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The aim of this study was to explore the relationship of iron and zinc deficiencies and anemia in children aged under 5 years living in malaria endemic area of South Kivu/DRC. We conducted a cross-sectional study in the health zone of Miti Murhesa in South Kivu/DRC. A total of 1088 children in good general health were included in this study. Almost 40% of children were anemic. The prevalence of iron deficiency (ID) was found in 34.9% and 49.1% children based on ferritin or free erythrocyte protoporphyrin (FEP), respectively. If anemia is present, we found iron deficiency anemia (IDA) according to the WHO-criteria (ferritin) in 31%, and according to FEP in 66% of children. The overall prevalence of zinc deficiency was 17.6%. If anemia is present, zinc deficiency was found in 24.4% of children. Inflammation/infection, based upon CRP, was present in 39.7% children. The independent factors associated with anemia were recent illness, middle upper arm circumference, weight-for-height, ID according to FEP, zinc deficiency, and submicroscopic Plasmodium infection. A high prevalence of ID was observed in children in South Kivu according to FEP. Ferritin as acute phase protein was less suited in this population due to a high frequency of infection/inflammation. Iron and zinc deficiencies were found to be significantly associated with anemia in this population.

Background Insecurity has characterized the Eastern regions of the Democratic Republic of Congo for decades. Providing health services to sustain women’s and children’s health during protracted conflict is challenging. This mixed-methods case study aimed to describe how reproductive, maternal, newborn, child, adolescent health and nutrition (RMNCAH+N) services have been offered in North and South Kivu since 2000 and how successful they were. Methods We conducted a case study using a desk review of publicly available literature, secondary analysis of survey and health information system data, and primary qualitative interviews. The qualitative component provides insights on factors shaping RMNCAH+N design and implementation. We conducted 49 interviews with government officials, humanitarian agency staff and facility-based healthcare providers, and focus group discussions with community health workers in four health zones (Minova, Walungu, Ruanguba, Mweso). We applied framework analysis to investigate key themes across informants. The quantitative component used secondary data from nationwide surveys and the national health facility information system to estimate coverage of RMNCAH+N interventions at provincial and sub-provincial level. The association between insecurity on service provision was examined with random effects generalized least square models using health facility data from South Kivu. Results Coverage of selected preventive RMNCAH+N interventions seems high in North and South Kivu, often higher than the national level. Health facility data show a small negative association of insecurity and preventive service coverage within provinces. However, health outcomes are poorer in conflict-affected territories than in stable ones. The main challenges to service provisions identified by study respondents are the availability and retention of skilled personnel, the lack of basic materials and equipment as well as the insufficient financial resources to ensure health workers’ regular payment, medicaments’ availability and facilities’ running costs. Insecurity exacerbates pre-existing challenges, but do not seem to represent the main barrier to service provision in North and South Kivu. Conclusions Provision of preventive schedulable RMNCAH+N services has continued during intermittent conflict in North and South Kivu. The prolonged effort by non-governmental organizations and UN agencies to respond to humanitarian needs was likely key in maintaining intervention coverage despite conflict. Health actors and communities appear to have adapted to changing levels and nature of insecurity and developed strategies to ensure preventive services are provided and accessed. However, emergency non-schedulable RMNCAH+N interventions do not appear to be readily accessible. Achieving the Sustainable Development Goals will require increased access to life-saving interventions, especially for newborn and pregnant women.

Ferroportin (FPN) is known as an iron exporter and its effect on RBC iron could therefore hamper the growth of malaria parasites, since parasites are in need of iron. The aim of this study was to examine the prevalence of FPN Q248H in South Kivu/DRC and to evaluate its role inWe conducted a cross-sectional study in the health zone of Miti Murhesa in South Kivu/DRC. 1088 children aged under five years were included. The FPN Q248H mutation was analyzed by PCR (N = 1071). Allele frequency was calculated based on Hardy-Weinberg equation.We found 11.4% FPN Q248H mutation. T allele frequency was estimated to be 0.0588 ± 0.0052. No significant differences for frequencies of anemia and malaria were observed between FPN Q248H mutation and FPN wild type. HoweverEven though FPN Q248H mutation is associated with lower hemoglobin values in

