This policy brief examines how community engagement influences progress toward onchocerciasis elimination in Cameroon and assesses policy-relevant barriers affecting Community-Directed Treatment with Ivermectin (CDTI). It draws on qualitative research conducted in 32 communities across four regions, including 145 in-depth interviews and 27 focus group discussions with community members and drug distributors, health workers, and local authorities. Findings highlight persistent challenges: limited disease knowledge, fear of adverse events, alcohol-related concerns, low motivation among community drug distributors, and increasing MDA fatigue. Evidence indicates that participation improves when trust, communication, and local ownership are strengthened. The brief positions community engagement as a core elimination strategy and recommends strengthening culturally adapted communication, adverse event management, incentives for community drug distributors, surveillance feedback, and multi-level coordination to advance national elimination goals.

Preventive chemotherapy (PC), involving the periodic administration of anthelmintic drugs such as albendazole or mebendazole to at-risk populations, is the main strategy for controlling soil-transmitted helminth (STH) infections in endemic countries. This study assessed the efficacy of a single dose of albendazole against STH infections in the Akonolinga Health District, Centre Region, Cameroon, where STH prevalence remains high despite more than a decade of PC implementation. A community-based screening survey identified 131 individuals infected with at least one of the target species, Ascaris lumbricoides or Trichuris trichiura. All infected participants received a single dose of Albendazole. Three weeks after treatment, stool samples were collected and examined using the Kato–Katz technique to evaluate treatment efficacy. Cure rate (CR), defined as the proportion of participants who became egg-free, and egg reduction rate (ERR), reflecting the decrease in egg counts, were computed. For A. lumbricoides, the CR was 94.9% (95% CI: 87.7 - 98.0) and the ERR was 97.5%, while for T. trichiura, the CR and ERR were 26.0% (95% CI: 17.5 - 36.7) and 29.8%, respectively. Compared with WHO efficacy thresholds, Albendazole showed satisfactory effectiveness against A. lumbricoides but poor efficacy against T. trichiura. Species-specific treatment strategies are urgently needed to improve STH control and support elimination efforts.

Introduction Understanding costs associated with identification of emerging infections is critical to inform the policy. Nested within a randomised controlled trial that found that a test-all (TA) model for rapid SARS-CoV-2 testing identified more SARS-CoV-2 cases than the standard screen-and-test (ST) model. Our study assessed the cost-effectiveness of integrating SARS-CoV-2 services into maternal, neonatal and child health (MNCH), HIV and tuberculosis (TB) clinics using the two models in Cameroon and Kenya.Methods The total costs of implementing the TA and ST models in Cameroon and Kenya were estimated from a health systems perspective using a micro-costing method. The cost per client tested (CPCT) and tested positive (CPCTP) for SARS-CoV-2 were estimated by dividing the total cost of each model by the number of clients tested and tested positive, respectively. A decision tree and cost-effectiveness acceptability curve were used to compare the cost-effectiveness of the two models.Results In Cameroon, the total cost of the TA model was US$141,942, while the ST model was US$48,020. In the TA model, the CPCT was US$7.66 and the CPCTP was US$508.75, whereas in the ST model, they were US$25.02 and US$727.58, respectively. In the TA model, the biggest cost was SARS-CoV-2 antigen rapid detection tests (Ag-RDTs) at 61% (US$86,853), whereas in the ST model, it was personnel at 39% (US$18,592). In Kenya, the total cost was US$39,264 in the TA model and US$27,500 in the ST model. The TA CPCT was US$13.04 and the CPCTP was US$1,189.81, whereas in the ST model the costs were $125.00 and $1,250.01 respectively. In both models in Kenya, the biggest expenditure was personnel, at 45% ($17,696) of cost in TA and 56% ($15,267) in ST. In both countries, the TA model was more cost-effective.Conclusions Implementation of the TA model is a more cost-effective approach to increase early identification of individuals with SARS-CoV-2 infection.

