Pandémie à Severe Acute Respiratory Syndrome-Coranovirus-2 (SARS-COV-2) en Afrique sub-saharienne : Quelles solutions innovantes pour contenir la propagation ? Severe Acute Respiratory Syndrome-Coranovirus-2 (SARS-COV-2) pandemic in sub-Saharan Africa: What innovative solutions to contain the propagation?

Since the dawn of time, epidemics have sometimes invaded large areas of the world, decimating entire populations; and this fact has been occurring even before the concept of globalization took on the scale we know nowadays. Millions of people lost their lives, as was the case of the “black plague” which occurred between 1347 and 1352, and the Spanish flu between 1918 and 1919. The COVID-19 pandemic that has started in its first outbreak in the city of Wuhan, China in December 2019, is very peculiar in terms of its contagious nature and the severity of clinical manifestations in vulnerable individuals, with a mortality rate that challenges even the most efficient healthcare systems with well-equipped hospitals in the world. Of course, the whole world has been so overwhelmed by the propagation of this new disease that containment measures taken at individual, community and national levels seem to have been taken too late. Anyway, we had no choice but just trying to limit the human and socioeconomic impacts, as well as the adverse effects which will certainly last beyond the end of the pandemic. Africa was affected a few weeks after other continents; thus, African countries should have learned from both positive and negative experiences of other countries and continents in order to better cope with this infectious threat. The most pessimistic or the most macabre predictions are often made for sub-Saharan Africa (SSA). To date, the scale of the COVID-19 epidemic on the African continent is visibly of less importance, compared to what is observed elsewhere, which does not suggest the way the pandemic is going to evolve in the next days or weeks. This is where the preventive measures advocated overseas deserve to be adopted by means of a “textualization” which must make them acceptable and applicable. Indeed, the “copy-paste” of these measures which demonstrate their effectiveness in Asian and Western countries is often not possible for cultural and economic reasons. And yet prevention remains the best weapon against this corona virus infection. So what confinement? What barriers and social distancing measures? What communication to use for the adoption of behaviors likely to protect individuals and communities? In other words, what prevention in a context of extreme poverty, combined with insufficiency of basic social services in terms of water and electricity supply and means of communication (dilapidated and poor roads, difficulty to have access to new information technologies including internet …). How to make people accept effective preventive measures amidst poor sanitation, poverty, cultural and faith-based obstacles … And this without procrastination which can only be fatal for communities already affected by malaria and other endemics even recognized as “neglected diseases” by the international community. Our thinking is based on the main prevention measures recommended throughout the world in regard to the current COVID-19 pandemic, and observation of their effective application in the community after the official proclamation of those measures in Kinshasa, the capital city of the Democratic republic of the Congo (DRC). A particular attention is paid to the various messages to raise awareness among the populations and the dissemination by the political and health authorities of information on the pandemic via public media and social networks. We have observed the reactions of people in terms of acceptance or refusal to apply the measures that are propagated through both written and audio-visual media. Considering these observations, we can then suggest locale but effective solutions for realistic preventive approach. Considering the socio-economic status of the populations, overcrowding in cities and especially the common faith in miraculous cure in our society, we hereby suggest a number of recommendations for the success of preventive measures against COVID-19 in SSA: Increase awareness among populations of the danger of the SARS-CoV-2 virus, by means of adapted messages which are given to community leaders who are truly trusted and influential. It is time for church leaders, traditional leaders, traditional healers and all those who have a voice to take the lead and pass on awareness messages to their respective communities. Provide basic needs of the population, supplying food items in a spirit of volunteerism by even using state resources and military support. During this time, it is necessary to pay decent salaries and bonuses to workers from all sectors to allow households acquire basic needs and secure autonomy during the lockdown period. Ensure regular supply of water and electric power, and free access to masks for underprivileged populations while making their use compulsory. Ensure that residents visit markets and other places to purchase goods in their respective districts or communes only at daytime. The creation of public canteens for selling food and non-alcoholic beverages at low cost should be encouraged. This has the advantage of reducing contact between people. If necessary, requisition state vehicles belonging to public and cooperative partner agencies for the mobility of hospital staff and