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In 2023, cholera affected approximately 1 million people and caused more than 5000 deaths globally, predominantly in low-income and conflict settings. In recent years, the number of new cholera outbreaks has grown rapidly. Further, ongoing cholera outbreaks have been exacerbated by conflict, climate change, and poor infrastructure, resulting in prolonged crises. As a result, the demand for treatment and intervention is quickly outpacing existing resource availability. Prior to improved water and sanitation systems, cholera, a disease primarily transmitted via contaminated water sources, also routinely ravaged high-income countries. Crumbling infrastructure and climate change are now putting new locations at risk - even in high-income countries. Thus, understanding the transmission and prevention of cholera is critical. Combating cholera requires multiple interventions, the two most common being behavioral education and water treatment. Two-dose oral cholera vaccination (OCV) is often used as a complement to these interventions. Due to limited supply, countries have recently switched to single-dose vaccines (OCV1). One challenge lies in understanding where to allocate OCV1 in a timely manner, especially in settings lacking well-resourced public health surveillance systems. As cholera occurs and propagates in such locations, timely, accurate, and openly accessible outbreak data are typically inaccessible for disease modeling and subsequent decision-making. In this study, we demonstrated the value of open-access data to rapidly estimate cholera transmission and vaccine effectiveness. Specifically, we obtained non-machine readable (NMR) epidemic curves for recent cholera outbreaks in two countries, Haiti and Cameroon, from figures published in situation and disease outbreak news reports. We used computational digitization techniques to derive weekly counts of cholera cases, resulting in nominal differences when compared against the reported cumulative case counts (i.e., a relative error rate of 5.67% in Haiti and 0.54% in Cameroon). Given these digitized time series, we leveraged EpiEstim-an open-source modeling platform-to derive rapid estimates of time-varying disease transmission via the effective reproduction number ( R t ). To compare OCV1 effectiveness in the two considered countries, we additionally used VaxEstim, a recent extension of EpiEstim that facilitates the estimation of vaccine effectiveness via the relation among three inputs: the basic reproduction number ( R 0 ), R t , and vaccine coverage. Here, with Haiti and Cameroon as case studies, we demonstrated the first implementation of VaxEstim in low-resource settings. Importantly, we are the first to use VaxEstim with digitized data rather than traditional epidemic surveillance data. In the initial phase of the outbreak, weekly rolling average estimates of R t were elevated in both countries: 2.60 in Haiti [95% credible interval: 2.42-2.79] and 1.90 in Cameroon [1.14-2.95]. These values are largely consistent with previous estimates of R 0 in Haiti, where average values have ranged from 1.06 to 3.72, and in Cameroon, where average values have ranged from 1.10 to 3.50. In both Haiti and Cameroon, this initial period of high transmission preceded a longer period during which R t oscillated around the critical threshold of 1. Our results derived from VaxEstim suggest that Haiti had higher OCV1 effectiveness than Cameroon (75.32% effective [54.00-86.39%] vs. 54.88% [18.94-84.90%]). These estimates of OCV1 effectiveness are generally aligned with those derived from field studies conducted in other countries. Thus, our case study reinforces the validity of VaxEstim as an alternative to costly, time-consuming field studies of OCV1 effectiveness. Indeed, prior work in South Sudan, Bangladesh, and the Democratic Republic of the Congo reported OCV1 effectiveness ranging from approximately 40% to 80%. This work underscores the value of combining NMR sources of outbreak case data with computational techniques and the utility of VaxEstim for rapid, inexpensive estimation of vaccine effectiveness in data-poor outbreak settings.

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Introduction: Surgical campaigns for thyroid surgery in low-income environments are very efficient, but there is little literature reporting results. These campaigns are complex due to multiple particularities: highly evolved cases, the need for professionals to travel or an obvious socio-cultural barrier influence towards the surgical act. We describe a surgical campaign in Cameroon to treat patients with goiter and issue some medical and sociocultural recommendations in view of our experience for its implementation with guarantees. Material and methods: An experienced group carried out an 11-day campaign at the Saint Martin de Porres Dominican Hospital, Yaounde, Cameroon. Demographic data, TSH values, surgery and complications after a 12-month follow-up were analyzed. Results: Thirty-eight patients with goiter were selected for the campaign and 32 patients (mean age, 40-years-old; 30 females) were operated. Bilateral goiter, as assessed with echography, was diagnosed in 13 patients (41%). Ten patients (31%) had a WHO grade II goiter (visible with the neck in a normal position). The surgical procedures were 18 unilateral thyroidectomy with isthmectomie, 13 total thyroidectomy, and 1 totalizing thyroidectomy, due to previous unilateral thyroidectomy (cancer recurrence). A pathological study in 13 patients (40%, extra cost 60 €) showed benign multinodular goiter/thyroid nodule (12 patients) and an extensive papillary carcinoma (one patient). Six months postoperatively, 3 patients had a slight dysphonia and one patient had persistent hypocalcemia. Follow-up was completed in all patients, either face to face (75%, 24 patients) or by phone (25%, 8 patients who failed to have a TSH test because of its cost, 23 €). Conclusions: Surgical campaigns to treat thyroid pathology can be carried out with guarantees if a series of important steps are followed: active participation of the patient's environment, thyroid ultrasound by the surgical team to decide which technique, intense awareness about monitoring and hormone replacement therapy, and the participation of local personnel for long-term follow-up.

