Introduction: in areas with intense perennial malaria transmission, limited data is available on the impact of environmental conditions especially rainfall on naturally acquired immunity against promising malaria vaccine candidates. For this reason, we have compared IgG antibody responses specific to Plasmodium spp. derived MSP3 and UB05 vaccine candidates, in plasma of children living in two areas of Cameroon differing in rainfall conditions. Methods: data about children less than 5 years old was collected during the years 2017 and 2018. Next malaria asymptomatic P. falciparum (Pf) infected children were selected following malaria test confirmation. MSP3 and UB05 specific IgG antibody responses were measured in participant's plasma using enzyme -linked immunosorbent assay (ELISA). Results: interestingly, IgG antibody responses specific to UB05 were significantly higher (p<0.0001) in Pf-negative children when compared to their asymptomatic Pf-infected counterparts living in monomodal rainfall areas. In contrast, a significantly higher (p<0.0001) IgG response to MSP3 was observed instead in asymptomatic Pfinfected children in the same population. In addition, IgG responses specific to UB05 remained significantly higher in bimodal when compared to monomodal rainfall areas irrespective of children's Pf infection status (p<0.0055 for Pf-positive and p<0.0001 for negative children). On the contrary, IgG antibody responses specific to MSP3 were significantly higher in bimodal relative to monomodal rainfall areas (P<0.0001) just for Pfnegative children. Conclusion: thus IgG antibody responses specific to UBO5 are a better correlate of naturally acquired immunity against malaria in Pfnegative Cameroonian children especially in monomodal rainfall areas.

False negative rapid diagnostic tests (RDTs) accruing to the non-detection of Plasmodium falciparum histidine-rich protein 2/3 (Pfhrp2/3) is threatening the diagnosis and management of malaria. Although regular monitoring is necessary to gauge the level of efficacy of the tool, studies in Cameroon remain limited. This study assessed Plasmodium spp. prevalence and Pfhrp2/3 gene deletions across ecological and transmission zones in Cameroon. This is a cross-sectional, multi-site, community- and hospital- based study, in 21 health facilities and 14 communities covering all five ecological settings in low seasonal (LS) and intense perennial (IPT) malaria transmission zones between 2019 and 2021. Participants were screened for malaria parasite using Pfhrp2 RDT and light microscopic examination of thick peripheral blood smears. DNA was extracted from dried blood spot using chelex®-100 and P. falciparum confirmed using varATS real-time quantitative Polymerase Chain Reaction (qPCR), P. malariae and P. ovale by real-time qPCR of Plasmepsin gene, and P. vivax using a commercial kit. Isolates with amplified Pfcsp and Pfama-1 genes were assayed for Pfhrp 2/3 gene deletions by conventional PCR. A total of 3,373 participants enrolled, 1,786 Plasmodium spp. infected, with 77.4

Background Since December 2019, the world has watched the rapid growth of a new pandemic, the COVID-19, a novel pandemic causing death and disruption of normal life. This COVID-19 continues to spread and poses serious threats to public health throughout the world. Even though vaccines are available, there is no guarantee of critical population vaccination, as there still exist stiff resistance to the uptake of the currently available vaccines. Purpose To assess nurses’ perceptions regarding the uptake of COVID-19 vaccines, determine the proportion of nurses vaccinated, as well as the associated factors influencing the uptake of COVID-19 vaccines, so as to alert decision makers on the possible limitations associated with the uptake of the vaccines in the nursing population in Fako Division, Cameroon. Methods This was a mixed method quantitative and qualitative study conducted in Fako Division. A multistage random sampling technique was employed to enroll participants into the study. We collected quantitative data from consented nurses through the use of a structured questionnaire from April 06 th to June 2 nd , 2022, and qualitative data from nurse leaders through focused-group discussion from June 3 rd to 23 rd , 2022. In the quantitative phase, we performed descriptive and inferential statistics using the SPSS Version 23.0 and in the qualitative phase, we performed a thematic content analyses and transcription. Results In the quantitative phase, we had more females 131(66.5%), and nurses aged 26-40years 90(45.7%). Most nurses worked in the maternity 49(24.9%). In the qualitative phase, 20(76.9%) were females. Regarding nurses perceptions of COVID-19 vaccines uptake, 133(67.5%) nurses had positive perceptions, and 26(07.6%) had “No trust” in the vaccines. Most nurses 109(55.3%) had not been vaccinated. Negative factors reported by nurses included the belief that the vaccines were dangerous and could cause death 120(60.9%) and 32(16.2%) said no one can influence them to change their minds about taking the vaccines. In the qualitative phase, a majority of the nurse leaders 15(57.7%) wished that COVID-19 vaccination should continue, but with accompanying research to eliminate side effects. It was observed that a majority of the nurse leaders 16(61.5%) had been vaccinated. The respondents reported some factors (belief factors, social influence and lack of knowledge), which had negatively influenced them from taking the COVID-19 vaccines. Conclusion Nurses perceived high relevance for the COVID-19 vaccines while a majority of the nurse leaders perceived that the COVID-19 vaccines are not safe, ineffective with numerous side effects, has a magnetic effect, politically motivated with bad faith, and has the possibility to cause infections. Furthermore, most nurses had not been vaccinated, but a majority of nurse leaders were reported to have taken a COVID-19 vaccine. Several negative factors including belief, social influence and religious factors were reported to have contributed to the lower uptake of the COVID-19 vaccines amongst nurses and nurse leaders in Fako division, Cameroon.

