Determinants of Residency Program Choice in Two Central African Countries: An Internet Survey of Senior Medical Students

Background: Central African countries have an increasing burden of disease, low specialist workforce densities, and under-resourced postgraduate medical education. The residency program choice of today’s medical students will determine specialist workforce density in the near future. This study aims to elucidate the factors that influence the choice of residency programs among medical students of two Central African countries. Methods: We designed an online questionnaire in French and English with closed-ended, open-ended, and Likert scale questions. Links to both forms were shared via the international messaging application, WhatsApp, and data were collected anonymously for one month. Respondents were sixth- and seventh-year medical students enrolled in nine Cameroonian and Congolese schools. The threshold of significance was set at 0.05 for bivariate analysis. Results: There were 149 respondents in our study, 51.7% were female, and 79.2% were from Cameroon. Almost every student (98%) expressed the wish to specialize, and a majority (77.2%) reported an interest in a residency program abroad. Preferred destinations were France (13.7%), Canada (13.2%), and the U.S.A. (11.9%). The most popular specialties were cardiology (9.4%), pediatrics (9.4%) and obstetrics and gynecology (8.7%). The choice of specialty was made based on the respondent’s perceived skills (85.9%), anticipated pay after residency (79.2%), and patient contact (79.2%). Conclusion: Understanding which specialties interest Cameroonian and Congolese medical students and the reasons for these choices can help develop better local programs

Atmospheric Pollution and Atopic Dermatitis

Atopic dermatitis is a frequent allergic dermatological disorder seen frequently in childhood. Affected patients often have a genetic predisposition and other atopic diseases like asthma, hay fever and allergic rhinitis. There are several triggering factors for atopic dermatitis among which the most recently established one is atmospheric or air pollution. The latter is due to the increased in industrialization in cities with the emission of waste products in the atmosphere as air pollutants. The role played by these pollutants in the pathogenesis of atopic dermatitis still remains largely unclear. This chapter elucidates the relationship between atmospheric pollution and atopic dermatitis

Seroprevalence of Hepatitis B and C Infections in Mokolo District Hospital, Northern Cameroon: The Value of a Screening Campaign

Background: Infections due to the hepatitis B (HBV) and hepatitis C (HCV) viruses constitute a global public health problem. Although screening of these infections remains a pivotal tool for timely detection and management of carriers, this preventive measure has been neglected in Africa. Objective: The current study determined the prevalence of hepatitis B surface antigen (HBsAg) and anti-HCV as well as their risk factors through a screening campaign organized in a rural setting in northern Cameroon. Methods: A cross-sectional analytical study was conducted during a screening campaign for viral hepatitis organized at the Mokolo District Hospital, Cameroon, from January 19, 2017 to February 27, 2017. Sociodemographic data from all consenting participants was collected and examined for signs of chronic liver disease. Participants were then screened for HBsAg and anti-HCV using a rapid diagnostic test (ACON®). Results: Of the 364 participants enrolled, 28.6% tested positive for HBsAg and 2.2% for anti-HCV. All HBsAg-positive and anti-HCV-positive individuals were asymptomatic and unaware of their infection status prior to testing. None of the socio-demographic factors assessed was associated with a positive HbsAg status. Conclusion: HBV and HCV infections are endemic in this rural health district. Participants who tested positive were apparently healthy and completely unaware of their infection status. Transmission of the hepatitis virus may be a public health concern in this district. It is recommended that community health education activities on preventive measures for HBV and HCV infections, regular screening for disease surveillance, and close follow-up of disease progression in these asymptomatic individuals be conducted

Prevalence and patterns of congenital heart diseases in Africa: a systematic review and meta-analysis protocol

Introduction: Congenital heart diseases (CHD) are common causes of cardiovascular morbidity and mortality among young children and adolescents living in Africa. Accurate epidemiological data are needed in order to evaluate and improve preventive strategies. This review aims to determine the prevalence of CHD and their main patterns in Africa. Methods and analysis: This systematic review and meta-analysis will include cross-sectional, case-control and cohort studies of populations residing inside African countries, which have reported the prevalence of CHD, confirmed by an echocardiographic examination and/or describing different patterns of these abnormalities in Africa. Relevant abstracts published without language restriction from 1 January 1986 to 31 December 2016 will be searched in PubMed, Exerpta Medica Database and online African journals as well as references of included articles and relevant reviews. Two review authors will independently screen, select studies, extract data and assess the risk of bias in each study. The study-specific estimates will be pooled through a random-effects meta-analysis model to obtain an overall summary estimate of the prevalence of CHD across studies. Clinical and statistical heterogeneity will be assessed, and we will pool studies judged to be clinically homogeneous. On the other hand, statistical heterogeneity will be evaluated by the ÷2 test on Cochrane's Q statistic. Funnel-plots analysis and Egger's test will be used to detect publication bias. Results will be presented by geographic region (central, eastern, northern, southern and western Africa). Ethics and dissemination: The current study will be based on published data, and thus ethical approval is not required. This systematic review and meta-analysis is expected to serve as a base which could help in estimating and evaluating the burden of these abnormalities on the African continent. The final report of this study will be published in a peer-reviewed journal. Trial registration number: PROSPERO CRD42016052880

