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ABSTRACT: The worldwide growing epidemic of diabetes is driven by the increase in type 2 diabetes. The very insidious natural history of type 2 diabetes and the availability of simple means to detect it as well as its preceding silent stages make type 2 diabetes and ideal disease for screening. Although public policies for type 2 diabetes screening do exist in many developed countries, issues related to its benefits on disease outcomes and its cost-effectiveness have been a concern. Recent results from the Anglo-Danish-Dutch Study of Intensive Treatment in People with Screen-Detected Diabetes in Primary Care (ADDITION)-Cambridge show that screening for type 2 diabetes is not associated with a reduction in mortality, either all-cause, cardiovascular or diabetes-related, after 10 years of follow-up. It seems crucial to raise the awareness of the medical community on the high risk of misinterpretation of these results as the death knell of type 2 diabetes screening. To that end, we discuss here some potential explanations of the lack of benefit, and we suggest a cautious uptake of the results, especially in low-income countries where type 2 diabetes screening is by far more likely to yield substantial health benefits.
Diabetes research and clinical practice 02/2013; · 2.16 Impact Factor
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ABSTRACT: Fruit of the Cameroonian medicinal tree Brenania brieyi is used in the treatment of endocrine disorders, including menopausal complaints. To assess the potential estrogenicity, 50mg/kg BW/day of a methanol extract from Brenania brieyi fruit was administered intravaginally twice a day to ovariectomized female Wistar rats for 3 and 7days. The uterine weight doubled within 7days, and the vaginal epithelial height increased both after 3 and 7days of treatment. In conclusion, the results suggest that fruit of Brenania brieyi contains estrogenic secondary metabolites.
Journal of Natural Medicines 04/2012; 61(1):86-89. · 1.39 Impact Factor
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ABSTRACT: The aim of this study was to investigate the determinants of active convulsive epilepsy in rural Cameroon, in order to inform prevention and control strategies at the local and regional levels.
This case-control study took place in the rural health district of Bafut, North-West Region of Cameroon. People with epilepsy receiving care in local health facilities or identified in the community were matched with non-epileptic controls for age and sex. The Limoges questionnaire was used for case definitions and screening for risk factors for epilepsy. Potential determinants were investigated through logistic regression models.
In all 170 participants (85 cases, with 85 controls) were included. Fewer cases than controls were married (27% vs. 58%; P<0·001) and more cases than control were living with parents (56% vs. 28%; P<0·001). In final multivariable regression analyses, a family history of epilepsy (odd ratio 3·11; 95% confidence interval: 1·61-6·01; P<0·001) and a poor obstetrical history (odd ratio: 4·34; 95% confidence interval: 1·29-14·58; P = 0·018) were significant determinants of active convulsive epilepsy.
In this rural area of Cameroon, the previously reported high prevalence of active convulsive epilepsy could be explained by a positive family history and a poor obstetrical history. The later being a potentially modifiable determinant, there is a need for additional efforts into maternal and child health, and for integrated disease control programs to mitigate the social impact of epilepsy.
Neurological Research 01/2012; 34(2):159-62. · 1.52 Impact Factor
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ABSTRACT: The Diabcare Africa project was carried out across six sub-Saharan African countries to collect standardised and comparable information for the evaluation of diabetes control, management and late complications in diabetic populations at specialist clinics.
A cross-sectional, descriptive study of 2352 type-2 diabetes patients who were treated at specialist clinics for at least 12 months prior to the study.
The mean age of patients was 53.0±16.0 years and had 8.0±6.0 years known duration of diabetes. 47% had their HbA1c assessed in the past year (mean 8.2±2.4%) with 29% achieving a level <6.5%. 21% had BP within 130/80 mmHg and 65% were treated for hypertension. Fasting lipids were assessed in 45% of the patients with mean cholesterol level of 4.9±1.2 mmol/L, HDL-cholesterol of 1.3±0.7 mmol/L and triglycerides of 1.2±0.7 mmol/L. 13% of the patients were treated for hyperlipidaemia, mostly with statins. Background retinopathy (18%) and cataract (14%) were the most common eye complications. Macrovascular disease was rare, and 48% had neuropathy.
Half of the patients benefitted from standard care, and a third had appropriate glycaemic control - attributed to access to, rather than quality of care. This study provided evidence to support appropriate interventions to diabetic populations of sub-Saharan origin.
