Contrary to the World Health Organisation, WHO, guidelines that malaria tested negative persons should not be prescribed Artemisinin-based Combination Therapy, ACTs, Cameroon doctors and nurses have been wrongly administering ACTs to patients who do not have malaria, a study found.
The study indicated that 84 percent of tested-negative persons received ACTs and following training on the use of Rapid Diagnosis Tests, RDTs, the number of tested negative cases that were prescribed antimalarial they did not need was halved.
“Only three out of ten patients who go to the hospital with a fever have malaria and giving malaria medication to people who do not have malaria means wasting the drug and increasing the possibility of becoming resistant to anti-malaria therapy”, Prof. Wilfred Mbacham said as he present the findings of the study to government officials on April 29.
When WHO realised ACTs, whose basic raw materials are not available were lacking around the world, the only way to save ACTs and prevent resistance was not to put too much new combination therapy into the communities. Also, if resistance to ACTs is developed there may be no immediate succour for malaria treatment, Mbacham provided the rationale for the project.
Carried out in Yaounde and Bamenda for a period of five years, the study has demonstrated that by training doctors to properly use the RDT technology, 1million doses of ACTs evaluated at FCFA 5billion every year could be preserved.
Mbacham who co-led the study with Dr. Virginia Wiseman from the London School of Hygiene & Tropical Medicine said the analyses were threefold; associated with the health systems problem, the prescribers and patients.
Part of study indicated that the Cameroonian population were better informed on ACTs than the population in Nigeria, such that while the intervention in Cameroon was at the level of the prescribers, in Nigeria the population had to be educated.
During the study, 95 tool-kits have been developed for behaviour change, such as, the card game, the protocol to use, and what to do indifferent situations.
Mbacham stressed that with the findings there is need to go back to the medical schools and redo the training programme to integrate the new technologies so that by the time students graduate from the medical school, they are already equipped with the algorithm to begin practice.
Being one of the best projects sponsored by the Bill and Melinda Gates Foundation to the tune of 450,00 dollars the Cameroon government is expected to start implementing the results of the study.
Though it is doubtful that government would do so, Arthur Essomba head of Department of Care and Health Technology reassured that the government would take up the study which the has been commended to other countries.
One of 25 projects in ten countries, the study was published in the Lancet on April 25 in commemoration of the malaria day.
The World Leprosy Day celebrated every 30 January or the closest Sunday is being celebrated in Cameroon amidst lack of funds to carry out research on the high prevalence in some regions of the country. There is no form of research on Leprosy at the moment. While there is a gradual increase in leprosy cases in Cameroon, Dr. Earnest Njih Tabah, Deputy Permanent Secretary of the National Committee for Leprosy, Buruli Ulcers, Yaws and Leishmaniasis Control advises that the population should report any abnormal patch on the skin that is not itching and not sensitive to the nearest health unit. In an Interview with The Post’s Leocadia Bongben ahead of the Leprosy Day celebrated in Cameroon on Sunday, he stressed that treatment if free through-out the country.
The Post: Can you present the disease Leprosy?
Dr Tabah: Leprosy is an age old, infectious disease caused by bacteria, mycobacterium leprae. The disease has existed for more than four thousand years and described in old civilizations such as the India, Chinese and Egyptian. It and also mentioned several times in the bible. The manifestations of the disease are mainly on the skin and nerves also. This starts with a skin patch that has a different coloration from the normal coloration of the body. In dark skin people it is lighter than the normal skin colour and darker than the normal skin colour in white skin persons. The peculiarity of this skin patch is that it loses sensitivity. It does not itch and no flex comes out when scratched. When nothing is done at the initial stage of the patch it evolves to attacking the nerves especially the peripheral nerves of the body. The attacked zones like the upper limbs, palms, sole of the feet, lose sensitivity function. The person is exposed to developing traumatic wounds. The parts of the body have to be protected because when they lose sensitivity they can carry hot objects without feeling and get brunt. The wounds become secondarily infected and this leads to amputation. It would only get to this stage if not detected early enough, when the skin patches are treated. Our wish is for people to consult early enough when they discover an abnormal skin patch.
Is it a small, or big, just any patch?
It can be big or small, the size does not matter. The most important thing is that it is a skin patch that has lost sensitivity; it is not itching and not painful. People should be curious enough to examine their bodies and mothers when bathing their babies should examine them regularly and other people around them. If such a patch is seen they should go to the nearest hospital or health unit for treatment.
Do all hospitals treat leprosy?
Yes, health workers receive basic training and the programme is also working to increase the skills and capacity of operational health workers and nurses in the management of leprosy. Care now is integrated into the minimum package of activities of the Cameroon health system. Leprosy now has to be handled in every health facility and not like what was observed in the past where they were secluded from other patients. The policy now is treatment at home with multi-drug therapy, which is effective and efficient in treating leprosy so they are safe and others around them are safe. They can live with their families and take their treatment normally and there is no risk of transmitting the disease. However, the risk is there only when a person has leprosy ha not commenced treatment. Once leprosy is diagnosed, the treatment is given for free.
