ArticleLiterature Review

Prevalence of prediabetes and diabetes mellitus among adults residing in Cameroon: A systematic review and meta-analysis

January 2018
Diabetes Research and Clinical Practice 137

DOI:10.1016/j.diabres.2017.12.005

Authors:

Jean Joel R Bigna

Pasteur Center of Cameroon

Jobert Richie N Nansseu

University of Yaounde I

Jean-Claude Katte

Faculty of Medicine and Biomedical Sciences, University of Yaounde 1

Jean Jacques N Noubiap

UCSF University of California, San Francisco

Aims To summarize current data on the prevalence of prediabetes and diabetes mellitus in Cameroon. Methods Population-based cross-sectional studies published between January 1, 2000 and April 30, 2017 including apparently healthy adults residing in Cameroon were searched in PubMed, EMBASE, African Journals Online, and African Index Medicus. We used a random-effects model to pool data. Results All included studies had a low risk of bias. Six studies were conducted in an urban setting only, one in a rural setting only, and five in both settings. The overall prevalence of diabetes mellitus was 5.8% (95%CI 4.1-7.9; 12 studies) in a pooled sample of 37,147 participants. The prevalence of prediabetes was 7.1% (95%CI: 3.0-21.9; 4 studies) in a pooled sample of 5,872 people. In univariable meta-regression analysis, the prevalence of diabetes mellitus increased with age, hypertension, overweight and obesity. There was no difference for sex and settings (rural versus urban). Conclusions This study reports a relatively high prevalence of diabetes mellitus and prediabetes in Cameroon, with no difference between urban and rural settings and between sexes. The main drivers include increasing age, overweight and obesity. Community-based educational programs are needed to tackle the burden of the disease in the country.

Surveillance of cardiovascular risk factors in the Fifth Military Sector Health Center, Ngaoundéré, Cameroon : Observational study (Preprint)

Article

Full-text available

Mar 2020

Background Noncommunicable diseases (NCDs) are the leading causes of death worldwide. They were responsible for 40 million of the 57 million deaths recorded worldwide in 2016. In Cameroon, epidemiological studies have been devoted to NCDs and their risk factors. However, none provides specific information on their extent or the distribution of their risk factors within the Cameroonian defense forces. Objective The objective of our study was to assess the cardiovascular risk of a Cameroonian military population compared with that of its neighboring civilian population. Methods We conducted a cross-sectional study that involved subjects aged 18 to 58 years, recruited from October 2017 to November 2018 at the Fifth Military Sector Health Center in Ngaoundéré, Cameroon. Data collection and assessment were done according to the World Health Organization (WHO)’s STEPS manual for surveillance of risk factors for chronic NCDs and the Alcohol Use Disorders Identification Test. Five cardiovascular risk factors were assessed: smoking, harmful alcohol consumption, obesity/overweight, hypertension, and diabetes. The risk was considered high in subjects with 3 or more of the factors. Univariate analysis and multivariate logistic regression were carried out according to their indications. ResultsOur study sample of 566 participants included 295 soldiers and 271 civilians of the same age group (median age 32 years versus 33 years, respectively; P=.57). The military sample consisted of 31 officers and 264 noncommissioned officers (NCOs). Soldiers were more exposed to behavioral risk factors than civilians, with a prevalence of smoking of 13.9% versus 4.4% (P

Prevalence of Diabetes and Associated Risk Factors among a Group of Prisoners in the Yaoundé Central Prison

Article

Full-text available

Jan 2020

Background: Diabetes is a public health problem worldwide, associated with increased morbidity and mortality. According to the International Diabetes Federation (IDF) 2017 data, around 425 million people worldwide suffer from diabetes. This number is expected to increase to 629 million in 2045. Various occidental studies reported the increased prevalence and lower control of diabetes among prisoners. However, there is no data on the characteristics of inmates with diabetes in sub-Saharan Africa. Methods: A cross-sectional study among incarcerated detainees from the Yaoundé Central Prison was conducted from January to July 2017. Diabetes was defined according to the American Diabetes Association (ADA) criteria. Analyzed variables included phenotypic characteristics, lifestyle, the reason for detention, the sentence severity, and the length of detention. Results: We recruited 437 inmates (344 men) with an average age of 37.0 (95% CI: 35.9-38.3) years. The most frequent age group was 20 to 39 years with 281 (64.7%) inmates, and the mean prison stay was 29.1 (95% CI: 25.7-32.8) months. The prevalence of diabetes in the Yaoundé Central Prison was 9.4%. The main cardiovascular risk factors were a sedentary lifestyle (91.1%), hypertension (39.6%), smoking (31.6%), and alcohol consumption (28.1%). Hypertension (p = 0.005), obesity (p = 0.005), obesity (p = 0.005), obesity (p = 0.005), obesity (p = 0.005), obesity (p = 0.005), obesity (. Conclusion: Diabetes prevalence in the Yaoundé Central Prison was high, at 9.4%, compared to that in the general population. It was associated with other classical cardiovascular risk factors and factors linked to the sentence (minor and major crimes). This trial is registered with CE00617/CRERSHC/2016.

Prevalence of type 2 diabetes and pre-diabetes in Sri Lanka: a systematic review and meta-analysis

Article

Full-text available

Aug 2023

Objective The purpose of this research was to determine the prevalence of diabetes and pre-diabetes in Sri Lanka. Design Systematic review and meta-analysis. Data sources MEDLINE (via PubMed), Web of Science, Sri Lankan Journals online and Google Scholar were searched for relevant articles published between January 1990 and June 2022 investigating the prevalence of pre-diabetes and diabetes in Sri Lanka. Methods Random effect meta-analyses were conducted to derive the pooled prevalence of pre-diabetes and diabetes and their 95% CIs. Heterogeneity was explored by subgroup and meta-regression analyses. Sensitivity analyses were used to evaluate the impact of any single study on the pooled estimates. Two authors screened articles, extracted data and evaluated the quality of selected studies. Results A total of 479 articles were reviewed, and 15 studies (n=30 137 participants) were selected in the final analysis. The overall pooled prevalence of diabetes was 12.07% (95% CI, 8.71% to 15.89%; prediction interval: 1.28–31.35). The pooled pre-diabetes prevalence was 15.57% (95% CI, 9.45% to 22.88%; prediction interval: 0.02–49.87). The pooled type 2 diabetes prevalence was the highest in the latest period of 2011–2021 (17.25%) than in the period of 2000s (11.84%) and 1990s (5.62%). Conclusions The growing trend of diabetes and pre-diabetes over the last 30 years is alarming in Sri Lanka. The government of Sri Lanka needs to take steps to improve diabetes education, screening, diagnosis and treatment. PROSPERO registration number CRD42021288591.

Prevalence, Risk Factors, and Awareness of Chronic Kidney Disease among Diabetes Mellitus and Hypertensive Individuals at the Buea Regional Hospital, Cameroon

Article

Full-text available

Jan 2023

Incidence of Hepatitis C Virus infection and the potential predictors among patients with diabetes mellitus in the Bamenda Regional Hospital in Cameroon

Article

Full-text available

Mar 2022

Introduction: Diabetes mellitus (DM) and Hepatitis C Virus (HCV) infections are a global major public health threat. Their co-infections and associated risk factors have been postulated in many countries, unfortunately, no such data exist in Cameroon. This study aims to determine the prevalence and possible predictors of HCV among DM patients. Methods: We conducted a cross-sectional study among DM patients at Regional Hospital Bamenda from February to June 2020. Blood samples were collected and tested for the presence of HCV. Data were analyzed using SPSS version 23. Results: The study comprised 193 participants. The mean (Std. error) age and random blood sugar level of the participants were 46.12(0.9) years and 134.15(4.07) g/dl respectively. HCV prevalence was 3.11% (6). The distribution of HCV infection did not show any significant difference with social demographic factors (p > 0.05). Similarly, HCV was insignificantly (p > 0.05) higher in patients with T2DM 6(3.4%), those with disease duration >5 years 4(4.4%), and those receiving injectable drugs 2(9.1%). Possible predictors (p<0.05) of HCV identified in this study include; uncontrolled diabetes (7.4%), family history of diabetes (19.2%), hepatitis 2(15.4%), alcohol intake (7.6%), multiple sex partners (6.5%), sharing sharp objects (9.1%), those with Tattoos (9.4%), scarification marks (3.6%), as well as those who have been hospitalized (6.7%), or received blood transfusion (25.0%) at least once. Conclusion: HCV testing and linkage to care among DM patients should be made imperative in order to design effective treatment and prevention programs that will reduce the morbidity and mortality rates.

Factors determining the occurrence of hyperglycemia in women practicing voluntary depigmentation in four hospitals in Yaoundé, Cameroon

Article

Jan 2023

Background: Voluntary depigmentation (VD) is a cosmetic practice with potentially local and systemic complications such as hyperglycemia. The aim of this study was to find determinants of hyperglycemia in women who practices VD. Methodology: we carried out a retrospective cohort study with from February to August 2020 in four hospitals in Yaoundé, Cameroon. This study included two groups of women: one made up of women who practices VD (exposed group) and the other of women who does not practices VD (group of “unexposed”). Data were collected on CSPro 7.4 software and analyzed on SPSS 25 software. The association between hyperglycemia and VD was measured using Chi-square test. Results: We recruited 181 women: 60 exposed and 121 unexposed. Prevalence of hyperglycemia in the exposed group was 43.3% versus 27.3% in the unexposed group. After logistic regression, the relative risk was significantly higher (RR=5.7; 95% CI: 2.04-15.60) in women practicing DV (p=0.001). The second determinant significantly associated with hyperglycemia was the presence of metabolic syndrome (RR=16.5; 95% CI: 4.82-56.04; p<0.001). Conclusion: VD is a risk factor for the occurrence of hyperglycemia in our context. Key words: Voluntary depigmentation; Hyperglycemia; Diabetes; Cameroon

Prediabetes Burden in Nigeria: A Systematic Review and Meta-Analysis

Article

Full-text available

Dec 2021

Prediabetes is a borderline glycemic status associated with both higher incidence of cardiovascular disease as well as higher risk of progression to diabetes. There is a rising burden of diabetes and prediabetes globally. This study aims to estimate the burden of prediabetes in Nigeria. Online searches of Google Scholar, PubMed, and Scopus were conducted and studies were selected based on predefined criteria. A total of 15 studies consisting of 14,206 individuals conducted between 2000 and 2019 were included in the meta-analysis with studies using American Diabetic Association (ADA) and World Health Organization (WHO) criteria pooled separately. The pooled prevalence of prediabetes in Nigeria was found to be 13.2% (95% CI: 5.6-23.2%, I 2 = 98.4%) using the ADA criteria and 10.4% (95% CI: 4.3-18.9%, I 2 = 99.2%) using the WHO criteria. According to the latest data by the United Nations, this translates to an estimated 15.8 and 12.5 million adult prediabetic individuals in Nigeria using the ADA and WHO criteria, respectively. The prevalence rates for women and men were similar at 12.1% (95% CI: 5-21%). The pooled prevalence rates for urban and rural settlements were also similar at 9% (95% CI: 2-22%). In conclusion, the prevalence of prediabetes in Nigeria was almost two times higher than the 7.3% estimate by the International Diabetes Federation in 2003. The similar rates of prediabetes between men and women and between urban and rural settlements points toward narrowing of cardiovascular risk burden between the two sexes and the two settlements. This represents higher future cardiovascular disease burden in the country further pressurizing the overstretched healthcare system.

Haematological Features and Urologic Pathologies of Diabetic Subjects at Bafoussam Regional Hospital: A Cross-Sectional Study

Article

Full-text available

May 2020

Background. Diabetes mellitus is at the origin of long-term complications. Objective. This study is aimed at assessing the haematological features and urologic pathologies of diabetic individuals at Bafoussam Regional Hospital. Methods. This was a cross-sectional study conducted from August 2018 to May 2019 in Bafoussam Regional Hospital, West Cameroon. A structured questionnaire was used to gather sociodemographic data. A trained nurse measured the physical and clinical features. Fasting plasma glucose was determined using the glucose meter Accu-Chek Active system. The full blood count (FBC) was carried out using Automatic full Blood Counter, and the CD4, CD3, and CD8 T-cell counts were determined using the flow cytometry method. Results. There were 455 diabetic patients, and 50 nondiabetic patients were included. The mean age of diabetic patients (56.94±14.33 years) was higher compared to that of nondiabetic individuals (34.76±14.35 years) (p<0.001). There was a significant relationship between married individuals (χ2=79.19, p<0.001, and df=4), housewife and retired (χ2=1117.38, p<0.001, and df=37), old age (40 years and above) (χ2=79.11, p<0.001, and df=3), and diabetes status. Diabetic patients had an odds of 5.52 to experience a urinary urge as compared to the controls (p<0.001, 95% CI=2.15-14.22). The majority of haematological parameters were negatively but not significantly correlated with diabetes. Binary logistic regression shows that MCV (r=−0.251, OR=0.778, and 95% CI=0.617–0.983; p=0.035) and RDW-CV (r=−0.477, OR=0.620, and 95% CI=0.454–0.848; p=0.003) negatively influence the probability of having diabetes. RDW-SD (r=0.135, OR=1.144, and 95% CI=1.014–1.291; p=0.029) positively influences the probability of having diabetes. Conclusion. This study revealed a significant haematological and urological profile difference according to diabetes status. Research and interventions targeted at diabetic population could help close gaps in diabetes complications.

