ARTICLE | doi:10.20944/preprints202304.0074.v1
Subject: Medicine And Pharmacology, Epidemiology And Infectious Diseases Keywords: Xpert MTB/RIF; Line-Probe Assay; MGIT 960 system; Mycobacterium tuberculosis; discrepant results
Online: 6 April 2023 (05:50:47 CEST)
The study sought to determine the rate of discordant results between genotypic and phe-notypic tests for the diagnosis of drug resistant tuberculosis (DR-TB). Sputum samples and cultured isolates from suspected DR-TB patients were respectively analysed for My-cobacterium tuberculosis by Xpert® MTB/RIF (Cepheid, USA) and Line Probe Assays (LPA) (Hain, Germany). Discrepant Rifampicin (RMP) resistant results were confirmed using BACTEC MGIT960 (BD, USA). Of 224 RMP-resistant by Xpert MTB/RIF, 5.4% were suscep-tible to RMP by LPA. MGIT960 showed 75% agreement with LPA. Discrepancy was at-tributed to either heteroresistance or DNA contamination during LPA testing in 58.3% of cases. In 25% of samples showing agreement in RMP resistance between Xpert MTB/RIF and MGIT960, discrepancy was attributed to laboratory errors causing false RMP suscep-tible results with LPA. Of 16.7% of cases, discrepancy was attributed to false RMP suscep-tible results with Xpert MTB/RIF. Of 224 isolates, susceptibility to isoniazid (INH) by LPA was performed in 73.7% RMP resistant isolates, of which, 80.6% were resistant. All RMP resistant isolates by Xpert MTB/RIF were confirmed in 98.5% by LPA if TB isolates were resistant to INH, but only confirmed in 81.3% if TB isolates were INH susceptible (ρ < 0.001). In conclusion, Laboratory errors should be considered when investigating dis-cordant results.
ARTICLE | doi:10.20944/preprints202211.0401.v1
Subject: Medicine And Pharmacology, Immunology And Allergy Keywords: TB-HIV integration; Challenges and barriers; Patients; O.R Tambo District; Eastern Cape; South Africa
Online: 22 November 2022 (03:08:13 CET)
Abstract: Tuberculosis (TB) and human immunodeficiency virus (HIV) epidemics in South Africa have been closely related and persistent, posing a significant burden for healthcare provision. We explored the patients perspectives on challenges and barriers of scaling up TB and HIV integrated services. A descriptive cross-sectional study applying a qualitive research approach was used. Through focus group discusssions (FGDs), we interviewed 29 patients accessing TB and HIV services at the study sites which were selected at primary health care (PHC) clinics in the O.R Tambo district in Eastern Cape, South Africa. Anonymised data was analysed using both content and thematic analysis technique. Challenges and barriers identified included a lack of health education about TB and HIV; an inadequate counselling for antiretroviral drugs (ARVs) and HIV; a lack of awareness of the National TB control program; and poor quality of services provided by the health care facilities. These findings suggest that the O.R. Tambo district needs to strengthen its TB-HIV integration immediately. Keywords: TB-HIV integration; Challenges and barriers; Patients; O.R Tambo District; Eastern Cape; South Africa
ARTICLE | doi:10.20944/preprints202304.0202.v1
Subject: Public Health And Healthcare, Health Policy And Services Keywords: model developement; TB– HIV integrated model; TB and HIV; model; quantitative and qualitative data
Online: 11 April 2023 (05:39:06 CEST)
Few studies have examined the pros and cons of integrated TB and HIV service delivery in public healthcare facilities, and even fewer have proposed conceptual models for improved integration. This study intends to fill that vacuum by outlining the development of a facility-based paradigm for integrating TB, HIV and patients services. The design of the proposed model were in stages that involved the evaluation of existing TB-HIV integration model and synthesis of both quantitative and qualitative data from the study sites which were selected public healthcare facilities at both rural and peri-urban settings in Oliver Reginald (O.R) Tambo District Municipality in Eastern Cape, South Africa. Secondary data on 2009-2013 TB-HIV clinical outcomes were obtained from multiple sources for quantitative analysis. Qualitative data involved focus group discussions among patient and heath care staff, which was thematically analysed. The development of a possibly better model and validation of this model show that the district's health system was reinforced by the model's guiding principles, which placed a strong emphasis on inputs, processes, outcomes, and integration effects.The model is adaptable to different healthcare delivery systems but will require support from healthcare stakeholders and professionals to be successful.
