Abstract: OBJECTIVE: This cross-sectional study investigates the factors associated with patient comprehension of frequently used prescription patterns and explores patients' preferences for the various methods. METHODS: We interviewed two hundred and four consenting patients selected consecutively from the waiting rooms of the St. Elizabeth Catholic Hospital-Shisong in the North West Region of Cameroon. We recorded socio-demographic data and their understanding and preference for four prescription modalities: pictograms, written out, symbols and Latin abbreviations. We studied the relationship between these variables in a logistic multivariate analysis. RESULTS: Understanding was best with symbols (89.7%) and worst when Latin abbreviations (26.9%) were used. Higher levels of education were associated with better understanding of Latin abbreviations (OR 18.87; 95% CI 2.44-142.86), written out prescriptions (OR 58.82; 95% CI 23.25-333.33), symbols (OR 1.47; 95% CI 4.25-50.00) and pictograms (OR 52.63; 92% CI 1.85-142.86) after controlling for confounding. Participants mostly preferred pictograms (40.7%) and written-out prescriptions (30.9%). CONCLUSION: Latin abbreviations were the most difficult to understand and should no longer be used. Symbols are more easily understood. PRACTICE IMPLICATIONS: Latin abbreviations should be discouraged. Symbols are better, especially for patients with low levels of education. Prescribing using pictograms and plain text may facilitate understanding in this setting.
Abstract: A combined measure of optimal antenatal care can provide more information on the role it plays in maternal health. Our objectives were to investigate the determinants of a measure of optimal antenatal care and the associated pregnancy outcomes. Data on 7,557 women taken from the 2004 Demographic and Health Survey in Cameroon were used to develop a new measurement of optimal antenatal care based on four indicators: at least four visits, first visit in first trimester, last visit in third trimester and a professional provider of antenatal care. We studied the relationship of this new variable with other related variables in a multivariate analysis, taking into account the complex study design. Almost sixty six percent of the women had optimal antenatal care. Secondary or higher education (OR 1.74; 95% CI 1.28–2.36), greater wealth (OR 2.31; 95% CI 1.73–3.1), urban residence (OR 1.42; 95% CI 1.12–1.82) and parity of 3–4 (OR 0.79; 95% CI 0.62–0.99) were independently associated with optimal antenatal care. Women with optimal antenatal care were more likely to deliver in a health unit (OR 2.91; 95% CI 2.42–3.49), to be assisted by a skilled health worker during delivery (OR 1.88; 95% CI 1.49–2.37) and to have a baby with a normal birthweight (OR 1.62; 95% CI 1.11–2.38). Obtaining and using a new measure for ANC is feasible. The association of optimal antenatal care to education, wealth and residence in this study, consistent with others, highlights the role of the country’s development in maternal health.
Abstract: The increasing urgency for evidence based practice, especially in resource limited settings has inspired many initiatives to this effect. In Africa there is limited skill in research synthesis and the production of systematic reviews. The Centre for the Development of Best Practices in Health, together with the South African Cochrane Centre organised a workshop to train Cameroonian researchers on how to initiate and complete systematic reviews. Five facilitators and fifteen participants met over a period of four days. At the end of the workshop the participants expressed high levels of satisfaction and motivation to conduct systematic reviews, but expressed the need for additional support. Facilitators of future systematic review courses should address challenges related to internet access, adult education and realistic expectations from the participants.
Abstract: Abstract
Background
The advent of highly active antiretroviral therapy (HAART) has reduced the morbidity and mortality due to HIV. The World Health Organisation (WHO) antiretroviral treatment (ART) guidelines focus on three classes of antiretroviral drugs, namely: nucleoside/nucleotide reverse transcriptase inhibitors (NRTI), non-nucleoside reverse transcriptase inhibitors (NNRTI) and protease inhibitors (PI). Two of the most common medications given in first-line treatment are the NNRTIs, efavirenz (EFV) and nevirapine (NVP). It is unclear which NNRTI is more efficacious for initial therapy.
Objectives
To determine which NNRTI, EFV or NVP, is more efficacious when given in combination with two NRTIs as part of initial ART for HIV infection in adults and children.
Search strategy
We used a comprehensive and exhaustive strategy in an attempt to identify all relevant studies, regardless of language or publication status, in electronic databases and conference proceedings from 1996 to 2009.
Selection criteria
All randomised controlled trials comparing EFV to NVP in HIV-infected individuals without prior exposure to ART, irrespective of the dosage or NRTI backbone.
The primary outcome of interest was virologic response to ART. Other primary outcomes included mortality, clinical progression, severe adverse events, and discontinuation of therapy for any reason. Secondary outcomes were immunologic response to ART, treatment failure, development of ART drug resistance, and prevention of sexual transmission of HIV.
Data collection and analysis
Two authors assessed each reference for inclusion and exclusion criteria established a priori. Data were abstracted independently using a standardised abstraction form. Data were analysed on an intention-to-treat basis and reported as per dosage of NVP.
