Anglewicz, Philip; Corker, Jamaica; Kayembe, Patrick
The rapid population growth of many African cities has important implications for population health, yet little is known about factors contributing to increasing population, such as the fertility of internal migrants. We examine whether in-migrants to Kinshasa have different fertility patterns than lifetime Kinshasa residents, and identify characteristics of migrants that may explain differences in fertility. We also use detailed migration histories to examine whether fertility differs by features of migration. We use representative data from the PMA2020 Project for 2197 women in Kinshasa, including 340 women who moved to Kinshasa. We examine differences between migrants and non-migrants in fertility and other fertility-related characteristics. We also examine whether fertility differs by duration of residence in Kinshasa, number of lifetime moves, age at first migration, urban/rural classification of birthplace, and the distinction between intra-Kinshasa migration and migration to Kinshasa.. Migrants have significantly higher fertility than permanent Kinshasa residents, but the difference is relatively small in magnitude. This higher fertility appears due in part to patterns of contraceptive use among migrants. There is noteworthy heterogeneity among migrants: higher fertility among migrants is associated with longer duration in Kinshasa, more lifetime moves, urban-Kinshasa migration, older age at first migration, and moving to Kinshasa from outside (as opposed to intra-Kinshasa migration).
Kasuku, Wanduma; Bouland, Catherine; De Brouwer, Christophe; Mareschal, Bertrand; Mulaji, Crispin
The management of hospital waste is a high-risk practice in the hospitals of Kinshasa, the largest city of the Democratic Republic of the Congo, from the point of view of public health and the environment. A multi-criteria study carried out in 4 hospitals assessed the situation and put forward solutions. Copyright © 2016. Publié par Elsevier Masson SAS.
Objective Leaded gasoline and lead paints are still in use in the Democratic Republic of Congo but data on blood lead levels in the general population are not available. We evaluated the Pb impregnation in children and adults (0 - 70 years old) in Kinshasa. Methods Blood lead was measured by atomic absorption in a sample of 485 healthy people (268 men and 217 women) living in Kinshasa between May 2003 and June 2004. Results Geometric mean blood lead was 120 µg/L (95% CI: 115-125), with a higher concentration in men than in women (127 vs 114 µg/L, p = 0.01). Sixty-three percent of children aged less than 6 years old presented blood lead levels above the 100 µg threshold. In the adult population, occupations with a potential risk of exposure to gasoline (car mechanics or garage owners, taxi drivers, conveyors and gas pump attendants) were associated with an extra blood lead of about 65µg/L. Conclusion This study indicates a relatively important Pb impregnation of the Kinshasa population. It demonstrates the existence of a major public health issue requiring corrective actions and the implementation of an appropriate regulation.
Muanda, Mbadu; Gahungu Ndongo, Parfait; Taub, Leah D.; Bertrand, Jane T.
Recent research from Kinshasa, DRC, has shown that only one in five married women uses modern contraception; over one quarter have an unmet need for family planning; and almost 400 health facilities across Kinshasa report that they provide modern contraception. This study addresses the question: with reasonable physical access and relatively high unmet need, why is modern contraceptive prevalence so low? To this end, the research team conducted 6 focus groups of women (non-users of any method, users of traditional methods, and users of modern methods) and 4 of husbands (of users of traditional methods and in non-user unions) in health zones with relatively strong physical access to FP services. Five key barriers emerged from the focus group discussions: fear of side effects (especially sterility), costs of the method, sociocultural norms (especially the dominant position of the male in family decision-making), pressure from family members to avoid modern contraception, and lack of information/misinformation. These findings are very similar to those from 12 other studies of sociocultural barriers to family planning in sub-Saharan Africa. Moreover, they have strong programmatic implications for the training of FP workers to counsel future clients and for the content of behavior change communication interventions. PMID:27907138
Muanda, Mbadu; Gahungu Ndongo, Parfait; Taub, Leah D; Bertrand, Jane T
Recent research from Kinshasa, DRC, has shown that only one in five married women uses modern contraception; over one quarter have an unmet need for family planning; and almost 400 health facilities across Kinshasa report that they provide modern contraception. This study addresses the question: with reasonable physical access and relatively high unmet need, why is modern contraceptive prevalence so low? To this end, the research team conducted 6 focus groups of women (non-users of any method, users of traditional methods, and users of modern methods) and 4 of husbands (of users of traditional methods and in non-user unions) in health zones with relatively strong physical access to FP services. Five key barriers emerged from the focus group discussions: fear of side effects (especially sterility), costs of the method, sociocultural norms (especially the dominant position of the male in family decision-making), pressure from family members to avoid modern contraception, and lack of information/misinformation. These findings are very similar to those from 12 other studies of sociocultural barriers to family planning in sub-Saharan Africa. Moreover, they have strong programmatic implications for the training of FP workers to counsel future clients and for the content of behavior change communication interventions.
Tuakuila, J; Kabamba, M; Mata, H; Mbuyi, F
The DRC, as most of African nations, does not have a national biomonitoring programme and there is a lack of information on background levels of environmental pollutants in the general DRC population, particularly in children. The focus of the data presented in this report aims to establish the background levels of a range of environmental pollutants in urine or blood from the children population of Kinshasa. Based on the representative data collection of the Kinshasa population, the survey selected 125 children aged 1-14years and living in Kinshasa (6years on average, 56% of girls, 100% of non-smokers, without amalgam fillings and consumers of fish 3 times per week). Biomarkers of a range of metals (As, Cd, Hg and Pb), pyrene (PAH) and benzene were analyzed in the blood or urine samples. Globally, the results indicate that the exposure levels of children living in Kinshasa are 10 times higher than those published by the American, Canadian and German children surveys. This study provides the first Reference Values of environmental pollutants [As, Cd, Hg, Pb, pyrene (PAH) and benzene] in the Kinshasa children population and reveals elevated levels of all biomarkers studied. The data set of this study may allow environmental and health authorities of DRC to undertake a national biomonitoring programme, especially with four insights for the protection of human heath.
The transition of new graduate students from school to the labor market in Democratic Republic of Congo has been a major topic for debate over the last twenty years. This study identifies the factors affecting collaboration between higher education and the labor market in Kinshasa, the Capital city of the Democratic Republic of Congo. Even though…
Shapiro, David; Tambashe, B. Oleko
Substantial ethnic differences in fertility were documented in the Congo in the mid-1950s. These differences, apparent as well among women residing in Kinshasa, the capital, were linked to variations across ethnic groups in the incidence of venereal diseases and sterility. By the mid-1970s ethnic differences in fertility had diminished but were…
This paper examines fertility transition in Kinshasa, capital of the Democratic Republic of the Congo (DRC) and second-largest city in sub-Saharan Africa. Shapiro (1996) documented the onset of fertility transition in the city, using data from 1990. Women's education was strongly inversely related to fertility, beginning with secondary schooling, and increases in women's education were important in initiating fertility transition in the city. The paper uses data from the 2007 Demographic and Health Survey in the DRC to examine fertility in Kinshasa and assess fertility transition since 1990, a period characterized by severe adverse economic conditions in the DRC. Fertility transition has continued at a strong pace. In part this reflects increased educational attainment of women, but it appears also to be largely a consequence of enduring economic hardship. The ongoing fertility decline has been accompanied by substantial delays in entry to marriage and childbearing, reflecting adverse economic conditions, which in turn have contributed to continuing declines in fertility.
Mfumu Kihumba, Antoine; Vanclooster, Marnik
Drinking water in Kinshasa, the capital of the Democratic Republic of Congo, is provided by extracting groundwater from the local aquifer, particularly in peripheral areas. The exploited groundwater body is mainly unconfined and located within a continuous detrital aquifer, primarily composed of sedimentary formations. However, the aquifer is subjected to an increasing threat of anthropogenic pollution pressure. Understanding the detailed origin of this pollution pressure is important for sustainable drinking water management in Kinshasa. The present study aims to explain the observed nitrate pollution problem, nitrate being considered as a good tracer for other pollution threats. The analysis is made in terms of physical attributes that are readily available using a statistical modelling approach. For the nitrate data, use was made of a historical groundwater quality assessment study, for which the data were re-analysed. The physical attributes are related to the topography, land use, geology and hydrogeology of the region. Prior to the statistical modelling, intrinsic and specific vulnerability for nitrate pollution was assessed. This vulnerability assessment showed that the alluvium area in the northern part of the region is the most vulnerable area. This area consists of urban land use with poor sanitation. Re-analysis of the nitrate pollution data demonstrated that the spatial variability of nitrate concentrations in the groundwater body is high, and coherent with the fragmented land use of the region and the intrinsic and specific vulnerability maps. For the statistical modeling use was made of multiple regression and regression tree analysis. The results demonstrated the significant impact of land use variables on the Kinshasa groundwater nitrate pollution and the need for a detailed delineation of groundwater capture zones around the monitoring stations. Key words: Groundwater , Isotopic, Kinshasa, Modelling, Pollution, Physico-chemical.
Mbanzulu, Kennedy Makola; Wumba, Roger; Mukendi, Jean-Pierre Kambala; Zanga, Josué Kikana; Shija, Fortunate; Bobanga, Thierry Lengu; Aloni, Michel Ntetani; Misinzo, Gerald
Diseases caused by mosquito-borne viruses are among the most important emerging diseases that threaten human and animal health, particularly in Africa. However, little attention has been paid to these diseases in the Democratic Republic of the Congo (DRC). The present cross-sectional study was undertaken between March and May 2014 to investigate the presence of mosquito-borne viruses in mosquitoes collected from five municipalities of Kinshasa, DRC. Mosquitoes were collected using BG-Sentinel traps and battery-powered aspirators. Female mosquitoes were pooled according to their genera and sampling locations, preserved in RNAlater, and later screened for viruses using reverse transcription PCR (RT-PCR) assays. A total of 2922 mosquitoes were collected and 29 pools of female mosquitoes, containing approximately 30 mosquitoes each, were tested. Twelve of the 29 (41.4%) mosquito pools were found to be infected with at least one arbovirus, with eight (27.5%) pools positive for Alphavirus, nine (31%) for Flavivirus, and five (17.2%) for Bunyaviridae. Chikungunya, o'nyong'nyong, and Rift valley fever viruses were detected. The present study shows that mosquitoes in Kinshasa carry mosquito-borne viruses that may have serious public health implications. Further investigations on the presence of mosquito-borne viruses in the human and livestock populations of Kinshasa and DRC are recommended. Copyright © 2017 The Author(s). Published by Elsevier Ltd.. All rights reserved.
Mpanya, Godéfroid; Tshefu, Antoinette; Likwela, Joris Losimba
The Democratic Republic of Congo (DRC) is one of the two most leading contributors to the global burden of disease due to malaria. This paper describes the malaria testing and treatment market in the nation's capital province of Kinshasa, including availability of malaria testing and treatment and relative anti-malarial market share for the public and private sector. A malaria medicine outlet survey was conducted in Kinshasa province in 2013. Stratified multi-staged sampling was used to select areas for the survey. Within sampled areas, all outlets with the potential to sell or distribute anti-malarials in the public and private sector were screened for eligibility. Among outlets with anti-malarials or malaria rapid diagnostic tests (RDT) in stock, a full audit of all available products was conducted. Information collected included product information (e.g. active ingredients, brand name), amount reportedly distributed to patients in the past week, and retail price. In total, 3364 outlets were screened for inclusion across Kinshasa and 1118 outlets were eligible for the study. Among all screened outlets in the private sector only about one in ten (12.1%) were stocking quality-assured Artemisinin-based Combination Therapy (ACT) medicines. Among all screened public sector facilities, 24.5% had both confirmatory testing and quality-assured ACT available, and 20.2% had sulfadoxine-pyrimethamine (SP) available for intermittent preventive therapy during pregnancy (IPTp). The private sector distributed the majority of anti-malarials in Kinshasa (96.7%), typically through drug stores (89.1% of the total anti-malarial market). Non-artemisinin therapies were the most commonly distributed anti-malarial (50.1% of the total market), followed by non quality-assured ACT medicines (38.5%). The median price of an adult quality-assured ACT was $6.59, and more expensive than non quality-assured ACT ($3.71) and SP ($0.44). Confirmatory testing was largely not available in the private
Background Maternal mortality in Kinshasa is high despite near universal availability of antenatal care and hospital delivery. Possible explanations are poor-quality care and by delays in the uptake of care. There is, however, little information on the circumstances surrounding maternal deaths. This study describes and compares the circumstances of survivors and non survivors of severe obstetric complications. Method Semi structured interviews with 208 women who survived their obstetric complication and with the families of 110 women who died were conducted at home by three experienced nurses under the supervision of EK. All the cases were identified from twelve referral hospitals in Kinshasa after admission for a serious acute obstetric complication. Transcriptions of interviews were analysed with N-Vivo 2.0 and some categories were exported to SPSS 14.0 for further quantitative analysis. Results Testimonies showed that despite attendance at antenatal care, some women were not aware of or minimized danger signs and did not seek appropriate care. Cost was a problem; 5 deceased and 4 surviving women tried to avoid an expensive caesarean section by delivering in a health centre, although they knew the risk. The majority of surviving mothers (for whom the length of stay was known) had the caesarean section on the day of admission while only about a third of those who died did so. Ten women died before the required caesarean section or blood transfusion could take place because they did not bring the money in time. Negligence and lack of staff competence contributed to the poor quality of care. Interviews revealed that patients and their families were aware of the problem, but often powerless to do anything about it. Conclusion Our findings suggest that women with serious obstetric complications have a greater chance of survival in Kinshasa if they have cash, go directly to a functioning referral hospital and have some leverage when dealing with health care staff PMID
Bompangue, Didier; Vesenbeckh, Silvan Manuel; Giraudoux, Patrick; Castro, Marcia; Muyembe, Jean-Jacques; Kebela Ilunga, Benoît; Murray, Megan
Background: Cholera is an endemic disease in certain well-defined areas in the east of the Democratic Republic of Congo (DRC). The west of the country, including the mega-city Kinshasa, has been free of cases since mid 2001 when the last outbreak ended. Methods and Findings: We used routinely collected passive surveillance data to construct epidemic curves of the cholera cases and map the spatio-temporal progress of the disease during the first 47 weeks of 2011. We compared the spatial distribution of disease spread to that which occurred in the last cholera epidemic in Kinshasa between 1996 and 2001. To better understand previous determinants of cholera spread in this region, we conducted a correlation analysis to assess the impact of rainfall on weekly health zone cholera case counts between December 1998 and March 2001 and a Generalized Linear Model (GLM) regression analysis to identify factors that have been associated with the most vulnerable health zones within Kinshasa between October 1998 and June 1999. In February 2011, cholera reemerged in a region surrounding Kisangani and gradually spread westwards following the course of the Congo River to Kinshasa, home to 10 million people. Ten sampled isolates were confirmed to be Vibrio cholerae O1, biotype El Tor, serotype Inaba, resistant to trimethoprim-sulfa, furazolidone, nalidixic acid, sulfisoxaole, and streptomycin, and intermediate resistant to Chloramphenicol. An analysis of a previous outbreak in Kinshasa shows that rainfall was correlated with case counts and that health zone population densities as well as fishing and trade activities were predictors of case counts. Conclusion: Cholera is particularly difficult to tackle in the DRC. Given the duration of the rainy season and increased riverine traffic from the eastern provinces in late 2011, we expect further increases in cholera in the coming months and especially within the mega-city Kinshasa. We urge all partners involved in the response to remain
Ilunga-Ilunga, Félicien; Levêque, Alain; Dramaix, Michèle
The objective of this study was to determine the source of health care funding for heads of households related to the management of severe malaria in children admitted to a Kinshasa reference hospital. This cross-sectional study was conducted on 1,350 hospitalised children under the age of 15 years treated for severe malaria in Kinshasa reference hospitals from January to November 2011 and the heads of households of these children. Only 46% of heads of households reported having sufficient funds directly available in the household budget. The remaining 54% had to call upon external sources of funding (sale of assets, loans, pawning goods). The use of a loan tended to increase significantly mainly for households with a low (adjusted odds ratio = 6.2), and intermediate socioeconomic status (adjusted odds ratio = 3.8) and for households working in the informal sector (adjusted odds ratio = 2.5). Similarly, the sale of assets was more frequently reported for households working in the informal sector (adjusted odds ratio = 2.4) and for female heads of households (adjusted odds ratio = 3.9). The management of severe malaria is a burden on household income. The majority of heads of households concerned needs to use external funding sources. A State subsidy for this management would help to reduce the risk of debt and sale of assets, especially for the poorest households.
Mann, J.M.; Francis, H.; Quinn, T.C.; Bila, K.; Asila, P.K.; Bosenge, N.; Nzilambi, N.; Jansegers, L.; Piot, P.; Ruti, K.; Curran, J.W.
A study of seroprevalence of the human immunodeficiency virus involving 2384 (96%) of Mama Yemo Hospital's (Kinshasa, Zaire) 2492 personnel found 152 (6.4%) to be seropositive. Prevalence was higher among women than among men (8.1% vs 5.2%); in women peak seroprevalence (13.9%) occurred in 20 to 29-year-olds. Workers most likely to be seropositive were those who were relatively young, those who were unmarried, those reporting a blood transfusion or hospitalization during the previous ten years, and those receiving medical injections during the previous three years. Medical, administrative, and manual workers had similar seroprevalence (6.5%, 6.4%, and 6.0%, respectively), and seropositivity was not associated with any measure of patient, blood, or needle contact. These findings are consistent with other hospital-based studies indicating low risks for occupational transmission of human immunodeficiency virus.
Kalongi, Y; Mwanza, K; Tshisuaka, M; Lusiama, N; Ntando, E; Kanzake, L; Shieh, W J; Zaki, S R; Lloyd, E S; Ksiazek, T G; Rollin, P E
A patient with undiagnosed Ebola (EBO) hemorrhagic fever (EHF) was transferred from Kikwit to a private clinic in Kinshasa, Democratic Republic of the Congo. A diagnosis of EHF was suspected on clinical grounds and was confirmed by detection of EBO virus-specific IgM and IgG in serum of the patient. During the course of the disease, although she had no known predisposing factors, the patient developed a periorbital mucormycosis abscess on eyelid tissue that was biopsied during surgical drainage; the abscess was histologically confirmed. Presence of EBO antigen was also detected by specific immunohistochemistry on the biopsied tissue. The patient survived the EBO infection but had severe sequelae associated with the mucormycosis. Standard barrier-nursing precautions were taken upon admission and upgraded when EHF was suspected; there was no secondary transmission of the disease.
Chae, Sophia; Kayembe, Patrick K; Philbin, Jesse; Mabika, Crispin; Bankole, Akinrinola
In the Democratic Republic of Congo, the penal code prohibits the provision of abortion. In practice, however, it is widely accepted that the procedure can be performed to save the life of a pregnant woman. Although abortion is highly restricted, anecdotal evidence indicates that women often resort to clandestine abortions, many of which are unsafe. However, to date, there are no official statistics or reliable data to support this assertion. Our study provides the first estimates of the incidence of abortion and unintended pregnancy in Kinshasa. We applied the Abortion Incidence Complications Method (AICM) to estimate the incidence of abortion and unintended pregnancy. We used data from a Health Facilities Survey and a Prospective Morbidity Survey to determine the annual number of women treated for abortion complications at health facilities. We also employed data from a Health Professionals Survey to calculate a multiplier representing the number of abortions for every induced abortion complication treated in a health facility. In 2016, an estimated 37,865 women obtained treatment for induced abortion complications in health facilities in Kinshasa. For every woman treated in a facility, almost four times as many abortions occurred. In total, an estimated 146,713 abortions were performed, yielding an abortion rate of 56 per 1,000 women aged 15-49. Furthermore, more than 343,000 unintended pregnancies occurred, resulting in an unintended pregnancy rate of 147 per 1,000 women aged 15-49. Increasing contraceptive uptake can reduce the number of women who experience unintended pregnancies, and as a consequence, result in fewer women obtaining unsafe abortions, suffering abortion complications, and dying needlessly from unsafe abortion. Increasing access to safe abortion and improving post-abortion care are other measures that can be implemented to reduce unsafe abortion and/or its negative consequences, including maternal mortality.
Hernandez, Julie H; Akilimali, Pierre; Kayembe, Patrick; Dikamba, Nelly; Bertrand, Jane
While geographic information systems (GIS) are frequently used to research accessibility issues for healthcare services around the world, sophisticated spatial analysis protocols and outputs often prove inappropriate and unsustainable to support evidence-based programme strategies in resource-constrained environments. This article examines how simple, open-source and interactive GIS tools have been used to locate family planning (FP) services delivery points in Kinshasa (Democratic Republic of Congo) and to identify underserved areas, determining the potential location of new service points, and to support advocacy for FP programmes. Using smartphone-based data collection applications (OpenDataKit), we conducted two surveys of FP facilities supported by partner organizations in 2012 and 2013 and used the results to assess gaps in FP services coverage, using both ratio of facilities per population and distance-based accessibility criteria. The cartographic outputs included both static analysis maps and interactive Google Earth displays, and sought to support advocacy and evidence-based planning for the placement of new service points. These maps, at the scale of Kinshasa or for each of the 35 health zones that cover the city, garnered a wide interest from the operational level of the health zones' Chief Medical Officers, who were consulted to contribute field knowledge on potential new service delivery points, to the FP programmes officers at the Ministry of Health, who could use the map to inform resources allocation decisions throughout the city. © The Author 2016. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: firstname.lastname@example.org.
Elongi Moyene, Jean-Pierre; Scheers, Hans; Tandu-Umba, Barthélémy; Haufroid, Vincent; Buassa-Bu-Tsumbu, Baudouin; Verdonck, Fons; Spitz, Bernard; Nemery, Benoit
Preeclampsia is frequent in Kinshasa (Democratic Republic of Congo), especially during the dry season. We tested whether preeclampsia was associated with exposure to environmental metals. Using a case-control design, 88 women hospitalized with preeclampsia (cases) and 88 healthy pregnant women from the antenatal clinic (controls) were included in the study; 67 and 109 women were enrolled during the rainy and dry season, respectively. The concentrations of 24 elements were quantified by inductively coupled plasma mass spectrometry (ICP-MS) in 24-h urine collections. Differences in the urinary excretion of metals were investigated between cases and controls, and the interaction with season was assessed. Cases and controls were well matched regarding age, parity and duration of pregnancy. In controls, the urinary concentrations of most elements were substantially higher than reference values for adults from industrially developed countries, e.g. for lead: geometric mean (GM) 8.0 μg/L [25(th)-75(th) percentile 3.1-13.8]. The daily urinary excretions of 14 metals were significantly higher in women with preeclampsia than in control women, e.g. for lead: GM 61 μg/day (25(th)-75(th) percentile 8-345) in women with preeclampsia vs 9 μg/day (25(th)-75(th) percentile 3-21) in controls (p < 0.001). A significant interaction was found between season and preeclampsia for several elements, with higher urinary excretions in preeclamptic women than controls during the dry season, but not during the rainy season. This study revealed not only that women with preeclampsia excrete higher amounts of several toxic metals, especially lead, than control women, but also that this excretion exhibits seasonal variation, thus possibly explaining the high incidence and seasonal variation of preeclampsia in Kinshasa. Although the exact sources of this exposure are unknown, these findings underscore the need for preventing environmental exposures to lead and other toxic metals.
Makanzu Imwangana, Fils; Dewitte, Olivier; Ntombi, Médard; Moeyersons, Jan
Diachronic mapping (1957, 1967, 2007 and 2010) shows an exponentially growing mega-gully network since roads were constructed through in the forests and plantations which occupied the sandy soils of the high town of Kinshasa. We found that the spatial occurrence of the mega-gullies (width ≥ 5 m) in this newly urbanized environment is controlled by two factors. First, there is a topographic control, given by the relation S = 0.00008A- 1.459, with S being the slope gradient (m m- 1) of the soil surface at the gully head and A the drainage area (ha) above the head. There is also a ‘road’ control, expressed by S = 22.991Lc- 1.999, with Lc being the cumulated length of roads in the basin above the gully head. The co-existence of both controls reflects the fact that the local sands are highly permeable and hence roads are more important generators of continuous runoff. The S-A relation noted above should not be applied outside the town where the road network is less dense. In contrast, the S-Lc relation may be used in both the town and rural areas underlain by porous soils where roads are the only generators of continuous runoff. We further conclude that the high town of Kinshasa is one of the most vulnerable places for gullying, and gullying can potentially transform the town into a badland. ‘Artisanal’ gully treatment is more successful than generally believed and the S-Lc relation can be a tool for mega-gully prevention.
Doudou, Yobi; Renaud, Piarroux; Coralie, L'Ollivier; Jacqueline, Franck; Hypolite, Situakibanza; Hypolite, Muhindo; Patrick, Mitashi; Andreia, Inocêncio da Luz Raquel; Van Sprundel, Marc; Marleen, Boelaert; Van Geertruyden, Jean-Pierre; Pascal, Lutumba
To determine the seroprevalence of toxoplasmosis in pregnant women, as well as the proportion of acutely infected and risk factors in the Democratic Republic of Congo. Thirty maternities in Kinshasa were randomly selected and women attending antenatal consultation were invited to participate. They were interviewed with a structured questionnaire about known risk factors (age, meat consumption, contact with soil, and presence of cat) and a venous blood sample was taken. Sera were analysed for total immunoglobulins (Ig) by VIDAS Toxo Competition using Enzyme Linked Fluorescent Assay. IgM was determined by VIDIA Toxo IgM and IgG avidity by VIDAS Toxo IgG avidity. A total of 781 women were included. Median age was 28 years old (IQR: 8.5). And 627 women (80.3%; 95% CI: 77.5-83.1) were found to be positive to total Ig and 17 out of 387 (4.4%; 95% CI: 2.3-6.4) were positive to IgM. IgG avidity was low for 2 (11.8%) women, intermediate for 2 (11.8%) and high for 13 women (76.4%). There was no statistically significant association between Toxoplasma gondii infection and any risk factors assessed. In Kinshasa, toxoplasmosis endemicity is highly prevalent. One woman out of twenty five had a recent toxoplasmosis infection and 20% were not protected against primo-infection, indicating a need for measures to prevent and control toxoplasmosis during pregnancy. Copyright © 2014 Asian Pacific Tropical Biomedical Magazine. Published by Elsevier B.V. All rights reserved.
Aldersey, Heather M; Turnbull, H Rutherford; Turnbull, Ann P
This article reports results of a 7-month qualitative study on intellectual and related developmental disabilities in Kinshasa, Democratic Republic of the Congo, particularly as they relate to the causes and meaning of intellectual and developmental disabilities (IDD). This study raises important questions related to the understanding of resilience of persons affected by IDD and the nature and purpose of support they use or desire.
De Boeck, H; Lunguya, O; Muyembe, J-J; Glupczynski, Y; Jacobs, J
Extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae are a major public health concern. We previously demonstrated the presence of ESBL-producing Enterobacteriaceae in sachet-packaged water bags sold in Kinshasa, the Democratic Republic of the Congo. In complement to the previous study, we aimed to assess the presence of ESBL-producing Enterobacteriaceae in waste waters in Kinshasa.Enterobacteriaceae isolates recovered from environmental water samples were screened and phenotypically confirmed as ESBL-producers by disk diffusion according to Clinical and Laboratory Standards Institute (CLSI) guidelines (CLSI M100-S21). Final identification to the species level and further antimicrobial susceptibility testing were carried out with MicroScan® NBC42 panels and the identification of bla (ESBL) coding genes was performed by a commercial multiplex ligation polymerase chain reaction (PCR) microarray (Check-Points CT 101, Wageningen, the Netherlands). Overall, 194 non-duplicate Enterobacteriaceae were recovered from several sewer and river sites in nine out of 24 municipalities of Kinshasa. Fourteen isolates (7.4 %) were confirmed as ESBL-producers, the main species being Enterobacter cloacae (46.6 %) and Klebsiella pneumoniae (40.0 %). Associated resistance to both aminoglycoside and fluoroquinolone antibiotics was observed in ten isolates; the remaining isolates showed co-resistance to either fluoroquinolone (n = 3) or to aminoglycoside (n = 1) alone. All but one isolate carried bla (CTX-M) genes belonging to the CTX-M-1 group. ESBL-producing Enterobacteriaceae are increasingly being reported from various sources in the community. The present results suggest that ESBL-producing Enterobacteriaceae are widespread in the environment in the community of Kinshasa. Cities in Central Africa should be added to the map of potentially ESBL-contaminated environments and highlight the need to reinforce safe water supply and public sanitation.
Kamika, Ilunga; Mngqawa, Pamella; Rheeder, John P; Teffo, Snow L; Katerere, David R
Peanut (Arachis hypogaea L.) is an important food crop in sub-Saharan Africa. In this survey, the mycological and aflatoxin contamination of peanuts collected from Kinshasa, Democratic Republic of Congo, and Pretoria, South Africa, was assessed. Twenty peanut samples were purchased randomly at informal markets in the two cities and analysed for mycoflora and aflatoxins (AFB1, AFB2, AFG1 and AFG2) using standard methods. The results indicated that 95% of the Kinshasa samples and 100% of the Pretoria samples were contaminated with aflatoxigenic fungi in the ranges 20-49,000 and 40-21,000 CFU/g, respectively. Seventy-five per cent of the Kinshasa samples and 35% of the Pretoria samples exceeded the maximum limits of AFB1 as set by The Joint FAO/WHO Expert Committee on Food Additives. Residents of both cities are at a high risk of aflatoxin exposure despite their apparent cultural, socio-economic, geographic and climatic differences. Further work needs to be done to understand the supply chains of peanut trade in informal markets of the two countries so that interventions are well targeted on a regional rather than a national level.
Background Cervical cancer is the most frequent cancer of women in the Democratic Republic of Congo (DRC). Nevertheless, the level of women’s awareness about cervical cancer is unknown. Knowledge, attitude and practice (KAP) are important elements for designing and monitoring screening programs. The study purpose was to estimate KAP on cervical cancer and to identify associated factors. Methods A cross-sectional study was conducted in Kinshasa, DRC, including 524 women aged 16–78 years (median age 28; interquartile range 22–35). The women were interviewed at home by trained field workers using a standardized questionnaire. The women’s score on knowledge, attitude and practice were dichotomized as sufficient or insufficient. We used binary and multiple logistic regression to assess associations between obtaining sufficient scores and a series of socio-demographic factors: age, residence, marital status, education, occupation, religion, and parity. Results The women’s score on knowledge was not significantly correlated with their score on practice (Spearman’s rho = 0.08; P > 0.05). Obtaining a sufficient score on knowledge was positively associated with higher education (adjusted odds ratio (OR) 7.65; 95% confidence interval (95% CI) 3.31-17.66) and formal employment (adjusted OR 3.35; 95% CI 1.85-6.09); it was negatively associated with being single (adjusted OR 0.44; 95% CI 0.24-0.81) and living in the eastern, western and northern zone of Kinshasa compared to the city centre. The attitude score was associated with place of residence (adjusted OR for east Kinshasa: 0.49; 95% CI 0.27-0.86 and for south Kinshasa: 0.48; 95% CI 0.27-0.85) and with religion (adjusted OR 0.55; 95% CI 0.35-0.86 for women with a religion other than Catholicism or Protestantism compared to Catholics). Regarding practice, there were negative associations between a sufficient score on practice and being single (adjusted OR 0.24; 95% CI 0.13-0.41) and living in the eastern
Ferrari, Giovanfrancesco; Ntuku, Henry M T; Ross, Amanda; Schmidlin, Sandro; Kalemwa, Didier M; Tshefu, Antoinette K; Lengeler, Christian
There is little data on the risk factors for malaria infection in large cities in central Africa and in all age groups. There may be different associations with the risk factors for areas with different malaria transmission intensities such as the effect of fever or age. This study aimed at identifying risk factors associated with Plasmodium infection and anaemia among children 6-59 months and individuals aged older than 5 years in Kinshasa, a large city with heterogeneity in malaria prevalence. This study analysed data from 3342 children aged 6-59 months from 25 non-rural health zones (HZs) and for 816 individuals aged older than 5 years from two HZs in Kinshasa (non-rural), collected during a cross sectional malaria survey in 2011. Logistic regression with random effects was used to investigate predictors for malaria and anaemia. Differences in risk factors in areas with a prevalence of less than 10 and 10 % or greater were investigated. There was evidence of a different age-pattern in the two transmission settings. For children under 5 years, the highest prevalence of malaria was observed in the 48-59 months group in both transmission settings, but it increased more gently for the lower transmission HZs (p = 0.009). In a separate analysis in children over 5 years in two selected HZs, the peak prevalence was in 5-9 years old in the higher transmission setting and in 15-19 years old in the lower transmission setting. Reported fever was associated with malaria in both transmission strata, with no evidence of a difference in these associations (p = 0.71); however in children older than 5 years there was a significant interaction with a stronger association in the low transmission HZ. Insecticide-treated net (ITN) use was associated with a lower risk of malaria infection in children 6-59 months in the high transmission HZs. Similar estimates were found in children over 5 years and the lower transmission HZ but the associations there were not
Nsambu, Muriel Nzazi; Bazira, Léodegal; Coulibaly, Tiekoura; Mbule, Albert; Wilmet, Michèle Dramaix; Likwela, Joris Losimba
Introduction La République Démocratique du Congo a été considérée comme un pays à circulation rétablie de poliovirus sauvage (PVS). Cet article décrit l’épidémie de PVS qui a sévit dans la province de Kinshasa de 2010 à 2011. Méthodes Les analyses ont porté sur les cas de paralysie flasque aigüe (PFA) enregistrés de décembre 2010 à décembre 2011, les données de surveillance des PFA, les données de couverture vaccinale et celles du monitorage indépendant des activités de vaccination supplémentaires. Résultats Entre décembre 2010 à décembre 2011, 298 cas de PFA ont été enregistrés par les zones de santé parmi lesquels 34 cas de PVS confirmés. 58% des cas de PVS avaient plus de 15 ans avec plus d'hommes que de femmes. 10 passages d'activités de vaccination supplémentaires ont été mis en œuvre dont 4 avaient ciblé toute la population de Kinshasa. Il n'y a plus eu de cas de PVS après le 3e passage. Le monitorage des activités de vaccination a montré une proportion de sujets non vaccinés allant de 4 à 13%. La performance du système de surveillance était globalement bonne. Conclusion La prédominance des adultes parmi les cas notifiés traduit leur susceptibilité alors qu'ils ne sont généralement pas concernés lors des campagnes de vaccination supplémentaires. Ceci devrait engager les autorités sanitaires à envisager des activités vaccinales supplémentaires ciblant les adultes afin de casser plus rapidement la chaîne de transmission. Les faiblesses subsistant dans le système de surveillance pourraient être jugulées par le renforcement de la surveillance à base communautaire. PMID:24062866
Twabela, Augustin Tshibwabwa; Lombe, Boniface Pongombo; Hankanga, Careen
Introduction Rabies is one of the major public health problems mostly affecting developing countries in Africa and Asia where 99.9% of all rabies related human deaths are recorded each year. In Democratic Republic of Congo, repeated outbreaks have been reported. Despite this, there is little reliable epidemiological data about rabies in the country for the development of effective control strategies. Materials and Methods A retrospective study was carried out in Kinshasa Province during a period of five years (2009–2013) to describe the proportion of rabid animals and the species involved in rabies transmission and maintenance. The survey also aimed at describing the spatial-temporal distribution of rabies. To gather information, the daily registers of institutions involved in rabies diagnosis were reviewed and each rabies case was traced back to area of occurrence for collection of geographic coordinates. Results and Discussion A total of 5,053 attacks were registered involving six animal species including dog, cat, monkey, rabbit, rat, and pig. Based on clinical observations, rabies was reported in dogs and cats while data obtained from the laboratory confirmed rabies cases included dogs, cats and a goat. The annual distribution showed a significant decrease of rabies cases from 2009 up to 2011 and a later increase up to 2013. There was no difference in rabies occurrence between seasons (p = 0.721). Rabies cases were three times higher in peri-urban zone than in urban zone OR = 3.4 (95% CI: 2.3–5.1). The positive proportion of rabies was 2.6% (95% CI: 2.1–3) based on clinical evidence and 65.9% (95% CI: 50–79.5) for laboratory confirmed cases. Conclusion and Suggestion This study confirms the endemicity of rabies in Kinshasa where occurrence of rabies cases was related to human population density and lifestyle. In order to control rabies, there is need to set up a surveillance program and implement efficient mass vaccination campaigns of susceptible
Bischoff, K M; Edrington, T S; Callaway, T R; Genovese, K J; Nisbet, D J
To determine the prevalence of antimicrobial resistance among Salmonella isolated from a central Texas dairy calf farm that raises animals for dairy-beef production. Salmonella isolates collected from 50 faecal samples were characterized for susceptibility to 20 antimicrobial agents. Seventy per cent of the faecal samples (35 of 50) tested positive for Salmonella, and high rates of resistance to the following drugs that are commonly used for treatment of bacterial enteritis in livestock were observed: ampicillin (88%), apramycin (83%), neomycin (86%), spectinomycin (91%) and oxytetracycline (90%). No resistance to the fluoroquinolone antibiotics was observed. The most prevalent Salmonella serotype was Kinshasha (22 of 35 samples), followed by Agona (4 of 35), Newport (3 of 35), Infantis (2 of 35), Montevideo (2 of 35), Lille (1 of 35) and Newington (1 of 35). The Kinshasa, Agona, Newport and Infantis serotypes all displayed resistance to ampicillin, chloramphenicol, streptomycin, sulphamethoxazole and tetracycline, and the penta-resistance phenotype was transferable to an Escherichia coli recipient strain. Multi-drug resistant Salmonella in dairy calves pose a costly animal health problem and a potential risk to the public health. This study emphasizes the need for alternative, non-antimicrobial intervention strategies for the control of zoonotic pathogens.
Mfumu Kihumba, Antoine; Vanclooster, Marnik; Ndembo Longo, Jean
This study assessed the vulnerability of groundwater against pollution in the Kinshasa region, DR Congo, as a support of a groundwater protection program. The parametric vulnerability model (DRASTIC) was modified and calibrated to predict the intrinsic vulnerability as well as the groundwater pollution risk. The method uses groundwater body specific parameters for the calibration of the factor ratings and weightings of the original DRASTIC model. These groundwater specific parameters are inferred from the statistical relation between the original DRASTIC model and observed nitrate pollution for a specific period. In addition, site-specific land use parameters are integrated into the method. The method is fully embedded in a Geographic Information System (GIS). Following these modifications, the correlation coefficient between groundwater pollution risk and observed nitrate concentrations for the 2013-2014 survey improved from r = 0.42, for the original DRASTIC model, to r = 0.61 for the calibrated model. As a way to validate this pollution risk map, observed nitrate concentrations from another survey (2008) are compared to pollution risk indices showing a good degree of coincidence with r = 0.51. The study shows that a calibration of a vulnerability model is recommended when vulnerability maps are used for groundwater resource management and land use planning at the regional scale and that it is adapted to a specific area.
