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Ojong EW, Ngemenya MN, Tafili MM, Tanue EA, Achidi EA. Association of non-alcoholic fatty liver disease with glycemic control among patients with type 2 diabetes mellitus at Limbe Regional Hospital, Southwest, Cameroon. World J Hepatol 2025; 17:101936. [PMID: 40027557 PMCID: PMC11866161 DOI: 10.4254/wjh.v17.i2.101936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2024] [Revised: 12/05/2024] [Accepted: 01/02/2025] [Indexed: 02/20/2025] Open
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) is a chronic metabolic disease characterized by combinations of insulin resistance and insulin deficiency. Non-alcoholic fatty liver disease (NAFLD) is emerging as a public health problem worldwide and affects up to 70% of patients with T2DM. Although patients with T2DM have an increased risk of developing advanced liver disease compared to healthy individuals, varying prevalence rates of NAFLD among patients with T2DM, ranging from 34% to 94%, have been reported. AIM To determine prevalence and identify associated factors of NAFLD among Limbe patients with T2DM and evaluate correlation with glycemic control. METHODS A cross-sectional study was carried out from February to June 2024 among patients with T2DM. Gamma-glutamyl transferase (GGT) activity and serum triglycerides (TGs) were measured by spectrophotometry. NAFLD was diagnosed using the fatty liver index score. Data were analyzed using SPSS version 26.0 for Windows. Student's t-test was used to compare the means of two groups. The χ 2 test was applied to determine the association of NAFLD and T2DM. Logistic regression analysis was performed to identify predictors of NAFLD. P < 0.05 was considered statistically significant. RESULTS Of the 150 patients with T2DM recruited for this study, 63 (58%) were females and the majority (84.7%) had good glycemic control (glycated hemoglobin < 7%). Prevalence of NAFLD among patients with T2DM was 19%. Patients with NAFLD had significantly elevated levels of TGs, GGT, and increased body mass index and waist circumference compared to those without NAFLD. There was a significant association between NAFLD and glycemic control. Predictive factors of NAFLD among patients with T2DM were vegetable intake of less than three times per week [adjusted odds ratio (aOR): 0.131, 95%CI: 0.020-0.839; P = 0.032], central obesity (aOR: 0.167, 95%CI: 0.037-0.748; P = 0.019), and metformin treatment for T2DM (aOR: 0.167, 95%CI: 0.037-0.718; P < 0.001). CONCLUSION The prevalence of NAFLD in patients with T2DM in Limbe Regional Hospital was 19%. Age, central obesity, metformin use, and infrequent consumption of vegetables were important predictors of NAFLD.
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Affiliation(s)
- Ebot Walter Ojong
- Medical Laboratory Science, Faculty of Health Sciences, University of Buea, Buea PO Box 63, Southwest, Cameroon.
| | - Moses Njutain Ngemenya
- Medical Laboratory Science, Faculty of Health Sciences, University of Buea, Buea PO Box 63, Southwest, Cameroon
| | - Melvis Mwantem Tafili
- Medical Laboratory Science, Faculty of Health Sciences, University of Buea, Buea PO Box 63, Southwest, Cameroon
| | - Elvis Asangbeng Tanue
- Medical Laboratory Science, Faculty of Health Sciences, University of Buea, Buea PO Box 63, Southwest, Cameroon
| | - Eric Akum Achidi
- Medical Laboratory Science, Faculty of Health Sciences, University of Buea, Buea PO Box 63, Southwest, Cameroon
- Department of Biochemistry and Molecular Biology, University of Buea, Buea PO Box 63, Southwest, Cameroon
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Socioeconomic inequalities in diabetes prevalence: the case of South Africa between 2003 and 2016. BMC Public Health 2023; 23:324. [PMID: 36788553 PMCID: PMC9926686 DOI: 10.1186/s12889-023-15186-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 02/01/2023] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND Diabetes is a growing epidemic worldwide and the effect of socioeconomic status (SES) is frequently acknowledged in the literature. This study aims to compare the effect of SES on diabetes prevalence in South Africa between 2003 and 2016. In addition, vulnerable groups regarding diabetes development in 2016 will be identified. METHODS Using DHS data there were 8,006 participants (59.19% women) in 2003 and 10,292 participants (59.42% women) in 2016. Logistic regression and odds ratios (ORs) with 95% confidence intervals (CIs) were calculated for diabetes by age, gender, educational level and place of residence. To identify vulnerable groups with high risk of developing diabetes in 2016, the method of p-value based regression tree analysis was applied using "wealth index" and "weight perception" as additional variables. RESULTS There was an increase in diabetes prevalence from 3.86% in 2003 to 4.46% in 2016. Women had more risk of developing diabetes at both time points (27% in 2003 and 24% in 2016 more risk). Increase in age and living in urban areas were associated with more risk of developing diabetes at both time points. There was no specific pattern regarding risk of developing diabetes and educational level in case of women. However, men who completed secondary school or had a higher diploma or above had more risk of developing diabetes in 2016 (OR = 2.24 and 4.67 respectively). Vulnerable groups who have higher risk of developing diabetes in 2016 were participants aged "60 years or older" with a wealth index of "rich" or "richer", followed by participants from the same age group who were "poor" or "poorer" and participants aged "40-59 years" with a wealth index of "rich" or "richer". Subsequently were participants from the age group "15-39 years" with a weight perception of "overweight" or "obese". CONCLUSION Diabetes prevalence increased in South Africa between 2003 and 2016. Main risk factors were age, gender and living in urban areas. Men with high educational level were more at risk of developing diabetes in 2016. Vulnerable groups in 2016 were participants 40 years and older, particularly with high SES. This was followed by younger participants who were obese or overweight.
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Nkoke C, Bain LE, Makoge C, Teuwafeu D, Mapina A, Nkouonlack C, Kouam W, Jingi AM, Choukem SP. Profile and outcomes of patients admitted with hyperglycemic emergencies in the Buea Regional Hospital in Cameroon. Pan Afr Med J 2021; 39:274. [PMID: 34754351 PMCID: PMC8556727 DOI: 10.11604/pamj.2021.39.274.14371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Accepted: 12/04/2018] [Indexed: 12/02/2022] Open
Abstract
Introduction hyperglycemic emergencies (diabetic ketoacidosis and hyperglycemic hyperosmolar state) are the most common serious acute metabolic complications of diabetes which result in significant morbidity and mortality. There is paucity of data on hyperglycemic emergencies in Cameroon. The objective of this study was to investigate the precipitants and outcomes of patients admitted for hyperglycemic emergencies in the Buea Regional Hospital in the South West Region of Cameroon. Methods in this retrospective study the medical records of patients admitted for hyperglycemic emergencies between 2013 and 2016 in the medical unit of the Buea Regional Hospital were reviewed. We extracted data on demographic characteristics, admission clinical characteristics, precipitants, and treatment outcomes. Logistic regression was used to determine predictors of mortality. Results data were available for 60 patients (51.7% females) admitted for hyperglycemic emergencies. The mean age was 55.2±16.3 (range 18-86). Overall there were 51 (85%) cases of hyperosmolar hyperglycemic state. Twenty six (43.3%) of the patients had hypertension. The most common precipitants of hyperglycemic emergencies were infections (41.7%), newly diagnosed diabetes (33.3%) and non-adherence to medications (33.3%). Mean admission blood glucose was 574mg/dl±70.0mg/dl. The median length of hospital stay was 6 days. Overall case fatality rate was 21.7%. Six (46.2%) deaths were related to infections. Predictors of mortality were a Glasgow coma score <13(p<0.001), a diastolic blood pressure <60 mmHg (p=0.034) and a heart rate >90(0.057) on admission. Conclusion admission for hyperglycemic emergencies in this semi-urban hospital is associated with abnormally high case fatality. Infections, newly diagnosed diabetes and non-adherence to medications are the commonest precipitants of hyperglycemic emergencies. Public health measures to reduce morbidity and mortality from hyperglycemic crisis are urgently needed.
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Affiliation(s)
- Clovis Nkoke
- Buea Regional Hospital and Clinical Research Education, Networking and Consultancy, Buea, Cameroon.,Clinical Research Education, Networking and Consultancy (CRENC), Douala, Cameroon
| | - Luchuo Engelbert Bain
- Athena Institute for Research on Innovation and Communication in Health and Life Sciences, Vrije Universiteit, Amsterdam, The Netherlands
| | - Christelle Makoge
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Denis Teuwafeu
- Buea Regional Hospital and Clinical Research Education, Networking and Consultancy, Buea, Cameroon
| | - Alice Mapina
- Buea Regional Hospital and Clinical Research Education, Networking and Consultancy, Buea, Cameroon
| | - Cyrille Nkouonlack
- Buea Regional Hospital and Clinical Research Education, Networking and Consultancy, Buea, Cameroon
| | - Wilfred Kouam
- Buea Regional Hospital and Clinical Research Education, Networking and Consultancy, Buea, Cameroon
| | - Ahmadou Musa Jingi
- Athena Institute for Research on Innovation and Communication in Health and Life Sciences, Vrije Universiteit, Amsterdam, The Netherlands
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Chetty L, Govender N, Govender GM, Reddy P. Demographic stratification of Type 2 diabetes and comorbidities in district healthcare in KwaZulu-Natal. S Afr Fam Pract (2004) 2021; 63:e1-e9. [PMID: 33881328 PMCID: PMC8377998 DOI: 10.4102/safp.v63i1.5218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 12/17/2020] [Accepted: 12/20/2020] [Indexed: 11/08/2022] Open
Abstract
Background Diabetes has been reported as the second leading cause of death and the top leading cause of death amongst women in South Africa; it is important to evaluate any epidemiological or demographic transition related to diabetes. This study evaluated the demographically stratified prevalence of type 2 diabetes mellitus (T2DM) and existing comorbidities amongst an outpatient population in a district healthcare facility in Kwazulu-Natal (KZN). Methods This retrospective cross-sectional study was conducted at a district hospital, and a retrospective record review of all outpatients who reported to the hospital to be treated for T2DM between the period, August 2018–January 2019, was used. Data, such as age, sex, ethnicity and any coexisting morbidity, were collected from outpatient hospital registers and electronically captured using a record review tool. Results There were significantly more female patients (3072) compared to male patients (1050) (p < 0.001) with a mean age of 59.21 years. Hypertension (77.9%) and cardiovascular problems (11.16%) were most frequent. Approximately 84% of women presented with T2DM and either one or two morbidities simultaneously. Female patients were at significantly higher risk of presenting with hypertension (odds ratio [OR] = 1.44, 95% confidence interval [CI]: 1.20;1.71), whilst their risk for cardiovascular problems was significantly lower compared to male patients (OR = 0.67, 95% CI: 0.54;0.83). Conclusion The prevalence of T2DM and comorbidities differed by demographic factors, such as sex, ethnicity and age. There is a need for flexible and adaptive approaches for the prevention and management of T2DM cases in order to allocate medical resources efficiently and according to the true burden of disease because of T2DM complications.
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Affiliation(s)
- Lauren Chetty
- Department of Community Health Studies, Faculty of Health Sciences, Durban University of Technology, Durban.
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Hockett CW, Praveen PA, Ong TC, Anandakumar A, Isom SP, Jensen ET, D’Agostino RB, Hamman RF, Mayer-Davis EJ, Lawrence JM, Pihoker C, Kahn MG, Mohan V, Tandon N, Dabelea D. Clinical profile at diagnosis with youth-onset type 1 and type 2 diabetes in two pediatric diabetes registries: SEARCH (United States) and YDR (India). Pediatr Diabetes 2021; 22:22-30. [PMID: 31953884 PMCID: PMC7785282 DOI: 10.1111/pedi.12981] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 12/12/2019] [Accepted: 01/09/2020] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Over the last decades, diabetes in youth has increased in both India and the United States, along with the burden of long-term complications and healthcare costs. However, there are limited standardized population-based data in contemporary youth cohorts for comparison of clinical and demographic characteristics of diabetes for both type 1 (T1D) and type 2 (T2D). METHODS In partnership, we harmonized demographic and clinical data from the SEARCH for Diabetes in Youth (SEARCH) registry in the United States and the Registry of People with Diabetes with Youth Age at Onset (YDR) in India to the structure and terminology of the Observational Medical Outcomes Partnership Common Data Model. Data were from youth with T1D and T2D, aged <20 years and newly diagnosed between 2006 and 2010. We compared key characteristics across registries using χ2 tests and t-tests. RESULTS In total, there were 9650 youth with T1D and 2406 youth with T2D from 2006 to 2012. SEARCH youth were diagnosed at younger ages than YDR youth for T1D and T2D (10.0 vs 10.5 years, P < .001 and 14.7 vs 16.1 years, P < .001, respectively). For T2D, SEARCH had a higher proportion of females and significantly lower proportion of youth of high socioeconomic status compared to YDR. For T1D and T2D, SEARCH youth had higher BMI, lower blood pressure, and lower A1c compared to YDR youth. CONCLUSIONS These data offer insights into the demographic and clinical characteristics of diabetes in youth across the two countries. Further research is needed to better understand why these differences exist.
