Proportion of thyroid cancer and other cancers in the democratic republic of Congo

BACKGROUND Cancer diagnosis is increasing around the world and in the Democratic Republic of the Congo(DRC).The proportion of thyroid cancer has increased over the past three decades.There are very few studies on cancer epidemiology,and in particular on thyroid cancer in the DRC.AIM To establish the most recent proportion of thyroid cancer in the DRC compared to other cancers.METHODS This is a retrospective and descriptive study of 6106 consecutive cancer cases listed in the pathological registers of 4 Laboratories in the city of Kinshasa.This study included all cancer cases recorded in the registers between 2005 and 2019.RESULTS From a sample of 6106 patients,including all cancer types,68.3%cases were female and 31.7%were male.Breast and cervical cancer were the most common types of cancer in women and,prostate and skin cancer were the most common types in men.Thyroid cancer was sixth in proportion in women and eleventh in men compared to all cancers.Papillary carcinoma was the most common of thyroid cancers.Rare cancers such as anaplastic and medullary thyroid carcinomas had a proportion of 7%and 2%,respectively.CONCLUSION Newer diagnostic tools led to a surge in cancer diagnoses in the DRC.Thyroid cancer has more than doubled its proportion over the last several decades in the country.

Contributions of the Measles Follow-Up Vaccination Campaign to Improving the Vaccination Coverage of Children Aged 6 - 59 Months in the Democratic Republic of the Congo in 2019

Background: In accordance with its measles elimination strategic plan 2012-2020, the Democratic Republic of the Congo (DRC) organized a follow-up vaccination campaign against measles from October to December 2019 in 26 provinces. This study aims to establish the contribution of this supplementary vaccination campaign to protecting children against measles. Methods: The survey was carried out in November 2020 among households of the DRC, according to the 2018 revised version of the World Health Organization’s stratified cluster sampling method, using multiple stage sampling. It targeted 280 children aged 6 - 59 months per stratum or province, with 10 children in each of the 28 selected clusters. Data collection using tablets with centralized and real-time data processing was preceded by enumeration to refine the household sampling frame. Clusters and households were selected by random draw. Data collected with CS Pro 7 software were analyzed with SPSS, Epi info 7 and Excel software to determine indicators and make before-after comparisons using the McNemar test, at a precision threshold of 5%. Results: Of the 8535 surveyed children, 89.5% were vaccinatedduring the follow-up campaign and 81.6% were vaccinated before. Only 3.7% had correctly completed campaign vaccination cards. Estimated vaccination coverage increased from 80.8% before the campaign to 92.6% after the campaign (p 0.001). Vaccination coverage after campaign against measles improved in all provinces (p < 0.001) except Bas-Uele and Maniema. Thirteen provinces reached the national coverage target of 95%, compared to five before the campaign. The proportion of zero-dose children dropped significantly after this campaign from 19.2% to 7.4% (p 0.001), and even fell below 1% in six provinces. Conclusion: This measles vaccination campaign improved overall vaccination coverage by 10% and reached more unvaccinated children. Efforts must continue to improve the retention of vaccination card, the adherence of unvaccinated children and the effectiveness of routine vaccination.

A Pilot Study about the First Cases of Coronary Angioplasty in Democratic Republic of Congo/Kinshasa: Patient Profile