policemen. A lockdown should be declared to limit people’s movement and allow them to rest at home during night time as long as necessary for the security and peace of mind. To cope with the closure of schools and universities, distance learning should be encouraged by facilitating access to the internet and the acquisition of lap-tops or even android mobile phones by school children and students. In the media, we should avoid talking only about sensational news regarding COVID-19, as if success no longer existed even in the epidemiological field. We should not follow the media that repeatedly talk about what psychologically traumatizes people. It is not a question here of trivializing the health crisis but one will make barrage with the one and the others in bad popularity to be made visible under pretext to act finally for the poor population. Denounce certain messages that fuel collective psychosis in social networks and, above all, the respect of confidentiality of medical information, even after the death of patients. Train and provide safety equipment to medical staff and encourage healthcare workers at the frontline of the COVID-19 crisis who are more exposed while continuing to serve. To talk about the treatment that remains uncertain in this area of viral diseases, while adopting well-documented treatment regimens that have proven to be effective elsewhere, researchers should be encouraged to draw on the African pharmacopoeia which presumably contains resources that are likely to contribute to solving this global challenge. The use of traditional African medicine should not, however, open a breach for charlatans of all stripes by imposing strict compliance with the rules in this area. Universities and other research institutions should contribute with technological innovations, particularly in the design and development of medical devices and equipment to improve patients care and, even in producing COVID-19 prevention tools. Since the dawn of time epidemics have occasionally invaded large areas of the world, decimating entire populations, and this even before the concept of globalization took on the scale we have known in recent decades. The deaths were sometimes counted by millions of people as was the case with the black plague which ranged from 1,347 to 1,352 or the Spanish flu from 1918 to 1919. The COVID-19 pandemic that appeared in its first outbreak in Wuhan, China is very particular in terms of its contagiousness and the seriousness of the clinical picture in fragile people, with a mortality rate challenging even the most efficient health systems with the most hospitals equipped with the world. No doubt surprised by the great contagiousness of this new pathology, the whole world is taken aback so that the national and individual containment measures seem to have been taken too late, in any case we have come to resign ourselves to limiting the human, social and economic damage, the harmful effects of which will certainly last beyond the end of the pandemic. Africa was affected a few weeks after the other continents; which should allow the countries of the continent to benefit from both positive and negative experiences from other countries and continents to better cope with this infectious danger. The most pessimistic if not the most macabre forecasts are regularly made for sub-Saharan Africa (SSA). To date, the scale of the epidemic on the African continent is visibly of less importance, compared to what is observed elsewhere; which does not suggest the evolution of the pandemic in the next days or weeks. This is where the prevention measures advocated elsewhere deserve to be adopted by means of a “textualization” which must make them acceptable and applicable. Indeed, the “copy-pasted” of these measures which demonstrate their effectiveness in Asian and Western countries is often not possible for cultural and economic reasons. And yet prevention remains the best weapon against this corona virus infection. So what confinement? What barriers and social distancing measures? What communication for the adoption of consistent behavior likely to protect individuals and communities? In other words, what prevention in a context of poverty of people, lack / weakness of basic social services in terms of water and electricity supply, see means of communication (dilapidated and deficit urban roads, access to new information technologies / internet …). How to make people accept (make themselves appropriate) effective preventive measures, despite insalubrity, poverty, cultural and religious burdens … And this without procrastination which can only be fatal for  communities already affected by malaria and other endemics sometimes even recognized as “neglected diseases” by the international community. Our thinking is based on the main prevention measures recommended throughout the world in the face of the current COVID-19 pandemic; and to observe their effectiveness in the community after their proclamation in the capital city of Kinshasa in the DRC. Particular attention is paid to the various messages to raise awareness among the population and the dissemination by the political and health authorities of information on the pandemic via public media and social networks. We have observed the reactions of people in terms of acceptance or difficulty / refusal to apply these measures decreed by the public and health authorities, through both written and audio-visual media. We can then, on the strength of these