Dynamics in the Prevalence of Insulin Resistance between 2005 and 2023 in Type 2 Diabetics in South Kivu in the East of the Democratic Republic of Congo: Cross-Sectional Studies

Aim: Sub-Saharan Africa is undergoing an epidemiological transition responsible for a change in the metabolic profile in favour of insulin resistance. The aim of this study was to assess the dynamics of the prevalence of insulin resistance and associated risk factors in diabetic patients in the Democratic Republic of Congo between 2005 and 2023. Method: We measured fasting blood glucose and insulin levels and looked for metabolic syndrome parameters (2009 criteria) in type 2 diabetes patients in 2005-2008 (n = 176) and in 2018-2023 (n = 303). The HOMA model was used to measure insulin sensitivity and islet β-cell secretory function. Results: Between 2005 and 2013, the trend was towards an increase in the prevalence of insulin resistance (from 13.1% to 50.8%;p Conclusion: This present study shows an increase in insulin resistance in Congolese urban areas and a persistence of atypical diabetes mellitus in Congolese rural areas, confirming the particularity of the pathophysiology of the disease in African areas currently influenced by the epidemiological transition. Further studies using an appropriate methodology are required.

Vitamin D, Parathyroid Hormone, Insulin Sensitivity and Islet β-Cell Secretory Function in Diabetic Patients from South Kivu in the Democratic Republic of Congo: Cross-Sectional Study

Background: The role of vitamin D and parathyroid hormone in the metabolic profile of type 2 diabetes mellitus in sub-Saharan Africa has not been adequately assessed. The aim of this study was to determine the prevalence of low vitamin D level and secondary hyperparathyroidism and their association with insulin sensitivity and β-cell secretory function among Congolese type 2 diabetics. Methodology: Fasting glycaemia, fasting insulin, 25OH D3 and human parathyroid hormone (hPTH) were measured in one hundred and eighty-four type 2 diabetic patients followed as outpatients in South Kivu. Levels of 25OH D3 65 pg/ml defined low vitamin D and elevated parathyroid hormone levels, respectively. The HOMA model was used to measure insulin sensitivity and β-cell secretory function. Results: Medians (IQR) were 25.3 (20.4 - 32.4) ng/ml for 25OH D3 and 53.7 (38.4 - 115.7) pg/ml for hPTH. 58.7% of diabetics had insulin resistance, 126 (68.5%) had low vitamin D and 80 (43.5%) had hyperparathyroidism. In multivariate analysis, hPTH (partial r = −0.28;p = 0.0002) and 25OH D3 (partial r = 0.16;p = 0.03) showed an independent association with insulin sensitivity after adjustment for body mass index and waist circumference. Finally, hPTH (partial r = 0.27;p = 0.0002) was the sole determinant of β-cell secretory function. Conclusions: This study confirms the high prevalence of low vitamin D level and secondary hyperparathyroidism and their association with insulin resistance and impaired islet β-cell secretory function among Congolese with type 2 diabetes mellitus. Vitamin D and calcium supplementation should be envisaged for cases of deficiency in this region.

Epidemiological and Cytopathological Profile of Dysplastic Lesions of the Cervix in South-Kivu/Dr Congo

Background: Cervical cancer is one of the most common cancers in women in the world. The recrudescence of dysplastic lesions is increasing, especially in developing countries, because of the absence of screening. The objective of this work is to determine the prevalence of dysplastic lesions of the cervix in women who are sexually active in South Kivu province. Methods: It was a cross-sectional, descriptive and analytical study of 625 women who came for gynecological consultation, all of whom had cervical-uterine Pap smears, during the period from January 1st, 2017 to December 31st, 2018 at Panzi General Referral Hospital (South Kivu, DR Congo). Data analysis was done using Epi Info software version 7. Results: The median age of the respondents was 34 years, 47.0% of them were married, and 59.0% had a low socio-economic level. The majority had first sexual intercourse between the ages of 15 and 20 (67.5%), a number of former sexual partners estimated at 1 - 5 (87.8%), did not use tobacco (97.4%) and did not use contraception (78.1%). Pap smear was normal in 82.88% of cases, inflammatory in 2.4% of cases and with cytologic abnormalities in 14.72% of cases. Rates of dysplastic lesions were significantly higher among women aged ≥35 years (p = 0.0245), brides (p = 0.0183) and nulliparas (p = 0.0042). Multivariate analysis revealed the adjusted OR (95% CI) statistically insignificant (p < 0.05) for the age group, marital status and parity respondents. Conclusion: Cervical cancer remains a real scourge in the world, especially in sub-Saharan Africa, where the diagnosis is often made when the pathology is at its stage almost incurable. Early detection of dysplastic lesions by Pap smear is therefore imperative in the eradication of this pathology.

