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A flare-up of tuberculosis due to war in Congo Brazzaville.

Congo Brazzaville, a country with a population of 3 million, experienced a period of war from 1997 to 1999. Before this time the annual increase in numbers of tuberculosis cases was on average 20%; in 2000 it was 84%. This situation had a considerable impact on the activities of the National Tuberculosis Programme. Before the war the diagnostic and treatment centres had notified nearly 100% of new cases of tuberculosis; in 2000 this had dropped to 76.19%, whereas the number of tuberculosis patients had almost doubled, from 5125 in 1999 to 9436 in 2000. New cases of smear-positive pulmonary tuberculosis represent 45% of cases, in comparison with an average of 55% before the war, and extrapulmonary tuberculosis 30% versus 21% before the war. The relapse rate has not changed significantly, by approximately 2%, while the default rate has risen significantly, from 20% to about 26%. The rates of new smear-positive tuberculosis cases who are cured or have completed treatment remain unchanged (70%), while the mortality rate dropped after the war from 6% to 1.23%. The war led to an increase in rates of tuberculosis, particularly in the two main cities, Brazzaville and Pointe-Noire, to which refugees had fled from the rural areas. This resulted in an excessive workload for the health workers. Sustained financial support is needed to reduce tuberculosis transmission in the Congo population.

Congo↗

[Human African trypanosomiasis in the urban milieu: the example of Kinshasa, Democratic Republic if the Congo, in 1998 and 1999].

Human African trypanosomiasis is an essentially rural disease. Occurrence in urban areas is uncommon except in cities that reproduce rural conditions conducive to the survival of glossinidae, i.e., forest and water. This is the case in neighborhoods near the zoo in Brazzaville, People's Republic of the Congo and in the residual mangrove forest in Conakry, Guinea. In Kinshasa, Democratic Republic of the Congo, an average of 39 cases were reported annually from 1970 to 1995. This figure increased to 254 in 1996 and 226 in 1997. This sharp rise led authorities to organize screening operations in some neighborhoods of the capital city. Results documented 433 cases in 1998 and 912 cases in 1999. The highest prevalence was found in outlying areas. This finding was probably related to focus of screening in these locations and to the practice of market gardening on plots surrounding the city. Placement of 276 insect traps along the Ndjili River led to the capture of 42,231 glossinidae over a 4 month period. Taken together, these findings indicate that the conditions necessary for active disease transmission are now reunited and that priority should be given to intensifying screening operations and information campaigns to health care providers working in the city.

Adolescent↗

[Choice of nutritional interventions in Congo: an approach for primary health care centres and for the community].

This research is aimed at testing and adapting a comprehensive and participatory approach to identification, selection and evaluation of nutritional interventions in Congo. The mains tools utilized here are a causal model, a ranking table and a HIPPOPOC table. The causal model was built by a multi-sectional team of 35 persons and used to conceptualize the nutrition of young children in Congo, to identify vulnerable determinants and relevant interventions. Three main determinants were identified: i) Food consumption of the child; ii) Health status of the child and iii) Caring practices of children and mothers. Each determinant was developed into a sub-model. For each sub-model, the team identified vulnerable factors and relevant interventions. The identification of six interventions was based on experience, scientific knowledge and on-going interventions of the members of the group during participatory discussions. As resources were limited, it was not possible to implement all of the six interventions; thus a selection of the most appropriate interventions was made using a ranking table. Before building the ranking table, a choice of the most appropriate criteria was made by the group: technical feasibility, acceptability by the population, acceptability by health workers, financial feasibility, short-term impact, potential of participation and sustainability. The ranking table for intervention selection allows a critical discussion on each intervention and leads to prioritization. Once the table was completed, the three most appropriate interventions were selected: communication for behavior change, improvement of quality of care, and promotion of improved complementary foodstuff production. Two of the interventions (psychosocial stimulation and community-based) identified needed more research for implementation. In order to determine clear objectives for intervention and to set up a monitoring and evaluation system, a practical tool was used: the HIPPOPOC table. This table represents a simplified view of the intervention in which project inputs (resources), processes (activities), outputs (immediate results), outcomes (short- or mid-term effects) and impacts (long-term effects) are clearly defined. The approach used here is based firstly on completeness as a way of guaranteeing the success of the design, implementation and evaluation of an intervention. Completeness means that all factors that may affect actions and their impact are taken into account. Secondly, participation is a key element of the process. All actors playing an active role in the decision-making process are present during the planning and evaluation process. This approach is meant to empower individuals and the community as a whole and develop within the community an awareness and a competence for problem solving. It involves multiple stakeholders (target groups, supervisors, sponsors, central as well as peripheral workers, experts, etc.) in design, implementation, needs assessment, monitoring and evaluation.