Mass gathering event restrictions were part of mitigation measures during the COVID-19 pandemic that were lifted as prevalence decreased and after vaccination rollout. We explored SARS-CoV-2 antigen rapid diagnostic test acceptability and positivity in community settings in Cameroon. In August-October 2022, community workers sensitized and referred individuals for COVID-19 testing to nearby testing points in Douala and Yaounde. Participants consented to SARS-CoV-2 antigen rapid diagnostic testing, a survey, or both components. We describe the positivity rate, COVID-19-related history, and Likert-scale testing perceptions. Factors associated with testing acceptance were analyzed using logistic regression. Overall, 20.5% (2,449/11,945) of sensitized individuals visited testing points, and 1,864 (76.1%) were enrolled; 50.6% accepted the survey and testing (46.0% accepted survey only). Seven (0.7%) of 1,006 individuals tested positive. Most (71.8%; 1,292/1,800) considered community testing more accessible than hospital-based testing. Individuals accepting versus refusing testing differed in perceived COVID-19 risk (67%, 49%; P <0.001), belief in accurate test results (79%, 47%; P <0.001), and ability to test easily (96%, 55%; P <0.001). Males (adjusted odds ratio [aOR]: 1.26 [1.04-1.53]) and those over 50 years (aOR: 1.9 [1.4-2.7]), with symptoms (aOR: 1.80 [1.30-2.50]), and at least partial vaccination (aOR: 0.76 [0.58-0.99]) were significantly associated with test acceptance. Refusal reasons included lack of perceived need for testing (33.8%) and testing discomfort (26.3%). Although community-based testing was generally perceived as important, actual testing uptake was low. In future pandemics, community testing should be optimized by addressing misinformation, offering alternative testing modalities for greater comfort, creating demand, and tailoring approaches to maximize testing uptake.

Objective: This article aims to analyze the relevance of clan strategies in the fight against Neglected Tropical Diseases (NTDs) in the Western region of Cameroon. Introduction: The abrupt cessation of mass distribution of Ivermectin for onchocerciasis control, due to the suspension of international funding in Cameroon, risks prolonging or undoing efforts made since the 2000s to eliminate onchocerciasis as a public health issue. To mitigate this, a strategy referred to as the "clan strategy" has been implemented. This strategy aims to empower families to manage their health issues, which have severe consequences on vision and skin. Methodology: This article is based on a descriptive and analytical study with a mixed approach (quantitative and qualitative), conducted from June to August 2025 in the health districts of Foumbot, Bamendjou, and Bangourain in the Western Region of Cameroon. Data collection for the analysis of performance indicators of the program was carried out using an Excel spreadsheet for the quantitative aspect, and semi-structured interviews and Focus Group Discussions (FGDs) for the qualitative part. The study was conducted in communities where this strategy has been implemented, involving District Health Chiefs, Health Area Chiefs, clan distributors, and 81 clan members (clan leaders, community representatives), as well as household heads in the communities. The aim was to assess their knowledge, participation, and perceptions regarding NTD-related activities. Results: Motivational challenges faced by distributors, treatment delays, absenteeism, and refusals were reduced due to the strong community ownership of the onchocerciasis control efforts, particularly in rural areas. The post-distribution coverage survey shows that 85% of the areas were adequately covered. The implementation of the clan strategy in the mass distribution of Ivermectin for onchocerciasis control serves as a viable alternative to the cessation of international funding for NT

