Drug toxicity and cost as barriers to community participation in HAT control in the Democratic Republic of Congo.
BACKGROUND
Active case-finding programmes by mobile teams are the cornerstone of West African Human African Trypanosomiasis (HAT) control. Low attendance rates of screening and low uptake of treatment after diagnosis are major problems. The objectives of this survey were to explore community perception of HAT, to assess acceptability of control activities and to identify barriers amenable to intervention.


METHODS
In September 2004, we conducted 33 focus group discussions with beneficiaries of the HAT control programme among various ethnic groups in two ecological settings (savannah and fluvial) of the Democratic Republic of Congo.


RESULTS
The population had a very detailed knowledge and understanding of HAT transmission, utility of screening, symptoms and treatment. Melarsoprol treatment was feared for its side effects. The sudden death of previously asymptomatic people during treatment was attributed to witchcraft, to which one becomes more vulnerable when the diagnosis is disclosed in public. Lack of confidentiality was also a problem because HAT carries a stigma as a mental disease. Lumbar punctures, especially when performed in public, were disliked but less feared. Financial barriers were a major obstacle for many patients.


CONCLUSIONS
Less toxic drugs, lowering financial barriers and improving confidentiality would have considerable impact on the participation in population screening for HAT.
Robays
J
J
Institute of Tropical Medicine, Epidemiology and Disease Control Unit, Antwerp, Belgium. jrobays@itg.be
Lefèvre
P
P
Lutumba
P
P
Lubanza
S
S
Kande Betu Ku Mesu
V
V
Van der Stuyft
P
P
Boelaert
M
M
D000328:Adult; D001294:Attitude to Health; D003256:Community Participation; D015023:Democratic Republic of the Congo / Q000453:epidemiology; D005260:Female; D017048:Health Care Costs; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility / Q000191:economics; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000523:psychology; D008549:Melarsoprol / Q000009:adverse effects; D010342:Patient Acceptance of Health Care / Q000523:psychology; D010554:Personality Disorders / Q000150:complications / Q000453:epidemiology; D012423:Rural Health; D014344:Trypanocidal Agents / Q000009:adverse effects; D014353:Trypanosomiasis, African / Q000188:drug therapy / Q000453:epidemiology / Q000523:psychology*
D014344:Trypanocidal Agents; D008549:Melarsoprol