Cameroon is usually referred to as 'Africa in Miniature' due to the diversity of its population and ecology. It is the only country in the world apart from Canada that has both English and French as its official languages. Discovered by Portuguese explorers in the 15th century; along the estuary of River Wouri, these explorers found a lot of shrimps and called the area 'Rio dos Camarões' meaning River of Shrimps. That is where Cameroon gets its name. Covering a total surface area of 475, 650 km² , the country's ecological zones varies from dense tropical forests in the southern part to the savannah in the northern part. There are several rivers, streams and lakes, which sometimes end up providing the condition that enables some neglected tropical diseases (NTDs) such as Onchocerciasis, Loa Loa, Soil-transmitted helminthiasis, Schistosomiasis and Lymphatic Filariasis to thrive.
Cameroon is situated in Central Africa and has a population of over 23 million and an annual growth rate of 2.6%. It is divided into 10 regions with 181 health districts, which form the implementation unit for all health activities. The country has Schistosomiasis, Soil Transmitted Helminths, Onchocerciasis, Trachoma and Lymphatic Filariasis. These diseases have been fully mapped throughout the country. They have many districts with all major Neglected Tropical Diseases and a wide range of co-endimicity.
Cameroon has six Neglected Tropical Disease programmes for: Onchocerciasis; Human African Trypanosomiasis, Buruli Ulcer, Yaws, Leishmaniasis, Leprosy, schistosomiasis, Soil Transmitted Helminths, Lymphatic Filariasis and Trachoma. These are coordinated by a central unit that was created in 2013. Cameroon has a Neglected Tropical Disease Master Plan which runs from 2012 – 2016. Its vision is to reduce Neglected Tropical Diseases so that they are no longer a socio-economic impediment in the country. Guinea Worm has been eradicated and a surveillance programme remains.
Cameroon has an integrated campaign for all the diseases and a joint planning process at national, regional, and district levels. Funding comes from the state, USAID, RTI, ENVISION and Helen Keller International. There are three main strategies: school-based interventions for Schistosomiasis and Soil Transmitted Helminths; community based interventions for Onchocerciasis, Lymphatic Filariasis and Trachoma; and deworming pre-school age children during vaccination campaigns.
This requires cross-sectoral collaboration within government and there is a Memorandum of Understanding between the Ministry of Health, the Ministry of Education, the Ministry for Secondary Education, and the United Councils of Cameroon. Non-governmental organisations support national leadership and are coordinated through Helen Keller International.
Challenges persist in the implementation of the Neglected Tropical Disease programme. There is insufficient funding for supervision and monitoring and evaluation of campaigns which affects data collection. There is insufficient funding for impact studies and no standard data capture platform (mobile or e-tools) or centralised database.
There are difficulties related to the health workforce. For example, Community Drug Distributors paid by treatment. However, there are delays in payment which decreases motivation and leads to attrition. There is competition for community health workers with other health programmes who can often pay more.
In some districts they have decided to treat with praziquantel twice a year because there are high reinfection rates.
There is an absence of vector controls. Bed net distribution has mainly been targeted at pregnant women. There needs to be more awareness raised within communities, that bed nets are also helpful for Lymphatic Filariasis .
There is a need to scale up integrated access to preventive chemotherapy and Community-Led Total Sanitation for schistosomiasis and Soil-Transmitted Helminths; whilst promoting equitable access for pre-school aged children, out of school children and adults. Cameroon also needs strategies for hot spots where there is Onchocerciasis and Loa Loa co-endemicity.
The Ministry of Public Health in Cameroon is responsible for the maintenance and implementation of all public health services. The health structure in Cameroon is divided into 3 levels:
1) The central level, represented by the central services of the Ministry of Public Health. The central level's functions are:
- Formulation of concepts, policies and strategies
- Co-ordination of activities; and regulation;
2) The intermediate level represented by 10 regional delegations of public health that coordinate health activities in the regions. The regional delegations provide technical support to health districts.
3) The peripheral level, represented by the district health services. The health districts are the operational units that are in charge of the implementation of health programmes. The health service is provided through a decentralized health system including 10 regional delegations of health, 181 health districts, 2,260 public health facilities, 4 general hospitals, 3 central hospitals, 14 regional hospitals, 164 district hospitals, 155 sub-division medical centres, and 1,920 integrated health centres.
