Access to High Quality Surgical Repair Services is a Fundamental Right of Patients with Obstetric Fistulas: A Study on Quality of Life Data in the Democratic Republic of the Congo

Purpose

The aim of this study was to assess quality of life (QoL) using the WHOQOL-BREF questionnaire among obstetric fistula (OF) patients before and after surgical repair of OF (SROF).

Methods

A longitudinal cohort study was conducted between November 2022 and October 2023 in the Democratic Republic of the Congo (DRC) among OF patients to assess their QoL before and after SROF. A systematic sampling technique was used to recruit a total of 158 OF patients. The WHOQOL-BREF questionnaire assessed general health, life experience, as well as physical, social, psychological, and environmental domains.

Results

The mean age among the 158 respondents was 33.51 ± 9.63 years, and 77.85% of them lived in rural areas. In terms of surgical outcomes, 80.38% had closure of the OF with regained continence, 5.7% had closure of the OF with persistent incontinence, and 13.9% had a failed surgical repair. Overall mean QoL scores were higher after OF surgical repair (3.83, standard deviation [SD]=0.89) in comparison to pre-operative (1.58, SD=0.63) (p<0.001). These QoL improvements included physical (mean score 66.32 post-surgery versus 28.37 before, p<0.001), social (mean score 64.92 post-surgery versus 27.90 before, p<0.001), psychological (mean score 68.09 post-surgery versus 21.28 before, p<0.001), environmental (mean score 48.41 post-surgery versus 16.91 before p<0.001), and general domains. Patients with a successful OF repair had a better QoL score than those with a closed fistula but ongoing incontinence or those for whom surgery failed to close the fistula.

Conclusion

The present study showed that among OF patients, all QoL domains were impaired before surgical repair and significantly improved after surgery. Successful OF closure alleviates the consequences of OF and helps to restore patients' wellbeing. Our findings call for improved access to high-quality surgical repair services as a fundamental right for OF patients.

Determinants and predictive model of failure of surgical repair of obstetric vesico-vaginal fistula in the Democratic Republic of the Congo

INTRODUCTION

Surgical repair of obstetric fistula aims to restore the anatomical and functional integrity of the urinary tract, enabling affected women to regain their dignity and quality of life. However, such repairs can end in a failure. The aim of this study is to develop a predictive score to identify factors influencing failure of surgical repair of obstetric vesico-vaginal fistula (FSROVVF) in the Democratic Republic of the Congo.

METHODS

This was an analytical cross-sectional study of 318 women with obstetric vesico-vaginal fistula (OVVF) who had undergone surgical management. A bivariate and then a multivariate analysis were performed. Score discrimination was assessed using the ROC curve and C-index, and score calibration using the Hosmer-Lemeshow test.

RESULTS

Surgical repair of OVVF was unsuccessful in 16.98% of cases (54/318). After logistic modeling, six criteria emerged as predictive factors for FSROVVF: the presence of fibrosis (AOR = 5.01; 95% CI:1.73-14.49), the presence of 2 or more fistulas (AOR = 9.04; 95% CI:3.01-27.13), the association of OVVF with another anatomoclinical entity of fistula (AOR = 3.16; 95% CI:1.09-9.13), the fistula size > 3 cm (AOR = 3.65; 95% CI:1.36-9.76), the peri-operative hemorrhage (AOR = 7.01; 95% CI:2.33-21.03), and the post-operative infection (AOR = 178.89; 95% CI:26.09-1226.64). A score ranging from 0 to 13 points was obtained, of which a value ≤ 5 points defines a low risk of FSROVVF, a value between 6 and 8 points defines a moderate risk and value ≥ 9 points corresponds to a high risk of FSROVVF. The area under the ROC curve of the score is 0.925 with a sensitivity of 61.11%, a specificity of 96.59%, a positive predictive value of 78.57% and a negative predictive value of 92.39%.

CONCLUSION

This study demonstrated that the number of fistulas ≥ 2, fistula size > 3 cm, fibrosis, association of OVVF with other types of fistulas, peri-operative hemorrhage, and post-operative infection are factors predictive of FSROVVF. These six factors are key contributors to the score used to predict FSROVVF. Once validated, this score will inform and enable preoperative counseling regarding the prognosis and the chances of a successful outcome of surgical repair of OVVF.

Knowledge of risk factors and early detection methods toward breast cancer among healthcare workers in Kinshasa, Democratic Republic of the Congo

BACKGROUND

Breast cancer (BC) is the most prevalent cancer among women, and it typically presents late in developing countries like the Democratic Republic of the Congo (DRC), leading to higher mortality rates. Late detection at advanced stages of breast cancer can be attributed to the absence of appropriate screening programs and low levels of awareness.

AIMS

To evaluate the level of BC knowledge among healthcare workers (HCWs) and identify determinants of good BC knowledge.

METHODS AND RESULTS

An analytical cross-sectional survey was conducted from March 1 to 31, 2022 involving HCWs practicing in Kinshasa, DRC. Data were collected using a questionnaire administered through direct interviews. Bivariate and multivariate regression techniques were applied. The study interviewed 543 HCWs, with a median age of 35 years (interquartile range: 29-43). Of these, 61% had good BC knowledge, while 39% had poor BC knowledge. Multivariate analysis revealed that HCWs aged 50 years and over (adjusted odds ratio [aOR] = 2.3 [1.2-4.5]), female HCWs (aOR = 1.8 [1.1-2.4]), HCWs working in public healthcare facilities (aOR = 1.5 [1.1-2.5]), and HCWs who had received training on BC (aOR = 1.9; 95% CI: 1.5-3.3) were determinants of good BC knowledge.

CONCLUSION

This study found that 61% of the surveyed HCWs had good BC knowledge. However, there is still room for improvement in terms of knowledge dissemination. Therefore, it is important to implement continuing medical education programs that focus on raising awareness and improving BC knowledge among HCWs.

Assessing high-risk sexual practices associated with human immunodeficiency virus infection among young female sex workers in Lubumbashi, Democratic Republic of the Congo: a cross-sectional study

INTRODUCTION

Young female sex workers (YFSWs) face a higher risk of HIV infection compared to older workers, but there is a lack of comprehensive data on their sexual practices and HIV infection risks, which may present unique challenges and vulnerabilities. The study aimed to identify high-risk sexual practices associated with HIV infection among YFSWs in Lubumbashi.

METHODS

We conducted an analytical cross-sectional study and used a comprehensive sample of all YFSWs who presented to the HIV/Sexually Transmitted Infections Screening and Treatment Center in Lubumbashi between April 2016 and December 2017. We collected data on socio-demographic characteristics and behavioral risk factors of female sex workers were collected using a structured questionnaire. Using STATA version 16, multivariate logistic regression was fitted and the results were presented as adjusted odds ratios (aORs) with their 95% confidence intervals (95% CIs).

RESULTS

A total of 572 YFSWs were included in the study, 19 of whom were HIV-positive (3.3%; 95% CI: 2.1-5.1%). Participants who were forced to have sex (aOR = 12.2; 95% CI: 3.2-46.4; p < 0.0001), those who did not use condoms systematically (aOR = 4.1; 95% CI: 1.3-13.0; p = 0.018), and those who had anal sex (aOR = 23.8; 95% CI: 6.9-82.4; p < 0.0001) were more likely to be HIV-positive.

CONCLUSION

The study reveals a concerning trend of higher hospital HIV prevalence among YFSWs compared to the general Congolese population. It also highlights a significant link between high-risk sexual practices and HIV infection, highlighting the need for urgent interventions.

HEAL Africa score to predict failure of surgical repair of obstetric urethro-vaginal fistula in the Democratic Republic of the Congo

INTRODUCTION

Obstetric fistula (OF) repair surgery aims to restore the anatomical and functional integrity of the urinary tract, allowing affected women to regain their dignity and quality of life. However, in some cases, this surgical repair may fail. The objective of this study was to develop a predictive score to identify factors associated with the failure of surgical repair of obstetric urethro-vaginal fistula (FSROUVF) in the Democratic Republic of the Congo (DRC).

