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1.
BMC Infect Dis ; 21(1): 1272, 2021 Dec 20.
Article in English | MEDLINE | ID: covidwho-1636004

ABSTRACT

BACKGROUND: Despite it being a global pandemic, there is little research examining the clinical features of severe COVID-19 in sub-Saharan Africa. This study aims to identify predictors of mortality in COVID-19 patients at Kinshasa Medical Center (KMC). METHODS: In this retrospective, observational, cohort study carried out at the Kinshasa Medical Center (KMC) between March 10, 2020 and July 10, 2020, we included all adult inpatients (≥ 18 years old) with a positive COVID-19 PCR result. The end point of the study was survival. The study population was dichotomized into survivors and non-survivors group. Kaplan-Meier plot was used for survival analyses. The Log-Rank test was employed to compare the survival curves. Predictors of mortality were identified by Cox regression models. The significance level of p value was set at 0.05. RESULTS: 432 patients with confirmed COVID-19 were identified and only 106 (24.5%) patients with moderate, severe or critical illness (mean age 55.6 ± 13.2 years old, 80.2% were male) were included in this study, of whom 34 (32%) died during their hospitalisation. The main complications of the patients included ARDS in 59/66 (89.4%) patients, coagulopathy in 35/93 (37.6%) patients, acute cardiac injury in 24/98 (24.5%) patients, AKI in 15/74 (20.3%) patients and secondary infection in 12/81 (14.8%) patients. The independent predictors of mortality were found to be age [aHR 1.38; 95% CI 1.10-1.82], AKI stage 3 [aHR 2.51; 95% CI 1.33-6.80], proteinuria [aHR 2.60; 95% CI 1.40-6.42], respiratory rate [aHR 1.42; 95% CI 1.09-1.92] and procalcitonin [aHR 1.08; 95% CI 1.03-1.14]. The median survival time of the entire group was 12 days. The cumulative survival rate of COVID-19 patients was 86.9%, 65.0% and 19.9% respectively at 5, 10 and 20 days. Levels of creatinine (p = 0.012), were clearly elevated in non-survivors compared with survivors throughout the clinical course and increased deterioration. CONCLUSION: Mortality rate of COVID-19 patients is high, particularly in intubated patients and is associated with age, respiratory rate, proteinuria, procalcitonin and acute kidney injury.


Subject(s)
COVID-19 , Adolescent , Adult , Aged , Cohort Studies , Democratic Republic of the Congo/epidemiology , Humans , Male , Middle Aged , Retrospective Studies , SARS-CoV-2
2.
BMC Infect Dis ; 22(1): 21, 2022 Jan 04.
Article in English | MEDLINE | ID: covidwho-1606369

ABSTRACT

BACKGROUND: In symptomatic patients, the diagnostic approach of COVID-19 should be holistic. We aimed to evaluate the concordance between RT-PCR and serological tests (IgM/IgG), and identify the factors that best predict mortality (clinical stages or viral load). METHODS: The study included 242 patients referred to the University hospital of Kinshasa for suspected COVID-19, dyspnea or ARDS between June 1st, 2020 and August 02, 2020. Both antibody-SARS-CoV2 IgM/IgG and RT-PCR method were performed on the day of admission to hospital. The clinical stages were established according to the COVID-19 WHO classification. The viral load was expressed by the CtN2 (cycle threshold value of the nucleoproteins) and the CtE (envelope) genes of SARS- CoV-2 detected using GeneXpert. Kappa test and Cox regression were used as appropriate. RESULTS: The GeneXpert was positive in 74 patients (30.6%). Seventy two patients (29.8%) had positive IgM and 34 patients (14.0%) had positive IgG. The combination of RT-PCR and serological tests made it possible to treat 104 patients as having COVID-19, which represented an increase in cases of around 41% compared to the result based on GeneXpert alone. The comparison between the two tests has shown that 57 patients (23.5%) had discordant results. The Kappa coefficient was 0.451 (p < 0.001). We recorded 23 deaths (22.1%) among the COVID-19 patients vs 8 deaths (5.8%) among other patients. The severe-critical clinical stage increased the risk of mortality vs. mild-moderate stage (aHR: 26.8, p < 0.001). The values of CtE and CtN2 did not influence mortality significantly. CONCLUSION: In symptomatic patients, serological tests are a support which makes it possible to refer patients to the dedicated COVID-19 units and treat a greater number of COVID-19 patients. WHO Clinical classification seems to predict mortality better than SARS-Cov2 viral load.


