Perceptions around COVID-19 among patients and community members in urban areas in Cameroon: A qualitative perspective.

At the onset of the COVID-19 pandemic, the Cameroonian government, to abide by international regulations, prescribed preventive measures, which affected many aspects of social, political, economic, and cultural life. However, there needs to be more in-depth exploration of how communities in Cameroon perceived and were impacted by COVID-19. We explored perceptions and misconceptions concerning COVID-19's impact on urban communities' daily lives in Cameroon. We conducted semi-structured interviews and focus group discussions with a heterogeneous sample of 25 participants from five different social categories (health personnel, patients with a confirmed COVID-19 infection, close contacts of patients, community members, and community leaders) to assess their perceptions of the disease. Interviews and FGDs were recorded, fully transcribed, coded manually, and analyzed using a thematic analysis iterative coding process. Three main themes were identified: 1) Knowledge of COVID-19: antagonism between disease and invention, 2) Barrier measures imposed by the "dominant culture," and 3) Impact of COVID-19 on daily lives. Our study revealed perceptions around general knowledge of the COVID-19 pandemic, noting acceptance and observation of government-imposed protective measures while highlighting the significant changes endured in participants' daily lives. These findings draw attention to the need to develop flexible and appropriate response strategies for different communities. Although Cameroonian populations were not as intensely affected by the burden of the disease of COVID-19 as other regions, they were still compelled to follow static "cookie-cutter" measures that were internationally imposed, affecting their daily lives in ways that seemed disproportionate to their own experiences of the crisis. These findings have potential implications for the legitimacy of public health institutions and responses.

Effect of systematic tuberculosis detection on mortality in young children with severe pneumonia in countries with high incidence of tuberculosis: a stepped-wedge cluster-randomised trial.

BACKGROUND: Tuberculosis diagnosis might be delayed or missed in children with severe pneumonia because this diagnosis is usually only considered in cases of prolonged symptoms or antibiotic failure. Systematic tuberculosis detection at hospital admission could increase case detection and reduce mortality. METHODS: We did a stepped-wedge cluster-randomised trial in 16 hospitals from six countries (Cambodia, Cameroon, Côte d'Ivoire, Mozambique, Uganda, and Zambia) with high incidence of tuberculosis. Children younger than 5 years with WHO-defined severe pneumonia received either the standard of care (control group) or standard of care plus Xpert MTB/RIF Ultra (Xpert Ultra; Cepheid, Sunnyvale, CA, USA) on nasopharyngeal aspirate and stool samples (intervention group). Clusters (hospitals) were progressively switched from control to intervention at 5-week intervals, using a computer-generated random sequence, stratified on incidence rate of tuberculosis at country level, and masked to teams until 5 weeks before switch. We assessed the effect of the intervention on primary (12-week all-cause mortality) and secondary (including tuberculosis diagnosis) outcomes, using generalised linear mixed models. The primary analysis was by intention to treat. We described outcomes in children with severe acute malnutrition in a post hoc analysis. This study is registered with ClinicalTrials.gov (NCT03831906) and the Pan African Clinical Trial Registry (PACTR202101615120643). FINDINGS: From March 21, 2019, to March 30, 2021, we enrolled 1401 children in the control group and 1169 children in the intervention group. In the intervention group, 1140 (97·5%) children had nasopharyngeal aspirates and 942 (80·6%) had their stool collected; 24 (2·1%) had positive Xpert Ultra. At 12 weeks, 110 (7·9%) children in the control group and 91 (7·8%) children in the intervention group had died (adjusted odds ratio [OR] 0·986, 95% CI 0·597-1·630, p=0·957), and 74 (5·3%) children in the control group and 88 (7·5%) children in the intervention group had tuberculosis diagnosed (adjusted OR 1·238, 95% CI 0·696-2·202, p=0·467). In children with severe acute malnutrition, 57 (23·8%) of 240 children in the control group and 53 (17·8%) of 297 children in the intervention group died, and 36 (15·0%) of 240 children in the control group and 56 (18·9%) of 297 children in the intervention group were diagnosed with tuberculosis. The main adverse events associated with nasopharyngeal aspirates were samples with blood in 312 (27·3%) of 1147 children with nasopharyngeal aspirates attempted, dyspnoea or SpO2 less than 95% in 134 (11·4%) of children, and transient respiratory distress or SpO2 less than 90% in 59 (5·2%) children. There was no serious adverse event related to nasopharyngeal aspirates reported during the trial. INTERPRETATION: Systematic molecular tuberculosis detection at hospital admission did not reduce mortality in children with severe pneumonia. High treatment and microbiological confirmation rates support more systematic use of Xpert Ultra in this group, notably in children with severe acute malnutrition. FUNDING: Unitaid and L'Initiative. TRANSLATION: For the French translation of the abstract see Supplementary Materials section.

