Implementation of test-and-treat with doxycycline and temephos ground larviciding as alternative strategies for accelerating onchocerciasis elimination in an area of loiasis co-endemicity: the COUNTDOWN consortium multi-disciplinary study protocol

Background Onchocerciasis is a priority neglected tropical disease targeted for elimination by 2025. The standard strategy to combat onchocerciasis is annual Community-Directed Treatment with ivermectin (CDTi). Yet, high prevalence rates and transmission persist following > 12 rounds in South-West Cameroon. Challenges include programme coverage, adherence to, and acceptability of ivermectin in an area of Loa loa co-endemicity. Loiasis patients harbouring heavy infections are at risk of potentially fatal serious adverse events following CDTi. Alternative strategies are therefore needed to achieve onchocerciasis elimination where CDTi effectiveness is suboptimal. Methods/design We designed an implementation study to evaluate integrating World Health Organisation-endorsed alternative strategies for the elimination of onchocerciasis, namely test-and-treat with the macrofilaricide, doxycycline (TTd), and ground larviciding for suppression of blackfly vectors with the organophosphate temephos. A community-based controlled before-after intervention study will be conducted among > 2000 participants in 20 intervention (Meme River Basin) and 10 control (Indian River Basin) communities. The primary outcome measure is O. volvulus prevalence at follow-up 18-months post-treatment. The study involves four inter-disciplinary components: parasitology, entomology, applied social sciences and health economics. Onchocerciasis skin infection will be diagnosed by skin biopsy and Loa loa infection will be diagnosed by parasitological examination of finger-prick blood samples. A simultaneous clinical skin disease assessment will be made. Eligible skin-snip-positive individuals will be offered directly-observed treatment for 5 weeks with 100 mg/day doxycycline. Transmission assessments of onchocerciasis in the communities will be collected post-human landing catch of the local biting blackfly vector prior to ground larviciding with temephos every week (0.3 l/m3) until biting rate falls below 5/person/day. Qualitative research, including in-depth interviews and focus-group discussions will be used to assess acceptability and feasibility of the implemented alternative strategies among intervention recipients and providers. Health economics will assess the cost-effectiveness of the implemented interventions. Conclusions Using a multidisciplinary approach, we aim to assess the effectiveness of TTd, alone or in combination with ground larviciding, following a single intervention round and scrutinise the acceptability and feasibility of implementing at scale in similar hotspots of onchocerciasis infection, to accelerate onchocerciasis elimination

Demographic and socioeconomic determinants of smoking in the Biyem-Assi health district, Yaoundé, Cameroon

Background There is a rise in the trend of tobacco smoking in Cameroon. The objective of the study was to investigate the demographic and socioeconomic determinants of smoking behaviour in the population of Biyem-Assi health district thereby estimating the prevalence of smoking in the district. Methods A descriptive cross sectional study was conducted on a sample size of 510 people. Data were collected using structured questionnaires on the demographic and socioeconomic characteristics of smoking in the Biyem-Assi health district. A multiple logistic regression analysis was conducted at 95% (p<0.05) confidence interval to identify the characteristics of smoking. Results The age range for the sampled population was 18-75. The study showed smoking prevalence of 38.75%. From the multiple logistic regressions, men were more likely to smoke than women (AOR: 6.02; 95% CI: 2.24-16.17). The respondents less than or equal to 35 years were 55% less likely to smoke than those above 35 (AOR: 0.45; 95% CI: 0.22-0.93), while those working with the informal sector were more likely to engage in smoking than those of the formal sector (AOR: 2.59; 95% CI: 1.25-5.38). The respondents who had friends or relatives who smoke were more likely to smoke (AOR: 24.56; 95% CI: 8.92-67.63) and those who believed public campaigns could prevent smoking were 75% less likely to smoke (AOR: 0.26; 95% CI: 0.12-.053). The respondents who were targeted by the regulation of smoking-free public places were 83% less likely to smoke (0.17; 95% CI: 0.07-.039). Conclusions The prevalence of smoking in the Biyem-Assi health district is high. Gender, age, occupation and having friends and relatives who smoke are highly associated with smoking behaviour

