Abstract.There is little published information on the epidemiology of neurological disorders in rural Central Africa, although the burden is considered to be substantial. This study aimed to investigate the pattern, etiology, and outcome of neurological disorders in children > 5 years and adults admitted to the rural hospital of Mosango, province of Kwilu, Democratic Republic of Congo, with a focus on severe and treatable infections of the central nervous system (CNS). From September 2012 to January 2015, 351 consecutive patients hospitalized for recent and/or ongoing neurological disorder were prospectively evaluated by a neurologist, subjected to a set of reference diagnostic tests in blood or cerebrospinal fluid, and followed-up for 3–6 months after discharge. No neuroimaging was available. Severe headache (199, 56.7%), gait/walking disorders (97, 27.6%), epileptic seizure (87, 24.8%), and focal neurological deficit (86, 24.5%) were the predominant presentations, often in combination. Infections of the CNS were documented in 63 (17.9%) patients and mainly included bacterial meningitis and unspecified meningoencephalitis (33, 9.4%), second-stage human African trypanosomiasis (10, 2.8%), and human immunodeficiency virus (HIV)-related neurological disorders (10, 2.8%). Other focal/systemic infections with neurological manifestations were diagnosed in an additional 60 (17.1%) cases. The leading noncommunicable conditions were epilepsy (61, 17.3%), psychiatric disorders (56, 16.0%), and cerebrovascular accident (23, 6.6%). Overall fatality rate was 8.2% (29/351), but up to 23.8% for CNS infections. Sequelae were observed in 76 (21.6%) patients. Clinical presentations and etiologies of neurological disorders were very diverse in this rural Central African setting and caused considerable mortality and morbidity.

SummaryBackgroundSigns indicating hypertensive retinopathy can help determine the extent of hypertensive cardiovascular, renal and cerebrovascular damage.ObjectivesTo study the association between hypertensive retinopathy and cardiovascular, renal and cerebrovascular changes, and to determine the predictors of hypertensive retinopathy in Congolese patients.MethodsA total of 159 hypertensive subjects (mean age: 58.9 ± 13.2 years) were enrolled from the cardiology out-patient clinic. Retinopathy grade was assessed on direct ophthalmoscopy. Hypertensive cardiovascular, renal and cerebrovascular changes were indicated by left ventricular hypertrophy (LVH), chronic kidney disease (CKD) and stroke, respectively.ResultsHypertensive retinopathy was present in 83.6% of the patients (grade 1: 42.1%; grade 2: 11.3%; grade 3: 23.3%; grade 4: 6.9%). There was no association between hypertensive retinopathy and the presence or absence of LVH (86.5 vs 73.3%, χ2 = 1.53, p = 0.21), chronic kidney disease (89.3 vs 83.3%, χ2 = 0.12, p = 0.73) or stroke (85.7 vs 83.2%, χ2 > 0.001, p = 0.99). On multivariate logistic regression, CKD was the most significant predictor of severe hypertensive retinopathy, with an odds ratio of 4.4.ConclusionNo association was found between hypertensive retinopathy and LVH, CKD or stroke. CKD was the most significant predictor of hypertensive retinopathy and there was a tendency toward increased risk of target-organ damage among patients with advanced hypertensive retinopathy.

Analysis of cerebrospinal fluid (CSF) obtained by lumbar puncture (LP) is an essential step for the diagnostic approach of neurological disorders, in particular neuro-infections. In low-resource settings, it is even often the only available diagnostic method. Despite its key contribution, little is known on the risks and benefits of LP in the large tropical areas where hospital-based neuroimaging is not available. The objectives of this study were to assess the safety and diagnostic yield of LP in a rural hospital of central Africa and to identify predictors of CSF pleocytosis (white blood cell count >5/μL) as surrogate marker of neuro-infections. From 2012 to 2015, 351 patients admitted for neurological disorders in the rural hospital of Mosango, Kwilu province, Democratic Republic of Congo, were evaluated using a systematic clinical and laboratory workup and a standard operating procedure for LP. An LP was successfully performed in 307 patients (87.5%). Serious post-LP adverse events (headache, backache or transient confusion) were observed in 23 (7.5%) of them but were self-limiting, and no death or long-term sequelae were attributable to LP. CSF pleocytosis was present in 54 participants (17.6%), almost always associated with neuro-infections. Presenting features strongly and independently associated with CSF pleocytosis were fever, altered consciousness, HIV infection and positive screening serology for human African trypanosomiasis. In conclusion, the established procedure for LP was safe in this hospital setting with no neuroimaging and CSF analysis brought a substantial diagnostic contribution. A set of presenting features may help accurately selecting the patients for whom LP would be most beneficial.

Childhood lead exposure remains a problem in developing countries, and little is known about its effects on early child neurodevelopment and temperament in the Democratic Republic of Congo (DRC). We, therefore, conducted this study to determine the association between lead exposure and the neurodevelopment and behaviour of children aged 12–24 months in Kinshasa, DRC. A cross-sectional study was conducted between February and June 2012, and parents of 104 children were invited to participate. Blood lead levels (BLLs) of each child were tested using the flame atomic spectrophotometry method. All children were subject to a clinical examination and assessed with two selected early child neurodevelopmental tools, the Gensini–Gavito and the baby characteristics questionnaire, to measure their neurodevelopment and temperament. Detectable BLLs ranged from 1 to 30 μg/dl with a geometric mean of 6.9 (SD 4.8) μg/dl. BLLs at 5–9 and ≥10 μg/dl were significantly associated with the child temperament (p <0.05). Perinatal and maternal factors did not seem to affect early child neurodevelopment and temperament. Children exposed to lead were reported with more temperament difficulties at even blood lead levels <10 μg/dl, suggesting the need for preventive and intervention measures to reduce lead exposure among children in Kinshasa, DRC.

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