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Introduction: the correct sexual and reproductive health knowledge of adolescents remains important to empower them for healthy decision-making. The study aimed to assess the sexual and reproductive health knowledge of secondary school adolescents in Fako, Cameroon. Methods: a cross-sectional survey of 1180 adolescents from nine schools in Fako, was conducted using a structured interviewer - guided questionnaire. Data were analysed using SPSS version 26. Descriptive statistics and logistic regression analysis were used to outline knowledge and to identify predictors of knowledge respectively. Statistical significance was set at p<0.05. Results: more than half (54.0%) of the participants had overall good sexual and reproductive health knowledge. However, 63.1% and 55.3% of the participants had poor knowledge on reproductive system functions and sexually transmissible infections respectively. In addition, 56.0% had overall good contraceptive knowledge, with 51.6% having poor knowledge on condom. Being male (AOR=0.43, 95% 0=0.20, 0.92) and using the internet to search for sexuality related information (AOR=0.46, 95% CI= 0.22, 0.94) were associated with good knowledge. Being in lower secondary school was an independent predictor of poor knowledge (AOR= 3.83, 95% CI= 1.67, 8.81). Conclusion: although slightly above half of adolescent secondary school students had good sexual and reproductive health knowledge, there existed several gaps in such knowledge. Policymakers especially in the education sector need to evaluate the current state of school-based sexual and reproductive health education in Cameroon, in order to design comprehensive curricula, that will begin from lower secondary school. Internet-based comprehensive sexuality education is also needed. [ABSTRACT FROM AUTHOR]

Abstract Background Anti-Wolbachia treatment with doxycycline is effective in sterilising and killing adult Onchocerca volvulus nematodes, proving superior to ivermectin and of great potential as an alternative approach for the treatment and control of onchocerciasis, particularly in areas of Loa loa co-endemicity. Nevertheless, the length of the required treatment poses potential logistical problems and risk of poor compliance, raising a barrier to the use of doxycycline in Mass Drug Administration (MDA) strategies. In 2007 and 2008 a feasibility trial of community-directed treatment with doxycycline was carried out in two health districts in Cameroon, co-endemic for O. volvulus and L. loa. With 17,519 eligible subjects, the therapeutic coverage was 73.8% with 97.5% compliance, encouraging the feasibility of using doxycycline community-directed delivery in restricted populations of this size. The current study evaluated the effectiveness of this community-directed delivery of doxycycline four years after delivery. Findings Infection with O. volvulus was evaluated by skin biopsy and nodule palpation. Of the 507 subjects recruited, 375 had completed the treatment with doxycycline followed by one or two rounds of annual ivermectin MDA and 132 received one or two rounds of annual ivermectin MDA alone. Statistically significant lower microfilarial prevalence (17.0% [doxycycline plus ivermectin group], 27.0% [ivermectin only group], p = 0.014) and load (p = 0.012) were found in people that had received doxycycline followed by ivermectin compared to those who received ivermectin only. Conclusions This study demonstrates the long-term effectiveness of doxycycline treatment delivered with a community-directed strategy even when evaluated four years after delivery in an area of ongoing transmission. This finding shows that a multi-week course of treatment is not a barrier to community-delivery of MDA in restricted populations of this size and supports its implementation to compliment existing control strategies for onchocerciasis, where needed.

Abstract Background Immunological mechanisms involved in the survival and development of human filarial species in the vertebrate host are poorly known due to the lack of suitable experimental models. In order to understand the role of cytokines in the survival and development of filarial larvae in the vertebrate host, we infected different strains of BALB/c mice deficient in a number of cytokine or cytokine receptor genes with Loa loa. The survival and development of larvae were monitored. Methods BALB/c mice genetically deficient in IL-4R, IFN-γ, IFN-γ/IL-5, IL-5, and IL-4R/IL-5 cytokine or cytokine receptor genes were infected with a human strain of L. loa and necropsies were performed at different time intervals up to 70 days post infection to monitor the survival and development of L. loa larvae. The larvae were teased out of the skin, muscles, peritoneal and pleural cavities, heart and lung tissues. The length and width of the recovered larvae were measured to assess their growth. Results In mice deficient for IL-4R, IFN-γ, IFN-γ/IL-5, IL-5 and IL-4R/IL-5, the larvae survived up to 5, 20, 40, 50 and 70 days respectively. Worms recovered 70 days post infection in IL-4R/IL-5 DKO mice were young adults and measured 10.12 mm in length and 0.1 mm in width. Overall, 47% of larvae were recovered from subcutaneous tissues, 40% from muscles, 6% from the peritoneal cavity and 4% from the pleural cavity, lungs and heart. Conclusion L. loa exhibits a differential survival and development in different strains of cytokine or cytokine receptor gene knockout mice with IL-4R and IL-5 playing critical roles in the host resistance to L. loa infection. The knock out BALB/c mouse therefore represents a useful tool to explore the key effectors of adaptive immunity involved in the killing of the L. loa parasite in a mammal host.

