scholarly journals Danger signs and management of suspected severe malaria cases at community level and in referral health facilities: an operational study in the Democratic Republic of the Congo

2021 ◽  
Author(s):  
Jean Okitawutshu ◽  
Aita Signorell ◽  
Jean-Claude Kalenga ◽  
Eric Mukomena ◽  
Giulia Delvento ◽  
...  
Keyword(s):  
Case Management ◽  
Severe Malaria ◽  
Democratic Republic ◽  
Case Fatality ◽  
Care Seeking ◽  
Danger Signs ◽  
Treatment Provision ◽  
Successful Case ◽  
Injectable Treatment ◽  
Republic Of The Congo

AbstractBackgroundEvidence from one trial in Africa suggests that pre-referral Rectal Artesunate (RAS) can be a life-saving intervention for severe malaria in remote settings, where parenteral treatment is not available. Recognition of danger signs indicative of severe malaria is critical for prompt and appropriate case management.MethodsAn observational study was conducted in the Democratic Republic of the Congo (DRC) in the frame of the multi-country CARAMAL project, to assess the effectiveness of RAS under real-world conditions. Severely ill feverish children <5 years seeking care from a community-based healthcare provider were recruited in three rural health zones into a patient surveillance system. They were subsequently followed within the healthcare system and at home after 28 days to determine care seeking, antimalarial treatment provision and health outcomes.ResultsOverall, 66.4% of patients had iCCM general danger signs, as well as more specific danger signs. Children aged 2-5 years (aOR=1.58, 95% CI 1.20–2.08) and those presenting iCCM general danger signs were more likely to receive RAS (aOR = 2.77, 95% CI 2.04–3.77). Injectable treatment was less likely with RAS pre-referral treatment (aOR=0.21, 95% 0.13– 0.33). In the post-RAS phase, the case fatality ratio was 7.1%. Children not receiving RAS had a higher risk of dying, but this was not statistically significant (aOR = 1.50, 95% CI 0.86– 2.60). The odds of dying were reduced in patients without iCCM general danger signs, but just not statistically so (aOR = 0.64, 95% CI 0.38–1.06). Full oral therapy at a RHF was highly protective (aOR = 0.13, 95% CI 0.07-0.26), while a full treatment of severe malaria (injectable + oral) was shown to also decrease massively the odds of dying (aOR = 0.26, 95% CI 0.09– 0.79) compared to injectable treatment alone.ConclusionsBetter understanding the determinants of successful case management, and targeted improvements of the health system (especially the provision of a full course of an oral antimalarial) are crucial for improving health oucomes of children with suspected severe malaria.

scholarly journals The changing epidemiology of human monkeypox - a potential threat? A systematic review

2021 ◽  
Author(s):  
Eveline Bunge ◽  
Bernard Hoet ◽  
Liddy Chen ◽  
Florian Lienert ◽  
Heinz Weidenthaler ◽  
...  
Keyword(s):  
Systematic Review ◽  
Democratic Republic ◽  
Data Extraction ◽  
Grey Literature ◽  
Case Fatality ◽  
West African ◽  
Smallpox Vaccination ◽  
Potential Threat ◽  
Significant Difference ◽  
Republic Of The Congo

