Prevalence and Risk Factors of Hypertension in Urban Areas of Cameroon: A Nationwide Population-Based Cross-Sectional Study.

Accurate estimates of the prevalence rate of hypertension and determinants in Cameroon are crucial to inform efficient prevention and control policies. The authors carried out a cluster-specific cross-sectional survey in urban areas of the 10 regions of Cameroon to assess the prevalence and risk factors of hypertension in Cameroonian adults using the WHO STEPwise approach to Surveillance (STEPS). Sociodemographic data were collected and blood pressure and glycemia were measured using standardized methods. Participants were adults of both sexes aged 16 years or older. A total of 15,470 participants were surveyed. The age-standardized prevalence rate of hypertension was 29.7%. The awareness rate was 14.1%. Independent correlates of hypertension included higher age, male sex, obesity, hyperglycemia, and living in the Savannah zone. The prevalence of hypertension is high in urban areas of Cameroon, with very low awareness. Prevention and control strategies should emphasize on improvement and vulgarization of population opportunistic screening and education.

Comprehensive strategies for the prevention and control of diabetes and cardiovascular diseases in Africa: future directions.

The countries of the Sub Saharan African region have insufficient resources and healthcare systems that are poorly adapted to cope with the longstanding burden associated with communicable diseases and the ongoing HIV/AIDS pandemic. In addition, the rising burden of non-communicable diseases, including diabetes, cardiovascular diseases, and their risk factors, poses additional challenges. These countries need to urgently develop strategies to address these challenges of disease prevention and control. These strategies will require a new vision and more relevant and 'suitable' vocabulary in dealing with healthcare design, planning and implementation (using a cross-sectorial approach). Lessons learnt from the past (e.g. primary health care) in sub-Saharan Africa and other regions of the world may equally prove useful in developing strategies for the prevention and control of non-communicable diseases. Any potential strategy must emphasize the crucial role of economic, social, and environmental health determinants as well as the use of appropriate health technology.

Prevalence, awareness, treatment and control of hypertension in a self-selected sub-Saharan African urban population: a cross-sectional study.

OBJECTIVES: Hypertension has been established as a major public health problem in Africa, but its specific contributions to disease burden are still incompletely understood. We report the prevalence and determinants of hypertension, detection, treatment and control rates among adults in major cities in Cameroon. DESIGN: Cross-sectional study. SETTINGS: Community-based multicentre study in major cities in Cameroon. PARTICIPANTS: Participants were self-selected urban dwellers from the Center, Littoral, North-West and West Regions, who attended on 17 May 2011 a screening campaign advertised through mass media. PRIMARY AND SECONDARY OUTCOMES MEASURES: Hypertension defined as systolic (and/or diastolic) blood pressure (BP)≥ 140 (90) mm Hg, or ongoing BP-lowering medications. RESULTS: In all, 2120 participants (1003 women) were included. Among them, 1007 (prevalence rate 47.5%) had hypertension, including 319 (awareness rate 31.7%) who were aware of their status. The prevalence of hypertension increased with age overall and by sex and region. Among aware hypertensive participants, 191 (treatment rate 59.9%) were on regular BP-lowering medication, and among those treated, 47 (controlled rate 24.6%) were at target BP levels (ie, systolic (and diastolic) BP<140 (90) mm Hg). In multivariable logistic regression analysis, male gender, advanced age, parental history of hypertension, diabetes mellitus, elevated waist and elevated body mass index (BMI) were the significant predictors of hypertension. Likewise, male gender, high BMI and physical inactivity were associated with poor control. CONCLUSIONS: High prevalence of hypertension with low awareness, treatment and control were found in this urban population; these findings are significant and alarming with consideration to the various improvements in the access to healthcare and the continuing efforts to educate communities over the last few decades.

The spectrum of skin diseases in a rural setting in Cameroon (sub-Saharan Africa).

