Facteurs associés à la survie en milieu pénitentiaire : étude en République démocratique du Congo.

OBJECTIVE: The objective of this study was to identify factors associated with survival among prisoners at Mbuji-Mayi Central Prison, in Democratic Republic of Congo between January 2014 and December 2016. METHODS: This is a retrospective cohort study. The mortality rate was calculated during the 3-year follow-up period and the Kaplan-Meier survival curve was determined. Cox regression and risk ratio (HR) were used to analyze and quantify factors associated with survival. The study involved a total of 793 inmates. RESULTS: The average age of inmates was 33 ± 10 years (extremes: 17-67 years). The median follow-up time was 12 months for a total of 7,513 person-months. The number of deaths recorded was 135, for a mortality rate of 17.9/1,000 person-months. Risk factors associated with death were malnutrition (HR = 17.5; 95% CI = [12.1; 25.4]) and tuberculosis (HR = 11.8; 95% CI = [7.7; 17.8]). CONCLUSION: This study highlights a high rate of deaths in prisons and identifies the two potential factors (malnutrition and tuberculosis) that prison and health authorities need to address.

Analysis of severe adverse effects following community-based ivermectin treatment in the Democratic Republic of Congo.

BACKGROUND: The progress of mass, community-directed, treatment with ivermectin (CDTI) for onchocerciasis control was disrupted by severe adverse effects (SAE) in the Democratic Republic of Congo (DRC). The study aimed at determining the frequency of post-CDTI SAE as well as factors associated with the occurrence of SAE. METHODS: Our retrospective study relied on SAE collection cards, as archived by the DRC Ministry of Health, and compiled for people who benefited from ivermectin treatment then further developed SAE. The study included 945 post-CDTI SAE recorded in DRC between 2003 and 2017. These cases occurred in 15 projects out of 22 projects implemented in the country. All cards were reviewed and analysed. RESULTS: Between the years 2003 and 2017, the total average population treated was around 15,552,588 among which 945 cases of SAE were registered in DR Congo, i.e. 6 cases of SAE for 100,000 persons treated per year. 55 deaths related to post-CDTI SAE were recorded, which represents 5.8% of all cases of SAE. Non-neurological SAE were dominated by severe headaches (74.8%), myalgia (64.0%) and arthralgia (62.7%). Neurological SAE were mainly coma (94.1%), motor deficit (75.4%) and palpebral subconjunctival haemorrhages (38.8%). Factors associated with the occurrence of SAE were: male, age over 18 years old, alcohol consumption, hemp intake and the presence of loiasis. The study also highlighted weaknesses of the National Program for Onchocerciasis Control (NPOC)  in terms of awareness campaigns among the population. CONCLUSION: Co-endemicity of loiasis and onchocerciasis is one of the key factors responsible for the occurrence of SAE following ivermectin treatment. Mobilization of resources necessary to the appropriate management of SAE and awareness of populations are essential to achieve onchocerciasis control in DRC.

[Factors associated with prison survival: Study in the Democratic Republic of Congo]. / Facteurs associés à la survie en milieu pénitentiaire : étude en République démocratique du Congo.

OBJECTIVE: The objective of this study was to identify factors associated with survival among prisoners at Mbuji-Mayi Central Prison, in Democratic Republic of Congo between January 2014 and December 2016. METHODS: This is a retrospective cohort study. The mortality rate was calculated during the 3-year follow-up period and the Kaplan-Meier survival curve was determined. Cox regression and risk ratio (HR) were used to analyze and quantify factors associated with survival. The study involved a total of 793 inmates. RESULTS: The average age of inmates was 33 ± 10 years (extremes: 17-67 years). The median follow-up time was 12 months for a total of 7,513 person-months. The number of deaths recorded was 135, for a mortality rate of 17.9/1,000 person-months. Risk factors associated with death were malnutrition (HR = 17.5; 95% CI = [12.1; 25.4]) and tuberculosis (HR = 11.8; 95% CI = [7.7; 17.8]). CONCLUSION: This study highlights a high rate of deaths in prisons and identifies the two potential factors (malnutrition and tuberculosis) that prison and health authorities need to address.

Untreated villages and factors associated with the absence of Community-Directed Treatment with Ivermectin (CDTI) in DRC.

