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1.  The Burden of Orphans and Vulnerable Children Due to HIV/AIDS in Cameroon 
The Open AIDS Journal  2012;6:245-258.
HIV/AIDS is a major public health problem in Cameroon and Africa, and the challenges of orphans and vulnerable children are a threat to child survival, growth and development. The HIV prevalence in Cameroon was estimated at 5.1% in 2010. The objective of this study was to assess the burden of orphans and vulnerable children due to HIV/AIDS in Cameroon. A structured search to identify publications on orphans and other children made vulnerable by AIDS was carried out. A traditional literature search on google, PubMed and Medline using the keywords: orphans, vulnerable children, HIV/AIDS and Cameroon was conducted to identify potential AIDS orphans publications, we included papers on HIV prevalence in Cameroon, institutional versus integrated care of orphans, burden of children orphaned by AIDS and projections, impact of AIDS orphans on Cameroon, AIDS orphans assisted through the integrated care approach, and comparism of the policies of orphans care in the central African sub-region. We also used our participatory approach working experience with traditional rulers, administrative authorities and health stakeholders in Yaounde I and Yaounde VI Councils, Nanga Eboko Health District, Isangelle and Ekondo Titi Health Areas, Bafaka-Balue, PLAN Cameroon, the Pan African Institute for Development-West Africa, Save the orphans Foundation, Ministry of Social Affairs, and the Ministry of Public Health. Results show that only 9% of all OVC in Cameroon are given any form of support. AIDS death continue to rise in Cameroon. In 1995, 7,900 people died from AIDS in the country; and the annual number rose to 25,000 in 2000. Out of 1,200,000 orphans and vulnerable children in Cameroon in 2010, 300,000(25%) were AIDS orphans. Orphans and the number of children orphaned by AIDS has increased dramatically from 13,000 in 1995 to 304,000 in 2010. By 2020, this number is projected to rise to 350,000. These deaths profoundly affect families, which often are split up and left without any means of support. Similarly, the death of many people in their prime working years hamper the economy. Businesses are adversely affected due to the need to recruit and train new staff. Health and social service systems suffer from the loss of health workers, teachers, and other skilled workers. OVC due to HIV/AIDS are a major public health problem in Cameroon as the HIV prevalence continues its relentless increase with 141 new infections per day. In partnership with the Ministry of Social Affairs and other development organizations, the Ministry of Public Health has been striving hard to provide for the educational and medical needs of the OVC, vocational training for the out-of- school OVC and income generating activities for foster families and families headed by children. A continous multi-sectorial approach headed by the government to solve the problem of OVC due to AIDS is very important. In line with the foregoing, recommendations are proposed for the way forward.
doi:10.2174/1874613601206010245
PMCID: PMC3514708  PMID: 23248738
AIDS; AIDS orphans; Cameroon; care; Central Africa; HIV; orphans; OVC effort index; prevalence; support; vulnerable children.
2.  Sensitisation to mites in a group of patients with asthma in Yaounde, Cameroon: a cross-sectional study 
BMJ Open  2014;4(1):e004062.
Objectives
Sensitisation of asthmatic patients to mites in sub-Saharan Africa has been less described. The aim of this study was to assess the prevalence and determinants of sensitisation to mites in asthmatic adolescents and adults in Yaounde, Cameroon.
Design
This was a cross-sectional study. Logistic regression models were employed to investigate the determinants of sensitisation to mites.
Setting
This study was carried out at the Jamot Hospital and CEDIMER private centre, in Yaounde, capital city of Cameroon.
Participants
All asthmatic patients received in consultations from January 2012 to June 2013 and in whom prick-skin tests for perennial aeroallergens were performed were included.
Outcome measures
Prevalence of sensitisation to mites and associated factors.
Results
In total, 201 patients (132 being women, 65.7%), with a median age of 36 (25th–75th centiles: 20–54) years were included, with 135 (67.2%) having a positive skin test for mites. Sensitisation to Dermatophagoïdes pteronyssinus, Dermatophagoides farinae and Blomia tropicalis was found in 53.2%, 49.8% and 47.8% of the patients, respectively. Intermittent rhinitis (16.3% vs 7.6%) and persistent rhinitis (43.0% vs 22.7%) were more frequent in sensitised patients than in the non-sensitised ones (p<0.010). Independent allergological determinants of sensitisation to mites were sensitisation to Alternaria alternata (adjusted OR 14.98 (95% CIs 1.96 to 114.4)) and sensitisation to Blattella germanica (3.48 (1.34 to 9.00)).
Conclusions
Sensitisation to mites was found in about two-thirds of asthmatic patients in this setting, with a frequent multiple sensitisations to A alternata and Blattella germanica. Systematically investigating asthmatic patients for mites' sensitisation and determinants will help optimising the care in this setting by combining the aetiological treatment for the allergy with symptomatic treatment for asthma, in order to modify the natural course of the disease.
doi:10.1136/bmjopen-2013-004062
PMCID: PMC3902465  PMID: 24390384
3.  New Highly Divergent rRNA Sequence among Biodiverse Genotypes of Enterocytozoon bieneusi Strains Isolated from Humans in Gabon and Cameroon▿  
Journal of Clinical Microbiology  2007;45(8):2580-2589.