Epidemiological Transition of Type 2 Diabetes Mellitus in Rural South West Cameroon

Article

Full-text available

Jan 2020

Prevalence of haemoglobin A1c based dysglycaemia among adult community dwellers in selected states in Nigeria: a descriptive cross-sectional study

Article

Full-text available

Jul 2023

Background: Type 2 diabetes mellitus (T2DM) is a disease of public health importance globally with an increasing burden of undiagnosed pre-diabetes and diabetes in low- and middle-income countries, Nigeria in particular. Pre-diabetes and diabetes are established risk factors for cardiovascular complications. However, data are scanty on the current prevalence of these conditions in Nigeria, based on haemoglobin A1c (HbA1c) diagnosis as recommended by the WHO in 2009. We aimed to determine the prevalence of pre-diabetes, diabetes, and undiagnosed diabetes among the adult population of Nigeria using HbA1c. Methodology: A cross-sectional, multi-site population study was carried out in selected states in Nigeria (namely, Ekiti, Lagos, Osun, Oyo, and Kwara states) involving 2,708 adults (≥18 years) in rural and urban community dwellers, without prior diagnosis of pre-diabetes or diabetes. Participants with ongoing acute or debilitating illnesses were excluded. Data were collected using an interviewer-administered pretested, semi-structured questionnaire. Socio-demographic, clinical (weight, height, blood pressure, etc.), and laboratory characteristics of participants including HbA1c were obtained. Data were analysed using STATA version 16. Results: The mean age of participants was 48.1 ± 15.8 years, and 65.5% were female. The overall prevalence of pre-diabetes and undiagnosed diabetes was 40.5% and 10.7%, respectively, while the prevalence of high blood pressure was 36.7%. The prevalence of pre-diabetes was the highest in Lagos (48.1%) and the lowest in Ekiti (36.7%), while the prevalence of diabetes was the highest in Kwara (14.2%) and the lowest in Ekiti (10%). There was a significant association between age of the participants (p< 0.001), gender (p = 0.009), educational status (p = 0.008), occupation (p< 0.001), tribe (p = 0.004), marital status (p< 0.001), blood pressure (p< 0.001), and their diabetic or pre-diabetic status. Independent predictors of diabetes and pre-diabetes include excess weight gain, sedentary living, and ageing. Participants within the age group 45-54 years had the highest total prevalence (26.6%) of pre-diabetes and diabetes. Conclusion: Over half of the respondents had pre-diabetes and diabetes, with a high prevalence of undiagnosed diabetes. A nationwide screening campaign will promote early detection of pre-diabetes and undiagnosed diabetes among adult Nigerians. Health education campaigns could be an effective tool in community settings to improve knowledge of the risk factors for diabetes to reduce the prevalence of dysglycaemia.

Knowledge, Practices and Experiences of Type II Diabetic Patients on Self- Care Management at the Limbe and Buea Treatment Centers

Article

Jan 2023

Prevalence of prediabetes and associated factors among community members in rural Isingiro district

Article

Full-text available

May 2023
BMC PUBLIC HEALTH

Background In rural Uganda a significant number of persons afflicted with pre-diabetes are unaware of the condition. This is likely to lead to diabetic complications resulting in catastrophic health expendirure.The burden of prediabetes in rural Isingiro has not previously been determined. This study examined the prevalence of prediabetes and the associated factors among rural community members. Methods We conducted a cross-sectional survey and enrolled 370 participants aged between 18 and 70 years in the Kabuyanda sub-county, rural Isingiro district in march 2021. Multistage sampling and systematic random sampling were conducted to select eligible households. Data was collected using a pretested WHO STEP-wise protocol questionnaire. The primary outcome was prediabetes (FBG = 6.1mmol/l to 6.9mmol/l), calculated as a proportion. Participants known to be diabetic or on medication were excluded. Chi-square tests and multivariate logistic regression model were performed for data analysis using STATA. Results The prevalence of prediabetes was 9.19% (95% CI 6.23–12.14). Independent factors significantly associated with pre-diabetes were; advancing age [AOR = 5.7, 95% CI:1.03–32.30], moderate-intensity work [AOR = 2.6,95% CI:1.23–5.63], high level of consumption of a healthy diet [AOR = 5.7, 95% CI:1.67–19.05] and body mass index [AOR = 3.7, 95% CI:1.41–9.20]. Conclusion Prediabetes is prevalent among adult community members in rural Isingiro, southwestern Uganda. Age and lifestyle factors predict prediabetes in this rural population, suggesting a need for targeted health promotion interventions.

Prevalence of cardiometabolic risk factors according to urbanization level, gender and age, in apparently healthy adults living in Gabon, Central Africa

Preprint

Full-text available

May 2023

Background The prevalence of cardiometabolic risk factors (CMRFs) is increasing in sub-Saharan Africa and represents a serious health issue. Specific and accurate data are required to implement prevention programs and healthcare strategies. Thus, the aim of this study was to estimate the prevalence rates of CMRFs according to the level of urbanization, age and gender in Gabon. Methods A cross-sectional study was conducted using the World Health Organization’s (WHO) stepwise approach for the surveillance of chronic disease risk factors. Participants over 18 years of age, without known underlying disease, from rural and urban areas of Gabon were included. Biological and behavioral data were collected using an adapted version of the standardized WHO survey questionnaire. Results The median age was 38[28-50] years. Tobacco consumption was more frequent in rural areas than in urban areas (26.1% vs 6.2%; p < 0.01). Men were more likely to be smokers than women, in both settings (aOR: 8.0[4.9-13.5], p < 0.01). Excessive alcohol consumption (19.4% vs 9.6%; p < 0.01) predominated in rural than in urban areas. Urban dwellers were less physically active than rural people (29.5% vs 16.3%; p < 0.01). In total, 79.9% of participants aged under 54 years had a high blood pressure (HBP) while 10.6% of the younger participants had pre-hypertension. Metabolic syndrome was higher in women (21.7% vs 10.0%; p < 0.01) than in men. Furthermore, 6.4% of men and 2.5% of women had a high risk of developing coronary heart diseases in the next 10 years (p = 0.03). Finally, 54.0% of the study population had three or four risk factors. Conclusion The prevalence rates of CMRFs were high in the study population. Disparities were observed according to urban and rural areas, gender and age groups. National prevention and healthcare strategies for cardiometabolic diseases in Gabon should take into account these observed differences.

Diabetes care cascade and associated factors in 10 700 middle-aged adults in four sub-Saharan African countries: a cross-sectional study

Article

Full-text available

Apr 2023

Objectives We investigated progression through the care cascade and associated factors for people with diabetes in sub-Saharan Africa to identify attrition stages that may be most appropriate for targeted intervention. Design Cross-sectional study. Setting Community-based study in four sub-Saharan African countries. Participants 10 700 individuals, aged 40–60 years. Primary and secondary outcome measures The primary outcome measure was the diabetes cascade of care defined as the age-adjusted diabetes prevalence (self-report of diabetes, fasting plasma glucose (FPG) ≥7 mmol/L or random plasma glucose ≥11.1 mmol/L) and proportions of those who reported awareness of having diabetes, ever having received treatment for diabetes and those who achieved glycaemic control (FPG <7.2 mmol/L). Secondary outcome measures were factors associated with having diabetes and being aware of the diagnosis. Results Diabetes prevalence was 5.5% (95% CI 4.4% to 6.5%). Approximately half of those with diabetes were aware (54%; 95% CI 50% to 58%); 73% (95% CI 67% to 79%) of aware individuals reported ever having received treatment. However, only 38% (95% CI 30% to 46%) of those ever having received treatment were adequately controlled. Increasing age (OR 1.1; 95% CI 1.0 to 1.1), urban residence (OR 2.3; 95% CI 1.6 to 3.5), hypertension (OR 1.9; 95% CI 1.5 to 2.4), family history of diabetes (OR 3.9; 95% CI 3.0 to 5.1) and measures of central adiposity were associated with higher odds of having diabetes. Increasing age (OR 1.1; 95% CI 1.0 to 1.1), semi-rural residence (OR 2.5; 95% CI 1.1 to 5.7), secondary education (OR 2.4; 95% CI 1.2 to 4.9), hypertension (OR 1.6; 95% CI 1.0 to 2.4) and known HIV positivity (OR 2.3; 95% CI 1.2 to 4.4) were associated with greater likelihood of awareness of having diabetes. Conclusions There is attrition at each stage of the diabetes care cascade in sub-Saharan Africa. Public health strategies should target improving diagnosis in high-risk individuals and intensifying therapy in individuals treated for diabetes.

Prevalence and Associated Factors to Severe Forms of Diabetic Retinopathy in Patients Received at the Angiography Unit of the Central Hospital of Yaounde

Article

Full-text available

Nov 2022

Purpose: The objective of our study was to determine the prevalence and factors associated with severe forms of diabetic retinopathy (DR) in patients received at the angiography unit of the Yaounde Central Hospital (YCH). Problem: Ocular complications have a particular place because of the social impact and the major handicap they cause. Diabetes in Cameroon affects 615,000 people, i.e. an overall prevalence of 6%, and it represents an important cause of blindness. Among the complications related to diabetes, diabetic retinopathy accounts for 2.6% of blindness in the world. Methods: We conducted a retrospective cross-sectional study of 476 diabetic patients over a three-year period from 2018 to 2020 at the ophthalmology unit of the Yaoundé Central Hospital. We retained complete diabetic patient records for the main data collected. Statistical analysis of the results was performed with Epi Info version 7.2.2.6 and Excel 2013 analysis software, with data compared using chi 2 with a threshold of p < 0.05 significant level. Results: The prevalence of DR at the angiography unit was estimated at 75.16%, of which 68.05% was type 2 and 7.10% was type 1. There was a statistically significant association between the duration of diabetes and the presence of DR (p=0.000). The angiographic diagnosis of DR in 359 (75.42%) patients corresponding to 711 (74.84%) eyes, and diabetic macular edema in 196 (41.09%) patients corresponding to 387 (40.73%) eyes. Severe forms of diabetic retinopathy were present in 35.72% of the patients with DR, i.e. in 230 (32.35%) eyes. The risk factors for DR were glycemic control, duration of diabetes and hypertension. Conclusion: Hence the importance of insisting on preventive measures and education of the diabetic patient, within the framework of a global and multidisciplinary management strategy, in order to prevent the untoward complications of ocular damage.

Healthcare providers’ and policymakers’ experiences and perspectives on barriers and facilitators to chronic disease self-management for people living with hypertension and diabetes in Cameroon

Article

Full-text available

Nov 2022

Background Hypertension and diabetes are chronic noncommunicable diseases ranked among the leading causes of morbidity and mortality in resource-limited settings. Interventions based on patient empowerment (PE) have been shown to be effective in the management of these diseases by improving a variety of important health outcomes. This study aims to examine from the healthcare providers’ and policymakers’ experiences and perspectives, the facilitators and barriers in the management of hypertension and diabetes for patient empowerment to achieve better health outcomes in the context of the healthcare system in Cameroon. Methods We carried out a qualitative study involving three levels of embedded analysis in a public primary healthcare delivery system in Cameroon, through 22 semi-structural interviews with healthcare providers and policymakers and 36 observations of physicians’ consultations. We combined thematic and lexicometric analyses to identify robust patterns of differences and similarities in the experiences and perspectives of healthcare providers and policymakers about direct and indirect factors associated with patients’ self-management of disease. Results We identified 89 barriers and 42 facilitators at the central, organizational, and individual levels; they were preponderant at the organizational level. Factors identified by healthcare providers mainly related to self-management of the disease at the organizational and individual levels, whereas policymakers reported factors chiefly at the central and organizational levels. Healthcare providers involved in the decision-making process for the delivery of healthcare tended to have a sense of ownership and responsibility over what they were doing to help patients develop self-management abilities to control their disease. Conclusion While interventions focused on improving patient-level factors are essential to PE, there is a need for interventions paying more attention to organizational and political barriers to PE than so far. Interventions targeting simultaneously these multilevel factors may be more effective than single-level interventions.

Patients’ and family caregivers’ experiences and perceptions about factors hampering or facilitating patient empowerment for self-management of hypertension and diabetes in Cameroon

Article

Full-text available

Nov 2022
BMC HEALTH SERV RES

Background Noncommunicable diseases like hypertension and diabetes require long-term management, and are financially draining for patients and their families bearing the treatment costs, especially in settings where the inadequacy or non-existence of the health insurance system prevails. Patient empowerment-focused interventions have been shown to improve adherence to therapeutic regimens and decrease unnecessary health care utilization and costs. This study aims to examine enabling and impeding factors to the development of patient empowerment in a resource-limited setting like Cameroon. Methods We used qualitative methods entailing three levels of investigation and involving a public primary healthcare hospital in Yaoundé, Cameroon. Data were collected through 40 semi-structural interviews with patients having hypertension or diabetes and their family caregivers, one focus group discussion with six patients, 29 observations of consultations of patients by specialist physicians, seven observations of care received by inpatients from generalist physicians, and nine documents on the management of hypertension or diabetes. A novel approach combining thematic and lexicometric analyses was used to identify similarities and differences in barriers and facilitators associated with patient empowerment at different levels of the healthcare delivery system in Cameroon. Results Barriers generally outnumbered facilitators. There were particularities as well as commonalities in reported facilitators and barriers linked to patient empowerment from different experiences and perspectives of outpatients, inpatients and their family caregivers, given the healthcare services and organization of health personal and resources that deliver healthcare services to meet the health needs of patients with hypertension or diabetes in Cameroon. While specific factors identified by patients were directly related to the self-management of their disease at the individual level, family caregivers were mainly focused on factors present at organizational and central levels, which are indirectly related to the management of the diseases and beyond the control of patients and families. Conclusions The preponderance of individual-level factors linked to patient empowerment more than those at the central and hospital/organizational levels calls for due attention to them in the multilevel design and implementation of patient empowerment interventions in resource-limited settings like Cameroon. Accounting for patient’s and families’ perspectives and opinions may be key to improving healthcare delivery.

Assessment of visceral adiposity index and lipid accumulation product index as markers of chronic kidney disease among diabetic and hypertensive patients at the Bamenda Regional Hospital, Cameroon: a cross-sectional study

Article

Full-text available

Jul 2022

Introduction: very limited studies have emphasized the importance of visceral adiposity index (VAI) and lipid accumulation product index (LAPI) in the prevention and management of chronic kidney disease (CKD) especially in diabetic and hypertension patients in developing countries including Cameroon. This study aimed at assessing whether VAI and LAPI are markers of CKD among diabetic and hypertensive patients at the Bamenda Regional Hospital, Cameroon. Methods: this analytical cross-sectional study was conducted at Bamenda Regional Hospital and involved 200 diabetic and/or hypertensive patients, including 77 males and 123 females. The participant´s anthropometric indices, biochemical parameters, VAI, LAPI, and glomerular filtration rate were investigated. A structured questionnaire was used to assess some risk factors of CKD and participant lifestyle. Results: the overweight (41%) and obesity (34%) statuses were prevalent in the population. A considerable proportion of subjects had elevated total cholesterol (46%), low-density lipoprotein (LDL) cholesterol (37.50%), triglycerides (24.5%), urea (40.5%) and creatinine (53.5%) levels. Stage 1 to 3 CKD was largely present in the elderly (>54-year-old) affecting the majority of patients (57.5%). Low education level and lack of physical activity were significantly associated with the prevalence of CKD (p < 0.001). On the contrary to creatinine (unadjusted OR = 1.36; 95% CI: 1.13-1.62), urea (unadjusted OR = 1.02; 95% CI: 1.01-1.03), HDL (unadjusted OR = 0.87; 95% CI: 0.78-0.97), total cholesterol/HDL ratio (unadjusted OR = 1.38; 95% CI; 1.12-1.71), VAI (unadjusted OR = 1.13; 95% CI: 1.05-1.22) and LAPI (unadjusted OR = 1.00; 95% CI: 1.00-1.00) were significantly associated with CKD status of the patients while HDL was negatively associated (unadjusted OR = 0.87; 95% CI: 0.78-0.97). The 9.905 and 5679 cut-offs of VAI and LAPI respectively for CKD discrimination obtained high sensitivity (75.0%) and specificity (≥79.6%). Conclusion: visceral adiposity index and LAPI were associated with CKD among diabetic and hypertensive patients. Visceral adiposity index and LAPI could be user-friendly tools for the early diagnosis of CKD among these categories of patients in Cameroon.

