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Background: Safe childbirth remains a daunting challenge, particularly in low-middle income countries, where most pregnancy-related deaths occur. Cameroon's maternal mortality rate, estimated at 529 per 100,000 live births in 2017, is significantly high. The WHO Safe Childbirth Checklist (SCC) was designed to improve the quality of care provided to pregnant women during childbirth. The SCC was implemented at the Yaoundé Gynaeco-Obstetric and Paediatric Hospital to improve the quality of care during childbirth.Methods: This study was a retrospective study to determine the adoption rate of the SCC and its association with maternal (eclampsia, perineal tears, and postpartum haemorrhage) and neonatal (stillbirth, neonatal asphyxia and neonatal death) complications. Data were collected 6 months after the introduction of the SCC. Multivariate binary logistic regression was used to analyse the association between the use of the SCC and maternofoetal complications.Results: Out of 1611 deliveries conducted, 1001 records were found, giving a retrieval rate of 62%. Twenty-five records were excluded. During the study period, the checklists were used in 828 of 976 clinical notes, with an adoption rate of 84.8% and a utilization rate of 93.9% at 6 months. Severe preeclampsia/eclampsia was associated with the non-use of the SCC (2.1 vs 5.4%, p = 0.041). Stillbirth, neonatal asphyxia, and neonatal death rates were not significantly different between the checklist and non-checklist groups. However, for all neonatal outcomes, the proportion of complications was lower when the checklist was used.Conclusion: The use of the SCC was associated with significantly reduced pregnancy complications, especially for reducing the rates of severe pre-eclampsia/eclampsia. The use of the SCC increased to 93.9% of all deliveries within 6 months. We advocate for the use of the WHO Safe Childbirth Checklist in maternity units. [ABSTRACT FROM AUTHOR]

Background: Vaccination is a major, but simple and cost effective public health intervention in the prevention of infectious diseases, especially in children. Nowadays, many children still miss scheduled vaccines in the Extended Program of Immunization (EPI) or are being vaccinated after the recommended ages.This study was aimed at assessing vaccination completeness and timeliness in children aged 0 to 11 months attending the vaccination clinic of the Yaounde Gynaeco-Obstetric and Pediatric Hospital.Methods: This was an observational cross-sectional study over a period of 3 months (1st February to 30th April 2016). 400 mothers were interviewed and their children's vaccination booklets analyzed. Information on the children and the parents was collected using a pretested questionnaire. Data analysis was done using SPSS version 20 software. Bivariate and multivariate analysis with logistic regression was done to assess the determinants of completeness and timeliness.Results: A total of 400 mother-infant pairs were sampled. The vaccination completeness rate was 96.3%. This rate varied between 99.50% for BCG and 94.36% for IPV. Most of the children were born at the Yaounde Gynaeco-Obstetric and Pediatric hospital where they were regularly receiving their vaccines. The proportion of correctly vaccinated infants was 73.3%. The most differed vaccines were BCG, PCV13 and IPV. Factors influencing immunization completeness were the father's profession and the mother's level of education.Conclusions: Despite the high immunization coverage, some children did not complete their EPI vaccines and many of them took at least one vaccine after the recommended age. [ABSTRACT FROM AUTHOR]

Sickle Cell Disease (SCD) is a debilitating illness that affects quality of life. Studies of the psychosocial burden of SCD on patients have been rarely reported in Africa. We used a quantitative method, with face-to-face administered questionnaires, to study indices of psychosocial stressors on adult SCD patients in Cameroon. The questionnaire included a 36-item stress factors scale evaluating general perceptions of stress and five main stressors' domain: disease factors, hospital factors, financial factors, family factors and quality of personal-life factors. Items pertaining to psychosocial stressors involved four response options with increasing severity: 0, 1, 2 or 3. Non-parametric tests were used for analysis. The majority of the 83 participants were urban dwellers, female, 20-30 years old, single, unemployed, with at least a secondary or tertiary education. Median age at diagnosis was 100 months; 47.8 % had >3 painful vaso-oclusive crises annually. Only 4.8 % had been treated with hydroxyurea. The majority reported moderate to severe difficulty coping with SCD. The 'degree of clinical severity' category displayed the highest median score (2.0), while familial stressors showed the lowest (0.8). Being female, married, with low education level, an additional affected sibling and low direct income were significantly associated with specific stressors' categories. In Cameroon, there is an urgent need to implement policies that ensure affordable access to health-care and practices to reduce SCD morbidity and improve patients' quality of life. [ABSTRACT FROM AUTHOR]