Background: The infant mortality rate in the province of South Kivu remains one of the highest in the Democratic Republic of Congo (DR Congo). The aim of this study is to estimate this mortality by identifying the associated factors in the health zones of Walungu and Miti-Murhesa, rural and post-conflict health zones of South Kivu, eastern DR Congo.Methods: We conducted a cross-sectional study in two post-conflict rural health zones, Miti-Murhesa and Walungu, between July 2016 and September 2017. Our study population consisted of women giving birth from two aforementioned areas during the period of study in which a structured questionnaire assessing the survival of the child resulting from the previous pregnancy was administered. Qualitative variables were described as counts and proportions and quantitative variables as means or medians depending on their distribution. To determine the factors associated with child survival, simple and multivariate logistic regression models were constructed. The materiality threshold was set at 5%. Results: The infant mortality rate is 49.7 ‰ in the two study areas overall and specifically 52.6 ‰ in Miti-Murhesa and 46.56 ‰ in Walungu. The factors associated with this mortality were the age of the mother under 20 years old [adjusted odds ratio ( ORa) = 2.3, 95% CI : 1.1-4.5 ; p = 0.022], household size greater than or equal to 7 people [( ORa = 3.7 ; 95% CI : 1.9-7.3 ; p Conclusion: Infant mortality in the post-crisis rural area of South Kivu remains high although it is relatively low compared to the national average (58 ‰). However, efforts still need to be made in order to hope to achieve the Sustainable Development Goals.

Background: The eastern Democratic Republic of Congo (DRC) has experienced decades-long armed conflicts which have had a negative impact on population’s health. Most research in public health explores measures that focus on a specific health problem rather than overall population health status. The aim of this study was to assess the health status of the population and its predictors in conflict settings of South Kivu province, using the World Health Organization Disability Assessment Schedule (WHODAS). Methods: Between May and June 2019, we conducted a community-based cross-sectional survey among 1440 adults in six health zones (HZ), classified according to their level of armed conflict intensity and chronicity in four types (accessible and stable, remote and stable, intermediate and unstable). The data were collected by a questionnaire including socio-demographic data and the WHODAS 2.0 tool with 12 items. The main variable of the study was the WHODAS summary score measuring individual’s health status and synthesize in six domains of disability (household, cognitive, mobility, self-care, social and society). Univariate analysis, correlation and comparison tests as well as hierarchical multiple linear regression were performed. Results: The median WHODAS score in the accessible and stable (AS), remote and stable (RS), intermediate (I) and unstable (U) HZ was 6.3 (0–28.6); 25 (6.3–41.7); 22.9 (12.5–33.3) and 39.6 (22.9–54.2), respectively. Four of the six WHODAS domain scores (household, cognitive, mobility and society) were the most altered in the UHZs. The RSHZ and IHZ had statistically comparable global WHODAS scores. The stable HZs (accessible and remote) had statistically lower scores than the UHZ on all items. In regression analysis, the factors significantly associated with an overall poor health status (or higher WHODAS score) were advanced age, being woman, being membership of an association; being divorced, separated or widower and living in an unstable HZ. Conclusions: Armed conflicts have a significantly negative impact on people’s perceived health, particularly in crisis health zones. In this area, we must accentuate actions aiming to strengthen people’s psychosocial well-being., SCOPUS: ar.j, info:eu-repo/semantics/published

Background: Good breastfeeding practice is essential in preventing malnutrition in children. The deuterium method is the best technique for assessing human breast milk output. We investigated whether deuterium doses < 30 g can be used to assess human breast milk using saliva and the new Agilent 4500S for Fourier transform infrared spectroscopy (FTIR). Methods: In a cross-sectional study, the breastmilk output of lactating mothers was evaluated using four different doses of deuterium in the Miti-Murhesa Health Zone (Democratic Republic of Congo). Lactating mothers of infants aged 3-23 months were recruited and assigned to a dosage group. Weight, height, and mid-upper arm circumference were measured and the body mass index calculated as weight/height2. Body composition (fat mass, free fat mass, total body water, and breastmilk output) was assessed using standard deuterium dilution methods. One-way ANOVA was used to compare the means in different groups and the chi² test to compare proportions. Results: Seventy-five lactating mothers were included in the study: 19 received 6 g, 20 received 10 g, 18 received 15 g, and 18 received 20 g deuterium. The mean ± standard deviation infant age was 10.6 ± 5.2, 11.1 ± 4.4, 10.9 ± 4.4, and 11.0 ± 3.9 months, respectively (p=0.076). We found no difference in the age and anthropometric parameters of the lactating mothers in the different groups. The mean ± standard deviation breast milk output rate was 796.6 ± 292.4, 260.8± 23.2, 749.8 ± 244.2, and 733.6 ± 207.1 g/d in the 6 g, 10 g, 15 g, and 20 g groups, respectively (p=0.883). Conclusions: The different doses of deuterium administered to lactating mothers resulted in similar breast milk output values. Thus, it is possible to evaluate human breast milk with deuterium doses

