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Background Clinical observations and animal studies have suggested that Salmonella intestinal carriage is promoted by concurrent Schistosoma infection. The present study assessed association of Salmonella intestinal carriage and Schistosoma mansoni infection among individuals in a Schistosoma endemic area in sub-Saharan Africa. Methods From November 2015 to March 2016, a cross-sectional community-wide study was conducted in Kifua II, a rural village in Kongo Central Province, Democratic Republic of Congo. Stool samples were collected and analyzed for Salmonella intestinal carriage (culture) and Schistosoma mansoni infection (Kato Katz microscopy with determination of egg load). Salmonella Typhimurium and Enteritidis isolates were assessed for genetic similarity with blood culture isolates obtained during the same period in a neighboring hospital using multi-locus variable-numbers tandem repeat analysis (MLVA). Results A total of 1,108 participants were included (median age 15 years (IQR: 7–36), male-to-female ratio of 1:1.1). The overall prevalence of Schistosoma mansoni infection and non-typhoidal Salmonella carriage was 51.2% (95% CI: 48.2–54.1) and 3.4% (95% CI: 2.5–4.7) respectively, with 2.2% (95% CI: 1.5–3.2) of participants coinfected. The proportion of Salmonella carriage tended to be higher among Schistosoma mansoni infected participants compared to non-infected participants but this difference did not reach statistical significance (4.2% versus 2.6%, p = 0.132). However, the proportion of Salmonella carriage among participants with a heavy Schistosoma mansoni infection was significantly higher compared to those with a light and moderate infection (8.7% versus 3.2%, p = 0.012) and compared to Schistosoma mansoni negatives (8.7% versus 2.6%, p = 0.002). The 38 Salmonella isolates comprised five and four Enteritidis and Typhimurium serotypes respectively, the majority of them had MLVA types identical or similar to those observed among blood culture isolates. Conclusion Salmonella intestinal carriage was associated with a heavy intensity of Schistosoma mansoni infection. Further studies are needed to address causation., Author summary Salmonella intestinal carriage may be facilitated by infection with Schistosoma mansoni, which is a flatworm that lives in the small blood vessels of the human intestinal tract. This situation has been described in tropical low and middle income countries, where both pathogens are endemic. The present study aimed to assess the association of Salmonella intestinal carriage with Schistosoma mansoni infection in Kifua II village, located in the Kongo Central province of the Democratic republic of Congo. We collected stool samples from 1,108 inhabitants of the village and analysed them for Salmonella (culture) and Schistosoma mansoni eggs (microscopy). Our findings showed that 3.4% of the participants had Salmonella in their stool and 51.2% were infected with Schistosoma mansoni. There was no association between overall Schistosoma infection and Salmonella carriage but Salmonella carriage was significantly higher among participants with heavy Schistosoma infection compared to those with a light and moderate infection (8.7% versus 3.2%, p = 0.012) and compared to those without Schistosoma mansoni infection (8.7% versus 2.6%, p = 0.002). Further, we showed that some Salmonella isolates recovered from stool were very similar to isolates obtained from invasive infections (blood cultures from patients in a neighbouring hospital).

Introduction La qualité des soins est essentielle pour sauver des vies humaines de différentes maladies. Cependant, un diagnostic inapproprié ne peut en aucun cas aboutir à une prise en charge correcte des patients ainsi qu’à des soins de qualité. Nous avons effectué une analyse descriptive transversale dans trois laboratoires des hôpitaux généraux en République Démocratique du Congo. Méthodes Une équipe d’experts nationaux dans le domaine des laboratoires avait conduit l’enquête au niveau de trois laboratoires cliniques des hôpitaux généraux de la République Démocratique du Congo. Des observations, visites et entretiens structurés à l´aide d’un questionnaire ont été utilisées pour évaluer la performance de ces laboratoires cliniques. Nous avons également utilisé un guide d’évaluation développé au niveau national pour l’évaluation des laboratoires. Résultats Les laboratoires cliniques des hôpitaux généraux visités ont présenté de nombreux déficits notamment en ce qui concerne les infrastructures, la formation de base et continue des personnels, les équipements, la supervision et le contrôle de qualité. Le plateau technique de ces laboratoires n’était pas adapté pour répondre aux besoins de la population en ce qui concerne les maladies fréquemment rencontrées dans ces zones. Nous avons également noté que, ces laboratoires sont peu ou presque pas accompagnés et qu’il n’y avait aucune équipe de coordination dédiée à la supervision et évaluation des laboratoires au niveau de l’hôpital, voire même au niveau de la zone de santé. En plus, les techniciens de ses différents laboratoires n’ont pas été supervisés pendant de nombreuses années. Conclusion Les laboratoires cliniques doivent être améliorés pour permettre un diagnostic adéquat de différentes maladies. Cette amélioration doit s’appuyer sur les maladies locales. Au sein du système, il est important de consacrer plus d’attention aux laboratoires cliniques. Un plaidoyer pour cette composante négligée du système de santé est nécessaire, car cette situation pourrait être la même dans de nombreux pays en voie de développement.