Subject(s)
COVID-19 , RNA, Viral , Antibodies, Viral , Democratic Republic of the Congo/epidemiology , Humans , Immunoglobulin M , SARS-CoV-2 , Serologic Tests
3.
Pan Afr Med J ; 38: 93, 2021.
Article in French | MEDLINE | ID: covidwho-1547720

ABSTRACT

Introduction: SARS-CoV-2 serology tests could play a crucial role in estimating the prevalence of COVID-19. The purpose of this study was to estimate the prevalence of COVID-19 among travellers and workers in Bukavu, a city in eastern Democratic Republic of the Congo. Methods: between May and August 2020, the Cellex qSARS-CoV-2 IgG/IgM Rapid Test (Cellex, Inc., USA), lateral flow immunoassay was used to rapidly detect and differentiate antibodies against SARS-CoV-2 among travellers and workers seeking medical certification. Results: among the 684 residents of the city of Bukavu screened for COVID-19 (4.2% Hispanic, 2.8% other African, 0.9% Asian), the seroprevalence anti-SARS-CoV-2 antibodies was 40.8% (IgG+/IgM+: 34.6%; IgG+/IgM-: 0.5%; IgG-/IgM+: 5.4%). Cumulative seroprevalence of anti-SARS-CoV-2 IgG antibodies increased from 24.5% to 35.2% from May to August 2020. Independent predictors of SARS-CoV-2 antibodies were age > 60 years [adjusted OR = 2.07(1.26-3.38)] and non-membership of the medical staff [adjusted OR = 2.28 (1.22-4.26)]. Thirteen point nine percent of patients seropositive for SARS-CoV-2 antibodies were symptomatic and hospitalized. Conclusion: this study shows a very high seroprevalence of SARS-CoV-2 antibodies among travellers and workers in Bukavu, a city in eastern Democratic Republic of the Congo, which may positively affect community immunity in the study population. Thus, the management of COVID-19 should be contextualized according to local realities.


Subject(s)
Antibodies, Viral/blood , COVID-19/epidemiology , SARS-CoV-2/isolation & purification , Travel , Adult , Age Factors , Aged , COVID-19/diagnosis , Democratic Republic of the Congo/epidemiology , Female , Hospitalization/statistics & numerical data , Humans , Immunoassay , Male , Middle Aged , SARS-CoV-2/immunology , Seroepidemiologic Studies
4.
Popul Health Metr ; 19(1): 44, 2021 11 04.
Article in English | MEDLINE | ID: covidwho-1503922

ABSTRACT

BACKGROUND: Poor data quality is limiting the use of data sourced from routine health information systems (RHIS), especially in low- and middle-income countries. An important component of this data quality issue comes from missing values, where health facilities, for a variety of reasons, fail to report to the central system. METHODS: Using data from the health management information system in the Democratic Republic of the Congo and the advent of COVID-19 pandemic as an illustrative case study, we implemented seven commonly used imputation methods and evaluated their performance in terms of minimizing bias in imputed values and parameter estimates generated through subsequent analytical techniques, namely segmented regression, which is widely used in interrupted time series studies, and pre-post-comparisons through paired Wilcoxon rank-sum tests. We also examined the performance of these imputation methods under different missing mechanisms and tested their stability to changes in the data. RESULTS: For regression analyses, there were no substantial differences found in the coefficient estimates generated from all methods except mean imputation and exclusion and interpolation when the data contained less than 20% missing values. However, as the missing proportion grew, k-NN started to produce biased estimates. Machine learning algorithms, i.e. missForest and k-NN, were also found to lack robustness to small changes in the data or consecutive missingness. On the other hand, multiple imputation methods generated the overall most unbiased estimates and were the most robust to all changes in data. They also produced smaller standard errors than single imputations. For pre-post-comparisons, all methods produced p values less than 0.01, regardless of the amount of missingness introduced, suggesting low sensitivity of Wilcoxon rank-sum tests to the imputation method used. CONCLUSIONS: We recommend the use of multiple imputation in addressing missing values in RHIS datasets and appropriate handling of data structure to minimize imputation standard errors. In cases where necessary computing resources are unavailable for multiple imputation, one may consider seasonal decomposition as the next best method. Mean imputation and exclusion and interpolation, however, always produced biased and misleading results in the subsequent analyses, and thus, their use in the handling of missing values should be discouraged.


Subject(s)
COVID-19 , Health Information Systems , Democratic Republic of the Congo/epidemiology , Humans , Pandemics , SARS-CoV-2
5.
Pan Afr Med J ; 40: 37, 2021.
Article in English | MEDLINE | ID: covidwho-1497891

