Undernutrition among under-five indigenous Mbororo children in the Foumban and Galim health districts of Cameroon: a cross-sectional study.

INTRODUCTION: despite increasing research interest on Indigenous peoples´ health worldwide, the nutritional status of Indigenous children in Cameroon remains unknown. This study was conducted to assess the prevalence of stunting, wasting, and underweight among under-five Indigenous Mbororo children in the Foumban and Galim health districts of the West Region. METHODS: a cross-sectional study was conducted involving 472 child-caregiver pairs from 16 Mbororo Communities in the Foumban and Galim health districts. Interviewer-administered questionnaires were used for data collection. Anthropometric measurements were collected using standard procedures. Socio-demographic data were analyzed using descriptive statistics. Anthropometric indices: height-for-age, weight-for-height, and weight-for-age - z-scores were analyzed using z-score 06 Stata version 11 and compared with World Health Organization growth reference standards. Ethical approval was obtained from the Faculty of Health Sciences Institutional Review Board of the University of Buea. RESULTS: overall prevalence of stunting, wasting and underweight were 55.08% (95% CI: 50.5-59.58), 13.77% (95% CI: 10.65-16.89), and 31.99% (95% CI: 27.76-36.21), respectively. Severe stunting, wasting and underweight were 34.53% (95% CI: 30.22-38.83), 3.18% (95% CI: 1.58-4.76), and 10.59% (95% CI: 7.80-13.37), respectively. Rates of stunting, wasting and underweight for female and male were: 56.88% and 52.71%; 12.38% and 14.72%; and 30.73% and 32.55%, respectively. Stunting, wasting and underweight rates varied with child age. CONCLUSION: the prevalence of undernutrition was high, indicating a serious public health problem and the necessity for strategies to ensure the optimal health of the target population.

Impact of Nutrition Education on the Nutrition Capacity of Caregivers and Nutrition Outcomes of Indigenous Mbororo Children in the West Region of Cameroon: Protocol for a Cluster Randomized Controlled Trial.

BACKGROUND: Inadequate diets and life-threatening infections have profound adverse implications for child growth, development, and survival, particularly among indigenous peoples. Evidence of the effectiveness of community-based nutrition education interventions in improving child feeding and nutrition outcomes among indigenous Mbororo population in Cameroon is scarce. OBJECTIVE: This study aims to investigate the impact of culturally tailored community-based nutrition education intervention on caregivers' knowledge, attitude, and practice regarding complementary feeding and on nutrition outcomes of indigenous Mbororo children (aged 3-59 months) in the Foumban and Galim health districts of the West Region of Cameroon. METHODS: A two-arm cluster randomized controlled trial will be conducted in the Foumban Health District and Galim Health District. The intervention and control arms will each comprise 5 clusters with 121 child-caregiver pairs. Participants in the intervention arm will be organized into 5 caregivers' peer-support platforms. A total of 12 educational sessions will be assigned to the intervention group by trained female Mbororo nutrition volunteers (n=6) and community health workers (n=6). The control arm will receive routine facility-based nutrition education. Data will be collected at 3-month and 6-month follow-up. Both descriptive statistics and multivariate logistic models will be used to estimate the effect of culturally tailored community-based nutrition education intervention (independent variable) on outcome variables (caregivers' knowledge, attitude, and practice), child growth (weight, height/length, weight for age), and morbidity status (diarrhea, cough, and fever) between both arms. Data assessors will be blinded to the group allocation. Ethical approval (reference no. 2019/1002-07/UB/SG/IRB/FHS) was obtained from the Faculty of Health Sciences Institutional Review Board at the University of Buea. RESULTS: Baseline data were collected in September 2019. In February 2020, 10 Mbororo communities (clusters) with 242 child-caregiver pairs were selected and allocated to the experimental and control arm in a 1:1 ratio. Community nutrition volunteers (n=6) and community health workers (n=6) were selected and trained. Data collection and analysis are ongoing, and results are not available for this manuscript. CONCLUSIONS: The findings of this study will provide evidence on the impact of culturally tailored and health belief model-based nutrition education on behavior change as a complementary strategy for strengthening health facility-based approaches in the reduction of malnutrition burden among the study population. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/23115.

Incidence and impact of hospital-acquired complications in an internal medicine unit of a reference hospital in Cameroon: a prospective cohort study.

