[Funding of a free healthcare campaign in a rural district of Cameroon: optimizing the role of civil society in sub-Saharan Africa]. / Financement d'une campagne de soins gratuits par une association dans un district rural au Cameroun Nécessité d'optimiser le rôle de la société civile en Afrique subsaharienne.

Financial barriers represent a major obstacle to access to health care in sub-Saharan Africa and thus to the implementation of the Bamako Initiative. We describe an experience in which a civil society organization financed a free healthcare campaign in a rural health district in Cameroon. In all, 2,073 patients received free consultations, laboratory tests, and drugs. Adults older than 40 years accounted for 55.7% of all patients. The most frequent diseases were: osteoarticular conditions (24.1%), malaria (20.8%), and intestinal parasitosis (12.5%). In health systems financed mainly by cost recovery, some population needs remain uncovered by health services. There is a need to involve and reinforce the role of civil society in health system financing. It can help to pool more funds and improve the management of health resources to increase financial access to health care for poor people.

[Thirty years of tuberculosis control in Cameroon: alternating "vertical" and "horizontal" health care delivery systems]. / Trente ans de lutte antituberculeuse au Cameroun: une alternance entre systèmes d'offre de soins de santé "vertical" et "horizontal".

BACKGROUND: In sub-Saharan Africa, tuberculosis remains endemic despite reforms of health systems and the tuberculosis control organization carried out in the last decades. METHODS: We conducted a retrospective study of tuberculosis control in Cameroon from the period 2009 back to 1980. Data were collected from documents and activity reports of tuberculosis control, and interviews with managers of the National tuberculosis control program. FINDINGS: The history of tuberculosis control in Cameroon from 2009 back to 1980 can be divided into three main periods. The first period, from 1980 to 1994, corresponded to the implementation of the 'primary health care' policy. At that time, tuberculosis case management was delivered free of charge, but centralized in specialized services with a gradual and mild increase in new cases detected. The second period, from 1995 to 2000, was characterized by the implementation of the 'primary health care reorientation' policy that decentralized tuberculosis care to all health facilities, but introduced cost recovery --which came along with a dramatic drop in the number of tuberculosis cases detected. The National tuberculosis control program, established in 1996, entrusted health facilities--especially hospitals--with the responsibility of tuberculosis diagnosis and treatment, and referred to them as tuberculosis diagnosis and treatment centers. During the third period, from 2001 to 2009, owing to major support from global health initiatives, the number of tuberculosis diagnosis and treatment centers was increased (reaching 216 centers in 2009), with a significant increase of new cases detected that peaked in 2006, from where the situation started declining till 2009. CONCLUSION: Tuberculosis control indicators have never been optimal in Cameroon, despite the generally positive trend from 1980 to 2009. The strategy of tuberculosis diagnosis and treatment centers, which are essentially nested within hospitals, seems to have reached its intrinsic limitations. Better performance in tuberculosis control will henceforth require greater decentralization of tuberculosis detection and treatment to health centers. This careful decentralization will improve access for tuberculosis patients and lead to a comprehensive use of hospital technical expertise for tuberculosis care.

Rheumatic diseases in patients attending a clinic at a referral hospital in Yaounde, Cameroon.

BACKGROUND: The spectrum of rheumatic diseases in sub-Saharan Africa remains poorly defined. OBJECTIVES: To determine the spectrum of rheumatic diseases in Yaounde. DESIGN: Descriptive cross-sectional study. SETTING: Rheumatology clinic at the Yaounde General Hospital, Cameroon. SUBJECTS: Twelve thousand four hundred and ninety four patients were referred to the outpatient department of the Internal Medicine service of the General Hospital of Yaounde over a 12-month period. Of these cases, 536 (9.4%) were diagnosed as belonging to the general class of rheumatic conditions. There were 334 (62.31%) females and 202 (37.69%) males. The mean age was 52.72 +/- 5.3 years. RESULTS: The 536 cases were further classified as follows: degenerative disease of the spine 196 (36.5%), osteoarthritis of the limbs 110 (20.5%), regional musculo-skeletal disorders 83 (15.5%), arthritis associated with infections 50 (9.3%), chronic inflammatory and connective tissue diseases 44 (8.2%), crystalline arthropathies 32 (5.9%) and miscellaneous (unclassified) rheumatic conditions 21 (4.1%). CONCLUSION: From these results, we concluded that degenerative disease of the spine and limbs are the most common forms of rheumatic disease in this region. Gout is the most commnon acute inflammatory arthropathy and rheumatoid arthritis the most prevalent arthropathy due to chronic inflammation.

