Tiko Health District Research Articles

Ownership, coverage, utilisation and maintenance of long-lasting insecticidal bed nets in three Health Districts in Cameroon: a cross-sectional study.

the Bamenda, Santa and Tiko Health Districts are in the highest malaria transmission strata of Cameroon. The purpose of this study was to explore the indicators of ownership and utilisation as well as maintenance of Long-Lasting Insecticidal Nets (LLINs) in three health districts in Cameroon. a cross-sectional household survey involving 1,251 households was conducted in the Tiko Health District (THD) in June and July 2017 and in Bamenda and Santa Health Districts in March to May 2018. A structured questionnaire was used to collect data on LLIN ownership, utilisation, and maintenance as well as demographic characteristics. the average number of LLINs per household was higher in the Bamenda Health District (BHD) compared to the THD (2.5, range; 0-6 vs. 2.4, range; 0-6) as well as the household ownership of at least one LLIN (93.3% vs. 89.0%). The proportion of the defacto population with universal utilisation was higher in BHD compared to THD (13.1% vs 0.2%). In the multinomial regression analysis, households in the SHD (p = 5.5x10-4, OR; 0.3, 95% C.I; 0.1-0.6), were less likely to own at least one LLIN compared to those in THD. Eighty-seven point one percent (87.1%) of household heads admitted that LLINs could be washed, while 50.1% affirmed the correct washing frequency. ownership of LLINs was low in the THD in comparison to the goal of one for every two household members. Overall, LLINs coverage and accessibility was still low after the free mass distribution campaigns (MDCs), as only 14.6% of children 0-5 years and 16.1% of the entire population used LLIN the night before the survey.

Schistosomiasis and Malaria Co-Infection in School Age Children in the Tiko Health District, South West Region, Cameroon

Schistosomiasis and Malaria Co-Infection in School Age Children in the Tiko Health District, South West Region, Cameroon

Situational Analysis of Malaria Control Following the 2021 Distribution of Long Lasting Insecticide-Treated Bed Nets in the Tiko Health District, South West Region, Cameroon

Malaria is still a major public health concern in Cameroon as more than 20 million people are at risk of the disease. Despite the government’s effort to scale up the distribution of long lasting insecticide-treated bed nets (LLINs), full ownership and optimal use is still limited. In 2021, over a million LLINs were made available for distribution in the South West Region. However, the current situation of malaria has not yet been ascertained following the 2021 mass distribution campaign (MDC). Therefore, the aim of this study was to determine LLIN ownership, coverage, usage and the prevalence of malaria following the 2021 MDC in the Tiko Health District (THD), South West Region of Cameroon. A cross-sectional study was carried from May 1 to 27, 2022 in which a multi-stage sampling technique was used to enroll eligible participants. Data were collected from household heads using questionnaires and capillary blood samples collected from consented household members were used to test for malaria. Data were analyzed using SPSS version 25 at 0.05 significance level. From the 150 households surveyed, 96 (64.0%) owned a mosquito net before the recent MDC. There was an overall significant increase (p p = 0.644) in LLINs ownership between areas where door-to-door (79.5%) and fixed “Hit and Run” (75.8%) strategies were used in the distribution of LLINs in THD. The prevalence of malaria was 10.2%. The regular use of LLINs was significantly associated (p = 0.007) with low malaria prevalence. The 2021 MDC had an impact on malaria prevalence in those who properly used them.

Prevalence, Primary Health Care Diagnosis, and Challenges Encountered by Health Care Workers in the Control of Schistosomiasis, in the Tiko Health District, South Western Cameroon

