Effect of early vitamin D supplementation on the incidence of preeclampsia in primigravid women: a randomised clinical trial in Eastern Democratic Republic of the Congo.

BACKGROUND: Previous studies have reported the association between maternal vitamin D deficiency and preeclampsia. However, the efficacy of vitamin D supplementation in reducing the occurrence of preeclampsia remains unclear. The objective of this study was to evaluate the effect of cholecalciferol supplementation on the incidence of preeclampsia in primigravid women and its related maternal and foetal outcomes. METHODS: A single-blinded clinical trial was conducted in fourteen antenatal care health facilities in the North (Goma, Mwesso, Nyiragongo) and South Kivu (Bukavu-Panzi) provinces of the Democratic Republic of Congo from March 1, 2020, to June 30, 2021. A total of 1300 primigravid women not exceeding 16 weeks of gestation were randomised with a 1:1 ratio to either the supplemented (A) or control (B) group. Each pregnant woman (A) presenting for antenatal care received a single monthly dose of cholecalciferol (60,000 IU) orally for 6 months. The control group received no vitamin D supplementation or placebo. Serum 25(OH)D was measured at recruitment and at 34 weeks of gestation. Outcomes were assessed monthly until delivery. RESULTS: The median maternal age was 21 years (14-40), while the median gestational age was 15 weeks (5.4-29.0). A significant reduction in the risk of preeclampsia [RR = 0.36 (0.19-0.69); p = 0.001] and preterm delivery [RR = 0.5 (0.32-0.78); p = 0.002] was observed in the intervention group. An RR of 0.43 [(0.27-0.67); p < 0.001] was found for low birth weight. The RR for caesarean section was 0.63 [(0.52-0.75); p < 0.001]. The APGAR score at the 5th minute (p = 0.021) and the size of the newborn were significantly higher in the supplemented group (p = 0.005). CONCLUSION: A single monthly dose (60,000 IU) of vitamin D supplementation, started in earlypregnancy, significantly reduced the incidence of preeclampsia and its maternal and foetal complications. TRIAL REGISTRATION: ISRCTN Register with ISRCTN46539495 on 17 November 2020.

A cross-sectional study exploring the characteristics of female survivors of sexual violence living with HIV/AIDS in the eastern region of Democratic Republic of Congo.

BACKGROUND: Sexual violence remains a persistent and devastating issue in eastern Democratic Republic of Congo (DRC). AIM: To elucidate the sociodemographic, sexual, and obstetrical characteristics associated with the experiences of victims of sexual violence (VSV) among women in the region. MATERIALS AND METHODS: A cross-sectional study was conducted involving 625 women from eastern DRC. Participants provided self-reported data, collected through interviews conducted by trained female interviewers in secure environments. Associations between VSV and various sociodemographic and reproductive health factors were examined. RESULTS: Of the respondents, 26.1% reported experiences of sexual violence. VSV were predominantly younger, with 56.44% aged between 15 and 24 years. Single women comprised 57.67% of VSV, and 37.42% identified as farmers. There were 33.13% of VSV who were illiterate, and 81.60% belonged to the low socio-economic stratum. Early physiological and reproductive milestones characterised VSV: 52.15% experienced menarche at or before 13 years, 34.97% initiated sexual intercourse before age 15, and 18.70% reported their first pregnancy before age 15. Higher nulliparity was observed in VSV (29.45%) compared to non-VSV (9.31%). A lower prevalence of HIV infection was found among VSV (11.04%) relative to non-VSV (25.76%). CONCLUSION: Sexual violence in the eastern DRC exhibits multifactorial associations. Younger women, those in certain occupations, and those with specific reproductive histories appear more vulnerable. The findings underscore the urgency for targeted interventions, enhanced access to education, and improved reproductive health services. Addressing these pressing issues should remain a primary focus in both societal and public health spheres.

School-based malaria prevalence: informative systematic surveillance measure to assess epidemiological impact of malaria control interventions in the Democratic Republic of the Congo.

