Challenges and strategies in the surgical management of traumatic spinal cord injuries in the Democratic Republic of the Congo.

BACKGROUND: Significant progress has been made in the management of traumatic spinal cord injuries. However, deep disparities persist in developing countries. This work aims to describe the different challenges in the surgical management of traumatic spinal cord injuries at the Kinshasa University Teaching Hospital and some strategies implemented to overcome them. METHODS: This is a cross-sectional study of 105 patients from January 2016 to June 2023. The variables of interest included: gender, age, cause, levels of lesion, hospital admission modalities, time to admission, time to surgery, AIS score at admission and on discharge, treatment, pre, peri- and post-operative complications and outcome. RESULTS: We admitted 105 patients. Only 16 % of them were taken to hospital in an ambulance. The average admission time was 49.9 ± 81.79 days. Seventy-two patients (68.6 %) were operated. The average time to surgery was 62.43 ± 85.20 days. No patient was stabilized at the trauma site. Osteosynthesis was performed with appropriate implants in 63.2 % and with improvised elements in 26.8 %. Four patients were operated without an image intensifier. Short-segmental fixation was performed in 8 patients. Twenty-one patients developed pressure ulcers. At discharge, 24 patients recovered their neurological function. Neurological status remained stationary in 43 patients. Five patients died. Seventeen patients went to rehabilitation center. There was no significant difference between the improvised strategies implemented and conventional procedures on functional recovery upon discharge from hospital or rehabilitation centre (p-value : 0.838 and 0.468 respectively). CONCLUSION: Our establishment faces many challenges in TSCI surgery: lack of pre-hospital emergency services and mutual health insurance, delay in admission, lack of surgical implants and image intensifier, the poverty of the population. Some strategies have been implemented to overcome some of them.

Cervical precancerous and cancerous lesions screening using Pap smear test at Provincial Referral Hospital of Bukavu, Eastern DR Congo: profile and recommendations to stakeholders.

Introduction: cervical cancer is a health concern worldwide. The South Kivu Province in the Eastern DR Congo is facing many cases of this disease but poorly screened and reported. The objective of this was to determine the prevalence of cell abnormalities at cervical cytology in a tertiary teaching hospital in Bukavu and their association with common risk factors of cervical cancer. Methods: a cross-sectional study was conducted on 142 women attending the Provincial Referral Hospital of Bukavu (HPGRB) from February to December 2021. Quantitative variables were described by their median following their asymmetric distributions and the qualitative variables in absolute and relative frequencies. Then the Chi-square test was used for the comparison of proportion. Results: forty-five percent of the participants had between three and five children. Twenty-two (15.5%) of the 142 patients reported to have two or more sexual partners and 17.5% reported the use of hormonal contraception. The prevalence of cell abnormalities at cervical cytology was 17% of which Low- Grade Squamous Intraepithelial Lesion (LSIL) was the most representative (12.9%). There was no statistically significant association between the common cervical risk factors and the occurrence of cell abnormalities. Conclusion: cervical pre-cancerous lesions are frequent in South Kivu province. The Pap smear test remains an early and affordable screening method and constitutes a secondary prevention strategy in women of 18 years and older in a low-income country such as DR Congo where vaccination against HPV is still hypothetic.

Postoperative maternal complications of caesarean section: a cross-sectional study at the Provincial General Hospital of Kananga in the Democratic Republic of Congo.

Introduction: the maternal complications of caesarean section make it considered a riskier route of delivery than the vaginal route. The caesarean patient in fact combines the risks of giving birth and those of abdominal surgery. The objective of our study is to determine the epidemiological and therapeutic profile of postoperative maternal complications of caesarean section at the Provincial General Hospital of Kananga from January 1st, 2016 to December 31st, 2020. Methods: this is a cross-sectional study of cases of postoperative maternal complications of cesarean section, based on non-probability convenience sampling for case selection. multivariable logistic regression was used in statistical analyses. Our study sample was 302 cases. Results: the hospital frequency of postoperative complications of cesarean section is 34.12% with the annual average of 60.40 (17.21) cases per year. The postoperative infections are the most frequent complication with more than 52.98% (n=160), treatment is surgical in 59.61% (n=180), the maternal mortality rate due to postoperative complications of cesareans is 5.63% (n=17). Five factors independently associated with postoperative complications of cesarean section were identifying: prolonged labor (aOR: 3.110, 95% CI: 1.040-9.250; p=0.001), defective hygiene of patients (aOR: 1.910, 95% CI: 1.090-10.930; p=0.001), uterine overdistension before caesarean section (aOR: 4.290, 95% CI: 3.320-5.550; p=0.000), multiparity (aOR: 2.070, 95% CI: 1.010-5.210; p=0.006) and emergency cesarean section (aOR: 1.510, 95% CI: 1.250-1.910; p=0.000) in our environment and during the period of our study. Conclusion: intraoperative complications of ceasarean section constitute a real health problem. These five factors independently associated with postoperative complications of cesarean section could be used for screening of high-risk women in obstetrical consultations during pregnancy monitoring.

