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In Cameroon, in 2019, tuberculosis (TB) treatment coverage was estimated at 53%, indicating that almost half of all people sick with TB were not diagnosed or linked to care. To inform strategies to improve access to TB services, we conducted an evaluation of the alignment between patient-initiated care-seeking behavior and spatial and institutional allocation of TB services. Data sources included the Cameroon Demographic and Health Survey (2018), the Health Facility List (2017), and routinely collected TB surveillance data. Data visualization was performed in Tableau and QGIS. The pathway analysis showed that only an estimated 9% of people attended a health facility providing TB services at initial care-seeking, with access varying from <3% to 16% across the ten regions of the country. While 72% of government and 56% of private hospitals (Level 2 facilities) provide TB services, most Cameroonians (87%) initially chose primary care (Level 1) or informal private sector sites (Level 0) without TB services. The gaps were greatest in regions with the highest prevalence of poverty, a significant determinant for TB. These results indicate that access may be improved by expanding TB services at both public and private facilities across the country, prioritizing regions with the greatest gaps.

Cassava is a key food security crop in Central Africa, but its production depends largely on the use of local farmers' varieties characterized by inherently low yield which is compounded by generally high susceptibility to various growth and yield-limiting pests and diseases. Improved cassava genotypes have demonstrated the potential to substantially improve cassava's contribution to food security and the development of the cassava industry and the improvement of nutrition status elsewhere in Western Africa. Eleven improved cassava genotypes were compared with a local landrace (LMR) used as a check under field conditions over two years in eight locations, grouped in four agro-ecologies in Cameroon. Pest and disease abundance/incidence and damage severity were evaluated. At harvest, root yield and carotenoid content were measured. Best linear unbiased predictors showed the lowest breeding value for LMR with the cassava mosaic virus disease (+ 66.40 ± 2.42) compared with 1.00 ± 0.02% for the most susceptible improved genotype. Two genotypes (I010040-27 and I011797) stood out for having higher predicted fresh root yield means which were at least 16 times greater compared with LMR. Predicted total carotenoid content was the highest (+ 5.04 ± 0.17) for improved genotype I070593 compared with LMR which showed the lowest (- 3.90 ± 0.06%) and could contribute to the alleviation of vitamin A deficiency from cassava-based food systems. Diffusion of high-yielding and nutritious genotypes could alleviate food and nutritional security in Central Africa.

Background: There are major gaps in the management of pediatric tuberculosis (TB) contact investigation for rapid identification of active tuberculosis and initiation of preventive therapy. This study aims to evaluate the impact of a community-based intervention as compared to facility-based model for the management of children in contact with bacteriologically confirmed pulmonary TB adults in low-resource high-burden settings., Methods/design: This multicenter parallel open-label cluster randomized controlled trial is composed of three phases: I, baseline phase in which retrospective data are collected, quality of data recording in facility registers is checked, and expected acceptability and feasibility of the intervention is assessed; II, intervention phase with enrolment of index cases and contact cases in either facility- or community-based models; and III, explanatory phase including endpoint data analysis, cost-effectiveness analysis, and post-intervention acceptability assessment by healthcare providers and beneficiaries. The study uses both quantitative and qualitative analysis methods. The community-based intervention includes identification and screening of all household contacts, referral of contacts with TB-suggestive symptoms to the facility for investigation, and household initiation of preventive therapy with follow-up of eligible child contacts by community healthcare workers, i.e., all young (< 5 years) child contacts or older (5-14 years) child contacts living with HIV, and with no evidence of TB disease. Twenty clusters representing TB diagnostic and treatment facilities with their catchment areas are randomized in a 1:1 ratio to either the community-based intervention arm or the facility-based standard of care arm in Cameroon and Uganda. Randomization was stratified by country and constrained on the number of index cases per cluster. The primary endpoint is the proportion of eligible child contacts who initiate and complete the preventive therapy. The sample size is of 1500 child contacts to identify a 10% difference between the arms with the assumption that 60% of children will complete the preventive therapy in the standard of care arm., Discussion: This study will provide evidence of the impact of a community-based intervention on household child contact screening and management of TB preventive therapy in order to improve care and prevention of childhood TB in low-resource high-burden settings., Trial Registration: ClinicalTrials.gov NCT03832023 . Registered on 6 February 2019.