Risk Factors for Hemorrhagic Stroke among Adults in the Democratic Republic of the Congo: A Hospital-Based Study in a Limited Resource Setting.

Background: The prevalence of stroke is increasing in sub-Saharan Africa. The scarcity of hospital-based stroke data in Lubumbashi (in the Democratic Republic of the Congo) led to the study, which was designed to describe the epidemiology of stroke and identify risk factors associated with hemorrhagic stroke among adult patients in Lubumbashi. Methods: This was a cross-sectional study of 158 adult patients admitted for stroke in the internal medicine department of Lubumbashi University Clinics from January 2018 to December 2020. Sociodemographic and clinical features, cardiovascular risk factors, and hospital mortality were collected. A logistic regression has determined the risk of developing a hemorrhagic stroke. Results: Of 9,919 hospitalized patients, 158 had a stroke with a hospital prevalence of 1.6%; 86 (54.4%) patients had a hemorrhagic stroke while 72 (45.6%) had an ischemic stroke. Of which 41.1% (65/158) were women. The mean age was 60.8 ± 13.3 years. Main clinical signs were hemiplegia (63.3%), headache (48.7%), speech disorders (38.6%), and dizziness (38.6%). Hypertension (82.9%) and hyperglycemia (53.2%) were the most common risk factors. Inhospital mortality was 22.8%. After logistic regression, independent predictors for developing hemorrhagic stroke were hypertension (aOR = 8.19; 95% CI: 2.72-24.66; p < 0.0001) and atrial fibrillation (aOR = 4.89; 95% CI: 1.41-16.89; p = 0.012). Conclusion: This study highlights the high stroke mortality in a resource-limited hospital and the burden of hypertension in the development of hemorrhagic stroke. It illustrates the need to establish stroke care setting to improve the quality of stroke care.

[Prevalence of overweight and obesity among adolescents in school in Lubumbashi, Democratic Republic of Congo]. / Prévalence du surpoids et de l'obésité chez l'adolescent en milieu scolaire à Lubumbashi, République Démocratique du Congo.

INTRODUCTION: overweight and obesity in adolescents are a major global public health issue due to their potential impact on health and increasing frequency. This study aims to determine the prevalence of overweight and obesity among adolescents attending public and private schools in Lubumbashi (DRC). METHODS: we conducted a cross-sectional study of 5341 adolescents aged 10-19 years, 2858 (53.5%) girls and 2483 (46.5%) boys. Weight and height were measured for each adolescent and then body mass index (BMI) was calculated. RESULTS: the average weight was 43,78 ± 11.62 kg (42,39 ± 12.11 kg for boys and 44.95 ± 11.04 kg for girls), the average height was 151,30 ± 13,09 cm (151.20 ± 14.64 cm for boys and 151,38 ± 11.58 cm for girls) and BMI was 18,82 ± 3.15 kg/m² (19.39 ± 3.39 kg/m² for boys and 18.17 ± 2.71 kg/m² for girls). The prevalence of overweight was 8% while that of obesity was 1%. The girls were significantly more affected by overweight (10.7% girls against 5% boys) and obesity (1.5% girls against 0.4% boys) than the boys. CONCLUSION: overweight and obesity in school environment are a reality in Lubumbashi. The prevalence of overweight and obesity in this age group category should be determined in a national evaluation plan in order to implement preventive and therapeutic strategies.

Prévalence du surpoids et de l'obésité chez l'adolescent en milieu scolaire à Lubumbashi, République Démocratique du Congo

Introduction: le surpoids et l'obésité au cours de l'adolescence constituent un problème préoccupant de santé publique à l'échelle mondiale en raison de leur retentissement potentiel sur la santé et de leur fréquence croissante. La présente étude avait pour objectif de déterminer la prévalence du surpoids et de l'obésité chez les adolescents scolarisés dans les établissements publics et privés à Lubumbashi, en République Démocratique du Congo. Méthodes: il s'agissait d'une étude transversale menée auprès de 5.341 adolescents âgés de 10 à 19 ans, dont 2.858 (53,5%) filles et 2.483 (46,5%) garçons ont constitué notre échantillon. Pour chacun d'eux, nous avons mesuré le poids et la taille puis calculé l'indice de masse corporelle (IMC). Résultats: la moyenne du poids était de 43,78 ± 11,62 kg (soit 42,39 ± 12,11 kg pour les garçons et 44,95 ± 11,04 kg pour les filles), celle de la taille était de 151,30 ± 13,09 cm (soit 151,20 ± 14,64 cm pour les garçons et 151,38 ± 11,58 cm pour les filles) et celle de l'IMC était de 18,82 ± 3,15 kg/m2 (soit 19,39 ± 3,39 kg/m2 pour les garçons et 18,17 ± 2,71 kg/m2 pour les filles). La prévalence du surpoids était de 8% et celle de l'obésité était de 1%. Les filles étaient significativement plus touchées par le surpoids (10,7% filles contre 5% garçons) et l'obésité (1,5 % filles contre 0,4% garçons) que les garçons. Conclusion: le surpoids et l'obésité chez les adolescents en milieu scolaire s'avèrent une réalité à Lubumbashi. La détermination de la prévalence du surpoids et de l'obésité pour cette catégorie d'âge au plan national est recommandable pour leurs préventions et prises en charges

[Blood pressure profile in adolescents at school in Lubumbashi, Democratic Republic of the Congo]. / Profil pressionnel de l'adolescent en milieu scolaire à Lubumbashi, République Démocratique du Congo.