Knowledge of risk factors and early detection methods toward breast cancer among healthcare workers in Kinshasa, Democratic Republic of the Congo.

BACKGROUND: Breast cancer (BC) is the most prevalent cancer among women, and it typically presents late in developing countries like the Democratic Republic of the Congo (DRC), leading to higher mortality rates. Late detection at advanced stages of breast cancer can be attributed to the absence of appropriate screening programs and low levels of awareness. AIMS: To evaluate the level of BC knowledge among healthcare workers (HCWs) and identify determinants of good BC knowledge. METHODS AND RESULTS: An analytical cross-sectional survey was conducted from March 1 to 31, 2022 involving HCWs practicing in Kinshasa, DRC. Data were collected using a questionnaire administered through direct interviews. Bivariate and multivariate regression techniques were applied. The study interviewed 543 HCWs, with a median age of 35 years (interquartile range: 29-43). Of these, 61% had good BC knowledge, while 39% had poor BC knowledge. Multivariate analysis revealed that HCWs aged 50 years and over (adjusted odds ratio [aOR] = 2.3 [1.2-4.5]), female HCWs (aOR = 1.8 [1.1-2.4]), HCWs working in public healthcare facilities (aOR = 1.5 [1.1-2.5]), and HCWs who had received training on BC (aOR = 1.9; 95% CI: 1.5-3.3) were determinants of good BC knowledge. CONCLUSION: This study found that 61% of the surveyed HCWs had good BC knowledge. However, there is still room for improvement in terms of knowledge dissemination. Therefore, it is important to implement continuing medical education programs that focus on raising awareness and improving BC knowledge among HCWs.

Pelvic organ prolapse: a cross-sectional study during mass campaign in two hospitals in the city of Kananga in the Democratic Republic of Congo.

Introduction: pelvic organ prolapse is a dynamic pathology that can worsen or regress especially postpartum and is the basis of several disorders that bother the patient and alter her quality of life. This study aims to determine the epidemiological, clinical, and therapeutic profile of pelvic organ prolapse in the town of Kananga. Methods: this is a cross-sectional study of cases of pelvic organ prolapse recorded during the mass campaign organized in the Bon-Berger Hospital of Tshikaji and Saint Georges Hospital of Katoka in the town of Kananga, from January 1 to July 31, 2023. Non-probability convenience sampling was used to select cases. Results: we recorded 138 cases of prolapse out of 572 patients. The prevalence of pelvic organ prolapse is 24.12% with an average monthly incidence of 19.71 (SD: 4.23) cases per month. The prevalence of recurrence of pelvic organ prolapse is 8.69%. The average age of patients is 54.86 (SD: 11.36) years with an average parity of 7.62 (SD: 1.8) deliveries. Its preoperative symptomatology consists of the intravaginal mass associated with digestive and urinary disorders in 97.00% (n=130), stage III hysterocele predominates in 68.70% (n=92), surgical treatment is the most practiced in 91.79% (n=123) and hysterectomy associated with the treatment of cystocele and rectocele by vaginal surgical access is the most practiced in 80.60% (n=108). Conclusion: pelvic organ prolapse is a real public health problem in the city of Kananga, its symptoms are classic and its treatment is surgical via the vaginal route.

Indicator-condition-guided HIV testing in rural DRC.

