Search

Background To date little has been published about epidemiology and public health capacity (training, research, funding, human resources) in WHO/AFRO to help guide future planning by various stakeholders. Methods A bibliometric analysis was performed to identify published epidemiological research. Information about epidemiology and public health training, current research and challenges was collected from key informants using a standardized questionnaire. Results From 1991 to 2010, epidemiology and public health research output in the WHO/AFRO region increased from 172 to 1086 peer-reviewed articles per annum [annual percentage change (APC) = 10.1%, P for trend < 0.001]. The most common topics were HIV/AIDS (11.3%), malaria (8.6%) and tuberculosis (7.1%). Similarly, numbers of first authors (APC = 7.3%, P for trend < 0.001), corresponding authors (APC = 8.4%, P for trend < 0.001) and last authors (APC = 8.5%, P for trend < 0.001) from Africa increased during the same period. However, an overwhelming majority of respondents (>90%) reported that this increase is only rarely linked to regional post-graduate training programmes in epidemiology. South Africa leads in publications (1978/8835, 22.4%), followed by Kenya (851/8835, 9.6%), Nigeria (758/8835, 8.6%), Tanzania (549/8835, 6.2%) and Uganda (428/8835, 4.8%) (P < 0.001, each vs South Africa). Independent predictors of relevant research productivity were ‘in-country numbers of epidemiology or public health programmes' [incidence rate ratio (IRR) = 3.41; 95% confidence interval (CI) 1.90-6.11; P = 0.03] and ‘number of HIV/AIDS patients' (IRR = 1.30; 95% CI 1.02-1.66; P < 0.001). Conclusions Since 1991, there has been increasing epidemiological research productivity in WHO/AFRO that is associated with the number of epidemiology programmes and burden of HIV/AIDS cases. More capacity building and training initiatives in epidemiology are required to promote research and address the public health challenges facing the cont

Background: The study aimed to identify the impact of non-disclosure of HIV status on the loss to follow-up (LTFU) of patients receiving anti-retroviral therapy. Methodology: A historic cohort of HIV patients from 2 major hospitals in Goma, Democratic Republic of Congo was followed from 2004 to 2012. LTFU was defined as not taking an ART refill for a period of 3 months or longer since the last attendance, and had not yet been classified as 'dead' or 'transferred-out'. Kaplan-Meier plots were used to determine the probability of LTFU as a function of time as inclusive of the cohort. The log-rank test was used to compare survival curves based on determinants. Cox proportional hazard modeling was used to measure predictors of LTFU from the time of treatment induction until December 15th, 2012 (the end-point). Results: The median follow-up time was 3.99 years (IQR = 2.33 to 5.59). Seventy percent of patients had shared their HIV status with others (95% CI: 66.3–73.1). The proportion of LTFU was 12% (95%CI: 9.6–14.4). Patients who did not share their HIV status (Adjusted HR 2.28, 95% CI 1.46–2.29), patients who did not live in the city of Goma (Adjusted HR 1.97, 95% CI 1.02–3.77), and those who attained secondary or higher education level (Adjusted HR 1.60, 95% CI 1.02–2.53) had a higher hazard of being LTFU. Conclusion: This study shows the relationship between the non–disclosure HIV status and LTFU. Healthcare workers in similar settings should pay more attention to clients who have not disclosed their HIV status, and to those living far from health settings where they receive medication.

Background: The study aimed to identify the impact of non-disclosure of HIV status on the loss to follow-up (LTFU) of patients receiving anti-retroviral therapy. Methodology: A historic cohort of HIV patients from 2 major hospitals in Goma, Democratic Republic of Congo was followed from 2004 to 2012. LTFU was defined as not taking an ART refill for a period of 3 months or longer since the last attendance, and had not yet been classified as 'dead' or 'transferred-out'. Kaplan-Meier plots were used to determine the probability of LTFU as a function of time as inclusive of the cohort. The log-rank test was used to compare survival curves based on determinants. Cox proportional hazard modeling was used to measure predictors of LTFU from the time of treatment induction until December 15th, 2012 (the end-point). Results: The median follow-up time was 3.99 years (IQR = 2.33 to 5.59). Seventy percent of patients had shared their HIV status with others (95% CI: 66.3–73.1). The proportion of LTFU was 12% (95%CI: 9.6–14.4). Patients who did not share their HIV status (Adjusted HR 2.28, 95% CI 1.46–2.29), patients who did not live in the city of Goma (Adjusted HR 1.97, 95% CI 1.02–3.77), and those who attained secondary or higher education level (Adjusted HR 1.60, 95% CI 1.02–2.53) had a higher hazard of being LTFU. Conclusion: This study shows the relationship between the non–disclosure HIV status and LTFU. Healthcare workers in similar settings should pay more attention to clients who have not disclosed their HIV status, and to those living far from health settings where they receive medication.

