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Retrospective Cohort Study to Investigate Pregnancy Outcomes in a Population of Advanced Maternal Age Congolese Women of Kinshasa: A Study Protocol

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Open Journal of Obstetrics and Gynecology 2024年第9期14卷 1398-1406页

作者： Anne Kapinga Mutshiaudi Thérèse Mikoka Walumpumpu Nicodem Nkutu Kimpu Joelle Lumaya Ambis Andy Mbangama Muela roger mbungu mwimba Kahindo P. Muyalalo Department of Gynecology and Obstetrics Cliniques Universitaires de Kinshasa Kinshasa Congo Department of Basic Sciences Faculty of Medicine University of Kinshasa Kinshasa Congo

Introduction: Pregnancies at advanced maternal age (AMA) are those occurring after the age of 35 years old. They carry a high risk of maternal-fetal morbidity and mortality, thus constituting a public health problem. Several African countries have reported an upward trend in both the age of childbirth and the frequency of women with AMA over the past 20 years. In the Democratic Republic of Congo (DRC), where maternal and neonatal morbidity and mortality remain very high, data on AMA pregnancies go back more than 20 years. Objective: We propose evaluating obstetrical outcomes among women in AMA in our setting and the associated factors. Methods: This retrospective cohort study will be conducted in two healthcare facilities (ESS) in Kinshasa. The study population will consist of all women who delivered a single fetus after 28 weeks of gestation between January 2012 and December 2022 (10 years) in the selected ESS. The data collected will be analyzed using R software version 4.2.0. Quantitative variables will be summarized as means with standard deviation or medians with interquartile range. Qualitative variables will be presented as proportions (%). Multivariate logistic regression will be used to determine the main maternal-fetal complications associated with AMA and predictors of obstetric outcomes. P Discussion: The high maternal and infant mortality rates in DRC are among the highest in the world. The context of maternal age has become a topic of growing interest due to its potential implications for the health of women and newborns, it is crucial to identify the risk factors associated with obstetric outcomes by identifying obstetrical outcomes associated with advanced maternal age in the DRC. Many Congolese women tend to start their maternity journey at a relatively young age. However, there is also an emerging trend towards delayed childbearing, particularly in urban areas and among women with access to education and family planning services. Conclusion: The re

关键词： Advanced Maternal Age Adverse Maternal and Perinatal Outcome Congolese Women Kinshasa

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Hydroxychloroquine-azithromycin,doubase C,and QTc prolongation in congolese patients with COVID-19:Myth or reality?

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World Journal of Virology 2024年第2期13卷 107-114页

作者： Brady Madioko Makanzu Jean-Robert Makulo Madone Ndona Mandina Dimosi roger Wumba Murielle Mashi Longokolo Hippolyte Situakibanza Ossam Odio Donat Sonzi Mangala Constantin Mihigo Bashengezi Benjamin Kabwe Mwilambwe Gilbert Kabanda Kurhenga Benjamin Longo-Mbenza roger mwimba mbungu Department of Cardiology Kinshasa University HospitalKinshasaDR CongoKinshasa University HospitalKinshasa 11Congo Nephrology Unit Kinshasa University HospitalKinshasaDemocratic Republic of the CongoKinshasa 11KinshasaCongo Department of Infectious Diseases Kinshasa University HospitalKinshasaDR CongoKinshasa 11Congo Department of Tropical Medicine University of KinshasaKinshasa 11Congo Department of Infectious Diseases University of Kinshasa HospitalKinshasa 11Congo Department of Tropical Medicine and Infectious Disease School of MedicineUniversity of KinshasaKinshasa 11Congo COVID-19 Treatment Center Kinshasa University HospitalKinshasaKinshasa 11Congo Centre de Recherche en Phytothérapie Pharmacopée Africaine et Technologie pharmaceutiqueKinshasa 11Congo Intensive Care Unit Kinshasa University HospitalKinshasa 11Congo Department of Gynecology and Obstetrics Kinshasa University HospitalKinshasa 11Congo

