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Kibu OD, Kepgang E, Sinsai R, Conner A, Asahngwa C, Ngwa W, Ngo NV, Fobellah NN, Muenyi CS, Zalamea NN, Gobina RM, Foretia DA. Barriers and Motivations for Health Insurance Subscription Among Health-Care Users in Cameroon. J Surg Res 2024; 293:158-167. [PMID: 37774593 DOI: 10.1016/j.jss.2023.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 08/12/2023] [Accepted: 09/03/2023] [Indexed: 10/01/2023]
Abstract
INTRODUCTION Surgical care is a significant component of the overall health expenditure in low- and middle-income countries. In Cameroon, out-of-pocket payments for surgical service are very high with many patients declining potentially curative surgical procedures. Less than 2% of the population is enrolled in a health insurance scheme leading to a propensity for catastrophic health expenses when accessing care. To assess the perceived barriers and motivations for health insurance subscription among health-care users in Cameroon. METHODS This was a cross-sectional community-based qualitative study conducted in the Center Region of Cameroon. A total of 37 health-care users (health insurance subscribers and nonsubscribers) were purposively identified. Four focused group discussions and thirteen in-depth interviews were conducted. All anonymized transcripts were analyzed using a thematic analysis approach. RESULTS The six major themes identified as barriers to health insurance subscription were lack of trust in the existing health insurance schemes, inadequate knowledge on how health insurance works, premiums believed to be too expensive, the complexity of the claims processing system, minimal usage of health-care services and practice of self-medication. Motivational factors included the knowledge of having access to quality health services even without money in the event of an unforeseen illness and having a large family/household size. The importance of mass sensitization on the benefits of health insurance was noted. CONCLUSION Health insurance is still very underutilized in Cameroon. This results in significant out-of-pocket payment for health services by Cameroonians with catastrophic consequences to households. With most Cameroonians in the informal sector and underemployed, it is imperative to put in place a national strategic plan to overcome existing barriers and increase health insurance coverage especially among the poor. This has the potential to significantly increase access to safe, quality, timely and affordable surgical care.
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Affiliation(s)
- Odette D Kibu
- Division of Health Policy and Research, Nkafu Policy Institute, Denis and Lenora Foretia Foundation, Yaoundé, Cameroon; Department of Public Health and Hygiene, University of Buea, Buea, Cameroon
| | - Evrard Kepgang
- Division of Health Policy and Research, Nkafu Policy Institute, Denis and Lenora Foretia Foundation, Yaoundé, Cameroon
| | - Regina Sinsai
- Division of Health Policy and Research, Nkafu Policy Institute, Denis and Lenora Foretia Foundation, Yaoundé, Cameroon
| | - Anna Conner
- College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Constantine Asahngwa
- Division of Health Policy and Research, Nkafu Policy Institute, Denis and Lenora Foretia Foundation, Yaoundé, Cameroon; Department of Anthropology, University of Yaoundé 1, Yaounde, Cameroon
| | - Wilfred Ngwa
- Division of Health Policy and Research, Nkafu Policy Institute, Denis and Lenora Foretia Foundation, Yaoundé, Cameroon
| | - Ngo V Ngo
- Division of Health Policy and Research, Nkafu Policy Institute, Denis and Lenora Foretia Foundation, Yaoundé, Cameroon
| | - Nkengafac N Fobellah
- Division of Health Policy and Research, Nkafu Policy Institute, Denis and Lenora Foretia Foundation, Yaoundé, Cameroon
| | | | - Nia N Zalamea
- Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee; Global Surgery Institute, University of Tennessee Health Science Center, Memphis, Tennessee; Center for Multicultural and Global Health, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Ronald M Gobina
- Division of Health Policy and Research, Nkafu Policy Institute, Denis and Lenora Foretia Foundation, Yaoundé, Cameroon; Department of Surgery, Buea Regional Hospital, Southwest Region, Cameroon
| | - Denis A Foretia
- Division of Health Policy and Research, Nkafu Policy Institute, Denis and Lenora Foretia Foundation, Yaoundé, Cameroon; Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee; Global Surgery Institute, University of Tennessee Health Science Center, Memphis, Tennessee; Center for Multicultural and Global Health, University of Tennessee Health Science Center, Memphis, Tennessee.
