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

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

Theory-driven logic of solution model for vaccine uptake.

Theory-driven logic of solution model for vaccine uptake.</p

Preliminary findings from need assessment.

Despite the policy recommendation and effectiveness of administering the hepatitis B birth-dose vaccine (HepB-BD) to newborns to prevent mother-to-child hepatitis B transmission, timely uptake remains an issue. Countries adopting the HepB-BD to their national immunization schedule report programmatic challenges to administering the vaccine within the recommended 24-hour window after delivery. Further, while the World Health Organization recommends streamlining three birth-dose vaccines (HepB-BD, BCG, and OPV0), scarce Sub-Saharan(SSA)-based literature reports on a streamlined and timely approach to birth-dose vaccines. As more SSA countries adopt the new birth-dose vaccine to their immunization schedules, a systematically developed implementation strategy—Vaccination of Newborns–Innovative Strategies to Hasten Birth-Dose vaccines’ delivery (VANISH-BD)—will facilitate the adoption and implementation of timely birth-dose vaccine uptake. In this paper, we describe the development of the implementation strategy using intervention mapping, an evidence-based and theory-driven approach. We report on the development of our intervention, beginning with the needs assessment based in Kinshasa Province, Democratic Republic of the Congo (DRC), informing step 1 of intervention mapping. The intervention is contextually relevant, locally produced, sustainable, and designed to improve timely birth-dose vaccine uptake in the DRC. We intend to inform future implementers about improving timely and streamlined birth-dose vaccine uptake and for VANISH-BD to be adapted for similar contexts.</div

Specific implementation plans and materials for streamlining timely birth-dose vaccines.

Specific implementation plans and materials for streamlining timely birth-dose vaccines.</p

Determinants, theoretical-based methods, and practical application for each study actor.

Determinants, theoretical-based methods, and practical application for each study actor.</p

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

Summary: 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