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Aims: The study measured the level of knowledge and attitudes towards malaria and examined associated factors among caregivers of under-five children. Study Design: The study was community-based, descriptive cross-sectional. Place and Duration of Study: The study was carried out in Buea Health District (BHD) from February to June 2020. Methodology: Data were obtained through face-to-face interviews with the caregivers of under-fives. The above mean scores were used to determine the level of knowledge. The attitude levels were measured by using 3-point Likert scales. Univariate and multivariate logistic regression analyses were performed to identify risk factors associated with knowledge and attitude. SPSS software version 20.0 was used for analysis. Results: Out of the 390 respondents, 69.5% of them had a neutral attitude. Meanwhile, 27.7 % of participants carried a favorable attitude towards malaria and only 2.8 % of them had an unfavorable attitude, Caregivers of under-five children who scored below the mean score were 25.1 % which was considered having poor knowledge and above the mean score was 74.9% which was considered good knowledge. In the multivariable logistic analysis, caregivers with a primary school level of education were 4.1 times (AOR = 4.1, CI = 1.486-11.102) times more likely of receiving a high malaria knowledge score as compared to those with no formal education. Factors associated with caregiver's attitude level towards malaria risk were educational level and marital status which showed significant associations in the univariate analysis Conclusion: Caregivers of under-fives displayed a good knowledge of malaria risk factors. However, in these endemic areas for malaria, caregiver attitude was found to be unenthusiastic and unresponsive, and this poses additional challenges in reaching the malaria elimination goal. Thus, suggesting that educational messages during the campaign should be contextual to reach out to local communities to trigger a positive behavioural change.

Background: Unsafe abortion is one of the commonest causes of maternal mortality and post-abortion care services have been acclaimed as the best remedy for this situation. Yet, high maternal mortality still prevails pointing to issues with the quality of services. The paper was designed to investigate women's motives for engaging in unsafe abortion; assess women's experiences on the quality of PAC services and identify the challenges women faced in accessing PAC services in Buea. Methods: This study recruited 10 participants in Buea. Using a structured interview, data was collected on women's motives for engaging in unsafe abortion; assess women's experiences on the quality of PAC services, and identify the challenges women faced in accessing PAC services in Buea. Thematic and grounded theory analytical techniques were used to organize and interpret the data. Results: Majority of women in Buea did not use contraceptives for different reasons ranging from personal, spousal consent, ignorance, and the fear of side effects of contraceptive use. The low contraceptive use accounts highly for unwanted pregnancy cases which results in the decisions to induce. Most of these women involuntarily engage in induced abortion, highly driven by second party influence like the request from spouse/partner, disappointment from the spouse, and fear of parents’ reactions; while some occur as a result of missed abortion. The quality of PAC services received by most of these women were merely emergency treatments without proper PAC activities like family planning counseling, provision of modern contraceptive methods, linkages to other reproductive health care services. Women in Buea encounter some challenges in the use of PAC services, pains associated with the procedure, the cost, the absence of some family planning methods, the absence of counselling before PAC and above all, non constant availability of blood in the bood bank for transfusion. Conclusion: This study concluded that most women in Buea engage in induced abortion on account of the pressure to terminate an unwanted pregnancy; resulting from low contraceptives use; desire to avoid problems from their spouses/partners as well as to pursue career ambition. Moreover, the quality of PAC services offered to women in Buea was emergency treatment; void of important aspects like family planning services, linkage to other reproductive health care services, and facilitating their social reinsertion and preventing future induce abortion.

