Time for malaria control in school-age children.

School-age children bear an under-appreciated burden of malaria. Across sub-Saharan Africa, the prevalence of infection peaks in this age-group, and an estimated 200 million school-age children are at risk of malaria. Infection in this age group not only threatens child health and education, but also serves as a source of onward parasite transmission, undermining elimination efforts. It is assumed that universal malaria interventions, such as bed nets and access to prompt diagnosis and treatment, cover this age group. However, school-age children are the group least likely to benefit from these interventions. Thus, interventions specifically targeting this age group are needed. Schools provide ready access to this population and are successfully employed to address other health concerns in schoolchildren, such as school-feeding for nutritional deficiencies and deworming campaigns for control of helminth infections

Changing spatial patterns and increasing rurality of HIV prevalence in the Democratic Republic of the Congo between 2007 and 2013

The Democratic Republic of the Congo (DRC) has one of the lowest HIV prevalence in sub-Saharan Africa, estimated at 1.1% [0.9-1.3] of adults aged 15-49 in 2013 (UNAIDS). Within the 2 million km2 country, however, there exists spatial variation in HIV prevalence, with the highest HIV prevalence observed in the large cities of Kinshasa and Lubumbashi. Globally, HIV is an increasingly rural disease, diffusing outwards from urban centers of high HIV prevalence to places where HIV was previously absent or present at very low levels. Utilizing data collected during Demographic and Health Surveillance (DHS) in 2007 and 2013 in the DRC, we sought to update the map of HIV prevalence in the DRC as well as to explore whether HIV in the DRC is an increasingly rural disease or remains confined to urban areas. Bayesian kriging and regression indicate that HIV prevalence in rural areas of the DRC is higher in 2013 than in 2007 and that increased distance to an urban area is no longer protective against HIV as it was in 2007. These findings suggest that HIV education, testing and prevention efforts need to diffuse from urban to rural areas just as HIV is doing

Low prevalence of Plasmodium malariae and Plasmodium ovale mono-infections among children in the Democratic Republic of the Congo: a population-based, cross-sectional study

Abstract Background In an effort to improve surveillance for epidemiological and clinical outcomes, rapid diagnostic tests (RDTs) have become increasingly widespread as cost-effective and field-ready methods of malaria diagnosis. However, there are concerns that using RDTs specific to Plasmodium falciparum may lead to missed detection of other malaria species such as Plasmodium malariae and Plasmodium ovale. Methods Four hundred and sixty six samples were selected from children under 5 years old in the Democratic Republic of the Congo (DRC) who took part in a Demographic and Health Survey (DHS) in 2013–14. These samples were first tested for all Plasmodium species using an 18S ribosomal RNA-targeted real-time PCR; malaria-positive samples were then tested for P. falciparum, P. malariae and P. ovale using a highly sensitive nested PCR. Results The prevalence of P. falciparum, P. malariae and P. ovale were 46.6, 12.9 and 8.3 %, respectively. Most P. malariae and P. ovale infections were co-infected with P. falciparum—the prevalence of mono-infections of these species were only 1.0 and 0.6 %, respectively. Six out of these eight mono-infections were negative by RDT. The prevalence of P. falciparum by the more sensitive nested PCR was higher than that found previously by real-time PCR. Conclusions Plasmodium malariae and P. ovale remain endemic at a low rate in the DRC, but the risk of missing malarial infections of these species due to falciparum-specific RDT use is low. The observed prevalence of P. falciparum is higher with a more sensitive PCR method

Spatial and social factors drive anemia in Congolese women

Anemia is common in women of child-bearing age in the Democratic Republic of the Congo (DRC). As part of the 2007 DRC Demographic and Health Survey (DHS), 4,638 women of childbearing age (including 526 pregnant women) were tested for HIV and had the hemoglobin content of their blood recorded. We assessed malaria prevalence using laboratory methods. The DHS provided extensive information for individuals, as well as household cluster coordinates which enabled us to derive several spatial variables. Multilevel analyses were conducted to determine individual and contextual risk factors for anemia. Prevalence varied geographically and was associated with both one's ethnic group and the amount and type of nearby agriculture. In contrast, prevalence was not affected by HIV or malaria status

