Cameroonian Children Research Articles

A cross-sectional study of acute dengue infection in paediatric clinics in Cameroon

BackgroundDengue fever is the world’s fastest spreading mosquito borne viral infection. It is prevalent throughout both subtropical and tropical region, and affects over 128 countries. Dengue virus (DENV) infection poses a serious global public health challenge to three billion people, resulting in approximately 200 million cases of morbidity and 50,000 cases of mortality annually. In Cameroon like in most sub-Saharan African countries, DENV infection occur concurrently with other infectious diseases whose symptoms often overlap, rendering differential diagnosis challenging. This study aims at determining the frequency of acute dengue among febrile children under 15 years attending hospitals in some areas of Cameroon.MethodsA total of 961 children under the age of 15 were recruited in a cross-sectional study using systematic sampling technique and by selecting each subject out of the three. The study was conducted in 10 public health centers in Cameroon. Demographic data and risk factors of the subjects were obtained using well-structured questionnaires. Dengue virus NS1 antigen, IgM and IgG were analysed using a Tell me fast® Combo Dengue NS1-IgG/IgM Rapid Test. An in-house ELISA test for dengue specific IgM antibody was equally performed for confirmation. Descriptive statistical analysis was performed using Graph pad version 6.0.ResultsA prevalence of 6.14% acute dengue virus infection was observed among children with febrile illness with a significant difference (p = 0.0488) between males (4.7%) and females (7.7%). In addition, children who reportedly were unprotected from vectors, showed a comparatively higher prevalence of the disease seropositivity than those practicing protective measures.ConclusionDENV infection therefore is an important cause of fever among children in Cameroon. Thus, there is a need to include differential screening for DENV infections as a tool in the management of fever in children in the country.

Comparison of two diagnostic techniques to determine the prevalence of <i>Schistosoma mansoni</i> infections in Cameroonian school children

Background: The Kato-Katz technique is recommended for diagnosis of Schistosoma mansoni infection by the World Health Organization. However, egg counts are subject to variability. The aim of this study is to determine the prevalence of S. mansoni infection in school children using two different techniques and to recommend the technique that should be routinely used in the diagnosis of this infection. Methodology: Field investigations on faecal samples from 299 Cameroonian school children were carried out in 2016 to compare the effectiveness of the Kato-Katz and Formalin-ether techniques in diagnosis of S. mansoni infections. Results: Schistosome eggs were detected in 37 (12.3%) samples with the Kato-Katz technique and 61 (20.4%) samples with the Formalin-ether technique. The difference between the prevalence observed for the two techniques was significant in males and age group 10 - 12 years ( p < 0.5). Conclusion: The Formalin-ether technique was more sensitive than the Kato-Katz method for detecting S. mansoni eggs in faecal matter. Despite its cost, the Formalin-ether technique can be routinely used in the laboratory for epidemiological studies of intestinal schistosomiasis Keywords: Formalin-ether, Kato-Katz Schistosoma mansoni , school children

Outcomes of protease inhibitor-based antiretroviral therapy amongst children and associated-factors in Yaoundé, Cameroon.

BackgroundThere are limited data on protease inhibitor (PI)-based antiretroviral therapy (ART) amongst children in resource-limited settings, for informing on optimal paediatric regimens.ObjectiveTo evaluate therapeutic response to PI-based ART amongst HIV-infected Cameroonian children.MethodsA retrospective study was conducted amongst children aged 2–18 years receiving a PI-based ART at the Essos Hospital Centre (EHC), Yaounde, Cameroon. Primary end points were therapeutic success on PI-based ART, defined as clinical success (WHO I/II clinical stage), immunological success (CD4 ≥ 500/mm3) and viral suppression (viral load [VL]<1000 copies/ml). Factors associated with therapeutic success were assessed in uni- and multivariate analysis using SPSS software v.2.0; with p<0.05 considered statistically significant.ResultsA total of 71 eligible children on PI-based ART were enrolled (42 on initial and 29 on substituted regimens), with a median age of 8 [IQR: 5–12] years and mean duration on ART of 7 years. Following therapeutic responses, all (100%) experienced clinical success, 95.2% experienced immunological success (91.7% on initial and 97.2% on substituted PI/r-based regimens) and 74.7% viral suppression. In univariate analysis, viral suppression was associated with: younger age (p<0.0001), living with parents as opposed to guardians (p = 0.049), and the educational level (p<0.0001). In multivariate analysis, only the age ranges of 10–14 years (OR: 0.22 [0.07–0.73]) and 15–18 years (OR: 0.08 [0.02–0.57]), were determinants of poor viral suppression.ConclusionAmong these Cameroonian children, PI-based ART confers favourable clinical and immunological outcomes. The poor rate of viral suppression was mainly attributed to adolescence (10–18 years).

