Facteurs d’affiliation aux pairs sont étroitement associés à la criminalité des jeunes incarcérés à la prison centrale de Kinshasa : Affiliation Factors to Peers are strongly associated to the Criminality among the Youth of the Central Prison of Kinshasa

Context and objective. Increasing crime is one of the major social problems facing in the context of armed conflicts of various kinds. The objective of this study is to investigate the determinants of the peer affiliation domain of criminal and violent criminal behavior. Methods. We undertook a case-control study included 500 subjects: 297 incarcerated criminals (189 violent criminals, as crime against a person and 108 non-violent criminals, as crime against property) against 203 noncriminal subjects, between August 2015 and December 2016. We selected control subjects from general population of the city of Kinshasa and matched them with cases according to gender, age (± 2 years) and geographical origin. Logistic regression analysis was used to investigate the determinants of criminality and of violent criminality. Results. Compared to noncriminals, criminals were significantly gang members (55.6% versus 4.9%, p<0.001), carry guns (40.1% versus 7.9%, p<0.001), attend parties with friends without parental supervision (69.7% versus 34%, p<0.001), and have friends who sell drugs (44.4% versus 14.8%, p<0.001). Compared to non-violent criminals, violent criminals were significantly more likely to be gang members (60.8% versus 46.3%, p=0.015), carry weapons (46.6% versus 28.7%, p=0.003) and have friends who sell heroin (50.3% versus 34.3%, p=0.008). In multivariate logistic regression analyse, being a gang member (ORa 13.6; 95% CI: 6.76-27.67), carrying a weapon (ORa 2.85; 95% CI: 1.5-5.42) and unsupervised parties (ORa 1.95; 95% CI: 1.25-3.02) were the independently associated with crime. Only carrying weapons (ORa 1.87; 95% CI: 1.05-3.32) emerged as an independent determinant of violent crime. Conclusion. Violent and non-violent crime is a continuum in which the former differs from the latter in terms of carrying a weapon. Gang involvement, social gatherings with friends and carrying weapons are the common threads of their criminal behavior. Contexte et objectif. La criminalité croissante compte parmi les problèmes sociaux majeurs en République Démocratique du Congo aux prises à des conflits armés de diverse nature. Cette étude a pour objectif de rechercher les déterminants du domaine d’affiliation aux pairs du comportement criminel et criminel violent. Méthodes. Nous avons entrepris une étude cas-témoin enrôlant 500 sujets : 297 criminels incarcérés (189 criminels violents, crime contre la personne et 108 criminels non violents, crime contre la propriété) contre 203 sujets non criminels, entre août 2015 et décembre 2016. Les témoins ont été recrutés dans la population générale de la ville de Kinshasa et appariés aux cas, selon le sexe (même), l’âge (± 2 ans) et la provenance géographique. L’analyse de régression logistique a été utilisée pour rechercher les déterminants de la criminalité. Résultats. Comparés aux non criminels, les criminels étaient significativement membres de gang (55,6% versus 4,9%, p < 0,001), porteurs des armes (40,1% versus 7,9% ; p <0,001), dans des soirées entre amissans supervision parentale (69,7% versus 34%, p<0,001), et  avaient des amis vendeurs de drogues (44,4% versus 14,8%, p<0,001). Par rapport aux criminels non violents, les criminels violents étaient significativement membres de gang (60,8% versus 46,3%, p=0,015), porteurs des armes (46,6% versus 28,7%, p=0,003) et avaient des amis vendeurs de drogues (50,3% versus 34,3%, p=0,008). En analyse de régression logistique multivariée, être membre de gang (ORa 13,6; IC 95% : 6,76-27,67), porter une arme (ORa 2,85; IC 95% : 1,5-5,42) et assister dans les soirées sans supervision (ORa 1,95; IC 95% : 1,25-3,02) constituaient les déterminants indépendamment associés à la criminalité. Seul porter des armes (ORa 1,87; IC 95% : 1,05-3,32) a émergé comme déterminant indépendant de la criminalité violente. Conclusion. La criminalité violente et non violente constitue un continuum dans lequel la première se différencie de la deuxième par le port d’arme. La participation à un gang, les soirées entre amis et le port d’arme constituent le fils conducteur de leur comportement criminel. &nbsp