Epidemiology of depressive disorders in people living with hypertension in Africa: a systematic review and meta-analysis

Objectives Better knowledge of epidemiology of depressive disorders in people living with hypertension can help to implement pertinent strategies to address its burden. The objective was to estimate the prevalence of depressive disorders and symptoms in people living with hypertension in Africa.Design Systematic review and meta-analysis.Data sources PubMed, EMBASE, African Index Medicus, African Journals OnLine were searched up to 31 January 2020, regardless of the language of publication.Eligibility criteria We included studies conducted among adult patients with hypertension (≥18 years) living in Africa and reporting the prevalence of depressive disorders and symptoms.Data extraction and synthesis Two independent investigators selected studies, extracted data and assessed the methodological quality of included studies by using the tools developed by Joanna Briggs Institute. Multivariate random-effects meta-analysis served to pool data by considering the variability between diagnostic tools used to identify patients with depressive disorders or symptoms.Results We included 11 studies with 5299 adults with hypertension. Data were collected between 2002 and 2017, from South Africa, Nigeria, Ghana, Ethiopia and Burkina Faso. The mean age varied between 50.3 years and 59.6 years. The proportion of men ranged from 28% to 54%. The adjusted prevalence of depressive disorders taking into account the variance between diagnostic tools was 17.9% (95% CI 13.0% to 23.4%). The prevalence of depressive symptoms and major depressive symptoms was 33.3% (95% CI 9.9% to 61.6%) and 7.8% (95% CI 3.0% to 14.5%), respectively. There was heterogeneity attributable to the diagnostic tools for depressive disorders and symptoms. There was no publication bias.Conclusion Notwithstanding the representativeness lack of some (sub) regions of Africa, weakening the generalisability of findings to the entire region; depressive disorders and symptoms are prevalent in people living with hypertension in Africa, indicating that strategies from clinicians, researchers and public health makers are needed to reduce its burden in the region

COVID-19 and dentistry in sub-Saharan Africa: an urgent need to strengthen preventive measures in oral health care settings.

To the editors of the Pan African Medical Journal, In December 2019, a new virus causing pneumonia called Severe Acute Respiratory Syndrom Coronavirus 2 (SARS-COV 2) appeared in the city of Wuhan in China. Since then, the disease named COVID-19 has spread around the world and was declared a pandemic on March 11, 2020 by the World Health Organization. As of May 10, 2020, the number of cases is estimated to 3,917,366, with 274,361 associated deaths. Even if the number of cases increased gradually, Africa still remains the least affected continent with 42,626 cases to date and 1,369 deaths [...]

Corrigendum: Lifestyle and Epidemiology: Poverty and Cardiovascular Diseases a Double Burden in African Populations

Cardiovascular diseases (CVDs), ranked top non-communicable diseases (NCDs), are the second leading cause of mortality in Africa, especially in sub-Saharan Africa (SSA) where they account for 73·4% global deaths and 80% of all premature deaths yearly. The ill-health due to CVDs in SSA is equivalent to the combined burden due to communicable, maternal, neonatal and nutritional diseases. Un-addressed, it is extrapolated that the Sustainable Development Goal 3.4 which targets NCDs will not be achieved. The preponderance of CVDs in SSA is due to determinants such as the epidemiological transition of diseases, aging, stress, illiteracy, poor health systems and poverty. This is quite worrisome for SSA dubbed “one of the most poverty stricken region on the globe”. As such, poverty in Africa may adversely affect CVDs, but this has been less examined. This chapter explores the impact of poverty on CVDs and healthcare systems related to CVDs in Africa

Global prevalence and incidence of surgical site infections after appendectomy: a systematic review and meta-analysis protocol.

Acute appendicitis is a surgical emergency and the most frequent aetiology of acute surgical abdominal pain in developed countries. Universally, its widely approved treatment is appendectomy. Like all surgical procedures, appendectomy can be associated with many complications among which are surgical site infections (SSIs).Despite the increasing number of appendectomies done around the world and the associated morbidities related to SSI after appendectomy, there is still scarcity of data concerning the global epidemiology of SSI after appendectomy. The current review aims at providing a summary of the published data on epidemiology of SSI after appendectomy. We will include randomised controlled trials, cohort studies, case-control and cross-sectional studies. Electronic databases including Embase, MEDLINE and ISI Web of Science (Science Citation Index) will be searched for relevant abstracts of studies published between 1 January 2000 and 30 December 2017, without language restriction. The review will be reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. After screening of abstracts, study selection, data extraction and assessment of risk of bias, we shall assess the studies individually for clinical and statistical heterogeneity. Appropriate meta-analytic techniques will then be used to pool studies judged to be clinically homogenous. Visual inspection of funnel plots and Egger's test will be used to detect publication bias. Results will be presented by country and continent. Since primary data are not collected in this study, ethical approval is not required. This review is expected to provide relevant data to help in quantifying the global burden of SSI after appendectomy. The final report will be published in a peer-reviewed journal. CRD42017075257

