Willingness to pay for treatment with highly active antiretroviral (HAART) drugs: a rural case study in Cameroon

This paper reports on the willingness of HIV/AIDS patients to pay for the most affordable triple therapy combination of antiretrovirals in a local setting in Cameroon. Questionnaires were used to evaluate willingness to pay, and patients who could still afford their medication 6 months after the survey were also investigated, to give an indication of actual ability to pay. In addition, oral interviews were carried out for clarification. In all, 84 patients out of a total of 186 were involved in the study. Results indicated that more men (39%) were willing to pay than women (22%), although more women (56%) were afflicted than men.Willingness to pay was directly dependent on cost with 69%, 22% and 9% of respondents indicating willingness to pay $1,$2 and $3 a day respectively. After 6 months of treatment, 22SAHARA-J (2004) 1(2): 107-113 Keywords: HIV/AIDS, treatment, access to antiretrovirals, drug costs, affordability. RÉSUMÉ Cette communication porte sur une bonne volonté des patients souffrants du VIH/SIDA à payer un prix assez abordable de la thérapie triple des anti-rétroviraux dans un milieu rural au Cameroun. Des questionnaires ont été utilisés afin d'évaluer cette bonne volonté à payer les médicaments. De plus, les patients qui avaient les moyens d'acheter leurs médicaments 6 mois après ces épreuves furent interviewés également. En plus de cela, les patients ont été interviewés avec le but d'obtenir des éclaircissements. Parmi les 186 patients, 84 participaient à l'étude. Les résultats de cette étude ont démontré que davantage d'hommes (39$1, $2 et$3 par jour respectivement. Au bout d'une période de 6 mois de traitement, 22% de patients étaient encore en thérapie. Une majorité de patients ont arrêté le traitement au bout de 6 mois faute de manque d'argent. En dehors du coût, le stigmate, l'incrédulité et les effets secondaires des médicaments étaient les facteurs principaux qui étaient contre la volonté de payer. Il est conseillé d'améliorer les services de consultation, de fournir de l'information, de réduire le coût de médicaments ainsi que les essais en laboratoire et l'élaboration des programmes de déstigmatisation afin d'améliorer la capacité de patients à payer pour les anti-rétroviraux. SAHARA-J (2004) 1(2): 107-113 Mots clés: le VIH/SIDA, le traitement, l'accès aux anti-rétroviraux, le coût de médicaments, avoir des moyens d'acheter

Preventing mother-to-child transmission: factors affecting mothers\' choice of feeding — a case study from Cameroon

This paper reports on factors influencing the decision of mothers regarding the type of feeding method for their babies in a rural setting in Cameroon. The aim of the study was to ascertain the proportion of mothers choosing the different methods of feeding, to determine the various factors influencing their choices, and to ascertain the relationships of these factors to their respective choices. Questionnaires were used on 108 HIV-positive mothers who had delivered babies and who were administered nevirapine at least 3 months prior to the study. A focus group discussion with mothers also took place. Findings were that more mothers (84%) chose breastfeeding than artificial feeding (16%), while a minority (4%) selected mixed feeding. Factors found to militate against artificial feeding were cost (69%), stigma (64%), family pressure (44%), inconvenience in preparation/administration (38%), prior education from health workers (23%), and loss of special attention from family (8%). On the other hand, advice of health worker (44%), ill health (19.5%), free milk (12.5%), job pressure (12.5%) and loss of beauty (12.5%) were found to militate against breastfeeding. A direct relationship was also found between age, educational level, income size, marital status and choice of feeding. Policies targeting stigma reduction and socio-cultural factors affecting the choice of feeding are needed to optimise uptake of the less risky methods of feeding which could in turn contribute to a reduction in transmission. Key words: HIV/AIDS, mother-to-child transmission prevention, feeding. La prévention de la transmission mère-enfant: les facteurs influençant le choix de la mère sur la méthode d'allaitement – une etude de cas du Cameroun RÉSUMÉ Cette communication présente des facteurs qui influencent la décision des mères concernant la méthode d\'allaitement de leur nourrissons, en zone rurale au Cameroun. Le but de cette étude était de s\'assurer de la proportion de mères qui choisissent de méthodes différentes d\'allaitement, de déterminer les facteurs influençant leur choix et d\'étudier la relation entre ces facteurs et les méthodes d\'allaitement choisies. Pour recueillir des données, un questionnaire a été utilisé auprès de 108 mères séropositives qui ont des nourrissons. Ces mères étaient sur le traitement de la névirapine depuis au moins 3 mois avant le début de cette étude. Une discussion d\'un groupe de foyer de mères a eu lieu. Les résultats ont montré que plus de 84% de mères ont choisi l\'allaitement maternel contre 16% qui ont choisi l\'allaitement artificiel alors qu\'une minorité (4%) ont choisi l\'allaitement mixte (maternel et artificiel). Les raisons contre l\'allaitement artificiel sont les suivants: le coût (69%); la stigmatisation (64%); les pressions familiales (44%); les inconvénients liés à la préparation et l\'administration du lait artificiel (38%); une éducation préliminaire de la part du personnel soignant (23%) et le manque de soins particuliers de la part de la famille (8%). D\'autre part, les facteurs qui favorisent l\'allaitement artificiel sont les suivants: les conseils du personnel de santé (44%); la mauvaise santé (19.5%); du lait artificiel gratuit (12.5%) et la perte de beauté (12.5%). Nous avons constaté une relation entre l\'âge de la femme, le niveau d\'éducation, le niveau du revenu, le statut civil et le choix d\'allaitement. Il est nécessaire de mettre en place des politiques visant la réduction de la stigmatisation et les facteurs socioculturels qui influencent le choix d\'une méthode d\'allaitement afin de maximiser une compréhension de méthodes d\'allaitement à moindre risque qui par la suite pourrait contribuer à la réduction de transmission. Mots clés :VIH/SIDA, prévention de la transmission mère-enfant, allaitement. Sahara J Vol.1(3) 2004: 132-13