Introduction: Vertical transmission of covid-19 is possible; its risk factors are worth researching. The placental changes found in pregnant women have a definite impact on the foetus.Case presentation: We report a case of a 25-year-old woman, gravida 3, para 2 (2 alive children), with a history of two caesarean deliveries, who was infected by the SARS-Cov-2 during the last term of her pregnancy. She gave birth by caesarean after 34 weeks of gestation to a new-born baby also infected with SARS-Cov-2. The per-operative observations noted several eruptive lesions in the pelvis, bleeding on contact. Microscopic examination of the foetal appendages revealed thrombotic vasculopathy in the placenta and in the umbilical cord vessels.Conclusion: This case is one of the first documented cases of COVID-19 in pregnancy in sub-Saharan Africa. We strongly suggest obstetricians to carefully examine the aspect of the peritoneum, viscera and foetal appendages in affected pregnant women.

Introduction Vertical transmission of covid-19 is possible; its risk factors are worth researching. The placental changes found in pregnant women have a definite impact on the foetus. Case presentation We report a case of a 25-year-old woman, gravida 3, para 2 (2 alive children), with a history of two caesarean deliveries, who was infected by the SARS-CoV-2 during the last term of her pregnancy. She gave birth by caesarean at 34 weeks of gestation to a newborn baby also infected with SARS-CoV-2. The peri-operative observations noted several eruptive lesions in the pelvis, bleeding on contact. Microscopic examination of the foetal appendages revealed thrombotic vasculopathy in the placenta and in the umbilical cord vessels. Conclusion This case is one of the first documented cases of COVID-19 in pregnancy in sub-Saharan Africa. We strongly suggest obstetricians to carefully examine the aspect of the peritoneum, viscera and foetal appendages in affected pregnant women.

One of the most important problems in controlling malaria is the limited access to effective and accurate diagnosis of malaria parasitemia. In the Democratic Republic of Congo (DRC), malaria is one of the leading causes of morbidity and mortality. The purpose of this study was to assess the prevalence of anemia and the relationship with asymptomatic submicroscopic Plasmodium infection. A cross-sectional study was carried out among 1,088 apparently healthy children aged between 6 and 59 months selected at random in the health zone of Miti Murhesa in South Kivu/DRC. Capillary blood was obtained for hemoglobin (Hb) concentration measurement by Hemocue® Hb 301. Malaria detection was performed by microscopy and the loop-mediated isothermal amplification (LAMP) assay. Anemia was defined as Hb < 11g/dL. We applied the chi-square test for comparisons, and multiple logistic regression was used to identify the risk factors for anemia and submicroscopic Plasmodium infection. The prevalence of anemia was 39.6%, and the prevalence of parasitemia was 15.9% and 34.0% using microscopy and LAMP test, respectively. Submicroscopic Plasmodium infection was found in 22.3% of the children. The independent risk factors for anemia are Plasmodium infection, children younger than 24 months, low middle-upper arm circumference, and history of illness two weeks before. Otherwise, children with submicroscopic malaria infection have a significantly increased risk for anemia, with a need of transfusion. The prevalence of malaria infection was underestimated, when microscopy was used to diagnose malaria. Children with low parasitemia detected by LAMP but not by microscopy showed a significantly increased prevalence of anemia.

