Ba Hamadou

Clinical, echocardiographic, and therapeutic aspects of congenital heart diseases of children at Douala General Hospital: A cross-sectional study in sub-Saharan Africa

INTRODUCTION Cardiovascular diseases in pediatric pathologies have emerged in the recent years in sub-Saharan Africa (SSA), with congenital heart diseases (CHDs) being the most frequent. Unfortunately, their diagnosis is usually delayed, thereby increasing childhood morbidity and mortality. OBJECTIVES Describe the clinical, echocardiographic, and therapeutic aspects of CHDs of children at Douala General Hospital. METHODS We carried out a cross-sectional descriptive study over a 10-year period, from January 2006 to December 2015. Files and reports of cardiac ultrasounds of patients aged ≤ 15 years were reviewed. RESULTS We reviewed the medical records of 1616 children, of which 370 (22.9%) had CHD. The age range was 1 day to 15 years, with a mean of 26 months. Heart murmur was the most frequent clinical sign, seen in 72.3% of the cases. CHD with left-to-right shunt was seen in 61.8%, with ventricular septal defect being the most common (29.8% of all cases). The second most common CHDs were those due to obstruction (20.4%), mainly pulmonary stenosis (19.6% of all cases). Cyanogenic CHDs accounted for 17.8% of cases, dominated by tetralogy of Fallot (7.4% of all cases). Indications for surgical treatment was found in 171 (46.2%) patients, but due to financial constraints, only 48 (28.1%) patients were operated. Among those who underwent surgery, 66.7% were operated abroad, and Humanitarian organizations financed the surgical management of 58.3% of those operated. CONCLUSIONS CHDs are seen in one out of five children seen in the pediatric cardiology unit of our Hospital for suspected heart disease. Most cases are diagnosed late in life as toddlers. The rate of surgical correction remains low due to financial constraints, with most cases operated abroad with the assistance of Humanitarian organizations.

Rheumatic heart disease awareness in the South West region of Cameroon : A hospital based survey in a Sub-Saharan African setting

Background Early diagnosis and adequate treatment of Group A streptococcal throat infection is an important initial stage in the primary prevention of acute rheumatic fever and rheumatic heart disease. This preventable condition associated with high mortality rates mandates a thorough understanding by the general public and the health. Objective The aim of the study was to assess the level of awareness about different aspects of rheumatic heart disease in patients coming to the outpatient department of the Buea regional Hospital, South West region of Cameroon. Methods This was a cross-sectional descriptive study carried in the outpatient department of the Buea Regional Hospital, Cameroon. The study population was adults and children aged 9 years and above. Data collection was done by using a self-administered questionnaire addressed to assess awareness on rheumatic heart disease. Results A total of 256 participants were interviewed, of which 70 (27.3%) were males. Their mean age was 34.4 ± 11.9 years (males: 36.2 ± 12.7 years versus females: 33.7 ± 11.6 years, p = 0.129). Most of the participants were in the 20 to 29 year old group (37.9%). More than two thirds (71.1%) of the participants reported having had sore throat at least once. The disease was treated with antibiotics in only 45.4%, with the treatment prescribed by a health care professional in 35.8% of the cases. About 73% of the respondents did not know what causes sore throat, and most (71.1%) were unaware of any complications that could arise from poorly treated sore throat. More than 70% of the participants did not know that sore throat can be associated with heart disease. Rheumatic heart disease was unknown to 82% of the participants and 95% of them did not know what causes RHD. Only 5.1% percent of the participants had an adequate knowledge of RHD. Age ≤ 35 years, post-secondary level of education, and having heard of RHD were significantly associated with an adequate knowledge. After adjusting for age, post-secondary education (aOR: 9, [95% C: 1.2–67.5], p = 0.019), and having heard of RHD (aOR: 18.1, [95% CI: 4.7–70.3], p<0.001) were still associated with a fair knowledge. Conclusions Levels of knowledge and awareness on rheumatic heart disease is low. This study provides important insight into the perception and practices related to sore throat that can be used in the design of awareness activities aimed reducing the risk of RHD in Cameroon. The appropriateness of antibiotics prescribed, and the health care provider awareness and knowledge levels regarding RHD in Cameroon has not been reported yet in the literature. This grey area deserves more research.

Prevalence, Awareness, and Control of Hypertension in Health Workers of Two Teaching Hospitals of Yaounde-Cameroon: The Hypertension Awareness Initiative (THAI) Pilot Survey

Introduction: High blood pressure is a public problem worldwide because of its high morbidity and mortality. The greatest burden is in low-income set-tings. The burden of disease has not been studied in health workers in our setting. Methods: Between December 2016 and June 2017, we carried out a cross-sectional descriptive and analytic study in two teaching hospitals in Yaounde, using the WHO STEP wise approach. Participants were consenting Physicians, Nurses, Midwives, and Nursing assistants of both sex, aged ≥ 21 years. Results: A total of 266 health workers were screened—31 Physicians, 144 Nurses, 80 Nursing assistants, and 11 Midwives. Their mean age was 41.1 ± 7.6 years (25 to 66 years), and 84.6% were females. The prevalence of Hypertension was 13.9%, of which 54.1% were newly diagnosed—Awareness rate of 45.9%. The control rate of known cases of hy-pertension was 64.7% (64.3% in those on monotherapy, and 66.7% in those on bitherapy). Age > 40 years, and adiposity were significantly associated with hypertension. Conclusion: Compared to the general population, the prevalence of hypertension amongst health workers was low, but with a high rate of un-awareness.

Multiple cerebral infarction revealing Takayasu's disease: a case report in a 32‐year‐old man from Cameroon, sub‐Saharan Africa

This case suggests that young patients with few vascular risk factors, and who present with acute stroke syndrome involving more than one vascular territory should be screened for an inflammatory or infectious cause.

