title: Human African trypanosomiasis in the Democratic Republic of the Congo: disease distribution and risk.
abstract: BACKGROUND
  For the past three decades, the Democratic Republic of the Congo (DRC) has been the country reporting the highest number of cases of human African trypanosomiasis (HAT). In 2012, DRC continued to bear the heaviest burden of gambiense HAT, accounting for 84 % of all cases reported at the continental level (i.e., 5,968/7,106). This paper reviews the status of sleeping sickness in DRC between 2000 and 2012, with a focus on spatio-temporal patterns. Epidemiological trends at the national and provincial level are presented.
  
  
  RESULTS
  The number of HAT cases reported yearly from DRC decreased by 65 % from 2000 to 2012, i.e., from 16,951 to 5,968. At the provincial level a more complex picture emerges. Whilst HAT control in the Equateur province has had a spectacular impact on the number of cases (97 % reduction), the disease has proved more difficult to tackle in other provinces, most notably in Bandundu and Kasai, where, despite substantial progress, HAT remains entrenched. HAT prevalence presents its highest values in the northern part of the Province Orientale, where a number of constraints hinder surveillance and control. Significant coordinated efforts by the National Sleeping Sickness Control Programme and the World Health Organization in data collection, reporting, management and mapping, culminating in the Atlas of HAT, have enabled HAT distribution and risk in DRC to be known with more accuracy than ever before. Over 18,000 locations of epidemiological interest have been geo-referenced (average accuracy ≈ 1.7 km), corresponding to 93.6 % of reported cases (period 2000-2012). The population at risk of contracting sleeping sickness has been calculated for two five-year periods (2003-2007 and 2008-2012), resulting in estimates of 33 and 37 million people respectively.
  
  
  CONCLUSIONS
  The progressive decrease in HAT cases reported since 2000 in DRC is likely to reflect a real decline in disease incidence. If this result is to be sustained, and if further progress is to be made towards the goal of HAT elimination, the ongoing integration of HAT control and surveillance into the health system is to be closely monitored and evaluated, and active case-finding activities are to be maintained, especially in those areas where the risk of infection remains high and where resurgence could occur.
authors.affiliation: National Sleeping Sickness Control Programme, Kinshasa, Democratic Republic of the Congo. crispinlumbala@gmail.com.
authors.forename: Crispin
authors.initials: C
authors.lastname: Lumbala
authors.affiliation: World Health Organization, Control of Neglected Tropical Diseases, Innovative and Intensified Disease Management, 1211, Geneva, 27, Switzerland. simarropp@gmail.com.
authors.forename: Pere P
authors.initials: PP
authors.lastname: Simarro
authors.affiliation: Food and Agriculture Organization of the United Nations, Sub-regional Office for Eastern Africa, Addis Ababa, Ethiopia. giuliano.cecchi@fao.org.
authors.forename: Giuliano
authors.initials: G
authors.lastname: Cecchi
authors.affiliation: Food and Agriculture Organization of the United Nations, Animal Production and Health Division, Viale delle Terme di Caracalla, 00153, Rome, Italy. m.paone@tiscali.it.
authors.forename: Massimo
authors.initials: M
authors.lastname: Paone
authors.affiliation: World Health Organization, Control of Neglected Tropical Diseases, Innovative and Intensified Disease Management, 1211, Geneva, 27, Switzerland. francoj@who.int.
authors.forename: José R
authors.initials: JR
authors.lastname: Franco
authors.affiliation: Neglected Tropical Diseases Department, Ministry of Public Health, Kinshasa, Democratic Republic of the Congo. kandevictor@yahoo.fr.
authors.forename: Victor
authors.initials: V
authors.lastname: Kande Betu Ku Mesu
authors.affiliation: National Sleeping Sickness Control Programme, Kinshasa, Democratic Republic of the Congo. jacqueline2fr@yahoo.fr.
authors.forename: Jacquies
authors.initials: J
authors.lastname: Makabuza
authors.affiliation: World Health Organization, Regional Office for Africa, Intercountry Support Team, Libreville, Gabon. diarraam@who.afro.int.
authors.forename: Abdoulaye
authors.initials: A
authors.lastname: Diarra
authors.affiliation: National Sleeping Sickness Control Programme, Kinshasa, Democratic Republic of the Congo. shampachansy@yahoo.fr.
authors.forename: Shampa
authors.initials: S
authors.lastname: Chansy
authors.affiliation: World Health Organization, Control of Neglected Tropical Diseases, Innovative and Intensified Disease Management, 1211, Geneva, 27, Switzerland. priottog@who.int.
authors.forename: Gerardo
authors.initials: G
authors.lastname: Priotto
authors.affiliation: Food and Agriculture Organization of the United Nations, Animal Production and Health Division, Viale delle Terme di Caracalla, 00153, Rome, Italy. raffaele.mattioli@fao.org.
authors.forename: Raffaele C
authors.initials: RC
authors.lastname: Mattioli
authors.affiliation: World Health Organization, Control of Neglected Tropical Diseases, Innovative and Intensified Disease Management, 1211, Geneva, 27, Switzerland. janninj@who.int.
authors.forename: Jean G
authors.initials: JG
authors.lastname: Jannin
mesh_terms: D015023:Democratic Republic of the Congo / Q000453:epidemiology; D003710:Demography; D006801:Humans; D011159:Population Surveillance; D015995:Prevalence; D018570:Risk Assessment; D014347:Trypanosoma brucei gambiense / Q000302:isolation & purification*; D014353:Trypanosomiasis, African / Q000188:drug therapy / Q000453:epidemiology*