Diagnostic ambiguity of aseptic necrobiosis of a uterine fibroid in a term pregnancy: a case report.

BACKGROUND: Uterine fibroids are the most common uterine tumours in females of reproductive age. During pregnancy, uterine fibroids may be complicated by aseptic necrobiosis. We herein report an ambiguous clinical presentation of uterine fibroids in pregnancy and discuss the diagnostic challenges encountered in our resource-constraint setting. CASE PRESENTATION: A term pregnant Cameroonian woman was admitted to our maternity unit with clinical findings suggestive of a strangulated umbilical hernia. She underwent an emergency caesarean section which fortuitously revealed aseptic necrobiosis of a uterine fibroid, managed within the same surgical intervention by myomectomy. Her post-operative course was uneventful. CONCLUSION: The authors highlight the need for a high index of suspicion by healthcare providers, as well as the need for a multidisciplinary approach for a favourable maternal and foetal outcome.

Fifteen years of annual mass treatment of onchocerciasis with ivermectin have not interrupted transmission in the west region of cameroon.

We followed up the 1996 baseline parasitological and entomological studies on onchocerciasis transmission in eleven health districts in West Region, Cameroon. Annual mass ivermectin treatment had been provided for 15 years. Follow-up assessments which took place in 2005, 2006, and 2011 consisted of skin snips for microfilariae (mf) and palpation examinations for nodules. Follow-up Simulium vector dissections for larval infection rates were done from 2011 to 2012. mf prevalence in adults dropped from 68.7% to 11.4%, and nodule prevalence dropped from 65.9% to 12.1%. The decrease of mf prevalence in children from 29.2% to 8.9% was evidence that transmission was still continuing. mf rates in the follow-up assessments among adults and in children levelled out after a sharp reduction from baseline levels. Only three health districts out of 11 were close to interruption of transmission. Evidence of continuing transmission was also observed in two out of three fly collection sites that had infective rates of 0.19% and 0.18% and ATP of 70 (Foumbot) and 300 (Massangam), respectively. Therefore, halting of annual mass treatment with ivermectin cannot be done after 15 years as it might escalate the risk of transmission recrudescence.

Seventeen years of annual distribution of ivermectin has not interrupted onchocerciasis transmission in North Region, Cameroon.

We studied onchocerciasis transmission and impact on ocular morbidity in three health districts in North Region, Cameroon, where annual mass ivermectin treatment has been provided for 12-17 years. The studies, which took place from 2008 to 2010, consisted of skin snips for microfilariae (mf), palpation examinations for nodules, slit lamp examinations for mf in the eye, and Simulium vector dissections for larval infection rates. Adults had mf and nodule rates of 4.8% and 13.5%, respectively, and 5.5% had mf in the anterior chamber of the eye. Strong evidence of ongoing transmission was found in one health district, where despite 17 years of annual treatments, the annual transmission potential was 543 L3/person per year; additionally, children under 10 years of age had a 2.6% mf prevalence. Halting ivermectin treatments in North Cameroon now might risk recrudescence of transmission and ocular disease.

Central African Field Epidemiology and Laboratory Training Program: building and strengthening regional workforce capacity in public health.

The Central African Field Epidemiology and Laboratory Training Program (CAFELTP) is a 2-year public health leadership capacity building training program. It was established in October 2010 to enhance capacity for applied epidemiology and public health laboratory services in three countries: Cameroon, Central African Republic, and the Democratic Republic of Congo. The aim of the program is to develop a trained public health workforce to assure that acute public health events are detected, investigated, and responded to quickly and effectively. The program consists of 25% didactic and 75% practical training (field based activities). Although the program is still in its infancy, the residents have already responded to six outbreak investigations in the region, evaluated 18 public health surveillance systems and public health programs, and completed 18 management projects. Through these various activities, information is shared to understand similarities and differences in the region leading to new and innovative approaches in public health. The program provides opportunities for regional and international networking in field epidemiology and laboratory activities, and is particularly beneficial for countries that may not have the immediate resources to host an individual country program. Several of the trainees from the first cohort already hold leadership positions within the ministries of health and national laboratories, and will return to their assignments better equipped to face the public health challenges in the region. They bring with them knowledge, practical training, and experiences gained through the program to shape the future of the public health landscape in their countries.

Urethral duplication in a 12-year-old child.

Urethral duplication is a rare congenital malformation affecting mainly boys. The authors report a case in a Cameroonian child who was diagnosed and managed at the Gynaeco-Obstetric and Paediatric Hospital, Yaounde. The malformation was characterized by the presence of an incontinent epispadic urethra and a normal apical urethra. We describe the difficulties faced in the management of this disorder in a developing country.

Does onchocerciasis transmission take place in hypoendemic areas? a study from the North Region of Cameroon.

OBJECTIVE: Community-directed treatment with ivermectin (CDTI) for onchocerciasis control is targeted to meso and hyperendemic areas in Africa. Below the threshold, communities are considered hypoendemic and, mass treatment is not recommended. As policy begins to shift from control to elimination, the role of hypoendemic areas in maintaining Onchocerca volvulus needs to be re-examined. The study determined whether independent transmission occurs in a hypoendemic area in the North region of Cameroon. METHODS: Ten 'high risk' communities along the River Mayo Douka system in Ngong Health District, at least 20 km from the nearest CDTI program were studied. Six hundred and forty-nine adults (over 20 years of age) and 561 children (under 10 years) were examined for nodules and microfilaria. A subsample of 334 adults was examined for onchocercal ocular morbidity. Simulium flies from 4 collection points were captured over 3 months annually for 2 years and dissected for larval stages of O. volvulus. RESULTS: Nodule and microfilariae (mf) prevalence among adults was 12.20% and 2.91%, and 9.2% and 0.48% among children, respectively. Blindness because of onchocerciasis was insignificant, although low rates of chronic onchocercal ocular disease (<2%) were observed. Four (0.16 percent) of 255 flies collected in 2008 were infected with L3 larval stage, and 1 black fly of 39 collected in 2009 had two L2 larval stage morphologically consistent with O. volvulus. CONCLUSION: Ngong is a 'hypoendemic' focus with likely low grade indigenous transmission in isolation from meso/hyperendemic areas. Consequently, transmission from hypoendemic areas could contribute to rapid disease recrudescence in the post-treatment phase of adjacent former meso and hyperendemic areas.