The burden of leprosy in Cameroon: fifteen years into the post-elimination era

Cameroon achieved the elimination target of leprosy in 2000, and has maintained this status ever since. However, a number of health districts in the country continue to report significant numbers of leprosy cases. The aim of this study was to assess the burden of leprosy in Cameroon from 2000 to 2014.; We obtained and analysed using the new leprosy burden concept of analysis, leprosy surveillance data collected between 2000 and 2014 from the National Leprosy Control Programme.; Cameroon achieved leprosy elimination in 2000, registering a prevalence rate of 0.94/10,000 population. The prevalence rate dropped further to reach 0.20/10,000 population (78% reduction) in 2014. Similarly, the new case detection rate dropped from 4.88/100,000 population in 2000 to 1.46/100,000 population (85.3% reduction) in 2014. All 10 regions of the country achieved leprosy elimination between 2000 and 2014; however, 10 health districts were still to do so by 2014. The number of high-leprosy-burden regions decreased from 8 in 2000 to 1 in 2014. Seven and two regions were respectively medium and low-burdened at the end of 2014. At the health districts level, 18 remained at the high-leprosy-burdened level in 2014.; The leprosy prevalence and detection rates as well as the overall leprosy burden in Cameroon have dropped significantly between 2000 and 2014. However, a good number of health districts remain high-leprosy-burdened. The National Leprosy Control Programme should focus efforts on these health districts in the next coming years in order to further reduce the burden of leprosy in the country

Spectre des maladies cérébro-vasculaires chez le sujet jeune à Douala

Introduction: Les accidents vasculaires cérébraux (AVC) constituent la seconde cause de mortalité dans le monde. Au Cameroun, les AVC du sujet jeune ne sont pas étudiés. L’objectif de ce travail était de déterminer la proportion des AVC du sujet jeune, les facteurs de risque cérébrovasculaire (FRCV) et de rechercher les facteurs prédictifs de décès intra-hospitalier à l’Hôpital Général de Douala (HGD). Méthodes: Il s’agissait d’une étude de cohorte prospective menée à l’HGD pendant une durée de 5 ans incluant les sujets âgés de 15 à 45 ans ayant fait un AVC confirmé par imagerie cérébrale. L’analyse univariée avait permis de déterminer les facteurs associés au décès et les facteurs ayant un p = 0,200 avaient été inclus pour l’analyse multivariée afin de déterminer les facteurs prédictifs de décès intra-hospitaliers. Résultats: 511 patients avaient été admis pour AVC dont 78 sujets jeunes (15,26%). Le sexe masculin était majoritaire (62,8%) et l’âge moyen des patients était de 38,36 ± 5,83 ans. L’hypertension artérielle (74,35%), l’alcoolisme (38,46%), les dyslipidémies (14,10%), le diabète (12,82%), l’obésité (11,53%) et le tabagisme (10,25%) étaient les principaux FRCV. Les AVC hémorragiques représentaient 56% des cas dont 11% d’hémorragie sousarachnoïdienne. La mortalité était de 26,92%. Le score de Glasgow inférieur 9/15 était apparu comme un facteur prédictif indépendant de décès intra-hospitalier (p = 0,02 ; OR = 0,12 ; IC 95% = 0,02-0,75). Conclusion: La proportion des AVC du sujet jeune est élevée ainsi que la mortalité. Les FRCV sont classiques et surtout modifiables d’où l’intérêt primordial de la sensibilisation, du dépistage précoce de la prise en charge des FRCV.Pan African Medical Journal 2016; 2

Neurocysticercosis and epilepsy in sub-Saharan Africa

International audienceNeurocysticercosis is a public health problem and the leading cause of epilepsy in developing countries especially in sub-Saharan Africa (SSA). In this paper, the authors review the epidemiology of cysticercosis and neurocysticercosis, as well as the non-specific clinical manifestations which render clinical diagnosis challenging especially in the sub-Saharan African context. Special attention is given to the association of epilepsy and neurocysticercosis, the former being the most common symptom of the later, and the role of the later in epileptogenesis is discussed. The state of the art guidelines regarding diagnostic tests and treatment options are discussed and proposals for prevention are made, given the specific socio-culturaland economic context of the endemic countries, mostly in SSA

Cardiovascular Risk Reduction in Diabetes in Sub-Saharan Africa: What should the Priorities be in the Absence of Global Risk Evaluation Tools?

Background The growing burden of type 2 diabetes in Sub-Saharan Africa (SSA) and related cardiovascular complications call for vigorous actions into prevention. Comprehensive cardiovascular risk evaluation is important for the success of such actions. Methods We have reviewed 3 currently existing sets of recommendations for cardiovascular prevention in diabetes in SSA. Distribution of major risk factors and patterns of reported cardiovascular outcomes are used to suggest orientations for cardiovascular prevention in diabetes in this region. Papers and reports published over the period 1990 to 2007 were used. Results Existing guidelines share some similarities, but also have areas of inconsistencies. They are generally adaptations of existing guidelines, focused more on individual risk factors, and are not usually backed-up by local evidence. They all have a projection on blood pressure lowering. This focus is supported by the high prevalence of hypertension among people with diabetes in SSA. Blood pressure and tobacco smoking are the modifiable risk factors accessible to evaluation and interventions on a wide scale in SSA. Appropriate blood pressure control will have a major impact on stroke (the commonest cardiovascular disease) through a reduction of the cerebrovascular risk, and to a lesser extent on coronary heart disease and total deaths in diabetes in this region. Conclusions In the absence of global risk evaluation tools, the use of blood pressure lowering as a primary focus of cardiovascular prevention strategies is relevant for SSA. However, there is a need to set-up diabetes and stroke registers to monitor outcomes and generate tools for accurate risk prediction and management in diabetes in this region

