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Resume Position du probleme Les soins centres sur le patient supposent une communication basee sur l'empathie, l’ecoute active et le dialogue. Notre etude examine les effets de l'integration de la sante mentale dans des centres de sante polyvalents sur la communication des soignants avec des patients tout-venants. L'objectif est de comparer la qualite de cette communication dans les centres de sante ou le personnel a recu une formation specifique pour la prise en charge des troubles mentaux (SM+) par rapport a ceux sans cette formation (SM − ). Methodes L’etude est realisee aupres de 18 soignants charges des consultations primaires curatives de 12 centres de sante associatifs en Guinee : quatre centres de sante SM+ avec sept soignants et huit SM − avec 11 soignants. L’etude utilise le Global Consultation Rating Scale (GCRS) pour apprecier la communication centree sur le patient. Elle repose sur des methodes mixtes : observation, entretiens semi-structures et de groupe. Resultats Les scores de GCRS obtenus par les soignants SM+ lors des observations sont generalement superieurs aux scores des soignants SM − . La cote d'avoir une consultation de « bonne qualite » est presque trois fois plus grande dans les structures SM+ que dans les SM − pour certaines etapes de la consultation. Le discours des soignants SM+ est plus centre sur le patient, et se distingue du discours plus biomedical des SM − . Les soignants SM − considerent que les differentes etapes d'une consultation centree sur le patient ne sont pas toutes applicables et disent « sauter des etapes », les SM+ estiment que toutes les etapes sont importantes et que l'integration de la sante mentale a ameliore leur communication grâce a la formation recue et la pratique de soins pour les personnes ayant des troubles mentaux. Conclusion L'integration de la sante mentale dans l'offre de soins de premiere ligne se presente comme une opportunite pour ameliorer la qualite de soins dans sa dimension « soins centres sur le patient ». Le developpement de soins centres sur le patient suppose cependant des conditions structurelles favorables.

BackgroundLong-lasting insecticidal nets (LLINs) are one of the key interventions in the global fight against malaria. Since 2014, mass distribution campaigns of LLINs aim for universal access by all citizens of Burundi. In this context, we assess the impact of LLINs mass distribution campaigns on malaria incidence, focusing on the endemic highland health districts. We also explored the possible correlation between observed trends in malaria incidence with any variations in climate conditions.MethodsMalaria cases for 2011—2019 were obtained from the National Health Information System. We developed a generalised additive model based on a time series of routinely collected data with malaria incidence as the response variable and timing of LLIN distribution as an explanatory variable to investigate the duration and magnitude of the LLIN effect on malaria incidence. We added a seasonal and continuous-time component as further explanatory variables, and health district as a random effect to account for random natural variation in malaria cases between districts.ResultsMalaria transmission in Burundian highlands was clearly seasonal and increased non-linearly over the study period. Further, a fast and steep decline of malaria incidence was noted during the first year after mass LLIN distribution (pConclusionThis study highlights that LLINs did reduce the incidence in the first year after a mass distribution campaign, but in the context of Burundi, LLINs lost their impact after only 1 year.

Introduction: In Sub-Saharan Africa, snakebites are a public health problem. In Ethiopia, clinical cases have been described, but little information exists on snakebites burden and its geographical distribution. The aim of this study was to document the spatial distribution of venomous snakes and snakebites in Ethiopia. Methodology: In a cross-sectional observational study, venomous snakes were collected during snake catching activities in six Ethiopian hotspot areas between April 2015 and September 2020. Species and habitat were described. In the hotspot areas, routine health information data on reported snakebites was collected in 78 districts and subsequently used to map annual incidence per district. Result: A total of 333 snakes were collected and 14 species were identified. The most prevalent species were Bitis arietans, Bitis arietanus somalica, Echis pyramidum, known as vipers, and Naja pallida, known as cobra. The highest number of snakes (75) was observed in the Northwest and Eastern parts of Ethiopia, mostly in cultivation and man-made farm land, wooded and moist dry savanna. In each hotspot a wide variety of species was observed, although composition was different. The highest snakebite incidence overlapped with the high snakes densities in Northwest Ethiopia. The snakebite annual average incidence at district level was very heterogeneous and ranged from < 15 cases/100,000 inhabitants (44% of the districts) to 309.2 cases/100,000 inhabitants. Conclusions: Snake diversity and distribution, linked to high incidence of snakebites in the hotspots, suggests a close interconnection between human, animal and environmental systems and could inform the need for antivenoms per geographical locality.

