[HIV testing among women in delivery rooms in Lubumbashi, Democratic Republic of the Congo: a catch-up strategy for prevention of mother-to-child transmission]. / Dépistage du VIH en salle de travail à Lubumbashi, République Démocratique du Congo. Une stratégie de rattrapage dans le cadre de la prévention de la transmission de la mère à l'enfant.

BACKGROUND: Although HIV testing is offered during antenatal care, the proportion of women giving birth without knowing their HIV status is still important in DR Congo. The objective of this study was to determine the acceptability of rapid HIV testing among parturients in labor room, and to identify factors that are associated with the acceptability of HIV testing. METHODS: Intervention including rapid HIV testing among pregnant women in labor rooms in Lubumbashi for 5 months, from September 2010 to February 2011. Pregnant women who tested HIV positive were attended by prevention of mother-to-child transmission service. Descriptive statistical analysis and logistic regression were performed. RESULTS: Among 474 pregnant women who enter the labor room, 433 (91.4%; confidence interval [CI]: 95%: 88.4-93.7%) had voluntary testing for HIV in the labor room after counseling. The acceptance of rapid testing for HIV was significantly higher when the duration of counseling was less or equal to 5 minutes (adjusted Odds ratio [aOR]=5.8; [CI] 95%: 2.6-13); among those who did not report having this screening test during antenatal care (aOR=3.8; [CI] 95%: 2-7.8), among those who were in early labor (aOR=2.3; [CI] 95%: 1.2-4.7) and lower in adolescents than in adults (aOR=0.1; [CI] 95%: 0.0-0.7). CONCLUSION: Counseling and voluntary HIV testing are accepted in our labor rooms. Consistently offering this service in the labor room could be a catch-up strategy to be combined with antenatal care testing.

Etude des facteurs de risque associes a l'apparition des fibromyomes uterins a Lubumbashi; Congo

1)Identifier les facteurs associes a l'apparition des fibromyomes uterins a Lubumbashi 2) Identifier les facteurs associes a l'apparition des fibromyomes uterins a Lubumbashi avant 30ans Materiel et methode :Une etude cas

Etude de la mortalite maternelle et des facteurs associes a l'hopital Jason Sendwe a Lubumbashi; Congo: de 2000 a 2010

L'hopital SENDWE est le deuxieme hopital de la Republique Democratique du Congo sur le plan capacite et est typique des pays pauvres. Cette etude a pour objectif de determiner le taux de mortalite maternelle ainsi que les facteurs associes a cette mortalite maternelle dans cette formation medicale.Methodes Cette etude; de type descriptif comparatif; s'etale sur 12 ans et couvre la periode qui va de janvier 2000 a decembre 2011. Pour analyser les donnees; nous avons utilise les mesures de tendance centrale et de dispersion; le calcul d'Odds ratio et d'intervalles de confiance. Les donnees ont ete encodees; traitees et analysees a l'aide des logiciels Excel 2007 et Epi info version 3.04.Resultats Le taux de mortalite maternelle fluctue en fonction des gestionnaires de l'hopital et de l'organisation de la maternite; nous avons les extremes de deces maternels de 314 pour 100.000 N.V. en 2002 et 870 pour 100.000 N.V. en 2011. Les etiologies les plus frequentes sont les hemorragies genitales avec 44;2. Les gestantes de 18 ans et moins courent pres de deux fois plus de risque que leurs homologues plus agees (OR=1;81 IC95 :1;38-2;38); celles de plus de 35 ans courent pres de quatre fois plus de risque que les moins de 35 ans (OR=3;93 IC 95 : 3;04-5;08). Les primipares presentent pres de deux fois plus de risque que les autres (OR=1;68 IC 95 : 1;32-2;14) et les grandes multipares ont douze fois plus de risque que les autres (OR=12;12 IC 95 : 9;64-15;24). Les gestantes et l'etat congolais ont une plus grande part de responsabilite dans la survenue des deces maternels.Conclusion Avec la disponibilisation d'un personnel qualifie; des trousses operatoires et des produits pharmaceutiques d'urgence ainsi que de poches de sang; la plupart des deces maternels sont evitables

