Barthelemy Kuate Defo

Areal and socioeconomic differentials in infant and child mortality in Cameroon

Given its geographical, socio-economic, ethnic and cultural diversity, Cameroon offers an excellent setting for investigating the contribution of geographical and socioeconomic factors to mortality differences in infancy and childhood. Such research is crucial for designing appropriate health policies at the national and regional levels. Using data from a nationally representative sample of more than 12,000 births, this study assesses infant and child mortality differences in Cameroon by residence area, mothers education, ethnicity, marital status and union type, religion and the interplay of those factors on differentials mortality. The most vulnerable groups of children in the country are: rural residents; residents of the East, North and South-West regions; Kaka-Baya and Fulbe-Fulani children; and children whose mothers have no education, are Traditionalists, are unmarried, or are in polygamous unions. Lack of maternal schooling alone explains all the excess childhood mortality of Fulbe-Fulani children, most of the excess mortality of children of the North and East regions, most of the excess mortality of the countryside vis-á-vis the metropolitan areas of Yaoundé and Douala, and most of the excess mortality of children of Traditionalists. The robustness of the excess neonatal mortality of newborns in the East region probably reflects the higher prevalence of tetanus in that region compared to the rest of the country. The study also suggests that the place/region of residence in Cameroon is likely to be a proxy for inequalities in the provision of and/or use of health services.

Demographic, epidemiological, and health transitions: are they relevant to population health patterns in Africa?

Background Studies of trends in population changes and epidemiological profiles in the developing world have overwhelmingly relied upon the concepts of demographic, epidemiological, and health transitions, even though their usefulness in describing and understanding population and health trends in developing countries has been repeatedly called into question. The issue is particularly relevant for the study of population health patterns in Africa and sub-Saharan Africa, as the history and experience there differs substantially from that of Western Europe and North America, for which these concepts were originally developed. Objective The aim of this study is two-fold: to review and clarify any distinction between the concepts of demographic transition, epidemiological transition and health transition and to identify summary indicators of population health to test how well these concepts apply in Africa. Results Notwithstanding the characteristically diverse African context, Africa is a continent of uncertainties and emergencies where discontinuities and interruptions of health, disease, and mortality trends reflect the enduring fragility and instability of countries and the vulnerabilities of individuals and populations in the continent. Africa as a whole remains the furthest behind the worlds regions in terms of health improvements and longevity, as do its sub-Saharan African regions and societies specifically. This study documents: 1) theoretically and empirically the similarities and differences between the demographic transition, epidemiological transition, and health transition; 2) simple summary indicators that can be used to evaluate their descriptive and predictive features; 3) marked disparities in the onset and pace of variations and divergent trends in health, disease, and mortality patterns as well as fertility and life expectancy trajectories among African countries and regions over the past 60 years; 4) the rapid decline in infant mortality and gains in life expectancy from the 1950s through the 1990s in a context of preponderant communicable diseases in all African countries; 5) the salient role of adult mortality, mostly ascribed to HIV/AIDS and co-morbidities, since the 1990s in reversing trends in mortality decline, its interruption of life expectancy improvements, and its reversal of gender differences in life expectancies disadvantaging women in several countries with the highest prevalence of HIV/AIDS; 6) the huge impact of wars in reversing the trends in under-five mortality decline in sub-Saharan countries in the 1990s and beyond. These assessments of these transition frameworks and these phenomena were not well documented to date for all five regions and 57 countries of Africa. Conclusion Prevailing frameworks of demographic, epidemiological, and health transitions as descriptive and predictive models are incomplete or irrelevant for charting the population and health experiences and prospects of national populations in the African context.

Fostering accurate HIV/AIDS knowledge among unmarried youths in Cameroon: Do family environment and peers matter?

