Browsing by Author "Kengne, André Pascal"

Now showing 1 - 5 of 5
  • Thumbnail Image
    Item
    Open Access
    Access to diagnostic tests and essential medicines for cardiovascular diseases and diabetes care: cost, availability and affordability in the west region of Cameroon
    (Public Library of Science, 2014) Jingi, Ahmadou M; Noubiap, Jean Jacques N; Onana, Arnold Ewane; Nansseu, Jobert Richie N; Wang, Binhuan; Kingue, Samuel; Kengne, André Pascal
    Objective: To assess the availability and affordability of medicines and routine tests for cardiovascular disease (CVD) and diabetes in the West region of Cameroon, a low-income setting. METHODS: A survey was conducted on the availability and cost of twelve routine tests and twenty medicines for CVD and diabetes in eight health districts (four urban and four rural) covering over 60% of the population of the region (1.8 million). We analyzed the percentage of tests and medicines available, the median price against the international reference price (median price ratio) for the medicines, and affordability in terms of the number of days' wages it would cost the lowest-paid unskilled government worker for initial investigation tests and procurement for one month of treatment. RESULTS: The availability of tests varied between 10% for the ECG to 100% for the fasting blood sugar. The average cost for the initial investigation using the minimum tests cost 29.76 days' wages. The availability of medicines varied from 36.4% to 59.1% in urban and from 9.1% to 50% in rural settings. Only metformin and benzathine-benzylpenicilline had a median price ratio of ≤1.5, with statins being largely unaffordable (at least 30.51 days' wages). One month of combination treatment for coronary heart disease costs at least 40.87 days' wages. CONCLUSION: The investigation and management of patients with medium-to-high cardiovascular risk remains largely unavailable and unaffordable in this setting. An effective non-communicable disease program should lay emphasis on primary prevention, and improve affordable access to essential medicines in public outlets.
  • Thumbnail Image
    Item
    Open Access
    Determining the prevalence and optimising the diagnosis of metabolic syndrome in people living with HIV
    (2017) Nguyen, Kim Anh; Kengne, André Pascal; Peer, Nasheeta
    Background and Purpose: With the introduction of potent antiretroviral therapy (ART) leading to longevity, cardio-metabolic diseases are emerging health concerns in people living with HIV. This thesis aims to 1) to quantify the burden of metabolic syndrome (MS), which is a constellation of cardio-metabolic risk factors, in people living with HIV infection (PLWHIV) from a global perspective; and in ≥18-year-old PLWHIV receiving HIV-care in the Western Cape, South Africa to 2) determine the MS prevalence and the agreement between the popular MS diagnostic criteria, 3) assess the distribution of cardio-metabolic risk factor clustering by adiposity levels, 4) determine the optimal waist circumference (WC) thresholds, and 5) HbA1c to define abdominal obesity and dysglycaemia, respectively, for the purpose of MS screening in South African PLWHIV. Methods: A systematic review with meta-analysis was conducted to determine the MS prevalence globally. The main study comprised a representative cross-sectional study of PLWHIV receiving HIV-care at 17 public healthcare clinics across the Western Cape, South Africa. Results: The global prevalence of MS was 16.7%-31.3% by different diagnostic criteria with substantial heterogeneity not explained by major study characteristics. The prevalence was higher in women than in men (International Diabetes Federation [IDF]-2005, 23.2% vs. 13.4%, p=0.030), in antiretroviral therapy (ART) versus non-ART users (Adult Treatment Panel III [ATPIII]-2001, 18.4% vs. 11.8%, p=0.001), and varied significantly by participant's age, duration of HIV diagnosis, CD4 count level, ART