Geo-climatic factors of Malaria morbidity in the Democratic Republic of Congo from 2001 to 2019

Background: Environmentally related morbidity and mortality still remain high worldwide, although they have decreased significantly in recent decades. This study aims to forecast malaria epidemics taking into account climatic and spatio-temporal variations and therefore identify geo-climatic factors predictive of malaria prevalence from 2001 to 2019 in the Democratic Republic of Congo. Methods: This is a retrospective longitudinal ecological study. The database of the Directorate of Epidemiological Surveillance including all malaria cases registered in the surveillance system based on positive blood test results, either by microscopy or by a rapid diagnostic test for malaria was used to estimate malaria morbidity and mortality by province of the DRC from 2001 to 2019. The impact of climatic factors on malaria morbidity was modeled using the Generalized Poisson Regression, a predictive model with the dependent variable Y the count of the number of occurrences of malaria cases during a period of time adjusting for risk factors. Results: Our results show that the average prevalence rate of malaria in the last 19 years is 13,246 (1,178,383−1,417,483) cases per 100,000 people at risk. This prevalence increases significantly during the whole study period (p 0.0001). The year 2002 was the most morbid with 2,913,799 (120,9451−3,830,456) cases per 100,000 persons at risk. Adjusting for other factors, a one-day in rainfall resulted in a 7% statistically significant increase in malaria cases (p 0.0001). Malaria morbidity was also significantly associated with geographic location (western, central and northeastern region of the country), total evaporation under shelter, maximum daily temperature at a two-meter altitude and malaria morbidity (p 0.0001). Conclusions: In this study, we have established the association between malaria morbidity and geo-climatic predictors such as geographical location, total evaporation under shelter and maximum daily temperature at a two-meter altitude. We show that the average number of malaria cases increased positively as a function of the average number of rainy days, the total quantity of rainfall and the average daily temperature. These findings are important building blocks to help the government of DRC to set up a warning system integrating the monitoring of rainfall and temperature trends and the early detection of anomalies in weather patterns in order to forecast potential large malaria morbidity events

Complications of childbirth and maternal deaths in Kinshasa hospitals: testimonies from women and their families

<p>Abstract</p> <p>Background</p> <p>Maternal mortality in Kinshasa is high despite near universal availability of antenatal care and hospital delivery. Possible explanations are poor-quality care and by delays in the uptake of care. There is, however, little information on the circumstances surrounding maternal deaths. This study describes and compares the circumstances of survivors and non survivors of severe obstetric complications.</p> <p>Method</p> <p>Semi structured interviews with 208 women who survived their obstetric complication and with the families of 110 women who died were conducted at home by three experienced nurses under the supervision of EK. All the cases were identified from twelve referral hospitals in Kinshasa after admission for a serious acute obstetric complication. Transcriptions of interviews were analysed with N-Vivo 2.0 and some categories were exported to SPSS 14.0 for further quantitative analysis.</p> <p>Results</p> <p>Testimonies showed that despite attendance at antenatal care, some women were not aware of or minimized danger signs and did not seek appropriate care. Cost was a problem; 5 deceased and 4 surviving women tried to avoid an expensive caesarean section by delivering in a health centre, although they knew the risk. The majority of surviving mothers (for whom the length of stay was known) had the caesarean section on the day of admission while only about a third of those who died did so. Ten women died before the required caesarean section or blood transfusion could take place because they did not bring the money in time. Negligence and lack of staff competence contributed to the poor quality of care. Interviews revealed that patients and their families were aware of the problem, but often powerless to do anything about it.</p> <p>Conclusion</p> <p>Our findings suggest that women with serious obstetric complications have a greater chance of survival in Kinshasa if they have cash, go directly to a functioning referral hospital and have some leverage when dealing with health care staff</p

Facteurs associés à la mortalité maternelle intra-hospitalière et circonstances de décès chez des femmes avec complications obstétricales sévères à Kinshasa (République démocratique du Congo)

