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1.
Sci Total Environ ; 754: 142175, 2021 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-32920409

RESUMO

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.


Assuntos
Amaranthus , Hidrocarbonetos Clorados , Praguicidas , Bifenilos Policlorados , República Democrática do Congo , Monitoramento Ambiental , Éteres Difenil Halogenados/análise , Humanos , Hidrocarbonetos Clorados/análise , Praguicidas/análise , Bifenilos Policlorados/análise , Medição de Risco
2.
PLoS One ; 15(12): e0244272, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33338063

RESUMO

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.


Assuntos
/diagnóstico , /epidemiologia , Adulto , Idoso , Coagulação Sanguínea , Cloroquina/administração & dosagem , Cloroquina/análogos & derivados , Coinfecção , Comorbidade , Tosse , República Democrática do Congo/epidemiologia , Feminino , Febre , Hospitalização , Hospitais Públicos , Humanos , Hidroxicloroquina/administração & dosagem , Inflamação , Testes de Função Hepática , Malária/complicações , Masculino , Pessoa de Meia-Idade , Análise de Regressão , Estudos Retrospectivos , Fatores de Risco , Classe Social , Taquicardia/complicações
3.
BMC Ecol ; 20(1): 66, 2020 11 30.
Artigo em Inglês | MEDLINE | ID: mdl-33256678

RESUMO

BACKGROUND: The fall Armyworm (FAW) Spodoptera frugiperda (JE Smith), is currently a devastating pest throughout the world due to its dispersal capacity and voracious feeding behaviour on several crops. A MaxEnt species distributions model (SDM) was developed based on collected FAW occurrence and environmental data's. Bioclimatic zones were identified and the potential distribution of FAW in South Kivu, eastern DR Congo, was predicted. RESULTS: Mean annual temperature (bio1), annual rainfall (bio12), temperature seasonality (bio4) and longest dry season duration (llds) mainly affected the FAW potential distribution. The average area under the curve value of the model was 0.827 demonstrating the model efficient accuracy. According to Jackknife test of variable importance, the annual rainfall was found to correspond to the highest gain when used in isolation. FAWs' suitable areas where this pest is likely to be present in South Kivu province are divided into two corridors. The Eastern corridor covering the Eastern areas of Kalehe, Kabare, Walungu, Uvira and Fizi territories and the Western corridor covering the Western areas of Kalehe, Kabare, Walungu and Mwenga. CONCLUSIONS: This research provides important information on the distribution of FAW and bioclimatic zones in South Kivu. Given the rapid spread of the insect and the climatic variability observed in the region that favor its development and dispersal, it would be planned in the future to develop a monitoring system and effective management strategies to limit it spread and crop damage.


Assuntos
Produtos Agrícolas , Animais , República Democrática do Congo , Spodoptera
4.
Rev Esp Anestesiol Reanim ; 67(10): 556-558, 2020 12.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-33168180

RESUMO

Most of the international bibliography published on Covid-19 pandemics is focused in the Asian, European or American continents. It seems that incidence is lower in Africa. In this article we hypothetize on several of the possible causes sustaining these differences. Population pyramid, climate, african population own vulnerability/resistance or sociopolitical factors are underlined. In the case the pandemics will spread in Africa, the lack of basic healthcare resources will perhaps make the consequences disastrous and of a dantesque magnitude.


Assuntos
/epidemiologia , Pandemias , África/epidemiologia , Fatores Etários , /mortalidade , República Democrática do Congo/epidemiologia , Europa (Continente)/epidemiologia , Humanos , Incidência , Malária/imunologia , Política , Temperatura , Estados Unidos/epidemiologia
5.
PLoS One ; 15(11): e0238985, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33166279