Introduction: Timely and appropriate management of snakebites in the tropics is a lifesaver. Many snakebite patients are being bitten in remote rural areas and do not manage to get in due time to healthcare facilities. This study assessed the clinical features and the risk factors associated with treatment outcomes of snakebite patients admitted at two hospitals in the Northwest of Ethiopia. Methodology: In a retrospective cohort study, routinely collected data from 250 patients’ medical charts at University of Gondar Hospital and Metema Hospital, between September 2012 and August 2020, were reviewed. Results: The median age of the snakebite cases was 24 years (95% CI = 22-26), with 80.8% male patients. At admission 148/250 patients presented in Clinical stage 1 or 2 (local symptoms only) and 73.7% presented more than 12 hours after the bite, 80.2% received antibiotics and 79.0% antivenom. The median duration of hospitalization was 3 days (95% CI = 3-4); 72% of the patients recovered and were discharged, 10.8% died and 0.5% underwent an amputation. On logistic regression analysis, residence in rural areas (AOR = 2.52, 95 % CI = 1.2-5.3), sign of bacterial superinfection on the bite site (AOR = 4.69. 95% CI = 1.4-15.4), clinical stage 3 or 4 with systemic symptoms or toxic signs at admission (AOR = 4.84, 95% CI = 1.3-18.0) and no treatment with antivenoms (AOR = 6.65, 95% CI = 1.6-27.7) were associated with bad outcome (death, amputation and/or referred/ went against medical advice). Conclusions: Timely presentation at early clinical stage, appropriate clinical management and availability of antivenoms are cornerstones to reduce snakebite morbidity and mortality.

Background Following earlier trials indicating that their potential in dengue vector control was constrained by housing structure, a large-scale cluster-randomized trial of insecticide treated curtains (ITCs) and water jar covers (ITJCs) was undertaken in Venezuela. Methods In Trujillo, Venezuela, 60 clusters (6223 houses total) were randomized so that 15 clusters each received either PermaNet insecticide-treated window curtains (ITCs), permanent insecticide-treated water storage jar covers (ITJCs), a combination of both ITCs and ITJCs, or no insecticide treated materials (ITMs). A further 15 clusters located at least 5km from the edge of the study site were selected to act as an external control. Entomological surveys were carried out immediately before and after intervention, and then at 6-month intervals over the following 27 months. The Breteau and House indices were used as primary outcome measures and ovitrap indices as secondary. Negative binomial regression models were used to compare cluster-level values of these indices between the trial arms. Results Reductions in entomological indices followed deployment of all ITMs and throughout the trial, indices in the external control arm remained substantially higher than in the ITM study arms including the internal control. Comparing the ratios of between-arm means to summarise the entomological indices throughout the study, the combined ITC+ITJC intervention had the greatest impact on the indices, with a 63% difference in the pupae per person indices between the ITC+ITJC arm and the internal control. However, coverage had fallen below 60% by 14-months post-intervention and remained below 40% for most of the remaining study period. Conclusions ITMs can impact dengue vector populations in the long term, particularly when ITCs and ITJCs are deployed in combination. Trial registration ClinicalTrials.gov ISRCTN08474420; www.isrctn.com.

