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BackgroundLoiasis (Loa loa filariasis) is considered a benign disease and is currently not included in the World Health Organization’s (WHO's) list of Neglected Tropical Diseases, despite mounting evidence suggesting significant disease burden in endemic areas. We conducted a retrospective cohort study to assess the mortality associated with L. loa microfilaremia in the Southwestern Republic of Congo.MethodsThe cohort included 3329 individuals from 53 villages screened for loiasis in 2004. We compared mortality rates in 2021 for individuals initially diagnosed as with or without L. loa microfilariae 17 years earlier. Data were analyzed at the community level to calculate crude mortality rates. Survival models were used to estimate the effect of L. loa microfilaremia on mortality in the population.ResultsAt baseline, prevalence of microfilaremia was 16.2%. During 17.62 years of cohort follow-up, 751 deaths were recorded, representing a crude mortality rate of 15.36 (95% CI, 14.28–16.50) per 1000 person-years. Median survival time was 58.5 (95% CI, 49.7–67.3) years and 39.2 (95% CI, 32.6–45.8) years for amicrofilaremic and microfilaremic indiviudals, respectively.ConclusionsA significant reduction in life expectancy was associated with L. loa microfilaremia, confirming previous observations from Cameroon. This adds to the evidence that loiasis is not a benign disease and deserves to be included in the WHO's list of Neglected Tropical Diseases.

Background: The global pandemic Coronavirus Disease 2019 (COVID-19) due to the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is reported to be potentially severe in patients with morbid conditions. One common reported comorbidities is diabetes. We aimed in this study to precise the clinical characteristics and outcomes in a series of congolese diabetic patients affected by COVID-19 infection. Patients and methods: We retrospectely studied from 256 COVID-19 patients, a cohort of 30 persons with previously known diabetes. The glycaemia controls have been obtained by plasma glucose assay. All patients have been tested positive to SARS-CoV-2 by RT-PCR method. Results: The COVID-19 diabetic patients represented 11,7% of all COVID-19 patients with confidence interval of 95% [7,77-15,65]. Older individuals and male sex were predominent. Dyspnea and sauration of oxygen < 90 were significatives and added risk factors were noted in 63.3% of patients, particulary hyperglycaemia with hypertension or obesity. The mortality rate at the percentage of 36.7% was more prevalent in patients with added comorbidities (30%) versus without comorbidities (6.7%). Conclusion: Congolese COVID-19 diabetic patients of male sex and older age exhibiting arterial hypertension and obesity are the most exposed to severe COVID-19 and increasead mortality rate. Keywords: COVID-19, SARS-CoV-2, diabetes, Congolese patients.

Background: COVID-19 is responsible for high morbidity and mortality. Vaccination is the main response strategy. Vaccination coverage remains low. This study investigated the factors for refusal of COVID-19 vaccination among health sciences students. Methodology: This was an analytical cross-sectional study conducted from July to October 2021. The cluster method was used and the Schwartz formula was used to obtain the minimum sample size. Socio-demographic, socio-cultural and vaccination status variables were collected. Statistical analysis was performed with Epi Info 7.2.2.6 software. The significance level was set at 5% Results: A total of 423 students were included. Vaccination coverage was 12.77%. The rate of students refractory to vaccination was 45.62%. Females were in the majority (54.40% vs 54.60%). The factors associated with refusal of the COVID-19 vaccination in our study were: lack of knowledge of the vaccines available in Congo (ORa=1.601 [1.009-2.539]; p=0.0453), perception of the uselessness of the vaccine (ORa=6.055 [3.646-10.055]; p < 0.0001) and the unavailability of the vaccine the student wishes to receive (ORa=2.652 [1.365-5.152]; p = 0.004). Conclusion: This study reveals low vaccination coverage and almost half of the students were refractory to vaccination against COVID-19. Awareness and involvement of students in health sciences who are public health actors are necessary to improve this vaccination coverage.