A Median Analysis of Factors Influencing Body Fatness in Urban School-Age Children in Cameroon.

Background Childhood overweight/obesity is a fast growing public health problem in developing countries. The adverse health consequences of obesity have been attributed to higher body fat levels and this has drawn overwhelming attention towards more accurate assessment of body fat. The goal of this study is to evaluate the relationships between selected behavioral factors and percentage body fat (%BF) estimated using bioelectrical impedance analysis in school-age children. Methods A cross-sectional analysis was carried out in randomly selected 6- to 11-year-old children (507 boys and 501 girls). Percentage body fat was assessed using bioelectrical impedance analysis. The behavioral factors were reported by parents using a structured questionnaire. Multiple quantile regression analysis was used to evaluate the relationship between the selected behavioral factors and %BF. Results With quantile regression, the daily consumption of fruits and vegetables, daily breakfast consumption, and high physical activity (>4–7 times/week) were significantly (p < 0.001) associated with a 4.95, 3.29, and 3.66 decrease in median %BF, respectively. Also, consumption of snacks (>3 times a day) (p < 0.001), high sedentary lifestyle (>3–6 hours/day) (p < 0.001), and motorization to school (p < 0.005) significantly increased the median %BF by 3.69, 3.01, and 1.39, respectively. The largest changes in median %BF were observed in girls. Conclusions Efforts are needed using longitudinal studies to clarify the effects of these behavioral factors on %BF in different regions and ethnic groups of Cameroon and also to assess whether any observed differences are of clinical relevance.

Molecular epidemiology of noroviruses in children under 5 years of age with acute gastroenteritis in Yaoundé, Cameroon.

Norovirus is a common cause of acute gastroenteritis (AGE) among children in developing countries. Limited data on the prevalence and genetic variability of norovirus are available in Cameroon, where early childhood mortality due to AGE is common. We tested 902 fecal specimens from children younger than 5 years of age hospitalized with AGE between January 2010 and December 2013. Overall, 76 (8.4%) samples tested positive for norovirus, of which 83% (63/76) were among children below 12 months old. Most of the noroviruses detected were in children infected between July and December of each year. All norovirus-positive specimens were genotyped, with 80% (61/76) being GII.4 (three variants detected). Genotypes GI.2, GI.6, GII.1, GII.2, GII.3, GII.6, GII.16, GII.17, and GII.21 were also detected. Interestingly, GII.4 Sydney and GII.17 Kawasaki viruses were found as early as 2010, years before their emergence globally. This study suggests norovirus is a significant cause of moderate to severe gastroenteritis among young children in Cameroon. The results are important to highlight appropriate prevention and control strategies for reducing the burden of norovirus disease.

Reframing understandings of cultural influences on learning science

This review essay addresses issues raised in Valerie Frede’s paper entitled: Comprehension of the nightandday cycle among French and Cameroonian children aged 7–8 years.

Neurodevelopmental outcomes in HIV-infected and uninfected African children.

HIV infection is associated with cognitive impairments, but outcomes are poorly explored in children starting antiretroviral therapy (ART) early or in those exposed but uninfected. Nested cross-sectional evaluation of the neurocognitive and behavioural outcomes of HIV-infected, HIV-exposed uninfected (HEU) and HIV-unexposed (HUU) Cameroonian children at age 4-9 years prospectively followed. Cognitive development was assessed in 127 HIV-infected, 101 HEU, 110 HUU children using the KABC-II, neurologic dysfunction using the Touwen examination and behavioural difficulties using the Strength and Difficulties Questionnaire (SDQ). Analyses were adjusted for children age, sex and primary language. Contextual factors were included in a second step to assess their effects on outcomes. All HIV-infected children were treated before 12 months. There was a negative linear gradient in KABC-II scores from HUU children to HEU and HIV-infected children [gradient: -6.0 (-7.7; -4.3) for nonverbal index, NVI, and -8.8 (-10.7; -6.8) for mental processing index, MPI]. After adjusting for contextual factors, scores of HEU children were not significantly different from those of HUU children (all P > 0.1) and differences between HIV-uninfected and HUU children reduced [NVI: from -11.9 (-15.3; -8.5) to -3.4 (-6.8; -0.01), MPI: from -17.6 (-21.3; -13.8) to -5.5 (-9.3; -1.7)]. Compared with uninfected children, HIV-infected children had more neurological dysfunctions and higher SDQ scores (P = 0.002). Despite early ART, perinatal-HIV infection is associated with poorer neurocognitive scores and increased behavioural difficulties during childhood. Contextual factors play an important role in this association, which emphasizes the need for early nutritional and developmental interventions targeting both HIV-affected infants and their relatives.