Caractéristiques et suivi de la dépression post-accident vasculaire cérébral à Kinshasa

BACKGROUND The World Health Organization has identified the emergence of non -communicable chronic diseases in developing countries including strokes. In Africa, stroke ranks first among the causes of death. Depression (PSD) is a common complication after stroke onset. To our knowledge there are no systematic studies which have focused on PSD Democratic Republic of Congo. OBJECTIVE The overall objective is to promote holistic care of stroke patients. To achieve this goal the following specific objectives were defined: to assess the prevalence of PSD, to determine the sociodemographic factors associated with the PSD occurrence , to determine clinical factors associated with PSD contribute to a better understanding of the term clinical PSD, to describe the evolution of the clinical profile of DPAVC on a one-year period , to determine factors associated to the development PSD over a period of one year. PATIENTS AND METHODS Two cross-sectional studies 58 and 56 patients and a longitudinal study of 30 patients were conducted between 1 August 2011 and 31 August 2012 at the rehabilitation center for people with disabilities in Kinshasa. The results have been published or accepted for publication by journals as articles. This doctoral dissertation was based on these three items. RESULTS Men were more represented than women. The subjects were rather young. Three quarters between them were under 65. The PSD was frequent among patients (53.6 %). The level of education of the patients was quite high. The PSD was associated with age ≥ 65 years, low level of education, the severity of neurological impairment assessed with the National Institutes of Health Stroke Scale (NIHSS), apathy by the scale of the apathy of Lille (LARS), evaluated with the scale of severity of fatigue (FSS) fatigue, the degree of disability assessed with the modified Rankin Scale (mRS) and poor condition assessment health by the patient. On the other side, satisfied subjects by perceived social support were less depressed than unmet subjects. Over a period of one year, the prevalence of depression did not differ significantly. Factors such as apathy and age ≥ 65 years remained associated with PSD with an increase in strength of the association for the first. CONCLUSION The PSD is common in Kinshasa. The observed frequence is, similar to that observed in previous work in the world and in Africa. Frequency remains stable over time. The results will allow a better understanding of the disease and improve care by involving psychiatrists in collaboration with the family or the immediate environment of the patient.(MED - Sciences médicales) -- UCL, 201

Stress syndrome in patients receiving outpatient treatment at the General Hospital, in Bangui, in a context of armed conflict

peer reviewedContext: in Africa's zones of conflict, recent studies report a high frequency of post-traumatic stress disorder (PTSD) particularly in community settings. Objective: this study aimed to contribute to a better management of patients experiencing violence subsequent to the Central African Republic socio-political conflict. Material and methods: we conducted a cross-sectional study of the medical records of patients receiving outpatient treatment in the Doctors Without Borders/Médecins Sans Frontières (France) Trauma Center, Bangui. Results: 33.33% (n=35) of patients had PTSD, while 17.14% (n=18) of patients had acute stress syndrome. Stress syndrome (SS) was associated with female sex, rape, anxiety and depression. Rape multiplied the risk of SS occurrence by 8. The average age was 30 years (P25:22 years; P75:40 years). The majority of patients had mood disorder (63.81%; n=67). Insomnia was present in 62.83% (n=66) of patients. Hospital Anxiety and Depression Scale (HADS) was present in 44.76 % of patients. Depression was found in 40.95% (n=43) of patients. Conclusion: the obtained results show how the society, apart from militia members, is affected by conflict-related violence in the country. These results can enrich the reflections on health organisation and on the management of patients in Central African, by considering the impact of conflict-related acute stress syndome in the short, medium and long term