Prevalence and factors associated with inappropriate anti-diabetic medication therapy among type 2 diabetes mellitus patients at the medical and surgical wards of Mbarara Regional Referral Hospital, Uganda

Article

Full-text available

Jun 2022
PLOS ONE

Background Inappropriate Anti-diabetic Medication Therapy (IADT) refers to a drug-related problem and includes ‘ineffective drug therapy’, ‘unnecessary drug therapy’, ‘dosage too high’, and ‘dosage too low’. This study aimed to determine the prevalence and factors associated with IADT among T2DM patients at Mbarara Regional Referral Hospital, Uganda (MRRH). Method A prospective cross-sectional study was conducted at the medical and surgical wards of MRRH from November 2021 to January 2022. One hundred and thirty-eight adult patients aged 18 years and above, with T2DM, were recruited using consecutive sampling. Patient file reviews and interviewer-administered questionnaire was used for data collection. The data were entered into and analyzed using SPSS version 25. Descriptive analysis was employed to describe the population and determine the prevalence of IADT. Types of IADTs were identified using Cipolle’s DRP classification tool. A univariate and multivariate logistic regression analysis was used to identify factors significantly associated with IADT. The Pvalue of < 0.05 was considered statistically significant at 95% confidence interval. Results A total of 138 hospitalized T2DM patients were studied. Eighty (58.0%) were females, and 70 (50.7%) were � 60 years of age. Out of a total of 138 participants, 97 experienced at least one IADT, with an estimated prevalence of 70.3%. ‘Dosage too high’ (29.2%) and ‘dosage too low’ (27.9%) were the most common type of IADTs. Age � 60 years (AOR, 8.44; 95% CI, 2.09–10.90; P-value = 0.003), T2DM duration of < 1 year (AOR, 0.37; 95% CI, 0.11–0.35; P-value = 0.019), and HbA1c of < 7% (AOR, 9.97; 95% CI, 2.34–13.57; P-value = 0.002) were found to be factors significantly associated with the occurrence of IADTs. Conclusion The overall prevalence of inappropriate anti-diabetic medication therapy among T2DM patients admitted to medical and surgical wards of MRRH was 70.3%. The most common type of IADT in this study was ‘dosage too high’, accounting for almost one-third followed by ‘dosage too low’ accounting for a quarter of total IADTs. Age greater or equal to 60 years, T2DM duration of < 1 year, and HbA1c of < 7% during the current admission were found to be factors significantly associated with the occurrence of IADTs in hospitalized T2DM patients.

Study of the frequency of diabetes mellitus and its risk factors in the emergency units of two hospitals in Dakar, Senegal

Article

Full-text available

Jan 2021

Introduction-Objectives: The global prevalence and mortality of diabetes mellitus worldwide is steadily increasing, and its increases are faster in low and middle-income countries. In Senegal, diabetes mellitus affects 2.1% of the population and is responsible for 3% of deaths from all causes. However, the epidemiological profile of the patients received in the emergency unit is not clearly established. This is how this study was conducted to find out the frequency of diabetes mellitus and the factors associated within the emergency unit of Dakar hospitals. Methodology: The study setting was the emergency unit of Pikines Hospital and The Principal Hospital of Dakar. This was an observational, descriptive cross-sectional study for analytical purposes looking for factors associated with the onset of diabetes. A representative sample was drawn and consecutive recruitment of eligible patients was carried out. The data collection tools were based on the WHO stepwise survey questionnaire and the data collection was conducted in an ethical manner. Results: It was 615 patients who were included, of which 53.7% at The Principal Hospital of Dakar and 46.3% at the Pikine’s Hospital. This was 72.4% of those surveyed who did not engage insufficient physical activity and only 3.6% reported consuming more than five fruits and vegetables per day. They were 22.7% to be overweight and 17.4% were obese. The patients who reported never having controlled their glycemia in their life were 40.4%. Among the patients who had measured their glycemia at least once in their life, 69.7% did so in a health facility, before resorting to the pharmacy and self-measurement. The frequency of diabetes mellitus was 16.9% of which 77% were previously diagnosed diabetes mellitus cases and 23% were newly diagnosed. The mean random capillary glycemia was 1.34 g/L with a standard deviation of 0.7 g/L. In decreasing order of frequency of metabolic complication diagnosed there was hyperglycaemic hyperosmolarity (48.8%) followed by diabetic ketoacidosis (39.5%). The risk factors identified for the onset of diabetes mellitus in the emergency’s unit population were age, existence of employment, and body mass index. Conclusion: The risk factors for diabetes mellitus are well represented in our emergency units. The fight for primary prevention of diabetes mellitus remains a multi-ministerial the challenge, as suggested by the associated factors identified in this study. All strategic plans for the fight against diabetes mellitus and non-communicable diseases, in general, must be built according to the One Health vision.

Prevalence, correlates and in-hospital outcomes of kidney dysfunction in hospitalized patients with heart failure in Buea-Cameroon

Article

Full-text available

Jan 2022
BMC Nephrol

Background Kidney dysfunction is common in patients with heart failure (HF) and has been associated with poor outcomes. This study aimed to determine the prevalence, correlates, and prognosis of kidney dysfunction in patients with HF in Cameroon, an understudied population. Methods We conducted a cross-sectional study in consecutive patients hospitalized with HF between June 2016 and November 2017 in the Buea Regional Hospital, Cameroon. Kidney dysfunction was defined as an estimated glomerular filtration rate < 60 ml/min/1.73m ² . Prognostic outcomes included death and prolonged hospital stay (> 7 days). We also performed a sensitivity analysis excluding racial considerations. Results Seventy four patients (86.1% of those eligible) were included. Their median age was 60 (interquartile range: 44–72) years and 46.0% ( n = 34) were males. Half of patients ( n = 37) had kidney dysfunction. Correlates of kidney dysfunction included previous diagnosis of HF (adjusted odds ratio [aOR]4.3, 95% CI: 1.1–17.5) and left ventricular hypertrophy (aOR3.4, 95% CI: 1.1–9.9). Thirty-six (48.9%) had prolonged hospital stay, and seven (9.5%) patients died in hospital. Kidney dysfunction was not associated with in-hospital death (aOR 0.4, 95% CI: 0.1–2) nor prolonged hospital stay (aOR 2.04, 0.8–5.3). In sensitivity analysis (excluding racial consideration), factors associated with Kidney dysfunction in HF were; anemia (aOR: 3.0, 95% CI: 1.1–8.5), chronic heart failure (aOR: 4.7, 95% CI: 0.9–24.6), heart rate on admission < 90 bpm (aOR: 3.4, 95% CI: 1.1–9.1), left atrial dilation (aOR: 3.2, 95% CI: 1.04–10), and hypertensive heart disease (aOR: 3.1, 95% CI: 1.2–8.4). Kidney dysfunction in HF was associated with hospital stay > 7 days (OR: 2.6, 95% CI: 1–6.8). Conclusion Moderate-to-severe kidney dysfunction was seen in half of the patients hospitalized with HF in our setting, and this was associated with a previous diagnosis of HF and left ventricular hypertrophy. Kidney dysfunction might not be the main driver of poor HF outcomes in this population. In sensitivity analysis, this was associated with anemia, chronic heart failure, heart rate on admission less than 90 bpm, left atrial dilatation, and hypertensive heart disease. Kidney dysfunction was associated with hospital stay > 7 days.

Research priorities for accelerating the achievement of three 95 HIV goals in Cameroon: a consensus statement from the Cameroon HIV Research Forum (CAM-HERO)

Article

Full-text available

Nov 2021

Introduction: the Treat-All remains the globally endorsed approach to attain the 95-95-95 targets and end the AIDS pandemic by 2030, but requires some country-level contextualization. In Cameroon, the specific research agenda to inform strategies for improving HIV policy was yet to be defined. Methods: under the patronage of the Cameroon Ministry of health, researchers, policy makers, implementing partners, and clinicians from 13 institutions, used the Delphi method to arrive at a consensus of HIV research priorities. The process had five steps: 1) independent literature scan by 5 working groups; 2) review of the initial priority list; 3) appraisal of priorities list in a larger group; 4) refinement and consolidation by a consensus group; 5) rating of top research priorities. Results: five research priorities and corresponding research approaches, resulted from the process. These include: 1) effectiveness, safety and active toxicity monitoring of new and old antiretrovirals; 2) outcomes of Antiretroviral Therapy (ART) with focus in children and adolescents; 3) impact of HIV and ART on aging and major chronic diseases; 4) ART dispensation models and impact on adherence and retention; 5) evaluations of HIV treatment and prevention programs. Conclusion: the research priorities resulted from a consensus amongst a multidisciplinary team and were based on current data about the pandemic and science to prevent, treat, and ultimately cure HIV. These priorities highlighted critical areas of investigation with potential relevance for the country, funders, and regulatory bodies.

Optimization of production conditions of biscuit from Musa sapientum flour (‘banane cochon’): Nutritional composition and glycaemic index of the optimized biscuit

Article

Full-text available

Oct 2021

Diet management through the consumption of food with recommended nutrient contents but having a low glycaemic index plays an important role in controlling diabetes and its complications. This study aims to develop biscuit from banane cochon flour in order to contribute to the prevention and management of diabetes. The chemical properties and glycaemic index of the ‘banane cochon’ were evaluated. This was followed by the optimization of production conditions of biscuits using the central composite design. The responses studied were dry matter, reducing sugar and lipid content. The resulting product was evaluated for its nutritional value and glycaemic index. It resulted that, ‘banane cochon’ has high dietary fibre (12.99%), potassium (1046.14 mg/100g), calcium (512.00 mg/100g), phosphorus (89.90 mg/100g) contents and a low glycaemic index (36.00). The optimum conditions were as thus: 25.81 g (quantity of margarine), 150°C (baking temperature) and 26 min (baking time). This resulted to an optimized biscuit having the following contents: minerals (potassium, magnesium, iron, calcium and phosphorus), dry matter content (95.7%), lipid content (18.71%), reducing sugar (12.01 g/100 g), protein (6.8%), carbohydrate (65.59%), dietary fibre (11.24%), ash content (4.70%) and glycaemic index of 50.77. The results achieved confirmed that Musa sapientum (‘banane cochon’) flour could be used to obtain a nutritive and a low glycaemic index biscuit.

Patients’ and family caregivers’ experiences and perceptions about factors hampering or facilitating patient empowerment for self-management of hypertension and diabetes in Cameroon: Evidence from thematic and lexicometric analyses of qualitative study data

Preprint

Full-text available

Oct 2021

Background Noncommunicable diseases like hypertension and diabetes require long-term management, and are financially draining for patients and their families bearing the treatment costs, especially in settings where the inadequacy or non-existence of the health insurance system prevails. Patient empowerment-focused interventions have been shown to improve adherence to therapeutic regimens and decrease unnecessary health care utilization and costs. This study aims to examine enabling and impeding factors to the development of patient empowerment in a resource-limited setting like Cameroon. Methods We used qualitative methods entailing three levels of investigation and involving a public primary healthcare hospital in Yaoundé, Cameroon. Data were collected through 40 semi-structural interviews with patients having hypertension or diabetes and their family caregivers, one focus group discussion with six patients, 29 observations of consultations of patients by specialist physicians, seven observations of care received by inpatients from generalist physicians, and nine documents on the management of hypertension or diabetes. A novel approach combining thematic and lexicometric analyses was used to identify similarities and differences in barriers and facilitators associated with patient empowerment at different levels of the healthcare delivery system in Cameroon. ResultsBarriers generally outnumbered facilitators. There were particularities as well as commonalities in reported facilitators and barriers linked to patient empowerment from different experiences and perspectives of outpatients, inpatients and their family caregivers, given the healthcare services and organization of health personal and resources that deliver healthcare services to meet the health needs of patients with hypertension or diabetes in Cameroon. While specific factors identified by patients were directly related to the self-management of their disease at the individual level, family caregivers were mainly focused on factors present at organizational and central levels, which are indirectly related to the management of the diseases and beyond the control of patients and families. Conclusions The preponderance of individual-level factors linked to patient empowerment more than those at the central and hospital/organizational levels calls for due attention to them in the multilevel design and implementation of patient empowerment interventions in resource-limited settings like Cameroon. Accounting for patient’s and families’ perspectives and opinions may be key to improving healthcare delivery.

Optimum biscuit from Musa sapientum L. and Vigna unguiculata L. composite flour: Effect on pancreatic histology, biochemical and hematological parameters of diabetic rats

Article

Full-text available

Sep 2021

This study investigated the effect of consumption of an optimum biscuit from composite flour of Musa sapientum L. (‘banana cochon’) and Vigna unguiculata L. (cowpea) on the pancreatic histology, biochemical and hematological parameters of streptozotocin-induced diabetic Wistar rats. The optimum biscuit was evaluated for its chemical properties and glycaemic index. The weekly fasting blood glucose level, food intake and weight of the rats were recorded. The effect of 28 days' consumption of different percentages of optimum biscuit with/without Metformin was also evaluated on the pancreatic histology, biochemical and hematological parameters of rats. Results showed that, the optimum biscuit is rich in minerals (potassium, magnesium and calcium), dietary fibre (9.4%) and is a low glycaemic index product (50.91%). Also, the optimum biscuit significantly lowered/maintained the blood glucose level of diabetic rats even though the weekly weights of the rats were reduced while food intake increased. Nonetheless, the hematological parameters of the treated diabetic rats were significantly (P < 0.05) improved when compared to the untreated diabetic rats groups. With the exception of total serum protein, other biochemical parameters such as serum creatinine, urea, alanine aminotransferase, alkaline phosphatase, aspartate aminotransferase and bilirubin in the treated diabetic groups were significantly (P < 0.05) reduced or closer to those of non-diabetic rats. The serum cholesterol, triglyceride, low-density lipoprotein levels were significantly (p < 0.05) reduced while the HDL level significantly increased in treated diabetic groups. Histological examination of the pancreas showed that treatment of diabetic groups with optimum biscuit was able to slow down the destruction (protection) of beta-cells. Thus, optimum biscuit could be used to improve the health status during the management and prevention of complications in diabetic patients.

