Health care‐seeking behaviour and diagnostic delays for Human African Trypanosomiasis in the Democratic Republic of the Congo

Abstract

Summary Objective About half of the patients with Human African trypanosomiasis (HAT) reported in the Democratic Republic of the Congo (DRC) are currently detected by fixed health facilities and not by mobile teams. Given the recent policy to integrate HAT control into general health services, we studied health seeking behaviour in these spontaneously presenting patients. Methods We took a random sample from all patients diagnosed with a first‐time HAT episode through passive case finding between 1 October 2008 and 30 September 2009 in the two most endemic provinces of the DRC. Patients were approached at their homes for a structured interview. We documented patient delay (i.e. time between onset of symptoms and contacting a health centre) and health system delay (i.e. time between first contact and correct diagnosis of HAT). Results Median patient delay was 4 months (IQR 1–10 months, n = 66); median health system delay was 3 months (IQR 0.5–11 months). Those first presenting to public health centres had a median systems delay of 7 months (IQR 2–14 months, n = 23). On median, patients were diagnosed upon the forth visit to a health facility (IQR 3rd–7th visit). Conclusions Substantial patient as well as health system delays are incurred in HAT cases detected passively. Public health centres are performing poorly in the diagnostic work‐up for HAT, mainly because HAT is a relatively rare disease with few and non‐specific early symptoms. Integration of HAT diagnosis and treatment into general health services requires strong technical support and well‐organized supervision and referral mechanisms.

Enhanced passive screening and diagnosis for gambiense human African trypanosomiasis in north-western Uganda – Moving towards elimination

“…Previous studies of rHAT in Uganda have demonstrated that difficulties in accessing appropriate diagnostics can be a barrier to diagnosis [33–35] and this is known to be a barrier throughout HAT endemic regions [24,36]. Further delays can be introduced by patients requiring a median of four visits to heath facilities and a seven months’ delay before being screened for gHAT [37]. Sensitisation of the public and health personnel was a core component of this new strategy.…”

Identification of Trypanosoma brucei AdoMetDC Inhibitors Using a High-Throughput Mass Spectrometry-Based Assay

“…T. brucei is transmitted by the Glossina fly and proliferates extracellularly in blood and lymph, eliciting nonspecific influenza-like symptoms in the early stage of the disease. The advanced stage, which occurs months to years after infection, ensues from the parasite crossing the blood-brain barrier (BBB) and is characterized by severe neurological symptoms 4 . The World Health Organization (WHO) estimated that there were fewer than 3000 cases of T.b.…”

Performance of the SD BIOLINE® HAT rapid test in various diagnostic algorithms for gambiense human African trypanosomiasis in the Democratic Republic of the Congo

“…These include the requirement for a source of power and a cold-chain, and the 50 dose format of CATT means that when the reagent is reconstituted, the doses must be used within a few days in order to avoid spoilage [15,16]. To reduce this wastage, the Institute of Tropical Medicine (ITM) developed the CATT D10, which contains reagents for 10 tests [16,17]. Whilst the CATT D10 is thermostable, the vial of reagent must be used within 24 hours after opening, which has restricted its widespread use by national HAT control programmes.…”