Self-medication and Anti-malarial Drug Resistance in the Democratic Republic of the Congo (DRC): A silent threat

Background Malaria is a global infectious (vector-borne: Anopheles mosquitoes) disease which is a leading cause of morbidity and mortality in Sub-Saharan Africa (SSA). Among all its parasitic (protozoan: Plasmodium sp.) variants, Plasmodium falciparum (PF) is the most virulent and responsible for above 90% of global malaria deaths hence making it a global public health threat. Main context Despite current front-line antimalarial treatments options especially allopathic medications and malaria prevention (and control) strategies especially governmental policies and community malaria intervention programs in SSA, PF infections remains prevalent due to increased antimicrobial/antimalarial drug resistance caused by several factors especially genetic mutations and auto(self)-medication practices in SSA. In this article, we focused on the Democratic Republic of Congo (DRC) as the largest SSA country by bringing perspective into the impact of self-medication and antimalarial drug resistance, and provided recommendation for long-term improvement and future analysis in malaria prevention and control in SSA. Conclusions Self-medication and anti-malarial drug resistance is a major challenge to malaria control in DRC and sub-Saharan Africa, and to achieve sustainable control, individual, community and governmental efforts must be aligned to stop self-medication, and strengthen the health systems against malaria

Xpert mycobacterium tuberculosis/rifampicin-detected rifampicin resistance is a suboptimal surrogate for multidrug-resistant tuberculosis in Eastern Democratic Republic of the Congo : diagnostic and clinical implications

CITATION: Bisimwa, B. C. et al. 2020. Xpert Mycobacterium tuberculosis/Rifampicin–Detected Rifampicin Resistance is a Suboptimal Surrogate for Multidrug-resistant Tuberculosis in Eastern Democratic Republic of the Congo: Diagnostic and Clinical Implications. Clinical Infectious Diseases, 73(2):e362–e370. doi:10.1093/cid/ciaa873The original publication is available at https://academic.oup.com/cid/Background Rifampicin (RIF) resistance is highly correlated with isoniazid (INH) resistance and used as proxy for multidrug-resistant tuberculosis (MDR-TB). Using MTBDRplus as a comparator, we evaluated the predictive value of Xpert MTB/RIF (Xpert)–detected RIF resistance for MDR-TB in eastern Democratic Republic of the Congo (DRC). Methods We conducted a cross-sectional study involving data from new or retreatment pulmonary adult TB cases evaluated between July 2013 and December 2016. Separate, paired sputa for smear microscopy and MTBDRplus were collected. Xpert testing was performed subject to the availability of Xpert cartridges on sample remnants after microscopy. Results Among 353 patients, 193 (54.7%) were previously treated and 224 (63.5%) were MTBDRplus TB positive. Of the 224, 43 (19.2%) were RIF monoresistant, 11 (4.9%) were INH monoresistant, 53 (23.7%) had MDR-TB, and 117 (52.2%) were RIF and INH susceptible. Overall, among the 96 samples detected by MTBDRplus as RIF resistant, 53 (55.2%) had MDR-TB. Xpert testing was performed in 179 (50.7%) specimens; among these, 163 (91.1%) were TB positive and 73 (44.8%) RIF resistant. Only 45/73 (61.6%) Xpert-identified RIF-resistant isolates had concomitant MTBDRplus-detected INH resistance. Xpert had a sensitivity of 100.0% (95% CI, 92.1–100.0) for detecting RIF resistance but a positive-predictive value of only 61.6% (95% CI, 49.5–72.8) for MDR-TB. The most frequent mutations associated with RIF and INH resistance were S531L and S315T1, respectively. Conclusions In this high-risk MDR-TB study population, Xpert had low positive-predictive value for the presence of MDR-TB. Comprehensive resistance testing for both INH and RIF should be performed in this setting.https://academic.oup.com/cid/article/73/2/e362/5863452?login=truePublishers versio

