Vincent de Paul Djientcheu

General public awareness, perceptions, and attitudes with respect to epilepsy in the Akwaya Health District, South-West Region, Cameroon

BACKGROUND This study was part of a series mandated by the Ministry of Public Healths National Epilepsy Control Program to obtain baseline data for a community-adapted epilepsy education program. METHODS We conducted 387 face-to-face interviews with subjects without epilepsy aged 15 years and above in 12 villages of the Akwaya Health District, Cameroon. RESULTS Most respondents (97.9%) had heard or read about epilepsy, 90.2% knew someone with epilepsy, and 90.4% had witnessed a seizure. About 51.4% would object to association with people with epilepsy (PWE), 68.7% would object to marriage to PWE, while 41.6% would offer them equal employment. For treatment, 30.2% would suggest going to a traditional healer or witch doctor, while 3.9% would not recommend any treatment at all. Predictors of attitudes were male gender, low or no level of education, having children, knowledge of the cause of epilepsy, and beliefs that epilepsy is contagious or is a form of insanity. CONCLUSION The high level of public awareness on epilepsy in the Akwaya Health District may suggest a high prevalence. This contrasts with prevailing negative attitudes. Our data provide new evidence for our hypothesis of regional variation in the determinants of epilepsy stigma in Cameroon.

Management of neural tube defects in a Sub-Saharan African country: the situation in Yaounde, Cameroon.

BACKGROUND Neural tube defect is a serious disabling but preventable congenital malformation with an incidence of 1.99 per 1000 births in Yaounde [A.K. Njamnshi, V. d e P. Djientcheu, A. Lekoubou, M. Guemse, M.T. Obama, R. Mbu, S. Takongmo, I. Kago. Neural tube defects are rare among black Americans but not in Sub-Saharan black Africans: The case of Yaounde-Cameroon. Journal of the Neurological Sciences 2008; 270: 13-17]. The management requires highly qualified personnel and a significant social cost. The aim of this study was to evaluate the management of neural tube defect in a resource-limited developing Sub-Saharan nation like Cameroon. METHODS We reviewed all patients with neural tube defects admitted in the neonatology unit of the Mother and Child Center (Chantal Biya Foundation Yaounde) between January 1st 2000 and December 31st 2006. RESULTS Sixty-nine (69) patients were enrolled. There was a male predominance (69.57%) in the sample. Myelomeningomecele represented 68.11% of cases, followed by encephalocele (27.54%) and meningocele (4.35%). Antenatal ultrasound examinations were done in 27 cases (32.8%). The prenatal diagnosis was made only in 8 cases. No medical abortion was performed in any of these cases. Medical abortion is illegal in Cameroon (except in certain specific situations) as well as other Sub-Saharan African countries. Hydrocephalus was diagnosed in 40.02% of cases. As most of the patients (62.32%) could not afford modern treatment, only 26.09% of them were operated at birth. The rest sought traditional and other forms of treatment, due to poverty or cultural beliefs. Eight patients (11.59%) died before surgery. Surgery consisted of local closure alone (40%) or local closure associated to CSF shunting (60%). The complications were wound dehiscence (13.69%), shunt infection (1.37%), meningitis (1.37%) and iatrogenic pulmonary oedema (1.37%). CONCLUSION Neural tube defects are the most frequent and disabling malformations in neonates in the Sub-Saharan African paediatric environment. Prenatal management and outcome at birth are limited by poverty and cultural beliefs. Prevention is possible and may be better than palliative care in developing countries.

Leptomeningeal cyst in newborns due to vaccum extraction: report of two cases

Two new cases of leptomeningeal cysts subsequent to vacuum extraction are reported. Both children presented with a huge, nonpulsating, transilluminating subgaleal collection over the anterior fontanel that appeared soon after instrument delivery. Plain X-rays, computed tomography, and magnetic resonance imaging confirmed that the subgaleal collection was cerebrospinal fluid and showed the presence of a diastatic coronal suture in both cases. Treatment consisted of duraplasty with periosteal flaps and application of fibrin glue. In one case, an associated porencephalic cyst was treated with a cystoperitoneal shunt. Surgical treatment of leptomeningeal cyst due to vaccum extraction is simple and should not be postponed, despite the tendency for the extracrainal cyst to regress, because of the potential risk of continuous growth of an underlying porencephalic cyst and risk of neurological damage.

