Determinants of uncontrolled allergic rhinitis in Kinshasa hospitals.

Objective: To identify the determinants of uncontrolled allergic rhinitis (UCAR) in a hospital setting in Kinshasa, Democratic Republic of Congo. Methods: Hospital-based cross-sectional study of 153 patients with allergic rhinitis (AR). The diagnosis of AR was based on clinical grounds according to the Allergic Rhinitis and its Impact on Asthma (ARIA) criteria. Categorization into controlled AR (CAR) and UCAR was based on the visual analog scale (VAS with cut off point of 5). Binary logistic regression was used to identify factors associated with UCAR. Results: Patients with UCAR (60.1%) proportionally outnumbered those with CAR (39.9%). There were significantly more patients younger than 30 years of age among patients with UCAR. Factors significantly associated with UCAR were age below 30 years (OR = 3.31; 95% CI: 1.49-7.36; p = 0.003), low serum vitamin D level (OR = 3.86; 95% CI: 1.72-8.68; p = 0.001), persistent form (OR = 3.11; 95% CI: 1.39-6.98; p = 0.006) and moderate to severe form of AR (OR = 4.31; 95% CI: 1.77-10.49; p = 0.001). Conclusions: Factors associated with UCAR in this study population were younger age less than 30 years, low vitamin D level, and persistent as well as moderate to severe AR. Further studies are needed to elucidate the underlying mechanisms favoring the occurrence of these factors.

Determinants of Survival of HIV Patients Receiving Dolutegravir: A Prospective Cohort Study in Conflict-Affected Bunia, Democratic Republic of Congo.

This study aims to determine the factors influencing HIV-related mortality in settings experiencing continuous armed conflict atrocities. In such settings, people living with HIV (PLHIV), and the partners of those affected may encounter specific difficulties regarding adherence to antiretroviral therapy (ART), and retention in HIV prevention, treatment, and care programs. Between July 2019 and July 2021, we conducted an observational prospective cohort study of 468 PLHIV patients treated with Dolutegravir at all the ART facilities in Bunia. The probability of death being the primary outcome, as a function of time of inclusion in the cohort, was determined using Kaplan-Meier plots. We used the log-rank test to compare survival curves and Cox proportional hazard modeling to determine mortality predictors from the baseline to 31 July 2021 (endpoint). The total number of person-months (p-m) was 3435, with a death rate of 6.70 per 1000 p-m. Compared with the 35-year-old reference group, older patients had a higher mortality risk. ART-naïve participants at the time of enrollment had a higher mortality risk than those already using ART. Patients with a high baseline viral load (≥1000 copies/mL) had a higher mortality risk compared with the reference group (adjusted hazard ratio = 6.04; 95% CI: 1.78-20.43). One-fourth of deaths in the cohort were direct victims of armed conflict, with an estimated excess death of 35.6%. Improving baseline viral load monitoring, starting ART early in individuals with high baseline viral loads, the proper tailoring of ART regimens and optimizing long-term ART, and care to manage non-AIDS-related chronic complications are recommended actions to reduce mortality. Not least, fostering women's inclusion, justice, peace, and security in conflict zones is critical in preventing premature deaths in the general population as well as among PLHIV.

Incidence and Predictors of Loss to Follow Up among Patients Living with HIV under Dolutegravir in Bunia, Democratic Republic of Congo: A Prospective Cohort Study.

This study aimed to examine the incidence and predictors of loss to follow up (LTFU) in the context of ongoing atrocities caused by armed conflict, where HIV treatment programs and HIV-infected patients may face unique challenges in terms of ART adherence and retention in care. We conducted an observational prospective cohort study of 468 patients living with HIV (PLWHIV) under dolutegravir (DTG) in all health facilities in Bunia between July 2019 and July 2021. Kaplan-Meier plots were used to determine the probability of LTFU as a function of time as inclusive of the cohort. The main outcome variable was LTFU, defined as not taking an ART refill for a period of 3 months or longer from the last attendance for refill, and not yet classified as 'dead' or 'transferred-out.' The log-rank test was used to compare survival curves based on predictors. Cox proportional hazard modeling was used to measure predictors of LTFU from the baseline until 31 July 2021 (the endpoint). A total of 3435.22 person-months (p-m) were involved in follow up, with an overall incidence rate of 33.48 LTFU per 1000 p-m. Patients who had less experience with ART at enrolment and the ethnically Sudanese, had a higher hazard of being LTFU compared to their reference groups. This study reports a high LTFU rate in this conflict setting. An ART program in such a setting should pay more attention to naive patients and other particularly vulnerable patients such as Sudanese during the pre-ART phase. The study implies the implementation of innovative strategies to address this high risk of being LTFU, reducing either the cost or the distance to the health facility.

