Survey paves the way for a national diabetes program in Cameroon

June 2005 Prof. Jean Claude Mbanya made a short visit to Denmark to give his presentation of the Cameroon Burden of Diabetes project, which he initiated two years ago. The project has reached its goal - a national diabetes program - one year ahead of time.

As a physician and professor of Endocrinology and currently Vice-President of IDF (International Diabetes Federation) in addition to other diabetes related involvements, Prof. Mbanya is a capacity in the fight against diabetes in Africa.

Cameroonian lifestyle results in extreme risk of type 2 diabetes

Is the diabetes complex in Cameroon any different from other African countries?
“Comparing with other African countries, who suffer from under nutrition, Cameroonians suffer from over nutrition, having a diet consisting of palm oil, corn flower products and red meat.”  Prof. Mbanya explains. “Diabetes in Africa is often an urban problem caused by rapid changes in lifestyle from a ‘hunters and gatherers’ way of life to a modern lifestyle. In Cameroon diabetes is also seen in rural areas.”

Whereas change in lifestyle is the most common cause of the development of type 2 diabetes in all developing countries, in Cameroon a strong cultural tradition must also be blamed for the prevalence of diabetes caused by obesity:
“Fat is beautiful, you don’t want a lean wife." says Prof. Mbanya. "Fattening your family is seen as taking good care of them, it starts with the newborn babies who are given a fat diet”.

Typical African problems are also an issue in Cameroon

What do the African countries have in common?
Prof. Mbanya: “Poverty, and a lack of developed health care systems, where the rudimentary systems existing are based on treating infectious disease, is an all-African problem. We have no social security system to give health care for free and the families are in most cases not able to pay for treating illness in any of their family members.”

Providing evidence to start the fight against diabetes

Prof. Mbanya applied in 2002 for support from World Diabetes Foundation for the "Cameroon Burden of Diabetes" (CAMBoD) project. The government in Cameroon showed a willingness to supply better diabetes care but lacked the necessary baseline information. “You need to provide the evidence to enable the governments to act, and in 2003 there were no numbers of morbidity and prevalence of diabetes in Cameroon”, Prof. Mbanya says.

The first step, a baseline study, was conducted in four sentinel sites - one in each ecological zone of Cameroon - to provide scientific knowledge to guide the prevention and control of diabetes.

Within a five year time frame it was the aim to influence the development of national and regional policy and to build local and regional capacities for surveillance, prevention and control of diabetes.

The baseline study had both a quantitative and qualitative components - the main objective of the qualitative component was to probe into underlying beliefs, perceptions and behaviours.

Different levels of people were involved; Health care providers, patients, community opinion leaders and traditional health care providers.

Facts about the baseline survey

In all 10,011 people in the ages 15 years and older from 4189 households participated in the study. This variety of people and approaches gives a good picture of the state of diabetes care and problem areas in Cameroon.

Some of the interesting results are listed below:

On health care facilities

• Of the 62 health care facilities visited in the four sentinel sites only five had organised diabetic clinics, where activities like health promotion screening and treatment normally took place
• Only four out of the 62 clinics had existing treatment guidelines for diabetes.No facility routinely tested for blood sugar level and glucometers were available in 30 out of 62 facilities (less than 50%)
• 70% of all the health care providers felt they needed more training on the management of diabetes and hypertension

On patients main concerns

• Most of the patients felt that the government failed to subsidize the drugs as they do with HIV/AIDS drugs
• Lack of money to buy drugs
• Lack of health clinics
• Lack of vital information and literature on their condition
• Patients on insulin regretted not just the unavailability of the insulin but also the difficulties linked to preservation and application of the drug. Refrigerator not always available in homes and electricity failures ruined insulin stocks

Obesity mistaken as good health

The survey also underlined some of the cultural barriers in Cameroon such as the “fat-is-beautiful” attitude and a strong tradition of seeking advice with traditional healers.

Many informants believed that obesity is natural and cannot be controlled. They also believed that being obese was a sign of health and good living.

Traditional Health providers another cultural obstacle

According to traditional healers diabetes can have a natural origin or a mystique origin, if it is natural, it is treatable in modern health facilities, whereas mystique origins first must be treated by the traditional healer. Most if not all interviewed healers claimed that diabetes is curable, some claiming they cured several cases.

Treatment is always scarification, incision or piercing with the use of blades or sharp metal devices, with the risk of developing diabetic foot or other complications.

The survey report recommends to involve the traditional healers to prevent misconceptions, and to educate them to avoid negative practices like scarification.

Survey has been a good base for change

With the help of the baseline survey it has been established that diabetic patients face lots of difficulties in seeking appropriate health care for their ill health condition. The survey recommends that future intervention strategies should target these difficulties.

Some changes have already been made. Basic blood glucose testing and measuring equipment has been made available at a reduced cost thanks to an agreement between LifeScan ( a Johnson and Johnson company) and the Ministry of Public Health in Cameroon.

The survey also recommends focusing on family support to involve the families in the treatment.
Recognition of early signs of complications to prevent and information about the importance of physical activity are other steps adviced to take.

The results of the gathered information now has an impact on people

Several initiatives have since been launched, based on the information gathered in the survey. Health care providers have been trained and informational material like leaflets, posters and comic strips have been produced.

Diabetes clinics have been made available in all areas of Cameroon, in June 2005 16 clinics have been opened so far.

With the facts in hand Prof. Jean Claude Mbanya has been able to convince the Cameroon government to implement a National Diabetes Program. The Ministry of Health has shown a lot of enthusiasm towards the National Diabetes Program and has wasted no time, the program is on the Cameroon budget for 2005 - one year ahead of plan.

With this program hopefully knowledge, treatment and medicine will be made available to the Cameroon people with diabetes.

“Today 80% of diabetes cases in Cameroon are undetected” Mbanya says, but he follows up with a smile. Because this percentage will hopefully change in the years to come, thanks to the efforts headed by Prof. Mbanya and his team.