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Yao JS, Kibu OD, Asahngwa C, Ngo NV, Ngwa W, Jasmin HM, Gobina RM, Foretia DA. A scoping review on the availability and utilization of essential opioid analgesics in Sub-Saharan Africa. Am J Surg 2023; 226:409-421. [PMID: 37024407 DOI: 10.1016/j.amjsurg.2023.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 03/08/2023] [Accepted: 03/13/2023] [Indexed: 03/28/2023]
Abstract
BACKGROUND Management of acute, post-operative, and chronic pain requires access to and availability of opioids. While often oversupplied in high-income countries, significant shortages exist in low- and middle-income countries. We conducted a scoping review on availability and usage of opioids in Sub-Saharan Africa (SSA). METHODS The five-stage approach of Arksey and O'Malley (2005) was used. MEDLINE via PubMed, EMBASE, and SCOPUS were search and results categorized into themes: 1) Local/regional availability and supply, 2) Consumption patterns, 3) Legislation and policy, 4) Costs and financing, 5) Knowledge and cultural beliefs, and 6) Education and training. RESULTS 6923 studies were identified from which 69 (1%) met inclusion criteria. Five key findings were: 1) Significant shortages exist, especially in rural areas, 2) Non-opioid analgesics commonly used as first-line acute pain management, 3) Barriers to market entry and bureaucratic processes prevent local production, 4) Significant knowledge gaps/myths exist amongst healthcare practitioners on opioid use, and 5) Continuous education and short courses will be critical. CONCLUSIONS Major challenges significantly limit availability and utilization of essential opioids in SSA. Reforms needed to upscale training and education, increase uptake by professionals, and increase market entry.
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Affiliation(s)
- Jane S Yao
- College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Odette D Kibu
- Division of Health Policy and Research, Nkafu Policy Institute, Yaoundé, Cameroon; Department of Public Health, University of Buea, Cameroon; Faculty of Health Science, University of Buea, Cameroon
| | - Constantine Asahngwa
- Division of Health Policy and Research, Nkafu Policy Institute, Yaoundé, Cameroon; Department of Anthropology, University of Yaoundé 1, Yaoundé, Cameroon
| | - Ngo V Ngo
- Division of Health Policy and Research, Nkafu Policy Institute, Yaoundé, Cameroon
| | - Wilfred Ngwa
- Division of Health Policy and Research, Nkafu Policy Institute, Yaoundé, Cameroon
| | - Hilary M Jasmin
- Health Science Library, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Ronald M Gobina
- Division of Health Policy and Research, Nkafu Policy Institute, Yaoundé, Cameroon; Health Science Library, University of Tennessee Health Science Center, Memphis, TN, USA; Buea Regional Hospital, Buea, Cameroon
| | - Denis A Foretia
- Division of Health Policy and Research, Nkafu Policy Institute, Yaoundé, Cameroon; Center for Multicultural and Global Health, University of Tennessee Health Science Center, Memphis, TN, USA; Global Surgery Institute, University of Tennessee Health Science Center, Memphis, TN, USA; Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA.
