Introduction: Cameroon's cities have a growing concentration of target children not adequately covered by routine immunization programmes. Methods: We conducted a descriptive cross-sectional study, based on exhaustive sampling of legal health care facilities offering routine immunization services in the health district of Djoungolo (city of Yaounde). The evaluation of the immunization programmes was based on the "Reaching Every District" approach. Results: Out of the 70 health care facilities that participated in the study, 3 (4.3%) had an updated microplan for routine immunization. Out of the 63 (89.4%) health care facilities with functional refrigerator, 12 (19.0%) vaccinated employing a fixed strategy on daily basis. Fifty-seven (81.0%) health care facilities did not conduct immunization sessions employing advanced strategy. Community participation in routine immunization programs was effective in 1 out of 12 districts health areas. A steadily updated vaccine tracking curve was available in 6 (8.5%) health facilities. Conclusion: The "Reaching Every District" approach implemented in Djoungolo health care district doesn't provide adequate coverage of a maximum rate of targeted children. The effectiveness of realistic microplanning, the regularity of vaccination sessions employing fixed and advanced strategies, action-oriented data monitoring, community revitalization plan to promote immunization are ways to improve the provision of vaccination services in this district.

BACKGROUND:While the effect of highly active antiretroviral therapy (HAART) on natural history of cervical lesions remains controversial, resource limited countries need to understand the relevance of their own data to their settings. We compared the risk of cervical disease in HAART-experienced women with that in women in the general population of Cameroon.METHODS:A retrospective cross sectional survey of women aged 35 years and above, attending a voluntary screening campaign for cervical cancer at the Nkongsamba Regional Hospital in Cameroon between February and May 2014. Squamous intraepithelial lesions (SIL) were determined by Pap smear. Multiple logistic regression was used to compare the odds of SIL in women on HAART to women from the community with unknown HIV status.RESULTS:Included were 302 women of whom 131(43.4%) were HIV-infected and receiving HAART on the site while 171 (56.6%) were women from the community. Cervical disease was observed in 51(16.9%) persons of whom 15 (11.5%) cases in the HAART group and 36 (21.1%) cases in the general group (p = 0.027). After controlling for age and other covariates, women in the HAART group had a 67% reduction in the odds of cervical lesions compared with the community group [adjusted odd ratio (aOR) = 0.33, 95%CI: 0.15-0.73, p = 0.006).CONCLUSION:HIV-infected women receiving HAART have a lower risk of cancer than women in the general population. This finding may not be attributed to HAART alone but to all the health benefits derived from receiving a comprehensive HIV care.

Long term use of antiretroviral therapy (ART) in persons living with human immunodeficiency virus (PLWHIV) is associated with disturbances in blood lipids which should be monitored. More data on such disturbances are needed in Cameroon to persuade the country program to institute their routine monitoring. We then sought to determine the prevalence and timing of dyslipidaemia in PLWHIV and receiving ART in a predominantly rural Cameroonian setting.

BACKGROUND:The antiretroviral therapy (ART) program of Cameroon recommends routine laboratory monitoring of haematological toxicity if a regimen contains zidovudine (AZT) and of hepatotoxicity for NVP-containing regimens on the 15th day after ART initiation. This study aimed to assess the relevance of this repeated laboratory measurements considered to be precocious, inaccessible and unavailable in a resource limited setting.METHODS:A retrospective cohort of HIV-infected patients of age 15 years and above enrolled for first line ART at The Regional Hospital of Nkongsamba in Cameroon. We monitored liver transaminases and blood cell indices after two weeks of ART initiation for any significant change from baseline. Factors associated with abnormal changes were examined using a multivariable logistic regression model with random effects.RESULTS:Enrolled were 154 patients of whom 105 (68.2%) were females. The mean ALAT (alanine aminotransferase) level at baseline was 17.87 ± 20.48 U/L increasing to 19.25 ± 12.01 U/L at two weeks of follow-up (p = 0.53) while the mean ASAT (aspartate aminotransferase) level increased from 17.32 ± 11.87 U/L at baseline to 21.02 ± 14.12 U/L at two weeks of follow-up (p = 0.02). We observed a drop in the mean haemoglobin concentration from 10.86 ± 2.63 g/dL at baseline to 10.36 ± 1.92 g/dL at the second week of follow-up (p = 0.02). The prevalence of elevated liver enzymes and anaemia after two weeks of treatment were 7.5% and 39.2% respectively. Stavudine containing regimens were most likely to induce hepatotoxicity [adjusted Odd Ratio (aOR) = 36.52, 95% CI: 1.44-924.38, p=0.029]. Baseline anaemia (aOR=60.08, 95% CI: 13.36-270.20, p < 0.0001) and body weight ≥ 60kg (aOR=0.28, 95% CI: 0.09-0.83, p = 0.02) were associated with anaemia at follow-up.CONCLUSION:There was no significant rise in the mean level of transaminases and thus scheduling their routine monitoring at the end of the second week could be skipped. Conversely, the drop in mean haemoglobin level had little clinical importance but the high prevalence of anaemia after a fortnight on treatment suggests a targeted instead of a routine monitoring; focusing on the high risk population with baseline anaemia and low body weight.

Access to Human Immunodeficiency Virus (HIV) care has been rolled out in Cameroon in the last decade through decentralised delivery of care and timely initiation of free antiretroviral drugs. We sought to describe the evolution of mortality and loss to follow up (LTFU) and their patient-related determinants at an HIV clinic which is facing significant challenges.

