Research Ethics in Training Curricula of Cameroon Health Training Institutions: A Cross-Sectional Study.

Introduction The quality of protection for research participants in Africa is still marked by the lack of trained actors in this area. The study was conducted to assess the availability of health research ethics in the curricula of health-related sciences training institutions in Cameroon. Methods The study involved a cross-sectional analysis to describe the training curricula on research ethics in health training institutions in Cameroon. Data were collected using a structured questionnaire that was administered face to face to the heads of institutions in late 2020. Results Twenty-one health training institutions were identified, and 18 (85.71%) participated. Health research ethics courses were present in the curricula of 16 (88.88%) of the institutions. Lectures were either a standalone module or part of a module in 14 (77.78%) institutions. The three first topics covered in the courses were the fundamental principles of ethics, the role of the ethics committee in the protection of research participants, and respect for research participants. A total of 14 (77.78%) institutions declared ethical clearance mandatory before the implementation of students' thesis protocols. Eight (50.00%) training institutions declared having at least one qualified lecturer to deliver training in research ethics evaluation. The organization of the training of lecturers in delivering lectures on research ethics was declared to be the main assistance needed. Conclusions The delivery of research ethics education in Cameroon's healthcare institutions is still limited by the fact that it does not cover all eligible populations, is not standardized, and does not yet promote the practice of requiring all student protocols to undergo preethical review prior to implementation. These points should be taken into account by the authorities in charge.

SARS-CoV-2 active infection and antibodies amongst health personnel during the outbreak in Cameroon: Strengthening the health system for response to future public health emergencies.

BACKGROUND: Health personnel (HP) are on the frontlines during response to public health emergencies like COVID-19. This risk of exposure suggests the need for safety in responding to any pandemic. Therefore, to ascertain the rate of SARS-CoV-2 infection and immunity, and their determinants amongst HP become relevant. METHODS: A cross sectional health facility-based study was carried-out amongst HP in the Centre Region of Cameroon from 1st February to 30th June 2021. Characteristics and access to preventive tools were collected using face-to-face administered questionnaire. Nasopharyngeal swabs and whole blood were collected for PCR, IgG and IgM testing respectively. STATA version 17 software was used for data analysis. Determinants of COVID-19 infection were explored by estimating crude and adjusted Odd Ratio. RESULTS: Out of 510 HP reached, 458 were enrolled with mean age of 35 (±10) years. Thirty-four (7.4%) were PCR-positive to SARS-CoV-2 with 73.5% being clinicians versus 9 (26.4%) non-clinicians (p = 0.05). Sero-positivity to SARS-CoV-2 IgG/IgM was 40.2% (184/458), with 84.2% being clinicians versus 29 (15.8%) non-clinicians (p = 0.733). Amongst the 34 HP with PCR-positivity, 16 (47%) had no antibodies, while, 15 (44%) were IgG only. An estimate of HP (43.7%) had at least an evidence of PCR, IgG or IgM contact to COVID-19. Determinants of PCR-positivity was being clinical staff (AOR = 0.29, P = 0.039); and that of IgG/IgM were being non clinical staff (AOR = 0.41, p = 0.018) and regular use of face masks (AOR = 0.44, p = 0.001). HP trained on IPC (24%) were mainly from peripheral level (74.7%, p = 0.002). CONCLUSION: Active infections were within the range of pandemic control (<10%). However, around two-fifths of participants have had contact with the virus, indicating that HP remains a population at risk of COVID-19 and other similarly-transmitted epidemic prone diseases, and also an important source of transmission. There is need of vaccine to achieve protectiveness, and optimal response also requires capacity building to improve the health system when challenged by a future pandemic.

Long-Lasting Insecticidal Net Ownership and Use in Mogode Health District, Cameroon.

BACKGROUND: Cameroon is a malaria-endemic country. Many control strategies including long-lasting insecticidal nets (LLIN) have been proposed to reduce the burden of malaria. The World Health Organization aims to achieve at least 80% of people sleeping under a LLIN. This study assessed the ownership and use of LLNs in the Mogode Health District (MHD). METHODS: A community-based cross-sectional study was conducted in MHD in September 2021. Data on ownership and LLINs use were collected using structured questionnaires following the Roll Back Malaria guidelines. Univariate and multivariate analyses were performed to assess the determinants of ownership and failure to LLIN use. RESULTS:  A total of 332 households were included from eight health areas. The proportion of households with at least one LLIN was 72.0% (238). However, 232 (70.0%) reported having used LLIN (sleeping under LLIN the previous night). Household heads with higher education were six times more likely to have owned LLINs than those with no education (adjusted odds ratio (AOR)=6.8; confidence interval (CI) 1.5, 31.0, p< 0.05). Additionally, household heads between the ages of 36-50 were 4.2 times (AOR= 4.2, CI 1.3-13.8, p< 0.05) likely to fail to use LLINs in households. However, households where heads had secondary education (AOR= 0.2, CI 0.1-0.6, p< 0.05), were negatively associated with failure to use LLINs. CONCLUSION: Ownership and use of LLINs in MHD remain challenging. Therefore, this finding will contribute to improving recommendations and updating strategies such as targeted messages aimed at raising awareness of malaria during mass LLIN distribution campaigns.

