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Papers by Nimpa Marcellin
Journal of Vaccines & Vaccination
Background and objective: Vaccination has been hailed as one of the most cost-effective public he... more Background and objective: Vaccination has been hailed as one of the most cost-effective public health intervention in modern medical history. For this intervention to be effective, vaccines must be stored and transported within the recommended temperatures ranges of 2°C to 8°C. However, few studies have investigated compliance to this recommendation. This study was designed to evaluate vaccine exposure to temperatures outside the recommended range during storage and transport within Cameroon's cold chain system. Methods: Forty-eight shipment boxes were prepared and placed at the National Vaccine Store on October 24, 2015. Each shipment contained ten vials of Diphtheria-Tetanus and Pertussis containing vaccines, a monitoring form and a datalogger. The dataloggers were programmed to continuously record temperatures as shipments moved from the National Vaccine Store to 48 target health facilities. Results: Regarding freeze exposure, 83% of shipments were exposed to freezing at one point during the study. During storage, freeze exposures were highest at the facility level (51%), followed by the district level (31%). The minimum temperatures reached ranged from-0.5°C to-23.8°C. Unlike freezing, all shipments were exposed to temperatures above 8°C at one point. 96% of shipments were exposured to temperatures above 8°C for over 10 h. During storage, heat exposures were highest at facility level, followed by district level. Transport was a major contributor to both heat and freeze exposures. The heavy use of outdated and uncertified cold chain equipment and gaps in healthcare worker knowledge, attitudes and practices were important contributors to inadvertent exposures. Conclusion: The findings suggest that the exposure of vaccines to temperatures outside the recommended range is a widespread problem in Cameroon. This problem requires urgent attention as it represents a real risk to the effectiveness of the immunization program.
PLoS Neglected Tropical Diseases, 2013
Background: Cameroon is known to be endemic with trachoma. To appreciate the burden of the diseas... more Background: Cameroon is known to be endemic with trachoma. To appreciate the burden of the disease and facilitate the national planning of trachoma control in the integrated control program for the neglected tropical diseases, an epidemiological mapping of trachoma was conducted in the Far North region in 2010-11. Methodology: A cross-sectional, cluster random sampling survey was carried out. The survey focused on two target populations: children aged 1 to 9 years for the prevalence of active trachoma and those aged 15 and over for the prevalence of trichiasis (TT). The sample frame was an exhaustive list of villages and neighborhoods of Health Districts (HDs). The World Health Organization simplified trachoma grading system was used for the recognition and registration of cases of trachoma. Principal Findings: 48,844 children aged 1 to 9 years and 41,533 people aged 15 and over were examined. In children aged 1-9 years, the overall prevalence of trachomatous inflammation-follicular (TF) was 11.2% (95% confidence intervals (CI): 11.0-11.5%). More girls were affected than boys (p = 0.003). Thirteen (13) of 27 HDs in the region showed TF prevalence of $10%. The overall TT prevalence was 1.0% (95% CI: 0.9-1.1%). There were estimated 17193 (95% CI: 12576-25860) TT cases in the region. The prevalence of blindness was 0.04% (95% CI: 0.03-0.07%) and visual impairment was 0.09% (95% CI: 0.07-0.13%). Conclusions/Significance: The survey confirmed that trachoma is a public health problem in the Far North region with 13 HDs qualified for district-level mass drug administration with azithromycin. It provided a foundation for the national program to plan and implement the SAFE strategy in the region. Effort must be made to find resources to provide the surgical operations to the 17193 TT cases and prevent them from becoming blind.
Journal of Vaccines & Vaccination
Background and objective: Vaccination has been hailed as one of the most cost-effective public he... more Background and objective: Vaccination has been hailed as one of the most cost-effective public health intervention in modern medical history. For this intervention to be effective, vaccines must be stored and transported within the recommended temperatures ranges of 2°C to 8°C. However, few studies have investigated compliance to this recommendation. This study was designed to evaluate vaccine exposure to temperatures outside the recommended range during storage and transport within Cameroon's cold chain system. Methods: Forty-eight shipment boxes were prepared and placed at the National Vaccine Store on October 24, 2015. Each shipment contained ten vials of Diphtheria-Tetanus and Pertussis containing vaccines, a monitoring form and a datalogger. The dataloggers were programmed to continuously record temperatures as shipments moved from the National Vaccine Store to 48 target health facilities. Results: Regarding freeze exposure, 83% of shipments were exposed to freezing at one point during the study. During storage, freeze exposures were highest at the facility level (51%), followed by the district level (31%). The minimum temperatures reached ranged from-0.5°C to-23.8°C. Unlike freezing, all shipments were exposed to temperatures above 8°C at one point. 96% of shipments were exposured to temperatures above 8°C for over 10 h. During storage, heat exposures were highest at facility level, followed by district level. Transport was a major contributor to both heat and freeze exposures. The heavy use of outdated and uncertified cold chain equipment and gaps in healthcare worker knowledge, attitudes and practices were important contributors to inadvertent exposures. Conclusion: The findings suggest that the exposure of vaccines to temperatures outside the recommended range is a widespread problem in Cameroon. This problem requires urgent attention as it represents a real risk to the effectiveness of the immunization program.
PLoS Neglected Tropical Diseases, 2013
Background: Cameroon is known to be endemic with trachoma. To appreciate the burden of the diseas... more Background: Cameroon is known to be endemic with trachoma. To appreciate the burden of the disease and facilitate the national planning of trachoma control in the integrated control program for the neglected tropical diseases, an epidemiological mapping of trachoma was conducted in the Far North region in 2010-11. Methodology: A cross-sectional, cluster random sampling survey was carried out. The survey focused on two target populations: children aged 1 to 9 years for the prevalence of active trachoma and those aged 15 and over for the prevalence of trichiasis (TT). The sample frame was an exhaustive list of villages and neighborhoods of Health Districts (HDs). The World Health Organization simplified trachoma grading system was used for the recognition and registration of cases of trachoma. Principal Findings: 48,844 children aged 1 to 9 years and 41,533 people aged 15 and over were examined. In children aged 1-9 years, the overall prevalence of trachomatous inflammation-follicular (TF) was 11.2% (95% confidence intervals (CI): 11.0-11.5%). More girls were affected than boys (p = 0.003). Thirteen (13) of 27 HDs in the region showed TF prevalence of $10%. The overall TT prevalence was 1.0% (95% CI: 0.9-1.1%). There were estimated 17193 (95% CI: 12576-25860) TT cases in the region. The prevalence of blindness was 0.04% (95% CI: 0.03-0.07%) and visual impairment was 0.09% (95% CI: 0.07-0.13%). Conclusions/Significance: The survey confirmed that trachoma is a public health problem in the Far North region with 13 HDs qualified for district-level mass drug administration with azithromycin. It provided a foundation for the national program to plan and implement the SAFE strategy in the region. Effort must be made to find resources to provide the surgical operations to the 17193 TT cases and prevent them from becoming blind.