Abstract Background The human parasite Onchocerca volvulus harbours Wolbachia endosymbionts essential for worm embryogenesis, larval development and adult survival. In this study, the development of Wolbachia-depleted microfilariae (first stage larvae) to infective third stage larvae (L3) in the insect vector Simulium damnosum was analysed. Methods Infected volunteers in Cameroon were randomly and blindly allocated into doxycycline (200 mg/day for 6 weeks) or placebo treatment groups. After treatment, blackflies were allowed to take a blood meal on the volunteers, captured and dissected for larval counting and DNA extraction for quantitative real-time PCR analysis. Results PCR results showed a clear reduction in Wolbachia DNA after doxycycline treatment in microfilariae from human skin biopsies with > 50% reduction at one month post-treatment, eventually reaching a reduction of > 80%. Larval stages recovered from the insect vector had similar levels of reduction of endosymbiotic bacteria. Larval recoveries were analysed longitudinally after treatment to follow the kinetics of larval development. Beginning at three months post-treatment, significantly fewer L3 were seen in the blackflies that had fed on doxycycline treated volunteers. Concomitant with this, the proportion of second stage larvae (L2) was significantly increased in this group. Conclusions Doxycycline treatment and the resulting decline of Wolbachia endobacteria from the microfilaria resulted in retarded development of larvae in the insect vector. Thus, anti-wolbachial treatment could have an additive effect for interrupting transmission by reducing the number of L3 that can be transmitted by blackflies.

Abstract Background Severe side effects following ivermectin treatment of onchocerciasis in areas of co-endemicity with loaisis have been an impediment for the work of the African Programme for Onchocerciasis Control (APOC) in forested regions of several countries. Doxycycline has been shown to be effective in the treatment of onchocerciasis and has the added advantages of killing adult Onchocerca volvulus but neither adult Loa loa nor their microfilariae. This drug therefore offers great potential for the treatment of onchocerciasis in areas of co-endemicity with loiasis. The limitation of use of this drug is the duration of treatment that may pose a potential problem with therapeutic coverage and compliance with treatment. To benefit from the advantages that doxycycline offers in the treatment of onchocerciasis, it will be necessary to establish an effective distribution system that can access remote communities. This study assessed the feasibility of a large-scale distribution of doxycycline for the treatment of onchocerciasis in areas of co-endemicity with loiasis using a community-directed approach. Methods The study was carried out in 5 health areas co-endemic for Onchocerca volvulus and Loa loa which had no prior experience of the Community Directed Treatment with Ivermectin (CDTI). The community-directed delivery process was introduced using a cascade mechanism from the central health system that passed through the regional health delegation, health district and the health areas. Community health implementers (CHIs) were trained to deliver doxycycline to community members and, under the supervision of the health system, to monitor and document drug intake and side effects. Results The community members adhered massively to the process. Of the 21355 individuals counted, 17519 were eligible for treatment and 12936 were treated with doxycycline; giving a therapeutic coverage of eligible population of 73.8%. Of the 12936 who started the treatment, 97.5% complied by the end of six weeks. No serious side effect was registered during the six week treatment. Conclusion This study indicates that when empowered the community health implementers can successfully deliver doxycycline for six weeks for the treatment of onchocerciasis in areas of co-endemicity with loiasis. The therapeutic coverage and the compliance treatment rate achieved in this study coupled to the known efficacy of doxycycline on O. volvulus, are indicators that the strategy involving the mass administration of doxycycline can be used to control onchocerciasis in those areas of co-endemicity with loiasis where ivermectin may be contraindicated.

Abstract Background Rapid and correct diagnosis of malaria is considered an important strategy in the control of the disease. However, it remains to be determined how well these tests can perform in those who harbour the parasite, but are asymptomatic, so that rapid diagnostic tests (RDTs) could be used in rapid mass surveillance in malaria control programmes. Methods Microscopic and immunochromatographic diagnosis of malaria were performed on blood samples from the hyperendemic Mount Cameroon region. Thin and thick blood films were stained with Giemsa and examined under light microscopy for malaria parasites. The RDT was performed on the blood samples for the detection of Plasmodium species. In addition, the performance characteristics of the test were determined using microscopy as gold standard. Results Results revealed 40.32% to be positive for microscopy and 34.41% to be positive for the RDT. Parasites were detected in a greater proportion of samples as the parasite density increase. Plasmodium falciparum was the predominant Plasmodium species detected in the study population either by microscopy or by the RDT. Overall, the test recorded a sensitivity and specificity of 85.33% and 95.05% respectively, and an accuracy of 91.40%. The sensitivity and specificity of the RDT increased as parasite densities increased. Conclusion The Hexagon Malaria Combi™ test showed a high sensitivity and specificity in diagnosing malaria in asymptomatic subjects and so could be suitable for use in mass surveillance programmes for the management and control of malaria.