Background: The objective of this pilot study was to describe clinical profile, electric, echocardiographic and angiographic caracteristics with procedural outcome of congolease patients undergoing coronarography in the first and only one cardiac catheterization center opened in Kinshasa. Methods: An analytical cross-sectional study was carried out over a period from October 2019 (date of establishment of the first coronary angiography unit in DR Congo) to March 2021. We proceeded to a serial sampling of the consecutive cases of all the patients who have an angiographic exploration of coronary arteries. Clinical, ECG and cardiac ultrasound data were collected in all patients. The indications for the coronary angiography examination were set by differents cardiologists on the basis of repolarization troubles in the electrocardiogram, cinetic troubles in echocardiography, positive stress test and chest pain in patients with cardiovascular risq factors. Results: The serie (47 patients) was predominantly male with a sex ratio M/W of 2.6. The average age was 59.8 ± 10.5 years. Arterial hypertension (HBP) was the main risk factor (89.4%);followed by diabetes mellitus (14.9%). Chest pain was the main functional sign with an atypical character in 44.7%. The ECG showed ST segment depression (17%) and T wave inversion (17%), the anterior region being the most affected. Hypokinesia was the most common echocardiographic abnormality (34%), followed by akinesia (10.6%). The anteroseptal and apical territories were affected in 12.8%. Dilated myocardiopathy (DMC) was significantly predominant in the male sex (29.4% vs 7.7%;p = 0.011). With radial puncture as the main approach, coronary angiography was pathological in 44% revealing mono-truncal lesions. The left coronary network was the most affected: the middle inter ventricular artery (12.8%), the proximal interventricular artery (10.6%) and the proximal circonflex artery (10.6%). In multivariate logistic regression analysis, age (for age > 50 years for men and >60 years for women), arterial hypertension and dilated cardiomyopathy emerged as independent determinants of pathological coronary angiography. Transluminal angioplasty was performed in 27.7% of patients. The bypass indication was retained in 4.3% of cases and medical treatment in 68%. Conclusion: Coronary angiography was used to diagnose lesions responsible for ischemic heart disease and to treat 27.7% of patients locally. The young age of patients and limited financial resources encourage the strengthening of preventive measures against cardio vascular risq factors.

Blood Safety in the Democratic Republic of the Congo: Literature Review

Background: The Democratic Republic of the Congo (DRC) faces severe malaria, postpartum haemorrhage, malnutrition and sickle cell disease that require transfusion. The latter poses immunological, infectious, metabolic and hemodynamic risks to recipients. Objective: To present transfusion safety in the DRC through data from the literature. Methods: This review consists of listing the various articles and abstracts published online and presented in scientific conferences having as a subject of interest transfusion safety in the DRC. Results: The review is dominated by articles from eastern DRC and blood mobilization is around 0.5% of the general population. All screening tests are serological with a proven residual risk. The prevalence of HIV, HBV, HCV and syphilis infections is documented at more than 80% and represents respectively 1.9%, 2.96%, 1.89% and 1.21%. The prevalence of other pathogens, the immunological and haemodynamic risk are very poorly documented (12.5% to 25%). The prevalence of Parvovirus B19 infection is 5.3% and that of bacterial contamination at 1.4%, that of malaria infestations between 0.3% and 28.3%, that of trypanosomiasis at 1.3%, that of babebiosis at 0.17% in blood donors. Allo-immunization represents 47.8%, adverse reactions 3.4%, iron deficiency 63.2, iron deficiency anemia 25.9% and anemia 36.5%. Pediatrics is the biggest user of this blood. Conclusion: The prevalence of HIV, HBV, HCV and Syphilis infections is within the range of sub-Saharan African countries. The serological test is systematic and involves the residual risk, it is necessary to introduce the molecular tests. The prevalence of other pathogens (emerging viruses, bacteria and hemoparasites), the immunological and metabolic risk is poorly documented. The search for these pathogens, irregular antibodies and the determination of ferritin in blood donations is not systematic.

Profile of retinal diseases in adult patients attending two major eye clinics in Kinshasa,the Democratic Republic of Congo

AIM:To determine the frequency and types of retinal diseases and the extend of the related visual loss in adult patients attending two public eye clinics of Kinshasa,Democratic Republic of Congo.METHODS:Review of medical records of patients with retinal diseases seen in the major eye clinics in Kinshasa,the University Hospital of Kinshasa(UHK)and Saint Joseph Hospital(SJH),from January 2012 to December 2014.Demographics and diagnoses were retrieved and analyzed.Outcome measures were frequency and prevalence of retinal diseases,blindness and low vision.RESULTS:A total of 40965 patients aged 40 y or older were examined during this period in both clinics.Of these,1208 had retinal disease,giving a 3-year and an annual prevalence of 3%and 1%,respectively.Mean age was 61.7±10.7 y,and 55.8%of the patients were males.Arterial hypertension(68.1%)and diabetes(43.3%)were the most common systemic comorbidities.Hypertensive retinopathy(41.8%),diabetic retinopathy(37.9%),age-related macular degeneration(AMD;14.6%),and chorioretinitis and retinal vein occlusion(7.3%each)were the most common retinal diseases,with 3-year prevalence rates of 1.3%,1.0%,0.43%,and 0.21%respectively.Bilateral low vision and blindness were present in 26.8%and 8.4%of the patients at presentation.Major causes of low vision and blindness were diabetic retinopathy(14.8%),AMD(4.9%),retinal detachment(2.8%),and retinal vein occlusion(2.5%).The prevalence was significantly higher among males than females,and at the UHK than SJH.CONCLUSION:Retinal diseases are common among Congolese adult patients attending eye clinics in Kinshasa.They cause a significant proportion of low vision and blindness.

