Taenia solium Cysticercosis in the Democratic Republic of Congo: How Does Pork Trade Affect the Transmission of the Parasite?

Taenia solium is a parasite that can affect both humans and pigs, causing important economic losses in pig production and being the main cause of acquired epilepsy in endemic areas. However, the parasite has been neglected in many African countries and particularly in the Democratic Republic of Congo (DRC), where recent data are non-existent. The present study is part of a first initiative to assess whether cysticercosis is actually present in DRC and to estimate its potential economic and public health importance. Focusing our work on porcine cysticercosis, we demonstrated high prevalence figures of active infections in villages in a rural area of DRC and in markets in the city of Kinshasa. Moreover, the intensity of infection was higher in pigs sampled in villages as compared to pigs sampled on urban markets. Preliminary surveys conducted in parallel in both study sites suggest an effect of pork trade on the transmission of the parasite selecting highly infected pigs at village level

Prevalence of plasmodium infection and accuracy of diagnostic tests for malaria infection in children under five in the health zone of Mont Ngafula1, an endemic area for malaria in Kinshasa, DRC

Masters DissertationDemocratic Republic of Congo (DRC) is one of the five countries that carry half of the global disease burden. Yet, malaria is an entirely preventable and treatable disease, when currently recommended interventions are properly implemented. Such interventions include confirmation of malaria diagnosis through microscopy or malaria rapid diagnostic tests (MRDTs) for every suspected case, even in children under five years of age. This study aimed to assess the prevalence of malaria infection and the performances of MRDT, the SD-Bioline a HRP2/PanLDH test using microscopy and PCR as the gold standard in a population based survey in children under five years of age living in endemic transmission settings. This is a cross sectional based survey conducted in the health areas in the health zone of Mont Ngafula1 during the dry season from April to August 2012. A total of 812 children of 3 to 59 months of age were included from the 2 selected HA. The sensitivity, specificity, positive and negative predictive values with their CI 95% were 93.5% (90.0-97.1), 81.1% (77.9-84.2), 60.6% (55.0-66.3) and 97.5% (96.2-98.9), respectively, in the overall study population when using microscopy as the gold standard and 88%.2 (79.2-97.3), 92.0% (84.3-99.7), 88.4% (79.6-97.3) and 91.8% (84.0-99.7) respectively, when PCR was used as the reference test . The prevalence of malaria with microscopy was 24.9% (CI 95%: 21.0-26.7).The differences between PCR and microscopy with the specificity or and the PPV in the overall population might be due to the threshold detection of microscopy that does not detect very low parasite density. The results of this study show the limitation of the MRDT SD-Bioline, a HRP2/PanLDH test, on population based survey because of the risk of an overestimation of the infection prevalence in children aged less than five years.Southern African Centre for Infectious Disease Surveillance (SACIDS

Prevalence of plasmodium infection and accuracy of diagnostic tests for malaria infection in children under five in the health zone of Mont Ngafula1, an endemic area for malaria in Kinshasa, DRC

Masters DissertationDemocratic Republic of Congo (DRC) is one of the five countries that carry half of the global disease burden. Yet, malaria is an entirely preventable and treatable disease, when currently recommended interventions are properly implemented. Such interventions include confirmation of malaria diagnosis through microscopy or malaria rapid diagnostic tests (MRDTs) for every suspected case, even in children under five years of age. This study aimed to assess the prevalence of malaria infection and the performances of MRDT, the SD-Bioline a HRP2/PanLDH test using microscopy and PCR as the gold standard in a population based survey in children under five years of age living in endemic transmission settings. This is a cross sectional based survey conducted in the health areas in the health zone of Mont Ngafula1 during the dry season from April to August 2012. A total of 812 children of 3 to 59 months of age were included from the 2 selected HA. The sensitivity, specificity, positive and negative predictive values with their CI 95% were 93.5% (90.0-97.1), 81.1% (77.9-84.2), 60.6% (55.0-66.3) and 97.5% (96.2-98.9), respectively, in the overall study population when using microscopy as the gold standard and 88%.2 (79.2-97.3), 92.0% (84.3-99.7), 88.4% (79.6-97.3) and 91.8% (84.0-99.7) respectively, when PCR was used as the reference test . The prevalence of malaria with microscopy was 24.9% (CI 95%: 21.0-26.7).The differences between PCR and microscopy with the specificity or and the PPV in the overall population might be due to the threshold detection of microscopy that does not detect very low parasite density. The results of this study show the limitation of the MRDT SD-Bioline, a HRP2/PanLDH test, on population based survey because of the risk of an overestimation of the infection prevalence in children aged less than five years.Southern African Centre for Infectious Disease Surveillance (SACIDS

Performance of HRP2-based rapid test in children attending the health centre compared to asymptomatic children in the community

BACKGROUND: The Democratic Republic of the Congo (DRC) is one of the five countries carrying half of global malaria burden with children 0–5 years old being most at risk. Rapid diagnostic tests (RDTs) are currently routinely used for the detection of Plasmodium infection in health centres and may be a useful tool for population-based survey. METHODS: This study assessed, in a stable transmission zone of Kinshasa, whether a HRP2-based RDT matches the selection criteria of the National Malaria Control Programme (NMCP), DRC and assessed the most relevant fever threshold in this context. RESULTS: RDTs and microscopy were concordant in 84.3% and 83.4% children in the health centre and at the community level, respectively. The sensitivity was high (>95%), but the specificity was too low and lower in the community (66.9%; 95%CI: 58.5-75.2) compared to the HC (79.4%; 95%CI: 75.7-83.2). The estimated parasitic threshold of 5,414 parasites/μl was with a sensitivity of 63.3% and a specificity of 71.8% not very discriminative, and thus not a threshold. CONCLUSION: HRP-based RDT gives a satisfactory proxy to estimate and monitor malaria endemicity, but the low specificity, far below the selection criteria of the NMCP, DRC is problematic for use in a clinical setting

