Low and stable HIV seroprevalence in pregnant women in Shaba province, Zaire.

Sentinel serosurveillance for HIV infection has been carried out in Shaba province, Zaire, among consecutive pregnant women attending antenatal clinics from 1989 to 1991. There were four surveillance sites (three urban and one semiurban), at which a total of 13 surveillance studies were made of 4,205 women. Overall, 3.1% were HIV seropositive. There were no significant differences in HIV seroprevalence between surveillance sites, and HIV seroprevalence did not increase at any of the surveillance sites during the 2-year period of study. Since changes in the population studied did not occur between surveillance studies, it is believed that the observed stable trend reflects stable HIV seroprevalence rates in the general adult population of the surveillance sites. Collateral HIV seroprevalence data were available from 8,725 blood donors at 20 sites (six urban, 14 rural) in the province, who had an overall HIV seroprevalence of 4.6%. The higher HIV seroprevalence rate among blood donors was probably due to selection bias, since HIV seroprevalence rates in two blood banks, which relied nearly exclusively on replacement donors, were 2.7 and 2.8%, our best estimate for HIV seroprevalence in the three cities where blood banks exist and where no surveillance studies were carried out. The stable and relatively low HIV seroprevalence rates in Shaba province are in sharp contrast with the rapidly increasing and much higher rates in neighboring Zambia and other East African cities. Reasons for this discrepancy are unclear, and their eludication may yield critical information for HIV prevention programs.

[The characteristics of pregnancy-puerperium in central Africa. I. Cesarean section in 3 different areas in Zaire]. / Particularismes de la gravido-puerpéralité en Afrique centrale. I. Opération césarienne dans trois environnements différents au Zaïre.

A series of 5,127 deliveries carried out in rural (Boende), in semi-urban (Bonzola) and in the urban university teaching hospital units was studied from April to September 1986 to assess pregnancy and the puerperium in a Zairian population. In particular the Caesarean section rate was looked at. Two hundred and forty eight Caesareans were carried out--a rate of 4.8%. More were carried out in university centres (8.6%), than in semi-urban districts (2.2%) or in rural hospitals (1.3%). The maternal morbidity due to haemorrhage and infection and the mortality were also higher in the urban and teaching hospitals (5.9% and 2.3%) than in the other hospitals. In Bonzola it was 2.5% and 0.3%. These figures suggest overall that carrying out Caesarean operations in developing countries with poor equipment has to be considered much more seriously than in centres that are well equipped.