Planned Health Care Non-Attendance and Asthma Control among Asthma Patients in Real Life Setting in an African Country: a Prospective Cohort Study

BACKGROUND: Compliance with scheduled medical visit is an indirect indicator of the adherence to treatment.The aim of this study was to determine the incidence of non-compliance with scheduled medical visits and investigate the predictors and relationship with disease control among patient with asthma in the sub-Saharan African setting. METHODS: We conducted a prospective study between January 2012 and August 2013. All patients with asthma receiving care at the Yaounde Jamot Hospital and CEDIMER medical practice were included. Planned medical visit occurred at month one; three; six and twelve following baseline evaluation. Regression models were employed to investigate the predictors of non-compliance. RESULTS: 186 patients [121 (65.1%) being female] were included. Their median age (25th-75th percentiles) was 35.5 (20.0-52.3) years. A total of 67 (36%) failed to attend at least one of the scheduled visits. The proportion of patients who failed to comply with scheduled visits was 48.4%; 68.8%; 73.5% and 79.5% at month one; three; six and twelve respectively. The accompanying rates of unacceptable asthma control were 17.2%; 24.4% and 20.8% respectively at three; six and twelve months of follow-up. Inadequate asthma control at baseline was the main predictor of non-compliance with medical visits; with adjusted odds ratio ranging from 2.00 to 4.67. Furthermore; non-sensitisation to non-pollinic aeroallergens was associated with 2.79 (95%CI 1.58-6.07) risk of non-compliance at one month of follow-up. CONCLUSION: Targeting education of patients with poorly controlled disease at baseline can potentially improve adherence to medical visit and anti-asthmatic treatments and outcomes of care

Clinical forms and determinants of different locations of extrapulmonary tuberculosis in an African country.

Background: Extra-pulmonary tuberculosis (EPTB) accounts for about 15% to 36% of all cases of TB and its prevalence has significantly increased with the advent of the global pandemic of human immune-deficiency virus (HIV) infection. A few studies are available on the determinants of EPTB. Aims: To determine the distribution and determinants of the main locations of EPTB in the context of high endemicity for HIV infection. Methods: This was a cross-sectional study among patients aged >15 years, receiving care in the pneumology service of the Yaounde Jamot Hospital, between October 2010 and December 2011. Logistic regressions were used to investigate potential determinants of different locations of EPTB. Results: Of the 788 eligible patients admitted during the study period, 100 (12.7%) had isolated EPTB, and 158 (20.1%) had both PTB and EPTB. Among 258 patients definitively included, 162 (62.8%) were men and the median age was 33 (25.75-44) years. Frequent extra-pulmonary locations of tuberculosis were lymph nodes (126 patients, 48.3%), pleura (121 patients, 46.4%) and peritoneum (25 patients, 9.6%). Using isolated pleural TB as a referent, independent determinants of isolated lymph node tuberculosis were HIV infection [odds ratio (95% CI), 2.58 (1.25-5.32)], duration of symptoms >6 weeks [2.41 (1.11-5.22)] and pulmonary involvement [2.39 (1.14-5.05)]. HIV infection [2.23 (1.06- 4.70)] and duration of symptoms >6 weeks [2.31 (1.08-4.96)] were also independent determinants of multifocal/disseminated tuberculosis. Conclusion: EPTB with or without concomitant PTB is frequent in this setting, with HIV infection being the main determinant.