Kunuanunua, Thomas S; Nsibu, Célestin N; Bodi, Joseph M; Tshibola, Thérèse K; Makusi Bura, Mimy; Magoga, Kumbundu; Ekila, Mathilde B; Situakibanza, Hypolite T; Aloni, Michel N
The decline of susceptibility of Plasmodium falciparum to chloroquine and sulfadoxine-pyrimethamine resulted in the change of drug policy. This policy has probably changed the facies of the severe form of malaria. A prospective study was conducted in Kinshasa, the Democratic Republic of Congo. Data on children aged ≤13 years, diagnosed with severe malaria were analyzed. In total, 378 children were included with an overall median age of 8 years (age range: 1-13 years). Dark urine was seen in 25.1% of cases. Metabolic acidosis (85.2%), hypoglycemia (62.2%) and hemoglobin ≤5 g/dl (39.1%) were the common laboratories features. Severe malaria anemia, cerebral malaria and Blackwater fever (BWF) were found in 39.1, 30.1 and 25.4%, respectively. Mortality rate was 4%. BWF emerges as a frequent form of severe malaria in our midst. Availing artemisin-based combination treatments in the health care system is a priority to reduce the incidence of BWF in our environment.
Dikassa, L; Mock, N; Magnani, R; Rice, J; Abdoh, A; Mercer, D; Bertrand, W
This study examines the relationship between severe diarrhoeal disease and maternal knowledge and behaviours related to hygiene and sanitation. Some 107 paediatric cases admitted to two hospitals in Kinshasa, Zaire in 1988 were matched on age and nearest-neighbour status to 107 controls. Personal interviews and observational methods were used to assess knowledge and behaviours related to hygiene and sanitation. Cases and controls had equivalent socioeconomic status, demographic profiles and access to water and sanitation facilities. However, cases generally exhibited lower levels of knowledge and less sanguine sanitary practices than did controls. Of particular interest was the finding that very specific behavioural items distinguished cases from controls. The disposal of the child faeces and household garbage and mother's knowledge that poor caretaker cleanliness was a cause of diarrhoea in children showed the strongest associations with risk of diarrhoea. There was an exponential relationship between the number of these items a mother answered incorrectly and the odds of diarrhoeal disease. The risk attributable to these three variables was as high as 70%. These findings provide further support for the view that focused educational interventions may have a substantial impact on the occurrence of severe diarrhoeal disease in low-income countries.
Yang, Chunfu; Li, Ming; Mokili, John L K; Winter, Jorn; Lubaki, Ndongala M; Mwandagalirwa, Kashamuka M; Kasali, Mwamba J; Losoma, Atibu J; Quinn, Thomas C; Bollinger, Robert C; Lal, Renu B
As the HIV-1 pandemic becomes increasingly complex, the genetic characterization of HIV strains bears important implications for vaccine research. To better understand the molecular evolution of HIV-1 viral diversity, we performed a comparative molecular analysis of HIV strains collected from high-risk persons in Kinshasa, Democratic Republic of Congo (DRC). Analysis of the gag-p24, env-C2V3 and -gp41 regions from 83 specimens collected in 1999-2000 revealed that 44 (53%) had concordant subtypes in the three regions (14 subsubtype A1, 10 subtype G, 8 subtype D, 5 subtype C, 2 each subsubtype F1 and CRF01_AE, and one each of subtypes H and J, and subsubtype A2, while the remaining 39 (47%) had mosaic genomes comprising multiple subtype combinations. Similar multisubtype patterns were also observed in 24 specimens collected in 1985. Sequence analysis of the gag-pol region (2.1 kb) from 21 discordant specimens in the gag-p24, env-C2V3 and -gp41 regions in 1985 and 1999-2000 further confirmed the complex recombinant patterns. Despite the remarkable similarity in overall subtype distribution, the intra- and intersubtype distances of major subtypes A1 and G increased significantly from 1985 to 1999-2000 (p=0.018 and p=0.0016, respectively). Given the complexity of HIV-1 viruses circulating in DRC, efforts should focus on the development of vaccines that result in cross-clade immunity.
Parker, L.; Maman, S.; Pettifor, A.; Chalachala, J. L.; Edmonds, A.; Golin, C. E.; Moracco, K.; Behets, F.
We evaluated the feasibility of a Positive Prevention intervention adapted for youth living with HIV/AIDS (YLWH) ages 15-24 in Kinshasa, Democratic Republic of the Congo. We conducted in-depth interviews and focus group discussions with intervention facilitators and YLWH participants on the following four areas of a feasibility framework:…
Kabongo Kamitalu, Ramsès; Aloni, Michel Ntetani
Aim. To assess the self-medication against malaria infection in population of Congolese students in Kinshasa, Democratic Republic of Congo (DRC). Methods. A cross-sectional study was carried out in University of Kinshasa, Kinshasa, Democratic Republic of Congo. Medical records of all students with malaria admitted to Centre de Santé Universitaire of University of Kinshasa from January 1, 2008, to April 30, 2008, were reviewed retrospectively. Results. The median age of the patients was 25.4 years (range: from 18 to 36 years). The majority of them were male (67.9%). Artemisinin-based combination treatments (ACTs) was the most used self-prescribed antimalarial drugs. However, self-medication was associated with the ingestion of quinine in 19.9% of cases. No case of ingestion of artesunate/artemether in monotherapy was found. All the medicines taken were registered in DRC. In this series, self-prescribed antimalarial was very irrational in terms of dose and duration of treatment. Conclusion. This paper highlights self-medication by a group who should be aware of malaria treatment protocols. The level of self-prescribing quinine is relatively high among students and is disturbing for a molecule reserved for severe disease in Congolese health care policy in management of malaria. PMID:27340411
Kabongo Kamitalu, Ramsès; Aloni, Michel Ntetani
Aim. To assess the self-medication against malaria infection in population of Congolese students in Kinshasa, Democratic Republic of Congo (DRC). Methods. A cross-sectional study was carried out in University of Kinshasa, Kinshasa, Democratic Republic of Congo. Medical records of all students with malaria admitted to Centre de Santé Universitaire of University of Kinshasa from January 1, 2008, to April 30, 2008, were reviewed retrospectively. Results. The median age of the patients was 25.4 years (range: from 18 to 36 years). The majority of them were male (67.9%). Artemisinin-based combination treatments (ACTs) was the most used self-prescribed antimalarial drugs. However, self-medication was associated with the ingestion of quinine in 19.9% of cases. No case of ingestion of artesunate/artemether in monotherapy was found. All the medicines taken were registered in DRC. In this series, self-prescribed antimalarial was very irrational in terms of dose and duration of treatment. Conclusion. This paper highlights self-medication by a group who should be aware of malaria treatment protocols. The level of self-prescribing quinine is relatively high among students and is disturbing for a molecule reserved for severe disease in Congolese health care policy in management of malaria.
Kinkenda, K N; Lusanga, N; Mbanzulu, N; Yanga, K
All cases of maternal mortality occurring at the University Clinic of Mont Amba in Kinshasa, Zaire, between 1961 and 1980 were analyzed. 20 of the 60 records of maternal deaths were excluded from the study for technical reasons, but the maternal mortality rates were calculated on the basis of all deaths. The highest rate of 197.53/100,000 live births occurred in 1961. The lowest rate, 35.76/100,000 live births, occurred in 1976. The maternal mortality rate for the entire series was 68.58/100,000 live births. Of the 40 women included, 5 were under 20 years old, 11 were 20-29, 18 were 30-39, and 6 were 40-49 years old. 30 of the women were from lower and 10 from higher socioeconomic level backgrounds. 8 were nulliparas, 9 had had few births, 8 were multiparas, and 13 were grand multiparas. 1 death occurred during pregnancy, 4 during labor, 30 postpartum, 3 during a cesarean, and 2 during a laparotomy for uterine rupture. The cause of death was hemorrhage in 14 cases, infection in 6 cases, vascular accident in 6 cases, anesthetic accident in 4 cases, acute pulmonary edema in 3 cases, hepatitis in 1 case, and bronchial pneumonia in 1 case. 85% of the deaths appear to have been avoidable; only the 6 deaths from vascular accidents were judged unavoidable. The maternal mortality rate was probably lower than those registered in developing countries in general because it included only obstetrical deaths in a university teaching hospital. 7 of the deaths from hemorrhage were due to uterine rupture. 3 of the deaths from vascular accidents were due of thromboembolism, 2 to amniotic embolism, and 1 to pulmonary embolism. 12 of the women died after a cesarean.
Iyamba, Jean-Marie Liesse; Wambale, José Mulwahali; Lukukula, Cyprien Mbundu; za Balega Takaisi-Kikuni, Ntondo
Surgical site infections (SSIs) after surgery are usually caused by Staphylococcus aureus and coagulase-negative staphylococci (CNS). In low income countries, methicillin resistant Staphylococcus aureus (MRSA) and methicillin resistant coagulase-negative staphylococci (MR-CNS) surgical site infections are particularly associated with high treatment cost and remain a source of mortality and morbidity. This study aimed to determine the prevalence and the sensitivity to antibiotics of MRSA and MR-CNS isolated from SSIs. Wound swabs were collected from 130 hospitalized surgical patients in two major hospitals of Kinshasa. S. aureus and CNS strains were identified by standard microbiological methods and latex agglutination test (Pastorex Staph-Plus). The antibiotic susceptibility of all staphylococcal strains was carried out using disk-diffusion method. Eighty nine staphylococcal strains were isolated. Out of 74 S. aureus and 15 CNS isolated, 47 (63.5%) and 9 (60%) were identified as MRSA and MR-CNS respectively. Among the MRSA strains, 47 strains (100%) were sensitive to imipenem, 39 strains (89%) to amoxycillin-clavulanic acid and 38 strains (81%) to vancomycin. All MR-CNS were sensitive to imipenem, amoxycillin-clavulanic acid and vancomycin. The isolated MRSA and MR-CNS strains showed multidrug resistance. They were both resistant to ampicillin, cotrimoxazole, erythromycin, clindamycin, ciprofloxacin, cefotaxime and ceftazidime. The results of the present study showed a high prevalence of MRSA and MR-CNS. Imipenem, amoxycillin-clavulanic acid and vancomycin were the most active antibiotics. This study suggests that antibiotic surveillance policy should become national priority as MRSA and MR-CNS were found to be multidrug resistant.
Kika, TM; Kintoki, EV; M’Buyamba-Kabangu, JR; Lepira, FB; Makulo, JR; Sumaili, EK; Kayembe, PK
Summary Background Uncontrolled hypertension remains an important issue in daily clinical practice worldwide. Although the majority of patients are treated in primary care, most of the data on blood pressure control originate from populationbased studies or secondary healthcare. Objective The aim of this study was to evaluate the frequency of uncontrolled hypertension and associated risk factors among hypertensive patients followed at primary care facilities in Kinshasa, the capital city of Democratic Republic of the Congo. Methods A sample of 298 hypertensive patients seen at primary healthcare facilities, 90 men and 208 women, aged ≥ 18 years, were consecutively included in this cross-sectional study. The majority (66%) was receiving monotherapy, and diuretics (43%) were the most used drugs. According to 2007 European Society of Hypertension/European Society of Cardiology hypertension guidelines, uncontrolled hypertension was defined as blood pressure ≥ 140/90 or ≥ 130/80 mmHg (diabetes or chronic kidney disease). Logistic regression analysis was used to identify the determinants of uncontrolled hypertension. Results Uncontrolled hypertension was observed in 231 patients (77.5%), 72 men and 159 women. Uncontrolled systolic blood pressure (SBP) was more frequent than uncontrolled diastolic blood pressure (DBP) and increased significantly with advancing age (p = 0.002). The proportion of uncontrolled SBP and DBP was significantly higher in patients with renal failure (p = 0.01) and those with high (p = 0.03) to very high (p = 0.02) absolute cardiovascular risk. The metabolic syndrome (OR 2.40; 95% CI 1.01–5.74; p = 0.04) emerged as the main risk factor associated with uncontrolled hypertension. Conclusion Uncontrolled hypertension was common in this case series and was associated with factors related to lifestyle and diet, which interact with blood pressure control. PMID:27965999
Iyamba, Jean-Marie Liesse; Wambale, José Mulwahali; Lukukula, Cyprien Mbundu; Takaisi-Kikuni, Ntondo za Balega
Introduction Surgical site infections (SSIs) after surgery are usually caused by Staphylococcus aureus and coagulase-negative staphylococci (CNS). In low income countries, methicillin resistant Staphylococcus aureus (MRSA) and methicillin resistant coagulase-negative staphylococci (MR-CNS) surgical site infections are particularly associated with high treatment cost and remain a source of mortality and morbidity. This study aimed to determine the prevalence and the sensitivity to antibiotics of MRSA and MR-CNS isolated from SSIs. Methods Wound swabs were collected from 130 hospitalized surgical patients in two major hospitals of Kinshasa. S. aureus and CNS strains were identified by standard microbiological methods and latex agglutination test (Pastorex Staph-Plus). The antibiotic susceptibility of all staphylococcal strains was carried out using disk-diffusion method. Results Eighty nine staphylococcal strains were isolated. Out of 74 S. aureus and 15 CNS isolated, 47 (63.5%) and 9 (60%) were identified as MRSA and MR-CNS respectively. Among the MRSA strains, 47 strains (100%) were sensitive to imipenem, 39 strains (89%) to amoxycillin-clavulanic acid and 38 strains (81%) to vancomycin. All MR-CNS were sensitive to imipenem, amoxycillin-clavulanic acid and vancomycin. The isolated MRSA and MR-CNS strains showed multidrug resistance. They were both resistant to ampicillin, cotrimoxazole, erythromycin, clindamycin, ciprofloxacin, cefotaxime and ceftazidime. Conclusion The results of the present study showed a high prevalence of MRSA and MR-CNS. Imipenem, amoxycillin-clavulanic acid and vancomycin were the most active antibiotics. This study suggests that antibiotic surveillance policy should become national priority as MRSA and MR-CNS were found to be multidrug resistant. PMID:25478043
Kashala-Abotnes, Espérance; Mumbere, Pépé Penghele; Mishika, Jeannette Mukanya; Ndjukendi, Ally Omba; Mpaka, Davin Beya; Bumoko, Makila-Mabe Guy; Kayembe, Tharcisse Kalula; Tshala-Katumbay, Désiré; Kazadi, Théodore Kayembe; Okitundu, Daniel Luwa E-Andjafono
Childhood lead exposure remains a problem in developing countries, and little is known about its effects on early child neurodevelopment and temperament in the Democratic Republic of Congo (DRC). We, therefore, conducted this study to determine the association between lead exposure and the neurodevelopment and behaviour of children aged 12-24 months in Kinshasa, DRC. A cross-sectional study was conducted between February and June 2012, and parents of 104 children were invited to participate. Blood lead levels (BLLs) of each child were tested using the flame atomic spectrophotometry method. All children were subject to a clinical examination and assessed with two selected early child neurodevelopmental tools, the Gensini-Gavito and the baby characteristics questionnaire, to measure their neurodevelopment and temperament. Detectable BLLs ranged from 1 to 30 μg/dl with a geometric mean of 6.9 (SD 4.8) μg/dl. BLLs at 5-9 and ≥10 μg/dl were significantly associated with the child temperament (p <0.05). Perinatal and maternal factors did not seem to affect early child neurodevelopment and temperament. Children exposed to lead were reported with more temperament difficulties at even blood lead levels <10 μg/dl, suggesting the need for preventive and intervention measures to reduce lead exposure among children in Kinshasa, DRC.
Mwandagalirwa, Kashamuka; Jackson, Elizabeth F.; McClamroch, Kristi; Ryder, Robert W.; Weir, Sharon S.
Background This study compares the sexual behavior and HIV prevalence of men and women at social venues where people meet new sexual partners in Eastern Kinshasa with the HIV prevalence and behavior of STI treatment and antenatal clinic patients in the same area. Methods ANC clinic patients, STI clinic patients and social venue patrons were interviewed, asked to provide a blood sample onsite, and provided information about obtaining test results. All social venue patrons at all identified social venues in the study area were invited to participate. Results 1,116 pregnant women; 66 male and 229 female STI clinic patients; and 952 male and 247 female patrons of social venues were interviewed and tested. HIV prevalence ranged by group: ANC patients (4%); female venue patrons (12%); female STI patients (16%); male venue patrons (2%); and male STI patients (23%). HIV prevalence among sexworkers at social venues (29%) was higher than the prevalence among other female patrons with new or multiple partnerships (19%) or among female patrons denying sexwork (6%). However, the absolute number of infected women was higher among women reporting recent new or multiple partnerships than the smaller group of sexworkers (23 vs 18). Two-thirds of the infected female STI patients (24/36) reported no more than one sexual partner in the past year. Conclusion Improving prevention programs in Kinshasa is essential. Prevention efforts should not neglect women at social venues who do not self-identify as sexworkers but have high rates of new sexual partnerships. PMID:19525891
Vallès, Xavier; Lusala, Patrick Lunzayiladio; Devalière, Hortense; Metsia-Thiam, Marie-Michele; Aguilar, Daniel; Cheyron, Anne-Laure; Cannet, Didier
The aim of the study was to ascertain the influence of knowledge and interventions in sexual and reproductive health and contraception practices among adolescent street girls from Kinshasa, Democratic Republic of the Congo. A cross-sectional study was carried out among street girls between 12 and 21 years of age. A standardised questionnaire was used, encompassing socio-demographic data and knowledge and practices regarding sexual and reproductive health. A network analysis was carried out. The study comprised 293 street girls. The mean age was 17.1 years (range 12-21 years) and the mean time spent living on the streets was 3.9 years (range 0-15 years). Commercial sex was reported by 78.5% (95% confidence interval [CI] 73.3%, 83.2%) as the main source of their income. During their last sexual intercourse, 44.0% (95%CI 38.1%, 50.4%) had not used a condom; 29.3% (95%CI 23.3%, 35.9%) had used hormonal contraception. Previous pregnancy was reported by 62.5% (95%CI 56.7%, 68.3%) and current pregnancy by 12.3% (95%CI 8.8%, 17.2%); 24.5% of previous pregnancies ended in voluntary termination, with a higher rate among the youngest street girls (12-15 years, 50.0%; p = 0.01). Time spent living on the streets was independently associated with pregnancy (odds ratio 1.2; 95%CI 1.1, 1.4). Practices and outcomes (previous or current pregnancy) were poorly correlated with knowledge about sexual and reproductive health. The network analysis confirmed the poor influence of exposure to intervention activities on sexual and reproductive health practices and outcomes, but did confirm a centrality effect of knowledge about HIV/AIDS. Street girls in Kinshasa are extremely vulnerable with regard to their sexual and reproductive health, especially the youngest street girls. Behavioural and biomedical interventions have had limited influence. Structural and societal changes are necessary to positively impact street girls' sexual and reproductive health. Knowledge about HIV/AIDS than
Mfumu Kihumba, Antoine; Ndembo Longo, Jean; Vanclooster, Marnik
A multivariate statistical modelling approach was applied to explain the anthropogenic pressure of nitrate pollution on the Kinshasa groundwater body (Democratic Republic of Congo). Multiple regression and regression tree models were compared and used to identify major environmental factors that control the groundwater nitrate concentration in this region. The analyses were made in terms of physical attributes related to the topography, land use, geology and hydrogeology in the capture zone of different groundwater sampling stations. For the nitrate data, groundwater datasets from two different surveys were used. The statistical models identified the topography, the residential area, the service land (cemetery), and the surface-water land-use classes as major factors explaining nitrate occurrence in the groundwater. Also, groundwater nitrate pollution depends not on one single factor but on the combined influence of factors representing nitrogen loading sources and aquifer susceptibility characteristics. The groundwater nitrate pressure was better predicted with the regression tree model than with the multiple regression model. Furthermore, the results elucidated the sensitivity of the model performance towards the method of delineation of the capture zones. For pollution modelling at the monitoring points, therefore, it is better to identify capture-zone shapes based on a conceptual hydrogeological model rather than to adopt arbitrary circular capture zones.
Katabuka, M; Mafuta, M E; Ngoma, A M; Beya, P Mutombo; Yuma, S; Aketi, L; Kayembe, K P; Gini, J R
To determine seroprevalence of hepatitis C virus (HCV), human immunodeficiency virus (HIV), and hepatitis B virus (HBV) and associated factors among transfused children. A multicenter cross-sectional study of transfused children aged between 18 mo and 13 y old was conducted in 4 hospitals in Kinshasa. Blood samples were collected for the detection of Hepatitis B surface antigen (HBsAg) and antibodies to HCV, HIV 1 and 2. A total of 177 (47.7 %) boys and 194 (52.3 %) girls participated in the study. The median age was 59.5 mo (Interquartile range IQR = 60.6). The prevalence rates of HCV, HBV, and HIV infection were 13.5 %, 1.6 %, and 1.3 %, respectively. Frequency of transfusion events were significantly associated with HCV (p < 0.001) and HIV (p < 0.05) infections. HCV infection was by far more frequently identified than HBV and HIV infections among Congolese transfused children. Frequency of transfusion events was the only significant risk factor associated with HCV and HIV infections but not for HBV.
Rimoin, A W; Hoff, N A; Djoko, C F; Kisalu, N K; Kashamuka, M; Tamoufe, U; LeBreton, M; Kayembe, P K; Muyembe, J J; Kitchen, C R; Saylors, K; Fair, J; Doshi, R; Papworth, E; Mpoudi-Ngole, E; Grillo, M P; Tshala, F; Peeters, M; Wolfe, N D
Despite recent declines in HIV incidence, sub-Saharan Africa remains the most heavily affected region in the global HIV/AIDS epidemic. Estimates of HIV prevalence in African military personnel are scarce and inconsistent. We conducted a serosurvey between June and September 2007 among 4043 Armed Forces personnel of the Democratic Republic of Congo (FARDC) stationed in Kinshasa, Democratic Republic of Congo (DRC) to determine the prevalence of HIV and syphilis infections and describe associated risk behaviours. Participants provided blood for HIV and syphilis testing and responded to a demographic and risk factor questionnaire. The prevalence of HIV was 3.8% and the prevalence of syphilis was 11.9%. Women were more likely than men to be HIV positive, (7.5% vs. 3.6% respectively, aOR: 1.66, 95% C.I: 1.21-2.28, p < 0.05). Factors significantly associated with HIV infection included gender and self-reported genital ulcers in the 12 months before date of enrollment. The prevalence of HIV in the military appears to be higher than the general population in DRC (3.8% vs. 1.3%, respectively), with women at increased risk of infection.
Behets, Frieda Mtf; Matendo, Richard; Vaz, Lara Me; Kilese, Nick; Nanlele, Diderot; Kokolomami, Jack; Okitolando, Emile W.; Van Rie, Annelies
OBJECTIVE: To assess the content and delivery of essential antenatal services before implementation of programmes for prevention of mother-to-child transmission (PMTCT) of human immunodeficiency virus (HIV). METHODS: We assessed 18 antenatal care centres (eight public units and ten managed by nongovernmental organizations) in Kinshasa, Democratic Republic of the Congo. We used a survey to capture information about the number and type of antenatal health workers, infrastructure capacity and the delivery of basic antenatal care services such as: nutritional counselling; tetanus toxoid vaccination; prevention and management of anaemia, malaria, sexually transmitted infections, and tuberculosis; and counselling for postpartum contraception. FINDINGS: Antenatal care units differed with respect to size, capacity, cost, service delivery systems and content. For instance, 17 of the 18 sites offered anaemia screening but only two sites included the cost in the card that gives access to antenatal care. Nine of the clinics (50%) reported providing the malaria prophyalxis sulfadoxine pyrimethamine as per national policy. Four (22%) of the sites offered syphilis screening. CONCLUSION: Scaling up PMTCT programmes in under-resourced settings requires evaluation and strengthening of existing basic antenatal care service delivery. PMID:17242833
Kibadi, K; Portaels, F; Pichot, Y; Kapinga, M; Moutet, F
Democratic Republic of Congo (DRC), a particular form of juvenile delinquency and insecurity intensifies in the city of Kinshasa. This is the phenomenon Kuluna. It is organized gangs equipped with machetes and other weapons. The main objective of this study is to know the phenomenon Kuluna and describe the upper limb injuries caused by machetes, while insisting on the specifics of the management of these lesions in our communities. This retrospective descriptive study examines 14 cases of wounds of the hand and forearm due to stab phenomenon Kuluna, in Kinshasa. It covers the period from 1 November 2010 to 1 November 2013. Among the 14 patients with lesions in the hand and forearm admitted and treated at the Unit of Plastic Reconstructive and Aesthetic Surgery, Hand Surgery and Burns, University Clinics of Kinshasa to attacks due to the phenomenon Kuluna. We have 11 men and 3 women. The average age was 33, 5 years (extremes of 21 and 56 years). The right upper limb is reached that the left upper limb, respectively 12 patients and 2 patients. The lesions are localized to the wrist in the majority of cases (10 patients) in the palm of hand and in 3 patients in the fingers in 1 patient. The palmar surface is reached (10 cases) and the dorsal (4 cases). Zone 5 of the International Classification of flexor and Zone 8 topographic classification extensors at hand are the predilection sites of lesions respectively the palmar surface (6 out of 10) and the dorsal (2 case 4). The median nerve at the wrist is cut in half the cases. On bone lesions localized to the forearm, we observed a high incidence of fracture of the ulna (62.5%). The treatment begins with the stabilization of bone pieces, gestures revascularization and nerve sutures and suture tendon and finally skin coverage. Rehabilitation was mandatory, she supervises the actions of repair and it continues until the recovery of function.
Kayembe, Patrick; Babazadeh, Saleh; Dikamba, Nelly; Akilimali, Pierre; Hernandez, Julie; Binanga, Arsene; Bertrand, Jane T
Modern contraceptive prevalence was 14.1% in 2007 in Kinshasa, the capital city of the Democratic Republic of the Congo (DRC). Yet virtually nothing was known about the family planning supply environment. Three surveys of health facilities were conducted in 2012, 2013, and 2014 to determine the number, spatial distribution, and attributes of sites providing family planning services. The 2012 and 2013 surveys aimed to identify the universe of family planning facilities while obtaining a limited set of data on "readiness" to provide family planning services (defined as having at least 3 modern methods, at least 1 person training in family planning in the last 3 years, and an information system to track distribution of products to clients) and output (measured by couple-years of protection, or CYP). In contrast, the 2014 survey, conducted under the umbrella of the Performance Monitoring and Accountability 2020 (PMA2020) project, was based on 2-stage cluster sampling. This article provides detailed analysis of the 2012 and 2013 surveys, including bivariate and multivariate analysis of correlates of readiness to provide services and of output. We identified 184 health facilities that reported providing at least 1 contraceptive method in 2012 and 395 facilities in 2013. The percentage of sites defined as "ready" to provide services increased from 44.1% in 2012 to 63.3% in 2013. For the 3-month period between January and March 2013, facilities distributed between 0 and 879.2 CYP (mean, 39.7). Nearly half (49%) of the CYP was attributable to implants, followed by IUDs (24%), CycleBeads (11%), and injectables (8%). In 2013, facilities supported by PEPFAR (n = 121) were more likely than other facilities to be rated as ready to provide services (P<.0001); however, PEPFAR-supported sites generated less CYP on average than sites supported by family planning implementing agencies (P<.0001). Multivariate analysis showed 3 variables were associated with CYP: type of health
Kayembe, Patrick; Babazadeh, Saleh; Dikamba, Nelly; Akilimali, Pierre; Hernandez, Julie; Binanga, Arsene; Bertrand, Jane T
Background: Modern contraceptive prevalence was 14.1% in 2007 in Kinshasa, the capital city of the Democratic Republic of the Congo (DRC). Yet virtually nothing was known about the family planning supply environment. Methods: Three surveys of health facilities were conducted in 2012, 2013, and 2014 to determine the number, spatial distribution, and attributes of sites providing family planning services. The 2012 and 2013 surveys aimed to identify the universe of family planning facilities while obtaining a limited set of data on “readiness” to provide family planning services (defined as having at least 3 modern methods, at least 1 person training in family planning in the last 3 years, and an information system to track distribution of products to clients) and output (measured by couple-years of protection, or CYP). In contrast, the 2014 survey, conducted under the umbrella of the Performance Monitoring and Accountability 2020 (PMA2020) project, was based on 2-stage cluster sampling. This article provides detailed analysis of the 2012 and 2013 surveys, including bivariate and multivariate analysis of correlates of readiness to provide services and of output. Results: We identified 184 health facilities that reported providing at least 1 contraceptive method in 2012 and 395 facilities in 2013. The percentage of sites defined as “ready” to provide services increased from 44.1% in 2012 to 63.3% in 2013. For the 3-month period between January and March 2013, facilities distributed between 0 and 879.2 CYP (mean, 39.7). Nearly half (49%) of the CYP was attributable to implants, followed by IUDs (24%), CycleBeads (11%), and injectables (8%). In 2013, facilities supported by PEPFAR (n = 121) were more likely than other facilities to be rated as ready to provide services (P<.0001); however, PEPFAR-supported sites generated less CYP on average than sites supported by family planning implementing agencies (P<.0001). Multivariate analysis showed 3 variables were
Lusey, Hendrew; San Sebastian, Miguel; Christianson, Monica; Dahlgren, Lars; Edin, Kerstin E
Masculinity studies are fairly new and young churchgoers are an under-researched group in the current Congolese church context. In response to this knowledge gap, this paper attempts to explore discourses of young churchgoers from deprived areas of Kinshasa regarding masculinity and sexuality in the era of HIV. A series of 16 semi-structured interviews were conducted with unmarried young churchgoers from the Salvation Army, Protestant and Revival churches. The interviews were tape-recorded, transcribed verbatim and analysed using discourse analysis. Five main discourses emerged: 'we are aware of the church message on sex', 'young men need sex', 'young women need money', 'to use or not to use condoms' and 'we trust in the church message'. Although all informants knew and heard church messages against premarital sex, many of them were sexually active. The perception was that young men were engaged in sexual activities with multiple partners as a result of sexual motivations surrounding masculinity and sexual potency, while young women sought multiple partners through transactional and intergenerational sex for economic reasons. These sexual practices of young people conflicted with church messages on sexual abstinence and faithfulness. However, a small number of participants challenged current gender norms and suggested alternative ways of being a man or a woman. To elucidate these alternatives, we suggest that church youths and church leaders might take concrete actions to deconstruct misconceptions about being men. In this way, they can possibly enhance a frank and fruitful dialogue on sex, sexuality and gender to promote positive masculinities and constructive partnerships to prevent HIV.
Lusey, Hendrew; San Sebastian, Miguel; Christianson, Monica; Dahlgren, Lars; Edin, Kerstin E.
Abstract Masculinity studies are fairly new and young churchgoers are an under-researched group in the current Congolese church context. In response to this knowledge gap, this paper attempts to explore discourses of young churchgoers from deprived areas of Kinshasa regarding masculinity and sexuality in the era of HIV. A series of 16 semi-structured interviews were conducted with unmarried young churchgoers from the Salvation Army, Protestant and Revival churches. The interviews were tape-recorded, transcribed verbatim and analysed using discourse analysis. Five main discourses emerged: ‘we are aware of the church message on sex’, ‘young men need sex’, ‘young women need money’, ‘to use or not to use condoms’ and ‘we trust in the church message’. Although all informants knew and heard church messages against premarital sex, many of them were sexually active. The perception was that young men were engaged in sexual activities with multiple partners as a result of sexual motivations surrounding masculinity and sexual potency, while young women sought multiple partners through transactional and intergenerational sex for economic reasons. These sexual practices of young people conflicted with church messages on sexual abstinence and faithfulness. However, a small number of participants challenged current gender norms and suggested alternative ways of being a man or a woman. To elucidate these alternatives, we suggest that church youths and church leaders might take concrete actions to deconstruct misconceptions about being men. In this way, they can possibly enhance a frank and fruitful dialogue on sex, sexuality and gender to promote positive masculinities and constructive partnerships to prevent HIV. PMID:25000272
Background Although breastfeeding is almost universally accepted in the Democratic Republic (DR) of Congo, by the age of 2 to 3 months 65% of children are receiving something other than human milk. We sought to describe the infant feeding practices and determinants of suboptimal breastfeeding behaviors in DR Congo. Methods Survey questionnaire administered to mothers of infants aged ≤ 6 months and healthcare providers who were recruited consecutively at six selected primary health care facilities in Kinshasa, the capital. Results All 66 mothers interviewed were breastfeeding. Before initiating breastfeeding, 23 gave their infants something other than their milk, including: sugar water (16) or water (2). During the twenty-four hours prior to interview, 26 (39%) infants were exclusively breastfed (EBF), whereas 18 (27%), 12 (18%), and 10 (15%) received water, tea, formula, or porridge, respectively, in addition to human milk. The main reasons for water supplementation included “heat” and cultural beliefs that water is needed for proper digestion of human milk. The main reason for formula supplementation was the impression that the baby was not getting enough milk; and for porridge supplementation, the belief that the child was old enough to start complementary food. Virtually all mothers reported that breastfeeding was discussed during antenatal clinic visit and half reported receiving help regarding breastfeeding from a health provider either after birth or during well-child clinic visit. Despite a median of at least 14 years of experience in these facilities, healthcare workers surveyed had little to no formal training on how to support breastfeeding and inadequate breastfeeding-related knowledge and skills. The facilities lacked any written policy about breastfeeding. Conclusion Addressing cultural beliefs, training healthcare providers adequately on breastfeeding support skills, and providing structured breastfeeding support after maternity discharge is
Kintoki Mbala, F; Longo-Mbenza, B; Mbungu Fuele, S; Zola, N; Motebang, D; Nakin, V; Lueme Lokotola, C; Simbarashe, N; Nge Okwe, A
The significant impact of seasonality and climate change on stroke-related morbidity and mortality is well established, however, some findings on this issue are conflicting. The objective was to determine the impact of gender, age, season, year of admission, temperature, rainfall and El Nino phenomenon on ischemic and hemorrhagic strokes and fatal cases of stroke. The study was carried out at the teaching hospital of Kinshasa, DRC, between January 1998 and December 2004. Rainy and dry seasons, elevated temperatures, indices of rainfalls El Nino years 1998, 2002 and 2004, but La Nina years 1999-2000 and neutral/normal years 2001 and 2003 were defined. Among 470 incident strokes, 34.5% of victims (n=162) died. Traditional seasons (small dry season, small rainy season, great dry season, great rainy season) and temperatures did not significantly (P>0.005) impact on stroke incidence. However, there was a positive association between the decrease in rainfall, El Nino, and incident ischemic strokes, but a significant positive association between the increase in rainfall, La Nina, and incident hemorrhagic strokes. Using logistic regression analysis, age ≥ 60 years (OR: 1.7, 95% CI: 1.2-2.5; P=0.018) and El Nino years (OR: 2, 95% CI: 1.2-3.3; P=0.009) were identified as the independent predictors of fatal strokes. Early warning systems should be developed to predict the impact of seasons and climate variability on stroke morbidity and mortality. Copyright © 2016 Elsevier Masson SAS. All rights reserved.
Buhendwa, Rudahaba Augustin; Roelants, Mathieu; Thomis, Martine; Nkiama, Constant E
The last study to establish centiles of main anthropometric measurements in Kinshasa was conducted over 60 years ago, which questions its current adequacy to describe or monitor growth in this population. To assess the nutritional status of school-aged children and adolescents and to estimate centile curves of height, weight and body mass index (BMI). A representative sample of 7541 school-aged children and adolescents (48% boys) aged 6-18 years was measured between 2010-2013. Smooth centiles of height, weight and BMI-for-age were estimated with the LMS method and compared with the WHO 2007 reference. Nutritional status was assessed by comparing measurements of height and BMI against the appropriate WHO cut-offs. Compared to the WHO reference, percentiles of height and BMI were generally lower. This difference was larger in boys than in girls and increased as they approached adolescence. The prevalence of short stature (< -2 SD) and thinness (< -2 SD) was higher in boys (9.8% and 12%) than in girls (3.4% and 6.1%), but the prevalence of overweight (> 1 SD) was higher in girls (8.6%) than in boys (4.5%). Children from Kinshasa fall below WHO centile references. This study established up-to-date centile curves for height, weight and BMI by age in children and adolescents. These reference curves describe the current status of these anthropometric markers and can be used as a basis for comparison in future studies.
Wumba, R; Enache-Angoulvant, A; Develoux, M; Mulumba, A; Mulumba, P M; Hennequin, C; Odio, T W; Biligui, S; Sala, J; Thellier, M
In the Democratic Republic of Congo (DRC), as in many African countries, AIDS and its procession of opportunistic infections are a major cause of morbidity and mortality. In Kinshasa, the estimated prevalence rate of HIV-infected persons is between 4 and 5%, corresponding to more than 200,000 people. Due to the lack of trained laboratory personnel and appropriate diagnostic equipment, no local investigation has been carried out to determine the prevalence of the opportunistic digestive parasitic infection in HIV-infected persons. As a step to obtaining this information that is needed for implementation of an adequate care policy, a preliminary investigation was carried out in Paris, France on 50 stool samples from 50 AIDS-patients hospitalized in 3 reference hospitals in Kinshasa. Eleven patients (22%) had digestive symptoms with a diarrhea syndrome. Further study using specialized techniques demonstrated 2 cases of digestive infection related to opportunistic parasites (4%). The first involved a Cryptosporidium sp. The second represented the first case of Enterocytozoon bieneusi infection reported in the literature from the DRC.
Pettifor, Audrey; Taylor, Eboni; Nku, David; Duvall, Sandra; Tabala, Martine; Meshnick, Steve; Behets, Frieda
To describe malaria knowledge, attitudes toward malaria and bed net use, levels of ownership and use of bed nets, and factors associated with ownership and use among pregnant women attending their first antenatal care (ANC) visit in Kinshasa, DRC. Women attending their first ANC visit at one maternity in Kinshasa were recruited to take part in a study where they were given free insecticide treated bed nets (ITNs) and then followed up at delivery and 6 months post delivery to assess ITN use. This study describes the baseline levels of bed net ownership and use, attitudes towards net use and factors associated with net use Among 351 women interviewed at baseline, 115 (33%) already owned a bed net and 86 (25%) reported to have slept under the net the previous night. Cost was reported as the reason for not owning a net by 48% of the 236 women who did not own one. In multivariable analyses, women who had secondary school or higher education were 3.4 times more likely to own a net (95% CI 1.6-7.3) and 2.8 times more likely to have used a net (95% CI 1.3-6.0) compared to women with less education Distribution of ITNs in antenatal clinics in this setting is needed and feasible. The potential for ITN use by this target population is high.