One approach to the control of schistosomiasis recommended by the World Health Organization (WHO) is for endemic countries to integrate schistosomiasis control measures into their primary health care (PHC) services. Assessment of their capacity to accommodate such control measures is of utmost importance. This study had as objectives to assess the capacity of the PHC system in the Tiko Health District to diagnose schistosomiasis and to evaluate health care workers’ perspectives of potential challenges to schistosomiasis control in the district. A total of 13 primary healthcare facilities were randomly selected and their laboratory records on schistosomiasis diagnosis were evaluated for quality (availability, documentation of key aspects and presentation), diagnostic methods used and parameters recorded (egg counts, haematuria). At each institution, more than 60% of health personnel participated in a survey in which a semi-structured questionnaire was used to collect data. A total of 170 healthcare workers working at various stations (laboratory, pharmacy, nurses, out-patient section) were interviewed. Out of the 13 health institutions, only 8(61.5%) had any data on diagnosis of the disease and used the sedimentation technique for diagnosis. One institution used the Syringe Filtration Technique (7.7%) in the diagnosis of S. haematobium and recorded the presence or absence of haematuria. No institution recorded key parameters like egg count for any patient. Five (38.5%) of the institutions, found mainly in the suburbs, had no laboratory services. Most of the healthcare workers (46.5%) were of the opinion that lack of knowledge of the disease is a major setback in the implementation of control. With respect to the different professions, it was observed that amongst the medical doctors (83.3%) and nurses (58.2%) this opinion was more popular. Pharmacy technicians (67.7%) and community directed distributors (52.2%) cited the poor sanitary conditions of homesteads as the greatest challenge in the implementation of any form of control. The primary healthcare system of the Tiko Health District lacks the capacity to accommodate control measures; all the hospital laboratories fall short of WHO recommendations for diagnosis of the disease. The control of schistosomiasis in this health district is likely to be hampered by several factors ranging from poor sanitation, poor knowledge of the diseases, lack of commitment of stakeholders and poor diagnostic techniques and reporting methods.

The effect of climatic factors on the number of malaria cases in an inland and a coastal setting from 2011 to 2017 in the equatorial rain forest of Cameroon

BackgroundWeather fluctuation affects the incidence of malaria through a network of causuative pathays. Globally, human activities have ultered weather conditions over time, and consequently the number of malaria cases. This study aimed at determining the influence of humidity, temperature and rainfall on malaria incidence in an inland (Muyuka) and a coastal (Tiko) settings for a period of seven years (2011–2017) as well as predict the number of malaria cases two years after (2018 and 2019).MethodsMalaria data for Muyuka Health District (MHD) and Tiko Health District (THD) were obtained from the Regional Delegation of Public Health and Tiko District Health service respectively. Climate data for MHD was obtained from the Regional Delegation of Transport while that of THD was gotten from Cameroon Development Coorporation. Spearman rank correlation was used to investigate the relationship between number of malaria cases and the weather variables and the simple seasonal model was used to forecast the number of malaria cases for 2018 and 2019.ResultsThe mean monthly rainfall, temperature and relative humidity for MHD were 200.38 mm, 27.050C, 82.35% and THD were 207.36 mm, 27.57 °C and 84.32% respectively, with a total number of malaria cases of 56,745 and 40,160. In MHD, mean yearly humidity strongly correlated negatively with number of malaria cases (r = − 0.811, p = 0.027) but in THD, a moderate negative yearly correlation was observed (r = − 0.595, p = 0.159). In THD, the mean seasonal temperature moderately correlated (r = 0.599, p = 0.024) positively with the number of malaria cases, whereas MHD had a very weak negative correlation (r = − 0.174, p = 0.551). Likewise mean seasonal rainfall in THD moderately correlated (r = − 0.559, p = 0.038) negatively with malaria cases, contrary to MHD which showed a very weak positive correlation (r = 0.425, p = 0.130). The simple seasonal model predicted 6,842 malaria cases in Muyuka, for 2018 and same number for 2019, while 3167 cases were observed in 2018 and 2848 in 2019. Also 6,738 cases of malaria were predicted for MHD in 2018 likewise 2019, but 7327 cases were observed in 2018 and 21,735 cases in 2019.ConclusionHumidity is the principal climatic variable that negatively influences malaria cases in MHD, while higher seasonal temperatures and lower seasonal rain fall significantly increase malaria cases in THD.

Distribution and factors associated with urogenital schistosomiasis in the Tiko Health District, a semi-urban setting, South West Region, Cameroon

