Availability, cost and affordability of essential cardiovascular disease medicines in the south west region of Cameroon: Preliminary findings from the Cameroon science for disease study

Dzudie, Anastase; Njume, Epie; Abanda, Martin Hongieh; Aminde, Leopold; Hamadou, Bâ; Dzekem, Bonaventure Suiru; Azabji, Marcel; Doualla, Marie Solange; Ngowe, Marcelin Ngowe; Kengne, André Pascal

doi:10.1371/journal.pone.0229307

Cited by 21 publications

(24 citation statements)

References 17 publications

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“…In 2018, 59.2% of the 8.9 (95% CI: 8.3-9.6) million PLWH with HTN globally were living in Sub-Saharan Africa [27]. In the absence of an integrated HTN and HIV care and no universal health coverage in many SSA countries including Cameroon, PLWH receive ART for free but do not get any BP check and when eventually checked, they do not seek treatment for HTN because of the relatively high cost and poor availability of the medications [31]. This exposes the growing PLWH population to HTN-mediated organ damage and raises strong concerns about the integration of HTN management in HIV clinics including identification of the main drivers of HTN that might be controlled in PLWH.…”

Section: Plos Onementioning

confidence: 99%

Hypertension among people living with HIV/AIDS in Cameroon: A cross-sectional analysis from Central Africa International Epidemiology Databases to Evaluate AIDS

et al. 2021

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Background Antiretroviral therapy (ART) success has led people to live longer with HIV/AIDS (PLWH) and thus be exposed to increasing risk of cardiovascular diseases (CVD). Hypertension (HTN), the biggest contributor to CVD burden, is a growing concern among PLWH. The current report describes the prevalence and predictors of HTN among PLWH in care in Cameroon. Methods This cross-sectional study included all PLWH aged 20 years and above who received care between 2016 and 2019 at one of the three Central Africa International Epidemiology Databases to Evaluate AIDS (CA-IeDEA) sites in Cameroon (Bamenda, Limbe, and Yaoundé). HTN was defined as blood pressure (BP) ≥140/90 mm Hg or self-reported use of antihypertensive medication. Logistic regressions models examined the relationship between HTN and clinical characteristics, and HIV-related factors. Results Among 9,839 eligible PLWH, 66.2% were women and 25.0% had prevalent HTN [age-standardized prevalence 23.9% (95% CI: 22.2–25.6)], among whom 28 (1.1%) were on BP lowering treatment, and 6 of those (21.4%) were at target BP levels. Median age (47.4 vs. 40.5 years), self-reported duration of HIV infection (5.1 vs 2.8 years years), duration of ART exposure (4.7 vs 2.3 years), and CD4 count (408 vs 359 cell/mm3) were higher in hypertensives than non-hypertensives (all p<0.001). Age and body mass index (BMI) were independently associated with higher prevalent HTN risk. PLWH starting ART had a 30% lower risk of prevalent HTN, but this advantage disappeared after a cumulative 2-year exposure to ART. There was no significant association between other HIV predictive characteristics and HTN. Conclusion About a quarter of these Cameroonian PLWH had HTN, driven among others by age and adiposity. Appropriate integration of HIV and NCDs services is needed to improve early detection, treatment and control of common comorbid NCD risk factors like hypertension and safeguard cardiovascular health in PLWH.

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Section: Plos Onementioning

confidence: 99%

Hypertension among people living with HIV/AIDS in Cameroon: A cross-sectional analysis from Central Africa International Epidemiology Databases to Evaluate AIDS

et al. 2021

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“…[66] However, being essential and cheap do not necessarily make medicines available or accessible. [67] Essential medicines' availability ranged from 25% in public facilities to 49% in private facilities in Cameroon, [68] and from 49% in public facilities to 71% in retail pharmacies in Malawi. [69] Anecdotally, frequent stock-outs of warfarin have been mentioned in some SSA studies.…”

Section: Challenges Accessing Anticoagulationmentioning

confidence: 99%

Improving anticoagulation in sub-Saharan Africa -- what are the challenges, and how can we overcome them?

Mouton

Blockman

Wiltshire

et al. 2020

Preprint

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Patients in sub-Saharan Africa generally have poor anticoagulation control. We review the potential reasons for this poor control, as well as the potential solutions. Challenges include the affordability and centralisation of anticoagulation care, problems with access to medicines and INR monitoring, the lack of locally-validated standardized dosing protocols, and low levels of anticoagulation knowledge among health care workers and patients. Increasing numbers of patients will need anticoagulation in the future because of the epidemiological transition in the region. We propose that locally-developed "warfarin care bundles" which address multiple anticoagulation challenges in combination may be the most appropriate solution in this setting currently.

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“…Higher rates were shown in a population in Taiwan [39]. This low rate of statin use in our study could be due to the high cost of the drug that is out of pocket payment in our setting [56]. The control of LDL-cholesterol was optimal in half of the patients on statin and the rate decreased significantly with the severity of CKD.…”

Section: Managementmentioning

confidence: 56%

Cardiovascular Disease Burden in Patients with Non-Dialysis Dependent Chronic Kidney Disease in Cameroon: Case of the Douala General Hospital

Halle¹,

Kom²,

Kamdem³

et al. 2020

OJNeph

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Introduction: Cardiovascular disease (CVD) is the major cause of morbidity and mortality in patients with chronic kidney disease (CKD). Objective: To evaluate the burden of CVD and audit the management of cardiovascular risk factors (CVRF) in patients with non-dialysis (ND) dependent CKD in Cameroon. Patients and Methods: A cross-sectional study in the Douala general hospital was conducted from January to March 2016, including CKD patients' stages 3 -5 ND. Socio-demographic data, comorbidities, medications and biological data were extracted from patient's records. For each participant, lipid profile and urinary protein excretion were measured; a resting electrocardiogram was done. Hypertension, diabetes, dyslipidemia, obesity, smoking, alcohol consumption, anemia, hyperuricemia, proteinuria and high calcium-phosphorus product were considered as CVRF. CVD was defined as a history of stroke, peripheral artery disease, coronary heart disease (CHD), left ventricular hypertrophy (LVH), heart failure (HF) and arrhythmia. We used KDOQI 2003, KDIGO 2012 and JNC 8 guidelines for definition and evaluation of the management of lipid abnormalities, proteinuria and hypertension respectively. Results: A total of 83 patients (45 males) were included; mean age was 56 ± 15 years. Mean number of CVRFs per patient was 5.19 ± 1.64; hypertension (90.3%), obesity (79.5%), anemia (78.3%), dyslipidemia (69.8%) and hyperuricemia (69.8%

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Availability, cost and affordability of essential cardiovascular disease medicines in the south west region of Cameroon: Preliminary findings from the Cameroon science for disease study

Abstract: BackgroundMore than 80% of premature deaths due to cardiovascular disease (CVD) occur in low-and middle-income countries. However, access to, and affordability of medications remain a challenge in these countries.

Cited by 21 publications

References 17 publications

Hypertension among people living with HIV/AIDS in Cameroon: A cross-sectional analysis from Central Africa International Epidemiology Databases to Evaluate AIDS

Hypertension among people living with HIV/AIDS in Cameroon: A cross-sectional analysis from Central Africa International Epidemiology Databases to Evaluate AIDS

Improving anticoagulation in sub-Saharan Africa -- what are the challenges, and how can we overcome them?

Cardiovascular Disease Burden in Patients with Non-Dialysis Dependent Chronic Kidney Disease in Cameroon: Case of the Douala General Hospital

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