Acceptabilité du dépistage volontaire du VIH chez les femmes enceintes à l'hôpital général de référence de Kenya à Lubumbashi en République Démocratique du Congo

Contexte. La majorité des enfants contaminés par le VIH se retrouve dans les pays en développement. En RD Congo, le nombre de nouveaux cas de VIH pédiatriques est de l'ordre de 28461 par an. L'objectif de cette étude était de déterminer l'acceptabilité du dépistage volontaire du VIH et l'adhérence à la prise en charge chez les femmes enceintes au service de prévention de la transmission du VIH de la mère à l'enfant de l'Hôpital Général de Référence (HGR) Kenya. Méthodologie. Une analyse opérationnelle des étapes du dépistage du VIH a été préalablement effectuée selon le modèle de Piot, chez 4895 femmes enceintes reçues aux Consultations Prénatales en 2007. Une enquête transversale a ensuite était conduite, sur un échantillon de convenance de 490 gestantes, pour rechercher les facteurs associés à l'acceptabilité du dépistage du VIH dans ce milieu. Les analyses statistiques descriptives et une régression logistique ont été appliquées pour l'analyse de données. Le ratio de couverture de la Névirapine a été calculé. Résultats. De toutes les gestantes admises aux CPN, 50,8% ont accepté le counselling pré-test, et 80% d'entre elles l'ont réellement effectué. De ce dernier groupe, seules 83% ont retiré le résultat du test. L'acceptabilité du test était significativement plus élevée parmi les gestantes de bas niveau d'étude (odds ratio ajusté ORa = 6,8 ; IC95% :3,5-13,35) et parmi celles qui arrivaient pour la première fois à la CPN (ORa=2, 3 ; IC : 1,2-4,4). L'adhérence à la prise en charge était de 22,4% des couples mère-enfants. Le ratio de couverture en Névirapine était de 11,4%. Conclusion. L'acceptabilité globale du dépistage du VIH et l'adhérence à la prise en charge sont relativement faibles à l'HGR Kenya. Pour améliorer le rendement de ce service, il faudrait sensibiliser les femmes et assurer le suivi des activités du service

Sterilite du couple a l'Institut Medical Chretien du Kasai

Introduction : Une etude transversale a ete menee de janvier 2004 a decembre 2007 a l'Institut Medical Chretien du Kasai. Objectifs : Definir le profil socioepidemiologique de la femme ayant consulte a l'Institut Medical Chretien du Kasai pour sterilite et determiner a partir des examens paracliniques simples la responsabilite de chaque conjoint et la cause de la sterilite. Resultats : 11des femmes ont consulte pour une notion de sterilite de minimum 2 ans. La moitie des sujets (50;8) est agee de moins de 35 ans; avec une moyenne d'age de 28 +/-3 ans. La sterilite feminine secondaire etait predominante (70;2) et la responsabilite mutuelle de l'homme et de la femme dans la sterilite a ete retrouvee dans 33des cas. Considere individuellement; l'homme est apparu avoir plus de responsabilite que la femme (34;6vs 21;4). Les femmes provenant du milieu urbain etaient majoritaires (62;1). Un niveau d'instruction ne depassant pas le cap de l'ecole secondaire apparaissait aussi comme un facteur frequemment associe a la sterilite (89.6). Les causes mecaniques ont ete plus frequentes que les causes fonctionnelles (81;2vs 18;8). L'oligo-asthenospermie a ete la cause gonadique masculine la plus importante dans notre serie (56;2). Conclusion : La sterilite du couple est un probleme de sante publique dans nos milieux a cause de sa frequence et de ses repercussions sociales. La prevention des infections sexuellement transmissibles pourrait concourir a contourner ce fleau

Prevalence et determinants de la malnutrition des enfants ages de moins de 5 ans dans le quartier Bongonga de Lubumbashi

