Publications by authors named "Jobert Richie N Nansseu"

41 Publications

Knowledge, attitudes, and practices associated with personal health care on urticaria in peripheral health facilities of Yaoundé, Cameroon (Sub-Saharan Africa).

Int J Dermatol 2021 Jun 8. Epub 2021 Jun 8.

Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon.

Background: Urticaria is an acute or chronic inflammatory dermatosis that is characterized by erythematous, edematous, itchy, and transient urticarial plaques that cover the skin and mucous membranes. The aim of this study was to evaluate the knowledge of consulting staff on urticaria in Yaoundé, Cameroon, as well as the attitudes and practices resulting from it.

Methods: We conducted a descriptive cross-sectional study. The participants were enrolled from January to April 2017 in 25 health facilities in Yaoundé, Cameroon. The sample consisted of health personnel including doctors, nurses, and nursing aids. Data were collected using a self-administered questionnaire; the evaluation scores for each heading were established. Data processing was done using the SPSS software Version 21.

Results: We recruited 101 participants, with a sex ratio of 0.4 (73/101 were female); 44.6% of the participants were doctors, and 50% of our participants had less than 5 years of professional experience. The level of knowledge on urticaria was insufficient for 40.6% of the staff enrolled. Attitudes towards urticaria were incorrect for 36.6% of staff, and 95% of our sample had harmful practices.

Conclusion: Our study reveals that skills of the health care provider regarding urticaria are generally poor and do not enable them to ensure an adequate management of the disease.
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http://dx.doi.org/10.1111/ijd.15681DOI Listing
June 2021

Assessment of the 10-year risk of cardiovascular disease among a group of patients on maintenance hemodialysis: A cross-sectional study from Cameroon.

JRSM Cardiovasc Dis 2017 Jan-Dec;6:2048004017705273. Epub 2017 Apr 18.

Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Cameroon; Nephrology Unit, Yaoundé University Teaching Hospital, Cameroon.

Objective: To assess the 10-year risk of cardiovascular disease and potential impacting factors among patients undergoing hemodialysis in Yaoundé, Cameroon.

Design: A cross-sectional study in January 2016.

Setting: Patients were recruited at the dialysis unit of the Yaoundé University Teaching Hospital, Cameroon.

Participants: These were hemodialysis patients aged 20 years and above, dialyzing in the above unit since at least 3 months and volunteering to be enrolled in the study.

Main Outcome Measures: The risk of cardiovascular disease was assessed using the Framingham risk score.

Results: We included 44 patients. The risk of cardiovascular disease ranged from less than 1% to more than 30% with a median of 12.3% (interquartile range 4.9-24.4). Twenty hemodialysis patients (45.5%) had a low risk of cardiovascular disease (<10%), 10 (22.7%), a moderate risk (10-20%), and 14 (31.8%) presented a high risk of cardiovascular disease (>20%). In multivariable linear regression analysis, duration on dialysis (adjusted β = 0.11; p = 0.003), number of weekly sessions of physical activity (adjusted β = -1.35; p = 0.018), fasting serum glucose levels (adjusted β = 4.22; p = 0.022), serum triglycerides levels (adjusted β = 5.94; p = 0.033), and serum urea levels (adjusted β = -2.08; p = 0.039) were independently impacting our patients' risk of cardiovascular disease.

Conclusion: Around 55% of our study population presented a moderate or high risk of cardiovascular disease. Duration on dialysis, number of physical activity sessions per week, fasting serum glucose, serum triglycerides, and serum urea levels may impact our hemodialysis patients' risk of cardiovascular disease.
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http://dx.doi.org/10.1177/2048004017705273DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5406155PMC
April 2017

Skin whitening among Cameroonian female university students: knowledge, attitudes, practices and motivations.

BMC Womens Health 2017 04 17;17(1):33. Epub 2017 Apr 17.

Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon.

Background: Lack of data on skin whitening (SW) among Cameroonian female university students prompted us to undertake the present study which aimed at assessing the knowledge, attitudes, practices and motivations of female university students vis-a-vis SW.

Methods: This was a cross-sectional study conducted from January to April 2013 in 4 university campuses of Yaoundé, Cameroon. Any female student regularly registered in one of the study sites, who was present at the campus when the investigator visited and volunteered to participate in the study was enrolled.

Results: Overall, we recruited 620 female students, their ages ranging from 16 to 46 years with a mean of 21.3 ± 2.9 years. Only 87 participants (14%) found that SW was a good practice. One hundred and sixty nine respondents (27.3%) were currently practicing SW with no age difference when compared to their counterparts (p = 0.09). The desire to have a uniform body skin color was the prevailing reason motivating the practice of SW (39.1%), followed by the need to have a soft skin (29%). Assessment of levels of knowledge regarding advantages of the black skin and deleterious effects of SW showed excellent scores (≥75% of good answers) only in 6.1 and 0.5% of cases respectively, with no difference between those practicing SW or not (all p values > 0.05).

Conclusion: The practice of SW is common among Cameroonian female university students who should therefore be educated on the advantages of the black skin and the harmful effects of SW.
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http://dx.doi.org/10.1186/s12905-017-0385-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5392984PMC
April 2017

Renin angiotensin aldosterone system altered in resistant hypertension in Sub-Saharan African diabetes patients without evidence of primary hyperaldosteronism.

JRSM Cardiovasc Dis 2017 Jan-Dec;6:2048004017695006. Epub 2017 Feb 1.

Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon; National Obesity Centre, Diabetes and Metabolic Diseases Unit, Yaoundé Central Hospital, Yaoundé, Cameroon.

Background: The renin-angiotensin-aldosterone system may be altered in patients with resistant hypertension. This study aimed to evaluate the relation between renin-angiotensin-aldosterone system activity and resistant hypertension in Cameroonian diabetes patients with resistant hypertension.

Methods: We carried out a case-control study including 19 diabetes patients with resistant hypertension and 19 diabetes patients with controlled hypertension matched to cases according to age, sex and duration of hypertension since diagnosis. After collection of data, fasting blood was collected for measurement of sodium, potassium, chloride, active renin and plasma aldosterone of which the aldosterone-renin ratio was derived to assess the activity of renin-angiotensin-aldosterone system. Then, each participant received 2000 ml infusion of saline solution after which plasma aldosterone was re-assayed.

Results: Potassium levels were lower among cases compared to controls (mean: (4.10 ± 0.63 mmol/l vs. 4.47 ± 0.58 mmol/l), though nonsignificant (p = 0.065). Active renin, plasma aldosterone both before and after the dynamic test and aldosterone-renin ratio were comparable between cases and controls (all p values > 0.05). Plasma aldosterone significantly decreased after the dynamic test in both groups (p < 0.001), but no participant exhibited a post-test value>280 pmol/l. We found a significant negative correlation between potassium ion and plasma aldosterone (ρ = -0.324;  = 0.047), the other correlations being weak and unsignificant.

Conclusion: Although this study failed to show an association between RH and primary hyperaldosteronism in our context, there was a hyperactivity of renin-angiotensin-aldosterone system. Moreover, this study confirms the importance of potassium dosage when screening the renin-angiotensin-aldosterone system.
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http://dx.doi.org/10.1177/2048004017695006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5347415PMC
February 2017

Burden and spectrum of bacterial infections among sickle cell disease children living in Cameroon.

BMC Infect Dis 2017 03 15;17(1):211. Epub 2017 Mar 15.

