scholarly journals Single versus Multiple Dose Ivermectin Regimen in Onchocerciasis-Infected Persons with Epilepsy Treated with Phenobarbital: A Randomized Clinical Trial in the Democratic Republic of Congo

Pathogens ◽  
2020 ◽  
Vol 9 (3) ◽  
pp. 205 ◽  
Author(s):  
Michel Mandro ◽  
Joseph Nelson Siewe Fodjo ◽  
Alfred Dusabimana ◽  
Deby Mukendi ◽  
Steven Haesendonckx ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Seizure Frequency ◽  
Democratic Republic ◽  
Democratic Republic Of Congo ◽  
Analysis Data ◽  
Seizure Freedom ◽  
Republic Of Congo ◽  
Group 2 ◽  
One Year ◽  
Group 1

Background: There is anecdotal evidence that ivermectin may decrease seizure frequency in Onchocerca volvulus-infected persons with epilepsy (PWE). Methods: In October 2017, a 12-month clinical trial was initiated in rural Democratic Republic of Congo. PWE with onchocerciasis-associated epilepsy experiencing ≥2 seizures/month were randomly allocated to receive, over a one-year period, ivermectin once or thrice (group 1), while other onchocerciasis-infected PWE (OIPWE) were randomized to ivermectin twice or thrice (group 2). All participants also received anti-epileptic drugs. Data was analyzed using multiple logistic regression. Results: We enrolled 197 participants. In an intent-to-treat analysis (data from group 1 and 2 combined), seizure freedom was more likely among OIPWE treated with ivermectin thrice (OR: 5.087, 95% CI: 1.378–19.749; p = 0.018) and twice (OR: 2.471, 95% CI: 0.944–6.769; p = 0.075) than in those treated once. Similarly, >50% seizure reduction was more likely among those treated with ivermectin twice (OR: 4.469, 95% CI: 1.250–16.620) and thrice (OR: 2.693, 95% CI: 1.077–6.998). Absence of microfilariae during the last 4 months increased the odds of seizure freedom (p = 0.027). Conclusions: Increasing the number of ivermectin treatments was found to suppress both microfilarial density and seizure frequency in OIPWE, suggesting that O. volvulus infection plays an etiological role in causing seizures.

scholarly journals Single Versus Multiple Dose Ivermectin Regimen in Onchocerciasis-infected Persons with Epilepsy Treated with Phenobarbital: A Randomized Clinical Trial in the Democratic Republic of Congo

2020 ◽  
Author(s):  
Michel Mandro ◽  
Alfred Dusambimana ◽  
Joseph Nelson Siewe Fodjo ◽  
Deby Mukendi ◽  
Stephen Haesendonckx ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Democratic Republic ◽  
Democratic Republic Of Congo ◽  
Seizure Freedom ◽  
Republic Of Congo ◽  
Group 2 ◽  
One Year ◽  
Intent To Treat ◽  
To Receive ◽  
Group 1

Background There is anecdotal evidence that ivermectin may decrease the frequency of seizures in Onchocerca volvulus-infected persons with epilepsy (PWE). Methods In October 2017, a 12-month clinical trial was initiated in rural Democratic Republic of Congo. PWE with onchocerciasis-associated epilepsy with ≥2 seizures/month were randomly allocated to receive over a one year period, ivermectin once or thrice (group 1), while other onchocerciasis-infected PWE (OIPWE) were randomized to ivermectin twice or thrice (group 2). All participants also received anti-epileptic drugs (AED). Study outcomes included seizure freedom during the last four months (primary endpoint), decrease in microfilarial density, and occurrence of adverse events. A multiple logistic regression model was used to evaluate the primary outcome. Results Of the 197 OIPWE enrolled, 100 were randomized to receive ivermectin thrice, 52 twice, and 45 once. In an intent-to-treat combined analysis of data from group 1 and 2, the probability to become seizure-free for OIPWE treated with ivermectin twice per year was significantly higher than in those treated once (OR: 5.087, 95% CI: 1.378-19.749; p=0.018) and individuals who received ivermectin twice had a 4.471 (95% CI: 0.944-6.769, p=0.075) times higher odds of seizure freedom than those received ivermectin once per year. Absence of microfilariae during the last 4 months was associated with a higher probability of seizure freedom (p=0.027). Conclusions Increasing the number of ivermectin treatments per year was found to suppress both microfilarial density and seizure frequency in OIPWE, suggesting that O. volvulus infection plays an etiological role in causing seizures. Registration: www.clinicaltrials.gov; NCT03852303

scholarly journals Status competition in Africa: Explaining the Rwandan–Ugandan clashes in the Democratic Republic of Congo

2018 ◽  
Vol 118 (472) ◽  
pp. 509-530 ◽  
Author(s):  
Henning Tamm
Keyword(s):  
Democratic Republic ◽  
Democratic Republic Of Congo ◽  
World Politics ◽  
Social Psychological ◽  
Republic Of Congo ◽  
Status Competition ◽  
Regional Newspapers ◽  
Ruling Elites ◽  
One Year ◽  
Social Psychological Perspective