BACKGROUND: HIV testing services are a key component of the 95-95-95-0 goals. In many parts of the Democratic Republic of the Congo the availability of test kits is limited for multiple reasons. Targeted testing of patients with HIV indicator conditions is therefore the only feasible option in these settings. METHODS: We introduced an indicator condition-guided HIV testing project in the Emergency Room of the Hôpital Géneral de Référence de Kikwit, DRC. RESULTS: We screened 1274 patients for indicator condition. In 94 (7.4%) patients, the treating physician diagnosed at least one HIV indicator. 34 (36.2%) tested HIV-positive (2.7% of screened patients). 52% of the newly diagnosed patients were lost to follow-up two months after the first diagnosis of HIV. CONCLUSION: In a resource-limited setting with insufficient availability of HIV-Tests, indicator-triggered testing is a useful tool to find a high number of HIV-positive patients. Loss to follow-up is one of the major challenges.

Essential surgery delivery in the Northern Kivu Province of the Democratic Republic of the Congo.

INTRODUCTION: Surgical services are an essential part of a functional healthcare system, but the Lancet Commission of Global Surgery (LCoGS) indicators of surgical capacity such as perioperative workforce and surgical volume are unknown in many low- and middle-income countries (LMICs) including the Democratic Republic of Congo (DRC). We aimed to determine the surgical capacity and its associated factors within the DRC. METHODS: Hospitals were assessed in the North Kivu province of the DRC. Hospital characteristics and surgical rates were determined using the WHO-PGSSC hospital assessment tool and operating room (OR) registries. The primary outcome of interest was the number of Bellwether operations (i.e. Caesarean sections, laparotomies, and external fixation for bone fractures) per 100,000 people. Univariate and multiple linear regressions were performed. Primary predictors were the number of trained surgeons, anaesthesiologists, and obstetricians (SAOs) and the number of perioperative providers (including clinical officers and nurse anaesthetists) per 100,000 people. RESULTS: Twenty-eight hospitals in North Kivu were assessed over one year in 2021; 24 (86%) were first-level referral health centres while 4 (14%) were second-level referral hospitals. In total, 11,176 Bellwether procedures were performed in the region in one year. Rates per 100,000 people were 1,461 Bellwether surgical interventions, 1.05 SAOs, and 13.1 perioperative providers. In univariate linear regression analysis, each additional SAO added 239 additional cases annually (p = 0.023), while each additional perioperative provider added 110 cases annually (p < 0.001). In our multiple regression analysis adjusting for other hospital services, the association between workforce and Bellwether surgeries was no longer significant. CONCLUSIONS: The surgical workforce in DRC did not meet the LCoGS benchmark of 20 SAOs per 100,000 people but was not an independent predictor of surgical capacity. Major investment is needed to simultaneously bolster healthcare facilities and increase surgical workforce training.

HEAL Africa score to predict failure of surgical repair of obstetric urethro-vaginal fistula in the Democratic Republic of the Congo.

INTRODUCTION: Obstetric fistula (OF) repair surgery aims to restore the anatomical and functional integrity of the urinary tract, allowing affected women to regain their dignity and quality of life. However, in some cases, this surgical repair may fail. The objective of this study was to develop a predictive score to identify factors associated with the failure of surgical repair of obstetric urethro-vaginal fistula (FSROUVF) in the Democratic Republic of the Congo (DRC). METHODS: This is an analytical cross-sectional study of 358 patients with obstetric urethro-vaginal fistula (OUVF) who received surgical repair. We conducted bivariate and multivariate analyses. Score discrimination was assessed using the receiver operating characteristic (ROC) curve, C-index, and score calibration according to the Hosmer-Lemeshow test. RESULTS: Surgical repair of OUVF failed in 24.86% of cases (89/358). After logistic modelling, 6 criteria predicted FSROUVF: the use of intravaginal indigenous products (AOR = 3.59; 95% CI: 1.51-8.53), the presence of fibrosis (AOR = 6.37; 95% CI: 1.70-23.82), the presence of 2 or more fistulas in the same patient (AOR = 7.03; 95% CI: 3.14-15.72), the total urethral damage (AOR = 3.29; 95% CI: 1.36-7.95), the fistula size > 3 cm (AOR = 5.65; 95% CI: 2.12-15.01), and the postoperative infection (AOR = 351.10; 95% CI: 51.15-2409.81). A score of 0 to 14 was obtained, with a value ≤5 points indicating a low risk of FSROUVF, a value between 6 and 8 indicating a moderate risk, and a value ≥9 points corresponding to a high risk of FSROUVF. The area under the ROC curve of the score is 0.938 with a sensitivity of 60.67%, a specificity of 96.28%, a positive predictive value of 84.38%, and a negative predictive value of 88.10%. CONCLUSION: We report a FSROUVF rate in the DRC approaching a quarter of operative patients. Predictors of failure included fibrosis, presence of 2 or more fistulas, total urethral involvement, fistula size greater than 3 cm, postoperative infection, and use of intravaginal indigenous products. These factors are constitutive of the HEAL Africa score, which once validated, may have value in pre-operative counselling of patients. This study could be valuable for policy and strategies to address the problem of OUVF in the DRC and in resource limited settings more generally.

