Serum Vitamin D Levels in a Population of Adult Asthmatics in Kinshasa, Democratic Republic of Congo

Background: Vitamin D deficiency is common in general population and is thought to be involved in the natural history of several chronic lung diseases such as asthma. However, the magnitude of the association has not yet been reported in asthmatic adults in Sub-Saharan Africa.  The aim of this study was to determine serum vitamin D levels in adult patients with asthma living in Kinshasa. Methods: A sample of 216 subjects reporting asthma were recruited from the University Clinics of Kinshasa and some parishes in Kinshasa. Socio-demographic data were recorded, nutritional status assessed via body mass index (BMI) calculation, FEV1 values obtained, and serum vitamin D levels measured. Serum vitamin D levels were analyzed according to the time spent outdoors in the sun and their correlation with BMI and FEV1. Results: Participants were on average 45.23 years old (SD 17.56) and predominately female (74%). Serum vitamin D levels ranged from 5 to 42 ng/ml, with an average of 20.8 ng/ml (SD 6.1). Vitamin D levels were normal (≥30 ng/ml) in ten subjects (4.8%; 95% CI: 1.9-7.7) and abnormal (<30 ng/ml) in 197 subjects (95.2%; 95% CI: 92.0-98.0); of this latter group, 89% (95% CI: 84.6-93.2) were vitamin D insufficient (10-29 ng/ml) and 6% (95% CI: 3.0-9.6) vitamin D deficient (<10 ng/ml).Mean serum vitamin D levels did not differ based on the time spent outdoors in the sun (p = 0.714), and there was no correlation between serum vitamin D and FEV1 (r = 0.018) or BMI (r = 0.033). Conclusions: Vitamin D insufficiency is common in adult asthmatics in Kinshasa but does not appear to be correlated with FEV1 or BMI. Additional population-based surveys are needed to fully assess associations between asthma and vitamin D concentrations for targeted interventions

Child mortality in the Democratic Republic of Congo: cross-sectional evidence of the effect of geographic location and prolonged conflict from a national household survey

Background The child mortality rate is a good indicator of development. High levels of infectious diseases and high child mortality make the Democratic Republic of Congo (DRC) one of the most challenging environments for health development in Sub-Saharan Africa (SSA). Recent conflicts in the eastern part of the country and bad governance have compounded the problem. This study aimed to examine province-level geographic variation in under-five mortality (U5M), accounting for individual- and household-level risk factors including environmental factors such as conflict. Methods Our analysis used the nationally representative cross-sectional household sample of 8,992 children under five in the 2007 DRC Demographic and Health Survey. In the survey year, 1,005 deaths among this group were observed. Information on U5M was aggregated to the 11 provinces, and a Bayesian geo-additive discrete-time survival mixed model was used to map the geographic distribution of under-five mortality rates (U5MRs) at the province level, accounting for observable and unobservable risk factors. Results The overall U5MR was 159 per 1,000 live births. Significant associations with risk of U5M were found for < 24 month birth interval [posterior odds ratio and 95% credible region: 1.14 (1.04, 1.26)], home birth [1.13 (1.01, 1.27)] and living with a single mother [1.16 (1.03, 1.33)]. Striking variation was also noted in the risk of U5M by province of residence, with the highest risk in Kasaï-Oriental, a non-conflict area of the DRC, and the lowest in the conflict area of North Kivu. Conclusion This study reveals clear geographic patterns in rates of U5M in the DRC and shows the potential role of individual child, household and environmental factors, which are unexplained by the ongoing conflict. The displacement of mothers to safer areas may explain the lower U5MR observed at the epicentre of the conflict in North Kivu, compared with rates in conflict-free areas. Overall, the U5M maps point to a lack of progress towards the Millennium Development Goal of reducing U5M by half by 2015

Etude observationnelle sur l’hémovigilance transfusionnelle à Kinshasa, République Démocratique du Congo: Haemovigilance in blood transfusion: an observational study from Kinshasa, the Democratic Republic of the Congo

