Applications of spatial transmission dynamic model- ing approaches to investigate infectious disease trans- mission and control has increased over the last two decades, with a research production of less than five ar- ticles per year in 1997 to more than 120 articles per year (Fig. 1). System dynamic models have been most useful in generating scenario analyses of the potential course and severity of infectious disease epidemics [16– 18, 21, 28–30], characterizing and forecasting the spa- tiotemporal transmission patterns of epidemic out- breaks, or assessing the effectiveness of interventions and the feasibility of achieving elimination targets. In these models, researchers artfully integrate key epi- demiological characteristics of the disease and strive to capture relevant mechanisms of disease transmission,
5 mL fasting peripheral venous blood was collected from subjects for various biochemical investigations. Routine biochemical tests included blood urea, serum creatinine, sodium, potassium, calcium and uric acid were carried out in the hospital laboratory. Estimated glomerular filtration rate (eGFR) was calculated by using Modification of Diet in Renal Disease (MDRD)  and Chronic Kidney DiseaseEpidemiology Collaboration (CKD-EPI) equation . Morning spot urine samples were collected for urine albumin and urine creatinine test. Serum creatinine and urine creatinine were measured by alkaline picrate jaffee´s kinetic method . Urine micro-albumin was estimated by nephelometer (nephstar®, Goldsite Diagnostics). Albumin/creatinine ratio (ACR) was calculated by using urine micro-albumin and urine creatinine and were expressed in mg/g creatinine.
MACBETH assigning values of 0 and 100. In the case of Foot and Mouth disease, the overall score was mainly due to its diseaseepidemiology (group A) and its economic, social and environmen- tal impact (group E). Group A contains the greatest number of criteria, and group E contains the most highly weighted criteria. Since weighting in M-MACBETH tended to be more evenly spread than in the spreadsheet tool we attributed the drop in rank to this ‘equalizing’ of weights, which had most influence on group A and group E. In the case of Chagas disease, the drop in rank within group A may also be attributed to the ‘equalizing’ of weights. Within group A, Chagas gained high scores for the highest weighted criteria and low scores for the lowest weighted criteria. A degree of ‘equalizing’ of the weights resulted in the observed drop in rank. Changes to other pathogens were less Figure 7. Disease ranking calculated in the spreadsheet tool for nine diseases. A: Criteria were weighted using a fixed mean value based on expert opinion (weighting method 1). The maximum score possible for any disease was 23.7. B: Criteria were weighted using a probability distribution representing the range of expert opinion (weighting method 2). Cumulative probability distribution shows the total score over 10,000 iterations for each disease. The maximum score of a disease was a mean of 23.5 (standard deviation 62.37, 95 th percentile = 27.2 after 10,000 iterations).
Kidney function is usually measured by estimating glomerular filtration rate (GFR), which is currently considered to be the best index. A direct measurement of GFR is possible, such as by assessing urinary iothalamate or inulin clearance, but this is cum- bersome and not suitable for route clinical or population screening. Several equations have been proposed to estimate GFR (eGFR) from serum creatinine and the currently recommended equation for adults is the Chronic Kidney Disease-Epidemiology Collab- oration (CKD-EPI) equation . The CKD-EPI equation also takes age, sex and race into account, because of their association with muscle mass, which influences the gen- eration of creatinine. It is particularly challenging to accurately estimate eGFR in older adults, because the increase in serum creatinine reflecting reduced kidney function is paralleled by an age-related decrease in muscle mass . Another issue is the need to calibrate serum creatinine assays across laboratories to use them to estimate GFR [8, 9]. Because creatinine depends on muscle mass and other factors, such as diet, that influence creatinine generation, there have been efforts to identify a marker of glomerular filtration that does not suffer from these limitations. Cystatin C, an endogenous protein produced by nearly all human cells that is freely filtered by the glomeruli, has recently been pro- posed as a new marker. Cystatin C-based equations to estimate GFR are now available [10–14]. Compared to creatinine, cystatin C-based equations better predicted all-cause mortality and cardiovascular events in people older than 65 years  as well as all-cause mortality and end-stage renal disease (ESRD) in general adult populations . Cystatin C may be combined with creatinine to estimate GFR , as demonstrated by some recently published equations cited above [13, 14]. Markers of glomerular filtration (e.g. serum cre- atinine and cystatin C) and markers of kidney damage (e.g. albuminuria, renal biopsy find- ings) are also part of the tests used to define CKD-staging.