Comprehension of the night and day cycle among French and Cameroonian children aged 7–8 years

In this article, we compared French and Cameroonian schoolchildren’s initial conceptions and comprehension of the night and day cycle in order to test for cultural influence. Forty students aged almost 8 years (Grade 2) were individually interviewed in their schools about night and day dynamics before they had received any teaching in astronomy. Results indicated that French children have significantly more heliocentric knowledge about the night and day cycle than Cameroonian children who propose rather a geocentric view, underlining the impact of cultural mediation (e.g., artifacts, media, and personal accounts). French children, who grow up in a mechanistic culture, give explanations of the night and day cycle based on the Earth’s rotation, whereas their Cameroonian peers, who live in an animistic society, mainly propose movements of the Sun to explain the cycle (consistent with their observations and local cosmologies). Regarding the organization of this knowledge, we found that only a few children had a coherent model of the night and day cycle. It did not appear to be influenced by cultural context, as both the French and Cameroonian children’s conceptions were mainly fragmented.

Perceived and Assessed Dental Treatment Needs of Schoolchildren in Benoe Division, Cameroon.

Oral health surveys combining clinical and subjective measures are effective to inform oral health policy, practice, and evaluation of oral health interventions. However, only a few studies have examined the agreement between these measures in developing countries. This study investigates dental treatment needs among Cameroon's schoolchildren; specifically, we aim to estimate the extent to which perceived and clinical measures are in agreement. Using a multistage sampling technique, we randomly selected 11 schools and their pupils to participate in this study. We conducted an oral clinical examination using a mouth mirror and blunt probe in a classroom to evaluate children's oral health. In addition, the participants filled out a questionnaire on sociodemographic characteristics, oral health behavior, and perceived treatment needs. To fulfill our aims, we use descriptive statistics and unconditional logistic regression. Out of 700 children invited to participate, 692 completed the study (98.8%). The mean age of the children was 11.45 y (SD = 1.21), and there were slightly more boys ( n = 366, 52.9%) than girls ( n = 326, 47.1%). The majority of the children (85.2%) felt that their oral health was good, and more than half (53.2%) reported a perceived need for dental treatment. While 68.2% ( n = 472) had at least 1 objective treatment need, only 65.8% of them perceived this need, indicating a medium level of sensitivity (65.9%, 95% CI = 61.4% to 70.2%). In addition, we observed a high positive predictive value (84.5%, 95% CI = 80.4% to 88.1%) for perceived treatment need to detect clinically evaluated dental treatment need. Our findings show that perceived treatment has a high positive predicted value to determine clinical treatment need. Subjective assessment of treatment need may be an alternative low-cost option to help policy makers to design oral health interventions for Cameroonian children. This study illustrates the potential of schoolchildren in a low-income country to make a good prediction of their dental treatment needs. The majority of these countries lack the human and material resources to conduct oral health surveys that include clinical assessment of treatment needs. Therefore, stakeholders can rely on data from self-administered oral health surveys to inform policy and delivery of services to schoolchildren in resource-limited settings.

Factors influencing the performance of routine immunization in urban areas: A comparative case study of two cities in Cameroon: Douala and Yaoundé

Urban areas are often omitted from investigations on immunization because the published literature tends to focus on rural settings. The two largest cities in Cameroon – Douala and Yaoundé – are the main drivers of the high number of unvaccinated children in Cameroon. The objective of our study was to identify the factors influencing vaccine incompleteness in Douala and Yaoundé in children (12–23 months of age).We conducted a community-based cross-sectional study using concomitant mixed methods (qualitative and quantitative) with an explanatory aim. The study was conducted in three health districts in each city between March and April 2016.The number of nonvaccinated and incompletely vaccinated children was higher in Yaoundé (3.1% and 40.3%, respectively) than in Douala (0.7% and 10.1%, respectively). The most frequent reason for nonvaccination was related to the parent/guardian not knowing the consequences of not being vaccinated and lack of money. According to the explanatory model, nonvaccination in both cities was associated with the following issues: (1) perceived high visibility of the health district office in terms of vaccination, (2) the shortage of health personnel in immunization centers, (3) attending a private health facility, (4) average or poor behavior of health personnel at immunization centers, and (5) poor knowledge of vaccine-preventable diseases.This mixed-methods study illustrates how inadequacies of the health district framework within urban areas are fueling poor performance of routine immunization in Cameroon. Further research should inform the development of community-centered vaccination services that are most needed, especially in rapidly urbanizing sub-Saharan Africa.

