[Effect of the Baby Friendly Hospital Initiative on the duration of exclusive breastfeeding in Kinshasa: A cluster randomized trial]. / Effet de la formation en Initiative des Hôpitaux Amis des Bébés sur la durée de l'allaitement maternel exclusif à Kinshasa : un essai randomisé par grappes.

BACKGROUND: Despite numerous advantages of breastfeeding, in Democratic Republic of the Congo, the rate of children exclusively breastfed up to six months remains low. The lack of breastfeeding support received by mothers from health care providers is an important factor of early cessation of breastfeeding. This study aimed to evaluate the effect of the training of health care providers, in the Baby Friendly Hospital Initiative, on the duration of exclusive breastfeeding (EBF) in Kinshasa. METHODS: A total of 422 mothers, recruited during the first antenatal care visit in 12 maternities and followed up to six months after delivery, were included in a cluster randomized trial. In the experimental group, health care providers were trained using the "20-Hour Course For Maternity Staff". Cox proportional hazards model was used to determine the effect of the intervention on the duration of EBF. RESULTS: The rate of EBF at six months was 2.8%; the median duration of EBF was 10.9 weeks (IQR 4.3 to 14.9). The hazard of discontinuing EBF before six month was 1.4 times higher in the control group (adjusted HR [95%CI]=1.40 (1.10-1.78), P=0.007). CONCLUSION: In this study, training of health care providers in the Baby Friendly Hospital Initiative was associated with a significant improvement in the duration of EBF. Extending this training to different maternities could improve the coverage of EBF in Kinshasa.

[Determinants of survival in HIV patients receiving antiretroviral therapy in Goma, Democratic Republic of Congo]. / Les déterminants de la survie des patients vivant avec le VIH sous thérapie antirétrovirale dans la ville de Goma, RD-Congo.

BACKGROUND: The study aimed to identify factors associated with the survival of patients receiving antiretroviral therapy. METHODS: A historic cohort of HIV patients from two major hospitals in Goma (Democratic Republic of Congo) was followed from 2004 to 2012. The Kaplan-Meier method was used to describe the probability of survival as a function of time since inclusion into the cohort. The log-rank test was used to compare survival curves based on determinants. The Cox regression model identified the determinants of survival since treatment induction. RESULTS: The median follow-up time was 3.56 years (IQR=2.22-5.39). The mortality rate was 40 deaths per 1000 person-years. Male gender (RR: 2.56; 95 %CI 1.66-4.83), advanced clinical stage (RR: 2.12; 95 %CI 1.15-3.90), low CD4 count (CD4 < 50) (RR: 2.05; 95 %CI : 1.22-3.45), anemia (RR: 3.95; 95 %CI 2.60-6.01), chemoprophylaxis with cotrimoxazole (RR: 4.29, 95 % CI 2.69-6.86) and period of treatment initiation (2010-2011) (RR: 3.34; 95 %CI 1.24-8.98) were statistically associated with short survival. CONCLUSION: Initiation of treatment at an early stage of the disease with use of less toxic molecules and an increased surveillance especially of male patients are recommended to reduce mortality.

Institutional frameworks for management of epizoonotic emergencies in six countries in the Eastern Africa region: a situational analysis.

INTRODUCTION: The Eastern Africa region is a hot-spot for epidemics of emerging zoonotic diseases ('epizoonotics'). However, the region's capacity for response to epidemics of zoonotic origin has not been documented. This paper presents a multi-country situational analysis on the institutional frameworks for management of zoonotic epidemics in the Eastern Africa region. METHODS: A multi-country assessment of 6 country teams was conducted (Uganda, Kenya, Tanzania, Ethiopia, DRC and Rwanda). It involved a review of records and interviews with key informants from agencies with a stake in the management of zoonotic and disasters in general in the respective countries. Qualitative data were analyzed for key emerging themes. FINDINGS: There are many socio-cultural risk factors to epidemic prone zoonotic diseases in the region. Countries have varying levels of preparedness for zoonotic emergencies. All 6 countries have a framework for disaster management. However, technical response to epidemics is managed by the line sectors, with limited Inter-sectoral collaboration. Some sectors were disproportionately more prepared than others. Surveillance systems are mostly passive and inadequate for early detection. All 6 countries have built reasonable capacity to respond to avian influenza, but not other zoonotic emergencies. Most countries lack personnel at the operational levels, and veterinary public health services are ill-facilitated. CONCLUSION: There is need to strengthen veterinary public health services at all levels, but with a 'one health' approach. There is also need to establish 'risk-based surveillance' hot spots for zoonotic epidemics and to build community resilience 'epizoonotic' diseases.