ABSTRACT

Proteinuria is a marker of severity and poor outcome of patients in intensive care unit (ICU). The objective of this study was to determine the frequency of proteinuria and the risk factors associated with proteinuria in Congolese COVID-19 patients. The present cross sectional study of proteinuria status is a post hoc analysis of data from 80 COVID-19 patients admitted at Kinshasa Medical Center (KMC) from March 10th to July 10th, 2020. The population under study came from all adult inpatients (≥18 years old) with a laboratory diagnosis by polymerase chain reaction (PCR) of COVID-19 were selected and divided into two groups (positive proteinuria and negative proteinuria group). Logistic regression models helped to identify the factors associated with proteinuria. The P value significance level was 0.05. Among 80 patients who tested positive for SARS-CoV-2 RT-PCR, 55% had proteinuria. The mean age was 55.2 ± 12.8 years. Fourty-seven patients (58.8%) had history of hypertension and 26 patients (32.5%) diabetes. Multivariable analysis showed age ≥ 65 years (aOR 5,04; 95% CI: 1.51-16.78), diabetes (aOR 3,15; 95% CI: 1.14-8.72), ASAT >40 UI/L (aOR 7,08; 95% CI: 2.40-20.87), ferritin >300 (aOR 13,47; 95% CI: 1.56-26.25) as factors independently associated with proteinuria in COVID-19 patients. Proteinuria is common in Congolese COVID-19 patients and is associated with age, diabetes, ferritin and aspartate aminotransferase (ASAT).


Subject(s)
COVID-19/complications , Diabetes Mellitus/epidemiology , Hypertension/epidemiology , Proteinuria/epidemiology , Adult , Age Factors , Aged , COVID-19/diagnosis , Cross-Sectional Studies , Democratic Republic of the Congo , Female , Humans , Intensive Care Units , Male , Middle Aged , Polymerase Chain Reaction , Proteinuria/etiology , Retrospective Studies , Risk Factors
6.
PLoS One ; 16(6): e0253110, 2021.
Article in English | MEDLINE | ID: covidwho-1496435

ABSTRACT

BACKGROUND: The World Health Organization recommends inpatient hospital treatment of young infants up to two months old with any sign of possible serious infection. However, each sign may have a different risk of death. The current study aims to calculate the case fatality ratio for infants with individual or combined signs of possible serious infection, stratified by inpatient or outpatient treatment. METHODS: We analysed data from the African Neonatal Sepsis Trial conducted in five sites in the Democratic Republic of the Congo, Kenya and Nigeria. Trained study nurses classified sick infants as pneumonia (fast breathing in 7-59 days old), severe pneumonia (fast breathing in 0-6 days old), clinical severe infection [severe chest indrawing, high (> = 38°C) or low body temperature (<35.5°C), stopped feeding well, or movement only when stimulated] or critical illness (convulsions, not able to feed at all, or no movement at all), and referred them to a hospital for inpatient treatment. Infants whose caregivers refused referral received outpatient treatment. The case fatality ratio by day 15 was calculated for individual and combined clinical signs and stratified by place of treatment. An infant with signs of clinical severe infection or severe pneumonia was recategorised as having low- (case fatality ratio ≤2%) or moderate- (case fatality ratio >2%) mortality risk. RESULTS: Of 7129 young infants with a possible serious infection, fast breathing (in 7-59 days old) was the most prevalent sign (26%), followed by high body temperature (20%) and severe chest indrawing (19%). Infants with pneumonia had the lowest case fatality ratio (0.2%), followed by severe pneumonia (2.0%), clinical severe infection (2.3%) and critical illness (16.9%). Infants with clinical severe infection had a wide range of case fatality ratios for individual signs (from 0.8% to 11.0%). Infants with pneumonia had similar case fatality ratio for outpatient and inpatient treatment (0.2% vs. 0.3%, p = 0.74). Infants with clinical severe infection or severe pneumonia had a lower case fatality ratio among those who received outpatient treatment compared to inpatient treatment (1.9% vs. 6.5%, p<0.0001). We recategorised infants into low-mortality risk signs (case fatality ratio ≤2%) of clinical severe infection (high body temperature, or severe chest indrawing) or severe pneumonia and moderate-mortality risk signs (case fatality ratio >2%) (stopped feeding well, movement only when stimulated, low body temperature or multiple signs of clinical severe infection). We found that both categories had four times lower case fatality ratio when treated as outpatient than inpatient treatment, i.e., 1.0% vs. 4.0% (p<0.0001) and 5.3% vs. 22.4% (p<0.0001), respectively. In contrast, infants with signs of critical illness had nearly two times higher case fatality ratio when treated as outpatient versus inpatient treatment (21.7% vs. 12.1%, p = 0.097). CONCLUSIONS: The mortality risk differs with clinical signs. Young infants with a possible serious infection can be grouped into those with low-mortality risk signs (high body temperature, or severe chest indrawing or severe pneumonia); moderate-mortality risk signs (stopped feeding well, movement only when stimulated, low body temperature or multiple signs of clinical severe infection), or high-mortality risk signs (signs of critical illness). New treatment strategies that consider differential mortality risks for the place of treatment and duration of inpatient treatment could be developed and evaluated based on these findings. CLINICAL TRIAL REGISTRATION: This trial was registered with the Australian New Zealand Clinical Trials Registry under ID ACTRN 12610000286044.