In Cameroon in 2017, malaria accounted for 53% of hospitalizations, 61% of deaths among under-five children. The National Program adopted since 2015 the integrated Community Directed Interventions (CDI) for the control of malaria. This study determined the impact of the home-based management of childhood malaria morbidity and mortality in the Penka-Michel and Santchou Health Districts of the West Region in Cameroon. A retrospective hospital record-based study was carried out to assess childhood malaria morbidity and mortality in Penka-Michel where CDI is implemented and in Santchou Health District where CDI is not implemented. Childhood malaria morbidity and mortality were determined from July 2014 to June 2019. The analysis of variance was used to compare the morbidity and mortality before and after CDI. P values of less than 0.05 was considered statistical significant. A total of 32,976 consultations files of children under-five were reviewed. The number of malaria cases increased significantly from 2733 (33.7%) before CDI to 5202 (38.4%) after CDI in the Penka Michel Health District but decreased from 2003 (41.9%) before CDI to 1723 (40.7%) after CDI in the Santchou Health District. The number of deaths caused by malaria increased from pre to post CDI in the Santchou Health District from 1(10%) before CDI to 3(30%) after CDI but decreased in the Penka Michel Health District from 5 (22.7%) before CDI to 3 (13.6%) after CDI. The implementation of the integrated CDI of malaria in the Penka Michel Health District has benefited the population by enhancing early detection of childhood malaria cases through CHWs in the community; thus significantly increasing morbidity and decreasing mortality. Key words: Cameroon, children under five, malaria, morbidity, mortality, integrated CDI.

This trial aims at testing the efficacy of weekly sexo-reproductive health educational text messages to improve perception of adolescent girls on sexo-reproductive health in Cameroon. This is a single-centered randomized controlled single-blinded trial. Adolescent girls aged 10 to 19 years in the Kumbo West Health District are the target population. A central computer generated randomization list was used to prevent selection bias and enable the production of the comparable groups for this trial. Allocation concealment (1:1) was determined by sequentially numbered sealed opaque envelopes. A total of 460 participants either receive the mobile phone text message or no text message. Data was collected at baseline, three month and six month intervals. A blinded program secretary sent out text messages and record delivery. The studies primary outcomes were improved knowledge and practices towards sexo-reproductive health, while its secondary outcomes were improved behaviour and attitudes towards sexo-reproductive health. Analysis was by intention-to-change behaviour. Covariates and subgroups were taken into account. This trial investigated the potential of SMS messages on sexo-reproductive health education to improve adolescent girl’s perception to attain better health outcomes. This trial contribute to the growing body of evidence on the use of mobile phone technology as a complementary strategy for strengthening health systems and achieving health-related goals oriented towards adolescent girls. Key words: Mobile phone, sexo-reproductive health, improved perception, randomization.

Introduction:cervical cancer is the fourth commonest cancer of women world-wide with increasing incidence in developing countries. This study determined the prevalence and assessed risk factors associated with precancerous cervical lesions among women in Cameroon. Methods:this cross-sectional study enrolled 925 women participants of a screening campaign for precancerous cervical lesions from June to November 2018 in the selected hospitals. A convenience sampling technique was used and socio-demographic, sexual and reproductive data collected from consented participants by means of self-administered questionnaire. During the gynaecologic examination, a cervical smear was collected, stained by the Papanicolaou staining technique and the results classified according to the Bethesda 2014 guidelines. Frequency, percentage, Chi square and regression analysis were conducted using SPSS version 20 and p-value considered at 0.05. Results:of the 925 participants aged 25-65 years (mean 40.2±10.2 SD), 113 (12.2%) had the lesions among whom 9(7.9%) had atypical squamous cells of undetermined significance, 75 (66.4 %) had Low-grade squamous intraepithelial lesion and 29 (25.7%) had high-grade squamous intraepithelial lesion. Factors associated with the lesions were: age 1.85 [1.42-2.41; p= 0.001] and parity [OR= 1.46; 95% CI: 1.30-1.89; P= 0.004]. Conclusion:the prevalence of precancerous lesions was 12.2%. Age, parity were significant risk factors. Regular screening targeting the population at risk in this study becomes a priority.

