Ten Recommendations for Accelerating Hypertension and Diabetes Control to Reduce Stroke, Heart, and Renal Disease with the Aim to Save Lives in Cameroon Through Partnerships and Collaborations.

Hypertension and diabetes are currently the most common, treatable, and controllable cardiovascular and metabolic risk factors for stroke, heart, and renal diseases in Cameroon. Hypertension affects 30% of adults aged ≥ 20 years with 90% as uncontrolled cases, while type 2 diabetes affects 6% of the same population, with 70% remaining underdiagnosed. Despite publication of the first Roadmap on raised blood pressure by the World Heart Federation in 2015, the Pan African Society of Cardiology Roadmap in 2017, and the technical package for cardiovascular disease management in primary health care (WHO-HEARTS) in 2020, very little progress has been made in improving the diagnosis, treatment, and control of cardiovascular risk factors and diseases in Cameroon. The Cameroon Cardiac Society and a dozen Cameroon non-communicable diseases societies, national organizations from the community and the civil society, along with researchers and members of academia and the health sector, came together under the patronage of representatives of the government to propose new strategies to improve hypertension and diabetes control and save lives in Cameroon. Two simple and practical algorithms for the management of hypertension and diabetes were developed. The ten recommendations tailored to be efficiently implemented in our country were summarized under the acronym 'A SMART VIEW' (Awareness, Screening, Manufacture, Activity, Research, Task-shifting, HIV/AIDS, Insurance, Education, and WHO-HEARTS). It is our hope that all stakeholders will further collaborate to remove barriers and enhance facilitators to deploy the proposed actions and reduce the burden of uncontrolled hypertension and untreated diabetes in Cameroon.

Hypertension and diabetes are very common, yet treatable, cardiovascular, and metabolic risk factors for stroke, heart, and renal diseases in Cameroon. One-third of all adults aged 20 years or more in Cameroon have hypertension, in most of whom it remains uncontrolled. In addition, while 6% of these adults have type 2 diabetes, more than two-thirds remain underdiagnosed. Despite efforts to improve the diagnosis, treatment, and control of cardiovascular risk factors and diseases in Cameroon, minimal progress has been made. The Cameroon Cardiac Society, supported by input from Cameroon non-communicable diseases societies, national institutions/organizations, and representatives from the community, research, academia, and the health sector, has now developed two practical algorithms and ten recommendations specific to the Cameroonian population in an attempt to improve the control of hypertension and diabetes in Cameroon. It is hoped that these stakeholders will further collaborate to ensure the efficient implementation of these recommendations across the country, with the ongoing aim of monitoring their effectiveness over the next five years.

Clinical and epidemiological characteristics and outcomes of patients hospitalized for COVID-19 in Douala, Cameroon.

INTRODUCTION: the coronavirus disease (COVID-19) is a disease that originated from Wuhan in December 2019. It rapidly spread across the globe causing high mortality especially among the elderly. Africa though not spared has limited studies regarding its effects on its population. We therefore sought to describe the epidemiological and clinical characteristics of COVID-19 in Douala, Cameroon. METHODS: we conducted a single-centre, retrospective, and observational study by reviewing records of patients managed for COVID-19 between the 8th March 2020 and 31st, May 2020. Cases were confirmed by real-time reverse transcriptase - polymerase chain reaction and were analysed for epidemiological, demographic, clinical, and radiological features. Outcomes were either clinical improvement by Day-28 or in-hospital mortality. RESULTS: we analyzed 282 case files, 192 were males (M: F=2: 1). The mean age was 52 (+/- 15) years. Hypertension and diabetes accounted for 75% of the chronic medical conditions identified. Main presenting complaints were dyspnea, cough, asthenia, and fever (55-60%). Radiographic analysis showed a ground-glass appearance in 85% of cases. Chloroquine/Hydroxychloroquine was the most (91.8%) frequently used drug in management protocols, 35% needed oxygen supplementation while 6 patients were intubated. Severe pneumonia (11.3%) was the commonest complication. They were 91 admissions in the intensive care unit. The average length of hospital stay was 10 (+/- 5) days. The mortality rate was 32%. CONCLUSION: our findings are concordant with universally reported data of COVID-19 hospitalised patients. These parameters are essential in designing effective prevention and control programs aimed at reducing the impact of the COVID-19 pandemic particularly in countries with limited resources.

Facteurs prédictifs de naissance d'un nouveau-né séronégatif issu d'une mère séropositive au VIH à Douala

Introduction. La transmission mère-enfant du VIH constitue le principal mode de contamination chez les enfants âgés de moins de 5 ans. L'introduction de la thérapie antirétrovirale chez les femmes enceintes séropositives, les accouchements par césarienne et l'allaitement artificiel ont réussi à réduire considérablement la transmission verticale du virus de l'immunodéficience humaine. En l'absence de ces mesures préventives, le taux de transmission verticale varie entre 10 à 40%. L'objectif de cette étude est de présenter les facteurs qui prédisposent à la transmission du VIH de la mère à l'enfant à Douala. Matériel et méthodes. Il s'agit d'une étude rétrospective, analytique et transversale menée à l'hôpital du district de Nylon, sur une période de sept mois allant de 01 décembre 2015 au 08 juin 2016. Les données ont été recueillies sur la base d'un questionnaire et les facteurs de transmission du VIH de la mère à l'enfant ont été évalués par régression logistique multi variée. Le test de Hosmer et Lemeshow a été utilisé pour vérifier l'ajustement du modèle. Les différences dans les proportions ont été testées en utilisant le test du chi carré. Les tests de Kruskal-Wallis ont été utilisés pour évaluer les différences globales, puis deux à deux le Mann-Whitney U-tests a été utilisé pour évaluer les différences entre les groupes. Résultats. Au total 157 dossiers de nourrissons ont été enrôlés dans cette étude, parmi eux, 20 étaient infectés par le VIH (P=12%). L'âge moyen au moment du diagnostic était de 4,3±3,6 mois (extrêmes : 1,5 et 16 mois). Les enfants nés avec un poids de moins de 2500 grammes présentaient un risque de TME de 5,6 fois supérieur par rapport à ceux nés avec un poids ≥2500 grammes (OR=5,6 ; IC95% :1,9-16,7). Les enfants qui n'avaient pas reçu de la Névirapine à la naissance (10/15) ont été plus infectés que ceux qui en avaient reçu (10/142) et présentaient un risque de 26,4 fois d'être infectés (OR=26,4 ; IC95% : 7,6-92,3 ; p<0,001). Conclusion. Les délais de mise sous traitement, le stade OMS IV de la maladie, l'alimentation mixte, les CD4 <100/mm3 se présentent comme étant les facteurs prédictifs de TME. Il est donc nécessaire de réduire la charge virale maternelle afin de pouvoir renforcer son système immunitaire et par ailleurs celui de l'enfant en favorisant l'allaitement maternel exclusif

