Caesarean section rate reduced by a redesigned birthing room. Results of a quality improvement intervention at a hospital in Democratic Republic of Congo.

OBJECTIVE: To evaluate the influence of a new birthing room at a tertiary hospital in eastern Democratic Republic of Congo (DRC), on the caesarean section (CS) rate in women classified as Robson group 1, i.e., nulliparous women at term with spontaneous onset of labour of one foetus in cephalic presentation. METHOD: As part of quality improvement interventions, a new birthing room designed to promote person-centredness was constructed at the labour ward at Panzi General Referral Hospital in DRC. In a quasi-experimental study on women classified as Robson 1, a comparison was performed between the group being cared for in the new birthing room and the group being cared for in the general birthing room. The main outcome measure was CS rate. RESULTS: In the new person-centred birthing room, the CS rate was 17.1 % versus 28.4 % in women cared for in the general birthing room (p-value 0.001). There was also a higher presence of accompanying persons (p-value < 0.0001) and less use of synthetic oxytocin for the augmentation of labour (p-value 0.024). No difference in fear and childbirth experience was identified between women in the two rooms. CONCLUSION: The results demonstrate that it is possible, in a low-income country as the Democratic Republic of Congo, to reduce the CS rate in women classified as Robson 1 by adapting the birthing environment to be more person-centred, without compromising other obstetric and neonatal outcomes.

A comprehensive evaluation of the accuracy of cervical pre-cancer detection methods in a high-risk area in East Congo.

BACKGROUND: Given the high burden of cervical cancer in low-income settings, there is a need for a convenient and affordable method for detecting and treating pre-cancerous lesions. METHODS: Samples for comparing the accuracy of cytology, virology and histology were collected. Identification of HPV E6/E7 mRNA was performed using PreTect HPV-Proofer. HPV DNA detection was performed by GP5+/6+ PCR, followed by reverse line blot (RLB) for typing. RESULTS: A total of 343 women, aged 25-60 years, attending gynaecological polyclinics in DR Congo were included for sample enrolment. The test positivity rate was conventional and liquid-based cytology (LBC) at cutoff ASCUS+ of 6.9 and 6.6%, respectively; PreTect HPV-Proofer of 7.3%; and consensus DNA PCR for 14 HR types of 18.5%. Sixteen cases of CIN2+ lesions were identified. Of these, conventional cytology identified 66.7% with a specificity of 96.2%, LBC identified 73.3% with a specificity of 96.9%, all at cutoff ASCUS+. HR-HPV DNA detected all CIN2+ cases with a specificity of 85.9%, whereas PreTect HPV-Proofer gave a sensitivity of 81.3% and a specificity of 96.6%. CONCLUSION: Both HPV detection assays showed a higher sensitivity for CIN2+ than did cytological methods. Detecting E6/E7 mRNA from only a subset of HR HPVs, as is the case with PreTect HPV-Proofer, resulted in a similar specificity to cytology and a significantly higher specificity than consensus HR HPV DNA (P<0.0001).

Experiences of female survivors of sexual violence in eastern Democratic Republic of the Congo: a mixed-methods study.

BACKGROUND: The conflict in eastern Democratic Republic of the Congo (DRC) is the deadliest since World War II. Over a decade of fighting amongst an array of armed groups has resulted in extensive human rights abuses, particularly the widespread use of sexual violence against women. METHODS: Using a mixed-methods approach, we surveyed a non-random sample of 255 women attending a referral hospital and two local non-governmental organizations to characterize their experiences of sexual and gender-based violence (SGBV). We then conducted focus groups of 48 women survivors of SGBV to elaborate on survey findings. Quantitative and qualitative data underwent thematic and statistical analysis respectively. FINDINGS: Of the women surveyed, 193 (75.7%) experienced rape. Twenty-nine percent of raped women were rejected by their families and 6% by their communities. Thirteen percent of women had a child from rape. Widowhood, husband abandonment, gang rape, and having a child from rape were significant risk factors for social rejection. Mixed methods findings show rape survivors were seen as "contaminated" with HIV, contributing to their isolation and over 95% could not access prophylactic care in time. Receiving support from their husbands after rape was protective against survivors' feelings of shame and social isolation. INTERPRETATION: Rape results not only in physical and psychological trauma, but can destroy family and community structures. Women face significant obstacles in seeking services after rape. Interventions offering long-term solutions for hyper-vulnerable women are vital, but lacking; reintegration programs on SGBV for women, men, and communities are also needed.

Césarienne en urgence absolue: risque anesthésique et pronostic foeto-maternel

Introduction : Le pronostic maternel et foetal des cesariennes en urgence absolue est severe dans les pays en developpement comme le notre. Il existe peu d'etudes sur l'epidemiologie; l'influence respective des facteurs obstetricaux et anesthesiques. Patients et methodes : Nous avons etudie les deux facteurs anesthesiques et obstetricaux dans une etude retrospective de 51 parturientes d'age moyen de 27;1 ans cesarisees en urgence absolue sur une periode d'une annee a l'Hopital General de Reference de Panzi. Ces urgences absolues ont ete groupees en deux classes; I et II selon la classification de LUCAS. Les donnees ont ete enregistrees sur le logiciel Excel. L'interpretation des resultats a ete faite a l'aide du pourcentage et du test de Chi carre de Pearson. Resultats : La couverture de la consultation prenatale (CPN) etait faible avec 45;1 de parturientes n'ayant realise aucune CPN. Les indications de la cesarienne etaient dominees par la rupture uterine a 22;2 pour la classe I et la souffrance foetale aigue 41;7 pour la classe II. 86;2 de cesariennes de la classe I etaient sous anesthesie generale et seules 10 des patients ont ete intubees. Le choc hemorragique constituait la complication la plus frequente dans 25;9 des cas suivi du syndrome de Mendelson 7;4 des cesarisees pour la classe I. Le taux de mortalite etait de 2. 17;6 des nouveaux nes presentaient un tableau d'asphyxie neonatale avec un score d'Apgar entre 0 et 3. Conclusion : L'anesthesie pour cesarienne en urgence absolue reste un probleme majeur de sante publique dans nos milieux. Le pronostic maternel et fotal est severe. Une formation continue des anesthesistes et des obstetriciens est utile pour la prise en charge des grossesses a risque