaire was designed to obtain information from participants on the general knowledge of malaria and practices regarding to the use of antimalarial medications. Results: Knowledge on malaria symptoms, transmission and prevention was reasonable among 80.6% (399) of the respondents (p < 0.07). Only 31.3% (155) of the respondent could attribute cause of malaria to protozoan of genus Plasmodium species. Majority of the respondents 56.9% (283) frequently treat malaria with ACT, 32.4% (161) with monotherapy, < 15% with other non-ACTs. Presumptive diagnosis was commonly practiced by 67.3% (333) of the respondents. The prevalence of self-medication in the study population was 18.4%. Only 57.2% (283) of respondents took prescribed antimalarials. Majority of self-medicated respondents (63%) obtained antimalarials from drugstores and friends. About 50.9% (252) of the respondents took medications regularly and 57.6% (258) completed the treatment regimen. Respondents whose treatments were based on laboratory diagnosis adhered better than those on self-medication or recommended at the pharmacy (p < 0.02). Conclusion: The findings revealed a high knowledge of malaria with poor practices regarding the use of antimalarials. Efforts are needed to educate inhabitants of the district on practices regarding the use of antimalarials to prevent early emergence of drug resistance. Keywords: Antimalarials, Drug resistance, Presumptive diagnosis, Self-medication, Adherenc

Blaming Active Volcanoes or Active Volcanic Blame? Volcanic Crisis Communication and Blame Management in the Cameroon

This chapter examines the key role of blame management and avoidance in crisis communication with particular reference to developing countries and areas that frequently experience volcanic episodes and disasters. In these contexts, the chapter explores a key paradox prevalent within crisis communication and blame management concepts that has been rarely tested in empirical terms (see De Vries 2004; Brändström 2016a). In particular, the chapter examines, what it calls, the ‘paradox of frequency’ where frequency of disasters leads to twin dispositions for crisis framed as either: (i) policy failure (active about volcanic blame on others), where issues of blame for internal incompetency takes centre stage, and blame management becomes a focus of disaster managers, and/or: (ii) as event failure (in this case, the blaming of lack of external capacity on active volcanoes and thereby the blame avoidance of disaster managers). Put simply, the authors investigate whether perceptions of frequency itself is a major determinant shaping the existence, operation, and even perceived success of crisis communication in developing regions, and countries experiencing regular disaster episodes. The authors argue frequency is important in shaping the behaviour of disaster managers and rather ironically as part of crisis communication can shape expectations of community resilience and (non)-compliance. In order to explore the implications of the ‘paradox of frequency’ further, the chapter examines the case of the Cameroon, where volcanic activity and events have been regular, paying particular attention to the major disasters in 1986 (Lake Nyos Disaster - LND) and 1999 (Mount Cameroon volcanic eruption - MCE)

Mycotoxin concentrations in rice from three climatic locations in Africa as affected by grain quality, production site, and storage duration

Information on the mycotoxin contamination of rice in Africa is limited although the risk of contamination is high. In this study, domestic milled rice processed by actors using suboptimal methods was purchased and total fumonisin (FUM), zearalenone, and aflatoxin concentrations determined at 0, 90, and 180 days after storage. Three different climatic locations, Cotonou (Benin) in the Guinea savanna, Yaoundé (Cameroon) in the Tropical forest, and N'diaye (Senegal) in the Sahel, were selected as storage sites. Subsets of the samples collected from Glazoue (Benin), Ndop (Cameroon), and Dagana (Senegal) were stored in plastic woven bags under room conditions in the respective sites with or without calcium oxide (burnt scallop shell—BSS, 0.1% w/w) treatment. Multivariance analysis showed that FUM concentration was positively influenced by the duration of storage only while zearalenone concentration was negatively influenced by relative humidity and head rice but positively by impurities. Zearalenone concentration was also influenced by sample collection/storage location, processing type, and duration of storage. Aflatoxin concentration was influenced negatively by storage room temperature and head rice but positively by impurities and chalky grains. In addition, aflatoxin concentration was influenced by collection/storage location and processing type. BSS treatment followed by storage for 6 months had no effect on the concentration of the three assessed mycotoxins. Strategies to reduce the risk of mycotoxin contamination in study sites will include the improvement of physical rice quality through better pre‐ and postharvest practices and proper packaging of both treated rice and untreated rice in hermetic systems before marketing and storage

Drug resistance profiles of Mycobacterium tuberculosis complex and factors associated with drug resistance in the Northwest and Southwest Regions of Cameroon.

