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Akilimali A, Bisimwa C, Aborode AT, Biamba C, Sironge L, Balume A, Sayadi R, Ajibade SB, Akintayo AA, Oluwadairo TO, Fajemisin EA. Self-medication and Anti-malarial Drug Resistance in the Democratic Republic of the Congo (DRC): A silent threat. Trop Med Health 2022; 50:73. [PMID: 36195896 PMCID: PMC9533625 DOI: 10.1186/s41182-022-00466-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 09/29/2022] [Indexed: 11/24/2022] Open
Abstract
Background Malaria is a global infectious (vector-borne: Anopheles mosquitoes) disease which is a leading cause of morbidity and mortality in Sub-Saharan Africa (SSA). Among all its parasitic (protozoan: Plasmodium sp.) variants, Plasmodium falciparum (PF) is the most virulent and responsible for above 90% of global malaria deaths hence making it a global public health threat. Main context Despite current front-line antimalarial treatments options especially allopathic medications and malaria prevention (and control) strategies especially governmental policies and community malaria intervention programs in SSA, PF infections remains prevalent due to increased antimicrobial/antimalarial drug resistance caused by several factors especially genetic mutations and auto(self)-medication practices in SSA. In this article, we focused on the Democratic Republic of Congo (DRC) as the largest SSA country by bringing perspective into the impact of self-medication and antimalarial drug resistance, and provided recommendation for long-term improvement and future analysis in malaria prevention and control in SSA. Conclusions Self-medication and anti-malarial drug resistance is a major challenge to malaria control in DRC and sub-Saharan Africa, and to achieve sustainable control, individual, community and governmental efforts must be aligned to stop self-medication, and strengthen the health systems against malaria.
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Affiliation(s)
- Aymar Akilimali
- Faculty of Medicine, Official University of Bukavu, Bukavu, DR, Congo.
| | - Charles Bisimwa
- Faculty of Pharmacy and Public Health, Official University of Bukavu, Bukavu, DR, Congo
| | | | | | - Leonard Sironge
- Faculty of Pharmacy and Public Health, Official University of Bukavu, Bukavu, DR, Congo
| | - Alain Balume
- Faculty of Medicine, Official University of Bukavu, Bukavu, DR, Congo
| | - Rahma Sayadi
- Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | | | - Akintola Ashraf Akintayo
- Department of Biomedical Convergence Science and Technology, Kyungpook National University, Daegu, 41566, South Korea
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It Is Time to Strengthen the Malaria Control Policy of the Democratic Republic of Congo and Include Schools and School-Age Children in Malaria Control Measures. Pathogens 2022; 11:pathogens11070729. [PMID: 35889975 PMCID: PMC9315856 DOI: 10.3390/pathogens11070729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 06/22/2022] [Accepted: 06/24/2022] [Indexed: 02/04/2023] Open
Abstract
Despite a decade of sustained malaria control, malaria remains a serious public health problem in the Democratic Republic of Congo (DRC). Children under five years of age and school-age children aged 5–15 years remain at high risk of symptomatic and asymptomatic malaria infections. The World Health Organization’s malaria control, elimination, and eradication recommendations are still only partially implemented in DRC. For better malaria control and eventual elimination, the integration of all individuals into the national malaria control programme will strengthen malaria control and elimination strategies in the country. Thus, inclusion of schools and school-age children in DRC malaria control interventions is needed.
