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 The Impact of Improved Water Supply on Cholera and Diarrhoeal Diseases in Uvira, Democratic Republic of the Congo: A Protocol for a Pragmatic Stepped-Wedge Cluster Randomised Trial and Economic Evaluation

2021 ◽  
Author(s):  
Karin Gallandat ◽  
Aurélie Jeandron ◽  
Ian Ross ◽  
Jaime Mufitini Saidi ◽  
Baron Bashige Rumedeka ◽  
...  
Keyword(s):  
Water Supply ◽  
Large Scale ◽  
Democratic Republic ◽  
Randomised Trial ◽  
Diarrhoeal Disease ◽  
Cluster Randomised Trial ◽  
Stepped Wedge ◽  
Cluster Randomised ◽  
Republic Of The Congo ◽  
The Impact

Abstract Introduction. Diarrhoeal disease remains a leading cause of mortality and morbidity worldwide. Cholera alone is estimated to cause 95,000 deaths per year, most of which occur in endemic settings with inadequate water access. Whilst a global strategy to eliminate cholera by 2030 calls for investment in improved drinking water services, there is limited rigorous evidence for the impact of improved water supply on endemic cholera transmission in low-income urban settings. Our protocol is designed to deliver a pragmatic health impact evaluation of a large-scale water supply intervention in Uvira (Democratic Republic of the Congo), a cholera transmission hotspot. Methods/Design.A stepped-wedge cluster randomised trial (SW-CRT) was designed to evaluate the impact of a large-scale drinking water supply intervention on cholera incidence among the 280,000 inhabitants of Uvira. The city was divided into 16 clusters, where new community and household taps will be installed following a randomised sequence over a transition period of up to 8 weeks in each cluster. The primary trial outcomes are the monthly incidence of “confirmed” cholera cases (patients testing positive by rapid detection kit) and of “suspected” cholera cases (patients admitted to the cholera treatment centre). Concurrent process and economic evaluations will provide further information on the context, costs and efficiency of the intervention. Discussion.In this protocol, we describe a pragmatic approach to conducting rigorous research to assess the impacts of a complex water supply intervention on severe diarrhoeal disease and cholera in an unstable, low-resource setting representative of cholera-affected areas. In particular, we discuss a series of pre-identified risks and linked mitigation strategies as well as the value of combining different data collection methods and preparation of multiple analysis scenarios to account for possible deviations from the protocol. The study described here has the potential to provide robust evidence to support more effective cholera control in challenging, high-burden settings. Trial registration. This trial is registered on clinicaltrials.gov (NCT02928341, 10th October 2016, https://clinicaltrials.gov/ct2/show/NCT02928341) and has received ethics approval from the London School of Hygiene and Tropical Medicine (8913, 10603) and from the Ethics Committee from the School of Public Health, University of Kinshasa, Democratic Republic of the Congo (ESP/CE/088/2015).

scholarly journals The impact of improved water supply on cholera and diarrhoeal diseases in Uvira, Democratic Republic of the Congo: a protocol for a pragmatic stepped-wedge cluster randomised trial and economic evaluation

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Karin Gallandat ◽  
Aurélie Jeandron ◽  
Ian Ross ◽  
Jaime Mufitini Saidi ◽  
Baron Bashige Rumedeka ◽  
...  
Keyword(s):  
Water Supply ◽  
Large Scale ◽  
Democratic Republic ◽  
Randomised Trial ◽  
Diarrhoeal Disease ◽  
Cluster Randomised Trial ◽  
Stepped Wedge ◽  
Cluster Randomised ◽  
Republic Of The Congo ◽  
The Impact