Child↗

Salivary gland tumours in Congo (Zaire).

From the files of the Department of Pathology of Kinshasa University Hospital, a retrospective study on salivary gland tumours in Congo (Zaire) had been carried out in order to determine their histological and epidemiological profile. Salivary gland tumours are rare in Congo, with a relative frequency of 1.8%. Pleomorphic adenoma (55.1%) and adenoid cystic carcinoma (15.9%) are the most common tumours. Parotid gland (36.6%) is the most frequent location of salivary gland tumours in this country. People aged between 30 and 39 years (19.9%) (Mean: 37.4 +/- 16.2 years) and females (M/F = 0.8/1) are most affected. No case of adenolymphoma is recorded in this series.

Adenoma, Pleomorphic↗

A 4-kilobase congo red binding plasmid DNA fragment of Shigella dysenteriae 1 suppresses the growth and cell differentiation in Escherichia coli.

A 4-kilobase congo red binding plasmid DNA fragment of pCAT 120 of Shigella dysenteriae 1 was transferred to an Escherichia coli K12 strain by transformation. Transformants were unable to grow in any liquid broth medium. Electron microscopic studies revealed that the transformants grown on tryptic soy agar were associated in clusters after cell division. Normal cell separation among the transformants in comparison with recipient E. coli K12 was only observed when the growth medium was supplemented with sterile culture filtrate of the recipient strain. An unknown factor(s) required for cell separation located on the chromosome was suppressed by a 4-kb congo red binding plasmid DNA (pCAT 120) fragment of S. dysenteriae 1.

Cell Division↗

Epidemiological studies of congo red Escherichia coli in broiler chickens.

This prospective cohort study was designed to confirm the association between Congo red binding Escherichia coli (CREC) and E. coli air sacculitis in commercial broilers. It was also designed to evaluate CREC as an air sacculitis risk factor and to explore the CREC relationship to other air sacculitis risk factors (poultry house temperature, air-ammonia levels, and presence of other diseases). In addition, this study was used to assess a possible role of the broiler-breeder flocks and hatchers in the spread of CREC air sacculitis. Congo red E. coli-associated airsacculitis risk was based on CREC exposure of the chicks in the hatchers. Breeder flocks with greater than 30 CREC colonies/plate from hatcher air sampling tests were placed in the high risk group; flocks with less than five CREC colonies/plate were placed in the low risk group. Increased risks of death due to air sacculitis (RR = 2.26), and increased death rates due to CREC air sacculitis (RR = 9.45) in high-risk flocks, identified CREC as an important air sacculitis risk factor. The attributable risk percent of CREC airsacculitis from hatcher exposure of CREC was 89.4%, pointing to the hatcher as the source of CREC infection. The association of specific broiler-breeder flocks to high levels of CREC in the hatchers, and subsequent air sacculitis, suggests that the broiler-breeders are the ultimate source of CREC.

Air Sacs↗

[Outbreak of Ebola hemorrhagic fever in the Republic of the Congo, 2003: a new strategy?].

This article describes the last Ebola haemorrhagic fever (EHF) outbreak that occurred in the Cuvette Ouest Region of the Republic of Congo from January to April 2003. Epidemiological study demonstrated that the first patient, in whom diagnosis was made retrospectively, became ill on December 25, 2002. Subsequently until May 7, 2003, a total of 143 cases were recorded in the Mbomo and Kéllé health districts including 129 fatalities. Thirteen cases were laboratory confirmed and 130 were epidemiologically linked. Fifty-three percent of patients were male. Age ranged form 5 days to 80 years. Transmission involved direct contact with an infected person especially within families. Epidemiological data traced introduction of Ebola virus into the population to three primary cases mainly involving hunters. In all three cases development of the disease followed contact with non-human primates (gorillas) and other mammals (antelope) that had either been killed or found dead. Three health care workers were infected during the epidemic but nosocomial transmission played a minor role in the epidemic. On June 5, the Minister of Health and Population of the Congo Republic officially declared that the outbreak of EHF was over in the Cuvette Ouest Region. The last case was recorded on April 22 in the small village of Ndjoukou.

