RESUMO
BACKGROUND: The link between measures of adiposity and prevalent screen-detected diabetes (SDM) in Africa has been less well investigated. We assessed and compared the strength of association and discriminatory capability of measures of adiposity including body mass index (BMI), waist circumference (WC), hip circumference (HC), waist-hip-ratio (WHR) and waist-height-ratio (WHtR) for prevalent SDM risk in a sub-Saharan African population. METHODS: Participants were 8663 adults free of diagnosed type 2 diabetes, who took part in the nationally representative Cameroon Burden of Diabetes (CAMBoD) 2006 survey. Logistic regression models were used to compute the odd ratio (OR) and 95% confidence interval (95%CI) for a standard deviation (SD) higher level of BMI (7.3), WC (12.5), HC (11.7), WHR (0.19) and WHtR (0.08) with prevalent SDM risk. Assessment and comparison of discrimination used C-statistic and relative integrated discrimination improvement (RIDI, %). RESULTS: The adjusted OR and 95%CI for prevalent SDM with each SD higher adipometric variable were: 1.05 (0.98-1.13) for BMI, 1.30 (1.16-1.46) for WC, 1.18 (1.05-1.34) for HC, 1.05 (1.00-1.16) for WHR and 1.26 (1.11-1.39) for WHtR. C-statistic comparisons and RIDI analyses showed a trend toward a significant superiority of WC over other adipometric variables in multivariable models. Combining adiposity variables did not improve discrimination beyond multivariable models with WC alone. CONCLUSION: WC was the best predictors and to some extent WHtR of prevalent SDM in this population, while BMI and WHR were less effective.
Assuntos
Índice de Massa Corporal , Diabetes Mellitus Tipo 2/epidemiologia , Programas de Rastreamento , Circunferência da Cintura , Razão Cintura-Estatura , Adulto , Camarões/epidemiologia , Diabetes Mellitus Tipo 2/diagnóstico , Feminino , Humanos , Masculino , Prevalência , Fatores de Risco , Relação Cintura-QuadrilAssuntos
Doença Crônica/prevenção & controle , Saúde Global , Comportamentos Relacionados com a Saúde , Estilo de Vida , Nações Unidas , Consumo de Bebidas Alcoólicas/efeitos adversos , Consumo de Bebidas Alcoólicas/economia , Consumo de Bebidas Alcoólicas/prevenção & controle , Causas de Morte/tendências , Doença Crônica/economia , Doença Crônica/mortalidade , Redução de Custos/tendências , Estudos Transversais , Países Desenvolvidos/economia , Países em Desenvolvimento/economia , Dieta com Restrição de Carboidratos/economia , Dieta com Restrição de Gorduras/economia , Dieta Hipossódica/economia , Quimioterapia Combinada/economia , Medicamentos Genéricos/economia , Medicamentos Genéricos/uso terapêutico , Previsões , Saúde Global/economia , Saúde Global/tendências , Custos de Cuidados de Saúde/tendências , Humanos , Atividade Motora , Fatores de Risco , Fumar/efeitos adversos , Fumar/economia , Abandono do Uso de Tabaco/economia , Estados UnidosRESUMO
BACKGROUND: Hypertension is becoming increasingly important in sub-Saharan Africa. However, evidences in support of this trend with time are still not available. The aim of this study was to evaluate the 10-year change in blood pressure levels and prevalence of hypertension in rural and urban Cameroon. METHODS: Two cross-sectional population-based surveys in Yaounde (urban area) and Evodoula (rural area) in 1994 (1762 subjects) and 2003 (1398 subjects) used similar methodologies in women and men aged >or=24 years. Data on systolic and diastolic blood pressures (SBP and DBP), body mass index, educational level, alcohol consumption and tobacco smoking were collected during the two periods. RESULTS: Between 1994 and 2003, blood pressure levels significantly increased in rural women (SBP, +18.2 mm Hg; DBP, +11.9 mm Hg) and men (SBP, +18.8 mm Hg; DBP, +11.6 mm Hg), all p<0.001. In the urban area, SBP increased in women (+8.1 mm Hg, p<0.001) and men (+6.5 mm Hg, p<0.001), and DBP increased only in women (+3.3 mm Hg, p<0.001). The OR (95% CI) adjusted on confounders comparing the prevalence of hypertension (blood pressure >or= 140/90 mm Hg and/or treatment) between 2003 and 1994 ranged from 1.5 (1.1 to 2.2) in urban men to 5.3 (3.2 to 8.9) in rural men. CONCLUSION: Blood pressure levels of this population have deteriorated over time, and the prevalence of hypertension has increased by twofold to fivefold. Adverse effects of risk factors could account for some of these changes. Prevention and control programmes are needed to reverse these trends and to avoid the looming complications.
