Wild Edible Plant Markets in Kisangani, Democratic Republic of Congo

Benefits from wild edible plants (WEP) are multiple for rural households as well as urban traders. To set species priorities for WEP market development and domestication, we performed an inventory of WEP species and traders in five markets and one road-side selling point in Kisangani. During four one-month sessions between September 2007 and July 2008, all WEP traders present in the target markets were interviewed. We registered 119 unique sellers, selling 15 different WEPs. The September-October period and ‘Marché Central’ were the most important for WEP trade in Kisangani. Added values and net incomes generated through WEP sales were very divergent. Four types of traders could be distinguished. Gnetum africanum trade involves the more dynamic traders. Cola acuminata, Garcinia kola and Piper guineense spices have local and international market potential. Within the wild fruits category we propose Landolphia owariensis and Tetracarpidium conophorum as priority species for local market development.     

Overview of Animal Rabies in Kinshasa Province in the Democratic Republic of Congo

IntroductionRabies is one of the major public health problems mostly affecting developing countries in Africa and Asia where 99.9% of all rabies related human deaths are recorded each year. In Democratic Republic of Congo, repeated outbreaks have been reported. Despite this, there is little reliable epidemiological data about rabies in the country for the development of effective control strategies.

Materials and Methods

A retrospective study was carried out in Kinshasa Province during a period of five years (2009–2013) to describe the proportion of rabid animals and the species involved in rabies transmission and maintenance. The survey also aimed at describing the spatial-temporal distribution of rabies. To gather information, the daily registers of institutions involved in rabies diagnosis were reviewed and each rabies case was traced back to area of occurrence for collection of geographic coordinates.

Results and Discussion

A total of 5,053 attacks were registered involving six animal species including dog, cat, monkey, rabbit, rat, and pig. Based on clinical observations, rabies was reported in dogs and cats while data obtained from the laboratory confirmed rabies cases included dogs, cats and a goat. The annual distribution showed a significant decrease of rabies cases from 2009 up to 2011 and a later increase up to 2013. There was no difference in rabies occurrence between seasons (p = 0.721). Rabies cases were three times higher in peri-urban zone than in urban zone OR = 3.4 (95% CI: 2.3–5.1). The positive proportion of rabies was 2.6% (95% CI: 2.1–3) based on clinical evidence and 65.9% (95% CI: 50–79.5) for laboratory confirmed cases.

Conclusion and Suggestion

This study confirms the endemicity of rabies in Kinshasa where occurrence of rabies cases was related to human population density and lifestyle. In order to control rabies, there is need to set up a surveillance program and implement efficient mass vaccination campaigns of susceptible animals.     

Ocular Pentastomiasis in the Democratic Republic of the Congo

Ocular pentastomiasis is a rare infection caused by the larval stage of pentastomids, an unusual group of crustacean-related parasites. Zoonotic pentastomids have a distinct geographical distribution and utilize reptiles or canids as final hosts. Recently, an increasing number of human abdominal infections have been reported in Africa, where pentastomiasis is an emerging, though severely neglected, tropical disease. Here we describe four ocular infections caused by pentastomids from the Democratic Republic of the Congo. Two cases underwent surgery and an Armillifer grandis infection was detected by morphological and molecular approaches. Thus far, 15 other cases of ocular pentastomiasis have been reported worldwide. Twelve cases were caused by Armillifer sp., recorded almost exclusively in Africa, where such infections occur as a consequence of hunting and consuming snakes, their final hosts. Seven further cases were caused by Linguatula serrata, a cosmopolitan pentastomid whose final hosts are usually canids. Intraocular infections caused permanent visual damage in 69% and a total loss of vision in 31% of reported cases. In contrast, ocular adnexal cases had a benign clinical course. Further research is required to estimate the burden, therapeutic options and pathogenesis of this neglected disease.     

