Journal Article > ResearchAbstract Only
Transfus Clin Biol. 2020 April 19; Volume 27 (Issue 3); 157-161.; DOI:10.1016/j.tracli.2020.04.001
Ndoumba AM, Tagny CT, Nzedzou G, Boum Y II, Mbanya D
Transfus Clin Biol. 2020 April 19; Volume 27 (Issue 3); 157-161.; DOI:10.1016/j.tracli.2020.04.001
Identify factors that influence the return of donors to increase their loyalty while improving blood safety is crucial in our context. Between October 2017 and April 2018, we conducted a descriptive cross-sectional study at the Blood Bank of the Yaoundé University Teaching Hospital. The study included all former donors who had not donated blood voluntarily for over a year. Quantitative variables were described using means and standard deviations. Fisher's exact test and Chi2 test were used for association measures between qualitative variables. Statistical test results were considered significant for a P<0.05 value. We interviewed a total of 101 inactive donors. The study population was 74.3% male, donors average 30±7 years. Female gender and good staff hospitality were the factors most associated with the intention to return. The barriers to donor return were mainly lack of information on blood needs (35.60%) and time constraint for blood donation (26.73%). Pro-social motivations such as altruism (30.70%) were the main possible sources of motivation cited. To reduce blood deficiency and mortality due to lack of blood products, non-financial material compensation, good outreach and communication strategy can increase inactive donors' loyalty and consequently in improving blood safety in our context.
Conference Material > Poster
Gohy B, Brodin N, Musambi M, Mafuko JM, Ndiramiye E, et al.
MSF Scientific Days International 2021: Research. 2021 May 18
Journal Article > CommentaryFull Text
PLoS Negl Trop Dis. 2015 November 12; Volume 9 (Issue 11); e0004075.; DOI:10.1371/journal.pntd.0004075
O'Brien DP, Ford NP, Vitoria M, Asiedu K, Calmy A, et al.
PLoS Negl Trop Dis. 2015 November 12; Volume 9 (Issue 11); e0004075.; DOI:10.1371/journal.pntd.0004075
Journal Article > ResearchFull Text
Int J Infect Dis. 2022 September 1; Volume 122; 215-221.; DOI:10.1016/j.ijid.2022.05.039
Zheng Q, Luquero FJ, Ciglenecki I, Wamala JF, Abubakar A, et al.
Int J Infect Dis. 2022 September 1; Volume 122; 215-221.; DOI:10.1016/j.ijid.2022.05.039
BACKGROUND
Cholera remains a public health threat but is inequitably distributed across sub-Saharan Africa. Lack of standardized reporting and inconsistent outbreak definitions limit our understanding of cholera outbreak epidemiology.
METHODS
From a database of cholera incidence and mortality, we extracted data from sub-Saharan Africa and reconstructed outbreaks of suspected cholera starting in January 2010 to December 2019 based on location-specific average weekly incidence rate thresholds. We then described the distribution of key outbreak metrics.
RESULTS
We identified 999 suspected cholera outbreaks in 744 regions across 25 sub-Saharan African countries. The outbreak periods accounted for 1.8 billion person-months (2% of the total during this period) from January 2010 to January 2020. Among 692 outbreaks reported from second-level administrative units (e.g., districts), the median attack rate was 0.8 per 1000 people (interquartile range (IQR), 0.3-2.4 per 1000), the median epidemic duration was 13 weeks (IQR, 8-19), and the median early outbreak reproductive number was 1.8 (range, 1.1-3.5). Larger attack rates were associated with longer times to outbreak peak, longer epidemic durations, and lower case fatality risks.
CONCLUSIONS
This study provides a baseline from which the progress toward cholera control and essential statistics to inform outbreak management in sub-Saharan Africa can be monitored.
Cholera remains a public health threat but is inequitably distributed across sub-Saharan Africa. Lack of standardized reporting and inconsistent outbreak definitions limit our understanding of cholera outbreak epidemiology.
METHODS
From a database of cholera incidence and mortality, we extracted data from sub-Saharan Africa and reconstructed outbreaks of suspected cholera starting in January 2010 to December 2019 based on location-specific average weekly incidence rate thresholds. We then described the distribution of key outbreak metrics.
