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Tshimbombu TN, Fefe MN, Shin M, Kanter JH, Crockett SC, Richard BR, Muyembe Tamfum JJ. Demographic and Clinical Factors Affecting Pediatric Survival in South Kivu, the Democratic Republic of the Congo. Am J Trop Med Hyg 2023; 108:231-234. [PMID: 36410325 PMCID: PMC9833088 DOI: 10.4269/ajtmh.22-0455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 09/05/2022] [Indexed: 11/23/2022] Open
Abstract
Promoting children's health is challenging in underresourced regions, with worse outcomes in areas of sociopolitical instabilities. This encapsulates the difficulties faced by the Panzi General Referral Hospital (PGRH) in South Kivu, the Democratic Republic of the Congo. In this retrospective, cross-sectional study of 456 children ≤ 18 years who presented to the pediatric emergency department of PGRH between December 2018 and May 2019, we present demographic and clinical predictors that affect pediatric survival. We note that referrals from external clinics (odds ratio [OR], 0.37; 95% CI, 0.18-0.75), poor maternal education (OR, 0.21; 95% CI, 0.07-0.67), diagnoses of meningitis (OR, 0.37; 95% CI, 0.18-0.75) or malnutrition (OR, 0.21; 95% CI, 0.07-0.67) are risk factors hindering pediatric survival. Paternal unemployment or longer durations of hospital stay, on the other hand, are protective toward survival. These predictors confirm the importance of accessibility and availability of medical resources and knowledge as levers to establish an effective, robust network of pediatric care delivery capable of withstanding South Kivu's unresolved political tumult.
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Affiliation(s)
| | - Mapendo N Fefe
- Department of Medicine, University of Kaziba, South-Kivu
| | | | - John H Kanter
- Section of Neurosurgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Sarah C Crockett
- Department of Emergency Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Bahizire R Richard
- Department of Public Health, Higher Institute Medical Techniques, Nyangezi, Democratic Republic of the Congo
| | - Jean-Jacques Muyembe Tamfum
- National Institute of Biomedical Research and Department of Medical Microbiology and Virology, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
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Budema PM, Murhega RB, Tshimbombu TN, Toha GK, Cikomola FG, Mudekereza PS, Mubenga LE, Balemba GM, Badesire DC, Kanmounye US. Hand grenade blast injuries in the Eastern Democratic Republic of Congo: a case series of 38 patients. BMC Emerg Med 2022; 22:43. [PMID: 35305564 PMCID: PMC8933972 DOI: 10.1186/s12873-022-00599-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 03/03/2022] [Indexed: 11/27/2022] Open
Abstract
Introduction The armed conflict in the Kivu province of the Democratic Republic of Congo has caused close to 12,000 deaths. One of the most lethal weapons in armed conflicts is the high explosive hand grenade. The study aimed to describe the epidemiology, presentation, and outcomes of hand grenade blast injuries (HGBI) in the Kivu province. Methods In this case series, the authors present 2017 to 2020 HGBI admissions at a Congolese trauma center. Measures of central tendency and spread were computed for continuous data. Complication and mortality rates were equally computed. Admission-to-discharge data were disaggregated by the body part injured and by complication status and visualized using time-to-event curves. Results Thirty-eight HGBI patients aged 31.4 (range 17–56) years were included in the study. Twenty-six (68.4%) were male and the patients were admitted 1.8 days post-injury on average. The patients were hemodynamically stable at admission; 84.2% received the antitetanic vaccine, 21.1% received broad-spectrum antibiotics, and all were debrided (100.0%). The complication rate was 13.2%, and the most common complication was anemia (7.9%). In addition, the mortality rate was 2.6%. The median admission-to-discharge time was 17.0 (range 4–71) days, and it was prolonged in patients with lower extremity injuries (23.0 days). Conclusion HGBIs cause avertable death and disability in the Kivu regions. These data suggest that the burden of HGBIs can be reduced with appropriate preventive and health systems strengthening interventions.
