Maladie rénale chronique: facteurs associés, étiologies, caractéristiques clinique et biologique à Lubumbashi en République Démocratique du Congo

Introduction: La maladie rénale chronique constitue un véritable problème mondial de santé publique du fait de l'augmentation de ses principaux facteurs de risque à savoir l'hypertension artérielle et le diabète sucré. Dans nos milieux à faible revenu et spécialement dans notre pays, peu d'études sont connues sur cette pathologie diagnostiquée à un stade très avancée et posant un problème de prise en charge. Méthodes: Il s'agit d'une étude descriptive transversale ayant été menée durant la période allant de juillet 2014 à juillet 2015 au service de dialyse de CMDC. Ont étéinclus tous les patients avec taux de filtration glomérulaire inférieur à  60ml/min/1,73 m2 ou créatinine élevée au-delà de trois mois durant notre période d'étude L'objectif de cette étude est de décrire les caractéristiques  sociodémographiques, les facteurs de risque et les paramètres biologiques de patients reçus pour insuffisance rénale. Résultats: Nous avons retenu 60 patients. L'âge moyen était de 51, 38+/-13, 47 ans avec la tranche d'âge la plus touchée comprise entre 50-59 ans. 51, 67% avaient un niveau d'instruction secondaire et 40% un niveau supérieur. Les facteurs de risque d'atteinte rénale étaient l' HTA 66, 64%, le diabète sucré 25%, l'usage des produits nephrotoxiques 35%, l'infection à VIH 11, 67%, l'obésité 10%, la drépanocytose 3, 3%. Le poids de naissance de naissance de nos patients ainsi que l'existence d'une maladie rénale familiale étaient des facteurs méconnus.85% de nos patients avaient un taux d'hémoglobine inférieur à 12g%.Conclusion: De cette observation, il ressort que l'âge de nos patients ne diffère pas de celui observé dans les autres milieux à revenu faible. Le niveau d'instruction de nos patients est plus élevé comparé aux autres études. Il serait mieux de  développer des stratégies de dépistage précoce de la maladie rénale pour éviterd'aboutir à l'hémodialyse qui reste un traitement très onéreux. Mots clés: Maladies rénales chroniques, facteurs associés, clinique, biologie, Lubumbash

Early Experiences in the Integration of Non-communicable Diseases into Emergency Primary Health Care, Beni Region, Democratic Republic of the Congo.

Background: Health services in humanitarian crises increasingly integrate the management of non-communicable diseases into primary care. As there is little description of such programs, this case study aims to describe the initial implementation of non-communicable disease management within emergency primary care in the conflict-affected Beni Region of Democratic Republic of the Congo (DRC). Objectives: We implemented and evaluated a primary care approach to hypertension and diabetes management to assess the feasibility of patient monitoring, early clinical and programmatic outcomes, and costs, after seven months of care. Methods: We designed clinical and programmatic modules for diabetes and hypertension management for clinical officers and the use of patient cards and community health workers to improve adherence. We used cohort analysis (April to October 2018), time-trend analysis, semi-structured interviews, and costing to evaluate the program. Findings: Increases in consultations for hypertension (incidence rate ratio [IRR] 13.5, 95% CI 5.8-31.5, p < 0.00) and diabetes (IRR 3.6, 95% CI 1-12.9, p < 0.05) were demonstrated up to the onset of violence and an Ebola epidemic in August 2018. Of 833 patients, 67% were women of median age 56. Nearly all were hypertensives (88.7%) and newly diagnosed (95.9%). Treatment adherence, defined as attending ≥2 visits in the seven month period, was demonstrated by 45.4% of hypertension patients. Community health workers had contact with 3.2-3.8 patients per month. Respondents stated that diabetes care remained fragmented with insulin and laboratory testing located outside of primary care. Program and management costs were 115 USD per person per treatment course. Conclusions: In an active conflict setting, we demonstrated that non-communicable disease care can be well-organized through clinical training and cohort analysis, and adherence can be addressed using patient-held cards and monitoring by community health workers. Nearly all diagnoses were new, emphasizing the need to establish self-management. Insecurity reduced access for patients but care continued for a subset of patients during the Ebola epidemic

CONTRIBUTION DE L’ENSEIGNEMENT SUPERIEUR ET UNIVERSITAIRE DU MANIEMA AU DIALOGUE INTERKIVUTIENS ET AUX RAPPORTS ENTRE LE MANIEMA ET LES DEUX KIVU.

