Fragile X syndrome in Democratic Republic of Congo: dysmorphic, cognitive and behavioral findings in 14 subjects from three families.

This study reports on 14 individuals with Fragile X syndrome from 3 Congolese Families. The majority (8/14) were males, with an average age of 18.4 (±11.1 [14-38]) years old. Typical dysmorphic characteristics of Fragile-X syndrome including elongated face, large and prominent ears were found in both males and females with the full mutation. Macroorchidism was found in all post-pubertal boys. The cognitive ability in our cohort varies widely ranging from mild (IQ 50-70) to moderate (IQ 35-49) intellectual disability (Average IQ of 60). All our female patients have ID.

Treatment adherence in retinoblastoma: A retro-prospective cohort study in Ivory Coast and the Democratic Republic of Congo.

BACKGROUND: In high-income countries, retinoblastoma is curable in more than 95% of cases, whereas in low-income countries, mortality remains high, especially when the diagnosis is made late or the treatment is discontinued. AIMS: To determine the factors associated with adherence to the treatment of retinoblastoma in the Ivory Coast and the Democratic Republic of Congo (DRC). METHODS AND RESULTS: A retro-prospective cohort study was carried out. Data were collected from patient folders and follow-up records of parents. RESULTS: A total of 175 children with retinoblastoma were registered from January 2013 to December 2015. Seventy-six children (43%) were 5 years old and above. Care costs were covered by families in 86.9% of cases. Chemotherapy refusal was recorded in 39 cases (22.3%), and enucleation refusal was recorded in 79 cases (45.1%). After 36 months of follow-up, we recorded 16.6% deaths, 27.4% treatment dropouts, and 18.3% loss to follow-up after treatment. The commonest cause for enucleation refusal was fear of infirmity, while chemotherapy refusal and absconding treatment were due to financial constraints. CONCLUSION: Poor adherence to retinoblastoma management was due to financial constraints, and a lack of knowledge of the disease and its treatment. Family psychosocial support is needed to improve this condition.

Usefulness of automated image analysis for recognition of the fragile X syndrome gestalt in Congolese subjects.

BACKGROUND: Computer-aided software such as the facial image diagnostic aid (FIDA) and Face2Gene has been developed to perform pattern recognition of facial features with promising clinical results. The aim of this pilot study was to test Face2Gene's recognition performance on Bantu Congolese subjects with Fragile X syndrome (FXS) as compared to Congolese subjects with intellectual disability but without FXS (non-FXS). METHOD: Frontal facial photograph from 156 participants (14 patients with FXS and 142 controls) predominantly young-adults to adults, median age 18.9 age range 4-39yo, were uploaded. Automated face analysis was conducted by using the technology used in proprietary software tools called Face2Gene CLINIC and Face2Gene RESEARCH (version 17.6.2). To estimate the statistical power of the Face2Gene technology in distinguishing affected individuals from controls, a cross validation scheme was used. RESULTS: The similarity seen in the upper facial region (of males and females) is greater than the similarity seen in other parts of the face. Binary comparison of subjects with FXS versus non-FXS and subjects with FXS versus subjects with Down syndrome reveal an area under the curve values of 0.955 (p = 0.002) and 0.986 (p = 0.003). CONCLUSION: The Face2Gene algorithm is separating well between FXS and Non-FXS subjects.

Les indicateurs de l'alimentation du nourrisson et du jeune enfant prédicteurs de la malnutrition chez les enfants 6-23 mois dans la zone de santé de Kapolowe, Haut-Katanga, R D Congo / NA