BACKGROUND: In southern Democratic Republic of the Congo, malaria transmission is stable with seasonal fluctuations. Different measurements can be used to monitor disease burden and estimate the performance of control programmes. Repeated school-based malaria prevalence surveys (SMPS) were conducted from 2007 to 2014 to generate up-to-date surveillance data and evaluate the impact of an integrated vector control programme. METHODS: Biannual SMPS used a stratified, randomized and proportional sampling method. Schools were randomly selected from the entire pool of facilities within each Health Area (HA). Subsequently, school-children from 6 to 12 years of age were randomly selected in a proportional manner. Initial point-of-care malaria diagnosis was made using a rapid detection test. A matching stained blood film was later examined by expert microscopy and used in the final analysis. Data was stratified and analysed based on age, survey time and location. RESULTS: The baseline SMPS (pre-control in 2007) prevalence was approximately 77%. From 2009 to 2014, 11,628 school-children were randomly screened. The mean age was 8.7 years with a near equal sex ratio. After exclusion, analysis of 10,493 students showed an overall malaria prevalence ratio of 1.92 in rural compared to urbanized areas. The distribution of Plasmodium falciparum malaria was significantly different between rural and urban HAs and between end of wet season and end of dry season surveys. The combined prevalence of single P. falciparum, Plasmodium malariae and Plasmodium ovale infections were 29.9, 1.8 and 0.3% of those examined, respectively. Only 1.8% were mixed Plasmodium species infections. From all microscopically detected infections (3545 of 10,493 samples examined), P. falciparum represented 88.5%, followed by P. malariae (5.4%) and P. ovale (0.8%). Cases with multiple species represented 5.3% of patent infections. Malaria prevalence was independent of age and gender. Control programme performance contributed to a significant decrease in mean P. falciparum infection density in urban compared to rural locations. Some rural areas remained highly refractory to control measures (insecticide-treated bed nets, periodic indoor residual spraying). CONCLUSION: The SMPS is a useful longitudinal measurement for estimating population malaria prevalence and demonstrating disease burden and impact of control interventions. SMPS can identify refractory areas of transmission and thus prioritize control strategies accordingly.

Rwanda 20 years on: investing in life.

Two decades ago, the genocide against the Tutsis in Rwanda led to the deaths of 1 million people, and the displacement of millions more. Injury and trauma were followed by the effects of a devastated health system and economy. In the years that followed, a new course set by a new government set into motion equity-oriented national policies focusing on social cohesion and people-centred development. Premature mortality rates have fallen precipitously in recent years, and life expectancy has doubled since the mid-1990s. Here we reflect on the lessons learned in rebuilding Rwanda's health sector during the past two decades, as the country now prepares itself to take on new challenges in health-care delivery.

[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.

Identifying characteristics associated with performing recommended practices in maternal and newborn care among health facilities in Rwanda: a cross-sectional study.

BACKGROUND: Although rates of maternal and neonatal mortality have decreased in many countries over the last two decades, they remain unacceptably high, particularly in sub-Saharan Africa. Nevertheless, we know little about the quality of facility-based maternal and newborn care in low-income countries and little about the association between quality of care and health worker training, supervision, and incentives in these settings. We therefore sought to examine the quality of facility-based maternal and newborn health care by describing the implementation of recommended practices for maternal and newborn care among health care facilities. We also aimed to determine whether increased training, supervision, and incentives for health workers were associated with implementing these recommended practices. We chose to study these aims in the Republic of Rwanda, where rates of maternal and newborn mortality are high and where substantial attention is currently focused on strengthening health workforce capacity and quality. METHODS: We used data from the 2007 Rwanda Service Provision Assessment. Using observations from 455 facilities and interviews from 1357 providers, we generated descriptive statistics to describe the use of recommended practices and frequencies of provider training, supervision, and incentives in the areas of antenatal, delivery, and newborn care. We then constructed multivariable regression models to examine the associations between using recommended practices and health provider training, supervision, and incentives. RESULTS: Use of recommended practices varied widely, and very few facilities performed all recommended practices. Furthermore, in most areas of care, less than 25% of providers reported having had any pre-service or in-service training in the last 3 years. Contrary to our hypotheses, we found no evidence that training, supervision, or incentives were consistently associated with using recommended practices. CONCLUSION: Our findings highlight the need to improve facility-based maternal and newborn care in Rwanda and suggest that current approaches to workforce training, supervision, and incentives may not be adequate for improving these critical practices.