The current recommended gold standard for radiola- belled GFR measurement is by using exogenous markers such as iothalamate, Chromium 51 ethylenediamine- tetraacetic acid ( 51 Cr-EDTA EDTA) or iohexol. 51 Cr- EDTA is a well-recognised exogenous marker and it is widely used for the assessment of GFR [4, 5]. However, the use of these exogenous markers is expensive, labour intensive, time consuming and not widely available in our country. Therefore, estimated GFR (eGFR) calcula- tion is important to overcome this problem. The best eGFR equation, ideally, should have lower bias and limits of agreement with greater precision and accuracy. To date, Modification of Diet in Renal Disease (MDRD) and Chronic Kidney Disease-Epidemiology Collaboration (CKD-EPI) equations are widely accepted to be used in clinical practices for GFR estimation [6, 7].
The review provides a summary of Parkinson’s disease research in Africa. It is evident that the scale of research done on the topic is not at the scale that it needs to be. In this study, several methodological issues need to be addressed. As clear from figure 1, most of these studies were covered in Northern and sub-Saharan Africa differing in geographic locations. Studies that took place in the same country were years apart or had different population characteristics. The populations covered in these research projects had differences in size (see table 1), age structure, sex ratios (see table 5), racial features and other socio-economic factors. There are discrepancies in the year as well as duration of the studies. Looking at tables 2 and 3 most of these studies took place before 2000s and few recent studies were recorded. The duration of these projects lie between the range of 1 and 10 years. Thus evaluating the diseaseepidemiology over time proves to be difficult. Many of the studies were typically small and hospital-based. These studies were derived from admission records. The frequencies based on hospital attendance are not likely to be representative of the frequencies observed in general population. Only door-to- door studies are able to reduce the bias associated with socioeconomic and cultural factors.
ACR- Albumin to creatinine ratio; BUN – Blood urea nitrogen; CKD – Chronic Kidney disease; CKD-EPI – Chronic Kidney disease – Epidemiology Collaboration; CKDu – Chronic kidney disease of unknown aetiology; COPCORD – Community acquired program for the control of rheumatic disease; E-GFR – Estimated glomerular filtration rate; ESRD – End stage renal disease; IDMS – Isotope dilution mass spectroscope; JOABPEQ – Japanese orthopaedic association back pain evaluation questionnaire; MDRD – Modification of Diet in Renal disease; MOH – Ministry of Health; NCD – Non-communicable diseases; NCP – North Central Province; NSAID’s – Non-steroidal anti-inflammatory drugs; NWP – North Western Province; WHO – World Health Organization.
CI: Confidence interval; CKD: Chronic Kidney Disease; CKD-EPIcre: Chronic Kidney DiseaseEpidemiology Collaboration creatinine equation; CKD- EPIcrecys: Chronic Kidney DiseaseEpidemiology Collaboration creatinine and cystatin C equation; CKD-EPIcys: Chronic Kidney DiseaseEpidemiology Collaboration cystatin C eq.; CV: Coefficient of variation; DEGS: German Health Interview and Examination Survey for Adults; DEGS1: German Health Interview and Examination Survey for Adults, first wave; eGFR: estimated glomerular filtration rate; FAScre: Full Age Spectrum creatinine equation; GFR: Glomerular filtration rate; GNHIES98: German National Health Interview and Examination Survey 1998; Hg: Mercury; IDMS: Isotope Dilution Mass Spectrometry; LM: Lund-Malmö equation; max: Maximum; md: Mean difference; MDRD: Modification of Diet in Renal Disease study equation; min: Minimum; RKI: Robert Koch-Institute; Scr: Serum creatinine; Scys: Serum cystatin C; SD: Standard deviation
37. Levey AS, Coresh J, Greene T, et al; Chronic Kidney DiseaseEpidemiology Collaboration. Using standardized serum creatinine values in the modification of diet in renal disease study equation for estimating glomerular filtration rate. Ann Intern Med. 2006;145(4):247–254. 38. Van Biesen W, Vanholder R, Veys N, et al. The importance of standard-
E pidem iologica l and surveillance data arc c ru cial to effective disease co n tro l as they provide an evidence base fo r p u b lic health action: to define those at risk, to set p rio ritie s, plan in te r ventions, and allocate resources. However, available data fo r E ngland and Wales are clearly biased and in sufficie nt to answer these ques tions, as they are fo r many other countries. Since the bu rden o f disease associated w ith P ID is like ly to be higher than currently th o u g h t, this represents a fundam ental gap in o u r knowledge o f S T l epidem iology. It pre vents a tru e realisation o f the burden o f repro ductive m o rb id ity am ong wom en and the developm ent o f an evidenced based approach to the provision o f G U M services. In ad dition, the recent re p o rt by the C M O ’s expert advisory group on C trachom atis highlighted the urgent need fo r in fo rm a tio n concerning P ID epidem iology, p a rtic u la rly in the assessment o f in te rve n tio n program m es aimed at genital chlam ydial in fe c tio n .’ M o n ito rin g the preva lence o f genital chlam ydial infe ction could be used to assess such a program m e. However, it is p o te n tia lly biased since, although the preva lence o f chlam ydial in fe ctio n may be reduced in the sh o rt te rm b y screening, this w ould not necessarily reflect a corresponding decrease in P ID prevalence. S h o rt te rm reductions in prevalence may be associated w ith reduced d u ra tio n o f in fe ctio n ra ther than reduced disease incidence. T h u s , it is o n ly by using P ID as the end p o in t measure that the tru e re prod uctive health im p a ct o f inte rventio n can be measured. '
New Zealand and Mongolia have recorded high IMD endemicity. New Zealand experienced an outbreak of serogroup B disease until an aggressive campaign with the OMV vaccine was initiated in 2004 that has con- tributed in part to lowering the incidence. Mongolia experienced serogroup A epidemics in the early 1990s. Australia currently experiences predominantly serogroup B disease with moderate attack rates after the introduction of a serogroup C vaccine saw a marked decline in rates of disease due to the C serogroup. China, Japan, Korea, Philippines, Singapore, Taiwan, and Thailand all experi- ence low levels of IMD. Other countries in this region do not have adequate population-based data to allow estima- tion of their true incidence rates.