BackgroundIncreased risk of schistosomiasis in peri-urban and urban towns is not uncommon. An epidemiological survey was carried out in the Tiko Health District (THD), an unmapped transmission focus for urogenital schistosomiasis (UGS), to assess the distribution, intensity, and risk factors associated with the occurrence of UGS.MethodsIn this cross-sectional survey, 12 communities were purposively selected from four health areas (HAs) (Likomba, Holforth, Holforth-Likomba, and Mutengene) in South West Region of Cameroon between June and August 2018. Consenting individuals were enrolled using a convenient sampling technique and administered a semi-structured questionnaire to document information on socio-demographic and water contact behaviour. Urine samples were examined for Schistosomahaematobium infection using test strip, filtration, and microscopy methods. Bivariate and binary logistic regression analyses were used to identify predictors of infection.ResultsThe overall prevalence of UGS in Likomba, Holforth-Likomba and Holforth was 31.5% [95% confidence interval (CI): 28.3–34.8] with geometric mean (GM) egg count of 28.7 (range: 2–450) eggs per 10 ml of urine. S.haematobium infection was not found in Mutengene HA. Infection was unevenly distributed among the HAs, Holforth-Likomba and Holforth being the most and least affected, respectively. The prevalence of infection varied (P < 0.001) among the affected communities, ranging from 12.0 to 56.9%. Infection status of the community related positively (P < 0.001) with proximity to stream (< 100 m), the degree of contact with water and number of improved water sources. Younger age group (5–14 years) [adjusted odds ratio (aOR): 3.7, 95% CI: 1.1–12.2] and intense water contact (degree II) (aOR: 5.2, 95% CI: 3.4–8.1) were associated with increased risk of infection. Similarly, significantly higher egg load was observed among younger aged groups (P = 0.02) and those who carried out intense water contact activities (P < 0.001).ConclusionsGenerally, THD is a moderate risk endemic focus for UGS but prevalence higher than 50.0% was observed in some communities. These findings warrant immediate mass chemotherapy with praziquantel to reduce morbidity. Provision of portable water and health education are proposed measures to reduce and eventually eliminate transmission in the area.Graphic abstract

Ownership and Utilisation of Long-Lasting Insecticidal Nets in Tiko Health District, Southwest Region, Cameroon: A Cross-Sectional Study.

Introduction Malaria is and remains a serious health concern in Africa. In Cameroon, where malaria is endemic and a major public health problem, the major control measure put in place is the use of long-lasting insecticidal nets (LLINs). In the Tiko Health District (THD), the challenges have been to assess and to evaluate the ownership and utilisation of LLINs. This study sought to assess the ownership and utilisation rates of LLINs in the THD. Methodology. A cross-sectional survey involving 418 households was conducted in four health areas in the THD. A structured questionnaire was used to collect data on LLIN ownership and utilisation as well as sociodemographic characteristics. Results The ownership of at least one LLIN per household, coverage, and accessibility were, respectively, 89%, 56.2%, and 66.3%, while installing LLINs on all beds in the household, sleeping under LLINs the previous night (SULPN), and universal utilisation were 72%, 24.9%, and 14.1%, respectively. Factors significantly associated with the ownership of at least one LLIN per household were respondent's age and gender. Heat (21.1%) and forgetfulness (6.5%) were the main reasons postulated for irregular utilisation of LLINs. Conclusion The ownership LLINs failed to guarantee utilisation and definitely effective control of malaria in the THD, as expected. Continuous and appropriate use of LLINs is indispensable, in addition to periodic sanitation, booster campaigns of LLIN distribution, and evaluation research for effective prevention and control of malaria.

The epidemiological status of urogenital schistosomiasis among reproductive aged individuals in the Tiko Health Area- a semi-urban setting in the Mount Cameroon area.

BackgroundUrogenital schistosomiasis (UGS) caused by S. haematobium has enormous reproductive health consequences including infertility. Reproductive aged individuals are a neglected group and not included in control programs in Cameroon. This study investigated the prevalence and severity of S. haematobium infection in the context of gender and socio-economic structures that shape behaviour among reproductive aged individuals living in Tiko, a semi-urban setting, Cameroon.Methodology/Principal findingsA cross-sectional study was carried out in the Tiko Health District (THD) between May to September 2019. Consenting individuals were enrolled using a convenient sampling technique and administered a semi-structured questionnaire to document data on socio-demographic and stream contact behaviour. A urine sample was collected and screened for the presence of S. haematobium ova using reagent strips, filtration and microscopy. The overall prevalence of S. haematobium infection was 22.8% (95% CL: 19.27–26.73) with geometric mean egg load of 18.74 (range: 1–1600) per 10ml of urine. Younger age group (15 – 20years) (OR: 5.13; 95% CL: 1.35–19.42), male (OR: 2.60 3.07; 95% CL: 1.54–4.40) and awareness of UGS (OR: 1.73; 95% CL: 1.02–2.95) were associated with higher odds of exposure to infection. Significantly higher intensity of infection was seen in males, singles and in the age group 15–30 years. It is worth noting that males carried out more activities which entailed longer duration in streams.Conclusion/SignificanceThe prevalence obtained shows that Tiko is a moderate-risk area for UGS with underlying morbidity-inducing infection intensity. The severity of the infection is more in males. Awareness of the disease is not enough to protect these communities from infection, but provision of public infrastructures and health education will limit contact with infested water and thus curtail the infection. There is an urgent need to involve all age groups in control programs.

