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Grimes KEL, Ebasone PV, Dzudie A, Nash D, Wainberg ML, Pence BW, Barrington C, Pefura E, Yotebieng M, Anastos K, Nsame D, Ajeh R, Nyenti A, Parcesepe AM. Factors influencing integration of mental health screening and treatment at HIV clinic settings in Cameroon: a qualitative study of health providers' perspectives. BMC Health Serv Res 2024; 24:519. [PMID: 38658992 PMCID: PMC11044447 DOI: 10.1186/s12913-024-10775-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 02/23/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Mental disorders are common among people with HIV (PWH) and are associated with poor HIV outcomes. Despite high unmet mental health needs among PWH, use of evidence-based mental health screening and treatment protocols remains limited at HIV treatment facilities across low-resource settings. Integrating mental health services into HIV care can reduce this gap. This study's objective was to explore factors that influence integration of mental health screening and treatment into HIV clinics in Cameroon. METHODS We analyzed 14 in-depth interviews with clinic staff supporting PWH at three urban HIV treatment clinics in Cameroon. Interviews focused on current processes, barriers and facilitators, and types of support needed to integrate mental health care into HIV care. Interviews were recorded and transcribed. French transcripts were translated into English. We used thematic analysis to identify factors that influence integration of mental health screening and treatment into HIV care in these settings. Ethical review boards in the United States and Cameroon approved this study. RESULTS Respondents discussed a lack of standardized mental health screening processes in HIV treatment facilities and generally felt ill-equipped to conduct mental health screening. Low community awareness about mental disorders, mental health-related stigma, limited physical space, and high clinic volume affected providers' ability to screen clients for mental disorders. Providers indicated that better coordination and communication were needed to support client referral to mental health care. Despite these barriers, providers were motivated to screen clients for mental disorders and believed that mental health service provision could improve quality of HIV care and treatment outcomes. All providers interviewed said they would feel more confident screening for mental disorders with additional training and resources. Providers recommended community sensitization, training or hiring additional staff, improved coordination to manage referrals, and leadership buy-in at multiple levels of the health system to support sustainable integration of mental health screening and treatment into HIV clinics in Cameroon. CONCLUSIONS Providers reported enthusiasm to integrate mental health services into HIV care but need more support and training to do so in an effective and sustainable manner.
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Affiliation(s)
- Kathryn E L Grimes
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | | | - Anastase Dzudie
- Clinical Research Education Networking and Consultancy, Yaoundé, Cameroon
| | - Denis Nash
- Institute for Implementation Science in Population Health, City University of New York, New York, NY, USA
| | - Milton L Wainberg
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, and New York State Psychiatric Institute, New York, NY, USA
| | - Brian W Pence
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Clare Barrington
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Marcel Yotebieng
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Kathryn Anastos
- Departments of Medicine and Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Denis Nsame
- Bamenda Regional Hospital, Bamenda, Cameroon
| | - Rogers Ajeh
- Clinical Research Education Networking and Consultancy, Yaoundé, Cameroon
| | | | - Angela M Parcesepe
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Lancaster KE, Remch M, Edmonds A, Ajeh R, Dzudie A, Adedimeji A, Nash D, Anastos K, Yotebieng M, Yone-Pefura EW, Nsame D, Parcesepe AM. Age-varying Associations of Depressive Symptoms and Heavy Episodic Drinking Throughout Adulthood Among People with HIV and Receiving care in Cameroon Within a National "treat all" Policy. AIDS Behav 2023; 27:2070-2078. [PMID: 36472684 PMCID: PMC10557023 DOI: 10.1007/s10461-022-03939-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2022] [Indexed: 12/12/2022]
Abstract
Comorbid depression and heavy episodic drinking (HED) may threaten the success of "treat all" policies in sub-Saharan Africa as the population of people with HIV (PWH) ages. We investigated associations between depressive symptoms and heavy episodic drinking (HED) and the extent the relationship differed across ages among PWH receiving HIV care in Cameroon. We conducted a retrospective analysis of 18-60-year-old PWH on antiretroviral therapy in Cameroon from January 2016 to March 2020. Age-varying effect modelling was conducted to assess associations between depressive symptoms and HED across ages and by gender. Prevalence of depression and HED was highest at ages 20 and 25, respectively. After age 25, the magnitude of the association between depressive symptoms and HED was significant and increased until age 30 (aOR: 1.88, 95% CI: 1.48, 2.39), with associations remaining significant until age 55 (aOR: 1.64, 95% CI: 1.17, 2.29). Women had more variability and higher magnitudes of associations between depressive symptoms and HED than men. The interrelationship between depressive symptoms and HED was significant throughout most of adulthood for PWH receiving HIV care in Cameroon. Understanding age and gender trends in these associations can guide integration efforts in HIV care settings.
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Affiliation(s)
| | - Molly Remch
- Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Andrew Edmonds
- Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Rogers Ajeh
- Clinical Research Education Networking and Consultancy, Yaounde, Cameroon
| | - Anastase Dzudie
- Clinical Research Education Networking and Consultancy, Yaounde, Cameroon
| | - Adebola Adedimeji
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Denis Nash
- City University of New York, New York, NY, USA
| | - Kathryn Anastos
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Marcel Yotebieng
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Denis Nsame
- Bamenda Regional Hospital, Bamenda, Cameroon
| | - Angela M Parcesepe
- Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, USA
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Parcesepe AM, Filiatreau LM, Gomez A, Ebasone PV, Dzudie A, Pence BW, Wainberg M, Yotebieng M, Anastos K, Pefura-Yone E, Nsame D, Ajeh R, Nash D. Coping Strategies and Symptoms of Mental Health Disorders Among People with HIV Initiating HIV Care in Cameroon. AIDS Behav 2023; 27:2360-2369. [PMID: 36609704 PMCID: PMC10224854 DOI: 10.1007/s10461-022-03963-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2022] [Indexed: 01/09/2023]
Abstract
Little is known about the coping strategies used among people with HIV (PWH), especially in sub-Saharan Africa, and the extent to which adaptive or maladaptive coping strategies are associated with symptoms of mental health disorders. We interviewed 426 PWH initiating HIV care in Cameroon and reported the prevalence of adaptive and maladaptive coping strategies, overall and by presence of symptoms of depression, anxiety, and PTSD. Log binominal regression was used to estimate the association between each type of coping strategy (adaptive or maladaptive) and symptoms of each mental health disorder, separately. Adaptive and maladaptive coping strategies were commonly reported among PWH enrolling in HIV care in Cameroon. Across all mental health disorders assessed, greater maladaptive coping was associated with higher prevalence of depression, anxiety, and PTSD. Adaptive coping was not associated with symptoms of any of the mental health disorders assessed in bivariate or multivariable models. Our study found that PWH endorsed a range of concurrent adaptive and maladaptive coping strategies. Future efforts should explore the extent to which coping strategies change throughout the HIV care continuum. Interventions to reduce maladaptive coping have the potential to improve the mental health of PWH in Cameroon.
