* Corresponding author: Eugene J Kongnyuy kongnyuy@gmail.com

Author Affiliations

1 Department of Obstetrics and Gynaecology, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon

2 Liverpool School of Tropical Medicine, Liverpool, UK

3 Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa

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BMC International Health and Human Rights 2006, 6:11 doi:10.1186/1472-698X-6-11

The electronic version of this article is the complete one and can be found online at: http://www.biomedcentral.com/1472-698X/6/11

Received: 5 May 2006

Accepted: 11 September 2006

Published: 11 September 2006

© 2006 Kongnyuy et al; licensee BioMed Central Ltd.

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background

Main symptoms of acute HIV infection. Sources are found in main article: Wikipedia:Hiv#Acute_HIV_infection. Model: Mikael Häggström. To discuss image, please see Template_talk:Häggström diagrams (Photo credit: Wikipedia)

The 2004 Demographic and Health Survey (DHS) in Cameroon revealed a higher prevalence of HIV in richest and most educated people than their poorest and least educated compatriots. It is not certain whether the higher prevalence results partly or wholly from wealthier people adopting more unsafe sexual behaviours, surviving longer due to greater access to treatment and care, or being exposed to unsafe injections or other HIV risk factors. As unsafe sex is currently believed to be the main driver of the HIV epidemic in sub-Saharan Africa, we designed this study to examine the association between wealth and sexual behaviour in Cameroon.

Methods

We analysed data from 4409 sexually active men aged 15–59 years who participated in the Cameroon DHS using logistic regression models, and have reported odds ratios (OR) with confidence intervals (CI).

Results

When we controlled for the potential confounding effects of marital status, place of residence, religion and age, men in the richest third of the population were less likely to have used a condom in the last sex with a non-spousal non-cohabiting partner (OR 0.43, 95% CI 0.32–0.56) and more likely to have had at least two concurrent sex partners in the last 12 months (OR 1.38, 95% CI 1.12–1.19) and more than five lifetime sex partners (OR 1.97, 95% CI 1.60–2.43). However, there was no difference between the richest and poorest men in the purchase of sexual services. Regarding education, men with secondary or higher education were less likely to have used a condom in the last sex with a non-spousal non-cohabiting partner (OR 0.24, 95% CI 0.16–0.38) and more likely to have started sexual activity at age 17 years or less (OR 2.73, 95% CI 2.10–3.56) and had more than five lifetime sexual partners (OR 2.59, 95% CI 2.02–3.31). There was no significant association between education and multiple concurrent sexual partnerships in the last 12 months or purchase of sexual services.

Conclusion

Wealthy men in Cameroon are more likely to start sexual activity early and have both multiple concurrent and lifetime sex partners, and are less likely to (consistently) use a condom in sex with a non-spousal non-cohabiting partner. These unsafe sexual behaviours may explain the higher HIV prevalence among wealthier men in the country. While these findings do not suggest a redirection of HIV prevention efforts from the poor to the wealthy, they do call for efforts to ensure that HIV prevention messages get across all strata of society.

Background

The toll of the acquired immunodeficiency syndrome (AIDS) pandemic has outstripped the worst predictions, especially in sub-Saharan Africa which is home to two-thirds of all people living with the human immunodeficiency virus (HIV) worldwide [1]. There has been an intense debate in the last four years on the relative roles of unsafe sex and unsafe health care on HIV spread in sub-Saharan Africa [2-7], but most public health experts believe that sexual transmission is the dominant mode of HIV spread in the region [1,8]. Risk factors for sexual transmission of HIV include multiple concurrent sexual partnerships, commercial sex, and inconsistent or non-use of condoms. These and other practices are influenced by many factors including lack of accurate information on the modes of HIV transmission, ignorance of own or sex partner’s HIV status, culture, economic conditions, mobility, and gender inequalities [9-12].

Economic and social conditions are significantly associated with HIV infection [13-15]. Kalichman and colleagues found that in South Africa, poor education, unemployment, discrimination, violence, and crime were significantly associated with HIV infection [16]. Poverty-related stressors have also been reported as strong predictors of a history of injecting drug use and deviant sexual behaviour, which are all significant risk factors for HIV infection [17]. However, findings have not been consistent throughout the literature. Studies in Kenya and Tanzania have shown HIV infection to be more prevalent among the rich than the poor people [18], and Fenton has questioned whether reducing poverty could lead to a sustainable solution to the HIV pandemic [19]. In addition, evidence from other investigations suggest that the rich may have a high risk of HIV infection because of exposure to unsafe injections given their (potential) greater access to health services [2-4,20-22]. While wealthy men may have a high risk of HIV infection due to disposable income, mobility, etc, poor women are more vulnerable to HIV infection due to lack of prevention choices and sale of sexual services within relationships for survival or advancement in harsh conditions [23,24]. Thus, the exact relationship between wealth and HIV infection remains blurred after more than two decades of research.

The 2004 Cameroon Demographic and Health Survey (DHS) showed the prevalence of HIV in the adult population in the country to be about 5.5%, significantly higher in wealthy people than their poorer counterparts [25]. HIV prevalence was 6.6% among people in the richest quintile of the population compared to 2.4% in the poorest quintile. In addition, it was 6.0% in people with secondary or higher education compared to 3.2% in those who have never been to school. It is not certain whether the higher prevalence results from wealthier people adopting more unsafe sexual behaviours, surviving longer due to greater access to treatment and care, or being exposed to unsafe health care and other HIV risk factors. Since the Joint United Nations Programme on HIV/AIDS and the World Health Organization state that unsafe sex is the main driver of the HIV epidemic in sub-Saharan Africa [1], the aim of this study is to examine the association between wealth and sexual behaviour among men in Cameroon.

Methods

Study design

This cross-sectional study is based on data from the 2004 DHS. The survey was approved by the Ethics Committee of the ORC Macro at Calverton in the USA and by the National Ethics Committee in the Ministry of Health in Cameroon. All study participants gave informed consent before participation and all information was collected confidentially.

Sampling technique

Methods used in the Cameroon DHS have been published elsewhere [25]. Briefly, the survey used a two-stage cluster sampling technique. The country was stratified into 12 domains (10 provinces and 2 major cities). Each domain is made up of enumeration areas (EAs) established by a general population and housing census in 2003. The sampling frame was a list of all EAs (clusters). Within each domain, a two-stage sample was selected. The first stage involved selecting 466 clusters (primary sampling units) with a probability proportional to the size, the size being the number of households in the cluster. The second stage involved the systematic sampling of households from the selected clusters. All men aged 15 to 59 years in the selected households were interviewed.

Data collection

Data were collected by visiting households and conducting face-to-face interviews to obtain information on demographic characteristics, wealth, and sexual behaviour; among other data. For the current study we extracted information on the 4409 sexually active men who participated in the survey.

Variables

We extracted data on sexual behaviour, wealth, age, place of residence, marital status, and religion.

We used five characteristics to define sexual behaviour: (a) age at first sexual activity (17 years or less versus more than 17 years), (b) condom use during the last sex with a non-spousal non-cohabiting partner (no versus yes), (c) number of sex partners in the last 12 months (2 or more versus 1 or none), (d) number of lifetime sex partners (more than 5 versus 5 or less), (e) ever paid for sex (yes or no). The cut-off points for age at coital debut and number of lifetime sex partners are based on the median values of Cameroonian men. In this study, unsafe sexual behaviour refers to behaviours that put people at risk of sexual transmission of HIV such as early onset of sexual activity, unprotected sex, multiple concurrent sex partners, multiple lifetime sex partners, and commercial sex.