Epidemiology of Schistosoma mansoni infection in Ituri Province,north-eastern Democratic Republic of the Congo

BackgroundSchistosomiasis, caused by Schistosoma mansoni, is of great significance to public health in sub–Saharan Africa. In the Democratic Republic of Congo (DRC), information on the burden of S. mansoni infection is scarce, which hinders the implementation of adequate control measures. We assessed the geographical distribution of S. mansoni infection across Ituri province in north-eastern DRC and determined the prevailing risk factors.Methods/Principal findingsTwo province–wide, community–based studies were conducted. In 2016, a geographical distribution study was carried out in 46 randomly selected villages across Ituri. In 2017, an in–depth study was conducted in 12 purposively–selected villages, across the province. Households were randomly selected, and members were enrolled. In 2016, one stool sample was collected per participant, while in 2017, several samples were collected per participant. S. mansoni eggs were detected using the Kato–Katz technique. In 2017, a point–of–care circulating cathodic S. mansoni antigen (POC–CCA) urine test was the second used diagnostic approach. Household and individual questionnaires were used to collect data on demographic, socioeconomic, environmental, behavioural and knowledge risk factors.Of the 2,131 participants in 2016, 40.0% were positive of S. mansoni infection. Infection prevalence in the villages ranged from 0 to 90.2%. Of the 707 participants in 2017, 73.1% were tested positive for S. mansoni. Prevalence ranged from 52.8 to 95.0% across the health districts visited. Infection prevalence increased from north to south and from west to east. Exposure to the waters of Lake Albert and the villages’ altitude above sea level were associated with the distribution.Infection prevalence and intensity peaked in the age groups between 10 and 29 years. Preschool children were highly infected (62.3%). Key risk factors were poor housing structure (odds ratio [OR] 2.1, 95% 95% confidence interval [CI] 1.02–4.35), close proximity to water bodies (OR 1.72, 95% CI 1.1–2.49), long-term residence in a community (OR 1.41, 95% CI 1.11–1.79), lack of latrine in the household (OR 2.00, 95% CI 1.11–3.60), and swimming (OR 2.53, 95% CI 1.20–5.32) and washing (OR 1.75, 95% CI 1.10–2.78) in local water bodies.Conclusions/SignificanceOur results show that S. mansoni is highly endemic and a major health concern in Ituri province, DRC. Infection prevalence and intensity, and the prevailing socioeconomic, environmental, and behavioural risk factors in Ituri reflect intense exposure and alarming transmission rates. A robust plan of action is urgently needed in the province.     

Using phytostabilisation to conserve threatened endemic species in southeastern Democratic Republic of the Congo

Outcrops in the southeastern Democratic Republic of the Congo (DRC) are recognized as some of the largest copper–cobalt orebodies in the world. They support a unique vegetation with nearly 600 metallophytes that include rare and endemic species. Mineral exploitation has increased considerably in the region since the 1900s, affecting both environmental and public health. Phytostabilisation of polluted areas represents an opportunity to decrease the bioavailability of heavy metals in the highly polluted soils that result from ore extraction. Such a technique has been successfully implemented near Lubumbashi with the grass Microchloa altera. However, long-term maintenance requires a good understanding of interspecific relationships, such as competition and facilitation. This study tested the establishment success of four herbaceous species from the Katangan Copperbelt by assessing the potential role of Microchloa altera as a nurse species. Two annual and two perennial species were sown in an experiment designed to study the influence of soil amendment and vegetation cover on seedling emergence, growth, and survival. These variables were monitored during the vegetation growing season as well as resprouting success for perennials. Microchloa altera showed a distinct effect on the emergence and survival of annual and perennial species and negatively affected the growth of individuals belonging to both groups of species.     

Environmental Drivers of Monkeypox Transmission in the Democratic Republic of the Congo

EcoHealth - Monkeypox (MPX) is an emergent severe zoonotic disease resembling that of smallpox. To date, most cases of human MPX have been reported in the Democratic Republic of the Congo (DRC)....     

