Non-communicable airway disease and air pollution in three African Countries: Benin, Cameroon and The Gambia.

BACKGROUND: Air pollution exposure can increase the risk of development and exacerbation of chronic airway disease (CAD). We set out to assess CAD patients in Benin, Cameroon and The Gambia and to compare their measured exposures to air pollution. METHODOLOGY: We recruited patients with a diagnosis of CAD from four clinics in the three countries. We collected epidemiological, spirometric and home air pollution data. RESULTS: Of the 98 adults recruited, 56 were men; the mean age was 51.6 years (standard deviation ±17.5). Most (69%) patients resided in cities and ever smoking was highest in Cameroon (23.0%). Cough, wheeze and shortness of breath were reported across the countries. A diagnosis of asthma was present in 74.0%; 16.3% had chronic obstructive pulmonary disease and 4.1% had chronic bronchitis. Prevalence of airflow obstruction was respectively 77.1%, 54.0% and 64.0% in Benin, Cameroon, and Gambia. Across the sites, 18.0% reported >5 exacerbations. The median home particulate matter less than 2.5 µm in diameter (PM2.5) was respectively 13.0 µg/m3, 5.0 µg/m3 and 4.4 µg/m3. The median home carbon monoxide (CO) exposures were respectively 1.6 parts per million (ppm), 0.3 ppm and 0.4 ppm. Home PM2.5 differed significantly between the three countries (P < 0.001) while home CO did not. CONCLUSION: Based on these results, preventive programmes should focus on ensuring proper spirometric diagnosis, good disease control and reduction in air pollution exposure.

CONTEXTE: L'exposition à la pollution de l'air peut accroître le risque de développement et d'aggravation des maladies chroniques des voies respiratoires (CAD). Nous avons entrepris d'évaluer les patients atteints de CAD au Bénin, au Cameroun et en Gambie et de comparer les niveaux d'exposition à la pollution de l'air qu'ils ont subis. MÉTHODOLOGIE: Nous avons sélectionné des patients ayant reçu un diagnostic de CAD dans quatre cliniques de ces trois pays. Nous avons collecté des informations épidémiologiques, des mesures spirométriques ainsi que des données sur la pollution de l'air à leur domicile. RÉSULTATS: En total, 98 individus adultes ont été sélectionnés pour cette étude. Parmi eux, 56 étaient de sexe masculin. L'âge moyen de ces participants était de 51,6 ans, avec un écart-type de ±17,5. La majorité des patients (69%) résidaient en milieu urbain, tandis que le taux de tabagisme le plus élevé était observé au Cameroun (23,0%). Les symptômes de toux, de respiration sifflante et d'essoufflement ont été rapportés dans tous les pays. Parmi les patients, 74% ont reçu un diagnostic d'asthme, 16,3% souffraient de maladie pulmonaire obstructive chronique et 4,1% de bronchite chronique. L'obstruction des voies respiratoires était présente respectivement chez 77,1%, 54,0% et 64,0% des cas au Bénin, au Cameroun et en Gambie. Sur l'ensemble des sites, 18,0% ont signalé plus de cinq exacerbations. La médiane des PM2.5 à domicile était de 13,0 µg/m3, 5,0 µg/m3 et 4,4 µg/m3, respectivement. Les expositions médianes au monoxyde de carbone (CO) à domicile étaient de 1,6 ppm, 0,3 ppm et 0,4 ppm respectivement. Les PM2,5 à domicile présentaient des différences significatives entre les trois pays (P < 0,001), contrairement au CO à domicile. CONCLUSION: En se basant sur ces résultats, il est recommandé que les programmes de prévention se focalisent sur un dépistage spirométrique adéquat, une gestion efficace de la maladie et une diminution de l'exposition à la pollution atmosphérique.

Prevalence of HIV infection among stroke patients in Douala.

