Poor glycaemic control: prevalence, factors and implications for the care of patients with type 2 diabetes in Kinshasa, Democratic Republic of the Congo: a cross-sectional study.

Introduction: Diabetes is a significant problem in sub-Saharan Africa and achieving glycaemic control poses a health challenge among patients living with type 2 diabetes. There are limited data on glycaemic control in Kinshasa, Democratic Republic of the Congo. This study assessed the prevalence and factors associated with glycaemic control to inform potential interventions to improve glycaemic control in Kinshasa. Methods: This was a cross-sectional study conducted between November 2021-September 2022 among patients recruited from 20 randomly selected health facilities in Kinshasa. Participants were asked to complete a structured questionnaire and to provide two millilitres of blood for Hb1AC assay. Poor glycaemic control was defined as HbA1c ≥7%. Univariate and multivariable logistic regressions were performed to identify factors associated with poor glycaemic control. Results: A total of 620 participants were recruited for this study. Study participants had a median age of 60 (IQR=53.5-69) years with the majority being female (66.1%), unemployed (67.8%), having income below the poverty line (76.4%), and without health insurance (92.1%). About two-thirds of the participants (420; 67.6%) had poor glycaemic control. Participants on monotherapy with insulin (AOR=1.64, 95%CI [1.10-2.45]) and those on a treatment duration ≥7 years (AOR=1.45, 95%CI [1.01-2.08]) were associated with increased odds of poor glycaemic control while being overweight (AOR= 0.47, 95%CI [0.26-0.85]) and those with uncontrolled blood pressure (AOR=0.65, 95% CI [0.48-0.90]) were protective for poor glycaemic control. Conclusion: Poor glycaemic control is prevalent among patients with type 2 diabetes in Kinshasa, DRC. Being on insulin alone and a duration of diabetes treatment equal or more than 7 years predisposed to poor glycaemic control. By contrary, having uncontrolled blood pressure and being overweight had protective effect against poor glycaemic control. These links between uncontrolled blood pressure and overweight on the one hand, and glycaemic control on the other are unusual. These reflect, among other things, the specific characteristics of diabetes in sub Saharan Africa.

Type 2 diabetes in the Democratic Republic of Congo: an urgent need for a management framework.

Glycaemic control is of one the main goals for managing type 2 diabetes. In sub-Saharan Africa and the Democratic Republic of the Congo, studies have reported alarming poor control rates. Patients with poor glycaemic control are exposed to complications leading to high cost of care and deteriorated quality of life. In recent studies by our group, we have demonstrated that poor glycaemic control is high and driven by proximal (individual) and distal (structural) factors in Kinshasa, Democratic Republic of the Congo. Financial constraints impacted many aspects of care at multiple levels from the Government to persons living with diabetes. Financial constraints prevented good preparation, organization and access to diabetes care. Difficulties in implementing lifestyle changes, lack of health literacy and limited healthcare support were also contributing to poor glycaemic control. Through a Delphi study, a group of experts reached a consensus on five potential strategies for improving glycaemic control in the Democratic Republic of Congo as follows: changing the healthcare system for better diabetes care extended to other noncommunicable diseases, ensuring consistent financing of the healthcare, augmenting the awareness of diabetes among the general population and the persons living with diabetes, easing the adoption of lifestyle modifications and reducing the burden of undiagnosed diabetes. This paper reflects on the urgent need for an improved management framework for diabetes care in the Democratic Republic of the Congo. Specifically, the Government needs to increase the investment in the prevention and treatment of noncommunicable diseases including diabetes.

Protocol: Developing a framework to improve glycaemic control among patients with type 2 diabetes mellitus in Kinshasa, Democratic Republic of the Congo.