ObjectivesThere is data scarcity on the overall effects of pneumococcal conjugate vaccines (PCVs) on otitis media (OM) in low- and middle-income countries. The impact of the 13-valent PCV (PCV13) program on OM was evaluated in Cameroon where infant vaccination was implemented in July 2011 using a 3-dose primary series at 6, 10 and 14 weeks of age.MethodsThrough community-based surveillance, we used a retrospective cohort study design to assess OM prevalence among PCV13-vaccinated children aged 24 to 36 months in 2015. This was compared with a 2013 age-matched cohort of PCV13-unvaccinated children. OM was diagnosed by clinical inspection for chronic suppurative OM (CSOM) and tympanometry for OM with effusion (OME). CSOM was defined as draining of the middle ear with duration of more than 2 weeks and prolonged OME was defined as a flat ‘type B’ tympanogram. PCV13-vaccinated and PCV13-unvaccinated cohorts were compared by calculating prevalence odds ratios for OM and baseline characteristics.ResultsAltogether, 111 OM cases were identified; 42/433 (9.7%) in the PCV13-unvaccinated in 2013 and 69/413 (16.7%) in the PCV13-vaccinated cohort in 2015. In the 2013 baseline survey, 3/433 (0.7%) children were identified with unilateral CSOM compared to 9/413 (2.2%) in the PCV13-vaccinated cohort in 2015. Bilateral prolonged OME was diagnosed in 7/433 (1.6%) PCV13-unvaccinated children and in 12/413 (2.9%) in PCV13-vaccinated children. Proportions of children with unilateral prolonged OME were 31/433 (7.2%) in the PCV13-unvaccinated group compared with 48/413 (11.6%) in the PCV13-vaccinated group. Multivariate logistic regression analysis showed evidence that PCV13-vaccinated children in 2015 had 40% less risk of contracting OM compared to PCV13-unvaccinated children in 2013 (adjusted prevalence odds ratios = 0.60 [95% confidence interval: 0.38 to 0.94], P = 0.025). Additionally, attributable proportion estimates show that, 58% of OM infections among the PCV13-vaccinated group would still have occurred despite PCV13 vaccination.ConclusionOur findings provide significant evidence on the effect of PCV13 in decreasing OM or OME among children in this age group. It also supports justification for government's continuation of PCV13 immunization program in the absence of GAVI's funding. Further research is needed to assess the long-term impact of the PCV13 program on in OM Cameroon.

During the 33rd Africa Cup of Nations (AFCON) football tournament in Cameroon, organizers and health authorities required a negative SARS-CoV-2 test result <48 hours before entry and provided free SARS-CoV-2 testing and vaccination at stadium and fan zone entrances. We describe the outcomes and implementation of mandatory SARS-CoV-2 testing at fan zones during AFCON. All consenting fan zones attendees were administered an electronic questionnaire capturing exposure factors, COVID-19-like symptoms, and COVID-19 vaccination status, before being tested for SARS-CoV-2 using an antigen rapid diagnostic test (Ag-RDT). Participants testing positive were sampled for confirmatory real-time SARS-CoV-2 polymerase chain reaction (PCR) and sequencing for variant surveillance. The case detection rate was estimated using PCR-confirmed cases, and the challenges were summarized from staff discussions and project/study documentation. In total, 4,820 fan zone attendees (median [interquartile range] age 30 [24-38], 27.7% females) were tested for SARS-CoV-2, including 1,228 (25.5%) fully vaccinated. Of 4,820 participants, 148 (3.1%) had a positive Ag-RDT result, of whom 67 consented to PCR testing and 19 of 64 (29.7%) were confirmed PCR-positive. The case detection rate was 40.1 (95% CI: 24.2-62.7) per 10,000 attendees. The Omicron variant (B.1.1.529) was found in all 11 samples successfully sequenced. The implementation of mandatory SARS-CoV-2 Ag-RDT at fan zone entrances was challenged by high attendance volume just prior to matches, lobbying of economic stakeholders, and inconsistent quality assurance when using test kits. Despite the challenges encountered, implementing mandatory SARS-CoV-2 Ag-RDT at fan zones, was a unique opportunity for SARS-CoV-2 case identification and genomic surveillance.