Resistance to African swine fever virus among African domestic pigs appears to be associated with a distinct polymorphic signature in the RelA gene and upregulation of RelA transcription

Abstract African swine fever virus (ASFV) is a highly contagious and fatal hemorrhagic disease of domestic pigs, which poses a major threat to the swine industry worldwide. Studies have shown that indigenous African pigs tolerate ASFV infection better than European pigs. The porcine v-rel avian reticuloendotheliosis viral oncogene homolog A (RelA) encoding a p65 kD protein, a major subunit of the NF-kB transcription factor, plays important roles in controlling both innate and adaptive immunity during infection with ASFV. In the present study, RelA genes from ASFV-surviving and symptomatic pigs were sequenced and found to contain polymorphisms revealing two discrete RelA amino acid sequences. One was found in the surviving pigs, and the other in symptomatic pigs. In total, 16 nonsynonymous SNPs (nsSNPs) resulting in codon changes were identified using bioinformatics software (SIFT and Polyphen v2) and web-based tools (MutPre and PredictSNP). Seven nsSNPs (P374-S, T448-S, P462-R, V464-P, Q478-H, L495-E, and P499-Q) were predicted to alter RelA protein function and stability, while 5 of these (P374-S, T448-S, P462-R, L495-E, and Q499-P) were predicted as disease-related SNPs. Additionally, the inflammatory cytokine levels of IFN-α, IL-10, and TNF-α at both the protein and the mRNA transcript levels were measured using ELISA and Real-Time PCR, respectively. The resulting data was used in correlation analysis to assess the association between cytokine levels and the RelA gene expression. Higher levels of IFN-α and detectable levels of IL-10 protein and RelA mRNA were observed in surviving pigs compared to healthy (non-infected). A positive correlation of IFN-α cytokine levels with RelA mRNA expression was also obtained. In conclusion, 7 polymorphic events in the coding region of the RelA gene may contribute to the tolerance of ASFV in pigs

Le système de production de la poule locale contraint son développement au Sud-Kivu, Est de la République Démocratique du Congo

Objectif : Cette étude a été menée envue de caractériser le système de production et de reproduction de la poule locale dans trois zones agro-écologiques du Sud-Kivu d’Avril jusqu’en Décembre, 2017. Méthodologie et résultats: Une enquête transversale a été menée à l’aide d’une interview auprès de 360 éleveurs répartis dans 3 zones agro-écologiques dont la haute, moyenne et basse altitude. Les principaux résultats trouvés indiquent que ces élevages sont gérés par les hommes, ayant un objectif tourné vers le marché (90,28%), comptent 24,38 poules qui sont élevés en divagation (94,17%) sans logement spécifique (81,11%). Les poules reçoivent une supplémentation alimentaire (65,28%) et un complément vitaminique (25,83%). La pseudopeste aviaire est la maladie la plus fréquente (89,72%), suite à l’absence de la vaccination (96,67%), les éleveurs recourent à la pharmacopée traditionnelle (77,5%). Chaque poule donne 13 œufs par cycle de ponte pour 2,96 cycles par an. 70,37% des œufs pondus sont incubés pour un taux d’éclosion de 84,50% et un taux de sevrage de 57,25%, intervenant à 2,52 mois après éclosion. Les épidémies et la prédation sont les principales contraintes auxquelles font face les éleveurs de la poule locale en plus du manque d’appuis par les services étatiques. Conclusion et application des résultats: Quoique cet élevage soit une activité secondaire et selon les techniques de production traditionnelle avec des faibles performances, il reste primordiale dans l’économie des familles rurales et mérite une attention particulière visant son amélioration. Une stabulation ainsi qu’une alimentation équilibrée permettraient d’accroitre la production et réduire les risques de perte des poules.Mots clés : Elevage, zones-agro écologiques, Contraintes, poule locale, Sud-Kivu

The effectiveness of community volunteers in counting populations and assessing their nutritional vulnerability during armed conflict: district health in D.R. Congo, Central Africa

