Stroke signs knowledge and factors associated with a delayed hospital arrival of patients with acute stroke in Kinshasa

Background

Rapid recognition and early medical intervention are essential to reduce stroke-related mortality and long-term disability. This study aimed to evaluate awareness of stroke symptoms/signs and determine factors delaying the hospital arrival of patients with acute stroke in Kinshasa.

Methods

Patients with stroke and/or accompanying family members were interviewed using a standard questionnaire, and their medical records were reviewed. Factors independently associated with a late arrival (≥4.5 h) to the hospital were identified using the logistic regression test in forward multivariate analysis.

Results

Overall, 202 patients with an average age of 57.9 ± 13.1 years were included. Only 27 (13.4%) patients immediately associated the initial symptoms with a stroke episode. Delayed hospital arrival was observed in 180 (89.1%) patients. Unmarried status (adjusted odds ratio [aOR], 2.29; 95% confidence interval [CI], 1.17-4.88; p = 0.007), low education level (aOR, 2.29; 95% CI, (1.12-5.10; p = 0,014), absence of impaired consciousness (aOR, 3.12; 95% CI, 1.52-4.43; p = 0.005), absence of a history of hypertention (aOR, 1.85; 95% CI, 1.18-3.78; p = 0.041), absence of a history of diabetes (aOR, 1.93; 95% CI, 1.15-4.58; p = 0.013), heavy alcohol consumption (aOR, 1.83; 95% CI, 1.12-2.83; p = 0.045), absence of a severe to very severe stroke (aOR, 4.93; 95% CI, 0.82-1.01; p = 0.002), and presence of ischemic stroke (aOR, 2.93; 95% CI, 1.54-4.59; p = 0.001) were identified as independent determinants of delayed hospital arrival.

Conclusions

This study depicted a low stroke awareness rate and a much longer prehospital delay than evidence-based guidelines recommend and identified eight factors that public health actions could target to promote the earliest management of stroke.

Epidemiological Profile and Attitudes of Pregnant Women Toward Urinary Incontinence: A Single-Center Cross-Sectional Study

OBJECTIVE

The objective was to highlight the epidemiological and clinical profile of urinary incontinence in pregnant women during the first trimester and to determine their knowledge and attitudes toward this condition in Kinshasa.

METHODS

We carried out a descriptive cross-sectional study among 127 pregnant women who came for prenatal consultations in the first trimester from January to March 2022 at the LISANGA Medical Centre in Kinshasa. A questionnaire was developed containing the Urinary Symptom Profile (USP) scale. Kolmogorov-Smirnov normality tests were used to determine the normality of the distribution of the study variables. Inferential statistics were performed. The significance level was 0.05.

RESULTS

The mean age was 29.7±5.5 years. Thirty-eight women (29.9%) were primigravida. The median age of pregnancy was 6 weeks of amenorrhoea. The prevalence of urinary incontinence was 73.2%, with 31.2% of urge urinary incontinence and 16.1% of stress incontinence. In 61.4% of cases, overactive bladder was associated with urinary incontinence. Among the incontinent pregnant women, 3.2% had consulted a doctor while accepting that this condition is a health problem, 13.4% knew they had a pelvic floor muscle, 4.7% had knowledge of its rehabilitation, and 8.7% had benefited from gymnastics during pregnancy.

CONCLUSIONS

Urinary incontinence was frequent in the first trimester of pregnancy with a predominance of urgency. It was hardly discussed during prenatal consultations and pregnant women were not aware of the pelvic floor muscle, its rehabilitation, and of gymnastics during pregnancy.

The implementation of infection prevention and control measures and health care utilisation in ACF-supported health facilities during the COVID-19 pandemic in Kinshasa, Democratic Republic of the Congo, 2020

BACKGROUND

Infection prevention and control (IPC) was a central component of the Democratic Republic of the Congo's COVID-19 response in 2020, aiming to prevent infections and ensure safe health service provision.

OBJECTIVES

We aimed to assess the evolution of IPC capacity in 65 health facilities supported by Action Contre la Faim in three health zones in Kinshasa (Binza Meteo (BM), Binza Ozone (BO), and Gombe), investigate how triage and alert validation were implemented, and estimate how health service utilisation changed in these facilities (April-December 2020).

METHODS

We used three datasets: IPC Scorecard data assessing health facilities' IPC capacity at baseline, monthly and weekly triage data, and monthly routine data on eight health services. We examined factors associated with triage and isolation capacity with a mixed-effects negative binomial model and estimated changes in health service utilisation with a mixed-model with random intercept and long-term trend for each health facility. We reported incidence rate ratios (IRRs) for level change when the pandemic began, for trend change, and for lockdown and post-lockdown periods (Gombe). We estimated cumulative and monthly percent differences with expected consultations.

RESULTS

IPC capacity reached an average score of 90% by the end of the programme. A one-point increase in the IPC score was associated with +6% and +5% increases in triage capacity in BO and Gombe, respectively, and with +21% and +10% increases in isolation capacity in the same zones. When the pandemic began, decreases were seen in outpatient consultations (IRR: 0.67, 95% confidence interval (CI) [0.48-0.95] BM&BO-combined; IRR: 0.29, 95%CI [0.16-0.53] Gombe), consultations for respiratory tract infections (IRR: 0.48, 95%CI [0.28-0.87] BM&BO-combined), malaria (IRR: 0.60, 95%CI [0.43-0.84] BM&BO-combined, IRR: 0.33, 95%CI [0.18-0.58] Gombe), and vaccinations (IRR: 0.27, 95%CI [0.10-0.71] Gombe). Maternal health services decreased in Gombe (ANC1: IRR: 0.42, 95%CI [0.21-0.85]).

CONCLUSIONS

The effectiveness of the triage and alert validation process was affected by the complexity of implementing a broad clinical definition in limited-resource settings with a pre-pandemic epidemiological profile characterised by infectious diseases with symptoms like COVID-19. Readily available testing capacity remains key for future pandemic response to improve the disease understanding and maintain health services.

Correlation of antifungal susceptibility and sequence types within Cryptococcus neoformans VNI from HIV patients, and ERG11 gene polymorphism

INTRODUCTION

Here we tested the correlation between minimum inhibitory concentrations (MICs) of major antifungal agents and sequence types (STs) within Cryptococcus neoformans VNI isolates, and explored the ERG11 gene of included strains.

MATERIALS AND METHODS

We analysed 23 C. neoformans strains categorised into two groups according to the distribution of the ST profile in Kinshasa clinics (Democratic Republic of Congo): major ST [ST93 (n = 15)], and less common STs [ST659 (n = 2), ST5 (n = 2), ST4 (n = 1), ST 53 (n = 1), ST31 (n = 1), and ST69 (n = 1)]. The MICs of the major antifungal agents [amphotericin B (AMB), 5-fluorocytosine (5FC) and fluconazole (FCZ)] were determined following EUCAST guidelines. ERG11 gene sequences were extracted from whole genome sequence of the isolates and compared with the wild-type gene sequence of the C. neoformans VNI.

RESULTS

Although major ST isolates appeared to have lower median MICs for AMB and 5FU than less common ST isolates (0.50 vs. 0.75 mg/L for AMB, 2 vs. 4 mg/L for 5FU, respectively), FCZ susceptibility was similar in both groups (4 mg/L) (p-value >0.05). The susceptibility profile of C. neoformans strains separately considered did not significantly affect the patients' clinical outcomes (p-value >0.05). Furthermore, two structural modalities of the ERG11 gene were observed: (1) that of the reference gene, and (2) that containing two exonic silent point substitutions, and one intronic point substitution located in a sequence potentially involved in pre-mRNA splicing (c.337-22C > T); with no association with the MICs of the isolates (p-value >0.05).

CONCLUSIONS

The lack of association/correlation found in this study calls for further investigations to better understand the mechanisms of C. neoformans resistance to antifungal agents.

"Hospital survival of patients with pulmonary embolism in a country with limited resources case of the city of Kinshasa"

BACKGROUND

Pulmonary embolism is a frequent cause of intra-hospital mortality. The survival of patients depends not only on the speed of diagnosis but also on the treatment initiated.

OBJECTIVE

to evaluate the intra-hospital survival of patients with pulmonary embolism in the city of Kinshasa.

METHODOLOGY

analytical cross-sectional study based on non-probability convenience sampling carried out in the city of Kinshasa; three hospitals selected for convenience on the basis of their technical platforms. The patients were judged to have had a pulmonary embolism after a chest CT angiography proved it. The data recorded on the Kobocollect site were exported in Excel format and analyzed with SPSS software version 23. The comparison of the means was made using the Student test and that frequencies with the Yates Chi-square test. The association was attributed by the calculation of the odds ratio and the survival presented according to the Cox regression.

RESULTS

Eighty-nine cases or 63 women and 26 men were analyzed, the mean age was 64.4 ± 15.6 years. Individuals over 65 died more (ß=0.043 and p-Value of 0.01) the female sex multiplied by 1.38 the risk of death (DNS, p-Value = 0.478). Approximately 80% of patients were classified as PESI stage II or III. Starting Rivaroxaban from the outset does not show any difference with enoxaparin in terms of intra-hospital survival.

CONCLUSION

Pulmonary embolism is a real problem in our environment, the age of more than 65 years and the female sex are factors of poor prognosis and predicted survival.