Early Appraisal of Option B+ In Tiko Health District- Cameroon

Introduction: Cameroon in 2014 had a HIV prevalence rate of 4.6 %. It is estimated that about 90% of new infections occur as a result of heterosexual relations. In 2010 in Cameroon, 7,300 babies were estimated to be born HIV positive due to mother-to-child transmission (MTCT). Faced with these realities, Cameroon has been stepping up its response steadily from Option A then B and now Option B+. To have an early appraisal of the Option B+ approach as far as the prevention of mother to child transmission of HIV (PMTCT) is concerned in the Tiko health district- Cameroon.&#x0D; Methodology: This cross-sectional hospital based study was carried out in Tiko from the 1st of December 2015 to the 31st of August 2016. With the use of a questionnaire, a total of 111 women whose infants underwent the polymerase chain reaction (PCR) test at six weeks were surveyed. Univariate and bivariate data analysis were performed with CDC- Epi-Info 7.2.2.6.&#x0D; Results: Out of 111 women included in this study, only 2 (1.8%) babies had a positive PCR test. Two cases of infected babies were realised in the study, 1 in each of the first two trimesters of pregnancy. It could probably be due to the fact that, these women got infected while they were already pregnant or maybe before their introduction to the Option B+. However, the infectious rate was similar to that of women on tritherapy. Interventions like the use of Antiretroviral (ART) drugs by infected pregnant women, safe delivery practices and safe infant feeding helped reduce the risk of transmission to infants (from 40% to 5%).&#x0D; Conclusion: The infection rate of 1.8 % is similar to those of women who are on tritherapy in many studies. Despite the fact that the implementation of option B+ looks more onerous, the long term benefits as far as cost effectiveness is concerned looks laudable. Thus this strategy should be adopted in resource restricted countries.

Prevalence, Infection Intensity and Risk Factors of Schistosomiasis and Soil Transmitted Helminthiasis among School Aged Children in Tiko Health District, Southwest Cameroon: A Community-Based Cross-Sectional Study

Aims: This study aimed at determining the prevalence, infection intensities and risk factors associated with Schistosomiasis (SCH) and Soil transmitted helminthiasis (STH) among school aged children (SAC) in Tiko Health District (THD).&#x0D; Study Design: A community-based cross-sectional study was conducted in three health areas (Likomba, Holforth and Tiko town) in Tiko Health District.&#x0D; Place and Duration of Study: The study was carried out in THD from July to October, 2018.&#x0D; Methodology: The study included 464 children of both sexes aged between 4 – 15 years. Stool and urine samples were collected from 464 children and processed using the Kato Katz and Urine filtration techniques respectively. Information on socio-demographic characteristics and risk factors were collected using structured questionnaires. Data was analyzed using SPSS version 25 with statistical significance set at p&lt; 0.05.&#x0D; Results: Of the 464 SAC examined, the overall prevalence of Schistosomiasis, STH and Schistosomiasis/STH co-infection rate in THD was 16.16%, 14.44% and 0.43% respectively. Females (18.98%; 14.81%) were more infected with Schistosomiasis when compared to STH than males (13.71%; 14.11%). The order of STH prevalence observed was Ascariasis (9.27%) &gt; Hookworm disease (3.88%) &gt; Trichuriasis (1.29%). The mean infection intensity for Urinary Schistosomiasis and STH was 4.36 eggs per 10ml and 11.74 eggs per gram (EPG) respectively. SAC residing in Likomba HA were significantly at higher risk of Schistosomiasis (aOR: 4.40, P=0.008) and STH (aOR: 2.14, P = 0.031). Use of tap water was associated with STH.&#x0D; Conclusion: Tiko Health District can be considered as a moderate-risk zone for Schistosomiasis and a low risk zone for STH infection according to WHO classification.