In Kinshasa, Democratic Republic of the Congo (DRC), between 68-86% of patients with type 2 diabetes present with poor glycaemic control leading to increased risk of complications and high cost of care. Identifying the factors driving glycaemic control is essential for better management. There is lack of data on factors associated with poor glycaemic control and targeted interventions in the DRC. This study aims to determine the factors associated with type 2 diabetes control and develop an appropriate intervention package in Kinshasa. The study will comprise of three sub-studies as follows: the first sub-study being a concurrent parallel mixed-methods cross-sectional study to determine factors driving poor glycaemic control among patients in Kinshasa. A total of 614 patients will be invited to participate in a cross-sectional study and respond to standardized questionnaires. A minimum of 20 purposively selected patients will participate in the qualitative study that will involve in-depth interviews about their perspectives on glycaemic control. In the quantitative study, multivariable logistic regression will be performed to determine factors associated with glycaemic control, after identifying the confounding factors. In the qualitative study, thematic analysis will be performed. Findings of the quantitative and qualitative studies on factors that are associated with glycaemic control will be triangulated. And allow to conduct the second sub-study, a qualitative inquiry with a minimum of 20 healthcare providers and 20 patients, selected purposively, to explore their perspectives about potential interventions to improve glycaemic control. At the last, the findings of both sub-studies will be subjected to an anonymous electronic three-round process Delphi study involving 25 stakeholders on the intervention package to develop a framework to optimise glycaemic control in Kinshasa. The implementation of the intervention package will occur after the completion of this study with expected substantial impact on the patients, healthcare providers, and health system.

Glycaemic control among type 2 diabetes patients in sub-Saharan Africa from 2012 to 2022: a systematic review and meta-analysis.

BACKGROUND: There is an increased burden of diabetes globally including in sub-Saharan Africa. The literature shows that glycaemic control among type 2 diabetes patients is poor in most countries in sub-Saharan Africa. Understanding the factors influencing glycaemic control in this region is therefore important to develop interventions to optimize glycaemic control. We carried out a systematic review to determine the prevalence and factors associated with glycaemic control in sub-Saharan Africa to inform the development of a glycaemic control framework in the Democratic Republic of the Congo. METHODS: We searched five databases (African Index Medicus, Africa-Wide Information, Global Health, PubMed, and Web of Science) using the following search terms: type-2 diabetes, glycaemic control, and sub-Saharan Africa. Only peer-reviewed articles from January 2012 to May 2022 were eligible for this review. Two reviewers, independently, selected articles, assessed their methodological quality using Joanna Briggs checklists, and extracted data. A meta-analysis was performed to estimate the prevalence of glycaemic control. Factors associated with glycaemic control were presented as a narrative synthesis due to heterogeneity as assessed by the I2. RESULTS: A total of 74 studies, involving 21,133 participants were included in the review. The pooled prevalence of good glycaemic control was 30% (95% CI:27.6-32.9). The glycaemic control prevalence ranged from 10-60%. Younger and older age, gender, lower income, absence of health insurance, low level of education, place of residence, family history of diabetes, longer duration of diabetes, pill burden, treatment regimen, side effects, use of statins or antihypertensives, alcohol consumption, smoking, presence of comorbidities/complications, and poor management were associated with poor glycaemic control. On the other hand, positive perceived family support, adequate coping strategies, high diabetes health literacy, dietary adherence, exercise practice, attendance to follow-up, and medication adherence were associated with good glycaemic control. CONCLUSION: Suboptimal glycaemic control is pervasive among patients with type-2 diabetes in sub-Saharan Africa and poses a significant public health challenge. While urgent interventions are required to optimize glycaemic control in this region, these should consider sociodemographic, lifestyle, clinical, and treatment-related factors. This systematic review and meta-analysis protocol is registered in PROSPERO under CRD 42021237941.

Safety and efficacy of oral fexinidazole in children with gambiense human African trypanosomiasis: a multicentre, single-arm, open-label, phase 2-3 trial.