Rotavirus and adenovirus infections in children with acute gastroenteritis after introducing the Rotasiil® vaccine in Kisangani, Democratic Republic of the Congo.

BACKGROUND: Although rotavirus vaccination has reduced the global burden of the virus, morbidity and mortality from rotavirus infection remain high in Sub-Saharan Africa. This study aimed to determine the prevalence of rotavirus and adenovirus infections in children under five years with acute gastroenteritis and to identify factors associated with rotavirus infection after the introduction of the Rotasiil® vaccine in 2019 in Kisangani, Democratic Republic of the Congo (DRC). METHODS: This study consisted of a cross-sectional hospital-based survey conducted from May 2022 to April 2023 in four health facilities in Kisangani, using a fecal-based test (rapid antigenic immuno-chromatographic diagnostic test, BYOSYNEX adenovirus/rotavirus BSS, Biosynex SA, Illkirch-Graffenstaden, France) of rotavirus and adenovirus infections among children under five years of age with acute gastroenteritis. RESULTS: A total of 320 children under five years of age with acute gastroenteritis were included. The prevalence of rotavirus infection was 34.4%, that of adenovirus was 6.3%, and that of both rotavirus and adenovirus coinfection was 1.3%. The prevalence of rotavirus was significantly higher in unvaccinated children than in vaccinated children (55.4% versus 23.1%; P < 0.001). This difference was observed only in children who received all three vaccine doses. Multivariate logistic regression analysis shows that the rate of rotavirus infection was significantly reduced in vaccinated children (adjusted OR: 0.31 [95% confidence intervals (CI): 0.19-0.56]; P < 0.001) and those whose mothers had an average (adjusted OR: 0.51 [95% CI: 0.25-0.91]; P = 0.018) or high level (adjusted OR: 0.34 [95% CI: 0.20-0.64]; P < 0.001) of knowledge about the rotavirus vaccine. CONCLUSIONS: The prevalence of rotavirus infection remains high in Kisangani despite vaccination. However, the prevalence of adenovirus infections was low in our series. Complete vaccination with three doses and mothers' average and high level of knowledge about the rotavirus vaccine significantly reduces the rate of rotavirus infection. It is, therefore, essential to strengthen the mothers' health education, continue with the Rotasiil® vaccine, and ensure epidemiological surveillance of rotavirus infection.

Pelvic floor symptoms among premenopausal women with pelvic organ prolapse in the Democratic Republic of the Congo.

INTRODUCTION AND HYPOTHESIS: Most of the literature on pelvic organ prolapse (POP) has been generated from postmenopausal patients in high-income countries. In the Democratic Republic of the Congo (DRC), a significant proportion of patients who present for surgical management of POP are premenopausal. Little is known about the impact of POP on pelvic floor symptoms in this population. The objective was to describe pelvic floor symptoms and sexual function among premenopausal patients presenting for POP surgery in DRC. METHODS: We performed a prospective cohort study of symptomatic premenopausal patients undergoing fertility-sparing POP surgery at a large referral hospital in the DRC. Pelvic floor symptoms were evaluated with the Pelvic Floor Distress Inventory Questionnaire and sexual function with the Pelvic organ prolapse/urinary Incontinence Sexual Questionnaire. Data are presented as means with standard deviations or counts with percentages. RESULTS: A total of 107 patients were recruited between April 2019 and December 2021. All had either stage III (95.3%) or stage IV (4.7%) prolapse. Ages were 34.2 ± 6.7 years; 78.5% were married. A majority of patients experienced low abdominal pain (82.2%), heaviness or dullness (95.3%), and bulging or protrusion of the prolapse (92.5%). Almost two-thirds of patients reported no longer being sexually active, and 80% stated that they were not sexually active because of POP. Of the 37 sexually active patients (34.6%), nearly all reported significant sexual impairment because of the prolapse, with only 4 reporting no sexual impairment. CONCLUSIONS: This study represents one of the largest prospective series of patients with premenopausal POP. Our results highlight the severity of pelvic floor symptoms and the negative effects on sexual function among this patient population with POP.