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Affiliation(s)
- Christine W Hockett
- Lifecourse Epidemiology of Adiposity and Diabetes Center, Colorado School of Public Health, University of Colorado Denver, Aurora, CO
| | - Pradeep A Praveen
- Department of Endocrinology & Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - Toan C. Ong
- Department of Pediatrics, University of Colorado, Aurora, CO
| | - Amutha Anandakumar
- Dr. Mohan’s Diabetes Specialties Centre and Madras Diabetes Research Foundation, Chennai, India
| | - Scott P Isom
- Department of Biostatistics and Bioinformatics, Wake Forest School of Medicine, Winston-Salem, NC
| | - Elizabeth T Jensen
- Department of Epidemiology, Wake Forest School of Medicine, Winston-Salem, NC
| | - Ralph B D’Agostino
- Department of Biostatistics and Bioinformatics, Wake Forest School of Medicine, Winston-Salem, NC
| | - Richard F Hamman
- Lifecourse Epidemiology of Adiposity and Diabetes Center, Colorado School of Public Health, University of Colorado Denver, Aurora, CO
| | | | - Jean M. Lawrence
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | | | - Michael G Kahn
- Department of Pediatrics, University of Colorado, Aurora, CO
| | - Viswanathan Mohan
- Dr. Mohan’s Diabetes Specialties Centre and Madras Diabetes Research Foundation, Chennai, India
| | - Nikhil Tandon
- Department of Endocrinology & Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - Dana Dabelea
- Lifecourse Epidemiology of Adiposity and Diabetes Center, Colorado School of Public Health, University of Colorado Denver, Aurora, CO
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Bavuma CM, Musafiri S, Rutayisire PC, Ng'ang'a LM, McQuillan R, Wild SH. Socio-demographic and clinical characteristics of diabetes mellitus in rural Rwanda: time to contextualize the interventions? A cross-sectional study. BMC Endocr Disord 2020; 20:180. [PMID: 33302939 PMCID: PMC7731466 DOI: 10.1186/s12902-020-00660-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 11/30/2020] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Existing prevention and treatment strategies target the classic types of diabetes yet this approach might not always be appropriate in some settings where atypical phenotypes exist. This study aims to assess the socio-demographic and clinical characteristics of people with diabetes in rural Rwanda compared to those of urban dwellers. METHODS A cross-sectional, clinic-based study was conducted in which individuals with diabetes mellitus were consecutively recruited from April 2015 to April 2016. Demographic and clinical data were collected from patient interviews, medical files and physical examinations. Chi-square tests and T-tests were used to compare proportions and means between rural and urban residents. RESULTS A total of 472 participants were recruited (mean age 40.2 ± 19.1 years), including 295 women and 315 rural residents. Compared to urban residents, rural residents had lower levels of education, were more likely to be employed in low-income work and to have limited access to running water and electricity. Diabetes was diagnosed at a younger age in rural residents (mean ± SD 32 ± 18 vs 41 ± 17 years; p < 0.001). Physical inactivity, family history of diabetes and obesity were significantly less prevalent in rural than in urban individuals (44% vs 66, 14.9% vs 28.7 and 27.6% vs 54.1%, respectively; p < 0.001). The frequency of fruit and vegetable consumption was lower in rural than in urban participants. High waist circumference was more prevalent in urban than in rural women and men (75.3% vs 45.5 and 30% vs 6%, respectively; p < 0.001). History of childhood under-nutrition was more frequent in rural than in urban individuals (22.5% vs 6.4%; p < 0.001). CONCLUSIONS Characteristics of people with diabetes in rural Rwanda appear to differ from those of individuals with diabetes in urban settings, suggesting that sub-types of diabetes exist in Rwanda. Generic guidelines for diabetes prevention and management may not be appropriate in different populations.
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Affiliation(s)
- Charlotte M Bavuma
- School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda.
| | - Sanctus Musafiri
- School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | | | | | - Ruth McQuillan
- School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Sarah H Wild
- School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
- Usher Institute, University of Edinburgh, Edinburgh, UK
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Massongo M, Balkissou AD, Kenyo CK, Sawa BN, Kanko N, Pefura EW. The STOPBANG score is effective for obstructive sleep apnea syndrome screening and correlates with its features, in a sub-Saharan African population. Pan Afr Med J 2020; 36:93. [PMID: 32774652 PMCID: PMC7392869 DOI: 10.11604/pamj.2020.36.93.17805] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 05/25/2020] [Indexed: 12/16/2022] Open
Abstract
Introduction the STOPBANG score is an easy-to-use screening tool for obstructive sleep apnea (OSA), which has not been validated in sub-Saharan Africa (SSA). We sought to evaluate its diagnostic performance in Cameroun. Methods this community-based study took place in a sub-urban area, from November 2015 to April 2016. Adults aged ≥19 years underwent a clinical assessment, including the STOPBANG and the Epworth sleepiness scale (ESS) questionnaires. A respiratory polygraph (RP) was performed on a randomly selected sample. Diagnosis performance included sensitivity (Se), specificity (Sp), and positive and negative predictive values (PPV and NPV). An association was sought between STOPBANG and OSA features. Results a total of 3033 were interviewed, of whom 102 had a RP. Their mean age was 49.1±17.9 years, the sex ratio was 1 and the mean body mass index 29.1±6.1 kg/m2. For OSA screening (apnea-hypopnea index (AHI) ≥5), the STOPBANG score at threshold 3 obtained: Se=82.9%, Sp=34.4%, PPV=45.9% and NPV=75.0%. For moderate-to-severe OSA (IAH ≥15), these values were 93.3%, 31.1%, 18.9% and 96.4% respectively. Furthermore, STOPBANG-based high risk of OSA correlated with AHI (9.1±10.7/hr vs 3.8±3.5/hr, p=0.0003) and oxygen desaturation index (6.4±7.9/hr vs 2.6±2.1/hr, p=0.0004). There was a non-significant association with ESS (6.3±5.3 vs 4.5±3.5, p=0.06). Conclusion in this Cameroonian population, the STOPBANG diagnostic performance did not differ from the original Caucasian one. It could therefore be proposed on a larger scale, since obesity and other OSA risk factors are increasing in SSA.
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Affiliation(s)
- Massongo Massongo
- Pulmonology Service, Jamot Hospital Yaoundé, Yaoundé, Cameroon.,Higher Institute of Medical Technology of Nkolondom, Yaoundé, Cameroon.,Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | - Adamou Dodo Balkissou
- Pulmonology Service, Jamot Hospital Yaoundé, Yaoundé, Cameroon.,Higher Institute of Medical Technology of Nkolondom, Yaoundé, Cameroon.,Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | | | - Brice Nouga Sawa
- Faculty of Health Sciences, Abdou Moumouni University of Niamey, Niamey, Niger
| | - Nadine Kanko
- Pulmonology Service, Jamot Hospital Yaoundé, Yaoundé, Cameroon.,Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | - Eric Walter Pefura
- Pulmonology Service, Jamot Hospital Yaoundé, Yaoundé, Cameroon.,Higher Institute of Medical Technology of Nkolondom, Yaoundé, Cameroon.,Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
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Kouitcheu Mabeku LB, Noundjeu Ngamga ML, Leundji H. Helicobacter pylori infection, a risk factor for Type 2 diabetes mellitus: a hospital-based cross-sectional study among dyspeptic patients in Douala-Cameroon. Sci Rep 2020; 10:12141. [PMID: 32699242 PMCID: PMC7376106 DOI: 10.1038/s41598-020-69208-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 04/03/2020] [Indexed: 02/07/2023] Open
Abstract
Diabetic mellitus patients are usually prone to chronic infections. However, there have been contradictory reports about the association between H. pylori infection and type II diabetes. The present study is aimed at evaluating the prevalence of Helicobacter pylori infection among type 2 dyspeptic diabetic patients in the littoral region of Cameroon. This cross sectional study comprised 93 type 2 diabetic dyspeptic patients and 112 non-diabetic dyspeptic patients attending the Gastroenterology Department at two reference hospitals in Douala-Cameroon. The study was approved by the local Ethical Committee of Medical Sciences. Participants were screened for the presence of both type 2 diabetes and H. pylori infection. Body mass index (BMI) of all the participants was also recorded. Data was analyzed using SSPS statistical package. H. pylori infection was found in 73.11% of diabetic patients versus 58.05% in non-diabetic participants, this difference was found to be significant (OR = 1.472, p = 0.0279). This relationship persists even when adjusted to factors such as age and income level of participants. Infected participants from age group ≥ 55 years and those with high income were those with a higher risk to develop diabetes. Infected patients with high BMI were more prone to develops diabetic mellitus compared with infected patients with normal BMI (p = 0.0034). Also, participant with high BMI were more prone to develops diabetic mellitus whether they were infected or not. Patients having both H. pylori + ve and BMI ≥ 25 kg/m2 were significantly more affected by diabetic mellitus than those in the others combined groups (p < 0.0001), suggested that high BMI and H. pylori infection together or not are factors that favor diabetes mellitus development. Separately or not, H. pylori infection and high BMI were risk factor for diabetes mellitus in our milieu.
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Affiliation(s)
- Laure Brigitte Kouitcheu Mabeku
- Microbiology and Pharmacology Laboratory, Department of Biochemistry, Faculty of Science, University of Dschang, P. O. Box 67, Dschang, Cameroon.
| | - Michelle Larissa Noundjeu Ngamga
- Microbiology and Pharmacology Laboratory, Department of Biochemistry, Faculty of Science, University of Dschang, P. O. Box 67, Dschang, Cameroon
| | - Hubert Leundji
- Gastroenterology Department, Laquintinie Hospital of Douala, P. O. Box 4035, Douala, Cameroon
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Simeni Njonnou SR, Boombhi J, Etoa Etoga MC, Tiodoung Timnou A, Jingi AM, Nkem Efon K, Mbono Samba Eloumba EA, Ntsama Essomba MJ, Kengni Kebiwo O, Tsitsol Meke AN, Talbit Ndjonya S, Dehayem Yefou M, Sobngwi E. Prevalence of Diabetes and Associated Risk Factors among a Group of Prisoners in the Yaoundé Central Prison. J Diabetes Res 2020; 2020:5016327. [PMID: 32047824 PMCID: PMC7003275 DOI: 10.1155/2020/5016327] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Revised: 12/10/2019] [Accepted: 12/24/2019] [Indexed: 12/21/2022] Open
Abstract
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.