Prevalence of human African trypanosomiasis in the Democratic Republic of the Congo

Human African Trypanosomiasis (HAT) is a major public health problem in the Democratic Republic of the Congo (DRC). Active and passive surveillance for HAT is conducted but may underestimate the true prevalence of the disease. We used ELISA to screen 7,769 leftover dried blood spots from a nationally representative population-based survey, the 2007 Demographic and Health Survey. 26 samples were positive by ELISA. Three of these were also positive by trypanolysis and/or PCR. From these data, we estimate that there were 18,592 people with HAT (95% confidence interval, 4,883-32,302) in the DRC in 2007, slightly more than twice as many as were reported.     

Identifying nascent wetland forest conversion in the Democratic Republic of the Congo

Wetlands cover large areas in the Democratic Republic of the Congo. However, their extent and distribution have not been accurately mapped. While wetland forests remain largely undisturbed, increasing threats by anthropogenic activities have been observed in areas with high population density per arable or exploitable land. The scarcity of terra firma forests in some territories of the Democratic Republic of the Congo has forced local communities to develop cropping methods that allow for cultivation in periodically flooded areas. Assessing wetlands extent and status is critical for long term conservation of these highly vulnerable ecosystems. In this study, we use multi-source and multi-resolution optical and radar remotely sensed data and elevation derived indices to map the wetlands of the Democratic Republic of the Congo. Results showed that wetlands are a significant part of the landscape in the country, covering an estimated 440,000 km² or 19.2 % of the total country area. By combining the wetlands map with a previously produced land cover depiction of the Democratic Republic of the Congo, a map including forested wetlands as a thematic class was derived. We investigated whether high terra firma population density and low percent remaining terra firma forest are related at the lowest administrative level (Sector); specifically, we tested these two variables as predictors of wetland forest cover loss. A polynomial regression relating population and primary terra firma forest to wetland forest cover loss yielded an r ² of 0.76, illustrating a nascent and significant land cover change dynamic. Areas most at risk for future wetland forest loss lie in the western Cuvette, and include (north–south) the Sud-Ubangi, Mongala, Equateur and Mai-Ndombe Districts. By quantifying available upland forest resources and overlaying with population density, it was possible to identify stressed areas inside of the forest domain (traditionally known for having generically high levels of forest resources). Results illustrate the need for addressing issues of wetland forest management and protection in the Democratic Republic of the Congo, especially where increasing populations are exhausting primary terra firma forest resources.     

How Do Local Folks Value Wild Meat,and Why It Matters? A Study in the Democratic Republic of Congo

Human Ecology - We elucidate the value orientations (VOs) towards wild meat/wildlife in the Tshopo Province of the Democratic Republic of Congo, distinguishing between the provincial capital and...     

Retention in a NGO supported antiretroviral program in the Democratic Republic of Congo

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.     

The phenotype and genotype of rheumatoid arthritis in the Democratic Republic of Congo

Introduction

Little is known about rheumatoid arthritis in the black, particularly in Congolese, populations. Our objective was to describe the phenotype and genotype of rheumatoid arthritis (RA) in Congolese.

Methods

All consecutive rheumatoid arthritis (RA) patients attending Kinshasa University Hospital in a three-year time period were included. Demographics, clinical features and tobacco consumption were noted. Disease Activity Score (DAS)-28 based on the erythrocyte sedimentation rate (ESR), Health Assessment Questionnaire (HAQ), anti-citrullinated peptide antibodies (CCP) antibodies and rheumatoid factor (RF) were determined. Radiographs were scored according to Sharp-van der Heijde. On a subset of patients and controls HLA-DRB1 typing was performed.

Results

A total of 114 females and 14 males aged 51.2 ± 14.9 were included. Mean duration of symptoms was four years. Moderate tobacco consumption was reported in a minority of patients. DAS-28 at first visit was >5.1 and HAQ ≥0.5 in all patients. X-rays showed joint erosions and/or joint space narrowing, mostly of a moderate grade in 55.8% of patients. Anti-CCP and/or RF were present in 48.6% of patients with available data (n = 72) and in 3.0% of controls (n = 67). Radiographic changes and nodules were more frequent in RF or anti-CCP positive patients. One copy of the shared epitope was found in 13 patients (35.1%) and 3 controls (12.5%). Two copies were found in one patient (2.7%) and in one control (4.2%).