Two variables were measured as proxy measures of wealth, that is, the wealth index and level of education attained. A score was attributed to each household amenity and the total score constituted the wealth index score [26]. We divided this score into three equal classes of wealth based percentiles, that is, less than 33.33th percentile (low, i.e. poorest), 33.33 to 66.66th percentile (medium, i.e. moderately rich), and more than 66.66th percentile (high, i.e. richest). The level of education attained was defined as never been to school, primary, and secondary or higher education.

Other variables were defined as follows: age was stratified into three 15 year age bands (15–29 years, 30–44 years, and 45–59 years), place of residence was defined as rural or urban, religion (was stratified into Christians, Muslims, and others), and marital status (was defined as never married, currently married, and divorced or widowed).

Statistical analyses

All cases in the DHS data are given weights to adjust for differences in probability of selection of subjects and to adjust for the non-response in order to produce the proper representation of the whole country [25]. The weight is determined such that it is inversely proportional to the response rate as well as the probability of selection. Therefore, the use of weights corrects for the differential response rates and the unequal probability used to select subjects in the sample. Data were collected and analysed using SPSS version 13.0 for Windows. We used individual weights data analysis in this study. Values for categories of the socio-demographic variables are expressed as absolute numbers (proportions). Unadjusted logistic regression analyses were carried out to investigate the bivariate relationship between each socio-demographic variable and sexual behaviour. Multiple logistic regression analyses were then carried out to find out which of the characteristics were independently associated with sexual behaviour. In the logistic regression models, the dependent variables were sexual behaviours (age at sexual debut, condom use in last casual sex, purchase of sexual services, number of sex partners in the previous 12 months, and number of lifetime sex partners) and the independent variables were wealth index, educational level, age, marital status, religion, and place of residence. The significance tests were two-tailed and statistical significance was defined at the alpha level of 0.05.

Results

Socio-demographic characteristics of study participants

A total of 4409 sexually active men participated in the study. Their mean age was 32.4 (standard deviation [SD] 11.4) years and the mean age at first sex was 18.0 (SD 4.1) years. The socio-demographic characteristics of the study population are shown in Table 1. Most of the study population was quite young, with the age group 15–29 years making up 48.3%. A majority of the men were married (60.5%) and the rest had never married (28.7%) or were divorced or widowed (10.9%). More than half (52.1%) had at least secondary education and 56% have had more than five lifetime sex partners.

Table 1. Socio-demographic characteristics of 4409 Cameroonian men who participated in the study, 2004

Univariate analyses

Bivariate associations between socio-demographic characteristics of the study population, including wealth, and sexual behaviour are shown in Table 2. Compared to poor men, the wealthiest men were more likely to start sexual activity at 17 years or less (OR 1.84, 95% CI 1.59 to 2.13) and less likely to have used a condom in the last sex with a non-spousal non-cohabiting partner (OR 0.16, 95% CI 0.13 to 0.19). In addition, the richest third of the study population were more likely to have had at least two concurrent sex partners in the last 12 months (OR 1.40, 95% CI 1.22 to 1.62) and more than five lifetime partners (OR 1.66, 95% CI 1.45 to 1.90). Wealth was not significantly associated with transactional sex. Compared with those who had never been to school, men who had secondary or higher education were more likely to have started sex at 17 years or less (OR 4.88, 95% CI 3.91 to 6.06) and less likely to have used a condom in the last sex with a non-spousal non-cohabiting partner (OR 0.8, 95% CI 0.06 to 0.12). In addition, the more educated men were more likely to have had at least two concurrent sex partners in the last 12 months (OR 1.32, 95% CI 1.08 to 1.60) and more than five lifetime sex partners (OR 2.02, 95% CI 1.68 to 2.43). The association between educational level attained and purchase of sexual services was not consistent.

Table 2. Unadjusted odds ratios of the associations between selected characteristics and sexual behaviours

Compared to men aged 15–29 years, those 45–59 years old were less likely to have had their sexual debut at less than 18 years (OR 0.20, 95% CI 0.17 to 0.25) and more likely to have used a condom in the last sex with a non-spousal non-cohabiting partner (OR 9.28, 95% CI 7.04 to 12.24). However, the oldest men (45–59 years) were more likely to have had at least two concurrent sex partners in the last 12 months (OR 1.32, 95% CI 1.11 to 1.56) and more than five lifetime partners (OR 4.43, 95% CI 3.88 to 5.06). Concerning transactional sex, the 45–59 year old men were less likely to have ever paid for sex (OR 0.17, 95% CI 0.06 to 0.47) but this was not a consistent trend with advancing age (P for trend = 0.154). Compared to men from the rural area, men from urban areas started sexual activity earlier (OR 1.37, 95% CI 1.22 to 1.54), were less likely to use a condom in sex with a non-spousal non-cohabiting partner (OR 0.31, 95% CI 0.26 to 0.36), and more likely to have had at least two concurrent sex partners in the last 12 months (OR 1.18, 95% CI 1.05 to 1.33) and more than five lifetime partners (OR 1.27, 95% CI 1.14 to 1.42). There was no difference in purchase of sexual services. Compared to Christians, Muslims (OR 0.46, 95% CI 0.39 to 0.54) were less likely to have had coital debut at an early age (P for trend = 0.036), more likely to use a condom in sex with a non-spousal non-cohabiting partner (OR 1.96, 95% CI 1.60 to 2.40), and less likely to have either concurrent (OR 0.69, 95% CI 0.59 to 0.82) or multiple lifetime (OR 0.47, 95% CI 0.40 to 0.54) sex partners. However, Muslims were more likely than Christians to pay for sex (OR 1.96, 95% CI 1.13 to 3.38). Men practising other religions were less likely to start sexual activity early (OR 0.73, 95% CI 0.61 to 0.88), more likely to use a condom in sex with a non-spousal non-cohabiting partner (OR 1.48, 95% CI 1.19 to 1.84) and less likely to have more than five lifetime partners (OR 0.81, 95% CI 0.69 to 0.96) compared to Christians. There was no difference between the two religious groups with regards to having concurrent sex partners in the previous 12 months and paying for sex. Compared to men who have never married, the married men were less likely to have paid for sex (OR 0.58, 95% CI 0.38 to 0.87) and more likely to have used a condom in the last sex with a non-spousal non-cohabiting partner (OR 7.07, 95% CI 6.04 to 8.32), had at least two concurrent sex partners in the last 12 months (OR 2.11, 95% CI 1.86 to 2.41), and more than five lifetime partners (OR 5.15, 95% CI 4.53 to 5.84). The pattern of risk behaviour was similar for divorced or widowed men compared to their counterparts who have never married.

Multivariate analyses

Table 3 shows the adjusted odds ratios from the multiple logistic regression modelling. After controlling for marital status, place of residence, religion, and age, wealth and education remained significantly associated with unsafe sexual behaviours. Compared to poor men, the wealthiest men were less likely to use a condom in the last sex with a non-spousal non-cohabiting partner (OR 0.43, 95% CI 0.32 to 0.56) and more likely to have had at least two concurrent (OR 1.38, 95% CI 1.12 to 1.19) and more than five lifetime (OR 1.97, 95% CI 1.60 to 2.43) sex partners. There was no significant association between being wealthy and either age of coital debut or paying for sex. Compared to men who had never been to school, those with secondary or higher education were more likely to have started sex early (OR 2.73, 95% CI 2.10 to 3.56), less likely to have used a condom in the last sex with a non-spousal non-cohabiting partner (OR 0.24, 95% CI 0.16 to 0.38), and more likely to have had more than five lifetime partners (OR 2.59, 95% CI 2.02 to 3.31). In addition, there was a significant trend towards multiple concurrent sexual partnerships with increasing level of education (P for trend = 0.002).

