Does glucose-6-phosphate dehydrogenase deficiency worsen the clinical features of sickle cell disease? A multi-hospital-based cross-sectional study.

BACKGROUND: The impact of glucose-6-phosphate dehydrogenase deficiency(G-6-PD) on the clinical course of sickle cell disease(SCD) is still controversial. The objectives of this study were to determine the prevalence of G-6-PD deficiency in patients with SCD and its effect on their clinical course. METHODS: A cross-sectional study of 122 SCD patients and 211 healthy blood donors was conducted in Kisangani city. Data were collected through clinical examination supplemented by patient medical records, and laboratory tests based on a survey form. G-6-PD activity was measured by spectrophotometry and the screening for SCD by the HemoTypeSC® rapid test. Statistical analysis was done using SPSS ver. 20.0. RESULTS: The prevalence of G-6-PD deficiency did not differ between SCD and non-SCD subjects, 35.2% vs. 33.6% respectively(p = .767). When comparing the hemoglobin level between SCD patients with and without G-6-PD deficiency, no significant difference was observed. However, in the 6 months prior to the study, SCD patients with G-6-PD deficiency had on average more transfusions than non-deficient SCD patients, 0.64 ± 0.897 vs. 0.24 ± 0.486(p = .004). Similarly, considering the clinical events of the last 12 months prior to the study, there were more hospitalizations, major vaso-occlusive crises and anemia requiring blood transfusion among G-6-PD deficient SCD patients compared to no-deficient, respectively 1.42 ± 1.451vs. 0.76 ± 1.112(p = .007); 1.37 ± 1.092 vs. 0.85 ± 1.014(p = .005); 0.74 ± 0.902 vs. 0.38 ± 0.739 (p = .007). CONCLUSION: The prevalence of G-6-PD deficiency in SCD patients was high but did not differ from that observed in controls. In addition, G-6-PD deficiency appeared to worsen the clinical features of SCD. Nevertheless, prospective studies further clarifying this observation are needed.

Les perturbations des enzymes ASAT, ALAT et LDH au cours du paludisme de l'adulte au Nord-est de la RDC / NA

Introduction : la présente étude avait pour objectif de ressortir certaines anomalies des enzymes hépatiques portant sur l'ASAT, l'ALAT et la LDH chez les patients impaludés en vue de contribuer à la prise en charge diagnostique du paludisme dans la ville de Butembo. Méthodes. Cette étude est descriptive. Elle a été réalisée dans le service de Médecine Interne et de Parasitologie de l'Hôpital Matanda du 1er juillet 2020 au 2 novembre 2020 soit pendant une période de 4 mois. Elle a porté sur une série de 100 patients impaludés avec goutte épaisse positive. Les paramètres d'intérêt étaient les caractéristiques sociodémographiques, les anomalies des enzymes hépatiques (ASAT, ALAT, LDH) et la densité parasitaire. Résultats : 100 patients ont été sélectionnés au cours de notre étude parmi lesquels 54 sujets de sexe féminin et 46 de sexe masculin. Le taux de LDH était élevé dans 73% des cas. Les transaminases ASAT et ALAT étaient élevées dans 28% et 31% des cas respectivement. Aucune corrélation significative n'a été retrouvée entre la densité parasitaire et les anomalies enzymatiques observées dans notre étude. Conclusion. Des variations notables des paramètres biologiques portant sur les anomalies de enzymes hépatiques dont l'ASAT, l'ALAT et la LDH ont été enregistrés au cours de l'accès palustre à Plasmodium falciparum chez l'adulte de la ville de Butembo. Ces paramètres pourraient avoir une utilité dans le diagnostic du paludisme et /ou constituer un indicateur de la sévérité de la maladie, spécialement lorsque les résultats parasitologiques ne sont pas disponibles ou sont incertains.

