Bioethics education in Democratic Republic of Congo: Experiences and challenges.

In regions marked by socio-economic turmoil, the task of teaching bioethics to health professionals and researchers can be more challenging than elsewhere. To demonstrate this, in this article we describe some of our teaching experiences in the Democratic Republic of Congo over the past decade. A first difficulty is linguistic. Anglo-Saxon language and culture largely dominates the field of bioethics, complicating teaching and education for those who do not master the language. A second obstacle is conceptual. Bioethics is often misunderstood as reflection on technological developments in medicine, which distorts its objectives and narrows its scope, particularly in resource-constrained settings. A third difficulty is cultural and political. Ethics in this setting is difficult to distinguish from common morality and the work of moralists, who comment on problems in medicine from a religious standpoint. Moreover, when interacting with communities and institutions that are strongly hierarchical, the critical stance of bioethics can give rise to resistance and rejection. These are among the array of difficulties that undoubtedly have given rise to sharp critiques of bioethics training initiatives in developing countries, where the introduction of bioethics has been depicted as a form of Western imperialism. While taking these criticisms seriously, our experiences in the field show how these seemingly insurmountable difficulties can be transformed into (more or less) manageable challenges.

Dans les régions marquées par un contexte socioéconomique difficile, les difficultés sont plus nombreuses qu'ailleurs pour ceux qui se donnent pour tâche de former à la réflexion éthique les professionnels de la santé et les chercheurs. Pour le montrer, nous évoquons dans cet article nos expériences en République Démocratique du Congo. Une première difficulté est à chercher du côté linguistique. En effet, la langue et la culture anglo-saxonnes dominent largement la discipline, compliquant la tâche de ceux qui maîtrisent mal l'anglais. Unedeuxième difficulté à surmonter est d'ordre conceptuel. Les objectifs et le champ d'application de la bioéthique sont souvent mal compris, ce qui peut conduire à confondre les spécialistesde la discipline tantôt avec des moralistes surtout préoccupés par le progrès biotechnologique, tantôt avec des référents religieux. La troisième difficulté évoquée est de nature politique et culturelle. Lorsqu'elle entre en interaction avec des communautés très hiérarchisées et conservatrices, la posture critique de la bioéthique peut susciter des réactions de rejet. Ce sont sans doute ces difficultés qui ont alimenté certaines critiques acerbes sur la pertinence des formations à l'éthique dans des zones marquées par les urgences sanitaires et alimentaires ou certaines accusations présentant ces démarches comme un avatar de plus de l'impérialisme occidental. Tout en prenant au sérieux ces difficultés, nous montrons par nos expériences qu'elles peuvent être transformées en défis à relever.

Assessing the contraceptive supply environment in Kinshasa, DRC: trend data from PMA2020.

Performance Monitoring and Accountability 2020 (PMA2020) is a population-based and facility-based survey program conducted in 11 countries to track contraceptive use dynamics and the supply environment. Annual data collection provides trend data unavailable from any other source. Two-stage cluster sampling was used to select 58 enumeration areas in Kinshasa; data were collected in 2014, 2015 and 2016 from three to six service delivery points (SDPs) per EA. Of the 228-248 SDPs surveyed each year, only two-thirds reported to offer family planning (FP) services. Of those reporting to offer FP, one-fifth or more did not do so on the day of the survey. As of 2016, only one-half of SDPs offering FP had at least three methods available, a proxy for contraceptive choice; only one in five had at least five methods. Long-acting reversible contraceptives, including implants and IUDs, were less widely offered and more often stocked out than resupply methods, including condoms, pills and injectables. Contraceptive stockouts were rampant: in 2016, over a quarter of the SDPs experienced stockouts of all methods (except condoms) in the previous 3 months, and two of the three most widely used methods-implants and injectables-were also the most likely to be stocked out. The findings documented the inconsistency in pricing of methods across facilities; moreover, less than one quarter of SDPs posted prices. Patterns in the contraceptive supply environment remained relatively unchanged between 2014 and 2016. The PMA2020 SDP module provides timely, actionable information to the DRC government, FP implementing organizations and donors involved in FP service delivery in Kinshasa, DRC. Yet the value of this information will be determined by the ability of the local FP stakeholders to use it in bringing the needed improvements identified by this survey to the contraceptive supply environment.

