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Rock K.S.,University of Warwick | Pandey A.,Center for Infectious Disease Modeling and Analysis | Ndeffo-Mbah M.L.,Center for Infectious Disease Modeling and Analysis | Atkins K.E.,London School of Hygiene and Tropical Medicine | And 3 more authors.
Epidemics | Year: 2017

Approaching disease elimination, it is crucial to be able to assess progress towards key objectives using quantitative tools. For Gambian human African trypanosomiasis (HAT), the ultimate goal is to stop transmission by 2030, while intermediary targets include elimination as a public health problem − defined as <1 new case per 10,000 inhabitants in 90% of foci, and <2000 reported cases by 2020. Using two independent mathematical models, this study assessed the achievability of these goals in the former Equateur province of the Democratic Republic of Congo, which historically had endemic levels of disease. The two deterministic models used different assumptions on disease progression, risk of infection and non-participation in screening, reflecting biological uncertainty. To validate the models a censor-fit-uncensor procedure was used to fit to health-zone level data from 2000 to 2012; initially the last six years were censored, then three and the final step utilised all data. The different model projections were used to evaluate the expected transmission and reporting for each health zone within each province under six intervention strategies using currently available tools. In 2012 there were 197 reported HAT cases in former Equateur reduced from 6828 in 2000, however this reflects lower active testing for HAT (1.3% of the population compared to 7.2%). Modelling results indicate that there are likely to be <300 reported cases in former Equateur in 2020 if screening continues at the mean level for 2000–2012 (6.2%), and <120 cases if vector control is introduced. Some health zones may fail to achieve <1 new case per 10,000 by 2020 without vector control, although most appear on track for this target using medical interventions alone. The full elimination goal will be harder to reach; between 39 and 54% of health zones analysed may have to improve their current medical-only strategy to stop transmission completely by 2030. © 2017 The Authors

Koole O.,Institute of Tropical Medicine | Kalenga L.,Congo Inc | Menten J.,Institute of Tropical Medicine | Ryder R.W.,University of California at San Diego | And 3 more authors.
PLoS ONE | Year: 2012

Background: Retention of patients in ART care is a major challenge in sub-Saharan programs. Retention is also one of the key indicators to evaluate the success of ART programs. Methods and Findings: A retrospective review of 1500 randomly selected medical charts of adult ART patients from a local non-governmental (NGO) supported ART program in the Democratic Republic of Congo (DRC). Retention was defined as any visit to the clinic in the 4 months prior to the abstraction date. Retention over time and across different sites was described. The relationship between patient characteristics and retention rates at 1 year was also examined. 1450 patients were included in the analysis. The overall retention rates were 81.4% (95% CI: 79.3-83.4), 75.2% (95% CI: 72.8-77.3), 65.0% (95% CI: 62.3-67.6) and 57.2% (95% CI: 54.0-60.3) at 6 months, 1 year, 2 years and 3 years respectively. The retention rates between sites varied between 62.1% and 90.6% at 6 months and between 55.5% and 86.2% at 1 year. During multivariable analysis weight below 50 kg (aHR: 1.33, 95%CI: 1.05-1.69), higher WHO stage at initiation (aHR: 1.22, 95%CI 0.85-1.76 for stage 3 and aHR: 2.98, 95%CI: 1.93-4.59 for stage 4), and male sex (aHR: 1.32, 95%CI: 1.05-1.65) remained as significant risk factors for attrition during the first year after ART initiation. Other independent risk factors were year of initiation (aHR: 1.73, 95%CI: 1.26-2.38 for the year 2007 and aHR: 3.06, 95%CI: 2.26-4.14 for the period 2008-2009), and site. Conclusions: Retention is a major problem in DRC, while coverage of patients on ART is still very low. With the flattening of funding for HIV care and treatment in sub-Saharan Africa, and with decreasing funding worldwide, maximizing retention during the much needed scaling-up will even be more important. © 2012 Koole et al.