adequate community perception of malaria is crucial to improving prevention, diagnosis, and treatment. This study aimed to determine the caregiver´s perception of the home-based management of childhood malaria in Baneghang and Fombap health areas, Cameroon.a cross-sectional study was carried out to assess the knowledge, attitudes, and practices of home caregivers (HCGs) in Baneghang, a health area under Community Directed Intervention (CDI), and Fombap, a CDI-free health area. Community health workers (CHWs) conducted a census to identify households with under-five children that constituted a sample frame, and then a systematic random sampling was used to select HCGs. Analysis of variance was used to compare the mean score perceptions of HCGs in the management of childhood malaria at the two sites.out of 420 HCGs interviewed, 161 (38.3%), 226 (53.8%), and 271 (64.5%) displayed correct knowledge, positive attitude, and good practice, respectively, towards childhood malaria prevention, diagnosis, and treatment in both study sites. The mean score knowledge of HCGs in Baneghang was significantly higher than that of those in Fombap (7.33 versus 6.94, p0.001). The mean score of attitudes of HCGs towards childhood malaria was also higher in Baneghang than in Fombap (6.59 versus 6.29, p=0.013). However, the mean scores of good practices of HCGs on childhood malaria in both health areas were similar (5.94 versus 5.92, p=0.921).home-based management of childhood malaria seems to have contributed to good knowledge and positive attitudes of HCGs on malaria prevention, diagnosis, and treatment.

World Health Organization recommends that basic surgical care be administered at the district level. In the absence of qualified surgeons, general practitioners are sometimes proposed to bridge the gap. Medical curricula in low- and middle-income countries must be designed accordingly. The aim of this study was to assess the achievements of training of undergraduate medical students in Cameroon towards meeting this objective. A descriptive cross-sectional study was carried out in the four state-owned medical schools in Cameroon. All students who had completed all clinical rotations were assessed with a self-administered questionnaire for their exposure and self-perceived comfort in conducting some selected basic surgical skills and procedures. A total of 304 (87.6%) students returned filled questionnaires. Their self-perceived comfort in surgical skills ranged from 25% (manual node tying) to 86% (surgical scrubbing). Adequate exposure to selected surgical procedures was 87% for repair of perineal tear complicating vaginal delivery, above 80% for caesarean section and incision and drainage of abscess, 73% for cast immobilization of extremity fracture and just above 50% for hernia repair and appendectomy. It was as low as 3% for bowel resection and anastomosis. The choice to perform extra-curricular activity for skills improvement was significantly associated with adequate exposure (p

Background: Vaccination is what is strongly recommended in protecting against childhood diseases. The Expanded Program of Immunization (EPI) in Cameroon started in 1976 as a pilot project and became operational all over the country in 1982 where vaccination is seen a fundamental right of every child in the country. However, rural areas have lots of constrains to the effective implementation of vaccination programs some of which are population-related. Purpose: This study aimed to assess the association between some factors and adherence to vaccination appointments in Ngambe Health District; a typical rural health district in Cameroon. Methods: This was a case control study where the vaccination records of health facilities in the district were reviewed and parents who respected their vaccination appointments formed the controls while those who missed a vaccination appointment were the cases. They were then traced for interviewed and data analyzed using Epi infos version 3.5.4. Results: Out of 94 parents, 37.2% had missed a vaccination appointment. In parents older than 36, the odds of missing an appointment was 11 (95%CI 3.69-34.43) while those with

Background and Aim: Malaria remains a major public health problem and a global threat to humanity especially in sub-Saharan Africa. In a bit to combat malaria in Cameroon, about 8million Cameroonian received the insecticide treating nets (ITNs) in 2011. However, hospital based reported prevalence of malaria still remains high. Our objective was to determine the community based prevalence and possible risk factors of malaria in pregnancy in the Mamfe health district, south west region-Cameroon. Methods: This was a community-based cross-sectional study involving 269 pregnant women in the Mamfe health district of Cameroon. Three out of the 5 health areas were randomly selected and pregnant women were later sampled by convenience and an interviewer administered questionnaire was done. Also rapid diagnostic test (RDT) for malaria was done for all the participants. Data was analysed using Epi info version 3.5.4 at a level of error of 5%. Results: Of the 269 pregnant women who took part in the study, 106 (39.6%) were positive for malaria. Risk factors associated with developing malaria among them were: presence of mosquito breeding sites (OR=0.001, 95%CI; 0.02-0.27, p-value=0.001), not sleeping under Insecticide treated nets(ITNs) (OR=0.01, 95%CI; 0.01-0.03, p-value=0.001), bushes around houses (OR=0.24, 95%CI; 0.07-0.79, p-value=0.02) and not taking intermittent preventive treatment (IPT) (OR=0.08, 95%CI; 0.01-0.49 p-value=0.01). Majority of participant knew malaria can be prevented by sleeping under ITNs 75% (95%CI; 69.9-80.5) and uptake of IPT 23.8% (95%CI; 18.8-29.2). Conclusion: Prevalence of malaria in pregnancy in the Mamfe health district is higher than reported by the regional delegation of public health for the south west. Risk factors include: mosquito breeding sites, bushes around compound, not taking IPT and none use bed nets are known to pregnant women. Interventions to fight against malaria in pregnancy should target intensification of health education on environmental hygiene and use of ITNs.

