[Epidemio-clinical and seminal profile of the man consulting for the desire to procreate: current situation in Lubumbashi, in the Democratic Republic of Congo]. / Profil épidémio-clinique et séminal de l'homme consultant pour désir de procréation: état des lieux à Lubumbashi, en République Démocratique du Congo.

Introduction: in Lubumbashi, as in upscale areas where explorations of fertility are very clever, the spermogram remains the essential analysis in the diagnosis of male infertility. This is the cause of 40% of couple infertility. The spermogram is the first step in identifying seminal abnormalities. The objective of this study was to determine the epidemiological-clinical and seminal profile of the man consulting for the desire to procreate in Lubumbashi. Methods: this was a cross-sectional study. We received 202 subjects in Lubumbashi, whose spermogram was performed from August 1st, 2020 to July 31st, 2021. The semen parameters were studied and interpreted according to WHO standards (2010) with studies of factors associated with their disturbance. Bivariate and multivariate analyzes had been carried out. The statistical significance threshold was set at p < 0.05. Results: the epidemiological-clinical profile of the respondents was as follows: the most represented age group was 30 to 39 years; infertility was primary in 80.69% of cases; the duration of the desire for paternity was 2 years at most in 44.55% of cases. The sperm abnormalities found were: oligozoospermia (40.09%), azoospermia (11.38%), asthenozoospermia (18.31%) and teratozoospermia (10.39%). Oligozoospermia was significantly associated with varicocele (ORa = 10.9 [3.0-39.5]; p < 0.0001), genital infection (ORa =2.7 [1.0-7, 2]; p = 0.041) and obesity (ORa = 2.6 [1.0-7.9]; p = 0.020) while azoospermia was the cure for inguinal hernia (ORa = 4.2 [1.0-17.2]; p = 0.049) and malnutrition (ORa =6.0 [1.2-29.7]; p = 0.027). Asthenozoospermia was significantly associated with the age group of 40 to 49 years (ORa = 6.6 [1.2-37.4]; p = 0.034), tobacco (ORa =7.5 [2.7 -21.0]; p = 0.000), undernutrition (ORa = 7.7 [1.0-61.9]; p = 0.045) and overweight (ORa =3.8 [1.3-11, 5]; p=0.019). Teratozoospermia was significantly associated with smoking (ORa = 5.6 [1.8-17.7]; p = 0.003) and overweight (ORa =5.3 [1.2-23.3]; p = 0.027). Conclusion: more than half of the respondents had, of the three main fertility parameters, at least one that was disturbed. Sperm count was the most affected parameter. Alcohol, tobacco, genital infection and malnutrition were the most common risk factors for the abnormalities observed.

[Model predicting failure in surgical repair of obstetric vesicovaginal fistula]. / Modèle prédictif de l'échec de la réparation chirurgicale de la fistule obstétricale vésico-vaginale.

INTRODUCTION: There are more than 2 million cases of genital fistula in sub-Saharan Africa and in Asia. They occur in people living in areas where the access to medical care during pregnancy and childbirth are limited or of poor quality and where few hospitals can provide adequate surgical repair. The purpose of this study was to develop a score to predict the factors influencing failure in surgical repair of obstetric vesicovaginal fistula (VVF) in the southeastern part of the province of the Upper Katanga. METHODS: We conducted a cross-sectional analytical study of 384 women with vesicovaginal fistula who had undergone surgery. We performed a multivariate and then a univariate analysis. The discrimination of the score was assessed using the ROC curve and the C-index while the calibration of the score using Hosmer-Lemeshow's test. RESULTS: Surgical repair of obstetric vesicovaginal fistula failed in 17.19% of cases (66/384). After logistic modelling, four criteria emerged as predictors of failure in surgical repair of vesicovaginal fistula: the presence of a fibrotic scar (OR=15.22; CI 95%: 7.34-31.58), the presence of 2 fistulas or more (OR=7.41; CI 95%: 3.05-17.97), transvescical approach (OR=4.26; CI 95%: 1.92-9.44) and urethral involvement (OR=3.93; CI 95%: 1.99-7.77). The area under the ROC curve for the score was 0.8759, with a sensitivity of 57.58%, a specificity of 91.82% and a positive predictive value of 91.25%. CONCLUSION: This study demonstrated that the number of fistulas, the presence of fibrotic scar, urethral involvement and transvescical approach are predictors of failure in surgical repair of vesicovaginal fistula.

[Seroprevalence and factors associated with Voluntary Counselling and Testing (VCT) for HIV among children in Lubumbashi, Democratic Republic of the Congo]. / Séroprévalence et facteurs associés à l'acceptation du Conseil et Dépistage Volontaire du VIH chez l'enfant à Lubumbashi, République Démocratique du Congo.