Community acceptability of the use of low-dose niclosamide (Bayluscide), as a molluscicide in the control of human schistosomiasis in Sahelian Cameroon.

Although field trials of the application of molluscicides for the control of human schistosomiasis have been conducted in several settings, the acceptability of molluscide use at the community level has been poorly documented. The death and putrefaction of aquatic organisms in water treated with niclosamide (Bayluscide), for example, and the yellowish colouration of such water, may decrease the molluscide's acceptability. It may be possible, however, to use doses of a molluscicide that are only just high enough to kill the target snails but not high enough to kill non-target fish and frogs, thereby reducing the application's impact on water quality and colour and improving its acceptability to local communities. In a study in northern Cameroon, Bayluscide WP70 was applied to ponds at concentrations of 0, 0.25, 0.5 or 1 g/m(3). Changes in human contact with the water in the ponds were explored both by direct observation and by in-depth interviews with key informants from the local community. Although all applications of niclosamide greatly decreased human use of the treated ponds for a few days, most informants (99%) were in favour of niclosamide application and only 6% of the interviewees gave change in water colour or bad smell as a reason for not using a particular water body. Over the few days post-application, use of ponds treated with 0.25 or 0.5 g Bayluscide WP70/m(3) was higher than that of the ponds treated with 1 g/m(3), indicating that relatively low-dose applications, if effective in controlling snails, may be more acceptable to local communities than applications at higher doses.

Loiasis--a neglected and under-estimated affliction: endemicity, morbidity and perceptions in eastern Cameroon.

Loiasis is a neglected disease that may have great social and economic impact in some endemic areas. This study was designed to update the geographical distribution of loiasis and assess the frequency and perceptions of the clinical signs of the disease in the Eastern province of Cameroon. The investigation covered 32 villages and involved 4146 respondents. Human infection with Loa loa was endemic in all the study villages but the prevalence of microfilaraemia generally decreased from south to north. All of the study villages had local names for eye worm and Calabar swellings that varied in meaning and among the various ethnic groups. The most common traditional treatment for eye worm was garlic or onion juice, which is dripped into the affected eye. The body sites that were most affected by Calabar swellings were the upper (30%) or lower (32%) limbs. The swellings were very painful (46%), mildly painful (28%) or painless (26%). Most respondents (94%) reported that the swellings itched. The prevalence of L. loa microfilaraemia in most of the study villages was >20%. These villages are clearly at risk of severe adverse events, with encephalopathy, following mass distribution of ivermectin. The prevalence of the main clinical manifestations of loiasis (i.e. eye worm and/or Calabar swellings) was twice that of detectable microfilaraemia.

Field trials of low dose Bayluscide on snail hosts of schistosome and selected non-target organisms in sahelian Cameroon.

More than 85% of all cases of schistosomiasis in Cameroon occur in the northern sahelian half of the country representing 20% of the population. Several workers have advocated the integrated approach to schistosomiasis control, including snail control, but the death and decay of aquatic organisms, and fish kill that often follows Bayluscide application at the dose of 1 g/m3 decrease its acceptability. The present study was designed to assess the effect of lower Bayluscide doses on snail host and non-target fish, frog, the tadpole kill. Bayluscide was applied to study ponds at concentrations of 0, 0.25, 0.5, and 1 g/m3 (ppm). Pre and post application assessment of snails hosts of schistosomes, fish, frog, and tadpole kill were carried out. All 0.25, 0.5, and 1 g/m3 Bayluscide concentrations reduced snail population significantly. Bayluscide concentration of 0.50 g/m3 applied in two rounds of 0.25 g/m3 resulted in high snail mortality and low lethality to fish, frogs, and tadpoles. Further studies are needed to assess the cost-effectiveness of Bayluscide in the control of schistosomiasis following the simplified approach.

