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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 31, No 2, March/April 2020
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AFRICA
empowers CSO through capacity building, unified action and
stakeholder consultations, along with promoting evidence-based
advocacy in preventing and controlling NCD.
33
No specific
activities by cardiology professional associations were reported
that aim at a 25% reduction in premature CVD mortality rate
by 2025, although Cameroon was represented at the 65th World
Health Assembly in 2019.
34
BP screening by businesses has proved
to be an effective strategy in early detection and monitoring of
hypertension.
19
However, in Cameroon BP screening has not yet
been addressed.
Based on the data collected for Cameroon, the following
strengths, threats, weaknesses and priorities are summarised.
Strengths
Cameroon ratified the WHO FCTC in 2006, which motivated
the development of policies to curb tobacco use and control
NCD.
20
Taxation of cigarettes also emerged from the FCTC.
Policies that address WHO best-buy interventions include those
on the prevention of tobacco and alcohol use as well as physical
inactivity and inadequate nutrition.
20
Promoting physical activity
through mass media and public education and awareness has
been reported.
28
The CAMBoD (Cameroon Burden of Diabetes) survey
provided data for implementing a programme on diabetes and
hypertension as these risk factors had emerged as public health
problems.
35
May measurement month (MMM), an initiative started by
the International Society of Hypertension, is a cross-sectional
BP survey of volunteer adults age ≥ 18 years. Screening at
public locations, including sponsorship from business entities,
requesting their corporate responsibility, is promoted.
30
Organisations co-ordinating the MMM in Cameroon are the
Cameroon Cardiac Society (CCS), CRENC, a non-profit
research organisation, and the Fondation Coeur et Vie.
30
Upgrading of the Shisong Cardiac Centre at St Elizabeth
Catholic General Hospital ensured improved treatment of
patients with heart diseases.
35
Total CVD death rates were lower
than other West African countries, Mauritania (16.6%) and
Senegal (16.9%), but higher than that of bordering Nigeria
(7.7%) (Table 1).
Threats
Cameroon with its high mortality rate attributable to infectious
diseases, inadequate health system characterised by absence of
health insurance, and lack of healthcare professionals, is also
burdenedby an increase inNCDand specificallyCVD.
35
Increased
risk factors are obesity, hypertension and hyperglycaemia, with
heart failure (HF) being the most significant form of CVD
impacting on young, economically active individuals.
35
In urban Cameroon, the hypertension prevalence is high,
with a very low awareness, which is attributed to the rapid
urbanisation along with high obesity, physical inactivity and
diabetes rates, increased salt consumption and tobacco use.
8
In
hypertensive patients, HF is common and often associated with
co-morbidities.
36
Hypertension accounted for 43.9 and 54.49% of
HF in sub-Saharan Africa (SSA) and Cameroon, respectively.
37
In
a hospital study, HF was the reason for 5.77% of all admissions
at the turn of the century, with a prevalence of 30% and overall
mortality rate of 9.03%.
38
RHD also remains a significant cause
of HF in SSA and is the third most common cause of HF
after hypertension and cardiomyopathies.
37
Recent data from
another hospital-based study confirmed hypertension (54.79%)
to be the foremost risk factor associated with HF, along with
diabetes (17.12%) and smoking (15.75%), as the most common
co-morbidities.
39
As elsewhere in Africa, HF carries a poor
prognosis with one out of five patients with HF in Cameroon
dying, and one out of four hospitalised within one year.
40,41
The rising burden of hypertension among people living with
HIV/AIDS is another threat, with at least 20% of HIV-infected
individuals found to be hypertensive. As in the general population,
awareness, detection, treatment and control of hypertension are
inadequate in these people.
42
Weaknesses
Although the NIMSPC-CNCD was developed as a reference
document for preventing and controlling NCD, it was never
implemented as a comprehensive, preventative intervention
strategy.
20
In the early 2000s, national programmes were
introduced with a focus on controlling hypertension, CVD,
diabetes and other NCD.
20
Discrepancies among the various
tobacco control policies regarding implementation also exist,
possibly because of the absence of a comprehensive tobacco-
prevention control programme.
43
As in most sub-Saharan countries, funding for health is
insufficient, and no national strategy is available to secure
funds.
44
Only in the 2016–2027 health sector strategy paper
were funds allocated for NCD prevention and control, and
optimal management of these resources could be sacrificed as
there is no national multi-sectoral committee on NCD.
20
The
NCD prevention policy is hampered by the absence of effective
monitoring and evaluation plans, causing a risk of neglect.
20
No
autonomous system exists for regulation of the pharmaceutical
sector, allowing quality medical products at affordable prices.
44
Although policies have been developed and the government
showed interest in establishing an NCD unit in the Ministry of
Public Health, no implementation is seen regarding regulations
intended for alcohol, physical activity and diet.
20
According to recent data, no community screening of RHD
has been done in Cameroon.
45
Therefore, the true prevalence of
RHD is possibly higher than recorded because patients are more
likely to seek medical attention only when symptoms present.
45
Priorities
Comprehensive interventions or programmes are needed to
address nutrition, physical inactivity and obesity among adults
and children, as has been done for tobacco control.
20
The
high prevalence of hypertension highlights an urgent need
to implement an up-to-date national programme targeting
risk factors and community awareness of NCD, specifically
CVD.
35
An adaptation and implementation of the PASCAR
roadmap,
46
which identified practical and effective solutions to
improve detection, treatment and control of hypertension on
the continent, are among the best ways forward. Cost-effective
strategies to prevent hypertension and improve awareness,
treatment and control were also suggested.
47