Cholesterolemia and triglyceridemia changes in adult with malaria in a hypo-endemic malaria region, Butembo-DR Congo

changes occur commonly among patients affected with malaria. This study aimed to assess lipid changes in blood among patients with malaria in Butembo, a hypoendemic region. Methods: This cross-sectional study, conducted in the Departments of Internal and Parasitology of Matanda Hospital, located in Butembo, from July 1st, 2020, to November 2, 2020; involved 100 patients diagnosed with malaria. Biochemical analyses carried out by three lab technicians were performed among patients who had positive malaria using positive thick film. Plasmodial species, the parasite density, the triglycerides, the total cholesterol, the HDL-cholesterol, the LDL-cholesterol were assessed. Results: Cholesteroleamia and HDLemia demonstrated a low level in 93% and in 61% of participants respectively; whereas 73% of cases showed an increased level of triglycerides in the blood. Lipidemia profile was independently associated with parasite density among patients with malaria. Conclusion: Although the lipid changes in the blood are not specific in the diagnosis of malaria, this study highlighted their status among patients with malaria. Further researches should be conducted to determine their impact on malaria outcomes. Therefore, dyslipidemia could be used in malaria screening.

Uptake of HIV/AIDS Services Following a Positive Self-Test Is Lower in Men Than Women in the Democratic Republic of the Congo.

As far as HIV self-testing (HIVST) is concerned, proving the link to HIV care for users with a positive result contributes to understanding the implementation of HIVST. We sought to examine whether there were differences by sex in the uptake of HIV services following a positive self-test in the Democratic Republic of the Congo (DRC). This was a mixed-methods study exploring linkage to care for HIVST through a secondary analysis of collected data from three pilot surveys recently conducted in three cities (Kinshasa, Kisangani, and Kindu) during 2018 and 2020 in the DRC. Linkage to HIV care was defined as delayed when observed beyond 1 week. A total of 1,652 individuals were self-tested for HIV. Overall, the proportion of linkage to HIV care was high (n = 258; 82.2%) among individuals having a positive result with HIV self-test (n = 314), but it was significantly lower in men (65.2%) than women (89.2%). Furthermore, linkage to HIV care of men was significantly delayed as compared with that of women (40.0 vs. 20.7%). These findings show a lower uptake of care following a positive self-test in men than women. This trend already previously observed in sub-Saharan Africa shed light on the need to increase linkages to care among men newly diagnosed through HIV self-testing.

Self-testing for HIV, HBV, and HCV using finger-stick whole-blood multiplex immunochromatographic rapid test: A pilot feasibility study in sub-Saharan Africa.

BACKGROUND: The burden of HIV, HBV, and HCV infections remains disproportionately high in sub-Saharan Africa, with high rates of co-infections. Multiplex rapid diagnostic tests for HIV, HBV and HCV serological testing with high analytical performances may improve the "cascade of screening" and quite possibly the linkage-to-care with reduced cost. Based on our previous field experience of HIV self-testing, we herein aimed at evaluating the practicability and acceptability of a prototype finger-stick whole-blood Triplex HIV/HCV/HBsAg self-test as a simultaneous serological screening tool for HIV, HBV, and HCV in the Democratic Republic of the Congo (DRC). METHODS: A cross-sectional multicentric study consisting of face-to-face, paper-based, and semi-structured questionnaires with a home-based and facility-based recruitment of untrained adult volunteers at risk of HIV, HBV, and HCV infections recruited from the general public was conducted in 2020 in urban and rural areas in the DRC. The practicability of the Triplex self-test was assessed by 3 substudies on the observation of self-test manipulation including the understanding of the instructions for use (IFU), on the interpretation of Triplex self-test results and on its acceptability. RESULTS: A total of 251 volunteers (mean age, 28 years; range, 18-49; 154 males) were included, from urban [160 (63.7%)] and rural [91 (36.3%)] areas. Overall, 242 (96.4%) participants performed the Triplex self-test and succeeded in obtaining a valid test result with an overall usability index of 89.2%. The correct use of the Triplex self-test was higher in urban areas than rural areas (51.2% versus 16.5%; aOR: 6.9). The use of video IFU in addition to paper-based IFU increased the correct manipulation and interpretation of the Triplex self-test. A total of 197 (78.5%) participants correctly interpreted the Triplex self-test results, whereas 54 (21.5%) misinterpreted their results, mainly the positive test results harboring low-intensity band (30/251; 12.0%), and preferentially the HBsAg band (12/44; 27.3%). The rates of acceptability of reuse, distribution of the Triplex self-test to third parties (partner, friend, or family member), linkage to the health care facility for confirmation of results and treatment, and confidence in the self-test results were very high, especially among participants from urban areas. CONCLUSIONS: This pilot study shows evidence for the first time in sub-Saharan Africa on good practicability and high acceptability of a prototype Triplex HIV/HCV/HBsAg self-test for simultaneous diagnosis of three highly prevalent chronic viral infections, providing the rational basis of using self-test harboring four bands of interest, i.e. the control, HIV, HCV, and HBsAg bands. The relatively frequent misinterpretation of the Triplex self-test points however the necessity to improve the delivery of this prototype Triplex self-test probably in a supervised setting. Finally, these observations lay the foundations for the potential large-scale use of the Triplex self-test in populations living in sub-Saharan Africa at high risk for HIV, HBV, and HCV infections.