Analysis of drugs in blood samples in some low- and middle-income countries (LMIC) can be difficult or practically impossible. Laboratories in those countries might not have the financial possibilities to buy expensive equipment, such as immunological test equipment for drug screening, equipment for high-performance liquid chromatography or gas chromatography for more specific drug analysis, or mass spectrometric detectors for specific identification. Also, the maintenance and repair of these types of equipment might be difficult because of a lack of local spare parts or maintenance personnel. The import of reagents and calibration standards might be difficult if the manufacturers do not have representatives in the country. Also, some countries do not allow the import of calibration standards for illicit drugs, so quantitation may be impossible. Due to the challenges with the analysis of drugs in blood samples, many countries rely on the analysis of urine samples instead of blood, often by using simple test strips (dipsticks) or point-of-care cups to determine the presence of drugs.1, 2 Tests of that type may not have good diagnostic accuracy as cross-reactions with other substances may occur.2, 3 Positive test results in urine only tell us that the drug has most likely been used. Therefore, blood, serum or plasma samples are preferred for therapeutic drug monitoring and for the analysis of drugs when assessing possible impairment or toxicological effects. It may then be necessary to ship samples to laboratories abroad for drug testing. There are strict regulations that need to be followed when shipping blood samples because they may be infectious. This includes the presence of absorbent material in the shipping container; an appropriate coolant; a water-protective inner package; accurate labelling; an import permit, and sometimes an export permit; and documentation.4, 5 Failure to comply with the appropriate shipping guidelines may result in delays or failures in delivery. A good alternative is to prepare dried matrix spots of whole blood, serum, or plasma that can be sent by regular mail or courier services. Dried matrix spots are much less contagious and therefore safer, and they can be stored at room temperature for several days without any significant degradation.6-8 The packaging and shipment of dried matrix spots are far simpler than with liquids, consisting of a water-protective package as the inner, primary container that holds the dried sample; next, a secondary, watertight envelope for additional protection; and finally, a sturdy, high-quality outer paper package.9 Dried blood or plasma spots have been used in epidemiological studies in LMICs, for example, in studies of infectious diseases6, 10, 11 and in therapeutic drug monitoring.12, 13 Dried samples are also suitable for analysis of drugs of abuse.7, 14, 15 Several devices are available to collect and ship dried matrix spots; some of them are designed to collect defined sample volumes. These devices might be too expensive for use in resource-limited settings. An inexpensive alternative could be to use large filter paper sheets for multiple samples. The use of homemade paper samples has previously been explored for protein analysis.16 In a research project on patients injured in road traffic crashes in Cameroon, it was decided to ship frozen liquid plasma samples (LPSs) abroad for qualitative drug testing. The first sample shipment was stranded at an airport and never arrived at the laboratory. It was therefore decided to ship dried plasma spots (DPSs) abroad for testing. Several months later, the project team found an alternative shipping carrier for frozen plasma samples, which were successfully delivered to the analytical laboratory. Here, we describe a simple procedure for the preparation and shipment of DPS and the results of drug testing compared with drug findings in frozen LPSs. Trauma patients admitted to Hôpital Laquintinie de Douala (Douala, Cameroon) after involvement in road traffic crashes were asked to participate in an anonymous and voluntary study that included testing for alcohol in breath and drugs in plasma. Participating patients gave informed consent. The study was approved by the National Ethical Committee for Research for Human Health, Cameroon, with Approval No. 2018/07/1080/CE/CNERSH/SP. Blood samples were collected in 4 ml vacutainer tubes containing 2.0 mg/ml potassium oxalate and 2.0 mg/ml sodium fluoride (Becton, Dickinson and Company, Franklin Lakes, NJ, United States). The samples were centrifuged at 2,000 rpm for 10 min at 4°C, and aliquots of plasma samples were frozen at −80°C at the National Public Health Laboratory (Yaoundé, Cameroon). After thawing, 4 × 15 μl plasma was applied onto a Whatman CF12 filter paper sheet (GE Healthcare Life Sciences, Buckinghamshire, United Kingdom) cut into a size of 21 × 28 cm. A pattern to help with the application of samples was printed on each sheet using a laser printer (Figure 1). The plasma spots were dried at room temperature overnight. Each filter paper sheet was transferred to a separate zip-locked plastic bag with two small silica gel humidity absorber sachets and sent with a courier carrier to the Department of Forensic Sciences of Oslo University Hospital (Oslo, Norway) for analysis. The filter paper sheets were kept frozen until they were analysed. Frozen LPSs were sent with a courier carrier to the Division of Clinical Pharmacology, Groote Schuur Hospital, University of Cape Town (Cape Town, South Africa) for analysis. Ice packs were placed in the shipping container with the samples. Filter paper sheets spotted with 15 μl real plasma samples, blank plasma, calibrators and quality controls were cut out using scissors and transferred to a glass vial, and 25 μl of internal standard and 1 ml of methanol were added. The tubes were sonicated for 15 min and centrifuged at 3,500 rpm for 5 min. The extract was brought to dryness at 50°C under a flow of nitrogen and redissolved in 100 μl UHPLC mobile phase (10 mM ammonium formate buffer pH 3.1). The following substances were used as internal standards: 2H5-alprazolam, 13C6-amphetamine, 13C6-benzoylecgonine, 2H4-buprenorphine, 13C6-clonazepam, 13C6-cocaine, 13C2-codeine, 13C6-diazepam, 2H4-diclazepam, 2H5-fentanyl, 2H7-flunitrazepam, 13C6-MDMA, 13C6-methadone, 13C6-methamphetamine, 2H3-morphine, 13C6-nitrazepam, 13C6-oxazepam, 2H3-oxycodone,13C4-tetrahydrocannabinol, 13C-2H3-tramadol, 2H6-zolpidem and 2H8-zopiclone. The analysis was performed using an Acquity UPLC instrument coupled to a Xevo TQ-S MS/MS from Waters Corporation (Milford, MA, United States). Chromatographic separations were performed on a Kinetex biphenyl core-shell column (100 × 2.1 mm ID, 1.7 μm particles) from Phenomenex (Torrance, CA, United States) at a column temperature of 60°C, a flow rate of 0.5 ml/min and gradient elution with mobile phases consisting of 10 mM ammonium formate buffer pH 3.1 (solvent A) and MeOH (solvent B). The method has previously been validated for the analysis of blood samples.17 We used the recommended cut-off concentrations adjusted for differences in sample volume (Table 1). Drug findings above the cut-off concentrations were reported as positive. Recovery from DPSs was tested by comparing DPSs made with spiked plasma with blank DPSs spiked after extraction (n = 8). For each substance, two concentrations were used. Samples of 15 μl were applied onto a filter paper sheet and left to dry at room temperature. The dried sample spots were extracted and analysed as described in Section 2.3. Internal standards were added after extraction to correct for instrumental variations. Of each plasma sample, 100 μl was extracted with 600 μl acetonitrile and centrifuged for 5 min at 13,000 rpm. The supernatant was transferred to a 12 × 75 mm borosilicate glass tube and dried at 40°C under a flow of nitrogen. Once dried, each sample was reconstituted with solvent A containing 2H3-doxepin and 2H5-diazepam as internal standards. The analysis was performed using an HPLC Sciex Exion instrument coupled to an X500R Time-of-Flight Mass Spectrometer, all from Sciex (Framingham, MA, United States). The chromatographic separation was performed using a Kinetex 2.6 μm phenyl-hexyl column, 100A, 50 × 4.6 mm from Phenomenex, at a temperature of 30°C. Gradient elution was employed with 5 mM ammonium formate (solvent A) and 0.05% formic acid in methanol (solvent B). The estimated cut-off concentration was 20 ng/ml. Drugs identified using a library of more than 700 substances were reported as positive. The transportation of frozen plasma samples took about 24 h. When they arrived at the laboratory, the samples had thawed but were still cold. Samples were frozen until analysis. Analytical findings are presented in Table 1. Only tramadol, diazepam and benzoylecgonine were detected in the samples. For tramadol and diazepam, qualitative analysis of LPSs using HPLC-TOF-MS confirmed the presence of drugs in almost all DPSs that tested positive. However, qualitative analyses found traces of benzoylecgonine in some more LPSs than the analysis of DPSs revealed. Benzoylecgonine is a metabolite of cocaine. None of the samples that tested positive for benzoylecgonine (DPSs or LPSs) contained cocaine. Diazepam is a sedative drug that is often given to trauma patients during treatment. Tramadol is an opiate used for severe pain but is also commonly used for recreational purposes in parts of the world, including Cameroon and other African countries. We were unable to collect data on drug administration to the included trauma patients, so we do not know whether the concentrations represent therapeutic or recreational use, or a combination. Only 15 μl plasma was applied when preparing DPSs, and only one DPS spot was analysed. The cut-off concentration could be lowered if two or more spots were extracted together. The recovery from DPSs is presented in Table 2. The recovery rates were relatively low for amphetamines and MDMA (7–11%), zopiclone (10–13%) and for tramadol (12–13%) but higher for other substances. Extraction with methanol was chosen based on previously published methods for extracting drugs from dried blood spots.18, 19 Preliminary experiments revealed that extracting drugs from DPS at the required low concentration was challenging but methanol gave relatively good results. Good recovery for THC, which often can be found in much lower concentrations than for instance amphetamine, was considered a key factor. Differences between the two methods might be caused by different cut-off concentrations, low extraction recovery for some drugs when analysing DPSs and degradation during storage. Also, cross-contamination between samples on the filter paper might be an issue. However, it is an accepted practice to place multiple dried blood samples in the same container along with sachets of desiccant for shipment.20 It is therefore unlikely that cross-contamination of dry material would be a problem on sheets with multiple DPSs as the drugs to a large extent are trapped within the dried matrix of plasma proteins. A low degree of cross-contamination was confirmed as the analysis of DPSs found diazepam in only 1 out of 98 samples that were found to be negative for diazepam in LPSs and tramadol in 2 out of 57 found negative in LPSs. The numbers of positive drug findings in LPSs among samples that were negative when analysing DPSs were similar. Thus, the differences between methods are most likely caused by differences in cut-off concentrations of the two methods. The analysis were performed using test methods that had not been fully validated for the quantitation of drugs. Recovery was sufficient to detect drugs in relevant concentrations, although the low recovery for some of the analytes will give a higher detection limit. Other extraction methods should be explored in further work as well as a full validation. The transportation of frozen LPSs from Cameroon to South Africa was done in the presence of cold packs. The use of dry ice would reduce the probability of thawing samples during transportation. However, it was impossible to find a courier transporter that could transport samples with dry ice. This study shows that the use of large pre-printed sheets of filter paper is a promising method that can be used to collect DPSs for simple and cheap transportation of plasma samples to the analytical laboratory. Its use should therefore be further investigated. We would like to thank Alicia Evans at the Mass Spectrometry Laboratory, Division of Clinical Pharmacology, Groote Schuur Hospital, University of Cape Town, South Africa, for analysing liquid plasma samples with TOF mass spectrometry and Sandrine H. N. Nguemeche and Pulcherie J. B. Etoga at the Laboratoire Modern de Reference, Yaoundé, for their assistance in the DPS preparation. We also thank Ago Mrsa and Leon Reubsaeth at the Department of Pharmacy, University of Oslo, for providing the filter paper. The recruitment of patients and collection of plasma samples were financially supported by the International Council on Alcohol, Drugs and Traffic Safety. The authors have no conflict of interest to declare. Research data are not shared.

