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Background Plasmodium falciparum malaria is associated with anaemia-related morbidity, attributable to host, parasite and drug factors. We quantified the haematological response following treatment of uncomplicated P. falciparum malaria to identify the factors associated with malarial anaemia. Methods Individual patient data from eligible antimalarial efficacy studies of uncomplicated P. falciparum malaria, available through the WorldWide Antimalarial Resistance Network data repository prior to August 2015, were pooled using standardised methodology. The haematological response over time was quantified using a multivariable linear mixed effects model with nonlinear terms for time, and the model was then used to estimate the mean haemoglobin at day of nadir and day 7. Multivariable logistic regression quantified risk factors for moderately severe anaemia (haemoglobin < 7 g/dL) at day 0, day 3 and day 7 as well as a fractional fall ≥ 25% at day 3 and day 7. Results A total of 70,226 patients, recruited into 200 studies between 1991 and 2013, were included in the analysis: 50,859 (72.4%) enrolled in Africa, 18,451 (26.3%) in Asia and 916 (1.3%) in South America. The median haemoglobin concentration at presentation was 9.9 g/dL (range 5.0–19.7 g/dL) in Africa, 11.6 g/dL (range 5.0–20.0 g/dL) in Asia and 12.3 g/dL (range 6.9–17.9 g/dL) in South America. Moderately severe anaemia (Hb < 7g/dl) was present in 8.4% (4284/50,859) of patients from Africa, 3.3% (606/18,451) from Asia and 0.1% (1/916) from South America. The nadir haemoglobin occurred on day 2 post treatment with a mean fall from baseline of 0.57 g/dL in Africa and 1.13 g/dL in Asia. Independent risk factors for moderately severe anaemia on day 7, in both Africa and Asia, included moderately severe anaemia at baseline (adjusted odds ratio (AOR) = 16.10 and AOR = 23.00, respectively), young age (age < 1 compared to ≥ 12 years AOR = 12.81 and AOR = 6.79, respectively), high parasitaemia (AOR = 1.78 and AOR = 1.58, respectively) and delayed parasite clearance (AOR = 2.44 and AOR = 2.59, respectively). In Asia, patients treated with an artemisinin-based regimen were at significantly greater risk of moderately severe anaemia on day 7 compared to those treated with a non-artemisinin-based regimen (AOR = 2.06 [95%CI 1.39–3.05], p < 0.001). Conclusions In patients with uncomplicated P. falciparum malaria, the nadir haemoglobin occurs 2 days after starting treatment. Although artemisinin-based treatments increase the rate of parasite clearance, in Asia they are associated with a greater risk of anaemia during recovery.

Background. Research has shown that patients fail to adhere to ART and TB treatment due to the long duration of both therapies, side effects, and forgetfulness. Objective. To assess the role of the double-way and single-way SMS on adherence to HIV and TB treatment. Materials and Methods. A randomized controlled trial among adult HIV and TB patients on treatment at the Buea Regional and Kumba District Hospitals, South West Region, Cameroon, was conducted. Participants were randomly allocated to the control, single-way, and double-way SMS intervention groups. HIV and TB participants were followed independently for a period of 6 months and 3 months, respectively. Baseline and post-intervention data were collected and analyzed using the chi-square and Student’s t-tests with statistical significance set at p < 0.05 . Results. A total of 210 HIV participants and 84 TB were recruited into the study with a mean age of 41.25 ± 10 years and 37.89 ± 13.27 years, respectively. Optimal adherence to ART and TB treatment at baseline was [65 (31%) CI: 0.247–0.372] and [35 (41.7%) CI: 0.311-0.522], respectively, and after the intervention, it increased to [72 (42.6%) CI: 0.347-0.495] and 41 (61.2%), respectively. There was an increase in adherence to ART among participants in the double-way SMS intervention group from 23 (32.9%) (RR: 1.04, CI: 0.8-1.31, p = 0.716 ) to 29 (48.3%) (RR: 1.06, CI: 0.75-1.50, p = 0.746 ). Combined single-way and double-way SMS significantly increased adherence to ART. Conclusions. The level of adherence was low among HIV and TB participants. The single-way and double-way SMS did not significantly increase adherence. However, a combination of both the double-way and single-way SMS intervention significantly improved adherence to ART.

BackgroundIntestinal parasitic infections remain of public health concern worldwide, especially among rural and poorest populations as a consequence of precariousness, lack of sanitation, non-availability of potable water and poor hygiene conditions. The present study aimed to better understand the epidemiology of intestinal parasitic infections in rural areas of forested Cameroon.MethodologyA cross-sectional survey was conducted in three Health Areas (Ndelele, Kentzou and Lolo) of the Ndelele Health District (East Region, Cameroon). Information on socio-demographic characteristics, knowledge, attitudes, and practices regarding intestinal parasitic infections were collected using a semi-structured questionnaire. Stool samples were collected and analyzed by the Kato-Katz and formalin-ether concentration techniques to complement simple direct examination.Principal FindingsA total of 406 individuals belonging to three main groups (Kako or Bantu, Baka or Pygmies and Central African Republic refugees) were enrolled in the study. The overall intestinal parasitic infection rate was 74.9%, including 57.2% cases of polyparasitism. Fourteen parasite species were identified, 89.1% being intestinal protozoa and 41.8% belonging to helminths. Infections with helminths were associated with Baka (P < 0.0001). Spring water consumption was associated with hookworm infection (OR = 3.87; P = 0.008). Garbage deposited near houses was positively associated with infection with Giardia lamblia (OR = 3.41; P = 0.003). Polyparasitism was positively linked to washing hand without soap before meal (OR= 11.64; p= 0.002).Conclusion/SignificanceIntestinal parasitic infections exhibited high rates in the Ndelele Health District, especially among indigenous and hard-to-reach populations (Pygmies). Hygiene measures appear as the main drivers sustaining transmission, and targeted strategies should be developed to efficiently fight against these debilitating diseases.Author summaryIntestinal parasitic infections such as soil transmitted helminthiasis and schistosomiasis, remain a public health concern in Cameroon. To better understand the epidemiology of these infections in hard-to-reach populations in rural areas, a cross-sectional study was carried out in three health areas of Ndelele health District in the Eastern-Cameroon. The rate of intestinal parasitic infections was high (74.9%) especially in indigenous populations (Baka-Pygmies) which exhibited high prevalence of soil transmitted helminth infections (83.3%). The study confirmed that the lack of sanitation and poor hygiene largely contribute to the endemicity of intestinal parasitic infections, particularly among indigenous populations. Targeted control strategies seem mandatory to reach these populations and offer them appropriate care to interrupt or reduce the transmission of these diseases.

