Predictors of measles vaccination coverage among children 6-59 months of age in the Democratic Republic of the Congo.

BackgroundMeasles is a significant contributor to child mortality in the Democratic Republic of the Congo (DRC), despite routine immunization programs and supplementary immunization activities (SIA). Further, national immunization coverage levels may hide disparities among certain groups of children, making effective measles control even more challenging. This study describes measles vaccination coverage and reporting methods and identifies predictors of vaccination among children participating in the 2013-2014 DRC Demographic and Health Survey (DHS).MethodsWe examined vaccination coverage of 6947 children aged 6-59 months. A multivariate logistic regression model was used to identify predictors of vaccination among children reporting vaccination via dated card in order to identify least reached children. We also assessed spatial distribution of vaccination report type by rural versus urban residence.ResultsUrban children with educated mothers were more likely to be vaccinated (OR = 4.1, 95% CI: 1.6, 10.7) versus children of mothers with no education, as were children in wealthier rural families (OR = 2.9, 95% CI: 1.9, 4.4). At the provincial level, urban areas more frequently reported vaccination via dated card than rural areas.ConclusionsResults indicate that, while the overall coverage level of 70% is too low, socioeconomic and geographic disparities also exist which could make some children even less likely to be vaccinated. Dated records of measles vaccination must be increased, and groups of children with the greatest need should be targeted. As access to routine vaccination services is limited in DRC, identifying and targeting under-reached children should be a strategic means of increasing country-wide effective measles control

Association of Previous Measles Infection With Markers of Acute Infectious Disease Among 9- to 59-Month-Old Children in the Democratic Republic of the Congo.

BackgroundTransient immunosuppression and increased susceptibility to other infections after measles infection is well known, but recent studies have suggested the occurrence of an "immune amnesia" that could have long-term immunosuppressive effects.MethodsWe examined the association between past measles infection and acute episodes of fever, cough, and diarrhea among 2350 children aged 9 to 59 months whose mothers were selected for interview in the 2013-2014 Democratic Republic of the Congo (DRC) Demographic and Health Survey (DHS). Classification of children who had had measles was completed using maternal recall and measles immunoglobulin G serostatus obtained via dried-blood-spot analysis with a multiplex immunoassay. The association with time since measles infection and fever, cough, and diarrhea outcomes was also examined.ResultsThe odds of fever in the previous 2 weeks were 1.80 (95% confidence interval [CI], 1.25-2.60) among children for whom measles was reported compared to children with no history of measles. Measles vaccination demonstrated a protective association against selected clinical markers of acute infectious diseases.ConclusionOur results suggest that measles might have a long-term effect on selected clinical markers of acute infectious diseases among children aged 9 to 59 months in the DRC. These findings support the immune-amnesia hypothesis suggested by others and underscore the need for continued evaluation and improvement of the DRC's measles vaccination program

Helminth infection and treatment among pregnant women in the Democratic Republic of Congo: An examination of associated risk factors, co-morbidities, and birth outcomes

Helminth infections have an extremely high burden of disease, infecting over a billion people globally. Yet helminthiases remain heavily neglected in research and intervention efforts, especially in women of childbearing age. The exclusion of pregnant and breastfeeding women from preventive chemotherapy campaigns has exacerbated the problem in places like the Democratic Republic of Congo (DRC), a resource-poor, helminth endemic country with a high national fertility rate. The overarching aim of this dissertation is to better describe the landscape of helminthiases in DRC’s pregnant population, elucidating effects of prenatal infection on both maternal and neonatal health. Chapter 1 provides a summary of disease pathogenesis, prevention and control strategies for schistosomiasis and soil-transmitted helminths. Chapter 2 describes the prevalence, risk factors, and symptoms associated with urogenital schistosomiasis in a cross-sectional survey of women attending antenatal clinics in southeastern DRC; poor symptom recognition and a three-fold increase in the odds of sexually transmitted co-infections were identified amongst mothers harboring S. haematobium. Chapter 3 utilizes causal inference methods to examine the longitudinal effects of prenatal schistosomiasis on downstream offspring health, finding no distinction in the risk of adverse birth outcomes between mothers with treated infection and uninfected controls. Chapter 4 explores predictors and birth effects of prenatal anthelminthic use at scale, finding that in a nationally representative survey of mother-child pairs in DRC, indiscriminate anthelminthic drug use is unevenly distributed across sociodemographic lines and associated with significantly reduced odds of neonatal death. The findings of this dissertation reiterate the vulnerability of mothers and their offspring to unmitigated helminthiases, as well as the neutral or beneficial effects imparted by prenatal deworming. Given the evidence amassed herein, expansion and institutionalization of preventive chemotherapy at the national level—including the systematic incorporation of pregnant women in mass drug administration campaigns throughout DRC— is warranted

