Eric Walter Pefura-Yone

Non-adherence to antiretroviral therapy in Yaounde: Prevalence, determinants and the concordance of two screening criteria

PURPOSE To assess the prevalence and determinants of non-adherence to antiretroviral therapy (ART) as well as the concordance of two screening criteria in a major center for human immunodeficiency virus (HIV) treatment in Yaounde, Cameroon. METHODS In 2011, we conducted a cross-sectional study involving a random sample of 889 adults (age > 18 years, 67.9% women) infected with HIV who were receiving chronic care at the Yaounde Jamot Hospital. Adherence was assessed via self-administered questionnaires using the Community Programs for Clinical Research on AIDS (CPCRA) index and the Center for Adherence Support Evaluation (CASE) index. RESULTS The prevalence of non-adherence to ART was 22.5% based on the CPCRA index and 34.9% based on the CASE index, with a low agreement between the two indexes [kappa = 0.37 (95% confidence interval 0.31-0.44)]. Independent determinants of CPCRA-diagnosed non-adherence were as follows: being a remunerated employee [odds ratio (95% confidence interval): 1.61 (1.14-2.28)], Pentecostal Christianity [2.18 (1.25-3.80)], alcohol consumption [1.65 (1.16-2.34)] and non-adherence to cotrimoxazole prophylaxis [5.73 (3.92-8.38)]. The equivalents for CASE-diagnosed non-adherence were [1.59 (1.19-2.12)], [1.83 (1.36-2.47)], [1.70 (1.27-2.28)], respectively, in addition to association with changes to the ART regimen [1.61 (1.17-2.20)]. CONCLUSIONS Non-adherence to ART remains high in this population. The careful evaluation of patients for the presence of determinants of non-adherence identified in this study may aid ART optimization.

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 5 years 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) months, 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 of Asthma and Allergic Rhinitis among Adults in Yaounde, Cameroon

Background Population-based estimates of asthma and allergic rhinitis in sub-Saharan African adults are lacking. We assessed the prevalence and determinants of asthma and allergic rhinitis in urban adult Cameroonians. Methods A community-based survey was conducted from December 2013 to April 2014 among adults aged 19 years and above (N = 2,304, 57.3% women), selected through multilevel stratified random sampling across all districts of Yaounde (Capital city). Internationally validated questionnaires were used to investigate the presence of allergic diseases. Logistic regressions were employed to investigate the determinants of allergic conditions. Results Prevalence rates were 2.7% (95% CI: 2.1-3.4) for asthma-ever, 6.9% (5.9-7.9) for lifetime wheezing, 2.9% (92.2-3.6) for current wheezing and 11.4% (10.1-12.7) for self-reported lifetime allergic rhinitis; while 240 (10.4%) participants reported current symptoms of allergic rhinitis, and 125 (5.4%) had allergic rhino-conjunctivitis. The prevalence of current asthma medication use and self-reported asthma attack was 0.8 (0.4-1.2) and 1 (0.6-1.4) respectively. Multivariable adjusted determinants of current wheezing were signs of atopic eczema [2.91 (1.09-7.74)] and signs of allergic rhinitis [3.24 (1.83-5.71)]. Age group 31-40 years [0.27(0.09-0.78), p = 0.016] was an independent protective factor for wheezing. Determinants of current rhinitis symptoms were active smoking [2.20 (1.37-3.54), p<0.001], signs of atopic eczema [2.84 (1.48-5.46)] and current wheezing [3.02 (1.70-5.39)]. Conclusion Prevalence rates for asthma and allergic rhinitis among adults in this population were at the lower tails of those reported in other regions of the world. Beside the classical interrelation between allergic diseases found in this study, active smoking was an independent determinant of allergic rhinitis symptoms. Nationwide surveys are needed to investigate regional variations.

