Prevalence of prolonged otitis media with effusion among 2 to 3 years old Cameroonian children in the era of 13-valent pneumococcal conjugate vaccines.

Objectives: There is data scarcity on the overall effects of pneumococcal conjugate vaccines (PCVs) on otitis media (OM) in low- and middle-income countries. The impact of the 13-valent PCV (PCV13) program on OM was evaluated in Cameroon where infant vaccination was implemented in July 2011 using a 3-dose primary series at 6, 10 and 14 weeks of age. Methods: Through community-based surveillance, we used a retrospective cohort study design to assess OM prevalence among PCV13-vaccinated children aged 24 to 36 months in 2015. This was compared with a 2013 age-matched cohort of PCV13-unvaccinated children. OM was diagnosed by clinical inspection for chronic suppurative OM (CSOM) and tympanometry for OM with effusion (OME). CSOM was defined as draining of the middle ear with duration of more than 2 weeks and prolonged OME was defined as a flat 'type B' tympanogram. PCV13-vaccinated and PCV13-unvaccinated cohorts were compared by calculating prevalence odds ratios for OM and baseline characteristics. Results: Altogether, 111 OM cases were identified; 42/433 (9.7%) in the PCV13-unvaccinated in 2013 and 69/413 (16.7%) in the PCV13-vaccinated cohort in 2015. In the 2013 baseline survey, 3/433 (0.7%) children were identified with unilateral CSOM compared to 9/413 (2.2%) in the PCV13-vaccinated cohort in 2015. Bilateral prolonged OME was diagnosed in 7/433 (1.6%) PCV13-unvaccinated children and in 12/413 (2.9%) in PCV13-vaccinated children. Proportions of children with unilateral prolonged OME were 31/433 (7.2%) in the PCV13-unvaccinated group compared with 48/413 (11.6%) in the PCV13-vaccinated group. Multivariate logistic regression analysis showed evidence that PCV13-vaccinated children in 2015 had 40% less risk of contracting OM compared to PCV13-unvaccinated children in 2013 (adjusted prevalence odds ratios = 0.60 [95% confidence interval: 0.38 to 0.94], P = 0.025). Additionally, attributable proportion estimates show that, 58% of OM infections among the PCV13-vaccinated group would still have occurred despite PCV13 vaccination. Conclusion: Our findings provide significant evidence on the effect of PCV13 in decreasing OM or OME among children in this age group. It also supports justification for government's continuation of PCV13 immunization program in the absence of GAVI's funding. Further research is needed to assess the long-term impact of the PCV13 program on in OM Cameroon.

The prevalence of otitis media in 2-3 year old Cameroonian children estimated by tympanometry.

BACKGROUND: Acute otitis media is a common illness in children under-five years of age and associated with major health care resources in high-income countries. However, there is paucity of data on its epidemiology and clinical presentation in low-income countries. We estimated the prevalence of otitis media and assessed risk factors among children in Cameroon. METHODS: A community-based cross-sectional prevalence study of otitis media (OM) was performed on randomly selected children aged 2-3 years in Yaoundé, Cameroon from March to June 2013. OM was assessed by clinical inspection for chronic suppurative otitis media (CSOM) and tympanometry for otitis media with effusion (OME). CSOM was defined as draining of the middle ear with duration of more than two weeks and OME was defined as a flat 'type B' tympanogram. RESULTS: Out of 529 children enrolled in the study, 433 (56% males) subjects with available tympanograms were evaluated. Altogether, 9.7% (42/433) of children met the case definition of CSOM, OME or its complications. This consisted of 3 (0.7%) children identified with unilateral CSOM; 7 (1.6%) children with bilateral OME; 31 (7.2%) with unilateral OME and 1 (0.2%) subject with unilateral dry tympanic membrane perforation. Logistic regression analyses showed statistically significant association between OM and parental reporting of "current symptoms of upper respiratory tract infections", Prevalence Odds Ratio (POR) = 3.71; 95% CI = 1.69-8.14). CONCLUSION: As many as two out of a hundred children between the ages of 2-3 years were affected by significant middle ear disease i.e. CSOM or bilateral OME. These data could be useful as a baseline for estimating the impact of pneumococcal conjugate vaccines (PCV13) introduced in July 2011 for infants in Cameroon.

Pertinence des indications d'examens d'imagerie medicale a Yaounde

OBJECTIF. evaluer la pertinence des indications d'examens d'imagerie medicale par rapport au referentiel 'Guide du bon usage des examens d'imagerie medicale' (GBU) de la Societe Francaise de Radiologie (SFR). MeTHODOLOGIE. etude transversale descriptive portant sur l'analyse des renseignements cliniques de 262 demandes d'examens d'imagerie medicale a Yaounde (Cameroun). Les renseignements cliniques etaient categorises (symptome; syndrome; diagnostic; finalite; antecedents; aucun) puis confrontes a la mention d'indication et aux grades de recommandation du GBU de la SFR. La compatibilite entre examen demande; renseignements cliniques et qualite du demandeur etait evaluee de meme que le niveau d'irradiation. ReSULTATS. Quarante cinq (17;2) demandes n'avaient aucune indication. Le symptome etait l'indication la plus frequente (30;8). 76;3 des demandes n'avaient aucune question de recherche (finalite). La mention d'indication etait influencee par le type d'information clinique (p0.0001) avec la plus forte proportion d'examen 'indique' (80;7) lorsque la finalite de l'examen etait precisee. Dans 23 des cas l'indication fournie permettait de juger l'examen demande non-conforme. Dans 59;5 l'examen demande etait 'indique' quelque soit le niveau d'irradiation. 31 examens sans indications etaient irradiants dont 7 de niveau II et 5 de niveau III. Dans 19 cas (7;3) le demandeur n'avait pas qualite pour demander l'examen. La compatibilite examen demande - qualite du demandeur etait plus faible en TDM. CONCLUSION. Il existe une proportion importante de demandes sans indication ou sans finalite de l'examen. Pres d'un quart d'indications sont non-conformes et les symptomes constituent les indications les plus frequentes. Un systeme d'information hospitaliere avec les renseignements cliniques et la finalite de l'examen en 'cases obligatoires' contribuerait a ameliorer la prescription des examens d'imagerie