ARTICLE | doi:10.20944/preprints202308.1356.v1
Subject: Medicine And Pharmacology, Epidemiology And Infectious Diseases Keywords: model; drug resistance tuberculosis; collaboration
Online: 18 August 2023 (11:35:08 CEST)
Infectious illnesses have always posed a threat to human health, with tuberculosis being a major concern. The use of various medications and antibiotics in the fight against such TB has led to the emergence of drug-resistant tuberculosis, which has become increasingly difficult to manage. While there have been a few studies and proposed conceptual models on how to manage and prevent various drug-resistant TB mutations and lineages, a model aimed at limiting and con-trolling such mutations in rural areas burdened with tuberculosis is lacking. This study seeks to map a model that is to be used to bridge the gap by facilitating the exchange of knowledge among healthcare professionals in healthcare facilities, diagnostic laboratories, and research institutes, particularly for underprivileged communities in the Eastern Cape. The model will also serve as a guide to monitor and evaluate epidemiological TB management plans.
ARTICLE | doi:10.20944/preprints202308.0224.v1
Subject: Medicine And Pharmacology, Epidemiology And Infectious Diseases Keywords: Keywords: Model; Drug resistance TB, Collaboration and Integration
Online: 3 August 2023 (08:17:13 CEST)
Infectious illnesses have always posed a threat to human health, with tuberculosis (TB) being a major concern. The use of various medications and antibiotics in the fight against such illnesses has led to the emergence of drug-resistant infectious diseases, which have become increasingly dif-ficult to manage as medical and scientific research has advanced. Inadequate medical infrastruc-ture, incorrect treatment practices that exacerbate resistance patterns, and transmission within communities and healthcare facilities are the main factors contributing to the spread of drug-resistant TB. Though treating individuals with multiple drug resistance (MDR) and extreme drug resistance (XDR) strains is challenging, early identification of resistance and the imple-mentation of a well-designed treatment regimen can result in a cure. Community-based inter-ventions that address socioeconomic barriers to adherence can also enhance treatment outcomes. While there have been few studies and proposed conceptual models on how to manage and prevent various drug-resistant TB mutations and lineages, a model aimed at limiting and controlling such mutations has been developed. This paradigm seeks to bridge the gap by facilitating the exchange of knowledge among healthcare professionals (HCP) in healthcare facilities (HCF), diagnostic laboratories (DL), and research institutes (RI), particularly for underprivileged communities in the Eastern Cape. The model guide will also monitor and evaluate TB management plans
ARTICLE | doi:10.20944/preprints202212.0359.v1
Subject: Medicine And Pharmacology, Pathology And Pathobiology Keywords: tuberculosis; spatial analysis; mutations; spoligotypes; heteroresistance; cluster
Online: 20 December 2022 (08:10:25 CET)
Tuberculosis (TB), an infectious airborne disease caused by Mycobacterium tuberculosis (Mtb), is a serious public health threat reported as the leading cause of morbidity and mortality worldwide. South Africa is a high TB burden country with TB being the highest infectious disease killer. The study investigated the distribution and clustering of Mtb mutations and spoligotypes in rural Eastern Cape Province. The Mtb isolates included were 1,157 from DR-TB patients and analysed by LPA followed by spoligotyping of 441 isolates, of these, 36 were whole genome sequenced. Distribution of mutations and spoligotypes was done by spatial analysis and clustering analysis was done by Bayesian model-based clustering of allele frequencies at heterozygous sites, using Mclust package in R. The rpoB gene had highest number of mutations. The distribution of rpoB and katG mutations was more prevalent in four health care facilities, inhA mutations were more prevalent in three healthcare facilities and heteroresistant isolates were more prevalent in five healthcare facilities. The Mtb was genetically diverse with Beijing more prevalent and largely distributed. Spatial analysis and mapping of gene mutations and spoligotypes revealed better picture of distribution. Clustering of isolates indicates that there is transmission of mixed infection in this area.
