Prevalence and determinants of overweight and obesity among school-aged children and adolescents

Obesity is a significant public health crisis affecting millions of children globally. The objective of this study was to identify the prevalence and associated factors of overweight/obesity among school children in Kinshasa, Democratic Republic of Congo (DRC). This was a descriptive cross-sectional study among school children and adolescents (n= 1442) from Kinshasa selected using multistage sampling method. A structured questionnaire was used to collect behavioral data. The WHO AnthroPlus was used to calculate BMI (body mass index). SPSS version 21 was used for data analysis. Potential covariates were examined using chi-square tests followed by multivariate logistic regression analyzes The study found that out of 1442 students, 72% of the sample was at a healthy weight, 15% were underweight and nearly 13% were overweight or obese. The prevalence of overweight and obesity was higher in girls as compared with boys. The results of multivariate logistic regressions showed that the gender of children, category of age, percent body fat, eating fruits and vegetables, and physical activity levels were significantly associated with childhood overweight/obesity. One in eight children and adolescents (12.8%) aged 6 to 18 years in Kinshasa going to primary and secondary schools were either overweight or obese

Correlation of antifungal susceptibility and sequence types within Cryptococcus neoformans VNI from HIV patients, and ERG11 gene polymorphism.

peer reviewed[en] INTRODUCTION: Here we tested the correlation between minimum inhibitory concentrations (MICs) of major antifungal agents and sequence types (STs) within Cryptococcus neoformans VNI isolates, and explored the ERG11 gene of included strains. MATERIALS AND METHODS: We analysed 23 C. neoformans strains categorised into two groups according to the distribution of the ST profile in Kinshasa clinics (Democratic Republic of Congo): major ST [ST93 (n = 15)], and less common STs [ST659 (n = 2), ST5 (n = 2), ST4 (n = 1), ST 53 (n = 1), ST31 (n = 1), and ST69 (n = 1)]. The MICs of the major antifungal agents [amphotericin B (AMB), 5-fluorocytosine (5FC) and fluconazole (FCZ)] were determined following EUCAST guidelines. ERG11 gene sequences were extracted from whole genome sequence of the isolates and compared with the wild-type gene sequence of the C. neoformans VNI. RESULTS: Although major ST isolates appeared to have lower median MICs for AMB and 5FU than less common ST isolates (0.50 vs. 0.75 mg/L for AMB, 2 vs. 4 mg/L for 5FU, respectively), FCZ susceptibility was similar in both groups (4 mg/L) (p-value >0.05). The susceptibility profile of C. neoformans strains separately considered did not significantly affect the patients' clinical outcomes (p-value >0.05). Furthermore, two structural modalities of the ERG11 gene were observed: (1) that of the reference gene, and (2) that containing two exonic silent point substitutions, and one intronic point substitution located in a sequence potentially involved in pre-mRNA splicing (c.337-22C > T); with no association with the MICs of the isolates (p-value >0.05). CONCLUSIONS: The lack of association/correlation found in this study calls for further investigations to better understand the mechanisms of C. neoformans resistance to antifungal agents

Néoplasies intraépithéliales du col utérin chez la congolaise à Kinshasa : intérêt des biomarqueurs immunohistochimiques: Intraepithelial neoplasias of the uterine cervix in the Congolese in Kinshasa : interest of immunohistochemical biomarkers

