The Bacterial Meningitis Epidemic in Banalia in the Democratic Republic of Congo in 2021.

BACKGROUND: The Banalia health zone in the Democratic Republic of Congo reported a meningitis epidemic in 2021 that evolved outside the epidemic season. We assessed the effects of the meningitis epidemic response. METHODS: The standard case definition was used to identify cases. Care was provided to 2651 in-patients, with 8% of them laboratory tested, and reactive vaccination was conducted. To assess the effects of reactive vaccination and treatment with ceftriaxone, a statistical analysis was performed. RESULTS: Overall, 2662 suspected cases of meningitis with 205 deaths were reported. The highest number of cases occurred in the 30-39 years age group (927; 38.5%). Ceftriaxone contributed to preventing deaths with a case fatality rate that decreased from 70.4% before to 7.7% after ceftriaxone was introduced (p = 0.001). Neisseria meningitidis W was isolated, accounting for 47/57 (82%), of which 92% of the strains belonged to the clonal complex 11. Reactive vaccination of individuals in Banalia aged 1-19 years with a meningococcal multivalent conjugate (ACWY) vaccine (Menactra®) coverage of 104.6% resulted in an 82% decline in suspected meningitis cases (incidence rate ratio, 0.18; 95% confidence interval, 0.02-0.80; p = 0.041). CONCLUSION: Despite late detection (two months) and reactive vaccination four months after crossing the epidemic threshold, interventions implemented in Banalia contributed to the control of the epidemic.

Modelling control strategies for pneumococcal meningitis outbreaks in the African meningitis belt.

INTRODUCTION: Pneumococcal meningitis outbreaks occur sporadically in the African meningitis belt. Outbreak control guidelines and interventions are well established for meningococcal but not pneumococcal meningitis. Mathematical modelling is a useful tool for assessing the potential impact of different pneumococcal control strategies. This work aimed to estimate the impact of reactive vaccination with pneumococcal conjugate vaccine (PCV) had it been implemented in past African meningitis belt outbreaks and assess their efficiency relative to existing routine infant immunisation with PCV. METHODS & RESULTS: Using recent pneumococcal meningitis outbreaks in Burkina Faso, Chad, and Ghana as case studies, we investigated the potential impact of reactive vaccination. We calculated the number needed to vaccinate to avert one case (NNV) in each outbreak setting and over all outbreaks and compared this to the NNV for existing routine infant vaccination. We extended previous analyses of reactive vaccination by considering longer-term protection in vaccinees over five years, incorporating a proxy for indirect effects. We found that implementing reactive vaccination in previous pneumococcal meningitis outbreaks could have averted up to 10-20 % of outbreak cases, with the biggest potential impact in Brong Ahafo, Ghana (2015-2016) and Goundi, Chad (2009). The NNV, and hence the value of reactive vaccination, varied greatly. 'Large' (80 + cumulative modelled cases per 100,000 population) and/or 'prolonged' (exceeding a response threshold of 10 suspected cases per 100,000 per week for four weeks or more) outbreaks had NNV estimates under 10,000. For routine infant vaccination with PCV, the estimated NNV ranged from 3,100-5,600 in Burkina Faso and 1,500-2,600 in Ghana. IMPLICATIONS: This analysis provides evidence to inform the design of pneumococcal meningitis outbreak response guidelines. Countries should consider reactive vaccination in each outbreak event, together with maintaining routine infant vaccination as the primary intervention to reduce pneumococcal disease burden and outbreak risk.

Frequency and determinants of phytotherapy use in patients with type 2 diabetes in the Dschang Health District, Cameroon: a cross-sectional study

Introduction: phytotherapy is widely used in Africa for the management of many diseases. Data on the use of phytotherapy in people with type 2 diabetes are scarce. We aimed to determine the frequency and factors associated with the consumption/use of phytotherapy products among patients with type 2 diabetes in the Dschang Health District. Methods: we conducted a cross-sectional study from January to May 2022, including community-dwelling or hospitalized patients with type 2 diabetes who had lived in the Dschang Health District for at least one year. Informed consent was obtained from all patients. Data were collected using a pre-designed questionnaire. Variables collected included socio-demographic characteristics, diabetes knowledge and practices, and perceptions of care. Results: we included 403 (249 women) patients with type 2 diabetes with a mean (SD) age of 63 (± 14.86) years). Among them, 240 (59.55%) used phytotherapy, either in combination with conventional treatment (168 (41.69%) participants) or not (72 (17.86%) participants), to treat diabetes. The most common reasons for using phytotherapy were easy accessibility and belief in its efficacy. Most patients used both treatments because they thought the combination was more effective. In univariable analysis, we observed a statistically significant association between level of education (p=0.003), socioeconomic level (p<0.001), place of residence (p=0.003), duration of diabetes (p=0.007), and use of phytotherapy. In multivariable analysis, only age between 51 and 60 years (OR: 0.50, 95% CI 0.298 - 0.8521; p=0.01) was associated with the use of phytotherapy. Conclusion: people living with T2D in the Dschang Health District frequently use phytotherapy as an antidiabetic remedy, especially those aged between 51 and 60 years, those with low education level, low socioeconomic level and medium duration of diabetes. There is a need to evaluate its effectiveness in treating diabetes and its adverse effects.

