Cocoa, livelihoods, and deforestation within the Tridom landscape in the Congo Basin: A spatial analysis.

In the context of emerging international trade regulations on deforestation-free commodities, the drivers of households' deforestation in conservation landscapes are of interest. The role of households' livelihood strategies including cocoa production, and the effects of human-elephant conflict are investigated. Using a unique dataset from a survey of 1035 households in the Tridom landscape in the Congo basin, the spatial autoregressive model shows that: (1) Households imitate the deforestation decisions of their neighbors; (2) A marginally higher income from cocoa production-based livelihood portfolios is associated with six to seven times higher deforestation compared to other livelihood strategies with a significant spillover effect on neighboring households' deforestation. The increase in income, mainly from cocoa production-based livelihoods in open-access systems can have a negative effect on forests. Households with a higher share of auto-consumption are associated with lower deforestation. If economic development brings better market access and lower auto-consumption shares, this is likely to positively influence deforestation. Without proper land use planning/zoning associated with incentives, promoting sustainable agriculture, such as complex cocoa agroforestry systems, may lead to forest degradation and deforestation.

Simultaneous measurements of radon, thoron and thoron progeny and induced cancer risk assessment in Djeno, Pointe-Noire, Republic of Congo.

In this study, the activity concentrations of radon (222Rn), thoron (220Rn) and thoron progeny were measured simultaneously in Djeno (Pointe-Noire, Republic of Congo) using RADUET detectors to evaluate the air quality and the radiological risks due to the inhalation of these radionuclides. Activity concentrations of radon progeny were calculated from those of radon. Indoor radon, thoron and progenies followed a lognormal distribution ranging between 20 and 40, 6 and 62, 8 and 17.6 and 0.4 and 19.6 Bq m-3 for radon, thoron, radon progeny and thoron progeny, respectively. Mean values for radon were lower than the worldwide values estimated by the United Nation Scientific Committee on the Effects of Atomic Radiation (UNSCEAR), which are 40 Bq m-3 (arithmetic mean) and 45 Bq m-3 (geometric mean). Radon concentrations in the dwellings under study were below the World Health Organization and the International Commission on Radiological Protection recommended reference levels, which are, respectively, 100 and 300 Bq m-3. The mean concentration of thoron was twice the world average value of 10 Bq m-3 estimated by UNSCEAR. Thoron progeny mean concentration was sharply greater than the typical value (0.3 Bq m-3) for indoor atmosphere provided by UNSCEAR. Annual effective dose ranges were 0.40-0.87 mSv (arithmetic mean, 0.57 ± 0.11 mSv) for radon and 0.10-4.14 mSv (arithmetic mean, 0.55 ± 0.77 mSv) for thoron. The mean value for radon was lower than the value (1.15 mSv) estimated by UNSCEAR, while the mean value for thoron was five times higher than the UNSCEAR value (0.10 mSv). The study showed that the use of the typical equilibrium factor value given by UNSCEAR to compute effective dose led to an error above 80%. Finally, the results of this study showed that the excess relative risk of radon-induced cancer was low, below 2% for the population under 55 y. The results presented in the present study prove that the population of Djeno is exposed to a relatively low potential risk of radon- and thoron-induced cancer.

Dynamic assessment of the impact of agricultural land use change and globalization on environmental quality in the tropical African Rainforest: evidence from the Congo Basin.

