By Julienne Stéphanie Nouetchognou, MPH – Health Policy Analyst
[dropcap type=”circle” color=”#FFFFFF” background=”#8C212A”]C[/dropcap]ardiovascular diseases, cancer, diabetes and other chronic diseases are often thought to be public health problems of significance only in developed countries. In reality, however, only 20 percent of chronic disease deaths occur in these countries, while 80 percent occur in developing countries where the vast majority of the world’s population lives. Cameroon, like other developing countries, is now experiencing the double burden of infectious and chronic, non-communicable diseases (NCDs). The burden of infectious diseases is largely driven by malaria, HIV/AIDS and tuberculosis. Yet, at the same time, the country is experiencing a tremendous increase in the burden of NCDs, displaying elements of a health transition in which a combination of both acute and chronic diseases now coexist in the same population and compete for limited resources.
According to the World Health Organization (WHO), non-communicable diseases (NCDs) in Cameroon (including cardiovascular diseases, diabetes, respiratory diseases and cancers) accounted for an estimated 31 percent of all mortality in 2008. The most prevalent NCDs in Cameroon are cardiovascular diseases, which accounted for 14 percent of total deaths across all age groups in 2008. In that same year, non-communicable variants of respiratory diseases, cancers and diabetes contributed four percent, three percent and two percent of total mortality respectively. Chronic diseases are now emerging in both rural and urban areas of Cameroon but the pace is particularly worrisome in urban areas.
A recent paper by Fezeu et al. shows that the prevalence of hypertension increased between twofold and fivefold in rural and urban Cameroonian men and women between 1994 and 2003. More specifically, the age-standardized prevalence of hypertension almost doubled from 20.1 percent to 37.2 percent among women and from 24.4 percent to 39.6 percent among men. Over a ten-year period systolic (SBP) and diastolic (DBP) blood pressure levels significantly increased as well.
In Cameroon there is a dearth of national data on the frequency of and trends in cancers. However, according to a number of hospital-based studies, for both men and women the five most common cancers are breast, uterine cervix, liver, non-Hodgkin lymphoma and prostate cancers. Prostate cancer is the most common malignancy in men with an age-standardized incidence and mortality rate of 19.2 and 15.2 per 100,000 persons per year respectively. Breast and cervical cancers are the most prevalent tumors in women. The age-standardized incidence and mortality rates are 27.9 and 16.6 per 100,000 persons per year for breast cancer and 24 and 19 per 100,000 persons per year for cervical cancer.
NCDs, the silent killers, have an insidious onset, provide debilitating complications and result in painful deaths. The WHO projects that 28 million people will die from a chronic disease by 2015 in Africa. In 2010 the estimated number of deaths attributable to diabetes was 11,852. According to the WHO there is a 20 percent chance of dying from NCDs among Cameroonians between the ages of 30 and 70 years. Justin Echouffo et al. highlight the role of demographic changes as key drivers of the epidemic of chronic diseases. Urbanization and the social mobility that has accompanied economic development are leading to increasing obesity, diabetes and hypertension with higher prevalence in urban than in rural areas. There is also an urban-rural deficit gradient in physical activity levels with significantly higher activity in rural than in urban dwellers and a protective effect of physical activity on glucose intolerance.
Cameroonians are increasingly exposed to contemporary and unhealthy global food trends. A qualitative survey among Cameroonian adolescents showed a strong preference for sweetened foods, with a trend showing a nutrition transition over time from a traditional diet in rural areas to a more westernized diet, characterized by processed food and sweet beverages, in urban areas. Moreover, obesity is still perceived, unfortunately, as a sign of good living as it confers respect and influence.
There is a significant lack of information on the specific impact of chronic diseases on the economy, society, education and the Cameroonian health care system. In 2001 a study estimated the average direct medical cost of treating a patient with diabetes at US$489 with 56 percent of this cost spent on hospital admissions, 33.5 percent on antidiabetic drugs, 5.5 percent on laboratory tests and 4.5 percent on consultation fees. The direct medical cost for treating all diabetic patients in Cameroon represented approximately 3.5 percent of the national budget for the 2001-2002 fiscal year.