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Affiliation(s)
- Sylvain Raoul Simeni Njonnou
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Jérôme Boombhi
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
- Yaoundé General Hospital, Yaoundé, Cameroon
| | - Martine Claude Etoa Etoga
- Department of Clinical Sciences, Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
- Yaoundé Central Hospital, Yaoundé, Cameroon
| | - Aimée Tiodoung Timnou
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Ahmadou Musa Jingi
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Kevin Nkem Efon
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
- Yaoundé Central Prison, Yaoundé, Cameroon
| | | | - Marie-Josiane Ntsama Essomba
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
- Yaoundé Central Hospital, Yaoundé, Cameroon
| | - Odette Kengni Kebiwo
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Alice Ninon Tsitsol Meke
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Stéphane Talbit Ndjonya
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Mesmin Dehayem Yefou
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
- Yaoundé Central Hospital, Yaoundé, Cameroon
| | - Eugène Sobngwi
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
- Yaoundé Central Hospital, Yaoundé, Cameroon
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Tsabang N, Djeufack LWT, Yedjou CG, Tchounwou PB. Importance of food plants in the prevention and treatment of diabetes in Cameroon. BIOACTIVE COMPOUNDS IN HEALTH AND DISEASE 2019; 2:11-26. [PMID: 32864583 PMCID: PMC7451804 DOI: 10.31989/bchd.v2i2.554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Diabetes is a metabolic pathology that affects the human body's capacity to adequately produce and use insulin. Type 1 (insulin-dependent) diabetes accounts for 5-10 % of diabetic patients. In Type 2 diabetes the insulin produced by the pancreatic islets is not properly used by cells due to insulin resistance. Gestational diabetes sometimes occurs in pregnant women and affects about 18 % of all pregnancies.Diabetes is one of the most important multifactorial metabolic chronic diseases with fatal complications. According to the International Diabetes Federation's estimations in 2015, 415 million people had diabetes and there will be an increase to 642 million people by 2040. Although many ethnopharmacological surveys have been carried out in several parts of the world, no ethnomedical and ethnopharmacological surveys have been done to identify plants used for the prevention and treatment of diabetes. OBJECTIVE This study aimed to collect and document information on food plants' remedies consumed for the prevention and treatment of diabetes in Cameroon. METHODS Ethnomedical and ethnopharmacological thorough preparations were conducted with 1131 interviewees from 58 tribes, following a random distribution. Diabetic patients recorded among this sample signed the informed consent and allowed us to evaluate the effectiveness of 10 identified food plants usually used for self-medication. They were divided into two groups: Group 1 comprised of 42 diabetic patients who regularly consume certain of these food plants, and Group 2 included 58 patients who were town-dwellers and did not regularly eat these identified food plants. RESULTS It was recorded that the onset of diabetes in patients were at about 70 years and 45 years for Group 1 and Group 2 respectively. Hence, a relationship was demonstrated between the onset of diabetes and the consumption of food plants. They contributed to the prevention and/or the delay in clinical manifestations. CONCLUSION Further investigations and/or clinical trials involving a large number of both type 1 and type 2 diabetics are needed to describe the therapeutic action of many food plants against diabetes. However, this study provides scientific support for the use of herbal medicines in the management of diabetes.
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Affiliation(s)
- Nole Tsabang
- Independent Consultant (Ex researcher of the Institute of Medical Researches and Medicinal Plants Studies (IMPM), Visiting lecturer at the University of Yaoundé I, Faculty of Medicine of Biomedical Science, at the University of Dschang, Faculty of Animal Biology and at the High Institute of Environmental Science, Yaounde-Cameroon
| | | | - Clément G Yedjou
- Cellomics and Toxicogenomics Research Laboratory, NIH-RCMI Center for Environmental Health, Jackson State University, Jackson, USA
| | - Paul B Tchounwou
- Molecular Toxicology Research Laboratory, NIH-Center for Environmental Health, College of Science, Engineering and Technology, Jackson State University, 1400 Lynch Street, P.O. Box 18540, Jackson, Mississippi, USA
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Acute Stroke Patients with Newly Diagnosed Diabetes Mellitus Have Poorer Outcomes than Those with Previously Diagnosed Diabetes Mellitus. J Stroke Cerebrovasc Dis 2018; 27:2327-2335. [PMID: 29784608 DOI: 10.1016/j.jstrokecerebrovasdis.2018.04.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 04/09/2018] [Accepted: 04/12/2018] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Diabetes mellitus (DM) is associated with poor outcomes in acute stroke patients (ASPs). This study aims to determine the prevalence of NDDM in the ASPs and to compare the outcome in NDDM and previously diagnosed DM (PDDM) in Cameroon. METHODS AND MATERIALS This was a hospital-based prospective cohort study that included ASPs with NDDM and PDDM. Outcome data were collected within 3 months of stroke onset. Chi-square and t tests were used for comparisons, whereas survival analysis was performed using Cox regression and Kaplan-Meier analysis. RESULTS Of the 701 ASPs included, 24.8% had PDDM (n = 174) and 9.4% NDDM (n = 66). NDDM had a higher mortality rate on admission and 3 months after stroke (P < .05). PDDM were more likely to survive within 3 months after stroke onset (log-rank test P = .008). The risk of dying among NDDM was increased (adjusted hazard ratio = 1.809; 95% confidence interval: 1.1532.839; P = .010). NDDM were more likely to have higher mean National Institutes of Health Stroke Scale and modified Rankin score (P < .05) on admission. PDDM were more likely to develop urinary tract infections during hospitalization (P = .015). There was no significant difference between functional outcome on admission and 3 months after stroke (P > .05). CONCLUSION NDDM are associated with increased mortality and are more likely to have poorer functional outcomes and more severe stroke than those with PDDM.
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Tindong M, Palle JN, Nebongo D, Aminde LN, Mboue-Djieka Y, Mbarga NTF, Dehayem MY, Choukem SP. Prevalence, Clinical Presentation, and Factors Associated With Diabetic Foot Ulcer in Two Regional Hospitals in Cameroon. INT J LOW EXTR WOUND 2018; 17:42-47. [DOI: 10.1177/1534734618764252] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study aimed to determine the prevalence of diabetic foot ulcer and high risk for ulceration, describe the clinical presentation, and identify factors associated with diabetic foot ulcer in the Southwest regional hospitals of Cameroon. In this cross-sectional study, data were collected using a structured questionnaire administered to consecutive patients with diabetes. Findings from detailed foot examination were recorded. Diabetic foot ulcer was diagnosed according to the International Working Group on Diabetic Foot (IWGDF) definition. Data were analyzed with Stata IC version 12. Of the 203 participants included, 63.1% were females. Age ranged from 26 to 96 years. The median duration of diabetes was 4.0 years (interquartile range 1.0-8.0 years). The prevalence of diabetic foot ulcer was 11.8% (24), of whom 29.2% (7) had high grade (grades 2 to 4), and most of the ulcers 58.3% (14) were located at the plantar region. The prevalence of high risk for ulceration was 21.8% (39). Loss of protective sensation (OR = 3.73, 95% CI = 1.43-9.71; P = .007), and peripheral arterial disease (OR = 3.48, 95% CI = 1.14-10.56; P = .028) were independently associated with diabetic foot. Diabetic foot ulcer is a common complication among patients with diabetes attending these regional hospitals. Loss of protective sensation, and peripheral arterial disease increase the odds of having diabetic foot ulcer, and we suggest them as the main target of interest for prevention.
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Affiliation(s)
- Maxime Tindong
- Health and Human Development (2HD) Research Network, Douala, Cameroon
- Université Libre de Bruxelles, Brussels, Belgium
| | | | - Daniel Nebongo
- Health and Human Development (2HD) Research Network, Douala, Cameroon
| | | | | | - Nicole T. Fouda Mbarga
- Health and Human Development (2HD) Research Network, Douala, Cameroon
- SporeDataInc, Durham, NC, USA
| | | | - Siméon-Pierre Choukem
- Health and Human Development (2HD) Research Network, Douala, Cameroon
- University of Buea, Buea, Cameroon
- Douala General Hospital, Douala, Cameroon
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Gato WE, Acquah S, Apenteng BA, Opoku ST, Boakye BK. Diabetes in the Cape Coast metropolis of Ghana: an assessment of risk factors, nutritional practices and lifestyle changes. Int Health 2017; 9:310-316. [PMID: 28911126 DOI: 10.1093/inthealth/ihx028] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 07/27/2017] [Indexed: 11/13/2022] Open
Abstract
Background Despite the significant increase in the incidence of diabetes in Ghana, research in this area has been lagging. The purpose of the study was to assess the risk factors associated with diabetes in the Cape Coast metropolis of Ghana, and to describe nutritional practices and efforts toward lifestyle change. Methods A convenient sample of 482 adults from the Cape Coast metropolis was surveyed using a self-reported questionnaire. The survey collected information on the demographic, socioeconomic characteristics, health status and routine nutritional practices of respondents. The aims of the study were addressed using multivariable regression analyses. Results A total of 8% of respondents reported that they had been diagnosed with diabetes. Older age and body weight were found to be independently associated with diabetes. Individuals living with diabetes were no more likely than those without diabetes to have taken active steps at reducing their weight. Conclusion The percentage of self-reported diabetes in this population was consistent with what has been reported in previous studies in Ghana. The findings from this study highlight the need for more patient education on physical activity and weight management.
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Affiliation(s)
- Worlanyo E Gato
- Department of Chemistry & Biochemistry, Georgia Southern University, Statesboro GA 30458, USA
| | - Samuel Acquah
- Department of Medical Biochemistry, School of Medical Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Bettye A Apenteng
- Department of Health Policy & Management, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, GA 30458, USA
| | - Samuel T Opoku
- Department of Health Policy & Management, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, GA 30458, USA
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Hennild DE, Bjerregaard-Andersen M, Joaquím LC, Christensen K, Sodemann M, Beck-Nielsen H, Jensen DM. Prevalence of impaired glucose tolerance and other types of dysglycaemia among young twins and singletons in Guinea-Bissau. BMC Endocr Disord 2016; 16:46. [PMID: 27491662 PMCID: PMC4973540 DOI: 10.1186/s12902-016-0126-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Accepted: 08/01/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Twins may be at increased risk of dysglycaemic disorders due to adverse fetal conditions. Data from Africa regarding this association is limited. We studied impaired glucose tolerance (IGT) and other types of dysglycemia among twins and singletons in Guinea-Bissau. METHODS The study was conducted from February 2011 until March 2012 at the Bandim Health Project, a health and demographic surveillance system site in the capital Bissau. Twins (n = 209) and singletons (n = 182) were recruited from a previously established cohort. Oral glucose tolerance tests (OGTT) were performed, along with anthropometrics and collection of clinical and dietary data. RESULTS Median age was 16.6 and 14.2 years between twins and singletons, respectively (P = 0.08). Mean birth weight was 2410 vs. 3090 g, respectively (P < 0.001). Twins had higher median fasting- and two hour capillary plasma glucose, 5.4(3.2-8.2) vs. 5.0(3.2-11.5) mmol/L (P < 0.001) and 6.8(3.4-11.3) vs. 6.2(3.2-12.1) mmol/L (P < 0.001), respectively, compared to singletons. The prevalence of IGT was 2.5 % (5/209) vs. 3.5 % (6/182) (RR = 0.73, 95 % CI: 0.20-2.64). 12 % (25/209) of twins had impaired fasting glucose (IFG), compared to 3.5 % (6/182) of singletons (3.63, 1.53-8.62). Dysglycemia (IGT and/or IFG or overt diabetes) was found in 17 % (35/209) vs. 9 % (16/182) (1.90, 1.08-3.37), respectively. CONCLUSIONS Twins had higher glucose levels in both the fasting and postprandial state. This may indicate a detrimental effect of the twin fetal environment on glucose metabolism later in life, a result contrary to Scandinavian register studies. The IGT burden was low in this young age group and the risk was similar in twins and singletons.
