Raoul Kamadjeu

In April 2013, a case of wild polio virus (WPV) was detected in the Somalia capital Mogadishu. This inaugurated what is now referred to as the 2013-2014 Horn of Africa Polio outbreak with cases reported in Somalia, Kenya and Ethiopia. By the notification of the last polio case in August 2014, 223 cases of WPV had been reported in Somalia, Kenya and Ethiopia of which 199 in Somalia alone. The outbreak response required timely exchange of information between the outbreak response coordination unit (in Nairobi) and local staff located in multiple locations inside the country. The need to track and timely respond to information requests, to satisfy the information/data needs of polio partners and to track key outbreak response performance indicators dictated the need to urgently set up an online dashboard. The Somalia Polio Room dashboard provided a graphical display of the polio outbreak data to track progress and inform decision making. The system was designed using free and open sources components and seamlessly integrated existing polio surveillance data for real time monitoring of key outbreak response performance indicators. In this article, we describe the design and operation of an electronic dashboard for disease surveillance in an outbreak situation and used the lessons learned to propose key design considerations and functional requirements for online electronic dashboards for disease outbreak response.

Somalia, one of the most unstable countries in the world, has been without a permanent government for nearly 2 decades. With a health system in total disarray, coverage of basic health interventions remains low and, maternal and child mortality is among the highest in the world. Health partners jointly outlined an integrated package of critical child survival interventions to be delivered through a population-based delivery strategy known as Child Health Days (CHDs), to reduce child mortality. Using this strategy, key child survival interventions are delivered to the community with an objective of reaching children <5 years and women of childbearing age in all districts of Somalia every 6 months. Through this strategy, immunization services were reached in remote areas, and coverage disparity between the urban and rural areas was reduced from 17% (42% urban and 25% rural) to 10% (50% urban and 60% rural). In addition, infants were reached with a third dose of diphtheria-pertussis-tetanus vaccine, achieving 51% coverage during 2009 and 66% in 2010. This paper summarizes the challenges of scaling up child interventions in the troubled context of Somalia by reviewing the planning, implementation, and achievements of CHDs as well as reflecting on challenges for the future of child survival in Somalia.

The objective of the study was to provide baseline and reference data on the prevalence and distribution of overweight and obesity, using different anthropometric measurements in adult urban populations in Cameroon. The Cameroon Burden of Diabetes Baseline Survey was a cross-sectional study, conducted in 4 urban districts (Yaoundé, Douala, Garoua and Bamenda) of Cameroon, using the WHO Step approach for population-based assessment of cardiovascular risk factors. Body mass index, waist circumference and waist-to-hip ratio were measured using standardized methods. Overall, 10,011 individuals, 6,004 women and 4,007 men, from 4,189 households, aged 15 years and above participated. Based on body mass index, more than 25% of urban men and almost half of urban women were either overweight or obese with 6.5% of men and 19.5% of women being obese. The prevalence of obesity showed considerable variation with age in both genders. Using body mass index provided the highest prevalence of obesity in men (6.5%) and waist-to-hip ratio the lowest prevalence (3.2%). Among women, using waist-to-hip ratio and waist circumference yielded the highest prevalence of obesity (28%) and body mass index the lowest (19.5%). There was a trend towards an increase in age-adjusted odd ratios of being overweight or obese with duration of education in both sexes. The study provides current data on anthropometric measurements and obesity in urban Cameroonian populations, and found high prevalences of overweight and obesity particularly over 35 years of age, and among women. Prevalence varied according to the measure used. Our findings highlight the need to carry out further studies in Cameroonian and other Sub-Saharan African populations to provide appropriate cut-off points for the identification of people at risk of obesity-related disorders, and indicate the need to implement interventions to reverse increasing levels of obesity.

Diabetes, obesity, and physical inactivity are common in urban areas in sub-Saharan Africa. This paper reports an investigation of lay knowledge, attitudes, and behaviors relating to diabetes and its main risk factors of urban Cameroonians. We carried out a qualitative study in four urban health districts, one from each of the main ecological areas of Cameroon. Participants were purposively selected to include a range of community key participants and articulate community members. Data were collected through in-depth interviews by using a pre-tested, semi-structured interview guide. Sixty-two interviews were conducted across the four sites. Awareness of diabetes and knowledge of its causes, clinical course, and complications were limited. Many participants believed diabetes was caused by excessive sugar consumption rather than excessive energy intake, obesity, or physical inactivity. Obesity, particularly in men, was largely perceived positively as a sign of "good living." Many participants underestimated the degree to which they were overweight. Physical activity was mostly viewed positively, although negative views were common about simple methods of increasing physical activity, such as walking. Several constraints to the adoption of healthy behaviors were identified. For diet, these included lack of knowledge of the composition of a healthy diet. Barriers to undertaking more physical activity included lack of facilities and inadequate time available. The results indicate the need for health education about diabetes and its main risk factors in these communities. Health education should be informed by lay perspectives to maximize the appropriateness of the messages and their effect on knowledge, attitudes, and behavior.

Objective To review the key issues related to the design and implementation of an electronic health record (EHR) system in urban primary health care (PHC) practice in Cameroon. Methodology The goal of the project was to assess EHR as a tool to improve providers' performance, quality and continuity of care, and the availability of data in PHC practice in Cameroon. A locally designed EHR system called MEDCAB was developed. The system was based on the International Classification for Primary Care (ICPC) and was designed taking into consideration the PHC practice environment in Cameroon. An original cohort of 14 users was involved in the experiment. Results Users generally showed good acceptance of the system. Monitoring the use of the system at the early stages of implementation was important to ensure immediate response to users' comments and requests. Some of the key issues identified during the development and implementation of the system were: user involvement, the choice of an appropriate terminology, pre-existing data collection culture and leadership issues. Some positive achievements brought about by the system included promotion of good medical practice and routine availability of consultation data. Conclusion Strengthening the medical record in general, and the EHR in particular, could contribute to its position as a valuable source of information for healthcare delivery, public health and policy making in Cameroon. Challenges to adoption are huge and successful implementation for any specific setting will require a comprehensive modelling of the local medical practice, the choice of an appropriate terminology and a co-ordinated approach involving all stakeholders.