Cameroon Baptist Convention Health Services

BackgroundEliminating maternal and perinatal morbidity and mortality are global health priorities. Cameroon has some of the highest levels of maternal and neonatal mortality in the world. Evidence-based maternal healthcare is vital to ensuring women’s and infants’ health; however, offering such services in low-income countries is often challenging. Mobile health interventions have the potential to overcome longstanding public health barriers to fill gaps in maternal and infant care. This is among the first qualitative studies in Cameroon that examines individual and interpersonal barriers to maternity care to inform mHealth intervention adaptation.MethodsWe conducted qualitative in-depth interviews (n=38) and three focus groups (n=18) with key stakeholders including previously pregnant women who experienced an adverse event, currently pregnant women, maternity care providers, healthcare administrators, and Ministry of Health representatives. Thematic analysis was performed using NVivo12 software. Themes were categorized on the individual and interpersonal levels. The current study is part of a larger, long-term implementation project to adapt MIST to the local contexts of Cameroon using mobile phones.ResultsA total of 56 respondents, 14 men and 42 women, participated in this qualitative research. Participants reported individual-level barriers for women’s timely and appropriate maternity care related to antenatal care initiation, antenatal care utilization, health literacy, and blind trust in providers. Participants suggested that women waited to initiate antenatal care, underutilized antenatal care, lacked perinatal health literacy, and trusted their providers, regardless of health outcomes and complications. At the interpersonal level, husbands, religious leaders, and family were identified by participants as influencing women’s perinatal healthcare decisions-making, both positively and negatively.ConclusionOur data reveal individual and interpersonal forces that affect maternal and perinatal care in Cameroon. Future public health efforts can focus on improving health literacy during pregnancy and reproductive years among women as well as in their close social networks.

Women living with HIV have an elevated risk for cervical cancer, present earlier, and have more recurrent human papillomavirus (HPV) infections compared with women without HIV. To update WHO recommendations on screening and treatment to prevent cervical cancer, we aimed to identify whether women living with HIV should be screened for cervical cancer at a specific age, the optimal screening interval following a negative cervical screen, and the screening interval following treatment. We conducted a systematic literature review on cervical cancer and HIV by searching MEDLINE, Embase, CENTRAL, the Cochrane Library, and clinical trial registries covering Jan 1, 2012, through to Oct 13, 2019, updating a previous systematic review covering database inception to July, 2012. Included articles reported original data and assessed one or more outcomes related to cervical precancer and cancer in women living with HIV; no restrictions on study design or setting were made. Articles were excluded if they did not include any women living with HIV, or if they reported only HPV genotype prevalence without any other relevant data. Two authors extracted data from any study reporting cervical cancer screening tests and histopathologically confirmed disease outcomes, by age. We analysed summary data on optimal age and screening intervals, providing pooled estimates when possible; we then conducted an individual patient data meta-analysis (IPDMA) to analyse age-specific data on cervical cancer and precancer. Authors of studies with 40 or more women living with HIV and cervical intraepithelial neoplasia (CIN) grade 2+ were invited to submit individual patient data for meta-analysis. Random-effects models were used to calculate predicted probabilities for cervical cancer screening results by age, HIV status, and antiretroviral therapy (ART) status. Of the 304 full-text articles screened, 34 studies from 12 countries, with 128 732 women, including 63 790 women living with HIV, were included in the systematic review. Of 55 studies potentially eligible for the IPDMA, eight studies provided data for 72 350 women, 12 527 of whom were living with HIV, from seven countries (Burkina Faso, Cameroon, India, Kenya, South Africa, Thailand, and the USA). In the IPDMA, the pooled predicted probability of CIN2 or CIN3 among women living with HIV increased from 6·0% (95% CI 0·74-64·1) for ages 15-19 years to 32·4% (8·3-72·7) for ages 20-24 years, 42·1% (16·4-80·2) for ages 25-29 years, 50·3% (16·3-80·0) for ages 30-34 years, 47·0% (16·3-80·0) for ages 35-39 years, 49·0% (16·3-80·2) for ages 40-44 years, 58·1% (17·0-81·5) for ages 45-49 years, and 55·3% (21·0-86·6) for age 50 years and older; invasive cervical cancer was uncommon before 30 years of age. In the systematic review, women living with HIV who had a negative baseline cytology result and negative HPV test had a cumulative incidence of developing CIN2+ that ranged from 0·8% to 5% within 4·2-6·4 years and a cumulative incidence of developing of CIN of any grade up to 10% within 12 years. Also in the systematic review, women living with HIV had high recurrence of CIN2+ following treatment (11-27% by 1 year follow-up, 3-64% by 3 years, and 57% by 10 years). No significant evidence of publication bias was found in the data included in the IPDMA (Egger's test p=0·83). Our data show a clear, age-related increase in CIN2 and CIN3 among women living with HIV, with the highest risk occurring in the 45-49-year age group. Our findings informed WHO recommendations to initiate cervical cancer screening for women living with HIV at age 25 years, with regular screening every 3-5 years. Expanding screening and treatment is necessary to reduce cervical cancer incidence towards its elimination. US Agency for International Development and US President's Emergency Plan for AIDS Relief.