Parker, L; Maman, S; Pettifor, A; Chalachala, J L; Edmonds, A; Golin, C E; Moracco, K; Behets, F
Effective HIV prevention programs for people living with HIV/AIDS (PLWH) are important to reduce new infections and to ensure PLWH remain healthy. This paper describes the systematic adaptation of a U.S.-developed Evidence Based Intervention (EBI) using the Centers for Disease Control and Prevention (CDC) Map of Adaption Process for use at a Pediatric Hospital in Kinshasa, Democratic Republic of the Congo (DRC). The adapted intervention, Supporting Youth and Motivating Positive Action or SYMPA, a six-session risk reduction intervention targeted for youth living with HIV/AIDS (YLWH) in Kinshasa was adapted from the Healthy Living Project and guided by the Social Action Theory. This paper describes the process of implementing the first four steps of the ADAPT framework (Assess, Select, Prepare, and Pilot). Our study has shown that an EBI developed and implemented in the U.S. can be adapted successfully for a different target population in a low-resource context through an iterative process following the CDC ADAPT framework. This process included reviewing existing literature, adapting and adding components, and focusing on increasing staff capacity. This paper provides a rare, detailed description of the adaptation process and may aid organizations seeking to adapt and implement HIV prevention EBIs in sub-Saharan Africa and beyond.
Parker, L.; Maman, S.; Pettifor, A.; Chalachala, J.L.; Edmonds, A.; Golin, C.E.; Moracco, K.; Behets, F.
Effective HIV prevention programs for people living with HIV/AIDS (PLWH) are important to reduce new infections and to ensure PLWH remain healthy. This paper describes the systematic adaptation of a U.S.-developed Evidence Based Intervention (EBI) using the Centers for Disease Control and Prevention (CDC) Map of Adaption Process for use at a Pediatric Hospital in Kinshasa, Democratic Republic of the Congo (DRC). The adapted intervention, Supporting Youth and Motivating Positive Action or SYMPA, a six-session risk reduction intervention targeted for youth living with HIV/AIDS (YLWH) in Kinshasa was adapted from the Healthy Living Project and guided by the Social Action Theory. This paper describes the process of implementing the first four steps of the ADAPT framework (Assess, Select, Prepare, and Pilot). Our study has shown that an EBI developed and implemented in the U.S. can be adapted successfully for a different target population in a low-resource context through an iterative process following the CDC ADAPT framework. This process included reviewing existing literature, adapting and adding components, and focusing on increasing staff capacity. This paper provides a rare, detailed description of the adaptation process and may aid organizations seeking to adapt and implement HIV prevention EBIs in sub-Saharan Africa and beyond. PMID:23063699
Tuakuila, Joel; Kabamba, Martin; Mata, Honoré; Mata, Gerard
The phasing out of lead from gasoline has resulted in a significant decrease in blood lead levels (BLLs) in children during the last two decades. Tetraethyl lead was phased out in DRC in 2009. The objective of this study was to test for reduction in pediatric BLLs in Kinshasa, by comparing BLLs collected in 2011 (2 years after use of leaded gasoline was phased out) to those collected in surveys conducted in 2004 and 2008 by Tuakuila et al. (when leaded gasoline was still used). We analyzed BLLs in a total of 100 children under 6 years of age (Mean ± SD: 2.9 ± 1.6 age, 64% boys) using inductively coupled argon plasma mass spectrometry (ICP - MS). The prevalence of elevated BLLs (≥ 10 μg/dL) in children tested was 63% in 2004 [n = 100, GM (95% CI) = 12.4 μg/dL (11.4 - 13.3)] and 71% in 2008 [(n = 55, GM (95% CI) = 11.2 μg/dL (10.3 - 14.4)]. In the present study, this prevalence was 41%. The average BLLs for the current study population [GM (95% CI) = 8.7 μg/dL (8.0 - 9.5)] was lower than those found by Tuakuila et al. (F = 10.38, p <0.001) as well as the CDC level of concern (10 μ/dL), with 3% of children diagnosed with BLLs ≥ 20 μg/dL. These results demonstrate a significant success of the public health system in Kinshasa, DRC-achieved by the removal of lead from gasoline. However, with increasing evidence that adverse health effects occur at BLLs < 10 μg/dL and no safe BLLs in children has been identified, the BLLs measured in this study continue to constitute a major public health concern for Kinshasa. The emphasis should shift to examine the contributions of non-gasoline sources to children's BLLs: car batteries recycling in certain residences, the traditional use of fired clay for the treatment of gastritis by pregnant women and leaded paint.
Tuakuila, Joel; Lison, Dominique; Mbuyi, Francois; Haufroid, Vincent; Hoet, Perrine
The objective of this study was to determine blood lead levels (BLLs) and the possible sources of exposure in the population of Kinshasa, the capital of the Democratic Republic of Congo. A cross-sectional survey was carried out from January to May 2008 in a representative sample of the Kinshasan population. BLL was measured in 275 individuals (53.4% women) aged 1-70 years in the urban area of Kinshasa and from 60 additional subjects in the rural area. Pb was also determined in environmental specimens (air and soil, indoor and outdoor). BLL in the study population ranged from 2.9 to 49.3 μg/dl (median, 9.9 μg/dl). The median BLL among children aged <6 years was 11.5 μg/dl (range: 3.0-37.8 μg/dl). Of these children, 71% had elevated BLL (≥10 μg/dl) and 22% had BLL ≥20 μg/dl. The proportion of elevated BLL (≥10 μg/dl) was higher for children aged <3 years than for children aged 3 to 5 years (97% vs 56%). A higher prevalence of elevated BLL was observed in urban compared with rural children (71% vs 20%). Significantly higher BLLs were also found in children whose mother consumed fired clay during pregnancy. Residential informal activities in the recycling of car batteries also contributed to elevated BLL in children. The elevated background of Pb exposure in the Kinshasan population indicates a public health issue that requires corrective actions. Pb-contaminated dust and air in children's home is an issue of public health concern. The use of leaded gasoline and the activities of car battery recycling in certain residences appear to constitute the main sources of exposure in the city of Kinshasa. The traditional use of fired clay for the treatment of gastritis by pregnant women is another significant contributor for elevated BLL in children.
Kalenga, Lucien; Lukela, Jean; Salumu, Freddy; Diallo, Ibrahim; Nico, Elena; Lampart, Emmanuel; Van den Bergh, Rafael; Shah, Safieh; Ogundahunsi, Olumide; Zachariah, Rony; Van Griensven, Johan
Abstract: Facility-based antiretroviral therapy (ART) provision for stable patients with HIV congests health services in resource-limited countries. We assessed outcomes and risk factors for attrition after decentralization to community-based ART refill centers among 2603 patients with HIV in Kinshasa, Democratic Republic of Congo, using a multilevel Poisson regression model. Death, loss to follow-up, and transfer out were 0.3%, 9.0%, and 0.7%, respectively, at 24 months. Overall attrition was 5.66/100 person-years. Patients with >3 years on ART, >500 cluster of differentiation type-4 count, body mass index >18.5, and receiving nevirapine but not stavudine showed reduced attrition. ART refill centers are a promising task-shifting model in low-prevalence urban settings with high levels of stigma and poor ART coverage. PMID:27787343
Maketa, Vivi; Vuna, Mimy; Baloji, Sylvain; Lubanza, Symphorien; Hendrickx, David; Inocêncio da Luz, Raquel Andrea; Boelaert, Marleen; Lutumba, Pascal
In Democratic Republic of Congo access to health care is limited because of many geographical and financial barriers, while quality of care is often low. Global health donors assist the country with a number of community-oriented interventions such as free distribution of bednets, antihelminthic drugs, vitamin A supplementation and vaccination campaigns, but uptake of these interventions is not always optimal. The aim of this study was to explore the perceptions of poor urban communities of the capital Kinshasa with regard to health issues in general as well as their experiences and expectations concerning facility-based health services and community-oriented health interventions. Applying an approach rooted in the grounded theory framework, focus group discussions were conducted in eight neighborhoods of poor urban areas in the city of Kinshasa in July 2011. Study participants were easily able to evoke the city's major health problems, with the notable exceptions of malnutrition and HIV/AIDS. They perceive the high out-of-pocket cost of health services as the major obstacle when seeking access to quality care. Knowledge of ongoing community-oriented health interventions seems good. Still, while the study participants agree that those interventions are beneficial; their acceptability seems to be problematic. This is chiefly put down to a lack of information and government communication about the programs and their interventions. Furthermore, the study participants referred to rumors and the deterring effect of stories about alleged harmful consequences of those interventions. Along with improving the provision and quality of general health care, the government and international actors must improve their efforts in informing the communities about disease control programs, their rationale and benefit/risk ratio. Directly engaging community members in a dialogue might be beneficial in terms of improving acceptability and overall access to health services and
Maketa, Vivi; Vuna, Mimy; Baloji, Sylvain; Lubanza, Symphorien; Hendrickx, David; Inocêncio da Luz, Raquel Andrea; Boelaert, Marleen; Lutumba, Pascal
In Democratic Republic of Congo access to health care is limited because of many geographical and financial barriers, while quality of care is often low. Global health donors assist the country with a number of community-oriented interventions such as free distribution of bednets, antihelminthic drugs, vitamin A supplementation and vaccination campaigns, but uptake of these interventions is not always optimal. The aim of this study was to explore the perceptions of poor urban communities of the capital Kinshasa with regard to health issues in general as well as their experiences and expectations concerning facility-based health services and community-oriented health interventions. Applying an approach rooted in the grounded theory framework, focus group discussions were conducted in eight neighborhoods of poor urban areas in the city of Kinshasa in July 2011. Study participants were easily able to evoke the city’s major health problems, with the notable exceptions of malnutrition and HIV/AIDS. They perceive the high out-of-pocket cost of health services as the major obstacle when seeking access to quality care. Knowledge of ongoing community-oriented health interventions seems good. Still, while the study participants agree that those interventions are beneficial; their acceptability seems to be problematic. This is chiefly put down to a lack of information and government communication about the programs and their interventions. Furthermore, the study participants referred to rumors and the deterring effect of stories about alleged harmful consequences of those interventions. Along with improving the provision and quality of general health care, the government and international actors must improve their efforts in informing the communities about disease control programs, their rationale and benefit/risk ratio. Directly engaging community members in a dialogue might be beneficial in terms of improving acceptability and overall access to health services and
Mwandagalirwa, Kashamuka; Jackson, Elizabeth F; McClamroch, Kristi; Bollinger, Robert; Ryder, Robert W; Weir, Sharon S
This study compares the sexual behavior and HIV prevalence of men and women at social venues where people meet new sexual partners in Eastern Kinshasa with that of sexually transmitted infection (STI) treatment and antenatal clinic (ANC) patients in the same area. ANC patients, STI clinic patients, and social venue patrons were interviewed, asked to provide a blood sample on-site, and provided with information about obtaining test results. Every patron at identified social venues in the study area was invited to participate. One thousand one hundred sixteen pregnant women; 66 male and 229 female STI clinic patients; and 952 male and 247 female patrons of social venues were interviewed and tested for HIV. HIV prevalence differed by group: ANC patients (4%); female venue patrons (12%); female STI patients (16%); male venue patrons (2%); and male STI patients (23%). HIV prevalence among sex workers at social venues (29%) was higher than HIV prevalence among other female patrons with new or multiple partnerships in the past four weeks (19%) and higher than HIV prevalence among female patrons denying sex work (6%). However, the absolute number of infected women was higher among women reporting recent new or multiple partnerships than among the smaller group of sex workers (23 vs. 18). Two-thirds of the infected female STI patients (24/36) reported no more than one and no new sexual partner in the past year. Improving prevention programs in Kinshasa is essential. Prevention efforts should not neglect women at social venues who do not self-identify as sex workers but who have high rates of new sexual partnership formation.
Ageing, exposure to pollution, and interactions between climate change and local seasons as oxidant conditions predicting incident hematologic malignancy at KINSHASA University clinics, Democratic Republic of CONGO (DRC).
Nkanga, Mireille Solange Nganga; Longo-Mbenza, Benjamin; Adeniyi, Oladele Vincent; Ngwidiwo, Jacques Bikaula; Katawandja, Antoine Lufimbo; Kazadi, Paul Roger Beia; Nzonzila, Alain Nganga
The global burden of hematologic malignancy (HM) is rapidly rising with aging, exposure to polluted environments, and global and local climate variability all being well-established conditions of oxidative stress. However, there is currently no information on the extent and predictors of HM at Kinshasa University Clinics (KUC), DR Congo (DRC). This study evaluated the impact of bio-clinical factors, exposure to polluted environments, and interactions between global climate changes (EL Nino and La Nina) and local climate (dry and rainy seasons) on the incidence of HM. This hospital-based prospective cohort study was conducted at Kinshasa University Clinics in DR Congo. A total of 105 black African adult patients with anaemia between 2009 and 2016 were included. HM was confirmed by morphological typing according to the French-American-British (FAB) Classification System. Gender, age, exposure to traffic pollution and garages/stations, global climate variability (El Nino and La Nina), and local climate (dry and rainy seasons) were potential independent variables to predict incident HM using Cox regression analysis and Kaplan Meier curves. Out of the total 105 patients, 63 experienced incident HM, with an incidence rate of 60%. After adjusting for gender, HIV/AIDS, and other bio-clinical factors, the most significant independent predictors of HM were age ≥ 55 years (HR = 2.4; 95% CI 1.4-4.3; P = 0.003), exposure to pollution and garages or stations (HR = 4.9; 95% CI 2-12.1; P < 0.001), combined local dry season + La Nina (HR = 4.6; 95%CI 1.8-11.8; P < 0.001), and combined local dry season + El Nino (HR = 4; 95% CI 1.6-9.7; P = 0.004). HM types included acute myeloid leukaemia (28.6% n = 18), multiple myeloma (22.2% n = 14), myelodysplastic syndromes (15.9% n = 10), chronic myeloid leukaemia (15.9% n = 10), chronic lymphoid leukaemia (9.5% n = 6), and acute lymphoid leukaemia (7.9% n = 5). After adjusting for confounders using Cox
Nzengu-Lukusa, Franck; Yuma-Ramazani, Sylvain; Sokolua-Mvika, Eddy; Dilu-Keti, Angèle; Malenga-Nkanga, Blanchard; Shuli, Jean Baptiste; Nzongola-Nkasu, Donatien Kayembe; Mbayo-Kalumbu, Ferdinand; Ahuka-Mundeke, Steve
Introduction En République Démocratique du Congo (RDC), plus d'un million de don de sang ont été réalisés entre 2007 et 2011. Cependant, aucun bilan portant sur la carence en fer et l'anémie ferriprive, conséquence d'un don de sang chez les donneurs de sang (DS), n'est disponible dans ce pays. L'objectif de cette étude était d'estimer la prévalence de la carence en fer, de l'anémie et de l'anémie ferriprive chezles DS au Centre National de Transfusion Sanguine (CNTS) à Kinshasa en RDC. Méthodes Entre Décembre 2012 et Août 2013, une étude transversale a été menée au CNTS où des DS éligibles au don de sang ont été inclus. Les informations socio démographiques et des prélèvements sanguins ont été collectés de manière simultanée au don de sang. La ferritine sérique a été dosée pour évaluer la carence en fer en utilisant la technique ELISA. L'hémogramme a été réalisé en vue d’évaluer et mettre au point l'anémie. Résultats Au total 386 DS ont été inclus dans cette étude. La prévalence de la carence en fer et de l'anémie ferriprive étaient respectivement de 63,2% (244/386) et 25,9% (100/386) des DS. Une anémie a été trouvée chez 36.5% (141/386) au moment du don de sang. Conclusion La carence en fer, l'anémie et l'anémie ferriprive demeurent très fréquentes chez les DS à Kinshasa. Ces résultats suggèrent la révision des tests biologiques utilisés dans le recrutement des DS au CNTS. Par ailleurs le dosage de la ferritine s'impose en routine chez les DS rég PMID:27303590
Misombo-Kalabela, André; Nguefack-Tsague, Georges; Kalla, Ginette Claude Mireille; Ze, Emmanuel Afane; Diangs, Kimpanga; Panda, Tshapenda; Kebela, Ilunga; Fueza, Serge Bisuta; Magazani, Nzanzu; Mbopi-Kéou, François-Xavier
Introduction L'objectif de cette étude était de déterminer les facteurs de risque associés à la tuberculose multi résistance à Kinshasa en République Démocratique du Congo. Méthodes Il s'agissait d'une étude cas témoins. Les cas comprenaient tous les patients tuberculeux résistants à la rifampicine et à l'isoniazide notifiés à Kinshasa de janvier 2012 à juin 2013. Les témoins étaient les patients tuberculeux traités durant la même période que les cas et qui à la fin du traitement étaient déclarés guéris. Pour cette étude, nous avons obtenu une clairance éthique. Résultats L’échantillon était constitué de 213 participants dont 132 hommes (62%) et 81 femmes (38%). L’âge médian était de 31ans (16-73 ans). Les facteurs associés significatifs (p< 0,05) à la tuberculose multi résistante étaient le non-respect des heures de prise de médicaments (0R = 111) (80% chez les cas et 4% chez les témoins), l’échec au traitement (0R = 20) (76% chez les cas et 13% chez les témoins); la notion de tuberculose multi résistante dans la famille (0R = 6.4) (28% chez les cas et 6% chez les témoins); la méconnaissance de la tuberculose multi résistante (0R = 3.2) (31% chez les cas et 59% chez les témoins); un séjour en prison (0R = 7.6) (10% chez les cas et 1% chez les témoins) et l'interruption du traitement (0R = 6.1) ( 59% chez les cas et 19% chez les témoins). Conclusion L’émergence de la tuberculose multi résistante peut être évitée par la mise en place des stratégies de diagnostic et de traitement appropriées. PMID:27516818
Background As teenagers have easy access to both radio programs and cell phones, the current study used these tools so that young people could anonymously identify questions about sex and other related concerns in the urban environment of the Democratic Republic of Congo. The purpose of this healthcare intervention was to identify and address concerns raised by young people, which are related to sexual health, and which promote youth health. Methods This healthcare intervention was conducted over a six month period and consisted of a survey carried out in Kinshasa. This focused on 14 to 24 old young people using phone calls on a radio program raising concerns related to sexuality. The radio program was jointly run by a journalist and a health professional who were required to reply immediately to questions from young people. All sexual health concerns were recorded and analyzed. Results Forty programs were broadcast in six months and 1,250 messages and calls were recorded: 880 (70%) from girls and 370 (30%) from boys, which represents an average of 32 interventions (of which 10 calls and 22 messages) per broadcast. Most questions came from 15-19- and 20-24-year-old girls and boys. Focus of girls’ questions: menstrual cycle calculation and related concerns accounted for the majority (24%); sexual practices (16%), love relationships (15%) and virginity (14%). Boys’ concerns are masturbation (and its consequences) (22%), sexual practices (19%), love relationships (18%) and worries about penis size (10%). Infections (genital and STI) and topics regarding HIV represent 9% and 4% of the questions asked by girls against 7% and 10% by boys. Concerns were mainly related to knowledge, attitudes and competences to be developed. Conclusions Concerns and sexual practices raised by teens about their sexual and emotional life have inspired the design of a practical guide for youth self-training and have steered the second phase of this interactive program towards supporting
Kilunga, Pitchouna I; Sivalingam, Periyasamy; Laffite, Amandine; Grandjean, Dominique; Mulaji, Crispin K; de Alencastro, Luiz Felippe; Mpiana, Pius T; Poté, John
The increasing contamination of fresh water resource by toxic metals and Persistence Organic Pollutants (POPs) is a major environmental concern globally. In the present investigation, surface sediments collected from three main rivers named, Makelele, Kalamu and Nsanga, draining through the city of Kinshasa, Democratic Republic of the Congo, were characterized for grain size, organic matter, toxic metals, POPs (including organochlorine pesticides (OCPs), polychlorinated biphenyls (PCBs), polybrominated diphenyl ethers (PBDEs)), and polycyclic aromatic hydrocarbons (PAHs). Furthermore, enrichment factor (EF) and geoaccumulation index (Igeo) were performed to determine metal source and pollution status. The results highlighted high concentration of toxic metals in all sediment samples, reaching the values (mg kg(-1)) of 325 (Cu), 549 (Zn), 165 (Pb) and 1.5 (Cd). High values of PCBs and OCPs were detected in sediment samples, e.g. in Makelele river, PCB values ranged from 0.9 to 10.9 with total PCBs (∑7 PCBs × 4.3): 169.3 μg kg(-1); OCPs from 21.6 to 146.8 with ∑OCPs: 270.6 μg kg(-1). The PBDEs concentrations were higher in investigated rivers comparatively with values detected in many rivers from Sub-Saharan Africa. The ΣPAHs value ranged from 22.6 to 1011.9 μg kg(-1). River contamination may be explained by local intense domestic activities, urban and agricultural runoff, industrial and hospital wastewaters discharge into the rivers without prior treatment. This research provides not only a first baseline information on the extent of contamination in this tropical ecosystem but also represents useful tools incorporated to evaluate sediment quality in the river receiving systems which can be applied to similar aquatic environments. Copyright © 2017 Elsevier Ltd. All rights reserved.
Ilunga-Ilunga, Félicien; Levêque, Alain; Ngongo, Léon Okenge; Laokri, Samia; Dramaix, Michèle
Background: In the Democratic Republic of Congo (DRC), few studies have focused on treatment-seeking paths selected by caretakers for the management of severe childhood malaria in an urban environment. The present study aims at describing the treatment-seeking paths according to the characteristics of households, as well as the subsequent impact on pre-hospitalisation delay and malarial fatality and on the main syndromes associated with severe childhood malaria. Methods: This descriptive study included data collected at nine hospitals in Kinshasa between January and November 2011. A total of 1,350 children, under 15 years of age and hospitalised for severe malaria, were included in the study. Results: Regarding the management of malaria, 31.5% of households went directly to the health centre or hospital while 68.5% opted for self-medication, church and/or traditional healing therapy. The most frequent first-line option was self-medication, adopted by more than 61.5% of households. Nevertheless, rational self-medication using antimalarial drugs recommended by the WHO (artemisinin-based combinations) was reported for only 5.5% of children. Only 12.5% of households combined 2 or 3 traditional options. The following criteria influenced the choice of a modern vs. traditional path: household socioeconomic level, residential environment, maternal education level and religious beliefs. When caretakers opted for traditional healing therapy, the pre-hospitalisation delay was longer and the occurrence of respiratory distress, severe anaemia and mortality was higher. Conclusion: The implementation of a malaria action plan in the Democratic Republic of Congo should take into account the diversity and pluralistic character of treatment-seeking behaviours in order to promote the most appropriate options (hospital and rational self-medication) and to avoid detrimental outcomes. PMID:25729313
Feinstein, Lydia; Dimomfu, Bruno Lapika; Mupenda, Bavon; Duvall, Sandra; Chalachala, Jean Lambert; Edmonds, Andrew; Behets, Frieda
Increasing coverage of quality reproductive health services, including prevention of mother-to-child transmission services, requires understanding where and how these services are provided. To inform scale-up, we conducted a population-based survey in Kinshasa, Democratic Republic of Congo. Stratified two-stage cluster sampling was used to select women ≥18 years old who had been pregnant within the prior three years. Participants were interviewed about their reproductive healthcare utilization and impressions of services received. We interviewed 1221 women, 98% of whom sought antenatal care (ANC). 78% of women began ANC after the first trimester and 22% reported <4 visits. Reasons for choosing an ANC facility included reputation (51%), friendly/accessible staff (39%), availability of comprehensive services (29%), medication access (26%), location (26%), and cost (21%). Most women reported satisfactory treatment by staff, but 47% reported that the ANC provider ignored their complaints, 23% had difficulty understanding responses to their questions, 22% wanted more time with the provider, 21% wanted more privacy, and 12% felt uncomfortable asking questions. Only 56% reported someone talked to them about HIV/AIDS. Strongest predictors of seeking inadequate ANC included low participant and partner education and lack of certain assets. Only 32% of women sought postnatal care. Some results varied by health zone. Scaling-up interventions to improve reproductive health services should include broad-based health systems strengthening and promote equitable access to quality ANC, delivery, and postnatal services. Personal and structural-level barriers to seeking ANC need to be addressed, with consideration given to local contexts. © 2013 John Wiley & Sons Ltd.
Incidence of catastrophic health expenditures for households: an example of medical attention for the treatment of severe childhood malaria in Kinshasa reference hospitals, Democratic Republic of Congo.
Ilunga-Ilunga, Félicien; Levêque, Alain; Laokri, Samia; Dramaix, Michèle
This study aimed to estimate the incidence of catastrophic health expenditures faced by households in Kinshasa with children affected by severe malaria. A total of 1350 children below the age of 15 year who were hospitalized due to severe malaria were included in the study. We analyzed the incidence of households facing catastrophic expenditures according to two thresholds: 40% of the household's capacity to pay and 10% of the household's total consumption. Based on the '40% of the capacity to pay' threshold, the incidence of catastrophic health expenditures reached 81.1%, and this estimate reached 46.4% for the '10% above total consumption' threshold. Regarding the ≥ 40% capacity to pay threshold, the incidences of catastrophic expenditures was higher among households with children who were admitted to state hospitals (adjusted odds ratio [aOR] 3.7) and private hospitals (aOR 59.1), for poor households (aOR 13), for households with medium socioeconomic statuses (aOR 3.2), for female-headed households (aOR 2.9), for households with children affected by the neurological form (aOR 4.8) and respiratory distress (aOR 3.6), and for households who opted for a pre-hospital resort (aOR 2.7). Similar results were obtained when the 10% above the total consumption threshold was applied. Greater government financing of medical attention would lead to a reduction in the catastrophic health expenditures faced by the poorest households. Copyright © 2014 King Saud Bin Abdulaziz University for Health Sciences. Published by Elsevier Ltd. All rights reserved.
Assessment of health service delivery capacities, health providers' knowledge and practices related to type 2 diabetes care in Kinshasa primary healthcare network facilities, Democratic Republic of the Congo.
Kapongo, Remy Y; Lulebo, Aimée M; Mafuta, Eric M; Mutombo, Paulin B; Dimbelolo, Jean Claude M; Bieleli, Isidore E
Democratic Republic of the Congo (DRC) is experiencing an increase in the morbi-mortality related to Non Communicable Diseases (NCD). The reform of DRC health system, based on Health District model, is needed in order to tackle this public issue. This article used 2006 International Diabetes Federation (IDF)'s guidelines to assess the capacities of health facilities belonging to Kinshasa Primary Health Care Network (KPHCN) in terms of equipments, as well as the knowledge, and the practice of their health providers related to type 2 diabetes care. A multicentric cross-sectional study was carried in 18 Health Facilities (HF) of KPHCN in charge of the follow-up of diabetic patients. The presence of IDF recommended materials and equipment was checked and 28 health providers were interviewed about their theoretical knowledge about patients' management and therapeutic objectives during recommended visits. Chi square test or Fisher exact test was used to compare proportions and the Student t-test to compare means. The integration of NCD healthcare in the KPHC network is feasible. The majority of HF possessed IDF recommended materials except for the clinical practice guidelines, urinary test strips, and monofilament, available in only one, two and four HF, respectively. KPHCN referral facilities had required materials for biochemical analyses, the ECG and for the fundus oculi test. Patients' management is characterized by a lack of attention on the impairment of renal function during the first visits and a poor respect of recommended practices during quarterly and annual visits. A poor knowledge of the reduction of cardiovascular risk factors-related therapeutic objectives has been also reported. The capacities, knowledge, and practice of T2D care were poor among HF of KPHCN. The lack of equipment and training of healthcare professionals should be supplied even to those who are not medical doctors. Special attention must to be put on the clinical practice guidelines
Mwanamoki, Paola M; Devarajan, Naresh; Niane, Birane; Ngelinkoto, Patience; Thevenon, Florian; Nlandu, José W; Mpiana, Pius T; Prabakar, Kandasamy; Mubedi, Josué I; Kabele, Christophe G; Wildi, Walter; Poté, John
The contamination of drinking water resources by toxic metals is a major problem in many parts of the world, particularly in dense populated areas of developing countries that lack wastewater treatment facilities. The present study characterizes the recent evolution with time of some contaminants deposited in the Congo River and Lake Ma Vallée, both located in the vicinity of the large city of Kinshasa, capital of Democratic Republic of Congo (DRC). Physicochemical parameters including grain size distribution, organic matter and trace element concentrations were measured in sediment cores sampled from Congo River (n = 3) and Lake Ma Vallée (n = 2). The maximum concentration of trace elements in sediment profiles was found in the samples from the sites of Pool Malebo, with the values of 107.2, 111.7, 88.6, 39.3, 15.4, 6.1 and 4.7 mg kg(-1) for Cr, Ni, Zn, Cu, Pb, As and Hg, respectively. This site, which is characterized by intense human activities, is especially well known for the construction of numerous boats that are used for regular navigation on Congo River. Concerning Lake Ma Vallée, the concentration of all metals are generally low, with maximum values of 26.3, 53.6, 16.1, 15.3, 6.5 and 1.8 mg kg(-1) for Cr, Ni, Zn, Cu, Pb and As, respectively. However, the comparison of the metal profiles retrieved from the different sampled cores also reveals specific variations. The results of this study point out the sediment pollution by toxic metals in the Congo River Basin. This research presents useful tools for the evaluation of sediment contamination of river-reservoir systems.
Kilunga, Pitchouna I; Kayembe, John M; Laffite, Amandine; Thevenon, Florian; Devarajan, Naresh; Mulaji, Crispin K; Mubedi, Josué I; Yav, Zéphirin G; Otamonga, Jean-Paul; Mpiana, Pius T; Poté, John
Although the United Nations General Assembly recognized in 2010 the right to safe and clean drinking water and sanitation as a human right that is essential to the full enjoyment of life and all other human rights, the contamination of water supplies with faecal pathogens is still a major and unsolved problem in many parts of the world. In this study, faecal indicator bacteria (FIB), including Escherichia coli (E. coli) and Enterococcus (ENT), were quantified over the period of June/July 2014 and June/July 2015 to assess the quality of hospital effluents (n = 3: H1, H2 and H3) and of rivers receiving wastewaters from the city of Kinshasa, Democratic Republic of Congo. The water and sediment samples from the river-receiving systems were collected in, upstream and downstream of the hospital outlet pipe (HOP) discharge. The analysis of E. coli and ENT in water and sediment suspension was performed using the cultural membrane filter method. The FIB characterization was performed for general E. coli, Enterococcus faecalis(E. faecalis) and human-specific Bacteroides by PCR using specific primers. The results revealed very high FIB concentration in the hospital effluent waters, with E. coli reaching the values of 4.2 × 10(5), 16.1 × 10(5) and 5.9 × 10(5) CFU 100 mL(-1), for the hospital effluents from H1, H2, and H3, respectively; and Enterococcus reaching the values of 2.3 × 10(4), 10.9 × 10(4) and 4.1 × 10(4) CFU 100 mL(-1), respectively. Interestingly, the FIB levels in the water and sediment samples from river-receiving systems are spatially and temporally highly variable and present in some samples with higher values than the hospital effluents. The PCR assays for human-specific Bacteroides HF183/HF134 further indicate that more than 98% of bacteria were from human origin. The results of this research therefore confirm the hypothesis of our previous studies, indicating that in developing countries (e.g., Democratic Republic of Congo and South India), the
The relationship between Plasmodium infection, anaemia and nutritional status in asymptomatic children aged under five years living in stable transmission zones in Kinshasa, Democratic Republic of Congo.
Maketa, Vivi; Mavoko, Hypolite Muhindo; da Luz, Raquel Inocêncio; Zanga, Josué; Lubiba, Joachim; Kalonji, Albert; Lutumba, Pascal; Van Geertruyden, Jean-Pierre
Malaria is preventable and treatable when recommended interventions are properly implemented. Thus, diagnosis and treatment focus on symptomatic individuals while asymptomatic Plasmodium infection (PI) plays a role in the sustainability of the transmission and may also have an impact on the morbidity of the disease in terms of anaemia, nutritional status and even cognitive development of children. The objective of this study was to assess PI prevalence and its relationship with known morbidity factors in a vulnerable but asymptomatic stratum of the population. A simple random sample, household survey in asymptomatic children under the age of five was conducted from April to September 2012 in two health areas of the health zone of Mont Ngafula 1, Kinshasa, Democratic Republic of Congo. The PI prevalence were 30.9% (95% CI: 26.5-35.9) and 14.3% (95% CI: 10.5-18.1) in Cité Pumbu and Kindele health areas, respectively, (OR: 2.7; p <0.001). All were Plasmodium falciparum infected and 4% were co-infected with Plasmodium malariae. In Cité Pumbu and Kindele, the prevalence of anaemia (haemoglobin <11 g/dL) was 61.6% (95% CI: 56.6-66.5) and 39.3% (95% CI: 34.0-44.6), respectively, (OR: 2.5; p <0.001). The health area of Cité Pumbu had 32% (95% CI: 27.5-37.0) of chronic malnutrition (HAZ score ≤ -2SD) compared to 5.1% (95% CI: 2.8-7.6) in Kindele. PI was predictor factor for anaemia (aOR: 3.5, p =0.01) and within infected children, there was an inverse relationship between parasite density and haemoglobin level (β = -5*10(-5), p <0.001). Age older than 12 months (aOR: 3.8, p = 0.01), presence of anaemia (aOR: 3.4, p =0.001), chronic malnutrition (aOR: 1.8, p = 0.01), having a single parent/guardian (aOR: 1.6, p =0.04), and the non-use of insecticide-treated nets (aOR: 1.7, p = 0.04) were all predictors for PI in the overall population. PI in asymptomatic children was correlated with anaemia and chronic malnutrition and was thus a harmful condition in the study
Burnett, Eleanor; Wannemuehler, Kathleen; Ngoie Mwamba, Guillaume; Yolande, Masembe; Guylain, Kaya; Muriel, Nzazi Nsambu; Cathy, Nzuzi; Patrice, Tshekoya; Wilkins, Karen; Yoloyolo, Norbert
Health facility (HF) and household (HH) data can complement each other to provide a better understanding of the factors that contribute to vaccination status. In 12 zones with low vaccination coverage within Kinshasa Province, Democratic Republic of Congo, we conducted 2 surveys: (1) a linked HH and HF survey among 6-11-month-old infants, and (2) a HH survey among 12-23-month-old children. Linked survey objectives were to identify factors associated with vaccination status and to explore methodological considerations for linked survey implementation. To provide linked HH and HF data, we enrolled 6-11-month-old infants in HH clusters in each zone and then surveyed HFs located within the 12 zones and cited by caregivers of the enrolled infants as the most recent HF visited for vaccination or curative care. To provide vaccination coverage estimates for the 12-zone area, we enrolled 12-23-month-old children in every fourth HH. Of the HHs with a child aged 6-23 months, 16% were ineligible because they had resided in the neighborhood for <3 months or were unavailable to be interviewed, 4% refused, and 80% were eligible and participated. Of 1224 enrolled infants 6-11 months of age, records of 879 (72%) were linked to one of the 182 surveyed HFs. For the coverage survey, 710 children aged 12-23 months participated. Home-based vaccination cards were available for 1210 of 1934 children (63%) surveyed. The surveys were successful in assessing HH information for 2 age groups, documenting written vaccination history for a large proportion of 6-23-month-old children, linking the majority of infants with their most recently visited HF, and surveying identified HFs. The implementation of the individually linked survey also highlighted the need for a comprehensive list of HFs and an analysis plan that addresses cross-classified clusters with only 1 child. © The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America.
Feinstein, Lydia; Edmonds, Andrew; Chalachala, Jean Lambert; Okitolonda, Vitus; Lusiama, Jean; Van Rie, Annelies; Chi, Benjamin H.; Cole, Stephen R.; Behets, Frieda
Objective Guidelines for prevention of mother-to-child transmission of HIV have developed rapidly, yet little is known about how outcomes of HIV-exposed infants have changed over time. We describe HIV-exposed infant outcomes in Kinshasa, Democratic Republic of Congo, between 2007 and 2013. Design Cohort study of mother–infant pairs enrolled in family-centered comprehensive HIV care. Methods Accounting for competing risks, we estimated the cumulative incidences of early infant diagnosis, HIV transmission, death, loss to follow-up, and combination antiretroviral therapy (cART) initiation for infants enrolled in three periods (2007–2008, 2009–2010, and 2011–2012). Results 1707 HIV-exposed infants enrolled at a median age of 2.6 weeks. Among infants whose mothers had recently enrolled into HIV care (N = 1411), access to EID by age two months increased from 28% (95% confidence limits [CL]: 24,34%) among infants enrolled in 2007-2008 to 63% (95% CL: 59,68%) among infants enrolled in 2011–2012 (Gray's p-value <0.01). The 18-month cumulative incidence of HIV declined from 16% (95% CL: 11,22%) for infants enrolled in 2007–2008 to 11% (95% CL: 8,16%) for infants enrolled in 2011–2012 (Gray's p-value = 0.19). The 18-month cumulative incidence of death also declined, from 8% (95% CL: 5,12%) to 3% (95% CL: 2,5%) (Gray's p-value = 0.02). LTFU did not improve, with 18-month cumulative incidences of 19% (95% CL: 15,23%) for infants enrolled in 2007-2008 and 22% (95% CL: 18,26%) for infants enrolled in 2011–2012 (Gray's p-value = 0.06). Among HIV-infected infants, the 24-month cumulative incidence of cART increased from 61% (95% CL: 43,75%) to 97% (95% CL: 82,100%) (Gray's p-value < 0.01); the median age at cART decreased from 17.9 to 9.3 months. Outcomes were better for infants whose mothers enrolled before pregnancy. Conclusions We observed encouraging improvements, but continued efforts are needed. PMID:24991903
[Combining microcredit, microinsurance, and the provision of health care can improve access to quality care in urban areas of Africa: Results of an experiment in the Bandalungwa health zone in Kinshasa, the Congo].
Manzambi Kuwekita, J; Gosset, C; Guillaume, M; Balula Semutsari, M-P; Tshiama Kabongo, E; Bruyere, O; Reginster, J-Y
This study, based on a survey conducted in 2008, examines how combining microcredit, microinsurance, and health care provision can improve access to quality care in the health zone of Bandalungwa, in Kinshasa. The bivariate analysis showed a significant association between increased purchasing power and earnings (p = 0.001), between earnings and savings (p = 0.000), and between health insurance and improved access to health care. These results show that 68.8% of borrowers reported an increase in their purchasing power, of whom 82% reported profits. Those with savings were 24.7 times more likely to purchase health insurance than those without; and 72% of those who regularly made health insurance payments improved their access to care. Combining microcredit, health microinsurance, and health care can improve access to quality health care at lower cost. This suggests that health insurance could usefully be integrated into the primary health-care system.