Diabetes research and clinical practice 11/2011; 95(1):30-6. · 2.16 Impact Factor
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ABSTRACT: BACKGROUND: To assess the pattern of metabolic profile associated with first stroke episode in a hospital setting in Cameroon. METHODS: All patients admitted for first-ever-in-lifetime stroke over a 6-month period were eligible for inclusion in the study. The 84% participation rate yielded 57 of 68 patients between 16 and 85 years of age. Fifty-seven control subjects were selected to match patients included for age range, sex, and known hypertension and diabetes. We measured fasting serum glucose, insulin, and lipids in controls and in patients between days 3 and 7 after admission. RESULTS: Total cholesterol was comparable in patients and controls (172.6 ± 39.5 vs 175.4 ± 49.7 mg/dL; P = .75), as were triglycerides (129.4 ± 56.1 vs 122.4 ± 60.7 mg/dL; P = .53). high-density lipoprotein cholesterol (HDL-C) levels were lower in patients than in controls (37.4 ± 20.6 vs 50.2 ± 18.0 mg/dL; P = .001), with comparable levels of low-density lipoprotein cholesterol (LDL-C; 109.4 ± 43.0 vs 100.7 ± 48.8 mg/dL; P = .32). The LDL-C/HDL-C ratio was higher in patients compared to controls (4.0 ± 3.0 vs 2.3 ± 1.7; P = .0001), as was the total cholesterol/HDL-C ratio (5.9 ± 3.5 vs 3.9 ± 1.8; P = .0001). Compared to controls, stroke patients had higher fasting insulin levels (5.9 ± 5.4 vs 2.3 ± 3.2 IU/mL; P < .001) and higher insulin resistance as measured by the homeostatic model assessment of insulin resistance (1.9 ± 2.2 vs 0.7 ± 1.0; P = .001). CONCLUSIONS: Stroke is associated with markers of insulin resistance, low serum levels of HDL, and high total cholesterol/HDL ratio in this African population. Studies with a larger sample size and cohort designs are warranted to explore the causal pathways, persistence of these abnormalities, and population-specific cut points.
Journal of stroke and cerebrovascular diseases: the official journal of National Stroke Association 06/2011;
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ABSTRACT: A good knowledge about diabetes could lead to early diagnosis and improved management.
To evaluate the level of diabetes awareness in Cameroonians, and to identify factors that influence this awareness.
In subjects aged ≥ 25 years (n=1000, 93.4% of response), details regarding risk factors, symptoms, treatment and complications of type 2 diabetes were collected. One mark was attributed to each true answer and a global diabetes awareness score was computed. Influence of age, gender, educational level, occupational level, notion of a relative having a chronic condition and presence of chronic disease were analyzed.
Eighty percent of subjects scored more than the total mean score. The highest score obtained by participants (0.10%) was 28/30. The mean total score was higher in men (p < 0.02) and in subjects with a relative having a chronic condition (p < 0.001). In multivariate analyses, age classes (p < 0.01), educational level (p < 0.001) and relatives with a chronic condition (p < 0.001) were associated to the global diabetes awareness score.
Diabetes awareness was generally good. This may be due to the fact that the study was conducted in an area where health promotion and health education on diabetes have been intensively delivered for the past 4 years.
Diabetes research and clinical practice 10/2010; 90(3):312-8. · 2.16 Impact Factor
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ABSTRACT: In resource-limited countries where the challenge of diabetes management is especially severe, there has been a recent call for the inclusion of traditional healers in the fight against diabetes. In response, some researchers have highlighted the dangers of incorporating traditional healers while others, have presented them as a potential asset to the health care system if well trained and guided. We report here on a pilot intervention to include traditional healers in the health promotion and prevention efforts for diabetes in Cameroon, as part of the Cameroon Burden of Diabetes (CAMBoD) project. We trained 106 healers in a range of topics and practices relating to diabetes prevention and care. Eight months later we carried out a field evaluation of 36 of them using in-depth semi-structured interviews and direct observation methods to find out if they remembered and applied the learning from the training. Most healers recalled and were applying some of the lessons learnt, including referral of patients for blood glucose tests at biomedical health facilities, desisting from scarifying patients with diabetes, and educating their patients, peers and other people in their communities about diabetes. Healers were enthusiastic about collaboration with the diabetes control program, though some wanted additional responsibilities. We conclude that healers could learn prevention strategies of diabetes relatively rapidly and collaborate in health promotion.
Global Health Promotion 06/2010; 17(2 Suppl):17-26.
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Epilepsia 05/2010; 51(5):931-2. · 3.96 Impact Factor
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ABSTRACT: To evaluate day-to-day variations of insulin needs in type 2 diabetic patients with end-stage renal disease (ESRD) on maintenance hemodialysis.