Predictors of Viral Non-Suppression among Patients Living with HIV under Dolutegravir in Bunia, Democratic Republic of Congo: A Prospective Cohort Study.

The Democratic Republic of the Congo adopted the integrase inhibitor dolutegravir (DTG) as part of its preferred first-line HIV treatment regimen in 2019. This study aimed to identify predictors of viral non-suppression among HIV-infected patients under a DTG-based regimen in the context of ongoing armed conflict since 2017 in the city of Bunia in the DRC. We conducted a cohort study of 468 patients living with HIV under DTG in all health facilities in Bunia. We calculated the proportion of participants with an HIV RNA of below 50 copies per milliliter. About three in four patients (72.8%) in this cohort had a viral load (VL) of <50 copies/mL after 6-12 months. After controlling for the effect of other covariates, the likelihood of having non-suppression remained significantly lower among the 25-34 age group and self-reported naïve patients with a baseline VL of ≥50 copies/mL. The likelihood of having non-suppression remained significantly higher among those who were at advanced stages of the disease, those with abnormal serum creatinine, those with high baseline HIV viremia over 1000 copies/mL, and the Sudanese ethnic group compared to the reference groups. This study suggests that we should better evaluate adherence, especially among adolescents and economically vulnerable populations, such as the Sudanese ethnic group in the city of Bunia. This suggests that an awareness of the potential effects of DTG and tenofovir is important for providers who take care of HIV-positive patients using antiretroviral therapy (ART), especially those with abnormal serum creatinine levels before starting treatment.

The Critical Need for Pooled Data on Coronavirus Disease 2019 in African Children: An AFREhealth Call for Action Through Multicountry Research Collaboration.

Globally, there are prevailing knowledge gaps in the epidemiology, clinical manifestations, and outcomes of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among children and adolescents; and these gaps are especially wide in African countries. The availability of robust age-disaggregated data is a critical first step in improving knowledge on disease burden and manifestations of coronavirus disease 2019 (COVID-19) among children. Furthermore, it is essential to improve understanding of SARS-CoV-2 interactions with comorbidities and coinfections such as human immunodeficiency virus (HIV), tuberculosis, malaria, sickle cell disease, and malnutrition, which are highly prevalent among children in sub-Saharan Africa. The African Forum for Research and Education in Health (AFREhealth) COVID-19 Research Collaboration on Children and Adolescents is conducting studies across Western, Central, Eastern, and Southern Africa to address existing knowledge gaps. This consortium is expected to generate key evidence to inform clinical practice and public health policy-making for COVID-19 while concurrently addressing other major diseases affecting children in African countries.

Effect of SARS-CoV-2 Infection in Pregnancy on Maternal and Neonatal Outcomes in Africa: An AFREhealth Call for Evidence through Multicountry Research Collaboration.

In the African context, there is a paucity of data on SARS-CoV-2 infection and associated COVID-19 in pregnancy. Given the endemicity of infections such as malaria, HIV, and tuberculosis (TB) in sub-Saharan Africa (SSA), it is important to evaluate coinfections with SARS-CoV-2 and their impact on maternal/infant outcomes. Robust research is critically needed to evaluate the effects of the added burden of COVID-19 in pregnancy, to help develop evidence-based policies toward improving maternal and infant outcomes. In this perspective, we briefly review current knowledge on the clinical features of COVID-19 in pregnancy; the risks of preterm birth and cesarean delivery secondary to comorbid severity; the effects of maternal SARS-CoV-2 infection on the fetus/neonate; and in utero mother-to-child SARS-CoV-2 transmission. We further highlight the need to conduct multicountry surveillance as well as retrospective and prospective cohort studies across SSA. This will enable assessments of SARS-CoV-2 burden among pregnant African women and improve the understanding of the spectrum of COVID-19 manifestations in this population, which may be living with or without HIV, TB, and/or other coinfections/comorbidities. In addition, multicountry studies will allow a better understanding of risk factors and outcomes to be compared across countries and subregions. Such an approach will encourage and strengthen much-needed intra-African, south-to-south multidisciplinary and interprofessional research collaborations. The African Forum for Research and Education in Health's COVID-19 Research Working Group has embarked upon such a collaboration across Western, Central, Eastern and Southern Africa.

Drug use in the management of uncomplicated malaria in public health facilities in the Democratic Republic of the Congo.