The rising human demand for food has increased the pursuit for more agricultural land to feed the ever-growing human population. Although agriculture constitutes the cornerstone of most economies and serves as a vital source of foreign earnings to others, experts suggest that it emits a substantial amount of greenhouse gases into the atmosphere, thereby enhancing global warming. Furthermore, with the growing pace of globalization, less developed countries are witnessing economic growth with detrimental impacts on the environment. Inspired by the need to protect tropical rainforests and basins, the current research aims to assess the dynamic impacts of agricultural land use change (LALUC) and globalization (LGLO) on environmental quality (LCO2) in the Congo Basin while controlling for economic growth (LGDP), biomass energy consumption (LBIO), and urbanization (LURBN). Based on panel data from 1980 to 2018, this study utilized second-generation econometric methods including the cross-sectional Im, Peseran Shin (CIPS), Westerlund bootstrapped co-integration test, autoregressive distributive lag/pooled mean group (ARDL/PMG), and the Dumitrescu Hurlin (D-H) panel causality estimates. The outcome reveals a long-run equilibrium co-integrating association among the estimated variables, and LALUC, LBIO, and LURBN were found to reduce LCO2, while LGDP and LGLO increase LCO2. These findings imply the inverted U-shaped relationship between LALUC, LBIO, and LURBN is beneficial for environmental quality in the Congo Basin. Based on the findings, environmental quality and economic growth can be achieved instantaneously in this region by engaging in large-scale production of biomass energy. Therefore, policymakers and governments should promote renewable energy use and convey foreign funds towards its enhancement, while investments in agriculture should prioritize environmentally benign practices such as agroforestry.

Hormone physiology and sleep dynamics among BaYaka foragers of the Congo Basin: Gendered associations between nighttime activity, testosterone, and cortisol.

Sleep quality is an important contributor to health disparities and affects the physiological function of the immune and endocrine systems, shaping how resources are allocated to life history demands. Past work in industrial and post-industrial societies has shown that lower total sleep time (TST) or more disrupted nighttime sleep are linked to flatter diurnal slopes for cortisol and lower testosterone production. There has been little focus on these physiological links in other socio-ecological settings where routine sleep conditions and nighttime activity demands differ. We collected salivary hormone (testosterone, cortisol) and actigraphy-based sleep data from Congolese BaYaka foragers (N = 39), who have relatively short and fragmented nighttime sleep, on average, in part due to their typical social sleep conditions and nighttime activity. The hormone and sleep data collections were separated by an average of 11.23 days (testosterone) and 2.84 days (cortisol). We found gendered links between nighttime activity and adults' hormone profiles. Contrary to past findings in Euro-American contexts, BaYaka men who were more active at night, on average, had higher evening testosterone than those with lower nighttime activity, with a relatively flat slope relating nighttime activity and evening testosterone in women. Women had steeper diurnal cortisol curves with less disrupted sleep. Men had steeper cortisol diurnal curves if they were more active at night. BaYaka men often hunt and socialize when active at night, which may help explain these patterns. Overall, our findings indicate that the nature of nighttime activities, including their possible social and subsistence contexts, are potentially important modifiers of sleep quality-physiology links, meriting further research across contexts.

Performance on the African neuropsychology battery using the learning ratio in a sample of healthy Congolese.

OBJECTIVE: Using the African Neuropsychology Battery (ANB), we seek to develop normative data by examining the demographic effects for two learning process scores: initial learning (Trial One) and learning ratio (LR, the percentage of items learned relative of to-be-learned material following Trial 1). METHODS: Healthy participants from the Democratic Republic of Congo completed the four memory tests of the ANB: the African Story Memory Test (ASMT), African List Memory Test (ALMT), African Visuospatial Memory Test (AVMT), and African Contextual Visuospatial Memory Test (ACVMT). We developed indices of learning for each subtest, as well as aggregate learning indices for Trial 1 and LR, and composite indices examining verbal, visual, contextual, and noncontextual learning, and grand indices comprising all four subtests. RESULTS: Trial 1 and LR scores each demonstrated acceptable intercorrelations across memory tests. We present normative data for Trial 1 and LR by age and education. CONCLUSION: These data provide normative standards for evaluating learning in Sub-Saharan Africa.

Prevalence and therapeutic management of snakebite cases in the health facilities of the Bouenza department from 2009 to 2021, Republic of Congo.

