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ObjectivesWe aimed to assess the level of adherence to COVID-19 preventive measures in the Democratic Republic of the Congo (DRC) and to identify factors associated with non-adherence.DesignA cross-sectional population-based online survey.SettingsThe study was conducted in 22 provinces of the DRC. Five provinces with a satisfactory number of respondents were included in the analysis: Haut Katanga, Kasaï-Central, Kasaï-Oriental, Kinshasa and North Kivu.ParticipantsThe participants were people aged ≥18 years, living in the DRC. A total of 3268 participants were included in the study analysis.InterventionsBoth convenience sampling (surveyors themselves contacted potential participants in different districts) and snowball sampling (the participants were requested to share the link of the questionnaire with their contacts) methods were used.Primary and secondary outcome measuresWe computed adherence scores using responses to 10 questions concerning COVID-19 preventive measures recommended by the WHO and the DRC Ministry of Health. We used logistic regression analysis with generalised estimating equations to identify factors of poor adherence. We also asked about the presence or absence of flu-like symptoms during the preceding 14 days, whether a COVID-19 test was done and the test result.ResultsData from 3268 participants were analysed. Face masks were not used by 1789 (54.7%) participants. Non-adherence to physical distancing was reported by 1364 (41.7%) participants. 501 (15.3%) participants did not observe regular handwashing. Five variables were associated with poor adherence: lower education level, living with other people at home, being jobless/students, living with a partner and not being a healthcare worker.ConclusionDespite compulsory restrictions imposed by the government, only about half of the respondents adhered to COVID-19 preventive measures in the DRC. Disparities across the provinces are remarkable. There is an urgent need to further explore the reasons for these disparities and factors associated with non-adherence.

Background High epilepsy prevalence and incidence have been reported in areas with high onchocerciasis transmission. Recent findings suggest that proper community-directed treatment with ivermectin (CDTI) is potentially able to prevent onchocerciasis-associated epilepsy (OAE). We assessed the epilepsy prevalence and onchocerciasis transmission in two Nigerian villages following more than 20 years of CDTI. Methods A cross-sectional door-to-door survey was performed in two villages in the Imo River Basin reported to be mesoendomic for onchocerciasis (Umuoparaodu and Umuezeala). Individuals were screened for epilepsy using a validated 5-item questionnaire. Persons suspected to have epilepsy were examined by a neurologist or a physician with training in epilepsy for confirmation. Onchocerciasis was investigated via skin snip microscopy and rapid diagnostic tests for Ov16 antibodies. Results were compared with previous findings from the Imo river basin. Results A total of 843 individuals from 257 households in the two villages were encountered. We detected four persons with epilepsy (PWE) giving a crude epilepsy prevalence of 0.5%. This finding differs from observations reported 14 years ago which showed an epilepsy prevalence of 2.8% in the neighbouring village of Umulolo (P = 0.0001), and 1.2% from 13 villages in the Imo river basin (P = 0.07). The seroprevalence of Ov16 antibodies was found to be 0%. Only 4.6% of skin snips were positive compared to 26.8% in previous surveys (P

Background: A recent study in the Logo and Rethy health zones in the Ituri Province in the Democratic Republic of Congo (DRC) reported that the majority of the persons with epilepsy (PWE) had not been treated with anti-epileptic medication (AEM) or had stopped treatment. Prior to the implementation of an epilepsy treatment programme in these health zones, this study investigated the perceptions and experiences regarding epilepsy and its treatment amongst community leaders, PWE and/or their families, traditional healers and health professionals. Methods: A total of 14 focus group discussions (FGD) and 39 semi-structured interviews (SSI) were conducted with PWE and/or their family members, community leaders, traditional healers, and health professionals in the Logo and Rethy health zones during February 2-19, 2017. Results: In the two health zones, the clinical signs of convulsive epilepsy were recognized by community members. However, a variety of misconceptions about epilepsy were identified including the beliefs that epilepsy is a family-related condition, a contagious disease, is transmitted by insects, saliva or by touching a person of the same sex during seizures, or is caused by evil spirits and witchcraft. The role of traditional healers in spreading these beliefs was revealed. The study also reported sexual abuse on PWE, stigmatisation of PWE and loss of productivity of PWE and their families. Some PWE had been using AEM and traditional treatment but were not convinced about the efficacy of these treatment options. The lack of training of health providers about epilepsy care, financial barriers in obtaining AEM, and the shortage of AEM at primary health facilities were revealed. As remedies, the community requested access to a decentralized center for epilepsy treatment. They also proposed using churches and community health workers as communication channels for information about epilepsy. Conclusions: Clinical signs of convulsive epilepsy were recognized by the community in the Logo and Rethy health zones but many misconceptions about epilepsy were identified. A comprehensive community-based epilepsy treatment programme with an affordable uninterrupted AEM supply needs to be established. Such a programme should address stigma, misconceptions, sexual abuse and foster the rehabilitation of PWE to alleviate poverty.

