Experiences of a Programme to Integrate Prevention, Diagnosis and Treatment of Cardiovascular Risk Factors into Public Primary Care in Rural Cameroon

Author(s): N.D. Labhardt*1, E. Manga2, B. Stoll3, A. Bischoff3
Affiliation(s): 1Health Department Basel, Switzerland, 2Ministry of Health of Cameroon, Mfou, Cameroon, 3Universty Hospitals of Geneva, Switzerland
Keywords: Primary care in Africa, non-communicable chronic disease, diabetes, hypertension
Background:

Cardiovascular disease has become a major cause of morbidity and mortality in the developing world and is an important economic burden for individuals and their families. It is now the leading cause of death in Sub-Saharan Africa among people over the age of 30. The rise of cardiovascular disease in developing countries is attributed to an increase of the modifiable risk factors, especially among the poorer part of the population, which often does not have access to an appropriate care for these conditions. High blood pressure and diabetes type 2, two of the most important modifiable cardiovascular risk factors, are of high prevalence among the population in Cameroon. However, up to now, the district primary care is not appropriately equipped nor trained to deliver adequate prevention, diagnosis and treatment of these conditions.

Summary/Objectives: The programme’s objective is to integrate prevention, diagnosis and treatment of hypertension and diabetes type 2 into the public primary care service of the about 90 healthcare facilities in two semi-rural regions of Central Cameroon. A baseline evaluation and need-assessment before intervention showed that nearly all facilities lacked equipment to measure blood glucose levels or glycosuria and that only about half of them had functioning material to measure blood pressure and body weight. Adequate anti-hypertensive and oral antidiabetic drugs were available in only very few of the evaluated centres and the majority of the staff were not able to define hypertension or diabetes nor were they able to name an appropriate treatment. The programme provides to the staff of public health facilities an initial 3-day training, based on a manual prepared for the training modules and containing care-algorithms, a programme-focused supervision in the health centre every 3 months and a 1-day refresher course after 6 months. All the trained health facilities received equipment to determine blood glucose levels, glycosuria, blood pressure and body weight and an initial stock of 2 oral antihyperglycaemic and 2 anti-hypertensive drugs from the essential drug list. The drugs are to be sold on fixed prices, which allows the staff to renew the stock regularly. Training and equipment of the total of 8 districts takes place in 3 stages. In March 2007 the first 2 districts were trained and equipped, followed by another 3 districts in November 2007. The remaining 3 districts will be integrated into the programme in February 2008.
Results:

On the oral presentation we will show the results of the programme-evaluation of 52 facilities at 6 months and of 29 facilities 12 months after the programme’s start. In a preliminary evaluation of the 29 centres trained in March 2007, healthcare providers showed a significantly improved performance in a questionnaire testing their knowledge right after the initial training as well as 6 months later. 6 months after the programme’s start, most of the equipment was again operational and there were only 2 ruptures in drug supply. In the meantime medical treatments on 205 newly diagnosed hypertensive and 52 new diabetic patients were started. Preliminary data suggest that satisfactory control of blood pressure and blood glucose was obtained in most of the patients with the application of the care algorithms. However, a majority of patients seem to show a low adherence with nearly one half of patients lost to follow-up during the first six months.

Lessons learned:

Technically the integration of prevention, diagnosis and treatment of cardiovascular risk factors, especially hypertension and diabetes type 2, into the district primary care system in Cameroon seems feasible. However, patients’ adherence and long term follow-up are of major concern. We conclude that for patients suffering from chronic conditions in this setting, a system involving house-visits, community workers and family members should be established in order to assure adherence.

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