RESULTS
We identified 999 suspected cholera outbreaks in 744 regions across 25 sub-Saharan African countries. The outbreak periods accounted for 1.8 billion person-months (2% of the total during this period) from January 2010 to January 2020. Among 692 outbreaks reported from second-level administrative units (e.g., districts), the median attack rate was 0.8 per 1000 people (interquartile range (IQR), 0.3-2.4 per 1000), the median epidemic duration was 13 weeks (IQR, 8-19), and the median early outbreak reproductive number was 1.8 (range, 1.1-3.5). Larger attack rates were associated with longer times to outbreak peak, longer epidemic durations, and lower case fatality risks.
CONCLUSIONS
This study provides a baseline from which the progress toward cholera control and essential statistics to inform outbreak management in sub-Saharan Africa can be monitored.
Conference Material > Video
Ntone R
Epicentre Scientific Day Paris 2021. 2021 June 10
Journal Article > ResearchFull Text
Sci Afr. 2021 July 1; Volume 12; e00802.; DOI:10.1016/j.sciaf.2021.e00802
Fai KN, Corine TM, Bebell LM, Mbroingong AB, Nguimbis EBPT, et al.
Sci Afr. 2021 July 1; Volume 12; e00802.; DOI:10.1016/j.sciaf.2021.e00802
Official case counts suggest Africa has not seen the expected burden of COVID-19 as predicted by international health agencies, and the proportion of asymptomatic patients, disease severity, and mortality burden differ significantly in Africa from what has been observed elsewhere. Testing for SARS-CoV-2 was extremely limited early in the pandemic and likely led to under-reporting of cases leaving important gaps in our understanding of transmission and disease characteristics in the African context. SARS-CoV-2 antibody prevalence and serologic response data could help quantify the burden of COVID-19 disease in Africa to address this knowledge gap and guide future outbreak response, adapted to the local context. However, such data are widely lacking in Africa. We conducted a cross-sectional seroprevalence survey among 1,192 individuals seeking COVID-19 screening and testing in central Cameroon using the Innovita antibody-based rapid diagnostic. Overall immunoglobulin prevalence was 32%, IgM prevalence was 20%, and IgG prevalence was 24%. IgM positivity gradually increased, peaking around symptom day 20. IgG positivity was similar, gradually increasing over the first 10 days of symptoms, then increasing rapidly to 30 days and beyond. These findings highlight the importance of diagnostic testing and asymptomatic SARS-CoV-2 transmission in Cameroon, which likely resulted in artificially low case counts. Rapid antibody tests are a useful diagnostic modality for seroprevalence surveys and infection diagnosis starting 5-7 days after symptom onset. These results represent the first step towards better understanding the SARS-CoV-2 immunological response in African populations.
Journal Article > ResearchFull Text
PLoS Negl Trop Dis. 2021 February 12; Volume 15 (Issue 2); e0009023.; DOI:10.1371/journal.pntd.0009023
Alcoba G, Ochoa C, Martins SB, Ruiz de Castañeda R, Bolon I, et al.
PLoS Negl Trop Dis. 2021 February 12; Volume 15 (Issue 2); e0009023.; DOI:10.1371/journal.pntd.0009023
BACKGROUND
Worldwide, it is estimated that snakes bite 4.5-5.4 million people annually, 2.7 million of which are envenomed, and 81,000-138,000 die. The World Health Organization reported these estimates and recognized the scarcity of large-scale, community-based, epidemiological data. In this context, we developed the "Snake-Byte" project that aims at (i) quantifying and mapping the impact of snakebite on human and animal health, and on livelihoods, (ii) developing predictive models for medical, ecological and economic indicators, and (iii) analyzing geographic accessibility to healthcare. This paper exclusively describes the methodology we developed to collect large-scale primary data on snakebite in humans and animals in two hyper-endemic countries, Cameroon and Nepal.