[Background] Anaemia is associated with adverse outcomes including early death in the first year of antiretroviral therapy (ART). This study reports on the factors associated with persistent anaemia among HIV-infected patients initiating ART in the Democratic Republic of Congo (DR Congo). [Methods] We conducted a retrospective cohort study and analyzed data from patients receiving HIV care between January 2004 and December 2012 at two major hospitals in Goma, DR Congo. Haemoglobin concentrations of all patients on ART regimen were obtained prior to and within one year of ART initiation. A logistic regression model was used to identify the predictors of persistent anaemia after 12 months of ART. [Results] Of 756 patients, 69% of patients were anaemic (IC95%: 65.7-72.3) at baseline. After 12 months of follow up, there was a 1.2 g/dl average increase of haemoglobin concentration (P < 0.001) with differences depending on the therapeutic regimen. Patients who received zidovudine (AZT) gained less than those who did not receive AZT (0.99 g/dl vs 1.33 g/dl; p< 0.001). Among 445 patient who had anaemia at the beginning, 33% (147/445) had the condition resolved. Among patients with anaemia at ART initiation, those who did not receive cotrimoxazole prophylaxis before starting ART(AOR 3.89; 95% CI 2.09-7.25; P < 0.001) and a AZT initial regimen (AOR 2.19; 95% CI 1.36-3.52; P < 0.001) were significantly at risk of persistent anaemia. [Conclusions] More than two thirds of patients had anaemia at baseline. The AZT-containing regimen and absence of cotrimoxazole prophylaxis before starting ART were associated with persistent anaemia 12 months, after initiation of treatment. Considering the large proportion of patients with persistence of anaemia at 12 months, we suggest that it is necessary to conduct a large study to assess anaemia among HIV-infected patients in Goma.

Background: Hypertension remains a public health challenge worldwide. In the Democratic Republic of Congo, its prevalence has increased in the past three decades. Higher prevalence of poor blood pressure control and an increasing number of reported cases of complications due to hypertension have also been observed. It is well established that non-adherence to antihypertensive medication contributes to poor control of blood pressure. The aim of this study is to measure non-adherence to antihypertensive medication and to identify its predictors. Methods: A cross-sectional study was conducted at Kinshasa Primary Health-care network facilities from October to November 2013. A total of 395 hypertensive patients were included in the study. A structured interview was used to collect data. Adherence to medication was assessed using the Morisky Medication Scale. Covariates were defined according to the framework of the World Health Organization. Logistic regression was used to identify predictors of non-adherence. Results: A total of 395 patients participated in this study. The prevalence of non-adherence to antihypertensive medication and blood pressure control was 54.2 % (95 % CI 47.3-61.8) and 15.6 % (95 % CI 12.1-20.0), respectively. Poor knowledge of complications of hypertension (OR = 2.4; 95 % CI 1.4-4.4), unavailability of antihypertensive drugs in the healthcare facilities (OR = 2.8; 95 % CI 1.4-5.5), lack of hypertensive patients education in the healthcare facilities (OR = 1.7; 95 % CI 1.1-2.7), prior experience of medication side effects (OR = 2.2; 95 % CI 1.4-3.3), uncontrolled blood pressure (OR = 2.0; 95 % CI 1.1-3.9), and taking non-prescribed medications (OR = 2.2; 95 % CI 1.2-3.8) were associated with non-adherence to antihypertensive medication. Conclusion: This study identified predictors of non-adherence to antihypertensive medication. All predictors identified were modifiable. Interventional studies targeting these predictors for improving adherence are, SCOPUS: ar.j, info:eu-repo/semantics/published