METHODS

This is an analytical cross-sectional study of 358 patients with obstetric urethro-vaginal fistula (OUVF) who received surgical repair. We conducted bivariate and multivariate analyses. Score discrimination was assessed using the receiver operating characteristic (ROC) curve, C-index, and score calibration according to the Hosmer-Lemeshow test.

RESULTS

Surgical repair of OUVF failed in 24.86% of cases (89/358). After logistic modelling, 6 criteria predicted FSROUVF: the use of intravaginal indigenous products (AOR = 3.59; 95% CI: 1.51-8.53), the presence of fibrosis (AOR = 6.37; 95% CI: 1.70-23.82), the presence of 2 or more fistulas in the same patient (AOR = 7.03; 95% CI: 3.14-15.72), the total urethral damage (AOR = 3.29; 95% CI: 1.36-7.95), the fistula size > 3 cm (AOR = 5.65; 95% CI: 2.12-15.01), and the postoperative infection (AOR = 351.10; 95% CI: 51.15-2409.81). A score of 0 to 14 was obtained, with a value ≤5 points indicating a low risk of FSROUVF, a value between 6 and 8 indicating a moderate risk, and a value ≥9 points corresponding to a high risk of FSROUVF. The area under the ROC curve of the score is 0.938 with a sensitivity of 60.67%, a specificity of 96.28%, a positive predictive value of 84.38%, and a negative predictive value of 88.10%.

CONCLUSION

We report a FSROUVF rate in the DRC approaching a quarter of operative patients. Predictors of failure included fibrosis, presence of 2 or more fistulas, total urethral involvement, fistula size greater than 3 cm, postoperative infection, and use of intravaginal indigenous products. These factors are constitutive of the HEAL Africa score, which once validated, may have value in pre-operative counselling of patients. This study could be valuable for policy and strategies to address the problem of OUVF in the DRC and in resource limited settings more generally.

[Epidemio-clinical and seminal profile of the man consulting for the desire to procreate: current situation in Lubumbashi, in the Democratic Republic of Congo]

Introduction

in Lubumbashi, as in upscale areas where explorations of fertility are very clever, the spermogram remains the essential analysis in the diagnosis of male infertility. This is the cause of 40% of couple infertility. The spermogram is the first step in identifying seminal abnormalities. The objective of this study was to determine the epidemiological-clinical and seminal profile of the man consulting for the desire to procreate in Lubumbashi.

Methods

this was a cross-sectional study. We received 202 subjects in Lubumbashi, whose spermogram was performed from August 1st, 2020 to July 31st, 2021. The semen parameters were studied and interpreted according to WHO standards (2010) with studies of factors associated with their disturbance. Bivariate and multivariate analyzes had been carried out. The statistical significance threshold was set at p < 0.05.

Results

the epidemiological-clinical profile of the respondents was as follows: the most represented age group was 30 to 39 years; infertility was primary in 80.69% of cases; the duration of the desire for paternity was 2 years at most in 44.55% of cases. The sperm abnormalities found were: oligozoospermia (40.09%), azoospermia (11.38%), asthenozoospermia (18.31%) and teratozoospermia (10.39%). Oligozoospermia was significantly associated with varicocele (ORa = 10.9 [3.0-39.5]; p < 0.0001), genital infection (ORa =2.7 [1.0-7, 2]; p = 0.041) and obesity (ORa = 2.6 [1.0-7.9]; p = 0.020) while azoospermia was the cure for inguinal hernia (ORa = 4.2 [1.0-17.2]; p = 0.049) and malnutrition (ORa =6.0 [1.2-29.7]; p = 0.027). Asthenozoospermia was significantly associated with the age group of 40 to 49 years (ORa = 6.6 [1.2-37.4]; p = 0.034), tobacco (ORa =7.5 [2.7 -21.0]; p = 0.000), undernutrition (ORa = 7.7 [1.0-61.9]; p = 0.045) and overweight (ORa =3.8 [1.3-11, 5]; p=0.019). Teratozoospermia was significantly associated with smoking (ORa = 5.6 [1.8-17.7]; p = 0.003) and overweight (ORa =5.3 [1.2-23.3]; p = 0.027).

Conclusion

more than half of the respondents had, of the three main fertility parameters, at least one that was disturbed. Sperm count was the most affected parameter. Alcohol, tobacco, genital infection and malnutrition were the most common risk factors for the abnormalities observed.

Knowledge regarding breast cancer among Congolese women in Kinshasa, Democratic Republic of the Congo

INTRODUCTION

Breast cancer is the most frequent type of cancer in women and is characterized by late clinical signs in developing countries, including the Democratic Republic of the Congo. One of the main reasons of death from breast cancer is lack of awareness and screening, which has led to late diagnosis (at an advanced stage). This study aims to measure women's knowledge regarding breast cancer in Kinshasa, in the Democratic Republic of the Congo.

MATERIALS AND METHODS

A cross-sectional study of 489 women aged 20-65 years was conducted. Data was collected using a predesigned, tested, self-administered questionnaire. The questionnaire included specific sections to test the participants' knowledge related to breast cancer and its screening, and practices related to breast self-examination (BSE). Bivariate and multivariate analyzes were used.

RESULTS

Our results indicated that 22.09% of the participants had good breast cancer knowledge and 77.91% had poor breast cancer knowledge. Overall, 322 (65.85%) participants recognized that BSE is a valuable method for early screening of BSE. In total, 136 (27.81%) respondents had learned to do the BSE and 216 (44.17%) had reported doing it. Two hundred and ninety-two (59.71%) respondents mentioned that any woman was at risk for breast cancer and 357 (71.78%) mentioned that it was possible to prevent breast cancer. Determinants of an adequate level of knowledge were higher/university educational level (adjusted odds ratio = 2.70; 95% confidence interval: 1.27-5.73; p = .010) and having previously been screened for breast cancer (adjusted odds ratio = 2.31; 95% confidence interval: 1.40-3.83; p = .001).

CONCLUSION

The majority (77.91%) of women have demonstrated poor knowledge of signs/symptoms, risk factors, and screening methods of breast cancer. Additional efforts should be made through women's healthcare workers to raise knowledge of breast cancer screening.

Adolescents’ knowledge, attitude and utilization of emergency contraceptive in Idjwi Island in the Democratic Republic of the Congo

Introduction: Unintended pregnancies are a major health problem and one of the main interventions to reduce unintended pregnancies and unsafe abortions is the correct use of emergency contraception (EC). The objective of this study was to assess knowledge, attitude, and utilization of EC among adolescent girls in Idjwi Island, Eastern of the Democratic Republic of the Congo. Methods: We conducted a cross-sectional survey of 353 adolescent girls aged 15-24 who were recruited and who completed a pre-established questionnaire after they were accepted into the survey. Data collected were analyzed with STATA 16 software and the comparison of variables with the Chi-square test and a significance threshold of 5%. Results: We found that 293 (83.0%) reported having ever had sexual intercourse and 220 had heard of EC. The proportion of respondents with sufficient knowledge was 59.1% (130/220) and the assessment of attitude towards the EC shows that 81.8% (180/220) of the respondents had a positive attitude towards EC. Of 293 respondents who had ever had sexual intercourse, 148 (50.5%) reported having ever used EC. Respondents with a secondary educational level (adjusted odds ratio =14.3 [7.2-28.3]) and university educational level (adjusted odds ratio =4.8 [1.8-13.0]) were more likely to use EC compared to those with a primary educational level. Conclusion: The study shows that the level of EC utilization was medium in Idjwi Island. Educational level was a major predictor of EC utilization. Therefore, it is recommended that strategies be developed to improve EC utilization by increasing the level of EC awareness among adolescent girls.

