Determinants of outcome of children with type 1 diabetes in the North West Region of Cameroon

Background: In sub-Saharan Africa the prognosis of children with type 1 diabetes is poor. Many are not diagnosed and those that are diagnosed have a reduced life expectancy (less than one year). This study set out to identify the factors that predict glucose control in children and adolescents with type 1 diabetes in the North West Region of Cameroon. Methods: A hospital based cross-sectional study involving 76 children/adolescents (41 girls and 35 boys, mean age of 15.1 ± 3.1 years) suffering from type 1 diabetes included in the “Changing Diabetes in Children” (CDiC) program and attending the clinics for children living with type 1 diabetes in the North West Region. Data on glycosylated haemoglobin (HbA1c) as well as clinical and biochemical parameters at diagnosis and during the study period were obtained from the hospital records of participants. A structured questionnaire was used to obtain information on socio-demographic characteristics and diabetes related practices from participants. Odds ratios (OR) were calculated using logistic regression to assess the association between determinants and good glucose control. Results: The study population had a mean HbA1c of 10.3 ± 2.9%. There was a significant decrease in the mean HbA1c from diagnosis (11.1%) to the study period (10.3%) (p = 0.011). Multivariate analysis indicated that having a mother as the primary caregiver (OR 0.02, 95% CI 0.002 – 0.189) and minimal/moderate caregiver involvement in insulin injection (OR 26.8, 95% CI 4.4 – 56.1) were independent predictors of glucose control. Conclusion: This study has demonstrated that having a mother as a primary caregiver is an important predictor of good glycaemic control among children with type 1 diabetes. It is currently unclear whether the direct involvement of the mother is important or whether “mother as a primary caregiver” is a strong indicator for a setting in which diabetes treatment is possible

Determinants of outcome of children with type 1 diabetes in the North West Region of Cameroon

Background: In sub-Saharan Africa the prognosis of children with type 1 diabetes is poor. Many are not diagnosed and those that are diagnosed have a reduced life expectancy (less than one year). This study set out to identify the factors that predict glucose control in children and adolescents with type 1 diabetes in the North West Region of Cameroon. Methods: A hospital based cross-sectional study involving 76 children/adolescents (41 girls and 35 boys, mean age of 15.1 ± 3.1 years) suffering from type 1 diabetes included in the “Changing Diabetes in Children” (CDiC) program and attending the clinics for children living with type 1 diabetes in the North West Region. Data on glycosylated haemoglobin (HbA1c) as well as clinical and biochemical parameters at diagnosis and during the study period were obtained from the hospital records of participants. A structured questionnaire was used to obtain information on socio-demographic characteristics and diabetes related practices from participants. Odds ratios (OR) were calculated using logistic regression to assess the association between determinants and good glucose control. Results: The study population had a mean HbA1c of 10.3 ± 2.9%. There was a significant decrease in the mean HbA1c from diagnosis (11.1%) to the study period (10.3%) (p = 0.011). Multivariate analysis indicated that having a mother as the primary caregiver (OR 0.02, 95% CI 0.002 – 0.189) and minimal/moderate caregiver involvement in insulin injection (OR 26.8, 95% CI 4.4 – 56.1) were independent predictors of glucose control. Conclusion: This study has demonstrated that having a mother as a primary caregiver is an important predictor of good glycaemic control among children with type 1 diabetes. It is currently unclear whether the direct involvement of the mother is important or whether “mother as a primary caregiver” is a strong indicator for a setting in which diabetes treatment is possible

Ongoing and planned activities to improve the management of patients with Type 1 diabetes across Africa : implications for the future