États de stress en consultation externe à l’hôpital général de Bangui dans un contexte de conflit arme: étude transversale descriptive

Introduction: dans les zones de conflit en Afrique les récentes études rapportent des fréquences élevées des états de stress posttraumatiques (ESPT) notamment en milieu communautaire. L'objectif général de cette étude est de contribuer à une meilleure prise en charge des patients confrontés à la violence subséquente au conflit sociopolitique en cours en République centrafricaine. Méthodes: il s'agit d'une étude transversale portant sur les dossiers des patients reçus en consultation externe Trauma center de Médecins sans Frontières/France à Bangui. Résultats: l'ESPT était présent chez 33.33 % (n = 35) alors que l'état de stress aigu était présent chez 17.14 % (n = 18) des patients. Les états de stress (ES) étaient associés au sexe féminin, au viol, à l'anxiété et à la dépression. Le viol multipliait par 8 le risque de survenue d'un ES. L'âge médian observé était de 30 ans (P25: 22 ans; P75: 40 ans). La majorité des patients présentait un trouble de l'humeur (63.81 %; n = 67). L'insomnie était présente chez 62.83 % (n = 66). L'anxiété (HADS) était présente chez 44.76 % des patients (n = 47). La dépression a été retrouvée chez 40.95 % (n = 43). Conclusion: les résultats obtenus montrent à quel point, au-delà des membres de milices, la société est touchée par la violence du conflit que traverse le pays. Ces résultats pourraient nourrir la réflexion sur l'organisation des soins et la prise en charge de la population centrafricaine considérant l'impact à court, moyen et long terme des états de stress aigus en situation de conflit

Factors associated with behavioral problems and cognitive impairment in children with epilepsy of Kinshasa, Democratic Republic of the Congo.

BACKGROUND: Behavioral problems and cognitive impairment are common in children with epilepsy (CWE). In sub-Saharan Africa, little is known about these comorbidities particularly their relationships with socioeconomic features. The goal of this study was to identify clinical and socioeconomic factors associated with behavioral problems and cognitive impairment in CWE of Kinshasa (Democratic Republic of the Congo). METHODS: This cross-sectional hospital-based study had included 104 CWE aged 6 to 17years. Behavioral problems were assessed by the child behavior checklist. The Wechsler nonverbal scale of ability was used to assess cognitive impairment. RESULTS: At least one behavioral problem was found in 34.6% of CWE. Internalized problems were increasing with father's age (p=0.034). Externalized problems were increasing with the decreased of mother's age (p=0.009) and with a previous antiepileptic treatment (p=0.032). Total behavioral problems were increasing with a previous antiepileptic treatment (p=0.029). Cognitive impairment was present in 73.3% of CWE. It was more common in boys (p=0.013), and it was increasing with a low household daily expenses (p=0.034), with a previous antiepileptic treatment (p=0.041), with an early onset of epileptic seizures (p=0.042), and with a high frequency of epileptic seizures (p=0.011). CONCLUSION: Behavioral problems and cognitive impairment are common in CWE. Multivariate analysis has shown that behavioral problems were associated with socioeconomic features only. Contrariwise, cognitive impairment was associated with both socioeconomic factors and clinical features. There is a need of more studies to improve knowledge of these comorbidities in the sub-Saharan Africa context

Évolution clinique de la dépression post-accident vasculaire cérébral à Kinshasa - [Clinical profile of post-cerebrovascular depression: descriptive cross-sectional study in the rehabilitation center for people with disabilities of Kinshasa (DR Congo)].

