| Peer-Reviewed

Maternal Morbidity Associated to Exposure to Trace Elements in Lubumbashi

Received: 27 August 2022    Accepted: 9 September 2022    Published: 27 September 2022
Views:       Downloads:
Abstract

Background: Pregnant women are exposed to toxic trace elements (TE) from mining plants. The aim of this study was to determine the incidence of morbid conditions among pregnant women and their relations to blood’s concentration of TE and their exposure factors in Lubumbashi. Methodology: A prospective cohort study of 378 mothers and 378 newborns exposed to TE was conducted from November 30, 2018, to May 30, 2019. The groups were constituted whether the TE concentration was higher or lower than the reference value. (Determined by ICP- OES Optima 8300 at the laboratory of the OCC/Lubumbashi). Correlation between the morbid conditions in the two groups and with each exposure factors by calculating chi square and the relative risk were obtained. (p ˂ 0.05) Results: Among pregnant women 61.4% had malaria, 47.6% anemia, 21.2% hypertension, 11% IUGR newborns and 8.7% a premature birth. Geophagia increased two times the risk of anemia [RR: 2.127 (1.410-3.209)] and hypertension [RR: 1.958 (1.177-3.259)]. The proximity to mining plants increased three times the risk of anemia [RR: 2.887 (1.830-5.554)] and hypertension [RR: 3.126 (1.876-5.208)]. The use of well water for drinking and housework increased two times the risk of hypertension [RR: 2.308 (1.385-3.845)] and IUGR newborn [RR: 1.752 (1.232-2.490)]. Biomass used for cooking increased three times the risk of hypertension [RR: 3.204 (1.114-9.212)]. Women working in mining plants had two times the risk of malaria: [RR 1.725 (1.145-2.599)]. Women whose husband worked in mining plants had three times the risk of premature birth [RR: 3.204 (1.552-6.616)]. High lead concentration increased five times the risk of anemia [RR: 4.63 (2.933-7.310)]; height times the risk of hypertension [RR: 8.170 (4.657-14.333)]; three times the risk of a IUGR newborn [RR: 2.601 (2.078-3.256)]. The linear correlation between lead and maternal hemoglobin was negative (r -0.335). High maternal concentration of cobalt, arsenic and cadmium increased two times the risk of hypertension. High maternal magnesium and high neonate cadmium concentrations increased two times the risk of premature births. High neonate lead, cobalt, zinc, and magnesium’ concentrations increased two times the risk of maternal anemia. But high neonate selenium concentration reduced to 60% [RR: 0.59 (0.360-0.978)] this risk. Low neonate selenium concentration increased four times the risk of IUGR neonate [RR: 4.116 (2.004-8.452)]. Conclusion: High concentration of toxic TE and low concentration of some essential TE in the blood of pregnant women are associated to morbid conditions such as anemia, malaria, maternal hypertension, IUGR and prematurity.

Published in Journal of Gynecology and Obstetrics (Volume 10, Issue 5)
DOI 10.11648/j.jgo.20221005.12
Page(s) 221-230
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Trace Elements, Maternal Morbidity, Exposure Factors, Mining Plants, Lubumbashi

