Dataset Information

Prediction of Under-Detection of Paediatric Tuberculosis in the Democratic Republic of Congo: Experience of Six Years in the South-Kivu Province.

ABSTRACT:

Introduction

In the field of tuberculosis (TB), and particularly in regard to paediatric TB (PedTB), clinical skills of health professionals play an important role in determining quality of care. In an era where novel diagnostic technologies and efficient treatment regimens are being made available for the poorest, we must not divert our attention from the importance of clinical skills, as this deliverable remains the cornerstone of individualized patient care and ultimately the best assurance for optimal use of resources. The aim of our work was to study the epidemiology of PedTB and the determinants of PedTB under-detection in the South-Kivu Province of the Democratic Republic of Congo (DRC), a setting with nearly no technical resources allowing to support the clinical diagnosis of PedTB, i.e. chest X-rays, rapid molecular tests or culture laboratories.

Methods

We collected TB notification data from 2010 to 2015 and analysed the space-time variations in notification for the different forms of TB among the 113 health facilities (HF) the South-Kivu Province, a region with a low HIV incidence. The different forms of TB notified were: smear positive pulmonary TB (SS+PTB), smear negative pulmonary TB (SS-PTB) and extra-pulmonary TB (EPTB). We further analysed the distribution of these different forms of the disease per age group and explored the possibility to predict the detection of PedTB.

Results

Significant differences were observed between HF in regard to the proportion of paediatric TB and the proportion of SS-TB among adults. We found a strong correlation between the proportion of PedTB and three major factors: the proportion of TB cases with no bacteriological confirmation (SS-TB) among adults, the number of TB cases notified by the HF and the fact that the HF was supported or not by Médecins Sans Frontières (MSF). The proportion of SS-TB among adults was found to be a valid indicator for predicting the level of detection of PedTB at the same HF.

Conclusion

Our observations strongly suggest that under-detection of PedTB is associated with insufficient clinical skills and technical resources at the HF level which similarly affects other forms of the disease, in particular SS-TB. We demonstrated that, in the specific context of South-Kivu, under-detection of PedTB can be predicted by a low SS-TB/SS+PTB ratio in the adult population. In the context of severely under-resourced settings, this ratio could be used to rapidly identify HF that should benefit in priority from deeper evaluation, and eventually targeted interventions.

SUBMITTER: Andre E

PROVIDER: S-EPMC5217857 | biostudies-literature | 2017

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Prediction of Under-Detection of Paediatric Tuberculosis in the Democratic Republic of Congo: Experience of Six Years in the South-Kivu Province.

André Emmanuel E Lufungulo Bahati Yvette Y Mulume Musafiri Eric E Bahati Rusumba Olivier O Van der Linden Dimitri D Zech Francis F

PloS one 20170106 1

<h4>Introduction</h4>In the field of tuberculosis (TB), and particularly in regard to paediatric TB (PedTB), clinical skills of health professionals play an important role in determining quality of care. In an era where novel diagnostic technologies and efficient treatment regimens are being made available for the poorest, we must not divert our attention from the importance of clinical skills, as this deliverable remains the cornerstone of individualized patient care and ultimately the best ass ...[more]