BACKGROUND: Hospital-acquired complications (HACs) contribute to increased morbidity, mortality and hospital costs. However, their burden is often overlooked in resource-limited settings. We sought to determine the incidence, risk factors and effects of HACs on direct medical costs. METHODS: This was a prospective cohort study conducted in the Internal Medicine inpatient ward of Douala General Hospital over 3 mo. Patients were examined daily from admission to discharge, transfer or death. Incidence of HACs was calculated and risk factors of HACs were determined using univariate and multivariate regression models. RESULTS: The cumulative incidence rate of HACs in 230 participants was 29.2/1000 patient-days. The incidence rate of infectious and non-infectious complications was 8.4/1000 and 20.9/1000 patient-days, respectively. The most common HAC was constipation (8.3/1000 patient-days). The most common infection was urinary tract infection (3.7/1000 patient-days). HIV infection and length of stay >8 d were significantly associated with the occurrence of HACs. Deep vein thrombosis was associated with the highest direct medical cost. CONCLUSION: The incidence of HACs is high in our setting and leads to increased length of hospital stays as well as greater direct medical costs. Thus, there is a need for effective preventive strategies.

Knowledge, attitudes and practices regarding urinary schistosomiasis among adults in the Ekombe Bonji Health Area, Cameroon.

INTRODUCTION: Urinary schistosomiasis (US) is endemic in Cameroon. Knowledge, attitudes and practices (KAP) are important aspects for control of the disease. However, data on these remain scanty. We aimed at evaluating knowledge, attitudes and practices regarding urinary schistosomiasis among adults in households in the Ekombe Bonji health area. METHODS: A community-based, cross-sectional study was carried out at Ekombe Bonji health area from February to March, 2017, involving all 12 communities. A pre-tested questionnaire was used to assess knowledge, attitudes and practices regarding urinary schistosomiasis among 198 adults and to record their socio-demographic, environmental and clinical variables. Data were stored in Excel version 2013 and analysed using Stata version 14.2. RESULTS: Of the 198 adults interviewed, only 35.4% had prior knowledge about urinary schistosomiasis. Among these, 94.3%, 74.3%, 57.7% knew the signs and symptoms, modes of transmission and preventive measures respectively. Only 14.3% knew the cause and treatment. 81.2% considered urinary schistosomiasis a serious disease and 77.1% believed it could be prevented, albeit, their practices to prevent infection were inadequate. CONCLUSION: Knowledge, attitudes and practices regarding urinary schistosomiasis among adults are inadequate, since most of them are not aware of the disease. Therefore, there is need for community-based interventions especially health education to effectively reduce the disease burden.

Chronic complications and quality of life of patients living with sickle cell disease and receiving care in three hospitals in Cameroon: a cross-sectional study.

BACKGROUND: Sickle Cell Disease (SCD) is associated with chronic multisystem complications that significantly influence the quality of life (QOL) of patients early in their life. Although sub-Saharan Africa bears 75% of the global burden of SCD, there is a paucity of data on these complications and their effects on the QOL. We aimed to record these chronic complications, to estimate the QOL, and to identify the corresponding risk factors in patients with SCD receiving care in three hospitals in Cameroon. METHODS: In this cross-sectional study, a questionnaire was used to collect data from consecutive consenting patients. Information recorded included data on the yearly frequency of painful crisis, the types of SCD, and the occurrence of chronic complications. A 36-Item Short Form (SF-36) standard questionnaire that examines the level of physical and mental well-being, was administered to all eligible participants. Data were analyzed with STATA® software. RESULTS: Of 175 participants included, 93 (53.1%) were female and 111 (aged ≥14 years) were eligible for QOL assessment. The median (interquartile range, IQR) age at diagnosis was 4.0 (2.0-8.0) years and the median (IQR) number of yearly painful crisis was 3.0 (1.0-7.0). The most frequent chronic complications reported were: nocturnal enuresis, chronic leg ulcers, osteomyelitis and priapism (30.9%, 24.6%, 19.4%, and 18.3% respectively). The prevalence of stroke and avascular necrosis of the hip were 8.0% and 13.1% respectively. The median (IQR) physical and mental scores were 47.3 (43.9-58.5) and 41.0 (38.8-44.6) respectively. Age and chronic complications such as stroke and avascular necrosis were independently associated with poor QOL. CONCLUSIONS: In this population of patients living with SCD, chronic complications are frequent and their QOL is consequently poor. Our results highlight the need for national guidelines for SCD control, which should include new-born screening programs and strategies to prevent chronic complications.

Depression Among HIV/AIDS Patients on Highly Active Antiretroviral Therapy in the Southwest Regional Hospitals of Cameroon: A Cross-Sectional Study.

