Experience in the integration of traditional medicine courses in the Faculty of Medicine of the University Notre-Dame du Kasayi in Kananga

Expérience de l’intégration des cours de Médecine traditionnelle dans la Faculté de Médecine de l’Université Notre-Dame du Kasayi à Kananga. 1. L'intégration des cours de Médecine traditionnelle dans le programme des cours de la Faculté de Médecine remonte de 1997. Les objectifs éducationnels étaient de former un nouveau type de Médecin capable d'appréhender et de concilier les deux approches thérapeutiques (médecine traditionnelle et conventionnelle) tant en milieu rurale qu’en milieu urbain. Partit de l'initiative des fondateurs de l'Université Notre-Dame du Kasayi, et sous l'encadrement de l'OMS dans cette expérimentation des outils d'enseignement et de l'OMS/AFRO, aujourd'hui l'enseignement est inscrit dans le programme national de la RDC. Au départ l'enseignement était modulé. En deuxième graduat sciences biomédicales le cours portait sur « Les sources des médicaments », en troisième graduat le cours portait sur « La validation de l'information thérapeutique (recherche et statistiques) », en premier doctorat il était axé sur « La Médecine traditionnelle et Obstétrique », en deuxième doctorat on parlait de « La Phytodiététique » et en troisième doctorat l’objet du cours était « la Législation et l’organisation de la médecine traditionnelle dans les soins de santé primaire en RDC ». Pendant les cours théoriques, des exposés des tradithérapeutes étaient souvent organisés. Pendant les travaux pratiques, les étudiants étaient également envoyés auprès des tradipraticiens assister à leurs consultations pour élaborer un rapport. Actuellement, pour se conformer au programme officiel des enseignements, tous les modules se donnent en 3ème doctorat et l’intitulé du cours est « Phytothérappie et Médecine traditionnelle » (45H). La partie pratique du cours consiste à la réalisation des enquêtes ethnopharmacologiques par les étudiants auprès des tradipraticiens et de différentes communautés et présentent leurs rapports d’enquêtes à la Faculté. 2. Depuis sa création jusqu’à ce jour 1000 médecins ont été formés avec cette nouvelle vision à l’U.Ka. Les Médecins évoluant dans les milieux ruraux rapportent que les deux médecines sont complémentaires. Pour certaines situations notamment l'épilepsie et l'inceste qui demandent un rituel du lignage, ils réfèrent les malades aux spécialistes de la médecine traditionnelle. 3. Depuis 2013, l’U.Ka a initié un projet de la sauvegarde et des essais de domestication des 30 plantes médicinales identifiées lors des enquêtes qu’elle a organisée à Kananga. L’herbarium aménagé sert de réserve de cette diversité biologique et d’outil pédagogique pour les étudiants de la Faculté de Médecine et le public universitaire. La flore médicinale en essai de domestication était constituée des classes de Magnoliopsida et Liliopsida issues des 8 familles botaniques et dont les 30 spécimens ciblés sont les suivants: Cassia occidentalis, Cassia floribunda, Cassia alata, Leucaena glauca, Jatropha curcas, Mytracarpus scaber, Calanchoe bizannata, Cymbopogon citratus, Moringa oleifera, Albizzia adiantifolia, Dioscorea bulbifera, Aloe vera, Tithonia diversifolia, Ageratum sp, Tephrosia vogelii, Vigna unguiculata, Euphorbia hirta, Alchornea cordifolia, Vinca rosea, Ocimum brasiliensis, Ocimum basilicum, Ananas comosus, Gnetum africanum, Morinda acida, Annona senegalensis, Harungana madagascariensis, Afromomum africanus, Wapaca sp, Caloncoba welwitch et Hymenocardia acida.Accès aux médicaments et plantes médicinales antipaludiques de qualité en territoires périurbains de Kinshas

“Hospital survival of patients with pulmonary embolism in a country with limited resources case of the city of Kinshasa”

