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1.
Artículo en Inglés | MEDLINE | ID: mdl-33806286

RESUMEN

Adherence to preventive measures is essential to reduce the risk of COVID-19 transmission. Two online surveys were conducted in the Democratic Republic of the Congo (DRC) from 23 April to 8 June 2020, and from August 24th to September 8th, respectively. A total of 3268 (round 1) and 4160 (round 2) participants were included. In both surveys, there was a moderate level of adherence to regular handwashing (85% and 77%, respectively), wearing of facemasks (41.4% and 69%, respectively), and respecting physical distancing (58% and 43.4%, respectively). The second survey found that, working in private (OR = 2.31, CI: 1.66-3.22; p < 0.001) and public organizations (OR = 1.61, CI: 1.04-2.49; p = 0.032) and being a healthcare worker (OR = 2.19, CI: 1.57-3.05; p < 0.001) significantly increased the odds for better adherence. However, a unit increase in age (OR = 0.99, CI: 0.98-0.99; p < 0.026), having attained lower education levels (OR = 0.60, CI: 0.46-0.78; p < 0.001), living in a room (OR = 0.36, CI: 0.15-0.89; p = 0.027), living in a studio (OR = 0.26, CI: 0.11-0.61; p = 0.002) and apartment (OR = 0.29, CI: 0.10-0.82; p = 0.019) significantly decreased the odds for better adherence. We recommend a multi-sectorial approach to monitor and respond to the pandemic threat. While physical distancing may be difficult in Africa, it should be possible to increase the use of facemasks.


Asunto(s)
República Democrática del Congo , Humanos , Pandemias , Encuestas y Cuestionarios
3.
Nat Commun ; 12(1): 830, 2021 02 05.
Artículo en Inglés | MEDLINE | ID: mdl-33547297

RESUMEN

In marine and freshwater oxygen-deficient zones, the remineralization of sinking organic matter from the photic zone is central to driving nitrogen loss. Deep blooms of photosynthetic bacteria, which form the suboxic/anoxic chlorophyll maximum (ACM), widespread in aquatic ecosystems, may also contribute to the local input of organic matter. Yet, the influence of the ACM on nitrogen and carbon cycling remains poorly understood. Using a suite of stable isotope tracer experiments, we examined the transformation of nitrogen and carbon under an ACM (comprising of Chlorobiaceae and Synechococcales) and a non-ACM scenario in the anoxic zone of Lake Tanganyika. We find that the ACM hosts a tight coupling of photo/litho-autotrophic and heterotrophic processes. In particular, the ACM was a hotspot of organic matter remineralization that controlled an important supply of ammonium driving a nitrification-anammox coupling, and thereby played a key role in regulating nitrogen loss in the oxygen-deficient zone.


Asunto(s)
Ciclo del Carbono/fisiología , Carbono/química , Chlorobi/metabolismo , Ciclo del Nitrógeno/fisiología , Nitrógeno/química , Synechococcus/metabolismo , Compuestos de Amonio/química , Compuestos de Amonio/metabolismo , Anaerobiosis/fisiología , Procesos Autotróficos , Carbono/metabolismo , Chlorobi/química , Clorofila/química , Clorofila/metabolismo , República Democrática del Congo , Ecosistema , Marcaje Isotópico , Lagos/química , Lagos/microbiología , Nitrificación/fisiología , Nitrógeno/metabolismo , Oxidación-Reducción , Synechococcus/química , Tanzanía
4.
BMC Med Educ ; 21(1): 136, 2021 Feb 27.
Artículo en Inglés | MEDLINE | ID: mdl-33639921

RESUMEN

BACKGROUND: Low- and Middle-income countries (LMIC) face considerable health and nutrition challenges, many of which can be addressed through strong academic leadership and robust research translated into evidence-based practice. A North-South-South partnership between three universities was established to implement a master's programme in nutritional epidemiology at the Kinshasa School of Public Health (KSPH), Democratic Republic of Congo (DRC). The partnership aimed to develop academic leadership and research capacity in the field of nutrition in the DRC. In this article we describe the educational approach and processes used, and discuss successes, challenges, and lessons learned. METHODS: Self-administered questionnaires, which included both open and closed questions, were sent to all graduates and students on the master's programme to explore students' experiences and perceptions of all aspects of the educational programme. Quantitative data was analysed using frequencies, and a thematic approach was used to analyse responses to open-ended questions. RESULTS: A two-year master's programme in Nutritional Epidemiology was established in 2014, and 40 students had graduated by 2020. Key elements included using principles of authentic learning, deployment of students for an internship at a rural residential research site, and support of selected students with bursaries. Academic staff from all partner universities participated in teaching and research supervision. The curriculum and teaching approach were well received by most students, although a number of challenges were identified. Most students reported benefits from the rural internship experience but were challenged by the isolation of the rural site, and felt unsupported by their supervisors, undermining students' experiences and potentially the quality of the research. Financial barriers were also reported as challenges by students, even among those who received bursaries. CONCLUSION: The partnership was successful in establishing a Master Programme in Nutritional Epidemiology increasing the number of nutrition researchers in the DRC. This approach could be used in other LMIC settings to address health and nutrition challenges.


