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Developing a Sustainable Economy in Cameroon is an ambitious effort as the authors try to set a blue print for Cameroon's economy. In the 1980s facing economic crisis, and as dictated by the structural adjustment programme, Cameroon sharply cut public investment expenditures before later cutting government consumption which were followed by privatisation, liquidation of public companies and reduction in the size of the public sector. All these measures are believed to have had devastating effects on the economy. Given the performance of the economy so far the authors suggest that much more effort, with a strong commitment of the main stakeholders, is required to guarantee sustainable economic development in Cameroon. Truly, very few countries in Africa possess such enormous human and natural resources as Cameroon does. This volume brings out the challenges Cameroon faces in its quest for development as well as for designing appropriate strategies for addressing those development challenges.

Performance-based financing (PBF)—a supply-side strategy that incentivizes health providers based on predefined quality and quantity criteria—introduced an innovative approach to reaching the poor by means of using PBF equity instruments. These PBF equity instruments include paying providers more to reach out to poor women, selecting services used by the poor, subsidizing user fees to reduce out-of-pocket expenses, and adding complementary demand-side intervention. Before the implementation of the PBF equity instrument in Cameroon, there were few initiatives/schemes to enable the poor to access maternal health services. Moreover, there is a significant research gap on how the equity elements are defined and implemented across contexts. This study aims to understand (i) how health facilities define and classify the poor and vulnerable in the context of PBF, (ii) how the equity elements are implemented at the community and facility levels, and (iii) the potential impact on access to and the use of maternal health services at the facility level and challenges in the implementation process. We used key informant interviews and focus group discussions (FGDs) based on a grounded theory approach to gain an understanding of the social processes and experiences. Data were collected from three districts in the Southwest region of Cameroon from April 2021 to August 2021. Data were transcribed and analyzed using MaxQDA. The thematic analysis approach/technique was used to analyze data. Key informant interviews and focus groups were conducted with 79 participants, including 28 health professionals and service administrators, 27 pregnant women, and 24 community health workers in three districts. Health facilities employed various subjective approaches to assess and define poor and vulnerable (PAV) persons. Home visits were reported to have an impact in reaching the poor and vulnerable to improve access to maternal services. Meanwhile, a delay in the payment of PBF incentives was reported to be the main challenge that had a negative relationship with the consistent provision of care to the poor and vulnerable, especially in private health facilities. The theory generated from our findings suggests that the impact of the PBF equity elements specific to maternal health depends on (i) a shared understanding of the definition of PAV among different stakeholders, including providers and users, as well as how the PAV is operationalized (structure), and (ii) the appropriate and timely payment of incentives to health facilities and health providers.

This study aimed to determine the various predictors associated to poor outcomes in patients with traumatic brain injury at the University Teaching Hospital of Bamenda, Cameroon. This descriptive and observational study was conducted at the University Teaching Hospital of Bamenda, Cameroon from February 1st 2023 to May 31st 2023. We included all patients managed for TBI in the named hospital within the study period who gave their consent. A prospective inclusion of data was done using a pre-established technical form aimed at collecting sociodemographic information, mechanism of TBI, clinical/paraclinical parameters and Glasgow Outcome Score (GOS) at one month follow-up. Patients with GOS 1, 2, 3 and 4 were considered as having a poor outcome and good outcome for GOS 5. Data collected were entered and analysed using the SPSS statistical software version 25.0. We found 93 patients who were eligible as per selection criteria. Mean age at presentation was 34.8 ± 15.0 years and there was a male preponderance (87.1 %). Road traffic accident (72 %) was the most common cause of injury followed by assault (14 %) and falls (9.9 %). The overall mortality was 16.1 % and 76.3 % had a good recovery at one month. Poor outcome (GOS<4 at one month) on univariate analysis was associated with delay to treatment > 1 day (p = 0.007, OR = 4.603), GCS less than or equal to 8 (p = 0.000, OR = 3.948), pupillary abnormalities (p = 0.000, OR = 21.630), secondary LOC (p = 0.026, OR = 8.538), intracerebral hematoma (p = 0.036, OR = 3.600), use of diuretics (p = 0.000, OR = 12.143), oxygen saturation less than 90 % (p = 0.026, OR = 5.538) and use of oxygen (p = 0.001, OR = 9.940) in patients with TBI. However, on multivariate analysis, only the GCS (p = 0.044, OR = 12.152) and delay to treatment (p = 0.024, OR = 18.349) retained statistical significance as independent predictors of poor outcomes. Our study suggests that numerous clinical/paraclinical factors such as GCS and patient-related factors like delay in seeking medical care negatively impact outcomes in TBI. This stress the need to carry out adequate clinical evaluation and good therapeutic care by physicians as well as population sensitization in order to reduce the mortality and morbidity related to TBI. Further prospective studies on larger sample size and a longer study period on outcome evaluation are warranted to provide more statistical power to our observations. •Traumatic brain injury is mostly seen in young male patients.•The Glasgow Coma scale and the Glasgow outcomes scale are used to assess the TBI severity and outcomes.•Low Glasgow Coma Scale and delayed treatment are associated to poor outcomes.

