Topic:

Epidemiology and public health

Abstract No.:

ISE.475

Title:

Community-based prohibitions related to human African trypanosomiasis (HAT) screening & treatment: origin and rationality

Author(s):

A. Mpanya¹, D. Hendrickx², S. Baloji³, C. Lumbala⁴, M.-A. Vuna⁵, S. Lubanza⁶, P. Lefèvre², M. Boelaert⁷, P. Lutumba⁸; ¹National Programe controle of HAT, Reseach, Kinshasa/CD, ²Institute of Tropical Medicine/Antwerp, Public Health, Antwerp/BE, ³Institut Supérieur des Techniques Médicales, Santé communautaire, Kinshasa/CD, ⁴Programme National de lutte contre la Trypanosomiase en RD Congo, Coordination provinciale du Kasai Oriental, Mbuji-mayi/CD, ⁵Institut National de Recherche Biomédicale, Epidemiology, Kinshasa/CD, ⁶Kinshasa University, Sociology-anthropology, Kinshasa/CD, ⁷Institute of Tropical Medicine, Public Health, Antwerp/BE, ⁸Institut National de Recherche Bio-médicale (INRB), Epidemiology, Kinshasa/CD

Abstract:

Background: Community-based prohibitions related to HAT screening and treatment have been reported in Bandundu and Kasai Oriental provinces in Democratic Republic of Congo respectively by Robays J and Mpanya A. These prohibitions have been identified as a major bottleneck in HAT control measures, but their origin and rational are not well documented. A better understanding of these prohibitions could lead to an improved effectiveness of current HAT screening and treatment strategies. In this study we aimed to describe the origin and the rational for these prohibitions.  
Methods: We conducted eight focus group discussions (FGD) with former patients and twenty-six interviews FGD with patients under treatment, nurses and members of HAT provincial coordination in Kasai Oriental and Bandundu.
Results: Melarsoprol (arsobal®) was perceived as a dangerous and inhumane drug to which many community-based prohibitions were linked. The new combination treatment (NECT) was perceived as a less toxic alternative which implied virtually no such prohibitions. Among the prohibitions described in this study, the most important one seemed to be a strict interdiction of sexual intercourse during treatment and six months thereafter. Additionally, nurses described prohibitions related to heavy labour, alcohol consumption and smoking. Former patients also reported a prohibition of eating hot food, which was repeated by several nurses.These prohibitions are very old and have been established through interactions between the communities and mobile team technicians since 1960. They are related mainly to the melarsoprol treatment regimen, although possible interactions with NECT should not be overlooked. 
Conclusion: The National HAT Control Programme needs to acknowledge the existence of such prohibitions and adapt its strategy accordingly.