Intestinal microsporidiosis due to Enterocytozoon bieneusi is a leading cause of chronic diarrhea in severely immunocompromised human immunodeficiency virus (HIV)-positive patients. It may be a public health problem in Africa due to the magnitude of the HIV pandemic and to poor sanitary conditions. We designed two prevalence studies of E. bieneusi in Central Africa, the first with HIV-positive patients from an urban setting in Gabon and the second with a nonselected rural population in Cameroon. Stool samples were analyzed by an immunofluorescence antibody test and PCR. Twenty-five out of 822 HIV-positive patients from Gabon and 22 out of 758 villagers from Cameroon were found to be positive for E. bieneusi. The prevalence rates of the two studies were surprisingly similar (3.0% and 2.9%). Genotypic analysis of the internal transcribed spacer region of the rRNA gene showed a high degree of diversity in samples from both countries. In Gabon, 15 isolates showed seven different genotypes: the previously reported genotypes A, D, and K along with four new genotypes, referred to as CAF1, CAF2, CAF3, and CAF4. In Cameroon, five genotypes were found in 20 isolates: the known genotypes A, B, D, and K and the new genotype CAF4. Genotypes A and CAF4 predominated in Cameroon, whereas K, CAF4, and CAF1 were more frequent in Gabon, suggesting that different genotypes present differing risks of infection associated with immune status and living conditions. Phylogenetic analysis of the new genotype CAF4, identified in both HIV-negative and HIV-positive subjects, indicates that it represents a highly divergent strain.
doi:10.1128/JCM.02554-06
PMCID: PMC1951207  PMID: 17537939
4.  The impact of health education on the prevalence of faecal-orally transmitted parasitic infections among school children in a rural community in Cameroon 
Background>
Faecal-orally transmitted parasites are those parasites which are spread through faecal contamination of food and drinks. Infections with these parasites are among the most common in the world being responsible for considerable morbidity and mortality, especially in children. This study was carried out to determine the impact of health education on the prevalence of faecal-orally transmitted parasitic infections among primary school children in a typical African rural community.
Methods
An intervention study was conducted in two villages in the South-West Region of Cameroon. A total of 370 volunteer pupils aged between 5-15 years were enrolled in the study out of which 208 were from Kake II (experimental arm) and 162 from Barombi-Kang (control arm). The research was conducted in two phases. In phase 1, stool samples were collected from all participants and analyzed using the formol-ether concentration technique and health education was given to the pupils in the experimental village but not in the control village. Phase 2 was conducted six months later during which only stool samples were collected and analyzed from both villages.
Results
Before health education intervention (phase1) faecal-orally transmitted parasites were present in 106 (50.9%) stool specimens collected in Kake II and in 84 (51.5%) of those collected in Barombi-kang. The difference in prevalence between these two villages was not significant (P>0.05). After health education intervention (phase2), 56 (26.9%) stool specimens were positive for faecal-oral parasite in Kake II and 92 (54.7%) in Barombi-kang, and the difference in prevalence between these two villages was statistically significant (P0.05). The change in the prevalence of infection was significant in Kake II (50.9% vs. 26.9%, P0.05). Hence, health education applied in the experimental village was responsible for the drop in the prevalence observed, especially among pupils infected with Ascaris lumbricoides (24.9% vs. 3.4%, P=0.004)
Conclusion
Health education through the framework of schools can be used as a strategy for the control of faecal-orally transmitted parasitic infections among children in African rural communities.
PMCID: PMC3201601  PMID: 22121446
Intestinal parasites; parasitic infections; health education; Cameroon
5.  Public awareness, knowledge and practice relating to epilepsy amongst adult residents in rural Cameroon - case study of the Fundong health district 
Introduction
Epilepsy associated stigma remains a main hindrance to epilepsy care, especially in developing countries. In Africa, anti-epileptic drugs are available, affordable and effective. As of now, no community survey on epilepsy awareness and attitudes has been reported from this area Cameroon with a reported high prevalence of epilepsy.
Methods
To contribute data to the elaboration of the National Epilepsy Control Programme, we carried out a cross-sectional descriptive community survey of 520 households. We had as main objective to obtain baseline data on the knowledge, attitudes and practice of adults towards epilepsy in rural Cameroon, and compare with existing data.
Results
Most respondents had heard or read about epilepsy, knew someone who had epilepsy and had seen someone having a seizure. The most frequently cited cause of epilepsy was witchcraft. Most subjects believed epilepsy is contagious. Epilepsy was a form of madness or insanity to 33.5% of them. Only 54.9% of respondents would meet a medical doctor for the treatment. Most respondents would not permit equal employment opportunities, association and child's marriage to someone with epilepsy. Age, female sex and level of education were associated to negative attitudes (p<0.001).
Conclusion
Adults in Fundong are very acquainted with epilepsy but have many erroneous beliefs about the condition. Their attitudes are generally negative. The National Epilepsy Programme must insist on modes of transmission, treatment options and first aid measures during epileptic seizures. The elderly (>50 years) and those without any formal education should be the main targets during health information, education and communication programmes.
doi:10.11604/pamj.2013.14.32.2284
PMCID: PMC3597900  PMID: 23503525
Cameroon; rural; epilepsy; awareness; practice; Fundong
6.  The lipid profile of HIV-infected patients receiving antiretroviral therapy in a rural Cameroonian population 
BMC Public Health  2014;14:236.
Background
Long term use of antiretroviral therapy (ART) in persons living with human immunodeficiency virus (PLWHIV) is associated with disturbances in blood lipids which should be monitored. More data on such disturbances are needed in Cameroon to persuade the country program to institute their routine monitoring. We then sought to determine the prevalence and timing of dyslipidaemia in PLWHIV and receiving ART in a predominantly rural Cameroonian setting.
Methods
A cross-sectional study conducted between August and October 2012 in HIV-infected persons aged 15 years or more and receiving first-line ART for at least six months at The Nkongsamba Regional Hospital in Cameroon. Lipid assays were carried out by enzymatic-linked colorimetric methods. A multiple logistic regression model was used to assess for factors related to dyslipidaemia.