Background Female Genital Schistosomiasis (FGS) is most often caused by presence of Schistosoma haematobium eggs lodged in the female reproductive tract which results in chronic fibrosis and scarring. In Cameroon, despite high community prevalences of urine-patent S. haematobium infections, FGS has yet to be studied in depth. To shed light on the clinical prevalence and socioeconomic effects of FGS, we undertook a formative community-based epidemiological and qualitative survey. Method A cross sectional multidisciplinary study of 304 girls and women from 11 remote rural fishing communities in Cameroon was undertaken using parasitological sampling, clinical colposcopy, and interviews. The lived experiences of those with FGS were documented using a process of ethnography with participant observation and in-depth interviews. Result Amongst 304 women and girls aged >5 years (Median age: 18; Interquartile range: 9.6–28), 198 females were eligible for FGS testing and 58 adult women were examined by clinical colposcopy. Of these, 34 were positive for FGS (proportion: 58.6%; 95% CI: 45.8–70.4), younger girls showing a higher FGS prevalence, and older women not shedding eggs showing a pattern for cervical lesions from earlier infection. In a subset of women with FGS selected purposively (12/58), in-depth interviews with participant observation revealed out-of-pocket expenditures of up to 500USD related health spending for repeated diagnosis and treatment of gynecological illnesses, and 9 hours daily lost reproductive labour. Psychosocial unrest, loss in social capital, and despair were linked with sub-fertility and persistent vaginal itch. Conclusion With our first formative evidence on prevalence, socioeconomic effects and experiences of FGS amongst women and girls in Cameroon, we have clarified to a new level of detail the deficit in provision of and access to peripheral health services in remote areas of Cameroon. Using this information, there is now strong evidence for national programs and services on women’s health and schistosomiasis to update and revise policies targeted on prevention and management of FGS. We therefore stress the need for regular provision of Praziquantel treatment to adolescent girls and women in S. haematobium endemic areas, alongside better access to tailored diagnostic services that can detect FGS and appropriately triage care at primary health level.

Intestinal parasitic infections (IPIs) remain a public health issue in developing countries where overcrowded settlements and poor sanitation are general rule. Due to paucity of IPIs data in known overcrowded Cameroonian prisons, this cross-sectional study conducted in 2015 in the New-Bell Central Prison (NBCP) aimed to establish biodiversity, prevalence and risk factors of intestinal protozoan and helminthe infections among inmates. Fresh stool samples collected from the NBCP volunteered inmates were laboratory examined microscopically as fresh mounts plus iodine, Kato-Katz smears, formalin-ether concentration and modified Ziehl-Nelseen stained sediments. Of a total 374 inmates who participated in the study, overall IPIs prevalence was 39.3%. Helminthe and protozoa prevalence was 16.6% and 24.6% respectively. Parasites species were recorded at following prevalence: Ascaris lumbricoides (10.4%), Trichuris trichiura (5.1%), Schistosoma mansoni (0.5%), Entamoeba histolytica/dispar (14.2%), Entamoeba coli (16.6%), Giardia intestinalis (7.2%), Chilomastix mesnili (2.4%), Blastocystis spp (2.1%) and Cryptosporidium sp (4.3%). Co-infections by two or three parasites were recorded among parasitized inmates. Overall IPIs prevalence was not significantly influenced by gender, age, detention duration, education level, handwashing practices, sanitation and drinking water source. However, highest IPIs prevalence occurred in males aged 30 to 49 years old, less than one year detainees, latrine users and those who drank borehole water. Systematic handwashing practices and education level did not influence significantly IPIs prevalence. All helminthe infections were of light intensities. Inmates in the New Bell central prison were parasitized by several species of protozoa and intestinal worms in varying prevalence depending on the detention period, the sex, the age and hygiene. A regular IPIs control among prison inmates was recommended to the NBCP managers to prevent related morbidity.

During pregnancy, the hematological system undergoes numerous changes so as to meet up with the demands of the developing fetus and placenta, with major alterations in blood volume and this differs with women from different regions. The aim of this study was therefore to assess the hematological parameters and risk factors for anemia among pregnant women according to different trimesters of pregnancy in Douala, Cameroon. Methods: A cross-sectional study was conducted from February to May 2017, and all pregnant women who attended antenatal visits during our study period and who suited our inclusion criteria were recruited. The study was carried out in the antenatal care Unit of the Douala Laquintinie Hospital (DLH). A pretested questionnaire was used for the necessary data collection. Venous blood was collected from each of these women to perform a Complete Blood Count (CBC) test using an automated hematological analyzer (URIT 3010). Data were analyzed using XLSTAT 2007 and Stata version 11 software. Results: The mean age of the participants was 28 (SD = 5 years). The prevalence of anemia among pregnant women was 22% with a majority (18.4%) of these women being mildly anemic. Mean Hemoglobin values were significantly higher among women in first trimester compared to the third (12.1 ± 0.9 g/dl vs 11.8 ± 1.3 g/dl; p = 0.043). There was also a significant change in mean hematocrit (HCT) values between the first and second trimester (32.8% ± 2.5% vs 31.4% ± 2.9%, p = 0.004) and between the first and third trimester (32.8% ± 2.5% vs 30.8% ± 3.5%, p -4). RBC count value was higher in the first trimester than in the second trimester (3.7 ± 0.3 × 1012/L vs 3.5 ± 0.4 × 1012/L, p -4) and in the third trimester (3.7 ± 0.3 × 1012/L vs 3.5 ± 0.4 × 1012/L, p = 0.001). After a multivariate analysis, the following categories of women had more odds of developing anemia; women between the age range of 30 - 35 (OR = 2.81, 95%CI: 1.16 - 6.81, p = 0.023), women in the second trimester of pregnancy (OR = 2.20, 95%CI: 0.88 - 5.48, p = 0.024), women with blood group O (OR = 3.57, 95%CI: 1.41 - 16.66, p = 0.012). Conclusion: This study confirms significant variations in hematological parameters. The findings reinforce the need for supplementation and provide additional information on hematological reference values in pregnancy in Cameroon. It also helps us understand that, third trimester, age range 30 - 35, and blood group may be potential risk factors associated with anemia in pregnancy though a cohort study would be necessary to ascertain this hypothesis.