Refus et hésitation vis-à-vis de la vaccination anti-COVID-19 à Douala, Cameroun / Refusal and hesitation regarding vaccination against COVID-19 in Douala, Cameroon

Introduction: la vaccination est l'une des stratégies recommandées par l'organisation mondiale de la santé pour réduire le poids de la COVID-19. Cependant, de nombreux pays africains comme le Cameroun présentent de faibles couvertures vaccinales anti-COVID19. Cette étude avait pour objectif d'étudier les raisons de refus de la population de la ville de Douala vis-à-vis de la vaccination contre la COVID-19. Méthodes: l'étude était transversale et analytique et conduite dans la ville de Douala du 10 Février au 31 Mai 2022. Les participants étaient âgés d'au moins 21 ans résidant dans la ville de Douala étaient interviewés. Les mesures d'association entre les variables d'intérêt ont été effectuées à l'aide des tests de Chi-deux et de Fisher avec un intervalle de confiance 95%. Résultats: au total, 1555 personnes avaient été inclues dans l'étude. Seulement 168 (11%) étaient vaccinées. La proportion de refus vaccinal était importante 711 (45,7%), 640 participants soit 41,1% hésitaient alors que 204 personnes soit 13,2% étaient favorable à la vaccination anti-COVID-19. Les raisons principales de refus de vaccination anti-COVID-19 étaient la crainte des effets indésirables 406 (44,8%), le manque d'information sur les vaccins 331 (36.5%) et le manque de confiance 302 (33,3%). Les facteurs associés au refus vaccinal étaient la religion (p=0,026) et le niveau d'étude (p=0,002). Conclusion: cette étude avait révélé la faible couverture vaccinale anti-COVID-19 à Douala avec une proportion importante de refus et hésitation vaccinale. Les stratégies de communications devraient tenir compte des raisons et facteurs associés au refus.

Introduction: vaccination is one of the strategies the World Health Organization recommends to reduce the burden of COVID-19. However, many African countries like Cameroon have low COVID-19 vaccination coverage. The purpose of this study was to investigate the reasons for the refusal of the population of the city of Douala to be vaccinated against COVID-19. Methods: we conducted a cross-sectional and analytical study in Douala from February 10 to May 31, 2022. Participants, aged at least 21 years and residing in the city of Douala, were interviewed. Associations between the variables of interest were measured using Chi-square and Fisher tests, with a 95% confidence interval. Results: a total of 1555 people were included in the study. Only 168 (11%) had been vaccinated. The proportion of vaccine refusal was high, with 711 (45.7%) refusing, 640 participants (41.1%) hesitating, and 204 people (13.2%) being in favor of COVID-19 vaccination. The main reasons for refusing anti-COVID-19 vaccination were fear of adverse effects (406; 44.8%), lack of information about vaccines (331; 36.5%), and lack of confidence (302; 33.3%). Factors associated with vaccine refusal were religion (p=0.026) and level of education (p=0.002). Conclusion: this study revealed low COVID-19 vaccination coverage in Douala, with a significant proportion of refusal and hesitation towards vaccination. Communication strategies should take into account the reasons and factors associated with refusal.

Beyond the numbers: An in-depth look at Cameroon's fifth national COVID-19 vaccination campaign through geographical and gender lenses.