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Sidibe A, Maglior A, Cueto C, Chen I, Le Menach A, Chang MA, Eisele TP, Andrinopolous K, Cherubin J, Lemoine JF, Bennett A. Assessing the role of the private sector in surveillance for malaria elimination in Haiti and the Dominican Republic: a qualitative study. Malar J 2019; 18:408. [PMID: 31806025 PMCID: PMC6896765 DOI: 10.1186/s12936-019-3024-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 11/21/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Haiti and the Dominican Republic (DR) are targeting malaria elimination by 2022. The private health sector has been relatively unengaged in these efforts, even though most primary health care in Haiti is provided by non-state actors, and many people use traditional medicine. Data on private health sector participation in malaria elimination efforts are lacking, as are data on care-seeking behaviour of patients in the private health sector. This study sought to describe the role of private health sector providers, care-seeking behaviour of individuals at high risk of malaria, and possible means of engaging the private health sector in Hispaniola's malaria elimination efforts. METHODS In-depth interviews with 26 key informants (e.g. government officials), 62 private providers, and 63 patients of private providers, as well as 12 focus group discussions (FGDs) with community members, were conducted within seven study sites in Haiti and the DR. FGDs focused on local definitions of the private health sector and identified private providers for interview recruitment, while interviews focused on private health sector participation in malaria elimination activities and treatment-seeking behaviour of febrile individuals. RESULTS Interviews revealed that self-medication is the most common first step in the trajectory of care for fevers in both Haiti and the DR. Traditional medicine is more commonly used in Haiti than in the DR, with many patients seeking care from traditional healers before, during, and/or after care in the formal health sector. Private providers were interested in participating in malaria elimination efforts but emphasized the need for ongoing support and training. Key informants agreed that the private health sector needs to be engaged, especially traditional healers in Haiti. The Haitian migrant population was reported to be one of the most at-risk groups by participants from both countries. CONCLUSION Malaria elimination efforts across Hispaniola could be enhanced by engaging traditional healers in Haiti and other private providers with ongoing support and trainings; directing educational messaging to encourage proper treatment-seeking behaviour; and refining cross-border strategies for surveillance of the high-risk migrant population. Increasing distribution of rapid diagnostic tests (RDTs) and bi-therapy to select private health sector facilities, accompanied by adopting regulatory policies, could help increase numbers of reported and correctly treated malaria cases.
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Affiliation(s)
- Abigail Sidibe
- Malaria Elimination Initiative, The Global Health Group, University of California, San Francisco, CA, USA
| | - Alysse Maglior
- Malaria Elimination Initiative, The Global Health Group, University of California, San Francisco, CA, USA
| | - Carmen Cueto
- Malaria Elimination Initiative, The Global Health Group, University of California, San Francisco, CA, USA
| | - Ingrid Chen
- Malaria Elimination Initiative, The Global Health Group, University of California, San Francisco, CA, USA
| | | | - Michelle A Chang
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Thomas P Eisele
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | | | | | | | - Adam Bennett
- Malaria Elimination Initiative, The Global Health Group, University of California, San Francisco, CA, USA.
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Ngatu NR, Kanbara S, Renzaho A, Wumba R, Mbelambela EP, Muchanga SMJ, Muzembo BA, Leon-Kabamba N, Nattadech C, Suzuki T, Oscar-Luboya N, Wada K, Ikeda M, Nojima S, Sugishita T, Ikeda S. Environmental and sociodemographic factors associated with household malaria burden in the Congo. Malar J 2019; 18:53. [PMID: 30808360 PMCID: PMC6390528 DOI: 10.1186/s12936-019-2679-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Accepted: 02/14/2019] [Indexed: 11/10/2022] Open