Asunto(s)
Educación de Postgrado/normas , Epidemiología/educación , Ciencias de la Nutrición/educación , Evaluación de Programas y Proyectos de Salud , Estudiantes/psicología , Creación de Capacidad , Estudios Transversales , Curriculum , República Democrática del Congo , Femenino , Humanos , Liderazgo , Masculino , Desarrollo de Programa
5.
Trans R Soc Trop Med Hyg ; 115(3): 245-252, 2021 03 06.
Artículo en Inglés | MEDLINE | ID: mdl-33611586

RESUMEN

Many control programmes against neglected tropical diseases have been interrupted due to the coronavirus disease 2019 (COVID-19) pandemic, including those that rely on active case finding. In this study we focus on gambiense human African trypanosomiasis (gHAT), where active screening was suspended in the Democratic Republic of Congo (DRC) due to the pandemic. We use two independent mathematical models to predict the impact of COVID-19 interruptions on transmission and reporting and achievement of the 2030 elimination of transmission (EOT) goal for gHAT in two moderate-risk regions of the DRC. We consider different interruption scenarios, including reduced passive surveillance in fixed health facilities, and whether this suspension lasts until the end of 2020 or 2021. Our models predict an increase in the number of new infections in the interruption period only if both active screening and passive surveillance were suspended, and with a slowed reduction-but no increase-if passive surveillance remains fully functional. In all scenarios, the EOT may be slightly pushed back if no mitigation, such as increased screening coverage, is put in place. However, we emphasise that the biggest challenge will remain in the higher-prevalence regions where EOT is already predicted to be behind schedule without interruptions unless interventions are bolstered.


Asunto(s)
/epidemiología , Control de Enfermedades Transmisibles/organización & administración , Tripanosomiasis Africana/epidemiología , Tripanosomiasis Africana/prevención & control , República Democrática del Congo/epidemiología , Humanos , Modelos Teóricos , Enfermedades Desatendidas/epidemiología , Enfermedades Desatendidas/prevención & control , Pandemias , Vigilancia de la Población , Trypanosoma brucei gambiense
6.
BMJ Open ; 11(1): e043356, 2021 01 18.
Artículo en Inglés | MEDLINE | ID: mdl-33462101

RESUMEN

OBJECTIVES: We aimed to assess the level of adherence to COVID-19 preventive measures in the Democratic Republic of the Congo (DRC) and to identify factors associated with non-adherence. DESIGN: A cross-sectional population-based online survey. SETTINGS: The study was conducted in 22 provinces of the DRC. Five provinces with a satisfactory number of respondents were included in the analysis: Haut Katanga, Kasaï-Central, Kasaï-Oriental, Kinshasa and North Kivu. PARTICIPANTS: The participants were people aged ≥18 years, living in the DRC. A total of 3268 participants were included in the study analysis. INTERVENTIONS: Both convenience sampling (surveyors themselves contacted potential participants in different districts) and snowball sampling (the participants were requested to share the link of the questionnaire with their contacts) methods were used. PRIMARY AND SECONDARY OUTCOME MEASURES: We computed adherence scores using responses to 10 questions concerning COVID-19 preventive measures recommended by the WHO and the DRC Ministry of Health. We used logistic regression analysis with generalised estimating equations to identify factors of poor adherence. We also asked about the presence or absence of flu-like symptoms during the preceding 14 days, whether a COVID-19 test was done and the test result. RESULTS: Data from 3268 participants were analysed. Face masks were not used by 1789 (54.7%) participants. Non-adherence to physical distancing was reported by 1364 (41.7%) participants. 501 (15.3%) participants did not observe regular handwashing. Five variables were associated with poor adherence: lower education level, living with other people at home, being jobless/students, living with a partner and not being a healthcare worker. CONCLUSION: Despite compulsory restrictions imposed by the government, only about half of the respondents adhered to COVID-19 preventive measures in the DRC. Disparities across the provinces are remarkable. There is an urgent need to further explore the reasons for these disparities and factors associated with non-adherence.


Asunto(s)
/prevención & control , Adhesión a Directriz/estadística & datos numéricos , Adolescente , Adulto , Estudios Transversales , República Democrática del Congo , Femenino , Guías como Asunto , Desinfección de las Manos , Humanos , Modelos Logísticos , Masculino , Máscaras , Persona de Mediana Edad , Cuarentena/estadística & datos numéricos , Encuestas y Cuestionarios , Adulto Joven
7.
Psychiatry Res ; 297: 113714, 2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33453497

RESUMEN

OBJECTIVES: Currently, there is little data on the mental health consequences of the COVID-19 pandemic in low- and middle-income countries (LMICs). This study aims to examine the pooled and separate prevalence and determinants of depression during the pandemic in samples from four LMICs. METHODS: Participants (N= 1267, 40.9% women) were recruited from the Democratic Republic of the Congo (DRC), Haiti, Rwanda, and Togo. They completed an online cross-sectional survey on sociodemographics, exposure and stigmatization related to COVID-19, the Hopkins Symptom Checklist depression subscale, and the Connor-Davidson Resilience Scale-2. RESULTS: The pooled prevalence for depression symptoms was 24.3% (95% CI: 22.08-26.79%), with significant differences across countries. Younger age, gender (women), and high levels of exposure and stigmatization related to COVIID-19, and resilience were associated with depression in the pooled data. There were significant variations at the country level. Stigmatization (but not exposure to COVID-19 and resilience) was a strong predictor among the four countries. CONCLUSIONS: The prevalence of depression symptoms in the LMICs are similar to those reported in China and in most high-income countries during the pandemic. The findings emphasize the need for implementing non-fear-based education programs during epidemics to reduce stigmatization.