The NTDs of public health importance are Onchocerciasis, Lymphatic Filariasis, Schistosomiasis, Soil-transmitted Helminthiasis, Trachoma, human African Trypanosomiasis and Buruli Ulcer. Onchocerciasis, Schistosomiasis and Soil-transmitted Helminthiasis are widespread all over the country. Lymphatic filariasis is also widespread but with low endemicity level. Trachoma is restricted in the northern regions. Buruli ulcer is found in 5 health districts. Human African trypanosomiasis occurs in 5 foci. Leprosy is still endemic in some districts. Guinea worm has been eradicated. Leishmaniasis is suspected in the far north region.
There are six national NTD programmes: Onchocerciasis, Schistosomiasis and intestinal helminthiasis, Lymphatic Filariasis, Trachoma, Yaw-Leprosy-Leishmaniasis-Buruli Ulcer, and human African trypanosomiasis. The government of Cameroon has recently adopted an integrated approach for the control of these NTDs, and developed a 2012-2016 master plan for co-implementation of different control interventions and co-administration of drugs, including Praziquantel, Ivermectin, Mebendazole, Albendazole and Azithromycin. Through this integrated effort, over 6.3, 9.5, 2.1, 7.1 and 1.5 million people were treated in 2012 for Onchocerciasis, Lymphatic Filariasis, Schistosomiasis, Soil-transmitted Helminthiasis, and Trachoma, respectively.
Centre for Schistosomiasis and Parasitology
The Centre for Schistosomiasis and Parasitology (CSP) has a recognised interest in tropical parasitology, especially schistosomiasis and intestinal helminthiasis. It serves as the focus research centre for the epidemiology of these parasitic diseases in Cameroon; and contributes to develop research, disease prevention and control. It plays a seminal role in research for schistosomiasis and soil-transmitted helminth in Cameroon, translating its unique expertise into action to improve the health of those who need it most.
The team has vast experience in applied field research and the development of control programmes, and is involved in several national and international research programmes. The CSP is linked to the University of Yaoundé I and assists the Ministry of Health in the implementation of control activities and operational research. The CSP employs a multidisciplinary team staff of 15 people, including researchers, lecturers, medical doctors, PhD students and technicians, with in-depth knowledge in epidemiology, parasitology, disease control and surveillance.
COUNTDOWN has partnered with the Centre for Schisto in Cameroon to address the NTD health system integration at the national and regional levels.
In Cameroon, the NTD Steering Committee is a multi-sectoral platform, which includes NGDO implementing partners, and makes policy and implementation decisions. Prof. Louis-Albert Tchuem Tchuente is the Secretary of the Steering Committee.
National-level activities will increase attention to NTDs, focusing particularly on the links between action on NTDs, poverty outcomes and cost-saving. These activities aim to: cultivate integrated and multi-sectoral working; influence national level prioritisation and investment; strengthen policies and their implementation and ultimately the scale-up of evidence-based programming. Activities may include: cultivating national champions; reaching high-level decision makers; training journalists; building new platforms and coalitions; conducting sensitisation meetings with national bodies and supporting their capacity to access, understand and apply research evidence; and through participation in national meetings.
The University of Buea, located in the South West Province of Cameroon and remains the main Anglophone university in the country.
Created in 1985, the university has tried to establish a rigorous research environment and the Faculty of Health Sciences is dedicated to achieving excellence through research for sustainable development. Both fundamental and applied research will be done to address issues of local, national and global concern as well as those of relevance to the country's health.
Outreach and cooperation activities of the University seek to create strategic alliances with institutions and organizations at home and abroad, in order to exploit the opportunities of an increasingly globalised world. One main goal is increased access to professional training at all levels to enable graduates to find jobs. The objectives of the Faculty of Health Sciences are in line with this goal. It strives to:
The University of Buea is collaborating with COUNTDOWN in operational research across the Mass Drug Administration scale-up themes (MST) and the integrated control strategies theme (ICST) to identify operational issues, to be addressed for the improvement of programme delivery, including complementary strategies for ‘Hotspots’, with poor compliance to the current MDA strategies and persistence of Onchocerciasis infection, in the Meme River Basin of the South West Cameroon.
Prof. Wanji is principal investigator for Onchocerciasis and Lymphatic Filariasis and heads the Buea Team of COUNTDOWN which is handling research at the district and community levels.