Evaluation of Clinical Laboratory Tests’ Turnaround Time in a Tertiary Hospital in Democratic Republic of the Congo

The delay in the delivery of laboratory results can be fatal and can even lead to the death of patients. This study was conducted at the clinical laboratory of the University Hospital of Kinshasa (UHK) from October 2020 to April 2021, aimed to evaluate the laboratory tests’ turnaround time (TAT) and to identify reasons for delay. TAT was quantified using a time and motion analysis approach. The evaluation of TAT consisted of comparing the overall intra-lab TAT with the suggested TAT using student t-test at 95% confidence intervals. Brainstorming was the root cause analysis tool used for identifying reasons for delay. In this study, the laboratory tests’ TATs were significantly higher (p < 0.001) comparing to international guidelines (60 minutes) and customers’ suggested TAT (120 minutes). Only 0.98% of the samples were reported within 60 minutes of patient reception and 1.47% within 120 minutes, i.e. an outlier rate of 98.5%. Root causes of delay related to Machinery, Management, Manpower, Materials, Method and Milieu. Because of many reasons, the laboratory is not meeting the established TAT. Preventive and curative measures must be undertaken to reduce the delay and improve the TAT.

A Case-Control Study of Obstetric Fistula Risk Factors in the Democratic Republic of the Congo

Background: Pregnant women in the Democratic Republic of Congo (DRC) are at increased risk for developing obstetric fistulas (OFs) as a result of obstructed labor, in conditions similar to many other African countries. No case-control study of biological and social risk factors for OF has been reported from the DRC. This study aimed to identify factors that would aid in prevention and early identification of women who are at risk of developing OF. Methods: Participants were enrolled in a case-control study at four obstetric clinics in the central DRC. Cases of OF were evaluated as they presented, then a control participant was enrolled among women presenting subsequently to the same clinic, seeking to match parity at the time of the fistula and tribe of the case. A questionnaire was administered to elicit physical, obstetric, demographic, socioeconomic, religion, geographic, and delivery attributes of the participants. Case-control comparisons sought to identify independent risk factors for OF in the total case-control pairs and in subgroups of the participants. Logistic regression was utilized to identify independent risk factors for OF in the total case-control study group and in selected subgroups of the participants, and linear regression was utilized to estimate the variation explained between case and control outcomes from the variables independently significant in the logistic regression models. Results: A total of 177 case-control pairs were enrolled. Among all pairs, shorter height of the case (odds ratio = 1.06, 95% Confidence Limits 1.02 - 1.12);more kilometers travelled to the delivery site (1.02, 1.01 - 1.02);her village, not town, residence (OR = 5.52, 2.72 - 11.2), and her lower professional status (2.95, 1.53 - 5.72) were statistically independent factors associated with OF development. When applied in linear regression comparison of the pairs, these variables yielded an r2 = 0.48, imputing 48% of the difference in delivery outcome between the pairs was explained by these variables. Among the 38 pairs who were primigravida, the independent variables were more kilometers travelled to the delivery site (1.02, 1.00 - 1.05), village, not town, residence (50.0, 10.2 - 248.7), and facility intended for lower patient acuity (3.7 s, 1.01 - 13.6, r2 = 0.66) patients who were matched on parity and tribe, the significant risk factors were professional status (OR = 0.29), greater distance travelled to the clinic (OR = 1.02, 1.01 - 1.02), village, not town, residence (5.52, 2.72 - 11.2), and mother’s lower professional status (2.95, 1.53 - 5.72) when the OF occurred. Conclusions: Our study showed biological and social factors associated with the development of OF. Shorter height was the only biological risk factor found to be statistically significant in the study population. Other factors were related to limited resources and limited access to medical care.