The chronicity of Sickle Cell Disease (SCD) could impair the quality of life of caregivers. We performed a quantitative study to assess various indices of psychosocial burden on Cameroonian parents ( N = 130) with at least one living SCD-affected child. Demographic and medical information were obtained from the participants and the review of the patients' medical records. The survey instrument included a 38-item stress factors scale using Likert-type statements, evaluating general perceptions of stress and five main specific stressors: disease factors (clinical severity), hospital factors, financial factors, family factors (life/dynamic) and SCD-child factors (perceived quality of life). The items pertaining to burden involved four response options with increasing severity: 0, 1, 2 or 3. Descriptive statistics and non-parametric tests were used for analysis. Participants were typically aged 38 years, urban dwellers (89 %), female (80 %), married (60.2 %), employed (61.7 %) and had secondary/tertiary education (82 %). Median age of SCD-affected children was 9 years. The median age at diagnosis of SCD was 6 months; 47.8 % had more than 3 painful crises per year. The majority of participants (88.3 %) experienced moderate to severe difficulty coping with SCD. On a 0-3 scale, median score of SCD clinical severity was the major factor to undermine the coping ability of parents (2.2); vaso-occlusive painful events (>3 per year) was the disease-related stressor that most impacted their coping ability. The family life dynamic was the least stressful (0.7). Unemployment affected all the stressors' categories. Stressors scores also increased with female, single, low education level, age of SCD-affected children or more than 3 children in the family. In Cameroon, there is an urgent need to implement practices that ensure affordable access to health-care and activities that would reduce SCD morbidity. [ABSTRACT FROM AUTHOR]

Background: Schistosomiasis and soil-transmitted helminthiasis (STH) are widely distributed in Cameroon. Although mass drug administration (MDA) of mebendazole is implemented nationwide, treatment with praziquantel was so far limited to the three northern regions and few health districts in the southern part of Cameroon, based on previous mapping conducted 25 years ago. To update the disease distribution map and determine where treatment with praziquantel should be extended, mapping surveys were conducted in three of the seven southern regions of Cameroon, i.e. Centre, East and West. Methodology: Parasitological surveys were conducted in April-May 2010 in selected schools in all 63 health districts of the three targeted regions, using appropriate research methodologies, i.e. Kato-Katz and urine filtration. Principal Findings: The results showed significant variation of schistosomiasis and STH prevalence between schools, villages, districts and regions. Schistosoma mansoni was the most prevalent schistosome species, with an overall prevalence of 5.53%, followed by S. haematobium (1.72%) and S. guineensis (0.14%). The overall prevalence of schistosomiasis across the three regions was 7.31% (95% CI: 6.86-7.77%). The prevalence for Ascaris lumbricoides was 11.48 (95% CI: 10.93-12.04%), Trichuris trichiura 18.22% (95% CI: 17.56-18.90%) and hookworms 1.55% (95% CI: 1.35-1.78%), with an overall STH prevalence of 24.10% (95% CI: 23.36-24.85%) across the three regions. STH was more prevalent in the East region (46.57%; 95% CI: 44.41-48.75%) in comparison to the Centre (25.12; 95% CI: 24.10-26.17%) and West (10.49%; 95% CI: 9.57-11.51%) regions. Conclusions/Significance: In comparison to previous data, the results showed an increase of schistosomiasis transmission in several health districts, whereas there was a significant decline of STH infections. Based on the prevalence data, the continuation of annual or bi-annual MDA for STH is recommended, as well as an extension of praziquantel in identified moderate and high risk communities for schistosomiasis. [ABSTRACT FROM AUTHOR]

