Epidemiological and Therapeutic Aspects of Obstetric Fistula in The Peri Urban Area of Butembo in the Democratic Republic of Congo

AbstractObjectiveAdequate iodine and Fe intakes are imperative during pregnancy to prevent fetal defects, but such data are not available in the Democratic Republic of Congo. We aimed to assess iodine and Fe status in pregnant women from Lubumbashi.DesignCross-sectional study. We measured urinary iodine concentration (UIC) in random urine samples using a modified Sandell–Kolthoff digestion method; the WHO reference medians were used to classify iodine intake as deficient, adequate, more than adequate or excessive. Serum ferritin concentrations were measured by immunoenzymatic assay and considered insufficient when <12 ng/ml.SettingMaternity units from rural, semi-urban and urban areas of Lubumbashi, Democratic Republic of Congo.SubjectsTwo hundred and twenty-five randomly selected pregnant women attending prenatal consultation, seventy-five postpartum women and seventy-five non-pregnant women as controls.ResultsOverall median UIC in pregnant women was 138 (interquartile range: 105–172) μg/l, indicating iodine deficiency, whereas postpartum and non-pregnant women had adequate iodine intake: median UIC = 144 μg/l and 204 μg/l, respectively. Median UIC values were lower in late pregnancy than in early pregnancy: in the first, second and third trimester respectively 255 μg/l, 70 μg/l and 88 μg/l in the rural area; 306 μg/l, 166 μg/l and 68 μg/l in the semi-urban area; and 203 μg/l, 174 μg/l and 99 μg/l in the urban area. Fe was insufficient in 39 % of pregnant women compared with 21 % of non-pregnant and postpartum women. In the third trimester, deficiencies in both iodine and Fe were high: 40 %, 12 % and 18 % in the rural, semi-urban and urban areas, respectively.ConclusionsOur data suggest that pregnant women are at risk of iodine and Fe deficiencies in Lubumbashi. Country policies fighting against iodine and Fe deficiencies during pregnancy should be reinforced.

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Malaria Parasite Species Composition of Plasmodium Infections Among Asymptomatic and Symptomatic School-Age Children in Rural and Urban Areas of Kinshasa, Democratic Republic of Congo

10.21203/rs.3.rs-389568/v1 ◽

2021 ◽

Author(s):

Sabin S. Nundu ◽

Richard Culleton ◽

Shirley V. Simpson ◽

Hiroaki Arima ◽

Jean-Jacques Muyembe ◽

...

Keyword(s):

Urban Area ◽

Rural Area ◽

Malaria Parasite ◽

Parasite Species ◽

Democratic Republic ◽

Democratic Republic Of Congo ◽

School Age Children ◽

Asymptomatic Malaria ◽

School Age ◽

Republic Of Congo

Abstract Background. Malaria remains a major public health concern in Democratic Republic of Congo (DRC), and school-age children are relatively neglected in malaria prevalence surveys and may constitute a significant reservoir of transmission. This study aimed to understand the burden of malaria infections in school-age children in Kinshasa/DRC.Methods. 634 (427 asymptomatic and 207 symptomatic) blood samples were collected from a cross-sectional survey of school-age children aged 6 to 14 years both without and with malaria symptoms. Nested-PCR was performed for malaria parasite species typing. Results. The overall prevalence of Plasmodium spp., Plasmodium falciparum, Plasmodium malariae and Plasmodium ovale was 62.3, 58.1, 19.9 and 10.8% among asymptomatic whereas it was 94.4, 93.2, 12.6 and 15.9% in symptomatic children, respectively. All Plasmodium species infections were significantly more prevalent in the rural area compared to the urban area in asymptomatic infections (p<0.001). Living in a rural as opposed to an urban area was associated with a five-fold greater risk of asymptomatic malaria parasite carriage (p<0.001). Amongst asymptomatic malaria parasite carriers, 43% of children in the rural area were co-infected with two or more species with P. falciparum + P. malariae the most common (24%) whereas in the urban setting, fewer children carried co-infections (16%) with P. falciparum + P. malariae again the most common (9%). A fifth of rural-dwelling symptomatic children were co-infected with two or more species with P. falciparum + P. ovale the most common (14%), while a quarter of symptomatic children in the urban area carried multiple species, with co-infections of P. falciparum + P. malariae the most common (11%). Conclusion. School-age children are at significant risk from both asymptomatic and symptomatic malaria parasite infections. Continuous systematic screening and treatment of school-age children in high-transmission settings across the country may reinforce malaria intervention measures.

