ABSTRACT
BACKGROUND There is increasing use of immunosuppressive drugs (ID) in sub-Saharan Africa as new indications emerge in this region; known for its high infection rates. Few data are available on infectious complications of ID in chronic rheumatic diseases (CRD) in Africa.OBJECTIVES To describe the pattern of serious infections (SI) in CRD patients treated with ID in the Douala General Hospital; Cameroon PATIENTS AND METHODS After prior ethical clearance; we reviewed medical records of adult patients treated with ID for at least 6 months in the rheumatology unit of the Douala General Hospital from January 1999 to December 2009. The types of ID; dosage; and treatment duration as well as the indication were recorded. All cases of serious infections were identified. SI were defined as requiring hospitalization; intravenous antibiotic; withdrawal of the drugs or resulting in death. RESULTS Sixty-four patients (43 females and 21 male) were enrolled. Indications for use of ID included rheumatoid arthritis; systemic lupus erythematosus and dermatomyositis. ID used included Prednisone (used in all the patients); Methotrexate; Cyclophosphamide; and Azathioprine. Seventeen (26.6) patients developed at least one SI: pulmonary tuberculosis (n=5); non-tuberculous pneumonia (n=6); febrile enteritis (n=5); and upper respiratory tract (n=2). Five patients presented more than one infection. Infections were increased for patients aged more than 60; cumulated dose of Prednisone more than 700 mg; combination of prednisone and Methotrexate. CONCLUSION Pulmonary infections are frequent in CRD patients treated by ID. Prospective studies are needed to better evaluate the burden and risk factors of this complication in sub-Saharan Africa
Subject(s)
Hospitals , Immunosuppressive Agents , Infections , Rheumatic DiseasesABSTRACT
Leprosy has been eliminated as a public health problem in most countries of the world according to the WHO; but the social stigma to the disease is still very high. The present study was performed to investigate the role of social stigma as a determinant for leprosy elimination in a leprosy endemic region of Cameroon. Focus group discussions; in-depth interviews and structured questionnaires were used to investigate leprosy social stigma among lepers; their contacts and a control group consisting of patients attending a health facility for reasons other than leprosy. Informed consent was sought and gained prior to starting the study. Focus group discussions and in-depth interviews identified three types of stigma: lack of self-esteem; tribal stigma and complete rejection by society. From the 480 structured questionnaires administered; there were overall positive attitudes to lepers among the study population and within the divisions (P=0.0). The proportion of participants that felt sympathetic with deformed lepers was 78.1[95confidence interval (CI): 74.4-81.8] from a total of 480. Three hundred and ninety nine (83.1) respondents indicated that they could share a meal or drink at the same table with a deformed leper (95CI: 79.7-86.5). Four hundred and three (83.9) participants indicated that they could have a handshake and embrace a deformed leper (95CI: 80.7-87.3). A total of 85.2(95.0CI: 81.9-88.4) participants affirmed that they could move with a deformed leper to the market or church. A high proportion of 71.5(95.0CI: 67.5-75.5) participants stated that they could offer a job to a deformed leper. The results indicate that Menchum division had the lowest mean score of 3.3 on positive attitudes to leprosy compared with Mezam (4.1) and Boyo (4.8) divisions. The high proportion of positive attitudes among the participants and in different divisions is a positive indicator that the elimination of leprosy social stigma is progressing in the right direction. Quantification of stigma to assess the elimination struggle is a new research area in public health