HIV testing, HIV status and outcomes of treatment for tuberculosis in a major diagnosis and treatment centre in Yaounde, Cameroon: a retrospective cohort study

BACKGROUND:Human immuno-deficiency virus (HIV) infection and tuberculosis are common and often co-occurring conditions in sub-Saharan Africa (SSA). We investigated the effects of HIV testing and HIV status on the outcomes of tuberculosis treatment in a major diagnosis and treatment centre in Yaounde, Cameroon. METHODS: Participants were 1647 adults with tuberculosis registered at the Yaounde Jamot's Hospital between January and December 2009. Multinomial logistic regression models were used to relate HIV testing and HIV status to the outcomes of tuberculosis treatment during follow-up, with adjustment for potential covariates. RESULTS: Mean age of participants was 35.5 years (standard deviation: 13.2) and 938 (57%) were men. Clinical forms of tuberculosis were: smear-positive (73.8%), smear-negative (9.4%) and extra-pulmonary (16.8%). Outcomes of tuberculosis treatment were: cure/completion (68.1%), failure (0.4%), default (20.1%), death (5.2%) and transfer (6.3%). Using cure/completion as reference, not testing for HIV was associated with adjusted odds ratio of 2.30 (95% confidence interval: 1.65-3.21), 2.26 (1.29-3.97) and 2.69 (1.62-4.46) for the risk of failure/default, death and transfer respectively. The equivalents for a positive test among those tested (1419 participants) were 1.19 (0.88-1.59), 6.35 (3.53-11.45) and 1.14 (0.69-1.86). CONCLUSIONS: Non-consent for HIV testing in this setting is associated with all unfavourable outcomes of tuberculosis treatment. However been tested positive was the strongest predictor of fatal outcome. Efforts are needed both to improve acceptance of HIV testing among patients with tuberculosis and optimise the care of those tested positive

Thoracocentèse versus drainage thoracique percutané dans le traitement des empyèmes thoraciques non tuberculeux de grande abondance: étude prospective et comparative préliminaire

Introduction: L'objectif de ce travail était de comparer l'efficacité de la thoracocentèse répétée versus le drainage thoracique percutané chez les malades adultes souffrant d'empyème thoracique de grande abondance. Méthodes: Dans cette étude prospective et comparative, 32 patients adultes atteints d'empyèmes thoraciques de grande abondance, répartis en 12 patients dans le groupe thoracocentèse répétée et 20 patients dans le groupe drainage thoracique percutané ont été inclus. Le principal critère de comparaison était la proportion de patients des deux groupes qui étaient décédés dans le service ou transférés en chirurgie (évolution défavorable). Les critères sécondaires de comparaison étaient la durée d'hospitalisation et les complications liées à chacune de ces deux techniques. Résultats: Les caractéristiques des malades à l'entrée étaient superposables dans les deux groupes. L'évolution défavorable était notée chez 3(25%) malades du groupe thoracocentèse et chez 5(25%) malades du groupe drainage thoracique (P=1,000). L'échec de la thoracocentèse était noté dans 3 cas et l'échec du drainage thoracique dans 4 cas. Un (5%) patient était décédé dans le groupe drainage et aucun patient n'était décédé dans le groupe thoracocentèse. La durée moyenne d'hospitalisation était de 31,7±22,7 jours chez les patients traités par thoracocentèse versus 29,4±16,7 jours chez les patients traités par drainage thoracique (P=0,768). Les complications liées à ces techniques étaient retrouvées chez 4(20%) malades traités par drainage et chez 1(8,3%) malade traité par thoracocentèse (P= 0,626). Conclusion: La thoracocentèse répétée et le drainage thoracique percutané paraissent avoir un taux d'échec et de complications similaire dans le traitement des empyèmes pleuraux de grande abondance.Pan African Medical Journal 2012; 13:1

Sensitisation to Blattella germanica among adults with asthma in Yaounde, Cameroon: a cross-sectional study