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Affiliation(s)
- Ditte Egegaard Hennild
- Bandim Health Project, INDEPTH Network, Apartado 861, 1004 Bissau Codex, Guinea-Bissau
- Department of Infectious Diseases, Odense University Hospital, Sdr. Boulevard 29, 5000 Odense C, Denmark
| | - Morten Bjerregaard-Andersen
- Bandim Health Project, INDEPTH Network, Apartado 861, 1004 Bissau Codex, Guinea-Bissau
- Department of Endocrinology, Odense University Hospital, Kløvervænget 6, 5000 Odense C, Denmark
- Research Center for Vitamins and Vaccines (CVIVA), Statens Serum Institute, Artillerivej 5, 2300 Copenhagen S, Denmark
| | - Luis Carlos Joaquím
- Bandim Health Project, INDEPTH Network, Apartado 861, 1004 Bissau Codex, Guinea-Bissau
- Guinean Diabetes Association (ANDD), Bissau, Guinea-Bissau
| | - Kaare Christensen
- The Danish Twin Registry, Epidemiology, Institute of Public Health, University of Southern Denmark, J.B. Winsløwsvej 9, 5000 Odense C, Denmark
- Department of Clinical Genetics, Odense University Hospital, Sdr. Boulevard 29, 5000 Odense C, Denmark
- Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Sdr. Boulevard 29, 5000 Odense C, Denmark
| | - Morten Sodemann
- Bandim Health Project, INDEPTH Network, Apartado 861, 1004 Bissau Codex, Guinea-Bissau
- Department of Infectious Diseases, Odense University Hospital, Sdr. Boulevard 29, 5000 Odense C, Denmark
| | - Henning Beck-Nielsen
- Department of Endocrinology, Odense University Hospital, Kløvervænget 6, 5000 Odense C, Denmark
- Elite Research Centre for Medical Endocrinology, Odense University Hospital, Sdr. Boulevard 29, 5000 Odense C, Denmark
| | - Dorte Møller Jensen
- Department of Endocrinology, Odense University Hospital, Kløvervænget 6, 5000 Odense C, Denmark
- Elite Research Centre for Medical Endocrinology, Odense University Hospital, Sdr. Boulevard 29, 5000 Odense C, Denmark
- The Research Unit of Gynaecology and Obstetrics, Odense University Hospital, Sdr. Boulevard 29, 5000 Odense C, Denmark
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Anemia in type 2 diabetic patients and correlation with kidney function in a tertiary care sub-Saharan African hospital: a cross-sectional study. BMC Nephrol 2016; 17:29. [PMID: 26994993 PMCID: PMC4799843 DOI: 10.1186/s12882-016-0247-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2015] [Accepted: 03/17/2016] [Indexed: 12/16/2022] Open
Abstract
Background Anemia is common in diabetic patients and increases morbidity and mortality, but its burden has been less well characterized in sub-Saharan Africans. We determined the prevalence of anemia and investigated the related factors, with a particular focus on the role of declining renal function, in type 2 diabetic patients attending a tertiary health care institution in Cameroon. Methods Hemoglobin (Hb) levels were measured in a consecutive sample of patients with type 2 diabetes, who reported for annual review at the outpatient section of the Douala General Hospital in 2013. Patients were classified as anemic according to the World Health Organisation criteria (Hb < 12 g/dl for females and Hb < 13 g/dl for males). Estimated glomerular filtration rate (eGFR) was calculated using the abbreviated Modification of Diet in Renal Disease Study Group formula. Determinants of Hb concentration and anemia were investigated using multivariable logistic regressions. Results A total of 636 patients were examined including 263 (prevalence rate 41.4 %) who had anemia. The prevalence of anemia increased significantly with deteriorating kidney function, although up to 31.9 % of patients with normal kidney function had anemia. Compared with their non-anemic counterparts, anemic diabetic patients were older, had longer duration of diabetes, lower eGFR, higher prevalence of proteinuria and diabetic retinopathy (all p < 0.05). In multivariable logistic regressions, eGFR (p = 0.001) and presence of retinopathy (p = 0.023) were the independent determinants of prevalent anemia. Conclusions The prevalence of anemia is high in type 2 diabetic patients attending referral institutions in Cameroon, including among those without chronic kidney disease. Routine screening for anemia in all diabetic patients may aid early identification and correction as appropriate.
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Salman M, Khan AH, Adnan AS, Sulaiman SAS, Hussain K, Shehzadi N, Jummaat F. Attributable causes of chronic kidney disease in adults: a five-year retrospective study in a tertiary-care hospital in the northeast of the Malaysian Peninsula. SAO PAULO MED J 2015; 133:502-9. [PMID: 26760124 PMCID: PMC10496555 DOI: 10.1590/1516-3180.2015.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 08/01/2015] [Indexed: 11/22/2022] Open
Abstract
CONTEXT AND OBJECTIVE Chronic kidney disease (CKD) is an escalating medical and socioeconomic problem worldwide. Information concerning the causes of CKD, which is a prerequisite for reducing the disease burden, is sparse in Malaysia. Therefore, this study aimed to evaluate the attributable causes of CKD in an adult population at a tertiary referral hospital. DESIGN AND SETTING Retrospective study at Hospital Universiti Sains Malaysia (HUSM). METHODS This was an analysis based on medical records of adult patients at HUSM. Data regarding demographics, laboratory investigations, attributable causes and CKD stage were gathered. RESULTS A total of 851 eligible cases were included. The patients' mean age was 61.18 ± 13.37 years. CKD stage V was found in 333 cases (39.1%) whereas stages IV, IIIb, IIIa, and II were seen in 240 (28.2%), 186 (21.9%), 74 (8.7%) and 18 (2.1%), respectively. The percentage of CKD stage V patients receiving renal replacement therapy was 15.6%. The foremost attributable causes of CKD were diabetic nephropathy (DN) (44.9%), hypertension (HPT) (24.2%) and obstructive uropathy (9.2%). The difference in the prevalence of CKD due to DN, HPT and glomerulonephritis between patients ≤ 50 and > 50 years old was statistically significant. CONCLUSION Our results suggest that DN and HPT are the major attributable causes of CKD among patients at a Malaysian tertiary-care hospital. Furthermore, the results draw attention to the possibility that greater emphasis on primary prevention of diabetes and hypertension will have a great impact on reduction of hospital admissions due to CKD in Malaysia.
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Affiliation(s)
- Muhammad Salman
- PharmD, MSc. Doctoral Student, Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia, and Lecturer, Department of Pharmacy Practice, University College of Pharmacy, University of the Punjab, Lahore-54000, Pakistan.
| | - Amer Hayat Khan
- BPharm, MPhil, PhD. Senior Lecturer, Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia.
| | - Azreen Syazril Adnan
- MD, MMed, FASN. Associate Professor, Chronic Kidney Disease Resource Centre, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, Kota Bharu, Kelantan, Malaysia.
| | - Syed Azhar Syed Sulaiman
- BParm, PharmD. Professor, Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia.
| | - Khalid Hussain
- BPharm, MPhil, PhD. Professor, University College of Pharmacy, University of the Punjab, Lahore-54000, Pakistan.
| | - Naureen Shehzadi
- PharmD, MPhil. Doctoral Student, University College of Pharmacy, University of the Punjab, Lahore-54000, Pakistan.
| | - Fauziah Jummaat
- MD, MMed. Lecturer, Department of Gynecology and Obstetrics, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, Kota Bharu, Kelantan, Malaysia.
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Kaze FF, Halle MP, Mopa HT, Ashuntantang G, Fouda H, Ngogang J, Kengne AP. Prevalence and risk factors of chronic kidney disease in urban adult Cameroonians according to three common estimators of the glomerular filtration rate: a cross-sectional study. BMC Nephrol 2015; 16:96. [PMID: 26149764 PMCID: PMC4492095 DOI: 10.1186/s12882-015-0102-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2014] [Accepted: 06/28/2015] [Indexed: 11/23/2022] Open
Abstract
Background Chronic kidney disease (CKD) is a major threat to the health of people of African ancestry. We assessed the prevalence and risk factors of CKD among adults in urban Cameroon. Methods This was a cross-sectional study of two months duration (March to April 2013) conducted at the Cité des Palmiers health district in the Littoral region of Cameroon. A multistage cluster sampling approach was applied. Estimated glomerular filtration rate (eGFR) was based on the Cockcroft-Gault (CG), the four-variable Modification of Diet in Renal Disease (MDRD) study and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations. Logistic regression models were used to investigate the predictors of CKD. Results In the 500 participants with a mean age of 45.3 ± 13.2 years included, we observed a high prevalence of overweight and obesity (60.4 %), hypertension (38.6 %) and diabetes (2.8 %). The mean eGFR was 93.7 ± 24.9, 97.8 ± 24.9 and 99.2 ± 31.4 ml/min respectively with the MDRD, CG and CKD-EPI equations. The prevalence of albuminuria was 7.2 % while the prevalence of decreased GFR (eGFR < 60 ml/min) and CKD (any albuminuria and/or eGFR < 60 ml/min) was 4.4 and 11 % with MDRD, 5.4 and 14.2 % with CG, and 8.8 and 10 % with CKD-EPI. In age and sex adjusted logistic regression models, advanced age, known hypertension and diabetes mellitus, increasing body mass index and overweight/obesity were the predictors of albuminuria, decreased GFR and CKD according to various estimators. Conclusion There is a high prevalence of CKD in urban adults Cameroonian, driven essentially by the commonest risk factors for CKD.
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Affiliation(s)
- Francois Folefack Kaze
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University Teaching Hospital of Yaoundé, University of Yaoundé 1, Yaoundé, Cameroon.
| | - Marie-Patrice Halle
- Department of Internal Medicine, Faculty of Medicine and Pharmaceutical Sciences, Douala General Hospital, University of Douala, Douala, Cameroon.
| | | | - Gloria Ashuntantang
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, Yaoundé General Hospital, University of Yaoundé 1, Yaoundé, Cameroon.
| | - Hermine Fouda
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, Douala General Hospital, University of Yaoundé 1, Yaoundé, Cameroon.
| | - Jeanne Ngogang
- Department of Biochemistry and Physiologic Sciences, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon.
| | - Andre-Pascal Kengne
- South African Medical Research Council, University of Cape Town, Cape Town, South Africa.
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Kyari F, Tafida A, Sivasubramaniam S, Murthy GVS, Peto T, Gilbert CE, The Nigeria National Blindness and Visual Impairment Study Group. Prevalence and risk factors for diabetes and diabetic retinopathy: results from the Nigeria national blindness and visual impairment survey. BMC Public Health 2014; 14:1299. [PMID: 25523434 PMCID: PMC4301086 DOI: 10.1186/1471-2458-14-1299] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 12/11/2014] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND In Nigeria, urbanisation and increasing life expectancy are likely to increase the incidence of non-communicable diseases. As the epidemic of diabetes matures, visual loss from diabetic retinopathy (DR) will increase unless mechanisms for early detection and treatment improve, and health systems respond to the growing burden of non-communicable diseases. METHODS A nationally-representative population-based sample of 13,591 participants aged ≥40 years selected by multistage-stratified-cluster-random-sampling with probability-proportional-to-size procedures were examined in 305 clusters in Nigeria between January 2005 to June 2007. All were asked about history of diabetes and underwent basic eye examination. Visual acuity (VA) was measured using logMAR E-chart. Participants with VA<6/12 and/or DR detected underwent detailed eye examination including dilated retinal examination and retinal photography. Systematic sampling of 1-in-7 gave a subsample (n=1759) examined in detail regardless of VA; and had random blood glucose (RBG) testing. Images were graded by Moorfields Eye Hospital Reading Centre. Participants were defined as having diabetes if they were previously diagnosed or RBG>11.1mmol/l or had DR. Data in the subsample were used to estimate the prevalence and to analyse risk factors for diabetes and DR using multivariable logistic regression. Additional information on the types of DR was obtained from participants not in the subsample. RESULTS In the subsample, 164 participants were excluded due to missing data; and 1,595 analysed. 52/1,595 had diabetes, a prevalence of 3.3% (95%CI 2.5-4.3%); and 25/52(48%) did not know. Media opacity in 8/52 precluded retinal examination. 9/44(20.5%) had DR. Higher prevalence of diabetes was associated with urban residence (Odds ratio [OR]1.87) and overweight/obesity (OR3.02/4.43 respectively). Although not statistically significant, DR was associated with hypertension (OR3.49) and RBG>15.0mmol/L (OR8.10). Persons with diabetes had 3 times greater odds of blindness. Of 11,832 other participants in the study sample, 175(1.5%) had history of diabetes; 28 had DR. Types of DR (total=37) included 10.8% proliferative, 51.4% macular oedema. CONCLUSION The age-adjusted prevalence of diabetes in Nigeria was 3.25% (95%CI 2.50-4.30) and over 10% of people with diabetes aged ≥40 years had sight-threatening-DR. These data will enable the development of better public health strategies for the control of diabetes and planning services for DR to prevent vision loss.
