Vaccination against tuberculosis, polio and hepatitis B at birth in Podor health district, Northern Senegal: cross-sectional study of vaccination coverage and its associated factors

Background In Senegal, studies focusing specifically on vaccination coverage with the Bacille de Calmette et Guérin (BCG) vaccine, the birth dose of oral polio vaccine (OPV zero dose) and the birth dose of hepatitis B (HepB-BD) vaccine are insufficient. This study aimed to highlight vaccination coverages with birth doses and factors associated with timely vaccination in Podor health district. Methods A cross-sectional study was carried out from June 19 to 22, 2020. The study population consisted of children aged 12 to 23 months of which 832 were included. A stratified two-stage cluster survey was carried out. The sources of data were home-based records (HBR), health facility registries (HFR) and parental recalls. Timely vaccination refers to any vaccination that has taken place within 24 h after birth. Descriptive analyzes, the chi-square test and logistic regression were performed. Results The crude vaccination coverages with BCG, OPV zero dose and HepB-BD were 95.2%, 88.3% and 88.1%, respectively. Vaccination coverages within 24 h after birth were estimated at 13.9%, 30% and 42.1%, respectively. The factors associated with timely HepB-BD are delivery in a health facility (AOR = 1.55; 95% CI = 1.02–2.40), access to television (AOR = 1.63; 95% CI = 1.16–2.29), weighing (AOR = 3.92; 95% CI = 1.97–8.53) and hospitalization of the newborn immediately after birth (AOR = 0.42; 95% CI = 0.28–0.62). Conclusion Timely administration of birth doses is a challenge in the Podor health district. The solutions would be improving geographic access to health facilities, involving community health workers, raising awareness and integrating health services.

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.

Vaccination dropout rates among children aged 12-23 months in Democratic Republic of the Congo: a cross-sectional study

Background Overall, 1.8 million children fail to receive the 3-dose series for diphtheria, tetanus and pertussis each year in the Democratic Republic of the Congo (DRC). Currently, an emergency plan targeting 9 provinces including Kinshasa, the capital of the DRC, is launched to reinforce routine immunization. Mont Ngafula II was the only health district that experienced high vaccination dropout rates for nearly five consecutive years. This study aimed to identify factors predicting high immunization dropout rates among children aged 12-23 months in the Mont Ngafula II health district. Methods A cross-sectional household survey was conducted among 418 children in June-July 2019 using a two-stage sampling design. Socio-demographic and perception data were collected through a structured interviewer-administered questionnaire. The distribution of 2017-2018 immunization coverage and dropout rate was extracted from the local health district authority and mapped. Logistic random effects regression models were used to identify predictors of high vaccination dropout rates. Results Of the 14 health areas in the Mont Ngafula II health district, four reported high vaccine coverage, only one recorded low vaccine coverage, and three reported both low vaccine coverage and high dropout rate. In the final multivariate logistic random effects regression model, the predictors of immunization dropout among children aged 12-23 months were: living in rural areas, unavailability of seats, non-compliance with the order of arrival during vaccination in health facilities, and lack of a reminder system on days before the scheduled vaccination. Conclusions Our results advocate for prioritizing targeted interventions and programs to strengthen interpersonal communication between immunization service providers and users during vaccination in health facilities and to implement an SMS reminder system on days before the scheduled vaccination.

Assessment of Knowledge and Attitude Regarding Risk Factors of Malaria Among Caregivers of Under-Five Children in the Buea Health District, South West Region, Cameroon

Aims: The study measured the level of knowledge and attitudes towards malaria and examined associated factors among caregivers of under-five children. Study Design: The study was community-based, descriptive cross-sectional. Place and Duration of Study: The study was carried out in Buea Health District (BHD) from February to June 2020. Methodology: Data were obtained through face-to-face interviews with the caregivers of under-fives. The above mean scores were used to determine the level of knowledge. The attitude levels were measured by using 3-point Likert scales. Univariate and multivariate logistic regression analyses were performed to identify risk factors associated with knowledge and attitude. SPSS software version 20.0 was used for analysis. Results: Out of the 390 respondents, 69.5% of them had a neutral attitude. Meanwhile, 27.7 % of participants carried a favorable attitude towards malaria and only 2.8 % of them had an unfavorable attitude, Caregivers of under-five children who scored below the mean score were 25.1 % which was considered having poor knowledge and above the mean score was 74.9% which was considered good knowledge. In the multivariable logistic analysis, caregivers with a primary school level of education were 4.1 times (AOR = 4.1, CI = 1.486-11.102) times more likely of receiving a high malaria knowledge score as compared to those with no formal education. Factors associated with caregiver's attitude level towards malaria risk were educational level and marital status which showed significant associations in the univariate analysis Conclusion: Caregivers of under-fives displayed a good knowledge of malaria risk factors. However, in these endemic areas for malaria, caregiver attitude was found to be unenthusiastic and unresponsive, and this poses additional challenges in reaching the malaria elimination goal. Thus, suggesting that educational messages during the campaign should be contextual to reach out to local communities to trigger a positive behavioural change.