Universal health insurance in Rwanda: major challenges and solutions for financial sustainability case study of Rwanda community-based health insurance part I.

INTRODUCTION: Universal Health Coverage (UHC) has engaged attention of policy makers at both global and country levels. UHC is one of three strategic priorities of World Health Organization's (WHO) general program of work for 2019-2023, and it is then a global health priority. Rwanda Community-Based Health Insurance is considered the vehicle for UHC and Universal Health Insurance in Rwanda. CBHI was officially introduced in 1999/2000 and through 2011/2012 Rwanda was not far from effective UHC. However, since then, CBHI faced chronic financial deficit. This study aims to assess challenges facing Community-Based Health Insurance financial sustainability and to propose indicative solutions. METHODS: quantitative, qualitative, analytical, longitudinal (2011-2018) and documentary mixed methods were applied. One National Pooling Risk (100%), 15 Community-Based Health Insurance districts (50%) and 60 Community Based Health Insurance sections (13.33%) were randomly selected and included in the study. To assess major challenges, "analyzing qualitative data G3658-6 approach" and "prioritization hanlon method" were used. RESULTS: the study highlighted five major challenges: (i) disproportionate risk-equalization in the social health insurance contributory system; (ii) unit cost exceeding individual income (premium plus other revenues and subsidies); (iii) imperfection in funding mobilization and recovery; (iv) cost-escalation; (v) diseconomy of scale; and the study proposed indicative solutions including injection of additional funding and shifting from current fee-for-service payment to fully active strategic purchasing mechanisms as accompanying measures. CONCLUSION: CBHI financial sustainability is achievable, but this is contingent upon persistence of political commitment efforts to achieve UHC, correction of highlighted imperfections and injection of additional funding to allow Rwanda Community-Based Health Insurance to meet and/or exceed its cost in the long-term.

[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.

Increased prevalence of obesity, diabetes mellitus and hypertension with associated risk factors in a mine-based workforce, Democratic Republic of Congo.

INTRODUCTION: The burden of non-communicable diseases (NCDs) is increasing rapidly in low- and middle-income countries, with the largest portion occurring in Africa. Results from earlier baseline measures on obesity, diabetes and hypertension (ODH) in the Tenke Fungurume Mining (TFM) workforce in 2010 showed high proportions of overweight, pre-diabetic and pre-hypertensive individuals, predicting an upward trend in the burden of ODH over time. The 2010-2015 longitudinal trends on ODH and related risk factors among the TFM workforce is presented herein, and projects the consequent burden of these diseases on the workforce by 2025 if an effective prevention program is not implemented. METHODS: A longitudinal, retrospective cohort study with 3-time intervals was conducted using occupational health records collected on all employees and contractors who had a pre-employment or follow up medical checkups covering the period between January 2010 and December 2015. Repeated paired t tests measured changes in mean values of quantitative risk factors, while a chi-square test assessed changes in prevalence and categorical risk factors over time. A linear projection model was used to predict the consequent morbidity of ODH for the subsequent 10 years up to 2025. RESULTS: Between 2010 and 2015, prevalence increased from 4.5% to 11.1% for obesity, 11.9% to 15.6% for diabetes, and 18.2% to 26.5% for hypertension. By 2025, provided no prevention program is implemented, prevalence is predicted to reach 25%, 24% and 42% respectively for obesity, diabetes and hypertension. CONCLUSION: Without implementation of a comprehensive NCD prevention plan, the burden of ODH and other NCDs is predicted to increase dramatically in the TFM workforce. Alone or combined, NCDs have the potential to dramatically increase operational costs while decreasing productivity over time.