Mother and Child Centre of the Chantal Biya Foundation, Yaoundé, Cameroon.

Background: Although sickle cell disease (SCD) children are highly susceptible to bacterial infections (BIs), there is a dreadful lack of data related to the burden and spectrum of BIs in sub-Saharan Africa (SSA), the highest affected region with SCD. This study aimed to determine the burden and spectrum of BIs among SCD children hospitalized in a pediatric reference hospital in Cameroon, a SSA country.

Methods: We conducted a retrospective analysis of records of children hospitalized from November 2012 to August 2015 in the SCD unit of the Mother and Child Centre of the Chantal Biya Foundation, Cameroon. We enrolled all known SCD children aged 15 years or less, hospitalized for a suspicion of BI and who presented a positive culture of a body specimen.

Results: A total of 987 SCD children were hospitalized during the study period. Cultures were positive for 96 patients (9.7%) among whom 60.4% males. Ages ranged from 6 to 192 months with a median of 53 (Interquartile range (IQR) 21-101) months. For children no more covered by the Expanded Programme on Immunization, only 13 (18.8%) had received the Pneumo 23® and Meningo A&C® antigens, and 12 (17.4%), the Typhim vi® and the Haemophilus influenzae type b antigens; 58 children (84.1%) had received no vaccine. The specimen yielding positive cultures were: blood (70.7%), urine (13.1%), pus (9.1%), synovial fluid (4.1%), cerebrospinal fluid (2.0%), and bone fragment (1.0%). The different types of infection included: urinary tract infections (13.5%), myositis (8.3%), arthritis (6.3%), osteomyelitis (4.2%), and meningitis (2.1%); the site of infection was unidentified in 65.6% of cases. The main bacteria included: Salmonella sp. (28.1%), Staphylococcus sp. (18.8%), Klebsiella pneumoniae (17.7%), Escherichia coli (10.4%), Enterobacter sp. (5.2%), Acinetobacter sp. (4.2%), Streptococcus sp. (4.2%) and Serratia sp. (4.2%).

Conclusion: This retrospective analysis revealed 9.7% cases of BIs, mainly caused by Salmonella sp. (28.1%), Staphylococcus sp. (18.8%), Klebsiella pneumoniae (17.7%), and Escherichia coli (10.4%).
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http://dx.doi.org/10.1186/s12879-017-2317-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5353947PMC
March 2017

Burden of human scabies in sub-Saharan African prisons: Evidence from the west region of Cameroon.

Australas J Dermatol 2018 Feb 1;59(1):e6-e10. Epub 2017 Mar 1.

Department of Parasitology and Mycology, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon.

Background/objectives: There is little data on the profile and magnitude of scabies in sub-Saharan African prisons. The present study aimed to assess the prevalence and determinants of scabies in prisons of the west region of Cameroon.

Methods: We conducted a cross-sectional study from March to August 2014, and consecutively recruited volunteer detainees of three randomly selected prisons in the West Region of Cameroon. The diagnosis was based on clinical findings after assessment by two experienced and well-trained dermatologists.

Results: We enrolled 755 prisoners, 17 (2%) of whom were women. Their mean age was 32 ± 12 years. There were 242 cases (32%) of scabies, with significantly more cases in the most crowded prison (P < 0.0001). Men were significantly more affected than women (P = 0.004) and the prevalence of scabies significantly decreased when the level of education increased (P < 0.0001). In addition to a low level of education (adjusted odds ratio (aOR) 1.90; P < 0.0001), sharing clothes/bedding (aOR 2.72; P < 0.0001) and the number of detainees per cell > 10 (aOR 1.89; P = 0.002), but not age, duration of incarceration, number of baths/week and washing/week, were independent drivers of scabies occurrence.

Conclusion: Almost one-third of prisoners suffered from scabies in our prisons. A low educational level, the sharing of clothes/bedding and number of detainees/cell > 10 were independent determinants of the disease. Urgent measures must be undertaken to reduce the burden of scabies in our prisons.
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http://dx.doi.org/10.1111/ajd.12540DOI Listing
February 2018

Knowledge, attitudes and practices of the medical personnel regarding atopic dermatitis in Yaoundé, Cameroon.

BMC Dermatol 2017 02 16;17(1). Epub 2017 Feb 16.

Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, P.O. Box: 8314, Yaoundé, Cameroon.

Background: Atopic dermatitis (AD) is a chronic, relapsing and pruritic inflammatory skin disease whose management remains unclear to most non-dermatologists. This study aimed to assess the knowledge, attitudes and practices (KAP) of the medical staff regarding AD in Yaoundé, Cameroon.

Methods: This was a cross-sectional study conducted from January to April 2014 in 20 health facilities located in Yaoundé, the capital city of Cameroon. All medical staff who provided their consent were included in the study. A score was established for each of the KAP categories, and subsequently grouped into 4 classes considering a score <50, 50-<65, 65-<85 or ≥85%, respectively.

Results: We enrolled 100 medical personnel, 62% of whom were females. Overall, the level of knowledge on AD was moderate (65%). Allergy was the main cause of AD, stated by 64% of participants. Only 43% personnel cited the genetic cause. Asthma was mentioned by 78% as an associated pathology. Regarding attitudes, the majority (84%) thought that AD is equally common among Black and Caucasian populations; 42% of participants believed that evolution is favorable when appropriate medical treatment is prescribed. These attitudes were considered wrong (64%). Similarly, the general level of practice was inadequate: 50%.

Conclusion: Levels of knowledge, attitudes and practices of the medical staff regarding AD were poor, implying that management of this condition is non optimal in our setting.
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http://dx.doi.org/10.1186/s12895-017-0053-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5314472PMC
February 2017

Prevalence and patterns of congenital heart diseases in Africa: a systematic review and meta-analysis protocol.

BMJ Open 2017 02 14;7(2):e015633. Epub 2017 Feb 14.

Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa.

Introduction: Congenital heart diseases (CHD) are common causes of cardiovascular morbidity and mortality among young children and adolescents living in Africa. Accurate epidemiological data are needed in order to evaluate and improve preventive strategies. This review aims to determine the prevalence of CHD and their main patterns in Africa.

Methods And Analysis: This systematic review and meta-analysis will include cross-sectional, case-control and cohort studies of populations residing inside African countries, which have reported the prevalence of CHD, confirmed by an echocardiographic examination and/or describing different patterns of these abnormalities in Africa. Relevant abstracts published without language restriction from 1 January 1986 to 31 December 2016 will be searched in PubMed, Exerpta Medica Database and online African journals as well as references of included articles and relevant reviews. Two review authors will independently screen, select studies, extract data and assess the risk of bias in each study. The study-specific estimates will be pooled through a random-effects meta-analysis model to obtain an overall summary estimate of the prevalence of CHD across studies. Clinical and statistical heterogeneity will be assessed, and we will pool studies judged to be clinically homogeneous. On the other hand, statistical heterogeneity will be evaluated by the χ2 test on Cochrane's Q statistic. Funnel-plots analysis and Egger's test will be used to detect publication bias. Results will be presented by geographic region (central, eastern, northern, southern and western Africa).

Ethics And Dissemination: The current study will be based on published data, and thus ethical approval is not required. This systematic review and meta-analysis is expected to serve as a base which could help in estimating and evaluating the burden of these abnormalities on the African continent. The final report of this study will be published in a peer-reviewed journal.

