Rapid Diagnostic Test (HRP2/pLDH) Positivity, Household Malaria Incidence and Impact of Community Participatory WASH Action in Kongo Central, DR Congo: A Mixed Method Study

Abstract

Summary: Malaria is one of the most prevalent and deadliest illnesses in the Sub-Saharan Africa. Despite recent gains made towards its control or elimination in past decades, many African countries still have endemic malaria transmission. Therefore, the search for novel disease control strategies and approaches are in progress. This study aimed to evaluate household malaria burden in Kongo central province, Democratic Republic of Congo (DRC), and the impact of community participatory water, sanitation and hygiene (WASH) action. Methods: Mixed method study was conducted in two semi-rural towns, Mbanza-Ngungu (WASH action site) and Kasangulu (control site), involving 625 households (3,712 individuals). Baseline and post-intervention surveys were conducted; an action research consisting of six-month prospective study was carried out which comprised two interventions: (1) community participatory WASH action and (2) anti-malaria education campaign. The latter was implemented in both study sites. In addition, rapid diagnostic test (RDT) for malaria was performed in respondents. Findings: Prevalence of positive malaria RDT among respondents decreased (38% vs. 20%) at WASH-action site, whereas it increased at the control site but not significantly. Of 96% of respondents who reported at least one malaria event occurring in the previous six-month period, only 66.5% of them received malaria care at a health setting. At household level, long-lasting insecticide-treated net (LLIN) was the most commonly used preventive measure (55%), followed by mosquito repellent (15%), indoor residual spraying (IRS) (2%), LLIN-IRS combination (2%); however, 24% of households did not use any measures. Mean household malaria incidence decreased in WASH action site; 2.3±2.2 cases vs. 1.2±0.7 cases, whereas no significant change was noted in control site. Moreover, malaria incidence rate was highest (60.9%) among households living in proximity to grassy and stagnant water spots. Proximity to high risk area (grassy/stagnant water spots) for malaria (ORa=5.13; 95%CI: 2-29-8.07; p<0.001), poor WASH (ORa=4.10; 95%CI: 2.11-7.08; p<0.001), and low household income (ORa=2.37; 95%CI: 1.05-3.12; p<0.05) were determinants of household malaria. Interpretation: Findings suggest the necessity to scale up the fight against malaria by integrating efficient indoor and outdoor preventive measures, including WASH intervention in residential environment, and improve malaria care accessibility. Funding Statement: This work was supported in part by JSPS KAKENHI Grant Number JP 17H04675. Declaration of Interests: The authors have no conflict of interest related to this study. Ethics Approval Statement: Prior to implementing this research, informed consent from was obtained from each household head, and ethical approval was also obtained from the School of Public Health of the University of Lubumbashi and the Faculty of Medicine of William Booth University in DRC. All medical procedures performed in this study were in accordance with the Helsinki declaration regarding the use of human subjects in research.