Background Monitoring and Evaluation (M&E) is essential in ensuring population’s access to immunization. Surveys are part of this M&E approach but its timing limits the use of its results to improve the coverage of the evaluated campaign. An oral cholera vaccination campaign was organized in a health district of the Far North region of Cameroon and involved an innovative M&E approach. The aim of this project was to assess the feasibility and effect of using recommendations of a community-based immunization and communication coverage survey conducted after the first round of an OCV campaign on the coverage of the second-round of the campaign. Methods Two community-based surveys were included in the M&E plan and conducted at the end of each of the campaign rounds. Data were collected by trained and closely supervised surveyors and reported using smartphones. Key results of the first-round survey were disseminated to campaign implementing team prior to the second round. The two rounds of the pre-emptive campaign were organized by the Cameroon Ministry of Public Health and partners with a two-week interval in the Mogode Health District of the Far North region of Cameroon in May and June 2017. Results Of 120 targeted clusters, 119 (99.1%) and 117 (97.5%) were reached for the first and second rounds respectively. Among the Mogode population eligible for vaccination, the immunization coverage based on evidence (card or finger mark) were estimated at 81.0% in the first round and increased to 88.8% in the second round (X2=69.0 and p <0.00). For the second round, we estimated 80.1% and 4.3% of persons who were administered 2 doses and 1 dose of OCV with evidence respectively, and 3.8% of persons who have not been vaccinated. The distribution of campaign communication coverage per health area was shared with the campaign coordination team for better planning of the second round campaign activities. Conclusions It is feasible to plan and implement coverage survey after first round OCV campaign and use its results for the better planning of the second round. For the present study, this is associated to the improvement of OCV coverage in the second-round vaccination. If this is persistent in other contexts, it may apply to improve coverage of any health campaign that is organized in more than one round.
Background The capacity of the Research Ethic Committee (REC) members to review research protocol is one of the frequently raised problems. The purpose of this study was to assess training needs of members of research ethics committee in Cameroon regarding research participant protection.Methods It was a cross-sectional descriptive study conducted in all the regions of Cameroon during the last quarter of the year 2020, assessing training needs of REC members’ ethical evaluation of health research protocols. Data were collected from all eligible REC members by trained and supervised surveyors using a well designed questionnaire integrated in smartphones via ODK-collect. The data were analyzed by estimating proportions with 95% Confidence Interval using the EpiInfo software version 7.2.2.6.Findings Out of the 79 ethics committee members reached, 64 (81.01%) accepted to participate including 28 (43.75) female. The result showed that,21 (32.81%) of ethics committee members were not trained in research ethics evaluation including 68.75% not exposed to training on research participants protection during clinical trials. A given fraction of respondent was not aware of the existence of key national regulations (25%) and international guidelines like the Helsinki Declaration (32.81%). Participants identified and ranked their priorities in terms of training needs in research participant’s protection, national text regulating research in Cameroon, evaluations’ procedures of research protocol, organization of research in Cameroon, and protection of participants in research involving the transfer of biological materials. The workshop and e-learning courses were seen to be the main accessible source of training.Conclusion Not all ethics committee members received training on ethical principles regarding research ethics review, review process and monitoring of research protocols, and on ethical issues associated to each study design including clinical trials. These gaps and the needs perceived by participants are to be taken into account when setting up a training program for RECs members on ethical evaluation in Cameroon.
Background Countries’ Expanded Program on Immunization (EPI) contribute to the reduction of mortality and morbidity, but access to these vaccines remains limited in most low-income countries. Objective We aim to assess whether involving community volunteers (CVs) to track children’s vaccination status and demographic movements and using recorded data to plan catch-up immunization sessions can improve children’s vaccination timeliness, completeness, and coverage. Methods This was a field-based randomized controlled trial and communities of the Foumban health district in West Cameroon were allocated to intervention or control groups. In the intervention group, a CV per community was trained to visit households monthly for a year to assess and record in a register, details of EPI-targeted children, their demographic movements and immunization status. The scanned recorded pages were sent to the health center immunization team through WhatsApp and used to organize monthly community catch-up immunization sessions. In the control group, EPI vaccination sessions were routinely conducted. Surveys were conducted at 6 and 12 months from the beginning of the intervention in both study groups to assess and compare immunization timeliness, coverage, and completeness. Results Overall, 30 buildings per cluster were surveyed at midline and endline. Of the 633 and 729 visited households in the intervention group at midline and endline, 630 (99.5%) and 718 (98.4%), respectively, consented to participate. In the control group, 507 and 651 households were visited and 505 (99.6%) and 636 (97.7%), respectively, consented to participate. At 12 months intervention, the month one timeliness of bacille