BACKGROUND QTc interval prolongation with an increased risk of torsade de pointes(Tsd)has been described in coronavirus disease 2019(COVID-19)patients treated with hydroxychloroquine(HCQ)and azithromycin(AZI)in Western *** the DR Congo,few studies have evaluated the safety of this association or proposed new *** To determine the incidence of QTc prolongation and Tsd in COVID-19 patients treated with HCQ-AZIs vs doubase C(new molecule).METHODS In present randomized clinical trial,we have included patients with mild or moderate COVID-19 treated with either HCQ-AZI or doubase ***(ECG)changes on day 14 of randomization were determined based on pretreatment *** QTc was defined as≥500 ms on day 14 or an increase of≥80 ms compared to pretreatment *** with cardiac disease,those undergoing other treatments likely to prolong QTc,and those with disturbed ECG tracings were excluded from the *** The study included 258 patients(mean age 41±15 years;52%men;3.4%diabetics,11.1%hypertensive).Mild and moderate COVID-19 were found in 93.5%and 6.5%of patients,*** baseline,all patients had normal sinus rhythm,a mean heart rate 78±13/min,mean PR space 170±28 ms,mean QRS 76±13 ms,and mean QTc 405±30 *** complaints suggesting cardiac involvement were reported during or after *** four patients(1.5%)experienced QTc interval prolongation beyond 500 ***,only five patients(1.9%)had an increase in the QTc interval of more than 80 *** prolongation was more significant in younger patients,those with high viral load at baseline,and those receiving HCQ-AZI(P<0.05).None of the patients developed *** QTc prolongation without Tsd was observed at a lower frequency in patients treated with HCQ-AZI vs doubase *** absence of comorbidities and concurrent use of other products that are likely to cause arrhythmia may explain our results.

关键词： QTc prolongation COVID-19 Doubase C HCQ-AZT Sub-Saharan Africa

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A Clinical Study to Assess the Effectiveness of Oral Combination Kit Therapy in Syndromic Management of Abnormal Vaginal Discharge (FEMINE Study) in Kinshasa, Democratic Republic of Congo

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Open Journal of Obstetrics and Gynecology 2024年第1期14卷 193-208页

作者： Feruzi Michel Mangala Muela Andy Mbangama Di-Mosi-Nkoy roger Wumba Ambis Joëlle Lumaya Nkongolo Freddy Muamba Tshitadi Jean Mukendi Ndombasi Neilda Lemba Otem Christian Ndesanzim Nkashama Bienvenu Kazadi Banza Jesual Lotoy Umba Adrien Tandu Mushengezi Dieudonné Sengeyi mwimba roger mbungu Department of Gynecology and Obstetrics University Clinics of Kinshasa Kinshasa DR Congo Congolese Society of Gynecology and Obstetrics Kinshasa DR Congo Department of Gynecology and Obstetrics Kinshasa Provincial General Reference Hospital Kinshasa DR Congo Departement of Tropical Medicine University Clinics of Kinshasa Kinshasa DR Congo

Background: Vaginal discharge is one of most common and nagging problems that women face. About 20% - 25% of women who visit gynecology department complain of vaginal discharge and leucorrhoea. An orally administered combination kit, containing 2 g secnidazole, 1 g azithromycin and 150 mg fluconazole (Azimyn FS Kit), has been successfully evaluated in clinical trials and used in several countries for management syndromic vaginal discharge due to infections. Methods: This is a longitudinal study which aimed to verify the clinical efficacy of the combined oral kit containing secnidazole, azithromycin and fluconazole (Azimyn FS Kit®) in the syndromic treatment of abnormal vaginal discharge in patients received in outpatient consultations in Kinshasa/DR Congo from March to September 2023. Results: Majority of patients had whitish vaginal discharge (51.6%) of average abundance (56.2%), accompanied by pruritus in 72.1% of cases, and dyspareunia in 23.5% of cases and hypogastralgia in 40.2% of cases. One week after treatment with the Azimyn FS® combined kit, at the greatest majority of patients (97.3%), abnormal vaginal discharge had decreased by more than 50% (84.1%). Two weeks after treatment with the Azimyn FS® combined kit, almost all patients (97.3%) no longer had abnormal vaginal discharge which had completely disappeared. Conclusion: A single dose of secnidazole, azithromycin and fluconazole in the form of an oral combi-kit (Azimyn FS Kit) has shown excellent therapeutic effectiveness in the syndromic treatment of abnormal vaginal discharge wherein patients were treated without diagnostic confirmation.