BACKGROUND: Skin disorders are generally considered to be more prevalent in the rural areas of Cameroon. This study was carried out to verify this assumption by describing the spectrum of skin disorders in a rural setting of Cameroon. METHODS: We carried out a community-based clinical skin examination of 400 consenting subjects from 4 villages of Cameroon: Nyamanga (27%), Yebekolo (24%), Mbangassina (23%) and Bilomo (26%). RESULTS: The overall prevalence of skin diseases in our sample was 62% {95% CI: 57.2%, 66.8%} (248/400). The commonest skin disorders were: fungal infections (25.4%), parasitic infestations (21.4%), atrophic skin disorders (11.7%), hypertrophic skin disorders (9.7%), disorders of skin appendages {acne} (8.9%), benign neoplasm (6.5%), bacterial skin infections (5.2%), pigmentation disorders (4.8%), and dermatitis/eczema (4.0%). Skin infections and infestations constituted 52.82% of all skin disorders. The overall prevalence of infectious and parasitic infestation was 32.75% {95%CI: 28.17%, 37.59%} (131/400) as against 29.25% {95%CI: 24.83%, 33.98%} (117/400) for non-infectious disorders.Among people with skin infections/parasitic infestations, those with fungal infections and onchocercal skin lesions were the most prevalent, accounting for 48.1% (63/131) and 35.1% (46/131); and an overall prevalence of 15.75% {95%CI: 12.3%, 19.7%} (63/400) and 11.5% {95%CI: 8.5%, 15.0%} (46/400) respectively.There was secondary bacterial infection in 12.1% {95%CI: 8.31%, 16.82%} (30/248) of subjects with skin diseases. Hypertrophic and atrophic disorders of the skin were mainly keloids (9.68%), scarification marks (6.05%) and burn scars (5.65%). Skin diseases like dermatitis and eczema (4.03%), malignant tumours and pigmentation disorders were rare in our sample.The proportion of subjects diagnosed with skin disorders after examination (62.8%) was significantly higher than the proportion of 40.8% that declared having skin diseases (p < 0.0001). CONCLUSION: The prevalence of skin diseases in the rural Mbam valley is alarming, dominated by easily treatable or preventable skin infections and their magnitude is highly neglected by the community, contrasting with findings in the urban setting. Similar studies are needed in other ecological/demographic settings of the country in order to construct a better understanding of the epidemiology of skin disorders. This would lead to the development of national policies to improve skin care.

Ethics of human genetic studies in sub-saharan Africa: the case of Cameroon through a bibliometric analysis.

UNLABELLED: Many ethical concerns surrounding human genetics studies remain unresolved. We report here the situation in Cameroon. OBJECTIVES: To describe the profile of human genetic studies that used Cameroonian DNA samples, with specific focus on i) the research centres that were involved, ii) authorship, iii) population studied, iv) research topics and v) ethics disclosure, with the aim of raising ethical issues that emerged from these studies. METHOD: Bibliometric Studies; we conducted a PubMed-based systematic review of all the studies on human genetics that used Cameroonian DNA samples from 1989 to 2009. RESULTS AND DISCUSSION: Fifty articles were identified, involving predominantly research centres from Europe (64%) and America (32%). Only 7 (14%) Cameroonian institutions and 14 (28%) Cameroonian authors were associated with these publications. At least 52% of publications were devoted to population genetics (variation/migration patterns) amongst 30 Cameroonian ethnic groups. Very few studies concerned public health related genetic issues and only 5 (10%) references were found for hemoglobinopathies like sickle cell anaemia. Almost all DNA samples are 'banked' outside of the African continent. Capacity building, rights to the genetic information and benefits to the individuals, communities and populations who contribute to these studies are addressed. CONCLUSIONS: 1) Our data suggests the need for a wider debate towards building capacity and addressing ethical issues related to human genomic research in sub-Saharan Africa and specifically in Cameroon; 2) National ethical guidelines and regulations concerning the collection, use and storage of human DNA are urgently needed in Cameroon.

Knowledge of Pregnant Women on Mother-to-Child Transmission of HIV in Yaoundé.

INTRODUCTION: Mother-to-child transmission of HIV is a major public health problem in Cameroon. The aim of this study was to assess knowledge of pregnant women on HIV transmission and prevention, particularly the four pillars of mother-to-child transmission. MATERIALS AND METHODS: This was a descriptive cross-sectional study from October 2008 to January 2009 at the Yaoundé Gynaecology-Obstetrics and Pediatric Hospital. All women presenting at the Ante-Natal Care (ANC) Clinic for the first time were included in the study after obtaining a verbal informed consent. RESULTS: The ages of the 260 women included in the study ranged from 15 to 42 years. Almost 99% (257/260) of the women interviewed had heard about HIV. Respectively, 80.5% (209/260), 89.3% (232/260) and 81.2% (211/260) of the women cited pregnancy, delivery, and breastfeeding as risk periods for HIV transmission from mother to child. Use of the male condom, the female condom, abstinence, and faithfulness to a single partner were considered as effective methods of HIV prevention by 73% (190/260), 76% (198/260), 88% (229/260) and 46% (120/260) of respondents respectively. About 79% (64/81) of participants with higher education considered HIV infection to be contagious as opposed to 45.5% (5/11) of women with no formal education (P = 0.008). CONCLUSION: Our data suggest that women have some good knowledge on the Prevention of Mother-To-Child Transmission (PMTCT) of HIV. Nevertheless, improving the formal educational level of these women may contribute to a further reduction of HIV transmission.

