RESUMO
BACKGROUND: The incidence of human African trypanosomiasis (HAT) or sleeping sickness in Kinshasa has been increasing since 1996. The objectives of this study were first to identify the optimal levels of knowledge, and then to determine the risk factors for HAT in the city of Kinshasa. METHODS: This case/control study was based on a structured questionnaire. Case-patients were detected and treated between 1 January 2004 and 31 December 2005. Each case-patient was paired with two seronegative controls of the same age and sex, living in the same type of environment. The study included 437 case-patients and 874 controls. RESULTS: The optimal level of knowledge defined by the list of elementary notions related to HAT was 44% for the case-patients and 37.0% for controls (p<0.0001). The majority of individuals (86.7%) was favorable to passive screening. The patients living in peripheral areas were more at risk than other groups, in rural areas (odds-ratio 12.1; 95% IC: 5.7-21.7), and remote areas (odds-ratio 8.9; 9% IC: 2.1-38.8). A family history of HAT (odds-ratio 12.9; 95% IC: 7.9-20.8), ignoring the transmission route (odds-ratio 11.2; 95% IC: 5.8-21.7), and the water supply in natural points (odds-ratio 6.9; 95% IC: 2.8-17.2) were also risk factors. CONCLUSION: The results identified avoidable factors, which could be taken into account, to decrease the incidence of new contamination, the morbidity, and mortality of HAT.
Assuntos
Doenças Transmissíveis Emergentes/epidemiologia , Tripanossomíase Africana/epidemiologia , Adulto , Estudos de Casos e Controles , República Democrática do Congo/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Saúde da População Urbana , Adulto JovemRESUMO
BACKGROUND: Despite efforts to control human African trypanosomiasis (HAT) in the field, this infection remains prevalent in endemic or epidemic form in most of its traditional habitats. In the Democratic Republic of Congo (DRC), HAT has extended beyond rural areas to reach large cities such as Kinshasa. The objective of this study was to analyse the characteristics of trypanosomiasis patients (cases) in Kinshasa and to compare them to those of healthy controls. METHODS AND POPULATION OF STUDY: This case-control study allowed us to compare case patients and controls for some epidemiologic, clinical and sociodemographic characteristics. In all, 1764 people (588 case-patients and 1176 controls) were interviewed according to a structured questionnaire. Case-patients were infected with trypanosomiasis and entered the National Human African Trypanosomiasis Program (PNLTHA-DRC) from January 2004 through December 2005. Controls were matched for sex, age and residence to the corresponding case-patient, but had negative results from the Card Agglutination Trypanosomiasis Test (CATT-Test) whole-blood serologic analysis. Each patient was matched with two controls. RESULTS: Cases were identified in all 24 districts of Kinshasa, but were concentrated in the outskirts (outlying areas and southern expansion) and in rural areas. Overall, 25% (144/588) of case-patients lived in urbanized areas. People in the labour market (aged 20-49 years) were affected more often than others. HAT affected men and women equally. It also affected at higher rates people who moved around a lot and those who worked in rural or domestic activities, especially those in close contact with watercourses. Sleep disorders were the primary clinical sign (85%). Cervical adenopathies were observed frequently (66%). Fever was reported in 68% of case-patients. Most (73.5%) were diagnosed at a very advanced stage of infection (meningoencephalitic or neurological stage). CONCLUSION: These results highlight several modifiable or avoidable characteristics associated with HAT. Interventions on them might make it possible to reduce the morbidity and mortality rates associated with HAT and prevent wider extension of this disease.