Summary Background Pulmonary embolism is a frequent cause of intra-hospital mortality. The survival of patients depends not only on the speed of diagnosis but also on the treatment initiated. Objective to evaluate the intra-hospital survival of patients with pulmonary embolism in the city of Kinshasa. Methodology analytical cross-sectional study based on non-probability convenience sampling carried out in the city of Kinshasa; three hospitals selected for convenience on the basis of their technical platforms. The patients were judged to have had a pulmonary embolism after a chest CT angiography proved it. The data recorded on the Kobocollect site were exported in Excel format and analyzed with SPSS software version 23. The comparison of the means was made using the Student test and that frequencies with the Yates Chi-square test. The association was attributed by the calculation of the odds ratio and the survival presented according to the Cox regression. Results Eighty-nine cases or 63 women and 26 men were analyzed, the mean age was 64.4 ± 15.6 years. Individuals over 65 died more (ß=0.043 and p-Value of 0.01) the female sex multiplied by 1.38 the risk of death (DNS, p-Value = 0.478). Approximately 80% of patients were classified as PESI stage II or III. Starting Rivaroxaban from the outset does not show any difference with enoxaparin in terms of intra-hospital survival. Conclusion Pulmonary embolism is a real problem in our environment, the age of more than 65 years and the female sex are factors of poor prognosis and predicted survival

Perspective piece effect of SARS-CoV-2 infection in pregnancy on maternal and neonatal outcomes in Africa: An AFREhealth call for evidence through multicountry research collaboration

© 2021 by The American Society of Tropical Medicine and Hygiene 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\u27s COVID-19 Research Working Group has embarked upon such a collaboration across Western, Central, Eastern and Southern Africa

Clinical characteristics and outcomes of patients hospitalized for COVID-19 in Africa : early insights from the Democratic Republic of the Congo

CITATION: Nachega, J. B. et al. 2020. Clinical characteristics and outcomes of patients hospitalized for COVID-19 in Africa : early insights from the Democratic Republic of the Congo. American Journal of Tropical Medicine and Hygiene, 103(6):2419–2428, doi:10.4269/ajtmh.20-1240.The original publication is available at https://www.ajtmh.orgENGLISH ABSTRACT: Little is known about the clinical features and outcomes of SARS-CoV-2 infection in Africa. We conducted a retrospective cohort study of patients hospitalized for COVID-19 between March 10, 2020 and July 31, 2020 at seven hospitals in Kinshasa, Democratic Republic of the Congo (DRC). Outcomes included clinical improvement within 30 days (primary) and in-hospital mortality (secondary). Of 766 confirmed COVID-19 cases, 500 (65.6%) were male, with a median (interquartile range [IQR]) age of 46 (34–58) years. One hundred ninety-one (25%) patients had severe/critical disease requiring admission in the intensive care unit (ICU). Six hundred twenty patients (80.9%) improved and were discharged within 30 days of admission. Overall in-hospital mortality was 13.2% (95% CI: 10.9–15.8), and almost 50% among those in the ICU. Independent risk factors for death were age < 20 years (adjusted hazard ratio [aHR] = 6.62, 95% CI: 1.85–23.64), 40–59 years (aHR = 4.45, 95% CI: 1.83–10.79), and ³ 60 years (aHR = 13.63, 95% CI: 5.70–32.60) compared with those aged 20–39 years, with obesity (aHR = 2.30, 95% CI: 1.24–4.27), and with chronic kidney disease (aHR = 5.33, 95% CI: 1.85–15.35). In marginal structural model analysis, there was no statistically significant difference in odds of clinical improvement (adjusted odds ratio [aOR] = 1.53, 95% CI: 0.88–2.67, P = 0.132) nor risk of death (aOR = 0.65, 95% CI: 0.35–1.20) when comparing the use of chloroquine/azithromycin versus other treatments. In this DRC study, the high mortality among patients aged < 20 years and with severe/critical disease is of great concern, and requires further research for confirmation and targeted interventions.https://www.ajtmh.org/view/journals/tpmd/103/6/article-p2419.xmlPublisher's versio

Severe Acute Respiratory Syndrome Coronavirus 2 Infection and Pregnancy in Sub-Saharan Africa: A 6-Country Retrospective Cohort Analysis

