Background and Aim. Environmental and occupational exposure to high dust levels are known to be associated with lung function impairment. We assessed the ambient air quality in the working environment and the respiratory health of female stone quarry workers in Lubumbashi, Democratic Republic of Congo (DRC) in a context of severe economic, security, and health crises. Methods. This was a case-control study conducted in three stone quarry sites. Participants were 256 dust-exposed female stone quarry workers matched to 256 unexposed female office workers and market tax collectors (N = 512). They each answered a structured respiratory health questionnaire and underwent physical examination and a lung function test with the use of a spirometer and peak flow meter. Quality of ambient air in the working environment was assessed by means of a BRAMC air quality monitor (BR-AIR-329). Results. Results showed that exposed women did not use any personal protective equipment (PPE); in quarry sites, abnormally high levels of PM_2.5 (205 ± 13.2 μg/m³ vs. 31.3 ± 10.3 μg/m³ in control sites; p < 0.001) and volatile organic compounds (VOC, 2.2 ± 0.2 μg/m³ vs. 0.5 ± 0.3 μg/m³, respectively; p < 0.01) were found. Furthermore, respiratory complaints were more common among exposed women (32.4% vs. 3.5% in controls; p < 0.01), who had abnormal chest auscultation and reduced lung capacity than controls (mean PEFR: 344.8 ± 2.26 and 405 ± 67.7 L/s, respectively; p < 0.001 Conclusion. Findings from this study show that in the midst of severe crises in the DRC, women stone quarry workers are exposed to abnormally high levels of respiratory hazards, which contribute to impaired lung function. There is a need to regulate quarry work and improve the working conditions in quarry sites in the DRC.

The authors have carried out a literature review of targeted relevant research with a focus on two countries of the African Great Lakes Region, i.e. Rwanda and the Democratic Republic of the Congo (DRC). The aim was to find a common thread between nulliparity and timely caesarean section through external clinical pelvimetry. Higher rates of nulliparity and caesarean section were found with poor outcome in terms of foeto-maternal prognosis. External clinical pelvimetry presented in Rwandan and Congolese nulliparae the same characteristics during pregnancy and at delivery: lower average values in comparison with multiparae who never experienced caesarean section; average values significantly lower in women who underwent caesarean than in those who delivered naturally; and a gradual and significant decrease in caesarean section rate as pelvic sizes increased. Cephalopelvic disproportion, the main cause of mechanical dystocia, was associated with significantly lower pelvic average values. On the basis of an appropriate tool to predict cephalopelvic disproportion and taking as an illustration of complication the case of obstetrical fistulas, the authors finally advocate the use of the pelvimeter to screen in time pelvises at higher risk for cephalopelvic disproportion in resource-constrained environment.

Since 2000, Rwanda has prioritized universal health coverage (UHC) and universal health insurance, achieving significant health gains. Its UHC model – centered on Community-Based Health Insurance (CBHI) and supported by public and faith-based providers – now faces financial sustainability challenges. Under Vision 2050, Rwanda aims to meet upper-middle-income country health-care standards by 2035 and high-income country (HIC) standards by 2050. This study assesses the financial sustainability of Rwanda’s UHC model from 2011 to 2021, with projections through 2041 under four scenarios: Scenario I (status quo, fee-for-service): Projects growing deficits reaching Rwandan Franc (RWF) 89.71 billion and a cumulative RWF 913.03 billion by 2040/2041. Scenario II (Fully Active Strategic Purchasing): Project net income of RWF 81.61 billion and cumulative reserves of RWF 516.94 billion by 2040/2041. This approach supports near-free health care, aligns with SDG 3.8 and WHO’s UHC Cube, and promotes reforms such as tariff adjustments, medical tourism, dual practice, and a comfortable package integrated with Ejo Heza Pension benefits. Strategic purchasing could eliminate 56.89% of undue costs, enabling 70% prepayment for facility plans: 45% for health service delivery, 10% for prior co-payments, and 15% for staff incentives. The remaining 30% (post-verification) would fund additional essential medicines, inpatient nutrition, financial sustainability, and resilience initiatives. Scenario III (1% UHC-HRV 2050 tax): Forecasts RWF 849.41 billion in net income and RWF 6,985.66 billion in reserves. Scenario IV (equity and modernization): Aims to expand clinical capacity 12-fold by 2041. Leveraging a strengthened CBHI system and a modest 1% levy for UHC and HRV 2050, Rwanda could promote clinical capacity strengthening up to 12-fold by 2041, retention and repatriation of specialized professionals, health infrastructure modernization, and meet HIC health-care standards by 2036 – 2040, ahead of 2050 initial milestone, saving up to USD 922.86 per capita in health expenditure. Rwanda’s robust UHC commitment provides a replicable model for sustainable health reform across Africa.

Ce travail avait pour objectif de déterminer la prévalence des symptômes respiratoires, leurs déterminants, ainsi que l’état de la fonction respiratoire des meuniers exposés aux poussières de manioc, maïs et soja à Lubumbashi, en République démocratique du Congo (RDC), en comparaison avec un groupe des travailleurs non-exposés. Une étude transversale descriptive et analytique a été menée en 2015 à laquelle ont pris part 288 meuniers et 118 agents (n = 406) d'une agence de sécurité (groupe contrôle) à Lubumbashi, en RDC. Les participants ont été examinés sur leur lieu de travail. Les informations obtenues concernant la santé respiratoire ont été recueillies sur la base d'un questionnaire standardisé. Une spirométrie a été réalisée chez chaque participant. L’âge moyen était de 27,6 ± 9 années chez les meuniers et 28,5 ± 7 chez les témoins. La durée journalière de travail était de 12,1±1,7 heures pour les meuniers contre 14,4±6,2 heures chez les témoins. Aucune différence significative n'a été trouvée en comparant les deux groupes. Cependant la prévalence des symptômes respiratoires était plus élevée chez les meuniers que chez le groupe contrôle, notamment pour les sifflements (1,9 fois plus), la sensation de gêne respiratoire (2,1 fois), l'essoufflement au repos (6 fois plus), l'essoufflement à l'effort (6,4 fois plus), la bronchite chronique (6,2 fois plus), la toux (5,3 fois plus) et la présence d'expectorations le matin (5,1 fois plus). Une association a donc été trouvée entre la profession meunière et tous les symptômes respiratoires. Les données spirométriques ont montré que le volume expiratoire maximal à la seconde (VEMS), le débit expiratoire de pointe (DEP) (p<0,05) et le rapport de Tiffeneau (VEMS/CVF) (p<0,001) étaient significativement réduits chez les meuniers comparés aux témoins. Cette étude a montré une prévalence élevée des symptômes respiratoires avec atteinte de la fonction pulmonaire chez les meuniers de Lubumbashi et suggère la nécessité de mettre en place des mesures préventives devant réduire l'exposition dans les meuneries.