References
[1] Firoz T, Chou D, Dadelszen V, Agrawalp, Priya V, Ozge T; Magee, Laura A, Nynke VDB, Say Lale. Measuring maternal health: focus on maternal morbidity. Bulletin of the World Health Organization, 2013; 91 (10), 794–796.
[2] Chou D, Tuncalp O, Firoz T. Constructing maternal morbidity- towards a standard tool to measure and monitor maternal health beyond mortality. BMC Pregnancy Childbirth 2016; 16: 45.
[3] Graham W, Woodd S, Byass P. Diversity and divergence: the dynamic burden of poor maternal health. Lancet 2016; 388: 2164–75.
[4] Storeng KT, Murray SF, Akoum MS, Ouattara F, Filippi V. Beyond body counts: a qualitative study of lives and loss in Burkina Faso after ‘near-miss’ obstetric complications. Soc Sci Med 2010; 71: 1749–56.
[5] Maternal and Newborn Health Disparities in Democratic Republic of the Congo, UNICEF, 2021.
[6] Kalenga KM, Mutach K, Nsungula K, et al. Les anémies au cours de la grossesse. Étude clinique et biologique. A propos de 463 cas observés à Lubumbashi. Rev Fr Gynecol Obstet 1989; 84: 393-9.
[7] Kalenga, M. K, et al., Anémie associée au paludisme et aux helminthiases intestinales à Lubumbashi, Santé Publique, vol. vol. 15, no. 4, 2003, pp. 413-421.
[8] Twite KE, Ngoy KF, Kalombo M, Nyenga M, Kaindu M, Kabulu K, Kalenga MK. Etat des reserves en fer des femmes enceintes, des femmes allaitantes et des enfants de 1 à 60 mois à lubumbashi, rd congo 1.
[9] Isango I Y, Koba C M, Kabamba N M, Malamba L D, Kakisingi NC, Mubinda KP, Mwilambwe NS, Manika M M, Ngwe TJ, Mwembo TA Kalenga MK. Hypertensive pathologies in peripartum: complications and maternal and neonatal outcome, Open Journal of Obstetrics and Gynecology, 2020, 10, 311-318.
[10] Malonga KF, Mukengeshayi AN, Nlandu R N, Karumb N K, Sekela MM, Tshamba H M, Sifa M, Etongola PM, Sakiko K, Sayumi N, Narufumi S, Lukuke H M. Effectiveness of Prevention of Mother-To-Child Transmission (PMTCT) of HIV infection Program in Lubumbashi, Democratic Republic of the Congo, Archives of Medecine 7, 2015.
[11] Kakisingi NC, Mutombo A, Mukomena E, Mukuku O, Makam G, Wembonyama S, Situakibanza NH, Mwamba C, Luboya ON. Frequency of malaria in pregnant women and utilization rate of use of antenatal care services in Lubumbashi medical district 2011-2015 (DRCongo), 10th ECTMIH Congress, Antwerp, Belgium, October 16-20, 2017.
[12] Stevens GA, Finucane MM, De-Regil LM, et al. Global, regional, and national trends in haemoglobin concentration and prevalence of total and severe anaemia in children and pregnant and nonpregnant women for 1995-2011: a systematic analysis of populationrepresentative data. Lancet Glob Health 2013; 1: e16–e25.
[13] Ngianga II K, Saseendran P, Channon AA, Nyovani KG, Madise J. A multilevel approach to correlates of anaemia in women in the Democratic Republic of Congo: findings from a nationally representative survey, European Journal of Clinical Nutrition, 2019.
[14] Sebahat T, Aziz P, Murat I, Gunfer T, Gulten E, Mevlut B, Yasin KT, Osman G. Interaction between anemia and blood levels of iron, zinc, copper, cadmium and lead in children. Indian J Pediatr 2007, 74: 827-30.
[15] Goyer RA. Lead toxicity: current concerns. Environ Health Prespect 1993, 100: 177-87.
[16] Stewart CP. Maternal micronutrient deficiency, fetal development, and the risk of chronic disease, J. Nutr. 140 (3) (2010) 437–445.
[17] Haider BA, I. Olofin M, Wang, D, Spiegelman M, Ezzati W, Fawzi W. Anaemia, prenatal iron use, and risk of adverse pregnancy outcomes: systematic review and meta-analysis, Bmj. 346 (2013) f3443.
