Fanny Nadia Dissak-Delon

Background: Due to high service demand, there is a critical need to rapidly identify injured patients in the greatest need of emergency trauma care resources in the Cameroon health system. We evaluated context‐specific indicators of mortality to develop a triage tool for trauma team activation (TTA) in Cameroon. Methods: Data were extracted from the 10‐site Cameroon Trauma Registry between July 2022 and December 2023. Injury and care patterns were evaluated as potential predictors of hospital mortality using logistic regression. Variables associated with mortality were included in the novel Cameroon triage criteria (CTC). Receiver operating characteristics (ROC) curves compared discrimination of mortality for CTC, estimated Injury Severity Score (eISS), and a United States level 1 trauma center team activation criteria. Results: Of 6912 patients, there were 313 (5%) in‐hospital deaths. Factors independently associated with in‐hospital death included burn injury (adjusted odds ratio [aOR] = 2.62), falls in patients greater than age 60 (aOR = 2.76), moderate‐to‐severe head injury (aOR = 12.5), and primary survey abnormalities (aOR = 11.8). The CTC (ROC AUC = 0.76, 95% CI = 0.73–0.79) was found to have superior discrimination to the US criteria (ROC AUC = 0.70, 95% CI = 0.67–0.72) and similar discrimination to eISS (ROC AUC = 0.78, 95% CI = 0.75–0.80). Conclusion: The CTC demonstrates mortality prediction using injury mechanism and primary survey data that can be obtained within minutes of arrival to identify highest risk patients in need of resources. We can prospectively validate these criteria in our 10‐hospital registry network to evaluate the impact of CTC activation on trauma survival.

Internally displaced women (IDW) affected by the "Anglophone crisis" in Cameroon navigate a landscape of overlapping vulnerabilities, including displacement-related poverty, gender-based violence (GBV), and systemic linguistic minoritization. While the psychological impact of war is well-documented, the mental health consequences of intersecting urban stressors in host settings like Douala remain under-researched. To explore how displacement, GBV exposure, and Anglophone identity intersect to shape the mental health experiences and resilience strategies of IDW in Douala, Cameroon. This qualitative study utilized semi-structured interviews with 33 Anglophone IDW (Median age: 34 years); residing in the Littoral Region for a median duration of 5 years). Participants were recruited via purposive and snowball sampling from various urban neighborhoods (e.g., Bonabéri, Mbanga). Data were analyzed through reflexive thematic analysis using NVivo 12, guided by an intersectional socio-ecological framework. Four major themes emerged: (1) "Swallowed Silence," where emotional repression functions as a strategic social protection against stigma; (2) Embodied Trauma and Cognitive Paralysis, manifesting as somatic distress and dissociation; (3) Chronic Survival Anxiety, driven by the "scarcity mindset" of economic precarity and ethno-linguistic discrimination; and (4) Adaptive Resilience, anchored in informal peer networks, spirituality, and cognitive restructuring. Mental health among Anglophone IDW is a dynamic process shaped more by ongoing structural "daily stressors" than by past events alone. Interventions must transcend clinical models to integrate GBV prevention, livelihood protection, and culturally safe mental health and psychosocial support (MHPSS) services delivered in English and Pidgin.

