Mitashi P, Hasker E, Mbo F, Van Geertruyden J P, Kaswa M, Lumbala C, Boelaert M, Lutumba P
Institute of Tropical Medicine, Antwerpen, Belgium; Faculty of Medicine, Kinshasa University, Kinshasa, Democratic Republic of the Congo; Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of Congo; International Health, Antwerp University, Antwerpen, Belgium.
Trop Med Int Health. 2015 Jan;20(1):98-105. doi: 10.1111/tmi.12404. Epub 2014 Oct 20.
Control of human African trypanosomiasis (HAT) in the Democratic Republic of Congo (DRC) has always been a vertical programme, although attempts at integration in general health services were made in recent years. Now that HAT prevalence is declining, the integration question becomes even more crucial. We studied the level of attainment of integration of HAT case detection and management in primary care centres in two high-prevalence districts in the province of Bandundu, DRC.
We visited all 43 first-line health centres of Mushie and Kwamouth districts, conducted structured interviews and inspected facilities using a standardised checklist. We focused on: availability of well trained staff - besides HAT, we also tested for knowledge on tuberculosis; availability of equipment, consumables and supplies; and utilisation of the services.
All health centres were operating but most were poorly equipped, and attendance rates were very low. We observed a median of 14 outpatient consultations per facility (IQR 8-21) in the week prior to our visit, that is two patients per day. The staff had good knowledge on presenting symptoms, diagnosis and treatment of both HAT and tuberculosis. Nine centres were accredited by the national programme as HAT diagnosis and treatment centres, but the most sensitive diagnostic confirmation test, the mini-anion exchange centrifugation technique (mAECT), was not present in any. Although all nine were performing the CATT screening test, only two had the required cold chain in working order.
In these high-prevalence districts in DRC, staff is well-acquainted with HAT but lack the tools required for an adequate diagnostic procedure. Attendance rates of these primary care centres are extremely low, making timely recognition of a resurgence of HAT unlikely in the current state of affairs.
在刚果民主共和国（DRC），人类非洲锥虫病（HAT）的防控一直是一个垂直项目，尽管近年来曾尝试将其纳入一般卫生服务体系。鉴于HAT的流行率正在下降，整合问题变得愈发关键。我们研究了刚果民主共和国班顿杜省两个高流行区的初级保健中心在HAT病例检测和管理方面的整合程度。
我们走访了穆希和夸穆特两个区的所有43个一线卫生中心，进行了结构化访谈，并使用标准化清单检查了设施。我们关注的方面包括：训练有素的工作人员的配备情况——除了HAT，我们还测试了他们对结核病的知识；设备、耗材和物资的供应情况；以及服务的利用情况。
所有卫生中心都在运营，但大多数设备简陋，就诊率很低。在我们走访前的一周，我们观察到每个设施的门诊咨询中位数为14次（四分位间距8 - 21），即每天两名患者。工作人员对HAT和结核病的症状表现、诊断和治疗有很好的了解。有9个中心被国家项目认可为HAT诊断和治疗中心，但最敏感的诊断确认试验——微型阴离子交换离心技术（mAECT），在任何一个中心都不存在。虽然所有9个中心都在进行卡片凝集试验（CATT）筛查，但只有两个中心的冷链设备正常运行。
在刚果民主共和国的这些高流行区，工作人员对HAT很熟悉，但缺乏进行充分诊断程序所需的工具。这些初级保健中心的就诊率极低，在当前情况下，不太可能及时发现HAT疫情的复发。