Little is known about attitudes of parents of Sickle Cell Anemia patients in sub-Saharan Africa regarding prenatal genetic diagnosis and termination of an affected pregnancy. In this study, structured face-to-face interviews were conducted with a sample of 130 parents in Cameroon that had at least one living child with Sickle Cell Anemia. The majority of participants lived in urban areas (89%), were female (80%), Christian (93%), married (60.2%) in monogamous households (81.1%), were employed (61.7%), and had at least a secondary or tertiary education (82%). The majority of parents accepted the principle of prenatal genetic diagnosis for Sickle Cell Anemia (89.8%) and termination of pregnancy (62.5%). Acceptance of the principle of pregnancy termination increased with unemployment ( p < .01) and single marital status ( p < .05). The results of this study suggest Cameroonian parents with children affected with Sickle Cell Anemia generally accept the principles of prenatal diagnosis and in some cases termination of a pregnancy affected with Sickle Cell Anemia. Additional findings, policy and practice implications, and research recommendations are presented. [ABSTRACT FROM AUTHOR]

Background: Foreign bodies are a rare cause of appendicitis. In most instances, ingested foreign bodies pass through the alimentary tract asymptomatically. However, those that enter the lumen of the vermiform appendix may not be able to re-enter the colon and may initiate an inflammatory process. We report a case of acute appendicitis induced by an unusual foreign body.Case Presentation: A 26-year-old Sub-Saharan woman presented with right iliac fossa pain and tenderness. She underwent an open appendectomy which revealed a condom fragment within the appendiceal lumen. A detailed retrospective history confirmed accidental ingestion of the condom 2 weeks prior to onset of symptoms.Conclusions: Although a rare finding, a variety of foreign bodies can be lodged in the appendix and may instigate an inflammatory process. There is a need to increase awareness of the potential dangers of ingested foreign bodies. [ABSTRACT FROM AUTHOR]

Purpose : We evaluated the survival time of patients with stage D cancer of the prostate (CaP) in Yaounde, Cameroon, so as to lay the groundwork for evaluating patient management and outcomes in such communities in sub-Saharan Africa. Patients and Materials : A cohort of 200 patients was recruited at diagnosis and followed over a 171 month period. They had a standard work-up and staging protocol except for the absence of bone scan. Treatment was offered after they were staged following the Whitemore ABCD-system. Standard statistical analysis was performed for quantitative variables and graphs developed for continuous variables. Pearson correlation and Chi-square tests were used to evaluate associations between variables. The Kaplan-Meier product-limit method was used to estimate survival functions and log-rank test to compare data from complete survival curves. The statistical significance level was fixed at p values less than or equal to 0.05. Results : The mean age of our patients was 67 years and 41.5% of them were in the 60-69 year-bracket. Survival was worse for those 66 years and older ( p =0.013). Patient survival correlated with tumor differentiation such that a Gleason score of 6 or greater meant diminished survival time ( p =0.014). For the entire group, median overall survival was 40.5 months, 44% at 5 years and 17% at 10 years. Patients who received multi-modal therapy (complete androgen ablation by surgical and medical means, and radiation to the pelvis and metastatic sites) seemed to have the best survival ( p <0.001) although patient stratification into treatment groups was not randomized. A comparison of survival of African-American cohorts and this group showed no statistical significance ( p =0.1). Conclusion : Survival of patients with prostate cancer in Yaounde is just as low as in African-Americans. Survival is worse however, for men older than 66 years in Yaounde. A call for comparative and collaborative clinical trials is made. [ABSTRACT FROM AUTHOR]

Background: The incidence of posterior urethral valve (PUV) is estimated at 1:5000-1:8000 males. It is the most common paediatric urologic urgency and the most common cause of male obstructive uropathy and chronic renal failure in children. The study aimed to describe the experience of Yaoundé gynaeco-obstetrics and paediatric hospital in the management of PUV.Methods: Retrospectively, medical records were retrieved over a ten year period and all data recorded and analyzed for study objectives. Patients were called and evaluated for outcomes regarding morbidity and mortality.Results: A total of 18 patients all males were managed over the ten year period, given prevalence of 13 cases/100,000 admissions and an admission rate of 2 per annum. The median age at presentation was 22 months and 13 (72.2%) participants presented late. Voiding urethrocystogram was done in all the participants where it showed dilated and elongated posterior urethral valves in 16 (88.9%) of the cases. Endoscopic valve ablation resulted in the relief of obstruction in all but 3 (16.7%) participants that had residual valves and 2 (11.2%) participants that had urethral stenosis. Type I valves were most common in 14 (78.0%) participants. The mean duration of follow up was 34.56 ± 21.47 months. Complications at final follow up were: 10 (55.6%) chronic renal failure, 2 (11.2%) end-stage renal failure. The case fatality rate was 5.6%.Conclusion: Many patients present late in our setting with already established complications. There is the need to counsel parents/guardians on the importance of long-term follow up after relief of obstruction. [ABSTRACT FROM AUTHOR]