[18] Guo Y, Zhang N, Zhang D, Ren Q, Ganz T, Liu S, Nemeth E. Iron homeostasis in pregnancy and spontaneous abortion, Am. J. Hematol. 94 (2), 2019: 184–188.
[19] F. Banhidy, N. Acs, E. H. Puho, A. E. Czeizel. Iron deficiency anemia: pregnancy outcomes with or without iron supplementation, Nutrition. 27 (1), 2011: 65–72.
[20] Uche-Nwachi EO, Odekunle A, Jacinto S, Burnett M, Clapperton M, David Y, Durga S, Greene K, Jarvis J, Nixon C, Seereeram R, Poon-King C, Singh R. Anemia in pregnancy: associations with parity, abortions and child spacing in primary healthcare clinic attendees in Trinidad and Tobago, Afr. Health Sci. 10 (1), 2010: 66–70.
[21] Poropat AE., Laidla, MAS. Lanphear B, Ball A, MielkeHW. Blood Lead and preeclampsia: a meta-analysis and review of implications. Environ. Res. 2018: 160, 12–19.
[22] Elongi M JP, Bamba D, Tandu U, Spitz B, Verdonck F, Dikamba N. Déterminants de la saisonnalité de la prééclampsie et éclampsie à Kinshasa. Med Afr Noire, 2011.
[23] Cham LC, Chuy KD, Mwembo TA, Chenge MF, Tamubango H, Kaniki A, and Kalenga MK. Toxic metallic trace elements in post-delivery mothers and their newborns residing near and far from mining operating plants in Lubumbashi, J Environ Sci Public Health 2020; 4 (4): 367-379.
[24] Cham LC, Chuy KD, Mwembo TA, Chenge MF, Tamubango H, Kaniki A, and Kalenga MK. Essential metallic trace elements in post-delivery mothers and their newborns residing near and far from mining operating plants in Lubumbashi, J Environ Sci Public Health 2020; 4 (4): 442-454.
[25] Cham LC, Chuy KD, Mwembo TA, Chenge MF, Tamubango H, Kaniki A, and Kalenga MK. Exposure factors to toxic trace elements among post-delivery mothers living in the vicinity of mining operating plants in Lubumbashi, J Environ Sci Public Health 2021; 5 (1): 155-168.
[26] Myaruhucha C. Food cravings, aversions, and pica among pregnant women in Dar es Salaam, Tanzania. Tanzania Journal of Health Research 2009; 11 (1): 29-34.
[27] Johnson D. Pica during Pregnancy. International Journal of Childbirth Education. 2017; 32 (1): 45-47.
[28] Ekosse GE, De Jager, L, Ngole V. Traditional mining, and mineralogy of geophagic clays from Limpopo and Free State provinces, South Africa. African Journal of Biotechnology. 2010; 9 (47): 8058-8067.
[29] Tayie F, Koduah G, Mork S. Geophagia clay soil as a source of mineral nutrients and toxicants. African Journal of Food, Agriculture, Nutrition and Development. 2013; 13 (1): 7157-7170.
[30] Kennedy D, Woodland C, Koren, G. Lead exposure, gestational hypertension, and pre-eclampsia: a systematic review of cause and effect. Journal of Obstetrics and Gynaecology. 2012; 32 (6): 512-517.
[31] Musa OP, Kayembe-Kitenge T, Haufroid V, et al. Preeclampsia, and blood lead (and other metals) in Lubumbashi, DR Congo. Environ Res 167.2018: 468-471.
[32] Young SL, Wilson MJ, Hillier S, et al. Differences and commonalities in physical, chemical, and mineralogical properties of Zanzibari geophagic soils. J Chem Ecol. 2010; 36: 129–140.
[33] Young S. A vile habit? The potential biological consequences of geophagia, with attention to iron. In: MacClancy J, Henry J, Macbeth H, eds. Consuming the Inedible: Neglected Dimensions of Food Choice. Oxford, United Kingdom: Berghahn; 2007.
[34] Njiru H, Elchalal U, and Paltiel O. Geophagy During Pregnancy in Africa: A Literature Review, obstetrical and gynecological survey, Volume 66, Number 7, 2011.