BACKGROUND: Few data are available on COVID-19 outcomes among pregnant women in sub-Saharan Africa (SSA), where high-risk comorbidities are prevalent. We investigated the impact of pregnancy on SARS-CoV-2 infection and of SARS-CoV-2 infection on pregnancy to generate evidence for health policy and clinical practice. METHODS: We conducted a 6-country retrospective cohort study among hospitalized women of childbearing age between 1 March 2020 and 31 March 2021. Exposures were (1) pregnancy and (2) a positive SARS-CoV-2 RT-PCR test. The primary outcome for both analyses was intensive care unit (ICU) admission. Secondary outcomes included supplemental oxygen requirement, mechanical ventilation, adverse birth outcomes, and in-hospital mortality. We used log-binomial regression to estimate the effect between pregnancy and SARS-CoV-2 infection. Factors associated with mortality were evaluated using competing-risk proportional subdistribution hazards models. RESULTS: Our analyses included 1315 hospitalized women: 510 pregnant women with SARS-CoV-2, 403 nonpregnant women with SARS-CoV-2, and 402 pregnant women without SARS-CoV-2 infection. Among women with SARS-CoV-2 infection, pregnancy was associated with increased risk for ICU admission (adjusted risk ratio [aRR]: 2.38; 95% CI: 1.42-4.01), oxygen supplementation (aRR: 1.86; 95% CI: 1.44-2.42), and hazard of in-hospital death (adjusted sub-hazard ratio [aSHR]: 2.00; 95% CI: 1.08-3.70). Among pregnant women, SARS-CoV-2 infection increased the risk of ICU admission (aRR: 2.0; 95% CI: 1.20-3.35), oxygen supplementation (aRR: 1.57; 95% CI: 1.17-2.11), and hazard of in-hospital death (aSHR: 5.03; 95% CI: 1.79-14.13). CONCLUSIONS: Among hospitalized women in SSA, both SARS-CoV-2 infection and pregnancy independently increased risks of ICU admission, oxygen supplementation, and death. These data support international recommendations to prioritize COVID-19 vaccination among pregnant women

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.http://www.ajtmh.org2022-02-01pm2021Obstetrics and Gynaecolog

The Critical Need for Pooled Data on COVID-19 in African Children: An AFREhealth Call for Action through Multi-Country Research Collaboration.

Globally, there are prevailing knowledge gaps in the epidemiology, clinical manifestations, and outcomes of SARS-CoV-2 infection among children and adolescents; however, these gaps are especially wide in African countries. The availability of robust age-disaggregated data is a critical first step in improving knowledge on disease burden and manifestations of COVID-19 among children. Furthermore, it is essential to improve understanding of SARS-CoV-2 interactions with comorbidities and co-infections such as HIV, tuberculosis, malaria, sickle cell disease and malnutrition, which are highly prevalent among children in sub-Saharan Africa. The African Forum for Research and Education in Health (AFREhealth) COVID-19 Research Collaboration on Children and Adolescents is conducting studies across Western, Central, Eastern, and Southern Africa to address existing knowledge gaps. This consortium is expected to generate key evidence to inform clinical practice and public health policymaking for COVID-19, while concurrently addressing other major diseases affecting children in African countries

Assessment of Clinical Outcomes Among Children and Adolescents Hospitalized With COVID-19 in 6 Sub-Saharan African Countries.