Trial Registration Number: PROSPERO CRD42016052880.
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http://dx.doi.org/10.1136/bmjopen-2016-015633DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5318562PMC
February 2017

Antiretroviral therapy related adverse effects: Can sub-Saharan Africa cope with the new "test and treat" policy of the World Health Organization?

Infect Dis Poverty 2017 Feb 15;6(1):24. Epub 2017 Feb 15.

Department of Epidemiology and Public Health, Centre Pasteur of Cameroon, Yaoundé, Cameroon.

Background: Recent studies have shown that early antiretroviral therapy (ART) initiation results in significant HIV transmission reduction. This is the rationale behind the "test and treat" policy of the World Health Organization (WHO). Implementation of this policy will lead to an increased incidence of ART-related adverse effects, especially in sub-Saharan Africa (SSA). Is the region yet ready to cope with such a challenging issue?

Main Body: The introduction and widespread use of ART have drastically changed the natural history of HIV/AIDS, but exposure to ART leads to serious medication-related adverse effects mainly explained by mitochondrial toxicities, and the situation will get worse in the near future. Indeed, ART is associated with an increased risk of developing cardiovascular disease, lipodystrophy, prediabetes and overt diabetes, insulin resistance and hyperlactatemia/lactic acidosis. The prevalence of these disorders is already high in SSA, and the situation will be exacerbated by the implementation of the new WHO recommendations. Most SSA countries are characterized by (extreme) poverty, very weak health systems, inadequate and low quality of health services, inaccessibility to existing health facilities, lack of (qualified) health personnel, lack of adequate equipment, inaccessibility and unaffordability of medicines, and heavy workload in a context of a double burden of disease. Additionally, there is dearth of data on the incidence and predictive factors of ART-related adverse effects in SSA, to anticipate on strategies that should be put in place to prevent the occurrence of these conditions or properly estimate the upcoming burden and prepare an adequate response plan. These are required if we are to anticipate and effectively prevent this upcoming burden.

Conclusion: While SSA would be the first region to experience the huge benefits of implementing the "test and treat" policy of the WHO, the region is not yet prepared to manage the consequential increased burden of ART-related toxic and metabolic complications. Urgent measures should be taken to fill the lacunae if SSA is not to become over-burdened by the consequences of the "test and treat" policy.
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http://dx.doi.org/10.1186/s40249-017-0240-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5310075PMC
February 2017

Electronic Cigarettes for Curbing the Tobacco-Induced Burden of Noncommunicable Diseases: Evidence Revisited with Emphasis on Challenges in Sub-Saharan Africa.

Pulm Med 2016 25;2016:4894352. Epub 2016 Dec 25.

Department of Epidemiology and Public Health, Centre Pasteur of Cameroon, Yaoundé, Cameroon; Faculty of Medicine, University of Paris Sud XI, Le Kremlin Bicêtre, France.

. This review examines whether electronic cigarettes (e-cigs) implementation or vulgarization in sub-Saharan Africa (SSA) could be helpful in curtailing the toll of tobacco smoking in the region. . There are about 1.3 billion smokers worldwide, with nearly 80% of them living in developing countries where the burden of tobacco-related illnesses and deaths is the heaviest. Studies report that e-cigs may facilitate smoking cessation, reduction, or abstinence and may pose only a small fraction of the risks of traditional tobacco cigarettes; e-cigs may also considerably reduce second-hand smoking. Thereby, implementation of e-cig use could help to substantially reduce the burden driven by tobacco smoking in SSA, in a particular context of lack of regulations and control policies towards this threat. However, the evidence is not clear on whether e-cigs are risk-free, especially if used in the long term. . On the whole, if e-cigs were to be introduced in SSA, they should be strictly recommended to current and/or ex-smokers as a method to quit smoking or prevent relapse and never-smokers should be strongly encouraged to avoid using these devices. Bans on sales of e-cigs to youngsters should be legislated, e-cig advertisements prohibited, and their usage continuously controlled and monitored.
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http://dx.doi.org/10.1155/2016/4894352DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5220510PMC
March 2017

Association of insulin treatment versus oral hypoglycaemic agents with diabetic retinopathy and its severity in type 2 diabetes patients in Cameroon, sub-Saharan Africa.

Ann Transl Med 2016 Oct;4(20):395

Department of Ophthalmology, Faculty of Medicine and Biomedical Sciences, Yaoundé, Cameroon.

Background: Type 2 diabetes mellitus (T2DM) is a chronic metabolic disease associated with multiple macro and microvascular complications, diabetic retinopathy (DR) being the commonest one. Recent literature has reported an increased risk of DR with insulin use.

Methods: We carried out a cross-sectional study at the Ophthalmology Department of the Douala General Hospital (DGH) during a 2-year period to explore the association between insulin treatment and both DR and its severity as compared with oral hypoglycemic agents (OHAs) in Cameroonian T2DM patients aged ≥35 years, and who were all screened for DR through eye examination including exhaustive retinal evaluation.

Results: In total, medical files of 134 T2DM patients were analyzed. The frequency of DR was 54.1% among patients on OHA and 73.9% among those on insulin treatment, giving an overall frequency of 57.5%. There were significantly more OHA treated patients than insulin treated patients (82.8% . 17.2%, P<0.001). As expected, both the OHA and insulin groups were comparable by age, sex, duration of diabetes, past history of hypertension, alcohol misuse, and current tobacco smoking. DR was almost significantly more frequent in T2DM patients under insulin regimen than in patients under OHA [73.9% . 54.1%; odds ratio (OR) 2.4; 95% confidence interval (CI), 0.9-6.6; P=0.06]. Proliferative diabetic retinopathy (PDR) was significantly more observed in insulin treated patients than in OHA treated patients (34.8% . 15.3%; OR 2.95; 95% CI, 1.1-8; P=0.035). Irrespective of staging, the frequency of diabetic macular edema (DME) was significantly higher in the insulin group than in the OHA group (43.5% . 19.8%; OR 3.1; 95% CI, 1.2-8; P=0.019).

Conclusions: Compared with OHA, insulin therapy may be associated with DR, DR severity and DME in these T2DM sub-Saharan African patients.
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http://dx.doi.org/10.21037/atm.2016.08.42DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5107390PMC
October 2016

Incidence, prevalence and genetic determinants of neonatal diabetes mellitus: a systematic review and meta-analysis protocol.

Syst Rev 2016 11 10;5(1):188. Epub 2016 Nov 10.

National Obesity Centre, Yaoundé Central Hospital, Yaoundé, Cameroon.

Background: In the absence of existing data, the present review intends to determine the incidence, prevalence and/or genetic determinants of neonatal diabetes mellitus (NDM), with expected contribution to disease characterization.

Methods: We will include cross-sectional, cohort or case-control studies which have reported the incidence, prevalence and/or genetic determinants of NDM between January 01, 2000 and May 31, 2016, published in English or French languages and without any geographical limitation. PubMed and EMBASE will be extensively screened to identify potentially eligible studies, completed by manual search. Two authors will independently screen, select studies, extract data, and assess the risk of bias; disagreements will be resolved by consensus. Clinical heterogeneity will be investigated by examining the design and setting (including geographic region), procedure used for genetic testing, calculation of incidence or prevalence, and outcomes in each study. Studies found to be clinically homogeneous will be pooled together through a random effects meta-analysis. Statistical heterogeneity will be assessed using the chi-square test of homogeneity and quantified using the I statistic. In case of substantial heterogeneity, subgroup analyses will be undertaken. Publication bias will be assessed with funnel plots, complemented with the use of Egger's test of bias.