observations, suggest possible solutions for realistic prevention, “local in fact” but which retains certain effectiveness. Taking into account the socio-economic level of the population, the promiscuity in the agglomerations and especially the beliefs in miracle cures which it is enough to find in the good therapist in the broad sense of the term, here are some conditions for the success of the measures of prevention against realistic COVID-19 in SSA: Make the population sufficiently aware of the danger of the Corona virus, by means of adapted messages which are received by community leaders who are truly recognized and influential. It is here where church leaders, traditional leaders, traditional healers and all those who have a voice must carry for the cause if necessary “well motivated”, with obligation to pass messages in the community with results. Ensure the basic needs of the population, where it is, by supplying agglomerations with food supplies, in a voluntarism manner by resorting in particular to the means of the State and the army. During this time, workers and workers, in order and in all sectors, are guaranteed wages and bonuses to enable them to secure autonomy in essential goods during confinement time. We will ensure a regular supply of water and electricity where the agreement exists. A free distribution of the masks will be made for the underprivileged population, while making their wearing compulsory. Ensure that residents only use daily markets and other places to acquire goods in their respective districts or communes for daily shopping. The creation of popular canteens for the low-cost sale of food and non-alcoholic beverages will be encouraged. This has the advantage of avoiding the mixing of populations. We will sometimes have to requisition state vehicles (ministries, specialized programs) and cooperation partners for the mobility of hospital staff and police. A curfew will be decided forever to limit movement and promote the night rest so necessary for the security and peace of mind. To cope with the closure of schools and universities, distance education will be encouraged, by facilitating access to the Internet and the acquisition by pupils and students of lap-tops or even Android phones. In the media, we should avoid talking only about the sensational, as if success no longer existed even in the epidemiological field. Do not do as in the media which only repeat what traumatizes more. It is not a question here of trivializing the health crisis but one will make barrage with the one and the others in bad popularity to be made visible under pretext to act finally for the poor population. Denounce certain messages that fuel collective psychosis in social networks, and above all respect the confidentiality of medical information, even after the disappearance of the persons concerned. Measures to rehabilitate and equip medical training and to encourage health workers at the forefront of the crisis more exposed to danger while continuing to serve. To talk about the treatment that remains uncertain in this area of viral diseases, while adopting well-documented treatment regimens that have proven themselves elsewhere, researchers will be encouraged to draw on the African pharmacopoeia which presumably contains resources which are likely to face this global challenge. The use of traditional African medicine should not, however, open a breach for charlatans of all stripes by imposing strict compliance with the rules in this area. Universities and other research institutions will contribute to the building of technological innovations, particularly in the design and development of medical equipment for the hospital care of patients, and even in COVID-19 prevention tools. Pandémie à Severe Acute Respiratory Syndrome-Coranovirus-2 (SARS-COV-2) en Afrique sub-saharienne : Quelles solutions innovantes pour contenir la propagation ? Severe Acute Respiratory Syndrome-Coranovirus-2 (SARS-COV-2) pandemic in sub-Saharan Africa: What innovative solutions to contain the propagation? Depuis la nuit des temps des épidémies ont de temps en temps envahi des larges territoires du monde en décimant des populations entières, et ceci bien avant même que le concept de mondialisation ne prenne l’ampleur qu’on lui connait ces dernières décennies. Les morts se sont parfois comptés par millions de personnes comme ce fut le cas avec la peste noire qui sévissait de 1347 à 1352 ou la grippe espagnole de 1918 à 1919. La pandémie à COVID-19 qui est apparue dans son premier foyer de Wuhan en Chine est bien particulière par sa contagiosité et la gravité des tableaux cliniques chez les personnes fragiles, avec un taux de mortalité défiant même les systèmes sanitaires performants avec les hôpitaux les plus équipés du monde. Sans doute surpris par la grande contagiosité de cette nouvelle pathologie, le monde entier est pris de court de telle sorte que les mesures de confinement nationales et individuelles semblent avoir été prises trop tard, en tout cas on en est arrivé à se résigner à limiter les dégâts humains, sociaux et économiques dont les effets néfastes dureront certainement au-delà de la fin de la pandémie. L’Afrique a été touchée quelques semaines après les autres continents ; ce qui devrait permettre aux Pays du continent de profiter tant des expériences positives et que négatives des autres pays et continents pour mieux faire face à ce péril infectieux. Les prévisions les plus pessimistes pour ne pas dire les plus macabres