BACKGROUND: Fexinidazole has been reported as an effective oral monotherapy against non-severe gambiense human African trypanosomiasis in a recent trial in adults. We aimed to assess the safety and efficacy of fexinidazole in children across all disease stages of gambiense human African trypanosomiasis. METHODS: We did a multicentre, single-arm, open-label, phase 2-3 trial at eight district hospitals in the Democratic Republic of the Congo. We recruited children with a Karnofsky score of more than 50, those aged 6 years to younger than 15 years, weighing 20 kg or more, and with confirmed gambiense human African trypanosomiasis (any stage). Children weighing 20 kg or more and less than 35 kg received oral fexinidazole of 1200 mg (two × 600 mg tablets) once per day for 4 days (days 1-4) followed by 600 mg (one × 600 mg tablet) once per day for 6 days (days 5-10). Children weighing 35 kg or more received oral fexinidazole of 1800 mg (three × 600 mg tablets) once per day for 4 days (days 1-4), followed by 1200 mg (two × 600 mg tablets) once per day for 6 days (days 5-10). The primary endpoint was fexinidazole treatment success rate 12 months after end of treatment. A rate greater than 80% was deemed acceptable and a target value of 92% was aimed for. Safety was assessed through routine monitoring. This study is completed and registered with ClinicalTrials.gov, number NCT02184689. FINDINGS: Between May 3, 2014, and Nov 22, 2016, we screened a total of 130 paediatric patients, of whom 125 (96%) received at least one dose of fexinidazole. All 125 patients (69 [55%] patients with stage 1, 19 [15%] with early stage 2, and 37 [30%] with late stage 2 gambiense human African trypanosomiasis) completed the 10-day treatment. Treatment success rate at 12 months was 97·6% (95% CI 93·1-99·5; 122 of 125 patients). The primary endpoint was met and the targeted value of 92% was exceeded. Treatment success at 12 months was elevated across all disease stages: 98·6% (95% CI 92·2-99·9; 68 of 69 patients) in stage 1, 94·7% (74·0-99·9; 18 of 19 patients) in early stage 2, and 97·3% (85·8-99·9; 36 of 37 patients) in late stage 2 gambiense human African trypanosomiasis. No new safety issues were observed beyond those found in adult trials. Overall, 116 (93%) of 125 patients reported 586 treatment-emergent adverse events, mainly mild or moderate. The most frequently reported treatment-emergent adverse events of interest during hospital admission were vomiting (86 [69%] of 125) and headache (41 [33%]). Seven (6%) of 125 patients had severe malaria, which was often accompanied by anaemia that was unrelated to fexinidazole. One patient died following dyspnoea and injury due to traumatic aggression 172 days after end of treatment, which was considered unrelated to fexinidazole or gambiense human African trypanosomiasis. INTERPRETATION: Oral fexinidazole is a safe and effective first-line treatment option across all gambiense human African trypanosomiasis disease stages in paediatric patients. FUNDING: Through the Drugs for Neglected Diseases initiative: the Bill & Melinda Gates Foundation (USA), the Republic and Canton of Geneva (Switzerland), the Dutch Ministry of Foreign Affairs (Netherlands), the Norwegian Agency for Development Cooperation (Norway), the Federal Ministry of Education and Research through KfW (Germany), the Brian Mercer Charitable Trust (UK), and other private foundations and individuals from the human African trypanosomiasis campaign. TRANSLATION: For the French translation of the abstract see Supplementary Materials section.

Prevalence and determinants of poor glycaemic control amongst patients with diabetes followed at Vanga Evangelical Hospital, Democratic Republic of the Congo.

