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Thompson N, Kyaw KWY, Singh L, Cikomola JC, Singh NS, Roberts B. The effect of COVID-19 on the non-COVID health outcomes of crisis-affected peoples: a systematic review. Confl Health 2024; 18:37. [PMID: 38664834 PMCID: PMC11044391 DOI: 10.1186/s13031-024-00592-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 04/09/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic posed considerable risks to populations affected by humanitarian crises in low- and middle-income countries (LMICs). However, there is limited understanding of how the pandemic may have affected non-COVID health outcomes among crisis-affected populations. Our aim was to examine the evidence on the impact of the COVID-19 pandemic on non-COVID-19 health outcomes for crisis-affected populations in LMICs. METHODS A systematic review methodology was applied following PRISMA guidelines. Eligibility criteria were: crisis-affected populations in LMICS; COVID-19; and all health topics, except for sexual and reproductive health which was covered in a linked review. Five bibliographic databases and additional grey literature sources were searched. The search period was from 2019 to 31 July 2022. Eligible papers were extracted and analysed using a narrative synthesis approach based on the study objectives and relevant health access and systems frameworks. A quality appraisal was also conducted. FINDINGS 4320 articles were screened, and 15 eligible studies were identified and included in this review. Ten studies collected health outcomes data. Eight related to mental health, which generally showed worse mental health outcomes because of the pandemic, and pandemic-related stressors were identified. Two studies assessed physical health outcomes in children, while none addressed physical health outcomes among adults. Nine studies reported on access to healthcare, revealing worse access levels due to the pandemic and noting key barriers to care. Seven studies reported on the impact on health systems, with key challenges including reduced and distorted health care funding, reduced staff capacity, interrupted medicines and supplies, weak information and mixed-messaging, and weak leadership. All fifteen studies on the social determinants of health, particularly highlighting the effect of increasing poverty, the role of gender, and food insecurity on health outcomes. The quality of papers was limited overall. CONCLUSION This review found some limited evidence indicating negative mental health effects, increased barriers to accessing care, damage to health systems and magnified impacts on the social determinants of health for crisis-affected people during the COVID-19 pandemic. However, the small number and limited quality of the studies make the overall strength of evidence quite weak.
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Affiliation(s)
- N Thompson
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - K W Y Kyaw
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - L Singh
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - J C Cikomola
- Faculty of Medicine, Université Catholique de Bukavu, Democratic Republic of the Congo, Central African Republic
| | - N S Singh
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Bayard Roberts
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK.
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Fortes-Lima CA, Burgarella C, Hammarén R, Eriksson A, Vicente M, Jolly C, Semo A, Gunnink H, Pacchiarotti S, Mundeke L, Matonda I, Muluwa JK, Coutros P, Nyambe TS, Cikomola JC, Coetzee V, de Castro M, Ebbesen P, Delanghe J, Stoneking M, Barham L, Lombard M, Meyer A, Steyn M, Malmström H, Rocha J, Soodyall H, Pakendorf B, Bostoen K, Schlebusch CM. The genetic legacy of the expansion of Bantu-speaking peoples in Africa. Nature 2024; 625:540-547. [PMID: 38030719 PMCID: PMC10794141 DOI: 10.1038/s41586-023-06770-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 10/20/2023] [Indexed: 12/01/2023]
Abstract
The expansion of people speaking Bantu languages is the most dramatic demographic event in Late Holocene Africa and fundamentally reshaped the linguistic, cultural and biological landscape of the continent1-7. With a comprehensive genomic dataset, including newly generated data of modern-day and ancient DNA from previously unsampled regions in Africa, we contribute insights into this expansion that started 6,000-4,000 years ago in western Africa. We genotyped 1,763 participants, including 1,526 Bantu speakers from 147 populations across 14 African countries, and generated whole-genome sequences from 12 Late Iron Age individuals8. We show that genetic diversity amongst Bantu-speaking populations declines with distance from western Africa, with current-day Zambia and the Democratic Republic of Congo as possible crossroads of interaction. Using spatially explicit methods9 and correlating genetic, linguistic and geographical data, we provide cross-disciplinary support for a serial-founder migration model. We further show that Bantu speakers received significant gene flow from local groups in regions they expanded into. Our genetic dataset provides an exhaustive modern-day African comparative dataset for ancient DNA studies10 and will be important to a wide range of disciplines from science and humanities, as well as to the medical sector studying human genetic variation and health in African and African-descendant populations.
