Trends of improved water and sanitation coverage around the globe between 1990 and 2010: inequality among countries and performance of official development assistance.

BACKGROUND: As the Millennium Development Goals ended, and were replaced by the Sustainable Development Goals, efforts have been made to evaluate the achievements and performance of official development assistance (ODA) in the health sector. In this study, we explore trends in the expansion of water and sanitation coverage in developing countries and the performance of ODA. DESIGN: We explored inequality across developing countries by income level, and investigated how ODA for water and sanitation was committed by country, region, and income level. Changes in inequality were tested via slope changes by investigating the interaction of year and income level with a likelihood ratio test. A random effects model was applied according to the results of the Hausman test. RESULTS: The slope of the linear trend between economic level and sanitation coverage has declined over time. However, a random effects model suggested that the change in slope across years was not significant (e.g. for the slope change between 2000 and 2010: likelihood ratio χ2 = 2.49, probability > χ2 = 0.1146). A similar pro-rich pattern across developing countries and a non-significant change in the slope associated with different economic levels were demonstrated for water coverage. Our analysis shows that the inequality of water and sanitation coverage among countries across the world has not been addressed effectively during the past decade. Our findings demonstrate that the countries with the least coverage persistently received far less ODA per capita than did countries with much more extensive water and sanitation coverage, suggesting that ODA for water and sanitation is poorly targeted. CONCLUSION: The most deprived countries should receive more attention for water and sanitation improvements from the world health community. A strong political commitment to ODA targeting the countries with the least coverage is needed at the global level

Associations between Household Latrines and the Prevalence of Diarrhea in Idiofa, Democratic Republic of the Congo: A Cross-Sectional Study.

Despite the importance of sanitation, few studies have assessed the effects of latrines on the health outcomes of children under 5 years of age. We assessed the relations between latrine coverage and the prevalence of diarrhea in children under 4 years of age. In this cross-sectional study, we analyzed the baseline data obtained as part of a longitudinal survey targeting 720 households in Idiofa, Bandundu, Democratic Republic of the Congo. We categorized latrines according to the presence of each major component and investigated whether diarrhea prevalence of children under 4 years of age is associated with latrine availability and improvement. Latrines have health benefits regardless of whether they are improved. Also worth noting is that comparatively well-equipped and more appropriately managed latrines could prevent child diarrhea more effectively than less equipped or inappropriately managed latrines. Households who have a latrine with a superstructure, roof, and no flies (a partly improved latrine) were found to be 52% less likely to report cases of diarrhea than households with unimproved latrines (adjusted odds ratio [OR] = 0.48, confidence interval [CI] = 0.31-0.76), which are all the other latrines not included in the partly improved latrine category. We have observed the profound protective effect of latrines with a superstructure. This study demonstrates that latrines are associated with significant improvements in health even when they do not fully meet the conditions of improved latrines. This study adds value to the limited evidence on the effect of latrines on health parameters by demonstrating that latrines have correlations with health benefits regardless of whether they are improved, as well as by elucidating the most essential components of improved latrines

Effects of improved sanitation on diarrheal reduction for children under five in Idiofa, DR Congo: a cluster randomized trial.

BACKGROUND: The lack of safe water and sanitation contributes to the rampancy of diarrhea in many developing countries. METHODS: This study describes the design of a cluster-randomized trial in Idiofa, the Democratic Republic of the Congo, seeking evidence of the impact of improved sanitation on diarrhea for children under four. Of the 276 quartiers, 18 quartiers were randomly allocated to the intervention or control arm. Seven hundred and-twenty households were sampled and the youngest under-four child in each household was registered for this study. The primary endpoint of the study is diarrheal incidence, prevalence and duration in children under five. DISCUSSION: Material subsidies will be provided only to the households who complete pit digging plus superstructure and roof construction, regardless of their income level. This study employs a Sanitation Calendar so that the mother of each household can record the diarrheal episodes of her under-four child on a daily basis. The diary enables examination of the effect of the sanitation intervention on diarrhea duration and also resolves the limitation of the small number of clusters in the trial. In addition, the project will be monitored through the 'Sanitation Map', on which all households in the study area, including both the control and intervention arms, are registered. To avoid information bias or courtesy bias, photos will be taken of the latrine during the household visit, and a supervisor will determine well-equipped latrine uptake based on the photos. This reduces the possibility of recall bias and under- or over-estimation of diarrhea, which was the main limitation of previous studies. TRIAL REGISTRATION: The study was approved by the Institutional Review Board of the School of Public Health, Kinshasa University (ESP/CE/040/15; April 13, 2015) and registered as an International Standard Randomized Controlled Trial (ISRCTN: 10,419,317) on March 13, 2015

Prevalence of Plasmodium falciparum isolates lacking the histidine rich protein 2 gene among symptomatic malaria patients in Kwilu Province of the Democratic Republic of Congo.

