Burden of atrial fibrillation among adults with heart failure in sub-Saharan Africa: a systematic review and meta-analysis.

OBJECTIVES: This study aimed to estimate the prevalence of atrial fibrillation (AF) in adults with heart failure (HF) and summarise the all-cause mortality ratio among adult patients with coexisting HF and AF in sub-Saharan Africa (SSA). SETTING: This was a systematic review and meta-analysis of cross-sectional and cohort studies with primary data on the prevalence and incidence of AF among patients with HF and the all-cause mortality ratio among patients with HF and AF in SSA. We combined text words and MeSH terms to search MEDLINE, PubMed and Global Health Library through Ovid SP, African Journals Online and African Index Medicus from database inception to 10 November 2021. Random-effects meta-analysis was used to estimate pooled prevalence. PRIMARY OUTCOME MEASURES: The prevalence and incidence of AF among patients with HF, and the all-cause mortality ratio among patients with HF and AF. RESULTS: Twenty-seven of the 1902 records retrieved from database searches were included in the review, totalling 9987 patients with HF. The pooled prevalence of AF among patients with HF was 15.6% (95% CI 12.0% to 19.6%). At six months, the all-cause mortality was 18.4% (95% CI 13.1% to 23.6%) in a multinational registry and 67.7% (95% CI 51.1% to 74.3%) in one study in Tanzania. The one-year mortality was 48.6% (95% CI 32.5% to 64.7%) in a study in the Democratic Republic of Congo. We did not find any study reporting the incidence of AF in HF. CONCLUSION: AF is common among patients with HF in SSA, and patients with AF and HF have poor survival. There is an urgent need for large-scale population-based prospective data to reliably estimate the prevalence, incidence and risk of mortality of AF among HF patients in SSA to better understand the burden of AF in patients with HF in the region. PROSPERO REGISTRATION NUMBER: CRD42018087564.

Atrial fibrillation among adults with heart failure in sub-Saharan Africa - prevalence, incidence and all-cause mortality: a systematic review and meta-analysis protocol.

INTRODUCTION: Heart failure (HF) remains a major non-communicable disease in sub-Saharan Africa (SSA) associated with high rates of readmission, mortality and loss of economic productivity as it affects mostly young and economically active adults. Atrial fibrillation (AFib) is a major determinant of mortality among patients with HF in SSA. Meanwhile, the use of anti-arrhythmic medications in the region remains unacceptably low. This review aims to evaluate the prevalence and incidence of AFib in adult patients with HF in SSA, and the all-cause mortality rate among patients with HF and AFib. METHODS AND ANALYSIS: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Protocols 2015 statement was used to prepare this protocol. All eligible studies from database inception to December, 31 2018 in MEDLINE, Embase, Google Scholar, Web of science and Africa-specific databases (AFROLIB, African Index Medicus and African Journals Online) will be included without language restrictions. The process of study screening, selection, data extraction and assessment of risk of bias will be conducted independently by two reviewers. Disagreements will be arbitrated by a third reviewer. Study-specific estimates will be pooled using random-effect meta-analysis and summary measures obtained will be presented in forest plots. The χ2 test on Cochrane's Q and the I2 statistics will be used to assess and quantify heterogeneity, respectively. The Egger's test and funnel plots will be used to assess publication bias. ETHICS AND DISSEMINATION: Since our review will be based on already published data, an ethical approval is not required. The findings of this review will be presented in conferences and peer-reviewed journals and shared on social media such as Researchgate, Facebook, WhatsApp and Twitter. PROSPERO REGISTRATION NUMBER: CRD42018087564.

The general public's knowledge of diabetes mellitus: A cross-sectional study in Cameroon.