Introduction. L'étude visait évaluer les indicateurs de l'alimentation du nourrisson et du jeune enfant liés à l'état nutritionnel dans la zone de santé de Kapolowe, province du Haut Katanga avant les essais cliniques. Matériel et méthodes. Nous avons conduit une étude descriptive transversale dans la communauté auprès des 568 couples mère-enfant 6-23 mois évalués sur les indicateurs nutritionnels associés à la malnutrition. Résultats. L'allaitement maternel optimal était observé chez 10,7% des couples mère-enfant et l'alimentation complémentaire adéquate bénéficiée par 5,5% des enfants. Presque 25,6% des ménages utilisaient des toilettes améliorées, 98,8% des ménages buvaient l'eau des sources protégées et 12,1% des mères pratiquaient un minimum de lavage de mains. Le premier aliment complémentaire donné à la moitié des enfants (46%) était importé, mais 60,3 % des mères utilisaient le mélange farine de maïs + huile + sucre comme aliment de complément. La prévalence de la malnutrition aiguë, de la malnutrition chronique et de l'insuffisance pondérale était respectivement de 11,9%, 37% et 26,8%. La malnutrition aiguë était associée à l'occupation de la mère, au niveau socio-économique du ménage, à la Religion de la mère, à la consultation prénatale suivie par la mère, au Minimum de Diversité Alimentaire, à l'allaitement maternel non optimal, aux infections récurrentes et au faible poids de naissance. L'insuffisance pondérale était associée au sexe, à l'occupation de la mère, au niveau socio-économique, à la religion de la mère, au minimum de diversité alimentaire, à l'allaitement maternel non optimal, aux infections récurrentes et au faible poids de naissance. La malnutrition chronique était associée au sexe, au niveau socio-économique,

Introduction. The aim of the study was to assess infant and young child feeding indicators related to nutritional status in the Kapolowe health zone, Haut Katanga province prior to the clinical trials. Material and methods. We conducted a descriptive cross-sectional study in the community among568 mother-child pairs 6-23 months of age assessed on nutritional indicators associated with malnutrition. Results. Optimal breastfeeding was observed in 10.7% of the mother-child pairs and adequate complementary feeding in 5.5%. Almost 25.6% of households used improved toilets, 98.8% of households drank water from protected springs and 12.1% of mothers practiced minimal hand washing,12.1% of mothers practiced minimal handwashing. The first supplementary food given to half of the children (46%) was imported food, but 60.3% of mothers used maize flour + oil + sugar as a complementary food. The prevalence of acute malnutrition, chronic malnutrition and under weight were 11.9%, 37% and26.8% respectively. Acute malnutrition was associated with the mother's occupation, household socio-economic level, mother's religion, prenatal consultation attended by the mother, minimum dietary diversity, non-optimal breastfeeding, recurrent infections, and low birth weigh. Underweight was associated with gender, maternal occupation, socio-economic level, maternal religion, minimum dietary diversity, non-optimal breastfeeding, recurrent infections and low birth weight. Chronic malnutrition was associated with gender, socio-economic level, minimum meal frequency, type of toilet used, non-optimal breastfeeding, recurrent infections, and low birth weight. Conclusion. The prevalence of malnutrition, in all its forms, is still very high and worrying among children aged 6-23 months. The feeding practices are predictors of it.

Vaccination contre la Covid-19: droits des personnes et obligations du Gouvernement Congolais en période d'urgence sanitaire

Cette étude avait pour objectif de mettre en exergue le rapport entre le bénéfice de la couverture vaccinale contre la Covid-19 et les risques individuels et collectifs encourus par la population. A travers le monde, les études ont monté que les campagnes de vaccination ont insufflé une dynamique positive à la lutte contre la pandémie et la courbe de la maladie a fléchi dans les populations vaccinées. Face à ces résultats probants, le législateur congolais doit s'en inspirer pour proposer des instruments juridiques en faveur d'une vaccination obligatoire contre la Covid-19 soumise à tous les citoyens et citoyennes Congolais sans exception. Si tout le monde peut être contaminé, tout le monde peut également faire preuve d'un certain degré de citoyenneté responsable pour réduire les risques de contracter la maladie et ne pas la transmettre à son entourage. La couverture vaccinale contre la Covid-19 est une des mesures de l'incidence de la maladie dans la population et qui ne peut prendre la quasi-totalité de la population qu'en la rendant obligatoire.

Air Quality in the Working Environment and Respiratory Health of Female Congolese Stone Quarry Workers.

