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Objectives: With the ongoing epidemiological transition in sub-Saharan Africa (SSA), conditions that require invasive treatment (surgery, cancer, and anaesthesia, etc.) will become increasingly common. Comprehensive geriatric assessment (CGA) is a multidisciplinary diagnostic process aimed at identifying older people at risk of negative outcomes. It is important to know whether this approach integrates care management strategies for older people in a context where health services for older people are scarce, and staff members have little training in geriatrics. The current work is a situational analysis on the use of CGA on invasive care (cancer, surgery, etc.) among older people in SSA. Methods: We searched PubMed-MEDLINE and other sources for studies reporting on CGA and conditions requiring invasive treatment in older patients in SSA. Results/Conclusions: We found no study that had comprehensively examined CGA and invasive care in SSA. There is, however, evidence that the offer of invasive care to older people has improved in SSA. Further research is needed to explore the applicability of CGA in SSA. Similarly, more investigations are needed on the role of CGA in the care trajectories of older people in SSA, in terms of outcomes and affordability. [ABSTRACT FROM AUTHOR]

Aging has been clearly associated with decline in visual and physical performance. Alteration of visual function is associated with negative health outcomes including physical frailty. We assessed the relationship between Visual Impairment (VI) and sarcopenia in older persons in Cameroon. In a cross-sectional survey conducted in Douala in 2019, sarcopenia was assessed using the SPPB (Short Physical Performance Battery) test scored from 0 to 12. The diagnosis of sarcopenia was based on SPPB test score < 9 while VI was self-reported. Of the 403 participants (50.4% male) with a mean age of 67.1 (± 6.2) years, 356 (88.3%) reported a VI while the prevalence of sarcopenia was 47.9% [95% CI 43.0–52.7]. After adjusting for several factors, VI was significantly associated with sarcopenia (OR 2.66 [95% CI 1.29–5.48]). Of the SPPB subtests, only chair stand test was negatively associated with VI (β = − 0.45 [95% CI − 0.82 to 0.07]). Our study supports an association between VI and sarcopenia. If confirmed by further cohort studies, this result would suggest that VI could be considered as an early indicator of sarcopenia among older people in sub-Saharan Africa. [ABSTRACT FROM AUTHOR]

Background: Chronic kidney disease (CKD) is a major health problem with growing prevalence in sub-Saharan Africa. Aim: Assess the prevalence and determinants of CKD in Garoua and Figuil cities of the North region of Cameroon. Methods: A cross-sectional survey was conducted from January to June 2018 in the two cities, using a multi-level cluster sampling. All adults with low estimated glomerular filtration rate (eGFR) (< 60 ml/min/1.73 m2) by Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation and/or albuminuria (≥ 30 mg/g) were reviewed three months later. Logistic regression models (accounting for the sampling strategy) were used to investigate the predictors of the outcomes. Results: A total of 433 participants were included, with a mean age (95%CI) of 45.0 (43.4–46.6) years, 212 (48.7%) men, 294 (67.9%) from Garoua and 218 (45.6%) with no formal education. Risk factors for chronic nephropathy were highly prevalent including longstanding use of street medications (52.8%), herbal medicines (50.2%) and non-steroidal anti-inflammatory drugs (50%), alcohol consumption (34.4%), hypertension (33.9%), overweight/obesity (33.6%), hyperuricemia (16.8%), smoking (11.3%) and hyperglycemia (6.5%). The prevalence of CKD was 11.7% overall, 10.7% in Garoua and 13% in Figuil participants. Equivalents figures for CKD G3-5 and albuminuria were 2.8%, 2.0% and 4.5%; and 9.1%, 9.3% and 8.5%, respectively. History of diabetes, increase systolic blood pressure, hyperglycemia and hyperuricemia were predictors of CKD. Conclusion: The prevalence of CKD is as high in these northern cities as previously reported in southern cities of Cameroon, driven mostly by known modifiable risk factors of chronic nephropathy. [ABSTRACT FROM AUTHOR]