Contexte : L'etat nutritionnel des enfants est un indicateur mondial de son bien-etre et indirectement celui de sa communaute. Les objectifs de ce travail consistent a evaluer l'etat nutritionnel des enfants ages de moins de cinq ans du quartier Bongonga de Lubumbashi; en RD Congo; et ses determinants. Methodes : Une enquete transversale a ete menee; dans des menages; aupres de 1963 enfants. Outre les variables anthropometriques; les conditions de vie ont egalement ete relevees. Une regression logistique a ete appliquee. Resultats : Les prevalences etaient de 33;5de retard de croissance et 3;8d'emaciation. En regression logistique; le niveau d'etude de la mere (moins de 7 ans); l'absence d'un robinet d'eau potable dans la parcelle; l'age superieur a 11 mois et la duree de sejour de l'enfant dans le quartier inferieure a 3 mois etaient significativement associes a un risque accru de retard de croissance. Le niveau bas d'etude de la mere et l'age de l'enfant (12 mois ou plus) etaient significativement associes du retard de croissance severe. Par ailleurs; l'anorexie; la diarrhee; la souffrance et l'age de l'enfant (moins de 12 mois) etaient les determinants significatifs d'une emaciation. Conclusion : Comparee a la classification de l'Organisation Mondiale de la Sante; la prevalence du retard de croissance est elevee et celle de l'emaciation basse. Afin de reduire la mortalite; la morbidite et contribuer au bien-etre de la population; il faut integrer ces facteurs dans toute intervention

Etat des reserves en fer des femmes enceintes; des femmes allaitantes et des enfants de 1 a 60 mois a Lubumbashi; RD Congo

Le present travail a pour objectif d'evaluer le statut martial des personnes a risque d'anemier a Lubumbashi. Le niveau des reserves en fer a ete determiner sur base du dosage de ferritine serique chez 53 femmes enceintes; 38 femmes allaitantes et 49 enfants de 1 a 60 mois. Cette etude montre que le statut martial est normal (ferritine entre 30-200 ng/ml) dans 23chez les femmes enceintes; 8chez les femmes allaitantes et 62chez les enfants. Dans les trois groupes; la carence martiale (ferritine 12 ng/ml) a ete observee respectivement dans 34; 58; et 20dans des cas alors que la precarence (ferritine entre 12-30ng/ml) ) a ete retrouve respectivement entre 43; 34; et 4des cas. Chez la femme enceinte; la grande majorite des cas de carence et de precarence a ete notee au deuxieme et au troisieme trimestre de la grossesse (62). Par ailleurs; 4d'enfants accusent une surcharge martiale (ferritine entre 500-1000 ng/ml). A la lumiere de ces resultats; une supplementation systematique en fer devra instauree chez les femmes allaittantes et les femmes enceintes au deuxieme et au troisieme trimestre de la grossesse. Chez les enfants; elle ne pourra etre indiquee que sur la base d'investigations approfondies

[Anemia prevalence in pregnant and breast-feeding women in Lubumbashi (Democratic Republic of the Congo). Impact of malaria and intestinal helminthiasis]. / Etude de l'anémie chez les femmes enceintes et les femmes allaitantes de Lubumbashi (République Démocratique du Congo). Impact du paludisme et des helminthiases intestinales.

OBJECTIVE: To determine the prevalence of anemia and associated factors (malaria and intestinal helminthiasis) in high risk groups of Lubumbashi, Congo, particularly in pregnant and breast-feeding women and children aged 1-2 years. MATERIAL AND METHODS: From March to May 2002, 632 pregnant women, 570 breast-feeding women, and 570 infants (1-2 years) were examined in three medical centers in Lubumbashi, Congo. Some of the subjects lived in deprived semi-urban areas (Bongonga and Sendwe), others in urban areas with a satisfactory socio-economic situation (University Clinic). RESULTS: Overall frequency of anemia was estimated between 50 and 80% in the study populations. The proportion of anemic cases was clearly higher in the Sendwe and Bongonga populations (70-80%) than in the other urban populations (50%) (P<0.01). For the three categories of examined subjects, anemia was found to be most prevalent among pregnant women (P<0.05). Anemia was found to be associated with malaria in 40% of the patients and with intestinal parasitism (ascaris / ankylostoma) in 9%. CONCLUSION: Considering these results, systematic screening and treatment of anemia and associated factors such as malaria and intestinal helminthiasis is needed for the Lubumbashi population.