Background: Little is known about the evolution of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) immunity in African communities.Aim: We evaluated changes in anti-SARS-CoV-2 antibodies, mortality and vaccination status in Cameroon between August 2021 and September 2022 to begin describing the evolution of the pandemic in Africa.Setting: The study was conducted across Cameroon’s 10 regional capitals, between 2021 and 2022 as the country hosted a mass gathering.Methods: We conducted a cross-sectional population-based survey in 2022, including SARS-CoV-2 seroprevalence testing and retrospective mortality estimation using two-stage cluster sampling. We estimated and compared seroprevalence and crude mortality rates (CMR) to a survey conducted in 2021 using the same methodology.Results: We performed serologic testing on 8400 individuals and collected mortality data from 22 314 individuals. Approximately 5% in each survey reported SARS-CoV-2-vaccination. Rapid diagnostic test-based seroprevalence increased from 11.2% (95% confidence interval [CI]: 10–12.5) to 59.8% (95% CI: 58.3–61.2) between 2021 and 2022, despite no increase in the proportion vaccinated. The CMR decreased from 0.17 to 0.06 deaths per 10 000 persons per day between 2021 and 2022. In 2022, no deaths were reportedly attributable to COVID-19 as compared to 17 deaths in 2021.Conclusion: Over a 12-month period encompassing two waves of omicron variant SARS-CoV-2 and a mass gathering, SARS-CoV-2 seropositivity in Cameroon approached 60%, and deaths declined despite low vaccination coverage.Contribution: This study challenges the assumption that high immunisation coverage is the sole determinant of epidemic control in the African context and encourages policymakers to increasingly rely on local research when designing response strategies for more effective outbreak management.

Background Contact tracing was described as a key strategy to contribute to controlling the spread of severe acute respiratory syndrome of Coronavirus 2 (SARS-CoV-2) but implementing it can be a challenge. Digitalisation of contact tracing is among the proposed solutions being explored in sub-Saharan African settings. We assessed the effectiveness of a digital tool to expand SARS-CoV-2 testing in exposed individuals in Cameroon. Methods We conducted a cluster-randomised (1:1) trial in eight health districts, including 22 facilities and SARS-CoV2 testing units, randomly assigned to a digital (intervention) or standard (control) contact tracing approach. The intervention consisted of a contact tracing module added to the digital platform " Mamal PRO " used for monitoring and coordination of Coronavirus Disease 2019 pandemic response in Cameroon. The primary outcome was the proportion of contacts declared by SAR-CoV-2 index patients who were successfully traced and tested for SARS-CoV-2 evaluated with a Poisson regression model with cluster adjustment. This study is registered with ClinicalTrials.gov (NCT05684887). Findings Between October 18, 2022, and March 31, 2023, we enrolled 164 index patients in the intervention arm and 149 in the control arm, who identi fi ed 854 and 849 contacts, respectively. In the intervention arm, 93.8% (801/854) of identi fi ed contacts were successfully reached by the tracing unit versus 54.5% (463/849) in the control arm. The intervention signi fi cantly increased the likelihood of successfully tracing contacts (adjusted relative risks (RR) 1.72 [95% CI: 1.00 - 2.95], p = 0.049). The median (interquartile range, IQR) time to successfully tracing contacts was 0 days [IQR: 0, 1] in the intervention and 1 day [IQR: 0, 2] in the control arm. In the intervention arm, 21.3% (182/854) of identi fi ed contacts received SARS-CoV-2 testing compared to 14.5% (123/849) in the control arm (adjusted RR 1.47 [95% CI: 0.44 - 4.90], p = 0.530). Interpretation Digitalising the contact tracing process improved exposure noti fi cation and facilitated the tracing of a greater number of contacts of individuals infected with SARS-CoV-2 in resource-limited settings.

Background: Little is known about attitudes towards COVID-19 vaccination in sub-Saharan Africa, where immunisation coverage is the lowest in the world. Aim: The study aimed to identify factors associated with COVID-19 vaccine hesitancy and uptake in Cameroon, and assess changes in these factors over a period of time. Setting: The study was conducted in the ten regions of Cameroon. Methods: The authors conducted a two-phase cross-sectional survey in the 10 regions of Cameroon, from July 2021 to August 2021 (Phase one) and from August 2022 to September 2022 (Phase two). We analysed reasons for vaccine hesitancy descriptively and used logistic regression to assess factors associated with hesitancy. Results: Overall, we enrolled 12 109 participants: 6567 (54.23%) in Phase one and 5542 (45.77%) in Phase two. Of these, 8009 (66.14%) were not interested in receiving the COVID-19 vaccine (n = 4176 in Phase one, n = 3833 in Phase two). The refusal rate increased significantly in the northern region from 27.00% in Phase 1 to 60.00% in Phase two. The leading contributor to COVID-19 vaccine hesitancy was fear that the vaccine was dangerous, which was significantly associated (95% confidence interval [CI], p 0.05%) with vaccine refusal in both phases. Overall, 32.90% of participants (n = 2578) perceived the COVID-19 vaccine to be dangerous. Advanced age, male gender, Muslim religion and low level of education were associated with vaccine acceptance. Participants reported that healthcare workers were the most trusted source of information about the COVID-19 vaccine by 5005 (42.84%) participants. Conclusion: Despite the investment of the Ministry of Health and its partners in community engagement, focussing on communication about the vaccine efficacy, tolerance and potential adverse events, fear of the vaccine remains high, likely leading to vaccine hesitancy in Cameroon between 2021 and 2022. Contribution: The study highlight regional variations in COVID-19 vaccine acceptance in Cameroon, with factors age, gender, religion and education influencing willingness to vaccine. Trust in health workers was high, indicating that, tailored, community-led vaccination strategies are key for improving vaccine uptake, not only for COVID-19 but also for future epidemics.