METHODOLOGY/PRINCIPAL FINDINGS
We compared available methods on snakebite epidemiology and on multi-cluster survey development. Then, in line with those findings, we developed an original study methodology based on a multi-cluster random survey, enhanced by geospatial, One Health, and health economics components. Using a minimum hypothesized snakebite national incidence of 100/100,000/year and optimizing design effect, confidence level, and non-response margin, we calculated a sample of 61,000 people per country. This represented 11,700 households in Cameroon and 13,800 in Nepal. The random selection with probability proportional to size generated 250 clusters from all Cameroonian regions and all Nepalese Terai districts. Our household selection methodology combined spatial randomization and selection via high-resolution satellite images. After ethical approval in Switerland (CCER), Nepal (BPKIHS), and Cameroon (CNERSH), and informed written consent, our e-questionnaires included geolocated baseline demographic and socio-economic characteristics, snakebite clinical features and outcomes, healthcare expenditure, animal ownership, animal outcomes, snake identification, and service accessibility.
CONCLUSIONS/SIGNIFICANCE
This novel transdisciplinary survey methodology was subsequently used to collect countrywide snakebite envenoming data in Nepal and Cameroon. District-level incidence data should help health authorities to channel antivenom and healthcare allocation. This methodology, or parts thereof, could be easily adapted to other countries and to other Neglected Tropical Diseases.
Worldwide, it is estimated that snakes bite 4.5-5.4 million people annually, 2.7 million of which are envenomed, and 81,000-138,000 die. The World Health Organization reported these estimates and recognized the scarcity of large-scale, community-based, epidemiological data. In this context, we developed the "Snake-Byte" project that aims at (i) quantifying and mapping the impact of snakebite on human and animal health, and on livelihoods, (ii) developing predictive models for medical, ecological and economic indicators, and (iii) analyzing geographic accessibility to healthcare. This paper exclusively describes the methodology we developed to collect large-scale primary data on snakebite in humans and animals in two hyper-endemic countries, Cameroon and Nepal.
METHODOLOGY/PRINCIPAL FINDINGS
We compared available methods on snakebite epidemiology and on multi-cluster survey development. Then, in line with those findings, we developed an original study methodology based on a multi-cluster random survey, enhanced by geospatial, One Health, and health economics components. Using a minimum hypothesized snakebite national incidence of 100/100,000/year and optimizing design effect, confidence level, and non-response margin, we calculated a sample of 61,000 people per country. This represented 11,700 households in Cameroon and 13,800 in Nepal. The random selection with probability proportional to size generated 250 clusters from all Cameroonian regions and all Nepalese Terai districts. Our household selection methodology combined spatial randomization and selection via high-resolution satellite images. After ethical approval in Switerland (CCER), Nepal (BPKIHS), and Cameroon (CNERSH), and informed written consent, our e-questionnaires included geolocated baseline demographic and socio-economic characteristics, snakebite clinical features and outcomes, healthcare expenditure, animal ownership, animal outcomes, snake identification, and service accessibility.
CONCLUSIONS/SIGNIFICANCE
This novel transdisciplinary survey methodology was subsequently used to collect countrywide snakebite envenoming data in Nepal and Cameroon. District-level incidence data should help health authorities to channel antivenom and healthcare allocation. This methodology, or parts thereof, could be easily adapted to other countries and to other Neglected Tropical Diseases.
Journal Article > ResearchFull Text
Front Public Health. 2023 July 26; Volume 11; 1188749.; DOI:10.3389/fpubh.2023.1188749
Onambele AAS, Yuya F, Schouame AA, Nolna SK, Socpa A
Front Public Health. 2023 July 26; Volume 11; 1188749.; DOI:10.3389/fpubh.2023.1188749
INTRODUCTION
Despite the efforts of Cameroon’s Ministry of Public Health against informal health centers (IHCs) because of their illegitimacy, the number of IHCs is increasing in Cameroon. Most of these IHCs have antenatal care services and screen pregnant women for HIV. However, nothing is known about the subsequent outcomes of those who tested positive for HIV. This study aimed to assess the initiation of antiretroviral therapy (ART) in ART-naïve pregnant women screened HIV positive in IHCs within three months of diagnosis and their ART retention at three months post-initiation. In addition, we sought to identify the factors associated with ART non-initiation in this population.