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Affiliation(s)
- Fatima Kyari
- />International Centre for Eye Health, Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
- />Department of Ophthalmology, College of Health Sciences, University of Abuja, Abuja, Nigeria
| | | | - Selvaraj Sivasubramaniam
- />Medical Statistics Team, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Gudlavalleti VS Murthy
- />International Centre for Eye Health, Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
- />Indian Institute of Public Health, Public Health Foundation of India, Hyderabad, Andra Pradesh India
| | - Tunde Peto
- />Moorfields Eye Hospital, London, UK
- />NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, UK
| | - Clare E Gilbert
- />International Centre for Eye Health, Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - The Nigeria National Blindness and Visual Impairment Study Group
- />International Centre for Eye Health, Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
- />Department of Ophthalmology, College of Health Sciences, University of Abuja, Abuja, Nigeria
- />Ministry of Health, Dutse, Jigawa State Nigeria
- />Medical Statistics Team, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
- />Indian Institute of Public Health, Public Health Foundation of India, Hyderabad, Andra Pradesh India
- />Moorfields Eye Hospital, London, UK
- />NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, UK
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Prevalence of diabetes in Zimbabwe: a systematic review with meta-analysis. Int J Public Health 2014; 60:1-11. [PMID: 25432797 DOI: 10.1007/s00038-014-0626-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Revised: 10/31/2014] [Accepted: 11/17/2014] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE Diabetes appears to be a growing problem in the African region. This study aims to estimate the prevalence of diabetes in Zimbabwe by collating and analyzing previously published data. METHODS Systematic review and meta-analysis of data reporting prevalence of diabetes in Zimbabwe was conducted based on the random effects model. We searched for studies published between January 1960 and December 2013 using MEDLINE, EMBASE and Scopus and University of Zimbabwe electronic publication libraries. In the meta-analysis, sub-groups were created for studies conducted before 1980 and after 1980, to understand the potential effect of independence on prevalence. RESULTS Seven studies were included in the meta-analysis with a total of 29,514 study participants. The overall pooled prevalence of diabetes before 1980 was 0.44% (95% CI 0.0-1.9%), after 1980 the pooled prevalence was 5.7% (95% CI 3.3-8.6%). CONCLUSIONS This study showed that the prevalence of diabetes in Zimbabwe has increased significantly over the past three decades. This poses serious challenges to the provision of care and prevention of disabling co-morbidities in an already disadvantaged healthcare setting.
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Oyegbade OO, Abioye-Kuteyi EA, Kolawole BA, Ezeoma IT, Bello IS. Screening for diabetes mellitus in a Nigerian family practice population. S Afr Fam Pract (2004) 2014. [DOI: 10.1080/20786204.2007.10873612] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
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Hilawe EH, Yatsuya H, Kawaguchi L, Aoyama A. Differences by sex in the prevalence of diabetes mellitus, impaired fasting glycaemia and impaired glucose tolerance in sub-Saharan Africa: a systematic review and meta-analysis. Bull World Health Organ 2014; 91:671-682D. [PMID: 24101783 DOI: 10.2471/blt.12.113415] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Revised: 02/21/2013] [Accepted: 03/25/2013] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE To assess differences between men and women in the prevalence of diabetes mellitus, impaired fasting glycaemia and impaired glucose tolerance in sub-Saharan Africa. METHODS In September 2011, the PubMed and Web of Science databases were searched for community-based, cross-sectional studies providing sex-specific prevalences of any of the three study conditions among adults living in parts of sub-Saharan Africa (i.e. in Eastern, Middle and Southern Africa according to the United Nations subregional classification for African countries). A random-effects model was then used to calculate and compare the odds of men and women having each condition. FINDINGS In a meta-analysis of the 36 relevant, cross-sectional data sets that were identified, impaired fasting glycaemia was found to be more common in men than in women (OR: 1.56; 95% confidence interval, CI: 1.20-2.03), whereas impaired glucose tolerance was found to be less common in men than in women (OR: 0.84; 95% CI: 0.72-0.98). The prevalence of diabetes mellitus - which was generally similar in both sexes (OR: 1.01; 95% CI: 0.91-1.11) - was higher among the women in Southern Africa than among the men from the same subregion and lower among the women from Eastern and Middle Africa and from low-income countries of sub-Saharan Africa than among the corresponding men. CONCLUSION Compared with women in the same subregions, men in Eastern, Middle and Southern Africa were found to have a similar overall prevalence of diabetes mellitus but were more likely to have impaired fasting glycaemia and less likely to have impaired glucose tolerance.
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Affiliation(s)
- Esayas Haregot Hilawe
- Department of Public Health and Health Systems, Nagoya University School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
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Jingi AM, Noubiap JJN, Ellong A, Bigna JJR, Mvogo CE. Epidemiology and treatment outcomes of diabetic retinopathy in a diabetic population from Cameroon. BMC Ophthalmol 2014; 14:19. [PMID: 24564334 PMCID: PMC3941950 DOI: 10.1186/1471-2415-14-19] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2013] [Accepted: 02/19/2014] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Diabetic retinopathy (DR) is the most common microvascular complication of diabetes. It can lead to significant visual loss. The aim of this study was to determine the frequency and clinical profile of diabetic retinopathy, and assess the outcomes of laser photocoagulation therapy in a diabetic population in Cameroon. METHODS We carried out a prospective cohort study during 24 months in the Department of Ophthalmology of the Douala General Hospital, Cameroon. We included all diabetic patients who were referred from diabetes clinics for ophthalmologic evaluation. Data included type and duration of diabetes, visual acuity, intra-ocular pressure, results of fundoscopy and fluorescein angiography, and outcomes two months after treatment with laser photocoagulation. RESULTS We included 407 patients; 88% had type 2 diabetes. Their mean duration of diabetes was 6.4 years (SD=6.6). Forty point three percent (164/407) of patients were found to have DR on fundoscopy. Of the 164 patients with DR, 63.4% (104/164) had non-proliferative and 36.6% (60/164) had proliferative DR. Diabetic maculopathy was found in 14.5% (59/407) of all participants, and 36% (59/164) of patients with DR. There was a strong correlation between the duration of diabetes and retinopathy status (p < 0.001, r = 0.9541). Overall, 17.4% (71/407) of patients were eligible for laser photocoagulation. Of these, 66.2% (47/71) were treated, and 78.7% (37/47) of treated patients came back for control two months later. Among these treated patients an improvement of the retinopathy was noted in 73% (27/37), no change in 16.2% (6/37) and a worsening in 10.8% (4/37). Severe proliferative DR was significantly associated with treatment failure (p < 0.001). CONCLUSIONS The frequency of DR may be high among diabetic patients in Cameroon. There was a good uptake of laser photocoagulation therapy among patients affected by DR in our setting, with good treatment outcomes. Interventions to prevent diabetes and increase the precocity of diagnosis and treatment of DR should be scaled up.
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Jacques Cabral TT, Tantchou Tchoumi JC, Butera G. Profile of cardiac disease in Cameroon and impact on health care services. Cardiovasc Diagn Ther 2014; 3:236-43. [PMID: 24400207 DOI: 10.3978/j.issn.2223-3652.2013.12.05] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Accepted: 12/04/2013] [Indexed: 11/14/2022]
Abstract
BACKGROUND Cardiovascular diseases (CVD) have emerged as a major public health problem and impose an escalating burden on the health care system in Cameroon. The aim of the study was to investigate the preparedness of health care services for patients presenting with CVD in general and specifically, in St. Elizabeth catholic general hospital Shisong, cardiac centre. PATIENTS AND METHODS Between November 2009 and November 2011, a population of 8,389 adults and 706 children consulted the referral cardiac centre of St. Elizabeth Catholic General Hospital. The patients' age ranges between 5 days and 103 years old, with a mean of 48.7±18 years. Female represented 54.2% of the total population. RESULTS Hypertension was diagnosed in 41.5% of patients. Isolated systolic hypertension was rarely found (4.2%) and 45.2% of patients were classified as class II according to the JNC7. Congestive heart failure was diagnosed in 29.6%. Forty-four percent of patients were in class III and 7% in class IV heart failure (NYHA). Arrhythmia was seen in 12.2% cases, with atrial fibrillation in 35.2%, followed by ventricular ectopic beats in 20.3%. Stable angina was diagnosed in 1.5%, and acute myocardial infarction 0.9%. In children, the prevalence of congenital heart disease was (4.3%). The disease the most detected was isolated ventricular septal defect, followed by tetralogy of Fallot. Post rheumatic valvulopathies were the main cause of heart failure in teenagers and young adults. Valve replacement with a mechanical valve was performed in 110 patients, valvuloplasty in eight patients, and surgical correction of congenital heart diseases in 105 cases. CONCLUSIONS Our data, collected in a rural area, shows the high prevalence of hypertension in rural sub-Saharan Africa. Congestive heart failure mainly due to post rheumatic valvulopathies is common amongst children and young adults.
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Affiliation(s)
| | | | - Gianfranco Butera
- Pediatric Cardiology, Cardiac Surgery and GUCH unit, Policlinico San Donato IRCCS, Italy
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Mwangi J, Gitonga L. Perceptions and Use of Herbal Remedies among Patients with Diabetes Mellitus in Murang’a North District, Kenya. ACTA ACUST UNITED AC 2014. [DOI: 10.4236/ojcd.2014.43024] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Bissong MEA, Fon PN, Tabe-Besong FO, Akenji TN. Asymptomatic bacteriuria in diabetes mellitus patients in Southwest Cameroon. Afr Health Sci 2013; 13:661-6. [PMID: 24250304 DOI: 10.4314/ahs.v13i3.20] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Asymptomatic bacteriuria (ASB) is common in diabetics and predisposes these patients to more severe urinary tract infections (UTIs). Reports on the prevalence and etiology of ASB especially in developing countries appear contradictory. OBJECTIVES To determine the prevalence and etiology of ASB and antimicrobial resistance of urinary isolates in diabetics and non-diabetics. METHODS The study involved a total of 265 participants including 154 diabetes mellitus patients and 111 non-diabetics in Southwest Cameroon. Mid-stream urine was collected from consented subjects and each sample tested using the dipstick, microscopy and culture techniques. Isolates were identified using standard biochemical tests. RESULTS ASB was detected in 33.2% of participants; 38.3% in diabetics and 26.1% in non-diabetics (P = 0.03). Coagulase-negative staphylococci (CNS) were the predominant organisms (36.3%) isolated from urine in both diabetics and nondiabetics. Other isolates included Klebsiella sp (15.9%), Candida sp (13.7%), E. coli (10.8%) and Serratia sp (10.8%). Candida sp was isolated more from diabetics than non-diabetics (P = 0.01). There was no significant difference in resistance between diabetics and non-diabetics (P > 0.05). Most isolates showed multiple resistance and ciprofloxacin was the most active ingredient against bacterial uropathogens. CONCLUSION The study revealed a high prevalence of ASB in diabetics than in non-diabetics. A change in the aetiologic spectrum was observed with Staphylococcus sp accounting for majority of ASB. Most isolates showed multiple resistance in both diabetics and non-diabetics; therefore the need to speed up sensitization against antibiotic abuse in Southwest Cameroon.
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Affiliation(s)
- Marie E A Bissong
- Department of Microbiology and Parasitology, Faculty of Science, University of Buea, Cameroon
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Asanghanwa M, van Genderen F, Verhaeghen K, Van der Auwera B, Sobngwi E, Mbanya JC, van Schravendijk C. Validation of an enzyme-linked immunosorbent assay for C-peptide analysis in Cameroon. Diabetes Res Clin Pract 2012; 98:459-64. [PMID: 23089552 DOI: 10.1016/j.diabres.2012.09.042] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2012] [Accepted: 09/20/2012] [Indexed: 11/21/2022]
Abstract
AIMS To validate an ELISA method for C-peptide analysis in Cameroon. METHODS We evaluated the linearity, detection limit, functional sensitivity, precision and accuracy, and further investigated for cross-reactivity by proinsulin, and interferences by lipids, bilirubin and hemoglobin. This method was compared with the Roche electrochemiluminescence immunoassay. C-peptide stability was assessed following a series of freeze-thaw cycles, and after storage at room temperature. The C-peptide reference range was determined by analyzing fifty plasma samples of Cameroonians without diabetes. RESULTS The ELISA was linear at least up to 7.09 μg/L, and had a detection limit of 0.09 μg/L, and a functional sensitivity of 0.32 μg/L. The inter- and intraassay %CV were 2.9-9.9%, and 5.2-9.4%, respectively. Recoveries were 81-94% in serum, and 93-98% in buffer. Comparison with the ECLIA yielded a good correlation coefficient (R(2)=0.98). There was no cross-reactivity with proinsulin, and no interference with lipids, bilirubin and hemoglobin. C-peptide was stable at room temperature for 24 h and up to 7 freeze-thaw cycles for medium (1-6 μg/L) and high (>6 μg/L) levels (<-15°C and <-70°C). The reference range for C-peptide was 0.38-3.63 μg/L. CONCLUSIONS This method is suitable for C-peptide analysis in low-income countries like Cameroon.
