Ethics of Human Resources Management in the Cameroonian Health System, Medical Nomadism and the Ineffectiveness of the Fight against High Blood Pressure

Context/objectives: The fight against Chronic Non-Communicable Diseases (NCDs) is a long-term undertaking, which requires available, motivated and well-managed human resources (HR). The administrative management of skills on both qualitative and quantitative levels is one of the essential functions of a health system. To better implement policies of fight against High Blood Pressure (HBP) and other chronic diseases, it is important to establish strategies to retain health personnel. This loyalty requires favorable working conditions and consideration of the contribution-reward couple. Good working conditions are likely to reduce the phenomenon of medical nomadism;conversely, poor HR management can contribute to their exodus towards exotic “green pastures”, thus leading to an additional crisis in the Cameroonian health system. The fight against HBP is a complex, multifaceted and multifactorial reality that requires appropriate management model for all types of resources mainly HR. The main objective of this research is to show the impact of poor management of human resources in Cameroon health system on medical nomadism and the ineffectiveness of the fight against High Blood Pressure. Method: A cross-sectional descriptive survey among five hundred (500) health facilities in the center region of Cameroon has been conducted. A stratified probabilistic technique has been used, and the number of health facilities to be surveyed has been determined using the “sample size estimation table” of Depelteau. The physical questionnaires have been printed and then distributed to data collectors. After data collection, the latter were grouped during processing in Excel sheets. The Chi-square test was used for data with a qualitative value and that of Kolmogorov-Sminorf for data with a quantitative value to assess the normality and reliability of data. The Crochach’s Alpha reliability test allowed us to have a summary of the means and variances and then to search for intragroup correlations between variables. Descriptive analysis was possible with the XLSTAT 2016 software. Results: 43.60% of Health Facilities (HF) managers were unqualified. 82.20% of HF managers have staff in a situation of professional insecurity. They are mainly contractual (49.00), decision-making agents (24.40%), casual agents (08.80). The proportion of unstable personnel is average of 22.00% and very unstable, 12.00%.

Factors of Adherence to Concurrent Tuberculosis Treatment and Antiretroviral Therapy among HIV-TB Co-Infected Individuals in the East Region, Cameroon in the COVID-19 Era: A Retrospective Cohort Study

Context/Objectives: Tuberculosis (TB) and HIV co-infection is a serious health problem in Cameroon. The problems associated with poor adherence to treatment are on the increase worldwide. This problem can be observed in all situations where patients are required to administer their own medication, whatever the type of illness. The general objective of this study was to assess the factors affecting adherence to treatment among HIV-TB co-infected patients in health facilities in the East Region in the COVID context. Method: A retrospective cohort study before and during COVID-19 was conducted in HIV care units in 13 health districts in the East Region of Cameroon. Data were collected using a questionnaire recorded in the Kobo Collect android application, analyzed using SPSS version 25 software and plotted using Excel. Results: The pre-COVID-19 cohort compared to the during-COVID-19 cohort had a 1.90 risk of not adhering to treatment (OR: 1.90, CI {1.90 - 3.37}) and the difference was statistically significant at the 5% level (p-value = 0.029). Frequency of adherence was 65.4% (140/214). Adherence before COVID-19 was 56.9% whereas during COVID-19, it was 74.3%. Conclusion: The implementation of targeted interventions in the COVID-19 context, using evidence-based data and integrating the individual needs of HIV-TB co-infected patients, improved adherence to concurrent anti-tuberculosis treatment and antiretroviral therapy during the COVID-19 Era.