regimens. In the study conducted in the Western Cape (N=748, median age 38 years), MS prevalence among PLWHIV was 28.2% (JIS-2009), 26.5% (IDF-2005), and 24.1% (ATPIII-2005), which was higher in women, participants with longer duration of diagnosed HIV infection, ART users not receiving 1st line regimen (all p≤0.039). There was a good agreement between sets of the criteria that was not affected by HIV-related factors (all kappa ≥0.81). Cardio-metabolic risk factors clustered across all categories of adiposity levels: 11.7% of normal-weight, and 15.1% of obese PLWHIV had two or more factors, and this distribution was not affected by HIV-specific features. The optimal WC thresholds for abdominal obesity were 92 cm (sensitivity 64%, specificity 64%) in women and 87 cm (sensitivity 48%, specificity 85%) in men, which differed from the internationally recommended 80 cm (women) and 94 cm (men). The optimal HbA1c thresholds to define oral glucose tolerance test diagnosed dysglycaemia was 5.75% (39.3 mmol/mol) (sensitivity 52%, specificity 85%), similar to the threshold of 5.7% (39 mmol/mol) recommended by the American Diabetes Association. The MS prevalence by the JIS was 28.2% and 29.7% using glucose-defined and HbA1c-defined dysglycaemia, with a good agreement between the original and modified criteria (kappa=0.81). Conclusions: The high prevalence of cardio-metabolic risk factor clustering in PLWHIV highlights the need for effective management strategies. Optimal performance of MS criteria in South African PLWHIV requires the use of the African-population-specific WC thresholds, while using HbA1c to diagnose dysglycaemia could be both effective and more practical than blood glucose defined dysglycaemia. However, these findings need to be confirmed and the effects of their introduction in routine care on healthcare behaviour and patient outcomes assessed through impact and implementation studies.
  • Thumbnail Image
    Item
    Open Access
    Metabolic syndrome and fatal outcomes in the post-stroke event: a 5-year cohort study in Cameroon
    (Public Library of Science, 2013) Balti, Eric Vounsia; Kengne, André Pascal; Fokouo, Jean Valentin Fogha; Nouthé, Brice Enid; Sobngwi, Eugene
    Background and Purpose: Determinants of post-acute stroke outcomes in Africa have been less investigated. We assessed the association of metabolic syndrome (MetS) and insulin resistance with post-stroke mortality in patients with first-ever-in-lifetime stroke in the capital city of Cameroon (sub-Saharan Africa). METHODS: Patients with an acute first-stroke event (n = 57) were recruited between May and October 2006, and followed for 5 years for mortality outcome. MetS definition was based on the Joint Interim Statement 2009, insulin sensitivity/resistance assessed via glucose-to-insulin ratio, quantitative insulin sensitivity check index and homeostatic model assessment. RESULTS: Overall, 24 (42%) patients deceased during follow-up. The prevalence of MetS was higher in patients who died after 28 days, 1 year and 5 years from any cause or cardiovascular-related causes (all p≤ 0.040). MetS was associated with an increased overall mortality both after 1 year (39% vs. 9%) and 5 years of follow-up (55% vs. 26%, p  = 0.022). Similarly, fatal events due to cardiovascular-related conditions were more frequent in the presence of MetS both 1 year (37% vs. 9%) and 5 years after the first-ever-in-lifetime stroke (43% vs. 13%, p  = 0.017). Unlike biochemical measures of insulin sensitivity and resistance (non-significant), in age- and sex-adjusted Cox models, MetS was associated with hazard ratio (95% CI) of 2.63 (1.03-6.73) and 3.54 (1.00-12.56) respectively for all-cause and cardiovascular mortality 5 years after stroke onset. CONCLUSION: The Joint Interim Statement 2009 definition of MetS may aid the identification of a subgroup of black African stroke patients who may benefit from intensification of risk factor management.