Monkeypox, a zoonotic disease caused by an orthopoxvirus, results in a smallpox-like disease in humans. Since monkeypox in humans was initially diagnosed in 1970 in the Democratic Republic of the Congo (DRC), it has spread to other regions of Africa (primarily West and Central), and cases outside Africa have emerged in recent years. We conducted a systematic review of peer-reviewed and grey literature on how monkeypox epidemiology has evolved, with particular emphasis on the number of confirmed, probable, and/or possible cases, age at presentation, mortality, and geographical spread. The review is registered with PROSPERO (CRD42020208269). We identified 48 peer-reviewed articles and 18 grey literature sources for data extraction. The number of human monkeypox cases has been on the rise since the 1970s, with the most dramatic increases occurring in the DRC. The median age at presentation has increased from 4 (1970s) to 21 years (2010-2019). There was an overall case fatality rate of 8.7%, with a significant difference between clades - Central African 10.6% (95% CI: 8.4% - 13.3%) vs. West African 3.6% (95% CI: 1.7% - 6.8%). Since 2003, import- and travel-related spread outside of Africa has occasionally resulted in outbreaks. Interactions/activities with infected animals or individuals are risk behaviors associated with acquiring monkeypox. Our review shows an escalation of monkeypox cases, especially in the highly endemic DRC, a spread to other countries, and a growing median age from young children to young adults. These findings may be related to the cessation of smallpox vaccination, which provided some cross-protection against monkeypox, leading to increased human-to-human transmission. The appearance of outbreaks beyond Africa highlights the global relevance of the disease. Increased surveillance and detection of monkeypox cases are essential tools for understanding the continuously changing epidemiology of this resurging disease.

scholarly journals Care-Seeking Behavior by Survivors of Sexual Assault in the Democratic Republic of the Congo

2011 ◽  
Vol 101 (6) ◽  
pp. 1054-1055 ◽  
Author(s):  
Sara E. Casey ◽  
Meghan C. Gallagher ◽  
Babou Rukengeza Makanda ◽  
Janet L. Meyers ◽  
Mereia Cano Vinas ◽  
...  
Keyword(s):  
Sexual Assault ◽  
Democratic Republic ◽  
Care Seeking ◽  
Care Seeking Behavior ◽  
Seeking Behavior ◽  
Republic Of The Congo

scholarly journals Treatment-seeking for children with suspected severe malaria attending community health workers and primary health centres in Adamawa State, Nigeria

2021 ◽  
Author(s):  
Tristan T. Lee ◽  
Elizabeth Omoluabi ◽  
Kazeem Ayodeji ◽  
Ocheche Yusuf ◽  
Charles Okon ◽  
...  
Keyword(s):  
Severe Malaria ◽  
Case Fatality Rate ◽  
Health Workers ◽  
Case Fatality ◽  
Treatment Seeking ◽  
Community Based ◽  
Danger Signs ◽  
Primary Health ◽  
Primary Health Centres ◽  
Rectal Artesunate

AbstractBackgroundThe Community Access to Rectal Artesunate for Malaria project investigated the feasibility of introducing pre-referral rectal artesunate into existing community-based health services. In that study, the case fatality rate of children visiting primary health centres (PHCs) was 19% compared to 6% in children first visiting community health workers, locally called Community Oriented Resource Persons (CORPs). As case management practices did not fully explain this finding, this publication investigates other reasons underlying the observed difference in case fatality.MethodsThe observational study enrolled 589 children under the age of five years with fever and danger signs indicative of severe malaria attending CORPs and PHCs in Adamawa State, Nigeria, between June 2018 and July 2020. After 28 days, follow-up visits were conducted with caregivers to understand background characteristics, severity of symptoms, home treatment administration, and treatment seeking practices during the child’s illness. These factors were compared between children visiting CORPs versus those visiting PHCs as their first health provider.ResultsChildren visiting PHCs were more likely to display danger signs indicative of central nervous system involvement (90% vs. 74%, p < 0.01) and have four or more danger signs (50% vs. 39%, p = 0.02). The delay between illness onset and visiting the community-based provider did not differ between children attending a CORP and children attending a PHC. PHC attendances more often lived in urban areas (16% vs 4%, p=0.01) and travelled farther to their first health provider, which was usually a community-based provider. Although practicing home treatment was common, especially among children attending PHCs (42% vs 33%, p=0.04), almost none of the children were given an antimalarial. PHCs were visited for their professionalism and experience while CORPs were visited for their low cost and because caregivers personally knew and trusted the provider.ConclusionsOur comparison of children with suspected severe malaria seeking care from two kinds of community-based health care providers in Nigeria suggest that illness severity may be the primary driver behind the observed difference in case fatality rate.