Discussion: This systematic review and meta-analysis is expected to draw a clear picture of phenotypic and genotypic presentations of NDM in order to better understand the condition and adequately address challenges in respect with its management.

Systematic Review Registration: PROSPERO CRD42016039765.
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http://dx.doi.org/10.1186/s13643-016-0369-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5105249PMC
November 2016

A comparison of quality of abstracts of systematic reviews including meta-analysis of randomized controlled trials in high-impact general medicine journals before and after the publication of PRISMA extension for abstracts: a systematic review and meta-analysis.

Syst Rev 2016 Oct 13;5(1):174. Epub 2016 Oct 13.

Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon.

Background: Journal abstracts including those reporting systematic reviews (SR) should contain sufficiently clear and accurate information for adequate comprehension and interpretation. The aim was to compare the quality of reporting of abstracts of SRs including meta-analysis published in high-impact general medicine journals before and after publication of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for abstracts (PRISMA-A) released in April 2013.

Methods: SRs including meta-analysis of randomized controlled trials published in 2012, 2014, and 2015 in top-tier general medicine journals were searched in PubMed. Data was selected and extracted by two reviewers based on the PRISMA-A guidelines which recommend to include 12 items. The primary outcome was the adjusted mean number of items reported; the secondary outcome was the reporting of each item and factors associated with a better reporting. Adjustment was made for abstract word count and format, number of authors, PRISMA endorsement, and publication on behalf of a group.

Results: We included 84 abstracts from 2012, 59 from 2014, and 61 from 2015. The mean number of items reported in 2015 (7.5; standard deviation [SD] 1.6) and in 2014 (6.8; SD 1.6) differed and did not differ from that reported in 2012 (7.2; SD 1.7), respectively; adjusted mean difference: 0.9 (95 % CI 0.4; 1.3) and -0.1 (95 % CI -0.6; 0.4). From 2012 to 2014, the quality of reporting was in regression for "strengths and limitations of evidence" and "funding"; contrariwise, it remained unchanged for the others items. Between 2012 and 2015, the quality of reporting rose up for "description of the effect", "synthesis of results", "interpretation", and "registration"; but decreased for "strengths and limitations of evidence"; it remained unchanged for the other items. The overall better reporting was associated with abstracts structured in the 8-headings format in 2014 and abstracts with a word count <300 in 2014 and 2015.

Conclusions: Not surprisingly, the quality of reporting did not improve in 2014 and suboptimally improved in 2015. There is still room for improvement to meet the standards of PRISMA-A guidelines. Stricter adherence to these guidelines by authors, reviewers, and journal editors is highly warranted and will surely contribute to a better reporting.
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http://dx.doi.org/10.1186/s13643-016-0356-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5064935PMC
October 2016

Patterns and trends in mortality among HIV-infected and HIV-uninfected patients in a major Internal Medicine Unit in Yaoundé, Cameroon: a retrospective cohort study.

JRSM Open 2016 Sep 1;7(9):2054270416654859. Epub 2016 Sep 1.

Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, PO Box 1364, Yaoundé, Cameroon; Internal Medicine Unit, Yaoundé University Hospital Centre, PO Box 4806, Yaoundé, Cameroon.

Objective: To describe the trends in mortality and the spectrum of disease in HIV-infected and -uninfected inpatients in a population in Yaoundé.

Design: A retrospective study.

Setting: Internal Medicine Unit, University Hospital Centre, Yaoundé, Cameroon.

Participants: All deaths registered between January 2000 and May 2007 in the unit.

Main Outcomes Measures: Sociodemographic characteristics, clinical features and results of all investigations done, cause of death.

Results: During the study period, 362 deaths were registered, consisting of 281 (77.6%) in HIV-infected patients, 54.4% of which were women. HIV-infected patients were younger (mean age: 40.2 (SD: 11.6) vs. 55.5 (SD: 18.3) years, p < 0.001) and economically active (60.3% vs. 24.4%, p < 0.001). Most HIV-infected patients (77.6%) were classified as WHO stage IV, with the rest being WHO stage III. Most HIV-infected patients (87.8%) had evidence of profound immunosuppression (CD4 < 200 cells/mm(3)). The mortality trend appeared to be declining with appropriate interventions. The most frequent causes of death in HIV-infected patients were pleural/pulmonary tuberculosis (34.2%), undefined meningoencephalitis (20.3%), other pneumonias (18.2%), toxoplasmosis (16.4%), cryptococcal meningitis (14.2%) and Kaposi sarcoma (15.7%). HIV-uninfected patients died mostly as a result of chronic diseases including liver diseases (17.3%), kidney failure (13.6%), congestive heart failure (11.1%) and stroke (9.9%).

Conclusion: There was a declining mortality due to HIV with appropriate interventions such as subsidised tests for HIV-infected patients, increased availability of HAART and other medications for prevention and treatment of opportunistic infections. The spectrum of HIV disease was wide and preventable.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5011308PMC
http://dx.doi.org/10.1177/2054270416654859DOI Listing
September 2016

The highly neglected burden of resistant hypertension in Africa: a systematic review and meta-analysis.

BMJ Open 2016 09 20;6(9):e011452. Epub 2016 Sep 20.

Department of Epidemiology and Public Health, Centre Pasteur of Cameroon, Yaoundé, Cameroon.

Objective: The hypertension epidemic in Africa collectively with very low rates of blood pressure control may predict an incremented prevalence of resistant hypertension (RH) across the continent. The aim of this study was to determine the prevalence of RH and associated risk factors in Africa.

Data Sources: We conducted a comprehensive search of electronic databases (PubMed, EMBASE, Africa Wide Information and Africa Index Medicus) completed by manual search of articles, regardless of language or publication date.

Methods: We included studies which have reported the prevalence and/or risk factors for RH in Africa from inception to 19 May 2016. Forest plots were drawn to visualise the combined prevalence of RH and extent of statistical heterogeneity between studies.

Results: Out of 259 retrieved studies, only 5 from Cameroon, Nigeria, Burkina Faso, Lesotho and Algeria with a total population of 4 068 patients were finally included in this review. There was no study from the Eastern part of Africa. Though the definition of RH was not similar across studies, its prevalence was respectively 11.7%, 4.9%, 14.6%, 14.3% and 19.0%, with an overall pooled prevalence of 12.1% (95% CI 8.0% to 17.7%). Potential risk factors were: non-compliance to treatment, ageing, male sex, dyslipidaemia, metabolic syndrome, previous cardiovascular events, physical inactivity and stress, but not excessive salt intake, alcohol and coffee ingestions. Moreover, diabetes, smoking, obesity and renal insufficiency yielded discrepant results.

Conclusions: There is a huge dearth of research on the epidemiology of RH in Africa. Thereby, an extensive study of RH prevalence and risk factors is still largely warranted to curtail the high and continuously increasing burden of hypertension across Africa.
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http://dx.doi.org/10.1136/bmjopen-2016-011452DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5051381PMC
September 2016

Rates and drivers of progression to pre-diabetes and diabetes mellitus among HIV-infected adults on antiretroviral therapy: a global systematic review and meta-analysis protocol.

BMJ Open 2016 09 15;6(9):e012852. Epub 2016 Sep 15.

Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa Medical Diagnostic Center, Yaoundé, Cameroon.