Introduction: Prehospital care, though critical to injury survival, is largely unavailable in many low and middle-income countries, including Cameroon. Lay first responder (LFR) programmes train persons with high injury exposure in first-aid and emergency transport, but stakeholder buy-in from trainees and healthcare workers (HCWs) is essential. To design a context-appropriate prehospital care system, we evaluated barriers and facilitators of implementing a driver-based LFR programme in Cameroon. Methods: In April 2023, we performed a mixed-methods evaluation targeting commercial mototaxi drivers and HCW in Limbe, Cameroon. Drivers were recruited for focus groups through union leaders. Trauma HCW at Limbe Regional Hospital completed Likert surveys and a subgroup completed semistructured interviews. Data collection focused on perceptions, barriers and facilitators of LFR programme implementation. Survey data were summarised using median and IQR. Interviews were recorded, transcribed, translated and analysed with open and axial coding using reflexive thematic analysis. Results: Overall, 92 mototaxi drivers and 34 HCWs participated in the LFR programme assessment. Among the HCW surveyed, 93% felt mototaxi drivers were capable of training as LFR but only 44% felt that drivers would be able to provide care safely. Interviews identified negative HCW perceptions of drivers, including drivers being uneducated and financially motivated, as key barriers, whereas driver exposure to injury was identified as a facilitator to LFR programme implementation. Driver groups demonstrated a positive perception of LFR training but identified unpaid time spent transporting injured persons as a significant barrier. Both groups described a need for hospital involvement in trainings and bidirectional standardised communication with HCW. Conclusions: In Cameroon, driver-based LFR may facilitate increased prehospital care but further exploration of possible systems of collaboration that promote long-term success of the programme is required. Specifically, sustainable implementation will need to include clear bidirectional communication guidelines and provide driver incentive commensurate to effort.

Background: Injured patients in Cameroon face high out-of-pocket costs and care discrepancies based on ability to pay. Per government declaration, all Cameroonian hospitals instituted emergency payment deferral (EPD) programmes to mitigate financial barriers to emergency care. Doctors or nurses decide on patients’ eligibility for the EPD programme. However, the impact of EPD on care patterns is unclear. Methods: The Cameroon Trauma Registry (CTR) is a prospective, multisite trauma registry collecting injured patient data from four hospitals in Cameroon. Using CTR data from March 2020 to February 2022, we analysed associations between patient participation in EPD programmes and healthcare interventions using univariate analysis and multivariate logistic regression. Results: Of 5287 CTR patients, 58% (n=3081) were emergency payment deferral recipients (EPDR). A greater proportion of EPDR lived in urban residences (89% EPDR vs 87% non-EPDR, p=0.003). EPDR more often presented with a ‘serious’ or more severe estimated injury severity (70% EPDR vs 59% non-EPDR, p<0.001). Compared with non-recipients, a smaller proportion of EPD recipients, a smaller proportion of EPDR underwent recommended X-rays (48% EPDR vs 51% non-EPDR, p<0.001). However, greater percentages of EPDR received a recommended ultrasound (3% vs 1%, p<0.001) or CT scan (14% EDPR vs 10% non-EDPR, p<0.001). EPDR more often did not receive radiological tests due to inability to pay (12% vs 4%, p<0.001). Moreover, 10% of EPDR did not undergo recommended surgery due to cost while 6% of non-EPDR did not undergo recommended surgery due to cost (p<0.001). Multivariate logistic regression controlling for injury severity and other demographics indicates that EPDR were less likely to undergo surgery (adjusted OR=0.63, p=0.001). Conclusion: Payment deferral programmes were associated with increased use of some imaging tests, but did not fully address the downstream financial barriers that impede health equity in Cameroon.

INTRODUCTION: Africa is the least motorized populated continent, yet it experiences the highest traffic fatality rate. Despite laws mandating helmet and seatbelt use, data on protective gear use among Cameroonian road traffic injury (RTI) patients remains sparse. METHODS: We extracted Cameroon Trauma Registry data prospectively collected from 10 hospitals during July 2022 to December 2023. Protective gear users wore helmets in motorcycle and seatbelts/car seats in vehicle crashes. We categorized patients into five economic clusters based on ownership of durable goods using parallel distance matrix computation. We analyzed associations between continuous variables with Wilcoxon rank-sum and categorical variables with χ² and multivariate logistic regression. Our primary outcome was in-hospital death or major disability at discharge. RESULTS: Among 3,554 RTI patients, 303 (9%) used protective gear. A larger proportion of patients who did not use protective gear were designated as majorly disabled or dead (20% vs. 16%, p < 0.001). The greatest percentage of protective gear users belonged to the richest cluster, while the poorest cluster patients comprised the smallest proportion of protective gear users (13% vs. 3%, p < 0.001). The richest cluster demonstrated the smallest percentage of major disability or death (13%), while the poorest cluster had the greatest percentage (28%, p < 0.001). When controlling for age, protective gear use, and injury severity, the three poorest clusters showed the greatest odds of major disability or death (cluster 3: adjusted odds ratio [AOR], 2.34; 95% confidence interval [CI], 1.58–3.46; cluster 4: AOR, 2.09; 95% CI, 1.59–2.74; cluster 5: AOR, 2.38; 95% CI, 1.24–4.58). CONCLUSION: Greater economic status is associated with increased protective gear use during RTIs in Cameroon. Despite suffering the most severe outcomes, the poorest patients remain less likely to use protective gear. Enforcement of protective gear laws and economic incentives such as price subsidies for helmets and seatbelts would particularly benefit the most vulnerable population. LEVEL OF EVIDENCE: Prognostic and Epidemiological; Level IV.

