[Factors associated with the quality of life of patients with knee osteoarthritis]

INTRODUCTION

knee osteoarthritis, a common condition in Sub-Saharan Africa, affects the quality of life of patients.

OBJECTIVE

Identify the factors associated with impaired quality of life.

PATIENTS AND METHODS

Cross-sectional and analytical study, carried out in the Department of Rheumatology at the University Teaching Hospital of Brazzaville, in two steps. The first made it possible to collect data of patients diagnosed as having knee osteoarthritis according to the the ACR criteria of 1986 and followed up from January 1st, 2013 to December 31st, 2017. The second step consisted in measuring the quality of life of patients using a specific quality-of-life questionnaire for knee and hip osteoarthritis OAKHQOL, then identifying by bivariate analysis after analysis of variance (ANOVA), the factors associated with an impairment of the quality of life (P≤ 5%). It took place from May 02 to November 02, 2018 (6 months). One hundred and nineteen patients were investigated.

RESULTS

We included in this study 103 women and 16 men (sex ratio M / F of 1/6). The average age was 56.1 ± 9 years (range 27 to 77 years). The mean evolution time was 5.1 ± 3.6 years. The knee osteoarthritis moderately impaired the overall quality of life of patients. The most affected dimensions were physical activity and pain (51.3% and 42.9% of patients between 25 and 50 respectively). The evolution time and functional impact were potentially associated with all dimensions of quality of life. Age was associated with poorer quality of life in the physical activities (p = 0.012) and social activities (p = 0.001) dimensions, as was obesity, with the social activities dimension (p = 0.004).

CONCLUSION

The duration of evolution and the functional impact were associated with deterioration in the quality of life.

Sustainable Development Goals and the challenge of Human resources for health in Congo

Background

In order to achieve the Sustainable Development Goals (SDGs), equitable access to skilled and motivated health workers within a performing health system is need to be ensured. The health system in Congo is characterized by low quantity and quality of Human resources for health (HRH), which constitutes an important barrier to achieving to expanding coverage and integrated primary health care.

Objectives

To estimate needs of HRH in Congo from 2019 to 2030 and analysed the capacity of the country to address the estimated needs.

Methods

Cross-sectional study was conducted in Ministry of Health from June to November 2018. Data from 2011 national HRH Census was used as the baseline for projections. We performed annual projections based on current numbers of midwives, nurses and physicians. Health workforce-population ratios by year in national and department level were provided. Population estimations were computed using Spectrum software assuming a 3% growth rate. Mapping for distribution by department was performed used QSGI software.

Results

In 2019, Congo has 4849 midwives, nurses and physicians, including 465 doctors, 912 midwives and 3469 nurses. All of Congo departments have not surpassed the availability threshold of 4, 5 midwives, nurses and physicians per 1000 inhabitants in 2019. In overall, this ratio will rise from 0.9 per 1000 inhabitants in 2019 to 0.42 per 1000 inhabitants in 2030 due to the retirement. Needs for additional workforce were estimated at 29416 midwives, nurses and physicians by 2030, average of 2451 per year. However, current national production capacity of human resources for health is very low and will not cover the estimated needs as scheduled.

Conclusions

There is a crisis in the health workforce in Congo, expressed in acute shortage. Results highlight needs of building adequate policies to address production and management of the health workforce, to come close to reaching the MDGs for health.

Key messages

At current production capacity, Congo has not the number of physicians, nurses, and midwives it needs to address HRH shortages in the national Health system by 2030. The health human resources crisis in sub-Saharan Africa countries will be a major obstacle to achieving the Millennium Development Goals.

[Erectile dysfonction after stroke in Brazzaville]

INTRODUCTION

Erectile dysfunction is one of the disability post-stroke the least documented. However, it affects the quality of life, not only the patient but also the couple.

OBJECTIVE

The purpose of this work was to study the characteristics of erectile dysfunction after stroke.

