Health in Cameroon

• Population: 24,348,25 estimate for 2019 [6]
• Surface Area: 475,650 Square Km
• Population density: 51 inhabitants per square Km
• Young population: 48% of total population below 15 years and 3.5% aged 65 and above[7]
• Annual growth rate: 2.6%

The 2014 CIA estimated average life expectancy in Cameroon was 57.35 years.[8] However, in 2017, the estimates were 65.5 and 61.0 years for females and males respectively.[9]

The population is estimated as 24,053,727 in 2017 [10] and Central Bureau of Census and Population Studies gives an official projection of 24,348,251 in 2019.[6]

There has been substantial increase from 2.3 million in 1900 through 4.34, 8.66, 11.7, 15.4, 20.1 millions in the years 1950, 1980, 1990, 2000, 2010 respectively.[11]

The per capita income of Cameroon in 2017 is $3,640, making it a low middle income country.[10] The current Health expenditure (CHE) per capita has been on an increase in the last 20 years; US$43, 48, 54 and 64 in the years 2000, 2005, 2010, 2016 respectively though out-of-pocket spending has been the main source of payment for health services for majority of Cameroonians throughout this period.[12] In 2016, of the health expenditure per capita of $64 spent, estimated that out-of-pocket spending accounted for 70% while domestic public spending, voluntary health insurance, aid accounted for 13%, 9% and 6% respectively and other sources just 2%.[12]

From 1990 till 2018 communicable, maternal, neonatal diseases as group is the leading causes of death followed by non-communicable diseases and injuries in Cameroon and Sub-Saharan Africa. However, globally this is not the same pattern observed as the group of non-communicable diseases has been the leading cause of death followed by the group of communicable, maternal & neonatal diseases and thirdly the group of injuries in the last three decades.[9] The top ten causes of death in 2018:

• Malaria
• HIV/AIDS
• Lower respiratory infections
• Neonatal disorder
• Diarrheal diseases
• Ischemic heart disease
• Stroke
• Tuberculosis
• Road injuries and
• Cirrhosis[9][13]

HIV/AIDS is the second cause of death in Cameroon in 2018 after malaria. Progress had been made in AIDS-related death and new infections in Cameroon; reduction in the number of deaths from 22,000 to 18,000 and the number of new infections from 36,000 to 23,000 between the years 2010 and 2018. In 2018, 540,000 people were living with HIV and the prevalence among adults (15–49 years) was 3.6%.[14] Moreover, the incidence among all people of all ages in Cameroon is 1.02% in 2018.[14] In Sub Saharan Africa, the incidence (new infections per 1,000 of population) among adults (15–49 years) declined from 3.39 in 2010, 2.49 in 2015 to 2.14 in 2017 and globally for adults it also declined from 0.44 to 0.40 between 2015 and 2017.[15]

Many organizations have been partnering with the government of Cameroon via the ministry of public health (MINSANTE) to against this disease.

Incidence of HIV in Cameroon from 1990 to 2018

The under 5 mortality rate, per 1,000 births is 155 and the neonatal mortality as a percentage of under 5's mortality is 24. In Cameroon the number of midwives per 1,000 live births is 0.2 and the lifetime risk of death for pregnant women 1 in 35.[16]

As of 2017:

• Prevalence of child stunting: 30.7%
• Prevalence of child experiencing wasting: 2.8%
• Prevalence of child (2–4 years) overweight: 20.9%
• Coverage of seven vaccine in target population: 72.1%[9]

The maternal mortality ratio is defined as the number of women who die due to causes related to pregnancy or aggravated by pregnancy and provision of care with such deaths occurring during pregnancy or delivery or within 42 days after the end of pregnancy, whatever the duration or type of pregnancy, expressed per 100,000 live births for a given period.[7] The maternal mortality ratio of Cameroon has shown decline in the last three decades from 728 per 100,000 live births in 1990 and to 596 in the year 2015. These deaths are however preventable with appropriate management and care. However, more efforts are needed so as to meet the global Sustainable Development Goals target of this indicator which is less than 70 per 100,000 lives births by 2030.[7][17] In the world at large, it reduced significantly by almost half (44% reduction) from 385 in the year 1990 to 216 in the year 2015; as compared to Sub-Saharan Africa from 987 in 1990 from 546 in 2015.[17]

Table 1: Maternal Mortality Ratio in Cameroon from 1990 to 2015

Source: World Health Organization, UNICEF, United Nations Population Fund and The World Bank, Trends in Maternal Mortality: 1990 to 2015, WHO, Geneva, 2015