Background According to the 2018 Demographic and Health Survey, undernutrition remains a public health problem among Cameroonian children under-five. This varies across the country, greatest in areas with ongoing humanitarian crisis, such as the Southwest region. However, data on the burden of undernutrition in the Southwest region is sparse. This study aimed to assess the prevalence and predictors of undernutrition among children under-five in the Buea health district of the Southwest region of Cameroon. Methods This was a community based cross-sectional study of 321 children under-five/caretaker pairs, surveyed from households selected using multistage randomized sampling. Data were collected by trained data collectors, with the aid of a structured, pre-tested questionnaire that captured information on sociodemographic characteristics, food security, dietary diversity and anthropometric measurements. The weight, height/length and mid upper arm circumference (MUAC) were measured using standardized instruments. Stunting, Wasting and Underweight of children were calculated from Z-scores of Height-for-age (HAZ), Weight-for-height (WHZ) and Weight-for-age (WAZ) based on 2006 WHO standards. Data was analysed using SPSS version 27.0. Predictors of malnutrition were obtained using multivariate logistic regression, adjusting for potential confounders. Results Overall, 31.8% (102/321) of the children were undernourished (26.5% stunted, 1.6% underweight, 3.7% wasted). Drinking water from inappropriate sources (OR: 2.32, 95% CI: 1.30–4.15) and a Dietary Diversity Score < 4 (OR: 2.59, 95%CI: 1.46–4.61) were independently associated with increased risk of stunting. Children of the male sex were more likely to be wasted than females (OR: 5.34, 95%CI: 1.09–26.14). Conclusion Childhood undernutrition, particularly stunting is common in the Buea Health District. Risk factors of undernutrition identified are potentially modifiable, highlighting the need for nutrition specific and sensitive interventions to improve dietary diversity, and the need to improve access to safe drinking water, and educate caretakers on the importance of clean potable water, good sanitation and hygiene for the proper growth and development of their children.

From field observations of credit cooperatives in Cameroon, we find that 19% of the loans taken are fully collateralized by savings held in the same institutions. This behavior is costly to the borrower, as it represents a net interest payment of about 24% per year. While traditional explanations may partly explain this behavior, interviews with members of the cooperatives suggest the following new rationale: members resort to borrowing to signal to friends and relatives that they are poor and do not have savings available. By doing so, they can avoid requests for financial help. We develop a signaling model to analyze the conditions under which this behavior is an equilibrium outcome.

Abstract This analysis describes specific gaps in the quality of health care in Central Africa and assesses the association between quality of clinical care and mortality at age 2–59 months. Regionally representative facility and household surveys for the Democratic Republic of the Congo, Cameroon and Central African Republic were collected between 2012 and 2016. These data are novel in linking facilities with households in their catchment area. Compliance with diagnostic and danger sign protocols during sick-child visits was observed by trained assessors. We computed facility- and district-level compliance indicators for patients aged 2–59 months and used multivariate multi-level logistic regression models to estimate the association between clinical assessment quality and mortality at age 2–59 months in the catchment areas of the observed facilities. A total of 13 618 live births were analysed and 1818 sick-child visits were directly observed and used to rate 643 facilities. Eight percent of observed visits complied with 80% of basic diagnostic protocols, and 13% of visits fully adhered to select general danger sign protocols. A 10% greater compliance with diagnostic protocols was associated with a 14.1% (adjusted odds ratio (aOR) 95% CI: 0.025–0.244) reduction in the odds of mortality at age 2–59 months; a 10% greater compliance with select general danger sign protocols was associated with a 15.3% (aOR 95% CI: 0.058–0.237) reduction in the same odds. The results of this article suggest that compliance with recommended clinical protocols remains poor in many settings and improvements in mortality at age 2–59 months could be possible if compliance were improved.