Introduction: few studies exist of snake bites in the Republic of Congo. This study reports epidemiological and management data on snake bites in the Bouenza department of the Republic of Congo. Methods: this is a retrospective and descriptive study based on questionnaire and analysis of files of snakebite victims over a period of 13 years (2009-2021). We collected data on incidence, age, gender, site of the bite, the season of the bite, deaths and treatment. Results: we identified 81 cases of bites recorded in 14 healthcare facilities: 54.32% of cases (44/81) at Nkayi Base Hospital; 11.11% (9/81) at Madingou Base Hospital; 1-5% (1-4/81) at each of the remaining facilities. Eight deaths were recorded in four health facilities. The sex ratio of snakebite victims was 1 (41 males: 40 females). The age most affected was 25-55 years (54.32% or 44/81). The lower limb was the bite site most reported at 13.98% (but in 84% or 68/81 cases the site was not recorded). More bites occurred during the rainy season (80.25%; 65/81). All victims received only symptomatic treatment based on antibiotics, anti-inflammatories and analgesics, as anti-venom serums are unavailable. The recorded incidence of snake bites in Bouenza was 18.62 per 100,000 of population. Conclusion: our study offers a preliminary report from a little-studied region. The incidence of snakebites recorded in Bouenza is lower than expected compared with studies from other African countries, and with earlier (20 years ago) studies from Congo. This may reflect incomplete record-keeping in under-resourced healthcare facilities.

Assessment of organ and effective doses received by adult patients undergoing computed tomography in three hospitals in Brazzaville, Congo Republic.

The present study aimed to evaluate adult patient data collected from three hospitals in Brazzaville, Congo Republic, for the purpose of estimating organ and effective doses for each included examination type. A total of 1277 adult patients (aged 16-97 years) who underwent head, chest, abdominopelvic (AP), chest-abdomen-pelvis (CAP), and lumbar spine computed tomography scans were considered. The organ and effective doses were estimated using a Monte Carlo-based method. The effective doses were also determined using k-factors. In general, the organ and effective doses estimated in this study were higher than those reported in the literature. The k-factor method underestimated the effective dose by up to 65.9%. This study demonstrates that urgent steps should be taken to reduce doses administered to patients to optimal levels. Such optimal levels may be achieved by adopting local diagnostic reference levels, together with the implementation of dose reduction strategies.

Prevalence of malaria among febrile patients and assessment of efficacy of artemether-lumefantrine and artesunate-amodiaquine for uncomplicated malaria in Dolisie, Republic of the Congo.

BACKGROUND: In the Republic of the Congo, malaria represents a major public health problem affecting all age groups. A regular surveillance of the current efficacy of first-line anti-malarial drugs is required in the face of possible emergence and spread of artemisinin-resistant Plasmodium falciparum strains in Africa. The purpose of this study was to determine the prevalence of malaria among febrile patients of all ages and assess the efficacy of artemether-lumefantrine (AL) and artesunate-amodiaquine (ASAQ) in Congolese children. METHODS: Febrile patients of all ages were initially screened for malaria by both rapid diagnostic test (RDT) and microscopy. Patients less than 12 years of age, with parasitaemia ≥ 1000 asexual parasites of P. falciparum/µL of blood, without any signs of severity, were enrolled in a therapeutic efficacy study and treated after obtaining their parents' (or legal guardian's) informed consent in two health centres in Dolisie. The patients were followed for 28 days in accordance with the 2009 World Health Organization standard protocol. If parasitaemia reappeared on or after day 7, the genetic profiles (genes expressing merozoite surface protein-1 [msp1], merozoite surface protein-2 [msp2], and glutamine-rich protein [glurp]) of pre-treatment and post-treatment isolates were compared by nested polymerase chain reaction (PCR) followed by capillary electrophoresis to make a distinction between recrudescence and re-infection. The clinical and parasitological outcome was analysed by the per-protocol method and Kaplan-Meier survival curves. RESULTS: A total of 994 febrile patients of all ages were screened by RDT and microscopy. Of 994 patients, 323 (32.5%) presented a positive RDT, and 266 (26.8%) were microscopy-positive. Based on microscopy as the reference diagnostic method, the sensitivity and the specificity of the RDT were 98.9 and 91.8%, respectively. The Cohen's kappa coefficient was 0.86. A total of 121 children aged less than 12 years (61 in AL treatment group and 60 in ASAQ treatment group) were included in therapeutic efficacy study. Before PCR correction, the proportions of adequate clinical and parasitological response were 96.6% for AL and 86.0% for ASAQ in the per-protocol population (P < 0.05). The PCR-corrected efficacy rates were 98.2% and 94.2% for AL and ASAQ, respectively (P > 0.05). Both treatments were well tolerated. CONCLUSIONS: AL and ASAQ remain highly effective for the first-line treatment of uncomplicated P. falciparum malaria in Dolisie. Despite high efficacy of first- and second-line treatment, there is a continuing need to scale up effective malaria preventive interventions and vector control strategies in the country. TRIAL REGISTRATION NUMBER: ACTRN12616001422415.

