IntroductionThe burden of non-communicable diseases (NCDs) is increasing in low and middle-income countries (LMIC). According to the World Health Organization (WHO) the largest increase occurs in Africa. Obesity, diabetes mellitus and hypertension (ODH) are major risk factors for cardiovascular diseases, causing nearly 18 million deaths worldwide. Various risks associated with mining as an occupational activity are implicated in NCDs' occurrence. This study describes the baseline prevalence of ODH and associated risk factors in the workforce of Tenke Fungurume Mining (TFM), in southern Democratic Republic of Congo.MethodsA cross-sectional study was conducted on a sample of 2,749 employees' and contractor's occupational health examination files for 2010. Socio-demographic, occupational, medical, anthropometric and behavioral characteristics were collected and assessed. Disease status regards ODH was based on WHO criteria. A multivariate logistic regression model was used.ResultsOverall prevalence of ODH was 4.5%, 11.7%, and 18.2% respectively. Proportions of pre-ODH individuals were 19.7%, 16.5%, and 47.8% respectively. Prevalence of ODH increased with age, professional grade, nature of work, gender and reported alcohol use. Smoking 10 or more cigarettes per day increased risk of diabetes and hypertension, while decreasing obesity.ConclusionRates of ODH and associated risk factors are higher in the TFM workforce, than in the general DRC population. This is likely reflective of other mining sites in the country and region. It is evident that ODH are associated with various socio-demographic, occupational, anthropometric, biomedical and behavioral risk factors. A NCD prevention program and close monitoring of disease and risk factors trends are needed in this population.

BackgroundIn southern Democratic Republic of the Congo, malaria transmission is stable with seasonal fluctuations. Different measurements can be used to monitor disease burden and estimate the performance of control programmes. Repeated school-based malaria prevalence surveys (SMPS) were conducted from 2007 to 2014 to generate up-to-date surveillance data and evaluate the impact of an integrated vector control programme.MethodsBiannual SMPS used a stratified, randomized and proportional sampling method. Schools were randomly selected from the entire pool of facilities within each Health Area (HA). Subsequently, school-children from 6 to 12 years of age were randomly selected in a proportional manner. Initial point-of-care malaria diagnosis was made using a rapid detection test. A matching stained blood film was later examined by expert microscopy and used in the final analysis. Data was stratified and analysed based on age, survey time and location.ResultsThe baseline SMPS (pre-control in 2007) prevalence was approximately 77%. From 2009 to 2014, 11,628 school-children were randomly screened. The mean age was 8.7 years with a near equal sex ratio. After exclusion, analysis of 10,493 students showed an overall malaria prevalence ratio of 1.92 in rural compared to urbanized areas. The distribution of Plasmodium falciparum malaria was significantly different between rural and urban HAs and between end of wet season and end of dry season surveys. The combined prevalence of single P. falciparum, Plasmodium malariae and Plasmodium ovale infections were 29.9, 1.8 and 0.3% of those examined, respectively. Only 1.8% were mixed Plasmodium species infections. From all microscopically detected infections (3545 of 10,493 samples examined), P. falciparum represented 88.5%, followed by P. malariae (5.4%) and P. ovale (0.8%). Cases with multiple species represented 5.3% of patent infections. Malaria prevalence was independent of age and gender. Control programme performance contributed to a significant decrease in mean P. falciparum infection density in urban compared to rural locations. Some rural areas remained highly refractory to control measures (insecticide-treated bed nets, periodic indoor residual spraying).ConclusionThe SMPS is a useful longitudinal measurement for estimating population malaria prevalence and demonstrating disease burden and impact of control interventions. SMPS can identify refractory areas of transmission and thus prioritize control strategies accordingly.