Seroprevalence of anti-SARS-CoV-2 IgG antibodies in HIV-positive and HIV-negative patients in clinical settings in Douala, Cameroon.

Background: The asymptomatic nature of COVID-19 coupled with differential testing are confounders in the assessment of SARS-CoV-2 incidence among people living with HIV (PLWH). As various comorbidities increase the risk of SARS-CoV-2 infection, it is crucial to assess the potential contribution of HIV to the risk of acquiring COVID-19. Our study aimed to compare the anti-SARS-CoV-2 IgG seroprevalence among people living with and without HIV. Methods: PLWH were enrolled in the HIV units of two health facilities in Douala, Cameroon. Participants were consecutively enrolled, among which 47 were people living with HIV and 31 were HIV-negative patients. SARS-CoV-2 antibody tests were performed on all participants. Overall, medical consultation was conducted. For HIV-positive participants only, viral load, antiretroviral regimen, duration of HIV infection, and duration of antiretroviral treatment were retrieved from medical records. Results: We found an overall SARS-CoV-2 IgG seroprevalence of 42.31% within the study population, with a SARS-CoV-2 IgG seroprevalence of 44.6% for PLWH and 38.7% among those without HIV infection; no significant statistical difference was observed. Adjusting for sex, HIV status, and BCG vaccination, the odds of previous SARS-CoV-2 infection were higher among married persons in the study population. Sex, BCG vaccination, and HIV status were not found to be associated with SARS-CoV-2 IgG seropositivity. Conclusions: Our findings support the lack of association between HIV status and susceptibility to SARS-CoV-2 infection. The ARV regimen, suppressed viral load, and Tenofovir boasted ARV regimen might not affect the body's immune response after exposure to SARS-CoV-2 among PLWH. Thus, if HIV is well treated, the susceptibility to COVID-19 in PLWH would be like that of the general population.

Building leadership and management competencies of national immunization teams in 16 Gavi-eligible countries through the EPI leadership and management programme.

BACKGROUND: Strengthening leadership and management competencies among national Expanded Programme on Immunization (EPI) teams will be critical to achieving global immunization targets and other sustainable developmental goals. However, there is little empirical evidence of the effectiveness of investments in leadership and management capacity in the context of national EPI programs. Therefore, we sought to evaluate the EPI Leadership and Management Programme (EPI LAMP), a nine-month certificate program for EPI teams in national Ministries of Health from Gavi priority countries in Anglophone and Francophone Africa and Asia. METHODS: We used a mixed-methods longitudinal evaluation to describe EPI LAMP at four levels: (1) participant response to the training experience based on program administration records and satisfaction surveys; (2) change in management and leadership skill based on competency surveys and exit interviews; (3) change in behavior in the workplace based on exit interviews; and (4) impact of the training on EPI program performance based on the results of each delegate's leadership project. RESULTS: In the first three cohorts, the programme engaged 16 countries (63 participants) and achieved an 86% graduation rate (54 alumni). Participants demonstrated significant improvement in management and leadership competencies across eight domains with the largest improvement observed in the domain of governance and leadership. Women showed greater increases than men, especially in the domains of Operations Management and Political Advocacy and Dialogue. We observed no difference in the gains made by French-speaking delegates compared to English-speaking participants. Breakthrough projects developed by each team improved EPI program performance, as measured by metrics specific to each project. DISCUSSION: Our results show that team-based leadership programs can foster improvements in management practice, collaboration, and problem-solving, and that engagement the broader policy and organizational context is needed to foster the systems thinking capacity required to address complex challenges and improve system performance.

A structured approach to effective mentoring of women health researchers in Africa.

