Alain Chichom-Mefire

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.

Motorcycles are a common mode of transport in major Cameroonian cities, contributing to a rising burden of injuries among both users and pedestrians. These groups differ in exposure, mechanisms, and vulnerability, yet both bear a disproportionately high injury burden. However, comparative data on their epidemiological patterns and outcomes remain scarce. To support targeted prevention policies, we analysed trauma registry data to describe demographic, crash, injury, clinical, and outcome characteristics across both populations. This was a retrospective analysis of the Cameroon Trauma Registry (CTR), which collects information on injured patients presenting to 10 hospitals across seven of the 10 regions of Cameroon. Patients presenting with motorcycle-related injuries between June 1 ^st 2022 and May 31 ^st 2023 were assessed for demographic, crash, injury, clinical patterns of care and outcomes variables and compared using χ² or Fisher’s exact tests for categorical data. The analysis was done using R version 4.2.1. A total of 2,757 motorcycle-related injury patients were included from the CTR database, including 2,339 (84.8%) motorcycle users and 418 (15.2%) pedestrians. Motorcycle users were mostly aged 15–34 years (59.1%) and males (83.0%), while pedestrians were frequently aged ≥60 years (23.4%) and females (37.8%). Helmet use among motorcycle users was low (3.0%). Alcohol involvement was more frequent among users (14.2%) than pedestrians (7.4%, p = 0.001). Most injuries occurred during work for users (33.1%) and during leisure for pedestrians (77.5%, p < 0.001). Severe multi-region injuries (abbreviated injury severity ≥3) were more common in users (21.9%) than pedestrians (16.1%, p = 0.014). Hospital admissions were high in both motorcycle users (60.2%) and pedestrians (58.4%); 6.2% required intensive care, and 2.2% underwent immediate surgery. Functional outcomes were similar: 44.8% had minor and 19.9% had major disability at discharge; 3.6% died during hospitalization. Motorcycle-related injuries in Cameroon disproportionately affect young male motorcycle users, with low helmet use, higher rates of alcohol use and severe trauma, together with older female pedestrians. Despite differing profiles, both motorcycle users and pedestrians face high disability and hospitalization rates. Targeted safety strategies are urgently needed to address these overlapping and distinct risks.

Background Commercial motorcycle riders are among the most vulnerable road users in low- and middle-income countries and contribute substantially to the burden of road traffic injuries. The use of personal protective equipment (PPE), including helmets and protective clothing, reduces injury severity; however, uptake remains suboptimal. This study evaluated the effectiveness of a theory-driven health education intervention in improving knowledge, attitudes, and use of PPE among commercial motorcycle riders in Cameroon. Methods A quasi-experimental, non-randomized controlled before-and-after study was conducted in Limbe (intervention) and Tiko (control) Health Districts between August 4, 2024, and April 6, 2025. Participants were recruited from a cohort of commercial motorcycle riders and followed over an eight-month intervention period. The intervention, guided by the Health Belief Model and developed using the Intervention Mapping framework, combined face-to-face sensitization sessions with mobile phone–based educational messaging adapted to participants’ literacy levels and communication preferences. Data were collected at baseline and endline using structured questionnaires and direct observation checklists. Intervention effects were estimated using difference-in-differences analysis with generalized estimating equations, adjusting for socio-demographic factors. Results A total of 313 riders were enrolled at baseline (183 intervention, 130 control), with 249 retained at endline (149 intervention, 100 control). The intervention was associated with significant improvements in PPE knowledge (β = 2.91; 95% CI: 2.14–3.68; p < 0.001) and attitudes (β = 5.76; 95% CI: 4.32–7.21; p < 0.001) compared with the control group. No statistically significant effect was observed for PPE practice scores (β = 0.21; 95% CI: −0.09–0.52; p = 0.171). Among individual PPE items, helmet use increased significantly in the intervention group relative to the control group (AOR = 2.38; 95% CI: 1.19–9.45; p = 0.036), while no significant effects were observed for gloves, trousers, eyeglasses, or closed-toe shoes. Conclusion The theory-driven health education intervention significantly improved knowledge and attitudes toward PPE and increased helmet use among commercial motorcycle riders but did not lead to broader improvements in the uptake of other protective equipment. These findings highlight the need for complementary structural and policy interventions to address persistent barriers to PPE use in similar low-resource settings.