The study assessed the ability of community volunteers, working with district health officials, to conduct a local census to count the population in their villages and assess their nutritional vulnerability. The study involved organizing community volunteers in village nutrition committee and assigning them to count the village population in a Kivu rural health district (D.R.Congo) and assess their vulnerability in terms of nutrition. The study took place in March and April 2003, during armed conflict in the region. Community volunteers supervised by district health officials collected data, presented here as median proportions (with their Max and Min), by age category. The results show that community volunteers were able to conduct this census with reliable results. The population distribution by age category was similar to the national model from a survey by experts. The community volunteers estimated a median of 22.2 % (6.2-100 %) of households in each village in the eastern DR Congo were vulnerable and required foreign aid. Community volunteers can contribute accurately to the collection of demographic data to be used in health programme planning, thus allowing these data to be followed even during instability and armed conflicts.Objectif : Evaluer la capacité des relais communautaires opérant dans le domaine de la nutrition à contribuer au dénombrement de la population de leurs villages respectifs sous la coordination du district sanitaire. Méthodologie : Une étude quasi expérimentale, consistant à organiser les relais communautaires en comités villageois de nutrition et à les responsabiliser dans le dénombrement de la population de leurs villages respectifs, a été mise sur pied dans un district sanitaire rural du Kivu (RD Congo). L’étude a été réalisée de mars à avril 2003 dans une situation de conflit armé. La collecte des données de la population a été assuée par les relais communautaires. Les médianes (minimum et maximum) des proportions observées par catégories d’âge ont été présentées. Résultats : Les relais ont été capables de faire un dénombrement de la population avec des résultats fiables. Les proportions de la population par catégorie d’âge observées se sont révélées similaires à celles du modèle national issu d’une enquête réalisée par des experts. Pour les relais communautaires, un pourcentage médian de 22,2 % (6,2-100 %) des ménages par village a été considéré comme vulnérables dans le contexte de l’Est de la RD Congo, nécessitant par conséquent une aide extérieure. Conclusion : Les relais communautaires peuvent contribuer à la récolte de données démographiques fiables pouvant permettre de planifier des programmes de santé publique, et le suivi de l’évolution démographique même dans une situation d’instabilité et de conflit armé

Efficacy of Artesunate Plus Amodiaquine for Treatment of Uncomplicated Clinical Falciparum Malaria in Severely Malnourished Children Aged 6–59 Months, Democratic Republic of Congo

info:eu-repo/semantics/publishedS3-00

Risk factors of African swine fever virus in suspected infected pigs in smallholder farming systems in South-Kivu province, Democratic Republic of Congo

Background African swine fever (ASF) is an infectious viral disease of domestic pigs that presents as a hemorrhagic fever, and for which no effective vaccine is available. The disease has a serious negative social and economic impact on pig keepers. There is limited information on the potential risk factors responsible for the spread of ASF in South Kivu. Objective The aim of this study was to determine the potential risk factors associated with ASF infection in suspected ASF virus (ASFV)-infected pigs. Methods We sampled whole blood from 391 pigs. Additionally, 300 pig farmers were interviewed using a structured questionnaire. Viral DNA was detected by using the real-time polymerase chain reaction technique. Results The majority of pigs sampled, 78% (95% confidence interval [CI], 74.4–82.6), were of local breeds. Over half, 60.4% (95% CI, 55.5–65.2), were female, and most of them, 90.5% (95% CI, 87.6–93.4), were adult pigs (> 1 year old). Viral DNA was detected in 72 of the 391 sampled pigs, indicating an overall infection rate of 18.4% (95% CI, 14.5–22.4). Multivariable logistic regression analysis revealed several risk factors positively associated with ASFV infection: feeding with swill in pen (odds ratio [OR], 3.8; 95% CI, 2.12–6.77); mixed ages of pigs in the same pen (OR, 3.3; 95% CI, 1.99–5.57); introduction of new animals to the farm (OR, 5.4; 95% CI, 1.91–15.28). The risk factors that were negatively (protective) correlated with ASFV positivity were the presence of male animals and the use of an in-pen breeding system. Conclusion Local pig farmers should be encouraged to adopt proper husbandry and feeding practices in order to increase the number of ASF-free farms