Local Differences in Human Immunodeficiency Virus Prevalence: A Comparison of Social Venue Patrons, Antenatal Patients, and Sexually Transmitted Infection Patients in Eastern Kinshasa

This study compares the sexual behavior and HIV prevalence of men and women at social venues where people meet new sexual partners in Eastern Kinshasa with the HIV prevalence and behavior of STI treatment and antenatal clinic patients in the same area

Evaluation du niveau de connaissance et des facteurs prédisposant aux hépatites B et C chez les patients suivis en consultations externes des trois hôpitaux de Kinshasa : étude transversale multicentrique: Assessment of level of knowledge and factors predisposing on hepatitis B and C in patients followed by external consultations of the three hospitals of Kinshasa: a multicenter cross-sectional study

Context and objective. Knowledge on prevention and risk factors for HBV and HCV in the community is essential in order to fight against efficiently the spread of HBV and HCV. The aim of this study was to assess the extent of the risk factors for hepatitis B and C virus infection in Congolese community settings through outpatients. Methods. A multicentric cross-sectional study was conducted from May to October 2016. It consisted directly in collecting information on hepatitis B and C from outpatients in 3 hospitals of Kinshasa: Clinique d’Or, CUK and CHEM. Data collection was done consecutively. Results. 133 patients were interviewed (male 66.9%, mean age 33.9 ± 7.8 years). Knowledge of hepatitis B or C was found in 58.6% patients. The predisposing factors of hepatitis B and C were on average 4 factors in the same person and 24.8% of the respondents had at least 4 predisposing factors. The high level of study was the major factor associated with best knowledge of hepatitis B and C (aOR: 15.81, 95% CI: 4.90-18.01, p <0.001). Conclusion. The frequency of predisposing factors for hepatitis B and C is high in our environment; sufficient information on the harmful effects of these viruses would reduce this frequency and increase knowledge about hepatitis B and C. Contexte et objectif. La connaissance par la population des moyens de prévention et des facteurs prédisposant est indispensable en vue de lutter efficacement contre la propagation des virus de l’hépatite B et C. L’objectif de cette étude était d’évaluer l’ampleur des facteurs prédisposant l’acquisition de l’infection par le virus de l’hépatite B et C en milieu communautaire congolais. Méthodes. Etude transversale multicentrique, ayant inclus des patients recrutés, par convenance en consultation externe des trois formations hospitalières de Kinshasa ; entre mai et octobre 2016. Elle avait consisté à recueillir directement par entretiens dirigés, des informations sur les connaissances des hépatites B et C. Résultats. Au total 133 sujets ont été interviewés (hommes 66,9%, âge moyen était de 33,9±7,8 ans). Près de 59% des patients avaient avoué avoir des connaissances sur les hépatites B et C. Les facteurs prédisposant aux hépatites B et C étaient en moyenne de 4 chez la même personne. Le niveau d’étude élevé a émergé comme seul facteur associé de manière indépendante, à la connaissance de l’hépatite B et C (ORa : 15,81 ; IC 95% : 4,90-18,01, p<0,001). Conclusion. La fréquence des facteurs prédisposant à l’hépatite B et C est élevée dans nos milieux, une information suffisante sur les méfaits de ces virus, permettrait de diminuer cette fréquence et d’augmenter la connaissance sur les hépatites B et C

Impact of extractive industries on malaria prevalence in the Democratic Republic of the Congo: a population-based cross-sectional study

Extraction of natural resources through mining and logging activities provides revenue and employment across sub-Saharan Africa, a region with the highest burden of malaria globally. The extent to which mining and logging influence malaria transmission in Africa remains poorly understood. Here, we evaluate associations between mining, logging, and malaria in the high transmission setting of the Democratic Republic of the Congo using population-representative malaria survey results and geographic data for environmental features and mining and logging concessions. We find elevated malaria prevalence among individuals in rural areas exposed to mining; however, we also detect significant spatial confounding among locations. Upon correction, effect estimates for mining and logging shifted toward the null and we did not find sufficient evidence to detect an association with malaria. Our findings reveal a complex interplay between mining, logging, space, and malaria prevalence. While mining concessions alone may not drive the high prevalence, unobserved features of mining-exposed areas, such as human migration, changing vector populations, or parasite genetics, may instead be responsible