  • Thumbnail Image
    Item
    Open Access
    Predicting pulmonary hypertension and outcomes in patients with left heart disease
    (2015) Dzudie Tamdja, Anastase Innocent; Sliwa-Hahnle, Karen; Kengne, André Pascal
    Pulmonary hypertension (PH) is defined as a rise in the pressure in the pulmonary arteries resulting from a variety of diseases including chronic infectious diseases, lung diseases and left heart diseases (LHD). It is a global health problem and accounts for a substantial portion of cardiovascular disease. PH due to LHD (PH-LHD) is credited to be the most common form of PH worldwide and is associated with adverse outcomes. Considering the suggestions of high prevalence and potential adverse outcomes of PH in sub-Saharan Africa (SSA), the investigation of the etiologies, clinical profile, correlates, and outcomes of PH-LHD in this region is a medical priority. Methods: Through a systematic review, we assessed existing evidence on the predictors of PH-LHD outcomes. Then, through two prospective multinational cohort registries, we investigated 1) the spectrum of PH in SSA; 2) the clinical profile and 6 months outcome of PH-LHD; 3) the role of electrocardiogram for diagnosing PH and 4) its prognostic role in heart failure (HF). PH was diagnosed by echocardiography in the context of clinical suspicion. Results: In high income countries, PH-LHD is almost invariably associated with increased mortality risk, but the effects on hospitalization are yet to be fully characterized. All groups of PH are found in SSA with LHD being the major cause. PH-LHD affects young people and is predominantly due to HF and rheumatic valvular heart disease. In these patients, left atrium size and tricuspid annular plan excursion are predictors of pulmonary pressures, and PH-LHD predicts short term hospitalization but not mortality. A normal electrocardiogram is very rare in patients with PH, but electrocardiogram criteria of right ventricular strain are rather rare and non-specific. Similarly, electrocardiogram abnormalities are frequent among Africans with HF, some have prognostic value for mortality risk. Conclusion: PH-LHD is the most common form of PH in SSA, with affected patients presenting with advanced disease, and it is associated with adverse outcomes. ECG abnormalities are prevalent in both PH and HF, but few of these abnormalities have prognostic value for mortality risk. Evaluating the efficacy and safety of low-cost and available drugs in reducing HF hospitalizations in PH-LHD is a key future priority. Improving early diagnosis of PH should also be encouraged.
  • Thumbnail Image
    Item
    Open Access
    Prevalence of asthma and allergic rhinitis among adults in Yaounde, Cameroon
    (Public Library of Science, 2015) Pefura-Yone, Eric Walter; Kengne, André Pascal; Balkissou, Adamou Dodo; Boulleys-Nana, Julie Raïcha; Efe-de-Melingui, Nelly Rachel; Ndjeutcheu-Moualeu, Patricia Ingrid; Mbele-Onana, Charles Lebon; Kenmegne-Noumsi, Elvira Christelle; Kolontchang-Yomi, Bar
    BACKGROUND: Population-based estimates of asthma and allergic rhinitis in sub-Saharan African adults are lacking. We assessed the prevalence and determinants of asthma and allergic rhinitis in urban adult Cameroonians. METHODS: A community-based survey was conducted from December 2013 to April 2014 among adults aged 19 years and above (N = 2,304, 57.3% women), selected through multilevel stratified random sampling across all districts of Yaounde (Capital city). Internationally validated questionnaires were used to investigate the presence of allergic diseases. Logistic regressions were employed to investigate the determinants of allergic conditions. RESULTS: Prevalence rates were 2.7% (95% CI: 2.1-3.4) for asthma-ever, 6.9% (5.9-7.9) for lifetime wheezing, 2.9% (92.2-3.6) for current wheezing and 11.4% (10.1-12.7) for self-reported lifetime allergic rhinitis; while 240 (10.4%) participants reported current symptoms of allergic rhinitis, and 125 (5.4%) had allergic rhino-conjunctivitis. The prevalence of current asthma medication use and self-reported asthma attack was 0.8 (0.4-1.2) and 1 (0.6-1.4) respectively. Multivariable adjusted determinants of current wheezing were signs of atopic eczema [2.91 (1.09-7.74)] and signs of allergic rhinitis [3.24 (1.83-5.71)]. Age group 31-40 years [0.27(0.09-0.78), p = 0.016] was an independent protective factor for wheezing. Determinants of current rhinitis symptoms were active smoking [2.20 (1.37-3.54), p<0.001], signs of atopic eczema [2.84 (1.48-5.46)] and current wheezing [3.02 (1.70-5.39)]. CONCLUSION: Prevalence rates for asthma and allergic rhinitis among adults in this population were at the lower tails of those reported in other regions of the world. Beside the classical interrelation between allergic diseases found in this study, active smoking was an independent determinant of allergic rhinitis symptoms. Nationwide surveys are needed to investigate regional variations.