We developed a 24-h euglycemic clamp in patients who received an average of 2,200 calories in a standardized three-meal and two-snack regimen per day, adjusted to body size and sex. Intravenous insulin was adjusted every 30 min to achieve 5.5 +/- 1.1 mmol/l glycemia over 24 h prehemodialysis, during hemodialysis session, and 24 h posthemodialysis in 10 type 2 diabetic patients, aged 55.7 +/- 8.7 years with 11.9 +/- 4.5 years diabetes duration, undergoing maintenance hemodialysis for 2.3 +/- 2.3 years. Insulin requirements were derived from the dose of insulin administered to maintain euglycemia per period of time and day-to-day comparisons performed.
Mean capillary glycemia was 5.5 +/- 0.3 mmol/l prehemodialysis and 5.3 +/- 0.2 mmol/l posthemodialysis (P = 0.39). Pre- and posthemodialysis areas under the glucose curve were comparable. This was achieved by infusing 23.6 +/- 7.7 IU/24 h prehemodialysis vs. 19.9 +/- 4.9 IU/24 h posthemodialysis, indicating a 15.3% decrease posthemodialysis (P = 0.09). Basal insulin needs decreased from 0.4 +/- 0.1/h prehemodialysis to 0.3 +/- 0.1/h posthemodialysis (P = 0.01). Total boluses were decreased by 2.2 +/- 3.1 IU (P = 0.15). Changes in blood urea did not correlate with changes in insulin needs (r = 0.1, P = 0.79).
The present study has demonstrated a significant 25% reduction in basal insulin requirements the day after dialysis compared with the day before. No significant change in boluses was observed, and overall the reduction of total insulin requirements was -15% equivalent to -4 IU/day posthemodialysis of marginal statistical significance.
Diabetes care 03/2010; 33(7):1409-12. · 8.09 Impact Factor
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Jean Claude Mbanya
Diabetes research and clinical practice 02/2010; 87(3):423-5. · 2.16 Impact Factor
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Jean Claude Mbanya
Diabetes research and clinical practice 01/2010; 87(1):132-5. · 2.16 Impact Factor
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ABSTRACT: High rates of foot complications have been reported in people with diabetes in sub-Saharan Africa (SSA). However, there is a paucity of data in support of the changing pattern with time. We report here data on trends in hospitalization for foot ulceration over an 8-year consecutive period in a specialized diabetes unit in SSA. Admission and discharge registers of the diabetes and endocrine unit of the Yaounde Central hospital, Cameroon, were reviewed for the period 2000 through 2007. Data were collected on the status for diabetes, presence of foot ulcer, age, sex, duration of hospitalization, amputation, and deaths.We found that 1841 patients with diabetes were admitted during the study period. The prevalence of foot ulceration was 13% (95% confidence interval [CI] = 11%-15%) and varied significantly by year of study (P = .001). The mean duration of hospitalization significantly decreased with time. Foot ulcer was associated with 115% (95% CI = 87%-148%) more bed use than other conditions in diabetes. Foot ulcer was associated with a nonsignificantly lower risk of death or dropout, with evidence of some attenuation with time. With one exception, the amputation rate of 16% (95% CI = 11%-20%) was similar across years. Foot ulcer is a major cause of hospital admission and bed use for diabetes in Cameroon.
The International Journal of Lower Extremity Wounds 12/2009; 8(4):180-6. · 1.20 Impact Factor
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ABSTRACT: 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.
Journal of Clinical Hypertension 10/2009; 11(10):564-72. · 1.83 Impact Factor
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ABSTRACT: To implement a protocol-driven primary nurse-led care for type 2 diabetes in rural and urban Cameroon.
We set-up three primary healthcare clinics in Yaounde (Capital city) and two in the Bafut rural health district. Participants were 225 (17% rural) patients with known or newly diagnosed type 2 diabetes, not requiring insulin, referred either from a baseline survey (38 patients, 17%), or secondarily attracted to the clinics. Protocol-driven glucose and blood pressure control were delivered by trained nurses. The main outcomes were trajectories of fasting capillary glucose and blood pressure indices, and differences in the mean levels between baseline and final visits.
The total duration of follow-up was 1110 patient-months. During follow-up, there was a significant downward trend in fasting capillary glucose overall (p<0.001) and in most subgroups of participants. Between baseline and final visits, mean fasting capillary glucose dropped by 1.6 mmol/L (95% CI: 0.8-2.3; p< or =0.001). Among those with hypertension, blood pressure also decreased significantly for systolic and marginally for diastolic blood pressure. No major significant change was noticed for body weight.
Nurses may be potential alternatives to improve access to diabetes care in settings where physicians are not available.