Table 3. Adjusted odds ratios of the association between selected characteristics and sexual behaviours

Other independent predictors of sexual behaviour were age, place of residence, religion, and marital status. Compared to young men (15–29 years), men in the oldest age group (45–59 years) were less likely to have had coital debut at younger than 18 years (OR 0.30, 95% CI 0.24 to 0.36), more likely to have used a condom in the last sex with a non-spousal non-cohabiting partner (OR 3.90, 95% CI 2.86 to 5.30) and less likely to have paid for sex (OR 0.20, 95% CI 0.07 to 0.61), but more likely to have had more than five lifetime sex partners (OR 4.06, 95% CI 3.29 to 5.02). Concerning place of residence, men living in urban areas were less likely to have used a condom in the last sex with a non-spousal non-cohabiting partner (OR 0.65, 95% CI 0.53 to 0.80) and more likely to have paid for sex (OR 2.10, 95% CI 1.24 to 3.56). For religion, Muslims were less likely to have started sex early (OR 0.68, 95% CI 0.56 to 0.82), had multiple concurrent sex partners in the last 12 months (OR 0.74, 95% CI 0.61 to 0.89), or multiple lifetime sex partners (OR 0.51, 95% CI 0.42 to 0.61), but more likely to have paid for sex (OR 2.12, 95% CI 1.22 to 4.03). Compared to never married men, married men were less likely to have had first sex at less than 18 years (OR 0.68, 95% CI 0.58 to 0.81) and more likely to have used condoms in the last sex with a non-spousal non-cohabiting partner (OR 3.49, 95% CI 2.86 to 4.25), but more likely to have had at least two concurrent sex partners in the last 12 months (OR 2.26, 95% CI 1.91 to 2.67).

Discussion

This study examined the association between wealth and sexual behaviour among resident Cameroonian men. Compared to the poorer men, wealthier men were more likely to start sexual activity at an early age, and have unprotected sex with a non-spousal non-cohabiting partner and both multiple concurrent and multiple lifetime sex partners. Other investigators have obtained similar results in other settings [18,19,27]. Mitsunaga and colleagues reported in 2005 that wealthy men in Nigeria are more likely to engage in extramarital sex than their poorer counterparts [27]. However, the findings are not consistent with those of others [13,28]. Kimuna and Djamba reported in 2005 that none of three proxies of wealth (education, occupation and household wealth index) was associated with extramarital sex in Zambia [28]. These differences may be due to differences in socio-cultural practices and the different stages of the HIV epidemic in different countries.

We also found that unsafe sexual behaviours became significantly more common with increasing level of education. Kirunga and Ntozi reported similar findings in 1997 in the Rakai district of Uganda [29]. However, a previous study in the city of Yaoundé reported that educated men were more prone to adopt safe sexual behaviours [30]. De Walgue and colleagues reported that although the risk for HIV infection increased with the level of education in south-western Uganda in 1989/1990, the trend reversed over the following decade such that in 1999/2000 the risk of HIV decreased with increasing education [31]. Paasche-Orlow and colleagues also reported in 2005 that educational attainment was associated with lower HIV risk sexual behaviours [32]. These differences suggest that the situation is not static, but changes over time. In the same country, different regions may be at different stages in the transition from unsafe to safer sexual behaviours.

Unsafe sexual behaviours were more prevalent in urban than rural areas. This is consistent with previous reports [33,34]. However, Voeten and colleagues have reported a higher prevalence of unsafe sexual behaviours in the rural compared to the urban areas of Nyanza province in Kenya [35]. Hladjk and colleagues have also reported the expansion of the HIV epidemic to rural areas and a trend towards a decline in some cities [36]. This suggests that like for education, different regions of the same country might be at different stages of the implementation of HIV prevention strategies. We found a higher prevalence of unsafe sexual behaviours in married and formerly married men; consistent with the findings of some [37,38] but not all authors [39]. These differences might be explained by cultural differences and the differences in the stages of the HIV epidemic. We found that there were more unsafe sexual behaviours among Christians than Muslims. The 2004 Cameroon DHS showed that animists have a lower HIV prevalence (1.2%) than Muslims (4.5%), Catholics (5.9%), and Protestants (6.3%) [25]. Other investigators have found that religiosity was positively associated with unsafe sexual behaviours among injecting drug users [40]. However, McCree and colleagues reported that religious African-American adolescent girls are less likely to engage in unsafe sexual behaviours [41]. Religion is strongly embedded in cultures and the degree of religiosity tends to vary from country to country.

Our study has some limitations. We did not control for unsafe health care practices. Previous epidemiological analyses of currently available data have suggested that the HIV epidemic in sub-Saharan Africa may be predominantly driven by iatrogenic transmission through unsafe injections [2,4,20,21]. The authors argue that when unsafe health care is controlled for, the apparent associations between sexual behaviours and HIV infection become non-significant [3,22]. Data from the 2004 Cameroon DHS do point to some iatrogenic transmission of HIV [25]. HIV prevalence among single men who have never had sex was 1.0%, and the prevalence of HIV was higher among men who reported having used condoms in the previous 12 months than in those who did not (5.7% versus 4.7%). However, HIV infection among condom users is not necessarily acquired through a non-sexual route; because for condoms to be effective in reducing (though not eliminating) the risk of HIV infection, they must be used correctly and consistently [42]. Certainly some infections in Cameroon and elsewhere are transmitted by unsafe injections, but we are of the opinion that current epidemiological evidence is overwhelmingly in favour of a predominant sexual HIV epidemic in sub-Saharan Africa [1]. Another limitation is that information was not collected on the sex of partners nor whether the men have ever practised anal sex. While sexual transmission in the context of sub-Saharan Africa may indirectly infer transmission during penile-vaginal intercourse, anal intercourse (whether homosexual or heterosexual) is not rare in the region [43,44]. We did not examine the potential confounding effect of polygamy on the relationships found in this study because less than 10% of participants had two or more wives. Nevertheless, the 2004 Cameroon DHS data did not find an association between type of matrimonial union and HIV prevalence (5.5% in polygamous and 5.4% in monogamous men) [25].

Conclusion

In conclusion, we found that wealthy men in Cameroon (as measured by household amenities and educational attainment) are more likely to start sexual activity early and have both multiple concurrent and lifetime sex partners, and less likely to (consistently) use a condom in sex with a non-spousal non-cohabiting partner. These unsafe sexual behaviours may explain the higher HIV prevalence among wealthier men in the country. While these findings do not suggest a redirection of HIV prevention efforts from the poor to the rich, they do call for efforts to ensure that HIV prevention messages get across all strata of society.

Competing interests

The author(s) declare that they have no competing interests.

Authors’ contributions

EJK and CSW conceived the study, collected the data, did the analyses and interpretation, and wrote the first draft of the manuscript. REM, PN, and LK critically revised the manuscript for important intellectual content. All authors read and approved the final manuscript.

Acknowledgements

The authors are grateful to Measure DHS for providing them with the 2004 Cameroon DHS data.