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Murhega RB, Budema PM, Tshimbombu TN, Toha GK, Cikomola FG, Mudekereza PS, Mubenga LE, Balemba GM, Badesire DC, Negida A, Kanmounye US. Firearm injuries among children due to the Kivu conflict from 2017 to 2020: A hospital-based retrospective descriptive cohort study. Afr J Emerg Med 2022; 12:44-47. [PMID: 35070653 PMCID: PMC8761602 DOI: 10.1016/j.afjem.2021.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 06/10/2021] [Revised: 11/11/2021] [Accepted: 11/28/2021] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Firearm-related injuries are deadly but avoidable. The case of Kivu, a region in the Eastern Democratic Republic of Congo (DRC), is alarming. Decades of unresolved regional conflicts birthed armed groups that have massacred inhabitants and injured several children. This regional instability has also created barriers to seeking and obtaining timely care, decreasing the survival rate. This region's lack of data on paediatric fatal and nonfatal firearm injuries (F&NFFIs) needs studying. Thus, we aim to determine the prevalence and evaluate the outcomes of paediatric F&NFFIs in Kivu. METHODS We included all F&NFFI paediatric patients (≤18 years), admitted at our institution between 2017 and 2020. We extracted data from patient records. Next, we assessed the relationship between determinants of paediatric outcomes using the Chi-square test and the student's t-test. Confounders were identified using cox regression. RESULTS This study included 101 paediatric patients, mostly male (63.4%), with an average age of 15.9 years residing 164.4 km on average from the hospital. On average, they were admitted 2.9 days post-injury, with the most affected anatomical regions being lower limbs (53.5%) and upper limbs (18.8%). The mean length of stay was 52.9 days, and the mortality rate was 4.0%. Also, injury complications increased the mean length of stay and mortality rate. In addition, mortality was correlated with circulatory failure and anaemia. DISCUSSION Paediatric F&NFFIs in Eastern DRC is a preventable tragedy. Mortality is increased by injury complications and correlates with some biological factors. Prevention strategies should be developed to protect children and appropriate measures should be established to improve rates of prehospital care and early hospital presentation to lower mortality and improve paediatric outcomes.
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Affiliation(s)
- Romeo Bujiriri Murhega
- Department of Surgery, Provincial General Reference Hospital of Bukavu, Bukavu, Democratic Republic of the Congo
- Faculty of Medicine, Université Catholique de Bukavu, Bukavu, Democratic Republic of the Congo
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon
| | - Paul Munguakonkwa Budema
- Department of Surgery, Provincial General Reference Hospital of Bukavu, Bukavu, Democratic Republic of the Congo
- Faculty of Medicine, Université Catholique de Bukavu, Bukavu, Democratic Republic of the Congo
| | - Tshibambe Nathanael Tshimbombu
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Georges Kuyigwa Toha
- Department of Surgery, Provincial General Reference Hospital of Bukavu, Bukavu, Democratic Republic of the Congo
- Faculty of Medicine, Université Catholique de Bukavu, Bukavu, Democratic Republic of the Congo
| | - Fabrice Gulimwentuga Cikomola
- Department of Surgery, Provincial General Reference Hospital of Bukavu, Bukavu, Democratic Republic of the Congo
- Faculty of Medicine, Université Catholique de Bukavu, Bukavu, Democratic Republic of the Congo
| | - Paterne Safari Mudekereza
- Department of Surgery, Provincial General Reference Hospital of Bukavu, Bukavu, Democratic Republic of the Congo
- Faculty of Medicine, Université Catholique de Bukavu, Bukavu, Democratic Republic of the Congo
| | - Léon-Emmanuel Mubenga
- Department of Surgery, Provincial General Reference Hospital of Bukavu, Bukavu, Democratic Republic of the Congo
- Faculty of Medicine, Université Catholique de Bukavu, Bukavu, Democratic Republic of the Congo
| | - Ghislain Maheshe Balemba
- Faculty of Medicine, Université Catholique de Bukavu, Bukavu, Democratic Republic of the Congo
- Department of Radiology, Provincial General Reference Hospital of Bukavu, Bukavu, Democratic Republic of the Congo
| | - Darck Cubaka Badesire
- Department of Surgery, Provincial General Reference Hospital of Bukavu, Bukavu, Democratic Republic of the Congo
- Faculty of Medicine, Université Catholique de Bukavu, Bukavu, Democratic Republic of the Congo
| | - Ahmed Negida
- Faculty of Medicine, Zagazig University, Zagazig, Egypt
- School of Pharmacy and Biomedical Science, University of Portsmouth, UK
| | - Ulrick Sidney Kanmounye
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon
- Corresponding author.