Results
Included were 114 participants of whom 83 (72.8%) were females. Their median age was 43 years (IQR: 36–51) and their median CD4 count was 436 cells/μl (IQR: 275–585) after a median duration on ART of 36 months (IQR: 12–60). The prevalence of dyslipidaemia was 70.2%. Hypercholesterolaemia was observed in 34 (29.8%) patients. One-third of them had a high LDL-cholesterol level (LDL-c ≥ 130 mg/dl). Hypertriglyceridaemia (TG ≥ 150 mg/dl) was present in 59 (51.8%) cases. The proportion of patients with a low HDL-cholesterol (HDL-c < 40 mg/dl) was 18.4% while those with a ratio of TC/HDL-c ≥ 5 were about 16.7%. A duration of 2–4 years on ART (adjusted Odd Ratio, aOR = 5.22, 95% CI: 1.43-19.06, p = 0.01), current smokers (aOR = 15.94, 95% CI: 1.13-225.61, p = 0.04) and a concurrent metabolic disease (aOR = 12.54, 95% CI: 1.02-153.86, p = 0.48) were independently associated with pro-atherogenic LDL-c values. Alcohol users had a more friendly LDL-c profile (aOR = 0.24, 95% CI: 0.07-0.74, p = 0.01).
Conclusion
The study has demonstrated a high prevalence of dyslipidaemia in HIV-patients receiving first-line ART in a predominantly rural setting of Cameroon. There is a need for the country HIV program to institute laboratory monitoring of blood lipids in patients over two years on first line ART with a focus on smokers.
doi:10.1186/1471-2458-14-236
PMCID: PMC3973972  PMID: 24606888
HIV; Antiretroviral therapy; Blood lipids; Cameroon
7.  Skin infections in male pupils of primary schools in Al Ahsa 
Objectives:
To determine the prevalence, the nature, and the possible socio-demographic risk factors involved in the development of common transmissible skin disorders (TSD) among the studied population.
Materials and Methods:
A cross-sectional consecutive survey was carried out from November 15, 2008 to May 14, 2009 in Al-Ahsa governorate. This study included 1337 male primary school children. Data were collected using the following tools: Socio-demographics and hygienic habits according to pre-established forms and a thorough dermatological examination of all the included children.
Results:
The prevalence of TSD was 27.15% with a statistically significant difference according to rural/urban locations (33.74% vs. 22.27%). Fungal infections were the leading diseases (9.1%) followed by bacterial infections (8.9%), parasitic infestations (4.3%), and viral infections (4.1%). TSD were significantly more frequent in students whose fathers have a primary or preparatory educational status and in the students having the habit to play barefooted.
Conclusion:
Our study found that TSD was relatively frequent among male primary school students in Al-Ahsa. Our study has several limitations. One major limitation is that female primary school students were excluded from the study. Despite this major limitation, we hope the findings may be useful in planning health care programs for Saudi children with the hope of reducing the prevalence of TSD in the future.
doi:10.4103/2230-8229.108189
PMCID: PMC3663166  PMID: 23723733
Childhood; skin infections; skin parasitic infestations
8.  Farmers' perception on the importance of variegated grasshopper (Zonocerus variegatus (L.)) in the agricultural production systems of the humid forest zone of Southern Cameroon 
Background
Zonocerus variegatus (Linnaeus, 1758) (Orthoptera: Pyrgomorphidae) is known as an agricultural pest in West and Central Africa. However, its importance in the agricultural production system in Cameroon has not been investigated. The study assesses farmers' perception on the importance of Z. variegatus in the agricultural production systems of the humid forest zone of Southern Cameroon.
Methods
Research was carried out in 5 villages of each of three Agro-Ecological, Cultural and Demographic Blocks (AECD-Blocks) of the Forest Margin Benchmark Area (FMBA). In each village, a semi-structured survey was used; male and female groups of farmers were interviewed separately.
Results
Z. variegatus is present throughout the humid forest zone of Southern Cameroon, where it is ranked as the third most economically important insect pest of agriculture. In the farmers' opinion, Z. variegatus is a polyphagous insect with little impact on young perennial crops. The length of the pre-farming fallow does not affect Z. variegatus pest pressure in the following crops. The increased impact of the grasshopper observed today in the fields, compared to what existed 10 years ago is as a result of deforestation and increase in surface of herbaceous fallow. The damage caused by Z. variegatus is higher in fields adjacent to C. odorata and herbaceous fallows than in those adjacent to forests and shrubby fallows. The fight against this grasshopper is often done through physical methods carried out by hand, for human consumption. The farmers highlight low usage of the chemical methods and a total absence of biological and ecological methods.
Conclusion
Farmers' perception have contributed to understanding the status of Z. variegatus in the humid forest zone of Southern Cameroon. The results are in general similar to those obtained in other countries.
doi:10.1186/1746-4269-2-17
PMCID: PMC1464119  PMID: 16573815
9.  A Cross-Sectional Study of Dermatological Problems Among Differently-Abled Children 
Indian Journal of Dermatology  2012;57(1):35-37.
Background:
Differently-abled children may be particularly susceptible to skin disorders either as a direct consequence of their disability or due of lack awareness regarding personal and environmental hygiene.
Aim:
To study the prevalence of skin problems in differently-abled children.
Materials and Methods:
A total of 122 differently-abled children in two special schools were examined for this study. Details regarding the disabilities were obtained from the school records.
Results:
More than half (53.2%) of the children had skin problems. Infections and infestations, acne, and dermatitis were the common dermatoses encountered in the present study.
Conclusion:
Periodic skin examination is of vital importance for all people with disabilities to reach a proper diagnosis and to offer treatment. Health education for teachers and parents on maintenance of sound personal hygiene and a clean environment is also recommended.
doi:10.4103/0019-5154.92674
PMCID: PMC3312654  PMID: 22470206
Differently-abled children; psychocutaneous diseases; skin diseases; school survey
10.  Pig-farming systems and porcine cysticercosis in the north of Cameroon 
Journal of Helminthology  2010;84(4):441-446.
