Epidemiological Studies on Proteeae Isolates from Clinical Specimens in the Laquintinie Hospital in Douala, Cameroon

The tribe Proteeae is a group of bacteria within the family Enterobacteriaceae and is responsible for most cases of nosocomial infections in hospital settings. The objective of this study was to determine the prevalence of members of Proteeae from clinical specimens in Laquintinie hospital in Douala. Specimens were collected from patients and screened for Proteeae using standard microbiological and biochemical methods (API 20 Enterobacteriaceae gallery). Of the 3414 clinical specimens made of 2712 urine, 264 blood, 243 CSF and 195 wounds and burns, 1136 (33.3%) yielded a positive bacterial growth, of which 230 (20.2%) were Gram positive and 906 (79.7%) were Gram negative. 164 (14.4%) isolates were identified as members of Proteeae of which 110 (67.1%) were from urine, 37( 22.6%) from wounds and burns, 10(6.1%) from blood and 7( 4.3%) from CSF. Speciation of the Proteeae isolates showed that 111 (67.7%) were Proteus mirabilis, 21(12.8%) Proteus vulgaris, 11 (6.7%) Providencia alcalifaciens, 6 (3.6%) Providencia stuartii, 4 (2.4%) Morganella morganii and 5 (3.0%) Proteus penneri and Providencia rettgeri. There was a significant difference between the type of clinical specimens and the age of patients (X2 = 52.623 p<0.05). Most Proteeae isolates where susceptible to imipemen, ceftazidine, chloramphenicol, gentamicin, nalidixic acid, ofloxacin and amikacin. These findings have significant clinical and epidemiological implications.Keywords: Proteeae isolates, Clinical specimens, Laquintinie Hospital, Cameroo

Prevalence of onchocerciasis in the Fundong Health District, Cameroon after 6 years of continuous community-directed treatment with ivermectin

Introduction: Onchocerciasis is one of the leading infectious causes of blindness affecting over 37 million people of which 99% are in Africa. The purpose of this study was to determine the prevalence of onchocerciasis in the Fundong Health District, a locality where community-directed treatment with ivermectin has been carried out for 6 consecutive years. Methods: Questionnaires covering participants’ identity, Rapid Epidemiological Assessment (REA) for onchocerciasis and parasitological parameters were distributed to participants. Skin snip (SS) was collected for laboratory investigation. Results: A total of 404 participants belonging to 200 households were randomly selected from the Fundong Health District, of which 134 (33.2%) were males and 270(66.8%) were females, 14 (3.5%) had microfilaredermia and 15(3.7%) had nodules. There was no significant difference in the prevalence of microfilaredermia with respect to age of participants (X2=2.749, P=0.601). There was however a statistically significant difference in the prevalence of nodule and impaired vision/eye itching (IVIE) with respect to age (X2=24.67, P<0.001). The greatest rate of infection was found among farmers (2.5%) followed by students (0.7%) and businessmen (0.25%). Conclusion: This study shows that the study area is now hypo-endemic for onchocerciasis, following 6 years of continuous treatment with ivermectin. Careful monitoring of onchocerciasis should however be continued to avoid that the area returns to its initial hyper endemicity

Toxoplasma antibodies amongst HIV/AIDS patients attending the University Teaching Hospital Yaounde in Cameroon

Toxoplasmosis is caused by an obligatory intracellular protozoon. It causes a wide range of diseases with toxoplasma encephalitis commonly encountered in HIV/AIDS patients. This work was carried out to determine the seroprevalence of toxoplasma antibodies (IgM and IgG) in HIV/AIDS patients attending the Yaoundé University Teaching Hospital (UTH) in Cameroon. Sera were collected from 133 HIV/AIDS patients at the out-patient department and the ELISA technique was employed serologically to determine toxoplasma antibodies. Of the 133 patients 83 (62.4%) were females and 59 (37.6%) were males; ninety three (69.9%) were positive for toxoplasma antibodies. Fourteen (10.8%) of the 93 of seropositive patients presented with both IgG and IgM-antibodies in their sera while fifty six (42.1%) and 8 (6.0%) were only sero-positive for toxoplasma IgG or IgM-antibody respectively This rate of infection was not dependent on the patient’s sex or age (X2=11.49, P>0.05). The data provides enough evidence to conclude that 64.7% of the positive cases were due to reactivated infection.Key words: Toxoplasmosis, HIV/AIDS, Pregnancy, Risk factors, Prevalence, Yaounde, Cameroon.doi: 10.4314/ajcem.v12i3.

