Yaoundé, Cameroon
Yaoundé, Cameroon

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Bigna J.J.R.,Center Pasteur of Cameroon | Bigna J.J.R.,University Paris - Sud | Kenne A.M.,Center Pasteur of Cameroon | Asangbeh S.L.,Agence Nationale de Recherche sur le SIDA et les Hepatites Virales
Systematic Reviews | Year: 2017

Background: Evidence suggests a relationship between human immunodeficiency virus (HIV) infection and chronic obstructive pulmonary disease (COPD). Although the high burden of COPD and the HIV disease is clearly demonstrated, to the best of our knowledge, there is a lack of summary and meta-analysis data on the epidemiology of COPD in the global HIV-infected population to date. The present protocol for a systematic review and meta-analysis intends to summarize existing data on the prevalence, incidence, and risk factors of COPD in the global HIV-infected population. Methods and design: The present review will include cohort, cross-sectional, and case-control studies conducted among HIV infected people, which report prevalence, incidence, and factors associated with COPD or enough data for their estimation. We will consider published and unpublished studies in English and French language, regardless of geographical location. Relevant records will be searched using PubMed/Medline, and Scopus from inception to December 31st, 2016. Reference lists of eligible papers and relevant review articles will be screened. Two investigators will independently screen, select studies, and extract data, with discrepancies resolved by consensus or arbitrarily by a third investigator. Risk of bias and methodological quality of the included studies will be assessed using the Newcastle-Ottawa Scale. Funnel-plots and Egger's test will be used to determine publication bias. The study-specific estimates will be pooled through a random-effects meta-analysis model to obtain an overall summary estimate. To keep the effect of studies with extremely small or extremely large estimates on the overall estimate to a minimum, the variance of the study-specific prevalence/incidence will be stabilized with the Freeman-Tukey single arc-sine transformation. The heterogeneity will be evaluated by the χ2 test on Cochrane's Q statistic. Results will be presented by geographic region and by antiretroviral therapy status. We plan to summarize data on factors associated with COPD in narrative format. Discussion: This systematic review and meta-analysis will give an overview of the epidemiology of COPD in the global HIV population to inform policy-makers and to provide accurate data that can underpin effective interventions for optimizing their detection and management. Systematic review registration: PROSPERO CRD42016052639. © 2017 The Author(s).


PubMed | University of Yaounde I, Sangmelima Referral Hospital, Center Pasteur of Cameroon and University of Cape Town
Type: Journal Article | Journal: Annals of translational medicine | Year: 2016

Type 2 diabetes mellitus (T2DM) is a chronic metabolic disease associated with multiple macro and microvascular complications, diabetic retinopathy (DR) being the commonest one. Recent literature has reported an increased risk of DR with insulin use.We carried out a cross-sectional study at the Ophthalmology Department of the Douala General Hospital (DGH) during a 2-year period to explore the association between insulin treatment and both DR and its severity as compared with oral hypoglycemic agents (OHAs) in Cameroonian T2DM patients aged 35 years, and who were all screened for DR through eye examination including exhaustive retinal evaluation.In total, medical files of 134 T2DM patients were analyzed. The frequency of DR was 54.1% among patients on OHA and 73.9% among those on insulin treatment, giving an overall frequency of 57.5%. There were significantly more OHA treated patients than insulin treated patients (82.8% Compared with OHA, insulin therapy may be associated with DR, DR severity and DME in these T2DM sub-Saharan African patients.


PubMed | University of Yaounde I, University of Douala, Center Pasteur of Cameroon, Sangmelima Reference Hospital and University of Cape Town
Type: Journal Article | Journal: BMJ open | Year: 2016

