[The cost of obstetric and neonatal care: Case study of the Jason Sendwe hospital maternity in Lubumbashi, Democratic Republic of Congo in 2015]. / Le coût des soins obstétricaux et néonatals : étude des cas à la maternité de l'hôpital Jason Sendwe à Lubumbashi, République démocratique du Congo, en 2015.

BACKGROUND: The aim of this study was to determine the user cost for obtaining obstetric and neonatal care during childbirth in the Jason Sendwe hospital in the city of Lubumbashi, Democratic Republic of Congo. METHODS: We conducted a cross-sectional study at the maternity of the Jason Sendwe hospital in Lubumbashi, reviewing charts and using a questionnaire given to 145 women who gave birth from 1st August to 30th September 2015. We calculated the cost based on the amounts paid by users for obtaining care, expressed in US dollars ($) at an exchange rate of 900 Congolese Francs (CDF) for $1. RESULTS: The average age of parturients was 27±6 years (m±SD). Nearly 9 out of 10 women were married (84.8%), 24.1% had a primary school educational level. The majority (62.1%) had no occupational activity and the average monthly income of those employed was $28. Many of their spouses were self-employed (36.6%) with an average monthly income of $113. Hemorrhage was the most common complication (12.4%); perinatal mortality was 12.4%, and was only registered in cases of dystocia. Cost of care for eutocic delivery was 5 times greater than for complicated vaginal delivery that in turn had a 2-fold lower cost than caesarean section. It follows from this study that the cost of care for eutocic delivery, complicated vaginal delivery and cesarean section was, respectively: 1.4%, 7.5%, and 13.4% of annual household income. In general, in case of childbirth, 51%, 40.7%, and 34.4% of households devoted more than 5%, 10% and 20% respectively of their annual income to obtain obstetric and neonatal care. CONCLUSION: The cost of obstetric and neonatal care is catastrophically high for households in Lubumashi. Undoubtedly, those who seek hospital care for childbirth must cope with financial problems related to the incurred debt. The State should review its healthcare financial policy to ensure access to quality care for all.

Conventional parasitology and DNA-based diagnostic methods for onchocerciasis elimination programmes.

Commonly used methods for diagnosing Onchocerca volvulus infections (microscopic detection of microfilariae in skin snips and nodule palpation) are insensitive. Improved methods are needed for monitoring and evaluation of onchocerciasis elimination programmes and for clinical diagnosis of individual patients. A sensitive probe-based qPCR assay was developed for detecting O. volvulus DNA, and this was tested with samples collected from an endemic area in eastern Côte d'Ivoire. The new test was evaluated with dried skin snip pairs from 369 subjects and compared to routine skin snip microscopy and nodule palpation results from the same individuals. Onchocerciasis prevalence for these samples by qPCR, skin snip microscopy, and nodule palpation were 56.9%, 26.0%, and 37.9%, respectively. Furthermore, the combination of all three tests produced an infection prevalence of 72.9%, which was significantly higher than 53.1% detected by microscopy plus nodule palpation without qPCR. However, the qPCR assay was negative for 54 of 229 individuals with palpable nodules. qPCR could be a useful tool for detecting residual O. volvulus infections in human populations as prevalence decreases in areas following community-directed treatment with ivermectin.

Low specificities of HIV diagnostic tests caused by Trypanosoma brucei gambiense sleeping sickness.

The accuracy of diagnostic tests for HIV in patients with tropical infections is poorly documented. Human African trypanosomiasis (HAT) is characterized by a polyclonal B-cell activation, constituting a risk for false-positive reactions to diagnostic tests, including HIV tests. A retrospective study of the accuracy of HIV diagnostic tests was performed with 360 human African HAT patients infected with Trypanosoma brucei gambiense before treatment and 163 T. b. gambiense-infected patients 2 years after successful treatment in Mbuji Mayi, East Kasai, Democratic Republic of the Congo. The sensitivities, specificities, and positive predictive values (PPVs) of individual tests and algorithms consisting of 3 rapid tests were determined. The sensitivity of all tests was 100% (11/11). The low specificity (96.3%, 335/348) and PPV (45.8%, 11/24) of a classical seroconfirmation strategy (Vironostika enzyme-linked immunosorbent assay [ELISA] followed by line immunoassay) complicated the determination of HIV status, which had to be determined by PCR. The specificities of the rapid diagnostic tests were 39.1% for Determine (136/348); 85.3 to 92.8% (297/348 to 323/348) for Vikia, ImmunoFlow, DoubleCheck, and Bioline; and 96.6 to 98.3% (336/348 to 342/348) for Uni-Gold, OraQuick, and Stat-Pak. The specificity of Vironostika was 67.5% (235/348). PPVs ranged between 4.9 and 64.7%. Combining 3 different rapid tests resulted in specificities of 98.3 to 100% (342/348 to 348/348) and PPVs of 64.7 to 100% (11/17 to 11/11). For cured HAT patients, specificities were significantly higher for Vironostika, Determine, Uni-Gold, and ImmunoFlow. T. b. gambiense infection decreases the specificities of antibody detection tests for HIV diagnosis. Unless tests have been validated for interference with HAT, HIV diagnosis using classical algorithms in untreated HAT patients should be avoided. Specific, validated combinations of 3 HIV rapid tests can increase specificity.

