Voluntary Counseling and Testing for HIV in Rural Area of Democratic Republic of the Congo: Knowledge, Attitude, and Practice Survey among Service Users

Aims. To determine the prevalence of HIV, the level of sexual risk for HIV, and determinants of VCT attendance among adult population living in a rural area. Methods. A cross-sectional study was conducted in Mbanza-Ngungu, Democratic Republic of the Congo. An anonymous questionnaire was designed to extract relevant data. Results. In our cohort, 69% were respondents of more than 24 years of age and the single marital status was most represented (64.1%). A high proportion of respondents (90.6%) visited VCT service for requiring information (good acceptability). Positive test for HIV was reported in 9.4% of respondents. In this cohort, 49.6% of respondents had declared themselves to never use condom. In binary analysis, there was association between positive HIV test and age (p=0.04) and religions (p=0.02). In this cohort, it was observed that positive HIV test was significantly associated with confidentiality (p=0.02). However, there was no association between positive HIV test and condom use (p=0.25), knowledge of VCT (p=0.81), service requested (p=0.20), and previous HIV test (p=0.68). Conclusions. Preventive information for AIDS should be recommended in the population living in rural zone

Black water fever associated with acute renal failure among Congolese children in Kinshasa

Acute renal failure (ARF) is reported in some severe forms of malaria such as black water fever (BWF). It is associated with a high mortality rate and can be managed effectively with adequate renal replacement. A prospective survey of children with dark urine after a malarial infection with Plasmodium falciparum was coupled with a chart review study of patients managed in the past 11 years in the Pediatrics′ Kinshasa University Hospital. Eighty-nine cases of ARF were identified, but data from only 63 patients were available, of whom 44 (69.8%) had severe malaria (39 with BWF and 5 with cerebral malaria). The mean age of the patients was 8.2 ± 1.73 years. Of the 39 cases of BWF, an association with quinine ingestion was observed in 32 children (82%). Urea and creatinine levels were elevated in all cases (135.4 ± 88.2 and 3.83 ± 2.81 mg/dL, respectively). Oligo-anuria was observed in 44.4%, severe metabolic acidosis (bicarbonate <15 mEq/L) in 61.5% and hyponatremia (<130 mEq/L) in 33.3%. Peritoneal dialysis was required in 36 patients, including 20 with BWF. The remaining patients were managed with conservative treatment. Twenty-eight children (44.4%), including 20 on dialysis, fully recovered and 14 died (22.2%), including eight cases of BWF. Our study suggests that ARF is commonly associated with BWF in Congolese children. Elevated urea and creatinine and severe metabolic acidosis were observed more often than other clinical/metabolic disturbances. Severe renal impairment remains a significant complication with a high mortality rate in low-resource settings

Interactions between malaria and HIV infections in pregnant women: a first report of the magnitude, clinical and laboratory features, and predictive factors in Kinshasa, the Democratic Republic of Congo

International audienceBackground: HIV and malaria are among the leading causes of morbidity and mortality during pregnancy in Africa. However, data from Congolese pregnant women are lacking. The aim of the study was to determine the magnitude, predictive factors, clinical, biologic and anthropometric consequences of malaria infection, HIV infection, and interactions between malaria and HIV infections in pregnant women. Methods: A cross-sectional study was conducted among pregnant women admitted and followed up at Camp Kokolo Military Hospital from 2009 to 2012 in Kinshasa, the Democratic Republic of Congo. Differences in means between malaria-positive and malaria-negative cases or between HIV-positive and HIV-negative cases were compared using the Student's t-test or a non-parametric test, if appropriate. Categorical variables were compared using the Chi-square or Fisher's exact test, if appropriate. Backward multivariable analysis was used to evaluate the potential risk factors of malaria and HIV infections. The odds ratios with their 95% confidence interval (95% CI) were estimated to measure the strengths of the associations. Analyses resulting in values of P < 0.05 were considered significant. Results: A malaria infection was detected in 246/332 (74.1%) pregnant women, and 31.9% were anaemic. Overall, 7.5% (25/332) of mothers were infected by HIV, with a median CD4 count of 375 (191; 669) cells/μL. The mean (±SD) birth weight was 2,613 ± 227 g, with 35.7% of newborns weighing less than 2,500 g (low birth weight). Low birth weight, parity and occupation were significantly different between malaria-infected and uninfected women in adjusted models. However, fever, anemia, placenta previa, marital status and district of residence were significantly associated to HIV infection. Conclusion: The prevalence of malaria infection was high in pregnant women attending the antenatal facilities or hospitalized and increased when associated with HIV infection

Évaluation du niveau d'information sur la drépanocytose des étudiants en médecine à Bruxelles, Belgique

Aim: The increasing prevalence of sickle cell disease (SCD) is an important issue in Belgium due to migrations from high prevalence areas. It has become the most common genetic disease in Belgium. The impact is important in terms of health service delivery, especially since Belgian physicians have little experience with the disease. This study was designed to determine the current level of knowledge about SCD among medical students at the Louvain's Catholic University, Brussels. Method: This study was part of a larger cross-sectional and descriptive study carried out at the Louvain's Catholic University in December 2010. Data were collected from medical students using self-administered structured questionnaires. Results: In this study, 152 students were enrolled. All respondents had heard about SCD, the majority during their medical school curriculum. All students (100%) thought SCD is an African disease. A majority recognized that SCD is a serious illness and that it is linked with malaria. Anemia was the most frequently cited symptoms (98.0%) followed by splenomegaly (77.5%). Only 51% reported pain as a symptom. A majority knew they would have patients with the disease in their future career but only 2.3% of students considered specializing in the field of SCD. Using criteria for scoring information delivery, awareness about SCD was among the lowest in Belgium. Conclusion: For Belgian medical students, SCD is an exotic disease. Too little information about SCD is delivered. Continuing medical education about SCD can be recommended for medical students in Belgium. © 2013.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Exploring association between MBL2 gene polymorphisms and the occurrence of clinical blackwater fever through a case-control study in Congolese children

