Resistance profiles of urinary Escherichia coli and Klebsiella pneumoniae isolates to antibiotics commonly prescribed for treatment of urinary tract infections at Monkole Hospital Center, Kinshasa, Democratic Republic of the Congo

Background: The occurrence of urinary tract infection (UTI) caused by multi-drug resistant bacteria is increasing worldwide and has become a major public health concern that requires global attention. To promote better treatment outcome of UTI and raise awareness of antibiotic resistance in the Democratic Republic of the Congo (DRC), we investigated the antimicrobial resistance profile of bacterial pathogens frequently isolated from urine samples of inpatients and outpatients with symptoms of UTI at the Monkole Hospital Center (MHC), Kinshasa from June 2017 to May 2018. Methodology: This was a retrospective review of results of uro-cultures of urine samples of both inpatients and outpatients who had clinical symptoms of UTI, over a period of one year at the MHC, Kinshasa, DRC. During this period, aerobic uro-cultures of urine were done on MacConkey agar (MAC) or Cystine-Lactose- Electrolyte-Deficient (CLED) agar media at 37oC incubation for 24 hours. Identification of bacterial isolates on the culture media and antimicrobial susceptibility to sixteen selected antibiotics were done using the integral system enterobacteria and the Vitek® 2 automated system according to the manufacturer’s instructions. The R-studio software was used for statistical analysis. Results: Of the 2765 uro-cultures performed during the period of study, 809 (29.3%) were positive for bacteria with Escherichia coli being the most frequently isolated bacteria pathogens. There was no significant difference (p>0.05) in the resistance rates of both E. coli and Klebsiella pneumoniae to most of the antibiotics such as amoxicillin-clavulanic acid, piperacillin-tazobactam, amikacin, levofloxacin, norfloxacin, cefuroxime, cefotaxime, cefixime and cephalexin but resistance rates of E. coli compared to K. pneumoniae was significantly higher to cotrimoxazole (OR=2.06, p=0.0016), ofloxacin (OR=3.43, p=0.0019), ciprofloxacin (OR=1.624, p=0.044) and significantly lower to imipenem (OR=0.037, p=0.0046), nitrofurantoin (OR=0.292, p=0.0004) and fosfomycin (OR=0.311, p=0.0003). Both pathogens showed resistance rates of more than 50.0% to doxycycline, cefuroxime, cefixime and cephalexin but resistance rates of K. pneumoniae to ofloxacin and cotrimoxazole was less than 50.0%. The isolates were least resistant to imipenem, piperacillin-tazobactam and amikacin, with less than 13.0% resistance rate. Conclusion: The findings of this study showed that E. coli is the most isolated bacterial uro-pathogen amongst patients with UTI at MHC Kinshasa, DRC, but both E. coli and K. pneumoniae were resistant to most commonly prescribed antibiotics used for treatment of UTI. Amikacin, piperacillin-tazobactam and imipenem demonstrated high invitro activity and should be prioritized for antimicrobial stewardship to prevent or delay emergence of resistance to them. To guarantee optimal treatment of UTI, regular pathogen surveillance and local antibiogram reporting are required. Further studies are needed in DRC to assess the burden and factors driving antimicrobial resistance nationwide

Global Burden of Sickle Cell Anaemia in Children under Five, 2010-2050: Modelling Based on Demographics, Excess Mortality, and Interventions

The global burden of sickle cell anaemia (SCA) is set to rise as a consequence of improved survival in high-prevalence low- and middle-income countries and population migration to higher-income countries. The host of quantitative evidence documenting these changes has not been assembled at the global level. The purpose of this study is to estimate trends in the future number of newborns with SCA and the number of lives that could be saved in under-five children with SCA by the implementation of different levels of health interventions.First, we calculated projected numbers of newborns with SCA for each 5-y interval between 2010 and 2050 by combining estimates of national SCA frequencies with projected demographic data. We then accounted for under-five mortality (U5m) projections and tested different levels of excess mortality for children with SCA, reflecting the benefits of implementing specific health interventions for under-five patients in 2015, to assess the number of lives that could be saved with appropriate health care services. The estimated number of newborns with SCA globally will increase from 305,800 (confidence interval [CI]: 238,400-398,800) in 2010 to 404,200 (CI: 242,500-657,600) in 2050. It is likely that Nigeria (2010: 91,000 newborns with SCA [CI: 77,900-106,100]; 2050: 140,800 [CI: 95,500-200,600]) and the Democratic Republic of the Congo (2010: 39,700 [CI: 32,600-48,800]; 2050: 44,700 [CI: 27,100-70,500]) will remain the countries most in need of policies for the prevention and management of SCA. We predict a decrease in the annual number of newborns with SCA in India (2010: 44,400 [CI: 33,700-59,100]; 2050: 33,900 [CI: 15,900-64,700]). The implementation of basic health interventions (e.g., prenatal diagnosis, penicillin prophylaxis, and vaccination) for SCA in 2015, leading to significant reductions in excess mortality among under-five children with SCA, could, by 2050, prolong the lives of 5,302,900 [CI: 3,174,800-6,699,100] newborns with SCA. Similarly, large-scale universal screening could save the lives of up to 9,806,000 (CI: 6,745,800-14,232,700) newborns with SCA globally, 85% (CI: 81%-88%) of whom will be born in sub-Saharan Africa. The study findings are limited by the uncertainty in the estimates and the assumptions around mortality reductions associated with interventions.Our quantitative approach confirms that the global burden of SCA is increasing, and highlights the need to develop specific national policies for appropriate public health planning, particularly in low- and middle-income countries. Further empirical collaborative epidemiological studies are vital to assess current and future health care needs, especially in Nigeria, the Democratic Republic of the Congo, and India