[35] Young SL. Pica in pregnancy: new ideas about an old condition. Annu Rev Nutr. 2010; 21: 403–422.
[36] Mitra, P., Sharma, S., Purohit, P. & Sharma, P. Clinical and molecular aspects of lead toxicity: An update. Crit. Rev. Clin. Lab. Sci. 54, 506–528, 2017.
[37] Navas-AA., Guallar E., Silbergel E K, Rothenberg SJ. Lead exposure and cardiovascular disease: A systematic review. Environ. Health Perspect. 115, 472–482, 2007.
[38] Vaziri N D, Gonick, HC. Cardiovascular effects of lead exposure. Indian J. Med. Res. 128, 426–435 (2008).
[39] Alissa E M, Ferns GA. Heavy metal poisoning and cardiovascular disease. J. Toxicol. 2011, 870125, 2011.
[40] Simoes MR. Acute lead exposure increases arterial pressure: Role of the renin-angiotensin system. PLoS ONE 6, e18730, 2011.
[41] TsoiMF, Lo CWH, Cheung TT. Blood Lead level and risk of hypertension in the United States National Health and Nutrition Examination Survey 1999–2016. Sci Rep 11, 3010 (2021).
[42] Kuruppu D, Hendrie HC, Lili Yang and Sujuan Gao. Selenium levels and hypertension: a systematic review of the literature, Public Health Nutrition; 2013.
[43] Navas-A A, Bleys J, Guallar E. Selenium intake and cardiovascular risk: what is new? Curr Opin Lipidol. 2008: 19, 43–49.
[44] Dantas AP, Tostes RC, Fortes ZB et al. In vivo evidence for antioxidant potential of estrogen in microvessels of female spontaneously hypertensive rats. Hypertension. 2002 39, 405–411.
[45] Salonen JT, Salonen R, Penttila I et al. Serum fatty acids, apolipoproteins, selenium and vitamin antioxidants and the risk of death from coronary artery disease. Am J Cardiol. 1985: 56, 226–231.
[46] Bastola, M. M., Locatis, C., Maisiak, R. et al. Selenium, copper, zinc and hypertension: an analysis of the National Health and Nutrition Examination Survey (2011–2016). BMC Cardiovasc Disord 20, 2020; 45.
[47] Oyagbemi AA, Omobowale TO, Awoyomi OV, Ajibade TO, Falayi OO, Ogunpolu BS, Okotie UJ, Asenuga ER, Adejumobi OA, Hassan FO, Ola-Davies OE, Saba AB, Adedapo AAand Yakubu MA. Cobalt chloride toxicity elicited hypertension and cardiac complication via induction of oxidative stress and upregulation of COX-2/Bax signaling pathway, Human and Experimental Toxicology, 1-14, 2018.
[48] Abhyankar LN, Jones MR, Guallar E, and Navas-AA, Arsenic Exposure and Hypertension: A Systematic Review; Environmental Health Perspectives, volume 120 number 4, April 2012.
[49] Gallagher CM and Meliker JR. Blood and Urine Cadmium, Blood Pressure, and Hypertension: A Systematic Review and Meta-analysis; Environmental Health Perspectives; volume 118 | number 12 | December 2010.
[50] Bauserman M, Conroy AL, North K, Patterson J, Bose C, Meshnick S. An Overview of Malaria in Pregnancy, Seminars in Perinatology, 2019.
[51] Modaresinejad, Nahrevanian H, Khatami S and Bagheri E. Biochemical Association between Essential Trace Elements and Susceptibility to Malaria in Outbred Mice after Inhibition with Dexamethasone or Induction with Lipopolysaccharide, Advanced Studies in Biology, Vol. 8, 2016, no. 2, 91-99.
[52] Shen PJ, Gong B, Xu FY, Luo Y. Four trace elements in pregnant women and their relationships with adverse pregnancy outcomes. Eur Rev Med Pharmacol Sci. 2015; 19 (24): 4690-7.
[53] Anuk TA, Polat N, Akdas S, Erol SA, Tanacan A, Huseyin DB, Ozlem LK Moraloglu TN, Dilek S Y. The Relation Between Trace Element Status (Zinc, Copper, Magnesium) and Clinical Outcomes in COVID-19 Infection During Pregnancy, Biological Trace Element Research, November 2020.
Cite This Article
  • APA Style