info:eu-repo/semantics/published

info:eu-repo/semantics/published

Background: As teenagers have easy access to both radio programs and cell phones, the current study used these tools so that young people could anonymously identify questions about sex and other related concerns in the urban environment of the Democratic Republic of Congo. The purpose of this healthcare intervention was to identify and address concerns raised by young people, which are related to sexual health, and which promote youth health. Methods: This healthcare intervention was conducted over a six month period and consisted of a survey carried out in Kinshasa. This focused on 14 to 24 old young people using phone calls on a radio program raising concerns related to sexuality. The radio program was jointly run by a journalist and a health professional who were required to reply immediately to questions from young people. All sexual health concerns were recorded and analyzed. Results: Forty programs were broadcast in six months and 1,250 messages and calls were recorded: 880 (70%) from girls and 370 (30%) from boys, which represents an average of 32 interventions (of which 10 calls and 22 messages) per broadcast. Most questions came from 15-19- and 20-24-year-old girls and boys. Focus of girls' questions: menstrual cycle calculation and related concerns accounted for the majority (24%); sexual practices (16%), love relationships (15%) and virginity (14%). Boys' concerns are masturbation (and its consequences) (22%), sexual practices (19%), love relationships (18%) and worries about penis size (10%). Infections (genital and STI) and topics regarding HIV represent 9% and 4% of the questions asked by girls against 7% and 10% by boys. Concerns were mainly related to knowledge, attitudes and competences to be developed. Conclusions: Concerns and sexual practices raised by teens about their sexual and emotional life have inspired the design of a practical guide for youth self-training and have steered the second phase of this interactive program towards supporting th, SCOPUS: ar.j, info:eu-repo/semantics/published

ResuméDans le présent travail de recherche, nous présentons un cadre d’analyse, de planification et de mise en œuvre d’une recherche-action portant sur l’apport de l’éducation sexuelle participative comme démarche de la communication stratégique, et ses effets sur le public d’adolescents en milieu scolaire. Le but ultime étant de proposer une meilleure alternative à l’amélioration de la double prévention des IST/VIH/SIDA et des grossesses non désirées chez les adolescents scolarisés de 15-19 ans à Kinshasa, RDC.Les principaux objectifs fixés à la présente recherche étaient :i) d’évaluer l’ampleur de la situation épidémiologique et sociale liée à la santé de reproduction y compris la prévention du VIH/SIDA chez les jeunes adolescents (15-19 ans) ;ii) d’identifier les besoins ainsi que les préoccupations spécifiques des adolescents et jeunes notamment en terme de vie sexuelle et affective ;iii) de projeter les axes de communication stratégiques susceptibles d’influencer positivement les comportements en vue d’améliorer la prévention des IST/VIH/SIDA et des grossesses précoces des adolescents et jeunes en milieu urbain ;iv) de construire sur base des observations et analyses précédentes, une approche de communication stratégique fondée sur l’éducation sexuelle participative; iv) et mesurer au point de vue cognitif et comportemental, l’écart attribuable à l’éducation sexuelle sur l’amélioration des connaissances, des attitudes et des pratiques favorables à la double prévention des IST/VIH/SIDA et des grossesses précoces chez les adolescents de 15-19 ans en milieu urbain de la RDC.Réalisée dans une perspective de la promotion de la santé, son cadre théorique chemine avec celui de l’évidence des liens entre les IST/VIH/SIDA et la santé sexuelle et de reproduction. La combinaison du modèle d’analyse PRECEDE avec l’outil de planification PROCESSUS-P, a servi de fil conducteur de ce travail.Cette étude confronte également la théorie de la communication avec le, Doctorat en Sciences de la santé publique, info:eu-repo/semantics/nonPublished

L'éducation sexuelle par les médias de masse contribue positivement à la prévention des infections sexuellement transmissibles (IST)/VIH et des grossesses précoces auprès des jeunes. L'objectifs de cette étude sont d'appréhender le niveau d'intégration de l'éducation sexuelle dans les émissions de santé à Kinshasa en République Démocratique du Congo et d'identifier les facteurs facilitant et limitant l'éducation sexuelle des jeunes dans les programmes audio-visuels congolais. Une triangulation des données provenant de la revue documentaire, de l'observation directe de quatre émissions de santé et des entretiens semi-directifs auprès des 15 responsables de programme audiovisuels, a été exploitée. Une étude de cas d'une expérience réussie dans le domaine a été complétée. Bien qu'il soit observé une programmation de quelques émissions de santé dans les grands médias audiovisuels de Kinshasa, leur potentiel pour l'éducation sexuelle n'est que très faiblement exploité. Dans les quatre médias observés, les émissions de santé sont diffusées à des heures de faible audience, et effleurent superficiellement l'éducation sexuelle dans un contexte de prévention des IST/VIH. La participation d'experts n'est pas systématique ;le cas échéant, leur expression n'est pas souvent adaptée à la compréhension du grand public. De plus en plus, ces programmes offrent les possibilités d'interactivité avec la communauté via le téléphone mobile. Parmi les obstacles à l'éducation sexuelle dans les média audiovisuels, il a été identifié le manque de clarté de la loi relative à la liberté de la presse, associée à la peur de la répression ;les freins liés aux considérations socioculturelles, la faible disponibilité de l'expertise, les préjugés sur la non préférence de ces types d'émissions par le public et le manque de retombées financières de ces programmes. Au regard des bénéfices de l'éducation sexuelle sur la vie et le bien-être des jeunes, une meilleure interprétation de la loi, une fédératio, JOURNAL ARTICLE, SCOPUS: ar.j, info:eu-repo/semantics/published

