Cameroon Baptist Convention Health Services

Bamenda, Cameroon

Cameroon Baptist Convention Health Services

Bamenda, Cameroon
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Kalua T.,Malawi Ministry of Health HIV | Barr B.A.T.,Centers for Disease Control and Prevention | Van Oosterhout J.J.,Dignitas International | Van Oosterhout J.J.,University of Malawi | And 13 more authors.
Journal of Acquired Immune Deficiency Syndromes | Year: 2017

The acceleration of prevention of mother-to-child transmission (PMTCT) activities, coupled with the rollout of 2010 World Health Organization (WHO) guidelines, led to important discussions and innovations at global and country levels. One paradigm-shifting innovation was Option B+ in Malawi. It was later included in WHO guidelines and eventually adopted by all 22 Global Plan priority countries. This article presents Malawi's experience with designing and implementing Option B+ and provides complementary narratives from Cameroon and Tanzania. Malawi's HIV program started in 2002, but by 2009, the PMTCT program was lagging far behind the antiretroviral therapy (ART) program because of numerous health system challenges. When WHO recommended Option A and Option B for PMTCT in 2010, it was clear that Malawi's HIV program would not be able to successfully implement either option without increasing existing barriers to PMTCT services and potentially decreasing women's access to care. Subsequent stakeholder discussions led to the development of Option B+. Operationalizing Option B+ required several critical considerations, including the complete integration of ART and PMTCT programs, systematic reduction of barriers to facilitate doubling the number of ART sites in less than a year, building consensus with stakeholders, and securing additional resources for the new program. During the planning and implementation process, several lessons were learned which are considerations for countries transitioning to "treat-all": Comprehensive change requires effective government leadership and coordination; national clinical guidelines must accommodate health system limitations; ART services and commodities should be decentralized within facilities; the general public should be well informed about major changes in the national HIV program; and patients should be educated on clinic processes to improve program monitoring. © 2017 Wolters Kluwer Health, Inc. All rights reserved.

PubMed | Health Services Cluster, Community of S.Egidio DREAM program, Ministry of Health, British Petroleum and 7 more.
Type: Journal Article | Journal: International journal of environmental research and public health | Year: 2015

The Drug Resource Enhancement against AIDS and Malnutrition Program (DREAM) gathered professionals in the field of Elimination of HIV-Mother-To-Child Transmission (EMTCT) in Maputo in 2013 to discuss obstacles and solutions for the elimination of HIV vertical transmission in sub-Saharan Africa. During this workshop, the benefits of administrating combined antiretroviral therapy (cART) to HIV positive women from pregnancy throughout breastfeeding were reviewed. cART is capable of reducing vertical transmission to less than 5% at 24 months of age, as well as maternal mortality and infant mortality in both HIV infected and exposed populations to levels similar to those of uninfected individuals. The challenge for programs targeting eMTCT in developing countries is retention in care and treatment adherence. Both are intrinsically related to the model of care. The drop-out from eMTCT programs before cART initiation ranges from 33%-88% while retention rates at 18-24 months are less than 50%. Comprehensive strategies including peer-to-peer education, social support and laboratory monitoring can reduce refusals to less than 5% and attain retention rates approaching 90%. Several components of the model of care for reduction of HIV-1 MTCT are feasible and implementable in scale-up strategies. A review of this model of care for HIV eMTCT is provided.

PubMed | Levine Childrens Hospital, Mount Sinai School of Medicine, Cameroon Baptist Convention Health Services and New York Medical College
Type: | Journal: SAGE open medicine | Year: 2016

Young women are more likely to be infected with HIV globally, in sub-Saharan Africa, and in Cameroon. Despite its clear clinical and public health benefits, condom use among HIV-infected women continues to be low. The objective of this study was to describe the prevalence of inconsistent condom use among HIV-infected women in Cameroon and the factors associated with it.We conducted a cross-sectional study of HIV-infected young women aged 17-26years from three semi-urban HIV clinics in the Northwest Region of Cameroon. This study was a subgroup analysis of a previously reported study on inconsistent condom use in HIV-infected and -uninfected youth. Inconsistent condom use was defined as reporting sometimes or never to questions regarding frequency of condom use. Logistic regression modeling was used to determine factors associated with inconsistent condom use.A total of 84 participants were recruited and submitted completed questionnaires for analysis. Median age was 24years (interquartile range=22-25) and the median age at HIV diagnosis was 21years (interquartile range=20-23). Fiftypercent of the participants reported no prior schooling or only primary school education. Overall, 61/84 (73%) reported inconsistent condom use. After adjusting for potential confounders, education to the secondary school level was protective against inconsistent condom use (odds ratio=0.19; confidence interval: 0.04-0.95), and having 2 pregnancies was associated with inconsistent condom use (odds ratio=7.52; confidence interval: 1.67-34.00).There is a high prevalence of inconsistent condom use among young HIV-infected women in Cameroon, which appears to be associated with lower levels of educational attainment and higher parity. Further larger studies assessing the factors associated with poor condom use in this population are warranted and may inform public health policy in resource-limited settings with high HIV prevalence.