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Affiliation(s)
- Angela M Parcesepe
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Lindsey M Filiatreau
- Department of Psychiatry, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Amanda Gomez
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Anastase Dzudie
- Clinical Research Education Networking and Consultancy, Yaoundé, Cameroon
| | - Brian W Pence
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Milton Wainberg
- Department of Psychiatry, Columbia University and New York State Psychiatric Institute, New York, NY, USA
| | - Marcel Yotebieng
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Kathryn Anastos
- Departments of Medicine and Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Denis Nsame
- Bamenda Regional Hospital, Bamenda, Cameroon
| | - Rogers Ajeh
- Clinical Research Education Networking and Consultancy, Yaoundé, Cameroon
| | - Denis Nash
- Institute for Implementation Science in Population Health, City University of New York, New York, NY, USA
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Parcesepe AM, Filiatreau LM, Ebasone PV, Dzudie A, Pence BW, Wainberg M, Yotebieng M, Anastos K, Pefura-Yone E, Nsame D, Ajeh R, Nash D. Prevalence of potentially traumatic events and symptoms of depression, anxiety, hazardous alcohol use, and post-traumatic stress disorder among people with HIV initiating HIV care in Cameroon. BMC Psychiatry 2023; 23:150. [PMID: 36894918 PMCID: PMC9996899 DOI: 10.1186/s12888-023-04630-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 02/22/2023] [Indexed: 03/11/2023] Open
Abstract
BACKGROUND This study explored the relationship between specific types of potentially traumatic events (PTEs) and symptoms of mental health disorders among people with HIV (PWH) in Cameroon. METHODS We conducted a cross-sectional study with 426 PWH in Cameroon between 2019-2020. Multivariable log binominal regression was used to estimate the association between exposure (yes/no) to six distinct types of PTE and symptoms of depression (Patient Health Questionnaire-9 score > 9), PTSD (PTSD Checklist for DSM-5 score > 30), anxiety (Generalized Anxiety Disorder-7 scale score > 9), and hazardous alcohol use (Alcohol Use Disorders Identification Test score > 7 for men; > 6 for women). RESULTS A majority of study participants (96%) reported exposure to at least one PTE, with a median of 4 PTEs (interquartile range: 2-5). The most commonly reported PTEs were seeing someone seriously injured or killed (45%), family members hitting or harming one another as a child (43%), physical assault or abuse from an intimate partner (42%) and witnessing physical assault or abuse (41%). In multivariable analyses, the prevalence of PTSD symptoms was significantly higher among those who reported experiencing PTEs during childhood, violent PTEs during adulthood, and the death of a child. The prevalence of anxiety symptoms was significantly higher among those who reported experiencing both PTEs during childhood and violent PTEs during adulthood. No significant positive associations were observed between specific PTEs explored and symptoms of depression or hazardous alcohol use after adjustment. CONCLUSIONS PTEs were common among this sample of PWH in Cameroon and associated with PTSD and anxiety symptoms. Research is needed to foster primary prevention of PTEs and to address the mental health sequelae of PTEs among PWH.
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Affiliation(s)
- Angela M Parcesepe
- Gillings School of Global Public Health, Department of Maternal and Child Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
- University of North Carolina at Chapel Hill, Carolina Population Center, Chapel Hill, NC, USA.
| | - Lindsey M Filiatreau
- Department of Psychiatry, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | | | - Anastase Dzudie
- Clinical Research Education Networking and Consultancy, Yaounde, Cameroon
| | - Brian W Pence
- Department of Psychiatry, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Milton Wainberg
- Department of Psychiatry, Columbia University and New York State Psychiatric Institute, New York, NY, USA
| | - Marcel Yotebieng
- Albert Einstein College of Medicine, Department of Medicine, Bronx, NY, USA
| | - Kathryn Anastos
- Albert Einstein College of Medicine, Departments of Medicine and Epidemiology & Population Health, Bronx, NY, USA
| | | | - Denis Nsame
- Bamenda Regional Hospital, Bamenda, Cameroon
| | - Rogers Ajeh
- Clinical Research Education Networking and Consultancy, Yaounde, Cameroon
| | - Denis Nash
- Institute for Implementation Science in Population Health, City University of New York, New York, NY, USA
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Parcesepe AM, Filiatreau LM, Gomez A, Ebasone PV, Dzudie A, Pence BW, Wainberg M, Yotebieng M, Anastos K, Pefura-Yone E, Nsame D, Ajeh R, Nash D. HIV-Related Stigma, Social Support, and Symptoms of Mental Health Disorders Among People with HIV Initiating HIV Care in Cameroon. AIDS Patient Care STDS 2023; 37:146-154. [PMID: 36802206 PMCID: PMC10024262 DOI: 10.1089/apc.2022.0187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
Abstract
HIV-related stigma has been associated with poor mental health among people with HIV (PWH). Social support is a potentially modifiable factor that may buffer negative mental health sequelae of HIV-related stigma. Little is known about the extent to which the modifying effect of social support differs across mental health disorders. Interviews were conducted with 426 PWH in Cameroon. Log binomial regression analyses were used to estimate the association between high anticipated HIV-related stigma and low social support from family or friends and symptoms of depression, anxiety, post-traumatic stress disorder (PTSD), and harmful alcohol use, separately. Anticipated HIV-related stigma was commonly endorsed with ∼80% endorsing at least 1 of 12 stigma-related concerns. In multivariable analyses, high anticipated HIV-related stigma was associated with greater prevalence of symptoms of depression {adjusted prevalence ratio (aPR) 1.6 [95% confidence interval (CI) 1.1-2.2]} and anxiety [aPR 2.0 (95% CI 1.4-2.9)]. Low social support was associated with greater prevalence of symptoms of depression [aPR 1.5 (95% CI 1.1-2.2)], anxiety [aPR 1.7 (95% CI 1.2-2.5)], and PTSD [aPR 1.6 (95% CI 1.0-2.4)]. However, social support did not meaningfully modify the relationship between HIV-related stigma and symptoms of any mental health disorders explored. Anticipated HIV-related stigma was commonly reported among this group of PWH initiating HIV care in Cameroon. Social concerns related to gossip or losing friends were of the greatest concern. Interventions focused on reducing stigma and strengthening support systems may be particularly beneficial and have the potential to improve the mental health of PWH in Cameroon.