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Affiliation(s)
- Cesar A Fortes-Lima
- Human Evolution Program, Department of Organismal Biology, Uppsala University, Uppsala, Sweden
| | - Concetta Burgarella
- Human Evolution Program, Department of Organismal Biology, Uppsala University, Uppsala, Sweden
- AGAP Institut, University of Montpellier, CIRAD, INRAE, Institut Agro, Montpellier, France
| | - Rickard Hammarén
- Human Evolution Program, Department of Organismal Biology, Uppsala University, Uppsala, Sweden
| | - Anders Eriksson
- cGEM, Institute of Genomics, University of Tartu, Tartu, Estonia
| | - Mário Vicente
- Centre for Palaeogenetics, University of Stockholm, Stockholm, Sweden
- Department of Archaeology and Classical Studies, Stockholm University, Stockholm, Sweden
| | - Cecile Jolly
- Human Evolution Program, Department of Organismal Biology, Uppsala University, Uppsala, Sweden
| | - Armando Semo
- CIBIO, Centro de Investigação em Biodiversidade e Recursos Genéticos, Universidade do Porto, Vairão, Portugal
- BIOPOLIS Program in Genomics, Biodiversity and Land Planning, CIBIO, Campus de Vairão, Vairão, Portugal
- Departamento de Biologia, Faculdade de Ciências, Universidade do Porto, Porto, Portugal
| | - Hilde Gunnink
- UGent Centre for Bantu Studies (BantUGent), Department of Languages and Cultures, Ghent University, Ghent, Belgium
- Leiden University Centre for Linguistics, Leiden, the Netherlands
| | - Sara Pacchiarotti
- UGent Centre for Bantu Studies (BantUGent), Department of Languages and Cultures, Ghent University, Ghent, Belgium
| | - Leon Mundeke
- University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Igor Matonda
- University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Joseph Koni Muluwa
- Institut Supérieur Pédagogique de Kikwit, Kikwit, Democratic Republic of Congo
| | - Peter Coutros
- UGent Centre for Bantu Studies (BantUGent), Department of Languages and Cultures, Ghent University, Ghent, Belgium
| | | | | | - Vinet Coetzee
- Department of Biochemistry, Genetics and Microbiology, University of Pretoria, Pretoria, South Africa
| | - Minique de Castro
- Biotechnology Platform, Agricultural Research Council, Onderstepoort, Pretoria, South Africa
| | - Peter Ebbesen
- Department of Health Science and Technology, University of Aalborg, Aalborg, Denmark
| | - Joris Delanghe
- Department of Diagnostic Sciences, Ghent University, Ghent, Belgium
| | - Mark Stoneking
- Department of Evolutionary Genetics, Max Planck Institute for Evolutionary Anthropology, Leipzig, Germany
- Laboratoire de Biométrie et Biologie Evolutive, UMR 5558, Université Lyon 1, CNRS, Villeurbanne, France
| | - Lawrence Barham
- Department of Archaeology, Classics & Egyptology, University of Liverpool, Liverpool, UK
| | - Marlize Lombard
- Palaeo-Research Institute, University of Johannesburg, Johannesburg, South Africa
| | - Anja Meyer
- Human Variation and Identification Research Unit, School of Anatomical Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Maryna Steyn
- Human Variation and Identification Research Unit, School of Anatomical Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Helena Malmström
- Human Evolution Program, Department of Organismal Biology, Uppsala University, Uppsala, Sweden
- Palaeo-Research Institute, University of Johannesburg, Johannesburg, South Africa
| | - Jorge Rocha
- CIBIO, Centro de Investigação em Biodiversidade e Recursos Genéticos, Universidade do Porto, Vairão, Portugal
- BIOPOLIS Program in Genomics, Biodiversity and Land Planning, CIBIO, Campus de Vairão, Vairão, Portugal
- Departamento de Biologia, Faculdade de Ciências, Universidade do Porto, Porto, Portugal
| | - Himla Soodyall
- Division of Human Genetics, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Academy of Science of South Africa, Pretoria, South Africa
| | | | - Koen Bostoen
- UGent Centre for Bantu Studies (BantUGent), Department of Languages and Cultures, Ghent University, Ghent, Belgium
| | - Carina M Schlebusch
- Human Evolution Program, Department of Organismal Biology, Uppsala University, Uppsala, Sweden.