IntroductionSub-Saharan Africa has low Caesarean (CS) levels, despite a global increase in CS use. In conflict settings, the pattern of CS use is unclear because of scanty data. We aimed to examine the opportunity of using routine facility data to describe the CS use in conflict settings.MethodsWe conducted a facility-based cross-sectional study in 8 health zones (HZ) of South Kivu province in eastern DR Congo. We reviewed patient hospital records, maternity registers and operative protocol books, from January to December 2018. Data on direct conflict fatalities were obtained from the Uppsala Conflict Data Program. Based on conflict intensity and chronicity (expressed as a 6-year cumulative conflict death rate), HZ were classified as unstable (higher conflict death rate), intermediate and stable (lower conflict death rate). To describe the Caesarean section practice, we used the Robson classification system. Based on parity, history of previous CS, onset of labour, foetal lie and presentation, number of neonates and gestational age, the Robson classification categorises deliveries into 10 mutually exclusive groups. We performed a descriptive analysis of the relative contribution of each Robson group to the overall CS rate in the conflict stratum.ResultsAmong the 29,600 deliveries reported by health facilities, 5,520 (18.6%) were by CS; 5,325 (96.5%) records were reviewed, of which 2,883 (54.1%) could be classified. The overall estimated population CS rate was 6.9%. The proportion of health facility deliveries that occurred in secondary hospitals was much smaller in unstable health zones (22.4%) than in intermediate (40.25) or stable health zones (43.0%). Robson groups 5 (previous CS, single cephalic, ≥ 37 weeks), 1 (nulliparous, single cephalic, ≥ 37 weeks, spontaneous labour) and 3 (multiparous, no previous CS, single cephalic, ≥ 37 weeks, spontaneous labour) were the leading contributors to the overall CS rate; and represented 75% of all CS deliveries. In unstable zones, previous CS (27.1%) and abnormal position of the fetus (breech, transverse lie, 3.3%) were much less frequent than in unstable and intermediate (44.3% and 6.0% respectively) and stable (46.7%and 6.2% respectively). Premature delivery and multiple pregnancy were more prominent Robson groups in unstable zones.ConclusionIn South Kivu province, conflict exposure is linked with an uneven estimated CS rate at HZ level with at high-risks women in conflict affected settings likely to have lower access to CS compared to low-risk mothers in stable health zones.

Background The importance of viewing health from a broader perspective than the mere presence or absence of disease is critical at primary healthcare level. However, there is scanty evidence-based stratification of population health using other criteria than morbidity-related indicators in developing countries. We propose a novel stratification of population health based on cognitive, functional and social disability and its covariates at primary healthcare level in DR Congo. Method We conducted a community-based cross-sectional study in adults with diabetes or hypertension, mother-infant pairs with child malnutrition, their informal caregivers and randomly selected neighbours in rural and sub-urban health zones in South-Kivu Province, DR Congo. We used the WHO Disability Assessment Schedule 2.0 (WHODAS) to measure functional, cognitive and social disability. The study outcome was health status clustering derived from a principal component analysis with hierarchical clustering around the WHODAS domains scores. We calculated adjusted odds ratios (AOR) using mixed-effects ordinal logistic regression. Results Of the 1609 respondents, 1266 had WHODAS data and an average age of 48.3 (SD: 18.7) years. Three hierarchical clusters were identified: 9.2% of the respondents were in cluster 3 of high dependency, 21.1% in cluster 2 of moderate dependency and 69.7% in cluster 1 of minor dependency. Associated factors with higher disability clustering were being a patient compared to being a neighbour (AOR: 3.44; 95% CI: 1.93–6.15), residency in rural Walungu health zone compared to semi-urban Bagira health zone (4.67; 2.07–10.58), female (2.1; 1.25–2.94), older (1.05; 1.04–1.07), poorest (2.60; 1.22–5.56), having had an acute illness 30 days prior to the interview (2.11; 1.24–3.58), and presenting with either diabetes or hypertension (2.73; 1.64–4.53) or both (6.37; 2.67–15.17). Factors associated with lower disability clustering were being informally employed (0.36; 0.17–0.78) or a petty trader/farmer (0.44; 0.22–0.85). Conclusion Health clustering derived from WHODAS domains has the potential to suitably classify individuals based on the level of health needs and dependency. It may be a powerful lever for targeting appropriate healthcare service provision and setting priorities based on vulnerability rather than solely presence of disease. Electronic supplementary material The online version of this article (10.1186/s12889-019-6431-z) contains supplementary material, which is available to authorized users.

