Confirmation of cholera by rapid diagnostic test amongst patients admitted to the cholera treatment centre in Uvira, Democratic Republic of the Congo

Abstract

IntroductionCholera is endemic in the Eastern provinces of the Democratic Republic of the Congo since 1978, and Uvira in South-Kivu has been reporting suspected cholera cases nearly every week for over a decade. The clinical case definition for suspected cholera is relatively non-specific, and cases are rarely confirmed by laboratory methods, especially in endemic settings. This may lead to over-estimation of cholera cases and limit effective public health responses.Methods and resultsBetween April 2016 and November 2017, 69% of the 2,059 patients admitted to the Uvira Cholera Treatment Centre (CTC) were tested for cholera with rapid diagnostic tests (RDTs). Of those admitted as suspected cholera cases, only 40% tested positive for cholera, equivalent to an estimated annual incidence of suspected/confirmed cholera in Uvira of 43.8 and 16.3 cases per 10,000 inhabitants respectively. A multivariable logistic regression indicates that boys aged 2 to 4 years, girls aged 5 to 15 years and adult men are respectively 1.9, 2.1 and 1.8 times more likely to test positive than adult women. On the contrary, boys under 2 are 10 times less likely to test positive. The odds of testing positive also increase as weekly admissions to the CTC rise, with up to a 5-fold increase observed during the weeks with the highest numbers of admissions compared to the lowest ones. Other predictors of cholera confirmation include duration of stay at the CTC, clinical outcome of admission, lower weekly rainfall and area of residence in Uvira, with the northern part of town having the highest confirmation rate.ConclusionCholera is an on-going public health problem in Uvira but the majority of suspected cases admitted to the CTC were found to be negative for cholera after RDT testing. These findings may have important implications for cholera control strategies in favour of interventions that address cholera and other diarrhoeal diseases alike.

Prevalence and diversity of enteric pathogens among cholera treatment centre patients with acute diarrhea in Uvira, Democratic Republic of Congo

“…The African Great Lakes region has been implicated in the spread of outbreaks to other parts of the country and Uvira, in particular, has had endemic cholera since the 1970s [18]. The only CTC in Uvira is located within the district hospital to provide appropriate free treatment for all patients presenting acute diarrhea, defined as: three or more loose/ water stools within 24 h [19]. All cases admitted are reported as cholera cases in the National Health Information System (NHIS) and are treated by national protocol for suspected cholera, receiving rehydration therapy and, occasionally, broad-spectrum antibiotics, zinc, or albendazole [19].…”

“…The only CTC in Uvira is located within the district hospital to provide appropriate free treatment for all patients presenting acute diarrhea, defined as: three or more loose/ water stools within 24 h [19]. All cases admitted are reported as cholera cases in the National Health Information System (NHIS) and are treated by national protocol for suspected cholera, receiving rehydration therapy and, occasionally, broad-spectrum antibiotics, zinc, or albendazole [19]. A recent linked study to confirm cholera cases by RDT among patients at the Uvira CTC found that only 40% tested positive [19].…”

“…All cases admitted are reported as cholera cases in the National Health Information System (NHIS) and are treated by national protocol for suspected cholera, receiving rehydration therapy and, occasionally, broad-spectrum antibiotics, zinc, or albendazole [19]. A recent linked study to confirm cholera cases by RDT among patients at the Uvira CTC found that only 40% tested positive [19].…”

“…The sampling and recruitment procedures have been described previously [19]. In brief, basic demographic and clinical information for each participant were extracted from CTC patient records, including: age, sex, location of residence, date of admission, date of discharge or transfer, symptoms, and whether the patient received antibiotics prior to rectal swab collection and, if so, the number of hours between first dose and the rectal swab collection.…”

Predicting quality and quantity of water used by urban households based on tap water service

“…Uvira is an identified hotspot for endemic cholera in Eastern DRC, from which the disease regularly spreads to less frequently affected areas of the country. [25][26][27] The present analysis draws on data collected as part of an evaluation of the impact of these improvements on households' water-related practices, and the incidence of suspected cholera and other diarrhoeal diseases. Its aim is to develop and assess spatially explicit predictive models for estimating the probability of households storing contaminated drinking water and for estimating the quantity of water used at home for domestic activities, based on piped water access and distance from surface water sources.…”