Pattern of Aedes aegypti and Aedes albopictus Associated with Human Exposure to Dengue Virus in Kinshasa, the Democratic Republic of the Congo.

Dengue is a worldwide public health concern. The current study assessed the extent of human exposure to the dengue virus in relation to the distribution pattern of Aedes aegypti and Ae. albopictus in Kinshasa. Cross-sectional surveys were carried out in 2021 and 2022. The baseline entomological survey involved 19 municipalities using a grid cell sampling approach. All containers holding water were inspected for the presence of larvae in each grid. The collected larvae were kept in an insectary until the adult emergence for morphological identification. Four hundred febrile patients attending the hospital were screened for the presence of dengue antibodies (IgG, IgM) and NS1 antigen using a rapid diagnostic test (RDT) Biosynex®. Residences of positive cases were geo-referenced. We evaluated 1850 grid cells, of which 19.5% were positive for Aedes larvae. The positive grid cells were identified in the Ndjili (44.0%), Mont Ngafula (32.0%) and Ngaliema (26.0%), and Limete (32.0%) municipalities. The Ae. aegypti (11.2%) predominated in the northwestern, and Ae. albopictus (9.1%) appeared in the high vegetation coverage areas. Of 61 (15.3%) participants exposed to dengue, 8.3% presented acute dengue. Young, (6-17 years), male, and Mont Amba district participants were most exposed to dengue. In conclusion, dengue occurrence in Kinshasa overlaps somewhat the geographical and ecological distributions of Ae. aegypti and Ae. albopictus. Both species are not homogenously distributed, likely due to environmental factors. These findings can assist the targeted control activities.

Pulmonary rehabilitation in Africa: where are we? a multimethod study.

Pulmonary rehabilitation (PR) is an integral part of the management of patients with chronic respiratory diseases. However, there is limited information available on the effectiveness and practice of PR in Africa. This study was conducted to examine the prevalence, structure, and organization of PR in Africa, as well as its substance and claimed efficacy. We conducted a multimethod study involving systematic review of PR studies (obtained from PubMed, Google Scholar, and Cochrane databases) and a web-based survey of African healthcare professionals engaged in PR (using a standardized questionnaire). The review included papers on at least one component of PR in Africa and excluded those on PR from other continents or assessing pulmonary disorders in general without PR, cardio-rehabilitation, or physiotherapy practice in general in Africa. The Cochrane risk of bias and the Newcastle Ottawa scale instruments were used to assess the quality of included studies. We narratively synthesised data across the studies to produce a holistic picture. Of the 14 studies included for qualitative synthesis, seven were randomized controlled trials on the effectiveness of PR treatments with a total number of 333 participants. Of the 39 surveys mailed to health professionals working in Africa, only 14 (35.8%) were returned. We found aerobic exercise and breathing exercises were the most used technique and that quality of life, exercise capacity, and lung function improved significantly after PR treatments. There were differences in the duration, frequency, and length of the programs across the continent. Half of the respondents indicated that their institutions had one or more PR programs for inpatient, outpatient, maintenance, and/or home-based programs. Additionally, aerobic activities, upper and lower extremity strength training were the most frequently used exercise modalities in PR programs, followed by breathing exercises. Pulmonary rehabilitation is understudied in Africa, but it has been linked to improved lung function, exercise capacity, and quality of life. There is a need to invest in techniques tailored to the continent to enhance the implementation of pulmonary rehabilitation in Africa.

Outcomes and adverse events of pre- and extensively drug-resistant tuberculosis patients in Kinshasa, Democratique Republic of the Congo: A retrospective cohort study.

BACKGROUND: Extensively drug-resistant tuberculosis (XDR TB) is a very serious form of tuberculosis that is burdened with a heavy mortality toll, especially before the advent of new TB drugs. The Democratic Republic of the Congo (DRC) is among the countries most affected by this new epidemic. METHODS: A retrospective analysis was performed of the records of all patients with pre- and extensively drug-resistant tuberculosis hospitalized from January 1, 2015 to December 31, 2017 and monitored for at least 6 months to one year after the end of their treatment in Kinshasa; an individualized therapeutic regimen with bedaquiline for 20 months was built for each patient. The adverse effects were systematically monitored. RESULTS: Of the 40 laboratory-confirmed patients, 32 (80%) patients started treatment, including 29 preXRB and 3 XDR TB patients. In the eligible group, 3 patients (9.4%) had HIV-TB coinfections. The therapeutic success rate was 53.2%, and the mortality rate was 46.8% (15/32); there were no relapses, failures or losses to follow-up. All coinfected HIV-TB patients died during treatment. The cumulative patient survival rate was 62.5% at 3 months, 53.1% at 6 months and 53.1% at 20 months. The most common adverse events were vomiting, Skin rash, anemia and peripheral neuropathy. CONCLUSION: The new anti-tuberculosis drugs are a real hope for the management of Drug Resistant tuberculosis patient and other new therapeutic combinations may improve favorable outcomes.