RESUMO

Prenatal care (PNC) and counseling about delivery method is an important strategy to prevent delivery complications among women with multiple prior Cesarean sections (CS). In low income countries, an elective CS is recommended for this population. This cross-sectional study examined factors associated with counseling about delivery method and its influence on the likelihood of an elective CS delivery. A total of 422 women with ≥2 prior CS who delivered across five hospitals in Democratic Republic of Congo (DRC) were interviewed about PNC and counseling. Descriptive statistics and multivariate regression were completed to ascertain factors associated with counseling. Only 33.6% delivered via planned CS; 60.7% required an emergency CS. One-quarter completed four PNC visits; 64.5% received counseling. Number of PNC visits and number of prior CS were significant predictors of receipt of counseling. Women who received ≥2 PNC visits were 2.2 times more likely to have received counseling (p = 0.000). Among women who received counseling, 38.6% had a planned CS compared with 24.7% in the non-counseled group. Counseling was associated with mode of delivery; emergency CS and vaginal delivery were more frequent among women who did not receive counseling (p = 0.008). These findings highlight the importance of counseling during PNC visits. This study also highlights the poor coverage and quality of counseling in this high-risk population and the need for improvements in PNC. Less than 40% of counseled women followed provider recommendations for a planned delivery via CS. The majority labored at home and later delivered emergently. The significant number of women who trial labor without medical supervision despite their high-risk status sheds light on the influence of patient perceptions about CS and acceptance of medical intervention during birth.


Assuntos
Cesárea/estatística & dados numéricos , Aconselhamento/estatística & dados numéricos , Cuidado Pré-Natal/estatística & dados numéricos , Adulto , Estudos Transversais , Parto Obstétrico/estatística & dados numéricos , República Democrática do Congo , Feminino , Humanos , Gravidez , Fatores de Risco , Mulheres
6.
Pan Afr Med J ; 37: 79, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33244342

RESUMO

Introduction: the control of the mosquito malaria vectors by the National Malaria Control Programme of the Democratic Republic of Congo (DRC) relies mainly on the use of long-lasting insecticide-treated nets (LLINs). However, the widespread emergence of resistance to pyrethroids is jeopardizing this control strategy. The objective of this study is to determine the status and resistance mechanisms involved in Anopheles gambiae s.l. population of DRC. Methods: pre-imaginal stages of An. gambiae s.l. were collected and standard WHO bioassays were performed on adult An. gambiae s.l. reared in the laboratory from larvae collected from different sites in the study area. The bioassays with the synergist PBO were also performed to determine the likely implication of oxydases in the resistance. The alleles of knock down resistance (Kdr) gene and species of anopheles were determined by PCR-RLFP. Results: all Anopheles mosquitoes tested belonged to the Anopheles gambiae complex. An. Gambiae (69.6%) was predominant, followed by An. Coluzzii (25.6%) and (4.8%) hybrids (An. gambiae/ An. coluzzii). Bioassays showed phenotypic resistance to the main insecticides used in the region, notably pyrethroids (deltamethrin, permethrin) and organochlorine (DDT). Only bendiocarb caused 100% mortality. Metabolic resistance involving oxidase enzymes was also detected using the synergist PBO after exposure to deltamethrin. The L1014F allele frequency of Kdr gene was detected in samples collected from all sites at varying frequencies (0.61-1.0). Conclusion: this study brings additional information on malaria vectors resistance to insecticides. It has shown cross-resistance to DDT and pyrethroids as well as the presence of Kdr gene. PBO significantly improved the effectiveness of deltamethrin. The results of this study can be helpful to policy makers in decision making for vector control programmes in the region.


Assuntos
Anopheles/efeitos dos fármacos , Resistência a Inseticidas/genética , Inseticidas/farmacologia , Controle de Mosquitos/métodos , Alelos , Animais , Anopheles/genética , República Democrática do Congo , Frequência do Gene , Malária/prevenção & controle , Mosquitos Vetores/efeitos dos fármacos , Piretrinas/farmacologia
7.
BMC Infect Dis ; 20(1): 830, 2020 Nov 11.
Artigo em Inglês | MEDLINE | ID: mdl-33176700

RESUMO

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.