The human digestive tract harbors complex microbial communities within its epithelial cell lining. Disruption in enteric immunity will promote gut dysbiosis, which can successively induce chronic inflammation within the mucous membrane and periphery. Interpretation of the specific gut microbiome changes observed during HIV infection is warranted in populations most affected.This was a case-control and comparative study design carried out between June 2018 to September 2019. A total of 40 volunteer adult participants were recruited (15 HIV-negative and 25 HIV-positive) at the Buea Regional Hospital. Blood analysis was done for CD4+ T cell count and HIV viral load. Fecal samples from all participants were analyzed using the 16S rRNA gene sequencing on the next-generation Illumina® MiSeq™ sequencer. Biomarker Linear Discriminant Analysis (LDA) score from LEfSe analysis indicated that the specific gut microbiome, Lachnoclostridium sp32343-sp32393-sp32423 communities could serve as an indicator for HIV infection. Findings also showed that Bacteroides vulgatus (seq 11 & seq 42), Megamonas funiformis (seq 63), unclassified members of Prevotallaceae family sp14289 (seq 51), sp13942 (seq 4), and Prevotella copri-sp13942 (seq 5) could be used as gut microbiome biomarkers for increased HIV viral load and decreased CD4+ T cell count. Meanwhile gut microbiome biomarkers for decreased HIV viral load and increased CD4+ T cell count were identified as Succinivibrionaceae sp56244 (seq 47), Eubacterium rectale (seq 8), Megamonas funiformis (seq 1 and seq 14), Prevotella copri (seq 29, seq 34, and seq 12) and unclassified Prevotellaceae sp13927 (seq 17), sp13942 (seq 5). Specific gut microbiome communities of Lachnoclostridium sp32343-sp32393-sp32423 could be used as an indicator of HIV presence. Some gut bacteria microbiome can be utilized in the management of HIV disease progression.