Asunto(s)
Ansiedad/epidemiología , Depresión/epidemiología , Estigma Social , Adulto , Ansiedad/psicología , Estudios Transversales , República Democrática del Congo/epidemiología , Escolaridad , Femenino , Haití/epidemiología , Humanos , Renta , Masculino , Salud Mental , Persona de Mediana Edad , Pandemias , Pobreza , Prevalencia , Rwanda/epidemiología , Estereotipo , Togo , Adulto Joven
8.
Viruses ; 13(2)2021 Jan 20.
Artículo en Inglés | MEDLINE | ID: mdl-33498495

RESUMEN

Newcastle disease (ND) is a highly transmissible and devastating disease that affects poultry and wild birds worldwide. Comprehensive knowledge regarding the characteristics and epidemiological factors of the ND virus (NDV) is critical for the control and prevention of ND. Effective vaccinations can prevent and control the spread of the NDV in poultry populations. For decades, the Democratic Republic of the Congo (DRC) has reported the impacts of ND on commercial and traditional poultry farming systems. The reports were preliminary clinical observations, and few cases were confirmed in the laboratory. However, data on the phylogenetic, genetic, and virological characteristics of NDVs circulating in the DRC are not available. In this study, the whole-genome sequences of three NDV isolates obtained using the next-generation sequencing method revealed two isolates that were a new variant of NDV, and one isolate that was clustered in the subgenotype VII.2. All DRC isolates were velogenic and were antigenically closely related to the vaccine strains. Our findings reveal that despite the circulation of the new variant, ND can be controlled in the DRC using the current vaccine. However, epidemiological studies should be conducted to elucidate the endemicity of the disease so that better control strategies can be implemented.


Asunto(s)
Enfermedad de Newcastle/epidemiología , Enfermedad de Newcastle/virología , Virus de la Enfermedad de Newcastle/clasificación , Virus de la Enfermedad de Newcastle/genética , Enfermedades de las Aves de Corral/virología , Animales , República Democrática del Congo/epidemiología , Genotipo , Virus de la Enfermedad de Newcastle/aislamiento & purificación , Filogenia , Aves de Corral/virología , Enfermedades de las Aves de Corral/epidemiología , ARN Viral/genética , Proteínas Virales/genética , Secuenciación Completa del Genoma
9.
Sci Total Environ ; 754: 142175, 2021 Feb 01.
Artículo en Inglés | MEDLINE | ID: mdl-32920409

RESUMEN

The contamination of water resource and food chain by persistent organic pollutants (POPs) constitutes a major environmental and human health concern worldwide. The aim of this study was to investigate the levels of POPs in irrigation water, soil and in Amaranthus viridis (A. viridis) from different gardening sites in Kinshasa to evaluate the potential environmental and human health risks. A survey study for the use of pesticides and fertilizers was carried out with 740 market gardeners. The levels of POPs (including organochlorine pesticides (OCPs), polychlorinated biphenyls (PCBs), polybrominated diphenyl ethers (PBDEs), and polycyclic aromatic hydrocarbons (PAHs)) were analyzed in irrigation water and 144 vegetable samples collected from different gardening sites. The assessment of potential human health risk was estimated by calculating daily intake and toxic equivalency to quantify the carcinogenicity. The results show highest PAH levels in A. viridis from all studied sites. The concentrations of the sum of seven PCBs (Σ7PCBS) congeners in analyzed plants ranged between 15.89 and 401.36 ng g-1. The distributions of OCPs in both water and A. viridis were congener specific, chlorpyrifos-ethyl and p,p'-DDE were predominantly detected. Among PBDEs, only BDE47 was quantified with noticeable concentration in A. viridis, while no PBDEs were detected in irrigation water. Higher estimated daily intake values indicate that consuming leafy vegetables might associate with increased human health risks. However, calculated incremental lifetime cancer risk values indicates no potential carcinogenic risk for the local population. The results of this study provide important information on A. viridis contamination by POPs and strongly recommend implementing the appropriate measures to control the use of chemicals used in studied gardening areas. Thus in Kinshasa, urban agriculture control programs for POPs and fertilizers is very important in order to protect the public health through direct and dietary exposure pathways.


Asunto(s)
Amaranthus , Hidrocarburos Clorados , Plaguicidas , Bifenilos Policlorados , República Democrática del Congo , Monitoreo del Ambiente , Éteres Difenilos Halogenados/análisis , Humanos , Hidrocarburos Clorados/análisis , Plaguicidas/análisis , Bifenilos Policlorados/análisis , Medición de Riesgo
10.
PLoS One ; 15(12): e0244272, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33338063