Context and objective. Although cervical cancer remains the second most frequent in women in Africa, immunohistochemical biomarkers for its diagnosis is rarely used in sub-Saharan Africa. The aim of this study was to demonstrate the contribution of biomarkers p16 and Ki-67 in the diagnosis of cervical intraepithelial neoplasia. Methods. This was a retrospective study carried out in five Pathology laboratories in Kinshasa. Biopsy slides were reread and reclassified by at least two independent pathologists in Kinshasa University Hospital based on the nomenclature of Bethesda/WHO. Immunolabelling (p16 and Ki-67) was carried out with external quality control in Europe. Results. A total of 70 cases were included. All 24 cases of high grade intraepithelial neoplasia (CIN2, CIN3 and CIS) were positively marked by p16 and Ki-67 whereas low grade lesions were positively marked for 41 cases of CIN1 and negatively marked for 5 cases (3 of CIN1 and 2 of CP). Certain lesions have been reclassified. Immunohistochemical labeling was significantly associated with the grade of intraepithelial neoplasia for p16 (p = 0.001) and for Ki-67 (p = 0.004). Conclusion.  p16 and Ki-67 are specific and reliable biomarkers for an optimal diagnosis of intraepithelial neoplasia of the cervix. Contexte et objectif.  Bien que le cancer du col utérin soit le deuxième cancer plus fréquent chez la femme en Afrique, le recours aux biomarqueurs immunohistochimiques reste exceptionnel en Afrique subsaharienne. La présente étude avait pour objectif de montrer l’apport des biomarqueurs p16 et Ki-67 dans le diagnostic des néoplasies intra-épithéliales du col utérin. Méthodes. C’était une étude rétrospective réalisée dans cinq laboratoires d’Anatomie Pathologique de Kinshasa. Des lames biopsiques ont été relues et reclassées par au moins deux pathologistes indépendants aux Cliniques Universitaires de Kinshasa en suivant la nomenclature de Bethesda/OMS. L’immunomarquage (p16 et Ki-67) a été réalisé avec un contrôle qualité externe en Europe. Résultats. 70 cas ont été inclus. Les 24 cas des néoplasies intra-épithéliales de haut grade (CIN2, CIN3 et CIS) étaient marquées positivement par p16 et Ki-67 alors que celles de bas grade étaient marquées positivement pour 41 cas de CIN1 et négativement pour 5 cas (3 de CIN1 et 2 de CP). Certaines lésions ont été requalifiées. L’immunomarquage était significativement associé au grade des néoplasies pour la p16 (p=0,001) et pour le Ki-67 (p=0,004). Conclusion. P16 et Ki-67 sont des biomarqueurs spécifiques et efficaces pour un diagnostic optimal des néoplasies intra-épithéliales du col utérin. &nbsp

Épidémiologie clinique et grande diversité génétique parmi les isolats de Cryptococcus spp. infectant les personnes vivant avec le VIH à Kinshasa, République démocratique du Congo

Neuromeningeal cryptococcosis (NMC) is a life-threatening opportunistic infection in advanced HIV disease patients (AHDP). It is caused by Cryptococcus spp. complexes and mainly occurs in sub-Saharan Africa. In this study, we performed molecular characterization and antifungal susceptibility profiling of Cryptococcus isolates from AHDP in Kinshasa (DRC). Additionally, we investigated a possible association between NMC severity factors and the Cryptococcus neoformans (Cn) multilocus sequence typing (MLST) profiles. We characterized the isolates using PCR serotyping, MALDI-TOF MS, internal transcribed spacer (ITS) sequencing, and MLST. Susceptibility testing for the major antifungal drugs was performed according to the EUCAST guidelines. Parameters associated with NMC severity, such as hypoglycorrhachia ( 30 cm H2O), and poor therapeutic outcome were compared with the Cn MLST sequences type (ST). Twenty-three out of 29 Cryptococcus isolates were identified as serotype A using PCR serotyping (79.3%; 95% IC: 65.5-93.1), while six (20.7%; 95% IC: 6.9-34.5) were not serotypable. The 29 isolates were identified by ITS sequencing as follows: Cryptococcus neoformans (23/29, 79.3%), Cutaneotrichosporon curvatus (previously called Cryptococcus curvatus) (5/29, 17.2%), and Papiliotrema laurentii (Cryptococcus laurentii) (1/29, 3.5%). Using the ISHAM MLST scheme, all Cn isolates were identified as molecular type VNI. These comprised seven different STs: ST93 (n = 15), ST5 (n = 2), ST53 (n = 1), ST31 (n = 1), ST4 (n = 1), ST69 (n = 1), and one novel ST that has not yet been reported from other parts of the world and was subsequently assigned as ST659 (n = 2). Of the included strains, only Papiliotrema laurentii was resistant to amphoterin B (1/29, 3.5%), 6.8% (2/29) were resistant to 5-flucytosine (the single Papiliotrema laurentii strain and one Cryptococcus neoformans isolate), and 13.8% (4/29) to fluconazole, including two of five (40%) Cutaneotrichosporon curvatus and two of 23 (8.7%) C. neoformans strains. We found a significative association between poor therapeutic outcome and a non-ST93 sequence type of causative strains (these concerned the less common sequence types: ST53, ST31, ST5, ST4, ST659, and ST69) (87.5% versus 40%, p = 0.02). Molecular analysis of Cryptococcus spp. isolates showed a wide species diversity and genetic heterogenicity of Cn within the VNI molecular type. Furthermore, it is worrying that among included strains we found resistances to several of the commonly used antifungals.Cryptococcose chez les personnes vivant avec le VIH à Kinshasa : étude épidémiologique et moléculaire3. Good health and well-bein

