Incidence and Predictors of Poor Outcome amongChildhood Tuberculosis in the North of Cameroon

Background. Childhood tuberculosis (TB) has been neglected by TB programs in Sub-Saharan Africa. The aim of this study was to determine the incidence and predictors of poor outcome in children with TB in the North region of Cameroon. Methods.It was a retrospective cohort study based on hospital TB registers and treatment TB forms, in all of the 18 functional diagnosis and therapeutic centers (DTC) in the North region. All children aged 0-15years, on anti-TB treatment between 2010-2016 were enrolled. Logistic regression was used to find independent factors associated to poor outcome. Results. Of the 668 children included [321 (48.1%) boys], the median (25th-75thpercentile) age was 11(6-14) years, with 75.9% children aged >5 years. Pulmonary TB was the most common (62.9%) with 34.3% smear-negative pulmonary TB. Extrapulmonary TB (62.1%) was mostly found in children aged 0-5years. HIV/TB coinfection was 10.3%. Incidence (95%CI) of poor outcome was 4.0 %( 2.5-5.5%). Predictors [OR (95%CI)] of poor outcome were: HIV positivechildren [3.995(1.131-14.112), p=0.031], management in peripheral DTC [32.451(4.211-250.099), p=0.001], and transferred in patients from a peripheral zone toward a 3rdor 4thDTC category [4.602(1.092-19.386), p=0.037]. Conclusion.Incidence of poor outcome of childhood TB was quite low in the North region of Cameroon. HIV, peripheral TDC and transferred in patients were predictors of poor outcome. A better management of HIV, retraining DTC personnel and early reference from peripheral DTC would reduce poor outcome among childhood TB.

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

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. 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. 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]]. 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