BACKGROUND AND AIM: Environmental and occupational exposure to high dust levels are known to be associated with lung function impairment. We assessed the ambient air quality in the working environment and the respiratory health of female stone quarry workers in Lubumbashi, Democratic Republic of Congo (DRC) in a context of severe economic, security, and health crises. METHODS: This was a case-control study conducted in three stone quarry sites. Participants were 256 dust-exposed female stone quarry workers matched to 256 unexposed female office workers and market tax collectors (N = 512). They each answered a structured respiratory health questionnaire and underwent physical examination and a lung function test with the use of a spirometer and peak flow meter. Quality of ambient air in the working environment was assessed by means of a BRAMC air quality monitor (BR-AIR-329). RESULTS: Results showed that exposed women did not use any personal protective equipment (PPE); in quarry sites, abnormally high levels of PM2.5 (205 ± 13.2 µg/m3 vs. 31.3 ± 10.3 µg/m3 in control sites; p < 0.001) and volatile organic compounds (VOC, 2.2 ± 0.2 µg/m3 vs. 0.5 ± 0.3 µg/m3, respectively; p < 0.01) were found. Furthermore, respiratory complaints were more common among exposed women (32.4% vs. 3.5% in controls; p < 0.01), who had abnormal chest auscultation and reduced lung capacity than controls (mean PEFR: 344.8 ± 2.26 and 405 ± 67.7 L/s, respectively; p < 0.001 Conclusion. Findings from this study show that in the midst of severe crises in the DRC, women stone quarry workers are exposed to abnormally high levels of respiratory hazards, which contribute to impaired lung function. There is a need to regulate quarry work and improve the working conditions in quarry sites in the DRC.

Epidemiology of Epilepsy in Lubumbashi, Democratic Republic of Congo.

BACKGROUND: Epilepsy is one of the most common neurological conditions, but the majority of epilepsy patients in sub-Saharan countries do not receive appropriate treatment. In the Democratic Republic of Congo (DRC), particularly in Lubumbashi, very few epidemiological studies on epilepsy have emerged. This study aims to analyze demographic characteristics, semiology of epileptic seizures, and their etiologies in patients followed in hospital. METHODS: This is a prospective descriptive study that enrolled 177 epileptic patients who performed a neurological consultation at the Centre Médical du Centre Ville (CMDC) in Lubumbashi (DRC) from January 1, 2016, to December 31, 2017. RESULTS: The mean age of the patients was 20.0 years (range: 5 months and 86 years). The male sex was predominant (57.1%). The mean age at the seizure onset was 13.1 years, and the mean duration between onset of seizures and consultation was 83.5 months. The family history of epilepsy was present in 27.7%. Generalized tonic-clonic seizures were the most frequent (58.2%), followed by atonic generalized seizures (9.6%) and focal clonic seizures (8.5%). The etiology was found in 68 (38.4%) patients and was dominated by neurocysticercosis (26.5%), meningitis (25%), perinatal pathologies (20.6%), and head injury (20.6%). CONCLUSION: This study is a useful starting point from which health programs and health professionals can work to improve the diagnosis and quality of epilepsy management in our community.

Evolution clinique et biologique des enfants infectés par le VIH sous traitement antirétroviral à Lubumbashi, République Démocratique du Congo

Introduction: en 2014, moins de 3 enfants sur dix (823 000 enfants environ) vivant avec le VIH avaient accès à un traitement antirétroviral (TAR), contre plus de quatre adultes sur dix. En conséquence, les enfants survivants qui ont une chance d´accéder au TAR sont traités souvent tardivement, à un stade avancé de la maladie. À Lubumbashi (RDC), les études sur l´évaluation du TAR chez l´enfant sont quasi nulles. Cette étude avait comme objectif décrire les caractéristiques sociodémographiques, cliniques, immunologiques et thérapeutiques des enfants infectés par le VIH et sous TAR et identifier les facteurs associés à un échec thérapeutique. Méthodes: il s'agit d'une étude transversale, réalisée du 1er janvier au 31 mars 2015 et portant sur une cohorte d'enfants de moins de 15 ans infectés par le VIH, suivis dans le service de Pédiatrie de l´hôpital Jason Sendwe. Résultats: 62 enfants âgés de moins de 15 ans infectés par le VIH ont été mis sous TAR. Les filles étaient prédominants (54,8%). 83,9% étaient à un stade clinique avancé (3 ou 4) lors de l´initiation au TAR. Notre étude montre que l´échec thérapeutique était significativement associé à l´âge ≥10 ans lors de l´évaluation de la prise en charge. Conclusion: l´étude a permis de montrer le retard avec lequel la prise en charge de l´enfant infecté VIH à Lubumbashi s´effectue; suggérant ainsi un renforcement du programme de la PTME et un dépistage précoce en vue d´une prise en charge précoce et la mise en place d´un mécanisme de rétention des enfants suivis