METHOD

This is a cross-sectional descriptive and analytical data collection survey conducted from February to October 2011, having identified, 104 patients for follow-up post-stroke, seen in outpatient Neurology University Hospital of Brazzaville and in the functional rehabilitation centers. Among them 54 had erectile dysfunction. The parameters studied were: age, marital status, history, vascular risk factors, and the location of the hemiplegic, the etiology of stroke, modified Rankin score and NIHSS. The clinical features and laboratory, the international index of erectile dysfunction (IIEF-5) in its French version. SPSS 12 was used for recording and statistical analysis of data. Chi(2) test was used for comparisons. The significance level was P≤0.05.

RESULTS

The frequency of erectile dysfunction after stroke was 51.92%, the average age was 56.32 years. The mean time to onset of erectile dysfunction after stroke was 5 months. The onset was progressive in 70,4%. The hypercholesterolemia was well correlated with the risk of erectile dysfunction (P=0.007) and its severity (P=0,01). Erectile dysfonction was moderate in 61.1% and almost bearable in half the cases.

CONCLUSION

Erectile dysfunction post-stroke is common with an impact in the lives of the couple. High cholesterol is an independent risk factor of occurrence of post-stroke.

[Simian smallpox (or monkey smallpox): study of 8 cases observed at Impfondo Hospital in Republic of Congo]

Monkeypox or simian smallpox is a viral disease whose clinical manifestations are similar to the human smallpox. In this study authors describe the care management and follow up of eight patients hospitalized at the Impfondo hospital in Congo. It was a transversal study conducted from the 23rd of May till the 7th of July 2003 at the District Hospital of Impfondo (Likouala province, Republic of Congo). We have analyzed 81 patient files hospitalized during that period. Using the Atlanta CDC criteria of case definition modified in 2003, monkeypox has been diagnosed in 8 patients. Our series has 4 male and 4 female patients. The mean age is 9.05 +/- 5.86 with extremes ranging from 5 months to 18 years old. The clinical manifestations included fever (n = 7), rash (n=8), articulations and muscles pains (n=2), mumps (n=4) and pruritus (n=6). 7 patients recovered among them 5 without complications and 2 with persistent hypochromic lesions for more than 6 weeks. The monkeypox strain responsible for these infections appeared not to be lethal to humans. However this study shows that monkeypox is an endemic public health risk in the sanitary district of Impfondo, within the Congo River basin. The endemic presence of monkeypox in the Congo basin could trigger a new outbreak if the viral strains involved here became lethal.

[Etiology of oligoarthritis in equatorial Africa. A retrospective study of 80 cases in Brazzaville, Congo]

PURPOSE

The objective was to determine causes of oligoarthritis in patients hospitalized in a Central Africa teaching hospital.

METHODS

We collected case reports of patients presenting with arthritis located in two or three joints. Analysis included the disease frequency, age, gender, and etiology. Etiology was defined according to common criteria used for the diagnosis of rheumatic diseases.

RESULTS

Eighty patients (60 males and 20 females; age range: 7-80 years; mean age: 35.6 years) were included in the study. Altogether they represented 5.8% of in-patients and 14.3% of the patients suffering from arthritis. The following causes were observed: HIV-related arthritis, 21 cases (12 males and nine females; mean age: 32.2 years). Arthritis was asymmetrical, acute and non-erosive. Recovery was observed after administration of a non steroidal anti-inflammatory drug for 4-6-weeks. Gout: 17 patients (15 males and two females; mean age: 51.1 years). Gout was related with one or more of the following: alcoholism (16 cases), hypertension (nine cases), and obesity (three cases), and was chronic in 12 patients. Infection-related arthritis: 17 cases (five males and 12 females; mean age 25.3 years). Portal of entry was either cutaneous (five cases) or obstetrical (seven cases). Most of the time, the causative microorganism was Staphylococcus. Rheumatic fever: five patients (four males and one female; mean age 18 years). Juvenile chronic arthritis: three cases (one male and two females; mean age 12.6 years). Reactive arthritis: three cases (three males; mean age: 32). Etiology is still unknown for 14 cases.