Sickle cell disease, sickle trait and the risk for venous thromboembolism: a systematic review and meta-analysis

Background Globally, sickle cell disease (SCD) is one of the most common haemoglobinopathy. Considered a public health problem, it leads to vessel occlusion, blood stasis and chronic activation of the coagulation system responsible for vaso-occlussive crises and venous thromboembolism (VTE) which may be fatal. Although contemporary observational studies suggest a relationship between SCD or sickle trait (SCT) and VTE, there is lack of a summary or meta-analysis data on this possible correlation. Hence, we propose to summarize the available evidence on the association between SCD, SCT and VTE including deep vein thrombosis (DVT) and pulmonary embolism (PE). Methods We searched PubMed and Scopus to identify all cross-sectional, cohort and case-control studies reporting on the association between SCD or SCT and VTE, DVT or PE in adults or children from inception to April 25, 2017. For measuring association between SCD or SCT and VTE, DVT, or PE, a meta-analysis using the random-effects method was performed to pool weighted odds ratios (OR) of risk estimates. Results From 313 records initially identified from bibliographic databases, 10 studies were eligible and therefore included the meta-analysis. SCD patients had significantly higher risk for VTE (pooled OR 4.4, 95%CI 2.6–7.5, p < 0.001), DVT (OR 1.1, 95% CI 1.1–1.2, p < 0.001) and PE (pooled OR 3.7, 95% CI 3.6–3.8, p < 0.001) as compared to non SCD-adults. A higher risk of VTE (OR 33.2, 95% CI 9.7–113.4, p < 0.001) and DVT (OR 30.7, 95% CI 1.6–578.2, p = 0.02) was found in pregnant or postpartum women with SCD as compared to their counterparts without SCD. Compared to adults with SCT, the risk of VTE was higher in adults with SCD (pooled OR 3.1, 95% CI 1.8–5.3, p < 0.001), and specifically in SCD pregnant or postpartum women (OR 20.3, 95% CI 4.1–102, p = 0.0003). The risk of PE was also higher in adults with SCD (OR 3.1, 95% CCI 1.7–5.9, p = 0.0004) as compared to those with SCT. The risk of VTE was higher in individuals with SCT compared to controls (pooled OR 1.7, 95% CI 1.3–2.2, p < 0.0001), but not in pregnant or postpartum women (OR 0.9, 95% CI 0.3–2.9, p = 0.863). Compared to controls, SCT was associated with a higher risk of PE (pooled OR 2.1, 95% CI 1.2–3.8, p = 0.012) but not of DVT (pooled OR 1.2, 95% CI 0.9–1.7, p = 0.157). Conclusion Individuals with SCD, especially pregnant or postpartum women, might have a higher risk of VTE compared to the general population. SCT might also increases the risk of VTE. However, currently available data are not sufficient to allow a definite conclusion. Further larger studies are needed to provide a definitive conclusion on the association between SCD, SCT and VTE

Severe clinical immunodeficiency in a patient with human immunodeficiency virus infection and relatively high CD4 counts: a case report.

The coexistence of neuromeningeal cryptococcosis and Kaposi's sarcoma is not surprising in a patient with human immunodeficiency virus infection and a low CD4 count, although it is rarely described. However, we describe such an association in a patient with human immunodeficiency virus infection and a relatively high CD4 count. A 41-year old Cameroonian woman presented to our hospital with subacute occipital headaches associated with photophobia, blurred vision, phonophobia, projectile vomiting, and tonic seizures. In her past history, there was an human immunodeficiency virus infection known for 12 years, for which she had been taking (with good compliance) tenofovir-lamivudine-efavirenz-based antiretroviral therapy for the same period of time. One month before the consultation, gastric Kaposi's sarcoma had been diagnosed, justifying the treatment with doxorubicin she had received. A clinical examination was unremarkable. A computed tomography scan of her brain was normal, and cerebrospinal fluid analysis revealed Cryptococcus neoformans. Her CD4 count was 353/mm. Orally administered antifungal treatment with fluconazole (1200 mg/day) and flucytosine (1500 mg × 4/day) was started immediately, but she died on the sixth day of this treatment. This clinical case shows that the coexistence of neuromeningeal cryptococcosis and gastric Kaposi's sarcoma is possible in all patients with human immunodeficiency virus infection, regardless of CD4 count