ARTICLE | doi:10.20944/preprints202211.0496.v1
Subject: Medicine And Pharmacology, Epidemiology And Infectious Diseases Keywords: hypertension, comorbidity, HIV, antiretroviral treatment, treatment outcomes
Online: 28 November 2022 (06:04:48 CET)
Globally, non-communicable diseases like hypertension are on the rise, existing concurrently with the human immunodeficiency virus (HIV) in populations, especially those in low- to middle-income countries. The introduction of antiretroviral treatment (ART) for people living with HIV was welcomed with great enthu-siasm across populations. A cross-sectional study of 100 purposively selected adult participants on an-tiretroviral treatment living in the OR Tambo district was conducted to determine factors associated with treatment outcomes among patients living with HIV and hypertension comorbidity. The data was analyzed using the Statistical Package for Social Sciences, with a p-value of 0.05 considered significant. A total of 86% of the female population, with a mean age of 39.76, was studied. Participants with improved viral load and CD4 cell count after initiation of ART increased from 63% to 68% and 74% to 90%, respectively whilst viral load suppression increased from 45.1% to 90.2%. Hypertension post-ART initiation increased from 9% to 34%, exacerbated by smoking (12%), alcohol (14%), vegetable consumption (39%), skipping breakfast (50%), sugar use (62%), and vigorous physical activity (12%). The onset of hypertension was linked to the start of ART, and risky behaviors influenced treatment outcomes. Primordial prevention, like strong health promotion inter-ventions for risk factors, is needed to improve life expectancy.
ARTICLE | doi:10.20944/preprints202208.0378.v1
Subject: Medicine And Pharmacology, Pathology And Pathobiology Keywords: Antibiotic resistance; Colonization; Prevalence; GBS; Resistance phenotype
Online: 22 August 2022 (08:04:16 CEST)
Group B Streptococcus (GBS), a commensal in the body, causes a wide range of infectious diseases. The colonisation levels of GBS and its resistance profile to antibiotics provide important information useful for orienting prevention strategies. There is little data available on the subject with determination of resistance phenotypes in Cameroon. We therefore aimed to determine the prevalence of colonization, antibiotic resistance, including patterns of inducible resistance to clindamycin of GBS in Yaounde. To achieve this goal, a prospective cross-sectional study with an analytical component was carried out from the 28th June to the 29th August 2020 at the BIOSANTE laboratory and the Yaounde Gynaeco-Obstetrics and Paediatrics hospital. Vaginal swabs and urine were collected on 163 women. This samples were analysed using 5% defibrinated sheep blood agar and chocolate plus polyvitex agar. The isolates were identified using the morphology of the colony, Gram staining, haemolysis, catalase test and latex grouping test. Antibiotic susceptibility testing was done by disk diffusion method following the recommendations of the ACFSM 2019. The double disk diffusion method was used to identify isolates with clindamycin inducible resistance. Our data was analysed by the software SPSS version 2.1. The results obtained showed that the global prevalence of colonization by GBS was 37% (57/163), 40.35% in non-pregnant women and 59.65% in pregnant women. Pregnancy (P-value = 0.019) and gestational age (P-value = 0.025) constituted the risk factors of maternal colonization by GBS. In addition, the strains of GBS were resistant to all antibiotics tested. A D test showcased that 64.7% of GBS were resistant in a constitutive manner to clindamycin. We also note the presence of M phenotypes. As a whole, our results demonstrate that the rate of GBS colonization in this study was similar or higher than those in the previous report in Cameroon. All this indicates that attention should be paid to this bacterium in the monitoring of antimicrobial resistance and in the care of pregnant women and newborns.