Background Up to the 21st century, traditional, complementary and alternative medicine(TCAM) is still used despite the wide spread of orthodox medicine. The magnitude, predictors and types of herbal remedies used for COVID-19 are assessed to tailor evidence based policy and drug formulation against COVID-19. Methods A community based cross sectional study was conducted among 1100 respondents from nine (9) communities selected in three health districts from May to July 2020. Pretested structured questionnaire were used to collect data from selected households on the use of TCAM, predictors as well as on the herbal preparations used for COVID-19. Nineteen (19) traditional healers were also interviewed on the types of herbal preparations use on patients tested or suspected for COVID-19 and the signs and symptoms identified. P-value Allium sativum, Azadirachta indica, Zingiber officinale, Artemisia annua were most commonly used herb for COVID-19. Cough, catarrh and fever were the main symptoms of COVID-19. Herbalists 79.7% [95% CI: 77.3–82.1] and bone setters 14.9% [95% CI: 12.8–17.0] were mostly visited. Logistic regression analysis showed age > 41 years (95% CI: 1.09–4.91), being a farmer (95% CI: 1.99–5.34), income levels between 185–370 USD (95% CI: 1.33–4.55), participants who resided in a rural setting (95% CI: 1.04–3.98), being knowledgeable on TCAM (95% CI: 1.54–6.45) and having a positive attitude towards TCAM (95% CI: 1.94–6.45) were predictors for TCAM use. Conclusion TCAM is widely used even in the era of orthodox medicine, and many factors contribute to its use in the Southwest region of Cameroon which should be taken into consideration in healthcare interventions that are sensitive to TCAM. Herbal preparations used during the COVID-19 pandemic can serve as baseline for drug development through efficacy and toxicity tests.

Introduction Chronic kidney disease (CKD) patients are at an extremely high risk of silent myocardial ischemia (SMI). However, there is a dearth of evidence on the worldwide prevalence of this very lethal and yet unrecognizable complication of CKD. The proposed systematic review and meta-analysis aims to estimate the global prevalence of SMI among CKD patients. Methods and analyses This protocol was conceived according to the preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) statement. The systematic review will involve all observational studies and clinical trials published until April 30, 2021, and reporting on the prevalence of SMI in CKD patients. Electronic sources including MEDLINE, Embase, Web of Science, and Cochrane database of systematic reviews will be perused for potentially eligible studies, restricted to only studies published in English or French. Two investigators will independently select studies and use a pre-pilot tested form to extract data. Further, they will independently perform a qualitative assessment of the risk of bias and overall quality of the selected studies, followed by a quantitative assessment using funnel plots and Egger’s tests. The heterogeneity between studies will be assessed with the Cochrane’s Q statistic, and the I2 statistic will measure the percentage of variation across studies that is due to their heterogeneity rather than chance; the I2 will decide if a meta-analysis can be conducted. In case it cannot be conducted, a descriptive analysis will be performed. Otherwise, study-specific estimates will be pooled using either a fixed-effects or a random-effects model, depending on the value of the I2 statistic. Subgroup and random effects meta-regression analyses will further investigate the potential sources of heterogeneity. Finally, sensitivity analyses will be performed to measure the impact of low-quality studies on the results of the meta-analysis, and power calculations will determine the probability that we will detect a true effect if it does exist. PROSPERO registration number CRD42020211929 Strengths and limitations of this study The intended systematic review and meta-analysis will fill the knowledge gap on the global prevalence of silent myocardial ischemia (SMI) in CKD patients. The eligible studies will be identified through a methodic literature search followed by a rigorous screening process; we will then use robust meta-analysis tools to pool the data and provide reliable estimates of the global prevalence of SMI in CKD patients. Two major limitations could be: the predominance of clinical trials that might limit the generalizability of the findings, given that some informative patients might have been sidelined by the strict inclusion criteria of these studies; the high probability of type 1 error originating from the important number of subgroup and sensitivity analyses.