The hypertension epidemic in Africa collectively with very low rates of blood pressure control may predict an incremented prevalence of resistant hypertension (RH) across the continent. The aim of this study was to determine the prevalence of RH and associated risk factors in Africa.We conducted a comprehensive search of electronic databases (PubMed, EMBASE, Africa Wide Information and Africa Index Medicus) completed by manual search of articles, regardless of language or publication date.We included studies which have reported the prevalence and/or risk factors for RH in Africa from inception to 19 May 2016. Forest plots were drawn to visualise the combined prevalence of RH and extent of statistical heterogeneity between studies.Out of 259 retrieved studies, only 5 from Cameroon, Nigeria, Burkina Faso, Lesotho and Algeria with a total population of 4068 patients were finally included in this review. There was no study from the Eastern part of Africa. Though the definition of RH was not similar across studies, its prevalence was respectively 11.7%, 4.9%, 14.6%, 14.3% and 19.0%, with an overall pooled prevalence of 12.1% (95% CI 8.0% to 17.7%). Potential risk factors were: non-compliance to treatment, ageing, male sex, dyslipidaemia, metabolic syndrome, previous cardiovascular events, physical inactivity and stress, but not excessive salt intake, alcohol and coffee ingestions. Moreover, diabetes, smoking, obesity and renal insufficiency yielded discrepant results.There is a huge dearth of research on the epidemiology of RH in Africa. Thereby, an extensive study of RH prevalence and risk factors is still largely warranted to curtail the high and continuously increasing burden of hypertension across Africa.


Gimou M.-M.,Center Pasteur of Cameroon | Charrondiere U.R.,Food and Agriculture Organization of the United Nations FAO | Leblanc J.-C.,Anses | Pouillot R.,7403 Wyndale Lane | And 2 more authors.
Journal of Food Composition and Analysis | Year: 2014

Twenty five minerals and trace elements were determined by flame atomic absorption spectrometry and inductively coupled plasma mass spectrometry in 64 pooled foods prepared "as consumed", representing 96.5% of the total diet in Yaoundé, Cameroon. High element contents (in mgkg-1) of some food samples are highlighted. "Dried spices for local sauce" (raw/toasted) highly contained calcium (7720), iron (143), magnesium (1970), potassium (20,100), copper (12.6), manganese (109), aluminium (120), and lead (14.3). "Dried and smoked fish and shrimps" (boiled) contained high levels of calcium (21,200), potassium (7300), zinc (43.6), aluminium (27.8), and arsenic (1.14). "Garden huckleberry and amaranth" (boiled/washed fresh leaves) contained high levels of calcium (3580), manganese (15.9) and barium (19.4). "Squash beans and sesame" (boiled) provided magnesium (1240), and zinc (29.5). "Shelled groundnut" (soaked/grilled/boiled) contained high levels of magnesium (1040), zinc (31.5), and copper (8.32). Selenium was found only in fish as mackerel (0.467) and sea bass (0.450). No food product exceeded the maximum levels set for lead, mercury and cadmium by the current European regulation. These results will be used for dietary exposure and health risk assessment. © 2014.


Gimou M.-M.,Center Pasteur of Cameroon | Pouillot R.,Chevy Chase | Charrondiere U.R.,Food and Agriculture Organization Nutrition Division | Noel L.,University Paris Est Creteil | And 2 more authors.
Food Additives and Contaminants - Part A Chemistry, Analysis, Control, Exposure and Risk Assessment | Year: 2014

Dietary exposure to trace elements (aluminium, antimony, barium, cadmium, lead, nickel, vanadium, copper, manganese, molybdenum, germanium, lithium, strontium and tellurium) was assessed by the total diet study (TDS) method. Sixty-four pooled samples representing 96.5% of the diet in Yaoundé, Cameroon, were prepared "as consumed" before analysis. Consumption data were sourced from a households' budget survey. Dietary exposures were compared with health-based guidance or nutritional values and to worldwide TDS results. The health-based guidance value was exceeded by ≤ 0.2% of the study population for aluminium, antimony, barium, cadmium, nickel and vanadium. For lead, the observed 95th percentile of exposure (3.05 μg kg-1 body weight day-1) equals the critical value considered by JECFA for cardiovascular effects; therefore, risk to health cannot be excluded for certain consumer groups. The population at risk of excess intake for manganese, copper, molybdenum and nickel was considered to be low (≤ 0.3%). The prevalence of inadequate intake was estimated at 5.9% for copper and was nil for molybdenum. Due to the lack of toxicological and/or nutritional consistent data to perform a risk assessment, dietary exposures to germanium, lithium, strontium and tellurium were provided as supplementary data. The food groups highest contributors to exposure were "tubers and starches" for aluminium (27%), lead (39%) and copper (26%), "cereals and cereal products" for cadmium (54%) and manganese (35%), "fruits, vegetables and oilseeds" for barium (34%), molybdenum (49%) and nickel (31%), "beverages" for antimony (27%) and "fish" for vanadium (43% - lower bound). Measures should be recommended to maintain low levels of exposure before the problem could become an important health or trade issue. © 2014 © 2014 Taylor & Francis.