Office versus ambulatory blood pressure measurements in diagnosing diurnal hypertension in sub-Saharan Africans: a comparative cross-sectional study in Cameroon

Background: Hypertension is the most frequent cardiovascular risk factor worldwide, with the greatest burden in low-income settings. We sought to know if the serial blood pressure (BP) readings measured in a single encounter, alongside other cardiovascular risk factors could reliably make the diagnosis of hypertension in a group of sub-Saharan Africans. Methods: Between October and November 2016, we carried-out a cross-sectional descriptive and analytic study in Yaounde, Cameroon. Adults of both sexes, aged ≥18 years were screened for cardiovascular risk factors using the WHO STEPwise approach. Participants with de novo elevated office BP underwent an ambulatory blood pressure measurement (ABPM) to ascertain hypertension. We then studied the determinants of ABPM diagnosed hypertension. Results: Of the 26 participants who had an ABPM, 23 (88.5%) had hypertension, and 3 (11.5%) had white coat hypertension (WCH). Of those with hypertension (n=22), 6 (27.3%) were dippers, 2 (9.1%) were extreme dippers, 9 (40.9%) were non-dippers, and 5 (22.7%) were reverse dippers. The three participants with White coat effect were non-dippers. The determinants of de novo hypertension on ABPM were: Age >50 years (OR: 4.1, P=0.001), adiposity (OR: 6.2, P=0.002), pulse pressure >65 mmHg (OR: 21.4, P de novo diurnal hypertension on ABPM. Conclusions: In people with de novo raised office BP, 9-in-10 will have hypertension on ABPM especially when they are aged >50 years, have abdominal obesity, high pulse pressure, and hyperuricemia. Those with white coat effect appeared to have a blunted BP dipping pattern.

Aetiologies and correlates of secondary mitral regurgitation in patients with dilated cardiopathy in Cameroon: a cross-sectional study

Background: Dilated cardiopathy is a heterogeneous group of heart disease in which there is progressive ventricular remodeling, with or without secondary functional mitral regurgitation (MR). MR has prognostic implications, and has not been studied in our setting. This work aimed at studying the occurrence, aetiologies and correlates of secondary MR in a group of patients with dilated cardiopathy in a resource limited setting in sub-Saharan Africa. Methods: We carried out a cross-sectional study in the echocardiography laboratories of three tertiary hospitals in the city of Yaounde, Cameroon. Participants were consecutively recruited over an eight month period, after results of echocardiograms. The severity of MR was assessed from the size of the regurgitant orifice and the mechanism of MR assessed with the Carpentier classification. Results: A total of 25 participants (13 males) with an echocardiographic dilated left ventricle were included in the study. Their mean age was 53.2 years (range: 22 to 84 years). All patients had MR, of whom 6 (24%) had severe MR (grade IV). Type I MR was seen in 14 (46%), type III in 10 (40%), and type I and III in 1 (4%) of patients. The baseline heart disease were primary 4 (16%), ischemic 10 (40%), hypertensive 10 (40%), and peri-partum cardiomyopathy. The left atrium was dilated in 22 (88%), raised filling pressure in 19 (76%), and raised pulmonary pressure in 15 (60%). The severity of MR significantly correlated with age (r=0.5, P=0.011), left ventricle end diastolic diameter (r=0.41, P=0.04), low ejection fraction (r=−0.378, P=0.031), and left atrial size (r=0.431, P=0.022). Conclusions: Secondary MR is almost always present in patients with dilated cardiopathy. The severity of MR correlated with age, low ejection fraction, left ventricular end diastolic diameter, and left atrial size.

Prevalence and correlates of chronic kidney disease in a group of patients with hypertension in the Savanah zone of Cameroon: a cross-sectional study in Sub-Saharan Africa

Background The prevalence of chronic kidney disease (CKD) is increasing worldwide due to an increase in the risk factors such as hypertension. The greatest burden is in low-income settings, coupled with late diagnosis and limited management resources. This work aimed at studying the prevalence and risk factors of CKD in a group of patients with hypertension in the Savanah zone in Sub-Saharan Africa (SSA). Methods We carried out a cross-sectional study between January and May 2016 in the regional Hospital of Garoua-Cameroon. Participants were adults ≥18 years of both sexes, who had a diagnosis of hypertension. Patients underwent a comprehensive clinical, biological, and electrocardiographic evaluation. Results A total of 400 patients with hypertension were included, of whom 132 (33%; 95% CI: 28.6-37.8%) were males. Their mean age was 54.16±11.17 years. Hypertension was controlled in 122 (30.5%; 95% CI: 26.2-35.2%) participants. Twelve percent had a positive urine dipstick for proteins. The mean glomerular filtration rate (GFR) was 75.27±24.87 mL/min/1.73m2. The prevalence of CKD was seen in 129 (32.3%; 95% CI: 27.9-36.98) participants. Stage 3A was the most frequent (62.01%). The main comorbidities were anemia (44.5%), obesity (39.75%), diabetes (32%), consumption of traditional medicines (15.75%), and hyperuricemia (10.75%). After multivariate analysis, age >50 years (aOR: 1.75; 95% CI: 1.06-2.89; P=0.027), female sex (aOR: 2.21; 95% CI: 1.29-3.78; P=0.0035), obesity (aOR: 1.58, 95% CI: 1.01-2.44; P=0.026) and the hyperuricemia (aOR: 3.67; 95% CI: 1.78-7.58; P<0.001) were independently associated with CKD. Conclusions The prevalence of CKD in adults with hypertension was high. This was associated with age greater than 50 years, female sex, obesity and the hyperuricemia.