Bartholome J.,CIRAD | Bartholome J.,French National Institute for Agricultural Research | Salmon F.,CIRAD - Agricultural Research for Development | Vigneron P.,Congo Inc | And 4 more authors.
BMC Plant Biology | Year: 2013

Background: The genetic basis of growth traits has been widely studied in forest trees. Quantitative trait locus (QTL) studies have highlighted the presence of both stable and unstable genomic regions accounting for biomass production with respect to tree age and genetic background, but results remain scarce regarding the interplay between QTLs and the environment. In this study, our main objective was to dissect the genetic architecture of the growth trajectory with emphasis on genotype x environment interaction by measuring primary and secondary growth covering intervals connected with environmental variations. Results: Three different trials with the same family of Eucalyptus urophylla x E. grandis hybrids (with different genotypes) were planted in the Republic of Congo, corresponding to two QTL mapping experiments and one clonal test. Height and radial growths were monitored at regular intervals from the seedling stage to five years old. The correlation between growth increments and an aridity index revealed that growth before two years old (r = 0.5; 0.69) was more responsive to changes in water availability than late growth (r = 0.39; 0.42) for both height and circumference. We found a regular increase in heritability with time for cumulative growth for both height [0.06 - 0.33] and circumference [0.06 - 0.38]. Heritabilities for incremental growth were more heterogeneous over time even if ranges of variation were similar (height [0-0.31]; circumference [0.19 to 0.48]). Within the trials, QTL analysis revealed collocations between primary and secondary growth QTLs as well as between early growth increments and final growth QTLs. Between trials, few common QTLs were detected highlighting a strong environmental effect on the genetic architecture of growth, validated by significant QTL x E interactions. Conclusion: These results suggest that early growth responses to water availability determine the genetic architecture of total growth at the mature stage and highlight the importance of considering growth as a composite trait (such as yields for annual plants) for a better understanding of its genetic bases. © 2013 Bartholomé et al.; licensee BioMed Central Ltd.

Ansong D.,Kwame Nkrumah University Of Science And Technology | Nhlema-Simwaka B.,Research for Equity and Community Health Trust | Baba A.,Congo Inc
Health Research Policy and Systems | Year: 2011

Background: Despite substantial investment in health capacity building in developing countries, evaluations of capacity building effectiveness are scarce. By analysing projects in Africa that had successfully built sustainable capacity, we aimed to identify evidence that could indicate that capacity building was likely to be sustainable.Methods: Four projects were selected as case studies using pre-determined criteria, including the achievement of sustainable capacity. By mapping the capacity building activities in each case study onto a framework previously used for evaluating health research capacity in Ghana, we were able to identify activities that were common to all projects. We used these activities to derive indicators which could be used in other projects to monitor progress towards building sustainable research capacity.Results: Indicators of sustainable capacity building increased in complexity as projects matured and included. - early engagement of stakeholders; explicit plans for scale up; strategies for influencing policies; quality assessments (awareness and experiential stages). - improved resources; institutionalisation of activities; innovation (expansion stage). - funding for core activities secured; management and decision-making led by southern partners (consolidation stage).Projects became sustainable after a median of 66 months. The main challenges to achieving sustainability were high turnover of staff and stakeholders, and difficulties in embedding new activities into existing systems, securing funding and influencing policy development.Conclusions: Our indicators of sustainable capacity building need to be tested prospectively in a variety of projects to assess their usefulness. For each project the evidence required to show that indicators have been achieved should evolve with the project and they should be determined prospectively in collaboration with stakeholders. © 2011 Bates et al; licensee BioMed Central Ltd.