Costly teaching contributes to the acquisition of spear hunting skill among BaYaka forager adolescents.

Teaching likely evolved in humans to facilitate the faithful transmission of complex tasks. As the oldest evidenced hunting technology, spear hunting requires acquiring several complex physical and cognitive competencies. In this study, we used observational and interview data collected among BaYaka foragers (Republic of the Congo) to test the predictions that costlier teaching types would be observed at a greater frequency than less costly teaching in the domain of spear hunting and that teachers would calibrate their teaching to pupil skill level. To observe naturalistic teaching during spear hunting, we invited teacher-pupil groupings to spear hunt while wearing GoPro cameras. We analysed 68 h of footage totalling 519 teaching episodes. Most observed teaching events were costly. Direct instruction was the most frequently observed teaching type. Older pupils received less teaching and more opportunities to lead the spear hunt than their younger counterparts. Teachers did not appear to adjust their teaching to pupil experience, potentially because age was a more easily accessible heuristic for pupil skill than experience. Our study shows that costly teaching is frequently used to transmit complex tasks and that instruction may play a privileged role in the transmission of spear hunting knowledge.

Assessment of biofilms formation of bacterial and fungal isolates using qualitative Congo red agar and semiquantitative crystal violet microtiter methods / Evaluación de la formación de biopelículas en aislamientos bacterianos y fúngicos por el método semicuantitativo de microtitulación con cristal violeta y el cualitativo de agar con rojo Congo

Introduction. Sixty-five percent of human infections are caused by bacteria or yeasts able to form biofilms. This feature makes them more resistant to antimicrobials and antifungals. Objective. To determine biofilm formation capacity of bacterial and fungal isolates by quantitative crystal violet microtiter and qualitative Congo red agar methods. Materials and methods. Brain-heart infusion, trypticase soy broth and Müeller­Hinton culture media were used in bacterial isolates for the quantitative method; brain-heart infusion broth and Sabouraud dextrose were used for yeasts. The same culture media plus 3% Congo red and 10% dextrose were used to apply the qualitative method in agar. The proposal by Stepanovic, et al. was used as a reference method. Results. We evaluated 103 bacterial isolates and 108 yeasts isolates. We did not recommend substitute brain-heart infusion broth for trypticase soy and Müeller-Hinton broths for biofilm formation assessment in bacterial isolates using the quantitative method. Sabouraud dextrose medium, both broth and agar, can replace brain-heart infusion to assess biofilm formation in yeasts, quantitatively and qualitatively. Conclusion. The study of biofilms in the microbiology laboratory, using Congo red agar qualitative method, is a simple, fast, and inexpensive procedure that provides precise information for the diagnosis and treatment of persistent infections caused by bacteria and yeasts.