    Cham Lubamba Chamy, Mwembo Tambwe Albert, Ngwe Thaba Jules, Kakudji Luhete Prosper, Mpoyo Wembonyama, et al. (2022). Maternal Morbidity Associated to Exposure to Trace Elements in Lubumbashi. Journal of Gynecology and Obstetrics, 10(5), 221-230. https://doi.org/10.11648/j.jgo.20221005.12

    Copy | Download

    ACS Style

    Cham Lubamba Chamy; Mwembo Tambwe Albert; Ngwe Thaba Jules; Kakudji Luhete Prosper; Mpoyo Wembonyama, et al. Maternal Morbidity Associated to Exposure to Trace Elements in Lubumbashi. J. Gynecol. Obstet. 2022, 10(5), 221-230. doi: 10.11648/j.jgo.20221005.12

    Copy | Download

    AMA Style

    Cham Lubamba Chamy, Mwembo Tambwe Albert, Ngwe Thaba Jules, Kakudji Luhete Prosper, Mpoyo Wembonyama, et al. Maternal Morbidity Associated to Exposure to Trace Elements in Lubumbashi. J Gynecol Obstet. 2022;10(5):221-230. doi: 10.11648/j.jgo.20221005.12

    Copy | Download

  • @article{10.11648/j.jgo.20221005.12,
      author = {Cham Lubamba Chamy and Mwembo Tambwe Albert and Ngwe Thaba Jules and Kakudji Luhete Prosper and Mpoyo Wembonyama and Mukendi Mutshimbe Richard and Momat Kitenge Felix and Kimbala Shimpiko Julien and Nsambi Bulanda Jospeh and Malonga Kaj Francoise and Kaniki Tshamala Arthur and Kinekinda Kalume Xavier and Kalenga Muenze Kayamba and Kakoma Sakatolo Zambeze},
      title = {Maternal Morbidity Associated to Exposure to Trace Elements in Lubumbashi},
      journal = {Journal of Gynecology and Obstetrics},
      volume = {10},
      number = {5},
      pages = {221-230},
      doi = {10.11648/j.jgo.20221005.12},
      url = {https://doi.org/10.11648/j.jgo.20221005.12},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.jgo.20221005.12},
      abstract = {Background: Pregnant women are exposed to toxic trace elements (TE) from mining plants. The aim of this study was to determine the incidence of morbid conditions among pregnant women and their relations to blood’s concentration of TE and their exposure factors in Lubumbashi. Methodology: A prospective cohort study of 378 mothers and 378 newborns exposed to TE was conducted from November 30, 2018, to May 30, 2019. The groups were constituted whether the TE concentration was higher or lower than the reference value. (Determined by ICP- OES Optima 8300 at the laboratory of the OCC/Lubumbashi). Correlation between the morbid conditions in the two groups and with each exposure factors by calculating chi square and the relative risk were obtained. (p ˂ 0.05) Results: Among pregnant women 61.4% had malaria, 47.6% anemia, 21.2% hypertension, 11% IUGR newborns and 8.7% a premature birth. Geophagia increased two times the risk of anemia [RR: 2.127 (1.410-3.209)] and hypertension [RR: 1.958 (1.177-3.259)]. The proximity to mining plants increased three times the risk of anemia [RR: 2.887 (1.830-5.554)] and hypertension [RR: 3.126 (1.876-5.208)]. The use of well water for drinking and housework increased two times the risk of hypertension [RR: 2.308 (1.385-3.845)] and IUGR newborn [RR: 1.752 (1.232-2.490)]. Biomass used for cooking increased three times the risk of hypertension [RR: 3.204 (1.114-9.212)]. Women working in mining plants had two times the risk of malaria: [RR 1.725 (1.145-2.599)]. Women whose husband worked in mining plants had three times the risk of premature birth [RR: 3.204 (1.552-6.616)]. High lead concentration increased five times the risk of anemia [RR: 4.63 (2.933-7.310)]; height times the risk of hypertension [RR: 8.170 (4.657-14.333)]; three times the risk of a IUGR newborn [RR: 2.601 (2.078-3.256)]. The linear correlation between lead and maternal hemoglobin was negative (r -0.335). High maternal concentration of cobalt, arsenic and cadmium increased two times the risk of hypertension. High maternal magnesium and high neonate cadmium concentrations increased two times the risk of premature births. High neonate lead, cobalt, zinc, and magnesium’ concentrations increased two times the risk of maternal anemia. But high neonate selenium concentration reduced to 60% [RR: 0.59 (0.360-0.978)] this risk. Low neonate selenium concentration increased four times the risk of IUGR neonate [RR: 4.116 (2.004-8.452)]. Conclusion: High concentration of toxic TE and low concentration of some essential TE in the blood of pregnant women are associated to morbid conditions such as anemia, malaria, maternal hypertension, IUGR and prematurity.},
     year = {2022}
    }
    