Abstract Introduction Diarrhoeal disease remains a leading cause of mortality and morbidity worldwide. Cholera alone is estimated to cause 95,000 deaths per year, most of which occur in endemic settings with inadequate water access. Whilst a global strategy to eliminate cholera by 2030 calls for investment in improved drinking water services, there is limited rigorous evidence for the impact of improved water supply on endemic cholera transmission in low-income urban settings. Our protocol is designed to deliver a pragmatic health impact evaluation of a large-scale water supply intervention in Uvira (Democratic Republic of the Congo), a cholera transmission hotspot. Methods/design A stepped-wedge cluster randomised trial (SW-CRT) was designed to evaluate the impact of a large-scale drinking water supply intervention on cholera incidence among the 280,000 inhabitants of Uvira. The city was divided into 16 clusters, where new community and household taps will be installed following a randomised sequence over a transition period of up to 8 weeks in each cluster. The primary trial outcomes are the monthly incidence of “confirmed” cholera cases (patients testing positive by rapid detection kit) and of “suspected” cholera cases (patients admitted to the cholera treatment centre). Concurrent process and economic evaluations will provide further information on the context, costs, and efficiency of the intervention. Discussion In this protocol, we describe a pragmatic approach to conducting rigorous research to assess the impacts of a complex water supply intervention on severe diarrhoeal disease and cholera in an unstable, low-resource setting representative of cholera-affected areas. In particular, we discuss a series of pre-identified risks and linked mitigation strategies as well as the value of combining different data collection methods and preparation of multiple analysis scenarios to account for possible deviations from the protocol. The study described here has the potential to provide robust evidence to support more effective cholera control in challenging, high-burden settings. Trial registration This trial is registered on clinicaltrials.gov (NCT02928341, 10th October 2016) and has received ethics approval from the London School of Hygiene and Tropical Medicine (8913, 10603) and from the Ethics Committee from the School of Public Health, University of Kinshasa, Democratic Republic of the Congo (ESP/CE/088/2015).

Conflicts in Biafra, Katanga and Cabinda as a result of the geopolitical legacy of colonialism

2020 ◽  
Vol 2020 (10-3) ◽  
pp. 238-246
Author(s):  
Olga Dzhenchakova
Keyword(s):  
Democratic Republic ◽  
Economic Factor ◽  
Colonial Period ◽  
Sub Saharan Africa ◽  
Negative Consequences ◽  
Post Colonial ◽  
Republic Of The Congo ◽  
Sub Saharan ◽  
The Republic ◽  
The Impact

The article considers the impact of the colonial past of some countries in sub-Saharan Africa and its effect on their development during the post-colonial period. The negative consequences of the geopolitical legacy of colonialism are shown on the example of three countries: Nigeria, the Democratic Republic of the Congo and the Republic of Angola, expressed in the emergence of conflicts in these countries based on ethno-cultural, religious and socio-economic contradictions. At the same time, the focus is made on the economic factor and the consequences of the consumer policy of the former metropolises pursuing their mercantile interests were mixed.

Dietary Patterns: A New Therapeutic Approach for Depression?

2019 ◽  
Vol 20 (2) ◽  
pp. 123-129 ◽  
Author(s):  
Mariana Jesus ◽  
Tânia Silva ◽  
César Cagigal ◽  
Vera Martins ◽  
Carla Silva
Keyword(s):  
Depressive Symptoms ◽  
Dietary Patterns ◽  
Large Scale ◽  
Randomized Clinical Trials ◽  
Dietary Intervention ◽  
Common Mental Disorder ◽  
Controlled Trial ◽  
Statistical Significance ◽  
Inverse Association ◽  
The Impact

Introduction: The field of nutritional psychiatry is a fast-growing one. Although initially, it focused on the effects of vitamins and micronutrients in mental health, in the last decade, its focus also extended to the dietary patterns. The possibility of a dietary cost-effective intervention in the most common mental disorder, depression, cannot be overlooked due to its potential large-scale impact. Method: A classic review of the literature was conducted, and studies published between 2010 and 2018 focusing on the impact of dietary patterns in depression and depressive symptoms were included. Results: We found 10 studies that matched our criteria. Most studies showed an inverse association between healthy dietary patterns, rich in fruits, vegetables, lean meats, nuts and whole grains, and with low intake of processed and sugary foods, and depression and depressive symptoms throughout an array of age groups, although some authors reported statistical significance only in women. While most studies were of cross-sectional design, making it difficult to infer causality, a randomized controlled trial presented similar results. Discussion: he association between dietary patterns and depression is now well-established, although the exact etiological pathways are still unknown. Dietary intervention, with the implementation of healthier dietary patterns, closer to the traditional ones, can play an important role in the prevention and adjunctive therapy of depression and depressive symptoms. Conclusion: More large-scale randomized clinical trials need to be conducted, in order to confirm the association between high-quality dietary patterns and lower risk of depression and depressive symptoms.