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Affiliation(s)
- M Asanghanwa
- Diabetes Research Centre, Brussels Free University, B-1090 Brussels, Belgium
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Community energy balance: a framework for contextualizing cultural influences on high risk of obesity in ethnic minority populations. Prev Med 2012; 55:371-81. [PMID: 22800683 DOI: 10.1016/j.ypmed.2012.07.002] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Revised: 06/21/2012] [Accepted: 07/05/2012] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Increases in the availability, affordability, and promotion of high-calorie foods and beverages and decreased obligations for routine physical activity have fostered trends of increased obesity worldwide. In high-income, plural societies, above average obesity prevalence is often observed in ethnic minority communities, suggesting that obesity-promoting influences are more prevalent or potent in these communities. METHODS An interdisciplinary group of scholars engaged in multiple rounds of focused discussion and literature review to develop a Community Energy Balance Framework (CEB). The objective was to explore the nature of the excess obesity risk in African descent and other ethnic minority populations and identify related implications for planning and evaluating interventions to prevent obesity. RESULTS A key principle that emerged is that researchers and programmers working with ethnic minority communities should contextualize the food- and physical activity-related sociocultural perspectives of these communities, taking into account relevant historical, political, and structural contexts. This perspective underscores the fallacy of approaches that place the entire burden of change on the individual, particularly in circumstances of social disadvantage and rapid cultural shifts. CONCLUSION The CEB framework is proposed for use and further development to aid in understanding potential health-adverse effects of cultural-contextual stresses and accommodations to these stresses.
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Katchunga P, Masumbuko B, Belma M, Kashongwe Munogolo Z, Hermans MP, M’Buyamba-Kabangu JR. Age and living in an urban environment are major determinants of diabetes among South Kivu Congolese adults. DIABETES & METABOLISM 2012; 38:324-31. [DOI: 10.1016/j.diabet.2012.02.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2011] [Revised: 02/22/2012] [Accepted: 02/22/2012] [Indexed: 12/30/2022]
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Echouffo-Tcheugui JB, Dzudie A, Epacka ME, Choukem SP, Doualla MS, Luma H, Kengne AP. Prevalence and determinants of undiagnosed diabetes in an urban sub-Saharan African population. Prim Care Diabetes 2012; 6:229-234. [PMID: 22682693 DOI: 10.1016/j.pcd.2012.05.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Revised: 04/26/2012] [Accepted: 05/14/2012] [Indexed: 01/21/2023]
Abstract
AIMS To report the prevalence of undiagnosed diabetes and its determinants among adults Cameroonian urban dwellers. METHODS On May 17th 2011, a community-based combined screening for diabetes and hypertension was conducted simultaneously in four major Cameroonian cities. Adult participants were invited through mass media. Fasting blood glucose was measured in capillary blood. RESULTS Of the 2120 respondents, 1591 (52% being men) received a fasting glucose test. The median age was 43.7 years, and 64.2% were overweight or obese. The sex-specific age adjusted prevalence (for men and women) were 10.1% (95% confidence interval [CI]: 8.1-12.1%) and 11.2% (95%CI: 9.1-13.3%) for any diabetes, and 4.6% (95%CI: 2.6-6.6%) and 5.1% (95%CI: 3.0-7.2%) for screened-detected diabetes, respectively. The prevalence of diabetes increased with increasing age in men and women (all p ≤ 0.001 for linear trend). Older age (p<0.001), region of residence (p<0.001), excessive alcohol intake (p=0.02) were significantly associated with screened-detected diabetes, while physical inactivity, body mass index, and high waist girth were not significantly associated with the same outcome. CONCLUSIONS Prevalence of undiagnosed diabetes is very high among Cameroonian urban dwellers, indicating a potentially huge impact of screening for diabetes, thus the need for more proactive policies of early detection of the disease.
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Napoli N, Zardi E, Strollo R, Arigliani M, Daverio A, Olearo F, Tosi D, Dicuonzo G, Scarpa F, Pedone C, Tegue Simo HH, Mottini G, Pozzilli P. Increased carotid thickness in subjects with recently-diagnosed diabetes from rural Cameroon. PLoS One 2012; 7:e41316. [PMID: 22916106 PMCID: PMC3423396 DOI: 10.1371/journal.pone.0041316] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2012] [Accepted: 06/20/2012] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND We have recently shown a high prevalence of diabetes and obesity in rural Cameroon, despite an improved lifestyle. Diabetes in rural Africa remains underdiagnosed and its role in increasing risk of atherosclerosis in these populations is unknown. We investigated the prevalence of carotid atherosclerosis and cardiovascular risk factors in a population of subjects with recently-diagnosed diabetes from rural Cameroon. METHODOLOGY/PRINCIPAL FINDINGS In a case-control study, carotid intima-media thickness (IMT) was measured in 74 subjects with diabetes (diagnosed <2 years), aged 47-85 and 109 controls comparable for age and sex. Subjects were recruited during a health campaign conducted in April 2009. Blood glucose control (HbA1c, fasting blood glucose) and major cardiovascular risk factors (complete lipid panel, blood pressure) were also measured. Mean carotid IMT was higher in subjects with diabetes than healthy controls at each scanned segment (common, internal carotid and bulb) (P<0.05), except the near wall of the left bulb. Vascular stiffness tended to be higher and pressure-strain elastic modulus of the left carotid was increased in subjects with diabetes than controls (P<0.05), but distensibility was similar between the two groups. At least one plaque >0.9 mm was found in 4%, 45.9% and 20% of diabetic subjects at the common, bulb or internal carotid, respectively. Only 25% of patients had an HbA1c<7%, while over 41.6% presented with marked hyperglycemia (HbA1c>9%). The prevalence of diabetic subjects with abnormal levels of LDL-cholesterol, triglycerides, HDL-cholesterol or blood pressure was 45%, 16.6%, 15% and 65.7%, respectively. CONCLUSIONS Carotid thickness is increased in subjects with diabetes from a rural area of Cameroon, despite the relatively recent diagnosis. These findings and the high rate of uncontrolled diabetes in this population support the increasing concern of diabetes and cardiovascular diseases in African countries and indicate the need for multifaceted health interventions in urban and rural settings.
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Affiliation(s)
- Nicola Napoli
- Endocrinology & Diabetes, Campus Bio-Medico University of Rome, Rome, Italy.
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Hwang CK, Han PV, Zabetian A, Ali MK, Narayan KMV. Rural diabetes prevalence quintuples over twenty-five years in low- and middle-income countries: a systematic review and meta-analysis. Diabetes Res Clin Pract 2012; 96:271-85. [PMID: 22261096 DOI: 10.1016/j.diabres.2011.12.001] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2011] [Revised: 11/15/2011] [Accepted: 12/01/2011] [Indexed: 01/29/2023]
Abstract
AIMS To verify the assertions that diabetes pandemic may be spreading across rural parts of low- and middle-income countries (LMICs), we performed a systematic review of published studies reporting diabetes prevalence in rural parts of LMICs. METHODS Electronic databases (EMBASE and MEDLINE) were searched for papers published from 1990 to 2011. Two independent reviewers screened the articles using structured criteria for inclusion and performed full-text reviews. Pooled prevalence of diabetes was estimated using meta-analysis. Potential factors influencing the estimates were identified by meta-regression and used for sensitivity analyses. RESULTS Rural prevalence of diabetes of LMICs was 5.6% (95% CI=4.6-6.6), and similar between men and women. This estimate remained robust in separate sensitivity analyses accounting for study quality, level of heterogeneity, age, and sex. In a multivariate meta-regression analysis, pooled prevalence varied by study year and region. Diabetes prevalence increased over time, from 1.8% (1.0-2.6) in 1985-1989, 5.0% (3.8-6.3) in 1990-1994, 5.2% (4.1-6.2) in 1995-1999, 6.4% (5.1-7.7) in 2000-2004, and to 8.6% (6.4-10.7) for 2005-2010 (p=0.001 for secular trend). CONCLUSIONS Prevalence of diabetes in rural parts of LMICs has risen dramatically. As 55% of LMIC populations live in rural areas, this trend has enormous implications for the global burden of diabetes.
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Duboz P, Chapuis-Lucciani N, Boëtsch G, Gueye L. Prevalence of diabetes and associated risk factors in a Senegalese urban (Dakar) population. DIABETES & METABOLISM 2012; 38:332-6. [PMID: 22521041 DOI: 10.1016/j.diabet.2012.02.011] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2011] [Revised: 02/21/2012] [Accepted: 02/26/2012] [Indexed: 12/19/2022]
Abstract
AIM The aim of this study was to estimate the prevalence of diabetes in the urban population living in Dakar, Senegal, and to investigate the factors associated with diabetes. METHODS Data from a 2009 survey of 600 individuals, aged 20 years or above and considered representative of the population of the city of Dakar, were evaluated. Socioeconomic characteristics, hypertension, capillary whole blood glucose, and weight and height measurements of these subjects were collected during face-to-face interviews. The statistical analyses used chi-square (chi2) tests and binary logistic regressions. RESULTS The percentage of participants with fasting blood glucose levels greater than or equal to 1.10 g/L and/or currently being treated for diabetes was 17.9% (n=107, 95% CI: 14.7-20.8). Observed rates of diabetes were significantly higher among women (chi2 = 6.3; P < 0.05), in subjects aged > 40 years (chi2=33.6; P < 0.001), in those with low educational levels (chi2=11.9; P < 0.05) and in those with hypertension (chi2 = 13.9; P < 0.001), and in those who were overweight (BMI ≥ 25 kg/m2 and < 30 kg/m2) or obese (BMI ≥ 30 kg/m2; chi2=40.3; P < 0.001). After adjusting for gender, age, educational level, BMI and blood pressure, the results showed that gender, age and BMI were associated with diabetes: women, older people and those with a higher BMI had significantly greater chances of being diabetic than the rest of the population, whatever their blood pressure and educational level. CONCLUSION Diabetes is becoming a pressing public-health problem in Senegal, and the major risk factors for the increasing diabetes prevalence in the city of Dakar are gender, age and body mass index.
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Affiliation(s)
- P Duboz
- UMR 6578 laboratoire d'anthropologie bioculturelle, CNRS, établissement français du sang, faculté de médecine secteur Nord, université de la Méditerranée, boulevard Pierre-Dramard, 13955 Marseille cedex 15, France.
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Nshisso LD, Reese A, Gelaye B, Lemma S, Berhane Y, Williams MA. Prevalence of hypertension and diabetes among Ethiopian adults. Diabetes Metab Syndr 2012; 6:36-41. [PMID: 23014253 PMCID: PMC3460264 DOI: 10.1016/j.dsx.2012.05.005] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To determine the prevalence of hypertension and diabetes among members of an Ethiopian occupational cohort; and to examine the proportion of adults who were aware of their conditions. METHODS A total of 2153 of subjects were included in this cross-sectional study. The World Health Organization STEPwise approach for non-communicable diseases was used to collect socio-demographic data, blood pressure measures and blood samples from participants. Prevalence estimates for hypertension and diabetes were determined separately. The 95% confidence intervals for prevalence estimates were also determined. RESULTS The overall prevalence of hypertension was 19.1% (95%CI: 17.1-20.8) and 22% (95%CI: 20.2-23.8) and 14.9% (95%CI: 13.4-16.4) among men and women respectively. The overall prevalence of diabetes was 6.5% (95%CI: 5.4-7.6) and 6.4% (95%CI: 5.0-7.8) and 6.6% (95%CI: 4.8-8.4) among men and women correspondingly. Notably, 15% of hypertensives reported never having had their blood pressure checked prior to the present study examination. Approximately 45% of participants who had their blood pressure checked were never diagnosed with hypertension, but were found to be hypertensive in our study. Approximately 27% of newly diagnosed diabetics (during this study) reported never having a previous blood glucose test. Among those who had their blood glucose assessed prior to this study, 17.4% were found to have diabetes but were never diagnosed. CONCLUSION The high prevalence of hypertension and diabetes reported in our study confirms findings from other Sub-Saharan Africa countries, and extends the literature to urban dwelling Ethiopians where non-communicable diseases are emerging as a major public health concern.
