Mapping water sources and access to drinking water in the Lake Chad region of Cameroon: a cross-sectional study.

Introduction: people's access to quality water resources significantly improves their health. In Cameroon, access to drinking water is still limited and unequally distributed over the national territory with alarming figures in the northern part of the country. This study aimed to assess the distribution of water points and characterise water storage and treatment practices in households of the Lake Chad region of Cameroon. Methods: we conducted a cross-sectional descriptive study in Goulfey, Mada, and Makary health districts of the Far North Region of Cameroon from December 2013 to February 2014. Data were collected in face-to-face interviews with a structured questionnaire to assess household water behaviour and an observational grid for the characterisation of water points. Results: we identified a total of 303 water points, out of which 288 were assessed. Of these, 29.5% (85/288) were non-functional with functional failure observed as the main reason (47.6%). Of the 531 households reached, 527 (99.2%) were interviewed. Most households (70.2%) used boreholes as their main water source and only 3% of households used lakes as drinking water. The majority of households (90.4%) used clay pots for water storage within their homes. Buckets with covers are used in 21 (4.0%) while only 1 (0.2%) household used buckets without covers. Only 138 (26.2%) households treat their water and the main treatment method used is chlorination (89.1%). Conclusion: this study provides further evidence that access to safe water remains a real problem in the Lake Chad Basin. Therefore, interventions are needed to address the problem, but further studies are needed to strengthen its implementation.

Characterization of Enteric Disease in Children by Use of a Low-Cost Specimen Preservation Method.

Diarrhea is a leading cause of death in children under five. Molecular methods exist for the rapid detection of enteric pathogens; however, the logistical costs of storing stool specimens limit applicability. We sought to demonstrate that dried specimens preserved using filter paper can be used to identify diarrheal diseases causing significant morbidity among children in resource-constrained countries. A substudy was nested into cholera surveillance in Cameroon. Enrollment criteria included enrollment between 1 August 2016 and 1 October 2018, age of <18 years, availability of a stool specimen, and having three or more loose stools within 24 h with the presence of dehydration and/or blood. A total of 7,227 persons were enrolled, of whom 2,746 met enrollment criteria and 337 were included in this analysis using the enteric TaqMan array card. Bacterial pathogens were compared to severity of diarrhea, age, and sex, among other variables. One hundred seven were positive for enterotoxigenic Escherichia coli, of which 40.2% (n = 43) had heat-labile enterotoxin (LT) and the heat-stable enterotoxin STh, 19.6% (n = 21) had LT and the heat-stable enterotoxin STp, and 49.5% (n = 53) had LT only. Major colonization factors (CFs) were present in 43.9% of enterotoxigenic E. coli (ETEC)-positive patients. Ninety-six were positive for Shigella, of whom 14 (14.6%) reported dysentery. Model-derived quantitative cutoffs identified 116 (34.4%) with one highly diarrhea-associated pathogen and 16 (4.7%) with two or more. Shigella and rotavirus were most strongly associated with diarrhea in children with mixed infections. Dried-filter-paper-preserved specimens eliminate the need for frozen stool specimens and will facilitate enteric surveillance and contribute to the understanding of disease burden, which is needed to guide vaccine development and introduction. This study confirms rotavirus, Shigella, and ETEC as major contributors to pediatric diarrheal disease in two regions of Cameroon.

Tracking Demographic Movements and Immunization Status to Improve Children's Access to Immunization (TDM-IAI): Protocol for a Field-Based Randomized Controlled Trial.

BACKGROUND: In Cameroon, the coverage, completeness, and timeliness of the Expanded Programme on Immunization (EPI) vaccines administration in children have remained heterogeneous and below the national and districts targets in several districts. In an effort to solve this problem, many interventions have been tested but none has shown significant improvement of the situation. OBJECTIVE: This trial aims to test whether involving Community Volunteers to assess children vaccination status and demographic movements and using recorded data to plan catch-up immunization sessions can improve children vaccination timeliness, completeness and coverage. METHODS: Communities of the Foumban Health district, West region of Cameroon will be selected and assigned to either intervention or control groups using a restricted randomization of 2. In the intervention group, one Community Volunteer per community will be trained to visit households and record EPI-targeted children in a register, record their demographic movements, and assess their immunization status monthly for a year. The information recorded will be snapped and sent to the competent health center immunization team through WhatsApp. These will be used to plan and implement monthly community catch up immunization sessions in collaboration with the community volunteer. In the control group, the routine immunization sessions will be conducted with health centers organizing either weekly vaccination sessions for communities situated not farther than 5 kilometers away from the health facility or monthly vaccination sessions in communities situated more than 5 kilometers away from the health center. Baseline, mid-term and end-line surveys will be conducted to assess and compare immunization coverage, timeliness, and completeness. RESULTS: Funded in 2018, data collection started in 2018 and has been completed. Data analysis and reporting are ongoing. CONCLUSIONS: This trial is expecting to test an innovative approach to improving children's immunization timeliness, completeness and coverage of immunization by tracking EPI targeted population vaccination status and denominator at household level and building collaboration between the community and health facilities vaccination teams to organize monthly community-based response vaccination sessions. This intervention is expected to improve children sustainable access to EPI vaccination as it offers assessing and responding to their immunization needs at monthly basis using low cost local human resources. TRIAL REGISTRATION: Pan African Clinical Trials Registry ID PACTR201808527428720; tinyurl.com/u058qnse. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/21734.