Laboratoire de géographie et d'aménagement de Montpellier, Université Paul Valéry Montpellier 3, Montpellier, France.
Service d'Ecologie et Contrôle des Maladies Infectieuses, Faculté de Médecine, Université de Kinshasa, République démocratique, Congo.
BMC Public Health. 2023 Aug 22;23(1):1592. doi: 10.1186/s12889-023-16449-2.
The Democratic Republic of the Congo (DRC) implemented the first strategic Multisectoral Cholera Elimination Plan (MCEP) in 2008-2012. Two subsequent MCEPs have since been implemented covering the periods 2013-2017 and 2018-2021. The current study aimed to assess the spatiotemporal dynamics of cholera over the recent 22-year period to determine the impact of the MCEPs on cholera epidemics, establish lessons learned and provide an evidence-based foundation to improve the implementation of the next MCEP (2023-2027).
In this cross-sectional study, secondary weekly epidemiological cholera data covering the 2000-2021 period was extracted from the DRC Ministry of Health surveillance databases. The data series was divided into four periods: pre-MCEP 2003-2007 (pre-MCEP), first MCEP (MCEP-1), second MCEP (MCEP-2) and third MCEP (MCEP-3). For each period, we assessed the overall cholera profiles and seasonal patterns. We analyzed the spatial dynamics and identified cholera risk clusters at the province level. We also assessed the evolution of cholera sanctuary zones identified during each period.
During the 2000-2021 period, the DRC recorded 520,024 suspected cases and 12,561 deaths. The endemic provinces remain the most affected with more than 75% of cases, five of the six endemic provinces were identified as risk clusters during each MCEP period (North Kivu, South Kivu, Tanganyika, Haut-Lomami and Haut-Katanga). Several health zones were identified as cholera sanctuary zones during the study period: 14 health zones during MCEP-1, 14 health zones during MCEP-2 and 29 health zones during MCEP-3. Over the course of the study period, seasonal cholera patterns remained constant, with one peak during the dry season and one peak during the rainy season.
Despite the implementation of three MCEPs, the cholera context in the DRC remains largely unchanged since the pre-MCEP period. To better orient cholera elimination activities, the method used to classify priority health zones should be optimized by analyzing epidemiological; water, sanitation and hygiene; socio-economic; environmental and health indicators at the local level. Improvements should also be made regarding the implementation of the MCEP, reporting of funded activities and surveillance of cholera cases. Additional studies should aim to identify specific bottlenecks and gaps in the coordination and strategic efforts of cholera elimination interventions at the local, national and international levels.
刚果民主共和国（DRC）于 2008-2012 年实施了首个战略性多部门霍乱消除计划（MCEP）。此后，又实施了两个后续的 MCEP，涵盖了 2013-2017 年和 2018-2021 年两个时期。本研究旨在评估最近 22 年来霍乱的时空动态，以确定 MCEP 对霍乱流行的影响，总结经验教训，并为下一个 MCEP（2023-2027）的实施提供循证基础。
在这项横断面研究中，从刚果民主共和国卫生部监测数据库中提取了 2000-2021 年期间每周的霍乱流行病学二级数据。将数据系列分为四个时期：MCEP 前 2003-2007 年（MCEP 前）、第一个 MCEP（MCEP-1）、第二个 MCEP（MCEP-2）和第三个 MCEP（MCEP-3）。对于每个时期，我们评估了整体霍乱概况和季节性模式。我们分析了空间动态，并确定了省级的霍乱风险群。我们还评估了每个时期确定的霍乱避难区的演变。
在 2000-2021 年期间，刚果民主共和国记录了 520,024 例疑似病例和 12,561 例死亡。受影响最严重的仍然是流行省份，超过 75%的病例来自这六个流行省份中的五个，这五个省份在每个 MCEP 期间都被确定为风险群（北基伍、南基伍、坦噶尼喀、上洛马米和上开赛）。在研究期间，发现了几个霍乱避难区：MCEP-1 期间有 14 个卫生区，MCEP-2 期间有 14 个卫生区，MCEP-3 期间有 29 个卫生区。在研究期间，季节性霍乱模式保持不变，旱季和雨季各有一个高峰。
尽管实施了三个 MCEP，但自 MCEP 前时期以来，刚果民主共和国的霍乱情况基本没有改变。为了更好地指导霍乱消除活动，应通过分析地方一级的流行病学、水、环境卫生和个人卫生、社会经济、环境和卫生指标，优化用于对优先卫生区进行分类的方法。还应改进 MCEP 的实施、受资助活动的报告以及霍乱病例的监测。应开展更多的研究，以确定地方、国家和国际各级霍乱消除干预措施的协调和战略努力中的具体瓶颈和差距。