BACKGROUND: Cameroon has been struggling with low Covid-19 vaccination coverage, with only 4.5 % of the population receiving the primary series as of November 2022. The COVID-19 Vaccine Delivery Partnership (CoVDP) conducted a high-level mission to Cameroon to assess progress and advocate for actions to address bottlenecks. The objective of the mission was to administer at least 3,000,000 doses of vaccines during the 5th Mass vaccination campaign. This study examines the factors contributing to the success of the campaign and uses a geographical and gender lens to assess the results. METHODS: The study is a secondary analysis of data from the DHIS2 collected during the 5th mass vaccination campaign for Covid-19. Descriptive statistics were used to assess coverages per location and gender expressed in OR. sccess factors, and chi-squared tests were used to assess differences in vaccine distribution across regions and by gender. RESULTS: This 5th vaccination campaign benefitted from a strong political commitment facilitated by CoVDP's mission, international support, collaboration, planning, supervision, and demand generation. The campaign recorded 2 019 118 administered vaccine doses, a staggering 46-fold increase in vaccinated individuals relative to the first round, with vaccination coverage reaching 10.1 % of the general population. However, the study reveals regional and gender disparities in vaccination coverage. Men had higher odds of being vaccinated than women in the three Sahel regions. Among individuals with comorbidities, the national coverage rate was only 14 %, and the Far North and East regions exhibited the lowest coverage rates. Janssen was the most used vaccine, and the total AEFI cases reported were 2 per 1000 vaccine doses. CONCLUSION: The 5th COVID-19 vaccination campaign in Cameroon saw a strong political commitment and was the most successful so far. Despite the gains, there was gender disparity in coverage in some regions. It is important to continue the established momentum, ensure equitable access in the Sahel regions, and reach high-priority groups with primary series and booster doses.

Meningococcal A conjugate vaccine coverage in the meningitis belt of Africa from 2010 to 2021: a modelling study.

Background: As of the end of 2021, twenty-four countries in the African meningitis belt have rolled out mass campaigns of MenAfriVac®, a meningococcal A conjugate vaccine (MACV) first introduced in 2010. Twelve have completed introduction of MACV into routine immunisation (RI) schedules. Although select post-campaign coverage data are published, no study currently comprehensively estimates MACV coverage from both routine and campaign sources in the meningitis belt across age, country, and time. Methods: In this modelling study, we assembled campaign data from the twenty-four countries that had introduced any immunisation activity during or before the year 2021 (Benin, Burkina Faso, Burundi, Cameroon, Central African Republic, Chad, Côte d'Ivoire, Democratic Republic of the Congo, Ethiopia, Eritrea, the Gambia, Ghana, Guinea, Guinea Bissau, Kenya, Mali, Mauritania, Niger, Nigeria, Senegal, South Sudan, Sudan, Togo and Uganda) via WHO reports and RI data via systematic review. Next, we modelled RI coverage using Spatiotemporal Gaussian Process Regression. Then, we synthesized these estimates with campaign data into a cohort model, tracking coverage for each age cohort from age 1 to 29 years over time for each country. Findings: Coverage in high-risk locations amongst children aged 1-4 in 2021 was estimated to be highest in Togo with 96.0% (95% uncertainty interval [UI] 92.0-99.0), followed by Niger with 87.2% (95% UI 85.3-89.0) and Burkina Faso, with 86.4% (95% UI 85.1-87.6). These countries had high coverage values driven by an initial successful mass immunisation campaign, followed by a catch-up campaign, followed by introduction of RI. Due to the influence of older mass vaccination campaigns, coverage proportions skewed higher in the 1-29 age group than the 1-4 group, with a median coverage of 82.9% in 2021 in the broader age group compared to 45.6% in the narrower age group. Interpretation: These estimates highlight where gaps in immunisation remain and emphasise the need for broader efforts to strengthen RI systems. This methodological framework can be applied to estimate coverage for any vaccine that has been delivered in both routine and supplemental immunisation activities. Funding: Bill and Melinda Gates Foundation.

Improved sub-seasonal forecasts to support preparedness action for meningitis outbreak in Africa.

West African countries are hit annually by meningitis outbreaks which occur during the dry season and are linked to atmospheric variability. This paper describes an innovative co-production process between the African Centre of Meteorological Applications for Development (ACMAD; forecast producer) and the World Health Organisation Regional Office for Africa (WHO AFRO; forecast user) to support awareness, preparedness and response actions for meningitis outbreaks. Using sub-seasonal to seasonal (S2S) forecasts, this co-production enables ACMAD and WHO AFRO to build initiative that increases the production of useful climate services in the health sector. Temperature and relative humidity forecasts are combined with dust forecasts to operationalize a meningitis early warning system (MEWS) across the African meningitis belt with a two-week lead time. To prevent and control meningitis, the MEWS is produced from week 1 to 26 of the year. This study demonstrates that S2S forecasts have good skill at predicting dry and warm atmospheric conditions precede meningitis outbreaks. Vigilance levels objectively defined within the MEWS are consistent with reported cases of meningitis. Alongside developing a MEWS, the co-production process provided a framework for analysis of climate and environmental risks based on reanalysis data, meningitis burden, and health service assessment, to support the development of a qualitative roadmap of country prioritization for defeating meningitis by 2030 across the WHO African region. The roadmap has enabled the identification of countries most vulnerable to meningitis epidemics, and in the context of climate change, supports plans for preventing, preparing, and responding to meningitis outbreaks.