Chaque année dans le monde, un peu plus d’un demi-million de femmes décèdent des suites de complications liées à la grossesse, à l’accouchement ou à l'interruption de grossesse. C’est seulement vers la fin des années 1980 que les écarts de mortalité maternelle entre les pays du Nord et ceux du Sud apparaissent comme sujet de préoccupation au niveau international. En effet, ces différences, plus importantes que tout autre indicateur de santé publique, sont telles que les niveaux peuvent être 100 fois plus élevés au Sud qu’au Nord. A Kinshasa, la capitale de la R.D.Congo, la mortalité maternelle est très élevée malgré le nombre important de structures de santé, de personnels de santé et d’utilisatrices des services de santé maternelle. C’est en vue d’analyser les facteurs de risque associés à la mortalité maternelle et les circonstances de survenue de complications obstétricales graves ou de décès maternels à Kinshasa, qu’une enquête cas-témoins a été réalisée en 2004. Menée dans douze maternités de référence et au domicile des femmes sélectionnées, l’étude compare 110 femmes décédées ayant eu une complication obstétricale grave à 208 femmes ayant survécu à ces types de complication. Les analyses multivariées montrent l’effet néfaste sur la survie de transferts nombreux de la future mère, mais aussi l’effet protecteur de s’être adressée directement à une structure de soins capable de prendre sa complication en charge et ainsi que de l’activité rémunératrice de la femme. Les femmes survivantes sont également plus nombreuses à avoir fréquenté les soins prénatals. Par ailleurs, le défaut d’équipements essentiels le plus souvent relevé dans les structures de santé de référence sont le manque de sang à transfuser ou d’oxygène. Dans un système dépourvu d’assurance maladie ou de tout autre mécanisme de solidarité, le manque d’argent est un obstacle majeur à l’accession aux soins. Les objectifs à court terme seraient d’instaurer un mécanisme solidaire de partage des coûts liés à l’accouchement et, à long terme, d’élaborer un schéma national d’assurance avec une couverture suffisante des soins de santé. Nos résultats permettent également d’insister sur l’importance d’améliorer l’accès aux soins obstétricaux essentiels pendant la grossesse et l’accouchement.Worldwide, more than half a million of women die every year of pregnancy or delivery-related complications. Awareness about this important public health problem increased after the launch of the Safe Motherhood Initiative in Nairobi in 1987; since then, various programmes have been initiated by international agencies to address the problem. North-South differences in maternal mortality are still high and the highest of the current public health indicators with levels being 100 times higher in several developing countries and especially in Sub-Saharan Africa. Maternal mortality is very high in Kinshasa, the D.R. Congo capital city, despite its numerous health services, the number of health professionals and the high rate of maternal health services’ use. A case-control survey was organised in 2004 to identify the risk factors associated to maternal death and the circumstances where serious obstetrical complications or maternal deaths occur.. The case-control study design compared each selected maternal death with two surviving women having had a similar obstetrical complication. Maternal deaths were identified over a 12 month period (January to December 2004) in twelve reference maternity wards in Kinshasa There were 110 case (maternal deaths) and 208 controls. Information was gathered by interviewing family members of the deceased and surviving women and from hospitals registers. Unadjusted and adjusted OR and 95% CI were estimated with SPSS version 14. Multivariate analysis showed the negative effect of excessive referrals and the protective effect of the following: having a paid activity, beginning the health services use itinerary in the referral maternity and having used antenatal care. The most common observed shortage of basic equipment in the surveyed maternities were the lack of blood (transfusion) or of oxygen. In a health system without insurance or any other solidarity mechanism, the lack of money is a real problem to access to health services. Short-term objectives would have been to initiate a costs division mechanism or to subsidy expenses linked to delivery and long-term, to prepare a national health insurance scheme able to provide a sufficient health coverage for the members or users. Our results underline the importance of improving the access to essential obstetrical care during pregnancy and delivery.Thèse de doctorat en sciences sociales (démographie) (DEMO 3) -- UCL, 200

Facteurs associés à la mortalité maternelle intra-hospitalière et circonstances de décès chez des femmes avec complications obstétricales sévères à Kinshasa (RDCongo)