Tobacco consumption patterns across gender and socioeconomic groups in Cameroon

Background Cameroon has substantial prevalence of both smoking and smokeless tobacco consumption, as well as of relative weak dual consumption. Cameroon's tobacco consumption appears to have geographical both urban and rural influences. The gender also seems to play an important role in influencing patterns of tobacco consumption nationwide. This study analyzes the determinants of smoking and smokeless tobacco consumption in Cameroon. Methods This study uses the 2011 Cameroon Demographic and Health Survey to analyze both smoking tobacco and smokeless tobacco consumption, stratified by gender and residence (urban/rural). Multivariate logistic regression models were used to evaluate the relationship between gender-based tobacco consumption and residence (urban/rural), age, marital status, education, socioeconomic quintile, and ethnic group. Results The analysis indicates that both men and women consume two distinctly different tobacco products. Tobacco is almost exclusively consumed by large proportions of men in both urban (12,23% for smoking tobacco and 1,52% for smokeless tobacco) and rural (19,15% for smoking tobacco and 3,94% for smokeless tobacco). The prevalence of tobacco consumption is less than 1% for women in both urban and rural areas for both smoking and smokeless tobacco. Conversely, while tobacco consumption does not appear to be related to socioeconomic status for women, it is likely that both the age and economic quintile influence the tobacco consumption of men in both rural and urban areas of the country. These tobacco consumption patterns are a reflection of the different production and market distribution for smokeless tobacco and smoking tobacco in Cameroon. Conclusions Distinct geographical by urban and rural, gender and socioeconomic distribution of tobacco consumption patterns are explored in order to begin the understanding of the tobacco epidemic environment in Cameroon

Enabling and regulating private sector provision of malaria services in three districts of Western Cameroon

Includes bibliographical references (leaves 369-414).This study aims to examine the existing enabling and regulatory interventions in Cameroon, and to explore their impact on the performance of private providers of malaria services. It makes recommendations to decision-makers on the best strategies for influencing the performance of private providers of public health services in low income countries. The study’s framework involves the Ministry of Health as a principal who authorises the private sector as an agent to provide malaria services to populations, in exchange for mutually agreed rewards and in the context of specified rules. Data were collected using both qualitative and quantitative research methods. This study found that the private sector provides a substantial portion of malaria services in Cameroon. There is evidence that enabling and regulatory interventions can enhance the private sector's quantity and quality of inputs which are used for expanding coverage, improving quality of care and affordability of malaria services. These interventions can approximate the objectives of multiple stakeholders including the Ministry of Health, Medical Council, managers, clinical staff and patients, thereby addressing the principal- agent problems in the health sector. Areas of private sector activity that are particularly difficult, but critical to influence are those of overcharging, unnecessary self-referral and issues of informal providers. Enabling interventions neither compete with nor negate traditional regulations in the health sector but seek to complement regulatory mechanisms by adding value from the perspective of influencing private sector providers’ behaviour. Government needs to invest in its ability - improving capacities and governance, providing resources and logistics - to oversee the ongoing development, implementation, monitoring and revision of enabling and regulatory interventions for the private health sector. The performance of private providers appears to be more positively influenced by enabling interventions than by regulatory mechanisms. In the absence of enabling interventions it may be inappropriate to try to influence the performance of private providers through regulatory mechanisms alone. While the resources needed for enforcement of regulations are limited, enabling and regulatory interventions can be integrated in such a way that it is in the interests of the private sector to comply with regulation of health service delivery. This can reduce the level of resources needed for effective enforcement of regulation amongst private providers. This study concludes that the integration of enabling and regulatory interventions appear to be a strategic policy option for influencing the performance of private providers of malaria services in low income countries

Performance-based financing for monitoring and evaluation of health system in Cameroon

Objective: To describe the context of, types of and approaches to monitoring and evaluation and the stakeholders’ perceptions of Performance-based financing (PBF) in Cameroon. Methods: This research used secondary data, both qualitative and quantitative, from the PBF monitoring and evaluation plan, reports and documents, and information from 380 qualitative interviews of stakeholders. Data was analysed using a systematic process of triangulation of responses in tabular form to assess the contribution of PBF towards strengthening the national system of monitoring and evaluation. Descriptive statistics were presented in form of frequencies. Results: The context of decentralisation and results-based management put monitoring and evaluation at the centre of public policy actions. Performance is measured in terms of effectiveness, efficiency, equity, accountability and transparency. The expected effect of PBF is not to reinforce the monitoring and evaluation system but to increase its performance. In conception, the design of PBF relies on substantial efforts of systematic monitoring and evaluation that can strengthen the national health system. The PBF brought changes to all the organisational systems of the supply of health services according to the monitoring and evaluation objectives, which were aligned to those of the national health system and management health information. Stakeholders were positive about the resulting performance of the central tool for monitoring and evaluation of PBF. Conclusion: Several types of monitoring and evaluation are conducted in the implementation of the PBF scheme, showing great potential to strengthen the national system through the harmonisation and standardisation of indicators and norms at all levels of the national health system pyramid

