Profil épidémiologique des Cardiopathies congénitales à l’Hôpital Provincial Général de Référence de Bukavu: Epidemiological profile of congenital cardiopathy at General provincial hospital of Bukavu

Context and objective. Congenital heart disease (CHD) is one of the leading causes of child mortality worldwide, but the data from sub-Saharan Africa remains paradoxically scarce. The objective of this study was to describe the epidemiological profile and outcome of congenital heart disease in a semi-rural setting. Methods. In a retrospective study, the medical records of patients admitted for congenital heart disease between November 2014 and October 2016 were examined at the Provincial General Reference Hospital of Bukavu. The diagnosis of clinically suspected CHD was confirmed by transthoracic Doppler echocardiography (TDE). Results. Of the 7,397 children studied during the study period, 54 had CHD with a hospital frequency of 0.73% and an average age of 3 years old. The female sex was predominant (53.7%) with sex ratio of 1.24/1. Their average age was 3 years old. The most observed CHD were isolated interventricular communication (38.9%), isolated interauricular communication (31.5%), an atrio-ventricular canal (13%) and a tetralogy of Fallot (11.1%). In the absence of an appropriate technical platform, only three children (5.5%) underwent surgery. 6 deaths (11.1%) were deplored. Conclusion: The CHD with a preponderance of interventricular and interauricular communication accounts for nearly one percent of admissions to this semi-rural hospital. Unfortunately, their surgical management of CHD remains a very serious problem, which explains late diagnosis and high mortality. Contexte et objectif. Les cardiopathies congénitales (CC) constituent l’une des causes majeures de mortalité infantile dans le monde, mais les données y relatives en Afrique subsaharienne restent paradoxalement fragmentaires. L’objectif de la présente étude était de décrire le profil épidémiologique et l’issue vitale des cardiopathies congénitales dans un milieu semi rural. Méthodes. Dans une étude documentaire, les dossiers des patients admis pour CC entre novembre 2014 à octobre 2016, ont été colligés, à l’Hôpital Provincial Général de Référence de Bukavu. Le diagnostic de CC suspecté cliniquement, était confirmé par une échocardiographie Doppler transthoracique. Résultats. Des 7397 enfants suivis pendant la période d’étude, 54 avaient une cardiopathie congénitale soit une fréquence hospitalière de 0,73 %. Le sexe féminin était prépondérant (53,7%) avec sexe ratio de 1,24/1. Leur âge moyen était de 3 ans. Les CC les plus observées étaient : la communication interventriculaire isolée (38,9%), une communication inter auriculaire isolée (31,5%), un canal atrio-ventriculaire (13%) et une tétralogie de Fallot (11,1%). Faute de plateau technique approprié, seuls trois enfants (5,5%) ont bénéficié d’une chirurgie. 6 décès (11.1%) ont été déplorés. Conclusion. La CC avec une prépondérance des communications interventriculaire et inter auriculaire rend compte de près d’un pourcent d’admissions dans cet hôpital semi rural. Malheureusement leur prise en charge chirurgicale reste un très sérieux problème responsable du diagnostic tardif et de la forte mortalité

Applying the Robson classification to routine facility data to understand the Caesarean section practice in conflict settings of South Kivu, eastern DR Congo