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Affiliation(s)
- Angela M. Parcesepe
- Department of Maternal and Child Health and Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Lindsey M. Filiatreau
- Department of Psychiatry, School of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Amanda Gomez
- Department of Maternal and Child Health and Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | - Anastase Dzudie
- Clinical Research Education Networking and Consultancy, Yaounde, Cameroon
| | - Brian W. Pence
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Milton Wainberg
- Department of Psychiatry, New York State Psychiatric Institute and Columbia University, New York, New York, USA
| | - Marcel Yotebieng
- Department of Medicine and Albert Einstein College of Medicine, Bronx, New York, USA
| | - Kathryn Anastos
- Department of Medicine and Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | | | - Denis Nsame
- Bamenda Regional Hospital, Bamenda, Cameroon
| | - Rogers Ajeh
- Clinical Research Education Networking and Consultancy, Yaounde, Cameroon
| | - Denis Nash
- Institute for Implementation Science in Population Health, City University of New York, New York, New York, USA
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Filiatreau LM, Ebasone PV, Dzudie A, Ajeh R, Pence BW, Wainberg M, Nash D, Yotebieng M, Anastos K, Pefura-Yone E, Nsame D, Parcesepe AM. Prevalence of stressful life events and associations with symptoms of depression, anxiety, and post-traumatic stress disorder among people entering care for HIV in Cameroon. J Affect Disord 2022; 308:421-431. [PMID: 35452755 PMCID: PMC9520993 DOI: 10.1016/j.jad.2022.04.061] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 01/19/2022] [Accepted: 04/10/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND Exposure to stressors increases the risk of mental health disorders. People living with HIV (PLWH) are particularly affected by poor mental health which can contribute to adverse HIV treatment outcomes. METHODS We estimated the prevalence of recent stressful life events (modified Life Events Survey) among a cohort of PLWH entering HIV care at three public health care facilities in Cameroon and quantified the association of seven types of stressful life events with symptoms of depression (Patient Health Questionnaire-9 scores>9), anxiety (General Anxiety Disorder-7 scores>9), and PTSD (PTSD Checklist for DSM-5 scores>30) using separate log-binomial regression models. RESULTS Of 426 PLWH enrolling in care, a majority were women (59%), in relationships (58%), and aged 21 to 39 years (58%). Recent death of a family member (39%) and severe illness of a family member (34%) were the most commonly reported stressful life events. In multivariable analyses, more stressful life event types, a negative relationship change, death or illness of a friend/family member, experience of violence, work-related difficulties, and feeling unsafe in one's neighborhood were independently associated with at least one of the mental health outcomes assessed. The greatest magnitude of association was observed between work-related difficulties and PTSD (adjusted prevalence ratio: 3.1; 95% confidence interval: 2.0-4.8). LIMITATIONS Given the design of our study, findings are subject to recall and social desirability bias. CONCLUSIONS Stressful life events were common among this population of PLWH entering care in Cameroon. Evidence-based interventions that improve coping, stress management, and mental health are needed.
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Affiliation(s)
- Lindsey M. Filiatreau
- Washington University in St. Louis, School of Medicine, Department of Psychiatry, St. Louis, MO, United States of America,Washington University in St. Louis, Brown School, International Center for Child Health and Development, St. Louis, MO, United States of America,University of North Carolina at Chapel Hill, Carolina Population Center, Chapel Hill, NC, United States of America,Corresponding author at: Washington University in St. Louis, Department of Psychiatry, United States of America. (L.M. Filiatreau)
| | | | - Anastase Dzudie
- Clinical Research Education Networking and Consultancy, Yaounde, Cameroon
| | - Rogers Ajeh
- Clinical Research Education Networking and Consultancy, Yaounde, Cameroon
| | - Brian W. Pence
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Department of Epidemiology, Chapel Hill, NC, United States of America
| | - Milton Wainberg
- Columbia University, Department of Psychiatry, New York, NY, United States of America
| | - Denis Nash
- City University of New York, Institute of Implementation Science in Population Health, New York, NY, United States of America
| | - Marcel Yotebieng
- Albert Einstein College of Medicine, Department of Medicine, Bronx, NY, United States of America
| | - Kathryn Anastos
- Albert Einstein College of Medicine, Department of Medicine, Bronx, NY, United States of America,Albert Einstein College of Medicine, Department of Epidemiology & Population Health, Bronx, NY, United States of America
| | | | - Denis Nsame
- Bamenda Regional Hospital, Bamenda, Cameroon
| | - Angela M. Parcesepe
- University of North Carolina at Chapel Hill, Carolina Population Center, Chapel Hill, NC, United States of America,University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Department of Maternal and Child Health, Chapel Hill, NC, United States of America
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7
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Parcesepe AM, Filiatreau LM, Ebasone PV, Dzudie A, Pence BW, Wainberg M, Yotebieng M, Anastos K, Pefura-Yone E, Nsame D, Ajeh R, Nash D. Psychiatric comorbidity and psychosocial stressors among people initiating HIV care in Cameroon. PLoS One 2022; 17:e0270042. [PMID: 35771857 PMCID: PMC9246197 DOI: 10.1371/journal.pone.0270042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 06/03/2022] [Indexed: 11/18/2022] Open
Abstract
Background Psychiatric comorbidity, the presence of two or more mental health disorders, has been associated with suboptimal HIV treatment outcomes. Little is known about the prevalence of psychiatric comorbidity among people with HIV (PWH) in sub-Saharan Africa. Methods We conducted interviews with PWH initiating HIV care in Cameroon between June 2019 and March 2020. Depression, anxiety, post-traumatic stress disorder (PTSD), and harmful drinking were dichotomized to represent those with and without symptoms of each. Psychiatric comorbidity was defined as having symptoms of two or more disorders assessed. Moderate or severe household hunger, high anticipatory HIV-related stigma, low social support, and high number of potentially traumatic events were hypothesized as correlates of psychiatric comorbidity. Bivariable log binomial regression models were used to estimate unadjusted associations between psychosocial stressors and psychiatric comorbidity. Results Among 424 participants interviewed, the prevalence of psychiatric comorbidity was 16%. Among those with symptoms of at least one mental health or substance use disorder (n = 161), the prevalence of psychiatric comorbidity was 42%. The prevalence of psychiatric comorbidity was 33%, 67%, 76%, and 81% among those with symptoms of harmful drinking, depression, anxiety, and PTSD, respectively. Among individuals with symptoms of a mental health or substance use disorder, a high number of potentially traumatic events (prevalence ratio (PR) 1.71 [95% CI 1.21, 2.42]) and high anticipatory HIV-related stigma (PR 1.45 [95% CI 1.01, 2.09]) were associated with greater prevalence of psychiatric comorbidity. Conclusion Psychiatric comorbidity was common among this group of PWH in Cameroon. The effectiveness and implementation of transdiagnostic or multi-focus mental health treatment approaches in HIV care settings should be examined.
