Five successive waves of SARS-CoV-2 infection in the Central African Republic: a prospective observational study from 2020-2022.

Introduction: the National Laboratory of Clinical Biology and Public Health (NLBPH) in Bangui in the Central African Republic (CAR) carries out the vast majority of molecular screening tests for SARS-CoV-2 infection nationwide. This study aimed to show the contribution of molecular diagnosis and genomic surveillance in monitoring the evolution of longitudinal variations of the SARS-CoV-2 infection epidemic in CAR between 2020 and the end of 2022. Methods: this is an observational study on the variations in the prevalence of detection of SARS-CoV-2 by RT-PCR at the NLCBPH from nasopharyngeal samples taken prospectively over a period of 3 years since the beginning of the COVID-19 epidemic. A subgroup of SARS-CoV-2 positive samples was selected for molecular sequencing performed by Illumina® and MinIon® at the National Institute for Biomedical Research in Kinshasa, Democratic Republic of the Congo. Results: from March 2020 to December 31th, 2022, 88,442 RT-PCR tests were carried out (4/5 of the country) and detected 9,156 cases of SARS-CoV-2 infection in 5 successive waves. The average age of the patients was 39.8 years (extremes ranging from to 92 years). Age(P=0.001), sex(P=0.001) and symptom presentation(P=0.001) were significantly associated with RT-PCR test positivity. Among the different variants identified during successive waves, the Omicron variant predominated during the last two waves. Conclusion: this prospective study over a period of 3 years, marked by 5 successive waves, made it possible to report that age, sex and the presence of clinical symptoms are associated with RT-PCR positivity. Among the different variants identified during successive waves, the Omicron variant predominated during the last two waves.

[Latent tuberculosis infection in children in Bangui: about 524 cases exposed at home to index cases of positive microscopy pulmonary tuberculosis]. / Infection tuberculeuse latente chez l'enfant à Bangui: à propos de 524 cas exposés à domicile aux cas index de tuberculose pulmonaire à microscopie positive.

INTRODUCTION: in endemic areas, despite BCG vaccination, the risk of developing tuberculosis (TB) in young children is high after exposure to adults with tuberculosis. The purpose of this study is to reduce the risk of active tuberculosis in children experiencing household exposure to adult index cases. METHODS: we conducted a cross-sectional multi-site study (April 2016- January 2019) of children aged 0 to 59 months experiencing household exposure to index cases. They were screened and followed up at the pediatric center in Bangui. RESULTS: five hundred twenty four children were included in the study. The average age of patients was 2 years and 1 month and sex ratio (male/female) was 1.02; more than eighty-eight percent (88.5%) of contacts had received a BCG vaccination versus 11.5% who were unvaccinated. In more than half of the cases (52%), contacts and index cases had shared the same room and daily contact time had been greater than 12h in 56% of households; more than nine percent (9.35%) of contacts had positive tuberculin skin (IDR) test. All children received chemoprophylaxis with rifampicin + isoniazid, according to the national guidelines and, despite this, 14 or 2.67% of patients developed active tuberculosis, including 13 patients with pulmonary tuberculosis and one with ganglionic tuberculosis. CONCLUSION: chemoprophylaxis of tuberculosis significantly reduced the risk of TB in children experiencing household exposure to index cases.

[Epidemiological and clinical features of tuberculosis at the Hôpital de l'Amitié in Bangui]. / Aspects épidémiologiques et cliniques de la tuberculose en milieu hospitalier à Bangui.