Epidemiological and clinical features of epileptic patients in Goma, Democratic Republic of the Congo

Introduction: Epilepsy is one of the most common neurological conditions but the majority of epileptic patients in sub-Saharan African countries do not receive appropriate treatment. In the Democratic Republic of the Congo (DRC), very few epidemiological studies have been conducted on epilepsy. The objective of this study was to describe socio-demographic characteristics, the type of epileptic seizures, and etiological factors of these seizures in a hospital cohort of epileptic patients followed at the Neuropsychiatric Hospital Center in Goma (in the DRC). Materials and methods: This was a cross-sectional study of 917 epileptic patients received in neurology consultation at the Neuropsychiatric Hospital Center in Goma (in the DRC) from January 1st, 2017 to December 31st, 2021. Results: The median age of patients was 16 years, the median age of the patients at onset of seizures was 13 years and the median time between onset of seizures and consultation was 8.0 months; 14.2% of had a family history of epilepsy. Generalized tonic-clonic seizures were the most frequent (76.7%), followed by motor focal impaired awareness seizures (5.2%) and non-motor focal aware seizures (3.6%). The etiologic factor was found in 444 (48.4%) patients and was dominated by chronic alcoholism (20.9%), neurocysticercosis (17.6%), meningitis (14.6%), malnutrition (11.3%), cerebral malaria (8.3%), and head injury (7.7%). Conclusion: This study provides an epidemiological overview of epilepsy in Goma city. The etiological factors and types of seizures will dictate the best possible treatment options.

Factors Associated with Acceptability of Newborn Screening for Sickle Cell Disease in Lubumbashi City, Democratic Republic of the Congo

Objective:

Sickle cell disease (SCD) is a major genetic disease that occurs early in childhood and can cause considerable morbidity and even death. Newborn screening (NBS) is one of the effective health services that have lowered the burden of SCD in wealthy countries. Surprisingly, NBS programs are essentially non-existent in subSaharan Africa, where the majority of babies are born with this condition. The objective of this study was to determine the level of acceptability of NBS and the factors influencing it in the population of Lubumbashi city in the Democratic Republic of the Congo.

Material and Methods:

From December 1, 2020, to December 31, 2020, data on sociodemographic characteristics, knowledge, and attitudes related to NBS for SCD were collected from 2032 adults in Lubumbashi city using a semi-structured and pre-tested questionnaire.

Results:

There was a good knowledge of SCD as a hereditary blood disorder (77.7%). NBS’s acceptability rate was 84.5%. Age (P = 0.002), sex (P = 0.025), and religion (p<0.001) were found to be significantly associated with the NBS acceptability.

Conclusion:

According to the findings of this study, NBS is widely accepted in Lubumbashi. The primary challenges to its adoption are likely to be financial and practical rather than social or cultural.

Knowledge, Attitudes, and Practices of Urban Workers toward Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome: Results from a Cross-sectional Study in Lubumbashi, Democratic Republic of the Congo

Objective:

This study aims to describe knowledge, attitudes, and practices about human immunodeficiency virus/ acquired immunodeficiency syndrome (HIV/AIDS) among a sample of 563 urban workers in Lubumbashi, in the Democratic Republic of the Congo.

Material and Methods:

This was a cross-sectional study where workers’ knowledge of HIV/AIDS was measured through a French adaptation of the Brief HIV Knowledge Questionnaire.

Results:

Overall, the level of knowledge of participating workers was poor (81.9%). Working in a private company (adjusted odds ratio [aOR] = 2.0 [1.2–3.3]) and having previously tested for HIV/AIDS (aOR = 2.5 [1.5–4.3]) were associated with good knowledge level about HIV/AIDS.

Conclusion:

Our results highlight the importance of implementing different awareness and education strategies for workers.

Determinants of Utilization and Quality of Antenatal Care Services in Lubumbashi, in the Democratic Republic of the Congo

Objectives:

Maternal and perinatal mortality is one of the best indicators of a society’s health status and development level. In the Democratic Republic of the Congo, antenatal care (ANC) utilization is generally low, and delayed initiation of care is very common. It is in this context that the present study on the utilization and quality of ANC carried out among women in Lubumbashi city aimed to identify determinants of the utilization and quality of ANC services.

Material and Methods:

This was a cross-sectional study conducted in Lubumbashi, relating to 1472 women who had given birth during the 12 months preceding the survey, selected by cluster sampling. Logistic regression was used to identify the relative effects of socio-demographic risk factors and all statistical tests were declared significant at a P < 0.05.

Results:

One tenth (10.5%) of the women in the sample did not attend ANC during their most recent pregnancy and 89.5% had attended ANC at least once. Of the 1318 women with at least one ANC visit, 55.9% had an early initiation of ANC and 53.2% received high quality ANC. Women aged 20–29 years (adjusted odds ratios [aOR] = 2.8 [1.6–5.1]), 30–39 years (aOR = 4.3 [2.1–8.9]) and ≥40 years (aOR = 6.5 [2.6–16.2]), married women (aOR = 1.9 [1.1–3.2]), women with secondary educational level (aOR = 4.9 [3.4–7.2]), and women with higher educational level (aOR = 15.3 [5.3–43.8]) were more likely to have at least one ANC during their pregnancy. Factors contributing to attend four or more ANC visits were secondary educational level (aOR = 1.4 [1.0–2.0]) and higher educational level (aOR = 1.9 [1.2–2.9]), primiparity (aOR = 1.5 [1.1–2.1]), and doing business activities (aOR = 1.4 [1.0–1.8]). Determinant of early initiation ANC was only the higher educational level (aOR = 2.2 [1.4–3.4]). Factors associated with high quality ANC were secondary educational level (aOR = 3.0 [2.1–4.3]) and higher educational level (aOR = 6.2 [3.8–9.9]), and receiving ANCs in a general referral hospital (aOR = 1.5 [1.2–2.0]).

Conclusion:

The use and quality of ANC services remain a serious problem in Lubumbashi city. This situation hampers the achievement of maternal and child health goals. Health education can help reduce this in our context.

Prevalence and Factors Associated with Acute Kidney Injury in Sub-Saharan African Adults: A Review of the Current Literature

Acute kidney injury (AKI) is a complex condition that can occur in both community and hospital settings and has many aetiologies. These aetiologies may be infectious, toxic, surgical, or related to the different management methods. Although it is a major public health problem worldwide, it must be emphasised that both its incidence and mortality rate appear to be very high in sub-Saharan African (SSA) countries compared to developed countries. The profile of AKI is very different from that of more developed countries. There are no reliable statistics on the incidence of AKI in SSA. Infections (malaria, HIV, diarrhoeal, and other diseases), nephrotoxins, and obstetric and surgical complications are the main aetiologies in Africa. The management of AKI is costly and associated with high rates of prolonged hospitalisation and in-hospital mortality.

Sickle Cell Disease Complications Following Air Travel: A Review of the Current Literature

Every year, the number of people using commercial aircraft is estimated at two billion, and more than 300 million people take long-haul flights. Sickle cell patients may be at risk during the air journey because significant hypobaric hypoxia may occur at cruising altitude. This literature review reports complications related to air travel such as painful crises, serious spleen complications (spleen infarcts) requiring a splenectomy, or even sudden death. Prevention of these complications includes environmental protection (maintaining pressure inside the aircraft cabin in a hypobaric condition) and individual prophylaxis (general recommendations for all travelers and specific measures for sickle-cell patients). In order to assess complications associated with air travel in sickle-cell patients, an assessment of their ability to fly is necessary. In addition, the flight fitness assessment identifies patients who will need additional oxygen during flight. When prescribed by the passenger’s physician, additional oxygen is provided by most airlines. Knowing these elements makes it possible to anticipate problems and provide appropriate responses to patients.