Urbanicity affects blood pressure and heart rate reactivity to a speech stressor in Cameroon.

OBJECTIVE: To examine the interactive influence of urbanicity on cardiovascular reactivity to speech stressors among 103 urban and 93 rural Cameroonians. METHOD: Heart rate, systolic, and diastolic blood pressure (HR, SBP, and DBP) changes from baseline were assessed during a speech preparation period, speech stressor task, and post-speech recovery period. RESULTS: After adjusting for income, age, BMI, and sex, urban subjects showed greater diastolic reactivity to the pre-speech and speech conditions than to recovery. Urban subjects also showed greater reactivity to the speech stressor than to other conditions. Urban subjects showed greater HR reactivity to the speech stressor. Rural subjects showed greater diastolic reactivity to the pre-speech and speech stressor and less recovery. CONCLUSION: Urbanicity affects blood pressure and heart rate differently for urban and rural Cameroonians. It also affects recovery from stressors. More exploration into the influence of urbanization on hypertension risk factors in developing countries is warranted.

Knowledge, attitudes and practice with respect to epilepsy among secondary school students in the Kumbo West Health District - North West Region- Cameroon.

BACKGROUND: The main goal of this study was to obtain baseline data on awareness and attitudes and practices with respect to epilepsy among secondary school students. METHODS: We interviewed a total of 659 students from three randomly selected secondary schools in the Kumbo West Health District, using a 12-item questionnaire in English. RESULTS: About 94.7% had heard about epilepsy, 25.8% had read on the subject, 55.2% knew someone with epilepsy and 77.7% had witnessed a seizure. While 37.9% of students would object to association with people with epilepsy (PWE), 47.8% would object to marriage with PWE. About 77.2% would offer equal employment to PWE although 72.7% believed there were jobs not suitable for PWE. Up to 58% of our sample thought epilepsy is contagious and about 62.2% of them declared that epilepsy is curable. Respectively 65%, 9%, and 30% would recommend a medical doctor, a traditional healer and God's help for treatment of epilepsy. Independent determinants of attitudes were found to be: the belief that epilepsy is a form of insanity or is contagious, having witnessed a seizure, being female, being a Christian and having a higher level of education. CONCLUSION: There was a high level of awareness on epilepsy and the negative attitudes observed among these students were better than those reported in the same community. The determinants of negative attitudes were found to be diversified, confirming our hypothesis of variation, and our data further suggest that the interplay between these factors may be more complex than generally thought. This requires further qualitative study.

Knowledge, attitudes and practices with respect to epilepsy among student nurses and laboratory assistants in the South West Region of Cameroon.

OBJECTIVE: This study was designed as part of a series of studies mandated by the Cameroon Ministry of Public Health (National Epilepsy Control Program) to obtain new data for improvement of the epilepsy teaching program in schools training health personnel in the South West Region of Cameroon. METHOD: A 12-item semistructured questionnaire was self-administered to 340 student nurses and laboratory assistants in five training schools for health personnel in the South West Region of Cameroon. RESULTS: All of them had heard about epilepsy, 86.5% knew someone with epilepsy, 88.5% had witnessed a seizure, but only 48.8% had read about epilepsy. About 33% and 52% would, respectively, object to their children associating with and marrying people with epilepsy (PWE). About 15.3% believed that epilepsy is a form of insanity, 10% thought epilepsy is contagious, 67.4% (P<0.001) would recommend medical treatment for epilepsy, 22% would offer prayers only, and 6% would recommend traditional medicine. Independent predictors of attitudes were: acquaintance with someone with epilepsy, knowledge of the cause of epilepsy, the belief that epilepsy is contagious or is a form of insanity, being male, and being in the first year of studies. CONCLUSION: The knowledge level in this student sample is high, but the relatively low proportion of respondents who have read about epilepsy suggests that the observed high level of awareness of epilepsy may be from knowledge gained in the community; thus, there exist knowledge gaps. Therefore, a teaching course on epilepsy needs to be introduced into the curriculum of these training schools as early as the first year of studies. The course content must take into account the belief and value systems of the community and address misconceptions about epilepsy.