Preliminary assessment of bovine trypanosomiasis and its vectors in Santa, Bali and Bafut Sub-Divisions of the, North West Region, Cameroon

A cross-sectional study involving a questionnaire, parasitological examination of cattle and entomological prospection were conducted in the Mezam Division of Cameroon from December 2013 to May 2014 in two seasons for the first time. The objectives were to determine the prevalence of bovine trypanosomiais and its vectors. Peasant farmers ﴾n=95﴿ were interviewed. Standard protocols for parasitological, hematocrit analysis as well as trypanosome identification were used. Acetone baited blue biconical traps ﴾n=5﴿ were used for entomological survey. Questionnaire survey revealed that trypanosomiasis was one of the major health problems affecting animals and a hindrance to agricultural activities. The overall prevalence was 10.3% ﴾31/301﴿. Trypanosome species identified consisted of: T. vivax (58.1%), T. brucei (25.8%), T. congolense (9.6%) and a mix infection (Trypanosoma congolense + Trypanosoma vivax) (6.5%). Vector survey revealed highest fly catch in Bafut subdivision as compared to others with a significant difference ﴾P<0.05﴿. Fly types recorded included: Tabanus 125 (71.4%), Stomoxys 31 (17.7%) and Glossina morsitans submorsitans 19 (10.9%). The overall Apparent Density (AD) was 1.53 fly per trap per day (f/t/d). Therefore, vector transmission and impact of the disease on production is alarming and should not be neglected. Control strategies have to be designed and implemented in Mezam Division in order to eradicate trypanosomiasis and its vectors.© 2016 International Formulae Group. All rights reserved.Keywords: Cattle, trypanosomiasis, Glossina, prevalence, Bafu

Pathway analysis following association study

Genome-wide association studies often emphasize single-nucleotide polymorphisms with the smallest p-values with less attention given to single-nucleotide polymorphisms not ranked near the top. We suggest that gene pathways contain valuable information that can enable identification of additional associations. We used gene set information to identify disease-related pathways using three methods: gene set enrichment analysis (GSEA), empirical enrichment p-values, and Ingenuity pathway analysis (IPA). Association tests were performed for common single-nucleotide polymorphisms and aggregated rare variants with traits Q1 and Q4. These pathway methods were evaluated by type I error, power, and the ranking of the VEGF pathway, the gene set used in the simulation model. GSEA and IPA had high power for detecting the VEGF pathway for trait Q1 (91.2% and 93%, respectively). These two methods were conservative with deflated type I errors (0.0083 and 0.0072, respectively). The VEGF pathway ranked 1 or 2 in 123 of 200 replicates using IPA and ranked among the top 5 in 114 of 200 replicates for GSEA. The empirical enrichment method had lower power and higher type I error. Thus pathway analysis approaches may be useful in identifying biological pathways that influence disease outcomes

Predictors of childhood severe malaria in a densely populated area: Douala, Cameroon