In Cameroon, there has been a drop from 63.4% in 1990 to 56.8% in 2000 and then an increase to 67.9% in 2017.[9] However, Globally, the 81% of live births worldwide occurred with the assistance of a skilled health personnel in 2018, up from 62% in 2005 and 69% in 2012 whereas that of Sub-Saharan Africa is just 59%in 2018.[15]

This increase in the coverage of live births by skilled birth attendants from the year 2000 in Cameroon could be attributed to the increase in the number of training institutions of health owned by the government, faith-based organization and also by private individuals; and also increase in the number of skilled health personnel employed in health facilities. Moreover, possibly because of the increase in mother and child health campaigns and demand to seek health this services in health facilities though traditional birth attendants are also present.[5]

Coverage of skill birth attendants, Cameroon

The proportion women of reproductive age (15 to 49 years) in Cameroon who have their family planning needs met with modern contraception methods increased about three folds from 14% in 1990, to 43.1% in 2015. As of 2017, still not up to half of women of reproductive age have their family planning needs as met as the percentage stands at 44.7%.[18] However, progress has been globally even though slowly from 74% in 2000 to 76% in 2019.[15]

Met need for family planning with modern contraception methods, Cameroon

Globally in the year 2000, the Under-5 mortality rate was 43 per 1,000 and neonatal mortality rate (likelihood of dying in the first 28 days of life) was 31 per 1,000.[15] Also globally, in 2017, the Under-5 morality and neonatal rates stood as 39 and 18.[18] As for Cameroon, the Under-5 and Neonatal mortality rates have shown a decline from 135.6 and 39.3 in 1990 to 73.5 and 23.4 in 2017 respectively. Many kids still die before getting celebrating their 5th birthday in Cameroon.

Table 2: Under-5 Mortality and Neonatal Mortality rates 1990–2017

Source: [9]

Transport injury is among the several types of injury. Pedestrian, cyclist, motorcyclist locally called "benskin" or "okada", motor vehicles, are among the most used road transport in Cameroon. As of 2014, the number of vehicles was estimated at 675,000. Recording more than 16,000 road accidents per year with more than 1000 deaths. In addition to the human loss which is dramatic, the economic loss is estimated at 100 billion FCFA (approximately US Dollars 168 million) per year.[19] The estimated number of people killed per 100 million km driven was 73, which is more than 35 times higher than on similar roads in the US and Europe.

Road traffic injury is a major cause of death in Cameroon and among the top ten causes in 2018. The estimates of the deaths per 100,000 in the year 2017 from all transport injuries was 15.88 while road injury alone was 14.79 in Cameroon. Moreover, the deaths per 100,000 were 17.96 low income countries had as opposed to 10.39 in high income countries. In 2017 in Sub Saharan Africa, the number of deaths per from road traffic injuries were estimated at 161,648.[9] Road traffic accidents are the largest cause of unintended injury in all regions, among low, middle income and high income countries. However, in developing countries, they have to deal with road accident in addition to some communicable diseases which are not a major issue in the high income countries.[20] This numbers of deaths from transport injury for Cameroon have increase from 3391 to 4408 in the last two decades with increasing number of death recorded among he males population.[9]

Percentage distribution by Sex of deaths due to Road Injury in Cameroon, 2017. Data from: https://vizhub.healthdata.org/gbd-compare/

These deaths could be as a result of several factors grouped into: transport operator (driver, cyclist, motorcyclist) factors, the state of the means of transport, the road or pavement, and also other environmental factors.

Distribution of the Death due to Road Injury in Cameroon, 2017 - Distribution by Age. Data from https://vizhub.healthdata.org/gbd-compare/

The Sustainable Development Goal number 3 (Ensure healthy lives and promote well-being for all ages) has nine major targets. The target number 6 which involves road injuries states:

• 3.6 By 2020 halve the number of global deaths and injury from road accident

Table 3: Number of deaths in Cameroon, Sub-Saharan Africa and the Globe from Traffic Injury (Road traffic Injury) 1990 - 2017

Source:[9]

Reports: Road Safety: Cameroon must redouble its effort and strengthen coordination[19]

In Cameroon, ministry of transport in collaboration with other ministries have been enforcing several methods to reduce this deaths in several sensitization campaigns (in schools, sending short messages to subscribers phones, special back to school programs), teams to do unannounced controls, alcohol test for drivers, improving on the high way signs, rehabilitation of road etc. However, she needs to redouble her effort and improve coordination,[19] cooperation with as well as human behavior in order to greatly reduce not only the number of deaths but also the Disability-adjusted life year DALYs which stands at 226,673 (157,195 for men)[9] road injury alone for Cameroon.