Background: There is limited assessment of whether research participants in low-income settings are afforded a full understanding of the meaning of medical research. There may also be particular issues with the understanding of genetic research. We used a rapid ethical assessment methodology to explore perceptions surrounding the meaning of research, genetics and genetic research in north west Cameroon. Methods: Eleven focus group discussions (including 107 adults) and 72 in-depth interviews were conducted with various stakeholders in two health districts in north west Cameroon between February and April 2012. Results: Most participants appreciated the role of research in generating knowledge and identified a difference between research and healthcare but gave varied explanations as to this difference. Most participants' understanding of genetics was limited to concepts of hereditary, with potential benefits limited to the level of the individual or family. Explanations based on supernatural beliefs were identified as a special issue but participants tended not to identify any other special risks with genetic research. Conclusion: We demonstrated a variable level of understanding of research, genetics and genetic research, with implications for those carrying out genetic research in this and other low resource settings. Our study highlights the utility of rapid ethical assessment prior to complex or sensitive research. [ABSTRACT FROM AUTHOR]

Background: Individuals with high microfilarial loads of Loa loa are at increased risk of neurologic serious adverse (SAE) events following ivermectin treatment against onchocerciasis. RAPLOA (Rapid Assessment Procedure for loiasis), a newly developed rapid assessment procedure for loiasis that relates the prevalence of key clinical manifestation of loiasis (history of eye worm) to the level of endemicity of the infection (prevalence of high intensity), is a very useful tool to identify areas at potential risk of L. loa post ivermectin treatment encephalopathy. In a perspective of treatment decision making in areas of co-endemicity of loiasis/onchocerciasis, it would be advantageous (both in time and cost savings) for national onchocerciasis control programmes to use RAPLOA and the Rapid epidemiologic assessment for onchocerciasis (REA), in combination in given surveys. Since each of the two rapid assessment tools have their own specificities, the workability of combining the two methods needed to be tested. Methods: We worked in 10 communities of a forest area presumed co-endemic for loiasis and onchocerciasis in the North-West Province of Cameroon where the mass-treatment with ivermectin had not been carried out. A four-step approach was used and comprised: (i) generating data on the prevalence and intensity of loiasis and onchocerciasis in an area where such information is scarce; (ii) testing the relationship between the L. loa microfilaraemia prevalence and the RAPLOA prevalence, (iii) testing the relationship between the O. volvulus microfiladermia prevalence and the REA prevalence, (iv) testing the workability of combining RAPLOA/REA by study teams in which a single individual can perform the interview for RAPLOA and the nodule palpation for REA. Results: The microfilaraemia prevalence of loiasis in communities ranged from 3.6% to 14.3%. 6 (0.61%) individuals had L. loa microfilarial loads above 8000 mf/ml but none of them attained 30,000 mf/ml, the threshold value above which the risk of developing neurologic SAE after ivermectin treatment is very high. None of the communities surveyed had RAPLOA prevalence above 40%. All the communities had microfiladermia prevalence above 60%. The microfiladermia results could be confirmed by the rapid epidemiologic method (nodule palpation), with all the 10 communities having REA prevalence above 20%. For the first time, this study has demonstrated that the two rapid assessment procedures for loiasis and onchocerciasis can be carried out simultaneously by a survey team, in which a single individual can administer the questionnaire for RAPLOA and perform the nodule palpation for REA. Conclusion: This study has: (i) Revealed that the Momo valley of the North West province of Cameroon is hyperendemic for onchocerciasis, but is of lower level of endemicity for L. loa. (ii) Confirmed the previous relationships established between RAPLOA and the L. loa microfilaraemia prevalence in one hand and between the REA and the O. volvulus microfiladermia prevalence in another hand (iii) Shown that RAPLOA and REA could be used simultaneously for the evaluation of loiasis and onchocerciasis endemicity in areas targeted by the African Programme for onchocerciasis Control for community-directed treatment with ivermectin (CDTI). [ABSTRACT FROM AUTHOR]