Hydroxyurea treatment for adult sickle cell anemia patients in Kinshasa

Background: Despite a high incidence of sickle cell anemia, hydroxyurea (HU) treatment is rarely used in the DR Congo. This study aims to assess the efficacy of HU, the incidence of side effects that may limit its use in adults and to determine the dose needed for clinical improvement in patients. Methods: In a prospective study, patients received an initial dose of 15 mg/kg/day which was increased by 5 mg/kg every 6 months, up to a maximum of 30 mg/kg/day. The response and side effects to HU were evaluated biologically and clinically every 3 months during a 2-year period. Results: Seventy adult patients with a moderate or severe clinical phenotype initiated treatment. Only minor side effects were reported. At the end of the 2-year treatment phase, 45 (64.3%) had dropped out, of whom 33 were without a clear reason. Clinical and biological improvement was more marked during the first year. There was a reduction in severe vaso-occlusive crises (p < 0.001), need for transfusion (p < 0.001), and hospitalization days (p = 0.038). Fetal hemoglobin (HbF) levels increased on average 2.9 times after 12 months (p < 0.001). The increase in mean corpuscular volume was greater in the first year (p < 0.001) than in the second year (p = 0.041). The decrease in leukocytes (p < 0.001) was significant during the first year. In 70% of patients, the 20 mg/kg/day dose was needed to reach the 20% HbF threshold. Conclusion: HU is effective and well tolerated. The magnitude of the response varies from one patient to another. Improvement of clinical manifestations is achieved in most patients with a relatively low dose. Effective implementation of HU treatment will require improved adherence to treatment.

[Interventional study on Dolutegravir and other antiretrovirals in patients with subclinical atherosclerosis in the Kinshasa Hospital]

Introduction

After 2016, the World Health Organization (WHO) proposed Dolutegravir (DTG) as an alternative first-line treatment for adults. Thus, the purpose of this study was to identify biomarkers of cardiometabolic risk capable of demonstrating the beneficial effect of Dolutegravir (DTG) compared to other antiretrovirals in predicting atherosclerosis in people living with HIV (PLHIV) and hospitalized in Kinshasa Hospital.

Methods

we conducted an interventional study of people living with HIV who had received antiretroviral therapy (ART) for at least 6 months and were treated in the structures of the network coordinated by the Catholic Church (BDOM-Bureau Diocésain des Oeuvres Médicales) and of the University Clinics of Kinshasa (CUK) between January 2017 and December 2021. Subclinical atherosclerosis was defined as Pulsed Pressure (PP) ≥60 mm Hg; Carotid Intima-Media Thickness (CIMT) > 0.8 mm; and Systolic Pressure Index (SPI) < 0.9. Logistic regression was used in the statistical analysis of associations.

Results

a total of 334 PLHIV were recruited, of whom 96.1% (n=321) were on ART and 13.9% (n=13) were ART naïve patients. The mean age of PLHIV was 51±12 years with a female predominance (70.4%; n=235); the independent determinants of subclinical atherosclerosis were marital status (aOR: 4. 95% CI 1.5-10.5; p<0.006), low socioeconomic level (aOR: 10.7, 95% CI 2.3-48.7 p<0.002), duration of HIV infection (aOR: 6.6, 95% CI 2.8-16; p<0.0001), duration of antiretroviral therapy ≥9 years (aOR: 0.3, 95% CI 0.2-0.7; p<0.005) and total cholesterol ratio/high-density lipoprotein-cholesterol (CT/HDL-c)(aOR: 2, 95% CI 1.1-3.6; p= 0.034). The mean values of traditional and emergent variables were significantly higher in the previous ART regimen without DTG than in the new regimen with DTG. However, dyslipidemia was detected during the new DTG-based regimen.

Conclusion

dyslipidemia was common during the DTG-based regimen. Marital status, low socioeconomic level, duration of HIV infection, duration of antiretroviral treatment beyond 9 years and the TC/HDL-c ratio were identified as determinants of subclinical atherosclerosis in PLHIV on ART hospitalized in the Kinshasa hospital.

Behavior of Adult Aedes aegypti and Aedes albopictus in Kinshasa, DRC, and the Implications for Control

Yellow fever and chikungunya outbreaks-and a few dengue cases-have been reported in the Democratic Republic of the Congo (DRC) in recent years. However, little is known about the ecology and behavior of the adult disease vector species, Aedes aegypti and Aedes albopictus, in DRC. Preliminary studies showed important differences in Aedes behavior in DRC and Latin-American sites. Therefore, this study aimed to assess the host-seeking and resting behaviors of female Ae. aegypti and Ae. albopictus, and their densities in four communes of Kinshasa (Kalamu, Lingwala, Mont Ngafula and Ndjili). Two cross-sectional surveys were carried out, one in the dry season (July 2019) and one in the rainy season (February 2020). We used three different adult vector collection methods: BG-Sentinel 2, BG-GAT, and prokopack. Both Aedes species were clearly exophagic, exophilic, and sought breeding sites outdoors. The adult house index for Ae. aegypti exceeded 55% in all communes except Lingwala, where it was only 27%. The Adult Breteau Index (ABI) for Ae. aegypti was 190.77 mosquitoes per 100 houses inspected in the rainy season and 6.03 in the dry season. For Ae. albopictus, the ABI was 11.79 and 3.52 in the rainy and dry seasons, respectively. Aedes aegypti showed unimodal host-seeking activity between 6 h and 21 h. The exophagic and exophilic behaviors of both species point to the need to target adult mosquitoes outdoors when implementing vector control.

SARS-CoV2 mutations and impact on mortality: observational study in a sub-saharan Africa hospital

BACKGROUND

One year after the coronavirus disease 2019 (COVID-19) pandemic, the focus of attention has shifted to the emergence and spread of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) variants of concern (VOCs). The aim of the study was to assess the frequency of VOCs in patients followed for COVID-19 at Kinshasa university hospital (KUH) during the 3rd and 4th waves of the pandemic in Kinshasa. Hospital mortality was compared to that of the first two waves.

METHOD

The present study included all patients in whom the diagnosis of SARS-CoV-2 infection was confirmed by the polymerase chain reaction (PCR). The laboratory team sequenced a subset of all SARS-CoV-2 positive samples with high viral loads define as Ct < 25 to ensure the chances to generate complete genome sequence. RNA extraction was performed using the Viral RNA Mini Kit (Qiagen). Depending on the platform, we used the iVar bioinformatics or artic environments to generate consensus genomes from the raw sequencing output in FASTQ format.

RESULTS

During the study period, the original strain of the virus was no longer circulating. The Delta VOC was predominant from June (92%) until November 2021 (3rd wave). The Omicron VOC, which appeared in December 2021, became largely predominant one month later (96%) corresponding the 4th wave. In-hospital mortality associated with COVID-19 fell during the 2nd wave (7% vs. 21% 1st wave), had risen during the 3rd (16%) wave before falling again during the 4th wave (7%) (p < 0.001).

CONCLUSION

The Delta (during the 3rd wave) and Omicron VOCs (during the 4th wave) were very predominant among patients followed for Covid-19 in our hospital. Contrary to data in the general population, hospital mortality associated with severe and critical forms of COVID-19 had increased during the 3rd wave of the pandemic in Kinshasa.

Reference intervals for cd, hg, Mn and Pb in the general children population (3-14 years) of Kinshasa, Democratic Republic of Congo (DRC) between June 2019 and June 2020

The reference intervals (RIs), proposed by the International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) and the International Union of Pure and Applied Chemistry (IUPAC), were derived for Cd, Hg, Mn and Pb in the blood and urine of the children population living in Kinshasa (n = 200, aged 3-14 years with 97 girls). Levels of metals were measured using coupled plasma mass (ICP-MS). In blood, the proposed RIs [P5-P95 (GM)] were 0.022-1.112 μg/L (0.074), 35.69-144.50 μg/L (71.43), 0.060 to 1.161 μg/L (0.208) and 6.597-15.740 μg/L (9.882) for Cd, Pb, Hg and Mn, respectively. Urinary levels [(P5-P95 (GM)] were 0.082-1.530 μg/L (0.366) for Cd, 1.827-18.500 μg/L (5.458) for Pb, 0.323-1.953 μg/L (0.709) for Hg and 0.070 to 1.703 μg/L (0.186) for Mn. As compared to the CDC updated blood Pb reference value (35 μg/L), Pb levels remain higher of public health concern. Cd and Mn levels were similar to those found in the same city in 2015 and databases involving non-occupationally exposed populations from other countries. Hg levels significantly lower than those found in the same city in 2015, probably due to exclusion criteria of metal exposure applying in the present survey (occupationally exposed to the studied metals, smoking habits, amalgam tooth fillings, fish consumption habit more than one time per week, etc.). These background metal exposures will be useful for future occupational and/or environmental surveys as well as undertaking a reliable regulation of chemical exposure in Kinshasa via a national HBM program.

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

INTRODUCTION

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

MATERIALS AND METHODS

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

RESULTS

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

CONCLUSION

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

Environmental and economic performances of municipal solid waste management strategies based on LCA method: A case study of kinshasa

Like many populated urban agglomerations in Africa, Kinshasa, the capital of Democratic Republic of Congo, faces several challenges to manage its exponentially growing Municipal Solid Waste. With its 12, 000, 000 people daily generating 7800 tons of Municipal Solid waste, the city still struggles with basic services such as waste collection and sanitary landfill. This causes major social, environmental and health related issues. With the aim of contributing to the implementation of a better management system in Kinshasa, this study evaluates the environmental impact and the cost of the existing waste management framework and proposes 6 alternative scenarios. Each scenario attempts to optimize Greenhouse gas emissions and cost, using the Life Cycle Assessment approach. Results show that the current municipal solid waste management in Kinshasa city emits 640,673 tons of CO₂ equivalent per year and costs a total of 17, 776, 169.78USD yearly. Focusing on increasing waste collection coverage and recycling activities in the proposed 6 scenarios, scenario 4 where all municipal solid waste is collected, produces 4,042,402 tons of CO₂ equivalent per year and costs 143, 296, 983.4 yearly. In scenario 7, considered the most optimized management model for Kinshasa in this study, municipal solid waste is valorized through different treatment processes and atmospheric pollution reaches 2,835,491 tons of CO₂ equivalent yearly, with a management cost of 152, 790, 779.4 USD/year. This study finds that the optimization of the Municipal Solid Waste management system in Kinshasa city causes the atmospheric pollution in terms of CO2 equivalent to decrease by half, when all waste is collected. Landfill diversion rate reaches up to 70%, but the overall MSW management cost increases by almost eight times as much as the current operational cost. The optimization of the management system is done by increasing waste collection coverage and implementing diverse streams of waste valorization. Despite the wide use of the Life Cycle Assessment method in waste management and decision making, this method has not yet been, to the best knowledge of the authors, applied in estimating Greenhouse gas emissions and cost of the Municipal Solid Waste in the specific context of Kinshasa city.