Helminth infection and treatment among pregnant women in the Democratic Republic of Congo: An examination of associated risk factors, co-morbidities, and birth outcomes

Helminth infections have an extremely high burden of disease, infecting over a billion people globally. Yet helminthiases remain heavily neglected in research and intervention efforts, especially in women of childbearing age. The exclusion of pregnant and breastfeeding women from preventive chemotherapy campaigns has exacerbated the problem in places like the Democratic Republic of Congo (DRC), a resource-poor, helminth endemic country with a high national fertility rate. The overarching aim of this dissertation is to better describe the landscape of helminthiases in DRC’s pregnant population, elucidating effects of prenatal infection on both maternal and neonatal health. Chapter 1 provides a summary of disease pathogenesis, prevention and control strategies for schistosomiasis and soil-transmitted helminths. Chapter 2 describes the prevalence, risk factors, and symptoms associated with urogenital schistosomiasis in a cross-sectional survey of women attending antenatal clinics in southeastern DRC; poor symptom recognition and a three-fold increase in the odds of sexually transmitted co-infections were identified amongst mothers harboring S. haematobium. Chapter 3 utilizes causal inference methods to examine the longitudinal effects of prenatal schistosomiasis on downstream offspring health, finding no distinction in the risk of adverse birth outcomes between mothers with treated infection and uninfected controls. Chapter 4 explores predictors and birth effects of prenatal anthelminthic use at scale, finding that in a nationally representative survey of mother-child pairs in DRC, indiscriminate anthelminthic drug use is unevenly distributed across sociodemographic lines and associated with significantly reduced odds of neonatal death. The findings of this dissertation reiterate the vulnerability of mothers and their offspring to unmitigated helminthiases, as well as the neutral or beneficial effects imparted by prenatal deworming. Given the evidence amassed herein, expansion and institutionalization of preventive chemotherapy at the national level—including the systematic incorporation of pregnant women in mass drug administration campaigns throughout DRC— is warranted

Prenatal chlamydial, gonococcal, and trichomonal screening in the Democratic Republic of Congo for case detection and management.

Prenatal Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), and Trichomonas vaginalis (TV) infections are associated with adverse birth outcomes. As rapid diagnostic tests become available, it is important to evaluate prenatal sexually transmitted infection (STI) prevalence, as well as the acceptability and feasibility of prenatal screening programs. We recruited 371 pregnant women from four clinics in Kisantu Health Zone, Democratic Republic of Congo (DRC) from October 2016 to March 2017. Trained clinicians collected cervical swabs, and samples were tested by nucleic acid amplification for CT, NG, and TV using a GeneXpert® system. Those testing positive for an STI were treated and asked to return after 4–8 weeks for tests-of-cure. Screening for STIs was widely accepted (99%). STI prevalence at baseline was: CT, 3.2%; NG, 1.5%; and TV, 14%; treatment completion was 97%. Symptoms were reported among 34% of STI-positive women at baseline, compared with 37% of STI-negative women. Upon first test-of-cure, 100% of returning women were cured of CT (n= 10) and NG (n= 5), but only 47% were cured of TV. This study demonstrates the feasibility of implementing diagnostic STI testing for case detection and treatment among expectant mothers in DRC, with implications for maternal and birth outcomes

Correction: Human T-cell lymphotropic virus type 1 transmission dynamics in rural villages in the Democratic Republic of the Congo with high nonhuman primate exposure

[This corrects the article DOI: 10.1371/journal.pntd.0008923.]