Buruli ulcer in Cameroon: the development and impact of the National Control Programme

BACKGROUND: Cameroon is endemic for Buruli ulcer (BU) and organised institutional BU control began in 2002. The objective was to describe the evolution, achievements and challenges of the national BU control programme (NBUCP) and to make suggestions for scaling up the programme. METHODS: We analysed collated data on BU from 2001 to 2014 and reviewed activity reports NBUCP in Cameroon. Case-detection rates and key BU control indicators were calculated and plotted on a time scale to determine trends in performance. A linear regression analysis of BU detection rate from 2005-2014 was done. The regression coefficient was tested statistically for the significance in variation of BU detection rate. PRINCIPAL FINDINGS: In 14 years of BU control, 3700 cases were notified. The BU detection rate dropped significantly from 3.89 to 1.45 per 100 000 inhabitants. The number of BU endemic health districts rose from two to 64. Five BU diagnostic and treatment centres are functional and two more are planned for 2015. The health system has been strengthened and BU research and education has gained more interest in Cameroon. CONCLUSION/SIGNIFICANCE: Although institutional BU control Cameroon only began 30 years after the first cases were reported in 1969, a number of milestones have been attained. These would serve as stepping stones for charting the way forward and improving upon control activities in the country if the major challenge of resource allocation is dealt with

Onchocerciasis in the Ntui Health District of Cameroon: epidemiological, entomological and parasitological findings in relation to elimination prospects

Abstract Background Despite decades of community-directed treatment with ivermectin (CDTI), onchocerciasis transmission persists in Cameroon and has been associated with increased risk for epilepsy in endemic communities. We investigated the onchocerciasis situation in the Ntui Health District (a known onchocerciasis focus in Cameroon where the Sanaga River constitutes the main source of black fly vectors) using parasitological, entomological and serological parameters. Methods In July 2021, community-based surveys were conducted in four villages (Essougli, Nachtigal, Ndjame and Ndowe). Onchocerciasis was diagnosed via microscopic examination of skin snips. Using rapid diagnostic tests, we screened children aged 3–6 years for Ov16 antibodies as a proxy for recent onchocerciasis transmission. Monthly black fly biting rates were obtained from the two riverside villages (Nachtigal and Essougli) for 12 consecutive months (July 2021 to June 2022) using the human landing catch technique. Some black flies were dissected each month to check for infection. Results Overall, 460 participants were recruited; mean age was 32.1 (range: 3–85) years with 248 (53.9%) being males. Among skin snipped participants (n = 425), onchocerciasis prevalence was 14.6%. Participants with epilepsy (n = 25) were more often skin snip positive (45.8% vs 12.7%; P < 0.001) and had higher microfilarial loads (9.2 ± 22.0 vs 0.7 ± 3.5 microfilariae/skin snip; P < 0.001) compared to their peers without epilepsy. Eight (6.5%) of the 123 tested children were Ov16 seropositive. The breeding sites we investigated along the Sanaga River during the current study harbored fewer vectors (annual biting rates reaching 530,322 vs 606,370 in the Mbam River) and exhibited lower black fly infection rates (annual transmission potentials reaching 1479 vs 4488 in the Mbam River) when compared to recent entomological reports in Cameroon. Conclusion Despite substantial biting rates, black fly infection rates (by microscopy) in the Ntui Health District were rather low resulting in overall low transmission potentials in study villages. Thanks to CDTI, O. volvulus infection in both humans and insects is on the decrease. However, there is evidence that O. volvulus is still endemic in these communities. Reducing the vector population will further accelerate onchocerciasis elimination prospects. Graphical Abstrac

Hypertension in Cameroon associated with high likelihood of obstructive sleep apnea: a pilot study

Abstract Background Although disordered sleep patterns predispose to hypertension (HTN), little is known on the effect of the latter on sleep patterns in sub-Saharan Africa. This study therefore sought to generate preliminary data on the likelihood (risk) of Obstructive sleep apnea (OSA) in hypertensive patients, with the aid of sleep questionnaires. Methods This case–control study, age-and-sex-matched HTN patients with normotensive participants, and compared sleep patterns in either group determined with the aid of the Berlin Questionnaire (BQ) and Epworth Sleepiness Scale (ESS). Results Overall, 50 HTN and 54 age- and sex-matched normotensive participants were enrolled. The prevalence of snoring was higher in participants with hypertension compared to normotensives (58.0% versus 44.0% respectively), though not significantly, (p = 0.167). However, the hypertensive cases (aged on average 54.78 ± 8.79 years and with mean duration since diagnosis of 4.46 ± 4.36 years) had a significantly higher likelihood of Obstructive Sleep Apnea (OSA) than the controls (aOR = 5.03; 95% CI, 1.90–13.33, p = 0.001) and but no significant resulting daytime sleepiness (p = 0.421). There was no clear trend observed between both the risk of OSA and daytime sleepiness and HTN severity. Although not significant, participants with controlled hypertension had lower rates of risk of OSA compared to those with uncontrolled HTN (50.0% versus 63.2%, p = 0.718). Conclusions Preliminary findings of this study (the first of its kind in Cameroon) suggests that hypertension is positively associated with likelihood of OSA in Cameroon. Further studies are required to investigate this further and the role of sleep questionnaires in our setting, cheap and easy to use tools which can be used to identify early, patients with hypertension in need for further sleep investigations. This will contribute to improving their quality of life and adherence to anti-hypertension treatment