The road towards sustainable control of schistosomiasis in the Democratic Republic of Congo:Pre-assessment of staff performance and material resources in endemic regions

Objective: To improve knowledge and practice of health staff as well as the availability of material resources for diagnosis and management of schistosomiasis in two endemic provinces of DRC(Kinshasa and Bas-Congo).Methods: Structured interviews were performed using questionnaires with staff from 35 healthcare facilities in 9 health zones(HZ) of Kinshasa and 2 HZ in Bas-Congo.Results: Schistosomiasis was reported to be present in all the included HZ.Health staff knew the most important symptoms of schistosomiasis, but advanced symptoms were more accurately reported in Bas-Congo.Knowledge of symptoms related to schistosomiasis such as anemia(P = 0.0 115) and pollakiuria(P = 0.0 260) was statistically different in both two provinces.Kato-Katz technique and urine filtration were unavailable in both provinces.Parasitological diagnosis was mostly performed using the direct smear method.PZQ was available in 70% of the health facilities, all situated in Bas-Congo.Diagnosis and treatment mostly relied on symptoms and cost more in urban area than in rural.Conclusions: Though knowledge on schistosomiasis among health staff appears sufficient, substantial efforts still must be made to improve the availability of diagnostic tools and treatment in the health facilities in DRC.

Improving Clinical Laboratory Quality through Reduction of Tests’ Turnaround Time in Democratic Republic of the Congo: Key Strategies

In Democratic Republic of the Congo (DRC), the laboratory TAT is significantly very long and do not comply with either international standards or the suggestions of customers. However, there is neither a national nor a local strategy to improve the laboratory TAT. The aim of the present study is to develop practical management strategies to shorten clinical laboratory tests’ TAT. This was a qualitative study conducted in Kinshasa. Focus groups and Lean tools were used respectively to generate a wide range of views from a variety of laboratory staff and to eliminate several form of waste in the laboratory flow process. Based on the identified root causes of delay, focus groups participants reported that there is a lot of scope for the improvement of TAT in DRC. Consistent attendance and punctuality are essential. The hospital management should implement the Laboratory Information Systems (LIS) and install Middleware. Total laboratory automation, inventory system for all reagents and supplies used in the laboratory, expansion of the sampling area, sufficient number of high-power machine and a clear job description are indispensable. LIS, 3.5 mL BD vacutainer BarricorTM tube and point-of-care testing (POCT) are necessary for workflow improvement. A reduction of 312 minutes was achieved by eliminating or decreasing non-value-added activities. Applying the suggested key strategies, and particularly the new workflow process, is a basis for improving the laboratory tests’ TAT. The algorithm presented can be easily implemented in other laboratories that face this type of problem.

Mass Distribution Campaign of Long-Lasting Insecticidal Nets in the Democratic Republic of Congo from 2018 to 2021 in the Context of the Emergence of COVID-19: Results and Lessons Learned

Introduction: The DRC had planned 23 mass distribution campaigns distribution of long-lasting insecticidal nets (LLIN) for the years 2018-2020, the implementation of which spanned from 2018 to July 2021. This article reviews the campaign’s planning process, the results, challenges, and lessons learned. Methods: A descriptive method was used to postpone the planning and implementation process according to the National Malaria Control Program (NMCP) standards adapted to the COVID-19 context. The changes and adaptations implemented as well as the challenges encountered are described. Results: Between January 2018 to June 2021, 23 LLIN mass distribution campaigns were organized in the DRC with the financial support of The Global Fund to Fight against Tuberculosis, AIDS and Malaria (GFTAM) and Against Malaria Foundation (AMF) allowing the distribution of 55,273,473 LLINs to 19,048,372 households at risk of malaria transmission with an average of 2.9 LLINs per household. The enumerated population (111,081,191) exceeded 7% of the micro plans projected population (102,790,391) while the number of households enumerated (19,311,629) was 3% lower compared to the micro planning projection households (19,862,417). Compared to a reported household coverage of 96% of households achieved over the expected households, the independent monitoring carried out revealed 91% of households served in the intervention areas. The main reasons for not reaching households mentioned by the respondents were absence at the time of distribution (26%) followed by the loss of vouchers (16%). Several communication channels were used among which, community workers were the most frequently mentioned (63.1%), followed by radios (18.5%) and churches (12.4%). Conclusion: Good planning, effective coordination of stakeholders, and revision of the implementing campaigns methods following the COVID-19 were factors in the success of this campaign. An effort to respect the schedules for renewing LLINs in households, coupled with good continuous distribution, is necessary to maintain the gains and hope for an impact in terms of morbidity and mortality reduction of malaria.

