CONGO: A cut too far? C-sections increase after policy change

BRAZZAVILLE, 15 September 2011 (IRIN) - A health policy shift that saw the introduction in May of free Caesarean section operations in 35 hospitals across the Republic of Congo - to curb the growing rate of maternal and infant mortality - seems to have prompted a proliferation of such operations, according to health officials.

"We are virtually living in the hospital because there are so many consultations," said Jean-Claude Kala, head of gynaecology at Makélékélé Hospital, south of Brazzaville. “The free service has helped many people because until very recently many women were dying because their husbands or their parents had no money to pay for a Caesarean."

Congo's health authorities introduced the free Caesarean sections to reduce a maternal mortality rate considered high. Officially it is 781 deaths per 100,000 live births. One in 28 women dies in childbirth.

In 2010, Kala said, 5 percent of the 10,000 births in the hospital were by Caesarian; "so far this year we have had fewer than 6,000 births, but 10 percent of them were by Caesarean. This shows that the rate is increasing in our hospital."

Makélékélé Hospital is one of the designated centres in Brazzaville where the free operations are available.

Between May and August, some 220 Caesarean sections and 29 obstetric operations were carried out, according to Kala, even though the hospital has only 150 beds and three gynaecologists.

Before the new policy, the cost of a Caesarean was 50,000-150,000 CFA francs (US$100-$300) in a country where it is estimated 70 percent of the population lives below the poverty line.

"We reckon there are more cases than before. But we should also note the decline in mortality of both women and children," Jean Louis Lengouango, director of Talangaï Hospital in the sixth district of Brazzaville, told IRIN.

Congo is a poor country. People are interested in anything offered for free“We have not seen any break in supplies of medical equipment since the scheme was introduced because we are regularly replenished by the Director of Studies and Planning of the Ministry of Health," said Lengouango, adding that all the doctors involved were state-funded.

A commission set up to evaluate the scheme estimates it will cost more than 2.8 billion CFA francs ($5.9 million) in 2011. Between May and August, the commission recorded 1,779 Caesarean deliveries out of 15,211 births, with 14 maternal deaths and 83 neonatal deaths.

"Congo is a poor country. People are interested in anything offered for free. For the moment it is difficult to assess the value of the measure. I think that after a few years it will show its limits," Paul Ngangoue, 71, told IRIN.

The UN Population Fund (UNFPA) is one of the partners supporting the initiative.

"We believe that free Caesarean sections and the promotion of family planning are among the elements that contribute to reducing deaths by 60 percent," said Jean René Kule, head of advocacy at UNFPA in Brazzaville. "It's an initiative that we want to see continued."

By John Irish

PARIS (Reuters) - Rwanda is open to extraditing Congolese warlord Laurent Nkunda as long as he does not face the death penalty in his homeland, ministers said on Monday.

The former leader of the National Congress for the Defence of the People (CNDP), a rebel force that repeatedly routed Democratic Republic of Congo's army, has been held under house arrest in Rwanda since 2009.

"We are talking to the Congolese authorities with regard to his extradition, but it is difficult," Foreign Minister Louise Mushikiwabo told reporters in Paris on the sidelines of a state visit by Rwandan President Paul Kagame.

"It's difficult for us to extradite a person to a country that has not abolished the death penalty even with certain guarantees," she said.

Nkunda's arrest heralded a new era in relations between the two African states, but what happens to Nkunda could still influence relations.

A United Nations panel reported in 2008 that the Rwandan army had supported Nkunda's rebel war in eastern Congo and if Nkunda were to stand trial in Congo, and he confirmed the U.N. allegations of Rwandan support, it would be embarrassing for Kagame and could harm relations with Congo anew.

"There is also the political aspect which makes his extradition difficult because we in Rwanda want lasting stability so everything that has a tendency to destabilise and to take us back to the (era of) conflict and confrontation remains delicate," she added.

Justice Minister Tharcisse Karugarama said that Nkunda's position as a soldier with supporters and his own military force meant that his case could not be treated like everybody else.

"It's a delicate issue not just about extradition, but generally legal and political aspects and the stability of the region," he said. "It's difficult for Rwanda, Congo and even Ndunka. We hope that soon there will be a lasting solution."

The Hague-based International Criminal Court (ICC) has not indicted Nkunda, but has opened investigations into him and the U.N. has accused his CNDP of serious human rights abuses, including sexual violence and recruitment of child soldiers during his five-year rebellion in eastern Congo.

Nkunda could face a tribunal for war crimes, treason and desertion charges in Congo.

Renaissance Builds City in Congo
13 September 2011
Bloomberg

LONDON — The investment unit of Renaissance Group plans to build
a 2,600-hectare city in the Democratic Republic of Congo as it seeks
to benefit from Africa's urbanization.