ARTICLE | doi:10.20944/preprints202311.1940.v1
Subject: Public Health And Healthcare, Public Health And Health Services Keywords: model; drug resistance tuberculosis; collaboration
Online: 30 November 2023 (03:59:32 CET)
Infectious illnesses have always posed a threat to human health, with tuberculosis being a major concern. The use of various drugs in the fight against such TB has led to the emergence of drug-resistant tuberculosis, which has become increasingly difficult to manage. While there have been a few studies and proposed conceptual models on how to manage and prevent various drug-resistant TB mutations and lineages, a model aimed at limiting and controlling such mutations in rural areas burdened with tuberculosis is lacking. This study seeks to map a model that is to be used to bridge the gap by facilitating the exchange of knowledge among healthcare professionals in healthcare facilities, diagnostic laboratories, and research institutes, particularly for underprivileged communities in the Eastern Cape. The model information is based on three published manuscripts; therefore, this is a follow-up study. The model will also serve as a practical guide to monitor and evaluate epidemiological TB management plans.
ARTICLE | doi:10.20944/preprints202305.0493.v1
Subject: Public Health And Healthcare, Public Health And Health Services Keywords: treatment outcomes; DR-TB; MDR-TB; TB-HIV co-infection; treatment success rate
Online: 8 May 2023 (09:36:25 CEST)
An essential metric for determining the efficacy of tuberculosis (TB) control programs is the evaluation of TB treatment outcomes. Assessing treatment outcomes is fundamental to facilitating the End TB Strategy set target. Clinic records from 457 patients with DR-TB were examined for data collection while 101 patients were followed up prospectively. Data were analyzed using Stata version 17.0. The odds ratio and 95% confidence interval were calculated to check the association between variables. P ≤ 0.05 was con-sidered statistically significant. Of the 427 participants, 65.8% had successful treatment whilst 34.2% had unsuccessful TB treatment. A total of 61.2% and 39% of the HIV-positive and HIV-negative participants had a successful TB treatment whilst 66% and 34% of both HIV-negative and positive participants had unsuccessful TB treatment. From 101 patients that were followed up, smokers had longer treatment outcomes compared to non-smokers. In the study with HIV/TB co-infection, men predominated. HIV and tuberculosis co-infection made therapy difficult with unfavorable effects on TB management. The treatment success rate (65.8%) is lower than the WHO threshold standard with a high proportion of patients lost to follow-up. The co-infection of tuberculosis and HIV resulted in undesirable treatment outcomes. Strengthening TB surveillance and control is recommended.
ARTICLE | doi:10.20944/preprints202304.0083.v3
Subject: Medicine And Pharmacology, Epidemiology And Infectious Diseases Keywords: drug-resistant TB; heteroresistance; mutations; spoligotyping
Online: 9 June 2023 (15:36:21 CEST)
Drug-resistant tuberculosis (DR-TB) is still a major public health concern in South Africa. Mutations in M. tuberculosis can cause varying levels of phenotypic resistance to anti-TB medications. There have been no prior studies on gene mutations and the genotyping of DR-TB in the rural Eastern Cape Province; hence we aimed to identify DR-TB mutations, genetic diversity and allocated lineages among patients in this area. Using Xpert® MTB/RIF, we assessed the rifampin-resistance of sputum samples collected from 1157 patients suspected of having tuberculosis. GenoType MTBDR plus VER 2.0 was used for the detection of mutations causing resistance to anti-TB medications. The next step was to spotlight type 441 isolates. The most prevalent rifampin resistance-conferring mutations were in rpoB codon S531L, in INH-resistant strains, katG gene at codon S315TB and the inhA gene at codon C-15TB had highest mutations; 54.5% and 24.7%, respectively. In addition, 24.6% of strains showed mutations in both the rpoB and inhA genes, while 69.9% of strains showed mutations in both the katG and rpoB genes. Heteroresistance was seen in 17.9% of all cases in the study. According to spoligotyping analysis, Beijing families predominated. Investigating the evolutionary lineages of M. tuberculosis isolates can be done using the information provided by the study's diversity of mutations. In locations where these mutations have been discovered, decision-making regarding standardization of treatment regimens or individualized treatment may be aided by the detection frequency of rpoB, katG, and inhA mutations in various study areas.