Tuberculosis (TB) is endemic in the Central African Republic (CAR) with an incidence rate of 391 per 100,000 population in 2015. This study aims to analyze current epidemiological and clinical features of TB at the Hôpital de l'Amitié in the Central African Republic. We conducted an analytic retrospective study of patients hospitalized in the Department of Medicine at the Hôpital de l'Amitié from 15 April 2010 to 14 October 2011. Data were collected using a questionnaire and then analyzed with Epi info software 3.5.3. Chi-square test was used to compare proportions, using a threshold significance level of 5%. The study included 220 patients, of whom 128 were women (58.18%). The average age of patients was 35.69± 10.65 years. In 42.70% of cases, patients had no professional activity. Prevalence of tuberculosis in hospital was 10.99%. On average, 12 cases of TB were recorded each month. Most common clinical signs included: chronic cough (71.81%), fever (96.82%), alteration of the general state (91.36%) and pulmonary condensation syndrome (63.64%). The diseases most commonly associated with tuberculosis were HIV/AIDS (73.36%), malaria (48.63%) and anemia (31.81%). The mean time between symptom onset and diagnosis was 37.65 days. Mortality rate was 18.63%. TB/HIV co-infection and neuromeningeal TB were associated with a high mortality rate (p < 0.05). Tuberculosis is a common disease in Bangui and it is often associated with HIV infection. Prognosis is poor in the case of neuromeningeal involvement. Prevention and routine monitoring in HIV infected patients may contribute to reduce the extent and severity of TB.

Histo-epidemiological profile of breast cancers among women in the Central African Republic: about 174 cases.

BACKGROUND: Breast cancer (BC) is the most common cancer in women worldwide and leading cause of cancer deaths indeveloping countries. There is very limited data on BC in the Central African Republic. The purpose of this study was to describe the epidemiological and histopathological characteristics of BC in Bangui. METHODS: This retrospective study reviewed cancer data registries and medical records from the Pathology Unit of the National Laboratory in Bangui and the General Surgery and Gyneacology service from 2003 to 2015. A questionnaire was designed to collect information and data was analysed using descriptive and inferential statistical methods. RESULTS: In total, 174 cases of BC were recorded, with an average annual frequency of13.4 cases per year. The age of the women at diagnosis varied from 16 to 90 years with a median of 45.5 years and InterQuartile range (IQR) 18 years. The age group of 45-54 years represented the majority of the study population (n = 51, 29.3%).About 25.9%ofthe patients were non-educated and 85.6% lived in cities. Over 48 % of the women were housewives with a moderate economic status (n = 99, 56.9%). Sixty nine percent of the specimens received at the pathology unit were pieces of breast tumour. Invasive ductal carcinoma (n = 113, 64.9%) was the main histological form and most of the tumours were of Grade III (n = 14, 46.7%). The only imaging assessment was ultrasound performed in (n = 53, 30.4%) women. Surgery was performed in (n = 166, 95.4%) patients, while (n = 159, 91.4%) received complementary chemotherapy. At the end of the study, 84.5%of the cases had died, 12.1% were alive and 3.4% were considered "lost to follow-up". CONCLUSION: BC is an important public health problem and affected most of the younger Central African women. Epidemiological and histological characteristics are more or less common to those described other developing countries. It is imperative to improve the awareness of health care institutions and women on the burden of BC, to carry out early screening of BC, and to strengthen the capacity of women's health care system.

Reproductive risk factors associated with breast cancer in women in Bangui: a case-control study.

BACKGROUND: Breast cancer (breast Ca) is recognised as a major public health problem in the world. Data on reproductive factors associated with breast Ca in the Central African Republic (CAR) is very limited. This study aimed to identify reproductive variables as risk factors for breast Ca in CAR women. METHODS: A case-control study was conducted among 174 cases of breast Ca confirmed at the Pathology Unit of the National Laboratory in Bangui between 2003 and 2015 and 348 age-matched controls. Data collection tools included a questionnaire, interviews and a review of medical records of patients. Data were analysed using SPSS software version 20. Odd ratios and 95% confidence intervals (CI) for the likelihood of developing breast Ca were obtained using unconditional logistic regression. RESULTS: In total, 522 women with a mean age of 45.8 (SD = 13.4) years were enrolled. Women with breast Ca were more likely to have attained little or no education (AOR = 11.23, CI: 4.65-27.14 and AOR = 2.40, CI: 1.15-4.99), to be married (AOR = 2.09, CI: 1.18-3.71), to have had an abortion (AOR = 5.41, CI: 3.47-8.44), and to be nulliparous (AOR = 1.98, CI: 1.12-3.49). Decreased odds of breast Ca were associated with being employed (AOR = 0.32, CI: 0.19-0.56), living in urban areas (AOR = 0.16, CI: 0.07-0.37), late menarche (AOR = 0.18, CI: 0.07-0.44), regular menstrual cycles (AOR = 0.44, CI: 0.23-0.81), term pregnancy (AOR = 0.26, CI: 0.13-0.50) and hormonal contraceptive use (AOR = 0.62, CI: 0.41-0.93). CONCLUSION: Breast Ca risk factors in CAR did not appear to be significantly different from that observed in other populations. This study highlighted the risk factors of breast Ca in women living in Bangui to inform appropriate control measures.