Main results
We identified seven randomised controlled trials that met our inclusion criteria.The trials were pooled as per dosage of NVP. None of these trials included children.The seven trials enrolled 1,688 participants and found no critical differences between EFV and NVP, except for different toxicity profiles. EFV is more likely to cause central nervous system side-effects, while NVP is more likely to result in raised transaminases and neutropoenia. There was a higher mortality rate in the NVP 400mg once daily arm.The quality of literature to support these conclusions is moderate to high. Drug resistance was slightly less common with EFV than NVP, but the quality of this literature is low since only one of the seven studies reported on this outcome. No studies reported on sexual transmission of HIV. The length of follow-up time, study settings, and NRTI backbone varied greatly.
Authors' conclusions
Both drugs have equivalent efficacies in initial treatment of HIV infection when combined with two NRTIs, but different side effects.
Abstract: Birthweight is a key predictor of future life outcomes. When this information is not available we must rely on maternal recall of weight or size. We evaluated the use of maternal recall of size as an indicator for birthweight, using data from the 2004 Demographic and Health Survey in Cameroon.
The overall agreement between recorded and recalled weight and subjective assessment of birth size was 90% (Kappa = 0.46). Concordant descriptions were associated with higher birthweights (P < 0.001), higher education (P = 0.008) and delivery in a health unit (P = 0.025). Specificity for low birthweight (92.9%) was much higher than sensitivity (59.9%) and the negative predictive value (96.1%) was much higher than the positive predictive value (44.4%). These results indicate that recall of size, in Cameroonian women and in other low resource settings, should be used only in the absence of other sources of data.
Notes: Early View (Articles online in advance of print)
Abstract: The burden of maternal mortality remains high in Cameroon even though the causes of maternal deaths and evidence-based interventions to address these factors are known. This article appraises the rising trend of maternal mortality in Cameroon, identifies lapses along the continuum of maternal care and raises priority issues relating to government commitment and the need for integration of evidence based interventions for maternal survival. It also presents an intervention model and proffers recommendations that may help Cameroon achieve the fifth Millennium Development Goal.
Abstract: Background
Tranexamic acid can reduce bleeding in patients undergoing elective surgery. We assessed the effects of early administration of a short course of tranexamic acid on death, vascular occlusive events, and the receipt of blood transfusion in trauma patients.
Methods
This randomised controlled trial was undertaken in 274 hospitals in 40 countries. 20 211 adult trauma patients with, or at risk of, significant bleeding were randomly assigned within 8 h of injury to either tranexamic acid (loading dose 1 g over 10 min then infusion of 1 g over 8 h) or matching placebo. Randomisation was balanced by centre, with an allocation sequence based on a block size of eight, generated with a computer random number generator. Both participants and study staff (site investigators and trial coordinating centre staff) were masked to treatment allocation. The primary outcome was death in hospital within 4 weeks of injury, and was described with the following categories: bleeding, vascular occlusion (myocardial infarction, stroke and pulmonary embolism), multiorgan failure, head injury, and other. All analyses were by intention to treat. This study is registered as ISRCTN86750102, Clinicaltrials.gov NCT00375258, and South African Clinical Trial Register DOH-27-0607-1919.
Findings
10  096 patients were allocated to tranexamic acid and 10 115 to placebo, of whom 10 060 and 10 067, respectively, were analysed. All-cause mortality was significantly reduced with tranexamic acid (1463 [14·5%] tranexamic acid group vs 1613 [16·0%] placebo group; relative risk 0·91, 95% CI 0·85–0·97; p=0·0035). The risk of death due to bleeding was significantly reduced (489 [4·9%] vs 574 [5·7%]; relative risk 0·85, 95% CI 0·76–0·96; p=0·0077).
Interpretation
Tranexamic acid safely reduced the risk of death in bleeding trauma patients in this study. On the basis of these results, tranexamic acid should be considered for use in bleeding trauma patients.
Funding
UK NIHR Health Technology Assessment programme, Pfizer, BUPA Foundation, and J P Moulton Charitable Foundation.
Abstract: Preconception care (PCC) is associated with improved pregnancy outcomes. Our objectives were to evaluate the need for PCC and the level of consumer awareness. A study was performed on consecutive patients presenting to primary and secondary care practices in two provinces in Cameroon. A total of 236 women aged 15 to 45 years were included. 36.4% of pregnancies had unfavorable outcomes, up to 20.3% had difficulties in getting pregnant and 29.7% had carried unwanted pregnancies. Very few women had ever done tests for diseases that could affect pregnancy and childbirth. We found some significant knowledge deficiencies about factors that may threaten maternal fetal health. 30.8% admitted to suffering domestic violence. There is an urgent need for the implementation of PCC in Cameroon. Many pregnancies are unplanned and frequently end up unfavorably. The rate of unwanted pregnancies is equally elevated. Consumer awareness is extremely low and domestic violence is high.
Abstract: Palm wine tapping is a common economic activity in low resource tropical settings. Palms trees grow to great heights and climbing them to obtain palm products is a hazardous profession especially when appropriate climbing material is not used. We noticed a peculiar facial injury occurring when the wine tappers fall from the high trees, sustaining not only spinal and head injuries, but also a tear in the angles of the mouth because they hold their machetes in their mouth. This is a report of two cases with photos. We think that the availability of adequate harnesses with loopholes for carrying hardware, and helmets can reduce the risks involved in this very risky and poorly paid profession.
