Unprotected intercourse for extra money among commercial sex workers in Kinshasa, Democratic Republic of Congo.

This study assessed the extent and correlates of the practice of engaging in unprotected intercourse for extra money among commercial sex workers (CSWs) in Kinshasa, Democratic Republic of the Congo. We conducted a cross-sectional survey using a structured, interviewer-administered questionnaire among a convenience sample of 136 CSWs. More than one-quarter of CSWs (26.5%) engaged in unprotected intercourse for extra money. These CSWs charged about 3.5 times more for unprotected intercourse than for protected intercourse. Multivariate logistic regression showed that CSWs who engaged in unprotected intercourse for extra money were significantly more likely to live or work in non-downtown (lower socioeconomic) areas of Kinshasa (odds ratio [OR] = 3.07), to have at least one child less than six years of age (OR = 2.95), and to know other CSWs who engaged in the same practice (OR = 9.38). We hypothesize that desperate socioeconomic conditions combined with peer/social norms drive the practice of engaging in unprotected intercourse for extra money. Additional circumstances under which Kinshasa CSWs engaged in unprotected intercourse included intercourse with clients who tore their condoms to increase sexual pleasure (58.8% of CSWs), episodes of condom failure (56.8% of CSWs), and unprotected intercourse with regular noncommercial partners (only 5.3% of CSWs with noncommercial partners always used condoms with these partners).

Hospital-based surveillance of malaria-related paediatric morbidity and mortality in Kinshasa, Zaire.

Although Plasmodium falciparum malaria is a leading cause of paediatric morbidity and mortality in Africa, few quantitative estimates are available about the impact of malaria on childhood health. To quantify the impact of the disease in an urban African setting, we reviewed the paediatric ward and mortuary records at Mama Yemo Hospital in Kinshasa, Zaire. From June 1985 to May 1986, 6208 children were admitted to the hospital, 2374 (38.2%) of whom had malaria; 500 of those with malaria died (case fatality rate, 21.1%). During this same period, there were 10,036 paediatric deaths, 1323 (13.2%) of which were attributed to malaria; 823 (62.2%) of these occurred in the emergency ward prior to hospitalization. Minimum population-based malaria mortality rates were highest for children aged less than 1 year (4.0 per 1000 per year). Over 70% of children admitted with malaria and greater than 80% of children who died from the disease were less than 5 years old. The total number of paediatric admissions and deaths remained relatively constant between 1982 and 1986; however, the proportional malaria admission rate increased from 29.5% in 1983 to 56.4% in 1986, and the proportional malaria mortality rate, from 4.8% in 1982 to 15.3% in 1986. These increases were temporally related to the emergence of chloroquine-resistant Plasmodium falciparum malaria in Kinshasa. Malaria is therefore a major cause of paediatric morbidity and mortality in the city, and this study indicates that hospital-based surveillance may be useful in monitoring disease-specific morbidity and mortality elsewhere in Africa.

PIP: The pediatric ward and mortuary records at Mama Yemo Hospital in Kinshasa, Zaire were studied in an attempt to estimate the impact of malaria-related pediatric morbidity and mortality. Although Plasmodium falciparum malaria is a frequent cause of pediatric mortality and morbidity, few students have been made to try estimate the effect of the disease on childhood survival. Of the 6208 children admitted to the 3 pediatric wards of Mama Yemo Hospital between in Mama Yemo Hospital, 2374 (38.2%) had malaria. Of those who had malaria, 70% were 5 years or younger. 500 of the 2374 hospitalized children with malaria died. This accounted for 13.2% of all pediatric deaths. A significant rise in the number of malaria admissions was observed between 1983 and 1984, but no one has pinpointed with any certainty the reason why. It appears that an acquired immunity to malaria develops among younger children and that the disease most dramatically affects infants. 62.2% of the pediatric deaths occurred in the emergency ward of the hospital. Fast and intense clinical management of the disease is essential to the survival of the children affected. Monitoring health care facilities and their abilities in the control of disease, will provide suggestions for improvements in health-care delivery programs that may positively affect malaria-related mortality.