BackgroundAccess to Human Immunodeficiency Virus (HIV) care has been rolled out in Cameroon in the last decade through decentralised delivery of care and timely initiation of free antiretroviral drugs. We sought to describe the evolution of mortality and loss to follow up (LTFU) and their patient-related determinants at an HIV clinic which is facing significant challenges.MethodsA retrospective review of point of care data from HIV patients was conducted in June 2012 at Nkongsamba Regional Hospital in Cameroon to establish mortality and LTFU rates. Univariable and multivariable Cox regression models were used to screen for factors associated with the outcomes. Telephone calls were made to trace patients LTFU.ResultsBetween June 2005 and December 2010, 2388 HIV infected patients were admitted. Of these, 1858 were aged 15 and above and were included in our analysis. Their median age was 36 years (IQR: 30–44) and they were followed up over a total risk period of 3647.3 person-years (pyrs). The overall mortality rate was 34.6 deaths per 1000 pyrs (95% CI: 29.0-41.1) while the overall LTFU rate was 94.6 per 1000 pyrs (95%CI: 85.1-105.1).The mortality rates steadily rose to a peak of 69.6 deaths per 1000 pyrs in 2009 and then fell drastically to 20.6 per 1000 pyrs in 2010. The LTFU rate increased sharply from 29.7 in 2006 to 138.2 in 2007 and remained virtually stable until 2010. The factors associated with mortality were: being male (aHR = 2.25, 95% CI: 1.58-3.19), clinical disease progression (aHR = 2.0, 95% CI: 1.58-2.53), CD4 count <200 cells/μl (aHR = 3.14, 95% CI: 1.27-7.73), haemoglobin level <10 g/dl (aHR = 2.50, 95% CI: 1.69-3.69). Major factors associated with high LTFU rate were: distance to clinic of over 5 km (aHR = 1.25, 95% CI: 1.00-1.55), being single, having partners with unknown HIV status or taking no treatment and with CD4 count >500 cells/μl. Two- thirds (66.7%) of traced LTFU patients were dead.ConclusionMortality and LTFU rates in our cohort were high but there is evidence that patients’ outcomes are improving. Interventions to address factors associated with high mortality and LTFU should be implemented for optimal results in patient care.

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Background Environmental surveillance (ES) for poliovirus is increasingly important for polio eradication, often detecting circulating virus before paralytic cases are reported. The sensitivity of ES depends on appropriate selection of sampling sites, which is difficult in low-income countries with informal sewage networks. Methods We measured ES site and sample characteristics in Nigeria during June 2018–May 2019, including sewage physicochemical properties, using a water-quality probe, flow volume, catchment population, and local facilities such as hospitals, schools, and transit hubs. We used mixed-effects logistic regression and machine learning (random forests) to investigate their association with enterovirus isolation (poliovirus and nonpolio enteroviruses) as an indicator of surveillance sensitivity. Results Four quarterly visits were made to 78 ES sites in 21 states of Nigeria, and ES site characteristic data were matched to 1345 samples with an average enterovirus prevalence among sites of 68% (range, 9%–100%). A larger estimated catchment population, high total dissolved solids, and higher pH were associated with enterovirus detection. A random forests model predicted “good” sites (enterovirus prevalence &gt;70%) from measured site characteristics with out-of-sample sensitivity and specificity of 75%. Conclusions Simple measurement of sewage properties and catchment population estimation could improve ES site selection and increase surveillance sensitivity.

IntroductionL'objectif principal de notre étude était d'identifier les bactéries associées à l'infection nosocomiale, dans le service de réanimation, de l'hôpital Laquintinie de Douala en vue d'améliorer la prise en charge et diminuer la létalité.MéthodesIl s'agissait d'une étude transversale et descriptive, menée du 1er mars au 31 mai 2011.Tous les patients hospitalisés depuis au moins 48 h étaient inclus dans l’étude et ceux présentant une infection documentée à l'admission étaient exclus. L'analyse des donnés a été faite par le logiciel SPSS 16.Les tests de Khi deux pour la signification.RésultatsLa prévalence de l'infection nosocomiale était de 12%, elle concernait des personnes âgées de plus de 60 ans et présentant une infection urinaire dans 79% des cas. La létalité était de 72% pour une durée moyenne de séjour de 11,7 ± 12,1 jours. Les bactéries responsables étaient en majorité des bactéries gram positifs (BGN), dont E coli dans 23,1% et les cocci gram positifs(CGP), dans 15,4% des cas.ConclusionL’étude de la résistance aux antibiotiques, montre une multi résistance, dont il faut tenir compte en mettant en place une stratégie de prévention active.

During the poliovirus outbreak in Cameroon from October 2013 to April 2015, the Ministry of Public Health’s Expanded Program on Immunization requested technical support to improve mapping of health district boundaries and health facility locations for more effective planning and analysis of polio program data. In December 2015, teams collected data on settlements, health facilities, and other features using smartphones. These data, combined with high-resolution satellite imagery, were used to create new health area and health district boundaries, providing the most accurate health sector administrative boundaries to date for Cameroon. The new maps are useful to and used by the polio program as well as other public health programs within Cameroon such as the District Health Information System and the Emergency Operations Center, demonstrating the value of the Global Polio Eradication Initiative’s legacy.