Epidemiology of Cancer in Rural Congo: Case of IME Kimpese Hospital, Democratic Republic of Congo

Background and Aim: Cancer is a public health problem in developing countries. It is aggravated by diagnostic confirmation difficulties. The aim of this study was to determine the epidemiological profile of cancers in Congolese rural areas. Methods: A historical cohort study was conducted with 914 histopathological protocols at the IME/Kimpese hospital from January 2008 to December 2013. Results: The mean age of patients was 55.2 ± 14.5 years, and 61.9% were women with a sex ratio of 2W/M. Ductal carcinoma (23.6%), squamous cell carcinoma (23.5%) and adenocarcinoma (23.1%) were the most common cancers. The most affected organs were breast (26.3%) and prostate (14.3%). 41.5% of cancers had an undifferentiated character and more than half (51.1%) a differentiated character. The majority of this cancer infiltrated other organs (57.9%). Among cancers where grade was found, 16% and 10.8% were respectively grades 1 and 4, and the presence of metastases was observed in 10.9% of cancers. Conclusion: Cancer is more frequent in elderly women with a predominance of squamous and ductal carcinoma. The presence of a national cancer registry is necessary in the country for a good follow-up of cancer cases.

Study of Biofilm Formation and Antibiotic Resistance Pattern of Bacteria Isolated from Diabetic Foot Ulcers in Hôpital de Référence Saint Joseph, Kinshasa, Democratic Republic of Congo

Foot infections resulting from biofilm producers and multi-drug resistant organisms is one of the most important complications of diabetes mellitus, as it can impede the wound healing process. This study was carried out in order to determine the antibiotic resistance pattern and the biofilm production in diabetic foot ulcers isolates. Clinical samples were collected from patients suffering from diabetic foot ulcers by using sterile swabs. Antibiotic susceptibility test was done using disk diffusion method on Mueller Hinton Agar. Biofilm formation was assessed by Crystal Violet Staining Method. Staphylococcus aureus isolates were resistant to ofloxacin (83.3%), ciprofloxacin (75.0%), trimethoprim-sulphamethoxazole (75.0%), and gentamicin (58.8%) but very sensitive to oxacillin (100.0%) and vancomycin (91.7%). Pseudomonas aeruginosa isolates showed resistance to the commonly used antibiotics such as ofloxacin, cefotaxime, ampicillin (81.8%), ceftazidime and imipenem (72.7%). The majority of bacteria studied were biofilm producers. This study showed that bacteria isolated from diabetic foot ulcers were biofilm producers and presented resistance to commonly used antibiotics. Knowledge on antibiotic sensitivity pattern and biofilm phenotype of the isolates will be helpful in determining the drugs for the treatment of diabetic ulcers.

Improving Demand for Health Services with the Involvement of Community Health Workers: A Case Study of Community Dynamics at Mosango Rural Health Zone in the Democratic Republic of Congo

Introduction: DRC is one of Sub-Saharan Africa country with high infant and maternal mortality. The major problem is the underuse of health services because of inaccessibility on all fronts and also the population under-information to the health and development problems. Community participation is one of the basic requirements and basic principles of the Primary Health Care to solve this problem. That is why we choose Mosango RHZ to assess the improvement of demand for health services with the involvement of community health workers. Methods: We conduct a cross-sectional study carried out in Mosango RHZ in 2019. The study combined a mixed method (quantitative and qualitative) based on the realist evaluation approach which takes into account the Context-Mechanisms-Effects explained in the conceptual framework model. Results: Four predictive factors determine the improvement of health indicators with the involvement of CHWS in activities of the Mosango RHZ: Having attended school (p = 0.000;OR = 0.150);Having sufficient theoretical knowledge on malaria, diarrhoea, pneumonia, malnutrition, availability of inputs to treat these diseases (p = 0.004;OR = 0.192);Having taken the training as CHWS and Having undergone more than one training as CHW (p = 0.013;OR = 0.074). This result corroborated with other studies carried in low- and middle-income countries like DRC. Conclusion: The involvement of CHWs on improving demand for health services is effective in Mosango RHZ. The improvement of health service indicators and the effectiveness of this community intervention were conditioned by capacity building of the CHWs, the availability of inputs and the involvement of the community in the activities of the health zone through the Community Action Cells.