CONCLUSION

Oligoarthritis appears to be secondary to HIV or bacterial infection in young adults, while gout affects more often the elderly. This study confirms that spondylarthropathy is unusual in Sub-Saharan Africa. Furthermore, it emphasizes the existence of numerous cases in whom etiology of the diseases is unknown.

Prevalence and clinical presentations of arthritis in HIV-positive patients seen at a rheumatology department in Congo-Brazzaville

OBJECTIVE

To determine the prevalence and clinical presentations of rheumatic manifestations in HIV-infected patients seen at a rheumatology department in Congo-Brazzaville.

METHODS

Over a one-year period, all patients admitted to the Brazzaville Teaching Hospital's rheumatology unit underwent serologic testing for the HIV by ELISA confirmed by Western blot. Standard criteria were used to classify the inflammatory joint diseases seen during the study period.

RESULTS

A total of 171 patients, 85 men and 86 women, were tested. The age range was 16 to 81 years, with a mean of 42.1 years. HIV tests were positive in 39 patients, 24 men and 15 women, with a mean age of 31.2 years, accounting for 22.8% of the overall patient population and for 35.1% of all patients with inflammatory rheumatic syndromes. HIV infection stage as determined based on Centers for Disease Control criteria was i.v. in 35 patients and II in the remaining four patients. Of the 39 HIV-positive patients, 32 had HIV-related arthritis, two had reactive arthritis, two had staphylococcal septic arthritis and three had infectious discitis. Of the 72 HIV-negative patients with inflammatory rheumatic syndromes, 22 had septic arthritis, 18 had infectious discitis, five had reactive arthritis, four had rheumatoid arthritis, four had gout, two had poststreptococcal rheumatic disease, one had juvenile chronic arthritis and 16 had unclassifiable arthritis. None of the remaining 60 HIV-negative patients had inflammatory joint manifestations.

CONCLUSION

HIV infection was both the leading reason for admission and the leading cause of arthritis. Acute, febrile, asymmetric, nondeforming, nonerosive polyarthritis of the small and large joints responsive to nonsteroidal antiinflammatory drug therapy was the most common clinical pattern of arthritis in HIV-positive patients. Reactive arthritis, septic arthritis and infectious discitis were rarely seen and had no specific features as compared to HIV-negative patients. Patients with arthritis should be tested for HIV infection. It follows that rheumatologists need to know how to provide counselling about HIV testing and how to disclose the results to their patients. They also need to be familiar with the management of HIV infection and to direct careful attention to the prevention of HIV transmission in health care facilities.

Rheumatoid arthritis in Congo-Brazzaville. A study of thirty-six cases

OBJECTIVES

To define the epidemiology, clinical features and outcomes of rheumatoid arthritis in a hospital-based population in Congo-Brazzaville.

PATIENTS AND METHODS

We retrospectively reviewed the medical records of the 36 subjects seen on an inpatient or outpatient basis at our rheumatology department who met American College of Rheumatology criteria for rheumatoid arthritis.

RESULTS

There were 28 women and eight men (male to female ratio, 0.28), with a mean age of 43.5 years. The total number of patients seen at our department during the study period was 3518, yielding a prevalence of 1% for rheumatoid arthritis. Seven per cent of the patients with inflammatory joint disease had rheumatoid arthritis. Mean disease duration was 9.5 years (range, 1-25 years). The onset was gradual in every case and distal joints were affected first in 33 patients. All the patients but one had bilateral symmetric polyarthritis; affected joints included the proximal interphalangeal joints (n: 33), the metacarpophalangeal joints (n: 27), the wrists (n: 27), the metatarsophalangeal joints (n: 20), the knees (n: 26), the elbows (n: 18), the hips (n: 4), the temporomandibular joints (n: 4), and the cervical spine (n: 5). Boutonnière deformity of the fingers was the most common joint deformity (n: 15), followed by ulnar drift (n: 9). Three patients had tenosynovitis, two had tendon rupture, one had carpal tunnel syndrome and one had rheumatoid nodules. Rheumatoid factors were found in 70% of cases. Evidence of chondrolysis was seen on roentgenograms in every case. Gold and chloroquine were the two most commonly used second-line agents. Seven patients were on prednisone, in a mean daily dose of 6 mg. Mean follow-up was 15 months (range: 3-36 months). Steinbrocker's disease activity stage was IV in 14 patients and III in eight patients; Steinbrocker's functional stage was IV in five patients and III in three.