sont régulièrement faites pour l’Afrique au sud du Sahara. A ce jour l’ampleur de l’épidémie sur le continent africain est visiblement de moindre importance, comparées à ce qui s’observe ailleurs ; ce qui ne laisse pas présager sur l’évolution de la pandémie dans les jours ou les semaines à venir. C’est ici où les mesures de préventions préconisées ailleurs méritent d’être adoptées moyennant une « contextualisation » qui doit les rendre acceptables et applicables. En effet, la « copie-collée » de ces mesures qui démontrent leur efficacité dans les pays asiatiques et occidentaux n’est souvent pas possible pour des raisons culturelles et économiques. Et pourtant, la prévention reste la meilleure arme contre cette infection à corona virus. Alors quel confinement ? Quelles mesures barrières et de distanciation sociale ? Quelle communication pour l’adoption d’un comportement conséquent de nature à protéger les individus et les communautés ? En d’autres termes quelle prévention dans un contexte de pauvreté des personnes, de manque /faiblesse des services sociaux de base en terme de fourniture d’eau et d’électricité, voir des moyens de communication (voirie urbaine délabrée et déficitaire, accès aux nouvelles technologies de l’information/internet …). Comment faire accepter (se faire approprier) des mesures efficaces de prévention, malgré l’insalubrité, la pauvreté, les pesanteurs culturelles et religieuses…. Et ceci sans atermoiement qui ne peut être que funeste pour les communautés déjà meurtries par le paludisme et d’autres endémies parfois même reconnues comme « maladies négligées » par la communauté internationale. Notre réflexion se base sur les mesures principales de prévention préconisées à travers le monde face à la présente pandémie de la COVID-19 ; et de constater leur effectivité dans la communauté après leur proclamation dans la ville capitale de Kinshasa en République démocratique du Congo (RDC). Une attention particulière est accordée aux différents messages de sensibilisation de la population et de diffusion par l’autorité politique et sanitaire de l’information sur la pandémie via les média publiques et les réseaux sociaux. Nous avons observé les réactions des personnes en termes d’acceptation ou de difficulté/refus d’application desdites mesures décrétées par l’autorité publique et sanitaire, à travers les média tant écrits qu’audio-visuels. Nous pouvons par la suite, fort de ces observations, proposer des pistes de solution pour une prévention réaliste, à « couleur locale » mais qui garde une certaine efficacité. Tenant compte du niveau socio-économique de la population, de la promiscuité dans les agglomérations et surtout des croyances en des remèdes miracles qu’il suffit de trouver chez le bon thérapeute au sens large du terme, voici quelques conditions pour le succès des mesures de prévention contre la COVID-19 réalistes en Afrique au sud du Sahara : Conscientiser suffisamment la population devant le danger du Corona virus, par des messages adaptés qui soient reçus par les leaders communautaires réellement reconnus et influents. C’est ici où les responsables d’Eglises, les chefs traditionnels, les tradithérapeutes et tous ceux qui ont une voix qui porte doivent être acquis pour la cause s’il le faut « bien motivés », avec obligation de passer les messages dans la communauté avec des résultats. Assurer les besoins de base de la population, là où elle est, en approvisionnant les agglomérations en vivres alimentaires, de manière volontariste en recourant notamment aux moyens de l’Etat et de l’armée. Pendant ce temps il est assuré aux travailleurs, dans l’ordre et tous secteurs confondus, des salaires et primes pour leur permettre de s’assurer une autonomie en biens de première nécessité pendant le temps de confinement. On veillera à un approvisionnement régulier en eau et en électricité là où l’accordement existe. Une distribution gratuite des masques sera faite pour la population déshéritée, tout en rendant leur port obligatoire. Faire en sorte que les habitants ne recourent pour les courses journalières qu’aux marchés et autres lieux d’acquisition de biens dans leurs quartiers ou communes respectifs. Il sera encouragé la création des cantines populaires pour la vente à bas prix des aliments et des boissons non alcooliques. Ceci a l’avantage d’éviter le brassage des populations. On sera parfois amené à réquisitionner les véhicules de l’Etat (ministères, programmes spécialisés) et des partenaires de coopération pour la mobilité du personnel des hôpitaux et des forces de l’ordre. Il sera décidé d’un couvre-feu pour toujours pour limiter les déplacements et favoriser le repos nocturne tant nécessaire pour la sécurité et la tranquillité des esprits. Pour faire face à la fermeture des écoles et des Universités, l’enseignement à distance sera encouragé, en facilitant l’accès à l’internet et l’acquisition par les élèves et les étudiants des lap-tops ou même des téléphones androïdes. Dans les médias on devra éviter de ne parler que du sensationnel, comme si le succès n’existait plus même dans le domaine épidémiologique. Ne pas faire comme dans les médias qui ne font que passer en boucle ce qui traumatise d’avantage. Il ne s’agit pas ici de banaliser la crise sanitaire mais on fera barrage aux uns et aux autres en mal de popularité de se faire visibles sous prétexte d’agir enfin pour la pauvre population. Dénoncer certains messages qui alimentent la psychose collective dans les réseaux sociaux, et surtout respect

