Comparison on treatment outcomes of patients enrolled on anti-retroviral therapy at different levels of the health-care system in a high HIV/AIDS setting.

HIV/AIDS prevalence in Botswana is amongst the highest in the world and remains a significant public health problem. however, the introduction of anti-retroviral therapy (ART) lead to a significant reduction in morbidity and mortality. Decentralization of anti-retroviral therapy has improved access to treatment for people living with HIV. Treatment outcomes for patient initiated on treatment at different levels of care is unknown and this study seeks to compare treatment outcomes of patients enrolled on ART at different levels of the health care. This is a retrospective cross-sectional study that included review of data from January 2017 to December 2018. The study was conducted in 2 health districts in the country. Nine hundred and sixty (960) patient's record were included in analysis. More than half (63%) of patients were enrolled at primary care level while 37% were at tertiary level. Sixty one percent (n = 587) were female while 39% (n = 373) were males. There were no statistically significant differences in viral load suppression after 12 months of treatment between patients enrolled at tertiary level and primary care level, x2 = 0.75, p value = 0.56. Time to initiation was longer at tertiary (median = 126) compared to primary are level (median = 18), p < 0.001. We reccommend further decentralization of ART services to lower levels of the health care system to initiate PLWHIV early on treatment and improve their health outcomes and reduce transmission through treatment by prevention.

Characterizing factors influencing adherence to surgery and chemotherapy amongst women suffering from breast cancer in Mbingo Baptist Hospital Cameroon.

Introduction: Breast cancer (BC) is the most prominent cancer in females and is cited as a leading cause of cancer-related mortality in women worldwide. We aimed to determine factors influencing adherence to surgery and chemotherapy in women with BC in Mbingo Baptist Hospital (MBH). Methods: we conducted a cross-sectional study in the MBH-Cameroon. Purposeful sampling was used to select participants for investigation. A structured questionnaire was applied to 82 women on chemotherapy in the oncology unit. Socio-demographic, clinical, and therapeutic data were collected from participants. The Morisky Medication Scale (MMS) was used to assess the patient's motivation and knowledge while the Adherence Starts with Knowledge (ASK12) questionnaire was used to measure the patient's barriers to treatment. SPSS was used for data analysis. Results: the mean age was 46.37 (SD 11 years). Most participants (67.1%) were in the group of (25-50 years). The majority (75.6%) of respondents attended at least primary school. The results showed that adherence to surgery and chemotherapy is low 44% and 56.1% respectively, and this was greatly influenced by treatment delay (P = 0.034), missed chemotherapy dose without medical indication (P=0.029), patient's motivation, and knowledge towards their disease and treatment (P=0.0001 and P=0.0001), respectively. Conclusion: our results revealed that adherence to surgery and chemotherapy among women with BC in MBH is low and is driven by the patient´s motivation, knowledge about the disease, and treatment.

Evaluation of quality of life and associated factors among HIV patients on antiretroviral therapy in North West region of Cameroon.

BACKGROUND: There is evidence that Quality of Life (QoL) of People Living with HIV/AIDS (PLHIV) has a significant role in ART retention, treatment adherence, and survival. As a result, QoL is becoming increasingly important for policymakers, program implementers, and researchers. However, factors associated with QoL, in a culturally diverse country like Cameroon are unknown. OBJECTIVE: We aimed to assess the QoL of PLHIV on ART and assess the extent to which physical, psychosocial, environmental, and spiritual factors drive QoL. METHOD: A cross-sectional study was conducted among 394 PLHIV aged >21 in North-West Cameroon from April to July 2019. Data were collected using WHO-QOL BREF questionnaire. Descriptive statistics, bivariate, and multivariate linear regression analyses were performed. RESULTS: Majority (34.5%) of participants were in the age range of 41-50, with 73% females. The average QoL of the respondents was "good" with mean score of 3.57 on 5 and 71.4% agreed to have satisfactory QoL. Bivariate regression analyses revealed that all six proposed predictors were significantly associated with QoL. Psychological factors made the greatest impact (ß = 0.213; p<0.003), followed by physical factors (ß = 0.19; p<0.001). CONCLUSION: PLHIV fairly agreed to have good QoL. The QoL was driven by mainly psychological and physical factors and not level of independence. However, the mean score perceptions for the investigated domains were low. Mental health services should consider these predictors when designing strategies to improve the QoL of PLHIV. While this study provides useful insights, other possible drivers of QoL among PLHIV should be investigated.