RESUMEN

OBJECTIVES: To describe the clinical characteristics of patients infected with SARS-CoV-2 at Clinique Ngaliema, a public hospital, in Kinshasa, in the Democratic Republic of Congo (DRC). METHODS: This retrospective study analyzed medical records including socio-demographics, past medical history, clinical manifestation, comorbidities, laboratory data, treatment and disease outcome of 160 hospitalized COVID-19 patients, with confirmed result of SARS-CoV-2 viral infection. RESULTS: The median age of patients was 54 years (IQR: 38-64), and there was no significant gender difference (51% of male). The most common comorbidities were hypertension (55 [34%]), diabetes (31 [19%]) and obesity (13 [8%]). Fever (93 [58%]), cough (92 [57%]), fatigue (87 [54%]), shortness of breath (72 [45%]) and myalgia (33 [21%]) were the most common symptoms, upon admission. Patients were categorized into mild (92 [57%]), moderate (19 [12%]) and severe (49 [31%]). Severe patients were older and were more likely to have comorbidities, compared to mild ones. The majority of patients (92% [147 of 160]) patients received hydroxychloroquine or chloroquine phosphate. Regression model revealed that older age, lower SpO2, higher heart rate and elevated AST at admission were all risk factors associated with in-hospital death. The prevalence of COVID-19 and malaria co-infection was 0.63% and 70 (44%) of all patients received antimalarial treatment before hospitalization. CONCLUSION: Our findings indicated that the epidemiological and clinical feature of COVID-19 patients in Kinshasa are broadly similar to previous reports from other settings. Older age, lower SpO2, tachycardia, and elevated AST could help to identify patients at higher risk of death at an early stage of the illness. Plasmodium spp co-infection was not common in hospitalized COVID-19 patients.


Asunto(s)
/diagnóstico , /epidemiología , Adulto , Anciano , Coagulación Sanguínea , Cloroquina/administración & dosificación , Cloroquina/análogos & derivados , Coinfección , Comorbilidad , Tos , República Democrática del Congo/epidemiología , Femenino , Fiebre , Hospitalización , Hospitales Públicos , Humanos , Hidroxicloroquina/administración & dosificación , Inflamación , Pruebas de Función Hepática , Malaria/complicaciones , Masculino , Persona de Mediana Edad , Análisis de Regresión , Estudios Retrospectivos , Factores de Riesgo , Clase Social , Taquicardia/complicaciones
11.
BMC Public Health ; 20(Suppl 4): 1807, 2020 Dec 18.
Artículo en Inglés | MEDLINE | ID: mdl-33339529

RESUMEN

BACKGROUND: Since its inception in 1988, the Global Polio Eradication Initiative (GPEI) has partnered with 200 countries to vaccinate over 2.5 billion children against poliomyelitis. The polio eradication approach has adapted to emerging challenges and diverse contexts. Knowledge assets gained from these experiences can inform implementation of future health programs, but only if efforts are made to systematically map barriers, identify strategies to overcome them, identify unintended consequences, and compare experiences across country contexts. METHODS: A sequential explanatory mixed methods design, including an online survey followed by key informant interviews (KIIs), was utilized to map tacit knowledge derived from the polio eradication experience from 1988 to 2019. The survey and KIIs were conducted between September 2018 and March 2019. A cross-case comparison was conducted of two study countries, the Democratic Republic of Congo (DRC) and Ethiopia, which fit similar epidemiological profiles for polio. The variables of interest (implementation barriers, strategies, unintended consequences) were compared for consistencies and inconsistencies within and across the two country cases. RESULTS: Surveys were conducted with 499 and 101 respondents, followed by 23 and 30 KIIs in the DRC and Ethiopia, respectively. Common implementation barriers included accessibility issues caused by political insecurity, population movement, and geography; gaps in human resources, supply chain, finance and governance; and community hesitancy. Strategies for addressing these barriers included adapting service delivery approaches, investing in health systems capacity, establishing mechanisms for planning and accountability, and social mobilization. These investments improved system infrastructure and service delivery; however, resources were often focused on the polio program rather than strengthening routine services, causing community mistrust and limiting sustainability. CONCLUSIONS: The polio program investments in the DRC and Ethiopia facilitated program implementation despite environmental, system, and community-level barriers. There were, however, missed opportunities for integration. Remaining pockets of low immunization coverage and gaps in surveillance must be addressed in order to prevent importation of wild poliovirus and minimize circulating vaccine-derived poliovirus. Studying these implementation processes is critical for informing future health programs, including identifying implementation tools, strategies, and principles which can be adopted from polio eradication to ensure health service delivery among hard-to-reach populations. Future disease control or eradication programs should also consider strategies which reduce parallel structures and define a clear transition strategy to limit long-term external dependency.


Asunto(s)
Erradicación de la Enfermedad/organización & administración , Poliomielitis/prevención & control , Niño , República Democrática del Congo/epidemiología , Etiopía/epidemiología , Recursos en Salud , Humanos , Programas de Inmunización/organización & administración , Vacunas contra Poliovirus/administración & dosificación , Política , Cobertura de Vacunación/organización & administración
12.
PLoS Negl Trop Dis ; 14(12): e0008832, 2020 12.
Artículo en Inglés | MEDLINE | ID: mdl-33315896