INTRODUCTION: The African Programme for Onchocerciasis Control (APOC), the main objective of which was the Community-Directed Treatment with Ivermectin (CDTI), was closed by the end of 2015. The purpose of this study was to describe untreated villages in DRC and to assess the factors associated with the absence of CDTI in endemic villages, between 2001 and 2014. METHODOLOGY: This retrospective study was descriptive. Several annual technical reports of the National Onchocerciasis Task Force (NOTF) and national technical reports of CDTI projects were analysed; 21 projects implemented to control the disease were considered, representing the coverage of 42,778 endemic villages. Data were collected over a 3 month-period, between October and December 2016. RESULTS: Only 15,700 endemic villages were not treated through an annual CDT with Mectizan, i.e. 36.7%. The population at risk totalled 29,712,381 individuals and 7,681,995 of them were not treated, i.e. 25.9%. Eight projects recorded high proportions of untreated villages, i.e. 7,100 endemic entities (16.6%). Factors independently associated with non-treatment were the fear of serious side effects (adjusted OR: 10.6; 95% CI: 4.5-27.7), supply impaired by insecurity (adjusted OR: 15.9; 95% CI: 6.7-41.4) and geographical inaccessibility (adjusted OR: 19; 95% CI: 6.9-63.9). CONCLUSION: After 15 CDTI-cycles in DRC, the mean geographical coverage and therapeutic coverage rates reached 63.3% and 74.1%, respectively. The 2025 target of onchocerciasis eradication, as advocated by APOC, will not be reached. Untreated areas are partly responsible for such results. Many weaknesses persist in the National Program for Onchocerciasis Control (NPOC) and new strategies of disease control should be investigated.

Prevalence of tuberculosis and associated risk factors in the Central Prison of Mbuji-Mayi, Democratic Republic of Congo.

BACKGROUND: Tuberculosis still remains a major public health concern in several provinces of the Democratic Republic of Congo, especially in prison settings. The present study aimed at determining tuberculosis (TB) prevalence and associated risk factors in inmates of the Mbuji-Mayi Central Prison. METHODS: This cross-sectional study was performed over a 6-month period (January to June 2015) in Mbuji-Mayi Central Prison. A total of 733 inmates were screened systematically for TB. The diagnosis was based on clinical examination and bacteriological tests. RESULTS: Tuberculosis was diagnosed in 130 inmates, what amounts to a 17.7 % prevalence (95 % confidence interval [CI] 15.1-20.6 %). The mean age ± SD of infected inmates was 31 ± 9.5 years old, and 94.8 % of them were male. Inmates were detained for a median period of 24 months (range: 3 months to 12 years). A cough lasting more than 2 weeks, body temperature higher than 39 °C, and weight loss were the predominating clinical signs. Factors independently associated with TB infection were overcrowding; highest population attributable fraction ([PAF] 88.2 %; adjusted odds ratio [OR] 9.8 [95 % CI 3.1-31.6]); malnutrition (body mass index of less than 18.5 kg/m(2)) (PAF 35.6 %; adjusted OR 2.1 [1.3-3.0]); and a detention period equal to or greater than 12 months (PAF 38.7 %; adjusted OR 2.1 [1.4-3.1]). CONCLUSIONS: Improving detention and sanitary conditions, as well as providing an adequate and early healthcare, are urgently needed to reduce TB prevalence in the prison environment.

Treatment-seeking Paths in the Management of Severe Malaria in Children under 15 Years of Age Treated in Reference Hospitals of Kinshasa, Democratic Republic of Congo.

BACKGROUND: In the Democratic Republic of Congo (DRC), few studies have focused on treatment-seeking paths selected by caretakers for the management of severe childhood malaria in an urban environment. The present study aims at describing the treatment-seeking paths according to the characteristics of households, as well as the subsequent impact on pre-hospitalisation delay and malarial fatality and on the main syndromes associated with severe childhood malaria. METHODS: This descriptive study included data collected at nine hospitals in Kinshasa between January and November 2011. A total of 1,350 children, under 15 years of age and hospitalised for severe malaria, were included in the study. RESULTS: Regarding the management of malaria, 31.5% of households went directly to the health centre or hospital while 68.5% opted for self-medication, church and/or traditional healing therapy. The most frequent first-line option was self-medication, adopted by more than 61.5% of households. Nevertheless, rational self-medication using antimalarial drugs recommended by the WHO (artemisinin-based combinations) was reported for only 5.5% of children. Only 12.5% of households combined 2 or 3 traditional options. The following criteria influenced the choice of a modern vs. traditional path: household socioeconomic level, residential environment, maternal education level and religious beliefs. When caretakers opted for traditional healing therapy, the pre-hospitalisation delay was longer and the occurrence of respiratory distress, severe anaemia and mortality was higher. CONCLUSION: The implementation of a malaria action plan in the Democratic Republic of Congo should take into account the diversity and pluralistic character of treatment-seeking behaviours in order to promote the most appropriate options (hospital and rational self-medication) and to avoid detrimental outcomes.