Delvaux, Damien; Ganza, Gloire; Kongota, Elvis; Fukiabantu, Guilain; Mbokola, Dim; Boudzoumou, Florent; Miyouna, Timothée; Gampio, Urbain; Nkodia, Hardy
Small-scale brittle structures such as shear fractures and tension joints are well developed in the indurated Paleozoic Inkisi red sandstones of the West-Congo Supergroup in the "pool" region of Kinshasa and Brazzaville, along the Congo River. They appear to be related to the evolution of intraplate stresses during the late Cretaceous-Paleogene period, possibly related to the opening of the South Atlantic. However, inferring paleostresses from such structures is difficult due to the lack of clear kinematic indicators, so we used mainly the geometry, architecture and sequence of the joint systems to infer paleostresses. A limited number of kinematic indicators for slip sense (displaced pebbles, irregularities on striated surfaces, slickensides) or extension (plume joints) confirm the general conclusions of the joint architecture analysis. We found evidence for two major brittle deformation systems, leading to almost orthogonal fracture sets. They both started by the development of plume joints, which progressively evolved into open tension joints, isolated shear fractures and long (up to several hundred meters) brittle shear zones. The first system started to develop under NE-SW extension and evolved into strike-slip with NNW-SSE horizontal compression while the second (and later), started to develop under NW-SE extension and evolved into strike-slip with NNE-SSW horizontal compression. The second brittle deformation episode was associated with fluid flow as shown by the presence of palygorskite-calcite veins in the most prominent fractures of the second fracture system. Along the NE-SW brittle shear zones which run parallel to the Congo River, carbonate-rich fault-gauge lenses are filled by sand derived from the crushed adjacent walls and calcite vein fragments injected at a high fluid pressure, with late precipitation of palygorskite. Our study demonstrates the existence of two fault systems between Kinshasa and Brazzaville, the first one orthogonal to the trend
Wangata, Jemima; Elenge, Myriam; De Brouwer, Christophe
Introduction Le transport en commun urbain constitue un secteur où les travailleurs sont très exposés aux accidents du travail. Cette étude visait une description épidémiologique des accidents du travail dans le secteur informel du transport en commun à Kinshasa en vue d'apporter les pistes d'amélioration de la sécurité des travailleurs dans cette activité. Méthodes Un questionnaire sur les accidents du travail, administré en Décembre 2012 a permis d'explorer les tendances significatives entre les accidents et leurs circonstances, leurs facteurs associés, leurs conséquences au sein d'une population des travailleurs (n = 472) du transport en commun à Kinshasa. Résultats Durant les 12 derniers précédant l’étude 76.5% des travailleurs ont connu au moins un accident du travail, 54,8% ont connu un arrêt d'au moins 1jour. Les accidents liés à la circulation routière étaient plus important suivis des chutes. Les facteurs ayant montré des différences significatives étaient le travail sous l'influence de l'alcool et le port des équipements de protection individuelle. Les plaies (46,3%) et les contusions (39,4%) étaient les lésions les plus courantes. Les membres supérieurs (51,3%) et inférieurs (30,7%) étaient les plus atteints. 76,6% des travailleurs ont assumé seuls leur prise en charge médicale. Conclusion L'incidence des accidents du travail dans ce secteur est très élevée. La mise en place d'une politique de prévention et gestion de différents facteurs associés ainsi qu'un système de déclaration d'accidents est nécessaire dans ce secteur. Les patrons ainsi que les politiques devraient veiller à une prise en charge médicale correcte pour des travailleurs accidentés. PMID:25667703
Kaswa, Michel K; Aloni, Muriel; Nkuku, Léontine; Bakoko, Brian; Lebeke, Rossin; Nzita, Albert; Muyembe, Jean Jacques; de Jong, Bouke C; de Rijk, Pim; Verhaegen, Jan; Boelaert, Marleen; Ieven, Margareta; Van Deun, Armand
Fluoroquinolones are the core drugs for the management of multidrug-resistant tuberculosis (MDR-TB). Molecular drug susceptibility testing methods provide considerable advantages for scaling up programmatic management and surveillance of drug-resistant TB. We describe here the misidentification of fluoroquinolone resistance by the GenoType MTBDRsl (MTBDRsl) (Hain Lifescience GmbH, Nehren, Germany) line probe assay (LPA) encountered during a feasibility and validation study for the introduction of this rapid drug susceptibility test in Kinshasa, Democratic Republic of Congo. The double gyrA mutation 80Ala and 90Gly represented 57% of all fluoroquinolone mutations identified from MDR-TB patient sputum samples, as confirmed by DNA sequencing. This double mutation was previously found to be associated with susceptibility to fluoroquinolones, yet it leads to absent hybridization of a wild-type band in the MTBDRsl and is thus falsely scored as resistance. Our findings suggest that MTBDRsl results must be interpreted with caution when the interpretation is based solely on the absence of a wild-type band without confirmation by visualization of a mutant band. Performance of the MTBDRsl LPA might be improved by replacing the gyrA wild-type probes by additional probes specific for well-documented gyrA mutations that confer clinically relevant resistance. Copyright © 2014, American Society for Microbiology. All Rights Reserved.
Aloni, Muriel; Nkuku, Léontine; Bakoko, Brian; Lebeke, Rossin; Nzita, Albert; Muyembe, Jean Jacques; de Jong, Bouke C.; de Rijk, Pim; Verhaegen, Jan; Boelaert, Marleen; Ieven, Margareta; Van Deun, Armand
Fluoroquinolones are the core drugs for the management of multidrug-resistant tuberculosis (MDR-TB). Molecular drug susceptibility testing methods provide considerable advantages for scaling up programmatic management and surveillance of drug-resistant TB. We describe here the misidentification of fluoroquinolone resistance by the GenoType MTBDRsl (MTBDRsl) (Hain Lifescience GmbH, Nehren, Germany) line probe assay (LPA) encountered during a feasibility and validation study for the introduction of this rapid drug susceptibility test in Kinshasa, Democratic Republic of Congo. The double gyrA mutation 80Ala and 90Gly represented 57% of all fluoroquinolone mutations identified from MDR-TB patient sputum samples, as confirmed by DNA sequencing. This double mutation was previously found to be associated with susceptibility to fluoroquinolones, yet it leads to absent hybridization of a wild-type band in the MTBDRsl and is thus falsely scored as resistance. Our findings suggest that MTBDRsl results must be interpreted with caution when the interpretation is based solely on the absence of a wild-type band without confirmation by visualization of a mutant band. Performance of the MTBDRsl LPA might be improved by replacing the gyrA wild-type probes by additional probes specific for well-documented gyrA mutations that confer clinically relevant resistance. PMID:24871222
Prevalence and determinants of use of complementary and alternative medicine by hypertensive patients attending primary health care facilities in Kinshasa, Democratic Republic of the Congo: a cross-sectional study.
Lulebo, Aimée M; Mapatano, Mala A; Mutombo, Paulin B; Mafuta, Eric M; Samba, Gédéon; Coppieters, Yves
In the Democratic Republic of the Congo the control of hypertension is poor, characterized by an increasing number of reported cases of hypertension related complications. Poor control of hypertension is associated with non-adherence to antihypertensive medication. It is well established that the use of complementary and alternative medicine is one of the main factors of non-adherence to antihypertensive medication. The aim of this study is to determine the prevalence and factors associated with the use of complementary and alternative medicine. A cross-sectional study was carried out at the Kinshasa Primary Health-care (KPHC) facilities network in November 2014. A structured interview questionnaire was administrated to a total of 280hypertensive patients. Complementary and alternative medicine were defined according to the National Institute of Health classification as a group of diverse medical and healthcare systems, practices, and products that are not presently considered to be part of conventional medicine. Data were summarized using proportion and mean (with standard deviation). The student's t test and χ(2) test were used respectively for mean and proportion comparison. Logistic regression analysis identified determinants of the use of complementary and alternative medicine. The prevalence of use of complementary and alternative medicine was 26.1% (95% CI: 20.7% - 31.8%).Determinants of use of complementary and alternative medicine included misperception about hypertension curability (OR = 2.1; 95%CI: 1.1-3.7) and experience of medication side effects (OR = 2.9; 95%CI: 1.7-5.1). The use of CAM for hypertensive patients is a major problem; antihypertensives with fewer side effects must be emphasized. Religious leaders must become involved in the communication for behavioral change activities to improve the quality of life for hypertensive patients.
Asymptomatic Plasmodium falciparum infection is associated with anaemia in pregnancy and can be more cost-effectively detected by rapid diagnostic test than by microscopy in Kinshasa, Democratic Republic of the Congo
Background In areas of high malaria transmission, Plasmodium falciparum infection during pregnancy is characterized by malaria-related anaemia, placental malaria and does not always result in clinical symptoms. This situation is associated with poor pregnancy outcomes. The aim of this study was to determine the extent of asymptomatic P. falciparum infection, its relation with anaemia as well as the most cost-effective technique for its diagnosis in healthy pregnant women living in Kinshasa, Democratic Republic of the Congo. Methods In a cross-sectional study design, information on socio-demographic characteristics and cost data were collected in healthy pregnant women attending antenatal care consultations. Plasmodium falciparum infection was diagnosed using rapid diagnostic test (RDT), microscopy and polymerase chain reaction (PCR). Haemoglobin concentration was also determined. Results In total, 332 pregnant women were enrolled. RDT and microscopy data were available for all the blood samples and 166 samples were analysed by PCR. The prevalence of asymptomatic P. falciparum infection using microscopy, RDTs and PCR, were respectively 21.6%, 27.4% and 29.5%. Taking PCR as a reference, RDTs had a sensitivity of 81.6% and a specificity of 94.9% to diagnose asymptomatic P. falciparum infection. The corresponding values for microscopy were 67.3% and 97.4%. The prevalence of anaemia was 61.1% and asymptomatic malaria increased five times the odds (p < 0.001) of having anaemia. RDTs were more cost-effective compared to microscopy. Incremental cost-effectiveness ratio was US$ 63.47 per microscopy adequately diagnosed case. Conclusion These alarming results emphasize the need to actively diagnose and treat asymptomatic malaria infection during all antenatal care visits. Moreover, in DRC, malaria and anaemia control efforts should be strengthened by promoting the use of insecticide-treated nets, intermittent preventive treatment with sulphadoxine-pyrimethamine and iron
Mense, Kennedy; Mapatano, Mala Ali; Mutombo, Paulin Beya; Muyer, Marie Claire
Introduction Le diabète est un problème majeur de santé publique et un fardeau économique mondial qui n’épargne pas la RD-Congo. Bien que sa prise en charge soit codifiée, la plupart des diabétiques n'arrivent pas à respecter les rendez-vous de suivi. Cette étude vise principalement à identifier les déterminants de la non-observance du suivi médical chez les diabétiques à Kinshasa. Méthodes Il s'agit d'une étude cas-témoins où les cas sont les patients diabétiques non observant le suivi médical et les témoins, ceux répondant régulièrement au suivi médical. Couvrant la période du 1erjanvier au 31 décembre 2010, l’étude a porté sur un échantillon aléatoire de 154 sujets répartis entre 77 cas et 77 témoins. Résultats Les données indiquent une association entre la non-observance du suivi médical et le revenu (niveau de vie) des ménages. Les cas provenant des ménages à faible revenu courent six fois plus le risque d’être non-observants. Par contre, entre le niveau de connaissance et la non-observance l'association notée n’était pas statistiquement significative. Le respect des rendez-vous pourrait être amélioré de 77% si le revenu des ménages des diabétiques était augmenté. Le coût total mensuel du suivi médical est estimé à 27,2 USD, alors que le revenu permanant des ménages se situe à 306,6 USD. Conclusion Le bas niveau de vie mais pas celui de l'ignorance est un déterminant de la non-observance des visites de suivi du malade diabétique. PMID:25309658
Kabamba, Arsène Tshikongo; Mukuku, Olivier; Shamashanga, Laurent Kwete; Kamunga, Daniel Badibanga; Bokanya, Alex Impele; Lukumwena, Zet Kalala; Longanga, Albert Otshudi
Introduction Le paludisme est toujours compté parmi les problèmes de santé publique prioritaires en République Démocratique du Congo suite au nombre de malades et de décès qu'il provoque. Cette étude évalue l'atteinte de la fonction hépatique au cours du paludisme grave chez les enfants de moins de 5 ans. Méthodes Il s'agit d'une étude cas-témoins menée de janvier à juin 2013 à Kinshasa (République Démocratique du Congo) où le dosage des bilirubines totale, directe et indirecte et la mesure de l'activité enzymatique de la Glutamate Pyruvate Transaminase (GPT), de la Glutamate Oxaloacétate Transaminase (GOT) et du taux d'hémoglobine ont été faits chez 46 enfants âgés de moins de 5 ans atteints de paludisme grave (groupe I) et chez 46 autres considérés sains avec une goutte négative (groupe II). Les résultats obtenus ont été comparés dans les deux groupes et le seuil de signification a été fixé à p <0,05. Résultats Les analyses statistiques relèvent que les valeurs sont considérablement élevées en ce qui concerne les deux transaminases (GOT et GPT), la bilirubine directe, la bilirubine indirecte et la bilirubine totale chez les enfants atteints du paludisme grave. Ces analyses montrent une différence significative en défaveur de ces derniers (p < 0,001). Conclusion En effet, cette augmentation des taux plasmatiques des paramètres biologiques analysés observée chez les enfants gravement impaludés traduit ainsi une altération de la fonction hépatique au cours d'un paludisme grave chez l'enfant de moins de cinq ans. PMID:25870721
Koy, Tshingani; Mukumbi, Henri; Malandala, Ghislain Lubangi Muteba; Donnen, Philippe; Wilmet–Dramaix, Michèle
Introduction A trithérapie (ARV) introduite en R.D.Congo en 1996, a permis l′amélioration substantielle de la qualité de vie des PVVIH et a réduit la morbimortalité liée au sida en R.D. Congo. L'objectif de cette étude est de présenter le profil épidémiologique comparatif, clinique, ainsi que l’évolution anthropométrique des PVVIH sous ARV à Kinshasa. Méthodes Etude de cohorte sur 438 PVVIH, de 18 ans et plus, suivies entre mai 2010 à 2011 à Amo Congo à Kinshasa. Une comparaison a été faite entre les patients suivis pendant un an et ceux perdus de vue. Le Chi carré de Mc Nemar et l'analyse de variance pour mesures répétées ont été appliqués pour étudier l’évolution. Résultats Près 12 mois de suivi, 11,4% de patients ont été perdus de vue. Parmi eux, on observait des proportions significativement plus élevées de personnes de niveau socioéconomique bas, d'indice de masse corporelle (IMC) bas, présentant de l'anorexie, des affections opportunistes. Les proportions de patients aux stades OMS 3 & 4 et naïfs étaient également significativement plus élevées et la durée sous ARV plus courte. Les gains moyens des paramètres anthropométriques au 12ème mois, étaient importants: de 3,6 [3,2 - 4,0] kg pour le poids, 1,8 (1,4 - 2,3) cm pour le périmètre abdominal, 0,9 (0,8 - 1,2) cm pour le périmètre brachial, 1,4 (1,2 - 1,5) kg/m2 pour l'IMC. La proportion de patients avec un IMC <18,5 kg/m2 a significativement plus baissé entre l'admission et le 12ème mois parmi les patients sans stomatite que parmi ceux avec stomatite. L'IMC moyen évoluait significativement différemment entre l'admission et le 12ème mois selon l’âge et la taille de ménage. Conclusion Les facteurs fragilisant la rétention des patients sous antirétroviraux et une évolution progressive de l’état nutritionnel ont été observés. PMID:25995784
Kalonda, J C Omba
The sexual violence's committed in the Democratic Republic of Congo (DRC) are from their scales and consequences on women, real public health, politico-legal, and socio-economical challenges. More than a million of women have been victims of sexual violence on a period of less than fifteen years. Systematic rapes of women were used as war weapon by different groups involved in the Congolese war. Sexual violence against women has impacted public health by spreading sexually transmissible diseases including HIV/AIDS, causing unwanted pregnancies, leading to the gynaecological complications of rape-related injuries, and inflicting psychological trauma on the victims. Despite high level of unwanted pregnancies observed, the Congolese law is very restrictive and interdict induced abortion. This paper presents three arguments which plead in favour of legalizing abortion in DRC: 1) a restrictive law on abortion forces women to use unsafe abortion and increase incidence of injuries and maternal mortality ; 2) DRC has ratified the universal Declaration of human rights, the African union charter, and has than to promote equality between sexes, in this is included women reproductive rights; 3) an unwanted birth is an additional financial charge for a woman, a factor increasing poverty and psychologically unacceptable in case of rape. From the politico-legal point of view, ending rape impunity and decriminalizing abortion are recommended. Decriminalizing abortion give women choice and save victims and pregnant women from risks related to the pregnancy, a childbirth, or an eventual unsafe abortion. These risks increase the maternal mortality already high in DRC (between 950 and 3000 for 100000 live births).
Tambashe, B. Oleko; Shapiro, David
Examines the impact of a woman's family background on transitions to sexual activity, marriage, and motherhood. Documents how parental education, parental survival status, and other factors are important in the transition to adult roles. Findings suggest that increases in educational levels should contribute to delays in these transitions and…
Binanga, Arsene; Bertrand, Jane T
ABSTRACT In the Democratic Republic of the Congo (DRC), the Ministry of Health authorizes only physicians and nurses to give injections, with one exception—medical and nursing students may also give injections if supervised by a clinical instructor. The emergence of the injectable contraceptive Sayana Press in some African countries prompted the DRC to test the acceptability and feasibility of distributing Sayana Press and other contraceptive methods at the community level through medical and nursing students. Sayana Press is similar in formulation to the injectable contraceptive Depo-Provera but contains a lower dose and is administered subcutaneously using a single-use syringe with a short needle called the Uniject system. The Uniject system allows Sayana Press to be administered by community health workers without clinical training or by self-injection. In this pilot, the advocacy objective was to obtain approval from the Ministry of Health to allow medical and nursing students to inject Sayana Press, as a first step toward authorization for community health workers to provide the method. The pilot described in this article documents a process whereby an innovative approach moved from concept to implementation to replication in less than 2 years. It also paved the way for testing additional progressive strategies to increase access to contraception at the community level. Because the pilot project included a research component designed to assess benefits and challenges, it provided the means to introduce the new task-shifting approach, which might not have been approved otherwise. Key pilot activities included: (1) increasing awareness of Sayana Press among family planning stakeholders at a national conference on family planning, (2) enlisting the support of key decision makers in designing the pilot, (3) obtaining marketing authorization to distribute Sayana Press in the DRC, (4) implementing the pilot from July to December 2015, (5) conducting quantitative and qualitative studies to assess acceptability and feasibility, and (6) disseminating the findings to family planning stakeholders. Before the pilot, Sayana Press was relatively unknown in the DRC, and there was no precedent for medical and nursing students providing family planning methods or giving injections at the community level. In less than 12 months, the approach gained legitimacy and acceptance. The key Ministry of Health decision maker orchestrated the closing session of the dissemination meeting on next steps, paving the way for pilot tests of 3 new task-shifting approaches: insertion of Implanon NXT by medical and nursing students, self-injection for Sayana Press with supervision by students, and injection of Sayana Press by community health workers with no formal clinical training. PMID:27979874
Tona, L; Kambu, K; Ngimbi, N; Mesia, K; Penge, O; Lusakibanza, M; Cimanga, K; De Bruyne, T; Apers, S; Totte, J; Pieters, L; Vlietinck, A J
Three major extracts from some traditional preparations, based on medicinal plants, used as antidiarrhoeal agents were investigated for their putative antiamoebic and spasmolytic activities in vitro. Results indicated that both biological activities are concentrated in the polyphenolic fraction, and not in the saponin or alkaloid containing fractions. The most active polyphenolic extracts were those from Euphorbia hirta whole plant, leaves of Alchornea cordifolia, Crossopteryx febrifuga, Nauclea latifolia, Psidium guajava, Tithonia diversifolia, stem bark of Harungana madagascariensis, Mangifera indica, Maprounea africana and Psidium guajava, inhibiting Entamoeba histolytica growth with MAC < 10 micrograms/ml. The same extracts, at a concentration of 80 micrograms/ml in an organ bath, also exhibited more than 70% inhibition of acetylcholine and/or KCl solution-induced contractions on isolated guinea-pig ileum.
Binanga, Arsene; Bertrand, Jane T
In the Democratic Republic of the Congo (DRC), the Ministry of Health authorizes only physicians and nurses to give injections, with one exception-medical and nursing students may also give injections if supervised by a clinical instructor. The emergence of the injectable contraceptive Sayana Press in some African countries prompted the DRC to test the acceptability and feasibility of distributing Sayana Press and other contraceptive methods at the community level through medical and nursing students. Sayana Press is similar in formulation to the injectable contraceptive Depo-Provera but contains a lower dose and is administered subcutaneously using a single-use syringe with a short needle called the Uniject system. The Uniject system allows Sayana Press to be administered by community health workers without clinical training or by self-injection. In this pilot, the advocacy objective was to obtain approval from the Ministry of Health to allow medical and nursing students to inject Sayana Press, as a first step toward authorization for community health workers to provide the method. The pilot described in this article documents a process whereby an innovative approach moved from concept to implementation to replication in less than 2 years. It also paved the way for testing additional progressive strategies to increase access to contraception at the community level. Because the pilot project included a research component designed to assess benefits and challenges, it provided the means to introduce the new task-shifting approach, which might not have been approved otherwise. Key pilot activities included: (1) increasing awareness of Sayana Press among family planning stakeholders at a national conference on family planning, (2) enlisting the support of key decision makers in designing the pilot, (3) obtaining marketing authorization to distribute Sayana Press in the DRC, (4) implementing the pilot from July to December 2015, (5) conducting quantitative and qualitative studies to assess acceptability and feasibility, and (6) disseminating the findings to family planning stakeholders. Before the pilot, Sayana Press was relatively unknown in the DRC, and there was no precedent for medical and nursing students providing family planning methods or giving injections at the community level. In less than 12 months, the approach gained legitimacy and acceptance. The key Ministry of Health decision maker orchestrated the closing session of the dissemination meeting on next steps, paving the way for pilot tests of 3 new task-shifting approaches: insertion of Implanon NXT by medical and nursing students, self-injection for Sayana Press with supervision by students, and injection of Sayana Press by community health workers with no formal clinical training.
Van Rie, Annelies; Dow, Anna; Mupuala, Aimee; Stewart, Paul
Objective To assess the effect of HIV care (including HAART if eligible) on neurodevelopment. Design Prospective cohort study Methods Motor and mental development of 35 HIV-infected children (age 18-71 months) was assessed at entry into care, and after 6 and 12 months using age-appropriate tools. Developmental trajectory was compared to 35 HIV-uninfected, affected and 90 control children using linear mixed effects models. Effects of age (≤ or >29 months) and timing of entry into care (before or after HAART eligibility) were explored in secondary analyses. Results At baseline, HIV-infected children had the lowest, control children the highest, and HIV-uninfected affected children intermediate mean developmental scores. After one year of care, HIV-infected children achieved mean motor and cognitive scores that were similar to HIV uninfected, affected children although lower compared to control children. Overall, HIV-infected children experienced accelerated motor development but similar gains in cognitive development compared to control children. Exploratory analyses suggest that younger children and those presenting early may experience accelerated greater gains in development. Conclusions HIV-infected children accessing care experience improved motor development, and may, if care is initiated at a young age or an early stage of the disease, also experience gains in cognitive development. PMID:19730268
enforcement agents who ensnared the smugglers in what became known as Operation Gamma . However, many questions about the nuclear rods remain unanswered...enlightenment through yoga and meditation . He altered these views following Aum’s poor showing in the 1990 Japanese general election. Shortly after this...Managing the Atom, Belfer Center for Science and International Affairs, Carnegie Non-Proliferation Project, The Next Wave : Urgently Needed New Steps
Mock, Nancy B.; And Others
The use of case-control methodology as an applied policy/planning research tool in assessing the potential effectiveness of behavioral interventions is studied in connection with diarrhea control in Zaire. Results with 107 matched pairs of children demonstrate the importance of hygiene-related knowledge and the utility of the research approach.…
Tuakuila, J; Kabamba, M; Mata, H; Mata, G
In this study we determined the concentration of 9 trace elements (As, Cd, Cu, Hg, Mn, Mo, Pb, Se and Zn) in whole blood of children (n=100, 64 girls, 36 boys and median age: 36 months) using inductively coupled plasma mass spectrometry (ICP-MS). The proportion of children potentially deficient in essential elements or poisoned by toxic elements was evaluated. The aging effects on the concentration of these elements were also investigated. The median values were 3.17μg/L (As), 0.15μg/L (Cd), 1.1mg/L (Cu), 2.1μg/L (Hg), 10.4μg/L (Mn), 17.7μg/L (Mo), 8.7μg/dL (Pb), 10.7μg/L (Se) and 5.0mg/L (Zn). The concentration of many elements (As, Cd, Hg, Mn, Pb and Zn) showed significant age variations but not sex influence. Regarding levels of the essential elements (Cu, Mn, Mo, Se and Zn), B-Cu, B-Mn, B-Se and B-Zn were in the normal range, whereas exceeded levels were observed for B-Mo. None of these children was deficient in essential elements. Except B-Cd, all toxic elements showed exceeded blood levels. The proportion of children potentially poisoned by toxic elements varies from 10% (n=10) to 95% (n=95) and depends on toxic element: 95% for As, 10% for Hg and 35% for Pb. The main health concerns emerging from this study are the high As, Hg and Pb exposures of the Kinshasan children requiring further documentation, corrective actions and the implementation of appropriate regulations.
Onyamboko, Marie A; Meshnick, Steven R; Fleckenstein, Lawrence; Koch, Matthew A; Atibu, Joseph; Lokomba, Victor; Douoguih, Macaya; Hemingway-Foday, Jennifer; Wesche, David; Ryder, Robert W; Bose, Carl; Wright, Linda L; Tshefu, Antoinette K; Capparelli, Edmund V
In many malaria-endemic countries, increasing resistance may soon compromise the efficacy of sulphadoxine-pyrimethamine (SP) for intermittent preventative treatment (IPT) of malaria in pregnancy. Artemisinin-based IPT regimens represent a promising potential alternative to SP. Pharmacokinetic and safety data supporting the use of artemisinin derivatives in pregnancy are urgently needed. Subjects included pregnant women with asymptomatic falciparum parasitaemia between 22-26 weeks (n = 13) or 32-36 weeks gestation (n = 13), the same women at three months postpartum, and 25 non-pregnant parasitaemic controls. All subjects received 200 mg orally administered AS. Plasma total and free levels of AS and its active metabolite DHA were determined using a validated LC-MS method. Non-compartmental pharmacokinetic analysis was performed using standard methods. All pregnant women delivered live babies. The median birth weight was 3025 grams [range 2130, 3620]; 2 of 26 babies had birth weights less than 2500 grams. Rates of parasite clearance by 12 hours post-dose were high and comparable among the groups. Rapid elimination of AS was observed in all three groups. The 90% CI for the pregnancy:postpartum ratio of geometric means for total and free AUC fell within the pre-specified 0.66 - 1.50 therapeutic equivalence interval. However, more pronounced pharmacokinetic differences were observed between the pregnancy and control subjects, with the 90% CI for the pregnancy:control ratio of geometric means for both total 0.68 (90% CI 0.57-0.81) and free AUC 0.78 (90% CI 0.63-0.95) not fully contained within the 0.66 - 1.50 interval. All subjects cleared parasites rapidly, and there was no difference in the percentage of women who were parasitaemic 12 hours after dosing. A single dose of orally administered AS was found to be both effective and without adverse effects in this study of second and third trimester pregnant women in the DRC. Although DHA AUC during pregnancy and postpartum were similar, the AUC for the pregnant group was less than the non-pregnant controls. The findings of this study suggest that additional studies on the pharmacokinetics of AS in pregnant women are needed. ClinicalTrials.gov: NCT00538382.
Modia O'Yandjo, A; Foidart, J-M; Rigo, J
The aim of this study was to assess the impact of HIV-1 and placental malaria co-infection on newborn biometry and Apgar scores. 146 HIV-1 infected and 149 HIV-1 uninfected consent mothers and their newborns were recruited. Placental biopsies examination confirmed the presence or absence of placental malaria. Birth weight (BW), placental weight, cranial circumference, brachial perimeter, height, Body Mass Index (BMI) and Apgar scores at 1', 5', 10' were taken. The Chi(2) test and t-Student test were used for data statistical analysis. The global placental malarial infection prevalence was 72% but was 91% in HIV-1 infected vs. 53.7% in HIV-1 uninfected mothers (p<0.0001). The mean BW of HIV-1 co-infected mother's newborns was slightly inferior to that of HIV-1 uninfected mother's babies (3,033±524g vs. 3,236±565g) but this difference was not statistically significant (p>0.05). No other significant biometric differences were noted (p>0.05). But, the co-infection influenced negatively Apgar scores at 5' (p<0.05). HIV-1 co-infected mothers were more frequently exposed to placental malaria infection. The co-infection reduced the Apgar scores taken at the fifth minute. Copyright © 2011 Elsevier Masson SAS. All rights reserved.
Matangila, Junior R.; Doua, Joachim Yorokpa; Linsuke, Sylvie; Madinga, Joule; Inocêncio da Luz, Raquel; Van Geertruyden, Jean-Pierre; Lutumba, Pascal
Background Anaemia reduces cognitive potential in school children, retards their growth and predisposes them to other diseases. As there is a paucity of data on the current burden of P. falciparum, S. mansoni and soil transmitted helminths (STH) infections and their correlation with schoolchildren’s anemia in the Democratic Republic of Congo (DRC), we collect these data. Methods This study reports baseline data collected from a randomized controlled trial investigating the impact of IPT with SP and SP-PQ on anemia and malaria morbidity in Congolese schoolchildren (Trial registration: NCT01722539; PACTR201211000449323). S. mansoni and STH infections were assessed using kato-katz technique. Malaria infection and hemoglobin concentration were assessed using Blood smear and Hemocontrol device, respectively. Results A total of 616 primary schoolchildren from 4 to 13 years old were enrolled in the study. The prevalence of Plasmodium spp. infection was 18.5% (95%CI:15.6–21.9). Amongst those infected, 24 (21%), 40 (35.1%), 40 (35.1%), 10 (8.8%), had light, moderate, heavy, very high malaria parasite density, respectively. Above 9 years of age (p = 0.02), male and history of fever (p = 0.04) were both associated with malaria infection. The overall prevalence of S. mansoni infection was 6.4% (95%CI:4.4–9.1). Girls were associated with S. mansoni infection (p = 0.04). T. trichiura was the most prevalent STH infection (26.3%), followed by A. lumbricoides (20.1%). Co-infection with malaria-S. mansoni and malaria-STH was, respectively, 1.5% (CI95%:0.7–3.3) and 6.4% (CI95% 4.4–9.1). The prevalence of anemia was found to be 41.6% (95%CI:37.7–45.6) and anemia was strongly related with Plasmodium ssp infection (aOR:4.1; CI95%:2.6–6.5;p<0.001) and S. mansoni infection (aOR:3.3;CI95%:1.4–7.8;p<0.01). Conclusion Malaria and S. mansoni infection were strongly associated with high prevalence of anemia in schoolchildren. Therefore, specific school-based interventions, such as intermittent preventive treatment or prophylaxis, LLITN distribution, anthelminthic mass treatment and micronutrient supplementation are needed to improve school children’s health. PMID:25372029
Matangila, Junior R; Doua, Joachim Yorokpa; Linsuke, Sylvie; Madinga, Joule; Inocêncio da Luz, Raquel; Van Geertruyden, Jean-Pierre; Lutumba, Pascal
Anaemia reduces cognitive potential in school children, retards their growth and predisposes them to other diseases. As there is a paucity of data on the current burden of P. falciparum, S. mansoni and soil transmitted helminths (STH) infections and their correlation with schoolchildren's anemia in the Democratic Republic of Congo (DRC), we collect these data. This study reports baseline data collected from a randomized controlled trial investigating the impact of IPT with SP and SP-PQ on anemia and malaria morbidity in Congolese schoolchildren (Trial registration: NCT01722539; PACTR201211000449323). S. mansoni and STH infections were assessed using kato-katz technique. Malaria infection and hemoglobin concentration were assessed using Blood smear and Hemocontrol device, respectively. A total of 616 primary schoolchildren from 4 to 13 years old were enrolled in the study. The prevalence of Plasmodium spp. infection was 18.5% (95%CI:15.6-21.9). Amongst those infected, 24 (21%), 40 (35.1%), 40 (35.1%), 10 (8.8%), had light, moderate, heavy, very high malaria parasite density, respectively. Above 9 years of age (p = 0.02), male and history of fever (p = 0.04) were both associated with malaria infection. The overall prevalence of S. mansoni infection was 6.4% (95%CI:4.4-9.1). Girls were associated with S. mansoni infection (p = 0.04). T. trichiura was the most prevalent STH infection (26.3%), followed by A. lumbricoides (20.1%). Co-infection with malaria-S. mansoni and malaria-STH was, respectively, 1.5% (CI95%:0.7-3.3) and 6.4% (CI95% 4.4-9.1). The prevalence of anemia was found to be 41.6% (95%CI:37.7-45.6) and anemia was strongly related with Plasmodium ssp infection (aOR:4.1; CI95%:2.6-6.5;p<0.001) and S. mansoni infection (aOR:3.3;CI95%:1.4-7.8;p<0.01). Malaria and S. mansoni infection were strongly associated with high prevalence of anemia in schoolchildren. Therefore, specific school-based interventions, such as intermittent preventive treatment or prophylaxis, LLITN distribution, anthelminthic mass treatment and micronutrient supplementation are needed to improve school children's health.
Leyka, Mukandu Basua Babintu; Baum, Prof Mylène; Diadié, Maiga; Kiyombo, Mbela; Mupenda, Bavon
All healthcare providers decide in someone else's place, for someone else. In doing so, they take their place in a long long tradition, that of medical paternalism. Patients are treated as children, incapable of making decisions about themselves. How then are we supposed to deal with patients like the street children of the Democratic Republic of the Congo, who are not part of our health-care system, who refuse care and prescriptions? Their refusal of caregivers forces us to seek strategies to dispel the conflicts, adapt outselves to the situation (self-medication, drug sales outside of dispensaries, etc.), but especially to rethink the relation between caregivers and patients. This does not mean abandoning the authoritarian patriarchal model for total relativism; the use of drugs such as antibiotics is and must remain surrounded by all the precautions necessary to avoid the further development of resistance; it does mean training and informing. The task facing us is that of health education and promotion, a long and continuous process, centered on patients and integrated with their care, aimed at making them capable of managing their disease. This procedure is part of a pragmatic approach: beyond the asymmetry involved in any relationship of power, it is essential to establish informed confidence, to look for adhesion and not constraint. Only this pragmatism can incite young people with sexually transmitted diseases (STDs) to use modern medicine and comply with the dosage instructions. Effective treatment of STDs is, according to WHO, one of the most powerful weapons in the battle against AIDS transmission.
Luboya, Evariste; Tshilonda, Jean-Christophe Bukasa; Ekila, Mathilde Bothale; Aloni, Michel Ntetani
Introduction L'insuffisance des moyens de base pour le dépistage et la prise en charge de la socioculturel Africain. D'où la nécessité de réaliser un travail de mise en sens du vécu et des émotions en vue d'information et de soutien psychologique des familles des drépanocytaires. Cette étude a eu pour objectif d'identifier la nature des répercussions psychosociales de la drépanocytose chez les parents et chez les malades. Méthodes Une approche qualitative a été utilisée. Des entretiens ont été menés auprès des parents et des patients drépanocytaires. Nos résultats ont fait l'objet d'une analyse thématique articulée sur les circonstances de découvertes de la maladie, les répercussions de la maladie et la perception de la prise en charge. Résultats Nos interviews ont montré des répercussions psychosociales importantes chez les parents d'enfants drépanocytaires et de stigmatisation des difficultés d'insertion sociale et scolaire pour les enfants drépanocytaires. Ces derniers sont les grands oubliés des récits de parents. La prise en charge est uniquement médicale avec des ressources très limitées et aucun accompagnement psychologique de la famille n'est assuré. Conclusion La prise en charge de cette maladie nécessite la mise en place d'une politique de prise en charge basée sur une approche globale de la maladie. PMID:25574334
Banza, Elvire Nzeba
There is one physics department in the Democratic Republic of Congo, at the University of Kinshasa. Since 2001, one woman graduate continued her studies in England, where she received a PhD, and currently two master's degree graduates from this program have joined the faculty as assistant professors.
Sesep, N'Sial Bal-Nsien
A study explored, from a sociolinguistic perspective, the phenomenon of indoubill, patterns and usage of a special variety of Lingala, among a group of delinquent urban youth in Kinshasa (Zaire). It is proposed that: (1) at a particular moment in its social history, the community experienced sociocultural change that brought with it a special…
Pineda-Peña, Andrea-Clemencia; Varanda, Jorge; Sousa, João Dinis; Theys, Kristof; Bártolo, Inês; Leitner, Thomas; Taveira, Nuno; Vandamme, Anne-Mieke; Abecasis, Ana B
Angola borders and has long-term links with Democratic Republic of Congo (DRC) as well as high levels of Human Immunodeficiency Virus (HIV) genetic diversity, indicating a potential role in the initial spread of the HIV-1 pandemic. Herein, we analyze 564 C2V3 and 354 pol publicly available sequences from DRC, Republic of Congo (RC) and Angola to better understand the initial spread of the virus in this region. Phylogeographic analyses were performed with the BEAST software. While our results pinpoint the origin of the pandemic to Kinshasa (DRC) around 1906, the introduction of HIV-1 to Angola could have occurred early between the 1910s and 1940s. Furthermore, most of the HIV-1 migrations out of Kinshasa were directed not only to Lubumbashi and Mbuji-Mayi (DRC), but also to Luanda and Brazzaville. Kinshasa census records corroborate these findings, indicating that the early exportation of the virus to Angola might be related to the high number of Angolans in Kinshasa at that time, originated mostly from the North of Angola. In summary, our results place Angola at the epicenter of the early HIV dissemination, together with DRC and RC.
Faria, Nuno R.; Rambaut, Andrew; Suchard, Marc A.; Baele, Guy; Bedford, Trevor; Ward, Melissa J.; Tatem, Andrew J.; Sousa, João D.; Arinaminpathy, Nimalan; Pépin, Jacques; Posada, David; Peeters, Martine; Pybus, Oliver G.; Lemey, Philippe
Thirty years after the discovery of HIV-1, the early transmission, dissemination, and establishment of the virus in human populations remain unclear. Using statistical approaches applied to HIV-1 sequence data from central Africa, we show that from the 1920s Kinshasa (in what is now the Democratic Republic of Congo) was the focus of early transmission and the source of pre-1960 pandemic viruses elsewhere. Location and dating estimates were validated using the earliest HIV-1 archival sample, also from Kinshasa. The epidemic histories of HIV-1 group M and nonpandemic group O were similar until ~1960, after which group M underwent an epidemiological transition and outpaced regional population growth. Our results reconstruct the early dynamics of HIV-1 and emphasize the role of social changes and transport networks in the establishment of this virus in human populations. PMID:25278604
Mbuyi-Muamba, J M; Malonda, N; Yuma, O
Ankylosing spondylitis has never been described in Zaïre and is considered to be rare in black African populations. We report two cases observed in the University Hospital of Kinshasa. The two patients are brothers. The diagnosis is based on anaemnestic, clinical and radiological findings. We therefore demonstrate the existence of this disease in Zaïre and presume that other similar cases may be diagnosed.
key element of Mursi’s ability to build support will be improving living standards and the economy; GDP growth fell to 1.5 percent in 2012 from just...pace. Central Africa The Great Lakes region of Central Africa has a total population of 128 million and includes parts or all of Burundi , Congo...cleavages, and active rebel groups. US Government-sponsored modeling suggests that Burundi , Congo (Kinshasa), and Uganda are all at risk of violent
Sese Seko began in the city of Goma in the mid-1990s. The second rebellion in the late 1990s began also in eastern Congo. The root causes of the...August 2009, Secretary of State Hillary Clinton visited Kinshasa and Goma in eastern Congo. At a press conference with Foreign Minister Alexis...against civilians in Luofu, a town north of Goma . According to the June 2009 U.N. Secretary General report, “the overall situation in the
Nuapia, Yannick; Chimuka, Luke; Cukrowska, Ewa
This study investigates the level of organochlorine pesticides in the raw food from open markets in Kinshasa, Democratic Republic of Congo (DRC), and Johannesburg, South Africa. It assesses the potential health risks associated with the organochlorine pesticide residues. The Quick, Easy, Cheap, Effective, Rugged, and Safe (QuEChERS) method has been developed for sample preparation. A total of 120 food samples (beans, cabbage, beef, and fish) were obtained from the open markets. The mean concentrations of organochlorine pesticides in raw foods collected from the Johannesburg market were significantly higher (p < 0.05) than those from the Kinshasa market. DDE recorded the highest mean concentration (253.58 ± 4.78 μg kg(-1)) in beef from Johannesburg, and α-BHC recorded the lowest mean concentration (38.54 ± 7.46 μg kg(-1)) in beans from Kinshasa. The investigation of health risk estimates revealed that the number of organochlorine pesticides exceeded the reference dose in the collected food samples. Copyright © 2016 Elsevier Ltd. All rights reserved.