Introduction: With the new 'test and treat' policy of the WHO, it is obvious that the number of HIV-infected patients taking antiretroviral therapy (ART) will grow exponentially, with consequential increase in the burden of diabetes mellitus (DM). Our aim is to summarise existing data on the incidence of pre-diabetes and DM, and associated risk factors among HIV-infected adults.

Methods And Analysis: This systematic review will include cohort studies reporting the incidence of pre-diabetes and/or DM, and associated risk factors among HIV-infected adults on ART, with these patients being free of any impaired glucose metabolism at study baseline. We will perform electronic searches in PubMed, Excerpta Medica Database (EMBASE), Web of Science and WHO Global Health Library, supplemented with manual searches. Articles published from 1 January 2000 to 31 July 2016, in English or French languages, and without any geographical restriction will be eligible for inclusion. 3 authors will independently screen, select studies, extract data and assess the risk of bias with discrepancies resolved by consensus. We will assess clinical heterogeneity by examining the study design and setting, criteria and cut-offs used to define pre-diabetes or DM, process of calculation of incidence and outcomes in each study. We will also assess statistical heterogeneity using the χ(2) test of homogeneity and quantify it using the I(2) statistic. A random effects meta-analysis will be used to estimate the overall cumulative incidence of pre-diabetes/DM and risk factors.

Ethics And Dissemination: This systematic review will use data from published studies and does not require ethics approval. Its results are expected to help putting in place action plans and preventive measures to curb the growing burden of DM in the HIV population on ART. Findings will be published in a peer-reviewed journal and presented at scientific conferences.

Prospero Registration Number: CRD42016039651.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5030590PMC
http://dx.doi.org/10.1136/bmjopen-2016-012852DOI Listing
September 2016

Prevalence and incidence of pulmonary hypertension among HIV-infected people in Africa: a systematic review and meta-analysis.

BMJ Open 2016 08 23;6(8):e011921. Epub 2016 Aug 23.

Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa Medical Diagnosis Center, Yaoundé, Cameroon.

Objective: Patients infected with HIV have a direly increased risk of developing pulmonary hypertension (PH), and of dying from the condition. While Africa carries the greatest burden of HIV infection worldwide, there is unclear data summarising the epidemiology of PH among HIV-infected people in this region. Our objective was to determine the prevalence and incidence of PH among HIV-infected people living across Africa.

Design: A systematic review and meta-analysis.

Participants: HIV-infected African people residing in Africa.

Outcome: Prevalence and incidence of PH diagnosed through echocardiography or right heart catheterisation.

Data Sources: Articles published in PubMed/MEDLINE, EMBASE, African Journals Online and African Index Medicus between 1 January 1980 and 30 June 2016, without any language restriction.

Results: Overall, 121 studies were screened; 3 were included in this review: 1 from Southern Africa (South Africa), 1 from Eastern Africa (Tanzania) and 1 from Central Africa (Cameroon). These studies included HIV-infected adult patients selected based on presentation with cardiovascular symptoms. No study reported PH incidence or PH incidence/prevalence among children and adolescents. The quality assessment yielded moderate risk of bias. Ages of participants ranged between 18 and 78 years, and the proportion of females varied between 52.3% and 68.8%. The prevalence of PH in the pooled sample of 664 patients was 14% (95% CI 6%-23%).

Limitations: Only 3 studies were found eligible from 3 regions of the African continent.

Conclusions: The prevalence of PH among HIV-infected people in Africa seems very high. Further studies are urgently warranted to determine the incidence of HIV-induced PH, which must include all subregions of Africa.

Trial Registration Number: Review registration number PROSPERO CRD42016033863.
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http://dx.doi.org/10.1136/bmjopen-2016-011921DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5013504PMC
August 2016

Prevalence and drivers of human scabies among children and adolescents living and studying in Cameroonian boarding schools.

Parasit Vectors 2016 07 19;9(1):400. Epub 2016 Jul 19.

Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon.

Background: The dire lack of information concerning the epidemiology of human scabies in Cameroon, especially in school milieus brought us to undertake the present study which aimed to determine the prevalence and associated factors of scabies in Cameroonian boarding schools.

Methods: A cross-sectional study was conducted from February to March 2015 in four boarding schools in Yaoundé and Buea (Cameroon). Participants were students currently residing in one of the study sites, volunteering to participate in the study and whose parents or guardians had given their consent in this respect. The diagnosis was based on clinical assessment independently performed by two dermatologists.

Results: A total of 1,902 students were recruited (50.5 % boys), with a mean age of 14.3 ± 2.5 years. Overall, 338 participants (17.8 %) were diagnosed with scabies. Age ≤ 15 years, male sex, number of students in the school > 500, no access to the school infirmary, sleeping with others, sharing beddings, clothes or toilet stuffs, pruritus in the close entourage and complaining of pruritus were significantly associated with the presence of mites in univariable logistic regression analyses. On the other hand, at least two baths per day, usage of soap for baths and finger nails always cut short appeared as protective factors. After multivariable analysis, male sex (adjusted OR (aOR) 2.06, 95 % CI: 1.40-3.01, P < 0.0001), first cycle level of education (aOR 1.67, 95 % CI: 1.02-2.71, P = 0.040), number of students per dormitory ≤ 10 (aOR 6.99, 95 % CI: 3.34-14.71, P < 0.0001), no access to the school infirmary (aOR 1.62, 95 % CI: 1.12-2.32, P = 0.009) and complaining of pruritus (aOR 93.37, 95 % CI: 60.04-145.19, P < 0.0001) were the independent factors associated with scabies.

Conclusions: The prevalence of scabies was 17.8 %. The male sex, first cycle level of education, a number of students per dormitory ≤ 10, no access to the school infirmary and complaining of pruritus were the independent factors significantly impacting the occurrence of scabies.
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http://dx.doi.org/10.1186/s13071-016-1690-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4950090PMC
July 2016

Atherogenic index of plasma and risk of cardiovascular disease among Cameroonian postmenopausal women.

Lipids Health Dis 2016 Mar 9;15:49. Epub 2016 Mar 9.

School of Health Sciences, Catholic University of Central Africa, Yaoundé, Cameroon.

Background: The paucity of data regarding the relationship between atherogenic index of plasma (AIP) and risk of cardiovascular disease (CVD) in postmenopausal women living in sub-Saharan Africa prompted us to conduct this study which aimed at assessing the interplay between AIP and risk of CVD among Cameroonian postmenopausal women.

Methods: This was a cross-sectional study conducted among 108 postmenopausal women in Yaoundé, Cameroon. Risk of CVD was calculated using the Framingham risk score, (FRS), and the AIP was derived as log (triglycerides/high-density lipoproteins cholesterol).

Results: Mean age of participants equaled 56.4 ± 6.9 years. AIP values ranged from -0.40 to 0.85 with a mean of 0.21 ± 0.27. There was a positive and significant correlation between AIP and body mass index (r = 0.234; p = 0.015), systolic blood pressure (r = 0.350; p < 0.001), diastolic blood pressure (r = 0.365; p < 0.001), fasting plasma glucose (r = 0.314; p = 0.001), uric acid (r = 0.374; p < 0.001), and total cholesterol (r = 0.374; p < 0.001), but not with age (r = -0.104; p = 0.284). The FRS varied between 1.2 % and >30 % with a mean of 13.4 ± 8.7 %. In univariable model, AIP significantly influenced the risk of CVD (β = 11.94; p < 0.001; R(2) = 0.136). But in the multivariable model, after adjusting for confounders, AIP did not impact the risk of CVD anymore (adjusted β = 1.98; p = 0.487; R(2) = 0.486).