Introduction: Sub-Saharan Africa has low Caesarean (CS) levels, despite a global increase in CS use. In conflict settings, the pattern of CS use is unclear because of scanty data. We aimed to examine the opportunity of using routine facility data to describe the CS use in conflict settings. Methods: We conducted a facility-based cross-sectional study in 8 health zones (HZ) of South Kivu province in eastern DR Congo. We reviewed patient hospital records, maternity registers and operative protocol books, from January to December 2018. Data on direct conflict fatalities were obtained from the Uppsala Conflict Data Program. Based on conflict intensity and chronicity (expressed as a 6-year cumulative conflict death rate), HZ were classified as unstable (higher conflict death rate), intermediate and stable (lower conflict death rate). To describe the Caesarean section practice, we used the Robson classification system. Based on parity, history of previous CS, onset of labour, foetal lie and presentation, number of neonates and gestational age, the Robson classification categorises deliveries into 10 mutually exclusive groups. We performed a descriptive analysis of the relative contribution of each Robson group to the overall CS rate in the conflict stratum. Results: Among the 29,600 deliveries reported by health facilities, 5,520 (18.6%) were by CS; 5,325 (96.5%) records were reviewed, of which 2,883 (54.1%) could be classified. The overall estimated population CS rate was 6.9%. The proportion of health facility deliveries that occurred in secondary hospitals was much smaller in unstable health zones (22.4%) than in intermediate (40.25) or stable health zones (43.0%). Robson groups 5 (previous CS, single cephalic, ≥ 37 weeks), 1 (nulliparous, single cephalic, ≥ 37 weeks, spontaneous labour) and 3 (multiparous, no previous CS, single cephalic, ≥ 37 weeks, spontaneous labour) were the leading contributors to the overall CS rate; and represented 75% of all CS deliveries. In unstable zones, previous CS (27.1%) and abnormal position of the fetus (breech, transverse lie, 3.3%) were much less frequent than in unstable and intermediate (44.3% and 6.0% respectively) and stable (46.7%and 6.2% respectively). Premature delivery and multiple pregnancy were more prominent Robson groups in unstable zones. Conclusion: In South Kivu province, conflict exposure is linked with an uneven estimated CS rate at HZ level with at high-risks women in conflict affected settings likely to have lower access to CS compared to low-risk mothers in stable health zones

Firearm injuries among children due to the Kivu conflict from 2017 to 2020: A hospital-based retrospective descriptive cohort study

Introduction: Firearm-related injuries are deadly but avoidable. The case of Kivu, a region in the Eastern Democratic Republic of Congo (DRC), is alarming. Decades of unresolved regional conflicts birthed armed groups that have massacred inhabitants and injured several children. This regional instability has also created barriers to seeking and obtaining timely care, decreasing the survival rate. This region\u27s lack of data on paediatric fatal and nonfatal firearm injuries (F&NFFIs) needs studying. Thus, we aim to determine the prevalence and evaluate the outcomes of paediatric F&NFFIs in Kivu. Methods: We included all F&NFFI paediatric patients (≤18 years), admitted at our institution between 2017 and 2020. We extracted data from patient records. Next, we assessed the relationship between determinants of paediatric outcomes using the Chi-square test and the student\u27s t-test. Confounders were identified using cox regression. Results: This study included 101 paediatric patients, mostly male (63.4%), with an average age of 15.9 years residing 164.4 km on average from the hospital. On average, they were admitted 2.9 days post-injury, with the most affected anatomical regions being lower limbs (53.5%) and upper limbs (18.8%). The mean length of stay was 52.9 days, and the mortality rate was 4.0%. Also, injury complications increased the mean length of stay and mortality rate. In addition, mortality was correlated with circulatory failure and anaemia. Discussion: Paediatric F&NFFIs in Eastern DRC is a preventable tragedy. Mortality is increased by injury complications and correlates with some biological factors. Prevention strategies should be developed to protect children and appropriate measures should be established to improve rates of prehospital care and early hospital presentation to lower mortality and improve paediatric outcomes

Psychopathological states among Congolese health workers during the first wave of COVID-19 pandemic: links with emotion regulation and social support