- Palaeo-Research Institute, University of Johannesburg, Johannesburg, South Africa.
- SciLifeLab, Uppsala, Sweden.
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Le Bec E, Kam M, Aebischer Perone S, Boulle P, Cikomola JC, Gandur ME, Gehri M, Kehlenbrink S, Beran D. Using Clinical Vignettes to Understand the Complexity of Diagnosing Type 1 Diabetes in Sub-Saharan Africa. Res Rep Trop Med 2023; 14:111-120. [PMID: 38024811 PMCID: PMC10656429 DOI: 10.2147/rrtm.s397127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 11/07/2023] [Indexed: 12/01/2023] Open
Abstract
Lack of awareness, access to insulin and diabetes care can result in high levels of morbidity and mortality for children with type 1 diabetes (T1DM) in sub-Saharan Africa (SSA). Improvements in access to insulin and diabetes management have improved outcomes in some settings. However, many people still present in diabetic ketoacidosis (DKA) in parallel to misdiagnosis of children with T1DM in contexts with high rates of communicable diseases. The aim of this study was to highlight the complexity of diagnosing pediatric T1DM in a healthcare environment dominated by infectious diseases and lack of adequate health system resources. This was done by developing clinical vignettes and recreating the hypothetico-deductive process of a clinician confronted with DKA in the absence of identification of pathognomonic elements of diabetes and with limited diagnostic tools. A non-systematic literature search for T1DM and DKA in SSA was conducted and used to construct clinical vignettes for children presenting in DKA. A broad differential diagnosis of the main conditions present in SSA was made, then used to construct a clinician's medical reasoning, and anticipate the results of different actions on the diagnostic process. An examination of the use of the digital based Integrated Management of Childhood Illness diagnostic algorithm was done, and an analysis of the software's efficiency in adequately diagnosing DKA was assessed. The main obstacles to diagnosis were low specificity of non-pathognomonic DKA symptoms and lack of tools to measure blood or urine glucose. Avenues for improvement include awareness of T1DM symptomatology in communities and health systems, and greater availability of diagnostic tests. Through this work clinical vignettes are shown to be a useful tool in analyzing the obstacles to underdiagnosis of diabetes, a technique that could be used for other pathologies in limited settings, for clinical teaching, research, and advocacy.