Introduction. Malaria is and remains a serious health concern in Africa. In Cameroon, where malaria is endemic and a major public health problem, the major control measure put in place is the use of long-lasting insecticidal nets (LLINs). In the Tiko Health District (THD), the challenges have been to assess and to evaluate the ownership and utilisation of LLINs. This study sought to assess the ownership and utilisation rates of LLINs in the THD. Methodology. A cross-sectional survey involving 418 households was conducted in four health areas in the THD. A structured questionnaire was used to collect data on LLIN ownership and utilisation as well as sociodemographic characteristics. Results. The ownership of at least one LLIN per household, coverage, and accessibility were, respectively, 89%, 56.2%, and 66.3%, while installing LLINs on all beds in the household, sleeping under LLINs the previous night (SULPN), and universal utilisation were 72%, 24.9%, and 14.1%, respectively. Factors significantly associated with the ownership of at least one LLIN per household were respondent’s age and gender. Heat (21.1%) and forgetfulness (6.5%) were the main reasons postulated for irregular utilisation of LLINs. Conclusion. The ownership LLINs failed to guarantee utilisation and definitely effective control of malaria in the THD, as expected. Continuous and appropriate use of LLINs is indispensable, in addition to periodic sanitation, booster campaigns of LLIN distribution, and evaluation research for effective prevention and control of malaria.

Background Incomplete adherence to antiretroviral therapy (ART) is one of the factors that contribute to HIV drug resistance, and it is a major problem for the public health system in controlling the HIV pandemic. There is emerging evidence that SMS can play an important role in health care delivery among patients with HIV on ART, especially in resource-limited settings. Objective This paper aims to assess the impact of two-way and one-way SMS text messaging on adherence to HIV treatment. We hypothesized that sending weekly text messages through the one-way and two-way SMS text messaging approach will improve adherence to ART among patients with HIV and improve associated clinical outcomes (quality of life). Methods A randomized controlled trial is being carried out among participants with HIV who have been on ART for at least one month from an accredited treatment center, namely the Buea Regional Hospital and Kumba District Hospital of South West Region, Cameroon. Participants with HIV, both male and female, aged 21 years and older make up a sample size of 207. The interventions involved the use of mobile phone text messages. Before commencing the intervention, a focus group discussion was carried out among the participants to understand their perception about the use of SMS-based interventions to improve adherence. A total of 246 participants were randomized to receive either a one-way text message (SMS sent to a recipient without recipient sending a reply) or two-way text message (SMS sent to a recipient and recipient sends a reply) or the control (no SMS, only standard care). Data on adherence and quality of life were collected at baseline and after 6 months and will be analyzed using SPSS version 21, while qualitative data will be analyzed using Atlas.ti 7.5. Results Data collection began in September 2019 with focus group discussions and baseline data collection. After 1 month of baseline data collection, the intervention began in October 2019, and postintervention data were collected after 6 months (March 2020). At the end of the study, we will be able to understand the perception of patients toward SMS text messaging–based interventions and also assess the impact of one-way and two-way SMS text messages on treatment adherence among patients with HIV and on associated clinical outcomes (quality of life). Conclusions The impact of SMS text messaging varies across different settings. The results from this study will determine the perception of patients toward an SMS text messaging–based intervention and its impact on adherence to ART. International Registered Report Identifier (IRRID) DERR1-10.2196/16127

Introduction: Blastocystis spp. is a protist found in humans. Although usually the most frequent protozoa found in stool samples of both symptomatic and healthy subjects, its pathogenic or rather opportunistic role is yet to be clearly elucidated. To attempt to fill this gap, a cross-sectional study was conducted to compare the frequency of Blastocystis spp. in HIV positive (HIV+) versus HIV negative (HIV-) individuals in four health facilities of the Center Region of Cameroon. Methodology: Stool samples were collected from 283 HIV positive and 245 HIV negative subjects and analyzed using direct diagnostic tests. Results: A total of 46 (8.7%) individuals were found infected with Blastocystis spp., including 6.7% HIV positive and 11.0% HIV negative. This species was more frequent in urban and semi-urban areas than in rural areas, but evenly distributed among genders and age groups as well as among all sectors of activity. The prevalence of Blastocystis spp. (11.3%) was higher in HIV+ patients with a CD4 count ≥ 500 cells / mm3, but no significant difference was found among HIV clinical stages. Likewise prevalence, the mean number of cysts per gram of stool was similar between HIV positive and HIV negative individuals. People infected with Blastocystis spp. showed diverse clinical signs, but only flatulence was significantly more prevalent. The frequencies of these clinical signs were not related to HIV status. Conclusion: No clear relationship links the infection with Blastocystis spp. to HIV, although its presence was associated with digestive disorder, suggesting that this parasite might not be opportunist.