BACKGROUND: German cockroach or Blattella germanica is commonly found in homes across the inter-tropical region. The contribution of sensitisation to Blattella germanica in people with asthma in sub-Saharan Africa has not received attention. The aim of this study was to assess the prevalence and investigate the predicting factors of sensitisation to Blattella germanica in patients with asthma in Yaounde, Cameroon. METHODS: This was a cross-sectional study conducted between January 2012 and June 2013. All patients (aged 15years and above) with asthma, receiving care at the Yaounde Jamot Hospital and the CEDIMER medical practice during the study period and who had received a prick skin testing for perennial aeroallergens were included in the study. RESULTS: The final sample comprised 184 patients including 123 (66.8%) women. The median age (25th-75th percentiles) was 38 (24-54) years. Prick skin test for Blattella germanica was positive in 47 (25.5%) patients. Sensitisation to Blattella germanica was associated with a sensitisation to mite in 41 (87.2%) patients, a sensitisation to Alternaria in 18 (38.3%) patients, and a sensitisation to cat or dog dander in 7 (14.9%) patients. Independent predicting factors of a sensitisation to Blattella germanica were the sensitisation to Blomia tropicalis [adjusted odd ratio (95% confidence interval) 4.10 (1.67-10.04), p=0.002] and sensitisation to Alternaria [3.67 (1.53-7.46), p=0.003]. CONCLUSIONS: Sensitisation to Blattella germanica is present in about a quarter of adult patients with asthma in Yaounde. Sensitisation to Alternaria and Blomia tropicalis appears to be a powerful predicting factor of sensitisation to Blattella germanica in this setting

First-line antiretroviral therapy and dyslipidemia in people living with HIV-1 in Cameroon: a cross-sectional study

<p>Abstract</p> <p>Background</p> <p>Data on lipid profile derangements induced by antiretroviral treatment in Africa are scarce. The aim of this study was to determine the prevalence and characteristics of lipid profile derangements associated with first-line highly active antiretroviral therapy (ART) among Cameroonians living with human immunodeficiency virus (HIV) infection.</p> <p>Methods</p> <p>This cross-sectional study was conducted between November 2009 and January 2010, and involved 138 HIV patients who had never received ART (ART-naive group) and 138 others treated for at least 12 months with first line triple ART regimens that included nevirapine or efavirenz (ART group). Lipid profile was determined after overnight fast and dyslipidemia diagnosed according to the US National Cholesterol Education Program III criteria. Data comparison used chi-square test, Student t-test and logistic regressions.</p> <p>Results</p> <p>The prevalence of total cholesterol ≥ 200 mg/dl was 37.6% and 24.6% respectively in ART group and ART-naive groups (p = 0.019). The equivalents for LDL-cholesterol ≥ 130 mg/dl were 46.4% and 21% (p ≤ 0.001). Proportions of patients with total cholesterol/HDL-cholesterol ratio ≥ 5 was 35.5% in ART group and 18.6% in ART-naive group (p ≤ 0.001). The distribution of HDL-cholesterol and triglycerides was similar between the two groups. In multivariable analysis adjusted for age, sex, body mass index, CD4 count and co-infection with tuberculosis, being on ART was significantly and positively associated with raised total cholesterol, LDL-cholesterol and TC/HDL cholesterol. The adjusted odd ratios (95% confidence interval, p-value) ART-treated vs. ART-naïve was 1.82 (1.06-1.12, p = 0.02) for TC ≥ 200 mg/dl; 2.99 (1.74-5.15), p < 0.0001) for LDL-cholesterol ≥ 130 mg/dl and 1.73 (1.04-2.89, p = 0.03) for TC/HDL-cholesterol ≥ 5.</p> <p>Conclusions</p> <p>First-line antiretroviral therapy that includes nonnucleoside reverse transcriptase inhibitors is associated with pro-atherogenic adverse lipid profile in people with HIV-1 infection compared to untreated HIV-infected subjects in Yaounde. Lipid profile and other cardiovascular risk factors should be monitored in patients on such therapy so that any untoward effects of treatments can be optimally managed.</p

Assessment of asthma control using asthma control test in chest clinics in Cameroon: a cross-sectional study