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Affiliation(s)
- Angela M. Parcesepe
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
- * E-mail:
| | - Lindsey M. Filiatreau
- Department of Psychiatry, School of Medicine, Washington University in St. Louis, St. Louis, MO, United States of America
| | | | - Anastase Dzudie
- Clinical Research Education Networking and Consultancy, Yaounde, Cameroon
| | - Brian W. Pence
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Milton Wainberg
- Department of Psychiatry and New York State Psychiatric Institute, Columbia University, New York, NY, United States of America
| | - Marcel Yotebieng
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, United States of America
| | - Kathryn Anastos
- Departments of Medicine and Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, United States of America
| | | | - Denis Nsame
- Bamenda Regional Hospital, Bamenda, Cameroon
| | - Rogers Ajeh
- Clinical Research Education Networking and Consultancy, Yaounde, Cameroon
| | - Denis Nash
- Institute for Implementation Science in Population Health, City University of New York, New York, NY, United States of America
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Fondoh VN, Ndzenjempuh N, Stella T, Fondoh RM, Awasom CN, Enow-Tanjong R, Egbengu EP, Leke R, Rose NFN, Nsame D. Prevalence of alpha and beta haemolysin among blood group O donors in Bamenda, Cameroon. Afr J Lab Med 2022; 11:1432. [PMID: 35547333 PMCID: PMC9082289 DOI: 10.4102/ajlm.v11i1.1432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 02/03/2022] [Indexed: 11/17/2022] Open
Abstract
Background The occurrence of high titres of alpha (anti-A) and beta (anti-B) haemolysin immunoglobulin G antibodies in blood causes haemolysis during blood transfusion from a group O donor, commonly and inappropriately known as the ‘universal blood donor’, to a group A, B or AB recipient. Surprisingly, haemolysin testing is not routinely done during blood transfusion services in Bamenda, Cameroon. Objective This study aimed to determine the prevalence of haemolysin among blood group ‘O’ donors at the Regional Hospital Bamenda Blood Bank, Bamenda, Cameroon. Methods This was a cross-sectional descriptive study carried out between June and September 2020 at the Regional Hospital Bamenda Blood Bank, Bamenda, Cameroon. Blood group O donors who were free from transfusion-transmissible infections were selected systematically and serially and their serum tested for the presence of haemolysin. Haemolysin titres were determined, and titres ≥ 8 were considered significant. The associations between haemolysin prevalence and age group, gender and Rhesus D blood group were determined using the chi-square test. Results The prevalence of haemolysin among the 480 study participants was 52.1% and significant haemolysin titres were detected in 18.5%. There was no association between haemolysin and gender, age group or the Rhesus D blood group. Conclusion The prevalence of significant titres of haemolysin among participants in this study was high. There is the need to test for haemolysin in blood group O donors to prevent the potential risk to blood group A, B, and AB recipients and to provide safer blood for transfusion.
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Affiliation(s)
- Victor N Fondoh
- Bamenda Regional Hospital Laboratory, Regional Hospital Bamenda, Cameroon
- Department of Medical Laboratory Sciences, School of Health and Medical Sciences, Catholic University of Cameroon, Bamenda, Cameroon
- Department of Health Economics Policy and Management, Faculty of Business Management, Catholic University of Cameroon, Bamenda, Cameroon
| | - Nobert Ndzenjempuh
- Department of Medical Laboratory Sciences, School of Health and Medical Sciences, Catholic University of Cameroon, Bamenda, Cameroon
| | - Tamunjoh Stella
- Department of Medical Laboratory Sciences, School of Health and Medical Sciences, Catholic University of Cameroon, Bamenda, Cameroon
| | - Richard M Fondoh
- North-West Regional Fund for Health Promotion, Bamenda, Cameroon
| | - Charles N Awasom
- Department of Anatomy, School of Health and Medical Science, Catholic University of Cameroon, Bamenda, Cameroon
| | - Rebecca Enow-Tanjong
- Department of Medical Laboratory Sciences, School of Health and Medical Sciences, Catholic University of Cameroon, Bamenda, Cameroon
| | - Egbe P Egbengu
- Department of Medicine and Surgery, School of Health and Medical Science, Catholic University of Cameroon, Bamenda, Cameroon
| | - Robert Leke
- Department of Medicine and Surgery, School of Health and Medical Science, Catholic University of Cameroon, Bamenda, Cameroon
| | | | - Denis Nsame
- Regional Hospital Bamenda, Bamenda, Cameroon
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Chiabi A, Forgwei MN, Bissong M, Niba L, Abah JN, Nsame D. Trends in Pediatric Hospitalizations and Mortality during the COVID-19 Pandemic in an Urban Setting in Cameroon. J Trop Pediatr 2022; 68:6555019. [PMID: 35348796 PMCID: PMC8992244 DOI: 10.1093/tropej/fmac026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The first case of coronavirus disease 2019 (COVID-19) in Cameroon was recorded in March 2020. In response to the pandemic, most countries like Cameroon instituted a number of control measures to curb its spread accross the country. These COVID-19 control measures added to the fear of this disease within the population may have led to other detrimental health effects like: the pattern of hospitalizations and hospital outcomes. METHODS We did a cross-sectional study with data from in-patient admission records of children admitted to the pediatric ward of the Regional Hospital Bamenda over a 24 months period (1st of March 2019 to the 28th of February 2021). The pre-pandemic period in Cameroon (that is, the first 12 months, from March 2019 to February 2020) and the pandemic period (that is, the last 12 months, from March 2020 to February 2021) were compared. RESULTS A total of 2282 hospitalization records were included in the study. Most of the hospitalized children were males (57.23%). There was a 19.03% decline in pediatric hospitalizations during the first 12 months of the pandemic, which was statistically significant (p = 0.00024). The causes of hospitalizations and mortality remained similar over both periods, with severe malaria, the leading cause of admissions. Hospital deaths before and during the pandemic were 1.6% and 1.9%, respectively. CONCLUSION There was a statistically significant decline in pediatric hospitalizations during the first 12 months of the pandemic as compared to the same period before the pandemic. Hospital mortality and causes of hospitalizations remained similar over both the periods.
