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A cost-effective algorithm for the diagnosis of Hepatitis C virus infection and prediction of HCV viremia in Cameroon.

Conventional tests for antibody to Hepatitis C virus (HCV) and HCV RNA require considerable time before results are available, remain very expensive and are not adapted to many sub-Saharan African countries where HCV is endemic. The aim of this study was to evaluate the accuracy of an algorithm consisting of two HCV rapid tests to diagnose and predict HCV viremia in patients in Cameroon. Three hundred and twenty nine plasma samples were screened by two HCV rapid tests (ImmunoComb II HCV, PBS Orgenics and Hexagon HCV, Human). Previous evaluation of these samples for HCV antibodies (anti-HCV) by conventional third generation ELISA, considered as a reference test, indicated that 168 were anti-HCV negative and 161 positive. Among the 161 anti-HCV positive plasma, 114 (71%) were HCV RNA-positive by RT-PCR assay. The ImmunoComb II HCV test provided the more sensitive detection of anti-HCV (sensitivity: 99.4% with a 95% CI = 96-100%). Surprisingly, the second HCV rapid test, Hexagon HCV, showed a high capacity to identify non-viremic subjects amongst anti-HCV positive cases (93.6% [95% CI: 82-99%]). These results suggest an algorithm using ImmunoComb II HCV as a first test to screen anti-HCV positive subjects, and Hexagon HCV as a second test to discriminate between viremic and non-viremic HCV seropositive subjects.

Algorithms↗

Wild fauna as a probable animal reservoir for Trypanosoma brucei gambiense in Cameroon.

In order to study the existence of a wild animal reservoir for Trypanosoma brucei gambiense in South Cameroon, blood was collected from wild animals in three human African trypanosomiasis foci and from a nonendemic control area. The 1142 wild animals sampled belonged to 36 different species pertaining to eight orders (407 primates, 347 artiodactyls, 265 rodents, 54 pangolins, 53 carnivores, 11 saurians and crocodilians, and five hyraxes). QBC and KIVI tests detected trypanosomes on 1.7% (13/762) and 18.4% (43/234) of animals examined, respectively. Using specific primers, T. brucei non-gambiense group 1 DNA was detected on 56 animals (4.9%). This infection rate was 5.3% in the endemic zone and 3.8% in the control zone. Of the 832 animals of the endemic zone, PCR revealed T. b. gambiense group 1 DNA in 18 (2.2%). These hosts included two rodents, two artiodactyls, two carnivores and two primates. T. b. gambiense group 1 was absent from animals from the nonendemic zone. A decrease in the prevalence of T. b. gambiense group 1 was observed in wild animals from the Bipindi sleeping sickness focus after a medical survey and vector control in this area. The epidemiological implications of these findings remain to be determined with further investigations.

Animals↗

Risk factors for herdsman-reported foot-and-mouth disease in the Adamawa Province of Cameroon.

We analysed responses from 147 Fulani herdsmen to a questionnaire about cattle herd-level risk factors for foot-and-mouth disease (FMD) in the previous year. The study used a cross-sectional design with a stratified, two-stage random sample of cattle herds in the Adamawa Province of Cameroon. The questionnaire was pre-tested at a local cattle market before a final version was translated into Foulfoulde (the local Fulani dialect). Variables were screened using a univariable analysis and logistic multiple-regression models were developed in a forward-selection process. Fifty-eight percent (50-65; 90% CIs) of herdsmen reported FMD in their herd in the previous 12 months. Important risk factors for FMD in the previous 12 months included going on transhumance (OR=2.6), buying cattle from markets (OR=2.2), mixing of herds at watering points (OR=2.4), feeding cotton-seed cake (OR=3.3), buffalo near the herd (OR=2.2) and administrative division. For the subset of herds that went on transhumance, coming in contact with an FMDV-diseased herd while on transhumance was the strongest factor (OR=16).

Animal Husbandry↗

Response of Trypanosoma vivax and Trypanosoma congolense in zebu cattle in North Cameroon to prophylactic treatment with two formulations of isometamidium.