Nzengu-Lukusa, Franck; Yuma-Ramazani, Sylvain; Sokolua-Mvika, Eddy; Dilu-Keti, Angèle; Malenga-Nkanga, Blanchard; Shuli, Jean Baptiste; Nzongola-Nkasu, Donatien Kayembe; Mbayo-Kalumbu, Ferdinand; Ahuka-Mundeke, Steve
In the Democratic Republic of Congo (DRC), the practice of blood transfusion is common with more than two hundred thousand one million blood donation per year has been made between 2007 and 2011. However, no report on iron deficiency and iron deficiency anemia as a result of a donation blood in DS is available in this country. This study aimed to estimate the extend of iron deficiency, anemia and iron deficiency anemia in volunteer blood donors (DS) in the National Blood Transfusion Center (CNTS) in Kinshasa, DRC. A cross-sectional study was conducted in CNTS where Kinshasa volunteer blood donors were included. Socio demographic information and blood samples were collected. Hematological parameters and Serum ferritin was assessed using respectively standard colorimetric and ELISA techniques. A total of 386 DS were included in this study. The prevalence of iron deficiency and iron deficiency anemia were respectively 63.2% (244/386) and 25.9% (100/386) of DS. Anemia was found in 36.5% (141/386) at the time of blood donation. Anemia, iron deficiency and iron-deficiency anemia are highly prevalent among blood donors in Kinshasa, DRC. Hence the needs to review the screening tests for the selection of blood donors and also include serum ferritin measurement for the routine assessment of blood donors, especially among regular blood donors.
Nkwembe-Ngabana, Edith; Ahuka-Mundeke, Steve; Kebela-Ilunga, Benoit; Londa, Emile Okitolo; Muyembe-Tamfum, Jean-Jacques
In the Democratic Republic of the Congo (DRC), several influenza epidemics are ignored because they are confused with other infectious diseases which have similar symptoms. Our study aims to assess influenza epidemics occurred in the DRC before 2008, year of the implementation of the influenza surveillance program in the DRC. We searched all the documents [articles, report,…] about influenza epidemic or acute respiratory infections [ARI] in the DRC before 2008 by using chosen key words. Epidemic description elements were identified and analyzed in each report. 4 documents have been found that had no article published. The sites of the epidemic outbreak were the rural health zones in Koshibanda and Kahemba, Bandundu [1995 and 2007], in Bosobolo, Equator  and in Kinshasa [2002-2003]. Attack and lethality rates were 3.9% and 16% in Koshibanda respectively; 0.1% and 2% in Kinshasa; 47.5% and 1.5% in Bosobolo and 14.6% and 2.9% in Kahemba. Children less than 5 years of age were the most affected. Their attack rates ranged between 22.6 and 57.7% and lethality rates ranged between 3.2 and 3.7%. The two epidemics in Bosobolo and Kinshasa were associated with H3N2 influenza virus. This literature review highlights a high morbidity and mortality due to rare influenza epidemics in the DRC.
Mpaka, Davin Mbeya; Okitundu, Daniel Luwa E-Andjafono; Ndjukendi, Ally Omba; N’situ, Adelin Mankubu; Kinsala, Sebastien Yabassi; Mukau, Joachim Ebwel; Ngoma, Valentin Malanda; Kashala-Abotnes, Espérance; Ma-Miezi-Mampunza, Samuel; Vogels, Annick; Steyaert, Jeans
Introduction Autism spectrum disorders (ASD) is a neurodevelopmental disorder that has been rarely diagnosed in Sub-Saharan Africa. Although a proportion of children do present features of ASD in the Democratic Republic of Congo (DRC), little is known about it prevalence. Often, the co-morbidities constitute the upfront symptoms and therefore may it recognition and management difficult, aggravating as such the prognosis. The present study therefore aimed at studying the clinical profile of autism spectrum disorder (ASD) and the associated morbidities among children and adolescents in outpatient clinics in Kinshasa, the Democratic Republic of Congo. Methods We conducted a cross sectional study in the three outpatients centers receiving patients referred for neurodevelopmental disorders in Kinshasa, DRC, from June 2008 to June 2010. A total of 450 subjects aged from 1-18 years old were referred and included in the study. The clinical diagnosis for ASD was made using the DSM-IV-R and the ADIR. Co-morbidities were identified using DSM-IV-R criteria together with an extensive clinical interview and observation. All patients were subject to an intellectual quotient evaluation and an electroencephalogram reporting. Results Of the 450 subjects referred, 120 (29.3%) received the diagnosis of ASD, with boys outnumbering girls (OR 3:1. The mean age was 7.9 years (SD 3.4) (p< 0.001). Intellectual disability (75.83 %) and epilepsy (72.50%) were the main co-morbidities significantly associated with autism (p< 0.001). It was also found that co-morbidities were most frequent in subjects with an IQ<70 (p=0.05). Conclusion ASD is frequent among patients referred for neurodevelopmental disorders in the three outpatients’ centers for neurodevelopmental disorders in Kinshasa. Males seem to be more affected than female. The main co-morbidities were epilepsy and intellectual disabilities. Our findings suggest that it is important to screen for ASD and co-morbidities among all subjects
Penchenier, L; Mouchet, J; Cros, B; Legall, P; Cosnefroy, J Y; Quézédé, P; Chandenier, J
In May 1993, at the end of the rainy season, outbreaks of Paederus sabaeus (Coleoptera, Staphylinidae) were recorded in Brazzaville (Congo), Kinshasa (Zaire), Franceville and Libreville (Gabon) and even in Bangui (CAR) at the North of the equator. A short review of previous outbreaks in Africa and on vesicant substances is given by the authors. These beetles are attracted to neon lights and they rest on the walls or on the skin of the occupants. When the insects are crushed on the bare skin their haemolymph liberate pederine and related vesicant components which provocate dermatitis. The insects disappeared spontaneously after three to four weeks.
Sese Seko began in the city of Goma in the mid-1990s. The second rebellion in the late 1990s began also in eastern Congo. The root causes of the current...carry out its mandate. In August 2009, Secretary of State Hillary Clinton visited Kinshasa and Goma in eastern Congo. At a press conference with...serious atrocities against civilians in Luofu, a town north of Goma . According to the June 2009 U.N. Secretary General report, “the overall situation in
ISS007-E-06305 (6 June 2003) --- This image featuring two capital cities on opposite banks of the Congo River was taken by an Expedition 7 crewmember onboard the International Space Station (ISS). The smaller city is Brazzaville on the north side of the river, and Kinshasa on the south side. The cities lie at the downstream end of an almost circular widening in the river known as Stanley Pool. The international boundary follows the south shore of the pool (~30 kilometers in diameter). The Congo River exits the pool through a markedly narrowed channel at a series of whitewater rapids that can be seen in this view from space.
Iloweka, Ernest Manganda
The Lower Congo is one of eleven provinces in the Democratic Republic of Congo, and is located southwest of Kinshasa Town Province. It has an area of approximately 53.947 km2 with a population of 1,504,361 at an estimated 237 persons per km2. The Province comprises five districts, including Lukaya and Cataracts where rural poverty is severe and the population struggle to make a living through agriculture and woodcutting. These activities result in excessive resource exploitation. The high demand for foodstuffs and the high consumption of wood (for energy, construction and export) in Kinshasa, the capital city of the Democratic Republic of Congo and the expanding towns of Matadi and Boma in the Lower Congo Province, are speeding the deforestation rate and unbalancing forest ecosystems. In addition there is the stress resulting from reduced josher (the rest period for agriculture ground), plus climate change and erosion. The phenomena that that we need to address in these two districts include deforestation, reduced josher, excessive agriculture, erosion, burning and climate change which taken together largely explain the current soil degradation. These areas are marked by excessive post deforestation savannah formation and extended areas of sandy soil, distributed throughout grass and shrub savannahs. This desertification, which is rampant in Lukaya and Cataracts, risks imprisoning the rural population in a vicious cycle of poverty if adequate solutions are not found.
Doshi, Reena H; Alfonso, Vivian H; Hoff, Nicole A; Mukadi, Patrick; Gerber, Sue; Bwaka, Ado; Higgins, Stephen G; Mwamba, Guillaume Ngoie; Okitolonda, Emile; Muyembe, Jean-Jacques; Rimoin, Anne W
Mumps is an acute viral infection and while the infection is usually mild, complications can lead to permanent sequelae including brain damage and deafness. The burden of mumps is currently unknown the Democratic Republic of Congo (DRC), we therefore assessed susceptibility to mumps infection among children 6-59 months of age. In collaboration with the 2013-2014 DRC Demographic and Health Survey, we conducted a serosurvey to assess population immunity to vaccine preventable diseases. Dried blood spot samples were collected from children 6 to 59 months of age and processed at the UCLA-DRC laboratory in Kinshasa, DRC using the Dynex Technologies Multiplier FLEX chemiluminescent immunoassay platform (Dynex multiplex assay, Chantilly, VA). Logistic multivariate analyses were used to determine risk factors for mumps seropositivity. Serologic and survey data were matched for 7195, 6-59 month-old children, among whom 22% were positive and 3% indeterminate for mumps antibodies in weighted analyses. In multivariate analyses, the odds of seropositivity increased with increasing age, female gender, number of children in household, increasing socioeconomic status and province (Kinshasa with the highest odds of positive test result compared with all other provinces). These data suggest that mumps virus is circulating in DRC and risk of exposure increases with age. At present, the introduction of a combined measles-mumps-rubella vaccine remains unlikely, as the capacity to maintain adequate vaccine coverage levels for routine immunization must be improved before additional antigens can be considered for the routine immunization schedule.
Wu, Joseph T; Peak, Corey M; Leung, Gabriel M; Lipsitch, Marc
The ongoing yellow fever epidemic in Angola strains the global vaccine supply, prompting WHO to adopt dose sparing for its vaccination campaign in Kinshasa, Democratic Republic of the Congo, in July-August, 2016. Although a 5-fold fractional-dose vaccine is similar to standard-dose vaccine in safety and immunogenicity, efficacy is untested. There is an urgent need to ensure the robustness of fractional-dose vaccination by elucidation of the conditions under which dose fractionation would reduce transmission. We estimate the effective reproductive number for yellow fever in Angola using disease natural history and case report data. With simple mathematical models of yellow fever transmission, we calculate the infection attack rate (the proportion of population infected over the course of an epidemic) with various levels of transmissibility and 5-fold fractional-dose vaccine efficacy for two vaccination scenarios, ie, random vaccination in a hypothetical population that is completely susceptible, and the Kinshasa vaccination campaign in July-August, 2016, with different age cutoff for fractional-dose vaccines. We estimate the effective reproductive number early in the Angola outbreak was between 5·2 and 7·1. If vaccine action is all-or-nothing (ie, a proportion of vaccine recipients receive complete protection [VE] and the remainder receive no protection), n-fold fractionation can greatly reduce infection attack rate as long as VE exceeds 1/n. This benefit threshold becomes more stringent if vaccine action is leaky (ie, the susceptibility of each vaccine recipient is reduced by a factor that is equal to the vaccine efficacy). The age cutoff for fractional-dose vaccines chosen by WHO for the Kinshasa vaccination campaign (2 years) provides the largest reduction in infection attack rate if the efficacy of 5-fold fractional-dose vaccines exceeds 20%. Dose fractionation is an effective strategy for reduction of the infection attack rate that would be robust with a
Lundja, J. O.; Decrosta, J. T.; Lechuga, P.
Government schools in Congo kinshasa are not providing quality education to the masses since many years, and this phenomenon has not escaped the eyes of experts, activists, and policy makers. However, there seems to be a general perception that the main, and sometimes even the sole, source of this problem are the low levels of government expenditure of education. And to prove their case supports of this view cite educational expenditure to GDP ratios in Congo kinshasa in comparison with that of some other nations. Though there may be reasonable arguments to increase the level of government expenditure on education, such hijacking of public debate to focus on - the level of expenditure - often overlooks more important issues. Contrary to common perception the level of per student expenditure on government schools in Delhi is reasonable, ranging from Fc.6000 to Fc.12000 p.a. There are a number of organisational deficiencies which do not create checks and balances for appropriate utilization of fund. Moreover, the division of these funds among social groups and for different purposes is also questionable. Though, female literacy lags significantly behind male literacy, about 15% points, extra resources provided for female education are insignificant. And in some schemes such as the one run for 'street children' and 'child labourers', large amounts are budgeted year after year without a single French congolese being spent. Also government schools catering to richer regions of Kinshasa seem to be spending more per child as compared to the poorer counterparts. The paper also proposes an education voucher model, which may have the potential to address some of the issues raised in the paper. Trends in expenditure under some schemes have been studied in relation to the purpose of expenditure. The issue of government expenditure on education is a complex one, and public space should be utilized to discuss them as they are, rather than reducing discussion to dogmatic wars
Kerstiëns, B; Matthys, F
On 6 May 1995, the Médecins sans Frontières (MSF) coordinator in Kinshasa, Democratic Republic of the Congo (DRC), received a request for assistance for what was believed to be a concurrent outbreak of bacillary dysentery and viral hemorrhagic fever (suspected Ebola hemorrhagic fever [EHF]) in the town of Kikwit, DRC. On 11 May, the MSF intervention team assessed Kikwit General Hospital. This initial assessment revealed a nonfunctional isolation ward for suspected EHF cases; a lack of water and electricity; no waste disposal system; and no protective gear for medical staff. The priorities set by MSF were to establish a functional isolation ward to deal with EHF and to distribute protective supplies to individuals who were involved with patient care. Before the intervention, 67 health workers contracted EHF; after the initiation of control measures, just 3 cases were reported among health staff and none among Red Cross volunteers involved in body burial.
Schmidt-Rhaesa, Andreas; Perissinotto, Renzo
Abstract Three females and one male specimen of a previously unconfirmed species of horsehair worms (Nematomorpha) from South Africa are described using Scanning Electron Microscopy. The females correspond to the description of Chordodes ferox Camerano, 1897, a species previously described from the Democratic Republic of the Congo (Congo-Kinshasa) and an adjacent, not further specified region of the Republic of Congo (Congo-Brazzaville). Characteristic is the presence of enlarged and elevated simple areoles around the base of a thorn areole, in combination with further cuticular characters. This is the latest of a total of six species of horsehair worms reported from South Africa so far. Two species of praying mantids, Polyspilota aeruginosa (Goeze, 1778) and Sphodromantis gastrica Stål, 1858, have been identified as hosts of Chordodes ferox, while its distribution range in the region and the period of adult emergence from the host remain largely unknown. PMID:27047243
Schmidt-Rhaesa, Andreas; Perissinotto, Renzo
Three females and one male specimen of a previously unconfirmed species of horsehair worms (Nematomorpha) from South Africa are described using Scanning Electron Microscopy. The females correspond to the description of Chordodes ferox Camerano, 1897, a species previously described from the Democratic Republic of the Congo (Congo-Kinshasa) and an adjacent, not further specified region of the Republic of Congo (Congo-Brazzaville). Characteristic is the presence of enlarged and elevated simple areoles around the base of a thorn areole, in combination with further cuticular characters. This is the latest of a total of six species of horsehair worms reported from South Africa so far. Two species of praying mantids, Polyspilota aeruginosa (Goeze, 1778) and Sphodromantis gastrica Stål, 1858, have been identified as hosts of Chordodes ferox, while its distribution range in the region and the period of adult emergence from the host remain largely unknown.
Diasolua Ngudi, Delphin; Kuo, Yu Haey; Lambein, Fernand
Processed cassava (Manihot esculenta Crantz) roots provide more than 60% of the daily energy intake for the population of the Democratic Republic of Congo. Insufficiently processed cassava roots in a diet deficient in sulfur amino acid have been reported to cause the irreversible paralytic disease konzo, afflicting thousands of women and children in the remote rural areas of Bandundu Province. "Cossettes" (processed cassava roots) purchased in several markets of Kinshasa were analyzed for their content of cyanogens, free amino acids, and total protein amino acids. Residual cyanogen levels were below the safe limit recommended by the codex FAO/WHO for cassava flour (10 mg kg(-1)). The amino acid score was evaluated. Lysine and leucine were the limiting amino acids. Methionine content was very low and contributed about 13% of the total sulfur amino acids. Dietary requirements for sulfur amino acids need to be adjusted for the loss caused by cyanogen detoxification.
The Yaka of southwestern Zaire and the capital, Kinshasa, practise some ten major healing cults with initiatory treatments. These follow the model of rites de passage and lead the patient to resituate him/herself in the group, while partially redramatizing the cosmology and the fundamental values of the society. The body-self is the source and scene of the healing. The therapeutic drama offers a space-time stage upon which metaphoric correspondents of organs, affects, energies and bodily functions are constituted and manipulated. Acting as the patient's maternal uncle, as trapper-hunter, and as demiurge and weaver, the healer aims at fighting the illness by turning it back against itself autodestructively. The initiate is 'reborn' thanks to the emergence of the vital flow, particularly through trance, leading her or him to take up a transformed presence in the world and the group: this is "the weaving of the vital flow."
Parker, L.; Maman, S.; Pettifor, A.; Chalachala, J.L.; Edmonds, A.; Golin, C. E.; Moracco, K.; Behets, F.
Aims The study aimed to understand providers’ role in delivering HIV transmission prevention counseling to youth living with HIV (YLWH). Methods We conducted 14 in-depth interviews with providers in Kinshasa, DRC. Results Providers’ lack of knowledge and comfort in talking to youth about sex because of cultural and religious beliefs about sexuality, coupled with confusion about legal issues related to youth and contraception, made it difficult for them to effectively counsel youth. Implications for practice and policy In order for providers to deliver effective prevention counseling to YLWH, clinics should follow adolescent-friendly clinic standards, provide counseling in an adolescent-friendly style, and institute an effective referral system for additional prevention services. Conclusion HIV prevention services can be improved through the creation of an adolescent-friendly environment and by providing “values clarification” and skill-based trainings so that providers are able to assess the role of their own beliefs and learn new skills. PMID:24409092
Luyeye Mvila, Gertrude; Batalansi, Donatien; Praet, Marleen; Marchal, Guy; Laenen, Annouschka; Christiaens, Marie-Rose; Brouckaert, Olivier; Ali-Risasi, Catherine; Neven, Patrick; Van Ongeval, Chantal
Compared to European women, breast cancers in African women present at a younger age, with a higher tumor grade and are more often estrogen receptor (ER)/progesterone receptor (PR) negative. We here investigate the histopathological and immunohistochemical characteristics (ER, PR and human epidermal growth receptor 2 (HER2)) and the proportion of triple negative (Tneg) invasive breast cancers from an unselected series of patients diagnosed in Kinshasa, and compare them to a population of Caucasian women with a palpable breast cancer. From 2010 till 2013, during the first breast cancer awareness campaign, organized in Kinshasa, 87 patients were diagnosed with invasive breast cancer. Diagnose was based on core biopsy. The control group consisted of Caucasian women (University Hospitals of Leuven, Belgium) with a palpable mass, diagnosed between 2000 till 2009, treated with surgery of which the histopathological and immunohistochemical characteristics were collected on excision specimens. Each patient in the Kinshasa group was matched based on age and tumor size to one or more patients of the Leuven database. Differences between both groups with respect to hormone receptors (ER, PR, HER2, Tneg) or grade are presented as relative risks (RR). The analysis is based on a log-binomial model accounting for clustering through matching by a random intercept for cluster. Differences between both groups with respect to hormone receptors correcting for grade is performed by the inclusion of grade as a covariate in the model. After adjusting for age, tumor volume and tumor grade, ER was more frequently negative (RR = 0.71, p < 0.001), with a trend in the same direction for PR (RR = 0.87, p = 0.057), and HER2 more often positive (RR = 1.60, p = 0.015) compared to the group from the University Hospitals of Leuven. There was no difference in the proportion of breast cancers being triple negative. Sub-analysis showed that the higher HER2 positive rate was only observed in older
Mupenda, Bavon; Duvall, Sandra; Maman, Suzanne; Pettifor, Audrey; Holub, Christina; Taylor, Eboni; Rennie, Stuart; Kashosi, Mujalambo; Lema, Mamie; Behets, Frieda
For this study we conducted in-depth interviews with 29 youth living with HIV (YLWH) and key informant interviews with 8 HIV care/support providers. We describe terms used to portray people living with HIV (PLWH) in Kinshasa, Democratic Republic of the Congo. Labels commonly used, mostly derogatory, described PLWH as walking corpses, dangers to others, or people deserving to die before others get infected. Blame and other accusations were directed at PLWH through anchoring or objectification. Being labeled sometimes made these youth suffer in silence, afraid to disclose their status, or avoid performing actions in public, preferring to let others do them. YLWH need psychosocial support to mitigate the harmful effects of these labels and strengthen their coping skills, whereas community, institutional, and national efforts are needed for stigma reduction. PMID:24463633
Galeazzi, G; Ardoin, F; Petithory, J C; Laurent, C
Infections with 3 species of malaria parasites are rarely encountered and observed in less than 0.05% of cases. We came across such an infection in four year-old, monozygote twin sisters, coming from Kinshasa (Democratic Republic of Congo). In both of them, parasitemia was low or very low for P. falciparum and P. ovale and of 0.1-0.2% for P. malariae. The twin sisters presented with an iron deficiency anaemia, associated with an heterozygous sickle-cell anaemia and a moderate splenomegaly. The biological tests results were similar. They responded well to treatment. We point out the difficulty in recognizing the concomitant presence of several species of hematozoaire on blood smear.
Mulenga, Philippe Cilundika; Kazadi, Alex Bukasa
Penis size is a huge topic of anxiety for a lot of men. Some of them are unhappy with their penis size as shown in the study conducted by Tiggemann in 2008. There are relatively few studies on erect penis size. This may reflect cultural taboos of researchers or doctors interacting with men who are in a state of sexual arousal. On the other hand, it is important for people who announce details on penis size to give the average penis size first and then sizes suggested by the researchers. We performed a cross-sectional survey in the two major urban centres of the Democratic Republic of Congo namely Kinshasa and Lubumbashi over a period of two years from May 2014 to May 2016. A total of 21 information sources constituted our sample, 8 in Kinshasa and 13 in Lubumbashi. We found it sufficient because in our culture discussing about sexual matter is rare. The parameters studied were: the nature of the source, the accuracy of the measurement method, the presence of bibliographical reference, the announced penis size. The majority of information sources used were radio or television broadcastings (23,8%); this can be explained by the fact that there are an increasing number of radio and television stations in our country and especially in large cities. With regard to accuracy of information about penis measurement method when sharing the message about penis size, our study showed that the majority of information sources did not indicate it when they announced penis size to the public (85,7%). Several sources did not report bibliographical references (57,1%). Announced data analysis on penis size showed that the average penis size was: 14 cm (28,6%), 15 cm (23,8%) and 15-20 cm (19%). All these results are intended to offer a warning to all players responsible for diffusing information on sexual health (penis size): scientific rigor consists in seeking information from reliable sources.
Coynel, Alexandra; Seyler, Patrick; Etcheber, Henri; Meybeck, Michel; Orange, Didier
The Congo (Zaire) River, the world's second largest river in terms both of water discharges and of drainage area after the Amazon River, has remained to date in a near-pristine state. For a period between 2 and 6 years, the mainstream near the river mouth (Brazzaville/Kinshasa station) and some of the major and minor tributaries (the Oubangui, Mpoko, and Ngoko-Sangha) were monitored every month for total suspended sediment (TSS), particulate organic carbon (POC), and dissolved organic carbon (DOC). In this large but relatively flat equatorial basin, TSS levels are very low and organic carbon is essentially exported as DOC: from 74% of TOC for the tributaries flowing in savannah regions and 86% for those flowing in the rain forest. The seasonal patterns of TSS, POC, and DOC show clockwise hysteresis in relation to river discharges, with maximum levels recorded 2 to 4 months before peak flows. At the Kinshasa/Brazzaville station, the DOC distribution is largely influenced by the input from the tributaries draining the large marshy forest area located in the center of the basin. There is a marked difference between specific fluxes, threefold higher in the forest basins than in the savannah basins. The computation of inputs to the Atlantic Ocean demonstrates that the Congo is responsible for 14.4 × 106 t/yr of TOC of which 12.4 × 106 t/yr is DOC and 2 × 106 t/yr is POC. The three biggest tropical rivers (the Amazon, the Congo, and the Orinoco), with only 10% of the exoreic world area drained to world oceans, contribute ˜4% of its TSS inputs but 15-18% of its organic carbon inputs. These proportions may double when considering only world rivers discharging into the open ocean.
Classification of very high resolution satellite remote sensing data in a pilot phase of the forest cover classification of the Democratic Republic of Congo, Forêts d'Afrique Central Evaluées par Télédetection (FACET) product
Singa Monga Lowengo, C.
The Observatoire Satellital des Forêts d'Afrique Centrale (OSFAC) based in Kinshasa, serves as the focal point of the GOFC-GOLD network for Central Africa. OSFAC's long term objective is building regional capacity to use remotely sensed data to map forest cover and forest cover change across Central Africa. OSFAC archives and disseminates satellite data, offers training in geospatial data applications in coordination with the University of Kinshasa, and provides technical support to CARPE partners. Forêts d'Afrique Centrale Évaluées par Télédétection (FACET) is an OSFAC initiative that implements the UMD/SDSU methodology at the national level and quantitatively evaluates the spatiotemporal dynamics of forest cover in Central Africa. The multi-temporal series of FACET data is a useful contribution to many projects, such as biodiversity monitoring, climate modeling, conservation, natural resource management, land use planning, agriculture and REDD+. I am working as Remote Sensing and GIS Officer in various projects of OSFAC. My activities include forest cover and lands dynamics monitoring in Congo Basin. I am familiar with the use of digital mapping software, GIS and RS (Arc GIS, ENVI and PCI Geomatica etc.), classification and spatial Analysis of satellite images, 3D modeling, etc. I started as an intern at OSFAC, Assistant Trainer (Professional Training) and Consultant than permanent employee since October 2009. To assist in the OSFAC activities regarding the monitoring of forest cover and the CARPE program in the context of natural resources management, I participated in the development of the FACET Atlas (Republic of Congo). I received data from Matt Hansen (map.img), WRI and Brazzaville (shapefiles). With all these data I draw maps of the ROC Atlas and statistics of forest cover and forest loss. We organize field work on land to collect data to validate the FACET product. Therefore, to assess forest cover in the region of Kwamouth and Kahuzi-Maiko Biega
Background The existence of socio-economic inequalities in child mortality is well documented. African cities grow faster than cities in most other regions of the world; and inequalities in African cities are thought to be particularly large. Revealing health-related inequalities is essential in order for governments to be able to act against them. This study aimed to systematically compare inequalities in child mortality across 10 major African cities (Cairo, Lagos, Kinshasa, Luanda, Abidjan, Dar es Salaam, Nairobi, Dakar, Addis Ababa, Accra), and to investigate trends in such inequalities over time. Methods Data from two rounds of demographic and health surveys (DHS) were used for this study (if available): one from around the year 2000 and one from between 2007 and 2011. Child mortality rates within cities were calculated by population wealth quintiles. Inequality in child mortality was assessed by computing two measures of relative inequality (the rate ratio and the concentration index) and two measures of absolute inequality (the difference and the Erreyger’s index). Results Mean child mortality rates ranged from about 39 deaths per 1,000 live births in Cairo (2008) to about 107 deaths per 1,000 live births in Dar es Salaam (2010). Significant inequalities were found in Kinshasa, Luanda, Abidjan, and Addis Ababa in the most recent survey. The difference between the poorest quintile and the richest quintile was as much as 108 deaths per 1,000 live births (95% confidence interval 55 to 166) in Abidjan in 2011–2012. When comparing inequalities across cities or over time, confidence intervals of all measures almost always overlap. Nevertheless, inequalities appear to have increased in Abidjan, while they appear to have decreased in Cairo, Lagos, Dar es Salaam, Nairobi and Dakar. Conclusions Considerable inequalities exist in almost all cities but the level of inequalities and their development over time appear to differ across cities. This implies that
Alsdorf, D. E.; Beighley, E., II; Lee, H.; Tshimanga, R.; Spencer, R. G.; O'Loughlin, F.
We review the published results on the Congo Basin hydrology and find that there are historic data, ongoing measurement recording efforts, and important model results. Annual rainfall is ~2000 mm/yr along an east-west trend, decreasing northward and southward to ~1100 mm/yr. While some studies show rain gauges at specific locations with declines in P greater than 10% from 1960 to 1990, other studies suggest that basin wide decreases from 1951 to 1993 are modest at 4.5% or that the trend is minimal. Studies during the 1950s using lysimeters, pans, and models suggest that the annual potential ET varies little across the basin at a 1100 mm/yr to 1200 mm/yr. Over the past century, river discharge data has been collected at 100s of stream gauges with historic and recent data at 96 locations now publicly available. Discharge of the Congo River at Kinshasa-Brazzaville experienced an increase of 21% during 1960-1970 in comparison to background values of the previous decades and of today. There does not appear to be a long-term discharge trend over the century of record. Satellite altimetry measurements collected during high and low flows show that the Cuvette Centrale wetland water levels are consistently 0.5m to 3m higher in elevation than the immediately adjacent Congo River levels. Wetland water depths are shallow at about 1m whereas the Congo is typically less than 15m deep everywhere upstream of Kinshasa. The wetlands do not appear to be marked by sizable channels such that the flows are diffusive. CO2 and CH4 evasion from the Congo waters directly to the atmosphere are estimated at 1.6 to 3.2 Tg/yr for CH4 from the Cuvette wetland waters and 105 to 204 g C/m2/yr for CO2 from waters of the Oubangui River. Using these published results, we suggest seven hypotheses that may lead to important water and carbon cycle discoveries. These hypotheses focus on the source of the Cuvette waters and how those waters leave the wetland; on river discharge generated by historic
Stanton, Michelle C.; Bockarie, Moses J.; Kelly-Hope, Louise A.
Vector control, including the use of bed nets, is recommended as a possible strategy for eliminating lymphatic filariasis (LF) in post-conflict countries such as the Democratic Republic of Congo (DRC). This study examined the geographical factors that influence bed net ownership in DRC in order to identify hard-to-reach communities that need to be better targeted. In particular, urban/rural differences and the influence of population density, proximity to cities and health facilities, plus access to major transport networks were investigated. Demographic and Health Survey geo-referenced cluster level data were used to map bed net coverage (proportion of households with at least one of any type of bed net or at least one insecticide-treated net (ITN)), and ITN density (ITNs per person) for 260 clusters. Bivariate and multiple logistic or Poisson regression analyses were used to determine significant relationships. Overall, bed net (30%) and ITN (9%) coverage were very low with significant differences found between urban and rural clusters. In rural clusters, ITN coverage/density was positively correlated with population density (r = 0.25, 0.27 respectively, p<0.01), and negatively with the distance to the two largest cities, Kinshasa or Lubumbashi (r = −0.28, −0.30 respectively, p<0.0001). Further, ownership was significantly negatively correlated with distance to primary national roads and railways (all three measures), distance to main rivers (any bed net only) and distance to the nearest health facility (ITNs only). Logistic and Poisson regression models fitted to the rural cluster data indicated that, after controlling for measured covariates, ownership levels in the Bas-Congo province close to Kinshasa were much larger than that of other provinces. This was most noticeable when considering ITN coverage (odds ratio: 5.3, 95% CI: 3.67–7.70). This analysis provides key insights into the barriers of bed net ownership, which will help inform both LF
Emeville, Elise; Ferdinand, Séverine; Punga, Augustin; Lufuma, Simon; Blanchet, Pascal; Romana, Marc; Multigner, Luc
Background Estrogens are thought to play a critical role in prostate carcinogenesis. It has been suggested that polymorphisms of genes encoding enzymes involved in estrogen metabolism are risk factors for prostate cancer. However, few studies have been performed on populations of African ancestry, which are known to have a high risk of prostate cancer. Objective We investigated whether functional polymorphisms of CYP17, CYP19, CYP1B1, COMT and UGT1A1 affected the risk of prostate cancer in two different populations of African ancestry. Methods In Guadeloupe (French West Indies), we compared 498 prostate cancer patients and 565 control subjects. In Kinshasa (Democratic Republic of Congo), 162 prostate cancer patients were compared with 144 controls. Gene polymorphisms were determined by the SNaPshot technique or short tandem repeat PCR analysis. Logistic regression was used to estimate adjusted odds ratios (OR) and 95% confidence intervals (CI). Results The AA genotype and the A allele of rs4680 (COMT) appeared to be inversely associated with the risk of prostate cancer in adjusted models for both Afro-Caribbean and native African men. For the A allele, a significant inverse association was observed among cases with low-grade Gleason scores and localized clinical stage, in both populations. Conclusions These preliminary results support the hypothesis that polymorphisms of genes encoding enzymes involved in estrogen metabolism may modulate the risk of prostate cancer in populations of African ancestry. PMID:27074016
Pavia, A T; Long, E G; Ryder, R W; Nsa, W; Puhr, N D; Wells, J G; Martin, P; Tauxe, R V; Griffin, P M
Diarrhea and weight loss are common features of pediatric and adult human immunodeficiency type 1 (HIV-1) infection, particularly in developing countries. We studied prospectively episodes of diarrhea in 559 children, ages 10 to 15 months, participating in a longitudinal study of perinatal HIV-1 infection in Kinshasa, Zaire. Children with HIV-1 infection had more frequent episodes of diarrhea and were more likely to present with fever or moderate or severe dehydration and to have persistent or fatal diarrhea. Of 9 HIV-1-positive infants with diarrhea, 3 had enteroadherence factor-positive Escherichia coli, compared with 5 of 74 HIV-1-negative children with diarrhea (P = 0.04); no other pathogen was associated with HIV-1 infection. In a logistic regression model diarrhea was significantly associated with HIV-1 infection in the child, moderate or severe malnutrition and symptoms of acquired immunodeficiency syndrome in the mother. Diarrhea among children with perinatal HIV infection in Zaire is more severe than among uninfected children and is associated with malnutrition and advanced disease in the mother.
Malukisa, J; Collet, M; Bokata, S; Odio, W
Out of the 3,000 species of snakes described in the world, 163 are currently known from D.R. of Congo. We performed a systematic survey in sugar-cane plantations of the Sugar Company of Kwilu-Ngongo (Bas-Congo), located at 160 km South-West from Kinshasa and exploiting nearly 10,000 ha. The plantation is divided into 3 sectors in the middle of which we deposited barrels filled of formaldehyde. All the employees of the Sugar Company of Kwilu-Ngongo were requested to collect encountered snakes and put them in the nearest barrel. Between August 9th and September 21st, 2004, we collected 36 snakes in two different sites, revealing the presence of 3 families and 12 species. The most abundant species in Causus maculatus (47% in the first site--Point 8--and 29% in the second site--Point 13). The most poisonous and dangerous species were captured only in the first site--point 8, and were Dendroaspis jamesoni and Naja melanoleuca, both young.
Lunguya, Octavie; Phoba, Marie-France; Mundeke, Steve Ahuka; Bonebe, Edmonde; Mukadi, Pierre; Muyembe, Jean-Jacques; Verhaegen, Jan; Jacobs, Jan
The diagnosis of typhoid fever (TF) in Kinshasa (DR Congo) was assessed by on-site surveys, external quality assessment (EQA) of the Widal test and a microbiological blood culture surveillance study. In 331/536 (61.8%) health facilities, clinicians diagnosed TF by clinical picture and the Widal test. An EQA on the Widal test consisting of three samples revealed correct scores by respectively 27.1%, 65.6% and 3.1% of 125 participating laboratories. Most (80.9% of 152 laboratories) performed <100 Widal tests per month, with a median sample positivity rate of 32.6% (range 0-90.7%). The Widal test was mostly performed on a single sample and by slide agglutination (89.5% and 97.0% respectively); errors in cold chain and procedures were recorded (not making serial dilutions, estimating titres by the intensity of agglutination). Among 293 prescribers, 52.2% and 40.8% requested the Widal test for treatment follow-up and detection of chronic carriers respectively. Salmonella Typhi was recovered from the blood in 2.4% of 3820 patients suspected as having TF, with non-typhoid Salmonellae and other Enterobacteriaceae accounting for the majority of organisms. In conclusion, clinicians rely highly on the Widal test for the diagnosis of TF and the Widal test is poorly performed and interpreted. Copyright © 2012 Royal Society of Tropical Medicine and Hygiene. Published by Elsevier Ltd. All rights reserved.
Laporte, Nadine; LeMoigne, Jacqueline; Elkan, Paul; Desmet, Olivier; Paget, Dominique; Pumptre, Andrew; Gouala, Patrice; Honzack, Miro; Maisels, Fiona
Central Africa has the second largest unfragmented block of tropical rain forest in the world; it is also one of the largest carbon and biodiversity reservoirs. With nearly one-third of the forest currently allocated for logging, the region is poised to undergo extensive land-use change. Through the mapping of the forests, our Integrated Forest Monitoring System for Central Africa (INFORMS) project aims to monitor habitat alteration, support biodiversity conservation, and promote better land-use planning and forest management. Designed as an interdisciplinary project, its goal is to integrate data acquired from satellites with field observations from forest inventories, wildlife surveys, and socio-economic studies to map and monitor forest resources. This project also emphasizes on collaboration and coordination with international, regional, national, and local partners-including non-profit, governmental, and commercial sectors. This project has been focused on developing remote sensing products for the needs of forest conservation and management, insuring that research findings are incorporated in forest management plans at the national level. The societal impact of INFORMS can be also appreciated through the development of a regional remote sensing network in central Africa. With a regional office in Kinshasa, (www.OSFAC.org), the contribution to the development of forest management plans for 1.5 million hectares of forests in northern Republic of Congo (www.tt-timber.com), and the monitoring of park encroachments in the Albertine region (Uganda and DRC) (www.albertinerift.org).