Prevalence and Associated Factors of Teenage Pregnancy among Secondary and High School Students in the Tiko Health District, South West Region, Cameroon

Introduction: Teenage pregnancy is a common public health problem with global estimates of 16 million teenage births yearly. It is one of the major causes of maternal and neonatal mortality worldwide with the majority of the cases seen in the low and middle-income countries. Cameroon has recorded the highest fertility rate among teenagers in the entire Central African region as of 2017. Notably, there are limited data available on assessing the awareness and prevention of teenage pregnancies among secondary and high school students in Cameroon. Thus, this study aimed at assessing the prevalence and associated factors of teenage pregnancy among secondary and high school students in the Tiko Health District, South West Region, Cameroon. Methods: A cross-sectional descriptive study was conducted whereby data was collected using self-administered questionnaires from 250 systematically sampled participants from five teaching institutions in the Tiko Health District. Data was analysed using the EPI Info software, version 7.0. The study was carried out from the 15th November 2018 to the 20th of May 2019. Results: We had a total of 250 participants. The prevalence of teenage pregnancy was 5.20% (95% CI 3.34 - 9.1). A total of 47.20% (95% CI: 37.56 - 53.6) of participants were sexually active. Having multiple partners was a major risk factor for teenage pregnancy (AOR: 3.2, 95%CI: 1.75 - 4.03, P-value: 0.03). After adjusting for confounders educational level was a risk factor for the awareness of teenage pregnancy (AOR: 0.54, 95%CI: 0.30 - 0.92, P-value: 0.04). Poor communication skills, social shyness, and lack of knowledge were potential barriers to contraceptive use. Conclusion: Having multiple sexual partners was a risk factor to the prevalence of teenage pregnancy. The majority of adolescents had considerate ideas of teenage pregnancy, its prevention, and its consequences. However, a good number of them lack adequate knowledge of a comprehensive sexuality education. Thus, measures have to be put in place to provide better sex education to adolescents.

A cross-sectional survey on the prevalence of anaemia and malnutrition in primary school children in the Tiko Health District, Cameroon.

IntroductionAnaemia and malnutrition are common health problems in developing countries with children being the most vulnerable. They have negative impacts on human performance, growth and development, in children, both as cause and consequences of disease. Although annual mass deworming and nutrition supplement strategies have been implemented in the Tiko Health District (THD), no study has been carried out to determine the prevalence of anaemia and malnutrition. The aim of this study was therefore designed to determine the prevalence of anaemia and malnutrition among primary school children aged 5-15 years in the Tiko Health District.MethodsA cross-sectional study was carried out in 10 randomly selected schools in the THD and a total of 400 school children were enrolled in the study. Body weight and height were measured using an electronic weighing scale and stadiometer respectively. Anthropometric indices: Height-for-Age Z scores (HAZ), Weight-for-Age Z scores (WAZ) and Body Mass Index-for-Age Z scores (BMIAZ) were analyzed and compared with WHO Growth Reference Standards using WHO Anthroplus software. Hemoglobin levels were determined using Urit-12 Haemoglobinometer and anaemia defined as Hemoglobin (Hb) < 11g/dl. Data analysis was done using the SPSS software.ResultsThe overall prevalence of malnutrition was 9.25%, prevalence of stunting 7.5% with 0.8% being severely stunted. The prevalence of wasting was 1% and underweight 0.7%. The overall prevalence of anaemia was 5%. Parents occupation and the absence of toilet were statistically associated with anaemia (P = 0.04 and P = 0.003). Age, floor type, absence of toilet and BMI were significantly associated with malnutrition (P = 0.00, P = 0.01, P = 0.02 and P = 0.003).ConclusionThis study revealed a low prevalence of malnutrition and anaemia which could be attributed to the deworming and nutrition supplement strategies which have been implemented.

Presence of an Unmapped Focus for Urogenital Schistosomiasis in the Tiko Health District in Cameroon: Implications for Control

Presence of an Unmapped Focus for Urogenital Schistosomiasis in the Tiko Health District in Cameroon: Implications for Control

Soil-transmitted Helminth infection in the Tiko Health District, South West Region of Cameroon: a post-intervention survey on prevalence and intensity of infection among primary school children.