Introduction: The goal of asthma treatment is to obtain and maintain a good control of symptoms. Investigating factors associated with inadequately control asthma could help in strategies to improve asthma control. This study aimed to determine the prevalence and factors associated with inadequately controlled asthma in asthma patients under chest specialist care. Methods: A cross-sectional study was conducted from November 2012 to May 2013. Physician-diagnosed asthma patients aged 12 years and above were included. A questionnaire was used to collect demographic data, comorbidities, and medical history of asthma. Asthma control was assessed using the Asthma Control Test (ACT), with a score less than 20 for inadequately controlled asthma and a score greater or equal to 20 for controlled asthma. A multivariate analysis was used to identify factors associated with inadequately controlled asthma. Results: Overall, 243 patients were included in this study. Asthma was controlled in 141 patients (58%) and inadequately controlled in 102 (42%). The mean duration of asthma was 8 years with an interquartile range of 4 and 18 years. Forty-three participants (17.7%) were not under any controller medication while the mean ACT score was 19.3 ± 4.6. Independent associations were found between inadequately controlled asthma and female gender (OR 1.91; 95% CI 1.06-3.47) and obesity (OR 1.81; 1.01-3.27). Conclusion: Asthma remains poorly controlled in a large proportion of asthma patients under specialist care in Cameroon. Educational programs for asthma patients targeting women and based on weight loss for obese patients may help in improving the control of asthma.Pan African Medical Journal 2016; 2

Evaluation of factors affecting adherence to asthma controller therapy in chest clinics in a sub-Saharan African setting: a cross-sectional study

Background: Adherence to controller therapy in asthma is a major concern during the management of the disease.Objective: To determine the adherence rate and identify the predictors of low adherence to asthma controller therapy.Methods: A cross-sectional study including asthma patients was conducted from November 1, 2012 to May 31, 2013 in 4 chest clinics in Cameroon. The adherence to asthma treatment was rated using Morisky Medication Adherence Scale. A multivariate logistic regression analysis was performed for the identification of factors associated with adherence to asthma treatment.Results: Among the 201 asthma patients included, 133 (66.2%) were female. The mean age of participants was 41.2 years. Sixty-one (30.3%) of the patients did not visit the chest physician during the last year prior to the study. Asthma was well controlled in 118 patients (58.7%). The prevalence of low adherence rate to asthma controller therapy was 44.8% and the absence of any chest specialist visit within the last 12 months was the only factor associated with the low adherence rate to asthma treatment (OR 5.57 ; 95% CI 2.84–10.93).Conclusion: The adherence rate to asthma controller therapy in Cameroon is low and it could be improved if scheduled visits are respected by patients.Keywords: Allergy, medication adherence, Afric

Psychiatric comorbidity and psychosocial stressors among people initiating HIV care in Cameroon

BACKGROUND: Psychiatric comorbidity, the presence of two or more mental health disorders, has been associated with suboptimal HIV treatment outcomes. Little is known about the prevalence of psychiatric comorbidity among people with HIV (PWH) in sub-Saharan Africa. METHODS: We conducted interviews with PWH initiating HIV care in Cameroon between June 2019 and March 2020. Depression, anxiety, post-traumatic stress disorder (PTSD), and harmful drinking were dichotomized to represent those with and without symptoms of each. Psychiatric comorbidity was defined as having symptoms of two or more disorders assessed. Moderate or severe household hunger, high anticipatory HIV-related stigma, low social support, and high number of potentially traumatic events were hypothesized as correlates of psychiatric comorbidity. Bivariable log binomial regression models were used to estimate unadjusted associations between psychosocial stressors and psychiatric comorbidity. RESULTS: Among 424 participants interviewed, the prevalence of psychiatric comorbidity was 16%. Among those with symptoms of at least one mental health or substance use disorder (n = 161), the prevalence of psychiatric comorbidity was 42%. The prevalence of psychiatric comorbidity was 33%, 67%, 76%, and 81% among those with symptoms of harmful drinking, depression, anxiety, and PTSD, respectively. Among individuals with symptoms of a mental health or substance use disorder, a high number of potentially traumatic events (prevalence ratio (PR) 1.71 [95% CI 1.21, 2.42]) and high anticipatory HIV-related stigma (PR 1.45 [95% CI 1.01, 2.09]) were associated with greater prevalence of psychiatric comorbidity. CONCLUSION: Psychiatric comorbidity was common among this group of PWH in Cameroon. The effectiveness and implementation of transdiagnostic or multi-focus mental health treatment approaches in HIV care settings should be examined