PubMed | University of Yaounde I, Center Pasteur of Cameroon, Harvard University and University of Cape Town
Type: Journal Article | Journal: BMJ open | Year: 2016

With the new test and treat policy of the WHO, it is obvious that the number of HIV-infected patients taking antiretroviral therapy (ART) will grow exponentially, with consequential increase in the burden of diabetes mellitus (DM). Our aim is to summarise existing data on the incidence of pre-diabetes and DM, and associated risk factors among HIV-infected adults.This systematic review will include cohort studies reporting the incidence of pre-diabetes and/or DM, and associated risk factors among HIV-infected adults on ART, with these patients being free of any impaired glucose metabolism at study baseline. We will perform electronic searches in PubMed, Excerpta Medica Database (EMBASE), Web of Science and WHO Global Health Library, supplemented with manual searches. Articles published from 1 January 2000 to 31 July 2016, in English or French languages, and without any geographical restriction will be eligible for inclusion. 3 authors will independently screen, select studies, extract data and assess the risk of bias with discrepancies resolved by consensus. We will assess clinical heterogeneity by examining the study design and setting, criteria and cut-offs used to define pre-diabetes or DM, process of calculation of incidence and outcomes in each study. We will also assess statistical heterogeneity using the (2) test of homogeneity and quantify it using the I(2) statistic. A random effects meta-analysis will be used to estimate the overall cumulative incidence of pre-diabetes/DM and risk factors.This systematic review will use data from published studies and does not require ethics approval. Its results are expected to help putting in place action plans and preventive measures to curb the growing burden of DM in the HIV population on ART. Findings will be published in a peer-reviewed journal and presented at scientific conferences.CRD42016039651.


Gimou M.-M.,Center Pasteur of Cameroon | Charrondiere U.R.,Food and Agriculture Organization FAO of the United Nations Nutrition Division | Leblanc J.-C.,ANSES | Noel L.,Environmental Inorganic Contaminants and Mineral Unit | And 2 more authors.
Food Additives and Contaminants - Part A Chemistry, Analysis, Control, Exposure and Risk Assessment | Year: 2013

Dietary exposure to 11 elements was assessed by the Total Diet Study (TDS) method. Sixty-four pooled samples representing 96.5% of the diet in Yaoundé, Cameroon, were prepared as consumed before analysis. Consumption data were sourced from a household budget survey. Dietary exposures were compared with nutritional or health-based guidance values (HBGV) and to worldwide TDS results. Elevated prevalence of inadequate intake was estimated for calcium (71.6%), iron (89.7%), magnesium (31.8%), zinc (46.9%) and selenium (87.3%). The percentage of the study population exceeding the tolerable upper intake levels was estimated as <3.2% for calcium, iron, magnesium, zinc and cobalt; 19.1% of the population exceeded the HBGV for sodium. No exceedance of the HBGV for inorganic mercury was predicted in the population. The margin of exposure ranged from 0.91 to 25.0 for inorganic arsenic depending on the reference point. The "Fish" food group was the highest contributor to intake for calcium (65%), cobalt (32%) and selenium (96%). This group was the highest contributor to the exposure to total arsenic (71%) and organic mercury (96%). The "Cereals and cereal products" highly contributed to iron (26%), zinc (26%) and chromium (25%) intakes. The "Tubers and starches" highly contributed to magnesium (39%) and potassium (52%) intakes. This study highlights the dietary deficiency of some essential elements and a low dietary exposure to toxic elements in Yaoundé. © 2013 Taylor & Francis.


Bigna J.J.R.,Center Pasteur of Cameroon | Bigna J.J.R.,University of Bordeaux 1
African Health Sciences | Year: 2016

The World Health Organization aims to eradicate wild poliovirus worldwide by the end of 2018. Cameroon and Nigeria, neighboring countries, have been affected by the terrorist and militant activities of the Islamist sect Boko Haram. Impacted regions are mainly the far North of Cameroon and Northern Nigeria. Targets of Boko Haram aggression in these zones include violence against polio workers, disruption of polio immunization campaigns, with consequent reduced access to health care and immunization. In addition to this significant problem, Northern Nigeria has historically seen rejection of polio virus vaccine initiatives. It remains to know how health systems can continue operations against polio in areas where Boko Haram operates. If appropriate measures are not urgently taken, it will be not possible to meet the 2018 goal of polio virus eradication. The response should include specialized immunization activities in conflict zones, will engagement of leaders. Countries should also explore immunization activities by soldiers and military personnel. © 2016, Makerere University, Medical School. All rights reserved.