[Spirometric reference values in the Bantu population aged 20-70 years in Kinshasa]. / Valeurs spirométries de référence dans la population bantoue de Kinshasa de 20 à 70 ans.

INTRODUCTION: Spirometric reference values cannot be extrapolated in the populations, being subject to many environmental and human variables; hence the interest of local studies in this field. METHODS: This study aims to determine the reference values among healthy adults in Kinshasa. We conducted a cross-sectional study including 7443 subjects (3208 women, 43%). FEV1, FVC, PEF were correlated with anthropometric data. Five age groups were formed and comparisons were made on the basis of sex, age, BMI and of the practice of sporting activity. RESULTS: Differences are evident between the sexes, in terms of FEV1 (3.00 vs 2.21 L), FVC (3.19 vs 2.38) and the PEF (6.8 vs 5.70 L/s); same as for the outer age categories. FEV1 ranged between 2.33 et 4.54 vs 1.93-3.3 L in the age group 20-29 years and 1,76-3,39 vs 1,60 vs 2,53 L in the age group 60-70 years; FVC ranged between 2,44-4,89 vs 1,96-3,56 L and 1,79-3,78 vs 1,66-2,74 L ; PEF ranged between 4,34-12.2 vs 3,62-8.58 L/s and 2.99-6.76 vs 2.99-7.34L/s in the age group 60-70 years. CONCLUSION: The differences related to gender, age, anthropometric data as well as to the practice of sporting activity are obvious. These results warrant further and more extended investigations and show the relevance of values based on percentiles in the determinantion of a spirometry standard in a given population.

Factors associated with uncontrolled asthma in adult asthmatics in Kinshasa, Democratic Republic of Congo.

BACKGROUND: The ultimate goal of asthma treatment is long-term control. Uncontrolled asthma is a major public health problem worldwide, but there is a lack of data on asthma control and its causes in the Democratic Republic of Congo (DRC). OBJECTIVE: To determine the socio-demographic, environmental, clinical, and biological factors and comorbidities associated with uncontrolled adult asthma in Kinshasa, DRC. METHODS: We performed a cross-sectional study of 216 male and female asthmatics aged 18 and over consecutively recruited from tertiary clinics and the community in Kinshasa between June 2017 and February 2018. For each subject, socio-demographic, clinical, para clinical and environmental data were recorded. Forced Expiratory Volume in one second (FEV1) values were obtained by Spirometry, allergen testing performed using the skin prick test, serum vitamin D levels measured by radioimmunoassay, and asthma control assessed using the asthma control test (ACT) score. Multiple logistic regression identified factors associated with uncontrolled asthma. RESULTS: The average age of participants was 45.2 (SD 17.6) years, 74% were female, and 42% had a low educational level. Among all asthmatics, the prevalence of uncontrolled asthma was 56%, abnormal serum vitamin D level 95%, abnormal FEV1 65%, sensitization to two allergens (cat dander and dust mites) 18%, sleep disorders 37%, and heartburn 60%. Male (aOR 2.24; 95% CIs 1.04-4.79), low educational level (aOR 3.26; 95% CIs 1.54-6.67), sensitization to both cat dander and dust mites (aOR 2.67; 95% CIs 1.16-6.14), FEV1 ≤80% (aOR 2.07; 95% CIs 1.08-3.96), abnormal serum vitamin D level (aOR 5.11; 95% CIs 1.17-22.33), sleep disorders (aOR 1.96; 95% CIs 1.04-3.71), and heartburn (aOR 2.02; 95% CIs 1.04-3.92) were significantly associated with uncontrolled asthma. CONCLUSION: Uncontrolled asthma is common in Kinshasa, and these factors associated with uncontrolled asthma may be considered as targets for future intervention strategies.