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Affiliation(s)
- Andreas Chiabi
- Correspondence: Andreas Chiabi, Faculty of Health Sciences, University of Bamenda, Cameroon, E mail:
| | | | - Marie Bissong
- Faculty of Health Sciences, University of Bamenda, Cameroon
| | - Loveline Niba
- Faculty of Health Sciences, University of Bamenda, Cameroon
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10
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Parcesepe AM, Filiatreau LM, Ebasone PV, Dzudie A, Ajeh R, Wainberg M, Pence B, Pefura-Yone E, Yotebieng M, Nsame D, Anastos K, Nash D. Gender, Mental Health, and Entry Into Care with Advanced HIV Among People Living with HIV in Cameroon Under a National 'Treat All' Policy. AIDS Behav 2021; 25:4018-4028. [PMID: 34091803 DOI: 10.1007/s10461-021-03328-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2021] [Indexed: 10/21/2022]
Abstract
Delays in diagnosis and linkage to HIV care persist among people living with HIV (PLWH), even after expanded access to ART worldwide. Mental health may influence timely linkage to HIV care. Greater understanding of the relationship among gender, mental health, and delayed linkage to HIV care can inform strategies to improve the health of PLWH. We interviewed 426 PLWH initiating HIV care in Cameroon between June 2019 and March 2020 to estimate the prevalence of depression, anxiety, and post-traumatic stress disorder (PTSD) and the association between mental health and entry into care with advanced HIV. Separate multivariable log binomial regression models were used to estimate the association between mental health exposure and entry into HIV care with advanced HIV. Stratified analyses were used to assess effect modification by gender. Approximately 20, 15, and 12% of participants reported symptoms of depression, PTSD, and anxiety, respectively. The prevalence of mental health symptoms did not vary significantly by gender. Overall, 53% of participants enrolled in HIV care with advanced HIV: 51% of men and 54% of women. Screening positive for one of the mental health disorders assessed was associated with greater prevalence of enrollment with advanced HIV among men, but not among women. Future research should examine gender-specific pathways between mental health symptoms and entry into care with advanced HIV, particularly for men in Cameroon. The extent to which untreated mental health symptoms drive gender disparities throughout the HIV care continuum should be explored further.
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Affiliation(s)
- Angela M Parcesepe
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, CB# 7445, Chapel Hill, NC, 27599, USA.
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Lindsey M Filiatreau
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Anastase Dzudie
- Clinical Research Education Networking and Consultancy, Yaounde, Cameroon
| | - Rogers Ajeh
- Clinical Research Education Networking and Consultancy, Yaounde, Cameroon
| | - Milton Wainberg
- Department of Psychiatry, Columbia University and New York State Psychiatric Institute, New York, NY, USA
| | - Brian Pence
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Marcel Yotebieng
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Denis Nsame
- Bamenda Regional Hospital, Bamenda, Cameroon
| | - Kathryn Anastos
- Departments of Medicine and Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Denis Nash
- Institute of Implementation Science in Population Health, Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA
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11
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Lancaster KE, Remch M, Dzudie A, Ajeh R, Adedimeji A, Nash D, Anastos K, Yotebieng M, Yone-Pefura EW, Nsame D, Parcesepe A. Heavy episodic drinking and HIV disclosure by HIV treatment status among People with HIV in IeDEA Cameroon. Int J Drug Policy 2021; 98:103431. [PMID: 34534821 DOI: 10.1016/j.drugpo.2021.103431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 08/11/2021] [Accepted: 08/16/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Heavy alcohol use is common among people with HIV (PWH), leading to sub-optimal HIV care outcomes. Yet, heavy episodic drinking (HED) is not routinely addressed within most HIV clinics in sub-Saharan Africa. HIV disclosure may provide social support, potentially reducing HED to cope with HIV. We examined the prevalence of HED and HIV disclosure by antiretroviral treatment (ART) status among PWH receiving HIV care in Cameroon. METHODS We analyzed routine HIV clinical data augmented with systematic alcohol use data among adult PWH receiving HIV care in three regional hospitals from January 2016 to March 2020. Recent HED prevalence was examined across PWH by ART status: those not on ART, recent ART initiators (ART initiation ≤30 days prior), and ART users (ART initiation >30 days prior); and by gender. We used log-binomial regression to estimate prevalence differences (PD) between HIV disclosure and recent HED by ART status. RESULTS Among 12,517 PWH in care, 16.4% (95%CI: 15.7, 17.0) reported recent HED. HED was reported among 21.2% (95%CI: 16.0, 26.3) of those not on ART, 24.5% (95%CI: 23.1, 26.0) of recent ART initiators, and 12.9% (95%CI: 12.2, 13.6) of ART users. Regardless of ART status, men were more likely than women to report HED. Those who disclosed HIV status had a lower HED prevalence than those who had not disclosed (aPD: -0.07; 95%CI: -0.10, -0.05) and not modified by gender. CONCLUSION The prevalence of recent HED was high among PWH in care. HED prevalence was highest among men and recent ART initiators. Longitudinal analyses should explore how HIV disclosure may support PWH in reducing or abstaining from HED through social support. Systematic HED screening and referral to care should be included in routine HIV clinical care, particularly for men, to improve engagement in the HIV care continuum in Cameroon.