BACKGROUND: Malaria the first causes of death from parasitic infection worldwide. Interventions to reduce the burden of malaria have produced a tremendous drop in malaria morbidity and mortality. However, progress is slower in DRC, which shares with Nigeria 39% of deaths related to malaria globally. Inappropriate use of drugs may be one of the factors of this below-average performance. The aim of this study was to describe the use of drugs in the management of uncomplicated malaria in public health facilities in DRC. METHODS: A drug use study was carried out in DRC from January to March 2014. In each of the former 11 provinces of DRC, one Rural Health Centre, one Urban Health Centre and one General Hospital were selected. In each of them, 100 patient's files containing prescription of anti-malarials from January to December 2013 were randomly selected. Among them, all of the files with diagnosis of uncomplicated malaria were included in this study. Prescribed anti-malarials, co-prescribed drugs and their indications were collected. Descriptive analyses were performed. RESULTS: A total of 2300 files out of 3300 (69.7%) concerned uncomplicated malaria and were included in analysis. Malaria treatment was initiated after a positive RDT or microscopy in 51.5% of cases, upon suspicion without requesting biological confirmation in 37% and despite negative results in 11%. Twenty-nine (29) different treatment regimens were used. The drugs recommended by the National Malaria Control Programme were used in 54.3% of cases (artesunate-amodiaquine 37.4% or artemether-lumefantrine 16.9%). The second most used anti-malarial was quinine (32.4%). Apart from anti-malarials, an average of 3.1 drugs per patient were prescribed, among which antibiotics (67.9%), analgesics and non-steroidal anti-inflammatory (NSAIDs) (all abbreviations to be explicated on first use) (70.6%), vitamins (29.1%), anaemia drugs, including blood transfusion (9.1%) and corticosteroids (5.7%), In 51.4% of cases there was no indication for the concomitant medication. CONCLUSION: Management of uncomplicated malaria in DRC is characterized by a low adherence to treatment policy, numerous treatment regimens, and abundant concomitant medication potentially harmful to the patient. This may contribute to the low performance of DRC in malaria control. Determinant of this irrational use of drugs need to be assessed in order to formulate and implement efficient corrective measures.

Profil de sensibilisation aux allergènes des asthmatiques adultes à Kinshasa, RDC : Etude transversale par prick-tests

Contexte. Environ 80% des asthmatiques sont atopiques. La sensibilisation aux allergènes communs présente certaines variabilités environnementales et géographiques. Objectif. Déterminer le profil de sensibilisation aux allergènes communs des asthmatiques adultes de la ville de Kinshasa. Méthodes. De juin 2017 à février 2018, 216 asthmatiques de 18 ans et plus, des 2 sexes, ont été consécutivement recrutés aux Cliniques Universitaires de Kinshasa et dans certaines paroisses et églises de réveil de la ville de Kinshasa. A l'aide d'un questionnaire validé, les variables sociodémographiques ont été précisées. Le prick-test a été réalisé avec cinq extraits commerciaux standardisés de phanères de chien et chat, l'acarien de poussière de maison (Blomia tropicalis, Bt), les moisissures (Alternaria alternata), et le jaune d'œuf. Résultats. L'âge moyen de la population était de 45,23 (ET=17,56) ans, 74% de sexe féminin, 47 % non sensibilisés et 53% sensibilisés à au moins un allergène. Vingt-cinq pourcent étaient monosensibilisées et 27% plurisensibilisées. Le profil de sensibilisation était Blomia tropicalis (72%), phanères de chat (46%), phanères de chien (34%), Alternaria alternata (13%) et jaune d'œuf (11%). Conclusion. Une plurisensibilisation aux allergènes communs chez les asthmatiques dans notre milieu est présente dont le profil dominé par les acariens et les phanères de chats. Des enquêtes futures incluant un plus grand nombre de sujets et recourant à des batteries de tests plus élargies s'imposent en vue d'une définition d'options diagnostiques et thérapeutiques dans notre contexte

Tendances de la tuberculose pulmonaire bactériologiquement confirmée et issues thérapeutiques en République Démocratique du Congo : 2007-2017

Contexte et objectifs. La République Démocratique du Congo compte parmi les pays à lourd fardeau pour la tuberculose (TB), l'incidence réelle de la maladie n'est pas formellement connue. La présente étude vise à décrire les tendances de l'incidence notifiée des patients atteints de tuberculose pulmonaire bactériologiquement confirmée (TP+) et leurs issues thérapeutiques. Méthodes. Cette étude documentaire, analyse les données des patients diagnostiqués et traités pour tuberculose de 2007 à 2017 en RDC. L'incidence notifiée des patients TP+, le taux d'accroissement annuel, les issues thérapeutiques ont été recherchés. Les variations du nombre de patients sont exprimées par les proportions. Les tendances sont présentées à travers les courbes de régression linéaire. Les issues thérapeutiques sont comparées à l'aide du z-score avec un seuil significatif de p˂ 0,05. Résultats. Au total 884 458 patients TP+ ont été rapportés, dont 820 858 nouveaux patients (NP TP+) et 63 600 déjà traités. Le taux d'accroissement au cours de cette décade était de 28,95%, soit de 66099 en 2007 à 93767 en 2017 pour les NP TP+. L'augmentation annuelle moyenne était de 2,41% +/- 3,28 pour les NP TP+ et de 5,7% +/- 0,26 par an pour les rechutes. La notification des échecs de traitement initial et repris après abandon de traitement ont une tendance à la baisse. L'évaluation thérapeutique de tous les cas cumulés a concerné 848 163 patients dont 789 716 NP TP+ et 58447 en retraitement. Le succès thérapeutique était de 88,0 % pour les NP TP+ et 70,0 % pour les rechutes, de 64,3 % pour les échecs et de 67,8% pour les repris en traitement après abandon. En somme 70 515 (8,3%) patients ont gardé des expectorations positives. Conclusion. Cette étude montre une tendance à la hausse de notification des cas incidents dont l'issue de traitement répond aux standards de l'OMS. En outre, un nombre des personnes demeurent porteurs de germes persistants précurseurs d'une TB pharmacorésistante acquise