Management of sickle cell disease: current practices and challenges in a northeastern region of the Democratic Republic of the Congo.

BACKGROUND: The Democratic Republic of the Congo (DRC) is the third most affected country worldwide by sickle cell disease (SCD). However, this disease is still orphaned in the country; large-scale control actions are rare, and little is known about its management. OBJECTIVE: To assess current practices in the management of SCD in Kisangani, DRC. METHODS: This cross-sectional study was conducted in six health facilities in Kisangani. It involved 198 presumed sickle cell patients attending the above health facilities. The study focused on the sociodemographic and clinical data of the participants, obtained through a clinical examination and their medical records. Diagnostic confirmation of SCD was made by high-performance liquid chromatography coupled to mass spectrometry. Data were analyzed using SPSS 20.0. RESULTS: The diagnosis of SCD was confirmed in 194 (98.0%; 95% CI: 94.9-99.2) participants, while it was not confirmed in 4 (2.0%; 95% CI: 0.8-5.1) participants. The diagnosis was mainly made by the Emmel test (42.9%). 45.8% of participants had previously been transfused with the blood of their parents. Folic acid was taken by 48.5% of participants and the previous intake of hydroxyurea was reported in 5.1% of participants. The participants vaccinated against Pneumococcus were 13.6% and against Haemophilus influenzae type b 28.3%. Penicillin prophylaxis was received by only 1.5% and malaria prophylaxis by 11.6% of participants. CONCLUSION: Standard-care practices for SCD patients in Kisangani are insufficient. The Congolese government should regard this disease as a health priority and consider actions to improve its management.

Comparison of practicability and effectiveness between unassisted HIV self-testing and directly assisted HIV self-testing in the Democratic Republic of the Congo: a randomized feasibility trial.