Conclusion: AIP may not be an independent factor impacting the risk of CVD among Cameroonian postmenopausal women. More studies are needed to better elucidate the interaction between AIP and risk of CVD in our setting.
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http://dx.doi.org/10.1186/s12944-016-0222-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4784375PMC
March 2016

Aspirin for primary prevention of cardiovascular disease.

Thromb J 2015 4;13:38. Epub 2015 Dec 4.

Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa ; Medical Diagnostic Centre, Yaoundé, Cameroon.

Although aspirin has a well-established role in preventing adverse events in patients with known cardiovascular disease (CVD), its benefit in patients without a history of CVD remains under scrutiny. Current data have provided insight into the risks of aspirin use, particularly bleeding, compared with its benefits in primary CVD prevention. Although aspirin is inexpensive and widely available, especially in developing countries, there is lack of evidence that the benefits outweigh the adverse events with continuous aspirin use in primary CVD prevention. Therefore, the decision to initiate aspirin therapy should be an individual clinical judgment that weighs the absolute benefit in reducing the risk of a first cardiovascular event against the absolute risk of major bleeding, and tailored to the patient's CVD risk. This risk must be calculated, based on accurate and cost-benefit locally developed risk assessment tools, the most discriminating threshold be identified. Additionally, patients preferences should be taken into account when making the decision to initiate aspirin therapy in primary prevention of CVD or not. Physicians should continuously be trained to calculate their patients CVD risk, and concomitant strategies be emphasized.
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http://dx.doi.org/10.1186/s12959-015-0068-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4669607PMC
December 2015

Prevalence and correlates of HIV-risky sexual behaviors among students attending the Medical and Social Welfare Center of the University of Maroua, Cameroon.

BMC Res Notes 2015 Nov 2;8:635. Epub 2015 Nov 2.

Department of Obstetrics and Gynecology, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon.

Background: Data on sexual behaviors in Cameroonian youths are needed to design and implement effective preventive strategies against HIV/AIDS. This study aimed at assessing sociodemographic and religious factors associated with sexual behaviors among university students in Cameroon.

Methods: In 2011, 411 university students were surveyed by a self-administered questionnaire at the Medical and Social Welfare Center of the University of Maroua. Logistic regression analyses were used to determine correlates of sexual behaviors.

Results: 80.8 % of students were sexually active. The mean age at sexual debut was 18.1 years (SD = 3.1). The frequency of premarital sex was 92.8 %. Pornography viewing [adjusted odds ratio (aOR): 4.0, 95 % CI 2.1-7.6; p < 0.0001] and an increased age of 1 year (aOR: 1.3, 95 % CI 2.0-7.6; p < 0.0001) were significantly associated with having previously had sex. The likelihood to have a lower (<18) age at sexual debut was increased by male gender (aOR: 2.5, 95 % CI 1.7-5; p < 0.001), and urban origin (aOR: 2.9, 95 % CI 1.5-5.7; p < 0.01). The probability to have a high number (#3) of lifetime sexual partners was increased by age (aOR: 1.1, 95 % CI 1.0-1.2; p < 0.001), pornography viewing (aOR: 4.3, 95 % CI 1.9-9.5; p < 0.001), an early sexual debut (aOR: 2.8, 95 % CI 1.6-5.0; p < 0.001), having had occasional sexual partners (aOR: 7.0, 95 % CI 3.7-13.1; p < 0.0001), and was decreased by Muslim religious affiliation (aOR: 0.2, 95 % CI 0.1-0.9; p < 0.05). Having had casual sexual partners was associated with less inconsistent condom use (aOR: 0.5, 95 % CI 0.2-0.9; p < 0.05).

Conclusions: Our findings indicate that there is an alarming level of risky sexual behaviors among the study population. Strong and efficient measures should be undertaken to handle such harmful behaviors, this for the prevention and control of HIV/AIDS and other STIs in this vulnerable population.
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http://dx.doi.org/10.1186/s13104-015-1638-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4630846PMC
November 2015

Assessing the knowledge, attitude and practice of family planning among women living in the Mbouda health district, Cameroon.

Reprod Health 2015 Oct 9;12:92. Epub 2015 Oct 9.

Pediatric Unit, Bertoua Regional Hospital, Bertoua, Cameroon.

Background And Objective: Promotion of family planning has been shown to reduce poverty, hunger, maternal and infant mortality, and contribute to women's empowerment. But many resource-limited countries still have very low rates of contraceptive use. The present study aimed to assess the knowledge, attitude and practice of family planning among women living in a resource-poor rural setting.

Methods: We conducted a cross-sectional study in January 2010 in the Mbouda Health District, Cameroon. After a multistage random selection, 120 households were selected. Participants were women aged at least 15 years old, sexually active, and who volunteered to participate in the study. Data were collected during an anonymous interview using a structured pre-tested questionnaire.

Results: A total of 101 women were enrolled, their ages ranging from 18-58 years with a mean of 31.7 ± 8.8 years. Ninety-six percent of these women had already heard about family planning. Almost all respondents (98 %) were aware of at least one contraceptive method, the most cited being the male condom (96 %), the safe period (86.1 %), injectables (76.2 %) and oral pills (75.2 %), Sixty-six women (65.3 %) were currently practicing at least one contraceptive method, and the three prevailing methods used were: the safe period (50 %), the male condom (34.8 %), and injectables (12.1 %). The main reasons precluding women from practicing contraception were lack of knowledge (31.4 %), uselessness (31.4 %) and unbearable side effects (8.6 %). Fourteen of these women (42.4 %) expressed the willingness to start practicing contraception if they received more information about the subject. Decision on the number of children to have was made by both the man and the woman in 59.5 % of cases. The practice of contraception had been decided by the couple in 39.6 % of cases, and 9.4 % of men were not aware that their wives were currently practicing contraception.

Conclusion: Although the level of awareness about family planning and contraceptive methods is quite satisfactory, the level of contraceptive use is not optimal in our setting. Consequently, more adapted educational and counseling interventions should be undertaken among women, and family planning messages directed to men need to be included too.
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http://dx.doi.org/10.1186/s12978-015-0085-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4598975PMC
October 2015

Assessment of the 10-year risk of cardiovascular events among a group of Sub-Saharan African post-menopausal women.

Cardiol J 2016 28;23(2):123-31. Epub 2015 Sep 28.

Department of Public Heanth, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon.

Background: Post-menopausal women may be at particular risk of developing cardiovascu-lar disease due to metabolic changes occurring at menopause. The present study aimed to assess the 10-year cardiovascular risk (CVR) among a group of post-menopausal women and to deter-mine associated factors.

Methods: This was a cross-sectional study conducted among post-menopausal women in Yaoundé, Cameroon. CVR was calculated using the Framingham risk score.