Prevalence of risk and factors associated with obstructive sleep apnea-hypopnea syndrome in an adult population in Kinshasa, Democratic Republic of Congo

Obstructive sleep apnea-hypopnea syndrome (OSAHS) is an underdiagnosed and lesser known disease in sub-Saharan Africa. We believe that this is the first descriptive and analytical cross-sectional study in Kinshasa (from February 1 to October 31, 2021), which included respondents aged ≥18 years. The study aimed to determine the prevalence of the risk and factors associated with OSAHS. Each participant signed a free and informed consent. Statistical analyses were performed using XLStat 2020 and the Statistical Package for the Social Sciences version 24 for Windows. Odds ratios (ORs) were calculated to determine the degree of association between these variables and a high risk of OSAHS. The significance threshold was p < 0.05 and confidence interval (CI) at 95%. There were 4,162 participants, including 2,287 men (54.9%), with an mean (SD) age of 32 ± 12.6 years. The prevalence of OSAS risk was 17.4% and 7.9% for men and women, respectively. The associated risk factors were male sex (OR 4, 95% CI 3.20-5.54), hypertension (OR 6.7, 95% CI 4.87-9.30), age ≥60 years (OR 8.7, 95% CI 4.07-18.88), obesity/overweight (OR 1.94, 95% CI 1.13-3.78), and excessive daytime sleepiness (OR 2.63, 95% CI 2.05-3.56). The risk of OSAS in Kinshasa is high and it increases with age, male sex, obesity, and hypertension. The Snoring, Tiredness, Observed apnea, high blood Pressure, Body mass index, Age, Neck circumference, and male Gender (STOP-BANG) questionnaire is an easy-to-use tool for diagnostic orientation.

Determinants of uncontrolled allergic rhinitis in Kinshasa hospitals

Objective

To identify the determinants of uncontrolled allergic rhinitis (UCAR) in a hospital setting in Kinshasa, Democratic Republic of Congo.

Methods

Hospital-based cross-sectional study of 153 patients with allergic rhinitis (AR). The diagnosis of AR was based on clinical grounds according to the Allergic Rhinitis and its Impact on Asthma (ARIA) criteria. Categorization into controlled AR (CAR) and UCAR was based on the visual analog scale (VAS with cut off point of 5). Binary logistic regression was used to identify factors associated with UCAR.

Results

Patients with UCAR (60.1%) proportionally outnumbered those with CAR (39.9%). There were significantly more patients younger than 30 years of age among patients with UCAR. Factors significantly associated with UCAR were age below 30 years (OR = 3.31; 95% CI: 1.49-7.36; p = 0.003), low serum vitamin D level (OR = 3.86; 95% CI: 1.72-8.68; p = 0.001), persistent form (OR = 3.11; 95% CI: 1.39-6.98; p = 0.006) and moderate to severe form of AR (OR = 4.31; 95% CI: 1.77-10.49; p = 0.001).

Conclusions

Factors associated with UCAR in this study population were younger age less than 30 years, low vitamin D level, and persistent as well as moderate to severe AR. Further studies are needed to elucidate the underlying mechanisms favoring the occurrence of these factors.

Sensitization and Clinical Characteristics of Congolese Children with Vernal Keratoconjunctivitis in Kinshasa

BACKGROUND

Data on the sensitization pattern and clinical characteristics of pediatric vernal keratoconjunctivitis (VKC) are scary in Central Africa. This chronic form of allergic conjunctivitis affects the quality of school life and work productivity. There is no study that shows the breadth of vernal keratoconjunctivitis in our setting.

PURPOSE

To describe the clinical characteristics of vernal keratoconjunctivitis in Kinshasa, to evaluate the sensitization profile and associated factors.

METHODS

A total of 400 children with vernal keratoconjunctivitis underwent a clinical examination and a skin prick test (SPT) for 10 allergens. Dermatophagoides pteronyssinus, Blomia tropicalis and cockroach were the most common allergens in 52, 1 %, 18, 8% and 13% respectively among sensitized children and 66, 4% showed polysensitization.

RESULTS

The main symptoms were itchy eyes 45%, brownish discoloration conjunctiva 17%, red eyes 12, 2%, eyelids rubbing 11, 5%, tearing 8, 7% and photophobia 5, 5%.The limbic form was predominant with 54%, followed by palpebral form 26% and mixed form 20%. The most common complications were superficial punctate keratitis 17, 2%, shield ulcer 1, 5%, corneal plaque 1, 3% and corneal erosion 1%.

CONCLUSION

This study outlines that 34, 5% of children attending the outpatient Ophthalmology Department in two hospitals of Kinshasa for vernal keratoconjunctivitis disease had a positive skin prick test to at least one allergen, in particular for Dermatophagoides pteronyssinus, Blomia tropicalis and cockroach.

High SARS-CoV-2 Seroprevalence after Second COVID-19 Wave (October 2020-April 2021), Democratic Republic of the Congo

Serologic surveys are important tools for estimating the true burden of COVID-19 in a given population. After the first wave of SARS-CoV-2 infections, a household-based survey conducted in Kinshasa, Democratic Republic of the Congo, estimated >292 infections going undiagnosed for every laboratory-confirmed case. To ascertain the cumulative population exposure in Kinshasa after the second wave of COVID-19, we conducted a prospective population-based cross-sectional study using a highly sensitive and specific ELISA kit. The survey included 2,560 consenting persons from 585 households; 55% were female and 45% male. The overall population-weighted, test kit-adjusted SARS-CoV-2 seroprevalence was 76.5% (95% CI 74.5%-78.5%). The seroprevalence was 4-fold higher than during the first wave, and positivity was associated with age, household average monthly income, and level of education. Evidence generated from this population-based survey can inform COVID-19 response, especially vaccination campaign strategies in the context of vaccine shortages and hesitancy.

Characterization of Human Papillomavirus 16 from Kinshasa (Democratic Republic of the Congo)-Implications for Pathogenicity and Vaccine Effectiveness

Human Papillomavirus (HPV) type 16 is the main etiological agent of cervical cancer worldwide. Mutations within the virus genome may lead to an increased risk of cancer development and decreased vaccine response, but there is a lack of information about strains circulating in Sub-Saharan Africa. Endocervical cytology samples were collected from 480 women attending a voluntary cervical cancer screening program at Monkole Hospital and four outpatient centers in Kinshasa, Democratic Republic of the Congo (DRC). The prevalence of HPV infection was 18.8% and the most prevalent high-risk types were HPV16 (12.2%) followed by HPV52 (8.8%) and HPV33/HPV35 (7.8% each). HPV16 strains were characterized: 57.1% were classified as C lineage; two samples (28.6%) as A1 and one sample belonged to B1 lineage. HPV33, HPV35, HPV16, and HPV58 were the most frequent types associated with low-grade intraepithelial lesion while high-grade squamous intraepithelial lesions were predominantly associated with HPV16. Several L1 mutations (T266A, S282P, T353P, and N181T) were common in Kinshasa, and their potential effect on vaccine-induced neutralization, especially the presence of S282P, should be further investigated. Long control region (LCR) variability was high with frequent mutations like G7193T, G7521A, and G145T that could promote malignancy of these HPV16 strains. This study provides a helpful basis for understanding HPV16 variants circulating in Kinshasa and the potential association between mutations of LCR region and malignancy and of L1 and vaccine activity.

Pattern of Aedes aegypti and Aedes albopictus Associated with Human Exposure to Dengue Virus in Kinshasa, the Democratic Republic of the Congo

Dengue is a worldwide public health concern. The current study assessed the extent of human exposure to the dengue virus in relation to the distribution pattern of Aedes aegypti and Ae. albopictus in Kinshasa. Cross-sectional surveys were carried out in 2021 and 2022. The baseline entomological survey involved 19 municipalities using a grid cell sampling approach. All containers holding water were inspected for the presence of larvae in each grid. The collected larvae were kept in an insectary until the adult emergence for morphological identification. Four hundred febrile patients attending the hospital were screened for the presence of dengue antibodies (IgG, IgM) and NS1 antigen using a rapid diagnostic test (RDT) Biosynex®. Residences of positive cases were geo-referenced. We evaluated 1850 grid cells, of which 19.5% were positive for Aedes larvae. The positive grid cells were identified in the Ndjili (44.0%), Mont Ngafula (32.0%) and Ngaliema (26.0%), and Limete (32.0%) municipalities. The Ae. aegypti (11.2%) predominated in the northwestern, and Ae. albopictus (9.1%) appeared in the high vegetation coverage areas. Of 61 (15.3%) participants exposed to dengue, 8.3% presented acute dengue. Young, (6-17 years), male, and Mont Amba district participants were most exposed to dengue. In conclusion, dengue occurrence in Kinshasa overlaps somewhat the geographical and ecological distributions of Ae. aegypti and Ae. albopictus. Both species are not homogenously distributed, likely due to environmental factors. These findings can assist the targeted control activities.

Are COVID-19's restrictive measures associated with people's quality of life and the prevalence of anxiety and depression in Kinshasa in the Democratic Republic of Congo?

BACKGROUND

The spread of COVID-19 and the economic repercussions of several restrictive measures have worsened the lives of the Congolese and caused panic, fear, and anxiety. No study has yet examined the effect COVID-19's restrictive measures had on the quality of life in the Congo.

AIMS

The purpose of this study is to determine if the restrictive measures of COVID-19 are associated with the quality of life and the prevalence of anxiety and depression in Kinshasa.

METHODS

A cross-sectional survey was conducted in seventeen Kinshasa municipalities. N=100 adults over the age of 18 were recruited (41 females, 58 males and 1 prefer not). Social Contacts Assessment (SCA), Time Use Survey (TUS), Manchester Short Assessment of quality of life (MANSA), Health status EQ-5D-3L, UCLA Loneliness Scale; Patient Health Questionnaire (PHQ-9); General Anxiety Disorder (GAD-7) and COVID-19 related questions were utilized. We conducted descriptive statistics and multiple regression analyses.