Clinical and prognostic features of cerebral toxoplasmosis in HIV-infected patients in Lubumbashi, Democratic Republic of the Congo

Introduction: Cerebral toxoplasmosis is the main opportunistic infection of the central nervous system (CNS) during in human immunodeficiency virus (HIV)-infection. The purpose of this study is to describe current epidemiologic, clinical, diagnostic, and prognostic features of cerebral toxoplasmosis during HIV-infection in hospital setting in Lubumbashi. Methods: This descriptive and analytic study examined the records of 21 HIV-positive patients with cerebral toxoplasmosis. Data were collected over 36 months (from January 2015 to December 2017) at the HIV/AIDS Center of Excellence in Lubumbashi (Democratic Republic of the Congo). Results: Twenty-one patients on 4,283 followed for HIV-infection completed the diagnostic criteria (a prevalence of 0.5%) with a sex ratio (M / F) of 1.3 and a mean age of 41.0±6 years. Major clinical manifestations were fever (100%), headaches (100%), motor deficit (61.9%), intracranial hypertension (47.6%), seizures (47.6%), and disorders of consciousness (42.9%). Cerebral imaging studies (4 Computed tomography scan) were performed and showed hypodensities with peripheral enhancement by cockade in 75% of the cases. The mean CD4 T-cell counts was 180.6±161.9 cells / mm3. Co-trimoxazole was the main anti-toxoplasma drug in all cases. The lethality rate was 42.9%. Conclusion: Early detection and primary prevention in HIV-infected patients remain essential to improve the prognosis and survival of these patients.

Neuromeningeal cryptococcosis in HIV-infected patients in Lubumbashi, Democratic Republic of the Congo

Introduction: Neuromeningeal cryptococcosis (NMC) is a severe and fatal opportunistic infection. Lethality is higher in the absence of treatment, especially in HIV co-infection. The objective of the present study was to determine the prevalence, epidemiological, clinical, biological, and therapeutic features as well as the outcome of NMC in HIV-infected patients. Methods: This is a retrospective study of 108 cases of NMC diagnosed in HIV-infected patients. Data were collected over 36 months (from January 2015 to December 2017) at the HIV/AIDS Center of Excellence in Lubumbashi (Democratic Republic of the Congo). Results: The overall prevalence of NMC is 2.5%. The mean age of the patients was 41.5±13.1 years, with 72.2% aged less than 50 years. The main clinical symptomatology was headache (100%) and fever (100%). The main cytochemical CSF abnormalities were hyperproteinorachia (91.9%), hypoglycorachia (94%) and hyper-lymphocytosis (98.2%). The mean CD4 count was 168.7±137.1/mm3. All patients were treated with fluconazole. The overall lethality was 43.5%. Conclusion: NMC is a serious opportunistic infection in HIV-infected patients, and the case fatality rate remains unacceptable. Management of NMC in HIV-positive patients requires early diagnosis, increased access to antiretrovirals and prompt initiation of appropriate treatment.

Prevalence of Hypertension and Associated Factors in Lubumbashi City, Democratic Republic of Congo: A Community-Based Cross-Sectional Study

BACKGROUND

Hypertension is the leading cause of cardiovascular disease morbidity and mortality worldwide. Its struggle involves knowing its prevalence. Insufficient data on hypertension in adults in Lubumbashi, Democratic Republic of Congo (DRC), prompted the conduct of this study. The objectives were to determine the prevalence of hypertension and to identify the associated factors in adults in Lubumbashi. Methodology. A cross-sectional study was carried out among 6,708 adults from October 15th to November 24th, 2018, in Lubumbashi. Anthropometric data, lifestyle, and medical history were collected. Hypertension was defined when the mean of the last two blood pressure (BP) measurements was greater than or equal for systolic (SBP) at 140 mmHg and for diastolic (DBP) at 90 mmHg or a history of taking antihypertensive medication whatever the value of the BP. Logistic regression was used to identify the relative effects of hypertension risk factors and all statistical tests were declared significant at a p value <0.05.

RESULTS

The female participants numbered 4479 (66.8%). The mean age of all participants was 47.9 ± 16.5 years. The mean SBP and DBP were 128.4 ± 25.9 mmHg and 79.1 ± 15.3 mmHg, respectively. The overall prevalence of hypertension was 33.6%. This prevalence was statistically higher in women than in men (34.5% vs. 31.7%; p=0.024). After logistic regression, the risk of hypertension increased with age >50 years (aOR = 5.85 [5.19-6.60]), overweight (aOR = 1.25 [1.11-1.41]), obesity (aOR = 1.25 [1.11-1.41]), central obesity (aOR = 1.37 [1.16-1.61]), diabetes mellitus (aOR = 2.19 [1.63-2.95]), alcohol consumption (aOR = 1.21 [1.05-1.39]), nonconsumption of vegetables (aOR = 1.35 [1.02-1.80]), and history of stroke (aOR = 2.57 [1.88-3.51]). Hypertension was inversely associated with being underweight (aOR = 0.68 [0.53-0.87]).

CONCLUSION

The prevalence of hypertension in the city of Lubumbashi is high as in other cities of the DRC and Africa. This situation requires the implementation of prevention, detection, and treatment programs for hypertension.

Occupational COVID-19 Prevention among Congolese Healthcare Workers: Knowledge, Practices, PPE Compliance, and Safety Imperatives

The SARS-CoV-2 (COVID-19) pandemic has had a tremendous impact on the functionality of health systems and world affairs. We assessed knowledge, attitudes, and practices (KAPs) of healthcare workers (HCWs) in the Democratic Republic of the Congo (DRC). This was a cross-sectional study conducted in 23 referral hospitals located in three towns of the DRC (Lubumbashi, Kamina, Mbuji-Mayi). In total, 613 HCWs were surveyed using the World Health Organization's (WHO's) "Exposure Risk Assessment in the Context of COVID-19" questionnaire. Participants included medical doctors (27.2%) and other categories of HCWs (72.8%). The mean age was 40.3 ± 11.7 years. Over 80% (range: 83-96%) of respondents had sufficient knowledge on each of the three domains: COVID-19 symptoms, disease transmission, and patient care approach. However, attitudes and practices scores were relatively low. Only 27.7% of HCWs were willing to receive a COVID-19 vaccine when it is available, whereas 55% of HCWs complied with good practices; 49.4% wore masks consistently and, surprisingly, only 54.9% used personal protective equipment (PPE) consistently at work and during contact with patients. Knowledge level was positively associated with the use of social media as a primary source of COVID-19-related information and the category of residence, with HCWs from towns already affected by the COVID-19 epidemic being more likely to have positive attitudes (adjusted OR, 1.64; 95%CI, 1.32-2.20) and comply with good practices (aOR, 2.79; 95%CI, 1.93-4.06). This study showed that most Congolese HCWs had sufficient knowledge on COVID-19, whereas the majority did not comply with consistent PPE use. The government of the DRC should urgently take major steps in capacity building for HCWs in outbreak preparedness and supplying hospitals with PPE.

Clinical, Histopathological, and Prognostic Characteristics of Patients with Prostate Cancer in Lubumbashi, Democratic Republic of Congo

INTRODUCTION

Prostate cancer is currently a public health problem with a frequency that varies from country to country. This study aims to describe the epidemiological, clinical, and histopathological and outcome features of prostate cancer in Lubumbashi in the Democratic Republic of Congo.

MATERIALS AND METHODS

This was a descriptive longitudinal study of patients diagnosed with prostate cancer at the University Clinics of Lubumbashi. The study period was 3 years (2017 to 2019). Parameters studied were age and clinical, biological (PSA level, prostatic specific antigen), histopathological, and outcome features.

RESULTS

The mean age of patients was 68.7 years (range: 47 and 90 years). The 60 to 69 age group was the most affected (43.18%). Elderly subjects (≥60 years old) represented 89.77% of the cases (n = 79). Voiding disorders were the main reason for consultation in 55.68% of the cases. The mean PSA level was 133.7 ng/ml (range: 4 and 1564.5 ng/ml) at diagnosis and 125.4 ng/ml after 3 months of follow-up (range: 0.16 and 1782.1 ng/ml). Adenocarcinoma was the predominant histological type (100%). In prognosis, 31.82% of patients had a Gleason score greater than 7 and 59.10% had a high risk at the D'Amico risk classification for Prostate Cancer. Hormone therapy was administered alone in 75% of the cases and in combination with pulpectomy in 13.64% of the cases. The 3-year overall survival was 56.82%.