[Funding of the management of severe malaria in children by Kinshasa households (Democratic Republic of Congo)]. / Financement de la prise en charge du paludisme grave de l’'enfant par les ménages à Kinshasa, République Démocratique du Congo.

INTRODUCTION: The objective of this study was to determine the source of health care funding for heads of households related to the management of severe malaria in children admitted to a Kinshasa reference hospital. METHODS: This cross-sectional study was conducted on 1,350 hospitalised children under the age of 15 years treated for severe malaria in Kinshasa reference hospitals from January to November 2011 and the heads of households of these children. RESULTS: Only 46% of heads of households reported having sufficient funds directly available in the household budget. The remaining 54% had to call upon external sources of funding (sale of assets, loans, pawning goods). The use of a loan tended to increase significantly mainly for households with a low (adjusted odds ratio = 6.2), and intermediate socioeconomic status (adjusted odds ratio = 3.8) and for households working in the informal sector (adjusted odds ratio = 2.5). Similarly, the sale of assets was more frequently reported for households working in the informal sector (adjusted odds ratio = 2.4) and for female heads of households (adjusted odds ratio = 3.9). CONCLUSION: The management of severe malaria is a burden on household income. The majority of heads of households concerned needs to use external funding sources. A State subsidy for this management would help to reduce the risk of debt and sale of assets, especially for the poorest households.

Incidence of catastrophic health expenditures for households: an example of medical attention for the treatment of severe childhood malaria in Kinshasa reference hospitals, Democratic Republic of Congo.

This study aimed to estimate the incidence of catastrophic health expenditures faced by households in Kinshasa with children affected by severe malaria. A total of 1350 children below the age of 15 year who were hospitalized due to severe malaria were included in the study. We analyzed the incidence of households facing catastrophic expenditures according to two thresholds: 40% of the household's capacity to pay and 10% of the household's total consumption. Based on the '40% of the capacity to pay' threshold, the incidence of catastrophic health expenditures reached 81.1%, and this estimate reached 46.4% for the '10% above total consumption' threshold. Regarding the ≥ 40% capacity to pay threshold, the incidences of catastrophic expenditures was higher among households with children who were admitted to state hospitals (adjusted odds ratio [aOR] 3.7) and private hospitals (aOR 59.1), for poor households (aOR 13), for households with medium socioeconomic statuses (aOR 3.2), for female-headed households (aOR 2.9), for households with children affected by the neurological form (aOR 4.8) and respiratory distress (aOR 3.6), and for households who opted for a pre-hospital resort (aOR 2.7). Similar results were obtained when the 10% above the total consumption threshold was applied. Greater government financing of medical attention would lead to a reduction in the catastrophic health expenditures faced by the poorest households.

Costs of treatment of children affected by severe malaria in reference hospitals of Kinshasa, Democratic Republic of Congo.

INTRODUCTION: Malaria remains a real problem of public health. Its hospital care generates important expenditures for affected households. The present study aimed to estimate direct and indirect costs of severe child malaria in reference hospitals in Kinshasa. METHODOLOGY: This prospective study included 1,350 children under 15 years of age suffering from severe malaria. The study was performed between 1 January and 30 November, 2011. Data were collected in nine reference hospitals. The studied parameters were direct pre-hospital costs, direct hospital costs, and indirect costs. Costs were assessed from the household point of view. RESULTS: Median costs associated with the disease ranged from 114 USD in confessional hospitals to 173 USD in state hospitals and 308 USD in private hospitals. Direct pre-hospital median costs ranged between 3 and 11 USD. Direct hospital costs reached 72 USD in confessional hospitals, 139 USD in state hospitals, and 254 USD in private hospitals. Indirect costs ranged from 22 USD in state hospitals to 30 USD in confessional hospitals and 46 USD in private hospitals, regardless of the status of the accompanying parent or guardian. Factors explaining the variability of costs were the neurological form of malaria, indirect recourse to hospital, socioeconomic level, type of prescribing person, child's status upon leaving the hospital, and child's transfusion status. CONCLUSIONS: The care of severe child malaria appeared to be expensive in private and state hospitals. A state subsidy of health care and regulation of the private sector would contribute to the reduction of malaria's financial impact.