BACKGROUND: Currently about 19 million people in Africa are known to be living with diabetes, mainly Type 2 diabetes (T2DM) (95%), estimated to grow to 47 million people by 2045. However, there are concerns with early diagnosis of patients with Type 1 diabetes (T1DM) as often patients present late with complications. There are also challenges with access and affordability of insulin, monitoring equipment and test strips with typically high patient co-payments, which can be catastrophic for families. These challenges negatively impact on the quality of care of patients with T1DM increasing morbidity and mortality. There are also issues of patient education and psychosocial support adversely affecting patients' quality of life. These challenges need to be debated and potential future activities discussed to improve the future care of patients with T1DM across Africa. METHODOLOGY: Documentation of the current situation across Africa for patients with T1DM including the epidemiology, economics, and available treatments within public healthcare systems as well as ongoing activities to improve their future care. Subsequently, provide guidance to all key stakeholder groups going forward utilizing input from senior-level government, academic and other professionals from across Africa. RESULTS: Whilst prevalence rates for T1DM are considerably lower than T2DM, there are concerns with late diagnosis as well as the routine provision of insulin and monitoring equipment across Africa. High patient co-payments exacerbate the situation. However, there are ongoing developments to address the multiple challenges including the instigation of universal health care and partnerships with non-governmental organizations, patient organizations, and pharmaceutical companies. Their impact though remains to be seen. In the meantime, a range of activities has been documented for all key stakeholder groups to improve future care. CONCLUSION: There are concerns with the management of patients with T1DM across Africa. A number of activities has been suggested to address this and will be monitored

Availability and use of long-acting insulin analogues including their biosimilars across Africa; findings and implications

Background: Prevalence rates of diabetes mellitus are growing across Africa with an appreciable number likely to be on insulin to manage their condition. This has significant implications on future morbidity and mortality exacerbated by high complication rates. Complication rates in patients requiring insulins are enhanced by hypoglycaemia. Long-acting insulin analogues were developed to reduce hypoglycaemia and improve patient compliance. However, they are typically appreciably more expensive than human and other insulins in Africa, and continuing controversies surrounding their benefits limits their listing on national essential medicine lists (EMLs). Biosimilars can reduce the prices long-acting insulin analogues. This needs assessing. Methods: Mixed methods approach including documentation of insulin utilisation patterns and prices among a range of African countries. In addition, input from senior level government, academic, and healthcare professionals from across Africa on the current situation with long-acting insulin analogues as well as potential changes needed to enhance future funding of long-acting analogue biosimilars. Results: There is variable listing of long-acting insulin analogues on national EMLs across Africa due to their high prices and issues of affordability. Even when listed, utilisation of long-acting insulin analogues is limited by similar issues including affordability. Appreciably lowering the prices of long-acting insulin analogues via biosimilars should enhance future listing on EMLs and use accompanied by educational and other initiatives. However, this will require increased competition to lower prices. Conclusion: There are concerns with value and funding of long-acting insulin analogues across Africa including biosimilars. A number of activities have been identified to improve future funding and listing on EMLs

Strategies to Improve Antimicrobial Utilization with a Special Focus on Developing Countries

From MDPI via Jisc Publications RouterHistory: accepted 2021-06-02, pub-electronic 2021-06-07Publication status: PublishedAntimicrobial resistance (AMR) is a high priority across countries as it increases morbidity, mortality and costs. Concerns with AMR have resulted in multiple initiatives internationally, nationally and regionally to enhance appropriate antibiotic utilization across sectors to reduce AMR, with the overuse of antibiotics exacerbated by the COVID-19 pandemic. Effectively tackling AMR is crucial for all countries. Principally a narrative review of ongoing activities across sectors was undertaken to improve antimicrobial use and address issues with vaccines including COVID-19. Point prevalence surveys have been successful in hospitals to identify areas for quality improvement programs, principally centering on antimicrobial stewardship programs. These include reducing prolonged antibiotic use to prevent surgical site infections. Multiple activities centering on education have been successful in reducing inappropriate prescribing and dispensing of antimicrobials in ambulatory care for essentially viral infections such as acute respiratory infections. It is imperative to develop new quality indicators for ambulatory care given current concerns, and instigate programs with clear public health messaging to reduce misinformation, essential for pandemics. Regular access to effective treatments is needed to reduce resistance to treatments for HIV, malaria and tuberculosis. Key stakeholder groups can instigate multiple initiatives to reduce AMR. These need to be followed up