Vitamin D Status and the Determinants of Preeclampsia in Pregnant Women in Goma (Democratic Republic of the Congo)

Background: Preeclampsia (PE) is a common condition, causing maternal and perinatal morbidity and mortality worldwide. In the absence of fully satisfactory treatment, screening remains one of the pillars of management. Low vitamin D status has been identified as a risk factor for PE. But, data on vitamin D status and risk factors for PE in the Democratic Republic of the Congo (DRC) is scanty. The aim of this study is to determine the level of Vitamin D and risk factors in preeclamptic patients in our environment. Methods: To fill this gap, we conducted a multicenter incident case control study on 190 pregnant women, 95 cases and 95 controls, receiving care from seven hospitals in Goma, in the eastern DRC, from April 1 to December 31, 2019. Socioeconomic, diet habits, clinical data, urinalysis and serum 25-hydroxy vitamin D [25(OH)D] levels were analyzed. Vitamin D deficiency was defined as serum 25(OH)D < 30 ng/ml. Bivariate and multivariate analysis were used to assess risk factors of PE. Results: The median vitamin D level in preeclamptic women was lower than in the control group (21.7 [Interquartile Range (IQR) = 19.2 - 24.1] ng/ml versus 28.5 [IQR = 24.9 - 31.4] ng/ml;(p < 0.001). PE was associated with: 1) vitamin D deficiency, Odds Ratio (OR) = 2.77 at 95% Confidence Interval-CI of [1.22 - 6.31];p = 0.015; 2) previous history of PE (OR = 12.30;95% CI [1.92 - 18.98];p = 0.008) and 3) high BMI (OR = 2.82;95% CI [1.28 - 6.21];p = 0.010). Smoking (OR = 0.33;95% CI [0.22 - 0.98];p = 0.015) and consumption of dairy products (OR = 0.39;95% CI [0.17 - 0.92];p = 0.032) were protective. Conclusion: The odds of PE were 3-fold in pregnant women with vitamin D deficiency. Vitamin D supplementation during pregnancy might reduce the risk of developing PE and ultimately reduce the consequences on maternal and perinatal advert outcomes.

Does New Regulation Points to an Effective Use of Strategic Environmental Assessment? Lessons from Democratic Republic of Congo

To date, an important debate regarding the use of Strategic Environmental Assessment in policy and plan-making seems to focus on whether to reform or develop SEA regulations. Despite the well-established theoretic relevance of legislation, there is only little empiric evidence, moreover in developing countries. This paper aims to verify the contributions of new regulations to a proper use of SEA, based on the case of the Democratic Republic of Congo. Both the SEA practice previously to the legislation reform and the newly introduced SEA system established by the new regulation were characterized. The new regulation was verified against the previous practice of SEA within the country and the compliance with international performance criteria. The outcomes suggest that the overall quality of SEA documentation is still in need of major improvements. Gaps include alternatives development and impacts monitoring. The biggest performance limitations of the new regulation are related to the length of SEA processes, public consultation, SEA information to provide, and alternatives to consider. Finally, it is suggested that regulation reform or straightforward adoption might not be enough to support an effective use of SEA.

Vaginal Colonization and Antibiotic Susceptibility Pattern of Group B <i>Streptococcus</i>Isolated from Pregnant Women in Maternitéde l’Hôpital Des Soeurs de Pauvres de Bergame de Kimbanseke, Kinshasa, Democratic Republic of Congo