BACKGROUND: Malaria rapid diagnostic tests have become a primary and critical tool for malaria diagnosis in malaria-endemic countries where Plasmodium falciparum Histidine Rich Protein 2-based rapid diagnostic tests (PfHRP2-based RDTs) are widely used. However, in the last decade, the accuracy of PfHRP2-based RDTs has been challenged by the emergence of P. falciparum strains harbouring deletions of the P. falciparum histidine rich protein 2 (pfhrp2) gene, resulting in false-negative results. In the Democratic Republic of Congo (D.R. Congo), little is known about the prevalence of the pfhrp2 gene deletion among P. falciparum isolates infecting symptomatic patients, especially in low to moderate transmission areas where pfhrp2 deletion parasites are assumed to emerge and spread. Here we determine the local prevalence and factors associated with pfhrp2 gene deletions among symptomatic malaria patients in the Kwilu Province of the D.R. Congo. METHODS: We used secondary data from a prospective health facility-based cross-sectional study conducted in 2018. Blood was collected for microscopy, PfHRP2-RDT, and spotted onto Whatman filter paper for downstream genetic analysis. Genomic DNA was extracted and used to perform PCR assays for the detection and confirmation of pfhrp2 gene deletions. Fischer's exact and the Kruskal-Wallis tests were applied to look for associations between potential explanatory variables and the pfhrp2 gene deletion with a level of statistical significance set at P < 0.05. RESULTS: Of the 684 enrolled symptomatic patients, 391 (57.7%) were female. The majority (87.7%) reported the presence of mosquito breeding sites within the household's compound, and fever was the most reported symptom (81.6%). The overall prevalence of the pfhrp2 gene deletion was 9.2% (95% CI: 6.7%-12.1%). The deletion of the pfhrp2 gene was associated with health zone of origin (P = 0.012) and age (P = 0.019). Among false-negative PfHRP2-RDT results, only 9.9% were due to pfhrp2 gene deletion. CONCLUSIONS: P. falciparum isolates with pfhrp2 gene deletions are relatively common among symptomatic patients in Kwilu province. Further investigations are needed to provide enough evidence for policy change. Meanwhile, the use of RDTs targeting PfHRP2 and parasite lactate dehydrogenase (pLDH) antigens could limit the spread of deleted isolates

Caractéristiques des gîtes larvaires associées à la prolifération des vecteurs du paludisme dans la Zone de Santé de Ngaba-Kinshasa