Objective To improve knowledge and practice of health staff as well as the availability of material resources for diagnosis and management of schistosomiasis in two endemic provinces of DRC (Kinshasa and Bas-Congo). Methods Structured interviews were performed using questionnaires with staff from 35 healthcare facilities in 9 health zones (HZ) of Kinshasa and 2 HZ in Bas-Congo. Results Schistosomiasis was reported to be present in all the included HZ. Health staff knew the most important symptoms of schistosomiasis, but advanced symptoms were more accurately reported in Bas-Congo. Knowledge of symptoms related to schistosomiasis such as anemia ( P = 0.0 115) and pollakiuria ( P = 0.0 260) was statistically different in both two provinces. Kato-Katz technique and urine filtration were unavailable in both provinces. Parasitological diagnosis was mostly performed using the direct smear method. PZQ was available in 70% of the health facilities, all situated in Bas-Congo. Diagnosis and treatment mostly relied on symptoms and cost more in urban area than in rural. Conclusions Though knowledge on schistosomiasis among health staff appears sufficient, substantial efforts still must be made to improve the availability of diagnostic tools and treatment in the health facilities in DRC.

Graphical abstract, Highlights • We assessed patterns of taeniasis in 24 village communities of Kimpese health zone. • Prevalence of taeniasis was very high and varied between households and villages. • Children of five to ten years were the most infected age group. • Taeniasis was not spatially correlated with porcine cysticercosis., Background Taenia solium infections are mostly endemic in less developed countries where poor hygiene conditions and free-range pig management favor their transmission. Knowledge on patterns of infections in both human and pig is crucial to design effective control strategies. The aim of this study was to assess the prevalence, risk factors and spatial distribution of taeniasis in a rural area of the Democratic Republic of Congo (DRC), in the prospect of upcoming control activities. Methods A cross-sectional study was conducted in 24 villages of the health zone of Kimpese, Bas Congo Province. Individual and household characteristics, including geographical coordinates were recorded. Stool samples were collected from willing participants and analyzed using the copro-antigen enzyme-linked immunosorbent assay (copro-Ag ELISA) for the detection of taeniasis. Blood samples were collected from pigs and analyzed using the B158/B60 monoclonal antibody-based antigen ELISA (sero-Ag ELISA) to detect porcine cysticercosis. Logistic regression and multilevel analysis were applied to identify risk factors. Global clustering and spatial correlation of taeniasis and porcine cysticercosis were assessed using K functions. Local clusters of both infections were identified using the Kulldorff’s scan statistic. Results A total of 4751 participants above 5 years of age (median: 23 years; IQR: 11–41) were included. The overall proportion of taeniasis positivity was 23.4% (95% CI: 22.2–24.6), ranging from 1 to 60% between villages, with a significant between-household variance of 2.43 (SE = 0.29, p

