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Delivery delays of laboratory results can result in death and/or economic loss to both the patient and the health system. Data is limited regarding turnaround time for tuberculosis testing in Cameroon. We evaluated intra- turnaround time in tuberculosis diagnosis, identified root causes, and brainstormed solutions to improve patient satisfaction. In this cross-sectional descriptive study, turnaround time for the pre-analytic phase was set at 3 hours, the analytic phase at 11 hours, and the post-analytic phase at 10 hours. The overall turnaround time was 24 hours. We used the Fishbone method of problem analysis involving the personnel of the Tuberculosis Reference Laboratory-Douala, to identify root causes. We brainstormed using the \"Whys\" causes of turnaround time failure during the process of tuberculosis diagnosis by GeneXpert MTB/RIF. We analyzed samples from 526 clients. The median turnaround time was 45 (Range: 2-120) hours. A total of 216(41.1%) clients had a turnaround time failure. The turnaround time failures in the pre-analytic, analytic, and post-analytics phases were 64(29.6%), 128(59.3%), and 12(11.1%) respectively. Overall, 19 root causes of turnaround time failure were identified and grouped into six categories, namely: equipment, administration, technical-staff, environment, material, and method. Equipment maintenance (defective or non-calibrated modules) was the critical cause of turnaround time failures accounting for 86 (39.8%) of the overall turnaround time failure. turnaround time in tuberculosis diagnosis is longer than expected, retarding patient care management. Focusing on equipment maintenance enhances the intra-laboratory testing process, thus improving overall patient satisfaction. The need for further studies to incorporate the extra-laboratory turnaround time in assessing the overall turnaround time is imperative.

Background Cameroon has faced frequent and severe cholera outbreaks since 1971, with case-fatality rates (CFRs) ranging from 12% in 1991, to 5.3% in 2014, all higher than the less than 1% cholera CFR target set by WHO. However, not many studies providing insight on context-specific risk factors have been published. The purpose of this study was to describe the recent cholera outbreaks in Cameroon and to determine factors associated with mortality. Methods This was an analytical cross-sectional study that employed a retrospective design exploiting Ministry of Public Health cholera line-lists from 2018–2023. These line lists were obtained from the Public Health Emergency Operations Coordination and Control Center, compiled into a single Microsoft Excel Sheet, cleaned and analyzed using Microsoft Excel 2016 and SPSS version 20. Cholera cases were defined as those confirmed in reference laboratories via stool culture and suspected cases with proven epidemiological link to laboratory-confirmed cases (suspected cases in health districts with active laboratory-confirmed cases). Factors associated with cholera mortality were identified using binary logistic regression (adjusted odds ratios), after socio-demographic, clinical, and geographical distribution of cholera cases were described. Maps were generated using QGIS version 3.28.14. Results Between May 2018 and March 2023, Cameroon experienced four cholera epidemics resulting in 18,986 reported cases and affecting 8 out of 10 administrative regions. The three coastal regions (Littoral, South and South-West Region) reported 83.4% (15,839/18,986) of all the cases while the remaining five affected regions jointly reported 16.6% (3,147/18,986) cases. The most represented age group were those aged 25–35 years (21.9%; 4,163/1,876) and the male: female sex ratio was 1.27. The overall CFR was 2.7% (478 deaths/17,967 cases with known outcome) and was highest among persons > 65 years (6.8%; 59/869). Urban areas notified more cases than rural areas (13,267 vs 5,484). Factors associated with increased mortality were male sex (aOR 1.61, 95% CI: 1.30—2.04 ), dry season (aOR 1.67, 95% CI: 1.28—2.22 ), age above 45 years (aOR 1.79, 95% CI: 1.45—2.22 ) and severe dehydration at consultation (aOR 12.76, 95% CI: 7.66–21.25 ). Conclusions Cholera outbreaks occurred in eight out of the ten administrative regions in Cameroon during the study period and mortality appeared to be driven by multiple factors notably severe dehydration at time of consultation, advanced age, male sex and the dry season. The high caseloads and case-fatality rates reiterate the need for further strengthening of existing cholera surveillance and outbreak response mechanisms.