A community survey of knowledge, perceptions, and practice with respect to epilepsy among traditional healers in the Batibo Health District, Cameroon.

OBJECTIVE: The purpose of this study was to gain an understanding of the approach of traditional healers to epilepsy care, in order to develop a community-based epilepsy care program in Batibo Health District. METHODS: With an 18-item questionnaire, interviews were carried out with 102 traditional healers randomly selected from two associations of traditional healers in the Batibo Health District. RESULTS: Most traditional healers had heard about epilepsy (98.0%), knew someone with epilepsy (97.8%), or had witnessed a seizure (92.2%). About 40% would object to their children associating with people with epilepsy (PWE), 46.1% would object to their children marrying PWE, and 51% linked the disease to insanity. Though 61.8% of the traditional healers could not offer any treatment for epilepsy, most of them thought it was treatable (74.5%) and would readily refer a patient to the hospital (95.1%). The independent predictors of attitudes were: middle age (30-49 years), P=0.00003; female gender, P=0.007; correct knowledge of the cause(s) of epilepsy, P=0.001; and the misconceptions that epilepsy is contagious and that epilepsy is a form of insanity, P=0.003 and 0.019, respectively. CONCLUSION: Traditional healers constituted the focus group studied so far in Cameroon that is most familiar with epilepsy. Although they still have some negative practices, the attitudes of traditional healers toward PWE in Batibo Health District are satisfactory, compared with those of the general public and students in the same community. These findings provide evidence for the first time in Cameroon suggesting that collaboration between the modern and traditional health systems with the view of bridging the epilepsy treatment gap is possible. There is a need to train traditional healers in epilepsy care in our context.

A survey of public knowledge, attitudes, and practices with respect to epilepsy in Badissa village, centre region of Cameroon.

OBJECTIVE: The aim of this study was to assess knowledge, attitudes, and practices (KAP) with respect to epilepsy in Badissa, as part of a series of studies mandated by the Cameroon Ministry of Public Health. METHOD: We interviewed 164 subjects face-to-face during a door-to-door survey. RESULTS: All of the subjects had heard about epilepsy; 98.8% knew at least one patient with epilepsy, and 97.6% had seen at least one epileptic seizure. With respect to attitudes, 16% and 32% would respectively prevent their children from associating with and marrying, people with epilepsy; 55.5% would offer people with epilepsy equal employment. The independent determinants of attitudes were the belief that epilepsy is a form of insanity (P=0.004) or is caused by a mental illness (P=0.003), having read about epilepsy (P=0.018), and being married (P=0.007). CONCLUSIONS: Our study demonstrates a high level of awareness and fairly good knowledge of epilepsy, a lower level of misconceptions, and better attitudes, in the study area confirming our hypothesis of a regional variation in these characteristics. This model of care may be useful in scaling up the epilepsy education program in Cameroon.

Secondary school students' knowledge, attitudes, and practice toward epilepsy in the Batibo Health District--Cameroon.

Using a 12-item questionnaire, we assessed knowledge, attitudes, and practice (KAP) toward epilepsy and identified determinants of inappropriate attitudes toward people with epilepsy (PWE) among 910 randomly selected secondary school students in Batibo (Cameroon). Ninety-five percent of the students had heard or read about epilepsy, 73.3% knew an epileptic, and 76.4% had witnessed a seizure. Those who would offer equal employment opportunities to PWE, refuse to associate with, or refuse to marry PWE represented 58.6%, 25.4%, and 64.2%, respectively. Negative attitudes appeared to be reinforced by beliefs that epilepsy is hereditary (25.7%), contagious (49.9%), or a kind of insanity (38%). Acquaintance with PWE tended to improve the misconception that epilepsy is contagious (p < 0.001), and to reinforce the view that it is a form of insanity (p < 0.01). A successful epilepsy education program must account for local beliefs, and secondary school students may constitute a good channel for community education.

Public awareness, perceptions, and attitudes with respect to epilepsy in Ebolowa and Sangmelima--Urban Cameroon.