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Affiliation(s)
- Enora Le Bec
- Internal Medicine, Etablissements Hospitaliers du Nord Vaudois, Yverdon, Switzerland
| | - Madibele Kam
- Pediatric University Hospital Charles de Gaulle, Ouagadougou, Burkina Faso
| | - Sigiriya Aebischer Perone
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Geneva, Switzerland
- Health Unit, International Committee of the Red Cross, Geneva, Switzerland
| | | | | | | | - Mario Gehri
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Sylvia Kehlenbrink
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women’s Hospital, Boston, MA, USA
| | - David Beran
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Geneva, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
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4
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Peer N, Nguyen KA, Hill J, Sumner AE, Cikomola JC, Nachega JB, Kengne AP. Prevalence and influences of diabetes and prediabetes among adults living with HIV in Africa: a systematic review and meta-analysis. J Int AIDS Soc 2023; 26:e26059. [PMID: 36924213 PMCID: PMC10018386 DOI: 10.1002/jia2.26059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 01/11/2023] [Indexed: 03/18/2023] Open
Abstract
INTRODUCTION In people living with human immunodeficiency virus (PLHIV), traditional cardiovascular risk factors, exposure to HIV per se and antiretroviral therapy (ART) are assumed to contribute to cardiometabolic diseases. Nevertheless, controversy exists on the relationship of HIV and ART with diabetes. To clarify the relationship between HIV and type 2 diabetes, this review determined, in PLHIV in Africa, diabetes and prediabetes prevalence, and the extent to which their relationship was modified by socio-demographic characteristics, body mass index (BMI), diagnostic definitions used for diabetes and prediabetes, and HIV-related characteristics, including CD4 count, and use and duration of ART. METHODS For this systematic review and meta-analysis (PROSPERO registration CRD42021231547), a comprehensive search of major databases (PubMed-MEDLINE, Scopus, Web of Science, Google Scholar and WHO Global Health Library) was conducted. Original research articles published between 2000 and 2021 in English and French were included, irrespective of study design, data collection techniques and diagnostic definitions used. Observational studies comprising at least 30 PLHIV and reporting on diabetes and/or prediabetes prevalence in Africa were included. Study-specific estimates were pooled using random effects models to generate the overall prevalence for each diagnostic definition. Data analyses used R statistical software and "meta" package. RESULTS Of the 2614 records initially screened, 366 full-text articles were assessed for eligibility and 61 were selected. In the systematic review, all studies were cross-sectional by design and clinic-based, except for five population-based studies. Across studies included in the meta-analysis, the proportion of men was 16-84%. Mean/median age was 30-62 years. Among 86,412 and 7976 participants, diabetes and prediabetes prevalence rates were 5.1% (95% CI: 4.3-5.9) and 15.1% (9.7-21.5). Self-reported diabetes (3.5%) was lower than when combined with biochemical assessments (6.2%; 7.2%). DISCUSSION While not statistically significant, diabetes and prediabetes were higher with greater BMI, in older participants, urban residents and more recent publications. Diabetes and prediabetes were not significantly different by HIV-related factors, including CD4 count and ART. CONCLUSIONS Although HIV-related factors did not modify prevalence, the diabetes burden in African PLHIV was considerable with suboptimal detection, and likely influenced by traditional risk factors. Furthermore, high prediabetes prevalence foreshadows substantial increases in future diabetes in African PLHIV.
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Affiliation(s)
- Nasheeta Peer
- Non-communicable Diseases Research Unit, South African Medical Research Council, Durban and Cape Town, South Africa.,Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Kim Anh Nguyen
- Non-communicable Diseases Research Unit, South African Medical Research Council, Durban and Cape Town, South Africa
| | - Jillian Hill
- Non-communicable Diseases Research Unit, South African Medical Research Council, Durban and Cape Town, South Africa
| | - Anne E Sumner
- Section on Ethnicity and Health, Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institute of Health, Bethesda, Maryland, USA.,National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland, USA
| | - Justin Cirhuza Cikomola
- Faculty of Medicine, Université Catholique de Bukavu, Bukavu, the Democratic Republic of the Congo
| | - Jean Bisimwa Nachega
- Division of Infectious Diseases, Department of Medicine, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, South Africa.,Department of Epidemiology, Infectious Diseases, and Microbiology, and Center for Global Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Andre-Pascal Kengne
- Non-communicable Diseases Research Unit, South African Medical Research Council, Durban and Cape Town, South Africa.,Department of Medicine, University of Cape Town, Cape Town, South Africa
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5
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Katte JC, Sibomana L, Hapunda G, Cikomola JC, Abidha CA. Diabetes in sub-Saharan Africa: what are the next steps? Lancet Diabetes Endocrinol 2022; 10:766-768. [PMID: 36228633 DOI: 10.1016/s2213-8587(22)00274-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 09/26/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Jean Claude Katte
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter EX1 2LU, UK; National Obesity Centre and Endocrinology and Metabolic Diseases Unit, Yaounde Central Hospital, Yaounde, Cameroon.