Larvicidal Activity of Inorganic Salts Against Anopheles Stephensi and Culex Quinquefasciatus

Mosquitoes transmit serious human diseases, causing millions of deaths worldwide every year and the development of resistance to chemical insecticides resulting in rebounding vectorial capacity. In this study, the larvicidal bioassays for activities of aqueous solutions of weak acid [(NH4)2SO4 and NaH2PO4] and weak base (Na2CO3 and NaHCO3) inorganic salts against late instar larvae of disease vectors Anopheles stephensi and Culex quinquefasciatus were carried out under laboratory settings. The four inorganic salts showed varied levels of larvicidal activities after 24 h-exposure on Anopheles stephensi and Culex quinquefasciatus larvae in a dose-dependent fashion. However, the larvicidal activities were relatively higher in Na2CO3 (LC50 = 3162 and 447 ppm) and NaHCO3 (LC50 = 5623 and 398 ppm) solutions as compared to those in (NH4)2SO4 (LC50 = 7943 and 1995 ppm) and NaH2PO4 (LC50 = 7943 and 7120 ppm). The present study showed that the inorganic salts Na2CO3, NaHCO3, (NH4)2SO4 and NaH2PO4 could serve as potential larviciding agents considering their low toxicity. Therefore, this study provides a first report on the larvicidal activity of the inorganic salts on mosquito larvae of disease vectors

Absence de mutation K13 associée à une résistance de l'artémisine chez Plasmodium falciparum en RDC

Artemisinin-based combination therapies (ACTs) have been recommended by the World Health Organization (WHO) as first-line treatment of uncomplicated Plasmodium falciparum (P. falciparum) malaria since 2005 in Democratic Republic of Congo (DRC) and a regular surveillance of the ACT efficacy is required to ensure the treatment effectiveness. Mutations in the propeller domain of the pfk13 gene were identified as molecular markers of artemisinin resistance (ART-R). This study investigated the pfk13-propeller gene polymorphism in clinical isolates of P. falciparum collected in the DRC. In 2017, ten geographical sites across DRC were selected for a cross-sectional study that was conducted first in Kinshasa from January to March, then in the nine other sites from September to December. Dried blood samples were collected from patients attending health centers for fever where diagnosis of Malaria was first made by rapid diagnostic test (RDT) available on site (SD Bioline malaria Ag Pf or CareStart Malaria Pf) or by thick blood smear and then confirmed by a P. falciparum real-time PCR assay. A pfk13-propeller segment containing a fragment that codes for amino acids at positions 427-595 was amplified by conventional PCR before sequencing. In total, 1070 patients were enrolled in the study. Real-time PCR performed confirmed the initial diagnosis of P. falciparum infection in 806 samples (75.3%; 95% CI: 72.6%- 77.9%). Of the 717 successfully sequenced P. falciparum isolates, 710 (99.0%; 95% CI: 97.9% - 99.6) were wild-type genotypes and 7 (1.0%; 95% CI: 0.4% - 2.1%) carried non-synonymous (NS) mutations in pfk13-propeller including 2 mutations (A578S and V534A) previously detected and 2 other (M472I and A569T) not yet detected in the DRC. Mutations associated with ART-R in Southeast Asia were not observed in DRC. However, the presence of other mutations in pfk13-propeller gene calls for further investigations to assess their implication in drug resistance