Background: Studies reporting the natural immune responses against malaria in children from different geographical settings in endemic areas are not readily available. This study was aimed at comparing the immune responses against Plasmodium falciparum MSP-119 antigen in children from five contrasting bioecological zones in Cameroon. Methods: In a cross-sectional survey, children between 2 and 15 years, were enrolled from five ecological strata including the south Cameroonian equatorial forest, sudano-sahelian, high inland plateau, high western plateau, and the coastal strata. The children were screened for clinical malaria (defined by malaria parasitaemia ≥ 5000 parasites/µl plus axillary temperature ≥ 37.5 °C). Their antibody responses were measured against P. falciparum MSP-119 antigen using standard ELISA technique. Results: In all, 415 children comprising 217 (52.3%) males participated. Total IgG and IgG1–IgG4 titres were observed to increase with age in all the strata except in the sudano-sahelian and high inland plateau strata. Total IgG and IgG1–IgG4 titres were significantly higher in the coastal strata and lowest in the high inland plateau (for IgG1 and IgG2) and sudano-sahelian strata (for IgG3 and IgG4). Titres of the cytophilic antibodies (IgG1 and IgG3) were significantly higher than the non-cytophilic antibodies (IgG2 and IgG4) in all the strata except in the sudano-sahelian and high inland plateau strata. Total IgG and IgG subclass titres were significantly higher in children positive for clinical malaria compared to negative children in all study sites except in the high western plateau and coastal (for IgG1 and IgG3), and the sudano-sahelian strata (for all antibodies). Furthermore, a significant positive correlation was observed between parasite density and IgG2 or IgG4 titres in all study sites except in the south Cameroonian equatorial forest and sudano-sahelian strata. Conclusions: This study showed that antibody responses against MSP-119 vary considerably in children from the different bioecological strata in Cameroon and could be linked to the differential exposure to malaria in the different strata. Furthermore, the rate of antibody acquisition was not observed to increase in an age-dependent manner in low transmission settings. [ABSTRACT FROM AUTHOR]

Background and Aim: Livestock are associated with pathogenic microbes and farm workers play a significant role in the transmission of zoonotic diseases (ZDs). Lack of awareness of exposure risk among farmers may influence their farm practices, thereby enhancing the spread of diseases on farms and to the community. This study was aimed at evaluating the knowledge, risk perception, and prevention and control practices of ZDs among poultry farmers to provide baseline data for establishing a “One Health” practical approach to reducing ZD transmission in poultry farms. Materials and Methods: Using the exponential discriminative snowball technique, a community-based cross-sectional study involving poultry farmers was carried out in the Buea Health District from April to July 2021. Six feed-producing mills were used as focal points to identify and recruit farmers who were also referred to other farmers. Questionnaires were used to collect data related to participants’ knowledge, risk perception, and prevention and control practices of ZDs. Descriptive analyses were performed for all variables while the chi-square test and logistic regression analysis were used to determine associations at 95% confidence level. Results: In all, 183 poultry farms and 207 workers were enrolled in the study. Despite being aware that animal diseases can be transmitted to humans, most participants showed poor knowledge (54.6%), low-risk perception (51.7%), and poor prevention/control practices (54.1%) on ZDs. The majority did not consider coming in contact with birds’ body fluid (blood) or apparently healthy birds to be a risk of infection. More participants with small farms (<500 birds) had low-risk perception of ZDs than those with larger farms (>1000 birds) (p = 0.03). Furthermore, most participants reported practicing hand washing but they neither used protective devices such as gloves and face masks, and >50% would not invite veterinary professionals to their farms. There was a significant association between risk perception and knowledge (p = 0.007; CI = 1.257–4.200) as well as between risk perception and prevention/control practice (p = 0.002; CI = 1.451–4.867). Conclusion: Poultry farm workers in Buea had poor knowledge and perception of ZD risk and this might have contributed to their poor prevention/control practices on the farms. Enhanced informal education of poultry farmers through training workshops and seminars will improve their knowledge and skills on ZD transmission risk and prevention. [ABSTRACT FROM AUTHOR]