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ABSTRACT The objective was to evaluate the inoculation with Aspergillus terreus and/or Trichoderma longibrachiatum on fermentation, chemical and microbiological composition of elephant grass 'Cameroon' silage (Cenchrus purpureus). Treatments were A. terreus at 105 colony forming units (CFU)/g (AT15), T. longibrachiatum at 105 CFU/g (TL20), a mixture of both at 105 CFU/g (MIX), and a control group without inoculation (CONTR). The design was completely randomized with seven replicates. The MIX silage was most stable, while CONTR, AT15, and TL20, had lower dry matter losses. There was no effect of inoculation in the chemical composition of silages. Only MIX silage (4.40) had pH above the minimum of 4.2 for humid grass silage and above the control (4.05). Bacteria from Diplococcus genus was identified at the opening of TL20 and CONTR silages. After air exposure, the population of rods, Lactobacillus, and total lactic acid bacteria was higher in theTL20 and MIX. The inclusion of a T. longibrachiatum and A. terreus mixture increases dry mater loss and silage pH. T. longibrachiatum was more efficient in maintaining populations of total lactic acid bacteria after opening; therefore, this strain has potential as an additive for elephant grass 'Cameroon' silage.

RESUMO O objetivo foi testar a inoculação com Aspergillus terreus e Trichoderma longibrachiatum sobre a fermentação, a composição bromatológica e microbiológica de silagem de capim-elefante cultivar 'Cameroon' (Cenchrus purpureus). Os tratamentos foram A. terreus a 105 unidades formadores de colônias (UFC)/g (AT15), T. longibrachiatum a 105 UFC/g (TL20), a mistura de ambos a 105 UFC/g (MIX), cada, e um controle não inoculado (CONTR). O delineamento foi inteiramente ao acaso, com sete repetições. A silagem MIX foi mais estável após abertura, enquanto CONTR, AT15 e TL20 apresentaram menor perda de massa seca. Não houve efeito de inoculação sobre a composição bromatológica das silagens. Apenas a silagem MIX (4,40) apresentou pH acima do mínimo de 4,2 para silagem de capim úmido e superior ao controle (4,05). Bactérias do gênero Diplococcus foram identificadas na abertura das silagens TL20 e CONTR. Após exposição ao ar, a população de bastonetes, Lactobacillus e bactérias láticas totais foram maiores em TL20 e MIX. A mistura de T. longibrachiatum e A. terreus aumenta a perda de matéria seca e o pH da silagem. T. longibrachiatum é mais eficiente em manter as populações de bactérias láticas totais após a abertura. Portanto, essa cepa tem potencial como aditivo para silagem de capim-elefante 'Cameroon'.

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Home blood pressure management, including self-monitoring and medication self-titration, is an efficient and cost-effective tool. Although its use is increasing globally, little is known about the feasibility of such interventions in low and middle-income countries. Further, the perspectives and experiences of healthcare providers who play a big role in ensuring the success of home blood pressure management interventions have not been documented. This qualitative study was conducted with a total of 35 healthcare providers (60% female, mean [SD] age = 37.3 [6.9 years] years), through 4 in-depth interviews from Peru, and 8 in-depth interviews and 4 focus groups from Cameroon. Study participants (healthcare providers) include physicians (primary care physicians), specialists (cardiologists and geriatricians), and nurses that were purposively recruited from two hospitals in two of the largest cities in both countries. Results were thematically analyzed by two researchers. Themes derived were related to feasibility and acceptability, and largely reflected providers in both countries endorsing home blood pressure management. Providers' concerns were in three main areas; 1) safety of patients when they self-titrate medications, 2) resources such as healthcare financing, local hospital policies that support communications with patients for home blood pressure management, and 3) sustainability through patient adherence, incorporating home blood pressure management within clinical guidelines and hospital policies, and complementing with continued health education and lifestyle modifications. According to providers, home blood pressure management may be feasible and acceptable if tailored multi-faceted protocols were introduced bearing in mind local contexts.