Malaria is a deadly parasitic disease caused a by protozoan parasite of the genus plasmodium. The challenges facing by chemotherapy and vector control couple with the lack of vaccine against malaria necessitate an urgent need for the development of alternative treatment regimens to combat this disease. One possible antimalarial treatment regimen is the use of probiotic bacteria as dietary supplements. Traditionally fermented milk is a rich source of probiotic bacteria that up to date, very few studies have been carried out on their immunoprotective effects against early malaria infection in mice. This study sought to assess the prophylactic activities of a probiotic bacterium Latilactobacillus sakei on malaria and inflammation in Plasmodium berghei infected mice. The probiotic bacterium was isolated from the Fulani's traditionally fermented milk and identified using the sequencing of the 16S r RNA gene. The repository activity of L. sakei on malaria was assessed using the method described by Peters with slight modification. Eighty-four BALB/c mice were randomly divided into two sets of seven groups of six mice each. One set received orally different doses of L. sakei Chloroquine and Sulfadoxine/Pyrimethamine for seven days before infection while the other set received for fourteen days before infection with 0.1 mL of 10(7) Plasmodium berghei. Parasitaemia density, haematological parameters and inflammatory cytokines profile were evaluated. Data were presented as Mean +/- SEM and analysed using SPSS version 20.0. The results of this study revealed that L. sakei significantly (p < 0.05) reduced in dose dependent manner parasite load, body weight loss and reduction of body temperature in all the treated mice when compare to untreated mice. Leukocytopenia, thrombocytosis and inflammation were also found to be significantly (p < 0.05) prevented in treated mice as compared to untreated mice. This study suggested that L sakei possesses immunomodulation and protective effects on early malaria infection in Plasmodium berghei mice.

OBJECTIVES: To evaluate the incidence and severity of kidney injury and explore the host factors to predict acute kidney injury (AKI) among tuberculosis (TB), human immunodeficiency virus (HIV), and TB/HIV patients on the treatment in Fako Division of Cameroon. METHODS: A prospective study was carried out from September 2018 to November 2019. Serum creatinine and urea were measured spectrophotometrically. The Chi-square test with cox regression was used to assess the association between the risk factors and AKI. RESULTS: The overall incidence of AKI and renal injury was 21.4%–41.4%, respectively. Stage 1 AKI as well as mild renal injury was more prevailing among the HIV-infected patients; 10.5% versus 31.4%. The highest incidences; 30.0% AKI, and 53.0% renal injury were recorded amongst those with TB/HIV coinfections and HIV mono-infections, respectively. Persons who were ≥40 years and those with low baseline hemoglobin levels were two times and two and half times more likely to develop AKI compared to their counterparts. CONCLUSIONS: The cumulative incidence of AKI in patients on treatment was high. Thus, it is important to evaluate the renal function of patients before treatment within the first 2 weeks of treatment.