Background In this protocol we describe a mixed methods study in the province of South Kivu, Democratic Republic of Congo evaluating the effectiveness of different demand side strategies to increase maternal health service utilization and the practice of birth spacing. Conditional service subsidization, conditional cash transfers and non-monetary incentives aim to encourage women to use maternal health services and practice birth spacing in two different health districts. Our methodology will comparatively evaluate the effectiveness of different approaches against each other and no intervention. Methods/design This study comprises four main research activities: 1) Formative qualitative research to determine feasibility of planned activities and inform development of the quantitative survey; 2) A community-based, longitudinal survey; 3) A retrospective review of health facility records; 4) Qualitative exploration of intervention acceptability and emergent themes through in-depth interviews with program participants, non-participants, their partners and health providers. Female community health workers are engaged as core members of the research team, working in tandem with female survey teams to identify women in the community who meet eligibility criteria. Female community health workers also act as key informants and community entry points during methods design and qualitative exploration. Main study outcomes are completion of antenatal care, institutional delivery, practice of birth spacing, family planning uptake and intervention acceptability in the communities. Qualitative methods also explore decision making around maternal health service use, fertility preference and perceptions of family planning. Discussion The innovative mixed methods design allows quantitative data to inform the relationships and phenomena to be explored in qualitative collection. In turn, qualitative findings will be triangulated with quantitative findings. Inspired by the principles of grounded theor y, qualitative analysis will begin while data collection is ongoing. This “conversation” between quantitative and qualitative data will result in a more holistic, context-specific exploration and understanding of research topics, including the mechanisms through which the interventions are or are not effective. In addition, engagement of female community health workers as core members of the research team roots research methods in the realities of the community and provides teams with key informants who are simultaneously implicated in the health system, community and target population.

Background Despite a reduction in the magnitude of endemic malaria reported in recent years, malaria and protein-energy malnutrition (PEM) still remain major causes of morbidity and mortality in sub-Saharan Africa among children under five. The relationship between malaria and malnutrition remains a topic of controversy. We aimed to investigate malaria infection according to nutritional status in a community-based survey. Methods A cohort of 790 children aged 6 to 59 months and residing in eastern Democratic Republic of the Congo was followed-up from April 2009 to March 2010 with monthly visits. Data on nutritional status, morbidity between visits, use of insecticide-treated nets and malaria parasitemia were collected at each visit. The Z scores height for age, weight for age and weight for height were computed using the reference population defined by the WHO in 2006. Thresholds for Z scores were defined at −3 and −2. A binary logistic model of the generalized estimating equation (GEE) was used to quantify the association between PEM indicators and malaria parasitemia. Odds ratio (OR) and their 95% confidence interval (95% CI) were computed. Results After adjustment for season, children with severe stunting (height for age Z score Conclusion Severely stunted children are at a lower risk of high-level malaria parasitemia.

Introduction: la malnutrition constitue une toile de fond sur laquelle se greffent plusieurs infections. L'objectif de ce travail est de déterminer les infections les plus létales, la durée médiane de séjour et le gain pondéral médian journalier des enfants malnutris. Méthodes: étude de cohorte rétrospective des enfants malnutris de 0 à 59 mois hospitalisés au Centre Nutritionnel et Thérapeutique de Bukavu du 1er janvier 2011 au 31 décembre 2013. L'évaluation du risque de survenue de décès par complication infectieuse a été faite par la mesure du risque relatif. Nous avons utilisé le test de Mann-Whitney pour comparer les médianes. Les Odd ratio ajustés par régression logistique et leurs intervalles de confiance à 95% du risque de mortalité ont été donnés pour chaque cause infectieuse. Résultats: au total, 574 enfants avaient été inclus. Cinq cent vingt et un (90.8%) enfants étaient sortis guéris, 10 (1.7%) avaient abandonné le traitement et 43 (7.5%) étaient décédés. La durée médiane de séjour était de 19 (13-26) jours et le gain pondéral médian journalier était de 7 (3-13) g/kg/j. Il existait une association statistiquement significative entre la mortalité et le sepsis / choc septique (p = 0,0004), la méningite (p = 0,00001), et l'infection à VIH (p = 0,02). Conclusion: une meilleure prise en charge de la malnutrition aigüe dans notre région devrait se baser sur la mise en place des unités spécialisées et bien équipées pour la prise en charge de la malnutrition associées aux infections sévères.The Pan African Medical Journal 2016;23

