Geo-Climatic Factors of Malaria Morbidity in the Democratic Republic of Congo from 2001 to 2019.

Background: Environmentally related morbidity and mortality still remain high worldwide, although they have decreased significantly in recent decades. This study aims to forecast malaria epidemics taking into account climatic and spatio-temporal variations and therefore identify geo-climatic factors predictive of malaria prevalence from 2001 to 2019 in the Democratic Republic of Congo. Methods: This is a retrospective longitudinal ecological study. The database of the Directorate of Epidemiological Surveillance including all malaria cases registered in the surveillance system based on positive blood test results, either by microscopy or by a rapid diagnostic test for malaria was used to estimate malaria morbidity and mortality by province of the DRC from 2001 to 2019. The impact of climatic factors on malaria morbidity was modeled using the Generalized Poisson Regression, a predictive model with the dependent variable Y the count of the number of occurrences of malaria cases during a period of time adjusting for risk factors. Results: Our results show that the average prevalence rate of malaria in the last 19 years is 13,246 (1,178,383−1,417,483) cases per 100,000 people at risk. This prevalence increases significantly during the whole study period (p < 0.0001). The year 2002 was the most morbid with 2,913,799 (120,9451−3,830,456) cases per 100,000 persons at risk. Adjusting for other factors, a one-day in rainfall resulted in a 7% statistically significant increase in malaria cases (p < 0.0001). Malaria morbidity was also significantly associated with geographic location (western, central and northeastern region of the country), total evaporation under shelter, maximum daily temperature at a two-meter altitude and malaria morbidity (p < 0.0001). Conclusions: In this study, we have established the association between malaria morbidity and geo-climatic predictors such as geographical location, total evaporation under shelter and maximum daily temperature at a two-meter altitude. We show that the average number of malaria cases increased positively as a function of the average number of rainy days, the total quantity of rainfall and the average daily temperature. These findings are important building blocks to help the government of DRC to set up a warning system integrating the monitoring of rainfall and temperature trends and the early detection of anomalies in weather patterns in order to forecast potential large malaria morbidity events.

Knowledge, behaviours, practices and beliefs regarding Human African Trypanosomiasis (HAT) among inhabitants of Kinshasa (Democratic Republic of Congo).

BACKGROUND: In Kinshasa, an average of less than 50 new cases of Human African Trypanosomiasis was notified, per year, between 1969 and 1995. The situation of endemic sleeping sickness suddenly worsened in 1996 with 254 new cases identified thanks to passive detection. No study dealing with conceptions relative to sleeping sickness was ever listed to date. The objective of this study was to determine the level of knowledge, behaviours, practices and local beliefs about sleeping sickness among residents of the endemic zone of Kinshasa. METHODS: The investigation relied on a case/control study. We used a quantitative and qualitative methodology (structured questionnaire and focus on discussion groups). Case-patients were people affected by trypanosomiasis between the 1st of January 2004 and the 31st of December 2005 and who registered to the National Human African Trypanosomiasis Program (PNLTHA-RDC). Controls were seronegative residents. The case/control ratio was of 1/2. RESULTS: A total of 437 case-patients and 874 controls were included in the study. Level of knowledge of elementary concepts about trypanosomiasis was low among case-patients (44%). The proportion of participants with a low level of education was more important in the group of case-patients (40%) than in the control group (25.6%). The supernatural origin of trypanosomiasis was evoked such as divine, sorcery and transgression of rules. Many respondents (31.4%) call on churches for help when they are not satisfied with the health centre where first therapeutic aid is provided. An important proportion of people who participated to the study (87%) were in favour of a passive detection. After testing the degree of statistical significance, several variables appeared to be determining factors for the acquisition of knowledge of Human African Trypanosomiasis in the city of Kinshasa: education level (elevated: 81%, low: 19%; p < 0.0001), age (> or =20 years old: 89.9%, < 20 years old: 10.1%; p < 0.0001), sex (57.2% of patients were male and 42.8% were female; p < 0.001), birth place (51.4% were not native of Kinshasa and 48.6% were indigenous or born in Kinshasa; p < 0.05) and travel/stay in endemic areas (yes: 56.3%, no: 43.7%; p < 0.0001). CONCLUSION: The very restrained knowledge of people involves a generalized lack of interest. Their behaviour illustrates their lack of concern by the fight against trypanosomiasis. Beliefs and practices of Kinshasa's inhabitants (coming from their conceptions) also stand in the way of plans meant to fight the disease. It is necessary to improve the knowledge of preventive strategies and to fight social prejudice and false beliefs by informing and educating populations.