Malaria still has a devastating impact on public health and welfare in Cameroon. Despite the increasing number of studies conducted on disease prevalence, transmission patterns or treatment, there are to date, not enough studies summarising findings from previous works in order to identify gaps in knowledge and areas of interest where further evidence is needed to drive malaria elimination efforts. The present study seeks to address these gaps by providing a review of studies conducted so far on malaria in Cameroon since the 1940s to date. Over 250 scientific publications were consulted for this purpose. Although there has been increased scale-up of vector control interventions which significantly reduced the morbidity and mortality to malaria across the country from a prevalence of 41% of the population reporting at least one malaria case episode in 2000 to a prevalence of 24% in 2017, the situation is not yet under control. There is a high variability in disease endemicity between epidemiological settings with prevalence of Plasmodium parasitaemia varying from 7 to 85% in children aged 6 months to 15 years after long-lasting insecticidal nets (LLINs) scale-up. Four species of Plasmodium have been recorded across the country: Plasmodium falciparum, P. malariae, P. ovale and P. vivax. Several primate-infecting Plasmodium spp. are also circulating in Cameroon. A decline of artemisinin-based combinations therapeutic efficacy from 97% in 2006 to 90% in 2016 have been reported. Several mutations in the P. falciparum chloroquine resistance (Pfcrt) and P. falciparum multidrug resistance 1 (Pfmdr1) genes conferring resistance to either 4-amino-quinoleine, mefloquine, halofanthrine and quinine have been documented. Mutations in the Pfdhfr and Pfdhps genes involved in sulfadoxine-pyrimethamine are also on the rise. No mutation associated with artemisinin resistance has been recorded. Sixteen anopheline species contribute to malaria parasite transmission with six recognized as major vectors: An. gambiae, An. coluzzii, An. arabiensis, An. funestus, An. nili and An. moucheti. Studies conducted so far, indicated rapid expansion of DDT, pyrethroid and carbamate resistance in An. gambiae, An. coluzzii, An. arabiensis and An. funestus threatening the performance of LLINs. This review highlights the complex situation of malaria in Cameroon and the need to urgently implement and reinforce integrated control strategies in different epidemiological settings, as part of the substantial efforts to consolidate gains and advance towards malaria elimination in the country.

The formalization of Cameroon's health policy has been largely prescribed by international institutions for several decades. Emblematic of the era of governance and partnership in countries with limited resources (Guilbaud, 2015), it places the public sector in a paradoxical situation, where the State called upon to stimulate, lead and supervise public action must develop balanced relations with its partners. Between this partnership dynamic that governs the State (Eboko, 2015) and the proces...

La formalisation de la politique de santé du Cameroun est en grande partie prescrite par les institutions internationales depuis plusieurs décennies. Emblématique de l’ère de la gouvernance et du partenariat dans les pays à ressources limitées (Guilbaud, 2015), elle place le secteur public dans une situation paradoxale, où l’Etat appelé à impulser, animer, encadrer l’action publique, doit aménager des relations équilibrées avec ses partenaires. Entre cette dynamique partenariale qui encadre l...

BACKGROUND Incomplete adherence to antiretroviral therapy (ART) is one of the factors that contribute to HIV drug resistance, and it is a major problem for the public health system in controlling the HIV pandemic. There is emerging evidence that SMS can play an important role in health care delivery among patients with HIV on ART, especially in resource-limited settings. OBJECTIVE This paper aims to assess the impact of two-way and one-way SMS text messaging on adherence to HIV treatment. We hypothesized that sending weekly text messages through the one-way and two-way SMS text messaging approach will improve adherence to ART among patients with HIV and improve associated clinical outcomes (quality of life). METHODS A randomized controlled trial is being carried out among participants with HIV who have been on ART for at least one month from an accredited treatment center, namely the Buea Regional Hospital and Kumba District Hospital of South West Region, Cameroon. Participants with HIV, both male and female, aged 21 years and older make up a sample size of 207. The interventions involved the use of mobile phone text messages. Before commencing the intervention, a focus group discussion was carried out among the participants to understand their perception about the use of SMS-based interventions to improve adherence. A total of 246 participants were randomized to receive either a one-way text message (SMS sent to a recipient without recipient sending a reply) or two-way text message (SMS sent to a recipient and recipient sends a reply) or the control (no SMS, only standard care). Data on adherence and quality of life were collected at baseline and after 6 months and will be analyzed using SPSS version 21, while qualitative data will be analyzed using Atlas.ti 7.5. RESULTS Data collection began in September 2019 with focus group discussions and baseline data collection. After 1 month of baseline data collection, the intervention began in October 2019, and postintervention data were collected after 6 months (March 2020). At the end of the study, we will be able to understand the perception of patients toward SMS text messaging–based interventions and also assess the impact of one-way and two-way SMS text messages on treatment adherence among patients with HIV and on associated clinical outcomes (quality of life). CONCLUSIONS The impact of SMS text messaging varies across different settings. The results from this study will determine the perception of patients toward an SMS text messaging–based intervention and its impact on adherence to ART. INTERNATIONAL REGISTERED REPORT DERR1-10.2196/16127

Background: Nosocomial infection’s (NIs) data are scarce in developing countries. In some of these countries, national guidelines for its prevention by health facilities have introduced surveillance recommendations including Infection Control Assessment Tool (ICAT). The aim of our study was to evaluate the compliance levels of NIs recommendations. Methodology: We conducted a cross-sectional study from September to December 2018 in 10 health facilities in Yaounde. A checklist with two modules from the ICAT (Health Facility information and Infection Control Program) was used to determine the degree of compliance towards the recommendations by performing interviews, observations and consultation of documents. Results: Sixty (60) % of health facilities are aware of the national guidelines and regulation on the fight against NIs but only 30% have adopted them. Accreditation standards applicable to health facilities are not known by any of the health facilities. The recommendations concerning demographic characteristics, water supply and the general characteristics on rooms were generally respected (more than 50%) in 90% of the health facilities. 100% of health facilities had less than fifty (50)% compliance level for the fight against NIs recommendations with compliance levels below 15% for 50% of them. This worst compliance (less than 15%) was especially observed with recommended practices concerning responsibilities and authorities (40% of health facilities), functionality of infection and control committees (50% of health facilities), key personnel responsible for fight against NIs (30% of health facilities) and study of outbreaks and surveillance of NIs (100% of health facilities). Training programs on fight against NIs had better scores (30% of health facilities with more than 50% of compliance levels). The Fischer test shows that there is a significant relationship between the compliance with all these recommended practices and the health facility capacity (P= 0, 0476) . Conclusion: NIs control programs in Yaounde health facilities are insufficient. Awareness, training, promotion and follow-up actions are necessary for the understanding and adoption of recommendations on the monitoring of NIs.

