Access to artemisinin-based combination therapies and other anti-malarial drugs in Kinshasa

Objective

Artemisinin-based combination therapies have been available since 2005 in the Democratic Republic of the Congo to treat malaria and to overcome the challenge of anti-malarial drug resistance as well as to improve access to effective treatments. The private sector is the primary distribution source for anti-malarial drugs and thus, has a key position among the supply chain actors for a rational and proper use of anti-malarial drugs. We aimed to assess access to nationally recommended anti-malarial drugs in private sector pharmacies of the capital-city of Kinshasa.

A Piot model to analyse case management in malaria control programmes

At the beginning of the 21st century, malaria remains one of the most important public health problems in the world. An important control strategy to address this burden is adequate case management of malaria patients. The success of this strategy, however, does not solely depend on diagnosis and treatment, but also on a sequence of steps that patients have to take when they are ill. Only when patients go through all these steps successfully will they be cured. In this paper, a model is presented in which these steps are described. The model provides a framework for analysing this type of malaria control strategy and for identifying the most critical challenges faced. Furthermore, the model is used to analyse recent literature on case management as part of malaria control programmes in order to highlight current knowledge, core issues and constraints, and to make recommendations for programme development and research.     

Congenital trypanosomiasis

The last successfully treated case of congenital trypanosomiasis in Zambia was in October 1978, with detailed analysis of immunoglobulins, illustrating the waning of blood and serum levels of IgA, IgG, and IgM during treatment, up to 99 days after treatment. Twenty-five years later, we report on a case of congenital trypanosomiasis. The disease is now rare and can be missed or dismissed as retroviral disease, particularly in adults. The main unusual symptoms were the prolonged intermittent convulsions in an otherwise well infant. Management of the disease is now more interdisciplinary, resources for laboratory support are fewer, lumbar puncture is more relevant, and antitrypanosomal drugs are more difficult to obtain. The mother died within one week of hospitalization and the infant initially responded to three doses of suramin and 3 weeks of melsopropol. Convulsions ceased during the second round of melsopropol. Unfortunately, the infant died of nosocomial infection.     

Postpartum health among rural Zambian women

Health problems after childbirth have received little attention compared to maternal morbidity in the antenatal period and during labour. We conducted a hospital-based study to investigate postpartum health problems in rural Zambian women. Health problems are very common: 84% of the 620 study participants reported at least one health problem. The majority of women who experienced a health problem took action to relieve the complaint. High vaginal swabs were used to diagnose a genital tract infection. Seventeen per cent of the swabs were abnormal; most women with abnormal result showed no symptoms of genital tract infection. Ninety three per cent of women with symptoms suggestive of a genital tract infection did not seek medical attention. Further research is needed to estimate the impact of self-reported health problems on women's daily lives. Women should be educated on specific conditions that require medical care. More information is also needed on the prevalence of sexually transmitted infections in antenatal and postpartum women including the feasibility of mass screening and treatment in this group of women.     

Diagnostic Accuracy and Feasibility of Serological Tests on Filter Paper Samples for Outbreak Detection of T.b. gambiense Human African Trypanosomiasis

Control of human African trypanosomiasis (HAT) in the Democratic Republic of Congo is based on mass population screening by mobile teams; a costly and labor-intensive approach. We hypothesized that blood samples collected on filter paper by village health workers and processed in a central laboratory might be a cost-effective alternative. We estimated sensitivity and specificity of micro-card agglutination test for trypanosomiasis (micro-CATT) and enzyme-linked immunosorbent assay (ELISA)/T.b. gambiense on filter paper samples compared with parasitology-based case classification and used the results in a Monte Carlo simulation of a lot quality assurance sampling (LQAS) approach. Micro-CATT and ELISA/T.b. gambiense showed acceptable sensitivity (92.7% [95% CI 87.4–98.0%] and 82.2% [95% CI 75.3–90.4%]) and very high specificity (99.4% [95% CI 99.0–99.9%] and 99.8% [95% CI 99.5–100%]), respectively. Conditional on high sample size per lot (≥ 60%), both tests could reliably distinguish a 2% from a zero prevalence at village level. Alternatively, these tests could be used to identify individual HAT suspects for subsequent confirmation.