Ignatius Ndong | Catholic University of Cameroon, Bamenda, Cameroon (original) (raw)

Papers by Ignatius Ndong

Research Square (Research Square), Jan 31, 2024

Research Square (Research Square), Nov 13, 2019

Background: Global efforts to scale-up malaria control interventions are gaining steam. These inc... more Background: Global efforts to scale-up malaria control interventions are gaining steam. These include the use of Long-Lasting Insecticide Nets, Indoor Residual Spraying, Intermittent Preventive Treatment and Test, Treat and Track. Despite these, the drive for malaria elimination is far from being realistic in endemic communities in Africa. This is partly due to the fact that asymptomatic parasite carriage, not specifically targeted by most interventions, remains the bedrock that fuels transmission. This has led to mass testing, treatment and tracking (MTTT) as an alternative strategy to target asymptomatic individuals. We report the impact of MTTT on the prevalence of asymptomatic malaria parasitaemia over a one-year period in Ghana, hypothesizing that implementing MTTT could reduce the rate of asymptomatic parasitaemia. Methods: A population of about 5,000 individuals in seven communities in the Pakro sub-district of Ghana participated in this study. A register was developed for each community following a census. MTTT engaged trained community-based health volunteers who conducted house-to-house testing using RDTs every four months and treated positive cases with Artemisinin-based Combination Therapy. Between interventions, community-based management of malaria was implemented for symptomatic cases. Results: MTTT Coverage was 98.8% in July 2017 and 79.3% in July 2018. Of those tested, asymptomatic infection with malaria parasites reduced from 36.3% (1,795/4941) in July 2017 to 32.9% (1,303/3966) in July 2018 (p=0.001). Prevalence of asymptomatic parasitaemia among children under 15 years declined from 52.6% (1,043/1984) in July 2017 to 47.5% (820/1,728) in July 2018 (p=0.002). Implementing MTTT significantly reduced asymptomatic parasitaemia by 24% from July 2017 to July 2018 after adjusting for age, ITN use and axillary temperature (OR=0.76, CI=0.67, 0.85 p≤0.001). Conclusion: This study has demonstrated that implementing MTTT is feasible and could reduce the prevalence of asymptomatic malaria parasitaemia in children under 15 years of age. Furthermore, the use of community-based health volunteers could ensure high coverage at lower cost of implementation.

Research Square (Research Square), May 14, 2024

Background Malaria remains a serious health challenge; thus, the need for continual improvements ... more Background Malaria remains a serious health challenge; thus, the need for continual improvements in treatment regimens and the adoption of new treatment guidelines to enhance case management is vital. We report trends in malaria case management over a 16-year period at the Jakiri Health Centre in Cameroon, an area that has been plagued with civil unrest since 2016. Methods Data were collected retrospectively from consultation, laboratory, and prescription registers and double entered into Excel. Analysis was conducted using SPSS statistics and Microsoft Excel. Results A total of 3,800 febrile patients visited the outpatient department (OPD), and 8,324 prescriptions were received by patients. Of these prescriptions, 11.6% (964) were anti-malarials, 3.5% (291) were ferrous sulfate (FS), 40.8% (3,396) were antibiotics (AB), and 44.1% (3,673) were analgesics. The antimalarials prescribed were artemisinin-based combination therapies (ACTs) 83.2% (802) and quinine (Q) 16.8% (162). No ACTs were prescribed between 2006 and 2011. The 5 to < 15 years age group received the highest proportion of ACTs (42.3%), followed by the 1 to < 5 years age group (31.8%). Males were more likely to be prescribed ACTs than females were (OR = 1.336, 95% CI 1.141-1.564; p < 0.0001). Between 2006 and 2013, the number of quinine prescriptions increased from 17.2% (21) in 2006 to a peak of 26.1% (30) in 2009 and progressively decreased to 0% between 2014 and 2019. Antibiotic prescription rates were high across all age groups. Analgesics were prescribed to all patients across age groups for malaria-positive patients. The prescription of antimalarials to malaria-negative patients was relatively low over time. Conclusion This study demonstrated that recommended malaria treatment guidelines have been adopted by the Jakiri Health Centre, which has transitioned from quinine as a rst-line treatment to ACTs. ACTs were not used in the facility until 2012. The prevalence of malaria is still very high, and most anti-malaria treatments are appropriate. However, antibiotics and analgesics were found to be highly prescribed. Contribution to literature 1. This is the rst account of malaria case management over 16 years following the adoption of 2004 malaria treatment guidelines in Jakiri an area with civil unrest. Page 3/17 2. Adherence to the treatment guidelines signi cantly improved over time with few patients receiving treatment for malaria with negative results. 3. The prescription of antibiotics to both malaria-positive and negative patients was very high throughout the study period.

