title: Integration of diagnosis and treatment of sleeping sickness in primary healthcare facilities in the Democratic Republic of the Congo.
abstract: BACKGROUND
  Control of human African trypanosomiasis (HAT) in the Democratic Republic of Congo (DRC) has always been a vertical programme, although attempts at integration in general health services were made in recent years. Now that HAT prevalence is declining, the integration question becomes even more crucial. We studied the level of attainment of integration of HAT case detection and management in primary care centres in two high-prevalence districts in the province of Bandundu, DRC.
  
  
  METHODS
  We visited all 43 first-line health centres of Mushie and Kwamouth districts, conducted structured interviews and inspected facilities using a standardised checklist. We focused on: availability of well trained staff - besides HAT, we also tested for knowledge on tuberculosis; availability of equipment, consumables and supplies; and utilisation of the services.
  
  
  RESULTS
  All health centres were operating but most were poorly equipped, and attendance rates were very low. We observed a median of 14 outpatient consultations per facility (IQR 8-21) in the week prior to our visit, that is two patients per day. The staff had good knowledge on presenting symptoms, diagnosis and treatment of both HAT and tuberculosis. Nine centres were accredited by the national programme as HAT diagnosis and treatment centres, but the most sensitive diagnostic confirmation test, the mini-anion exchange centrifugation technique (mAECT), was not present in any. Although all nine were performing the CATT screening test, only two had the required cold chain in working order.
  
  
  CONCLUSIONS
  In these high-prevalence districts in DRC, staff is well-acquainted with HAT but lack the tools required for an adequate diagnostic procedure. Attendance rates of these primary care centres are extremely low, making timely recognition of a resurgence of HAT unlikely in the current state of affairs.
authors.affiliation: Institute of Tropical Medicine, Antwerpen, Belgium; Faculty of Medicine, Kinshasa University, Kinshasa, Democratic Republic of the Congo; Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of Congo; International Health, Antwerp University, Antwerpen, Belgium.
authors.forename: P
authors.initials: P
authors.lastname: Mitashi
authors.forename: E
authors.initials: E
authors.lastname: Hasker
authors.forename: F
authors.initials: F
authors.lastname: Mbo
authors.forename: J P
authors.initials: JP
authors.lastname: Van Geertruyden
authors.forename: M
authors.initials: M
authors.lastname: Kaswa
authors.forename: C
authors.initials: C
authors.lastname: Lumbala
authors.forename: M
authors.initials: M
authors.lastname: Boelaert
authors.forename: P
authors.initials: P
authors.lastname: Lutumba
mesh_terms: D001291:Attitude of Health Personnel; D015023:Democratic Republic of the Congo; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D011320:Primary Health Care / Q000458:organization & administration*; D014347:Trypanosoma brucei gambiense / Q000302:isolation & purification*; D016833:Trypanosoma brucei rhodesiense / Q000302:isolation & purification*; D014353:Trypanosomiasis, African / Q000175:diagnosis* / Q000628:therapy; D014376:Tuberculosis / Q000175:diagnosis / Q000628:therapy
keywords: Democratic Republic of Congo; RD Congo; RDC; centros sanitarios de atención primaria; human African trypanosomiasis; primary healthcare facilities; tripanosomiasis humana Africana; trypanosomiase humaine africaine; établissements de soins de santé primaires