Background: The last three decades have seen a series of HIV interventions in sub-Saharan Africa. However, youths still have a mixture of correct and incorrect HIV/AIDS knowledge of transmission routes and prevention strategies. Previous studies have identified parents and peers as the most important socializing agents for youths. This paper assesses the relationships between family structure, family/peer communication about sexuality and accurate knowledge of transmission routes and prevention strategies. Methods: Data were drawn from the Cameroon Family Life and Health Survey (CFHS) conducted in 2002. The CFHS collected information on a representative sample of 4 950 people aged 10 years and over nested within 1 765 selected households from the 75 localities forming the administrative prefecture of Bandjoun, using detailed questionnaires about family, HIV/AIDS/STDs knowledge, sexual behaviors, contraception, health, media exposure, household assets and neighborhood characteristics. The survey cooperation rates were high (97%). For the purpose of this study, a sub-sample of 2 028 unmarried youths aged 12 - 29 years was utilized. Results: Overall, 42% of respondents reported accurate knowledge of documented HIV transmission routes whereas 21% of them had inaccurate knowledge such as AIDS can be transmitted through mosquito bites or casual contact with an infected person. Only 9% of respondents were knowledgeable about all HIV prevention strategies. Multivariate analyses showed that family structure, communication with parents/guardians and peers about sexual topics were significantly associated with accurate HIV knowledge. Additionally, age, education, sexual experience and migration had significant effects on accurate knowledge. Finally, living in poor households and disadvantaged neighborhoods significantly increased inaccurate knowledge of HIV transmission modes and prevention strategies. Conclusions: This paper evidenced the limited effects of HIV interventions/programmes in sub-Saharan Africa. Indeed, few respondents reported accurate knowledge about HIV transmission routes and prevention strategies. Findings showed that the role of family environment as source of accurate HIV knowledge transmission routes and prevention strategies is of paramount significance; however, families have been poorly integrated in the design and implementation of the first generation of HIV interventions. There is an urgent need that policymakers work together with families to improve the efficiency of these interventions. Peer influences is likely controversial because of the double positive effect of peer-to-peer communication on both accurate and inaccurate knowledge of HIV transmission routes.BackgroundThe last three decades have seen a series of HIV interventions in sub-Saharan Africa. However, youths still have a mixture of correct and incorrect HIV/AIDS knowledge of transmission routes and prevention strategies. Previous studies have identified parents and peers as the most important socializing agents for youths. This paper assesses the relationships between family structure, family/peer communication about sexuality and accurate knowledge of transmission routes and prevention strategies.MethodsData were drawn from the Cameroon Family Life and Health Survey (CFHS) conducted in 2002. The CFHS collected information on a representative sample of 4 950 people aged 10 years and over nested within 1 765 selected households from the 75 localities forming the administrative prefecture of Bandjoun, using detailed questionnaires about family, HIV/AIDS/STDs knowledge, sexual behaviors, contraception, health, media exposure, household assets and neighborhood characteristics. The survey cooperation rates were high (97%). For the purpose of this study, a sub-sample of 2 028 unmarried youths aged 12 - 29 years was utilized.ResultsOverall, 42% of respondents reported accurate knowledge of documented HIV transmission routes whereas 21% of them had inaccurate knowledge such as AIDS can be transmitted through mosquito bites or casual contact with an infected person. Only 9% of respondents were knowledgeable about all HIV prevention strategies. Multivariate analyses showed that family structure, communication with parents/guardians and peers about sexual topics were significantly associated with accurate HIV knowledge. Additionally, age, education, sexual experience and migration had significant effects on accurate knowledge. Finally, living in poor households and disadvantaged neighborhoods significantly increased inaccurate knowledge of HIV transmission modes and prevention strategies.ConclusionsThis paper evidenced the limited effects of HIV interventions/programmes in sub-Saharan Africa. Indeed, few respondents reported accurate knowledge about HIV transmission routes and prevention strategies. Findings showed that the role of family environment as source of accurate HIV knowledge transmission routes and prevention strategies is of paramount significance; however, families have been poorly integrated in the design and implementation of the first generation of HIV interventions. There is an urgent need that policymakers work together with families to improve the efficiency of these interventions. Peer influences is likely controversial because of the double positive effect of peer-to-peer communication on both accurate and inaccurate knowledge of HIV transmission routes.

