C. Kuaban

Mortality and its determinants among patients infected with HIV-1 on antiretroviral therapy in a referral centre in Yaounde, Cameroon: a retrospective cohort study

Objectives Mortality has declined in people with HIV infection, subsequent to the improved access to antiretroviral therapy (ART). We assessed the incidence and determinants of mortality among patients with HIV-1 infection who were started on ART in a referral treatment centre for HIV infection in Yaounde, Cameroon. Design Cohort study with baseline assessment between 2007 and 2008, and follow-up during 5u2005years until June 2012. Setting The accredited HIV treatment centre of the Yaounde Jamot Hospital in the capital city of Cameroon. Participants People living with HIV infection who started ART between 2007 and 2008 at the study centre. Outcome measures All-cause mortality over time; accelerated failure time models used to relate baseline characteristics to mortality occurrence during follow-up. Results Of the 1444 patients included, 827 (53.7%) were men, and the median age (25–75th centiles) was 38 (31–45) years. The median duration of follow-up was 14.1 (1.1–46.4)u2005months, during which 235 deaths were recorded (cumulative incidence rate: 16.3%), including 208 (88.5%) during the first year of follow-up. Baseline predictors of mortality were male gender (adjusted HR 2.15 (95% CI 1.34 to 3.45)), active tuberculosis (2.35 (1.40 to 3.92)), WHO stages III–IV of the disease (3.63 (1.29 to 10.24)), low weight (1.03 (1.01 to 1.05)/kg), low CD4 count (1.04 (1.01 to 1.07)/10/mm3 lower CD4) and low haemoglobin levels (1.12 (1.00 to 1.26)/g/dL lower). Conclusions Mortality rate among patients with HIV is very high within the first year of starting ART in this centre. Early start of the treatment at a less advanced stage of the disease, and favourable levels of CD4 could reduce early mortality, but would have to be tested.

Prevalence and determinants of excessive daytime sleepiness in hypertensive patients: a cross-sectional study in Douala, Cameroon

Objective To determine the prevalence and determinants of excessive daytime sleepiness (EDS) among a group of sub-Saharan Africans living with hypertension. Design A cross-sectional study. Setting Cardiology outpatient unit of the Douala General Hospital in Cameroon. Participants Patients aged 15u2005years and over, being followed for hypertension between 1st January and 31st July 2013. Patients with unstable heart failure, stroke and head trauma were excluded. Main outcome measure EDS was the outcome of interest. It was defined as an Epworth sleeping scale greater or equal to 10. Logistic regression was used to identify factors associated with EDS. Results A total of 411 patients participated in this study, with a sex ratio (male/female) of 0.58 and a mean age of 55.56u2005years. No patient was underweight and the mean body mass index was 30u2005kg/m2. Controlled blood pressure was found in 92 (22.4%) patients. The prevalence of EDS was 62.78% (95% CI 58.08 to 67.47). The factors independently associated with EDS were: type 2 diabetes (OR 2.51; 95% CI 1 to 6.29), obesity (OR 2.75; 95% CI 1.52 to 4.97), snoring (OR 7.92; 95% CI 4.43 to 14.15) and uncontrolled blood pressure (OR 4.34; 95% CI 2.24 to 8.40). Conclusions A significant proportion of hypertensive patients suffer from EDS and present a high risk of sleep apnoea. Preventive measures targeted on weight loss, type 2 diabetes and snoring should be considered among these patients.

Prevalence and determinants of cigarette smoking among college students: a cross-sectional study in Douala, Cameroon

BackgroundTobacco is the most important avoidable risk for non communicable diseases. While tobacco consumption is stable or declining in developed countries, it is increasing in the developing world with a rate of 3.4 % per annum. The objective of this study was to estimate the prevalence and factors associated with cigarette smoking among college students.MethodsA cross-sectional study was conducted from December 2012 to April 2013 in secondary schools in Douala, Cameroon. A self-administered questionnaire was used to collect sociodemographic data, smoking behavior and peer smoking among college students. Logistic regression analyses was employed to identify factors associated with cigarette smoking.ResultsOf a total of 2623 students included, 1579 (60.2 %) were female. The mean age of participants was 19.2u2009±u20092.53 years. The prevalence of current smoking was 11.2 % [95 % confidence interval (CI) 10 – 12], with 20 % in males and 5.3 % in females. Cigarette smoking was with significantly associated with friends smoking [Odds ratio (OR) 6.66; 95 % CI 4.69 – 9.45)], male gender (OR 3.61; 95 % CI 2.52 – 5.16), increase in age (OR 1.10; 1.03 – 1.17), parental smoking 1.69 (1.04 – 2.76), and attending general education (OR 1.85; 1.23 – 2.78).ConclusionsCigarette smoking constitutes a significant health hazard in college students in Douala. Youth population and especially male students should be continuously targeted by preventive measures and sensitization campaigns against tobacco use. Parents should be aware on the influence of their smoking behavior on initiation of smoking in their children and should be encouraged to quit smoking.