Behavioral risk factors of breast cancer in Bangui of Central African Republic: A retrospective case-control study.

Breast cancer is recognized as a major public health problem in developing countries; however, there is very little evidence of behavioral factors associated with breast cancer risk. This study was conducted to identify lifestyles as risk factors for breast cancer among Central African women. A case-control study was conducted with 174 cases confirmed histologically by the pathology unit of the National Laboratory and 348 age-matched controls. Data collection tools included a questionnaire with interviews and medical records of patients. Data were analyzed using SPSS software version 20. Odd ratio (OR) and 95% confidence intervals (95% CI) were obtained by unconditional logistic regression. In total, 522 women were studied with a mean age of 45.8 (SD = 13.4) years. By unconditional logistic regression model, women with breast cancer were more likely to have attained illiterate and elementary education level [11.23 (95% CI, 4.65-27.14) and 2.40 (95% CI, 1.15-4.99)], married [2.09 (95% CI, 1.18-3.71)], positive family history [2.31 (95% CI, 1.36-3.91)], radiation exposure [8.21 (95% CI, 5.04-13.38)], consumption charcuterie [10.82 (95% CI, 2.39-48.90)], fresh fish consumption [4.26 (95% CI, 1.56-11.65)], groundnut consumption [6.46 (95% CI, 2.57-16.27)], soybean consumption [16.74 (95% CI, 8.03-39.84)], alcohol [2.53 (95% CI, 1.39-4.60)], habit of keeping money in bras[3.57 (95% CI, 2.24-5.69)], overweight [5.36 (95% CI, 4.46-24.57)] and obesity [3.11(95% CI, 2.39-20.42)]. However, decreased risk of breast cancer was associated with being employed [0.32 (95% CI, 0.19-0.56)], urban residence [0.16 (95% CI, 0.07-0.37)], groundnut oil consumption [0.05 (95% CI, 0.02-0.14)], wine consumption [0.16 (95% CI, 0.09-0.26)], non habit of keeping cell phone in bras [0.56 (95% CI, 0.35-0.89)] and physical activity [0.71(95% CI, 0.14-0.84)]. The study showed that little or no education, marriage, positive family history of cancer, radiation exposure, charcuterie, fresh fish, groundnut, soybean, alcohol, habit of keeping money in bras, overweight and obesity were associated with breast cancer risk among Central African women living in Bangui. Women living in Bangui should be more cautious on the behavioral risk associated with breast cancer.

Epidemiology of breast cancer: retrospective study in the Central African Republic.

BACKGROUND: Breast cancer is recognised as a major public health problem in developing countries; however, there is very limited evidence about its epidemiology in the Central African Republic. The aim of this study was to investigate the epidemiological and histopathological characteristics of breast cancer in Bangui. METHODS: This is a retrospective study based on the data collected from pathological anatomy records from 2003 to 2015 in Bangui. A questionnaire was designed to collect information and data was analysed using descriptive and inferential statistical methods. RESULTS: The mean age was 45.83 (SD = 13.5) years. The age group of 45-54 years represented the majority of the study population (29.3%). Over 69.5% of the women were housewives with a moderate economic status (56.9%). Less than 14% of the study population had a level of academic degree and 85.6% lived in cities. The breast cancer prevalence was 15.27%. The age-standardized incidence and death by world population (ASW) were 11.19/100,000 and 9.97/100,000 respectively. 50-54 years were most affected. Left breast cancer is mainly common and the time between first symptoms and consultation is more than 48 months. Most (69%) of the samples analysed were lumpectomy. The most common morphology of breast cancer was invasive ductal carcinoma (64.9%). Scarff Bloom Richardson III was the main grade in both common pathological types, but their proportion showed no significant increase along with time (χ2 = 7.06, p = 0.54). Invasion of regional lymph node differed significantly among the pathological type of breast cancer (χ2 = 24.6, p = 0.02). Surgery and chemotherapy were appropriate treatment yet 84.5% of the cases died. CONCLUSION: The findings of this study showed that breast cancer is common and mostly affected women. Epidemiological trends are more or less common to those of developing countries with a predominance of invasive ductal carcinoma. However, most of the women studied live in an urban area and developed the disease in advanced stage. The establishment of an appropriate framework will effectively contribute to promoting the early detection and reducing the incidence of this disease in the population.