Regional approach to building operational level capacity for disaster planning: the case of the Eastern Africa region.

BACKGROUND: The Eastern Africa region is regularly affected by a variety of disasters ranging from drought, to human conflict and population displacement. The magnitude of emergencies and response capacities is similar across the region. In order to strengthen public health disaster management capacities at the operational level in six countries of the Eastern Africa region, the USAID-funded leadership project worked through the HEALTH Alliance, a network of seven schools of public health from six countries in the region to train district-level teams. OBJECTIVES: To develop a sustainable regional approach to building operational level capacity for disaster planning. METHODS: This project was implemented through a higher education leadership initiative. Project activities were spear-headed by a network of Deans and Directors of public health schools within local universities in the Eastern Africa region. The leadership team envisioned a district-oriented systems change strategy. Pre-service and in-service curricula were developed regionally and district teams were formed to attend short training courses. Project activities began with a situational analysis of the disaster management capacity at national and operational levels. The next steps were chronologically the formation of country training teams and training of trainers, the development of a regional disaster management training curriculum and training materials, the cascading of training activities in the region, and the incorporation of emerging issues into the training curriculum. An evaluation model included the analysis of preparedness impact of the training program. RESULTS: The output from the district teams was the creation of individual district-level disaster plans and their implementation. This 4-year project focused on building operational level public health emergency response capacity, which had not previously been part of any national program. Use of the all-hazard approach rather than a scenario-based contingency planning led to the development of a standardized curriculum for training both in-service and pre-service personnel. Materials developed during the implementation phases of the project have been incorporated into public health graduate curricula in the seven schools. This systems-based strategy resulted in demonstrable outcomes related to district preparedness and university engagement in disaster management. CONCLUSION: University partnerships are an effective method to build district-level disaster planning capacity. Use of a regional network created a standardized approach across six countries.

Prevalence du cancer en Republique Democratique du Congo : donnees anatomopathologiques recueillies aux Cliniques Universitaires et a l'Hopital General de Reference de Kinshasa

Introduction. Les maladies chroniques non transmissibles; parmi lesquelles les cancers; constituent un poids de morbimortalite de plus en plus important dans les pays en voie de developpement. En Republique Democratique du Congo; l'absence de registre national de cancer est un handicap serieux a l'evaluation epidemioclinique reelle de ce groupe d'affections. C'est pour pallier a cette carence que ce travail a ete initie ; l'objectif etant de decrire les cancers les plus frequents sur base des donnees anatomopathologiques rapportees dans deux institutions hospitalieres de Kinshasa.Methodologie. Les registres et les protocoles de biopsies ont ete consultes aupres des laboratoires d'anatomie pathologique des Cliniques Universitaires; ainsi que de l'hopital General de Reference de Kinshasa. L'enquete a couvert la periode de 1969 a 2008 (40 ans). Resultats. Au total; 4137 cas de cancers ont ete repertories. L'age moyen des patients etait de 42;2 ans; plus jeune pour le sexe feminin; qui etait egalement plus affecte. Dans ce dernier groupe; les cancers du col uterin (27;7); du sein (13;7); des organes lymphoides (10); et de la peau (8;6); etaient les plus frequents. Parmi les sujets du sexe masculin : les cancers des organes lymphoides (15;9); le Sarcome de Kaposi (14;5); le cancer de la prostate (14); le cancer du foie (12;6); et enfin celui de la peau (11;7); ont ete les plus rapportes. Conclusion. Cette enquete; comme les donnees d'autres pays africains; revele la preponderance du sexe feminin et la survenue precoce des cancers dans ce groupe. Le cancer du col uterin et celui du sein sont les formes les plus frequentes; tandis que le profil des cancers masculins retient les organes lymphoides et la prostate en tete de liste. La creation et la tenue d'un registre national de cancer s'imposent comme un prealable a toute definition de strategie adequate de prevention du cancer dans notre pays