Incidence and predictors of death among adult patients treated for tuberculosis in two regions of Cameroon: 2010 to 2015

Objectives: Mortality during tuberculosis (TB) remains high in Africa. The purpose of our study was to determine the incidence and predictors of death during TB treatment in Cameroon.Materials and Methods: Data of subjects aged ≥15 years were retrospectively extracted from registers in all TB diagnostic and treatment centers in the Western and Northern regions of Cameroon from 2010 to 2015. Cox regression models were used to determine predictors of death during TB treatment.Results: Of the 19,681 patients included, 12,541 (63.7%) were male and their median age (25th-75th percentile) was 34 (26–45) years. The cumulative incidence (95% confidence interval [CI]) of death during TB treatment was 8.0% (7.5–8.5%). The predictors (hazard ratios [95% CI]) of death were: Age &gt;34 years (1.479 [1.295–1.688], P &lt; 0.001), female sex (1.471 [1.286–1.683], P &lt; 0.001), extra-pulmonary TB (1.723 [1.466–2.026], P &lt; 0.001), human immunodeficiency virus infection (3.739 [3.269–4.276], P &lt; 001]), TB treatment in the Western region (2.241 [1.815–2.768], P &lt; 0.001), treatment before 2012 (1.215 [1.073–1.376], P = 0.002)and low body weight (1st quartile and 2nd quartile) (2.568 [2.133–3.092], [P &lt; 0.001]) and (1.569 [1.298–1.896], P &lt; 0.001) respectively.Conclusion: The incidence of death during TB was relatively high in the Western and Northern regions of Cameroon. Recognition of these persons at greatest risk may improve care and reduce death durinng TB treatment

Prevalence of potentially traumatic events and symptoms of depression, anxiety, hazardous alcohol use, and post-traumatic stress disorder among people with HIV initiating HIV care in Cameroon

BACKGROUND: This study explored the relationship between specific types of potentially traumatic events (PTEs) and symptoms of mental health disorders among people with HIV (PWH) in Cameroon. METHODS: We conducted a cross-sectional study with 426 PWH in Cameroon between 2019-2020. Multivariable log binominal regression was used to estimate the association between exposure (yes/no) to six distinct types of PTE and symptoms of depression (Patient Health Questionnaire-9 score \u3e 9), PTSD (PTSD Checklist for DSM-5 score \u3e 30), anxiety (Generalized Anxiety Disorder-7 scale score \u3e 9), and hazardous alcohol use (Alcohol Use Disorders Identification Test score \u3e 7 for men; \u3e 6 for women). RESULTS: A majority of study participants (96%) reported exposure to at least one PTE, with a median of 4 PTEs (interquartile range: 2-5). The most commonly reported PTEs were seeing someone seriously injured or killed (45%), family members hitting or harming one another as a child (43%), physical assault or abuse from an intimate partner (42%) and witnessing physical assault or abuse (41%). In multivariable analyses, the prevalence of PTSD symptoms was significantly higher among those who reported experiencing PTEs during childhood, violent PTEs during adulthood, and the death of a child. The prevalence of anxiety symptoms was significantly higher among those who reported experiencing both PTEs during childhood and violent PTEs during adulthood. No significant positive associations were observed between specific PTEs explored and symptoms of depression or hazardous alcohol use after adjustment. CONCLUSIONS: PTEs were common among this sample of PWH in Cameroon and associated with PTSD and anxiety symptoms. Research is needed to foster primary prevention of PTEs and to address the mental health sequelae of PTEs among PWH