Background: Democratic Republic of Congo has shifted from pan test to mono-specific malaria RDT tests. A new Histidine rich protein 2 (HRP2)-based Rapid Diagnostic Tests for malaria diagnosis was then implemented. Objective: This study evaluated the performances of this new diagnostic tool compared to the thick smear as the gold standard. Method: The study was conducted in Kisantu Health zone in the Democratic Republic of the Congo (DRC) where malaria is known as endemic disease. Asymptomatic children aged between 0 and 10 years were included in the study. Malaria tests such as Rapid Diagnostic test (RDT) and blood smear were perform in all enrolled children. Blood smear was considered as a reference test. In the performance analysis, only thick positive smears confirmed as Pf by thin smear were considered positive in calculation. The sensitivity, specificity and positive and negative predictive values of CareStart Malaria Pf (HRP-2) RTD Ag compared to the thick smear. Result: The prevalence of malaria infection was 78.3% and 14.7% using rapid diagnostic test and thick blood smear, respectively. Considering the gold standard, proportion of false positives was 77.5%. The Sensitivity was 83.1% (CI95%: 72.4-94.9) and specificity was 22.5% (CI95%: 20.2-25.0). The Positive Predictive Value (PPV) was 15.2% and Negative Predictive Value (NPV) was 88.9%. It appears that the HRP2-based test presently used in the Democratic Republic of Congo over estimates malaria infections. Conclusion: CareStart Malaria Pf (HRP-2) RTD Ag, currently in use in the DRC detects a very high proportion of false positives. Those children falsely positive were subject to be treated unnecessarily. Therefore, there is need of adapting the choice of RDT for malaria policy accordingly.

To adequately plan mass drug administration campaigns, the Democratic Republic of the Congo (DRC) needs further support for the mapping and monitoring of schistosomiasis (SCH) and soil-transmitted helminths (STH). We conducted a community-based survey in the health districts of Mosango and Yasa Bonga of the Kwilu province, DRC. A stratified two-stage cluster random sampling method was used to include participants into three different strata: Preschool-aged children (PSAC), school-aged children (SAC), and adults who were further subdivided into women of reproductive age (WRA) and other adults. In total, surveyors visited 30 villages, and 1 206 individuals participated in the study. Stool samples were collected to perform duplicate Kato-Katz smears for the detection of SCH and STH infection. Hookworm was the most prevalent infection in both districts, 34.1% (95%CI: 32.0–38.4), followed by A. lumbricoides (2.7%; 95%CI: 1.3–2.9) and T. trichiura (1.9%; 95%CI: 1.1–2.7). We did not find any SCH infection. The prevalence of each STH infection was similar across all risk groups, and the majority of the infected individuals was carrying light intensity infection. Compared to SAC, other adults were equally infected with hookworm. The prevalence of STH infection in SAC guides the MDA implementation because schoolchildren are most at risk and easily accessible program targets if school attendance is high. The current treatment strategy targets PSAC, SAC and WRA. However, this study shows that adults in general could also benefit from deworming. Therefore, community-wide preventive chemotherapy would be the most appropriate choice to control the hookworm burden rapidly., Author summary Helminths are a group of intestinal worms that cause abdominal discomfort, diarrhea, and anemia due to blood loss in the stool. Regular mass drug administration (MDA) is one strategy to fight these worm infections. The appropriate MDA treatment scheme is chosen based on a population survey estimating the burden of infection. This survey is usually done in schoolchildren because they suffer the most from these infections and they are easy to reach through school infrastructures. However, one particular worm, the hookworm, is also highly present and clinically relevant in adults. We conducted a community-based survey in two districts of the Kwilu Province of the DRC. We found that hookworm was the predominant infection in the area and that adults were as often infected as the schoolchildren. Therefore, to effectively reduce hookworm infection, we advise extending treatment schemes to the entire community.

Introduction: Schistosomiasis (SCH) is an important public health problem in developing countries and school-aged children are the most affected. This study explored health and nutritional status and their correlation with SCH in children attending primary school (3rd to 6th class) living in the area of Kasansa in the Democratic Republic of Congo. Methods: Across-sectional household survey was carried out in Kasansa health area in February 2011. Children whose parents reported to attend primary school (3rd to 6th class) were included. Socio-demographic characteristics, information on morbidity history and risk factor were collected using a semi-structured questionnaire. S. mansoni and malaria infection were assessed using the Kato-katz technique and rapid diagnostic test, respectively. Haemoglobin concentration was also performed using a portable HemoControl device. Bivariate and multiple logistic regressions were used to assess risk factors for S. mansoni. Results: A total of 197 school aged children participated in the study with a median age of 12 years and 53.8% of them were boys. The overall health status of the children was poor with very high prevalences of S. mansoni infection (89.3%), malaria infection (65.1%), anaemia (61.4%) and stunting (61.0%). Regular contact with river water was the most important risk factor (OR: 11.7; p