When you say the multi-drug therapy is effective, does it means when the patients take the treatment they get cured?
They get cured. Since the treatment was introduced in 1985, there have not been cases of relapse in Cameroon and if there are any, these are minimal to the point that we cannot say the treatment is not effective.
What is this multi-drug therapy?
It is a combination of three molecules, rifampicin, clofazimine and dapsone. This is the regiment given for multi-bacillary adults-
What does that mean?
Leprosy is classified into two main groups: the minor form of leprosy and the multi-bacillary which is the most severe form of leprosy. The same drug is given for the two groups but the duration differs with respect to the class of leprosy. The treatment for severe leprosy is 12 months while for minor leprosy is six months and the doses may vary. There are doses for children and adults, and given free through-out the country.
What is the state of leprosy in Cameroon?
The state of leprosy can be explained from two periods. The first era is before leprosy was declared as eliminated as a public health problem in Cameroon, prior to 2000. At that time, the number of cases was very high. In 1985 we could count 3000 new cases per year. The efforts and strategies put in place were able to curb the number of cases to below 1000 cases per year by 2000. At that time, with respect to the World Health organization, WHO definition, Cameroon was considered as having eliminated leprosy as a public health problem. That is, if the prevalence was less than 1000 and one case per 10,000 inhabitants. But, the era between 2000 till date is such that the leprosy prevalence has remained below 1000 cases. We have been registering on the average 450 to 600 cases per year. But, I must say that in the last three years, from 2009, the number of cases has seen a regular and gradual increase from 453 in 2009 through 532 in 2010 to 552 in 2011. The data for 2012 is still partial but when we finally get the whole data for Cameroon, it would be about the same level or slightly higher than what we had last year. Seen from this angle, leprosy cases are gradually increasing.
Which are the areas with a high prevalence?
Leprosy is endemic in four regions of the country: the North, Southwest, East and Adamawa. In the north for instance the prevalence is almost 1.2 per 10,000 inhabitants, above the elimination threshold. In the Southwest and Adamawa it is about 0.8 per 10,000 inhabitants, above the national level of 0.18 per 10,000 inhabitants.
What is the reason for the regular increase of leprosy cases?
Maybe the fact that between 2009 and now, there has been some kind of drop in surveillance activities in the field and the fact that the personnel have not been properly trained. They are also not well motivated like in the other programmes, enough effort is not put in the control activity and as such the number of cases has gradually increased in the community or is never detected. It is also a mark to show that the efforts put in the past years are also yielding fruits because the level of activity has increased. Maybe cases that were hidden and not detected in the community are now detected.
Is there any kind of research in prevention and treatment?
Research as such in the field of leprosy is absent but last year there was a research in the attitudes practices and knowledge of leprosy with respect to the general population. We had one or two studies but the results are not yet published. We need to do a lot of research to understand why leprosy is more prevalent in some zones that in others. Is it the nature of the environment, the attitude of the people or customs that favour leprosy prevalence? The problem is lack of means to carry out the research because this is a costly venture.
Is there any innovation in the celebration of Leprosy Day?
We are celebrating the 60th World Leprosy Day and we have as theme “Leprosy is still with us, let’s mobilize to conquer it”. This theme is in-line with the explanations given above and we need to call upon the population and the medical personnel to double efforts and take their responsibility as health care providers. They should also know that leprosy has its particularities and if more efforts are not put in, cases may continue to miss out and only discovered later with complication. On the part of the population, they should take any abnormal patch on their body to the health facility for confirmation, diagnosis and treatment. The activities to mark the day would center on sensitization in the communities, health talks and screening to detect cases, conduct sensitivity test and put them on treatment in case of leprosy.
Is there any provision for former leprosy victims?
We have a programme for former leprosy victims; we follow them to see if their complications are not worsening. We have a programme of prevention and management of disabilities. Those who already have permanent disabilities and the state is not worsening are helped to live with their situation. For those having new complication like ulcers there is need for operation and may lead to amputation. The programme has the possibility of treating and providing prosthesis-artificial limbs and arms.
Lippia Tea- tea from a plant Lippia multiflora, though not yet known to the larger public, is one of the societal benefits of botanical research, Prof. Bernard-Aloys Nkongmeneck has said.
From the study of the plants Nkongmeneck came to the conclusion that Lippia tea brings down hypertension, eases digestion and awaken certain physiological qualities in the body.
The leaves are harvested, dried in a dust free environment, ground and is ready to boil and drink. Presently, sachets have been offered by a Canadian partner, so that lippie tea can be conserved in tea bags like Lipton tea.
Through botanical research, a medicinal plant that has a lot of virtues such as Annickia chlorantha, locally known as ‘yellow tree back”, has been identified to cure hepatitis. This tree back has been transformed used to produce ‘Epazor’ which has proven to be a good drug.