Assessment of Breast Cancer Knowledge among Health Workers in Bangui, Central African Republic: a Cross-sectional Study.

BACKGROUND: Breast cancer is the leading cause of cancer deaths among women worldwide. High breast cancer mortality has been attributed to lack of public awareness of the disease. Little is known about the level of knowledge of breast cancer in Central African Republic. This study aimed to investigate the knowledge of health professionals on breast cancer. MATERIALS AND METHODS: This cross-sectional study was conducted among 158 health professionals (27 medical; 131 paramedical) in 17 hospitals in Bangui using a self-administered questionnaire. Descriptive statistical analysis, Person's χ 2 test and ANOVA were applied to examine associations between variables with <0.05 being considered significant. RESULTS: Data analyzed using SPSS version 20 indicates that average knowledge about breast cancer perception of the entire population was 47.6%, diagnosis method 45.5%, treatment 34.3% and risk factors 23.8%. Most respondents (65.8%) agreed that breast cancer is important in the Central African Republic and that family history is a risk factor (44.3%). Clinical assessments and mammography were considered most suitable diagnostic methods, and surgery as the best treatment. The knowledge level was significantly higher among medical than paramedical staff with regard to risk factors, diagnosis and treatment. However the trainee group had very high significant differences of knowledge compared with all other groups. CONCLUSIONS: There is a very urgent need to update the various training programs for these professionals, with recommendations of retraining. Health authorities must create suitable structures for the overall management of cancer observed as a serious public health problem.

[Epidermal Tuberculosis in an orphan living with HIV in the Pediatric Unit of Bangui (Central African Republic)]. / Tuberculose cutanee chez un orphelin vivant avec le VIH au complexe pediatrique de Bangui (Republique Centrafricaine).

We report the case of ulceration of the anterior chest region in a non BCG vaccinated adolescent. Tuberculosis confirmations has been made by the isolation of M. tuberculosis from the pus culture in Löwenstein-Jensen medium. Topography and chronology of the clinical manifestations argue in favour of scrofuloderma. For technical reasons, we were not able to distinguish scrofuloderma from the gum. The use of the single standard regime of tuberculosis treatment according to the immunological status has provided a healing of skin injury in children living with HIV. In addition, this observation emphasises the medical interest to implement systematic vaccination against tuberculosis and to ensure effective control of the disease, particularly in orphans.

Nous rapportons le cas d'une ulcération de la région antérieure du thorax chez un adolescent non vacciné par le BCG. L'étiologie tuberculeuse a été prouvée par l'isolement de M. tuberculosis à la culture du pus sur milieu de Löwenstein Jensen. La topographie et la chronologie des manifestations cliniques plaident en faveur d'un scrofuloderme. Cependant, les moyens d'investigation disponibles n'ont pu mettre en évidence de foyer infectieux contigu de sorte qu'il n'a pas été possible de discriminer le scrofuloderme du gomme. La mise en route du seul régime standard de traitement de la tuberculose, au regard du niveau d'immunocompétence, a permis d'obtenir une cicatrisation de la lésion cutanée chez cet adolescent atteint de VIH. En outre, cette observation souligne l'intérêt non seulement de vacciner contre la tuberculose mais d'en assurer le contrôle de l'efficacité par la suite; notamment chez les orphelins.