La zone de Ngaba est située dans la Ville de Kinshasa et elle compte une population de 254947dont une large proportion souffre de paludisme (69,1% pour l’année 2017), un taux de loin plus élevé que dans les autres zones de santé environnantes. Cette situation découle d'une importante prolifération des anophèles dans le site. Cette étude est conduite pour explorer et déterminer les facteurs associés à la prolifération des vecteurs du paludisme dans cette zone malgré les conditions environnementales qui s’avèrent défavorables à une telle prolifération. Une meilleure compréhension de ces facteurs va contribuer à une mitigation plus efficace, voire à une élimination de cette condition. Au cours de l’année 2018, nous avons mené un travail de terrain consistant dans la visite de nombreuses gites potentielles de prolifération des anophèles dans cette zone en vue d’y prélever des données sur le type de gîtes, l'origine de l'eau (eau de pluie ou autre), la nature de la collection d'eau (flaque), caractéristiques de l'eau (claire), les paramètres bioécologiques (physico-chimique) des gîtes, l'exposition au soleil (ensoleillé), présence ou non de la végétation, présence des composés organiques (aucune), la nature du sol (humide et marécageux). L’analyse de ces données à travers un modèle multivarié nous a montré que les cours et plans d'eau de Ngaba sont pollués mais les anophèles s'y sont/seraient adaptées. Plusieurs facteurs tels que le type de gîtes, l'origine de l'eau (eau de pluie), la nature de la collection d'eau (flaque), caractéristiques de l'eau (claire), les paramètres bioécologiques (physico-chimique) des gîtes, l'exposition au soleil (ensoleillé), présence de la végétation (aucune couverture végétale), présence des composés organiques (aucune), la nature du sol (humide et marécageux) et la densité larvaire sont présents à Ngaba et sont associés à la prolifération des vecteurs du paludisme.  La zone de Ngaba est située dans la Ville de Kinshasa et elle compte une population de 254947dont une large proportion souffre de paludisme (69,1% pour l’année 2017), un taux de loin plus élevé que dans les autres zones de santé environnantes. Cette situation découle d'une importante prolifération des anophèles dans le site. Cette étude est conduite pour explorer et déterminer les facteurs associés à la prolifération des vecteurs du paludisme dans cette zone malgré les conditions environnementales qui s’avèrent défavorables à une telle prolifération. Une meilleure compréhension de ces facteurs va contribuer à une mitigation plus efficace, voire à une élimination de cette condition. Au cours de l’année 2018, nous avons mené un travail de terrain consistant dans la visite de nombreuses gites potentielles de prolifération des anophèles dans cette zone en vue d’y prélever des données sur le type de gîtes, l'origine de l'eau (eau de pluie ou autre), la nature de la collection d'eau (flaque), caractéristiques de l'eau (claire), les paramètres bioécologiques (physico-chimique) des gîtes, l'exposition au soleil (ensoleillé), présence ou non de la végétation, présence des composés organiques (aucune), la nature du sol (humide et marécageux). L’analyse de ces données à travers un modèle multivarié nous a montré que les cours et plans d'eau de Ngaba sont pollués mais les anophèles s'y sont/seraient adaptées. Plusieurs facteurs tels que le type de gîtes, l'origine de l'eau (eau de pluie), la nature de la collection d'eau (flaque), caractéristiques de l'eau (claire), les paramètres bioécologiques (physico-chimique) des gîtes, l'exposition au soleil (ensoleillé), présence de la végétation (aucune couverture végétale), présence des composés organiques (aucune), la nature du sol (humide et marécageux) et la densité larvaire sont présents à Ngaba et sont associés à la prolifération des vecteurs du paludisme

The effect of a mass distribution of insecticide-treated nets on insecticide resistance and entomological inoculation rates of Anopheles gambiae s.l. in Bandundu City, Democratic Republic of Congo

Introduction:&nbsp;insecticide-treated nets (ITNs) remain the mainstay of malaria vector control in the Democratic Republic of Congo. However, insecticide resistance of malaria vectors threatens their effectiveness. Entomological inoculation rates and insecticide susceptibility in&nbsp;Anopheles gambiae s.l.&nbsp;were evaluated before and after mass distribution of ITNs in Bandundu City for possible occurrence of resistance. Methods:&nbsp;a cross-sectional study was conducted from 15th&nbsp;July 2015 to 15th&nbsp;June 2016. Adult mosquitoes were collected using pyrethrum spray catches and human landing catches and identified to species level and tested for the presence of sporozoites. Bioassays were carried out before and after distribution of ITNs to assess the susceptibility of adult mosquitoes to insecticides. Synergist bioassays were also conducted and target site mutations assessed using Polymerase chain reaction (PCR). Results:&nbsp;a total of 1754 female&nbsp;An. gambiae s.l.&nbsp;were collected before and after deployment of ITNs. Fewer mosquitoes were collected after the distribution of ITNs. However, there was no significant difference in sporozoite rates or the overall entomological inoculation rate before and after the distribution of ITNs. Test-mosquitoes were resistant to deltamethrin, permethrin, and Dichlorodiphenyltrichloroethane but susceptible to bendiocarb. Pre-exposure of mosquitoes to Piperonyl butoxide increased their mortality after exposure to permethrin and deltamethrin. The frequency of the Kinase insert domain receptor (kdr)-West gene increased from 92 to 99% before and after the distribution of nets, respectively. Conclusion:&nbsp;seasonal impacts could be a limiting factor in the analysis of these data; however, the lack of decrease in transmission after the distribution of new nets could be explained by the high-level of resistance to pyrethroid