Let’s tweet again? Social networks and literature achievement in high school students

2021 ◽  
pp. 1-64
Author(s):  
Gian Paolo Barbetta ◽  
Paolo Canino ◽  
Stefano Cima
Keyword(s):  
High School ◽  
High School Students ◽  
Web 2.0 ◽  
Large Scale ◽  
Standardized Test ◽  
Controlled Trial ◽  
School Students ◽  
Negative Effect ◽  
Internet Connections ◽  
The Impact

Abstract The availability of cheap Wi-Fi internet connections has encouraged schools to adopt Web 2.0 platforms for teaching, with the intention of stimulating students’ academic achievement and participation in school. Moreover, during the recent explosion of the SARS-CoV-2 crisis that forced many countries to close schools (as well as offices and factories), the widespread diffusion of these applications kept school systems going. Despite their widespread use as teaching tools, the effect of adopting Web 2.0 platforms on students’ performance has never been rigorously tested. We fill this gap in the literature by analyzing the impact of using Twitter as a teaching tool on high school students’ literature skills. Based on a large-scale, randomized controlled trial that involved 70 schools and about 1,500 students, we find that using Twitter to teach literature has an overall negative effect on students’ average achievement, reducing standardized test scores by about 25 percent of a standard deviation. The negative effect is stronger on students who usually perform better.

Overcoming the Challenges of Experimental Research: Lessons From a Criminal Justice Case Study Involving TASER Exposure

2018 ◽  
Vol 42 (3) ◽  
pp. 358-385 ◽  
Author(s):  
Natalie Todak ◽  
Michael D. White ◽  
Lisa M. Dario ◽  
Andrea R. Borrego
Keyword(s):  
Criminal Justice ◽  
Large Scale ◽  
Human Subjects ◽  
Controlled Trial ◽  
Human Subjects Research ◽  
Case Study Approach ◽  
Study Approach ◽  
Randomized Controlled ◽  
The Impact

Objective: To provide guidance to criminologists for conducting experiments in light of two common discouraging factors: the belief that they are overly time-consuming and the belief that they can compromise the ethical principles of human subjects’ research. Method: A case study approach is used, based on a large-scale randomized controlled trial experiment in which we exposed participants to a 5-s TASER shock, to describe how the authors overcame ethical, methodological, and logistical difficulties. Results: We derive four pieces of advice from our experiences carrying out this experimental trial: (1) know your limitations, (2) employ pilot testing, (3) remain flexible and patient, and (4) “hold the line” to maintain the integrity of the research and the safety of human subjects. Conclusions: Criminologists have an obligation to provide the best possible evidence regarding the impact and consequences of criminal justice practices and programs. Experiments, considered by many to be the gold standard of empirical research methodologies, should be used whenever possible in order to fulfill this obligation.

scholarly journals Genetic legacy of state centralization in the Kuba Kingdom of the Democratic Republic of the Congo

2018 ◽  
Vol 116 (2) ◽  
pp. 593-598 ◽  
Author(s):  
Lucy van Dorp ◽  
Sara Lowes ◽  
Jonathan L. Weigel ◽  
Naser Ansari-Pour ◽  
Saioa López ◽  
...  
Keyword(s):  
Large Scale ◽  
Democratic Republic ◽  
Central Province ◽  
Genome Wide ◽  
Genetic Patterns ◽  
Genetic Impact ◽  
Genome Wide Data ◽  
Republic Of The Congo ◽  
History Of ◽  
State Centralization

