title: Geospatial and age-related patterns of Taenia solium taeniasis in the rural health zone of Kimpese, Democratic Republic of Congo.
abstract: BACKGROUND
  Taenia solium infections are mostly endemic in less developed countries where poor hygiene conditions and free-range pig management favor their transmission. Knowledge on patterns of infections in both human and pig is crucial to design effective control strategies. The aim of this study was to assess the prevalence, risk factors and spatial distribution of taeniasis in a rural area of the Democratic Republic of Congo (DRC), in the prospect of upcoming control activities.
  
  
  METHODS
  A cross-sectional study was conducted in 24 villages of the health zone of Kimpese, Bas Congo Province. Individual and household characteristics, including geographical coordinates were recorded. Stool samples were collected from willing participants and analyzed using the copro-antigen enzyme-linked immunosorbent assay (copro-Ag ELISA) for the detection of taeniasis. Blood samples were collected from pigs and analyzed using the B158/B60 monoclonal antibody-based antigen ELISA (sero-Ag ELISA) to detect porcine cysticercosis. Logistic regression and multilevel analysis were applied to identify risk factors. Global clustering and spatial correlation of taeniasis and porcine cysticercosis were assessed using K functions. Local clusters of both infections were identified using the Kulldorff's scan statistic.
  
  
  RESULTS
  A total of 4751 participants above 5 years of age (median: 23 years; IQR: 11-41) were included. The overall proportion of taeniasis positivity was 23.4% (95% CI: 22.2-24.6), ranging from 1 to 60% between villages, with a significant between-household variance of 2.43 (SE=0.29, p<0.05). Taeniasis was significantly associated with age (p<0.05) and the highest positivity was found in the 5-10 years age group (27.0% (95% CI: 24.4-29.7)). Overall, 45.6% (95% CI: 40.2-51) of sampled pigs were sero-positive. The K functions revealed a significant overall clustering of human and pig infections but no spatial dependence between them. Two significant clusters of taeniasis (p<0.001; n=276 and n=9) and one cluster of porcine cysticercosis (p<0.001; n=24) were found.
  
  
  CONCLUSIONS
  This study confirms high endemicity and geographical dispersal of taeniasis in the study area. The role of age in taeniasis patterns and significant spatial clusters of both taeniasis and porcine cysticercosis were evidenced, though no spatial correlation was found between human and pig infections. Urgent control activities are needed for this endemic area.
authors.affiliation: Institute of Health and Society, Université Catholique de Louvain, Brussels, Belgium; Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium; Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo. Electronic address: jmadinga@yahoo.fr.
authors.forename: Joule
authors.initials: J
authors.lastname: Madinga
authors.affiliation: Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.
authors.forename: Kirezi
authors.initials: K
authors.lastname: Kanobana
authors.affiliation: Zone de santé Rurale de Kimpese, Democratic Republic of the Congo.
authors.forename: Philippe
authors.initials: P
authors.lastname: Lukanu
authors.affiliation: Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Abatih
authors.affiliation: Programme National de Lutte contre la Trypanosomiase Humaine Africaine, Kinshasa, Democratic Republic of the Congo.
authors.forename: Sylvain
authors.initials: S
authors.lastname: Baloji
authors.affiliation: Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo.
authors.forename: Sylvie
authors.initials: S
authors.lastname: Linsuke
authors.affiliation: Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Praet
authors.affiliation: Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo.
authors.forename: Serge
authors.initials: S
authors.lastname: Kapinga
authors.affiliation: Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.
authors.forename: Katja
authors.initials: K
authors.lastname: Polman
authors.affiliation: Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo; Department of Tropical Medicine, University of Kinshasa, Democratic Republic of the Congo.
authors.forename: Pascal
authors.initials: P
authors.lastname: Lutumba
authors.affiliation: Institute of Health and Society, Université Catholique de Louvain, Brussels, Belgium.
authors.forename: Niko
authors.initials: N
authors.lastname: Speybroeck
authors.affiliation: Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.
authors.forename: Pierre
authors.initials: P
authors.lastname: Dorny
authors.affiliation: Department of Infectious Disease and Epidemiology, Imperial College, London, UK.
authors.forename: Wendy
authors.initials: W
authors.lastname: Harrison
authors.affiliation: Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.
authors.forename: Sarah
authors.initials: S
authors.lastname: Gabriel
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000822:Animal Husbandry / Q000592:standards; D000818:Animals; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D015023:Democratic Republic of the Congo; D004797:Enzyme-Linked Immunosorbent Assay; D005191:Family Characteristics; D005260:Female; D006801:Humans; D008297:Male; D008460:Meat / Q000469:parasitology*; D008875:Middle Aged; D011159:Population Surveillance; D015995:Prevalence; D012307:Risk Factors; D012423:Rural Health; D034421:Sus scrofa / Q000469:parasitology*; D013552:Swine; D013553:Swine Diseases / Q000453:epidemiology* / Q000517:prevention & control / Q000635:transmission; D041201:Taenia solium / Q000254:growth & development / Q000302:isolation & purification*; D013622:Taeniasis / Q000453:epidemiology* / Q000517:prevention & control / Q000635:transmission / Q000662:veterinary; D055815:Young Adult; D015047:Zoonoses
keywords: Democratic republic of Congo; Epidemiology; Porcine cysticercosis; Spatial clustering; Taeniasis