Functioning and disability in recent research from Cameroon: a narrative synthesis
Minal Ray1, Lorena Wallace1, Lawrence Mbuagbaw2,3,&, Lynn Cockburn1
1University of Toronto, Department of Occupational Science & Occupational Therapy, Toronto, Canada, 2McMaster University, Department of Health Research Methods Evidence and Impact, Hamilton, ON, Canada, 3Centre for the Development of Best Practices in Health, Yaoundé, Cameroon
Lawrence Mbuagbaw, McMaster University, Department of Health Research Methods Evidence and Impact, Hamilton, ON, Canada, Centre for the Development of Best Practices in Health, Yaoundé, Cameroon
people living with disabilities in Cameroon face many barriers to daily functioning and social participation. However, there is limited research on disabilities and their impact. We sought to examine the research related to disability from Cameroon.
we conducted a systematic review, bibliometric analysis, and narrative synthesis of research related to disability, functioning, and social participation from Cameroon published during 2005-2014. The articles were screened in duplicate to identify articles addressing impacts of disability on functioning. Disability was contextualized using the International Classification of Functioning, Disability and Health (ICF) framework. Data were analyzed narratively per identified themes using an inductive data-driven approach.
a total of 46 studies were included following full-text review of which 36 addressed non-communicable diseases and conditions, 7 addressed infectious diseases and 3 addressed neglected tropical diseases. Among ICF Activity and Participation Restrictions, work and employment was the highest reported category (19 studies), followed by intimate relationships (14 studies), and looking after one's health (8 studies). Among ICF Environmental Factors, societal attitudes were the highest reported category (21 studies), followed by health services, systems and policies (14 studies) and support and relationships (11 studies). Among other common themes, knowledge and awareness was the highest reported category (22 studies), closely followed by traditional beliefs (20 studies) and financial barriers (9 studies).
there is a small body of primary research from Cameroon on disability. The main themes related to disability are stigma, limited knowledge and awareness, poor quality of care and hindered employment opportunities. Further efforts are required to investigate the complexities of living with a disability in Cameroon and strategies to enhance adequate participation in activities of daily life.
Globally, over a billion people live with disabilities . Years of 'healthy life lost due to disability' is 80% higher in Africa than in high-income countries . Cameroon is an African country with a population of over 22 million people . It is bordered by six other countries: Nigeria, Chad, the Central African Republic, Equatorial Guinea, Gabon, and the Republic of Congo. Political and social strife in surrounding nations in recent years has put a strain on Cameroon. As of December 2014, over 200,000 people had fled their home nations crossing Cameroonian borders to find refuge .
Cameroon has a rich cultural tradition but a poor economy. The difficulties Cameroon faces include high unemployment rates, political challenges, insufficient infrastructure, a resource-lacking educational system, and a poor healthcare system which is struggling to meet the needs of its growing population [5, 6]. Cameroon ranks 152 on the United Nations (UN) Human Development index , indicating that the rate of desirable life outcomes of the people of Cameroon is below the world average. In 2010, there were 1.1 physicians per 10,000 people . Although life expectancy at birth is rising, it is currently only 55.7 years  compared to the average global life expectancy of 71 years . Such factors negatively affect the health and well-being of the people of Cameroon.
The current body of research on disability in low-income countries such as Cameroon is quite small [10
]. Most of the studies that do exist are concerned with prevalence and patterns of disability and do not address the impact of disability. Disability related research priorities for the Cameroonian health and social services systems have not been clearly stipulated, no funds are allocated to disability research, and little attention is paid to disability and rehabilitation programming. The lack of research and relevant reviews make it difficult for clinicians, educators, and policy makers to locate and evaluate empirically based evidence relevant to the population. The provision of a comprehensive review of disability-related research in Cameroon could guide practice, policy, and future research to improve the lives of the general population and people living with disability (PLWD). A combination of systematic review and bibliometric review methods alongside a narrative synthesis were chosen to address this need.
The International Classification of Functioning, Disability and Health (ICF) proposes that disability can be understood as the result of complex interactions between health conditions and personal, environmental, and occupational factors impacting social participation and day-to-day functioning [11
]. The ICF provides an integrated biopsychosocial framework for understanding human functioning and the factors related to disability [11
]. According to the ICF, disability involves dysfunction between three levels: impairments, activity limitations, and participation restrictions [11
]. The ICF has been adopted and used around the world in many different contexts, including disability research.
The ICF is becoming more widespread as researchers strive towards common understandings
and language for discussions of health and disability, and therefore the use
of the ICF framework is favorable for research on disability and functioning
in Cameroon. For this study, we used the ICF as an organizational framework to
understand the impacts of disability on functioning and the contextual factors
that impact the relationship between disability and functioning. Because the
focus of this paper is on Activity and Participation Restrictions that result
from disability and Environmental Factors that impact disability and functioning,
we do not report on or discuss the Impairments in [body] Structure and Function,
which are also part of the ICF framework [11
The purpose of this review is to inform and guide research priorities, policy
development, funding allocations, and evidence based-practice in Cameroon. The
specific objectives were:
(1) To access, categorize, and synthesize the disability research focused on
social participation and functioning from Cameroon published during 2005-2014;
examine and synthesize the impact of disability on the functioning of Cameroonians,
including activities of daily living and social participation;
(3) To identify and describe the environmental factors which are most commonly
studied, such as stigma and barriers to accessibility.