Assuntos
Soropositividade para HIV/diagnóstico , Soropositividade para HIV/epidemiologia , HIV/imunologia , Programas de Rastreamento/métodos , Testes Sorológicos/métodos , Adolescente , Adulto , República Democrática do Congo/epidemiologia , Estudos de Viabilidade , Feminino , Seguimentos , Soropositividade para HIV/virologia , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Adulto Jovem
8.
Lancet Child Adolesc Health ; 4(12): 884-888, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33217357

RESUMO

BACKGROUND: Few fetuses survive childbirth when the mother is positive for Ebola virus, with almost all being miscarried or stillborn, or dying shortly after birth. Before 2019, only two infants had been reported surviving past 28 days, of whom one tested positive for Ebola virus and subsequently received experimental therapies. Little is understood regarding the care of surviving neonates born to Ebola virus-positive mothers in the postnatal period and how novel anti-Ebola virus therapies might affect neonatal outcomes. METHODS: In this case series, we report on two neonates liveborn during the 2018-20 North Kivu Ebola epidemic in the Democratic Republic of the Congo who, along with their Ebola virus-positive mothers, received investigational monoclonal antibody treatment (mAB114 or REGN-EB3) as part of a randomised controlled trial (NCT03719586). FINDINGS: Both infants were born Ebola-negative and progressed well while in the Ebola Treatment Centre. Neither neonate developed evidence of Ebola virus disease during the course of the admission, and both were Ebola-negative at 21 days and remained healthy at discharge. INTERPRETATION: To our knowledge these neonates are the first documented as Ebola virus-negative at birth after being born to Ebola virus-positive mothers, and only the third and fourth neonates ever documented to have survived into infancy. Although no conclusions can be drawn from this small case series, and further research is required to investigate the neonatal effects of antibody therapies, these cases warrant review regarding whether post-delivery antibody therapy should be considered for all liveborn neonates of Ebola virus-positive mothers. In the context of a low resource setting, where survival of low-birthweight infants is poor, these cases also highlight the importance of adequate neonatal care. FUNDING: None.


Assuntos
Anticorpos Monoclonais/uso terapêutico , Doença pelo Vírus Ebola/tratamento farmacológico , Fatores Imunológicos/uso terapêutico , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Complicações Infecciosas na Gravidez/tratamento farmacológico , Adolescente , República Democrática do Congo , Ebolavirus/isolamento & purificação , Feminino , Doença pelo Vírus Ebola/sangue , Humanos , Lactente , Recém-Nascido , Nascimento Vivo , Morte Materna , Gravidez , Complicações Infecciosas na Gravidez/sangue , Ensaios Clínicos Controlados Aleatórios como Assunto , Adulto Jovem
9.
PLoS One ; 15(11): e0242713, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33227017

RESUMO

BACKGROUND: In efforts to control malaria infection, the Democratic Republic of Congo has implemented several strategies. Studies assessing their efficiency mainly involved at-risk groups, especially children under five years of age. This study aimed to determine the prevalence and identify the risk factors associated with Plasmodium spp. infection. METHODS: From October 2014 to March 2015, individuals aged at least 15 years were selected randomly and enrolled in a cross-sectional study conducted throughout the country. Microscopy and polymerase chain reaction (PCR) analysis were used for the detection of Plasmodium ssp. RESULTS: From 2286 individuals recruited, 1870 with valid laboratory results were included in the study for further analysis. The prevalence of Plasmodium spp. infection assessed by microscopy (355/ 1870 (19%) was lower than that estimated by PCR (580/1870 (31%). In addition, the difference between the two results was statistically significant (P < 0.0001). The most prevalent Plasmodium species was P. falciparum, either as mono-infection (96.3%; 95% C.I. 93.9-98.1) or combined with P. malariae (3.7%; 95% C.I. 2.8-5.9). The mean parasite density was 3272739 trophozoites/µL of blood. Women had higher risks of being infected than men (OR 2.03, 95% C.I.: 1.96. 2.62, P = 0.041)]. CONCLUSION: In this study, the molecular detection and species identification of Plasmodium spp. showed that, despite all efforts for malaria control, malaria remains a public health problem in the Democratic Republic of Congo. The high prevalence and parasite density of Plasmodium spp. in adults make this age group a potential parasitic infectious reservoir for the at-risk groups and supports the need to include this age group in further programs for malaria control.