Introduction La malnutrition constitue une toile de fond sur laquelle se greffent plusieurs infections. L'objectif de ce travail est de déterminer les infections les plus létales, la durée médiane de séjour et le gain pondéral médian journalier des enfants malnutris. Méthodes Étude de cohorte rétrospective des enfants malnutris de 0 à 59 mois hospitalisés au Centre Nutritionnel et Thérapeutique de Bukavu du 1er janvier 2011 au 31 décembre 2013. L’évaluation du risque de survenue de décès par complication infectieuse a été faite par la mesure du risque relatif. Nous avons utilisé le test de Mann-Whitney pour comparer les médianes. Les Odd ratio ajustés par régression logistique et leurs intervalles de confiance à 95% du risque de mortalité ont été donnés pour chaque cause infectieuse. Résultats Au total, 574 enfants avaient été inclus. Cinq cent vingt et un (90.8%) enfants étaient sortis guéris, 10 (1.7%) avaient abandonné le traitement et 43 (7.5%) étaient décédés. La durée médiane de séjour était de 19 (13-26) jours et le gain pondéral médian journalier était de 7 (3-13) g/kg/j. Il existait une association statistiquement significative entre la mortalité et le sepsis / choc septique (p = 0,0004), la méningite (p = 0,00001), et l'infection à VIH (p = 0,02). Conclusion Une meilleure prise en charge de la malnutrition aigüe dans notre région devrait se baser sur la mise en place des unités spécialisées et bien équipées pour la prise en charge de la malnutrition associées aux infections sévères.

BACKGROUND: The cost of current standard ready-to-use therapeutic food (RUTF) is among the major obstacles to scaling up community-based management of acute malnutrition (CMAM), an important child survival strategy. Identifying a cheaper alternative is a global public health priority. OBJECTIVE: We sought to compare the efficacy of soya-maize-sorghum RUTF (SMS-RUTF) with that of standard peanut paste-based RUTF (P-RUTF). DESIGN: We used a nonblinded, parallel-group, simple randomized controlled trial along with a day care approach that enrolled 2 groups of children aged 6-23 and 24-59 mo, respectively, with severe acute malnutrition (SAM). RESULTS: Intention-to-treat (ITT) and per-protocol (PP) analyses showed noninferiority of SMS-RUTF compared with P-RUTF for the recovery rate [ITT: Δ = -2.0% (95% CI: -7.6%, 3.6%); PP: -1.9% (95% CI: -5.3%, 1.4%)], weight gain [Δ = -0.7 g · kg(-1)· d(-1)(95% CI: -1.3, 0.0 g · kg(-1)· d(-1))], and length of stay [Δ = 2.0 d (95% CI: -1.7, 5.8 d)] in children ≥24 mo of age. In children ≤23 mo of age, the recovery rate of SMS-RUTF was inferior to that of P-RUTF [ITT: Δ = -20.8% (95% CI: -29.9%, -11.7%); PP: -17.2% (95% CI: -25.6%, -8.7%)]. Treatment with SMS-RUTF resulted in a greater increase in hemoglobin [0.670 g/dL (95% CI: 0.420, 0.921 g/dL);P< 0.001]. Treatment with both RUTFs resulted in the replenishment of all of the amino acids tested except for methionine. There were no differences at discharge between RUTF groups in fat mass [Δ = 0.3 kg (95% CI: -0.6, 1.6 kg);P= 0.341] or fat mass index [Δ = 0.4 kg/m(2)(95% CI: -0.3, 1.1 kg/m(2));P= 0.262]. By contrast, comparisons of fat-free mass indicated lower concentrations than the community controls after treatment with either of the 2 RUTFs [Δ = -1.3 kg (95% CI: -2.4, -0.1 kg) andP= 0.034 for comparison between community controls and the SMS-RUTF group; Δ = -1.8 kg (95% CI: -2.9, -0.6 kg) andP= 0.003 for comparison between community controls and the P-RUTF group]. CONCLUSION: SMS-RUTF can be used to treat SAM in children aged ≥24 mo to reduce the costs of CMAM programs. More research is required to optimize SMS-RUTF for younger children. This trial was registered in the Pan African Clinical Trial Registry as PACTR201303000475166.

Background: Recent published studies on efficacy and safety of antimalarial treatment in children with Severe Acute Malnutrition (SAM) suffering from uncomplicated malaria are not available. Methods: Between March 2007 and December 2010 the efficacy of AS+AQ in treating uncomplicated malaria children under five with SAM was carried out in Lwiro (Eastern Republic Democratic of Congo) according to the WHO standard protocol. Among the 445 children included, 69 had SAM. AS+AQ was given according to national protocol. Analysis was done using per protocol method. Odds ratio (OR) and their 95% confidence interval (95% CI) were computed. Results: The treatment failure rate was 24.4% of 414 infections included in the analysis. After adjustment for malaria parasitemia, ACPR in children without SAM were 73.0% when it was 91.4% among those with SAM (OR 3.15 95%CI 1.19 – 8.30). Malaria parasitemia median at admission was statistically low among children who had subsequently Adequate Clinical and Parasitological Response (ACPR). Conclusion: AS+AQ has a good efficacy among children with both uncomplicated falciparum malaria and malnutrition including severe acute form. AS+AQ dosing national strategy unmodified can be used, to treat under five children with malnutrition including severe acute form suffering from uncomplicated malaria.