[Anemia associated with malaria and intestinal helminthiasis in Lubumbashi]. / Anémie associée au paludisme et aux helminthiases intestinales à Lubumbashi.

The purpose of this study is to evaluate and determine the prevalence of anemia and associated factors (malaria and intestinal helminthiasis) in some high risk groups, especially in pregnant and breast-feeding women and in children aged 1-2 years old from within a deprived semi-urban population of Lubumbashi (Bongonga and Sendwe). These results were compared to those obtained from an urban population having a more satisfying socio-economic situation (University Clinics). The overall frequency of anemia in the subjects studied from the three centres varies from 50-80%. The proportion of anemic cases is clearly higher in the Bongonga and Sendwe populations (70-80%) than in that of the urban group (50%) (P < 0.05). Among all of the subjects examined, pregnant women are found to be the group with the highest proportion of anemic patients (P < 0.05). All things considered, anemia is associated with malaria in 40% of the cases and with intestinal parasitism (Ascaris and/or Ankylostome infestation) in 9%. Faced with such a situation, the strategy to fight against anemia and associated parasitosis demands and requires multi-disciplinary actions centred on health education, collective screening and specific anti-parasite treatment.

Determination of renin, angiotensin converting enzyme and angiotensin II levels in human placenta, chorion and amnion from women with pregnancy induced hypertension.

OBJECTIVE: Pregnancy induced hypertension has been shown to be associated with a normal or low activity of the maternal circulating renin-angiotensin system (RAS) but little is known of the local RAS in placenta and fetal membranes. The present study attempts to determine, at full term of human preeclamptic pregnancies, the activity of the chorioplacental renin-angiotensin system. PATIENTS AND MEASUREMENTS: We analysed the concentrations of active renin, prorenin, angiotensin converting enzyme (ACE) and angiotensin II in homogenates of human placenta and fetal membranes from preeclamptic patients at full term pregnancy. The values of renin, ACE and angiotensin II found in the patients with moderate preeclampsia (gestosis index 0-1) (n = 10) were compared with those of normal pregnant women (n = 8). RESULTS: Our experiments showed that in preeclamptic pregnancies, the chorion membrane contained the highest concentrations of active renin (2905 +/- 152 pg/g, mean +/- SD), prorenin (21,315 +/- 2849 pg/g) and ACE (1258 +/- 302 U/g) whereas the placenta had more angiotensin II than the chorion and amnion (741 +/- 45 vs 456 +/- 40 and 428 +/- 64 pg/g, respectively). In the placenta, as in the fetal membranes, no significant difference was found in the levels of active renin, ACE or angiotensin II between hypertensive patients and normal subjects but a slightly lower level of chorionic prorenin (P < 0.05) was observed in pregnancy induced hypertension. CONCLUSION: These findings indicate that in moderate preeclampsia (gestosis index 0-1), the activity of the renin-angiotensin system in term human placenta and fetal membranes remains essentially normal.

Down-regulation of angiotensin AT1 receptor by progesterone in human placenta.