Assuntos
Malária , Plasmodium , Reação em Cadeia da Polimerase , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , República Democrática do Congo/epidemiologia , Feminino , Humanos , Malária/sangue , Malária/epidemiologia , Malária/genética , Masculino , Pessoa de Meia-Idade , Plasmodium/classificação , Plasmodium/genética , Prevalência
10.
Afr Health Sci ; 20(2): 656-657, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33163027

RESUMO

Background: The objectives of the article are to assess the role of a strategic response in the prevention and control of the disease and the need for extending supports to the survivors of disease. Introduction: Since the start of the August last year, a new outbreak of Ebola virus disease has been reported in provinces of the Democratic Republic of the Congo. Methods: As of now, close to 1170 cases and 740 deaths have been attributed to the diseases due to the associated complications in the region.As of now, close to 1170 cases and 740 deaths have been attributed to the diseases due to the associated complications in the region. Result: In order to effectively respond to the outbreak, a wide range of strategies have been proposed. It is a fact that the survivors of the disease outbreak face multiple challenges, the task of organizing eye clinics to promote early detection of the problems among the survivors has been initiated. Conclusion: In conclusion, Ebola virus disease is a life threatening disease and is linked with a wide range of complications, including those involving eyes. Thus, the need of the hour is to formulate a strategic response comprising of different strategies which not only aim to reduce the incidence of the disease, but also to extend quality assured care to the survivors.


Assuntos
Surtos de Doenças/prevenção & controle , Oftalmopatias/etiologia , Doença pelo Vírus Ebola/complicações , Uveíte/virologia , Transtornos da Visão/virologia , República Democrática do Congo/epidemiologia , Programas de Triagem Diagnóstica , Serviços de Saúde , Doença pelo Vírus Ebola/epidemiologia , Humanos , Sobreviventes , Uveíte/diagnóstico , Transtornos da Visão/diagnóstico
12.
Pan Afr Med J ; 37: 30, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33062131

RESUMO

Premature birth remains a major concern for obstetric and pediatric teams. The objective of our work is to determine the causes and frequencies of premature childbirth in our environment, more particularly at the HGR Malemba. This is a descriptive cross-sectional study conducted in the obstetrics and gynecology department of the HGR Malemba. Who included 24 premature deliveries between 1st January and 31st December 2018. The hospital frequency of preterm birth was 4.6%, the average age of childbirth was 28 ± 6.7 years, married births were 75%, housewives were 45.8%, the women born were large multiparous in 41.7%, the pathologies occurring during pregnancy: urinary tract infections (75%); malaria (25%), maternal age <18 years or >35 years and urinary tract infections constitute important risk factors for preterm birth. The study we conducted shows that the rate of premature delivery remains high in the city of Malemba. The early identification of the cause allows their reduction through the improvement of the health care system in our environment.


Assuntos
Complicações na Gravidez/epidemiologia , Nascimento Prematuro/epidemiologia , Adolescente , Adulto , Estudos Transversais , República Democrática do Congo , Feminino , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Malária/complicações , Malária/epidemiologia , Idade Materna , Pessoa de Meia-Idade , Gravidez , Complicações na Gravidez/fisiopatologia , Fatores de Risco , Infecções Urinárias/complicações , Infecções Urinárias/epidemiologia , Adulto Jovem
13.
Am J Trop Med Hyg ; 103(6): 2419-2428, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33009770