METHODS
May 01, 2019 to August 31, 2020, we carried out a prospective cohort study of ART-naïve pregnant women who attended their first antenatal care visit and screened HIV positive at IHCs in the cities of Douala and Ebolowa in Cameroon. Standardized questionnaires were used to interview consenting participants at three points: the day of the delivery of the antenatal HIV test result, three months later, and three months after ART initiation. The data collected were entered into KoboCollect and analyzed using SPSS V23.0 software. The Chi-square test was used to compare proportions, Kaplan Meier techniques and Cox proportional hazards regression was used to estimate retention in ART and identify factors associated with ART non-retention, respectively.
RESULTS AND DISCUSSION
A total of 85 ART-naïve pregnant women living with HIV were enrolled in the study. The median age and gestational age at the first antenatal care visit were 29 years (interquartile range (IQR), 2333.5) and 28weeks of amenorrhea (IQR, 2032), respectively. Only 34% (29/85) initiated ART, and 65.5% (19/29) of the initiators were retained in ART three months later. Lack of perceived self-efficacy to initiate ART (adjust Hazard Ratio = 5.57, 90% CI: 1.29 to 24.06), increased the probability of not be retaining in ART by any time during three months post initiation. Given the low ART uptake and the low retention in care among pregnant women living with HIV screened in IHCs, PMTCT policies in Cameroon should pay greater attention to this population, to facilitate their continuum of PMTCT care.
Despite the efforts of Cameroon’s Ministry of Public Health against informal health centers (IHCs) because of their illegitimacy, the number of IHCs is increasing in Cameroon. Most of these IHCs have antenatal care services and screen pregnant women for HIV. However, nothing is known about the subsequent outcomes of those who tested positive for HIV. This study aimed to assess the initiation of antiretroviral therapy (ART) in ART-naïve pregnant women screened HIV positive in IHCs within three months of diagnosis and their ART retention at three months post-initiation. In addition, we sought to identify the factors associated with ART non-initiation in this population.
METHODS
May 01, 2019 to August 31, 2020, we carried out a prospective cohort study of ART-naïve pregnant women who attended their first antenatal care visit and screened HIV positive at IHCs in the cities of Douala and Ebolowa in Cameroon. Standardized questionnaires were used to interview consenting participants at three points: the day of the delivery of the antenatal HIV test result, three months later, and three months after ART initiation. The data collected were entered into KoboCollect and analyzed using SPSS V23.0 software. The Chi-square test was used to compare proportions, Kaplan Meier techniques and Cox proportional hazards regression was used to estimate retention in ART and identify factors associated with ART non-retention, respectively.
RESULTS AND DISCUSSION
A total of 85 ART-naïve pregnant women living with HIV were enrolled in the study. The median age and gestational age at the first antenatal care visit were 29 years (interquartile range (IQR), 2333.5) and 28weeks of amenorrhea (IQR, 2032), respectively. Only 34% (29/85) initiated ART, and 65.5% (19/29) of the initiators were retained in ART three months later. Lack of perceived self-efficacy to initiate ART (adjust Hazard Ratio = 5.57, 90% CI: 1.29 to 24.06), increased the probability of not be retaining in ART by any time during three months post initiation. Given the low ART uptake and the low retention in care among pregnant women living with HIV screened in IHCs, PMTCT policies in Cameroon should pay greater attention to this population, to facilitate their continuum of PMTCT care.
Conference Material > Abstract
Karl F
Epicentre Scientific Day Paris 2021. 2021 June 10
BACKGROUND
While 2.5 million envenomings and 130,000 deaths occur globally due to snakebites, with 1 million envenomings and 30,000 deaths in sub-Saharan Africa, the accessibility of antivenom for treatment of snakebites remain limited. The Inoserp® Pan-Africa antivenom is being used in many African countries including Cameroon but there is few data on its efficacy or tolerance in those settings. We therefore aim to evaluate the tolerance and efficacy of the Inoserp® Pan-Africa antivenom (AVS) in Cameroon.