Document collected by the University of Texas Libraries from the web-site of the Reseau Documentaire International Sur La Region Des Grands Lacs Africains (International Documentation Network on the Great African Lakes Region). The Reseau distributes "gray literature", non-published or limited distribution government or NGO documents regarding the Great Lakes area of central Africa including Rwanda, Burundi, and the Democratic Republic of Congo.UT Librarie

Vitamin A deficiency and protein-energy malnutrition in a sample of pre-school age children in the Kivu Province in Zaire.

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Mortality in the Democratic Republic of Congo: a nationwide survey

Background: Commencing in 1998, the war in the Democratic Republic of Congo has been a humanitarian disaster, but has drawn little response from the international community. To document rates and trends in mortality and provide recommendations for political and humanitarian interventions, we did a nationwide mortality survey during April-July, 2004. Methods: We used a stratified three-stage, household-based cluster sampling technique. Of 511 health zones, 49 were excluded because of insecurity, and four were purposely selected to allow historical comparisons. From the remainder, probability of selection was proportional to population size. Geographical distribution and size of cluster determined how households were selected: systematic random or classic proximity sampling. Heads of households were asked about all deaths of household members during January, 2003, to April, 2004. Findings: 19 500 households were visited. The national crude mortality rate of 2·1 deaths per 1000 per month (95% CI 1·6-2·6) was 40% higher than the sub-Saharan regional level (1·5), corresponding to 600 000 more deaths than would be expected during the recall period and 38 000 excess deaths per month. Total death toll from the conflict (1998-2004) was estimated to be 3·9 million. Mortality rate was higher in unstable eastern provinces, showing the effect of insecurity. Most deaths were from easily preventable and treatable illnesses rather than violence. Regression analysis suggested that if the effects of violence were removed, all-cause mortality could fall to almost normal rates. Interpretation: The conflict in the Democratic Republic of Congo remains the world's deadliest humanitarian crisis. To save lives, improvements in security and increased humanitarian assistance are urgently needed

Assessment of vitamin A deficiency by ophtalmological examination, serum retinol concentration and RDR test in preschool zairean children

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Using MALDI-TOF mass spectrometry to identify ticks collected on domestic and wild animals from the Democratic Republic of the Congo

International audienceMatrix-assisted laser desorption/ionization mass spectrometry (MALDI-TOF MS) has recently emerged as an alternative to morphological and molecular tools to identify tick species. In this study, we set out to evaluate and confirm the ability of MALDI-TOF MS to identify different species of ticks collected in the Democratic Republic of the Congo and preserved in 70% ethanol. A total of 575 ticks, of which 530 were collected from domestic pigs and 45 from wild animals, were subjected to MALDI-TOF MS analysis to evaluate the intraspecies reproducibility and interspecies specificity of MS profiles obtained from the different species. Morphologically, the ticks belonged to seven different species, namely Rhipicephalus complanatus , Rhipicephalus congolensis , Haemaphysalis muhsamae , Ixodes cumulatimpunctatus , Amblyomma exornatum , Amblyomma compressum and an unidentified Rhipicephalus sp. A total of 535/575 (93%) of the spectra obtained were of good enough quality to be used for our analyses. Our home-made MALDI-TOF MS arthropod database was upgraded with spectra obtained from between one and five randomly selected specimens per species. For these reference specimens, molecular identification of the ticks was also made using 16S, 12S rDNA genes and the Cox1 mtDNA gene sequencing. The remaining good quality spectra were then queried against the upgraded MALDI-TOF MS database, showing that 100% were in agreement with the morphological identification, with logarithmic score values (LSVs) between 1.813 and 2.51. The consistency between our morphological, molecular and MALDI-TOF MS identification confirms the capability and precision of MALDI-TOF MS for tick identification