Results: We enrolled 108 women, their ages ranging from 45 to 80 years, with a mean of 56.4 ± ± 6.9 years. CVR ranged between 1.2% and greater than 30% with a mean of 13.4 ± 8.7%. Forty-three (39.8%) participants had a low CVR (< 10%), 39 (36.1%) women had a moderate CVR (10-20%), and 21 (24.1%) women had a high CVR (> 20%). Low-density lipoproteins cholesterol (LDL-C; b = 3.27, p = 0.004), fasting plasma glucose (b = 5.40, p = 0.015), and diastolic blood pressure (DBP; b = 3.49, p < 0.0001) were independently associated with CVR. Women not married (i.e. single, divorced or widowed) (adjusted odds ratio [aOR] 4.66, p = 0.002), those with high titers of LDL-C (≥ 1.6 g/L; aOR 5.07, p = 0.001), and those with elevated DBP (≥ 90 mm Hg; aOR 8.10, p < 0.0001) presented an increased likelihood to be at an advanced level of CVR.

Conclusions: A significant number of post-menopausal women are at considerable risk of cardiovascular events in our setting. Therefore, they should be educated to adopt healthy life-styles for substantial reduction in their CVR.
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http://dx.doi.org/10.5603/CJ.a2015.0056DOI Listing
March 2017

The Acute Chest Syndrome in Cameroonian children living with sickle cell disease.

BMC Pediatr 2015 Sep 21;15:131. Epub 2015 Sep 21.

Mother and Child Centre of the Chantal Biya Foundation, Yaoundé, Cameroon.

Background: Although sub-Saharan Africa (SSA) is particularly affected by sickle cell disease (SCD), there is dearth of research on this topic in the region, specifically targeting the magnitude of SCD-related complications. We therefore conducted this study to determine the burden of acute chest syndrome (ACS) and describe its clinical and therapeutic aspects among SCD children in Cameroon, a SSA country.

Methods: This was a retrospective study carried-out from September 2013 to June 2014 at the SCD unit of the Mother and Child Centre of the Chantal Biya Foundation, a pediatric reference centre in Yaoundé, Cameroon. We enrolled all SCD children with confirmed diagnosis of ACS, and recorded their clinical presentation at admission along with their evolution during hospitalization.

Results: Twenty one cases of ACS were identified during the study period, from 338 hospitalizations of children with SCD. Ages ranged from 11 months to 16 years with a mean (standard deviation) of 5.5 (3.4) years, and a male/female sex ratio of 3.2/1. We noticed relatively low levels of HbF, from 6.4 to 21.9% with a mean of 14.6% (6.0%). The three main symptoms at admission were fever (90.5%), cough (81%) and chest pains (28.6%). Two patients (9.5%) developed ACS 2 days after admission. The mean values of leukocytes, neutrophils, serum CRP, serum LDH and hemoglobin were respectively 32479.4 (17862.3)/mm(3), 23476 (11543.7)/mm(3), 228.2 (132.6) mg/l, 3452.3 (2916.3) IU/l and 6.5 (1.2) g/dl. The main localizations of radiological alveolar consolidations were the lower lobes (90.5%). Treatment associated broad-spectrum antibiotics (100%), hydration (100%), analgesics (43.2%), whole blood transfusion (66.7%), and oxygen supplementation (33.3%). Blood transfusion significantly improved hemoglobin level (p = 0.039). The duration of hospitalization, the mean of which was 6.8 (3.1) days, was influenced by none of the tested variables (all p values > 0.05).

Conclusion: ACS is frequent among SCD children in our milieu. Its etiologies seem to be multifactorial. Patients' parents should be educated to recognize early signs and symptoms of the disease, and consult rapidly. Additionally, clinicians must be trained to diagnose ACS, and manage it promptly and efficiently to avoid its related catastrophic consequences.
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http://dx.doi.org/10.1186/s12887-015-0454-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4578678PMC
September 2015

Hypertension prevalence, incidence and risk factors among children and adolescents in Africa: a systematic review and meta-analysis protocol.

BMJ Open 2015 Sep 15;5(9):e008472. Epub 2015 Sep 15.

Department of Preventive and Social Medicine, Laval University, Québec City, Québec, Canada.

Introduction: The African adult population is facing a growing epidemic of hypertension. Establishment of accurate epidemiological data on hypertension in African children and adolescents may have important implications for hypertension preventive strategies in Africa.

Methods And Analysis: This systematic review and meta-analysis will follow the MOOSE Guidelines. Relevant abstracts published in English/French from 1 January 1985 to 31 July 2015 will be searched in PubMed, Google Scholar and Online African journals. Full texts of eligible studies will then be accessed through PubMed, Google Scholar, HINARI and the respective journals' websites. Relevant unpublished papers and conference proceedings will also be checked. Data will be analysed using R statistical software. The study-specific estimates will be pooled through a random-effects meta-analysis model to obtain an overall summary estimate of the prevalence/incidence of hypertension across studies. Also, we will assess the association between risk factors and hypertension. Heterogeneity of studies will be evaluated by the χ(2) test on Cochrane's Q statistic. Funnel plots analysis and Egger's test will be done to detect publication bias. Results will be presented by geographic region (central, eastern, northern, southern and western Africa). A p value less than 0.05 will be considered significant for factors that predicted hypertension.

Ethics And Dissemination: The current study is based on published data, and thus ethical approval is not required. This systematic review and meta-analysis is expected to serve as input for designing early life preventive and control strategies, and as a guide for future research based on existing gaps. The final report of the systematic review in the form of a scientific paper will be published in peer-reviewed journals. Findings will further be presented at conferences and submitted to relevant health authorities.

Trial Registration Number: CRD42015019029.
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http://dx.doi.org/10.1136/bmjopen-2015-008472DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4577976PMC
September 2015

Are the current recommendations for the use of aspirin in primary prevention of cardiovascular disease applicable in low-income countries?

Vasc Health Risk Manag 2015 25;11:503-6. Epub 2015 Aug 25.

Sickle Cell Disease Unit, Mother and Child Centre, Chantal BIYA Foundation, Yaoundé, Cameroon ; Department of Public Health, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon.

Although evidence has accumulated that long-term aspirin therapy is beneficial in secondary prevention of cardiovascular disease (CVD), a lot of controversies persist regarding the benefit of aspirin use in primary prevention of CVD. In low-income countries (LIC) specifically, the decision to prescribe aspirin for primary CVD prevention is more problematic, as there is a dearth of evidence in this regard. Aspirin has been shown to have relative beneficial effects in preventing a first myocardial infarction, but not stroke. However, as stroke is the prevailing CVD in many LIC, especially in Africa, the benefit of aspirin in these settings is therefore questionable. Indeed, there is no published trial that has evaluated the benefits and risks of continuous aspirin therapy in populations of LIC. Furthermore, though cardiovascular risk assessment is crucial in decision-making for the use of aspirin in primary prevention of CVD, there are no risk assessment tools that have been validated in African populations. Studies are urgently warranted, to determine the usefulness of aspirin in primary prevention of CVD in low-income settings where the drug is highly available and affordable, as CVD is becoming the leading cause of deaths in LIC.
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http://dx.doi.org/10.2147/VHRM.S87398DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4556041PMC
May 2016

Features of human scabies in resource-limited settings: the Cameroon case.

BMC Dermatol 2015 Jul 23;15:12. Epub 2015 Jul 23.

Department of Medicine and Medical Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon.

Background: The persistent high prevalence of human scabies, especially in low- and middle-income countries prompted us to research the sociodemographic profile of patients suffering from it, and its spreading factors in Cameroon, a resource-poor setting.

Methods: We conducted a cross-sectional survey from October 2011 to September 2012 in three hospitals located in Yaoundé, Cameroon, and enrolled patients diagnosed with human scabies during dermatologists' consultations who volunteered to take part in the study.