Multiple Cassava Viruses’ Co-Infections and Resurgence of Pests Are Leading to Severe Symptoms and Yield Losses on Cassava in the South-Kivu Region, Democratic Republic of Congo

A survey was completed during the last five years (2014-2018) to update and assess changes in the cassava pests and diseases occurrence as well as to understand how these changes occur regarding the recent new viruses spread under a climate change context in the South-Kivu region, Democratic Republic of Congo. The eight territories of South-Kivu were surveyed during the rainy seasons from 2015 until 2017 except for Uvira and Fizi where data were recorded in 2018 regarding the prevalence of unstable agro ecological factors which may influence pest and diseases dynamic in these two territories. During the data collection, pests and disease incidence and severity were recorded as well as the sampling of cassava leaves for molecular viruses’ detection. The recorded data showed that Cassava mosaic disease (CMD) remains the most encountered disease (75% - 80%) and its vector (the whitefly Bemisia tabaci) the most important pest (10 - 18 adult whiteflies per leaf). The major changes were recorded for Cassava brown streak disease, recently reported in the region, for which a significant increase was recorded, with not reports before 2012 to 70% - 80% incidence in 2018 in the Ruzizi plain area (Uvira and Fizi). Molecular detection revealed a coexistence of both two viruses, the cassava brown streak virus (CBSV) and Ugandan cassava brown streak virus (UCBSV) in single and mixed infections. Co-infections cassava mosaic and cassava brown streak diseases were frequently recorded resulting in severe expression leaves’ symptoms and tuber yields’ losses. Common pests and diseases considered as minor have drastically become serious threat to cassava production by increasing both their incidence and severity values. The cassava bacterial blight (20%), cassava green mite (20% - 70%), cassava mealy bugs and cassava grasshoppers were recorded as a great challenge in relation with an occurrence of long dry season resulting in four consecutive dry months without rain. The high occurrence of CBSD on new CMD-resistant varieties has enforced farmers to recover local CMD-susceptible varieties which revealed a relative CBSD-tolerance and moderate yield losses. This need for virus control is really challenging cassava crop in a region where the diseases pressure is high and people consume cassava and its products seven days a week. Research gaps identified in the study are the need for breeding new varieties with tolerance/resistance to both CMD and CBSD viruses as well as the extensive use of rapid multiplex diagnostic tools to ensure early diagnostic and availability of good quality planting material at farmers’ level.

The Place of Human Papillomavirus Test in the Screening of Intraepithelial Lesions of Cervix in South-Kivu Province, DR Congo

Introduction: Human papillomavirus (HPV) infection remains the most common cause of cervical intraepithelial neoplasia. The objective of this study is to evaluate the sensitivity and predictive value of the HPV test associated with the cervico-uterine smear in the screening of cervical intraepithelial neoplasia in our environment. Methodology: This is a descriptive cross-sectional study of 625 women who consulted in the department of gynecology for cervical cancer screening, of whom 300 received an HPV test;during the period from January the 1st to December 31st, 2018 at Panzi general reference hospital (South-Kivu, DRC). Data analysis was done using Epi Info version 7 software. Results: For all respondents (n = 625), the cervico-uterine smear was normal in 82.88%, inflammatory in 2.4% of cases and with cellular atypia in 14.72%. The HPV test was positive in 87 respondents against 213 negatives cases, i.e. a prevalence of HPV of 29% [95% CI: 23.9% - 34.5%]. Among women with precancerous lesions, 27.6% had HPV infection;among those with normal smears, 29.3% of them had HPV infection;however, this difference was not statistically significant. Patients with dysplastic lesions, 31.3% had genotypes with very high carcinogenic potential;and for those with a normal Pap smear, 45.1% had genotypes with very high carcinogenic potential;however, this difference was also not statistically significant. Conclusion: The human papillomavirus test remains a very important indication cation in the detection of cervical intraepithelial neoplasia, its sensitivity remaining clearly superior to that of cytology, especially for high grade lesions.

Decision-Making Information System for Academic Careers in Congolese Universities: From Analysis to Design of a Data Warehouse

Universities collect and generate a considerable amount of data on students throughout their academic career. Currently in South Kivu, most universities have an information system in the form of a database made up of several disparate files. This makes it difficult to use this data efficiently and profitably. The aim of this study is to develop this transactional database-based information system into a data warehouse-oriented system. This tool will be able to collect, organize and archive data on the student’s career path, year after year, and transform it for analysis purposes. In the age of Big Data, a number of artificial intelligence techniques have been developed, making it possible to extract useful information from large databases. This extracted information is of paramount importance in decision-making. By way of example, the information extracted by these techniques can be used to predict which stream a student should choose when applying to university. In order to develop our contribution, we analyzed the IT information systems used in the various universities and applied the bottom-up method to design our data warehouse model. We used the relational model to design the data warehouse.