Convulsions associees a la fievre et developpement psychomoteur en soins de sante primaires a Kinshasa

Une etude prospective menee pendant 3 mois dans 2 centres des soins de sante primaires a Kinshasa; a permis de decrire les caracteristiques semiologiques des Convulsions Febriles (CF) presentees par 148 patients; ages de 5 a 71 mois. Les CF ont ete decrites en fonction de leur distribution; leur duree et leur repetition eventuelle. Les caracteres lateralises; prolonges et repetitifs etaient consideres comme des facteurs de gravite. Le Quotient de Developpement psychomoteur (QDP) des patients a ete evalue sur base de l'echelle de Gensini et Gavito; reprenant les domaines de lamotricite; de la communication; et de l'adaptation. Le QDP etait bas chez 6;7des patients. 5avaient un retard dans le domaine de la motricite; 3;4dans le domaine de la communication; et 2;7dans celui de l'adaptation. Nous n'avons pas note de lien significatif entre le QDP global; et les facteurs de gravite des CF. Toutefois; tous les enfants ayant un retard dans le domaine de la motricite; avaient presente des convulsions repetees avant leur admission: (p=0;02 [OR=1;096 (IC 95) : 1;060 -1;128)]. La motricite etait l'element le plus significativement atteint chez les malades ayant presente les CF. Cette observation merite d'etre validee par des etudes cas temoins; incluant un plus grand nombre de sujets

Mortality of young patients with diabetes in Kinshasa, DR Congo.

AIMS: As data on mortality of young patients with diabetes is not available in the Democratic Republic of Congo (DRC), we studied mortality rates, the influence of some determinants and causes of death. METHODS: A retrospective review of standardized medical records of all patients with diabetes aged

Determinants of consistent condom use among female commercial sex workers in the Democratic Republic of Congo: implications for interventions.

OBJECTIVE: To identify correlates of consistent condom use among commercial sex workers (CSW) over a four-week period. METHODS: A total of 2638 CSW selected in all the provincial capital cities in the Democratic Republic of Congo using the time location sampling technique were interviewed to collect information on sociodemographic data, sexual history and behaviour, consumption of intoxicants (alcohol and drugs), knowledge of condoms, their accessibility and the pattern of their use over a four-week period, and exposure to HIV/AIDS prevention services. RESULTS: 40% (95% CI 38.1 to 41.8) of the CSW have used condoms consistently and this pattern differed according to the category of sexual partners (61.4% in the case of paying partners and 38.2% in the case of non-paying partners). Consistent condom use was associated with age, those aged 20-44 years were more likely to be consistent users (OR 1.34, 95% CI 1.06 to 1.69), having cited it as a prevention means for HIV (OR 2.88, 95% CI 2.09 to 3.96), less time in commercial sex work, higher number of clients (OR 3.83, 95% CI 2.95 to 4.96), exposure to voluntary counselling and testing (VCT; OR 2.02, 95% CI 1.70 to 2.42), and access to condoms (OR 1.51, 95% CI 1.25 to 1.82). CONCLUSIONS: The risk perception bias associated with non-paying partners, time as a commercial sex worker and age should be taken into account when planning interventions targeting CSW. Access to condoms and VCT should be improved because they are likely to impact on behaviour.

Obesity in diabetic patients in Kinshasa, Democratic Republic of Congo.