关键词： Oral Combination Kit Therapy Syndromic Management Abnormal Vaginal Discharge

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Iron and Oxidative Status Following Routine Iron Supplementation: Reflection on Pregnancy Outcomes in a Cohort of Women in Kinshasa, DR Congo

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Open Journal of Obstetrics and Gynecology 2019年第5期9卷 582-596页

作者： Andy Mbangama Muela Barthélémy Tandu-Umba roger mbungu mwimba Department of Obstetrics and Gynecology University Clinics of Kinshasa Kinshasa Congo

Background: Anemia during pregnancy is associated with oxidative stress, which might expectedly provoke harmful consequences on maternal and perinatal outcomes. Use of iron in women during pregnancy improves maternal hematologic parameters, while likely to worsen oxidative status. Objectives: Our study thus aimed to assess adverse outcomes on all women having been routinely iron supplemented during pregnancy. Methods: This is a prospective observational cohort of 74 pregnant women with singleton pregnancy whose baseline iron and oxidative status along with variations throughout pregnancy have been recently assessed at university clinics of Kinshasa, DR Congo. Obstetrical adverse outcomes were assessed according to the diagnosis of anemia and oxidative stress considered at recruitment, at 28 - 32 weeks of gestation and at term. For statistical calculations, we used t-test, chi-square test, ANOVAR and regression, the significance being stated at p < 0.05. Results: Complications significantly associated with anemia at the beginning of pregnancy were acute fetal distress (OR = 3.9, p < 0.03), prematurity (OR = 7.3, p < 0.007), low birth weight or LBW (OR = 3.4, p < 0.05), birth asphyxia (OR = 15.1, p < 0.002) and neonatal hypoglycemia (OR = 3, p < 0.05). When the diagnosis of anemia was considered at 28 - 32 weeks of gestation, significant associations were found with gestational diabetes mellitus or GDM (OR = 3.8, p < 0.05), cesarean section (OR = 4.8, p < 0.003), prematurity (OR = 5.3, p < 0.03), birth asphyxia (OR = 10.9, p < 0.008) and neonatal hypoglycemia (OR = 4.7, p < 0.02). At term, the diagnosis of anemia was significantly associated with GDM (OR = 9.2, p < 0.01), premature rupture of membranes or PROM (OR = 2.8, p < 0.05), cesarean section (OR = 6.03, p < 0.01), birth asphyxia (OR = 2.9, p < 0.05) and neonatal hypoglycemia (OR = 3, p ?As of oxidative stress diagnosed at recruitment, significant associations were found with PROM (OR = 9, p < 0.02), cesarean se

关键词： Routine Iron Supplementation Iron and Oxidative Status Pregnancy Outcomes Kinshasa

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Routine Iron Supplementation during Pregnancy: Its Reflection on Iron and Oxidative Status in a Cohort of Pregnant Women in Kinshasa, DR Congo

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Open Journal of Obstetrics and Gynecology 2019年第1期9卷 98-115页

作者： Andy Muela Mbangama Barthélémy Tandu-Umba roger mwimba mbungu Department of Obstetrics and Gynecology University Clinics of Kinshasa Kinshasa DR Congo