Regulation of the angiotensin AT1 receptor in human placenta is poorly understood. In this study, we analyzed the time course of angiotensin AT1 receptor expression, internalization, and recycling by human trophoblast cells. We also studied the effects of estradiol, progesterone, and chloroquine on regulation of the angiotensin AT1 receptor in 48-h cell culture. The angiotensin II receptor expression increased with the time of incubation, reaching a level at 48 h of culture that was about 120% above the initial value. A large majority of angiotensin II receptors was of the AT1 subtype, as it was completely inhibited by losartan (1 mumol/L). The internalization of [125]angiotensin II binding and the angiotensin AT1 receptor recycling were also time dependent, with t1/2 values of 12 and 21 min, respectively. In human trophoblast cells exposed to progesterone (10 mumol/L) for 48 h, angiotensin AT1 receptor density was decreased by 49%, whereas estradiol (10 mumol/L) or chloroquine (100 mumol/L) treatment was ineffective. In the freshly isolated trophoblast cells initially treated with unlabeled angiotensin II (200 nmol/L) for 30 min, chloroquine was shown to decrease angiotensin AT1 receptor recycling by 73%, whereas estradiol and progesterone had no effect. These findings indicate that progesterone induces a down-regulation of the angiotensin AT1 receptor in human placenta and that the recycling of this receptor can be delayed by chloroquine.

Angiotensin II and its different receptor subtypes in placenta and fetal membranes.

The recent discovery of a local renin-angiotensin system in trophoblastic tissues has raised many questions regarding its role in the physiology of normal gestation and its implications in the pathophysiology of hypertension during pregnancy. In this article, the authors first review the most interesting aspects of the chorioplacental renin-angiotensin system, dwelling on the tissue distribution of angiotensin II and its receptor subtypes in the placenta and fetal membranes of different species. The relationship between angiotensin II and other locally synthesized chorioplacental substances is also analysed and the therapeutic implications of phenomena observed in pregnancy-associated hypertension are discussed.

Angiotensin-II stimulates estradiol secretion from human placental explants through AT1 receptor activation.

A complete renin-angiotensin system has been shown to be present in human placenta, but its physiological role is poorly known. To investigate the implication of this system in the regulation of steroid hormone secretion, we studied the effect of angiotensin-II on the release of estradiol and progesterone from human placental explants. Our experiments showed that angiotensin-II stimulated estradiol secretion from term placental explants in a dose- and time-dependent fashion, although progesterone release was unaffected. Estradiol release induced by angiotensin-II (0.2 mumol/L) was blocked by angiotensin AT1 receptor antagonist losartan in a dose-dependent manner, suggesting the involvement of the AT1 receptor subtype in the process. On the contrary, the angiotensin AT2 receptor antagonist PD123319 (1 mumol/L) or the angiotensin AT2 receptor agonist CGP42112A (1 mumol/L) had no effect. Analysis of the amount of steroid hormones in the placental tissues incubated for 12 h showed that angiotensin-II increased estradiol production by 34% compared with the unstimulated explants, whereas the total levels of the estrogen precursor androstenedione and testosterone were decreased by 30-45% in the presence of the peptide, suggesting a stimulatory effect on the aromatization step. This hypothesis was reinforced by the absence of effect of angiotensin-II on both estradiol and testosterone concentrations in the placental explants pretreated with the aromatase inhibitor 4-hydroxyandrostenedione (25 mumol/L). Progesterone synthesis was not affected by angiotensin-II. The present study indicates that angiotensin-II induces the secretion of estradiol from human placenta through the angiotensin AT1 receptor subtype activation, and this effect seems to be linked to the stimulation of local androgen aromatization.

Down regulation of the angiotensin II receptor subtype AT2 in human myometrium during pregnancy.

Samples of human myometrium have been collected during pregnancy and from non-pregnant women. Binding studies revealed the presence of a 50-fold higher density of angiotensin II AT2 receptor in the non-pregnant state than during gestation. Low levels of the AT1 receptor subtype (approx. 20 fmol/mg protein) were detected in both pregnant and non-pregnant myometrium. Outside pregnancy, the AT2 receptor accounted for greater than 95% of all angiotensin receptors, whereas during pregnancy the value dropped to about 40%. The down regulation of the human myometrial AT2 receptor during pregnancy may be related to the high hormonal content of the environment induced by gestation. The mechanism by which the AT2 receptor is regulated appears to be different to that of the AT1 receptor.