[Obstetric fistulas among people living in northern Katanga province, Democratic Republic of the Congo: about 242 cases]. / Fistules obstétricales dans la province du Haut-Katanga, République Démocratique du Congo: à propos de 242 cas.

Obstetric fistulas are a major public health problem in poor countries. This study aimed to describe the epidemiological, clinical and therapeutic features of obstetric fistulas in northern Katanga province, Democratic Republic of the Congo. We conducted a descriptive cross-sectional study of 242 patients with obstetric fistula living in northern Katanga province from September 2009 to December 2013. The parameters studied included maternal sociodemographic data, obstetric and neonatal parameters, specific features of the fistula as well as management approach and outcome. Variables were analyzed using Epi Info 7.1 software. Out of 242 patients with obstetric fistula, 229 (95%) patients delivered vaginally and among them 74.6% delivered at home. In 93,4% of cases the new-born died in the perinatal period. The average age of patients was 27.9 ± 10.3 years. One out of six patients had less than 20 years and in general almost 1 out of 2 patients had less than 25 years. Seven out of ten patients had a parity of less than 3 and the average parity was 2.5±2.0. Ninety percent of patients had a low educational level and 95% lived alone. The patients had, on average, a history of fistula of more than 4.7±4.4 years, it was a vesico-vaginal fistula (96%) type 2-3 (37%) and it was repaired using a transvaginal approach (67%). The average failure rate was 14%. Obstetric fistula is a real public health problem in our environment and it deserves further consideration to be eradicated.

[External anthropometric measurement and pelvimetry among nulliparous women in Lubumbashi: risk factors and predictive score of mechanical dystocia]. / Étude anthropométrique et pelvimétrique externe chez les nullipares de Lubumbashi: facteurs de risque et score prédictif de la dystocie mécanique.

INTRODUCTION: Maternal and perinatal morbi-mortality is higher in most of sub-Saharan Africa compared to the rest of the world. All women at risk for mechanical dystocia should be screened before labor and referred to a better equipped Hospital for childbirth. This would reduce morbi-mortality. This study aims to develop a predictive score of mechanical dystocia during childbirth among nulliparous Congolese women. METHODS: We conducted a cross-sectional study of nulliparous women with single pregnancy in 7 Maternity Units in the city of Lubumbashi (DRC). Women' size, weight, and external pelvimetry results were collected and analyzed. Univariate and multivariate analyses were performed. Discrimination score was assessed using the ROC curve. RESULTS: We included in the study 535 nulliparous women, of whom 126 (23.55%) had given birth by cesarean section due to mechanical dystocia. After logistic modelling, three criteria emerged as predictive factors for mechanical dystocia: maternal height <150 cm (adjusted OR=2.96 [1,49-5,87]), bi-ischiatic diameter <8 cm (adjusted OR =15.96 [3,46-73,56]), and Trillat's pre-pubic diameter <11 cm (adjusted OR =2.34 [1,36-4,01]). The area under the ROC curve of the score was 0.6549 with a sensitivity of 23.81%, a specificity of 97.80% and a positive predictive value of 76.92%. CONCLUSION: It has been observed that 10th percentile of the three maternal anthropometric measures was predictive of mechanical dystocia. When they were used together, these three values allowed for the development of lowest-cost screening score for use in low income settings.

Severe malaria and death risk factors among children under 5 years at Jason Sendwe Hospital in Democratic Republic of Congo.