Objectifs : Décrire l’évolution du profil clinique de la DPAVC sur une période d’un an et déterminer les facteurs associés à l’évolution de la DPAVC sur une période d’un an. Méthodes : Il s’agit d’une étude longitudinale portant sur 30 patients suivis pour hémiplégie post-accident vasculaire cérébral au Centre de réhabilitation pour personnes handicapées de Kinshasa (CRPHK). La sévérité de la dépression a été évaluée avec le « Patient Health Questionnaire » en abrégé PHQ9. Le protocole de l’étude a été administré à chaque patient à deux reprises avec une année d’intervalle. Résultats : L’âge moyen des patients était de 55,87±12,67ans. Soixante-dix pour cent des patients étaient des hommes. Il n’a pas été noté de différence statistiquement significative entre les deux évaluations pour l’état neurologique, l’état de santé perçu et les résultats du test de l’attention. Le pourcentage des patients présentant un syndrome dépressif était de 26,67 % en 2011 et de 20 % en 2012. Les scores aux échelles de l’invalidité et de l’apathie ont été améliorés de manière significative. La moyenne observée pour l’invalidité est passée de 2,77±1,19 à 2,46±2,19 (p=0,002). De 66,7 % en 2011, la proportion des patients capables de marcher sans aide est passée à 93,3 % en 2012 (p=0,03). Par ailleurs, la proportion des patients apathiques est passée de 43,3 % à 13,3 % (p=0,01). L’âge supérieur ou égal à 65ans, le sexe féminin, les troubles de sommeil post-AVC et l’apathie sont restés associés à la DPAVC entre les deux évaluations, avec une augmentation de la force de l’association pour l’apathie. Conclusions : La fréquence de la DPAVC chez les patients de Kinshasa est élevée et reste stable dans le temps. L’invalidité est la caractéristique clinique qui a évolué le plus favorablement. L’association avec l’apathie, présente au début de l’étude s’est renforcée dans le temps

Therapeutic itinerary of children living with epilepsy in Kinshasa: Features, determinants, and relationships with behavioral problems and cognitive impairment.

Epilepsy mostly affects children in sub-Saharan Africa. However, little is known about the therapeutic itinerary of these children living with epilepsy (CWE). This study aimed to describe the therapeutic itinerary of CWE in Kinshasa and to analyze its relationships with clinical features, behavioral problems, and cognitive impairment. This hospital-based study has included 104 CWE aged 6 to 17  years. The features of their therapeutic itinerary and their relationship with clinical features, behavioral problems, and cognitive impairment were analyzed. The vast majority of CWE (87%) has started their therapeutic itinerary by the Western medicine. The first source of information about epilepsy as well as the type of antiepileptic treatment varied with the socioeconomic status of families of CWE. The total duration of the therapeutic itinerary was shorter for the CWE who were living with both their parents (P = .038), who had generalized seizures (P = .0073) or who had no family history of epileptic seizures (P = .019). The CWE who had total behavioral problem, compared with the others, were putting more time (P = .021) to reach the Centre de Santé Mentale Telema (CSMT) after the suspicion or the diagnostic of epilepsy. The total duration of CWE who had cognitive impairment (P = .021) was longer than that of CWE who had not cognitive impairment. The therapeutic itinerary of CWE in Kinshasa began with Western medicine. The remainder of this therapeutic itinerary looks like what is described in sub-Saharan literature with the majority of CWE seeking the healing based on beliefs. This study also shows that the therapeutic itinerary of CWE was associated with socioeconomic conditions, clinical features, behavioral problems, and cognitive impairment

Profil clinique de la dépression post- accident vasculaire cérébral étude transversale descriptive menée au centre de réhabilitation des personnes handicapées de Kinshasa (RD Congo)- [Clinical profile of post-cerebrovascular depression: descriptive cross-sectional study in the rehabilitation center for people with disabilities of Kinshasa (DR Congo)}