The prevalence of otitis media in 2–3 year old Cameroonian children estimated by tympanometry

BackgroundAcute otitis media is a common illness in children under-five years of age and associated with major health care resources in high-income countries. However, there is paucity of data on its epidemiology and clinical presentation in low-income countries. We estimated the prevalence of otitis media and assessed risk factors among children in Cameroon. MethodsA community-based cross-sectional prevalence study of otitis media (OM) was performed on randomly selected children aged 2–3 years in Yaoundé, Cameroon from March to June 2013. OM was assessed by clinical inspection for chronic suppurative otitis media (CSOM) and tympanometry for otitis media with effusion (OME). CSOM was defined as draining of the middle ear with duration of more than two weeks and OME was defined as a flat ‘type B’ tympanogram. ResultsOut of 529 children enrolled in the study, 433 (56% males) subjects with available tympanograms were evaluated. Altogether, 9.7% (42/433) of children met the case definition of CSOM, OME or its complications. This consisted of 3 (0.7%) children identified with unilateral CSOM; 7 (1.6%) children with bilateral OME; 31 (7.2%) with unilateral OME and 1 (0.2%) subject with unilateral dry tympanic membrane perforation.Logistic regression analyses showed statistically significant association between OM and parental reporting of “current symptoms of upper respiratory tract infections”, Prevalence Odds Ratio (POR) = 3.71; 95% CI = 1.69–8.14). ConclusionAs many as two out of a hundred children between the ages of 2–3 years were affected by significant middle ear disease i.e. CSOM or bilateral OME. These data could be useful as a baseline for estimating the impact of pneumococcal conjugate vaccines (PCV13) introduced in July 2011 for infants in Cameroon.

Visual attention in 5-year-olds from three different cultures.

Cognitive processes differ markedly between children from different cultures, with best evidence for attention to visual scenes and the activities of others. Children from urban Western cultures tend to focus on focal objects, whereas children from urban East-Asian cultures rather attend to contextual elements of a visual scene. Regarding the attention to others’ activities, children from subsistence-based farming communities often observe several activities simultaneously, while children from urban Western contexts focus on activities sequentially. Here we assessed 144 5-year-old children from three prototypical cultural contexts (urban Germany, rural Cameroon, urban Japan) to investigate variations in attention across a variety of tasks. Attention to the elements of a visual scene was assessed in an optical illusion task, in picture descriptions and an eye-tracking paradigm. Attention to and learning from others’ activities was assessed in a parallel action task and a rule-based game. Some tasks indicated higher context-sensitive attention in urban Japan, while other findings indicated higher context-sensitive attention in urban Germany. Levels of parallel attention and learning from others’ activities were lower in rural Cameroonian children compared to the urban samples. Across tasks, the visual attention measures were unrelated. These findings substantiate that culture has a profound influence on early cognitive development, already in the preschool years. Furthermore, they raise critical questions about the early origins of cultural specificities in attention and the generalizability of attention phenomena beyond specific tasks and populations.

Chapter 9 – Migration, violent extremism and social exclusion

Chapter 9 – Migration, violent extremism and social exclusion

Bucco-dental manifestations of sickle-cell anemia in Cameroonian children and adolescents

Bucco-dental manifestations of sickle-cell anemia in Cameroonian children and adolescents

Human capital accumulation of children in Cameroon: does disability really matter?

ABSTRACTAlthough most of the world's disabled people live in developing countries, little is known about the consequences of disability in this part of the world. Using the DHS-MICS 2011 data of Cameroon, this paper contributes to the literature by providing new robust estimates of the effect of child disability on education in a developing country context. It controls for unobserved heterogeneity within the households by using a ‘true’ sibling fixed effect model and also accounts for the severity of disability. The results show that moderate and severe disabilities reduce the probability that a child attends school and diminish school progress.