Molecular detection of arboviruses in Aedes mosquitoes collected from Kyela district, Tanzania

Arboviruses belong to a group of viruses that are transmitted by arthropods, mainly mosquitoes and ticks causing clinical disease symptoms in humans and animals ranging from febrile illnesses to hemorrhagic fevers. The present study aimed at examining the circulation of Chikungunya, Dengue, Yellow fever and Rift valley fever viral genomes in Aedes mosquitoes from Kyela district in Tanzania. A systematic vector surveillance spanning two months and covering 5 sites in Kyela district was carried out in order to evaluate the potential role of Aedes spp in arbovirus transmission in the study area. Mosquitoes were collected, identified to species level by using morphological keys, pooled in respect species and collection sites and screened for arboviruses by RT-PCR. Adult mosquitoes were collected from April to May, 2015 using CO 2 -baited CDC light traps, magnet traps as well as human landing collection (HLC). The study sites included Kyela town, Kajunjumele, Ipida, Matema and Njisi villages. A total of 480 bloodfeed Aedes ssp were collected, identified and grouped in to 24 pools (1-20 mosquitoes per pool) according to species level and location. Out of the 480 Aedes spp collected, Aedes aegypti represented the most abundant species totaling 338 (70.4%), followed by Aedes africanus 102 (21.2%) and Aedes natalensis being the minority 40 (8.3%). Arboviruses were detected in 9 pools (37.5%) including Alphaviruses (8 pools) and Flaviviruses (1 pool). No sample was positive for Bunyaviruses. Chikungunya virus (CHIKV) was detected in 6 (75%) alphavirus positive pools that were collected mostly in the areas where rice cultivation was common. The findings of this study suggest that people from this region are highly likely to be exposed to arbovirus infections which may represent significant public health concerns

Prevalence of gastro-intestinal helminths in slaughtered cattle in Walungu territory, South Kivu Province, Eastern Democratic Republic of Congo

Austin Journal of Veterinary Science & Animal Husbandry; 2018; Vol. 5(1): 1039An abattoir cross sectional survey was carried out to determine the prevalence of gastrointestinal parasitic helminths in slaughtered cattle at Kankinda and Mugogo Municipal abattoirs located in Walungu territory, South Kivu province, eastern Democratic Republic of Congo. Using qualitative and quantitative coprological examination, 200 fecal samples were tested. Gastrointestinal helminths’ eggs were detected in only 148 samples tested giving an overall prevalence of 74%. The most diversity class was nematodes with four species, followed by trematode and cestode with two species in each, both representing species abundances of 44.4%, 22.2% and 22.2% respectively and only one protozoan species was identified (11.1%). However, the prevalence of helminths in relation to sex and age group revealed no statistical difference at P value >0.05. The exotic breed presented the highest infection rate of 72.5% (OR=4.6, 95% CI: 1.9–11.1; p=0.0004) compared to the local breed. Similarly high prevalence of helminthes was found in slaughtered cattle from local farms 90.6% (OR=4.1; 95% CI: 1.9–9.5; p=0.0001) compared to cattle imported from Rwanda. The prevalent helminthes species identified were Eimeria bovis (74%), followed by Schistosoma bovis (41%); Hymenolepis diminuta (39%); Toxocara vitulorum (32.5%) and the least species observed were Fasciola gigantica (18%); Strongyloides papillosus (11.5%); Trichonstrongylus sp (7%); Haemonchus spp (6.5%); and Moniezia spp (6%). These findings reflect a growing burden of gastrointestinal parasite infections at abattoir level. Therefore, a proper management, improved hygiene and regular deworming practices should be institutionalized for prevention and control of parasitic infections in livestock