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1.  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
2.  Mortality and its determinants among patients infected with HIV-1 on antiretroviral therapy in a referral centre in Yaounde, Cameroon: a retrospective cohort study 
BMJ Open  2013;3(7):e003210.
Objectives
Mortality has declined in people with HIV infection, subsequent to the improved access to antiretroviral therapy (ART). We assessed the incidence and determinants of mortality among patients with HIV-1 infection who were started on ART in a referral treatment centre for HIV infection in Yaounde, Cameroon.
Design
Cohort study with baseline assessment between 2007 and 2008, and follow-up during 5 years until June 2012.
Setting
The accredited HIV treatment centre of the Yaounde Jamot Hospital in the capital city of Cameroon.
Participants
People living with HIV infection who started ART between 2007 and 2008 at the study centre.
Outcome measures
All-cause mortality over time; accelerated failure time models used to relate baseline characteristics to mortality occurrence during follow-up.
Results
Of the 1444 patients included, 827 (53.7%) were men, and the median age (25–75th centiles) was 38 (31–45) years. The median duration of follow-up was 14.1 (1.1–46.4) months, during which 235 deaths were recorded (cumulative incidence rate: 16.3%), including 208 (88.5%) during the first year of follow-up. Baseline predictors of mortality were male gender (adjusted HR 2.15 (95% CI 1.34 to 3.45)), active tuberculosis (2.35 (1.40 to 3.92)), WHO stages III–IV of the disease (3.63 (1.29 to 10.24)), low weight (1.03 (1.01 to 1.05)/kg), low CD4 count (1.04 (1.01 to 1.07)/10/mm3 lower CD4) and low haemoglobin levels (1.12 (1.00 to 1.26)/g/dL lower).
Conclusions
Mortality rate among patients with HIV is very high within the first year of starting ART in this centre. Early start of the treatment at a less advanced stage of the disease, and favourable levels of CD4 could reduce early mortality, but would have to be tested.
doi:10.1136/bmjopen-2013-003210
PMCID: PMC3710986  PMID: 23852140
EPIDEMIOLOGY
3.  Prevalence, awareness, treatment and control of hypertension in a self-selected sub-Saharan African urban population: a cross-sectional study 
BMJ Open  2012;2(4):e001217.
Objectives
Hypertension has been established as a major public health problem in Africa, but its specific contributions to disease burden are still incompletely understood. We report the prevalence and determinants of hypertension, detection, treatment and control rates among adults in major cities in Cameroon.
Design
Cross-sectional study.
Settings
Community-based multicentre study in major cities in Cameroon.
Participants
Participants were self-selected urban dwellers from the Center, Littoral, North-West and West Regions, who attended on 17 May 2011 a screening campaign advertised through mass media.
Primary and secondary outcomes measures
Hypertension defined as systolic (and/or diastolic) blood pressure (BP)≥ 140 (90) mm Hg, or ongoing BP-lowering medications.
Results
In all, 2120 participants (1003 women) were included. Among them, 1007 (prevalence rate 47.5%) had hypertension, including 319 (awareness rate 31.7%) who were aware of their status. The prevalence of hypertension increased with age overall and by sex and region. Among aware hypertensive participants, 191 (treatment rate 59.9%) were on regular BP-lowering medication, and among those treated, 47 (controlled rate 24.6%) were at target BP levels (ie, systolic (and diastolic) BP<140 (90) mm Hg). In multivariable logistic regression analysis, male gender, advanced age, parental history of hypertension, diabetes mellitus, elevated waist and elevated body mass index (BMI) were the significant predictors of hypertension. Likewise, male gender, high BMI and physical inactivity were associated with poor control.
Conclusions
High prevalence of hypertension with low awareness, treatment and control were found in this urban population; these findings are significant and alarming with consideration to the various improvements in the access to healthcare and the continuing efforts to educate communities over the last few decades.
doi:10.1136/bmjopen-2012-001217
PMCID: PMC3433777  PMID: 22923629
Cardiology; Hypertension; Epidemiology; Public Health
4.  Dyslipidaemia in HIV-1-infected patients receiving protease inhibitors after initial treatment with first-line-based non-nucleoside reverse transcriptase inhibitors: a cross-sectional study 
BMJ Open  2012;2(4):e001317.
Objectives
Lipid abnormalities associated with antiretroviral therapy in people with HIV infection are more frequent with protease inhibitors (PI)-based regimens. Whether effects extend to patients receiving a PI subsequent to failure on non-nucleoside reverse-transcriptase inhibitors (NNRTI)-based regimen is still unknown. We investigated the effects of secondary treatment with a PI on the lipid profile in a group of patients with HIV infection in Cameroon.