Group B Streptococcus (GBS) is a Gram-positive bacterium which often colonizes maternal vaginal and rectal epitheliums and can be transmitted to the neonate during delivery. GBS infections may cause significant maternal and neonatal morbidity, including sepsis, pneumonia and meningitis. In Democratic Republic of Congo, few studies have been done on GBS colonization of pregnant women. This study was conducted in Kinshasa, Democratic Republic of Congo in order to determine the prevalence of GBS vaginal colonization among pregnant women at a gestational age of 35 - 37 weeks and the antibiotic susceptibility. Vaginal swabs of 104 pregnant women were inoculated onto Chromatic Strepto B medium. GBS isolates were identified by Gram staining, catalase test, blue-green colonies and confirmed to be GBS by Strepto B latex test kit. Antibiotic susceptibility test was done using the disc diffusion method. The prevalence of GBS vaginal colonization was 23.07%. Of the isolates studied 100%, 75%, 62.5%, 50% were sensitive to vancomycin, clindamycin, cefazolin, and erythromycin respectively. Our findings seem to suggest that maternal GBS colonization rate in this study was higher compared to a previous report from Bukavu in Democratic Republic of Congo. All isolates were found to be sensitive to vancomycin which was the most effective antibiotic for the treatment of GBS infections.

Floristic Inventory and Evaluation of Carbon Sequestration Potential of the Misomuni Forest Massif,Kikwit City (Democratic Republic of the Congo)

The aim of this study was to inventory plant biodiversity and to evaluate the carbon sequestration potential of the Misomuni forest massif.An inventory of all trees with diameter at breast height(dbh)≥10 cm measured at 1.30 m height was performed.The aerial biomass(AGB)was used for estimating the stored CO2 and its carbon equivalent.88 plant species belonging to 71 genera and 32 families were inventoried.Fabaceae family displayed the highest number of species and genera.The highest basal area values were displayed by Scorodophloeus zenkeri(7.34±2.45 m2/ha),Brachystegia laurentii(5.82±1.94 m2/ha),Entandrophragma utile(5.28±1.94 m2/ha),Pentadesma butyracea(4.53±1.51 m2/ha).The highest values of stored carbon and their carbon equivalent were observed in Pentadesma butyracea(15.13±5.00 and 50.55±16.85 t/ha),Picralima nitida(7.02±2.34 and 23.66±7.88 t/ha),Strombosia tetandra(6.56±2.18 and 22.10±7.36 t/ha).The Misomuni forest massif is thus much floristically diversified and plays a significant role in the sequestration of CO2.The total AGB of the inventoried trees is 183.78±61.26 t/ha corresponding to stored carbon and carbon equivalent of 96.63±32.21 t/ha and 289.92±96.64 t/ha respectively.The protection of this ecosystem is highly needed for combatting climatic changes at local,national and regional scales and for the conservation biodiversity habitat.

High prevalence of epilepsy in onchocerciasis endemic health areas in Democratic Republic of the Congo

Background:A high prevalence of epilepsy has been observed in many onchocerciasis endemic regions.This study is to estimate the prevalence of active epilepsy and exposure to Onchocerca volvulus infection in a rural population in Ituri province,Democratic Republic of Congo.Methods:In August 2016,a community-based cross-sectional study was conducted in an onchocerciasis endemic area in the rural health zone of Logo,Ituri Province.Households within two neighbouring health areas were randomly sampled.To identify persons with epilepsy,a three-stage approach was used.In the first stage,all individuals of the selected households were screened for epilepsy by non-medical field workers using a validated 5-item questionnaire.In the second and third stage,suspected cases of epilepsy were examined by non-specialist medical doctors,and by a neurologist,respectively.A case of epilepsy was defined according to the 2014 International League Against Epilepsy(ILAE)guidelines.Exposure to O.volvulus was assessed by testing for IgG4 antibodies to an O.volvulus antigen(OV16 Rapid Test,)in individuals aged 3 years and older.Results:Out of 1389 participants included in the survey,64 were considered to have active epilepsy(prevalence 4.6%)(95%confidence interval[CI]:3.6-5.8).The highest age-specific epilepsy prevalence estimate was observed in those aged 20 to 29 years(8.2%).Median age of epilepsy onset was 10 years,with a peak incidence of epilepsy in the 10 to 15 year-old age group.OV16 test results were available for 912 participants,of whom 30.5%(95%CI,27.6-33.6)tested positive.The prevalence of OV16 positivity in a village ranged from 8.6 to 68.0%.After adjusting for age,gender and ivermectin use,a significant association between exposure to onchocerciasis and epilepsy was observed(adjusted odds ratio=3.19,95%CI:1.63-5.64)(P<0.001).Conclusions:A high prevalence of epilepsy and a significant association between epilepsy and exposure to O.volvulus were observed in the population in Ituri province,Democratic Republic of Congo.There is an urgent need to implement a CDTI programme and to scale up an epilepsy treatment and care programme.