A survey was conducted in 150 households owning 1756 pigs in the rural areas of Mayo-Danay division in the north of Cameroon. A questionnaire survey was carried out to collect information on the pig-farming system and to identify potential risk factors for Taenia solium cysticercosis infection in pigs. Blood samples were collected from 398 pigs with the aim of estimating the seroprevalence of T. solium cysticercosis. The results showed that 90.7% of the pigs are free roaming during the dry season and that 42.7% of households keeping pigs in the rural areas have no latrine facility. Seventy-six per cent of the interviewed pig owners confirmed that members of the household used open-field defecation. Enzyme-linked immunosorbent assay (ELISA) for antigen and antibody detection showed an apparent prevalence of cysticercosis of 24.6% and 32.2%, respectively. A Bayesian approach, using the conditional dependence between the two diagnostic tests, indicated that the true seroprevalence of cysticercosis in Mayo-Danay was 26.6%. Binary logistic regression analysis indicated that a lack of knowledge of the taeniasis–cysticercosis complex and the absence of a pig pen in the household were associated with pig cysticercosis.
doi:10.1017/S0022149X10000167
PMCID: PMC2965494  PMID: 20334716
11.  Emergence of a Novel and Highly Divergent HTLV-3 in a Primate Hunter in Cameroon 
Virology  2010;401(2):137-145.
The recent discovery of human T-lymphotropic virus type 3 (HTLV-3) in Cameroon highlights the importance of expanded surveillance to better understand the prevalence and public health impact of this new retrovirus. HTLV diversity was investigated in 402 persons in rural Cameroon who reported simian exposures. Plasma from 29 persons (7.2%) had reactive serology. HTLV tax sequences were detected in 3 persons. Phylogenetic analysis confirmed HTLV-1 infection in two individuals, and HTLV-3 infection in a third person (Cam2013AB). The complete proviral genome from Cam2013AB shared 98% identity and clustered tightly in distinct lineage with simian T-lymphotropic virus type 3 (STLV-3) subtype D recently identified in two guenon monkeys near this person’s village. These results document a fourth HTLV-3 infection with a new and highly divergent strain we designate HTLV-3 (Cam2013AB) subtype D demonstrating the existence of a broad HTLV-3 diversity likely originating from multiple zoonotic transmissions of divergent STLV-3.
doi:10.1016/j.virol.2010.03.010
PMCID: PMC2862145  PMID: 20353873
retrovirus; zoonoses; HTLV; STLV; emergence; nonhuman primates; hunters; evolution; diversity
12.  Prevalence of Trachoma in the North Region of Cameroon: Results of a Survey in 15 Health Districts 
Background
To estimate the prevalence of trachoma in the North Region of Cameroon in order to facilitate the planning of trachoma control activities in this region, a survey was carried out in 2011 and 2012 in 15 health districts (HDs).
Methodology
A cross-sectional, two-stage cluster random sampling survey was carried out. The survey focused on two target populations: children aged 1 to 9 years for the prevalence of Trachomatous Inflammation-Follicular (TF) and those aged 15 and over for the prevalence of Trachomatous Trichiasis (TT). The sample frame was an exhaustive list of villages and neighborhoods of HDs. The World Health Organization simplified trachoma grading system was used for the recognition and registration of cases of trachoma.
Principal Findings
30,562 children aged 1 to 9 years and 24,864 people aged 15 and above were examined. In children aged 1–9 years, the overall prevalence of TF was 4.2% (95% confidence intervals (CI): 4.0–4.5%). Three (3) of 15 HDs in the region showed TF prevalence of ≥10% (Poli, Rey Bouba, and Tcholliré). The overall TT prevalence was 0.25% (95% CI: 0.20–0.33%). There were estimated 1265 TT cases in the region. The prevalence of blindness was 0.01% (95% CI: 0.00–0.03%), low vision was 0.11% (95% CI: 0.07–0.17%), and corneal opacity was 0.22% (95% CI: 0.17–0.29%).
Conclusions/Significance
This survey provides baseline data for the planning of activities to control trachoma in the region. The overall prevalence of TF in the region is 4.2%, and that of TT is 0.2%; three HDs have a TF prevalence ≥10%. These three HDs are eligible for mass drug administration with azythromycin, along with the implementation of the “F” and “E” components of the SAFE strategy.
Author Summary
Trachoma is the most common infectious cause of blindness. Recurrent episodes of infection with Chlamydia trachomatis cause conjunctival inflammation in children who go on to develop scarring and blindness as adults. The current effort led by the World Health Organization (WHO) and the Alliance for Global Elimination of Blinding Trachoma by the year 2020 (GET2020) is to eliminate trachoma as a blinding disease worldwide by the year 2020 using the SAFE strategy (Surgery, Antibiotics, Facial cleanliness and Environmental improvement). To estimate the prevalence of trachoma in the North Region of Cameroon in order to facilitate the planning of trachoma control activities in this region, a survey was carried out in 2011 and 2012 in 15 health districts (HDs). The overall prevalence of TF in the region is 4.2%, and that of TT is 0.25%; three HDs have a TF prevalence ≥10%. These three HDs are eligible for mass drug administration with azythromycin, along with the implementation of the “F” and “E” components of the SAFE strategy. There were estimated 1265 TT. This survey provides baseline data for the planning of activities to control trachoma in the region.
doi:10.1371/journal.pntd.0002932
PMCID: PMC4055491  PMID: 24922055
13.  The Evolution of HIV-1 Diversity in Rural Cameroon and its Implications in Vaccine Design and Trials 
Viruses  2010;2(2):639-654.