The authors thank Drs Stuart Brody and Sitawa R Kimuna for critical review of an earlier version of this manuscript.

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AIDS Care 2005, 17:892-901.

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Bracher M, Santow G, Watkins SC: Assessing the potential of condom use to prevent the spread of HIV: a microsimulation study.

Stud Fam Plann 2004, 35:1-17.

Brody S, Potterat JJ: Assessing the role of anal intercourse in the epidemiology of AIDS in Africa.

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Lane T, Pettifor A, Pascoe S, Fiamma A, Rees H: Heterosexual anal intercourse increases risk of HIV infection among young South African men.

AIDS 2006, 20:123-125.

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C’est en ouvrant le carnet de voyage du photographe Adam Nadel au Nigéria, en Ouganda et au Cambodge, que la Mairie de Paris relaie une exposition consacrée à l’infection parasitaire la plus meurtrière du monde. Ces travaux, qui représentent quinze années d’enquête en différents points du globe, mettent des visages sur des statistiques, tout en rappelant que la mobilisation internationale doit s’intensifier pour lutter contre une maladie qui touche essentiellement les pays pauvres!

Les chiffres de l’Organisation mondiale de la santé sont là : en 2010, le paludisme a été à l’origine de quelque 655 000 décès, pour la plupart parmi les enfants africains… « Maintes fois les pays ont démontré que la défaite du paludisme est tout simplement une question de ressources » constate Ban Ki-Moon, secrétaire général des Nations Unies…
Dr Eric Mouzin, médecin épidémiologiste au partenariat Rock Back Malaria co-organisateur de l’exposition

L’artiste ne cherche pas seulement à émouvoir. Il rappelle qu’avec 0,50 centimes on peut apporter des soins rapides capables de sauver une vie et il montre concrètement comment les populations tentent de s’organiser pour se protéger du fléau.

Dr Eric Mouzin, médecin épidémiologiste au partenariat Rock Back Malaria co-organisateur de l’exposition

(01:13)

RFI | 16 Mai 2012 | RFI

L’hôpital Laquintinie n’est pas resté en marge du vent de grève généralisée qui souffle dans les hôpitaux publics du Cameroun depuis lundi dernier. Vêtus de leur blouse blanche ou bleu, le personnel de cet hôpital s’est massé à l’ombre, sous les arbres, à l’abri des rayons ardents de soleil, hier, mardi, 24 avril 2012. Sur des pancartes, leurs revendications. Dans l’ensemble, les réclamations du personnel médico-sanitaire de l’hôpital Laquintinie sont la même que celles des autres hôpitaux.

Le tout, mentionné en 8 point dans un préavis de grève signé conjointement par Balla Balla président du Syndicat national du personnel médico-sanitaire du Cameroun (Synpems) et de Nga Onana Sylvain, président national du syndicat national des personnels et établissements/ entreprises du secteur de la santé du Cameroun (Cap/ santé). Ledit préavis de grève annonçant un arrêt de travail à partir du 23 avril 2012 dans tous les hôpitaux de 1ère et de tous les hôpitaux publics du Cameroun.

Solidaires  

« Nous sommes solidaires à ce mouvement de grève,  en respect du mot d’ordre, sur pratiquement tous les points du préavis de grève. Car, certains sont respectés chez nous. Notre principale revendication c’est le 8ème point : l’amendement du statut particulier des corps des fonctionnaires de la santé publique. Mais, au delà de cela, nous avons d’autres problèmes », explique Apolo Obeka Ndom, président régional du Synpems. A en croire ce dernier, les principales revendications du personnel médico-sanitaire de Laquintinie tournent autour de l’amélioration des conditions de travail. « La plupart des salles n’ont pas de toilettes. Dans la nuit, les infirmiers et les malades font les selles dans des pots qu’ils vident le matin. C’est très désagréable », poursuit-il. C’est sur ces points que des négociations ont été faites entre le personnel syndical et la direction de l’hôpital Laquintinie. Pour les problèmes spécifiques à l’hôpital Laquintinie, un délai de 100 jours a été donné à la direction à compté de samedi, 21 avril 2012.

Selon le président régional du Synpems, des négociations ont eu lieu entre le Synpems régional et le directeur de l’hôpital jeudi et samedi dernier. Et c’est ce même samedi que les présidents des deux syndicats en grève (Synpems et Cap/santé) sont descendus à Douala pour leur donner des consignes de grève. « Nous allons continuer le service minimum jusqu’à jeudi (demain). Passé ce délai, même le service minimum sera suspendu.  Il est prévue une rencontre entre les responsables syndicaux et le ministre de la santé publique jeudi et si nos revendications ne trouvent pas satisfaction, la paralysie sera totale », explique Apolo Obeka Ndom selon qui le ministre de la Santé publique a publié un communiqué demandant la continuité du service minimum.

Blaise Djouokep | 26 Avril 2012 | Mutations |

Pour quelque 120.000 malades sous ARV sur un total d’environ 570.000 personnes infectées, le gouvernement camerounais annonçait en 2011 des dépenses de 12 milliards de francs CFA (24 millions USD) pour l’achat de ces médicaments qui font intervenir la mise en ligne de huit protocoles due au fait que ce pays d’Afrique centrale concentre les différents types du Vih, de sources officielles.

De l’avis du ministre de la Santé publique, André Mama Fouda, à l’occasion de la dernière édition de la Journée mondiale de lutte contre le Sida, “c’est très très difficile de gérer en même temps 8 protocoles. C’est ce qui peut entraîner, pour certains protocoles, des tensions à un moment donné”.

Pour pouvoir mieux répondre à ces besoins importants, les autorités ont choisi d’encourager les initiatives de production locale de médicaments liés à la pandémie. Premier résultat de cette option, la Compagnie industrielle pharmaceutique (Cinpharm), déjà engagée dans la fabrication de médicaments génériques, s’est associée avec le laboratoire allemand 1A Pharma Gmbh.

“Nous souhaitons avec notre partenaire mettre tout en œuvre pour qu’au cours de l’année 2012 nous puissions être à même de mettre sur le marché les premiers antirétroviraux made in Cameroon qui devraient respecter la qualité”, a déclaré à la presse après la signature de la convention de partenariat vendredi à Yaoundé le patron de Cinpharm, Célestin Tawamba.

Aucune indication du début de la mise à disposition des premiers spécimens des médicaments concernés n’est pour l’instant donnée. Tawamba s’empresse tout de même d’attirer l’attention sur l’enjeu de “rassurer d’abord les porteurs de cette maladie” en leur fournissant à des prix plus abordables le traitement.

Selon le ministre de la Santé publique en novembre 2011, “aujourd’hui, les traitements antirétroviraux sous forme générique que nous avons, coûtent entre 7.500 et 10.000 (francs CFA, ndlr) au maximum par mois et par individu. C’est ça le traitement mensuel. Ce qui veut dire qu’en un an, ça représente par individu dans l’ordre de 100.000-120.000 francs”.

“Il faudrait aujourd’hui pousser la réforme de la mise à disposition de ce médicament de telle manière que ceux qui peuvent se le payer puissent l’acheter et que ceux qui n’ont pas la possibilité l’Etat leur (en) offre”, a plaidé Célestin Tawamba.

Le pays a enregistré une progression encourageante en passant à une séroprévalence de 4,8% pour une population totale de 20 millions d’habitants, contre 5,5% en 2004. A travers l’Institut de recherches médicales et d’études des plantes médicinales (IMPM, organisme sous tutelle du ministère de la Recherche scientifique et de l’Innovation), il produit déjà ses propres tests de dépistage du Vih.