Although infectious diseases (HIV/AIDS, malaria and tuberculosis) dominate the allocation of scarce public health resources, there is growing evidence that chronic diseases are at least receiving some attention from the government. Major deficiencies still exist in both quality of care and access to it, such that chronic diseases and their risk factors are diagnosed infrequently and often managed inadequately. Health facilities are swamped with large patient numbers. Health care workers do not always have the appropriate knowledge or skills, particularly in communication, to provide optimal patient-centered care. Shortages in essential drugs, lack of access to others (e.g., cholesterol-lowering agents), and limited use of testing (e.g., glycated hemoglobin) all directly hinder health care delivery in remote areas.
There is still a dearth of information on all NCDs and related risk factors. More nationally representative data is needed to track risk factors and complications of NCDs. The increasing burden of cerebrovascular disease (CVD) and other chronic diseases in Africa in general and Cameroon in particular has not been accompanied by corresponding adjustments in health service structures, human resources or service delivery mechanisms. The current health care system was developed to provide acute, episodic care. It is inadequately designed and not sufficiently resourced to care for patients with chronic conditions such as CVDs who require repeated visits, better information and counseling on lifestyle changes to minimize complications and improve adherence to treatment and self-care. The government can, and certainly must, do better.
Julienne Stéphanie Nouetchognou is a Health Policy Analyst at the Nkafu Policy Institute, a Cameroonian think-tank at the Denis & Lenora Foretia Foundation in Yaoundé. She can be reached at [email protected]
I am impressed with your analysis my dear sister. When we start thinking this way, we shall get somewhere someday. Courage
Great article juliènne!!! NCDs continue to be a major problem for Developing countries like Cameroon.
Great article Julienne. NCDs continue to be a major problem for developing countries.
Kudos to Julienne and the Foretia Foundation team for highlighting NCDs. It is evident communicable diseases continue to be a problem, but NCD are often over-looked and under-resourced areas of health care in low and middle income countries. I’ll be sharing this with our open Global Health Catalyst LinkedIn group for the benefit of others working with similar challenges
Julienne, great article! I was delighted to be informed about the situation of non-communicable diseases in Cameroon. I like the way you tackled the nature of the current situation and the challenges. Every article should have a life, as a suggestion, the next chapter of this topic should focus on how both the government and private healthcare sector in Cameroon can judiciously address this silent epidemic with the limited resources at their disposal. Also, I will like to hear how the citizens can play their part in reducing the amount of deaths caused by these non-communicable diseases. In the next article, you can include an example of how other African countries have successfully addressed or are currently addressing this silent epidemic. Thanks for sharing. Keep it up!
Am really overwhelm on the activities of your foundation in Cameroon. I wish to find out for how long this foundation have been existing and how its prioritze its projects. Am really glad to know the foundation is involved in different social domains.
This is a timely and good article that shows the relationship between health and development. Life expectancy, as an indicator of a healthy population, comes to the fore in an indirect analysis of the causes and consequences of NCDs in Cameroon. The remark that Cameroon’s health care system is currently designed to respond to episodic and chronic healthcare corroborates my own research (See Nji, 2004. Why poor people remain poor) that the health route for the poor changes with the degree of poverty which itself is a factor of crises in the economy. The remark about poor communication and lack of professional skills in the health sector is very pertinent too that comes on the heels of my crusade in the class room, on farmers’ fields and on the truck pusher’s hawker benches for better communication. We are all familiar with the phenomenon of most of our medical practitioners who are poor in communication: very often, before a patient tells a consulting doctor what his/her problem is, the doctor has churned out a long list of prescriptions! Furthermore, what does one expect when individuals cheat to pass exams and bribe to get into teacher training colleges? Garbage in, garbage out! It will be interesting to run a correlation analysis between four variables in the Cameroon economy: wellness, wealthiness, democracy and justice.to see what this brings. This article on the silent epidemic is reminiscent of “poor people’s diseases”, and identifies the chronic dearth of sustainable health policies and the weaknesses of institutions in Cameroon to address the problems of Quality of Life.
Brilliant Julienne. This piece is an eye opener, addressing certain aspects of ignorance most people tend to live with due to a particular mind-set. This is much needed information.
Belle approche d’analyse ma grande!!!