Economic Stress, Precariousness and Risk of High Blood Pressure: A Descriptive Survey of Life Models within Households of the Central Region of Cameroon

Context/Objective: High blood pressure (HBP) currently represents the most widespread chronic non-communicable disease in Cameroon. The increase in its prevalence in the country is the result of multiple factors including economic stress imposed by precariousness, poor living conditions, sources of anxiety, anguish, depression and other behavioral disorders. Economic stress is a globalizing concept that integrates into a purely hermeneutic approach, a particular functioning of the nervous system of an individual who faces employment problems and precarious remuneration conditions. The non-satisfaction by an individual of his basic needs due to insufficient financial means can cause him to become irritable, aggressive, and socially and symbolically isolated, thereby increasing the desire to resort to morbid life models such as excessive consumption of narcotics and other psychoactive substances often associated with high blood pressure. The fight against the emergence of BPH is a complex, multifaceted and multifactorial reality that requires taking into account economic stress. The main objective of this survey is to describe the situation of economic stress within the Cameroonian population, which imposes precariousness and life models at risk of high blood pressure. Specifically, we determined the level of household income and the sources of income. Methods: A cross-sectional survey with a descriptive aim among five hundred households in the Central Region of Cameroon was conducted. A probabilistic technique called simple randomness was used. The number of households to be surveyed was determined indirectly using the Cochrane formula. Data collection in face-to-face mode using a physical questionnaire took place from July 1 to August 31, 2023, after obtaining ethical clearance from the Regional Health Research Ethics Committee, Human from the Center and an administrative authorization for data collection. Regarding their processing, the data was grouped during processing in Excel sheets. Normality and reliability tests of the collected data were carried out. For this, the Chi-square test was used for data with a qualitative value and that of Kolmogorov-Sminorf for data with a quantitative value. Descriptive analysis was possible using R software version 3.2, SPSS version 25.0, XLSTAT 2016, PAST and EXCEL programs from Microsoft Office 2013. Results: The main results highlight economic stress, with 45.60% of households surveyed earning less than US$154 per month;55% of household heads were women in single-parent families;14% of household heads were unemployed, 22% worked in the private sector and 19% were self-employed. This general economic situation leads to precarious living conditions, thereby increasing the risk of high blood pressure among the Cameroonian population.

The Effect of the COVID-19 Pandemic on Health Service Accessibility for Children under 5 in the Mayo-Tsanaga and Logone & Chari Departments, Far North Cameroon

Context/objectives: The COVID-19 pandemic has disrupted all programs, potentially impacting access to health services for children under 5 years old. The Far North of Cameroon is one of the northern regions with a prevalence of malnourished children ranging from 5% to 10%. Due to the barrier measures implemented to combat the pandemic, many parents are reluctant to take their children to healthcare facilities. Some of these children were benefiting from the Ambulatory Care Center (ACC) program prior to the COVID-19 outbreak. The main objective of this research is to assess the impact of COVID-19 on access to health services for children under 5 in the Mayo Tsanaga (MT) and Logone & Chari (LC) departments. The implementation of barrier measures could significantly increase the risk of malnutrition among children under 5 years old. Method: A cross-sectional analytical study was conducted in the MT and LC departments, employing both retrospective and prospective approaches. Data was collected through questionnaire, interview guide and a review of existing data prior to the pandemic (DHIS 2). Kobo Collect software was used for data collection, and R software was used for analysis. Results: Children who benefitted from the ACC program during the COVID-19 period were found to have a lower prevalence of malnutrition compared to those who did not benefit (OR: 0.09, CI {0.0 - 0.44}). Conclusion: COVID-19 has led to a decrease in the utilization of health facilities in both departments of the study, resulting in an increase in health issues such as malnutrition among children under 5 years old. Various policies have been implemented to improve attendance at health facilities.

粒度分布对超低水泥刚玉质浇注料流变性的影响

用浇注料流变仪研究了粒度分布对超低水泥刚玉质浇注料流变性的影响。结果表明 :粒度分布对超低水泥浇注料的流变性影响较大。随着粒度分布系数 (q)的减小 (从 0 .2 9、0 .2 6到 0 .2 3) ,浇注料的剪切应力、粘度和屈服应力增加 ,需水量上升 ,说明流变性变差。以 2 %的SiO2 微粉等量替代q =0 .2 3的浇注料中的Al2 O3微粉后 ,试样的流变性得到明显改善 ,更适合用于泵送施工 :浇注料的需水量减少 ,自流值提高。