Background: Baseline prevalence surveys in Cameroon in 2010-2012 showed that trachoma was endemic primarily in the north of the country, with 23 evaluation units (EUs) requiring interventions against active (inflammatory) trachoma. This study presents data from prevalence surveys conducted in 2016-2022 following interventions against trachoma in the East, North, Far North and Adamaoua regions of Cameroon. Methods: EUs were created based on health district boundaries. Within each EU, clusters were selected using probability of selection proportional to population size. Participants were examined for trachomatous inflammation-follicular (TF) and trachomatous trichiasis (TT). Results: A total of 151 800 people were examined in 45 surveys across 35 EUs. Based on the most recent survey results, TF prevalence was greater than the 5% TF elimination threshold in two EUs. Ten EUs had TT prevalence estimates greater than the 0.2% elimination threshold. Conclusions: Trachoma remains a public health problem in Cameroon. Continued interventions are needed in EUs with prevalence estimates greater than elimination thresholds, including antibiotic mass drug administration and improved access to TT surgery. Future surveys will be needed to determine when national elimination of trachoma as a public health problem has been achieved.

Introduction: M-pox is a re-emerging pathogen that is spreading rapidly in developing countries, presenting a serious health risk. Data are scarce on M-pox and its determinants in endemic countries such as Cameroon. This study aimed to assess the epidemiological burden and factors linked to the resurgence of M-pox in high-risk communities in Cameroon. Methodology: A community-based surveillance was conducted from April to October 2022, among 88 individuals at the Ayos Health District (AHD). Participants were interviewed, and cases of M-pox were defined based on World Health Organization (WHO) clinical criteria. Data were analyzed using CSPro v.6.0 and SPSS v.20.0, with p < 0.05 as the statistical significance level. Results: The overall suspected M-pox cases rate was 25% (22/88). Following logistic regression, history of chickenpox (OR 0.14, p = 0.05); history of smallpox (OR 9.14, p < 0.001), vaccination against poxviruses (p < 0.001), skin infection (OR 210, p < 0.001), upper respiratory infection (p < 0.001), atypical dermatitis (OR 144, p < 0.001), skin allergy (OR 68.57, p < 0.001), contact with an individual suffering from M-pox in the last 14 days before symptoms onset (OR 9.14, p < 0.001), contact with animals in the last 14 days before symptom onset (OR 12.68, p  0.001), regular meal consumption (OR 0.35, p = 0.04), meal-sharing, and handling of bushmeat (p = 0.01) were significantly associated with M-pox infection. Conclusions: The clinical features of M-pox were common in rural Cameroonian setting, suggesting the need for active surveillance in these high-risk communities.