Uncontrolled hypertension among patients managed in primary healthcare facilities in Kinshasa, Democratic Republic of the Congo.

BACKGROUND: Uncontrolled hypertension remains an important issue in daily clinical practice worldwide. Although the majority of patients are treated in primary care, most of the data on blood pressure control originate from population-based studies or secondary healthcare. OBJECTIVE: The aim of this study was to evaluate the frequency of uncontrolled hypertension and associated risk factors among hypertensive patients followed at primary care facilities in Kinshasa, the capital city of Democratic Republic of the Congo. METHODS: A sample of 298 hypertensive patients seen at primary healthcare facilities, 90 men and 208 women, aged ≥ 18 years, were consecutively included in this cross-sectional study. The majority (66%) was receiving monotherapy, and diuretics (43%) were the most used drugs. According to 2007 European Society of Hypertension/European Society of Cardiology hypertension guidelines, uncontrolled hypertension was defined as blood pressure ≥ 140/90 or ≥ 130/80 mmHg (diabetes or chronic kidney disease). Logistic regression analysis was used to identify the determinants of uncontrolled hypertension. RESULTS: Uncontrolled hypertension was observed in 231 patients (77.5%), 72 men and 159 women. Uncontrolled systolic blood pressure (SBP) was more frequent than uncontrolled diastolic blood pressure (DBP) and increased significantly with advancing age (p = 0.002). The proportion of uncontrolled SBP and DBP was significantly higher in patients with renal failure (p = 0.01) and those with high (p = 0.03) to very high (p = 0.02) absolute cardiovascular risk. The metabolic syndrome (OR 2.40; 95% CI 1.01-5.74; p = 0.04) emerged as the main risk factor associated with uncontrolled hypertension. CONCLUSION: Uncontrolled hypertension was common in this case series and was associated with factors related to lifestyle and diet, which interact with blood pressure control.

Sickle cell trait is not associated with chronic kidney disease in adult Congolese patients: a clinic-based, cross-sectional study.

OBJECTIVE: The aim of this study was to evaluate the determinants of chronic kidney disease (CKD) with special emphasis on sickle cell trait (SCT). METHODS: Three hundred and fifty-nine patients (171 men and 188 women), aged 18 years or older, with reduced kidney function (eGFR < 90 ml/min/1.73 m(2)) and seen at secondary and tertiary healthcare in Kinshasa were consecutively recruited in this cross-sectional study. Serum creatinine and haemoglobin electrophoresis were performed in each patient. CKD was defined as < 60 ml/min/1.73 m(2). Logistic regression analysis was used to assess determinants of CKD with a special emphasis on SCT. A p-value < 0.05 defined the level of statistical significance. RESULTS: SCT was present in 19% of the study population; its frequency was 21 and 18% (p > 0.05) in patients with and without CKD, respectively. In multivariate analysis, sickle cell trait was not significantly (OR: 0.38; 95% CI: 0.559-1.839; p = 0.235) associated with CKD; the main determinants were dipstick proteinuria (OR: 1.86; 95% CI: 1.094-3.168; p = 0.02), the metabolic syndrome (OR: 1.69; 95% CI: 1.033-2.965; p = 0.03), haemoblobin ≥ 12 g/dl (OR: 0.36; 95% CI: 0.210-0.625; p = 0.001), and personal history of hypertension (OR: 2.16; 95% CI: 1.202-3.892; p = 0.01) and of diabetes mellitus (OR: 2.35; 95% CI: 1.150-4.454; p = 0.001). CONCLUSION: SCT was not an independent determinant of CKD in the present case series. Traditional risk factors emerged as the main determinants of CKD.

HIV infection and risk factors among the armed forces personnel stationed in Kinshasa, Democratic Republic of Congo.