Background The greater efficacy of antiretroviral drugs has directed focus towards improving the lifestyle and longevity of people living with HIV/AIDS (PLWHA). Malnutrition impacts the immune system and is influenced by HIV infection and drugs. The aim of this study was to investigate the effect of malnutrition on the immune status of PLWHA in the study population. Methods A cross sectional study was conducted among 610 HIV positive participants between the months of May 2019 to November 2020 in HIV treatment centres in Fako Division. A questionnaire was used to collect lifestyle data. BMI was used to classify nutritional status. Venous blood was analysed for haemoglobin levels, some macro- and micro-nutrients (Albumin, total cholesterol, triglycerides, iron, calcium, magnesium and Vitamin D), CD4+ cell count, viral load and some inflammatory cytokines (IL-1, IL-6 and TNF-α). Results Based on BMI results, 316 (52.8%) participants were malnourished, with 39 (6.5%) being undernourished and 277 (46%) were over nourished (overweight and obese). The majority of the patients were deficient in Vitamin D (74.8%) and serum iron (82.4%). Albumin revealed a positive relationship with CD4 cell count (r = 0.208, P = 0.009) and a negative relationship with viral load (r = -0.229, P = 0.010). There was a positive correlation between serum iron and CD4 cell count (r = 0.250, P = 0.044). Albumin correlated negatively with IL-6 (r = -0.109, P = 0.035) and TNF (r = -0.121, P = 0.014). Total cholesterol correlated negatively with TNF-α (r = -0.269, P<0.001) while calcium and magnesium correlation positively with TNF (r = 0.108, P = 0.029) and IL-1 (r = 0.105, P = 0037) respectively. Conclusion It could be concluded that macro- and micronutrients may considerably modulate the immune recovery of PLWHA, thus affecting the quality of life. Study received funding from CANTAM (Ref: 2517/FCRM/D/DR/08–18)

Background: Knowledge of the core gut microbiome among Cameroonians is a preliminary step for a better implementation of treatment strategies to correct dysbiosis and improve health care management. HIV infection has continued to cause high mortality among those infected, but the types and frequency of human gut microbiota associated with or without HIV/AIDS presence have not been identified in the adult populations in Cameroon. Methods: This was a case-control and comparative study design that ran from June 2018 to September 2019. Stool Samples were purposively collected from 40 participants (15 HIV-negative and 25 HIV-positive) for the 16S rRNA gene sequencing on the next-generation Illumina® MiSeq™ sequencer. Blood samples were collected for HIV determine testing, CD4 Tcell count, and HIV viral load. Sequences were clustered into operational taxonomic units (OTUs) at ninety-nine percent identity and their representatives were accustomed to using a phylogenetic approach. Results: The study showed a phylogenetic taxonomy of the gut microbiome communities in two kingdoms (Archea and Bacteria) and eight Phylum [Firmicutes (44.7%), Bacteroidetes (43.7%), Proteobacteria (8.7%), Actinobacteria (1%), Fusobacteria (0.2%), Euryarchaeota (0.01%), Synergistetes (0.01%), Verrucomicrobia (0.01%) and unclassified phylum (1.7%)]. A total of 347 gut microbiota species were identified, including 55 unique species/oligotypes, and 28 pathobionts from the study population. HIV infection was characterized by significant gut microbiota compositional changes with HIV-positive less diverse (56 strains absent) with significantly increased OTUs of the butyrate-producing microbiome species as compared to HIV-negative individuals (p=0.001). Conclusions: A profile of 347 gut microbiome bacterial species was identified in the Cameroonian community. Particularly, from the 347 gut microbiome bacterial species profiled, eight phyla were identified, with 55 unique species/oligotypes containing more than one sequence and 28 pathobionts. A host of unknown/unclassified gut microbiome bacterial species were also noted circulating among the study population.

This study aims to determine the prevalence of alcohol among injured road traffic crash victims (motor vehicle drivers, motorcycle riders, and pedestrians) admitted to three major health centers in Cameroon (one in Douala and two in Yaoundé). This study also investigated the associations between alcohol use and some socio-demographic and injury characteristics among injured road users, such as gender and age, level of education, religion, type of road user, time of day and week, and injury severity. Alcohol use was measured using breathalyzers, and data on age, gender, education level, religion, type of road user, time of the crash, crash characteristics, and injury severity were recorded using a questionnaire. Of the 350 participants, 30.9% had blood alcohol concentrations (BACAC s) above 0.08% (legal limit for drivers); the proportion was highest among motorcycle riders (36.5%), followed by pedestrians (24.8%) and motor vehicle drivers (18.9%). The proportion with BACAC above 0.08% was highest on weekend nights and among those who were most seriously injured. Those who reported being Muslims had a lower prevalence of alcohol. Multivariable logistic regression analysis confirmed those associations. Many road traffic injuries could have been avoided if the patient had not consumed alcohol. Actions should therefore be taken to reduce the proportion of alcohol-impaired road users.