Background: The COVID-19 pandemic is an unprecedented stressor for frontline healthcare workers, notably increasing acute stress disorder and depression rates. Emotion regulation and social support could be major protective factors against such psychopathological states, but their role has not been explored outside Western contexts. Objective: To assess the association between emotion regulation, social support, acute stress disorder, and depression among healthcare workers directly confronted with the first wave of COVID-19 pandemic in the eastern Democratic Republic of the Congo. Method: A cross-sectional study assessed acute stress disorder, depression, adaptive (i.e. acceptance, positive refocusing, …) and maladaptive (i.e. self-blame, rumination, catastrophizing, …) emotion regulation strategies, social support (instrumental, emotional, and informational levels), as well as self-reported situations and feelings related to COVID-19, in a population of 252 frontline healthcare workers (121 women; 131 men; mean age: 39 ± 11 years old) at the Referral General Hospital of Bukavu. We also explored the relations between these variables through bivariate and multivariate logistic regression. Results: Forty percent of participants presented symptoms of depression, and 16% presented acute stress disorder. In bivariate logistic regression, these psychiatric outcomes were associated with the availability of a COVID-19 protection kit [OR = 0.24 (0.12–0.98)], hostility toward health workers [OR = 3.21 (1.23–4.21)], putting into perspective [OR = 0.91 (0.43–0.98)], self-blame [OR = 1.44 (1.11–2.39)], catastrophizing [OR = 1.85 (1.01–4.28)], blaming others [OR = 1.77 (1.04–3.32)], emotional support [OR = 0.83 (0.49–0.98)], instrumental support [OR = 0.74 (0.28–0.94)], and informational support [OR = 0.73 (0.43–0.98)]. In multivariate logistic regression, hostility [OR = 2.21 (1.54–3.78)], self-blame [OR = 1.57 (1.02-2.11)], rumination [OR = 1.49 (1.11-3.13)] and emotional support [OR = 0.94 (0.65-0.98)] remained significantly associated with psychiatric outcomes. Conclusion: Depression and acute stress disorder were highly prevalent among Congolese healthcare workers during the first wave of the COVID-19 health pandemic. Hostility, self-blame, rumination, and social support were associated with depression and/or acute stress disorder and should be targeted by interventions aiming to support health workers’ wellbeing. HIGHLIGHTS Frontline health workers presented high prevalence of acute stress disorder (16%) and depression (40%) during the first wave of COVID-19 pandemic in the Eastern Democratic Republic of the Congo, as they were working in hostile environment without enough protection kits. Acute stress disorder and depression were negatively associated with adaptive emotion regulation and social support; and positively with maladaptive emotion regulation. Intervention aiming to support health workers in pandemics should target emotion regulation and social support

Kernohan–Woltman notch phenomenon in patient with subdural hematoma and ipsilateral hemiparesis in Bukavu

Key Clinical Message Kernohan–Woltman phenomenon is a rare and paradoxical neurological situation in which a transtentorial lesion leads to compression of the contralateral cerebral peduncle responsible for compression of the descending corticospinal fibers with clinical consequence of a motor deficit ipsilateral to the primary lesion. This phenomenon should attract the attention of clinicians in order to avoid unfortunate incidents such as wrong‐side craniotomy in neurosurgical practice. In this work, we report a similar situation. Abstract The Kernohan–Woltman notch phenomenon is a rare and paradoxical neurological situation in which transtentorial damage is observed leading to compression of the contralateral cerebral peduncle responsible for compression of descending corticospinal fibers with the clinical consequence of a motor deficit ipsilateral to the primary lesion. This phenomenon has been found in several situations including tumors and cerebral hematomas after craniocerebral trauma. In this work, we have reported the case of a 52‐year‐old man with hemiparesis ipsilateral to a large chronic subdural hematoma

Human Milk output among mothers previously treated for severe acute malnutrition in childhood in Democratic Republic of Congo