Conclusion

Congolese patients with RA consult long after disease onset. Despite this delay, the majority presents without major damage and is RF, anti-CCP and SE negative. We put forward the hypothesis that besides different environmental factors there is probably also a particular genetic risk profile in Congolese patients, different from the HLA-DRB1 shared epitope.     

Antiretroviral Treatment Program Retention among HIV-Infected Children in the Democratic Republic of Congo

Background

Retaining patients with HIV infection in care is still a major challenge in sub- Saharan Africa, particularly in the Democratic Republic of Congo (DRC) where the antiretroviral treatment (ART) coverage is low. Monitoring retention is an important tool for evaluating the quality of care.

Methods and Findings

A review of medical records of HIV -infected children was performed in three health facilities in the DRC: the Amo-Congo Health center, the Monkole Clinic in Kinshasa, and the HEAL Africa Clinic in Goma. Medical records of 720 children were included. Kaplan Meier curves were constructed with the probability of retention at 6 months, 1 year, 2 years and 3 years. Retention rates were: 88.2% (95% CI: 85.1%–90.8%) at 6 months; 85% (95% CI: 81.5%–87.6%) at one year; 79.4% (95%CI: 75.5%–82.8%) at two years and 74.7% (95% CI: 70.5%–78.5%) at 3 years. The retention varied across study sites: 88.2%, 66.6% and 92.5% at 6 months; 84%, 59% and 90% at 12 months and 75.7%, 56.3% and 85.8% at 24 months respectively for Amo-Congo/Kasavubu, Monkole facility and HEAL Africa. After multivariable Cox regression four variables remained independently associated with attrition: study site, CD4 cell count <350 cells/µL, children younger than 2 years and children whose caregivers were member of an independent church.

Conclusions

Attrition remains a challenge for pediatric HIV positive patients in ART programs in DRC. In addition, the low coverage of pediatric treatment exacerbates the situation of pediatric HIV/AIDS.     

Morbidity associated with Schistosoma mansoni infection in north-eastern Democratic Republic of the Congo

BackgroundReducing morbidity is the main target of schistosomiasis control efforts, yet only rarely do control programmes assess morbidity linked to Schistosoma sp. infection. In the Democratic Republic of Congo (DRC), and particularly in north-eastern Ituri Province, little is known about morbidity associated with Schistosoma mansoni infection. For this reason, we aimed to assess intestinal and hepatosplenic morbidity associated with S. mansoni infection in Ituri Province.Methods/Principal findingsIn 2017, we conducted a cross-sectional study in 13 villages in Ituri Province, DRC. S. mansoni infection was assessed with a Kato-Katz stool test (2 smears) and a point-of-care circulating cathodic antigen (POC-CCA) urine test. A questionnaire was used to obtain demographic data and information about experienced intestinal morbidity. Each participant underwent an abdominal ultrasonography examination to diagnose hepatosplenic morbidity. Of the 586 study participants, 76.6% tested positive for S. mansoni. Intestinal morbidity reported in the two preceding weeks was very frequent, and included abdominal pain (52.7%), diarrhoea (23.4%) and blood in the stool (21.5%). Hepatosplenic morbidity consisted of abnormal liver parenchyma patterns (42.8%), hepatomegaly (26.5%) and splenomegaly (25.3%). Liver pathology (adjusted odds ratio [aOR] 1.20, 95% confidence interval [CI] 1.06–1.37, p = 0.005) was positively and significantly associated with S. mansoni infection. Hepatomegaly (aOR 1.52, 95% CI 0.99–2.32, p = 0.053) and splenomegaly (aOR 1.12, 95% CI 0.73–1.72, p = 0.619) were positively but not significantly associated with S. mansoni infection at the individual level. At the village level, S. mansoni prevalence was positively associated with the prevalence of hepatomegaly and splenomegaly. High-intensity S. mansoni infections were associated with diarrhoea, blood in the stool, hepatomegaly, splenomegaly, and liver parenchyma (C, D, E and F pathology patterns). Four study participants were diagnosed with ascites and five reported hematemesis.Conclusions/SignificanceOur study documents a high burden of intestinal and hepatosplenic morbidity associated with S. mansoni infection status in Ituri Province. The findings call for targeted interventions to address both S. mansoni infection and related morbidity.     