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Affiliation(s)
- Lemba D Nshisso
- Department of Epidemiology, Multidisciplinary International Research Training Program, University of Washington School of Public Health, Seattle, WA, USA
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Sobngwi E, Ndour-Mbaye M, Boateng KA, Ramaiya KL, Njenga EW, Diop SN, Mbanya JC, Ohwovoriole AE. Type 2 diabetes control and complications in specialised diabetes care centres of six sub-Saharan African countries: the Diabcare Africa study. Diabetes Res Clin Pract 2012; 95:30-6. [PMID: 22071431 DOI: 10.1016/j.diabres.2011.10.018] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2011] [Revised: 10/10/2011] [Accepted: 10/13/2011] [Indexed: 12/17/2022]
Abstract
AIM The Diabcare Africa project was carried out across six sub-Saharan African countries to collect standardised and comparable information for the evaluation of diabetes control, management and late complications in diabetic populations at specialist clinics. METHODS A cross-sectional, descriptive study of 2352 type-2 diabetes patients who were treated at specialist clinics for at least 12 months prior to the study. RESULTS The mean age of patients was 53.0±16.0 years and had 8.0±6.0 years known duration of diabetes. 47% had their HbA1c assessed in the past year (mean 8.2±2.4%) with 29% achieving a level <6.5%. 21% had BP within 130/80 mmHg and 65% were treated for hypertension. Fasting lipids were assessed in 45% of the patients with mean cholesterol level of 4.9±1.2 mmol/L, HDL-cholesterol of 1.3±0.7 mmol/L and triglycerides of 1.2±0.7 mmol/L. 13% of the patients were treated for hyperlipidaemia, mostly with statins. Background retinopathy (18%) and cataract (14%) were the most common eye complications. Macrovascular disease was rare, and 48% had neuropathy. CONCLUSIONS Half of the patients benefitted from standard care, and a third had appropriate glycaemic control - attributed to access to, rather than quality of care. This study provided evidence to support appropriate interventions to diabetic populations of sub-Saharan origin.
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Affiliation(s)
- Eugene Sobngwi
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, United Kingdom.
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Echouffo-Tcheugui JB, Kengne AP. Chronic non-communicable diseases in Cameroon - burden, determinants and current policies. Global Health 2011; 7:44. [PMID: 22112686 PMCID: PMC3251529 DOI: 10.1186/1744-8603-7-44] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2011] [Accepted: 11/23/2011] [Indexed: 11/10/2022] Open
Abstract
Cameroon is experiencing an increase in the burden of chronic non-communicable diseases (NCDs), which accounted for 43% of all deaths in 2002. This article reviews the published literature to critically evaluate the evidence on the frequency, determinants and consequences of NCDs in Cameroon, and to identify research, intervention and policy gaps. The rising trends in NCDs have been documented for hypertension and diabetes, with a 2-5 and a 10-fold increase in their respective prevalence between 1994 and 2003. Magnitudes are much higher in urban settings, where increasing prevalence of overweight/obesity (by 54-82%) was observed over the same period. These changes largely result from the adoption of unfavorable eating habits, physical inactivity, and a probable increasing tobacco use. These behavioral changes are driven by the economic development and social mobility, which are part of the epidemiologic transition. There is still a dearth of information on chronic respiratory diseases and cancers, as well as on all NDCs and related risk factors in children and adolescents. More nationally representative data is needed to tract risk factors and consequences of NCDs. These conditions are increasingly been recognized as a priority, mainly through locally generated evidence. Thus, national-level prevention and control programs for chronic diseases (mainly diabetes and hypertension) have been established. However, the monitoring and evaluation of these programs is necessary. Budgetary allocations data by the ministry of health would be helpful, to evaluate the investment in NCDs prevention and control. Establishing more effective national-level tobacco control measures and food policies, as well as campaigns to promote healthy diets, physical activity and tobacco cessation would probably contribute to reducing the burden of NCDs.
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Affiliation(s)
- Justin B Echouffo-Tcheugui
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.
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Lissock CNAA, Sobngwi E, Ngassam E, Ngoa Etoundi LS. Rural and urban differences in metabolic profiles in a Cameroonian population. Pan Afr Med J 2011; 10:1. [PMID: 22187583 PMCID: PMC3282926 DOI: 10.4314/pamj.v10i0.72204] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2011] [Accepted: 08/10/2011] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION 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. METHODS 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. RESULTS 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. CONCLUSION 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.
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Azevedo M, Alla S. Diabetes in sub-saharan Africa: kenya, mali, mozambique, Nigeria, South Africa and zambia. Int J Diabetes Dev Ctries 2011; 28:101-8. [PMID: 20165596 PMCID: PMC2822152 DOI: 10.4103/0973-3930.45268] [Citation(s) in RCA: 93] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Until a few years ago, a limited number of epidemiologists or public health experts mentioned the words “diabetes.” As new lifestyles, imported dietary practices, and globalization take roots in the developing world, as Africa is, today, diabetes and its complications are considered an epidemic in Africa, compelling African governments to start paying more attention to its impact as thousands of Africans run the risk of dying young. The potential severity of diabetes is such that some epidemiologists predict that its economic impact and death toll will surpass the ravages of HIV and AIDS in the near future. On the African sub-continent, present literature and the work of the World Diabetes Foundation have highlighted three countries, namely, Mali, Mozambique, and Zambia. However, the conditions in South Africa, Kenya, and Nigeria, some of the most developed areas of the continent, provide a clue to how people are coping and how governments are responding to diabetes and its full impact. This study is, therefore, a meta-summary of the incidence and prevalence of today's emerging silent killer or diabetes in Sub-Saharan Africa. The theme is that time is running out for Africa and that, as was for HIV/AIDS, by the time the governments wake up and stop denying the catastrophic potential of the epidemic, diabetes will simply overwhelm the continent's resources, and the world will witness the death of millions of Africans. The last section is a call for action against diabetes in terms of advocacy, promotion of awareness, and public health policies that empower people to diabetes self-management.
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Affiliation(s)
- Mario Azevedo
- Department of Epidemiology and Biostatistics, College of Public Service Chair, School of Health Sciences, College of Public Service, Jackson State University, Mississippi, USA
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Jaffiol C. Le diabète sucré en Afrique : un enjeu de santé publique. BULLETIN DE L'ACADÉMIE NATIONALE DE MÉDECINE 2011. [DOI: 10.1016/s0001-4079(19)31983-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Dalal S, Beunza JJ, Volmink J, Adebamowo C, Bajunirwe F, Njelekela M, Mozaffarian D, Fawzi W, Willett W, Adami HO, Holmes MD. Non-communicable diseases in sub-Saharan Africa: what we know now. Int J Epidemiol 2011; 40:885-901. [PMID: 21527446 DOI: 10.1093/ije/dyr050] [Citation(s) in RCA: 363] [Impact Index Per Article: 25.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Sub-Saharan Africa (SSA) has a disproportionate burden of both infectious and chronic diseases compared with other world regions. Current disease estimates for SSA are based on sparse data, but projections indicate increases in non-communicable diseases (NCDs) caused by demographic and epidemiologic transitions. We review the literature on NCDs in SSA and summarize data from the World Health Organization and International Agency for Research on Cancer on the prevalence and incidence of cardiovascular diseases, diabetes mellitus Type 2, cancer and their risk factors. METHODS We searched the PubMed database for studies on each condition, and included those that were community based, conducted in any SSA country and reported on disease or risk factor prevalence, incidence or mortality. RESULTS We found few community-based studies and some countries (such as South Africa) were over-represented. The prevalence of NCDs and risk factors varied considerably between countries, urban/rural location and other sub-populations. The prevalence of stroke ranged from 0.07 to 0.3%, diabetes mellitus from 0 to 16%, hypertension from 6 to 48%, obesity from 0.4 to 43% and current smoking from 0.4 to 71%. Hypertension prevalence was consistently similar among men and women, whereas women were more frequently obese and men were more frequently current smokers. CONCLUSIONS The prevalence of NCDs and their risk factors is high in some SSA settings. With the lack of vital statistics systems, epidemiologic studies with a variety of designs (cross-sectional, longitudinal and interventional) capable of in-depth analyses of risk factors could provide a better understanding of NCDs in SSA, and inform health-care policy to mitigate the oncoming NCD epidemic.
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Affiliation(s)
- Shona Dalal
- Department of Epidemiology, Harvard School of Public Health, Boston, MA 02115, USA.
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Fezeu L, Fointama E, Ngufor G, Mbeh G, Mbanya JC. Diabetes awareness in general population in Cameroon. Diabetes Res Clin Pract 2010; 90:312-8. [PMID: 20933293 DOI: 10.1016/j.diabres.2010.06.029] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2010] [Accepted: 06/28/2010] [Indexed: 12/21/2022]
Abstract
BACKGROUND A good knowledge about diabetes could lead to early diagnosis and improved management. OBJECTIVE To evaluate the level of diabetes awareness in Cameroonians, and to identify factors that influence this awareness. METHODS In subjects aged ≥ 25 years (n=1000, 93.4% of response), details regarding risk factors, symptoms, treatment and complications of type 2 diabetes were collected. One mark was attributed to each true answer and a global diabetes awareness score was computed. Influence of age, gender, educational level, occupational level, notion of a relative having a chronic condition and presence of chronic disease were analyzed. RESULTS Eighty percent of subjects scored more than the total mean score. The highest score obtained by participants (0.10%) was 28/30. The mean total score was higher in men (p < 0.02) and in subjects with a relative having a chronic condition (p < 0.001). In multivariate analyses, age classes (p < 0.01), educational level (p < 0.001) and relatives with a chronic condition (p < 0.001) were associated to the global diabetes awareness score. CONCLUSIONS Diabetes awareness was generally good. This may be due to the fact that the study was conducted in an area where health promotion and health education on diabetes have been intensively delivered for the past 4 years.
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Affiliation(s)
- Leopold Fezeu
- Health of Populations in Transition Research Group, Cameroon, France.
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Evaristo-Neto AD, Foss-Freitas MC, Foss MC. Prevalence of diabetes mellitus and impaired glucose tolerance in a rural community of Angola. Diabetol Metab Syndr 2010; 2:63. [PMID: 21040546 PMCID: PMC2987913 DOI: 10.1186/1758-5996-2-63] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2010] [Accepted: 11/01/2010] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND To determine the prevalence of diabetes mellitus (DM) and impaired glucose tolerance (IGT) in a rural community (Bengo) of Angola. METHODS A random sample of 421 subjects aged 30 to 69 years (30% men and 70% women) was selected from three villages of Bengo province. This cross-sectional home survey was conducted using a sampling design of stage conglomerates. First, clinical and anthropometric data were obtained and fasting capillary glucose level was determined. Subjects who screened positive (fasting capillary glucose ≥ 100 mg/dl and < 200 mg/dl) and each sixth consecutive subject who screened negative (fasting capillary glucose < 100 mg/dl) were submitted to the second phase of survey, consisting of the 75-g oral glucose tolerance test. Data was analyzed by the use of SAS statistical software. RESULTS The prevalence rates of diabetes mellitus and IGT were 2.8% and 8.1%, respectively. The age group with the highest prevalence of diabetes was 60 to 69 years (42%). Impaired glucose tolerance prevalence was 38% in the 40 to 49 year age group and it increased with age, considering that the 50 to 59 and 60 to 69 year age groups as a whole represent 50% of all subjects with impaired glucose tolerance. The prevalence of diabetes mellitus did not differ significantly between men (3.2%) and women (2.7%) (p = 0.47). On the other hand, the prevalence of impaired glucose tolerance among women showed almost twice that found in men (9.1% vs. 5.6%, respectively). Overweight was present in 66.7% of the individuals with diabetes mellitus and 26.5% of individuals with impaired glucose tolerance showed overweight or obesity. CONCLUSIONS Although the prevalence of diabetes mellitus was low, the prevalence of impaired glucose tolerance is considered to be within an intermediary range, suggesting a future increase in the frequency of diabetes in this population.