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Asahngwa C, Kibu OD, Ngo NV, Ngwa W, Muenyi CS, Zalamea NN, Gobina RM, Nkwi P, Foretia DA. Hospital Detention for the Inability to Pay: A Qualitative Study of Patient Experiences in Cameroon. J Surg Res 2023; 290:257-265. [PMID: 37315440 DOI: 10.1016/j.jss.2023.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 05/07/2023] [Accepted: 05/15/2023] [Indexed: 06/16/2023]
Abstract
INTRODUCTION Equitable access to quality surgical care and low-cost healthcare services for all segments of the population remains a big problem in many African health systems. In Cameroon, it is very common to find medically discharged patients who have received surgical treatment and are unable to pay the resulting bills. These patients can be held in detention in hospitals until payments are complete. Even the corpses of patients who die with unpaid medical bills can be withheld until their family members pay off the debt. While this practice has been ongoing for many y, there remains very little scholarship on the issue reported in the literature. The main objective of this study was to uncover the lived experiences of discharged patients residing in hospital detention for being unable to pay their medical bills. METHODS In-depth interviews, focus group discussions, and observations were conducted with purposefully selected patients living in detention in 2 rural private hospitals in the Fundong Health District in Cameroon. A thematic framework technique was used to analyze the transcribed data. The study was ethically approved by the Cameroon Bioethics Initiative, and informed consent was obtained from all participants. RESULTS Living in hospital detention after receiving treatment constitutes an economic, social, and psychological burden for patients. Economically, it exacerbated poverty for the patients unable to purchase food, medications, and clothing due to lack of jobs and financial support. Socially, many of these individuals suffered from isolation, loneliness, shame, stigma, risk of contracting other diseases, and precarious sleeping conditions. The psychological burden was comprised of stress, depression, trauma, nightmares, and suicidal thoughts. CONCLUSIONS The experiences of discharged patients in hospital detention suggest that they live in very deplorable conditions. There is a need for a functional healthcare protection mechanism, such as universal health coverage, to reduce the cost of healthcare services and surgical operations. Alternative payment mechanisms should also be considered.
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Affiliation(s)
- Constantine Asahngwa
- Division of Health Policy and Research, Nkafu Policy Institute, Yaoundé, Cameroon; Department of Anthropology, University of Yaoundé 1, Yaoundé, Cameroon
| | - Odette D Kibu
- Division of Health Policy and Research, Nkafu Policy Institute, Yaoundé, Cameroon; School of Public Health, University of Buea, Buea, Cameroon
| | - Ngo V Ngo
- Division of Health Policy and Research, Nkafu Policy Institute, Yaoundé, Cameroon
| | - Wilfred Ngwa
- Division of Health Policy and Research, Nkafu Policy Institute, Yaoundé, Cameroon
| | - Clarisse S Muenyi
- College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Nia N Zalamea
- Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee; Global Surgery Institute, University of Tennessee Health Science Center, Memphis, Tennessee; Center for Multicultural and Global Health, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Ronald M Gobina
- Division of Health Policy and Research, Nkafu Policy Institute, Yaoundé, Cameroon; Buea Regional Hospital, South West Region, Cameroon
| | - Paul Nkwi
- Department of Anthropology, University of Yaoundé 1, Yaoundé, Cameroon
| | - Denis A Foretia
- Division of Health Policy and Research, Nkafu Policy Institute, Yaoundé, Cameroon; Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee; Global Surgery Institute, University of Tennessee Health Science Center, Memphis, Tennessee; Center for Multicultural and Global Health, University of Tennessee Health Science Center, Memphis, Tennessee.
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Obegu P, Nkangu M, Ngo NV, Wanda F, Kasonde M, Kibu OD, Abong N, Ndiforchu V, Fantaye AW, Buh A, Gobina RM, Foretia DA, Fobellah N, Yaya S. Community participation for reproductive, maternal, newborn and child health: insights from the design and implementation of the BornFyne-prenatal management system digital platform in Cameroon. Front Digit Health 2023; 5:1218641. [PMID: 37664872 PMCID: PMC10470631 DOI: 10.3389/fdgth.2023.1218641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 07/27/2023] [Indexed: 09/05/2023] Open
Abstract
Introduction Across communities in low-middle income countries, digital health is currently revolutionizing the delivery of health services, particularly in the field of reproductive, maternal, newborn, and child health (RMNCH) services. While studies have shown the effectiveness of mHealth in delivering RMNCH services, there is little information about factors that enhance mHealth services utilization in low-cost settings including stakeholders' level of influence on the implementation of digital health intervention in sub-Saharan Africa. This paper seeks to describe important lessons on the levels of stakeholders' direct or indirect influence on the design and implementation of the BornFyne-PNMS digital health platform to support RMNCH services. Methods A participatory research (PR) design approach was employed to explore stakeholders' perspectives of a new initiative, through direct engagement of local priorities and perspectives. The process of introducing the digital application called the BornFyne-PNMS for district health delivery system and the community, and integrating it within the district health delivery system was guided by research-to-action, consistent with the PR approach. To explore stakeholders' perspectives through a PR approach, we conducted a series of stakeholder meetings fashioned after focus group discussions. Results Issues around male involvement in the program, sensitization and equity concerns arose. Emergent challenges and proposed strategies for implementation from diverse stakeholders evidently enriched the design and implementation process of the project intervention. Stakeholder meetings informed the addition of variables on the mobile application that were otherwise initially omitted, which will further enhance the RMNCH electronic data collection for health information systems strengthening in Cameroon. Discussion This study charts a direction that is critical in digital health delivery of RMNCH in a rural and low-income community and describes the important iterative stakeholder input throughout the study. The strategy of stakeholders' involvement in the BornFyne PNMS implementation charts a direction for ownership and sustainability in the strengthening of Cameroon's health information system.