In October 2020, after the first wave of coronavirus disease 2019 (COVID-19), only 8290 confirmed cases were reported in Kinshasa, Democratic Republic of the Congo, but the real prevalence remains unknown. To guide public health policies, we aimed to describe the prevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) immunoglobulin G (IgG) antibodies in the general population in Kinshasa.We conducted a cross-sectional, household-based serosurvey between 22 October 2020 and 8 November 2020. Participants were interviewed at home and tested for antibodies against SARS-CoV-2 spike and nucleocapsid proteins in a Luminex-based assay. A positive serology was defined as a sample that reacted with both SARS-CoV-2 proteins (100% sensitivity, 99.7% specificity). The overall weighted, age-standardized prevalence was estimated and the infection-to-case ratio was calculated to determine the proportion of undiagnosed SARS-CoV-2 infections.A total of 1233 participants from 292 households were included (mean age, 32.4 years; 764 [61.2%] women). The overall weighted, age-standardized SARS-CoV-2 seroprevalence was 16.6% (95% CI: 14.0-19.5%). The estimated infection-to-case ratio was 292:1. Prevalence was higher among participants ≥40 years than among those18 years (21.2% vs 14.9%, respectively; P .05). It was also higher in participants who reported hospitalization than among those who did not (29.8% vs 16.0%, respectively; P .05). However, differences were not significant in the multivariate model (P = .1).The prevalence of SARS-CoV-2 is much higher than the number of COVID-19 cases reported. These results justify the organization of a sequential series of serosurveys by public health authorities to adapt response measures to the dynamics of the pandemic.

High-throughput serological tests that can detect neutralizing antibodies against SARS-CoV-2 are desirable for serosurveillance and vaccine efficacy evaluation. Although the conventional neutralization test (cVNT) remains the gold standard to confirm the presence of neutralizing antibodies in sera, the test is too labour-intensive for massive screening programs and less reproducible as live virus and cell culture is involved. Here, we performed an independent evaluation of a commercially available surrogate virus neutralization test (sVNT, GenScript cPass™) that can be done without biosafety level 3 containment in less than 2 hours. When using the cVNT and a Luminex multiplex immunoassay (MIA) as reference, the sVNT obtained a sensitivity of 94% (CI 90-96%) on a panel of 317 immune sera that were obtained from hospitalized and mild COVID-19 cases from Belgium and a sensitivity of 89% (CI 81-93%) on a panel of 184 healthcare workers from the Democratic Republic of Congo. We also found strong antibody titer correlations (rs>0.8) among the different techniques used. In conclusion, our evaluation suggests that the sVNT could be a powerful tool to monitor/detect neutralising antibodies in cohort and population studies. The technique could be especially useful for vaccine evaluation studies in sub-Saharan Africa where the basic infrastructure to perform cVNTs is lacking.

Background Dengue, yellow fever, chikungunya and Zika are among the most important emerging infectious vector-borne diseases worldwide. In the Democratic Republic of Congo (DRC), increases in cases of dengue and outbreaks of yellow fever and chikungunya have been reported since 2010. The main vectors of these arboviruses, Aedes aegypti and Aedes albopictus, have been reported in DRC, but there is a lack of detailed information on their presence and spread to guide disease control efforts. Methods In 2018, two cross-sectional surveys were conducted in Kinshasa province (DRC), one in the rainy (January/February) and one in the dry season (July). Four hundred houses were visited in each of the four selected communes (N’Djili, Mont Ngafula, Lingwala and Kalamu). Within the peri-domestic area of each household, searches were conducted for larval habitats, which were then surveyed for the presence of Aedes larvae and pupae. A subset of the immature specimens were reared to adults for morphological identification followed by DNA barcoding of the specimens to validate identifications. Results The most rural commune (Mont Ngafula) had the highest pupal index (number of Aedes spp. pupae per 100 inspected houses) at 246 (20) pupae/100 houses, and Breteau index (BI; number of containers positive for immature stages of Aedes spp. per 100 households) at 82.2 (19.5) positive containers/100 houses for the rainy (and dry) season, respectively. The BI was 21.5 (4.7), 36.7 (9.8) and 41.7 (7.5) in Kalamu, Lingwala and N’Djili in the rainy (and dry) season, respectively. The house index (number of houses positive for at least one container with immature stages of Aedes spp. per 100 inspected houses) was, on average, across all communes, 27.5% (7.6%); and the container index (number of containers positive for immature stages of Aedes spp. per 100 inspected containers) was 15.0% (10.0%) for the rainy (and dry) season, respectively. The vast majority of Aedes-positive containers were found outside the houses [adjusted odds ratio 27.4 (95% confidence interval 14.9–50.1)]. During the dry season, the most productive containers were the ones used for water storage, whereas in the rainy season rubbish and tires constituted key habitats. Both Ae. aegypti and Ae. albopictus were found. Anopheles larvae were found in different types of Aedes larval habitats, especially during the rainy season. Conclusions In both surveys and in all communes, the larval indices (BI) were higher than the arbovirus transmission threshold values established by the World Health Organization. Management strategies for controlling Aedes in Kinshasa need to target the key types of containers for Aedes larvae, which are mainly located in outdoor spaces, for larval habitat destruction or reduction. Graphical Abstract