CONCLUSION

Prostate cancer is frequent and has a poor outcome in our country. The establishment of an individual screening policy would be an undeniable advantage in improving the prognosis.

Case Report: Three Cases of Neurocysticercosis in Central Africa

Neurocysticercosis (NCC) is an infection prevalent in developing countries; however, it is neglected in the Democratic Republic of the Congo (DRC) and in sub-Saharan Africa. Here, we present three different cases seen in a consulting room in Lubumbashi. These cases are evidence that NCC is more common than it was previously thought in sub-Saharan Africa. Neurocysticercosis is a pathology-neglected and ignored infection, not only by the population but also by health professionals and health authorities in the DRC, and because of that, it is important to increase the research about NCC in the DRC to assess the prevalence and risk factors for NCC to assess the severity of the phenomenon and to help designing appropriate prevention and control measures.

Prevalence and characteristics of HIV infection among female sex workers in Lubumbashi, Democratic Republic of Congo

Introduction

female sex workers (FSWs) are considered a high-risk group for acquiring HIV infection due to their HIV prevalence estimated to be 10-20 times higher than in woman in the general population. This study aimed to determine the prevalence and risk factors of HIV among female sex workers (FSWs) in Lubumbashi.

Methods

a cross-sectional study was conducted among FSWs presenting for the first time at the sexually transmitted infections (STIs) clinic of Katuba, Lubumbashi, between April 2016 and December 2017. Information on the participants´ socio-demographic characteristics, sexual behaviors, and HIV serology results were collated and analyzed using a multiple logistic regression to identify factors associated to HIV infection among FSWs.

Results

information on 1555 sex workers was analysed in this study, the prevalence of HIV was 8.2%. The median age of the participants was 26 years (IQR: 21-34). Of the 127 HIV positive sex workers, 74% have been in the business for two years or less, 97% sell sex as their main income, 74% have more than 5 sexual intercourses per week, 95% reported using condom, 73% reported having history of STIs, 70% reported using alcohol before sex and 97% reported having three or more sexual partners per week. After adjusting for potentials cofounders, Age, Sex work as main income, years of selling sex, condom use, and alcohol use before sex were found to have a significant effect on HIV infection among sex workers.

Conclusion

these findings highlight the vulnerability of FSWs to HIV infection and the necessity of immediate interventions to strengthen HIV prevention through behavioral change strategies and making available Pre-exposure Prophylaxis (PrEP) for FSWs in Lubumbashi.

Increased prevalence of obesity, diabetes mellitus and hypertension with associated risk factors in a mine-based workforce, Democratic Republic of Congo

Introduction

The burden of non-communicable diseases (NCDs) is increasing rapidly in low- and middle-income countries, with the largest portion occurring in Africa. Results from earlier baseline measures on obesity, diabetes and hypertension (ODH) in the Tenke Fungurume Mining (TFM) workforce in 2010 showed high proportions of overweight, pre-diabetic and pre-hypertensive individuals, predicting an upward trend in the burden of ODH over time. The 2010-2015 longitudinal trends on ODH and related risk factors among the TFM workforce is presented herein, and projects the consequent burden of these diseases on the workforce by 2025 if an effective prevention program is not implemented.

Methods

A longitudinal, retrospective cohort study with 3-time intervals was conducted using occupational health records collected on all employees and contractors who had a pre-employment or follow up medical checkups covering the period between January 2010 and December 2015. Repeated paired t tests measured changes in mean values of quantitative risk factors, while a chi-square test assessed changes in prevalence and categorical risk factors over time. A linear projection model was used to predict the consequent morbidity of ODH for the subsequent 10 years up to 2025.

Results

Between 2010 and 2015, prevalence increased from 4.5% to 11.1% for obesity, 11.9% to 15.6% for diabetes, and 18.2% to 26.5% for hypertension. By 2025, provided no prevention program is implemented, prevalence is predicted to reach 25%, 24% and 42% respectively for obesity, diabetes and hypertension.

Conclusion

Without implementation of a comprehensive NCD prevention plan, the burden of ODH and other NCDs is predicted to increase dramatically in the TFM workforce. Alone or combined, NCDs have the potential to dramatically increase operational costs while decreasing productivity over time.

[Model predicting failure in surgical repair of obstetric vesicovaginal fistula]

Introduction

Il y a plus de 2 millions de cas de fistule génitale en Afrique subsaharienne et en Asie. Elles surviennent dans les zones où l'accès aux soins à l'accouchement est limité ou de qualité médiocre et où peu d'hôpitaux offrent les interventions chirurgicales correctives nécessaires. L'objectif de cette étude est de développer un score prédictif permettant d'identifier les facteurs influant sur l'échec de la réparation chirurgicale de la fistule obstétricale vésico-vaginale (ERCF) dans la partie Sud-Est de la province du Haut-Katanga.

Méthodes

Il s'agit d'une étude transversale analytique menée sur 384 femmes porteuses d'une fistule obstétricale vésico-vaginale ayant bénéficié d'une prise en charge chirurgicale. Nous avons procédé par une analyse univariée puis multivariée. La discrimination du score était évaluée à l'aide de la courbe Receiving Operating Characteristics (ROC) et du C-index et la calibration du score selon le test d'Hosmer-Lemeshow.

Résultats

La réparation chirurgicale de la fistule obstétricale vésico-vaginale s'était soldée par un échec dans 17,19% des cas (66/384). Après modélisation logistique, quatre critères ressortent comme facteurs prédictifs d'ERCF: la présence d'une fibrose cicatricielle (ORa=15,22; IC95%: 7,34-31,58), la présence de 2 fistules ou plus (ORa=7,41; IC95%: 3,05-17,97), l'abord trans-vésical comme voie d'abord (ORa=4,26; IC95%: 1,92-9,44) et l'atteinte urétrale (ORa=3,93; IC95%: 1,99-7,77). L'aire sous la courbe ROC du score est de 0,8759 avec une sensibilité de 57,58%, une spécificité de 91,82% et une valeur prédictive positive de 91,25%.

Tuberculosis and HIV co-infection in Congolese children: risk factors of death

Introduction

Human immunodeficiency virus (HIV) and tuberculosis (TB) are the leading causes of death from infectious disease worldwide. The prevalence of HIV among children with TB in moderate to high prevalence countries ranges between 10% and 60%. This study aimed to determine the prevalence of HIV infection among children treated for TB in Directly Observed Treatment Short-Course (DOTS) clinics in Lubumbashi and to identify risk of death during this co-infection.

Methods

This is a cross-sectional study of children under-15, treated for tuberculosis from January 1, 2013 to December 31, 2015. Clinical, paraclinical and outcome data were collected in 22 DOTS of Lubumbashi. A statistical comparison was made between dead and survived HIV-infected TB children. We performed the multivariate analyzes and the significance level set at p-value <0.05.

Results

A total of 840 children with TB were included. The prevalence of HIV infection was 20.95% (95% CI: 18.34-23.83%). The mortality rate was higher for HIV-infected children (47.73%) compared to HIV-uninfected children (17.02%) (p<0.00001). Age <5 years (aOR=6.50 [1.96-21.50]), a poor nutritional status (aOR=23.55 [8.20-67.64]), and a negative acid-fast bacilli testing (aOR=4.51 [1.08-18.70]) were associated with death during anti-TB treatment.

Conclusion

TB and HIV co-infection is a reality in pediatric settings in Lubumbashi. High mortality highlights the importance of early management.