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Among the 40 genera of Barychelidae, only nine genera are described from the African continent. Thorell (1899) described Ammonius Thorell, 1899 based on a male from Cameroon. In 1965 Benoit added more information from the holotype, with detailed illustrations of the male palp bulb and the eye group. Since then, few taxonomic revisions or new species of Barychelidae have been proposed from the African continent. Ammonius can be distinguished by the strongly pronounced retrolateral lobe of the male cymbium and the aspect of the bilobed spermathecae of the female. We redescribe the holotype male of A. pupulus Thorell, 1899 and describe the female for the first time. Additionally, a new species is described: Ammonius benoiti sp. nov., from Ivory Coast. The morphology of the tarsal setae is presented through SEM photographs. New distribution records of the genus are provided.

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Polydiscidium is an enigmatic, monotypic, and rarely reported genus of Ascomycota of uncertain placement. The morphologically unique Polydiscidium martynii grows on dead wood and forms compound ascomata composed of thick, black, gelatinous somatic tissue that branches out from a common base. Multiple apothecia are located on the branches, mostly toward the tips, and are composed of 8-spored asci and paraphyses embedded in a gelatinous matrix that turns blue in Melzer's reagent. The species was previously known from only three collections from Guyana (holotype), Trinidad, and the Democratic Republic of the Congo and no sequences exist. Due to its peculiar morphology, taxonomic affinities of Polydiscidium have been debated, with different authors having placed it in Helotiaceae, Leotiaceae, or Leotiomycetes incertae sedis. Recent collections of this species resulting from long-term field work in Guyana and Cameroon led us to revisit the morphology and phylogenetic position of this fungus. Newly generated sequences of P. martynii were added to an Ascomycota-wide six-locus data set. The resulting phylogeny showed Polydiscidium to be a member of order Sclerococcales (Eurotiomycetes). Next, a four-locus (18S, ITS, 28S, mtSSU) phylogenetic reconstruction revealed that Polydiscidium is congeneric with Sclerococcum. A new combination is proposed for this species, Sclerococcum martynii. Micromorphological features, including the gelatinous hymenium composed of asci with amyloid gel cap and septate brown ascospores, are in agreement with Sclerococcum. New combinations are proposed for two additional species: Sclerococcum chiangraiensis and S. fusiformis. Finally, Dactylosporales is considered a later synonym of Sclerococcales.

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Although subsistence hunting is cross-culturally an activity led and practiced mostly by men, a rich body of literature shows that in many small-scale societies women also engage in hunting in varied and often inconspicuous ways. Using data collected among two contemporary forager-horticulturalist societies facing rapid change (the Tsimane' of Bolivia and the Baka of Cameroon), we compare the technological and social characteristics of hunting trips led by women and men and analyze the specific socioeconomic characteristics that facilitate or constrain women's engagement in hunting. Results from interviews on daily activities with 121 Tsimane' (63 women and 58 men) and 159 Baka (83 women and 76 men) show that Tsimane' and Baka women participate in subsistence hunting, albeit using different techniques and in different social contexts than men. We also found differences in the individual and household socioeconomic profiles of Tsimane' and Baka women who hunt and those who do not hunt. Moreover, the characteristics that differentiate hunter and non-hunter women vary from one society to the other, suggesting that gender roles in relation to hunting are fluid and likely to change, not only across societies, but also as societies change.

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Hypertension is the leading risk factor for global disease burden. Self-management of high blood pressure (BP) through self-monitoring and self-titration of medications, has proved to be one successful and cost-effective tool to achieve better BP control in many high-income countries but not much is known about its potential in low- and middle-income countries (LMICs). We used semi-structured questionnaires and focus groups in three LMICs; Peru, Cameroon and Malawi to examine perceptions and attitudes of patients diagnosed with essential hypertension towards living with hypertension, BP measurement and treatment, patient-physician relationship and opinions about self-management of high blood pressure. Results in all three countries were comparable. Patients showed varied levels of health literacy related to hypertension. BP measurement habits were mostly affected by resources available and caregiver support. Treatment and adherence to it were primarily affected by cost. Most patients were welcoming of the idea of self-management but skeptical about the ability to do self-monitoring accurately and the safety involving self-titration of medications.

