Primary health care for hypertension by nurses in rural and urban sub-Saharan Africa.

To implement a nurse-led protocol for the care of hypertension, 5 clinics were established in Yaounde (urban) and Bafut (rural) in Cameroon. International guidelines were adapted and 10 nurses were trained. The initial cohort of patients was referred from a field survey. The program proceeded for 26 months and 454 patients (45% urban) were registered in the clinics. Relative to urban participants, rural participants were more often women (59% vs 45%, P=.002) and less likely to have diabetes (7.2% vs 41.2%, P<.001). Between baseline and final visits, systolic and diastolic blood pressures dropped by 11.7 mm Hg (95% confidence interval, 8.9-14.4) and 7.8 (95% confidence interval, 5.9-9.6), respectively (P<.001). These changes were consistent in subgroups and after adjustment. Most dropouts occurred around the initial visit and among urban participants and nondiabetics. Nurse-led clinics are effective for improving hypertension care in these settings and require implementation and validation through controlled trials.

Diabetes Mellitus: Indigenous naming, indigenous diagnosis and self-management in an African setting: the example from Cameroon.

BACKGROUND: The objective was to examine how the indigenous naming, indigenous self-diagnosis and management of diabetes evolved with awareness in order to develop a socially oriented theoretical model for its care. METHODS: The data was collected through a one-year extended participant observation in Bafut, a rural health district of Cameroon. The sample consisted of 72 participants in a rural health district of Cameroon (men and women) with type 2 diabetes. We used participant observation to collect data through focus group discussions, in depth interviews and fieldwork conversations. The method of analysis entailed a thick description, thematic analysis entailing constant comparison within and across FGD and across individual participants and content analysis. RESULTS: The core concepts identified were the evolution of names for diabetes and the indigenous diagnostic and self-management procedures. Participants fell into one of two naming typologies: (a) Naming excluding any signs and symptoms of diabetes; (b) naming including signs and symptoms of diabetes. Participants fell into two typologies of diagnostic procedures: (a) those that use indigenous diagnostic procedures for monitoring and controlling diabetes outcomes and b) those that had initially used it only for diagnosis and continued to use them for self management. These typologies varied according to how participants' awareness evolved and the impact on self-diagnosis and management. CONCLUSION: The evolution of names for diabetes was an important factor that influenced the subsequent self-diagnosis and management of diabetes in both traditional and modern biomedical settings.

Ten-year changes in central obesity and BMI in rural and urban Cameroon.

OBJECTIVE: To compare the 10-year changes in the distribution of adiposity in rural and urban Cameroonian populations. METHODS AND PROCEDURES: Two cross-sectional surveys of populations in the same rural and urban areas of Cameroon, aged>or=24 years, were carried out in 1994 (1,762 subjects) and 2003 (1,398 subjects) using similar methodology. All eligible subjects answered a structured questionnaire on their educational level, alcohol consumption, and tobacco smoking and weight, height, and waist circumference (WC) were measured. RESULTS: Between 1994 and 2003, the age-standardized prevalence of BMI>or=25 kg/m2 increased significantly only in the rural area (+54% for women and +82% for men), while the age-standardized prevalence of central obesity (WC>or=80 cm (women), >or=94 cm (men)) increased significantly only in the urban population (+32% for women and +190% for men). These differences persisted after adjustments for age group, alcohol consumption, tobacco smoking, and level of education, and within almost all the strata of the studied risk factors. DISCUSSION: Changes in adiposity over time in Cameroon were characterized by an increase of BMI in the rural area and of WC in the urban area.

Perceived risk factors of cardiovascular diseases and diabetes in Cameroon.

We set out to assess the perceived risk factors of cardiovascular diseases (CVDs) and diabetes mellitus in an urban setting using focus group discussions and in-depth interviews to collect data from different stakeholders constituting the triangle of care. Ethnomethodological analyses were done manually and with Ethnograph software. The results showed an awareness of emergence of CVD and diabetes in Cameroon and perceived relationships between risk factors and CVD and diabetes. The awareness of behavioural risk factors was higher than the biological ones, though perceptions about them were muddled. The main drawbacks for reducing risk factors were perceived to emerge from the lack of a national policy programme on non-communicable diseases; and the low level of awareness of the need to reduce these risk factors. The assessment illustrates that there is currently a mismatch between the needs and expectations of all the stakeholders regarding health promotion and advice on risk factors reduction and an apparent reluctance by health care providers to fulfil this role. This issue can only be addressed in countries of sub-Sahara through capacity building for control and prevention of CVD risk factors.