INTRODUCTION: HIV patients are now having longer life expectancies with the use of antiretroviral therapy (ART). However, the issue of mental illness has surfaced with depression being the most common in these patients, which has markedly reduced patient adherence to ART. In Cameroon, the management of HIV/AIDS does not incorporate psychiatric manifestations and depression is therefore underdiagnosed. The aim of our study was to determine the prevalence and determinants of depressive symptoms and their association with adherence to ART among HIV/AIDS patients on HAART in the Southwest Regional Hospitals of Cameroon. METHODS: This was a cross-sectional hospital-based study carried out in the BRH and LRH over a 3-month period. Three hundred HIV patients aged 21 and above were recruited. Depression and adherence to treatment were assessed using the nine-item Patient Health Questionnaire (PHQ-9) and eight-item Morisky Medication Adherence Scale questionnaires, respectively. Data were analysed using Epi-info version 3.4.5. RESULTS: The prevalence of depression was 26.7% (95% CI 20.6-33.7%); 75.0% of those with depression were non-adherent to HAART compared to 37.3% of those without depression (p value <0.001). The statistically significant risk factors associated with depression were unemployment (OR 2.38; 95% CI 1.26-4.50), age ≤40 years (OR 2.13; 95% CI 1.20-3.70) and CD4 counts ≤200 cells/µl (OR 3.70; 95% CI 1.45-9.09). CONCLUSION: The prevalence of depression was high and depression was significantly associated with non-adherence to HAART. Interventions to enhance early identification and treatment of depression in patients with HIV/AIDS are needed. Depression screening should be included as part of the routine consultation of HIV/AIDS patients to ensure early detection and treatment.

A Retrospective One-Year Estimation of the Volume and Nature of Surgical and Anaesthetic Services Delivered to the Populations of the Fako Division of the South-West Region of Cameroon: An Urgent Call for Action.

BACKGROUND: Surgery-related conditions account for the majority of admissions in primary referral hospitals in Sub-Saharan Africa. The role of surgery in the reduction of global disease burden is well recognized, but there is a great qualitative and quantitative disparity in the delivery of surgical and anaesthetic services between countries. This study aims at estimating the nature and volume of surgery delivered in an entire administrative division of Cameroon. METHODS: In this retrospective survey conducted during the year 2013, we used a standard tool to analyse the infrastructure and human resources involved in the delivery of surgical and anaesthetic services in the Fako division in the south-west region of Cameroon. We also estimated the nature and volume of surgical services as a rate per catchment population. RESULTS: Public, private and mission hospital contributed equally to the delivery of surgical services in the Fako. For every 100,000 people, there were <5 operative rooms. A total of 2460 surgical interventions were performed by 2.2 surgeons, 1.1 gynaecologists and 0.3 anaesthetists. These surgical interventions consisted mostly of minor and emergency procedures. Neurosurgery, paediatric, thoracic and endocrine surgery were almost non-existent. CONCLUSIONS: The volume of surgery delivered in the Fako is far below the minimum rates required to meet up with the most basic requirements of the populations. It is likely that most of these surgical needs are left unattended. A community-based assessment of unmet surgical needs is necessary to accurately estimate the magnitude of the problem and guide surgical capacity improvements.

Failure to rescue patients from early critical complications of oesophagogastric cancer surgery.

'Failure to rescue' is a significant cause of mortality in gastrointestinal surgery. Differences in mortality between high and low-volume hospitals are not associated with large difference in complication rates but to the ability of the hospital to effectively rescue patients from the complications. We reviewed the critical complications following surgery for oesophageal and gastric cancer, their prevention and reasons for failure to rescue. Strategies focussing on perioperative optimization, the timely recognition and management of complications may be essential to improving outcome in low-volume hospitals.

Post-traumatic pancreatic pseudocyst managed by Roux-en-Y drainage.

A pancreatic pseudocyst is a collection of serous fluid in relation to the pancreas following acute pancreatitis. If pancreatography is performed, most pseudocysts will be found to have a connection with the pancreatic ductal system. Most will resolve spontaneously but clinically significant pseudocysts (∼5%) may require surgical intervention. Surgical (laparoscopic or open) direct drainage of pancreatic pseudocysts into the upper gastrointestinal tract is the mainstay of treatment with the possibility of pancreatic resection if malignancy is suspected. We report a persistent post-traumatic pancreatic pseudocyst of 8-year duration, despite recurrent percutaneous aspiration that was finally managed by a Roux-en-Y drainage.

