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

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Neurological complications of sickle cell disease in Africa: protocol for a systematic review

INTRODUCTION: Sickle cell disease (SCD) is highly prevalent in Africa. Considered as a public health problem, it is associated with high morbidity and mortality. Neurological complications of SCD can cause significant disability with important socioeconomic and psychological impact on the patients and their families, and can even lead to death if not properly managed. There are important knowledge gaps regarding the burden of neurological complications of SCD in African populations. We propose to conduct the first systematic review to summarise the epidemiological data available on neurological complications of SCD in Africa. METHODS AND ANALYSIS: We will search PubMed, MEDLINE, EMBASE and the African Index Medicus from 1 January 1950 to 31 May 2016 for studies of neurological complications of SCD in Africa. After study selection, full-text paper acquisition, data extraction and synthesis, we will assess all studies for quality, risk of bias and heterogeneity. Appropriate methods of meta-analysis will be used to pool prevalence estimates from studies with similar features, globally and in major subgroups. This protocol complies with the 2015 Preferred Reporting Items for Systematic reviews and Meta-Analysis protocols (PRISMA-P) guidelines. ETHICS AND DISSEMINATION: The proposed study will use published data. Therefore, there is no requirement for ethical approval. This review is expected to provide relevant data to help quantify the burden of neurological complications of SCD in African populations, inform policymakers and identify further research topics. The final report of the systematic review will be published in a peer-reviewed journal and presented at conferences. REVIEW REGISTRATION NUMBER: CRD42016039574

What is the best strategy for the prevention of transfusion-transmitted malaria in sub-Saharan African countries where malaria is endemic?

The transmission of malaria by blood transfusion was one of the first recorded incidents of transfusion-transmitted infections (TTIs). Although the World Health Organization (WHO) recommends that blood for transfusion should be screened for TTIs, malaria screening is not performed in most malaria-endemic countries in sub-Saharan Africa (SSA). The transfusion of infected red blood cells may lead to severe post-transfusion clinical manifestations of malaria, which could be rapidly fatal. Ensuring that blood supply in endemic countries is free from malaria is highly problematical, as most of the donors may potentially harbour low levels of malaria parasites. Pre-transfusion screening within endemic settings has been identified as a cost-effective option for prevention of transfusion-transmitted malaria (TTM). But currently, there is no screening method that is practical, affordable and suitably sensitive for use by blood banks in SSA. Even if this method was available, rejection of malaria-positive donors would considerably jeopardize the blood supply and increase morbidity and mortality, especially among pregnant women and children who top the scale of blood transfusion users in SSA. In this context, the systematic prophylaxis of recipients with anti-malarials could constitute a good alternative, as it prevents any deferral of donor units as well as the occurrence of TTM. With the on-going programme, namely the Affordable Medicine Facility - Malaria, there is an increase in the availability of low-priced artemisinin-based combination therapy that can be used for systematic prophylaxis. It appears nonetheless an urgent need to conduct cost-benefit studies in order to evaluate each of the TTM preventive methods. This approach could permit the design and implementation of an evidence-based measure of TTM prevention in SSA, advocating thereby its widespread use in the region

Prevalence and correlates of depressive symptoms in HIV-positive patients: a cross-sectional study among newly diagnosed patients in Yaoundé, Cameroon

BACKGROUND: Depression is one of the most common neuropsychiatric complications of HIV disease, and in turn it is associated with worse HIV-related outcomes. Data on depression among HIV-infected patients in Cameroon are scarce. In this study, we report the prevalence and correlates of depressive symptoms among newly diagnosed HIV-infected patients in Yaoundé, Cameroon. METHODS: Interviews were conducted with 100 newly diagnosed HIV-infected patients at three referral hospitals of Yaoundé. Depression was assessed using the nine-item Patient Health Questionnaire (PHQ-9). A positive depression screen was defined as PHQ-9 score greater than 9. RESULTS: The overall prevalence of depressive symptoms was 63% (95% CI: 53.2 to 71.8), the majority having symptoms corresponding to moderate depression. Multiple logistic regression analysis showed that probable depressed patients were more likely than those who were not depressed to have had experience of alcohol abuse (OR: 19.03, 95% CI 3.11-375.85; p = 0.0083), and a 100 CD4 cells/mm3 fewer was associated with a 2.9 times increase of the odds of probable depression (95% CI 1.88-4.84; p < 0.0001). CONCLUSIONS: Our findings indicate a high prevalence of depressive symptoms in newly diagnosed HIV-infected patients in our setting, and their association with alcohol abuse and severe immunosuppression. This study also highlights the necessity to integrate mental health interventions into routine HIV clinical care in Cameroon

Maternal hyperglycemia during labor and related immediate post-partum maternal and perinatal outcomes at the Yaoundé Central Hospital, Cameroon