METHODS
We performed a Phase IV clinical trial and included participants 5 years and above with snakebites in 14 healthcare centers across 6 of the 10 regions of Cameroon. Participants with envenomation were treated with Inoserp AVS and followed-up for 3 days in the hospital and 15 more days at home. The main study endpoints were complete follow-up to day 15, occurrence of adverse events, including disability or death.
RESULTS
Between October 15, 2019 and April 30, 2021, we included 427 participants with snakebites. Echis ocellatus (43.3%) was the most incriminated. Most frequent signs at admission were pain and edema with 90.9% (388/427) and 75.2% (321/427) respectively. We administered AVS to 81.3% (347/427) of patients with an average dose of 2 doses of AVS. Coagulation disorders was present in 50.4% (215/427) of the participants. We reported 12 deaths (2.7%); none were imputed to the administration of AVS. According to preliminary analysis necessitating confirmation, we observed at least one mild or moderate adverse event in 75 of 347 patients (21.6%), including tachypnea, tachycardia and bradycardia.
CONCLUSIONS
Snakebites are still an important neglected problem. Treatment with the Inoserp® Pan-Africa AVS appeared to be well tolerated in the Cameroonian patients and ongoing analysis will help to better assess its effectiveness.
KEY MESSAGES: Snakebites are neglected and their management is most at times inappropriate. We found the Inoserp® Pan-Africa antivenom to be well tolerated in the Cameroonian population.
This abstract is not to be quoted for publication.
While 2.5 million envenomings and 130,000 deaths occur globally due to snakebites, with 1 million envenomings and 30,000 deaths in sub-Saharan Africa, the accessibility of antivenom for treatment of snakebites remain limited. The Inoserp® Pan-Africa antivenom is being used in many African countries including Cameroon but there is few data on its efficacy or tolerance in those settings. We therefore aim to evaluate the tolerance and efficacy of the Inoserp® Pan-Africa antivenom (AVS) in Cameroon.
METHODS
We performed a Phase IV clinical trial and included participants 5 years and above with snakebites in 14 healthcare centers across 6 of the 10 regions of Cameroon. Participants with envenomation were treated with Inoserp AVS and followed-up for 3 days in the hospital and 15 more days at home. The main study endpoints were complete follow-up to day 15, occurrence of adverse events, including disability or death.
RESULTS
Between October 15, 2019 and April 30, 2021, we included 427 participants with snakebites. Echis ocellatus (43.3%) was the most incriminated. Most frequent signs at admission were pain and edema with 90.9% (388/427) and 75.2% (321/427) respectively. We administered AVS to 81.3% (347/427) of patients with an average dose of 2 doses of AVS. Coagulation disorders was present in 50.4% (215/427) of the participants. We reported 12 deaths (2.7%); none were imputed to the administration of AVS. According to preliminary analysis necessitating confirmation, we observed at least one mild or moderate adverse event in 75 of 347 patients (21.6%), including tachypnea, tachycardia and bradycardia.
CONCLUSIONS
Snakebites are still an important neglected problem. Treatment with the Inoserp® Pan-Africa AVS appeared to be well tolerated in the Cameroonian patients and ongoing analysis will help to better assess its effectiveness.
KEY MESSAGES: Snakebites are neglected and their management is most at times inappropriate. We found the Inoserp® Pan-Africa antivenom to be well tolerated in the Cameroonian population.
This abstract is not to be quoted for publication.
Conference Material > Abstract
Natukunda N
Epicentre Scientific Day Paris 2023. 2023 June 8
BACKGROUND
Childhood tuberculosis is underdiagnosed at low-level healthcare settings because of poor access to specimen collection, rapid molecular testing, clinical evaluation and chest radiography. Decentralizing childhood tuberculosis diagnosis at district hospital (DH) and primary health centre (PHC) levels could improve case detection.