Secondary repair of severe chronic fourth-degree perineal tear due to obstetric trauma.

Obstetric injury is the commonest cause of anal incontinence. We report a case of anal incontinence as a result of severe chronic fourth-degree perineal tear secondary to birthing with complete disruption of the perineum. Secondary repair consisting of an anterior sphincter repair and levatorplasty in a poor resourced area rendered excellent immediate clinical result. The outcome of anterior sphincter repair following obstetric trauma is good but long-term follow-up is required because of the underlying complexity of obstetric injury. As prevention is not always possible, immediate recognition and adequate primary treatment is of importance.

Diagnostic and therapeutic challenges of isolated small bowel perforations after blunt abdominal injury in low income settings: analysis of twenty three new cases.

BACKGROUND: Isolated small bowel injury (ISBI) related to abdominal blunt trauma is rare. Timely diagnosis could be difficult, especially in the absence of modern imaging and laparoscopic facilities. The determinants of mortality under such circumstances are unclear. METHODS: This study presents twenty three cases of ISBI related to blunt abdominal injury identified between January 2005 and December 2009 in a level III Hospital in Limbe, Cameroon. Data were retrieved from an ongoing prospective study on injuries and augmented by analysis of individual patient's files. We analysed information regarding modalities of diagnosis, delay between injury and diagnosis, operative findings, treatment and outcome. RESULTS: The ages of our patients ranged from 7 to 38 years with a mean of 19 years. Thirteen patients were children below the age of 16. The most frequent mechanism of injury was a fall (n=11). Associated lesions were identified in 7 patients. Delay between injury and diagnosis was above 12h in 16 patients. Fifteen cases were admitted with obvious signs of peritonitis. Erect chest X-ray identified a pneumoperitoneum in 11 of the 17 patients for whom it was requested. Most perforations were located in the ileum. A total of 7 complications occurred in 5 patients. These included 4 cases of post-operative peritonitis. Two patients with at least one associated lesion died. CONCLUSION: ISBI is seldom suspected. This causes delay in diagnosis and most cases present with a diffuse peritonitis. Early diagnosis and management in low income environment is likely to be improved by a greater awareness of clinicians about this injury, serial clinical assessment and repeated erect chest X-ray, rather than sophisticated tools such as CT scan or laparoscopy.

Anthropometric and hemodynamic profiles of athletes and their relevance to performance in the mount cameroon race of hope.

PURPOSE: Many factors influence athletes' performance including anthropometric, physiological and environmental parameters. High altitude is characterized by adverse environmental conditions that are not found at sea level. We investigated the influence of some anthropometric and physiological factors on performance in the context of the Mount Cameroon Race of Hope. METHODS: Age, height, weight, blood pressure, heart rate and breathing rate of 83 finisher athletes of both genders were collected during medical checkup, and race time was recorded at the arrival line. Measured and calculated data association with performance was assessed. RESULTS: The race time was significantly influenced by the area of training (p=0.0022), and gender (p=0.0036) of athletes; BMI showed significant association with race time in the overall athletes' population; this was confirmed in male (r=0.565; p=0.034) but not in female athletes (r=0.749; p=0.058). Weight class showed significant association to performance, the lighter athletes performing better than the heavier (p<0.00001). None of the investigated physiological parameters showed association to the race time. CONCLUSIONS: We hypothesized that high altitude training and body size are significantly influential on athletes' performance in the Mount Cameroon race of hope and similar mountain races.

Meckel's diverticulum: a case report from the University Hospital Center Yaoundé, Cameroon.

To the best of our knowledge there is no reported case of Meckel's diverticulum (MD) in Cameroon. The prevalence of MD in the general population is 2-3 %. The aim of this paper is to recapitulate the role of this pathology in acute abdomens and abdominal pain of uncertain aetiology in young patients and to review the medical literature.

Burns in pregnancy: a case report from Buea Regional Hospital, Cameroon.

BACKGROUND: To the best of our knowledge similar cases of severe burns in pregnancy have not been published in Cameroon; indicating the rarity of this devastating condition and therefore the dilemma that practitioners may be confronted with in its management. This report is to help the Physician understand the factors that should determine his/her management decisions by reviewing the limited literature of burns in pregnancy. A multidisciplinary approach by a team of Obstetricians, Anesthetist/Intensive care Physicians, Pediatricians and Surgeons is indispensible. Adequate resuscitation, fight against sepsis, the gestational age and the severity of the burn will determine the outcome or prognosis.