This is sold in pharmacies after homologation by the Ministry of Public Health to cure viral hepatitis. This is a product that brings economic gains, and the product in the US is being introduced into the stock market.
To Nkongmeneck, this is proof that botanical research contributes to solving the problems of society development.
Besides, botanical research can propose models of agroforestry for high yield to the population and an added value, he said.
These and other results were presented during an open door day organised by Prof. Nkongmeneck and his research team under the theme, “Botanical research for development” on recently. The objective of the day was to make the results available to the public and for policy makers to use them for the development for the country.
Nkongmeneck on the occasion intimated that botanical research is the sparkplug of development and that a country that does not understand this, is putting the development of its people at stake.
To valorise botanical research, Nkongmeneck said there is need to put in place a methodology that works well to arrive at good results. Botanical research is conducted in four axis, ethno-botany, systematic botany, forestry technology, and agroforestry.
Denis Sonwa, Researcher at the Centre for International Forestry recalled that in last 20 years botanical research has been strongly influenced by what was decided in Rio on the convention on bio-diversity, climate change and desertification. These contributed in shaping botanical research and there is need for Nkongmeneck and his team of researchers to respond to the new orientations in research, he said.
In the Congo Basin, emphasizes is laid on biodiversity, the major theme of environment, Sonwa said adding that botanical research would have respond to environmental preoccupations of Reduction of Emissions from Deforestation and Degradation, REDD and Climate change.
He said the sub disciplines of botany are an illustration of the interface between and usefulness to the needs of man and society.
To Sonwa, Botanical research can actually bring development through conservation or management. Either in conservation or use of plants, if botanist do not describe a plant one cannot know what is being conserved and it is difficult to use it. “This provides a connection between botany and the needs of the population, in health. Also, the link between forestry and agricultural resources managed in the same space”, he said.
Contributions from Prof. Daniel Lantum, and kamsu Kom provided Nkongmeneck’s research team with a multidisciplinary approach.
The day ended with a discussion of the natural history museum run by Nkongmeneck in mutation with double goal of education and research, though not mentioned enough and new orientations for the development of the museum.
Cameroon would be the third center of excellence after Senegal and Ghana opened by the South African based Foundation, African Institute of Mathematical Science, AIMS to train the next generation of mathematical scientists to tackle Africa’s development problems.
A convention for the effective start of the Cameroon center was signed in Yaoundé by the Minister of Higher Education, Jacques Fame Ndongo for the Cameroon government and the Director of AIMS-NEI, Thierry Zomahoun and Barry Green, Director of AIMS South Africa on Monday January 28.
The Cameroon campus would train talented young Africans in five different domains: health and biosciences, business and governance, natural resources, TIC and food security. The center is expected to go operation in September, but avenues are explored to get a temporary site at the National School of Engineering, Polytechnic while awaiting the construction of a permanent site.
Meanwhile, President Biya has order the disbursement of 1 million dollars for the acquisition of 2 hectares of land for the construction of a permanent campus.
Speaking to the press after signing the convention, Prof. Barry Green, said Africa has to endeavor to solve its development problems by itself. For him it would be difficult for Cameroon to meet its development needs without the necessary experts. He maintained that mathematical science is central in training the next general of Africans to solve Africa’s problems.
The center would offer scholarships to the students who would study in an enabling environment with a computer lab, lecture and dining halls. He said only the best would be selected by a panel of experts. The students while submitting their applications would chose a center and at the moment about 1000 applicants are expected.
“We would like to ensure gender balance, excellent students to cover many areas of mathematical science, not pure mathematics but a variety of areas, physics included”.
A panel of 8-10 experts would examine each application and make a selection of 50 or 30 for each center. Students would send their applications through the AIMS central network which are scrutinized for the best.“There is no interference from government or the institute”, Green stressed”.
Our mission is to encourage mathematical science in African and Cameroon should play a big part in as Senegal, South Africa and Ghana. “We have great talented young people who can actually solve Africans problems and we are passionate about giving them the chance to do this”.
To him Cameroon has been a big player ( through their performance) in the South African center and we want to help build the same model in Cameroon, he said.
AIMS is out to contribute to the next generation of scientists, businessmen, leaders in Africa that can help solve Africa and we believe young people can and we should give them the tools to do this, he declared.
The teaching model in AIMS has been proven to be innovative because it does not follow the traditional model we find in the university. AIMS model provides for strong interaction between teachers and students from discussions, where one learn from mistakes. It is not by hearing and learning that one becomes an expert but doing, Green stated.
Our students are taught and encouraged to ask questions, even if the wrong questions, by asking three wrong questions the come out with right question and a right answer, he explained. Leading experts from all over the world, and Noble Prize winners would be brought to teach in Cameroon.
In partnership with the government of Canada, South Africa, Germany, Britain and international organizations, AIMS launched the “Next Einstein Initiative”, NEI to detect and incubate a network of centers of excellence young talented scientists in Africa. AIMS-NEI is a pan African network of centers with innovative training model in research and the promotion of mathematical sciences.