Henley C.,Policy and Research Group | Forgwei G.,Baptist Center | Welty T.,Cameroon Baptist Convention Health Services | Golden M.,University of Washington | And 3 more authors.
Sexually Transmitted Diseases | Year: 2013

BACKGROUND: Partner services (PSs) are a long-standing component of HIV control programs in the United States and some parts of Europe. Small randomized trials suggest that HIV PS can be effective in identifying persons with undiagnosed HIV infection. However, the scalability and effectiveness of HIV PS in low-income countries are unknown. METHODS: We used data collected from 2009 to 2010 through a large HIV PS program in Cameroon to evaluate HIV PS in a developing country. HIV-positive index cases diagnosed in antenatal care, voluntary counseling and testing, and inpatient facilities were interviewed to collect information on their sexual partners. Partners were contacted via telephone or home visit to notify, test, and enroll those found to be HIV positive in medical care. RESULTS: Health advisors interviewed 1462 persons with HIV infection during the evaluation period; these persons provided information about 1607 sexual partners. Health advisors notified 1347 (83.8%) of these partners, of whom 900 (66.8%) were HIV tested. Of partners tested, 451 (50.1%) were HIV positive, of whom 386 (85.6%) enrolled into HIV medical care. An average 3.2 index cases needed to be interviewed to identify 1 HIV case. CONCLUSIONS: HIV PS can be successfully implemented in a developing country and is highly effective in identifying persons with HIV infection and linking them to care. Copyright © 2013 American Sexually Transmitted Diseases Association. All rights reserved.

Perlman S.,Pathfinder International | Wamai R.G.,Northeastern University | Bain P.A.,Harvard University | Welty T.,Cameroon Baptist Convention Health Services | And 2 more authors.
PLoS ONE | Year: 2014

Objectives: We assessed the knowledge and awareness of cervical cancer, HPV and HPV vaccine, and willingness and acceptability to vaccinate in sub-Saharan African (SSA) countries. We further identified countries that fulfill the two GAVI Alliance eligibility criteria to support nationwide HPV vaccination. Methods: We conducted a systematic review of peer-reviewed studies on the knowledge and awareness of cervical cancer, HPV and HPV vaccine, and willingness and acceptability to vaccinate. Trends in Diphtheria-tetanus-pertussis (DTP3) vaccine coverage in SSA countries from 1990-2011 were extracted from the World Health Organization database. Findings: The review revealed high levels of willingness and acceptability of HPV vaccine but low levels of knowledge and awareness of cervical cancer, HPV or HPV vaccine. We identified only six countries to have met the two GAVI Alliance requirements for supporting introduction of HPV vaccine: 1) the ability to deliver multi-dose vaccines for no less than 50% of the target vaccination cohort in an average size district, and 2) achieving over 70% coverage of DTP3 vaccine nationally. From 2008 through 2011 all SSA countries, with the exception of Mauritania and Nigeria, have reached or maintained DTP3 coverage at 70% or above. Conclusion: There is an urgent need for more education to inform the public about HPV, HPV vaccine, and cervical cancer, particularly to key demographics, (adolescents, parents and healthcare professionals), to leverage high levels of willingness and acceptability of HPV vaccine towards successful implementation of HPV vaccination programs. There is unpreparedness in most SSA countries to roll out national HPV vaccination as per the GAVI Alliance eligibility criteria for supporting introduction of the vaccine. In countries that have met 70% DTP3 coverage, pilot programs need to be rolled out to identify the best practice and strategies for delivering HPV vaccines to adolescents and also to qualify for GAVI Alliance support. © 2014 Perlman et al.

Ogembo J.G.,University of Massachusetts Medical School | Manga S.,Cameroon Baptist Convention Health Services | Nulah K.,Cameroon Baptist Convention Health Services | Foglabenchi L.H.,Cameroon Baptist Convention Health Services | And 5 more authors.
Vaccine | Year: 2014