ATSA synthesis : Cameroon chapter

Pre-publication copyThere are already a number of tobacco control measures in place in Cameroon, including some limited smoke-free provisions, an advertising ban and some labeling requirements. However, improved implementation and enforcement and a comprehensive national tobacco control bill remain central goals of the tobacco control community. Though Cameroon has ratified the Framework Convention on Tobacco Control (FCTC) none of the existing measures is FCTC-compliant. This country report is part of the African Tobacco Situational Analyses (ATSA) initiative

Determinants of dog owner-charged rabies vaccination in Kinshasa, Democratic Republic of Congo

<div><p>Rabies is a preventable fatal disease that causes about 61,000 human deaths annually around the world, mostly in developing countries. In Africa, several studies have shown that vaccination of pets is effective in controlling the disease. An annual vaccination coverage of 70% is recommended by the World Health Organization as a control threshold. The effective control of rabies requires vaccination coverage of owned dogs. Identification of the factors determining dog owners’ choice to vaccinate is necessary for evidence-based policy-making. However, for the Democratic Republic of Congo (DRC), the limited data on rabies vaccination coverage makes it difficult for its control and formulation of appropriate policies. A cross-sectional study was conducted in Kinshasa (Lemba commune) with dog-owning households and owned dogs as study populations. The association between dog vaccination and independent factors (household socio-demographics characteristics, dog characteristics, knowledge of rabies and location of veterinary offices/clinics) was performed with Epi-info 7. The Odds Ratio (OR) and p-value < 0.05 were used to determine levels of significance. A total of 166 households owning dogs and 218 owned dogs were investigated. 47% of the dogs had been vaccinated within one year preceding the survey which is higher than the critical coverage (25 to 40%) necessary to interrupt rabies transmission but below the 70% threshold recommended by WHO for control. The determinants of vaccination included socio-economic level of the household (OR = 2.9, p<0.05), formal education level of the dog owner (OR = 4, p<0.05), type of residence (OR = 4.6, p<0.05), knowledge of rabies disease (OR = 8.0, p<0.05), knowledge of location of veterinary offices/clinics (OR = 3.4, p<0.05), dog gender (OR = 1.6, p<0.05) and dog breed (OR = 2.1, p<0.05). This study shows that the vaccination coverage in this area can easily reach the WHO threshold if supplemented by mass vaccination campaigns.</p></div

Use of medical services and medicines attributable to type 2 diabetes care in Yaoundé, Cameroon: a cross-sectional study

Abstract Background The increasing numbers of people with type 2 diabetes (T2D) is a global concern and especially in sub-Saharan Africa, where diabetes must compete for resources with communicable diseases. Diabetes intensifies health care utilisation and leads to an increase in medical care costs. However, In Cameroon like in most developing countries, data on the impact of diabetes on the medical health system are scarce. We aimed to analyse the use of medical services and medicines attributable to T2D care in Yaoundé, Cameroon. Methods We conducted a cross-sectional study comparing the use of medical services and medicines on 500 people with T2D attending the diabetic outpatient units of three hospitals in Yaoundé and 500 people without diabetes matched for age, sex and residence. We performed multivariate logistic and quantile regressions to assess the effect of diabetes on the use of medical services and medicines and the presence of other chronic health problems. Models were adjusted for age, educational level, marital status, occupation and family income. Results Overall, the rate of use of health services was found to be greater in people with T2D than those without diabetes. People with T2D had greater odds of having an outpatient visit to any clinician (OR 97.1 [95% CI: 41.6–226.2]), to be hospitalised (OR 11.9 [95% CI: 1.6–87.9]), to take at least one medicine (OR 83.1 [37.1–185.8]) compared with people without diabetes. We also observed an association between diabetes and some chronic diseases/diabetes complications including hypertension (OR 9.2 [95% CI: 5.0–16.9]), cardiovascular diseases (OR 1.9 [95% CI: 0.8–4.9]), peripheral neuropathy (OR 6.2 [95% CI: 3.4–11.2]), and erectile dysfunction (OR 5.8 [95% CI: 2.7–12.1]). Conclusions This study showed that the presence of diabetes is associated with an increased use of health care services and medicines as well as with some chronic diseases/diabetes complications

Dog-owning households’ characteristics associated to dog rabies vaccination.

<p>Dog-owning households’ characteristics associated to dog rabies vaccination.</p

Knowledge factors associated to dog rabies vaccination.

<p>Knowledge factors associated to dog rabies vaccination.</p