Identification of the PfK13 mutations R561H and P441L in the Democratic Republic of Congo.

OBJECTIVES: Partial artemisinin resistance, mediated by Plasmodium falciparum K13 (PfK13) mutations, has been confirmed in certain areas of East Africa that are historically associated with high-level antimalarial resistance. The Democratic Republic of Congo (DRC) borders these areas in the East. This study aimed to determine the prevalence of resistance markers in six National Malaria Control Program surveillance sites; Boende, Kabondo, Kapolowe, Kimpese, Mikalayi, and Rutshuru. METHODS: The single nucleotide polymorphisms (SNPs) in P. falciparum genes PfK13, Pfdhfr, Pfdhps, Pfmdr1, and Pfcrt were assessed using targeted next-generation sequencing of isolates collected at enrollment in therapeutic efficacy studies. RESULTS: PfK13 SNPs were detected in two samples: in Kabondo (R561H) and in Rutshuru (P441L), both areas near Uganda and Rwanda. The Pfdhps ISGEGA haplotype, associated with reduced sulfadoxine-pyrimethamine chemoprevention efficacy, ranged from 0.8% in Mikalayi (central DRC) to 42.2% in Rutshuru (East DRC). CONCLUSIONS: R561H and P441L observed in eastern DRC are a concern, as they are associated with delayed artemisinin-based combination therapies-clearance and candidate marker of resistance, respectively. This is consistent with previous observations of shared drug resistance profiles in parasites of that region with bordering areas of Rwanda and Uganda. The likely circulation of parasites has important implications for the ongoing surveillance of partial artemisinin-resistant P. falciparum and for future efforts to mitigate its dispersal.

Screening and risk factors for cervical cancer among survivors of sexual violence in conflict settings, in Eastern Democratic Republic of Congo.

This study assesses the risk that rape survivors have of developing cervical cancer in the context of conflict. A cross-sectional and descriptive study conducted in Bunyakiri and Kavumu, a conflict region in the east of the Democratic Republic of the Congo during the period from September 1 to 10, 2022, including 47 women survivors of sexual violence, 41 of whom were selected on the basis of certain criteria with age ranging from 18 to 50 years. Speculum examination was performed with visual inspection with acetic acid (VIA). After collecting data, the latter were encoded in the Excel file and grouped in the form of tables then analyzed after calculating the percentage. Ages of 21-30 years was the most represented, i.e., 56%. Among them, 34.1% were married and 31.7% were abandoned. Majority was in secondary school (46.3%) and illiterates (34.1%). 36.5% complained of pelvic pain and 36.5% reported first sexual intercourse at the age range of 13-15 years, of which 25 cases, i.e., 61% were sexually active. 39% reported having had 3 sexual partners in their life. VIA was negative in 97.5% of cases. It should be mentioned in this study that the environment of conflict zone, the circumstances of rape and the risky sexual behavior of survivors are an ecosystem that predisposes them to cervical cancer.

Cette étude évalue le risque qu'ont les survivantes de viol de développer un cancer du col de l'utérus dans un contexte de conflit. Une étude transversale et descriptive menée à Bunyakiri et Kavumu, région de conflit à l'est de la République Démocratique du Congo durant la période du 1er au 10 septembre 2022, incluant 47 femmes survivantes de violences sexuelles, dont 41 ont été sélectionnées sur la base de certains critères avec un âge allant de 18 à 50 ans. L'examen au spéculum a été réalisé avec inspection visuelle à l'acide acétique (VIA). Après collecte des données, ces dernières ont été encodées dans le fichier Excel et regroupées sous forme de tableaux puis analysées après calcul du pourcentage. La tranche d'âge de 21 à 30 ans était la plus représentée, soit 56 %. Parmi eux, 34,1% étaient mariés et 31,7% étaient abandonnés. La majorité était scolarisée dans le secondaire (46,3%) et analphabète (34,1%). 36,5% se plaignaient de douleurs pelviennes et 36,5% rapportaient leurs premiers rapports sexuels entre 13 et 15 ans, dont 25 cas, soit 61% étaient sexuellement actifs. 39 % déclarent avoir eu 3 partenaires sexuels dans leur vie. VIA était négatif dans 97,5 % des cas. Il convient de mentionner dans cette étude que l'environnement de la zone de conflit, les circonstances du viol et le comportement sexuel à risque des survivantes constituent un écosystème qui les prédispose au cancer du col de l'utérus.