| | - Laurien Sibomana
- Department of Medicine, University of Pittsburg, Pittsburgh, PA, USA
| | - Given Hapunda
- Department of Psychology, University of Zambia, Lusaka, Zambia
| | - Justin Cirhuza Cikomola
- Department of Internal Medicine, Faculty of Medicine, Catholic University of Bukavu, Bukavu, Democratic Republic of the Congo
| | - Carol A Abidha
- Faculty of Medicine and University Hospital, Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
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6
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Mwene-Batu P, Lemogoum D, de le Hoye L, Bisimwa G, Hermans MP, Minani J, Amani G, Mateso GQ, Cikomola JC, Dramaix M, Donnen P. Association between severe acute malnutrition during childhood and blood pressure during adulthood in the eastern Democratic Republic of the Congo: the Lwiro cohort study. BMC Public Health 2021; 21:847. [PMID: 33933039 PMCID: PMC8088659 DOI: 10.1186/s12889-021-10908-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 04/23/2021] [Indexed: 12/14/2022] Open
Abstract
Introduction Little is known about the long-term outcomes of Severe Acute Malnutrition (SAM) during childhood. As such, this study aims to explore the association between childhood SAM and blood pressure (BP) in adulthood in a context without nutrition transition. Methodology We identified 524 adults (Median age: 22 years) who were treated for SAM during childhood in Eastern DRC between 1988 and 2007. They were compared with 407 age-and-sex matched subjects with no history of SAM in the community. The variables examined for this study were the systolic (SBP), diastolic (DBP), mean (MBP) blood pressure (BP) and pulse pressure (PP), as well as high blood pressure (HBP) defined as BP ≥ 140/90 mmHg and/or use of BP-lowering drug(s) in adulthood. For comparison, linear and logistic regression models were used for analysing continuous and dichotomous variables, respectively. Results Of the 524 exposed located, 145 were selected according to age. A total of 97 unexposed were recruited. Compared to unexposed, exposed had slightly higher SBP and PP after adjusting for occupation, body mass index (BMI) and food consumption [SBP = 1.4 mmHg (− 2.2, 4.8) and PP = 2.6 mmHg (− 0.3, 6.0)]. However, their DBP was lower than that of the unexposed [− 1.6 mmHg (− 4.6, 1.5)]. MBP and creatinine levels were similar between the two groups. The prevalence of HBP adjusted for age was higher among exposed than unexposed (9.7% vs 5.3%). In addition, the odds of having HBP was higher among exposed than unexposed, however the observed difference was not statistically significant [Odds Ratio (OR) 1.9 (0.7, 5.6)]. Finally, using multiple regression analysis, although the effect was not significant, SAM was a major contributor to HBP [adjusted OR 3.1 (0.9,10.9), p = 0.064], while only male gender and higher BMI (overweight/obesity) emerged as independent predictors of HBP among this young study population. Conclusions This study suggests that an episode of SAM in childhood has a weak impact on BP variability in young Congolese adults (from DRC) living in an environment without nutrition transition. However, people who experienced a period of SAM tended to have a higher prevalence of HBP and a much higher risk of developing HBP than unexposed. Additional multicentre studies involving a larger cohort would provide greater understanding of the impact of SAM on the overall risk of BP disorders during adulthood.
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Affiliation(s)
- Pacifique Mwene-Batu
- Ecole Régionale de Santé Publique, Université Catholique de Bukavu, Bukavu, Democratic Republic of Congo. .,Ecole de Santé Publique, Université Libre de Bruxelles, Brussels, Belgium. .,Nutritional department, Centre de Recherche en Sciences Naturelles, Lwiro, Democratic Republic of Congo. .,Institute of Health and Society, Université Catholique de Louvain, Brussels, Belgium. .,Hôpital Provincial General de Reference de Bukavu, Université Catholique de Bukavu, Bukavu, Democratic Republic of Congo.