INTRODUCTION: Malaria is still a major public health concern in the Democratic Republic of Congo. Its morbidity and mortality challenge the actual strategies of the fight agains malaria. This study was aimed to describe the epidemiology, the clinical caracteristics and the risk factors of death associated to severe malaria in the pediatric population under 5 years at Sendwe Hospital of Lubumbashi. METHODS: This analytical retrospective study was conducted in Lubumbashi, in the province of Haut-Katanga. All patients under 5 years hospitalized for severe malaria were registered from January 2014 to December 2016. RESULTS: Among the 3,092 patients hospitalised during our study period, 452 (14.6%) were admitted for severe malaria. The average age was 27.04 months, the male sex was the most affected (53.54% with the sex-ratio 1.15). The most frequent forms of gravity noticed were cerebral malaria (48.23%) and severe anemia (46.90%). Death was noted in the evolution in 28.32%. Repeated convulsion (OR = 2.27; 95% CI: 1.47-3.48), coma (OR = 3.55; 95% CI: 2.19-5.74) and severe acute malnutrition (OR = 3.32; 95% CI: 1.56-7.06) were asscociated with a high risk of death. CONCLUSION: This research shows that severe malaria is still an important cause of morbidity and mortality among young children in Lubumbashi. Neurologic and anemic forms are the most frequent. The predictive signs of death are: repeated convulsions, coma and severe acute malnutrition.

A cross-sectional study on obesity and related risk factors among women of the central market of Lusonga in Lubumbashi, Democratic Republic of Congo.

INTRODUCTION: Obesity is known as one of adjuvant factors for increase in non-communiable diseases (NCDs). The aim of this study was to describe the prevalence of obesity and identify its risk factors among women of the central market of Lusonga in Lubumbashi, Democratic Republic of Congo. METHODS: In October 2014, we interviewed a total of 430 women selling in the central market of Lusonga in Lubumbashi. Data on sociodemographic characteristics, health-related habits and behaviors, diet, physical activity, chronic diseases, blood pressure and anthropometric measurements were collected. A multivariate logistic regression model was fitted. RESULTS: Prevalence of overweight and obesity was 16.51% and 13.26% respectively. The logistic regression did not show any significant association between age and obesity. Risk of obesity was lower in married women (adjusted odds ratio (aOR) = 0.23 (0.08-0.63)). Women with low educational profile (primary school or less) were more likely to be obese than those with higher education (secondary or high school) (aOR = 2.50 (1.12-5.63)). Risk of obesity increased with living in urban area (aOR = 2.52 (1.00-6.36)), use of oral birth control pills (aOR = 11.07 (3.52-34.83)) and low consumption of fruit (aOR = 5.47 (1.88-15.92)) and vegetable (aOR = 2.42 (1.05-5.56)). Obese women were more likely to be hypertensive than non-obese (aOR = 7.15 (2.46-20.75)) and diabetics (aOR = 3.62 (1.62-8.11)). CONCLUSION: This study has reported a prevalence of 13.26% of obesity among women selling at Lusonga's market. Marital status, education level, residence, use of oral birth control pills and consumption of fruit and vegetables had a significant association with the prevalence of obesity in this category of women.

[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.

[Labour in women with scarred uterus in the Democratic Republic of the Congo: trial of scar and factors influencing the outcome]. / Accouchements sur utérus cicatriciel en République Démocratique du Congo: épreuve utérine et facteurs déterminants de l'issue.

