Prevalence and causes of blindness and visual impairment in Muyuka: a rural health district in South West Province, Cameroon.

AIM: To estimate the prevalence and causes of blindness and visual impairment in the population aged 40 years and over in Muyuka, a rural district in the South West Province of Cameroon. METHODS: A multistage cluster random sampling methodology was used to select 20 clusters of 100 people each. In each cluster households were randomly selected and all eligible people had their visual acuity (VA) measured by an ophthalmic nurse. Those with VA <6/18 were examined by an ophthalmologist. RESULTS: 1787 people were examined (response rate 89.3%). The prevalence of binocular blindness was 1.6% (95% CI: 0.8% to 2.4%), 2.2% (1.% to 3.1%) for binocular severe visual impairment, and 6.4% (5.0% to 7.8%) for binocular visual impairment. Cataract was the main cause of blindness (62.1%), severe visual impairment (65.0%), and visual impairment (40.0%). Refractive error was an important cause of severe visual impairment (15.0%) and visual impairment (22.5%). The cataract surgical coverage for people was 55% at the <3/60 level and 33% at the <6/60 level. 64.3% of eyes operated for cataract had poor visual outcome (presenting VA<6/60). CONCLUSIONS: Strategies should be developed to make cataract services affordable and accessible to the population in the rural areas. There is an urgent need to improve the outcome of cataract surgery. Refractive error services should be provided at the community level.

High-grade intra-epithelial neoplasia and prostate cancer in Dibombari, Cameroon.

High-grade prostatic intra-epithelial neoplasia (HGPIN) occurs a decade earlier in men of African descent in the US and Brazil, compared to white men. Prostate cancer incidence and mortality is worse in the African-American than in US white men. Sub-Saharan Africa was thought to be a low incidence area. This disparity has been attributed to lifestyle factors such as diet. We report the results of prostatic biopsies, from an ongoing national prostate cancer survey. One hundred and eleven men aged 40 y and over were recruited for medical interview (AUA symptom score), prostate specific antigen (PSA) assay and digital rectal examination (DRE). Between six and 10 cores of random digitally guided needle biopsies were performed on 24 subjects that had either suspicious prostates on digital rectal examination +/ or PSA > or =4 ng/ml. All lesions of the prostate were described on routine histopathology. The Gleason score and proportion of tissue involved with cancer, was determined. Eight men had benign prostatic hyperplasia (BPH), six had cancer, another six had low grade intra-epithelial neoplasia, two had HGPIN, there was one case of BPH and chronic prostatitis and one case of chronic prostatitis only. The cancer patients were aged 58-75 y (mean 66.93 y). Gleason scores ranged from 5 to 9, there was one score of 3. Cancer made up 20-80% tissue samples. HGPIN was found in two cases (mean age 58 y). Significant prostate cancer and the pre-cancerous lesion HGPIN exist in Dibombari, Cameroon. The purported low incidence of prostate cancer may reflect cultural and economic barriers to health care.

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.

Age at menarche and urbanization in Cameroon: current status and secular trends.

Status quo data on the age at menarche were obtained on samples of Cameroonian girls living in urban (Yaoundé) (n = 205), suburban (n = 505) and rural areas (n = 201). Mean ages at menarche, estimated by probit analysis, are 13.18 years (SD 1.08) in Yaoundé, 13.98 years (SD 1.55) in the suburban area, and 14.27 years (SD 1.65) in the rural area. The early menarcheal age observed in Yaoundé girls attending 'privileged schools' (12.72 years, SD 1.18) substantiates the hypothesis that in good environmental conditions Africans are as early-maturing as Asiatic or Mediterranean populations. Comparison with retrospective data on age at menarche during previous decades reveals the presence of a clear secular trend towards earlier maturation, at a rate of 2.5-3.2 months per decade, only in the main cities of the country (Yaoundé/Douala) and a lack of temporal variation in rural areas. The degree of urbanization influences maturational age and its evolution, probably through improvements in the nutritional standards.