This paper analyzes the effects of the accumulating human capital proxied with the educational level on the decision to work as self-employed in Cameroon. The methodological approach mobilizes discrete-choice models on data drawn from the second Employment and Informal Sector Survey carried out by the National Institute of Statistics. By releasing the hypothesis of the uniqueness of the labor market and assuming that decisions to work as wage earned and as self-employed are occupational choices, empirical findings reveal that the willingness to become self-employed declines with the increase of the accumulating human capital. This main result suggests that becoming self-employed in Cameroon is not a return to human capital accumulation but a default option which is probably derived from the poor wage employment opportunities and the prevalence of the informal sector. By also suggesting that opportunity motivation is less common among individuals with a higher level of education, another explanation for this result may be the lack of formal entrepreneurial culture as well as educational and training programs targeting entrepreneurial skills development.

The increasing human population is indeed responsible for the upsurge in the demand for cocoa products and the saddling pressure on the global cocoa market. Sadly, the contributions of some major producers like Nigeria, Brazil, Ghana, to the global cocoa market is dwindling (while others are appreciating). Climate change, diseases and poor farm management have been identified as major factors affecting global cocoa production. Nigeria, was the major focus of this research. Cocoa farms were investigated (Nigeria only), black pod disease (BPD) pressure was described by ETAPOD (a model for black pod disease prediction), while climate and cocoa production data were obtained from the relevant databases. On the global scene, Ghana, Nigeria, Cameroon, Brazil, Ecuador and Colombia experienced shortfall in their contribution to global cocoa production from 26.15, 20.55, 7.45, 12.14, 4.07, and 1.40%, respectively (1970s), to 16.99, 6.31, 5.67, 4.54, 3.96, and 1.09%, respectively (2000s). Cross River State, Nigeria's leading producer of cocoa (1970–1990s) is currently ranked 3rd in the nation. Unfortunately, cocoa farmers in Nigeria are completely dependent on pesticide application (100%) to save their crops. A prognosis of global BPD outbreak showed that Honduras (15.1%) and Lagos, Nigeria (14.4%) are foremost hotspots for BPD invasion. Hopefully, scientific advancement in cocoa production might be the key to these problems.

Background We undertook a modified systematic review of research regarding educational approaches to and effectiveness of pre-registration palliative care nursing, to inform the development of a short course in palliative care for pre-registration nursing students in Cameroon. The aim of this review was to examine educational approaches applied to pre-registration palliative care nursing education and their effectiveness, and to discuss implications for the development of palliative care curricula in resource-poor countries. Method A modified systematic review of research on palliative care educational interventions, conducted with pre-registration student nurses was undertaken. Relevant literature was gathered from CINAHL, EMBASE, MEDLINE and PsychINFO databases for the period 2000–2013. Inclusion was limited to studies of educational interventions evaluating the effectiveness and outcomes of palliative and end of life care education with pre-registration student nurses. Results 17 studies were found, all of which were conducted in resource-rich countries: United States of America, Canada, Australia, and United Kingdom. Palliative care nursing education at pre-registration level is either delivered as a discrete course within the curriculum or palliative care content is embedded into other nursing specialty courses throughout the wider curriculum. Palliative care education is delivered to students at a variety of stages in their nursing program, using a mix of both didactic and experiential educational strategies. Course facilitators span palliative care specialists, educators who have attended ‘train-the-trainer’ courses in palliative care, and nurses with hospice experience. Education is underpinned by transformative and experiential learning theories and reported as effective in improving students’ attitudes towards care of the dying. Conclusion The educational strategies identified in this review may be applicable to resource-poor countries. However, there are challenges in transferability because of the lack of availability of specialist palliative care practitioners who can serve as educators, specialist palliative care units/institutions for experiential learning, funds to design and use high fidelity simulations, and palliative care textbooks and other educational materials. There is thus a need for innovative educational strategies that can bridge these barriers in resource-poor countries. There is also a need for further research into how palliative care education impacts on pre-registration student nurses’ knowledge and practice.