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Resumen Camerún es uno de los seis países de África Central con más de 20 millones de habitantes. Para caracterizar el desempeño de la investigación de Camerún, las publicaciones de los Camerúnes en el Science Citation Index Expanded durante el período de 1936-2015, indexadas en la base de datos Thomson Reuters SCI-EXPANDED, fueron estudiadas en este trabajo. Todos los documentos de ese período con Camerún en el campo de dirección fueron incluidos en el estudio. Se analizaron el tipo de documento, el idioma, la tendencia y las colaboraciones, así como el resultado de diferentes categorías de temas. También se analizaron las interpretaciones de los países, instituciones y autores, incluyendo el total, único, colaborativo, primer autor, y publicaciones de autor correspondientes. Los artículos fueron analizados por la producción científica y los resultados de investigación de individuos, instituciones y países colaborativos con Camerún. Los análisis incluyeron 8 457 artículos (85 % de 10 591 publicaciones de Camerún). Estos análisis bibliométricos de las publicaciones camerunesas aportaron ideas interesantes sobre autores, instituciones y modelos de colaboración. Los resultados mostraron que la investigación en Camerún era altamente dependiente de colaboraciones extranjeras, y la colaboración internacional fue responsable del creciente número de publicaciones a lo largo de los años. Se encontró que los artículos con autores primarios o autores correspondientes de fuera de Camerún obtuvieron más citas que los otros y que los artículos sin ninguna colaboración internacional tenían citas más bajas. El número de artículos indexados por SCI-EXPANDED ha mostrado un aumento en términos de artículos cameruneses que es considerablemente mayor que el aumento en el número de todos los artículos en SCI-EXPANDED. Los artículos eran más frecuentes que otros tipos de publicación y en su mayor parte en inglés. La Universidad de Yaundé I ocupó el primer lugar en artículos de colaboración interinstitucional, el rango de los artículos de colaboración interinstitucional y el rango de los artículos del primer autor y los artículos de autores correspondientes. La Universidad de Yaundé I también estuvo en una posición de liderazgo absoluta desde 1970 hasta 2015, seguida muy de lejos por las otras instituciones. Las categorías de medicina tropical, ciencias vegetales, salud pública ambiental y ocupacional, y enfermedades infecciosas, representaron el mayor número de artículos publicados. Aunque la física y la química dominaron el ranking de los 20 mejores autores cameruneses, un artículo independiente de matemáticas fue el más citado, con 60 citas en 2015 a un autor camerunés. Los tres principales investigadores productivos fueron: T. C. Kofane, B. T. Ngadjui, P. Woafo, todos de la Universidad de Yaundé I. Francia y Estados Unidos dominaron el ranking de países con una fuerte colaboración científica con Camerún.

Abstract Cameroon is one of the six countries of Central Africa with more than 20 000 000 residents. To characterize the Cameroon research performance, Cameroonians publications in the Science Citation Index Expanded during the period of 1936-2015, indexed in the Thomson Reuters SCI-EXPANDED database, were studied in this work. All documents of that period with Cameroon in the address field were included in the study. The document type, language, trend and collaborations were analyzed, as well as the output of different subject categories. Performances of countries, institutions and authors, including total, single, collaborative, first author, and corresponding author publications were also analyzed. Articles were analyzed by the scientific output and research performances of individuals, institutions and collaborative countries with Cameroon. Analyses included 8 457 articles (85 % of 10 591 Cameroonian publications). These bibliometric analyses of Cameroonian publications provided interesting insights concerning authors, institutions and collaboration patterns. Results showed that research in Cameroon was highly dependent on foreign collaborations, and the international collaboration was responsible for the increasing number of publications over the years. It was found that the articles with either first authors or corresponding authors from outside Cameroon got more citations than the others, and that the articles without any international collaboration had lower citations. The number of articles indexed by SCIEXPANDED has seen an increase in terms of Cameroonian articles that is considerably greater that the increase in number of all articles in SCI-EXPANDED. Articles were more frequent than other types of publication and they were mostly in English. The University of Yaoundé I ranked top one in inter-institutionally collaborative articles, the rank of the total inter-institutionally collaborative articles, and the rank of first author articles and corresponding author articles. The University of Yaoundé I also was in an absolute leading position from 1970s to 2015, followed far away by the other institutions. The categories of tropical medicine, plant sciences, environmental and occupational public health, and infectious diseases, represented the largest number of published articles. Even though physics and chemistry dominated the ranking of the top 20 best Cameroonian authors, an independent mathematics article was the most cited, with 60 citations in 2015 to a Cameroonian author. The top three productive researchers were T. C. Kofane, B. T. Ngadjui, P. Woafo, all from University of Yaoundé I. France and the USA dominated the ranking of countries with strong scientific collaboration with Cameroon.