CONCLUSION

The features and outcomes of rheumatoid arthritis in Congo-Brazzaville match textbook descriptions except for a lower prevalence of extraarticular manifestations. Similar findings have been reported for East Africa, South Africa, and some countries of West Africa.

[Diagnosis of arthritis in black Africa. Apropos of 473 cases in Congo]

A cross-sectional study of arthritis was conducted in the Rheumatology Department of the Brazzaville Teaching Hospital, Congo. A total of 473 patients with arthritis seen between 1989 and 1991 were subjected to the limited tests available. Gout was the leading diagnosis (n = 83). Septic arthritis (n = 82) and infectious discitis (n = 55) were the most common reasons for admission. Tests often failed to identify the causative organism; Staphylococcus was the most commonly recovered organism. Tuberculous discitis was less common than discitis due to pyogenic bacteria. HIV-related arthritis (n = 57) usually manifested as severe, febrile, asymmetrical, nonerosive, polyarthritis. Cases of rheumatoid arthritis (n = 29) fit the classical description of the disease. In 83 patients with monoarthritis, oligoarthritis, or polyarthritis, no etiology could be identified.

[Epidemiological and clinical aspects of gout in equatorial Africa. Apropos of 60 cases followed in the Department of Rheumatology of the Teaching Hospital Center in Brazzaville]

Between December 15, 1988 and November 30, 1990, the application of Rome and New York criteria enabled the diagnosis of 60 cases of gout among patients with arthritis or hyperuricemia seen as out-patients or hospitalised in the Department of Rheumatology of the Brazzavile T.H.G. There were 57 men and 3 women, with a mean age of 51. Gout is the primary form of inflammatory arthropathy in adults in the Congo. Affecting all socio-professional groups, it is diversely associated with obesity, alcoholism, hypertension and diabetes. Initial involvement affects the big toe. Oligo and polyarticular forms predominate because of the absence or delay in specific treatment. This series included 30 per cent of cases of chronic gout. Evidence of renal impairment was found in one third of patients. However, urate lithiasis was absent. Tophi were found preferentially over the elbows. Sickle cell disease was responsible for one case of tophaceous gout. In contrast with the results of studies undertaken before the 1980s, gout is seen to be a common condition in equatorial Africa.

[Bone density in 20 black African young adults of the Bantu race is identical to that in subjects of white race]

Bone mineral content (BMC in g) as well as bone mineral density (BMD in g/cm2) were measured by dual photon absorptiometry in 20 black africans and 20 white individuals of the same age and sex. The BMC of african males, as well as their body mass index (BMI), were significantly less than those of the whites. In contrast, neither BMD nor the ratio of BMC to BMI differed between the two groups. These results suggest that morphotype plays a greater role than the ethnic factor in the determination of bone mass in the young adult.

[Prospective study of rheumatic manifestations in human immunodeficiency virus infection. Apropos of 26 cases in Congo]

A 12-month prospective study of the osteo-articular complaints in HIV infected patients was carried out in the Department of Rheumatology, Brazzaville, Congo. Positivity of the HIV serology was systematically researched. And so the authors have observed rheumatic disorders in 26 patients, 12 males, 14 females, with a mean age of 36 years (ranged from 13 to 78). These disorders are as follow: linked to HIV oligo or polyarthritis, 18 cases; septic arthritis 3 cases; destructive spondylodiscitis 2 cases; bilateral sciatica with paralysis 3 cases; tropical myositis 2 cases. Contamination was heterosexual in 23 patients, iatrogenic in 3 other ones. HIV infection was at the CDC stades II (7 patients) or IV (19 patients). The prevalence of osteo-articular manifestations in HIV infected patients who are admitted in the hospital of Brazzaville, Congo is evaluated at only 4%.