Little is known about COVID-19 outcomes among children and adolescents in sub-Saharan Africa, where preexisting comorbidities are prevalent. To assess the clinical outcomes and factors associated with outcomes among children and adolescents hospitalized with COVID-19 in 6 countries in sub-Saharan Africa. This cohort study was a retrospective record review of data from 25 hospitals in the Democratic Republic of the Congo, Ghana, Kenya, Nigeria, South Africa, and Uganda from March 1 to December 31, 2020, and included 469 hospitalized patients aged 0 to 19 years with SARS-CoV-2 infection. Age, sex, preexisting comorbidities, and region of residence. An ordinal primary outcome scale was used comprising 5 categories: (1) hospitalization without oxygen supplementation, (2) hospitalization with oxygen supplementation, (3) ICU admission, (4) invasive mechanical ventilation, and (5) death. The secondary outcome was length of hospital stay. Among 469 hospitalized children and adolescents, the median age was 5.9 years (IQR, 1.6-11.1 years); 245 patients (52.4%) were male, and 115 (24.5%) had comorbidities. A total of 39 patients (8.3%) were from central Africa, 172 (36.7%) from eastern Africa, 208 (44.3%) from southern Africa, and 50 (10.7%) from western Africa. Eighteen patients had suspected (n = 6) or confirmed (n = 12) multisystem inflammatory syndrome in children. Thirty-nine patients (8.3%) died, including 22 of 69 patients (31.9%) who required intensive care unit admission and 4 of 18 patients (22.2%) with suspected or confirmed multisystem inflammatory syndrome in children. Among 468 patients, 418 (89.3%) were discharged, and 16 (3.4%) remained hospitalized. The likelihood of outcomes with higher vs lower severity among children younger than 1 year expressed as adjusted odds ratio (aOR) was 4.89 (95% CI, 1.44-16.61) times higher than that of adolescents aged 15 to 19 years. The presence of hypertension (aOR, 5.91; 95% CI, 1.89-18.50), chronic lung disease (aOR, 2.97; 95% CI, 1.65-5.37), or a hematological disorder (aOR, 3.10; 95% CI, 1.04-9.24) was associated with severe outcomes. Age younger than 1 year (adjusted subdistribution hazard ratio [asHR], 0.48; 95% CI, 0.27-0.87), the presence of 1 comorbidity (asHR, 0.54; 95% CI, 0.40-0.72), and the presence of 2 or more comorbidities (asHR, 0.26; 95% CI, 0.18-0.38) were associated with reduced rates of hospital discharge. In this cohort study of children and adolescents hospitalized with COVID-19 in sub-Saharan Africa, high rates of morbidity and mortality were observed among infants and patients with noncommunicable disease comorbidities, suggesting that COVID-19 vaccination and therapeutic interventions are needed for young populations in this region

Severe Acute Respiratory Syndrome Coronavirus 2 Infection and Pregnancy in Sub-Saharan Africa: A 6-Country Retrospective Cohort Analysis.

Few data are available on COVID-19 outcomes among pregnant women in sub-Saharan Africa (SSA), where high-risk comorbidities are prevalent. We investigated the impact of pregnancy on SARS-CoV-2 infection and of SARS-CoV-2 infection on pregnancy to generate evidence for health policy and clinical practice. We conducted a 6-country retrospective cohort study among hospitalized women of childbearing age between 1 March 2020 and 31 March 2021. Exposures were (1) pregnancy and (2) a positive SARS-CoV-2 RT-PCR test. The primary outcome for both analyses was intensive care unit (ICU) admission. Secondary outcomes included supplemental oxygen requirement, mechanical ventilation, adverse birth outcomes, and in-hospital mortality. We used log-binomial regression to estimate the effect between pregnancy and SARS-CoV-2 infection. Factors associated with mortality were evaluated using competing-risk proportional subdistribution hazards models. Our analyses included 1315 hospitalized women: 510 pregnant women with SARS-CoV-2, 403 nonpregnant women with SARS-CoV-2, and 402 pregnant women without SARS-CoV-2 infection. Among women with SARS-CoV-2 infection, pregnancy was associated with increased risk for ICU admission (adjusted risk ratio [aRR]: 2.38; 95% CI: 1.42-4.01), oxygen supplementation (aRR: 1.86; 95% CI: 1.44-2.42), and hazard of in-hospital death (adjusted sub-hazard ratio [aSHR]: 2.00; 95% CI: 1.08-3.70). Among pregnant women, SARS-CoV-2 infection increased the risk of ICU admission (aRR: 2.0; 95% CI: 1.20-3.35), oxygen supplementation (aRR: 1.57; 95% CI: 1.17-2.11), and hazard of in-hospital death (aSHR: 5.03; 95% CI: 1.79-14.13). Among hospitalized women in SSA, both SARS-CoV-2 infection and pregnancy independently increased risks of ICU admission, oxygen supplementation, and death. These data support international recommendations to prioritize COVID-19 vaccination among pregnant women