Tertiary care for infertile couples: aetiological diagnoses and conventional treatment outcomes in Kisangani, Democratic Republic of the Congo.

BACKGROUND: In sub-Saharan Africa, tubal factors are described as the main aetiological factors of infertility. Under these conditions, medically assisted procreation is particularly indicated. However, Assisted Reproductive Technology centres are less available. Thus, infertile couples are quickly oriented towards available alternative conventional treatments. The present study aimed to determine the aetiological factors of infertility, the outcomes of the therapeutic options offered, and the factors associated with the success of conventional treatment among infertile couples seeking tertiary care in Kisangani. METHODS: A cross-sectional study was conducted at two tertiary health facilities in Kisangani. Infertile couples who provided consent underwent specific examinations necessary for the exploration of infertility and were treated and followed up for a minimum of 6 months. The therapeutic options that were offered were expectant attitude, medical treatment, surgical treatment or transfer to an in vitro fertilization unit. The pregnancy diagnosis was performed by ultrasound. RESULTS: A total of 272 infertile couples underwent specific examinations, were treated and were followed up for a minimum of 6 months. Many determinant causes were mostly linked to wives rather than husbands. Overall, only 34 women among 211 who were treated became pregnant during the follow-up period; 61 couples were advised to resort to IVF or adoption, but the couples for whom expectant the attitude was indicated immediately rejected it. The patients who therapeutically succeeded at the end of the treatment were those who were younger than 35 years (OR = 2.27; 95% CI = 1.06-4.87; P = 0.017), had a duration of infertility of less than five years (OR = 6.08; 95% CI = 1.79-20.69; P = 0.001) and had secondary infertility (OR = 6.08; 95% CI = 1.79-20.69; P = 0.001). CONCLUSION: Kisangani faces a major issue in the treatment of infertility. Treatment of patients using conventional methods is limited by the predominance of tubal factors as aetiological determinants of infertility. The low pregnancy rate found in this study provided additional evidence of this. This paper represents a serious plea to national policy-makers to encourage them to pay attention to issues surrounding infertility.

Mort in utero tardive: fréquence, facteurs associés et méthodes de déclenchement du travail à Kisangani, République Démocratique du Congo / Late fetal death: frequency, associated factors and methods of labor induction in Kisangani, Democratic Republic of Congo

La mort fœtale tardive fait référence à la mort in utéro (MIU) de survenue spontanée à partir de 22 semaines d'aménorrhée (SA), mais avant tout début du travail d'accouchement, ce qui constitue une tragédie pour la mère, les membres de la famille et du personnel soignant. La présente étude a déterminé l'ampleur, les facteurs associés et les méthodes de déclenchement artificiel du travail d'accouchement sur MIU. Méthodes : Il s'est agi d'une étude transversale descriptive, multicentrique menée dans 3 hôpitaux de Kisangani, pendant une période de 3 ans. La collecte des données était rétrospective, des cas de MIU à partir de 28 SA. Résultats : La fréquence de MIU tardive était de 6,48%. Les principaux facteurs associés étaient l'infection urinaire (35,4%), le paludisme sur grossesse (27,5%) et l'hypertension artérielle gravidique (27,5%). Le taux de participation aux consultations prénatales (CPN) n'était que de 63,5 %. Les méthodes de déclenchement artificiel du travail d'accouchement utilisées étaient le Misoprostol (42,7%), l'ocytocine (17,7%) soit les deux combinées (25%). La césarienne était indiquée à un taux de 26,4%. Conclusion : la fréquence de MIU tardive est élevée à Kisangani. L'infection urinaire, le paludisme et l'hypertension artérielle en constituaient les principaux facteurs associés. Le Misoprostol était la méthode de déclenchement du travail les plus utilisées. Un suivi régulier des CPN pourrait réduire le taux de MIU.

Prevalence of gestational diabetes in Eastern Democratic Republic of Congo.