Abstract
Background Malaria is one of the most severe public health issues that result in massive morbidity and mortality in most countries of the sub-Saharan Africa (SSA). This study aimed to determine the scope of household, accessibility to malaria care and factors associated with household malaria in the Democratic Republic of Congo (DRC). Methods This was a community-based cross-sectional study conducted in an urban and a rural sites in which 152 households participated, including 82 urban and 70 rural households (1029 members in total). The ‘malaria indicator questionnaire’ (MIQ) was anonymously answered by household heads (respondents), reporting on malaria status of household members in the last 12 months. Results There were 67.8% of households using insecticide-treated bed nets (ITN) only, 14.0% used indoor residual spraying (IRS) only, 7.3% used ordinary bed nets (without insecticide treatment), 1.4% used mosquito repelling cream, 2.2% combined ITN and IRS, whereas 7.3% of households did not employ any preventive measure; p < 0.01). In addition, 96.7% of households were affected by malaria (at least one malaria case), and malaria frequency per household was relatively high (mean: 4.5 ± 3.1 cases reported) in the last 12 months. The mean individual malaria care expenditure was relatively high (101.6 ± 10.6 USD) in the previous 12 months; however, the majority of households (74.5%) earned less than 50 USD monthly. In addition, of the responders who suffered from malaria, 24.1% did not have access to malaria care at a health setting. Furthermore, a multivariate analysis with adjustment for age, education level and occupation showed that household size (OR = 1.43 ± 0.13; 95% CI 1.18–1.73; p < 0.001), inappropriate water source (OR = 2.41 ± 0.18; 95% CI 1.17–2.96; p < 0.05) absence of periodic water, sanitation and hygiene (WASH) intervention in residential area (OR = 1.63 ± 1.15; 95% CI 1.10–2.54; p < 0.05), and rural residence (OR = 4.52 ± 2.47; 95% CI 1.54–13.21; p < 0.01) were associated with household malaria. Conclusion This study showed that household size, income, WASH status and rural site were malaria-associated factors. Scaling up malaria prevention through improving WASH status in the residential environment may contribute to reducing the disease burden.
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Affiliation(s)
- Nlandu Roger Ngatu
- School of Medicine and Graduate School of Public Health, International University of Health and Welfare, Narita, Japan.
| | - Sakiko Kanbara
- Graduate School of Nursing, University of Kochi, Kochi, Japan
| | | | - Roger Wumba
- Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Etongola P Mbelambela
- Department of Environmental Medicine, Kochi University Medical School, Nankoku, Japan
| | | | - Basilua Andre Muzembo
- School of Medicine and Graduate School of Public Health, International University of Health and Welfare, Narita, Japan
| | - Ngombe Leon-Kabamba
- Department of Public Health, University of Kamina, Kamina, Democratic Republic of the Congo
| | - Choomplang Nattadech
- School of Medicine and Graduate School of Public Health, International University of Health and Welfare, Narita, Japan
| | - Tomoko Suzuki
- School of Medicine and Graduate School of Public Health, International University of Health and Welfare, Narita, Japan
| | - Numbi Oscar-Luboya
- School of Public Health, University of Lubumbashi, Lubumbashi, Democratic Republic of the Congo
| | - Koji Wada
- School of Medicine and Graduate School of Public Health, International University of Health and Welfare, Narita, Japan
| | - Mitsunori Ikeda
- Graduate School of Nursing, University of Kochi, Kochi, Japan
| | - Sayumi Nojima
- Graduate School of Nursing, University of Kochi, Kochi, Japan
| | | | - Shunya Ikeda
- School of Medicine and Graduate School of Public Health, International University of Health and Welfare, Narita, Japan
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Nkoli Mandoko P, Sinou V, Moke Mbongi D, Ngoyi Mumba D, Kahunu Mesia G, Losimba Likwela J, Bi Shamamba Karhemere S, Muepu Tshilolo L, Tamfum Muyembe JJ, Parzy D. Access to artemisinin-based combination therapies and other anti-malarial drugs in Kinshasa. Med Mal Infect 2018. [DOI: 10.1016/j.medmal.2018.02.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Damien BG, Aguemon B, Abdoulaye Alfa D, Bocossa D, Ogouyemi-Hounto A, Remoue F, Le Hesran JY. Low use of artemisinin-based combination therapy for febrile children under five and barriers to correct fever management in Benin: a decade after WHO recommendation. BMC Public Health 2018; 18:168. [PMID: 29357869 PMCID: PMC5778640 DOI: 10.1186/s12889-018-5077-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 01/12/2018] [Indexed: 11/16/2022] Open