Within the framework of a series of studies mandated by the Ministry of Public Health of Cameroon to obtain baseline data for an epilepsy education program adapted to our communities, we interviewed 456 subjects without epilepsy in the Ebolowa Regional and Sangmelima District Hospitals. We found that 99.6 and 72.6% had heard or knew a person or people with epilepsy (PWE) and 76.8% had seen a seizure. About 58% of respondents would offer equal employment opportunities to PWE; 39.6% and 33.6% would respectively object to their children associating with or marrying PWE; 13% associated epilepsy with insanity and witchcraft, whereas 82.5% would recommend modern treatment for epilepsy. Predictors of negative attitudes were the beliefs that epilepsy is hereditary (26.3%) and epilepsy is a form of insanity (13%). Familiarity with epilepsy in Ebolowa and Sangmelima is high, and attitudes toward PWE are better there than in other areas of Cameroon. These results demonstrate a regional variation in public awareness and attitudes toward epilepsy and suggest that urban populations may constitute targets as well as channels for epilepsy sensitization campaigns in Cameroon.

General public awareness, perceptions, and attitudes with respect to epilepsy in the Akwaya Health District, South-West Region, Cameroon.

BACKGROUND: This study was part of a series mandated by the Ministry of Public Health's National Epilepsy Control Program to obtain baseline data for a community-adapted epilepsy education program. METHODS: We conducted 387 face-to-face interviews with subjects without epilepsy aged 15 years and above in 12 villages of the Akwaya Health District, Cameroon. RESULTS: Most respondents (97.9%) had heard or read about epilepsy, 90.2% knew someone with epilepsy, and 90.4% had witnessed a seizure. About 51.4% would object to association with people with epilepsy (PWE), 68.7% would object to marriage to PWE, while 41.6% would offer them equal employment. For treatment, 30.2% would suggest going to a traditional healer or witch doctor, while 3.9% would not recommend any treatment at all. Predictors of attitudes were male gender, low or no level of education, having children, knowledge of the cause of epilepsy, and beliefs that epilepsy is contagious or is a form of insanity. CONCLUSION: The high level of public awareness on epilepsy in the Akwaya Health District may suggest a high prevalence. This contrasts with prevailing negative attitudes. Our data provide new evidence for our hypothesis of regional variation in the determinants of epilepsy stigma in Cameroon.

General public knowledge, attitudes, and practices with respect to epilepsy in the Batibo Health District, Cameroon.

Our aim was to obtain baseline data for an epilepsy education program adapted to communities in Cameroon. We conducted 302 face-to-face interviews with patients without epilepsy, caregivers, and visitors in the Batibo District Hospital. Most respondents (99.3%) had heard or read about epilepsy, 89.7% knew someone with epilepsy, and 87.7% had witnessed a seizure. About 43% would object to associating with people with epilepsy (PWE) and 75.8% would object to their children marrying PWE, whereas 35.1% would offer PWE equal employment. Predictors of negative attitudes were: advanced age, lack of formal education, and the belief that epilepsy is hereditary, contagious, or a form of insanity. In conclusion, the high level of public awareness of epilepsy in the Batibo Health District may reflect the magnitude of the condition, contrasting with the prevalent negative attitudes. A successful epilepsy education program must take into account the beliefs and value systems of the community.

Cardiovascular disease and the global tobacco epidemic: a wake-up call for cardiologists.

The global tobacco epidemic continues unabated with the recruitment of young people, including women, to join the ranks of smokers. Even though cardiovascular diseases account for some of the major tobacco-related morbidity and mortality, cardiologists and their professional societies have lagged behind in the crusade against tobacco. A great opportunity exists for more involvement and leadership role by cardiologists, especially in countries where tobacco control efforts are not well established. For this to happen, there is a need to identify barriers to cardiologists' involvement in tobacco prevention and cessation efforts and to devise locally-relevant strategies to address them. Also, the areas where the contribution of cardiologists can be most fruitful must be identified. Considering that a substantial portion of the future burden of cardiovascular disease will occur among current tobacco users, treating tobacco dependence and supporting tobacco quitters are the most urgent tasks for cardiologists interested in reducing the human toll of tobacco. The cardiovascular community must consider the variety of needs and available resources to fight tobacco in different regions. Recommendations to involve more cardiologists in tobacco control, at the clinical, public health and policy levels, are presented.