BackgroundHuman Immunodeficiency Virus (HIV) remains a major public health concern in sub-Saharan Africa. In Cameroon, young people are disproportionately affected but underrepresented in HIV testing statistics.ObjectiveTo explore knowledge, attitudes, and behaviours related to HIV testing among youth in Kumba, Cameroon, and to identify barriers to inform community-based interventions.MethodsA cross-sectional qualitative study was conducted using nine focus group discussions (FGDs) with 75 youth (52 females and 23 males) aged 18 - 35 years across four quarters in the Kumba II municipality. Participants were purposively sampled to reflect diverse educational and occupational backgrounds. Data were thematically analysed using Braun and Clarke’s framework with NVivo Version 14.ResultsParticipants demonstrated high awareness of HIV testing services (90.7%) and transmission via sexual contact (96.0%), though knowledge gaps remained regarding non-sexual transmission and testing procedures. While 93.3% had previously undergone HIV testing, 57.3% reported stigma and 46.7% raised confidentiality concerns as ongoing barriers. Female participants feared being labelled as promiscuous, while males cited social norms that discourage help-seeking. Most participants supported school-based or youth-centred community testing, emphasising the need for privacy and youth-friendly environments. Key motivators for testing included the desire to know one’s status (82.7%), symptom appearance (28.0%), and unprotected sex (17.3%).ConclusionsDespite strong awareness and high testing uptake, stigma and confidentiality concerns persist among youth in Kumba. To enhance HIV testing rates, community-based strategies should prioritise mobile clinics, peer outreach, and confidential youth-centred services. Strengthening education about HIV transmission and demystifying the testing process may further reduce barriers.