Facteurs d’affiliation aux pairs sont étroitement associés à la criminalité des jeunes incarcérés à la prison centrale de Kinshasa : Affiliation Factors to Peers are strongly associated to the Criminality among the Youth of the Central Prison of Kinshasa

Context and objective. Increasing crime is one of the major social problems facing in the context of armed conflicts of various kinds. The objective of this study is to investigate the determinants of the peer affiliation domain of criminal and violent criminal behavior. Methods. We undertook a case-control study included 500 subjects: 297 incarcerated criminals (189 violent criminals, as crime against a person and 108 non-violent criminals, as crime against property) against 203 noncriminal subjects, between August 2015 and December 2016. We selected control subjects from general population of the city of Kinshasa and matched them with cases according to gender, age (± 2 years) and geographical origin. Logistic regression analysis was used to investigate the determinants of criminality and of violent criminality. Results. Compared to noncriminals, criminals were significantly gang members (55.6% versus 4.9%, p<0.001), carry guns (40.1% versus 7.9%, p<0.001), attend parties with friends without parental supervision (69.7% versus 34%, p<0.001), and have friends who sell drugs (44.4% versus 14.8%, p<0.001). Compared to non-violent criminals, violent criminals were significantly more likely to be gang members (60.8% versus 46.3%, p=0.015), carry weapons (46.6% versus 28.7%, p=0.003) and have friends who sell heroin (50.3% versus 34.3%, p=0.008). In multivariate logistic regression analyse, being a gang member (ORa 13.6; 95% CI: 6.76-27.67), carrying a weapon (ORa 2.85; 95% CI: 1.5-5.42) and unsupervised parties (ORa 1.95; 95% CI: 1.25-3.02) were the independently associated with crime. Only carrying weapons (ORa 1.87; 95% CI: 1.05-3.32) emerged as an independent determinant of violent crime. Conclusion. Violent and non-violent crime is a continuum in which the former differs from the latter in terms of carrying a weapon. Gang involvement, social gatherings with friends and carrying weapons are the common threads of their criminal behavior. Contexte et objectif. La criminalité croissante compte parmi les problèmes sociaux majeurs en République Démocratique du Congo aux prises à des conflits armés de diverse nature. Cette étude a pour objectif de rechercher les déterminants du domaine d’affiliation aux pairs du comportement criminel et criminel violent. Méthodes. Nous avons entrepris une étude cas-témoin enrôlant 500 sujets : 297 criminels incarcérés (189 criminels violents, crime contre la personne et 108 criminels non violents, crime contre la propriété) contre 203 sujets non criminels, entre août 2015 et décembre 2016. Les témoins ont été recrutés dans la population générale de la ville de Kinshasa et appariés aux cas, selon le sexe (même), l’âge (± 2 ans) et la provenance géographique. L’analyse de régression logistique a été utilisée pour rechercher les déterminants de la criminalité. Résultats. Comparés aux non criminels, les criminels étaient significativement membres de gang (55,6% versus 4,9%, p < 0,001), porteurs des armes (40,1% versus 7,9% ; p <0,001), dans des soirées entre amissans supervision parentale (69,7% versus 34%, p<0,001), et  avaient des amis vendeurs de drogues (44,4% versus 14,8%, p<0,001). Par rapport aux criminels non violents, les criminels violents étaient significativement membres de gang (60,8% versus 46,3%, p=0,015), porteurs des armes (46,6% versus 28,7%, p=0,003) et avaient des amis vendeurs de drogues (50,3% versus 34,3%, p=0,008). En analyse de régression logistique multivariée, être membre de gang (ORa 13,6; IC 95% : 6,76-27,67), porter une arme (ORa 2,85; IC 95% : 1,5-5,42) et assister dans les soirées sans supervision (ORa 1,95; IC 95% : 1,25-3,02) constituaient les déterminants indépendamment associés à la criminalité. Seul porter des armes (ORa 1,87; IC 95% : 1,05-3,32) a émergé comme déterminant indépendant de la criminalité violente. Conclusion. La criminalité violente et non violente constitue un continuum dans lequel la première se différencie de la deuxième par le port d’arme. La participation à un gang, les soirées entre amis et le port d’arme constituent le fils conducteur de leur comportement criminel. &nbsp

