Tsi Njim

Cutaneous onchocerciasis in Dumbu, a pastoral area in the North-West region of Cameroon: diagnostic challenge and socio-economic implications

Onchocerciasis is a severe parasitic infestation caused by Onchocerca volvulus which causes disabling skin and subcutaneous tissue changes and ultimately leads to blindness. It has a huge public health impact due to its socioeconomic burden and the vast number of people it affects in developing countries. In this case, a 60 years old woman was encountered with leopard skin like changes, rashes and pruritus on the left leg; which had been managed as cutaneous mycosis for over a period of 8 years. A diagnosis of onchocerciasis was finally made after a skin snip identified onchocercal microfilariae. The above case shows that onchocerciasis is still a neglected tropical disease (NTD) in Cameroon. This emphasizes the need for more expansive outreach programs in remote areas in Cameroon, a change in health policies to ensure the eradication of this disabling disease and health promotion amongst vulnerable populations.

The neglected burden of snakebites in Cameroon: a review of the epidemiology, management and public health challenges

ObjectivesSnakebite is an underestimated medical and surgical emergency in developing countries responsible for a high disease burden. Optimal management of snake envenomation in these resource-limited settings is precluded by several public health challenges. In this review, we discuss the disease burden of snakebites in Cameroon and the public health challenges of its management in view of making recommendations essential for policy-making. MEDLINE, African Journals Online and Google Scholar were searched from January 1990 to February 2017 for studies addressing snakebite in Cameroon. Our search extended to include grey literature from book chapters, conference proceedings, theses and documents from organizations.ResultsOur results suggest that snakebites pose a significant health and economic burden in Cameroon. A composite of factors contributes to the challenge of managing snakebites in Cameroon and include: inadequate disease surveillance; poor health-seeking behaviours of patients; under-production and scarcity of anti-venom serum and the relatively high cost of anti-venom serum. There is an urgent need to revamp the current health policies through health education, promotion and building of sustainable health systems. Disease surveillance and management can be improved by providing refresher courses for healthcare providers and subsidization of the prices of anti-venom serum in pharmacies in the country.

An appraisal of the neglected tropical diseases control program in Cameroon: the case of the national program against onchocerciasis

BackgroundOnchocerciasis is a severe parasitic infestation which causes disabling skin and subcutaneous tissue changes. Current global estimates suggest that it accounts for 1135.7 disability adjusted life years (DALYs) per 100,000 population. The disease is endemic in many African countries including Cameroon, probably suggesting that the current health policies are inadequate to achieve eradication of the disease. We aimed to appraise the current Onchocerciasis control program in Cameroon in the context of existing literature.MethodsWe carried out a MEDLINE search via PubMed to source for articles on Onchocerciasis in Cameroon.ResultsOur appraisal of the literature suggests that Onchocerciasis poses a significant health and economic burden in Cameroon. A composite of factors contribute to the challenge of containing and eradicating Onchocerciasis in Cameroon and include: continuous transmission of the disease; non-compliance to mass drug administration; inability of health care providers (HCPs) to adequately diagnose the disease; limited access of most individuals in endemic zones to annual preventive chemotherapy and inadequate population education on simple and practical measures to prevent the disease. More robust population-based epidemiologic studies are needed to better quantify the current disease burden and consequently guide intervention strategies for complete disease eradication.ConclusionOnchocerciasis is still a neglected tropical disease (NTD) in Cameroon and urgently demands a need for intensification and probably modification of some strategies in the current onchocerciasis elimination program. Control of the disease will contribute to achievement of the corresponding Sustainable Development Goals (SDGs) quota.

Determinants of burnout syndrome among nursing students in Cameroon: cross-sectional study

ObjectivesBurnout syndrome defined as a state of emotional exhaustion and disengagement; which could reduce optimal healthcare delivery, is relatively common amongst healthcare trainees. We sought to assess the determinants of burnout syndrome amongst nursing students in Cameroon. A cross-sectional study which included 447 nursing students recruited after written informed consent by convenience sampling, was carried out from January to April 2018. A printed self-administered questionnaire assessing burnout using the OLdenburg Burnout Inventory was used. Multivariable linear regression was used to identify independent determinants of burnout syndrome.ResultsMost (81.17%) of the students were female with the average for disengagement items being 17.10 ± 3.09 (minimum = 8, maximum = 26) and 20.94 ± 3.04 (minimum = 13, maximum = 31) for exhaustion items. After multivariable linear regression analysis, satisfaction with results (RC: − 1.42, 95% CI − 2.52, − 0.32, p value: 0.012) and regret of choice of nursing studies (RC: 2.13, 95% CI 0.58, 3.68, p value = 0.007) were found to be independent predictors of burnout in these students. Early identification of these determinants is required to prevent progression to burnout.