Adolescent↗

[Anemia prevalence in pregnant and breast-feeding women in Lubumbashi (Democratic Republic of the Congo). Impact of malaria and intestinal helminthiasis].

OBJECTIVE: To determine the prevalence of anemia and associated factors (malaria and intestinal helminthiasis) in high risk groups of Lubumbashi, Congo, particularly in pregnant and breast-feeding women and children aged 1-2 years. MATERIAL AND METHODS: From March to May 2002, 632 pregnant women, 570 breast-feeding women, and 570 infants (1-2 years) were examined in three medical centers in Lubumbashi, Congo. Some of the subjects lived in deprived semi-urban areas (Bongonga and Sendwe), others in urban areas with a satisfactory socio-economic situation (University Clinic). RESULTS: Overall frequency of anemia was estimated between 50 and 80% in the study populations. The proportion of anemic cases was clearly higher in the Sendwe and Bongonga populations (70-80%) than in the other urban populations (50%) (P<0.01). For the three categories of examined subjects, anemia was found to be most prevalent among pregnant women (P<0.05). Anemia was found to be associated with malaria in 40% of the patients and with intestinal parasitism (ascaris / ankylostoma) in 9%. CONCLUSION: Considering these results, systematic screening and treatment of anemia and associated factors such as malaria and intestinal helminthiasis is needed for the Lubumbashi population.

Anemia↗

Failure of the Congo red dye uptake test to discriminate between virulent and avirulent avian Escherichia coli.

Twenty avian Escherichia coli isolates from normal and diseased chickens were compared by use of three virulence tests. These tests included the uptake of Congo red dye, an embryo lethality test, and a quantitative microtiter complement resistance test. A direct correlation was seen between the results of the complement resistance test and the embryo lethality test. The results of the Congo red test did not correlate with the two other tests.

Animals↗

Ultrastructural immunohistochemical localization of polyclonal IgG, C3, and amyloid P component on the congo red-negative amyloid-like fibrils of fibrillary glomerulopathy.

Renal biopsies from seven patients with Congo red-negative amyloid-like fibrillary glomerulopathy (FGP) were examined by protein A gold immuno-electron microscopy. Ultrastructurally, the fibrils in all cases exhibited positive immunostaining for IgG, both Ig light chains, C3, and amyloid P component (AP), but did not show positive immunostaining for glomerular basement membrane (GBM)-associated proteins (collagen type IV and heparan-sulfate proteoglycans) or microfibril-associated proteins (fibronectin and fibrillin). In a triple-label study, AP and IgG were colocalized along the same fibril, whereas the gold probes for the detection of collagen type IV were absent. The results suggest that the fibrils are comprised of polyclonal IgG and C3 that bind AP. AP was immunolocalized sparsely but regularly along the lamina rara interna of normal GBM. AP was absent in the fibrils in a case of diabetic glomerulopathy, was scattered randomly without specificity for the electron-dense deposits in the GBM of membranous glomerulopathy, and lined up regularly along the fibrils in amyloid deposits. FGP is an entity in which the fibrils bind AP but lack the beta-pleated sheet structure necessary for Congo red staining that is typical of amyloid.

Amyloid↗

Efficacy of sulfadoxine/pyrimethamine in the treatment of uncomplicated Plasmodium falciparum malaria in Republic of Congo.