Introducción. El 65 % de las infecciones humanas son producidas por bacterias o levaduras, cuya capacidad de formar biopelículas las hace más resistentes a los antimicrobianos y antifúngicos. Objetivo. Determinar la capacidad de formación de biopelículas en aislamientos bacterianos y fúngicos por medio de los métodos cuantitativo de microtitulación con cristal violeta y cualitativo de cultivo en agar con rojo Congo. Materiales y métodos. Con el método cuantitativo, se utilizaron los medios de cultivo infusión cerebro-corazón, tripticasa de soya y Müeller-Hinton para aislamientos bacterianos; para levaduras, se usaron caldo infusión cerebro-corazón y Sabouraud dextrosa. Para el método cualitativo de cultivo en agar, se utilizaron los mismos medios de cultivo más una solución con 3 % de rojo Congo y 10 % de dextrosa. Cómo método de referencia, se utilizó la propuesta de Stepanovic et al. Resultados. Se evaluaron 103 aislamientos bacterianos y 108 de levaduras. No es recomendable sustituir el caldo infusión cerebro-corazón por los caldos tripticasa de soya y Müeller-Hinton en el método cuantitativo, para evaluar la formación de biopelículas en los aislamientos bacterianos. El medio Sabouraud dextrosa, en caldo y agar, puede sustituir al de infusión de cerebro-corazón para evaluar la formación de biopelículas en levaduras, tanto por el método cuantitativo como por el cualitativo. Conclusión. El estudio de las biopelículas en el laboratorio de microbiología, a partir del método cualitativo de cultivo en agar con rojo Congo, es un procedimiento sencillo, rápido y de bajo costo, que proporciona información útil para el diagnóstico y la terapéutica de infecciones persistentes causadas por bacterias y levaduras.

[Contrat unique, une approche innovante de financement du niveau intermédiaire du système de santé en République Démocratique du Congo : processus et défis de mise en œuvre].

Basket fund, an innovative approach for intermediate health system level financing in the Democratic Republic of Congo: Implementation process and challenges. BACKGROUND: Universal health coverage should allow countries to establish a financing strategy in order to guarantee the health of the population. AIM: Our objective was to describe the process and preliminary results of the implementation of the basket fund approach as a mode of financing the intermediate level (provincial health divisions) of the Congolese health system. SETTING: The study was conducted in the provincial health divisions (PHDs), representing the intermediate level of the health system in the Democratic Republic of Congo, where the basket fund approach has been implementedMethods: We conducted a mixed-methods convergent study as part of the evaluation of the basket fund approach in the Democratic Republic of Congo, five years after its introduction (2014-2019). Data was collected through a document review and individual interviews by telephone. A descriptive analysis of the quantitative data was conducted using Statistical Package for Social Sciences (SPSS) version 24 software. The qualitative data were analysed by thematic analysis using a pre-established thematic framework. RESULTS: The implementation of the basket fund approach was effective in some (PHDs) (53.8% in 2016). The operating costs of the PHDs varied according to the size, density and number of health zones covered. In the PHDs where the basket fund was operational, this approach appeared to contribute to improved planning and management in the use of resources, the partnership between technical and financial partners (TFPs and PHDs) and incentives for the performance of PHD agents. CONCLUSION: In the DRC, the basket fund approach has contributed to improved collaboration between donors in the health sector and facilitated the decentralisation of funding planning to the provincial level.

Impact of Semi-Annual Albendazole on Lymphatic Filariasis and Soil-Transmitted Helminth Infection: Parasitological Assessment after 14 Rounds of Community Treatment.

Between October 2012 and October 2015, we conducted a community trial to assess the impact of semi-annual (twice yearly) community treatment with albendazole on lymphatic filariasis in Seke Pembe, a village in the Republic of the Congo. Semi-annual community treatment with albendazole has been continued in the community since October 2015. We conducted an additional parasitological assessment survey in October 2019, 6 months after the 14th round of semi-annual treatment. Between October 2012 and October 2015, Wuchereria bancrofti antigenemia and microfilaremia rates in the community had decreased from 17.3% to 4.7% and from 5.3% to 0.3%, respectively. In October 2019, the antigenemia rate had decreased further to 2.8% (19 of 687). No microfilariae were found in night blood smears from persons with circulating filarial antigenemia (0 of 16), suggesting that W. bancrofti transmission has been interrupted in Seke Pembe. Semi-annual albendazole treatments also reduced significantly infection rates with soil-transmitted helminths.

Intestinal parasitic infections in a population of BaAka Pygmies inhabiting the Congo Basin in the Central African Republic.