Abstract Yoweri Museveni’s rebels seized power in Uganda in 1986, with Rwandan refugees making up roughly a quarter of his troops. These refugees then took power in Rwanda in 1994 with support from Museveni’s regime. Subsequently, between 1999 and 2000, the Rwandan and Ugandan comrades-in-arms turned on each other in a series of deadly clashes in the Democratic Republic of Congo, a country they had invaded together only one year earlier. What explains these fratricidal clashes? This article contends that a social–psychological perspective focused on status competition between the Rwandan and Ugandan ruling elites provides the most compelling answer. Long treated as ‘boys’, the new Rwandan rulers strove to enhance their social status vis-à-vis the Ugandans, seeking first equality and then regional superiority. Economic disputes over Congo’s natural resources at times complemented this struggle for status but cannot explain all of its phases. The article draws on interviews with senior Rwandan, Ugandan, and former Congolese rebel officials, and triangulates them with statements given to national and regional newspapers at the time of the clashes. More broadly, it builds on the recently revitalized study of status competition in world politics and makes a case for integrating research on inter-African relations.

Efficacy and safety of malarial prophylaxis with mefloquine during pregnancy in Kisangani, Democratic Republic of Congo: a randomized clinical trial

2021 ◽  
Author(s):  
Noël Labama Otuli ◽  
Roland Marini Djang’eing’a ◽  
Joris Losimba Likwela ◽  
Jean‐Didier Bosenge Nguma ◽  
Mike‐Antoine Maindo Alongo ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Randomized Clinical Trial ◽  
Democratic Republic ◽  
Democratic Republic Of Congo ◽  
Efficacy And Safety ◽  
Republic Of Congo

scholarly journals Onchocerciasis-associated epilepsy in the Democratic Republic of Congo: Clinical description and relationship with microfilarial density

2019 ◽  
Author(s):  
Joseph Nelson Siewe Fodjo ◽  
Michel Ndahura Mandro ◽  
Deby Mukendi ◽  
Floribert Tepage ◽  
Sonia Menon ◽  
...  
Keyword(s):  
Seizure Frequency ◽  
Clinical Characteristics ◽  
Democratic Republic ◽  
Democratic Republic Of Congo ◽  
Wide Spectrum ◽  
Multivariable Analysis ◽  
Republic Of Congo ◽  
History Of ◽  
Health Zone ◽  
Density Methods

Background: High epilepsy prevalence and incidence were observed in onchocerciasis-endemic villages in the Democratic Republic of Congo (DRC). We sought to investigate the clinical characteristics of onchocerciasis-associated epilepsy (OAE), and the relationship with microfilarial density. Methods: In October 2017, ivermectin-naive persons with epilepsy (PWE) were recruited from onchocerciasis-endemic areas in the Logo health zone in the DRC. Additional PWE were enrolled in the Aketi health zone, where ivermectin had been distributed annually for 14 years. Past medical history, clinical characteristics and skin snips for Onchocerca volvulus detection were obtained from participants. Bivariate and multivariable analyses were used to investigate associations with microfilarial density. Results: Of the 420 PWE in the Logo health zone, 392 were skin snipped (36.5% positive). Generalized motor seizures were most frequent (392 PWE, 93.3%), and nodding seizures were reported in 32 (7.6%) participants. Twelve PWE (3.1%) presented Nakalanga features. More skin snip-positive participants reported a family history of epilepsy (p=0.027). Eighty-one onchocerciasis-infected PWE were recruited in the Aketi health zone. Positive correlations between seizure frequency and microfilarial density were observed in Logo (Spearman-rho=0.181; p=0.0003) and Aketi (Spearman-rho=0.228; p=0.046). In the multivariable analysis which adjusted for age, gender and previous anti-epileptic drug use, factors associated with high seizure frequency included: high microfilarial density (RR=1.004, 95% CI: 1.002–1.007; p<0.001), history of nodding seizures (RR=3.852, 95% CI: 2.926–5.082; p<0.001) and shorter duration of epilepsy (RR=0.948, 95% CI: 0.928–0.968; p<0.001). In Aketi, previous ivermectin use was associated with reduced seizures (RR=0.69, 95% CI: 0.58–0.83; p<0.001). Conclusion: In onchocerciasis-endemic regions in the DRC, a wide spectrum of seizures was observed. Nodding seizures, Nakalanga features, and a positive association between microfilarial density and seizures suggest a high OAE prevalence in the study villages, requiring a double management strategy: treatment with anti-epileptic drugs and stronger onchocerciasis elimination programs.

The Role of Gender in Agent Banking: Evidence from the Democratic Republic of Congo

2020 ◽  
Author(s):  
Richard Chamboko ◽  
Robert Cull ◽  
Xavier Gine ◽  
Soren Heitmann ◽  
Fabian Reitzug ◽  
...  
Keyword(s):  
Democratic Republic ◽  
Democratic Republic Of Congo ◽  
Republic Of Congo
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