Background: Depression of the immune system caused by the human immunodeficiency virus (HIV) promotes the onset of opportunistic infections including intestinal parasites. Objectives: In this study, we are comparing the prevalence of these parasitic infections among individuals infected with HIV (HIV+) and non-infected (HIV-) enrolled in four HIV care units in the Centre Region of Cameroon. Methods: A cross-sectional study was conducted and stool samples were collected from 283 HIV positive subjects and 245 seronegative subjects. These samples were processed using direct wet mount, formol-ether concentration, Kato-Katz procedure, modified Ziehl-Neelsen staining, and Baermann techniques to identify both common and opportunistic intestinal parasites. Logistic regression analyses were used to assess the association between HIV infection and socio-demographics factors as well as infection with intestinal parasites. Results: A total of 123 (23.4%) individuals were found infected with at least one protozoan parasite species, and nine (1.7%) with intestinal worms. Overall, infection rates were 27.9% and 22.4% among HIV+ and HIV- subjects, respectively. The frequencies of Cryptosporidium spp. and Entamoeba histolytica/dispar were significantly more important among HIV+ subjects (P < 0.0455). Pentatrichomonas hominis and Entamoeba coli were significantly more prevalent among HIV- subjects (P < 0.0210). Heterogeneity was observed in the distribution of intestinal parasites, according to socio-demographic parameters. In addition, Cryptosporidium spp. was significantly associated with the decrease in CD4 cell count (P = 0.0035). The frequencies of infections with Cryptosporidium spp., Isospora belli, and Iodamoeba buetschlii were significantly more important in HIV positive patients not taking antiretroviral (P < 0.0226). Conclusions: Cryptosporidium spp., Entamoeba histolytica/dispar, and Blastocystis spp. were the intestinal pathogens more often found among HIV infected individuals. HIV positive subjects were significantly more infected with intestinal parasites than seronegatives in intermediate and rural settings, among individuals aged more than 45 years and among unemployed individuals.

Schistosomiasis is endemic in Cameroon with three Schistosoma species infecting human in many areas. Data from many countries endemic for S.mansoni, S.haematobium and S.japonicum reported an age-dependent antibody response profile using homologous adult schistosome antigen extract. Less is known about the antibody profile in schistosomiasis endemic areas in Cameroon. This study aimed to assess the IgM and IgG antibody profiles using adult S.guineensis extract in immune sera from Schistosoma egg positive Cameroonians from intestinal or urinary schistosomiasis endemic areas. Whole adult S.guineensis antigen was extracted from a Cameroonian S.guineensis strain maintained in laboratory. The antigen extract was a supernatant obtained after centrifugation of grinded freeze-thawed 45 days old worms in enzyme inhibitor solution. Sera were obtained from residents of schistosomiasis endemic areas with microscopically confirmed monospecific infection by S.guineensis, S.mansoni or S.haematobium and Schistosoma free control sera from non endemic area. IgM and IgG antibody titers detection was proceeded by indirect ELISA using HRP-conjugated secondary IgM or IgG antibody. Optical densities (OD) were recorded with a spectrophotometer plate reader at 495 nm and mean OD were statistically analyzed according to age using Student t-test and egg load using ANOVA test. A total of 189 sera were tested. Sera from S.haematobium, S.mansoni and S.guineensis infections represented 68, 73 and 46 respectively. Of S.mansoni infection sera, 31 were collected at Lagdo and 42 in S.mansoni monospecific focus. Age had no significant influence on mean IgM and IgG antibodies OD although mean IgM and IgG changed with age. Mean IgG antibody increased with age in the three schistosomiasis sera. According to age, mean IgM decreased in S.guineensis infections sera, decreased from young to participants aged 15 to 24 years then increased in older in schistosomiasis mansoni sera. In schistosomiasis haematobium sera, mean IgM increased from young to participants aged 15 to 24 years then decreased in older. Egg load influenced significantly mean IgM and IgG titers. Mean IgM OD decreased with egg load in each of the schistosomiasis whereas mean IgG decreased in intestinal schistosomiasis sera. Mean IgM and IgG antibody titers detected with adult S.guineensis extract using ELISA technique in either intestinal or urinary schistosomiasis endemic areas in Cameroon were not age dependent but egg load depended on egg load in urine and stool samples. Diagnostic performance of the adult S.guineensis extract in antibody detection has been tested.Read Complete Article at ijSciences: V82019042038 AND DOI: http://dx.doi.org/10.18483/ijSci.2038

Following highly prevalent Plasmodium resistant strains to antimalarial monotherapies in malaria endemic countries, uncomplicated malaria treatment policy changed to artemisinine-based combination therapies (ACTs). After adoption of this new treatment policy in a country, sufficient care is needed to be taken to prevent occurrence of resistance to the latest drugs. As Cameroon shifted to ACT in 2004, this study aimed to assess knowledge and practices of health workers in government health facilities of the Littoral region regarding mild malaria management in health facilities as well as according to prescription qualities of ACTs in leaflets received in pharmacies. A total of 66 physicians and 16 nurses were questioned in 10 health facilities and 503 medical leaflets with ACTs prescriptions were viewed in 17 pharmacies. All medical workers questioned correctly were defined mild malaria and were aware of the antimalarial policy change in Cameroon. Overall ACTs prescription for mild malaria management in children and adult patients was 72.2% and 87.8% respectively. An important proportion of health workers prescribed antimalarial monotherapies and non recommended antimalarial for uncomplicated malaria treatment. 31.7% of participants did not systematically recommend laboratory diagnostic test before antimalarial prescription. Of leaflets viewed in pharmacies, ACTs were prescribed by physicians, nurses and laboratory technicians. Age was the only criteria for ACTs prescription. Appropriate ACTs quality prescription ranged between 81.2% and 94.4%. Of the ACTs prescribed, blisters had the highest (92.9%) appropriate quality prescription and solutions the lowest (83.3%). According to qualification of prescribers, physicians had the highest score (93.1%) of appropriate quality prescription and laboratory technicians the lowest score (28.1%). For all ACTs containing medical leaflets, concomitant medications were recorded namely antipyretic (73.9%), antibiotic (21.9%), non steroid anti-inflammatory (19.9%) or vitamins (18.1%). Data gathered indicated that although health workers were aware of uncomplicated malaria treatment policy change in Cameroon, mild malaria mismanagement was prevailing in health facilities of the Littoral region and ACTs quality prescription in medical leaflets was not optimal. Therefore, awareness is still needed among prescribers in order to prevent or at least slow the occurrence of Plasmodium resistant strains to ACTs in Cameroon.