Artemisia Spp. Derivatives for COVID-19 Treatment: Anecdotal Use, Political Hype, Treatment Potential, Challenges, and Road Map to Randomized Clinical Trials

The world is currently facing a novel COVID-19 pandemic caused by SARS-CoV-2 that, as of July 12, 2020, has caused a reported 12,322,395 cases and 556,335 deaths. To date, only two treatments, remdesivir and dexamethasone, have demonstrated clinical efficacy through randomized controlled trials (RCTs) in seriously ill patients. The search for new or repurposed drugs for treatment of COVID-19 continues. We have witnessed anecdotal use of herbal medicines, including Artemisia spp. extracts, in low-income countries, and exaggerated claims of their efficacies that are not evidence based, with subsequent political controversy. These events highlight the urgent need for further research on herbal compounds to evaluate efficacy through RCTs, and, when efficacious compounds are identified, to establish the active ingredients, develop formulations and dosing, and define pharmacokinetics, toxicology, and safety to enable drug development. Derivatives from the herb Artemisia annua have been used as traditional medicine over centuries for the treatment of fevers, malaria, and respiratory tract infections. We review the bioactive compounds, pharmacological and immunological effects, and traditional uses for Artemisia spp. derivatives, and discuss the challenges and controversies surrounding current efforts and the scientific road map to advance them to prevent or treat COVID-19

Proceedings of a Sickle Cell Disease Ontology workshop - Towards the first comprehensive ontology for Sickle Cell Disease

Sickle cell disease (SCD) is a debilitating single gene disorder caused by a single point mutation that results in physical deformation (i.e. sickling) of erythrocytes at reduced oxygen tensions. Up to 75% of SCD in newborns world-wide occurs in sub-Saharan Africa, where neonatal and childhood mortality from sickle cell related complications is high. While SCD research across the globe is tackling the disease on multiple fronts, advances have yet to significantly impact on the health and quality of life of SCD patients, due to lack of coordination of these disparate efforts. Ensuring data across studies is directly comparable through standardization is a necessary step towards realizing this goal. Such a standardization requires the development and implementation of a disease-specific ontology for SCD that is applicable globally. Ontology development is best achieved by bringing together experts in the domain to contribute their knowledge. The SCD community and H3ABioNet members joined forces at a recent SCD Ontology workshop to develop an ontology covering aspects of SCD under the classes: phenotype, diagnostics, therapeutics, quality of life, disease modifiers and disease stage. The aim of the workshop was for participants to contribute their expertise to development of the structure and contents of the SCD ontology. Here we describe the proceedings of the Sickle Cell Disease Ontology Workshop held in Cape Town South Africa in February 2016 and its outcomes. The objective of the workshop was to bring together experts in SCD from around the world to contribute their expertise to the development of various aspects of the SCD ontology

Misconceptions about HIV infection in Kinshasa (Democratic Republic of Congo): a Case-control Study on knowledge, attitudes and practices

Objectives: To evaluate the prevalence of HIV-related misconceptions in an Outpatient Centre of Kinshasa (D.R.Congo) and analyze the association between these beliefs and HIV infection. Methods: A case-control study was carried out from December 2010 until June 2012. We assessed 1,630 participants aged 15-49 attending a primary outpatient centre in Kinshasa: 762 HIV Voluntary Counseling and Testing attendees and 868 blood donors. A 59-item questionnaire about knowledge, attitudes and practice was administered during a face-to-face interview, followed by an HIV test. Cases and controls were respondents with a newly diagnosed HIV positive or negative test, respectively. Unconditional logistic regression was used to analyse the association between misconceptions and HIV seropositivity. Results:Two hundred and seventy four cases and 1,340 controls were recruited. Cases were more likely than controls to have a low socioeconomic status, no education, to be divorced/separated or widowed. An association was found between the following variables and HIV-seropositivity: having a poor HIV knowledge (adjusted OR=2.79; 95%CI:1.43-5.45), not knowing a virus is the cause of AIDS (adjusted OR=2.03; 95%CI:1.38-2.98) and reporting more than three HIV-transmission-related misconceptions (adjusted OR=3.30; 95%CI:1.64-6.64), such as thinking an HIV+ person cannot look healthy and that HIV is transmitted by sorcery, God´s punishment, a kiss on the mouth, mosquitoes, coughs/sneezes or undercooked food. Conclusion:Despite having access to health care services, there are still many people in Kinshasa that have HIV-related misconceptions which increase their HIV risk. Our findings underscore the need for a culturally-adapted and gender-orientated basic HIV information into Congolese HIV prevention programs