Research Square (Research Square), Nov 21, 2019

Malaria Journal

Background Prompt diagnosis and treatment of malaria prevents a mild case from developing into se... more Background Prompt diagnosis and treatment of malaria prevents a mild case from developing into severe disease and death. Unfortunately, parasitological testing of febrile children is greater in the public and formal private sector than in the informal private sector where many patients with malaria-like symptoms first seek treatment. This study was aimed at improving implementation of the T3 policy among OTCMS using some interventions that could be scaled-up easily at the national level. Methods Interventions were evaluated using a two-arm, cluster randomized trial across 8 rural communities (4 clusters per arm), in two adjacent districts of Ghana. A total of 7 OTCMS in the intervention arm and 5 OTCMS in the control arm in the selected communities participated in the study. Five interventions were implemented in the intervention arm only. These were acquisition of subsidized malaria rapid diagnostic test (RDT) kits, training of OTCMS, supportive visits to OTCMS, community sensitiza...

Scientific Reports

The coronavirus disease 2019 (COVID-19) pandemic devastated countries worldwide, and resulted in ... more The coronavirus disease 2019 (COVID-19) pandemic devastated countries worldwide, and resulted in a global shutdown. Not all infections are symptomatic and hence the extent of SARS-CoV-2 infection in the community is unknown. The paper presents the dynamics of the SARS-CoV-2 epidemic in the Greater Accra Metropolis, describing the evolution of seroprevalence through time and by age group. Three repeated independent population-based surveys at 6-week intervals were conducted in from November 2020 to July 2021. The global and by age-groups weighted seroprevalences were estimated and the risk factors for SARS-CoV-2 antibody seropositivity were assessed using logistic regression. The overall age-standardized SARS-CoV-2 antibody seroprevalence for both spike and nucleocapsid increased from 13.8% (95% CI 11.9, 16.1) in November 2020 to 39.6% (95% CI 34.8, 44.6) in July 2021. After controlling for gender, marital status, education level, and occupation, the older age group over 40 years had...

PLOS ONE

Background Mass test, treat and track (MTTT) of malaria is ongoing in the Pakro sub district of G... more Background Mass test, treat and track (MTTT) of malaria is ongoing in the Pakro sub district of Ghana. In the delivery of MTTT of malaria, community health volunteers are trained to routinely provide this service through a door-to-door strategy. Following the report of the first cases of COVID-19 in Ghana, we conducted this study to explore the effects of the pandemic on the implementation of the MTTT of malaria intervention. Methods Using qualitative methodology, we conducted ten focus groups discussions (FGDs) in eight communities: eight with community members (N = 49); one with health workers (N = 6), and one with MTTT of malaria volunteers. In addition, two in-depth interviews (IDI) were conducted, one with health worker and another with a health manager. All interviews were recorded, translated into English during transcription and analysed using QSR NVivo 12. Thematic content analysis was used in this study. Results The findings of the study showed an increase in the number of...

Pathogens

Background: Malaria remains a serious threat to children under 15 years of age in sub-Sahara Afri... more Background: Malaria remains a serious threat to children under 15 years of age in sub-Sahara Africa. Mass testing, treatment and tracking (MTTT) of malaria has been reported to reduce parasite load significantly. However, the impact of MTTT on the prevalence of febrile illnesses in children under 15 is not yet clear. This study explores the impact of MTTT complemented by prompt home-based management of malaria on febrile illnesses and their treatment in children under 15 years old. Methods: A cohort of 460 children under 15 years were recruited from the Pakro subdistrict in Ghana during a community-wide implementation of a quarterly MTTT intervention. The MTTT implementation involved testing all household members for malaria using RDTs, and positive cases were treated with Artemisinin-based combination therapy (ACT). Febrile illnesses among this cohort in the two weeks prior to the prevalence survey at baseline and endline were recorded to constitute date for analysis. Results: The ...