Results: We included 255 patients of whom 158 (62 %) were male. Age ranged from 0 to 80 years old with a median of 18 (Inter quartile range: 3-29) years. One to eight persons of our patients' entourage exhibited pruritus (mean = 2.1 ± 1.8). The number of persons per bed/room varied from 1 to 5 (mean = 2.1 ± 0.8). The first dermatologist's consultation occurred 4 to 720 days after the onset of symptoms (mean = 77.1 ± 63.7). The post-scabies pruritus (10.2 % of cases) was unrelated to the complications observed before correct treatment (all p values > 0.05), mainly impetiginization (7.1 %) and eczematization (5.9 %).

Conclusion: Human scabies remains preponderant in our milieu. Populations should be educated on preventive measures in order to avoid this disease, and clinicians' knowledges must be strengthened for its proper diagnosis and management.
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http://dx.doi.org/10.1186/s12895-015-0031-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4512092PMC
July 2015

Fructosamine measurement for diabetes mellitus diagnosis and monitoring: a systematic review and meta-analysis protocol.

BMJ Open 2015 May 15;5(5):e007689. Epub 2015 May 15.

Non-communicable Disease Research Unit, South African Medical Research Council and University of Cape Town, Cape Town, South Africa.

Introduction: Fructosamine is a marker of glucose control reflecting the average glycaemic level over the preceding 2-3 weeks. Fructosamine has not gained as much popularity as glycated haemoglobin (HbA1c) for diabetes mellitus (DM) control monitoring, and the related underlying reasons remain unclear. We aim to search for and summarise available evidence on the accuracy of fructosamine measurements to diagnose and monitor DM.

Methods And Analysis: This systematic review will include randomised control trials, controlled before-and-after studies, time series designs, cohort studies, case-control studies and cross-sectional surveys reporting the diagnosis and/or monitoring of DM (type 1 DM, type 2 DM and gestational DM) with fructosamine compared with other measures of glycaemia (fasting glucose, oral glucose tolerance test, random glucose, HbA1c), without any language restriction. We will perform electronic searches in PubMed, Scopus and other databases, supplemented with manual searches. Articles published from 1 January 1980 to 30 June 2015 will be eligible for inclusion in this review. Two authors will independently screen, select studies, extract data and assess the risk of bias with discrepancies resolved by consensus. We will assess clinical heterogeneity by examining the types of interventions and outcomes in each study, and pool studies judged to be clinically homogeneous. We will also assess statistical heterogeneity using the χ(2) test of homogeneity and quantify it using the I(2) statistic. Absolute accuracy measures (sensitivity, specificity) will be pooled in a bivariate random-effects model, allowing for intersetting variability. Negative and positive predictive values will be computed for fructosamine, compared with another measure of glycaemia from the pooled estimates of sensitivity and specificity, using Bayes' theorem.

Ethics And Dissemination: This systematic review will use data from published studies and does not require ethics approval. Findings will be published in a peer-reviewed journal and presented at scientific conferences.

Trial Registration Number: PROSPERO (ID=CRD42015015930).
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http://dx.doi.org/10.1136/bmjopen-2015-007689DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4442252PMC
May 2015

Prevalence, infectivity and correlates of hepatitis B virus infection among pregnant women in a rural district of the Far North Region of Cameroon.

BMC Public Health 2015 May 2;15:454. Epub 2015 May 2.

Department of Obstetrics and Gynecology, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon.

Background: Epidemiological data on hepatitis B virus (HBV) infection among pregnant women in Cameroon are very scarce, especially in the rural milieu. The purpose of this study was to determine the prevalence and factors associated with HBV infection, and the infectivity of rural pregnant women in the Far North Region of Cameroon.

Methods: A cross-sectional study was conducted in three rural health facilities of the Guidiguis health district between December 2013 and March 2014. We consecutively recruited 325 pregnant women attending antenatal consultations. A pretested questionnaire was used to collect socio-demographic data and factors associated with HBV infection. The presence of hepatitis B surface antigen (HBsAg), hepatitis B e antigen (HBeAg) and human immunodeficiency virus (HIV) were determined using commercial test strips. Regression analyses were used to assess correlates of HBV infection.

Results: The mean age was 24.4 (SD5.6) years. Most women were married (97.2%) and housewives (96.4%), with less than secondary education level (80%). Only 4 women (1.2%) had been vaccinated against HBV. Thirty-three women (10.2%) were HBsAg-positive, of whom 4 (12.1%) were positive to HBeAg. The prevalence of HIV infection was 2.5% (8/325). Overall, 5 (1.5%) women were co-infected with HIV and HBV. Independent correlates of HBV infection included history of blood transfusion (adjusted odd ratio 12.59, 95% CI 1.46-108.89; p = 0.021) and concurrent infection by HIV (adjusted odd ratio 22.53, 95% CI 4.76-106.71; p < 0.0001).

Conclusion: The prevalence of HBV infection among pregnant women in this rural milieu is high. History of blood transfusion and HIV infection are highly associated with HBV infection. The relative low rate of women positive to both HBsAg and HBeAg suggests that perinatal transmission of HBV might not be the prevailing mode of HBV transmission in this area.
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http://dx.doi.org/10.1186/s12889-015-1806-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4428236PMC
May 2015

Primary care physicians' practice regarding diabetes mellitus diagnosis, evaluation and management in the West region of Cameroon.

BMC Endocr Disord 2015 Apr 4;15:18. Epub 2015 Apr 4.

Internal Medicine Unit, Edéa Regional Hospital, Edéa, Cameroon.

Background: Primary care physicians (PCPs) are the main providers of diabetes care especially in resource-limited countries which experience extreme shortage of specialists. The present study aimed to evaluate PCPs' approach towards diabetes mellitus (DM) diagnosis, evaluation and management in Cameroon.

Methods: We carried-out a cross-sectional survey in February 2012 in the West Region of Cameroon. Using a structured pretested questionnaire, we interviewed all PCPs working in the region who were present at their working place when the investigators visited, and volunteered to be enrolled in the study.

Results: Sixty-six PCPs were interviewed. Their ages ranged from 24 to 56 years (mean 38.3, standard deviation 9.2 years). The levels of knowledge of PCPs regarding DM diagnosis were: 72.7%, 37.9%, 19.7% and 32.8% respectively obtained when using fasting plasma glucose, post-prandial glycemia, random glycemia and glycated hemoglobin as diagnostic tools. Only 6 PCPs (9.9%) prescribed the correct minimal work-up to evaluate diabetes patients at diagnosis. PCPs advised lifestyle modifications in 92.4% of cases, and thirty nine (53.1%) PCP's used to prescribe both generic and specialty oral anti-diabetic drugs in case of uncomplicated type 2 DM management. The two main classes of anti-diabetic drugs prescribed were biguanides (77.3%) and sulfonamides (60.6%). Nearly all PCPs (97%) used to give frequent follow-up appointments to their patients. Ninety eight point five percent of participants were willing to receive any further continuous training on DM management.

Conclusion: PCPs knowledge and practices towards diabetes mellitus diagnosis, evaluation and management were not optimal, stressing the need to improve their capacities regarding diabetes care. As such, more educational initiatives should be taken on, alongside regular upgrade and dissemination of clinical guidelines.
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http://dx.doi.org/10.1186/s12902-015-0016-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4403824PMC
April 2015
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