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Affiliation(s)
- Pamela Obegu
- Health Promotion Alliance of Cameroon, Yaounde, Cameroon
| | - Miriam Nkangu
- Health Promotion Alliance of Cameroon, Yaounde, Cameroon
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Ngo Valery Ngo
- Nkafu Policy Institute, Denis and Lenora ForetiaFoundation, Yaounde, Cameroon
| | - Franck Wanda
- Health Promotion Alliance of Cameroon, Yaounde, Cameroon
| | - Mwenya Kasonde
- Health Promotion Alliance of Cameroon, Yaounde, Cameroon
| | - Odette D. Kibu
- Nkafu Policy Institute, Denis and Lenora ForetiaFoundation, Yaounde, Cameroon
| | - Nelly Abong
- Health Promotion Alliance of Cameroon, Yaounde, Cameroon
| | | | | | - Amos Buh
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Ronald M. Gobina
- Nkafu Policy Institute, Denis and Lenora ForetiaFoundation, Yaounde, Cameroon
| | - Denis A. Foretia
- Nkafu Policy Institute, Denis and Lenora ForetiaFoundation, Yaounde, Cameroon
- Center for Multicultural and Global Health, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Nkengafack Fobellah
- Nkafu Policy Institute, Denis and Lenora ForetiaFoundation, Yaounde, Cameroon
| | - Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Ottawa, ON, Canada
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Yao J, Ngo NV, Kibu OD, Asahngwa C, Jasmin HM, Gobina RM, Foretia DA. Availability and Use of Essential Opioid Analgesics in Sub-Saharan Africa: A Scoping Review Protocol. Int J Surg Protoc 2023; 27:1-8. [PMID: 36789102 PMCID: PMC9896994 DOI: 10.29337/ijsp.184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 11/21/2022] [Indexed: 02/16/2023] Open
Abstract
Introduction The treatment of acute, peri-operative, and chronic pain by healthcare practitioners and health systems requires appropriate access to and availability of essential opioid medications. While opioids are often oversupplied and overprescribed in high-income countries, there are significant inequities as many low- and middle-income countries (LMICs) experience severe shortages. In fact, while the richest 10% in the world reside in countries receiving almost 90% of all available opioids, 50% of the poorest in the world reside in countries receiving just 1% of all available opioids.Understanding the social, economic, cultural, and regulatory barriers to access essential opioid analgesics in LMICs is critical in delineating and prioritizing appropriate interventions. We aim to conduct a scoping review on the availability and usage of essential opioid analgesics in LMICs, specifically in sub-Saharan Africa, to identify barriers, themes, and knowledge gaps. Materials and Methods We will utilize the framework for conducting scoping reviews by Arksey and O'Malley. We will perform the search for articles in 3 electronic databases (i.e., SCOPUS, PubMed, Embase) and relevant gray literature. Only articles in English will be included. There will be no restriction on the publication period. All articles will directly involve either the availability and/or the use of essential opioid analgesics. Studies will be restricted to focus on sub-Saharan Africa. We will use a tailored extraction frame to extract relevant information from published articles that meet our inclusion criteria. We will analyze the data using both descriptive statistics and thematic analysis on the main study questions. Ethics and Dissemination Since we will not be collecting primary data, formal ethical approval is not required.Our study findings will be disseminated through abstracts, conference presentations, and peer-reviewed publications. Highlights 50 percent of the poorest in the world reside in countries receiving just 1 percent of all available opioidsThere is a paucity of data analyzing the inequitable distribution of essential opioid analgesics worldwideOur scoping review will identify barriers, themes, and knowledge gaps on the availability and use of essential opioids in SSAIt will identify areas for further research and potential policy initiatives.