Comparison of novel and standard diagnostic tools for the detection of Schistosoma mekongi infection in Lao People’s Democratic Republic and Cambodia

Background:Given the restricted distribution of Schistosoma mekongi in one province in Lao People’s Democratic Republic(Lao PDR)and two provinces in Cambodia,together with progress of the national control programmes aimed at reducing morbidity and infection prevalence,the elimination of schistosomiasis mekongi seems feasible.However,sensitive diagnostic tools will be required to determine whether elimination has been achieved.We compared several standard and novel diagnostic tools in S.mekongi-endemic areas.Methods:The prevalence and infection intensity of S.mekongi were evaluated in 377 study participants from four villages in the endemic areas in Lao PDR and Cambodia using Kato-Katz stool examination,antibody detection based on an enzyme-linked immunosorbent assay(ELISA)and schistosome circulating antigen detection by lateral-flow tests.Two highly sensitive test systems for the detection of cathodic and anodic circulating antigens(CCA,CAA)in urine and serum were utilized.Results:Stool microscopy revealed an overall prevalence of S.mekongi of 6.4%(one case in Cambodia and 23 cases in Lao PDR),while that of Opisthorchis viverrini,hookworm,Trichuris trichiura,Ascaris lumbricoides and Taenia spp.were 50.4%,28.1%,3.5%,0.3%and 1.9%,respectively.In the urine samples,the tests for CCA and CAA detected S.mekongi infections in 21.0%and 38.7%of the study participants,respectively.In the serum samples,the CAA assay revealed a prevalence of 32.4%,while a combination of the CAA assay in serum and in urine revealed a prevalence of 43.2%.There was a difference between the two study locations with a higher prevalence reached in the samples from Lao PDR.Conclusions:The CCA,CAA and ELISA results showed substantially higher prevalence estimates for S.mekongi compared to Kato-Katz thick smears.Active schistosomiasis mekongi in Lao PDR and Cambodia might thus have been considerably underestimated previously.Hence,sustained control efforts are still needed to break transmission of S.mekongi.The pivotal role of highly sensitive diagnostic assays in areas targeting elimination cannot be overemphasised.

Patients with severe schistosomiasis mansoni in Ituri Province, Democratic Republic of the Congo

Background:Severe hepatosplenic complications arise in patients with chronic Schistosoma mansoni infection after heavy exposure to disease agents in endemic areas.These complications are rarely reported and,hence,underestimated.Case presentation:We report on eight patients with severe morbidity associated with S.mansoni infection in Ituri Province,northeastern Democratic Republic of Congo(DRC).The patients were identified during a community-based survey in 2017;one patient was seen at the district hospital.After taking the patients'history,a clinical examination and an abdominal ultrasonographical examination were performed.S.mansoni infection was diagnosed in fecal(Kato-Katz technique)and urine(point-of-case circulating cathodic antigen test)samples.These eight patients with severe intestinal and hepatosplenic complications were identified from four villages with high 5.mansoni infection prevalence and related morbidity.The patients'ages ranged from 19 to 57 years;four patients were women.Three patients reported hematemesis.Two patients were severely anemic.All patients reported non-specific abdominal symptoms,such as diarrhea(six patients),abdominal pain(seven patients),and blood in the stool(five patients),as well as weight loss(two patients).Abdominal ultrasonography revealed ascites in four patients.All patients had portal hypertension with hepatomegaly(seven patients)or splenomegaly(five patients).Of the six patients with a discernable liver parenchyma pattern,five displayed pattern F and three patient displayed pattern E.Liver parenchyma was not visible for two patients with severe ascites.An 5.mansoni infection was confirmed in six patients,with infection intensity ranging from light to heavy.All S.mansoni positive patients were treated with praziquantel(40 mg/kg body weight)and referred to the district hospital for follow-up.One patient with severe ascites died two weeks after we saw her.Due to security and accessibility reasons,the villages could not be visited again and the patients were lost to follow-up.Conclusions:Our observations of patients with severe schistosomiasis document the severe degree of endemicity of S.mansoni in the province and suggest an urgent need for adequate schistosomiasis control measures that target vulnerable population groups and address severe complications.