The physiopathology of malaria is complex. More understanding would be useful for a better management of the disease. This study was undertaken to describe clinical presentation and some biochemical parameters in childhood malaria in order to identify some factors of disease severity. Eighty six (86) children (0 to 15 years old) were recruited in Douala, clinical data recorded and blood sample collected. Thirty one (31) healthy children were also targeted to serve as control. Blood glucose, hemoglobin, transaminases and nitric oxide were determined by spectrophotometry. C reactive protein (CRP) was also investigated. The results confirmed that severe malaria significantly affects children under 5 years. Severe malaria was associated with hyperpyrexia and prostration. Coma, convulsions and unconsciousness were more indicative of cerebral malaria. Hemoglobin and blood glucose levels decreased significantly in severe malaria patients compared with uncomplicated malaria patients or controls (P < 0.001). On the contrary, blood transaminases and CRP levels increased significantly in malaria patients compared to controls (P < 0.001). From these results, it is clear that childhood severe malaria is associated with prostration, coma, unconsciousness, convulsions and hyperpyrexia. Low levels of haemoglobin and glycemia, as well as high levels of transaminases and CRP has been identified as predictor of malaria severity.Keywords: Childhood malaria, clinical presentation, physiopatholog

Spatio-temporal patterns in a mechanical model for mesenchymal morphogenesis

We present an in-depth study of spatio-temporal patterns in a simplified version of a mechanical model for pattern formation in mesenchymal morphogenesis. We briefly motivate the derivation of the model and show how to choose realistic boundary conditions to make the system well-posed. We firstly consider one-dimensional patterns and carry out a nonlinear perturbation analysis for the case where the uniform steady state is linearly unstable to a single mode. In two-dimensions, we show that if the displacement field in the model is represented as a sum of orthogonal parts, then the model can be decomposed into two sub-models, only one of which is capable of generating pattern. We thus focus on this particular sub-model. We present a nonlinear analysis of spatio-temporal patterns exhibited by the sub-model on a square domain and discuss mode interaction. Our analysis shows that when a two-dimensional mode number admits two or more degenerate mode pairs, the solution of the full nonlinear system of partial differential equations is a mixed mode solution in which all the degenerate mode pairs are represented in a frequency locked oscillation

Échecs thérapeutiques chez les enfants infectés par le VIH en suivi de routine dans un contexte à ressources limitées au Cameroun

Introduction: L'objectif de cette étude était de déterminer les facteurs associés aux échecs thérapeutiques chez les enfants infectés par le VIH à l'Hôpital Laquintinie de Douala.Méthodes: Une étude transversale rétrospective a été menée sur une période de 5 mois en 2010, recrutant 222 enfants âgés de 1 à 18 ans et sous TARV depuis au moins 24 semaines. Les données  sociodémographiques, cliniques, biologiques et de l'observance thérapeutique des patients ont été collectés à partir des dossiers des patients, et analysées avec le logiciel SPSS (version 16).Résultats: 39 (17,6%) des enfants étaient en échec thérapeutique (délai moyen de survenue 26,8 mois) et 73,4% d'entre eux sont passés en seconde ligne. Les garçons avaient en moyenne un risque 5 fois plus élevé de faire un échec thérapeutique que les filles (OR=3,9; p=0,035). 94,4% des enfants suivis avaient un faible taux de CD4 à l'initiation (' 25%) associé au risque élevé d'échec thérapeutique (OR=5,2; p=0,007).  Les enfants issus de famille monoparentale représentaient près de la moitié des cas d'échecs thérapeutiques. Sur 39 cas en échec thérapeutique, 41% des enfants étaient des orphelins. Parmi les enfants sous TARV, 46% prenaient leur trithérapie sous forme de médicaments séparés parmi lesquels 52,1% étaient en échec thérapeutique. Conclusion: Les échecs thérapeutiques et le passage en seconde ligne dépendaient du contexte familial des enfants, de leur statut immunologique à l'initiation du traitement, de leur sexe et de la forme galénique du TARV.Key words: VIH, enfants, échec thérapeutiqu

Six Improved Cameroonian Potato Varieties Introduced In Vitro Through Meristem Culture

Introduction:Availability of disease-free, high yielding potato planting material is a major challenge to producers. This study focused on evaluating the ability of locally improved varieties to be introduced for the first time in vitro. Meristem tip culture was used to regenerate in vitro plantlets from improved potato varieties in Cameroon. Materials and methods: Six varieties including Cipira, Mafo, Jacob 2005, Bambui Wonder, Tubira and Irad 2005 were taken from IRAD potato breeding program. Ten meristems were cultured per replicate (4) per variety.The number of meristem tips sprouting, rooting, the number of nodes and shoot length were recorded weekly over a period of 4 weeks. Results and discussion: Meristem tips of all potato varieties regenerated plantlets with vigorous shoots and roots. Sprouting began in the first week and ranged from 40% (Tubira) to 75% (Cipira and Jacob 2005). Rooting began in the 2nd week and ranged from 7.5 % (Cipira) to 37.5 % (Irad 2005 and Tubira). Regenerated shoots of all varieties had nodes averaging from 10.0 to 12.5, thus ready for micro-propagation. Conclusion: All six improved potato varieties can be introduced in vitro for rapid multiplication of planting material. Regenerated plantlets should be serologically tested to check they are free from diseases especially viruses