Prognostic models for the clinical management of malaria and its complications: a systematic review

Objective Malaria infection could result in severe disease with high mortality. Prognostic models and scores predicting severity of infection, complications and mortality could help clinicians prioritise patients. We conducted a systematic review to assess the various models that have been produced to predict disease severity and mortality in patients infected with malaria. Design A systematic review. Data sources Medline, Global health and CINAHL were searched up to 4 September 2019. Eligibility criteria for selecting studies Published articles on models which used at least two points (or variables) of patient data to predict disease severity; potential development of complications (including coma or cerebral malaria; shock; acidosis; severe anaemia; acute kidney injury; hypoglycaemia; respiratory failure and sepsis) and mortality in patients with malaria infection. Data extraction and synthesis Two independent reviewers extracted the data and assessed risk of bias using the Prediction model Risk Of Bias Assessment Tool. Results A total of 564 articles were screened and 24 articles were retained which described 27 models/ scores of interests. Two of the articles described models predicting complications of malaria (severe anaemia in children and development of sepsis); 15 articles described original models predicting mortality in severe malaria; 3 articles described models predicting mortality in different contexts but adapted and validated to predict mortality in malaria; and 4 articles described models predicting severity of the disease. For the models predicting mortality, all the models had neurological dysfunction as a predictor; in children, half of the models contained hypoglycaemia and respiratory failure as a predictor meanwhile, six out of the nine models in adults had respiratory failure as a clinical predictor. Acidosis, renal failure and shock were also common predictors of mortality. Eighteen of the articles described models that could be applicable in reallife settings and all the articles had a high risk of bias due to lack of use of consistent and up-to-date methods of internal validation. Conclusion Evidence is lacking on the generalisability of most of these models due lack of external validation. Emphasis should be placed on external validation of existing models and publication of the findings of their use in clinical settings to guide clinicians on management options depending on the priorities of their patients

Cutaneous onchocerciasis in Dumbu, a pastoral area in the North-West region of Cameroon: diagnostic challenge and socio-economic implications

Onchocerciasis is a severe parasitic infestation caused by Onchocerca volvulus which causes disabling skin and subcutaneous tissue changes and ultimately leads to blindness. It has a huge public health impact due to its socioeconomic burden and the vast number of people it affects in developing countries. In this case, a 60 years old woman was encountered with leopard skin like changes, rashes and pruritus on the left leg; which had been managed as cutaneous mycosis for over a period of 8 years. A diagnosis of onchocerciasis was finally made after a skin snip identified onchocercal microfilariae. The above case shows that onchocerciasis is still a neglected tropical disease (NTD) in Cameroon. This emphasizes the need for more expansive outreach programs in remote areas in Cameroon, a change in health policies to ensure the eradication of this disabling disease and health promotion amongst vulnerable populations.Key words: Onchocerciasis, neglected tropical disease, blindness, Dumbu, Cameroo

Identifying risk factors for the development of sepsis during adult severe malaria.

BACKGROUND: Severe falciparum malaria can be compounded by bacterial sepsis, necessitating antibiotics in addition to anti-malarial treatment. The objective of this analysis was to develop a prognostic model to identify patients admitted with severe malaria at higher risk of developing bacterial sepsis. METHODS: A retrospective data analysis using trial data from the South East Asian Quinine Artesunate Malaria Trial. Variables correlating with development of clinically defined sepsis were identified by univariable analysis, and subsequently included into a multivariable logistic regression model. Internal validation was performed by bootstrapping. Discrimination and goodness-of-fit were assessed using the area under the curve (AUC) and a calibration plot, respectively. RESULTS: Of the 1187 adults with severe malaria, 86 (7.3%) developed clinical sepsis during admission. Predictors for developing sepsis were: female sex, high blood urea nitrogen, high plasma anion gap, respiratory distress, shock on admission, high parasitaemia, coma and jaundice. The AUC of the model was 0.789, signifying modest differentiation for identifying patients developing sepsis. The model was well-calibrated (Hosmer-Lemeshow Chi squared = 1.02). The 25th percentile of the distribution of risk scores among those who developed sepsis could identify a high-risk group with a sensitivity and specificity of 70.0 and 69.4%, respectively. CONCLUSIONS: The proposed model identifies patients with severe malaria at risk of developing clinical sepsis, potentially benefiting from antibiotic treatment in addition to anti-malarials. The model will need further evaluation with more strictly defined bacterial sepsis as outcome measure

Takayasu's arteritis in an adult female from Cameroon: diagnosis via Doppler echocardiography

No abstract available

Burnout as a predictor of depression: a cross-sectional study of the sociodemographic and clinical predictors of depression amongst nurses in Cameroon