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BACKGROUND: Little information is available on the validity of anthropometry or impedance-based equations for prediction of total body water (TBW) in African children. This study was designed to validate and develop equations to predict total body water in Cameroonian children. METHODS: TBW was measured by deuterium dilution in 102 children between 24 and 60 months of age and compared with the ones predicted by 5 anthropometric and 7 BIA equations. Multiple linear regression analysis was used to develop prediction equations for TBW from anthropometric parameters. RESULTS: Unacceptable discrepancies in the estimates of TBW at individual level were noted with all the equations tested. The following new anthropometry and BIA equations for the estimation of TBW were respectively developed: TBW = 6.488 + 0.434 × sex−0.039 × age + 0.670 × weight−0.081 × MUAC (cm)−0.372 × BMI (adjustedR2= 0.71,RMSE = 3.6), and TBW =−6.206 + 0.0037 × height2/Z−0.041 × age + 0.265 × weight + 0.1214 × height (adjustedR2=0.68, RMSE = 1.4). The cross-validation procedures revealed that the predicted values of TBW compared with measured values are accurate at a group level. CONCLUSION: The current published anthropometric and BIA equations are invalid for the estimation of TBW in Cameroonian preschool children. The newly developed anthropometry or BIA prediction equations are valid for use in Cameroonian children aged 24­60 months

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BACKGROUND: Armillaria is a globally distributed mushroom-forming genus composed primarily of plant pathogens. Species in this genus are prolific producers of rhizomorphs, or vegetative structures, which, when found, are often associated with infection. Because of their importance as plant pathogens, understanding the evolutionary origins of this genus and how it gained a worldwide distribution is of interest. The first gasteroid fungus with close affinities to Armillaria-Guyanagaster necrorhizus-was described from the Neotropical rainforests of Guyana. In this study, we conducted phylogenetic analyses to fully resolve the relationship of G. necrorhizus with Armillaria. Data sets containing Guyanagaster from two collecting localities, along with a global sampling of 21 Armillaria species-including newly collected specimens from Guyana and Africa-at six loci (28S, EF1α, RPB2, TUB, actin-1 and gpd) were used. Three loci-28S, EF1α and RPB2-were analyzed in a partitioned nucleotide data set to infer divergence dates and ancestral range estimations for well-supported, monophyletic lineages. RESULTS: The six-locus phylogenetic analysis resolves Guyanagaster as the earliest diverging lineage in the armillarioid clade. The next lineage to diverge is that composed of species in Armillaria subgenus Desarmillaria. This subgenus is elevated to genus level to accommodate the exannulate mushroom-forming armillarioid species. The final lineage to diverge is that composed of annulate mushroom-forming armillarioid species, in what is now Armillaria sensu stricto. The molecular clock analysis and ancestral range estimation suggest the most recent common ancestor to the armillarioid lineage arose 51 million years ago in Eurasia. A new species, Guyanagaster lucianii sp. nov. from Guyana, is described. CONCLUSIONS: The armillarioid lineage evolved in Eurasia during the height of tropical rainforest expansion about 51 million years ago, a time marked by a warm and wet global climate. Species of Guyanagaster and Desarmillaria represent extant taxa of these early diverging lineages. Desarmillaria represents an armillarioid lineage that was likely much more widespread in the past. Guyanagaster likely evolved from a gilled mushroom ancestor and could represent a highly specialized endemic in the Guiana Shield. Armillaria species represent those that evolved after the shift in climate from warm and tropical to cool and arid during the late Eocene. No species in either Desarmillaria or Guyanagaster are known to produce melanized rhizomorphs in nature, whereas almost all Armillaria species are known to produce them. The production of rhizomorphs is an adaptation to harsh environments, and could be a driver of diversification in Armillaria by conferring a competitive advantage to the species that produce them.

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The World Health Organization (WHO) classifies snake bites as neglected public health problem affecting mostly tropical and subtropical countries. In Africa there are an estimated 1 million snake bites annually with about half needing a specific treatment. Women, children and farmers in poor rural communities in developing countries are the most affected. Case management of snake bites are not adequate in many health facilities in developing countries where personnel are not always abreast with the new developments in snake bite management and in addition, quite often the anti-venom serum is lacking. We report the case of a medical doctor bitten by a cobra in the rural area of Poli, Cameroon while asleep in his bedroom. Lack of facilities coupled with poor case management resulted in a fatal outcome.