Predictors of antiretroviral therapy interruptions and factors influencing return to care at the Nkolndongo Health District, Cameroon.

BACKGROUND: Antiretroviral therapy is a lifelong commitment that requires consistent intake of tablets to optimize health outcomes, attain and maintain viral suppression. OBJECTIVE: We aimed to elicit predictors of treatment interruption amongst PLHIV and identify motivating factors influencing return to care. METHOD: We conducted a cross-sectional study using a mixed-method approach in four hospitals in Yaoundé. Sociodemographic and clinical data were collected from ART registers. Using purposeful sampling, thirteen participants were enrolled for interviews. Quantitative data were analyzed using Epi-Info and Atlas-TI for qualitative analysis. Ethical clearance approved by CBCHS-IRB. RESULTS: A total of 271 participants records were assessed. The mean age was 33 years (SD±11years). Private facilities CASS and CMNB registered respectively 53 (19.6%) and 14 (5.2%) participants while CMA Nkomo and IPC had 114 (42.1%) and 90 (33.2%) participants. Most participants (75.3%) were females [OR 1.14; CI 0.78-1.66] compare with males. 78% had no viral load test results. Transport cost and stigmatization constituted the most prominent predictors of treatment interruption (47.5%) and (10.5%) respectively. Belief in the discovery of an eminent HIV cure and the desire to raise offspring motivated 30% and 61%, respectively to resume treatment. CONCLUSION: Structural barriers like exposed health facility, and dispensing ARVs in open spaces stigmatizes clients and increases odds of attrition. Attrition of patients on ART will be minimized through implementation of client centered approaches like multiplying proxy ART pick points, devolving stable clients to community ARV model.

Acute respiratory infection related to air pollution in Bamenda, North West Region of Cameroon.

INTRODUCTION: Air pollution is a global health problem. It's responsible for over 4 million deaths each year and constitutes a risk factor for acute respiratory infections (ARI). The aims of this study was to assess knowledge about air pollution, and to determine environmental risk factors associated with ARIs occurence in the city of Bamenda, Cameroon. METHODS: We conducted a cross sectional study and performed a rectrospective analysis of ARI consultation within the period March 2016 to July 2016 in the Bamenda Health District. We interviewd 201 patients and recorded 1849 cases from hospital registers of patients diagnosed ARI from January 2013 to April 2016. Epi-info 7.2 was used for data entry and analysis. Logistic regression analysis was conducted to determine the importance of the different environmental risk factors. RESULTS: Over 70% of the participants used at least a form of solid fuel for cooking. The Odds of developing an ARI was 3.62 greater among those exposed to indoor cooking compared to the unexposed (OR 3.62, CI 1.45-4.90). Participants exposed to open fire burning were 1.91 times more like to develop ARI compared to unexposed (OR: 1.91, CI 1.03-3.55: p : 0.03). Particulate Matter (PM 2.5) levels was 13.2 times higher than the World Health Organization (WHO) recommended levels. Dry and dusty weathers increased the risk of ARIs (OR 3.24; CI 1.47-7.13). The prevalence of ARIs in the Bamenda Health District was 6% of all consultations. CONCLUSION: Using solid fuels in poorly ventilated homes increase the total air particle suspension indoor. Inhalling this poor air irritates the repiratory tract, eyes while longterm exposure increases the odds of cancers. Ventilating homes with indoor cooking space reduces exposure while using clean fuels like electricity reduces the odds of ARI associated with pollution.