A diagnosis of COVID-19 is based on a positive PCR test for SARS-CoV-2. Over the past year, PCR testing capacity has varied globally due to the availability of tests, and testing strategies have targeted mainly symptomatic individuals. Therefore, the spread of the virus is probably wider than the numbers reported by official surveillance systems that are based on PCR results. Serology tests detect antibodies against SARS-CoV-2, which start being measurable around 1–2 weeks after infection. They are used in seroprevalence studies to estimate the proportion of people in a population that has been infected, including asymptomatic infection. These studies are of particular importance in African countries, where reported testing and incidence are among the lowest in the world.

Background Behavioural risk factors for cholera are well established in rural and semi-urban contexts, but not in densely populated mega-cities in Sub-Saharan Africa. In November 2017, a cholera epidemic occurred in Kinshasa, the Democratic Republic of the Congo, where no outbreak had been recorded for nearly a decade. During this outbreak, we investigated context-specific risk factors for cholera in an urban setting among a population that is not frequently exposed to cholera. Methodology/Principal findings We recruited 390 participants from three affected health zones of Kinshasa into a 1:1 matched case control study. Cases were identified from cholera treatment centre admission records, while controls were recruited from the vicinity of the cases’ place of residence. We used standardized case report forms for the collection of socio-demographic and behavioural risk factors. We used augmented backward elimination in a conditional logistic regression model to identify risk factors. The consumption of sachet water was strongly associated with the risk of being a cholera case (p-value 0.019), which increased with increasing frequency of consumption from rarely (OR 2.2, 95% CI 0.9–5.2) to often (OR 4.0, 95% CI 1.6–9.9) to very often (OR 4.1, 95% CI 1.0–16.7). Overall, more than 80% of all participants reported consumption of this type of drinking water. The risk factors funeral attendance and contact with someone suffering from diarrhoea showed a p-value of 0.09 and 0.08, respectively. No socio-demographic characteristics were associated with the risk of cholera. Conclusions/Significance Drinking water consumption from sachets, which are sold informally on the streets in most Sub-Saharan African cities, are an overlooked route of infection in urban cholera outbreaks. Outbreak response measures need to acknowledge context-specific risk factors to remain a valuable tool in the efforts to achieve national and regional targets to reduce the burden of cholera in Sub-Saharan Africa., Author summary Cholera is a diarrheal disease caused by ingestion of the Vibrio cholerae bacterium. Outbreaks in urban areas are becoming increasingly frequent in Sub-Saharan Africa. Risk factors for cholera have been studied in rural settings but not sufficiently in urban areas. Understanding context-specific risk factors is key for successful outbreak response. During a cholera outbreak in Kinshasa, the Democratic Republic of the Congo we were able to identify a previously unknown behavioural risk factor of particular relevance in urban settings–the consumption of drinking water from plastic sachets. Water sachets are sold on the streets of all major cities in Sub-Saharan Africa. It requires biting off an edge and sucking out the water, and we think that external contamination of these sachets was an important transmission route in the Kinshasa outbreak. Water sachets are predominantly consumed by socio-economically disadvantaged groups who lack piped water supply in their homes and have poor access to sanitary infrastructure. This makes our findings particularly relevant because these are the very populations who are at increased risk of getting and transmitting cholera. Health messaging and response measures should include consumption of water sachets as a potential risk factor during future cholera outbreaks in urban low-resource settings.