Professeur en sciences du médicament responsable de laboratoire à la faculté de médecine Xavier Bichat à Paris en France, le Camerounais Bruno Eto a mis au point un médicament qu’il présente comme un pas décisif supplémentaire dans le traitement du Vih/Sida. “Nous avons trouvé une molécule qui a pour but de restaurer les défenses de l’organisme détruit par le virus du Sida, donc la restauration immunitaire de l’organisme”, a expliqué celui-ci à Xinhua.

Du nom de fagaricine (F-532 pour la dénomination commerciale), le produit annoncé est décrit comme un complément au traitement par les ARV. “L’application de ce produit est simple. Lorsqu’on est infecté par le virus du Sida, lorsque les défenses de l’organisme sont à 300, 250, c’est là qu’on commence à apprendre le médicament pour tuer le virus”, fait savoir le Pr. Eto.

Il s’agit, affirme le chercheur, d’un biophytomédicament (mélange d’extraits végétaux comme les lignanes et les alcaloïdes), de la même espèce que la biodiabétine qui lutte contre le diabète et d’autres découvertes réalisées par lui à partir des plantes naturelles utilisées dans la pharmacopée africaine. “Ce n’est pas comme les ARV qu’on ne peut jamais arrêter. On peut arrêter un voire deux mois, on reprend sans danger”, guide-t-il encore.

Commercialisée pour la première fois en 2005, la fagaricine est disponible au Burkina Faso, en Guinée-Conakry, aux Comores, au Gabon, au Tchad, en République démocratique du Congo (RDC) et au Congo-Brazzaville om elle bénéficie d’autorisations de mise sur le marché. “Maintenant, on cherche une représentation pour avoir une autorisation au Cameroun et au Nigeria”.

“Le coût réel de ce médicament, c’est moins de 10 euros. Mais, comme on le produit à très petites quantités et qu’il y a beaucoup d’intermédiaires, le produit coûte autour de 15 euros pour 100 comprimés. On a mis des petites boîtes en attendant des productions massives. Notre objectif, c’est de mettre en Afrique des usines qui peuvent fabriquer ce médicament parce que la technologie est très simple”, annonce Bruno Eto.

C’est une importante brèche pour les médicaments d’origine végétale que le Dr. Emmanuel Eben-Moussi, autre personnalité éminente camerounaise de la médecine, décrit comme “le gisement d’avenir dans le cadre de la biodiversité pour obtenir même de nouveaux médicaments”, puisque “70% de la population fait appel directement ou indirectement à la pharmacopée traditionnelle”.

“N’oubliez pas jusqu’au 19e siècle tous les médicaments dans le monde étaient d’origine végétale. Mais il faut fouiller pas seulement dans la forêt, il faut chercher dans la mer, les insectes, partout. Le problème, c’est que nos médicaments que nous avons, la plupart n’ont pas encore été homologués en passant par les mailles des systèmes de contrôle et de règlementation officiels”, suggère-t-il.

Xinhua | 24 Avril 2012 | Xinhua

Pour quelque 120.000 malades sous ARV sur un total d’environ 570.000 personnes infectées, le gouvernement camerounais annonçait en 2011 des dépenses de 12 milliards de francs CFA (24 millions USD) pour l’achat de ces médicaments qui font intervenir la mise en ligne de huit protocoles due au fait que ce pays d’Afrique centrale concentre les différents types du Vih, de sources officielles.

De l’avis du ministre de la Santé publique, André Mama Fouda, à l’occasion de la dernière édition de la Journée mondiale de lutte contre le Sida, “c’est très très difficile de gérer en même temps 8 protocoles. C’est ce qui peut entraîner, pour certains protocoles, des tensions à un moment donné”.

Pour pouvoir mieux répondre à ces besoins importants, les autorités ont choisi d’encourager les initiatives de production locale de médicaments liés à la pandémie. Premier résultat de cette option, la Compagnie industrielle pharmaceutique (Cinpharm), déjà engagée dans la fabrication de médicaments génériques, s’est associée avec le laboratoire allemand 1A Pharma Gmbh.

“Nous souhaitons avec notre partenaire mettre tout en œuvre pour qu’au cours de l’année 2012 nous puissions être à même de mettre sur le marché les premiers antirétroviraux made in Cameroon qui devraient respecter la qualité”, a déclaré à la presse après la signature de la convention de partenariat vendredi à Yaoundé le patron de Cinpharm, Célestin Tawamba.

Aucune indication du début de la mise à disposition des premiers spécimens des médicaments concernés n’est pour l’instant donnée. Tawamba s’empresse tout de même d’attirer l’attention sur l’enjeu de “rassurer d’abord les porteurs de cette maladie” en leur fournissant à des prix plus abordables le traitement.

Selon le ministre de la Santé publique en novembre 2011, “aujourd’hui, les traitements antirétroviraux sous forme générique que nous avons, coûtent entre 7.500 et 10.000 (francs CFA, ndlr) au maximum par mois et par individu. C’est ça le traitement mensuel. Ce qui veut dire qu’en un an, ça représente par individu dans l’ordre de 100.000-120.000 francs”.

“Il faudrait aujourd’hui pousser la réforme de la mise à disposition de ce médicament de telle manière que ceux qui peuvent se le payer puissent l’acheter et que ceux qui n’ont pas la possibilité l’Etat leur (en) offre”, a plaidé Célestin Tawamba.

Le pays a enregistré une progression encourageante en passant à une séroprévalence de 4,8% pour une population totale de 20 millions d’habitants, contre 5,5% en 2004. A travers l’Institut de recherches médicales et d’études des plantes médicinales (IMPM, organisme sous tutelle du ministère de la Recherche scientifique et de l’Innovation), il produit déjà ses propres tests de dépistage du Vih.

Professeur en sciences du médicament responsable de laboratoire à la faculté de médecine Xavier Bichat à Paris en France, le Camerounais Bruno Eto a mis au point un médicament qu’il présente comme un pas décisif supplémentaire dans le traitement du Vih/Sida. “Nous avons trouvé une molécule qui a pour but de restaurer les défenses de l’organisme détruit par le virus du Sida, donc la restauration immunitaire de l’organisme”, a expliqué celui-ci à Xinhua.

Du nom de fagaricine (F-532 pour la dénomination commerciale), le produit annoncé est décrit comme un complément au traitement par les ARV. “L’application de ce produit est simple. Lorsqu’on est infecté par le virus du Sida, lorsque les défenses de l’organisme sont à 300, 250, c’est là qu’on commence à apprendre le médicament pour tuer le virus”, fait savoir le Pr. Eto.

Il s’agit, affirme le chercheur, d’un biophytomédicament (mélange d’extraits végétaux comme les lignanes et les alcaloïdes), de la même espèce que la biodiabétine qui lutte contre le diabète et d’autres découvertes réalisées par lui à partir des plantes naturelles utilisées dans la pharmacopée africaine. “Ce n’est pas comme les ARV qu’on ne peut jamais arrêter. On peut arrêter un voire deux mois, on reprend sans danger”, guide-t-il encore.

Commercialisée pour la première fois en 2005, la fagaricine est disponible au Burkina Faso, en Guinée-Conakry, aux Comores, au Gabon, au Tchad, en République démocratique du Congo (RDC) et au Congo-Brazzaville om elle bénéficie d’autorisations de mise sur le marché. “Maintenant, on cherche une représentation pour avoir une autorisation au Cameroun et au Nigeria”.