Despite recent declines in HIV incidence, sub-Saharan Africa remains the most heavily affected region in the global HIV/AIDS epidemic. Estimates of HIV prevalence in African military personnel are scarce and inconsistent. We conducted a serosurvey between June and September 2007 among 4043 Armed Forces personnel of the Democratic Republic of Congo (FARDC) stationed in Kinshasa, Democratic Republic of Congo (DRC) to determine the prevalence of HIV and syphilis infections and describe associated risk behaviours. Participants provided blood for HIV and syphilis testing and responded to a demographic and risk factor questionnaire. The prevalence of HIV was 3.8% and the prevalence of syphilis was 11.9%. Women were more likely than men to be HIV positive, (7.5% vs. 3.6% respectively, aOR: 1.66, 95% C.I: 1.21-2.28, p < 0.05). Factors significantly associated with HIV infection included gender and self-reported genital ulcers in the 12 months before date of enrollment. The prevalence of HIV in the military appears to be higher than the general population in DRC (3.8% vs. 1.3%, respectively), with women at increased risk of infection.

[Determinants of survival in HIV patients receiving antiretroviral therapy in Goma, Democratic Republic of Congo]. / Les déterminants de la survie des patients vivant avec le VIH sous thérapie antirétrovirale dans la ville de Goma, RD-Congo.

BACKGROUND: The study aimed to identify factors associated with the survival of patients receiving antiretroviral therapy. METHODS: A historic cohort of HIV patients from two major hospitals in Goma (Democratic Republic of Congo) was followed from 2004 to 2012. The Kaplan-Meier method was used to describe the probability of survival as a function of time since inclusion into the cohort. The log-rank test was used to compare survival curves based on determinants. The Cox regression model identified the determinants of survival since treatment induction. RESULTS: The median follow-up time was 3.56 years (IQR=2.22-5.39). The mortality rate was 40 deaths per 1000 person-years. Male gender (RR: 2.56; 95 %CI 1.66-4.83), advanced clinical stage (RR: 2.12; 95 %CI 1.15-3.90), low CD4 count (CD4 < 50) (RR: 2.05; 95 %CI : 1.22-3.45), anemia (RR: 3.95; 95 %CI 2.60-6.01), chemoprophylaxis with cotrimoxazole (RR: 4.29, 95 % CI 2.69-6.86) and period of treatment initiation (2010-2011) (RR: 3.34; 95 %CI 1.24-8.98) were statistically associated with short survival. CONCLUSION: Initiation of treatment at an early stage of the disease with use of less toxic molecules and an increased surveillance especially of male patients are recommended to reduce mortality.

Left ventricular hypertrophy and geometry in type 2 diabetes patients with chronic kidney disease. An echocardiographic study.

OBJECTIVE: We assessed left ventricular structural alterations associated with chronic kidney disease (CKD) in Congolese patients with type 2 diabetes. METHODS: This was a cross-sectional study of a case series. We obtained anthropometric, clinical, biological and echocardiographic measurements in 60 consecutive type 2 diabetes patients (37 females, 62% ) aged 20 years or older from the diabetes outpatient clinic, University of Kinshasa Hospital, DRC. We computed creatinine clearance rate according to the MDRD equation and categorised patients into mild (CrCl > 60 ml/min per 1.73 m(2)), moderate (CrCl 30-60 ml/min per 1.73 m(2)) and severe CKD (< 30 ml/min per 1.73 m(2)). Left ventricular hypertrophy (LVH) was indicated by a LV mass index (LVMI) > 51 g/m(2.7) and LV geometry was defined as normal, or with concentric remodelling, eccentric or concentric hypertrophy, using relative wall thickness (RWT) and LVMI. RESULTS: Compared to patients with normal kidney function, CKD patients had higher uric acid levels (450 ± 166 vs 306 ± 107 µmol/l; p ≤ 0.001), a greater proportion of LVH (37 vs 14%; p ≤ 0.05) and longstanding diabetes (13 ± 8 vs 8 ± 6 years; p ≤ 0.001). Their left ventricular internal diameter, diastolic (LVIDD) was (47.00 ± 6.00 vs 43.00 ± 7.00 mm; p ≤ 0.001), LVMI was (47 ± 19 vs 36.00 ± 15 g/m2.7; p ≤ 0.05) and proportions of concentric (22 vs 11%; p ≤ 0.05) or eccentric (15 vs 3%; p ≤ 0.05) LVH were also greater. Severe CKD was associated with increased interventricular septum, diastolic (IVSD) (12.30 ± 3.08 vs 9.45 ± 1.94 mm; p ≤ 0.05), posterior wall thickness, diastolic (PWTD) (11.61 ± 2.78 vs 9.52 ± 1.77 mm; p ≤ 0.01), relative wall thickness (RWT) (0.52 ± 0.17 vs 0.40 ± 0.07; p ≤ 0.01) rate of LVH (50 vs 30%; p ≤ 0.05), and elevated proportions of concentric remodelling (25 vs 15%; p ≤ 0.05) and concentric LVH (42 vs 10%; p ≤ 0.05) in comparison with patients with moderate CKD. In multivariable adjusted analysis, hyperuricaemia emerged as the only predictor of the presence of LVH in patients with CKD (adjusted OR 9.10; 95% CI: 2.40-33.73). CONCLUSION: In keeping with a higher rate of cardiovascular events usually reported in patients with impaired renal function, CKD patients exhibited LVH and abnormal LV geometry.

