Introduction: multidrug-resistant tuberculosis (MDR-TB) is a critical health challenge in Cameroon, with the Centre region bearing the heaviest burden. Despite its prevalence, national notification rates remain low (26%). Methods: we extracted data from the National TB database for 2020-2021 and administered questionnaires to surveillance staff working in all the MDR-TB diagnosis and treatment centres (DTCs). Attributes of the surveillance system were evaluated according to CDC guidelines. We developed a grid with specific scores to rank the performance of simplicity, timeliness, data quality, and stability. Results: we interviewed 33 surveillance staff from 12 DTCs: 3 (9%) medical doctors, 19 (58%) nurses, and 11 (33%) laboratory technicians. Twenty-seven percent (9/33) of staff could define presumptive MDR-TB cases, 82% (27/33) found the reporting form easy to fill, and 88% (29/33) used less than 10minutes to complete it. Completeness of MDR-TB data was 86% (41/48), and the timeliness of reports was 8% (4/48). None of the 41 reports submitted was cross-checked by a second person before submission. Fifty-eight percent (7/12) of DTCs had functional MDR-TB diagnosis machines, and 17% (2/12) had a focal point person for surveillance of MDR-TB. Conclusion: the MDR-TB SS in the Centre region was complex, unstable, not timely, and had poor quality data. Staff training, regular supportive supervision, and regular maintenance of diagnosis machines could improve MDR-TB case detection and control in the Centre region of Cameroon.
Introduction: neonatal respiratory distress (NRD) is a major contributor to neonatal morbidity and mortality in middle-income countries. The objective of this study was to identify independent risk factors for NRD using classical logistic regression and to explore multivariate interactions using a classification and regression tree (CART) model and correlation heatmaps. Methods: a retrospective cohort study was conducted from January 2023 to December 2024 at the National Reference Center for Neonatology in Rabat. During the study period, 630 newborns who met the inclusion criteria were included in 2 groups: neonates with respiratory distress (n=421) and neonates without respiratory distress (n=209). The identification of risk factors was carried out using bivariate as well as multivariate analyses and Python (Scikit-learn, Seaborn) for CART modeling and heatmap visualization. Results: six hundred and thirty (630) births were collected during this period. Neonatal respiratory distress was multifactorial. Statistical analysis could reveal mostly maternal anemia (OR = 8.10; CI: 95 (7.52 -43.55); p < 0.05), diabetes (OR = 3.65; CI: 95 (1.98-6.72); p = 0.001), caesarean section (OR = 4.23; CI: 95 (1.54-11. 59); p = 0.001), prematurity (OR = 2.45; CI: 95 (1.41-4.26); p = 0.01), as significant independent predictors of NRD (all p < 0.05). The CART model achieved perfect test set performance (AUC=1.00; sensitivity=100%; specificity=100%), suggesting potential overfitting. A Spearman correlation heatmap confirmed strong associations (ρ > 0.88) between NRD and all predictors. Conclusion: both classical and AI-based methods converged in identifying relevant clinical predictors. Interpretable AI models may enhance neonatal risk stratification, especially in resource-limited contexts.
Introduction: toxoplasmosis, although often benign, poses significant risks during pregnancy due to the possibility of congenital toxoplasmosis (CT). Maternal-fetal screening relies on early toxoplasma serology and monthly monitoring of seronegative women. Since 2020, the COVID-19 pandemic has disrupted routine screening programs. This study aimed to describe serological follow-up at our university hospital before and during the pandemic and assess its impact on CT incidence. Methods: we conducted a retrospective study including all maternal toxoplasma serologies sent to the Parasitology Laboratory of Farhat Hached University Hospital, Sousse, from January 2016 to December 2021. Screening quality was assessed by the number of serologies per pregnancy and gestational age at the first test. Results: a total of 33,786 maternal serologies were processed. Annual requests remained stable (~7,000) until 2019 but fell below 4,000 after the pandemic onset. From 2016 - 2019, 15% of women had ≥3 serologies, with half having the first test before 10 weeks of gestation. Post-pandemic, only 11% had >2 serologies, and 39% were screened before 10 weeks. First-time postpartum serologies doubled from 2% to 4.8%. Ninety-four maternal infections were identified, with an annual peak of 8.7% in 2020. Seven CT cases were confirmed, four of which occurred in 2020 - 2021; one was diagnosed antenatally. Conclusion: adherence to recommended maternal-fetal toxoplasmosis screening declined significantly during the COVID-19 pandemic. These findings highlight the urgent need to raise awareness among healthcare providers and strengthen preventive measures for seronegative pregnant women.
Globally, mental health disorders such as depression, stress, and anxiety are prevalent amongst undergraduate medical students, which may negatively impact their academic performance. In low-middle-income settings (LIMCs), where academic expectations are significant with limited mental health resources, this link necessitates further investigations. The protocol outlines a systematic review to synthesize evidence on the link between mental health status and academic outcomes amongst undergraduate medical students in LMICs. The systematic review will be conducted and reported in line with the JBI methodology and PRISMA 2020 guiding statement. A comprehensive electronic literature database search, namely Scopus, MEDLINE (PubMed), CINAHL, and Google Scholar, will be carried out using Medical Search Terms (MeSH) for articles published within the past 10 years (January 2016-December 2026). The search and selection of relevant studies will be conducted by two independent reviewers, with 2 additional reviewers independently screening titles, abstracts, and full texts. Data will be independently extracted by all reviewers, and any conflicts arising during this process will be resolved through a fifth reviewer. The JBI Critical Appraisal Checklists will be used to evaluate bias. All included studies will be subjected to narrative thematic synthesis using NVivo software. The JBI ConQual approach will be used to evaluate the confidence of the synthesized findings, which incorporates dependability and credibility themes.
Introduction: tuberculosis (TB) is a treatable infection caused by Mycobacterium tuberculosis, an airborne bacterium spreading from person to person. Tuberculosis remains a major global health concern, and South Africa has the highest incidence. Tuberculosis control is hampered by loss to follow-up and low adherence to treatment. Tuberculosis lost to follow-up has never been described in Buffalo City Metro (BCM), Eastern Cape, South Africa. The aim of this study was to estimate the proportion of lost to follow-up and identify associated risk factors. Methods: the retrospective cohort study was conducted using the secondary data from the Tier.Net system. Descriptive statistics were used to report epidemiological findings. The Poisson regression model was used to determine risk factors for lost to follow-up. Results: during the study period there were 14,182 records of tuberculosis case patients in Buffalo City Metro. Of these, 1,969 (14.8%) were lost to follow-up. The median age was 40, Interquartile Range (IQR): 31-47 years, and the majority were male (1,432/1,969, 72.7%), (1,801/1,969, 91.4%) had pulmonary tuberculosis. Antiretroviral therapy (Adjusted Incidence Rate Ratio (aIRR) 0.80, 95% confidence interval (CI): 0.72-0.89; P<0.001), age 30-44 years (aIRR 0.88, 95% CI: 0.79-0.99; P=0.04) were associated with lower probability, and new tuberculosis case (aIRR 2.96, 95% CI: 2.28-3.83; P<0.001) was associated with higher probability of tuberculosis lost to follow-up. Conclusion: our study demonstrated that being on antiretroviral therapy and newly diagnosed with tuberculosis were independently and significantly associated with a lower risk of loss to follow-up. This demonstrates the importance of early initiation of antiretroviral therapy and tuberculosis treatment, age-appropriate tailored support, and enhanced retention to care is integral in continuity of care. Addressing these programmatic factors can improve lost to follow-up (LTFU) and improve linkage to care. Therefore, improve clinical TB outcomes in similar high-burden settings.