[Maternal and fetal outcomes of unattended pregnancies in Lubumbashi, Democratic Republic of Congo]

Introduction

Unattended pregnancies are characterized by significant morbidity maternal and morbidity and mortality fetal. This study aims to determine the frequency of unattended pregnancies, to describe the socio-demographic profile and to assess the maternal and fetal outcomes during childbirth among women who did not attend antenatal care (ANC) in the city of Lubumbashi.

Methods

It was an analytical cross-sectional study of maternal pregnancy from December 2013 to May 2014 in 10 maternity hospitals in Lubumbashi. Women who did not receive ANC were compared to women who had followed them (ANC≥4). Maternal socio-demographic parameters, maternal and perinatal morbidity and mortality were analyzed.

Results

We found that the frequency of no pregnancy monitoring was 21.23% and the mean number of antenatal visits was 2.6 ± 1.9. An analysis of the relationship between ANC and socio-demographic characteristics of women who were delivered shows that the lack of follow-up was 2.29 times higher for adolescent girls than for adult women (OR=2.29 [1.54-3.41]), 4 times higher for women living alone than for women living in unions (OR=4.00 [2.05-7.79]) and 4.08 times higher for women with low levels of education (illiterate or primary) than among those with a high level of education (OR=4.08 [3.08-5.40]). Compared to those who followed them well, we did not find that women who did not attend ANC had a high risk of obstetric emergency (OR = 1.90 [1.26-2.95]), rupture of membranes fetal admission (OR=1.31 [1.02-1.68]), fetal mal presentation (OR=1.89 [1.03-3.44]), caesarean delivery (OR=1.78 [1.21-2.63]), eclampsia (OR=3.00 [1.09-8.70]), uterine rupture (OR=4.76 [1.00-47.19]) and anemia (OR=2.33 [1.06-5.13]). Rates of preterm birth (OR = 1.93 [1.33-2.80]), post-maturity (OR=1.47 [1.00-2.30]), low birth weight (OR=2.33 [1.56-3.46]), neonatal depression (OR=3.89 [2.52-6.02]), neonatal transfer (OR=1.60 [1.11-2.32]) and perinatal mortality (OR=2.70 [1.59-4.57]) were significantly higher in neonates from women with prenatal consultations than in those with well followed.

Conclusion

Our study shows that the lack of follow-up of ANC is associated with high maternal morbidity and high perinatal morbidity and mortality in our environment.

[Prevalence of overweight and obesity among adolescents in school in Lubumbashi, Democratic Republic of Congo]

INTRODUCTION

overweight and obesity in adolescents are a major global public health issue due to their potential impact on health and increasing frequency. This study aims to determine the prevalence of overweight and obesity among adolescents attending public and private schools in Lubumbashi (DRC).

METHODS

we conducted a cross-sectional study of 5341 adolescents aged 10-19 years, 2858 (53.5%) girls and 2483 (46.5%) boys. Weight and height were measured for each adolescent and then body mass index (BMI) was calculated.

RESULTS

the average weight was 43,78 ± 11.62 kg (42,39 ± 12.11 kg for boys and 44.95 ± 11.04 kg for girls), the average height was 151,30 ± 13,09 cm (151.20 ± 14.64 cm for boys and 151,38 ± 11.58 cm for girls) and BMI was 18,82 ± 3.15 kg/m² (19.39 ± 3.39 kg/m² for boys and 18.17 ± 2.71 kg/m² for girls). The prevalence of overweight was 8% while that of obesity was 1%. The girls were significantly more affected by overweight (10.7% girls against 5% boys) and obesity (1.5% girls against 0.4% boys) than the boys.

CONCLUSION

overweight and obesity in school environment are a reality in Lubumbashi. The prevalence of overweight and obesity in this age group category should be determined in a national evaluation plan in order to implement preventive and therapeutic strategies.

[External anthropometric measurement and pelvimetry among nulliparous women in Lubumbashi: risk factors and predictive score of mechanical dystocia]

Introduction

Maternal and perinatal morbi-mortality is higher in most of sub-Saharan Africa compared to the rest of the world. All women at risk for mechanical dystocia should be screened before labor and referred to a better equipped Hospital for childbirth. This would reduce morbi-mortality. This study aims to develop a predictive score of mechanical dystocia during childbirth among nulliparous Congolese women.

Methods

We conducted a cross-sectional study of nulliparous women with single pregnancy in 7 Maternity Units in the city of Lubumbashi (DRC). Women' size, weight, and external pelvimetry results were collected and analyzed. Univariate and multivariate analyses were performed. Discrimination score was assessed using the ROC curve.

Results

We included in the study 535 nulliparous women, of whom 126 (23.55%) had given birth by cesarean section due to mechanical dystocia. After logistic modelling, three criteria emerged as predictive factors for mechanical dystocia: maternal height <150 cm (adjusted OR=2.96 [1,49-5,87]), bi-ischiatic diameter <8 cm (adjusted OR =15.96 [3,46-73,56]), and Trillat's pre-pubic diameter <11 cm (adjusted OR =2.34 [1,36-4,01]). The area under the ROC curve of the score was 0.6549 with a sensitivity of 23.81%, a specificity of 97.80% and a positive predictive value of 76.92%.

Conclusion

It has been observed that 10th percentile of the three maternal anthropometric measures was predictive of mechanical dystocia. When they were used together, these three values allowed for the development of lowest-cost screening score for use in low income settings.

Albumin, copper, manganese and cobalt levels in children suffering from sickle cell anemia at Kasumbalesa, in Democratic Republic of Congo

Background

Sickle Cell Anemia (SCA) is characterized by high levels of oxidative stress markers and low levels of antioxidant capacity. Antioxidant defence mechanisms against the harmful effects of ROS requires cellular and extracellular enzymes. These enzymes requires micronutrient for complete activity. Information on micronutrients such as manganese, cobalt and copper in SCA population was poorly documented in the literature.

Methods

Plasma copper, manganese, cobalt and albumin concentrations determined by atomic absorption spectrophotometry were compared between two groups of children: 76 with SCA (Hb-SS) and 76 without SCA (controls). This study was conducted in the Muhona Hospital of Kasumbalesa, which is situated in a rural and low in resources.

Results

The mean age was 10.0 years (SD = 5.4) in SCA children and 9.2 years (SD = 4.7) in the control group. The levels of cobalt, manganese, copper and albumin were not different between the two groups (p > 0.05).

Conclusion

In our study, albumin, manganese, cobalt and copper values did not differ between SCA children in steady state and Hb-AA children. The lack of differences in plasma elemental concentrations between the two groups in context of increased demands in the SCA group, may represent adequate compensatory intake or elemental dyshomeostasis in the SCA group.

[Blood pressure profile in adolescents at school in Lubumbashi, Democratic Republic of the Congo]

Introduction

L'objectif de cette étude était de donner le profil de la pression artérielle (PA) des adolescents âgés de 15 à 19 ans en milieu scolaire à Lubumbashi, République Démocratique du Congo.

Méthodes

il s'agit d'une étude transversale, portant sur les adolescents âgés de 15 à 19 ans au moyen d'un échantillonnage aléatoire des écoles secondaires de Lubumbashi durant les années scolaires 2013-2014, 2014-2015 et 2015-2016. Trois mesures de PA étaient effectuées le même jour.

Résultats

1766 adolescents âgés de 15-19 ans ont été inclus parmi eux 995 étaient de sexe féminin et 771 garçons. Les garçons avaient significativement une pression artérielle systolique élevée que les filles dans les tranches d'âges de 17, 18 et 19 ans. La pression artérielle diastolique n'était pas différente statistiquement dans toutes les tranches d'âges dans les deux sexes. Par contre, dans les deux sexes, la pression artérielle systolique été en corrélation significative avec le poids, la taille, l'indice de masse corporelle, le tour de taille et la fréquence cardiaque. Quant à la pression artérielle diastolique, des corrélations significatives étaient retrouvées avec le poids et l'indice de masse corporelle chez les filles alors que la fréquence cardiaque était en corrélation significative dans les deux sexes.