Performance de l'oxymétrie nocturne dans le diagnostic du syndrome d'apnées du sommeil. Etude monocentrique menée au centre Hospitalier de Longjumeau/France

Contexte & objectif. Le syndrome d'apnées du sommeil est une pathologie fréquemment sous diagnostiquée et souvent méconnue; particulièrement à cause d'une accessibilité insuffisante au gold-standard du diagnostic, la polysomnographie ou la polygraphie ventilatoire. Et pourtant, l'affection est responsable des complications surtout cardiovasculaires majeures. L'objectif de la présente étude était d'évaluer le niveau de performance de l'oxymétrie nocturne dans le diagnostic du syndrome d'apnées du sommeil. Méthodes. Enquête transversale menée entre le 1er janvier 2016 et le 30 septembre 2017. Tous les patients hospitalisés pour suspicion du syndrome d'apnées du sommeil ont bénéficié d'une oxymétrie nocturne et d'une polygraphie ventilatoire. Les logiciels Excel 2010 et SSPSS 21.0 ont permis d'analyser les données. Nous avons déterminé la sensibilité, la spécificité, la valeur prédictive positive et la valeur prédictive négative. La courbe ROC a été calculée. p < 0,05. Résultats. Au total 201 patients d'âge moyen de 64,6±11,8 ans, avec une prédominance masculine (55%) et en majorité obèses (IMC moyen de 32kg/m²) ont été inclus. La sensibilité et la spécificité de l'oxymétrie nocturne sont respectivement de 87 et de 85% avec une courbe ROC montrant une surface importante sous la courbe de 0,75. Conclusion. Avec sa sensibilité et spécificité élevées, l'oxymétrie nocturne peut constituer une alternative valable au diagnostic du syndrome d'apnées du sommeil. Son innocuité et sa bonne acceptabilité en font un outil facilement exportable et recommandable en cas de carence de moyens appropriés

Leçons apprises de la gestion des épidémies de la maladie à virus Ebola en République Démocratique du Congo de 2007 à 2017 / Lessons learned from the management of Ebola outbreaks in the Democratic Republic of Congo from 2007 to 2017

Contexte et objectifs. La RDC a un écosystème favorable à la survenue des maladies d'origine zoonotique à l'interface homme-animal dont la maladie à virus Ebola (MVE). Face à une létalité reconnue être élevée pour cette dernière, cette étude s'est focalisée sur les épidémies survenues à Mweka (2007 et 2008), à Isiro (2012), à Boende (2014) et à Likati (2017) afin de décrire les différents éléments de réponse mis en place lors de chacune de ces épidémies et identifier ceux qui ont une influence significative sur l'ampleur de l'épidémie. Méthodes. Une étude documentaire analytique sur les données secondaires recueillies lors de la gestion de ces cinq épidémies de la MVE survenues en RDC. Les statistiques descriptives ont été réalisées pour caractériser chaque épidémie. Les analyses univariées de chaque élément de réponse ont été menées en rapport avec la létalité. Résultats. Un total de 422 cas a été enregistré avec 282 décès soit 66,8 % de létalité. La grande majorité de cas se trouve dans la tranche d'âge de 15 à 49 ans. Le sexe féminin est le plus représenté. Parmi tous les éléments de la réponse, dans un modèle univarié, le déploiement du laboratoire mobile (p=0,002), la fonctionnalité des commissions (p=0,001), le déploiement d'une équipe multidisciplinaire et le système de surveillance performant (p=0,001) sont associés significativement à la létalité. Conclusion. Le déploiement rapide du laboratoire mobile sur le terrain, le déploiement des équipes multidisciplinaires, la bonne fonctionnalité des commissions et le système de surveillance fonctionnel ont permis de réduire significativement la létalité