Data collection and search strategy:
a comprehensive search of major and relevant databases available through the
University of Toronto library (https://onesearch.library.utoronto.ca/) was conducted
in January of 2015. Literature was obtained from the following databases/providers:
Biomed Central, Elton B. Stephens Co. (EBSCO), Francis, Journal Storage, Popline,
Project Muse, Proquest, PubMed, Social Science Abstracts, Scopus, Web of Science,
and OVID databases. The tables of contents of two journals published in Cameroon,
the African Journal of Integrated Health and African Health Sciences, were also
Data management and data sharing:
citations were downloaded into the reference
management system Zotero (https://www.zotero.org/). A pre-developed extraction
table in Microsoft Excel was used to record relevant information when conducting
in-depth analyses of articles that fit the inclusion criteria.
title and abstract were reviewed to ensure that articles met the following inclusion criteria:
Indexed between January 1, 2005 and December 31, 2014; primary health-related research focusing on humans living in Cameroon; published in English or French; Mixed-method, observational, qualitative, and quantitative studies; articles with analysis of primary or secondary data collected in Cameroon. Studies using secondary data were included if an original analysis was conducted on this data (e.g. articles that conduct analysis on data collected from Demographic and Health Surveys studies were acceptable for inclusion); in multi-country studies, where Cameroon was one of two or more countries, the study was included if information and results regarding Cameroon could be extracted independently from data about other countries.
Publications such as commentaries and letters to the editor that did not involve direct contact with participants; animal, plant and basic pharmaceutical/lab studies; secondary studies (i.e. reviews); masters and Doctoral theses.
From the list of health-related research from Cameroon, we screened for studies that included information on disabilities. First, the Zotero library (containing the list of health related research from Cameroon for a ten year period), was thoroughly screened in duplicate by MR and LW via title and abstract reviews to identify all studies that potentially addressed disability and functioning. Only studies that had a focus on a health condition were included. A 'health condition' was defined as a disease or disorder affecting a person's mental or physical health or daily functioning. Such conditions include: Non-communicable diseases and conditions (including mental health disorders), infectious diseases, and neglected tropical diseases. These groupings were identified based on those found within Cameroon's Sectoral Strategy for Health document [12
]. Identified studies were then carefully read in full text to further identify studies that addressed impacts of disability (i.e. ability to function, to live one's life, or carry out daily occupation). A third author (LM or LC) was invited to arbitrate when a consensus could not be reached.
using an inductive, data-driven approach, the results sections of included articles were systematically searched for data relevant to the ICF categories related to activity and participation. Additional potential themes were drawn from data. Raw data was extracted directly from articles, and grouped using the ICF categories and addition working themes not captured by the ICF categories. The themes were verified by the team. Descriptive statistics were conducted using counts and percentages. Raw data fitting each category or theme was narratively analyzed and information was synthesized. Content for each identified theme is reported narratively.
Our search retrieved 8624 studies of which 3009 were remaining after deduplication. Eighty-five were eligible for full text review, of which 46 were included in our narrative synthesis.
Figure 1 is a Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) flow diagram detailing our screening process .
Characteristics of included studies:
a total of 46 studies were included following full-text review of which 36 addressed
non-communicable diseases and conditions, 7 addressed infectious diseases and
3 addressed neglected tropical diseases. There was a predominance of quantitative
survey approaches and few phenomenological or anthropological studies. Table
provides a brief description of the included studies and outlines the
location, design, and disease or condition covered. The studies came from many
parts of Cameroon, with more from the Central, North West, and South West regions.
There was a dominance of studies addressing neurological conditions due to the
relatively large number of articles addressing epilepsy.
in addition to the ICF categories, we identified other themes that became apparent during this analysis.
addresses the disease groupings in more detail by looking at the disease conditions that fall within each grouping. The ICF Activity and Participation Restrictions, ICF Environmental Factors, and additional common themes that were mentioned at least once are plotted in Table 2
quantifies the number of studies that addressed each of the ICF categories and additional common themes. Among ICF Activity and Participation Restrictions, work and employment was the highest reported category (19 studies), followed by intimate relationships (14 studies), and looking after one's health (8 studies). Among ICF Environmental Factors, societal attitudes was the highest reported category (21 studies), followed by health services, systems and policies (14 studies) and support and relationships (11 studies). Among other common themes, knowledge and awareness was the highest reported category (22 studies), closely followed by traditional beliefs (20 studies) and financial barriers (9 studies).
Non-Communicable Diseases and Conditions
Mental health and mental illness:
eight articles that directly addressed mental health/illness met our criteria.
These articles discussed the impact of mental disability on functioning. Four
articles focused on depression [14-17
]. Three of these studies
addressed depression in people living with HIV and AIDS (PLWHA). Topics included
the prevalence, predictors, or correlates of depression, and the efficacy of
intervention. Two articles included participants with psychosis/schizophrenia
and other mental illnesses [18
One article examined suicide [20
]. No studies were found
that discussed indigenous conceptualizations of mental health or mental illness,
anxiety disorders, personality disorders, or eating disorders. Knowledge and
awareness of mental health in the public and in health systems was addressed
in three studies. St. Louis & Roberts [21
], looked at attitudes
about mental illness in general and discussed stigma of mental illness: compared
to Canadians and Americans, people in Cameroon had more negative impressions
of mental illness, were less likely to endorse advocating for treatment, were
more likely to engage in stigmatizing behaviour, and viewed people with mental
illness as unable to function in daily living. Keugoung et al [20
and Gaynes et al [14
] assessed the capacity of district
health systems to deliver quality mental health care. Results suggest that most
people with depression or other mental illness did not seek biomedical treatment,
there was a lack of specific guidelines for treatment of mental health disorders
among primary healthcare facilities, and a general lack of professionals trained
in mental health care [14
with millions of inhabitants (such as the Far North region) did not have doctors
trained in psychiatry [20
]. People with severe mental illness
living in rural districts were referred to a psychiatric hospital in Yaoundé and
follow-up communication between doctors in this hospital and the patient´s local
doctors did not occur [20
]. Knowledge of mental health/illness
was also limited. Eighty-seven percent of consulting nurses interviewed by Keugoung
et al [20
] were not able to name any signs of depression
and did not know it was associated with suicide. No other studies were found
that addressed health worker capacity to address other disabilities.