RESULTS

suggest that depression and anxiety are more prevalent (PHQ-9 and GAD-7 scores were 9.1 (SD=6.8) and 8.5 (SD=6.1) respectively). Negative associations were found between the quality of life and living alone (B=-0.35, p=0.05) and mental health decline due to COVID- 19 (B=-0.30, p=0.04). Those who described themselves as less lonely reported a higher quality of life (B=0.34, p=0.03).

CONCLUSIONS

Living alone is associated with a lower quality of life. This study fills a gap in the literature on public health in the DRC and low- and middle-income countries.

Prevalence and determinants of osteoporosis in Congolese patients with axial rheumatism: a cross-sectional hospital-based study

Introduction

osteoporosis seems to be uncommon in sub-Saharan Africa. The aim of this study was to determine prevalence and determinants of osteoporosis in Congolese outpatients attending rheumatology consultation for axial rheumatism in Kinshasa, Democratic Republic of the Congo.

Methods

a cross-sectional hospital-based study from January to December 2018 among outpatients received for axial rheumatism in 8 hospitals of Kinshasa. The parameters of interest were age, sex, body mass index (BMI), alcoholism, smoking, physical activity, sunlight exposure, intake of dairy products, the notion of personal or parental fracture, a bone mineral density (BMD) and a phosphocalcic metabolism. The BMD was measured by using the dual energy X-ray absorptiométry. Serum level of calcium, Vitamin D, phosphore and parathormon were determined to assess the phosphocalcic metabolism. Osteoporosis was defined by a T-Score ≤ -2.5 SD. Standard statistical tests were used to analyze the results.

Results

ninety patients (75 women and 15 men) were included. Their mean age was 63.5 ± 12.2 years. Low back pain 71.1% (n=63) was the main symptom. The rate of patients with osteoporosis, osteopenia, and normal bone density was 34.4% (n=31), 43.9% (n=44), and 16.7% (n=15) respectively. Pathological bone fractures were not noted. Ageing (aOR: 1.31, IC95%: 1.11-1.54; p=0.002), smoking (aOR: 14.65, IC95%: 1.38-156.1; p=0.045) and non-obese status (aOR: 32.3, IC95% 1.50-696; p=0.032) were identified as determinants of osteoporosis.

Conclusion

in the present study, osteoporosis is common in Congolese patients with axial pain and is more frequent in women. Its determinants are ageing, smoking and non-obese status.

Factors associated with death in COVID-19 patients over 60 years of age at Kinshasa University Hospital, Democratic Republic of Congo (DRC)

Introduction

the objectives of the present study were to determine the mortality rate in patients over 60 years of age with COVID-19 and to identify risk factors.

Methods

the present historical cohort study took place at the Kinshasa University Hospital (KUH), DRC. Older patients admitted from March 2020 to May 2021 and diagnosed COVID-19 positive at the laboratory were selected. The relationship between clinical and biological risk factors, treatment, and in-hospital mortality was modeled using Cox regression.

Results

of two hundred and twenty-two patients at least 60 years old, 97 died, for a mortality rate of 43.69%. The median age was 70 years (64-74) with extremes of 60 to 88 years. Low oxygen saturation of < 90% (aHR 1.69; 95% CI [1.03-2.77]; p=0.038) was an independent predictor of mortality. The risk of death was reduced with corticosteroid use (aHR 0.54; 95% CI [0.40-0.75]; p=0.01) and anticoagulant treatment (aHR 0.53; 95% CI [0.38-0.73]; p=0.01).

Conclusion

mortality was high in seniors during COVID-19 and low oxygen saturation on admission was a risk factor for mortality. Corticosteroid therapy and anticoagulation were protective factors. These should be considered in management to reduce mortality.

Comparison of clinical and biological characteristics of HIV-infected patients presenting Cryptococcus neoformans versus C. curvatus/C. laurentii meningitis

Background

Cryptococcal meningitis is mainly caused by Cryptococcus neoformans/C. gattii complex. We compared the clinical, biological, and antifungal susceptibility profiles of isolates from HIV-Infected Patients (HIVIP) with C. neoformans (Cn) versus C. curvatus/C. laurentii (Cc/Cl) meningitis.

Methods

Comparative analytical study were conducted. Apart from patients’ clinical data, the following analysis were performed and the results were compared in both groups: biochemical examination, cryptococcal antigen test, India ink staining, and culture on Cerebral Spinal Fluid (CSF), strains identification by mass spectrometry, ITS sequencing, PCR serotyping and antifungal susceptibility. The main outcome variable was the “species of Cryptococcus identified”, which was compared to other variables of the same type using the Pearson Chi-square test or the Fisher exact test.

Results

A total of 23 (79.3%) Cn meningitis cases versus 6 (20.7%) Cc/Cl meningitis were retained.Cn meningitis was more frequently associated with headache (100% vs 50%, p = 0.005) than Cc/Cl meningitis and meningeal signs were more frequent in Cn infected patients. Biologically, hypoglycorrhachia and low CD₄ count were more observed in Cn group (90% vs 20% of patients, p = 0.01; 45.6 vs 129.8 cells/µL, p = 0.02, respectively). A higher proportion of Cn strains (91.3%) showed a low Minimum Inhibitory Concentration (MIC) (< 8 mg/L) for fluconazole compared to Cc/Cl strains (66.7%). Also, Cc/Cl strains resistant to 5-flucytosine and amphotericin B were found in 16.7% of cases for each of the two antifungal agents. Cryptococcus detection by routine analysis (India ink, culture, and antigens) was better for Cn samples than Cc/Cl. Except ITS sequencing, which identified all strains of both groups, mass spectrometry and serotyping PCR identified Cn strains better than Cc/Cl (100% vs 80%, p = 0.1; 100% vs 0%, p < 0.0001, respectively). After treatment with amphotericin B, 5-flucytosine, and fluconazole in both groups, the outcome was similar.

Conclusions

Clinical presentation of Cn meningitis is certainly more severe than that of Cc/Cl meningitis, but Cc/Cl infection should be considered in the management of HIVIP with meningeal syndrome because of the diagnostic difficulty and the high MICs of antifungal agents required for the treatment of meningitis due to these cryptococcal species.

Bio-surveillance of environmental pollutants in the population of Kinshasa, Democratic Republic of Congo (DRC): a small pilot study

BACKGROUND

Environmental pollutants are known to be ubiquitous and may present toxic effects (endocrine-disruption properties, carcinogenicity …) and represent a real threat to human health. The aim of the present pilot study was to assess the content of environmental pollutants (inorganic, persistent, and non-persistent pollutants) in biological samples (urine, serum, and whole blood), collected from volunteers in Kinshasa, capital of Democratic Republic of Congo, in order to identify pollutants of interest and to design a protocol for a larger scale study.

METHODS

From randomly selected 15 volunteers living in Kinshasa, aged from 25 to 66 years, (mean age = 43.4 years), including 10 men and 5 women, urine, whole blood, and serum samples were used in this study to estimate the contents in these environmental pollutants, using inductively coupled plasma mass spectrometry, gas chromatography coupled to mass spectrometry, and liquid chromatography coupled to mass spectrometry.

RESULTS

When compared to data nationally and internationally available, the preliminary outcomes of this study indicated a very high level of exposure to environmental pollutants in the population of Kinshasa, especially for heavy metals, parabens and triclosan. To a lesser extent, contamination measured for glyphosate, phthalates, organochlorine pesticides, pyrethroids and dialkylphosphate pesticides was also significant. In contrast, the investigated population of Kinshasa was found to be weakly exposed to other persistent organic pollutants like polychlorinated biphenyls, brominated flame retardants, phenolic organohalogens, and perfluoroalkyl substances.

CONCLUSION

Although the biologic fluids were collected from a limited number of volunteers (n = 15), the results of the present report clearly indicate that the population of Kinshasa is not spared by the investigated environmental pollutants. Moreover, this study gives us important information to design a larger scale study protocol.

[Lesions on CT scan in patients hospitalized for coronavirus pneumonia during the first wave of the SARS-CoV-2 pandemic at the University Clinics in Kinshasa (DRC)]

Introduction

l´objectif principal de cette étude, consiste à ressortir les aspects tomodensitométriques thoraciques (TDM) observés lors de la première vague de la pandémie à SARS-CoV-2 chez les patients hospitalisés pour pneumonie à COVID-19 aux Cliniques Universitaires de Kinshasa (CUK).

Méthodes

étude descriptive portant sur les examens TDM thoraciques des 26 patients hospitalisés pour pneumonie à COVID-19 aux CUK sur une période de 9 mois, allant de 17 mars au 17 novembre 2020. Un appareil TDM 16 barrettes de marque Hitachi a été utilisé chez tous nos patients. Après analyse, les lésions trouvées ont été réparties en lésions évocatrices et non évocatrices de l´infection à SARS-CoV-2.

Résultats

l´âge médian des patients était de 53,02 ans. Le sexe masculin était le plus touché avec 76,9%. La détresse respiratoire était le symptôme clinique le plus rencontré avec 61,5%. Comme comorbidité, l´hypertension artérielle (HTA) et l´insuffisance rénale étaient les plus retrouvées avec 30% et 6%. Les opacités en Verre dépoli bilaterales avec prédominance périphérique étaient prédominantes (69,2%), suivies des condensations (57,7%) et des crazy paving (19,2%). Le stade sévère était le plus fréquemment rencontré (34,61%). L´embolie pulmonaire distale et proximale était la complication la plus fréquente (11,5%). Parmi les pathologies associées la pleurésie et l´HTA pulmonaire étaient les plus rencontrées (30%, 8%). La majorité de nos patients, ont présentés des lésions parenchymateuses pulmonaires correspondant au stade TDM précoce de la maladie (50%).

Conclusion

les lésions TDM évocatrices de COVID-19, observées aux CUK lors de la première vague sont dominées par les plages d´opacités en verre dépoli, suivies des condensations parenchymateuses non systématisées et des crazy paving. Les lésions atypiques moins observées, étaient constituées des condensations pseudo-nodulaires, d´atteinte unilatérale, d´atteinte péribronchovasculaire et d´infection sur le poumon remanié. Le stade TDM sévère était la plus fréquente. L´embolie pulmonaire proximale et distale était la complication la plus rencontrée. Les aspects trouvés corroborent majoritairement les observations de la littérature.