BACKGROUND: HIV self-testing (HIVST) can be performed using directly assisted and unassisted approaches in facilities or communities to reach different populations. The aim of this study was to compare the practicability and effectiveness of the two delivery approaches for HIVST, unassisted HIVST (UH) and directly assisted HIVST (DAH), in the field setting of Kisangani, the Democratic Republic of the Congo (DRC). METHODS: A randomized (1:1), non-blinded, non-inferiority trial using a blood-based and facility-based HIVST method was carried out in four facilities in Kisangani, the DRC, targeting populations at high risk for HIV infection. The primary outcome was the difference in the practicability of the HIV self-test between the two arms. Practicability was defined as successfully performing the test and correctly interpreting the result. Requests for assistance, positivity rate, linkage to care, and willingness to buy an HIV self-test kit constituted the secondary outcomes for HIVST effectiveness. The adjusted risk ratios (aRRs) were calculated using Poisson regression. RESULTS: The rate of successfully performing the test was same (93.2%) in the UH and DAH arms. The rate of correctly interpreting the results was 86.9% in the UH arm versus 93.2% in the DAH arm, for a difference of - 6.3%. After the follow-up 72 h later, participants in the UH arm had a significantly lower chance of correctly interpreting the test results than those in the DAH arm (aRR: 0.60; P = 0.019). Although the positivity rate was 3.4% among the participants in the DAH arm and 1.7% among those in the UH arm, no significant differences were found between the two arms in the positivity rate, requests for assistance, and linkage to care. Willingness to buy an HIV self-test was higher in the UH arm than in the DAH arm (92.3% versus 74.1%; aRR: 4.20; P < 0.001). CONCLUSION: The results of this study indicate that UH is as practicable and effective as DAH among individuals at high risk for HIV infection in Kisangani, the DRC. However, additional support tools need to be assessed to improve the interpretation of the self-test results when using the UH approach. TRIAL REGISTRATION: PACTR201904546865585. Registered 03 April 2019 - Retrospectively registered, https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=6032.

Students' knowledge on sickle cell disease in Kisangani, Democratic Republic of the Congo.

Background: Education is needed as an action to reduce morbidity and mortality from sickle cell disease (SCD), an important but largely neglected risk to child survival in most African countries as Democratic Republic of Congo (DRC).Objective: To assess the knowledge of Kisangani University students in DRC regarding SCD.Methods: In this non-experimental, cross-sectional study, a validated questionnaire was used to assess the knowledge of 2 112 Kisangani University students in DRC and data were analyzed using SPSS version 20.Results: Most participants, 92.9% (95% confidence interval [CI]: 91.7-93.9) were knowledgeable about SCD and have heard about it through schools and/or universities (46.3%), followed by family (34.5%) and health-care workers (23.5%). Nine hundred and seventy-three (46.1%; 95% CI: 44.0-48.2) and 37.9% (95% CI: 35.9-40.0) subjects indicated, respectively, that SCD is an acquired and hereditary disease. Moreover, 53.6% (95% CI: 51.5-55.7) said that the diagnosis of SCD is made by blood tests, while 46.2% (95% CI: 44.1-48.3) talked about urine tests. About 85.6% were unaware of the risk of children becoming sickle cell patients when both parents have SCD. To prevent SCD, pre-marital screening was cited by only 7.7% (95% CI: 6.6-8.9) of subjects and no measure was known by 25.4% (95% CI: 23.6-27.3). However, 79.6% (95% CI: 77.8-81.3) approved the need of pre-marital screening of SCD.Discussion: This study highlighted that the Kisangani university students' knowledge regarding SCD is poor and needs to be improved; education programs and motivational campaigns to be enhanced.

Acceptability, feasibility, and individual preferences of blood-based HIV self-testing in a population-based sample of adolescents in Kisangani, Democratic Republic of the Congo.

BACKGROUND: Adolescents living in sub-Saharan Africa constitute a vulnerable population at significant risk of HIV infection. This study aims to evaluate the acceptability, feasibility, and accuracy of home-based, supervised HIV self-testing (HIVST) as well as their predictors among adolescents living in Kisangani, Democratic Republic of the Congo (DRC). METHODS: A cross-sectional, door-to-door survey using a blood-based HIV self-test and a peer-based supervised HIVST approach was conducted from July to August 2018 in Kisangani, DRC. The acceptability and feasibility of HIVST were assessed among adolescents' consenting to use and interpret HIV self-test. The accuracy of HIVST was estimated by the sensibility and specificity of adolescent-interpreted HIV self-test. Factors associated with acceptability and feasibility of HIVST were analyzed with logistic regression. RESULTS: A total of 628 adolescents (including 369 [58.8%] females) aged between 15 and 19 years were enrolled. Acceptability of HIVST was high (95.1%); 96.1% of participants correctly used the self-test, and 65.2% asked for verbal instructions. The majority of adolescents (93.5%) correctly interpreted their self-test results. The Cohen's κ coefficient between the results read by adolescents and by supervisors was 0.62. The correct interpretation decreased significantly when adolescents had no formal education or attended primary school as compared to those currently attending university (37.0% versus 100%; adjusted OR: 0.01 [95% CI: 0.004-0.03]). In the hands of adolescents at home, the sensitivity of the Exacto Test HIV Self-test was estimated at 100%, while its specificity was 96.0%. The majority of participants (68.0%) affirmed that post-test counseling was essential, and that face-to-face counseling (78.9%) was greatly preferred. CONCLUSIONS: Home-based, supervised HIVST using a blood-based self-test and peer-based approach can be used with a high degree of acceptability and feasibility by adolescents living in Kisangani, DRC. Misinterpretation of test results is challenging to obtaining good feasibility of HIVST among adolescents with poor educational level. Face-to-face post-test counseling seems to be preferred among Kisangani's adolescents.