Objectives: To formatively evaluate the HIGHER Women consortium's Mentor Protégée Program (MPP) and derive lessons for successful African women scientist mentorship. Design: Desk review of program documents and cross-sectional surveys of mentors and protégées. Setting: All 10 regions of Cameroon. Participants: Women working in health research participating in the MPP. Interventions: Building health research skills and providing support for women to cope within the African psycho-social environment using a holistic approach. Main outcome measures: Formed mentor-protégés duos applying the MPP with measurable accomplishments. Results: The consortium counted 121 members with 103 protégées and 18 mentors. Of 103 protégées, 35 responded to the 2018 survey, while 77 responded to the 2022 survey. Mentioned benefits of the program included an increase in scientific peer-reviewed journal publications and presentations at national and international conferences. In the 2022 survey, a Pearson correlation showed an r of 0.41, which, although not statistically significant (p = .592), suggests a positive correlation between the increased number of peer-reviewed articles and increased number of years as HIGHER Women protégées. Conclusions: Mentorship programs can help over time to bridge the gender gaps within Africa as well as the gaps between African-led research and the rest of the world while making a meaningful contribution to enhancing the quality, diversity, and productivity of researchers. A mentoring program such as the HIGHER Women MPP can be improved by leveraging local and international partners to foster the mentoring program's sustainability, scalability, and expanded reach. Funding: World Health Organization's Special Programme for Research and Training in Tropical Diseases (WHO/TDR) and Canada's International Development Research Centre (IDRC Canada).

A structured approach to effective mentoring of women health researchers in Africa

Objectives: To formatively evaluate the HIGHER Women consortium's Mentor Protégée Program (MPP) and derive lessons for successful African women scientist mentorship. Design: Desk review of program documents and cross-sectional surveys of mentors and protégées. Setting: All 10 regions of Cameroon Participants: Women working in health research participating in the MPP. Interventions: Building health research skills and providing support for women to cope within the African psychosocial environment using a holistic approach. Main outcome measures: Formed mentor-protégés duos applying the MPP with measurable accomplishments. Results: The consortium counted 121 members with 103 protégées and 18 mentors. Of 103 protégées, 35 responded to the 2018 survey, while 77 responded to the 2022 survey. Mentioned benefits of the program included an increase in scientific peer-reviewed journal publications and presentations at national and international conferences. In the 2022 survey, a Pearson correlation showed an r of 0.41, which, although not statistically significant (p = .592), suggests a positive correlation between the increased number of peer-reviewed articles and increased number of years as HIGHER Women protégées. Conclusions: Mentorship programs can help over time to bridge the gender gaps within Africa as well as the gaps between African-led research and the rest of the world while making a meaningful contribution to enhancing the quality, diversity, and productivity of researchers. A mentoring program such as the HIGHER Women MPP can be improved by leveraging local and international partners to foster the mentoring program's sustainability, scalability, and expanded reach.

Integration of Traditional Healers in Human African Trypanosomiasis Case Finding in Central Africa: A Quasi-Experimental Study.

BACKGROUND: Based on the premise that Africans in rural areas seek health care from traditional healers, this study investigated a collaborative model between traditional healers and the national Human African Trypanosomiasis (HAT) programs across seven endemic foci in seven central African countries by measuring the model's contribution to HAT case finding. METHOD: Traditional healers were recruited and trained by health professionals to identify HAT suspects based on its basics signs and symptoms and to refer them to the National Sleeping Sickness Control Program (NSSCP) for testing and confirmatory diagnosis. RESULTS: 35 traditional healers were recruited and trained, 28 finally participated in this study (80%) and referred 278 HAT suspects, of which 20 (7.19%) were CATT positive for the disease. Most cases originated from Bandundu (45%) in the Democratic Republic of Congo and from Ngabe (35%) in Congo. Twelve (4.32%) patients had confirmatory diagnosis. Although a statistically significant difference was not shown in terms of case finding (p = 0.56), traditional healers were able to refer confirmed HAT cases that were ultimately cared for by NCSSPs. CONCLUSION: Integrating traditional healers in the control program of HAT will likely enhance the detection of cases, thereby, eventually contributing to the elimination of HAT in the most affected communities.

Molecular prevalence of intestinal parasites infections in children with diarrhea in Franceville, Southeast of Gabon.

