Vaccinators' Perception of HPV Vaccination in the Saa Health District of Cameroon

Introduction: Cervical cancer is the second most prevalent cancer among women in Cameroon. In November 2020, the HPV vaccine was introduced into the expanded programme on immunisation. However, uptake of the vaccine has been slow in the Centre region as opposed to other regions in the country. We therefore sought to describe vaccinators' perception of HPV vaccination in Saa health district.Methods: A self-administered questionnaire with both open-ended and closed questions was used to assess the perception of HPV vaccination among 24 vaccinators from the Saa health district. Quantitative data were summarised as proportions while qualitative data were deductively and inductively coded and thematically analysed.Results: Most vaccinators (75%, n = 18) had a good knowledge about cervical cancer and HPV vaccination. Fourteen (58.3%, n = 14) vaccinators correctly reported the target group, number and spacing of doses for the HPV vaccine. Fourteen (58.3%) vaccinators favoured HPV vaccination while the others (n = 10) were sceptical. Sceptics felt manufacturers hadn't given enough proof of the safety of the vaccine and lacked confidence in government's assessment of the epidemiological situation. The COVID 19 pandemic, fear of infertility and the negative influence of social media were perceived as the main reasons for community hesitancy. Vaccinators criticised health authorities for failing to sensitise the population about the HPV vaccine before its introduction.Conclusion: Vaccinators' perceptions of HPV vaccination may influence the offer of HPV vaccination services. Measures to increase acceptance of HPV vaccination and ownership of the activity among vaccinators have to be put in place.

The role of process mining tools in STEMI networks: where should we build a new primary PCI centre?

Background In ST-segment elevation myocardial infarction (STEMI), time delay between symptom onset and treatment is critical to improve outcome. The expected transport delay between patient location and percutaneous coronary intervention (PCI) centre is paramount for choosing the adequate reperfusion therapy. The “Centre” region of Portugal has heterogeneity in PCI assess due to geographical reasons. Purpose We aimed to explore time delays between regions using process mining (PM) tools. Methods We retrospectively assessed the Portuguese Registry of Acute Coronary Syndromes for patients with STEMI from October 2010 to September 2019, collecting information on geographical area of symptom onset, reperfusion option, and in-hospital mortality. We used a PM toolkit (PM4H – PMApp Version) to build two models (one national and one regional) that represent the flow of patients in a healthcare system, enhancing time differences between groups. One-way analysis of variance was employed for the global comparison of study variables between groups and post hoc analysis with Bonferroni correction was used for multiple comparisons. Results Overall, 8956 patients (75% male, 48% from 51 to 70 years) were included in the national model (Fig. 1A), in which primary PCI was the treatment of choice (73%), with the median time between admission and primary PCI <120 minutes in every region; “Lisboa” and “Centro” had the longest delays, (orange arrows). Fibrinolysis was performed in 4.5%, with a median time delay <1 hour in every region. In-hospital mortality was 5%, significantly higher for those without reperfusion therapy compared to PCI and fibrinolysis (10% vs. 4% vs. 4%, P<0.001). In the regional model (Fig. 1B) corresponding to the “Centre” region of Portugal divided by districts (n=773, 74% male, 47% from 51 to 70 years), only 61% had primary PCI, with “Guarda” (05:04) and “Castelo Branco” (06:50) showing significant longer delays between diagnosis and reperfusion treatment (orange and red arrows, respectively) than “Coimbra” (01:19) (green arrow); only 15% of patients from “Castelo Branco” had primary PCI. Fibrinolysis was chosen in 10% of patients, mostly in “Castelo Branco” (53%), followed by “Guarda” (30%), with a median time delay of 39 and 48 minutes, respectively. Regarding mortality, PCI and fibrinolysis groups had similar death rates while those patients without reperfusion had higher mortality (5% vs. 3% vs. 13%, P=0.001). Conclusion Process mining tools help to understand referencing networks visually, easily highlighting inefficiencies and potential needs for improvement. The “Centre” region of Portugal has lower rates and longer delay to primary PCI partially due to the geographical reasons, with worse outcomes in remote regions. The implementation of a new PCI centre in one of these districts, is critical to offer timely first-line treatment to their population. Funding Acknowledgement Type of funding sources: None. Figure 1

The role of process mining tools in STEMI networks: where should we build a new primary PCI centre?