Universal Journal of Public Health, 2017

Diarrhoea remains a major public health concern of our times with bad drinking water and frequent... more Diarrhoea remains a major public health concern of our times with bad drinking water and frequent poor disposal of human waste matter. Caused by a variety of conditions, it spans from diarrhoea which are of viral bacterial to sometimes metal intoxication. In Cameroon, it is one of the 10 major causes of illness. To assess the burden and lost income due to diarrhoea, the study quantified how much households in the Bamenda Health District (BHD), North West Region (NWR) of Cameroon are losing because of the incidence of diarrhoea related infections. A cluster sampling technique was used to select 8 Public Integrated Health Centres in 8 Health Areas, with an estimated population of about 189,730 people. Data for all reported diarrhoea cases for 2011 and 2012 was collected from the Health Centres. The Cost of Illness (CoI) methodology was used to quantify the direct and indirect cost of diarrhoea infections. It was estimated that about USD22, 361 and USD37, 198 was lost by households in general in 2011 and 2012 respectively. The economic burden over the two years was estimated at USD53, 602.3. If this amount were projected over 10 years it will imply that about USD260, 000 will be lost to the treatment of diarrhoea infections.

Acta Tropica, 2015

National malaria treatment policies are devised to guide health professionals and to facilitate d... more National malaria treatment policies are devised to guide health professionals and to facilitate diagnosis and case management. Following the recommendations of the WHO, Cameroon changed its malaria treatment policy from monotherapy to artemisinin-based combination therapy (ACT) as the first-line treatment for uncomplicated malaria. We report an investigation into trends of case management following this change in policy. Data was collected retrospectively, through consultation and perusal of laboratory and prescription registers of the Mbakong Health Centre. Analysis of data was done using SPSS and SAS Statistics. Data presented herein demonstrate that from 2006-2012, a total of 2,484 (58.7%) of the total prescriptions included an anti-malarial, 1,989 (47.0%) included an antibiotic and 1,935(45.7%) included an antipyretic. The anti-malarials prescribed were Anti-malaria combination therapy (ACT)-1,216 (47.6%), quinine 1,044 (40.8%) or SP 296 (11.6%). Of the 1,216 patients prescribed an ACT, 441(36.3%) had a positive malaria parasite confirmation, 746 (61.3%) were negative for plasmodium. Overall, 29 patients (2.4%) were treated either with an ACT without any test performed. Quinine intake was recorded in 566 (54.2%) patients positive for plasmodium. ACT prescription increased from 23% in 2007 to between 44%-45% in 2008-2009. During this period there was a corresponding drop in the prescription of quinine from 38% in 2007 to 13% in 2009 (r =-0.43, p>0.05). Sulphadoxine-Pyrimethamine (SP) was restrictively prescribed to women of childbearing age (97.0%) after 2008. Antibiotics prescription dropped from 53.7% to 39.3% from 2010-2012. The odds of being prescribed an antibiotic was significantly higher in patients with a malaria negative result compared to malaria positive patients (OR=6.12, CI 4.74-7.91, p<0.00001). Overall, there is an over treatment of malaria, thus departing from the WHO guidelines of appropriate treatment. Although there is an overall increase in the prescription of ACT, less prescription of quinine and a noticeable restrain from prescription of SP to febrile cases, the old practice was still rampant. There is need for healthcare workers to adhere to guidelines in order to enhance the rational use of drugs to achieve appropriate treatment of uncomplicated malaria according to WHO guidelines.