scholarly journals Pre-referral rectal artesunate and referral completion among children with suspected severe malaria in the Democratic Republic of the Congo, Nigeria and Uganda

2021 ◽  
Author(s):  
Nina C Brunner ◽  
Elizabeth Omoluabi ◽  
Phyllis Awor ◽  
Jean Okitawutshu ◽  
Antoinette Tshefu ◽  
...  
Keyword(s):  
Severe Malaria ◽  
Democratic Republic ◽  
Health Workers ◽  
Health Centre ◽  
Rapid Improvement ◽  
Primary Health ◽  
Republic Of The Congo ◽  
Referral Completion ◽  
Rectal Artesunate ◽  
Roll Out

Background: Children who receive pre-referral rectal artesunate (RAS) require urgent referral to a health facility where appropriate treatment for severe malaria can be provided. However, the rapid improvement of a child's condition after RAS administration may influence a caregiver's decision to follow this recommendation. Currently, the evidence on the effect of RAS on referral completion is limited. In this study, we investigated the relationship between RAS implementation and administration and referral completion. Methods and Findings: An observational study accompanied the roll-out of RAS in three malaria endemic settings in the Democratic Republic of the Congo (DRC), Nigeria and Uganda. Community health workers and primary health centres enrolled children under five years with suspected severe malaria before and after the roll-out of RAS. All children were followed up 28 days after enrolment to assess their treatment seeking pathways, treatments received, and their health outcome. In total, 8,365 children were enrolled, 77% of whom fulfilled all inclusion criteria and had a known referral completion status. Referral completion was 67% (1,408/2,104) in DRC, 48% (287/600) in Nigeria and 58% (2,170/3,745) in Uganda. In DRC and Uganda, RAS users were less likely to complete referral than RAS non-users in the pre-roll-out phase (adjusted odds ratio [aOR] = 0.48, 95% CI 0.30-0.77 and aOR = 0.72, 95% CI 0.58-0.88, respectively). Among children seeking care from a primary health centre in Nigeria, RAS users were less likely to complete referral compared to RAS non-users in the post-roll-out phase (aOR = 0.18, 95% CI 0.05-0.71). In Uganda, among children who completed referral, RAS users were significantly more likely to complete referral on time than RAS non-users enrolled in the pre-roll-out phase (aOR = 1.81, 95% CI 1.17-2.79). Conclusions: The findings of this study raise legitimate concerns that the roll-out of RAS may lead to lower referral completion in children who were administered pre-referral RAS. To ensure that community-based programmes are effectively implemented, barriers to referral completion need to be addressed at all levels. Alternative effective treatment options should be provided to children unable to complete referral.

scholarly journals Adherence to the referral advice after introduction of rectal artesunate for pre-referral treatment of severe malaria at the community level: a noninferiority trial in the Democratic Republic of the Congo

2019 ◽  
Vol 18 (1) ◽  
Author(s):  
Patrick M. Mvumbi ◽  
Jeanine Musau ◽  
Ousmane Faye ◽  
Hyppolite Situakibanza ◽  
Emile Okitolonda
Keyword(s):  
Community Health ◽  
Severe Malaria ◽  
Community Health Workers ◽  
Democratic Republic ◽  
Community Care ◽  
Health Workers ◽  
Post Intervention ◽  
Republic Of The Congo ◽  
Rectal Artesunate ◽  
Children Under 5