the literature on neurological conditions was dominated by studies addressing
knowledge, attitudes, and perceptions of epilepsy. Of a total of 12 studies in
this category, 11 addressed epilepsy [22-32
] and one addressed
Parkinson's Disease (PD) [33
]. Studies surveyed the public,
secondary school students, and healthcare providers in different health districts
across Cameroon to determine prevalence of stigmatizing attitudes towards people
living with epilepsy (PLWE). Discrimination against PLWE was the highest when
concerning the prospect of marriage. While stigma was present among medical professionals,
stigma was greatest amongst traditional healers. In Badissa Village, lower rates
of stigmatizing attitudes were attributed to an epilepsy education and treatment
program established 10 years prior to the study [28
contrast, districts which lacked an epilepsy education and treatment program
at the time the studies were conducted (Akwaya Health District, Batibo Health
District, Fundong Health District, Kumbo West Health District, Ebolowa and Sangmelima)
showed high rates of stigmatizing attitudes. All 10 studies found that predictors
of negative attitudes towards PLWE were the beliefs that epilepsy is contagious
and a form of insanity. In contrast to studies that focused on quantifying the
prevalence of stigmatizing beliefs, Allotey & Reidpath [22
and Cubo et al [33
] qualitatively focused on the impacts
of epilepsy and PD, respectively, on functioning. PLWE reported a lack of supportive
relationships and disruptions to meaningful family relationships [22
Caregiver burden was a factor in caring for PLWE as well as people with PD [22
In regards to intimate relationships, hypersexuality was found among people with
]. Restrictions placed on sexual intercourse by medical
doctors and healers affected self-esteem for males and contributed to internalized
]. Restrictions placed on PLWE by medical care
providers and cultural beliefs resulted in the internalization of a 'sick' role,
which posed barriers to participation in productive activities [22
PLWE reported being subject to high levels of discrimination which hindered their
participation in community, social and civic life, and reduced their "social
]. PLWE were excluded from employment opportunities,
resulting in difficulties supporting their family and affording medications for
their condition; 40/42 participants reported compliance with medications only
when finances were available [22
]. Furthermore, 30/42 participants
reported interruptions in education due to seizures; some were expelled from
school because of them [22
]. Participation in domestic life
was also hindered. For example, women were advised to stay away from open fires
which resulted in an inability to participate in cooking - an important role
for women in Cameroon [22
the only sensory condition that was studied with regard to the impact on functioning
was the loss of hearing [34
Studies addressing vision loss reported only prevalence and did not discuss impacts
on functioning [36
De Clerck [34
] addressed the low quality of life of deaf
individuals. She found that societal attitudes were highly discriminating and
questioned the ability of deaf individuals to participate in activities associated
with 'full personhood' in Africa such as employment, marriage, having children,
and supporting a family. Deaf individuals reported internalized stigma, negatively
affecting perceptions of themselves and other deaf people [34
Access to employment opportunities was restricted due to a lack of education
and low literacy rates among people who are deaf [34
Jobs that were obtained were often difficult and precarious [34
The lack of employment opportunities for deaf individuals resulted in financial
barriers and further marginalization [34
]. Deaf individuals
lacked supportive relationships, were often left out of the family [34
and experienced human rights violations such as sexual abuse [34
Many deaf individuals were not aware of the Cameroonian legal system and lacked
the knowledge to self-advocate [34
of five studies addressing the impacts of physical disabilities, Bremer et al
], Fernande and Paul-Iva [39
] addressed participation restrictions for people
living with mobility impairments (PLWMI). Kiani [40
and Zamo-Akono [41
] and Zamo-Akono [42
addressed employment restrictions. All five studies found that having a physical
disability made it difficult to participate in employment [38-42
For PLWMI, participation in employment was impacted by a lack of access to education
due to the physical inaccessibility of schools and financial barriers [38-40
PLWMI reported reduced availability of health services [38
as medical consultation and transportation were costly and taxis often refused
to provide service [38
].Participants reported that healthcare
workers were not informed nor sensitive to the needs of PLWMI, negatively impacting
quality of service [38
]. PLWMI reported a lack of supportive
relationships and stigmatizing societal attitudes [38
Participation was restricted in their community, social, and civic life due to
the inaccessibility of public spaces and societal attitudes [39
Beliefs, such as disabilities are caused by divine punishment, can lead PLWD
to avoid being in public spaces [39
]. Participation in domestic
life was difficult for PLWMI due to activity limitations for tasks such as fetching
water and cooking, and participation in social life, such as marriage [38
Fernande and Paul-Ivan [39
] discussed the violation of rights
of that PLWD face. Even though laws regarding accessibility exist in Cameroon,
they are rarely adhered to and PLWD are left out of decision-making processes
regarding open space planning and policies [39
Metabolic and cardiovascular conditions:
six articles regarding metabolic and cardiovascular conditions were included.
Of these, four discussed knowledge, attitudes, or awareness of risk factors
Four addressed the impact of these conditions on participation and functioning
by examining management of disease through activity and lifestyle modifications
[43-45, 47, 48].