Major Trends in Refractories Industry at the Beginning of the 21^(st) Century

An analysis of the present and of the future of the refractories industry is being presented , considering some important technical, economical, human and environmental issues , on a worldwide basis. Refractories are still neededas confinement materials to prevent heat and mass transferlosses in many diverse manufacturing industries , and will remain so , but the main challenges , this industry do needto meet, are to adjust to an overcapacity production , to cope with new needs of the customers , in particular the'outsourcing' , which is a new customer / supplier relationship being adopted by many of them, and to keep the research and development alive in a more and more competitive arena. Among the direct consequences , are the need to keep the education world in refractory engineering training alive and to cope with macro and micro projects to change the image of the Refractories , from a commodity material to a sophisticated 'high-tech' composite material . Some suggestions are provided in the text.

Different Approaches to Incorporating Natural Flake Graphite into Al2O3—SiC—C Castables

In this stil undergoing work,three approaches have been adopted to incorporate natural flake graphite into Al2O3-SiC-C castables by adding either micropellets of graphite or cushed briquette of alumina-graphite of finally surface modified flake graphite by TiO2 coating,Characteristics of these approaches are described,Overall properties including flowability,compactness,cold and hot stredgths ,slag resistance,anti-oxdation and thermal shock resistance of the castables have been compared in correlation with the ways of incorporating graphite,Very encouraging results have been achieved by using micropellets of graphite or crushed alumian-graphite briquete in comparison with straight natural flake graphite addition.

Rheological Behavior of Bauxite-Based SiC-Containing Castables

Low cement (LC) and ultra low cement (ULC) bauxite SiC castables are important and high performance monolithic refractories and they have been widely used in iron making and incinerator linings. In this work, rheological behavior of LC and ULC bauxite based SiC containing castables has been studied, including the effects of SiC content and cement content on rheological properties of the castables. The results show that with an increase of SiC and cement content, rheological properties of the castables deteriorate. On the other hand, moderate amounts of SiC (4%～8%) and of calcium aluminate cement (2%～4%) have very slight influence on rheological properties, (i.e. when the castables are sheared their torque and yield torque only slightly increase with the shearing speed). The rheological characteristics of the castables follow Bingham fluid and always show shear thinning behavior.

Rheological Behavior of the Matrixes of Bauxite-Based Castables

Rheplpgy of castables is greatly affected and controlled by rheological behavior of their matrix. In this work ,the rheological properties of bauxite-based castable matrix have been studied. The effects of super-fine silica and alumina addition , water/ cement ratio, dispersants and bauxite particle-size on viscosity, shear rate and shear stress of the slur-ries have been investigated . Based on these results, the range of optimum composition of the matrix with good rheological behavior has been obtained.

Effect of Water Addition on Rheological Behaviour of BauxiteBased Low-cement Castables

Water addition has direct impact on castables and needs to be under control placement and properties, In this work, two rheological properties, flow resistance and torque viscosity, have been measured against time, with different water addition in the same bauxile-based LC Castable mix. The flow resistance indicates the mobility, whereas the torque viscosity dictates the stability of a castable during installation. It has been observed that with 6.0wt% water addition, such a mix possesses good vibration castable characteristics; with 6.5 wt%, it shows good self-flow castable characteristics; and with 7.0 wt%, it can be a good pumpable castable, in every case with comparable mechanical properties. While with 7.5 wt% water addition, the properties of such castable are definitively impaired.

Rheology of Alumina-Based Graphite-Containing Castables

In this work, the rheological behavior of ultra-low cement alumina-based castables with addition of flake graphite and extruded graphite pellets has been investigated by using IBB rheometer. Emphasis has been laid on the influence of the type and amount of carbon addition on rheological properties of the alumina-based castables and the results are compared with corresponding alumina castable samples without any carbon addition. It is found that alumina-based castables with extruded graphite pellets have good rheological behavior and flowability with lower water demand (<6.3%) and no segregation during the shearing of castable.