Inconclusive results with HIV serodiagnosis algorithms, and HIV-1 and HIV-2 co-infection in North-eastern Democratic Republic of Congo

Background:Inconclusive serodiagnosis of HIV infection is particularly frequent in Central Africa. The aims of this study were to: (i) determine the rate of inconclusive results with the two-test algorithm that the WHO proposed in 1997 (WHO II) versus the three-test algorithm (revised in 2012 and consolidated in 2015 by WHO) for HIV testing, and (ii) determine the prevalence of HIV-1 and HIV-2 co-infection in the north-eastern region of the Democratic Republic of the Congo (DRC).Methods:A multicentre cross-sectional study was performed between March and June 2016 in Kisangani and Bunia, the capital cities of Tshopo and Ituri provinces respectively. Alere Determine HIV-1/2 (Alere Medical Co. Ltd., Japan), Uni-GoldTM HIV (Trinity Biotech Manufacturing Ltd., Ireland) and recomLine HIV-1 and HIV-2 IgG (Biosynex, France) were the first, second and third tests in the serial algorithm.Results : The rate of inconclusive results was 1.1% (95% CI: 0.4 to 3.1) with the two-test algorithm and 0.4% (95% CI: 0.1 to 2.1) with the three-test algorithm (p less than 0.001). The prevalence of HIV-1 and HIV-2 co-infection among HIV positive sera was 16.7% (95% CI: 4.7 to 44.8).Conclusion:The three-test algorithm HIV testing strategy significantly reduces the rate of inconclusive results. In addition, the prevalence of HIV-1 and HIV-2 co-infection is higher in a context where HIV-2 infection is poorly documented. Large-scale research is essential to clarify these results

Type 2 diabetes mellitus among the elderly in Goma, Democratic Republic of the Congo: prevalence, clinical features and complications

Background and aim: Diabetes is one of the leading non-communicable diseases in the world; diabetes is common in the elderly. The aim of this study is to assess the prevalence, clinical features and complications of type 2 diabetes mellitus among the elderly in the Hôpital Provincial du Nord Kivu in Goma. Subjects and Methods: A cross sectional study was based on data collected among the elderly from 2013 to 2015 in the Department of Internal Medicine. Overall, 418 elders were included. Results: The prevalence of type 2 diabetes mellitus was 8.6% (95% CI: 6.3 to 11.7). Overall, 54% of the elderly were males while 46% were females. Among males, 6.6% were diagnosed with diabetes whereas 11.0% were among females (p less than 0.001). All elderly diabetic subjects (n = 36) were taking anti diabetic drugs such as insulin or oral medications (sulfonylurea and or biguanide). Among those, 15 (41.7%) were on insulin and 21 (58.3%) on oral anti diabetic. Mean fasting glucose was higher among elderly individuals taking oral medications compared with their counterparts on insulin (104.4 versus 157.3 mg/dl, p less than 0.001). The asthenia (86.1%), the polyuria (13.9%), the coma (11.1%) and the polydipsia (5.6%) were the principal symptoms on admission. The infectious, metabolic, micro vascular and macrovascular complications were diagnosed in this study. Conclusion: Our study provides evidence on the high prevalence of type 2 diabetes mellitus among elderly individuals. Moreover, the study found many factors associated with type 2 diabetes mellitus among the elderly and the difficulty of diagnosing diabetes in the elderly. Hence, there is need to enhance the existing prevention programmes with emphasis on social determinants of diabetes, which need to be clarified by broad epidemiological studies at the population level. Keywords: Diabetes; Type 2; Elderly; Goma; Democratic Republic of the Congo