To determine the prevalence of HIV infection among stroke patients admitted to the Douala General Hospital (DGH) and to describe the clinical characteristics and outcome of the stroke patients with HIV infection. This prospective cohort study took place in 2010-2015 at the DGH. The study included patients older than 15 years with a CT-confirmed stroke. All patients underwent HIV tests with Western-Blot confirmation. The functional prognosis of the patients was assessed by the Rankin score at 6 months after stroke onset. The prevalence rate of HIV among stroke patients was 6.6% (40/608). Of the 40 HIV-positive patients, 58% were aware of their status at admission; 83% of these patients were receiving antiretroviral therapy. Males were predominant (65%), and the mean age was 51.3 ± 10.4 years. Hypertension was the main cerebrovascular risk factor (65%). At admission, 47.5% of HIV+ patients were febrile, and 7.5% presented with coma. Ischemic stroke accounted for 60% of cases. The mean CD4 cell count was 351 ± 236/mm3 with a median of 330/mm3. The length of stay was 10 ± 8 days. At 6 months, the cumulative mortality of HIV+ patients was 37.5%, and 38.5% were dependent (Rankin>2). HIV prevalence is high among stroke patients in our setting. This suggests that an HIV test should be routinely proposed to stroke patients.

Gender disparities in pulmonary hypertension at a tertiary centre in Cameroon.

BACKGROUND: Pulmonary hypertension (PH) is a potent cause of heart failure and has been little investigated in the African setting. OBJECTIVE: To investigate the effects of gender on the clinical presentation, echocardiographic features and outcomes of patients with PH in Douala, Cameroon. METHODS: A prospective cohort study was conducted from March 2012 to December 2013 as part of the Pan African Pulmonary Hypertension Cohort study. PH was diagnosed by echocardiography and defined as a right ventricular systolic pressure >35 mmHg in the absence of acute right heart failure. Patients were followed up for a maximum of 12 months for primary endpoint mortality. RESULTS: In total, 130 patients with PH were recruited; 71 (54.6%) were women. The median age was 59.2 years for men and 58.3 years for women (p=0.76). Active smoking and alcohol use were more frequent in men than women (both p<0.001), but women had greater exposure to indoor cooking fumes than men (p<0.001). Previous tuberculosis infection (11.3% v. 1.7%) and S3 gallop rhythm (30.9% v. 11.9%) were more common in women (both p<0.03). Women had a significantly higher mean systolic blood pressure (134 mmHg v. 125 mmHg; p=0.04) and pulse pressure (53.8 mmHg v. 44.9 mmHg; p=0.01) and a lower mean haemoglobin concentration (10.4 g/dL v. 12.4 g/dL; p<0.05) compared with men. Echocardiographic left ventricular (LV) systolic dysfunction was more frequent in men: mean LV ejection fraction 42.6% v. 51.5% (p=0.01) and mean fractional shortening 21.4% v. 28.6% (p=0.01). The overall mortality rate was 20.3%, and rates were similar in the two groups (Kaplan-Meier log rank 1.1; p=0.30). CONCLUSIONS: Despite differences in baseline characteristics including cardiovascular risk factors, mortality rates on follow-up were similar in men and women in this study. However, these different baseline characteristics probably suggest differences in the pathogenesis of PH in men and women in our setting that need further investigation.

Gender disparities in pulmonary hypertension at a tertiary centre in Cameroon

Background. Pulmonary hypertension (PH) is a potent cause of heart failure and has been little investigated in the African setting.Objective. To investigate the effects of gender on the clinical presentation, echocardiographic features and outcomes of patients with PH in Douala, Cameroon.Methods. A prospective cohort study was conducted from March 2012 to December 2013 as part of the Pan African Pulmonary Hypertension Cohort study. PH was diagnosed by echocardiography and defined as a right ventricular systolic pressure >35 mmHg in the absence of acute right heart failure. Patients were followed up for a maximum of 12 months for primary endpoint mortality.Results. In total, 130 patients with PH were recruited; 71 (54.6%) were women. The median age was 59.2 years for men and 58.3 years for women (p=0.76). Active smoking and alcohol use were more frequent in men than women (both p<0.001), but women had greater exposure to indoor cooking fumes than men (p<0.001). Previous tuberculosis infection (11.3% v. 1.7%) and S3 gallop rhythm (30.9% v. 11.9%) were more common in women (both p<0.03). Women had a significantly higher mean systolic blood pressure (134 mmHg v. 125 mmHg; p=0.04) and pulse pressure (53.8 mmHg v. 44.9 mmHg; p=0.01) and a lower mean haemoglobin concentration (10.4 g/dL v. 12.4 g/dL; p<0.05) compared with men. Echocardiographic left ventricular (LV) systolic dysfunction was more frequent in men: mean LV ejection fraction 42.6% v. 51.5% (p=0.01) and mean fractional shortening 21.4% v. 28.6% (p=0.01). The overall mortality rate was 20.3%, and rates were similar in the two groups (Kaplan-Meier log rank 1.1; p=0.30).Conclusions. Despite differences in baseline characteristics including cardiovascular risk factors, mortality rates on follow-up were similar in men and women in this study. However, these different baseline characteristics probably suggest differences in the pathogenesis of PH in men and women in our setting that need further investigation

Clinical characteristics and outcomes of tuberculosis in Douala, Cameroon: a 7-year retrospective cohort study.