Determinants of infant and early childhood mortality in Cameroon: The role of socioeconomic factors, housing characteristics, and immunization status

Abstract This study examines factors impinging on the survival of children in Cameroon using longitudinal data collected by the United Nations Demographic Training and Research Institute of Yaounde, Cameroon. It deals especially with the role of socioeconomic factors (mothers education, employment, marital status, ethnicity, and household income), housing characteristics (construction materials, power source, source of water supply, extent of crowding), and immunization status on infant and child mortality. Two‐state parametric and nonparametric hazards models for the risk of death at any time within the course of the study are used, with and without accounting for unmeasured heterogeneity. Overall, overcrowding has robust deleterious effects on infant and child survival. As regards the effects of socioeconomic variables, the robustness of the effects of household income and ethnic differentials are unchanged, even after controlling for unmeasured heterogeneity; the deleterious effects of marital status ...

Mortality and Attrition Processes in Longitudinal Studies in Africa: An Appraisal of the Iford Surveys

This paper considers the impact of sample-attrition through dropouts on mortality analyses, using the pioneering IFORD survey of Yaounde (Cameroon). The essential issue in the IFORD surveys is the possibility that mortality of members of the cohort may differentially select some children, with specific underlying characteristics. The paper implements a method to assess the following three distinct concerns that may arise in the analysis of the IFORD data: (a) the estimation of the relationship between the covariates and the rate of occurrence of mortality or attrition over time; (b) the study of the interrelation between processes under a specific set of conditions during intervals between rounds for those children still alive and in the survey at the beginning of each interval; and (c) the issue of whether mortality and mortality differentials are affected when attrition is ignored. This approach accounts for sample-selection bias that may have resulted in the attrition process. The analyses provide insi...

Effects of infant feeding practices and birth spacing on infant and child survival: a reassessment from retrospective and prospective data.

Retrospective and prospective data collected in Cameroon were used to reassess hypotheses about how infant and early childhood mortality is affected by birth spacing and breast-feeding. These data show that: (a) a short preceding birth interval is detrimental for child survival in the first 4 months of life; (b) full and partial breast-feeding have direct protective effects on child survival in the first 4-6 months of life, with the effects of the former stronger than those of the latter; (c) early subsequent conception significantly increases mortality risks in the first 16 months of life of the index child. These findings are robust to various controls, e.g. study design, data defects, childs health conditions at/around birth, postnatal maternal and child recurrent illnesses, patterns of utilisation of health care services, and immunisation status of the child.

Risky sexual behaviour among unmarried young people in Cameroon: another look at family environment.

Most studies of the association between family structure and risky sexual behaviour among adolescents and young adults have employed a risk perspective which assumes that, compared with other types, two-parent families are protective. Drawing from a positive-oriented approach in this study, it is hypothesized that within each family type some influential factors may mitigate such anticipated deleterious effects of non-intact families and decrease sexual risk-taking. The paper examines specifically the effects of risk and protective factors with an emphasis on family processes associated with resilience, using data from a pooled sample of 1025 females and males aged 12-24 years from Bandjoun (West Cameroon). Findings show that the quality of parent/guardian-youth relationships significantly decreases the odds of risky sexual behaviour by 36%, 65% and 50% in neither-, one- and two-parent families, respectively. For two-parent families only, parental control acts as a significant protective factor; it decreased by 41% the odds of risky sexual behaviour. Programmatically, protective family factors such as parent/guardian-youth interactions need to be promoted to improve the efficiency of reproductive health and HIV interventions in sub-Saharan Africa.