Subject(s)
Fever/complications , Health Facilities/statistics & numerical data , Hospitalization/statistics & numerical data , Infant Mortality/trends , Infections/mortality , Pneumonia/mortality , Anti-Infective Agents/therapeutic use , Body Temperature , Democratic Republic of the Congo/epidemiology , Female , Humans , Infant , Infant, Newborn , Infections/drug therapy , Infections/epidemiology , Kenya/epidemiology , Male , Nigeria/epidemiology , Pneumonia/drug therapy , Pneumonia/epidemiology
7.
Pan Afr Med J ; 39: 230, 2021.
Article in French | MEDLINE | ID: covidwho-1464030

ABSTRACT

Introduction: the main purpose of this study is to describe chest computed tomography (CT) findings in 26 patients hospitalized with COVID-19 pneumonia during the first wave of the SARS-CoV-2 pandemic at the University Clinics in Kinshasa (UCK). Methods: we conducted a descriptive study of chest CT findings in 26 patients hospitalized with coronavirus pneumonia at the UCK over a 9-month period, from March 17 to November 17, 2020. Hitachi - CT-scanner 16 slice was used in all our patients. After analyzing lesions, these were divided into lesions suggestive and non-suggestive of SARS-CoV-2 infection. Results: the average age of patients was 53.02 years. Male sex was the most affected (76.9%). Respiratory distress was the most common clinical symptom (61.5%). Arterial hypertension and renal failure were the most common comorbidities (3O% and 6%). Bilateral ground-glass opacities, with a predominantly peripheral distribution, accounted for 69.2% of cases, followed by condensations (57.7%) and crazy paving (19.2%). Severe COVID-19 was most frequently found (34.61%). Distal and proximal pulmonary embolism was the most common complication (11.5%). Among the associated diseases, pleurisy and pulmonary PAH were most frequently found (30.8%). The majority of our patients had parenchymal lung lesions, corresponding to early-stage disease on CT (50%). Conclusion: at the UCK, during the first wave of SARS-CoV-2 pandemic, lesions on CT suggestive of COVID-19 were dominated by plaque-like ground-glass opacities, followed by nonsystematized parenchymatous condensations and crazy paving. The less observed atypical lesions consisted of unilateral, peribronchovascular pseudo-nodular condensations and infection in the remodeled lung. Severe COVID-19 was the most common CT finding. Proximal and distal pulmonary embolism was the most common complication. This study highlights that these findings are consistent with those reported in the literature.


Subject(s)
COVID-19/complications , Hospitalization , Pneumonia, Viral/diagnostic imaging , Tomography, X-Ray Computed/methods , Adolescent , Adult , Aged , COVID-19/diagnostic imaging , Child , Child, Preschool , Democratic Republic of the Congo , Female , Humans , Infant , Male , Middle Aged , Pneumonia, Viral/virology , Severity of Illness Index , Sex Distribution , Young Adult
8.
Glob Health Sci Pract ; 9(3): 682-689, 2021 Sep 30.
Article in English | MEDLINE | ID: covidwho-1449261

ABSTRACT

Lessons learned from one global health program can inform responses to challenges faced by other programs. One way to disseminate these lessons is through courses. However, such courses are often delivered by and taught to people based in high-income countries and thus may not present a truly global perspective. The Synthesis and Translation of Research and Innovations from Polio Eradication (STRIPE) is a consortium of 8 institutions in Afghanistan, Bangladesh, the Democratic Republic of the Congo, Ethiopia, India, Indonesia, Nigeria, and the United States that seeks to carry out such a transfer of the lessons learned in polio eradication. This short report describes the collaborative process of developing content and curriculum for an international course, the learnings that emerged, the barriers we faced, and recommendations for future similar efforts. Various parts of our course were developed by teams of researchers from countries across South Asia and sub-Saharan Africa. We held a series of regional in-person team meetings hosted in different countries to improve rapport and provide a chance to work together in person. The course content reflects the diversity of team members' knowledge in a variety of contexts. Challenges to this effort included team coordination (e.g., scheduling across time zones); hierarchies across and between countries; and the coronavirus disease (COVID-19) pandemic. We recommend planning for these hierarchies ahead of time and ensuring significant in-person meeting time to make the most of international collaboration.


Subject(s)
Curriculum , Disease Eradication/methods , Global Health/education , Immunization Programs/methods , Internationality , Poliomyelitis/prevention & control , Afghanistan , Bangladesh , Democratic Republic of the Congo , Ethiopia , Humans , India , Indonesia , Nigeria , Poliomyelitis/drug therapy , United States
9.
Waste Manag Res ; 39(10): 1237-1244, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1440861

