Burden of atrial fibrillation among adults with heart failure in sub-Saharan Africa: a systematic review and meta-analysis

Objectives This study aimed to estimate the prevalence of atrial fibrillation (AF) in adults with heart failure (HF) and summarise the all-cause mortality ratio among adult patients with coexisting HF and AF in sub-Saharan Africa (SSA). Setting This was a systematic review and meta-analysis of cross-sectional and cohort studies with primary data on the prevalence and incidence of AF among patients with HF and the all-cause mortality ratio among patients with HF and AF in SSA. We combined text words and MeSH terms to search MEDLINE, PubMed and Global Health Library through Ovid SP, African Journals Online and African Index Medicus from database inception to 10 November 2021. Random-effects meta-analysis was used to estimate pooled prevalence. Primary outcome measures The prevalence and incidence of AF among patients with HF, and the all-cause mortality ratio among patients with HF and AF. Results Twenty-seven of the 1902 records retrieved from database searches were included in the review, totalling 9987 patients with HF. The pooled prevalence of AF among patients with HF was 15.6% (95% CI 12.0% to 19.6%). At six months, the all-cause mortality was 18.4% (95% CI 13.1% to 23.6%) in a multinational registry and 67.7% (95% CI 51.1% to 74.3%) in one study in Tanzania. The one-year mortality was 48.6% (95% CI 32.5% to 64.7%) in a study in the Democratic Republic of Congo. We did not find any study reporting the incidence of AF in HF. Conclusion AF is common among patients with HF in SSA, and patients with AF and HF have poor survival. There is an urgent need for large-scale population-based prospective data to reliably estimate the prevalence, incidence and risk of mortality of AF among HF patients in SSA to better understand the burden of AF in patients with HF in the region

Evidence for an enhanced HIV/AIDS policy and care in Cameroon: proceedings of the second Cameroon HIV Research Forum (CAM-HERO) 2021

To achieve the Sustainable Development Goal of zero hunger, multi-sectoral strategies to improve nutrition are necessary. Building towards this goal, the food and agriculture sector must be considered when designing nutritional interventions. Nevertheless, most frameworks designed to guide nutritional interventions do not adequately capture opportunities for integrating nutrition interventions within the food and agriculture sector. This paper aims to highlight how deeply connected the food and agriculture sector is to underlying causes of malnutrition and identify opportunities to better integrate the food and agriculture sector and nutrition in low and middle income countries. In particular, this paper: (1) expands on the UNICEF conceptual framework for undernutrition to integrate the food and agriculture sector and nutrition outcomes, (2) identifies how nutritional outcomes and agriculture are linked in six important ways by defining evidence-based food and agriculture system components within these pathways: as a source of food, as a source of income, through food prices, women’s empowerment, women’s utilization of time, and women’s health and nutritional status, and (3) shows that the food and agriculture sector facilitates interventions through production, processing and consumption, as well as through farmer practices and behavior. Current frameworks used to guide nutrition interventions are designed from a health sector paradigm, leaving agricultural aspects not sufficiently leveraged. This paper concludes by proposing intervention opportunities to rectify the missed opportunities generated by this approach. Program design should consider the ways that the food and agriculture sector is linked to other critical sectors to comprehensively address malnutrition. This framework is designed to help the user to begin to identify intervention sites that may be considered when planning and implementing multi-sectoral nutrition program

Giant congenital melanocytic nevus in a Cameroonian child: a case report

Abstract Background Giant congenital melanocytic nevus is a very rare condition characterized by a large skin lesion and an increased risk of complications like neurocutaneous melanosis and malignant transformation. Reports of giant congenital melanocytic nevus are scarce in the sub-Saharan African literature and here we present a case of this disease in a Cameroonian adolescent. Case presentation A 12-year-old Cameroonian girl from the "Baka" ethnic group, with no relevant family and medical histories presented with a progressively extensive brownish-black nodular hypertrophic skin lesion of approximately 45 cm, which she had had since she was 2-days old. The lesion covered her entire back giving an appearance of “turtle child”, which was highly suggestive of a giant congenital melanocytic nevus. She was booked in for a surgical intervention organized by a health campaign within her community. Meanwhile she was provided with psychological support and her family was counseled on warning signs of complications which would warrant an urgent consultation. Conclusions Here we presented a case of giant congenital melanocytic nevus, apparently the first in the Cameroonian literature. In view of the potential severe complications as well as psychological trauma of this pathology, we draw clinicians’ attention to this extremely rare but real pathology in our country, for a timely diagnosis and management