SETTING: Tuberculosis (TB) clinic, Douala Laquintinie Hospital, Douala, Cameroon. OBJECTIVE: To describe the clinical characteristics of TB and to investigate predictors of poor treatment outcomes. DESIGN: A registry-based, retrospective cohort study of all TB cases recorded from 2007 to 2013 was conducted. Multinomial logistic regression models were used to identify predictors of poor outcomes. RESULTS: Of 8902 TB cases included, 5110 (57.4%) were males. The median age was 33 years. The prevalence of human immunodeficiency virus (HIV) infection was 37.6%, with a significant decline over the study years (P = 0.000). The main clinical form of TB was smear-positive TB (50.5%). The treatment success rate was 75.2%, while the mortality rate was 8.1%. The year of TB diagnosis, retreatment cases, sputum non-conversion at the end of month 2, HIV infection and HIV testing not done were associated with death. Retreatment and non-conversion of sputum were associated with treatment failure, while male sex, age, sputum non-conversion, HIV infection and HIV testing not done were associated with loss to follow-up. CONCLUSION: TB management objectives may be attained by focusing specifically on higher risk groups to prevent poor treatment outcomes.

[Clinical and immunological profile of HIV-infected patients at the initiation of antiretroviral therapy in Douala]. / Profil clinique et immunologique des patients infectés par le VIH à l'initiation du traitement antirétroviral à Douala.

The aim of this study was to describe the clinical and immunological profile of patients infected with HIV after initiation of antiretroviral therapy. Sociodemographic characteristics, clinical and immunological patients were recorded. Chi square test and Mann-Whitney were used to compare variables. The multivariate regression model identified risk factors. So that, 936 (56.2%) patients were in stages III and IV of the WHO and 65.2% at an advanced stage of the disease. Factors associated with initiation at an advanced stage, were male sex (p = 0.007) and time to diagnosis (p = 0.005). In 2/3 cases, treatment is started at an advanced stage of disease. It is therefore important to intensify awareness campaigns for early detection and encourage patients to ensure regular medical follow-up screening.

[Evaluation of tuberculous patients' management when re-treated in Cotonou, Benin]. / Évaluation de la prise en charge des patients admis au régime de retraitement à Cotonou, Bénin.

Retreatment of tuberculosis is the leading risk factor for drug resistance if the management is not adequate and complete. The objective of this study was to evaluate the management of cases of retreatment in Cotonou. This was a retrospective, descriptive cross type which covered a period of 5 years. Outcomes of retreatment cases were compared against those for new cases that were registered during the same period. We analyzed the cases of 389 retreatment patients and 4542 new cases. The success rates of treatment were generally satisfactory (80% vs. 86%, P=0.0001). Of adverse outcomes, the rate of loss of sight of was 12% versus 7%, P=0.26, the rate was 23% for cases of occasions. The failure rate was low and similar in both populations (2%). The retreatment regimen for patients with TB in Cotonou appears to give generally satisfactory results. The high loss to follow-up in case of retreatment means that a personalized therapeutic approach for such patients is needed in general and in particular in the case of defaulters.

Correlates of cigarette smoking among university students in Cameroon.

OBJECTIVE: To determine factors associated with smoking among university students in Cameroon. DESIGN: A cross-sectional survey was carried out using an anonymous self-administered questionnaire among a convenience sample of 3000 students from three universities (the Université des Montagnes, and the Universities of Douala and Yaounde 1) in Cameroon; 190 students (5.9%) did not consent to the survey. Socio-demographic characteristics and smoking trends were recorded. Logistic regression was used to identify risk factors for smoking. RESULTS: Of the students selected, 1862 (62%) were male. The mean age was 23.3 years. We found that 30.1% of students had tried smoking and that 5.6% (n = 168) reported regular smoking. Smoking prevalence among male and female students was respectively 9.5% and 1%. The mean age of smokers was 24.1 years. Only 12.5% of regular smokers were nicotine-dependent. Factors motivating smoking were pleasure, imitation, snobbery and curiosity. In the multivariate analysis, smoking was statistically associated with age, male sex, exposure to friends who smoke and living with smokers. CONCLUSION: Although the prevalence of smoking found in our study was low, effective tobacco control programmes targeting factors such as age, male sex and peer influence should be implemented in universities. Future studies are needed to evaluate the impact of these interventions.