INTRODUCTION: Pygmy tribes inhabit tropical environment of Central Africa. After expulsion from their original habitat by the Bantu people, they settled in a local forest ecosystem where they live with very low sanitary standards. Their actual morbidity remains unknown. OBJECTIVE: The aim of the study was to analyze the prevalence of intestinal parasitic infections in BaAka Pygmies inhabiting the Congo Basin in the Central African Republic. MATERIAL AND METHODS: The study was conducted in 2015, and involved a group of 950 Pygmies living inthe Sangha-Mbaere and Lobaye prefectures. Single stool samples were collected from study participants, fixed in 10% formalin, transported from Africa to Europe, and analyzed by light microscopy using 5 different diagnostic methods (direct smear, decantation with distilled water, Fülleborne's flotation, Kato-Miura thick smear, DiaSyS/PARASYS system sedimentation) at the Military Institute of Medicine in Warsaw, Poland. RESULTS: Microscopic examination revealed infections with 14 different species of intestinal nematodes, cestodes, trematodes and protozoa. According to the study findings, 90.5% of BaAka Pygmies were found to be infected with intestinal parasites, and 70.8% had mixed infections. Most of the pathogenic intestinal parasites were nematodes (85.0%), with Asrcaris lumbricoides (29.8%), hookworm (29.4%) and Trichuris trichiura (10.7%) being predominant. CONCLUSIONS: Poor sanitation, limited the high prevalence of intestinal parasitic infections in the community of Pygmies. The negative test results may prove the effectiveness of periodic deworming campaigns chich, implemented by non-governmental organizations, are voluntary with respect to the informed consent principle.

Identification of Substandard and Falsified Medicines: Influence of Different Tolerance Limits and Use of Authenticity Inquiries.

Substandard and falsified medicines have severe public health and socioeconomic effects, especially in low- and middle-income countries. The WHO has emphasized the need for reliable estimates of the prevalence of such medicines to efficiently respond to this problem. In the present study, we used 601 medicine samples collected in Cameroon, the DR Congo, and Malawi to assess the rates of substandard and falsified medicines based on different criteria. Based on the specifications of the U.S. Pharmacopoeia for the amount of the active pharmaceutical ingredients, the rate of out-of-specification medicines was 9.3%. By contrast, this rate ranged from 3.3% up to 35.0% if the tolerance limits of other pharmacopoeias or recently published medicine quality studies were used. This shows an urgent need for harmonization. Principal methods to assess the rate of falsified medicines are packaging analysis, chemical analysis, and authenticity inquiries. In the present study, we carried out an authenticity inquiry for the aforementioned medicine samples, contacting 126 manufacturers and 42 distributors. Response rates were higher for samples stated to be manufactured in Asia (52.4%) or Europe (53.8%) than for samples manufactured in Africa (27.4%; P < 0.001). One sample had been identified as falsified by packaging analysis by the local researchers and two additional ones by chemical analysis. Notably, seven additional falsified samples were identified by the authenticity inquiries. The total rate of falsified medicines resulted as 1.7%. Considerations are discussed for assessing the rates of "substandard" and "falsified" medicines in future medicine quality studies.

Modern contraceptive availability and stockouts: a multi-country analysis of trends in supply and consumption.

Approximately 214 million women of reproductive age lack adequate access to contraception for their family planning needs, yet patterns of contraceptive availability have seldom been examined. With growing demand for contraceptives in some areas, low contraceptive method availability and stockouts are thought to be major drivers of unmet need among women of reproductive age, though evidence for this is limited. In this research, we examined trends in stockouts, method availability and consumption of specific contraceptive methods in urban areas of four sub-Saharan African countries (Burkina Faso, Democratic Republic of Congo, Kenya and Nigeria) and India. We used representative survey data from the Performance Monitoring for Action Agile Project that were collected in quarterly intervals at service delivery points (SDP) stratified by sector (public vs private), with all countries having five to six quarters of surveys between 2017 and 2019. Among SDPs that offer family planning, we calculated the percentage offering at least one type of modern contraceptive method (MCM) for each country and quarter, and by sector. We examined trends in the percentage of SDPs with stockouts and which currently offer condoms, emergency contraception, oral pills, injectables, intrauterine devices and implants. We also examined trends of client visits for specific methods and the resulting estimated protection from pregnancy by quarter and country. Across all countries, the vast majority of SDPs had at least one type of MCM in-stock during the study period. We find that the frequency of stockouts varies by method and sector and is much more dynamic than previously thought. While the availability and distribution of long-acting reversible contraceptives (LARCs) were limited compared to other methods across countries, LARCs nonetheless consistently accounted for a larger portion of couple years of protection. We discuss findings that show the importance of engaging the private sector towards achieving global and national family planning goals.