Primary care diabetes. 09/2009; 3(3):181-8.
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Ethnicity & disease 02/2009; 19(2 Suppl 2):S2-8-10. · 0.90 Impact Factor
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Epilepsia 10/2008; 49(9):1639-42. · 3.96 Impact Factor
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ABSTRACT: 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.
Health Education Research 09/2008; 23(4):612-20. · 1.66 Impact Factor
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ABSTRACT: Asthma is an important health condition in sub-Saharan Africa, with major gaps in clinical care. The aim of this project was to implement nurse-led care for asthma in rural Cameroon.
We set-up a nurse-led structured management program for asthma in Bafut rural health district in Cameroon from 1998 to 2000. After an initial phase of intensive medical supervision, nurses were offered to run the clinics independently. Patients were monitored for all-cause mortality, hospitalizations, and control of asthma attacks.
At the final evaluation, 87 (73.4% women) were registered in the two pilot clinics. They were 4 to 92 years of age (median 51) and had been diagnosed with asthma for 0 to 40 years. The median duration of follow-up was 5 months (range 1-20) and patients attended on average 3 visits (range 1 to 14). During follow-up, a 66-year-old participant died and 170 emergency hospital admissions/consultations were recorded in 34 participants, 82.3% of them being women. Overall there was a significant downward trend in the number of days/month with attacks with the duration of follow-up, and at the last visit most patients had improved compared with the initial visit. This trend was apparent in most subgroups of participants. Hospital admission before baseline visit was a predictor of hospital admission during follow-up, hazard ratio (95% confidence interval) 3.20 (1.30-7.91), p = 0.012.
The program was well received by the community at large. A marked improvement was observed for most patients as substantiated by the reduction in the number of asthma attacks. Trained nurses are a good alternative for the management of asthma in a resource-limited context.
Journal of Asthma 09/2008; 45(6):437-43. · 1.52 Impact Factor
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ABSTRACT: Background: The growing burden of type 2 diabetes in Sub-Saharan Africa (SSA) and related cardiovascular complications call for vigorous actions into prevention. Comprehensive cardiovascular risk evaluation is important for the success of such actions.Methods: We have reviewed 3 currently existing sets of recommendations for cardiovascular prevention in diabetes in SSA. Distribution of major risk factors and patterns of reported cardiovascular outcomes are used to suggest orientations for cardiovascular prevention in diabetes in this region. Papers and reports published over the period 1990 to 2007 were used.Results: Existing guidelines share some similarities, but also have areas of inconsistencies. They are generally adaptations of existing guidelines, focused more on individual risk factors, and are not usually backed-up by local evidence. They all have a projection on blood pressure lowering. This focus is supported by the high prevalence of hypertension among people with diabetes in SSA. Blood pressure and tobacco smoking are the modifiable risk factors accessible to evaluation and interventions on a wide scale in SSA. Appropriate blood pressure control will have a major impact on stroke (the commonest cardiovascular disease) through a reduction of the cerebrovascular risk, and to a lesser extent on coronary heart disease and total deaths in diabetes in this region.Conclusions: In the absence of global risk evaluation tools, the use of blood pressure lowering as a primary focus of cardiovascular prevention strategies is relevant for SSA. However, there is a need to set-up diabetes and stroke registers to monitor outcomes and generate tools for accurate risk prediction and management in diabetes in this region.
Clinical Medicine : Cardiology. 01/2008;
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ABSTRACT: To evaluate the prevalence, awareness, treatment and control of hypertension in a diabetic population of Cameroon, a sub-Saharan African country.
Two hundreds and ten diabetic patients were consecutively enrolled over a 6-month period. A questionnaire was administered and physical examination done. The JNC VI and the latest WHO criteria were used to diagnose hypertension and diabetes, respectively, and control of hypertension was assessed against five different targets.
Ninety-one percent of the participants had type 2 diabetes. Prevalence and awareness rates for hypertension were 66.7% (n=140) and 87.1% (n=122), respectively. Treatment rate among those aware of their hypertension status was 80.3% (n=98). Patients with hypertension were older, more overweight/obese and had a longer duration of diabetes. ACE inhibitors and diuretics were the two most used blood pressure (BP) lowering drugs. Following the ADA/JNC 7 goal, the control rate of hypertension among treated patients was 10.2% (n=10).
Diabetic patients in Cameroon exhibit a very high prevalence of hypertension and are about three times more affected than the general population. Awareness and treatment rates are high, but the control rate is very low. Large scale studies with intervention component are urgently required.
Diabetes Research and Clinical Practice 09/2007; 77(2):293-9. · 2.75 Impact Factor