One approach to the control of schistosomiasis recommended by the World Health Organization (WHO) is for endemic countries to integrate schistosomiasis control measures into their primary health care (PHC) services. Assessment of their capacity to accommodate such control measures is of utmost importance. This study had as objectives to assess the capacity of the PHC system in the Tiko Health District to diagnose schistosomiasis and to evaluate health care workers’ perspectives of potential challenges to schistosomiasis control in the district. A total of 13 primary healthcare facilities were randomly selected and their laboratory records on schistosomiasis diagnosis were evaluated for quality (availability, documentation of key aspects and presentation), diagnostic methods used and parameters recorded (egg counts, haematuria). At each institution, more than 60% of health personnel participated in a survey in which a semi-structured questionnaire was used to collect data. A total of 170 healthcare workers working at various stations (laboratory, pharmacy, nurses, out-patient section) were interviewed. Out of the 13 health institutions, only 8(61.5%) had any data on diagnosis of the disease and used the sedimentation technique for diagnosis. One institution used the Syringe Filtration Technique (7.7%) in the diagnosis of S. haematobium and recorded the presence or absence of haematuria. No institution recorded key parameters like egg count for any patient. Five (38.5%) of the institutions, found mainly in the suburbs, had no laboratory services. Most of the healthcare workers (46.5%) were of the opinion that lack of knowledge of the disease is a major setback in the implementation of control. With respect to the different professions, it was observed that amongst the medical doctors (83.3%) and nurses (58.2%) this opinion was more popular. Pharmacy technicians (67.7%) and community directed distributors (52.2%) cited the poor sanitary conditions of homesteads as the greatest challenge in the implementation of any form of control. The primary healthcare system of the Tiko Health District lacks the capacity to accommodate control measures; all the hospital laboratories fall short of WHO recommendations for diagnosis of the disease. The control of schistosomiasis in this health district is likely to be hampered by several factors ranging from poor sanitation, poor knowledge of the diseases, lack of commitment of stakeholders and poor diagnostic techniques and reporting methods.

The use of alcohol among road users injured in road traffic crashes and admitted to three major hospitals in Cameroon was studied. Alcohol use was measured using breathalyzers, and data on age, gender, education level, religion, type of road user, time of the crash, crash characteristics, and injury severity were recorded using a questionnaire. Of the 350 participants, 30.9% had blood alcohol concentrations (BACs) above 0.08% (legal limit for drivers); the proportion was highest among motorcycle riders (36.5%), followed by pedestrians (24.8%) and motor vehicle drivers (18.9%). The proportion with BAC above 0.08% was highest on weekend nights and among those who were most seriously injured. Those who reported being Muslims had a lower prevalence of alcohol. Multivariable logistic regression analysis confirmed those associations. Many road traffic injuries could have been avoided if the patient had not consumed alcohol. Actions should therefore be taken to reduce the proportion of alcohol-impaired road users.Supplemental data for this article is available online at https://doi.org/10.1080/17457300.2022.2030365 .

Objective This study aimed to assess the prevalence of drinking and driving on roadways in urban areas and highways in Cameroon, and to determine the associations between drinking and driving and socio-demographic factors. Methods A cross-sectional study of motor vehicle drivers was performed on Fridays, Saturdays, and Sundays between May and September 2020 with three driver groups: (1) random motor vehicle drivers (including riders) on major highways, (2) drivers recruited at car stations in Yaounde, and (3) at fuel stations in Douala. Alcohol was measured using breathalyzers, and a questionnaire collected socio-demographic data. Results In total, 2402 motor vehicle drivers were asked to participate in the study and 1701 (70.8%) gave informed consent. The vast majority (98.6%) were men. Drivers aged 30-39 years constituted the largest age group on highways and in Yaounde, whereas 18-29 years was the largest age group in Douala. The highest prevalence of alcohol was observed among drivers in Yaounde, which included mainly clandestine taxi car drivers and motorcycle taxi riders, where about 30% had blood alcohol concentrations (BAC) above the legal limit of 0.08%. The proportion with BACs above the legal limit was about 6% among the drivers in Douala, which included mainly motorcycle taxi riders, and about 4% among drivers on highways. Conclusions The findings indicate that drinking and driving is a major traffic safety problem on Cameroonian public roads, especially among motorcycle taxi riders and clandestine taxi drivers in towns, which represent the major mass transportation means in the country. Drinking and driving education and legislation should be better developed and enforced in order to reduce the number road traffic crashes.

Ethnopharmacological relevance: Milk production, processing and consumption are integral part of traditional practices in Fulani tribe of Cameroon. It has been observed that Fulani are resistant to malaria. Dairy products traditionally processed by Fulani are intensively used in the ritual treatment of malarial, inflammations and behavioural disorders. Many studies have demonstrated that fermented milk is a rich source of probiotic bacteria. However, the antimalarial activity of probiotics isolated from this natural source has not been experimentally tested. Aim of the study: Hence, this study was therefore aimed at evaluating the antimalarial activity of a probiotic bacterium Lactobacillus sakei isolated from traditionally fermented milk in mice infected with chloroquine sensitive Plasmodium berghei ANKA. Materials and methods: The probiotic bacterium was isolated from the Cameroonian Mborro Fulani's traditionally fermented milk and identified using the 16S r RNA gene sequencing. The schizontocidal activity of Lactobacillus sakei on established malaria infection was evaluated. Eighty-four healthy young adult Balb/c mice infected with Plasmodium berghei parasite were randomly divided into two sets of seven group of six mice each, and were given three different doses of Lactobacillus sakei, chloroquine and sulfadoxine/pyrimethamine for seven and fourteen days respectively. The level of parasitaemia, body temperature, survival time and haematological parameters were evaluated. Results: The parasite growth inhibition was observed to increase with increasing dose of probiotic bacterium with maximum suppression being 100 % at dose 3 on day 20. Also, the probiotic bacterium significantly prevented body weight loss and was associated with body temperature reduction and prevented (p<0.05) a decrease in haematological parameters compared to that untreated malaria infected mice. Conclusion: The results obtained suggest that Lactobacillus sakei is a probiotic bacterium with antimalarial activity in mice infected with chloroquine sensitive Plasmodium berghei.