OBJECTIVE: To determine the prevalence of gestational diabetes and associated risk factors in the eastern region of the Democratic Republic of Congo (DRC). METHODS: A cross-sectional study was conducted in Goma city, Idjwi, Ngungu and Rutshuru districts between April 2019 and February 2021. Pregnant women between 24-28 weeks of amenorrhea who consented to participate in the study were included. Blood sugar, anthropometric parameters and obstetrical and family history were studied. Gestational diabetes was defined as blood glucose level between 92 and 125 mg/dL. RESULTS: The overall prevalence was 21.2% (n = 391) and was higher in Rutshuru [27.2% (n = 92)] and Goma [26.9% (n = 134)] compared to Ngungu [10.0% (n = 110)] (p = 0.005). An increased risk was associated with a history of a newborn weighing ≥ 4000 g [OR 2.4 95% CI (1.3 - 4.4)] or family diabetes [OR 2.9 95% CI (2.0 - 4.9)]. Median age in the pathological group was not different from that with normal blood glucose [25.0 (16.0 - 44.0) Vs 26.0 (16.0 - 44.0)] (p = 0.67). The prevalence tended to increase for pregnant women with a mid-upper arm circumference ≥ 280 mm [28.1% (n = 57)] Vs [19.3% (n = 322)] if < 280 mm, [OR (95% CI)] [1.5 (0.9-2.3)] (p = 0.13). CONCLUSION: Gestational diabetes was found in one out of five pregnant women regardless their age. A history of macrosomia birth and diabetes in the family were the main risk factors.

Prenatal care counseling and delivery method among women with multiple Cesareans: A cross-sectional study from Democratic Republic of Congo.

Prenatal care (PNC) and counseling about delivery method is an important strategy to prevent delivery complications among women with multiple prior Cesarean sections (CS). In low income countries, an elective CS is recommended for this population. This cross-sectional study examined factors associated with counseling about delivery method and its influence on the likelihood of an elective CS delivery. A total of 422 women with ≥2 prior CS who delivered across five hospitals in Democratic Republic of Congo (DRC) were interviewed about PNC and counseling. Descriptive statistics and multivariate regression were completed to ascertain factors associated with counseling. Only 33.6% delivered via planned CS; 60.7% required an emergency CS. One-quarter completed four PNC visits; 64.5% received counseling. Number of PNC visits and number of prior CS were significant predictors of receipt of counseling. Women who received ≥2 PNC visits were 2.2 times more likely to have received counseling (p = 0.000). Among women who received counseling, 38.6% had a planned CS compared with 24.7% in the non-counseled group. Counseling was associated with mode of delivery; emergency CS and vaginal delivery were more frequent among women who did not receive counseling (p = 0.008). These findings highlight the importance of counseling during PNC visits. This study also highlights the poor coverage and quality of counseling in this high-risk population and the need for improvements in PNC. Less than 40% of counseled women followed provider recommendations for a planned delivery via CS. The majority labored at home and later delivered emergently. The significant number of women who trial labor without medical supervision despite their high-risk status sheds light on the influence of patient perceptions about CS and acceptance of medical intervention during birth.

[Abnormal semen analyses in men undergoing premarital screening and in infertile couples in Butembo-Democratic Republic of Congo]. / Anomalies du spermogramme en consultations prénuptiales et dans les couples infertiles à Butembo, République Démocratique du Congo.

The purpose of this study was to determine the prevalence of spermogram abnormalities in men consulting for premarital screening and in infertile couples in Butembo. We conducted a retrospective descriptive study at the Graben University Diagnostic Center. The study population consisted of 890 male subjects aged 21-57 years, of whom 779 underwent prenuptial screening and 111 subjects fertility tests. The overall prevalence of spermogram anomalies in this population was 25.8%, corresponding to a total incidence of 22.9% of premarital consultants and 46,0% of males in infertile couples. Mean pH was: 7.22+/- 0.22. The average volume of semen collected was: 2.56 +/- 1.41 ml. Abnormalities were detected in all spermogram parameters, with a predominance of abnormalities in the same subject (86.5%), mainly in oligoasthenoteratozoospermia (44.8% of cases). Asthenozoospermia was the most common abnormality (90.9% of cases), followed by oligozoospermia (87.4% of cases), teratozoospermia (66.9% of cases), necrozoospermia (55.6% of cases), and azoospermia (10.4% of cases). This study highlights that the cytological profile of the spermogram of this population in Butembo is dominated by associations of anomalies. Other tests such as bacteriological examinations and biochemical marker assays are necessary, in order to identify the causes of abnormalities and to provide appropriate therapies.