Field trials of low dose Bayluscide on snail hosts of schistosome and selected non-target organisms in sahelian Cameroon

More than 85 percent of all cases of schistosomiasis in Cameroon occur in the northern sahelian half of the country representing 20 percent of the population. Several workers have advocated the integrated approach to schistosomiasis control, including snail control, but the death and decay of aquatic organisms, and fish kill that often follows Bayluscide application at the dose of 1g/m³ decrease its acceptability. The present study was designed to assess the effect of lower Bayluscide doses on snail host and non-target fish, frog, the tadpole kill. Bayluscide was applied to study ponds at concentrations of 0, 0.25, 0.5, and 1 g/m³ (ppm). Pre and post application assessment of snails hosts of schistosomes, fish, frog, and tadpole kill were carried out. All 0.25, 0.5, and 1 g/m³ Bayluscide concentrations reduced snail population significantly. Bayluscide concentration of 0.50 g/m³ applied in two rounds of 0.25 g/m³ resulted in high snail mortality and low lethality to fish, frogs, and tadpoles. Further studies are needed to assess the cost-effectiveness of Bayluscide in the control of schistosomiasis following the simplified approach.

Hematuria and Dysuria in the Self-Diagnosis of Urinary Schistosomiasis among School-Children in Northern Cameroon

The present study was designed to assess the value of self reported hematuria and dysuria in the diagnosis of urinary schistosomiasis at the individual level. A sample of 964 school children of grade 5 and 6 from 15 schools of the French speaking educational system in the Sudano-sahelian zone of northern Cameroon were submitted to a questionnaire related to hematuria and dysuria; and provided a urine sample each. The urine samples were processed using the dip stick and sedimentation methods; and the degree of microhematuria and oviuria determined. In all 964 questionnaires were collected; 843 urine samples examined for microhematuria and 871 for oviuria. The percentage of children reporting hematuria increased with the degree of microhematuria and the intensity of infection. Among the various indicators of urinary schistosome infection; microhematuria had the highest sensitivity (76); followed by self reported hematuria or dysuria (65); and dysuria (52). The specificity was highest for self reported hematuria; and lowest for self reported hematuria or dysuria. The efficiency of self reported hematuria or dysuria increased with the intensity of infection and was highest (100) for heavy infections ( 400 eggs/ml g urine). We advocate the use of self reported hematuria or dysuria for the assessment of S. haematobium at the individual level

The epidemiology of Plasmodium falciparum malaria in two Cameroonian villages: Simbok and Etoa.

In support of ongoing immunologic studies on immunity to Plasmodium falciparum, demographic, entomologic, parasitologic, and clinical studies were conducted in two Cameroonian villages located 3 km apart. Simbok (population = 907) has pools of water present year round that provide breeding sites for Anopheles gambiae, whereas Etoa (population = 485) has swampy areas that dry up annually in which A. funestus breed. Results showed that individuals in Simbok receive an estimated 1.9 and 1.2 infectious bites per night in the wet and dry season, respectively, whereas individuals in Etoa receive 2.4 and 0.4 infectious bites per night, respectively. Although transmission patterns differ, the rate of acquisition of immunity to malaria appears to be similar in both villages. A prevalence of 50-75% was found in children < 10 years old, variable levels in children 11-15 years old, and 31% in adults. Thus, as reported in other parts of Africa, individuals exposed to continuous transmission of P. falciparum slowly acquired significant, but not complete, immunity.

[Transfusion practices and quantification of blood loss in a surgical setting in Cameroon]. / Etude des pratiques transfusionnelles et quantification des pertes sanguines en milieu chirurgical Camerounais.

The purpose of this prospective study was to analyze compliance by surgical teams with new guidelines for blood transfusion. Study was focused on routine, presumably hemorrhagic procedures performed electively in adults at the Central Hospital in Yaounde, Cameroon. Overall blood loss was less than 20% of the total volume in 89% of the 303 patients included. Blood loss was between 20 and 30% in 10.6% and greater than 30% in 0.3%. Administration of replacement blood products was warranted only in the last two groups. Blood transfusion was performed in 104 patients and was unjustified in 81.7%. Seven percent of the remaining 199 patients presented indications for transfusion which was not performed and not compensated for by appropriate alternative precautions. At least one unit of whole blood had been requested and delivered to the operating room in 70% of cases with blood loss less than 20%, but was used in only 45% of cases. This study demonstrates poor compliance with new guidelines for blood transfusion in the surgical setting. Overconsumption of blood products represents the main problem. These findings underline the need for wider teaching of new blood transfusion strategies. Interest in this information is usually great in developing countries where blood banks are faced with limited facilities, qualified personnel, and supplies.

