[Iron status in 72 Congolese patients with sickle cell anemia]. / Le statut martial chez soixante-douze drépanocytaires homozygotes congolais.

Multiple blood transfusions, intestinal parasites, and high iron needs during the growth period are all factors that influence iron status in African children. To determine their iron status and its association with these factors, we studied 72 homozygous sickle-cell patients in a steady state in Kinshasa. Iron status was determined by a combination of several indicators: ferritin, transferrin, blood count, total iron binding capacity, transferrin saturation, and C-reactive protein. These results were compared with those from a matched control group without sickle-cell disease. Compared to the control group, 5 patients (11%) were iron-deficient, while 18 (35%) had an iron overload, probably due to multiple blood transfusions. This study shows the importance of periodic assessments of iron status in homozygous sickle cell patients to prevent and manage any iron imbalance.

Gallbladder disease in young Congolese with sickle cell anemia: an ultrasound survey.

Patients with sickle cell anemia have been shown to present with a high prevalence of gallbladder disease. Relatively few data exist on the prevalence of gallbladder disease in Africans with autosomal recessive gene for sickle hemoglobin. To establish this relationship, we examined the 1-year incidence of gallbladder disease among 190 consecutive children and young adults with sickle cell anemia aged 3-24 years using ultrasound. There were 130 males (68.4 per cent) and 60 females (31.6 per cent). Incidence of cholelithiasis, cholecystitis, hydrops of gallbladder, and biliary sludge were 58.4, 25.3, 18.4, and 2.1 per cent, respectively. Of the 190 patients, 61 (37.3 per cent) presented hepatobiliary symptoms. The incidence of cholelithiasis depended on age. The age group 10-14 years and leucocytes > 10000/mm3 were considered as risk factors of the cholelithias onset, while female gender was isolated as a risk factor for the hydrops of the gallbladder outcome. In conclusion, the ultrasonographic examination is recommended for patients with hepatobiliary symptoms with respect to the high prevalence of the autosomal recessive gene for sickle hemoglobin in Congo, Central Africa.

Low birth weight and risk of hypertension in African school children.

BACKGROUND: In accordance with Baker's programming hypothesis, many studies have demonstrated a relationship between low birth weight (LBW) and high risk of hypertension in adulthood. The present study examines a possible association between LBW and the risk of a child having hypertension later in life. METHODS: The study was a cross-sectional, semi-urban survey. Information on the perinatal characteristics of 2648 randomly sampled school children was collected retrospectively in Kinshasa town, Democratic Republic of Congo. RESULTS: High risk of hypertension in these African school children was related to LBW (<2.500 g); the odds ratio was 2 (95% confidence interval 0.9-8.2, P<0.01) and 2.3 (95% confidence interval 0.6-11.5, P<0.01) for systolic and diastolic hypertension respectively. Birth weight was inversely related with both blood pressure and heart rate; the strongest association was shown in females and adolescents. CONCLUSIONS: Antenatal stress leading to LBW may be associated with programming induced by foetal undernutrition, which in turn leads to the emergence of cardiovascular disease and increased risk of hypertension.

Survey of rheumatic heart disease in school children of Kinshasa town.

STUDY OBJECTIVE: To determine the prevalence of rheumatic heart disease and study the association of this disease to factor such as personal host and environment. DESIGN: A cross sectional survey was carried out by a specially trained medical team. SETTING: The study involved high risk school children aged 5-16 years from Binza-Kinshasa urban area and adjoining slums in semi-urban area of Kinshasa town. METHODS: A total of 4848 children randomly selected on the list of semi-urban and urban schools and representing 10% of the schools population were included in the survey with clinical echocardiographic examinations. RESULTS: Of the 4848 children screened, prevalence of rheumatic heart disease was 14.03/1000. The prevalence was significantly greater in slums schools (22.2/1000) than in urban school (4/1000). In slums area, the mitral valve was the valve most commonly affected by rheumatic heart disease. Risk factors such as birth in rainy season (RR=2.2), low birth weight (RR=1.81), low socioeconomic status (RR=2.68), malnutrition8 persons/household (RR=4.10) and migrant status (RR=4.79) predicted significantly rheumatic heart disease occurrence in children living in the semi-urban area (slums). Only birth in rainy season (RR=3.24) predicted significantly rheumatic heart disease onset in children having residence in the urban area. CONCLUSIONS: Rheumatic heart disease runs a more severe course in Kinshasa, because appropriate medical care, sanitary conditions, primary and secondary prophylaxis are not available. Echocardiograpy is necessary to identify cases of rheumatic heart disease.