PIP: "Status quo data on the age at menarche were obtained on samples of Cameroonian girls living in urban (Yaounde) (n=205), suburban (n=505) and rural areas (n=201).... Comparison with retrospective data on age at menarche during previous decades reveals the presence of a clear secular trend towards earlier maturation, at a rate of 2.5-3.2 months per decade, only in the main cities of the country (Yaounde/Douala) and a lack of temporal variation in rural areas. The degree of urbanization influences maturational age and its evolution, probably through improvements in the nutritional standards." (EXCERPT)

Rapid assessment of drug abuse in Cameroon.

The present paper describes a rapid assessment that was carried out in Cameroon from March to November 1994 and presents a summary of the findings and recommendations. It was the first rapid assessment study conducted by Cameroon in collaboration with the Economic Community of Central African States, with technical assistance from the World Health Organization and the support of the United Nations International Drug Control Programme. It was hoped that the study would help to fill gaps in the information available on drug abuser profiles, the types of drugs abused and the response of the community to drug abuse in Cameroon. In focus group discussions, key informant interviews and interviews with drug abusers, it was revealed that Cameroon was not only used by drug traffickers as a transit country, but was also a drug-consuming country. The drug consumers were both males and females from all age groups. The drugs consumed ranged from traditional drugs to imported cocaine and heroin. Cannabis was the most frequently consumed drug, followed by amphetamine-type tablets and a broad range of pharmaceuticals. Solvents were mainly consumed by street children in northern Cameroon. Local beer and gin also held a special place in society. In order to tackle the existing problems, programmes offering preventive education and alternative forms of recreation for youth were necessary, and national policies on demand and supply reduction should be harmonized.

Impact of Schistosoma haematobium infection and of praziquantel treatment on anaemia of primary school children in Bertoua, Cameroon.

There is some debate as to the extent to which Schistosoma haematobium haematuria may be the cause of anaemia. Our goal was to evaluate the impact of a single 40 mg kg-1 dose of praziquantel on anaemia. Since praziquantel does not reduce the hookworm intensity of infection (a major cause of anaemia in children in the area) changes in the prevalence of anaemia in the study population should be due only to the elimination of S. haematobium. Seven hundred and seventy-one primary schoolboys from Bertoua (East Cameroon) were divided into four groups: high infection, moderate infection treated with praziquantel or placebo, and non-infected. Haemoglobin concentrations of the children were determined at the onset of the study and 6 months after the praziquantel intervention. Mean haemoglobin concentrations were not significantly different for no infection or for mild or heavy infection by S. haematobium. A factorial analysis of variance using S. haematobium intensity of infection, malaria and intestinal parasite infections and age as independent variables and haemoglobin concentration as the dependent variable show that only age and malaria infection show a significant relationship with haemoglobin concentration. Despite treatment with praziquantel, all the children in the treatment groups had lower mean haemoglobins 6 months after intervention. A factorial analysis of variance using age, malaria infection and the treatment category as independent variables and the difference in haemoglobin concentration as the dependent variable shows that only malaria infection showed a significant relationship with haemoglobin concentration.(ABSTRACT TRUNCATED AT 250 WORDS)

The impact of Schistosoma haematobium infection and of praziquantel treatment on the growth of primary school children in Bertoua, Cameroon.

Our objective was to determine in a Cameroonian school population the effect of mild to moderate S. haematobium infection intensity on growth and development of children before and 6 months after praziquantel treatment. Previous studies have yielded contradictory results. Children from Bertoua schools were divided into four study groups: heavily infected (> 500 eggs 10 ml-1), moderately infected (1-499 eggs 10 ml-1) treated with praziquantel, a similar group treated with placebo, and an uninfected control group. Anthropometric measures--height for age per cent median (HAPM), and weight for age per cent median (WAPM)--were significantly higher among the uninfected children. Stepwise regression analysis showed that S. haematobium and Ascaris infections were the strongest predictors of the HAPM with hookworm and malaria infections playing a lesser role. Post treatment comparison of the praziquantel treatment group and the placebo group showed no significant differences for the anthropometric indicators except for mid-arm circumference. Longer observations of growth after treatment as well as monitoring of the rate of reinfection would be necessary to understand better the effect of S. haematobium on growth.

