ABSTRACT
INTRODUCTION: The significant impact of seasonality and climate change on stroke-related morbidity and mortality is well established, however, some findings on this issue are conflicting. The objective was to determine the impact of gender, age, season, year of admission, temperature, rainfall and El Nino phenomenon on ischemic and hemorrhagic strokes and fatal cases of stroke. METHODS: The study was carried out at the teaching hospital of Kinshasa, DRC, between January 1998 and December 2004. Rainy and dry seasons, elevated temperatures, indices of rainfalls El Nino years 1998, 2002 and 2004, but La Nina years 1999-2000 and neutral/normal years 2001 and 2003 were defined. RESULTS: Among 470 incident strokes, 34.5% of victims (n=162) died. Traditional seasons (small dry season, small rainy season, great dry season, great rainy season) and temperatures did not significantly (P>0.005) impact on stroke incidence. However, there was a positive association between the decrease in rainfall, El Nino, and incident ischemic strokes, but a significant positive association between the increase in rainfall, La Nina, and incident hemorrhagic strokes. Using logistic regression analysis, age ≥ 60 years (OR: 1.7, 95% CI: 1.2-2.5; P=0.018) and El Nino years (OR: 2, 95% CI: 1.2-3.3; P=0.009) were identified as the independent predictors of fatal strokes. CONCLUSION: Early warning systems should be developed to predict the impact of seasons and climate variability on stroke morbidity and mortality.
Subject(s)
El Nino-Southern Oscillation , Rain , Seasons , Stroke/epidemiology , Adolescent , Adult , Aged , Aged, 80 and over , Child , Climate Change , Democratic Republic of the Congo/epidemiology , Droughts , Female , Hospitals, University/statistics & numerical data , Humans , Incidence , Male , Middle Aged , Patient Admission/statistics & numerical data , Retrospective Studies , Stroke/mortality , Temperature , Young AdultABSTRACT
OBJECTIVES: To investigate the independent effect of HIV/ AIDS in the genesis of acute or chronic rhinosinusitis. METHODS: This case-control study was performed among patients managed for chronic rhinosinusitis between January and April 2009 the ENT and Head and Neck Department General Hospital of Kinshasa, DRCongo. Cases were matched with controls according to gender and age. Logic regression analysis served to identify factors associated with presence of chronic rhinosinusitis. RESULTS: The study population with 108 patients included 81 cases ofrhinosinusitis, 27 controls, 78 females, 30 males, 52 with HIV/AIDS and 56 HIV seronegatives. The mean age was 34+/-19 years (range 1 year-74 years). Only HIV/AIDS was identified as a significant and independent determinant of presence of chronic rhinosinusitis (OR= 19,6 95% CI 4,3 -88,9; P< 0,0001). CONCLUSION: Early ENT evaluation and continuous follow-up of HIV-infected patients are suggested. Age upper 20 years and high education attainment were significantly associated with high risk of chronic rhinosinusitis among HIV-infected patients, respectively.
Subject(s)
HIV Infections/epidemiology , Rhinitis/epidemiology , Sinusitis/epidemiology , Adolescent , Adult , Africa, Central/epidemiology , Aged , Case-Control Studies , Child , Child, Preschool , Chronic Disease , Female , Humans , Infant , Male , Middle Aged , Risk Factors , Young AdultABSTRACT
BACKGROUND: Classification of diabetes mellitus is not easily stated in Central Africa using the current diabetes classification of World Health Organization/American Diabetes Association. The objective of the study is to determine the prevalence, classification and risk factors of diabetes mellitus in Kinshasa Hinterland. METHODS: A multilevel and stratified random sample cross-sectional study included 9770 black Africans (4580 men and 5190 women) aged 12 years and above in urban metropolitan (Kinshasa city) and rural (Kikwit) areas. Participants were examined and administered a structured questionnaire and a capillary whole blood glucose test was done. RESULTS: The mean age of participants was 46 +/- 15 years. Overall crude and age adjusted prevalences of diabetes were 25% (n = 2472) and 18%, respectively. Using WHO/ADA classification, Type diabetes (80%) was commoner than undetermined form (12%), Type 1B (3.5%), Type 1A (2.5%) and Other specific types (2%). According to plasma insulin and plasma C-peptide levels, participants with undetermined form were classified Type 2 diabetics. Thus, the rate of Type 2 diabetes among diabetics was estimated 92%. Urban location, age, abdominal obesity arterial hypertension, physical inactivity, inappropriate diet (lack of fruits-vegetables, refined sugar, animal fat and protein, starvation, social inequalities, cigarette smoking, alcohol intake were significantly and positively associated with diabetes in general and type 2 diabetes in particular. CONCLUSION: The high prevalence of diabetes is due to the unexpected high rates of type 2 diabetes, aging, urbanization, and sedentary lifestyle consequences. The majority of risk factors of diabetes are potentially modifiable by primary prevention.