West-Central Africa is an epicenter of the HIV pandemic; endemic to Cameroon are HIV-1 viruses belonging to all (sub)subtypes and numerous Circulating Recombinant Forms (CRFs). The rural villages of Cameroon harbor many strains of HIV-1, though these areas are not as well monitored as the urban centers. In the present study, 82 specimens obtained in 2000 and 2001 from subjects living in the rural villages of the South and West Regions of Cameroon were subtyped in gag, pol, and env and compared to 90 specimens obtained in 2006–2008 in the same regions, in order to analyze HIV-1 evolution in these rural areas. It was found that in the South Region, the proportion of unique recombinant forms (URFs) remained constant (~40%), while the amount of URFs containing fragments of a CRF increased by 25%. (Sub)subtypes A1, F2, H, and K, and CRF09_cpx, identified in 2000 and 2001, were replaced by CRFs 01_AE, 13_cpx, 14_BG, and 18_cpx in 2006–2008. In the West Region, (sub)subtypes A2, C, G, and H, and CRFs 01_AE and 09_cpx, identified in 2000–2001, were replaced by sub-subtype A1 and CRFs 25_cpx and 37_cpx in 2006–2008. The proportion of URFs in the West Region dropped significantly over the time period by 43%. In both Regions, the proportion of CRF02_AG increased at all loci. These findings demonstrate that the evolution of HIV-1 is distinct for each endemic region, and suggests that the proportion of URFs containing CRF fragments is increasing as the genetic identity of the virus continues to shift dramatically. This highlights the concern that subtype-specific vaccines may not be relevant in Cameroon, and that the distribution of viral diversity in these regions of Cameroon must be carefully monitored.
doi:10.3390/v2020639
PMCID: PMC2975583  PMID: 21072143
HIV-1 Diversity; Rural Cameroon; phylogenetics
14.  The Evolution of HIV-1 Diversity in Rural Cameroon and its Implications in Vaccine Design and Trials 
Viruses  2010;2(2):639-654.
West-Central Africa is an epicenter of the HIV pandemic; endemic to Cameroon are HIV-1 viruses belonging to all (sub)subtypes and numerous Circulating Recombinant Forms (CRFs). The rural villages of Cameroon harbor many strains of HIV-1, though these areas are not as well monitored as the urban centers. In the present study, 82 specimens obtained in 2000 and 2001 from subjects living in the rural villages of the South and West Regions of Cameroon were subtyped in gag, pol, and env and compared to 90 specimens obtained in 2006–2008 in the same regions, in order to analyze HIV-1 evolution in these rural areas. It was found that in the South Region, the proportion of unique recombinant forms (URFs) remained constant (∼40%), while the amount of URFs containing fragments of a CRF increased by 25%. (Sub)subtypes A1, F2, H, and K, and CRF09_cpx, identified in 2000 and 2001, were replaced by CRFs 01_AE, 13_cpx, 14_BG, and 18_cpx in 2006–2008. In the West Region, (sub)subtypes A2, C, G, and H, and CRFs 01_AE and 09_cpx, identified in 2000–2001, were replaced by sub-subtype A1 and CRFs 25_cpx and 37_cpx in 2006–2008. The proportion of URFs in the West Region dropped significantly over the time period by 43%. In both Regions, the proportion of CRF02_AG increased at all loci. These findings demonstrate that the evolution of HIV-1 is distinct for each endemic region, and suggests that the proportion of URFs containing CRF fragments is increasing as the genetic identity of the virus continues to shift dramatically. This highlights the concern that subtype-specific vaccines may not be relevant in Cameroon, and that the distribution of viral diversity in these regions of Cameroon must be carefully monitored.
doi:10.3390/v2020639
PMCID: PMC2975583  PMID: 21072143
HIV-1 Diversity; Rural Cameroon; phylogenetics
15.  Prevalence of Trachoma in the Far North Region of Cameroon: Results of a Survey in 27 Health Districts 
Background
Cameroon is known to be endemic with trachoma. To appreciate the burden of the disease and facilitate the national planning of trachoma control in the integrated control program for the neglected tropical diseases, an epidemiological mapping of trachoma was conducted in the Far North region in 2010–11.
Methodology
A cross-sectional, cluster random sampling survey was carried out. The survey focused on two target populations: children aged 1 to 9 years for the prevalence of active trachoma and those aged 15 and over for the prevalence of trichiasis (TT). The sample frame was an exhaustive list of villages and neighborhoods of Health Districts (HDs). The World Health Organization simplified trachoma grading system was used for the recognition and registration of cases of trachoma.
Principal Findings
48,844 children aged 1 to 9 years and 41,533 people aged 15 and over were examined. In children aged 1–9 years, the overall prevalence of trachomatous inflammation–follicular (TF) was 11.2% (95% confidence intervals (CI): 11.0–11.5%). More girls were affected than boys (p = 0.003). Thirteen (13) of 27 HDs in the region showed TF prevalence of ≥10%. The overall TT prevalence was 1.0% (95% CI: 0.9–1.1%). There were estimated 17193 (95% CI: 12576–25860) TT cases in the region. The prevalence of blindness was 0.04% (95% CI: 0.03–0.07%) and visual impairment was 0.09% (95% CI: 0.07–0.13%).
Conclusions/Significance
The survey confirmed that trachoma is a public health problem in the Far North region with 13 HDs qualified for district-level mass drug administration with azithromycin. It provided a foundation for the national program to plan and implement the SAFE strategy in the region. Effort must be made to find resources to provide the surgical operations to the 17193 TT cases and prevent them from becoming blind.
Author Summary
Trachoma is the leading infectious cause of blindness in the world, which is caused by repeated eye infections with the bacterium Chlamydia trachomatis. The global objective of trachoma control is to eliminate trachoma as a blinding disease worldwide by Year 2020, using the World Health Organization-endorsed SAFE strategy (Surgery to correct trichiasis, Antibiotics to treat infection, Facial cleanliness and Environmental improvement to interrupt transmission). In order to implement the control program, the knowledge of the disease distribution and prevalence in each district is essential. Disease mapping surveys were conducted in 27 health districts in the Far North region in Cameroon. Thirteen health districts have a prevalence of trachomatous inflammation–follicular ≥10% in children aged 1–9 years and qualify for district-level mass antibiotic treatment as well as intensive implementation of other components of SAFE. There are estimated to be 17193 trichiasis cases in the region, which need surgical operations to prevent from being blinded. The survey provided a foundation for the national program to plan and implement the SAFE strategy in the region.
doi:10.1371/journal.pntd.0002240
PMCID: PMC3662655  PMID: 23717703
16.  Prevalence, correlates and pattern of Hepatitis B among antenatal clinic attenders in Yaounde-Cameroon: is perinatal transmission of HBV neglected in Cameroon? 