Background: Depression is a debilitating mental health condition which affects an estimated 350 million people worldwide annually. Nurses are twice as likely to suffer from depression than professionals in other professions. This leads to a considerable loss of efficiency and productivity. We sought to determine the prevalence and predictors of depression among nurses in Cameroon. Methods: Cross-sectional analysis carried out over 6 months (January – June 2018) using nurses from public and private healthcare institutions sampled consecutively in the two English-speaking regions (North west and South west regions) of Cameroon. The nurses were handed a structured, printed, self-administered questionnaire to fill and hand in at their earliest convenience. Depression and burnout were assessed using the Patient Health Questionnaire – 9 and the Oldenburg Burnout Inventory respectively. Results: A total of 143 nurses were recruited (mean age: 29.75 ± 6.55 years; age range: 20–55 years, 32.87% male). The overall prevalence of depression was 62.24%. Independent predictors of depression after multivariable analysis were: Number of night shifts a week (adjusted odds ratio: 1.58; p value: 0.045, 95% CI; 1.01, 2.48) and Total Oldenburg Burnout Inventory score (adjusted odds ratio: 1.21, p value: 0.001; 95% CI; 1.08, 1.35). Recreational drug use was also found to perfectly predict the outcome – depression. Conclusion: Depression is highly prevalent among nurses in the English-speaking regions of Cameroon. Accurate predictors could prove vital for early detection and management of affected individuals. Predictors presented herein require further investigation via multicentric nationwide studies, to obtain more generalizable results. Keywords: Burnout syndrome, Nurses, Depression, Cameroon, Oldenburg burnout inventory, Patient health Questionnaire-

High birth weight in a suburban hospital in Cameroon:An analysis of the clinical cut-off, prevalence, predictors and adverse outcomes

BACKGROUND AND AIMS: High birth weight (HBW) increases the risk of maternal and fetal morbidity and mortality. Its prevalence and adverse outcomes may be reduced if risk factors are identified and managed during pregnancy. The cut-off value for HBW remains debatable. The objectives of this study were to identify the optimal cut-off value and determine the prevalence, predictors and adverse outcomes of HBW in a suburban area of Cameroon. DESIGN: A 6-year retrospective register analysis and a 3-month prospective phase. SETTING: A secondary care level (regional) hospital in the city of Buea (southwest region of Cameroon). PARTICIPANTS: Women who delivered in this hospital over a 6-year period (retrospective phase) and consenting pregnant mothers and their infants (singletons, born at >28 weeks gestation) (prospective phase). OUTCOME MEASURES: 90th centile of birth weights; prevalence of HBW defined as birth weight above the 90th centile; sociodemographic, maternal and obstetrical factors associated with HBW; maternal and neonatal adverse outcomes of HBW. RESULTS: Of the 4941 newborns reviewed in registers, the 90th centile of birth weights was 3850 g. Using this new cut-off, we obtained a prevalence of 14.0% for HBW in the 200 newborns included in the prospective phase. This was significantly higher than the prevalence (9.5%) yielded when the traditional cut-off of 4000 g was used (p=0.003). None of the factors assessed was independently associated with HBW. Newborns with HBW were more likely to have shoulder dystocia (p<0.01), and their mothers more likely to suffer from prolonged labour (p=0.01) and postpartum haemorrhage (p<0.01). CONCLUSIONS: The results of this study suggest that the cut-off for HBW in this population should be 3850 g. Thus, 3 of every 10 babies born with HBW in this hospital are likely not receiving optimal postnatal care because 4000 g is currently used to qualify for additional support

Current Issues in the Development of Foetal Growth References and Standards.

PURPOSE OF REVIEW: This paper discusses the current issues in the development of foetal charts and is informed by a scoping review of studies constructing charts between 2012 and 2018. RECENT FINDINGS: The scoping review of 20 articles revealed that there is still a lack of consensus on how foetal charts should be constructed and whether an international chart that can be applied across populations is feasible. Many of these charts are in clinical use today and directly affect the identification of at risk newborns that require treatment and nutritional strategies. However, there is no agreement on important design features such as inclusion and exclusion criteria; sample size and agreement on definitions such as what constitutes a healthy population of pregnant women that can be used for constructing foetal standards. SUMMARY: This paper therefore reiterates some of these current issues and the scoping review showcases the heterogeneity in the studies developing foetal charts between 2012 and 2018. There is no consensus on these pertinent issues and hence if not resolved will lead to continued surge of foetal reference and standard charts which will only exacerbate the current problem of not being able to make direct comparisons of foetal size and growth across populations