Cutaneous leishmaniasis (CL) patients coinfected with HIV are known to show a more severe, prolonged course of disease; the immunological basis is not known. We now assessed clinical features, sera and skin biopsies of HIV(+) and HIV(-) patients with CL to identify drivers of increased susceptibility to Leishmania. CL lesion numbers, surface, and healing duration were significantly increased in HIV(+) as compared to HIV(-) patients (2.5, 14 and4-fold, respectively). Patients with HIV infection exhibited lower serum Leishmania-specific IgG levels and decreased IL-6 and IL-8. Most importantly, dramatically decreased numbers of CD4(+) T cells (approximately eightfold), but not CD8(+) cells, together with fewer CXCR3(+) Th1 cells, fewer Foxp3(+) effector/regulatory T cells, and reduced levels of IFN-γ expression were found in lesional skin. Our findings suggest that compromised CD4(+) T-cell responses may be responsible for worsened disease outcome leading to defects in parasite elimination in the absence of sufficient numbers of IFN-γ-producing Th1 cells.

Background:Dihydroartemisinin-piperaquine (DP) is increasingly recommended for antimalarial treatment in many endemic countries; however, concerns have been raised over its potential under dosing in young children. We investigated the influence of different dosing schedules on DP's clinical efficacy.Methods and Findings:A systematic search of the literature was conducted to identify all studies published between 1960 and February 2013, in which patients were enrolled and treated with DP. Principal investigators were approached and invited to share individual patient data with the WorldWide Antimalarial Resistance Network (WWARN). Data were pooled using a standardised methodology. Univariable and multivariable risk factors for parasite recrudescence were identified using a Cox's regression model with shared frailty across the study sites. Twenty-four published and two unpublished studies (n = 7,072 patients) were included in the analysis. After correcting for reinfection by parasite genotyping, Kaplan-Meier survival estimates were 97.7% (95% CI 97.3%-98.1%) at day 42 and 97.2% (95% CI 96.7%-97.7%) at day 63. Overall 28.6% (979/3,429) of children aged 1 to 5 years received a total dose of piperaquine below 48 mg/kg (the lower limit recommended by WHO); this risk was 2.3-2.9-fold greater compared to that in the other age groups and was associated with reduced efficacy at day 63 (94.4% [95% CI 92.6%-96.2%], p

Additional file 3: This table shows a classification of RDTs on the basis of some operational characteristics. Assessment of the suitability for field use included the simplicity of performing the test based on the insert instructions and illustrations on the one hand and the ease of interpretation of results within the time frame stated in the insert. The provision or requirement of additional materials like testubes, pipettes etc. were also taken into consideration in the final assessments. The scale used for classifying RDTs based on operational characteristics is alsho shown.

OBJECTIVE: Report on the early outcomes achieved in the prevention of mother-to-child transmission (PMTCT) programme in the Djoungolo Health District using more effective antiretroviral PMTCT regimens. METHODS: Observational cohort of HIV exposed infants. MAIN OUTCOME MEASURE: early infant HIV status and 3-month mortality rate. RESULTS: From March 2008 to March 2010 587 HIV-positive mother-baby pairs were enrolled and classified according to the following maternal antiretroviral regimen: Group 1: highly active antiretroviral therapy (HAART) Group 2: dual therapy Group 3: no treatment. 484/587 (82%) underwent HIV-early infant diagnosis at a median age of 7 weeks; 4.5% (95% CI 2.65-6.34) were HIV-infected. HIV transmission rate differed by maternal prophylaxis: 1.7% for HAART 2.7% for dual therapy and 15.7% for Group 3 (p < 0.001) but not by feeding method (2.74%)-exclusive breastfeeding vs. 5.34% formula (NS). The 3-month mortality rate stands at 1%. CONCLUSIONS: The 4.5% MTCT-rate of HIV-1 reported confirms the feasibility and effectiveness of a district wide PMTCT programme using HAART in low-income settings.

To evaluate the effectiveness of 10 years' annual single dose ivermectin treatment on onchocerciasis transmission in hyperendemic areas of Cameroon and Uganda.Baseline nodule and microfilaria ('skin snip') prevalence data were available from 10 hyperendemic sentinel communities in Cameroon (from 1996) and hyperendemic 20 sentinel communities in Uganda (from 1993). We returned to these villages in 2005, 10 months after the last annual ivermectin distribution, to repeat the cross-sectional surveys. Each sentinel community reported a mean interval treatment coverage of eligible persons of88% (range 37-100%). Data were analyzed for more than 6200 person examinations. In Cameroon, 719 peopleor=10 years were examined at the baseline survey in 1996 and 838 at the follow-up survey in 2005. In Uganda, 1590 peopleor=10 years were examined at the baseline survey in 1993 and 2122 people at the follow-up survey in 2005. We also examined children under 10 in Cameroon (1996, n = 185; 2005, n = 448) and Uganda (1993, n = 177; 2005, n = 130). In Uganda, the vitality of worms was judged using standard histological criteria in 80 nodules excised in 2005.The prevalence of microfilaria carriers among older children and adults (or=10 years) in Cameroon sentinel communities dropped from 70.1% to 7.04% (P0.0001) over the 10-year treatment period; that of nodule carriers from 58% to 9.55% (P0.0001). Similarly, in Uganda, the prevalence of microfilaria carriers fell from 71.9% to 7.49% (P0.0001) over the 13-year treatment period, and that of nodule carriers from 53.21% to 9.66% (P0.0001). The number of microfilaria carriers among children10 years in Cameroon decreased from 29.73% to 3.8% (P0.0001), and in Uganda from 33.89% to 3.1% (P0.0001). In 2005, worms excised from nodules in Uganda, 81.4% of males remained alive, and 64% of females, with 24% of them inseminated.A decade or more of annual single dose ivermectin treatment in hyperendemic areas has reduced onchocerciasis to 'hypoendemicity', but onchocerciasis transmission persists. For now, annual treatment with ivermectin should be continued in formerly mesoendemic and hyperendemic zones.