RESUMO

Little is known about the clinical features and outcomes of SARS-CoV-2 infection in Africa. We conducted a retrospective cohort study of patients hospitalized for COVID-19 between March 10, 2020 and July 31, 2020 at seven hospitals in Kinshasa, Democratic Republic of the Congo (DRC). Outcomes included clinical improvement within 30 days (primary) and in-hospital mortality (secondary). Of 766 confirmed COVID-19 cases, 500 (65.6%) were male, with a median (interquartile range [IQR]) age of 46 (34-58) years. One hundred ninety-one (25%) patients had severe/critical disease requiring admission in the intensive care unit (ICU). Six hundred twenty patients (80.9%) improved and were discharged within 30 days of admission. Overall in-hospital mortality was 13.2% (95% CI: 10.9-15.8), and almost 50% among those in the ICU. Independent risk factors for death were age < 20 years (adjusted hazard ratio [aHR] = 6.62, 95% CI: 1.85-23.64), 40-59 years (aHR = 4.45, 95% CI: 1.83-10.79), and ≥ 60 years (aHR = 13.63, 95% CI: 5.70-32.60) compared with those aged 20-39 years, with obesity (aHR = 2.30, 95% CI: 1.24-4.27), and with chronic kidney disease (aHR = 5.33, 95% CI: 1.85-15.35). In marginal structural model analysis, there was no statistically significant difference in odds of clinical improvement (adjusted odds ratio [aOR] = 1.53, 95% CI: 0.88-2.67, P = 0.132) nor risk of death (aOR = 0.65, 95% CI: 0.35-1.20) when comparing the use of chloroquine/azithromycin versus other treatments. In this DRC study, the high mortality among patients aged < 20 years and with severe/critical disease is of great concern, and requires further research for confirmation and targeted interventions.


Assuntos
/epidemiologia , Mortalidade Hospitalar/tendências , Pandemias , /patogenicidade , Adolescente , Adulto , Doenças Assintomáticas , Azitromicina/uso terapêutico , /tratamento farmacológico , Cloroquina/uso terapêutico , República Democrática do Congo/epidemiologia , Combinação de Medicamentos , Enoxaparina/uso terapêutico , Feminino , Hospitalização/estatística & dados numéricos , Hospitais , Humanos , Unidades de Terapia Intensiva , Lopinavir/uso terapêutico , Masculino , Pessoa de Meia-Idade , Obesidade/diagnóstico , Obesidade/fisiopatologia , Obesidade/virologia , Alta do Paciente/estatística & dados numéricos , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/fisiopatologia , Insuficiência Renal Crônica/virologia , Estudos Retrospectivos , Fatores de Risco , Ritonavir/uso terapêutico , Índice de Gravidade de Doença , Resultado do Tratamento
14.
Pan Afr Med J ; 36: 280, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33088409

RESUMO

Introduction: female sex workers (FSWs) are considered a high-risk group for acquiring HIV infection due to their HIV prevalence estimated to be 10-20 times higher than in woman in the general population. This study aimed to determine the prevalence and risk factors of HIV among female sex workers (FSWs) in Lubumbashi. Methods: a cross-sectional study was conducted among FSWs presenting for the first time at the sexually transmitted infections (STIs) clinic of Katuba, Lubumbashi, between April 2016 and December 2017. Information on the participants´ socio-demographic characteristics, sexual behaviors, and HIV serology results were collated and analyzed using a multiple logistic regression to identify factors associated to HIV infection among FSWs. Results: information on 1555 sex workers was analysed in this study, the prevalence of HIV was 8.2%. The median age of the participants was 26 years (IQR: 21-34). Of the 127 HIV positive sex workers, 74% have been in the business for two years or less, 97% sell sex as their main income, 74% have more than 5 sexual intercourses per week, 95% reported using condom, 73% reported having history of STIs, 70% reported using alcohol before sex and 97% reported having three or more sexual partners per week. After adjusting for potentials cofounders, Age, Sex work as main income, years of selling sex, condom use, and alcohol use before sex were found to have a significant effect on HIV infection among sex workers. Conclusion: these findings highlight the vulnerability of FSWs to HIV infection and the necessity of immediate interventions to strengthen HIV prevention through behavioral change strategies and making available Pre-exposure Prophylaxis (PrEP) for FSWs in Lubumbashi.