Omorodion, F I
The manifestation of acquired immune deficiency syndrome (AIDS) all over the world has increased the need for information on the nature and pattern of sexual networking in Africa, where there is a dearth of such information. In the present study, information on the sexual networking of market women in Benin City, Nigeria, was obtained using a questionnaire instrument. The questionnaire covered the sexual, reproductive, and health behaviors of these women. The data revealed that the levels of both premarital and extramarital sexual networking are high. Such a high degree of sexual networking has exposed a number of these women to sexually transmitted diseases. The manifestation of AIDS in this society will be widespread and devastating to the people and the society because these women are in a polygamous relationship in a society that frowns on the use of contraceptives by couples. In addition, controversies surround the correlation between socioeconomic status (SES) and AIDS, geographical areas of prevalence, and the role of prostitutes in the spread of the disease. For example, studies in Africa show that whereas there is no correlation between SES and AIDS in Kinshasa, the attack rate was higher in educated people in Rwanda and Zambia. Moreover, there are predominantly urban outbreaks in other countries, such as Uganda (Piot & Carael, 1988).
Mukwa, L F T; Gillis, A; Vanhese, V; Romay, G; Galzi, S; Laboureau, N; Kalonji-Mbuyi, A; Iskra-Caruana, M L; Bragard, C
Banana bunchy top virus (BBTV), belonging to the genus Babuvirus, is the most devastating and widespread banana virus. Banana and plantain are major crops in terms of household income and food security in Democratic Republic of Congo (DRC). Despite the large area under banana and plantain cultivation in the country, before this study, the genetic characterization of BBTV isolates had only been undertaken for two provinces. In the study presented here, genetic variation in BBTV was assessed from 52 BBTV isolates collected in five out of 11 provinces in DRC (Bandundu, Bas-Congo, Katanga, Kinshasa and Kasaï Oriental) and in two provinces using sequences previously described in databases. Full genome sequencing of DNA-R components was performed, revealing low genetic variation (98-100 % nucleotide identity) among the BBTV isolates detected. The phylogenetic analyses showed that all the DRC isolates were clustered in the South Pacific clade of BBTV. Based on the coding region for the replication initiator protein, haplotype diversity was estimated to be 0.944 ± 0.013, with 30 haplotypes from 68 isolates in DRC. Such diversity shows a haplotype distribution mainly at the sub-regional level in DRC. In addition, the sequence determination from the whole genome of selected isolates confirmed low genetic variation among isolates from seven DRC provinces (97-100 % nucleotide identity). This study strengthened the hypothesis of a single BBTV introduction some time ago, followed by the spread of the virus in the country.
Canossi, A; Piancatelli, D; Aureli, A; Oumhani, K; Ozzella, G; Del Beato, T; Liberatore, G; El Aouad, R; Adorno, D
The aim of this study was to provide genetic and anthropological information on the Chaouya (CH), an Arabic-speaking population living in West Morocco, Atlantic coast (Settat). In 98 unrelated healthy CH volunteers, we first investigated the human leukocyte antigen (HLA) class I and II allele polymorphisms using a sequence-based typing method and examined haplotypes and relatedness of this group to other African and Mediterranean populations. The study showed the close relatedness with Tunisian population and other North Africans, together with a strong influence of various immigrations, mainly Spaniards, French, and Portuguese, as expected. Nevertheless, analysis of class II allele frequencies (afs) showed that Oromo and Amhara Ethiopian groups cluster together with the Berbers and other North Africans, confirming the relationship between these populations (Afro-Asiatic linguistic group, Hamites). South and sub-Saharan Africans cluster separately at a great distance from CH, except the sub-Saharan Bantu population from Congo Kinshasa, which shows a relatively close genetic relationship ascribable to the effect of a diversifying selection. On the other hand, considering HLA class I afs analyses, it was noteworthy that CH grouped together with sub-Saharans, showing a close genetic distance mainly with Ugandas and Kenians Luo.
Taylor, Steve M; Juliano, Jonathan J; Trottman, Paul A; Griffin, Jennifer B; Landis, Sarah H; Kitsa, Paluku; Tshefu, Antoinette K; Meshnick, Steven R
Molecular assays can provide critical information for malaria diagnosis, speciation, and drug resistance, but their cost and resource requirements limit their application to clinical malaria studies. This study describes the application of a resource-conserving testing algorithm employing sample pooling for real-time PCR assays for malaria in a cohort of 182 pregnant women in Kinshasa. A total of 1,268 peripheral blood samples were collected during the study. Using a real-time PCR assay that detects all Plasmodium species, microscopy-positive samples were amplified individually; the microscopy-negative samples were amplified after pooling the genomic DNA (gDNA) of four samples prior to testing. Of 176 microscopy-positive samples, 74 were positive by the real-time PCR assay; the 1,092 microscopy-negative samples were initially amplified in 293 pools, and subsequently, 35 samples were real-time PCR positive (3%). With the real-time PCR result as the referent standard, microscopy was 67.9% sensitive (95% confidence interval [CI], 58.3% to 76.5%) and 91.2% specific (95% CI, 89.4% to 92.8%) for malaria. In total, we detected 109 parasitemias by real-time PCR and, by pooling samples, obviated over 50% of reactions and halved the cost of testing. Our study highlights both substantial discordance between malaria diagnostics and the utility and parsimony of employing a sample pooling strategy for molecular diagnostics in clinical and epidemiologic malaria studies.
Brureau, Laurent; Moningo, Dieudonné; Emeville, Elise; Ferdinand, Séverine; Punga, Augustin; Lufuma, Simon; Blanchet, Pascal; Romana, Marc; Multigner, Luc
Estrogens are thought to play a critical role in prostate carcinogenesis. It has been suggested that polymorphisms of genes encoding enzymes involved in estrogen metabolism are risk factors for prostate cancer. However, few studies have been performed on populations of African ancestry, which are known to have a high risk of prostate cancer. We investigated whether functional polymorphisms of CYP17, CYP19, CYP1B1, COMT and UGT1A1 affected the risk of prostate cancer in two different populations of African ancestry. In Guadeloupe (French West Indies), we compared 498 prostate cancer patients and 565 control subjects. In Kinshasa (Democratic Republic of Congo), 162 prostate cancer patients were compared with 144 controls. Gene polymorphisms were determined by the SNaPshot technique or short tandem repeat PCR analysis. Logistic regression was used to estimate adjusted odds ratios (OR) and 95% confidence intervals (CI). The AA genotype and the A allele of rs4680 (COMT) appeared to be inversely associated with the risk of prostate cancer in adjusted models for both Afro-Caribbean and native African men. For the A allele, a significant inverse association was observed among cases with low-grade Gleason scores and localized clinical stage, in both populations. These preliminary results support the hypothesis that polymorphisms of genes encoding enzymes involved in estrogen metabolism may modulate the risk of prostate cancer in populations of African ancestry.
Ngiyulu, René Makuala; Gini-Ehungu, Jean Lambert; Mbuyi-Muamba, Jean Marie
Background. The aim of this study was to investigate and determine the risk factors associated with poor growth among SCA children. Methods. A cross-sectional study was conducted in Kinshasa, the capital's country. The nutritional status was assessed using the Z scores of the anthropometric indices. Results. We gathered data on the 256 patients, 138 females (53.9%), who entered the study. The mean age at presentation was 8.4 ± 4.9 years of age. Underweight, stunting, and wasting were found, respectively, in 47.7%, 10.5%, and 50.3% of SCA children. A history of hand-foot syndrome, more than 3 blood transfusions, being less than 12 months of age when receiving the first transfusion, more than two severe sickle crises per year, a medical history of severe infections, and the presence of hepatomegaly were associated with poor growth. When comparing sickle cell patients under 12 years of age (n = 159) to a group of 296 age-matched children with normal Hb-AA, a significantly higher proportion of subjects with stunting and underweight were found among SCA. Conclusion. Nutritional status encountered in Congolese sickle cell children has been described for the first time in this study. A high prevalence of poor growth in SCA children was found in our study. PMID:28250985
Acquired immunodeficiency syndrome (AIDS) is believed to have begun in Rwanda with the transmission of green monkey virus to humans; the virus spread among prostitutes and truck drivers along the highways and then to the cities. In the most threatened areas, for example, Kinshasa in Zaire, 20% of the inhabitants are infected. 8% of pregnant women are human immunodeficiency virus (HIV)-positive. Social conditions are important. In Kenya prostitutes who work along the highways are carriers of socially transmitted diseases and genital sores. They are 60-80% HIV-positive. The better-off prostitutes at bars and hotels enjoy better health and fewer contacts and are 30% HIV-positive. It should be possible to develop a vaccine against the AIDS virus, but only a few virologists believe that this can be done within 10 years. Because HIV virus mutates rapidly, many different vaccines would have to be prepared. About 80 countries are cooperating with the World Health Organization to combat HIV and AIDS in Africa. Traveling and working abroad is beginning to be a problem. 15 countries have introduced restrictions on foreign visitors. Swedish midwives have an important role to play in fighting HIV. Their youth counseling activities can spread information about HIV and AIDS. Children who are in early stages of sexuality are probably the most important group to be influenced. It is already too late to begin informing 15-17 year olds about the disease. Midwives should probably be starting much sooner, perhaps even with 10-year olds.
Hanson, Kara; Goodman, Catherine
The World Health Organization guidelines have recommended that all cases of suspected malaria should receive a confirmatory test with microscopy or a malaria rapid diagnostic test (RDT), however evidence from sub-Saharan Africa (SSA) illustrates that only one-third of children under five with a recent fever received a test. The aim of this study was to evaluate availability, price and market share of microscopy and RDT from 2009/11 to 2014/15 in 8 SSA countries, to better understand barriers to improving access to malaria confirmatory testing in the public and private health sectors. Repeated national cross-sectional quantitative surveys were conducted among a sample of outlets stocking anti-malarial medicines and/or diagnostics. In total, 169,655 outlets were screened. Availability of malaria blood testing among all screened public health facilities increased significantly between the first survey wave in 2009/11 and the most recent in 2014/15 in Benin (36.2, 85.4%, p < 0.001), Kenya (53.8, 93.0%, p < 0.001), mainland Tanzania (46.9, 89.9%, p < 0.001), Nigeria (28.5, 86.2%, p < 0.001), Katanga, the Democratic Republic of the Congo (DRC) (76.0, 88.2%, p < 0.05), and Uganda (38.9, 95.6%, p < 0.001). These findings were attributed to an increase in availability of RDTs. Diagnostic availability remained high in Kinshasa (the DRC) (87.6, 97.6%) and Zambia (87.9, 91.6%). Testing availability in public health facilities significantly decreased in Madagascar (88.1, 73.1%, p < 0.01). In the most recent survey round, the majority of malaria testing was performed in the public sector in Zambia (90.9%), Benin (90.3%), Madagascar (84.5%), Katanga (74.3%), mainland Tanzania (73.5%), Uganda (71.8%), Nigeria (68.4%), Kenya (53.2%) and Kinshasa (51.9%). In the anti-malarial stocking private sector, significant increases in availability of diagnostic tests among private for-profit facilities were observed between the first and final survey rounds in Kinshasa (82.1, 94
Parr, Jonathan B; Verity, Robert; Doctor, Stephanie M; Janko, Mark; Carey-Ewend, Kelly; Turman, Breanna J; Keeler, Corinna; Slater, Hannah C; Whitesell, Amy N; Mwandagalirwa, Kashamuka; Ghani, Azra C; Likwela, Joris L; Tshefu, Antoinette K; Emch, Michael; Juliano, Jonathan J; Meshnick, Steven R
Rapid diagnostic tests (RDTs) account for more than two-thirds of malaria diagnoses in Africa. Deletions of the Plasmodium falciparum hrp2 (pfhrp2) gene cause false-negative RDT results and have never been investigated on a national level. Spread of pfhrp2-deleted P. falciparum mutants, resistant to detection by HRP2-based RDTs, would represent a serious threat to malaria elimination efforts. Using a nationally representative cross-sectional study of 7,137 children under five years of age from the Democratic Republic of Congo (DRC), we tested 783 subjects with RDT-/PCR+ results using PCR assays to detect and confirm deletions of the pfhrp2 gene. Spatial and population genetic analyses were employed to examine the distribution and evolution of these parasites. We identified 149 pfhrp2-deleted parasites, representing 6.4% of all P. falciparum infections country-wide (95% confidence interval 5.1-8.0%). Bayesian spatial analyses identified statistically significant clustering of pfhrp2 deletions near Kinshasa and Kivu. Population genetic analysis revealed significant genetic differentiation between wild-type and pfhrp2-deleted parasite populations (GST = .046, p ≤ .00001). Pfhrp2-deleted P. falciparum is a common cause of RDT-/PCR+ malaria among asymptomatic children in the DRC and appears to be clustered within select communities. Surveillance for these deletions is needed, and alternatives to HRP2-specific RDTs may be necessary.
Liesse Iyamba, J M; Seil, M; Nagant, C; Dulanto, S; Deplano, A; El Khattabi, C; Takaisi Kikuni, N B; Dehaye, J P
The effect of EGTA on the adhesion and on the formation of a biofilm by two reference and eight clinical strains of Staphylococcus aureus was studied. All the clinical strains were isolated from patients from Kinshasa. Spa typing confirmed that these clinical strains were distinct. The Biofilm Ring Test (BFRT®) showed that EGTA (100 µM-10 mM) inhibited the adhesion of the four clinical methicillin-resistant (MRSA) strains and the crystal violet staining method that it inhibited the formation of a biofilm by all the strains. Divalent cations abolished the effect of EGTA on the formation of a biofilm, specially in the clinical MRSA strains. EGTA had no effect on established biofilms. Only concentrations of EGTA higher than 10 mM were toxic to eukaryotic cells. Our results establish the effectiveness and the safety of lock solutions with EGTA to prevent the formation in vitro of biofilms by S. aureus. © 2014 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.
Junqueira, Dennis Maletich; Almeida, Sabrina Esteves de Matos
Human migration is a major process that shaped the origin and dissemination of HIV. Within HIV-1, subtype B (HIV-1B) is the most disseminated variant and it is assumed to be the causative agent in approximately 11% of all cases of HIV worldwide. Phylogenetic studies have revealed that HIV-1B emerged in Kinshasa (Africa) and was introduced into the Caribbean region via Haiti in or around 1966 by human migration. After localized dispersion, the virus was brought to the United States of America via homosexual/bisexual contact around 1969. Inside USA, the incidence of HIV-1B infection increased exponentially and it became established in the population, affecting not only homosexual individuals but also heterosexual individuals and injecting drug users. Soon after, the virus was disseminated and became established in other regions, including Europe, Asia, Latin America, and Australia. Recent studies suggest that, in addition to this pandemic clade, several lineages have emerged from Haiti and reached other Caribbean and Latin American countries via short-distance dissemination. Different subtype B genetic variants have also been detected in these epidemics. Four genetic variants have been described to date: subtype B', which mainly circulates in Thailand and other Asian countries; a specific variant mainly found in Trinidad and Tobago; the GPGS variant, which is primarily detected in Korea; and the GWGR variant, which is mainly detected in Brazil. This paper reviews the evolution of HIV-1B and its impact on the human population.
Carrel, Margaret; Janko, Mark; Mwandagalirwa, Melchior Kashamuka; Morgan, Camille; Fwamba, Franck; Muwonga, Jérémie; Tshefu, Antoinette K.; Meshnick, Steven; Emch, Michael
The Democratic Republic of the Congo (DRC) has one of the lowest HIV prevalence in sub-Saharan Africa, estimated at 1.1% [0.9-1.3] of adults aged 15-49 in 2013 (UNAIDS). Within the 2 million km2 country, however, there exists spatial variation in HIV prevalence, with the highest HIV prevalence observed in the large cities of Kinshasa and Lubumbashi. Globally, HIV is an increasingly rural disease, diffusing outwards from urban centers of high HIV prevalence to places where HIV was previously absent or present at very low levels. Utilizing data collected during Demographic and Health Surveillance (DHS) in 2007 and 2013 in the DRC, we sought to update the map of HIV prevalence in the DRC as well as to explore whether HIV in the DRC is an increasingly rural disease or remains confined to urban areas. Bayesian kriging and regression indicate that HIV prevalence in rural areas of the DRC is higher in 2013 than in 2007 and that increased distance to an urban area is no longer protective against HIV as it was in 2007. These findings suggest that HIV education, testing and prevention efforts need to diffuse from urban to rural areas just as HIV is doing. PMID:26974234
The last studies concerning some main Congo basin rivers allowed to subdivide their multi-annual flows into several homogeneous phases. As in West Africa, 1970 was the year of the major hydroclimatic event announcing a weaker flowing period. In the absence of long, reliable and available flow series in the whole Congo basin of 3,8 106km2 area, the present study concerns only the Congo River at Brazzaville/Kinshasa and two of the main tributaries of its right bank, Ubangui at Bangui and Sangha at Ouesso, with hydrologic data available from the first half of the 20th century. For Congo River, in comparison with its secular average, after an excess flow noted during the sixties, a significant drop of 10% occurs in the eighties. However, a return to normal conditions is recorded from 1995. For Ubangui and Sangha, the flows remain weaker since 1970. Within the bi-modal hydrological regimes of Sangha and Congo river, because they are equatorial, we also observe since many years a small decline of the secondary flood of april-june. This phenomenon was emphasized especially these last years and is founded in others rivers of Central Africa, where it reflects the variations of de rainfall patterns and the surfaces features. For the Congo basin, the situation is worrying because that affects the inland waterway transport. Moreover that wakes also the project of junction by a canal of the Congo and Chari basins for fighting against the hydrological decline of Lake Chad.
Ntumba, Patient; Lotoy, Vianney; Djungu, Saint Jean; Fleury, Rolland; Petitdidier, Monique; Gemünd, André; Schwichtenberg, Horst
GPS networks for scientific studies are developed all other the world and large databases, regularly updated, like IGS are also available. Many GPS have been installed in West and Central Africa during AMMA (African Monsoon Multiplidisciplinary Analysis), IHY (International heliophysical Year)and many other projects since 2005. African scientists have been educated to use those data especially for meteorological and ionospheric studies. The annual variations of ionospheric parameters for a given station or map of a given region are very intensive computing. Then grid or cloud computing may be a solution to obtain results in a relatively short time. Real time At the University of Kinshasa the chosen solution is a grid of several PCs. It has been deployed by using Globus Toolkit on a Condor pool in order to support the processing of GPS data for ionospheric studies. To be user-friendly, graphical user interfaces(GUI) have been developed to help the user to prepare and submit jobs. One is a java GUI for desktop client, the other is an Android GUI for mobile client. The interest of a grid is the possibility to send a bunch of jobs with an adequate agent control in order to survey the job execution and result storage. After the feasibility study the grid will be extended to a larger number of PCs. Other solutions will be in parallel explored.
Peterman, Amber; Palermo, Tia; Bredenkamp, Caryn
We sought to provide data-based estimates of sexual violence in the Democratic Republic of Congo (DRC) and describe risk factors for such violence. We used nationally representative household survey data from 3436 women selected to answer the domestic violence module who took part in the 2007 DRC Demographic and Health Survey along with population estimates to estimate levels of sexual violence. We used multivariate logistic regression to analyze correlates of sexual violence. Approximately 1.69 to 1.80 million women reported having been raped in their lifetime (with 407 397-433 785 women reporting having been raped in the preceding 12 months), and approximately 3.07 to 3.37 million women reported experiencing intimate partner sexual violence. Reports of sexual violence were largely independent of individual-level background factors. However, compared with women in Kinshasa, women in Nord-Kivu were significantly more likely to report all types of sexual violence. Not only is sexual violence more generalized than previously thought, but our findings suggest that future policies and programs should focus on abuse within families and eliminate the acceptance of and impunity surrounding sexual violence nationwide while also maintaining and enhancing efforts to stop militias from perpetrating rape.
Kadima, Bertin Tshimanga; Gini Ehungu, Jean Lambert; Ngiyulu, René Makwala; Ekulu, Pépé Mfutu; Aloni, Michel Ntetani
Neonatal screening for sickle cell anaemia is not common practice in the Democratic Republic of Congo, and we determined the prevalence in children with unknown electrophoresis of haemoglobin and anaemia. A cross-sectional study was conducted in four hospitals in the country's capital Kinshasa. We screened 807 patients with anaemia (Hb < 6 g/dL) for sickle cell disease. The overall mean age at presentation was 42.7 months ± 29.7 months, and most patients (76.3%) were less than five years of age, with a peak incidence at seven to 36 months of age (45%). The median age at the first transfusion was 29 months (range 4-159 months). Of these 807 children, 36 (4.5%) were homozygous for haemoglobin S disease and 45 (5.6%) were heterozygotes. The proportion of patients with homozygous sickle cell anaemia was slightly higher in children with a medical history of hand foot syndrome, in children who had received more than three transfusions and in children up to 36 months of age at their first transfusion. The high prevalence of sickle cell anaemia in children in Sub-Saharan Africa underlines the need for neonatal screening or, if that is not possible, screening of all children with severe anaemia to identify patients with the disease and provide early management. ©2015 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.
Biey, E M; Musibono, E D; Verstraete, W
Vegetable fruit garden wastes were treated anaerobically using a multistage Dranco system. The digesters were composed of three 50 L vessels kept in mesophilic conditions. They were operating at 14.5-17% TS. By controlling the pH in the system, the start-up for biogas production was shortened to 60 days. The pH correction was a buffering which enhanced methanogenic activity in the digesters. With a loading rate of 4.1 kg VS/m3 reactor/day, the production of biogas was 5 m3/m3 reactor/ day, and 60-70% methane content. This allowed making a multisystem by starting every 3 weeks with new vessels in order to maintain biogas production, to be used in industries or in local communities in low-tech countries. The designed model was started in Kinshasa (Congo) where a project is expected to treat one ton of solid waste on a daily basis, for a production of 100 m3 biogas. This cost effectiveness of the system is demonstrated and presents the opportunity for biowaste treatment coupled with environmental protection and substantial energy recovery.
Palermo, Tia; Bredenkamp, Caryn
Objectives. We sought to provide data-based estimates of sexual violence in the Democratic Republic of Congo (DRC) and describe risk factors for such violence. Methods. We used nationally representative household survey data from 3436 women selected to answer the domestic violence module who took part in the 2007 DRC Demographic and Health Survey along with population estimates to estimate levels of sexual violence. We used multivariate logistic regression to analyze correlates of sexual violence. Results. Approximately 1.69 to 1.80 million women reported having been raped in their lifetime (with 407 397–433 785 women reporting having been raped in the preceding 12 months), and approximately 3.07 to 3.37 million women reported experiencing intimate partner sexual violence. Reports of sexual violence were largely independent of individual-level background factors. However, compared with women in Kinshasa, women in Nord-Kivu were significantly more likely to report all types of sexual violence. Conclusions. Not only is sexual violence more generalized than previously thought, but our findings suggest that future policies and programs should focus on abuse within families and eliminate the acceptance of and impunity surrounding sexual violence nationwide while also maintaining and enhancing efforts to stop militias from perpetrating rape. PMID:21566049
Kadima, Bertin Tshimanga; Gini-Ehungu, Jean Lambert; Mbutiwi, Fiston Ikwa Ndol; Bahati, John Tunda; Aloni, Michel Ntetani
In the Democratic Republic of Congo, the incidence of sickle cell anemia (SCA) is estimated around 40 000 neonates per year. However, it is notoriously difficult to perform conventional electrophoresis in all hospitals and laboratories, especially at peripheral levels and rural area. A panel of multiple clinical and laboratory features that would enhance sickle cell disease were assessed for the detection of the disease in highly resource-scarce settings. A prospective study was conducted in Kinshasa. Venous blood samples were drawn from each study participant in order to determine the hematologic parameters, the peripheral smears, and the hemoglobin electrophoresis. We used Cohen's κ statistic to examine the agreement of each variable and diagnosis of sickle cell disease. A total of 807 patients were screened for sickle cell disease. Among these 807 children, 36 (4.5%) were homozygous for Hb S disease. The presence of at least 8% erythroblasts (PPV: 91%, NPV: 99%, sensitivity: 83.3%, specificity: 99.6%, κ value: .86) and sickle cells (PPV:100%, NPV: 98%, sensitivity: 50%, specificity: 100%, κ value: .66) in the peripheral blood smear had an acceptable agreement for sickle cell disease. These two biological markers may guide the clinician in the decision-making to initiate the management of the children as a sickle cell patient, pending confirmation of the disease by electrophoresis techniques. © 2017 Wiley Periodicals, Inc.
In comparison with the commercially available ELISA test for HIV, new more appropriate tests for use in African locales are being supported by USAID, PATH, the International Development Research Center of Canada and the Rockefeller Foundation. ELISA tests are suited for high volume, high technology, automation, data management, accuracy, and cost about US$1 per test. In contrast, tests for African laboratories must be inexpensive, suitable for small numbers of tests, possibly no refrigeration or electricity, and unsophisticated technicians. a series of 5 prototype tests designed for african laboratories been evaluated at the Mama Yemo Hospital, Kinshasa, Zaire, under the auspices of Diagnostic Technology for Community Health (USAID-funded) and managed by PATH. Results comparable to those with ELISA could be achieved with duplicate testing, but the cost remained about the same. to lower final costs, development and overhead for the supplier must be carried by donor funds. With there criteria in mind, PATH is working on a public sector HIV test taking 30 minutes, costing US$.25 per test, requiring minimal equipment and training. A test using an 8-well blank with a comb containing solid phase HIV gp41 peptide, and read by color development, has shown promise. If it can be produced locally, it will cost about $US.14 per test. Such low-cost test kits may even cause the price of commercially available HIV tests to decline.
de Sousa, João Dinis; Alvarez, Carolina; Vandamme, Anne-Mieke; Müller, Viktor
HIV-1 M originated from SIVcpz endemic in chimpanzees from southeast Cameroon or neighboring areas, and it started to spread in the early 20th century. Here we examine the factors that may have contributed to simian-to-human transmission, local transmission between humans, and export to a city. The region had intense ape hunting, social disruption, commercial sex work, STDs, and traffic to/from Kinshasa in the period 1899–1923. Injection treatments increased sharply around 1930; however, their frequency among local patients was far lower than among modern groups experiencing parenteral HIV-1 outbreaks. Recent molecular datings of HIV-1 M fit better the period of maximal resource exploitation and trade links than the period of high injection intensity. We conclude that although local parenteral outbreaks might have occurred, these are unlikely to have caused massive transmission. World War I led to additional, and hitherto unrecognized, risks of HIV-1 emergence. We propose an Enhanced Heterosexual Transmission Hypothesis for the origin of HIV-1 M, featuring at the time and place of its origin a coincidence of favorable co-factors (ape hunting, social disruption, STDs, and mobility) for both cross-species transmission and heterosexual spread. Our hypothesis does not exclude a role for parenteral transmission in the initial viral adaptation. PMID:23202448
Rojkoff, Sébastien; Perissinotto, Renzo
Abstract New material collected recently throughout the Afrotropical region has led to a major reassessment of taxa within the genera Anelaphinis Kolbe, 1892, Atrichelaphinis Kraatz, 1898 and other closely related genera. As a result, the name Megalleucosma Antoine, 1989 is here synonymised with Anelaphinis and a lectotype is designated for the type species, Cetonia dominula Harold, 1879. The genus Atrichelaphinis is redefined and a new subgenus, Atrichelaphinis (Eugeaphinis), is proposed for Elaphinis simillima Ancey, 1883, Elaphinis vermiculata Fairmaire, 1894, Niphetophora rhodesiana Péringuey, 1907, Atrichelaphinis deplanata Moser, 1907 (with Anelaphinis kwangensis Burgeon, 1931 as junior synonym) and Anelaphinis sternalis Moser, 1914. Additionally, three new species and one new subspecies are recognised and described in this new subgenus: Atrichelaphinis (Eugeaphinis) bomboesbergica sp. n. from South Africa; Atrichelaphinis (Eugeaphinis) bjornstadi sp. n. from Tanzania; Atrichelaphinis (Eugeaphinis) garnieri sp. n. from south–east Africa (Tanzania, Zimbabwe); and Atrichelaphinis (Eugeaphinis) deplanata minettii ssp. n. from central Africa (Malawi, Mozambique, Congo-Kinshasa, Congo-Brazzaville, South Africa, Rwanda, Zambia, Zimbabwe). The genus Atrichelaphinis is compared to its closest relatives and two separate keys are proposed, one for Atrichelaphinis and one for the sub-Saharan genera exhibiting completely or partially fused parameres. PMID:25709532
Wilburn, David R.
The global mining industry has invested a large amount of capital in mineral exploration and development over the past 15 years in an effort to ensure that sufficient resources are available to meet future increases in demand for minerals. Exploration data have been used to identify specific sites where this investment has led to a significant contribution in global mineral supply of cobalt or where a significant increase in cobalt production capacity is anticipated in the next 5 years. This report provides an overview of the cobalt industry, factors affecting mineral supply, and circumstances surrounding the development, or lack thereof, of key mineral properties with the potential to affect mineral supply. Of the 48 sites with an effective production capacity of at least 1,000 metric tons per year of cobalt considered for this study, 3 producing sites underwent significant expansion during the study period, 10 exploration sites commenced production from 1995 through 2008, and 16 sites were expected to begin production by 2013 if planned development schedules are met. Cobalt supply is influenced by economic, environmental, political, and technological factors affecting exploration for and production of copper, nickel, and other metals as well as factors affecting the cobalt industry. Cobalt-rich nickel laterite deposits were discovered and developed in Australia and the South Pacific and improvements in laterite processing technology took place during the 1990s and early in the first decade of the 21st century when mining of copper-cobalt deposits in Congo (Kinshasa) was restricted because of regional conflict and lack of investment in that country's mining sector. There was also increased exploration for and greater importance placed on cobalt as a byproduct of nickel mining in Australia and Canada. The emergence of China as a major refined cobalt producer and consumer since 2007 has changed the pattern of demand for cobalt, particularly from Africa and
Mulenga, Philippe Cilundika; Kazadi, Alex Bukasa
Introduction La taille du pénis constitue une préoccupation de beaucoup des gens actuellement et certains ne sont pas satisfaits de la dimension de leur pénis comme le montre l’étude de Tiggemann en 2008. Il existe relativement peu d'études sur le pénis en érection. Cela peut refléter les tabous culturels des chercheurs ou des médecins en interaction avec les hommes qui sont dans un état d’excitation sexuelle. Toutes fois, il est important pour les personnes qui annoncent des détails sur la taille du pénis d’annoncer d’abord les repères de la mesure du pénis puis ensuite donner les chiffres que proposent les chercheurs. Méthodes Notre enquête de type descriptif transversale s’est effectuée dans les deux grandes villes de la République Démocratique du Congo à savoir la ville de Kinshasa et la ville de Lubumbashi, pendant une période de deux ans soit de Mai 2014 à Mai 2016. Au total, 21 sources d’information ont constitué notre échantillon dont 8 à Kinshasa et 13 à Lubumbashi et nous avons trouvé cela suffisant car les sujets à caractère sexuel sont souvent rares chez nous. Les paramètres étudiés étaient: la nature de la source, la précision de la technique de la mesure, la présence de référence bibliographique, la longueur annoncée du pénis. Résultats La majorité des sources d’information sont faites des émissions de radio et de télévision (23,8%), ceci pourra s’expliquer par le fait que dans notre milieu il y a de plus en plus des chaines de radio et télévision et surtout dans les grandes villes. Concernant la précision de la technique de la mesure du pénis lors du partage du message sur la taille du pénis, l’étude nous montre que la majorité des sources d’information ne signale pas cela lorsqu’elles annoncent la taille du pénis au public soit 85,7%. Plusieurs sources ne déclarent pas les références bibliographiques (57,1%). Lorsqu’on regarde même les chiffres de la taille du p
Health communicators use entertainment and mass media to prevent HIV transmission. Population Services International operates an AIDS Mass Media Project as an adjunct to its Condom Social Marketing Project. It collaborates with the Government of Zaire's National AIDS Program. Its 1st target is urban youth because most AIDS cases in Zaire were infected as teenagers, urban youth have access to television (TV), and they take part in high risk sexual behavior. The project uses various AIDS songs to reach this group. A 6-month posttest shows that the 1st song was so effective that 65% heard it and that 93% of them recalled the major AIDS messages and 85% said that they changed their behavior. The project distributes a video of the 1990 World AIDS Day concert. Research in Zaire and other African countries shows that the threat AIDS poses to children's health strongly motivates parents' behavior. Thus the 2nd target is the 20-30 year old group--young and prospective parents. The project boasts a 4-part TV series about a groom who does not reveal his AIDS status to his young bride until after their wedding night. 2 scenes stress the benefits of condoms. After its 1st airing, 66% of the 20-30 year old group in Kinshasa watched all 4 parts of the series. Of these, about 75% said they would change their behavior. Most people in Zaire change behavior by using condoms. Indeed, during the mass media campaign, condom sales grew 1000% which saved almost 7200 lives. The project also features comic strips informing working men and women and teenagers about AIDS and distributes an inexpensive notebook listening AIDS facts and myths for school children. The project uses regional radio stations to broadcast 28 AIDS feature programs, 22 radio spots, 8 AIDS radio dramas, and 2 songs to high priority rural areas. These AIDS radio efforts have indeed influenced AIDS knowledge and attitudes.
Patel, M R; Nana, M; Yotebieng, M; Tabala, M; Behets, F; Van Rie, A
Five primary health care clinics in Kinshasa, Democratic Republic of Congo. To examine timing and predictors of delayed initiation of antiretroviral therapy (ART) during anti-tuberculosis treatment. Prospective observational cohort of adult patients receiving integrated treatment for tuberculosis (TB) and human immunodeficiency virus (HIV) who are expected to initiate ART at 1 month if CD4 count is <100 cells/mm(3) or if patient is World Health Organization (WHO) Clinical Stage 4 for reasons other than extra-pulmonary TB, at 2 months if CD4 count is 100-350 cells/mm(3), or at completion of anti-tuberculosis treatment if subsequently CD4 count is ≤ 350 cells/mm(3) or patient has WHO Clinical Stage 4. Of 492 patients, 235 (47.8%) experienced delayed initiation of ART: 171 (72.8%) initiated ART late, after a median delay of 12 days (interquartile range [IQR] 4-27) and 64 (27.2%) never initiated ART. Contraindication to any antiretroviral drug (aOR 2.91, 95%CI 1.22-6.95), lower baseline CD4 count (aOR 1.20, 95%CI 1.08-1.33/100 cells/mm(3)), TB drug intolerance (aOR 1.93, 95%CI 1.23-3.02) and non-disclosure of HIV infection (aOR 1.50, 95%CI 1.03-2.18) predicted delayed ART initiation. Despite fully integrated treatment, half of all patients experienced delayed ART initiation. Pragmatic approaches to ensure timely ART initiation in those at risk of delayed ART initiation are needed.
de Sousa, João Dinis; Müller, Viktor; Lemey, Philippe; Vandamme, Anne-Mieke
The processes that permitted a few SIV strains to emerge epidemically as HIV groups remain elusive. Paradigmatic theories propose factors that may have facilitated adaptation to the human host (e.g., unsafe injections), none of which provide a coherent explanation for the timing, geographical origin, and scarcity of epidemic HIV strains. Our updated molecular clock analyses established relatively narrow time intervals (roughly 1880–1940) for major SIV transfers to humans. Factors that could favor HIV emergence in this time frame may have been genital ulcer disease (GUD), resulting in high HIV-1 transmissibility (4–43%), largely exceeding parenteral transmissibility; lack of male circumcision increasing male HIV infection risk; and gender-skewed city growth increasing sexual promiscuity. We surveyed colonial medical literature reporting incidences of GUD for the relevant regions, concentrating on cities, suffering less reporting biases than rural areas. Coinciding in time with the origin of the major HIV groups, colonial cities showed intense GUD outbreaks with incidences 1.5–2.5 orders of magnitude higher than in mid 20th century. We surveyed ethnographic literature, and concluded that male circumcision frequencies were lower in early 20th century than nowadays, with low rates correlating spatially with the emergence of HIV groups. We developed computer simulations to model the early spread of HIV-1 group M in Kinshasa before, during and after the estimated origin of the virus, using parameters derived from the colonial literature. These confirmed that the early 20th century was particularly permissive for the emergence of HIV by heterosexual transmission. The strongest potential facilitating factor was high GUD levels. Remarkably, the direct effects of city population size and circumcision frequency seemed relatively small. Our results suggest that intense GUD in promiscuous urban communities was the main factor driving HIV emergence. Low circumcision rates
de Sousa, João Dinis; Müller, Viktor; Lemey, Philippe; Vandamme, Anne-Mieke
The processes that permitted a few SIV strains to emerge epidemically as HIV groups remain elusive. Paradigmatic theories propose factors that may have facilitated adaptation to the human host (e.g., unsafe injections), none of which provide a coherent explanation for the timing, geographical origin, and scarcity of epidemic HIV strains. Our updated molecular clock analyses established relatively narrow time intervals (roughly 1880-1940) for major SIV transfers to humans. Factors that could favor HIV emergence in this time frame may have been genital ulcer disease (GUD), resulting in high HIV-1 transmissibility (4-43%), largely exceeding parenteral transmissibility; lack of male circumcision increasing male HIV infection risk; and gender-skewed city growth increasing sexual promiscuity. We surveyed colonial medical literature reporting incidences of GUD for the relevant regions, concentrating on cities, suffering less reporting biases than rural areas. Coinciding in time with the origin of the major HIV groups, colonial cities showed intense GUD outbreaks with incidences 1.5-2.5 orders of magnitude higher than in mid 20(th) century. We surveyed ethnographic literature, and concluded that male circumcision frequencies were lower in early 20(th) century than nowadays, with low rates correlating spatially with the emergence of HIV groups. We developed computer simulations to model the early spread of HIV-1 group M in Kinshasa before, during and after the estimated origin of the virus, using parameters derived from the colonial literature. These confirmed that the early 20(th) century was particularly permissive for the emergence of HIV by heterosexual transmission. The strongest potential facilitating factor was high GUD levels. Remarkably, the direct effects of city population size and circumcision frequency seemed relatively small. Our results suggest that intense GUD in promiscuous urban communities was the main factor driving HIV emergence. Low circumcision rates
Alsdorf, D. E.; Beighley, E.; Laraque, A.; Lee, H.; Tshimanga, R.; O'Loughlin, F.; Mahe, G. M.; Dinga, B. J.; Moukandi, G.; Spencer, R.