Introduction: Syphilis rapid test results may be influenced by numerous environmental and genetic factors., Methods: The proportion of false positive syphilis non-treponemal (NT) and treponemal (T) test results using immuno-chromatographic dual syphilis rapid test on serum from Cameroonian blacks (n=103) versus French blacks (n=104) or French caucasians (n=51), all HIV-negative and free of clinical syphilis, was examined., Results: Black individuals in Cameroon had a significantly higher frequency of false positive NT or T tests than black individuals in France. black individuals in France had a higher frequency of indeterminate NT tests as compared to caucasians in France., Conclusion: Both racial and environmental factors may affect immuno-chromatographic dual syphilis rapid testing., Competing Interests: The authors declare no competing interests.

Introduction: The incidence of breast cancer (BCa) in Cameroon is on the rise and accounts for a leading cause of mortality. An understanding of the knowledge and practices on breast cancer and breast self-examination (BSE) among teachers are important first steps which will guide the designing of interventions aimed at raising awareness across the general population., Methods: We conducted a cross-sectional study in April 2016 involving 345 consenting female undergraduate students in the Higher Teachers Training College, Bambili, Cameroon. Data was collected using a pretested self-administered questionnaire and analysed using descriptive methods., Results: The mean age of the respondents was 22.5±3.2years and a vast majority (n = 304, 88.1%) had heard about BCa primarily from the television/radio (n=196, 64.5%). Overall, less than a quarter (n=65, 21.4%) of respondents who had heard about BCa had sufficient knowledge on its risk factors and signs/symptoms. A plurality (53.3%) thought BCa can be prevented via vaccination while over a third (38.7%) opined that BCa can be treated spiritually. Less than half (47%) of respondents who had heard about BCa had heard about BSE amongst which only 55 (38.5%) had ever practiced it., Conclusion: Though most students are aware of the existence of breast cancer, their overall knowledge on its risk factors and clinical presentation is insufficient with a concomitant low practice of BSE. These highlighted gaps warrants intensification of sensitization campaigns and educational programmes in order to raise knowledge levels and enhance prevention strategies that would aid in reducing the burden of breast cancer in Cameroon.

Background: The enormous challenge to maternal well-being with associated maternal wastages during labour has remained an unsurmountable problem in Cameroon which reflects the current high maternal mortality rate. Evidence abounds that cost-effective and affordable health interventions like the use of the partograph will contribute to curb the alarming number of intrapartum maternal deaths. However, little is known about the level of knowledge and utilization of this simple life-saving tool in the North-and South-West Regions, Cameroon., Methods: Using a self-administered structured questionnaire, a cross-sectional study was conducted from January 4th-March 25th 2016 among non-physician obstetric care providers (OCPs) across urban public health institutions in these regions. Logistic regression models were used to identify factors associated with good knowledge and routine utilization of the partograph., Results: Of the 79 eligible participants, 71 (89.9%) took part in the study. The mean age of the respondents was 37.9±10.0 years with majority being female (85.9%). Less than one-third (29.6%) of the respondents had good knowledge on the partograph and only 23 (32.4%) routinely used it in monitoring labour. OCPs working in Maternal and Infant Welfare Clinics were about 4 times more likely than those working in Regional/District Hospitals to have good knowledge on the partograph [AOR = 3.88 (95% CI:1.07-14.04)], p = 0.04. Little or no knowledge of the partograph and poor staff strength in the study centres were factors militating against its routine use., Conclusions: The knowledge and use of the partograph in this study is sub-optimal. Regular in-service training of OCPs superimposed with periodic workshops and seminars, provision of reasonable staff numbers, and mandatory institutional policies on routine use of the partograph are recommended as vital first steps towards ensuring the safety of women in labour in the North-and South-West Regions of Cameroon.