Accurately identifying kidney disease patients who are at a high fracture risk is important to appropriately target high risk groups for fracture prevention, diagnosis, and therapeutic trials. Chapter 3 revealed FRAX may be an accurate tool to predict fractures in individuals with reduced kidney function and guide treatment decisions. Given concerns about the safety and efficacy of bisphosphonates in individuals with more severe decrements in kidney function applying early therapeutic intervention could conceivably prevent fractures later on when bisphosphonates are contraindicated (40, 41); research in the general population has found that due to bisphosphonates long half-life (40) residual effects of the drug may occur years after discontinuation (42-44). With 1 in 10 women > 65 years of age with ESRD sustaining a fracture over three years (20) and over 60% of dialysis patients dying after sustaining a hip fracture, early preventative therapy could be particularly important (45). Regarding kidney transplant recipients, Naylor et al. previously concluded that the discrimination and calibration of FRAX in kidney transplant recipients may be improved by adding transplant specific risk factors (7). However, chapter 5 found few transplant-specific risk factors reached statistical significance suggesting a modified version of FRAX may not need to be developed for kidney transplant recipients. However, diabetes might be an additional risk factor for clinicians to use to help identify recipients who have a high fracture risk, and who may benefit from fracture prevention strategies such as a lower dose of steroids.
N. meningitidis, a Gram-negative β -proteobacterium of the family Neisseriaceae, is an exclusive pathogen in humans, carried asymptomatically in the nasopharynx by 5%–10% of adults in nonepidemic periods. It is an aerobic diplococcus and can be either structurally encapsulated or not encapsulated. Capsule polysaccharide expression of the bacteria plays a key role in meningococcal pathogenesis. N. meningitidis strains that cause invasive disease are almost always encapsulated, which helps survival of the bacteria during invasive disease and promotes transmission as well as protection from antibodies and phagocytic cells. 47
that lower respiratory tract infections due to bacterial and fungal species were high in the cameroonian context. This study also showed that the risk of infection was also associated with age and sex with men being the most infected on the one hand and adult being the most concerned by the contamination on the other hand. The alarming finding of antibiotic resistance observed in this study should lead practitioners to prescribe these drugs rationally, preferably based on the data of an antibiotic susceptibility test. Thus, it is more than necessary to establish a regular surveillance of antibiotic resistance which must be generalized at the level of all health care centers in order to define therapeutic and prophylactic strategies adapted to the local epidemiology. The judicious application of preventive measures can only be conceived as part of a prevention programme involving all hospital departments.