Tuberculosis and HIV co-infection in Congolese children: risk factors of death.

INTRODUCTION: Human immunodeficiency virus (HIV) and tuberculosis (TB) are the leading causes of death from infectious disease worldwide. The prevalence of HIV among children with TB in moderate to high prevalence countries ranges between 10% and 60%. This study aimed to determine the prevalence of HIV infection among children treated for TB in Directly Observed Treatment Short-Course (DOTS) clinics in Lubumbashi and to identify risk of death during this co-infection. METHODS: This is a cross-sectional study of children under-15, treated for tuberculosis from January 1, 2013 to December 31, 2015. Clinical, paraclinical and outcome data were collected in 22 DOTS of Lubumbashi. A statistical comparison was made between dead and survived HIV-infected TB children. We performed the multivariate analyzes and the significance level set at p-value <0.05. RESULTS: A total of 840 children with TB were included. The prevalence of HIV infection was 20.95% (95% CI: 18.34-23.83%). The mortality rate was higher for HIV-infected children (47.73%) compared to HIV-uninfected children (17.02%) (p<0.00001). Age <5 years (aOR=6.50 [1.96-21.50]), a poor nutritional status (aOR=23.55 [8.20-67.64]), and a negative acid-fast bacilli testing (aOR=4.51 [1.08-18.70]) were associated with death during anti-TB treatment. CONCLUSION: TB and HIV co-infection is a reality in pediatric settings in Lubumbashi. High mortality highlights the importance of early management.

Integration of Human African Trypanosomiasis Control Activities into Primary Healthcare Services: A Scoping Review.

Human African trypanosomiasis (HAT) also known as sleeping sickness is targeted for elimination as a public health problem by 2020 and elimination of infection by 2030. Although the number of reported cases is decreasing globally, integration of HAT control activities into primary healthcare services is endorsed to expand surveillance and control. However, this integration process faces several challenges in the field. This literature review analyzes what is known about integrated HAT control to guide the integration process in an era of HAT elimination. We carried out a scoping review by searching PubMed and Google Scholar data bases as well as gray literature documents resulting in 25 documents included for analysis. The main reasons in favor to integrate HAT control were related to coverage, cost, quality of service, or sustainability. There were three categories of factors influencing the integration process: 1) the clinical evolution of HAT, 2) the organization of health services, and 3) the diagnostic and therapeutic tools. There is a consensus that both active and passive approaches to HAT case detection and surveillance need to be combined, in a context-sensitive way. However, apart from some documentation about the constraints faced by local health services, there is little evidence on how this synergy is best achieved.

Passive Screening and Diagnosis of Sleeping Sickness with New Tools in Primary Health Services: An Operational Research.