Stress, anxiété, dépression et qualité de vie des patients tuberculeux pharmacorésistants à Kinshasa, République Démocratique du Congo: Stress, anxiety, depression and quality of life of drug-resistant tuberculosis patients in Kinshasa, Democratic Republic of the Congo

Contexte & objectif. La prise en charge médicale de la tuberculose pharmacorésistante connaît des progrès dans le monde. Mais, le volet psychosocial a été peu exploré en République Démocratique du Congo. La présente étude a évalué la qualité de vie des patients tuberculeux pharmacorésistants (PTP) suivis au Centre d’Excellence Damien (CEDA) à Kinshasa. Méthodes. L’échelle de stress perçu (PSS), l’Hospital Anxiety and Depression Scale (HADS) et l’Indicateur de Santé Perceptuelle de NOTTINGHAM (ISPN) ont été utilisés dans une étude transversale réalisée du 1er avril au 31 décembre 2018 sur 81 PTP hospitalisés au CEDA de Kinshasa. La méthode de régression logistique a recherché les déterminants de la qualité de vie. Résultats. Au cours de la période de l’étude, 81 PTP étaient reçus dont 62 TB multirésistants (TB MR, 76,5%) contre 19 TB ultrarésistants (TBUR, 23,5%), constituant les deux groupes d’étude. L’âge moyen des sujets était de 34,7±14,3 ans. Les hommes étaient légèrement prépondérants (53 %) avec un sex ratio H/F de 1,1. La tranche d’âge de 21 à 30 ans était plus représentée (35%). Trois-quarts des sujets étaient solitaires (75%), plus de deuxtiers avaient un niveau secondaire (69%), plus de la moitié n’avait pas d’occupation (56%), près de deux-tiers fréquentaient les Eglises indépendantes (60%). Trente-cinq pourcents des patients avaient une mauvaise qualité de vie. Celle-ci était liée à l’âge >40 ans, au type TBMR, au retard d’accompagnement psychosocial, au niveau d’étude primaire, à la présence de la co-infection tuberculoseVIH/SIDA, au stress perçu et à l’anxiété-dépression. Conclusion. Les patients tuberculeux pharmacorésistants à Kinshasa ont une qualité de vie altérée. Cette situation est favorisée par l’âge >40 ans, le type de tuberculose pharmacorésistante, le retard d’accompagnement psychosocial, le faible niveau d’étude, la présence de la coinfection tuberculose-VIH/SIDA, le stress perçu,  l’anxiété et la dépression.  Context and objective. Despite many progress in the treatment of drug-resistant tuberculosis, psychosocial aspects remain poorly adressed in the Democratic Republic of Congo. This study aimed to evaluate the quality of life of drug-resistant tuberculosis patients. Methods. A cross-sectional survey was conducted in hospitalized drug-resistant tuberculosis patients at CEDA Kinshasa, during the period from April 1 to December 31th, 2018, through the perceived stress scale (PSS), the Hospital Anxiety and Depression Scale (HADS) and the NOTTINGHAM Health Profil (NHP) tools. Data from 62 multdrug rerestitant TB patients (MDR TB, 76,5%) were compared with 19 ultraresistant (PXDR, 23.5 %) and analyzed, using a multivariate logistic regression analysis to assess the determinants of quality of life. Results. Among a total of 81 pharmaco-resistant TB patients, average age 34.7 ± 14.3 years, with a slight man preponderance (53 %), 35% had a poor quality of life. This was linked to age > 40 years, MDRTB type, delayed psychosocial support, primary education, the presence of TB/HIV co-infection, and perceived stress and anxiety-depression. Conclusion. The study reveals an impaired quality of life in Drug-resistant tuberculosis patients in Kinshasa, with some identified correlates. Targeted measures are needed to improve the management of these patients