BackgroundThe long-term survival of patients on antiretroviral treatment in Congo remains less documented. Our study aimed to analyze the long-term survival of adults living with HIV on ART (Antiretroviral Therapy).MethodsWe conducted a historical cohort study on 2,309 adult PLHIV (People Living with HIV) followed between January 1, 2003 and December 31, 2017 whose viral load and date of initiation of ART were known. The Kaplan Meier method was used to estimate the probability of survival and the Cox regression model to identify factors associated with death.ResultsThe median age was 49 years; the female sex was predominant with 68.56%. The probability of survival at 14 years was 83%, (95% CI (Confidence Interval) [78-87]). On the other hand, when the lost to follow-up died, it was 66% (95% CI [62-70]) in the worst scenario. Stratified cox regression analysis showed that: being male, AHR (Adjusted Hazard Ratio) = 1.65 (95% CI [1.26-2.17]) was significantly associated with death, p-value 1000 copies / ml, AHR = 2.56 (95% CI [1.93-3.40]), be in the advanced WHO clinical stage, in particular: stage II, AHR = 4.07 (95% CI [2.36-7.01]); stage III, AHR = 13.49 (95% CI [8.99-20.27]) and stage IV, AHR = 34.45 (95% CI [23.74-50]) were also significantly associated with death; p-value ConclusionThe long-term survival of PLHIV is worrying despite the offer of ARVs.

Background Neglected Tropical Diseases amenable to Preventive Chemotherapy (PC-NTDs) affect the poorest populations around the world, especially in Africa. Scientific information on the distribution and level of endemicity of these diseases in the Republic of the Congo (RoC) is scarce in the published literature. We sought to collect all available epidemiological data on PC-NTDs in the RoC to document the historical and current situation and identify challenges in reaching the elimination of NTDs. Methods We searched Medline and Horizon databases for studies published until to July 4th, 2019, on onchocerciasis, lymphatic filariasis, soil-transmitted helminth infections, schistosomiasis, and trachoma in the RoC. Unpublished reports were also reviewed. We included all epidemiological studies containing community data and excluded case reports. Location, prevalence data, and dates of the studies were extracted. Principal findings We identified 933 records, of which 56 met the inclusion criteria. The articles published before 1960 mainly concerned onchocerciasis and schistosomiasis. Despite a low number over the studied period, since 2005 there has been a steady increase in the number of publications. Most of the studies were cross-sectional and conducted in the general population. Trachoma is endemic in the Sangha and Likouala departments (prevalence of trachomatous inflammation-follicular > 5% in some villages), and further mapping is essential to properly assess the burden of this disease in the country. While the prevalence of soil-transmitted helminths is still high (over 20%) in a large part of Congo, cases of lymphatic filariasis (based on Wuchereria bancrofti antigenaemia and/or microfilaraemia) and onchocerciasis are becoming rare and very focused. To achieve the elimination of PC-NTDs, further intervention is required. Conclusions Except for trachoma, whose epidemiological situation should be better evaluated, PC-NTDs are endemic in the RoC, and actions to control them have been taken by health authorities. To eliminate PC-NTDs, which are still present in some locations, new mapping surveys are needed, and increased investment in scientific research should be encouraged in the country.

Background: Viral load is the key indicator of the effectiveness of antiretroviral treatment in HIV patients. Study aimed to determine antiretroviral treatments failure rates and associated risk factors among HIV-infected adult patients in Congo. Methods: Data from the Congolese AIDS and Epidemics Control Council were combined to create a historical cohort. Patients were followed up between 2003 to 2017. Mixed logistic regression was used to identify treatment failure associated-factors. Intercooled Stata 10 (StataCorp LP, College Station, Texas, USA) software packages was used for analysis. Results: Over 14 years of follow-up, a total of 25,500 visits for 6391 adult patients were reported. Among them, 88% i.e. 22,328 visits (for a total of 6127 patients) were visits with treatment failure. In the multivariate analysis, being aged >26 years, having primary education level, being student, others nationality, unspecifiedmarital status and being worker in informal sector were found associated with a higher risk of treatment failure. Conversely, being pensioners, receiving second line therapeutic protocols and having good adherence to treatment were found significantly associated with a lower risk of treatment failure. Conclusion: Antiretroviral treatments failure among HIV-treated patients is common in Congo. Developing treatment adherence-centered interventions with focus in patients who have low socio-economic status needed to reduced treatments failure. As treatment failure is not only determined by individual factors, psychosocial supports and availability of antiretroviral drugs needs to be taken into account.

