BackgroundThe Malaria Vaccine Implementation Program, coordinated by the World Health Organization, intended to initiate the roll-out of the RTS, S/AS01 malaria vaccine in 3 sub-Saharan African countries in 2018. With sub-optimal implementation, the effectiveness of this vaccine in routine clinical use could be significantly lower than its measured efficacy in randomized trials. This study had as objectives to systematically review and summarize published studies addressing the challenges faced during the implementation phase of malaria vaccination programs and randomized trials conducted in sub-Saharan Africa. The review also sought to report proposed solutions to the challenges identified.MethodThis was a systematic review of studies published between 1947 and 2017. Medline, Embase and the Cochrane library databases were searched. Of the 365 studies retrieved, 8 eligible studies reported on challenges of implementing a malaria vaccine in sub-Saharan Africa and possible solutions to these challenges. Data were abstracted from the eligible studies and a qualitative synthesis was done.ResultsThe 8 studies included in the review had a total of 6189 participants and used a variety of methodologies (3 qualitative, 1 quantitative, 3 mixed method studies and 1 clinical trial review). There was an overall positive acceptance towards the new malaria vaccine (n = 6/8 studies), with a mean acceptance rate of 86.1% (95% CI: 62.0–110.2, n = 2). The main challenges to vaccine receptivity were: inadequate community engagement due to lack of information about the vaccine (n = 6), fear of the vaccine’s side effects (n = 5), inefficient delivery of vaccination services to children (n = 4), and sub-optimal quality of the health services (n = 3). Main themes identified from the proposed solutions consisted of the following: using dynamic communication models and trusted sources for delivering vaccine-related health information to the communities (n = 6), community engagement at both national and district level (n = 6), implementing the new vaccine services alongside the existing health services already delivered (n = 6).Conclusion/RecommendationsEffective implementation of the malaria vaccine program requires careful consideration of the socio-cultural context of each community. The RTS, S/AS01 malaria vaccine acceptance and uptake may be significantly enhanced if caregivers’ perceptions about vaccines and their importance are adequately fine-tuned. In order to achieve these, community participation and the provision of adequate information in an acceptable form via reliable communication channels seem to be imperative.

Background The endemic nature of the hepatitis B virus (HBV) in Sub-Saharan Africa is a significant public health problem that places health care providers (medical students inclusive) at increased risk of occupational exposure. However vaccination against HBV is not systematic among medical students in Cameroon. Thus, we sought to evaluate awareness and HBV vaccine coverage among medical students in Cameroon. Methods Using semistructured questionnaire and a cross-sectional approach, medical students from 3 State Universities in Cameroon were evaluated for their knowledge, attitudes, and vaccination status against the HBV. Data were collected over a 3-month period. HBV vaccine status was defined as complete (3 doses), partial (1 and 2 doses), and unvaccinated. Data were entered and analyzed using Epi-info 7. Results There were 714 respondents among whom 186 (26.05%) had been vaccinated at least once against HBV. Sixty-six (9.24%) were partially vaccinated and 120 (16.81%) completely vaccinated. No student had done postvaccination serologic testing to confirm full immunisation. Eighty-three percent (83.00%) of respondents had adequate knowledge on HBV infection and vaccine, while 90.00% had adequate knowledge on HBV transmission. Most medical students had a positive attitude towards the HBV vaccine. The most common negative attitudes were worries about the side effects and fears of being infected by the vaccine. Conclusion Despite adequate knowledge on HBV infection and vaccination only about 1 in 6 medical students had completed the HBV vaccination series. This highlights the need for better health policies aimed at increasing access and coverage of the HBV in at-risk populations like medical students.