INTRODUCTION: Despite proposals for screening infants or preschool children for HIV infection, the proportion of children who grow or die with unknown HIV status is high in the Democratic Republic of the Congo (DRC). This study aimed to determine the seroprevalence during a voluntary screening and to identify factors associated with Voluntary Counselling and Testing (VCT) for HIV in the paediatric population of non-HIV infected or non-HIV exposed infants and children in Lubumbashi, DRC. METHODS: We conducted a cross-sectional prospective analytical study in 4 community VCT centers divided into 4 health zones in the city of Lubumbashi, DRC (Lubumbashi, Ruashi, Kampemba and Kenya) over the period 1 August 2006 - 31 September 2007. The study aimed to evaluate voluntary testing for HIV among children less than 15 years. The sociodemographic characteristics and the parameters related to Voluntary Counselling and Testing (VCT) for HIV were analyzed. Usual descriptive statistical analyses and logistic regression were perfomed. RESULTS: Out of 463 children screened for HIV, 41 (8.9%; 95% CI: 6.5%-11.9%) were HIV positive. Voluntary Counselling and Testing (VCT) for HIV in the paediatric population of non-HIV infected or non-HIV exposed infants or children was significantly higher in children over 2 years of age (adjusted odds ratio (AOR)=3.6 [95% CI: 1,1-12,2]) when both of their parents had negative or uknown HIV status (AOR = 27.4 [95% CI: 9,4-80,0]), when either or both of their biological parents were alive (AOR = 24.9 [95% CI: 2,4-250,8]) and when screening programs were not only carried out by health professionals (AOR = 2.9 [95% CI: 1,0-7,9]). CONCLUSION: Our study shows a high HIV prevalence among children supporting the need for VCT highly accepted by parents and tutors in the city of Lubumbashi.

Prevalence of obesity, diabetes mellitus, hypertension and associated risk factors in a mining workforce, Democratic Republic of Congo.

INTRODUCTION: The burden of non-communicable diseases (NCDs) is increasing in low and middle-income countries (LMIC). According to the World Health Organization (WHO) the largest increase occurs in Africa. Obesity, diabetes mellitus and hypertension (ODH) are major risk factors for cardiovascular diseases, causing nearly 18 million deaths worldwide. Various risks associated with mining as an occupational activity are implicated in NCDs' occurrence. This study describes the baseline prevalence of ODH and associated risk factors in the workforce of Tenke Fungurume Mining (TFM), in southern Democratic Republic of Congo. METHODS: A cross-sectional study was conducted on a sample of 2,749 employees' and contractor's occupational health examination files for 2010. Socio-demographic, occupational, medical, anthropometric and behavioral characteristics were collected and assessed. Disease status regards ODH was based on WHO criteria. A multivariate logistic regression model was used. RESULTS: Overall prevalence of ODH was 4.5%, 11.7%, and 18.2% respectively. Proportions of pre-ODH individuals were 19.7%, 16.5%, and 47.8% respectively. Prevalence of ODH increased with age, professional grade, nature of work, gender and reported alcohol use. Smoking 10 or more cigarettes per day increased risk of diabetes and hypertension, while decreasing obesity. CONCLUSION: Rates of ODH and associated risk factors are higher in the TFM workforce, than in the general DRC population. This is likely reflective of other mining sites in the country and region. It is evident that ODH are associated with various socio-demographic, occupational, anthropometric, biomedical and behavioral risk factors. A NCD prevention program and close monitoring of disease and risk factors trends are needed in this population.

Postgraduate and research programmes in Medicine and Public Health in Rwanda: an exciting experience about training of human resources for health in a limited resources country.

The area of Human Resources for Health (HRH) is the most critical challenge for the achievement of health related development goals in countries with limited resources. This is even exacerbated in a post conflict environment like Rwanda. The aim of this commentary is to report and share the genesis and outcomes of an exciting experience about training of qualified health workers in medicine and public health as well as setting - up of a research culture for the last nine years (2006 - 2014) in Rwanda. Many initiatives have been taken and concerned among others training of qualified health workers in medicine and public health. From 2006 to 2014, achievements were as follows: launching and organization of 8 Master of Medicine programmes (anesthesiology, family and community medicine, internal medicine, obstetrics & gynecology, otorhinolaryngology, pediatrics, psychiatry and surgery) and 4 Master programmes in public health (MPH, MSc Epidemiology, MSc Field Epidemiology & Laboratory Management, and Master in Hospital and Healthcare Administration); training to completion of more than 120 specialists in medicine, and 200 MPH, MSc Epidemiology, and MSc Field Epidemiology holders; revival of the Rwanda Medical Journal; organization of graduate research training (MPhil and PhD); 3 Master programmes in the pipeline (Global Health, Health Financing, and Supply Chain Management); partnerships with research institutions of great renown, which contributed to the reinforcement of the institutional research capacity and visibility towards excellence in leadership, accountability, and self sustainability. Even though there is still more to be achieved, the Rwanda experience about postgraduate and research programmes is inspiring through close interactions between main stakeholders. This is a must and could allow Rwanda to become one of the rare examples to other more well-to-do Sub - Saharan countries, should Rwanda carry on doing that.