Dose-dependent and time-dependent metabolic, hemodynamic, and redox disturbances in dexamethasone-treated Wistar rats

Article

Apr 2021

Objectives Dexamethasone is used experimentally to induce insulin resistance and type 2 diabetes. However, data concerning the dose, the duration of treatment, and the associated comorbidities are inconsistent. The aim of this study was to compare the effects of different doses of dexamethasone and the duration of treatment necessary for the development of a model of insulin resistance that mimics the clinical condition with the associated comorbidities. Methods Dexamethasone was administered intramuscularly to male Wistar rats, at doses of 500 and 1,000 µg/kg/day for the subchronic treatment (eight consecutive days) and at doses of 5, 25, 50, and 100 µg/kg/day in chronic treatment (28 consecutive days). Effects on body weight, metabolism, hemodynamics, renal function, and redox status were evaluated. Results Both treatments induced a progressive body weight loss that was drastic in subchronic treatment, improved glucose tolerance without affecting fasting glycemia. Doses of 1,000 and 100 µg/kg were associated with hypertriglyceridemia, hypertension, and increased heart rate, cardiac and renal hypertrophy. Increased creatinemia associated with reduced creatinuria were observed in sub-chronic treatment while increased proteinuria and reduced creatinuria were noticed in chronic treatment. 1,000 µg/kg dexamethasone caused an increase in hepatic, and renal malondialdehyde (MDA) and glutathione (GSH) coupled with a reduction in catalase activity. The dose of 100 µg/kg induced a rise in GSH and catalase activity but reduced MDA levels in the kidney. Conclusions Doses of 1,000 µg/kg for subchronic and 100 µg/kg for chronic treatment exhibited similar effects and are the best doses to respective time frames to induce the model.

Efficacy and Safety of Berberine for Prediabetes: A Systematic Evaluation and Meta-Analysis

Article

Full-text available

Jan 2021

A systematic analysis on prevalence and sub-regional distribution of undiagnosed diabetes mellitus among adults in African countries

Article

Full-text available

Feb 2021

Gizachew Tadesse Wassie

Abstract Background Despite the high prevalence of diabetes in Africa, the extent of undiagnosed diabetes in the region is still poorly understood. This systematic review and meta-analysis was designed to determine the pooled prevalence of undiagnosed diabetes mellitus among adults in Africa. Methods We conducted a systematic desk review and electronic web-based search of PubMed, Google Scholar, EMBASE, and the World Health Organization’s Hinari portal (which includes the SCOPUS, African Index Medicus, and African Journals Online databases), identifying peer-reviewed research studies on the prevalence of undiagnosed diabetes among adult individuals using pre-defined quality and inclusion criteria. We ran our search from June 1, 2018 to Jun 14, 2020.We extracted relevant data and presented descriptive summaries of the studies in tabular form. The I2 test was used to assess heterogeneity across studies. A random effects model was used to estimate the pooled prevalence of undiagnosed diabetes mellitus at a 95% confidence interval (CI). Funnel plot asymmetry and Egger’s tests were used to check for publication bias. The final effect size was determined by applying a trim and fill analysis in a random-effects model. Results Our search identified 1442 studies amongst which 23 articles were eligible for inclusion in the final meta-analysis. The average pooled prevalence of undiagnosed diabetes mellitus among adults was 3.85 (95% CI: 3.10–4.60). The pooled prevalence of undiagnosed diabetes mellitus based on geographic location was 4.43 (95% CI: 3.12–5.74) in Eastern Africa; 4.72 (95% CI: 2.64–6.80) in Western Africa; 4.27 (95% CI: 1.77–6.76) in Northern Africa and 1.46 (95%CI: 0.57–2.34) in southern Africa respectively. Conclusion Our findings indicate a high prevalence of undiagnosed diabetes in Africa and suggest that it may be more prevalent in Western Africa than the rest of the regions. Given the high levels of undiagnosed diabetes in the Africa region, more attentionshould be paid to incorporating diabetes screening and treatment services into existing diabetes related programs to reduce the prevalence of undiagnosed cases. Keywords Diabetes mellitus . Undiagnosed . Meta-analysis . Africa

Oral health status and cardiovascular risk profile in Cameroonian military population

Article

Full-text available

Jan 2021

Background: Periodontal diseases (PD) seem to appear today as predictors of some cardiovascular diseases (CVD). There is a lack of data on the oral health among Cameroonian military population, and its relationship with CVD. Purpose: Investigate on the link between oral health of Cameroonian military from the Ngaoundéré garrison and their cardiovascular risk profile. Participants and methods: A cross-sectional study at the Fifth Military Sector Health Center in Ngaoundéré was conducted. General health parameters assessment was done according to the World Health Organization STEPS manual for surveillance of risk factors for non-communicable chronic diseases and the Alcohol Use Disorders Identification Test. The periodontal status was assessed using Dutch Periodontal Screening Index. Results: Two hundred and five participants who were officers and non-commissioned officers (aged 47 ± 08 and 32 ± 08 years respectively), with 86.4% of men were included. Smoking was associated to periodontitis (OR = 4.44 [1.73-11.43], p = 0.0031). Quality of oral hygiene was associated to high cardiovascular risk profile, poor/good (OR = 3.96 [1.07-14.57], p = 0.0386) and medium/good (OR = 3.44 [1.11-10.66], p = 0.0322). Conclusion: Lifestyle as tobacco consumption and poor oral hygiene were associated to CVD among military, and this call for change.

Assessing the Health Status of Students at Université Des Montagnes in Cameroon

Article

Full-text available

Jan 2020

Berberine and Prediabetes: A Clinical Observational Study

Article

Full-text available

Jan 2020

A systematic analysis on prevalence and sub-regional distribution of undiagnosed diabetes mellitus among adults in African countries

Research

Full-text available

Sep 2020

A systematic analysis on prevalence and sub-regional distribution of undiagnosed diabetes mellitus among adults in African countries

Article

Full-text available

Oct 2020

Background Despite the high prevalence of diabetes in Africa, the extent of undiagnosed diabetes in the region is still poorly understood. This systematic review and meta-analysis was designed to determine the pooled prevalence of undiagnosed diabetes mellitus among adults in Africa. Methods We conducted a systematic desk review and electronic web-based search of PubMed, Google Scholar, EMBASE, and the World Health Organization’s Hinari portal (which includes the SCOPUS, African Index Medicus, and African Journals Online databases), identifying peer-reviewed research studies on the prevalence of undiagnosed diabetes among adult individuals using pre-defined quality and inclusion criteria. We ran our search from June 1, 2018 to Jun 14, 2020. We extracted relevant data and presented descriptive summaries of the studies in tabular form. The I ² test was used to assess heterogeneity across studies. A random effects model was used to estimate the pooled prevalence of undiagnosed diabetes mellitus at a 95% confidence interval (CI). Funnel plot asymmetry and Egger’s tests were used to check for publication bias. The final effect size was determined by applying a trim and fill analysis in a random-effects model. Results Our search identified 1442 studies amongst which 23 articles were eligible for inclusion in the final meta-analysis. The average pooled prevalence of undiagnosed diabetes mellitus among adults was 3.85 (95% CI: 3.10–4.60). The pooled prevalence of undiagnosed diabetes mellitus based on geographic location was 4.43 (95% CI: 3.12–5.74) in Eastern Africa; 4.72 (95% CI: 2.64–6.80) in Western Africa; 4.27 (95% CI: 1.77–6.76) in Northern Africa and 1.46 (95%CI: 0.57–2.34) in southern Africa respectively. Conclusion Our findings indicate a high prevalence of undiagnosed diabetes in Africa and suggest that it may be more prevalent in Western Africa than the rest of the regions. Given the high levels of undiagnosed diabetes in the Africa region, more attention should be paid to incorporating diabetes screening and treatment services into existing diabetes related programs to reduce the prevalence of undiagnosed cases.

Chronic kidney disease in Cameroon: A scoping review

Article

Full-text available

Sep 2020
BMC Nephrol

Objectives: This scoping review sought to summarize available data on the prevalence, associated factors, etiology, comorbidities, treatment, cost and mortality of chronic kidney disease (CKD) in Cameroon. Methods: We searched PubMed, Scopus and African Journals Online from database inception to 31 March, 2020 to identify all studies published on the prevalence, associated factors, etiology, comorbidities, treatment, cost and mortality of CKD in Cameroon. Results: Thirty studies were included. The prevalence of CKD varied from 3 to 14.1 and 10.0%-14.2% in rural and urban areas, respectively. The prevalence of CKD in patients with hypertension, diabetes mellitus, and human immunodeficiency virus was 12.4-50.0, 18.5%, and 3.0-47.2%, respectively. Hypertension (22.3-59.1%), chronic glomerulonephritis (15.8-56.2%), and diabetes mellitus (15.8-56.2%) were the most common causes of CKD. The cause was unknown in 13.5-17.0% of the cases. Advanced age, hypertension, diabetes mellitus, and obesity were frequent associated factors. Hemodialysis was the main treatment modality in patients with End Stage Renal Disease (ESRD). The monthly cost of management of non-dialyzed CKD was 163 US dollars. The one-year mortality rate of ESRD was 26.8-38.6%. Conclusion: Chronic kidney disease affects about one in 10 adults in the general population in Cameroon. Patients with hypertension, diabetes mellitus, and human immunodeficiency virus bear the greatest burden of CKD in Cameroon. Advanced age, hypertension, diabetes mellitus, and obesity are major factors associated with CKD. Chronic kidney disease in Cameroon is associated with high morbidity and mortality and huge economic cost on the patient.

A systematic analysis on prevalence and sub-regional distribution of undiagnosed diabetes mellitus among adults in African countries

Article

Full-text available

Aug 2020

Getenet Dessie

Antibiotic Resistance Profile of Uropathogenic Bacteria in Diabetic Patients at the Bafoussam Regional Hospital, West Cameroon Region

Article

Full-text available

Jul 2020

Background Urinary tract infections constitute a major public health concern. The aim of the study is to look into the antibiotic sensitivity profile of uropathogenic bacteria among diabetic individuals in the Diabetology Unit of the Bafoussam Regional Hospital, West Cameroon. Methods A cross-sectional study was carried out in Bafoussam Regional Hospital. Urine was collected in a sterile jar previously labelled. The microorganisms were isolated on agar medium and their final identification was carried out on the API20E gallery. The antibiogram was performed using agar diffusion methods. Results Escherichia coli (25.30%) and Staphylococcus aureus (19.27%) were the most noticed species in the diabetic patients, whereas Escherichia coli (32.00%) and Klebsiella pneumoniae (22.00%) were the most noticed in non-diabetic patients. There was a significant association between antibiotic resistance and diabetic status (for ceftriaxone: X2 = 23.78 and P-value < 0.001; for cefixime: X2 = 19.31 and P-value < 0.001; for ceftazidime: X2 = 9.45 and P-value = 0.008; for cefotaxime: X2 = 10.97 and P-value = 0.004; for cefepime: X2 = 27.93 and P-value < 0.001; and for ciprofloxacin: X2 = 11.13 and P-value = 0.003). Multidrug resistance rate against some bacterial species were higher in diabetic patients (62.50% for Escherichia coli, 63.16% for Klebsiella pneumoniae, and 78.57% for Staphylococcus aureus) compared with non-diabetic patients (37.50% for Escherichia coli, 36.84% for Klebsiella pneumoniae, and 21.43% for Staphylococcus aureus). Conclusions This study revealed that there is an association between antibiotic resistance and diabetic status. Research and interventions must be focused on the elderly diabetic population in order to fight against the occurrence of drug-resistant uropathogenes.

Review of Ongoing Activities and Challenges to Improve the Care of Patients With Type 2 Diabetes Across Africa and the Implications for the Future

Article

Full-text available

Mar 2020

Background There has been an appreciable increase in the number of people in Africa with metabolic syndrome and Type 2 diabetes (T2DM) in recent years as a result of a number of factors. Factors include lifestyle changes, urbanisation, and the growing consumption of processed foods coupled with increasing levels of obesity. Currently there are 19 million adults in Africa with diabetes, mainly T2DM (95%), estimated to grow to 47 million people by 2045 unless controlled. This has a considerable impact on morbidity, mortality and costs in the region. There are a number of issues to address to reduce the impact of T2DM including improving detection rates and current access to services alongside addressing issues of adherence to prescribed medicines. There are also high rates of co-morbidities with infectious diseases such as HIV and tuberculosis in patients in Africa with T2DM that require attention.Objective Document ongoing activities across Africa to improve the care of patients with T2DM especially around issues of identification, access, and adherence to changing lifestyles and prescribed medicines. In addition, discussing potential ways forward to improve the care of patients with T2DM based on ongoing activities and experiences including addressing key issues associated with co-morbidities with infectious diseases.Our ApproachContextualise the findings from a wide range of publications including internet based publications of national approaches coupled with input from senior level government, academic and other professionals from across Africa to provide future guidance.Ongoing ActivitiesA number of African countries are actively instigating programmes to improve the care of patients with T2DM starting with improved diagnosis. This recognises the growing burden of non-communicable diseases across Africa, which has been neglected in the past. Planned activities include programmes to improve detection rates and address key issues with diet and lifestyle changes, alongside improving monitoring of care and activities to enhance adherence to prescribed medicines. In addition, addressing potential complexities involving diabetes patients with infectious disease co-morbidities. It is too early to fully assess the impact of such activities,Conclusion There are a number of ongoing activities across Africa to improve the management of patients with diabetes including co-morbidities. However, more needs to be done considering the high and growing burden of T2DM in Africa. Ongoing research will help further benefit resource allocation and subsequent care.

