Efficacy of fixed-dose combination artesunate-amodiaquine versus artemether-lumefantrine for uncomplicated childhood Plasmodium falciparum malaria in Democratic Republic of Congo: a randomized non-inferiority trial.

BACKGROUND: In 2005, the Democratic Republic of Congo (DRC) adopted artesunate and amodiaquine (ASAQ) as first-line anti-malarial treatment. In order to compare the efficacy of the fixed-dose formulation ASAQ versus artemether-lumefantrine (AL), a randomized, non-inferiority open-label trial was conducted in Katanga. METHODS: Children aged six and 59 months with uncomplicated Plasmodium falciparum malaria were enrolled and randomly allocated into one of the two regimens. The risk of recurrent parasitaemia by day 42, both unadjusted and adjusted by PCR genotyping to distinguish recrudescence from new infection, was analysed. RESULTS: Between April 2008 and March 2009, 301 children were included: 156 with ASAQ and 145 with AL. No early treatment failures were reported. Among the 256 patients followed-up at day 42, 32 patients developed late clinical or parasitological failure (9.9% (13/131) in the ASAQ group and 15.2% (19/125) in the AL group). After PCR correction, cure rates were 98.3% (95%CI, 94.1-99.8) in the ASAQ group and 99.1% (95%CI, 94.9-99.9) in the AL group (difference -0.7%, one sided 95% CI -3.1). Kaplan-Meier PCR-adjusted cure rates were similar. Both treatment regimens were generally well tolerated. CONCLUSION: Both ASAQ and AL are highly effective and currently adequate as the first-line treatment of uncomplicated falciparum malaria in this area of Katanga, DRC. However, in a very large country, such as DRC, and because of possible emergence of resistance from other endemic regions, surveillance of efficacy of artemisinin-based combination treatments, including other evaluations of the resistance of ASAQ, need to be done in other provinces. TRIAL REGISTRATION: The protocol was registered with the clinicaltrials.gov, open clinical trial registry under the identifier number NCT01567423.

[Frequency of sexually transmitted infections and related factors in Pweto, Democratic Republic of Congo, 2004]. / Frecuencia de infecciones de transmisión sexual y factores relacionados en Pweto, República Democrática del Congo, 2004.

OBJECTIVES: To estimate the prevalence of genital ulcer and urethral discharge in Pweto, Democratic Republic of Congo, and to analyze the association between the estimated prevalence and age, marital status, profession, and number of sexual partners. METHODS: We performed a descriptive cross-sectional study through a survey conducted in May 2004 in a representative sample of 106 men in Pweto aged between 15 and 65 years old, with a precision of 9.5%. Questionnaire items about current or previous ulceration and urethral discharge where self-reported and referred to the previous year as of the date of the survey. To study the associations, crude and adjusted odds ratios (OR) were calculated using multivariate logistic regression. RESULTS: The prevalence was 39.6% (95% confidence interval [CI], 30-49) for urethral discharge and 33% (95%CI, 24-42) for genital ulcer. Soldiers were identified as a risk group independently of age, the number of sexual partners during the previous year, and marital status. The multivariate analysis showed an adjusted OR of 3.25 (95%CI, 1.10-9.95) (p < 0.05) for the frequency of urethral discharge in soldiers compared with other professions. CONCLUSIONS: The high prevalence of sexually transmitted infections in Pweto and the associated factors identified prompted the initiation of a controlled condom donation program for soldiers. In conflict situations with a high prevalence of sexually transmitted infections and lack of health services, humanitarian aid organizations should implement prevention activities focused on risk groups.

Frecuencia de infecciones de transmisión sexual y factores relacionados en Pweto, República Democrática del Congo, 2004 / Frequency of sexually transmitted infections and related factors in Pweto, Democratic Republic of Congo, 2004

Objetivos: Estimar la prevalencia de ulceración genital y exudado uretral en Pweto, República Democrática del Congo, así como analizar la asociación de las prevalencias estimadas, con la edad, el estado civil, la profesión y el número de parejas sexuales. Métodos: Estudio descriptivo y transversal mediante encuesta, realizada a una muestra representativa de 106 varones de Pweto, de entre 15 y 65 años de edad, en mayo de 2004, con una precisión del 9,5%. Las preguntas sobre la presencia actual o antecedentes de ulceración y exudado fueron autoinformadas y referidas al último año a partir del día de la encuesta. Para el estudio de las asociaciones, se calculó la odds ratio (OR) cruda y posteriormente la OR ajustada mediante una regresión logística multivariante. Resultados: La prevalencia fue del 39,6% (intervalo de confianza [IC] del 95%, 30-49) para el exudado uretral y del 33% (IC del 95%, 24-42) para la ulceración genital. Independientemente de la edad, el número de parejas sexuales durante el último año y el estado civil, los militares fueron identificados como un grupo de riesgo. El análisis multivariante nos muestra una OR ajustada de 3,25 (IC del 95%, 1,10-9,95; p < 0,05) para la frecuencia del exudado uretral de los militares frente a otras profesiones. Conclusiones: La alta prevalencia de infecciones de transmisión sexual (ITS) en Pweto y las asociaciones encontradas desencadenaron la instauración de un programa de donación supervisada de preservativos para los militares. En situaciones de conflicto, con alta prevalencia de ITS y los servicios sanitarios deficientes, las organizaciones de ayuda humanitaria deberían implementar actividades de prevención focalizadas en los grupos de riesgo

Objectives: To estimate the prevalence of genital ulcer and urethral discharge in Pweto, Democratic Republic of Congo, and to analyze the association between the estimated prevalence and age, marital status, profession, and number of sexual partners. Methods: We performed a descriptive cross-sectional study through a survey conducted in May 2004 in a representative sample of 106 men in Pweto aged between 15 and 65 years old, with a precision of 9.5%. Questionnaire items about current or previous ulceration and urethral discharge where self-reported and referred to the previous year as of the date of the survey. To study the associations, crude and adjusted odds ratios (OR) were calculated using multivariate logistic regression. Results: The prevalence was 39.6% (95% confidence interval [CI], 30-49) for urethral discharge and 33% (95%CI, 24-42) for genital ulcer. Soldiers were identified as a risk group independently of age, the number of sexual partners during the previous year, and marital status. The multivariate analysis showed an adjusted OR of 3.25 (95%CI, 1.10-9.95) (p < 0.05) for the frequency of urethral discharge in soldiers compared with other professions. Conclusions: The high prevalence of sexually transmitted infections in Pweto and the associated factors identified prompted the initiation of a controlled condom donation program for soldiers. In conflict situations with a high prevalence of sexually transmitted infections and lack of health services, humanitarian aid organizations should implement prevention activities focused on risk groups