Background: Cameroon has the highest age-standardized incidence rate of cervical cancer (30/100,000 women) in Central Africa. In 2010-2011, the Cameroon Baptist Convention Health Services (CBCHS) received donated human papillomavirus (HPV) vaccine, Gardasil, from Merck & Co. Inc. through Axios Healthcare Development to immunize 6400 girls aged 9-13 years. The aim was to inform the Cameroon Ministry of Health (MOH) of the acceptability, feasibility, and optimal delivery strategies for HPV vaccine. Methods and findings: Following approval by the MOH, CBCHS nurses educated girls, parents, and communities about HPV, cervical cancer, and HPV vaccine through multimedia coverage, brochures, posters, and presentations. Because educators were initially reluctant to allow immunization in schools, due to fear of adverse events, the nurses performed 40.7% of vaccinations in the clinics, 34.5% in community venues, and only 24.7% in schools. When no adverse events were reported, more schools and communities permitted HPV vaccine immunization on their premises. To recover administrative costs, CBCHS charged a fee of US$8 per 3-dose series only to those who were able to pay. Despite the fee, 84.6% of the 6,851 girls who received the first dose received all three doses. Conclusions and lessons learned: With adequate education of all stakeholders, HPV vaccination is acceptable and feasible in Cameroon. Following this demonstration project, in 2014 the Global Access to Vaccines and Immunization (GAVI) Alliance awarded the Cameroon MOH HPV vaccine at a price of US$4.50 per dose to immunize sixth grade girls and girls aged 10 years who are not in school in two districts of Cameroon. © 2014 Elsevier Ltd.

PubMed | Yaounde Gyneco Obstetrics and Pediatric Hospital, Northeastern University, Boston University, Cameroon Baptist Convention Health Services and 3 more.
Type: Journal Article | Journal: PloS one | Year: 2016

In 2007, the Cameroon Baptist Convention Health Services (CBCHS) implemented a screen-and-treat cervical cancer prevention program using visual inspection with acetic acid enhanced by digital cervicography (VIA-DC).We retrospectively analyzed 46,048 medical records of women who received care through the CBCHS Womens Health Program from 2007 through 2014 to determine the prevalence and predictors of positive VIA-DC, rates of same day treatment, and cohort prevalence of invasive cervical cancer (ICC).Of the 44,979 women who were screened for cervical cancer, 9.0% were VIA-DC-positive, 66.8% were VIA-DC-negative, 22.0% were VIA-DC-inadequate (normal ectocervix, but portions of the transformation zone were obscured), and 2.2% were VIA-DC-uncertain (cervical abnormalities confounding VIA-DC interpretation). Risk factors significantly associated with VIA-DC-positive screen were HIV-positivity, young age at sexual debut, higher lifetime number of sexual partners, low education status and higher gravidity. In 2014, 31.1% of women eligible for cryotherapy underwent same day treatment. Among the 32,788 women screened from 2007 through 2013, 201 cases of ICC were identified corresponding to a cohort prevalence of 613 per 100,000.High rate of VIA-DC-positive screens suggests a significant burden of potential cervical cancer cases and highlights the need for expansion of cervical cancer screening and prevention throughout the 10 regions of Cameroon. VIA-DC-inadequate rates were also high, especially in older women, and additional screening methods are needed to confirm whether these results are truly negative. In comparison to similar screening programs in sub-Saharan Africa there was low utilization of same day cryotherapy treatment. Further studies are required to characterize possible program specific barriers to treatment, for example cultural demands, health system challenges and cost of procedure. The prevalence of ICC among women who presented for screening was high and requires further investigation.

PubMed | University of Douala, Cameroon Baptist Convention Health Services, University of Venda and University of Buea
Type: Journal Article | Journal: BMC infectious diseases | Year: 2016

Malaria is one of the leading causes of morbidity and mortality in children and HIV infection as well as other factors may worsen the situation. This study was aimed at determining the factors influencing malaria parasite prevalence and density as well as anaemia in HIV-infected children in Mutengene, Cameroon from November, 2012 to April, 2013.A semi-structured questionnaire was used to record information on socio-demographic factors and use of preventive measures by caregivers of HIV-infected children aged 1-15 years and of both sexes. Venous blood was collected; blood films were prepared and Giemsa-stained for parasite detection and speciation. Haemoglobin concentration was measured and the anaemic status determined. Data was analysed using Epi Info 7 software.A total of 234 children were studied. The overall malaria parasite prevalence was 24.8% (58) and was significantly higher (31.9%, P=0 .004) in females, those who did not implement any preventive measure at all (66.7%, P=0.03) and children who used antiretroviral therapy (ART) (28.6%, P=0.02) when compared with their respective counterparts. Geometric mean parasite density (GMPD) was significantly higher (3098.4, P=0.02) in children who presented with fever, had CD4 T cells 500 cells/L (491.3, P=0.003) and those with moderate anaemia (1658.8, P=0.03) than their respective counterparts. Although there was no significant difference, GMPD was however higher in males (549.0); those not on ART (635.0) and highest in children <5years old (633.0) than their respective counterparts. The overall prevalence of anaemia was 49.6% (116). The value was significantly highest (58.3%, P=0.01) in the 11-15 years age group; those with CD4 T cell level 200-499 (72.7%, P=0.001) and children with fever (85.7%, P=0.01).Implementation of proper and integrated malaria preventive measures as well as frequent monitoring of anaemia on prescription of ART could likely improve the health conditions of HIV-infected children thus avoiding malaria-related morbidity and mortality.

