Human African trypanosomiasis amongst urban residents in Kinshasa: a case-control study.
BACKGROUND
Increasing numbers of human African trypanosomiasis (HAT) cases have been reported in urban residents of Kinshasa, Democratic Republic Congo since 1996. We set up a case-control study to identify risk factors for the disease.


METHODS
All residents of the urban part of Kinshasa with parasitologically confirmed HAT and presenting for treatment to the city's specialized HAT clinics between 1 August, 2002 and 28 February, 2003 were included as cases. We defined the urban part as the area with contiguous habitation and a population density >5000 inhabitants per square kilometre. A digital map of the area was drawn based on a satellite image. For each case, two serologically negative controls were selected, matched on age, sex and neighbourhood. Logistic regression models were fitted to control for confounding.


RESULTS
The following risk factors were independently associated with HAT: travel, commerce and cultivating fields in Bandundu, and commerce and cultivating fields in the rural part of Kinshasa. No association with activities in the city itself was found.


CONCLUSIONS
In 2002, the emergence of HAT in urban residents of Kinshasa appears mainly linked to disease transmission in Bandundu and rural Kinshasa. We recommend to intensify control of these foci, to target HAT screening in urban residents to people with contact with these foci, to increase awareness of HAT amongst health workers in the urban health structures and to strengthen disease surveillance.
Institute of Tropical Medicine, Antwerp, Belgium. jrobays@itg.be
J
J
Robays
A
A
Ebeja Kadima
P
P
Lutumba
C
C
Miaka mia Bilenge
V
V
Kande Betu Ku Mesu
R
R
De Deken
J
J
Makabuza
M
M
Deguerry
P
P
Van der Stuyft
M
M
Boelaert
D000293:Adolescent; D000328:Adult; D000382:Agricultural Workers' Diseases / Q000209:etiology; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D015023:Democratic Republic of the Congo; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D014195:Travel; D014353:Trypanosomiasis, African / Q000517:prevention & control / Q000635:transmission*; D014504:Urban Health