Clinical significance of low forced expiratory flow between 25% and 75% of vital capacity following treated pulmonary tuberculosis: a cross-sectional study

Objectives The aim of this study was to assess the prevalence and determinants of post-tuberculosis chronic respiratory signs, as well as the clinical impact of a low forced expiratory flow between 25% and 75% (FEF25–75%) in a group of individuals previously treated successfully for pulmonary tuberculosis. Design This was a cross-sectional study involving individuals in their post-tuberculosis treatment period. They all underwent a spirometry following the 2005 criteria of the American Thoracic Society/European Respiratory Society. Distal airflow obstruction (DAO) was defined by an FEF25–75% <65% and a ratio forced expiratory volume during the first second (FEV1)/forced vital capacity (FVC) ≥ 0.70. Logistic regression models were used to investigate the determinants of persisting respiratory symptoms following antituberculous treatment. Setting This study was carried out in the tuberculosis diagnosis and treatment centre at Yaounde Jamot Hospital, which serves as a referral centre for tuberculosis and respiratory diseases for the capital city of Cameroon (Yaounde) and surrounding areas. Participants All consecutive patients in their post-tuberculosis treatment period were consecutively enrolled between November 2012 and April 2013. Results Of the 177 patients included, 101 (57.1%) were men, whose median age (25th-75th centiles) was 32 (24–45.5) years. At least one chronic respiratory sign was present in 110 (62.1%) participants and DAO was found in 67 (62.9%). Independent determinants of persisting respiratory signs were the duration of symptoms prior to tuberculosis diagnosis higher than 12 weeks (adjusted OR 2.91; 95% CI 1.12 to 7.60, p=0.029) and presence of DAO (2.22; 1.13 to 4.38, p=0.021). Conclusions FEF25–75%<65% is useful for the assessment and diagnosis of post-tuberculous DAO. Mass education targeting early diagnosis of pulmonary tuberculosis can potentially reduce the prevalence of post-tuberculosis respiratory signs and distal airflow obstruction.

Sensibilisation à Blomia tropicalis chez les patients asthmatiques à Yaoundé, Cameroun

INTRODUCTION The aim of this study was to determine the prevalence and investigate associated factors for Blomia tropicalis (BT) sensitization in adolescent and adult patients with asthma in Yaoundé (Cameroon). METHODS We performed a cross-sectional study of 18 months duration (January 2012 to June 2013). All asthmatic patients who were seen for a consultation during the study period and who had a skin prick testing for perennial aeroallergens were included in the study. RESULTS Two hundred and one asthmatic patients (132 female patients, 65.7%) with median age (1st-3rd quartiles) of 35 (20-51.5) years were included in the study. Ninety-six (47.8%) patients had positive skin tests to BT. BT sensitization was associated with sensitization to two other dust mites (Dermatophagoides pteronyssinus [DP] and Dermatophagoides farinae [DF]) in 75 (86.2%) patients. The only clinical factor associated with BT sensitization was the presence of persistent rhinitis (odds ratio [confidence interval 95%]: 2.06 [1.12-3.81]). The independent allergenic factors associated with BT sensitization were sensitization to DP (3.49 [CI 95%: 1.49-8.19]), to DF (4.88 [CI 95%: 2.10-11.36]) and to German cockroach (4.16 [CI 95%: 1.72-10.09]). CONCLUSION Blomia tropicalis sensitization is common in asthmatic patients in Yaoundé. It occurs most often in the context of sensitization to multiple aeroallergens, particularly with sensitization to other dust mites and German cockroach.

Perennial aeroallergens sensitisation and risk of asthma in African children and adolescents: a case-control study

Abstract Objectives: The distribution and impact of various aeroallergens on asthma occurrence vary across regions. We investigated the association between sensitisation to perennial aeroallergens and asthma risk in children and adolescents in Yaounde, Cameroon. Methods: This was a case-control study involving children and adolescents with asthma (cases) vs. non-allergic counterparts (controls). Children/adolescents with doctor-diagnosed asthma were included over a period of 30 months, and controls were selected from the community through random sampling. Logistic regression models were used to relate perennial aeroallergens sensitisation with asthma. Results: The asthma and control groups included, respectively, 151 and 372 participants, with no sex ratio difference. The mean age (standard deviation) was 11.9 (4.4) years in cases and 11.3 (3.7) years in controls. The prevalence of sensitisation to any aeroallergen (cases vs. controls) was 76.8% (116/151) and 32.3% (120/372), p < 0.001. Sensitisation to mites was found in 104 (68.9%) cases vs. 56 (15.1%) controls, p < 0.001. In multivariable analysis, sensitisation to Alternaria alternata, Blattella germanica and dander (cat and dog) was not associated with asthma. However, sensitisation to mites was significantly associated with asthma. Odds ratios (95% CI) for sensitisation to Dermatophagoides pteronyssinus, Dermatophagoides farinae and Blomia tropicalis in relation with asthma were 7.28 (3.75–14.15), 2.65 (1.27–5.45) and 3.23 (1.68–6.21), respectively. Conclusions: Sensitisation to mites was the main perennial allergenic factor associated with asthma in children and adolescents in this setting. This has application for the selection of patients with asthma who could benefit from the control of exposure to mites and specific immunotherapy.