OBJECTIVE: To assess the general public's level of knowledge on diabetes mellitus (DM) and identify related sources of information in Cameroon. STUDY DESIGN: This was a cross-sectional study conducted in 2015 in two health facilities in Yaoundé and Edéa. METHODS: We included consenting adults, except health professionals. The level of knowledge on DM was evaluated on 24 points corresponding to 24 questions addressing either DM definition, signs and symptoms, risk factors or complications. RESULTS: Overall, 1524 persons (40.2% males) were included. Almost 99% of respondents had already heard of DM, but only 16.3% had ever received education on DM. The median score for the global knowledge was 79% (IQR 67-88). A person in the close entourage (71.3%) or a health professional (58.8%) constituted the major sources of information; school (13.3%) and media (television (23.6%), newspaper/magazine (10.0%), radio (9.6%) and internet (6.8%) were less common. Younger ages (<45years), lower levels of education, semi-urban residency, were independently associated with a lower level of knowledge on DM. CONCLUSIONS: The general public's level of knowledge on DM may be satisfactory, though needing to be improved. Schools and media should be capitalized to educate people on DM, targeting especially young adults and the less educated.

Giant congenital melanocytic nevus in a Cameroonian child: a case report.

BACKGROUND: Giant congenital melanocytic nevus is a very rare condition characterized by a large skin lesion and an increased risk of complications like neurocutaneous melanosis and malignant transformation. Reports of giant congenital melanocytic nevus are scarce in the sub-Saharan African literature and here we present a case of this disease in a Cameroonian adolescent. CASE PRESENTATION: A 12-year-old Cameroonian girl from the "Baka" ethnic group, with no relevant family and medical histories presented with a progressively extensive brownish-black nodular hypertrophic skin lesion of approximately 45 cm, which she had had since she was 2-days old. The lesion covered her entire back giving an appearance of "turtle child", which was highly suggestive of a giant congenital melanocytic nevus. She was booked in for a surgical intervention organized by a health campaign within her community. Meanwhile she was provided with psychological support and her family was counseled on warning signs of complications which would warrant an urgent consultation. CONCLUSIONS: Here we presented a case of giant congenital melanocytic nevus, apparently the first in the Cameroonian literature. In view of the potential severe complications as well as psychological trauma of this pathology, we draw clinicians' attention to this extremely rare but real pathology in our country, for a timely diagnosis and management.

Assessment of the general public's knowledge of stroke: A cross-sectional study in Yaoundé, Cameroon.

BACKGROUND: Stroke knowledge and awareness in the general public is important to improve stroke prevention and ensure prompt response to disease onset. Addressing the dearth of data in Africa, this study aimed to determine the level of knowledge on stroke definition, symptoms, risk factors and complications in the general population living in Yaoundé, Cameroon. METHODS: From February to April 2015, we conducted a cross-sectional study at the Nicolas Barre Hospital Centre. With the exception of the health personnel, we recruited all individuals aged ≥18years who visited the Centre for one reason or another and who volunteered to answer our questionnaire. The level of knowledge on stroke was evaluated on 28 points corresponding to 28 questions addressing either stroke definition, warning signs and symptoms, risk factors or complications. RESULTS: In total, 1.025 participants (57.4% females) were enrolled. The median age was 34years (interquartile range: 26-48); 14.9% and 9.8% of the participants were known hypertensive and diabetes patients, respectively. Overall, 99% of participants had already heard about stroke. The mean score of knowledge was 81.3±11.1%. The main sources of information on stroke were the close entourage (83.0%) and the health personnel (73.0%); media (television (16.4%), newspaper (8.0%), internet (7.7%), and radio (2.2%)) and school (8.0%) were the least represented. Speech disturbances (98.3%) and weakness, numbness or paralysis of one part of the body (98.0%) were the major warning signs and symptoms cited. Hypertension (98.5%) and overweight/obesity (97.8%) were the most known risk factors; 98.7% of people were aware of stroke common complications. Younger age (<45years), male sex, lower level of education and previous experience of stroke education were independently associated with a lower level of knowledge on stroke. CONCLUSION: The general public's level of knowledge on stroke in Yaoundé is good, though still needing to be improved. Media and schools should be capitalized to communicate on stroke, as these means will help to reach the youngest and the least educated who seem to have lower levels of knowledge.