Rock K.S.,University of Warwick | Torr S.J.,University of Warwick | Lumbala C.,Congo Inc | Keeling M.J.,University of Warwick
Parasites and Vectors | Year: 2015

Background: The virulent vector-borne disease, Gambian human African trypanosomiasis (HAT), is one of several diseases targeted for elimination by the World Health Organization. This article utilises human case data from a high-endemicity region of the Democratic Republic of Congo in conjunction with a suite of novel mechanistic mathematical models to address the effectiveness of on-going active screening and treatment programmes and compute the likely time to elimination as a public health problem (i.e. <1 case per 10,000 per year). Methods: The model variants address uncertainties surrounding transmission of HAT infection including heterogeneous risk of exposure to tsetse bites, non-participation of certain groups during active screening campaigns and potential animal reservoirs of infection. Results: Model fitting indicates that variation in human risk of tsetse bites and participation in active screening play a key role in transmission of this disease, whilst the existence of animal reservoirs remains unclear. Active screening campaigns in this region are calculated to have been effective, reducing the incidence of new human infections by 52-53 % over a 15-year period (1998-2012). However, projections of disease dynamics in this region indicate that the elimination goal may not be met until later this century (2059-2092) under the current intervention strategy. Conclusions: Improvements to active detection, such as screening those who have not previously participated and raising overall screening levels, as well as beginning widespread vector control in the area have the potential to ensure successful and timely elimination. © 2015 Rock et al.

Background: The primary open angle glaucoma (POAG) is the most common form of glaucoma in Africa. This is a serious disease as it induces a definitive blindness. Early diagnosis is critical to prevent this blindness. In Sub-Sahara Africa, the lack of ophthalmologists gives general practitioner a particular role; that of being generally the first contact of the patient. Between 2011 and 2013, our department received 215 patients with POAG and referred by their general practitioner for a visual loss. In 100[%] of cases, a reading glasses for presbyopia has been prescribed them for an average of two years before the visit to the ophthalmologist. In 97.67[%] of cases (210 patients / 215) POAG was terminally on both sides. The purpose of this study was to assess knowledge of these general practitioners on the POAG. Methods: A total of 100 general practitioners working in private practice in Brazzaville, answered a questionnaire in the form of multiple-choice question (MCQ). The study took place over one month (January 2014). These physicians were randomly selected based on their availability to complete the MCQ. Each physician was seen only once and disposed of 30 minutes to answer four questions, namely, the definition of POAG, circumstances of discovery, the duration of the monitoring and whether or not family screening of POAG was necessary. Each answer was worth 1 point. Knowledge of glaucoma was deemed insufficient for a score less than or equal to 1/4, for an average rating greater than 1/4 but less than or equal to 3/4, sufficient for a score of 4/4. Results: Only 8[%] were able to define POAG, 12[%] had a clear idea about the circumstances of discovery of the disease, 10[%] knew that the follow-up was lifetime, and 16[%] had checked the appropriate box on family screening of POAG cases. Six (6) [%] had a score of 4/4, 18[%] had a score between 1/4 and 3/4, and 76[%] had a rating lower than 1/4. Conclusion: The general practitioner in Brazzaville poorly understands POAG. Hence, severe visual impairment is commonly diagnosed because patients arrived late at the hospital. Training curricula for medical students should be adapted. © 2015, Bioline International. All rights reserved.

Congo Inc | Date: 2011-07-27

computer software and users manuals therefor, sold as a unit, for use in managing communication, training and coaching for a sales organization.

Congo Inc | Date: 2015-02-05


Introduction Recently we have recorded some progress against the transmission of poliovirus in the African Region. This is attributable to a number of factors, including commitment of global partnerships against polio, improvement of existing strategies as well as a number of innovations in response to the disease in the Region. Methods The WHO Regional Office in Africa documented these practices that led to the noticeable progress in the polio eradication initiative in the African Region, as lessons learnt and as part of polio legacy planning. The documentation exercise covered eight countries, namely Angola, Chad, Cote d'Ivoire, Democratic Republic of Congo, Ethiopia, Nigeria, Tanzania and Togo. Results A number of practices were identified. Some of these practices cut across countries while others were peculiar to specific countries. We have thus developed some manuscripts to capture these practices for publication in scientific journal so as to place them in the public domain for use. Conclusion It is hoped that these practices will be deployed to other public health programmes in the Region and beyond. © 2016 The Author(s)

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