[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.

Is a bio-psychosocial approach model possible at the first level of health services in the Democratic Republic of Congo? An organizational analysis of six health centers in South Kivu.

BACKGROUND: The health system, in the Democratic Republic of Congo, is expected to move towards a more people-centered form of healthcare provision by implementing a biopsychosocial (BPS) approach. It's then important to examine how change is possible in providing healthcare at the first line of care. This study aims to analyze the organizational capacity of health centers to implement a BPS approach in the first line of care. METHODS: A mixed descriptive and analytical study was conducted from November 2017 to February 2018. Six health centers from four Health Zones (South Kivu, Democratic Republic of Congo) were selected for this study. An organizational analysis of six health centers based on 15 organizational capacities using the Context and Capabilities for Integrating Care (CCIC) as a theoretical framework was conducted. Data were collected through observation, document review, and individual interviews with key stakeholders. The annual utilization rate of curative services was analyzed using trends for the six health centers. The organizational analysis presented three categories (Basic Structures, People and values, and Key Processes). RESULT: This research describes three components in the organization of health services on a biopsychosocial model (Basic Structures, People and values, and Key processes). The current functioning of health centers in South Kivu shows strengths in the Basic Structures component. The health centers have physical characteristics and resources (financial, human) capable of operating health services. Weaknesses were noted in organizational governance through sharing of patient experience, valuing patient needs in Organizational/Network Culture, and Focus on Patient Centeredness & Engagement as well as partnering with other patient care channels. CONCLUSION: This study highlighted the predisposition of health centers to implement a BPS approach to their organizational capacities. The study highlights how national policies could regulate the organization of health services on the front line by relying more on the culture of teamwork in the care structures and focusing on the needs of the patients. Paying particular attention to the values of the agents and specific key processes could enable the implementation of the BPS approach at the health center level.

Evaluation of the applicability of internal controls on self-collected samples for high-risk human papillomavirus is needed.

BACKGROUND: Self-collection of cervical samples to detect high-risk human papillomavirus (hr-HPV) is a trending topic in primary cervical cancer screening. This study evaluates the applicability of a self-sampling device to routine molecular procedures for hr-HPV detection. METHODS: In a primary health care facility in Kinshasa, Congo, 187 self-collected samples (Evalyn Brush) were gathered and sent to Ghent University Hospital (UZ Ghent) and Algemeen Medisch Labo (AML) in Belgium where routine tests for hr-HPV were applied (Abbott RealTime hr-HPV and qPCR (E6/E7), respectively). Sample type effect was evaluated by comparing the internal control (IC) between the self-collected samples and routine, clinician-taken samples randomly selected from the UZ Ghent archive. RESULTS: In UZ Ghent an error was encountered in 9.1% (17/187) of self-collected samples due to a lack of IC signal. The hr-HPV prevalence in the remaining 170 samples was 18,8%. Comparing IC results between the self-collected and clinician-collected groups, a significant difference (p < 0,001) was found, with higher IC signals in the clinician-collected group. In AML, an error was encountered in 17.6% (33/187) of samples, including 16/17 of the UZ Ghent. The remaining sample with IC error gave a negative result in AML. Among the 154 samples without IC error at AML, a correlation of 90% was seen between both laboratories with a 77% negativity rate. CONCLUSION: Testing the self-collected specimens by 2 routine hr-HPV tests gave a high IC error rate (9.1-17.6%). A possible solution would be to differentiate cut-offs for IC values depending on sample type, as currently used cut-offs are set for clinician-taken samples.

Determinants of Access to Essential Surgery in the Democratic Republic of Congo.