These authors stressed the importance of reducing risk factors for diabetes
and cardiovascular conditions. Kiawi et al  found
that knowledge of these topic areas in Douala, Yaounde, Bamenda and Garoua
was limited, and
diabetes was considered to be 'the sugar disease,' with its cause attributed
solely to eating sweet foodstuffs. Diabetes was commonly self-diagnosed, using
methods such as tasting one's urine. If the urine tasted sweet, it was assumed
to be because of diabetes . Diabetes was not seen
as a big threat to ones' health and not viewed as a chronic condition .
Awah et al  reported that a reduction in risk factors
was difficult due to the lack of a national policy programme on non-communicable
diseases combined with low awareness of the need for a reduction of risk factors.
Perhaps some progress was made as the results of a study conducted by Fezeu
et al  indicated that individuals residing in the
Bamenda health district had adequate general knowledge about risk factors,
treatments, and complications of diabetes. Examining societal beliefs that
may be correlated to diabetes, Kaiwi et. al. found that poverty is associated
thinness and with walking as a means of transportation. As a result, having
a larger body size was valued and walking as a form of exercise was not .
Hence, obesity, along with physical inactivity and poor diet, was often not
believed to be associated with diabetes. Traditional beliefs regarding the
cause of diabetes,
such as that the disease is a result of a social transgression of the patient
or punishment from ancestors for neglecting culturally important rituals, may
lead people to seek traditional healers . In addition,
many patients did not have the financial means to follow recommended diets
to access biomedical services and medicines , resulting
in reliance on more affordable traditional options .
Cancer: the search revealed two studies that addressed cancer. Neither
addressed the impacts of cancer on participation in daily life, however they
factors resulting in delay in seeking care  or an
unwillingness to seek care . Inadequate health services
and lack of knowledge and awareness about cancer combined with the role of
were discussed in both studies.
despite the large number of studies focusing on HIV infection, few studies examined
disability related to HIV. Seven studies about infectious diseases addressed
disability or functioning: six addressed HIV [51-56
one focused on tuberculosis (TB) [57
The main activity and participation restrictions faced by PLWHA identified in
these six studies included: human rights violations, acquisition of necessities,
engaging in work and employment; and engaging in intimate relationships. Jacobi
et al. reported 12% of participants experienced violations of their human rights
due to their HIV status [53
]. Participants in this study
reported being forced to change their residence or being unable to rent housing
and some believed it was due to their HIV status [53
percent of the participants lost their job at least once in the past 12 months
and more than 40% of believed it was due to their HIV status [53
Engaging in intimate relationships was hindered for PLWHA as 25% of participants
isolated themselves and decided to refrain from marriage, sex, or having children
due to internalized feelings of shame or guilt, self-blame, and low self-esteem
]. Boyer found that PLWHA were discriminated against
within their family [51
]. Suzan-Monti et. al reported that
among 1673 participants, 15% did not disclose their serostatus to their main
partner, however, individuals who knew someone else with HIV in their family
or social circle were more likely to disclose their HIV status [56
PLWHA with stronger social supports reported better physical and mental health
Access to healthcare and quality of care received was impacted by inability to
pay for treatment, individual attitudes of healthcare professionals, and lack
of services. In their study on HIV-related stigma, Rosenburg et al. reported
that Cameroonian nursing students witnessed nurses providing poorer quality of
care to a PLWHA than to other patients. This study reported that not only were
PLWHA discriminated against by nurses, but nurses caring for PLWHA were also
discriminated against [55
Neglected tropical diseases:
we identified only three studies on the impact of the impairments caused by neglected
tropical diseases on functioning. Two addressed the impacts of Buruli Ulcer Disease
] and one paper addressed
]. These studies focused mainly on knowledge
and awareness of the diseases, as well as factors influencing treatment-seeking
behaviours. Amuyunzu-Nyamongo et al found that children in Cameroon have greater
knowledge and awareness of onchocerciasis and its treatment than children in
Uganda and Nigeria [60
]. The papers on BUD discussed knowledge
of perceived etiology of BUD, factors influencing the form of treatment sought,
and financial/social costs of treatment. Grietens et al found that study participants
believed that even if BUD can be attributed to natural causes (i.e. 'microbes'),
there were also beliefs that occurrence was influenced by witchcraft or patients'
disregard of societal rules. These studies indicate that a large percentage of
Cameroonians with BUD alternate between the use of traditional and biomedical
treatment or utilize both types of treatment [59
Cost of treatment and the unequal balance of power between doctor and patient
were found to have a larger influence on treatment seeking behaviour than beliefs
in a treatment type [59
]. One study showed that the median
cost burden of BUD amounted to 25% of patients' annual household earnings [58
influencing patients to choose traditional healing in an attempt to cut treatment
]. Families of BUD patients tried to cope with
costs by relying on friends and relatives to assist them financially. In 63%
of households, coping strategies included the social isolation of the BUD patient
Methodology and process:
use of the ICF was helpful because it provided the researchers with a list of categories that look at functioning from a wide lens, however there were still aspects that were missing, and additional themes were identified that were not included in the ICF categories. The broad categories of the ICF have been used effectively in other reviews of disability and rehabilitation . One benefit of the use of the ICF framework is that its standardized categories allow for these findings to be compared to similar reviews from Cameroon and other countries in the future.