We tested the efficacy of two formulations of isometamidium in a tsetse-infested farm in North Cameroon from 20 August 2000 to 5 January 2001. A total of 90 adult cattle were used in three groups of 30 each corresponding to two treated and one untreated control. Drug efficacies were evaluated in terms of reduction of parasite incidence in the host's blood, maintenance of packed-cell volume (PCV) and weight gains. Both drugs reduced the incidence of parasites even though re-infections 2 weeks after treatment were common. PCV values were similar in both treated groups but higher than in the untreated control. Body weight changes followed a similar trend with the control losing weight from a mean of 427+/-119kg at the beginning to 398+/-93kg in 4 months. Weights increased from 375+/-76 and 396+/-110 to 396+/-69 and 418+/-112kg in the Veridium and Trypamidium groups, respectively. Efficacy was similar between the two formulations of isometamidium in the prophylaxis of bovine trypanosomosis. However, the presence of parasites in some animals barely 2 weeks after treatment suggested that either infections were not cleared or residual drug effects were not sufficient to prevent re-infections.

Animals↗

Impact of four years of large-scale ivermectin treatment with low therapeutic coverage on the transmission of Onchocerca volvulus in the Mbam valley focus, central Cameroon.

The extent to which ivermectin treatments have an impact on onchocerciasis transmission is a matter of some concern. We investigated this issue in the Mbam valley, a hyperendemic focus located in a forest-savannah mosaic area of Cameroon. Parasitological examinations of 5-9-year-old children, who had never received any antifilarial drug, were conducted before the first distribution of ivermectin in 1991-1993 and again in 2002, after four annual rounds of mass treatments. After matching for gender, age and village of residence, the prevalence and intensity of microfilaridermia corresponded respectively, in 2002, to 66.2 and 42.0% of the initial values. The decrease was more marked among the youngest children who, compared with the older ones, were submitted to the reduced force-of-infection earlier in their life. The results of the present study suggest that the specific vectorial competence of Simulium squamosum cytotype B, the vector of Onchocerca volvulus in the Mbam valley, allows a significant decrease in onchocerciasis transmission after several years of treatment, despite low therapeutic coverage. Though these results are encouraging, efforts should be made to improve the therapeutic coverage in the area.

Animals↗

Evaluating a malaria intervention strategy using knowledge, practices and coverage surveys in rural Bolifamba, southwest Cameroon.

We evaluated the impact of a malaria intervention in Bolifamba in rural Cameroon. The intervention consisted of educating the community on management of malaria and provision of a dispensary for early diagnosis and treatment. In July 2001, prior to the intervention, a questionnaire was used to obtain information on knowledge of and practices toward childhood malaria of 185 mothers of children aged 0-5 years. The same questionnaire was administered to 120 of the 185 mothers, one-year post-intervention. Clinical and laboratory investigations were carried out on children whose mothers were interviewed. A comparison of pre- and post-intervention data indicated significant changes in (i) the use of appropriate malaria treatment (from 50% to 81.7%); (ii) recognition of splenomegaly as a feature of malaria (from 18.4% to 80.8%); (iii) prevalence of splenomegaly (from 26.5% to 13.3%); (iv) prevalence of fever (from 27.8% to 13.3%); (v) parasite prevalence (from 60.5% to 44.2%) and (vi) severe malaria anaemia (from 2.6% to 0.0%). These findings revealed that proper education of villagers, particularly mothers, on malaria and the presence of health facilities, where treatment is readily available at affordable cost, close to villages, are important strategies that would reduce malaria morbidity and mortality significantly.

Adolescent↗

Malaria vectors and urbanization in the equatorial forest region of south Cameroon.