Renaissance Partners is working on a master plan for the new urban center
after securing land outside Lubumbashi, the country's second-largest city,
Arnold Meyer, Renaissance Partners' managing director for real estate
in Africa, said in London.

"The West has peaked in terms of economic growth and the new markets are
in Africa," Meyer said. "And the main drivers of this growth in Africa are
going to be cities."

Renaissance's Lubumbashi project will be more than double the size of Tatu
City, the $5 billion center that the firm is building from scratch outside
the Kenyan capital of Nairobi.

Tatu City, a 1,000-hectare site about nine miles north of the capital, will
eventually have 62,000 residents and include a stadium, technology park,
hospital, shops, office towers and playgrounds, the firm said in October,
when it started the project. The Nairobi Stock Exchange is in talks with
Renaissance about relocating there. Renaissance expects the city's first
buildings to be erected by the end of 2013, Meyer said.

Read more:
http://www.themoscowtimes.com/business/article/renaissance-builds-city-in-congo/443611.html#ixzz1XzgQdPex
The Moscow Times

[This method treats the HIV-infected member of the couple before the person might otherwise qualify for ARVs clinically. This is great, if the couple is monogamous or the partners use barrier protection with outside partners (and as back-up with each other). What may be more interesting is if protocols are developed to address pre-exposure prophylaxis (PrEP) in the form of ARVs for the negative member of the couple. This method would protect the negative partner from contracting HIV from his/her partner, and from outside partners, thereby reducing potential co-infection as well.]


KIGALI, 12 September 2011 (PlusNews) - HIV-positive Rwandans in discordant relationships will start taking antiretroviral treatment (ART) as soon as they test positive as part of a plan to boost national HIV prevention and treatment efforts.

"There is evidence that antiretroviral treatment, once started early for eligible HIV-positive patients, alleviates their suffering and reduces the devastating impact of the pandemic," Anita Asiimwe, head of the Institute of HIV/AIDS Disease Prevention and Control, told IRIN/PlusNews. "Antiretroviral therapy has the potential both to reduce mortality and morbidity rates among HIV-infected people, and to improve their quality of life."

In May 2011, a landmark study - HPTN 052 - showed major reductions in HIV transmission among discordant couples due to early treatment. The authors of the nine-country study concluded that earlier initiation of HIV treatment led to a 96 percent reduction in HIV transmission to the uninfected partner.

According to the government, an estimated 7.1 percent of cohabiting couples seeking voluntary counselling and testing services in the capital, Kigali, are HIV discordant. Infections within stable relationships have been identified as one of the main sources of new cases in Rwanda.

Rwanda has a successful ART programme; Asiimwe said the country had achieved 93 percent coverage of people needing treatment under UN World Health Organization (WHO) guidelines, which recommend initiation of treatment at a CD4 count - a measure of immune strength - of 350 and below.

"HIV-positive people in discordant relationships will start ART regardless of their CD4 count," said Sabin Nsanzimana, coordinator of the HIV and Sexually Transmitted Infections (STI) Care and Treatment Department at the Ministry of Health's Centre for Treatment and Research on AIDS, Malaria, Tuberculosis and other Epidemics, TRAC Plus. "We hope to start as soon as the guidelines are approved at the senior management meeting and [endorsed by] the Ministry of Health."

Rwanda is going ahead despite the fact that WHO has not yet released prevention guidelines for discordant couples. At an International AIDS Society conference in Rome in July, the head of WHO's HIV/AIDS department, Gottfried Hirnschall, said the organization had delayed the release of guidelines following the HPTN 052 results.

Nsanzimana said the added cost of putting thousands more people on treatment would be compensated for by the reduction in new HIV infections and treatment down the line.

"This strategy will help us make gains on those who will be prevented from infection since these won't have to be treated or even followed up with much money," he said.

Challenges

"When my wife was pregnant, she took the mandatory HIV test at the health centre and it was positive. Now why should I go for testing to make a mockery of myself?" said Gregory Ruseesa, a taxi tout in suburb of Nyabugogo in the capital, Kigali. "If she has it [HIV], I definitely have it too."

The head of HIV and STI care and treatment at the Rwanda Biomedical Centre, Muhayimpundu Ribakare, said: "Here in Rwanda it's just very few couples that go for HIV voluntary counselling and testing services; of course this means they are not aware of their HIV status - if they are positive they end up infecting their partners.”

According to Nsanzimana, the government will also need to intensify its efforts to improve ART adherence to ensure patients do not develop resistance.

"A patient on ART who doesn't follow prescription and, say, skips a dose, is likely to get the drug-resistant HIV," he said. "Once this happens, the resistant HIV requires another type of medication which is expensive."

The first handover of money in Mr de Villepin's presence occurred in 1995, he said, involving 10m francs from the then Zairean President Mobutu Sese Seko.