Background Hepatitis B is a major health concern in Africa. The vaccine against hepatitis B virus (HBV) was introduced into the Expanded Programme on Immunization (EPI) of Cameroon and Senegal in 2005, and of CAR (Central African Republic) in 2008. A cross-sectional study was conducted to assess HBV immunization coverage following the vaccine’s introduction into the EPI and factors associated with having been vaccinated. Methods All hospitalized children, regardless of the reasons for their hospitalization, between 3 months and 6 years of age, for whom a blood test was scheduled during their stay and whose condition allowed for an additional 2 mL blood sample to be taken, and who provided the parent’s written consent were included. All children anti-HBs- and anti-HBc + were tested for HBsAg. Vaccination coverage was assessed in three different ways: immunization card, maternal recall and serologic anti-HBs profile. Results 1783 children were enrolled between April 2009 and May 2010. An immunization card was only available for 24 % of the children. The median age was 21 months. Overall HBV immunization coverage based on immunization cards was 99 %, 49 % and 100 % in Cameroon, CAR and Senegal, respectively (p

WWARN Artemisinin based Combination Therapy (ACT) Africa Baseline Study Group; International audience; Background: Artemisinin-resistant Plasmodium falciparum has emerged in the Greater Mekong sub-region and poses a major global public health threat. Slow parasite clearance is a key clinical manifestation of reduced susceptibility to artemisinin. This study was designed to establish the baseline values for clearance in patients from Sub-Saharan African countries with uncomplicated malaria treated with artemisinin-based combination therapies (ACTs). Methods: A literature review in PubMed was conducted in March 2013 to identify all prospective clinical trials (uncontrolled trials, controlled trials and randomized controlled trials), including ACTs conducted in Sub-Saharan Africa, between 1960 and 2012. Individual patient data from these studies were shared with the WorldWide Antimalarial Resistance Network (WWARN) and pooled using an a priori statistical analytical plan. Factors affecting early parasitological response were investigated using logistic regression with study sites fitted as a random effect. The risk of bias in included studies was evaluated based on study design, methodology and missing data. Results: In total, 29,493 patients from 84 clinical trials were included in the analysis, treated with artemether-lumefantrine (n = 13,664), artesunate-amodiaquine (n = 11,337) and dihydroartemisinin-piperaquine (n = 4,492). The overall parasite clearance rate was rapid. The parasite positivity rate (PPR) decreased from 59.7 % (95 % CI: 54.5–64.9) on day 1 to 6.7 % (95 % CI: 4.8–8.7) on day 2 and 0.9 % (95 % CI: 0.5–1.2) on day 3. The 95th percentile of observed day 3 PPR was 5.3 %. Independent risk factors predictive of day 3 positivity were: high baseline parasitaemia (adjusted odds ratio (AOR) = 1.16 (95 % CI: 1.08–1.25); per 2-fold increase in parasite density, P 37.5 °C) (AOR = 1.50 (95 % CI: 1.06–2.13), P = 0.022); severe anaemia (AOR = 2.04 (95 % CI: 1.21–3.44), P = 0.008); areas of low/moderate transmission setting (AOR = 2.71 (95 % CI: 1.38–5.36), P = 0.004); and treatment with the loose formulation of artesunate-amodiaquine (AOR = 2.27 (95 % CI: 1.14–4.51), P = 0.020, compared to dihydroartemisinin-piperaquine). Conclusions: The three ACTs assessed in this analysis continue to achieve rapid early parasitological clearance across the sites assessed in Sub-Saharan Africa. A threshold of 5 % day 3 parasite positivity from a minimum sample size of 50 patients provides a more sensitive benchmark in Sub-Saharan Africa compared to the current recommended threshold of 10 % to trigger further investigation of artemisinin susceptibility.

Background Artemether-lumefantrine is the most widely used artemisinin-based combination therapy for malaria, although treatment failures occur in some regions. We investigated the effect of dosing strategy on efficacy in a pooled analysis from trials done in a wide range of malaria-endemic settings. Methods We searched PubMed for clinical trials that enrolled and treated patients with artemether-lumefantrine and were published from 1960 to December, 2012. We merged individual patient data from these trials by use of standardised methods. The primary endpoint was the PCR-adjusted risk of Plasmodium falciparum recrudescence by day 28. Secondary endpoints consisted of the PCR-adjusted risk of P falciparum recurrence by day 42, PCR-unadjusted risk of P falciparum recurrence by day 42, early parasite clearance, and gametocyte carriage. Risk factors for PCR-adjusted recrudescence were identified using Cox's regression model with frailty shared across the study sites. Findings We included 61 studies done between January, 1998, and December, 2012, and included 14 327 patients in our analyses. The PCR-adjusted therapeutic efficacy was 97.6% (95% CI 97.4-97.9) at day 28 and 96.0% (95.6-96.5) at day 42. After controlling for age and parasitaemia, patients prescribed a higher dose of artemether had a lower risk of having parasitaemia on day 1 (adjusted odds ratio [OR] 0.92, 95% CI 0.86-0.99 for every 1 mg/kg increase in daily artemether dose; p=0.024), but not on day 2 (p=0.69) or day 3 (0.087). In Asia, children weighing 10-15 kg who received a total lumefantrine dose less than 60 mg/kg had the lowest PCR-adjusted efficacy (91.7%, 95% CI 86.5-96.9). In Africa, the risk of treatment failure was greatest in malnourished children aged 1-3 years (PCR-adjusted efficacy 94.3%, 95% CI 92.3-96.3). A higher artemether dose was associated with a lower gametocyte presence within 14 days of treatment (adjusted OR 0.92, 95% CI 0.85-0.99; p=0.037 for every 1 mg/kg increase in total artemether dose). Interpretation The recommended dose of artemether-lumefantrine provides reliable efficacy in most patients with uncomplicated malaria. However, therapeutic efficacy was lowest in young children from Asia and young underweight children from Africa; a higher dose regimen should be assessed in these groups.