Congo is facing frequent failures of treatment of Plasmodium falciparum malaria with chloroquine (CQ), which is still recommended and used as a first-line drug. In Pointe-Noire and Brazzaville, the two largest cities that contain approximately 60% of the population of Congo, we compared the efficacy of CQ versus sulfadoxine/pyrimethamine (SP) for treatment of uncomplicated malaria in children 6-59 months old (mean = 33 months) using the standard World Health Organization (WHO) 14-day in vivo test in two phases between 1999 and 2002. Patients enrolled were randomly assigned to receive SP (25 mg/kg of sulfadoxine and 1.25 mg/kg of pyrimethamine) or CQ (25 mg/kg). In the first phase of the study, 46 patients were assigned to the CQ (n = 23) or SP (n = 23) groups in Pointe-Noire and 52 children were assigned to the CQ (n = 26) or to SP (n = 26) groups in Brazzaville. Results were interpreted according to the WHO lot quality assurance sampling method, and treatment failure rates for SP versus CQ were < 25% versus > 25% in both cities. In the second phase of the study, we accurately determined the actual proportion of treatment failures for SP in Brazzaville. Thus, in 75 of the 80 children enrolled and followed-up until day 14, no clinical or parasitologic failure was recorded and no serious adverse reaction was observed. Since the CQ treatment failure rate exceeds the unacceptable upper limit, SP seems well to be an appropriate alternative for the first-line treatment of uncomplicated P. falciparum malaria, at least in the settings of the present study.

Acetaminophen↗

[Virological surveillance of acute flaccid paralysis in Democratic Republic of Congo from 1997-2001].

The purpose of this report is to describe the results of virological surveillance of acute flaccid paralysis (AFP) in Democratic Republic of Congo (DRC), a war-torn country. A total of 3658 stool samples were collected from patients with AFP in provinces under government control and processed as recommended by WHO. The number of specimens tested increased from 32 in 1997 to 2471 in 2001 as the national epidemiologic surveillance program for AFP improved. The national reference laboratory accredited in 1999 was appraised on the basis of the annual rate of non-polio enterovirus isolation which rose from 10% in 1999 to 20% in 2001 and by the percentage of lab results reported within 28 days which rose from 50% in 1999 to over the 80% threshold required by WHO in 2001. From 1997 to 2001, 68 strains of wild poliovirus were isolated including 52 type 1 strains, one type 2 strain and 15 type 3 strains. Most cases of poliomyelitis (81%) reported between 1997 and 2001 involved children aged 0 to 5 years. Only 12% of cases involved children aged 6 to 14 years and 3% involved young adults. Sixty-seven percent of the 45 poliomyelitis patients with documented vaccine status had received 0 to 3 doses of oral poliovirus vaccine (OPV). Fifteen children (33%) developed the disease despite having received more than 4 required doses of OPV. Since 1997 three provinces of DRC, ie., Bas-Congo, Kinshasa city and Nord-Kivu, have been free of wild poliovirus. In 2001 wild poliovirus circulation had been stopped throughout the country thanks to implementation of routine immunization and especially of the national immunization days (NIDs) program.

Acute Disease↗

[Treatment of hyperthyroidisms in Brazzaville Teaching Hospital, Congo].

Between January 1994 and December 2003, a total of 118 patients (MIF = 1/13) with thyrotoxicosis was studied at the endocrine and metabolic diseases unit of the Centre Hospitalier Universitaire de Brazzaville, in Congo. 72 patients (61%) had Graves' hyperthyroidism, 23 (19.6%) had toxic multinodular goitre while the rest had toxic adenoma (7.6%), and thyroiditis (4.2%). The mean age was 26.6 +/- 7.9 years for Graves' cases and 49.4 +/- 9.3 years for toxic multinodular goitre cases. The clinical presentation was similar to other reported series. Thirty-seven patients (31.3%) did not return after the first admission. All patients responded to carbimazole therapy and no major side-effect was recognized. Ten patients (8.5%/) underwent subtotal thyroidectomy, among them one developed hypothyroidism a year later. The result of this study shows that thyrotoxicosis is not a rare condition in Congo.

Adenoma↗

[Preliminary results of an herpetology investigation in sugar cane plantation in Democratic Republic of Congo].

Out of the 3,000 species of snakes described in the world, 163 are currently known from D.R. of Congo. We performed a systematic survey in sugar-cane plantations of the Sugar Company of Kwilu-Ngongo (Bas-Congo), located at 160 km South-West from Kinshasa and exploiting nearly 10,000 ha. The plantation is divided into 3 sectors in the middle of which we deposited barrels filled of formaldehyde. All the employees of the Sugar Company of Kwilu-Ngongo were requested to collect encountered snakes and put them in the nearest barrel. Between August 9th and September 21st, 2004, we collected 36 snakes in two different sites, revealing the presence of 3 families and 12 species. The most abundant species in Causus maculatus (47% in the first site--Point 8--and 29% in the second site--Point 13). The most poisonous and dangerous species were captured only in the first site--point 8, and were Dendroaspis jamesoni and Naja melanoleuca, both young.