Patterns of non-traumatic myelopathies in Yaoundé (Cameroon): a hospital based study

Background The relative frequency of compressive and non-compressive myelopathies and their aetiologies have not been evaluated extensively in most sub-Saharan African countries. The case of Cameroon is studied. Methods Admission registers and case records of patients in the neurology and neurosurgery departments of the study hospital were reviewed from January 1999 to December 2006. Results 224 (9.7% of all admissions) cases were non-traumatic paraplegia/paraparesis or tetraplegia/tetraparesis and 147 were due to myelopathies, representing 6.3% of all cases admitted during the study period and 65.6% of cases of paraplegia or tetraplegia; 88% were compressive myelopathies. Aetiologies were dominated by primary and secondary spinal tumours (mainly prostate carcinoma, lymphoma and liver carcinoma) that each accounted for 24.5% of cases. Other causes included spinal tuberculosis (12.9%), tropical spastic paraparesis (five positive for human T cell lymphotrophic virus (HTLV)-I and one for HTLV-II) (4.8%), spinal degenerative disease (4.1%), acute transverse myelitis (4.1%), HIV myelopathy (1.4%), vitamin B12 deficiency myelopathy and multiple sclerosis (0.7%). No aetiology was found in 21.1% of participants. Conclusions Myelopathies in our setting are dominated by spinal compressions. Metastasis is a leading cause of spinal cord compression with liver carcinoma being more frequent than reported elsewhere. Infections nevertheless remain a major cause of spinal cord disease and both cancers and infections constitute public health targets for reducing the incidence of myelopathies.

Stroke may appear to be rare in Saudi-Arabian and Nigerian children with sickle cell disease, but not in Cameroonian sickle cell patients.

We read with much interest the excellent review entitled ‘Defining stroke risk in children with sickle cell anaemia’ (Hoppe, 2005), but felt the necessity to clarify two issues. In reviewing the epidemiology of stroke in sickle cell disease (SCD), Dr Hoppe stated that, ‘Stroke appears to be rare in SaudiArabian and Nigerian children with SCD’ and cited among other studies Izuora et al (1989) and Obama et al (1994). Concerning the incidence rates of stroke in SCD in Nigeria, Izuora et al (1989) did report a relative incidence of associated neurological disorders of 1AE3% and that cerebrovascular accidents were responsible for 57AE5% of that number. It should be noted that the study by Obama et al (1994) was not done in Nigeria. This study was done in Yaounde, Cameroon: a neighbouring country to Nigeria. In this study of paediatric stroke in general, the average annual stroke incidence was 1AE85 per 1000 (18AE5%) paediatric hospitalisations in Yaounde and the main aetiological factor was homozygous SCD, accounting for nearly a third of stroke cases (31AE4%). We have recently studied a sample of 120 homozygous sickle cell patients in Yaounde, Cameroon. Clinical examinations and computerised tomography scans identified a stroke prevalence of 6AE7% with an annual recurrence rate of 25% (Njamnshi et al, 2005). This prevalence rate in our study might be an underestimation, given that we did not use more sensitive procedures that detect silent infarcts like magnetic resonance imaging and neuropsychological testing. Moreover, recent genetic studies indicated that the Cameroon and atypical haplotypes were more prevalent than reported in patients with homozygous (SS) sickle cell disease in general (Sarnaik & Ballas, 2001). In one report on 80 beta S chromosomes studied in Cameroonians, 13 exhibited the Cameroon haplotype (Lapoumeroulie et al, 1992). Furthermore, neonates with four or more alpha-genes whose beta(S) haplotype was Ben/CAR, Cameroon or CAR/CAR seemed to be at a higher risk for cerebrovascular accidents than other patients (Sarnaik & Ballas, 2001; Lyra et al, 2005). This may explain why stroke does not appear to be rare in Cameroonian sickle cell patients. In conclusion, we believe that stroke is not so rare in SCD, as reported in African patients and, for Cameroon in particular, stroke risk in these patients may be even higher because of the presence of atypical beta(S) haplotypes. It is therefore important not to minimise the magnitude of this problem, which has far reaching consequences. Alfred Kongnyu Njamnshi Ambroise Wonkam Vincent de Paul Djientcheu Pierre Ongolo-Zogo Marie-Therese Obama Wali F. T. Muna Roman Sztajzel Faculty of Medicine and Biomedical Sciences, University of Yaounde 1, Yaounde, Cameroon, Africa, Department of Neurology, and Department of Genetic Medicine and Development, University Hospitals of Geneva, Geneva, Switzerland E-mail: aknjamnshi@yahoo.co.uk

Prevalence and determinants of diabetic polyneuropathy in a sub-Saharan African referral hospital