Targeting the gut microbiota in diagnosing diseases has recently gained interest in microbiome studies. Early and fast disease prognosis could be derived from Gram stain assessment of fecal flora distribution. Gram staining could guide the culturomics and sequencing approaches. The present study aimed at identifying fecal Gram stain morphotype and distribution patterns among HIV-negative and HIV-positive individuals, and assessing the associations of this flora with diet, CD4+ T cell count, and antiretroviral treatment; hence Gram stain was performed for all the stool samples. The study was carried out between August 2018 and February 2019. In this study, we recruited 213 participants, of which 108 were infected with HIV and 105 HIV-negative individuals without a known history of drugs consumption for the last 6 months as control. Findings revealed that the occurrence of a single pattern was significantly associated with age (p = 0.016) and diet (p = 0.012) between HIV-infected and HIV-negative individuals. Also, for the Gram stain fecal flora distribution count, the frequency of scanty pattern was significantly associated with age (p = 0.027) and the nature of drinks consumed (p = 0.039). Furthermore, the mean CD4+ T cell count was significantly higher in a diverse pattern (730 cells/mm3) compared to the depleted pattern (285 cell/mm3) (p = 0.015). HIV-negative individuals had a significant high Gram stain flora diverse pattern when compared to HIV-positive individuals and those on Antiretroviral treatment (ART) (p = 0.010). The Gram stain flora distribution among the participants showed a significant high abundance pattern among HIV-positive individuals on ART and HIV-negative individuals, compared to HIV-positive individuals who were not yet on ART (p = 0.0001). The Gram stain flora morphotype and distribution pattern decrease with the reduction of CD4+ T cell count and vice versa. Besides, we found that diet rich in energy-yielding and protective food, younger age participants and HAART were associated with Gram stain fecal flora distribution. Further works are warranted to ascertain these associations for possibilities of utilizing Gram fecal flora to infer immune status and better guide interpretation of patients' prognosis in HIV condition.

Highly active anti-retroviral therapy (HAART) use by HIV patients since the mid-1990’s has led to a significant drop in HIV mortality. However, HAART and HIV related metabolic syndrome (hypertriglyceridaemia, reduced HDL-c, abdominal obesity, hypertension, and insulin resistance) is associated with increased cardiovascular risk in aging HIV sero-positive patients. This study was aimed at investigating the predictors of metabolic syndrome and influence of metabolic syndrome on cardiovascular (CV) risk amongst persons living with HIV on HAART. This is a hospital-based case-control study. The cases were HIV sero-positive individuals on HAART for at least 6 months and controls were HIV sero-negative individuals. Out of 135 participants, 74 (54.8%) were females amongst which 53/75 (70.7%) were in the cases group and 21/60 (35%) were in the control group. The mean age of the participants was 42.04 (±9.61) years. HIV-infected participants at moderate CV risk based on the DAD risk calculator were more frequently diagnosed with metabolic syndrome based on the International Diabetes Federation (IDF) criteria with high statistical significance than those at low CV risk (5/19 – 26.3% vs. 12/55 – 21.8%, P=<0.001). Bivariate analysis of metabolic syndrome predictors in the study population revealed that gender is associated with increased odds of metabolic syndrome (OR: 5.376, 95% CI: 1.907-15.153; P=0.001). Gender was the only predictor associated with metabolic syndrome (OR: 6.958, CI: 2.317-20.896; P=0.001) following multivariate analysis of gender, vegetables or fruits intake, vigorous physical activity and family history of CVD and females were 7 times more likely to develop metabolic syndrome than males. More HAART-treated HIV patients at moderate CVD risk develop metabolic syndrome than those at low CVD risk. Female HIV patients on HAART have higher chances of developing metabolic syndrome compared to their male counterparts. HIV patients particularly females should be screened early for metabolic syndrome following HAART initiation.