BackgroundWaist circumference (WC), waist-to-hip ratio (WHR) and waist-to-height ratio (WHtR) are all independent predictors of cardio-metabolic risk and therefore important in HIV/AIDS patients on antiretroviral therapy at risk of increased visceral adiposity. This study aimed to assess the extent of agreement between these parameters and the body mass index (BMI), as anthropometric parameters and in classifying cardio-metabolic risk in HIV/AIDS patients.MethodsA secondary analysis of data from a cross-sectional study involving 200 HIV/AIDS patients was done. Anthropometric parameters were measured from participants using standard guidelines and central obesity defined according to recommended criteria. Increased cardio-metabolic risk was defined according to the standard cut-off values for all four parameters. Data were analyzed using STATA version 14.1.ResultsThe prevalence of WC-defined central obesity, WHR-defined central obesity and WHtR > 0.50 were 33.5%, 44.5% and 36.5%, respectively. The prevalence of BMI-defined overweight and obesity was 40.5%. After adjusting for gender and HAART status, there was a significant linear association and correlation between WC and BMI (regression equation: WC (cm) = 37.184 + 1.756 BMI (Kg/m2) + 0.825 Male + 1.002 HAART, (p < 0.001, r = 0.65)), and between WHtR and BMI (regression equation: WHtR = 0.223 + 0.011 BMI (Kg/m2)– 0.0153 Male + 0.003 HAART, (p < 0.001, r = 0.65)), but not between WHR and BMI (p = 0.097, r = 0.13). There was no agreement between the WC, WHtR and BMI, and minimal agreement between the WHR and BMI, in identifying patients with an increased cardio-metabolic risk.ConclusionDespite the observed linear association and correlation between these anthropometric parameters, the routine use of WC, WHR and WHtR as better predictors of cardio-metabolic risk should be encouraged in these patients, due to their minimal agreement with BMI in identifying HIV/AIDS patients with increased cardio-metabolic risk. HAART status does not appear to significantly affect the association between these anthropometric parameters.

Background: There is uncertainty regarding the status of emergency obstetric and neonatal care (EmONC) in the Cameroonian context where maternal and neonatal mortality are persistently high. This study sought to evaluate the coverage, functionality and quality of EmONC services in Kumba health district (KHD), the largest health district in Southwest Cameroon.. Methods: A retrospective study of routine EmONC data for the periods 1 January 2011 to 31 December 2012 (when EmONC was being introduced) and 1 January 2013 to 31 December 2014 (when EmONC was fully instituted) was conducted. Coverage, functionality and quality of EmONC services were graded as per United Nations (UN) standards. Data was analysed using Epi-Info version 7 statistical software. Results: Among the 31 health facilities in KHD, 12 (39%) had been delivering EmONC services. Three (25%) of these were geographically inaccessible Among the 9 facilities that were assessed, 4 facilities (44%) performed designated signal functions, with 2 being comprehensive (CEmONC) and 2 basic (BEmONC). These exceeded the required minimum of 2.8 EmONC facilities/500000, 0.6 CEmONC facilities/500000 and 2.2 BEmONC facilities/500000, with reference to an estimated KHD population of 265,071. The signal functions that were least likely to be performed were neonatal resuscitation, manual evacuation of retained products and use of anticonvulsants. In 2011-2012, the facilities performed 35% of expected deliveries. This dropped to 28% in 2013-2014. Caesarean sections as a proportion of expected deliveries remained very low: 1.

ObjectiveThe rapid scale-up of antiretroviral therapy (ART) coverage in sub-Saharan Africa has encountered the challenge of maintaining international clinical standards of ART utilization and change of ART regimens. In Cameroon, scarce reports have documented the motives for change of ART. This study had as objective to investigate the reasons for switch in ART through a secondary analysis and descriptive synthesis of data from a cross-sectional study at the Limbe Regional Hospital.ResultsOne hundred participants were included. Their mean age was 40.2 ± 8.0 years and 70% of them were females. The median duration of ART use was 60 months. Zidovudine-Lamivudine-Nevirapine regimen was received by 83% of patients while the Stavudine-Lamivudine-Nevirapine regimen had the highest median duration of use (58 months). Most patients had experienced changes in ART (especially from Stavudine-Lamivudine-Nevirapine regimen) with the chief reason being unavailability of their previous regimens. Four patients had their ART changed due to active tuberculosis, 4 due to pregnancy and 7 due to ART toxicity (4 and 3 for peripheral neuropathy and lipodystrophy respectively). In conclusion, shortages in ART hugely influenced switch in regimens. In such a context, modifications in ART possibly deviate from guidelines with resultant sub-optimal therapy and enhanced drug resistance.Electronic supplementary materialThe online version of this article (10.1186/s13104-017-2948-3) contains supplementary material, which is available to authorized users.