BACKGROUND Diabetic peripheral neuropathy is the commonest complication of diabetes mellitus, and a major cause of limb amputations. In general however, the magnitude of diabetic neuropathy in sub-Saharan Africans with diabetes has been less reliably quantified. We assessed the prevalence and determinants of diabetic polyneuropathy in hospital settings in Cameroon. METHODS We conducted a cross-sectional survey at the Douala Laquintinie Hospital, which is one of the main reference hospital in the economic capital of Cameroon (3 million populations). Participants included all patients with type 1 (T1DM) or type 2 (T2DM) diabetes who reported to the hospital regardless of the reason, during a 5-month recruitment period. Polyneuropathy was defined as diabetic in a patient with a Diabetic Neuropathy Examination score of >3/16 and/or a monofilament score of <5/9. RESULTS A total of 306 patients were recruited, including 196 women (64%) and 294 (96%) with T2DM. The mean (standard deviation) values were 59.8 (11.2) years for age and 8.4 (8.2) years for diabetes duration. Clinical signs of polyneuropathy were present in 102 (crude prevalence rate: 33.3%) patients. The polyneuropathy was symptomatic in 79/102 (77.4%) patients. Determinants of polyneuropathy were urban residence (p=0.02), infection with hepatitis C virus (p=0.002), infection with HIV (p=0.012) and presence of albuminuria (p=0.0001). CONCLUSION About one in three patients with diabetes reporting to the hospital in our setting has prevalent diabetes related polyneuropathy. This emphasizes the importance of routine implementation of therapeutic education and other measures to limit the complications.

Management of tethered cord syndrome in adults: a case report in Cameroon

Tethered cord syndrome (TCS) is spinal cord fixation from multiple pathological entities. No case of TCShas been reported in our region. The goal of this case report was to describe a TCS managed at the Douala General hospital. Mrs. EEL, 23 year old consulted in 2012 for urinary and fecal incontinence. She had a past history of a spina bifida at birth operated on day two of life. On admission, lumbar MRI showed an abnormally low lying conus medullaris ending at S. Microsurgery permitted to gradually detach the spinal cord from subcutaneous tissue and carefully free the spinal nerves. A 12 months post-surgery, the patient could control defecation, and achieve proper micturition. TCS should also be ruled out in patients who present with urinary and ano-rectal symptoms especially of childhood onset; more so with present day availability of modern radiological tools like MRI.

Exploring three approaches to offer distance learning courses through a social network of health researchers in three African countries

The Institute of Tropical Medicine in Antwerp hereby presents the results of two pilot distance learning training programmes, developed under the umbrella of the AFRICA BUILD project (FP7). The two courses focused on evidence-based medicine (EBM): with the aim of enhancing research and education, via novel approaches and to identify research needs emanating from the field. These pilot experiences, which were run both in English-speaking (Ghana), and French-speaking (Mali and Cameroon) partner institutions, produced targeted courses for the strengthening of research methodology and policy. The courses and related study materials are in the public domain and available through the AFRICA BUILD Portal (http://www.africabuild.eu/taxonomy/term/37); the training modules were delivered live via Dudal webcasts. This paper assesses the success and difficulties of transferring EBM skills with these two specific training programmes, offered through three different approaches: fully online facultative courses, fully online tutor supported courses or through a blended approach with both online and face-to-face sessions. Key factors affecting the selection of participants, the accessibility of the courses, how the learning resources are offered, and how interactive online communities are formed, are evaluated and discussed.

Epilepsy and skin anomalies in tuberous sclerosis complex: Report of five cases and review of the sub-Saharan African literature

Tuberous sclerosis complex (TSC) is a multi-organ disease characterized by hamartomatous involvement of several organs notably the brain, skin, eye, kidneys, heart and lungs. This rare disorder (incidence is estimated between 1/5,800 and 1/10,000 births) results from mutation of the TSC1 gene on chromosome 9q34 or from mutation of the TSC2 gene on chromosome 16q13. In 80% of cases, it is a consequence of a de novo mutation while in the remaining cases its transmission follows an autosomal dominant pattern. Epilepsy is the main neurological complication associated with TSC, with 80 to 90% of patients having epilepsy in their lifetime while skin anomalies are seen in 60 to 70% of cases. There have been few reports on TSC from sub-Saharan Africa and to the best of our knowledge none has focused specifically on neurological complications mainly epilepsy and specificities of skin abnormalities in the sub-Saharan black Africans. Five cases of TSC with characteristics skin lesions and drug resistant epilepsy are reported. Children presenting with epilepsy, especially focal epilepsy should have a careful dermatological examination. Similarly, all suspected cutaneous lesions must be evaluated with imaging study for the detection of signs of TSC. An earlier management of epilepsy may prevent cognitive impairment associated with frequent epileptic seizures.