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Affiliation(s)
- Jane Yao
- College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Ngo Valery Ngo
- Division of Health Policy and Research, Nkafu Policy Institute, Yaoundé, Cameroon
| | - Odette D. Kibu
- Division of Health Policy and Research, Nkafu Policy Institute, Yaoundé, Cameroon,Department of Public Health, University of Buea, Cameroon
| | - Constantine Asahngwa
- Division of Health Policy and Research, Nkafu Policy Institute, Yaoundé, Cameroon
| | - Hilary M. Jasmin
- Health Science Library, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Ronald M. Gobina
- Division of Health Policy and Research, Nkafu Policy Institute, Yaoundé, Cameroon,Buea Regional Hospital, Buea, Cameroon
| | - Denis A. Foretia
- Division of Health Policy and Research, Nkafu Policy Institute, Yaoundé, Cameroon,Center for Multicultural and Global Health, University of Tennessee Health Science Center, Memphis, TN, USA,Global Surgery Institute, University of Tennessee Health Science Center, Memphis, TN, USA
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Essouma M, Soh DM, Temgoua MN, Gobina RM, Nono AT, Atenguena EO, Maimouna M, Ashuntantang GE. Adult T-type lymphoblastic lymphoma presenting as hypercalcemic crisis and aplastic anemia: a case report. J Med Case Rep 2019; 13:305. [PMID: 31594542 PMCID: PMC6781379 DOI: 10.1186/s13256-019-2225-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 08/08/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hypercalcemia and aplastic anemia are two uncommon presentations of non-Hodgkin lymphoma that potentially worsen the disease prognosis. Although hypercalcemia has been reported in the B-cell subtypes and some T-cell subtypes of non-Hodgkin lymphoma, it has not been described in T-cell lymphoblastic lymphoma. The same applies to aplastic anemia, which is also not described in T-type lymphomas. CASE PRESENTATION We report a case of a 52-year-old Cameroonian man with acute kidney injury who presented with confusion, abdominal pain, constipation, polyuria, polydipsia, calciphylaxis, enlarged lymph nodes, tachycardia, and a blood pressure of 170/88 mmHg. Laboratory investigations revealed hypercalcemia (total/ionized 199.5/101.75 mg/L), normal serum phosphorus (40.20 mg/L), and a low intact parathyroid hormone (9.70 pg/ml). Complete blood count revealed pancytopenia. Peripheral blood smear confirmed thrombocytopenia but showed neither blasts nor flower cells. Bone marrow aspirate revealed hypocellularity with no blasts or fibrosis. Lymph node biopsy was suggestive of T-cell precursor lymphoma. T-lymphoblastic lymphoma presenting with hypercalcemic crisis and aplastic anemia was diagnosed, and the patient received the cyclophosphamide-doxorubicin-vincristine-prednisone protocol of chemotherapy together with filgrastim and whole-blood transfusion for aplastic anemia. The short-term outcome was fatal, however. CONCLUSIONS Severe hypercalcemia and aplastic anemia are potential paraneoplastic syndromes of adult T-type lymphoblastic lymphoma, with fatal short-term outcome.
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Affiliation(s)
- Mickael Essouma
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon.
| | - Dorothée M Soh
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Mazou N Temgoua
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Ronald M Gobina
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Aristide T Nono
- Nephrology Unit, Yaoundé General Hospital, Yaoundé, Cameroon
| | | | - Mahamat Maimouna
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon.,Nephrology Unit, Yaoundé General Hospital, Yaoundé, Cameroon
| | - Gloria E Ashuntantang
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon.,Nephrology Unit, Yaoundé General Hospital, Yaoundé, Cameroon
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