Knowledge and awareness among the public:
lack of knowledge and awareness of disease and disability among the public was the most common theme identified in this literature, with several studies addressing knowledge and awareness of epilepsy, and a few others on cancer, diabetes and hypertension. This lack of knowledge affects care-seeking behavior and results in further impairments and disability, disease exacerbations, disease transmission, and social exclusion.
stigma towards PLWD was found in 21 studies across multiple disease conditions, including mental health conditions, epilepsy, hearing loss, and mobility impairments. These findings indicate that stigma towards PLWD results in a cycle of discrimination and marginalization. Stigma can be conceptualized as a way to mark groups who are viewed to be 'unworthy' of social investment [62
]. PLWD were viewed to be less capable and were excluded from work and social participation in the community. Therefore, they were perceived as contributing less to society and had fewer financial resources, perpetuating stigma against them. A common American theory of stigma holds that stigma is a social process; created as a way to reduce the perceived personal risk regarding loss of one's social identity [63
] and economic status [64
]. As the risk of status loss for PLWD in Cameroon is high, it is not surprising that people are afraid of such loss and take measures to separate themselves from those who experience it. Thus, stigmatizing beliefs may arise from and contribute to an 'us versus them' mentality [65
], with status loss being projected away from the stigmatizer onto the group of people who experience the disability. PLWD are negatively labeled and associated with undesirable characteristics [66
]. Stigmatization draws on existing forms of social prejudice and power [64
], which in Cameroon appear to include beliefs about the causes of disability. Disability can be perceived as preventable, controllable, or punishment for social/cultural offences or immoral behaviours [39
], which are then associated with 'carriers' of the disability [64
]. Beliefs that attribute the cause of disability to individual decisions or choices rather than to external factors may provide others with justification for holding stigma and discrimination against the 'wrong doers' of society.
A social model of disability [11
], provides a way to understand that functioning and participation of PLWD in Cameroon is limited by stigma and discrimination as much as, and perhaps even more so, than the physical and mental limitations posed by the impairment itself. Further studies on disability, stigma, discrimination, and strategies to promote social inclusion are needed.
Impacts on quality of care:
research related to mental health, epilepsy, mobility impairments, and HIV suggests that lack of knowledge and stigma was found among healthcare providers including physicians, nurses and traditional healers [20
]. Lack of knowledge among healthcare providers can lead to poor quality services, misdiagnosis, inappropriate treatment and delays in treatment leading to poor prognosis for conditions such as cancer [49
The literature on epilepsy suggests that the level of stigmatizing attitudes held by healthcare providers is comparable to those among the general public; with traditional healers having the highest rates of negative attitudes among healthcare providers [30
Social support, intimate relationships and marriage:
the difficulties encountered related to intimate relationships and marriage were addressed in number of studies [24-32
], and need to be further explored. While not well explored in these studies, it appears that beliefs about what is best for a family may be prioritized over the needs of a disabled family member, in keeping with the overall collectivist nature of society in Cameroon. The lack of a health insurance and income supports for PLWD also appears to play a role regarding social support, intimate relationships and marriage. For example, the costs involved in biomedical treatment for Buruli Ulcer, including travel to hospital, the caregiver's lost wages, and costs of supporting the admitted patient financially, were much greater when families were involved in patient care [58
], which led many families to avoid these costs by socially isolating the patient in the hospital, negatively impacting the patient's well-being [58
]. Similarly, mental illness may also lead to a loss of familial relationships. Menick et al. discussed how families abandoned their loved one with mental illness on a main street in Yaoundé, hoping that a 'hypnotist' could heal them [16
Gaps in the healthcare systems
Lack of health workers:
there is a shortage of mental healthcare workers in Sub-Saharan Africa [20
For example, in 2011 there were 0.03% psychiatrists per 100,000 people in Cameroon,
approximately 6 or 7 in the country [69
]. Mental healthcare
training is lacking: the majority of primary care doctors and nurses have not
received in-service training in mental health care within the past five years
]. Healthcare professionals need education regarding
the prevalence, causes, and management of mental health conditions, which could
help to reduce stigma, and more research is required to better understand conditions
and effective treatments. We did not find any other papers addressing human resources
for other disabilities.
Work, employment, and financial barriers to medical care:
restrictions to employment, and financial barriers to medical consultation and treatment were two key themes identified in this literature. PLWD were refused employment or faced unequal employment opportunities due to social stigma, participation restrictions, and a lack of education [22
]. This exclusion from fair work and employment combined with the lack of social assistance for PLWD in Cameroon resulted in poverty and financial barriers. As a result, seeking treatment from medical providers and compliance of medication became second priority.
Gaps in research:
the perception that there is a lack of research on disability in Africa was
supported by the results of our review. Two major gaps were the lack of primary
studies focused on disability and the lack of literature reviews of disability
research. Of the studies included in this review, few focused on disability,
functioning, and participation as the main topic of research investigation.
Rather, findings related to functioning and social participation were more
often mentioned indirectly, as smaller findings in relation to the main topic
of the study. Other gaps of note were identified in the mental health literature.
The studies were focused on the prevalence and correlates of mental illness.
Only one study directly examined the efficacy of an intervention for mental
Using the ICF framework and additional themes, information from primary research studies related to disability in Cameroon was collated. Existing research topics and gaps in the literature were identified. This review found that there is a very small body of primary research on the impacts of disability in Cameroon, with no secondary literature reviews identified. A strong need for further disability research exists, especially research that addresses other aspects of disability besides prevalence and correlates alone.
We recommended that future research focus on the impacts of disability on functioning and participation in these and other areas of daily life: community participation and contribution; functioning in domestic activities; familial, intimate and other social relationships and dynamics, and the impact of environmental factors. Research should also be conducted that examines the prevalence and impacts of various types of stigma including discrimination, prejudice, and inequality; generally and specific to conditions. Mental health research is needed to examine stigma as well as traditional conceptualizations of mental health and traditional, psychosocial, and biomedical forms of interventions.
Future research on the factors is essential to gain greater insight into the challenges experienced by people with disabilities living in Cameroon, as well as to inform decision making in a number of areas, including: disability policy, funding allocation to improve the lives of people with disabilities, clinical services and evidence-based healthcare for people with disabilities, and directions for future research efforts.