| | - Daniel Lemogoum
- Hôpital ULB-Erasme , Université Libre de Bruxelles, Brussels, Belgium
| | - Laurène de le Hoye
- Ecole de Santé Publique, Université Libre de Bruxelles, Brussels, Belgium
| | - Ghislain Bisimwa
- Ecole Régionale de Santé Publique, Université Catholique de Bukavu, Bukavu, Democratic Republic of Congo.,Nutritional department, Centre de Recherche en Sciences Naturelles, Lwiro, Democratic Republic of Congo
| | - Michel P Hermans
- Division of Endocrinology & Nutrition, Cliniques universitaires St-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Jimmy Minani
- Hôpital Provincial General de Reference de Bukavu, Université Catholique de Bukavu, Bukavu, Democratic Republic of Congo
| | - Gaylord Amani
- Ecole Régionale de Santé Publique, Université Catholique de Bukavu, Bukavu, Democratic Republic of Congo
| | - Guy-Quesney Mateso
- Hôpital Provincial General de Reference de Bukavu, Université Catholique de Bukavu, Bukavu, Democratic Republic of Congo
| | - Justin Cirhuza Cikomola
- Hôpital Provincial General de Reference de Bukavu, Université Catholique de Bukavu, Bukavu, Democratic Republic of Congo.,Faculty of Medicine, Univeristé catholique de Bukavu, Bukavu, Democratic Republic of Congo
| | - Michelle Dramaix
- Ecole de Santé Publique, Université Libre de Bruxelles, Brussels, Belgium
| | - Philippe Donnen
- Ecole de Santé Publique, Université Libre de Bruxelles, Brussels, Belgium
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7
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Mateso GQ, Baguma M, Mwene-Batu P, Balemba GM, Nzabara F, Makali S, Bedha A, Furaha B, Minani J, Muhindo CT, Malembaka EB, Masimango MI, Shindano TA, Cikomola JC, Mubagwa K. Atypical respiratory distress in eastern Democratic Republic of the Congo prior to the COVID-19 pandemic. A case report. Trop Dis Travel Med Vaccines 2021; 7:9. [PMID: 33823942 PMCID: PMC8022307 DOI: 10.1186/s40794-021-00134-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 03/23/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND Predictions have been made that Africa would be the most vulnerable continent to the novel Coronavirus disease 2019 (COVID-19). Interestingly, the spread of the disease in Africa seems to have been delayed and initially slower than in many parts of the world. Here we report on two cases of respiratory distress in our region before the official declaration of the disease in December 2019, cases which in the present times would be suspect of COVID-19. CASE PRESENTATION These two cases (one 55-year-old man and one 25-year-old woman) of acute respiratory distress secondary to atypical pneumonia were seen in Bukavu, in Eastern Democratic Republic of the Congo (DRC), between September and December 2019. One patient had returned from China and the other had close contacts with travellers from China in the 2 weeks prior to the onset of symptoms. In either case, the aetiology could not be accurately determined. However, the two cases presented a clinical picture (progressive dyspnoea, preceded by dry cough and fever) and laboratory changes (procalcitonin within the normal range, slight inflammation, and lymphopenia) compatible with a viral infection. The chest X-ray series of the first patient showed lesions (reticulations, ground glass, and nodules ≤6 mm) similar to those currently found in COVID-19 patients. In addition, unlike the 25-year-old female patient who had no comorbidity, the 55-year-old male patient who had hypertension as comorbidity, developed a more severe acute respiratory distress which progressed to death. CONCLUSION These cases bring to the attention the fact that COVID-19-like syndromes may have already been present in the region months before the official beginning of the pandemic. This also brings to question whether a prior presence of the disease or infections with related virus may account for the delayed and less extensive development of the pandemic in the region.