Response to the Novel Corona Virus (COVID-19) Pandemic Across Africa: Successes, Challenges, and Implications for the Future

Background: The COVID-19 pandemic has already claimed considerable lives. There are major concerns in Africa due to existing high prevalence rates for both infectious and non-infectious diseases and limited resources in terms of personnel, beds and equipment. Alongside this, concerns that lockdown and other measures will have on prevention and management of other infectious diseases and non-communicable diseases (NCDs). NCDs are an increasing issue with rising morbidity and mortality rates. The World Health Organization (WHO) warns that a lack of nets and treatment could result in up to 18 million additional cases of malaria and up to 30,000 additional deaths in sub-Saharan Africa. Objective: Document current prevalence and mortality rates from COVID-19 alongside economic and other measures to reduce its spread and impact across Africa. In addition, suggested ways forward among all key stakeholder groups. Our Approach: Contextualise the findings from a wide range of publications including internet-based publications coupled with input from senior-level personnel. Ongoing Activities: Prevalence and mortality rates are currently lower in Africa than among several Western countries and the USA. This could be due to a number of factors including early instigation of lockdown and border closures, the younger age of the population, lack of robust reporting systems and as yet unidentified genetic and other factors. Innovation is accelerating to address concerns with available equipment. There are ongoing steps to address the level of misinformation and its consequences including fines. There are also ongoing initiatives across Africa to start addressing the unintended consequences of COVID-19 activities including lockdown measures and their impact on NCDs including the likely rise in mental health disorders, exacerbated by increasing stigma associated with COVID-19. Strategies include extending prescription lengths, telemedicine and encouraging vaccination. However, these need to be accelerated to prevent increased morbidity and mortality. Conclusion: There are multiple activities across Africa to reduce the spread of COVID-19 and address misinformation, which can have catastrophic consequences, assisted by the WHO and others, which appear to be working in a number of countries. Research is ongoing to clarify the unintended consequences given ongoing concerns to guide future activities. Countries are learning from each other

Challenges and innovations brought about by the Covid-19 pandemic regarding medical and pharmacy education especially in Africa and implications for the future

Background: Multiple measures introduced early to restrict COVID-19 have dramatically impacted the teaching of medical and pharmacy students, exacerbated by the lack of infrastructure and experience with e-learning at the start of the pandemic. In addition, the costs and reliability of the Internet across Africa pose challenges alongside undertaking clinical teaching and practical programmes. Consequently, there is a need to understand the many challenges and how these were addressed, given increasingly complex patients, to provide future direction. Method: An exploratory study was conducted among senior-level medical and pharmacy educators across Africa, addressing four key questions, including the challenges resulting from the pandemic and how these were dealt with. Results: Staff and student members faced multiple challenges initially, including adapting to online learning. In addition, concerns with the lack of equipment (especially among disadvantaged students), the costs of Internet bundles, and how to conduct practicals and clinical teaching. Multiple activities were undertaken to address these challenges. These included training sessions, developing innovative approaches to teaching, and seeking ways to reduce Internet costs. Robust approaches to practicals, clinical teaching, and assessments have been developed. Conclusions: Appreciable difficulties to teaching arising from the pandemic are being addressed across Africa. Research is ongoing to improve education and assessments

Coronavirus disease 2019 (COVID-19) pandemic across Africa : current status of vaccinations and implications for the future