PubMed | Mount Sinai School of Medicine and Cameroon Baptist Convention Health Services
Type: Journal Article | Journal: Diabetes/metabolism research and reviews | Year: 2016

Human immunodeficiency virus (HIV) and certain antiretrovirals are associated with diabetes. Few studies have examined the prevalence of and factors associated with diabetes among HIV-infected individuals on combination antiretroviral therapy (cART) in sub-Saharan Africa; some report prevalence estimates between 3.5-26.5% for diabetes in Cameroon and 20.2-43.5% for prediabetes in sub-Saharan Africa.In a cross-sectional study, HIV-infected individuals (16-65years old) were screened for diabetes using haemoglobin A1c (HbA1c ). We further categorized HbA1C as normoglycemia (HbA1c <5.7%), prediabetes (HbA1c 5.7-6.4%) or diabetes (HbA1c 6.5%). Dysglycemia was defined as HbA1c 5.7%. Logistic regression modelling was used to assess factors associated with having dysglycemia.Of 500 participants, 363 (72.6%) were female. Median age was 42.5years [interquartile range (IQR): 36.5-49.5]. Nineteen patients (3.8%) had diabetes and 170 patients (34%) were classified as having prediabetes. One hundred nine (22%) had a CD4+ count <200cells/mm(3) , and 464 (93%) had received >28days of ART at time of screening. Median abdominal circumference for women was 79.5cm (IQR: 75.5-85.3) and for men, 86.5cm (IQR: 81.7-90.5). Adjusting for age, sex, socio-economic status, CD4 cell count, being on cART >28days, body mass index, hypertension, history of hypertension, abdominal circumference and duration of HIV infection, larger abdominal circumference was associated with higher prevalence of prediabetes or diabetes (adjusted odds ratio=1.07, 95% confidence interval: 1.03-1.11), while being on cART (adjusted odds ratio=0.46, confidence interval: 0.22-0.99) was associated with lower prevalence.There was a high prevalence of dysglycemia among Cameroonian HIV-infected adults. Larger abdominal circumference was associated with higher prevalence, while cART was associated with lower prevalence. Copyright 2016 John Wiley & Sons, Ltd.

PubMed | Cameroon Baptist Convention Health Services
Type: Journal Article | Journal: BMC health services research | Year: 2016

Despite the recent international focus on maternal and child nutrition, little attention is paid to nutrition capacity development. Although infant feeding counselling by health workers increases caregivers knowledge, and improves breastfeeding, complementary feeding, and childrens linear growth, most of the counselling in sub-Saharan Africa is primarily conducted by nurses or volunteers, and little is done to develop capacity for nutrition at the professional, organizational, or systemic levels. The Cameroon Baptist Convention Health Services Nutrition Improvement Program (NIP) has integrated a cadre of nutrition counselors into prevention of mother-to-child transmission of HIV programs, infant welfare clinics, and antenatal clinics to improve infant and young child feeding practices (IYCF). The study objective was to evaluate the effects of NIPs infant feeding counselors on exclusive breastfeeding (EBF), complementary feeding (CF), and childrens linear growth.A cross-sectional evaluation design was used. Using systematic random sampling, caregivers were recruited from NIP sites (n=359) and non-NIP sites (n=415) from Infant Welfare Clinics (IWCs) in the Northwest (NWR) and Southwest Regions (SWR) of Cameroon between October 2014 and April 2015. Differences in EBF and CF practices and childrens linear growth between NIP and non-NIP sites were determined using chi-square and multiple logistic regression.After adjusting for differences in religion, occupation, and number of months planning to breastfeed, children were almost seven times (Odds Ratio [OR]: 6.9; 95% Confidence Interval [CI]: 2.30, 21.09; =1.94) more likely to be exclusively breastfed at NIP sites compared to non-NIP sites. After adjusting for differences in occupation, religion, number of months planning to breastfeed, rural environment, economic status, attending other Infant Welfare Clinics, and non-biological caregiver, children were five times (OR: 5.5; CI: 3.37, 9.02; =1.71) more likely to be stunted at non-NIP sites compared to non-NIP sites.Training a cadre of nutrition counselors is one approach towards increasing nutrition human resources to implement nutrition interventions to improve maternal and child nutrition. In this research project, the study design did not allow for conclusive results, but rather suggest IYCF counseling provided by nutrition counselors was effective in increasing EBF and reduced the risk of stunting in children 6-8 months.

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