Spatial and socio-behavioral patterns of HIV prevalence in the Democratic Republic of Congo

This study uses a 2007 population-based household survey to examine the individual and community-level factors that increase an individual's risk for HIV infection in the Democratic Republic of Congo (DRC). Using the 2007 DRC Demographic Health Surveillance (DHS) Survey, we use spatial analytical methods to explore sub-regional patterns of HIV infection in the DRC. Geographic coordinates of survey communities are used to map prevalence of HIV infection and explore geographic variables related to HIV risk. Spatial cluster techniques are used to identify hotspots of infection. HIV prevalence is related to individual demographic characteristics and sexual behaviors and community-level factors. We found that the prevalence of HIV within 25 km of an individual's community is an important positive indicator of HIV infection. Distance from a city is negatively associated with HIV infection overall and for women in particular. This study highlights the importance of improved surveillance systems in the DRC and other African countries along with the use of spatial analytical methods to enhance understanding of the determinants of HIV infection and geographic patterns of prevalence, thereby contributing to improved allocation of public health resources in the future

Pooled Amplicon Deep Sequencing of Candidate Plasmodium falciparum Transmission-Blocking Vaccine Antigens

Polymorphisms within Plasmodium falciparum vaccine candidate antigens have the potential to compromise vaccine efficacy. Understanding the allele frequencies of polymorphisms in critical binding regions of antigens can help in the designing of strain-transcendent vaccines. Here, we adopt a pooled deep-sequencing approach, originally designed to study P. falciparum drug resistance mutations, to study the diversity of two leading transmission-blocking vaccine candidates, Pfs25 and Pfs48/45. We sequenced 329 P. falciparum field isolates from six different geographic regions. Pfs25 showed little diversity, with only one known polymorphism identified in the region associated with binding of transmission-blocking antibodies among our isolates. However, we identified four new mutations among eight non-synonymous mutations within the presumed antibody-binding region of Pfs48/45. Pooled deep sequencing provides a scalable and cost-effective approach for the targeted study of allele frequencies of P. falciparum candidate vaccine antigens

The links between agriculture, Anopheles mosquitoes, and malaria risk in children younger than 5 years in the Democratic Republic of the Congo: a population-based, cross-sectional, spatial study

Background: The relationship between agriculture, Anopheles mosquitoes, and malaria in Africa is not fully understood, but it is important for malaria control as countries consider expanding agricultural projects to address population growth and food demand. Therefore, we aimed to assess the effect of agriculture on Anopheles biting behaviour and malaria risk in children in rural areas of the Democratic Republic of the Congo (DR Congo). Methods: We did a population-based, cross-sectional, spatial study of rural children (0]=0·89), with the probability of malaria infection increased between 0·2% (95% UI −0·1 to 3·4) and 2·6% (–1·5 to 6·6) given a 15% increase in agricultural cover, depending on other risk factors. The models predicted that large increases in agricultural cover (from 0% to 75%) increase the probability of infection by as much as 13·1% (95% UI −7·3 to 28·9). Increased risk might be due to Anopheles gambiae sensu lato, whose probability of biting indoors increased between 11·3% (95% UI −15·3 to 25·6) and 19·7% (–12·1 to 35·9) with a 15% increase in agriculture. Interpretation: Malaria control programmes must consider the possibility of increased risk due to expanding agriculture. Governments considering initiating large-scale agricultural projects should therefore also consider accompanying additional malaria control measures. Funding: National Institutes of Health, National Science Foundation, Bill & Melinda Gates Foundation, President's Malaria Initiative, and Royster Society of Fellows at the University of North Carolina at Chapel Hill