Déterminants de l'utilisation de la moustiquaire impregnée d'insecticide chez les enfants de moins de cinq ans à Kinshasa

Contexte. Le paludisme est un probleme majeur de sante publique en Republique Democratique du Congo. L'utilisation de la moustiquaire impregnee d'insecticide (MII) compte parmi les options les plus efficaces retenues pour lutter contre ce fleau. Cette pratique est encore faible dans la communaute et loin d'approcher le seuil de 60fixe par le sommet d'Abuja. Objectif. Identifier les determinants de l'utilisation de la MII par les enfants de moins de cinq ans a Kinshasa Materiel et methodes. Etude de type transversale; conduite entre le 05 et le 20 aout 2008; dans la zone de sante de Lemba a Kinshasa; sur un echantillon de 299 menages. L'unite statistique retenue dans l'etude etait le menage disposant d'au moins un enfant de moins de cinq ans. La prevalence de l'utilisation de la MII a ete estimee; et la regression logistique a permis d'en identifier les determinants. Resultats. La frequence d'utilisation de la MII dans la population d'etude etait de 42;5(IC95: 36;9 - 48;1). Les determinants de son utilisation identifies etaient : la taille du menage (p= 0;032); l'utilisation d'alternatives a la MII (OR : 0;27 ; IC95:0;15 - 0;48 ; p 0;001) ; l'exposition aux p

Influence of Carotid Intima Media Thickness on Cardiovascular Risk Stratification in Black Hypertensive Patients. A Cross-Sectional Study

Objective: to assess the influence of carotid intima-media thickness in addition to traditional risk factors on cardiovascular risk assessment in hypertensive patients. Methods: 60 hypertensive patients ( 45 years) seen at the outpatient hypertension Clinic were included in the present study. They underwent the followings procedures: (i) medical history; physical examination and clinic blood pressure measurement; (ii) routine blood chemistry; (iii) carotid B mode ultrasound. Increased carotid IMT was defined as values 0.9 mm and 1.3 mm. 2007 ESH/ESC guidelines were used to assess cardiovascular risk. Chi square and Student t tests were used as appropriate. P value 0.05 defined the level ofstatistical significance. Results: according to 2007 ESH/ESC guidelines 5 (8); 16 (27); 25 (42) and 14 patients (23) were at low; moderate; high and very high risk; respectively. With the integration of cIMT; 5 (31) and 2 patients (8) initially at moderate and high risk; respectively; shifted from these categories to high and very high risk ones. The net reclassification improvement was 12for all the population. No changes were observed in initially low and very high risk patients. Conclusion: Carotid intima-media thickeness may improve cardiovascular risk stratification; mainly in moderate or intermediate risk hypertensive patients

Determinants de la frequentation tardive des services de soins prenatals dans les zones de sante de l'Equateur et du Katanga en Republique Democratique du Congo

