Programme National de Lutte contre la Trypanosomiase Humaine Africain, Kinshasa, Democratic Republic of Congo.
PLoS Negl Trop Dis. 2012 Jan;6(1):e1467. doi: 10.1371/journal.pntd.0001467. Epub 2012 Jan 17.
Control of human African trypanosomiasis (sleeping sickness) in the Democratic Republic of Congo is based on mass population active screening by mobile teams. Although generally considered a successful strategy, the community participation rates in these screening activities and ensuing treatment remain low in the Kasai-Oriental province. A better understanding of the reasons behind this observation is necessary to improve regional control activities.
Thirteen focus group discussions were held in five health zones of the Kasai-Oriental province to gain insights in the regional perceptions regarding sleeping sickness and the national control programme's activities.
Sleeping sickness is well known among the population and is considered a serious and life-threatening disease. The disease is acknowledged to have severe implications for the individual (e.g., persistence of manic periods and trembling hands, even after treatment), at the family level (e.g., income loss, conflicts, separations) and for communities (e.g., disruption of community life and activities). Several important barriers to screening and treatment were identified. Fear of drug toxicity, lack of confidentiality during screening procedures, financial barriers and a lack of communication between the mobile teams and local communities were described. Additionally, a number of regionally accepted prohibitions related to sleeping sickness treatment were described that were found to be a strong impediment to disease screening and treatment. These prohibitions, which do not seem to have a rational basis, have far-reaching socio-economic repercussions and severely restrict the participation in day-to-day life.
CONCLUSIONS/SIGNIFICANCE: A mobile screening calendar more adapted to the local conditions with more respect for privacy, the use of less toxic drugs, and a better understanding of the origin as well as better communication about the prohibitions related to treatment would facilitate higher participation rates among the Kasai-Oriental population in sleeping sickness screening and treatment activities organized by the national HAT control programme.
在刚果民主共和国，控制人类非洲锥虫病（昏睡病）的方法是通过移动小组对人群进行大规模主动筛查。尽管这种方法通常被认为是成功的策略，但在东方省的卡赛地区，社区参与这些筛查活动和随后治疗的比例仍然很低。为了改善区域控制活动，有必要更好地了解这一观察结果背后的原因。
在东方省的五个卫生区进行了 13 次焦点小组讨论，以了解该地区对昏睡病和国家控制规划活动的看法。
昏睡病在人群中广为人知，被认为是一种严重且危及生命的疾病。这种疾病被认为对个人有严重影响（例如，即使在治疗后，躁狂期和颤抖的手仍会持续存在），对家庭有严重影响（例如，收入损失、冲突、分离），对社区也有严重影响（例如，社区生活和活动的中断）。确定了筛查和治疗的几个重要障碍。描述了对药物毒性的恐惧、筛查过程中缺乏保密性、经济障碍以及移动小组与当地社区之间缺乏沟通等问题。此外，还描述了一些与昏睡病治疗相关的被该地区接受的禁令，这些禁令被发现是疾病筛查和治疗的严重障碍。这些禁令似乎没有合理的依据，对社会经济产生了深远的影响，严重限制了人们参与日常生活。
结论/意义：更适应当地条件的移动筛查日历，对隐私有更多尊重，使用毒性更小的药物，更好地了解禁忌的起源，并更好地传达与治疗相关的禁忌，将有助于提高卡赛地区人民对国家 HAT 控制规划组织的昏睡病筛查和治疗活动的参与率。