cohort study following pregnant women in Maharashtra, India to examine the effect of sickle cell disease (SCD) screening on intimate partner violence (IPV). In India and similar settings, positive SCD screening requires partner disclosure to facilitate paternal SCD screening to determine the likelihood of the child inheriting sickle cell trait compared to sickle cell anemia. Of the 182 participants, 91 had positive sickle cell disease screening and 91 had negative sickle cell disease. Participants with positive SCD screening were ≥2 times as likely to experience IPV compared to participants with negative SCD screening. Mulawa et al. assessed HIV disclosure among adolescents with perinatally-acquired HIV (APHIV) using egocentric social network analysis. The team analyzed social network data from 58 APHIV (mean age 14 years) with 349 relationships. They found participants disclosed their HIV status to only one-third of their relationships. Using multivariable regression, they found significant increases in HIV disclosure odds when participants presumed the potential disclosure recipient to be older than the participant, also living with HIV, and trustworthy.Articles in this collection also used qualitative methods to explore questions around disclosure related to PrEP and STIs. Beesham et al. conducted in-depth, qualitative interviews with 13 women aged 18-25 years who had participated in the Evidence for Contraceptive Options and HIV Outcomes (ECHO) Trial in Durban, South Africa and who accessed and continued PrEP through study exit, to explore aspects of oral PrEP disclosure. They found that all participants disclosed PrEP use to at least one disclosure recipient who was usually a family member and/or sexual partner. PrEP disclosure led to increased PrEP adherence support from disclosure recipients. However, some women reported barriers to disclosure related to PrEP stigma and misconceptions. Mwima et al. similarly explored PrEP disclosure barriers through in-depth, qualitative interviews with 14 women aged 18-24 years on PrEP for ≥ 6 months and who had recently engaged in transactional sex in Kampala, Uganda. They found that PrEP disclosure barriers included PrEP stigma and misconceptions, fear of judgement and violence from disclosure recipients, and a lack of disclosure guidance from healthcare institutions. Strategies to overcome these barriers included utilizing psychosocial coping skills, disclosing to peers with for social support, and connecting with healthcare workers for PrEP information and disclosure support. Finally, Chitneni et al. explored STI partner notification (PN) through 32 in-depth, qualitative interviews with STI stakeholders including patients with prior STI, healthcare workers, pharmacists, and healthcare administrators in rural, southwestern Uganda. Three candidate STI PN models to guide the interviews. Overall, participants found the nursing model favorable as nurses are generally trained to support STI care. The pharmacy model had potential as patients often seek pharmacy care early and as monetary incentives could align with STI PN. However, pharmacists would need STI PN training, and pharmacies would need restructuring to allow privacy. The community health worker model was deemed appropriate for education and advocacy and less-so for STI treatment.The final two manuscripts addressed interventions to reduce stigma and support HIV disclosure. Chenneville et al. described a stigma-reduction intervention (Healthy, Open, Proud) originally created for mental health and outlined the steps needed to adapt this to HIV with a specific focus on women and disclosure support. Li et al. conducted a cluster randomized controlled trial evaluating an intervention to assist adults with HIV to disclose their HIV status to household children in Guangxi, China. The team used a first-order Markhov Chain Model to evaluate participants' transition through the Health Action Process Approach framework stages from pre-intention to action over 12 months. Among the 791 participants, the intervention significantly facilitated participant transition from no intention to disclose pre-intervention to actual disclosure post-intervention.The manuscripts in this collection span the spectrum from identifying disclosure correlates, to qualitatively exploring disclosure questions, to developing and testing interventions. While several manuscripts focused on topics typically associated with disclosure, such as HIV, Halim et al.'s work examining associations of sickle cell disease disclosure with IPV reminds us that stigma can be associated with numerous sexual and reproductive health conditions, especially in the context of unequal gender power dynamics. Through this Collection, we found consistent themes across disclosure topics. Barriers to disclosure were often related to perceived stigma and fears of enacted stigma, such as IPV. Participants who did disclose their condition, often limited their disclosure to trusted recipients who could provide social support. Additionally, Chenneville et al. outlined methods for adapting an evidence-based disclosure intervention from mental health to HIV. Our goal in this Collection is to further inspire researchers to connect and build upon similar underlying frameworks and methods to further progress the field of disclosure overall.

The Igisoro game is utilized by Rwandan occupational therapists as a therapeutic tool for interventions in different settings, including mental health. This study used a qualitative exploratory approach to explore the perceptions of occupational therapists and their clients regarding the use and value of the Igisoro game in rehabilitation. Seventeen occupational therapists completed a questionnaire about their views on the efficacy of Igisoro as a therapeutic tool. Semi-structured interviews were conducted with twelve occupational therapy clients. The occupational therapists reported that Igisoro improves clients’ concentration, problem-solving skills and socialization. The client group reported three main sets of benefits from playing Igisoro.

Access to palliative care is an urgent global need. Countries with the greatest palliative care needs have limited access. In Cameroon, demand for palliative care is growing due to the rising incidence of life-limiting conditions. Identifying available palliative care services and programs could provide an understanding of access gaps and inform future roadmaps for palliative care development in the country. We aim to map available palliative care services, identify gaps and inform recommendations to promote early access to palliative care in Cameroon. We undertook a literature review of articles reporting any aspects of palliative care in Cameroon. We searched Embase, MEDLINE, Scopus, PsycINFO, CINAHL, PubMed and gray literature. Data were analyzed thematically using the World Health Organization model for the assessment of palliative care development. We identified 41 articles reporting 21 organizations with some form of palliative care services such as clinical services, education, advocacy and research. These were led mostly by individual health care providers or private and faith-based organizations. Major palliative care initiatives included training in the form of workshops, and adult and pediatric outpatient, in-patient and community-based palliative care. There were few reports of oral morphine production, community engagement, advocacy and palliative care research. Progress in palliative care development was reported in five regions of Cameroon over the last two decades. Findings suggest the need for an intersectoral approach including government, community, and health care stakeholders to achieve sustainable palliative care. This could potentially ensure equitable access to palliative care in Cameroon.