Background: Motorcycles are a common mode of transport in major Cameroonian cities, contributing to a rising burden of injuries among both users and pedestrians. These groups differ in exposure, mechanisms, and vulnerability, yet both bear a disproportionately high injury burden. However, comparative data on their epidemiological patterns and outcomes remain scarce. To support targeted prevention policies, we analysed trauma registry data to describe demographic, crash, injury, clinical, and outcome characteristics across both populations. Methods: This was a retrospective analysis of the Cameroon Trauma Registry (CTR), which collects information on injured patients presenting to 10 hospitals across seven of the 10 regions of Cameroon. Patients presenting with motorcycle-related injuries between June 1 ^st 2022 and May 31 ^st 2023 were assessed for demographic, crash, injury, clinical patterns of care and outcomes variables and compared using χ ² or Fisher’s exact tests for categorical data. The analysis was done using R version 4.2.1. Results: A total of 2,757 motorcycle-related injury patients were included from the CTR database, including 2,339 (84.8%) motorcycle users and 418 (15.2%) pedestrians. Motorcycle users were mostly aged 15-34 years (59.1%) and males (83.0%), while pedestrians were frequently aged ≥60 years (23.4%) and females (37.8%). Helmet use among motorcycle users was low (3.0%). Alcohol involvement was more frequent among users (14.2%) than pedestrians (7.4%, p = 0.001). Most injuries occurred during work for users (33.1%) and during leisure for pedestrians (77.5%, p < 0.001). Severe multi-region injuries (abbreviated injury severity ≥3) were more common in users (21.9%) than pedestrians (16.1%, p = 0.014). Hospital admissions were high in both motorcycle users (60.2%) and pedestrians (58.4%); 6.2% required intensive care, and 2.2% underwent immediate surgery. Functional outcomes were similar: 44.8% had minor and 19.9% had major disability at discharge; 3.6% died during hospitalization. Conclusion: Motorcycle-related injuries in Cameroon disproportionately affect young male motorcycle users, with low helmet use, higher rates of alcohol use and severe trauma, together with older female pedestrians. Despite differing profiles, both motorcycle users and pedestrians face high disability and hospitalization rates. Targeted safety strategies are urgently needed to address these overlapping and distinct risks.

Road traffic injuries (RTIs) are a major global public health concern, often leading to serious physical and psychological consequences, including post-traumatic stress disorder (PTSD). A limited understanding of specific RTI patient characteristics, particularly regarding PTSD screening recommendation and uptake in health facilities in Cameroon, hinders the development of effective PTSD management strategies. This study aimed to determine the epidemiological profile of RTI patients and PTSD screening uptake in hospitals in Fako Division, Cameroon. A chart review of medical records of RTI patients received between 2019 and 2023 was conducted from July 30 ^th , 2024 to August 30 ^th , 2024 at three hospitals in Fako Division, Cameroon: Buea Regional Hospital, Saint Luke Hospital, and Limbe Regional Hospital. A data extraction form was used to collect demographic information, injury characteristics, and PTSD screening recommendations and uptake. We used Chi-square test to investigate associations between independent variables and PTSD screening recommendation and uptake. A multivariable logistic regression model was built to identify independent predictors. A total of 4218 RTI patients were included. Patients were predominantly male, 69.6% (2937/4218). The age group of 26–35 years recorded the highest proportion, 31.7% (1339/4218). Only 12.7%(534/4218) of patients were hospitalized, with only 11.0% (59/534) of hospitalized patients recommended for PTSD screening, and 44.1% (26/59) of those recommended undergoing screening. Independent predictors for PTSD screening recommendation included sedative given (AOR = 6.5, 95%CI = 1.4-30.1), psychotherapy recommended (AOR = 19.2, 95%CI = 8.9-41.6), and transfusion performed (AOR = 3.5, 95%CI = 1.5-7.9). PTSD screening uptake was significantly associated with recommendation for psychotherapy (COR = 4.2, 95%CI = 1.4-12.7). Males were mostly involved. PTSD screening recommendation (11.0%) and uptake (44.1%) were low among RTI patients. PTSD screening uptake was significantly associated with recommendation for psychotherapy. This underscores the urgent need for systematic PTSD screening and integrated mental health services to develop tailored management strategies and improve outcomes in Fako Division and similar contexts.

BACKGROUND: Hemorrhage is the leading cause of preventable trauma death in Cameroon, yet only 4% of injured patients receive imaging capable of diagnosing hemorrhage. Smartphone-based ultrasonography (SBU) may enable extended focused assessment of sonography for trauma (eFAST) in resource-poor settings, but a context-informed eFAST curriculum is needed to rapidly train providers in Cameroon to identify life-threatening injuries. We hypothesized that trauma providers in Cameroon could gain eFAST competence following a novel SBU training. METHODS: We developed a novel 5-hour SBU eFAST curriculum, which underwent iterative revision and testing on Cameroonian medical students until 80% of three cohorts achieved skill metrics. The curriculum was then administered to all trauma providers at three Cameroonian hospitals and evaluated for educational efficacy, usability, and acceptability. Extended focused assessment of sonography for trauma competence was defined as achieving usable images on a validated quality scale and >80% on a knowledge assessment including image interpretation. Usability and acceptability were evaluated using the System Usability Scale and Likert surveys. Five providers participating in train-the-trainers (TT) program went on to administer additional trainings; performance was compared between TT- and investigator-led trainings. RESULTS: Twenty-six students and 26 trauma care providers received SBU training. Overall, 81% (n = 21) of medical students achieved eFAST competence. Educational efficacy improved from 60% to 100% over three curriculum iterations. Subsequently, 100% (n = 26) of trauma care providers achieved SBU competence. Smartphone-based ultrasonography usability (interquartile range, 70–82.5) and acceptability were extremely high; all providers agreed that SBU will improve diagnosis of hemorrhage (Likert interquartile range, 5–5). There were no statistical differences in provider competence between investigator- and TT-led trainings. CONCLUSION: Cameroonian trauma care providers can attain eFAST competence following one 5-hour SBU training. A multisite prospective trial will assess SBU feasibility and effectiveness in expanding diagnostic capacity and reducing preventable deaths. LEVEL OF EVIDENCE: Therapeutic/Care Management; Level III.

