Bacteria and viruses in the upper respiratory tract of Congolese children with radiologically confirmed pneumonia.

BACKGROUND: Acute pneumonia remains a leading cause of death among children below 5 years of age in the Democratic Republic of the Congo (DR Congo), despite introduction of the 13-valent pneumococcal conjugate vaccine (PCV13) in 2013. Potential pathogens in the nasopharynx of hospitalised children with pneumonia have not been studied previously in DR Congo. Here we compare clinical characteristics, risk factors and nasopharyngeal occurrence of bacteria and viruses between children with severe and non-severe pneumonia. METHODS: Between June 2015 and June 2017, 116 children aged from 2 to 59 months hospitalised due to radiologically confirmed pneumonia at Panzi referral university hospital, Bukavu, Eastern DR Congo were included in the study and sampled from nasopharynx. A multiplex real-time PCR assay for detection of 15 different viruses and 5 bacterial species was performed and another multiplex PCR assay was used for pneumococcal serotype/serogroup determination. RESULTS: During the study period 85 (73%) of the children with radiologically confirmed pneumonia met the WHO classification criteria of severe pneumonia and 31 (27%) had non-severe pneumonia. The fatality rate was 9.5%. Almost all (87%) children were treated with antibiotics before they were hospitalised, in most cases with amoxicillin (58%) or trimethoprim-sulfamethoxazole (20%). The frequency of potential pathogens in the nasopharynx of the children was high, and any viral or bacterial nucleic acids present at high levels, irrespective of species or type, were significantly associated with severe pneumonia as compared with non-severe cases (52% versus 29%, p = 0.032). White blood cell count > 20,000/µL and C-Reactive Protein > 75 mg/dL were associated with severe pneumonia at admission. Fatal outcome was in the multivariable analysis associated with having a congenital disease as an underlying condition. One or more pneumococcal serotypes/serogroups could be identified in 61 patients, and out of all identified serotypes 31/83 (37%) were non-PCV13 serotypes. CONCLUSIONS: The occurrence of any bacteria or any viruses at high levels was associated with severe pneumonia at admission. Children with congenital disorders might need a higher attention when having symptoms of acute respiratory infection, as developed pneumonia could lead to fatal outcome.

Knowledge Attitude and Practice (KAP) survey among healthcare professionals in pediatrics on the psychomotor development of children. Case of urban and rural health areas in South Kivu in the Democratic Republic of Congo: a cross-sectional study.

Development refers to change. The study of development is the understanding of how a subject functions at a particular age or time in life. The objective of this study was to evaluate the knowledge, attitude, and practice of pediatric healthcare personnel on the psychomotor development of the child. Methods: This was a cross-sectional study of knowledge, attitude, and practice conducted in the health areas of South Kivu. Results: Twenty-six caregivers participated in the survey. Men were the most represented (61.5%), mean age 27.62±5.07 years; median experience in pediatrics: 1 year; predominantly urban setting with 69.2%. General practitioners were more represented, with 57.7%. The overall state of knowledge was insufficient in 69.2%. Knowledge1 improves with increasing experience in pediatrics (P=0.008), and qualification improves knowledge1 (P=0.033) and knowledge3 (P=0.009). Knowledge4 improved from rural to urban settings (P=0.022).A good knowledge of the scales used in the evaluation of psychomotor development influences the use of one or the other (P=0.000). The authors also notice that those who indicate and/or have physical therapy practiced in rehabilitation are generally those who have a good knowledge of the use of psychomotor development assessment tools (P=0.010). Conclusion: This study highlights the low theoretical knowledge of caregivers on psychomotor development in our study setting, resulting in late diagnosis and consequently poor treatment of psychomotor development disorders. The results of this study indicate a need for continuing education for pediatric caregivers on the psychomotor development of the child.

Experience on trial of labor and vaginal delivery after two previous cesarean sections: A cohort study from a limited-resource setting.

OBJECTIVE: To determine the success rate of trial of labor after two cesarean sections (TOLA2C) in the low-resource setting of the Democratic Republic of Congo (DRC) and to describe factors associated with success and related complications. METHODS: A prospective cohort study was conducted from 2015 to 2020 in a teaching hospital. Patients who underwent TOLA2C were followed across prenatal visits, onset of spontaneous labor, and delivery. Demographics and clinical characteristics were documented. Pearson and Fisher χ2 tests were used. Predictors of successful vaginal delivery were determined by logistic regression (P Ë‚ 0.05). RESULTS: Among 532 patients, the success rate of TOLA2C was 405 (76.1%). Factors associated with success included birth spacing ≥24 months (adjOR: 2.02 ; 95% CI 1.14-3.56; P = 0.015), previous vaginal delivery (adjOR: 5.02; 95% CI 2.71-9.31; P Ë‚ 0.001), intercalated vaginal delivery (adjOR: 5.15; 95% CI 2.28-11.65; P Ë‚ 0.001), cervical dilation >6 cm (adjOR: 2.37; 95% CI 1.92-6.05; P = 0.031) and/or complete dilation on arrival in the delivery room (adjOR: 1.96; 95% CI 1.33-11.45; P = 0.047) and oxytocin stimulation (adjOR: 4.24; 95% CI 1.82-9.91; P Ë‚ 0.001). No association with hemorrhage, uterine rupture, transfer to neonatology, or maternal-neonatal deaths was observed. CONCLUSIONS: TOLA2C is possible in a low-resource setting with a high success rate and low rates of complications. Patient selection and obstetrical team competency are required.