Abstract Background The Democratic Republic of the Congo adopted the strategy of using, at the community level, a dose of rectal artesunate as a pre-referral treatment for severe malaria amongst children under 5 years who could not quickly reach a health care facility and take oral medication. However, the adherence to referral advice after the integration of this strategy and the acceptability of the strategy were unknown. Methods To assess adherence by the mothers/caretakers of children under 5 years to referral advice provided by the community health workers after pre-referral treatment of severe malaria with rectal artesunate, the authors conducted a noninferiority community trial with a pre- and post-intervention design in 63 (pre-intervention) and 51 (post-intervention) community care sites in 4 provinces (Kasaï-Oriental, Kasaï-Central, Lomami, Lualaba) from August 2014 through June 2016. The pre- and post-intervention surveys targets 387 mothers of children under 5 years and 63 community health workers and 346 mothers and 41 community health workers, respectively. A 15% margin was considered for noninferiority analyses due to the expected decrease in adherence to referral advice after the introduction of the new intervention. Results The mothers acknowledged that the rectal route was often used (60.7%), and medicines given rectally were considered more effective (63.6%) and easy to administer (69.7%). The acceptability of pre-referral rectal artesunate was relatively high: 79.4% (95% CI 75.4–83.3) among mothers, 90.3% (95% CI 82.3–96.8) among community health workers, and 97.8% (95% CI 93.3–100) among nurses. Adherence to referral advice at post-intervention [84.3% (95% CI 80.6–88.1)] was non-inferior to pre-intervention adherence [94.1% (95% CI 91.7–96.4)]. Conclusions The integration of pre-referral rectal artesunate for severe malaria into the community care site in the DR Congo is feasible and acceptable. It positively affected adherence to referral advice. However, more health education is needed for parents of children under 5 years and community health workers.

scholarly journals Neuromeningeal cryptococcosis in HIV-infected patients in Lubumbashi, Democratic Republic of the Congo

2021 ◽  
Vol 11 (3) ◽  
pp. 73-77
Author(s):  
Joe Kabongo Katabwa ◽  
Olivier Mukuku ◽  
Guy Kanja Lwamba ◽  
Stanislas Okitotsho Wembonyama
Keyword(s):  
Opportunistic Infection ◽  
Case Fatality Rate ◽  
Democratic Republic ◽  
Case Fatality ◽  
Hiv Positive ◽  
Fatality Rate ◽  
Clinical Symptomatology ◽  
Appropriate Treatment ◽  
Republic Of The Congo ◽  
The Mean

Introduction: Neuromeningeal cryptococcosis (NMC) is a severe and fatal opportunistic infection. Lethality is higher in the absence of treatment, especially in HIV co-infection. The objective of the present study was to determine the prevalence, epidemiological, clinical, biological, and therapeutic features as well as the outcome of NMC in HIV-infected patients. Methods: This is a retrospective study of 108 cases of NMC diagnosed in HIV-infected patients. Data were collected over 36 months (from January 2015 to December 2017) at the HIV/AIDS Center of Excellence in Lubumbashi (Democratic Republic of the Congo). Results: The overall prevalence of NMC is 2.5%. The mean age of the patients was 41.5±13.1 years, with 72.2% aged less than 50 years. The main clinical symptomatology was headache (100%) and fever (100%). The main cytochemical CSF abnormalities were hyperproteinorachia (91.9%), hypoglycorachia (94%) and hyper-lymphocytosis (98.2%). The mean CD4 count was 168.7±137.1/mm3. All patients were treated with fluconazole. The overall lethality was 43.5%. Conclusion: NMC is a serious opportunistic infection in HIV-infected patients, and the case fatality rate remains unacceptable. Management of NMC in HIV-positive patients requires early diagnosis, increased access to antiretrovirals and prompt initiation of appropriate treatment.

scholarly journals Community access to rectal artesunate for malaria (CARAMAL): a large-scale observational implementation study in the Democratic Republic of the Congo, Nigeria and Uganda

2021 ◽  
Author(s):  
Christian Lengeler ◽  
Christian Burri ◽  
Phyllis Awor ◽  
Prosciova Athieno ◽  
Joseph Kimera ◽  
...  
Keyword(s):  
Case Management ◽  
Health Facility ◽  
Large Scale ◽  
Democratic Republic ◽  
Controlled Trial ◽  
Implementation Study ◽  
Republic Of The Congo ◽  
The Impact ◽  
Community Access ◽  
Rectal Artesunate