Abstract Background: Intestinal parasitic infestations are among the most common communicable diseases in the world with a higher prevalence in developing countries. They are caused by protozoa which have long been associated with foodborne and waterborne disease outbreaks. The aim of our study was to present the profile of protozoa isolated from stool samples in Yaounde from 2010-2020 and to analyse the association of intestinal parasitic diseases with age and gender during the same period. Methods: This retrospective and observational study was carried out from January 04, 2010 to January 10, 2020 in Yaounde, capital of the Center region, at Centre Pasteur of Cameroon. After collecting the stool samples, the intestinal protozoa were identified using the Bailenger concentration technique and staining with Kop-Color II. Microscopic observation between slide and coverglass was focused on trophozoites and cysts of protozoa. Results: A total of 106.846 stool samples were analyzed during the study period and the overall infestation rate of intestinal protozoa was 8.4% (8958 samples positive for the presence of a protozoan). Women were the most represented with 5697 samples (9.0%) compared to 3052 (7.5%) samples for men. This difference in gender distribution was significant (p<0.0001). The participants were between 1–105 years (mean±SD = 42.6±19.4) of age. The age distribution of the patients showed that the age group with the highest prevalence of infestation (9.4%) ranged from 21–40 years with a significant difference in distribution (p<0.001) from one age group to another. A significant decrease of stool samples was also observed depending on the years of the study (p<0.0001). The distribution of identified protozoa was: 3.3% for Entamoeba hartmanni, 1.9% for Entamoeba coli, 1.8% for Entamoeba histolytica histolytica, 0.4% for Trichomonas intestinalis, 0.4% for Entamoeba histolytica minuta, 0.3% for Gardia duodenalis, 0.2% for Chilomatix mesnilii, 0.1% for Endolimax nana, 0.04% for Isospora belli, 0.02% for Balantidium coli, 0.006% for Cyclospora cayetanensis and 0.003% for Pseudolimax butschlii. A statistically significant association of age groups (p<0.0001) and sex (p<0.0001) with the identified protozoa was obtained in our study with a higher risk of infestation in women and those of the 21–40 years age group were the most vulnerable. Conclusion: The overall infestation rate of intestinal protozoa is high in Yaounde with highest contamination being amongst women and people 32 years of age. Moreover, despite the significant decrease of infestations over the years, measures must still be taken to prevent diseases caused by intestinal protozoa in the Cameroonian context.
Recent studies in rural Cameroon indicated the prevalence of 24.5% of STH infection in Nkondjock , 29.6 % in Mfou Health District , 18 % in Akonolinga Health District  and 33.76% in Munyenge . The prevalence of STH in urban setting revealed a different epidemiology panorama. For instance, the prevalence of helminths infection was 5.8% in Douala , and 4.95% in Bazou . WHO is recommending WASH (Water Sanitation and Hygiene) interventions. STHs are transmitted through contact with faeces of infected persons. Infection does occur when larvae living in the soil enter bare skin. Administration of chemotherapy is used to treat infection. However, there is a high probability of reinfection in the absence of an efficient WASH system.
Abstract Background: Traditional medicines are an important part of healthcare in sub-Saharan Africa. Traditional medicine has long been used in Cameroon and the world over in the prevention and treatment of diseases, physical and mental disorders as well as social imbalance. Building successful disease management programs that are sensitive to traditional medicine practices, achieving primary and Universal Health Coverage (UHC), will require an understanding of their current use, and roles as well as the state of regulation. This review was done to identify the role, research gaps, and suggest perspectives for future research as far as traditional medicine is concerned in Cameroon. Methods: Database searches were done through the internet using Google scholar, Google, PubMed, Sci-hub, books, theses, and related websites involving the use of key words in both English and French Languages. Out of the 93 articles only 12 original articles and 3 reviews met the inclusion criteria. Results: Studies show that 4.6% (urban settlement) compared to 94% (semi urban settlements) in Sub-Saharan Africa with Cameroon inclusive use and patronize traditional herbal medicine. One of the priorities of the African Regional Strategy on Promoting the Role of traditional medicine (TM) in Health Systems was found to be the promotion of collaboration between practitioners of traditional and conventional medicine. However, despite the health benefits such collaboration could bring to the populations, decades of disregard of traditional medicine practices and products has created mistrust between the two sectors hampering all the efforts being made to promote this potentially useful partnership. Based on this review, traditional herbal medicine plays a role in oral health, reproductive health and HIV /AIDS in Cameroon. Conclusion: It is undoubtedly evident that traditional medicine plays a role in primary healthcare sector in Cameroon which must be further assessed to see specific roles in achieving UHC, ensure collaboration as stipulated by the WHO as well as hindrances to collaboration and also regulation strategies to ensure quality products, practices and practitioners.
Centers for Disease Control and Prevention data on reported pertussis over time will be presented and compared with data from recent studies on prolonged cough illnesses in adolescents and adults and with the rate of total B pertussis infections and the rate of B pertussis infections with cough illnesses in defined pop- ulations. All prospective, published studies during the last 20 years of prolonged cough illnesses in adolescents and adults in which B pertussis infection was looked for by serologic study (enzyme-linked immunosorbent assay [ELISA]) have been ana- lyzed. Rate data over time of B pertussis infection in adolescents and adults were determined from studies in which B pertussis antibody-titer changes over time were determined. Rate data on B pertussis illnesses were determined from the prolonged cough- illnesses studies mentioned above and 1 serologic study with specimens at multiple time points and data collected on respira- tory illness.