    Copy | Download

  • TY  - JOUR
    T1  - Maternal Morbidity Associated to Exposure to Trace Elements in Lubumbashi
    AU  - Cham Lubamba Chamy
    AU  - Mwembo Tambwe Albert
    AU  - Ngwe Thaba Jules
    AU  - Kakudji Luhete Prosper
    AU  - Mpoyo Wembonyama
    AU  - Mukendi Mutshimbe Richard
    AU  - Momat Kitenge Felix
    AU  - Kimbala Shimpiko Julien
    AU  - Nsambi Bulanda Jospeh
    AU  - Malonga Kaj Francoise
    AU  - Kaniki Tshamala Arthur
    AU  - Kinekinda Kalume Xavier
    AU  - Kalenga Muenze Kayamba
    AU  - Kakoma Sakatolo Zambeze
    Y1  - 2022/09/27
    PY  - 2022
    N1  - https://doi.org/10.11648/j.jgo.20221005.12
    DO  - 10.11648/j.jgo.20221005.12
    T2  - Journal of Gynecology and Obstetrics
    JF  - Journal of Gynecology and Obstetrics
    JO  - Journal of Gynecology and Obstetrics
    SP  - 221
    EP  - 230
    PB  - Science Publishing Group
    SN  - 2376-7820
    UR  - https://doi.org/10.11648/j.jgo.20221005.12
    AB  - Background: Pregnant women are exposed to toxic trace elements (TE) from mining plants. The aim of this study was to determine the incidence of morbid conditions among pregnant women and their relations to blood’s concentration of TE and their exposure factors in Lubumbashi. Methodology: A prospective cohort study of 378 mothers and 378 newborns exposed to TE was conducted from November 30, 2018, to May 30, 2019. The groups were constituted whether the TE concentration was higher or lower than the reference value. (Determined by ICP- OES Optima 8300 at the laboratory of the OCC/Lubumbashi). Correlation between the morbid conditions in the two groups and with each exposure factors by calculating chi square and the relative risk were obtained. (p ˂ 0.05) Results: Among pregnant women 61.4% had malaria, 47.6% anemia, 21.2% hypertension, 11% IUGR newborns and 8.7% a premature birth. Geophagia increased two times the risk of anemia [RR: 2.127 (1.410-3.209)] and hypertension [RR: 1.958 (1.177-3.259)]. The proximity to mining plants increased three times the risk of anemia [RR: 2.887 (1.830-5.554)] and hypertension [RR: 3.126 (1.876-5.208)]. The use of well water for drinking and housework increased two times the risk of hypertension [RR: 2.308 (1.385-3.845)] and IUGR newborn [RR: 1.752 (1.232-2.490)]. Biomass used for cooking increased three times the risk of hypertension [RR: 3.204 (1.114-9.212)]. Women working in mining plants had two times the risk of malaria: [RR 1.725 (1.145-2.599)]. Women whose husband worked in mining plants had three times the risk of premature birth [RR: 3.204 (1.552-6.616)]. High lead concentration increased five times the risk of anemia [RR: 4.63 (2.933-7.310)]; height times the risk of hypertension [RR: 8.170 (4.657-14.333)]; three times the risk of a IUGR newborn [RR: 2.601 (2.078-3.256)]. The linear correlation between lead and maternal hemoglobin was negative (r -0.335). High maternal concentration of cobalt, arsenic and cadmium increased two times the risk of hypertension. High maternal magnesium and high neonate cadmium concentrations increased two times the risk of premature births. High neonate lead, cobalt, zinc, and magnesium’ concentrations increased two times the risk of maternal anemia. But high neonate selenium concentration reduced to 60% [RR: 0.59 (0.360-0.978)] this risk. Low neonate selenium concentration increased four times the risk of IUGR neonate [RR: 4.116 (2.004-8.452)]. Conclusion: High concentration of toxic TE and low concentration of some essential TE in the blood of pregnant women are associated to morbid conditions such as anemia, malaria, maternal hypertension, IUGR and prematurity.
    VL  - 10
    IS  - 5
    ER  - 

    Copy | Download

Author Information
  • Department of Gynecology and Obstetrics, Faculty of Medicine, University of Lubumbashi, Lubumbashi, Democratic Republic of Congo

  • Department of Gynecology and Obstetrics, Faculty of Medicine, University of Lubumbashi, Lubumbashi, Democratic Republic of Congo

  • Department of Gynecology and Obstetrics, Faculty of Medicine, University of Lubumbashi, Lubumbashi, Democratic Republic of Congo

  • Department of Gynecology and Obstetrics, Faculty of Medicine, University of Lubumbashi, Lubumbashi, Democratic Republic of Congo

  • Department of Gynecology and Obstetrics, Faculty of Medicine, University of Lubumbashi, Lubumbashi, Democratic Republic of Congo

  • Department of Gynecology and Obstetrics, Faculty of Medicine, University of Lubumbashi, Lubumbashi, Democratic Republic of Congo

  • Department of Gynecology and Obstetrics, Faculty of Medicine, University of Lubumbashi, Lubumbashi, Democratic Republic of Congo

  • Department of Gynecology and Obstetrics, Faculty of Medicine, University of Lubumbashi, Lubumbashi, Democratic Republic of Congo

  • Department of Gynecology and Obstetrics, Faculty of Medicine, University of Lubumbashi, Lubumbashi, Democratic Republic of Congo

  • Department of Gynecology and Obstetrics, Faculty of Medicine, University of Lubumbashi, Lubumbashi, Democratic Republic of Congo

  • Engineering School, University of Lubumbashi, Lubumbashi, Democratic Republic of Congo

  • Department of Gynecology and Obstetrics, Faculty of Medicine, University of Lubumbashi, Lubumbashi, Democratic Republic of Congo

  • Department of Gynecology and Obstetrics, Faculty of Medicine, University of Lubumbashi, Lubumbashi, Democratic Republic of Congo

  • Department of Gynecology and Obstetrics, Faculty of Medicine, University of Lubumbashi, Lubumbashi, Democratic Republic of Congo

  • Sections