Introduction: L'objectif général poursuivi dans cette étude est de décrire le tableau clinique de la dépression post-accident vasculaire cérébral (DPAVC) à Kinshasa. Méthodes: Il s'agit d'une étude transversale descriptive portant sur 56 patients suivis pour hémiplégie post-accident vasculaire cérébral au Centre de réhabilitation pour personnes handicapées de Kinshasa (CRPHK) du 1er au 31 août 2011. Résultats: Au Patient Health Questionnaire (PHQ9), 21. 40 % des patients présentaient une dépression modérée à sévère. A l'échelle de Rankin, 63. 8% des patients étaient capables de marcher sans aide. L'apathie modérée à sévère était présente chez 44. 64%; à l'échelle de sévérité de la fatigue, le score de 12. 7 % des sujets était compatible avec un état dépressif. La dépression était associée à la sévérité des troubles neurologiques, à l'incapacité évaluée avec l'échelle de Rankin, à l'apathie et à une appréciation mauvaise de son propre état de santé par le patient. Conclusion: La DPAVC est fréquente à Kinshasa parmi les patients en réhabilitation. La fréquence observée est comparable à celles retrouvées dans des travaux antérieurs dans le monde et aux rares travaux publiés en Afrique. La DPAVC est associée de manière significative à la sévérité des troubles neurologiques, au degré d'handicap, à la fatigue, à l'apathie et à la mauvaise perception de son état de santé

Sociodemographic profile and social support for post-stroke depression in Kinshasa: A rehabilitation based cross-sectional study

The World Health Organization has highlighted the emergence of non-communicable chronic diseases, including stroke, in developing countries. As a cause of death, stroke ranks first in Africa. Stroke is the foremost cause of neuropsychiatric disease, including post-stroke depression (PSD) which is a very common disease. Surveys of this condition in Congolese pa tients are virtually non-existent. The objectives of this study were to assess the prevalence of PSD in Congolese patients and identify associated sociodemographic factors. Age, sex, address, province of origin, social and professional status, education, religion and consumption habits were chosen as indicators or parameters of interest to be examined in this study. The results of descriptive analyses are presented as frequencies for categorical variables and as mean ± standard deviation for quantitative variables. The association between different variables was assessed using tables of comparisons of proportions and the Chi-square test. Logistic regression was performed to predict the occurrence of PSD. There were more male than female patients. The mean age was 54.67 ± 12.51 years. Nearly 3 fourths of the patients were aged less than 65. The family was the primary source of social support. The majority was satisfied by the social support received from the family. Just over half the study patients (53.6%) had mild to severe depression as assessed by the PHQ9. Univariate analysis and logistic regression indicated a statistically significant association between low educational level and the occurrence of PSD. However, there was no relationship between age, sex or drinking habits and the onset of PSD. The majority of the subjects were satisfied by the social support from their families. Depression was common after stroke with the occurrence of 53.6%. These results highlight the need to investigate, diagnose and treat PSD, which is a risk factor for morbidity and mortality after stroke

Are the children with epilepsy treated traditionally a disadvantaged group? A pilot study

peer reviewedIntroduction: in sub-Saharan Africa, the proportion of persons with epilepsy who seek traditional treatment is estimated at 80%. Despite that children are the firsts concerned by epilepsy, the characteristics and particularities of the children with epilepsy (CWE) who resort to traditional treatment are not known. The aim of this pilot study was to identify clinical particularities of the CWE who resort to traditional treatment. Methods: CWE between 6 to 17 years were included in the study based on their histories of previous antiepileptic treatments. The CWE previously treated by traditional healers were compared to others CWE. Results: data from 140 CWE whose previous treatments had been documented were selected. The duration of epilepsy (7 [3.0-9.8] years versus 3 [1.0-7.0] years, p=0.013) was higher for the CWE traditionally treated compared to the CWE without any antiepileptic treatment. The seizure frequency (8.7 [1.5-91.3]/month versus 1 [3-30.4]/month, p=0.036) was higher for the CWE traditionally treated compared to the CWE without any antiepileptic treatment, but the p-value was under the Bonferroni correction (p=0.017). There was no differences between the CWE traditionally treated and the CWE previously treated with antiepileptic drugs. Conclusion: compared to others, the CWE who resort to traditional medicine spend much time before consulting health facilities and could have a more serious epilepsy. We have discussed on factors that could explain these differences