Biennial surveillance of Plasmodium falciparum anti-malarial drug resistance markers in Democratic Republic of Congo, 2017 and 2019

peer reviewedBackground: Because of the loss of chloroquine (CQ) effectiveness, the Democratic Republic of Congo (DRC)’s malaria treatment policy replaced CQ by sulfadoxine–pyrimethamine (SP) as first-line treatment of uncomplicated malaria in 2003, which in turn was replaced by artemisinin-based combination therapies (ACT) in 2005. The World Health Organization (WHO) recommends monitoring of anti-malarial drug resistance every 2 years. The study aimed to provide baseline data for biennial molecular surveillance of anti-malarial drug resistance by comparing data from a study conducted in 2019 to previously published data from a similar study conducted in 2017 in the DRC. Methods: From July to November 2019, a cross-sectional study was conducted in ten sites which were previously selected for a similar study conducted in 2017 across the DRC. P. falciparum malaria was diagnosed by a rapid diagnostic test (RDT) or by microscopy and dried blood samples (DBS) were taken from patients who had a positive test. Segments of interest in pfcrt and pfk13 genes were amplified by conventional PCR before sequencing. Results: Out of 1087 enrolled patients, 906 (83.3%) were PCR-confirmed for P. falciparum. Like in the 2017-study, none of the mutations known to be associated with Artemisinine (ART) resistance in Southeast Asia was detected. However, non-synonymous (NS) mutations with unknown functions were observed among which, A578S was detected in both 2017 and 2019-studies. The overall prevalence of pfcrt-K76T mutation that confers CQ-resistance was 22.7% in 2019-study compared to 28.5% in 2017-study (p-value = 0.069), but there was high variability between sites in the two studies. Like in 2017-study, the pfcrt 72–76 SVMNT haplotype associated with resistance to amodiaquine was not detected. Conclusion: The study reported, within 2 years, the non-presence of molecular markers currently known to be associated with resistance to ART and to AQ in P. falciparum isolated in the DRC. However, the presence of polymorphisms with as-yet unknown functions was observed, requiring further characterization. Moreover, an overall decrease in the prevalence of CQ-resistance marker was observed in the DRC, but this prevalence remained highly variable from region to region. © 2022, The Author(s)

Mammography Services Quality Assurance: Baseline Standards for Latin America and the Caribbean

Fil: Barr, Helen. No especifíca;Fil: Blanco, Susana Alicia Ana. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Ministerio de Salud. Instituto Nacional del Cáncer; ArgentinaFil: Butler, Priscilla. No especifíca;Fil: da Paz, María Angela. No especifíca;Fil: Fleitas, Ileana. No especifíca;Fil: Craig, George. No especifíca;Fil: Jimenez, Pablo. No especifíca;Fil: Luciani, Silvana. No especifíca;Fil: Manrique, Javier. No especifíca;Fil: Mazal, Jonathan. No especifíca;Fil: Medlen, Kayiba. No especifíca;Fil: MIller, Colie. No especifíca;Fil: Mora, Patricia. No especifíca;Fil: Valdez Moreno, Martha Elena. No especifíca;Fil: Mosodeen, Murrie. No especifíca;Fil: Mysler, Gustavo. No especifíca;Fil: Nuche-Berenguer, Bernardo. No especifíca;Fil: Pastel, Mary. No especifíca;Fil: Pinochet, Miguel. No especifíca;Fil: Sisney, Gale. No especifíca;Fil: Ruiz Trejo, Cesar. No especifíca;Fil: Saraiya, Mona. No especifíca;Fil: Solis, Esteban. No especifíca;Fil: Swann, Phillip. No especifíca

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

peer reviewedBackground: 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. © 202

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

peer reviewedBackground: 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. © 2021, The Author(s)

Garantía de calidad de los servicios de mamografía: Normas básicas para América Latina y el Caribe

Fil: Barr, Helen. No especifíca;Fil: Blanco, Susana Alicia Ana. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Ministerio de Salud. Instituto Nacional del Cáncer; ArgentinaFil: Albarracín, Virginia Helena. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Priscilla, Butler. No especifíca;Fil: da Paz, María Angela. No especifíca;Fil: Fleitas, Ileana. No especifíca;Fil: Jiménez, Pablo. No especifíca;Fil: Luciani, Silvana. No especifíca;Fil: Manrique, Javier. No especifíca;Fil: Mazal, Jonathan. No especifíca;Fil: Medlen, Kayiba. No especifíca;Fil: Miller, Collie. No especifíca;Fil: Mora, Patricia. No especifíca;Fil: Valdez Moreno, Martha Elena. No especifíca;Fil: Mosodeen, Murrie. No especifíca;Fil: Mysler, Gustavo. No especifíca;Fil: Nusche Berenguer, Bernardo. No especifíca;Fil: Pastel, Mary. No especifíca;Fil: Pinochet, Miguel. No especifíca;Fil: Ruiz Trejo, Cesar. No especifíca;Fil: Sisney, Gale. No especifíca;Fil: Saraiya, Mona. No especifíca;Fil: Solis, Esteban. No especifíca;Fil: Swann, Phillip. No especifíca