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Affiliation(s)
| | - Molly Remch
- University of North Carolina at Chapel Hill, United States
| | - Anastase Dzudie
- Clinical Research Education Networking and Consultancy, Yaounde, Cameroon
| | - Rogers Ajeh
- Clinical Research Education Networking and Consultancy, Yaounde, Cameroon
| | - Adebola Adedimeji
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Denis Nash
- City University of New York, New York, NY, United States
| | - Kathryn Anastos
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Marcel Yotebieng
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, United States
| | | | - Denis Nsame
- Bamenda Regional Hospital, Bamenda, Cameroon
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12
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Filiatreau LM, Ebasone PV, Dzudie A, Ajeh R, Pence B, Wainberg M, Nash D, Yotebieng M, Anastos K, Pefura-Yone E, Nsame D, Parcesepe AM. Correlates of self-reported history of mental health help-seeking: a cross-sectional study among individuals with symptoms of a mental or substance use disorder initiating care for HIV in Cameroon. BMC Psychiatry 2021; 21:293. [PMID: 34090367 PMCID: PMC8180128 DOI: 10.1186/s12888-021-03306-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 05/25/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Mental health and substance use disorders (MSDs) increase the risk of poor human immunodeficiency virus (HIV) care outcomes among people living with HIV (PLWH). Receipt of mental health care may improve these adverse outcomes. We aimed to identify correlates of prior mental health help-seeking among PLWH with symptoms of an MSD in Cameroon. METHODS We characterize prior mental health help-seeking from formal (mental health specialist/general medical provider) and informal (traditional healer/religious leader) sources among 161 people with symptoms of depression (Patient Health Questionnaire-9 scores> 9), anxiety (General Anxiety Disorder-7 scores> 9), probable post-traumatic stress disorder (PTSD Checklist for DSM-5 scores> 30), or possible alcohol use disorder (Alcohol Use Disorders Identification Test scores≥16) who were newly entering HIV care at three healthcare facilities in Cameroon between June 2019 and March 2020. Help-seeking was defined as ever speaking to a formal or informal source about emotional problems, sadness, or the way they were feeling or behaving. We estimated the association between sociodemographic and psychosocial measures and lifetime mental health help-seeking from each type of source using log-binomial regression. RESULTS Overall, 55.3% of 161 PLWH with MSD symptoms reported prior mental health help-seeking, with 24.2% and 46.0% seeking help from formal and informal sources, respectively. Religious leaders were the most common source of help (40.4%), followed by general medical professionals (22.4%), traditional healers (16.8%), and mental health specialists (7.4%). Individuals with higher depressive, anxiety, and trauma symptom severity scores were more likely to have sought help than those with lower scores. Individuals with possible alcohol use disorder were the least likely to have sought help. Prior help-seeking was more common among those reporting a higher number of lifetime traumatic events (prevalence ratio [PR]: 1.06; 95% confidence interval [CI]: 1.01, 1.11) and those with a history of emotional intimate partner violence (PR: 1.34; 95% CI: 1.01, 1.80). CONCLUSIONS Prior mental health help-seeking was associated with psychosocial stressors. Help-seeking from informal networks was more common than formal help-seeking. Training in the provision of evidence-based mental health support for informal networks could improve access to mental health care for PLWH with MSDs in Cameroon.
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Affiliation(s)
- Lindsey M. Filiatreau
- grid.10698.360000000122483208Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | | | - Anastase Dzudie
- Clinical Research Education Networking and Consultancy, Yaounde, Cameroon
| | - Rogers Ajeh
- Clinical Research Education Networking and Consultancy, Yaounde, Cameroon
| | - Brian Pence
- grid.10698.360000000122483208Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - Milton Wainberg
- grid.413734.60000 0000 8499 1112Department of Psychiatry, Columbia University and New York State Psychiatric Institute, New York, NY USA
| | - Denis Nash
- grid.212340.60000000122985718Institute of Implementation Science in Population Health, Graduate School of Public Health and Health Policy, City University of New York, New York, NY USA
| | - Marcel Yotebieng
- grid.251993.50000000121791997Department of Medicine, Albert Einstein College of Medicine, Bronx, NY USA
| | - Kathryn Anastos
- grid.251993.50000000121791997Departments of Medicine and Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY USA
| | | | - Denis Nsame
- Bamenda Regional Hospital, Bamenda, Cameroon
| | - Angela M. Parcesepe
- grid.10698.360000000122483208Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC USA ,grid.10698.360000000122483208Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
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13
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Adedimeji A, Ajeh R, Pierz A, Nkeng R, Ndenkeh JJ, Fuhngwa N, Nsame D, Nji M, Dzudie A, Anastos KM, Castle PE. Challenges and opportunities associated with cervical cancer screening programs in a low income, high HIV prevalence context. BMC Womens Health 2021; 21:74. [PMID: 33602194 PMCID: PMC7890622 DOI: 10.1186/s12905-021-01211-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 02/04/2021] [Indexed: 01/26/2023]
Abstract
Background Cervical cancer is a leading cause of death among Cameroon women. The burden of cervical cancer is in part traceable to the inadequate understanding of socio-contextual determinants of access to screening and prevention opportunities. We explored multilevel individual, community and structural factors that facilitate or inhibit cervical cancer prevention in women at risk in a low-income, high HIV prevalence context. Methods We utilized an exploratory qualitative approach to obtain data through focus group discussions and in-depth interviews from May to August, 2018. A two-stage purposive sampling strategy was used to select 80 women and 20 men who participated in 8 focus group discussions and 8 in-depth interviews. The socio-ecological model guided data analyses to identify micro-, meso-, and macro-level determinants of cervical cancer screening. Results Micro-level factors including lack of awareness and knowledge about cervical cancer, lack of access to information, excessive cost of cervical cancer screening, low risk perceptions, and poor health seeking behaviors were major barriers for women seeking cervical cancer screening. Meso-level factors, such as social networks, socio-cultural norms, perceptions of the role of men and HIV-related stigma when screening is integrated into HIV care, also engender negative attitudes and behaviors. Macro-level barriers to cervical cancer screening included poorly equipped health facilities and a lack of national cancer prevention policies and programs. Conclusion In the context of the call for elimination of cervical cancer as a public health problem, our findings highlight challenges and opportunities that should be considered when implementing interventions to increase uptake of cervical cancer screening in low-middle income settings.