[Etiology of spontaneous pneumothorax in Senegal: prospective study in Dakar University Hospital]. / Etiologies du pneumothorax spontané au Sénégal: étude prospective au CHU de Fann-Dakar.

Pneumothorax is defined as the presence of air in the pleural space. There is a paucity of data on pneumothorax in Senegal. The purpose of this prospective study conducted over a 18-month period was to determine the etiological and clinical characteristics of spontaneous pneumothorax in Senegal. This study was conducted in the respiratory disease unit of Dakar University Hospital between June 2005 and November 2006. All patients over the age of 15 years admitted with a diagnosis of spontaneous pneumothorax were included. Sociodemographic, clinical, radiological and biological data were recorded for all patients. Of the 1,053 patients admitted to the unit during the study period, 73 (6.93%) presented spontaneous pneumothorax that was classified as primary in 8 cases and secondary in 65. Median patient age was 32 years (range, 16 to 86). The male-to-female ratio was 3.6/1. The most common cause of secondary spontaneous pneumothorax was pulmonary tuberculosis followed by emphysema. The findings of this study indicate that secondary spontaneous pneumothorax is predominant in Senegal. Pulmonary tuberculosis that is endemic in the country is the main cause of secondary spontaneous pneumothorax and accounts for almost 3/4 of cases.

[Lung abscess due to community acquired Klebsiella pneumonia]. / Pneumopathie communautaire abcédée à Klebsiella pneumoniae.

INTRODUCTION: In western countries, community-acquired pneumonias due to Klebsiella pneumoniae (Kp) are rare and associated with a poor prognosis and a high mortality. The severity is in part linked to the virulence of Kp. Immuno-depression, sepsis and visceral abscesses are frequently found, constituting other classical risk factors for severity and contributing to the poor prognosis. The therapeutic strategy is based on third generation cephalosporins, aminoglycosides and quinolones. CASE REPORT: We report the case of a young adult, with undiagnosed diabetes, hospitalized as an emergency for septic shock complicating a community-acquired pneumonia due to Kp and associated with multiple brain and lung abscesses. After several weeks of treatment, initially with empirical then specific antibiotics, a favourable outcome was obtained. CONCLUSION: This case report underlines the particular severity of infections due to Kp and their main pathophysiological mechanisms. It is also an opportunity to highlight the potential responsibility of Kp in the presence of a pneumonia with lung abscesses and finally to update the principles of antibiotic therapy.

[Clinical, biological and radiological spectrum of newly diagnosed pulmonary tuberculosis]. / Profil clinique, biologique et radiologique des nouveaux cas de tuberculose pulmonaire au Centre Hospitalier Universitaire de Fann-Dakar.

The aim of the present study was to describe the clinical, biological and the chest-X ray presentations of newly diagnosed pulmonary tuberculosis. A retrospective study of 200 patients was performed from January to October 2004 in the respiratory diseases unit of Dakar's University Teaching Hospital. Among the 200 cases, 140 (70%) were male, giving a sex ratio of 2.3. The mean age of our patients was 35.5 years (range: 14-81 years). The group age of 20 to 39 years was the most affected (55,5% of patients). The median diagnostic delay was 4 months (range: 7 days to 2 years). Haemoptysis revealed the disease in 27% of cases. The chest X-ray showed bilateral lesions in 65% of cases. When they were unilateral, the right side was the most concerned. Of the 200 patients, the lesions interested all parts of at least one lung in 106 (53%). Among our patients, 153 (76.5%) had cavitations and 145 (72.5%) had infiltrates. A pleural effusion was associated to the lung lesions in 10% of the patients. Biologically, we reported 80% cases (n=160) of hypochromic microcytic anaemia. Of the 27 HIV tests done, 18 (66.7%) were positive all for HIV1. Delay in the diagnosis of pulmonary tuberculosis was very long and our data illustrate the need for improved education of the community and event of healthcare workers about the benefit of early diagnosis of tuberculosis.