Background: In 2010, an estimated 141 new HIV infections occurred per day in Cameroon and reports suggest an upsurge of these rates by 2020 if current trends continue. Mother-to-child transmission (MTCT) of HIV is a major public health challenge, and maternal knowledge on HIV transmission during pregnancy and its prevention is important in curtailing paediatric HIV acquisition., Objectives: We aimed at establishing the prevalence of maternal HIV infection as well as assessing knowledge on HIV, MTCT and prevention of MTCT (PMTCT) of HIV among pregnant women in a rural area of Cameroon., Methods: This study was conducted in two phases: a 29 month retrospective analysis of 1866 deliveries within three rural health facilities in the Babessi sub-division, Northwest Cameroon and a 1 month prospective phase wherein 150 consenting pregnant women attending antenatal care (ANC) at the study centres were consecutively recruited., Results: Overall, the prevalence of maternal HIV infection was 5.0% (100/2016). All (100%) of the interviewed pregnant women were aware of HIV infection and most (76.7%) had adequate knowledge on its routes of transmission. Meanwhile, only 79.3% (119/150) of them were aware of MTCT with slightly above a third (37.0%) having adequate knowledge on the periods of transmission. The proportions of women correctly stating: during pregnancy, during labour/delivery and during breastfeeding as possible periods of MTCT of HIV were 63.0%, 60.5% and 89.1% respectively. A majority (76.3%) of these women had inadequate knowledge on PMTCT of HIV., Conclusion: The overall prevalence of maternal HIV warrants strengthening of current intervention strategies including scaling-up of PMTCT measures. Among others, intensification of HIV-related ANC services to improve the pregnant women's awareness and knowledge on MTCT and its prevention are vital steps in curbing the growing burden of paediatric HIV.

Background: Severe acute malnutrition (SAM) is a major health problem, and the cause of more than half of childhood deaths in children less than 5 years in developing countries. Globally, 20 million children under 5 years of age are severely malnourished according to the World Health Organization (WHO). In Cameroon, the prevalence of SAM remains high and estimated at 1.9% in 2011 and 1.3% in 2014. The aim of this study was to determine the epidemiology, clinical aspects and outcome of SAM at the Yaounde Gynaeco-Obstetric and Pediatric Hospital (YGOPH)., Methods: We retrospectively reviewed the medical records of children hospitalized in the YGOPH for SAM over a period of 8 1/2 years (from September 2006 to March 2015). We included the medical records of children under 15 years of age who were hospitalized in the pediatric unit of the YGOPH for the management of SAM. Data was collected using a data entry form and was analyzed with Epi info version 3.5.4 software. Data was considered statistically significant for P less than 0.05., Results: The prevalence of SAM was 2.72%. The median age was 9 months (range, 23 days-112 months). The most represented age group was 6 to 12 months with 34.6% of the children. The most frequent symptoms on admission were: wasting (58.1%) and fever (53.6%). The mean interval between the onset of symptoms and admission was 30.36 days. Marasmus was the most frequent clinical form of SAM observed in 88.8% of the children. Respiratory tract infections were the most common comorbidities and were present in 45 patients (25.1%), followed by malaria in 15.1% of cases. The sero-prevalence of human immuno deficiency virus (HIV) was 43.75% amongst the 32 children whose HIV status was known. Dehydration was the most frequent complication, with an occurrence of 29.6%. A total of 58.7% of patients were discharged following clinical improvement and the mortality rate was 15%. The average duration of hospitalization was 8.25 days., Conclusions: SAM is a frequently encountered pathology in this context with a high mortality, thus the need to step up prevention strategies. Health education during pediatric consultations and vaccination sessions on the appropriate feeding of the young infant and the child should be reinforced., Competing Interests: The authors have no conflict of interest to declare.

Background: An unsafe abortion is defined as a procedure for terminating an unintended pregnancy carried out either by a person lacking the necessary skills or in an environment that does not conform to minimal medical standards or both. Majority of these unsafe abortions are carried out in rural areas of developing countries, usually by unskilled persons who do not have proper knowledge of the anatomy of reproductive organs and in unhygienic environments thus leading to various complications., Case Presentation: We discuss the case of a 21 year old female who presented in septic shock after she underwent an unsafe abortion of an 11 weeks pregnancy with uterine wall perforation and bowel injury that required resection., Conclusion: Unsafe abortion is an important public health problem which accounts for a significant cause of maternal mortality and morbidity in resource poor countries. A high index of suspicion of clandestine abortion with ensuing complications should prevail when faced with a woman of child bearing age with the triad of vaginal bleeding, amenorrhea and pelvic sepsis.