Heterogeneity of Modern Contraceptive Use among Urban Slum and Nonslum Women in Kinshasa, DR Congo: Cross-Sectional Analysis

Urban populations have been increasing at an alarming rate, with faster growth in urban slums than that in nonslums over the past few decades. We examine the association between slum residence and the prevalence of contraceptive use among women of reproductive age, and assess if the effect was modified by household wealth. We conducted cross-sectional analysis comprising 1932 women in slums and 632 women in nonslums. We analyzed the moderating effect through an interaction between household wealth and neighborhood type, and then conducted stratified multivariable logistic-regression analysis by the type of neighborhood. Fewer women living in nonslum neighborhoods used modern methods compared to those living in slum neighborhoods. Within slum neighborhoods, the odds of using modern contraceptive methods were higher among women visited by community health workers than among those who had not been visited. Parity was one of the strong predictors of modern contraceptive use. Within nonslum neighborhoods, women from the wealthiest households were more likely to use modern contraceptives than those from the poorest households. Household wealth moderated the association between the type of neighborhood and modern contraceptive use. The study findings suggested heterogeneity in modern contraceptive use in Kinshasa, with a surprisingly higher contraceptive prevalence in slums.

Ocular Morbidity-A Critical Analysis to Improve Outpatient Services in an Eye Department in a Sub-Saharan Megacity

The aim of this study was to analyse outpatient services in an ophthalmic clinic of a church-run hospital providing secondary level care in an African megacity, paying special attention to the poorest users of the services. The range of examination was reviewed from 500 patient records of all ages consecutively chosen on random days attending the outpatient department for the first time in order to optimize workflow and to analyse the offered treatment modalities. Mean age was 41.9 ± 21.9 years, and 53.6% of the patients were female. Of the patients, 74.8% presented with visual impairment. The most frequent findings were refractive errors (35.8%), presbyopia (21.2%), allergic conjunctivitis (14.0%), cataract (13.2%) and glaucoma (6.4%). Patient management consisted of optical treatment (49.6%), surgery (11.4%) and medical treatment (39.0%). These results show the importance of the demand in refractive services and the need to train specific service providers. Knowing the frequencies of common conditions enables more appropriate diagnostic and treatment strategies, e.g., the importance of refractive errors, and should lead to improvements in training, staffing, therapeutics and patient outcomes. This approach can be applied to many other outpatient services and should be evaluated in light of the city’s impoverished health outreach and educational situation.

Decrease in late presentation for HIV care in Kinshasa, DRC, 2006-2020

INTRODUCTION

Late presentation for HIV care is a well-described issue for the success of ART outcomes and the cause of higher morbidity, mortality and further transmission. Monitoring the level of late presentation and understanding the factors associated with it would help to tailor screening and information strategies for better efficiency. We performed a retrospective cohort study in Kinshasa, the capital of the DRC. The studied population included HIV-positive adults newly enrolled in HIV care between January 2006 and June 2020 at 25 HIV urban care facilities. Patient information collected at presentation for HIV care included age, sex, WHO clinical stage and screening context. We used 2 definitions of late presentation: the WHO definition of advanced HIV disease (WHO stage 3/4 or CD4 cell count < 200 cells/mm3) and a more inclusive definition (WHO stage 3/4 or CD4 cell count < 350 cells/mm3).

RESULTS

A total of 10,137 HIV-infected individuals were included in the analysis. The median age was 40 years; 68% were female. A total of 45.9% or 47.5% of the patients were late presenters, depending on the definition used. The percentage of patients with late presentation (defined as WHO stage 3/4 or CD4 cell count < 350 cells/mm3) decreased during recent years, from 70.7% in 2013 to 46.5% in 2017 and 23.4% in 2020. Age was associated with a significantly higher risk of LP (p < 0.0001). We did not observe any impact of sex.

CONCLUSIONS

The frequency of late presentation for care is decreasing in Kinshasa, DRC. Efforts have to be continued. In particular, the issue of late diagnosis in older individuals should be addressed.

[Epidemiologic and histopathologic characteristics of 1280 uterine cervical cancers in Kinshasa]

OBJECTIVE

Due to the lack of both cancer registry and large scale cervical screening in most african countries, only theoretical studies are available. The objective of our work was to provide epidemiological and histopathological characteristics of cervical cancer based on concrete observations.

METHODS

This study was carried out on all cancers (n=5801) collected in the last 10 years from 5 pathology laboratories of Kinshasa; the histologic slides of the cervical cancers (n=1280) were reviewed by at least two pathologists and classified according to the 2014 OMS classification.

RESULTS

The cervical cancers accounted for 22% of all cancers and 40,4% of breast and gynecological cancers. The cervical cancer was the most common among women aged 49-58. Squamous cell carcinomas were the most observed type (73,2%) followed by adenocarcinomas (18,4%) and adenosquamous carcinomas (8,4%). Keratinized (47,2%) and non keratinized squamous carcinoma (20,8%) were the most frequent subtypes among squamous carcinomas and the usual adenocarcinoma among adenocarcinomas (9,6%). In the mucinous adenocarcinoma subtype, only the signet ring cells (1,3%) variant was found. Among cervical cancers, 69% were grade I, 20% grade II and 11% grade III.

CONCLUSION

Our study provides a concrete database of epidemiological and histopathological cervical cancer particularities in Kinshasa, useful to initiate a cancer register, as well as cervical screening and HPV vaccine campaigns.

A Population-Based Cross-Sectional Survey

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic is impacting the mental health of the population, but data on its impact in developing countries are lacking. The purpose of this study is to assess the psychological aspects of the COVID-19 pandemic in the population of Kinshasa.

METHODS

This cross-sectional and analytical study included 456 randomly selected respondents in the Ngafani district of the municipality of Selembao during the period from August 1 to October 30, 2020. Socio-demographic data, and data concerning COVID-19 and its impact on mental health, were studied. Anxiety and depression were studied using the Hospital Anxiety and Depression Scale (HADS).

RESULTS

The two genders were represented in equal proportions; the patients had a mean age of 40.4±17.2 years with a high frequency of patients aged over 50 years. All had agreed to observe social distancing, but only 36.8% had accepted isolation. Using the HADS, 47.4% had a doubtful anxiety state and 23.7% had a definite anxiety state; 36.8% had a doubtful depressive state and 25% had a definite depressive state. Old age (≥50 years), female gender, lack of occupation, and isolation were independent determinants associated with anxiety and depression.

CONCLUSION

The frequency of anxiety and depression during the COVID-19 pandemic was high. Older age, female gender, lack of a profession, and isolation were associated with anxiety and depression.

HCV Diagnosis and Sequencing Using Dried Blood Spots from Patients in Kinshasa (DRC): A Tool to Achieve WHO 2030 Targets

The World Health Organization has established an elimination plan for hepatitis C virus (HCV) by 2030. In Sub-Saharan Africa (SSA) access to diagnostic tools is limited, and a number of genotype 4 subtypes have been shown to be resistant to some direct-acting antivirals (DAAs). This study aims to analyze diagnostic assays for HCV based on dried blood spots (DBS) specimens collected in Kinshasa and to characterize genetic diversity of the virus within a group of mainly HIV positive patients. HCV antibody detection was performed on 107 DBS samples with Vidas^® anti-HCV and Elecsys anti-HCV II, and on 31 samples with INNO-LIA HCV. Twenty-six samples were subjected to molecular detection. NS3, NS5A, and NS5B regions from 11 HCV viremic patients were sequenced. HCV seroprevalence was 12.2% (72% with detectable HCV RNA). Both Elecsys Anti-HCV and INNO-LIA HCV were highly sensitive and specific, whereas Vidas^® anti-HCV lacked full sensitivity and specificity when DBS sample was used. NS5B/NS5A/NS3 sequencing revealed exclusively GT4 isolates (50% subtype 4r, 30% 4c and 20% 4k). All 4r strains harbored NS5A resistance-associated substitutions (RAS) at positions 28, 30, and 31, but no NS3 RAS was detected. Elecsys Anti-HCV and INNO-LIA HCV are reliable methods to detect HCV antibodies using DBS. HCV subtype 4r was the most prevalent among our patients. RASs found in subtype 4r in NS5A region confer unknown susceptibility to DAA.

larval indices in Kinshasa, Democratic Republic of Congo

BACKGROUND

Dengue, yellow fever, chikungunya and Zika are among the most important emerging infectious vector-borne diseases worldwide. In the Democratic Republic of Congo (DRC), increases in cases of dengue and outbreaks of yellow fever and chikungunya have been reported since 2010. The main vectors of these arboviruses, Aedes aegypti and Aedes albopictus, have been reported in DRC, but there is a lack of detailed information on their presence and spread to guide disease control efforts.

METHODS

In 2018, two cross-sectional surveys were conducted in Kinshasa province (DRC), one in the rainy (January/February) and one in the dry season (July). Four hundred houses were visited in each of the four selected communes (N'Djili, Mont Ngafula, Lingwala and Kalamu). Within the peri-domestic area of each household, searches were conducted for larval habitats, which were then surveyed for the presence of Aedes larvae and pupae. A subset of the immature specimens were reared to adults for morphological identification followed by DNA barcoding of the specimens to validate identifications.