Caractéristiques épidémiologiques et histopathologiques de 1280 cancers du col utérin à Kinshasa

OBJECTIF : Vu le manque de registre du cancer et de programme de dépistage à grande échelle du cancer du col utérin dans la plupart des pays africains, des modèles mathématiques sont à la base des données disponibles. Cette étude vise à cerner concrètement les particularités épidémiologiques et histopathologiques du cancer du col utérin. MÉTHODES : Parmi les cancers (n = 5801) diagnostiqués dans cinq laboratoires d’anatomie pathologique de Kinshasa durant 10 ans, les lames histologiques des cancers du col ont fait l’objet d’une relecture et d’une classification selon l’OMS 2014. RÉSULTATS : Les cancers du col utérin (n = 1280) ont représenté 22 % de l’ensemble des cancers et 40,4 % des cancers mammaires et gynécologiques. La tranche d’âge la plus touchée était celle de 49 à 58 ans. Le carcinome malpighien correspond à 73,2 %, l’adénocarcinome à 18,4 % et le carcinome adénosquameux à 8,4 % des cancers cervicaux. Les sous-types se distribuaient comme suit : le carcinome kératinisant 47,2 %, le non kératinisant 20,8 %, l’adénocarcinome usuel 9,6 % et le villoglandulaire 5,3 %. Dans le sous-type des carcinomes mucineux, seul le variant à cellules en bague à chaton (1,3 %) était représenté. Parmi les cancers du col utérin, 69 % étaient de grade histologique I, 20 % de grade II et 11 % de grade III. CONCLUSION : Cette étude des particularités épidémiologiques et histopathologiques du cancer du col utérin à Kinshasa fournit une base de données concrètes pour initier un registre du cancer et des campagnes de dépistage et de vaccination contre le HPV.[Epidemiologic and histopathologic characteristics of 1280 uterine cervical cancers in Kinshasa]. OBJECTIVE: Due to the lack of both cancer registry and large scale cervical screening in most african countries, only theoretical studies are available. The objective of our work was to provide epidemiological and histopathological characteristics of cervical cancer based on concrete observations. METHODS: This study was carried out on all cancers (n=5801) collected in the last 10 years from 5 pathology laboratories of Kinshasa; the histologic slides of the cervical cancers (n=1280) were reviewed by at least two pathologists and classified according to the 2014 OMS classification. RESULTS: The cervical cancers accounted for 22% of all cancers and 40,4% of breast and gynecological cancers. The cervical cancer was the most common among women aged 49-58. Squamous cell carcinomas were the most observed type (73,2%) followed by adenocarcinomas (18,4%) and adenosquamous carcinomas (8,4%). Keratinized (47,2%) and non keratinized squamous carcinoma (20,8%) were the most frequent subtypes among squamous carcinomas and the usual adenocarcinoma among adenocarcinomas (9,6%). In the mucinous adenocarcinoma subtype, only the signet ring cells (1,3%) variant was found. Among cervical cancers, 69% were grade I, 20% grade II and 11% grade III. CONCLUSION: Our study provides a concrete database of epidemiological and histopathological cervical cancer particularities in Kinshasa, useful to initiate a cancer register, as well as cervical screening and HPV vaccine campaigns

Evaluation of the usefulness of intermittent preventive treatment of malaria in pregnancy with sulfadoxine-pyrimethamine in a context with increased resistance of Plasmodium falciparum in Kingasani Hospital, Kinshasa in the Democratic Republic of Congo