Assuntos
Infecções por HIV/epidemiologia , Profissionais do Sexo/estatística & dados numéricos , Comportamento Sexual/estatística & dados numéricos , Doenças Sexualmente Transmissíveis/epidemiologia , Adulto , Estudos Transversais , República Democrática do Congo , Feminino , Humanos , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Parceiros Sexuais , Adulto Jovem
15.
PLoS One ; 15(10): e0239682, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33119587

RESUMO

Groundwater inflow to an underground mine will seriously affect its mining plan and engineering geology safety. Groundwater models are powerful tools commonly used in the mines to develop dewatering strategies. Many mines in the Kolwezi area have been present since the 1950s, and groundwater flow patterns have been significantly influenced by mining activities. A mining plan is developed for an underground mine with overturned syncline strata in Kolwezi, Congo. Previous groundwater models using layered homogeneous media lowered model accuracies. A new three-dimensional groundwater model using FEFLOW, consisting of a combined regionally and locally geology models integrating 16 hydrogeological cross-sections and borehole logging data, are formulated to predict the underground dewatering in the study area. A 31-days pumping tests with 3 pumping wells and 28 observation wells are carried out to estimate the hydrogeological properties. The simulated water level data match the observed data rather well. Under 8 scenarios of possible well designs, the model predicts a possible dewatering capacity greater 23,900 m3/d at the initial stage of mining. The concept of the model and its application can be a reference for other mines with complex geology for mining safety in the region of interest.


Assuntos
Monitoramento Ambiental/métodos , Previsões/métodos , Água Subterrânea/análise , Simulação por Computador , República Democrática do Congo , Análise de Elementos Finitos , Geologia/métodos , Mineração/métodos , Abastecimento de Água/métodos
16.
BMC Infect Dis ; 20(1): 741, 2020 Oct 09.
Artigo em Inglês | MEDLINE | ID: mdl-33036564

RESUMO

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 .


Assuntos
Cólera/epidemiologia , Criptosporidiose/epidemiologia , Cryptosporidium/genética , Diarreia/epidemiologia , Surtos de Doenças , Escherichia coli Enterotoxigênica/genética , Infecções por Escherichia coli/epidemiologia , Vibrio cholerae/genética , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Animais , Criança , Pré-Escolar , Cólera/microbiologia , Criptosporidiose/parasitologia , República Democrática do Congo/epidemiologia , Testes Diagnósticos de Rotina , Diarreia/microbiologia , Doenças Endêmicas , Infecções por Escherichia coli/microbiologia , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase Multiplex , Prevalência , Microbiologia da Água , Adulto Jovem
17.
BMC Infect Dis ; 20(1): 734, 2020 Oct 07.
Artigo em Inglês | MEDLINE | ID: mdl-33028245

RESUMO

BACKGROUND: HIV continues to be the main determinant morbidity with high mortality rates in Sub-Saharan Africa, with a high number of patients being late presenters with advanced HIV. Clinical management of advanced HIV patients is thus complex and requires strict adherence to updated, empirical and simplified guidelines. The current study investigated the impact of the implementation of a new clinical guideline on the management of advanced HIV in Kinshasa, Democratic Republic of Congo (DRC). METHODS: A retrospective analysis of routine clinical data of advanced HIV patients was conducted for the periods; February 2016 to March 2017, before implementation of new guidelines, and November 2017 to July 2018, after the implementation of new guidelines. Eligible patients were patients with CD4 < 200 cell/µl and presenting with at least 1 of 4 opportunistic infections. Patient files were reviewed by a medical doctor and a committee of 3 other doctors for congruence. Statistical significance was set at 0.05%. RESULTS: Two hundred four and Two hundred thirty-one patients were eligible for inclusion before and after the implementation of new guidelines respectively. Sex and age distributions were similar for both periods, and median CD4 were 36 & 52 cell/µl, before and after the new guidelines implementation, respectively. 40.7% of patients had at least 1 missed/incorrect diagnosis before the new guidelines compared to 30% after new guidelines, p < 0.05. Clinical diagnosis for TB and toxoplasmosis were also much improved after the implementation of new guidelines. In addition, only 63% of patients had CD4 count test results before the new guidelines compared to 99% of patients after new guidelines. Death odds after the implementation of new guidelines were significantly lower than before new guidelines in a multivariate regression model that included patients CD4 count and 10 other covariates, p < 0.05. CONCLUSIONS: Simplification and implementation of a new and improved HIV clinical guideline coupled with the installation of laboratory equipment and point of care tests potentially helped reduce incorrect diagnosis and improve clinical outcomes of patients with advanced HIV. Regulating authorities should consider developing simplified versions of guidelines followed by the provision of basic diagnostic equipment to health centers.