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Thioub M, Mbaye M, Zolo Y, Sghiouar M, Diop S, Wague D, Sy EHCN, Thiam AB, Tshimbombu TN, Kanmounye US, Ba MC. The Burden of Pediatric Subarachnoid Hemorrhage Healthcare Disparities in Senegal: A Retrospective Cohort Study. Pediatr Neurosurg 2022; 57:78-84. [PMID: 34915522 DOI: 10.1159/000521450] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 12/13/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Pediatric aneurysms are uncommon but potentially deadly clinical conditions with varied etiology and outcomes. In low-resource countries, numerous barriers prevent the timely diagnosis and management of pediatric aneurysmal subarachnoid hemorrhage (aSAH). Thus, this study aimed to assess the mortality of pediatric aSAH stemming from limited access to pediatric neurological surgery care in Senegal. METHODS Pediatric aSAH patients admitted at the authors' institution from 2012 to 2020 were recruited. Spearman Rho's correlation, McNemar's test, and Wilcoxon signed-rank test were used. Odds ratios and their 95% confidence intervals were calculated, and the population attributable fraction (PAF) was used to quantify aSAH mortality attributable to lack of surgical care. RESULTS Twenty-four pediatric patients (12 females and 12 males) aged 12.2 (95% CI = 10.0-14.3) years presented with aSAH. Most patients had a single aneurysm measuring 12.6 (6.1-19.0) mm with 1 patient having 2. The median WFNS grade was 3 (range [1-4]), and the mean Fisher grade was 4 (range [1-4]). Fifteen patients (62.5%) had surgical treatment on day 15.0 (IQR = 23.0) of hospitalization. The overall mortality rate was 20.8%, and the PAF of mortality for lack of surgical treatment during hospitalization was 0.08. CONCLUSION Eight percent of deaths among pediatric aSAH patients who do not receive surgical treatment are attributable to lack of access to surgical treatment. Health system strengthening policies should be implemented to address this health inequity.
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Affiliation(s)
- Mbaye Thioub
- Neurosurgery Department, Fann Teaching Hospital, Dakar, Senegal
| | - Maguette Mbaye
- Neurosurgery Department, Fann Teaching Hospital, Dakar, Senegal
| | - Yvan Zolo
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon,
| | - Manal Sghiouar
- Neurosurgery Department, Fann Teaching Hospital, Dakar, Senegal
| | - Sagar Diop
- Neurosurgery Department, Principal Hospital of Dakar, Dakar, Senegal
| | - Daouda Wague
- Neurosurgery Department, Fann Teaching Hospital, Dakar, Senegal
| | | | | | - Tshibambe Nathanael Tshimbombu
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon.,Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | | | - Momar Code Ba
- Neurosurgery Department, Fann Teaching Hospital, Dakar, Senegal
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Budema PM, Murhega RB, Tshimbombu TN, Toha GK, Cikomola FG, Mudekereza PS, Mubenga LE, Maheshe-Balemba G, Badesire DC, Kanmounye US. Fatal and nonfatal firearm injuries in the eastern Democratic Republic of Congo: a hospital-based retrospective descriptive cohort study assessing correlates of adult mortality. BMC Emerg Med 2021; 21:116. [PMID: 34641813 PMCID: PMC8506075 DOI: 10.1186/s12873-021-00506-3] [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: 06/14/2021] [Accepted: 09/22/2021] [Indexed: 11/10/2022] Open
Abstract
Introduction The Eastern Democratic Republic of Congo (DRC) has been the battleground for multiple armed conflicts, resulting in many fatal and nonfatal firearm injuries (F&NFFIs). Chronic insecurity has stressed the health system’s resources and created barriers to seeking, reaching, and receiving timely care further increasing the F&NFFI burden. Our institution is the largest trauma center in the region and receives the bulk of F&NFFI cases. We aimed to identify correlates of mortality in Congolese F&NFFI patients. Methods We included all F&NFFI patients admitted to our institution between 2017 and 2020. We extracted data from patient charts and admission logs. We identified mortality correlates using the two-sample t-test, Chi-square test, and multivariable regression analysis. A P-value of less than 0.05 was considered statistically significant. Results This study included 814 adult patients, mostly male (86%) with an average age of 34.5 years and living 154.4 km away from the hospital on average. The most affected anatomical sites were the lower limbs (48.2%) and upper limbs (23.2%). The median length of stay was 34.0 days, and the in-hospital mortality rate was 3.6%. In addition, mortality was negatively correlated with diastolic blood pressure (P = 0.01), SaO2 (P < 0.001), and hemoglobin concentration (P = 0.002). Conclusion F&NFFIs cause an enormous burden in the region, and mortality is correlated with some clinical and biological variables. Thus, the study findings will inform F&NFFI referral, triage, and management in low-resource and mass casualty settings.