METHODS
TB-Speed decentralisation is an operational research using a pre-post intervention cross-sectional design in 12 DHs and 47 PHCs of 12 districts in Cambodia, Cameroon, Côte d’Ivoire, Mozambique, Sierra Leone and Uganda. The intervention included a comprehensive childhood tuberculosis diagnosis package consisting of systematic tuberculosis screening for all under-15-year-old sick children, clinical evaluation, Xpert Ultra-testing on one nasopharyngeal aspirate (NPA) and stool samples, and chest radiography for children with presumptive tuberculosis, using either PHC-focused or DH-focused decentralization approaches. We collected aggregated and individual data for children whose parents consented. We present the comparison of the proportion of tuberculosis case detected pre-intervention from August 2018 to Nov 2019 versus post-intervention from March 2020 to September 2021, overall and by decentralization approach, and the uptake and acceptability of the diagnostic package in Uganda.
FINDINGS
In Uganda, 52233 and 46035 children attended care pre-intervention versus post-intervention respectively. 26/52233 (0.05%) and 42/46035 (0.09%) children were diagnosed with tuberculosis pre-intervention and post-intervention respectively, p-value=0.114. In DH-focused district, it was 10/24208 (0.04%) and 23/17914 (0.1%) pre-intervention and post-intervention respectively, and 16/28025 (0.06%) and 19/28121 (0.1%) for PHC-districts, respectively. The uptake of TB screening was 43104/46035 (93.6%) overall, among the 732 enrolled children 724/ and 532 had a valid Ultra result using NPA and stool, respectively. Health care workers overall experienced decentralized childhood TB diagnostic as acceptable, with NPA and stool sample collection feasible both at DH and PHC.
CONCLUSION
Decentralizing innovative childhood tuberculosis diagnosis can increase tuberculosis case detection with limited impact when using the PHC decentralization approach.
KEY MESSAGE
Although decentralizing childhood TB diagnosis is acceptable, overcoming feasibility issues may improve the effective implementation and scale-up of such interventions at low levels of care.
This abstract is not to be quoted for publication.
Childhood tuberculosis is underdiagnosed at low-level healthcare settings because of poor access to specimen collection, rapid molecular testing, clinical evaluation and chest radiography. Decentralizing childhood tuberculosis diagnosis at district hospital (DH) and primary health centre (PHC) levels could improve case detection.
METHODS
TB-Speed decentralisation is an operational research using a pre-post intervention cross-sectional design in 12 DHs and 47 PHCs of 12 districts in Cambodia, Cameroon, Côte d’Ivoire, Mozambique, Sierra Leone and Uganda. The intervention included a comprehensive childhood tuberculosis diagnosis package consisting of systematic tuberculosis screening for all under-15-year-old sick children, clinical evaluation, Xpert Ultra-testing on one nasopharyngeal aspirate (NPA) and stool samples, and chest radiography for children with presumptive tuberculosis, using either PHC-focused or DH-focused decentralization approaches. We collected aggregated and individual data for children whose parents consented. We present the comparison of the proportion of tuberculosis case detected pre-intervention from August 2018 to Nov 2019 versus post-intervention from March 2020 to September 2021, overall and by decentralization approach, and the uptake and acceptability of the diagnostic package in Uganda.
FINDINGS
In Uganda, 52233 and 46035 children attended care pre-intervention versus post-intervention respectively. 26/52233 (0.05%) and 42/46035 (0.09%) children were diagnosed with tuberculosis pre-intervention and post-intervention respectively, p-value=0.114. In DH-focused district, it was 10/24208 (0.04%) and 23/17914 (0.1%) pre-intervention and post-intervention respectively, and 16/28025 (0.06%) and 19/28121 (0.1%) for PHC-districts, respectively. The uptake of TB screening was 43104/46035 (93.6%) overall, among the 732 enrolled children 724/ and 532 had a valid Ultra result using NPA and stool, respectively. Health care workers overall experienced decentralized childhood TB diagnostic as acceptable, with NPA and stool sample collection feasible both at DH and PHC.
CONCLUSION
Decentralizing innovative childhood tuberculosis diagnosis can increase tuberculosis case detection with limited impact when using the PHC decentralization approach.
KEY MESSAGE
Although decentralizing childhood TB diagnosis is acceptable, overcoming feasibility issues may improve the effective implementation and scale-up of such interventions at low levels of care.
This abstract is not to be quoted for publication.