Effect of COVID-19 on immunization coverage of children aged 0-11 months in the center region of Cameroon.

The occurrence of epidemics is known to contribute in reducing the capacity of health facilities to deliver care and the predisposition of populations to seek care through several mechanisms. The objective was to assess the effect of the COVID-19 on vaccination coverage of the expanded program of immunization (EPI) vaccines in children aged 0-11 months. The study involved a descriptive and case control designs exhaustively targeting health facilities in health areas from selected health districts. The descriptive part explored the distribution of immunization coverage 12 months before and during COVID-19. Data were extracted from monthly EPI reports of health areas. Cases were months with immunization coverages of Bacille Calmette-Guerin (BCG), Measles Mumps-Rubella 1 (MMR1) or Diphtheria-Pertussis-Tetanus Hepatitis B + Hemophilus influenzae type b dose 3 (DPT-Hi+Hb3) less than 80%. The exposure were months belonging to the pandemic period. Of the 78 targeted health areas, 74 (94.87%) were reached. The monthly immunization coverage of BCG, RR1, DPT-Hi+Hb 1 and 3 decreased during the pandemic period by minimum 30%. Being a health-area month belonging to the COVID-19 pandemic period was found to be significantly associated to lower BCG [OR=2.00 (1.61; 2.50); P#x003C;0.001], MMR1 [OR=2.45 (1.76; 3.41); P#x003C;0.001] and DPT-Hi+Hb3 [OR=2.11 (1.68; 2.640); P#x003C;0.001] immunisation coverage. COVID-19 had a significant effect on the decrease of immunization coverages of antigens offered in the EPI program. This raises the need to develop interventions during health emergencies to prevent disruption of health services access.

Innovative approach in assessing the children's immunization status when it cannot be documented.

During surveys, it is recommended that children immunization status should be based on immunization documents. It has been noted that in some communities, a number of children are claimed to be vaccinated but have no evidence of vaccination. This work is proposed to estimate routine immunization coverage in children based on both documented vaccination and the tracking of undocumented immunization. It was a community-based survey targeting children aged 0-59 months in which the immunization status of children was assessed based on vaccination documents and based on a questionnaire tracking immunization sites and period for children with undocumented vaccination. The vaccination coverage and completeness were estimated from data collected in immunization cards and re-estimated after tracking the immunization status of children with no immunization cards. Of 1435 children reached in households, 1430 (99.7%) were included. Of 1072 children aged 12-59 months, 194 (18.1%) received DPT-Hi+Hb 3 with evidence and 399 (37.2%) with evidence and tracking. In the same age group, the dropout rate from DPT-Hi+Hb 1 (157 doses administered) to DPT-Hi+Hb 3 (127 doses administered) with evidence was 19.1% and 42.4% with evidence and tracking. The tracking of immunization status in children with no evidence of vaccination allows to determine their immunization status and to improve the reliability of the estimated vaccination coverage. This strategy could be adopted to be part of the planning and implementation of vaccination coverage surveys of EPI vaccines.

Chronic diseases and mortality among hospitalised COVID-19 patients at Bafoussam Regional Hospital in the West region of Cameroon.

Reducing mortality among COVID-19 cases is a major challenge for most health systems worldwide. Estimating the risk of preexisting comorbidities on COVID-19 mortality may promote the importance of targeting at-risk populations to improve survival through primary and secondary prevention. This study was conducted to explore the contribution of exposure to some chronic diseases on the mortality of COVID-19. This was a case control study. The data were collected from the records of all patients hospitalised at Bafoussam Regional Hospital (BRH) from March 2020 to December 2021. A grid was used to extract data on patient history, case management and outcome of hospitalised patients. We estimated the frequency of each common chronic disease and assessed the association between suffering from all and each chronic disease (Diabetes or/and Hypertension, immunodeficiency condition, obesity, tuberculosis, chronic kidney disease) and fatal outcome of hospitalised patients by estimating crude and adjusted odd ratios and their corresponding 95% confidence intervals (CI) using time to symptom onset and hospital admission up to three days, age range 65 years and above, health professional worker and married status as confounder's factors. Of 645 included patients, 120(20.23%) deaths were recorded. Among these 645 patients, 262(40.62%) were males, 128(19.84%) aged 65 years and above. The mean length of stay was 11.07. On admission, 204 (31.62%) patients presented at least one chronic disease. The most common chronic disease were hypertension (HBP) 73(11.32%), followed by diabetes + HBP 62 (9.61%), by diabetes 55(8.53%) and Immunodeficiency condition 14(2.17%). Diabetes and Diabetes + HBP were associated with a higher risk of death respectively aOR = 2.71[95%CI = 1.19-6.18] and aOR = 2.07[95% CI = 1.01-4.23] but HBP did not significantly increased the risk of death. These results suggest that health authorities should prioritize these specific group to adopt primary and secondary preventive interventions against SARS-CoV-2 infection.