Effects of Door-to-Door Hang-Up Visits on the Use of Long-Lasting Insecticide-Treated Mosquito Nets in the Democratic Republic of the Congo: A Cluster Randomized Controlled Trial

Malaria accounts for 14% of child deaths in the Democratic Republic of the Congo, and one of the key interventions used to prevent malaria is to distribute insecticide-treated bednets (ITNs), especially long-lasting insecticidal nets (LLINs). The global health community and the Roll Back Malaria initiative have been struggling to achieve universal health coverage using ITNs, and recent studies have reported mixed results about the effects of door-to-door visits and mass distribution campaigns. We aimed to compare LLIN use for those provided by door-to-door hang-up visits and by conventional fixed distribution from distribution centers accompanied by a mass distribution campaign. A cluster randomized control trial was conducted in rural areas of Maniema Province, Democratic Republic of the Congo (DR Congo). Cross-sectional surveys were conducted on 2120 and 2156 households, respectively, with at least one child aged less than five in 76 villages. We assessed the effectiveness of door-to-door hang-up visits on the use of LLINs by exploring the interaction between the “intervention group” and “time” using generalized estimating equation models. Increased LLINs use was observed in all age groups in both arms, but usage differences were not significantly different (relative risk (RR) of LLINs use among children &lt; 5 in the intervention group versus the control group after adjusted for clustering: 1.06, 95% CI: 0.85–1.33). We conclude that the door-to-door hang-up visits are not sufficient to persuade individuals (pregnant woman, children &lt; 5, or all study participants) to use LLINs, although it did appear to be effective for the youngest children in the household

Factors associated with postpartum health problems among married women of reproductive age in the Democratic Republic of the Congo: a sross-sectional study in Kenge City

Maternal mortality is attracting attention worldwide, but maternal health problems after delivery have received less attention. Most studies focus on prenatal maternal health problems. We aimed to identify factors associated with postpartum health problems among married women of reproductive age in Democratic Republic of the Congo. We employed a cross-sectional studydesign and randomly enrolled 700 married women of reproductive age in Kenge city. Data collection instrument was developed using the UNICEF Multiple Indicator Cluster Survey. T-test, chi-square test, and binary logistic regression analysis were performed using the SPSS version 24.0. Significant risk factors associated with postpartum health problems were initial postnatal care period; within 24 hours (Odds Ratio [OR]=2.197, 95% confidence interval [CI]: [1.156–4.174], p=.016); within 7 days (OR=1.972, 95% CI: [1.102–3.528, p=.022]; within 14 days (OR=2.124, 95% CI: [1.082–4.172], p=.029) among reproductive health and health service utilization characteristics. Health education by RECO (Relais Cmunataure) was associated with postpartum health problems including PCIME (Prise en Charge Integree des Maladies de l'Enfant; OR=1.845, 95% CI: [1.038–3.282], p=.037); hand washing (OR=1.897, 95% CI: [1.060–3.396], p=.031); malaria (OR=2.003, 95% CI: [1.192–3.366], p=.009) among Maternal and Child Health intervention characteristics. In conclusion, it is necessary to develop and promote health policies and educational programs focusing on PNC service within 24 hours, PNC services within 7 days, PCIME, hand washing, prevention of malaria.La mortalité maternelle attire l'attention dans le monde entier, mais les problèmes de santé maternelle après l'accouchement ont reçu moins d'attention. La plupart des études se concentrent sur les problèmes de santé maternelle prénataux. Nous avons cherché à identifier les facteurs associés aux problèmes de santé du post-partum chez les femmes mariées en âge de procréer en République Démocratique du Congo. Nous avons utilisé un plan d'étude transversal et avons recruté au hasard 700 femmes mariées en âge de procréer dans la ville de Kenge. L'instrument de collecte de données a été mis au point à l'aide de l'enquête par grappes à indicateurs multiples de l'UNICEF. Le test T, le test du Khi-deux et l'analyse de régression logistique binaire ont été réalisés à l'aide de la version 24.0 de SPSS. Les facteurs de risque significatifs associés aux problèmes de santé du post-partum étaient la période initiale de soins postnatals; dans les 24 heures (rapport de cotes [OU] = 2,197, intervalle de confiance à 95%[IC]: [1,156 à 4,174], p = 0,016); dans les 7 jours (OR = 1,972, IC 95%: [1,102–3,528, p = 0,022]; dans les 14 jours (OR = 2,124, IC 95%: [1,082–4,172], p = 0,029) chez les personnes en santé de la reproduction et les caractéristiques de l‘utilisation des services de santé. L‘éducation sanitaire assurée par RECO (Relais Cmunataure) a été associée à des problèmes de santé du postpartum, notamment à la prise en charge des maladies de l‘enfant; OR = 1.845, IC 95%: [1.038–3.282], p =. 037), le lavage des mains (OR = 1,897, IC 95%: [1,060–3,396], p = 0,031); le paludisme (OR = 2,003, IC 95%: [1,192–3,366], p = 0,009) parmi les caractéristiques des interventions de santé maternelle et infantile En conclusion, il est nécessaire d‘élaborer et de promouvoir des politiques de santé et des programmes éducatifs axés sur les services de SPN dans un délai de 24 heures, les services de SPN dans le délais de 7 jours, la PCIME, le lavage des mains et la prévention du paludisme.Keywords: Postpartum Health Problem; Maternal health; Postnatal care; Democratic Republic of the Congo; Health educationAfr J Reprod Health 2019; 23[3]:30-4