“Le coût réel de ce médicament, c’est moins de 10 euros. Mais, comme on le produit à très petites quantités et qu’il y a beaucoup d’intermédiaires, le produit coûte autour de 15 euros pour 100 comprimés. On a mis des petites boîtes en attendant des productions massives. Notre objectif, c’est de mettre en Afrique des usines qui peuvent fabriquer ce médicament parce que la technologie est très simple”, annonce Bruno Eto.

C’est une importante brèche pour les médicaments d’origine végétale que le Dr. Emmanuel Eben-Moussi, autre personnalité éminente camerounaise de la médecine, décrit comme “le gisement d’avenir dans le cadre de la biodiversité pour obtenir même de nouveaux médicaments”, puisque “70% de la population fait appel directement ou indirectement à la pharmacopée traditionnelle”.

“N’oubliez pas jusqu’au 19e siècle tous les médicaments dans le monde étaient d’origine végétale. Mais il faut fouiller pas seulement dans la forêt, il faut chercher dans la mer, les insectes, partout. Le problème, c’est que nos médicaments que nous avons, la plupart n’ont pas encore été homologués en passant par les mailles des systèmes de contrôle et de règlementation officiels”, suggère-t-il.

Xinhua | 24 Avril 2012 | Xinhua

Sur le portail de l’hôpital central de Yaoundé (Hcy), l’écriteau «nous ne sommes plus au niveau du directeur», met le passant au parfum de ce qui peut être l’ambiance à l’intérieur. Les femmes en blouses blanches assises à même le sol, donnent le ton de leurs réclamations à coups de sifflets. La présence de leurs collègues et des patients curieux les galvanisent davantage «nous souffrons, on se nourrit des avocats et de la banane», ironise une infirmière, une autre d’ajouter «nous irons jusqu’au bout». Toutes ces plaintes sont détaillées à souhait sur les multiples affiches qui sont déployées «stop au détournement des malades», «l’amendement des statuts particuliers des corps des fonctionnaires de santé», «où sont les primes des contractuels, bulletin de solde nul», «nous en avons marre de la maltraitance merci de nous écouter», «après Dieu c’est qui? Pourquoi nous négliger?».

Les revendications du personnel médical sont regroupées en huit points dont les plus cruciaux sont la prise en charge gratuite des personnels de santé malade et de leur famille nucléaire et l’amendement du statut particulier des corps des fonctionnaires de la santé publique.«Je suis du personnel médical mais je dois payer mes soins et ceux de ma famille au même titre qu’un patient ordinaire», regrette une gréviste.  Pour ce qui est de la directrice, Bella Assoumpta, c’est bouche cousue «elle a demandé qu’on ferme le portail afin que les médias ne soient pas alertés», explique une infirmière. Du côté du centre hospitalier et universitaire de Yaoundé (Chuy), se sont les hommes en grande majorité qui mène la cadence.

Cependant, les revendications vont dans le même sens. «Le statut a été adopté et enregistré aux greffes en janvier 2008 par le conseil d’administration, il n’a même pas été appliqué qu’on envisage déjà de le réviser», affirme le vice président du syndicat national des personnels des établissements du secteur de la santé du Cameroun (Synpems), Balla Clément. Entre autres ils se plaignent du traitement du personnel à deux mesures «certains bénéficient déjà des avantages liés au statuts et d’autres pas. Comment cela peut-il s’expliquer?», s’étonne un gréviste. Et les messages des affiches expliquent ce point de vue à suffisance «arrêt au tribalisme et au sectarisme», «non aux répressions contre les syndicats.» Au Chuy, c’est avec beaucoup de retenues que le personnel ne verse pas dans l’invective «depuis près de 8 ans, nous n’avons pas de bulletin de paye parce que les responsables ne veulent pas la transparence. C’est à croire qu’on  est dans une cuisine». Le ministre du travail et de la sécurité sociale, Grégoire  Owona en mars 2012, dans une correspondance adressée au représentant du collectif des délégués du personnel, M. Eyebe Menye, invite les responsables du Chu «à prendre des dispositions nécessaires pour se conformer à la réglementation, dans le cadre de l’assainissement du climat social au sein de l’établissement sanitaire».

Dans le même sillage, en avril 2011, le ministre de la santé publique, André Mama Fouda invite les responsables du Chu «à bien vouloir examiner avec grand attention cette  situation dans le sens de l’exécution des résolutions des sessions sociales des 1er  mars 2007 et 9 février 2011 qui n’ont pas toutes été suivies d’effet». Suite à la grève du 5 mars dernier, à l’Hcy le ministre de la santé publique avait recommandé, lors d’une réunion, que le personnel soit pris en charge gratuitement.

Mais jusqu’à ce jour, ces consignes n’ont pas été appliquées par la directrice. Toutes les recommandations ainsi édictées par la hiérarchie sont restées lettre morte. Tout comme le mot d’ordre de dialogue prôné ce week-end par le Minsanté dans un communiqué rendu public et destiné à désamorcer la grève. Le ministre Mama Fouda n’a pas été entendu. Même si le slogan des grévistes du Chu dit : «on ne désavoue pas le chef de l’Etat». De plus, le président de la représentation syndicale, M. Awona Essomba, et d’autres personnels font l’objet de poursuites judiciaires diligentées par le directeur du Chu, Maurice Nkam, depuis mars dernier.

Nadine Guepi (Stagiaire) | 24 Avril 2012 | Mutations |

La mesure prise par le secrétaire d’Etat a suscité l’étonnement aussi bien aux Pays-Bas qu’à l’étranger, d’autant plus que l’Office of Biotechnology Activities, aux Etats-Unis, après quelques hésitations, n’a vu aucun problème dans la publication de l’article de Ron Fouchier.

Mais la mesure suscite aussi de la compréhension. Ben Ale, professeur en matière de Sécurité et de Lutte contre les catastrophes à l’Université de Delft, ne trouve pas injustifié que les autorités réfléchissent sur la nécessité de publier des articles sur des organismes ou d’autres biens qui puissent susciter un problème à l’échelle mondiale. “Dans le cas présent, les chercheurs indiquent qu’un virus muté de grippe peut susciter un pandémie. Cela me semble suffisamment préoccupant.”

Code de conduite
Les recherches scientifiques sur les virus constituent une nécessité médicale. En même temps, les connaissances acquises peuvent contribuer à la mise au point d’armes biologiques. Le fameux dilemme “A double usage” a amené en 2007 l’Académie néerlandaise des Sciences a créer un Code de conduite sur la Biosécurité. Ce code cite explicitement les risques des publications scientifiques. “Ce code scientifique était censé sensibiliser les scientifiques aux risques eventuels. Non pas pour entraver les recherches”, dit Koos van der Bruggen, secrétaire du groupe de travail à l’origine du code.

Les recherches sur H5N1

Ron Fouchier et ses confrères ont fait des recherches pour savoir si le virus H5N1 pouvait muter dans l’organisme humain. Ils ont réussi à développer une variante en laboratoire qui est transmissible entre les hélices(. En théorie, il suffit ensuite de peu pour faire un virus transmissible par l’homme. Cette découverte lui a valu cette semaine de figurer dans le Top 100 de Time Magazine des personnalités les plus influentes. La rédaction soutient Fouchier dans ses recherches : “Son travail n’est pas sans danger, mais ne rien faire est encore plus dangereux.”