Background In ST-segment elevation myocardial infarction (STEMI), time delay between symptom onset and treatment is critical to improve outcome. The expected transport delay between patient location and percutaneous coronary intervention (PCI) centre is paramount for choosing the adequate reperfusion therapy. The “Centre” region of Portugal has heterogeneity in PCI assess due to geographical reasons. Purpose We aimed to explore time delays between regions using process mining (PM) tools. Methods We retrospectively assessed the Portuguese Registry of Acute Coronary Syndromes for patients with STEMI from October 2010 to September 2019, collecting information on geographical area of symptom onset, reperfusion option, and in-hospital mortality. We used a PM toolkit (PM4H – PMApp Version) to build two models (one national and one regional) that represent the flow of patients in a healthcare system, enhancing time differences between groups. One-way analysis of variance was employed for the global comparison of study variables between groups and post hoc analysis with Bonferroni correction was used for multiple comparisons. Results Overall, 8956 patients (75% male, 48% from 51 to 70 years) were included in the national model (Fig. 1A), in which primary PCI was the treatment of choice (73%), with the median time between admission and primary PCI <120 minutes in every region; “Lisboa” and “Centro” had the longest delays, (orange arrows). Fibrinolysis was performed in 4.5%, with a median time delay <1 hour in every region. In-hospital mortality was 5%, significantly higher for those without reperfusion therapy compared to PCI and fibrinolysis (10% vs. 4% vs. 4%, P<0.001). In the regional model (Fig. 1B) corresponding to the “Centre” region of Portugal divided by districts (n=773, 74% male, 47% from 51 to 70 years), only 61% had primary PCI, with “Guarda” (05:04) and “Castelo Branco” (06:50) showing significant longer delays between diagnosis and reperfusion treatment (orange and red arrows, respectively) than “Coimbra” (01:19) (green arrow); only 15% of patients from “Castelo Branco” had primary PCI. Fibrinolysis was chosen in 10% of patients, mostly in “Castelo Branco” (53%), followed by “Guarda” (30%), with a median time delay of 39 and 48 minutes, respectively. Regarding mortality, PCI and fibrinolysis groups had similar death rates while those patients without reperfusion had higher mortality (5% vs. 3% vs. 13%, P=0.001). Conclusion Process mining tools help to understand referencing networks visually, easily highlighting inefficiencies and potential needs for improvement. The “Centre” region of Portugal has lower rates and longer delay to primary PCI partially due to the geographical reasons, with worse outcomes in remote regions. The implementation of a new PCI centre in one of these districts, is critical to offer timely first-line treatment to their population. FUNDunding Acknowledgement Type of funding sources: None. Figure 1

Measuring the Technical and Scale Efficiency of Smallholder Maize (Zea mays) Farmers in Cameroon: The Case of the Centre Region

Urbanisation has led to the development of new markets, including that for cereals for human consumption, where maize cultivation has taken on an important role among smallholder producers in some countries, such as Cameroon. However, the cultivation of maize in the centre region of Cameroon raises several questions, including the efficiency of these farmers. This article presents the level and determinants of technical performance of smallholder maize farmers. The research method was based on field surveys. The study was carried out between September 2019 and December 2020 in the Centre Region of Cameroon. The research methods used included field work, field surveys through semi-structured interviews on 1060 (545 women and 515 men) maize farm managers who were selected in a reasoned method based on the file of the Ministry of Agriculture and Rural Development of Cameroon. Data from the study was analysed using Data Envelopment Analysis (DEA) method and the Tobit model allowed us to identify the determinants of the performance of these maize farms. The results show that the efficiency scores of the production and income outputs are 0.7773 and 0.6707, respectively, and provide evidence for the inefficiency of smallholder maize farmers in the Centre Region. Gender, cropping system, maize variety and number of treatments have a significant and positive influence on the productive efficiency of the farms while the only determinant that influences the income efficiency of the farmers is the maize variety used. Ultimately, smallholder maize farmers are not performing well in terms of both production and income. Value chain actors need to act on three main pillars around family farms: socio-economic characteristics (the place of women and education policy), the production system (access to quality seeds, and production techniques) and institutional factors (access to extension, financing and membership to a producer organization).