Clinical characteristics and outcomes of tuberculosis in Douala, Cameroon: a 7-year retrospective cohort study.

SETTINGnTuberculosis (TB) clinic, Douala Laquintinie Hospital, Douala, Cameroon.nnnOBJECTIVEnTo describe the clinical characteristics of TB and to investigate predictors of poor treatment outcomes.nnnDESIGNnA registry-based, retrospective cohort study of all TB cases recorded from 2007 to 2013 was conducted. Multinomial logistic regression models were used to identify predictors of poor outcomes.nnnRESULTSnOf 8902 TB cases included, 5110 (57.4%) were males. The median age was 33 years. The prevalence of human immunodeficiency virus (HIV) infection was 37.6%, with a significant decline over the study years (P = 0.000). The main clinical form of TB was smear-positive TB (50.5%). The treatment success rate was 75.2%, while the mortality rate was 8.1%. The year of TB diagnosis, retreatment cases, sputum non-conversion at the end of month 2, HIV infection and HIV testing not done were associated with death. Retreatment and non-conversion of sputum were associated with treatment failure, while male sex, age, sputum non-conversion, HIV infection and HIV testing not done were associated with loss to follow-up.nnnCONCLUSIONnTB management objectives may be attained by focusing specifically on higher risk groups to prevent poor treatment outcomes.

Comparison of different nucleic acid preparation methods to improve specific HIV-1 RNA isolation for viral load testing on dried blood spots

In resource-limited countries (RLCs), WHO recommends HIV viral load (VL) on dried blood spots (DBS) for antiretroviral therapy (ART) monitoring of patients living in non-urban settings where plasma VL is not available. In order to reduce the impact of proviral DNA interference, leading to false positive results in samples with low plasma VL, we compared three different nucleic acid preparation methods with the NucliSens (Biomérieux) extraction, known for its high recovery of nucleic acids on DBS. Paired plasma-DBS samples (n=151) with predominantly low plasma VL (≤10,000 copies/ml; 74%) were used. At the threshold of 1,000 copies/ml on DBS, 51% and 10% were misclassified as false positives or false negatives, respectively with NucliSens, versus 41% and 20% with m2000sp (Abbott), described as more specific for RNA recovery. DNase treatments of nucleic acid extracts and free virus elution (FVE) protocol before nucleic acid extraction, reduced the proportion of false positives to 0% and 19%, but increased the proportion of false negatives to 40% and 73%. More efforts are thus still needed to improve performance of VL assays on DBS to monitor patients on ART in RLCs and allow timely switch to more costly second or third line ART regimes.

Active case finding: comparison of the acceptability, feasibility and effectiveness of targeted versus blanket provider-initiated-testing and counseling of HIV among children and adolescents in Cameroon

BackgroundChildren and adolescents still lag behind adults in accessing antiretroviral therapy (ART), which is largely due to their limited access to HIV testing services. This study compares the acceptability, feasibility and effectiveness of targeted versus blanket provider-initiated testing and counseling (PITC) among children and adolescents in Cameroon.MethodsDuring a 6-month period in three hospitals in Cameroon, we invited HIV-positive parents to have their biological children (6xa0weeks-19xa0years) tested for HIV (targeted PITC). During that same period and in the same hospitals, we also systematically offered HIV testing to all children evaluated at the outpatient department (blanket PITC). Children of consenting parents were tested for HIV, and positive cases were enrolled on ART. We compared the acceptability, feasibility and effectiveness of targeted and blanket PITC using Chi-square test at 5% significant level.ResultsWe enrolled 1240 and 2459 eligible parents in the targeted PITC (tPITC) and blanket PITC (bPITC) group, and 99.7% and 98.8% of these parents accepted the offer to have their children tested for HIV, respectively. Out of the 1990 and 2729 children enrolled in the tPITC and bPITC group, 56.7% and 90.3% were tested for HIV (pu2009<u20090.0001), respectively. The HIV positivity rate was 3.5% (CI:2.4–4.5) and 1.6% (CI:1.1–2.1) in the tPITC and bPITC (pu2009=u20090.0008), respectively. This finding suggests that the case detection was two times higher in tPITC compared to bPITC, or alternatively, 29 and 63 children have to be tested to identify one HIV case with the implementation of tPITC and bPITC, respectively. The majority (84.8%) of HIV-positive children in the tPITC group were diagnosed earlier at WHO stage 1, and cases were mostly diagnosed at WHO stage 3 (39.1%) (pu2009<u20090.0001) in the bPITC group. Among the children who tested HIV-positive, 85.0% and 52.5% from the tPITC and bPITC group respectively, were enrolled on ART (pu2009=u20090.0018).ConclusionsThe tPITC and bPITC strategies demonstrated notable high HIV testing acceptance. tPITC was superior to bPITC in terms of case detection, case detection earliness and linkage to care. These findings indicate that tPITC is effective in case detection and linkage of children and adolescents to ART.Trial registrationTrial registration Number: NCT03024762. Name of Registry: ClinicalTrial.gov. Date registration: January 19, 2017 (‘retrospectively registered’). Date of enrolment first patient: 15/07/2015.