Objective To determine the prevalence of schistosomiasis (SCH) and soil-transmitted helminths (STH) in the Democratic Republic of Congo, and to assess the capacity of the local health centers for diagnosis and treatment. Methods Cross-sectional school-based survey in two Health Districts in the province of Kwilu. We collected a stool and a urine sample for parasitological examination. Urine filtration and duplicate Kato-Katz thick smears were used for the diagnosis of SCH. Health centers were evaluated using a structured questionnaire. Results In total, 526 children participated in the study and the overall prevalence of S. mansoni infection was 8.9% (95%CI: 3.5-13.2) in both districts. The prevalence was higher in Mosango (11.7%; 95%CI: 8.9-14.8) than Yasa Bonga district (6.2%; 95%CI: 1.1-11.4). Urine filtration showed that S. haematobium infection was not present. The combined STH infection prevalence was 58.1% in both districts; hookworm infection was the most common STH found in 52.9% (95%CI: 29.3-62.4) of subjects, followed by A. lumbricoides 9.3% (95%CI: 5.8-15.5) and T. trichiura 2.1% (95%CI: 0.9-4.9). Mixed STH infections were observed as well as SCH-STH co-infection. Conclusion Further mapping of both SCH and STH burden is needed, and coverage of preventive chemotherapy in school age children should be increased. This article is protected by copyright. All rights reserved.

Resume Introduction En Republique democratique du Congo, les donnees sur les geohelminthiases (GH) sont fragmentaires. L’objectif etait de determiner et de comparer la prevalence des GH chez les enfants d’âge scolaire a Kinshasa, Republique democratique du Congo. Methodologie Une etude transversale a ete menee de mai a octobre 2009 aupres des enfants dans les ecoles primaires et les menages. Resultats Quatre cent trente huit enfants ont ete inclus dans l’etude dont 235 dans les ecoles et 203 dans les menages. La proportion des enfants scolarises dans les menages etait de 77,8 %. La frequence globale des GH etait de 66,9 %, et respectivement de 69,4 % et 64 % dans les ecoles et dans les menages. A. lumbricoides , Trichuris trichiura et Ankylostoma sp. representaient respectivement 56,2 % ; 38,7 % et 1,7 % dans les ecoles et 39,9 % ; 51,7 % et 1 % dans les menages. La difference entre les 2 groupes etait significative pour A . lumbricoides (OR = 2,0 ; IC 95 % : 1,3–3,0) et T . trichiura (OR = 0,6 ; IC 95 % : 0,4–0,9) mais pas pour les ankylostomes. Conclusion Cette etude a montre une frequence elevee des GH chez les enfants d’âge scolaire dans cette region. Un plus grand investissement dans les mesures preventives est la seule condition requise pour reduire la prevalence des GH dans notre milieu.

Background: Anaemia reduces cognitive potential in school children, retards their growth and predisposes them to other diseases. As there is a paucity of data on the current burden of P. falciparum, S. mansoni and soil transmitted helminths (STH) infections and their correlation with schoolchildren's anemia in the Democratic Republic of Congo (DRC), we collect these data. Methods: This study reports baseline data collected from a randomized controlled trial investigating the impact of IPT with SP and SP-PQ on anemia and malaria morbidity in Congolese schoolchildren (Trial registration: NCT01722539; PACTR201211000449323). S. mansoni and STH infections were assessed using kato-katz technique. Malaria infection and hemoglobin concentration were assessed using Blood smear and Hemocontrol device, respectively. Results: A total of 616 primary schoolchildren from 4 to 13 years old were enrolled in the study. The prevalence of Plasmodium spp. infection was 18.5% (95%CI:15.6-21.9). Amongst those infected, 24 (21%), 40 (35.1%), 40 (35.1%), 10 (8.8%), had light, moderate, heavy, very high malaria parasite density, respectively. Above 9 years of age (p = 0.02),male and history of fever (p = 0.04) were both associated with malaria infection. The overall prevalence of S. mansoni infection was 6.4% (95%CI:4.4-9.1). Girls were associated with S. mansoni infection (p = 0.04). T. trichiura was the most prevalent STH infection (26.3%), followed by A. lumbricoides (20.1%). Co-infection with malaria-S. mansoni and malaria-STH was, respectively, 1.5% (CI95%:0.7-3.3) and 6.4% (CI95% 4.4-9.1). The prevalence of anemia was found to be 41.6% (95%CI:37.7-45.6) and anemia was strongly related with Plasmodium ssp infection (aOR:4.1; CI95%:2.6-6.5;p