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Affiliation(s)
- Paul Munguakonkwa Budema
- Department of Surgery, Provincial General Reference Hospital of Bukavu, Bukavu, Democratic Republic of Congo.,Faculty of Medicine, Université Catholique de Bukavu, Bukavu, Democratic Republic of Congo
| | - Roméo Bujiriri Murhega
- Department of Surgery, Provincial General Reference Hospital of Bukavu, Bukavu, Democratic Republic of Congo.,Faculty of Medicine, Université Catholique de Bukavu, Bukavu, Democratic Republic of Congo.,Research Department, Association of Future African Neurosurgeons, 37B Avenue des Marais, Forgeron, Funa, Kinshasa, Democratic Republic of Congo
| | - Tshibambe Nathanael Tshimbombu
- Research Department, Association of Future African Neurosurgeons, 37B Avenue des Marais, Forgeron, Funa, Kinshasa, Democratic Republic of Congo.,Geisel School of Medicine at Dartmouth, 1 Rope Ferry Rd, Hanover, NH, 03755, USA
| | - Georges Kuyigwa Toha
- Department of Surgery, Provincial General Reference Hospital of Bukavu, Bukavu, Democratic Republic of Congo.,Faculty of Medicine, Université Catholique de Bukavu, Bukavu, Democratic Republic of Congo
| | - Fabrice Gulimwentuga Cikomola
- Department of Surgery, Provincial General Reference Hospital of Bukavu, Bukavu, Democratic Republic of Congo.,Faculty of Medicine, Université Catholique de Bukavu, Bukavu, Democratic Republic of Congo
| | - Paterne Safari Mudekereza
- Department of Surgery, Provincial General Reference Hospital of Bukavu, Bukavu, Democratic Republic of Congo.,Faculty of Medicine, Université Catholique de Bukavu, Bukavu, Democratic Republic of Congo
| | - Léon-Emmanuel Mubenga
- Department of Surgery, Provincial General Reference Hospital of Bukavu, Bukavu, Democratic Republic of Congo.,Faculty of Medicine, Université Catholique de Bukavu, Bukavu, Democratic Republic of Congo
| | - Ghislain Maheshe-Balemba
- Faculty of Medicine, Université Catholique de Bukavu, Bukavu, Democratic Republic of Congo.,Department of Radiology, Provincial General Reference Hospital of Bukavu, Bukavu, Democratic Republic of Congo
| | - Darck Cubaka Badesire
- Department of Surgery, Provincial General Reference Hospital of Bukavu, Bukavu, Democratic Republic of Congo.,Faculty of Medicine, Université Catholique de Bukavu, Bukavu, Democratic Republic of Congo
| | - Ulrick Sidney Kanmounye
- Research Department, Association of Future African Neurosurgeons, 37B Avenue des Marais, Forgeron, Funa, Kinshasa, Democratic Republic of Congo.
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