Antiretroviral therapy supply chain quality control and assurance in improving people living with HIV therapeutic outcomes in Cameroon

BackgroundEvaluation of medication efficacy and safety is an essential guarantee to successful therapeutic outcome in public health practices. However, larger distribution chain supply in developing countries such as Cameroon is often challenged by counterfeit drugs, poor manufacturing, storage and degradation leading to health and patient adverse consequences. Yet, access to supply chain management in strengthening ARVs quality assurance and outcomes remains poorly documented. More than 53,000 patients have been enrolled on free ARVs medications, but little is documented on quality assurance and validity of safety for affected populations along the supply chain management since 2008.MethodsThe cross sectional study was conducted in ARVs distribution units and centers in central, littoral and south west regions of Cameroon. ARVs drugs samples included Nevirapine, Efavirenz, and fixed dose combinations of Zidovudinexa0+xa0Lamivudine, Lamivudinexa0+xa0Stavudine and Zidovudinexa0+xa0Lamivudinexa0+xa0Nevirapine. Drugs packaging and labeling was assessed and galenic assays were performed at National Laboratory of quality Control of Medications and Expertise (LANACOME), Yaoundé, Cameroon.ResultsThe study covered 16 structures located in eight different towns including the central ARVs store, two regional pharmaceutical procurement centers and thirteen HIV approved treatment centers and management units. A total of 35 ARVs products were collected. Only eight ARVs drugs containing Lamivudine and Stavudine presented with white stains on tablets, however these drugs were standard for all other tests performed. The others 28 ARVs products were standards to all assays performed.ConclusionWe concluded that ARVs drugs freely accessible and distributed to PLWHA are of good quality in Cameroon. However, with the increase number of patients under HAART since 2013, adoption of “Test and Treat” approach to reach the 90-90-90 goals and with the implementation of new national antiretroviral regimen guidelines and molecules such as boosted protease inhibitors, continuous quality control and assurance surveillance, monitoring and evaluation is recommended. Assessment of quality of formulations that are more susceptible to degradation such as pediatric formulations for averting the rising multidrug resistance trend is also desired.

Prévalence de l’asthme et de la rhinite allergique chez l’adulte à Yaoundé, Cameroun

Introduction Tres peu de donnees sont disponibles sur la prevalence de l’asthme et de la rhinite allergique chez l’adulte en Afrique subsaharienne. Les objectifs de cette etude etaient de determiner la prevalence de l’asthme et de la rhinite allergique, ainsi que les facteurs lies a l’hote associes a ces deux affections a Yaounde, Cameroun. Methodes Cette enquete transversale communautaire incluant les sujets adultes âges de 19xa0ans et plus a ete realisee de novembre 2013xa0a avril 2014xa0a Yaounde, Cameroun. Un echantillonnage stratifie a 3xa0niveaux dans l’ensemble des sept arrondissements de la ville de Yaounde a ete utilise pour l’inclusion des sujets dans l’etude. Resultats Des 2304xa0sujets inclus, 1321 (57,3xa0%) etaient de sexe feminin et leur âge moyen (ecart-type) etait de 34,9 (13,5) ans. Les prevalences de l’asthme-vie et de sifflement-vie etaient respectivement de 2,7xa0% (IC95xa0%xa0: 2,1xa0%-3,4xa0%) et de 6,9xa0% (5,9xa0%–7,9xa0%). La prevalence des sifflements actuels etaient de 2,9xa0% (2,2xa0%–3,6xa0%). La prevalence de la rhinite allergique auto-declaree au cours de la vie etait de 11,4xa0% (10,1xa0%–12,7xa0%). Les symptomes de rhinite allergique actuelle etaient rapportes par 240 (10,4xa0%) sujets et 125 (5,4xa0%) sujets avaient une rhino-conjonctivite. En analyse multivariee, les facteurs independants associes aux sifflements actuels etaient la tranche d’âge de 31xa0a 40xa0ans [ odds ratio (IC95xa0%)xa0: 0,27 (0,09–0,78), p xa0=xa00,016], les signes d’eczema atopique [2,91 (1,09–7,74), p xa0=xa00,033] et les signes de rhinite allergique [3,24 (1,83–5,71), p p p xa0=xa00,002] et les sifflements actuels [3,02 (1,70–5,39), p Discussion En dehors de l’association classique entre les maladies allergiques retrouvees dans cette etude, le tabagisme actif etait independamment associe aux symptomes de rhinite allergique. Conclusion Dans cette etude realisee dans une metropole d’Afrique centrale, les prevalences de l’asthme et de la rhinite allergique chez les adultes se situent a la limite inferieure de celles rapportees dans d’autres regions du monde.