BACKGROUND: Dengue, yellow fever, chikungunya and Zika are among the most important emerging infectious vector-borne diseases worldwide. Besides sporadic dengue cases, yellow fever and chikungunya outbreaks have been increasingly reported in Democratic Republic of Congo (DRC) in the last decade. The main vectors of these arboviruses, Aedes aegypti and Aedes albopictus, were reported in DRC, but there is a lack of detailed information on their presence and spread hampering transmission risk assessments in the region. METHODS: In 2018, two cross-sectional surveys were realized in Kinshasa province (DRC), one in the rainy (January/February) and one in the dry season (July). Four hundred houses were visited in each of the four selected communes (N’Djili, Mont Ngafula, Lingwala and Kalamu). Breedings sites were recorded, larvae and pupae collected and reared to obtain adults for genus and species identification. A subset of specimens was DNA-barcoded for validation of the morphological species identification. RESULTS: The most rural commune (Mont Ngafula) had the highest density levels, with a Breteau Index of 82.2 and 19.5/100 houses in rainy and dry season, respectively. The Breteau Index in the other communes Kalamu, Lingwala and N’Djili elevated to 21.5 (4.7), 36.7 (9.8) and 41.7 (7.5) in the rainy (and dry) season. The House index was on average 27.5% and 7.6%; and the Container Index 15.0% and 10.0% in rainy and dry season, respectively. The vast majority of Aedes positive containers was found outside the houses (adjusted OR 27.4 (95%CI 14.9-50.1)). The main breeding sites were used tires, water storage containers and trash. Anopheles larvae were also found in Aedes breeding sites, especially during the rainy season.CONCLUSIONS: These results show that Kinshasa is highly infested with Aedes spp. which indicates a high potential for arbovirus transmission in the area. During the dry season, the most productive containers (for Aedes pupae production) are containers used for water storage, whereas in the rainy season this is trash and tires. The present study also evidences that Aedes breeding sites are mainly located outdoors. Based on the results of this study, a contextualized Aedes control strategy can be designed for Kinshasa.

Background. Various arboviruses are transmitted to humans by mosquitoes, particularly Aedes aegypti and Aedes albopictus, two invasive and frequently sympatric species. The objective of this study was to evaluate the behavior of Ae. albopictus with regards to houses and association with other mosquitoes in Havana province. Methods. All deposits containing water in the houses and vacant lots of urban and peri urban municipalities of the province Havana were sampled during two periods: the first 1995 – 1999 and the second 2010-2018. Results. Patterns in the presence of Ae. albopictus in the study area were observed: the persistent absence of Ae. albopictus in one municipality; in two municipalities, starting from an absence in the first period to a rapid dispersion in the following period; and a sustained decrease in the dispersion of Ae. albopictus in two other municipalities. The association of Ae. albopictus with other mosquitoes smaller in the peripheral municipalities, although being the ones with the greatest presence of Ae. albopictus. However overall, we found an increase in this association when comparing the period 2010-2018 with the first period since its introduction in Havana. Inside the houses, Ae albopictus was present in 8% (2016) to 21.5% (2013) with an average of 15%, which evidences an initial domiciliation of the species.Conclusions. The results obtained in this work show an initiation of domiciliation of Ae albopictus in the urban area of Havana province. This is important to alert the National Control Program to strengthen the entomological monitoring of Ae. albopictus, and not only Ae. aegypti. The follow up of this domiciliation is important to guide control efforts, knowing its role as a vector of different arboviruses.