[Psycho-social and economic reintegration of women operated for urogenital fistula]. / Réinsertion psycho-sociale et économique des femmes opérées pour fistules obstétricales et non obstétricales au Congo.

OBJECTIVE: To study the psycho-social and economic reintegration of women operated for genital fistula in Congo. MATERIAL AND METHODS: This was a descriptive observational study conducted in Brazzaville and Ewo, Republic of Congo, from April 1 to October 31, 2018. It included patients operated for genital fistula between 2008 and 2017. Variables of interest were socio-demographic, reproductive and clinical characteristics. The analysis was performed using the SPSS 20 software. RESULTS: The overall, 34 patients were studied, with age ranging from 29 to 65 years old with a median of 43 (39, 50) year. The context of fistula occurrence was obstetrical in 24 women (70%). The Practice of an income-generating activity before, during and after fistula was 76%; 32% and 64% (P=0.0007). Concerning the psychological status, in these women, self-esteem went from 26% to 73% (P=0.0003) and the prevalence of suicidal thoughts went from 29% before fistula treatment to 0% after (P=0.0009). The tendency to isolate themselves went from 44% before fistula cure to 3% after (P=0.00008). With regards to reproductive life, 54% of women had no desire for maternity and 17% did not have a desire of sexual intercourse. Only 26% of women benefited from the psychologist. Support. CONCLUSION: In this series, we observed a resumption of income-generating activities in women operated for a treatment of urogenital fistula and a psychological recovery with an increase in self-esteem and a decrease in suicidal thoughts. LEVEL OF EVIDENCE: 4.

Applying the Robson classification to routine facility data to understand the Caesarean section practice in conflict settings of South Kivu, eastern DR Congo.

INTRODUCTION: Sub-Saharan Africa has low Caesarean (CS) levels, despite a global increase in CS use. In conflict settings, the pattern of CS use is unclear because of scanty data. We aimed to examine the opportunity of using routine facility data to describe the CS use in conflict settings. METHODS: We conducted a facility-based cross-sectional study in 8 health zones (HZ) of South Kivu province in eastern DR Congo. We reviewed patient hospital records, maternity registers and operative protocol books, from January to December 2018. Data on direct conflict fatalities were obtained from the Uppsala Conflict Data Program. Based on conflict intensity and chronicity (expressed as a 6-year cumulative conflict death rate), HZ were classified as unstable (higher conflict death rate), intermediate and stable (lower conflict death rate). To describe the Caesarean section practice, we used the Robson classification system. Based on parity, history of previous CS, onset of labour, foetal lie and presentation, number of neonates and gestational age, the Robson classification categorises deliveries into 10 mutually exclusive groups. We performed a descriptive analysis of the relative contribution of each Robson group to the overall CS rate in the conflict stratum. RESULTS: Among the 29,600 deliveries reported by health facilities, 5,520 (18.6%) were by CS; 5,325 (96.5%) records were reviewed, of which 2,883 (54.1%) could be classified. The overall estimated population CS rate was 6.9%. The proportion of health facility deliveries that occurred in secondary hospitals was much smaller in unstable health zones (22.4%) than in intermediate (40.25) or stable health zones (43.0%). Robson groups 5 (previous CS, single cephalic, ≥ 37 weeks), 1 (nulliparous, single cephalic, ≥ 37 weeks, spontaneous labour) and 3 (multiparous, no previous CS, single cephalic, ≥ 37 weeks, spontaneous labour) were the leading contributors to the overall CS rate; and represented 75% of all CS deliveries. In unstable zones, previous CS (27.1%) and abnormal position of the fetus (breech, transverse lie, 3.3%) were much less frequent than in unstable and intermediate (44.3% and 6.0% respectively) and stable (46.7%and 6.2% respectively). Premature delivery and multiple pregnancy were more prominent Robson groups in unstable zones. CONCLUSION: In South Kivu province, conflict exposure is linked with an uneven estimated CS rate at HZ level with at high-risks women in conflict affected settings likely to have lower access to CS compared to low-risk mothers in stable health zones.