Hyperactivite adrenergique dans un cas de tetanos grave traitee[sic] par anesthesie peridurale continue

Le tetanos est une affection hautement mortelle et son traitement d'un cout tres eleve. Le taux de mortalite dans notre milieu ces 5 dernieres annees est de 66. Chez les tetaniques; la mort subite est principalement due aux troubles de rythme cardiaque liees a l'hyperactivite adrenergique et a un moindre degre au laryngospasme. Pour traiter et prevenir la survenue des troubles de rythme cardiaque chez une fille de 15 ans; les auteurs rapportent cette observation ou une anesthesie peridurale; par catheter laisse une semaine en place; a permis de passer la periode critique sans complications cardiaques graves

Hyperactivite adrenergique dans un cas de tetanos grave traite par anesthesie peridurable continue

Le tetanos est une affection hautement mortelle et son traitement d'un cout tres eleve. Le taux de mortalite dans notre milieu ces 5 dernieres annees est de 66 pour cent. Chez les tetaniques; la mort subite est principalement due aux troubles du rythme cardiaque lies a l'hyperactivite adrenergique et a un moindre degre au laryngospasme. Pour traiter et prevenir la survenue des troubles de rythme cardiaque chez une fille de 15 ans; les auteurs rapportent cette situation ou une anesthesie peridurable; par catheter laisse une semaine en place; a permis de passer la periode critique sans complications cardiaques graves

Infection with human immunodeficiency virus type 1 (HIV-1) and human T cell lymphotropic viruses among leprosy patients and contacts: correlation between HIV-1 cross-reactivity and antibodies to lipoarabinomannan.

To determine the association between leprosy and human retroviral infections, 57 leprosy patients, 39 leprosy contacts, and 500 pregnant women were investigated serologically for antibodies to human immunodeficiency virus type 1 (HIV) and human T cell lymphotropic virus (HTLV) types I and II. Antibodies to Mycobacterium leprae phenolic glycolipid I (PGL-I), and lipoarabinomannan (LAM) were also analyzed. A low prevalence of HIV-1 infection was observed among leprosy patients (3.5%), leprosy contacts (0), and pregnant women (3.6%). Antibodies to HTLV-I but not -II were found more often in leprosy patients (8.7%) and contacts (12.8%) than in pregnant women (0). Sera from leprosy patients and leprosy contacts were often false-positive for HIV-1 by ELISA and were indeterminate by Western blot. LAM IgM and PGL-I IgM antibodies in sera from leprosy patients yielded significant cross-reactivities with HIV-1 pol and gag proteins. These data suggest that mycobacterial cell wall antigens may share common epitopes with HIV. Caution should be exercised when interpreting HIV-1 ELISA and Western blot data from regions where leprosy or other mycobacterial diseases are endemic.

Traitement de la crise vaso-occlusive drepanocytaire grace a l'association Nootropil/voltarene

Dans une etude prospective effectuee sur 102 patients; tous drepanocytaires homozygotes en crise vaso-occlusive; l'administration concomitante du Nootropil a la dose de 100 mg/kg par voie intraveineuse directe lente; et du Voltarene a la dose de 3 mg/kg par voie intramusculaire profonde; a permis d'obtenir un amendement rapide et efficace des douleurs. Le temps moyen necessaire pour obtenir une remission totale des phenomenes hyperalgiques est de 23;1 minutes; avec un point de depart du decompte; le moment de l'injection de deux produits. Cette association tres synergique permet donc d'ameliorer; d'une facon tres remarquable et tres spectaculaire; la prise en charge des sickleniques en crise vaso-occlusive; et autorise un lever precoce des malades