Abstract
Vector control, including the use of bed nets, is recommended as a possible strategy for eliminating lymphatic filariasis (LF) in post-conflict countries such as the Democratic Republic of Congo (DRC). This study examined the geographical factors that influence bed net ownership in DRC in order to identify hard-to-reach communities that need to be better targeted. In particular, urban/rural differences and the influence of population density, proximity to cities and health facilities, plus access to major transport networks were investigated. Demographic and Health Survey geo-referenced cluster level data were used to map bed net coverage (proportion of households with at least one of any type of bed net or at least one insecticide-treated net (ITN)), and ITN density (ITNs per person) for 260 clusters. Bivariate and multiple logistic or Poisson regression analyses were used to determine significant relationships. Overall, bed net (30%) and ITN (9%) coverage were very low with significant differences found between urban and rural clusters. In rural clusters, ITN coverage/density was positively correlated with population density (r = 0.25, 0.27 respectively, p<0.01), and negatively with the distance to the two largest cities, Kinshasa or Lubumbashi (r = −0.28, −0.30 respectively, p<0.0001). Further, ownership was significantly negatively correlated with distance to primary national roads and railways (all three measures), distance to main rivers (any bed net only) and distance to the nearest health facility (ITNs only). Logistic and Poisson regression models fitted to the rural cluster data indicated that, after controlling for measured covariates, ownership levels in the Bas-Congo province close to Kinshasa were much larger than that of other provinces. This was most noticeable when considering ITN coverage (odds ratio: 5.3, 95% CI: 3.67–7.70). This analysis provides key insights into the barriers of bed net ownership, which will help inform both LF and malaria bed net distribution campaigns as part of an integrated vector management strategy.
Highlights
The goal of the Global Programme to Eliminate Lymphatic Filariasis (GPELF), established in 2000, is to eliminate lymphatic filariasis (LF) as a public health problem by 2020 [1]. This will primarily be achieved through the use of mass drug administration (MDA) of albendazole plus either ivermectin or diethylcarbamazine (DEC) to the at-risk population
To begin to address these issues, this paper aimed to explore the influence of geographical factors such as human demography, infrastructure and transport networks on bed net ownership in Democratic Republic of Congo (DRC)
This map demonstrates that the majority of the surveyed population are located in the more accessible south-eastern half of the country, with a small proportion of the population being sampled in the central region of the country where the Congo River basin dominates the landscape
Summary
The goal of the Global Programme to Eliminate Lymphatic Filariasis (GPELF), established in 2000, is to eliminate lymphatic filariasis (LF) as a public health problem by 2020 [1]. Whilst the programme is showing signs of success in many LF endemic countries [1], more than half of the 32 LF countries in sub-Saharan Africa are yet to implement MDA, 11 years after the GPELF was launched The majority of these countries are post-conflict countries with fragile health systems in a resource poor setting, recovering from the ravages of war. Efficient management of the distribution of bed nets could accelerate the elimination of LF in these areas despite the late start of MDA. Of these post-conflict countries, the Democratic Republic of Congo (DRC) has the heaviest burden of LF, with an at-risk population of almost 50 million [1]
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