Background: Road traffic injuries (RTIs) are a growing public health problem requiring urgent attention in Cameroon where emergency medical services (EMS) are underdeveloped. In other countries, training laypersons to provide prehospital care has been shown to improve injury outcomes, but requires buy-in from the persons being trained to provide care. To inform development of a lay first responder (LFR) program in Cameroon, this study aimed to assess the willingness of community members and associated factors to provide prehospital care for RTIs along the N3 highway, a road linking Cameroon’s two largest cities, known to have high incidence of RTIs. Methods: We conducted a cross-sectional survey of community members living along the N3 highway, between June 18^th and August 16^th, 2024. Health district officials and community leaders identified N3 communities across 11 health districts with high rates of RTI. Purposeful sampling was performed in each community to assess exposure to injury and willingness to participate in prehospital care. Trained research assistants verbally administered a structured questionnaire to each consenting household representative; data collected included socio-demographic characteristics, injury exposure, first aid knowledge and attitudes, and willingness to provide prehospital care to victims of RTIs. Associations between demographic factors and willingness to provide prehospital care were assessed using multivariable logistic regression. Data were analyzed using IBM-SPSS version 26.0 and statistical significance was set at p < 0.05. Results: A total of 449 adult community members were surveyed. Most [268 (59.7%)) respondents were male with a median age of 33 years (interquartile range: 26–40). The majority, 333 (74.6%) community members were willing to provide care to injured victims. However, a third [167 (37.2%)] had adequate knowledge (scored ≥ 80%) of first aid and only 23 (5%) had been trained in first aid. Factors independently associated with willingness to provide prehospital care included having adequate first aid knowledge (adjusted odd ratio (aOR) = 1.69, 95% confidence interval (CI): 1.01–2.81, p = 0.046), primary education (aOR=4.20, 95% CI: 1.19–4.81, p = 0.026) and secondary education (aOR=4.70, 95% CI: 1.34–16.53, p = 0.016) compared to respondents with no formal education, prior witness of RTI (aOR=1.68, 95% CI: 1.055–2.68, p = 0.028), being aged between 30 and 40 years (aOR=1.82, 95% CI: 1.06–3.14, p = 0.031) and community members being able to call dedicated phone numbers to report RTIs (aOR=3.11, 95% CI: 1.28–7.54, p = 0.012). Conclusion: Most community members living in injury exposed-communities reported willingness to participate in prehospital care. However, first-aid knowledge is currently lacking in these communities. LFR training is needed in these communities to enable willing community members to contribute to prehospital efforts for RTIs along this road network.

Background: Road traffic injuries (RTIs) are a major global public health concern, often leading to serious physical and psychological consequences, including post-traumatic stress disorder (PTSD). A limited understanding of specific RTI patient characteristics particularly regarding PTSD screening recommendation and uptake in Cameroon hinders, the development of effective PTSD management strategies. This study aimed to determine the epidemiological profile of RTI patients in Fako Division, Cameroon, to inform the development of tailored PTSD management interventions. Material and methods: A chart review of medical records of RTI patients received between 2019 and 2023 was conducted from July 30 ^th 2024 to August 30 ^th 2024 at three hospitals in Fako Division, Cameroon: Buea Regional Hospital, Saint Luke Hospital Buea, and Limbe Regional Hospital. A data extraction form was used to collect demographic information, injury characteristics, and PTSD screening recommendations and uptake. Descriptive statistics and Chi square test were used for data analysis. The data was analysed in SPSS version 25. Results: A total of 4218 RTI patients were received and managed at the three hospitals during the study period. Patients were predominantly male, 2937(69.6%). The age group of 26-35 years recorded the highest proportion, 1339(31.7%). The median age of patients was 28 years (interquartile range: 22-37). Students, 820(19.4%) were among the most involved in RTIs. Only 59(11.0%) out of the 534(12.7%) hospitalized patients after RTIs were recommended for PTSD screening, and only 26(44.1%) underwent PTSD screening. Lower limbs, 2136(50.6%), and upper limbs, 1639(38.9%) were the most affected location for the traumatic injury. In-hospital mortality was recorded in 27(5.1%) of the patients. Means of transportation of patient to the hospital, ( p =0.050), pain medication given ( p =0.024), sedative given ( p = < 0.001), surgery performed ( p =0.005), psychotherapy recommended ( p = < 0.001) and transfusion performed ( p =p =0.010). Conclusion: Few patients were recommended for PTSD screening and uptake was low. This indicates a significant gap in access to PTSD and mental health services for RTI patients in Fako. PTSD screening uptake was significantly associated with recommendation for psychotherapy. Findings provide information for developing tailored PTSD management strategies and improving patients’ outcomes in this region.