Entomological surveys were carried out in the town of Mbalmayo and in the nearby rural village of Olama, within the equatorial forest zone of Cameroon. Mosquitoes were captured when landing on human volunteers and by pyrethrum spray catches. Malaria vectors captured were Anopheles gambiae Giles (M and S forms) and A. moucheti Evans in both areas, together with A. funestus Giles in Mbalmayo. One A. marshallii (Theobald) specimen infected by Plasmodium falciparum was found in Olama. Anopheles moucheti was the most abundant anopheline species caught in Olama, while A. gambiae was the most abundant in Mbalmayo. All these vectors were highly anthropophilic as indicated by the fact that only 5 of 201 blood meals analysed had been taken from non-human hosts. Plasmodium falciparum was the only malaria parasite species found in Mbalmayo, while P. malariae was also found in Olama. The annual entomological inoculation rate was estimated at 129 infective bites/person/year in Mbalmayo and 322 in Olama. Comparison with data published in 1955 from Mbalmayo, before expansion of the town, showed the impact of urbanization on the composition of the vector system and malaria transmission dynamics. Such changes should be considered when implementing sustainable control measures.

Animals↗

High prevalence of Trypanosoma brucei gambiense group 1 in pigs from the Fontem sleeping sickness focus in Cameroon.

To understand the importance of domestic pigs in the epidemiology of human trypanosomiasis, PCR was used to identify trypanosome populations in 133 pigs from the Fontem sleeping sickness focus of Cameroon. The results from this study show that 73.7% (98/133) of pigs from the Fontem area carry at least one trypanosome species. Trypanosoma vivax, T. brucei s.l. and T. congolense forest were found in 34.6% (46/133), 40.0% (53/133) and 46.0% (61/133) of the pigs respectively. T. simiae and T. congolense savannah were not identified in these animals. The use of repeated DNA sequences detected T. b. gambiense group 1 in 14.8% (15/101) of the pigs. Such pigs can be possible reservoir hosts for T. b. gambiense group 1 and contribute to the maintenance of the disease in the area. Mixed infections were revealed in 35.3% (47/133) of the pigs. Furthermore, we observed that under natural conditions, 52.4% (11/21) of the pigs from the Fontem focus carry mixed infections with T. b. gambiense group 1. No significant difference was observed between the percentage of T. b. gambiense group 1 single and mixed infections, and between the prevalence of this trypanosome in pigs from villages with and without sleeping sickness patients.

Animals↗

Prevalence and incidence of bovine trypanosomosis on the Adamaoua plateau in Cameroon 10 years after the tsetse eradication campaign.

Between March 2004 and February 2005, the monthly incidence of trypanosome infections was measured in cattle from nine sentinel herds in the Adamaoua province of Cameroon. Three herds of 20 cattle each were kept on the plateau which has been cleared from tsetse flies about 10 years ago, three other herds were grazing in the tsetse infested valley whereas the last three were herded in the buffer zone. The cross-sectional study showed that the initial trypanosomosis prevalence was 1.8, 5.2 and 2.0% on the plateau, in the buffer zone and the valley, respectively. During the longitudinal study, the trypanosomosis incidence was high in the valley (3.7-20%) and the buffer zone (1.8-13.4%), whereas it was significantly lower (0-2.1%) on the plateau. Tsetse flies, mainly Glossina morsitans submorsitans and a few G. tachinoides, were caught in the valley and the buffer zone, but none on the plateau. The data indicate a low trypanosomosis risk on the plateau. Further entomological studies, however, are required to clarify the origin of the trypanosome infections on the plateau.

Animals↗

Widely varying SIV prevalence rates in naturally infected primate species from Cameroon.

Although it is now well established that a substantial proportion of wild-living primates in sub-Saharan Africa harbor SIV, no study to date has examined to what extent the various species are naturally infected. In this study, we first describe the development and validation of sensitive and specific SIV antibody detection assays representing all major known primate lentiviral lineages on a panel of 207 sera from 11 different primate species with known infection status. The newly developed assays were then used to determine SIV prevalence rates in nine primate species native to Cameroon. Analysis of 722 sera revealed widely varying prevalence rates, ranging from an apparent absence of SIV infection in crested mona (0/70), grey cheeked (0/36) and agile mangabeys (0/92), to prevalence rates of 3%, 4%, 11%, 27%, 39% and 52% for mustached (6/203), greater spot-nosed (8/193), northern talapoin (3/26), mantled guereza (14/52), De Brazza's (9/23) and mandrill (14/27) monkeys, respectively. The epidemiology of naturally occurring SIV infections is thus more complex than previously appreciated and the various non-human primate hosts seem to differ in their susceptibility to SIV infection. The newly developed assays should now permit to define with greater accuracy existing SIV reservoirs and associated human zoonotic risk.