Objectifs. Estimer la frequence de la frequentation tardive des soins prenatals; et en identifier les principaux determinants dans certaines zones de sante de la Republique Democratique du Congo. Methodologie. Etude transversale analytique; dans 6 zones de sante de 2 provinces de la RD Congo; portant sur 465 gestantes ou femmes allaitantes; selectionnees selon un echantillonnage a plusieurs degres. Les caracteristiques sociodemographiques; l'histoire genesique; et les facteurs d'utilisation des soins de sante ontete collectes. La frequentation prenatale tardive etait definie comme une premiere visite accomplie par une femme enceinte apres le 4eme mois de gestation; ou apres la 16eme semaine d'amenorrhee. Le test de chi-carre; le test t de Student; et la regression logistique ont ete utilises pour etudier les associations; comparer les moyennes; et identifier les determinants. Resultats. La frequentation des soins prenatals interessait 85.7des repondantes; et etait tardive pour 59.8des grossesses (IC95: 54.0-65.6). Sa frequence etait plus elevee dans le milieu rural et parmi les multipares. Elle est motivee par les contraintes financieres ou l'absence de problemes lors de la grossesse. Elle est determinee par le milieu de vie; le niveau d'etude; la religion; la parite; la gestite; l'age; la taille du menage; l'occupation; et la perception du tarif applique. Elle est reduite par l'instruction et l'emploi remunere. Conclusion. Le delai dans l'initiation de la CPN demeure encore un probleme dans les zones de sante de notre pays. Cette situation handicape l'atteinte des objectifs de sante de la mere et de l'enfant. L'identification de principaux determinants de ce retard incite a promouvoir des strategies ciblees; en vue d'influencer les comportements et les attitudes des personnes les plus vulnerables. L'education sanitaire; l'implication de la communaute; et la mise en oeuvre desstrategies qui reduisent le payement direct au point de prestation; peuvent contribuer a minimiser ce phenomene dans notre contexte

Increased Carotid Intima-Media Thickness and Associated Risk Factors among Congolese Hypertensive Patients in Kinshasa. A Cross-Sectional Study

Objective. To assess the prevalence of increase carotid Intima-media thickness and associated risk factors in hypertensive patients. Methods. 60 consecutive hypertensive patients ( 45 years) seen at the outpatient hypertension Clinic were included in the present study. They underwent the following procedures: (i) medical history; physical examination and clinic blood pressure measurement; (ii) routine blood chemistry; (iii) carotid B mode ultrasound. Increased carotid IMT was defined as values 0.9 mm and 1.3 mm or values 75th percentile. 2007 ESH/ESC guidelines were used to assess cardiovascular risk. Univariate logistic regression analysis was used to evaluate risk factors associated with increased cIMT. P value 0.05 defined the level of statistical significance. Results. Increased IMT was present in 12and 32of patients using values 0.9 mm and 0.8 (75th percentile); respectively. Age 60 years (OR: 7.5; 95CI: 1.9-30; p = 0.003); diabetes 5 years (OR: 2.0; 95CI: 1.1-3.7; p = 0.016); hypertension 7 years (OR: 3.6; 95CI: 1.1-13; p = 0.029) and uric acid 7 mg/dl (OR: 4.6; 95CI: 1.4-15; p = 0.012) emerged as the main predictors of the risk of having increased cIMT. Conclusion. Increased IMT was common among the present case series; diabetes; hypertension and hyperuricemia; all components of the MetS; emerged as the main modifiable risk factors associated with increased cIMT. Therapeutic lifestyle changes should be encouraged in addition to antihypertensive therapy in these patients

Issues thérapeutiques des patients tuberculeux suivis dans les centres de dépistage et de traitement de la ville de Matadi, dans le contexte du VIH

