title: Efficiency of an intervention package for arterial hypertension comprising telemanagement in a Cameroonian rural setting: The TELEMED-CAM study.
abstract: BACKGROUND
  Sub-Saharan Africa has a disproportionate burden of disease and an extreme shortage of health workforce. Therefore, adequate care for emerging chronic diseases can be very challenging. We implemented and evaluated the effectiveness of an intervention package comprising telecare as a mean for improving the outcomes of care for hypertension in Rural Sub-Saharan Africa.
  
  
  METHODS
  The study involved a telemedicine center based at the Yaounde General Hospital (5 cardiologists) in the Capital city of Cameroon, and 30 remote rural health centers within the vicinity of Yaoundé (20 centers (103 patients) in the usual care group, and 10 centers (165 patients) in the intervention groups). The total duration of the intervention was 24 weeks.
  
  
  RESULTS
  Participants in the intervention group had higher baseline systolic (SBP) and diastolic (DBP) blood pressure, and included fewer individuals with diabetes than those in the usual care group (all p < 0.01). Otherwise, the baseline profile was mostly similar between the two groups. During follow-up, more participants in the intervention groups achieved optimal BP control, driven primarily by greater improvement of BP control among High risk participants (hypertension stage III) in the intervention group.
  
  
  CONCLUSIONS
  An intervention package comprising tele-support to general practitioners and nurses is effective in improving the management and outcome of care for hypertension in rural underserved populations. This can potentially help in addressing the shortage of trained health workforce for chronic disease management in some settings. However context-specific approaches and cost-effectiveness data are needed to improve the application of telemedicine for chronic disease management in resource-limited settings.
authors.affiliation: Service of Medicine A, General Hospital of Yaounde, Yaounde, Cameroon.
authors.forename: Samuel
authors.initials: S
authors.lastname: Kingue
authors.affiliation: Service of Medicine A, General Hospital of Yaounde, Yaounde, Cameroon.
authors.forename: Prisca
authors.initials: P
authors.lastname: Angandji
authors.affiliation: Service of Medicine A, General Hospital of Yaounde, Yaounde, Cameroon.
authors.forename: Alain Patrick
authors.initials: AP
authors.lastname: Menanga
authors.affiliation: Service of Medicine A, General Hospital of Yaounde, Yaounde, Cameroon.
authors.forename: Gloria
authors.initials: G
authors.lastname: Ashuntantang
authors.affiliation: Diabetes and Endocrine service, Yaounde Central Hospital, Yaounde, Cameroon.
authors.forename: Eugene
authors.initials: E
authors.lastname: Sobngwi
authors.affiliation: CHU de Cotonou, Benin.
authors.forename: Rosemonde Akindes
authors.initials: RA
authors.lastname: Dossou-Yovo
authors.affiliation: Service of Medicine A, General Hospital of Yaounde, Yaounde, Cameroon.
authors.forename: Francois Folefack
authors.initials: FF
authors.lastname: Kaze
authors.affiliation: NCRP for Cardiovascular and Metabolic Disease, South African Medical Research Council & University of Cape Town, Cape Town, South Africa, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
authors.forename: André Pascal
authors.initials: AP
authors.lastname: Kengne
authors.affiliation: Service of Internal Medicine, General Hospital of Douala, Douala, & Buea faculty of Health Sciences, Buea, Cameroon, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
authors.forename: Anastase
authors.initials: A
authors.lastname: Dzudie
authors.affiliation: Diabetes and Endocrine service, Yaounde Central Hospital, Yaounde, Cameroon.
authors.forename: Pierre
authors.initials: P
authors.lastname: Ndobo
authors.affiliation: Service of Medicine A, General Hospital of Yaounde, Yaounde, Cameroon.
authors.forename: Walinjom
authors.initials: W
authors.lastname: Muna
mesh_terms: D000328:Adult; D000368:Aged; D002163:Cameroon / Q000453:epidemiology; D003362:Cost-Benefit Analysis; D005260:Female; D006284:Health Plan Implementation / Q000191:economics / Q000592:standards*; D006801:Humans; D006973:Hypertension / Q000191:economics / Q000453:epidemiology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D015397:Program Evaluation; D012424:Rural Population / Q000706:statistics & numerical data; D017216:Telemedicine / Q000191:economics / Q000458:organization & administration* / Q000592:standards
keywords: Cameroon; Hypertension; control; sub-saharan Africa; telemedicine