Assuntos
Antirretrovirais/uso terapêutico , Infecções por HIV/tratamento farmacológico , Adolescente , Adulto , Instituições de Assistência Ambulatorial , Contagem de Linfócito CD4 , República Democrática do Congo , Feminino , Guias como Assunto , Infecções por HIV/complicações , Infecções por HIV/mortalidade , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Toxoplasmose/complicações , Toxoplasmose/diagnóstico , Tuberculose/complicações , Tuberculose/diagnóstico , Adulto Jovem
18.
PLoS Negl Trop Dis ; 14(10): e0008634, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-33027266

RESUMO

INTRODUCTION: Bacterial meningitis still constitutes an important threat in Africa. In the meningitis belt, a clear seasonal pattern in the incidence of meningococcal disease during the dry season has been previously correlated with several environmental parameters like dust and sand particles as well as the Harmattan winds. In parallel, the evidence of seasonality in meningitis dynamics and its environmental variables remain poorly studied outside the meningitis belt. This study explores several environmental factors associated with meningitis cases in the Democratic Republic of Congo (DRC), central Africa, outside the meningitis belt area. METHODS: Non-parametric Kruskal-Wallis' tests were used to establish the difference between the different health zones, climate and vegetation types in relation to both the number of cases and attack rates for the period 2000-2018. The relationships between the number of meningitis cases for the different health zones and environmental and socio-economical parameters collected were modeled using different generalized linear (GLMs) and generalized linear mixed models (GLMMs), and different error structure in the different models, i.e., Poisson, binomial negative, zero-inflated binomial negative and more elaborated multi-hierarchical zero-inflated binomial negative models, with randomization of certain parameters or factors (health zones, vegetation and climate types). Comparing the different statistical models, the model with the smallest Akaike's information criterion (AIC) were selected as the best ones. 515 different health zones from 26 distinct provinces were considered for the construction of the different GLM and GLMM models. RESULTS: Non-parametric bivariate statistics showed that there were more meningitis cases in urban health zones than in rural conditions (χ2 = 6.910, p-value = 0.009), in areas dominated by savannah landscape than in areas with dense forest or forest in mountainous areas (χ2 = 15.185, p-value = 0.001), and with no significant difference between climate types (χ2 = 1.211, p-value = 0,449). Additionally, no significant difference was observed for attack rate between the two types of heath zones (χ2 = 0.982, p-value = 0.322). Conversely, strong differences in attack rate values were obtained for vegetation types (χ2 = 13.627, p-value = 0,001) and climate types (χ2 = 13.627, p-value = 0,001). This work demonstrates that, all other parameters kept constant, an urban health zone located at high latitude and longitude eastwards, located at low-altitude like in valley ecosystems predominantly covered by savannah biome, with a humid tropical climate are at higher risk for the development of meningitis. In addition, the regions with mean range temperature and a population with a low index of economic well-being (IEW) constitute the perfect conditions for the development of meningitis in DRC. CONCLUSION: In a context of global environmental change, particularly climate change, our findings tend to show that an interplay of different environmental and socio-economic drivers are important to consider in the epidemiology of bacterial meningitis epidemics in DRC. This information is important to help improving meningitis control strategies in a large country located outside of the so-called meningitis belt.