INTRODUCTION: The integration of human African trypanosomiasis (HAT) activities into primary health services is gaining importance as a result of the decreasing incidence of HAT and the ongoing developments of new screening and diagnostic tools. In the Democratic Republic of Congo, this integration process faces multiple challenges. We initiated an operational research project to document drivers and bottlenecks of the process. METHODS: Three health districts piloted the integration of HAT screening and diagnosis into primary health services. We analysed the outcome indicators of this intervention and conducted in-depth interviews with health care providers, seropositives, community health workers and HD management team members. Our thematic interview guide focused on factors facilitating and impeding the integration of HAT screening. RESULTS: The study showed a HAT-RDT-positive rate of 2.2% in Yasa Bonga, 2.9% in Kongolo and 3% in Bibanga, while the proportion of reported seropositives that received confirmatory examinations was 76%, 45.6% and 68%, respectively. Qualitative analyses indicated that some seropositives were unable to access the confirmation facility. The main reasons that were given included distance, RDT rupture, lack of basic screening equipment and financial barriers (additional hospital fees not included in free treatment course), fear of lumbar puncture and the perception of HAT as a disease of supernatural origin. CONCLUSION: Passive screening using HAT RDTs in primary health services inevitably has some limitations. However, regarding the epidemiological context and some obstacles to integrated implementation, this cannot on its own be a relevant alternative to the elimination of HAT by 2020. FUNDING: We acknowledge the agency that provided financial support for this study, the Belgian Development Cooperation. The funder had no role in the study design, data collection and analysis, decision to publish or preparation of the manuscript. Philippe Mulenga received financial support thanks to a doctoral grant from the Belgian Development Cooperation under the FA4 agreement. Funding for the study and Rapid Service Fees was provided by the Epidemiology and Tropical Diseases Unit of the Institute of Tropical Medicine, Antwerp.

Predictive Model for the Risk of Severe Acute Malnutrition in Children.

BACKGROUND: The nutritional status is the best indicator of the well-being of the child. Inadequate feeding practices are the main factors that affect physical growth and mental development. The aim of this study was to develop a predictive score of severe acute malnutrition (SAM) in children under 5 years of age. METHODS: It was a case-control study. The case group (n = 263) consisted of children aged 6 to 59 months admitted to hospital for SAM that was defined by a z-score weight/height < -3 SD or presence of edema of malnutrition. We performed a univariate and multivariate analysis. Discrimination score was assessed using the ROC curve and the calibration of the score by Hosmer-Lemeshow test. RESULTS: Low birth weight, history of recurrent or chronic diarrhea, daily meal's number less than 3, age of breastfeeding's cessation less than 6 months, age of introduction of complementary diets less than 6 months, maternal age below 25 years, parity less than 5, family history of malnutrition, and number of children under 5 over 2 were predictive factors of SAM. Presence of these nine criteria affects a certain number of points; a score <6 points defines children at low risk of SAM, a score between 6 and 8 points defines a moderate risk of SAM, and a score >8 points presents a high risk of SAM. The area under ROC curve of this score was 0.9685, its sensitivity was 93.5%, and its specificity was 93.1%. CONCLUSION: We propose a simple and efficient prediction model for the risk of occurrence of SAM in children under 5 years of age in developing countries. This predictive model of SAM would be a useful and simple clinical tool to identify people at risk, limit high rates of malnutrition, and reduce disease and child mortality registered in developing countries.

[Prevalence of overweight and obesity among adolescents in school in Lubumbashi, Democratic Republic of Congo]. / Prévalence du surpoids et de l'obésité chez l'adolescent en milieu scolaire à Lubumbashi, République Démocratique du Congo.

INTRODUCTION: overweight and obesity in adolescents are a major global public health issue due to their potential impact on health and increasing frequency. This study aims to determine the prevalence of overweight and obesity among adolescents attending public and private schools in Lubumbashi (DRC). METHODS: we conducted a cross-sectional study of 5341 adolescents aged 10-19 years, 2858 (53.5%) girls and 2483 (46.5%) boys. Weight and height were measured for each adolescent and then body mass index (BMI) was calculated. RESULTS: the average weight was 43,78 ± 11.62 kg (42,39 ± 12.11 kg for boys and 44.95 ± 11.04 kg for girls), the average height was 151,30 ± 13,09 cm (151.20 ± 14.64 cm for boys and 151,38 ± 11.58 cm for girls) and BMI was 18,82 ± 3.15 kg/m² (19.39 ± 3.39 kg/m² for boys and 18.17 ± 2.71 kg/m² for girls). The prevalence of overweight was 8% while that of obesity was 1%. The girls were significantly more affected by overweight (10.7% girls against 5% boys) and obesity (1.5% girls against 0.4% boys) than the boys. CONCLUSION: overweight and obesity in school environment are a reality in Lubumbashi. The prevalence of overweight and obesity in this age group category should be determined in a national evaluation plan in order to implement preventive and therapeutic strategies.

