Déterminants de la morbidité et de la mortalité dues au choléra à Lubumbashi, République Démocratique du Congo : étude cas-témoins non appariée

Le choléra est endémo-épidémique dans la ville de Lubumbashi, en République Démocratique du Congo. En raison de son importance en termes de morbidité et de mortalité, le choléra constitue un véritable problème de santé publique. L'objectif de notre étude était de décrire le profil clinique, épidémiologique, biologique et thérapeutique des patients cholériques et d'identifier les déterminants de la morbidité et de la mortalité due au choléra dans la ville de Lubumbashi. Il a été retenu 386 cas et 386 témoins dans les unités de traitement et les centres de santé de janvier 2017 à décembre 2020. Les cas positifs répondaient à la définition du ministère de la santé : " toute personne, âgée de 2 ans et plus pendant l'épidémie, présentant au moins trois selles liquides par jour, avec ou sans vomissements ; ou tout décès par diarrhée aiguë ". Nous avons utilisé une enquête structurée. L'Odds Ratio quantifie la force de l'association. Régression logistique avec STATA 12 pour les analyses statistiques. En plus, QGIS 3.12 et Excel 2017, étaient utilisés pour générer les Figures et les Tableaux des résultats. Le seuil de signification statistique a été fixé à 5% et IC95% était utilisé. 5 112 cas et 146 décès, soit un taux de létalité de 2,9%. Par rapport aux témoins, déterminants significativement associés (P<0,05) au choléra : sexe masculin (OR =1,41 [1,04-1,89]), niveau d'éducation inférieur ou égal à 6 ans de scolarité (OR= 1,64 [1.05-2.54]), contact connu avec un cas de choléra, OR=5.9 [2.60-13.67], utilisation de récipients non-latrines (OR=2.1 [1.5-3.0]), méconnaissance des moments critiques de lavage des mains (OR=1.46 [1.08-1.98]). Pour les décès, les déterminants étaient statistiquement associés (P<0,05) : Déshydratation sévère (OR = 2,67 [1,45-4,34]), délai de plus de 24 heures entre l'apparition des signes et le traitement (OR=2,23 [1,22-4,05]) et niveau d'éducation plus de 6 ans de scolarité (OR= 0,39 [0,21-0,71]). L‘identification des déterminants du choléra et des décès dans la ville de Lubumbashi est une étape importante pour revoir les politiques, les plans opérationnels et développer des stratégies efficaces, appropriées et optimales pour le contrôle du choléra. Cholera is endemo-epidemic in the city of Lubumbashi, Democratic Republic of Congo. Due to its importance in terms of morbidity and mortality, cholera is a real public health problem. This paper focuses on describing the clinical, epidemiological, biological, and therapeutic profile of cholera patients and identifying the determinants of cholera morbidity and mortality in the city of Lubumbashi. 386 cases and 386 controls were retained in the treatment units and health centers from January 2017 to December 2020. Positive cases met the Ministry of Health criteria: "any person, 2 years of age and older during the epidemic, presenting at least three loose stools per day, with or without vomiting; or any death from acute diarrhoea". A structured survey was used. The Odds Ratio quantifies the strength of association. Logistic regression with STATA 12 was used for the statistical analysis. Moreover, QGIS 3.12 and Excel 2017 were used to generate figures and tables of the results of the study. The threshold of statistical significance was set at 5% and 95% CI was used. There were 5,112 cases and 146 deaths, a case fatality rate of 2.9%. Compared to controls, determinants were significantly associated (P<0.05) with cholera: male sex (OR =1.41 [1.04-1.89]), education level less than or equal to 6 years of schooling (OR= 1.64 [1.05-2. 54]), known contact with a cholera case (OR=5.9 [2.60-13.67]), use of non-latrine containers (OR=2.1 [1.5-3.0]), and lack of awareness of critical hand washing times (OR=1.46 [1.08-1.98]). For death, the determinants are statistically associated (P<0.05) with cholera: Severe dehydration (OR = 2.67 [1.45-4.34]), delay of more than 24 hours between onset of signs and treatment (OR=2.23 [1.22-4.05]), and level of education more 6 years of schooling (OR= 0.39 [0.21-0.71]). Determining the determinants of cholera and death in the city of Lubumbashi is an important step towards revisiting policies, operational plans, and in developing effective, appropriate, and optimal strategies for cholera control

Assessment of the integrated disease surveillance and response system implementation in health zones at risk for viral hemorrhagic fever outbreaks in North Kivu, Democratic Republic of the Congo, following a major Ebola outbreak, 2021

Abstract Background The Democratic Republic of the Congo (DRC) experienced its largest Ebola Virus Disease Outbreak in 2018–2020. As a result of the outbreak, significant funding and international support were provided to Eastern DRC to improve disease surveillance. The Integrated Disease Surveillance and Response (IDSR) strategy has been used in the DRC as a framework to strengthen public health surveillance, and full implementation could be critical as the DRC continues to face threats of various epidemic-prone diseases. In 2021, the DRC initiated an IDSR assessment in North Kivu province to assess the capabilities of the public health system to detect and respond to new public health threats. Methods The study utilized a mixed-methods design consisting of quantitative and qualitative methods. Quantitative assessment of the performance in IDSR core functions was conducted at multiple levels of the tiered health system through a standardized questionnaire and analysis of health data. Qualitative data were also collected through observations, focus groups and open-ended questions. Data were collected at the North Kivu provincial public health office, five health zones, 66 healthcare facilities, and from community health workers in 15 health areas. Results Thirty-six percent of health facilities had no case definition documents and 53% had no blank case reporting forms, limiting identification and reporting. Data completeness and timeliness among health facilities were 53% and 75% overall but varied widely by health zone. While these indicators seemingly improved at the health zone level at 100% and 97% respectively, the health facility data feeding into the reporting structure were inconsistent. The use of electronic Integrated Disease Surveillance and Response is not widely implemented. Rapid response teams were generally available, but functionality was low with lack of guidance documents and long response times. Conclusion Support is needed at the lower levels of the public health system and to address specific zones with low performance. Limitations in materials, resources for communication and transportation, and workforce training continue to be challenges. This assessment highlights the need to move from outbreak-focused support and funding to building systems that can improve the long-term functionality of the routine disease surveillance system