As teenagers have easy access to both radio programs and cell phones, the current study used these tools so that young people could anonymously identify questions about sex and other related concerns in the urban environment of the Democratic Republic of Congo. The purpose of this healthcare intervention was to identify and address concerns raised by young people, which are related to sexual health, and which promote youth health., Journal Article, info:eu-repo/semantics/published

info:eu-repo/semantics/published

info:eu-repo/semantics/published

info:eu-repo/semantics/published

info:eu-repo/semantics/published

Human parvovirus 4 infections are primarily associated with parenteral exposure in western countries. By ELISA, we demonstrate frequent seropositivity for antibody to parvovirus 4 viral protein 2 among adult populations throughout sub-Saharan Africa (Burkina Faso, 37%; Cameroon, 25%; Democratic Republic of the Congo, 35%; South Africa, 20%), which implies existence of alternative transmission routes.

Human parvovirus 4 infections are primarily associated with parenteral exposure in western countries. By ELISA, we demonstrate frequent seropositivity for antibody to parvovirus 4 viral protein 2 among adult populations throughout sub-Saharan Africa (Burkina Faso, 37%; Cameroon, 25%; Democratic Republic of the Congo, 35%; South Africa, 20%), which implies existence of alternative transmission routes.

Context: Homeless children are at risk of getting many diseases, including sexually transmitted infections (STI). The number of street children is on the rise in the Democratic Republic of Congo (DRC), while very little is known about their health problems. Objectives: To determine knowledge of HIV (transmission and prevention means), sexual activity, exposure to HIV-prevention services, and to identify correlates of risky sexual behaviour (not having used a condom at first or last sexual encounter and/or having multiple sexual partners over a 12-month period) among street children in Kinshasa. Results: At the time of the survey, most participants (85.8%, 95% CI = 83.5-88.1) were sexually experienced and 55.8% had their first sexual intercourse when they were already living on the streets. The median age at first sexual activity was 14.3 years for males and 13.5 years for females. Compared to males (median number of sexual partners = 1), females tended to be more involved with multiple sexual partners (median = 12). Condoms were used less at the fist sexual encounter (20.2%; 95% CI =17.3-23.1) and the pattern of condom use depended on the type of sexual partners (61.1% at last sexual encounter with a paid/paying partner and 23.1% at last sexual encounter with a non-paid/non-paying partner). In males, sleeping in a NGO-provided night shelter (OR= 0.47; 95% CI = 0.27–0.79), and having had the first sexual intercourse while living on the streets (OR = 0.55; 95% CI = 0.35-0.88) were protective of risky sexual behaviour, while a history of drug use (OR = 3.00; 95% CI = 1.46–6.18), and being aged 20 to 24 years (OR = 1.59; 95% 1.00–2.55) increased the likelihood of displaying risky sexual behaviour. In females, not knowing where to get a condom (OR = 0.04; 95% CI = 0.005–0.29), having started sexual activity when living on the streets (OR = 0.10; 95% CI = 0.01–0.73) and not having an income-generating activity (OR = 0.09; 95% CI = 0.01–0.44) were protective of risky sexua

Poster commenté, info:eu-repo/semantics/nonPublished

(i.f. 2.145), info:eu-repo/semantics/published

Arterial stiffening is more accelerated in blacks than in whites. Whether this is attributed to an enhanced vascular reactivity to environmental stress stimulation remains unknown. We therefore decided to test the hypothesis that cold pressor test (CPT) elicits a greater increase in arterial stiffness and an enhanced sympathetic skin vasoconstriction in African blacks than in whites normotensives., Journal Article, Research Support, Non-U.S. Gov't, info:eu-repo/semantics/published