Objectives: Burnout syndrome (BOS) is an affection mostly resulting from chronic job-related stress. Many studies have identified job-related and non-job-related factors associated with BOS. Our aim of this study was to assess the level of BOS in private and public hospital healthcare providers in Fako division, Cameroon and evaluate the impact of physical activity and sleep quality (SQ)., Methods: The study was carried out in five randomly selected hospitals in Fako Division over a three-month period. Consenting doctors, nurses and laboratory technicians were recruited using consecutive sampling methods. Sociodemographic and professional characteristics were collected using a structured questionnaire. BOS was assessed using the Maslach Burnout Inventory Human Services Survey (MBI-HSS). Sleep quality (SQ) and physical activity (PA) were assessed using the Pittsburgh Sleep Quality Index (PSQI) and Global Physical Activity Questionnaire (GPAQ) respectively. Odd ratios and 95% confidence intervals were calculated and a statistical significance was set for p -value < 0.05., Results: The mean age was 32 ± 6 years and 70.9% female. BOS prevalence was 66.3% with 71.4% in females and 53.9% in males ( p = 0.002). Of the 232 participants with BOS, 65.7%, 52% and 53.7% had moderate to high emotional exhaustion, depersonalization and decreased personal accomplishment, respectively. Moderate to high PA as well as poor SQ were not significantly associated with BOS while longer sleep duration (>8 h) was associated with a greater odd of BOS., Conclusions: The prevalence of BOS was high among healthcare professionals. While PA showed no protective effects, high sleep duration could increase its risk., Competing Interests: Conflict of Interest: The authors declare no conflict of interest., (© 2023 the Author(s), licensee AIMS Press.)

Introduction: obesity poses significant public health concerns, being a risk factor for most non-communicable diseases and future cardiovascular diseases. Maternal obesity could be associated with adverse maternal-foetal outcomes, and there is a scarcity of data regarding obesity in pregnancy in our setting. Our objective was to determine the prevalence and knowledge of obesity and excessive Gestational Weight Gain (GWG) among pregnant women attending ANC in the Fako Division., Methods: we conducted a hospital-based cross-sectional study from January 28 to May 29, 2020, in the Limbe District Hospital (LDH) and Buea Road Integrated Health Centre (BRIHC). We collected data on socio-demographic prevalence, including knowledge of obesity and excessive GWG among pregnant women. Data was analysed using IBM SPSS version 26., Results: out of the 317 participants included, 58.9% (n=185) were aged 20-29 years, 36% (n=116) unemployed. The mean gestational age was 28.82 ± 7.75 weeks and 33.1% (n=105) were nulliparous. The prevalence of obesity in pregnancy and excessive GWG were 42.3% (n=134) and 41.6% (n=132) respectively. Respondents who consumed alcohol were more likely to be obese (aOR: 2.11, 95% CI 1.19-3.71; p; = 0.01). Those aged <20 (aOR: 0.064, 95% CI 0.007-0.57; p= 0.014) and 20-29 years (aOR: 0.297, 95% CI 0.16-0.56; p<0.001) were less likely to be obese than those 30-39 years. 46.1% (n=147) had poor knowledge of the complications of obesity in pregnancy, while 77.3% (n=245) had moderate knowledge of the safe and effective weight management methods during pregnancy. Late ANC booking was associated with excessive GWG (P=0.002)., Conclusion: maternal obesity and excessive GWG is highly prevalent among ANC clients in the Fako Division, with excessive GWG being associated with late ANC booking. Hence, there is a need to design community-based interventions that could increase rates of early booking visits and consequently increase its benefits., Competing Interests: The authors declare no competing interests., (Copyright: Ebiambu Ondoh Agwara et al.)

Introduction: the correct sexual and reproductive health knowledge of adolescents remains important to empower them for healthy decision-making. The study aimed to assess the sexual and reproductive health knowledge of secondary school adolescents in Fako, Cameroon., Methods: a cross-sectional survey of 1180 adolescents from nine schools in Fako, was conducted using a structured interviewer - guided questionnaire. Data were analysed using SPSS version 26. Descriptive statistics and logistic regression analysis were used to outline knowledge and to identify predictors of knowledge respectively. Statistical significance was set at p<0.05., Results: more than half (54.0%) of the participants had overall good sexual and reproductive health knowledge. However, 63.1% and 55.3% of the participants had poor knowledge on reproductive system functions and sexually transmissible infections respectively. In addition, 56.0% had overall good contraceptive knowledge, with 51.6% having poor knowledge on condom. Being male (AOR=0.43, 95% CI=0.20, 0.92) and using the internet to search for sexuality related information (AOR=0.46, 95% CI= 0.22, 0.94) were associated with good knowledge. Being in lower secondary school was an independent predictor of poor knowledge (AOR= 3.83, 95% CI= 1.67, 8.81)., Conclusion: although slightly above half of adolescent secondary school students had good sexual and reproductive health knowledge, there existed several gaps in such knowledge. Policymakers especially in the education sector need to evaluate the current state of school-based sexual and reproductive health education in Cameroon, in order to design comprehensive curricula, that will begin from lower secondary school. Internet-based comprehensive sexuality education is also needed., Competing Interests: The authors declare no competing interests., (Copyright: Rita Muso Fubam et al.)