Discussion

Au cours de notre étude, il était question de déterminer les valeurs moyennes de PA et sa corrélation avec les paramètres anthropométriques, la FC et le poids de naissance chez les adolescents d'âge compris entre 15 et 19 ans. Notre étude a révélé des valeurs moyennes de PAS chez les garçons qui étaient plus élevées que les filles statistiquement significatives dans les tranches d'âges de 17, 18 et 19 ans alors que les valeurs moyennes de PAD n'avait pas de différence statistiquement significative dans toutes les tranches d'âges dans les deux sexes. Harrabi et al. [16], dans leur étude incluant 1569 sujets âgés de 13 à 19 ans, avaient trouvé que les garçons de 16, 17 et 18 ans avaient des PAS élevées sans différence statistiquement significatives mais les différences statistiquement significatives étaient remarquées chez les filles de 13 et 14 ans concernant la PAD. Dans son étude chez les enfants, Forrester et al. [17] avaient rapporté une corrélation positive entre la PAS et l'âge chez les garçons et négative chez les filles. Cette corrélation négative trouvée entre la PAS et l'âge chez les filles pourrait être expliquée par les modifications hormonales liées à la puberté qui commencent plus tôt chez les filles que chez les garçons. Se référant à la littérature, la PA augmente avec la croissance en âge plus chez les garçons suite à l'augmentation de la masse musculaire pendant la puberté [18-20].

Notre étude a montré que la PAS était en corrélation significative avec le poids, la taille, l'IMC, le tour de taille et la FC dans les deux sexes. Ce constat est similaire à celui faite par l'étude de Harrabi et al. [16] qui rapportait que la PAS était en corrélation positive avec la taille (garçons: r = 0,33; p < 0,0001; filles: r = 0,08; p = 0,02), le poids (garçons: r = 0,47, p < 0,0001; filles: r = 0,35; p < 0,0001) et l'âge (r = 0,12; p < 0,0001). Quant à la PAD dans notre étude, les corrélations significatives positives étaient retrouvées avec le poids (r = 0,093; p = 0,003) et l'IMC (r = 0,079; p = 0,012) seulement chez les filles, alors que la FC était en corrélation significative positive chez les garçons (r = 0,168; p < 0,0001) mais non chez les filles (r = 0,12, p < 0,0001) [16]. Dans une étude similaire chez les adolescents réalisée par Sinaiko et al. [21], une corrélation a été trouvée entre le poids et la PAS chez les garçons (r = 0,167, p < 0,0001) et les filles (r = 0,112, p < 0,0001). L'effet de la taille et du poids sur la PA a déjà été démontré dans plusieurs études transversales antérieures sur les enfants concluant en une forte corrélation positive [22,23]. L'insuffisance de déclaration des naissances à l'état civil dans plusieurs pays en développement, conséquente au recours aux poids de naissance déclarés auprès des parents ou tuteurs, serait un biais dans la réalisation des résultats statistiquement comparables.

Conclusion

Malgré les faiblesses potentielles de la présente étude dans sa conception transversale et les mesures de la PA le même jour, les données pourraient aider les responsables de la santé à adopter une stratégie nationale de prévention de l'hypertension artérielle dans notre population.

Fragile X checklists: A meta-analysis and development of a simplified universal clinical checklist

BACKGROUND

Clinical checklists available have been developed to assess the risk of a positive Fragile X syndrome but they include relatively small sample sizes. Therefore, we carried out a meta-analysis that included statistical pooling of study results to obtain accurate figures on the prevalence of clinical predictors of Fragile X syndrome among patients with intellectual disability, thereby helping health professionals to improve their referrals for Fragile X testing.

METHODS

All published studies consisting of cytogenetic and/or molecular screening for fragile X syndrome among patients with intellectual disability, were eligible for the meta-analysis. All patients enrolled in clinical checklists trials of Fragile X syndrome were eligible for this review, with no exclusion based on ethnicity or age. Odds ratio values, with 95% confidence intervals as well as Cronbach coefficient alpha, was reported to assess the frequency of clinical characteristics in subjects with intellectual disability with and without the fragile X mutation to determine the most discriminating.

RESULTS

The following features were strongly associated with Fragile X syndrome: skin soft and velvety on the palms with redundancy of skin on the dorsum of hand [OR: 16.85 (95% CI 10.4-27.3; α:0.97)], large testes [OR: 7.14 (95% CI 5.53-9.22; α: 0.80)], large and prominent ears [OR: 18.62 (95% CI 14.38-24.1; α: 0.98)], pale blue eyes [OR: 8.97 (95% CI 4.75-16.97; α: 0.83)], family history of intellectual disability [OR: 3.43 (95% CI 2.76-4.27; α: 0.81)] as well as autistic-like behavior [OR: 3.08 (95% CI 2.48-3.83; α: 0.77)], Flat feet [OR: 11.53 (95% CI 6.79-19.56; α:0.91)], plantar crease [OR: 3.74 (95% CI 2.67-5.24; α: 0.70)]. We noted a weaker positive association between transverse palmar crease [OR: 2.68 (95% CI 1.70-4.18; α: 0.51)], elongated face [OR: 3.69 (95% CI 2.84-4.81; α: 0.63)]; hyperextensible metacarpo-phalangeal joints [OR: 2.68 (95% CI 2.15-3.34; α: 0.57)] and the Fragile X syndrome.

CONCLUSION

This study has identified the highest risk features for patients with Fragile X syndrome that have been used to design a universal clinical checklist.

[Development of a predictive score of severe acute malnutrition among children under 5 years of age]

Introduction

L’objectif de cette étude est de développer un score prédictif de la malnutrition aiguë sévère (MAS) chez les enfants de 6 à 59 mois.

Méthodes

Etude cas-témoins: les cas (n = 263) étaient les enfants de 6 à 59 mois admis à l’hôpital Sendwe de Lubumbashi pour une MAS; les témoins (n = 263) étaient les enfants de même âge admis dans le même hôpital pour une pathologie autre que la MAS. Nous avons procédé par une analyse univariée puis multivariée. La discrimination du score était évaluée à l’aide de la courbe ROC et du C-index.

Résultats

Après modélisation logistique, neuf critères ressortent comme facteurs prédictifs de MAS: le faible poids à la naissance, la diarrhée à répétition/chronique, le nombre de repas journaliers < 3, l’âge d’arrêt d’allaitement maternel < 6 mois, l’âge d’introduction d’alimentation de complément < 6 mois, l’âge maternel < 25 ans, la parité < 5, l’antécédent familial de malnutrition et le nombre d’enfants âgés de moins de 5 ans dans la fratrie ≥ 3. L’aire sous la courbe ROC est de 0,9685, la sensibilité de 93,54%, la spécificité de 93,16%, la valeur prédictive positive de 93,18% et le rapport de vraisemblance positif de 6,84%.

Conclusion

Nous proposons un score prédictif du risque de survenue de MAS dans une population de moins de 5 ans. Ce score prédictif de MAS serait un outil clinique utile et simple pour cibler la population à risque, limiter les taux élevés de malnutrition et réduire la morbidité et la mortalité infanto-juvénile enregistrés dans les pays en développement.

Severe malaria and death risk factors among children under 5 years at Jason Sendwe Hospital in Democratic Republic of Congo

INTRODUCTION

Malaria is still a major public health concern in the Democratic Republic of Congo. Its morbidity and mortality challenge the actual strategies of the fight agains malaria. This study was aimed to describe the epidemiology, the clinical caracteristics and the risk factors of death associated to severe malaria in the pediatric population under 5 years at Sendwe Hospital of Lubumbashi.

METHODS

This analytical retrospective study was conducted in Lubumbashi, in the province of Haut-Katanga. All patients under 5 years hospitalized for severe malaria were registered from January 2014 to December 2016.