Despite a reduction in the magnitude of endemic malaria reported in recent years, malaria and protein-energy malnutrition (PEM) still remain major causes of morbidity and mortality in sub-Saharan Africa among children under five. The relationship between malaria and malnutrition remains a topic of controversy. We aimed to investigate malaria infection according to nutritional status in a community-based survey.A cohort of 790 children aged 6 to 59 months and residing in eastern Democratic Republic of the Congo was followed-up from April 2009 to March 2010 with monthly visits. Data on nutritional status, morbidity between visits, use of insecticide-treated nets and malaria parasitemia were collected at each visit. The Z scores height for age, weight for age and weight for height were computed using the reference population defined by the WHO in 2006. Thresholds for Z scores were defined at -3 and -2. A binary logistic model of the generalized estimating equation (GEE) was used to quantify the association between PEM indicators and malaria parasitemia. Odds ratio (OR) and their 95% confidence interval (95% CI) were computed.After adjustment for season, children with severe stunting (height for age Z score-3) were at lower risk of malaria parasitemia greater or equal to 5000 trophozoits/μL of blood as compared to those in with a better nutritional status (height for age Z score≥-2) (OR=0.48, 95% CI: 0.25-0.91).Severely stunted children are at a lower risk of high-level malaria parasitemia.

In the Kivu region located in east of the Democratic Republic of the Congo, malnutrition and malaria is a major cause of morbidity and mortality. The relationship between malaria and malnutrition is unclear and has never been studied in the Kivu region. This report presents an analysis of data from 5695 children aged 0 to 5 years, admitted to the paediatric ward of Lwiro hospital between November 1992 and February 2004. The weight/age (W/A) index and weight/height (W/H) index expressed with standard deviation in relation to the reference median were calculated (Z score). The association between protein-energetic malnutrition and malaria infection and nutritional indicators was measured based on prevalence ratios determined by univariate analysis and adjusted Odds Ratio (OR) derived using a multivariate model. The prevalence of malaria at the time of admission was 35.8 % (n=5695). The W/A and W/H indexes and serum albumin level were correlated with malaria-related morbidity. Logistic regression showed that high malaria OR was associated with both anthropometric nutritional indicators [WHZ-2: OR (CI 95 %) 1.7 (1.4-2.2)] [WAZ-2: OR (CI 95 %) 1.3 (1.1-1.6)] and biological nutritional indicators [serum albuminor = 23 g/L: OR (CI 95 %) 1.6 (1.2-2.1)]. Our findings indicate that malnourished children at admission have a lower risk of malaria infection.

In the Kivu region located in east of the Democratic Republic of the Congo, malnutrition and malaria is a major cause of morbidity and mortality. The relationship between malaria and malnutrition is unclear and has never been studied in the Kivu region. This report presents an analysis of data from 5695 children aged 0 to 5 years, admitted to the paediatric ward of Lwiro hospital between November 1992 and February 2004. The weight/age (W/A) index and weight/height (W/H) index expressed with standard deviation in relation to the reference median were calculated (Z score). The association between protein-energetic malnutrition and malaria infection and nutritional indicators was measured based on prevalence ratios determined by univariate analysis and adjusted Odds Ratio (OR) derived using a multivariate model. The prevalence of malaria at the time of admission was 35.8 % (n=5695). The W/A and W/H indexes and serum albumin level were correlated with malaria-related morbidity. Logistic regression showed that high malaria OR was associated with both anthropometric nutritional indicators [WHZ > -2: OR (CI 95 %) 1.7 (1.4-2.2)] [WAZ > -2: OR (CI 95 %) 1.3 (1.1-1.6)] and biological nutritional indicators [serum albumin > or = 23 g/L: OR (CI 95 %) 1.6 (1.2-2.1)]. Our findings indicate that malnourished children at admission have a lower risk of malaria infection.