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Nachega JB, Mbala-Kingebeni P, Otshudiema J, Mobula LM, Preiser W, Kallay O, Michaels-Strasser S, Breman JG, Rimoin AW, Nsio J, Ahuka-Mundeke S, Zumla A, Muyembe Tam-Fum JJ. Responding to the Challenge of the Dual COVID-19 and Ebola Epidemics in the Democratic Republic of Congo-Priorities for Achieving Control. Am J Trop Med Hyg 2020; 103:597-602. [PMID: 32563272 PMCID: PMC7410434 DOI: 10.4269/ajtmh.20-0642] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
As of June 11, 2020, the Democratic Republic of the Congo (DRC) has reported 4,258 COVID-19 cases with 90 deaths. With other African countries, the DRC faces the challenge of striking a balance between easing public health lockdown measures to curtail the spread of SARS-CoV-2 and minimizing both economic hardships for large sectors of the population and negative impacts on health services for other infectious and noninfectious diseases. The DRC recently controlled its tenth Ebola virus disease (EVD) outbreak, but COVID-19 and a new EVD outbreak beginning on June 1, 2020 in the northwest Équateur Province have added an additional burden to health services. Although the epidemiology and transmission of EVD and COVID-19 differ, leveraging the public health infrastructures and experiences from coordinating the EVD response to guide the public health response to COVID-19 is critical. Building on the DRC’s 40 years of experience with 10 previous EVD outbreaks, we highlight the DRC’s multi-sectoral public health approach to COVID-19, which includes community-based screening, testing, contact-tracing, risk communication, community engagement, and case management. We also highlight remaining challenges and discuss the way forward for achieving control of both COVID-19 and EVD in the DRC.
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Affiliation(s)
- Jean B Nachega
- Department of Epidemiology and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Department of Medicine, Centre for Infectious Diseases, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.,Department of Epidemiology, Infectious Diseases and Microbiology, Center for Global Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Placide Mbala-Kingebeni
- Department of Medical Microbiology and Virology, National Institute of Biomedical Research (INRB), Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - John Otshudiema
- Health Emergencies Program, COVID-19 Response, Epidemiological Surveillance Team, World Health Organisation, Kinshasa, Democratic Republic of the Congo
| | - Linda M Mobula
- Ebola Response Team, Health, Nutrition and Population, Global Practice, World Bank Group, Washington, District of Columbia
| | - Wolfgang Preiser
- National Health Laboratory Service (NHLS), Cape Town, South Africa.,Division of Medical Virology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Oscar Kallay
- Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | | | - Joel G Breman
- American Society of Tropical Medicine and Hygiene and United States National Institutes of Health, Fogarty International Center, Bethesda, Maryland
| | - Anne W Rimoin
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles (UCLA), Los Angeles, California
| | - Justus Nsio
- Department of Medical Microbiology and Virology, National Institute of Biomedical Research (INRB), Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Steve Ahuka-Mundeke
- Department of Medical Microbiology and Virology, National Institute of Biomedical Research (INRB), Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Alimuddin Zumla
- National Institute for Health Research Biomedical Research Centre, University College London Hospitals, London, United Kingdom.,Division of Infection and Immunity, Department of Infection, Centre for Clinical Microbiology, University College London, London, United Kingdom
| | - Jean-Jacques Muyembe Tam-Fum
- Department of Medical Microbiology and Virology, National Institute of Biomedical Research (INRB), Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
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Mukadi P, Gillet P, Lukuka A, Mbatshi J, Otshudiema J, Muyembe JJ, Buyze J, Jacobs J, Lejon V. External quality assessment of reading and interpretation of malaria rapid diagnostic tests among 1849 end-users in the Democratic Republic of the Congo through Short Message Service (SMS). PLoS One 2013; 8:e71442. [PMID: 23967211 PMCID: PMC3742745 DOI: 10.1371/journal.pone.0071442] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Accepted: 07/01/2013] [Indexed: 11/18/2022] Open
Abstract
Background Although malaria rapid diagnostic tests (RDT) are simple to perform, they remain subject to errors, mainly related to the post-analytical phase. We organized the first large scale SMS based external quality assessment (EQA) on correct reading and interpretation of photographs of a three-band malaria RDT among laboratory health workers in the Democratic Republic of the Congo (DR Congo). Methods and Findings High resolution EQA photographs of 10 RDT results together with a questionnaire were distributed to health facilities in 9 out of 11 provinces in DR Congo. Each laboratory health worker answered the EQA by Short Message Service (SMS). Filled-in questionnaires from each health facility were sent back to Kinshasa. A total of 1849 laboratory health workers in 1014 health facilities participated. Most frequent errors in RDT reading were i) failure to recognize invalid (13.2–32.5% ) or negative test results (9.8–12.8%), (ii) overlooking faint test lines (4.1–31.2%) and (iii) incorrect identification of the malaria species (12.1–17.4%). No uniform strategy for diagnosis of malaria at the health facility was present. Stock outs of RDTs occurred frequently. Half of the health facilities had not received an RDT training. Only two thirds used the RDT recommended by the National Malaria Control Program. Performance of RDT reading was positively associated with training and the technical level of health facility. Facilities with RDT positivity rates >50% and located in Eastern DR Congo performed worse. Conclusions Our study confirmed that errors in reading and interpretation of malaria RDTs are widespread and highlighted the problem of stock outs of RDTs. Adequate training of end-users in the application of malaria RDTs associated with regular EQAs is recommended.
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Affiliation(s)
- Pierre Mukadi
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
- Université Pédagogique Nationale, Kinshasa, Democratic Republic of the Congo
| | - Philippe Gillet
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Albert Lukuka
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
- Laboratoire National de Référence Paludisme (Programme National de Lutte contre le Paludisme), Kinshasa, Democratic Republic of the Congo
| | - Joêl Mbatshi
- Programme National de Lutte contre la Tuberculose, Kinshasa, Democratic Republic of the Congo
| | - John Otshudiema
- Integrated Health Project - United States President’s Malaria Initiative, Kinshasa, Democratic Republic of the Congo
| | - Jean-Jacques Muyembe
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
- Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Jozefien Buyze
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Jan Jacobs
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Veerle Lejon
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
- Institut de Recherche pour le Développement, UMR 177 IRD-CIRAD INTERTRYP, Campus International de Baillarguet, Montpellier, France
- * E-mail:
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