Worldwide, more than half a million of women die every year of pregnancy or delivery-related complications. Awareness about this important public health problem increased after the launch of the Safe Motherhood Initiative in Nairobi in 1987; since then, various programmes have been initiated by international agencies to address the problem. North-South differences in maternal mortality are still high and the highest of the current public health indicators with levels being 100 times higher in several developing countries and especially in Sub-Saharan Africa. Maternal mortality is very high in Kinshasa, the D.R. Congo capital city, despite its numerous health services, the number of health professionals and the high rate of maternal health services’ use. A case-control survey was organised in 2004 to identify the risk factors associated to maternal death and the circumstances where serious obstetrical complications or maternal deaths occur.. The case-control study design compared each selected maternal death with two surviving women having had a similar obstetrical complication. Maternal deaths were identified over a 12 month period (January to December 2004) in twelve reference maternity wards in Kinshasa There were 110 case (maternal deaths) and 208 controls. Information was gathered by interviewing family members of the deceased and surviving women and from hospitals registers. Unadjusted and adjusted OR and 95% CI were estimated with SPSS version 14. Multivariate analysis showed the negative effect of excessive referrals and the protective effect of the following: having a paid activity, beginning the health services use itinerary in the referral maternity and having used antenatal care. The most common observed shortage of basic equipment in the surveyed maternities were the lack of blood (transfusion) or of oxygen. In a health system without insurance or any other solidarity mechanism, the lack of money is a real problem to access to health services. Short-term objectives would have been to initiate a costs division mechanism or to subsidy expenses linked to delivery and long-term, to prepare a national health insurance scheme able to provide a sufficient health coverage for the members or users. Our results underline the importance of improving the access to essential obstetrical care during pregnancy and delivery.Chaque année dans le monde, un peu plus d’un demi-million de femmes décèdent des suites de complications liées à la grossesse, à l’accouchement ou à l'interruption de grossesse. C’est seulement vers la fin des années 1980 que les écarts de mortalité maternelle entre les pays du Nord et ceux du Sud apparaissent comme sujet de préoccupation au niveau international. En effet, ces différences, plus importantes que tout autre indicateur de santé publique, sont telles que les niveaux peuvent être 100 fois plus élevés au Sud qu’au Nord. A Kinshasa, la capitale de la R.D.Congo, la mortalité maternelle est très élevée malgré le nombre important de structures de santé, de personnels de santé et d’utilisatrices des services de santé maternelle. C’est en vue d’analyser les facteurs de risque associés à la mortalité maternelle et les circonstances de survenue de complications obstétricales graves ou de décès maternels à Kinshasa, qu’une enquête cas-témoins a été réalisée en 2004. Menée dans douze maternités de référence et au domicile des femmes sélectionnées, l’étude compare 110 femmes décédées ayant eu une complication obstétricale grave à 208 femmes ayant survécu à ces types de complication. Les analyses multivariées montrent l’effet néfaste sur la survie de transferts nombreux de la future mère, mais aussi l’effet protecteur de s’être adressée directement à une structure de soins capable de prendre sa complication en charge et ainsi que de l’activité rémunératrice de la femme. Les femmes survivantes sont également plus nombreuses à avoir fréquenté les soins prénatals. Par ailleurs, le défaut d’équipements essentiels le plus souvent relevé dans les structures de santé de référence sont le manque de sang à transfuser ou d’oxygène. Dans un système dépourvu d’assurance maladie ou de tout autre mécanisme de solidarité, le manque d’argent est un obstacle majeur à l’accession aux soins. Les objectifs à court terme seraient d’instaurer un mécanisme solidaire de partage des coûts liés à l’accouchement et, à long terme, d’élaborer un schéma national d’assurance avec une couverture suffisante des soins de santé. Nos résultats permettent également d’insister sur l’importance d’améliorer l’accès aux soins obstétricaux essentiels pendant la grossesse et l’accouchement.(DEMO 3) -- UCL, 200