What is known about this topic
- Disability is more prevalent in low-income countries;
- There is limited research on disability and the impact of disability
in low-income countries.
What this study adds
- Disability in Cameroon is linked stigma and discrimination;
- There is a general lack of knowledge and awareness on disability
among the public and health workers in Cameroon;
- Disability has an important impact on quality of care and employment.
The author declare no competing interest.
MR and LW collected, screened and analyzed the data. MR and LW wrote the first draft of the manuscript. LM and LC revised several versions of the manuscript. All authors approved the final version.
We acknowledge the help of Dominique Outouen Tchemy and Simolen Jumbam for assistance with translation of some articles.
Tables and figures
characteristics of studies included in this review including the location,
design and disease or condition covered
Table 2: international classification of functioning, disability and health (ICF) categories identified in Cameroonian disability research; an “x” indicates
that at least one study addressed the ICF category or theme: some studies addressed more than one condition
Figure 1: flow diagram of screening and selection
Figure 2: themes addressed in functioning and disability research from Cameroon
- WHO. Disability and health: fact sheet N°352. Accessed 13 February 2017.
- WHO. Global burden of disease: 2004 update. Accessed 13 February 2017.
- WHO. Global atlas of medical devices. Accessed 13 February 2017.
- UNHCR. 2015 UNHCR country operations profile Cameroon. Accessed 13 February 2017.
- IMF. Cameroon: 2014 Article IV Consultation. Accessed 13 February 2017.
- Lantum DN, Mbah D, Fogang JT, Minkoulou MEM. Situation Analysis of Health Research in Cameroon. Accessed 14 February 2017.
- UNDP. Human development reports: Cameroon. Accessed 13 February 2017.
- WHO/GHWA. Cameroon. Accessed 13 February 2017.
- WHO. Global health observatory (GHO) data. Accessed 13 February 2017.
- Mitra S, Posarac A, Vick BC. Disability and poverty in developing countries: a snapshot from the World Health Survey. Accessed 20 March 2017.
- WHO. International Classification of Functioning. Accessed 13 February 2017.
- Ministère de la Santé Publique. Cameroun: strategie sectorielle de Sante 2001-2015. Accessed 13 February 2017.
- Moher D, Liberati A, Tetzlaff J, Altman DG, Group
P. Preferred reporting items for systematic reviews and meta-analyses:
the PRISMA statement. PLoS Med. 2009; 6(7): e1000097. PubMed | Google
- Gaynes BN, Pence BW, Atashili J, O'Donnell J, Kats D, Ndumbe PM. Prevalence and predictors of major depression in HIV-infected patients on antiretroviral therapy in Bamenda, a semi-urban center in Cameroon. PLoS One. 2012;7(7): e41699. PubMed | Google Scholar
- L'Akoa R M, Noubiap JJ, Fang Y, Ntone FE, Kuaban
C. Prevalence and correlates of depressive symptoms
in HIV-positive patients: a cross-sectional study among
newly diagnosed patients in Yaounde, Cameroon.
BMC Psychiatry. 2013 Sep 22; 13:228. PubMed | Google
- Mbassa Menick D, Menguene Mviena J. Modalités expressives des dépressions en psychopathologie camerounaise. Synapse. 2006; 222:39-46. PubMed | Google Scholar
- Pence BW, Gaynes BN, Atashili J, O'Donnell JK,
Kats D, Whetten K et al. Feasibility, safety, acceptability,
and preliminary efficacy of measurement-based care depression treatment
for HIV patients
in Bamenda, Cameroon. AIDS Behav. 2014; 18(6): 1142-51. PubMed | Google
- Mbassa Menick D. Réhabilitation psychosociale des malades mentaux errants: Évaluation d'un dispositif mis en place dans la ville de Yaoundé. Synapse. 2006; 224:48-52. PubMed | Google Scholar
- Mbassa Menick D. Auteurs d'homicides et de tentatives
d'homicides, quelles caractéristiques, etude portant sur des rapports
d'expertises psychiatriques faits au Cameroun. Med
Trop (Mars). 2009; 69(3): 255-62. PubMed | Google
- Keugoung B, Kongnyu ET, Meli J, Criel B. Profile
of suicide in rural Cameroon: are health systems doing
enough. Trop Med Int Health. 2013;18(8): 985-92. PubMed | Google
- St Louis KO, Roberts PM. Public attitudes toward
mental illness in Africa and North America. Afr J Psychiatry
(Johannesbg). 2013; 16(2): 123-33. PubMed | Google
- Allotey P, Reidpath D. Epilepsy, culture, identity
and well-being: a study of the social, cultural and
environmental context of epilepsy in Cameroon. J Health Psychol. 2007;
12(3): 431-43. PubMed | Google
- Bain LE, Awah PK, Takougang I, Sigal Y, Ajime TT.
Public awareness, knowledge and practice relating to epilepsy amongst
adult residents in rural Cameroon--case study of the Fundong health district.