Background:?Due to maternal and fetal physiologic demand, the rate along with amplitude of anemia is expected to rise over pregnancy. The iron and oxidative status also are expected to vary accordingly. It is thus assumed that iron supplementation will somewhat modify the profile observed in markers of iron and oxidative status of our series. Objectives: We aimed to measure variations of indices of iron and oxidative status of iron supplemented women over pregnancy. Methods: This is a prospective observational cohort of 74 pregnant women with singleton pregnancy whose baseline iron and oxidative status have been recently assessed at University Clinics of Kinshasa, DR Congo. Women with anemia (Hb < 10 g%) took iron for curative purposes (320 mg/day of ferric ammonium citrate) while the others received preventive iron supplementation (160 mg/day). Iron was associated with 15 mg folate/day. Nutritional iron intake was measured through a 24-hour recall using a questionnaire of common foods, including stuffs and habits likely to impede iron absorption. Biological parameters of iron and oxidative status included hemoglobin, hematocrit, ferritin, serum iron, transferrin, superoxide dismutase or SOD, uric acid, oxidized LDL and blood glucose. For statistical calculations we used t-test, chi-square test, ANOVAR and regression, the significance being stated at p Results: Trimester wise evolution of hematologic status in anemic women shows a rise in values of hemoglobin (+average 1 gr/dl) and hematocrit (+3%) throughout pregnancy, with significant change only between recruitment and 28 - 32 weeks. In non anemic women a significant decrease was observed, although levels remained normal. For ferritin (7.5 - 53 ng/mL from recruitment to term) and transferrin (107 - 157 g/L), significant rise was found in anemic women from recruitment to 28 - 32 weeks, while in non anemic notable change occurred only for transferrin (133 - 204 g/L). Serum iron significantly increased (53 - 83 μg/d

关键词： Iron Supplementation Pregnancy Iron And Oxidative Status Kinshasa

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Rationale of a Cohort Study on Risk of Obstetrical Outcomes Associated with Iron Supplementation during Pregnancy

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Open Journal of Obstetrics and Gynecology 2018年第6期8卷 598-609页

作者： Andy Muela Mbangama Barthélémy Tandu-Umba roger mwimba mbungu Department of Obstetrics and Gynecology University Clinics of Kinshasa Kinshasa DR Congo

Background: Anemia is one of the most widely prevalent disorders, affecting the lives of almost half a billion women of reproductive age, contributing to over 100,000 maternal and almost 600,000 perinatal deaths (mostly through pre-term delivery, low birth weight) each year. Increased risk of infant mortality and reduced cognitive development and reduced energy levels which affect productivity in adults are cited. During pregnancy increased requirements, inadequate intake of iron and other micronutrients and parasitic (malaria, hookworm) as wells as bacterial (mostly urinary tract) infections are the main causes. In order to reduce such maternal and neonatal burden, it has been worldwide admitted to adopt cost-effective preventive interventions during pregnancy, including iron-folic acid supplementation, de-hookworming medication and anti-malarial prevention or treatment. Intestinal absorption of iron is limited by a lot of factors including bioavailability, iron status of the woman, substances accompanying or contained in diet, chelating agents such as diet fibers or calcium salts. Any supplementation put additional constraint in terms of absorption. Unabsorbed iron is known to have pro-oxidant properties likely to induce production of free radicals. These in turn might induce oxidative stress accountable for in generation of many obstetrical outcomes. This potential link between oxidative stress resulting from free radicals hyperproduction induced by non absorbed iron and harmful maternal/perinatal conditions is rarely questioned by searchers. Objectives: To determine overall (food and supplemented) iron consumption, iron and oxidative status in a cohort of pregnant women and to seek associations between findings and adverse obstetrical outcomes. Methods: At the University Clinics of Kinshasa, we designed a protocol for a prospective cohort study dealing with clinical and biochemical parameters of oxidative stress among pregnant women iron supplemented. Women with

关键词： Obstetrical Outcomes Iron Supplementation Oxidative Stress

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Expectant Management of Preterm Ruptured Membranes before 34 Gestational Weeks at the University Hospital of Kinshasa, a Tertiary Referral Hospital in the Democratic Republic of Congo

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Open Journal of Obstetrics and Gynecology 2022年第7期12卷 633-648页