Les fistules obstétricales constituent un problème majeur de Santé Publique dans les pays pauvres. L’objectif de ce travail est de décrire les aspects épidémiologiques, cliniques et thérapeutiques des fistules obstétricales dans la province du Haut-Katanga, République Démocratique du Congo. L’étude est transversale descriptive, portant sur 242 patientes souffrant de la fistule obstétricale dans la province du Haut-Katanga durant la période allant de Septembre 2009 à Décembre 2013. Les paramètres étudiés étaient les données sociodémographiques maternelles, les paramètres obstétricaux et néonatals, les caractéristiques spécifiques de la fistule ainsi que les modalités et l’issue de la prise en charge. Les variables ont été analysées sur logiciel Epi-info version 7.1. Des 242 cas de fistules, 229 patientes ont accouché par voie basse soit 95% d’entre elles et 74,6% à domicile. Le nouveau-né était décédé en période périnatale dans 93,4% des accouchements. L’âge moyen des patientes était de 27,9±10,3 ans. Environ une patiente sur six avait moins de 20 ans et dans l’ensemble près d’une patiente sur 2 avait moins de 25 ans. 7 patientes sur 10 avaient une parité inférieure à 3 et la parité moyenne était de 2,5±2,0. Nonante pourcent des cas avaient un niveau d’études bas et 95% vivaient seules. La fistule avait en moyenne plus de 4,7±4,4 ans d’âge, était vésico-vaginale (96%), de type 2-3 (37%) et réparée par voie vaginale (67%). Le taux d’échecs était de 14%. La fistule obstétricale constitue un réel problème de Santé Publique dans notre milieu et mérite une réflexion profonde pour son éradication.

BackgroundAlthough rates of maternal and neonatal mortality have decreased in many countries over the last two decades, they remain unacceptably high, particularly in sub-Saharan Africa. Nevertheless, we know little about the quality of facility-based maternal and newborn care in low-income countries and little about the association between quality of care and health worker training, supervision, and incentives in these settings. We therefore sought to examine the quality of facility-based maternal and newborn health care by describing the implementation of recommended practices for maternal and newborn care among health care facilities. We also aimed to determine whether increased training, supervision, and incentives for health workers were associated with implementing these recommended practices. We chose to study these aims in the Republic of Rwanda, where rates of maternal and newborn mortality are high and where substantial attention is currently focused on strengthening health workforce capacity and quality.MethodsWe used data from the 2007 Rwanda Service Provision Assessment. Using observations from 455 facilities and interviews from 1357 providers, we generated descriptive statistics to describe the use of recommended practices and frequencies of provider training, supervision, and incentives in the areas of antenatal, delivery, and newborn care. We then constructed multivariable regression models to examine the associations between using recommended practices and health provider training, supervision, and incentives.ResultsUse of recommended practices varied widely, and very few facilities performed all recommended practices. Furthermore, in most areas of care, less than 25% of providers reported having had any pre-service or in-service training in the last 3 years. Contrary to our hypotheses, we found no evidence that training, supervision, or incentives were consistently associated with using recommended practices.ConclusionOur findings highlight the need to improve facility-based maternal and newborn care in Rwanda and suggest that current approaches to workforce training, supervision, and incentives may not be adequate for improving these critical practices.

IntroductionMaternal anthropometric parameters as risk factors for cesarean section have always been a matter of interest and concern for obstetricians. Some of these parameters have been shown to be predictors of dystocia. This study aims at showing the relationship between cesarean section indications and anthropometric parameters sizes in Rwandan nulliparae for the purpose of comparison and appropriate recommendations.MethodsA cross-sectional and analytical study was made on data collected from 32 operated patients among 152 nulliparae with singleton pregnancy at term and vertex presentation. Concerned anthropometric parameters were height, weight and six pelvic distances. Fisher exact and Student’s tests were used to compare observed proportions and mean values, respectively.ResultsFindings were as follows: 1) the overall cesarean section rate was 21.05%; 2) acute fetal distress (31.3 %), generally contracted pelvis (28.1 %), and engagement failure (25%) were the most frequent indications of cesarean section; 3) all patients ≤ 145 cm tall were operated on for general pelvis contraction whose proportion was significantly higher in them than in the others (p < 0.01); 4) more than half of pelvis contraction cases were observed in patients weighing ≤ 50 kg, but the difference with other weight categories was not significant; 5) considered external pelvic diameters but the Biiliac Diameter displayed average measurements smaller in clinically contracted pelvis than in other CS indications.ConclusionExternal pelvimetry associated with specific other anthropometric parameters could be helpful in the screening of generally contracted pelves, and consequently pregnancies at high risk of cephalopelvic disproportion in nulliparous women, particularly in developing countries with limited resources. Further investigations are requested to deal with this topic in depth.