Nadine Kayiba's Quick Files

The Quick Files feature was discontinued and it’s files were migrated into this Project on March 11, 2022. The file URL’s will still resolve properly, and the Quick Files logs are available in the Project’s Recent Activity

Mise en place d’un système de surveillance moléculaire de la résistance aux antipaludiques en République Démocratique du Congo : rôle, avantages et défis

Drug resistance is a major obstacle to malaria control in the DRC. Two systematic reviews and three original studies indicate widespread resistance of P. falciparum to chloroquine and sulfadoxine-pyrimethamine as well as an imminent risk of local emergence or dissemination of resistance to artemisinin from sub-regional foci. In addition, the epidemiological context prevailing in the country is marked by a significant socio-economic burden of malaria and significant socio-health disparities within the population. This results in inadequate therapeutic behaviors that can worsen drug resistance. The system put in place for the molecular surveillance of this resistance demonstrates considerable epidemiological advantages and feasibility in local conditions but remains prone to financial and organizational challenges for its effective implementation in the national antimalarial policy.(SP - Sciences de la santé publique) -- UCL, 202

Employees’ perceptions regarding social health insurance: A case of Kinshasa, Democratic Republic of Congo

Sustaining splendid health has always been a wish for every employee of any formal organisation. If health is not excellent, employees are likely not to function as expected hence it is imperative to have social health insurance. This article reports on the findings derived from a research conducted in Kinshasa, Democratic Republic of Congo. The researcher personally distributed structured questionnaires among employees in 15 organisations. Findings show that the majority of the respondents experience problems in organizing their health care where it emerged that, 1) the majority of the employees from public sector are not assisted in organizing their health care, 2) they use out-out-pocket financing means for their health care, 3) in general, employees from public sector are not aware of health insurance and interestingly employees from mix companies and private sector are knowledgeable on health insurance, 4) respondents with post matric qualifications prefer to use private hospital when they are sick, 5) employees choose health facility based on good quality service provided. In general, it emerged from the findings that there is willingness to pay contribution should the social health insurance be introduced

Simulation of carbon- monoxide rich syngas through gasification and co-gasification of biomass.

Syngas is an interesting energy source for metallurgical processes, as an energy carrier syngas is an efficient way of utilizing the energy in biomass. Utilizing syngas in fuming processes as a carbon source instead of coal was an approach to minimize carbon dioxide emissions produced in the fuming process. In the fuming process, secondary materials are processed to improve the extraction of copper, lead, and zinc.  The objective of this project was to find a suitable biomass and gasification agent that result in syngas with a high percentage of carbon monoxide and a low percentage of carbon dioxide. Because of the high need of carbon in the fuming process, syngas could be a suitable reduction agent. The most efficient thermo-chemical process for syngas production from biomass is gasification.  The investigated biomass where sawdust, wood, and a co-gasification with a percentage of peat. The gasification agents investigated where carbon dioxide, oxygen, air, and hydrogen. This was investigated by using FactSage8.1 to simulate the gasification and co-gasification of chosen biomasses and gasification agents. Stoichiometric calculations of the fuels and gasification agents were done to get the correct reduction and combustion reactions.  The results from the simulations showed that carbon dioxide was the best gasification agent and gasifying sawdust alone results in the highest simulated levels of carbon monoxide in the gasification temperature between 1000 to 1200 ᵒC.  Other studies showed that biomass gasification with carbon dioxide or a mixture of at least 60 percent of carbon dioxide as a gasification agent was a promising way for energy production and lowering carbon dioxide emissions. It also shows a correlation between increasing carbon dioxide as a gasification agent and higher level of carbon monoxide in the produced syngas. Other studies implied that the maximum level of carbon dioxide that results in the maximum fraction of carbon monoxide and methane was 60 percent.  Each gasification agent investigated have advantages and disadvantages, they lead to different gas composition, by-products, and heating value, which gasification agent to use depends on the result wanted. Carbon dioxide was the gasification agent that shows the best result in a simulated environment, but the same result cannot be guaranteed in real-life experiments, and discrepancies are to be expected. Further study in form of a real-life experiment are needed to compare with the simulated results, as the effects of ash forming elements and test of gasifier are needed.