PMID: 28060846

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Project description:African swine fever (ASF) is the most important disease constraining smallholder pig production in the Democratic Republic of Congo, causing high mortality in domestic pigs with severe impacts on the livelihoods of local populations. This study was conducted with the aim of determining the prevalence of ASF and circulating virus genotypes in asymptomatic pigs raised on smallholder farms in the South Kivu province to understand the transmission dynamics of ASF and ultimately improving disease control. A cross-sectional survey was carried out in 5 districts where 267 pig blood were screened for both antibody and viral genome using indirect Enzyme Linked Immunosorbent Assay (ELISA) and polymerase chain reaction (PCR) respectively. Additionally, amplicons from PCR positive samples were sequenced by Sanger method for genetic analysis of ASF virus (ASFV) based on the C-terminal region of the B646L gene that encodes the major capsid protein p72 and the gene E183L encoding the p54 protein. The overall seroprevalence obtained based on antibody to p30 protein was 37 % and was significantly higher (P < 0.05) in adult (>1 year) animals (44.7 %) than in younger (<1 year) ones (33.5 %). Moreover, the seropositivity varied significantly (P < 0.05) according to the pig husbandry system practiced within the districts investigated with Uvira (55 %) and Mwenga (42.2 %) having the highest ASFV antibodies, while the lowest (10.5 %) were in Kalehe. Free-range pigs exhibited a higher level of seropositivity to ASFV antibody (68.9 %) than pigs kept in the pigsty housing system (21.6 %). However, no statistically significant differences (P > 0.05) were observed when sex of the animal and breed were factored. PCR detection of ASFV amplified a specific band of expected size (257 bp) in 61 out of 267 blood samples, confirming the presence of the viral DNA in 22.8 % of asymptomatic domestic pigs. Statistical analysis revealed that ASFV infection in domestic pigs varied significantly (p < 0.001) according to geographical location and breed, with the highest infection rate found in Walungu district (33.7 %) while the lowest was registered in Kalehe (15.8 %). Local pigs (27.2 %) were more infected than crosses (9.2 %). Phylogenetic analyses based on partial sequences of the p72 and p54 genes revealed that all the ASFV detected belonged to genotype IX, which has previously been reported in other parts of DR Congo, and was clustered together with isolates from Kenya, Uganda and Republic of Congo. This study avails the first evidence of the presence of ASF virus in domestic pigs in the absence of outbreaks in South Kivu province, eastern DR Congo, indicating a need to raise awareness among pig farmers and veterinary authorities on the application of biosecurity measures and good husbandry practices to control the disease.

Project description:Background:Work-related musculoskeletal disorders (WRMSDs) are a major constraint to worker performance and health. However, research on their prevalence and associated factors among workers at gold mines in the Democratic Republic of Congo (DRC) is insufficient. The present study aimed to determine the prevalence and predictors of WRMSDs among workers of a Gold Mine in South Kivu, DRC.Methods:Cross sectional data on prevalence of WRMSDs and risk factors was collected using a modified Nordic questionnaire and upper limb Core QX checklist from 196 workers of a gold mine. WRMSDs were defined as pain or injury(ies) or discomfort, numbness or limitation of movement in the musculoskeletal system at any time in the past 12?months which lasted at least 24?h. These had to be either induced or aggravated by work and circumstances of its performance. A generalised linear model of the Poison family with link log and robust error variances was used to generate prevalence ratios (PRs) and 95% confidence intervals (CIs) for the factors associated with WRMSDs. The effect of individual, ergonomic and psychosocial factors on WRMSDs were investigated while controlling for known confounders.Results:Most workers were males 187 (95.4%) and their age ranged between 23 and 60?years with mean of 36.3?years. Of the 196 workers, 49 (25.0%) reported having at least one WRMSD during the previous 12?months. WRMSDs with highest occurrence rate were the lower back pain (14.8%), followed by thighs/hip pain (9.2%) and shoulder pain (8.2%). Prolonged heavy lifting/shovelling shovelling (PR?=?1.69, 95% CI [1.32, 3.24] and longer work shifts (>?9?h) (PR?=?3.56, 95% CI [1.76, 16.58]) were predictive for WRMSDs while jobs with low demands were protective against WRMSDs (PR?=?0.18, 95% CI [0.08, 0.44]).Conclusion:The prevalence of WRMSDs is high and associated with prolonged heavy lifting/shovelling, longer work shifts and job demands. We recommend lowering workload and job demands and improving work ergonomics to mitigate and prevent the WRMSDs among workers in goldmines.

Dataset Information

Prediction of Under-Detection of Paediatric Tuberculosis in the Democratic Republic of Congo: Experience of Six Years in the South-Kivu Province.

Introduction

Methods

Results

Conclusion

Publications

Prediction of Under-Detection of Paediatric Tuberculosis in the Democratic Republic of Congo: Experience of Six Years in the South-Kivu Province.

Similar Datasets

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