Background: A mobile health unit may be useful to follow up adult and pediatric patients on antiretroviral treatment and living in remote areas devoid of laboratory facilities. The study evaluated the use of the simplified, robust, single-plateform, volumetric, pan-leucogating Auto40 flow cytometer (Apogee Flow Systems Ltd, Hemel Hempstead, UK) for CD4 T cell numeration in a mobile unit, compared against a reference flow cytometry method., Methods: The therapeutic mobile unit of the Laboratoire National de Santé Hygiène Mobile, Yaoundé, Cameroon, was equipped with the Auto40. A FACSCalibur flow cytometer (Becton Dickinson Immuno-cytometry System, San Jose, CA, USA) was used as reference method. EDTA-blood samples from volunteers were first subjected to CD4 T cell count in the mobile unit, and an aliquot was sent within 4 hours to Centre International de Référence Chantal Biya, Yaoundé, for FACSCalibur assay., Results: Two HIV screening campaigns with the mobile unit were organised in December 2009 and January 2010. The campaign in the suburb of Yaoundé which was 20 km from the reference laboratory included 188 volunteers comprising 93 children less than 5 years old. The campaign in Ambang Bikok (53 km far from Yaoundé) included 69 adult volunteers. In Yaoundé suburb, mean ± standard deviation (SD) CD4 T cell count was 996 ± 874 cells/μl by Auto40, and 989 ± 883 cells/μl by FACSCalibur; in Ambang Bikok, mean ± SD CD4 T cell count was 1041 ± 317 cells/μl by Auto40, and 1032 ± 294 cells/μl by FACSCalibur. Results by Auto40 and FACSCalibur were highly correlated in Yaoundé (r(2) = 0.982) as in Ambang Bikok (r(2) = 0.921). Bland-Altman analysis showed a close agreement between Auto40 and FACSCalibur results expressed in absolute count as in percentage in Yaoundé and Ambang Bikok. When pooling the 257 CD4 T cell count measurements, the Auto40 yielded a mean difference of +7.6 CD4 T cells/μl higher than by reference flow cytometry; and the sensitivity and specificity of Auto40 in enumerating absolute CD4 T cell counts of less than 200 cells/μl were 87% and 99%, respectively, and in enumerating absolute CD4 T cell counts of less than 350 cells/μl were 87% and 98%, respectively. The intrarun and interun precisions of the Auto40 assay assessed in the mobile unit were 5.5% and 7.9%, respectively., Conclusions: The Auto40 flow cytometer installed in a therapeutic mobile unit and operated far from its reference laboratory gave a perfect correlation with the reference method, and could be useful in carrying out immunological monitoring of HIV-infected patients living in areas without access to laboratory facilities.

Background: Schistosomiasis and soil-transmitted helminthiasis (STH) are widely distributed in Cameroon. Although mass drug administration (MDA) of mebendazole is implemented nationwide, treatment with praziquantel was so far limited to the three northern regions and few health districts in the southern part of Cameroon, based on previous mapping conducted 25 years ago. To update the disease distribution map and determine where treatment with praziquantel should be extended, mapping surveys were conducted in three of the seven southern regions of Cameroon, i.e. Centre, East and West., Methodology: Parasitological surveys were conducted in April-May 2010 in selected schools in all 63 health districts of the three targeted regions, using appropriate research methodologies, i.e. Kato-Katz and urine filtration., Principal Findings: The results showed significant variation of schistosomiasis and STH prevalence between schools, villages, districts and regions. Schistosoma mansoni was the most prevalent schistosome species, with an overall prevalence of 5.53%, followed by S. haematobium (1.72%) and S. guineensis (0.14%). The overall prevalence of schistosomiasis across the three regions was 7.31% (95% CI: 6.86-7.77%). The prevalence for Ascaris lumbricoides was 11.48 (95% CI: 10.93-12.04%), Trichuris trichiura 18.22% (95% CI: 17.56-18.90%) and hookworms 1.55% (95% CI: 1.35-1.78%), with an overall STH prevalence of 24.10% (95% CI: 23.36-24.85%) across the three regions. STH was more prevalent in the East region (46.57%; 95% CI: 44.41-48.75%) in comparison to the Centre (25.12; 95% CI: 24.10-26.17%) and West (10.49%; 95% CI: 9.57-11.51%) regions., Conclusions/significance: In comparison to previous data, the results showed an increase of schistosomiasis transmission in several health districts, whereas there was a significant decline of STH infections. Based on the prevalence data, the continuation of annual or bi-annual MDA for STH is recommended, as well as an extension of praziquantel in identified moderate and high risk communities for schistosomiasis.