Population lymphocytaire des nourrissons exposés mais non infectés par le VIH à Douala

Introduction. L'objectif de cette étude était de mettre rechercher la présence d'un déficit en cellules T chez le nourrisson exposé non infectés (ENI), l'hypothèse étant que le déficit serait plus marqué lorsque la charge virale maternelle est élevée. Matériels et méthodes. Il s'agit d'une étude transversale analytique menée du 1er décembre 2015 au 08 juin 2016. En phase rétrospective, les données ont été collectées à base d'un questionnaire préétabli. En phase prospective les prélèvements sanguins ont été effectués et les profils immunologiques ont été établis. Les facteurs de transmission du VIH de la mère à l'enfant ont été évalués par régression logistique multi variée. Le test de Hosmer et Lemeshow ont été utilisés pour vérifier l'ajustement du modèle. Résultats. 153 patients répartis en trois groupes dont 60 enfants exposés non infectés, 60 enfants non exposés (NE) et 33 enfants exposés infectés (EI) ont été enrôlés. Les profils immunologiques des enfants NE et ENI ont montré une différence statistiquement significative (P=0,007) pour les taux de CD4. Les profils immunologiques des enfants de la tranche d'âge de 12 à 59 mois d'une part EI et ENI ont montré des différences significatives pour les CD45 (P=0,003), les CD4 (P=0,01), les CD8 (P=0,02). Conclusion. Chez les nourrissons non infectés nés de mères séropositives, plusieurs anomalies immunologiques peuvent être détectées. Ces anomalies pourraient être une conséquence de l'exposition au VIH in utero et en début de vie, et/ou à l'exposition aux médicaments antirétroviraux, ou à la transmission précoce des infections virales persistantes telles que CMV

Seroprevalence, attitudes and practices of the Baka Pygmies of eastern Cameroon towards HIV and AIDS.

INTRODUCTION: The vulnerable health status of Pygmies is the result of their continual exposure to the modern world. The purpose of this study was to determine the prevalence of HIV and the attitudes and practices of Baka populations towards HIV infection. METHODOLOGY: A descriptive and cross-sectional study was conducted over a five-month period in 12 Pygmy camps. A questionnaire was completed to collect information, and anonymous screenings were held. For screening, whole blood was collected. The Determine HIV-1/2 test was used as the rapid test, and the SD Bioline HIV-1/2 test was used as the second test. Associations between variables were checked. RESULTS: A total of 560 Baka were recruited. The sex ratio was 0.92. Among the means of transmission, sexual intercourse was the most frequently cited (37.6%). A minority (28.5%) knew where to undergo an HIV test, 24.2% did not know that there exists treatment enabling patients to have a higher quality of life, and 75.7% had never used a condom. A total of 86.9% had never been tested for HIV. Subjects who had sex with the Bantu were three times more likely to be infected (p = 0.02), as well as those who had had more than three sexual partners. CONCLUSIONS: The changes affecting contemporary societies are inevitably influenced by the dominant factors of modernity, particularly progress, development, and social dynamics in all their aspects. Baka knowledge about HIV/AIDS is limited. Educational efforts, increased awareness, and guidance are needed.

Sexual Risk Behaviours among Patients Living with HIV/AIDS in Douala in 2012

Introduction :The establishment of a positive HIV serologic status of an individual could have been an inhibitory factor to prevent risk behaviours in people living with HIV/AIDS. We conducted a cross-sectional study in order to assess the prevalence and predictors of risk behaviors among HIV-positive people in Douala-Cameroon. Method: We used pre-checked questionnaires to systematically collect data from four HIV Treatment centers inDouala. This was done to some of them during the distribution of drugs; and to others during their classical rendezvous; between the months of May and July 2012. The Chi-Square and Student t-test were used forcross tabulation of variables; multiple regression analysis was performed to identify predictors of risky sexual behaviours. Result: Of the 330 persons interviewed. Sixty percent were reported to have had sexual intercourse after the diagnosis of HIV. We obtained 37 HIV-positive partners and 63 had HIV-negative partners or partners with unknown status. Among our patients; 45 of the subjects with regular partners reported to have had anal or vaginal sex. Those; whose score on the knowledge about HIV / AIDS was 50 and where 90 of them were less susceptible to the condom during intercourse (p: 0.01). About 74 of patient on ARV were less susceptible to the use of condom during sexual inter course (p: 0.03)Conclusion:Risk sexual behaviours among people living with HIV/AIDS are common and potentially expose their partners. For HIV-positive partners these habits pose a real risk of suprainfection by other strains of HIV. The need to increase awareness and education among people living with HIV is therefore highly recommended