Active and passive tobacco smoking among students of the University of Yaoundé I, Cameroon

Background Tobacco smoking is a leading cause of preventable deaths globally. Although tobacco-induced burden has started decreasing in developed countries, it is continuously increasing in developing countries with young populations being mostly affected. This study aimed to determine the prevalence of active and passive smoking among youths in Cameroon. Methods This was a cross-sectional study carried-out from May-July 2017 at the University of Yaoundé I, Cameroon. We included any student registered at the University, found at one of the campuses when the investigators visited, and volunteering to participate. Smoking status was classified as never, former (last smoked more than 12 month ago) or current (smoked regularly in the last 12 months). Passive smoking was defined as a regular exposure to tobacco smoke since the last twelve months. Results Overall, 949 (54% males) were included in this study, with a median age of 23 years (interquartile range (IQR) 21-26). The prevalence of former, current and passive smoking was 3.4% (95% confidence interval (CI): 2.3-4.6), 0.8% (95%CI: 0.2-1.4), and 27.7% (95%CI: 24.9-30.6), respectively. Exposure to other people's smoke ranged from 1 to 50 hours per week, with a median of 1 hour/week (IQR 1-2). Those who smoked were more likely to be males (odds ratio (OR) 2.05, 95%CI: 1.03-4.08; p=0.037) and/or hazardous alcohol drinkers (OR 4.93, 95%CI: 2.55-9.52; p< 0.001). Similarly, males (OR 1.57, 95%CI: 1.18-2.11; p=0.002) and/or hazardous alcohol drinkers (OR 2.10, 95%CI: 1.55-2.86; p< 0.001) were more at risk of passive smoking. Conclusions Although the prevalence of active smoking seemed low in this population, almost one-third of students were passive smokers, reflecting a high burden of tobacco smoking in the general population. Therefore, regulations towards tobacco consumption should be reinforced in our country. Specifically, special laws banning and severely punishing smoking in public places should be voted and adopted

Atrial fibrillation among adults with heart failure in sub-Saharan Africa-prevalence, incidence and all-cause mortality: A systematic review and meta-analysis protocol

Introduction Heart failure (HF) remains a major non-communicable disease in sub-Saharan Africa (SSA) associated with high rates of readmission, mortality and loss of economic productivity as it affects mostly young and economically active adults. Atrial fibrillation (AFib) is a major determinant of mortality among patients with HF in SSA. Meanwhile, the use of anti-arrhythmic medications in the region remains unacceptably low. This review aims to evaluate the prevalence and incidence of AFib in adult patients with HF in SSA, and the all-cause mortality rate among patients with HF and AFib. Methods and analysis The Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Protocols 2015 statement was used to prepare this protocol. All eligible studies from database inception to December, 31 2018 in MEDLINE, Embase, Google Scholar, Web of science and Africa-specific databases (AFROLIB, African Index Medicus and African Journals Online) will be included without language restrictions. The process of study screening, selection, data extraction and assessment of risk of bias will be conducted independently by two reviewers. Disagreements will be arbitrated by a third reviewer. Study-specific estimates will be pooled using random-effect meta-analysis and summary measures obtained will be presented in forest plots. The test on Cochrane's Q and the I 2 statistics will be used to assess and quantify heterogeneity, respectively. The Egger's test and funnel plots will be used to assess publication bias. Ethics and dissemination Since our review will be based on already published data, an ethical approval is not required. The findings of this review will be presented in conferences and peer-reviewed journals and shared on social media such as Researchgate, Facebook, WhatsApp and Twitter. PROSPERO registration number CRD42018087564

Household costs incurred when seeking and receiving paediatric tuberculosis services: a survey in Cameroon and Kenya