Performance based financing and job satisfaction in a semiurban health district in Cameroon

The performance based financing approach is being tested in four regions of Cameroon, including the Littoral region. Our study aimed to study the effects associated with the implementation of the performance based financing approach within the health facilities based in the health district of Edea in the Littoral region in Cameroon. We've carried out a cross sectional analytical study among 178 health personnel from 21 health facilities under PBF-contract within the health district of Edea. We have studied their sociodemographic characteristics, the individual and collective effects resulting from the performance based financing subsidies and the level of job satisfaction. Participants' job satisfaction was measured with the French version of the Minnesota satisfaction scale. The results were presented in a descriptive and analytical form at the alpha = 5% and the P-value 5%. We recruited 113 women and 65 men. The mean age was 39.19 ± 8.95 years. The individual results of the performance based financing were the regular collection of subsidies between F CFA 20-40.000 (42.1%), the improvement of working conditions (74.2%) and living conditions (67.4%) and the acquisition of new skills (69.7%). Collectively, participants confirmed the increase of the users attendance (65.7%), the improvement of the internal organization (79.8%), the purchase of new equipment (84.3%) and the improved quality of health care (86%). Satisfaction is influenced by age (P=0.016), gender (P=0.01), occupational category (P=0.04), type of health facility (P=0.02) and the amount of subsidies (P=0.03). The healthcare personnel's were satisfied with the improvement of their social conditions (66.67%), working conditions (62.88%), the transparency in health centers management (69%) and their involvement in the health centers' functioning (76.6%). Participants were dissatisfied with their salaries (70.2%) and the lack of opportunities for advancement (47.8%). The positive effects of the performance based financing approach contributed to the job satisfaction of the healthcare workers in the Edea health district. These results should prompt the government to extend the performance based financing approach to communities and other health districts in Cameroon

[Risky Sexual Behavior And Prevalence Of HIV In Sex Workers In Douala In 2011]. / Comportements Sexuels A Risque Et Seroprevalence Du VIH Chez Des Travailleuses De Sexe De Douala En 2011.

BACKGROUND: With an HIV seroprevalence of 14%, sex workers in Douala remain a population at high risk of viral infection. Many campaigns have been carried out with the objective of informing and helping to prevent the spread of infections. This study aims to identify the reoccurring and new risky sexual behaviors and to make recommendations concerning the observations. MATERIALS AND METHODS: A cross sectional study was carried out in the city of Douala. Screening tests were carried out and a questionnaire looked at information concerning different variables. The associations between these variables were evaluated by calculating odds ratios rough-and their confidence intervals at 95%. RESULTS: A seroprevalence of 12.5% was recorded. The average years worked were 25±3. We noted 89% of participants were on HIV medicine (P= 0.001). There was no significant correlation between the sex worker's age and her HIV status (P= 0.458), and no significant correlation between their age and educational level (P= 0.502). 89% of the participants reported using condoms during their paid sexual relations, among them 9% were HIV positive (P=0.04). 87.5% of HIV positive participants reported engaging in anal sex (P=0.007). CONCLUSION: Seroprevalence remains high in sex workers in Douala. They continue to engage in risky sexual behaviors, endangering themselves and their partners. We therefore suggest to increase informational campaigns to increase awareness in this at-risk population.

