Health-seeking behaviour in the city of Lubumbashi, Democratic Republic of the Congo: results from a cross-sectional household survey.

BACKGROUND: Concerns about the occurrence of disease among household members generally initiate treatment-seeking actions. This study aims to identify the various treatment-seeking options of patients in Lubumbashi, analyze their health-seeking behaviour, identify determinants for the use of formal care, and analyze direct health care expenditure. METHODS: A cross-sectional survey of households in Lubumbashi was conducted in July 2010. Information was collected from a randomly selected sample of 251 households with at least one member who had been ill in the 2 weeks preceding the survey. RESULTS: Frequently used initial treatment-seeking options consist of self-medication based on modern medicines (54.6%), the use of first-line health services (23.1%) and hospitals (11.9%), with a perceived effectiveness of 51%, 83% and 91% respectively. If people go for a second option, then formal health care services are most often preferred. The majority (60%) of patients' spontaneous itineraries reflect the expected functioning of a local health care system, with a patient flow characterised by the use of a first line health facility prior to the use of hospital-based services. Chronicity of the disease is the main determinant of seeking formal care. Analysis of care expenditure reveals that drugs are the only line of expenditure in the informal system and the main source of expenditure in the formal system; costs do not discriminate between first-line health services and hospitals, and the payment system is regressive since the poorest patients pay the same amounts as the richest. CONCLUSIONS: This study points to the importance of self-medication as the first therapeutic option for the majority of patients in Lubumbashi, whatever the nature of the health problem. There is a lot of room to rationalise this practice. Although formal care is not common initial therapeutic option, it is the source of care most patients turn to, especially when they believe having a chronic disease. Patients' itineraries in this urban environment are complex; health managers should try and deal with this reality. Finally, our study indicates that poor patients face the same level of out-of-pocket payments as the more wealthy ones, hence the need for more equitable health care financing arrangements.

Silicosis in underground miners in Lubumbashi, Democratic Republic of the Congo: 27 cases.

Silicosis is one of the most prevalent occupational lung diseases and a public health problem throughout the world. Underground miners of copper and cobalt are exposed to the dust of these minerals and thus to the risk of developing silicosis. The objective of this report was to describe a series of silicosis cases in miners exposed to mineral dusts at a mining company operating since the colonial era in Lubumbashi, Katanga province, in the Democratic Republic of the Congo (DRC). This descriptive retrospective study reviewed records at the occupational safety and health department of the mining company mentioned above and included 2500 underground miners who worked there between 1970 and 1995; it collected and analyzed their medical records. Chest radiographs of silicosis patients were classified according to the ILO International Classification of Radiographs of Pneumoconiosis. All miners were males (mean age: 48.5 ±12.5), had low literacy levels, and used no protective device (i.e., mask) against dust. Their mean number of working years in the underground mines was 25.07±7.39 years. Of the 2500 miners, 1.08 % (27/2,500) had developed silicosis. The most common clinical manifestations were dyspnea and cough, and the most prevalent radiologic features large opacities (92.59 %), small opacities (96.27 %), and pleural thickening (25.92 %). The fatality rate was 100 %. This study revealed the absence of safety measures among Congolese underground miners from Lubumbashi, which might have contributed to the development of silicosis in some of them. It is thus necessary to implement occupational safety measures to reduce their risk of silicosis.

Risk factors for low birth weight in Lubumbashi, Democratic Republic of the Congo.

The aim of this study was to identify the risk factors associated with low birth weight (LBW) in the city of Lubumbashi (DR Congo). This case-control study of singleton births took place from July to December 2014 in 3 referral maternity units in Lubumbashi. The mothers' social and demographic characteristics and medical and obstetric history, especially during this pregnancy, as well as the newborns' sex were compared between the case group (< 2500 g) and the control group. The usual statistics and logistic regression were used to analyze the results. The significance level was set at P < 0.05. We observed that a low educational level (OR adjusted = 2.5 [1.5-4.0]), employment (OR adjusted = 2.0 [1.3-3.1]), lack of prenatal care (OR adjusted = 2.5 [1.5-4.2]), maternal anemia (OR adjusted = 7.6 [2.3-24.8]), malaria during the pregnancy (OR adjusted = 1.5 [1.0-2.3]), urogenital infections during pregnancy (OR adjusted = 1.6 [1.1-2.5]), gestational hypertension (OR adjusted = 2.7 [1.5-4.9]), and maternal malnutrition (OR adjusted = 8.3 [2.4-28.5]) were all significantly associated with LBW. This study shows that some maternal demographic, medical, and obstetric factors influence the birth of LBW infants. Because some of these factors can be addressed and treated, the reduction of neonatal morbidity and mortality associated with LBW requires improving the health care system in our city, including its accessibility.