INTRODUCTION: This study aimed to highlight blood pressure (BP) profile in adolescents aged 15-19 years at school in Lubumbashi, Democratic Republic of the Congo. METHODS: We conducted a cross-sectional study of adolescents aged 15-19 years through random sampling of the secondary schools in Lubumbashi during the school years 2013-14, 2014-15 and 2015-16. Blood pressure was measured three times in the same day. RESULTS: Our study included 1766 adolescents aged 15-19 years, of whom 995 were females and 771 boys. Boys' systolic blood pressure was significantly higher than that of girls aged 17, 18 and 19 years. Diastolic blood pressure was not statistically different in all different age groups in both sexes. On the other hand, in both sexes, systolic blood pressure was significantly correlated with body weight, size, body mass index, waist size and heart rate. With regard to diastolic blood pressure, significant correlations were found with body weight and body mass index in girls while heart rate was significantly correlated in both sexes. CONCLUSION: Despite the potential weaknesses of the present study with special regard to its cross-sectional design and to BP measures in the same day, collected data could help health authorities to adopt a national hypertension prevention strategy.

Oscillometric blood pressure by age and height for non overweight children and adolescents in Lubumbashi, Democratic Republic of Congo.

BACKGROUND: The diagnosis of hypertension in children is complex because based on normative values by sex, age and height, and these values vary depending on the environment. Available BP references used, because of the absence of local data, do not correspond to our pediatric population. Accordingly, our study aimed to provide the BP threshold for children and adolescents in Lubumbashi (DRC) and to compare them with German (KIGGS study), Polish (OLAF study) and Chinese (CHNS study) references. METHODS: We conducted a cross-sectional study among 7523 school-children aged 3 to 17 years. The standardized BP measurements were obtained using a validated oscillometric device (Datascope Accutor Plus). After excluding overweight and obese subjects according to the IOTF definition (n = 640), gender-specific SBP and DBP percentiles, which simultaneously accounted for age and height by using an extension of the LMS method, namely GAMLSS, were tabulated. RESULTS: The 50th, 90th and 95th percentiles of SBP and DBP for 3373 boys and 3510 girls were tabulated simultaneously by age and height (5th, 25th, 50th, 75th and 95th height percentile). Before 13 years the 50th and 90th percentiles of SBP for boys were higher compared with those of KIGGS and OLAF, and after they became lower: the difference for adolescents aged 17 years was respectively 8 mmHg (KIGGS) and 4 mmHg (OLAF). Concerning girls, the SBP 50th percentile was close to that of OLAF and KIGGS studies with differences that did not exceed 3 mmHg; whereas the 90th percentile of girls at different ages was high. Our oscillometric 50th and 90th percentiles of SBP and DBP were very high compared to referential ausculatory percentiles of the CHNS study respectively for boys from 8 to 14 mmHg and 7 to 13 mmHg; and for girls from 10 to 16 mmHg and 11 to 16 mmHg. CONCLUSIONS: The proposed BP thresholds percentiles enable early detection and treatment of children and adolescents with high BP and develop a local program of health promotion in schools and family.

Feasibility and implementation of community-based malaria case management with integrated vector control in the Democratic Republic of Congo.

BACKGROUND: Malaria prevalence in the Mulumbu Health Area in Lualaba Province, Democratic Republic of the Congo has remained high (>70 %) despite repeated vector control (indoor residual spray) and mass insecticide-treated bed net coverage. Therefore, a pilot study was implemented to attack the parasite directly and demonstrate the feasibility and acceptability of community case management of malaria (CCMm) using trained community health workers (CHWs). METHODS: A 13 month prospective evaluation of CCMm was undertaken in 14 rural villages. Focus group discussions and structured interviews were conducted in pre- and post-intervention periods to assess community acceptability of CCMm. Weekly data collected by CHWs assessed program impact over time, matched with malaria school-based prevalence surveys (MSPS) in the Mulumbu Health Area (CCMm study arm) compared to a comparison (non-CCMm) arm in the Mpala Health Area approximately 25 km apart. RESULTS: Overall population perception of the CCMm was highly positive. 6619 community contacts were managed by CHWs from which 1433 (21.6 %) were malaria positive by rapid detection tests during the 10 month intervention. Among the malaria infected, 94.7 % (1358) were recorded as 'uncomplicated' infections with 99.7 % provided full course of treatment. CHWs referred 278 (4.2 %) patients deemed 'complicated' to a designated primary health center for advanced care. While pre-intervention MSPS data revealed significantly higher (p = 0.0135) malaria in the CCMm area compared to the non-CCMm area, at post-intervention there was no statistical difference (p = 0.562) between the two areas. Notably, for the first time, no malaria-related deaths were recorded in the 14 CCMm intervention villages during observation. CONCLUSION: Community case management of malaria was shown to be an effective and promising strategy for prompt and effective management of malaria. It was well accepted by the community and showed evidence of a reduction in malaria morbidity and mortality. Further refinement of CCMm implementation, cost implications and sustainability is advised before expanding the programme.