OBJECTIVE: To assess the distribution of Mass Index (BMI) and the prevalence of obesity at the time of diagnosing diabetes in the primary health care network in Kinshasa, Democratic Republic of Congo (DRC), from 1993 to 1999. METHODOLOGY: A total of 4967 patients with diabetes were classified according to BMI, age at diagnosis (< 30 years versus > or = 30 years), sex and subsequent treatment (insulin treated versus non-insulin treated). WHO criteria were used to define diabetes and obesity. RESULTS: One diabetic patient in 4 was underweight (26.4%). The prevalence of obesity was 8.1%. Undernutrition was more prevalent in male patients aged < 30 years at diagnosis and, in contrast, obesity was more prevalent in patients aged > or = 30 years at diagnosis, especially among women. CONCLUSION: Undernutrition is highly prevalent at the time of diagnosis in young diabetic patients in Kinshasa. The overall prevalence of obesity at diagnosis is relatively low, except in women diagnosed at > or = 30 years of age. Prospective studies are needed in the Democratic Republic of Congo to characterize secular trends of undernutrition and obesity in order to improve preventive and management strategies.

[Some common errors in health information system report (DR Congo)]. / Quelques erreurs courantes d'analyse d'un système d'information sanitaire (RD Congo).

The development of operational health information systems in sub-Saharan African countries still poses some difficult challenges. In fact, the analysis of the 1996 annual report from the "Health for All Project" in Kinshasa contains a certain number of ambiguities. They are situated at the levels of indicators for coverage which exceed 100% and of incidence rates equal to 0%, whereas they're were certain cases of poor choices for the denominator. This article discusses the ensuing difficulties of interpretation and suggests presenting the coverage of the programme for the target population separately from that of the population outside the health zone, as well as proposing to give the constant K the value of 1000 or 10000 if needed in order to attain the true incidence rate, which otherwise would remain equal to zero. The correct denominator is proposed where it is indicated.

Evaluation of growth monitoring programme in children in Kinshasa.

A high dropout rate was noted at the under five clinic of the University of Kinshasa Teaching Hospital. A preliminary study carried out in March 1984 on 197 children indicated that none of them had completed the five year period of the growth monitoring programme. Five hundred mothers of children attending the under five year clinic were then randomly selected from the 1224 who registered between September 1983 and August 1984. They were interviewed at home during a six week period. This paper confirms the dropout problem. It discusses whether mothers should abandon the visits early. It concludes that health workers should be trained to advise mothers to bring their children to the programme up to five years though the attendance frequency may be reduced from the second year onwards.

Technique traditionnelle de sevrage dans la zone de sante de Basankusu

Des encadreurs de sante et de developpement ont ete utilises comme informateurs cles pour decrire la technique traditionnelle de sevrage dans la zone de sante rurale de Basankusu. Les donnees qualitatives obtenues ont ete discutees en seance pleniere devant les encadreurs de la zone de sante de Bolomba; voisine de Basankusu. La conduite du sevrage dans ce milieu rural est satisfaisant a bien d'egards. L'allaitement au sein exclusif se pratique jusqu'a 5 mois. Le sevrage est progressif et s'etend au dela de 18 mois. La chikwangue; aliment de sevrage de base est premastique par la mere avant la consommation par l'enfant. Il faut neanmoins deplorer la faible utilisation des cereales combinees aux legumineuses; aliment pourtant cultive dans la region pour le sevrage. Cette defaillance pourrait donc constituer une matiere pour l'education nutritionnelle

A propos de l'eau potable dans la zone de sante de Mont Amba

L'accessibilite a l'eau potable dans les zones peripheriques de la ville de Kinshasa apparait faible. La qualite aussi laisse fort a desirer. Les auteurs ont evalue la qualite de l'eau potable a travers la zone de sante du Mont Amba en selectionnant 4 points de prelevements couvrant les differents modes d'approvisionnement: source; puits; et robinets. Les resultats des analyses physico-chimiques et bacteriologiques ont revele que les echantillons d'eau preleves ne satisfont pas pas aux normes tel que definies par l'OMS. Des recommandations ont ete formulees pour ameliorer cette situation