Contexte. La tuberculose et l'infection a VIH/SIDA sont deux problemes majeurs de sante publique en Republique Democratique du Congo. Dans la lutte antituberculeuse; la co-infection VIH/TB pose un probleme en matiere de choix du regime therapeutique; du moment optimal du debut du traitement et pour l'issue du traitement antituberculeux. Cette etude vise a evaluer l'association entre le statut serologique VIH du patient; le traitement par anti-retroviraux (ARV); et l'issue therapeutique sous antituberculeux. Methodes. Une etude de cohorte retrospective portant sur 484 patients; avec tuberculose pulmonaire a frottis positif; depistes et suivis en 2008-2009; a ete realisee dans les 3 centres de sante de diagnostic et de traitement de la Zone de Sante de Matadi. Le test Khi-carre a permis de comparer l'association entre l'issue et la serologie VIH d'une part; et entre l'issue et le traitement antiretroviral pour les co-infectes d'autre part. Le risque relatif a permis de mesurer la force de ces associations. Resultats. L'etude a inclus 484 malades tuberculeux a frottis positif (261 hommes; 223femmes). Un malade tuberculeux sur dix etait VIH+ (10;5; IC95: 7;8- 13;2). Le taux de succes therapeutique parmi les tuberculeux VIH+ etait plus faible que celui des tuberculeux VIH- (72;6 vs 87;8; RR = 0;83[0;69 - 0;98]) et le taux d'issue defavorable parmi les tuberculeux VIH+ etait superieur a celui des tuberculeux VIH- (13;7 vs 6; RR = 2;29[1;04 - 4;99]). L'issue therapeutique des patients co-infectes n'est pas influencee par le traitement antiretroviral. Conclusion. Cette etude a montre que l'issue therapeutique de la tuberculose chez les sujets infectes par le VIH est moins favorable que celle des sujets seronegatifs. L'impact des ARV sur l'issue du traitement antituberculeux n'a pas ete clairement etabli

Metabolic syndrome using national cholesterol education program criteria in black patients with arterial hypertension

Objective: to assess the prevalence and correlates of the metabolic syndrome (MS) in black patients with essential hypertension. Methods: A total of 100 consecutive essential hypertensives (53 men and 47 women, mean age 49 ± 10 years, BMI 27 ± 5 Kg/m², SBP 155 ± 19 mmHg, DBP 101 ± 11 mmHg) attending the University of Kinshasa outpatient hypertension clinic and included in a case-control study of lipids and lipoproteins were considered for the present cross sectional analysis. All patients underwent clinical, laboratory and electrocardiographic investigations searching for lipid and lipid cardiovascular risk factors. NCEP-ATP III criteria were used to define the MS. Between group comparisons were made with the Student t test, Mann Whitney U test or Chi square as appropriate. Results: 31 hypertensive patients (33%), 23 men and 8 women, fulfilled the NCEP-ATP III criteria of the MS. In univariate analysis, aside the variables defining the MS, patients with the MS had a significantly higher TC/HDL-c ratio (4.44 ± 2.40 vs 3.79 ± 1.82; p ≤ 0.05) and proportion (13% vs 3%, p ≤ 0.05) of smokers; they paradoxically showed lower proportion (39% vs 52%, p ≤ 0.05) of left ventricular hypertrophy (LVH) in comparison to those without the MS. The two groups were similar for age, sex distribution, duration of hypertension, physical activity, treatment status, BP and other biological variables. Multivariate logistic regression analysis was used to determine the independent contribution of risk factors to the risk of MS. Conclusion: MS is common among Congolese patients with essential hypertension and seems to be paradoxically associated with less pronounced cardiac damage probably due to the phenomenon of reverse epidemiology of traditional cardiovascular risk factors

Decreased ventilatory response to exercise by dopamine-induced inhibition of peripheral chemosensitivity.

The contribution of the peripheral chemoreflex to the ventilatory response to exercise and aerobic exercise capacity remains incompletely understood. Low-dose dopamine has been reported to specifically inhibit the peripheral chemoreceptors. We therefore investigated the effects of intravenous dopamine (3 microg kg(-1)min(-1)) on cardiopulmonary exercise test (CPET) variables in 13 healthy young male subjects. The study was prospective, placebo-controlled, and randomized with more than 24h between placebo and dopamine administrations. During the CPET, dopamine decreased the .V(E)/.V(CO2) output slope (24.61+/-1.84 vs. 23.09+/-1.81, placebo vs. Dopamine respectively, p=0.025), without affecting maximum workload, .V(E) and O(2) uptake. In conclusion, our study reveals that inhibition of peripheral chemoreflex function with dopamine decreases the .V(E)/.V(CO2) slope during dynamic exercise, with no change in aerobic exercise capacity.

[Study of prostate cancer screening in a population of employees of a Kinshasa company in the Democratic Republic of Congo. Detection rate and nutritional and geographical risk factors]. / Etude de dépistage du cancer de la prostate au sein d'une population d'employés d'une entreprise de Kinshasa en république démocratique du Congo. Taux de détection et facteurs de risques nutritionnels et géographiques.