BACKGROUND: The prevalence of diabetes mellitus is increasing dramatically in developing countries, where diabetic patients usually present with poor glycaemic control, leading to complications and worsening the prognosis. AIM: The aim of this study was to determine the extent of poor glycaemic control and its determinants in diabetic patients. SETTING: The study was conducted in a rural area of the province of Kwilu, Democratic Republic of the Congo. METHODS: This research comprised a cross-sectional study involving 300 Type 1 and 2 diabetic patients attending Vanga Evangelical Hospital in the Democratic Republic of the Congo from January 2018 to March 2018. Patients' sociodemographic, clinical and biological characteristics, accessibility to the health structure and treatment were described. The determinants of poor glycaemic control were identified using multivariate logistic regression at the p 0.05 level of statistical significance. RESULTS: The mean age of participants was 46.9 ± 16.3 years, 68.4% were men, and 62.3% had Type 2 diabetes mellitus. Poor glycaemic control was present in 78% of patients. The independent determinants of poor glycaemic control were tobacco use (adjusted odds ratio [aOR]: 2.01 [1.77-5.20], p = 0.015), the presence of comorbidities (aOR: 2.86 [1.95-6.65], p = 0.007), the presence of a factor contributing to hyperglycaemia (aOR: 2.74 [1.83-3.67], p = 0.014), missing scheduled appointments (aOR: 2.59 [1.94-7.13], p = 0.006) and non-adherence to treatment (aOR: 4.09 [1.35-6.39], p = 0.008). CONCLUSION: This study shows that more than three-quarters of diabetics undergoing treatment are not controlled, with mainly patient-related factors as the main explanatory factors for this poor glycaemic control. Therefore, the establishment of a therapeutic education programme and wider integration of diabetes care services, mainly at the primary level of the healthcare pyramid, should contribute to improved diabetes treatment.

Frequency and determinants of ocular trauma in the Kimpese Rural Health Zone, Kongo Central, Democratic Republic of Congo

Context and objective. Ocular trauma is very common and its etiological factors vary by region and age group. This study aims to describe the magnitude and determinants of ocular trauma complications in rural areas. Methods. We conducted a retrospective study of patients admitted for ocular trauma at Kimpese Hospital between January 2014 and December 2016. Univariate logistic regression was used to assess the determinants of ocular trauma complications. The statistical significance level is p˂ 0.05. Results. A total of 223 patients were included. The majority of participants were men (69.5%), over 18 years of age (70%), with poor visual acuity (57.8%) and bilateral ocular involvement (51.1%). Plant objects (44.8%) and metal objects (15.2%) were the most common traumatic agents. After treatment, an improvement in visual acuity was observed in 64.3% of patients with previously poor visual acuity (p < 0.001). The delay of care > 7 days [aOR: 2.286 (95% CI: 1.302-4.012), p=0.004] and the poor visual acuity on admission [aOR: 5.906 (95% CI: 3.231-10.796), p< 0.0001] emerged as determinants of the onset of complications. Conclusion. Awareness-raising efforts for early consultation after ocular trauma and integration of eye care at the primary level should be promoted for efficiency in care

Active management of third stage of labour, post­partum haemorrhage and maternal death rate in the Vanga Health Zone, Province of Bandundu, Democratic Republic of the Congo

Background: Post-partum haemorrhage (PPH) is the single largest cause of maternal death worldwide and a particular burden for developing countries. In Africa, about 33.9 % of maternal deaths are due to PPH. In the Democratic Republic of the Congo (DRC), the prevalence of PPH is unknown. PPH can be prevented with active management of the third stage of labour (AMTSL). Objectives: To describe the practice of AMTSL in Vanga Health Zone and to calculate the incidence of PPH in Vanga Health Zone. Method: An intervention study with post-test-only design was conducted among health maternity wards using a data collection sheet to obtain information. All pregnant women attending Vanga Health maternity wards constituted the study population. Frequencies were determined for variables of interest. Results: From April 2007 to March 2008, 6339 deliveries took place at Vanga Health maternity wards, representing 71% of the institutional delivery rate. The number of deliveries realised with the practice of (AMTSL) were 5562; 366 cases of PPH were reported, making an incidence of 5.77%. Three cases of maternal deaths ­ two of which were related to PPH ­ were reported during the study period, which means there was a decline of 70% compared with the previous two years. Conclusion: The prevalence of PPH has been estimated to be 5.77%; PPH represents the cause of 67% of all maternal deaths. The extension of AMTSL practice, combined with the assurance of better supplies of oxytocin to enhance drug management, is strongly advised/suggested. As a number of births still take place outside the health maternity wards, the introduction of oral misoprostol could be considered a part of AMTSL for use by patients being treated by traditional midwives