Introduction:despite increasing research interest on Indigenous peoples´ health worldwide, the nutritional status of Indigenous children in Cameroon remains unknown. This study was conducted to assess the prevalence of stunting, wasting, and underweight among under-five Indigenous Mbororo children in the Foumban and Galim health districts of the West Region. Methods:a cross-sectional study was conducted involving 472 child-caregiver pairs from 16 Mbororo Communities in the Foumban and Galim health districts. Interviewer-administered questionnaires were used for data collection. Anthropometric measurements were collected using standard procedures. Socio-demographic data were analyzed using descriptive statistics. Anthropometric indices: height-for-age, weight-for-height, and weight-for-age - z-scores were analyzed using z-score 06 Stata version 11 and compared with World Health Organization growth reference standards. Ethical approval was obtained from the Faculty of Health Sciences Institutional Review Board of the University of Buea. Results:overall prevalence of stunting, wasting and underweight were 55.08% (95% CI: 50.5-59.58), 13.77% (95% CI: 10.65-16.89), and 31.99% (95% CI: 27.76-36.21), respectively. Severe stunting, wasting and underweight were 34.53% (95% CI: 30.22-38.83), 3.18% (95% CI: 1.58-4.76), and 10.59% (95% CI: 7.80-13.37), respectively. Rates of stunting, wasting and underweight for female and male were: 56.88% and 52.71%; 12.38% and 14.72%; and 30.73% and 32.55%, respectively. Stunting, wasting and underweight rates varied with child age. Conclusion:the prevalence of undernutrition was high, indicating a serious public health problem and the necessity for strategies to ensure the optimal health of the target population.

BackgroundThe COVID-19 pandemic has been associated with significant psychological and social distress worldwide. We investigated fear and depression among adults in Cameroon during different phases of the COVID-19 outbreak.MethodsAn online survey was conducted in Cameroon from June–December 2020 using a structured questionnaire. Socio-demographic data and information regarding COVID-19 history were obtained. Fear and depressive symptoms were assessed using the Fear of COVID-19 score (FCV-19S) and the Patient Health Questionnaire (PHQ-9), respectively. Responses were clustered in weeks to better appreciate their evolution over time.ResultsOverall, 7381 responses from all ten regions of Cameroon were analysed (median age: 30 years, 73.3% male). The prevalence of depression (PHQ-9 score ≥ 10) was 8.4%, and that of high fear of COVID-19 (FCV-19S scores ≥19) was 57.4%. These rates were similar across genders, age-groups, and region of residence. While mean weekly PHQ-9 scores remained fairly stable throughout the study period (range: 2.53–3.21;p = 0.101), mean FCV-19S scores were highest during the early weeks but decreased significantly thereafter (from 20.31 to 18.34;p ConclusionDepression amidst the COVID-19 crisis is less prevalent in Cameroon than in other countries. Prompt and widespread dissemination of adequate COVID-19 information may reduce the risks for depression by dispelling fear and anxiety among Cameroonians.