ABSTRACT

Incineration is the most used healthcare waste (HCW) disposal method. Disease outbreaks due to Ebola virus and SARS-CoV2 require attention to HCW management to avoid pathogens spread and spillover. This study describes HCW management prior to incineration and hospital incinerators performance by analysing bottom ashes from hospitals in Kinshasa, Democratic Republic of Congo. We used semi-structured interviews to capture information on pre-incineration waste management and analysed the chemical composition of 27 samples of incinerator bottom ashes using the energy dispersive X-ray fluorescence. Neither sorting nor waste management measures were applied at hospitals surveyed. Incinerator operators were poorly equipped and their knowledge was limited. The bottom ash concentrations of cadmium, chromium, nickel and lead ranged between 0.61-10.44, 40.15-737.01, 9.11-97.55 and 16.37-240.03 mg kg-1, respectively. Compared to Chinese incinerator performance, the concentrations of some elements were found to be lower than those from China. This discrepancy may be explained by the difference in the composition of HCW. The authors conclude that health care waste in Kinshasa hospitals is poorly managed, higher concentrations of heavy metals are found in incinerator bottom ashes and the incinerators quality is poor. They recommend the strict application of infection prevention control measures, the training of incinerator operators and the use of high-performance incinerators.


Subject(s)
COVID-19 , Metals, Heavy , Coal Ash , Delivery of Health Care , Democratic Republic of the Congo , Hospitals , Humans , Incineration , Metals, Heavy/analysis , RNA, Viral , SARS-CoV-2
11.
BMC Health Serv Res ; 21(1): 831, 2021 Aug 18.
Article in English | MEDLINE | ID: covidwho-1362055

ABSTRACT

OBJECTIVE: This study aimed to assess health facilities' readiness to provide safe surgical care during Ebola and COVID-19 era in Uganda and in the Eastern DR Congo. METHODS: A cross-sectional study was conducted in selected national, regional referral and general hospital facilities in Uganda and in the eastern part of DR Congo from 1st August 2020 to 30th October 2020. Data was analysed using Stata version 15. RESULTS: The participation rate was of 37.5 % (72/192) for both countries. None of the hospitals fulfilled the readiness criteria for safe surgical care provision in both countries. The mean bed capacity of participating health facilities (HF) was 184 in Eastern DR Congo and 274 in Uganda with an average surgical ward bed capacity of 22.3 % (41/184) and 20.4 % (56/274) respectively. The mean number of operating rooms was 2 and 3 in Eastern DR Congo and Uganda respectively. Nine hospitals (12.5 %) reported being able to test for Ebola and 25 (34.7 %) being able to test for COVID-19. Postponing of elective surgeries was reported by 10 (13.9) participating hospitals. Only 7 (9.7 %) hospitals reported having a specific operating room for suspect or confirmed cases of Ebola or COVID-19. Appropriate Personal Protection Equipment (PPE) was reported to be available in 60 (83.3 %) hospitals. Most of the staff had appropriate training on donning and doffing of PPE 40 (55.6 %). Specific teams and protocols for safe surgical care provision were reported to be present in 61 (84.7 %) and 56 (77.8 %) respectively in Uganda and Eastern DR Congo participating hospitals. CONCLUSIONS: The lack of readiness to provide safe surgical care during Ebola and COVID-19 era across the participating hospitals in both countries indicate a need for strategies to enhance health facility supplies and readiness for safe surgical provision in resource-limited settings.


Subject(s)
COVID-19 , Hemorrhagic Fever, Ebola , Cross-Sectional Studies , Democratic Republic of the Congo/epidemiology , Health Facilities , Hemorrhagic Fever, Ebola/epidemiology , Hemorrhagic Fever, Ebola/prevention & control , Humans , SARS-CoV-2 , Uganda/epidemiology
13.
BMJ Glob Health ; 6(7)2021 07.
Article in English | MEDLINE | ID: covidwho-1329053

ABSTRACT

INTRODUCTION: Health service use among the public can decline during outbreaks and had been predicted among low and middle-income countries during the COVID-19 pandemic. In March 2020, the government of the Democratic Republic of the Congo (DRC) started implementing public health measures across Kinshasa, including strict lockdown measures in the Gombe health zone. METHODS: Using monthly time series data from the DRC Health Management Information System (January 2018 to December 2020) and interrupted time series with mixed effects segmented Poisson regression models, we evaluated the impact of the pandemic on the use of essential health services (outpatient visits, maternal health, vaccinations, visits for common infectious diseases and non-communicable diseases) during the first wave of the pandemic in Kinshasa. Analyses were stratified by age, sex, health facility and lockdown policy (ie, Gombe vs other health zones). RESULTS: Health service use dropped rapidly following the start of the pandemic and ranged from 16% for visits for hypertension to 39% for visits for diabetes. However, reductions were highly concentrated in Gombe (81% decline in outpatient visits) relative to other health zones. When the lockdown was lifted, total visits and visits for infectious diseases and non-communicable diseases increased approximately twofold. Hospitals were more affected than health centres. Overall, the use of maternal health services and vaccinations was not significantly affected. CONCLUSION: The COVID-19 pandemic resulted in important reductions in health service utilisation in Kinshasa, particularly Gombe. Lifting of lockdown led to a rebound in the level of health service use but it remained lower than prepandemic levels.


