Drivers of the Adoption and Exclusive Use of Clean Fuel for Cooking in Sub-Saharan Africa: Learnings and Policy Considerations from Cameroon

Household air pollution (HAP) caused by the combustion of solid fuels for cooking and heating is responsible for almost 5% of the global burden of disease. In response, the World Health Organisation (WHO) has recommended the urgent need to scale the adoption of clean fuels, such as liquefied petroleum gas (LPG), in low and middle-income countries (LMICs). To understand the drivers of the adoption and exclusive use of LPG for cooking, we analysed representative survey data from 3343 peri-urban and rural households in Southwest Cameroon. Surveys used standardised tools to collect information on fuel use, socio-demographic and household characteristics and use of LPG for clean cooking. Most households reported LPG to be clean (95%) and efficient (88%), but many also perceived it to be expensive (69%) and unsafe (64%). Positive perceptions about LPG's safety (OR = 2.49, 95% CI = 2.04, 3.05), cooking speed (OR = 4.31, 95% CI = 2.62, 7.10), affordability (OR = 1.7, 95% CI = 1.38, 2.09), availability (OR = 2.17, 95% CI = 1.72, 2.73), and its ability to cook most dishes (OR = 3.79, 95% CI = 2.87, 5.01), were significantly associated with exclusive LPG use. Socio-economic status (higher education) and household wealth (higher income) were also associated with a greater likelihood of LPG adoption. Effective strategies to raise awareness around safe use of LPG and interventions to address financial barriers are needed to scale wider adoption and sustained use of LPG for clean cooking, displacing reliance on polluting solid fuels

The prognostic value of serum uric acid in the acute phase of hemorrhagic stroke patients in black Africans

Introduction: very few studies have been conducted to evaluate the prevalence of hyperuricemia and its impact on the prognosis amongst acute hemorrhagic stroke (AHS) patients. The objectives was to determine the prevalence of hyperuricemia in AHS patients and examined the association between hyperuricemia and stroke outcomes in the Douala General Hospital (DGH). Methods: this was a hospital based prospective cohort which included AHS patients with baseline SUA levels and 3 months post stroke follow-up data. SUA values were divided into quintiles. Associations between hyperuricemia and stroke outcomes were analyzed using multiple logistic regression and survival analysis (cox regression and Kaplan Meier).   Results: a total of 221 AHS patients were reviewed with a mean age of 55.8±11.8 years. The prevalence of hyperuricemia among AHS patients was 34.4% with mean SUA level of 376.8±131.9 µmol/l. On multivariate analysis, hyperuricemia was not independently associated with early death [(OR = 1.072 (CI: 0.370-3.056; p = 0.897)] and poor functional outcome [(OR=2.487 (CI: 0.771-8.699; p = 0.154)] after hemorrhagic stroke. No significant increase in stroke deaths was observed across higher SUA quintiles amongst hemorrhagic stroke patients (p = 0.326). No statistically significant correlation was observed between SUA level and NIHSS (r = 0.063, p = 0.353) and between SUA level and mRS (r = 0.030, p = 0.662) in hemorrhagic stroke. Conclusion: about one third of patients present with hyperuricemia in the acute phase of hemorrhagic stroke. Hyperuricemia can act as risk factor for stroke because of its relationship with CVRFs but hyperuricemia has no impact on the severity and short-term outcome amongst black African hemorrhagic stroke patients

Pattern of venous thromboembolic diseases in a resources-limited setting in Cameroon

Introduction: Admission for a medical illness is associated with an increased risk of venous thrombo-embolism; however reports addressing at this issue are rare in Cameroon. We sought to assess the pattern of thrombo-embolism among in-medical patients of a semi-urban hospital. Methods: We prospectively included 79 hospitalized medical patients of the Military Hospital of Bamenda (north-west region-Cameroon). From July 2010 and December 2013, we collected baseline demographic data, risk factors of venous thromboembolism, clinical presentation, diagnostic process and treatment. Results: In the 1445 patients admitted for medical illnesses, a total of 79 venous thrombo-embolic diseases were detected (55 deep vein thrombosis, 14 pulmonary embolism, 9 post-phlebitic syndrome and 1 cerulae alba dolens). The leading risk factors were prolonged immobilization (100%), age > 40 years (78.9%), obesity (43%), long distance travel (30.4%) and HIV-AIDS (21.5%). Thirty one (40.5%) had ≤ 2 cumulative risk factors, and 8 (10.1%) more than 4. All the patients in the group had a significant risk of deep vein thrombosis: 5 (6.3%), 34 (43%) and 40 (50.6%) with moderate, high and very high risk respectively. Increasing number of deep vein thrombosis was associated with increasing level of the risk and the clinical probability scores. Lower limb location of deep vein thrombosis was the most frequent with 75 (94.9%) cases. Almost all the patients received appropriate therapy with heparin and oral anticoagulant during their hospital stay. The mean length of hospital stay was 17.5 +/-15 (range 4- 62) days; disability and death occurred in 15 (19%) and 17 (21.5%) respectively. Conclusion: Venous thromboembolism is also a common concern in a semi-urban practice of our country. Long distance travel, one of the leading risk factors merits to be more specifically studied.Pan African Medical Journal 2016; 2