Background
Few studies have evaluated the prevalence of HBV in the general Cameroonian population or among antenatal attendants. The aim of this study was to determine the prevalence, correlates and patterns of Hepatitis B surface antigen among pregnant women attending antenatal care in Yaounde-Cameroon.
Methods
This was a cross-sectional multicenter study carried out in a referral hospital and two secondary hospitals in Yaounde, the capital of Cameroon. The study lasted 15 months (March 2011 to June 2012), and recruited 959 pregnant women. Patient recruitment was consecutive. The HBsAg was tested using the Monalisa HBsAg Ultra ELISA kit. Other hepatitis B markers were equally tested.
We used the statistical package for social sciences (SPSS) version 14.0 software to conduct a quantitative analysis of the derived data. Simple descriptive statistics such as means, standard deviations, and proportions were used to describe the data. We tested for association in categorical variables using the chi-squared (χ2) test. The odds ratio (OR) and the corresponding 95% confidence intervals (95% CI) were used to summarise the strength of association between specific binary exposure and outcome variables. The level of statistical significance for the study was set at p < 0.05.
Results
The prevalence of hepatitis B infection (HBsAg) among antenatal clinic attenders in our setting was 7.7%. Amongst these women, just 5.4% were previously aware of their HBsAg status. The rate of HBV infectivity was high, with 28% of HBsAg positive women having evidence of HBeAg in their plasma, and up to 45.8% of these women lacking antibodies against hepatitis B e antigen (anti-HBe). About 41% of the pregnant women had had previous contact with HBV as evidenced by the positive status for anti-HBc.
Just 2.7% of the pregnant women had previously been vaccinated against HBV. The mean age for HBsAg positivity in our setting was 26.9 ±4.7 years, and the most affected age group was the 25 – 29 years age group. There was no statistically significant association between age or other socio-demographic risk factors and HBsAg status. Numerous risk factors for HBV acquisition exists in our settings, but amongst these, only a history of a contact with hepatitis B infection was found to be significantly associated with HBsAg positivity (OR 1.63, 95% C.I 1.15-2.30). Finally, the coinfection rate of HBV/HIV was 0.74%.
Conclusion
The prevalence of hepatitis B among pregnant women in Cameroon is high, and the pattern tends towards high infectivity and therefore increased risk of perinatal HBV transmission. These highlight the need to step up preventive efforts against hepatitis B infection and perinatal HBV transmission in our community.
doi:10.1186/1471-2393-13-158
PMCID: PMC3751222  PMID: 23924215
Hepatitis B; Pregnancy; Prevalence; Risk factors; Low resource setting
17.  Comparison of Red and Infrared Low-level Laser Therapy in the Treatment of Acne Vulgaris 
Indian Journal of Dermatology  2012;57(2):128-130.
Background/Purpose:
Acne vulgaris is a very prevalent skin disorder and remains a main problem in practice. Recently, phototherapy with various light spectrums for acne has been used. There are some evidences that low-level laser therapy (LLLT) has beneficial effect in the treatment of acne lesions. In this study, two different wavelengths of LLLT (630 and 890 nm) were evaluated in treatment of acne vulgaris.
Materials and Methods:
This study was a single-blind randomized clinical trial. Patients with mild to moderate acne vulgaris and age above 18 years and included were treated with red LLLT (630 nm) and infrared LLLT (890 nm) on the right and left sides of the face respectively, twice in a week for 12 sessions, and clinically assessed at baseline and weeks 2, 4, 6, and 8.
Results:
Twenty-eight patients were participated in this study. Ten weeks after treatment acne lesion were significantly decreased in the side treated by 630 nm LLLT (27.7±12.7 to 6.3±1.9) (P<0.001), but this decrease was not significant in the site treated by 890 nm LLLT (26.9±12.4 to 22.2±8.5) (P>0.05).
Conclusion:
Red wavelength is safe and effective to be used to treat acne vulgaris by LLLT compared to infrared wavelength.
doi:10.4103/0019-5154.94283
PMCID: PMC3352636  PMID: 22615511
Acne vulgaris; clinical trial; low-level laser therapy
18.  Mass treatment of trachoma with azithromycin 1.5% eye drops in the Republic of Cameroon: feasibility, tolerance and effectiveness 
Aims
An epidemiological study carried out in 2006 indicated a high prevalence of blinding trachoma in the Kolofata Health District, Far North Region, Republic of Cameroon. As a result, the national blindness control programme of Cameroon instituted a trachoma elimination programme using the SAFE strategy.
Methods
A campaign to treat the entire district population with azithromycin 1.5% eye drops was undertaken in February 2008. To measure the effectiveness of treatment on the prevalence of active trachoma, two epidemiological studies were conducted on a representative sample of children aged between 1 and 10 years. The first study was performed just prior to the treatment campaign and the second study was performed 1 year later.
Results
The prevalence of active forms of trachoma (trachomatous inflammation—follicular (TF) + TF/trachomatous inflammation—intense (TI)) dropped from 31.5 (95% CI 26.4 to 37.5)% before treatment to 6.3 (95% CI 4.1 to 9.6)% 1 year after treatment—a reduction of nearly 80%. There were no reports of serious or systemic side effects. Tolerance was excellent and no treatment was interrupted.