INTRODUCTION: L'objectif principal de notre étude était d'identifier les bactéries associées à l'infection nosocomiale, dans le service de réanimation, de l'hôpital Laquintinie de Douala en vue d'améliorer la prise en charge et diminuer la létalité. METHODES: Il s'agissait d'une étude transversale et descriptive, menée du 1er mars au 31 mai 2011.Tous les patients hospitalisés depuis au moins 48 h étaient inclus dans l'étude et ceux présentant une infection documentée à l'admission étaient exclus. L'analyse des donnés a été faite par le logiciel SPSS 16.Les tests de Khi deux pour la signification. RESULTATS: la prévalence de l'infection nosocomiale était de 12%, elle concernait des personnes âgées de plus de 60 ans et présentant une infection urinaire dans 79% des cas. La létalité était de 72% pour une durée moyenne de séjour de 11,7 - 12,1 jours. Les bactéries responsables étaient en majorité des bactéries gram positifs (BGN), dont E coli dans 23,1% et les cocci gram positifs(CGP), dans 15,4% des cas. CONCLUSION: L'étude de la résistance aux antibiotiques, montre une multi résistance, dont il faut tenir compte en mettant en place une stratégie de prévention active.

BACKGROUND:With an HIV seroprevalence of 14%, sex workers in Douala remain a population at high risk of viral infection. Many campaigns have been carried out with the objective of informing and helping to prevent the spread of infections. This study aims to identify the reoccurring and new risky sexual behaviors and to make recommendations concerning the observations.MATERIALS AND METHODS:A cross sectional study was carried out in the city of Douala. Screening tests were carried out and a questionnaire looked at information concerning different variables. The associations between these variables were evaluated by calculating odds ratios rough-and their confidence intervals at 95%.RESULTS:A seroprevalence of 12.5% was recorded. The average years worked were 25±3. We noted 89% of participants were on HIV medicine (P= 0.001). There was no significant correlation between the sex worker's age and her HIV status (P= 0.458), and no significant correlation between their age and educational level (P= 0.502). 89% of the participants reported using condoms during their paid sexual relations, among them 9% were HIV positive (P=0.04). 87.5% of HIV positive participants reported engaging in anal sex (P=0.007).CONCLUSION:Seroprevalence remains high in sex workers in Douala. They continue to engage in risky sexual behaviors, endangering themselves and their partners. We therefore suggest to increase informational campaigns to increase awareness in this at-risk population.

Introduction : le cholera est en mode endemo-epidemique dans la ville de Douala, comme dans de nombreuses grandes villes d’Asie et d’Afrique. Notre objectif etait de decrire les aspects epidemiologiques, cliniques et bacteriologiques de l’epidemie de cholera survenue en 2011 a Douala, afin de mieux riposter lors des nouvelles flambees epidemiques. Materiels et methodes : l’etude etait transversale et retrospective. L’echantillonnage etait systematique. Resultats : Parmi les 5292 nouveaux cas suspects notifies durant toute l’annee, les jeunes âges de 16 a 34 ans etaient les plus atteints (52,8%, p=0,000), il en etait de meme des hommes contrairement aux femmes (56,2% vs 43,8%, P=0,000). Deux pics de frequence de 429 cas chacun, ont ete observes aux 41e et 45e semaines epidemiologiques. Le taux d’attaque etait de 0,23‰ pour une population de 2 271722 habitants. Le nombre de cas variait significativement selon les districts de sante, Deido avait notifie le plus grand nombre de cas (1597 soit 30,2%, p=0,007). Le taux de letalite de Douala etait de 1,27%, alors que celui de Deido etait de 1,82%. Les patients etaient le plus souvent admis dans un etat de deshydratation severe (43,7%, p=0,000). La duree moyenne d’hospitalisation etait de 2,3±1 jours, et variait significativement entre les districts de sante (p=0,007). Le vibrio cholerae, serogroupe O1, biotype El Tor, serotype Ogawa a ete confirme chez le cas index. Par ailleurs 195 prelevements de selles sur 272 ont ete confirmes, soit 71,7%. Selon l’antibiogramme, le vibrio cholerae etait sensible a la Doxycycline et l’Erythromycine. Conclusion : L’epidemie de cholera de Douala en 2011 etait grave. L’exploitation des donnees de cette etude aura pour resultat l’optimisation de la prevention et de la prise en charge medicale du cholera lors des nouvelles flambees epidemiques. Mots cles : Vibrio Cholerae, letalite, Douala, Cameroun

Objective: To characterize the province-specific incidence patterns of measles in Cameroon and determine if an increase in measles incidence during the period January 2000-June 2001 is consistent with coincident epidemics in several regions with different inter-epidemic periods.Method: Periodic behavior of the monthly measles incidence time-series from each province of Cameroon was analyzed using time-series analysis and cluster techniques. Cumulative incidence in each province of Cameroon over a five-year period was associated with birth rates, and vaccination coverage.Results: Distinct patterns of measles incidence were found in two different areas of Cameroon. The three northern-most provinces experience major epidemics every year. Seven southern provinces show evidence of experiencing major epidemics every third year. In January 2000, Cameroon experienced coincident peaks in these two cycles and thus an increase in measles incidence countrywide over the previous year. Higher cumulative province-specific incidence rates were associated with higher birth rates and Lower routine vaccination coverage rates.Conclusion: Within one country, two dramatically different dynamic patterns of measles incidence were observed. Long-term surveillance data is crucial to the evaluation of measles immunization campaigns. The availability of a five-year record of measles incidence in Cameroon reveals an interesting dynamic pattern of measles incidence that accounts for the increase in countrywide incidence in 2000-2001. (c) 2005 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.