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Malaria parasite species composition of Plasmodium infections among asymptomatic and symptomatic school-age children in rural and urban areas of Kinshasa, Democratic Republic of Congo

Malaria Journal ◽

10.1186/s12936-021-03919-4 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Sabin S. Nundu ◽

Richard Culleton ◽

Shirley V. Simpson ◽

Hiroaki Arima ◽

Jean-Jacques Muyembe ◽

...

Keyword(s):

Urban Area ◽

Urban Areas ◽

Malaria Parasite ◽

Democratic Republic ◽

Democratic Republic Of Congo ◽

School Age Children ◽

Asymptomatic Malaria ◽

School Age ◽

Republic Of Congo ◽

Symptomatic Malaria

Abstract Background Malaria remains a major public health concern in the Democratic Republic of Congo (DRC), and school-age children are relatively neglected in malaria prevalence surveys and may constitute a significant reservoir of transmission. This study aimed to understand the burden of malaria infections in school-age children in Kinshasa/DRC. Methods A total of 634 (427 asymptomatic and 207 symptomatic) blood samples collected from school-age children aged 6 to 14 years were analysed by microscopy, RDT and Nested-PCR. Results The overall prevalence of Plasmodium spp. by microscopy, RDT and PCR was 33%, 42% and 62% among asymptomatic children and 59%, 64% and 95% in symptomatic children, respectively. The prevalence of Plasmodium falciparum, Plasmodium malariae and Plasmodium ovale spp. by PCR was 58%, 20% and 11% among asymptomatic and 93%, 13% and 16% in symptomatic children, respectively. Among P. ovale spp., P. ovale curtisi, P. ovale wallikeri and mixed P. ovale curtisi + P. ovale wallikeri accounted for 75%, 24% and 1% of infections, respectively. All Plasmodium species infections were significantly more prevalent in the rural area compared to the urban area in asymptomatic infections (p < 0.001). Living in a rural as opposed to an urban area was associated with a five-fold greater risk of asymptomatic malaria parasite carriage (p < 0.001). Amongst asymptomatic malaria parasite carriers, 43% and 16% of children harboured mixed Plasmodium with P. falciparum infections in the rural and the urban areas, respectively, whereas in symptomatic malaria infections, it was 22% and 26%, respectively. Few children carried single infections of P. malariae (2.2%) and P. ovale spp. (1.9%). Conclusion School-age children are at significant risk from both asymptomatic and symptomatic malaria infections. Continuous systematic screening and treatment of school-age children in high-transmission settings is needed.

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Frequency and management of non-obstetric fistula in the Democratic Republic of Congo: experience from Fistula Care Plus project

Nepal Journal of Obstetrics and Gynaecology ◽

10.3126/njog.v13i2.21883 ◽

2018 ◽

Vol 13 (2) ◽

Author(s):

Alexandre Delamou ◽

Michel Mpunga ◽

Félicien Banze ◽

Dolores Nembunzu ◽

Kenny Raha ◽

...

Keyword(s):

Rural Areas ◽

Democratic Republic ◽

Surgical Repair ◽

Democratic Republic Of Congo ◽

Obstetric Fistula ◽

Type I ◽

Medical Procedure ◽

Republic Of Congo ◽

Congenital Origin ◽

Free Generation

Aims: To describe the frequency and management of non-obstetric fistula (NOF) in Democratic Republic of Congo (DRC). Methods: A retrospective cohort study reviewed patients’ medical records in three fistula repair sites supported by the USAID-funded Fistula Care Plus (FC+) Project, covering 1 January 2015 to 31 December 2017. Study variables included demographic characteristics, fistula etiology as reported by surgeon, fistula type (Waaldijk classification), and treatment outcomes. Results: Of 1984 women treated for female genital fistula between 2015 and 2017 in the three sites, 384 (19%) were considered to be NOF cases. 91% of these women resided in rural areas. 49.3% were married/in relationship at time of treatment compared to 69% before the fistula (p<0.001). Most (n=316; 82.3%) had no previous repair attempts and 96.2% had an intact urethra. Type III (n=247; 64.3%) and type I (n=121; 31.5%) fistulas (Waaldijk classification) were most common. The main causes of NOF were medical procedure (n=305; 79.4%), congenital origin (41; 10.7%) or sexual assault (28; 7.3%). Caesarean section (n=234; 76.7%) and hysterectomy (n=54; 17.7%) were the most common causative procedures. 369 women with NOF received surgical repair (96%), mainly through routine services (n=317; 85.9%). At discharge, 353 women were closed and dry (95.7%) and 11 were closed with residual incontinence (3.0%). Conclusions: NOF, particularly due to iatrogenic causes, was relatively common in DRC. Surgical repair at FC+-supported sites led to good clinical outcomes. However, to achieve a fistula-free generation in DRC, prevention of iatrogenic fistula is needed, requiring improved quality of maternal care.

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