Randomized control trials have provided evidence that some community-based interventions (CBIs) work in vector-borne diseases (VBDs). Conversely, there is limited evidence on how well those CBIs succeed in producing specific outcomes in different contexts. To conduct a realist synthesis for knowledge translation on this topic, we examined the extent to which realist concepts (context, mechanisms, and outcomes) and their relationships are present in the existing literature on CBIs for VBDs. Articles on CBIs were identified from prior scoping reviews of health interventions for VBDs. Content of the articles was extracted verbatim if it referred either to realist concepts or CBI features. The number of articles and the average number of words extracted per category per CBI were quantified. Content of the articles was scrutinized to inductively gather qualitative evidence on the interactions between realist concepts. We reviewed 41 articles on 17 CBIs from 12 countries. The average number of words used for mechanisms was much lower than those used for outcomes and context (309,474, and 836, respectively). The average number of words used for mechanisms increased when a CBI was described in three or more articles. There were more extensive accounts on CBI features than on mechanisms. It was difficult to gather evidence on the interactions among realist concepts from the content of the articles. Scarce reporting on mechanisms in published articles limits conducting a realist synthesis of CBIs in VBDs. More transdisciplinary research that goes beyond the biomedical paradigm is needed to boost the development of intervention mechanisms in this field.

BACKGROUND Arboviruses such as dengue, yellow fever, chikungunya and Zika are among the most important emerging infectious diseases worldwide. Yellow fever and chikungunya outbreaks, and few dengue cases have been reported in Democratic Republic of Congo (DRC) in recent years. Although the main vectors of these arboviruses, Aedes aegypti and Aedes albopictus , were reported in DRC, the lack of detailed information on their presence and spread hampers transmission risk assessments in this region. METHODS In 2018, two cross-sectional surveys were realized in Kinshasa province (DRC), one in the rainy (January/February) and one in the dry season (July). Four hundred houses were visited in each of the four selected communes (N’Djili, Mont Ngafula, Lingwala and Kalamu). Breedings sites were recorded, larvae and pupae collected and reared to obtain adults for genus and species identification. A subset of specimen was DNA-barcoded for species validation. RESULTS The most rural commune (Mont Ngafula) had the highest infestation levels, with a Breteau Index of 82.2 and 19.5/100 houses in rainy and dry season, respectively. The Breteau Index in the other communes Kalamu, Lingwala and N’Djili elevated to 21.5 (4.7), 36.7 (9.8) and 41.7 (7.5) in the rainy (and dry) season respectively. The House index was on average 27.5% and 7.6%; and the Cotainer Index 15.0% and 10.0% in rainy and dry season, respectively. The vast majority of Aedes positive containers were found outside the houses (aOR 27.3 (95%CI 14.9-50.0)). The main breeding sites were used tires, water storage containers and trash. Anopheles larvae were also found in Aedes breeding sites in all four communes in the rainy season. CONCLUSIONS These results show that Kinshasa is highly infested with Aedes spp. which indicates a high potential for arbovirus transmission in the area. The present study evidences that Aedes breeding sites are mainly located outdoors. The most productive containers (for Aedes pupae production) during the dry season are the water storage containers, while over the rainy season these are the artificial containers, especially tires. This will have an impact on the design of control strategies for these vectors in Kinshasa.

Background: Cholera is endemic in the Democratic Republic of the Congo. Starting in 2016, a cholera epidemic swept through the country and in November 2017 reached the capital of Kinshasa, which had not experienced a cholera outbreak for nearly a decade. Behavioural risk factors for cholera are well established in rural and semi-urban contexts but not in densely populated mega-cities from Sub-Saharan Africa. Such information is crucial to guide context-specific control measures. We seized the outbreak in Kinshasa as an opportunity to investigate context-specific risk factors for cholera in this urban setting among a mobile population that is not frequently exposed to cholera. Methods: We recruited 390 participants into a 1:1 age-matched case control study from three affected health zones of Kinshasa between 1 and 28 February 2018. Cases were identified from cholera treatment centre admission records, while controls were recruited from the neighbourhood of the cases’ place of residence. We collected data on socio-demographic and behavioural risk factors using standardized case report forms. We used augmented backward elimination in a conditional logistic regression model to identify risk factors, using a p-values of 0.05 as cut-off to define statistical significance. Results: The consumption of sachet water was significantly associated with the risk of being a cholera case (p-value 0.019), which increased with increasing frequency of consumption from rarely [OR 2.223, 95% CI 0.944-5.235] to often [OR 4.031, 95% CI 1.642-9.891] to very often [OR 4.144, 95% CI 1.029-16.653]. Overall, more than 80% of all participants reported consumption of this type of drinking water. Funeral attendance and recent contact with someone suffering from diarrhoea were borderline insignificant risk factors (p-value 0.09 and 0.08, respectively). No socio-demographic characteristics were associated with the risk of cholera. Conclusions: Drinking water consumption from sachets, which are sold informally on the streets in most Sub-Saharan African cities, should be considered as a potential route of infection during future cholera outbreaks in similar urban settings. Outbreak investigation and response need to acknowledge context-specific risk factors to remain a valuable tool in the efforts to achieve national and regional targets to reduce the burden of cholera in Africa.