Pan Afr Med J. 2013; 14: 32. PubMed | Google
- Njamnshi AK, Angwafor SA, Baumann F, Angwafo FF,
3rd, Jallon P, Muna WF. Knowledge, attitudes, and practice
of Cameroonian medical students and graduating physicians with respect
Epilepsia. 2009; 50(5): 1296-9. PubMed | Google
- Njamnshi AK, Angwafor SA, Jallon P, Muna WF. Secondary
school students' knowledge, attitudes, and practice
toward epilepsy in the Batibo Health District--Cameroon. Epilepsia. 2009;
50(5): 1262-5. PubMed | Google
- Njamnshi AK, Angwafor SA, Tabah EN, Jallon P, Muna
WF. General public knowledge, attitudes, and practices with respect to
epilepsy in the Batibo Health District, Cameroon. Epilepsy Behav. 2009;14(1):
83-8. PubMed | Google
- Njamnshi AK, Tabah EN, Yepnjio FN, Angwafor SA, Dema F, Fonsah JY et al. General public awareness, perceptions, and attitudes with respect to epilepsy in the Akwaya Health District, South-West Region, Cameroon. Epilepsy Behav. 2009;15(2):179-85. PubMed | Google Scholar
- Njamnshi AK, Yepnjio FN, Bissek AC, Tabah EN, Ongolo-Zogo
P, Dema F et al. A survey of public knowledge, attitudes,
and practices with respect to epilepsy in Badissa village, centre region
Epilepsy Behav. 2009; 16(2): 254-9. PubMed | Google
- Njamnshi AK, Yepnjio FN, Tabah EN, Dema F, Angwafor
SA, Fonsah JY et al. Public awareness, perceptions,
and attitudes with respect to epilepsy in Ebolowa and Sangmelima--Urban
Behav. 2009; 14(4): 628-33. PubMed | Google
- Njamnshi AK, Bissek AC, Yepnjio FN, Tabah EN, Angwafor
SA, Kuate CT et al. A community survey of knowledge,
perceptions, and practice with respect to epilepsy among traditional
healers in the Batibo
Health District, Cameroon. Epilepsy Behav. 2010; 17(1):
95-102. PubMed | Google
- Njamnshi AK, Tabah EN, Bissek AC, Yepnjio FN, Angwafor
SA, Dema F et al. Knowledge, attitudes and practices
with respect to epilepsy among student nurses and laboratory assistants
in the South
West Region of Cameroon. Epilepsy Behav. 2010; 17(3):
381-8. PubMed | Google
- Njamnshi AK, Tabah EN, Bissek AC, Yepnjio FN, Kuate
C, Angwafor SA et al. Knowledge, attitudes and practice
with respect to epilepsy among secondary school students in the Kumbo
District - North West Region- Cameroon. Epilepsy Behav.
2010; 18(3): 247-53. PubMed | Google
- Cubo E, Doumbe J, Martinez-Martin P, Rodriguez-Blazquez
C, Kuate C, Mariscal N et al. Comparison of the clinical
profile of Parkinson's disease between Spanish and Cameroonian Cohorts.
J Neurol Sci. 2014;
336(1): 122-6. PubMed | Google
- De Clerck GA. Fostering Deaf People's Empowerment:
the Cameroonian deaf community and epistemological
equity. Third World Quarterly. 2011; 32(8): 1419-35. PubMed | Google
- Touko A, Mboua CP, Tohmuntain PM, Perrot AB. Sexual
vulnerability and HIV seroprevalence among the deaf
and hearing impaired in Cameroon. J Int AIDS Soc. 2010
Feb 4; 13:5. PubMed | Google
- Oye JE, Kuper H, Dineen B, Befidi-Mengue R, Foster
A. Prevalence and causes of blindness and visual impairment
in Muyuka: a rural health district in South West Province, Cameroon.
Br J Ophthalmol.
2006; 90(5): 538-42. PubMed | Google
- Oye JE, Kuper H. Prevalence and causes of blindness
and visual impairment in Limbe urban area, South West
Province, Cameroon. Br J Ophthalmol. 2007; 91(11): 1435-9. PubMed | Google
- Bremer K, Cockburn L, Ruth A. Reproductive health
experiences among women with physical disabilities
in the Northwest Region of Cameroon. Int J Gynaecol Obstet. 2010; 108(3):
211-3. PubMed | Google
- Abanda F, Biligha P. Citizenship and vulnerability:
The case of the disabled citizen and urbanism policies
of the real estate public space in Cameroon. Studia Universitatis Babes-Bolyai
2014; 59(1): 321-34. PubMed | Google
- Kiani S. Women with disabilities in the North-West
province of Cameroon: resilient and deserving of greater
attention. Disability & Society.
2009; 24(4): 517-31. PubMed | Google
- Nanfosso RAT, Zamo-Akono CM. Fertility, Health
and Female Labour Force Participation in Urban Cameroon.
International Business Research. 2010; 3(2): 136-56. PubMed | Google
- Zamo-akono C. Disability and Labour Force Participation
in Cameroon. International Journal of Human Resource
Studies. 2013; 3(2): 1. PubMed | Google
- Kiawi E, Edwards R, Shu J, Unwin N, Kamadjeu R,
Mbanya JC. Knowledge, attitudes, and behavior relating
to diabetes and its main risk factors among urban residents in Cameroon:
survey. Ethn Dis. 2006; 16(2): 503-9. PubMed | Google
- Awah PK, Kengne AP, Fezeu LL, Mbanya JC. Perceived
risk factors of cardiovascular diseases and diabetes
in Cameroon. Health Educ Res. 2008; 23(4): 612-20. PubMed | Google
- Kamadjeu RM, Edwards R, Atanga JS, Unwin N, Kiawi
EC, Mbanya JC. Prevalence, awareness and management
of hypertension in Cameroon: findings of the 2003 Cameroon Burden of
Diabetes Baseline Survey.
J Hum Hypertens. 2006; 20(1): 91-2. PubMed | Google
- Fezeu L, Fointama E, Ngufor G, Mbeh G, Mbanya JC.
Diabetes awareness in general population in Cameroon.