Background Increasing resistance of Plasmodium falciparum to sulfadoxine-pyrimethamine (SP) threatens its usefulness for intermittent preventive treatment in pregnancy (IPTp-SP). The prophylactic effects of IPTp-SP on maternal malaria and adverse pregnancy outcomes were evaluated in Kingasani Hospital, Kinshasa in the Democratic Republic of Congo (DRC). Methods Laboring women (n = 844) and respective newborns were investigated. Blood samples collected from women were tested for malaria using rapid diagnostic test (RDT), blood smears examination, and real-time PCR. The hemoglobin level was measured by HemoCue© analyzer. A PCR-RFLP method was applied for detecting N51I, C59R, and S108N mutations on dhfr along with A437G and K540E mutations on dhps in P. falciparum positive samples. Logistic regression models assessed relationships between IPTp-SP uptake and pregnancy outcomes. Results P. falciparum malaria was detected at delivery in 10.8% of women and was statistically associated with fever during the pregnancy (OR = 2.9 [1.5; 6.3]; p = 0.004) and maternal anemia (OR = 3.9 [2.4; 6.3]; p 0.05). Conversely, three or more doses of SP were associated with reduced maternal anemia at delivery (OR = 0.4 [0.2; 0.9]; p = 0.024), shortened gestation (OR = 0.4 [0.2; 0.8]; p = 0.009), and low-birth weights (OR = 0.2 [0.1; 0.5]; p < 0.001). Conclusion IPTp-SP was not associated with reduced maternal malaria in our study, but evidence was found of a prophylactic effect against adverse pregnancy outcomes. To counteract further loss of clinical effects of IPTp-SP in the study population, alternative strategies able to improve its anti-malarial efficacy such as combination of SP with partner molecules should be implemented

Care-seeking behaviour and socio-economic burden associated with uncomplicated malaria in the Democratic Republic of Congo

Abstract Background This study aimed to estimate the socio-economic costs of uncomplicated malaria and to explore health care-seeking behaviours that are likely to influence these costs in the Democratic Republic of Congo (DRC), a country ranked worldwide as the second most affected by malaria. Methods In 2017, a cross-sectional survey included patients with uncomplicated malaria in 64 healthcare facilities from 10 sentinel sites of the National Malaria Control Programme (NMCP) in the DRC. A standard questionnaire was used to assess health care-seeking behaviours of patients. Health-related quality of life (HRQL) and disutility weights (DW) of illness were evaluated by using the EuroQol Group’s descriptive system (EQ-5D-3L) and its visual analogue scale (EQ VAS). Malaria costs were estimated from a patient’s perspective. Probabilistic sensitivity analyses (PSA) evaluated the uncertainty around the cost estimates. Generalized regression models were fitted to assess the effect of potential predictive factors on the time lost and the DW during illness. Results In total, 1080 patients (age: 13.1 ± 14 years; M/F ratio: 1.1) were included. The average total costs amounted to US$36.3 [95$ 16.7 [95% CI 16.3–17.1] as direct costs and US$ 19.6 [95% CI 18.9–20.3] indirect costs. During care seeking, economically active patients and their relatives lost respectively 3.3 ± 1.8 and 3.4 ± 2.1 working days. This time loss occurred mostly at the pre-hospital stage and was the parameter associated the most with the uncertainty around malaria cost estimates. Patients self-rated an average 0.36 ± 0.2 DW and an average 0.62 ± 0.3 EQ-5D index score per episode. A lack of health insurance coverage (896 out of 1080; 82.9%) incurred substantially higher costs, lower quality of life, and heavier DW while leading to longer time lost during illness. Residing in rural areas incurred a disproportionally higher socioeconomic burden of uncomplicated malaria with longer time lost due to illness and limited access to health insurance mechanisms. Conclusion Uncomplicated malaria is associated with high economic costs of care in the DRC. Efforts to reduce the cost-of-illness should target time lost at the pre-hospital stage and social disparities in the population, while reinforcing measures for malaria control in the country