Introduction: Although cardiovascular diseases (CVDs) are among the leading causes of death in Sub-Saharan Africa (SSA), prevention is not a priority and effective treatments are not widely available. This perspective discusses the burden, challenges, and potential opportunities for improvement of CVD prevention and control efforts in SSA.Areas Covered: This paper focuses on ischemic heart disease and stroke, and their key contributors of obesity, hypertension, diabetes and dyslipidaemia which are well-established, rapidly rising, and significant contributors to disease burden in SSA. However, their prevention, detection, treatment and control of are currently disorganized, inconsistent, unreliable, and insufficient with most SSA countries not geared to respond to this growing problem. National policies are frequently lacking or, if available, remain poorly implemented, for the control of these conditions. Primary healthcare systems have not adapted to cope with these rising CVD burdens and remain weak, underfunded and under resourced. Numerous barriers at the healthcare service, healthcare provider, and patient levels prevent optimal CVD risk factor care.Expert Opinion: Innovative approaches such as task-shifting with the reallocation of care to lower-level healthcare workers and the potential use of inexpensive technological options should be encouraged to provide equitable CVD preventive and curative solutions to SSA's poor. [ABSTRACT FROM AUTHOR]

Background: Little is known on the magnitude and correlates of insulin resistance in HIV-infected people in Africa. We determined the prevalence of insulin resistance and investigated associated factors in HIV-infected adult Cameroonians. Methods: We conducted a cross-sectional study at the Yaoundé Central Hospital, Cameroon; during which we enrolled HIV-infected people aged 30 to 74 years with no previous history of cardiovascular disease. An homeostatic model assessment of insulin resistance (HOMA-IR) like index served to assess insulin sensitivity with insulin resistance defined by values of 2.1 or higher. Results: We included 452 patients (20% men). Their mean age was 44.4 ± 9.8 years and 88.5% of them were on antiretroviral therapy (93.3% on first line regimen including Zidovudine, lamivudine and Efavirenz/Nevirapine). Of all participants, 28.5% were overweight, 19.5% had obesity and 2.0% had diabetes. The prevalence of insulin resistance was 47.3% without any difference between patients on ART and those ART-naïve (48.5% vs. 38.5%; p = 0.480). Obesity was the only factor independently associated with insulin resistance (adjusted odds ratio: 2.28; 95% confidence interval: 1.10-4.72). Conclusion: Insulin resistance is present in nearly half of HIV-infected patients in Cameroon despite a low prevalence rate of diabetes, and is associated with obesity. [ABSTRACT FROM AUTHOR]

Introduction: Cardiovascular disease is the leading cause of morbidity and mortality in patients on maintenance hemodialysis. We investigated the pattern and correlates of cardiac lesions in a group of Cameroonians on chronic hemodialysis. Methods: This was a cross-sectional study conducted at the Yaoundé General Hospital's hemodialysis unit, involving 45 patients (29 men, 64%) on maintenance hemodialysis for at least three months using a native arterio-venous fistula. Cardiovascular risk factors, biological, electrocardiographic and echocardiographic data were collected. Results: Hypertension (29%), chronic glomerulonephritis (24%) and diabetes mellitus (24%) were the main etiological factors of chronic kidney disease. Blood pressure was controlled in 14 (31%) patients. Nineteen (42%) patients had anemia and 5 (14%) had a calcium-phosphorus product >55 mg²/dl². All patients had at least one cardiovascular risk factors with hypertension (95%), anemia (42%) and highcalcium-phosphorus product (42%) being the most frequent. Thirty-eight (84%) patients had at least one cardiac lesion and 11 (29%) had three or more lesions. The cardiac lesions were left ventricular hypertrophy (60%), valvular calcifications (38%), heart failure (36%), conduction disorders (33%), pericardial effusion (13%), valvular diseases (11%) and ischemic heart diseases (2%). Left ventricular hypertrophy was significantly associated with a longer duration on dialysis and low hemoglobin level (both p<0.047) while cardiac failure and valvular calcifications were associated with advanced age and high interdialytic weight gain (both p <0.05). Conclusion: Cardiac lesions and cardiovascular risk factors are frequent in these patients receiving sub-optimal dose maintenance hemodialysis despite their younger age, suggesting an increased susceptibility to cardiovascular complications. [ABSTRACT FROM AUTHOR]

The article presents the results of an experiment with nurse-led care for epilepsy in Cameroon. The study compared the introduction of nurses to the public and private sector in the capital, Yaounde, as well as the Bafut district. The authors assert that a successful reduction in the number of days with seizures among the patients demonstrates that the nurse-led care model is viable and should be tested with clinical trials.