Cause-specific child mortality performance and contributions to all-cause child mortality, and number of child lives saved during the Millennium Development Goals era: a country-level analysis

Background: During the Millennium Development Goal (MDG) era, impressive reductions in the under-5 mortality rate (U5MR) have been observed, although the MDG 4 target was not met. So far, cause-specific progress in child mortality has been analyzed and discussed mainly at the global and regional levels. Objectives: We aimed to explore annual changes in cause-specific mortality at the country level, assess which causes contributed the most to child mortality reduction in 2000–2015, and estimate how many child lives were saved. Methods: We used the cause-specific child mortality estimates published by Liu and colleagues. We derived average annual changes in cause-specific child mortality rates and cause-specific contribution to overall child mortality in 2000–2015. We estimated the number of cause-specific child deaths averted during the MDG era, assuming that cause-specific child mortality remained the same as in 2000. We targeted the 75 Countdown countries where 95% of maternal and child deaths occurred during the MDG era. Results: Wide disparities existed across causes within countries, both in neonatal and post-neonatal mortality reduction, except for a few countries such as China, Rwanda, and Cambodia. In 20 of the 45 sub-Saharan African countries, malaria was the main contributor to post-neonatal mortality reduction, and pneumonia was the main contributor in only six countries. A single disease often contributed to a substantial proportion of the child mortality reduction, particularly in west and central African countries. Diarrhea-specific post-neonatal child mortality reduction accounted for 7.1 million averted child deaths (24.5%), while pneumonia accounted for another 6.7 million averted child deaths (23%). Conclusions: This study demonstrates country-specific characteristics with regards to cause-wise child mortality that could not be identified by global or regional analyses. These findings provide the global community with evidence for formulating national policies and strategies to achieve the Sustainable Development Goals in child mortality reduction

Community Participation in and Perception of Community-Directed Treatment with Ivermectin in Kinshasa, DRC

The success of community-directed treatment with Ivermectin (CDTI) depends on active community participation. We conducted a case study nested in a cross-sectional study in the Binza Ozone Health Zone (ZS) in Kinshasa, Democratic Republic of Congo, in order to investigate community's knowledges and perceptions of onchocerciasis and on all CDTI's aspects. We interviewed 106 people aged 20 and over, purposively selected, through eight individual interviews and 12 focus groups. Themes used for collecting data were drawn for the Health Belief Model and data were analyzed using a deductive thematic approach. The term onchocerciasis was unknown to participants who called it “Mbitiri”, the little black fly, in their local language. This disease is seen as curse put on the sufferer by a witch and perceived as a threat because of the “Mbitiri” bites. The afflicted participants were reluctant to seek treatment and preferred traditional practitioners or healers. CDTI is considered devastating because of adverse effects of ivermectin as well as inefficient after occurrence of deaths. This explains the low level of community adhesion and participation to this strategy. Recruitment procedures for community distributors are poorly understood and awareness and health education campaigns are either non-existent or rarely carried out. Nevertheless, the latter should be regularly done