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Affiliation(s)
- Antonio D Evaristo-Neto
- Department of Internal Medicine, Endocrinology and Metabolism Division, Ribeirào Preto School of Medicine, Sào Paulo University, Brazil
| | - Maria Cristina Foss-Freitas
- Department of Internal Medicine, Endocrinology and Metabolism Division, Ribeirào Preto School of Medicine, Sào Paulo University, Brazil
| | - Milton C Foss
- Department of Internal Medicine, Endocrinology and Metabolism Division, Ribeirào Preto School of Medicine, Sào Paulo University, Brazil
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Mbeh GN, Edwards R, Ngufor G, Assah F, Fezeu L, Mbanya JC. Traditional healers and diabetes: results from a pilot project to train traditional healers to provide health education and appropriate health care practices for diabetes patients in Cameroon. Glob Health Promot 2010; 17:17-26. [PMID: 20595335 DOI: 10.1177/1757975910363925] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In resource-limited countries where the challenge of diabetes management is especially severe, there has been a recent call for the inclusion of traditional healers in the fight against diabetes. In response, some researchers have highlighted the dangers of incorporating traditional healers while others, have presented them as a potential asset to the health care system if well trained and guided. We report here on a pilot intervention to include traditional healers in the health promotion and prevention efforts for diabetes in Cameroon, as part of the Cameroon Burden of Diabetes (CAMBoD) project. We trained 106 healers in a range of topics and practices relating to diabetes prevention and care. Eight months later we carried out a field evaluation of 36 of them using in-depth semi-structured interviews and direct observation methods to find out if they remembered and applied the learning from the training. Most healers recalled and were applying some of the lessons learnt, including referral of patients for blood glucose tests at biomedical health facilities, desisting from scarifying patients with diabetes, and educating their patients, peers and other people in their communities about diabetes. Healers were enthusiastic about collaboration with the diabetes control program, though some wanted additional responsibilities. We conclude that healers could learn prevention strategies of diabetes relatively rapidly and collaborate in health promotion.
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Affiliation(s)
- George N Mbeh
- Health of Populations in Transition Yaounde, Cameroon.
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Idemyor V. Diabetes in sub-Saharan Africa: health care perspectives, challenges, and the economic burden of disease. J Natl Med Assoc 2010; 102:650-3. [PMID: 20690330 DOI: 10.1016/s0027-9684(15)30643-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The growing incidence of diabetes mellitus in the world is a widespread concern. While there has been improvement in the epidemiology and management of the disease in the developed world, the same cannot be said in sub-Saharan Africa. The disease is getting less attention as is the funding that it merits compared to communicable diseases. Type 2 diabetes is becoming more prevalent due to rising rates of obesity, physical inactivity, and urbanization. In contrast to the developed world, where the majority of the people with diabetes are over the age of 60 years, the sub-Saharan Africa diabetic population is in the economically productive age group of 30 to 45 years. The late diagnosis of diabetes in this region, coupled with inequalities in accessing care, leads to early presentations of diabetic complications. The health care delivery agenda is overwhelmed by poverty, as such diabetes management costs have to compete with other health issues such as antiretroviral drugs for HIV/ AIDS, tuberculosis treatment, and malarial control programs. There is an urgent need to place diabetes on the national health agenda in sub-Saharan Africa and ensure that this agenda is properly positioned and integrated into the health policies and strategies.
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Affiliation(s)
- Vincent Idemyor
- University of Port Harcourt College of Health Sciences, Port Harcourt, Nigeria.
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Abstract
While communicable diseases such as human immunodeficiency virus/acquired immune deficiency syndrome, malaria, and tuberculosis have continued to pose greater threats to the public health system in sub-Saharan Africa (SSA), it is now apparent that non-communicable diseases such as diabetes mellitus are undoubtedly adding to the multiple burdens the peoples in this region suffer. Type 2 diabetes mellitus (T2DM) is the most common form of diabetes (90-95%), exhibiting an alarming prevalence among peoples of this region. Its main risk factors include obesity, rapid urbanization, physical inactivity, ageing, nutrition transitions, and socioeconomic changes. Patients in sub-Saharan Africa also show manifestations of beta-cell dysfunction and insulin resistance. However, because of strained economic resources and a poor health care system, most of the patients are diagnosed only after they have overt symptoms and complications. Microvascular complications are the most prevalent, but metabolic disorders and acute infections cause significant mortality. The high cost of treatment of T2DM and its comorbidities, the increasing prevalence of its risk factors, and the gaps in health care system necessitate that solutions be planned and implemented urgently. Aggressive actions and positive responses from well-informed governments appear to be needed for the conducive interplay of all forces required to curb the threat of T2DM in sub-Saharan Africa. Despite the varied ethnic and transitional factors and the limited population data on T2DM in sub-Saharan Africa, this review provides an extensive discussion of the literature on the epidemiology, risk factors, pathogenesis, complications, treatment, and care challenges of T2DM in this region.
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Affiliation(s)
- Vivian C Tuei
- Department of Molecular Biosciences, Bioengineering University of Hawaii, Honolulu, USA
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Muyer MT, Muls E, Mapatano MA, Makulo R, Mvitu M, Kimenyembo W, Mandja M, Kimbondo P, Bieleli E, Kaïmbo wa Kaïmbo D, Nseka N, Okitolonda W, Truyers C, Buntinx F. Estimating prevalence of diabetes in a Congolese town was feasible. J Clin Epidemiol 2010; 64:172-81. [PMID: 20705425 DOI: 10.1016/j.jclinepi.2010.03.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2009] [Revised: 03/16/2010] [Accepted: 03/29/2010] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To study prevalence, determinants, and complications at diagnosis of diabetes and intermediate hyperglycemia (IH) in Kisantu, a semirural town in Bas-Congo province, Democratic Republic of Congo. STUDY DESIGN AND SETTING A large-scale analytical cross-sectional population-based survey was performed in 2007 in Kisantu. After extensive sensitization, the study sample was collected using a modified World Health Organization (WHO) STEPwise strategy, taking subsequently a random sample of streets, households within streets, and inhabitants aged 20 years and older within households. After informed consent, subjects were invited to fixed sites for interview, anthropometry, clinical examination (blood pressure, monofilament, and ophthalmology), and biochemical tests (fasting capillary glucose, serum creatinine, and albuminuria). Fasting glycemia was repeated or 2-hour postload glycemia was measured the next day in subjects with an initial glycemia of 126-199 mg/dL (7.0-11.1 mmol/L) or 100-125 mg/dL (5.6-6.9 mmol/L), respectively. Hence, prevalence of diabetes, impaired fasting glucose, and impaired glucose tolerance according to both 2006 WHO/International Diabetes Federation and 2003 American Diabetes Association criteria could be evaluated. Bivariate and multivariate analyses were used for statistical analyses. RESULTS Response rate was 93.7% (1,898 of 2,025). Complete data were available in 1,866 (92.1%) subjects. CONCLUSION Estimating the prevalence of diabetes and IH in a small Congolese town was proven to be feasible.
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Affiliation(s)
- Muel Telo Muyer
- Ecole de Santé Publique, Université de Kinshasa Kinshasa, Democratic Republic of Congo
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Abstract
In Sub-Saharan Africa, prevalence and burden of type 2 diabetes are rising quickly. Rapid uncontrolled urbanisation and major changes in lifestyle could be driving this epidemic. The increase presents a substantial public health and socioeconomic burden in the face of scarce resources. Some types of diabetes arise at younger ages in African than in European populations. Ketosis-prone atypical diabetes is mostly recorded in people of African origin, but its epidemiology is not understood fully because data for pathogenesis and subtypes of diabetes in sub-Saharan African communities are scarce. The rate of undiagnosed diabetes is high in most countries of sub-Saharan Africa, and individuals who are unaware they have the disorder are at very high risk of chronic complications. Therefore, the rate of diabetes-related morbidity and mortality in this region could grow substantially. A multisectoral approach to diabetes control and care is vital for expansion of socioculturally appropriate diabetes programmes in sub-Saharan African countries.
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Affiliation(s)
- Jean Claude N Mbanya
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon.
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Fezeu L, Balkau B, Sobngwi E, Kengne AP, Vol S, Ducimetiere P, Mbanya JC. Waist circumference and obesity-related abnormalities in French and Cameroonian adults: the role of urbanization and ethnicity. Int J Obes (Lond) 2010; 34:446-53. [PMID: 20065972 PMCID: PMC2941697 DOI: 10.1038/ijo.2009.256] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVES To evaluate the effect of urbanization and ethnicity on correlations between waist circumference (WC) and obesity-related cardiovascular risk factors. METHODS 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. RESULTS 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. CONCLUSION 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.
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Affiliation(s)
- L Fezeu
- INSERM U780-IFR69, Epidemiological and Biostatistical Research, Villejuif, France.
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Napoli N, Mottini G, Arigliani M, Creta A, Giua R, Incammisa A, Carotti S, Sihom F, Yimagou I, Alombah R, Mbanya JC, Pozzilli P. Unexpectedly high rates of obesity and dysglycemia among villagers in Cameroon. Diabetes Metab Res Rev 2010; 26:10-2. [PMID: 20101655 DOI: 10.1002/dmrr.1036] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Our survey in Cameroon recorded obesity and dysglycemia in inhabitants, which are similar to those reported elsewhere in the region. Typically these metabolic disturbances are attributed to the adoption of a new urban lifestyle including diminished physical activity and an altered ('Western') diet. Unexpectedly we found that, like urban populations, our rural population had high rates of metabolic disturbances, despite living in villages and being physically active and consuming traditional diet that is high in plant sources of food and low in meat. From our preliminary study, we raise the possibility that the environmental elements that are driving the pandemic of obesity and diabetes in sub-Saharan Africa are far more complex than heretofore appreciated.
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Affiliation(s)
- Nicola Napoli
- Department of Endocrinology and Diabetes, University Campus Bio-Medico, Rome, Italy
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Chemometrics as an option to assess clinical data from diabetes mellitus type 2 patients. Open Med (Wars) 2009. [DOI: 10.2478/s11536-009-0059-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
AbstractThe present study deals with the application of two major multivariate statistical approaches - Cluster Analysis (CA) and Principal Components Analysis (PCA) as an option for assessment of clinical data from diabetes mellitus type 2 patients. One hundred clinical cases of patients are considered as object of the statistical classification and modeling, each one of them characterized by 34 various clinical parameters. The goal of the study was to find patterns of similarity, both between the patients and the clinical tests. Each group of similarity is interpreted revealing at least five clusters of correlated parameters or five latent factors, which determine the data structure. Relevant explanation of the clustering is found based on the pattern of similarity like glucose level, anthropometric data, enzyme level, liver function, kidney function etc. It is assumed that this classification could be of help in optimizing the performance of clinical test for this type of patients and for designing a pattern for the role of the different groups of test in determining the metabolic syndrome of the patients.
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BeLue R, Okoror TA, Iwelunmor J, Taylor KD, Degboe AN, Agyemang C, Ogedegbe G. An overview of cardiovascular risk factor burden in sub-Saharan African countries: a socio-cultural perspective. Global Health 2009; 5:10. [PMID: 19772644 PMCID: PMC2759909 DOI: 10.1186/1744-8603-5-10] [Citation(s) in RCA: 207] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2009] [Accepted: 09/22/2009] [Indexed: 02/07/2023] Open
Abstract
Background Sub-Saharan African (SSA) countries are currently experiencing one of the most rapid epidemiological transitions characterized by increasing urbanization and changing lifestyle factors. This has resulted in an increase in the incidence of non-communicable diseases, especially cardiovascular disease (CVD). This double burden of communicable and chronic non-communicable diseases has long-term public health impact as it undermines healthcare systems. Purpose The purpose of this paper is to explore the socio-cultural context of CVD risk prevention and treatment in sub-Saharan Africa. We discuss risk factors specific to the SSA context, including poverty, urbanization, developing healthcare systems, traditional healing, lifestyle and socio-cultural factors. Methodology We conducted a search on African Journals On-Line, Medline, PubMed, and PsycINFO databases using combinations of the key country/geographic terms, disease and risk factor specific terms such as "diabetes and Congo" and "hypertension and Nigeria". Research articles on clinical trials were excluded from this overview. Contrarily, articles that reported prevalence and incidence data on CVD risk and/or articles that report on CVD risk-related beliefs and behaviors were included. Both qualitative and quantitative articles were included. Results The epidemic of CVD in SSA is driven by multiple factors working collectively. Lifestyle factors such as diet, exercise and smoking contribute to the increasing rates of CVD in SSA. Some lifestyle factors are considered gendered in that some are salient for women and others for men. For instance, obesity is a predominant risk factor for women compared to men, but smoking still remains mostly a risk factor for men. Additionally, structural and system level issues such as lack of infrastructure for healthcare, urbanization, poverty and lack of government programs also drive this epidemic and hampers proper prevention, surveillance and treatment efforts. Conclusion Using an African-centered cultural framework, the PEN3 model, we explore future directions and efforts to address the epidemic of CVD risk in SSA.
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Affiliation(s)
- Rhonda BeLue
- Department of Health Policy and Administration, 604 Ford Building, The Pennsylvania State University, University Park, PA, USA
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