Subject(s)
COVID-19 , Pandemics , Communicable Disease Control , Democratic Republic of the Congo/epidemiology , Health Services , Humans , Pandemics/prevention & control , Public Facilities , SARS-CoV-2
14.
Malar J ; 20(1): 282, 2021 Jun 25.
Article in English | MEDLINE | ID: covidwho-1327930

ABSTRACT

BACKGROUND: Severe metabolic acidosis and acute kidney injury are major causes of mortality in children with severe malaria but are often underdiagnosed in low resource settings. METHODS: A retrospective analysis of the 'Artesunate versus quinine in the treatment of severe falciparum malaria in African children' (AQUAMAT) trial was conducted to identify clinical features of severe metabolic acidosis and uraemia in 5425 children from nine African countries. Separate models were fitted for uraemia and severe metabolic acidosis. Separate univariable and multivariable logistic regression were performed to identify prognostic factors for severe metabolic acidosis and uraemia. Both analyses adjusted for the trial arm. A forward selection approach was used for model building of the logistic models and a threshold of 5% statistical significance was used for inclusion of variables into the final logistic model. Model performance was assessed through calibration, discrimination, and internal validation with bootstrapping. RESULTS: There were 2296 children identified with severe metabolic acidosis and 1110 with uraemia. Prognostic features of severe metabolic acidosis among them were deep breathing (OR: 3.94, CI 2.51-6.2), hypoglycaemia (OR: 5.16, CI 2.74-9.75), coma (OR: 1.72 CI 1.17-2.51), respiratory distress (OR: 1.46, CI 1.02-2.1) and prostration (OR: 1.88 CI 1.35-2.59). Features associated with uraemia were coma (3.18, CI 2.36-4.27), Prostration (OR: 1.78 CI 1.37-2.30), decompensated shock (OR: 1.89, CI 1.31-2.74), black water fever (CI 1.58. CI 1.09-2.27), jaundice (OR: 3.46 CI 2.21-5.43), severe anaemia (OR: 1.77, CI 1.36-2.29) and hypoglycaemia (OR: 2.77, CI 2.22-3.46) CONCLUSION: Clinical and laboratory parameters representing contributors and consequences of severe metabolic acidosis and uraemia were independently associated with these outcomes. The model can be useful for identifying patients at high risk of these complications where laboratory assessments are not routinely available.


Subject(s)
Acidosis/diagnosis , Malaria, Falciparum/complications , Uremia/diagnosis , Acidosis/parasitology , Africa South of the Sahara , Child , Child, Preschool , Democratic Republic of the Congo , Female , Gambia , Ghana , Humans , Infant , Kenya , Malaria, Falciparum/parasitology , Male , Mozambique , Nigeria , Prognosis , Retrospective Studies , Rwanda , Tanzania , Uganda , Uremia/parasitology
15.
Viruses ; 13(7)2021 07 13.
Article in English | MEDLINE | ID: covidwho-1314760

ABSTRACT

More than a year after the first identification of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) as the causative agent of the 2019 coronavirus disease (COVID-19) in China, the emergence and spread of genomic variants of this virus through travel raise concerns regarding the introduction of lineages in previously unaffected regions, requiring adequate containment strategies. Concomitantly, such introductions fuel worries about a possible increase in transmissibility and disease severity, as well as a possible decrease in vaccine efficacy. Military personnel are frequently deployed on missions around the world. As part of a COVID-19 risk mitigation strategy, Belgian Armed Forces that engaged in missions and operations abroad were screened (7683 RT-qPCR tests), pre- and post-mission, for the presence of SARS-CoV-2, including the identification of viral lineages. Nine distinct viral genotypes were identified in soldiers returning from operations in Niger, the Democratic Republic of the Congo, Afghanistan, and Mali. The SARS-CoV-2 variants belonged to major clades 19B, 20A, and 20B (Nextstrain nomenclature), and included "variant of interest" B.1.525, "variant under monitoring" A.27, as well as lineages B.1.214, B.1, B.1.1.254, and A (pangolin nomenclature), some of which are internationally monitored due to the specific mutations they harbor. Through contact tracing and phylogenetic analysis, we show that isolation and testing policies implemented by the Belgian military command appear to have been successful in containing the influx and transmission of these distinct SARS-CoV-2 variants into military and civilian populations.