The present study was designed to assess the perceptions of hematuria, the most conspicuous sign of urinary schistosomiasis, in selected communities of the sudano-sahelian zone of Cameroon. Study questionnaires related to knowledge, beliefs and stigma associated with hematuria were administered to 964 pupils from 15 randomly selected schools. In order to ascertain children perceptions, we interviewed 143 adults living less than 2 kilometers from the target school. School children provided urine samples that were examined using the dip stick and sedimentation methods. Exposure to sun was the most reported cause of hematuria (53% adult and 62% children respondents), followed by drinking of dirty water (18% adults and 41% children). Only 15% of adult and 26% school children could relate hematuria to wading, a common means of exposure to urinary schistosomiasis. More than half of the school children stated that hematuria was a sign of disease (56%). Few pupils perceived hematuria to be a sign of strength (6%), while others related it to puberty (30%). Most pupils (80%) reported that hematuria was preventable while others (20% ) ascribed it to witchcraft. Pupils reported that hematuria could be cured in the hospital (65%), by the traditional healer (21%), or by reading Holy Scriptures (14%). Some respondents (35% of adult, and 40% of school children) stated that it was shameful to have blood in urine. Almost half of the adult respondents and 26% of the school children reported that hematuria was contagious. Boys and girls had similar levels of oviuria (OR=0.79 p>0.05), but boys were 4 times more likely to report hematuria (OR= 3.62, p<0.001). There was a poor understanding of the means of exposure, transmission and treatment of hematuria. Some aspects of the perceptions of hematuria reported herein corroborate with previous studies carried out in Cameroon, Niger, Ghana, Kenya and Tanzania. They should be considered, together with other socioeconomic and cultural determinants in the design of educational messages applicable to the study region.

The present study was designed to assess the value of self reported hematuria and dysuria in the diagnosis of urinary schistosomiasis at the individual level. A sample of 964 school children of grade 5 and 6 from 15 schools of the French speaking educational system in the Sudano-sahelian zone of northern Cameroon were submitted to a questionnaire related to hematuria and dysuria, and provided a urine sample each. The urine samples were processed using the dip stick and sedimentation methods, and the degree of microhematuria and oviuria determined. In all 964 questionnaires were collected, 843 urine samples examined for microhematuria and 871 for oviuria. The percentage of children reporting hematuria increased with the degree of microhematuria and the intensity of infection. Among the various indicators of urinary schistosome infection, microhematuria had the highest sensitivity (76%), followed by self reported hematuria or dysuria (65%), and dysuria (52%). The specificity was highest for self reported hematuria, and lowest for self reported hematuria or dysuria. The efficiency of self reported hematuria or dysuria increased with the intensity of infection and was highest (100%) for heavy infections (> 400 eggs/ml g urine). We advocate the use of self reported hematuria or dysuria for the assessment of S. haematobium at the individual level.

Aim: Gallstone disease is increasing in sub-saharan Africa (SSA). In the west, the majority of stones can be dissolved with bile salts, since the major component is cholesterol. This medical therapy is expensive and not readily accessible to poor populations of SSA. It was therefore necessary to analyze the chemical composition of biliary stones in a group of patients, so as to make the case for introducing bile salt therapy in SSA., Methods: All patients with symptomatic gallstones were recruited in the study. All stones removed during cholecystectomy were sent to Houston for x-ray diffraction analysis. Data on age, sex, serum cholesterol, and the percentage by weight of cholesterol, calcium carbonate, and amorphous material in each stone was entered into a pre-established proforma. Frequencies of the major components of the stones were determined., Results: Sixteen women and ten men aged between 27 and 73 (mean 44.9) years provided stones for the study. The majority of patients (65.38%) had stones with less than 25% of cholesterol. Amorphous material made up more than 50% and 100% of stones from 16 (61.53%) and 9 (34.61%) patients respectively., Conclusion: Cholesterol is present in small amounts in a minority of gallstones in Yaounde. Dissolution of gallstones with bile salts is unlikely to be successful.