RESULTS

The most rural commune (Mont Ngafula) had the highest pupal index (number of Aedes spp. pupae per 100 inspected houses) at 246 (20) pupae/100 houses, and Breteau index (BI; number of containers positive for immature stages of Aedes spp. per 100 households) at 82.2 (19.5) positive containers/100 houses for the rainy (and dry) season, respectively. The BI was 21.5 (4.7), 36.7 (9.8) and 41.7 (7.5) in Kalamu, Lingwala and N'Djili in the rainy (and dry) season, respectively. The house index (number of houses positive for at least one container with immature stages of Aedes spp. per 100 inspected houses) was, on average, across all communes, 27.5% (7.6%); and the container index (number of containers positive for immature stages of Aedes spp. per 100 inspected containers) was 15.0% (10.0%) for the rainy (and dry) season, respectively. The vast majority of Aedes-positive containers were found outside the houses [adjusted odds ratio 27.4 (95% confidence interval 14.9-50.1)]. During the dry season, the most productive containers were the ones used for water storage, whereas in the rainy season rubbish and tires constituted key habitats. Both Ae. aegypti and Ae. albopictus were found. Anopheles larvae were found in different types of Aedes larval habitats, especially during the rainy season.

CONCLUSIONS

In both surveys and in all communes, the larval indices (BI) were higher than the arbovirus transmission threshold values established by the World Health Organization. Management strategies for controlling Aedes in Kinshasa need to target the key types of containers for Aedes larvae, which are mainly located in outdoor spaces, for larval habitat destruction or reduction.

[Frequency of hyperlipasemia in patients with bone fractures on follow up at the Military General Hospital in camp Kokolo]

Introduction

décrire le profil des lipases sériques chez les patients présentant une fracture osseuse et en rechercher les facteurs associés.

Méthodes

il s´agit d´une étude transversale réalisée de juillet à octobre 2013 à l´Hôpital Général Militaire de Référence Kokolo (HGMRK). Etaient inclus, les patients admis pour fracture osseuse et qui avaient consenti de participer à l´étude. Le groupe contrôle était constitué des donneurs bénévoles de sang. Les paramètres d´intérêt étaient les caractéristiques démographiques des patients, la lipasémie, le lipidogramme, le siège et le nombre de fractures.

Résultats

quatre-vingt-trois patients avaient été inclus dans l´étude, tous du sexe masculin. Leur âge moyen était de 35,8 ± 12,8 ans. Un peu plus de soixante-dix-huit pourcent (78,3%) des fractures étaient dus à un traumatisme par balle. Le fémur était le siège le plus fréquent des fractures (30%), suivi par les os de l´avant-bras (20%) et le cubitus (15%). La concentration sérique moyenne de la lipasémie était de 43,6 ± 2,9 UI/L (valeur normale: ≤38UI/L) chez les fracturés contre 30,3 ± 2,3 UI/L chez les sujets contrôles (p<0,0001).

Conclusion

une hyperlipasémie a été constatée chez des victimes de fractures osseuses, à une fréquence significativement plus élevée que chez les sujets contrôles. Cette hyperlipasémie n´était pas associée à la présence du syndrome clinico-biologique d´embolie graisseuse.

Genital prolapse: epidemiology, clinic and therapeutic at Saint Joseph Hospital of Kinshasa

The aim of the study was to describe the epidemiological, clinical and therapeutical profile of genital prolapse in the gynecology and obstetrics service of Saint Joseph Hospital of Kinshasa. This is a descriptive study carried out from medical files of patients who have suffered from genital prolapse in the gynecology and obstetrics service of Saint Joseph Hospital from January 1st, 2008 to December 31st, 2017. It is based on the no probabilistic sampling of suitability. We recorded 161 cases of genital prolapses upon 13957 patients. The genital prolapses frequency was 1.2% with an annual average of 16.1 cases (SD 10.1) per year. The symptomatology consisted of pelvic mass associated with urinary and digestives troubles (94.0%, n=140). The stage III of cysto-colpocele was the most frequent (56.0%, n=82). The vaginal hysterectomy associated to rectocele and cystocele cure was the most performed operation (52.0%, n=69). The recurrence rate was of 2.0% (3 out of 148 cases). The genital prolapse really exist in our milieu, its symptomatology is classical and its treatment is mostly surgical by vaginal access.

[Determinants of non-compliance with antiretroviral therapy in adult patients in Kinshasa]

Introduction

l´objectif de cette étude était d´identifier les déterminants de non-observance des patients vivant avec le VIH (PVVIH) au TAR (traitement antirétroviral) à Kinshasa.

Méthodes

dans une étude transversale conduite à Kinshasa du 1^ermai au 31 août 2015 chez des PVVIH âgées d´au moins 18 ans et sous traitement antirétroviral depuis au moins 3 mois. Un échantillon probabiliste de 400 patients a été pris en compte. Le CASE Adherence Index (méthode subjective) et le renouvellement d´ordonnance (méthode objective) ont évalué l´observance. Les déterminants de la non-observance ont été recherchés par régression logistique multiple.

Résultats

les 400 PVVIH avaient un âge médian de 43 ans (18-75). La fréquence de non-observance globale était de 25,5%. La fréquence de la non-observance objective était plus élevée que celle de la non-observance subjective (29% vs 21%, p = 0,01). Le paiement de la consultation (ORaj: 1,70; IC95%: 1,02-2,81; p = 0,042), les effets indésirables (ORaj: 2,23; IC95%: 1,33-3,75; p = 0,002) et le manque de perception tel que l´oubli d´une dose qui peut aggraver la maladie (ORaj: 4,16; IC95%: 1,04-16,68; p=0,045) ont émergé comme déterminants de la non-observance. La présence d´une personne de confiance était un facteur protecteur contre la non-observance (ORaj: 0,54; IC95%: 0,39-0,93; p = 0,004).

Conclusion

la fréquence de la non-observance au TAR demeure élevée à Kinshasa. La différence de fréquence entre l´appréciation objective et subjective de l´observance indique l´importance de la biologie dans le suivi des PVVIH sous antirétroviraux. La prise en compte des déterminants sera nécessaire pour définir des stratégies qui permettront l´amélioration de l´observance.

Health facility readiness and provider knowledge as correlates of adequate diagnosis and management of pre-eclampsia in Kinshasa, Democratic Republic of Congo

BACKGROUND

Hypertensive disorders in pregnancy are the second most common cause of maternal mortality in the Democratic Republic of Congo (DRC), accounting for 23% of maternal deaths. This study aimed to assess facility readiness, and providers' knowledge to prevent, diagnose, and treat pre-eclampsia.

METHODS

A facility-based cross-sectional study was conducted in 30 primary health centres (PHCs) and 28 referral facilities (hospitals) randomly selected in Kinshasa, DRC. In each facility, all midwives and physicians involved in maternal care provision (n = 197) were included. Data on facility infrastructure and providers' knowledge about pre-eclampsia were collected using facility checklists and a knowledge questionnaire. Facility readiness score was defined as the sum of 13 health commodities needed to manage pre-eclampsia. A knowledge score was defined as the sum of 24 items about the diagnosis, management, and prevention of pre-eclampsia. The score ranges from 0 to 24, with higher values reflecting a better knowledge. The Mann-Witney U test was used to compare median readiness scores by facility type and ownership; and median knowledge scores between midwives in hospitals and in PHCs, and between physicians in hospitals and in PHCs.

RESULTS

Overall, health facilities had 7 of the 13 commodities, yielding a median readiness score of 53.8%(IQR: 46.2 to 69.2%). Although all provider groups had significant knowledge gaps about pre-eclampsia, providers in hospitals demonstrated slightly more knowledge than those in PHCs. Midwives in public facilities scored higher than those in private facilities (median(IQR): 8(5 to 12) vs 7(4 to 8), p = 0.03). Of the 197 providers, 91.4% correctly diagnosed severe pre-eclampsia. However, 43.9 and 82.2% would administer magnesium sulfate and anti-hypertensive drugs to manage severe pre-eclampsia, respectively. Merely 14.2 and 7.1% of providers were aware of prophylactic use of aspirin and calcium to prevent pre-eclampsia, respectively.

CONCLUSION

Our study showed poor availability of supplies to diagnose, prevent and treat pre-eclampsia in Kinshasa. While providers demonstrated good knowledge regarding the diagnosis of pre-eclampsia, they have poor knowledge regarding its prevention and management. The study highlights the need for strengthening knowledge of providers toward the prevention and management of pre-eclampsia, and enhancing the availability of supplies needed to address this disease.

Quality of antimalarials in Kinshasa peri-urban areas with regard to local pharmaceutical legislation and regulation

BACKGROUND

In the context of old pharmaceutical legislation and regulations not adapted to current realities, the aim of the present study was to evaluate the existing pharmaceutical system in peri-urban areas of Kinshasa.

METHODS

A prospective study was carried out during the period 2016-2018. The most used antimalarial medicines were identified through household and pharmaceutical establishment surveys. The samples of the obtained medicines were assayed with generic separation methods using the high-performance liquid chromatography technique coupled to a diode array detector. The registration status was checked for 126 antimalarial brand names. A characterization was carried out in 196 pharmaceutical establishments on the basis of standards set out by the Ministry of Health.

RESULTS

Of the 75 samples assayed, 19% (14/75) were non-compliant. Of the 124 brand names, 46.0% (57/124) were unlicensed and 14.5% (18/124) had an expired licence. Of the 196 pharmaceutical establishments, only 2 (1.0%) had an authorization to practice, none met all the Ministry of Health minimum standards and 24.5% (48/196) met the World Health Organization Guidelines for the Storage of Essential Medicines and Other Health Commodities.

CONCLUSIONS

More resources should be mobilized to apply regulator sanctions.

Description of the targeted water supply and hygiene response strategy implemented during the cholera outbreak of 2017-2018 in Kinshasa, DRC

Background

Rapid control of cholera outbreaks is a significant challenge in overpopulated urban areas. During late-2017, Kinshasa, the capital of the Democratic Republic of the Congo, experienced a cholera outbreak that showed potential to spread throughout the city. A novel targeted water and hygiene response strategy was implemented to quickly stem the outbreak.

Methods

We describe the first implementation of the cluster grid response strategy carried out in the community during the cholera outbreak in Kinshasa, in which response activities targeted cholera case clusters using a grid approach. Interventions focused on emergency water supply, household water treatment and safe storage, home disinfection and hygiene promotion. We also performed a preliminary community trial study to assess the temporal pattern of the outbreak before and after response interventions were implemented. Cholera surveillance databases from the Ministry of Health were analyzed to assess the spatiotemporal dynamics of the outbreak using epidemic curves and maps.