Agriculture↗

[Lymphatic filariasis in Republic of Congo and scrotal elephantiasis].

Cases of scrotal elephantiasis operated in the Brazzaville' hospital are naturally imputed to Wuchereria bancrofti, in spite of the absence of parasitological proof. This is due to the fact that data's diffused by WHO which are widely included in the literature, unfortunately present this filariasis as being endemic in the Republic of Congo. But it is impossible to identify what works are at the origin of this assertion during the 30 last years. What is certain, it is that no case of lymphatic filariasis was found at the time of the field surveys carried out on filariasis both in the Congo and in Gabon, country also presented as an endemic territory, at the end of the Seventies and during the Eighties. These works were unfortunately published in French. Since this time no publication related a fieldwork or a conclusive clinical observation has confirmed the presence of Wuchereria bancrofti in these two countries of Central Africa.

Animals↗

[Prospective study of rheumatic manifestations in human immunodeficiency virus infection. Apropos of 26 cases in Congo].

A 12-month prospective study of the osteo-articular complaints in HIV infected patients was carried out in the Department of Rheumatology, Brazzaville, Congo. Positivity of the HIV serology was systematically researched. And so the authors have observed rheumatic disorders in 26 patients, 12 males, 14 females, with a mean age of 36 years (ranged from 13 to 78). These disorders are as follow: linked to HIV oligo or polyarthritis, 18 cases; septic arthritis 3 cases; destructive spondylodiscitis 2 cases; bilateral sciatica with paralysis 3 cases; tropical myositis 2 cases. Contamination was heterosexual in 23 patients, iatrogenic in 3 other ones. HIV infection was at the CDC stades II (7 patients) or IV (19 patients). The prevalence of osteo-articular manifestations in HIV infected patients who are admitted in the hospital of Brazzaville, Congo is evaluated at only 4%.

Acquired Immunodeficiency Syndrome↗

[Epidemiological status of onchocerciasis in the Congo].

Analysis of 25 surveys carried out in the Congo between 1978 and 1987 (covering nine of the ten administrative regions), during which 6,215 subjects were examined, showed that onchocerciasis is endemic in the southern part of the country. Two main foci meeting at the southern exit of Brazzaville (Pool region) were identified. One focus in the Djoué basin. The other is the zone along the Congo river stretching from below Brazzaville south west to the Zaire border. Two secondary foci were noted, one in the region of the Bouenza and the other west of the Mayombe mountains. Surveys carried out in the north of the country and in the west did not reveal any onchocerciasis. However, certain areas of primary forest in these regions were found to be endemic for Mansonella streptocerca. Simulium damnosum s.l. in the sole vector of onchocerciasis. In both the Pool foci, and in the Mayombe focus, prevalences assessed from microfilarial and cyst counts were high but the mean microfilarial densities were relatively low. In certain villages over 90% of the population aged over 14 years may present with microfilariae and nearly 70% may present cysts.

Adolescent↗

[Prevalence and causes of blindness in the Congo].

A population-based survey on the prevalence of blindness and eye disease has been conducted throughout the Congo. This was the first time such a survey had been carried out in a central African country with an equatorial climate. In comparison with data available from other African countries, the two rather unexpected characteristics resulting from the survey were lower blindness prevalence rates and the extremely rare cases of bilateral corneal scarring. In accordance with sampling procedures recommended by the WHO Programme for the Prevention of Blindness, 7041 people were selected and examined. The prevalence of blindness (visual acuity less than 3/60 in the better eye) was 0.3% (5700 people). The prevalence of low vision (visual acuity between 6/24 and 3/60 in the better eye) was 2.1% (40,000 people). The major causes of blindness and low vision were cataract (81% and 80%, respectively) and glaucoma (9% and 3.4%, respectively). A total of 22,000 people in the Congo require cataract surgery. Almost four-fifths of the current burden of blindness in this country is potentially curable through the provision of cataract surgery and aphakic glasses.

Aged↗