RESUMEN

BACKGROUND: Human African trypanosomiases caused by the Trypanosoma brucei gambiense parasite is a lethal disease targeted for eradication. One of the main disease control strategies is active case-finding through outreach campaigns. In 2014, a new method for active screening was developed with mini, motorcycle-based, teams. This study compares the cost of two active case-finding approaches, namely the traditional mobile teams and mini mobile teams, in the two health districts of the Democratic Republic of the Congo. METHODS: The financial and economic costs of both approaches were estimated from a health care provider perspective. Cost and operational data were collected for 12 months for 1 traditional team and 3 mini teams. The cost per person screened and diagnosed was calculated and univariate sensitivity analysis was conducted to identify the main cost drivers. RESULTS: During the study period in total 264,630 people were screened, and 23 HAT cases detected. The cost per person screened was lower for a mini team than for a traditional team in the study setting (US$1.86 versus US$2.08). A comparable result was found in a scenario analysis, assuming both teams would operate in a similar setting, with the cost per person screened by a mini team 15% lower than the cost per person screened by a traditional team (1.86 $ vs 2.14$). The main explanations for this lower cost are that mini teams work with fewer human resources, cheaper means of transportation and do not perform the Capillary Tube Centrifugation test or card agglutination test dilutions. DISCUSSION: Active HAT screening with mini mobile teams has a lower cost and could be a cost-effective alternative for active case-finding. Further research is needed to determine if mini mobile teams have similar or better yields than traditional mobile teams in terms of detections and cases successfully treated.


Asunto(s)
Prestación de Atención de Salud/métodos , Tamizaje Masivo/economía , Tamizaje Masivo/métodos , Tripanosomiasis Africana/diagnóstico , Tripanosomiasis Africana/epidemiología , Pruebas de Aglutinación , Prestación de Atención de Salud/economía , República Democrática del Congo/epidemiología , Costos de la Atención en Salud , Humanos , Sensibilidad y Especificidad , Trypanosoma brucei gambiense
13.
Glob Health Sci Pract ; 8(4): 638-653, 2020 12 23.
Artículo en Inglés | MEDLINE | ID: mdl-33361232

RESUMEN

BACKGROUND: The coronavirus disease (COVID-19) pandemic poses a grave threat to refugees and internally displaced persons (IDPs). We examined knowledge, attitudes, and practices with respect to COVID-19 prevention among IDPs in war-torn Eastern Democratic Republic of the Congo (DRC). METHODS: Mixed-methods study with qualitative (focus group discussions, [FGDs]) and quantitative (52-item survey questionnaire) data collection and synthesis. RESULTS: FGDs (N=23) and survey questionnaires (N=164 IDPs; N=143 comparison group) were conducted in May 2020. FGD participants provided narratives of violence that they had fled. IDPs were statistically more likely to have larger household size, experience more extreme poverty, have lower educational attainment, and have less access to information through media and internet versus the comparison group (P<.05 for the comparison group). IDPs had a high level of awareness (99%) and fear (98%) of COVID-19, but lower specific knowledge (15% sufficient knowledge versus 30% among the comparison group, P<.0001), a difference which remained significant in a multivariable model adjusting for confounding. IDPs faced major barriers to implementing COVID-19 prevention measures. Physical distancing was impossible for IDPs in crowded shelters, and 70% reported coming in close contact with someone other than a family member within the past 24 hours (versus 56% of the comparison group, P=.014). Frequent movements in and out of the camp for subsistence left IDPs vulnerable to the introduction of COVID-19: 61% left the camp on a daily basis and 65% had received a visitor in the past month. Despite acceptance of hand hygiene for prevention, 92% lacked soap (versus 65% of the comparison group, P<.0001). IDPs' desire for peace and to return to their native homes, where COVID-19 precautions could be feasibly implemented, overshadowed their perceived benefits of measures such as a COVID-19 vaccine. CONCLUSIONS: These findings provide empiric evidence supporting the vulnerability of IDPs to COVID-19 and call for action to protect neglected displaced populations.


Asunto(s)
/prevención & control , Conductas Relacionadas con la Salud , Conocimientos, Actitudes y Práctica en Salud , Pandemias , Refugiados , Condiciones Sociales , Adolescente , Adulto , Anciano , /virología , República Democrática del Congo , Femenino , Higiene de las Manos , Humanos , Masculino , Persona de Mediana Edad , Jabones , Encuestas y Cuestionarios , Violencia
14.
PLoS One ; 15(12): e0242046, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33347460

RESUMEN

INTRODUCTION: Delivering integrated sexual and reproductive health services (SRHS) in emergencies is important in order to save lives of the most vulnerable as well as to combat poverty, reduce inequities and social injustice. More than 60% of preventable maternal deaths occur in conflict areas and especially among the internally displaced persons (IDP). Between 2016 and 2018, unprecedented violence erupted in the Kasaï's region, in the Democratic Republic of Congo (DRC), called the Kamuina Nsapu Insurgency. During that period, an estimated three million of adolescent girls and women were forced to flee; and have faced growing threat to their health, safety, security, and well-being including significant sexual and reproductive health challenges. Between August 2016 and May 2017, the "Sous-Cluster sur les violences basées sur le genre (SC-VBG)" in DRC (2017) reported 1,429 Gender Based Violence (GBV) incidents in the 49 service delivery points in the provinces of Kasaï, Kasaï Central and Kasaï Oriental. Rape cases represented 79% of reported incidents whereas sexual assault and forced marriage accounted for respectively 11% and 4% of Gender Based Violence (GBV) among women and adolescent girls. This study aims to assess the availability of SRHS in the displaced camps in Kasaï; to evaluate the SRHS needs of young girls and women in the reproductive age (12-49). Studies of sexual and reproductive health (SRH) in the Democratic Republic of Congo (DRC) have often included adolescent girls under the age of 15 because of high prevalence of child marriage and early onset of childbearing, especially in the humanitarian context. According to the 2013 Demographic and Health Survey (DHS), about 16% of surveyed women got married by age 14 while the prevalence of early child marriage (marriage by 15) was estimated at 30%; to assess the use of SRHS services and identify barriers as well as challenges for SRH service delivery and use. Findings from this study will help provide evidence to inform towards more needs-based and responsive SRH service delivery. This is hoped for ultimately improve the quality and effectiveness of services, when considering service delivery and response in humanitarian settings. DATA AND METHODS: We will conduct a mixed-methods study design, which will combine quantitative and qualitative approaches. Based on the estimation of the sample size, quantitative data will be drawn from the community-based survey (500 women of reproductive age per site) and health facility assessments will include assessments of 45 health facilities and 135 health providers' interviews. Qualitative data will comprise materials from 30 Key Informant Interviews (KII) and 24 Focus Group Discussions (FGDs), which are believed to achieve the needed saturation levels. Data analysis will include thematic and content analysis for the KIIs and FGDs using ATLAS.ti software for the qualitative arm. For the quantitative arm, data analysis will combine frequency and bivariate chi-square analysis, coupled with multi-level regression models, using Stata 15 software. Statistic differences will be established at the significance level of 0.05. We submitted this protocol to the national ethical committee of the ministry of health in September 2019 and it was approved in January 2020. It needs further approval from the Scientific Oversee Committee (SOC) and the Provincial Ministry of Health. Prior to data collection, informed consents will be obtained from all respondents.