OBJECTIVE: To detect prostate cancer in the employees of a Kinshasa company and to identify sociodemographic and clinical characteristics of men with prostate cancer. MATERIAL AND METHODS: From September 2004 to December 2005, a cross-sectional, prospective prostate cancer screening study by PSA, digital rectal examination and transrectal ultrasound was conducted in 162 men aged 40 to 70 years. The upper limit of normal for PSA was 2.5ng/ml. Finger-guided prostatic biopsy was only performed in subjects with suspicious findings (n=38). Histological examination was performed in the Department of Defense of Armed Forces, Institute of Pathology, at Brugmann teaching hospital and the Kinshasa University Clinics. RESULTS: Four adenocarcinomas, two PIN II and two PIN III were detected, that is a prostate cancer detection rate of 2.5%. Prostate cancer was only detected among men from three of the eight provinces. Two of the men with prostate cancer had a diet rich in animal fats and two had a family history of prostate cancer. The mean PSA in men with prostate cancer was high (17.37+/-8.56ng/ml) compared to men without prostate cancer (2.7+/-4.2ng/ml). DISCUSSION: The underestimated prostate cancer detection rate of 2.5% is close to that of 2.6 to 3.2% for Caucasians in Europe and America but less than that of 5.1% for the black American population. This study provides a database on prostate cancer in the Democratic Republic of Congo.

Determinants of consistent condom use among female commercial sex workers in the Democratic Republic of Congo: implications for interventions.

OBJECTIVE: To identify correlates of consistent condom use among commercial sex workers (CSW) over a four-week period. METHODS: A total of 2638 CSW selected in all the provincial capital cities in the Democratic Republic of Congo using the time location sampling technique were interviewed to collect information on sociodemographic data, sexual history and behaviour, consumption of intoxicants (alcohol and drugs), knowledge of condoms, their accessibility and the pattern of their use over a four-week period, and exposure to HIV/AIDS prevention services. RESULTS: 40% (95% CI 38.1 to 41.8) of the CSW have used condoms consistently and this pattern differed according to the category of sexual partners (61.4% in the case of paying partners and 38.2% in the case of non-paying partners). Consistent condom use was associated with age, those aged 20-44 years were more likely to be consistent users (OR 1.34, 95% CI 1.06 to 1.69), having cited it as a prevention means for HIV (OR 2.88, 95% CI 2.09 to 3.96), less time in commercial sex work, higher number of clients (OR 3.83, 95% CI 2.95 to 4.96), exposure to voluntary counselling and testing (VCT; OR 2.02, 95% CI 1.70 to 2.42), and access to condoms (OR 1.51, 95% CI 1.25 to 1.82). CONCLUSIONS: The risk perception bias associated with non-paying partners, time as a commercial sex worker and age should be taken into account when planning interventions targeting CSW. Access to condoms and VCT should be improved because they are likely to impact on behaviour.

Clinical correlates of left ventricular hypertrophy in black patients with arterial hypertension.

OBJECTIVE: To assess the relationship between the lipid profile, other cardiovascular risk factors and left ventricular hypertrophy (LVH) in black hypertensive patients. MATERIALS AND METHODS: We undertook a cross-sectional study of a case series at the hypertension clinic, University of Kinshasa Hospital. Lipids, lipoproteins and other cardiovascular risk factors were analysed in 100 consecutive hypertensive patients. Left ventricular hypertrophy was assessed by 12-lead electrocardiography (ECG) using Cornell voltage index. RESULTS: Forty-eight hypertensive patients, 26 men and 22 women, had LVH. With univariate analysis, the patients with LVH were older (age 52 +/- 9 vs 45 +/- 9 years; p /= 1.03 mmol/l (adjusted OR 0.19; 95% CI: 0.057-0.651), plasma glucose >/= 6.11 mmol/l (adjusted OR 0.19; 95% CI: 0.046- 0.828), or on treatment for hypertension (adjusted OR 0.23; 95% CI: 0.082-0.645) had a lower risk for cardiac damage compared to their respective control groups. CONCLUSION: LVH is a common complication in Congolese hypertensives. Dyslipidaemia, high plasma glucose levels, the duration of hypertension and being on antihypertensive therapy appear to be the main predictors of hypertensive cardiac damage.