OBJECTIVES To determine the prevalence and risk factors associated with rifampicin (RIF)-resistant tuberculosis using GeneXpert technology. METHODS A cross-sectional study was conducted from April 2018 to November 2019 among tuberculosis (TB)-infected Cameroonian patients in the Littoral Region using records from patients presenting with clinically suspected or documented TB. The patients were screened for TB using GeneXpert MDR/RIF ultra. Data were documented with an ad hoc survey form and analysed with SPSS version 22. RESULTS 153 patients were included in the study. 64.1% were males; mean age was 37.9 ± 14.7 years and median age 37 years (range: 2-82). Most patients were new cases (76.4%). Relapses accounted for 8.5% and recurrences for 2.6%. Pulmonary TB was diagnosed among 98.7% patients using mostly sputum samples (85%). The prevalence of RIF resistance was 6.7% (95% CI: 3.4%-12.7%). This prevalence was significantly higher in samples of mucus and mucopurulent aspect (P-value = 0.04). RIF-resistant M. tuberculosis strains were significantly more frequent among relapses than new cases (23.1% vs. 2.3% P-value

Background Incomplete adherence to antiretroviral therapy (ART) is one of the factors that contribute to HIV drug resistance, and it is a major problem for the public health system in controlling the HIV pandemic. There is emerging evidence that SMS can play an important role in health care delivery among patients with HIV on ART, especially in resource-limited settings. Objective This paper aims to assess the impact of two-way and one-way SMS text messaging on adherence to HIV treatment. We hypothesized that sending weekly text messages through the one-way and two-way SMS text messaging approach will improve adherence to ART among patients with HIV and improve associated clinical outcomes (quality of life). Methods A randomized controlled trial is being carried out among participants with HIV who have been on ART for at least one month from an accredited treatment center, namely the Buea Regional Hospital and Kumba District Hospital of South West Region, Cameroon. Participants with HIV, both male and female, aged 21 years and older make up a sample size of 207. The interventions involved the use of mobile phone text messages. Before commencing the intervention, a focus group discussion was carried out among the participants to understand their perception about the use of SMS-based interventions to improve adherence. A total of 246 participants were randomized to receive either a one-way text message (SMS sent to a recipient without recipient sending a reply) or two-way text message (SMS sent to a recipient and recipient sends a reply) or the control (no SMS, only standard care). Data on adherence and quality of life were collected at baseline and after 6 months and will be analyzed using SPSS version 21, while qualitative data will be analyzed using Atlas.ti 7.5. Results Data collection began in September 2019 with focus group discussions and baseline data collection. After 1 month of baseline data collection, the intervention began in October 2019, and postintervention data were collected after 6 months (March 2020). At the end of the study, we will be able to understand the perception of patients toward SMS text messaging–based interventions and also assess the impact of one-way and two-way SMS text messages on treatment adherence among patients with HIV and on associated clinical outcomes (quality of life). Conclusions The impact of SMS text messaging varies across different settings. The results from this study will determine the perception of patients toward an SMS text messaging–based intervention and its impact on adherence to ART. International Registered Report Identifier (IRRID) DERR1-10.2196/16127