BACKGROUND: Blackwater fever (BWF), one of the most severe and life-threatening forms of falciparum malaria, is characterized by acute massive intravascular haemolysis, often leading to acute renal failure. Thus far, the genetics of the underlying susceptibility to develop BWF is not fully elucidated. Deficiency in the MBL protein, an important component of the innate immune system, has previously been suggested to be a susceptibility factor for the development of severe malaria. This study aimed to evaluate the association between MBL2 gene polymorphisms, known to affect the MBL protein level/activity, and the occurrence of BWF among Congolese children. METHODS: This is a case-control study. Cases were patients with BWF, whereas controls, matched for gender and age, had uncomplicated malaria (UM). Dried blood spot was collected for genotyping. RESULTS: A total of 129 children were screened, including 43 BWF and 86 UM. The common allele in BWF and UM was A, with a frequency of 76.7 and 61.0%, respectively (OR: 2.67 (0.87-829) and p = 0.079). The frequency of the C allele was 18.6 and 29.1% in BWF and UM groups, respectively, with p = 0.858. Not a single D allele was encountered. Genotype AA was at higher risk for BWF whereas genotypes A0 (AB and AC) were over-represented in UM group (OR: 0.21 (0.06-0.78)) with p = 0.019. Nine haplotypes were observed in this study: 3 high MBL expression haplotypes and 6 low MBL expression haplotype. One new haplotype HYPC was observed in this study. None of these haplotypes was significantly associated with BWF. CONCLUSION: This pilot study is a preliminary research on MBL2 gene and infectious diseases in DRC. The study results show a higher risk for BWF in AA. This suggests that future studies on BWF should further investigate the contribution of a strong immune response to the occurrence of BWF.status: publishe

High IgG1 Malaria Antibodies Level in Children is a Possible Risk Factor of Blackwater Fever: A Case-Control Study

peer reviewedContext: Pathogenesis of acute massive intravascular hemolysis in Blackwater fever is very complex. Mostly, Malaria immunity deficiency in expatriates, Quinine and Plasmodium are incriminated. The possible role of malaria IgG1 antibodies in BWF is not fully elucidated. Objectives: This study aimed to determine the profile of malaria IgG1 for malaria crude antigen in children developing blackwater fever compared to patients with uncomplicated malaria Methods: This case-control study was conducted in 4 medical institutions across Kinshasa. Cases were patients with Blackwater fever (BWF) whereas controls had uncomplicated Plasmodium falciparum malaria (UM). For each case, 2 controls were recruited and were matched for age, sex and the area of residence. Malaria IgG1 were assessed by standard ELISA and absorbance measured in an automated plate reader. Results: The majority of BWF cases (81.4%) were above 5 years old while only 18.6% were aged below 5 (OR: 1.33; 0.53-3.32). The level of malaria IgG antibodies in BWF children were significantly higher compared to uncomplicated malaria (p=0.002). Quinine was used by 95.3% of the BWF cases ([OR: 50.19 (10.75-234.42)] p<0.001) versus in uncomplicated malaria. There was no linear correlation between the age of patients and the logarithm of antibodies. R2 is totally null (p=0.335). Conclusion: Malaria IgG1 antibodies is significantly elevated in children with BWF and could trigger the occurrence of BWF. The absence of correlation with age suggests that BWF could not be age dependent

Exploring association between MBL2 gene polymorphisms and the occurrence of clinical blackwater fever through a case-control study in Congolese children.

BACKGROUND: Blackwater fever (BWF), one of the most severe and life-threatening forms of falciparum malaria, is characterized by acute massive intravascular haemolysis, often leading to acute renal failure. Thus far, the genetics of the underlying susceptibility to develop BWF is not fully elucidated. Deficiency in the MBL protein, an important component of the innate immune system, has previously been suggested to be a susceptibility factor for the development of severe malaria. This study aimed to evaluate the association between MBL2 gene polymorphisms, known to affect the MBL protein level/activity, and the occurrence of BWF among Congolese children. METHODS: This is a case-control study. Cases were patients with BWF, whereas controls, matched for gender and age, had uncomplicated malaria (UM). Dried blood spot was collected for genotyping. RESULTS: A total of 129 children were screened, including 43 BWF and 86 UM. The common allele in BWF and UM was A, with a frequency of 76.7 and 61.0%, respectively (OR: 2.67 (0.87-829) and p = 0.079). The frequency of the C allele was 18.6 and 29.1% in BWF and UM groups, respectively, with p = 0.858. Not a single D allele was encountered. Genotype AA was at higher risk for BWF whereas genotypes A0 (AB and AC) were over-represented in UM group (OR: 0.21 (0.06-0.78)) with p = 0.019. Nine haplotypes were observed in this study: 3 high MBL expression haplotypes and 6 low MBL expression haplotype. One new haplotype HYPC was observed in this study. None of these haplotypes was significantly associated with BWF. CONCLUSION: This pilot study is a preliminary research on MBL2 gene and infectious diseases in DRC. The study results show a higher risk for BWF in AA. This suggests that future studies on BWF should further investigate the contribution of a strong immune response to the occurrence of BWF