Albendazole Treatment Improves Work Capacity in Women Smallholder Farmers Infected with Hookworm: A Double-Blind Randomized Control Trial.

An estimated 4.7 billion people live in regions exposed to soil-transmitted helminths, intestinal parasites that have significant impacts on the health of women smallholder farmers. The goal of this trial was to determine whether treatment with albendazole impacts the work capacity of these farmers. This is a prospective double-blind, randomized effectiveness trial. Participants (N = 250) were randomly selected from safe motherhood groups in the Democratic Republic of Congo. Prevalence/intensity of hookworm infection, hemoglobin, and demographics was obtained. At study (Time = 0), participants were randomized into treatment (albendazole 400 mg) and placebo (similar placebo tablet) groups. A step test was administered as a proxy metric for work capacity. Work capacity was defined as ∆heart rate before and after 3 minutes of step testing, in beats per minute. At study (time = 7 months), the step test was repeated and work capacity remeasured. The ∆work capacity (time = 0 minus time = 7 months) was the primary outcome. Investigators/field assistants were blinded to who was enrolled in groups, hookworm status, and step test results. Regression showed highly significant interactive effects of hookworm status and treatment group relative to ∆work capacity after controlling for resting pulse rate and age (P < 0.002). Estimated marginal means for work capacity (WC) for each of four groups (hookworm positive plus placebo, hookworm positive plus treatment, hookworm negative plus placebo, and hookworm negative plus treatment) showed women who were hookworm positive and received treatment decreased heart rate by 9.744 (95% confidence interval [CI]: 6.42, 13.07) beats per minute (increased WC), whereas women who were hookworm positive and received placebo saw a nonsignificant decrease of 0.034 (95% CI: -3.16, 3.84) beats per minute. Treatment with albendazole was associated with improved aerobic work capacity posttreatment. Given modest costs of drug distributions, risk benefits of periodic deworming warrants further study in larger controlled trials.

'There is fear but there is no other work': a preliminary qualitative exploration of the experience of sex workers in eastern Democratic Republic of Congo.

Two decades of conflict and insecurity have had a devastating impact on many in the Democratic Republic of Congo (DRC), including marginalised groups such as sex workers. In the province of North Kivu, many residents face desperate conditions that render them vulnerable to exploitation and abuse. As a result, many turn to the sex trade in what can often be described as 'survival sex'. This small-scale qualitative study explores the experience of urban sex workers in the eastern region of the DRC. Sex workers were recruited at their place of business and asked to participate in a semi-structured interview. Eight participants were recruited, including seven women and one man. Our analysis identified several themes: (1) economic hardship as a catalyst for joining the sex trade, (2) significant work-related violence and (3) a paucity of available resources or assistance. Responses to specific prompts indicated that sex workers do not trust law enforcement and there are significant barriers to both medical care and local resources. Further studies of this vulnerable population and its needs are encouraged in order to develop programmes that provide the means to manage the hazards of their work and obtain an alternative source of income.

Knowledge and Attitudes about and Practices of Condom Use for Reducing HIV Infection among Goma University Students in the Democratic Republic of Congo

The Democratic Republic of Congo (DRC) is experiencing increasing human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) in young adults. This is despite the government's widespread campaign on HIV/AIDS awareness. In this study; high-risk university students who engage in casual sex; but who have good literacy skills; were surveyed to ascertain whether the education campaigns in the country influenced their condom use practice. This study sought to determine Goman University students' knowledge and attitudes about and practices of condom use for the purpose of reducing HIV infection. A descriptive cross-sectional quantitative study; using a self-administered questionnaire; was carried out. The ages of the students varied between 18 and 33. Most of them were men: 111 (80); 129 (93) were single; and most participants were Protestants (61; 44) and Roman Catholics (57; 41). The majority of participants (137; 99) knew about condoms; while 132 (96) were aware that condoms were available from and sold by pharmacies. Seventy-two (52 ) understood that condoms helped to prevent HIV; pregnancy and sexually transmitted infections (STIs). Ninety-four (68) said that they knew how to use a condom; while 111 (80) stated that the price of condoms was not a barrier to usage thereof. One hundred and two (74) suggested that the university should supply students with condoms. Ninety-one (66) were sexually active and 98 (71) of participants reported that they had unprotected sex. Condom awareness was high and information was available from varying sources. Condoms were accepted as a means to prevent HIV/AIDS; STIs and pregnancy. Some ethnic groups disapproved of condom use because of religious and cultural beliefs. Consistent use of condoms was low in Goma University students

Fertility desires and the feasibility of contraception counseling among genital fistula patients in eastern Democratic Republic of the Congo.

OBJECTIVE: To determine the fertility and contraceptive desires of genital fistula patients in eastern Democratic Republic of the Congo (DRC) and to evaluate the impact of contraceptive counseling and its effect on contraceptive knowledge and use. METHODS: Group contraceptive counseling was offered to fistula patients at HEAL Africa Hospital between February and May 2010. Fertility desires and contraceptive knowledge were assessed via verbally administered questionnaires before and after counseling, and use of modern contraceptive methods was tracked. RESULTS: Of the 61 participants, 22/34 (64.7%) of those who desired children wanted to wait at least 1 year after repair before attempting pregnancy. Overall, 31/58 (53.4%) women had heard of birth control, although only 15 (24.6%) knew any specific methods, and none had ever used contraception. After counseling, all participants could recall 1 or more methods. Of the 25 participants discharged over the subsequent 3 months, 5 (20.0%) and 3 additional fistula patients selected a modern method of contraception. CONCLUSION: Desire for contraception and birth spacing among women with fistula is significant. Basic group contraception counseling and access are feasible and lead to increased contraceptive knowledge and use.