The impact of Schistosoma haematobium infection and of praziquantel treatment on the growth of primary school children in Bertoua, Cameroon

The association between urinary schistosomiasis and anaemia among infected children remains controversial. The purpose of this study was to determine the impact of schistosoma haematobium infection and treatment with praziquantel on hemoglobin levels among male children aged 6-15 years in Bertoua. Urine examination of 2665 children revealed an infection rate of 23.9 per cent. Children with moderate infection were randomly selected into treatment (238) and placebo (198) groups. Among uninfected children; 174 were randomly selected to serve as controls. Malaria; geohelminth infections and hemoglobin levels were determined before and six months after praziquantel/placebo intervention

Mannan as an antigen in cell-mediated immunity (CMI) assays and as a modulator of mannan-specific CMI.

Mannan (MAN) extracted from Candida albicans 20A was investigated for its potential as an antigen in the detection of cell-mediated immunity (CMI) in vivo and in vitro and for its ability to modulate CMI when administered intravenously (i.v.). CBA/J mice were either immunized as adults by the cutaneous inoculation of 10(6) viable blastoconidia or colonized as infants (primed) and then boosted cutaneously as adults. When immunized animals were footpad tested with MAN, highly significant delayed-type hypersensitivity (DH) responses were detected. The DH responses to MAN were of a greater magnitude than those noted with the same quantity of cell wall glycoprotein (GP), an ethylenediamine extract of the cell wall which contains both glucan and MAN. In contrast, GP was a better antigen for the detection of CMI responses in an in vitro lymphoproliferative assay with either spleen or lymph node cell suspensions. Mice treated with MAN i.v. prior to the initiation of immunization or between priming and secondary inoculations developed significantly suppressed DH reactions when tested with either MAN or GP. The lowest effective dose of MAN was 250 micrograms, maximum suppression occurred with 500 micrograms, and either dose given 1 week prior to immunization was suppressive. The suppression by MAN was specific for MAN or the MAN-containing GP. Responses to another unrelated candidal antigen, a membrane extract designated BEX, were relatively unaffected. MAN, therefore, was an effective antigen for the detection of CMI in vivo, and its administration i.v. created what appeared to be a MAN-specific suppression since it could be detected with both MAN and a MAN-containing extract from the cell wall. Caution must be exercised in the interpretation of these data, however, since the protein component of each of these extracts has not been characterized with respect to its potential role in the phenomena observed.

Drug abuse among women

Drug abuse is a problem in Cameroon which has not been looked into depth in as it should be. The extent of drug abuse is immense involving children; women and men. The most common drugs used are licit drugs; such as tobacco; which is grown as a cash crop and used in the cigarette industry of the country; palmwine (alcohol); from the oil palm tree or raffia palm tree; commonly called white wine; matango; or palm tree mimbo; or distilled alcoholic drinks extracted from white wine; cocoa; corn; cassava; ripe plantain; beers made by licensed breweries and imported wines and distilled alcoholic drinks

Carence en iode et reproduction chez les femmes de l'Adamaoua

La malnutrition est aggravee par les deficiences en oligo-elements et l'une des formes les plus connues est la carence en iode qui donne des troubles divers. Cette carence atteint environ 160 millions de personnes en Afrique contre 300 millions en Chine; 200 millions en Inde; 100 millions en Indinesie; 60 millions en Amerique et quelques millions de cas en Europe. Les troubles dus a la carence en iode (TDCI) sont un probleme general qui touche 12de la population mondiale. Au Cameroun; l'enquete nationale sur les TDCI montre que 6 millions de personnes sur 11 millions sont atteintes; de meme que toutes les 10 provinces mais a des taux differentes de prevalence. Ainsi une forte endemicite est signalee a l'Extreme-Nord (Doukoula 75); au Nord-Ouest (64a Oshie et 59a Jakiri); dans l'Adamaoua (45dans Vina); dans Ouest (58dans le Noun) et une endemicite moindre dans l'Est (14a Batouri)