ARTICLE | doi:10.20944/preprints202308.1895.v1
Subject: Public Health And Healthcare, Primary Health Care Keywords: keyword multidrug-resistant tuberculosis; gene mutations; heteroresistance; Beijing variants
Online: 29 August 2023 (03:33:51 CEST)
Multidrug-resistant tuberculosis emerged as a serious challenge to tuberculosis management and control. In the Eastern Cape, the Beijing variants are prevalent and a driving force of multidrug-resistant tuberculosis; hence, we investigated the distribution of gene mutations in Beijing strains compared to non-Beijing strains. Multidrug-resistant tuberculosis and heteroresistant isolates were identified in 412 sputum cultures by drug susceptibility testing. The isolates were analyzed for mutations in three genes associated with resistance to antituberculosis first-line drugs: katG and inhA promoters for isoniazid and rpoB for rifampicin. All isolates were genotyped by spoligotyping. There were more males than females and a more economically active age group in the study. The most prevalent mutations in rpoB resistance were in S531L, katG in S315Tb, and inhA in c-15tb. Heteroresistance was found in 18 isolates. Beijing variants were predominant. Most of the heteroresistant isolates were INH, with heteroresistance occurring more in the inhA gene mutation region c-15tb. Beijing and LAM variants were found more frequently in INH heteroresistant isolates. Mutations in katG S315Tb and rpoB S531L were higher in Beijing variants. The Beijing family is a major contributor to the epidemiological picture and accounts for most of the multidrug-resistant tuberculosis in the study area.
ARTICLE | doi:10.20944/preprints202302.0060.v1
Subject: Biology And Life Sciences, Virology Keywords: vaccination; acceptance; Covid-19; epidemiology; Cameroon; urban area; rural area
Online: 3 February 2023 (06:23:26 CET)
The Covid-19 pandemic has rapidly evolved in December 2019 and to prevent its spread, effective vaccines has been produced and made available to the population. Despite their availability so far in Cameroon, the vaccination coverage remains low. This study aimed at describing the epidemiology of the acceptance of vaccines against Covid-19 in some urban and rural areas of Cameroon. A cross-sectional, descriptive and analytical survey was conducted from March 2021 to August 2021 targeting unvaccinated individuals from urban and rural area. After getting appropriate administrative authorizations and an ethical clearance from the Institutional Review Board (or Ethics Committee) of Douala University (N° 3070CEI-Udo/05/2022/M), a cluster sampling at many degrees was performed and a language adapted questionnaire was filled by each consenting participant. Data were analyzed using Epi info version 184.108.40.206 software and for P-values ˂ 0.05, the difference was considered as statistically significant. Out of 1053 individuals, 58.02% (611/1053) participants were residing in urban and 41.98% (442/1053) in rural areas. Good knowledge relative to Covid-19 was significantly higher in urban areas as compared to rural areas (97.55%vs.85.07, P<0.000). The proportion of respondents who intended to accept the anti Covid-19 vaccine was significantly higher in urban areas than rural areas (42.55%vs.33.26, p=0.0047). Conversely, the proportion of anti Covid-19 reluctant respondents thinking that the vaccine can induce a disease was significantly higher in rural areas than urban areas (54 (35.07 vs 8.84, P<0.0001). The significant determinants of anti-COVID-19 acceptance were the level of education (p=0.0001) and profession in the rural areas (p=<0.0001), and only the profession (p=0.0046) in the urban areas. This study globally shows that anti-COVID-19 vaccination remains a major challenge in urban as well as rural area in Cameroon. We should keep sensitizing and educate population about vaccine importance in preventing the COVID-19 spread.