Few phenomena have had as profound or long-lasting consequences in human history as the emergence of large-scale centralized states in the place of smaller scale and more local societies. This study examines a fundamental, and yet unexplored, consequence of state formation: its genetic legacy. We studied the genetic impact of state centralization during the formation of the eminent precolonial Kuba Kingdom of the Democratic Republic of the Congo (DRC) in the 17th century. We analyzed genome-wide data from over 690 individuals sampled from 27 different ethnic groups from the Kasai Central Province of the DRC. By comparing genetic patterns in the present-day Kuba, whose ancestors were part of the Kuba Kingdom, with those in neighboring non-Kuba groups, we show that the Kuba today are more genetically diverse and more similar to other groups in the region than expected, consistent with the historical unification of distinct subgroups during state centralization. We also found evidence of genetic mixing dating to the time of the Kingdom at its most prominent. Using this unique dataset, we characterize the genetic history of the Kasai Central Province and describe the historic late wave of migrations into the region that contributed to a Bantu-like ancestry component found across large parts of Africa today. Taken together, we show the power of genetics to evidence events of sociopolitical importance and highlight how DNA can be used to better understand the behaviors of both people and institutions in the past.

scholarly journals The impact of support programmes for survivors of sexual violence: micro-level evidence from eastern Democratic Republic of the Congo

2018 ◽  
Vol 34 (3) ◽  
pp. 201-223 ◽  
Author(s):  
Christine Amisi ◽  
Rosalie Biaba Apassa ◽  
Aline Cikara ◽  
Gudrun Østby ◽  
Ragnhild Nordås ◽  
...  
Keyword(s):  
Sexual Violence ◽  
Democratic Republic ◽  
Republic Of The Congo ◽  
Micro Level ◽  
Support Programmes ◽  
The Impact

scholarly journals The Impact of Different Types of Violence on Ebola Virus Transmission During the 2018–2020 Outbreak in the Democratic Republic of the Congo

2020 ◽  
Vol 222 (12) ◽  
pp. 2021-2029
Author(s):  
John Daniel Kelly ◽  
Sarah Rae Wannier ◽  
Cyrus Sinai ◽  
Caitlin A Moe ◽  
Nicole A Hoff ◽  
...  
Keyword(s):  
Time Series ◽  
Ebola Virus ◽  
Democratic Republic ◽  
Linear Time ◽  
Series Data ◽  
Absolute Increase ◽  
Republic Of The Congo ◽  
Health Zone ◽  
The Impact ◽  
Violent Events

Abstract Background Our understanding of the different effects of targeted versus nontargeted violence on Ebola virus (EBOV) transmission in Democratic Republic of the Congo (DRC) is limited. Methods We used time-series data of case counts to compare individuals in Ebola-affected health zones in DRC, April 2018–August 2019. Exposure was number of violent events per health zone, categorized into Ebola-targeted or Ebola-untargeted, and into civilian-induced, (para)military/political, or protests. Outcome was estimated daily reproduction number (Rt) by health zone. We fit linear time-series regression to model the relationship. Results Average Rt was 1.06 (95% confidence interval [CI], 1.02–1.11). A mean of 2.92 violent events resulted in cumulative absolute increase in Rt of 0.10 (95% CI, .05–.15). More violent events increased EBOV transmission (P = .03). Considering violent events in the 95th percentile over a 21-day interval and its relative impact on Rt, Ebola-targeted events corresponded to Rt of 1.52 (95% CI, 1.30–1.74), while civilian-induced events corresponded to Rt of 1.43 (95% CI, 1.21–1.35). Untargeted events corresponded to Rt of 1.18 (95% CI, 1.02–1.35); among these, militia/political or ville morte events increased transmission. Conclusions Ebola-targeted violence, primarily driven by civilian-induced events, had the largest impact on EBOV transmission.

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