Background: Patient-centred care is an essential component of quality of health care. We hypothesize that integration of a mental health care package into versatile first-line health care services can strengthen patient participation, an important dimension of patient-centred care. The objective of this study is to analyse whether consultations conducted by providers in facilities that integrated mental health care score higher in terms of patient participation. Methods: This study was conducted in Guinea in 12 not-for-profit health centres, 4 of which had integrated a mental health care package (MH+) and 8 had not (MH-). The study involved 450 general curative consultations (175 in MH+ and 275 in MH-centres), conducted by 18 care providers (7 in MH+ and 11 in MH-centres). Patients were interviewed after the consultation on how they perceived their involvement in the consultation, using the Patient Participation Scale (PPS). The providers completed a self-administered questionnaire on their perception of patient's involvement in the consultation. We compared scores of the PPS between MH+ and MH-facilities and between patients and providers. Results: The mean PPS score was 24.21 and 22.54 in MH+ and MH-health centres, respectively. Participation scores depended on both care providers and the health centres they work in. The patients consulting an MH+ centre were scoring higher on patient participation score than the ones of an MH-centre (adjusted odds ratio of 4.06 with a 95% CI of 1.17-14.10, p = 0.03). All care providers agreed they understood the patients' concerns, and patients shared this view. All patients agreed they wanted to be involved in the decision-making concerning their treatment; providers, however, were reluctant to do so. Conclusion: Integrating a mental health care package into versatile first-line health services can promote more patient-centred care., SCOPUS: ar.j, info:eu-repo/semantics/published

Background Pathogens causing acute fever, with the exception of malaria, remain largely unidentified in sub-Saharan Africa, given the local unavailability of diagnostic tests and the broad differential diagnosis. Methodology/Principal Findings We conducted a cross-sectional study including outpatient acute febrile syndromes in both children and adults, between November 2015 and June 2016 in Kinshasa, Democratic Republic of Congo. Serological and molecular diagnostic tests for arboviral infections were performed on blood, including PCR and NS1-RDT for acute, and ELISA and IFAT for past infections. Conclusions/Significance Among 342 patients, aged 2 to 68 years, 45.3% tested positive on malaria Rapid Diagnostic Test. However, 87.7% received antimalarial and 64.3% antibacterial treatment. Further investigation among 235 fever cases revealed 19 (8.1%) acute dengue and 2 (0.9%) acute chikungunya infections, with an important proportion of participants already exposed to flaviviridae (possibly dengue) and alphaviridae (possibly chikungunya) in the past, namely 30.2 % and 26.4% respectively. We found no evidence of exposure to Zika nor yellow fever virus.

Objective: Information on the cost of implementing residual insecticide treatment (RIT) for Aedes control is scarce. We evaluated the incremental cost on top of intensive conventional routine activities of the Aedes control programme (ACP) in the city of Santiago de Cuba, Cuba. Methods: We conducted the cost analysis study in 2011-2012, from the perspective of the ACP. Data sources were bookkeeping records, activity registers of the Provincial ACP Centre and the accounts of an RIT implementation study in 21 clusters of on average four house blocks comprising 5180 premises. Results: The annual cost of the routine ACP activities was 19.66 US$ per household. RIT applications in rounds at 4-month intervals covering, on average, 97.2% and using 8.5g of delthametrine annually per household, cost 3.06 US$ per household per year. Delthametrine comprised 66.5% of this cost; the additional cost for deploying RIT comprised 15.6% of the total ACP routine cost and 27% of the cost related to routine adult stage Aedes control. Conclusions: The incremental cost of implementing RIT is high. It should be weighed against the incremental effect on the burden caused by the array of pathogens transmitted by Aedes. The cost could be reduced if the insecticide became cheaper, by limiting the number of yearly applications or by targeting transmission hot spots.