Assuntos
Pressão Sanguínea/fisiologia , Hipertensão/epidemiologia , População Rural/estatística & dados numéricos , População Urbana/estatística & dados numéricos , Adulto , Idoso , Consumo de Bebidas Alcoólicas/epidemiologia , Índice de Massa Corporal , Camarões/epidemiologia , Estudos Transversais , Diástole/fisiologia , Escolaridade , Feminino , Humanos , Hipertensão/etiologia , Hipertensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Prevalência , Fumar/epidemiologia , Sístole/fisiologia , Fatores de TempoRESUMO
OBJECTIVE: To determine the clinical features, regularly associated microorganisms and their susceptibility to antibiotics, and the clinical outcomes of foot ulcers in patients with diabetes at the Yaoundé Central Hospital, Cameroon. METHOD: A retrospective analysis of routinely collected hospital data, and data validation by survey of clinical notes was conducted from November 1999 to October 2002 for adult diabetic patients with foot ulcers. Clinical data were recorded for each patient, followed by a record of microbiological investigations where available. RESULTS: Of 503 patients with diabetes admitted during the study period, 54 (10.7%) had foot ulcers. Male subject represented 66.7% of this population. The mean age of the study population was 59.66 +/- 1.52 years. The foot ulcer led to the diagnosis of diabetes in six patients in whom the condition was previously unidentified. Of the 54 patients with foot ulcers, nine (16.7%) were selected for surgery and the remaining 45 were managed conservatively. Microbiological investigations were available for 21 patients. Proteus mirabilis was the most frequent microorganism yielded, and was regularly associated with Staphylococcus aureus. All the microorganisms isolated showed high sensitivity to second-generation quinolone antibiotics and were regularly sensitive to aminoglycoside antibiotics. Nine (16.7%) patients died and seven (13%) were discharged at their own request. CONCLUSION: The mortality rate among our diabetic patients with foot ulcers is high and the combination of second-generation quinolone and aminoglycoside antibiotics can be proposed as a probabilistic antibiotic approach to treating foot infection.
Assuntos
Antibacterianos/uso terapêutico , Infecções Bacterianas/tratamento farmacológico , Infecções Bacterianas/microbiologia , Pé Diabético/complicações , Infecção dos Ferimentos/tratamento farmacológico , Infecção dos Ferimentos/microbiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Amputação Cirúrgica/estatística & dados numéricos , Infecções Bacterianas/diagnóstico , Infecções Bacterianas/epidemiologia , Camarões/epidemiologia , Contagem de Colônia Microbiana , Pé Diabético/cirurgia , Uso de Medicamentos/estatística & dados numéricos , Feminino , Humanos , Masculino , Auditoria Médica , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Seleção de Pacientes , Padrões de Prática Médica/estatística & dados numéricos , Prevalência , Estudos Retrospectivos , Gestão da Qualidade Total , Resultado do Tratamento , Infecção dos Ferimentos/diagnóstico , Infecção dos Ferimentos/epidemiologiaRESUMO
There is evidence that the prevalence of certain non-communicable diseases, such as diabetes and hypertension, is increasing rapidly in parts of sub-Saharan Africa. Others, such as asthma and epilepsy, are known to be common but to be poorly managed. This paper describes a project, funded by the Department for International Development of the British Government, which aims to provide costed and evaluated treatment packages for use at primary health care level, methods and materials for evaluating the quality of non-communicable disease care, and a protocol for the assessment for national opportunities for the prevention of hypertension, heart disease and diabetes. Methods are being developed and piloted in urban and rural Tanzania and Cameroon.
PIP: Declining death rates from communicable diseases, together with population aging, leads to a higher incidence and prevalence of noncommunicable diseases (NCDs), such as atherosclerotic disorders, cancers, and chronic respiratory disease. These NCDs gradually become the population's predominant health problems. Evidence indicates that the prevalence of certain NCDs, such as diabetes and hypertension, is increasing rapidly in parts of sub-Saharan Africa. Others, such as asthma and epilepsy, are common, but poorly managed. This paper describes a project funded by the British Government's Department for International Development to provide costed and evaluated treatment packages for use at the primary health care level, methods and materials for evaluating the quality of noncommunicable disease care, and a protocol for assessing national opportunities to prevent hypertension, heart disease, and diabetes. Methods are now being developed and piloted in urban and rural Tanzania and Cameroon.
Assuntos
Asma/epidemiologia , Países em Desenvolvimento , Diabetes Mellitus/epidemiologia , Epilepsia/epidemiologia , Hipertensão/epidemiologia , Asma/diagnóstico , Asma/terapia , Camarões , Centros Comunitários de Saúde , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/terapia , Epilepsia/diagnóstico , Epilepsia/terapia , Promoção da Saúde , Humanos , Hipertensão/diagnóstico , Hipertensão/terapia , Cooperação Internacional , Prevalência , Tanzânia , Reino UnidoRESUMO
Large prolactin-secreting pituitary adenomas with suprasellar extension are often complicated by visual field defects, for which surgical decompression is the accepted treatment. However, surgical management of large prolactinomas is often not curative. This report describes a group of six unselected male patients who presented with visual field defects and reduced visual acuity due to large pituitary tumours with suprasellar extension. All six patients also had loss of libido and/or impotence. A rapid serum prolactin estimation enabled the diagnosis of prolactinoma to be made, and CT revealed a large pituitary adenoma with suprasellar extension. The patients were treated with bromocriptine, in doses increasing from 2.5 to 20 mg daily, as the sole therapy. Symptoms were relieved and serum prolactin levels were restored to normal or near normal; visual field defects resolved and visual acuity recovered in all patients. A repeat CT showed evidence of tumour shrinkage especially of the suprasellar extension, in all the patients. A diagnosis of prolactinoma should always be considered in a patient with a large pituitary tumour. The clinical history and a rapid prolactin assay will confirm the diagnosis. Treatment with bromocriptine leads to rapid improvement in perimetry and visual acuity as well as tumour shrinkage, obviating the need for pituitary surgery.