Assessment of Clinical Outcomes Among Children and Adolescents Hospitalized With COVID-19 in 6 Sub-Saharan African Countries

Importance: Little is known about COVID-19 outcomes among children and adolescents in sub-Saharan Africa, where preexisting comorbidities are prevalent. / Objective: To assess the clinical outcomes and factors associated with outcomes among children and adolescents hospitalized with COVID-19 in 6 countries in sub-Saharan Africa. / Design, Setting, and Participants: This cohort study was a retrospective record review of data from 25 hospitals in the Democratic Republic of the Congo, Ghana, Kenya, Nigeria, South Africa, and Uganda from March 1 to December 31, 2020, and included 469 hospitalized patients aged 0 to 19 years with SARS-CoV-2 infection. / Exposures: Age, sex, preexisting comorbidities, and region of residence. / Main Outcomes and Measures: An ordinal primary outcome scale was used comprising 5 categories: (1) hospitalization without oxygen supplementation, (2) hospitalization with oxygen supplementation, (3) ICU admission, (4) invasive mechanical ventilation, and (5) death. The secondary outcome was length of hospital stay. / Results: Among 469 hospitalized children and adolescents, the median age was 5.9 years (IQR, 1.6-11.1 years); 245 patients (52.4%) were male, and 115 (24.5%) had comorbidities. A total of 39 patients (8.3%) were from central Africa, 172 (36.7%) from eastern Africa, 208 (44.3%) from southern Africa, and 50 (10.7%) from western Africa. Eighteen patients had suspected (n = 6) or confirmed (n = 12) multisystem inflammatory syndrome in children. Thirty-nine patients (8.3%) died, including 22 of 69 patients (31.9%) who required intensive care unit admission and 4 of 18 patients (22.2%) with suspected or confirmed multisystem inflammatory syndrome in children. Among 468 patients, 418 (89.3%) were discharged, and 16 (3.4%) remained hospitalized. The likelihood of outcomes with higher vs lower severity among children younger than 1 year expressed as adjusted odds ratio (aOR) was 4.89 (95% CI, 1.44-16.61) times higher than that of adolescents aged 15 to 19 years. The presence of hypertension (aOR, 5.91; 95% CI, 1.89-18.50), chronic lung disease (aOR, 2.97; 95% CI, 1.65-5.37), or a hematological disorder (aOR, 3.10; 95% CI, 1.04-9.24) was associated with severe outcomes. Age younger than 1 year (adjusted subdistribution hazard ratio [asHR], 0.48; 95% CI, 0.27-0.87), the presence of 1 comorbidity (asHR, 0.54; 95% CI, 0.40-0.72), and the presence of 2 or more comorbidities (asHR, 0.26; 95% CI, 0.18-0.38) were associated with reduced rates of hospital discharge. / Conclusions and Relevance: In this cohort study of children and adolescents hospitalized with COVID-19 in sub-Saharan Africa, high rates of morbidity and mortality were observed among infants and patients with noncommunicable disease comorbidities, suggesting that COVID-19 vaccination and therapeutic interventions are needed for young populations in this region

Mortality in Sickle Cell Anemia in Africa: A Prospective Cohort Study in Tanzania

Background: The World Health Organization has declared Sickle Cell Anemia (SCA) a public health priority. There are 300,000 births/year, over 75% in Africa, with estimates suggesting that 6 million Africans will be living with SCA if average survival reaches half the African norm. Countries such as United States of America and United Kingdom have reduced SCA mortality from 3 to 0.13 per 100 person years of observation (PYO), with interventions such as newborn screening, prevention of infections and comprehensive care, but implementation of interventions in African countries has been hindered by lack of locally appropriate information. The objective of this study was to determine the incidence and factors associated with death from SCA in Dar-es-Salaam.Methods and Findings: A hospital-based cohort study was conducted, with prospective surveillance of 1,725 SCA patients recruited from 2004 to 2009, with 209 (12%) lost to follow up, while 86 died. The mortality rate was 1.9 (95% CI 1.5, 2.9) per 100 PYO, highest under 5-years old [7.3 (4.8-11.0)], adjusting for dates of birth and study enrollment. Independent risk factors, at enrollment to the cohort, predicting death were low hemoglobin (= 102 mu mol/L) [1.7 (1.0-2.9); p = 0.044] as determined by logistic regression.Conclusions: Mortality in SCA in Africa is high, with the most vulnerable period being under 5-years old. This is most likely an underestimate, as this was a hospital cohort and may not have captured SCA individuals with severe disease who died in early childhood, those with mild disease who are undiagnosed or do not utilize services at health facilities. Prompt and effective treatment for anemia in SCA is recommended as it is likely to improve survival. Further research is required to determine the etiology, pathophysiology and the most appropriate strategies for management of anemia in SCA