Amino Acid Sequence↗

Full-length sequence analysis of SIVmus in wild populations of mustached monkeys (Cercopithecus cephus) from Cameroon provides evidence for two co-circulating SIVmus lineages.

Mustached monkeys (Cercopithecus cephus), which form a significant component of primate bushmeat in west central Africa, are infected with simian immunodeficiency virus (SIVmus). We identified and genetically characterized five new SIVmus strains infecting wild living mustached monkeys from Cameroon. Phylogenetic analysis of partial pol sequences revealed that SIVmus strains form two distinct groups within the clade comprised of lentiviruses isolated from Cercopithecus nictitans (SIVgsn), Cercopithecus mona (SIVmon) and C. cephus (SIVmus). Characterisation of three full-length SIVmus genomes confirmed the presence of two distinct lineages infecting mustached monkeys. These two variants of SIVmus, here designated SIVmus-1 and SIVmus-2, were isolated from animals sharing habitats within the same geographic region. Phylogenetic analyses showed that the diversification of SIVmus, SIVgsn and SIVmon involved inter-lineage recombination, and suggested that one of the SIVmus lineages likely resulted from cross-species transmission and recombination involving SIVmus and an as yet uncharacterized SIV. These results indicate that cross-species transmission and recombination play a major role in the evolution of primate lentiviruses among sympatric primate species.

Animals↗

Detection and identification of trypanosomes by polymerase chain reaction in wild tsetse flies in Cameroon.

The prevalence of various species and subgroups of trypanosomes in infected flies from three sleeping sickness foci in Cameroon was determined by the use of polymerase chain reaction (PCR). The predominant tsetse species found were Glossina palpalis palpalis. Microscopical examination of 943 non-teneral tsetse flies revealed an average infection rate of 10.4%. A total of 90 flies were analyzed for trypanosome identification with primer sets specific for Trypanosoma (Trypanozoon) brucei s.l., T. (Duttonella) vitax, T. (Nannomonas) simiae, and forest type T. (Nannomonas) congolense. PCR succeeded in identifying 52 of the 90 infected flies. Other primers were also tested on microscope positive/PCR-negative infections, and trypanosome subgroups were detected (Kilifi type and savannah type T. congolense). PCR amplification allowed identification of immature infections and revealed mixed-infections. The PCR technique failed to identify 42.2% (38/90) of the parasitologically positive flies and the reasons for this failure are discussed.

Animals↗

Prevalence and determinants of current contraceptive method use in a palm oil company in Cameroon.

The principal reasons given by African women for not using contraception include their lack of economic power and control over their choice of partner. An epidemiologic descriptive survey of a cross-section of the female personnel of a Cameroonian palm oil company (SOCAPALM) was carried out in August 1995, to evaluate the various determinants and level of use of various family planning methods in a well defined population of women in employment. An exhaustive list of all the households in the five villages of SOCAPALM was compiled and all women between 15 and 49 years of age who had lived on the palm oil plantation for at least a year were interviewed. The adjusted odds ratios showed that use of modern contraceptive methods was significantly associated with the woman having received secondary education, having more than three children, being the head of the household and, in cases where there was a man regularly present in the household, his approval of family planning. Recently receiving information (during the last month) about family planning was not identified by multivariate analysis as a significant factor affecting the decision to use modern or traditional contraception. The same factors were found to be associated with the use of traditional methods of contraception, but having had an illegal abortion was also associated with the use of such methods. Thus, the level of knowledge about family planning and the prevalence of contraceptive use was significantly higher for women living in industrial environments (such as SOCAPALM), than in the overall population of women in Cameroon. The economic power of the woman, the presence of a strong social reproductive health network, and the positive attitude of men and community leaders were the most important factors affecting the family planning decision of the women.