Sex differences in daily activity intensity and energy expenditure and their relationship to cortisol among BaYaka foragers from the Congo Basin.

OBJECTIVES: The pooling of energetic resources and food sharing have been widely documented among hunter-gatherer societies. Much less is known about how the energetic costs of daily activities are distributed across individuals in such groups, including between women and men. Moreover, the metabolic physiological correlates of those activities and costs are relatively understudied. MATERIALS AND METHODS: Here, we tracked physical activity, energy expenditure (EE), and cortisol production among Congo Basin BaYaka foragers engaged in a variety of daily subsistence activities (n = 37). Given its role in energy mobilization, we measured overall daily cortisol production and short-term cortisol reactivity through saliva sampling; we measured physical activity levels and total EE via the wGT3X-bt actigraph and heart rate monitor. RESULTS: We found that there were no sex differences in likelihood of working in common activity locations (forest, garden, house). Across the day, women spent greater percentage time in moderate-to-vigorous physical activity (%MVPA) and had lower total EE than men. Females with higher EE (kCal/hr) produced greater cortisol throughout the day. Though not statistically significant, we also found that individuals with greater %MVPA had larger decreases in cortisol reactivity. DISCUSSION: BaYaka women sustained higher levels of physical activity but incurred lower energetic costs than men, even after factoring in sex differences in body composition. Our findings suggest that the distribution of physical activity demands and costs are relevant to discussions regarding how labor is divided and community energy budgets take shape in such settings.

Practice of standard monitoring during anaesthesia in hospitals of North Kivu: a survey of health facilities of the health antenna of Butembo.

BACKGROUND: Standard monitoring during anaesthesia is a core element of patient safety and practice of safe anesthesia has reduced morbidity and mortality worldwide. The main objective of this study was to assess the practice of standard monitoring during anaesthesia in the hospitals of North Kivu, so as to establish a baseline overview of the situation, and orientate plans towards safe anaesthesia in the region. METHODS: This study was a cross-sectional survey of health facilities of the Health Antenna of Butembo in Democratic Republic of Congo and was conducted from October to December 2018. Questionnaires were brought to anaesthesia providers in the health facilities. The study included 1 answer from the anaesthesia practitioners who accepted to participate. The practices of standard monitoring in the health facilities were compared to WHO-WSFA guidelines. Data was captured and analyzed with Epi Info 7. RESULTS: Forty out of 90 health facilities (44.4%) of 10 health zones responded on the questionnaire. Twenty-three health facilities (57.5%) were from private sector and 17 (42.5%) from public sector. Sixteen health facilities (40.0%) were from the Butembo health zone. The median number of anaesthesia providers was 2 per health facility. Of all the anaesthesia providers, none were physicians, 47.5% were nurses practicing anaesthesia without any training in anaesthesia and 47.5% were nurse anaesthetists. All the health facilities were providing general anaesthesia whereas spinal anaesthesia was provided in 22 out of 40 centers (55%). Seventy percent (28/40) of the facilities were below standard according to WHO-WSFA guidelines. Only 40% (16/40) were using a pulse oximeter and 10% (4/40) declared that ECG was occasionally used. CONCLUSION: The practice of standard monitoring is poor in health facilities of the Health Antenna of Butembo. Efforts should be made to improve monitoring which is a key element of safe anaesthesia.