Asunto(s)
Prestación Integrada de Atención de Salud/organización & administración , Refugiados/psicología , Servicios de Salud Reproductiva/organización & administración , Salud de la Mujer , Adolescente , Adulto , Niño , República Democrática del Congo , Femenino , Humanos , Persona de Mediana Edad , Salud Reproductiva , Salud Sexual , Adulto Joven
15.
Artículo en Inglés | MEDLINE | ID: mdl-33334018

RESUMEN

BACKGROUND: Thousands of artisanal workers are exposed to mineral dusts from various origins in the African Copperbelt. We determined the prevalence of respiratory symptoms, pulmonary function, and urinary metals among artisanal stone-crushers in Lubumbashi. METHODS: We conducted a cross-sectional study of 48 male artisanal stone-crushers and 50 male taxi-drivers using a standardized questionnaire and spirometry. Concentrations of trace metals were measured by Inductively Coupled - Plasma Mass Spectrometry (ICP-MS) in urine spot samples. RESULTS: Urinary Co, Ni, As, and Se were higher in stone-crushers than in control participants. Wheezing was more prevalent (p = 0.021) among stone-crushers (23%) than among taxi-drivers (6%). In multiple logistic regression analysis, the job of a stone-crusher was associated to wheezing (adjusted Odds Ratio 4.45, 95% Confidence Interval 1.09-18.24). Stone-crushers had higher values (% predicted) than taxi-drivers for Forced Vital Capacity (105.4 ± 15.9 vs. 92.2 ± 17.8, p = 0.048), Forced Expiratory Volume in 1 Second (104.4 ± 13.7 vs. 88.0 ± 19.6, p = 0.052), and Maximum Expiratory Flow at 25% of the Forced Vital Capacity (79.0.1 ± 20.7 vs. 55.7 ± 30.1, p = 0.078). CONCLUSION: Stone-crushers were more heavily exposed to mineral dust and various trace elements than taxi-drivers, and they had a fourfold increased risk of reporting wheezing, but they did not have evidence of more respiratory impairment than taxi-drivers.


Asunto(s)
Polvo , Exposición Profesional , Estudios Transversales , República Democrática del Congo/epidemiología , Polvo/análisis , Humanos , Masculino , Zambia
16.
PLoS One ; 15(12): e0244486, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33382748

RESUMEN

INTRODUCTION: Little is known about the outcomes of subjects with a history of severe acute malnutrition (SAM). We therefore sought to explore the long-term effects of SAM during childhood on human capital in adulthood in terms of education, cognition, self-esteem and health-related disabilities in daily living. METHODOLOGY: We traced 524 adults (median age of 22) in the eastern Democratic Republic of the Congo, who were treated for SAM during childhood at Lwiro hospital between 1988 and 2007 (median age 41 months). We compared them with 407 community controls of comparable age and sex. Our outcomes of interest were education, cognitive function [assessed using the Mini Mental State Examination (MMSE) for literate participants, or its modified version created by Ertan et al. (MMSE-I) for uneducated participants], self-esteem (measured using the Rosenberg Self-Esteem Scale) and health-related social and functional disabilities measured using the World Health Organization Disability Assessment Schedule (WHODAS). For comparison, we used the Chi-squared test along with the Student's t-test for the proportions and means respectively. RESULTS: Compared with the community controls, malnutrition survivors had a lower probability of attaining a high level of education (p < 0.001), of reporting a high academic performance (p = 0.014) or of having high self-esteem (p = 0.003). In addition, malnutrition survivors had an overall mean score in the cognitive test that was lower compared with the community controls [25.6 compared with 27.8, p = 0.001 (MMSE) and 22.8 compared with 26.3, p < 0.001(MMSE-I)] and a lower proportion of subjects with a normal result in this test (78.0% compared with 90.1%, p < 0.001). Lastly, in terms of health-related disabilities, unlike the community controls, malnutrition survivors had less social disability (p = 0.034), but no difference was observed as regards activities of daily living (p = 0.322). CONCLUSION: SAM during childhood exposes survivors to low human capital as regards education, cognition and behaviour in adulthood. Policy-deciders seeking to promote economic growth and to address various psychological and medico-social disorders must take into consideration the fact that appropriate investment in child health as regards SAM is an essential means to achieve this.