Results

From January 2017 to November 2018, a total of 1712 suspected cholera cases were reported in Kinshasa. During this period, the most affected health zones included Binza Météo, Limeté, Kokolo, Kintambo and Kingabwa. Following implementation of the response strategy, the weekly cholera case numbers in Binza Météo, Kintambo and Limeté decreased by an average of 57% after 2 weeks and 86% after 4 weeks. The total weekly case numbers throughout Kinshasa Province dropped by 71% 4 weeks after the peak of the outbreak.

Conclusion

During the 2017–2018 period, Kinshasa experienced a sharp increase in cholera case numbers. To contain the outbreak, water supply and hygiene response interventions targeted case households, nearby neighbors and public areas in case clusters using a grid approach. Following implementation of the response, the outbreak in Kinshasa was quickly brought under control. A similar approach may be adapted to quickly interrupt cholera transmission in other urban settings.

The human parvovirus B19/human immunodeficiency virus co-infection in healthy eligible voluntary blood donors at the Blood Transfusion National Center in Kinshasa

Introduction

Parvovirus B19 (PVB19) is one of several viruses transmissible by blood transfusion. Levels of exposure to PVB19 among HIV-infected voluntary blood donors are comparable to those among HIV-negative controls because, in blood donors, the PVB19 infection is transmitted mainly via the respiratory route. Thus, we hypothesize that the seroprevalence of PVB19 in HIV-positive blood donors is equal to the seroprevalence of PVB19 in HIV-negative blood donors. The objective of this study was to compare the seroprevalence of PVB19 between asymptomatic HIV-positive and HIV-negative blood donors.

Methods

A random sample of 360 eligible blood donors were firstly examined for HIV antibodies by using ELISA automaton and so were categorized as HIV-positive donors and HIV-negative donors. Then the two categories of donors were examined for PVB19 IgG and IgM by using ELISA kits. The seroprevalence of PVB19 in HIV-positive donors was compared to that of HIV-negative donors by using chi-square test or Fisher's exact test. All statistical analyzes were performed with SPSS 21.

Results

The prevalences of PVB19 IgG and IgM in HIV-positive blood donors were 92.1% (35 of 38) and 44.7% (17 of 38), respectively and those in control group were 89.1% (287 of 322) and 46.3% (149 of 322), respectively. But for both IgG and IgM the difference was not statistically significant (p > 0.05).

Conclusion

This research confirms our hypothesis: the seroprevalence of PVB19 in HIV-positive blood donors is equal to the seroprevalence of PVB19 in HIV-negative blood donors.

Epidemiology of Childhood Blindness and Low Vision in Kinshasa-democratic Republic of the Congo

Purpose: To determine the magnitude and causes of blindness and low vision in children in Kinshasa.Methods: A study was conducted to carry out a survey in 96 health areas in Kinshasa city. Children aged less than 16 years old with supposed visual problems (Visual acuity < 6/18) were identified by volunteers and surveyors in households and were thereafter examined by two ophthalmologists. Prevalence and causes of blindness and low vision were determined. For each child, anatomic sites of abnormality, etiologic factors and avoidable causes responsible for visual impairment were considered.Results: Thirty-six children with bilateral visual impairment were identified, including 10 cases of blindness and 26 cases of low vision. The prevalence of blindness and low vision was, respectively, 0.08% [95% CI 0.04-0.14] and 0.19% [95% CI 0.13-0.28].Optic nerve and whole globe were the main anatomical sites responsible for blindness in, respectively, in 30% and 20%. Optic nerve atrophy and glaucoma were the leading causes of childhood blindness. The globe apparently normal (50%), uvea (12%) and cornea (12%) were the most common anatomic site responsible for low vision with refractive errors (42%) and uveitis (12%) as the main causes. Childhood and hereditary factors accounted for, respectively, 16.7% and 13.9% of low vision cases. Visual impairment was due to avoidable causes in 69.4% of children.Conclusion: Damage to the optic nerve and refractive errors were respectively the maincauses of blindness and low vision among children in Kinshasa.

Monitoring the presence of trypanosomes' DNA - Including Trypanosoma brucei gambiense DNA - From the midguts of riverine Glossina trapped in the south east outskirts of Kinshasa City (Democratic Republic of Congo)

Even if the number of Human African Trypanosomiasis (HAT) cases from Kinshasa province in DRC is going towards elimination for the last decade, cases still occur in the periphery of the city. The diagnosis of 21 cases in the south periphery of Kinshasa, between 2015 and 2017 gives evidence of the existence of an active focus in this area. Here, we present the results of a punctual entomological survey that was realized in july 2014 in the outskirts of the southeast of Kinshasa. Using pyramidal traps, we caught tsetse flies during 2 days, dissecting the fresh ones for further molecular analysis. The average Apparent Density of flies per Trap and per Day was three with a maximum of 5.6 flies in Nganda PIO. Polymerase chain reaction analysis of the midguts provided evidence of a high prevalence (57.2%) of infected flies. Ninety three percent of the trypanosomes that were identified belonged to the Nanomonas species, but Trypanozoon trypanosomes were also present in 24% of the infected flies, including mixed infections with Nanomonas, including 3 flies carrying Trypanosoma brucei gambiense, the human pathogen of trypanosomiasis. These results show that at the time of the field's study there was an active reservoir of trypanosomes, closed to pigsties, knowing that pig is a potential animal reservoir. It also demonstrates that xenomonitoring using the entomological approach can be an efficient tool for monitoring sleeping sickness. Finally, results are discussed in the frame of WHO's HAT elimination project. Regarding Kinshasa, it points out the need of regular epidemiologic surveys.

Pattern of uncontrolled allergic rhinitis in a hospital setting of Kinshasa, Democratic Republic of Congo

Aim

To determine the clinical and allergic features of uncontrolled allergic rhinitis (UCAR) in the Democratic Republic of Congo (DRC).

Methods

Observational cross‐sectional study of 311 patients with UCAR. Allergic rhinitis was diagnosed clinically with sensitization to inhalant allergens and then confirmed by skin prick test. Severity was assessed using the Visual Analog Scale (VAS), with VAS scores greater than or equal to 5 used as cut off to determine uncontrolled status.

Results

The mean age of UCAR patients was 30.7 ± 15.1 years and 66.9% of the patients were females. Three out of four patients had persistent UCAR while the remainder had intermittent symptoms. UCAR was associated with rhinosinusitis and asthma in 18.6% and 18% of the patients, respectively. Among UCAR patients, 95.2% were polysensitized. The allergens most frequently involved were mites (82%), cat (27.3%), and dog (26.7%). The most frequent symptoms were nasal congestion, sneezing, and runny nose. There were 44.4% of the patients treated with nasal corticosteroids and 33.1% with oral antihistamine (anti‐H1).

Conclusions

This study reports on the clinical phenotype of UCAR in the DRC. The findings contribute to our understanding of UCAR in this population and may be used to implement strategies to reduce the prevalence and burden of UCAR in this setting.

Clinical and radiological features of knee osteoarthritis in patients attending the university hospital of Kinshasa, Democratic Republic of Congo

INTRODUCTION

The aim of the present study was to describe the clinical and radiological features of knee osteoarthritis in Congolese outpatients attending the University Hospital of Kinshasa (UHK).

METHODS

A cross-sectional study was performed in the rheumatology unit of the UHK from January to August 2012. Patients were consecutively recruited. The diagnosis of Osteoarthritis (OA) was based on the criteria of the American College for Rheumatology. Demographic, clinical and x-rays data were collected. The X-rays severity was assessed according to Kellgren and Lawrence's method.

RESULTS

1049 patients attended the Rheumatology unit of the UHK during the study period. An accurate diagnosis was reported for 839 patients, of whom 376 (44.8%) suffered from OA. Knee OA was diagnosed in 118 patients (31.4% of all OA patients). 101 patients accepted to be included in the study, 78 women (77.2%) and 23 men (22.8%). Their average age was 58.9 ± 10 years. A body mass index (BMI) ≥ 25kg/m2 was observed in 68 patients of whom 28 were obese (BMI ≥ 30kg/m2). The main symptoms were a mechanical pain (100%), swelling (40.6%), crepitus (79.2%) and mobility reduction (X%). Knee deformities were observed in some patients. At baseline, radiological damages > stage 2 of Kellgren-Lawrence were found in 70 patients.

CONCLUSION

Knee OA is a common disease among outpatients who attend the unit of Rheumatology of the UHK. Its clinical profile is the same as what is reported in the literature. Obesity and skeletal abnormalities are encountered in the majority of patients.

Proportion of pregnant women screened for hypertensive disorders in pregnancy and its associated factors within antenatal clinics of Kinshasa, Democratic Republic of Congo

Background

Screening for hypertensive disorders in pregnancy (HDP) is clinically important for identifying women at high risk, and planning early preventative interventions to improve pregnancy outcomes. Several studies in developing countries show that pregnant women are seldom screened for HDP. We conducted a study in Kinshasa, DR Congo, in order to assess the proportion of pregnant women screened for HDP, and to identify factors associated with the screening.

Methods

We conducted a facility-based cross-sectional study in a random sample of 580 pregnant women attending the first antenatal visit. Data collection consisted of a review of antenatal records, observations at the antenatal care services, and interviews. A pregnant woman was considered as screened for HDP if she had received the tree following services: blood pressure measurement, urine testing for proteinuria, and HDP risk assessment. Multivariable logistic regression, with generalized estimating equations, was used to identify factors associated with the screening for HDP.

Results

Of the 580 pregnant women, 155 (26.7%) were screened for HDP, 555 (95.7%) had their blood pressure checked, 347(59.8%) were assessed for risk factors of HDP, and 156 (26.9%) were tested for proteinuria. After multivariable analysis, screening for HDP was significantly higher in parous women (AOR = 2.09; 95% CI, 1.11–3.99; P = 0.023), in women with a gestational age of at least 20 weeks (AOR = 5.50; 95% CI, 2.86–10.89; P = 0.002), in women attending in a private clinic (AOR = 3.49; 95% CI, 1.07–11.34; P = 0.038), or in a hospital (AOR = 3.24; 95% CI, 1.24–8.47; P = 0.017), and when no additional payment was required for proteinuria testing at the clinic (AOR = 2.39; 95% CI, 1.14–5.02; P = 0.021).

