[The epidemiological approach of clefts lip and palate in the eastern of Democratic Republic of Congo]. / Les fentes labiopalatines à l'est de la République Démocratique du Congo. Aspects épidémiologiques.

OBJECTIVE: This study aims to present the epidemiological profile of clefts lip/palate observed in the eastern of Democratic Republic of Congo (DRC) from January 2002 to May 2004, period of civil wars. METHOD: It is a retrospective study realized at Doctors on Call for service Learning Center (DOCS LC) in Goma/DRC concerning 89 cases of cleft lip/palate operated during the same period. The data processing was facilitated by the software package SPSS 17.0 installed in the IT center of DOCS. RESULTS: The average age of the consultation is 9.9 years with extreme of zero and 42 years. Both sexes are concerned: 50.6% of male and 49.4% of female. The more cleft extends from the superior lip to the palate through the alveolus, the more the frequency of the various types of clefts lips/palate decreases: 59.6% (simple clefts lip), 37.1% (labio-alveolar clefts), and 2.2% (cleft palate). The left incomplete cleft lip variety represents 33.7% of all varieties. Most of clefts lips/palate come from the first to the fifth pregnancy with a peak of frequency (19.1%) in the second pregnancy. No family history about congenital deformation was found from 97% of our patients. CONCLUSION: The epidemiology of cleft lip/palate in our area would be more connected to environmental factors than genetics: no family history of congenital deformation was seen for most of our patients during this period of civil war.

Career intentions of medical students trained in six sub-Saharan African countries.

INTRODUCTION: Sub-Saharan Africa(SSA) is the world region worst affected by physician migration. Identifying reasons why medical students wish to stay or leave Africa could assist in developing strategies which favour retention of these graduates. This study investigated the career intentions of graduating students attending medical schools in SSA to identify interventions which may improve retention of African physicians in their country of training or origin. METHODS: Final year medical students attending nine medical schools in SSA were surveyed--students from four schools in South Africa and one school each in the Democratic Republic of Congo, Kenya, Nigeria, Tanzania and Uganda. The response rate was 78.5% (990 of 1260 students); data from the 984 students who indicated they were remaining in medicine were entered into a database, and descriptive statistics were obtained. RESULTS: Most (97.4%) of the 984 responding students were African by birth. The majority (91.2%) intended to undertake postgraduate training; the top three specialty choices were surgery (20%), internal medicine (16.7%), and paediatrics (9%). Few were interested in family medicine (4.5%) or public health (2.6%) or intended to practice in rural areas (4.8%). Many students (40%) planned to train abroad. About one fifth (21%) intended to relocate outside sub-Saharan Africa. These were about equally divided between South Africans (48%) and those from the other five countries (52%). The top perceived career-related factors favouring retention in Africa were career options and quality and availability of training opportunities. Several factors were reported significantly more by South African than the other students. The top personal factors for staying in Africa were a desire to improve medicine in Africa, personal safety, social conditions and family issues. The top career-related factors favouring relocation outside Africa were remuneration, access to equipment and advanced technology, career and training opportunities, regulated work environment and politics of health care in Africa. Several of these were reported significantly more by students from the other countries as compared with South Africans. The top personal factors favouring relocation outside Africa were personal safety, opportunity for experience in a different environment, social conditions and greater personal freedom. DISCUSSION: The career intentions of African medical students are not aligned with the continent's health workforce needs. A number of interventions that warrant further attention were identified in this study.

Obstetric uterine ruptures in a rural area in Zaïre.

Uterine ruptures with their deplorable sequelae constitute a major obstetrical problem in the rural areas of Africa. The maternal and perinatal mortality remain high as a result, mainly due to the lack of early and adequate care for these patients. Grande-multiparity is one of the major predisposing factors. Prevention must necessarily include the availability of family planning advice, improved organization of and access to maternal care, and good supervision during delivery and the post-partum period. The general improvement of the overall socio-economic condition is a pre-condition to the improvement of access to care.

Penile cancer in rural Zaïre.

Penile cancer is a malignant tumour which we rarely encounter in rural Zaïre because circumcision is practised in several tribes at early age. We describe in 5 patients, penile cancer all from the same ethnic group (Hema, Nilotic ethnic group) living both in Zaïre and Uganda. In this tribe circumcision is not a routine surgical act. Delayed consultation and subsequent treatment are often seen. It is emphasized again that the lack of circumcision and living in poor hygienic circumstances are predisposing factors for squamous cell carcinoma (SCC) of the penis.

Selenium and the thyroid: how the relationship was established.

Several hypotheses concerning consequences of selenium deficiency on iodine metabolism can be proposed on the basis of experimental studies in rats and from epidemiological and experimental studies in humans. By decreasing intracellular GSH peroxidase activity, selenium deficiency may increase hydrogen peroxide (H2O2) supply and lead over several weeks to the thyroid atrophy observed in myxoedematous cretins. By improving thyroid hormone synthesis and by decreasing peripheral thyroxin (T4) deiodination, selenium deficiency could protect fetal brain T4 supply and thus prevent neurologic cretinism. Selenium deficiency may protect against iodine deficiency by decreasing T4 metabolism--and thus iodide leakage and--perhaps also by increasing H2O2 supply and thyroid hormone synthesis and thus thyroid efficiency.

Selenium deficiency mitigates hypothyroxinemia in iodine-deficient subjects.

Studies were performed to assess the role of combined selenium and iodine deficiency in the etiology of endemic myxedematous cretinism in a population in Zaire. One effect of selenium deficiency may be to lower glutathione peroxidase activity in the thyroid gland, thus allowing hydrogen peroxide produced during thyroid hormone synthesis to be cytotoxic. In selenium-and-iodine-deficient humans, selenium supplementation may aggravate hypothyroidism by stimulating thyroxin metabolism by the selenoenzyme type I iodothyronine 5'-deiodinase. Selenium supplementation is thus not indicated without iodine or thyroid hormone supplementation in cases of combined selenium and iodine deficiencies.

Cesarean section--indications and risks in rural Zaire.

In a retrospective study in rural Zaire, 10.2% of all deliveries were conducted by cesarean section. Common indications were contracted pelvis and uterine dysfunction (37%) and previous cesarean delivery (32%). Compared with normal delivery, mortality was higher after cesarean section. Cesarean section should only be performed by well-trained personnel and when vaginal delivery is deemed inappropriate.