Conclusion
Mass treatment with azithromycin 1.5% eye drops is feasible, well tolerated and effective.
doi:10.1136/bjo.2009.161513
PMCID: PMC2922718  PMID: 19692356
19.  Oculocutaneous albinism 
Oculocutaneous albinism (OCA) is a group of inherited disorders of melanin biosynthesis characterized by a generalized reduction in pigmentation of hair, skin and eyes. The prevalence of all forms of albinism varies considerably worldwide and has been estimated at approximately 1/17,000, suggesting that about 1 in 70 people carry a gene for OCA. The clinical spectrum of OCA ranges, with OCA1A being the most severe type with a complete lack of melanin production throughout life, while the milder forms OCA1B, OCA2, OCA3 and OCA4 show some pigment accumulation over time. Clinical manifestations include various degrees of congenital nystagmus, iris hypopigmentation and translucency, reduced pigmentation of the retinal pigment epithelium, foveal hypoplasia, reduced visual acuity usually (20/60 to 20/400) and refractive errors, color vision impairment and prominent photophobia. Misrouting of the optic nerves is a characteristic finding, resulting in strabismus and reduced stereoscopic vision. The degree of skin and hair hypopigmentation varies with the type of OCA. The incidence of skin cancer may be increased. All four types of OCA are inherited as autosomal recessive disorders. At least four genes are responsible for the different types of the disease (TYR, OCA2, TYRP1 and MATP). Diagnosis is based on clinical findings of hypopigmentation of the skin and hair, in addition to the characteristic ocular symptoms. Due to the clinical overlap between the OCA forms, molecular diagnosis is necessary to establish the gene defect and OCA subtype. Molecular genetic testing of TYR and OCA2 is available on a clinical basis, while, at present, analysis of TYRP1 and MATP is on research basis only. Differential diagnosis includes ocular albinism, Hermansky-Pudlak syndrome, Chediak-Higashi syndrome, Griscelli syndrome, and Waardenburg syndrome type II. Carrier detection and prenatal diagnosis are possible when the disease causing mutations have been identified in the family. Glasses (possibly bifocals) and dark glasses or photocromic lenses may offer sufficient help for reduced visual activity and photophobia. Correction of strabismus and nystagmus is necessary and sunscreens are recommended. Regular skin checks for early detection of skin cancer should be offered. Persons with OCA have normal lifespan, development, intelligence and fertility.
doi:10.1186/1750-1172-2-43
PMCID: PMC2211462  PMID: 17980020
20.  Impact of community-based vector control on house infestation and Trypanosoma cruzi infection in Triatoma infestans, dogs and cats in the Argentine Chaco 
Acta tropica  2007;103(3):201-211.
The relative impact of two community-based vector control strategies on house infestation by Triatoma infestans and Trypanosoma cruzi infection in bugs, domestic dogs and cats was assessed in two neighboring rural areas comprising 40 small villages and 323 houses in one of the regions most endemic for Chagas disease in northern Argentina. The prevalence and abundance of domestic infestation were 1.5- and 6.5-fold higher, respectively, in the area under pulsed, non-supervised control actions operating under the guidelines of the National Vector Control Program (NCVP) than in the area under sustained, supervised surveillance carried out jointly by the UBA research team and NCVP. The prevalence of infestation and infection varied widely among village groups within each area. In the pulsed control area, the prevalence of infection in bugs, dogs and cats was two- to three-fold higher than in the area under sustained surveillance, most of the infected animals qualified as autochthonous cases, and evidence of recent transmission was observed. Infection was highly aggregated at the household level and fell close to the 80/20 rule. Using multiple logistic regression analysis clustered by household, infection in dogs was associated positively and significantly with variables reflecting local exposure to infected T. infestans, thus demonstrating weak performance of the vector surveillance system. For high-risk areas in the Gran Chaco region, interruption of vector-mediated domestic transmission of T. cruzi requires residual insecticide spraying that is more intense, of a higher quality and sustained in time, combined with community participation and environmental management measures.
doi:10.1016/j.actatropica.2007.06.007
PMCID: PMC2931801  PMID: 17686448
Chagas disease; Dogs; Cats; Risk factors; Surveillance; Sentinel; Trypanosoma cruzi; Triatoma infestans; vector control
21.  Gastrointestinal symptoms in atopic eczema 
Archives of Disease in Childhood  1998;78(3):230-234.
AIMS—To determine the prevalence of gastrointestinal symptoms in children with eczema and the association of such symptoms with the extent of eczema or skin prick test results.
METHODS—Sixty five children with atopic eczema and a control group matched for age and sex were recruited. Their parents completed a questionnaire about the children's gastrointestinal symptoms. The children's skin was examined; their weight, height, and abdominal circumference were measured; and skin prick tests were carried out.
RESULTS—Gastrointestinal symptoms, especially diarrhoea, vomiting, and regurgitation, were more common in the children with eczema. Diarrhoea appeared to be associated with the ingestion of specific foods. Gastrointestinal symptoms were related to diffuse eczema and positive skin prick tests to foods. There was no anthropometric differences between the patient and control groups.
CONCLUSIONS—A gastrointestinal disorder is common in children with eczema, especially with diffuse distribution. This may be responsible for substantial symptoms and may play a part in the pathogenesis of the disease and in the failure to thrive with which it is sometimes associated.


PMCID: PMC1717511  PMID: 9613352
22.  Dichloro-tetrafluoro-ethane as a Freezing Agent 
California Medicine  1956;84(3):151-154.
Surgical skin planing is, in the hands of an experienced operator, a safe and highly effective procedure for treating a number of cutaneous defects, most notably pitted acne scars.
The operation is facilitated by the use of a new instrument (jet-spray handpiece) which allows the operator to freeze the skin and plane it almost simultaneously, and by a new freezing agent, dichlorotetrafluoro-ethane, which adds to the safety by eliminating the old hazards of inflammability, explosion, and the toxic inhalation of ethyl chloride.