Knowledge, attitudes and practices regarding depression among primary health care providers in Fako division, Cameroon

Abstract Background Mental health and mental illness are often overlooked in the management of patients in our health services. Depression is a common mental disorder worldwide. Recognising and managing mental illnesses such as depression by primary health care providers (PHCPs) is crucial. This study describes the knowledge, attitudes and practices (KAP) of PHCPs regarding depression in Fako Division. Methods A cross-sectional study was conducted among PHCPs (general practitioners, nurses, pharmacy attendants and social workers) in public-owned health facilities in the four health districts in Fako Division. Participants were selected by a consecutive convenience sampling. A structured questionnaire including the Depression Attitude Questionnaire (DAQ) was used to collect information about their socio-demographic characteristics, professional qualifications and KAP about depression. Results The survey had a response rate of 56.7%. Most of the 226 participants (92.9%) were aware that depression needs medical intervention. Only 1.8% knew a standard tool used to diagnose depression. Two-thirds agreed that majority of the cases of depression encountered originate from recent misfortune. About 66% felt uncomfortable working with depressed patients. Also, 45.1% of PHCPs did not know if psychotropic drugs were available at pharmacies within their health area. Very few (15.2%) reported to have prescribed psychotropic drugs. Less than half (49.1%) of the participants had prior formal training in mental health. Conclusion PHCPs in Fako Division tend to have limited knowledge and poor attitudes regarding depression. Practices towards diagnosis and management of depression tend to be inadequate. There is an urgent need to train PHCPs in mental health in general and depression diagnosis and management in particular

Measles outbreak in a poorly vaccinated region in Cameroon: a case series study, public health challenges and recommendations

Measles is a highly contagious viral infection and still a leading cause of vaccine-preventable deaths in Africa; especially in unvaccinated populations. We reviewed the medical reports of the measles outbreak that occurred in Misaje, in the North west region of Cameroon from 11/03/2015 to 14/05/2015. Six measles cases were recorded during this period; three of them complicated by bacterial infections. Measles should be considered as a differential diagnosis for any febrile rash especially among poorly vaccinated populations. Primary preventive methods implemented by clinicians could help control outbreaks; especially with delays in public health intervention. Also, gaps in health policies in Cameroon should be addressed to scale up  vaccination coverage in remote communities like Misaje to reduce the incidence of measles outbreaks.Key words: Measles, outbreaks, Cameroo

Risk factors of lower limb cellulitis in a level-two healthcare facility in Cameroon: a case-control study.

BACKGROUND: Cellulitis is a common infection of the skin and subcutaneous tissues. It is associated with significant morbidity from necrosectomies and amputations especially in sub-Saharan Africa. We aimed at identifying the risk factors and burden of lower limb cellulitis to inform preventive strategies in Cameroon. METHODS: This was a hospital-based case-control study carried out in the Bamenda Regional Hospital (BRH) between September 2015 and August 2016. Cases were defined as consenting adults admitted to the surgical unit who presented with a localised area of lower limb erythema, warmth, oedema and pain, associated with fever (temperature ? 38 °C) and/or chills of sudden onset. Controls were adults hospitalised for diseases other than cellulitis, necrotising fasciitis, myositis, abscess or other variants of dermo-hypodermitis. Cases and controls were matched (1:2) for age and sex. RESULTS: Of the 183 participants (61 cases of cellulitis and 122 controls) included in the study, the median age was 52 years [Interquartile range (IQR): 32.5-74.5]. After controlling for potential confounders, obesity [adjusted odds ratio (AOR) = 4.7, 95% CI (1.5-14.7); p = 0.009], history of skin disruption [AOR = 12.4 (3.9-39.1); p < 0.001], and presence of toe-web intertrigo [AOR = 51.4 (11.7-225.6); p < 0.001] were significantly associated with cellulitis. Median hospital stay was longer (14 days [IQR: 6-28]) in cases compared to the controls (3 days [IQR: 2-7]). Among the cases, Streptococci species were the most frequent (n = 50, 82%) isolated germ followed by staphylococci species (n = 9, 15%). Patients with cellulitis were more likely to undergo necrosectomy (OR: 21.2; 95% CI: 7.6-59.2). Toe-web intertrigo had the highest (48.9%) population attributable risk for cellulitis, followed by history of disruption of skin barrier (37.8%) and obesity (20.6%). CONCLUSION: This study showed a high disease burden among patients with cellulitis. While risk factors identified are similar to prior literature, this study provides a contextual evidence-base for clinicians in this region to be more aggressive in management of these risk factors to prevent disease progression and development of cellulitis