Diabetes Res Clin Pract. 2010; 90(3): 312-8. PubMed | Google
- Awah PK, Unwin NC, Phillimore PR. Diabetes Mellitus:
Indigenous naming, indigenous diagnosis and self-management
in an African setting: the example from Cameroon. BMC
Endocr Disord. 19 February 2009;
9: 5. Google
- Awah PK, Phillimore P. Diabetes, Medicine and Modernity
in Cameroon. Africa: Journal of the International African
Institute. 2008; 78(4): 475-95. PubMed | Google
- Ekortarl A, Ndom P, Sacks A. A study of patients
who appear with far advanced cancer at Yaounde General
Hospital, Cameroon, Africa. Psychooncology. 2007; 16(3): 255-7. PubMed | Google
- Tebeu PM, Major AL, Rapiti E, Petignat P, Bouchardy
C, Sando Z et al. The attitude and knowledge of cervical
cancer by Cameroonian women; a clinical survey conducted in Maroua, the
capital of Far North
Province of Cameroon. Int J Gynecol Cancer. 2008; 18(4):
761-5. PubMed | Google
- Boyer S, Clerc I, Bonono CR, Marcellin F, Bile
PC, Ventelou B. Non-adherence to antiretroviral treatment
and unplanned treatment interruption among people living with HIV/AIDS
Individual and healthcare supply-related factors. Soc
Sci Med. 2011; 72(8): 1383-92. PubMed | Google
- Boyer S, Protopopescu C, Marcellin F, Carrieri
MP, Koulla-Shiro S, Moatti JP et al. Performance of
HIV care decentralization from the patient's perspective: health-related
quality of life and perceived
quality of services in Cameroon. Health Policy Plan.
2012; 27(4): 301-15. PubMed | Google
- Jacobi CA, Atanga PN, Bin LK, Mbome VN, Akam W,
Bogner JR et al. HIV/AIDS-related stigma felt by people
living with HIV from Buea, Cameroon. AIDS Care. 2013; 25(2): 173-80. PubMed | Google
- Marcellin F, Bonono CR, Blanche J, Carrieri MP, Spire B, Koulla-Shiro S et al. Higher risk of unsafe sex and impaired quality of life among patients not receiving antiretroviral therapy in Cameroon: results from the EVAL survey (ANRS 12-116). AIDS. 2010;24 Suppl 1: S17-25. PubMed | Google Scholar
- Rosenburg N, Taliaferro D, Ercole P. HIV-related
stigma among nursing students in Cameroon. J Assoc
Nurses AIDS Care. 2012; 23(2): 170-6. PubMed | Google
- Suzan-Monti M, Blanche J, Bile P, Koulla-Shiro
S, Abu-Zaineh M, Marcellin F et al. Individual and structural factors
associated with HIV status disclosure to main partner in Cameroon: ANRS
12-116 EVAL survey, 2006-2007. J Acquir Immune Defic Syndr. 2011; 57
Suppl 1: S22-6. PubMed | Google
- Yakam AN, Noeske J, Angumua C, Bowong S, Fono LA.
Management of tuberculosis patients in the urban setting:
Health service delivery and health care-seeking behaviour. Sante Publique
25(5): 647-53. PubMed | Google
- Grietens KP, Boock AU, Peeters H, Hausmann-Muela
S, Toomer E, Ribera JM. "It is me who endures but my family that suffers":
social isolation as a consequence of the household cost burden of Buruli
ulcer free of charge hospital treatment. PLoS Negl Trop Dis. 2008; 2(10):
e321. PubMed | Google
- Peeters Grietens K, Toomer E, Um Boock A, Hausmann-Muela S, Peeters H, Kanobana K et al. What role do traditional beliefs play in treatment seeking and delay for Buruli ulcer disease,insights from a mixed methods study in Cameroon. PLoS One. 2012; 7(5): e36954. PubMed | Google Scholar
- Amuyunzu-Nyamongo M, Tchounkeu YF, Oyugi RA, Kabali
AT, Okeibunor JC, Manianga C et al. Drawing and interpreting
data: Children's impressions of onchocerciasis and
community-directed treatment with ivermectin
(CDTI) in four onchocerciasis endemic countries in
Africa. Int J Qual Stud Health Well-being. 2011; 6(2):
5918. PubMed | Google
- Njelesani J, Couto S, Cameron D. Disability and
rehabilitation in Tanzania: a review of the literature.
Disabil Rehabil. 2011; 33(23-24): 2196-207. PubMed | Google
- Reidpath DD, Chan KY, Gifford SM, Allotey P. "He
hath the French pox": stigma, social value and social
exclusion. Sociol Health Illn. 2005; 27(4): 468-89. PubMed | Google
- Major B, Eccleston CP. Stigma and social exclusion.
New York. Psychology Press. 2005. Google
- Deacon H. Towards a sustainable theory of health-related
stigma: lessons from the HIV/AIDS literature. J Community
Appl Soc Psychol. 2006; 16(6): 418-25. PubMed | Google
- Link BG, Phelan JC. Stigma and its public health
implications. Lancet. 2006; 367(9509): 528-9. PubMed | Google
- Link BG, Phelan JC. Conceptualizing stigma. Annual
review of Sociology. 2001; 27(1): 363-85. PubMed | Google
- Njamnshi AK, Angwafor SA, Tabah EN, Yepnjio FN,
Lekoubou AZ, Dema F et al. Knowledge, perceptions and
practice with respect to epilepsy among traditional healers in the Batibo
Cameroon. J Neurol Sci. 2009; 28(5): 1262-1265. PubMed | Google
- WHO. Mental Health Atlas 2014. Accessed 13 February 2017.
- WHO. Mental health atlas 2011: Cameroon. Accessed 13 February 2017.