Purpose Population-based prevalence surveys are essential for decision-making on interventions to achieve trachoma elimination as a public health problem. This paper outlines the methodologies of Tropical Data, which supports work to undertake those surveys.Methods Tropical Data is a consortium of partners that supports health ministries worldwide to conduct globally standardised prevalence surveys that conform to World Health Organization recommendations. Founding principles are health ministry ownership, partnership and collaboration, and quality assurance and quality control at every step of the survey process. Support covers survey planning, survey design, training, electronic data collection and fieldwork, and data management, analysis and dissemination. Methods are adapted to meet local context and needs. Customisations, operational research and integration of other diseases into routine trachoma surveys have also been supported.Results Between 29th February 2016 and 24th April 2023, 3373 trachoma surveys across 50 countries have been supported, resulting in 10,818,502 people being examined for trachoma.Conclusion This health ministry-led, standardised approach, with support from the start to the end of the survey process, has helped all trachoma elimination stakeholders to know where interventions are needed, where interventions can be stopped, and when elimination as a public health problem has been achieved. Flexibility to meet specific country contexts, adaptation to changes in global guidance and adjustments in response to user feedback have facilitated innovation in evidence-based methodologies, and supported health ministries to strive for global disease control targets.

Introduction: papilledema refers to the swelling of the head of the optic nerve, a major sign of many local, locoregional or systemic pathologies that may involve patients' visual or vital prognosis. This condition represents a diagnostic and therapeutic emergency frequently encountered in our facilities. Therefore it is deemed and opportune to identify the most common etiologies observed in Cameroonian hospitals. Method: we conducted a documentary and descriptive study of patients with papilledema presenting to the Ophthalmology Department of the Hospital of Instruction, Application and Reference of the Armed Forces of Yaounde from 1st October 2013 to 31st December 2016. The variables under investigation included epidemiological data (age, sex), clinical data (functional signs, visual acuity, appearance of the papilla and associated signs according to the Hoyt and Beesten classification), complementary examinations performed (fluorescein angiography, visual field, biology, radiography, CT scan) and the etiological diagnosis. Epi-info 3.5.3 software was used for statistical analysis and the Chi-square test was performed at a 5% significance level (p < 5%). Results: during the study period, papilledema was found in 26 out of 5023 patients, reflecting a rate of 0.5%. The average age of patients was 32.7 +/- 10.9 years, ranging from 7 to 79 years, for 13 women and 13 men. Papilledema was bilateral in 15 (57.7%) patients and unilateral in 11 (42.3%), or 41 affected eyes. The etiologies were 11 (42,3%) inflammatory optic neuropathies, 5 (19,2%) arterial hypertension, 4 (15,4%) central retinal vein occlusions, 3 (11,5%) eye contusions, 2 (7,7%) hydrocephalus and 1 case (3,9%) of cerebral malaria. Conclusion: inflammatory and vascular optic neuropathies were the most common etiologies of papilledema in our facilities.

Objective: The aim of this article is to analyze the factors behind the resignation of Community Distributors. Methodology: The qualitative method was used to collect data through individual interviews and focus groups in the health districts of Kouoptamo, Foumbot and Massangam in the West region of Cameroon. Between 2020 and 2022, these interviews were conducted with Beneficiaries, Community Distributors, managers of district health services and health facilities, and also town hall managers. The data collected was analyzed using the content analysis technique and interpreted using Michel Crozier's Systemic Analysis. Results: The methodological procedures used led to a number of results, including the low or non-existent coverage of CDs, the choice of CDs, the lack of community ownership, the discrepancy between actual and official data, and the diversion and sale of medicines, the main consequence of which is the misuse of Mectizan. Furthermore, faced with a lack of support, community distributors are showing a lack of interest in distributing this product and are resigning. To alleviate this problem, health professionals are trying to replace them with health auxiliaries, nurses and trainees, who unfortunately have no knowledge of their area of activity. Conclusion: As the Community Distributor is the key to Ivermectin Treatment under the Community Directive, it is important to review its status on the scale of actors and to consider strategies for its funding in order to revitalize the CDTI strategy for the elimination of onchocerciasis.