Perceptions of health, health care and community-oriented health interventions in poor urban communities of Kinshasa, Democratic Republic of Congo

In Democratic Republic of Congo access to health care is limited because of many geographical and financial barriers, while quality of care is often low. Global health donors assist the country with a number of community-oriented interventions such as free distribution of bednets, antihelminthic drugs, vitamin A supplementation and vaccination campaigns, but uptake of these interventions is not always optimal. The aim of this study was to explore the perceptions of poor urban communities of the capital Kinshasa with regard to health issues in general as well as their experiences and expectations concerning facility-based health services and community-oriented health interventions. Applying an approach rooted in the grounded theory framework, focus group discussions were conducted in eight neighborhoods of poor urban areas in the city of Kinshasa in July 2011. Study participants were easily able to evoke the city’s major health problems, with the notable exceptions of malnutrition and HIV/AIDS. They perceive the high out-of-pocket cost of health services as the major obstacle when seeking access to quality care. Knowledge of ongoing community-oriented health interventions seems good. Still, while the study participants agree that those interventions are beneficial; their acceptability seems to be problematic. This is chiefly put down to a lack of information and government communication about the programs and their interventions. Furthermore, the study participants referred to rumors and the deterring effect of stories about alleged harmful consequences of those interventions. Along with improving the provision and quality of general health care, the government and international actors must improve their efforts in informing the communities about disease control programs, their rationale and benefit/risk ratio. Directly engaging community members in a dialogue might be beneficial in terms of improving acceptability and overall access to health services and interventions. Novel ways of reducing the high out-of-pocket expenditure should also be explored

The Challenges of Research Informed Consent in Socio-Economically Vulnerable Populations: A Viewpoint From the Democratic Republic of Congo

In medical research, the ethical principle of respect for persons is operationalized into the process of informed consent. The consent tools should be contextualized and adapted to the different socio-cultural environment, especially when research crosses the traditional boundaries and reaches poor communities. We look at the challenges experienced in the malaria Quinact trial, conducted in the Democratic Republic of Congo, and describe some lessons learned, related to the definition of acceptable representative, the role of independent witness and the impact of socio-economic vulnerability. To ensure children's protection, consent is required by the parents or, in their absence, by a legally mandated representative. In our setting, children's responsibility is often entrusted permanently or temporarily to relatives or friends without a tribunal mandate. Hence, a notion of 'culturally acceptable representative' under supervision of the local Ethics Committee may be more suitable. To ensure protection of illiterate subjects, an independent witness is required to confirm that the consent was freely given. However, in low-literacy contexts, potential witnesses often don't have any previous relationship with patient and there may be power-unbalance in their relationship, rather than genuine dialogue. In poor communities, trial participation may be seen as an opportunity to secure access to healthcare. Poverty may also lead to 'competition' to access the research-related benefits, with a risk of disturbance at societal or household level. Adjusting consent procedures to sociocultural and socioeconomic realities is essential for fulfilling the underlying ethical principles. This requires a collaborative dialogue between researchers, regulators and ethics committees.status: publishe

Phase 3 Evaluation of an Innovative Simple Molecular Test for the Diagnosis of Malaria and Follow-Up of Treatment Efficacy in Pregnant Women in Sub-Saharan Africa (Preg-Diagmal)

The malaria parasite Plasmodium falciparum (Pf) can sequester in the placenta resulting in low density of peripheral parasitemia and consequently in false negative malaria diagnosis (by microscopy) in pregnant women. Moreover, the use of rapid diagnostic tests (RDTs) in diagnostic strategies, including those for the detection of a malaria infection during pregnancy, is constrained by either persistent malaria antigen (histidine-rich protein 2; HRP2) after successful treatment, leading to false positive test results, or by false negative results as previously mentioned due to parasite sequestration (which is further exacerbated due to the low limited of detection [LoD] of conventional RDTs) or to HRP2 deletion. Recently, a direct blood polymerase chain reaction combined with a nucleic acid lateral flow immunoassay (dbPCR-NALFIA) has been developed, which circumvents these challenges and has demonstrated its diagnostic potential in phase 1 and 2 studies. The PREG-DIAGMAL trial presented in this manuscript will assess the diagnostic performance of dbPCR-NALFIA for the diagnostic of malaria in pregnant women and its potential to monitor treatment efficacy in these subjects. The work is ancillary embedded in an ongoing EDCTP funded trial, the PyraPreg project (PACTR202011812241529) in which the safety and efficacy of a newly registered Artemisinin-Based Combination (Pyronaridine-Artesunate) is being evaluated in pregnant women. This is a Phase 3 diagnostic evaluation conducted in 2 African countries: Democratic Republic of the Congo (DRC) and Burkina Faso. Pregnant women fulfilling the inclusion criteria of the PyraPreg study will be also invited to participate in the PREG-DIAGMAL study. Diagnostic accuracy will be assessed following the WHO/TDR guidelines for the evaluation of diagnostics and reported according to STARD principles. Due to the lack of a 100% specific and sensitive standard diagnostic test for malaria, the sensitivity and specificity of the new test will be compared to the available diagnostic practice in place at the selected settings (microscopy and/or RDT) and to quantitative PCR as the reference test. This phase 3 diagnostic study is designed towards the evaluation of the performance of a new diagnostic tool for the screening of malaria and the monitoring of treatment in pregnant women under real conditions life. If successful, the dbPCR-NALFIA could be a valuable tool to add to the diagnostic arsenal for malaria, in particular during pregnancy. Trial registration: Pan African Clinical Trial Registry database (PACTR202203780981413). Registered on 17 March 2022