Calmette–Guerin (BCG) vaccine did not increase in the intervention group compared with the control group for the age groups 0-11 months (adjusted odds ratio [aOR] 1.1, 95% CI 0.7-1.8) and 0-59 months (aOR 1.1, 95% CI 0.9-1.4), and significantly increased for the first-year BCG vaccine administration for the age group 0-23 months (aOR 1.5, 95% CI 1.1-2.2). The coverage of diphtheria-pertussis-tetanus and hepatitis B+Hemophilus influenzae type B (DPT-Hi +Hb) dose 3 (aOR 2.0, 95% CI 1.5-2.7) and of DPT-Hi+Hb dose 1 (aOR 1.8, 95% CI 1.4-2.4) vaccines increased significantly in the intervention group compared with the control group in the age groups 12-59 months and 12-23 months, respectively. Specific (DPT-Hi+Hb dose 1 to DPT-Hi+Hb dose 3: aOR 1.9, 95% CI 1.4-2.6) and general (BCG to measles: aOR 1.5, 95% CI 1.1-2.1) vaccine completeness increased significantly in the intervention group compared with the control group. Conclusions Findings support that involving CVs to track children’s vaccination status and demographic movements and using recorded data to plan catch-up immunization sessions improve children’s vaccination timeliness, completeness, and coverage. This strategy should be adopted to improve access to vaccination for EPI target populations and the consistency verified in other contexts. Trial Registration Pan African Clinical Trials Registry PACTR201808527428720; https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=3548
BACKGROUND Vaccines offered by countries’ expanded program on immunization contribute to the reduction of mortality and morbidity, but access to these vaccines remains quite limited in most developing countries. OBJECTIVE The present trial assesses whether involving Community Volunteers (CV) to track children vaccination status and demographic movements and using recorded data to plan catch-up immunization sessions can improve children vaccination timeliness, completeness and coverage. METHODS This was a randomized controlled field trial in which communities of the Foumban Health district based in West region of Cameroon were allocated to intervention or control groups. In the intervention group, a CV per community was trained to visit households monthly for a year to record EPI targeted children in a Community EPI register (CER), their demographic movements and assess their immunization status. CER recorded page was snapped and sent to health center immunization team through WhatsApp and used to plan and implement monthly community catch up immunization sessions. In the control group, the EPI immunization sessions were conducted as routinely. Surveys were conducted at 6 (midline) and 12 (end line) months from the beginning of the intervention in both study groups to assess and compare immunization timeliness, coverage and completeness. RESULTS Thirty-two clusters per study group of about 160 buildings were followed for a year. In each cluster, a sample of 30 building was selected and surveyed at midline and endline. Of 792 and 876 households (HH) targeted for surveys in midline and end line in the intervention groups, 98.0% and 99.5% were reached respectively whereas in the control group, 1296 and 722 HH were targeted and 72.3% and 70.2% reached in midline and endline surveys respectively. One year after the implementation of the intervention, the timeliness of BCG administration in the first month of life did not increase in the intervention group compared to the control group for the age groups 0-11 (adjOR = 1.1 (0.7-1.8)) and 0-59 months (AdjOR=1.1(0.9-1.4)); meanwhile the increase was significant for the first year BCG administration for the age group 0-23 months (adjusted (AdjOR= 1.5 (1.1-2.2)). The coverage of DPT-Hi+Hb3 (AdjOR= 2.0 (1.5-2.7)), DPT-Hi+Hb1(adjOR= 1.8 (1.4-2.4)) significantly increased in the intervention group compared to the control group in age groups 12-59 and 12-23 months. Specific (DPT-Hi+Hb1 to DPT-Hi+Hb3) (AdjOR= 1.9 (1.4-2.6)) and general (BCG to measles) (AdjOR=1.5 (1.1-2.1)) vaccine completeness increased significantly in the intervention group compared to the control group. CONCLUSIONS Results of the present trial support that involving Community Volunteers to track children vaccination status and demographic movements and using recorded data to plan catch-up immunization sessions improve children vaccination timeliness, completeness and coverage. If its consistency is verified in other contexts, this strategy should be adopted to improve access to vaccination for EPI target populations. CLINICALTRIAL Pan African Clinical Trials Registry ID: PACTR201808527428720; Approved and registered on the August 22, 2018.
Background Due to its high attack rate, COVID 19 is responsible for a high number of deaths despite its relatively low lethality rate. This study was conducted to assess the relationship between time to consultation, presence of respiratory complications at hospital admission and fatal outcome of COVID 19 cases. Methods This was a case control design study which collected data from records of all COVID 19 patients admitted in Bafoussam Regional Hospital from March 2020 to April 2021. The association between the delay in seeking care, dyspnoea and blood oxygen level at admission, and fatal outcome was assessed by estimating crude and adjusted odd ratio. Results Of 400 included patients, 239 (59.75%) were male, 84 (23.73%) health professionals and 144 (36.0%) aged 64 years and above. The mean duration of hospitalization was 11.39 days and 120 (30.0%) admitted patient died. Seeking care during or before the end of the first day of symptom onset significantly reduced the risk (Adjusted (A) OR = 0.4 (0.16-0.98)) of fatal outcome, whereas waiting three (AOR=0.6(0.31-1.16))or seven days (AOR=0.91(0.47-1.75)) did not change this risk. Dyspnoea (AOR=2.71(1.38-5.29)) or oxygen level <95% (AOR=22.87(2.99-174.76)) significantly increased the risk of fatal outcome. Conclusions Health interventions contributing for early detection and connection of COVID 19 cases to care before respiratory complications occur are expected to reduce mortality in COVID 19 patients.
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