Malaria Rapid Diagnostic Test (HRP2/pLDH) Positivity, Incidence, Care Accessibility and Impact of Community WASH Action in DR Congo: Mixed Method Study involving 625 Households
Authors: Ngatu Nlandu Roger , Muzembo Basilua Andre , Kanbara Sakiko , Wumba Roger , Ikeda Mitsunori , Mbelambela Etongola Papy , Muchanga Sifa Marie-Joelle , Choomplang Nattadech , Suzuki Tomoko , Wada Koji , Mahfuz Al Hasan , Sugishita Tomohiko , Miyazaki Hiroyuki , Ikeda Shunya , Hirao Tomohiro 
Published: January 2021

Abstract
Background
Malaria is one of the most prevalent and deadliest illnesses in sub Saharan Africa. Despite recent gains made towards its control or elimination in past decades, many African countries still have endemic malaria transmission. Thus, the search for disease control strategies is indispensable. This study aimed to assess malaria burden at household level in Kongo central province, Democratic Republic of Congo (DRC), and the impact of community participatory water, sanitation and hygiene (WASH) action.
Methods
Mixed method research was conducted in two semi-rural towns, Mbanza-Ngungu (WASH action site) and Kasangulu (WASH control site) between 1 January 2017 through March 2018, involving 625 households (3,712 household members). Baseline and post-intervention malaria surveys focusing on malaria episodes and preventive measures in previous six-month period using the World Bank/WHO Malaria Indicator Questionnaire. An action research consisting of a six-month study was carried out which comprised two interventions: a community participatory WASH action aiming at eliminating mosquito breeding areas in the residential environment and a community anti-malaria education campaign. The latter was implemented at both the WASH action and Control sites. In addition, baseline and post-intervention malaria rapid diagnostic test (RDT) was performed among respondents. Furthermore, a six-month hospital-based epidemiological study was conducted from 1 January through June 2017. Medical records of patients admitted at selected referral hospitals (one hospital per study site) were used to determine malaria trend in the sites.
Results
Long-lasting insecticide-treated net (LLIN) was the most commonly used preventive measure (55%), followed by mosquito repellent (15%), indoor residual spraying (2%), LLIN and indoor residual spraying combination (2%); however, 24% of households did not use any measures. Baseline malaria survey showed that 96% of respondents (heads of households) have reported at least one malaria episode occurring in the previous six-month period (January-June 2017); of them only 66.5% of them received malaria care at a health setting. In the Action Research, at household level, mean number of self-reported incident malaria cases decreased at WASH action site (2.3±2.2 cases vs. 1.2±0.7 cases, respectively; p<0.05), whereas it remained unchanged at the Control site. Similarly, RDT results showed that the prevalence rate of positive RDT among the respondents decreased significantly at WASH-action site (38% in pre-test vs. 20% in post-test; p<0.05), whereas no significant change was observed at the Control site. Data collected from referral hospitals showed high malaria incidence rate, 67.4%, as compared to other diseases (70% of pediatric malaria cases and 30% of cases from Internal medicine departments). Low household monthly income (ORa=2.37; 95%CI: 1.05-3.12; p<0.05), proximity to high risk area (grassy/stagnant water spots) for malaria (ORa=5.13; 95%CI: 2-29-8.07; p<0.001), poor general WASH status in residential area (ORa=4.10; 95%CI: 2.11-7.08; p<0.001) were predictors of household malaria.
Conclusion
This research showed high prevalence of positive malaria RDT among study participants, which was significantly reduced by a 6-month WASH intervention. Additionally, hospital-based epidemiological data showed high malaria incidence. The findings suggest the necessity for DRC government 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 to reduce malaria burden in Congolese population. This would be a step towards achieving universal health coverage in the Congo.