Mr Bourgi said that money from the leaders of several former African colonies was then passed to Mr Chirac and Mr de Villepin over the next 10 years. Speaking on Europe 1 radio, he estimated the total amount to be about $20m.

Senegalese President Abdoulaye Wade, Burkina Faso's Blaise Compaore, former Ivory Coast President Laurent Gbagbo, Republic of Congo President Denis Sassou Nguesso and the late Gabonese President Omar Bongo all visited Mr de Villepin in his office, handing over $10m for the 2002 election campaign, Mr Bourgi claimed.

It's just that I don't want to participate in the frenzy. 

For me, it is odd. I had a different experience. I was in another country when it happened, I'm in another country now. And while to some extent it's about all of us, it's about some more than others, and I wasn't there, or even nearby. 

Eventually telling stories about terrible things, while cathartic, is also exhausting. 

And I'm happy not to be around during the circus, and I'm not even turning on my TV here today, or tomorrow. 

Suffice it to say that I acknowledge that it affected all of us and will continue to do so.

A moment of silence, please (that means you, news media).

Rwanda is developing its own film industry 17 years after genocide tore the country apart. The Rwanda Film Festival brings portable movie screens to rural areas so people can see films, some for the first time.

Reporting from Kigali, Rwanda—</div>— Beneath a star-filled African sky, crowds of city dwellers and rural farmers gather before a giant inflatable screen. It's movie night in Rwanda and thousands have come to see films selected in this year's Rwanda Film Festival.

Most of them have never seen a motion picture on a large screen before and for many this will be the first feature-length film they have ever seen — in any format.

Seventeen years after the genocide that tore this country apart — killing more than 800,000 in just 100 days — there is a palpable sense of renewal in Rwanda. Health and economic indicators are on the rise and the nation is leading the way on the continent in business reform and anti-corruption practices.

Now the country's artists — writers, directors and actors — are telling their own stories on their own terms. Known as the Land of a Thousand Hills, Rwanda is trying to become Hillywood and Rwandan filmmakers hope to have a place in the international film spectrum that is shaking up the developing world with India's Bollywood rivaling Hollywood and Nigeria's Nollywood trying to catch up.

( Read more... )

Finding that disease-bearing mosquitoes are drawn to foot odor, researchers in Africa, which accounts for 90% of malaria deaths worldwide, are planning to use the smell from sweaty socks in traps.

As a boy in remote western Kenya, Fredros Okumu sat under the stars, smothered by the smoke of the family fire, until it was time to go to bed.

Even now, when he returns home to his village, a 29-year-old man who left and achieved things, he still sits in the darkness, eyes stinging, nose running, enveloped in the choking smoke. Its smell clings to his hair and clothing, but at least it serves its purpose: keeping the mosquitoes at bay.

Like almost everyone in the village of Uyoma, Okumu lost family and friends to mosquito-borne malaria when he was growing up. So the smoke of burning Kenyan bush herbs was his friend.

"One of the things growing up, I caught malaria at least twice a year. I lost cousins, around five of them. And if you speak to any African boy who is 29 years old and grew up in an African village, he would either have a similar situation, or worse," he said in a phone interview from Tanzania, where he works as an entomologist for the Ifakara Health Institute, a medical and public health research institute.

Mosquitoes responsible for spreading malaria, such as the female Anopheles varieties, are particularly attracted to feet.

In a splendid example of African inventiveness, Okumu is developing a toxic mosquito trap for African villages that attracts the insects using a human scent that mosquitoes apparently cannot resist: smelly socks.

Read the rest.

DR Congo tin 'smuggled' by UN man




A UN employee in the Democratic Republic Congo has been arrested for trying to smuggle more than a tonne of tin ore into Rwanda, officials say.


He was found in his UN vehicle with 24 packages each containing 50kg of cassiterite, said DR Congo Information Minister Lambert Mende.


The UN peacekeeping mission, known as Monusco, has confirmed that one of its local employees has been detained.


There are some 22,000 UN troops in DR Congo following years of conflict.


Armed groups continue to operate in parts of the east - some are funded by the trade in the country's rich minerals.


In March, the government lifted a six-month ban on mining in eastern DR Congo, imposed in a bid to stop the illegal trade.



The US has also passed a law obliging electronics manufacturers to ensure they are not buying minerals which come from conflict areas.

I discovered the link to this site through Lexxus Legal's Facebook page, which led me to this two-part post.  Both include links to videos, plus some free downloads.  This is Africa goes beyond music, but it's turned out to be a treasure trove of free downloads of tunes and mixtapes.  

1. Congolese urban music in a world of global influences (Part 1)
2. The Congolese urban music (Part 2): Modernisers of Coupé Décalé
Lexxus is mentioned in Part 1, and you can check out more of his videos here, and a short in which he talks about his mission here.