BMC Public Health

Background: Malaria remains endemic in Ghana despite several interventions. Studies have demonstr... more Background: Malaria remains endemic in Ghana despite several interventions. Studies have demonstrated very high levels of asymptomatic malaria parasitaemia in both under-five and school-age children. Mass testing, treatment and tracking (MTTT) of malaria in communities is being proposed for implementation with the argument that it can reduce parasite load, amplify gains from the other control interventions and consequently lead to elimination. However, challenges associated with implementing MTTT such as feasibility, levels of coverage to be achieved for effectiveness, community perceptions and cost implications need to be clearly understood. This qualitative study was therefore conducted in an area with ongoing MTTT to assess community and health workers' perceptions about feasibility of scale-up and effectiveness to guide scale-up decisions. Methods: This qualitative study employed purposive sampling to select the study participants. Ten focus group discussions (FGDs) were conducted in seven communities; eight with community members (n = 80) and two with health workers (n = 14). In addition, two in-depth interviews (IDI) were conducted, one with a Physician Assistant and another with a Laboratory Technician at the health facility. All interviews were recorded, transcribed, translated and analyzed using QSR NVivo 12. Results: Both health workers and community members expressed positive perceptions about the feasibility of implementation and effectiveness of MTTT as an intervention that could reduce the burden of malaria in the community. MTTT implementation was perceived to have increased sensitisation about malaria, reduced the incidence of malaria, reduced household expenditure on malaria and alleviated the need to travel long distances for healthcare. Key challenges to implementation were doubts about the expertise of trained Community-Based Health Volunteers (CBHVs) to diagnose and treat malaria appropriately, side effects of Artemisinin-based Combination Therapies (ACTs) and misconceptions that CBHVs could infect children with epilepsy. Conclusion: The study demonstrated that MTTT was perceived to be effective in reducing malaria incidence and related hospital visits in participating communities. MTTT was deemed useful in breaking financial and geographical barriers to accessing healthcare. The interventions were feasible and acceptable to community members, despite observed challenges to implementation such as concerns about CBHVs' knowledge and skills and reduced revenue from internally generated funds (IGF) of the health facility.

BMJ Global Health

BackgroundGlobal efforts to scale up malaria control interventions that work, are gaining momentu... more BackgroundGlobal efforts to scale up malaria control interventions that work, are gaining momentum. These include the use of long-lasting insecticide nets, intermittent preventive treatment and test, treat and track using artemisinin-based combination therapies. Mass testing, treatment and tracking (MTTT) of the entire populations complemented by home-based management (HBM) using volunteers could be an effective approach at lower cost. MTTT of children in Ghana has demonstrated a parasite load reduction of 90%. However, unanswered questions include – Could this be scaled-up? What proportion of the community could be covered? What do we need? Can MTTT reduce asymptomatic parasitaemia levels in under-15 children?MethodsThe target population for this study was 5000 asymptomatic individuals in seven communities in the Pakro subdistrict in Ghana. A community register was developed following a census. Community volunteers conducted quarterly house-to-house testing (using RDTs) and treatin...

Universal Journal of Public Health

Access to health care is a fundamental human right, which places a legal obligation on states to ... more Access to health care is a fundamental human right, which places a legal obligation on states to ensure access to quality, timely, acceptable, and affordable health care for its citizens. However, many states struggle to meet this basic right for their citizens given that every year about 100 million people are pushed into poverty, while 150 million people suffer financial catastrophe due to out of pocket payments for health. In Cameroon, studies have shown that about 64% of households cannot access healthcare, because they perceive the cost of care to be high. In 2012, the National Health Accounts (NHA) estimated that about 70% of the Total Health Expenditure (THE) for the country was borne by households. Compared to its peers, the contribution of Cameroonian households is the third highest in Sub-Saharan Africa, where the average is 34%. To remedy this situation, Cameroon has initiated reflections aimed at establishing a universal health coverage (UHC) scheme for its population. This paper therefore aimed at providing a synthesis of Cameroon's progress and assessing if the country is on track to achieving UHC by 2035.