Abstract Background Data on the prevalence and complications of gestational diabetes are very scarce in Cameroon. The aim of this study was to evaluate the uptake of screening for gestational diabetes and assess the immediate post-partum outcome of hyperglycemic parturient mothers and perinatal outcome of their babies. Methods A prospective cohort study was held at the Maternity of the Yaoundé Central Hospital from March to June 2013. One hundred volunteer women in labor without overt diabetes mellitus and having fasted for 8 to 12 h were recruited. No intervention was given. A clinical examination was done and capillary glucose recorded. Parturient women were categorized into two groups (hyperglycemic and non-hyperglycemic subjects) based on glycemia results interpreted according to the International Association of Diabetes and Pregnancy Study Groups. Mothers’ clinical examination was repeated and neonates examined immediately after delivery. Perinatal outcomes associated with maternal hyperglycemia during labor were assessed using relative risks. A p value <0.05 was considered statistically significant. Results One hundred women with a mean age of 27 (SD 6) years were recruited. Of them, 22 (22 %) had already been screened for gestational diabetes at baseline. Thirty-one (31 %) were diagnosed with hyperglycemia during labor, and this condition was highly associated with macrosomia in neonates (RR = 8.9, 95 % CI 2.70–29.32; p < 0.001). Other complications associated with maternal hyperglycemia during labor were perineal tears, cesarean section, and intrauterine fetal death, though the association was not statistically significant. Conclusions The main finding of this study is that maternal hyperglycemia during labor is highly associated with macrosomia in neonates. About a third of mothers were concerned with hyperglycemia during labor, and gestational diabetes was insufficiently screened in this series

Sero-epidemiology of human immunodeficiency virus, hepatitis B and C viruses, and syphilis infections among first-time blood donors in Edéa, Cameroon

SummaryBackgroundBlood safety remains an issue of major concern in transfusion medicine in sub-Saharan Africa. Blood-borne agents such as the human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV), and Treponema pallidum are among the greatest threats to blood safety for the recipient. This study aimed to determine the seroprevalence and risk factors of HIV, HCV, HBV, and syphilis infections among first-time blood donors at the new hospital-based blood bank in Edéa, Cameroon.MethodsWe carried out a retrospective analysis of blood donor data recorded between December 2011 and May 2012 at the blood bank of the Edéa Regional Hospital. Antibodies to HIV types 1 and 2 were screened with the Determine and ImmunoComb tests. Hepatitis B surface antigen and antibodies to HCV were detected using DIASpot test strips. Syphilis was diagnosed using the Venereal Disease Research Laboratory (VDRL) test and the Treponema pallidum hemagglutination assay (TPHA).ResultsA total of 543 blood donors were included, among whom 349 (64.3%) were family replacement donors. One hundred and fifteen donors (21.2%) were infected with at least one pathogen. The overall seroprevalence rates of HIV, HBV, HCV, and syphilis were 4.1%, 10.1%, 4.8%, and 5.7%, respectively. We found a total of 26 dual infections. The most common combinations were HBV–HCV and HBV–HIV. There was a significant association between HIV and HBV infections (adjusted odds ratio (aOR) 3.46, 95% CI 1.29–9.39; p=0.014), and between HBV and HCV infections (aOR 2.81, 95% CI 1.02–10.12; p=0.036). Compared to voluntary donors, family replacement donors were significantly more infected by at least one screened pathogen (aOR 1.81, 95% CI 1.14–2.88; p=0.013), and more infected specifically by HIV (aOR 3.66, 95% CI 1.07–12.55; p=0.039) and syphilis (aOR 2.81, 95% CI 1.05–7.46; p=0.039).ConclusionsOur findings indicate that blood safety remains a major problem in Cameroon where hospital-based blood banks and family replacement donors are predominant. There is an urgent need for a national blood transfusion program in Cameroon that will establish a nationally coordinated blood transfusion service based on the principles of voluntary regular non-remunerated blood donation

Prevalence and risk factors of overweight and obesity among children aged 6–59 months in Cameroon: a multistage, stratified cluster sampling nationwide survey

BACKGROUND: Childhood obesity is one of the most serious public health challenges of the 21st century. The prevalence of overweight and obesity among children ( 2) and obesity (BMI for age > 3). Regression analyses were performed to investigate risk factors of overweight/obesity. RESULTS: The prevalence of overweight and obesity was 8% (1.7% for obesity alone). Boys were more affected by overweight than girls with a prevalence of 9.7% and 6.4% respectively. The highest prevalence of overweight was observed in the Grassfield area (including people living in West and North-West regions) (15.3%). Factors that were independently associated with overweight and obesity included: having overweight mother (adjusted odds ratio (aOR) = 1.51; 95% CI 1.15 to 1.97) and obese mother (aOR = 2.19; 95% CI = 155 to 3.07), compared to having normal weight mother; high birth weight (aOR = 1.69; 95% CI 1.24 to 2.28) compared to normal birth weight; male gender (aOR = 1.56; 95% CI 1.24 to 1.95); low birth rank (aOR = 1.35; 95% CI 1.06 to 1.72); being aged between 13-24 months (aOR = 1.81; 95% CI = 1.21 to 2.66) and 25-36 months (aOR = 2.79; 95% CI 1.93 to 4.13) compared to being aged 45 to 49 months; living in the grassfield area (aOR = 2.65; 95% CI = 1.87 to 3.79) compared to living in Forest area. Muslim appeared as a protective factor (aOR = 0.67; 95% CI 0.46 to 0.95).compared to Christian religion. CONCLUSION: This study underlines a high prevalence of early childhood overweight with significant disparities between ecological areas of Cameroon. Risk factors of overweight included high maternal BMI, high birth weight, male gender, low birth rank, aged between 13-36 months, and living in the Grassfield area while being Muslim appeared as a protective factor. Preventive strategies should be strengthened especially in Grassfield areas and should focus on sensitization campaigns to reduce overweight and obesity in mothers and on reinforcement of measures such as surveillance of weight gain during antenatal consultation and clinical follow-up of children with high birth weight. Meanwhile, further studies including nutritional characteristics are of great interest to understand the association with religion, child age and ecological area in this age group, and will help in refining preventive strategies against childhood overweight and obesity in Cameroon