Ten-year change in blood pressure levels and prevalence of hypertension in urban and rural Cameroon.

BACKGROUND: Hypertension is becoming increasingly important in sub-Saharan Africa. However, evidences in support of this trend with time are still not available. The aim of this study was to evaluate the 10-year change in blood pressure levels and prevalence of hypertension in rural and urban Cameroon. METHODS: Two cross-sectional population-based surveys in Yaounde (urban area) and Evodoula (rural area) in 1994 (1762 subjects) and 2003 (1398 subjects) used similar methodologies in women and men aged >or=24 years. Data on systolic and diastolic blood pressures (SBP and DBP), body mass index, educational level, alcohol consumption and tobacco smoking were collected during the two periods. RESULTS: Between 1994 and 2003, blood pressure levels significantly increased in rural women (SBP, +18.2 mm Hg; DBP, +11.9 mm Hg) and men (SBP, +18.8 mm Hg; DBP, +11.6 mm Hg), all p<0.001. In the urban area, SBP increased in women (+8.1 mm Hg, p<0.001) and men (+6.5 mm Hg, p<0.001), and DBP increased only in women (+3.3 mm Hg, p<0.001). The OR (95% CI) adjusted on confounders comparing the prevalence of hypertension (blood pressure >or= 140/90 mm Hg and/or treatment) between 2003 and 1994 ranged from 1.5 (1.1 to 2.2) in urban men to 5.3 (3.2 to 8.9) in rural men. CONCLUSION: Blood pressure levels of this population have deteriorated over time, and the prevalence of hypertension has increased by twofold to fivefold. Adverse effects of risk factors could account for some of these changes. Prevention and control programmes are needed to reverse these trends and to avoid the looming complications.

Classical cardiovascular risk factors and all-cause mortality in rural Cameroon.

BACKGROUND: High levels of cardiovascular risk factors have been reported in rural Africa. How these translate into major outcomes remain unknown. AIM: To assess the association between selected risk factors and all-cause mortality in rural Cameroon. DESIGN: Nine-year's prospective cohort study. METHODS: The 9-year's vital status was ascertained for 350 participants screened for cardiovascular risk factors in Bafut, Cameroon in 1998. Cox models were used to compute the hazard ratio (HR) and 95% confidence interval (CI) for selected risk factors. RESULTS: Vital status was available for all participants, except 22 (6.3%) who were excluded from analyses. At baseline, compared with women, men had significantly higher waist-to-hip ratio, were more likely to be ex- or current smokers and alcohol consumers (all P < or = 0.008). The total duration of follow-up was 2771 person-years. This duration was longer for women (P = 0.04). During follow-up 47 deaths were recorded, 31 (66%) in men (P = 0.023). In multivariate Cox analyses, age, male gender, current smoking, systolic blood pressure and fasting capillary glucose were significant predictors of total mortality during follow-up. CONCLUSION: Gender, smoking, fasting capillary glucose, blood pressures and age are potential determinants of overall death in rural Cameroon. More elaborated cohort studies are needed to refine these conclusions and monitor the progression of these populations through epidemiological transition stages.

The Burden of High Blood Pressure and Related Risk Factors in Urban Sub-Saharan Africa: Evidences from Douala in Cameroon

Objective: To provide the current burden of high blood pressure and related risk factors in urban setting in Cameroon. Methods:We used the WHO STEPS approach for Surveil-lance of non-communicable diseases and their risk factors to collect data from 2;559 adults aged 15-99 years; residing at Cite des Palmiers in Douala; Cameroon. Results: The level of education was low with up to 60of participants totalizing less than primary school. Smoking habits were 6 times more frequent in men (p0.001) and 85of participants reported alcohol consumption. Sedentary lifestyles at work and at leisure time were prevalent. Women displayed high prevalence of obesity in general.The mean blood pressure and the prevalence of hypertension increased with age in men and women.The prevalence of hypertension was 20.8; and the risk of hypertension significantly increased with clustering of risk factors in the general population (p=0.001) and in men (p=0.008). Conclusions: This study provides additional evidence on the growing problem of hypertension and related risk factors in urban Cameroon; and confirms the feasibility of using the WHO STEPS approach for the surveillance of NCDs in Africa. There is a need for rapid implementation of preventive strategies in the country

Knowledge, attitudes and practices of nursing staff in a rural hospital of Cameroon: how much does the health care provider know about the human immunodeficiency virus/acquired immune deficiency syndrome?

Qualitative and quantitative approaches were used in a rural hospital of Cameroon to assess how much nursing personnel know about and practise in regard to human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS), and to determine health service factors that influence knowledge, attitudes and practices (KAP). Participants included 107 nursing and laboratory staff and 62 patients with AIDS. Self-administered questionnaires were used for nurses, and close-ended questionnaires were administered to patients with AIDS (as a verification tool for staff responses). Focus group discussions (FGD) held with nurse supervisors evaluated health service factors that influence KAP. Overall, 70.1% of the nurses who responded scored highly in the knowledge section compared to 50.5% in the attitude and practice section. There were several outstanding misconceptions and malpractices about HIV/AIDS. Knowledge, but not attitude, was significantly influenced by the grade of the staff (P< 0.001 and P = 0.17, respectively). Approximately 15% of 62 patients with AIDS indicated that they were attended to with signs of disgust and/or hatred. The major health service factors thought to influence KAP, confirmed by many in all the FGD, included: the lack of adequate information; the lack of commitment to alter attitudes and practices; the lack of in-service promotions; and the ongoing fear of becoming infected with the virus through caring for patients with AIDS. Low income also seemed to have an influence on KAP. Therefore, it is imperative that ongoing education programmes are provided for nurses to enable them to meet the needs of the increasing HIV prevalence in our community. Information, education and communication, and compliance with international working norms, remain essential tools in the control of HIV/AIDS spread in our hospital settings.