Motor and Visual-spatial Cognition Development in Primary School-Aged Children in Cameroon and Germany

ABSTRACTIt was the main goal of this study to investigate the motor and visual-spatial development in primary school-aged children in Cameroon and Germany. Thirty-four children from each country completed a motor test and a mental rotation test. It was found that children in Cameroon showed a better motor ability (better overall gross motor score and also on most single items) than children in Germany did. This can be explained by the early motor stimulation in infancy in Cameroon. Concerning mental rotation performance, Cameroonian children perform below chance level. A positive correlation between the overall motor ability and mental rotation performance could only be analyzed and conducted in the German sample. Therefore, this study emphasizes the need for the development of culture-fair cognitive tests.

Characterization of pharmaceutical medication without a medical prescription in children before hospitalization in a resource-limited setting, Cameroon.

IntroductionThe use of different therapeutic approaches is common among sick children in Cameroon. The main objective of this study was to characterize the use of non-prescription drugs and describe the therapeutic itineraries of sick children before admission to the hospital.MethodsA cross-sectional and prospective study was conducted from January to May 2017. A closed-ended questionnaire (CEQ) consisting of one or several response options was administered to the parents/guardians of the children on admission to the hospital in the pediatric ward of the Laquintinie Hospital in Douala (LHD) and the Cité des Palmiers District Hospital (CPDH) of the city of Douala. Inclusion of participants was made consecutively for adolescents who gave their consent and parents or guardians who signed the informed consent for all children. The confidentiality of the data was ensured by the replacement of the names by codes.ResultsOverall, 295 hospitalized children were included with an average age of 3.1 (SD: 3.3) years in the study. More than half of these children (58.6%) came from LHD. More than 90% of parents had at least one therapeutic recourse (TR). The ratio of boys to girls 3/1. Self-medication (74.1%) and medical consultation (16.9%) were the main therapeutic paths in 1st recourse. The medical consultation (80.2%) and the pharmaceutical advice (16.9%) were used frequently in 2nd recourse. The mean lapse time to see a medical professional was 2.7 days (min-max: 0-14 days). The main symptoms associated with TR were fever (76.6%), vomiting (24.7%) and diarrhea (22.7%). The most frequently used drugs were Analgesics/antipyretics (47.6%), antimalarials (15.0%) and antibiotics (10.2%) and the family medicine box was the highest source of drugs.ConclusionSelf medication remains the first therapeutic path, followed by medical consultation as second therapeutic path taken when the disease is perceived as serious.

Epidemiological, Clinical and Biological Characteristics of Cameroonian Children and Adolescents with Sickle-Cell Anemia

A total of 126 patients were included in the study- 65 girls and 61 boys. The mean age of the subjects was 8 ± 4 years (ranging from three to sixteen years). The most represented age group was that from 3-4 years of age. Most of the participants were from the Central Region (46%). All of the subjects were homozygous for hemoglobin SS. Subjects with yearly frequency of three vaso-occlusive crises represented 42.9% of the sample. 57.9% of the patients had been polytransfused within the past 3 years (>2 transfusions). Up to 45.2% of the patients had been hospitalized within the past year.

Profile of Stunted Children in Cameroon, A Mics 2014 Analyses

Profile of Stunted Children in Cameroon, A Mics 2014 Analyses

Observed HIV drug resistance associated mutations amongst naïve immunocompetent children in Yaoundé, Cameroon.

The emergence of drug resistance mutations (DRMs) has been a major threat for successful lifelong combination antiretroviral therapy (cART), especially for HIV-vertically infected children within the context of the prevention of mother-to-child transmission (PMTCT). This study aimed to evaluate DRMs amongst immune competent treatment-naïve children in Cameroon. A cross-sectional study was conducted between 2015 and 2016 amongst 55 proxy consented HIV-1 positive children, aged 9 months to 6 years. They were all immune competent, cART naïve and with unknown history of PMTCT. CD4 cell counts and genotypic drug resistance testing were performed using standard methods. Levels of DRMs to protease (PR) inhibitors (PIs), nucleoside reverse transcriptase inhibitors (NRTIs) and non-NRTIs were 27.6%, 3.7% and 40.7%, respectively. Only minor DRMs were observed for PR. The observed mutations for NRTI were K65R, T215I and K219E (33.0% each) and for NNRTI: V106M, Y181C and Y188H (6.0% each). Only minor accessory mutations were found in the integrase (IN) region. Despite widely available cART we still observe naïve HIV children, especially from the rural communities. We observe that a proportion of study participants had HIV-1 drug resistance associated mutations (RAMs). Data generated could help strengthen the current PMTCT programmes within the country. There is a need to upscale approaches for drug resistance testing for children in Cameroon and many other resource-limited settings.