Universal Journal of Public Health

Cameroon faces significant income and health inequalities, due to the health sector's reliance on... more Cameroon faces significant income and health inequalities, due to the health sector's reliance on out-of-pocket spending for 70% of healthcare financing. To solve this problem, the government in 2015 began reflections for the putting in place of a universal health coverage (UHC) scheme. However, a number of planning, budgeting and resource management processes must be strengthened to facilitate this reform. This paper aims at reviewing the structure of resource allocation within the ministry of health to assess if it reflects the government's desire to enhance service availability and readiness for the impending UHC. Data was derived from finance laws (chapter 40) of 2014 to 2018. The data was analyzed using Microsoft Excel. The results reveal a high centralization of the budget in favor of the central administration to the detriment of the operational level. Allocations to the regional and district levels are insensitive to the size and needs of the population of the regions and districts. As a consequence, there are great disparities between the regions and between urban and rural areas, leading to inequity in service delivery. In order to increase the quantity and quality of primary care in an effort to reach UHC, we recommend that more resources be directed to the operational level while district managers are capacitated to effectively and efficiently use these funds.

Diarrhoea remains a major public health concerns of our times with bad drinking water and frequen... more Diarrhoea remains a major public health concerns of our times with bad drinking water and frequent poor disposal of human waste matter. Caused by a variety of conditions, it spans from diarrhoea which are of viral bacterial to sometimes metal intoxication. In Cameroon, it is one of the 10 major cause of illness. To assess the burden and lost income due to diarrhoea, the study quantifying how much households in the Bamenda Health District (BHD), NWR of Cameroon are losing because of the incidence of diarrhoea related infections. A cluster sampling technique was used to select 8 Public Integrated Health Centres in 8 Health Areas, with an estimated population of about 189,730 people. Data for all reported diarrhoea cases for 2011 and 2012 was collected from the Health Centres. The Cost of Illness (CoI) methodology was used to quantify the direct and indirect cost of diarrhoea infections. It was estimated that about USD22, 361 and USD37, 198 was lost by households in general in 2011 and 2012 respectively. The economic burden over the two years was estimated at USD53, 602.3. If this amount were projected over 10 years it will imply that about USD260, 000 will be lost to the treatment of diarrhoea infections.

Malaria Journal, 2014

Malaria is the leading cause of death worldwide. It is urgent to assess the impact of interventio... more Malaria is the leading cause of death worldwide. It is urgent to assess the impact of interventions and scaled-up control efforts. Despite reported reduction in malaria prevalence in Africa, the trends in Cameroon are not yet fully understood. The aim of this study was to investigate the trends in malaria admissions among febrile patients seeking treatment over a seven-year period (2006-2012) in an endemic area in Cameroon, hypothesizing a declining trend. This period followed changes in malaria treatment policy. The objectives were to identify possible trends in malaria admissions and to evaluate the impact of changes to treatment guidelines on the prevalence. Data was collected through consultation and perusal of laboratory and prescription registers of the Mbakong Health Centre. Data analysis was conducted using SPSS and SAS Statistics. Analysis revealed that 4,230 febrile patients were received from 2006-2012. Of these febrile cases, 29.30% were confirmed positive. Between 2006 and 2012 confirmed malaria positive cases of those tested fluctuated, dropping from 53.21% in 2006 to 17.20% in 2008; then rising to 35.00% in 2011 and, finally, dropping to 18.2% of those tested in 2012. The prevalence in females and males across all age groups were similar: a slightly higher risk of males to have malaria (OR = 1.08, 95% CI 0.94-1.25) were not practically significant. Of those tested, the 5 to &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 15 years and the 1 to &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 5 years age groups were the hardest hit by malaria in the area. A practically visible and significant association was observed between the age and gender with regards to the number of malaria positive results (Pearson ×2 = 153.675, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.00001, Cramer&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s V = 0.352). Malaria prevalence exhibited a fluctuating yet declining trend, as observed over the 28 quarters between January, 2006 and December, 2012. The changes to the treatment guidelines appear to result in a declining trend as was observed between 2006 and 2008. However, malaria admissions fluctuated between 2008 and 2012. There is, therefore, a need to step up control efforts of especially the vulnerable groups, such as the very young.

Malaria Journal, 2014

Research Square (Research Square), Jan 31, 2024

Research Square (Research Square), Nov 13, 2019

Research Square (Research Square), May 14, 2024

Research Square (Research Square), Nov 21, 2019

Malaria Journal

Scientific Reports

PLOS ONE

Pathogens

Universal Journal of Public Health, 2017

Acta Tropica, 2015

BMC Public Health

BMJ Global Health

Universal Journal of Public Health

Malaria Journal, 2014