Background Although malaria is preventable and curable, 1 child dies of this disease every 2 minutes in Africa. Home-based management of malaria reduces the progression of severe malaria by more than 50%. Scalable, efficacious, and cost-effective strategies are needed to empower the capacities of home caregivers of children younger than 5 years of age in health education, diagnosis, and treatment of malaria at home. Objective The main objective of this trial is to assess the impact of the management provided by home caregivers on the prevention, diagnosis, and treatment of malaria in children younger than 5 years as compared to the home-based malaria management component of the integrated community-directed intervention (CDI) strategy of community health workers (CHWs). Methods A randomized controlled trial will be conducted. CHWs have conducted a census of all households where there is at least one child younger than 5 years with their home caregivers. These children and their home caregivers have been randomly placed into the intervention or control groups among the households identified. The trial will allow malaria home-based prevention, diagnosis, and treatment of 350 children younger than 5 years old by home caregivers in the Fombap area (intervention group) where the integrated CDI strategy will not implemented. This group will be compared to the home-based malaria management component of the integrated CDI strategy in which 350 children in the same age group will be followed up by CHWs in the Baneghang area (control group). The primary outcomes will be the prevention, diagnosis, and treatment of malaria in children younger than 5 years of age by home caregivers at home. The secondary outcomes comprise the malaria follow-up indicators produced by home caregivers in the intervention group and those produced by CHWs in the control group. Both descriptive and one-way analysis of variance estimation techniques will be used to compare the mean difference in the 2 strategies. Results From September 2019 to October 2019, all home caregivers with children younger than 5 years of age were identified in the intervention and control group by CHWs. Following this, 203 home caregivers with their 350 children younger than 5 years were randomly selected and enrolled in the intervention group, while 225 home caregivers with their 350 children younger than 5 years were enrolled in the control group. In the intervention group, 203 home caregivers were trained in November 2019. This home treatment effectively started in December 2019 and will continue until May 2020. Conclusions Findings from this randomized controlled trial will contribute to resolving the challenges of severe malaria and to limiting the death due to malaria of children younger than 5 years. This will bring benefits to home caregivers who will know how to promptly diagnose and properly treat malaria in their children at home. Trial Registration Pan African Clinical Trial Registry (PACTR) 202003487018009; https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=9788 International Registered Report Identifier (IRRID) DERR1-10.2196/19633

BACKGROUND Although malaria is preventable and curable, 1 child dies of this disease every 2 minutes in Africa. Home-based management of malaria reduces the progression of severe malaria by more than 50%. Scalable, efficacious, and cost-effective strategies are needed to empower the capacities of home caregivers of children younger than 5 years of age in health education, diagnosis, and treatment of malaria at home. OBJECTIVE The main objective of this trial is to assess the impact of the management provided by home caregivers on the prevention, diagnosis, and treatment of malaria in children younger than 5 years as compared to the home-based malaria management component of the integrated community-directed intervention (CDI) strategy of community health workers (CHWs). METHODS A randomized controlled trial will be conducted. CHWs have conducted a census of all households where there is at least one child younger than 5 years with their home caregivers. These children and their home caregivers have been randomly placed into the intervention or control groups among the households identified. The trial will allow malaria home-based prevention, diagnosis, and treatment of 350 children younger than 5 years old by home caregivers in the Fombap area (intervention group) where the integrated CDI strategy will not implemented. This group will be compared to the home-based malaria management component of the integrated CDI strategy in which 350 children in the same age group will be followed up by CHWs in the Baneghang area (control group). The primary outcomes will be the prevention, diagnosis, and treatment of malaria in children younger than 5 years of age by home caregivers at home. The secondary outcomes comprise the malaria follow-up indicators produced by home caregivers in the intervention group and those produced by CHWs in the control group. Both descriptive and one-way analysis of variance estimation techniques will be used to compare the mean difference in the 2 strategies. RESULTS From September 2019 to October 2019, all home caregivers with children younger than 5 years of age were identified in the intervention and control group by CHWs. Following this, 203 home caregivers with their 350 children younger than 5 years were randomly selected and enrolled in the intervention group, while 225 home caregivers with their 350 children younger than 5 years were enrolled in the control group. In the intervention group, 203 home caregivers were trained in November 2019. This home treatment effectively started in December 2019 and will continue until May 2020. CONCLUSIONS Findings from this randomized controlled trial will contribute to resolving the challenges of severe malaria and to limiting the death due to malaria of children younger than 5 years. This will bring benefits to home caregivers who will know how to promptly diagnose and properly treat malaria in their children at home. CLINICALTRIAL Pan African Clinical Trial Registry (PACTR) 202003487018009; https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=9788 INTERNATIONAL REGISTERED REPORT DERR1-10.2196/19633

The advantages of antibiotics have been most clearly seen in those acute bacterial infections which had a high mortality before the introduction of antibiotics. The reality of the potential harmful effects of antibiotics, both short term in individual patients and long term in favoring emergent resistance and opportunistic pathogens are discussed. Bacterial resistance makes the standard treatments ineffective, and increases the risk of infection spreading. The shortage of novel antibiotics has strengthened the efforts of genome sequencing to control bacterial resistance. The future would include novel approaches, based on a re-conceptualization of the nature of resistance, disease and prevention.