Determinants socio-economiques de l'automedication aux antimalariens a Kisangani/RD Congo

Objectif de l'etude : evaluer l'importance et les determinants socio-economiques de l'automedication aux anti-malariens dans la commune de la Tshopo a Kisangani Materiel et methodes : Nous avons realise une etude transversale utilisant un questionnaire d'enquete pour collecter les donnees. Par un echantillonnage systematique; 384 menages au minimum ont ete enquetes. Resultats : Au total 386 responsables de menage ont participe a l'enquete. 346 (89;6) de responsables avaient reconnu pratiquer l'automedication aux anti-malariens. Deux facteurs socio-economiques etaient significativement lies a l'automedication dans l'analyse classique : le revenu mensuel des responsables (p=0;0013) et la charge familiale en terme de nombre d'enfants (p=0;0034). L'age; le sexe; l'occupation des responsables; le niveau d'instruction et la religion des responsables n'etaient pas associes a la pratique. A l'analyse multi variee; les deux facteurs sont restes significatifs : les revenus superieurs a 100 dollars americains previennent la pratique [ORaj=0;25 (0;11-0;58); p=0;001] et le nombre eleve d'enfants dans le menage la favorise [ORaj=3;94(1;62-9;55); p=0;0024] entre 3-4 enfants et ORaj=3;34(1;067-10;46); p=0;038); a partir de 7 enfants) Conclusion : La prevalence de l'automedication aux anti-malariens est alarmante dans la commune de la Tshopo a Kisangani. La menace de la resistance; la circulation possible de medicaments de qualite douteuse et le contexte local de controle de qualite fait de cette pratique un probleme important de sante publique. Une evaluation serieuse de cette pratique serait donc utile dans le futur

Determinants socio-economiques de l'automedication aux antimalariens a Kisangani/RD Congo

Objectif de l'etude: evaluer l'importance et les determinants socio-economiques de l'automedication aux anti-malariens dans la commune de la Tshopo a Kisangani Materiel et methodes: Nous avons realise une etude transversale utilisant un questionnaire d'enquete pour collecter les donnees. Par un echantillonnage systematique; 384 menages au minimum ont ete enquetes.Resultats: Au total 386 responsables de menage ont participe a l'enquete. 346 (89;6) de responsables avaient reconnu pratiquer l'automedication aux anti-malariens. Deux facteurs socio-economiques etaient significativement lies a l'automedication dans l'analyse classique : le revenu mensuel des responsables (p=0;0013) et la charge familiale en terme de nombre d'enfants (p=0;0034). L'age; le sexe; l'occupation des responsables; le niveau d'instruction et la religion des responsables n'etaient pas associes a la pratique.A l'analyse multi variee; les deux facteurs sont restes significatifs : les revenus superieurs a 100 dollars americains previennent la pratique [ORaj=0;25 (0;11-0;58); p=0;001] et le nombre eleve d'enfants dans le menage la favorise [ORaj=3;94(1;62-9;55); p=0;0024] entre 3-4 enfants et ORaj=3;34(1;067-10;46); p=0;038); a partir de 7 enfants) Conclusion:La prevalence de l'automedication aux anti-malariens est alarmante dans la commune de la Tshopo a Kisangani. La menace de la resistance; la circulation possible de medicaments de qualite douteuse et le contexte local de controle de qualite fait de cette pratique un probleme important de sante publique. Une evaluation serieuse de cette pratique serait donc utile dans le futur