Design
This was a cross-sectional study.
Setting
This study was carried out at the registered centre for HIV treatment of the Yaounde Jamot Hospital in Cameroon.
Participants
Participants were consecutively recruited between November 2009 and January 2010. There were 138 HIV-1 patients on initial treatment with an NNRTI regimen and 66 HIV patients on secondary treatment with a PI for at least 12 months. Lipid abnormalities were based on the National Cholesterol Education Program, Adult Treatment Panel III criteria.
Outcome measures
Levels of lipid parameters among patients on PI and NNRTI.
Results
Median (IQR) levels (mg/dl), NNRTI-treated versus PI-treated patients were 185 (149–225) and 189 (147–244) for total cholesterol, 46 (27–66) and 42 (28–82) for high-density lipoprotein (HDL)-cholesterol, 121 (90–169) and 126.9 (71–176) for low-density lipoprotein (LDL)-cholesterol, 134 (98–174) and 138 (111–167) for triglycerides, and 4.3 (2.9–6.2) and 5.1 (2.6–7.9) for total/HDL-cholesterol ratio (all p>0.32). The most frequent lipid abnormality in the two groups was high LDL-cholesterol (46.4% (NNRTI) vs 54.5% (PI)). The occurrence of lipid abnormalities was similar in the two groups (all p>0.29).
Conclusions
The use of PI does not appear to deteriorate the lipid profile of HIV patients above and beyond abnormalities induced by an unsuccessful initial treatment with NNRTI. Monitoring of lipid profile during HIV treatment regardless of the regimens would improve timely detection and management of abnormalities, to mitigate related risks.
doi:10.1136/bmjopen-2012-001317
PMCID: PMC3425906  PMID: 22874631
HIV & AIDS; Therapeutics; Adverse events; Diabetes & Endocrinology; Lipid disorders
5.  Incidence, time and determinants of tuberculosis treatment default in Yaounde, Cameroon: a retrospective hospital register-based cohort study 
BMJ Open  2011;1(2):e000289.
Objectives
High rates of antituberculosis treatment discontinuation have been reported in some areas of Africa. The aim of this study was to determine the rate, time to and determinants of antituberculosis treatment default in Yaounde.
Design
This was a retrospective cohort study based on hospital registers. Tuberculosis treatment default or antituberculosis treatment discontinuation was defined as any interruption of treatment for at least 2 months following treatment initiation. Sociodemographic and clinical predictors of treatment discontinuation were investigated with the use of Cox regressions models.
Setting
This study was carried out in the tuberculosis diagnosis and treatment centre at Yaounde Jamot Hospital, which serves as a referral centre for tuberculosis and respiratory diseases for the capital city of Cameroon (Yaounde) and surrounding areas.
Participants
All (1688) patients started on antituberculosis treatment at the centre between January and December 2009 were enrolled. Outcome measures were antituberculosis treatment default and time to treatment default.
Results
Of the 1688 included patients, 337 (20%) defaulted from treatment, 86 (5.1%) died, treatment failed in 6 (0.4%) and 104 (6.2%) were transferred. Therefore, treatment was successfully completed in 1154 (68.4%) patients. Median duration to treatment discontinuation was 90 days (IQR 30–150), and 62% of treatment discontinuation occurred during the continuation phase. Hospitalisation during the intensive phase (adjusted HR 0.69; 95% CI 0.54 to 0.89) and non-consenting for HIV screening (1.65; 1.24 to 2.21) were the main determinants of defaulting from treatment in multivariable analysis.
Conclusions
The default incidence rate is relatively high in this centre and treatment discontinuation occurs frequently during the continuation phase of treatment. Action is needed to improve adherence to treatment when received on an ambulatory basis, to clarify the association between HIV testing and antituberculosis treatment default, and to identify other potential determinants of treatment discontinuation in this setting.
Article summary
Article focus
To determine the rates, time to and determinants of antituberculosis treatment discontinuation in the era of directly observed treatment in sub-Saharan Africa, using the situation in Cameroon as an example.
Key messages
Antituberculosis treatment success rates remain sub-optimal in sub-Saharan Africa, a region which has the highest global incidence rates of tuberculosis.
Treatment discontinuation is one of the main reasons for the high tuberculosis rates, but has not recently been fully explored in Africa.
Knowledge of the determinants of antituberculosis treatment discontinuation is critical for informing health service and policy solutions needed to improve the outcomes of care for tuberculosis and contain the spread of the disease.
Strengths and limitations of this study
This was a large cohort study with 1688 participants.
This was also a retrospective study which lacked some key information.
doi:10.1136/bmjopen-2011-000289
PMCID: PMC3225586  PMID: 22116091

Results 1-5 (5)