Background Understanding the epidemiology of intestinal parasitic infections is essential for the effective management of HIV infection in areas where intestinal parasites are also endemic. Data on the prevalence of intestinal parasitic infections in people living with HIV/AIDS in Cameroon are scarce. This study was designed to determine the prevalence of intestinal parasitic infections, as well as assess the predisposing factors for the infections in HIV/AIDS patients in Fako division of Cameroon. Methods Stool specimen was collected from consented participants and examined for ova, cysts, larvae or oocytes using the Kato-Katz, Formalin-Ether Concentration, Modified Ziehl-Neelsen and Modified field staining techniques. Statistical analyses performed included the Chi-square test and logistic regression. Results At the end of the study, 300 participants were enrolled, the majority being females 236 (78.6%). The participants were between 21–70 years (mean±SD=40±10) of age. The overall prevalence of intestinal parasites was 82.6% (95% CI: 78.4–87.0). The prevalence of infection was associated with age, being more prevalent in the age group 51–60 years (p=0.032). Intestinal protozoa were more prevalent than intestinal helminthes (74.3% vs 11.3%). The parasites isolated included: Cryptosporidium parvum (44.0%), Blastocystis hominis (25.0%), Microsporidium spp. (21.0%), Entamoeba histolytica (7.3%), Ascaris lumbricoides (4.3%), Isospora belli (4.3%), Trichuris trichiura (2.3%), hookworm (2.7%), Hymenolepis nana (1.3%), Strongyloides stercoralis (0.7%), Cyclospora cayetatensis (3.7%) and Giardia lamblia (3.3%). The predisposing factors for infection with intestinal parasites included poor educational background (OR=0.33, p=0.02), unskilled worker (OR=0.27, p=0.04), a well as source of drinking water (OR=2.6, p=0.03), and living with cats as pets (OR=3.06, p=0.01). Conclusions A very high prevalence of intestinal parasitic infections was observed in people living with HIV/AIDS. Routine screening for intestinal parasites should be instituted as part of HIV care in Fako division of Cameroon to improve the management of HIV/AIDS.

Introduction:low socioeconomic status is a risk factor for maternal death and contraceptive use has been shown to reduce maternal deaths in those poor settings. Despite the tremendous benefits of contraceptives in the regulation of reproductive health indicators, its use in less developed countries continue to remain unacceptably low. The purpose of this study was primarily to assess the contraceptive method mix and then determine the predictors of contraceptive use in the Cameroon Development Corporation (CDC) plantation camps. Methods:mix sampling was used. Firstly, two CDC camp localities (Tiko and Pena Mboko) were purposively selected. Pre-existing clusters within these localities were then randomly selected and then eligible participants within the sampled clusters systematically selected. Using the main street junction as starting point, direction of sample collection was determined by spinning a plastic bottle. From the start of street junction and moving in direction of the bottle pointer, all households left to the principal investigator were visited in search of eligible participants which were sexually active women aged 15-49 years who gave consent/assent. One participant was selected per household. We used pretested interviewer-administered questionnaires that covered information on socio-demographic characteristics, reproductive health and contraceptive use. Statistical significance was set at p-value ≤ 0.05. Results:six hundred and thirty four (634) sexually active women aged 15-49 years were included in the study; majority were 25-35 years (246; 38.8%). The current contraceptive prevalence was 63.1% [59.3-66.8] (400); of which 312 participants (78%) used a single method while 88 (22%) participants used contraceptives in combination. The most common methods in use were rhythm (196; 49%), male condom (109; 27.2%) and implants (63; 15.8%). When adjusted, statistically significant determinants for contraceptive use were age range and marital status such that odds of using contraceptives was lower in women < 35 years and those cohabiting (AOR= 0.71 [0.50-1.00] and AOR=0.62 [0.44-0.87] respectively). Conclusion:current contraceptive practice in the CDC plantation camps is geared toward less effective traditional methods than the more effective modern methods. More health education is needed to adjust this paradigm.