RESULTS

Among the 3,092 patients hospitalised during our study period, 452 (14.6%) were admitted for severe malaria. The average age was 27.04 months, the male sex was the most affected (53.54% with the sex-ratio 1.15). The most frequent forms of gravity noticed were cerebral malaria (48.23%) and severe anemia (46.90%). Death was noted in the evolution in 28.32%. Repeated convulsion (OR = 2.27; 95% CI: 1.47-3.48), coma (OR = 3.55; 95% CI: 2.19-5.74) and severe acute malnutrition (OR = 3.32; 95% CI: 1.56-7.06) were asscociated with a high risk of death.

CONCLUSION

This research shows that severe malaria is still an important cause of morbidity and mortality among young children in Lubumbashi. Neurologic and anemic forms are the most frequent. The predictive signs of death are: repeated convulsions, coma and severe acute malnutrition.

Oscillometric blood pressure by age and height for non overweight children and adolescents in Lubumbashi, Democratic Republic of Congo

Background

The diagnosis of hypertension in children is complex because based on normative values by sex, age and height, and these values vary depending on the environment. Available BP references used, because of the absence of local data, do not correspond to our pediatric population. Accordingly, our study aimed to provide the BP threshold for children and adolescents in Lubumbashi (DRC) and to compare them with German (KIGGS study), Polish (OLAF study) and Chinese (CHNS study) references.

Methods

We conducted a cross-sectional study among 7523 school-children aged 3 to 17 years. The standardized BP measurements were obtained using a validated oscillometric device (Datascope Accutor Plus). After excluding overweight and obese subjects according to the IOTF definition (n = 640), gender-specific SBP and DBP percentiles, which simultaneously accounted for age and height by using an extension of the LMS method, namely GAMLSS, were tabulated.

Results

The 50th, 90th and 95th percentiles of SBP and DBP for 3373 boys and 3510 girls were tabulated simultaneously by age and height (5th, 25th, 50th, 75th and 95th height percentile).

Before 13 years the 50th and 90th percentiles of SBP for boys were higher compared with those of KIGGS and OLAF, and after they became lower: the difference for adolescents aged 17 years was respectively 8 mmHg (KIGGS) and 4 mmHg (OLAF). Concerning girls, the SBP 50th percentile was close to that of OLAF and KIGGS studies with differences that did not exceed 3 mmHg; whereas the 90th percentile of girls at different ages was high. Our oscillometric 50th and 90th percentiles of SBP and DBP were very high compared to referential ausculatory percentiles of the CHNS study respectively for boys from 8 to 14 mmHg and 7 to 13 mmHg; and for girls from 10 to 16 mmHg and 11 to 16 mmHg.

Conclusions

The proposed BP thresholds percentiles enable early detection and treatment of children and adolescents with high BP and develop a local program of health promotion in schools and family.

Electronic supplementary material

The online version of this article (10.1186/s12872-018-0741-4) contains supplementary material, which is available to authorized users.

[Obstetric fistulas among people living in northern Katanga province, Democratic Republic of the Congo: about 242 cases]

Les fistules obstétricales constituent un problème majeur de Santé Publique dans les pays pauvres. L’objectif de ce travail est de décrire les aspects épidémiologiques, cliniques et thérapeutiques des fistules obstétricales dans la province du Haut-Katanga, République Démocratique du Congo. L’étude est transversale descriptive, portant sur 242 patientes souffrant de la fistule obstétricale dans la province du Haut-Katanga durant la période allant de Septembre 2009 à Décembre 2013. Les paramètres étudiés étaient les données sociodémographiques maternelles, les paramètres obstétricaux et néonatals, les caractéristiques spécifiques de la fistule ainsi que les modalités et l’issue de la prise en charge. Les variables ont été analysées sur logiciel Epi-info version 7.1. Des 242 cas de fistules, 229 patientes ont accouché par voie basse soit 95% d’entre elles et 74,6% à domicile. Le nouveau-né était décédé en période périnatale dans 93,4% des accouchements. L’âge moyen des patientes était de 27,9±10,3 ans. Environ une patiente sur six avait moins de 20 ans et dans l’ensemble près d’une patiente sur 2 avait moins de 25 ans. 7 patientes sur 10 avaient une parité inférieure à 3 et la parité moyenne était de 2,5±2,0. Nonante pourcent des cas avaient un niveau d’études bas et 95% vivaient seules. La fistule avait en moyenne plus de 4,7±4,4 ans d’âge, était vésico-vaginale (96%), de type 2-3 (37%) et réparée par voie vaginale (67%). Le taux d’échecs était de 14%. La fistule obstétricale constitue un réel problème de Santé Publique dans notre milieu et mérite une réflexion profonde pour son éradication.

Prevalence of obesity, diabetes mellitus, hypertension and associated risk factors in a mining workforce, Democratic Republic of Congo

Introduction

The burden of non-communicable diseases (NCDs) is increasing in low and middle-income countries (LMIC). According to the World Health Organization (WHO) the largest increase occurs in Africa. Obesity, diabetes mellitus and hypertension (ODH) are major risk factors for cardiovascular diseases, causing nearly 18 million deaths worldwide. Various risks associated with mining as an occupational activity are implicated in NCDs' occurrence. This study describes the baseline prevalence of ODH and associated risk factors in the workforce of Tenke Fungurume Mining (TFM), in southern Democratic Republic of Congo.

Methods

A cross-sectional study was conducted on a sample of 2,749 employees' and contractor's occupational health examination files for 2010. Socio-demographic, occupational, medical, anthropometric and behavioral characteristics were collected and assessed. Disease status regards ODH was based on WHO criteria. A multivariate logistic regression model was used.

Results

Overall prevalence of ODH was 4.5%, 11.7%, and 18.2% respectively. Proportions of pre-ODH individuals were 19.7%, 16.5%, and 47.8% respectively. Prevalence of ODH increased with age, professional grade, nature of work, gender and reported alcohol use. Smoking 10 or more cigarettes per day increased risk of diabetes and hypertension, while decreasing obesity.

Conclusion

Rates of ODH and associated risk factors are higher in the TFM workforce, than in the general DRC population. This is likely reflective of other mining sites in the country and region. It is evident that ODH are associated with various socio-demographic, occupational, anthropometric, biomedical and behavioral risk factors. A NCD prevention program and close monitoring of disease and risk factors trends are needed in this population.

A cross-sectional study on obesity and related risk factors among women of the central market of Lusonga in Lubumbashi, Democratic Republic of Congo

Introduction

Obesity is known as one of adjuvant factors for increase in non-communiable diseases (NCDs). The aim of this study was to describe the prevalence of obesity and identify its risk factors among women of the central market of Lusonga in Lubumbashi, Democratic Republic of Congo.

Methods

In October 2014, we interviewed a total of 430 women selling in the central market of Lusonga in Lubumbashi. Data on sociodemographic characteristics, health-related habits and behaviors, diet, physical activity, chronic diseases, blood pressure and anthropometric measurements were collected. A multivariate logistic regression model was fitted.

Results

Prevalence of overweight and obesity was 16.51% and 13.26% respectively. The logistic regression did not show any significant association between age and obesity. Risk of obesity was lower in married women (adjusted odds ratio (aOR) = 0.23 (0.08-0.63)). Women with low educational profile (primary school or less) were more likely to be obese than those with higher education (secondary or high school) (aOR = 2.50 (1.12-5.63)). Risk of obesity increased with living in urban area (aOR = 2.52 (1.00-6.36)), use of oral birth control pills (aOR = 11.07 (3.52-34.83)) and low consumption of fruit (aOR = 5.47 (1.88-15.92)) and vegetable (aOR = 2.42 (1.05-5.56)). Obese women were more likely to be hypertensive than non-obese (aOR = 7.15 (2.46-20.75)) and diabetics (aOR = 3.62 (1.62-8.11)).

Conclusion

This study has reported a prevalence of 13.26% of obesity among women selling at Lusonga's market. Marital status, education level, residence, use of oral birth control pills and consumption of fruit and vegetables had a significant association with the prevalence of obesity in this category of women.