Knowledge, attitudes and practices regarding depression among primary health care providers in Fako division, Cameroon

BackgroundMental health and mental illness are often overlooked in the management of patients in our health services. Depression is a common mental disorder worldwide. Recognising and managing mental illnesses such as depression by primary health care providers (PHCPs) is crucial. This study describes the knowledge, attitudes and practices (KAP) of PHCPs regarding depression in Fako Division.MethodsA cross-sectional study was conducted among PHCPs (general practitioners, nurses, pharmacy attendants and social workers) in public-owned health facilities in the four health districts in Fako Division. Participants were selected by a consecutive convenience sampling. A structured questionnaire including the Depression Attitude Questionnaire (DAQ) was used to collect information about their socio-demographic characteristics, professional qualifications and KAP about depression.ResultsThe survey had a response rate of 56.7%. Most of the 226 participants (92.9%) were aware that depression needs medical intervention. Only 1.8% knew a standard tool used to diagnose depression. Two-thirds agreed that majority of the cases of depression encountered originate from recent misfortune. About 66% felt uncomfortable working with depressed patients. Also, 45.1% of PHCPs did not know if psychotropic drugs were available at pharmacies within their health area. Very few (15.2%) reported to have prescribed psychotropic drugs. Less than half (49.1%) of the participants had prior formal training in mental health.ConclusionPHCPs in Fako Division tend to have limited knowledge and poor attitudes regarding depression. Practices towards diagnosis and management of depression tend to be inadequate. There is an urgent need to train PHCPs in mental health in general and depression diagnosis and management in particular.

Motorbike-handlebar hernia - a rare traumatic abdominal wall hernia: a case report and review of the literature

BackgroundHandlebar hernias are very rare and arise following a sudden force from a handle-like object impacting a focal area of the abdomen, which results in a disruption of the underlying abdominal muscle and fascia without necessarily disrupting the overlying skin. Other than a reducible swelling on the abdominal wall, the physical examination of such patients is usually unremarkable and the diagnosis could easily be missed.Case presentationAn 8-year-old Cameroonian boy with no significant past history presented to our emergency service with a tender left flank swelling following a road traffic accident. He was knocked down by a motorbike with resulting impact of the handlebar on his abdomen. A handlebar hernia was diagnosed on the basis of a reducible abdominal swelling with a positive cough impulse. A herniorrhaphy was done the following day after resuscitation and his postoperative period was uneventful.ConclusionsHandlebar hernias, although rare, should be suspected when patients present with an abdominal swelling following blunt abdominal trauma involving a handlebar-like object. A good history and physical examination are usually enough to pose an early diagnosis of handlebar hernia. Management typically involves surgical intervention to prevent complications. The timing and surgical approach should be decided on a case-by-case basis.

Bowel Resection and Ileotransverse Anastomosis as Preferred Therapy for 15 Typhoid Ileal Perforations and Severe Peritoneal Contamination in a Very Elderly Patient

Typhoid ileal perforation (TIP) is the most lethal complication of typhoid fever. Although TIP is a surgical emergency by consensus, there is still much controversy regarding the most appropriate surgical approach to be used. Bowel exteriorization and secondary closure are usually recommended for patients presenting late with multiple TIPs and heavy peritoneal soiling. We, however, discuss a unique case of an 86-year-old patient with 15 typhoid ileal perforations successfully treated with one-step surgery comprising bowel resection and ileotransverse anastomosis in a resource-constrained setting of Cameroon.

Takayasu's arteritis in an adult female from Cameroon: diagnosis via Doppler echocardiography.

Lesson Takayasu arteritis is rare in black people. Doppler echocardiography may assist in its diagnosis with good response to steroids.

Measles outbreak in a poorly vaccinated region in Cameroon: a case series study, public health challenges and recommendations

Measles is a highly contagious viral infection and still a leading cause of vaccine-preventable deaths in Africa; especially in unvaccinated populations. We reviewed the medical reports of the measles outbreak that occurred in Misaje, in the North west region of Cameroon from 11/03/2015 to 14/05/2015. Six measles cases were recorded during this period; three of them complicated by bacterial infections. Measles should be considered as a differential diagnosis for any febrile rash especially among poorly vaccinated populations. Primary preventive methods implemented by clinicians could help control outbreaks; especially with delays in public health intervention. Also, gaps in health policies in Cameroon should be addressed to scale up vaccination coverage in remote communities like Misaje to reduce the incidence of measles outbreaks.

Identifying risk factors for the development of sepsis during adult severe malaria

AbstractBackgroundSevere falciparum malaria can be compounded by bacterial sepsis, necessitating antibiotics in addition to anti-malarial treatment. The objective of this analysis was to develop a prognostic model to identify patients admitted with severe malaria at higher risk of developing bacterial sepsis.MethodsA retrospective data analysis using trial data from the South East Asian Quinine Artesunate Malaria Trial. Variables correlating with development of clinically defined sepsis were identified by univariable analysis, and subsequently included into a multivariable logistic regression model. Internal validation was performed by bootstrapping. Discrimination and goodness-of-fit were assessed using the area under the curve (AUC) and a calibration plot, respectively.ResultsOf the 1187 adults with severe malaria, 86 (7.3%) developed clinical sepsis during admission. Predictors for developing sepsis were: female sex, high blood urea nitrogen, high plasma anion gap, respiratory distress, shock on admission, high parasitaemia, coma and jaundice. The AUC of the model was 0.789, signifying modest differentiation for identifying patients developing sepsis. The model was well-calibrated (Hosmer–Lemeshow Chi squared = 1.02). The 25th percentile of the distribution of risk scores among those who developed sepsis could identify a high-risk group with a sensitivity and specificity of 70.0 and 69.4%, respectively.ConclusionsThe proposed model identifies patients with severe malaria at risk of developing clinical sepsis, potentially benefiting from antibiotic treatment in addition to anti-malarials. The model will need further evaluation with more strictly defined bacterial sepsis as outcome measure.