Strategies de reduction de la mortalite maternelle en Republique Centrafricaine

Mortalité maternelle est un grave problème de santé publique en RCA avec un taux de 1355 décès pour 100.000 naissances vivantes. Quatre principales difficultés sont à la base de ce problème: a) Difficultés liées à l´accès aux soins. b) Difficultés liées à l´insuffisance et à la répartition inégale du personnel de santé. c) Difficultés liées à la prise en charge des urgences obstétricales et au système de référence. d) Difficultés liées à l´utilisation des services de santé. La réduction de la mortalité maternelle peut utiliser un certain nombre de stratégies efficaces et réalisables en Centrafrique. Cependant, le manque d´un guide clair et explicite limite la mise en oeuvre et la coordination de ces stratégies. Trois options politiques complémentaires ont été définies dans l´objectif de réduire la mortalité maternelle en Centrafrique: 1- Renforcement des capacités nationales en matière de la santé de la reproduction. 2- Renforcement des capacités nationales en matière de la santé de la reproduction. 3- Mobilisation des différentes ressources en faveur de la lutte contre la mortalité maternelle.

Réduction de la mortalité infanto-juvénile par une meilleure prise en charge de la malnutrition et du VIH

En RCA, il est globalement ressorti des différents rapports de suivi des indicateurs des OMD que les progrès sont les plus lents en ce qui concerne l'OMD1 (Eradiquer l'extrême pauvreté et la faim), l´OMD 4 (Réduire la mortalité des enfants de moins de 5 ans), l'OMD 5 (Améliorer la santé maternelle) et l'OMD 6 (Combattre le VIH/Sida, le Paludisme et les autres maladies). A l'heure actuelle, dans la plupart des pays à ressources limitées, le cercle vicieux reliant la malnutrition au VIH/SIDA sous tendue par la pauvreté potentialise la mortalité infanto-juvénile. Mondialement, le taux de mortalité des enfants de moins de 5 ans a été réduit de 35 %, passant de 88‰ en 1990 à 57,2 ‰ en 2010 malgré l'accroissement de la population.

Stratégies de réduction de la mortalité maternelle en République Centrafricaine

L'organisation structurelle du système de santé est régie par les dispositions du Décret n° 02.109 du 23 mai 2002, portant organisation du Ministère de la Santé Publique et de la Population et fixant les attributions du Ministre. Calquée sur la résolution sur le scénario de développement sanitaire en trois phases en vue d'instaurer la santé pour tous les Africains, adoptée par le 35ème Comité Régional de l'OMS pour l'Afrique à LUSAKA en 1985, l'organisation du système de santé en République Centrafricaine est de type pyramidal à trois niveaux : central, intermédiaire et périphérique. Le niveau central est chargé de : concevoir, élaborer et appliquer la politique du Gouvernement dans le domaine de la santé publique et de la population. Le niveau intermédiaire comprend sept Régions Sanitaires (RS) correspondant aux régions administratives du pays. Chaque RS est composée de deux à trois préfectures sauf la RS n°7 (Bangui) qui compte huit arrondissements. Il est chargé d'appliquer les directives de l'action politique sanitaire reçue du niveau central. Le niveau périphérique est composé de 16 préfectures et de 8 circonscriptions sanitaires de Bangui qui correspondent au découpage administratif du pays. La préfecture sanitaire et les circonscriptions sanitaires de Bangui sont chargées d'appliquer les directives de la région.

[Lipomatous polyposis of the colon: a case report]. / Polypose lipomateuse colique.

Lipomatous polyposis of the colon is a rare affection, with about 10 published cases. This affection is characterized by a great number of polyps which can reach several hundreds, of diffuse location on the entire length of the colon, with a higher density on the left colon and the sigmoid. The size of polyps varies from 1 to 10 cm. When they are voluminous, they can be cause of obstruction, ulceration or bleeding. We report a case of colonic lipomatous polyposis, associated with an ileocolic lipomatous, an ileocolic diverticulosis and adenomatous polyps in a 70-year-old man.