Introduction: several international guidelines are available on drug treatment for hypertension, but the control of hypertension remains very poor in sub-Saharan Africa (SSA). We investigated the commonly prescribed antihypertensive drugs and their association with blood pressure (BP) control in adult Cameroonians. Methods: we consecutively recruited hypertensive outpatients attending the Buea and Limbe Regional Hospitals (southwest region of Cameroon). Controlled BP was defined as BP < 140/90mmHg in hypertensive patients aged 60 years or younger, diabetics or patients with chronic kidney disease or a BP < 150/90mmHg in non-diabetic hypertensive patients older than 60 years of age (JNC8). Results: of the 408 participants included (mean age 61.1 years), 67% were female. The median duration of hypertension was 6 years and the median duration of the current treatment was 22 weeks. Commonly prescribed antihypertensives were calcium channel blockers (CCB, 35.1%), thiazide/thiazide-like diuretics (TD/TLD, 26.1%) and angiotensin-converting enzyme inhibitors (ACEI, 19.5%). The median monthly cost of antihypertensive was 10279.6 CFA (approximately equal to US$ 172). Seventy percent (70%) of participants were receiving at least 2 drugs, with ACEI+TD/TLD, CCB+TD/TLD, and ACEI+CCB+TD/TLD being the most frequent combination. The rate of BP control was 52% overall, and 60% in participants on monotherapy. Conclusion: CCBs were the most prescribed single antihypertensive drugs in this setting while ACEI+TD/TLD was the most common combination. About half of patients were at target BP control levels Improving availability and affordability of these medications may improve hypertension management and control. [ABSTRACT FROM AUTHOR]

Background Low density lipoprotein cholesterol (LDL-C) levels are used to estimate cardiovascular disease (CVD) risk and to guide prescriptions. To circumvent the challenges of direct LDL-C measurement, guidelines recommend the use of Friedewald formula derived LDL-C levels. Despite reported limitations of this formula, its validity in sub-Saharan Africans has not been adequately investigated. Objective To assess the validity of the Friedewald formula derived against directly (homogeneous) measured LDL-C in adult Cameroonians. Methods We reviewed the fasting lipid profiles of 2500 patients, performed between March 2012 and January 2016 using enzymatic colorimetric method (reference), at the Douala General Hospital laboratory. The Friedewald formula was used to calculate LDL-C from total cholesterol, high density lipoprotein cholesterol and triglyceride levels. Calculated LDL-C values were compared to the reference values, and clinical significance of differences between the two methods was assessed using total error allowable (TEa). Results The difference between means of calculated and the reference LDL-C values was neither statistically nor clinically significant (3.33 ± 1.51 vs. 3.33 ± 1.25 mmol/l; p = 0.704). The calculated LDL-C correlated positively with the measured LDL-C value (r = 0.749) and both methods showed a good agreement on Bland-Altman plot. Conversely, there was only moderate agreement (kappa = 0.478, 95% CI: 0.455–0.502) between the two values in the stratification of cardiovascular risk according to the National Cholesterol Education Program/Adult Treatment Panel III. Consequently, 40.6% of the participants were misclassified. Conclusion Friedewald formula is technically accurate but has a modest clinical accuracy which can translate into a substantial misclassification of patients' cardiovascular risk and subsequent inappropriate therapeutic decisions. [ABSTRACT FROM AUTHOR]