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Affiliation(s)
- Guy-Quesney Mateso
- Department of Internal Medicine, Hôpital Provincial Général de Référence de Bukavu (HPGRB), Bukavu, Democratic Republic of the Congo
| | - Marius Baguma
- Department of Internal Medicine, Hôpital Provincial Général de Référence de Bukavu (HPGRB), Bukavu, Democratic Republic of the Congo. .,Faculty of Medicine, Université Catholique de Bukavu (UCB), Bukavu, Democratic Republic of the Congo.
| | - Pacifique Mwene-Batu
- Department of Internal Medicine, Hôpital Provincial Général de Référence de Bukavu (HPGRB), Bukavu, Democratic Republic of the Congo.,Faculty of Medicine, Université Catholique de Bukavu (UCB), Bukavu, Democratic Republic of the Congo.,École Régionale de Santé Publique (ERSP), Université Catholique de Bukavu (UCB), Bukavu, Democratic Republic of the Congo
| | - Ghislain Maheshe Balemba
- Department of Internal Medicine, Hôpital Provincial Général de Référence de Bukavu (HPGRB), Bukavu, Democratic Republic of the Congo.,Faculty of Medicine, Université Catholique de Bukavu (UCB), Bukavu, Democratic Republic of the Congo.,École Régionale de Santé Publique (ERSP), Université Catholique de Bukavu (UCB), Bukavu, Democratic Republic of the Congo
| | - Fabrice Nzabara
- Department of Internal Medicine, Hôpital Provincial Général de Référence de Bukavu (HPGRB), Bukavu, Democratic Republic of the Congo.,Faculty of Medicine, Université Catholique de Bukavu (UCB), Bukavu, Democratic Republic of the Congo
| | - Samuel Makali
- Department of Internal Medicine, Hôpital Provincial Général de Référence de Bukavu (HPGRB), Bukavu, Democratic Republic of the Congo.,Faculty of Medicine, Université Catholique de Bukavu (UCB), Bukavu, Democratic Republic of the Congo.,École Régionale de Santé Publique (ERSP), Université Catholique de Bukavu (UCB), Bukavu, Democratic Republic of the Congo
| | - Aline Bedha
- Department of Internal Medicine, Hôpital Provincial Général de Référence de Bukavu (HPGRB), Bukavu, Democratic Republic of the Congo.,Faculty of Medicine, Université Catholique de Bukavu (UCB), Bukavu, Democratic Republic of the Congo
| | - Bonheur Furaha
- Department of Internal Medicine, Hôpital Provincial Général de Référence de Bukavu (HPGRB), Bukavu, Democratic Republic of the Congo
| | - Jimmy Minani
- Department of Internal Medicine, Hôpital Provincial Général de Référence de Bukavu (HPGRB), Bukavu, Democratic Republic of the Congo
| | - Christian Tshongo Muhindo
- Department of Internal Medicine, Hôpital Provincial Général de Référence de Bukavu (HPGRB), Bukavu, Democratic Republic of the Congo.,Faculty of Medicine, Université Catholique de Bukavu (UCB), Bukavu, Democratic Republic of the Congo
| | - Espoir Bwenge Malembaka
- Faculty of Medicine, Université Catholique de Bukavu (UCB), Bukavu, Democratic Republic of the Congo.,École Régionale de Santé Publique (ERSP), Université Catholique de Bukavu (UCB), Bukavu, Democratic Republic of the Congo
| | - Mannix Imani Masimango
- Department of Internal Medicine, Hôpital Provincial Général de Référence de Bukavu (HPGRB), Bukavu, Democratic Republic of the Congo.,Faculty of Medicine, Université Catholique de Bukavu (UCB), Bukavu, Democratic Republic of the Congo
| | - Tony Akilimali Shindano
- Department of Internal Medicine, Hôpital Provincial Général de Référence de Bukavu (HPGRB), Bukavu, Democratic Republic of the Congo.,Faculty of Medicine, Université Catholique de Bukavu (UCB), Bukavu, Democratic Republic of the Congo
| | - Justin Cirhuza Cikomola
- Department of Internal Medicine, Hôpital Provincial Général de Référence de Bukavu (HPGRB), Bukavu, Democratic Republic of the Congo.,Faculty of Medicine, Université Catholique de Bukavu (UCB), Bukavu, Democratic Republic of the Congo
| | - Kanigula Mubagwa
- Faculty of Medicine, Université Catholique de Bukavu (UCB), Bukavu, Democratic Republic of the Congo
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