Epidemiology of Overweight and Obesity in Adults Living in Cameroon: A Systematic Review and Meta‐Analysis

Article

Aug 2019

Objective: This study aimed to summarize current data on overweight and obesity among adults living in Cameroon. Methods: PubMed, Embase, Web of Science, Global Index Medicus, African Journals Online, and local databases were searched for population-based cross-sectional studies conducted in the general population from January 2000 to December 2017. A random-effects model was used to pool data. Results: Overall, 26 studies (55,155 participants) were included. The prevalence of overweight was 26.0% (95% CI: 17.6%-35.3%) based on BMI. Furthermore, the overall prevalence of obesity was 15.1% (95% CI: 9.3%-22.1%) based on BMI, 16.4% (95% CI: 10.8%-22.8%) based on waist circumference ≥ 102 cm for males and ≥ 88 cm for females, 36.7% (95% CI: 26.8%-47.2%) based on waist circumference ≥ 94 cm for males and ≥ 80 cm for females, 32.6% (95% CI: 26.9%-38.7%) based on waist to hip ratio ≥ 0.90 for males and ≥ 0.85 for females, and 31.9% (95% CI: 27.8%-36.2%) based on percent body fat ≥ 25% for males and ≥ 35% for females. Overall, the burden was higher in females compared with males; there was no difference between urban and rural settings or between studies conducted in 2000 to 2009 and 2010 to 2016. Conclusions: The burden of overweight and obesity is high among adults in Cameroon, putting many at increased risk for developing associated metabolic and cardiovascular complications.

The effect of zinc supplementation in pre-diabetes: A protocol for systematic review and meta-analysis

Article

Full-text available

Jul 2019
MEDICINE

Background: The number of people with diabetes and pre-diabetes is growing exponentially. Human studies have shown that zinc supplementation is beneficial for pre-diabetes. However, owing to the low quality, small sample size, and methodological heterogeneity of these studies, this conclusion is not convincing. Consequently, in order to determine whether zinc supplementation is effective and safe in pre-diabetic patients, it is necessary to conduct a meta-analysis of high-quality clinical trials. Methods: We will retrieve MEDLINE (PubMed), EMBASE, the Web of Science, Cochrane Library, and the ClinicalTrials.gov website without restriction on language. Randomized controlled trials (RCTs) of Zinc supplementation for adult patients with pre-diabetes will be searched in multiple databases from inception to October 2020. The primary outcome of the meta-analysis is the HbA1c. The secondary outcomes include the fasting blood glucose (FBG), fasting insulin (FINS), homeostasis model assessment of insulin resistance (HOMA-IR), and quantitative insulin sensitivity check index (QUICKI). Two assessors will utilize the Cochrane Collaboration's risk of bias tool to evaluate the RCTs and all statistical data will be analyzed by using the Review Manage software V5.3.0. Results: This study will provide high-quality synthesis of effectiveness and safety of zinc supplementation for pre-diabetes. Conclusion: This systematic review and meta-analysis will provide the available evidence to assess whether the zinc supplementation is beneficial to glucose control and insulin resistance in patients with pre-diabetes. Prospero registration number: CRD 42018095724.

Self-reported behavior of eating quickly is correlated with visceral fat area in Japanese non-obese adults

Article

Full-text available

Jan 2019
ASIA PAC J CLIN NUTR

Background and objectives: This cross-sectional study investigated the relationship between eating speed and fat accumulation in Japanese non-obese adults. Methods and study design: In total, 381 non-obese participants aged 35-74 years underwent a health checkup including fat distribution. All participants underwent magnetic resonance imaging to quantify visceral fat area (VFA) and subcutaneous fat area (SFA). Information on eating speed was obtained using a self-administrated questionnaire. Results: The numbers of participants with self-reported behavior of eating slowly, medium, or quickly were 24 (6.3%), 180 (47.2%), and 177 (46.5%), respectively. The prevalence of VFA ≥100 cm2 was higher in the eating quickly group than in the eating slowly (p<0.05) or medium groups (p<0.05). On the other hand, no significant differences in SFA ≥100 cm2 were observed between groups. In addition, multiple stepwise regression analysis showed that eating quickly was positively correlated with VFA (standard β=0.068, p<0.05), but not with SFA. Conclusions: Although eating quickly was positively correlated with bigger VFA in Japanese non-obese adults, no associations were found between eating speed and SFA.

Adherence to antidiabetic medication and factors associated with non-adherence among patients with type-2 diabetes mellitus in two regional hospitals in Cameroon

Article

Full-text available

Apr 2019
BMC Endocr Disord

Background Diabetes mellitus is a growing cause of disease burden globally. Its management is multifaceted, and adherence to pharmacotherapy is known to play a significant role in glycaemic control. Data on medication adherence among affected patients is unknown in Cameroon. In this study, the level of adherence and factors influencing non-adherence to antidiabetic medication among patients with type-2 diabetes was assessed. Methods A hospital-based cross-sectional study among adult patients receiving care in the diabetic clinics of the Limbe and Bamenda Regional Hospitals in Cameroon was conducted. Medication adherence was assessed using the Medication Compliance Questionnaire (MCQ). Factors associated with non-adherence to medication were determined using basic and adjusted multivariable logistic regression models. Results A total of 195 patients with type 2 diabetes were recruited. The prevalence of non-adherence to medication was 54.4% [95% confidence interval (CI): 47.1–61.5%]. In multivariable analysis, age > 60 years (aO.R. = 0.48, 95% CI: 0.25–0.94), alcohol consumption (aO.R. = 2.13, 95% CI: 1.10–4.14) and insulin alone therapy (aO.R. = 2.85, 95% CI: 1.01–8.08) were associated with non-adherence. Patients attributed their non-adherence to forgetfulness (55.6%), lack of finances (38.2%) and disappearance of symptoms (14.2%). Conclusions Adherence to anti-diabetic medication is poor in this study with more than half of participants being non-adherent. Urgent interventions are required to tackle this problem in combined efforts to stem this looming diabetes epidemic.

Association between urban-rural location and prevalence of type 2 diabetes and impaired fasting glucose in West Africa: a cross-sectional population-based epidemiological study

Article

Full-text available

Sep 2023

Objectives We investigated the association between urban/rural location and both type 2 diabetes mellitus (T2DM) and pre-diabetes among populations of five West African countries. Design Cross-sectional studies, using the WHO Stepwise (STEPs) survey data. Setting National representative data of both urban and rural areas from Benin, Burkina Faso, Ghana, Liberia and Mali. Participants Adults comprising 15 468 participants (6774 men and 8746 women; 7663 urban and 7805 rural residents) aged between 25 and 64 years. Results The age and sex-adjusted prevalence of T2DM was 6.2% for urban areas and 2.5% for rural areas. The prevalence of impaired fasting glucose (IFG) was 6.6% for urban areas, and 3.0% for rural areas. No differences by sex were observed. The crude relative risk (RR) and 95% CI of T2DM and IFG in urban compared with rural areas were 2.69 (1.85 to 3.91) and 2.37 (1.53 to 3.66), respectively. This reduced to RR: 2.03, 95% CI (1.34 to 3.08) and RR: 2.04, 95% CI (1.27 to 3.28), respectively, after adjusting for covariables. Conclusion The prevalence of both T2DM and IFG was more than two times as high in urban areas compared with rural areas in West Africa. Behavioural risk factors are common among urban populations, with ongoing urbanisation expected to drive increases in the prevalence of T2DM. These results could guide planning for T2DM screening, preventive strategies and resource allocation in West Africa.

Chronic Disease Comorbidities Among Injured Patients in Cameroon: A Retrospective Cohort Study

Article

Dec 2022
J SURG RES

Introduction Chronic diseases are increasing but underdiagnosed in low-income and middle-income countries (LMICs), where injury mortality is already disproportionately high. We estimated prevalence of known chronic disease comorbidities and their association with outcomes among injured patients in Cameroon. Materials and methods Injured patients aged ≥15 y presenting to four Cameroonian hospitals between October 2017 and January 2020 were included. Our explanatory variable was known chronic disease; prevalence was age-standardized. Outcomes were overall in-hospital mortality and admission or transfer from the emergency department (ED). Associations between known chronic disease and outcomes were evaluated using logistic regression adjusted for age, gender, estimated injury severity score (eISS), hospital, and household socioeconomic status. Unadjusted eISS-stratified and age-stratified outcomes were also compared via chi-squared tests. Results Of 7509 injured patients, 370 (4.9%) reported at least one known chronic disease; age-standardized prevalence was 8.4% (95% confidence interval [CI] 7.5%-9.2%). Patients with known chronic disease had higher mortality (4.6% versus 1.5%, adjusted odds ratio [aOR]: 2.61 [95% CI: 1.25-5.47], P = 0.011) and were more likely to be admitted or transferred from the ED (38.7% versus 19.8%, aOR: 1.40 [95% CI: 1.02-1.92], P = 0.038) compared to those without known comorbidities. Crude differences in mortality (11.3% versus 3.3%, P = 0.002) and hospital admission or transfer (63.8% versus 46.6%, P = 0.011) were most notable for patients with eISS 16-24. Conclusions Despite underdiagnosis among Cameroonians, we demonstrated worse injury outcomes among those with known chronic diseases. Integrating chronic disease screening with injury care may help address underdiagnosis in Cameroon. Future work should assess whether chronic disease prevention in LMICs could improve injury outcomes.

Prevalence of chronic non-communicable diseases in Ethiopia: A systematic review and meta-analysis of evidence

Article

Full-text available

Aug 2022

Background Non-communicable diseases (NCDs) are a growing global health challenge disproportionately impacting low- and middle-income settings, including Ethiopia. Currently, the body of evidence describing the burden of NCDs is fragmented, inconsistent, health facility- or institution-based, and out-dated in Ethiopia. We conducted a systematic review of the literature and meta-analysis of the prevalence of NCDs in community settings in Ethiopia. Review methodology Community-based quantitative studies published in English between January 1st, 2012, and June 30th, 2022, that reported on the prevalence of NCDs in Ethiopia were included. A systematic search of Medline, Embase, Scopus, CINAHL, and Global Health using pretested search terms related to NCDs was conducted, and data were extracted using a piloted data extraction proforma adapted from the Joanna Briggs Institute tool. Meta-analysis was performed using Stata 16. While the pooled prevalence of Diabetes Mellitus (DM) and undiagnosed (DM) was computed and presented using forest plots, then overall prevalence of NCDs and other various types of NCDs were narratively synthesized. I ² was used to assess heterogeneity. Studies that did not fulfill the criteria (used similar tool to measure the types of NCDs) for meta-analysis were narratively synthesized. Results Twenty-two studies met the inclusion criteria. Five studies measured the prevalence of NCDs (all NCDs together), ranging from 29 to 35% (prevalence estimates not pooled). The pooled prevalence of Diabetes Mellitus (DM) across ten studies was 5% (95% CI: 4–7%). Three studies each reported on the prevalence of undiagnosed DM (pooled prevalence 5%, 95% CI: 4–7%) and pre-DM (pooled prevalence 7%, 95% CI: 3–14%%). In a narrative analysis the prevalence of cardiovascular conditions ranged from 13.4 to 32.2% ( n = 3 studies), cancer mortality ranged from 4 to 18% ( n = 3 studies) and respiratory conditions ranged from 1 to 18% ( n = 3 studies). Some studies have determined more than one NCDs and that is why the total number of studies are exceeding more than twenty studies. Conclusion and recommendations Our analysis found that approximately one-third of Ethiopians have an NCD, with cardiovascular diseases the most common of all NCDs. The prevalence of respiratory conditions also appears high, but there are insufficient data for a pooled estimate. Whilst the prevalence of DM appears relatively low, there is evidence that the magnitude is increasing. Public health actions to address the high burden of cardiovascular and respiratory diseases, as well as the increasing magnitude of DM in Ethiopia, must be prioritized. Systematic review registration PROSPERO [CRD42020196815].

Combining HbA1c and glycated albumin improves detection of dysglycaemia in mixed-ancestry South Africans

Article

May 2022

Background Combining HbA1c with glycated albumin (GA) may improve detection of dysglycaemia. As BMI correlates positively with HbA1c and negatively with GA, HbA1c may be more effective in obese and GA in nonobese individuals. Methods To relate these findings to Africans, we assessed in 1274 South Africans living in CapeTown (male 26%; age 48±16y; BMI 28.7 kg/m² (range 15.6–73.8); obesity 39.9% and no prior diabetes history) the: (1) correlation of BMI with HbA1c and GA, (2) ability of HbA1c and GA separately and jointly, to detect OGTT-diagnosed dysglycaemia (diabetes plus prediabetes). Data collection took place between 2014 and 2016 in the City of Cape Town. Dysglycaemia was diagnosed by glucose criteria for the OGTT. Youden index was used to optimize diagnostic thresholds for HbA1c and GA. Findings Normal glucose tolerance, prediabetes and diabetes occurred in 76%, 17% and 7%, respectively. BMI positively correlated with HbA1c [r = 0·34 [95%CI: 0·29,0·39)] and negatively with GA [-0·08 (0·13,0·03)]. For HbA1c the optimal threshold by Youden-index for dysglycaemia diagnosis was: 6·0% (95%CI: 5·8,6·2) and for GA: 13·44% (12·72,14·71). In the nonobese, obese and total cohort, HbA1c-alone detected: 51% (42–60), 72% (65,78), 63% (57,68), respectively; GA-alone detected 55% (52% (46,63), 52% (44, 59) and 53% (47,53), respectively; whereas: HbA1c+GA detected: 69% (60,76), 82% (75,87) and 76% (71, 81). Therefore, for the total cohort detection of dysglycaemia HbA1c-alone vs HbA1c+GA detected 63% (57,68) vs 76% (71,81). Interpretation The opposite correlations of HbA1c and GA with BMI have now been demonstrated in an African-based population. Improving detection of dysglycaemia by combining HbA1c and GA has important implications for diabetes risk screening. Funding AES is supported by the intramural programs of the National Institute of Diabetes and Digestive and Kidney Diseases and the National Institute of Minority Health and Health Disparities of the National Institutes of Health (NIH, Bethesda, Maryland, USA). DBS is supported by the intramural program of the Clinical Center of NIH. The South African Medical Research Council (SAMRC) funded the VMH study with funds from the National Treasury under its Economic Competitiveness and Support Package (MRC-RFA-UFSP-01–2013/VMH Study).

