Maternal determinants of diarrhea in children under five in Lubumbashi, Democratic Republic of the Congo.

Diarrheal diseases are one of the leading causes of death among children younger than 5 years of age in the world in general and in sub-Saharan Africa in particular. Mothers are predominantly responsible for child care and housekeeping in this region. The objective of this study was to determine the prevalence of diarrhea and identify its maternal determinants in children under five in the city of Lubumbashi. A cross-sectional study conducted throughout March 2018 collected data from 299 mothers through a household survey. A pretested structured questionnaire was used to collect data in face-to-face interviews. The prevalence of diarrhea in children under 5 in Lubumbashi was 35.8%. In the univariate analysis, the variables associated with diarrhea were single motherhood, soap-free handwashing after latrine use, and the presence of feces around the latrines. Multivariate analysis revealed that the presence of feces around latrines (OR adjusted = 2.12 [1.18-3.80]) was associated with diarrhea. Defective cleaning by mothers, specifically their failure to keep latrine areas clean and free of feces, is associated with the risk of diarrhea in children under five in the study area. A hygiene intervention program must be designed to promote healthy behavior to alleviate the burden of diarrhea in children.

Respiratory health of women selling cassava, corn and soybean flour in Lumbumbashi, Democratic Republic of the Congo.

The aim of this study was to determine the prevalence of respiratory complaints in Congolese women selling grain flours in Lubumbashi. The study enrolled 370 women, including 183 cassava, corn and soybean flour selling women (exposed group) and 187 tax collectors in municipal markets (control group) in Lubumbashi, DRC. A standardized respiratory health questionnaire was used, and a lung function test performed with the use of peak flow-meters. The prevalence of respiratory complaints was markedly higher in dust-exposed women than controls. In addition, peak expiratory flow rate (PEFR) was significantly lower in the exposed group than in controls (342.46 ± 65.62 vs. 410.89 ± 70.91, respectively ; P<0.05). After adjustment for age and education level, women involved in cassava, corn and soybean flour selling business were more likely to develop respiratory complaints ad disorders as compared to controls.

Risk factors for low birth weight in Lubumbashi, Democratic Republic of the Congo.

The aim of this study was to identify the risk factors associated with low birth weight (LBW) in the city of Lubumbashi (DR Congo). This case-control study of singleton births took place from July to December 2014 in 3 referral maternity units in Lubumbashi. The mothers' social and demographic characteristics and medical and obstetric history, especially during this pregnancy, as well as the newborns' sex were compared between the case group (< 2500 g) and the control group. The usual statistics and logistic regression were used to analyze the results. The significance level was set at P < 0.05. We observed that a low educational level (OR adjusted = 2.5 [1.5-4.0]), employment (OR adjusted = 2.0 [1.3-3.1]), lack of prenatal care (OR adjusted = 2.5 [1.5-4.2]), maternal anemia (OR adjusted = 7.6 [2.3-24.8]), malaria during the pregnancy (OR adjusted = 1.5 [1.0-2.3]), urogenital infections during pregnancy (OR adjusted = 1.6 [1.1-2.5]), gestational hypertension (OR adjusted = 2.7 [1.5-4.9]), and maternal malnutrition (OR adjusted = 8.3 [2.4-28.5]) were all significantly associated with LBW. This study shows that some maternal demographic, medical, and obstetric factors influence the birth of LBW infants. Because some of these factors can be addressed and treated, the reduction of neonatal morbidity and mortality associated with LBW requires improving the health care system in our city, including its accessibility.

[Hemogram findings in Congolese children with sickle cell disease in remission]. / L'hémogramme de l'enfant drépanocytaire congolais au cours des phases stationnaires.

INTRODUCTION: Sickle cell disease is associated with a wide range of clinical and laboratory findings depending on genetic modulators and environmental factors. The most severe forms of sickle cell disease occur in patients with the Bantu haplotype. The purpose of this study was to determine the hematological profile of Congolese patients with homozygous sickle cell disease during periods of remission. PATIENTS AND METHODS: Hemograms were performed in two series of patients with sickle cell disease in remission, i.e., one including 89 patients with a mean age of 8.7 years and the other including 42 patients with a mean age of 8.9 years. Hemograms were performed using an automated counter and reticulocytes were counted manually on peripheral blood smears. Fetal hemoglobin level (HbF) was measured by chromatography (HPLC). The mean values obtained were compared with those obtained in a sickle-cell-disease-free control group. Some parameters were also compared with those obtained in a group of patients exhibiting complications of sickle cell disease. RESULTS: Hemograms in the first series of patients demonstrated the following values: Hb: 7.2 g/dl; Hct 23.1%, red cells: 2.47 tera/L, leukocytes: 14.9 giga/L; VGM: 95.3 fL; CCMH:30.3% L and platelets:345,3 giga/L. Blood count showed 30.4% of polynuclear neutrophils, 33% de lymphocytes, 0.8% of polynuclear basophiles, 14% of monocytes, 7.8% of polynuclear eosinophils and 14% of erythroblasts. Mean HbF level was 7.2% and reticulocytes were at 88%. In the sickle cell disease-free group, the leukocyte rate was almost three fold higher than in the patient group exhibiting sickle cell disease in remission even though rates were higher than during complications. CONCLUSION: Hemogram profiles in Congolese patients with sickle cell disease are similar to those reported in the literature for subjects exhibiting the Bantou haplotype. Leukocytosis was associated with esinophilia and monocytosis suggested a topical state and chronic inflammation.