Conclusion

Our results show that screening for HDP during the first antenatal visit in Kinshasa is not universal. The factors associated with screening included maternal as well as clinics’ characteristics. More effort should be made both at maternal and clinic levels to improve the screening for HDP in Kinshasa.

[Spirometric reference values in the Bantu population aged 20-70 years in Kinshasa]

INTRODUCTION

Spirometric reference values cannot be extrapolated in the populations, being subject to many environmental and human variables; hence the interest of local studies in this field.

METHODS

This study aims to determine the reference values among healthy adults in Kinshasa. We conducted a cross-sectional study including 7443 subjects (3208 women, 43%). FEV1, FVC, PEF were correlated with anthropometric data. Five age groups were formed and comparisons were made on the basis of sex, age, BMI and of the practice of sporting activity.

RESULTS

Differences are evident between the sexes, in terms of FEV1 (3.00 vs 2.21 L), FVC (3.19 vs 2.38) and the PEF (6.8 vs 5.70 L/s); same as for the outer age categories. FEV1 ranged between 2.33 et 4.54 vs 1.93-3.3 L in the age group 20-29 years and 1,76-3,39 vs 1,60 vs 2,53 L in the age group 60-70 years; FVC ranged between 2,44-4,89 vs 1,96-3,56 L and 1,79-3,78 vs 1,66-2,74 L ; PEF ranged between 4,34-12.2 vs 3,62-8.58 L/s and 2.99-6.76 vs 2.99-7.34L/s in the age group 60-70 years.

CONCLUSION

The differences related to gender, age, anthropometric data as well as to the practice of sporting activity are obvious. These results warrant further and more extended investigations and show the relevance of values based on percentiles in the determinantion of a spirometry standard in a given population.

Community Participation in and Perception of Community-Directed Treatment with Ivermectin in Kinshasa, DRC

The success of community-directed treatment with Ivermectin (CDTI) depends on active community participation. We conducted a case study nested in a cross-sectional study in the Binza Ozone Health Zone (ZS) in Kinshasa, Democratic Republic of Congo, in order to investigate community's knowledges and perceptions of onchocerciasis and on all CDTI's aspects. We interviewed 106 people aged 20 and over, purposively selected, through eight individual interviews and 12 focus groups. Themes used for collecting data were drawn for the Health Belief Model and data were analyzed using a deductive thematic approach. The term onchocerciasis was unknown to participants who called it "Mbitiri", the little black fly, in their local language. This disease is seen as curse put on the sufferer by a witch and perceived as a threat because of the "Mbitiri" bites. The afflicted participants were reluctant to seek treatment and preferred traditional practitioners or healers. CDTI is considered devastating because of adverse effects of ivermectin as well as inefficient after occurrence of deaths. This explains the low level of community adhesion and participation to this strategy. Recruitment procedures for community distributors are poorly understood and awareness and health education campaigns are either non-existent or rarely carried out. Nevertheless, the latter should be regularly done.

[Epidemiology and clinical pattern of ocular toxoplasmosis in Kinshasa]

PURPOSE

To determine the epidemiology and clinical pattern of Congolese patients with ocular toxoplasmosis.

PATIENTS AND METHODS

A retrospective study was conducted on records of patients with ocular toxoplasmosis examined in the Teaching Hospital of Kinshasa (DR Congo) from 2010 to 2012. Each patient underwent a complete ophthalmic examination. Sociodemographic data, clinical symptoms and signs, visual outcome, modality of treatment and type of complications were studied.

RESULTS

Thirty-five cases of ocular toxoplasmosis were diagnosed out of 18,144 patients, giving a frequency of 0.2 %. Eighteen men (51.4 %) were affected, with a sex ratio of 1.05. The mean age of the patients was 40.9±20 years (range: 10-72 years). The mean time until consultation was 10 months (range: 2 days-84 months). Ocular involvement was unilateral for 65.7 % of patients. Decreased visual acuity (77.1 %) and pain (7.1 %) were the main ocular complains. Chorioretinal lesions involved the central retina in 26 patients (74.3 %). Five patients (14.2 %) developed recurrences during follow-up. Complications affected 17 patients (48.6 %), with macular scarring (34.3 %) and cataract (17.1 %) being the most common. At the first consultation, 61.7 % of the affected eyes had visual impairment (VA<0.3). Visual impairment was associated with macular lesions (P<0.001, OR=3 [1.4-6.1]) and age greater than 45 years (P=0.002, OR=11 [2.2-53.6]).

CONCLUSION

In our context, complications are common with ocular toxoplasmosis,s and they lead to visual impairment in the majority of patients.

G1 is the major APOL1 risk allele for hypertension-attributed nephropathy in Central Africa

Background

Sub-Saharan Africans exhibit a higher frequency of chronic kidney disease (CKD) than other populations. In this study, we sought to determine the frequency of apolipoprotein L1 (APOL1) genotypes in hypertension-attributed CKD in Kinshasa, Democratic Republic of the Congo.

Methods

We performed a case-control study identifying 162 subjects: 79 with hypertension-attributed CKD and 83 controls living in Kinshasa who were genotyped for APOL1 risk variants between July 2013 and November 2016. We selected control subjects from the general population and matched them with the cases according to age. Logistic regression analysis was used to examine the relationship between APOL1 high-risk genotypes and CKD.

Results

The frequencies of the APOL1 G1 and G2 alleles were 19.1 and 7.1%, respectively. The number of individuals with the G1 and G2 risk alleles was significantly higher in the CKD group (12.7%) than in the control group (2.4%), particularly in individuals with end-stage kidney disease (14.3%). Subjects carrying two risk alleles was strongly and independently associated with hypertension-attributed nephropathy, with an adjusted odds ratio of 7.7 (95% confidence interval 1.5-39.7; P = 0.014). The high-risk APOL1 genotypes were G1/G1 and G1/G2, whereas G2/G2 was not found in the study population.

Conclusions

The results of this study demonstrate the association of high-risk APOL1 genotypes with kidney disease in Kinshasa. The absence of G2/G2 may be consistent with powerful selective sweeps induced by Trypanosoma brucei gambiense infection. In contrast, the presence of APOL1 G2/G2 among individuals of African ancestry in the USA may indicate relaxation of natural selection in a trypanosome-free environment.

Molecular identification of Plasmodium species in symptomatic children of Democratic Republic of Congo

Background

Worldwide, the highest malaria mortality is due to Plasmodium falciparum infection. However, other species of Plasmodium (Plasmodium vivax, Plasmodium ovale, Plasmodium malariae, and Plasmodium knowlesi) can also cause malaria. Therefore, accurate identification of malaria species is crucial for patient management and epidemiological surveillance. This study aimed to determine the different Plasmodium species causing malaria in children under 5 years old in two provinces (Kinshasa and North Kivu) of the Democratic Republic of Congo (DRC).

Methods

From October to December 2015, a health-facility based cross-sectional study was conducted in General Reference Hospitals in Kinshasa and North Kivu. Four hundred and seven blood samples were collected from febrile children aged ≤ 5 years. Nested polymerase chain reaction assays were performed for Plasmodium species identification.

Results

Out of 407 children, 142 (34.9%) were infected with Plasmodium spp. and P. falciparum was the most prevalent species (99.2%). Among those infected children, 124 had a mono infection with P. falciparum and one with P. malariae. Mixed infections with P. falciparum/P. malariae and P. falciparum/P. vivax were observed in 6 (1.5%) and 8 (2.0%) children, respectively. The prevalence of infection was higher in females (64.8%) than in males (35.2%), p < 0.001. The age-specific distribution of infection showed that children of less than 2 years old were less infected (18.4%) compared to those aged above 2 years (81.6%), p < 0.001.

Conclusion

Although this study showed clearly that the most prevalent species identified was P. falciparum, the findings demonstrate the existence of non-falciparum malaria, especially P. malariae and P. vivax among children aged ≤ 5 years living both Kinshasa and North Kivu Provinces in DRC.

Assessment of heavy metals in raw food samples from open markets in two African cities

The present study was performed to assess the level of biologically potent metallic elements (Al, Cd, Cr, Cu, Hg, Mn, Pb and Zn), metalloid (As) and non-metal (Se) in different raw food from open markets in Kinshasa (Democratic Republic of Congo) and Johannesburg (South Africa). Hundred twenty different food samples comprising of cabbage, bean, beef and fish were collected, digested in the microwave system and analysed for trace metals using ICP-OES, ICP-MS and mercury analyser. The obtained results were used to evaluate the health risk of these elements via consumption of foods. The investigation revealed that the mean level of trace elements ranged Al: 1.62 ± 0.32 to 52.10 ± 3.45, As: 1.62 ± 0.32 to 5.33 ± 1.04, Cd: 0.16 ± 0.09 to 3.93 ± 0.12, Cr: 0.58 ± 0.24 to 17.29 ± 2.03, Cu: 0.69 ± 0.15 to 15.70 ± 1.67, Hg: 1.53 ± 0.1 to 2.94 ± 0.23, Mn: 5.34 ± 1.37 to 18.31 ± 3.45, Pb: 0.16 ± 0.09 to 4.14 ± 1.08, Se: 0.18 ± 0.08 to 1.41 ± 0.97, Zn: 5.47 ± 1.83 to 75.12 ± 5.67 mg kg^-1. The average values of As, Cd, Cr, Cu, Hg, Mn, Pb, Se and Zn in raw foods collected from Johannesburg market were significantly higher (p < 0.05) than those from the Kinshasa market. While the highest Al contents (p < 0.05) were found in the food sold in Kinshasa open market. The levels of most studied metals in the raw foods were exceeding the recommended maximum acceptable limit proposed by the Joint FAO/WHO Expert Committee on Food. The combined Target Hazard Quotients (THQ) values for all samples from both markets were greater than 1 which indicates a potential health risk to the local consumer.