Asunto(s)
Desarrollo Infantil/fisiología , Salud del Niño , Cognición/fisiología , Desnutrición Aguda Severa/complicaciones , Sobrevivientes/estadística & datos numéricos , Actividades Cotidianas , Adolescente , Adulto , Estudios de Casos y Controles , Preescolar , República Democrática del Congo , Evaluación de la Discapacidad , Escolaridad , Femenino , Estudios de Seguimiento , Humanos , Lactante , Masculino , Pruebas de Estado Mental y Demencia/estadística & datos numéricos , Autoimagen , Desnutrición Aguda Severa/mortalidad , Desnutrición Aguda Severa/fisiopatología , Desnutrición Aguda Severa/rehabilitación , Sobrevivientes/psicología , Adulto Joven
17.
Afr J Prim Health Care Fam Med ; 12(1): e1-e9, 2020 Dec 15.
Artículo en Francés | MEDLINE | ID: mdl-33354981

RESUMEN

Reform and Performance of the Provincial Health Inspectorate and the Provincial Division of Health of South Kivu in the Democratic Republic of Congo. BACKGROUND: The intermediate level incorporated both the Provincial Health Inspectorate (IPS) and the Provincial Health Division (DPS) of Health. The new constitution of 2006 gave impetus to decentralisation, which became effective in 2015. The reform introduced at the intermediate level clearly separated the IPS and the DPS. This article assesses the effect of this reform on the performance of IPS and DPS in South Kivu, Democratic Republic of Congo. METHODOLOGY: The study is evaluative before and after and covers the period from 2012 to 2017. It uses mixed methods: three techniques were used to collect data including observation, document review and individual interviews. The analysis of the quantitative data concerned the evolution of the indicators; that of qualitative data was carried out by themes from two theoretical models: the ministerial functional framework and the 'Strengths, Weaknesses, Opportunities and Threats' analysis framework (SWOT analysis). Scores were assigned to each managerial function according to their level of performance for better comparison. RESULTS: After the reform, a decline in the performance score of activities devolved to IPS is noted, mainly due to the low funding of activities. On the other hand, in the DPS, the evolution of the score is favorable, because of the strong support given to the reform at this level by the partners and the government. The alignment of partners to a single contract for funding DPS activities is observed. The weak financing of the health sector by the government remains a weak point, however, and the brain drain a threat to institutional sustainability. The introduction of the single financing contract constitutes an opportunity to improve the performance of the provincial management team. DISCUSSION AND CONCLUSION: The study shows the improvement in the performance of managerial functions of the DPS and the regression to the IPS. The low funding of IPS by the Congolese government could jeopardise the reform.


Asunto(s)
Gobierno , Reforma de la Atención de Salud , Calidad de la Atención de Salud , República Democrática del Congo , Sector de Atención de Salud , Personal de Salud , Financiación de la Atención de la Salud , Humanos , Política
18.
BMC Infect Dis ; 20(1): 830, 2020 Nov 11.
Artículo en Inglés | MEDLINE | ID: mdl-33176700

RESUMEN

BACKGROUND: HIV self-testing (HIVST) can be performed using directly assisted and unassisted approaches in facilities or communities to reach different populations. The aim of this study was to compare the practicability and effectiveness of the two delivery approaches for HIVST, unassisted HIVST (UH) and directly assisted HIVST (DAH), in the field setting of Kisangani, the Democratic Republic of the Congo (DRC). METHODS: A randomized (1:1), non-blinded, non-inferiority trial using a blood-based and facility-based HIVST method was carried out in four facilities in Kisangani, the DRC, targeting populations at high risk for HIV infection. The primary outcome was the difference in the practicability of the HIV self-test between the two arms. Practicability was defined as successfully performing the test and correctly interpreting the result. Requests for assistance, positivity rate, linkage to care, and willingness to buy an HIV self-test kit constituted the secondary outcomes for HIVST effectiveness. The adjusted risk ratios (aRRs) were calculated using Poisson regression. RESULTS: The rate of successfully performing the test was same (93.2%) in the UH and DAH arms. The rate of correctly interpreting the results was 86.9% in the UH arm versus 93.2% in the DAH arm, for a difference of - 6.3%. After the follow-up 72 h later, participants in the UH arm had a significantly lower chance of correctly interpreting the test results than those in the DAH arm (aRR: 0.60; P = 0.019). Although the positivity rate was 3.4% among the participants in the DAH arm and 1.7% among those in the UH arm, no significant differences were found between the two arms in the positivity rate, requests for assistance, and linkage to care. Willingness to buy an HIV self-test was higher in the UH arm than in the DAH arm (92.3% versus 74.1%; aRR: 4.20; P < 0.001). CONCLUSION: The results of this study indicate that UH is as practicable and effective as DAH among individuals at high risk for HIV infection in Kisangani, the DRC. However, additional support tools need to be assessed to improve the interpretation of the self-test results when using the UH approach. TRIAL REGISTRATION: PACTR201904546865585. Registered 03 April 2019 - Retrospectively registered, https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=6032.