Integration of Human African Trypanosomiasis Control Activities into Primary Health Services in the Democratic Republic of the Congo: A Qualitative Study of Stakeholder Perceptions.

Human African trypanosomiasis is close to elimination in several countries in sub-Saharan Africa. The diagnosis and treatment is currently rapidly being integrated into first-line health services. We aimed to document the perspective of stakeholders on this integration process. We conducted 12 focus groups with communities in three health zones of the Democratic Republic of the Congo and held 32 interviews with health-care providers, managers, policy makers, and public health experts. The topic guide focused on enabling and blocking factors related to the integrated diagnosis and treatment approach. The data were analyzed with NVivo (QSR International, Melbourne, Australia) using a thematic analysis process. The results showed that the community mostly welcomed integrated care for diagnosis and treatment of sleeping sickness, as they value the proximity of first-line health services, but feared possible financial barriers. Health-care professionals thought integration contributed to the elimination goal but identified several implementation challenges, such as the lack of skills, equipment, motivation and financial resources in these basic health services. Patients often use multiple therapeutic itineraries that do not necessarily lead them to health centers where screening is available. Financial barriers are important, as health care is not free in first-line health centers, in contrast to the population screening campaigns. Communities and providers signal several challenges regarding the integration process. To succeed, the required training of health professionals, as well as staff deployment and remuneration policy and the financial barriers in the primary care system need to be addressed, to ensure coverage for those most in need.

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.

Prévalence du surpoids et de l'obésité chez l'adolescent en milieu scolaire à Lubumbashi, République Démocratique du Congo

Introduction: le surpoids et l'obésité au cours de l'adolescence constituent un problème préoccupant de santé publique à l'échelle mondiale en raison de leur retentissement potentiel sur la santé et de leur fréquence croissante. La présente étude avait pour objectif de déterminer la prévalence du surpoids et de l'obésité chez les adolescents scolarisés dans les établissements publics et privés à Lubumbashi, en République Démocratique du Congo. Méthodes: il s'agissait d'une étude transversale menée auprès de 5.341 adolescents âgés de 10 à 19 ans, dont 2.858 (53,5%) filles et 2.483 (46,5%) garçons ont constitué notre échantillon. Pour chacun d'eux, nous avons mesuré le poids et la taille puis calculé l'indice de masse corporelle (IMC). Résultats: la moyenne du poids était de 43,78 ± 11,62 kg (soit 42,39 ± 12,11 kg pour les garçons et 44,95 ± 11,04 kg pour les filles), celle de la taille était de 151,30 ± 13,09 cm (soit 151,20 ± 14,64 cm pour les garçons et 151,38 ± 11,58 cm pour les filles) et celle de l'IMC était de 18,82 ± 3,15 kg/m2 (soit 19,39 ± 3,39 kg/m2 pour les garçons et 18,17 ± 2,71 kg/m2 pour les filles). La prévalence du surpoids était de 8% et celle de l'obésité était de 1%. Les filles étaient significativement plus touchées par le surpoids (10,7% filles contre 5% garçons) et l'obésité (1,5 % filles contre 0,4% garçons) que les garçons. Conclusion: le surpoids et l'obésité chez les adolescents en milieu scolaire s'avèrent une réalité à Lubumbashi. La détermination de la prévalence du surpoids et de l'obésité pour cette catégorie d'âge au plan national est recommandable pour leurs préventions et prises en charges