(i.f. 2.145), info:eu-repo/semantics/published

Arterial stiffening is more accelerated in blacks than in whites. Whether this is attributed to an enhanced vascular reactivity to environmental stress stimulation remains unknown. We therefore decided to test the hypothesis that cold pressor test (CPT) elicits a greater increase in arterial stiffness and an enhanced sympathetic skin vasoconstriction in African blacks than in whites normotensives., Journal Article, Research Support, Non-U.S. Gov't, info:eu-repo/semantics/published

Poster commenté, info:eu-repo/semantics/nonPublished

Context: Homeless children are at risk of getting many diseases, including sexually transmitted infections (STI). The number of street children is on the rise in the Democratic Republic of Congo (DRC), while very little is known about their health problems. Objectives: To determine knowledge of HIV (transmission and prevention means), sexual activity, exposure to HIV-prevention services, and to identify correlates of risky sexual behaviour (not having used a condom at first or last sexual encounter and/or having multiple sexual partners over a 12-month period) among street children in Kinshasa. Results: At the time of the survey, most participants (85.8%, 95% CI = 83.5-88.1) were sexually experienced and 55.8% had their first sexual intercourse when they were already living on the streets. The median age at first sexual activity was 14.3 years for males and 13.5 years for females. Compared to males (median number of sexual partners = 1), females tended to be more involved with multiple sexual partners (median = 12). Condoms were used less at the fist sexual encounter (20.2%; 95% CI =17.3-23.1) and the pattern of condom use depended on the type of sexual partners (61.1% at last sexual encounter with a paid/paying partner and 23.1% at last sexual encounter with a non-paid/non-paying partner). In males, sleeping in a NGO-provided night shelter (OR= 0.47; 95% CI = 0.27–0.79), and having had the first sexual intercourse while living on the streets (OR = 0.55; 95% CI = 0.35-0.88) were protective of risky sexual behaviour, while a history of drug use (OR = 3.00; 95% CI = 1.46–6.18), and being aged 20 to 24 years (OR = 1.59; 95% 1.00–2.55) increased the likelihood of displaying risky sexual behaviour. In females, not knowing where to get a condom (OR = 0.04; 95% CI = 0.005–0.29), having started sexual activity when living on the streets (OR = 0.10; 95% CI = 0.01–0.73) and not having an income-generating activity (OR = 0.09; 95% CI = 0.01–0.44) were protective of risky sexua

Symposium organisé par le Comité Belge de lutte contre l’Hypertension et Société Belgique de Cardiologie, info:eu-repo/semantics/nonPublished

Symposium organisé par le Comité Belge de lutte contre l’Hypertension et Société Belgique de Cardiologie, info:eu-repo/semantics/nonPublished

Background To date little has been published about epidemiology and public health capacity (training, research, funding, human resources) in WHO/AFRO to help guide future planning by various stakeholders. Methods A bibliometric analysis was performed to identify published epidemiological research. Information about epidemiology and public health training, current research and challenges was collected from key informants using a standardized questionnaire. Results From 1991 to 2010, epidemiology and public health research output in the WHO/AFRO region increased from 172 to 1086 peer-reviewed articles per annum [annual percentage change (APC) = 10.1%, P for trend < 0.001]. The most common topics were HIV/AIDS (11.3%), malaria (8.6%) and tuberculosis (7.1%). Similarly, numbers of first authors (APC = 7.3%, P for trend < 0.001), corresponding authors (APC = 8.4%, P for trend < 0.001) and last authors (APC = 8.5%, P for trend < 0.001) from Africa increased during the same period. However, an overwhelming majority of respondents (>90%) reported that this increase is only rarely linked to regional post-graduate training programmes in epidemiology. South Africa leads in publications (1978/8835, 22.4%), followed by Kenya (851/8835, 9.6%), Nigeria (758/8835, 8.6%), Tanzania (549/8835, 6.2%) and Uganda (428/8835, 4.8%) (P < 0.001, each vs South Africa). Independent predictors of relevant research productivity were ‘in-country numbers of epidemiology or public health programmes' [incidence rate ratio (IRR) = 3.41; 95% confidence interval (CI) 1.90-6.11; P = 0.03] and ‘number of HIV/AIDS patients' (IRR = 1.30; 95% CI 1.02-1.66; P < 0.001). Conclusions Since 1991, there has been increasing epidemiological research productivity in WHO/AFRO that is associated with the number of epidemiology programmes and burden of HIV/AIDS cases. More capacity building and training initiatives in epidemiology are required to promote research and address the public health challenges facing the cont