作者： roger mbungu mwimba Anselme mbungu Mulaila Joëlle Lumaya Ambis Andy Mbangama Muela Adrien Tandu Umba Berry Kinkenda Nsiangangu Malka Salamo Azama Thérèse Biselele Bakambuvua Kahindo P. Muyayalo Department of Obstetrics and Gynecology University of Kinshasa Kinshasa Democratic Republic of the Congo Neonatal Unit Department of Pediatrics University Hospital of Kinshasa Democratic Republic of the Congo Institute of Reproductive Health Center for Reproductive Medicine Tongji Medical College Huazhong University of Science and Technology Wuhan China

Premature Rupture of Membranes (PROM) with the resulting prematurity remains a major public health issue in the Democratic Republic of Congo (DRC). This study aimed to assess expectant management of PPROM before 34 weeks at the university hospital of Kinshasa. We conducted a retrospective analysis of expectantly managed PROM before 34 weeks between January 2008 and December 2018. Maternal and fetal outcomes were collected, and all data were analyzed using the SPSS 23.0 software. Of the 113 patients included in the study, 2.6% were diagnosed with PROM before 34 weeks. We observed prolongation of the pregnancy duration;the median latency period was eight days, and the average gestational age at delivery of 32.85 ± 2.5 weeks. Chorioamnionitis (23%), severe oligoamnios (7%), and acute fetal distress (4%) were complications observed during the latency period. In the postpartum period, endometritis (6.2%), neonatal jaundice (39.8%), anemia (25.7%), ulcerative necrotizing enterocolitis (6.2%), cerebromeningeal hemorrhage (5.3%), and acute respiratory distress syndrome (4.4%) were complications observed. The risk of infection during the latency period was significantly associated with irregular (P = 0.045) or lack (P = 0.006) antenatal care (ANC) attendances and C-Reactive Protein (CRP) results 6 (P = 0.013). The risk of neonatal death was significantly associated to infection during the latency period (P = 0.011), irregular (P = 0.009) or lack of ANC (P = 0.000) attendances, Birth weight g (P = 0.039) as well as Gestational age at birth between 28 to 30 Weeks (S) (P = 0.021). These findings report first-time pregnancy outcomes related to the management of PPROM before 34 weeks in our setting. We found that the conservative attitude adopted allowed the prolongation of pregnancies, reducing the risks associated with prematurity. Nevertheless, attendance in good quality ANC could reduce the frequency of PROM and related adverse outcomes.

关键词： Premature Rupture of Membranes Gestational Age Expectant Management Pregnancy Outcomes D. R. Congo

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A Clinical Study to Assess the Effectiveness of Oral Combination Kit Therapy in Syndromic Management of Abnormal Vaginal Discharge (FEMINE Study) in Kinshasa, Democratic Republic of Congo

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Open Journal of Obstetrics and Gynecology（妇产科期刊） 2024年第1期

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Rationale of Cross-Sectional Descriptive Study on Clinical Effectiveness of Oral Combination Therapy Based on Secnidazole, Azithromycin and Fluconazole in Syndromic Treatment of Abnormal Vaginal Discharge in Kinshasa/DR Congo

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Open Journal of Obstetrics and Gynecology 2023年第11期13卷 1807-1815页

作者： Muela Andy Mbangama Feruzi Michel Mangala Di-Mosi-Nkoyi roger Wumba Ambis Joelle Lumaya Nkongolo Freddy Muamba Mubalamata Eugene-Patrick Lukusa Nkashama Bienvenu Kazadi Ndombasi Nelda Lemba Banza Jésual Lotoy Oteme Christian Ndesanzim mwimba roger mbungu Departement of Obstétrics and Gynecology University Clinics of Kinshasa Kinshasa DR Congo Departement of Tropical Medecine University Clinics of Kinshasa Kinshasa DR Congo