Angiotensin II induces human placental lactogen and pregnancy-specific beta 1-glycoprotein secretion via an angiotensin AT1 receptor.

The purpose of this work was to determine which subtype of angiotensin II receptors was involved in angiotensin II-induced human placental lactogen (hPL) and pregnancy-specific beta 1-glycoprotein (SP1) secretion from human placenta. The experiments were performed using placental explants and isolated trophoblast cells. They were pretreated with Dup753 (antagonist of angiotensin AT1 receptor), PD123319 (antagonist of AT2 subtype) or with CGP42112A (agonist of angiotensin AT2 receptor) before the addition of angiotensin II. The octapeptide angiotensin II significantly increased the hPL and SP1 release from both placental explants and isolated trophoblast cells. The angiotensin AT1 receptor antagonist Dup753 inhibited the angiotensin II-stimulated hPL and SP1 secretion in a dose-dependent manner but the AT2 specific ligands PD123319 and CGP42112A had no effect. This study indicates that the angiotensin AT1 receptor is the main mediator of angiotensin II in the stimulation of hPL and SP1 secretion from human placenta.

[Epidemiological considerations on the deliveries of stillbirths in the maternity unit of Gecamines Sendwe of Lubumbashi (Zaire)]. / Considérations épidémiologiques sur les accouchements des mort-nés à la maternité Gécamines Sendwe de Lubumbashi (Zaïre).

In a retrospective study covering the period from January 1/1980 to December 31/1984, the authors found 1535 stillborn infants in the maternity unit of Gecamines Sendwe. The stillbirth rate was very high (30.80 per 1000). It was found that all the pregnancies in which the outcome was fatal for the fetus had not been adequately supervised: 17.84 per cent of women were never examined during their pregnancy while 82.15 per cent underwent less four prenatal visits. The group of primipara and secondipara was predominant (61.88 per cent) between the mothers which had stillborn infants. Urinary tract infection (23.95 per cent) and malaria (17.55 per cent) were the most frequent diseases found in this series.

[Identification of angiotensin II receptor and determination of its subtypes in rabbit and guinea pig fetal tissue]. / Identification du récepteur à l'angiotensine II et détermination de ses sous-types dans les annexes foetales du lapin et du cobaye.

Membrane angiotensin II receptors were measured in trophoblastic tissues using a 2-step procedure. The first step consisted of the relative measurement performed at a fixed 125I[Sar1 Ile8]AII concentration of 0.15 nM in order to determine which tissues had a sufficient number of binding sites for studying the competition curves. The second consisted of determining the maximal binding (Bmax) and the dissociation constant (Kd) for [Sar1 Ile8] AII and the receptor subtypes in these tissues. The relative binding measurement revealed a significant number of occupied sites in rabbit fetal placenta and chorion (159 +/- 17 and 51 +/- 10 fmol/mg proteins) and in guinea pig chorion (132 +/- 12). The mean values of the other trophoblastic tissues were 3-10-fold lower in the 2 species. The competition curves obtained from tissues with high angiotensin II binding receptors showed the predominance of the AT2 subtype in rabbit fetal placenta (AT1/AT2 = 25/75) and of the AT1 receptor in guinea pig chorion (97/3) and in rabbit chorion (90/10). The [SAR1 Ile8] AII affinity (Kd) obtained from Scatchard plot analysis was 1.2 +/- 0.2 nM (n = 5) in fetal placenta and 1.2 (n = 1) in rabbit chorion and 0.5 +/- 0.1 (n = 3) in guinea pig chorion. In these tissues, the respective Bmax values were 1,281 +/- 115 (n = 5), 263 (n = 1) and 1,188 +/- 134 fmol/mg proteins (n = 3). These findings indicate that rabbit fetal placenta and chorion and guinea pig chorion are the most important sites of action for the renin-angiotensin system present in trophoblastic tissues.