Tuberculosis and HIV co-infection in Congolese children: risk factors of death

Introduction: Human immunodeficiency virus (HIV) and tuberculosis (TB) are the leading causes of death from infectious disease worldwide. The prevalence of HIV among children with TB in moderate to high prevalence countries ranges between 10% and 60%. This study aimed to determine the prevalence of HIV infection among children treated for TB in Directly Observed Treatment Short-Course (DOTS) clinics in Lubumbashi and to identify risk of death during this co-infection.Methods: this is a cross-sectional study of children under-15, treated for tuberculosis from January 1, 2013 to December 31, 2015. Clinical, paraclinical and outcome data were collected in 22 DOTS of Lubumbashi. A statistical comparison was made between dead and survived HIV-infected TB children. We performed the multivariate analyzes and the significance level set at p-value <0.05.Results: a total of 840 children with TB were included. The prevalence of HIV infection was 20.95% (95% CI: 18.34-23.83%). The mortality rate was higher for HIV-infected children (47.73%) compared to HIV-uninfected children (17.02%) (p<0.00001). Age <5 years (aOR=6.50 [1.96-21.50]), a poor nutritional status (aOR=23.55 [8.20-67.64]), and a negative acid-fast bacilli testing (aOR=4.51 [1.08-18.70]) were associated with death during anti-TB treatment. Conclusion: TB and HIV co-infection is a reality in pediatric settings in Lubumbashi. High mortality highlights the importance of early management

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

Retinoblastoma in Sub-Saharan Africa: Case Studies of the Republic of Côte d'Ivoire and the Democratic Republic of the Congo.

PURPOSE: In most low-income countries, the diagnosis of retinoblastoma is delayed, resulting in a severe prognosis. The objectives of this study were to describe the access to diagnosis and care of children diagnosed with retinoblastoma and the challenges in two sub-Saharan African countries: the Republic of Côte d'Ivoire and the Democratic Republic of the Congo. PATIENTS AND METHODS: A descriptive cross-sectional study was conducted. Data were collected from the medical records of patients admitted during the period of January 1, 2013 to December 31, 2014. Data were entered and analyzed using Epi Info7.1 software and SAS 9.3. RESULTS: One hundred sixteen cases of retinoblastoma were collected, including 60 boys and 56 girls. The median diagnosis age was 3 years for both countries. Ninety-eight patients (84%) had unilateral retinoblastoma. Most of the patients presented with advanced disease (76% had extraocular retinoblastoma). Median time between initial symptoms and diagnosis was 8.5 months (range, 0.4 to 116.7 months). Median time between diagnosis and treatment initiation was 31 days (range, 0 to 751 days). The median cost for the treatment of the disease was estimated at $1,954 per patient. CONCLUSION: Late diagnosis of retinoblastoma, with extraocular disease, occurs frequently in both African countries. It is associated with delay in initiating treatment, and the cost of the treatment remains unaffordable for most of the families. Support groups for parents of affected children and the support of the Franco-African Pediatric Oncology Group remain important in improving early diagnosis and providing treatment in sub-Saharan African countries.

Albumin, copper, manganese and cobalt levels in children suffering from sickle cell anemia at Kasumbalesa, in Democratic Republic of Congo.

BACKGROUND: Sickle Cell Anemia (SCA) is characterized by high levels of oxidative stress markers and low levels of antioxidant capacity. Antioxidant defence mechanisms against the harmful effects of ROS requires cellular and extracellular enzymes. These enzymes requires micronutrient for complete activity. Information on micronutrients such as manganese, cobalt and copper in SCA population was poorly documented in the literature. METHODS: Plasma copper, manganese, cobalt and albumin concentrations determined by atomic absorption spectrophotometry were compared between two groups of children: 76 with SCA (Hb-SS) and 76 without SCA (controls). This study was conducted in the Muhona Hospital of Kasumbalesa, which is situated in a rural and low in resources. RESULTS: The mean age was 10.0 years (SD = 5.4) in SCA children and 9.2 years (SD = 4.7) in the control group. The levels of cobalt, manganese, copper and albumin were not different between the two groups (p > 0.05). CONCLUSION: In our study, albumin, manganese, cobalt and copper values did not differ between SCA children in steady state and Hb-AA children. The lack of differences in plasma elemental concentrations between the two groups in context of increased demands in the SCA group, may represent adequate compensatory intake or elemental dyshomeostasis in the SCA group.