Spectre des maladies cérébro-vasculaires chez le sujet jeune à Douala

Introduction: Les accidents vasculaires cérébraux (AVC) constituent la seconde cause de mortalité dans le monde. Au Cameroun, les AVC du sujet jeune ne sont pas étudiés. L’objectif de ce travail était de déterminer la proportion des AVC du sujet jeune, les facteurs de risque cérébrovasculaire (FRCV) et de rechercher les facteurs prédictifs de décès intra-hospitalier à l’Hôpital Général de Douala (HGD). Méthodes: Il s’agissait d’une étude de cohorte prospective menée à l’HGD pendant une durée de 5 ans incluant les sujets âgés de 15 à 45 ans ayant fait un AVC confirmé par imagerie cérébrale. L’analyse univariée avait permis de déterminer les facteurs associés au décès et les facteurs ayant un p = 0,200 avaient été inclus pour l’analyse multivariée afin de déterminer les facteurs prédictifs de décès intra-hospitaliers. Résultats: 511 patients avaient été admis pour AVC dont 78 sujets jeunes (15,26%). Le sexe masculin était majoritaire (62,8%) et l’âge moyen des patients était de 38,36 ± 5,83 ans. L’hypertension artérielle (74,35%), l’alcoolisme (38,46%), les dyslipidémies (14,10%), le diabète (12,82%), l’obésité (11,53%) et le tabagisme (10,25%) étaient les principaux FRCV. Les AVC hémorragiques représentaient 56% des cas dont 11% d’hémorragie sousarachnoïdienne. La mortalité était de 26,92%. Le score de Glasgow inférieur 9/15 était apparu comme un facteur prédictif indépendant de décès intra-hospitalier (p = 0,02 ; OR = 0,12 ; IC 95% = 0,02-0,75). Conclusion: La proportion des AVC du sujet jeune est élevée ainsi que la mortalité. Les FRCV sont classiques et surtout modifiables d’où l’intérêt primordial de la sensibilisation, du dépistage précoce de la prise en charge des FRCV.Pan African Medical Journal 2016; 2

Evaluation of factors affecting adherence to asthma controller therapy in chest clinics in a sub-Saharan African setting: a cross-sectional study

Background: Adherence to controller therapy in asthma is a major concern during the management of the disease.Objective: To determine the adherence rate and identify the predictors of low adherence to asthma controller therapy.Methods: A cross-sectional study including asthma patients was conducted from November 1, 2012 to May 31, 2013 in 4 chest clinics in Cameroon. The adherence to asthma treatment was rated using Morisky Medication Adherence Scale. A multivariate logistic regression analysis was performed for the identification of factors associated with adherence to asthma treatment.Results: Among the 201 asthma patients included, 133 (66.2%) were female. The mean age of participants was 41.2 years. Sixty-one (30.3%) of the patients did not visit the chest physician during the last year prior to the study. Asthma was well controlled in 118 patients (58.7%). The prevalence of low adherence rate to asthma controller therapy was 44.8% and the absence of any chest specialist visit within the last 12 months was the only factor associated with the low adherence rate to asthma treatment (OR 5.57 ; 95% CI 2.84–10.93).Conclusion: The adherence rate to asthma controller therapy in Cameroon is low and it could be improved if scheduled visits are respected by patients.Keywords: Allergy, medication adherence, Afric

Serum Uric Acid Is Associated with Poor Outcome in Black Africans in the Acute Phase of Stroke

Background. Prognostic significance of serum uric acid (SUA) in acute stroke still remains controversial. Objectives. To determine the prevalence of hyperuricemia and its association with outcome of stroke patients in the Douala General Hospital (DGH). Methods. This was a hospital based prospective cohort study which included acute stroke patients with baseline SUA levels and 3-month poststroke follow-up data. Associations between high SUA levels and stroke outcomes were analyzed using multiple logistic regression and survival analysis (Cox regression and Kaplan-Meier). Results. A total of 701 acute stroke patients were included and the prevalence of hyperuricemia was 46.6% with a mean SUA level of 68.625 ± 24 mg/l. Elevated SUA after stroke was associated with death (OR = 2.067; 95% CI: 1.449–2.950; p < 0.001) but did not predict this issue. However, an independent association between increasing SUA concentration and mortality was noted in a Cox proportional hazards regression model (adjusted HR = 1.740; 95% CI: 1.305–2.320; p < 0.001). Furthermore, hyperuricemia was an independent predictor of poor functional outcome within 3 months after stroke (OR = 2.482; 95% CI: 1.399–4.404; p = 0.002). Conclusion. The prevalence of hyperuricemia in black African stroke patients is quite high and still remains a predictor of poor outcome