BACKGROUND:Anti-tuberculosis drug resistance continues to be a major obstacle to tuberculosis (TB) control programmes with HIV being a major risk factor in developing TB. We investigated anti-TB drug resistance profiles and the impact of socioeconomic as well as behavioural factors on the prevalence of TB and drug resistance in two regions of Cameroon with such data paucity. METHODS:This was a hospital-based study in which 1706 participants, comprising 1133 females and 573 males consecutively enrolled from selected TB and HIV treatment centres of the Northwest and Southwest regions. Demographic, clinical and self-reported risk behaviours and socioeconomic data were obtained with the consent of participants using questionnaires. Culture and drug resistance testing were performed according to standard procedures. RESULTS:The prevalence of resistance to at least one anti-TB drug was 27.7% and multi-drug resistance was 5.9%. Smoking, concurrent alcohol consumption and smoking, being on antiretroviral therapy for ≤ 12 months and previous household contact with TB patient were independently associated with tuberculosis prevalence, while only previous tuberculosis infection was associated with drug resistance in a univariate analysis. CONCLUSION:The study showed a high prevalence of drug resistance TB in the study population with only previous TB infection associated with drug resistance in a univariate analysis. It also provides evidence in our context, of the role of alcohol and smoking in increasing the risk of developing TB, which is more likely in people living with HIV/AIDS. Therefore, it is important for public health authorities to integrate and intensify alcohol/smoking abstention interventions in TB and HIV control programs in Cameroon

Using a composite adherence tool to assess ART response and risk factors of poor adherence in pregnant and breastfeeding HIV-positive Cameroonian women at 6 and 12 months after initiating option B+

Abstract Background Antiretroviral therapy (ART) adherence in preventing HIV mother-to-child transmission in association with virological suppression and risk factors of low adherence in the Cameroon’s Option B+ programme are poorly understood. We used a composite adherence score (CAS) to determine adherence and risk factors of poor adherence in association with virological treatment response in HIV-positive pregnant and breastfeeding women who remained in care at 6 and 12 months after initiating ART. Methods We prospectively enrolled 268 women after ART initiation between October 2013 and December 2015 from five facilities within the Kumba health district. Adherence at 6 and 12 months were measured using a CAS comprising of a 6-month medication refill record review, a four-item self-reported questionnaires and a 30-day visual analogue scale. Adherence was defined as the sum scores of the three measures and classified as high, moderate and low. Measured adherence levels were compared to virological suppression rates at month 12 and risk factors of poor adherence were determined. Results At 6 and 12 months, 217 (81.0%) and 185 (69.0%) women were available for adherence evaluation. Respectively. Of those, 128 (59.0%) and 68 (31.4%) had high or moderate adherence as per the CAS tool at month 6, and 116 (62.7%) and 48 (24.9%) at month 12, respectively. Viral loads were assessed in 165 women at months 12, and 92.7% had viral suppression (< 1000 copies/mL). Viral suppression was seen in 100% of women with high, 89.5% with moderate, and 52.9% with low adherence using the CAS tool. Virological treatment failure was significantly associated with low adherence [OR 7.6, (95%CI, 1.8–30.8)]. Risk factors for low adherence were younger age [aOR 3.8, (95%CI, 1.4–10.6)], primary as compared to higher levels of education [aOR 2.7, (95%CI, 1.4–5.2)] and employment in the informal sector compared to unemployment [aOR 1.9, (95%CI,1.0–3.6)]. Conclusions During the first year of Option B+ implementation in Cameroon our novel CAS adherence tool was feasible, and useful to discriminate ART adherence levels which correlated with viral suppression. Younger age, less educated and informal sector employed women may need more attention for optimal adherence to reduce the risk of virological failure

Physicochemical and nutritional properties of rice as affected by parboiling steaming time at atmospheric pressure and variety

To elucidate the effect of different parboiling steaming time on the physicochemical and nutritional quality of rice, four varieties, NERICA1, NERICA7, IR841, and WITA4, were soaked at the same initial temperature (85°C) and steamed for 5, 15, 25, 35, and 45 min. NERICA7 steamed for 25 min recorded the highest head rice yield (71.9%). Nonparboiled IR841 recorded the shortest cooking time (17.0 min), while NERICA1 steamed for 35 min recorded the longest cooking time (26.1 min). NERICA1 steamed for 45 min was the hardest (63.2 N), while nonparboiled IR841 was the softest (28.7 N). NERICA7 recorded higher peak and final viscosities across all steaming times compared to the other varieties. NERICA7 steamed for 35 and 45 min recorded the lowest total starch (77.3%) and the highest protein (13.2%) content, respectively. NERICA7 steamed for 25 and 45 min recorded the highest phosphorus (0.166%), magnesium (572 mg/kg), and potassium (2290 mg/kg) content, respectively. We conclude that, depending on desired physicochemical and nutritional properties, specific varieties and steaming times can be selected to achieve those outcomes