ARTICLE | doi:10.20944/preprints202301.0457.v1
Subject: Biology And Life Sciences, Virology Keywords: COVID-19; serological markers (IgM/IgG); Prevalence; private universities; Cameroon
Online: 25 January 2023 (11:27:36 CET)
Background: COVID-19 remains a rapidly evolving and deadly pandemic worldwide. This necessitates the continuous assessment of existing diagnostic tools for robust, up-to-date and cost-effective pandemic response strategy. We sought to determine the infection rate (PCR-positivity) and degree of spread (IgM/IgG) of SARS-CoV-2 in three university settings in Cameroon Method: Study volunteers were recruited from November 2020 to July 2021 among COVID-19 non-vaccinated students in three Universities from two regions of Cameroon (West and Centre). Molecular testing was performed by RT-qPCR on nasopharyngeal swabs and IgM/IgG antibodies in plasma were detected using the Abbott Panbio IgM/IgG rapid diagnostic test (RDT) at the Virology Laboratory of CREMER/IMPM/MINRESI. The molecular and serological profiles were compared and, p<0.05 considered statistically significant. Results: Amongst the 291 participants enrolled (mean age 22.59±10.43 years), 19.59% (57/291) were symptomatic and 80.41 %(234/2691) asymptomatic. Overall COVID-19 PCR-positivity rate was 21.31% (62/291), distributed as follows: 25.25% from UdM-Bangangte; 27.27% from ISSBA-Yaounde and 5% from IUEs/INSAM-Yaounde. Women were more affected than men (28.76% [44/153] vs. 13.04% [18/138], p<0.0007) and they significantly expressed more IgM+/IgG+ (15.69% [24/153] vs. 7.25% [10/138], p<0.01). Participants from Bangangté, the nomadic, and the “non-contact cases” mainly presented an active infection compared to those from Yaoundé (p= 0.05; p=0.05 and p=0.01 respectively). Overall IgG seropositivity (IgM-/IgG+ and IgM+/IgG+) was 24.4% (71/291). A proportion of 26.92% (7/26) presenting COVID-19 IgM+/IgG- had negative PCR versus 73.08% (19/26) with positive PCR, p<0.0001. Furthermore, 17.65% (6/34) with COVID-19 IgM+/IgG+ had negative PCR as compared to 82.35% positive PCR (28/34), p<0.0001. Lastly, 7.22% (14/194) with IgM-/IgG- had a positive PCR. Conclusion: This study calls for a rapid preparedness and response strategy in higher institutes in case of any future pathogen with pandemic or epidemic potentials. The observed disparity between IgG/IgM and viral profile supports prioritizing assays targeting the virus (nucleic acid or antigen) for diagnosis and antibody screening for sero-surveys
ARTICLE | doi:10.20944/preprints202303.0426.v1
Subject: Public Health And Healthcare, Public Health And Health Services Keywords: Acinetobacter baumannii; Resistance; carbapenemases; Health Facilities
Online: 24 March 2023 (06:49:01 CET)
Carbapenems have long been considered as treatment of choice for Gram-Negative Bacteria (GNB) infections, and today the clinical utility of this class is threatened by the emergence and spread of resistance favored by its increasing use. According to the WHO, Acinetobacter baumannii, nosocomial infection agent, tops the list of priority antibiotic-resistant pathogens, considered to be the most risky for humans. This study sought to determine the prevalence of Acinetobacter baumannii strains producing carbapenemases in four health facilities in the Center and Littoral regions of Cameroon and the associated risk factors. An analytical cross-sectional study was conducted over a six-month period from January to June 2022. All Acinetobacter baumanii or suspected strains isolated from pathological samples at the bacteriology laboratory of different health facilities were systematically collected and underwent a re-identification. After successfully subculturing and growing on nutrient agar, re-identification and antimicrobial susceptibility Testing (AST) were performed using the VITEK 2 System and the Kirby-Bauer method according to the guidelines of the Clinical and Laboratory Standards Institute (CLSI). Detection and phenotypic characterization of carbapenemases was performed according to adequate standard procedures. A total of 168/226 clinical isolates of Acinetobacter baumannii were confirmed after re-identification of which 52.69% came from male patients, and 55.09% from participants aged between 10-39 years old and 46.71% from pus samples. A very high resistance rates to all families of antibiotics was noted except to colistin (10.2%). About 40.12% of these strains produced carbapenemases with 62.69% of class B and 37.31% of class A. In addition, frequent hospitalisation was significantly associated to the production of carbapenemase among Acinetobacter baumanii (Ajusted-OR=16.53, P-value<0.0001). This study highlighted the emergence of carbapenemase-producing Acinetobacter baumannii which is increasingly growing. Continuous drug-resistant monitoring and preventive measures could help to prevent and curb the dissemination of A.baumanii resistance genes, especially in hospital settings.