Expert en biotechnologie et du double usage des connaissances, le Néerlandais Koos van der Bruggen suit de près le débat actuel : “Pour moi, en se référant à la réglementation sur les exportations, le secrétaire d’Etat fait preuve d’un pis-aller, fondé à tort ou à raison sur l’angoisse du terrorisme. ” Ainsi se crée l’étrange situation que la revue Nature peut publier les résultats de l’étude américano-japonaise mais que Science ne peut disposer des conclusions des chercheurs néerlandais.

Conflit
Au premier abord, l’office américain avait trouvé irresponsable une publication de l’enquête néerlandaise ainsi qu’un article semblable écrit par une équipe américo-japonaise. Les chercheurs, mais aussi l’OMS ont fait par de leur déception. L’Organisation mondiale de la santé exigeait l’ouverture dans l’intérêt de la lutte contre la grippe. Le NSABB modifia son opinion après avoir vu la version adaptée du Centre médical Erasme.

Ceci mis à part, tout terroriste n’est pas capable de mettre en pratique les conclusions de la recherche. De plus, selon les scientifiques néerlandais, nous ne sommes pas à l’abri d’Etats voyous qui peuvent les reproduire sans aide. Cet argument ne suffit pas selon Ale. “La période nécessaire à ces pays pour faire ce virus nous donne un délai supplémentaire pour développer un vaccin. L’argument selon lequel ils peuvent le faire seuls est un peu vrai, mais il n’y a pas de raison d’être imprudent.” Bien entendu, la recette du virus tombera en fin de compte dans le domaine public, reconnaît-il. “Mais les Etats peu scrupuleux ne vont pas nécessairement suivre notre tempo.”

Question de principe
L’ interdiction d’une publication scientifique n’a jamais eu lieu jusqu’à présent aux Pays-Bas. Koos van der Bruggen : “De plus, il manque aux Pays-Bas une structure nécessaire pour arriver à un jugement correct. Aux Etats-Unis, c’est le NSABB qui remplit ce rôle. Il y a possibilité de discussions qui mènent parfois à l’annulation d’une décision prise antérieurement.”

Sur invitation du gouvernement néerlandais, les fonctionnaires, virologues et experts en matière de sécurité débattent la semaine prochaine sur le sujet. “Espérons que les résultats vont offrir à Bleeker un échappatoire élégant.”

Selon Van der Bruggen, il est question d’une enquête scientifique fondamentale, pour laquelle aucune autorisation d’exportation n’est nécessaire. “C’est une question de principe. J’espère que le secrétaire d’Etat ne s’éloignera pas du débat.”

Willemien Groot| 23 Avril 2012 | RNW|

The new research links regular dental imaging to one of the most common types of brain tumors and suggests adults who were regularly exposed to X-rays in the past, before dosages were lowered, might have an especially pronounced risk.

For the new study, scheduled to be published online on Tuesday in the the American Cancer Society’s journal Cancer, researchers examined data from more than 1,400 patients who had been diagnosed with meningioma: This is a type of tumor that grows in membranes surrounding the brain and spinal cord and generally is noncancerous, but can lead to headaches, vision and memory problems and loss of speech and motor control. The researchers compared those individuals to more than 1,300 adults who were tumor-free.

Adults who developed brain tumors were more than twice as likely to say that they had bitewing X-rays yearly, if not more frequently, according to the findings. Bitewing X-rays, which require patients to bite down on an X-ray film holder, show the crowns of the upper and lower teeth at the same time.

The researchers also found a link between the tumors and panorex dental exams, which use an X-ray outside the mouth to take a broad image of a patient’s full mouth and are often used to look at problems such as infections and fractures. The increased risk of meningioma was particularly pronounced among individuals who were younger than 10 when they received the exam.

Dr. John B. Ludlow, a professor of oral and maxillofacial radiology at the University of North Carolina who was not associated with the study, said that it revealed a statistical association between a history of dental X-rays and meningiomas that he called “thought provoking, if not sobering.”

He cautioned, however, that dental techniques have changed over the years.

“Given the relatively long time frame between exposure to ionizing radiation and appearance of sold tumor cancers, most of the cases in the [study] received dental x-ray exposures two or more decades prior to the appearance of a tumor,” Ludlow stated in an email to The Huffington Post. In the past, the film was slower, meaning patients underwent X-ray radiation for a longer time, while newer units have reduced exposure in other ways, he said.

“It is important to keep diagnostic imaging risks in perspective,” Ludlow said.

The American Dental Association, the world’s largest national dental society, says that the number of times the average person undergoes X-rays depends on a slew of factors, including their age, risk for disease and overall oral health. Its guidelines for dentists, last revised in 2004, state that practitioners must weigh the benefits of taking X-rays against the risk of exposure — with the effects accumulating over time.

“My view is if an X-ray is necessary for medical treatment, then one should go ahead and get that X-ray,” said Dr. Keith L. Black, chairman and professor in the department of neurosurgery at Cedars-Sinai Medical Center. The current study is not the first to look at the possible association but is among the largest and best designed, he said.

“If I was going to get a root canal and I needed an X-ray, for example, I would get one,” Black said, claiming that he regularly refuses imaging at the dentist’s office. “But the reflex to get one every year is overexposing one to X-rays. And these are going to the base of the brain, toward the base of the skull.”

The new findings are important because dental X-rays are the most common source of exposure to ionizing radiation among residents of the United States, according to the study’s authors. And while they write that full-mouth and bitewing X-rays are associated with lower levels of exposure than other types of medical imaging, the No. 1 environmental — and generally modifiable — risk factor for meningioma is exposure to ionizing radiation.

“It’s hard to define a threshold because it’s very complex frequency and dosing equations go into that,” Black said. “We just need to be more aware of the risk and try to limit the use.”

Catherine Pearson | April 10, 2012 | Huffpo |

We wish him a prompt recovery and we all pray that he returns to the pitch to do what he loved to do: play football.

According to medical doctors, Muamba suffered from Hypertrophic Cardiomyopthy, also known as HCM. What it is exactly? read below:

Hypertrophic Cardiomyopathy. Courtesy ADAM Encyclopedia

Hypertrophic cardiomyopathy (HCM) is a condition in which the heart muscle becomes thick. The thickening makes it harder for blood to leave the heart, forcing the heart to work harder to pump blood.

Causes, incidence, and risk factors

Hypertrophic cardiomyopathy is often asymmetrical, meaning one part of the heart is thicker than the other parts. The condition is usually passed down through families (inherited). It is believed to be a result of several problems (defects) with the genes that control heart muscle growth.

Younger people are likely to have a more severe form of hypertrophic cardiomyopathy. However, the condition is seen in people of all ages.

Symptoms

Chest pain

Dizziness

Fainting, especially during exercise

Heart failure (in some patients)

High blood pressure (hypertension)

Light-headedness, especially with or after activity or exercise

Sensation of feeling the heart beat (palpitations)

Shortness of breath

Other symptoms that may occur are:

Fatigue, reduced activity tolerance

Shortness of breath when lying down

Some patients have no symptoms. They may not even realize they have the condition until it is found during a routine medical exam.

The first symptom of hypertrophic cardiomyopathy among many young patients is sudden collapse and possible death. This is caused by very abnormal heart rhythms (arrhythmias), or from the blockage of blood leaving the heart to the rest of the body.