Contributing to Healthy Landscapes by Sustainable Land Use Planning

The ecological-based methodologies are determinant to develop complete strategies in restoring the ecosystems at a landscape scale. Those methodologies start with comprehending ecological processes by mapping fundamental structures of the territory (water, soil, biodiversity), also called green infrastructures. The adequate land use planning and its forthcoming implementation will guarantee a multifunctional landscape, better ecosystem services provision, and a possibility of developing new economies. The intervention of Landscape Architecture at the landscape scale will also provide information about the place and the type of restoration actions to be implemented. The Centre Region was the most affected by rural fires from 2017, representing 15% of the total region area (416 thousand hectares). These events reflect the high importance of rethinking the territory with more suitable land uses, considering the concepts of sustainability, resilience, and ecological integrity. This work proposes a Landscape Transformation Plan for the Centre Region of Portugal, applying the FIRELAN model. The results show that about 35% of the Centre Region should have restoration action towards a more sustainable landscape.

Innovations in Acheulean Biface production at la Noira (France) during Middle Pleistocene in Western Europe

The archaeological sequence of la Noira (Centre region, France) yielded two phases of occupation: ca 700 ka (stratum a) and ca 450 ka (stratum c). No site between these two dates has yet been discovered in the area, and this chronological period has thus been interpreted as a gap in settlement from MIS 16 to MIS 12, two crucial phases of occupation in Western Europe, before and after the long glacial event MIS 12 which record the onset of the Acheulean in Europe and earliest evidence of innovations from MIS 12 considered as a shift in human evolution. Here, we compare these two levels and track technological innovations during this time, combining technological analysis with geometric morphometrics with the use of 3D models comparison of the Large Cutting Tools (LCTs). Stratum a yielded an Early Acheulean, one of the few evidence in Europe presents tools with mainly short shaping sequences on local millstone slabs, with special attention to tips, but with clear management of tool volume. Stratum c, dated to the MIS 11, differs in that both local millstone and flints from distant sources show longer shaping sequences, the use of soft hammers for several series of removals on tools, combined with final regularizing retouch on entire edges. The morphometric approach shows a morphological transition from oval to teardrop shapes for the thinnest tools. Our data suggest a clear technological filiation between strata a and c and in la Noira populations from MIS 16 and MIS 12, as suggested for innovations of core technologies and land-use patterns, and raise question on local human behavioral evolution over the Middle Pleistocene in Western Europe.

Efficacy of Methanolic and Aqueous Extracts of Thevetia peruviana (pers.) K. Schum on Growth of Phytophthora colocasiae Racib, Causal Agent of Taro Late Blight in Cameroon

This study aims to evaluate the antifungal activities of methanolic and aqueous extracts of Thevetia peruviana seeds on the in vitro growth of Phytophthora colocasiae. A randomized sample block design containing four treatments (T-: absolute control, AE, ME and Callomil Plus at the dose of 12.5 μL/ml) with three repetitions was used. Plant extracts were used at three concentrations: C1: 12.5 µl/ml; C2: 25 µl/ml and C3: 50 µl/ml. The study took place in the University of Yaoundé 1, Faculty of Sciences, Department of Plant Biology, Laboratory of Phytopathology and Crop Protection, and in the Institute of Agricultural Research for Development (IARD) of Yaoundé, Laboratory of Phytopathology, during the year 2019-2020. Aqueous and methanolic extracts of T. peruviana were prepared and used at the concentrations of 12.5, 25 and 50 μL/ml. P. colocasiae was isolated from infected taro leaf cultivars "Macumba/Ibo coco" located in three different regions in Cameroon: West, Littoral and Centre. The different leaf explants of taro were put in V8 agar medium and maintained in pure culture. Mycelial fragments of P. colocasiae of about 0.8 cm in diameter were cut and placed in sterile Petri dishes containing Potato Dextrose Agar (PDA) medium supplemented with different concentrations of plant extracts and incubated at 23±1°C for seven days for the evaluation of the radial growth. Methanolic and aqueous extracts have completely inhibited the growth of West and Littoral strains at 25 μL/mL while total inhibition of the pathogen was not obtained with strain of Centre region. The lowest inhibition was obtained with the strain of Centre region (85.1%) for aqueous extract and (70.95%) for methanolic extract compare to 100% for West and Littoral region at highest concentration. The aqueous extract at the concentration of 25 μL/ml totally inhibited the in vitro radial growth of some strains of P. colocasiae. This extract, active against P. colocasiae could be used as alternative to fungicides for the control of taro leaf blight. In other hand, the strain of Littoral region was most sensible to extracts than the others. This strain could be used to provide a genetic resource for future trials in natural conditions in greenhouse and in the field.