INTRODUCTION: Avec une séroprévalence au VIH estimée à 14%, les travailleuses du sexe constituent un groupe à risque élevé dans la ville de Douala. Afin de réduire les risques de contamination et de transmission au sein de cette frange de la population, de nombreuses campagnes de sensibilisation et de prévention ont été organisées à cet effet. La présente étude compte répertorier les comportements sexuels à risque résiduels et /ou nouveaux observés au cours leurs activités quotidiennes et d'en faire de recommandations. MATÉRIELS ET MÉTHODES: Une étude transversale a été menée pour cela dans la ville de Douala. Des tests de dépistage ont été effectués et un questionnaire prétexté renseignait sur différentes variables. Le test du khi carré a été utilisé pour la mesure des associations entre les variables. Le seuil de significativité était de 5%. RÉSULTATS: La séroprévalence était de 12,5%. L'âge moyen de travail était de 25±3 ans. On comptait 89% des consommatrices de drogue séropositives (P= 0,001). On ne notait pas d'association significative entre l'âge des sujets et leur statut sérologique (p= 0,458), encore moins avec leur niveau d'instruction (p= 0,502). Dans cette étude, 89% de sujets disaient utiliser des préservatifs pendant les rapports sexuels payant et parmi elles, 9% étaient séropositives (P=0,04). On comptait 87,5% de séropositives qui avaient des rapports anaux (P=0,007). CONCLUSION: La séroprévalence demeure importante chez les travailleuses de sexe à Douala. Elles pratiquent toujours des comportements sexuels à risque susceptibles de les exposer ainsi que leurs partenaires. Des efforts de sensibilisation sont donc recommander au profit de cette population à risque.

[Risky behavior for HIV transmission in pupils and students in Douala, Cameroon]. / Comportement a risque de transmission du HIV des eleves et etudiants de Douala, Cameroun.

BACKGROUND: One of the measures taken in Cameroon to respond to the infection of the human immunodeficiency virus is the organization of an annual awareness campaign called "Vacations without AIDS". During the 2011 campaign, we conducted a study involving 2509 young volunteers, with the aim to list the various residual and/or new behaviors exposing individuals to this infection, in a context characterized by a multiplication of awareness campaigns. MATERIALS AND METHODS: All persons who presented at the screening booth were included in this study. A pretext questionnaire was used to collect the data. The associations between variables were evaluated using crude Odd ratios with a confidence interval of 95%. RESULTS: The sex ratio in our study was 1.2 in favor of the females and the average age was 25.52 years ±3, with a seroprevalence of 3.98%. Regarding HIV testing, respectively 55.4% of secondary school students, 36.3% of university students and 8% of primary school pupils undertook an HIV test (p = 0.000). Based on gender: 28.9% of boys versus 24.5% of girls had a history of STI (p = 0.014). 27.4% of heterosexual versus 72.2% of homosexual had a history of STI (p = 0.000), as well as 34.5% with multiple sex partners versus 24.9% with a single partner (p = 0.000). In addition to that, 23.1% of systematic condom users versus 59.5% of less rigorous users of condom had a STI. CONCLUSION: This data is in accordance with the literature, especially regarding the socio-cultural and economic approach of these risky behaviors. The major finding is the reduction of risky behaviors according to the level of education. It is therefore recommended to improve of the knowledge of AIDS as early as the primary curriculu.

INTRODUCTION: L'une des mesures prises au Cameroun en vue de la riposte à l'infection du virus de l'immunodéficience humaine est l'organisation d'une campagne de sensibilisation annuelle dénommée « Vacances sans SIDA ". Celle de 2011 a permis de mener une étude incluant 2509 jeunes volontaires, avec pour objectif de répertorier les différents comportements résiduels et/ou nouveaux, exposant à cette infection, dans un contexte caractérisé par une multiplication des campagnes de sensibilisation. MATÉRIELS ET MÉTHODES: Toutes les personnes s'étant présentées aux stands de dépistage avaient été intégrées dans cette étude. Un questionnaire prétexté avait permis de collecter les données. Les associations entre différentes variables avaient été évaluées par calcul des Odds-Ratios bruts et de leurs intervalles de confiance à 95%. RÉSULTATS: Le sexe ratio était de 1,2 en faveur du sexe féminin et la moyenne d'âge de 25,52 ± 3ans, avec une séroprévalence de 3,98%. Concernant le test du VIH, 55,4% de lycéens, 36,3% d'universitaires et 8% du primaire avaient respectivement fait un test du VIH (p= 0,000). En fonction du sexe, 28,9% de garçons contre 24,5% de filles avaient des antécédents d'IST (p= 0,014). Ils étaient également présents chez 27,4% d'hétérosexuel contre 72,2% d'homosexuels (p=0,000) et chez 34,5% d'enquêtés qui avaient plusieurs partenaires sexuels contre 24,9% qui en avaient un seul (p=0,000). Par ailleurs 23,1% d'utilisateurs systématiques de préservatifs en avaient connu. CONCLUSION: Les données retrouvées sont conformes à la littérature. Notamment les approches socioculturelles et économiques de ces comportements à risque. Le constat majeur est la diminution des comportements à risque en fonction du niveau d'instruction. Il est donc recommandé l'amélioration des connaissances du VIH/SIDA dès le niveau primaire.