Prévalence du tabagisme chez le personnel de l'Hôpital Général de Douala, Cameroun

Introduction: La pr&eacute;valence du tabagisme parmi le personnel de sant&eacute; hospitalier au Cameroun n'est pas connue alors que le tabagisme est en expansion dans ce pays avec 13,2% de fumeurs selon l&rsquo;OMS. Pour combler ce manque une enqu&ecirc;te sur les consommations, les connaissances, opinions et attitudes vis-&agrave;-vis des fumeurs a &eacute;t&eacute; conduite &agrave; l&rsquo;H&ocirc;pital G&eacute;n&eacute;ral de Douala, l&rsquo;un des h&ocirc;pitaux de r&eacute;f&eacute;rence du Cameroun. M&eacute;thodes: Du 1er au 30 Avril 2010, des questionnaires anonymes ont &eacute;t&eacute; distribu&eacute;s par des enqu&ecirc;teurs dans les services ou via les surveillants et recueillis et analys&eacute;s de fa&ccedil;on anonyme. R&eacute;sultats: Sur 402 questionnaires distribu&eacute;s 277 ont &eacute;t&eacute; r&eacute;cup&eacute;r&eacute;s. La pr&eacute;valence de fumeurs est de 3,6% parmi les soignants et de 9,4% parmi les autres personnels soit en moyenne sur l&rsquo;ensemble de l&rsquo;h&ocirc;pital 5,4%. Les produits fum&eacute;s &eacute;taient toujours des cigarettes. L&rsquo;initiation du tabagisme &agrave; souvent &eacute;t&eacute; tardive (21,5 ans) et la d&eacute;pendance est absente ou faible chez 33% des fumeurs. Les personnes pensent que c&rsquo;est leur devoir de questionner sur le tabac et de prendre en charge les fumeurs, mais ils sont presque un sur deux &agrave; ignorer la loi Camerounaise. Conclusion: Le tabagisme chez le personnel hospitalier est une r&eacute;alit&eacute; au Cameroun ; le personnel soignant et les pouvoirs publics devraient s&rsquo;impliquer davantage dans la lutte contre ce fl&eacute;au qui est en expansion dans les pays du sud

Evaluation of factors affecting adherence to asthma controller therapy in chest clinics in a sub-Saharan African setting: a cross-sectional study

Background: Adherence to controller therapy in asthma is a major concern during the management of the disease. Objective: To determine the adherence rate and identify the predictors of low adherence to asthma controller therapy. Methods: A cross-sectional study including asthma patients was conducted from November 1, 2012 to May 31, 2013 in 4 chest clinics in Cameroon. The adherence to asthma treatment was rated using Morisky Medication Adherence Scale. A multivariate logistic regression analysis was performed for the identification of factors associated with adherence to asthma treatment. Results: Among the 201 asthma patients included, 133 (66.2%) were female. The mean age of participants was 41.2 years. Sixty-one (30.3%) of the patients did not visit the chest physician during the last year prior to the study. Asthma was well controlled in 118 patients (58.7%). The prevalence of low adherence rate to asthma controller therapy was 44.8% and the absence of any chest specialist visit within the last 12 months was the only factor associated with the low adherence rate to asthma treatment (OR 5.57 ; 95% CI 2.84\u201310.93). Conclusion: The adherence rate to asthma controller therapy in Cameroon is low and it could be improved if scheduled visits are respected by patients

Assessment of asthma control using asthma control test in chest clinics in Cameroon: a cross-sectional study

Introduction: The goal of asthma treatment is to obtain and maintain a good control of symptoms. Investigating factors associated with inadequately control asthma could help in strategies to improve asthma control. This study aimed to determine the prevalence and factors associated with inadequately controlled asthma in asthma patients under chest specialist care. Methods: A cross-sectional study was conducted from November 2012 to May 2013. Physician-diagnosed asthma patients aged 12 years and above were included. A questionnaire was used to collect demographic data, comorbidities, and medical history of asthma. Asthma control was assessed using the Asthma Control Test (ACT), with a score less than 20 for inadequately controlled asthma and a score greater or equal to 20 for controlled asthma. A multivariate analysis was used to identify factors associated with inadequately controlled asthma. Results: Overall, 243 patients were included in this study. Asthma was controlled in 141 patients (58%) and inadequately controlled in 102 (42%). The mean duration of asthma was 8 years with an interquartile range of 4 and 18 years. Forty-three participants (17.7%) were not under any controller medication while the mean ACT score was 19.3 ± 4.6. Independent associations were found between inadequately controlled asthma and female gender (OR 1.91; 95% CI 1.06-3.47) and obesity (OR 1.81; 1.01-3.27). Conclusion: Asthma remains poorly controlled in a large proportion of asthma patients under specialist care in Cameroon. Educational programs for asthma patients targeting women and based on weight loss for obese patients may help in improving the control of asthma.Pan African Medical Journal 2016; 2