Introduction: Little is known regarding health care seeking behaviors of women in sub-Saharan Africa, specifically Cameroon, who experience violence. The proportion of women who experienced violence enrolled in the Cameroon Trauma Registry (CTR) is lower than expected. Methods: We concatenated the databases from the October 2017-December 2020 CTR and 2018 Cameroon Demographic and Health Survey (DHS) into a singular database for cross-sectional study. Continuous and categorical variables were compared with Wilcoxon rank-sum and Fisher’s exact test. Multivariable logistic regression examined associations between demographic factors and women belonging to the DHS or CTR cohort. We performed additional classification tree and random forest variable importance analyses. Results: 276 women (13%) in the CTR and 197 (13.1%) of women in the DHS endorsed violence from any perpetrator. A larger percentage of women in the DHS reported violence from an intimate partner (71.6% vs. 42.7%, p<0.001). CTR women who experienced IPV demonstrated greater university-level education (13.6% vs. 5.0%, p<0.001) and use of liquid petroleum gas (LPG) cooking fuel (64.4% vs. 41.1%, p<0.001). DHS women who experienced IPV reported greater ownership of agricultural land (29.8% vs. 9.3%, p<0.001). On regression, women who experienced IPV using LPG cooking fuel (aOR 2.55, p = 0.002) had greater odds of belonging to the CTR cohort while women who owned agricultural land (aOR 0.34, p = 0.007) had lower odds of presenting to hospital care. Classification tree variable observation demonstrated that LPG cooking fuel predicted a CTR woman who experienced IPV while ownership of agricultural land predicted a DHS woman who experienced IPV. Conclusion: Women who experienced violence presenting for hospital care have characteristics associated with higher SES and are less likely to demonstrate factors associated with residence in a rural setting compared to the general population of women experiencing violence.

Despite high injury mortality rates, Cameroon currently lacks a formal prehospital care system. In other sub-Saharan African low and middle-income countries, Lay First Responder (LFR) programs have trained non-medical professionals with high work-related exposure to injury in principles of basic trauma care. To develop a context-appropriate LFR program in Cameroon, we used trauma registry data to understand current layperson bystander involvement in prehospital care and explore associations between current non-formally trained bystander-provided prehospital care and clinical outcomes. The Cameroon Trauma Registry (CTR) is a longitudinal, prospective, multisite trauma registry cohort capturing data on injured patients presenting to four hospitals in Cameroon. We assessed prevalence and patterns of prehospital scene care among all patients enrolled the CTR in 2020. Associations between scene care, clinical status at presentation, and outcomes were tested using univariate and multivariate logistic regression. Injury severity was measured using the abbreviated injury score. Data were analyzed using Stata17. Of 2212 injured patients, 455 (21%) received prehospital care (PC) and 1699 (77%) did not receive care (NPC). Over 90% (424) of prehospital care was provided by persons without formal medical training. PC patients were more severely injured (p<0.001), had markers of increased socioeconomic status (p = 0.01), and longer transport distances (p<0.001) compared to NPC patients. Despite increased severity of injury, patients who received PC were more likely to present with a palpable pulse (OR = 6.2, p = 0.02). Multivariate logistic regression adjusted for injury severity, socioeconomic status and travel distance found PC to be associated with reduced emergency department mortality (OR = 0.14, p<0.0001). Although prehospital injury care in Cameroon is rarely performed and is provided almost entirely by persons without formal medical training, prehospital intervention is associated with increased early survival after injury. Implementation of LFR training to strengthen the frequency and quality of prehospital care has considerable potential to improve trauma survival.