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Affiliation(s)
- Adebola Adedimeji
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY, 10461, USA.
| | - Rogers Ajeh
- Clinical Research Education, Networking and Consultancy, Yaoundé, Cameroon
| | - Amanda Pierz
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY, 10461, USA
| | - Relindis Nkeng
- Clinical Research Education, Networking and Consultancy, Yaoundé, Cameroon
| | - Jackson Jr Ndenkeh
- Clinical Research Education, Networking and Consultancy, Yaoundé, Cameroon.,Center for International Health, Ludwig Maximillian University of Munich, Munich, Germany
| | - Norbert Fuhngwa
- Clinical Research Education, Networking and Consultancy, Yaoundé, Cameroon
| | - Denis Nsame
- Limbe Regional Hospital, Limbe, Southwest Region, Cameroon
| | - Miriam Nji
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Anastase Dzudie
- Clinical Research Education, Networking and Consultancy, Yaoundé, Cameroon
| | - Kathryn M Anastos
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY, 10461, USA
| | - Philip E Castle
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY, 10461, USA
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14
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Fondoh VN, Fondoh RM, Awasom CN, Edith PL, Ntungwen WA, Roland B, Enow-Tanjong R, Njukeng P, Shang J, Egbengu EP, Maruta T, Etheline A, Leke R, Leo A, Nsame D. Haematological reference intervals for healthy adults in Bamenda, Cameroon. Afr J Lab Med 2020; 9:1193. [PMID: 33392055 PMCID: PMC7756783 DOI: 10.4102/ajlm.v9i1.1193] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 07/01/2020] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND In the era of evidence-based medicine, haematological reference intervals are essential for the interpretation of data for clinical decision-making, monitoring of treatment and research. It is not uncommon that reference intervals used in most African countries have been obtained from published scientific literature, textbooks, reagent/instrument manuals. OBJECTIVE The aim of this study was to determine haematological reference intervals of healthy adults in Bamenda, Cameroon. METHODS This was a cross-sectional study conducted between June and November 2015. Participants were voluntary blood donors at the Blood Bank Service of the Regional Hospital Bamenda aged between 18 and 65 years. The mean, median and standard deviation of the mean were calculated for each haematological parameter. The 95th percentile reference intervals were determined using the 2.5th and 97.5th percentile. The differences between gender for all the parameters were evaluated using the Kruskal-Wallis test. Significance was determined at the 95% confidence level. RESULTS Out of a total of 340 participants, 202 (59.4%) were men and 138 (40.6%) were women. The median red blood cell, haemoglobin, haematocrit and mean cell haemoglobin concentration were significantly higher in men than women (p < 0.001). The median white blood cell, absolute lymphocytes count, absolute granulocytes and platelet counts for men were significantly lower than those for women (p < 0.011). CONCLUSION We propose that the present established haematological reference intervals in this study should be used for clinical management of patients and interpretation of laboratory data for research in Bamenda.
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Affiliation(s)
- Victor N Fondoh
- Administration/Quality Management, Bamenda Regional Hospital Laboratory, Regional Hospital Bamenda, Bamenda, Cameroon
- Department of Medical Laboratory Sciences, School of Health and Medical Sciences, Catholic University of Cameroon, Bamenda, Cameroon
- Department of Health Economics Policy and Management, Faculty of Business Management, University of Cameroon, Bamenda, Cameroon
| | - Richard M Fondoh
- Administration/Pharmaceutical Management, North-West Regional Fund for Health Promotion, Bamenda, Cameroon
| | - Charles N Awasom
- Department of Anatomy, School of Health and Medical Sciences, Catholic University of Cameroon, Bamenda, Cameroon
| | - Pefoule L Edith
- Bamenda Regional Hospital Laboratory, Regional Hospital Bamenda, Cameroon
| | | | - Bong Roland
- Product Safety/Quality Control Mangement, Geochim Sarl, Cameroon
| | - Rebeca Enow-Tanjong
- Department of Medical Laboratory Science, School of Health and Medical Sciences , Catholic University of Cameroon, Bamenda, Cameroon
| | | | - Judith Shang
- Laboratory Service, Center for Disease Control and Prevention, Yaoundé, Cameroon
| | - Egbe P Egbengu
- Department of Medicine and Surgery, School of Health and Medical Sciences, Catholic University of Cameroon, Bamenda, Cameroon
| | - Talkmore Maruta
- East Central and Southern Africa Health Community, Arusha, United Republic of Tanzania
| | - Akazong Etheline
- Department of Biochemistry, University of Dschang, Dschang, Cameroon
| | - Robert Leke
- Department of Medicine and Surgery, School of Health and Medical Sciences, Catholic University of Cameroon, Bamenda, Cameroon
| | - Ayuk Leo
- TB-Department, Regional Hospital Bamenda, Bamenda, Cameroon
| | - Denis Nsame
- Administration/Management, Regional Hospital Bemenda, Bamenda, Cameroon
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15
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Castle PE, Ajeh R, Dzudie A, Kendowo E, Fuhngwa N, Simo-Wambo AG, Nsame D, Orock E, Hebert TM, Pierz AJ, Murokora D, Anastos K, Adedimeji A. A comparison of screening tests for detection of high-grade cervical abnormalities in women living with HIV from Cameroon. Infect Agent Cancer 2020; 15:45. [PMID: 32676125 PMCID: PMC7353796 DOI: 10.1186/s13027-020-00311-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 07/02/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Women living with human immunodeficiency virus (WLWH), especially those living in low- and middle-income countries (LMIC), are at increased risk of cervical cancer. The optimal cervical-cancer screening strategy for WLWH has not been determined. We therefore conducted a pilot study of screening methods in WLWH living in Limbe, Cameroon. METHODS Five-hundred sixty-six WLWH, aged 25-59 years, were enrolled. After self-collecting a cervicovaginal specimen, they underwent a pelvic exam, during