Epidemiological Significance of the Colonization of Streptococcus Agalactiae in the Anorectum and Endocervix of Non-Parturients in Jos, Nigeria

Knowledge of Group B Streptococcus (GBS) carriage and infections in Africa is very scanty but few cases have been reported in Nigeria in particular. Streptococcus agalactiae has been reported to cause infections and diseases in non-parturients and adults ranging from bacteremia, osteomylitis, arthritis, and endocarditis to breast abscess among others, hence the necessity for this study. Fifty six non-pregnant women of different age groups and social status were screened for GBS in Plateau State Specialist Hospital using the Christie, Atkins and Munch-Petersen (CAMP) and hippurate hydrolysis tests. Two (3.6 %) of the 56 women were positive for GBS. The 2 isolates were all from the anorectum. The endocervix yielded no culture. The antibiogram showed that ampicillin is the drug of choice with all isolates (100%) sensitive to the drug. No statistically significant relationship was observed between the clinical and epidemiological characteristics of the patients and GBS carriage (P>0.05). This survey shows a much lower carriage proportion than that reported in Ibadan, Nigeria from non-parturients.Key words: Streptococcus agalactiae, epidemiology, anorectum, endocervix, non-parturient

The impact of health education on the prevalence of faecal-orally transmitted parasitic infections among school children in a rural community in Cameroon

Background: Faecal-orally transmitted parasites are those parasites which are spread through faecal contamination of food and drinks. Infections with these parasites are among the most common in the world being responsible for considerable morbidity and mortality, especially in children. This study was carried out to determine the impact of health education on the prevalence of faecal-orally transmitted parasitic infections among primary school children in a typical African rural community. Methods: An intervention study was conducted in two villages in the South-West Region of Cameroon. A total of 370 volunteer pupils aged between 5-15 years were enrolled in the study out of which 208 were from Kake II experimental arm) and 162 from Barombi-Kang (control arm). The research was conducted in two phases. In phase 1, stool samples were collected from all participants and analyzed using the formol-ether concentration technique and health education was given to the pupils in the experimental village but not in the control village. Phase 2 was conducted six months later during which only stool samples were collected and analyzed from both villages. Results: Before health education intervention (phase1) faecal-orally transmitted parasites were present in 106 (50.9%) stool specimens collected in Kake II and in 84 (51.5%) of those collected in Barombi-kang. The difference in prevalence between these two villages was not significant (P>0.05). After health education intervention (phase2), 56 (26.9%) stool specimens were positive for faecal-oral parasite in Kake II and 92 (54.7%) in Barombi-kang, and the difference in prevalence between these two villages was statistically significant (P0.05). The change in the prevalence of infection was significant in Kake II (50.9% vs. 26.9%, P0.05). Hence, health education applied in the experimental village was responsible for the drop in the prevalence observed, especially among pupils infected with Ascaris lumbricoides (24.9% vs. 3.4%, P=0.004) Conclusion: Health education through the framework of schools can be used as a strategy for the control of faecal-orally transmitted parasitic infections among children in African rural communities.Key words: Intestinal parasites, parasitic infections, health education, Cameroo

Knowledge and practices relating to malaria in a semi-urban area of Cameroon: choices and sources of antimalarials, self-treatment and resistance

