THE STATE OF SICKLE-CELL IN CAMEROON
The Epidemiology in Cameroon
Sickle Cell Disorder (SCD) common in people from sub Saharan Africa, India, the Middle East and the Mediterranean. The population of Cameroon is around 17 million. Recent evidence from Cameroon suggests a carrier frequency of 20% and prevalence of about 20/1000 births from epidemiological reports. This translates to an estimated incidence of 7000 new babies, (ref. WHO 2007). 80% of these will die by their 5th birthday (refs. OILD Brazzaville 2006, Dakar 2007)
Public Health Burden in Cameroon
Given the prevalence of infectious diseases such as malaria, HIV and respiratory tract infections SCD has only recently become a priority for management in African countries. The population of Cameroon is around 17 million. The causes of mortality and morbidity as above are coupled with a weak economy and government revenue as well as increased external debt. With a basic monthly salary of about 70 USD, malnutrition is significant. Many patients (for lack of funds) use traditional medicines to address problems ofSCD. In summary, patients with SCD in Cameroon are more susceptible to crises than those living in developed countries because of environmental (malnutrition, malaria, infections, economic) and genetic factors (Bantu heliotype).
Public Health Strategy of Cameroon
The public health system is organized on 4 levels: Central (highest), Regional, Divisional & District (lowest). Assigned into this structure, are 2 modern nationwide referral hospitals and hundreds of health facilities in varying states of functioning. Private institutions, churches and NGO’s operate more than 50% of health facilities. Serious medical cases are supposed to be referred upward across the hierarchy and eventually to one of the only 2 referral hospitals (located one each in Douala &Yaounde- respectively, the chief economic and administrative cities in Cameroon). Some recent initiatives have been attempted to reduce the burden of SSA including (refs. www.CRTV.cm TV news broadcast, March 2010 & Fine Forest Foundation reports 2009): CRTV news on OILD sickle cell campaigning featuring the First Lady, March 2010 Mass education through public meetings Patchy screening sessions using economic laboratory methods Unfortunately the above is limited mainly to the capital cities and surrounds. Moreover, there is hardly any reliable arrangement underpinning the public health system for the medical management of haemoglobinopathies, such as SCD. The Government of Cameroon is well-aware of the appalling situation and has in recent years made a commendable effort towards developing a public sector strategy (to combat sickle cell disease) to match the WHO’s endorsed plan, (Refs. LFSCA “Africa Cry” Report to WHO 2007; Minster Mama Fouda, Cameroon, 2008). Indeed, we know that representations
have been made to the WHO and the UN by several African countries, including Cameroon, for help to address what has recently been adopted as the fourth global public health concern. However, until the strategy is resourced for implementation, the dire situation shall remain.
The Likelihood of and Access to Quality CareBarriers to healthcare include:
- Inadequacy or non-existence of healthcare provision
- Patient’s inability to pay for healthcare
- Non-availability of quality medicine
- Lack of supervision and training of medical personnel
- Geographical inaccessibility and non-existence of the communication structures needed for the long distance between patients’ homes and the nearest health centre.
We know from reports, over the last 10years, that there is hardly any reliable arrangement in the public health system in Cameroon for the medical management of haemoglobinopathies. There are hardly credible records or facilities to address the epidemiology, the screening and onward systematic follow-up of those diagnosed with sickle cell. This is true for the public sector, and even more so for the private sector, where-in caveat emptor would be an understatement indeed.
The Epidemiology in Cameroon
Hospitalised patients have to obtain their own medicines and materials needed to treat them. Public sector pharmacies are at best undersupplied and those who can afford it turn to the private sector which is costly, unregulated and sometimes dangerous, the fee paying system is beyond the means of most Cameroonians. The result as stated previously, is that patients resort to traditional medicines for SSA with even worse outcomes likelihoods. (Refs Country Field Reports, N-S TechnoMed Ltd 2010).
Suffice to add that, the recent initiatives, stated previously, in Cameroon to reduce the burden of SCD seem to indicate that the focus is on public awareness of sickle cell disease and prevention of new cases through mass education.
Infrastructure and Economic Plight
This is because the infrastructure and economic plight of countries such as Cameroon imply that the emphasis is on preventative healthcare which tends to be more affordable, measurable and attractive to donor organisations. The country cannot afford the costs of the intensive medical support required to manage complicated cases hence the very high morbidity and mortality.