INTRODUCTION: In the Democratic Republic of Congo (DRC), the determinants and barriers of essential surgical care are not well described, hindering efforts to improve national surgical programs and access. METHODS: A cross-sectional study evaluated access to essential surgery in the Butembo and Katwa health zones in the North Kivu province of DRC. A double-clustered random sample of community members was surveyed using questions derived from the Surgeons OverSeas Surgical Needs Assessment Survey, a validated tool to determine the reasons for not seeking, reaching, or receiving a Bellwether surgery (i.e., caesarean delivery, laparotomy, and external fixation of a fracture) when needed. RESULTS: Overall, 887 households comprising 5944 community members were surveyed from April to August 2022. Six percent (n = 363/5944) of the study population involving 35% (n = 309/887) households needed a Bellwether surgery in the previous year, 30% (n = 108/363) of whom died. Of those who needed surgery, 25% (n = 78) did not go to the hospital to seek care and were more likely to find transportation unaffordable (P = 0.042). The most common reasons for not seeking care were lack of funds for hospitalization, prior poor hospital experience, and fear of hospital care. CONCLUSIONS: Access and delivery of essential surgery are drastically limited in the North Kivu province of the DRC, such that a quarter of households needing surgery fails to seek surgical care. Poor access was predominantly driven by households' inability to pay for surgery and community distrust of the hospital system.

Prevalence of hepatitis B and C viral co-infection and associated factors with HIV infection in children in South Kivu, Democratic Republic of the Congo.

BACKGROUND: The World Health Organization's (WHO) 2030 goal of eradicating Hepatitis B and C viruses must also include HIV co-infected children. However, data on the prevalence of this condition are lacking in the Democratic Republic of Congo (DRC), which is considered as one of the countries with high-prevalence of these viruses. The need to assess the extent of this co-infection in the children of this country is therefore important in order to capitalize on efforts to improve prevention and management of both infections. METHODOLOGY: This is a comparative cross-sectional study conducted from February 04, 2015 to September 03, 2019 at 14 General Reference Hospitals with a pediatric HIV management programme in South Kivu province. The study compared the frequency of hepatitis B (HBV) and C (HCV) markers and factors associated with these two viruses in two equal groups: HIV-positive and HIV-negative children. The data were analyzed using the SPSS version 20.0 software and the significance level was set at p-value less than 0.05. RESULTS: The study involved a total of 594 children, 297 of whom were HIV-positive and 297 negative. HBsAg was found in 8.7% of HIV-positive patients and 0.7% for HCV antibodies. On the other hand, among the HIV-negative patients, the proportion of HBsAg was 0.7% but no cases with anti-HCV antibodies were detected. HIV status increases by 14 times the risk of co-occurring with HBV [OR 14.1 (95% CI: 3.33-60.2); p < 0.001] and this risk is not apparent for HCV (p = 0.297). Multivariate logistic regression showed that history of jaundice in the family (aOR:4.19;95% CI: 2.12-11.59), recent hospitalization (aOR:10.7;95% CI: 6.69-17.2), surgery (aOR: 3.24;95% CI: 1.18-8.92), piercing (aOR: 4.26;95% CI: 1.70-10.7) and transfusion in the last 6 months (aOR: 2.69;95% CI: 1.55-4.67) were significantly associated with higher risk of being HBV- HIV co-infected. CONCLUSION: This study investigated the importance of hepatitis viral co-infections in HIV-positive children in South Kivu. Particular attention should be paid to prevention and early detection of these co-infections in this population.

Epidemiological profile of cancer at the laboratory of anatomy and pathological cytology of mungbere in the Democratic Republic of Congo.

INTRODUCTION: Cancer is the second leading cause of death worldwide, causing about 10 million deaths per year, 70 % of which occur in low- and middle-income countries. In the DRC, the absence of a national cancer registry is a handicap to the definition of a strategy to combat this disease. The purpose of this study is to establish an epidemiological profile of cancer in this laboratory in order to overcome this deficit in this part of the country. METHODOLOGY: We conducted a descriptive study of 1636 histopathological analysis reports from 2015 to 2021 at the Anatomy and Pathological Cytology Laboratory of Anualite Hospital in Mungbere. RESULTS: A total of 502 cases of cancer have been identified; female accounted for 51.4 % of cases; all age groups are affected; The most common cancers in both sexes are Kaposi's sarcoma (17.9 %), breast cancer (15.3 %), lymphoma (13.7 %), cervical cancer (9.6 %) and squamous cell carcinoma of the skin (9 %). In women, breast cancer (27.1 %), cervical cancer (18.6 %), Kaposi's sarcoma (10.1 %), lymphoma (7.4 %) and squamous cell carcinoma of the skin (5.8 %) and in men Kaposi's sarcoma (26.2 %), lymphoma (20.5 %), liver cancer (13.1 %)) and squamous cell carcinoma of the skin (12.3 %). CONCLUSION: Cancer affects all age groups with a slight female predominance. The most common in both sexes are Kaposi's sarcoma, breast cancer, lymphoma, cervical cancer and squamous cell carcinoma of the skin. For an effective fight against cancer, the creation of a national cancer registry is an emergency in our country.