Hypertrophic cardiomyopathy is a major cause of death in young athletes who seem completely healthy but die during heavy exercise. However, certain normal changes in athletes’ hearts can confuse the diagnosis.

Signs and tests

The health care provider will perform a physical exam and listen to the heart and lungs with a stethoscope. Listening with a stethoscope may reveal abnormal heart sounds or a murmur. These sounds may change with different body positions.

The pulse in your arms and neck will also be checked. The doctor may feel an abnormal heartbeat in the chest.

Tests used to diagnose heart muscle thickness, problems with blood flow, or leaky heart valves (mitral valve regurgitation) may include:

24-hour Holter monitor (heart monitor)

Cardiac catheterization

Chest x-ray

ECG

Echocardiography (the most common test) with Doppler ultrasound

MRI of the heart

Transesophageal echocardiogram (TEE)

Not all of these tests are useful for evaluating all of these conditions.

Blood tests may be done to rule out other possible diseases.

If you are diagnosed with hypertrophic cardiomyopathy, your health care provider may recommend that your close blood relatives (family members) be screened for the condition.

Treatment

The goal of treatment is to control symptoms and prevent complications. Some patients may need to stay in the hospital until the condition is under control (stabilized).

If you have symptoms, you may need medication to help the heart contract and relax correctly. Some medications used include beta-blockers and calcium channel blockers, which may reduce chest pain and other symptoms, particularly with exercise. Medications will often relieve symptoms so patients do not need more invasive treatments.

Some people with arrhythmias may need anti-arrhythmic medications. If the arrhythmia is due to atrial fibrillation, blood thinners may also be used to reduce the risk of blood clots.

Some patients may have a permanent pacemaker placed. However, pacemakers are used less often today than they were in the past.

When blood flow out of the heart is severely blocked, an operation called surgical myectomy may be done. This procedure cuts and removes a portion of the thickened part of the heart. Patients who have this procedure often show significant improvement. If the heart’s mitral valve is leaking, surgery may be done to repair or replace the valve.

In some cases, patients may be given an injection of alcohol into the arteries that feed the thickened part of the heart (alcohol septal ablation), essentially causing a controlled heart attack.

An implantable-cardioverter defibrillator (ICD) may be needed to prevent sudden death. ICDs are used in high-risk patients. High risks include:

Drop in blood pressure during exercise

Family history of cardiac arrest

History of cardiac arrest or ventricular tachycardia

History of unexplained fainting

Life-threatening heart rhythms on a Holter monitor

Severe heart muscle thickness

Expectations (prognosis)

Some people with hypertrophic cardiomyopathy may not have symptoms and live a normal lifespan. Others may get worse gradually or rapidly. The condition may develop into a dilated cardiomyopathy in some patients.

People with hypertrophic cardiomyopathy are at higher risk for sudden death than the normal population. Sudden death can occur at a young age.

Hypertrophic cardiomyopathy is a well-known cause of sudden death in athletes. Almost half of deaths in hypertrophic cardiomyopathy happen during or just after the patient has done some type of physical activity.

If you have hypertrophic cardiomyopathy, always follow your doctor’s advice concerning exercise and medical appointments. Patients are sometimes advised to avoid strenuous exercise.

Complications

Dilated cardiomyopathy

Heart failure

Life-threatening heart rhythm problems (arrhythmias)

Severe injury from fainting

Calling your health care provider

Call for an appointment with your health care provider if:

You have any symptoms of hypertrophic cardiomyopathy

You develop chest pain, palpitations, faintness, or other new or unexplained symptoms

Prevention

If you are diagnosed with hypertrophic cardiomyopathy, your health care provider may recommend that your close blood relatives (family members) be screened for the condition.

Some patients with mild forms of hypertrophic cardiomyopathy are only diagnosed by screening echocardiograms because of their known family history.

If you have high blood pressure, make sure you take your medication and follow your doctor’s recommendations.

References

Maron BJ. Hypertrophic cardiomyopathy. Zipes DP, Libby P, Bonow RO, Braunwald E, eds.Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine. 8th ed. St. Louis, Mo: WB Saunders; 2007:chap 65.
Wexler RK, Elton T, Pleister A, Feldman D. Cardiomyopathy: An overview. Am Fam Physician. 2009;79:778-784.
Bernstein D. Diseases of the myocardium. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Pa: Saunders Elsevier;2007:chap 439.

Review Date: 5/17/2010.

Reviewed by: Michael A. Chen, MD, PhD, Assistant Professor of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, Washington. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

to read more, visit the website: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001243/

A.D.A.M. Medical Encyclopedia.

The 23-year-old Bolton midfielder collapsed during an FA Cup match against Tottenham on Saturday after suffering from cardiac arrest. He was taken to London Chest Hospital where he’s improving and talking to doctors after needing 15 shocks from a defibrillator.

Medics tried unsuccessfully to revive Muamba for 48 minutes on Saturday before he arrived at the hospital, Bolton team doctor Jonathan Tobin said. It took another 30 minutes, after 15 shocks from a defibrillator, before the player’s heart started beating again on its own.

“They were working on him without his heart having a muscular beat,” Tobin said. “In effect, he was dead in that time … throughout the whole resuscitation period you are worrying.

“You know the longer the resuscitation goes on the less chance there is of survival, but this is slightly different. This is a very fit 23-year-old.”

On Monday, the former England under-21 international started breathing independently and speaking. He likely survived because of the emergency care, which kept blood and oxygen supplied to his vital organs. Defibrillators are used to restore normal heart rhythm when there is no beat or an irregular beat.

Dr. Andrew Deaner, a cardiologist and Tottenham fan who was at the game Saturday, left his seat and rushed onto the field to help Muamba.

“If you’re going to use the term ‘miraculous,’ I guess it could be used here,” Deaner said. “He has made a remarkable recovery so far.

“Two hours after (regaining consciousness) I whispered in his ear, ‘What’s your name?’ and he said, ‘Fabrice Muamba.’ I said, ‘I hear you’re a really good footballer’ and he said, ‘I try.’ I had a tear in my eye.”

The cause of the cardiac arrest is yet to be discovered. The doctors said Muamba had undergone a routine screening for heart defects in August. He was checked again on Sunday, with the test producing a “normal” result.

It is too early to say if he will return to the field.

“As things stand, his life is not in danger at this time,” Deaner said. “It is early days, so it is not possible to say (if he will play again).”

Tobin added that the “early signs of recovery have continued.”

“I went to see Fabrice last night,” Tobin said Wednesday. “He said, ‘Hi Doc.’ I asked him how he was and he said, ‘Fine.’”

Muamba was visited on Wednesday by former Arsenal teammate Thierry Henry, the New York Red Bulls striker, who flew to London. Muamba went from the Arsenal academy in 2002 to the first team in 2005 before leaving two years later for Birmingham. In 2008, he moved to Bolton.

On Wednesday, with Muamba’s condition improving, the squad decided to go ahead with Saturday’s match against Blackburn. Bolton also will return to White Hart Lane on Tuesday to play Tottenham in the FA Cup quarterfinal match that was abandoned after Muamba collapsed just before halftime.

“We spoke together with the players as a group this morning and I talked with Fabrice’s family last night,” Bolton manager Owen Coyle said. “Fabrice’s father Marcel and his fiancee Shauna were keen that we fulfill our fixtures. Once the players knew this, there was no doubt in our minds that we would play the matches.”

ROB HARRIS | 03/21/12 | AP