Asunto(s)
Seropositividad para VIH/diagnóstico , Seropositividad para VIH/epidemiología , VIH/inmunología , Tamizaje Masivo/métodos , Pruebas Serológicas/métodos , Adolescente , Adulto , República Democrática del Congo/epidemiología , Estudios de Factibilidad , Femenino , Estudios de Seguimiento , Seropositividad para VIH/virología , Humanos , Masculino , Persona de Mediana Edad , Satisfacción del Paciente , Adulto Joven
19.
BMC Infect Dis ; 20(1): 741, 2020 Oct 09.
Artículo en Inglés | MEDLINE | ID: mdl-33036564

RESUMEN

BACKGROUND: Cholera remains a major global health challenge. Uvira, in the Democratic Republic of the Congo (DRC), has had endemic cholera since the 1970's and has been implicated as a possible point of origin for national outbreaks. A previous study among this population, reported a case confirmation rate of 40% by rapid diagnostic test (RDT) among patients at the Uvira Cholera Treatment Centre (CTC). This study considers the prevalence and diversity of 15 enteric pathogens in suspected cholera cases seeking treatment at the Uvira CTC. METHODS: We used the Luminex xTAG® multiplex PCR to test for 15 enteric pathogens, including toxigenic strains of V. cholerae in rectal swabs preserved on Whatman FTA Elute cards. Results were interpreted on MAGPIX® and analyzed on the xTAG® Data Analysis Software. Prevalence of enteric pathogens were calculated and pathogen diversity was modelled with a Poisson regression. RESULTS: Among 269 enrolled CTC patients, PCR detected the presence of toxigenic Vibrio cholerae in 38% (103/269) of the patients, which were considered to be cholera cases. These strains were detected as the sole pathogen in 36% (37/103) of these cases. Almost half (45%) of all study participants carried multiple enteric pathogens (two or more). Enterotoxigenic Escherichia coli (36%) and Cryptosporidium (28%) were the other most common pathogens identified amongst all participants. No pathogen was detected in 16.4% of study participants. Mean number of pathogens was highest amongst boys and girls aged 1-15 years and lowest in women aged 16-81 years. Ninety-three percent of toxigenic V. cholerae strains detected by PCR were found in patients having tested positive for V. cholerae O1 by RDT. CONCLUSIONS: Our study supports previous results from DRC and other cholera endemic areas in sub-Sahara Africa with less than half of CTC admissions positive for cholera by PCR. More research is required to determine the causes of severe acute diarrhea in these low-resource, endemic areas to optimize treatment measures. TRIAL REGISTRATION: This study is part of the impact evaluation study entitled: "Impact Evaluation of Urban Water Supply Improvements on Cholera and Other Diarrheal Diseases in Uvira, Democratic Republic of Congo" registered on 10 October 2016 at clinicaltrials.gov Identification number: NCT02928341 .


Asunto(s)
Cólera/epidemiología , Criptosporidiosis/epidemiología , Cryptosporidium/genética , Diarrea/epidemiología , Brotes de Enfermedades , Escherichia coli Enterotoxigénica/genética , Infecciones por Escherichia coli/epidemiología , Vibrio cholerae/genética , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Animales , Niño , Preescolar , Cólera/microbiología , Criptosporidiosis/parasitología , República Democrática del Congo/epidemiología , Pruebas Diagnósticas de Rutina , Diarrea/microbiología , Enfermedades Endémicas , Infecciones por Escherichia coli/microbiología , Femenino , Humanos , Lactante , Masculino , Persona de Mediana Edad , Reacción en Cadena de la Polimerasa Multiplex , Prevalencia , Microbiología del Agua , Adulto Joven
20.
Artículo en Inglés | MEDLINE | ID: mdl-33066059

RESUMEN

Background. Public markets were exempted from the restrictive regulations instituted to limit the rapid spread of the COVID-19 pandemic in the Democratic Republic of the Congo (DRC). In the early stage of the pandemic, we assessed people's knowledge, attitudes, and behavior on public markets towards COVID-19. Methods. We conducted a cross-sectional study from 16 to 29 April 2020 among sellers and customers frequenting the food sections of ten public markets in three large cities (Kolwezi, Likasi, and Lubumbashi) and one small town (Lwambo) of the former Katanga province. We administered a questionnaire on knowledge (about clinical characteristics, transmission and prevention) and on attitudes in relation to COVID-19. We also observed prevailing practices (hand-washing and mask-wearing). Results: Of the 347 included participants (83% women, 83% sellers), most had low socioeconomic status and a low level of education. Only 30% of participants had correct knowledge of COVID-19. The majority of the respondents (88%) showed no confidence in the government's ability to manage the upcoming pandemic crisis. Nearly all respondents (98%) were concerned about the associated increase in food insecurity. Preventive practices were rarely in place. Conclusion: For an effective implementation of measures to prevent the spread of COVID-19 in Africa, appropriate health education programs to improve knowledge and attitudes are warranted among the population frequenting public markets.


Asunto(s)
Comercio , Infecciones por Coronavirus/prevención & control , Conocimientos, Actitudes y Práctica en Salud , Pandemias/prevención & control , Neumonía Viral/prevención & control , Infecciones por Coronavirus/epidemiología , Estudios Transversales , República Democrática del Congo/epidemiología , Femenino , Humanos , Masculino , Neumonía Viral/epidemiología , Encuestas y Cuestionarios
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