The ability to sharply differentiate between keloid and hypertrophic scar is fundamental to surgical skin planing. A hypertrophic scar results from the removal or destruction of the cutaneous appendages (hair follicles, oil and sweat glands and ducts); whereas a keloid is an idiosyncratic response without regard to damage of the appendages.
Properly performed surgical planing does not entirely remove these appendages and therefore healing occurs without scarring.
Images
PMCID: PMC1532901  PMID: 13304667
23.  Prevalence of Oral, Skin, and Oral and Skin Lesions of Lichen Planus in Patients Visiting a Dental School in Southern India 
Indian Journal of Dermatology  2012;57(2):107-109.
Background:
Lichen planus (LP) is a mucocutaneous disease that is relatively common among adult population. LP can present as skin and oral lesions. This study highlights the prevalence of oral, skin, and oral and skin lesions of LP.
Aims:
The aim of this study was to evaluate the prevalence of oral, skin, and oral and skin lesions of LP from a population of patients attending the Department of Oral Medicine and Radiodiagnosis, Pushpagiri College of Dental Sciences, Tiruvalla, Kerala, India.
Materials and Methods:
A cross-sectional study was designed to evaluate the prevalence of oral, skin, and oral and skin lesions of LP. This is a ongoing prospective study with results of 2 years being reported. LP was diagnosed on the basis of clinical presentation and histopathological analysis of mucosal and skin biopsy done for all patients suspected of having LP. Statistical analysis was carried out using SPSS (Statistical package for social sciences) software version 14. To test the statistical significance, chi-square test was used.
Results:
Out of 18,306 patients screened, 8,040 were males and 10,266 females. LP was seen in 118 cases (0.64%). Increased prevalence of LP was observed in middle age adults (40–60 years age group) with lowest age of 12 years and highest age of 65 years. No statistically significant differences were observed between the genders in skin LP group (P=0.12) and in oral and skin LP groups (P=0.06); however, a strong female predilection was seen in oral LP group (P=0.000036). The prevalence of cutaneous LP in oral LP patients was 0.06%.
Conclusion:
This study showed an increased prevalence of oral LP than skin LP, and oral and skin LP with a female predominance.
doi:10.4103/0019-5154.94276
PMCID: PMC3352630  PMID: 22615505
Lichen planus; mucocutaneous; precancerous
24.  Circulation of human influenza viruses and emergence of Oseltamivir-resistant A(H1N1) viruses in Cameroon, Central Africa 
Background
While influenza surveillance has increased in most developing countries in the last few years, little influenza surveillance has been carried out in sub-Saharan Africa and no information is available in Central Africa. The objective of this study was to assess the prevalence of influenza viruses circulating in Yaounde, Cameroon and determine their antigenic and genetic characteristics.
Methods
Throat and/or nasal swabs were collected from November 2007 to October 2008 from outpatients with influenza-like illness (ILI) in Yaounde, Cameroon and analyzed by two different techniques: a one-step real time reverse transcription-polymerase chain reaction (RT-PCR) and virus isolation in MDCK cells. Typing and subtyping of virus isolates was performed by hemagglutination inhibition (HI), and viruses were sent to the WHO Collaborating Centre in London, UK for further characterization and analyses of antiviral resistance by enzyme inhibition assay and nucleotide sequencing.
Results
A total of 238 patients with ILI were sampled. During this period 70 (29%) samples were positive for influenza by RT-PCR, of which only 26 (11%) were positive by virus isolation. By HI assay, 20 of the 26 isolates were influenza type A (10 H3N2 and 10 H1N1) and 6 were influenza type B (2 B/Victoria/2/87 lineage and 4 B/Yagamata/16/88 lineage). Seven (70%) of the H1N1 isolates were shown to be resistant to oseltamivir due to a H275Y mutation.
Conclusions
This study confirmed the circulation of influenza A(H1N1), A(H3N2) and B viruses in the human population in Central Africa and describes the emergence of oseltamivir-resistant A(H1N1) viruses in Central Africa.
doi:10.1186/1471-2334-10-56
PMCID: PMC2838889  PMID: 20205961
25.  Current Status of HIV/AIDS in Cameroon: How Effective are Control Strategies? 
Nearly three decades after its discovery, HIV infection remains the number one killer disease in Sub-Saharan Africa where up to 67% of the world’s 33 million infected people live. In Cameroon, based on a Demographic Health Survey carried out in 2004, the national HIV prevalence is estimated at 5.5% with women and youths being predominantly infected. Orphans and vulnerable children (OVC) from the HIV and AIDS pandemic have increased steadily over the years; hospital occupancy is estimated at about 30%, hence stretching the health system; co-infections like HIV/tuberculosis have been reported to reach 40–50% of infected cases and 95% of teachers are said not to be productive on several counts. Thus, the impact is multi-sectorial. Furthermore, the HIV epidemic in Cameroon is peculiar because of the wide HIV-1 genetic diversity of HIV-1 Group M observed with several subtypes reported (A, B, C, D, F, G, H, J, K), predominantly subtype A. There are also circulating recombinant forms, mainly CRF02_AG. In addition, HIV-1 Groups O and N have all been noted in Cameroon. These findings have great implications not only for HIV diagnosis, but also for responsiveness to therapy as well as for vaccine development. In 1986, the initial response of the Cameroon government to the increasing trends in the HIV/AIDS infection was to create a National AIDS Control Committee to coordinate a national AIDS programme. By 2000, the first National Strategic Plan was drawn for 2000–2005. The second National Strategic Plan for 2006–2010 is currently being implemented and covers various axes. Some results obtained show that there has been significantly positive outcomes noted in the various arms of intervention by the Cameroon government.
PMCID: PMC3699997  PMID: 19151432
HIV; AIDS; strategies; Cameroon

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