Context and objective. Although most countries in sub-Saharan Africa have transfusion centers, haemovigilance data are paradoxically scarce. The objective of the present study was to identify the recipient adverse effect (RAT) of blood transfusion. Methods. We conducted a cross-sectional observational study in two blood transfusion centers in Kinshasa, between July and November 2015. The general principles of haemovigilance during the transfusion episode were observed to identify the EIR. On each blood product, bacteriological, immunological, serological and parasitic analyzes were systematically performed. Results. 346 subjects were enrolled (female, 53.2%).The overall frequency of RAT during transfusion was 2.9%. It was most commonly urticaria (5 cases), pruritus (4 cases), fever (3 cases) and vomiting (3 cases). Control tests on patients with RAT yielded the following results: 2 seropositive for Human Immunodeficiency Virus (HIV), 2 seropositive for Hepatitis C virus (HVC), and 1 seropositive for Rapid Plasma Reagent (RPR) test. Conclusion. RAT is relatively common in Kinshasa due partially to compatibility error. The observance of the protocols of haemovigilance system is not optimal in both hospitals studied. A large multicenter study should be performed to better identify the concerns and thus secure blood products. Contexte et objectif. Bien que la plupart de pays d’Afrique subsaharienne aient de centres transfusionnels, mais les données sur l’hémovigilance sont paradoxalement fragmentaires. L’objectif de la présente étude était d’identifier l’effet indésirable du receveur (EIR) transfusionnel. Méthodes. Nous avons réalisé une étude observationnelle transversale dans deux centres de transfusion sanguine à Kinshasa, entre juillet et novembre 2015.Les principes généraux de l’hémovigilance au cours de l’épisode transfusionnel ont été observés en vue d’identifier l’EIR. Pour tout cas d’EIR, le contrôle du groupe sanguin, des analyses bactériologique, immunologique (test de compatibilité), sérologique et parasitaire ont été systématiquement effectués dans la poche du produit sanguin labile (PSL) et du receveur. Résultats.346 sujets ont été enrôlés (sexe féminin, 53,2%).La fréquence globale d’EIR durant la transfusion a été de 2,9%.Il s’agissait de l’urticaire (5 cas), d’un prurit (4 cas), de la fièvre (3 cas) et de vomissements (3 cas). Alors qu’en milieu alcalin, tous les tests étaient compatibles, deux cas d’incompatibilités ont été observés à la fois en milieu albumineux et de Coombs. Après contrôle de qualité des cas ayant présenté l’EIR, 5 PSL de donneurs se sont révélés positifs (HIV, 2 cas ; HVC, 2 cas et rapid plasma reagen test, RPR, 1 cas). Conclusion. L’EIR est relativement fréquente à Kinshasa due en partie par une erreur de compatibilité. L’observance des protocoles du système de l’hémovigilance n’est pas optimale dans les deux formations étudiées. Une étude multicentrique à grande échelle est à envisager pour mieux identifier les écueils de l’hémovigilance et ainsi sécuriser les PSL

Vitamin D Deficiency and Risk of Uterine Leiomyoma among Congolese Women. A Hospital-Based Case-Control Study

The aim of the present study was to assess the relationship, between Vitamin D deficiency and uterine leiomyoma in Congolese women.From April 1 to October 31, 2014, 216 patients with ultrasound diagnosis of uterine leiomyoma (cases) and 216 women without this condition (controls) recruited in six medical facilities in Kinshasa were enrolled in the present study. A single blood sample was obtained from all participants to assess serum17β-estradiol and progesterone concentration using RIA and 25(OH) D by IRMA. Vitamin D deficiency was defined as 25(OH) D levels &lt;4 ng/mL and &lt;12 ng/mL using local and IOM cut-off levels, respectively. Chi square, Student t and Mann Whitney tests were used for group comparison. Logistic regression analysis was used to identify factors associated with Vitamin D deficiency. Vitamin D deficiency was observed in 17.1% and 47.7% of patients with ULM using local and IOM criteria defining different steps of vitamin D respectively. Compared to controls, the difference was statistically significant only when using local criteria (17.7% vs 10.2%; p = 0.028).ULM main risk factors were age ≥35 years (aOR=2,974; 95%CI 1,702-5,139; p = 0,001); null parity (aOR=3,951;95%CI 2,311-6,754;  p= 0,001). Familial history of ULM (aOR=2,619; 95% CI 1,376-4,986; p =0,003) personal history of ULM a(OR3,776; 95% CI 1,885-7,565;  p=0,001); absence of menopause(OR5,502; 95% CI 2,615-11,517; p= 0,001); high serum progesterone levels (aOR 2,320 95% CI1,136-4,711; p= 0,021),   alcohol consumption  (aOR0,295; 95 % CI 0,150-0,580; p= 0,001) and Vitamin D deficiency(aOR2,153; 95% CI 1,035-4,517; p=  0,040).  Vitamin D deficiency was a common finding in patients with ULM and emerged as one of the main risk factors. However, this relationship need to be confirmed with a representative sample of women with ULM

Bcl2, Bax and LMP1 Genes Expression in Uterine Leiomyoma Tissue According to Vitamin D Status among Congolese Women