Introduction: Malaria is a major public health problem in Sub-Saharan Africa where it kills a child under the age of five every 30 seconds. In Cameroon, malaria accounts for 40-45% of medical consultations, 57% of hospitalization days and 40% of mortality among children below 5 years. Community knowledge and practices can enhance the fight against this disease. The aim of the study was to make a local analysis of the people’s knowledge and practices relating to the choice and source of antimalarials, self-medication, malaria dosage and resistance in order to establish behavioural baseline and epidemiological determinants and their implications for malaria control. Methods: The design was a community-based cross-sectional study in a semi-urban setting. The survey consisted of 253 volunteer participants (from among 350 contacted) from different socio-demographic backgrounds to whom structured questionnaires were administered. The respondent’s consent was sought and gained and subjects who could not read or write or understand English language were communicated to in the local language. The questionnaire was administered by trained interviewers according to the schedule of the respondent. The data was analysed using SPSS. Results: Antimalarials commonly cited for malaria treatment were chloroquine (26.1%) and nivaquine (14.6%) and analgesics: panadol (23%) and paracetamol (12.3%) including native drugs (6.3%). 141(55.7%) (95% confidence interval (CI): 49.6–61.8%) participants practiced self-medication of malaria. 26.1% participants knew the correct adult malarial dosage for chloroquine or nivaquine. 125(40.4%) (95% CI: 34.4-46.7%) participants got their antimalarials from health centers, 27(10.6%) from shops, 24(9.5%) from hawkers, 23(9.1%) from the open market and 16 (6.3%) from herbalists. 66 (26.1%) (95% CI: 20.7-31.5%) participants knew the correct adult dosage for chloroquine or nivaquine treatment of malaria. 85(33.6%) (95% CI: 27.8–36.6%) participants had correct knowledge of malarial resistance. Of the 85 (33.6%) participants who had correct knowledge of antimalarial drug resistance, 52(20.6%) ascribed antimalarial drug resistance to continuous fever for a long time during treatment, 15 (5.9%) to serious fever during treatment and 18 (7.1%) when chloroquine does not stop fever. 23(27.1%) participants with correct knowledge of malarial resistance were in the 31-35 age group bracket compared with other age groups (P=0.1). There was a significant difference in correct knowledge of malarial resistance and participant’s profession (p=0.0). Conclusion: Malaria self-medication is common in Ndu but knowledge of antimalarial drug resistance is poor. Improvement in the self-treatment of malaria could be attained by providing clear information on choices of drugs for malaria treatment. Proper health information on the rational use of ant-malarial drugs must be provided in an appropriate manner to all groups of people in the society including village health workers, women associations, churches, school children, “Mngwah” opinion leaders, herbalists, health workers and chemists. Self-medication should be improved upon by giving correct information on the dosage of malaria treatment on radio, television, posters and newspapers because banning it will push many people to use it in hiding.Key words: Malaria, knowledge, practices, antimalarials, choices, sources, self-medication, resistance, Cameroo

Elimination of Leprosy as a public health problem by 2000 AD: an epidemiological perspective

Introduction: Leprosy is caused by Mycobacterium leprae and manifests as damage to the skin and peripheral nerves. The disease is dreaded because it causes deformities, blindness and disfigurement. Worldwide, 2 million people are estimated to be disabled by leprosy. Multidrug therapy is highly effective in curing leprosy, but treating the nerve damage is much more difficult. The World Health Assembly targeted to eliminate leprosy as a public health problem from the world by 2000. The objective of the review was to assess the successes of the leprosy elimination strategy, elimination hurdles and the way forward for leprosy eradication. Methods: A structured search was used to identify publications on the elimination strategy. The keywords used were leprosy, elimination and 2000. To identify potential publications, we included papers on leprosy elimination monitoring, special action projects for the elimination of leprosy, modified leprosy elimination campaigns, and the Global Alliance to eliminate leprosy from the following principal data bases: Cochrane data base of systematic reviews, PubMed, Medline, EMBASE, and the Leprosy data base. We also scanned reference lists for important citations. Key leprosy journals including WHO publications were also reviewed. Results: The search identified 63 journal publications on leprosy-related terms that included a form of elimination of which 19 comprehensively tackled the keywords including a book on leprosy elimination. In 1991, the 44th World Health Assembly called for the elimination of leprosy as a public health problem in the world by 2000. Elimination was defined as less than one case of leprosy per 10000-population. Elimination has been made possible by a confluence of several orders of opportunities: the scientific (the natural history of leprosy at the present state of knowledge), technological (multi-drug therapy and the blister pack); political (commitment of governments) and financial (support from NGOs for example the Nippon Foundation that supplies free multi-drug therapy) opportunities. Elimination created the unrealistic expectation that the leprosy problem could be solved by 2000. First, the elimination goal was not feasible in several areas which had high incidence of leprosy. Even if elimination was to be attained, significant numbers of new cases of leprosy would continue to occur and many people with physical imperfections, severe psychological, economic and social problems caused by leprosy would need continuous assistance. Extra-human reservoirs of Mycobacterium leprae, the relationship between leprosy and poverty, prevention of disabilities, lack of a reliable laboratory test to detect subclinical infection and a vaccine are also challenging issues. Conclusion: The evidence base available to inform on leprosy elimination is highly positive with the availability of multi-drug therapy blister packs. There are concerns that leprosy was not the right disease to be targeted for elimination as there are no reliable diagnostic tests to detect subclinical infection including the lack of a vaccine, extra-human reservoirs (monkeys and armadillos), increase in the burden of child cases, no good epidemiological indicator as prevalence instead of incidence is used to measure elimination. Multi-drug therapy treats leprosy very well but there is no proof that it concurrently interrupts transmission. The high social stigma, prevention of disabilities, and the relationship between leprosy and poverty are still major concerns.Key words: Leprosy, elimination, multi-drug therapy, public health, eradication, epidemiolog