Assuntos
Clima , Ecossistema , Epidemias/estatística & dados numéricos , Meningites Bacterianas/epidemiologia , República Democrática do Congo/epidemiologia , Haemophilus influenzae/isolamento & purificação , Humanos , Modelos Estatísticos , Neisseria meningitidis/isolamento & purificação , Estações do Ano , Fatores Socioeconômicos , Streptococcus pneumoniae/isolamento & purificação
19.
PLoS One ; 15(10): e0239607, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33017442

RESUMO

BACKGROUND: HIV self-testing (HIVST) is an additional approach to increasing uptake of HIV testing services. The practicability and accuracy of and the preference for the capillary blood self-test (Exacto Test HIV) versus the oral fluid self-test (OraQuick HIV self-test) were compared among untrained individuals in the Democratic Republic of the Congo (DRC). METHODS: This multicenter cross-sectional study (2019) used face-to-face, tablet-based, structured questionnaires in a facility-based HIVST approach. Volunteers from the general public who were at high risk of HIV infection, who were between 18 and 49 years of age, and who had signed an informed consent form were eligible for the study. The successful performance and correct interpretation of the self-test results were the main outcomes of the practicability evaluation. The successful performance of the HIV self-test was conditioned by the presence of the control band. The sensitivity and specificity of the participant-interpreted results compared to the laboratory results were estimated for accuracy. Preference for either type of self-test was assessed. Logistic regression models were used to examine factors associated with participants' preference. RESULTS: A total of 528 participants were included in this survey. The rate of successful performance of the HIV self-tests was high, with the blood test (99.6%) and the oral-fluid test (99.4%) yielding an absolute difference of 0.2% (95% CI: -1.8 to 1.1; P = 0.568). The rate of correct interpretation of the HIV self-test results was 84.4% with the blood test versus 83.8% with the oral-fluid test (difference = 0.6; 95% CI: -0.2 to 1.7; P = 0.425). Misinterpretation (25.4% for the blood test and 25.6% for the oral-fluid test) and inability to interpret (20.4% for the blood test and 21.1% for the oral-fluid test) test results were significantly more prevalent with invalid tests. The Exacto Test HIV self-test and the OraQuick HIV self-test showed 100% and 99.2% sensitivity, and 98.9% and 98.1% specificity, respectively. Preference for oral-fluid-based HIVST was greater than that for blood-based HIVST (85.6% versus 78.6%; P = 0.008). Preference for the blood test was greater among participants with a university education (86.1%; aOR = 2.4 [95% CI: 1.1 to 4.9]; P = 0.016), a higher risk of HIV infection (88.1%; aOR = 2.3 [95% CI: 1.0 to 5.3]; P = 0.047), and knowledge about the existence of HIVST (89.3%; aOR = 2.2 [95% CI: 1.0 to 5.0]; P = 0.05). CONCLUSION: Our field observations demonstrate that blood-based and oral-fluid-based HIVST are both practicable approaches with a high and comparable rate of accuracy in the study setting. Although preference for the oral-fluid test was generally greater, preference for the blood test was greater among participants with a university education, a high risk of HIV infection, and knowledge about the existence of HIVST. Both approaches seem complementary in the sense that users can choose the type of self-test that best suits them for a similar result. Taken together, our observations support the use of the two HIV self-test kits in the DRC.


Assuntos
Sorodiagnóstico da AIDS/métodos , Infecções por HIV/diagnóstico , Sorodiagnóstico da AIDS/estatística & dados numéricos , Adolescente , Adulto , Líquidos Corporais/imunologia , Estudos Transversais , República Democrática do Congo , Feminino , Anticorpos Anti-HIV/análise , Anticorpos Anti-HIV/sangue , Infecções por HIV/sangue , Infecções por HIV/imunologia , Humanos , Masculino , Pessoa de Meia-Idade , Boca/imunologia , Participação do Paciente , Autocuidado , Inquéritos e Questionários , Adulto Jovem
20.
Artigo em Inglês | MEDLINE | ID: mdl-33066059

RESUMO

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.


Assuntos
Comércio , Infecções por Coronavirus/prevenção & controle , Conhecimentos, Atitudes e Prática em Saúde , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Infecções por Coronavirus/epidemiologia , Estudos Transversais , República Democrática do Congo/epidemiologia , Feminino , Humanos , Masculino , Pneumonia Viral/epidemiologia , Inquéritos e Questionários
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