Journal abstracts including those reporting systematic reviews (SR) should contain sufficiently clear and accurate information for adequate comprehension and interpretation. The aim was to compare the quality of reporting of abstracts of SRs including meta-analysis published in high-impact general medicine journals before and after publication of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for abstracts (PRISMA-A) released in April 2013.SRs including meta-analysis of randomized controlled trials published in 2012, 2014, and 2015 in top-tier general medicine journals were searched in PubMed. Data was selected and extracted by two reviewers based on the PRISMA-A guidelines which recommend to include 12 items. The primary outcome was the adjusted mean number of items reported; the secondary outcome was the reporting of each item and factors associated with a better reporting. Adjustment was made for abstract word count and format, number of authors, PRISMA endorsement, and publication on behalf of a group.We included 84 abstracts from 2012, 59 from 2014, and 61 from 2015. The mean number of items reported in 2015 (7.5; standard deviation [SD] 1.6) and in 2014 (6.8; SD 1.6) differed and did not differ from that reported in 2012 (7.2; SD 1.7), respectively; adjusted mean difference: 0.9 (95 % CI 0.4; 1.3) and-0.1 (95 % CI -0.6; 0.4). From 2012 to 2014, the quality of reporting was in regression for strengths and limitations of evidence and funding; contrariwise, it remained unchanged for the others items. Between 2012 and 2015, the quality of reporting rose up for description of the effect, synthesis of results, interpretation, and registration; but decreased for strengths and limitations of evidence; it remained unchanged for the other items. The overall better reporting was associated with abstracts structured in the 8-headings format in 2014 and abstracts with a word count <300 in 2014 and 2015.Not surprisingly, the quality of reporting did not improve in 2014 and suboptimally improved in 2015. There is still room for improvement to meet the standards of PRISMA-A guidelines. Stricter adherence to these guidelines by authors, reviewers, and journal editors is highly warranted and will surely contribute to a better reporting.


PubMed | University of Yaounde I, Center Pasteur of Cameroon and New York University
Type: Editorial | Journal: Infectious diseases of poverty | Year: 2016

Recently published large randomized controlled trials, START, TEMPRANO and HPTN 052 show the clinical benefit of early initiation of antiretroviral treatment (ART) in HIV-infected persons and in reducing HIV transmission. The trials influenced the World Health Organization (WHO) decision to issue updated recommendations to prescribe ART to all individuals living with HIV, irrespective of age and CD4 cell count.It is clear that the new 2015 WHO recommendations if followed, will change the face of the HIV epidemic and probably curb its burden over time. Implementation however, requires that health systems, especially those in low and middle-income settings, be ready to face this challenge on a large scale. HIV prevention and treatment are easy in theory yet hard in practice. The new WHO guidelines for initiation of ART regardless of CD4 cell count will lead to upfront increases in the costs of healthcare delivery as the goal is to treat all those now newly eligible for ART. Around 22 million people living with HIV qualify and will therefore require ART. Related challenges immediately follow: firstly, that everyone must be tested for HIV; secondly, that anyone who has had an HIV test should know their result and understand its significance; and, thirdly, that every person identified as HIV-positive should receive and remain on ART. The emergence of HIV drug resistant strains when treatment is started at higher CD4 cell count thresholds is a further concern as persons on HIV treatment for longer periods of time are at increased risk of intermittent medication adherence.The new WHO recommendations for ART are welcome, but lacking as they fail to consider meaningful solutions to the challenges inherent to implementation. They fail to incorporate actual strategies on how to disseminate and adopt these far-reaching guidelines, especially in sub-Saharan Africa, an area with weak healthcare infrastructures. Well-designed, high-quality research is needed to assess the feasibility, safety, acceptability, impact, and cost of innovations such as the universal voluntary testing and immediate treatment approaches, and broad consultation must address community, human rights, ethical, and political concerns.

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