Introduction Tuberculosis(TB), currently has limited treatment options, and faces worldwide threat of drug-resistance(DR). In 2022, the DR-TB prevalence in Cameroon was 1.4% among new-cases and 8.3% among retreatment-cases. We analyzed the DR-TB database to descript the trends and DR-TB profile, treatment-outcome and associated risk-factors so-as-to propose measures to enhance program performance in Cameroon. Materials and methods We conducted a retrospective cohort study, analysed the DR-TB database of the Littoral region from 2013 to 2022. We appreciated the data-quality using zero-reporting, completeness, consistency, and validity indicators. We categorized DR-TB into Rifampicin-resistant-TB(RR-TB), multi-drug-resistant-TB(MDR-TB), pre-extensive-drug-resistant-TB(pre-XDR-TB), and XDR-TB and performed descriptive statistics. We assessed DR-TB treatment outcome targeting > 80% cure and/or completed treatment. Multiple logistic regression was used to determine risk factors related to poor treatment outcomes, and adjusted relative risk(RR) was considered significant at p  < 0.05. Results Overall database quality was 93.7% with uniqueness 100%, data-completeness 82.5%, consistency 97% and validity 95.1%. A total of 567 DR-TB cases were reported, with median age of 34 (1–80) years, male-to-female sex ratio (3:2). Cases were classified as 19(3.4%) RR-TB, 536(94.6%) MDR-TB, 7(1.3%) pre-XDR-TB, and 4(0.7%) XDR-TB. Case-reporting increased from 2013, reaching their peak in 2018. The overall treatment refusal rate was 123(11.9%) and treatment outcomes of 270(60.8%) cured, 116(26.4%) completed, 32(7.2%) deaths, 19(4.3%) lost-to-follow-up, and 6(1.4%) failure were recorded. We identified 84 dead (CFR:14.8%) amongst whom 52(62%) refused treatment, 17(20%) occurred during the first month of therapy and 13(15.5%) HIV-TB co-infected. Male gender [ p  = 0.006, RR = 2.5 (95% CI: 1.3–4.7)], HIV positive status [ p  = 0.012, RR = 2.1 (95% CI: 1.2–3.7)], and previous DR-TB status [ p  = 0.02, RR = 3.9 (95% CI: 1.3–12.0)] were statistically associated to poor treatment outcomes. Conclusion In the Littoral Region-Cameroon, cases of DR-TB increased from 2013, reaching their peak in 2018 befor dropping right up to 2022. RR-TB, MDR-TB, Pre-XDR-TB and XDR-TB represented 3.4%, 94.6%, 1.3% and 0.7% of all reported DR-TB cases. Overall, DR-TB treatment success rate was 87.2%. Male-gender, HIV-positive status, and previous DR-TB are associated with poor TB treatment outcomes. We recommend universal drug susceptibility testing to ensure early/maximum DR-TB case-detection and proper pre-treatment counselling to limit the high death rates and anti-TB treatment refusal rates which are setbacks from achieving end-TB strategies.

Background In September 2023, fifty cases of chronic limb ulcers of unknown origin were reported in six Health Districts (HDs) in Northern Cameroon. This disease, locally called “Ladde”, was described as of mystical origin, transmitted by insect bites. We aimed to describe the cases, identify the cause and socio-anthropological considerations. Methodology We conducted a mixed descriptive cross-sectional study in November 2023. A case was any person that had presented a skin ulcer on any of the four limbs for at least 4 weeks any time during the study period, suspected of infectious cause or contamination, associated or not to other conditions and residing in the study area from January 2018 to October 2023. After active case-finding in health facilities and within the community, we featured sociodemographic (sex, age, occupation), clinical (location, signs/symptoms, ulcer occurrence), and therapeutic data (itinerary, treatment and outcome). We collected blood samples, ulcer swabs and skin biopsies to test for pathogens ( Haemophilus ducreyi, Treponema pallidum, Mycobacterium ulcerans , Mycobacterium leprae , Leishmania ), performed an entomological survey to search for potential vectors and conducted a socio-anthropological survey (individual interviews and focus group discussions) to explore community perceptions. Results We identified 153 cases in total: 119 (77.8%) were men. The median age was 38.5 years (9 months to 94 years). Farmers ( n  = 63, 41.2%), followed by housewives ( n  = 24, 15.7%) were the most affected. The lower limbs ( n  = 138, 90.2%) were the preferred location. Pain ( n  = 130, 85.0%), swelling ( n  = 113, 73.9%), ulceration ( n  = 43, 28.1%) and fever ( n  = 42, 27.5%) were the most frequent signs/symptoms at the beginning. In 79 (51.6%) cases, the ulcers occurred spontaneously and 67 (43.8%) after trauma (road injuries, blunt objects ulcers). For treatment, 129 (84.3%) cases visited a traditional healer who ordered decoctions ( n  = 98, 64.1%) and poultices ( n  = 95, 62.1%) using powder; 81 (52.9%) cases visited a health facility and received Cloxacillin ( n  = 78, 51%) and diclofenac ( n  = 70, 45.8%). Ten (6.5%) cases were completely cured. Six out of ninety-four (6.4%) cases tested were HIV positive, 8 (8.5%) were syphilis positive, all referred for appropriate care. Dermohypodermatitis ( n  = 14 out of 28, 50%) and pyogenic granuloma ( n  = 12 out of 28, 43%) were the main anatomopathological findings. No patient was positive for Mycobacterium ulcerans, Haemophilus ducreyi or Treponema pallidum pertenue. The entomological investigation did not reveal any potential insect vectors for leishmaniasis. Socio-anthropological survey mostly reported that “Ladde” is a disease of diabolic origin caused by a spirit which comes from a demon-possessed animal or tree. Conclusion Posttraumatic leg ulcers and dermohypodermatitis were the predominant clinical and anatomopathological patterns. Traditional practitioners were the main point of care. Strengthening the capacity of health and laboratory personnel in the diagnosis and management of chronic skin ulcers pathogens is recommended to improve the outcome of chronic ulcers.