While the SARS-CoV-2 dynamic has been described globally, there is a lack of data from Sub-Saharan Africa. We herein report the dynamics of SARS-CoV-2 lineages from March 2020 to March 2022 in Cameroon. Of the 760 whole-genome sequences successfully generated by the national genomic surveillance network, 74% were viral sub-lineages of origin and non-variants of concern, 15% Delta, 6% Omicron, 3% Alpha and 2% Beta variants. The pandemic was driven by SARS-CoV-2 lineages of origin in wave 1 (16 weeks, 2.3% CFR), the Alpha and Beta variants in wave 2 (21 weeks, 1.6% CFR), Delta variants in wave 3 (11 weeks, 2.0% CFR), and omicron variants in wave 4 (8 weeks, 0.73% CFR), with a declining trend over time (p = 0.01208). Even though SARS-CoV-2 heterogeneity did not seemingly contribute to the breadth of transmission, the viral lineages of origin and especially the Delta variants appeared as drivers of COVID-19 severity in Cameroon.

Background: Trachomatous trichiasis (TT) is a painful, potentially blinding eye condition that can be managed through epilation or surgery. Women are affected by TT approximately twice as often as men and are believed to face gendered barriers to receiving surgical care to prevent vision loss. Methods: We used data from 817 cross-sectional surveys conducted during 2015-2019 in 20 African countries to estimate the prevalence difference (PD) between female and male eyes for four outcomes potentially indicating gender-related differences in TT management: (1) received surgery and developed postoperative TT (PTT), (2) never offered surgery, (3) offered surgery but declined it, and (4) offered epilation but never offered surgery. Results: The prevalence was modestly elevated among female eyes compared with male eyes for having PTT (PD:1.8 [95% confidence limits (CL): 0.6, 3.0]) and having declined surgery for the eye (PD: 6.2 [95% CL: 1.8, 10.7]). The proportion offered epilation was similar by gender (PD:0.5 [95% CL: -0.4, 1.3]), while never having been offered surgery was somewhat more prevalent among male eyes (PD: -2.1 [95% CL: -3.5, -0.7]). Conclusions: Our results suggest potential gender differences in TT management. More research is needed to determine the causes and implications of the observed differences.

BACKGROUND:Trachoma is the leading infectious cause of blindness. To reduce transmission, water, sanitation, and hygiene (WaSH) improvements are promoted through a comprehensive public health strategy. Evidence supporting the role of WaSH in trachoma elimination is mixed and it remains unknown what WaSH coverages are needed to effectively reduce transmission. METHODS/FINDINGS:We used g-computation to estimate the impact on the prevalence of trachomatous inflammation-follicular among children aged 1-9 years (TF1-9) when hypothetical WaSH interventions raised the minimum coverages from 5% to 100% for "nearby" face-washing water (<30 minutes roundtrip collection time) and adult latrine use in an evaluation unit (EU). For each scenario, we estimated the generalized prevalence difference as the TF1-9 prevalence under the intervention scenarios minus the observed prevalence. Data from 574 cross-sectional surveys conducted in 16 African and Eastern Mediterranean countries were included. Surveys were conducted from 2015-2019 with support from the Global Trachoma Mapping Project and Tropical Data. When modeling interventions among EUs that had not yet met the TF1-9 elimination target, increasing nearby face-washing water and latrine use coverages above 30% was generally associated with consistent decreases in TF1-9. For nearby face-washing water, we estimated a ≥25% decrease in TF1-9 at 65% coverage, with a plateau upon reaching 85% coverage. For latrine use, the estimated decrease in TF1-9 accelerated from 80% coverage upward, with a ≥25% decrease in TF1-9 by 85% coverage. Among EUs that had previously met the elimination target, results were inconclusive. CONCLUSIONS:Our results support Sustainable Development Goal 6 and provide insight into potential WaSH-related coverage targets for trachoma elimination. Targets can be tested in future trials to improve evidence-based WaSH guidance for trachoma.

RESUME L’ectropion paralytique fait suite habituellement a une paralysie du septieme nerf crânien. Il peut etre a l’origine d’un syndrome sec avec larmoiement chronique genant pour le patient. Nous rapportons un cas d’ectropion total droit revelant une paralysie faciale peripherique chez une patiente vue a l’Hopital Central de YaoundeABSTRACTParalytic ectropion usually follows paralysis of the seventh cranial nerve. It can be the cause of a sicca syndrome with chronic tearing which is bothersome for the patient. We report a case of total right ectropion revealing peripheral facial paralysis in a female patient seen at the Yaounde Central Hospital.