Derivation, validation and comparative performance of a simplified chest X‐ray score for assessing the severity and outcome of pulmonary tuberculosis

To derive and validate against the Ralph et al. score, a simplified chest X‐ray (CXR) score (SCS) for predicting the outcome of smear‐positive pulmonary tuberculosis (SPPTB) among patients with high prevalence of human immunodeficiency virus (HIV) infection.

Evaluation of factors affecting adherence to asthma controller therapy in chest clinics in a sub-Saharan African setting: a cross-sectional study

BACKGROUND Adherence to controller therapy in asthma is a major concern during the management of the disease. OBJECTIVE To determine the adherence rate and identify the predictors of low adherence to asthma controller therapy. METHODS A cross-sectional study including asthma patients was conducted from November 1, 2012 to May 31, 2013 in 4 chest clinics in Cameroon. The adherence to asthma treatment was rated using Morisky Medication Adherence Scale. A multivariate logistic regression analysis was performed for the identification of factors associated with adherence to asthma treatment. RESULTS Among the 201 asthma patients included, 133 (66.2%) were female. The mean age of participants was 41.2 years. Sixty-one (30.3%) of the patients did not visit the chest physician during the last year prior to the study. Asthma was well controlled in 118 patients (58.7%). The prevalence of low adherence rate to asthma controller therapy was 44.8% and the absence of any chest specialist visit within the last 12 months was the only factor associated with the low adherence rate to asthma treatment (OR 5.57 ; 95% CI 2.84-10.93). CONCLUSION The adherence rate to asthma controller therapy in Cameroon is low and it could be improved if scheduled visits are respected by patients.

Complex sleep apnea at auto‐titrating CPAP initiation: prevalence, significance and predictive factors

Obstructive sleep apnea (OSA) patients may develop central respiratory events under continuous positive airway pressure (CPAP), referred to as complex sleep apnea (CompSA).

Determinants of restrictive spirometric pattern in a sub-Saharan urban setting: a cross-sectional population-based study

Background Restrictive spirometric pattern is a risk factor for all-cause and cause-specific mortality. Objective We assessed the prevalence of restrictive pattern and investigated its determinants in a major sub-Saharan Africa city. Methods Participants were adults (≥ 19 years) who took part in a population-based survey in Yaounde (Cameroon) between December 2013 and April 2014. Restrictive pattern was based on a FVC below the lower limit of the normal (LLN) and a ratio forced expiratory volume in one second (FEV1)/FVC ≥ LLN (LLN-based restrictive pattern) or a FVC <80% and FEV1/FVC ≥ LLN (fixed cut-off based restrictive pattern). Determinants were investigated by logistic regressions. Results In all, 1003 participants [514 (51.2%) women] with a mean age of 33.7 years were included. The prevalence of restrictive pattern was 18.8% (95%CI: 16.6-21.2) based on LLN and 15.0% (13.0-17.2) based on fixed cut-off. LLN-based restrictive pattern was mild in 148 (78.3%) subjects, moderate in 35 (18.5%) and severe in 6 (3.2%). Determinants of LLN-based restrictive pattern were age ≥ 60 years [adjusted odds ratio 2.90 (95%CI 1.46-5.77), p=0.002), history of pulmonary tuberculosis [3.81(1.42-10.20), p=0.008], prevalent heart diseases [3.81 (1.20-12.12), p=0.024] and underweight [5.15(1.30-20.39), p=0.020]. Determinants were largely similar with slightly different effect sizes for fixed cut-off based restrictive pattern. Conclusion Restrictive pattern was very frequent in this city. Clinical implications These results enhance the needs to increase the efforts to prevent and control tuberculosis, cardiovascular diseases and underweight in this setting.