The impact of the COVID-19 pandemic on the provision & utilisation of primary health care services in Goma, Democratic Republic of the Congo, Kambia district, Sierra Leone & Masaka district, Uganda.

INTRODUCTION: This study aimed to determine whether the COVID-19 pandemic had an impact on essential primary healthcare services at public primary healthcare facilities. METHODS: The number of weekly consultations for antenatal care (ANC), outpatient (OPD), immunisations (EPI), family planning (FP) and HIV services, between January 2018 and December 2020, were collected from 25 facilities in Masaka district, Uganda, 21 in Goma, and 29 in Kambia district, Sierra Leone. Negative binomial regression models accounting for clustering and season were used to analyse changes in activity levels between 2018, 2019 and 2020. RESULTS: In Goma, we found no change in OPD, EPI or ANC consultations, FP was 17% lower in March-July 2020 compared to 2019, but this recovered by December 2020. New diagnoses of HIV were 34% lower throughout 2020 compared to 2019. In Sierra Leone, compared to the same periods in 2019, facilities had 18-29% fewer OPD consultations throughout 2020, and 27% fewer DTP3 doses in March-July 2020. There was no evidence of differences in other services. In Uganda there were 20-35% fewer under-5 OPD consultations, 21-66% fewer MCV1 doses, and 48-51% fewer new diagnoses of HIV throughout 2020, compared to 2019. There was no difference in the number of HPV doses delivered. CONCLUSIONS: The level of disruption varied across the different settings and qualitatively appeared to correlate with the strength of lockdown measures and reported attitudes towards the risk posed by COVID-19. Mitigation strategies such as health communications campaigns and outreach services may be important to limit the impact of lockdowns on primary healthcare services.

Huge left atrial myxoma: about 2 cases resected in the Democratic Republic of Congo.

BACKGROUND: Myxoma is the most common cardiac tumor, found in 75-80% of cases in the left atrium. It can grow quietly and therefore reach a large size before being symptomatic. Poor availability of echocardiography also contributes to delayed diagnosis. In Sub-Saharan African countries, myxoma diagnosis can be missed for many patients. Myxoma resection surgery, although technically simple, is not always possible, because of the lack of cardiac surgery development. The aim of this report is to describe the first two consecutive resection cases of huge left-atrial myxoma performed in Kinshasa, Democratic Republic of Congo (DRC) and to discuss the specificities of this surgery in this low-resource context. CASE PRESENTATION: Two patients, 54 and 48 years old, were diagnosed with giant myxoma of the left atrium in the management of progressive dyspnea The first patient's transthoracic echocardiography revealed a pedunculated atrial mass (37 × 48 mm) on the interatrial septum, passing through the mitral valve. For the second patient, the mass (64 × 26 mm) was attached to the roof of the left atrium and protruded into the mitral valve, with significant mitro-tricuspid regurgitation The first patient underwent a simple resection of the myxoma. For the second patient, it was associated to a mitro-tricuspid annuloplasty. The postoperative course was simple for the first patient, but the second patient developed a biventricular failure requiring vasoactive drugs. Both patients were discharged alive from the hospital on postoperative days 10 and 12, respectively. They are regularly followed up and are doing well 2 years after surgery. DISCUSSION AND CONCLUSION: Surgical resection is the only effective treatment of myxoma. Our first results are encouraging The poor availability of the echocardiography is a challenge in the diagnosis of myxoma. The development of cardiac surgery in DRC and ongoing country-level efforts to address diagnostic challenges for these often silent tumors will allow us to expect more resections to be performed locally and larger series published.