Background The purpose of antimicrobial resistance (AMR) surveillance is to guide clinical decision-making, characterize trends in resistance infections, and provide epidemiological data to study the impact of AMR on health and the effectiveness of control measures in health facilities and the community. To do this, regular and relevant assessments of standardized AMR surveillance systems are essential to prioritize threats and improve their performance and cost-effectiveness. The scarcity of data and the absence of a local and national strategy on the surveillance of antibiotic resistance in Sub-Saharan Africa and even more so in Cameroon do not allow an effective response to be carried out against the scourge. This gap led us to conduct a study on the evaluation of the attributes of the antibiotic resistance surveillance system in Cameroon. Methodology We conducted a descriptive, cross-sectional study over a period of one year from January to December 2021. The study was conducted in the sentinel sites of surveillance in Cameroon, namely, those of the Centre, South-West, Littoral, and North regions. Using structured questionnaires and a pre-established and pre-tested interview guide, we collected data that allowed us to assess a surveillance system's quantitative and qualitative attributes according to the CDC guidelines. Scores were assigned based on the different questionnaires to assess the attributes of the AMR surveillance system. Results Of the evaluated attributes, it appears that although the system is useful (88.9%, i.e., a score of 2), and has good completeness of data transmission (98.9%, i.e., a score of 3), it is not simple (64.3%, i.e., a score of 1), not stable (58.6%, i.e., a score of 1), not acceptable (58.6%, i.e., a score of 1), and presents poor data quality (11.05%, a score of 1). Conclusions The AMR surveillance system in Cameroon is useful with good completeness. However, many other attributes have poor performance, indicating the importance of improving the antimicrobial surveillance system.

Metodos Se recopilaron datos sobre casos de colera desde enero de 2016 hasta septiembre de 2023 en las 10 regiones de Camerun, procedentes del software DHIS-2, listados nacionales de casos de colera, informes de situacion y bases de datos del Centre Pasteur du Camerun y del Laboratorio Nacional de Salud Publica. Estos datos se introdujeron en la herramienta del Grupo de Trabajo Mundial para el Control del Colera con el fin de determinar un indice de prioridad por distritos basado en cuatro indicadores de colera: incidencia, mortalidad, persistencia y positividad de las pruebas. Se calculo un indice de vulnerabilidad basado en 12 factores de vulnerabilidad. Se clasificaron como areas prioritarias para intervenciones multisectoriales los distritos con un indice de prioridad [greater than or equal to]9 y los distritos con un indice de prioridad <9 pero con [greater than or equal to]9 factores de vulnerabilidad.