AbstractThe key to reducing malaria deaths in highly endemic areas is prompt access to quality case management. Given that many severe cases occur at peripheral level, rectal artesunate (RAS) in the form of suppositories was developed in the 1990s. RAS allows the rapid initiation of life-saving antimalarial treatment, before referral to a health facility with full case management capabilities. One randomized controlled trial published in 2009 showed a protective effect of RAS pre-referral treatment against overall mortality of 26%, but with significant differences according to study sites and length of referral. Two important issues remained unaddressed to-date: (1) whether the mortality impact of RAS observed under controlled trial conditions could be replicated under real-world circumstances; and (2) clear operational guidance for the wide-scale implementation of RAS, including essential health system determinants for optimal impact.From 2018 to 2020, the Community Access to Rectal Artesunate for Malaria (CARAMAL) project was conducted as a large-scale observational implementation study in Nigeria, Uganda and the Democratic Republic of the Congo (DRC). CARAMAL aimed to provide high-quality field evidence on the two issues above, in three remote settings with high malaria endemicity. In order to achieve this, a number of complementary study components were implemented. The core of the CARAMAL study was the Patient Surveillance System (PSS), which allowed to track cases of severe febrile illness from first contact at the periphery to a referral health facility, and then on to a Day 28 visit at the home of the patient. Community and provider cross-sectional surveys complemented the PSS.Here we describe in some detail RAS implementation, as well as the key CARAMAL study components and basic implementation experience. This manuscript provides an extensive reference document for the companion papers describing the impact, referral process, post-referral treatment and cost-effectiveness of the RAS intervention.

scholarly journals Acceptability of Rectal Artesunate as pre-referral treatment for severe malaria in children under 5 years by health workers and caregivers in the Democratic Republic of the Congo, Nigeria and Uganda

2021 ◽  
Author(s):  
Phyllis Awor ◽  
Joseph Kimera ◽  
Proscovia Athieno ◽  
Gloria Tumukunde ◽  
Jean Okitawutshu ◽  
...  
Keyword(s):  
Severe Malaria ◽  
Democratic Republic ◽  
Health Workers ◽  
Household Surveys ◽  
Care Providers ◽  
Child Caregivers ◽  
Republic Of The Congo ◽  
Rectal Artesunate ◽  
Roll Out ◽  
Children Under 5

Background In children below 6 years with suspected severe malaria who are several hours from facilities providing parenteral treatment, pre-referral rectal artesunate (RAS) is recommended by the World Health Organization to prevent death and disability. A number of African countries are in the process of rolling out quality-assured RAS for pre-referral treatment of severe malaria at community-level. The success of RAS depends, among other factors, on the acceptability of RAS in the communities where it is being rolled-out. Yet to date, there is limited literature on RAS acceptability. This study aimed to determine the acceptability of RAS by health care providers and child caregivers in communities where quality assured RAS was rolled out. Methods This study was nested within the comprehensive multi-country observational research project Community Access to Rectal Artesunate for Malaria (CARAMAL). The CARAMAL project was implemented in the Democratic Republic of the Congo (DRC), Nigeria, and Uganda between 2018 and 2020. Data from three different sources were analysed to understand RAS acceptability: Interviews with health workers during three healthcare provider surveys, with caregivers of children under 5 years of age during three household surveys, and with caregivers of children who were recently treated with RAS and enrolled in the CARAMAL Patient Surveillance System. Results RAS acceptability was high among all interviewed stakeholders in the three countries. After the roll-out of RAS, 97-100% heath care providers in DRC considered RAS medication as very good or good, as well as 98-100% in Nigeria and 93-100% in Uganda. Majority of caregivers whose children had received rectal artesunate for pre-referral management of severe malaria indicated that they would want to get the medication again, if their child had the same illness (99.8% of caregivers in DRC, 100% in Nigeria and 99.9% in Uganda). Further, using data from three household surveys, 67-80% of caregivers whose children had not received RAS considered the medication as useful. Conclusion RAS was well accepted by health workers and child caregivers in DRC, Nigeria and Uganda. Acceptability is unlikely to be an obstacle to the large-scale roll-out of RAS in the studied settings.

Sign in / Sign up

Export Citation Format

Share Document