Sanitation in schools in Yaounde : cause for concern

The objective of the study was to survey school sanitation facilities in two health districts in Yaounde. Questionnaires were administered to head teachers by medical students during the sanitary inspection of school premises. 15 out of 30 schools surveyed (50 percent) did not have the minimum number of toilets ; 25 schools (83 percent) did not have enough wash basins while 27 (90 percent) did not have enough urinals. All nursery schools had soap; toilet paper and hand towels in wash rooms as opposed to very few primary and secondary schools. School health nurses were not involved in health education and sanitation activities. Both head teachers and surveyors rated sanitation in the schools to be fair or poor in well over 59 percent of cases. Recommendations have been made for present Cameroonian sanitary norms to be updated and their strict application ensured

Code of practice for brachytherapy physics: report of the AAPM Radiation Therapy Committee Task Group No. 56. American Association of Physicists in Medicine.

Recommendations of the American Association of Physicists in Medicine (AAPM) for the practice of brachytherapy physics are presented. These guidelines were prepared by a task group of the AAPM Radiation Therapy Committee and have been reviewed and approved by the AAPM Science Council.

1995 survey of physics teaching efforts in radiation oncology residency programs.

A physics teaching survey was constructed and sent to the 83 radiation oncologist training programs. The survey requested program information regarding size, staffing, curriculum, lab/rotation programs, organization, requirements, instructor makeup, teaching materials, and board certification examination results. The surveys were sent to the physicist responsible for the physics program. Forty-nine (59%) institutions returned completed surveys, of which 43 (88%) were university-associated programs, and 27 (55%) were 4-year programs. On average, there were two residents/year. Most programs (39) taught physics exclusively during the first year (PG2). Some programs taught different subjects (or levels) to different year residents. Radiation dosimetry, treatment planning, and brachytherapy constituted nearly half of the teaching hours. On average the total classroom time expended by physicists was 61.4 h/year with a range of 24-118 h. The mean for laboratory/demonstration time was 27 h/year with 18 programs providing none. Physics orientation/rotations ranged from 1 to 480 h with a mean of 170 h for a physics rotation taking place in year 2 (PG3). Mandatory attendance was 80% for first-year residents and decreased in later years. Homework was assigned in 76% of the programs, and 65% of the programs were graded. The primary instructors averaged 18.2 years of experience, and the majority were ABR/ABMP certified. Khan's textbook was the most prevalent resource for most subjects. No correlation could be made between teaching hours and ABR physics percentile scoring. The survey results reveal enormous differences in national teaching efforts.

Resistant hypertension in Yaounde.

Sixty six consecutive patients with resistant hypertension were studied over a period of 12 months. During that same period 565 patients were seen in all for hypertension given an average prevalence of 11.7% of resistant hypertension. Men were more frequently affected, however mean systolic and diastolic blood pressure levels were higher in women. Past history of poor compliance, overweight, renal impairment and cardiac abnormalities were important predictors of poor response to therapy. Resistance to therapy was not related to the class or the type of medication taken. Side effects were more numerous in the resistant group. Biochemically, apart from abnormal renal function tests, the other baseline tests were similar in both groups of resistant and non resistant hypertensives.

CT-guided percutaneous insertion of interstitial radiotherapy catheters in head and neck tumors.

We describe a new method of placing interstitial radiation therapy catheters in patients with head and neck tumors. In three patients with recurrent inoperable head and neck tumors CT guidance was utilized to insert interstitial radiation therapy catheters percutaneously. This method enabled palliative radiation therapy to be administered without the need for surgical placement of seeds or catheters. The detailed anatomical localization of tumor and vascular structures provided by CT enabled precise percutaneous placement of afterloading catheters while ensuring safety. Pain was reduced and tumor size was decreased in all three patients. The CT-guided percutaneous insertion of afterloading catheters is a simple yet effective method of providing interstitial radiation therapy for head and neck tumors.

The effect of lead, gold, and silver backings on dose near 125I seeds.