Peritraumatic dissociation and post-traumatic stress disorder in individuals exposed to armed conflict in the Democratic Republic of Congo.

The purpose of this study was to verify the hypothesis that there is an association between peritraumatic dissociation (PD) and post-traumatic stress disorder (PTSD) in individuals exposed to recurrent armed conflict. More specifically, we sought to evaluate whether PD differentially predicts PTSD according to the degree of exposure to the potentially traumatic event (PTE), the level of education, and gender. A total of 120 individuals between 17 and 75 years of age, including 51 women, completed the Traumatic Events List, the Peritraumatic Dissociative Experiences Questionnaire, and the French version of the Posttraumatic Stress Disorder Checklist Scale, as well as a questionnaire providing information regarding sociodemographic details. The group of participants with high scores for PD had significantly more PTSD. PD differentially predicts PTSD depending on the level of education and gender of the individual. Those who had been physically assaulted and raped, as well as the less educated, were more likely to be dissociated during PTE· exposure compared to witnesses and those with a higher level of education. The primary target population for prevention and early management should comprise individuals with high levels of PD, low levels of education, and women

Do patients from the Democratic Republic of Congo with schizophrenia have facial emotion recognition deficits?

Patients with schizophrenia can have difficulty recognizing emotion, and the impact of this difficulty on social functioning has been widely reported. However, earlier studies did not thoroughly explore how this deficit may vary according to emotion intensity, or how it may differ among individuals and across cultures. In the present study, our aim was to identify possible deficits in facial emotion recognition across a wide range of emotions of different intensities among patients with schizophrenia from the Democratic Republic of Congo (DRC). Thirty stable patients with schizophrenia and 30 healthy controls matched for age and level of education were evaluated using a validated and integrative facial emotion recognition test (TREF). A total recognition score and an intensity threshold were obtained for each emotion. Patients with schizophrenia had emotion recognition deficits, particularly for negative emotions. These deficits were correlated to the severity of negative symptoms. Patients showed no threshold deficit at the group level, but analysis of individual profiles showed marked heterogeneity across patients for the intensity of the emotion decoding deficit. Our study confirms the existence of deficits in emotion recognition for negative emotions in patients with schizophrenia, generalizes it to DRC patients, and underlines considerable heterogeneity among patients

Inter-individual variability of social perception and social knowledge impairments among patients with schizophrenia.

Deficits in social perception and knowledge and their negative impact on social functioning, have been repeatedly reported among patients with schizophrenia. However, earlier studies have focused on an overall assessment of social perception and social knowledge, without exploring their sub-components nor the interindividual variation of the deficit. This study aims to refine the exploration of this deficit and to assess its interindividual variation. Twenty-nine patients with schizophrenia and 24 healthy controls, matched for age and gender, completed a validated and integrated social perception and knowledge task (i.e. the PerSo test). Patients with schizophrenia had reduced performance in all PerSo subtests, namely contextual fluency, interpretation and social convention. However, these deficits were not correlated with the severity of clinical symptoms, and individual profiles analyses showed a marked heterogeneity among patients on their abilities. Our study confirms the existence of deficits in social perception and knowledge and underlines their considerable heterogeneity. Therefore, it is necessary to test and rehabilitate individually social perception and knowledge

Trauma awareness and preparedness: Their influence on posttraumatic stress disorder development related to armed conflict experience