Abstract
Background Artemisinin-based combination therapy (ACT), used to treat uncomplicated malaria cases, is one of the main strategies of malaria control and elimination. One of the main objectives of the Benin National Malaria Control Program’s (NMCP) strategic plan is to ensure that at least 80% of uncomplicated malaria is treated with ACT within 24 h. Therefore, it was of great interest to measure whether the country case management of fever amongst children under five, adhered to the NMCP’s strategic plan and look into the barriers to the use of ACT. Methods A cross-sectional survey based on a cluster and multi-stage sampling was conducted in two rural health districts in Benin. We recruited 768 and 594 children under five years were included in the northern and in the southern respectively. Data was collected on the general use of ACT and on the correct use of ACT that adheres to the NMCP’s strategy, as well as the barriers that prevent the proper management of fever amongst children. To assess the certain predictors of ACT usage, logistic regression was used, while taking into account the cluster random effect. Results Among febrile children aged 6 to 59 months, 20.7% in the south and 33.9% in north received ACT. The correct use of ACT, was very low, 5.8% and in southern and 8.6% northern areas. Caregivers who received information on ACT were 3.13 time more likely in the south and 2.98 time more likely in the north to give ACT to their feverish child, PPR = 3.13[1.72–4.15] and PPR = 2.98 [2.72–3.11] respectively. Chloroquine and quinine, other malaria treatments not recommended by NMCP, were still being used in both areas: 12.3 and 3.3% in the south and 11.4 and 3.0% in the north. Conclusion In Benin, the use and the correct use of ACT for febrile children remains low. The study also showed that having received information about the use of ACT is positively associated with the use of ACT. This point highlights the fact that efforts may not have been sufficiently integrated with social communication, which should be based on the behavioural determinants of populations. Electronic supplementary material The online version of this article (10.1186/s12889-018-5077-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- B G Damien
- Institut de Recherche pour le Développement (IRD), Maladies Infectieuses et Vecteurs: Ecologie, Génétique, Evolution et Contrôle (MIVEGEC), UMR IRD 224-CNRS 5290, University of Montpellier, Montpellier, France. .,Centre de Recherche Entomologique de Cotonou, Bénin / Institut de Recherche pour le Développement, UMR 224-CNRS 5290 MIVEGEC, Cotonou, Bénin. .,Département de Santé Publique, Faculté des Sciences de la Santé de Cotonou, Université d'Abomey-Calavi, Cotonou, Bénin.
| | - B Aguemon
- Département de Santé Publique, Faculté des Sciences de la Santé de Cotonou, Université d'Abomey-Calavi, Cotonou, Bénin
| | - D Abdoulaye Alfa
- Centre de Recherche Entomologique de Cotonou, Bénin / Institut de Recherche pour le Développement, UMR 224-CNRS 5290 MIVEGEC, Cotonou, Bénin
| | - D Bocossa
- Université Paris 8, UFR Etudes - Recherche - et Ingénierie en territoires - Environnements - Société, Saint-Denis, France
| | - A Ogouyemi-Hounto
- Unité d'Enseignement et de Recherche en Parasitologie Mycologie/Faculté des Sciences de la Santé, Laboratoire du Centre de Lutte Intégrée contre le Paludisme, Université d'Abomey-Calavi, Cotonou, Bénin
| | - F Remoue
- Institut de Recherche pour le Développement (IRD), Maladies Infectieuses et Vecteurs: Ecologie, Génétique, Evolution et Contrôle (MIVEGEC), UMR IRD 224-CNRS 5290, University of Montpellier, Montpellier, France.,Centre de Recherche Entomologique de Cotonou, Bénin / Institut de Recherche pour le Développement, UMR 224-CNRS 5290 MIVEGEC, Cotonou, Bénin
| | - J-Y Le Hesran
- Institut de Recherche pour le Développement (IRD) / Mère et enfant face aux infections tropicales (MERIT), UMR 216, Cotonou, Bénin
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