Varicella Coinfection in Patients with Active Monkeypox in the Democratic Republic of the Congo

From 2006 to 2007, an active surveillance program for human monkeypox (MPX) in the Democratic Republic of the Congo identified 151 cases of coinfection with monkeypox virus and varicella zoster virus from 1158 suspected cases of human MPX (13%). Using clinical and socio-demographic data collected with standardized instruments by trained, local nurse supervisors, we examined a variety of hypotheses to explain the unexpectedly high proportion of coinfections among the sample, including the hypothesis that the two viruses occur independently. The probabilities of disease incidence and selection necessary to yield the observed sample proportion of coinfections under an assumption of independence are plausible given what is known and assumed about human MPX incidence. Cases of human MPX are expected to be underreported, and more coinfections are expected with improved surveillance.     

Feeding ecology of the armored shrew, from the north-eastern Democratic Republic of Congo

The diet of Scutisorex somereni (Soricomorpha: Soricidae) from forests in the Democratic Republic of Congo was investigated to elucidate its feeding ecology in the context of its unique spinal modifications. It ate a wide range of small and large invertebrates, including representatives of Coleoptera, Formicidae, Lepidoptera and Diptera larvae, Chilopoda, Diplopoda and Araneae, but the principal prey was Oligochaeta. All diet samples contained Oligochaeta and these contributed 38–45% of prey volume. While 64% of prey occurrences were <10 mm in length, 56% of prey volume comprised invertebrates >26 mm, mostly large Oligochaeta (some of >50 mm). Soil-dwelling prey comprised 46% by composition (59% by volume) of the diet. Besides its peculiar skeletal modifications, it has an exceptionally long intestine relative to its body size. It was concluded that S. somereni is primarily an earthworm-eating shrew and partially subterranean rather than truly fossorial in foraging mode. Its diet and foraging mode cannot explain the unique vertebral modifications of this zoological curiosity.     

Prospects for Bonobo Insectivory: Lui Kotal, Democratic Republic of Congo

Chimpanzees (Pan troglodytes) are well-known to eat invertebrates, especially social insects, across Africa, but allopatric bonobos (P. paniscus) are not. Bonobo insectivory is sparsely documented and apparently sporadic. However, the availability to bonobos of social insect prey and raw materials with which to make tools to exploit them is unknown. Here, we test a set of hypotheses that relates to questions of presence, abundance, density, and distribution of taxa that Pan consume and of vegetation suitable for making extractive foraging tools. We worked at Lui Kotal, Democratic Republic of Congo, where unprovisioned bonobos live in intact forest, far from villages. We collected insect and fecal specimens, transected for prey and assessed raw materials, and monitored mounds of Macrotermes. All but 1 of the major taxa of relevant termites, ants, and (stinging) honey bees were present. The 3 main taxa of insects that chimpanzees elsewhere eat —Macrotermes (fungus-growing termites), Dorylus (Anomma; army or driver ants), and Apis (honey bees)— were abundant and widespread, and usually at densities exceeding those at well-known chimpanzee study-sites. Similarly, woody and nonwoody vegetation suitable for making fishing probes was common at mounds of Macrotermes. There is no obvious ecological reason why bonobos should not use elementary technology in extractive foraging, e.g., termite-fish, ant-fish, ant-dip, honey-dip, to obtain social insects.