OBJECTIVE: Our study aims to identify risks factors associated with failed trial of scar and to set a predictive score of labour in women with scarred uterus in the Democratic Republic of the Congo. METHODS: We conducted a multicenter cross-sectional analytic study of patients with scarred uterus in four maternity units in the Democratic Republic of the Congo (DRC) from 1 January to 31 December 2013. Logistic regression model was used to identify factors associated with failed trial of scar. We set a predictive score based on this model in order to predict trial of scar failure in maternity units in the DRC. ROC curve was used to assess the ability of the set score to identify patients at risk for trial of scar failure. The cut off point for the predictive score was determined on the basis of the Youden-index-based optimal sensitivity and specificity. All the tests in our study were carried out by using a significance threshold of α=0.05. RESULTS: Two explanatory factors in trial of scar failure were retained. They were the socio-demographic factor (maternal age) and three obstetric factors (fundal height, fetal presentation and premature rupture of membranes). Predictive score was set to predict trial of scar failure. This score was determined based on four elements: maternal age, evaluation of the gestational sac on admission, fundal height and fetal presentation. The minimum score was set at 4 and the maximum score was set at 16. The threshold value was set at 7. A total score greater than or equal to 7 reflects a risk of trial of scar failure. CONCLUSION: We set a predictive score to predict trial of scar failure. This score was determined based on four elements: maternal age, evaluation of the gestational sac on admission, fundal height and fetal presentation. A total score greater than or equal to 7 reflects a risk of trial of scar failure.

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.

Cesarean section indications and anthropometric parameters in Rwandan nulliparae: preliminary results from a longitudinal survey.

INTRODUCTION: Maternal anthropometric parameters as risk factors for cesarean section have always been a matter of interest and concern for obstetricians. Some of these parameters have been shown to be predictors of dystocia. This study aims at showing the relationship between cesarean section indications and anthropometric parameters sizes in Rwandan nulliparae for the purpose of comparison and appropriate recommendations. METHODS: A cross-sectional and analytical study was made on data collected from 32 operated patients among 152 nulliparae with singleton pregnancy at term and vertex presentation. Concerned anthropometric parameters were height, weight and six pelvic distances. Fisher exact and Student's tests were used to compare observed proportions and mean values, respectively. RESULTS: Findings were as follows: 1) the overall cesarean section rate was 21.05%; 2) acute fetal distress (31.3 %), generally contracted pelvis (28.1 %), and engagement failure (25%) were the most frequent indications of cesarean section; 3) all patients ≤ 145 cm tall were operated on for general pelvis contraction whose proportion was significantly higher in them than in the others (p < 0.01); 4) more than half of pelvis contraction cases were observed in patients weighing ≤ 50 kg, but the difference with other weight categories was not significant; 5) considered external pelvic diameters but the Biiliac Diameter displayed average measurements smaller in clinically contracted pelvis than in other CS indications. CONCLUSION: External pelvimetry associated with specific other anthropometric parameters could be helpful in the screening of generally contracted pelves, and consequently pregnancies at high risk of cephalopelvic disproportion in nulliparous women, particularly in developing countries with limited resources. Further investigations are requested to deal with this topic in depth.

Enhancing formal educational and in-service training programs in rural Rwanda: a partnership among the public sector, a nongovernmental organization, and academia.

Global disparities in the distribution, specialization, diversity, and competency of the health workforce are striking. Countries with fewer health professionals have poorer health outcomes compared with countries that have more. Despite major gains in health indicators, Rwanda still suffers from a severe shortage of health professionals.This article describes a partnership launched in 2005 by Rwanda's Ministry of Health with the U.S. nongovernmental organization Partners In Health and with Harvard Medical School and Brigham and Women's Hospital. The partnership has expanded to include the Faculty of Medicine and the School of Public Health at the National University of Rwanda and other Harvard-affiliated academic medical centers. The partnership prioritizes local ownership and-with the ultimate goals of strengthening health service delivery and achieving health equity for poor and underserved populations-it has helped establish new or strengthen existing formal educational programs (conferring advanced degrees) and in-service training programs (fostering continuing professional development) targeting the local health workforce. Harvard Medical School and Brigham and Women's Hospital have also benefited from the partnership, expanding the opportunities for training and research in global health available to their faculty and trainees.The partnership has enabled Rwandan health professionals at partnership-supported district hospitals to acquire new competencies and deliver better health services to rural and underserved populations by leveraging resources, expertise, and growing interest in global health within the participating U.S. academic institutions. Best practices implemented during the partnership's first nine years can inform similar formal educational and in-service training programs in other low-income countries.