Abortion, Illegal↗

Laparoscopic surgery in the Cameroon.

A new surgical section of operative laparoscopy was installed in General Hospital of Yaoundé, Cameroon, in April 1992 after many years of collaboration between the University of Clermont-Ferrand and the University of Yaoundé. A total of 735 laparoscopic operations were conducted in the first 5 years. Conditions facilitating such a project are discussed.

Cameroon↗

Search for Enterocytozoon bieneusi infection in wild monkeys in Cameroon.

Faecal samples collected from 42 wild monkeys in Cameroon were examined for microsporidia by light microscopy (using Weber trichrome and Uvitex 2B stains) and by PCR (using Enterocytozoon bieneusi specific primers). None of the 42 samples was positive, suggesting that wild monkeys do not represent a major reservoir for microsporidia in Central Africa.

Animals↗

Relationship between onchocerciasis and epilepsy: a matched case-control study in the Mbam Valley, Republic of Cameroon.

Studies conducted during the past 10 years to investigate the possible relationship between onchocerciasis and epilepsy have led to contradictory results. In 1991-92 and 2001 we investigated 14 villages in central Cameroon to evaluate the relationship, at the community level, between the prevalence of epilepsy and the endemicity level of onchocerciasis. A case-control study compared the microfilarial loads of 72 epileptic and 72 non-epileptic individuals, matched according to sex, age, and village of residence. The prevalence of epilepsy and the community microfilarial load (CMFL) were closely related (P < 0.02), and the case-control study demonstrated that the microfilarial loads (microfilariae per snip) in the epileptic group (arithmetic mean = 288, median = 216) were significantly higher (P < 10(-4)) than in the control group (arithmetic mean = 141, median = 63). The results strongly support the existence of a link between onchocerciasis and epilepsy. The fact that such a relationship has not been found recently in some other West and Central African areas is probably due to the lowered endemicity of onchocerciasis following vector- and ivermectin-related control measures applied over the past 5-25 years. The socio-economic and demographic impact of onchocerciasis-related epilepsy should be evaluated, and taken into account as part of all onchocerciasis control programmes.

Adolescent↗

Snakebite in northern Cameroon: 134 victims of bites by the saw-scaled or carpet viper, Echis ocellatus.

Echis ocellatus is one of the most deadly snakes known to humans, yet the procurement of antivenom for the treatment of these snakebites in Africa has become increasingly difficult and expensive. There is no consensus for the management of victims, and little is known of actual recent experiences with these cases in ordinary health care settings in Africa. All cases of snakebite reliably identified as bites of E. ocellatus and admitted to Kolofata District Hospital, northern Cameroon, from January 1993 to December 2002 were described retrospectively or prospectively. Of 134 cases admitted, 63% were male, three-quarters were aged < 30 years, and 85% survived. Pasteur polyvalent antivenom for Africa was administered intravenously in all but 1 case, but patients rarely received more than 10 mL. In most cases, appropriate antivenom can be administered effectively at a fraction of the recommended dose (20-60 mL), even in patients with serious complications presenting days after having been bitten; however, death is more likely in late presenters.

Adolescent↗

Perceptions of malaria transmission, presentation and management in northern Cameroon.

During early 2001, 1197 adult health service users in a poor rural district of northern Cameroon were interviewed in order to discover prevalent beliefs about malaria. The survey included questions about the name of the disease, its cause and transmission, signs and symptoms, cure, and local importance as a cause of sickness and death. Interviewees showed good understanding of the signs and symptoms of malaria, its importance, and its association with the rains. Most felt that either a medical or a herbal treatment could cure malaria. Only 1% identified mosquitoes as a source of transmission. Health education to explore beliefs and to correct misconceptions should precede and accompany the introduction of technological interventions in malaria control programmes in traditional societies.

Adolescent↗