BACKGROUND: Pediatric diarrhea caused by a range of pathogens, including intestinal parasites, is one of main causes of death among children under 5 years of age. The distribution of these parasitic infections overlaps in many environmental, socioeconomic and epidemiological settings. Their distribution and prevalence varies from region to region. In the current study, we assess the prevalence of intestinal parasites among pediatric patients with syndromic diarrheal disease living in Franceville, Gabon. METHODS: A cross-sectional study conducted in the Amissa Bongo Regional Hospital and Chinese-Gabonese Friendship Hospital in Franceville, between November 2016 and August 2017, enrolled a total of 100 diarrheic children between 0 and 180 months of age. Parasite detection in stool samples was performed using molecular diagnostic by PCR. Difference in means were tested by Student's t test and ANOVA while principal component analysis was used to determine the correlation between parasite distributions and age groups. RESULTS: The overall prevalence of intestinal parasite infection was 61% (61/100). Hymenolepis sp and Cryptosporidium hominis/parvum were the most common parasites (31 and 19%, respectively), followed by Encephalitozoon intestinalis (15%), Trichuris trichiura (4%), Dientamoeba fragilis (4%), and Enterocytozoon bieneusi (2%). The polyparasitism rate was 19.7%, with 83.3% double and 16.7% triple infections. Protozoan infections (66.7%) were more prevalent than helminths infections (33.3%). Seasonal association of the circulation of intestinal parasite was statistically significant (p = 0.03). Correlations between different parasites was also observed. CONCLUSION: The prevalence of intestinal parasitic infections is highest in diarrheic pediatric children. The prevalence of parasitic infections indicates that protozoa and helminths are the most common parasites in the Franceville environment. This study reinforces the importance of routine examination of diarrheic stool samples for the diagnostic of intestinal parasites. Further analyses are required to better understand the local epidemiology and risk factors associated with the transmission of intestinal parasites in Franceville, Gabon. KEYSWORDS: diarrhea, children, intestinal parasitic infections, molecular diagnostic, Franceville, Gabon.

Factors influencing the performance of routine immunization in urban areas: A comparative case study of two cities in Cameroon: Douala and Yaoundé.

Urban areas are often omitted from investigations on immunization because the published literature tends to focus on rural settings. The two largest cities in Cameroon - Douala and Yaoundé - are the main drivers of the high number of unvaccinated children in Cameroon. The objective of our study was to identify the factors influencing vaccine incompleteness in Douala and Yaoundé in children (12-23 months of age). We conducted a community-based cross-sectional study using concomitant mixed methods (qualitative and quantitative) with an explanatory aim. The study was conducted in three health districts in each city between March and April 2016. The number of nonvaccinated and incompletely vaccinated children was higher in Yaoundé (3.1% and 40.3%, respectively) than in Douala (0.7% and 10.1%, respectively). The most frequent reason for nonvaccination was related to the parent/guardian not knowing the consequences of not being vaccinated and lack of money. According to the explanatory model, nonvaccination in both cities was associated with the following issues: (1) perceived high visibility of the health district office in terms of vaccination, (2) the shortage of health personnel in immunization centers, (3) attending a private health facility, (4) average or poor behavior of health personnel at immunization centers, and (5) poor knowledge of vaccine-preventable diseases. This mixed-methods study illustrates how inadequacies of the health district framework within urban areas are fueling poor performance of routine immunization in Cameroon. Further research should inform the development of community-centered vaccination services that are most needed, especially in rapidly urbanizing sub-Saharan Africa.

Molecular epidemiology and surveillance of circulating rotavirus and adenovirus in Congolese children with gastroenteritis.

Infectious Diarrhea caused by rotavirus and adenovirus, is a leading cause of death in children in sub-Sahara Africa but there is limited published data on the diverse rotavirus genotypes and adenovirus serotypes circulating in the Republic of Congo. In this study, we investigated the prevalence of severe diarrhea caused by rotavirus A (RVA) and Adenovirus serotype 40 and 41 in Congolese children hospitalized with severe gastroenteritis. Stool samples were collected from 655 Congolese children less than 60 months of age hospitalized with acute gastroenteritis between June 2012 and June 2013. Rotavirus and adenovirus antigens were tested using commercially available ELISA kits and the RVA G- and P- genotypes were identified by seminested multiplex RT-PCR. Three hundred and four (46.4%) children were tested positive for RVA. Adenovirus infection was found in 5.5% of the 564 tested children. Rotavirus infection was frequently observed in children between 6-12 months (55.9%). The dry season months recorded increased RVA infection while no seasonality of adenovirus infection was demonstrated. The most common RVA genotypes were G1 (57.5%), G2 (6.4%), G1G2 mixture (15.5%), P[8] (58%), P[6] (13.2%), and P[8]P[6] mixture (26%). Additionally, the genotype G12P[6] was significantly associated with increased vomiting. This first study on Congolese children demonstrates a high prevalence and clinical significance of existing rotavirus genotypes. Adenovirus prevalence is similar to that of other Central African countries. This baseline epidemiology and molecular characterization study will contribute significantly to the RVA surveillance after vaccine implementation in the country.