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.

Assessing Training Needs of Health Personnel on the Process of Selecting Blood Donors and Transfusion in the West Region of Cameroon.

Introduction: Blood transfusion is a health care procedure that can expose the donor and receiver to risks. The knowledge and practices of healthcare personnel on blood transfusion are necessary to anticipate and/or prevent the occurrence of avoidable transfusion risks. The aim of this study was to assess the training needs of health personnel on blood donor selection procedure. Methods: We conducted a cross-sectional study targeting health personnel in health facilities that reported contributing in offering blood transfusion services in the West region of Cameroon between March and May 2022. A questionnaire administered face to face was used to collect data from the targeted health personnel exhaustively included from health facilities. Knowledge and practices were assessed by estimating the rate of correct answers. STATA software was used to analyze the data. Results: Of the 41 health facilities that reported offering blood transfusion services, 35 (85.3%) were covered. Category 5 and 4 health facilities were respectively 23 (65.7%) and 9 (25.7%). Among the 325 health personnel involved in transfusion, 302 (92.9%) were reached among which, 201 (66.6%) were female and 127 (42.1%) were nurses. Two hundred and ten (69.5%) had already received training on blood transfusion and 268 (88.7%) expressed a need for training on blood transfusion of which 139 (51.8%) on blood donors' selection. Sixteen (5.3%) knew how to identify blood donor and 116 (38.4) knew the minimum required tests to be performed on the donors' blood before the transfusion. Six (2.0%) out of 302 health personnel were able to select blood donors and identify minimum tests to be performed on donors' blood. Conclusion: There is a real need for training of health personnel on the blood donor selection process. Health authorities should ensure that all health personnel involved in blood transfusion receive a minimum of training in blood donor selection and testing.

An Age-stratified, Randomized Immunogenicity Trial of Killed Oral Cholera Vaccine with Delayed Second Dose in Cameroon.

The recommended schedule for killed oral cholera vaccine (OCV) is two doses, 2 weeks apart. However, during vaccine campaigns, the second round is often delayed by several months. Because more information is needed to document antibody responses when the second dose is delayed, we conducted an open-label, phase 2, noninferiority clinical trial of OCV. One hundred eighty-six participants were randomized into three dose-interval groups (DIGs) to receive the second dose 2 weeks, 6 months, or 11.5 months after the first dose. The DIGs were stratified into three age strata: 1 to 4, 5 to 14, and > 14 years. Inaba and Ogawa vibriocidal titers were assessed before and after vaccination. The primary analysis was geometric mean titer (GMT) 2 weeks after the second dose. Data for primary analysis was available from 147 participants (54, 44, and 49 participants from the three DIGs respectively). Relative to the 2-week interval, groups receiving a delayed second dose had significantly higher GMTs after the second dose. Two weeks after the second dose, Inaba GMTs were 55.1 190.3, and 289.8 and Ogawa GMTs were 70.4, 134.5, and 302.4 for the three DIGs respectively. The elevated titers were brief, returning to lower levels within 3 months. We conclude that when the second dose of killed oral cholera vaccine was given after 6 or 11.5 months, vibriocidal titers were higher than when given after the standard period of 2 weeks. This provides reassurance that a delayed second dose does not compromise, but rather enhances, the serological response to the vaccine.

Training needs of health researchers in research ethics in Cameroon: a cross-sectional study.