Neonatal screening for sickle cell anaemia in the Democratic Republic of the Congo: experience from a pioneer project on 31 204 newborns.

BACKGROUND: Despite the high prevalence of sickle cell disease in Africa, a neonatal screening programme is available in only a few countries in the sub-Saharan region. AIM: To describe our experience of a pioneer study on 31,304 newborns screened systematically in the Democratic Republic of the Congo. METHODS: The prevalence of haemoglobinopathies was determined by a thin-layer isoelectric focusing method on dry filter-paper samples. RESULTS: Of the 31,204 newborns screened by isoelectric focusing, 5,276 (16.9%) displayed sickle cell trait and 428 (1.4%) were homozygous for haemoglobin S. No statistical differences were observed in the different ethno-linguistic groups, but some tribes displayed a higher prevalence of the betaS gene, attributable to a higher prevalence of malaria, and a greater frequency of haemoglobin S homozygotes, in part attributable to an endogamic marriage system. CONCLUSION: The neonatal screening programme has now been introduced in the Democratic Republic of the Congo, but the main challenges are to track all the new cases for a confirmatory test and to initiate early management.

Blood transfusion rate in Congolese patients with sickle cell anemia.

OBJECTIVE: The main objective of this study was to evaluate the rate of blood transfusion in African Sickle Cell Patients and the risks related to the use of total blood. METHODS: 186 sickle cell patients (95 males and 91 females) aged 0-21 years were regularly followed over a 3 years period in Katanga province, DR Congo. Indications for blood transfusion were mainly based on clinical criteria and Hb level (less than 5g% ml or a drop of 2g% under the steady state value). All the subjects, who were transfused, wer screened for hepatitis B surface antigen (HBs Ag) and Human Immune deficit Virus (HIV). RESULTS: Of 186 patients, 150 (80.6%) were transfused and the average blood transfusion requirement was 0.4 units per patient-year. According to the age of first transfusion, 75.3% (113/150) of them were transfused before the 6th year of life; but the frequency of transfusions seemed to decline in children aged more than 13 years. The risk of HIV infection from blood transfusion was estimated at 1 per 37.1 units or 26 per 1000 blood units. The hepatitis B surface antigen was detected in 15 cases (10%) and HIV serology was positive in 17 patients (11.3%). CONCLUSION: Because of the complications related to blood transfusions in Africa, efforts are needed in order to reduce the frequency of transfusions, by preventive measures (early diagnosis, malarial and penicillin-prophylaxis) and to use more rational indications.

[Medicine and health in the Democratic Republic of Congo: from Independence to the Third Republic]. / Médecine et santé en République Démocratique du Congo: de l'Indépendance à la 3e République.

The birth and mortality rates in the Democratic Republic of Congo (DRC), a former Belgian colony, are high, i.e., 48.9/1000 and 17/1000 respectively. The DRC also has one of the highest maternal death rates in the world, i.e., 1289/100,000 live births. Health conditions have not improved since independence. Access to drinking water is limited, living conditions are poor, and food availability in households is low. The mean health services utilization rate in the DRC is estimated to be 0.15 visits/inhabitant/year. The incidence of transmissible diseases is rising. This increase is observed even for illnesses that were under control before independence such as sleeping sickness, onchocerciasis, leprosy, and tuberculosis. One the main causes of mortality and morbidity in the population is malaria that is responsible for the deaths of 150,000 to 250,000 children under the age of 5 every year. The HIV prevalence rate is 4.5% with 1.19 million persons with AIDS and 930,000 orphans whose parents died of AIDS. Other potentially epidemic diseases including bubonic plaque and Ebola hemorrhagic fever are serious threats. Non-transmissible diseases are also on the rise including diabetes, systemic arterial hypertension, cancer and neglected diseases such as sickle cell anemia. To meet these challenges, the country's health authorities have established a program called the Strategy for Reinforcement of the Health System (SRHS). One goal of the SRHS is to develop health zones in order to improve access to quality health care for the whole population.