We review the published results on the Congo Basin hydrology and summarize the historic and ongoing research. Annual rainfall is 1900 mm/yr along an east-west trend across the basin, decreasing northward and southward to 1100 mm/yr. Historic studies using lysimeters, pans, and models suggest that the annual potential evapotranspiration varies little across the basin at 1100 to 1200 mm/yr. Over the past century, river discharge data have been collected at hundreds of stream gauges with historic and recent data at 96 locations now publicly available. Congo River discharge at Kinshasa-Brazzaville experienced an increase of 21% during the 1960-1970 decade in comparison to most other decades. Satellite altimetry measurements of high and low flows show that water levels in the "Cuvette Centrale" wetland are 0.5m to 3.0m higher in elevation than the immediately adjacent Congo River levels. Wetland water depths are shallow at about a meter and there does not appear to be many sizable channels across the "Cuvette"; thus, wetland flows are diffusive. Cuvette waters alone are estimated to emit about 0.5 Pg CH4 and CO2 equivalents/yr, an amount that is significant compared to global carbon evasions. Using these results, we suggest seven hypotheses that focus on the source of the Cuvette waters and how these leave the wetland, on the river discharge generated by historic rainfall, on the connection between climate change and the rainfall-runoff generated by the migrating "tropical rainbelt," on deforestation and hydroelectric power generation, and on the amount of carbon emitted from Congo waters.
Patel, Monita R.; Westreich, Daniel; Yotebieng, Marcel; Nana, Mbonze; Eron, Joseph J.; Behets, Frieda; Van Rie, Annelies
Among patients with tuberculosis and human immunodeficiency virus type 1, CD4-stratified initiation of antiretroviral therapy (ART) is recommended, with earlier ART in those with low CD4 counts. However, the impact of implementation fidelity to this recommendation is unknown. We examined a prospective cohort study of 395 adult patients diagnosed with tuberculosis and human immunodeficiency virus between August 2007 and November 2009 in Kinshasa, Democratic Republic of the Congo. ART was to be initiated after 1 month of tuberculosis treatment at a CD4 count of <100 cells/mm3 or World Health Organization stage 4 (other than extrapulmonary tuberculosis) and after 2 months of tuberculosis treatment at a CD4 count of 100–350 cells/mm3. We used the parametric g-formula to estimate the impact of implementation fidelity on 6-month mortality. Observed implementation fidelity was low (46%); 54% of patients either experienced delays in ART initiation or did not initiate ART, which could be avoided under perfect implementation fidelity. The observed mortality risk was 12.0% (95% confidence interval (CI): 8.2, 15.7); under complete (counterfactual) implementation fidelity, the mortality risk was 7.8% (95% CI: 2.4, 12.3), corresponding to a risk reduction of 4.2% (95% CI: 0.3, 8.1) and a preventable fraction of 35.1% (95% CI: 2.9, 67.9). Strategies to achieve high implementation fidelity to CD4-stratified ART timing are needed to maximize survival benefit. PMID:25787266
Li, Daniel; Wilkins, Kimberly; McCollum, Andrea M.; Osadebe, Lynda; Kabamba, Joelle; Nguete, Beatrice; Likafi, Toutou; Balilo, Marcel Pie; Lushima, Robert Shongo; Malekani, Jean; Damon, Inger K.; Vickery, Michael C. L.; Pukuta, Elisabeth; Nkawa, Frida; Karhemere, Stomy; Tamfum, Jean-Jacques Muyembe; Okitolonda, Emile Wemakoy; Li, Yu; Reynolds, Mary G.
Monkeypox virus (MPXV), a zoonotic orthopoxvirus (OPX), is endemic in the Democratic Republic of Congo (DRC). Currently, diagnostic assays for human monkeypox (MPX) focus on real-time quantitative polymerase chain reaction (PCR) assays, which are typically performed in sophisticated laboratory settings. Herein, we evaluated the accuracy and utility of a multiplex MPX assay using the GeneXpert platform, a portable rapid diagnostic device that may serve as a point-of-care test to diagnose infections in endemic areas. The multiplex MPX/OPX assay includes a MPX-specific PCR test, OPX-generic PCR test, and an internal control PCR test. In total, 164 diagnostic specimens (50 crusts and 114 vesicular swabs) were collected from suspected MPX cases in Tshuapa Province, DRC, under national surveillance guidelines. The specimens were tested with the GeneXpert MPX/OPX assay and an OPX PCR assay at the Institut National de Recherche Biomedicale (INRB) in Kinshasa. Aliquots of each specimen were tested in parallel with a MPX-specific PCR assay at the Centers for Disease Control and Prevention. The results of the MPX PCR were used as the gold standard for all analyses. The GeneXpert MPX/OPX assay performed at INRB had a sensitivity of 98.8% and specificity of 100%. The GeneXpert assay performed well with both crust and vesicle samples. The GeneXpert MPX/OPX test incorporates a simple methodology that performs well in both laboratory and field conditions, suggesting its viability as a diagnostic platform that may expand and expedite current MPX detection capabilities. PMID:27994107
Alsdorf, Douglas; Beighley, Ed; Laraque, Alain; Lee, Hyongki; Tshimanga, Raphael; O'Loughlin, Fiachra; Mahé, Gil; Dinga, Bienvenu; Moukandi, Guy; Spencer, Robert G. M.
We review the published results on the Congo Basin hydrology and summarize the historic and ongoing research. Annual rainfall is ~1900 mm/yr along an east-west trend across the basin, decreasing northward and southward to ~1100 mm/yr. Historic studies using lysimeters, pans, and models suggest that the annual potential evapotranspiration varies little across the basin at 1100 to 1200 mm/yr. Over the past century, river discharge data have been collected at hundreds of stream gauges with historic and recent data at 96 locations now publicly available. Congo River discharge at Kinshasa-Brazzaville experienced an increase of 21% during the 1960-1970 decade in comparison to most other decades. Satellite altimetry measurements of high and low flows show that water levels in the "Cuvette Centrale" wetland are 0.5 m to 3.0 m higher in elevation than the immediately adjacent Congo River levels. Wetland water depths are shallow at about a meter and there does not appear to be many sizable channels across the "Cuvette"; thus, wetland flows are diffusive. Cuvette waters alone are estimated to emit about 0.5 Pg CH4 and CO2 equivalents/yr, an amount that is significant compared to global carbon evasions. Using these results, we suggest seven hypotheses that focus on the source of the Cuvette waters and how these leave the wetland, on the river discharge generated by historic rainfall, on the connection between climate change and the rainfall-runoff generated by the migrating "tropical rainbelt," on deforestation and hydroelectric power generation, and on the amount of carbon emitted from Congo waters.
Molinario, G.; Hansen, M.; Potapov, P.; Altstatt, A. L.; Justice, C. O.
The FACET forest cover and forest cover loss 2000-2005-2010 data set has been produced by South Dakota State University, the University of Maryland and the Kinshasa-based Observatoire Satellital des Forets D'Afrique Central (OSFAC) with funding from the USAID Central African Regional Program for the Environment (CARPE). The product is now available or being finalized for the DRC, the ROC and Gabon with plans to complete all Congo Basin countries. While FACET provides unprecedented synoptic detail in the extent of Congo Basin forest and the forest cover loss, additional information is required to stratify land cover into types indicative of biomass content. Analysis of the FACET patterns of deforestation, more detailed remote sensing analysis of biophysical attributes within the FACET land cover classes and GIS-derived classes of degradation obtained through variable distance buffers based on relevant literature and ground truth data are combined with the existing FACET classes to produce a ranking of land cover from low biomass to high biomass for the Democratic Republic of Congo. The resulting classification can be used in all Reduced Emissions from Degradation and Deforestation (REDD) pre-inventory phases when baseline forest cover needs to be known and the location and amount of forest biomass inventory plots needs to be designed. FACET cover loss classes were kept in the classification and can provide the Monitoring, Reporting and Verification tools needed for REDD projects. The project will be demonstrated for the Maringa Lopori Wamba Landscape of the DRC where this work was funded by the African Wildlife Foundation to support the design of a REDD pilot project.
Tshibassu, Pierre M.; Kayembe, Patrick K.; Kitetele, Faustin; Edidi, Samuel; Ekila, Mathilde B.; Wumba, Roger; Lepira, François B.; N. Aloni, Michel
Objectives The decision to initiate the antiretroviral therapy in HIV-infected children living in poor countries is compromised by lack of resources. The objective of this study is to identify simple clinical and biological markers other than CD4+ count and viral load measurement that could help the decision to introduce antiretroviral treatment and to monitor patients. Methods A cross sectional study was conducted between January and March 2005 in Kinshasa, Democratic Republic of Congo. Results Eighty-four children infected with HIV were recruited. In this cohort, the lymphocytes (P = 0.001) and CD4 (P = 0.0001) were significantly lower in children with immunological stage 3 and viral load (P = 0.027) was significantly higher in children at the same immunological stage. Reticulocytes (r = +0.440), white blood cells count (r = +0.560), total lymphocytes (r = +0.675) and albumin (r = +0.381) showed positive significant correlations with CD4. Haemoglobin (r = − 0.372), Haematocrit (r = − 0.248), red blood cells (r = − 0.278) and CD4 (r = − 0.285) showed negative significant correlations with viral load. Neutropaenia (P = 0.02), enlarged nodes (P = 0.005) and oral candidiasis (P = 0.04) were associated with viral load >10 000 copies/ml. Oral candidiasis (P = 0.02) was associated with CD4 level < 15%. Conclusion Oral candidiasis, enlarged nodes, total lymphocytes count, neutropaenia and albumin predict severe immunodepression. These clinical and biological markers may guide the clinician in making the decision to initiate antiretroviral therapy in highly resource-scarce settings. PMID:26182826
Rupp, Stephanie; Ambata, Philippe; Narat, Victor; Giles-Vernick, Tamara
In the absence of direct evidence, an imagined "cut hunter" stands in for the index patient of pandemic HIV/AIDS. During the early years of colonial rule, this explanation goes, a hunter was cut or injured from hunting or butchering a chimpanzee infected with simian immunodeficiency virus, resulting in the first sustained human infection with the virus that would emerge as HIV-1M. We argue here that the "cut hunter" relies on a historical misunderstanding and ecological oversimplification of human-chimpanzee (Pan Troglodytes troglodytes) interactions that facilitated pathogenic transmission. This initial host shift cannot explain the beginnings of the HIV/AIDS pandemic. Instead, we must understand the processes by which the virus became transmissible, possibly between Sangha basin inhabitants and ultimately reached Kinshasa. A historical epidemiology of the late nineteenth and twentieth centuries, provides a much-needed corrective to the major shortcomings of the cut hunter. Based on 62 oral historical interviews conducted in southeastern Cameroon and archival research, we show that HIV emerged from ecological, economic, and socio-political transformations of the late nineteenth and twentieth centuries. The gradual imposition of colonial rule built on and reoriented ecologies and economies, and altered older patterns of mobility and sociality. Certain changes may have contributed to the initial viral host shift, but more importantly, facilitated the adaptation of HIV-1M to human-to-human transmission. Our evidence suggests that the most critical changes occurred after 1920. This argument has important implications for public health policy, underscoring recent work emphasizing alternative pathways for zoonotic spillovers into human beings.
Johnson, A M; Laga, M
Recent developments concerning heterosexual transmission of HIV (review of 1988 literature only) suggest improved understanding of the pattern of spread and role of risk behaviors and biological cofactors in its transmission. 3 distinct patterns if HIV infection are known: heterosexual spread in sub-Saharan Africa and the Caribbean, spread primarily among homosexuals and injecting drug users in Europe, North American and much of Latin America and Australia, and both homosexual and heterosexual transmission in Asia, the Pacific, the Middle East and Eastern Europe, where prevalence is low. In Africa an estimated 80% of cases are acquired heterosexually. Important risk factors are number of sex partners, sex with prostitutes, being a prostitute, being a sex partner of an infected person, and having a history of other sexually transmitted diseases. Prevalence rates have risen rapidly in Zaire and Kenya. In Africa, acquisition of HIV is related to sexual activity only. In contrast, in the U.S., heterosexual cases make up only 4% of all cases, and in Europe only 6%. Data on types of sexual transmission of HIV are mounting, in aggregate suggestive of a marked heterogeneity in infectivity and possibly susceptibility between individuals. Among couples where the man is positive, in some places individuals appear to be highly infective, notably those from Kinshasa, Zaire and Haiti, while other series of discordant couples the receptive partner remained seronegative for several years. Transmission from women to men appears to be less efficient than from men to women, as has been observed with other STDs such as gonorrhea. Biological cofactors implicated in enhanced HIV transmission appear to be advanced CDC Stage IV AIDS disease, with low T-helper lymphocyte counts and high antigenemia; concomitant STDS, especially those with genital ulceration; lack of circumcision; oral contraceptive use; practice of anal intercourse; inconsistent or no use of condoms. Theoretical models for
Mukadi, Pierre; Gillet, Philippe; Lukuka, Albert; Mbatshi, Joêl; Otshudiema, John; Muyembe, Jean-Jacques; Buyze, Jozefien; Jacobs, Jan; Lejon, Veerle
Although malaria rapid diagnostic tests (RDT) are simple to perform, they remain subject to errors, mainly related to the post-analytical phase. We organized the first large scale SMS based external quality assessment (EQA) on correct reading and interpretation of photographs of a three-band malaria RDT among laboratory health workers in the Democratic Republic of the Congo (DR Congo). High resolution EQA photographs of 10 RDT results together with a questionnaire were distributed to health facilities in 9 out of 11 provinces in DR Congo. Each laboratory health worker answered the EQA by Short Message Service (SMS). Filled-in questionnaires from each health facility were sent back to Kinshasa. A total of 1849 laboratory health workers in 1014 health facilities participated. Most frequent errors in RDT reading were i) failure to recognize invalid (13.2-32.5% ) or negative test results (9.8-12.8%), (ii) overlooking faint test lines (4.1-31.2%) and (iii) incorrect identification of the malaria species (12.1-17.4%). No uniform strategy for diagnosis of malaria at the health facility was present. Stock outs of RDTs occurred frequently. Half of the health facilities had not received an RDT training. Only two thirds used the RDT recommended by the National Malaria Control Program. Performance of RDT reading was positively associated with training and the technical level of health facility. Facilities with RDT positivity rates >50% and located in Eastern DR Congo performed worse. Our study confirmed that errors in reading and interpretation of malaria RDTs are widespread and highlighted the problem of stock outs of RDTs. Adequate training of end-users in the application of malaria RDTs associated with regular EQAs is recommended.
Efficacy and safety of intermittent preventive treatment in schoolchildren with sulfadoxine/pyrimethamine (SP) and SP plus piperaquine in Democratic Republic of the Congo: a randomised controlled trial.
Matangila, Junior R; Doua, Joachim Y; Mitashi, Patrick; da Luz, Raquel Inocêncio; Lutumba, Pascal; Van Geertruyden, Jean Pierre
In endemic areas, malaria and its adverse effects in schoolchildren may be prevented by intermittent preventive treatment (IPTsc). However, the most appropriate drug regimen for IPTsc remains to be identified. A randomised controlled trial was conducted in Kinshasa, DRC. Enrolled schoolchildren were assigned to a passive control arm (n = 212), sulfadoxine/pyrimethamine (SP) (n = 202) or SP plus piperaquine (SP/PQ) (n = 202). The primary endpoint was haemoglobin (Hb) change. Secondary endpoints were anaemia, parasitaemia prevalence and clinical malaria incidence. Data were analysed by modified intention-to-treat (mITT) and per-protocol. A linear mixed mode was used due to repeated measurements. Of 616 enrolled children, 410 (66.6%) were eligible for mITT analysis. The control arm was used as reference. After 12 months, the Hb level increased by 0.20 g/dL (95% CI -0.61 to 0.47; P = 0.168) and 0.39 g/dL (0.12-0.66; P <0.01) in the SP and SP/PQ arms, respectively. SP treatment reduced anaemia, malaria parasitaemia and clinical malaria by 10% (0-20%; P = 0.06), 19% (2-33%; P = 0.042) and 25% (-32 to 57%; P = 0.37), respectively. The corresponding values for SP/PQ were 28% (19-37%; P <0.001), 40% (26-52%; P <0.001) and 58% (17-79%; P <0.01). No deaths or severe adverse events (SAEs) were observed. SP/PQ offered substantial protection against anaemia, malaria parasitaemia and clinical malaria and showed no SAEs. SP/PQ, a combination of two long-acting non-artemisinin-based antimalarials, may be a valuable option for IPTsc in Africa. Copyright © 2017 Elsevier B.V. and International Society of Chemotherapy. All rights reserved.
Yotebieng, Marcel; Moracco, Kathryn E; Thirumurthy, Harsha; Edmonds, Andrew; Tabala, Martine; Kawende, Bienvenu; Wenzi, Landry K; Okitolonda, Emile W; Behets, Frieda
To elucidate the mechanisms by which a cash incentive intervention increases retention in prevention of mother-to-child transmission services. We used data from a randomized controlled trial in Kinshasa, Democratic Republic of Congo. Perceptual factors associated with loss to follow-up (LTFU) through 6 weeks postpartum were first identified. Then, binomial models were used to assess interactions between LTFU and identified factors, and the cash incentive intervention. Participants were less likely to be LTFU if they perceived HIV as a "very serious" health problem for their baby vs. not [risk difference (RD), -0.13; 95% confidence interval (CI): -0.30 to 0.04], if they believed it would be "very likely" to pass HIV to their baby if they did not take any HIV drug vs. not (RD, -0.15; 95% CI: -0.32 to 0.02), and if they anticipated that not having money would make it difficult for them to come to the clinic vs. not (RD, 0.12; 95% CI: -0.07 to 0.30). The effect of each of the 3 factors on LTFU was antagonistic to that of receiving the cash incentive intervention. The excess risk due to interaction between the cash incentive intervention and the anticipated difficulty of "not having money" to come to the clinic was exactly equal to the effect of removing this perceived barrier (excess risk due to interaction, -0.12; 95% CI: -0.35 to 0.10). Our analyses show that cash transfers improve retention in prevention of mother-to-child transmission services mainly by mitigating the negative effect of not having money to come to the clinic.
Plana, Vanessa; Gascoigne, Angus; Forrest, Laura L; Harris, David; Pennington, R Toby
This paper presents a historical biogeographic analysis of African Begonia based on combined internal transcribed spacer (ITS) and trnL intron sequences. Age range estimates for Begonia in Africa ranged from only 1.5 Ma for some terminal nodes to 27 Ma for basal nodes when the ages of Réunion (2 Ma) andMayotte (5.4 Ma) were used to date the split between Begonia salaziensis and Begonia comorensis. Assuming a more recent origin age for Begonia salaziensis (2 Ma) provided age estimates in other parts of the phylogeny which agreed with patterns observed in other African organisms. A large proportion of the Begonia diversity seen today in Africa is of pre-Pleistocene origin. Species of Pleistocene origin are concentrated in species-rich groups such as sections Loasibegonia, Scutobegonia, and Tetraphila, which have their centre of diversity in western Central Africa. Phylogenetically isolated taxa such as Begonia longipetiolata, Begonia iucunda, and Begonia thomeana date to the late Miocene, a period of extended aridification on the African continent that had severe effects on African rain forest species. A general pattern is identified where phylogenetically isolated species occur outside the main identified rain forest refuges. Endemic species on the island of São Tomé such as Begonia baccata, Begonia molleri, and Begonia subalpestris appear to be palaeoendemics. Of these species, the most recent age estimate is for B. baccata, which is dated at ca. 3 Ma. Therefore, São Tomé appears to have functioned as an important (if previously unrecognised) pre-Pleistocene refuge. On the mainland, areas such as the Massif of Chaillu in Gabon, southern Congo (Brazzaville), and far western areas of Congo (Kinshasa) have played similar roles to São Tomé.
Raifu, Amidu O.; El-Zein, Mariam; Sangwa-Lugoma, Ghislain; Ramanakumar, Agnihotram; Walter, Stephen D.
Background Visual inspection with acetic acid (VIA) and Lugol’s iodine (VILI) are used to screen women for cervical cancer in low-resource settings. Little is known about correlates of their diagnostic accuracy by healthcare provider. We examined determinants of VIA and VILI screening accuracy by examiner in a cross-sectional screening study of 1528 women aged 30 years or older in a suburb of Kinshasa, Democratic Republic of Congo. Methods We used a logistic regression model for sensitivity and specificity to estimate the diagnostic accuracy of VIA and VILI, independently performed by nurse and physician, as a function of sociodemographic and reproductive health characteristics. Results Nurses rated tests as positive more often than physicians (36.3% vs 30.2% for VIA, 26.2% vs 25.2% for VILI). Women’s age was the most important determinant of performance. It was inversely associated with sensitivity (nurse’s VIA: p<0.001, nurse’s VILI: p = 0.018, physician’s VIA: p = 0.005, physician’s VILI: p = 0.006) but positively associated with specificity (all four combinations: p<0.001). Increasing parity adversely affected sensitivity and specificity, but the effects on sensitivity were significant for nurses only. The screening performance of physician’s assessment was significantly better than the nurse’s (difference in sensitivity: VIA = 13%, VILI = 16%; difference in specificity: VIA = 6%, VILI = 1%). Conclusions Age and parity influence the performance of visual tests for cervical cancer screening. Proper training of local healthcare providers in the conduct of these tests should take into account these factors for improved performance of VIA and VILI in detecting cervical precancerous lesions among women in limited-resource settings. PMID:28107486
Aung, Kya J. M.; Bola, Valentin; Lebeke, Rossin; Hossain, Mohamed Anwar; de Rijk, Willem Bram; Rigouts, Leen; Gumusboga, Aysel; Torrea, Gabriela; de Jong, Bouke C.
The rapid diagnosis of rifampin resistance is hampered by a reported insufficient specificity of molecular techniques for detection of rpoB mutations. Our objective for this study was to document the prevalence and prognostic value of rpoB mutations with unclear phenotypic resistance. The study design entailed sequencing directly from sputum of first failure or relapse patients without phenotypic selection and comparison of the standard retreatment regimen outcome, according to the mutation present. We found that among all rpoB mutations, the best-documented “disputed” rifampin resistance mutations (511Pro, 516Tyr, 526Asn, 526Leu, 533Pro, and 572Phe) made up 13.1% and 10.6% of all mutations in strains from Bangladesh and Kinshasa, respectively. Except for the 511Pro and 526Asn mutations, most of these strains with disputed mutations tested rifampin resistant in routine Löwenstein-Jensen medium proportion method drug susceptibility testing (DST; 78.7%), but significantly less than those with common, undisputed mutations (96.3%). With 63% of patients experiencing failure or relapse in both groups, there was no difference in outcome of first-line retreatment between patients carrying a strain with disputed versus common mutations. We conclude that rifampin resistance that is difficult to detect by the gold standard, phenotypic DST, is clinically and epidemiologically highly relevant. Sensitivity rather than specificity is imperfect with any rifampin DST method. Even at a low prevalence of rifampin resistance, a rifampin-resistant result issued by a competent laboratory may not warrant confirmation, although the absence of a necessity for confirmation needs to be confirmed for molecular results among new cases. However, a result of rifampin susceptibility should be questioned when suspicion is very high, and further DST using a different system (i.e., genotypic after phenotypic testing) would be fully justified. PMID:23761144
Leyka, Mukandu Basua Babintu; Baum, Mylène Botbol
The goal of this study carried out on street children and care providers was to determine the opinions of the staff of these institutions--foster homes--and their degree of satisfaction. Out of twenty homes of the zone or healthcare district of Kasavubu in the city of Kinshasa in the Democratic Republic of the Congo (DRC), ten were chosen at random (50%). In them, we selected one hundred street children--the beneficiaries--, ten care providers and ten protocol programs--of guardianship. The players--beneficiaries and providers--answered questions on their perceptions and expectations regarding to following: the range of activities provided, its organization, its quality and their degree of satisfaction of the site and on the development of skills. The results obtained demonstrated the predominance on useful activities ("welfarism") and on charity. The respondents declared they sometimes commit antisocial actions (theft) to access education, which is similar to a form of obtaining independence. The protocols for guardianship are often the conceived by experts. However, in a general way for young respondents, it is relatively difficult for experts alone (assistants and social educators or others) to provide precise and exhaustive data on the needs felt by street children. In view of these results, it is thus ethically acceptable to resort to the ability-based approach in the conception, the setting up and the evaluation of guardianship protocols for street children. What the youth think, the range of activities provided, the conception and the quality of the guardianship protocols is an important stake in the development of the skills. It is highly probable that the emergence of such protocols cannot be undertaken except if street children have a degree of independence in relation to experts and can assert a specific point of view.
Background Blackwater fever (BWF) is one of the severe forms of malaria. This complication was first described among non-immune European expatriates in the malaria endemic areas. Recently, resurgence of this form of malaria has been reported among the indigenous populations. The objective of this study was to investigate the risk factors among BWF patients. Methods A case–control study was conducted between in four hospitals located in Kinshasa, Democratic Republic of Congo from January 2010 to December 2011. One hundred and twenty nine children were recruited with 43 (cases) and 86 (control). Results No significant difference in the gender and age distribution was observed between the case and control). The sex-ratio male to female in the case group and control group was respectively 1:1.0 and 1:1.1. The mean age was 8.62 years (SD = 3.84) in patients with haemoglobinuria and 8.55 years (SD = 3.77) in the control group. No difference in frequency of co-infection with Plasmodium falciparum and Plasmodium malariae was observed between the two groups. Significant differences in haemoglobin, haematocrit, creatinine, urea and platelets levels were observed between the two groups (p < 0.001), but not for blood group and lactate dehydrogenase (LDH) level. Majority of the BWF cases occurred during the rainy season (88.4%). Treatment with quinine (95.3%) was significantly associated with cases (p < 0.001). Seven (16.2%) of the haemoglobinuric children developed acute renal failure. Conclusion Rainy season, low parasitaemia and quinine ingestion were the major risk factors significantly associated with haemoglobinuria. Acute renal failure was observed as the major complication of BWF. PMID:23767699
Pagès, J R; Durand, P; Southgate, V R; Tchuem Tchuenté, L A; Jourdane, J
The taxonomic status of the two known strains of Schistosoma intercalatum, the Lower Guinea strain (originating from Edea, Cameroon) and the Zaire strain (originating from Kinshasa, Democratic Republic of Congo, formerly Zaire) was examined using random amplified polymorphic DNA (RAPD) markers. Two additional species within the S. haematobium group, S. haematobium and S. mattheei, were included in the study. DNA was extracted from four male and four female worms of each species and strain under investigation. In all, 13 primers gave reproducible and informative marker patterns; the monomorphic bands in all the males and females of each sample were scored, and 138 bands were included in the final analysis. Overall, 14 RAPD fragments were shared by all the schistosomes studied, and 19 RAPD fragments were considered to be sex markers. Only 22% (20/91) of the RAPD fragments were shared between S. intercalatum Zaire and S. intercalatum Cameroon. The mean values recorded for the Nei and Li's genetic distances between S. haematobium and S. mattheei and between S. intercalatum Zaire and S. intercalatum Cameroon were 0.546 and 0.596, respectively. A principal component analysis and one-way analysis of variance (ANOVA/MANOVA) showed a significant separation between S. intercalatum Zaire and S. intercalatum Cameroon. The data support the hypothesis that S. intercalatum Zaire and S. intercalatum Cameroon are distinct species. Additional molecular-biology studies are in progress that involve the use of nuclear and mitochondrial markers to confirm the extent of the genetic divergence prior to the establishment of final decision on the taxonomic status of the two strains of S. intercalatum.
Mambanzulua Ngoma, Philippe; Hiligsmann, Serge; Sumbu Zola, Eric; Culot, Marc; Fievez, Thierry; Thonart, Philippe
Leaves of Mangifera Indica (MI, mango leaves) and Manihot Utilissima (MU, cassava leaves) are available in tropical regions and are the most accessible vegetal wastes of Kinshasa, capital of Democratic Republic of Congo. These wastes are not suitably managed and are not rationally valorized. They are abandoned in full air, on the soil and in the rivers. They thus pollute environment. By contrast, they can be recuperated and treated in order to produce methane (energy source), organic fertilizer and clean up the environment simultaneously. The main objective of this study was to investigate methane production from MI and MU leaves by BMP tests at 30°C. The yields achieved from the anaerobic digestion of up to 61.3 g raw matter in 1 l medium were 0.001 l/g and 0.100 l CH4/g volatile solids of MI and MU leaves, respectively. The yield of MU leaves was in the range mentioned in the literature for other leaves because of a poor presence of bioactive substrates, and low C/N ratio. This methane yield corresponded to 7% of calorific power of wood. By contrast, the methane yield from MI leaves was almost nil suggesting some metabolism inhibition because of their rich composition in carbon and bioactive substrates. Whereas classical acidogenesis and acetogenesis were recorded. Therefore, methane production from the sole MI leaves seems unfavorable by comparison to MU leaves at the ambient temperature in tropical regions. Their solid and liquid residues obtained after anaerobic digestion would be efficient fertilizers. However, the methane productivity of both leaves could be improved by anaerobic co-digestion.
Chomba, Elwyn; Tshefu, Antoinette; Onyamboko, Marie; Kaseba - Sata, Christine; Moore, Janet; McClure, Elizabeth M; Moss, Nancy; Goco, Norman; Bloch, Michele; Goldenberg, Robert L
Objective To study pregnant women’s knowledge, attitudes and behaviors towards tobacco use and secondhand smoke (SHS) exposure, and exposure to advertising for and against tobacco products in Zambia and the Democratic Republic of the Congo (DRC). Design Prospective cross-sectional survey between November 2004 and September 2005. Setting Antenatal care clinics in Lusaka, Zambia and Kinshasa, DRC. Population Pregnant women in Zambia (909) and the DRC (847). Methods Research staff administered a structured questionnaire to pregnant women attending antenatal care clinics. Main Outcome Measures Pregnant women’s use of tobacco, exposure to SHS, knowledge of the harms of tobacco, and exposure to advertising for and against tobacco products. Results Only about 10% of pregnant women reported having ever tried cigarettes (6.6% Zambia; 14.1% DRC). However, in the DRC, 41.8% of pregnant women had ever tried other forms of tobacco, primarily snuff. About 10% of pregnant women and young children were frequently or always exposed to SHS. Pregnant women’s knowledge of the hazards of smoking and SHS exposure was extremely limited. About 13% of pregnant women had seen or heard advertising for tobacco products in the last 30 days. Conclusions Tobacco use and SHS exposure pose serious threats to the health of women, infants, and children. In many African countries, maternal and infant health outcomes are often poor and will likely worsen if maternal tobacco use increases. Our findings suggest that a “window of opportunity” exists to prevent increased tobacco use and SHS exposure of pregnant women in Zambia and the DRC. PMID:20230310
Introduction Little is known about rheumatoid arthritis in the black, particularly in Congolese, populations. Our objective was to describe the phenotype and genotype of rheumatoid arthritis (RA) in Congolese. Methods All consecutive rheumatoid arthritis (RA) patients attending Kinshasa University Hospital in a three-year time period were included. Demographics, clinical features and tobacco consumption were noted. Disease Activity Score (DAS)-28 based on the erythrocyte sedimentation rate (ESR), Health Assessment Questionnaire (HAQ), anti-citrullinated peptide antibodies (CCP) antibodies and rheumatoid factor (RF) were determined. Radiographs were scored according to Sharp-van der Heijde. On a subset of patients and controls HLA-DRB1 typing was performed. Results A total of 114 females and 14 males aged 51.2 ± 14.9 were included. Mean duration of symptoms was four years. Moderate tobacco consumption was reported in a minority of patients. DAS-28 at first visit was >5.1 and HAQ ≥0.5 in all patients. X-rays showed joint erosions and/or joint space narrowing, mostly of a moderate grade in 55.8% of patients. Anti-CCP and/or RF were present in 48.6% of patients with available data (n = 72) and in 3.0% of controls (n = 67). Radiographic changes and nodules were more frequent in RF or anti-CCP positive patients. One copy of the shared epitope was found in 13 patients (35.1%) and 3 controls (12.5%). Two copies were found in one patient (2.7%) and in one control (4.2%). Conclusion Congolese patients with RA consult long after disease onset. Despite this delay, the majority presents without major damage and is RF, anti-CCP and SE negative. We put forward the hypothesis that besides different environmental factors there is probably also a particular genetic risk profile in Congolese patients, different from the HLA-DRB1 shared epitope. PMID:23958186
Kim, D.; Lee, H.; Jung, H. C.; Beighley, E.; Laraque, A.; Tshimanga, R.; Alsdorf, D. E.
Rivers and wetlands are very important for ecological habitats, and it plays a key role in providing a source of greenhouse gases (CO2 and CH4). The floodplains ecosystems depend on the process between the vegetation and flood characteristics. The water level is a prerequisite to an understanding of terrestrial water storage and discharge. Despite the lack of in situ data over the Congo Basin, which is the world's third largest in size ( 3.7 million km2), and second only to the Amazon River in discharge ( 40,500 m3 s-1 annual average between 1902 and 2015 in the main Brazzaville-Kinshasa gauging station), the surface water level dynamics in the wetlands have been successfully estimated using satellite altimetry, backscattering coefficients (σ0) from Synthetic Aperture Radar (SAR) images and, interferometric SAR technique. However, the water level estimation of the Congo River remains poorly quantified due to the sparse orbital spacing of radar altimeters. Hence, we essentially have limited information only over the sparsely distributed the so-called "virtual stations". The backscattering coefficients from SAR images have been successfully used to distinguish different vegetation types, to monitor flood conditions, and to access soil moistures over the wetlands. However, σ0 has not been used to measure the water level changes over the open river because of very week return signal due to specular scattering. In this study, we have discovered that changes in σ0 over the Congo River occur mainly due to the water level changes in the river with the existence of the water plants (macrophytes, emergent plants, and submersed plant), depending on the rising and falling stage inside the depression of the "Cuvette Centrale". We expand the finding into generating the multi-temporal water level maps over the Congo River using PALSAR σ0, Envisat altimetry, and Landsat Normalized Difference Vegetation Index (NDVI) data. We also present preliminary estimates of the river
Ache Rocha Lopes, V.; Trigg, M. A.; O'Loughlin, F.; Laraque, A.
While there have been notable advances in deriving river characteristics such as width, using satellite remote sensing datasets, deriving river bathymetry remains a significant challenge. Bathymetry is fundamental to hydrodynamic modelling of river systems and being able to estimate this parameter remotely would be of great benefit, especially when attempting to model hard to access areas where the collection of field data is difficult. One such region is the Congo Basin, where due to past political instability and large scale there are few studies that characterise river bathymetry. In this study we test whether it is possible to use passive optical remote sensing to estimate the depth of the Congo River using Landsat 8 imagery in the region around Malebo Pool, located just upstream of the Kinshasa gauging station. Methods of estimating bathymetry using remotely sensed datasets have been used extensively for coastal regions and now more recently have been demonstrated as feasible for optically shallow rivers. Previous river bathymetry studies have focused on shallow rivers and have generally used aerial imagery with a finer spatial resolution than Landsat. While the Congo River has relatively low suspended sediment concentration values the application of passive bathymetry estimation to a river of this scale has not been attempted before. Three different analysis methods are tested in this study: 1) a single band algorithm; 2) a log ratio method; and 3) a linear transform method. All three methods require depth data for calibration and in this study area bathymetry measurements are available for three cross-sections resulting in approximately 300 in-situ measurements of depth, which are used in the calibration and validation. The performance of each method is assessed, allowing the feasibility of passive depth measurement in the Congo River to be determined. Considering the scarcity of in-situ bathymetry measurements on the Congo River, even an approximate
Mikobi, Tite Minga; Lukusa Tshilobo, Prosper; Aloni, Michel Ntetani; Mvumbi Lelo, Georges; Akilimali, Pierre Zalagile; Muyembe-Tamfum, Jean Jacques; Race, Valérie; Matthijs, Gert; Mbuyi Mwamba, Jean Marie
Background Sickle cell anemia is an inflammatory disease and is characterized by chronic hemolysis. We sought to evaluate the association of lactate dehydrogenase levels with specific clinical phenotypes and laboratory variables in patients with sickle cell anemia. Methods The present cross-sectional study was conducted in Sickle Cell Centre of Yolo in Kinshasa, the Democratic Republic of Congo. Two hundred and eleven patients with Sickle Cell Anemia in steady state were recruited. Seventy-four participants with normal Hb (Hb-AA) were selected as a control group. Results The average rates of hemoglobin, hematocrit, and red blood cells tended to be significantly lower in subjects with Hb-SS (p<0.001). The average rates of white blood cells, platelets, reticulocytes and serum LDH were significantly higher in subjects with Hb-SS (p<0.001). The average rates of Hb, HbF, hematocrit and red blood cells of Hb-SS patients with asymptomatic clinical phenotype were significantly higher than those of the two other phenotypes. However, the average rates of white blood cells, platelets, reticulocytes, and LDH of Hb-SS patients with the severe clinical phenotype are higher than those of two other clinical phenotypes. Significant correlations were observed between Hb and white blood cell in severe clinical phenotype (r3 = -0.37 *) between Hb and red blood cells in the three phenotypes (r1 = 0.69 * r2 * = 0.69, r3 = 0.83 *), and finally between Hb and reticulocytes in the asymptomatic clinical phenotype and severe clinical phenotype (r1 = -0.50 * r3 = 0.45 *). A significant increase in LDH was observed in patients with leg ulcer, cholelithiasis and aseptic necrosis of the femoral head. Conclusion The increase in serum LDH is accompanied by changes in hematological parameters. In our midst, serum LDH may be considered as an indicator of the severity of the disease. PMID:25946088
Mwanamoki, Paola M; Devarajan, Naresh; Thevenon, Florian; Birane, Niane; de Alencastro, Luiz Felippe; Grandjean, Dominique; Mpiana, Pius T; Prabakar, Kandasamy; Mubedi, Josué I; Kabele, Christophe G; Wildi, Walter; Poté, John
This paper discusses the occurrence and spatial distribution of metals and persistent organic pollutants (POPs: including organochlorine pesticides (OCPs), polychlorinated biphenyls (PCBs), Polybrominated diphenyl ethers (PBDEs), and polycyclic aromatic hydrocarbons (PAHs) in sediments from a river-reservoir system. Surface sediments were sampled from thirteen sites of the Congo River Basin and Lake Ma Vallée, both situated in the vicinity of the capital city Kinshasa (Congo Democratic Republic). Sediment qualities were evaluated using toxicity test based on exposing Ostracods to the sediment samples. The highest metal concentrations were observed in sediments subjected to anthropogenic influences, urban runoff and domestic and industrial wastewaters, discharge into the Congo River basin. Ostracods exposed to the sediments resulted in 100% mortality rates after 6d of incubation, indicating the ultimate toxicity of these sediments as well as potential environmental risks. The POPs and PAHs levels in all sediment samples were low, with maximum concentration found in the sediments (area of pool Malebo): OCP value ranged from 0.02 to 2.50 with ∑OCPs: 3.3μgkg(-1); PCB ranged from 0.07 to 0.99 with Total PCBs (∑7×4.3): 15.31μgkg(-1); PAH value ranged from 0.12 to 9.39 with ∑PAHs: 63.89μgkg(-1). Our results indicate that the deterioration of urban river-reservoir water quality result mainly from urban stormwater runoff, untreated industrial effluents which discharge into the river-reservoirs, human activities and uncontrolled urbanization. This study represents useful tools incorporated to evaluate sediment quality in river-reservoir systems which can be applied to similar aquatic environments.