Subject(s)
COVID-19/virology , Military Personnel , SARS-CoV-2/classification , SARS-CoV-2/genetics , Afghanistan/epidemiology , Belgium , COVID-19/epidemiology , China/epidemiology , Democratic Republic of the Congo/epidemiology , Genome, Viral , Genomics , Humans , Mali/epidemiology , Molecular Epidemiology , Mutation , Niger/epidemiology , Phylogeny , Travel , Whole Genome Sequencing
17.
PLoS One ; 16(6): e0236971, 2021.
Article in English | MEDLINE | ID: covidwho-1262536

ABSTRACT

Coronaviruses play an important role as pathogens of humans and animals, and the emergence of epidemics like SARS, MERS and COVID-19 is closely linked to zoonotic transmission events primarily from wild animals. Bats have been found to be an important source of coronaviruses with some of them having the potential to infect humans, with other animals serving as intermediate or alternate hosts or reservoirs. Host diversity may be an important contributor to viral diversity and thus the potential for zoonotic events. To date, limited research has been done in Africa on this topic, in particular in the Congo Basin despite frequent contact between humans and wildlife in this region. We sampled and, using consensus coronavirus PCR-primers, tested 3,561 wild animals for coronavirus RNA. The focus was on bats (38%), rodents (38%), and primates (23%) that posed an elevated risk for contact with people, and we found coronavirus RNA in 121 animals, of which all but two were bats. Depending on the taxonomic family, bats were significantly more likely to be coronavirus RNA-positive when sampled either in the wet (Pteropodidae and Rhinolophidae) or dry season (Hipposideridae, Miniopteridae, Molossidae, and Vespertilionidae). The detected RNA sequences correspond to 15 alpha- and 6 betacoronaviruses, with some of them being very similar (>95% nucleotide identities) to known coronaviruses and others being more unique and potentially representing novel viruses. In seven of the bats, we detected RNA most closely related to sequences of the human common cold coronaviruses 229E or NL63 (>80% nucleotide identities). The findings highlight the potential for coronavirus spillover, especially in regions with a high diversity of bats and close human contact, and reinforces the need for ongoing surveillance.


Subject(s)
Animals, Wild/virology , Chiroptera/virology , Coronavirus Infections/veterinary , Coronavirus/isolation & purification , Rodentia/virology , Animals , Animals, Wild/genetics , Chiroptera/genetics , Congo/epidemiology , Coronavirus/genetics , Coronavirus Infections/enzymology , Coronavirus Infections/pathology , Coronavirus Infections/virology , Democratic Republic of the Congo/epidemiology , Environmental Monitoring/methods , Phylogeny , RNA, Viral/genetics , Rodentia/genetics
18.
BMC Infect Dis ; 21(1): 539, 2021 Jun 07.
Article in English | MEDLINE | ID: covidwho-1261266

ABSTRACT

BACKGROUND: In sub-Saharan Africa, acute respiratory infections (ARI), acute gastrointestinal infections (GI) and acute febrile disease of unknown cause (AFDUC) have a large disease burden, especially among children, while respective aetiologies often remain unresolved. The need for robust infectious disease surveillance to detect emerging pathogens along with common human pathogens has been highlighted by the ongoing novel coronavirus disease 2019 (COVID-19) pandemic. The African Network for Improved Diagnostics, Epidemiology and Management of Common Infectious Agents (ANDEMIA) is a sentinel surveillance study on the aetiology and clinical characteristics of ARI, GI and AFDUC in sub-Saharan Africa. METHODS: ANDEMIA includes 12 urban and rural health care facilities in four African countries (Côte d'Ivoire, Burkina Faso, Democratic Republic of the Congo and Republic of South Africa). It was piloted in 2018 in Côte d'Ivoire and the initial phase will run from 2019 to 2021. Case definitions for ARI, GI and AFDUC were established, as well as syndrome-specific sampling algorithms including the collection of blood, naso- and oropharyngeal swabs and stool. Samples are tested using comprehensive diagnostic protocols, ranging from classic bacteriology and antimicrobial resistance screening to multiplex real-time polymerase chain reaction (PCR) systems and High Throughput Sequencing. In March 2020, PCR testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and analysis of full genomic information was included in the study. Standardised questionnaires collect relevant clinical, demographic, socio-economic and behavioural data for epidemiologic analyses. Controls are enrolled over a 12-month period for a nested case-control study. Data will be assessed descriptively and aetiologies will be evaluated using a latent class analysis among cases. Among cases and controls, an integrated analytic approach using logistic regression and Bayesian estimation will be employed to improve the assessment of aetiology and associated risk factors. DISCUSSION: ANDEMIA aims to expand our understanding of ARI, GI and AFDUC aetiologies in sub-Saharan Africa using a comprehensive laboratory diagnostics strategy. It will foster early detection of emerging threats and continued monitoring of important common pathogens. The network collaboration will be strengthened and site diagnostic capacities will be reinforced to improve quality management and patient care.