To identify priority areas for multisectoral interventions for cholera control in Cameroon. We collected data on cholera cases from January 2016 to September 2023 in all 10 regions of Cameroon sourced from the DHIS-2 software, national cholera line lists, situation reports and databases of the and the National Public Health Laboratory. We entered these data into the Global Task Force on Cholera Control tool to determine a priority index for districts based on four cholera indicators: incidence, mortality, persistence and test positivity. We calculated a vulnerability index based on 12 vulnerability factors. We categorized districts with a priority index ≥ 9 and districts with a priority index < 9 but with ≥ 9 vulnerability factors as priority areas for multisectoral interventions. Between 2016 and 2023, Cameroon reported 24 813 suspected cholera cases in nine regions. Of 200 health districts, we identified 48 (24.0%) as priority areas for multisectoral interventions, 35 based on a priority index ≥ 9 and 13 based on vulnerability factors. These priority areas were home to 40.4% (11 488 089/28 433 067) of the country's population in 2023 and accounted for 91.3% (22 668/24 813) of the cholera cases between 2016 and 2023. Centre, Littoral, South-West and Far North regions account for 85.4% (41/48) of the priority areas for multisectoral interventions. Identification of priority areas for multisectoral interventions provided evidence for decision-making to enhance cholera preparedness and prevention. The availability of data facilitated this classification, and the ownership and leadership of the main governmental stakeholders were essential.

Cholera has re-emerged as a major global public health emergency, with reported cases and deaths tripling between 2022 and 2025 especially in Africa, due to climate shocks, population displacement, fragile water and sanitation systems, and delays in laboratory confirmation. Early detection is critical to interrupt transmission and reduce mortality, underscoring the need for decentralised point-of-care diagnostics. We conducted a prospective field evaluation of three cholera rapid diagnostic tests (RDTs): SD Bioline Cholera Ag O1/O139, Crystal VC O1, and Cholkit, during active cholera outbreaks in Cameroon. Tests were performed on fresh stool samples by laboratory technicians and by non-laboratory health workers at primary health-care facilities. Diagnostic performance was assessed using PCR as the reference standard. In a subset of samples, RDTs were also performed after alkaline peptone water (APW) enrichment to assess its effect on diagnostic accuracy. Inter-operator agreement and ease of use were evaluated. Among 492 suspected cholera cases enrolled, 377 samples had PCR results available for analysis. When performed at the point of care, RDT sensitivity ranged from 88% to 95%, comparable to laboratory-based testing, while specificity ranged from 72% to 85%. APW enrichment was associated with a consistent reduction in sensitivity across all three RDTs and reduced specificity for SD Bioline. Inter-operator agreement was high (Cohen's κ 0·81-0·89). More than 80% of end users reported that RDTs were easy to use under outbreak conditions. Cholera RDTs demonstrated high sensitivity, strong inter-operator reliability, and operational feasibility when deployed directly on fresh stool samples by non-laboratory staff. Integrating RDTs into decentralised surveillance systems, without APW enrichment, can accelerate outbreak detection and support timely response in high-burden, resource-limited settings.

IntroductionDelivery delays of laboratory results can result in death and/or economic loss to both the patient and the health system. Data is limited regarding turnaround time for tuberculosis testing in Cameroon. We evaluated intra- turnaround time in tuberculosis diagnosis, identified root causes, and brainstormed solutions to improve patient satisfaction.Materials and methodsIn this cross-sectional descriptive study, turnaround time for the pre-analytic phase was set at 3 hours, the analytic phase at 11 hours, and the post-analytic phase at 10 hours. The overall turnaround time was 24 hours. We used the Fishbone method of problem analysis involving the personnel of the Tuberculosis Reference Laboratory-Douala, to identify root causes. We brainstormed using the \"Whys\" causes of turnaround time failure during the process of tuberculosis diagnosis by GeneXpert MTB/RIF.ResultsWe analyzed samples from 526 clients. The median turnaround time was 45 (Range: 2-120) hours. A total of 216(41.1%) clients had a turnaround time failure. The turnaround time failures in the pre-analytic, analytic, and post-analytics phases were 64(29.6%), 128(59.3%), and 12(11.1%) respectively. Overall, 19 root causes of turnaround time failure were identified and grouped into six categories, namely: equipment, administration, technical-staff, environment, material, and method. Equipment maintenance (defective or non-calibrated modules) was the critical cause of turnaround time failures accounting for 86 (39.8%) of the overall turnaround time failure.Conclusionturnaround time in tuberculosis diagnosis is longer than expected, retarding patient care management. Focusing on equipment maintenance enhances the intra-laboratory testing process, thus improving overall patient satisfaction. The need for further studies to incorporate the extra-laboratory turnaround time in assessing the overall turnaround time is imperative.