Raifu, Amidu O; El-Zein, Mariam; Sangwa-Lugoma, Ghislain; Ramanakumar, Agnihotram; Walter, Stephen D; Franco, Eduardo L
Visual inspection with acetic acid (VIA) and Lugol's iodine (VILI) are used to screen women for cervical cancer in low-resource settings. Little is known about correlates of their diagnostic accuracy by healthcare provider. We examined determinants of VIA and VILI screening accuracy by examiner in a cross-sectional screening study of 1528 women aged 30 years or older in a suburb of Kinshasa, Democratic Republic of Congo. We used a logistic regression model for sensitivity and specificity to estimate the diagnostic accuracy of VIA and VILI, independently performed by nurse and physician, as a function of sociodemographic and reproductive health characteristics. Nurses rated tests as positive more often than physicians (36.3% vs 30.2% for VIA, 26.2% vs 25.2% for VILI). Women's age was the most important determinant of performance. It was inversely associated with sensitivity (nurse's VIA: p<0.001, nurse's VILI: p = 0.018, physician's VIA: p = 0.005, physician's VILI: p = 0.006) but positively associated with specificity (all four combinations: p<0.001). Increasing parity adversely affected sensitivity and specificity, but the effects on sensitivity were significant for nurses only. The screening performance of physician's assessment was significantly better than the nurse's (difference in sensitivity: VIA = 13%, VILI = 16%; difference in specificity: VIA = 6%, VILI = 1%). Age and parity influence the performance of visual tests for cervical cancer screening. Proper training of local healthcare providers in the conduct of these tests should take into account these factors for improved performance of VIA and VILI in detecting cervical precancerous lesions among women in limited-resource settings.
Mikobi, Tite Minga; Lukusa, Prosper Tshilobo; Aloni, Michel Ntetani; Lumaka, Aimé; Akilimali, Pierre Zalagile; Devriendt, Koenraad; Matthijs, Gert; Mbuyi Muamba, Jean-Marie; Race, Valerie
Information about the association with alpha thalassemia in sickle cell patients is unknown in the Democratic Republic of Congo. There is very little data on the alpha thalassemia in patients suffering from sickle cell anemia in Central Africa, and their consequences on the clinical expression of the disease. A cross-sectional study was conducted in 106 sickle cell patients living in the country's capital Kinshasa. The diagnosis of sickle cell anemia was confirmed with a molecular test using PCR-RFLP (restriction fragment length polymorphism) technique. The diagnosis of thalassemia was performed by the technique of multiplex ligation dependent probe amplification. The mean age of our patients was 22.4±13.6 years. The α(3.7) heterozygous deletion, the α(3.7) homozygous deletion and the α(3.7) triplication were respectively encountered in 23.6%, 25.5% , and 11.3% of patients. Patients with normal αα/αα genotype represented 39.6% of the study population. The average of severe vaso-occlusive crises, the rates of blood transfusions per year, the rate of osteonecrosis, cholelithiasis and leg ulcers were significantly lower in the group of patients with α(3.7) homozygous deletion and α(3.7) triplication. The prevalence of α(3.7) triplication was higher in sickle cell patients in the Democratic Republic of Congo than in worldwide series. The α(3.7) triplication and α(3.7) homozygous deletion were associated with less severe forms of the Sickle cell anemia in Congolese patients. These results showed the need to investigate systematically the alpha-globin gene mutations in sickle cell population in Central Africa. © 2017 Wiley Periodicals, Inc.
Mavakala, Bienvenu K; Le Faucheur, Séverine; Mulaji, Crispin K; Laffite, Amandine; Devarajan, Naresh; Biey, Emmanuel M; Giuliani, Gregory; Otamonga, Jean-Paul; Kabatusuila, Prosper; Mpiana, Pius T; Poté, John
Management of municipal solid wastes in many countries consists of waste disposal into landfill without treatment or selective collection of solid waste fractions including plastics, paper, glass, metals, electronic waste, and organic fraction leading to the unsolved problem of contamination of numerous ecosystems such as air, soil, surface, and ground water. Knowledge of leachate composition is critical in risk assessment of long-term impact of landfills on human health and the environment as well as for prevention of negative outcomes. The research presented in this paper investigates the seasonal variation of draining leachate composition and resulting toxicity as well as the contamination status of soil/sediment from lagoon basins receiving leachates from landfill in Mpasa, a suburb of Kinshasa in the Democratic Republic of the Congo. Samples were collected during the dry and rainy seasons and analyzed for pH, electrical conductivity, dissolved oxygen, soluble ions, toxic metals, and were then subjected to toxicity tests. Results highlight the significant seasonal difference in leachate physicochemical composition. Affected soil/sediment showed higher values for toxic metals than leachates, indicating the possibility of using lagoon system for the purification of landfill leachates, especially for organic matter and heavy metal sedimentation. However, the ecotoxicity tests demonstrated that leachates are still a significant source of toxicity for terrestrial and benthic organisms. Therefore, landfill leachates should not be discarded into the environment (soil or surface water) without prior treatment. Interest in the use of macrophytes in lagoon system is growing and toxic metal retention in lagoon basin receiving systems needs to be fully investigated in the future. This study presents useful tools for evaluating landfill leachate quality and risk in lagoon systems which can be applied to similar environmental compartments. Copyright © 2016 Elsevier Ltd. All
Madinga, Joule; Linsuke, Sylvie; Mpabanzi, Liliane; Meurs, Lynn; Kanobana, Kirezi; Speybroeck, Niko; Lutumba, Pascal; Polman, Katja
Schistosomiasis is a poverty-related parasitic infection, leading to chronic ill-health. For more than a century, schistosomiasis has been known to be endemic in certain provinces of the Democratic Republic of Congo (DRC). However, a clear overview on the status of the disease within the country is currently lacking, which is seriously hampering control. Here, we review the available information on schistosomiasis in DRC of the past 60 years. Findings and data gaps are discussed in the perspective of upcoming control activities.An electronic literature search via PubMed complemented by manual search of non-peer-reviewed articles was conducted up to January 2015. The search concerned all relevant records related to schistosomiasis in the DRC from January 1955 onwards. A total of 155 records were found, of which 30 met the inclusion criteria. Results were summarized by geographical region, mapped, and compared with those reported sixty years ago. The available data reported schistosomiasis in some areas located in 10 of the 11 provinces of DRC. Three species of Schistosoma were found: S. mansoni, S. haematobium and S. intercalatum. The prevalence of schistosomiasis varied greatly between regions and between villages, with high values of up to 95 % observed in some communities. The overall trend over 60 years points to the spread of schistosomiasis to formerly non-endemic areas. The prevalence of schistosomiasis has increased in rural endemic areas and decreased in urban/peri-urban endemic areas of Kinshasa. Hepatosplenomegaly, urinary tract lesions and anaemia were commonly reported in schistosomiasis endemic areas but not always associated with infection status.The present review confirms that schistosomiasis is still endemic in DRC. However, available data are scattered across time and space and studies lack methodological uniformity, hampering a reliable estimation of the current status of schistosomiasis in DRC. There is a clear need for updated prevalence data
Thea, D M; Porat, R; Nagimbi, K; Baangi, M; St Louis, M E; Kaplan, G; Dinarello, C A; Keusch, G T
To examine the relation of circulating cytokines and cytokine antagonists to the progression of human immunodeficiency virus type 1 (HIV-1) disease. Cross-sectional analysis. An ambulatory acquired immunodeficiency syndrome (AIDS) research clinic in Kinshasa, Zaire. 48 women with AIDS, 51 women with HIV infection who were clinically asymptomatic, and 11 female controls who did not have HIV infection, all from Zaire. Plasma levels of interleukin-1beta, tumor necrosis factor-alpha (TNF-alpha), interleukin-6, interleukin-8, interferon-gamma, interleukin-1beta receptor antagonist (interleukin-1Ra), and TNF soluble receptor p55 (TNFsRp55) were assayed by specific radioimmunoassays. Plasma levels of interferon-gamma were assayed by commercial enzyme-linked immunosorbent assay. The Wilcoxon rank-sum test was used to assess the significance of mean and median differences between groups. Of the 48 patients with AIDS, circulating interleukin-1beta was detected in 2, TNF-alpha in 4, interleukin-6 in 3, and interleukin-8 in 12. None of these factors were seen in any of the 11 controls. Median values of interleukin-1beta (320 pg/mL), TNF-alpha (210 pg/mL), and interleukin-8 (750 pg/mL) were elevated in HIV-infected asymptomatic patients compared with patients with AIDS (2-, 2.6-, and 18.7-fold higher, respectively; P < 0.001). Interleukin-1Ra and TNFsRp55 levels were substantially higher than interleukin-1beta and TNF-alpha levels in HIV-infected asymptomatic patients (73- and 14-fold, respectively) and were higher than those in patients with AIDS (17.8- and 1.74-fold, respectively). High circulating levels of the proinflammatory cytokines interleukin-1beta and TNF-alpha, combined with an excess of their natural inhibitors interleukin-1Ra and TNF-sRp55, were seen in clinically asymptomatic HIV-1-positive African women but not in African women with AIDS or in HIV-negative controls. Circulating cytokine antagonists may play a clinical role in modulating cytokine
Laffite, Amandine; Kilunga, Pitchouna I.; Kayembe, John M.; Devarajan, Naresh; Mulaji, Crispin K.; Giuliani, Gregory; Slaveykova, Vera I.; Poté, John
Data concerning the occurrence of emerging biological contaminants such as antibiotic resistance genes (ARGs) and fecal indicator bacteria (FIB) in aquatic environments in Sub-Saharan African countries is limited. On the other hand, antibiotic resistance remains a worldwide problem which may pose serious potential risks to human and animal health. Consequently, there is a growing number of reports concerning the prevalence and dissemination of these contaminants into various environmental compartments. Sediments provide the opportunity to reconstruct the pollution history and evaluate impacts so this study investigates the abundance and distribution of toxic metals, FIB, and ARGs released from hospital effluent wastewaters and their presence in river sediments receiving systems. ARGs (blaTEM, blaCTX-M, blaSHV, and aadA), total bacterial load, and selected bacterial species FIB [Escherichia coli, Enterococcus (ENT)] and species (Psd) were quantified by targeting species specific genes using quantitative PCR (qPCR) in total DNA extracted from the sediments recovered from 4 hospital outlet pipes (HOP) and their river receiving systems in the City of Kinshasa in the Democratic Republic of the Congo. The results highlight the great concentration of toxic metals in HOP, reaching the values (in mg kg−1) of 47.9 (Cr), 213.6 (Cu), 1434.4 (Zn), 2.6 (Cd), 281.5 (Pb), and 13.6 (Hg). The results also highlight the highest (P < 0.05) values of 16S rRNA, FIB, and ARGs copy numbers in all sampling sites including upstream (control site), discharge point, and downstream of receiving rivers, indicating that the hospital effluent water is not an exclusive source of the biological contaminants entering the urban rivers. Significant correlation were observed between (i) all analyzed ARGs and total bacterial load (16S rRNA) 0.51 to 0.72 (p < 0.001, n = 65); (ii) ARGs (except blaTEM) and FIB and Psd 0.57 < r < 0.82 (p < 0.001, n = 65); and (iii) ARGs (except blaTEM) and toxic metals
Impact of Moringa oleifera lam. Leaf powder supplementation versus nutritional counseling on the body mass index and immune response of HIV patients on antiretroviral therapy: a single-blind randomized control trial.
Tshingani, Koy; Donnen, Philippe; Mukumbi, Henri; Duez, Pierre; Dramaix-Wilmet, Michèle
To achieve effective antiretroviral therapy (ART) outcomes, adherence to an antiretroviral regimen and a good immunometabolic response are essential. Food insecurity can act as a real barrier to adherence to both of these factors. Many people living with human immunodeficiency virus (PLHIV) treated with ART in the Democratic Republic of the Congo (DRC) are faced with nutritional challenges. A significant proportion are affected by under nutrition, which frequently leads to therapeutic failure. Some HIV care facilities recommend supplementation with Moringa oleifera (M.O.) Lam. leaf powder to combat marginal and major nutritional deficiencies. This study aims to assess the impact of M.O. Lam. leaf powder supplementation compared to nutritional counseling on the nutritional and immune status of PLHIV treated with ART. A single-blind randomized control trial was carried out from May to September 2013 at an outpatient clinic for HIV-infected patients in Kinshasa (DRC). Sixty adult patients who were at stable HIV/AIDS clinical staging 2, 3 or 4 according to the World Health Organization (WHO), and were undergoing ART were recruited. After random allocation, 30 patients in the Moringa intervention group (MG) received the M.O. Lam. leaf powder daily over 6 months, and 30 in the control group (CG) received nutritional counseling over the same period. Changes in the body mass index (BMI) were measured monthly and biological parameters were measured upon admission and at the end of the study for the patients in both groups. The two study groups were similar in terms of long-term nutritional exposure, sociodemographic, socioeconomic, clinical, and biological features. At 6 months follow-up, patients in the MG exhibited a significantly greater increase in BMI and albumin levels than those in the CG. The interaction between the sociodemographic, clinical, and biological characteristics of patients in the two groups was not significant, with the exception of professional
Delvaux, Damien; Everaerts, Michel; Kongota Isasi, Elvis; Ganza Bamulezi, Gloire
After the break-up and separation of South America from Africa and the initiation of the South-Atlantic mid-oceanic ridge in the Albian, at about 120 Ma, ridge-push forces started to build-up in the oceanic lithosphere and were transmitted to the adjacent continental plates. This is particularly well expressed in the passive margin and continental interior of Central Africa. According to the relations of Wiens and Stein (1985) between ridge-push forces and basal drag in function of the lithospheric age of oceanic plates, the deviatoric stress reaches a compressional maximum between 50 and 100, Ma after the initiation of the spreading ridge, so broadly corresponding to the Paleocene in this case (~70-20 Ma). Earthquake focal mechanism data show that the West-Congo margin and a large part of the Congo basin are still currently under compressional stresses with an horizontal compression parallel to the direction of the active transform fracture zones. We studied the fracture network along the Congo River in Kinshasa and Brazzaville which affect Cambrian sandstones and probably also the late Cretaceous-Paleocene sediments. Their brittle tectonic evolution is compatible with the buildup of ridge-push forces related to the South-Atlantic opening. Further inland, low-angle reverse faults are found affecting Jurassic to Middle Cretaceous cores from the Samba borehole in the Congo basin and strike-slip movements are recorded as a second brittle phase in the Permian cores of the Dekese well, at the southern margin of the Congo basin. An analysis of the topography and river network of the Congo basin show the development of low-amplitude (50-100 m) long wavelengths (100-300 km) undulations that can be interpreted as lithospheric buckling in response to the compressional intraplate stress field generated by the Mid-Atlantic ridge-push. Wiens, D.A., Stein, S., 1985. Implications of oceanic intraplate seismicity for plate stresses, driving forces and theology. Tectonophysics
Mandina Ndona, Madone; Longo-Mbenza, Benjamin; Wumba, Roger; Tandu Umba, Barthelemy; Buassa-bu-Tsumbu, Baudouin; Mbula Mambimbi, Marcel; Wobin, Thaddée Odio; Mbungu Fuele, Simon
Background: The purpose of this study was to determine the cross-sectional association between some sociodemographic factors and antiretroviral therapy (ART), as well as the incidence and predictors of type 2 diabetes mellitus among Central Africans with human immunodeficiency virus (HIV) disease. Methods: This study had a cross-sectional design and was a prospective analysis of 102 patients with HIV disease (49 on ART versus 53 not on ART) in Kinshasa, Democratic Republic of Congo, between 2004 and 2008. A Cox regression model was used to assess for any relationship between type 2 diabetes and exposure to combination ART without protease inhibitors, after adjusting for known risk factors for type 2 diabetes, nadir CD4 and CD8 levels, viral load, marital status, and religion. Results: Unexpectedly elevated rates of smoking, excess alcohol intake, and ART-related total, abdominal, and peripheral obesity were observed in our study group of HIV patients. At the end of follow-up, five patients were diagnosed with type 2 diabetes (incidence rate 4.9%, 9.8 per 1000 person-years). Univariate risk factors for type 2 diabetes were male gender (relative risk [RR] 1.1, 95% confidence interval [CI] 1.01–1.4; P = 0.019), traditional religion versus new charismatic religion (RR 1.1, 95% CI 1.01–1.3; P = 0.046), exposure to ART (RR 1.1, 95% CI 1.002–1.3; P = 0.034), and single status (RR 6.2, 95% CI 1.5–15; P = 0.047). In multivariate analysis, strong significant independent predictors of type 2 diabetes were belonging to a traditional religion (HR 2.1, 95% CI 1.1–4.2; P = 0.036) and a relative increase in nadir CD4 cell count (beta coefficient 0.003; P < 0.0001). Conclusion: ART-related obesity and type 2 diabetes are becoming increasing problems in Central Africans with HIV disease. A relative increase in nadir CD4 count and traditional religion status appear to be the strongest independent predictors of type 2 diabetes. PMID:23226071
Laffite, Amandine; Kilunga, Pitchouna I; Kayembe, John M; Devarajan, Naresh; Mulaji, Crispin K; Giuliani, Gregory; Slaveykova, Vera I; Poté, John
Data concerning the occurrence of emerging biological contaminants such as antibiotic resistance genes (ARGs) and fecal indicator bacteria (FIB) in aquatic environments in Sub-Saharan African countries is limited. On the other hand, antibiotic resistance remains a worldwide problem which may pose serious potential risks to human and animal health. Consequently, there is a growing number of reports concerning the prevalence and dissemination of these contaminants into various environmental compartments. Sediments provide the opportunity to reconstruct the pollution history and evaluate impacts so this study investigates the abundance and distribution of toxic metals, FIB, and ARGs released from hospital effluent wastewaters and their presence in river sediments receiving systems. ARGs (bla TEM, bla CTX-M, bla SHV, and aadA), total bacterial load, and selected bacterial species FIB [Escherichia coli, Enterococcus (ENT)] and species (Psd) were quantified by targeting species specific genes using quantitative PCR (qPCR) in total DNA extracted from the sediments recovered from 4 hospital outlet pipes (HOP) and their river receiving systems in the City of Kinshasa in the Democratic Republic of the Congo. The results highlight the great concentration of toxic metals in HOP, reaching the values (in mg kg(-1)) of 47.9 (Cr), 213.6 (Cu), 1434.4 (Zn), 2.6 (Cd), 281.5 (Pb), and 13.6 (Hg). The results also highlight the highest (P < 0.05) values of 16S rRNA, FIB, and ARGs copy numbers in all sampling sites including upstream (control site), discharge point, and downstream of receiving rivers, indicating that the hospital effluent water is not an exclusive source of the biological contaminants entering the urban rivers. Significant correlation were observed between (i) all analyzed ARGs and total bacterial load (16S rRNA) 0.51 to 0.72 (p < 0.001, n = 65); (ii) ARGs (except bla TEM) and FIB and Psd 0.57 < r < 0.82 (p < 0.001, n = 65); and (iii) ARGs (except bla TEM) and toxic
Kibadi, K.; Moutet, F.
Summary Les séquelles de brûlures de la main sont encore fréquentes dans les pays à ressources limitées. Trente-deux patients, représentant 38 mains, ont été admis et traités, entre le 1er décembre 2010 et le 1er mai 2014 aux Cliniques Universitaires de Kinshasa en République Démocratique du Congo (RDC). nous avons observé 22 patients (69 %) dans le groupe de jeunes (patients âgés de moins de 18 ans), et 10 patients (31 %) chez les adultes (18 à 59 ans). Aucun patient dans le groupe de seniors (60 ans et plus) n’a été observé. Dans le groupe de jeunes, la tranche d’âge de 1 à 5 ans a été la plus atteinte avec 13 malades (40 %). l’accident à la maison était le plus fréquent (72 %). le mécanisme de la brûlure était le plus souvent thermique par flammes (51 %) ou par liquide chaud (34 %). les rétractions et brides sont les lésions le plus observées (84 %). la rétraction dorsale globale « main en griffe» est observée chez 40 % de patients traités, associée à des cicatrices hypertrophiques et chéloïdiennes dans 84 % de cas. Chez les 32 mains traitées chirurgicalement, des excision-greffes ont été réalisées dans 43,7 %, des lambeaux locaux dans 43,7 % et des lambeaux à distance dans 12,5 % de cas. A la sortie de l’hôpital, 84 % de « bons » résultats ont été observés. le suivi a été de 18 mois. le traitement des séquelles de brûlures de la main est possible dans ces pays, exemple de la rDC. Mais les défis à surmonter dans ces pays sont nombreux : la faible accessibilité aux techniques actuelles de la chirurgie plastique, la prise en charge initiale inadéquate des brûlures, la pauvreté. PMID:26668560
Spencer, Robert G.M.; Hernes, Peter J.; Aufdenkampe, Anthony K.; Baker, Andy; Gulliver, Pauline; Stubbins, Aron; Aiken, George R.; Dyda, Rachael Y.; Butler, Kenna D.; Mwamba, Vincent L.; Mangangu, Arthur M.; Wabakanghanzi, Jose N.; Six, Johan
The Congo River, which drains pristine tropical forest and savannah and is the second largest exporter of terrestrial carbon to the ocean, was sampled in early 2008 to investigate organic matter (OM) dynamics in this historically understudied river basin. We examined the elemental (%OC, %N, C:N), isotopic (δ13C, Δ14C, δ15N) and biochemical composition (lignin phenols) of coarse particulate (>63 μm; CPOM) and fine particulate (0.7–63 μm; FPOM) OM and DOC, δ13C, Δ14C and lignin phenol composition with respect to dissolved OM (14C = -62.2 ± -13.2‰, n = 5) compared to CPOM and DOM (mean Δ14C = 55.7 ± 30.6‰, n = 4 and 73.4 ± 16.1‰, n = 5 respectively). The modern radiocarbon ages for DOM belie a degraded lignin compositional signature (i.e. elevated acid:aldehyde ratios (Ad:Al) relative to CPOM and FPOM), and indicate that the application of OM degradation patterns derived from particulate phase studies to dissolved samples needs to be reassessed: these elevated ratios are likely attributable to fractionation processes during solubilization of plant material. The relatively low DOM carbon-normalized lignin yields (Λ8; 0.67–1.12 (mg(100 mg OC)-1)) could also reflect fractionation processes, however, they have also been interpreted as an indication of significant microbial or algal sources of DOM. CPOM appears to be well preserved higher vascular plant material as evidenced by its modern radiocarbon age, elevated C:N (17.2–27.1) and Λ8 values (4.56–7.59 (mg(100 mg OC)-1)). In relation to CPOM, the aged FPOM fraction (320–580 ybp 14C ages) was comparatively degraded, as demonstrated by its nitrogen enrichment (C:N 11.4–14.3), lower Λ8 (2.80–4.31 (mg(100 mg OC)-1)) and elevated lignin Ad:Al values similar to soil derived OM. In this study we observed little modification of the OM signature from sample sites near the cities of Brazzaville and Kinshasa to the head of the estuary (~350 km) highlighting the potential for future studies to
Muhindo Mavoko, Hypolite; Kalabuanga, Marion; Delgado-Ratto, Christopher; Maketa, Vivi; Mukele, Rodin; Fungula, Blaise; Inocêncio da Luz, Raquel; Rosanas-Urgell, Anna; Lutumba, Pascal; Van geertruyden, Jean-Pierre
Background In the Democratic Republic of Congo, artesunate-amodiaquine (ASAQ) is the first-line medication recommended for uncomplicated malaria treatment. We conducted a study in Kinshasa to describe the clinical features of the disease and assess the efficacy of ASAQ and its impact on the multiplicity of infection in children with uncomplicated malaria. Methods Children aged 12 to 59 months with uncomplicated P. falciparum malaria were treated with ASAQ and followed up passively for 42 days. To distinguish new infections from recrudescent parasites, samples were genotyped using a stepwise strategy with three molecular markers (GLURP, MSP2 and MSP1). We then assessed PCR-corrected and -uncorrected day-42 cure rates and multiplicity of infection (MOI). Results In total, 2,796 patients were screened and 865 enrolled in the study. Clinical features were characterized by history of fever (100%), coryza (59.9%) and weakness (59.4%). The crude and PCR-corrected efficacies of ASAQ were 55.3% (95%CI: 51.8–58.8) and 92.8% (95%CI: 91.0–94.6) respectively, as 83.6% (95%CI: 79.1–87.2) of the recurrences were new infections. Compared to monoclonal infections, polyclonal infections were more frequent at enrollment (88.1%) and in recurrences (80.1%; p = 0.005; OR: 1.8, 95%CI: 1.20–2.8). The median MOI at enrollment (MOI = 3.7; IQR: 0.7–6.7) decreased to 3 (IQR: 1–5) in the recurrent samples (p<0.001). Patients infected with a single haplotype on day 0 had no recrudescence; the risk of recrudescence increased by 28% with each additional haplotype (HR: 1.3, 95%CI: 1.24–1.44). Conclusion The PCR-corrected efficacy of ASAQ at day 42 was 92.8%, but crude efficacy was relatively poor due to high reinfection rates. Treatment outcomes were positively correlated with MOI. Continued monitoring of the efficacy of ACTs—ASAQ, in this case—is paramount. Trial Registration ClinicalTrials.gov NCT01374581 PMID:27280792
Longo-Mbenza, B; Muaka, M Mvitu; Yokobo, E Cibanda; Phemba, I Longo; Mokondjimobe, E; Gombet, T; Ndembe, D Kibokela; Mona, D Tulomba; Masamba, S Wayiza
Because of the demographic transition, lifestyle changes, urbanization, and nutrition transition, Central Africans are at higher risk of ocular diseases associated with oxidative stress and visual disability. This study aimed to estimate the normal values of oxidant status defined by oxidized low-density lipoprotein (Ox-LDL), 8-Isoprostane and 8-hydroxy-deoxyguanosine (8-OHdG) and to determine their pathogenic role in the prevalence and the severity of visual disability among these black Africans. This was a cross-sectional study, run in a case-control study randomly selected from Kinshasa province, DR Congo. The study included 150 type 2 diabetes mellitus (T2DM) patients (cases) matched for sex and age to 50 healthy non diabetic controls. Logistic regression models were used to identify independent determinants of visual disability. The presence rates were 8.5% for blindness, 20.5% for visual impairment and 29% for visual disability including blindness and visual impairment. After adjusted for taro leaves intake, red beans intake, T2DM, aging, waist circumference, and systolic blood pressure, we identified low education level (OR=3.3 95%CI 1.5-7.2; p=0.003), rural-urban migration (OR=2.6 95% CI 1.2-5.6; p=0.017), and high Ox-LDL (OR=2.3 95% CI 1.1-4.7; p=0.029) as the important independent determinants of visual disability. After adjusted for education, intake of red beans, intake of taro leaves, triglycerides, and T2DM, we identified no intake of safou fruit (OR=50.7 95% CI 15.2-168.5; p<0.0001), rural-urban migration (OR=3.9 95%CI 1.213; p=0.012), and high 8-OHdG (OR=14.7 95% CI 3.9-54.5; p<0.0001) as the significant independent determinants of visual disability. After adjusted for education level, no intake of red beans, no intake of Taro leaves, triglycerides, and T2DM, we identified no intake of Safou fruit (OR=43.1 95% CI 13.7-135.4; p<0.0001), age ≥ 60 years (OR=3.4 95% CI 1.3-9; p=0.024), and high 8-Isoprostane (OR=11 95% CI 3.4-36.1; p<0.0001) as the
Yotebieng, Marcel; Thirumurthy, Harsha; Moracco, Kathryn E.; Kawende, Bienvenu; Chalachala, Jean Lambert; Wenzi, Landry Kipula; Ravelomanana, Noro Lantoniaina Rosa; Edmonds, Andrew; Thompson, Deidre; Okitolonda, Emile W.; Behets, Frieda
Background Novel strategies are needed to increase retention in and uptake of prevention of mother-to-child HIV transmission (PMTCT) services in sub-Saharan Africa. Objective To determine whether small, increasing cash payments conditional on attending scheduled clinic visits and receiving proposed services can increase the proportions of HIV-infected pregnant women who accept available PMTCT services and remain in care through six weeks postpartum. Methods Newly diagnosed HIV-infected women, ≤32 weeks pregnant, were recruited at antenatal care clinics in Kinshasa, Democratic Republic of Congo, and assigned in a 1:1 ratio to an intervention or control group using computer-based randomization. The intervention group received compensation on the condition that they attended scheduled clinic visits and accepted offered PMTCT services ($5, plus $1 increment at each subsequent visit), while the control group received usual care. Outcomes assessed included: 1) retention in care at six weeks postpartum, and 2) to uptake PMTCT services, measured by attendance of all scheduled clinic visits and acceptance of proposed services through six weeks postpartum. Analyses were intent-to-treat. Results Between April 2013 and August 2014, 612 potential participants were identified, 545 were screened, and 433 were enrolled and randomized. At six weeks post-partum, the proportion of participants retained in care was higher in the intervention group than the control group (174/216, 80·6% vs. 157/217, 72·4%; risk ratio (RR), 1·11; 95% confidence interval (CI), 1·00–1·24). The proportion of participants who attended all clinic visits and accepted proposed services was higher in the intervention group than the control group (146/216, 67·6% vs. 116/217, 53·5%; RR, 1·26; 95% CI, 1·08–1·48). Results were similar after adjusting for marital status, age, and education. Conclusions Among newly diagnosed HIV-infected women, small, incremental cash incentives resulted in increased
Edmonds, Andrew; Feinstein, Lydia; Okitolonda, Vitus; Thompson, Deidre; Kawende, Bienvenu; Behets, Frieda
Background The consequences of decentralizing prevention of mother-to-child HIV transmission and HIV-exposed infant services to antenatal care (ANC)/labor and delivery (L&D) sites from dedicated HIV care and treatment (C&T) centers remain unknown, particularly in low prevalence settings. Methods In a cohort of mother–infant pairs, we compared delivery of routine services at ANC/L&D and C&T facilities in Kinshasa, Democratic Republic of Congo from 2010–2013, using methods accounting for competing risks (eg, death). Women could opt to receive interventions at 90 decentralized ANC/L&D sites, or 2 affiliated C&T centers. Additionally, we assessed decentralization’s population-level impacts by comparing proportions of women and infants receiving interventions before (2009–2010) and after (2011–2013) decentralization. Results Among newly HIV-diagnosed women (N = 1482), the 14-week cumulative incidence of receiving the package of CD4 testing and zidovudine or antiretroviral therapy was less at ANC/L&D [66%; 95% confidence interval (CI): 63% to 69%] than at C&T (88%; 95% CI: 83% to 92%) sites (subdistribution hazard ratio, 0.62; 95% CI: 0.55 to 0.69). Delivery of cotrimoxazole and DNA polymerase chain reaction testing to HIV-exposed infants (N = 1182) was inferior at ANC/L&D sites (subdistribution hazard ratio, 0.84; 95% CI: 0.76 to 0.92); the 10-month cumulative incidence of the package at ANC/L&D sites was 89% (95% CI: 82% to 93%) versus 97% (95% CI: 93% to 99%) at C&T centers. Receipt of the pregnancy (20% of 1518, to 64% of 1405) and infant (16%–31%) packages improved post decentralization. Conclusions Services were delivered less efficiently at ANC/L&D sites than C&T centers. Although access improved with decentralization, its potential cannot be realized without sufficient and sustained support. PMID:26262776
Leulmi, Hamza; Socolovschi, Cristina; Laudisoit, Anne; Houemenou, Gualbert; Davoust, Bernard; Bitam, Idir; Raoult, Didier; Parola, Philippe
Little is known about the presence/absence and prevalence of Rickettsia spp, Bartonella spp. and Yersinia pestis in domestic and urban flea populations in tropical and subtropical African countries. Fleas collected in Benin, the United Republic of Tanzania and the Democratic Republic of the Congo were investigated for the presence and identity of Rickettsia spp., Bartonella spp. and Yersinia pestis using two qPCR systems or qPCR and standard PCR. In Xenopsylla cheopis fleas collected from Cotonou (Benin), Rickettsia typhi was detected in 1% (2/199), and an uncultured Bartonella sp. was detected in 34.7% (69/199). In the Lushoto district (United Republic of Tanzania), R. typhi DNA was detected in 10% (2/20) of Xenopsylla brasiliensis, and Rickettsia felis was detected in 65% (13/20) of Ctenocephalides felis strongylus, 71.4% (5/7) of Ctenocephalides canis and 25% (5/20) of Ctenophthalmus calceatus calceatus. In the Democratic Republic of the Congo, R. felis was detected in 56.5% (13/23) of Ct. f. felis from Kinshasa, in 26.3% (10/38) of Ct. f. felis and 9% (1/11) of Leptopsylla aethiopica aethiopica from Ituri district and in 19.2% (5/26) of Ct. f. strongylus and 4.7% (1/21) of Echidnophaga gallinacea. Bartonella sp. was also detected in 36.3% (4/11) of L. a. aethiopica. Finally, in Ituri, Y. pestis DNA was detected in 3.8% (1/26) of Ct. f. strongylus and 10% (3/30) of Pulex irritans from the villages of Wanyale and Zaa. Most flea-borne infections are neglected diseases which should be monitored systematically in domestic rural and urban human populations to assess their epidemiological and clinical relevance. Finally, the presence of Y. pestis DNA in fleas captured in households was unexpected and raises a series of questions regarding the role of free fleas in the transmission of plague in rural Africa, especially in remote areas where the flea density in houses is high.
Leulmi, Hamza; Socolovschi, Cristina; Laudisoit, Anne; Houemenou, Gualbert; Davoust, Bernard; Bitam, Idir; Raoult, Didier; Parola, Philippe
Little is known about the presence/absence and prevalence of Rickettsia spp, Bartonella spp. and Yersinia pestis in domestic and urban flea populations in tropical and subtropical African countries. Methodology/Principal findings Fleas collected in Benin, the United Republic of Tanzania and the Democratic Republic of the Congo were investigated for the presence and identity of Rickettsia spp., Bartonella spp. and Yersinia pestis using two qPCR systems or qPCR and standard PCR. In Xenopsylla cheopis fleas collected from Cotonou (Benin), Rickettsia typhi was detected in 1% (2/199), and an uncultured Bartonella sp. was detected in 34.7% (69/199). In the Lushoto district (United Republic of Tanzania), R. typhi DNA was detected in 10% (2/20) of Xenopsylla brasiliensis, and Rickettsia felis was detected in 65% (13/20) of Ctenocephalides felis strongylus, 71.4% (5/7) of Ctenocephalides canis and 25% (5/20) of Ctenophthalmus calceatus calceatus. In the Democratic Republic of the Congo, R. felis was detected in 56.5% (13/23) of Ct. f. felis from Kinshasa, in 26.3% (10/38) of Ct. f. felis and 9% (1/11) of Leptopsylla aethiopica aethiopica from Ituri district and in 19.2% (5/26) of Ct. f. strongylus and 4.7% (1/21) of Echidnophaga gallinacea. Bartonella sp. was also detected in 36.3% (4/11) of L. a. aethiopica. Finally, in Ituri, Y. pestis DNA was detected in 3.8% (1/26) of Ct. f. strongylus and 10% (3/30) of Pulex irritans from the villages of Wanyale and Zaa. Conclusion Most flea-borne infections are neglected diseases which should be monitored systematically in domestic rural and urban human populations to assess their epidemiological and clinical relevance. Finally, the presence of Y. pestis DNA in fleas captured in households was unexpected and raises a series of questions regarding the role of free fleas in the transmission of plague in rural Africa, especially in remote areas where the flea density in houses is high. PMID:25299702
Longo-Mbenza, B; Nkondi Nsenga, J; Vangu Ngoma, D
To report on the association between certain components of the metabolic syndrome/Insulin resistance, gender, cardiovascular diseases and Helicobacter (H.) pylori seropositivity/Infection and the response of these cardiovascular risk factors to Helicobacter pylori titers after an antibiotic course. In 205 consecutive Africans referred to the cardiovascular Center of LOMO MEDICAL in Kinshasa for management of their cardiovascular diseases, the proportions of seropositives for H. pylori and H. pylori infection (H. pylori seropositivity and histologically proven H. pylori gastritis) were investigated. The association between traditional cardiovascular risk factors, certain components of the metabolic syndrome and each H. pylori disease group (seropositivity or infection) was evaluated. The response of the cardio-metabolic level to H. pylori antibody titers after an antibiotic course was also evaluated for patients with H. pylori infection. Baseline levels of H. pylori antibody titer and cardio-metabolic parameters were compared with those after the antibiotic treatment. A total of 62.4% of participants were tested positive for the H. pylori antibody. Out of all participants, 25% had H. pylori infection and chronic gastritis without H. pylori. Men were more (p<0.01) H. pylori seropositive than women. Older age, higher triglycerides, higher weight, wider waist girth, higher fibrinogenemia, greater intima-mediathighness and higher rate of hypertension were significantly associated with H. pylori seropositivity. Lower HDL-cholesterol, higher levels of systolic blood pressure, triglycerides, uric acid, fibrinogen, hematocrit, glycemia, arterial hypertension hypercholesterolemia, diabetes mellitus hypo-HDL-cholesterolemia, hyperuricemia (Total), Overweight, overall obesity, abdominal obesity were significantly associated with H. pylori infection. Within the total population, there was a significant dose-response relationship between the rates of arterial hypertension, rate
Between 1 September and 24 October 1976, 318 cases of acute viral haemorrhagic fever occurred in northern Zaire. The outbreak was centred in the Bumba Zone of the Equateur Region and most of the cases were recorded within a radius of 70 km of Yambuku, although a few patients sought medical attention in Bumba, Abumombazi, and the capital city of Kinshasa, where individual secondary and tertiary cases occurred. There were 280 deaths, and only 38 serologically confirmed survivors. The index case in this outbreak had onset of symptoms on 1 September 1976, five days after receiving an injection of chloroquine for presumptive malaria at the outpatient clinic at Yambuku Mission Hospital (YMH). He had a clinical remission of his malaria symptoms. Within one week several other persons who had received injections at YMH also suffered from Ebola haemorrhagic fever, and almost all subsequent cases had either received injections at the hospital or had had close contact with another case. Most of these occurred during the first four weeks of the epidemic, after which time the hospital was closed, 11 of the 17 staff members having died of the disease. All ages and both sexes were affected, but women 15-29 years of age had the highest incidence of disease, a phenomenon strongly related to attendance at prenatal and outpatient clinics at the hospital where they received injections. The overall secondary attack rate was about 5%, although it ranged to 20% among close relatives such as spouses, parent or child, and brother or sister. Active surveillance disclosed that cases occurred in 55 of some 550 villages which were examined house-by-house. The disease was hitherto unknown to the people of the affected region. Intensive search for cases in the area of north-eastern Zaire between the Bumba Zone and the Sudan frontier near Nzara and Maridi failed to detect definite evidence of a link between an epidemic of the disease in that country and the outbreak near Bumba. Nevertheless it was