# Background Elimination of catastrophic costs due to tuberculosis (TB) is one of the three targets of the World Health Organization (WHO) End TB Strategy. Limited data have yet been reported on the costs experienced by households of children receiving TB services. We quantified the economic impact on households with children seeking and receiving TB services during the Catalyzing Pediatric TB Innovations (CaP-TB) project in Cameroon and Kenya. # Methods Within the INPUT stepped-wedge cluster-randomised study evaluating the effect of CaP-TB integration of TB services in paediatric entry points, we designed a cross-sectional facility-based survey with retrospective data collection using a standardised questionnaire adapted from the WHO Global taskforce on TB patient cost generic survey instrument. Caregivers of children receiving TB services (screening, diagnosis and treatment of drug-sensitive TB) during the CaP-TB project were interviewed between November 2020 and June 2021. Direct medical, direct non-medical, and indirect costs for TB services were analysed following WHO Global taskforce recommendations. We used the human capital and output-based approaches to estimating income loss. All costs are presented in 2021 US dollars. # Results A total of 56 caregivers representing their households (Cameroon, 26, and Kenya, 30) were interviewed. The median household costs for TB services, estimated using the human capital approach, were \$255 (IQR; \$130-631) in Cameroon and \$120 (\$65-236) in Kenya. The main cost drivers across both countries were direct non-medical costs (transportation and food), 52%; and medical costs, 34%. Approximately 50% of households reported experiencing dissavings (taking a loan, or selling an asset) to deal with costs related to TB disease. Using a threshold of 20% of annual household income, 50% (95%CI; 37-63%) of households experienced catastrophic costs when using the human capital approach; (46% (95%CI; 29-65%) in Cameroon and 53% (95%CI; 36-70%) in Kenya). Estimated costs and incidence of catastrophic costs increased when using the output-based approach in a sensitivity analysis. # Conclusions Accessing and receiving TB services for children results in high levels of cost to households, despite the provision of free TB services. Strategies to reduce costs for TB services for children need to address social protection measures or explore decentralisation. **Registration:** https://clinicaltrials.gov/ct2/show/NCT03862261

Effect of COVID-19 on paediatric TB service delivery and patients’ comfort receiving TB services in Cameroon and Kenya during COVID: a qualitative assessment

Background The outbreak of COVID-19 has caused a setback to the gains achieved in tuberculosis (TB) control by impairing TB diagnosis, delaying treatment initiation and aggravating TB deaths. This study explored the effect of COVID-19 on paediatric TB services provided through the Catalysing Paediatric TB Innovations (CaP-TB) project among caregivers of children receiving TB services and healthcare workers (HCWs) providing TB services in Cameroon and Kenya.Methods From March to September 2021, in-depth interviews (44) were conducted with caregivers whose children under 5 years had gone through TB services and programme managers (10) overseeing the CaP-TB project. Focus group discussions were conducted with HCWs (07) and community health workers (04) supporting TB care services. Transcripts were coded and analysed by using MAXQDA V.12.Results The COVID-19 pandemic has caused fear and anxiety among HCWs and caregivers. This fear was motivated by stigma related to COVID-19 and affected the ability to screen patients for TB due to the similarity of symptoms with COVID-19. The health-seeking behaviour of patients was affected, as many caregivers avoided hospitals and those accessing the facilities concealed their sickness due to fear of testing positive or being vaccinated. In addition, COVID-19 mitigation strategies implemented by both government and health facilities to curb the spread of the virus limited patient access to paediatric healthcare services. These included temporary closure of health facilities due to COVID-19 infections among staff, transfer of services to other spaces, spacing out patient appointments and reduced time spent with patients.Conclusions The outbreak of COVID-19 has induced fear and stigma that affected patients’ health-seeking behaviour and provider attitudes towards paediatric TB service delivery. In addition, facility and governmental measures put in place to mitigate COVID-19 impact negatively affected paediatric service delivery. Training for health personnel, timely provision of personal protective equipments and appropriate communication strategies could help mitigate COVID-19 impact on paediatric TB service delivery