Compared to global estimates, Sub-Saharan Africa (SSA) has the highest projected rates of increase in type 2 diabetes (T2D) over the next 25years. This is attributed to the ageing population, increasing urbanisation and the associated lifestyle changes. Although the prevalence does not differ by gender, deaths attributable to T2D in SSA are greater in women, likely due to differences in beliefs and access to care. Women in SSA also have greater risk factor burden for T2D than men, in particular obesity, which is explained in part by sociocultural factors. The pathogenesis of diabetes differs between African and Caucasian women, with implications for risk assessment. African women are more insulin resistant than their Caucasian counterparts, despite a more 'favourable' body fat distribution. Notably, women in SSA face the dual burden of T2D and HIV/AIDS. HIV positive women in SSA are typically young and obese, with the latter being exacerbated by anti-retroviral therapy (ART). Cultural perceptions regarding weight loss and limited financial resources are the major limitations to the management of T2D. Hence prevention is vital. However, there is a paucity of studies examining the effectiveness and sustainability of interventions to reduce T2D in SSA. [ABSTRACT FROM AUTHOR]

Background Data on recent stroke trends in the context of rapidly deteriorating risk profile of populations within Africa is very limited. We investigated the admission trend for stroke and related outcomes in a major referral hospital in Cameroon. Methods Admission and discharge registries, and patient files for the period 1999–2012 of the medical department of the Yaoundé Central Hospital were reviewed for evidence of admission for stroke, and outcomes during hospitalization. Trajectories of case-fatality and risk factors over time were assessed, with adjustment for confounders using logistic regression models. Results Of the 28,239 medical admissions registered during the study period, 1688 (6.0%) were due to stroke. This proportion ranged from 2.5% in 1999–2000 to 13.1% in 2011–2012 overall and similarly in men and women. Mean age, alcohol consumption and history of stroke varied across years (all p ≤ 0.006). Computed tomography confirmed that stroke increased from 34.4% in 1999–2000 to 84.2% in 2011–2012, while the length of stay decreased from 21 to 10 days (both p < 0.0001 for linear trend). Case-fatality rate increased from 14.4% to 22.4%. The adjusted odd ratio (95% CI) 2011–2012 vs. 1999–2000 was 2.93 (1.40–6.13), p < 0.0001 for the linear trend across years. The unadjusted relative risk of death from stroke patients vs. general admissions was 0.95 (0.87–1.05) overall, 0.82 (0.71–0.94) in men and 1.08 (0.95–1.23) in women. Conclusion During the last decade and a half, stroke admissions and case-fatality have increased in the study setting, reflecting in part the inadequate coping capacity of the health care system. [ABSTRACT FROM AUTHOR]

Background and purpose Fructosamine provides an estimate of diabetes control over a shorter period than HbA 1c , and has been proposed as a suitable parameter to monitor glycemic control in low-income countries. The aim of this study was to investigate determinants of fructosamine levels in an urban non-diabetic population of Cameroon. Methods This was a cross-sectional study including 437 healthy adults with no known history of diabetes mellitus, aged 40 years and above, recruited from the ten administrative regions, representing major ethnic groups in the country. Plasma glucose and fructosamine were measured after an overnight fasting. Univariable and multivariable analyses were used to investigate the factors associated with fructosamine measurements. Results Fructosamine levels ranged from 68.2 to 940.8 μmol/l with a mean (standard deviation) of 294.4 (131.3) μmol/l. These levels varied significantly across regions and were higher in men than in women ( p = 0.001) and in those with screen-detected diabetes than in those with normoglycemia ( p < 0.0001). There was a negative correlation between fructosamine and body mass index ( r = −0.15, p = 0.009), and a positive correlation with fasting plasma glucose (FPG) ( r = 0.37, p < 0.0001) and total bilirubinemia ( r = 0.21, p < 0.0001). In multivariable model, sex, BMI, FPG, total bilirubine and screen-detected diabetes were no longer associated with fructosamine levels. Conclusion Fructosamine was not independently associated with age, sex, ethnicity, and the glycemic status. Further studies need to be carried out to better elucidate all the factors determining the measurement of fructosamine in order to accurately interpret its values in diabetic populations. [ABSTRACT FROM AUTHOR]