BACKGROUND: Researchers are responsible for the protection of health research participants. The purpose of this study was to identify and prioritize the training needs of researchers involved in human health research in Cameroon. METHODS: It was a cross-sectional study conducted in all the Cameroon regions in the last quarter of 2020. It targeted researchers involved in human health research selected by systematic stratified sampling from health and training institutions, and health facilities. Data were collected using a face-to-face administered questionnaire deployed in Smartphones via the ODK-collect. The distribution of participants' exposure to research ethics training was described as well as their knowledge on the related regulatory texts. A score was used to rank the training needs identified by the participants. RESULTS: Of 168 reached participants, 134 (79.76%) participated in the study. A total of 103 (76.87%) researchers reported having received training in human health research ethics and 98 (73.13%) perceived need of training in research ethics. Of those involved in clinical, vaccine, and field trials, 63.64, 33.33, 52.53% have been exposed respectively to related training regarding participants' protection. Having received at least one training in research ethics significantly increase the proportion of researchers systematically submitting application for ethical evaluation prior to implementation (OR = 3.20 (1.31-7.78)). Training priorities identified by researchers include: guidelines and regulations on health research ethics and research participant's protection in Cameroon, procedures for evaluating research protocols, protection of research participants in clinical trials, and fundamental ethics principles. CONCLUSION: The coverage of researchers in training regarding research participant protection remains limited in a number of areas including those related to clinical trial participant protection and research participant protection in Cameroon. Improving this coverage and addressing perceived needs of researchers are expected to contribute in improving their ability in playing their role in research participant protection.

Mortality among hospitalized COVID-19 patients in the West Cameroon Regional Hospital.

Introduction: despite its relatively low case-fatality rate, COVID-19 is a concern with high mortality and morbidity of hospitalized cases. This study was conducted to assess the relationship between time to consultation, presence of respiratory complications at hospital admission and fatal outcome of COVID-19 cases. Methods: this was a case control study with data collected from records of all patients admitted in the Bafoussam Regional Hospital (BRH) from March 2020 to April 2021. Cases were patients with a fatal outcome and controls were patients that were discharged. The association between the delay in seeking care, dyspnea and blood oxygen level at admission, and fatal outcome was assessed by estimating crude and adjusted odd ratio. Results: of 400 included patients, 239 (59.75%) were male, 84 (23.73%) health professionals and 144 (36.0%) aged 64 years and above. On admission, 236 patients presented at least one sign of respiratory complication. The mean duration of hospitalization was 11.4 days and 120 (30.0%) admitted patients died. Seeking care before the end of the first day of symptom onset (adjusted (A) OR=0.44 [0.21-0.97]) or within the first three days (AOR=0.48 [0.26-0.89]) significantly reduced the risk of fatal outcome, whereas waiting seven days (AOR=0.74 [0.42-1.33]) did not change this risk. Presenting dyspnea (AOR=2.39 [1.32-4.31]) or blood oxygen level <95% (AOR=3.67 [1.37-9.83]) significantly increased the risk of fatal outcome. Conclusion: mortality was one in three patients. Early arrival at the hospital helped to reduce the risk of mortality unlike presenting respiratory complication that increased the risk. Health interventions contributing for early detection and link of COVID-19 cases to care before respiratory complications occur are expected to reduce mortality in COVID-19 patients.

Tracking Demographic Movements and Immunization Status to Improve Children's Access to Immunization: Field-Based Randomized Controlled Trial.

BACKGROUND: Countries' Expanded Program on Immunization (EPI) contribute to the reduction of mortality and morbidity, but access to these vaccines remains limited in most low-income countries. OBJECTIVE: We aim to assess whether involving community volunteers (CVs) to track children's vaccination status and demographic movements and using recorded data to plan catch-up immunization sessions can improve children's vaccination timeliness, completeness, and coverage. METHODS: This was a field-based randomized controlled trial and communities of the Foumban health district in West Cameroon were allocated to intervention or control groups. In the intervention group, a CV per community was trained to visit households monthly for a year to assess and record in a register, details of EPI-targeted children, their demographic movements and immunization status. The scanned recorded pages were sent to the health center immunization team through WhatsApp and used to organize monthly community catch-up immunization sessions. In the control group, EPI vaccination sessions were routinely conducted. Surveys were conducted at 6 and 12 months from the beginning of the intervention in both study groups to assess and compare immunization timeliness, coverage, and completeness. RESULTS: Overall, 30 buildings per cluster were surveyed at midline and endline. Of the 633 and 729 visited households in the intervention group at midline and endline, 630 (99.5%) and 718 (98.4%), respectively, consented to participate. In the control group, 507 and 651 households were visited and 505 (99.6%) and 636 (97.7%), respectively, consented to participate. At 12 months intervention, the month one timeliness of bacille Calmette-Guerin (BCG) vaccine did not increase in the intervention group compared with the control group for the age groups 0-11 months (adjusted odds ratio [aOR] 1.1, 95% CI 0.7-1.8) and 0-59 months (aOR 1.1, 95% CI 0.9-1.4), and significantly increased for the first-year BCG vaccine administration for the age group 0-23 months (aOR 1.5, 95% CI 1.1-2.2). The coverage of diphtheria-pertussis-tetanus and hepatitis B+Hemophilus influenzae type B (DPT-Hi +Hb) dose 3 (aOR 2.0, 95% CI 1.5-2.7) and of DPT-Hi+Hb dose 1 (aOR 1.8, 95% CI 1.4-2.4) vaccines increased significantly in the intervention group compared with the control group in the age groups 12-59 months and 12-23 months, respectively. Specific (DPT-Hi+Hb dose 1 to DPT-Hi+Hb dose 3: aOR 1.9, 95% CI 1.4-2.6) and general (BCG to measles: aOR 1.5, 95% CI 1.1-2.1) vaccine completeness increased significantly in the intervention group compared with the control group. CONCLUSIONS: Findings support that involving CVs to track children's vaccination status and demographic movements and using recorded data to plan catch-up immunization sessions improve children's vaccination timeliness, completeness, and coverage. This strategy should be adopted to improve access to vaccination for EPI target populations and the consistency verified in other contexts. TRIAL REGISTRATION: Pan African Clinical Trials Registry PACTR201808527428720; https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=3548.

