Estimation and determinants of direct medical costs of ischaemic heart disease, stroke and hypertensive heart disease: evidence from two major hospitals in Cameroon.

BACKGROUND: Cardiovascular disease (CVD) is the largest contributor to the non-communicable diseases (NCD) burden in Cameroon, but data on its economic burden is lacking. METHODS: A prevalence-based cost-of-illness study was conducted from a healthcare provider perspective and enrolled patients with ischaemic heart disease (IHD), ischaemic stroke, haemorrhagic stroke and hypertensive heart disease (HHD) from two major hospitals between 2013 and 2017. Determinants of cost were explored using multivariate generalized linear models. RESULTS: Overall, data from 850 patients: IHD (n = 92, 10.8%), ischaemic stroke (n = 317, 37.3%), haemorrhagic stroke (n = 193, 22.7%) and HHD (n = 248, 29.2%) were analysed. The total cost for these CVDs was XAF 676,694,000 (~US$ 1,224,918). The average annual direct medical costs of care per patient were XAF 1,395,200 (US$ 2400) for IHD, XAF 932,700 (US$ 1600) for ischaemic stroke, XAF 815,400 (US$ 1400) for haemorrhagic stroke, and XAF 384,300 (US$ 700) for HHD. In the fully adjusted models, apart from history of CVD event (ß = - 0.429; 95% confidence interval - 0.705, - 0.153) that predicted lower costs in patients with IHD, having of diabetes mellitus predicted higher costs in patients with IHD (ß = 0.435; 0.098, 0.772), ischaemic stroke (ß = 0.188; 0.052, 0.324) and HHD (ß = 0.229; 0.080, 0.378). CONCLUSIONS: This study reveals substantial economic burden due to CVD in Cameroon. Diabetes mellitus was a consistent driver of elevated costs across the CVDs. There is urgent need to invest in cost-effective primary prevention strategies in order to reduce the incidence of CVD and consequent economic burden on a health system already laden with the impact of communicable diseases.

Leave no one behind: response to new evidence and guidelines for the management of cryptococcal meningitis in low-income and middle-income countries.

In 2018, WHO issued guidelines for the diagnosis, prevention, and management of HIV-related cryptococcal disease. Two strategies are recommended to reduce the high mortality associated with HIV-related cryptococcal meningitis in low-income and middle-income countries (LMICs): optimised combination therapies for confirmed meningitis cases and cryptococcal antigen screening programmes for ambulatory people living with HIV who access care. WHO's preferred therapy for the treatment of HIV-related cryptococcal meningitis in LMICs is 1 week of amphotericin B plus flucytosine, and the alternative therapy is 2 weeks of fluconazole plus flucytosine. In the ACTA trial, 1-week (short course) amphotericin B plus flucytosine resulted in a 10-week mortality of 24% (95% CI -16 to 32) and 2 weeks of fluconazole and flucytosine resulted in a 10-week mortality of 35% (95% CI -29 to 41). However, with widely used fluconazole monotherapy, mortality because of HIV-related cryptococcal meningitis is approximately 70% in many African LMIC settings. Therefore, the potential to transform the management of HIV-related cryptococcal meningitis in resource-limited settings is substantial. Sustainable access to essential medicines, including flucytosine and amphotericin B, in LMICs is paramount and the focus of this Personal View.

Overweight and obesity in children aged 3-13 years in urban Cameroon: a cross-sectional study of prevalence and association with socio-economic status.

BACKGROUND: Childhood overweight/obesity is increasing rapidly in developing countries. There is a need to provide more evidence on its burden in sub-Saharan Africa, and to identify associated factors in order to set preventive measures. We aimed to determine the prevalence of overweight/obesity and assess its association with the socioeconomic status in nursery and primary school children in urban Cameroon. METHODS: In this cross-sectional study, we included by multi-staged cluster random sampling 1343 children from high (HSES, n = 673) and low (LSES, n = 670) socioeconomic status schools in Douala. Parent/child demographic data were collected, and children's anthropometric parameters were measured using validated methods. The World Health Organization body mass index-for-age reference curves were used. RESULTS: The prevalence of overweight/obesity was 12.5% (13.2% in girls, 11.8% in boys). The risk of overweight/obesity was 2.40 (95% CI 1.70, 3.40) higher in HSES children compared to LSES after adjusting for age and gender. However this association was attenuated to 1.18 (95% CI 0.59, 2.35) once adjustment had been made for a range of potential confounders. CONCLUSIONS: Overweight/obesity is relatively common in sub-Saharan African children and prevalence is associated with HSES. However, this association may be mediated by sweet drink consumption, passive means of travel to school and not doing sport at school. We suggest that these potentially modifiable behaviors may be effective targets for obesity prevention. Further studies should specifically focus on unhealthy behaviors that mediate overweight/obesity as well as other non communicable diseases in children.

Cross-sectional assessment of three commonly used measures of adherence to combination antiviral therapy in a resource limited setting.

Nowadays, global coverage of combination antiretroviral therapy (cART) has increased due to a continuous process to scale up access. This increase has potentially transformed HIV-infection from a fatal to a chronic disease: a transformation only possible if the prescribed medications are taken accordingly. We therefore evaluated optimal adherence to cART by three commonly used methods: visual analogue scale (VAS), four days recall (FDR) and clinic attendance (CA) for the last six months in 301 HIV-infected patients on cART for at least six months at the Douala General Hospital, Cameroon. Optimal adherence was defined to be greater than or equal to the 95th percentile estimate of each method. We found that 70.8% of our study population was female. The mean age was 40.8 years (SD 10.5) and 85% were on first line cART. Median CD4 count was 397 cells/ml (252-559). Optimal adherence by VAS, FDR and CA, was 68.1%, 83.4%, and 73.4%, respectively. VAS and FDR inter-correlated strongly (Pearson's Chi square coefficient, r = 0.58, p < 0.001). Higher CD4 count above 200 cells/ml was associated with optimal adherence by CA (Adjusted Odds Ratio [AOR]:2.6 (95% CI: 1.2-5.3, p < 0.001)). As high optimal adherence to cART is associated with good clinical outcome in HIV patients, simple methods such as the VAS for evaluating adherence, should be integrated to the HIV clinic of the Douala General Hospital.