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Inadequate vitamin A (VA) nutrition continues to be a major problem worldwide, and many interventions being implemented to improve VA status in various populations need to be evaluated. The interpretation of results after an intervention depends greatly on the method selected to assess VA status. To evaluate the effect of an intervention on VA status, researchers in Cameroon, India, Indonesia, Mexico, Senegal and Zambia have used serum retinol as an indicator, and have not always found improvement in response to supplementation. One problem is that homeostatic control of serum retinol may mask positive effects of treatment in that changes in concentration are observed only when status is either moderately to severely depleted or excessive. Because VA is stored mainly in the liver, measurements of hepatic VA stores are the “gold standard” for assessing VA status. Dose response tests such as the relative dose response (RDR) and the modified relative dose response (MRDR), allow a qualitative assessment of VA liver stores. On the other hand, the use of the vitamin A-labeled isotope dilution (VALID) technique, (using 13C or 2H-labeled retinyl acetate) serves as an indirect method to quantitatively estimate total body and liver VA stores. Countries including Cameroon, China, Ghana, Mexico, Thailand and Zambia are now applying the VALID method to sensitively assess changes in VA status during interventions, or to estimate a population’s dietary requirement for VA. Transition to the use of more sensitive biochemical indicators of VA status such as the VALID technique is needed to effectively assess interventions in populations where mild to moderate VA deficiency is more prevalent than severe deficiency.

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La polyvalence fonctionnelle des végétaux se matérialise à travers les nombreux usages que les peuples du Nord-Cameroun en font. Ils ont mis sur place un savoir -: faire local qui leur a permis d'exploiter de manière efficace leur environnement végétal. La disparition des essences de valeur les oblige à développer d'autres stratégies en relation avec une nouvelle ère marquée par la consommation de produits manufacturés. Le présent article récapitule les principaux usages des plantes par les peuples du Nord-Cameroun, évalue leurs stratégies de mise en valeur des herbacées et des ligneux et interroge sur la validité des dispositions en cours portant sur la préservation du patrimoine végétal mis en péril par l'homme et par la nature.

The functional versatility of plants can be seen in their numerous uses by the people of Northern Cameroon. They have implemented local know-how which has allowed them to effectively exploit their botanical environment. The disappearance of valuable species has forced them to develop other strategies, with a new era marked by the consumption of manufactured products. This article summarizes the principal uses of plants by the people of Northern Cameroon, evaluates their strategies for extracting value from grasses and woods, and questions the validity of the measures currently in place to preserve the botanical heritage at risk due to the actions of man and nature.

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Leprosy has been eliminated as a public health problem in most countries of the world according to the WHO, but the social stigma to the disease is still very high. The present study was performed to investigate the role of social stigma as a determinant for leprosy elimination in a leprosy endemic region of Cameroon. Focus group discussions, in-depth interviews and structured questionnaires were used to investigate leprosy social stigma among lepers, their contacts and a control group consisting of patients attending a health facility for reasons other than leprosy. Informed consent was sought and gained prior to starting the study. Focus group discussions and in-depth interviews identified three types of stigma: lack of self-esteem, tribal stigma and complete rejection by society. From the 480 structured questionnaires administered, there were overall positive attitudes to lepers among the study population and within the divisions (P=0.0). The proportion of participants that felt sympathetic with deformed lepers was 78.1% [95% confidence interval (CI): 74.4-81.8%] from a total of 480. Three hundred and ninety nine (83.1%) respondents indicated that they could share a meal or drink at the same table with a deformed leper (95% CI: 79.7-86.5%). Four hundred and three (83.9%) participants indicated that they could have a handshake and embrace a deformed leper (95% CI: 80.7-87.3%). A total of 85.2% (95.0% CI: 81.9-88.4%) participants affirmed that they could move with a deformed leper to the market or church. A high proportion of 71.5% (95.0% CI: 67.5%-75.5%) participants stated that they could offer a job to a deformed leper. The results indicate that Menchum division had the lowest mean score of 3.3 on positive attitudes to leprosy compared with Mezam (4.1) and Boyo (4.8) divisions. The high proportion of positive attitudes among the participants and in different divisions is a positive indicator that the elimination of leprosy social stigma is progressing in the right direction. Quantification of stigma to assess the elimination struggle is a new research area in public health.