Subject(s)
Diabetes Mellitus, Type 2/epidemiology , Diabetes Mellitus/classification , Disease Outbreaks , Sedentary Behavior , Adult , Black People/psychology , Black People/statistics & numerical data , Cross-Sectional Studies , Democratic Republic of the Congo/epidemiology , Diabetes Mellitus/epidemiology , Diabetes Mellitus, Type 2/psychology , Female , Humans , Male , Middle Aged , Prevalence , Risk Factors , Rural Population/statistics & numerical data , Socioeconomic Factors , Surveys and Questionnaires , Young AdultABSTRACT
OBJECTIVE: To determine the relationship between pulse pressure, traditional risk factors, vision impairment and different clinical forms of diabetic retinopathy. METHODS: A cross-sectional study was conducted between December 1st, 2004 and July 16th, 2005 within the care centers of Kinshasa, DRC. The origin population (n=3010 diabetics) served to estimate the diabetic retinopathy prevalence while a random sample of 301 diabetics participated to this analytic study: age>or=20 years, anthropometry, components of blood pressure, fasting glycaemia, optometry, fundoscopy, stages of diabetic retinopathy. RESULTS: The rate of diabetic retinopathy was 31.6% 95 CI: 26.3-36.9 in Kinshasa town. In the random sample, diabetic retinopathy was non proliferative in the majority (90%). Subjective decrease of acuity was associated with diabetic retinopathy in the sample (OR=2.7; 95% CI 1.1-5.4; p<0.05), among women (OR=2.7; 95% CI 1.3-5.7; p<0.05), and in patients with type 2-diabetes (OR=2; 95% CI 1.1-3.4; p<0.05). Objective decrease of acuity was associated with diabetic retinopathy in the study sample (OR=3.6; 95% CI 1.1-12.6; p<0.05). Visual impairment was significantly associated with diabetic retinopathy in women (OR=3.6; 95% CI 1.1-12.6; p<0.05) and proliferative diabetic retinopathy. Pregnancy after diabetes mellitus onset was a significant risk factor of diabetic retinopathy for women (OR=3.2; 95% CI 1.1-13.2; p<0.05). Using logistic regression analysis, family history of diabetic retinopathy (OR=3.2; 95% CI 1.2-8.8; p<0.05), diabetes duration >/=4 years (OR=3.4; 95% CI 1.4-8.5; p<0.01), and pulse pressure>or=60 mmHg (OR=5; 95% CI 2-12.8; p<0.001) were the independent and significant predictors of diabetic retinopathy. CONCLUSION: Urgent programme of prevention and control of diabetic retinopathy and its risk factors is needed.
Subject(s)
Blindness/etiology , Diabetic Retinopathy/complications , Diabetic Retinopathy/physiopathology , Cross-Sectional Studies , Democratic Republic of the Congo , Female , Humans , Male , Middle Aged , Pulse , Severity of Illness IndexABSTRACT
Objectif: Determiner la relation entre la pression pulsee; les facteurs de risque traditionnels; les troubles visuels et la prevalence des differentes formes cliniques de la retinopathie diabetique. Materiel et methodes : Une etude transversale a ete menee entre le 1er decembre 2004 et le 16 juillet 2005 dans les centres de sante a Kinshasa. RDC. La population mere (n=3010 diabetiques) a servi a estimer la prevalence de la retinopathie diabetique tandis qu_fun echantillon representatif (n=301) a ete soumis a une approche analytique : age.20 ans; anthropometrique; composantes de la pression arterielle; glycemie a jeun; optometrie; fond d_foeil; severite de la retinopathie diabetique. Resultats : La baisse subjective etait associee a la retinopathie diabetique dans l_fechantillon (Or=2;7 IC951;1-5;4 ; p0;05) et en cas de diabete de type 2 (OR1;1-3;4 ;p0;05). La baisse subjective de l'acuite visuelle etait associee a la retinopathie diabetique dans l'echantillon (OR1;1-12;6 ;p0;05). Le risque de deficience visuelle etait plus que triple par la retinopathie diabetique chez les femmes (OR1;1-12;6 ;p0;05). Porter une grossesse apres le diagnostic de diabete multipliait par 3 le risque de retinopathie diabetique chez les femmes (OR1;1-13;2 ;p0;05). Apres regression logistique; le risque multivarie de retinopathie diabetique etait predit de facon independante par les antecedetnss familiaux de diabete sucre (OR1;2-8;8 ; p0;05); la duree du diabete . 4 annees (OR1;4-8;5 ;p0;01); la pression pulsee .60 mmHg (OR2- 12;8 ;p0;001). Conclusion : Un programme de prevention et de controle de la retinopathie diabetique et de ses facteurs de risque est souhaite pour l le benefice de l'urgence