Introduction Despite high injury mortality rates, Cameroon currently lacks a formal prehospital care system. In other sub-Saharan African low and middle-income countries, Lay First Responder (LFR) programs have trained non-medical professionals with high work-related exposure to injury in principles of basic trauma care. To develop a context-appropriate LFR program in Cameroon, we used trauma registry data to understand current layperson bystander involvement in prehospital care and explore associations between current non-formally trained bystander-provided prehospital care and clinical outcomes. Methods The Cameroon Trauma Registry (CTR) is a longitudinal, prospective, multisite trauma registry cohort capturing data on injured patients presenting to four hospitals in Cameroon. We assessed prevalence and patterns of prehospital scene care among all patients enrolled in a prospective, multisite trauma registry (Cameroon Trauma Registry (CTR)) in 2020. Associations between scene care, clinical status at presentation, and outcomes were tested using univariate and multivariate logistic regression. Injury severity was measured using the abbreviated injury score. Data were analyzed using Stata17. Results Of 2212 injured patients, 455 (21%) received prehospital care (PC) and 1699 (77%) did not receive care (NPC). Over 90% (424) of prehospital care was provided by persons without formal medical training. The most common prehospital interventions performed included bleeding control (370, 57%) and fracture immobilization (139, 21%). PC patients were more severely injured (pConclusions Although prehospital injury care in Cameroon is rarely performed and is provided almost entirely by persons without formal medical training, prehospital intervention is associated with increased early survival after injury. Implementation of LFR training to strengthen the frequency and quality of prehospital care has considerable potential to improve trauma survival. LFR training in Cameroon should target commercial drivers given high work-related exposure to the injured and emphasize bleeding control interventions.

Despite having the highest rates of injury-related mortality in the world, trauma system capacity in sub-Saharan Africa remains underdeveloped. One barrier to prompt diagnosis of injury is limited access to diagnostic imaging. As part of a larger quality improvement initiative and to assist priority setting for policy makers, we evaluated trauma outcomes among patients who did and did not receive indicated imaging in the Emergency Department (ED). We hypothesize that receiving imaging is associated with increased early injury survival. We evaluated patterns of imaging performance in a prospective multi-site trauma registry cohort in Cameroon. All trauma patients enrolled in the Cameroon Trauma Registry (CTR) between 2017 and 2019 were included, regardless of injury severity. Patients prescribed diagnostic imaging were grouped into cohorts who did and did not receive their prescribed study. Patient demographics, clinical course, and outcomes were compared using chi-squared and Kruskal-Wallis tests. Multivariate logistic regression was used to explore associations between radiologic testing and survival after injury. Of 9,635 injured patients, 47.5% (4,574) were prescribed at least one imaging study. Of these, 77.8% (3,556) completed the study (COMPLETED) and 22.2% (1,018) did not receive the prescribed study (NC). Compared to COMPLETED patients, NC patients were younger (p = 0.02), male (p<0.01), and had markers of lower socioeconomic status (SES) (p<0.01). Multivariate regression adjusted for age, sex, SES, and injury severity demonstrated that receiving a prescribed study was strongly associated with ED survival (OR 5.00, 95% CI 3.32–7.55). Completing prescribed imaging was associated with increased early survival in injured Cameroonian patients. In a resource-limited setting, subsidizing access to diagnostic imaging may be a feasible target for improving trauma outcomes.