Background Artesunate-amodiaquine (AS-AQ) is one of the most widely used artemisinin-based combination therapies (ACTs) to treat uncomplicated Plasmodium falciparum malaria in Africa. We investigated the impact of different dosing strategies on the efficacy of this combination for the treatment of falciparum malaria. Methods Individual patient data from AS-AQ clinical trials were pooled using the WorldWide Antimalarial Resistance Network (WWARN) standardised methodology. Risk factors for treatment failure were identified using a Cox regression model with shared frailty across study sites. Results Forty-three studies representing 9,106 treatments from 1999-2012 were included in the analysis; 4,138 (45.4%) treatments were with a fixed dose combination with an AQ target dose of 30 mg/kg (FDC), 1,293 (14.2%) with a non-fixed dose combination with an AQ target dose of 25 mg/kg (loose NFDC-25), 2,418 (26.6%) with a non-fixed dose combination with an AQ target dose of 30 mg/kg (loose NFDC-30), and the remaining 1,257 (13.8%) with a co-blistered non-fixed dose combination with an AQ target dose of 30 mg/kg (co-blistered NFDC). The median dose of AQ administered was 32.1 mg/kg [IQR: 25.9-38.2], the highest dose being administered to patients treated with co-blistered NFDC (median = 35.3 mg/kg [IQR: 30.6-43.7]) and the lowest to those treated with loose NFDC-25 (median = 25.0 mg/kg [IQR: 22.7-25.0]). Patients treated with FDC received a median dose of 32.4 mg/kg [IQR: 27-39.0]. After adjusting for reinfections, the corrected antimalarial efficacy on day 28 after treatment was similar for co-blistered NFDC (97.9% [95% confidence interval (CI): 97.0-98.8%]) and FDC (98.1% [95% CI: 97.6%-98.5%]; P = 0.799), but significantly lower for the loose NFDC-25 (93.4% [95% CI: 91.9%-94.9%]), and loose NFDC-30 (95.0% [95% CI: 94.1%-95.9%]) (P

BACKGROUND: Artemisinin-resistant Plasmodium falciparum has emerged in the Greater Mekong sub-region and poses a major global public health threat. Slow parasite clearance is a key clinical manifestation of reduced susceptibility to artemisinin. This study was designed to establish the baseline values for clearance in patients from Sub-Saharan African countries with uncomplicated malaria treated with artemisinin-based combination therapies (ACTs). METHODS: A literature review in PubMed was conducted in March 2013 to identify all prospective clinical trials (uncontrolled trials, controlled trials and randomized controlled trials), including ACTs conducted in Sub-Saharan Africa, between 1960 and 2012. Individual patient data from these studies were shared with the WorldWide Antimalarial Resistance Network (WWARN) and pooled using an a priori statistical analytical plan. Factors affecting early parasitological response were investigated using logistic regression with study sites fitted as a random effect. The risk of bias in included studies was evaluated based on study design, methodology and missing data. RESULTS: In total, 29,493 patients from 84 clinical trials were included in the analysis, treated with artemether-lumefantrine (n = 13,664), artesunate-amodiaquine (n = 11,337) and dihydroartemisinin-piperaquine (n = 4,492). The overall parasite clearance rate was rapid. The parasite positivity rate (PPR) decreased from 59.7 % (95 % CI: 54.5-64.9) on day 1 to 6.7 % (95 % CI: 4.8-8.7) on day 2 and 0.9 % (95 % CI: 0.5-1.2) on day 3. The 95th percentile of observed day 3 PPR was 5.3 %. Independent risk factors predictive of day 3 positivity were: high baseline parasitaemia (adjusted odds ratio (AOR) = 1.16 (95 % CI: 1.08-1.25); per 2-fold increase in parasite density, P 37.5 °C) (AOR = 1.50 (95 % CI: 1.06-2.13), P = 0.022); severe anaemia (AOR = 2.04 (95 % CI: 1.21-3.44), P = 0.008); areas of low/moderate transmission setting (AOR = 2.71 (95 % CI: 1.38-5.36), P = 0.004); and treatment with the loose formulation of artesunate-amodiaquine (AOR = 2.27 (95 % CI: 1.14-4.51), P = 0.020, compared to dihydroartemisinin-piperaquine). CONCLUSIONS: The three ACTs assessed in this analysis continue to achieve rapid early parasitological clearance across the sites assessed in Sub-Saharan Africa. A threshold of 5 % day 3 parasite positivity from a minimum sample size of 50 patients provides a more sensitive benchmark in Sub-Saharan Africa compared to the current recommended threshold of 10 % to trigger further investigation of artemisinin susceptibility.

Background:Dihydroartemisinin-piperaquine (DP) is increasingly recommended for antimalarial treatment in many endemic countries; however, concerns have been raised over its potential under dosing in young children. We investigated the influence of different dosing schedules on DP's clinical efficacy.Methods and Findings:A systematic search of the literature was conducted to identify all studies published between 1960 and February 2013, in which patients were enrolled and treated with DP. Principal investigators were approached and invited to share individual patient data with the WorldWide Antimalarial Resistance Network (WWARN). Data were pooled using a standardised methodology. Univariable and multivariable risk factors for parasite recrudescence were identified using a Cox's regression model with shared frailty across the study sites. Twenty-four published and two unpublished studies (n = 7,072 patients) were included in the analysis. After correcting for reinfection by parasite genotyping, Kaplan-Meier survival estimates were 97.7% (95% CI 97.3%-98.1%) at day 42 and 97.2% (95% CI 96.7%-97.7%) at day 63. Overall 28.6% (979/3,429) of children aged 1 to 5 years received a total dose of piperaquine below 48 mg/kg (the lower limit recommended by WHO); this risk was 2.3-2.9-fold greater compared to that in the other age groups and was associated with reduced efficacy at day 63 (94.4% [95% CI 92.6%-96.2%], p