The introduction of effective vaccines in December 2020 marked a significant step forward in the global response to COVID-19. Given concerns with access, acceptability, and hesitancy across Africa, there is a need to describe the current status of vaccine uptake in the continent. An exploratory study was undertaken to investigate these aspects, current challenges, and lessons learnt across Africa to provide future direction. Senior personnel across 14 African countries completed a self-administered questionnaire, with a descriptive analysis of the data. Vaccine roll-out commenced in March 2021 in most countries. COVID-19 vaccination coverage varied from low in Cameroon and Tanzania and up to 39.85% full coverage in Botswana at the end of 2021; that is, all doses advocated by initial protocols versus the total population, with rates increasing to 58.4% in Botswana by the end of June 2022. The greatest increase in people being fully vaccinated was observed in Uganda (20.4% increase), Botswana (18.5% increase), and Zambia (17.9% increase). Most vaccines were obtained through WHO-COVAX agreements. Initially, vaccination was prioritised for healthcare workers (HCWs), the elderly, adults with co-morbidities, and other at-risk groups, with countries now commencing vaccination among children and administering booster doses. Challenges included irregular supply and considerable hesitancy arising from misinformation fuelled by social media activities. Overall, there was fair to reasonable access to vaccination across countries, enhanced by government initiatives. Vaccine hesitancy must be addressed with context-specific interventions, including proactive programmes among HCWs, medical journalists, and the public

Adherence to Diabetes Self-care Behaviours and Associated Factors amongst Adults with Type 2 Diabetes in an Urban Setting in Cameroon

Background: Type 2 diabetes mellitus (T2DM) is currently a major global public health burden associated with acute and chronic complications. Adherence to some diabetes self-care behaviours slows the progression of short-term and long-term adverse cardiovascular outcomes. The aim of this study was to determine the prevalence of adherence to some domains of diabetes self-care behaviours and to identify the factors associated with adherence amongst adults living with type 2 diabetes in the Bamenda III health district of the North West Region of Cameroon. Methods: A community-based cross-sectional study involving 162 adults living with type 2 diabetes (mean age 57.1± 9.6 years) living in the Bamenda III health district in the North West Region of Cameroon using a convenient random sampling technique. Anthropometric and diabetes related measurements were carried out following standard procedures. Adherence to diabetes self-care behaviours was assessed using a self-administered structured questionnaire. Logistic regression analysis was used to identify the predictors of diabetes self-care behaviours. Results: The overall prevalence of diabetes self-care adherence in the study population was 36.4%. In addition, we observed that there was a significantly (p= 0.002) higher mean FBS amongst participants with poor dietary adherence compared to those with good dietary (175.4mg/dl vs 136.8 mg/dl) respectively. Bivariate analysis revealed being 67 years and older (OR 5.3) and diabetes duration of more than 5 years (OR 4.6) were significantly (p < 0.05) associated with adherence to diabetes self-care behaviours. Multivariate analysis indicated that being older than 67 years (OR 4.8, 95% CI, 1.9 – 14.8) was an independent predictor for adherence to diabetes self-care behaviours. Conclusion: This study has shown a poor overall adherence to diabetes self-care behaviours amongst adults living with type 2 diabetes in our setting. In addition, being older than 67 years was an independent predictor of good adherence to diabetes self-care behaviours. There is need for an integrated approach in the management of T2DM involving treatment as well as health education that will improve on the health and quality of life of the patients

Strategies to improve antimicrobial utilization with a special focus on developing countries

Antimicrobial resistance (AMR) is a high priority across countries as it increases morbidity, mortality and costs. Concerns with AMR have resulted in multiple initiatives internationally, na-tionally and regionally to enhance appropriate antibiotic utilization across sectors to reduce AMR, with the overuse of antibiotics exacerbated by the COVID-19 pandemic. Effectively tackling AMR is crucial for all countries. Principally a narrative review of ongoing activities across sectors was undertaken to improve antimicrobial use and address issues with vaccines including COVID-19. Point prevalence surveys have been successful in hospitals to identify areas for quality improvement programs, principally centering on antimicrobial stewardship programs. These include reducing prolonged antibiotic use to prevent surgical site infections. Multiple activities centering on education have been successful in reducing inappropriate prescribing and dispensing of antimicrobials in ambulatory care for essentially viral infections such as acute respiratory infections. It is imperative to develop new quality indicators for ambulatory care given current concerns, and instigate programs with clear public health messaging to reduce misinformation, essential for pandemics. Regular access to effective treatments is needed to reduce resistance to treatments for HIV, malaria and tuberculosis. Key stakeholder groups can instigate multiple initiatives to reduce AMR. These need to be followed up