which a provider also collected a cervical specimen and visual inspection after acetic acid (VIA) was performed. Both self- and provider-collected specimens were tested for high-risk HPV by the Xpert HPV Test (Cepheid, Sunnyvale, CA, USA), with the residual of the latter used for liquid-based cytology. Women testing HPV positive on either specimen and/or VIA positive were referred to colposcopy and biopsies. However, because of poor attendence for follow-up colposcopy for the screen positives due to civil strife and technical issues with biopsies, high-grade cytology and/or clinical diagnosis of cancer was used as the primary high-grade cervical abnormality endpoint. Clinical performances for high-grade cervical abnormality of HPV testing and VIA for screening WLWH, and the most carcinogenic HPV genotypes and/or VIA to triage high-risk HPV-positive WLWH, were evaluated. RESULTS Four-hundred eighty-seven (86.0%) WLWH had results for HPV testing on both specimen, VIA, and cytology and were included in the analysis. Forty-nine (10.1%) had a high-grade cervical abnormality. HPV testing on provider- and self-collected specimens was more sensitive than VIA (95.9 and 91.8% vs. 43.8%, respectively, p < 0.01 for both comparisons) for identifying women with high-grade cervical abnormalities. HPV testing on provider- and self-collected specimens was less specific than VIA (57.5 and 51.6% vs. 89.7%, respectively, p < 0.01 for both comparisons) for identifying women with high-grade cervical abnormalities; HPV testing on provider-collected specimens was more specific than on self-collected specimens (p < 0.01). Among HPV-positive women, HPV16/18/45 detection or VIA positivity had a sensitivity and positive predictive value of 73.5 and 29.0%, respectively, for provider-collected specimens and 68.8 and 22.9%, respectively, for self-collected specimens for high-grade cervical abnormalities. CONCLUSIONS HPV testing was more sensitive but less specific than VIA for detection of high-grade cervical abnormality in WLWH. Improved triage methods for HPV-positive WLWH are needed. TRIAL REGISTRATION NCT04401670 (clinicaltrials.gov); retrospectively registered on May 26, 2020.
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Affiliation(s)
- Philip E. Castle
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY USA
| | - Rogers Ajeh
- Clinical Research Education, Networking and Consultancy, Yaoundé, Cameroon
| | - Anastase Dzudie
- Clinical Research Education, Networking and Consultancy, Yaoundé, Cameroon
| | - Ernestine Kendowo
- Clinical Research Education, Networking and Consultancy, Yaoundé, Cameroon
| | - Norbert Fuhngwa
- Clinical Research Education, Networking and Consultancy, Yaoundé, Cameroon
| | | | - Denis Nsame
- Limbe Regional Hospital, Limbe, Southwest Region Cameroon
| | - Enow Orock
- Department of Biomedical Sciences, University of Buea, Buea, Cameroon
| | - Tiffany M. Hebert
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY USA
| | - Amanda J. Pierz
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY USA
| | | | - Kathryn Anastos
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY USA
| | - Adebola Adedimeji
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY USA
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16
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Adedimeji A, Ajeh R, Dzudie A, Kendowo E, Fuhngwa N, Nsame D, Simo-Wambo AG, Orock E, Hebert TM, Pierz AJ, Murokora D, Anastos K, Castle PE. Cervical human papillomavirus DNA detection in women living with HIV and HIV-uninfected women living in Limbe, Cameroon. J Clin Virol 2020; 128:104445. [PMID: 32470891 DOI: 10.1016/j.jcv.2020.104445] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 05/04/2020] [Accepted: 05/14/2020] [Indexed: 01/22/2023]
Abstract
BACKGROUND There are limited data on cervical HPV prevalence in Cameroon and none from its Anglophone region. We investigated cervical HPV prevalence in HIV-uninfected (HIV[-]) and HIV-infected (WLWH) women living in the region. METHODS A convenience sample of consecutively recruited HIV[-] women (n = 295) and women living with HIV (WLWH) (n = 560) attending the Limbé Regional Hospital were enrolled into a cervical screening study. Women underwent screening that included HPV testing of self-collected and provider-collected specimens. We calculated the HPV prevalence by HIV status, overall and stratified by age, and among WLWH, stratified by CD4 counts. We compared the concordance for the detection of HPV between self- and provider-collected specimens. RESULTS Crude HPV prevalence was 21.69 % (95 % confidence interval [95 %CI] = 17.21-26.48 %) for HIV[-] women and 46.43 % (95 %CI = 42.24-50.66 %) for WLWH (p < 0.001). Among WLWH, older age (ptrend = 0.01) and higher CD4 counts (ptrend = 0.007) were associated with lower HPV prevalence. There was a good-to-excellent agreement for HPV detection between specimens, and self-collected were more likely than provider-collected specimens to test HPV positive, for all women and stratified by HIV status. CONCLUSIONS HIV-related immunosuppression was a risk factor for HPV prevalence in this population. HPV testing of self-collected specimens appeared to be less specific than HPV testing of provider-collected specimens.
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Affiliation(s)
- Adebola Adedimeji
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Rogers Ajeh
- Clinical Research Education, Networking and Consultancy, Yaoundé, Cameroon
| | - Anastase Dzudie
- Clinical Research Education, Networking and Consultancy, Yaoundé, Cameroon
| | - Ernestine Kendowo
- Clinical Research Education, Networking and Consultancy, Yaoundé, Cameroon
| | - Norbert Fuhngwa
- Clinical Research Education, Networking and Consultancy, Yaoundé, Cameroon
| | - Denis Nsame
- Limbe Regional Hospital, Limbe, Southwest Region, Cameroon
| | | | - Enow Orock
- Department of Biomedical Sciences, University of Buea, Cameroon
| | - Tiffany M Hebert
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Amanda J Pierz
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Kathryn Anastos
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Philip E Castle
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA.
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