title: Detecting and staging podoconiosis cases in North West Cameroon: positive predictive value of clinical screening of patients by community health workers and researchers.
abstract: The suitability of using clinical assessment to identify patients with podoconiosis in endemic communities has previously been demonstrated. In this study, we explored the feasibility and accuracy of using Community Health Implementers (CHIs) for the large scale clinical screening of the population for podoconiosis in North-west Cameroon.
  
  
  
  Before a regional podoconiosis mapping, 193 CHIs and 50 health personnel selected from 6 health districts were trained in the clinical diagnosis of the disease. After training, CHIs undertook community screening for podoconiosis patients under health personnel supervision. Identified cases were later re-examined by a research team with experience in the clinical identification of podoconiosis.
  
  
  
  Cases were identified by CHIs with an overall positive predictive value (PPV) of 48.5% [34.1-70%]. They were more accurate in detecting advanced stages of the disease compared to early stages; OR 2.07, 95% CI = 1.15-3.73, p = 0.015 for all advanced stages). Accuracy of detecting cases showed statistically significant differences among health districts (χ2 = 25.30, p = 0.0001).
  
  
  
  Podoconiosis being a stigmatized disease, the use of CHIs who are familiar to the community appears appropriate for identifying cases through clinical diagnosis. However, to improve their effectiveness and accuracy, more training, supervision and support are required. More emphasis must be given in identifying early clinical stages and in health districts with relatively lower PPVs.
authors.affiliation: Parasites and Vector Biology research unit (PAVBRU), Department of Microbiology and Parasitology, University of Buea, Buea, Cameroon. swanji@yahoo.fr.|Research Foundation for Tropical Diseases and the Environment (REFOTDE), Buea, Cameroon. swanji@yahoo.fr.
authors.forename: Samuel
authors.initials: S
authors.lastname: Wanji
authors.affiliation: Parasites and Vector Biology research unit (PAVBRU), Department of Microbiology and Parasitology, University of Buea, Buea, Cameroon.|Research Foundation for Tropical Diseases and the Environment (REFOTDE), Buea, Cameroon.
authors.forename: Jonas A
authors.initials: JA
authors.lastname: Kengne-Ouafo
authors.affiliation: Research Foundation for Tropical Diseases and the Environment (REFOTDE), Buea, Cameroon.
authors.forename: Fabrice R
authors.initials: FR
authors.lastname: Datchoua-Poutcheu
authors.affiliation: Parasites and Vector Biology research unit (PAVBRU), Department of Microbiology and Parasitology, University of Buea, Buea, Cameroon.|Research Foundation for Tropical Diseases and the Environment (REFOTDE), Buea, Cameroon.
authors.forename: Abdel Jelil
authors.initials: AJ
authors.lastname: Njouendou
authors.affiliation: Parasites and Vector Biology research unit (PAVBRU), Department of Microbiology and Parasitology, University of Buea, Buea, Cameroon.|Research Foundation for Tropical Diseases and the Environment (REFOTDE), Buea, Cameroon.
authors.forename: Dizzel Bita
authors.initials: DB
authors.lastname: Tayong
authors.affiliation: Research Foundation for Tropical Diseases and the Environment (REFOTDE), Buea, Cameroon.|Department of Biochemistry and Molecular Biology, University of Buea, Buea, Cameroon.
authors.forename: David D
authors.initials: DD
authors.lastname: Sofeu-Feugaing
authors.affiliation: Research Foundation for Tropical Diseases and the Environment (REFOTDE), Buea, Cameroon.|Laboratory of Parasitology and Ecology, Department of Animal Biology and Physiology, University of Yaoundé I, Yaounde, Cameroon.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Amvongo-Adjia
authors.affiliation: Parasites and Vector Biology research unit (PAVBRU), Department of Microbiology and Parasitology, University of Buea, Buea, Cameroon.|Research Foundation for Tropical Diseases and the Environment (REFOTDE), Buea, Cameroon.
authors.forename: Bridget A
authors.initials: BA
authors.lastname: Fovennso
authors.affiliation: Research Foundation for Tropical Diseases and the Environment (REFOTDE), Buea, Cameroon.
authors.forename: Yolande F
authors.initials: YF
authors.lastname: Longang-Tchounkeu
authors.affiliation: Center for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA.
authors.forename: Fasil
authors.initials: F
authors.lastname: Tekola-Ayele
authors.affiliation: Parasites and Vector Biology research unit (PAVBRU), Department of Microbiology and Parasitology, University of Buea, Buea, Cameroon.|Research Foundation for Tropical Diseases and the Environment (REFOTDE), Buea, Cameroon.
authors.forename: Peter A
authors.initials: PA
authors.lastname: Enyong
authors.affiliation: Wellcome Trust Centre for Global Health Research, Brighton and Sussex Medical School, Falmer Campus, Brighton, BN1 9PX, UK.
authors.forename: Melanie J
authors.initials: MJ
authors.lastname: Newport
authors.affiliation: Wellcome Trust Centre for Global Health Research, Brighton and Sussex Medical School, Falmer Campus, Brighton, BN1 9PX, UK.
authors.forename: Gail
authors.initials: G
authors.lastname: Davey
mesh_terms: D000328:Adult; D002163:Cameroon / Q000453:epidemiology; D003150:Community Health Workers; D004604:Elephantiasis / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology / Q000517:prevention & control; D005240:Feasibility Studies; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods; D008507:Medically Underserved Area; D012108:Research Personnel; D012424:Rural Population; D012720:Severity of Illness Index
keywords: Cameroon; Community Health Implementers; Podoconiosis; Predictive value; Screening