Current antiretroviral therapy has reduced morbidity and mortality of HIV patients. However, their induced hepatotoxicity constitutes a risk. In this issue, we report a clinical case of fulminant hepatitis, observed in the HIV unit of the hepatogastroenterology department of the General hospital of Loandjili in Pointe-Noire. The patient is a 36-year-old female HIV treated with triple-dug combination antiretroviral therapies (ART) including one antiprotease (ritonavir) and two non-nucleoside reverse transcriptase inhibitors (nevirapine and efavirenz). He developed fulminant hepatitis five years after treatment initiation. He succumbed to the side effects. Although antiretroviral combination therapies are the standard of care for HIV infection, increased vigilance is warranted to early identify this side effect and adjust treatment in order to prevent fatal consequences.

Coinfection with human immunodeficiency virus (HIV) and viral hepatitis is associated with high morbidity and mortality in the absence of clinical management, making identification of these cases crucial. Screening for hepatitis viral-HIV coinfection before initiation of treatment for viral hepatitis or HIV is recommended. In this context, we report a case of possible cross-reaction between the serology of viral hepatitis C and HIV infection by rapid diagnostic orientation tests. Although these rapid tests are the main diagnostic tools in developing countries, their scientific validation must be required before they are made available to practitioners. The knowledge and the rigorous application of diagnostic algorithms of viral infections will make it possible to save money and to better organize the prevention and management strategies for patients as part of an integrated Hepatitis/HIV program.

Resume Objectif Determiner les connaissances et pratiques de la douleur rhumatismale. Materiel et methode Etude transversale descriptive et analytique menee du 5 janvier au 30 septembre 2016, dans dix centres de sante (CS) de Brazzaville, selectionnes par echantillonnage a deux degres parmi 39 CS, repartis dans neuf districts sanitaires. Ont ete considerees comme douleur rhumatismale, 222 cas pour lesquels, le registre des consultations mentionnait douleur de l’appareil locomoteur. Cinquante-quatre cas tires au sort ont permis d’analyser les pratiques. Les infirmiers (36) et infirmiers-assistants sanitaires (15), 46 femmes et 5 hommes d’âge moyen 44,4 ± 9,1 ans, presents le jour de l’enquete etaient interroges. Le logiciel Epi info version 7.1 a permis l’analyse statistique univariee pour les variables quantitatives et multivariee pour les variables identifiees comme ayant un lien possible avec la connaissance et les pratiques. Resultats Le niveau de connaissance etait evalue mauvais. La mesure de la douleur n’etait connue que par 13,73 % des agents. Les medicaments de la douleur etaient connus par 75 % des infirmiers et 80 % des assistants sanitaires. Il s’agissait d’un generique dans 85,18 % cas. Dans 38,04 % des cas, le medicament n’etait pas un antalgique. Le dosage et la posologie etaient adaptes dans 64,81 % et 20,37 % des cas. La duree du traitement etait correcte dans 20,37 % des cas. Le niveau de connaissance ne differait pas selon la categorie professionnelle. Conclusion Les pratiques contrastent avec le faible niveau de connaissance.

Background: Poor nutrition during a child's early years can have irreversible consequences for their health. The objective of our study was to identify the factors associated with exclusive breastfeeding (EBF) among mothers of children 0 to 6 months in the Talangai Health District (THD). Methods: This was a cross-sectional analytical study carried out from April 17 to July 17, 2018 in the THD. Our study involved 256 mothers of children 0-6 months old in THD Health Facilities (HF). The logistic regression was used to identify factors associated with EBF. Epi Info software version 3.5.4 was used for data entry and the STATA 14 program for data analysis. Results: The average age of the mothers was 27 years old. More than half of the mothers were between 15-25 years old or 53.9%. The majority of mothers were housewives (63.3%) and more than half had a secondary education (60.9%). There was a predominance of separated or divorced mothers, 71.1% and the third rank of the child, 38.3%. The prevalence of exclusive breastfeeding was 36.7%. Being a middle or senior manager was significantly associated with breastfeeding, AOR=2.9 [1.5, 5.3], p-value