School-aged children suffer the most from schistosomiasis infection in sub Saharan Africa due to poverty and limited sanitary conditions. Mapping of disease burden is recommended and there is a need of updating prevalence data which is as old as 20 years in the Democratic Republic of Congo. An epidemiological and parasitological study was carried out in 2011 in the health zone of Kasansa. Six health areas (HA) were included in the study. In each health area, one primary school was selected. School-aged children were screened for S. mansoni infection using parallel Kato-Katz and direct microscopy techniques. A total of 335 school-aged children were screened. The average prevalence was 82.7% and ranged between 59.5–94.9%. Four of the six HAs had a prevalence level over 91%. Of all infected children, about half 112 (43.2%) had light parasite density. These results demonstrate that Schistosoma mansoni infection is a bigger problem than anticipated and there is an urgent need to implement effective control measures., Author Summary Schistosomiasis (SCH) is a parasitic infection and one gets infected when bathing or in contact with contaminated fresh water bodies like rivers. It has been shown that people living in poor sanitary conditions and especially school-aged children suffer the most from this infection. Mapping is needed in order to control or prevent the disease. However, in the Democratic Republic of the Congo (DRC), surveillance of schistosomiasis is lacking. Previous data on distribution of schistosomiasis may have lost relevance since the disease was last mapped 20 years ago. This study was carried out in 2011 in the health zone of Kasansa, DRC. Six primary schools were visited and stool samples were collected from children attending the 3rd class. The stool samples were analyzed for S. mansoni infection. Up to 335 children were recruited and 82.7% were infected. Moreover, in 4 health areas over 91% of the children were infected. Of all infected children, almost half, 112 (43.2%) had light parasite density. These results demonstrate that Schistosoma mansoni infection is a bigger problem than anticipated and there is an urgent need to put effective control measures.

Schistosomiasis is a poverty-related parasitic infection, leading to chronic ill-health. For more than a century, schistosomiasis has been known to be endemic in certain provinces of the Democratic Republic of Congo (DRC). However, a clear overview on the status of the disease within the country is currently lacking, which is seriously hampering control. Here, we review the available information on schistosomiasis in DRC of the past 60 years. Findings and data gaps are discussed in the perspective of upcoming control activities. An electronic literature search via PubMed complemented by manual search of non-peer-reviewed articles was conducted up to January 2015. The search concerned all relevant records related to schistosomiasis in the DRC from January 1955 onwards. A total of 155 records were found, of which 30 met the inclusion criteria. Results were summarized by geographical region, mapped, and compared with those reported sixty years ago. The available data reported schistosomiasis in some areas located in 10 of the 11 provinces of DRC. Three species of Schistosoma were found: S. mansoni, S. haematobium and S. intercalatum. The prevalence of schistosomiasis varied greatly between regions and between villages, with high values of up to 95 % observed in some communities. The overall trend over 60 years points to the spread of schistosomiasis to formerly non-endemic areas. The prevalence of schistosomiasis has increased in rural endemic areas and decreased in urban/peri-urban endemic areas of Kinshasa. Hepatosplenomegaly, urinary tract lesions and anaemia were commonly reported in schistosomiasis endemic areas but not always associated with infection status. The present review confirms that schistosomiasis is still endemic in DRC. However, available data are scattered across time and space and studies lack methodological uniformity, hampering a reliable estimation of the current status of schistosomiasis in DRC. There is a clear need for updated prevalence data and well-designed studies on the epidemiology and transmission of schistosomiasis in DRC. This will aid the national control program to adequately design and implement strategies for sustainable and comprehensive control of schistosomiasis throughout the country.