The objective of this paper is to describe genes expression patterns of the anti-apoptotic Bcl2 and pro apoptotic Bax as well as EBV infection marker LMP1 in, leiomyoma tissue according to patients vitamin D status. To investigate the relationship between alterations of genes expression patterns and serum vitamin D levels, samples from 105 women undergoing surgery for uterine leiomyoma in 6 hospitals in Kinshasa from April 1 to October 31, 2014 were obtained for genes expression analysis of Bcl-2, Bax and LMP-1 genes. Genes expression in leiomyomas was measured by immunohistochemistry. Serum vitamin D levels were determined by IRMA. Association between vitamin D status and genes expression was assessed using logistic regression analysis. From 105 women providers of leiomyoma tissues examined, 41 were sufficients in vitamin D, 36 were insufficients and 28 deficients. In uterine leiomyoma tissues obtained Bcl2 was expressed in 96 (91.4%) of samples with low, moderate and high expression observed in 33.3%, 32.4% and 25.7%, respectively. The differences in Bcl2 expression between the three subgroups of vitamin D categories were not statistically significant.As a mirror of Bcl2 expression, Bax protein was not expressed in the majority (n = 95, 90.5%) of samples. Similar to Bcl2, the differences in Bax expression between the three subgroups of vitamin D categories did not reach the level of statistical significance. Of the 105 leiomyoma tissue examined, LMP1 was observed in 30 (28.6%) of samples and showed a tendency towards increased expression with the decline in vitamin D levels; however, the tendency was fairly not statistically significant.In multivariate analysis, predictors of Bcl2 expression were age, parity, and overweight/obesity and insufficiency/deficiency vitamin D; however, the differences observed were not statistically significant. The same predictors were also associated with Bax expression but once again the observed differences were not statistically significant. Vitamin D deficiency, the only predictor significantly associated with LMP1 expression, conferred a 3.9 fold greater risk (aOR 3.9; 95% CI 1.068-14.242; p = 0.039) of expressing LMP1 in leiomyoma tissue.In the present study, Bcl2 gene expression in ULM tissues tended to increase with the decline in vitamin D levels but observed differences were not statistically significant. In contrast, LMP1 gene expression was significantly associated with vitamin D deficiency. In spite of methodological limits, these findings do suggest a role of Vitamin D deficiency in the development and progression of ULM

Plant anatomy as a tool for evaluating the effect of different levels of nitrogen, plant population density, row spacing and irrigation on kenaf (Hibiscus cannabinus) fibre development

Kenaf (Hibiscus cannabinus) provides high-quality fibre that is used in papermaking, building materials and absorbents. The study aims were to conduct a proper anatomical study of fibre development in kenaf stems, and to investigate if the number of fibre wedges, fibre rings (layers) and fibre bundles can be used as a tool to determine fibre development response to different agronomic practices. The practices evaluated included different nitrogen levels (0, 50, 100 and 150 kg N ha−1) under both rainfed and irrigated conditions, as well as different combinations of plant population densities (300 000, 400 000, 500 000 and 600 000 plants ha−1) and row spacing (0.17, 0.34 and 0.50 m) under rainfed conditions. In most cases N, water and plant population density were the principal factors affecting the number of fibre rings and fibre bundles, but not the number of fibre wedges. Higher levels of N and more water increased the number of fibre rings and fibre bundles, whereas at higher plant population densities, these decreased. No clear trends were observed with regards to row spacing. The results of this study suggested that under local conditions, 150 kg N ha−1 applied in two splits, 300 000 plants ha−1 and 0.50 m row spacing was the optimal combination of agronomic practices in terms of fibre development per plant. This paper gives a more complete explanation of fibre development in kenaf and shows how plant anatomy can be used as a tool to assess fibre development.Sustainable Fiber Solution (SFS), the National Research Foundation (NRF) and Reconstruction and Development Programme (RDP).http://www.tandfonline.com/loi/tjps202018-06-22hj2017Plant Production and Soil Scienc

Factors affecting haemoglobin dynamics in African children with acute uncomplicated Plasmodium falciparum malaria treated with single low dose primaquine or placebo