Background: Malnutrition is a public health problem, as wasting affects 7.5% of children worldwide. The harmful effects of severe acute malnutrition (SAM) can last a lifetime, but how SAM in childhood affects later breastfeeding ability is not clear. In the present study, we assessed the human milk output and body composition among mothers with a history of childhood SAM. Methods: This retrospective cohort study was carried out in Miti-Murhesa Health Zone (Democratic Republic of Congo) from January 15 to March 17, 2020. We selected lactating mothers with breastfed infants aged 2–12 months. Two categories of mothers were included: those who had been treated for SAM during their childhood (years 1988–2003; n = 39) and a community control with no history of SAM (n = 40). The weight, height, and mid-upper arm circumference were measured and body mass index (BMI) calculated as weight/height2. Body composition and human milk output were assessed using standard deuterium dilution methods. Student t and chi2 tests ware applied to compare two groups. Results: The mean age ± standard deviation of the mothers was 24.4 ± 5.1 and 26.0 ± 6.1 years for the SAM and control groups, respectively (p = 0.186). The age of their infants was 5.4 ± 2.3 months in both groups (p = 0.962). In the SAM and control groups, the mean maternal BMI was 23.8 ± 2.3 and 23.6 ± 3.7 kg/m2 (p = 0.849), mean Fat Mass 27.1% ± 5.0 and 27.1% ± 5.8% (p = 0.708), and the mean Fat Free mass 72.9% ± 5.0 and 72.9% ± 5.8% (p = 0.998), respectively. Human milk output was 833.7 ± 152.1 g/d in SAM group and 827.4 ± 171.4 g/d in the control group (p = 0.864). Conclusions: We found no significant difference in human milk output and body composition in mothers treated for SAM during childhood compared to community controls.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Body composition of adults with a history of severe acute malnutrition during childhood using the deuterium dilution method in eastern DR Congo: the Lwiro Cohort Study

Background: Few studies have evaluated the body composition (BC) of adults who suffered from severe acute malnutrition (SAM) during childhood, a population at risk of long-term noncommunicable diseases. Objective: We performed an observational cohort study to evaluate BC in a group of young adults aged 11–30 y after nutritional rehabilitation for SAM, in the Democratic Republic of the Congo (DRC). Methods: We evaluated 151 adults in eastern DRC who were treated for SAM during childhood between 1988 and 2007. They were compared with 120 aged- and sex-matched control adults living in the same community who had not been exposed to malnutrition as children. The main variables of interest were the different compartments of adult BC (fat-free mass [FFM], fat mass [FM], and 2 indices of height-normalized BC: FFM index [FFMI] and FM index [FMI]) measured by deuterium dilution. Results: The mean age in both groups was 23 y, and females represented 49% and 56% of the exposed and nonexposed groups, respectively. SAM-exposed males had lower mean ± SD weight (53.6 ± 6.4 compared with 56.4 ± 7.9 kg, P = 0.029) and lower height (159.9 ± 6.6 compared with 163.6 ± 6.7 cm, P = 0.003) compared to unexposed males. SAM-exposed subjects had less FFM (–1.56 kg [–2.93, –0.20]; P = 0.024) but this observation was more marked in males (45.4 ± 5.4 compared with 48.2 ± 6.9 kg, P = 0.01) than in females. No differences in FM were noted between SAM-exposed and unexposed subjects. Adjusting for height, FFMI and FMI showed no difference between SAM-exposed and unexposed in either sex. Conclusion: SAM during childhood is associated with reduced FFM in adulthood which is probably due to a shorter height

The outcome of pectoralis major myocutaneous flap in the reconstruction of large defects in the lower face region after high velocity gunshot injury in the eastern part of DR Congo.

INTRODUCTION : Severe ballistic injuries to the face are common occurrence in South-Kivu province in the eastern Democratic Republic of the Congo (DRC) due to the 20 years’ unrest. High velocity ballistic injury creates large, complex and composite defects. Large soft tissue defects of the lower face actually rise concern as it is associated with cosmetic and functional deficits with that impact on patient's quality deeper than injuries in other areas of the body. [...

Unusual posterior elbow dislocation associated with radial head fracture managed non- operatively in Low and Middle Income countries.

The elbow is a complex joint consisting of ulnohumeral, proximal radioulnar, and radiocapitellar articulation. [...