This study examined influences of trauma awareness and preparedness on the development of posttraumatic stress disorder (PTSD) in civilian and military personnel with exposure to the civil war. Participants were 302 people with exposure to civil war in the Democratic Republic of Congo (civilians = 68%; females = 47%; age range = 16 to 76 years old, SD = 13.58 years). Participants completed the Posttraumatic Checklist Scale, General Self-Efficacy Scale, and Traumatic Events List. The data were analysed to predict PTSD development from trauma awareness and preparedness, taking exposure to multiple traumas into account as a risk factor. Findings suggest that trauma awareness and preparedness play an important role among military personnel in moderating the risk of developing PTSD, more so than among the civilian population. Mental health professionals working with civil war survivors should seek to explore trauma awareness and preparedness as resources for minimising risk for PTSD in armed conflict situations.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Stress syndrome in patients receiving outpatient treatment at the General Hospital, in Bangui, in a context of armed conflict

peer reviewedContext: in Africa's zones of conflict, recent studies report a high frequency of post-traumatic stress disorder (PTSD) particularly in community settings. Objective: this study aimed to contribute to a better management of patients experiencing violence subsequent to the Central African Republic socio-political conflict. Material and methods: we conducted a cross-sectional study of the medical records of patients receiving outpatient treatment in the Doctors Without Borders/Médecins Sans Frontières (France) Trauma Center, Bangui. Results: 33.33% (n=35) of patients had PTSD, while 17.14% (n=18) of patients had acute stress syndrome. Stress syndrome (SS) was associated with female sex, rape, anxiety and depression. Rape multiplied the risk of SS occurrence by 8. The average age was 30 years (P25:22 years; P75:40 years). The majority of patients had mood disorder (63.81%; n=67). Insomnia was present in 62.83% (n=66) of patients. Hospital Anxiety and Depression Scale (HADS) was present in 44.76 % of patients. Depression was found in 40.95% (n=43) of patients. Conclusion: the obtained results show how the society, apart from militia members, is affected by conflict-related violence in the country. These results can enrich the reflections on health organisation and on the management of patients in Central African, by considering the impact of conflict-related acute stress syndome in the short, medium and long term

Mental health outcomes, literacy and service provision in low- and middle-income settings: a systematic review of the Democratic Republic of the Congo

Abstract In the Democratic Republic of the Congo (DRC), the prevalence of mental health issues could be greater than in other low-income and middle-income countries because of major risk factors related to armed conflicts and poverty. Given that mental health is an essential component of health, it is surprising that no systematic evaluation of mental health in the DRC has yet been undertaken. This study aims to undertake the first systematic review of mental health literacy and service provision in the DRC, to bridge this gap and inform those who need to develop an evidence base. This could support policymakers in tackling the issues related to limited mental health systems and service provision in DRC. Following Cochrane and PRISMA guidelines, a systematic (Web of Science, Medline, Public Health, PsycINFO, and Google Scholar) search was conducted (January 2000 and August 2023). Combinations of key blocks of terms were used in the search such as DRC, war zone, mental health, post-traumatic stress disorder (PTSD), anxiety, depression, sexual violence, war trauma, resilience, mental health systems and service provision. We followed additional sources from reference lists of included studies. Screening was completed in two stages: title and abstract search, and full-text screening for relevance and quality. Overall, 50 studies were included in the review; the majority of studies (n = 31) were conducted in the Eastern region of the DRC, a region devastated by war and sexual violence. Different instruments were used to measure participants’ mental health such as the Hopkins Symptoms Checklist (HSCL-25), The Harvard Trauma Questionnaire, Patient Health Questionnaire (PHQ-9); General Anxiety Disorder (GAD-7), and Positive and Negative Symptoms Scale (PANSS). Our study found that wartime sexual violence and extreme poverty are highly traumatic, and cause multiple, long-term mental health difficulties. We found that depression, anxiety, and PTSD were the most common problems in the DRC. Psychosocial interventions such as group therapy, family support, and socio-economic support were effective in reducing anxiety, depression, and PTSD symptoms. This systematic review calls attention to the need to support sexual violence survivors and many other Congolese people affected by traumatic events. This review also highlights the need for validating culturally appropriate measures, and the need for well-designed controlled intervention studies in low-income settings such as the DRC. Better public mental health systems and service provision could help to improve community cohesion, human resilience, and mental wellbeing. There is also an urgent need to address wider social issues such as poverty, stigma, and gender inequality in the DRC