Valeurs spirométries de référence dans la population bantoue de Kinshasa de 20 à 70 ans

Introduction: les valeurs spirométriques de référence ne sont pas extrapolables entre populations, étant tributaires de nombreuses variables humaines et environnementales, d'où l'intérêt des études locales dans ce domaine. L'objectif est de déterminer des valeurs de référence chez des adultes sains de Kinshasa. Méthodes: une étude transversale incluant 7443 sujets (3208 femmes, 43%). Le VEMS, la CVF et le DEP ont été corrélés aux données anthropométriques. Cinq groupes d'âge ont été constitués et les comparaisons effectuées en fonction du sexe, de l'âge, de l'IMC et de la pratique d'une activité sportive.Résultats: les différences sont évidentes entre sexes, pour le VEMS (3,00 vs 2,21 L), la CVF (3,19 vs 2,38 L), et le DEP (6,8 vs 5,70 L/s); de même que pour les tranches d'âge extrêmes. Elles sont comprises entre: 2,33 et 4,54 vs 1,93-3,3 L dans le groupe de 20-29 ans et 1,76-3,39 vs 1,60 vs 2,53 L chez les 60-70 ans; pour La CVF entre 2,44-4,89 vs 1,96-3,56 L et 1,79-3,78 vs 1,66-2,74 L; pour le DEP entre 4,34-12,2 vs 3,62-8,58 L/s et 2,99-6,76 vs 2,99-7,34L/s chez les 60-70 ans. Conclusion: les différences liées au genre, à l'âge, aux données anthropométriques ainsi qu'à la pratique d'une activité sportive sont évidentes. Ces résultats justifient des enquêtes plus étendues et montrent la pertinence des valeurs basées sur les percentiles dans la déterminantion d'un référentiel spirométrique dans une population donnée

Molecular surveillance of Plasmodium falciparum resistance to artemisinin-based combination therapies in the Democratic Republic of Congo.

Malaria is a major public health problem in the Democratic Republic of Congo. Despite progress achieved over the past decade in the fight against malaria, further efforts have to be done such as in the surveillance and the containment of Plasmodium falciparum resistant strains. We investigated resistance to artemisinin-based combination therapies currently in use in Democratic Republic of Congo by surveying molecular polymorphisms in three genes: pfcrt, pfmdr1 and pfk13 to explore possible emergence of amodiaquine, lumefantrine or artemisinin resistance in Democratic Republic of Congo. This study essentially revealed that resistance to chloroquine is still decreasing while polymorphism related to amodiaquine resistance seems to be not present in Democratic Republic of Congo, that three samples, located in the east of the country, harbor Pfmdr1 amplification and that none of the mutations found in South-East Asia correlated with artemisinine resistance have been found in Democratic Republic of Congo. But new mutations have been identified, especially the M476K, occurred in the same position that the M476I previously identified in the F32-ART strain, strongly resistant to artemisinine. Antimalarial first-line treatments currently in use in Democratic Republic of Congo are not associated with emergence of molecular markers of resistance.

High Prevalence of Plasmodium falciparum Infection in Asymptomatic Individuals from the Democratic Republic of the Congo.

Malaria remains a major public health problem in the Democratic Republic of Congo (DRC) with 14 million cases reported by the WHO Malaria Report in 2014. Asymptomatic malaria cases are known to be prevalent in endemic areas and are generally untreated, resulting in a significant source of gametocytes that may serve as reservoir of disease transmission. Considering that microscopy certainly underestimates the prevalence of Plasmodium infections within asymptomatic carriers and that PCR assays are currently recognized as the most sensitive methods for Plasmodium identification, this study was conducted to weigh the asymptomatic carriage in DRC by a molecular method. Six provinces were randomly selected for blood collection in which 80 to 100 individuals were included in the study. Five hundred and eighty blood samples were collected and molecular diagnosis was performed. Globally, almost half of the samples collected from asymptomatic individuals (280/580; 48.2%) had Plasmodium infections and the most species identified was P. falciparum alone in combination with P. malariae. The high prevalence reported here should interpellate the bodies involved in malaria control in DR Congo to take into account asymptomatic carriers in actions taken and consider asymptomatic malaria as a major hurdle for malaria elimination.