Prevalence of Malaria and the Use of Long-lasting Insecticide Treated Bed Nets in Households of Rural and Semi-urban Communities in Mbengwi Health District, North West Region, Cameroon

Aims: In Cameroon, on August 2011 and October 2015 the Ministry of Public Health launched the national campaign for distribution of long-lasting insecticide-treated bed nets (LLINs) to all families as a means of effectively fighting malaria transmission. The study area Mbengwi Health District found in the North West Region of Cameroon benefitted from this distribution of LLINs, but the impact of this intervention has not been evaluated. This study was designed to assess the use of LLINs in selected households of rural and semi-urban communities in Mbengwi Health District. Study Design: A cross sectional study was conducted in households, between July 2017 to September 2017 in Mbengwi health district. Methodology: Two questionnaires were administered; one to the household head and the other to the occupants. Blood samples were obtained to diagnose and quantify malaria parasite and to determine hemoglobin concentrations (HB). A total of 93 households and 440 inhabitants of all sexes and age groups were surveyed. Results: Of the 440 participants, 49 were positive for malaria parasite giving an overall prevalence of 11.1%. From the questionnaires it was observed that 87 (93.5%) of the households owned LLINs, with up to 82 (94.3%) sleeping under the nets. All the owners of LLINs (87; 100%) obtained the nets from the government free of charge. There was no significant difference in bed-net ownership (p=0.978) and usage (p=0.664) between the rural and semi-urban communities. Malaria prevalence was significantly lower among users of LLINs (4.8%) than non-users (23.5%, p<0.001). Malaria parasite density negatively correlated significantly with HB (r= -0.097, p=0.041). Conclusion: Overall, there was a high degree ownership and usage of LLINs by households in both rural and semi-urban communities, which was associated with protection from malaria infection.

Personalised Cardiac Rehabilitation Outreach Service Reduces Mortality and Hospitalisations in Heart Failure with Reduced Ejection Fraction

BackgroundHeart failure (HF) has become a major cause of morbidity and mortality worldwide. Despite significant improvements in the management of HF, the overall outcomes remain poor. In addition to pharmacotherapy and device therapy, non-pharmacological interventions are needed to mitigate the effects of this illness. The aim of this study was to evaluate the impact of the heart failure outreach program on the rate of mortality, HF hospitalisations and guideline directed medical therapy (GDMT) for HF in South Western Sydney Local Health District (SWSLHD).MethodsIn this observational, registry based study, adult patients diagnosed with Heart failure with reduced ejection fraction (HFrEF) within the South Western Sydney Local Health District (SWSLHD) and invited to participate in the heart failure outreach service between March 2011 and January 2016 were included in the study. The primary outcome was all-cause mortality. In addition, we examined the rate of optimal medical therapy, HF hospitalisations and the total lengths of stay.ResultsA total of 818 patients were included in the study; 470 (57.5%) patients were enrolled and 348 (42.5 %) not enrolled into the program. At the end of the follow up period (median 978 days, interquartile range (IQR) 720-1237), the primary outcome of mortality was observed significantly less in the enrolled group (122 (26%) vs. 133 (38.2%), p<0.001) independently of other variables. In addition, significantly fewer enrolled patients had >3 hospital admissions for HF (16.2% vs. 35.6%, p<0.001) and reduced median admission days (14.5 days [IQR 8-25] vs 22 [IQR 12-37], p <0.001). Patients enrolled into the program were much more likely to be on GDMT (76.6% vs 56.6%, p<0.001).ConclusionsEnrolment in the heart failure outreach program was associated with a significant reduction in mortality as well as a reduction in the frequency and length of hospital admissions. In addition, the rate of GDMT was significantly higher in the enrolled group. With the high prevalence of heart failure, these programs should be considered in the routine management of patients with HFrEF.

Relationship between high rates of intestinal parasitic infections and knowledge, attitudes, and practices of Ndelele Health District populations (East Region, Cameroon): a cross-sectional mixed approach

BackgroundIntestinal parasitic infections remain of public health concern worldwide, especially among rural and poorest populations as a consequence of precariousness, lack of sanitation, non-availability of potable water and poor hygiene conditions. The present study aimed to better understand the epidemiology of intestinal parasitic infections in rural areas of forested Cameroon.MethodologyA cross-sectional survey was conducted in three Health Areas (Ndelele, Kentzou and Lolo) of the Ndelele Health District (East Region, Cameroon). Information on socio-demographic characteristics, knowledge, attitudes, and practices regarding intestinal parasitic infections were collected using a semi-structured questionnaire. Stool samples were collected and analyzed by the Kato-Katz and formalin-ether concentration techniques to complement simple direct examination.Principal FindingsA total of 406 individuals belonging to three main groups (Kako or Bantu, Baka or Pygmies and Central African Republic refugees) were enrolled in the study. The overall intestinal parasitic infection rate was 74.9%, including 57.2% cases of polyparasitism. Fourteen parasite species were identified, 89.1% being intestinal protozoa and 41.8% belonging to helminths. Infections with helminths were associated with Baka (P < 0.0001). Spring water consumption was associated with hookworm infection (OR = 3.87; P = 0.008). Garbage deposited near houses was positively associated with infection with Giardia lamblia (OR = 3.41; P = 0.003). Polyparasitism was positively linked to washing hand without soap before meal (OR= 11.64; p= 0.002).Conclusion/SignificanceIntestinal parasitic infections exhibited high rates in the Ndelele Health District, especially among indigenous and hard-to-reach populations (Pygmies). Hygiene measures appear as the main drivers sustaining transmission, and targeted strategies should be developed to efficiently fight against these debilitating diseases.Author summaryIntestinal parasitic infections such as soil transmitted helminthiasis and schistosomiasis, remain a public health concern in Cameroon. To better understand the epidemiology of these infections in hard-to-reach populations in rural areas, a cross-sectional study was carried out in three health areas of Ndelele health District in the Eastern-Cameroon. The rate of intestinal parasitic infections was high (74.9%) especially in indigenous populations (Baka-Pygmies) which exhibited high prevalence of soil transmitted helminth infections (83.3%). The study confirmed that the lack of sanitation and poor hygiene largely contribute to the endemicity of intestinal parasitic infections, particularly among indigenous populations. Targeted control strategies seem mandatory to reach these populations and offer them appropriate care to interrupt or reduce the transmission of these diseases.