Cardiovascular diseases (CVDs) and their risk factors are a major cause of illness and death worldwide, especially in low- and middle-income countries like Cameroon. Physiotherapist-led health promotion (PLHP) has proven effective in improving health and reducing CVD risks. Understanding patient perspectives is crucial for designing effective, context-specific PLHP interventions. This study explored patients’ views, experiences, perceived usefulness, acceptability, and preferred methods of PLHP, through a sequential explanatory mixed-methods approach. The quantitative data highlights a significant burden of CVD conditions and risk factors among patients seen in physiotherapy services. Qualitatively, three themes were identified and included: (1) perspectives and experiences of people at risk or with CVDs (pwCVDs) on PLHP; (2) perceived usefulness and acceptability of PLHP; (3) preferred delivery methods of PLHP. Participants reported positive feedback on PLHP and physiotherapy services. Barriers to effective PLHP included high workloads for physiotherapists, limited service access in rural areas, and prohibitive costs. Despite these challenges, participants expressed strong confidence in physiotherapists’ competence, though they also called for improved regulation and ongoing professional development. PLHP components, especially physical treatment and dietary advice, were deemed highly useful and acceptable. Patients suggested various delivery methods, including peer support groups, home visits, and mass media interventions. This study highlights the need to improve the scope of practice, competence of physiotherapists, and accessibility of physiotherapy services in Cameroon for pwCVDs. It is necessary to adopt multidisciplinary approaches to achieve better outcomes for risk factors like diabetes and hypertension in context.

Background: Cardiovascular diseases (CVDs) and associated risk factors are a growing concern in Cameroon. Physiotherapists (PTs) can play a crucial role in prevention and management. However, the extent of Cameroonian PT involvement in health promotion (HP) activities remains unclear. This study assessed Cameroonian physiotherapists’ current HP practices for people at risk of or with CVDs (pwCVDs). Methods: A cross-sectional survey was administered online to PTs practising in Cameroon. Results: Out of 181 PT responses, 95% reported providing a variety of HP activities, including weight management (74%), dietary advice (73%), physical activity (69%), smoking cessation (69%), stress management (61%), and sleep promotion (48%). While PTs were confident in lifestyle assessments, they felt less confident about sleep interventions. Strong beliefs, confidence, team support, and time allocation enhanced HP practice. However, preference for passive modalities, patient adherence issues, organisational challenges, role ambiguity among healthcare providers, inadequate training opportunities, and the absence of established guidelines for CVD prevention negatively affect HP practice. Conclusions: These findings highlight the challenges and opportunities for enhancing HP delivery within the physiotherapy profession in Cameroon. The findings are useful for future strategies by clinical practitioners and policy makers to address barriers and leverage facilitators effectively for scaling up HP initiatives in Cameroon.

Wilms tumour (WT) is one of the cancer types targeted by the Global Initiative for Childhood Cancer (GICC). The objective of this study was to describe the outcomes of Wilms Africa Phase II in sub-Saharan Africa. Wilms Africa Phase II used a comprehensive WT treatment protocol in a multi-centre, prospective study conducted in eight hospitals in Ethiopia (2), Ghana (2), Malawi, Cameroon, Zimbabwe and Uganda. Eligibility criteria were: age younger than 16years, unilateral WT, diagnosed between 1 January 2021 and 31 December 2022. We included 230 WT patients, median age 3years, 53% male. Median maximum tumour diameter at diagnosis was 13.6cm and 33% of patients had metastatic disease. Nephrectomy was performed in 71% of patients, of whom 21% had a tumour rupture. Two-year event-free survival (EFS) was 41.3%±3.9% after a median follow-up of 17months (range: 1-33months), with treatment abandonment considered an event. Treatment abandonment occurred in 26% and death during treatment in 14%. Disease relapse occurred in 10%. Two-year EFS of the 26 patients who received radiotherapy was 64.5%±9.7% with no reported disease relapse. Patients continue to present late with advanced WT in sub-Saharan Africa, and their survival is below the 60% GICC target. Prevention of treatment abandonment and treatment-related mortality remain important. Earlier diagnosis and access to radiotherapy are expected to decrease disease-related mortality.