The 2013–2016 Ebola epidemic in West Africa challenged traditional international mechanisms for public health team mobilisation to control outbreaks. Consequently, in February 2016, the European Union (EU) launched the European Medical Corps (EMC), a mechanism developed in collaboration with the World Health Organization (WHO) to rapidly deploy teams and equipment in response to public health emergencies inside and outside the EU. Public Health Teams (PHTs), a component of the EMC, consist of experts in communicable disease prevention and control from participating countries and the European Centre for Disease Prevention and Control (ECDC), to support affected countries and WHO in risk assessment and outbreak response. The European Commission’s Directorate-General European Civil Protection and Humanitarian Aid Operations and Directorate-General Health and Food Safety, and ECDC, plan and support deployments. The first EMC-PHT deployment took place in May 2016, with a team sent to Angola for a yellow fever outbreak. The aims were to evaluate transmission risks to local populations and EU citizens in Angola, the risk of regional spread and importation into the EU, and to advise Angolan and EU authorities on control measures. International actors should gain awareness of the EMC, its response capacities and the means for requesting assistance.

Background Pathogens causing acute fever, with the exception of malaria, remain largely unidentified in sub-Saharan Africa, given the local unavailability of diagnostic tests and the broad differential diagnosis. Methodology We conducted a cross-sectional study including outpatient acute undifferentiated fever in both children and adults, between November 2015 and June 2016 in Kinshasa, Democratic Republic of Congo. Serological and molecular diagnostic tests for selected arboviral infections were performed on blood, including PCR, NS1-RDT, ELISA and IFA for acute, and ELISA and IFA for past infections. Results Investigation among 342 patients, aged 2 to 68 years (mean age of 21 years), with acute undifferentiated fever (having no clear focus of infection) revealed 19 (8.1%) acute dengue–caused by DENV-1 and/or DENV-2 –and 2 (0.9%) acute chikungunya infections. Furthermore, 30.2% and 26.4% of participants had been infected in the past with dengue and chikungunya, respectively. We found no evidence of acute Zika nor yellow fever virus infections. 45.3% of patients tested positive on malaria Rapid Diagnostic Test, 87.7% received antimalarial treatment and 64.3% received antibacterial treatment. Discussion Chikungunya outbreaks have been reported in the study area in the past, so the high seroprevalence is not surprising. However, scarce evidence exists on dengue transmission in Kinshasa and based on our data, circulation is more important than previously reported. Furthermore, our study shows that the prescription of antibiotics, both antibacterial and antimalarial drugs, is rampant. Studies like this one, elucidating the causes of acute fever, may lead to a more considerate and rigorous use of antibiotics. This will not only stem the ever-increasing problem of antimicrobial resistance, but will–ultimately and hopefully–improve the clinical care of outpatients in low-resource settings. Trial registration ClinicalTrials.gov NCT02656862., Author summary Malaria remains one of the most important causes of fever in sub-Saharan Africa. However, its share is declining, since the diagnosis and treatment of malaria have improved significantly over the years. Hence leading to an increase in the number of patients presenting with non-malarial fever. Often, obvious clinical signs and symptoms like cough or diarrhea are absent, probing the question: “What causes the fever?” Previous studies have shown that the burden of arboviral infections–like dengue and chikungunya–in sub-Saharan Africa is underestimated, which is why we screened for four common arboviral infections in patients presenting with ‘undifferentiated fever’ at an outpatient clinic in suburban Kinshasa, Democratic Republic of Congo. Among the patients tested, we found that one in ten presented with an acute arboviral infection and that almost one in three patients had been infected in the past. These findings suggest that clinicians should think about arboviral infections more often, thereby refraining from the prescription of antibiotics, a practice increasingly problematic given the global rise of antimicrobial resistance.