Family Environment and Premarital Intercourse in Bandjoun (West Cameroon)

Family environment is one of the most influential factors on youth sexual behavior but has received little investigation in sub-Saharan Africa. Yet, a comprehensive understanding of family influences could improve the efficiency of reproductive health (RH) interventions. Using retrospective data from a population-based survey, life-table analysis was utilized to compute the median age at premarital intercourse among 1,182 youth aged 12-24 years. Discrete-time hazard models were used in multivariate analysis to estimate the effects of family structures and parent-child interactions on premarital intercourse. Overall, 42% of participants had a premarital intercourse, and the median age at first sex was 16.9 years. Participants in nuclear two-parent families had the highest median (17.7) compared with those in nuclear one-(16.7), extended one-(16.5), extended two-parent families (16.9) or other relatives (16.8). Youth from monogamous families had the highest median (16.9) compared to those from polygamous (16.3) and other families (16.0). Orphans and youth reporting family transitions were more likely to initiate first sex at an earlier age compared with non-orphans and non-movers, with a median of 16.1 and 16.9 years, respectively. Multivariate results showed that living in extended families, being orphaned, and family transitions significantly increased the risk of premarital intercourse. Polygamy showed marginal effects. Stronger parent-child relationships and higher levels of parental control decreased the risk of premarital intercourse. Unexpectedly, parent-child communication was significantly associated with a higher risk of sexual debut. Programmatically, family environment is an important resource that needs to be promoted when designing RH interventions in sub-Saharan Africa.

Determinants of low birthweight: a comparative study.

The study compares biological, socioeconomic and behavioural determinants of low birthweight in Cameroon and the United States. Some factors in low birthweight are found to be cross-national, but others are specific to the setting. Positive risk factors of low birthweight in both countries include unmarried motherhood, female sex, multiple births, and preterm births. Outcome of the previous pregnancy is a positive risk factor in the US, but not in Cameroon. Significant negative risk factors include prenatal care visits (in both countries), mothers education (in the US only), births to mothers aged 20-34 and birth orders of 2 or more (in Cameroon only). Separate analyses of all births and the subsamples of singleton births reveal that estimates for the two groups differ only marginally.

The Burden of Mental Disorders in the Eastern Mediterranean Region, 1990-2013.

The Eastern Mediterranean Region (EMR) is witnessing an increase in chronic disorders, including mental illness. With ongoing unrest, this is expected to rise. This is the first study to quantify the burden of mental disorders in the EMR. We used data from the Global Burden of Disease study (GBD) 2013. DALYs (disability-adjusted life years) allow assessment of both premature mortality (years of life lost–YLLs) and nonfatal outcomes (years lived with disability–YLDs). DALYs are computed by adding YLLs and YLDs for each age-sex-country group. In 2013, mental disorders contributed to 5.6% of the total disease burden in the EMR (1894 DALYS/100,000 population): 2519 DALYS/100,000 (2590/100,000 males, 2426/100,000 females) in high-income countries, 1884 DALYS/100,000 (1618/100,000 males, 2157/100,000 females) in middle-income countries, 1607 DALYS/100,000 (1500/100,000 males, 1717/100,000 females) in low-income countries. Females had a greater proportion of burden due to mental disorders than did males of equivalent ages, except for those under 15 years of age. The highest proportion of DALYs occurred in the 25–49 age group, with a peak in the 35–39 years age group (5344 DALYs/100,000). The burden of mental disorders in EMR increased from 1726 DALYs/100,000 in 1990 to 1912 DALYs/100,000 in 2013 (10.8% increase). Within the mental disorders group in EMR, depressive disorders accounted for most DALYs, followed by anxiety disorders. Among EMR countries, Palestine had the largest burden of mental disorders. Nearly all EMR countries had a higher mental disorder burden compared to the global level. Our findings call for EMR ministries of health to increase provision of mental health services and to address the stigma of mental illness. Moreover, our results showing the accelerating burden of mental health are alarming as the region is seeing an increased level of instability. Indeed, mental health problems, if not properly addressed, will lead to an increased burden of diseases in the region.