Background: Epilepsy is a leading cause of morbidity and mortality in sub-Saharan Africa. A high epilepsy prevalence has been reported in onchocerciasis-endemic regions, where seizure onset commonly occurs during childhood or early adolescence. We investigated epilepsy in individuals aged 5-19 years living in onchocerciasis-endemic regions. Methods: Between 2016 and 2018, household epilepsy surveys were performed in onchocerciasis-endemic villages in Cameroon, Democratic Republic of Congo, Nigeria, South Sudan, Tanzania, and Uganda. Using a validated questionnaire, all households were screened for children and adolescents suspected to have epilepsy. The latter were further examined by a trained clinical officer, medical doctor and/or neurologist for confirmation. Onchocerciasis-associated epilepsy (OAE) was defined as epilepsy starting between the ages of 3-18 years in previously healthy children living in onchocerciasis meso- or hyper-endemic areas, with no other known cause of seizures. Findings: Of the 13 000 children and adolescents aged 5-19 years who were screened, 676 (5·2%) had epilepsy; of those, 450 (66·6%) met all OAE diagnostic criteria. Eighty percent of individuals with epilepsy had seizures monthly, 25·7% showed cognitive abnormalities, and 9·8% had burns or traumatic lesions related to seizures. Only 53·6% of participants with epilepsy received daily anti-epileptic treatment, and 62·1% had not completed primary education by the age of 13 years. Excess mortality among subjects with epilepsy ranged from 26 to 69 per 1000 individuals aged 5-19 years. Epilepsy annual incidence was 6·1 per 1000 individuals, and was lowest in areas with low onchocerciasis transmission. Interpretation: OAE causes considerable morbidity and mortality among individuals aged 5-19 years and affects their health, education and quality of life. Urgent action is needed to prevent children from developing OAE, and to provide treatment and care for all children and adolescents with epilepsy in onchocerciasis-endemic regions. Funding Statement: ERC Advanced Grant (67105), NSETHIO Project. Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: Ethical approval was obtained for all studies from the ethics committee of the University of Antwerp, Belgium and from the ethics committees in the African countries. The study aims and procedures were explained to all participants in the language of their choice and signed or finger-printed informed consent was obtained from participants, parents or caretakers, and assent from adolescents (age 12–19 years). All personal information was encoded and treated confidentially.

Objectives: To investigate the reasons for the high prevalence of epilepsy (>6%) discovered in 2015 in the Aketi health zone in the north of the Democratic Republic of the Congo. Methods: Persons with epilepsy (PWE) diagnosed in a door-to-door survey in 2015 were traced and re-examined in 2017 by a neurologist. Confirmed PWE were paired with matched controls. For onchocerciasis assessment, children 7-10 years old were tested for IgG4 Onchocerca volvulus (OV16) antibodies, a rapid epidemiological mapping of onchocerciasis (REMO) study was performed, and ivermectin coverage was investigated. Results: Forty-three (61.4%) previously diagnosed PWE were traced; the neurologist confirmed the epilepsy diagnosis in all of them. The overall OV16 positivity rate was 64.5%. Poor ivermectin coverage (55.9%) and a high prevalence of onchocercal nodules (>70%) were observed. The prevalence of epilepsy was 5.7% in Aketi rural town, with nine PWE (13.8%) experiencing head nodding seizures. A case-control study showed that PWE had lower body weight and higher ivermectin coverage in 2017 than healthy controls. Conclusions: The high prevalence of epilepsy in the Aketi health zone, despite 14 years of community-directed treatment with ivermectin (CDTI), was found to be associated with high onchocerciasis transmission and low ivermectin use. An awareness programme to increase ivermectin coverage and the introduction of a bi-annual CDTI programme should be considered. (c) 2018 The Authors. Published by Elsevier Ltd on behalf of International Society for Infectious Diseases. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). We thank the Fons Peeters and the VZW Aketi for logistical assistance, and the populations of Wela, Makoko, and Aketi for their collaboration in the study. R. Colebunders received funding from the European Research Council (ERC) (grant number 671055, project title NSETHIO). The funder had no role in the study design, in the collection, analysis, and interpretation of the data, in the writing of the manuscript, or in the decision to submit the manuscript for publication.