Paludisme à la première consultation prénatale : prévalence et facteurs associés en milieu rural au Sud Kivu à l'Est de la République Démocratique du Congo

Contexte : Les femmes enceintes constituent un groupe vulnérable face au paludisme. Dans l'objectif de déterminer la prévalence et les facteurs associés au paludisme pendant la grossesse, une étude a été menée dans la zone de santé rurale de Miti-Murhesa, à l'Est de la République Démocratique du Congo (RDC), trois ans après une distribution de Moustiquaires Imprégnées d'Insecticide (MII).Méthodes : Les données de 478 femmes enceintes recueillies à leur première consultation prénatale entre novembre 2010 et juillet 2011 ont été analysées. Les femmes étaient recrutées au deuxième trimestre de la grossesse aux centres hospitaliers de Murhesa et de Lwiro. Un cas de paludisme était défini par une goutte épaisse positive pour le plasmodium. L'altitude de la résidence d'origine de chacune des femmes était mesurée par un GPS. Résultats : A l'admission 9,5% (n = 453) de femmes présentaient une infection palustre. En régression logistique, la fréquence du paludisme était plus élevée chez les primigestes, chez les femmes avec niveau socio-économique bas et chez celles vivant à moins de 1683 m d'altitude ; les rapports de cote ajustés (IC 95%) étaient respectivement de [2,55 (1,05-6,19) ; P = 0,039] ; [4,78 (1,36-16,76) ; P = 0,033] et [2,34 (1,10-5,02) ; P = 0,029].Conclusion : Ces résultats montrent que le paludisme est resté présent chez les femmes enceintes trois ans après une distribution de moustiquaires à Miti-Murhesa. La première grossesse, le niveau socioéconomique bas et la résidence en basse altitude étaient des facteurs significativement associés au paludisme. Ces résultats appellent à intensifier les activités de prévention contre le paludisme dans la communauté de manière à protéger plus efficacement les femmes en âge de procréer

[Malaria infection and nutritional status: results from a cohort survey of children from 6-59 months old in the Kivu province, Democratic Republic of the Congo]. / Infection palustre et état nutritionnel: résultats d'une cohorte d'enfants âgés de 6 à 59 mois au Kivu en République démocratique du Congo.

BACKGROUND: Despite a reduction in the magnitude of endemic malaria reported in recent years, malaria and protein-energy malnutrition (PEM) still remain major causes of morbidity and mortality in sub-Saharan Africa among children under five. The relationship between malaria and malnutrition remains a topic of controversy. We aimed to investigate malaria infection according to nutritional status in a community-based survey. METHODS: A cohort of 790 children aged 6 to 59 months and residing in eastern Democratic Republic of the Congo was followed-up from April 2009 to March 2010 with monthly visits. Data on nutritional status, morbidity between visits, use of insecticide-treated nets and malaria parasitemia were collected at each visit. The Z scores height for age, weight for age and weight for height were computed using the reference population defined by the WHO in 2006. Thresholds for Z scores were defined at -3 and -2. A binary logistic model of the generalized estimating equation (GEE) was used to quantify the association between PEM indicators and malaria parasitemia. Odds ratio (OR) and their 95% confidence interval (95% CI) were computed. RESULTS: After adjustment for season, children with severe stunting (height for age Z score<-3) were at lower risk of malaria parasitemia greater or equal to 5000 trophozoits/µL of blood as compared to those in with a better nutritional status (height for age Z score≥-2) (OR=0.48, 95% CI: 0.25-0.91). CONCLUSION: Severely stunted children are at a lower risk of high-level malaria parasitemia.

[Impact of mid-level management and support on the performance of a district health system in the Democratic Republic of the Congo]. / Gouvernance et soutien provincial au district de santé en RD-Congo.

INTRODUCTION: The aim of this study was to assess the contribution of mid-level management and support practices to the overall performance of a district healthcare system. METHODS: This case study was carried out in the North Kivu Province of the Democratic Republic of the Congo. It was based on analysis of (i) preventive and curative healthcare services and (ii) management and support practices provided from 2000 to 2008. RESULTS: In response to recurring sociopolitical unrest since 1992, the mid-level health system (provincial level) in North Kivu has strengthened management and support practices. The main goals have been to optimize allocation of interventions by external emergency organizations and integration of specialized program activities, to harmonize intervention techniques implemented by external partners, to standardize supervision of sanitary districts with regard to care provider skills, and to adapt strategic options defined by the Ministry of Health to the provincial level. Using this comprehensive approach, the performance of the North Kivu Province in terms of curative and preventive care has exceeded the national average since 2001. Between 2001 and 2008, use of curative services progressed from 0.36 to 0.50 new cases/capita/year. Positive results have also been recorded for infrastructure coverage, essential medicine stock, health information system, and emergency preparedness. CONCLUSION: Stronger mid-level management and support practices have improved care activities in the health district while protecting the population from unstructured interventions by emergency organizations or specialized programs. A comprehensive management approach has also improved the resilience of the district and increased its contribution to Millennium Development Goals.