Brachytherapy for ocular melanoma uses 125I seeds backed by a gold shield. Conflicting results are reported in the literature on the effect of the gold on dose close to the seeds. In this work, a small lucite jig was constructed such that the seed-to-detector separation remained fixed as high-Z materials of lead, silver, and gold were moved in and out of position behind the seed. The jig was clamped in place in the water filled tank of a beam scanning system. The response of two p-type silicon diodes was measured at several distances from the seed with and without the high-Z backings. The response with the high-Z backing relative to water, found to be the same for each diode and the same for lead and gold, decreased from about 1.01 at 1.5 mm to about 0.92 at 20 mm. It has been suggested in the literature that L-shell fluorescent x rays of approximately 10 keV from the gold backing might contribute significantly to the dose within 7 mm of the seed. To test this, the response with the gold backing relative to water was measured with an aluminum cap of 1-mm wall thickness covering the diode. The cap transmits about 70% of the 125I influence but is essentially infinitely thick to 10-keV photons. The relative response (gold/water) was the same with and without the cap showing that the contribution of 10-keV x rays is negligible. Compared to water, the silver backing was found to enhance the diode response by about 14% between 5 to 10 mm from the seed.

[Effects of iodized salt in the treatment of endemic goiter in school children in a rural environment in Cameroon]. / Les effets du sel iodé dans le traitement du goitre endémique chez les écoliers en milieu rural au Cameroun.

The efficiency of iodized salt in Cameroon has been tested during 7 months in school children living in an endemic goitrous area. The salt contained 150 mg of iodine per kilogramme of salt when it left the production site. The regression rate of goiter was 84.0% and was not different from that obtained with a single oral administration of 240 mg of iodized oil to an age and sex matched population. Excretion of iodine in urine increased significantly (P < 0.05). Eight biochemical cases of thyroid dysfunction (7 cases of hypothyroidism and 1 case of hyperthyroidism) were observed. However these observations do not preclude the use of iodized salt in the prevention and the treatment of goiter in endemic areas.

Interseed effects on dose for 125I brachytherapy implants.

Dose calculations in multiseed brachytherapy implants are done by adding the contribution of each individual seed and by assuming that radiation from each seed is unaffected by the presence of the other seeds. To test the validity of this assumption, dose measurements with various configurations of multiseed implants of 125I model 6702 and 125I model 6711 sources were performed. For a linear configuration of three 125I model 6702 seeds at 1-cm separation, with their transverse axes coincident, doses at distances of 3.05 and 5.09 cm from the center along the transverse axis were found to be about 8% lower than the sum of doses from the three individual seeds. However, for three seeds at 1-cm intervals with their longitudinal axes coincident, doses at 3.05 and 5.09 cm distances from the center along the longitudinal axis were found to be about equal to the dose sums from individual seeds. These initial experiments indicated that the magnitude of the interseed effect depends upon the orientation of the seed relative to each other in an implant. To evaluate the importance of this interseed effect for multiseed configurations of 125I model 6702 and 125I model 6711 seeds, dose rates at various distances from a two-plane implant (each plane containing a 3 x 3 array of sources in a 1-cm spacing square grid) were measured in a Solid Water phantom with LiF TLDs. These measurements were carried out in two different planes at different orientations relative to the implant. The average values of the interseed effect at distances ranging from 1 to 7 cm outside the implant were observed to be about the same for 125I model 6702 and model 6711 sources. The mean value of the interseed effect was 6% and the maximum was 12%. On the whole, the interseed effect reduces the dose at the periphery of the iodine implant by 6%.

A simple eye-lens shielding technique compatible with independent jaws of a linear accelerator.

A technique, compatible with accelerators having independent collimators, is presented, which greatly simplifies alignment of pencil eye-lens shields. The patient is placed so that the eye to be shielded is on the central axis of the beam and the accelerator's collimators are adjusted independently to define the field. A divergent lead shield 14 cm long is suspended from a wire that hangs along the central axis from a blocking tray in its usual location. The suspension length is variable and adjusted on the first day so that the shield is about 1 cm above the patient's eye. On subsequent treatment days, the wire is simply put in place on the tray with no further adjustment required. This technique reduces setup time and makes the shield positioning highly reproducible.