IntroductionSoil-transmitted helminths (STH) infection remains a public health problem in sub-Saharan Africa with children being most vulnerable. STH infection may result in impairment, permanent disability or death. Annual mass deworming has been implemented in the Tiko Health District (THD), however, no study has assessed the current prevalence of STH infection. This study aimed to determine the prevalence, intensity of STH infections and associated risk factors among school children.MethodsTwo months after the school deworming exercise, 400 children were sampled from 10 schools in THD. Stool samples were collected and analyzed using the Kato-katz technique. Data on socio-demographic and behavioral factors were collected using questionnaires. Data were analyzed using SPSS and intensity of infection categorized following WHO recommendations. Descriptive data were calculated with frequencies (n) and proportions (%), prevalence and 95% confidence interval calculated for gender and age respectively. Differences in prevalence for socio-demographic characteristics and behavioral variables were calculated with Chi square (χ2). Independent sample t-test was used to compare the means in the number of eggs in feces between male and female school children.ResultsThe prevalence of STH was 1% (95% CI: 0.02-1.98). Ascaris lumbricoides was the only STH species detected and all cases were of low intensities. The arithmetic mean egg intensity was 3.1egg per gram of faeces. Rates of infection were similar between gender and age. Site of defecation showed an association with STH infection (χ2 = 13.63, p=0.03).ConclusionThese findings suggested a low prevalence of STH infection which could be explained by the prior deworming of children, modification in environmental and behavioral factors. Questions on effectiveness of annual mass deworming in achieving STH elimination targets need to be investigated further.

Prevention of mother-to-child transmission of the Human Immunodeficiency Virus: investigating the uptake and utilization of maternal and child health services in Tiko health district, Cameroon.

IntroductionDespite evidence that interventions to prevent mother-to-child transmission (PMTCT) of HIV are effective in ensuring a healthy child and keeping mothers alive, there are many challenges to achieving successful interventions in Cameroon. The study was conducted to investigate factors that affect access to and utilization of maternal and child health (MCH) and PMTCT services among women in Tiko health district in Cameroon.MethodsWe conducted a cross-sectional, descriptive study on women of reproductive age who had experienced a pregnancy using a self-administered, structured questionnaire, in health facilities offering PMTCT services and in communities within the district.ResultsFour hundred and thirteen women were interviewed. The majority, 98.4%, of them attended antenatal care (ANC) during their most recent pregnancy. Of these women, 87.4% of them made at least four ANC visits. HIV testing during the first visit among the ANC attendees was 85.5%. Approximately, 92.1% of women who tested for HIV received their results on the same day. All participants reported to have given birth in a health facility during their most recent pregnancy. No education (Odds Ratio [OR] 0.11; 95% CI 0.01-0.83) and acquisition of primary education (OR 0.25; 95% CI 0.06-0.88) was associated with better male partner involvement in PMTCT.ConclusionThe uptake of MCH/PMTCT services was high in this study. Further exploration of these levels is warranted so that this model of care and engagement can be replicated in other parts of the country where uptake is low.

Effects of Malaria on Iron Stores in the Pregnant Women of Buea and Tiko Health District, South West Region, Cameroon

Malaria infection has a complex effect on iron metabolism that may affect the interpretation of haemoglobin, serum ferritin, serum transferrin and serum iron. The main objective of this study was to determine the effect of malaria parasitaemia on the iron store forms of pregnant women in the Buea and Tiko health districts of the S.W Region of Cameroon. This investigation was carried out from the 3rd of August 2011 to the 30th of April 2012. The non-probabilistic sampling method was used to recruit a total of 377 pregnant women into the study. Questionnaires were used for the collection of secondary data. The microscopy method was used to detect the presence of malaria infection. A total of 41.4% (156/377) of the pregnant women were infected with Plasmodium falciparum. Of the infected cases; 32.1% had low levels of serum ferritin ( 360 mg/dl), and 45.5% had low levels of serum iron (<9.0 μmol/l). The quantitative results using regression analysis justified that 88% variation in serum ferritin, transferrin and iron were accounted for by variation in malaria parasitaemia during the second and the third trimesters. Serum iron, ferritin and transferrin measurements should be incorporated as one of the routine laboratory tests during the regular antenatal care visits.

Voluntary counseling and testing for HIV among high school students in the Tiko health district, Cameroon

Voluntary counseling and testing for HIV among high school students in the Tiko health district, Cameroon