Background: Single low-dose primaquine (SLDPQ) effectively blocks the transmission of Plasmodium falciparum malaria, but anxiety remains regarding its haemolytic potential in patients with glucose-6-phopshate dehydrogenase (G6PD) deficiency. We, therefore, examined the independent effects of several factors on haemoglobin (Hb) dynamics in falciparum-infected children with a particular interest in SLDPQ and G6PD status. Methods: This randomised, double-blind, placebo-controlled, safety trial was conducted in Congolese and Ugandan children aged 6 months–11 years with acute uncomplicated P. falciparum and day (D) 0 Hbs ≥ 6 g/dL who were treated with age-dosed SLDPQ/placebo and weight-dosed artemether lumefantrine (AL) or dihydroartemisinin piperaquine (DHAPP). Genotyping defined G6PD (G6PD c.202T allele), haemoglobin S (HbS), and α-thalassaemia status. Multivariable linear and logistic regression assessed factor independence for continuous Hb parameters and Hb recovery (D42 Hb > D0 Hb), respectively. Results: One thousand one hundred thirty-seven children, whose median age was 5 years, were randomised to receive: AL + SLDPQ (n = 286), AL + placebo (286), DHAPP + SLDPQ (283), and DHAPP + placebo (282). By G6PD status, 284 were G6PD deficient (239 hemizygous males, 45 homozygous females), 119 were heterozygous females, 418 and 299 were normal males and females, respectively, and 17 were of unknown status. The mean D0 Hb was 10.6 (SD 1.6) g/dL and was lower in younger children with longer illnesses, lower mid-upper arm circumferences, splenomegaly, and α-thalassaemia trait, who were either G6PDd or heterozygous females. The initial fractional fall in Hb was greater in younger children with higher D0 Hbs and D0 parasitaemias and longer illnesses but less in sickle cell trait. Older G6PDd children with lower starting Hbs and greater factional falls were more likely to achieve Hb recovery, whilst lower D42 Hb concentrations were associated with younger G6PD normal children with lower fractional falls, sickle cell disease, α-thalassaemia silent carrier and trait, and late treatment failures. Ten blood transfusions were given in the first week (5 SLDPQ, 5 placebo). Conclusions: In these falciparum-infected African children, posttreatment Hb changes were unaffected by SLDPQ, and G6PDd patients had favourable posttreatment Hb changes and a higher probability of Hb recovery. These reassuring findings support SLDPQ deployment without G6PD screening in Africa

Effect of SARS-CoV-2 Infection in Pregnancy on Maternal and Neonatal Outcomes in Africa: An AFREhealth Call for Evidence through Multicountry Research Collaboration

In the African context, there is a paucity of data on SARS-CoV-2 infection and associated COVID-19 in pregnancy. Given the endemicity of infections such as malaria, HIV, and tuberculosis (TB) in sub-Saharan Africa (SSA), it is important to evaluate coinfections with SARS-CoV-2 and their impact on maternal/infant outcomes. Robust research is critically needed to evaluate the effects of the added burden of COVID-19 in pregnancy, to help develop evidence-based policies toward improving maternal and infant outcomes. In this perspective, we briefly review current knowledge on the clinical features of COVID-19 in pregnancy; the risks of preterm birth and cesarean delivery secondary to comorbid severity; the effects of maternal SARS-CoV-2 infection on the fetus/neonate; and in utero mother-to-child SARS-CoV-2 transmission. We further highlight the need to conduct multicountry surveillance as well as retrospective and prospective cohort studies across SSA. This will enable assessments of SARS-CoV-2 burden among pregnant African women and improve the understanding of the spectrum of COVID-19 manifestations in this population, which may be living with or without HIV, TB, and/or other coinfections/comorbidities. In addition, multicountry studies will allow a better understanding of risk factors and outcomes to be compared across countries and subregions. Such an approach will encourage and strengthen much-needed intra-African, south-to-south multidisciplinary and interprofessional research collaborations. The African Forum for Research and Education in Health's COVID-19 Research Working Group has embarked upon such a collaboration across Western, Central, Eastern and Southern Africa

High-dose alkylating chemotherapy in BRCA-altered triple-negative breast cancer:the randomized phase III NeoTN trial

Exploratory analyses of high-dose alkylating chemotherapy trials have suggested that BRCA1 or BRCA2-pathway altered (BRCA-altered) breast cancer might be particularly sensitive to this type of treatment. In this study, patients with BRCA-altered tumors who had received three initial courses of dose-dense doxorubicin and cyclophosphamide (ddAC), were randomized between a fourth ddAC course followed by high-dose carboplatin-thiotepa-cyclophosphamide or conventional chemotherapy (initially ddAC only or ddAC-capecitabine/decetaxel [CD] depending on MRI response, after amendment ddAC-carboplatin/paclitaxel [CP] for everyone). The primary endpoint was the neoadjuvant response index (NRI). Secondary endpoints included recurrence-free survival (RFS) and overall survival (OS). In total, 122 patients were randomized. No difference in NRI-score distribution (p = 0.41) was found. A statistically non-significant RFS difference was found (HR 0.54; 95% CI 0.23–1.25; p = 0.15). Exploratory RFS analyses showed benefit in stage III (n = 35; HR 0.16; 95% CI 0.03–0.75), but not stage II (n = 86; HR 1.00; 95% CI 0.30–3.30) patients. For stage III, 4-year RFS was 46% (95% CI 24–87%), 71% (95% CI 48–100%) and 88% (95% CI 74–100%), for ddAC/ddAC-CD, ddAC-CP and high-dose chemotherapy, respectively. No significant differences were found between high-dose and conventional chemotherapy in stage II-III, triple-negative, BRCA-altered breast cancer patients. Further research is needed to establish if there are patients with stage III, triple negative BRCA-altered breast cancer for whom outcomes can be improved with high-dose alkylating chemotherapy or whether the current standard neoadjuvant therapy including carboplatin and an immune checkpoint inhibitor is sufficient. Trial Registration: NCT01057069