Subject(s)
Communicable Diseases/diagnosis , Communicable Diseases/epidemiology , Mass Screening , Sentinel Surveillance , Bayes Theorem , Burkina Faso , Case-Control Studies , Cote d'Ivoire , Democratic Republic of the Congo , Fever/epidemiology , Fever/microbiology , Gastrointestinal Diseases/epidemiology , Gastrointestinal Diseases/microbiology , Humans , Real-Time Polymerase Chain Reaction , Respiratory Tract Infections/epidemiology , South Africa
19.
Int J Environ Res Public Health ; 18(10)2021 05 17.
Article in English | MEDLINE | ID: covidwho-1238891

ABSTRACT

CONTEXT: In this era of patient-centered care, it is increasingly important for HIV/AIDS care and treatment programs to customize their services according to patients' clinical stage progression and other risk assessments. To enable such customization of HIV care and treatment delivery, the research evidence explaining factors associated with patients' clinical stages is needed. OBJECTIVES: The primary objective of this study was to produce such scientific evidence by analyzing the most recent data for patients at outpatient clinics in the provinces of Kinshasa and Haut-Katanga and to examine the patient characteristics associated with WHO stages of disease progression. METHODS: Using a quantitative retrospective cohort study design, we analyzed data from 49,460 people living with HIV (PLHIV) on antiretroviral therapy (ART) from 241 HIV/AIDS clinics located in Haut-Katanga and Kinshasa provinces of the Democratic Republic of Congo. We performed Chi-square and multinomial logistic regression analyses. RESULTS: A small proportion (i.e., 4.4%) of PLHIV were at WHO's clinical progression stage 4, whereas 30.7% were at clinical stage 3, another 22.9% at stage 2, and the remaining 41.9% were at stage 1, the least severe stage. After controlling for other demographic and clinical factors included in the model, the likelihood of being at stage 1 rather than stage 3 or 4 was significantly higher (at p ≤ 0.05) for patients with no tuberculosis (TB) than those with TB co-infection (adjusted odds ratio or AOR, 5.73; confidence interval or CI, 4.98-6.59). The odds of being at stage 1 were significantly higher for female patients (AOR, 1.35; CI, 1.29-1.42), and those with the shorter duration on ART (vs. greater than 40.37 months). Patents in rural health zones (AOR, 0.32) and semi-rural health zones (AOR, 0.79) were less likely to be at stage 1, compared to patients in urban health zones. CONCLUSIONS: Our study showed that TB co-infection raised the risk for PLHIV to be at the severe stages of clinical progression of HIV. Such variation supports the thesis that customized HIV management approaches and clinical regimens may be imperative for this high-risk population. We also found significant variation in HIV clinical progression stages by geographic location and demographic characteristics. Such variation points to the need for more targeted efforts to address the disparities, as the programs attempt to improve the effectiveness of HIV care and treatment. The intersectionality of vulnerabilities from HIV, TB, and COVID-19-related hardships has elevated the need for customized care and treatment even more in the COVID-19 era.


Subject(s)
COVID-19 , HIV Infections , Ambulatory Care Facilities , Democratic Republic of the Congo/epidemiology , Female , HIV Infections/drug therapy , HIV Infections/epidemiology , Humans , Retrospective Studies , SARS-CoV-2
20.
Int J Environ Res Public Health ; 18(10)2021 05 12.
Article in English | MEDLINE | ID: covidwho-1227021

ABSTRACT

Intimate Partners' Violence (IPV) is a public health problem with long-lasting mental and physical health consequences for victims and their families. As evidence has been increasing that COVID-19 lockdown measures may exacerbate IPV, our study sought to describe the magnitude of IPV in women and identify associated determinants. An online survey was conducted in the Democratic Republic of Congo (DRC) from 24 August to 8 September 2020. Of the 4160 respondents, 2002 eligible women were included in the data analysis. Their mean age was 36.3 (SD: 8.2). Most women (65.8%) were younger than 40 years old. Prevalence of any form of IPV was 11.7%. Being in the 30-39 and >50 years' age groups (OR = 0.66, CI: 0.46-0.95; p = 0.026 and OR = 0.23, CI: 0.11-048; p < 0.001, respectively), living in urban setting (OR = 0.63, CI: 0.41-0.99; p = 0.047), and belonging to the middle socioeconomic class (OR = 0.48, CI: 0.29-0.79; p = 0.003) significantly decreased the odds for experiencing IPV. Lower socioeconomic status (OR = 1.84, CI: 1.04-3.24; p = 0.035) and being pregnant (OR = 1.63, CI: 1.16-2.29; p = 0.005) or uncertain of pregnancy status (OR = 2.01, CI: 1.17-3.44; p = 0.011) significantly increased the odds for reporting IPV. Additional qualitative research is needed to identify the underlying reasons and mechanisms of IPV in order to develop and implement prevention interventions.


Subject(s)
COVID-19 , Intimate Partner Violence , Adult , Communicable Disease Control , Cross-Sectional Studies , Democratic Republic of the Congo/epidemiology , Female , Humans , Pregnancy , Prevalence , Risk Factors , SARS-CoV-2 , Sexual Partners , Surveys and Questionnaires , Violence
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