Association between Urban-Rural Location and the Prevalence of Both T2DM and IFG Among West African Populations

Article

Jan 2021

Background: In Africa, epidemiological data on type 2 diabetes (T2DM) and impaired fasting glucose (IFG) is incomplete, especially in relation to the influence of rapid urbanisation on risk of disease. We investigated the association between urban/rural location and both T2DM and prediabetes among West African populations from five countries. Methods: This study used WHO STEPs surveys comprising 15,468 participants (6,774 men and 8,746 women; 7,663 urban and 7,805 rural residents) with data from Benin, Burkina Faso, Ghana, Liberia, and Mali. χ 2 tests were used for comparisons of percentages. Multinomial Logistic regression was used to calculate the relative risk (RR) and 95% confidence intervals (CIs) of T2DM and IFG in urban and rural dwellers, adjusting for age, sex, education, and profession. Results: The age and sex-adjusted prevalence of T2DM was 6.2% for urban areas and 2.5% for rural areas. The prevalence of IFG was 6.6% for urban areas, and 3.0% for rural areas. No differences by sex were observed. The crude RR and 95% CI of T2DM and IFG in urban compared with rural areas were 2.69 (1.85, 3.91) and 2.37 (1.53, 3.66) respectively. This reduced to RR: 2.03, 95% CI: (1.34, 3.08) and RR: 2.04, 95% CI: (1.27, 3.28) respectively after adjusting for covariables. Interpretation: Behavioural risk factors are common among urban populations, with ongoing urbanisation expected to drive increases in the prevalence of T2DM. These results could guide planning for T2DM screening, preventive strategies, and resource allocations in West Africa. Funding: Australian Government through the Higher Degree Research Program Award. Declaration of Interest: The authors declare no conflict of interest. Ethical Approval: Each country obtained ethical approval from a local ethics committee, and informed consent was obtained from each participant.

Transcutaneous auricular vagus nerve stimulation for impaired glucose tolerance: A randomized controlled trial protocol

Article

Apr 2021

Background Impaired glucose tolerance (IGT) is the early stage of diabetes and it would be deteriorated to type 2 diabetes mellitus (T2DM) easily if no intervention provided. In western medicine, drug therapy assisted with the intervention of lifestyle is predominated. However, drug therapy brings serious side effect and high prices, while lifestyle intervention is difficult to be insisted on by patients. Therefore, a green and effective intervention mode is urgently needed. Transcutaneous auricular vagus nerve stimulation (taVNS) is a noninvasive and green therapeutic method based on the theory of traditional Chinese medicine (TCM), which can regulate glucose metabolism and reduce blood glucose, but the clinical effect of it has not been clarified yet at present. Hence, this randomized controlled trial (RCT) aims at exploring the effectiveness and safety of taVNS in the treatment of IGT. Methods A total of 158 patients with IGT will be randomized into a taVNS group and a transcutaneous non-auricular vagus nerve stimulation (tnVNS) group, 79 cases in each one. In the taVNS group and the tnVNS group, electric stimulation would be applied to Yídăn (胰胆pancreas and gallbladder, CO11) and Pǐ (脾spleen, CO13) on auricular concha and Jiān (肩shoulder SF4,5) on auricular rim respectively. The electric stimulation parameters would be the same in the patients of two groups, for 30 min in each treatment, twice a day, 6 weeks as one course and 2 courses of treatment required totally. In week 0, 6 and 12 of intervention, the effectiveness indicators would be determined, i.e. fasting plasma glucose (FPG), 2-hour plasma glucose (2hPG) and glycosylated hemoglobin (HbA1c) successively. On week 0 and 12, body mass index (BMI) would be calculated, respiration, pulse and blood pressure would be recorded separately. Discussion Through observing the regulatory effect of taVNS on FPG, 2hPG, HbA1c and BMI as well as the adverse reactions, the effectiveness and safety of taVNS in treatment of IGT would be evaluated. This study will provide a safe, effective, convenient and non-toxic side effect intervention for clinical treatment of IGT and prevention from the occurrence and development of T2DM. Trial registration: 该临床试验已在http://register.clinicaltrials.gov完成注册, 临床注册号:ClinicalTrials.gov NCT03343262. Trial registration: This trial has been registered on http://register.clinicaltrials.gov. Clinical Registration Number: ClinicalTrials.gov NCT03343262.

Prevalence of diabetes and pre-diabetes in Bangladesh: a systematic review and meta-analysis

Article

Full-text available

Sep 2020

Objective: The purpose of this paper is to perform a systematic review and meta-analysis in order to summarise the prevalence of diabetes and pre-diabetes and their associated risk factors in Bangladesh. Design: Systematic review and meta-analysis. Participants: General population of Bangladesh. Data sources: PubMed, Medline, Embase, Bangladesh Journals Online, Science Direct, Scopus, Cochrane Library and Web of Science were used to search for studies, published between 1st of January 1995 and 31st of August 2019, on the prevalence of diabetes and pre-diabetes and their associated risk factors in Bangladesh. Only articles published in the English language articles were considered. Two authors independently selected studies. The quality of the articles was also assessed. Results: Out of 996 potentially relevant studies, 26 population-based studies, which together involved a total of 80 775 individuals, were included in the meta-analysis. The pooled prevalence of diabetes in the general population was 7.8% (95% CI: 6.4-9.3). In a sample of 56 452 individuals, the pooled prevalence of pre-diabetes was 10.1% (95% CI: 6.7-14.0; 17 studies). The univariable meta-regression analyses showed that the prevalence of diabetes is associated with the factors: the year of study, age of patients and presence of hypertension. The prevalence of diabetes was significantly higher in urban areas compared with rural areas, while there was no significant gender difference. Conclusions: This meta-analysis suggests a relatively high prevalence of pre-diabetes and diabetes in Bangladesh, with a significant difference between rural and urban areas. The main factors of diabetes include urbanisation, increasing age, hypertension and time period. Further research is needed to identify strategies for early detecting, prevention and treatment of people with diabetes in the population. Prospero registration number: CRD42019148205.

Chronic Kidney Disease in Cameroon: A scoping review

Preprint

Full-text available

Jun 2020

Objectives This scoping review sought to summarize available data on the prevalence, associated factors, etiology, comorbidities, treatment, cost, and mortality of chronic kidney disease (CKD) in Cameroon. Methods We searched PubMed, Scopus and African Journals Online from database inception to 31 March, 2020 to identify all studies published on the prevalence, associated factors, etiology, comorbidities, treatment, cost and mortality of CKD in Cameroon. Results Thirty studies were included. The population prevalence of CKD varied from 3-14.1% and 10.0%-14.2% in rural and urban areas, respectively. The prevalence of CKD in patients with hypertension, diabetes mellitus, and human immunodeficiency virus was 12.4-50.0%, 18.5%, and 3.0-47.2%, respectively. Hypertension (22.3-59.1%), chronic glomerulonephritis (15.8-56.2%), and diabetes mellitus (15.8-56.2%) were the most common causes of CKD. The cause was unknown in 13.5-17.0% of the cases. Advanced age, hypertension, diabetes mellitus, and obesity were frequent associated factors. Hemodialysis was the main treatment modality in patients with End Stage Renal Disease (ESRD). The monthly cost of management of non-dialyzed CKD was 163 US dollars. The one-year mortality rate of ESRD was 26.8-38.6%. Conclusion Chronic kidney disease in affects about one in ten adults in the general population in Cameroon Patients with hypertension, diabetes mellitus, and human immunodeficiency virus bear the greatest burden of CKD in Cameroon. Advanced age, hypertension, diabetes mellitus, and obesity are major factors associated with CKD. Chronic kidney disease in Cameroon is associated with high morbidity and mortality and huge economic cost on the patient.

Understanding prediabetes: definition, prevalence, burden and treatment options for an emerging disease

Article

Apr 2019

Prediabetes is defined as a state of abnormal glucose homeostasis where blood glucose levels are elevated above those considered normal, but not as high as those required for a diagnosis of diabetes. As a condition intermediate between normal glucose homeostasis and the pathological condition of diabetes, the characterization of prediabetes as a distinct pathogenic condition is controversial. Emerging evidence suggests that the condition of prediabetes is associated with pathophysiological changes in several tissues and organs, which would support its recognition as a distinct pathological entity; the recent inclusion of prediabetes and associated billable conditions in the most recent ICD-10 codes provides additional credence to this position. This minireview summarizes our understanding of prediabetes and provides evidence that it should be considered a distinct and important clinical entity.

A Community-Based Assessment of Hypertension and Some Other Cardiovascular Disease Risk Factors in Ngaoundéré, Cameroon

Article

Full-text available

Jan 2016

Background and Objective. Cardiovascular diseases are primary causes of death worldwide with well documented risk factors whose varying impacts added to the complexity in CVD management dictate the need for region-specific studies. We aimed at investigating the interactions between CVD risk factors and hypertension in Ngaoundéré. Methods. A cross-sectional survey was carried out from March to August 2014. Sociodemographic, fasting blood glucose, blood pressure, and anthropometric data were recorded. Statistical analyses were carried out using SAS software version 9.1. Results. 700 adults resident in Ngaoundéré for at least two years consented and were included in the survey. Abdominal obesity, physical inactivity, and hypertension were the dominant risk factors recording 51.1%, 35.4%, and 20.4%, respectively. The prevalence of hyperglycaemia, tobacco consumption, obesity, and alcohol consumption was 5.6%, 8.3%, 9.6%, and 18.1%, respectively. Advanced age, hyperglycaemia, a divorced marital status, and alcohol consumption were independent determinants of high blood pressure. Conclusion. Physical inactivity, abdominal obesity, and hypertension were the most prevalent CVD risk factors, and the role of advanced age and hyperglycaemia in the occurrence of high blood pressure was reiterated. Health programs need to focus on effective screening, prevention, and control of CVDs in the Adamawa Region and Cameroon at large.

Distribution and patterning of non-communicable disease risk factors in indigenous Mbororo and non-autochthonous populations in Cameroon: cross sectional study

Article

Full-text available

Nov 2016
BMC PUBLIC HEALTH

Background Data on Non-Communicable Diseases (NCDs) among indigenous populations are needed for interventions to improve health care. We conducted a survey in 2013 among rural indigenous Mbororo, Fulbe and other ethnic groups to determine the distribution of risk factors of NCDs in Cameroon. Methods We selected seven targets of NCD risk factors: tobacco use, alcohol use, diet (salt/sugar intake, vegetable/fruit consumption), raised blood pressure, raised blood glucose, physical inactivity and weight measures. The WHO STEPwise approach was used to collect data from 1921 consenting participants aged ≥20 years. Prevalence of NCD risk factors was summarised by descriptive statistics. Results Underweight was widespread, Mbororo (50.8%) and Fulbe (37.2%). Increase in prevalence of six risk factors was observed among the Fulbe when compared to Mbororo. Participants aged 20–39 years had low levels of physical activity, poor diet and higher levels of alcohol consumption (except Mbororo) and those aged ≥40 years had higher prevalence of diabetes, hypertension, current smoking and overweight/obesity. Men and women differed in current smoking, occasional/daily alcohol consumption, pre-hypertension and hypertension, continuous walking for at least ten minutes, and weight measures for Fulbe and Mbororo, p < 0.05. Conclusion Distribution of NCD risk factors was high among settled Fulani (Fulbe) when compared to indigenous nomadic Fulani (Mbororo). Change from nomadic to settled life might be accompanied by higher prevalence of NCDs. This data should be used to develop intervention programmes to curb the rising burden of NCDs in rural indigenous and non-indigenous populations.

Urban and rural prevalence of diabetes and pre-diabetes and risk factors associated with diabetes in Tanzania and Uganda

Article

Full-text available

May 2016

Background The increase in prevalence of diabetes and pre-diabetes in sub-Saharan Africa underlines the importance of understanding its magnitude and causes in different population groups. We analyzed data from the Africa/Harvard Partnership for Cohort Research and Training (PaCT) studies to determine the prevalence of diabetes and pre-diabetes and risk factors associated with diabetes. Methodology Participants were randomly selected from peri-urban (n=297) and rural (n=200) communities in Uganda, and teachers were recruited from schools (n=229) in urban Tanzania. We used a standardized questionnaire to collect socio-demographic and self-reported disease status including diabetes status. Blood glucose was also measured after participants fasted for 8 h. We used standard protocols for anthropometric and blood pressure measurement. Results The overall prevalence of diabetes was 10.1% and was highest in rural Ugandan residents (16.1%) compared to teachers in Tanzania (8.3%) and peri-urban Ugandan residents (7.6%). The prevalence of pre-diabetes was 13.8%. The prevalence of self-reported diabetes was low across all sites, where 68% of participants with diabetes were not captured by self-report. In multivariable logistic regression analysis, family history (OR 2.5, 95% CI: 1.1, 5.6) and hypertension (OR 2.3, 95% CI: 1.1, 5.2) were significantly associated with diabetes. Conclusions The prevalence of diabetes and pre-diabetes in Uganda and Tanzania is high, differs markedly between population groups, and remains undiagnosed in an alarmingly high proportion of individuals. These findings highlight the need for large-scale, prospective studies to accurately quantify the burden and identify effective intervention and treatment strategies across diverse African populations.

Epidemiologiy of obesity among university students in Douala, Cameroon

Article

Full-text available

Dec 2015

PURPOSE: To determine the prevalence of obesity, its risk factors, and its health risks among students of the University of Douala. METHODS: In April, 2011, 2696 students volunteered to participate in a screening campaign for diabetes, high blood pressure (HBP), and obesity. Their physical activity (PA) level was also evaluated. RESULTS: The sample consisted of 1276 (47.3%) men and 1420 (52.7%) women with a mean age of 23.8 ± 3.5 years. The general prevalence of obesity was 4.1%, and it was more common among women (p = 0.043). The age group most highly affected was those 35 years or older, with a prevalence of 39.5% (p<0.02). Among the obese, the risk level was high in 78 (70.9%) women. The prevalence of HBP was higher among obese than non-obese students (20.9% vs. 12.5%, p = 0.019), and the prevalence of diabetes five times higher (4.5% vs. 0.8%, p = 0.003). Obesity was highly associated with alcohol consumption (p = 0.01), physical inactivity (p = 0.007), and family history of diabetes (p = 0.008). CONCLUSION: Obesity is a worrisome disorder among students in Douala. Educating students about this topic and developing an obesity prevention and management program may improve their health.

Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement

Article

Full-text available

Jan 2014

Systematic reviews should build on a protocol that describes the rationale, hypothesis, and planned methods of the review; few reviews report whether a protocol exists. Detailed, well-described protocols can facilitate the understanding and appraisal of the review methods, as well as the detection of modifications to methods and selective reporting in completed reviews. We describe the development of a reporting guideline, the Preferred Reporting Items for Systematic reviews and Meta-Analyses for Protocols 2015 (PRISMA-P 2015). PRISMA-P consists of a 17-item checklist intended to facilitate the preparation and reporting of a robust protocol for the systematic review. Funders and those commissioning reviews might consider mandating the use of the checklist to facilitate the submission of relevant protocol information in funding applications. Similarly, peer reviewers and editors can use the guidance to gauge the completeness and transparency of a systematic review protocol submitted for publication in a journal or other medium.

Research methods and reporting. preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement

Article

Full-text available

Jul 2009
PLOS MED

Systematic reviews and meta-analyses have become increasingly important in health care. Clinicians read them to keep up to date with their field [1],[2], and they are often used as a starting point for developing clinical practice guidelines. Granting agencies may require a systematic review to ensure there is justification for further research [3], and some health care journals are moving in this direction [4]. As with all research, the value of a systematic review depends on what was done, what was found, and the clarity of reporting. As with other publications, the reporting quality of systematic reviews varies, limiting readers' ability to assess the strengths and weaknesses of those reviews. Several early studies evaluated the quality of review reports. In 1987, Mulrow examined 50 review articles published in four leading medical journals in 1985 and 1986 and found that none met all eight explicit scientific criteria, such as a quality assessment of included studies [5]. In 1987, Sacks and colleagues [6] evaluated the adequacy of reporting of 83 meta-analyses on 23 characteristics in six domains. Reporting was generally poor; between one and 14 characteristics were adequately reported (mean = 7.7; standard deviation = 2.7). A 1996 update of this study found little improvement [7]. In 1996, to address the suboptimal reporting of meta-analyses, an international group developed a guidance called the QUOROM Statement (QUality Of Reporting Of Meta-analyses), which focused on the reporting of meta-analyses of randomized controlled trials [8]. In this article, we summarize a revision of these guidelines, renamed PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses), which have been updated to address several conceptual and practical advances in the science of systematic reviews (Box 1). Box 1: Conceptual Issues in the Evolution from QUOROM to PRISMA Completing a Systematic Review Is an Iterative Process The conduct of a systematic review depends heavily on the scope and quality of included studies: thus systematic reviewers may need to modify their original review protocol during its conduct. Any systematic review reporting guideline should recommend that such changes can be reported and explained without suggesting that they are inappropriate. The PRISMA Statement (Items 5, 11, 16, and 23) acknowledges this iterative process. Aside from Cochrane reviews, all of which should have a protocol, only about 10% of systematic reviewers report working from a protocol [22]. Without a protocol that is publicly accessible, it is difficult to judge between appropriate and inappropriate modifications.

Prevalence and determinants of chronic kidney disease in rural and urban Cameroonians: A cross-sectional study

Article

Full-text available

Jul 2015
BMC Nephrol

Chronic kidney disease (CKD) is a global public health problem that disproportionally affects people of African ethnicity. We assessed the prevalence and determinants of CKD and albuminuria in urban and rural adults Cameroonians. This was a cross-sectional study of 6-month duration (February to July 2014), conducted in the health district of Dschang (Western Region of Cameroon), using a multistage cluster sampling. All adults diagnosed with albuminuria (≥30 mg/g) and/or decreased estimated glomerular filtration rate (eGFR) (<60 ml/min/1.73 m(2)) were re-examined three months later. Logistic regression models were used to relate baseline characteristics with prevalent CKD. We included 439 participants with a mean age of 47 ± 16.1 years; with 185 (42.1 %) being men and 119 (27.1 %) being urban dwellers. There was a high prevalence of hypertension (25.5 %), diabetes (9.8 %), smoking (9.3 %), alcohol consumption (59.7 %), longstanding use of herbal medicine (90.9 %) and street medications (87.5 %), and overweight/obesity (53.3 %) which were predominant in rural area. The prevalence of CKD was 13.2 % overall, 14.1 % in rural and 10.9 % in urban participants. Equivalents figures for CKD stages G3-G4 and albuminuria were 2.5 %, 1.6 % and 5.0 %; and 12.1 %, 14.1 % and 6.7 % respectively. Existing hypertension and diabetes were associated with all outcomes. Elevated systolic blood pressure and the presence of hypertension and diabetes were the predictors of albuminuria and CKD while urban residence was associated with CKD stages G3-G4. The prevalence of CKD and albuminuria was high in this population, predominantly in rural area, and driven mostly by the commonest risk factors.

Early Detection and Treatment of Type 2 Diabetes Reduce Cardiovascular Morbidity and Mortality: A Simulation of the Results of the Anglo-Danish-Dutch Study of Intensive Treatment in People With Screen-Detected Diabetes in Primary Care (ADDITION-Europe)

Article

Full-text available

May 2015

To estimate the benefits of screening and early treatment of type 2 diabetes compared with no screening and late treatment using a simulation model with data from the ADDITION-Europe study. We used the Michigan Model, a validated computer simulation model, and data from the ADDITION-Europe study to estimate the absolute risk of cardiovascular outcomes and the relative risk reduction associated with screening and intensive treatment, screening and routine treatment, and no screening with a 3- or 6-year delay in the diagnosis and routine treatment of diabetes and cardiovascular risk factors. When the computer simulation model was programmed with the baseline demographic and clinical characteristics of the ADDITION-Europe population, it accurately predicted the empiric results of the trial. The simulated absolute risk reduction and relative risk reduction were substantially greater at 5 years with screening, early diagnosis, and routine treatment compared with scenarios in which there was a 3-year (3.3% absolute risk reduction [ARR], 29% relative risk reduction [RRR]) or a 6-year (4.9% ARR, 38% RRR) delay in diagnosis and routine treatment of diabetes and cardiovascular risk factors. Major benefits are likely to accrue from the early diagnosis and treatment of glycemia and cardiovascular risk factors in type 2 diabetes. The intensity of glucose, blood pressure, and cholesterol treatment after diagnosis is less important than the time of its initiation. Screening for type 2 diabetes to reduce the lead time between diabetes onset and clinical diagnosis and to allow for prompt multifactorial treatment is warranted. © 2015 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered.

Obesity phenotypes in urban and rural Cameroonians: A cross-sectional study

Article

Full-text available

Dec 2015

Despite the increasing prevalence of diabetes and other health consequences of obesity, little is known on the metabolic profile across categories of body mass index (BMI) among African populations. We therefore assessed the prevalence and distribution of body size phenotypes among urban and rural Cameroonians. Adults (n = 1628; 41% rural dwellers) aged 24-74 years in 1994 provided data on BMI and metabolic health, defined on the basis of elevated levels of blood pressure (BP); triglycerides, fasting plasma glucose (FPG), and insulin resistance as assessed with homeostasis model assessment (HOMA). Cross-classification of BMI categories and metabolic status (healthy/unhealthy) created six groups. Metabolic measures include elevated blood pressure; elevated triglycerides (≥150 mg/dL or 1.69mmo/L), elevated fasting plasma glucose (≥100 mg/dl or 5.6 mmol/L or documented use of antidiabetic medications), and elevated homeostasis model assessment of insulin resistance value (HOMA-IR > 90(th) percentile). A total of 25.2% of participants were overweight yet metabolically healthy (<1 abnormality) and 10.1% were obese yet metabolically healthy, whereas 1.4% were normal weight but metabolically abnormal (≥2 abnormalities). Proportion of rural dwellers with abnormal metabolic phenotype across normal-weight, overweight, obese categories were 2.9%, 0.8% and 0.3%, respectively; and 0 .3%, 2.2% and 2.6% among urban dwellers. Metabolically abnormal participants increased linearly across BMI categories (p < 0.001). BMI categories and metabolic status interacted to affect age, gender, BMI, FPG, triglycerides, and BP status distributions (all p < 0.04). Metabolic status and residence (rural vs. urban) interacted to influence the distribution across BMI categories of diastolic BP, BMI, waist circumference, fasting and 2-hour glucose, triglycerides, HOMA-IR, and prevalent diabetes (all p < 0.005), with differential occurrence of BMI categories and metabolic status among urban and rural participants. Metabolic healthy obesity and obesity with a favorable cardiometabolic profile are not uncommon among Cameroonians, including among rural dwellers; but the latter group tended to have a better profile.

Risk factors of impaired fasting glucose and type 2 diabetes in Yaoundé, Cameroon: A cross sectional study

Article

Full-text available

Jan 2015
BMC PUBLIC HEALTH

Background The prevalence of diabetes is increasing worldwide, particularly in low and middle income countries, where treatment and control are often unavailable and inaccessible. Information on risk factors at local and regional levels is of utmost importance for tailored prevention programmes to curb the rise in diabetes.The current study was undertaken to investigate the prevalence of Impaired Fasting Glucose (IFG)/Type 2 Diabetes (T2D) and its risk factors in the adult population in Biyem-Assi-Yaoundé, Cameroon.Methods Information on cardiovascular risk factors using the WHO STEPwise approach was obtained for 1623 men and women aged 25 years and older of the CAMBoD Project in Biyem-Assi, Yaoundé, Cameroon. T2D was defined as fasting capillary glucose (FCG)¿¿¿7.0 mmol/l and/or being on diabetes medication, IFG/T2D as FCG¿¿¿6.1 mmol/l and/or being on diabetes medication. Descriptive statistics and multivariate logistic regression analyses were used to describe prevalence of IFG/T2D, prevalence of risk factors for IFG/T2D and to investigate the association of risk factors with prevalence of IFG/T2D.ResultsPrevalence of T2D and of IFG/T2D was 3.3% and 5.7%. Prevalence of hypertension, obesity and abdominal obesity (elevated waist circumference) was 26.6%, 28.4% and 34.9%, respectively. Age and abdominal obesity were significantly associated with IFG/T2D in multivariate logistic regression.Conclusion For successful primary prevention of T2D in the general population in Cameroon tailored efforts to address obesity, particularly abdominal obesity, and associated life-style factors are warranted.

P22 Coincidence of diabetes mellitus and hypertension in a semi-urban Cameroonian population

Article

Full-text available

Jul 2014
BMC PUBLIC HEALTH

Background Hypertension and diabetes mellitus are increasingly common in population within Africa. We determined the rate of coincident diabetes and hypertension and assessed the levels of co-awareness, treatment and control in a semi-urban population in Cameroon. Methods A total of 1702 adults (967 women) self-selected from the community were consecutively recruited in Bafoussam (West region of Cameroon) during November 2012. Existing diabetes and hypertension and treatments were investigated and blood pressure and fasting blood glucose measured. Multinomial logistic regressions models were used to investigate the determinants of prevalent diabetes and hypertension. Results Age-standardized prevalence rates (95% confidence intervals) men vs. women were 40.4% (34.7 to 46.1) and 23.8% (20.4 to 27.2) for hypertension alone; 3.3% (1.5 to 5.1) and 5.6% (3.5 to 7.7) for diabetes alone; and 3.9% (2.6 to 5.2) and 5.0% (3.5 to 6.5) for hypertension and diabetes. The age-standardized awareness, treatment and control rates for hypertension alone were 6.5%, 86.4% and 37.2% for men, and 24.3%, 52.1% and 51.6% in women. Equivalent figures for diabetes alone were 35.4%, 65.6% and 23.1% in men and 26.4%, 75.5% and 33.7% in women; and those for hypertension and diabetes were 86.6%, 3.3% and 0% in men, and 74.7%, 22.6% and 0% in women. Sex, age and adiposity were the main determinants of the three conditions. Conclusions Coincident diabetes and hypertension is as high as diabetes alone in this population, driven by sex, age and adiposity. Awareness, treatment and control remain unacceptably low.

Prevalence and correlates of diabetes mellitus in Malawi: Population-based national NCD STEPS survey

Article

Full-text available

May 2014
BMC Endocr Disord

Background Previously considered as a disease of the affluent, west or urban people and not of public health importance, diabetes mellitus is increasingly becoming a significant cause of morbidity and mortality in sub-Saharan Africa. However, population-based data to inform prevention, treatment and control are lacking. Methods Using the WHO STEPwise approach to chronic disease risk factor surveillance, a population-based, nationwide cross-sectional survey was conducted between July and September 2009 on participants aged 25–64 years. A multi-stage cluster sample design and weighting were used to produce a national representative data for that age range. Detailed findings on the magnitude of diabetes mellitus and impaired fasting blood glucose are presented in this paper. Results Fasting blood glucose measurement was conducted on 3056 participants (70.2% females, 87.9% from rural areas). The age- sex standardised population-based mean fasting blood glucose was 4.3 mmol/L (95% CI 4.1-4.4 mmol/L) with no significant differences by age, sex and location (urban/rural). The overall prevalence of impaired fasting blood glucose was 4.2% (95% CI 3.0%-5.4%). Prevalence of impaired blood glucose was higher in men than in women, 5.7% (95% CI 3.9%-7.5%) vs 2.7% (95% CI 1.6%- 3.8%), p < 0.01. In both men and women, prevalence of raised fasting blood glucose or currently on medication for diabetes was 5.6% (95% CI 2.6%- 8.5%). Although the prevalence of diabetes was higher in men than women, 6.5% (95% CI 2.6%-10.3%) vs 4.7% (95% CI 2.4%-7.0%), in rural than urban, 5.4% (95% CI 2.4%-8.4%) vs 4.4% (95% CI 2.8%-5.9%) and in males in rural than males in urban, 6.9% (95% CI 2.8%-11.0%) vs 3.2% (95% CI 0.1%-6.3%), the differences were not statistically significant, p > 0.05. Compared to previous estimates, prevalence of diabetes increased from <1.0% in 1960s to 5.6% in 2009 (this study). Conclusion High prevalence of impaired fasting blood glucose and diabetes mellitus call for the implementation of primary healthcare approaches such as the WHO package for essential non-communicable diseases to promote healthy lifestyles, early detection, treatment and control.

