Article (Scientific journals)
Drivers of the dynamics of the spread of cholera in the Democratic Republic of the Congo, 2000-2018: An eco-epidemiological study.
Kayembe Ntumba, Harry César; Bompangue, Didier; Linard, Catherine et al.
2023In PLoS Neglected Tropical Diseases, 17 (8), p. 0011597
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Keywords :
Infectious Diseases; Public Health, Environmental and Occupational Health
Abstract :
[en] BACKGROUND: The dynamics of the spread of cholera epidemics in the Democratic Republic of the Congo (DRC), from east to west and within western DRC, have been extensively studied. However, the drivers of these spread processes remain unclear. We therefore sought to better understand the factors associated with these spread dynamics and their potential underlying mechanisms. METHODS: In this eco-epidemiological study, we focused on the spread processes of cholera epidemics originating from the shores of Lake Kivu, involving the areas bordering Lake Kivu, the areas surrounding the lake areas, and the areas out of endemic eastern DRC (eastern and western non-endemic provinces). Over the period 2000-2018, we collected data on suspected cholera cases, and a set of several variables including types of conflicts, the number of internally displaced persons (IDPs), population density, transportation network density, and accessibility indicators. Using multivariate ordinal logistic regression models, we identified factors associated with the spread of cholera outside the endemic eastern DRC. We performed multivariate Vector Auto Regressive models to analyze potential underlying mechanisms involving the factors associated with these spread dynamics. Finally, we classified the affected health zones using hierarchical ascendant classification based on principal component analysis (PCA). FINDINGS: The increase in the number of suspected cholera cases, the exacerbation of conflict events, and the number of IDPs in eastern endemic areas were associated with an increased risk of cholera spreading outside the endemic eastern provinces. We found that the increase in suspected cholera cases was influenced by the increase in battles at lag of 4 weeks, which were influenced by the violence against civilians with a 1-week lag. The violent conflict events influenced the increase in the number of IDPs 4 to 6 weeks later. Other influences and uni- or bidirectional causal links were observed between violent and non-violent conflicts, and between conflicts and IDPs. Hierarchical clustering on PCA identified three categories of affected health zones: densely populated urban areas with few but large and longer epidemics; moderately and accessible areas with more but small epidemics; less populated and less accessible areas with more and larger epidemics. CONCLUSION: Our findings argue for monitoring conflict dynamics to predict the risk of geographic expansion of cholera in the DRC. They also suggest areas where interventions should be appropriately focused to build their resilience to the disease.
Disciplines :
Human health sciences: Multidisciplinary, general & others
Author, co-author :
Kayembe Ntumba, Harry César  ;  Université de Liège - ULiège > Sphères ; Department of Basic Sciences, Faculty of Medicine, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
Bompangue, Didier;  Department of Basic Sciences, Faculty of Medicine, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo ; Chrono-Environnement, UMR CNRS 6249, Université de Franche-Comté, Besançon, France
Linard, Catherine;  Department of Geography, Université de Namur, Namur, Belgium
Mandja, Bien-Aimé;  Department of Basic Sciences, Faculty of Medicine, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
Batumbo, Doudou;  Department of Basic Sciences, Faculty of Medicine, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
Matunga, Muriel;  Graduate School Public Health Department, Adventist International Institute of Advanced Studies, Silang, Cavite, Philippines
Muwonga, Jérémie;  Department of Medical Biology, Faculty of Medicine, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
Moutschen, Michel  ;  Centre Hospitalier Universitaire de Liège - CHU > > Service des maladies infectieuses - médecine interne
Situakibanza, Hippolyte;  Department of Internal Medicine, Faculty of Medicine, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo ; Department of Parasitology and Tropical Medicine, Faculty of Medicine, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
Ozer, Pierre ;  Université de Liège - ULiège > Sphères
Language :
English
Title :
Drivers of the dynamics of the spread of cholera in the Democratic Republic of the Congo, 2000-2018: An eco-epidemiological study.
Publication date :
28 August 2023
Journal title :
PLoS Neglected Tropical Diseases
ISSN :
1935-2727
eISSN :
1935-2735
Publisher :
Public Library of Science (PLoS), United States
Volume :
17
Issue :
8
Pages :
e0011597
Peer reviewed :
Peer Reviewed verified by ORBi
Available on ORBi :
since 11 September 2023

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