The human health chapter of climate change and ozone depletion

Climate change is one of the greatest emerging threats of the 21st century. There is much scientific evidence that climate change is giving birth to direct health events including more frequent weather extremes, increase in epidemics, food and water scarcity. Indirect risks to health are related to changes in temperature and precipitation, leading to droughts and floods, which affect agricultural yields and production. In some regions of the world, these impacts compromise food security and threaten human health through the spread of infectious diseases, malnutrition, and food contamination. The health impacts of climate change constitute a major task for public health planners and policymakers because they require new techniques and approaches to deal with the complexities and uncertainties that are bound with it. The complexities related to the problem are far beyond simple epidemiologic analysis and interpretations of disease causation. There is need to strengthen existing health systems with the ability to assess health vulnerabilities and build capacity to fight health risks due to climate change. This paper explores the health impacts of climate change in humans in general, while emphasizing on the role of local government and policy makers in the control of health related hazards to climateKeywords: climate change, health impacts, policy maker

HIV-1/HIV-2 co-infection among voluntary counselling and testing subjects at a regional hospital in Cameroon

Background: HIV/AIDS is a major public health problem in Cameroon which had a prevalence of 5.1% in 2010 with 141 new infections per day. The fear of voluntary counseling and testing (VCT) is an obstacle to HIV prevention. Objectives: To determine the prevalence of HIV-1, HIV-2 and HIV-1/HIV-2 co-infection among people attending a health facility for VCT. Methods: Venous blood was collected from participants using aseptic techniques in a descriptive observational crosssectional study. DETERMINE HIV-1/2 and SD BIOLINE HIV-1/2 3.0 qualitative tests were used for the detection of HIV-1 and HIV-2 in their sera. Range and consistency checks were carried out on the data and analysed using Epi-Info. Results: Of 290 individuals tested, 78(26.9%) were positive for HIV-1 and HIV-2. Among the 78 HIV positive individuals, 62 (79.5%) had HIV-1, 1(1.3%) had HIV-2 and 15(19.2%) had concurrent HIV-1/ HIV-2. Among those infected, 57(73.1%) were females including 21(26.9%) males. Conclusion: HIV-1 is the major cause of AIDS and VCT is well accepted. Co-infection with HIV-1/HIV-2 may lead to anti-retroviral drug resistance. VCT should be encouraged so that positive cases can initiate therapy on time to stay ahead of anti-retroviral drug resistance

Environmental exposure to carcinogens in northwestern Cameroon

Background: In developing countries, 6% of deaths are due to cancer but cancer prevention is not practiced. Humans can prevent themselves from a number of workplace and environmental carcinogens. Objectives: To assess exposure to carcinogens, risky behaviours and associated preventive methods. Methods: A structured questionnaire was used to collect information on carcinogen exposure in the workplace and environment through trained field staff from volunteers after gaining informed consent. Data was analysed using SPSS. Results: Participants were exposed to recognized carcinogens and environmental hazards. Thirty-five (83.3%) [95% CI:72.0- 94.6] participants knew the carcinogen names they were exposed to. Common hygienic practices such as taking a bath and washing work dresses at the workplace, use of detergents to wash hands, and no smoking or eating at the workplace were poor. Twenty-nine (69.0%) [95% CI: 47.0 – 75.0] participants could smell the carcinogenic chemicals they use. Thirty (71.4%) [95% CI: 65.0 – 77.0] participants had been instructed in the use of protective equipment against carcinogens. Participants used preventive devices like hand gloves, laboratory coats, boots, face masks, goggles, ear plugs and respirators. Conclusions: Exposure to carcinogens is common necessitating case-control and cohort studies in this locality on cancer prevalence and incidence