Meta-analysis of prevalence

Article

Full-text available

Aug 2013
J EPIDEMIOL COMMUN H

Meta-analysis is a method to obtain a weighted average of results from various studies. In addition to pooling effect sizes, meta-analysis can also be used to estimate disease frequencies, such as incidence and prevalence. In this article we present methods for the meta-analysis of prevalence. We discuss the logit and double arcsine transformations to stabilise the variance. We note the special situation of multiple category prevalence, and propose solutions to the problems that arise. We describe the implementation of these methods in the MetaXL software, and present a simulation study and the example of multiple sclerosis from the Global Burden of Disease 2010 project. We conclude that the double arcsine transformation is preferred over the logit, and that the MetaXL implementation of multiple category prevalence is an improvement in the methodology of the meta-analysis of prevalence.

Hypertension in Sub-Saharan Africa: Cross-Sectional Surveys in Four Rural and Urban Communities

Article

Full-text available

Mar 2012
PLOS ONE

Cardiovascular disease (CVD) is the leading cause of adult mortality in low-income countries but data on the prevalence of cardiovascular risk factors such as hypertension are scarce, especially in sub-Saharan Africa (SSA). This study aims to assess the prevalence of hypertension and determinants of blood pressure in four SSA populations in rural Nigeria and Kenya, and urban Namibia and Tanzania. We performed four cross-sectional household surveys in Kwara State, Nigeria; Nandi district, Kenya; Dar es Salaam, Tanzania and Greater Windhoek, Namibia, between 2009-2011. Representative population-based samples were drawn in Nigeria and Namibia. The Kenya and Tanzania study populations consisted of specific target groups. Within a final sample size of 5,500 households, 9,857 non-pregnant adults were eligible for analysis on hypertension. Of those, 7,568 respondents ≥ 18 years were included. The primary outcome measure was the prevalence of hypertension in each of the populations under study. The age-standardized prevalence of hypertension was 19.3% (95%CI:17.3-21.3) in rural Nigeria, 21.4% (19.8-23.0) in rural Kenya, 23.7% (21.3-26.2) in urban Tanzania, and 38.0% (35.9-40.1) in urban Namibia. In individuals with hypertension, the proportion of grade 2 (≥ 160/100 mmHg) or grade 3 hypertension (≥ 180/110 mmHg) ranged from 29.2% (Namibia) to 43.3% (Nigeria). Control of hypertension ranged from 2.6% in Kenya to 17.8% in Namibia. Obesity prevalence (BMI ≥ 30) ranged from 6.1% (Nigeria) to 17.4% (Tanzania) and together with age and gender, BMI independently predicted blood pressure level in all study populations. Diabetes prevalence ranged from 2.1% (Namibia) to 3.7% (Tanzania). Hypertension was the most frequently observed risk factor for CVD in both urban and rural communities in SSA and will contribute to the growing burden of CVD in SSA. Low levels of control of hypertension are alarming. Strengthening of health care systems in SSA to contain the emerging epidemic of CVD is urgently needed.

Bias in Meta-Analysis Detected by a Simple, Graphical Test

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Full-text available

Sep 1997

Objective: Funnel plots (plots of effect estimates against sample size) may be useful to detect bias in meta-analyses that were later contradicted by large trials. We examined whether a simple test of asymmetry of funnel plots predicts discordance of results when meta-analyses are compared to large trials, and we assessed the prevalence of bias in published meta-analyses. Design: Medline search to identify pairs consisting of a meta-analysis and a single large trial (concordance of results was assumed if effects were in the same direction and the meta-analytic estimate was within 30

Rural and urban differences in metabolic profiles in a Cameroonian population

Article

Full-text available

Nov 2011

The difference between modern lifestyle in urban areas and the traditional way of life in rural areas may affect the population's health in developing countries proportionally. In this study, we sought to describe and compare the metabolic (fasting blood sugar and lipid profile) profile in an urban and rural sample of a Cameroonian population, and study the association to anthropometric risk factors of obesity. 332 urban and 120 rural men and women originating from the Sanaga Maritime Department and living in the Littoral Region in Cameroon voluntarily participated in this study. In all participants, measurement of height, weight, waist circumference, hip circumference, blood pressure systolic (SBP) and blood pressure diastolic (DBP), resting heart rate (RHR), blood glucose and lipids was carried out using standard methods. Total body fat (BF%) was measured using bio-impedancemetry. Body mass index (BMI) and waist to hip ratio (WHR) were calculated. Low Density Lipoprotein-cholesterol (LDL-c) concentrations were calculated using the Friedwald formula. World Health Organization criteria were used to define high and low levels of blood pressure, metabolic and anthropometric factors. The highest blood pressure values were found in rural men. Concerning resting heart rate, only the youngest women's age group showed a significant difference between urban and rural areas (79 ± 14 bpm vs 88 ± 12 bpm, p = 0.04) respectively. As opposed to the general tendency in our population, blood glucose was higher in rural men and women compared to their urban counterparts in the older age group (6.00 ± 2.56 mmol/L vs 5.72 ± 2.72 mmol/L, p = 0.030; 5.77 ± 3.72 vs 5.08 ± 0.60, p = 0,887 respectively). Triglycerides (TG) were significantly higher in urban than rural men (1.23 ± 0.39 mmol/L vs 1.17 ± 0.64 mmol/L, p = 0.017). High Density Lipoprotein-cholesterol (HDL-c) levels were higher in rural compared to urban men (2.60 ± 0.10 35mmol/L vs 1.97 ± 1.14 mmol/L, p<0.001 respectively). However, total Cholesterol (TC) and LDL-c were significantly higher in urban than in rural men (p<0.001 and p = 0.005) and women (p<0.001 respectively. Diabetes' rate in this population was 6.6%. This rate was higher in the rural (8.3%) than in the urban area (6.0%). Age and RHR were significantly higher in diabetic women than in non-diabetics (p = 0.007; p = 0.032 respectively). In a multiple regression, age was an independent predictor of SBP, DBP and RHR in the entire population. Age predicted blood glucose in rural women only. BMI, WC and BF% were independent predictors of RHR in rural population, especially in men. WC and BF% predicted DBP in rural men only. Anthropometric parameters did not predict the lipid profile. Lipid profile was less atherogenic in rural than in urban area. The rural population was older than the urban one. Blood pressure and blood glucose were positively associated to age in men and women respectively; this could explain the higher prevalence of diabetes in rural than in urban area. The association of these metabolic variables to obesity indices is more frequent and important in urban than in rural area.

Urbanization, Physical Activity, and Metabolic Health in Sub-Saharan Africa

Article

Full-text available

Feb 2011

We examined the independent associations between objectively measured free-living physical activity energy expenditure (PAEE) and the metabolic syndrome in adults in rural and urban Cameroon. PAEE was measured in 552 rural and urban dwellers using combined heart rate and movement sensing over 7 continuous days. The metabolic syndrome was defined using the National Cholesterol Education Program-Adult Treatment Panel III criteria. Urban dwellers had a significantly lower PAEE than rural dwellers (44.2 ± 21.0 vs. 59.6 ± 23.7 kJ/kg/day, P < 0.001) and a higher prevalence of the metabolic syndrome (17.7 vs. 3.5%, P < 0.001). In multivariate regression models adjusted for possible confounders, each kJ/kg/day of PAEE was associated with a 2.1% lower risk of prevalent metabolic syndrome (odds ratio 0.98, P = 0.03). This implies a 6.5 kJ/kg/day difference in PAEE, equivalent to 30 min/day of brisk walking, corresponds to a 13.7% lower risk of prevalent metabolic syndrome. The population attributable fraction of prevalent metabolic syndrome due to being in the lowest quartile of PAEE was 26.3% (25.3% in women and 35.7% in men). Urban compared with rural residence is associated with lower PAEE and higher prevalence of metabolic syndrome. PAEE is strongly independently associated with prevalent metabolic syndrome in adult Cameroonians. Modest population-wide changes in PAEE may have significant benefits in terms of reducing the emerging burden of metabolic diseases in sub-Saharan Africa.

Nutrient intakes and dysglycaemia in populations of West African origin

Article

Full-text available

Jan 2011
BRIT J NUTR

Examining the relationship between glucose intolerance and dietary intake in genetically similar populations with different dietary patterns and rates of type 2 diabetes may provide important insights into the role of diet in the pathogenesis of this disease. The objective of the present study was to assess the relationship between dietary variables and dysglycaemia/type 2 diabetes among three populations of African origin. The study design consists of a cross-sectional study of men and women of African descent aged 24-74 years from Cameroon (n 1790), Jamaica (n 857) and Manchester, UK (n 258) who were not known to have diabetes. Each participant had anthropometric measurements and underwent a 2 h 75 g oral glucose tolerance test. Habitual dietary intake was estimated with quantitative FFQ, developed specifically for each country. The age-adjusted prevalence of undiagnosed type 2 diabetes in Cameroon was low (1·1 %), but it was higher in Jamaica (11·6 %) and the UK (12·6 %). Adjusted generalised linear and latent mixed models used to obtain OR indicated that each 1·0 % increment in energy from protein, total fat and saturated fats significantly increased the odds of type 2 diabetes by 9 (95 % CI 1·02, 1·16) %, 5 (95 % CI, 1·01, 1·08) % and 16 (95 % CI 1·08, 1·25) %, respectively. A 1 % increase in energy from carbohydrates and a 0·1 unit increment in the PUFA:SFA ratio were associated with significantly reduced odds of type 2 diabetes. The results show independent effects of dietary factors on hyperglycaemia in African origin populations. Whether modifying intake of specific macronutrients helps diabetes prevention needs testing in randomised trials.

Waist circumference and obesity-related abnormalities in French and Cameroonian adults: The role of urbanization and ethnicity

Article

Full-text available

Mar 2010
INT J OBESITY

To evaluate the effect of urbanization and ethnicity on correlations between waist circumference (WC) and obesity-related cardiovascular risk factors. 1471 rural and urban Cameroonians, and 4185 French, from community-based studies, aged > or =25 years, not treated for hypertension, diabetes and dyslipidemia participated in this study. Slopes of obesity-related abnormalities with WC were compared using an interaction term between place of residence and WC. Women in urban Cameroon and men in France had significantly higher WC and BMI relative to their gender counterparts. Urban Cameroonians had higher abdominal adiposity, but lower BP and better metabolic profile than the French. WC was positively associated to all the obesity-related abnormalities in the three sites except to FPG (both genders) and blood lipids (women) in rural Cameroon. A 5 cm larger WC was associated with a higher increment among urban than rural Cameroonians for diastolic blood pressure (DBP) (women, 1.95/0.63 mm Hg; men, 2.56/1.44 mm Hg), HOMA-IR (women, 0.11/0.05), fasting plasma glucose (FPG) (men, 0.09/-0.01 mmol/l) and triglycerides (women, 0.06/0.01 mmol/l; men, 0.09/0.03 mmol/l), all P<0.05. A 5 cm larger WC was associated with a higher increment among urban Cameroon than French people for DBP (women, 1.95/1.28 mm Hg, P<0.01; men, 2.56/1.49 mm Hg, P<0.01), but with a lower increment for HOMA-IR (women, 0.11/0.14, P<0.05), FPG (women, 0.05/0.09 mmol/l), total cholesterol (women, 0.07/0.11 mmol/l; men, 0.10/0.13 mmol/l) and triglycerides (women, 0.06/0.11 mmol/l; men, 0.09/0.13 mmol/l) all P<0.05. Ethnicity and urbanization modify the association of WC with obesity-related metabolic abnormalities. WC cutoff points derived from Caucasians may not be appropriate for black Sub-Saharan Africans.

Trim and Fill: A Simple Funnel-Plot-Based Method of Testing and Adjusting for Publication Bias in Meta-Analysis

Article

Full-text available

Jul 2000

We study recently developed nonparametric methods for estimating the number of missing studies that might exist in a meta-analysis and the effect that these studies might have had on its outcome. These are simple rank-based data augmentation techniques, which formalize the use of funnel plots. We show that they provide effective and relatively powerful tests for evaluating the existence of such publication bias. After adjusting for missing studies, we find that the point estimate of the overall effect size is approximately correct and coverage of the effect size confidence intervals is substantially improved, in many cases recovering the nominal confidence levels entirely. We illustrate the trim and fill method on existing meta-analyses of studies in clinical trials and psychometrics.

Physical activity and it relationship with obesity. Hypertension and diabetes in urban and rural Cameroon

Article

Full-text available

Jul 2002

To evaluate and compare physical activity patterns of urban and rural dwellers in Cameroon, and study their relationship with obesity, diabetes and hypertension. We studied 2465 subjects aged >or=15 y, recruited on the basis of a random sampling of households, of whom 1183 were urban dwellers from Yaoundé, the capital city of Cameroon and 1282 rural subjects from Bafut, a village of western Cameroon. They all had an interviewer-administered questionnaire for the assessment of their physical activity and anthropometric measurements, blood pressure and fasting blood glucose determination. The procedure was satisfactorily completed in 2325 (94.3%) subjects. Prevalences were age-adjusted and subjects compared according to their region, sex and age group. Obesity was diagnosed in 17.1 and 3.0% urban and rural women, respectively (P<0.001), and in 5.4 vs 1.2% urban and rural men, respectively (P<0.001). The prevalence of hypertension was significantly higher in urban vs rural dwellers (11.4 vs 6.6% and 17.6 vs 9.1% in women and men, respectively; P<0.001). Diabetes was more prevalent in urban compared to rural women (P<0.05), but not men. Urban subjects were characterized by lower physical activity (P<0.001), light occupation, high prevalence of multiple occupations, and reduced walking and cycling time compared to rural subjects. Univariate analysis showed significant associations between both physical inactivity and obesity and high blood pressure. The relationship of physical inactivity with hypertension and obesity were independent in both urban and rural men, but not in women. Body mass index, blood pressure and glycaemia were higher in the first compared with the fourth quartiles of energy expenditure. Obesity, diabetes and hypertension prevalence is higher in urban compared to rural dwellers in the populations studied. Physical activity is significantly lower and differs in pattern in urban subjects compared to rural. Physical inactivity is associated with these diseases, although not always significant in women.

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

Article

May 2015
J Clin Hypertens

Prevalence of prediabetes and diabetes mellitus among adults residing in Cameroon: A systematic review and meta-analysis

Abstract

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