Background: Vaginal discharge is one of the most common troubles faced by childbearing age women. About 20% - 25% of women who visit service of gynecology complain of vaginal discharge and leucorrhoea. Management of vaginal discharge in low-income countries generally depends on syndromic approach, which limits the understanding of specific responsible agents. Thus targeted management is based on the identification of causal organism and targeting of therapy against it, while syndromic management is based on presence of high risk factors. Thus the oral combination kit (Azimyn FS Kit®) offers convenience of a one-day treatment compared to other multidose treatments, which will also ensure high patient adherence to treatment, thus increasing chances of desired results. Due to its widespread use, it is proposed to evaluate the effectiveness of this oral association kit therapy in management of vaginal discharge in the population of our milieu in the Democratic Republic of Congo (DRC) particularly those received in outpatient consultation in some medical facilities in city of Kinshasa. Expensive laboratory tests and the associated waiting period for result mean that patient remains without treatment while waiting for test results. Therefore, by adopting a syndromic management approach, patient’s eligibility for treatment will be decided based on abnormal vaginal discharge, their characteristics, severity and other presentations symptomatic. This approach will also avoid losing sight of patients during follow-up and will help to reduce financial burden for patients. Objectives: To determine the efficacy and safety of oral combination kit therapy containing secnidazole, azithromycin and fluconazole (Azimyn FS Kit®) in syndromic treatment of abnormal vaginal discharge in patients received in outpatient consultation in some medical facilities in the city of Kinshasa;to measure rate of recurrence of abnormal vaginal discharge in these patients. And to identify the adverse eff

关键词： Combination Therapy Syndromic Treatment Abnormal Vaginal Discharge

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Benefit of Iron Supplementation with Ferric Sodium EDTA (NaFe <sup>3+</sup>-EDTA) in the Treatment of Anemia during Pregnancy in Democratic Republic of Congo (FERARI Study)

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Open Journal of Obstetrics and Gynecology 2021年第10期11卷 1411-1424页

作者： Muela Andy Mbangama Difunda Victor Muela mwimba roger mbungu Moyenne Jean Pierre Elongi Ambis Joëlle Lumaya Ndombasi Nelda Lemba Umba Adrien Tandu Otem Christian Ndesanzim Nkashama Bienvenu Kazadi Litambelo Serge Etana Department of Gynecology and Obstetrics University Clinics of Kinshasa Kinshasa DR Congo Congolese Society of Gynecology and Obstetrics Kinshasa DR Congo Department of Gynecology and Obstetrics Kinshasa Provincial General Reference Hospital Kinshasa DR Congo

Background: Oral iron supplements, usually in the form of ferrous salts, are associated with gastric side effects, poor compliance and failure of anemia treatment. To make iron more bioavailable, reduce the gastric side effects and increase the patient compliance, newer iron form, Ferric Sodium EDTA, has become available on the market. Objective: To assess the change in hemoglobin level after iron supplementation with Ferric Sodium EDTA during pregnancy. Materials and Methods: This is a longitudinal study concerning 337 women attending antenatal care in maternity hospitals in the Democratic Republic of Congo from May to December 2020. The study included sociodemographic and anthropometric variables along with type of feed, hemoglobin level at recruitment and after three weeks of taking iron supplement with Ferric Sodium EDTA (Hemoforce Plus Zinc® syrup). For statistical analysis, we used t-test or ANOVA and chi-square test, the significance being stated at p Results: The frequency of pregnancy anemia was 51.4%. The mean hemoglobin value of the overall study group was 8.7 ± 0.5 g/dL. The mean maternal age and weight were 28.9 ± 6.2 years and 65.3 ± 11.7 kg, respectively. Most pregnant women (83.1%) had a diet consisting of food of plant and animal origin in equal proportions. Mean of Body Mass Index (BMI) was 24.6 ± 4.6 Kg/m2 and 44.3% were overweight and obese. The co-morbidities associated were malaria and intestinal parasitosis found in 45% and 5.9% of cases, respectively. After iron treatment with Ferric Sodium

关键词： Iron Supplementation Ferric Sodium EDTA NaFe3+-EDTA Anemia Pregnancy

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