Patient satisfaction is considered an indicator of quality of care. This study aimed to assess the degree of clients‘ satisfaction with family planning (FP) services in government health centers in Congo. A cross-sectional study was conducted. A total of 635 clients nested in 27 health facilities were included in the analysis. Satisfaction was defined as "having a good perception of provider technical skills, being satisfied with the service organization and having a general positive appreciation of FP services. Statistical analyses were performed using SPSS v15. Among 635 clients, 57% perceived lack of technical competence in providers, 88% perceived good organization in FP services and 77% declared having general positive appreciation of FP services. Global level of client satisfaction was 42%. In conclusion client satisfaction with FP service was low and strengthening health workers technical competence is crucial. But, as the quality is multidimensional, other aspects especially significant funding investment and quality-assurance interventions must be taken into account.Keywords: family planning, services, user satisfaction, Congo

Background: The risk of contracting HIV is very high in Men who have sex with men (MSM) compared to the general population. This study aimed to estimates HIV prevalence among MSM in 2018 in Congo and identified associated factors. Methods: Cross-sectional study using the respondent-driven sampling method was conducted. Blood samples were collected and tested for HIV. Chi-square or Fischer test was used for proportion comparisons and logistic regression was carried out to assess predictors of HIV infection in MSM using the Statistical Package for the Social Sciences (SPSS) software. Results: HIV prevalence among 182 MSM was 41,2%. Average age was 25±5 years. Current age between 25-29 years (ORa=18.9 [1.9 – 25.0]; p=0.01), current age between 30-34 years (ORa=47 [40.0 – 59.0]; p=0.003), not use condoms for passive penetration (ORa=5.2 [1.1 – 24.1]; p=0.03), and non-use of the condom due to faithfulness to one's partner (ORa=6.9 [1.9 - 25.1]; p=0.003) were found associated with HIV infection among MSM. Conversely, being more than 20 years old at first anal sex was found to be associated with reduced risk of acquiring HIV (ORa=0.2; IC=1.1 – 11,4; p=0.03). Conclusion: Among MSM in Congo, HIV prevalence is high as a result of high-risk sexual behavior. Programs aimed at reducing risk should be enhanced in MSM including, as a priority, preventive advice, condom supplies, HIV and STI testing and communication.

The continued scaling-up of antiretroviral therapy (ART) in Sub-Saharan Africa provides an opportunity to further study its impact on sexual behaviors among people living with HIV/AIDS (PLWHA). We explored time trend and correlates of sexual activity among PLWHA initiating ART in Cameroon and compared sexual risk behaviors between patients sexually active before and after initiating ART and those resuming sexual activity after ART initiation. Analyses were based on longitudinal data collected within the randomized trial (n=459) conducted in nine rural district hospitals in Cameroon. Sexual activity was defined as reporting at least one sexual partner during the previous 3 months. Inconsistent condom use (ICU) was defined as reporting to have "never," "sometimes," or "nearly always" used condoms at least once with a partner(s) either HIV-negative or of unknown HIV status during the same period. Mc Nemar tests were used to assess time trend, while mixed-effect logistic regressions were conducted to analyze the effect of time since ART initiation on sexual activity. The proportion of sexually active patients significantly increased over time: from 31.8% at baseline to 40.2 and 47.1% after 6 and 12 months of ART, respectively (p=0.001), to 55.9% after 24 months (p=0.02). After adjustment for behavioral and psychosocial factors, time since ART initiation was independently associated with reporting sexual activity (AOR [95% CI]=1.30 [1.17-1.46] per 6-month increase, p=0.001). ICU was more frequent among patients sexually active both before and after ART initiation than among those who resumed sexual activity after ART initiation (82 vs. 59%, p

La recherche scientifique est une activite obligatoire a tout enseignant a l’universite. Nous avons realise ce travail de synthese en apportant des innovations dans les composantes d’un protocole de recherche. Le but de notre travail est de rappeler aux chercheurs de tous les domaines, la demarche a suivre pour rediger un bon projet de recherche encore appele protocole de recherche. Un protocole de recherche complet doit contenir les onze composantes suivantes : le titre ; l’introduction ; la problematique ; l’hypothese ; les objectifs ; les generalites ; la methode ; le calendrier ; le budget ; la bibliographie et la mention des liens d’interet. La methode d’etude est la partie essentielle du protocole de recherche. En conclusion, tout chercheur doit maitriser la procedure d’elaboration d’un protocole de recherche lui permettant d’aboutir a des resultats valides et de publier des articles scientifiques de bonne qualite.