An innovative approach in monitoring oral cholera vaccination campaign: integration of a between-round survey.

BACKGROUND: Monitoring and Evaluation (M&E) is essential in ensuring population's access to immunization. Surveys are part of this M&E approach but its timing limits the use of its results to improve the coverage of the evaluated campaign. An oral cholera vaccination campaign was organized in a health district of the Far North region of Cameroon and involved an innovative M&E approach. The aim of this project was to assess the feasibility and effect of using recommendations of a community-based immunization and communication coverage survey conducted after the first round of an OCV campaign on the coverage of the second-round of the campaign. METHODS: Two community-based surveys were included in the M&E plan and conducted at the end of each of the campaign rounds. Data were collected by trained and closely supervised surveyors and reported using smartphones. Key results of the first-round survey were disseminated to campaign implementing team prior to the second round. The two rounds of the pre-emptive campaign were organized by the Cameroon Ministry of Public Health and partners with a two-week interval in the Mogode Health District of the Far North region of Cameroon in May and June 2017. RESULTS: Of 120 targeted clusters, 119 (99.1%) and 117 (97.5%) were reached for the first and second rounds respectively. Among the Mogode population eligible for vaccination, the immunization coverage based on evidence (card or finger mark) were estimated at 81.0% in the first round and increased to 88.8% in the second round (X2=69.0 and p <0.00). For the second round, we estimated 80.1% and 4.3% of persons who were administered 2 doses and 1 dose of OCV with evidence respectively, and 3.8% of persons who have not been vaccinated. The distribution of campaign communication coverage per health area was shared with the campaign coordination team for better planning of the second round campaign activities. CONCLUSIONS: It is feasible to plan and implement coverage survey after first round OCV campaign and use its results for the better planning of the second round. For the present study, this is associated to the improvement of OCV coverage in the second-round vaccination. If this is persistent in other contexts, it may apply to improve coverage of any health campaign that is organized in more than one round.

Drug Safety Monitoring in Health Programs of Cameroon.

Background: Data are needed to serve as evidence in planning the strengthening of pharmacovigilance in health programs administering drugs to populations. The present study was proposed to map the distribution of pharmacovigilance units in health programs, assess the availability of key resources, the implementation of key pharmacovigilance activities and identify needs of involved actors. Methods: It was a cross sectional descriptive study targeting all health programs of the Cameroon Ministry of Public Health administering drugs/vaccines to the population. Data were collected using semi structured questionnaire administered face to face to key persons in charge of drug safety monitoring or drug management in health programs. Results: Out of the 09 health programs involved in drug distribution, 07 consented to participate. Five out of them (71.4%) claimed to have existing pharmacovigilance units. Office space, computers, operating budget, data analysis software and a trained staff were available in 28.6%, 42.9%, 42.9%, 14.3%, 00.0%, and 42.9% of the health programs respectively. One of the 7 health programs (14.3%) declared conducting detection/notification of adverse events following exposure drugs, 2 (28.6%) conduct causality assessment and 3 (42.8%) conduct analysis of pharmacovigilance data. All health programs proposed to prioritize the allocation of budget and qualified personnel and the training of existing personnel as key interventions to improve drugs/vaccines safety monitoring in health programs. Conclusion: The study reports limited coverage of Cameroon health programs with activities leading to drugs and vaccine safety monitoring. Suggested actions have to be taken into account when attempting to improve the situation.