Background: Inadequate vaccination coverage with increased risk of vaccine preventable disease outbreaks remain a problem in Africa. The aim of this study was to assess the vaccination coverage levels under the Expanded Program on Immunization (EPI) in a health area and to identify factors that affect vaccination coverage in view of providing valuable data for disease prevention. Methods: A cross-sectional household survey was conducted in August 2017 in the Mbonge health area, Southwest Cameroon. Clustered sampling technique was used to select study communities and a purposive sampling design was used to select households. An interviewer-administered questionnaire was used to obtain information from consenting caregivers of children aged 9–23 months. Vaccination coverage was assessed by consulting the vaccination cards and parents’ recall. In households with more than one child aged 9-23months, the youngest was chosen. Results: Overall, 300 caregivers were enrolled into the study. The average vaccination coverage for the past three years (2014-2016) was 34.0%. Two hundred and fifty-five (85%) children had vaccination cards. Amongst the children, 143 (47.7%) had taken all vaccines as recommended while 30 (10%) had not received a single dose. Factors significantly associated with incomplete vaccination status included: occupation (being a farmer) (p-value=0.011), marital status (married) (p-value=0.048), caregiver’s utilization of health facility (p-value=0.003), low levels of mothers’ utilization of antenatal care (ANC) services (p-value=0.000), and low knowledge on vaccination (p-value=0.000). Conclusion and Global Health Implications: Adequate vaccination coverage can be attained through good sensitization and health education for primary caregivers. Targeting families living far away from vaccination centers, using appropriate communication and vaccination strategies may improve vaccination coverage in the Mbonge Health Area of South West Region, Cameroon. Key words: • Assessment • Vaccination Coverage Expanded Program on Immunization • Mbonge Health Area • Cameroon • EPI Copyright © 2020 Ewang et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in this journal, is properly cited.

Hepatotoxicity is historically the 3rd most common reason for drug withdrawal and toxicity-related discontinuation of treatment. This study was aimed at determining the incidence and the onset of hepatotoxicity and at evaluating the relationship of some risk factors for hepatotoxicity among Human Immunodeficiency Virus- (HIV-) positive, tuberculosis (TB), and HIV/TB patients on treatment. This was a prospective follow-up study involving 125 participants from the HIV/AIDS and TB treatment centres in three hospitals in Fako Division of Cameroon. These TB and HIV patients were initiated on RHEZ (R = Rifampicin, H = Isoniazid, E = Ethambutol, and P = Pyrazinamide) and TELE (efavirenz/tenofovir/lamivudine), respectively, and followed up for 12 weeks between September 2018 and November 2019. The levels of liver enzymes (transaminases, gamma-glutamyltransferase, alkaline phosphatase, and unconjugated/total bilirubin) were measured spectrophotometrically using serum. The Chi-squared (χ2) test was used to assess the association between risk factors and hepatotoxicity, while the Kaplan-Meier survival analysis with the log-rank test was used to determine the occurrence of hepatotoxicity in the different groups. We followed the general study population for a total person time of 6580 person-days, with an incidence rate and cumulative incidence of 8 cases per 1000 person-days (53/6580 person-days) and 42.4% (53/125), respectively (95% confidence interval), recorded after 12 weeks of follow-up of all the participants. The onset of hepatotoxicity in the total study population was statistically significant (χ2=9.5334; p=0.022979; CI=95%), with the majority observed at week eight of follow-up. Also, the incidence rate and cumulative incidence of hepatotoxicity with respect to HIV/AIDS, TB, and HIV/TB patients, respectively, at 95% confidence interval were: 8 cases per 1000 person-days (32/3843 person-days) and 32/76 (42.1%), 6 cases per 1000 person-days (12/1932 person-days) and 12/32 (37.5%), and 11 cases per 1000 person-days (9/805 person-days) and 9/17 (52.9%). This study shows that the incidence rate and cumulative incidence of hepatotoxicity in HIV/AIDS, TB, and HIV/TB patients on treatment were high in Fako Division, Cameroon. Also, it is very important to check these patients’ liver function especially within the first 12 weeks of treatment.

The human gut microbiota consortium consists of microorganisms that are sensitive to some antimicrobial agents. These gut microbiota are essential in upholding a healthy gut environment. A few of the gut microbiota has been described as pathobiont, which is involved in microbial translocation that drives systemic inflammation in immunocompromised individuals. Conjoin utilization of cotrimoxazole as prophylaxis and antiretroviral therapy (ART) has shown to reduce microbial translocation markers lipopolysaccharides binding proteins (LBP) and sCD14 in HIV-infected individuals, but the mechanisms underlying these clinical benefits have not been exploited. Our study was aimed at investigating the effect of HAART and cotrimoxazole on gut pathobiont that has been associated with microbial translocation among HIV-positive treatment-naive patients and HIV-negative individuals. A Cross-Sectional study design was used involving 62 participants; of which 31 were HIV-positive naive patients (target group), while 31 others were HIV-negative individuals (control group). Stool specimens from all the participants were collected and processed aseptically using six culture medium and 14 culture conditions from August 2018 to January 2019. Results showed that pathobionts including E.coli, Klebsiella spp, Proteus spp, Salmonella spp, Enterobacter spp, Staphylococcus aureus, and Clostridium spp were sensitive to cotrimoxazole with74.5%, 100%, 66.7%, 100%, 100%, 100% and 100% respectively. Members belonging to the Enterobacteriaceae family were all sensitive to antiretroviral with zidovudine combinations. All Staphylococcus aureus 44 (100%) were sensitive to Efavirenz. The proportions of Susceptible and resistant cultured gut microbiota to cotrimoxazole and HAART between HIV-negative individuals and HIV-positive treatment naive patients were not significantly different (p = 0.635). Cotrimoxazole and some antiretrovirals could reduce pathobiont burden in HIV immunocompromised patients. The synergy between cotrimoxazole and zidovudine based combinations may explain the clinical benefits of low microbial translocation among HIV-infected individuals on treatment from previous studies, thus providing further rationale for extending coverage. (C) 2019 The Authors. Published by Elsevier B.V. on behalf of African Institute of Mathematical Sciences / Next Einstein Initiative.